Total Urine Research Articles

Differences in the urinary metabolome and proteome between wet and dry nights in children with monosymptomatic nocturnal enuresis and nocturnal polyuria.

Nocturnal enuresis (NE) is a common disease with multiple pathogenic mechanisms. This study aimed to compare levels of metabolites and proteins between wet and dry nights in urine samples from children with monosymptomatic NE (MNE). Ten boys with MNE and nocturnal polyuria (age: 7.6 ± 1.3 years) collected their total nighttime urine production during a wet and a dry night. Untargeted metabolomics and proteomics were performed on the urine samples by liquid chromatography coupled with high-mass accuracy tandem mass spectrometry (LC-MS/MS). On wet nights, we found reduced urine osmolality (P = 0.025) and increased excretion of urinary potassium and sodium by a factor of, respectively, 2.1 (P = 0.038) and 1.9 (P = 0.19) compared with dry nights. LC-MS identified 59 metabolites and 84 proteins with significantly different levels between wet and dry nights (fold change (FC) < 0.67 or > 1.5, P < 0.05). Some compounds were validated by different methodologies. During wet nights, levels of compounds related to oxidative stress and blood pressure, including adrenalin, were increased. We found reduced levels of aquaporin-2 on wet nights. The FCs in the 59 metabolites were positively correlated to the FCs in the same metabolites identified in urine samples obtained during the evening preceding wet and dry nights. Oxidative stress, which in the literature has been associated with nocturia and disturbances in sleep, might be increased during wet nights in children with MNE. We further found evidence of increased sympathetic activity. The mechanisms related to having wet nights in children with MNE seem complex, and both free water and solute handling appear to be important. A higher resolution version of the Graphical abstract is available as Supplementary information.

Fluid balance during physical work in the heat is not modified by the menstrual cycle when fluids are freely available.

We tested the hypothesis that women may be more at risk of becoming dehydrated during physical work in the heat in the early follicular phase (EF), compared with the late follicular (LF) and mid-luteal (ML) phases of the menstrual cycle when allowed free access to drink. Twelve healthy, eumenorrheic, unacclimated women (26 ± 5 yr) completed three trials (EF, LF, and ML phases) involving 4 h of exposure to 33.8 ± 0.8 °C, 54 ± 1% relative humidity. Each hour, participants walked on a treadmill for 30 min at a rate of metabolic heat production of 338 ± 9 W. Participants drank a cool, flavor-preferred non-caloric sport drink ad libitum. Nude body weight was measured pre- and post-exposure, and percent changes in body weight loss were interpreted as an index of changes in total body water. Total fluid intake and urine output were measured and sweat rate was estimated from changes in body mass corrected for fluid intake and urine output. Fluid intake was not different between phases (EF: 1,609 ± 919 mL; LF: 1,902 ± 799 mL; ML: 1,913 ± 671; P = 0.202). Total urine output (P = 0.543) nor sweat rate (P = 0.907) differed between phases. Percent changes in body mass were not different between phases (EF: -0.5 ± 0.9%; LF: -0.3 ± 0.9%; ML: -0.3 ± 0.7%; P = 0.417). This study demonstrates that the normal hormonal fluctuations that occur throughout the menstrual cycle do not alter fluid balance during physical work in the heat.NEW & NOTEWORTHY The effect of the menstrual cycle on fluid balance during physical work in the heat when fluids are freely available is unknown. This study demonstrates that fluid balance is not modified in women across three distinct phases of the menstrual cycle during physical work in the heat These results indicate that when women have free access to cool fluid during physical work in the heat, they respond similarly across all three phases to maintain fluid homeostasis across the menstrual cycle.

Evaluation of the chromium-EDTA complex and creatinine as markers for urinary volume in cattle

ABSTRACT Creatinine and intravenously infused Cr-EDTA complex were compared as markers for urinary volume estimation in cattle fed diets containing different concentrate levels. Ten Nellore heifers were used in a two-period crossover design and fed with two diets of divergent maize silage to concentrate ratios (90:10 and 50:50). The urinary marker concentrations were strongly and positively associated with each other, and both correlated strongly and negatively with total urine volume. Creatinine excretion and chromium recovery did not vary according to diets, but chromium recovery exhibited a lower variance among animals. The evaluation of urine spot samples showed that sampling time affects both markers, with the lowest urinary concentrations obtained when samples were taken early in the morning. Both creatinine and the Cr-EDTA complex produce similar estimates of urine volume. However, despite the greater precision of the estimates obtained with chromium, the values obtained with creatinine exhibited less bias and are, therefore, more accurate.

Urinary Catheterization In The Emergency Room In Patients With Complaints Of Pain

Urine retention is an emergency that must get immediate help / action, because total urine retention that lasts several days can result in urosepsis which can end in death, so it needs rapid management by catheterization. Comparing the effectiveness of jelly administration techniques applied to the tip of the catheter and jelly sprayed directly on the urethral meatus on pain complaints in patients with urinary catheterization. The type of research used is quasy experiment, the sample taken with purposive sampling technique, this study seeks to reveal the causal relationship of the dependent and independent variables with measurements after the intervention.

Gastrointestinal permeability and inflammatory status of preweaning dairy calves in response to decreasing the ratio of n-6 to n-3 fatty acid in milk replacer

The ratio of n-6 to n-3 fatty acid (FA) is between 2 and 10 times higher in milk replacer (MR) than in whole milk, which may promote inflammation and compromise the integrity of the intestinal epithelium. To evaluate how decreasing the n-6:n-3 FA ratio of MR affects gastrointestinal (GIT) permeability and inflammatory status, 30 dairy calves (2.8 ± 1.06 d of age; mean ± standard deviation) were randomly assigned to be fed an MR with an n-6:n-3 FA ratio of 40:1 (CON; 29.3% crude fat of DM; n = 15) or 6.5:1 (n-3; 29.1% crude fat of DM; n = 15). Calves were fed 7.0 L/d in 2 meals. Calves were weighed and fecal consistency was analyzed weekly. On d 22, calves were administered Cr-EDTA, lactulose, and d-mannitol to assess GIT permeability. Blood and total urine were sequentially collected for 6 and 24 h, respectively, and analyzed for marker content. Whole blood collected 4 h after the meal was subjected to an ex vivo lipopolysaccharide (LPS) challenge to evaluate cytokine secretion from blood cells. Calves were euthanized on d 25 for collection of intestinal tissue samples. Tissue samples were processed to assess FA composition by gas chromatography, histomorphology by bright-field microscopy, and gene expression of tight junction proteins, lipid metabolism enzymes, and immune molecules by real-time quantitative PCR. Data were analyzed using PROC GLIMMIX in SAS (version 9.4, SAS Institute Inc.). Growth performance and fecal consistency were unaffected. Calves fed MR with a lower ratio of n-6 to n-3 FA had 2-fold higher n-3 FA contents and 2-fold lower ratios of n-6 to n-3 FA in proximal jejunum and ileum tissues. Total urinary recovery (0-24 h relative to marker administration) and plasma concentrations of the markers were unaffected. Expression of TJP1 tended to be higher in proximal jejunum tissue and lower in ileum tissue of n-3 calves. The expression of TLR4 and TNFA tended to be higher and CD14 was higher in ileum tissue of n-3 calves. Plasma concentrations of interleukin-4 were decreased in response to the ex vivo LPS challenge in n-3 calves. Histomorphology and GIT permeability were largely unaffected by treatment. Furthermore, the inclusion of linseed and algae oil may promote inflammation, as suggested by greater concentrations of the acute-phase proteins haptoglobin and serum amyloid A postprandially, demonstrating that fat sources should be evaluated for their suitability for MR formulations. Understanding how MR composition affects dairy calf health may improve nutritional strategies on farm.

Lack of furosemide responsiveness predict severe acute kidney injury after liver transplantation

Acute kidney injury (AKI) remains to be a common but severe complication after liver transplantation (LT). However, there are still few clinically validated biomarkers. A total of 214 patients who underwent routine furosemide (1–2 mg/kg) after LT were retrospectively included. The urine output during the first 6 h was recorded to evaluate the predictive value of AKI stage 3 and renal replacement therapy (RRT). 105 (49.07%) patients developed AKI, including 21 (9.81%) progression to AKI stage 3 and 10 (4.67%) requiring RRT. The urine output decreased with the increasing severity of AKI. The urine output of AKI stage 3 did not significantly increase after the use of furosemide. The area under the receiver operator characteristic (ROC) curves for the total urine output in the first hour to predict progression to AKI stage 3 was 0.94 (p < 0.001). The ideal cutoff for predicting AKI progression during the first hour was a urine volume of less than 200 ml with a sensitivity of 90.48% and specificity of 86.53%. The area under the ROC curves for the total urine output in the six hours to predict progression to RRT was 0.944 (p < 0.001). The ideal cutoff was a urine volume of less than 500 ml with a sensitivity of 90% and specificity of 90.91%. Severe AKI after liver transplantation seriously affects the outcome of patients. Lack of furosemide responsiveness quickly and accurately predict AKI stage 3, and patients requiring RRT after the operation.

Association between urinary arsenic level and serum testosterone in Chinese men aged 18 to 79 years

Objective: To investigate the association between the urinary arsenic level and serum total testosterone in Chinese men aged 18 to 79 years. Methods: A total of 5 048 male participants aged 18 to 79 years were recruited from the China National Human Biomonitoring (CNHBM) from 2017 to 2018. Questionnaires and physical examinations were used to collect information on demographic characteristics, lifestyle, food intake frequency and health status. Venous blood and urine samples were collected to detect the level of serum total testosterone, urinary arsenic and urinary creatinine. Participants were divided into three groups (low, middle, and high) based on the tertiles of creatinine-adjusted urinary arsenic concentration. Weighted multiple linear regression was fitted to analyze the association of urinary arsenic with serum total testosterone. Results: The weighted average age of 5 048 Chinese men was (46.72±0.40) years. Geometric mean concentration (95%CI) of urinary arsenic, creatinine-adjusted urinary arsenic and serum testosterone was 22.46 (20.08, 25.12) μg/L, 19.36 (16.92, 22.15) μg/g·Cr and 18.13 (17.42, 18.85) nmol/L, respectively. After controlling for covariates, compared with the low-level urinary arsenic group, the testosterone level of the participants in the middle-level group and the high-level group decreased gradually. The percentile ratio (95%CI) was -5.17% (-13.14%, 3.54%) and -10.33% (-15.68%, -4.63). The subgroup analysis showed that the association between the urinary arsenic level and testosterone level was more obvious in the group with BMI<24 kg/m2 group (Pinteraction=0.023). Conclusion: There is a negative association between the urinary arsenic level and serum total testosterone in Chinese men aged 18 to 79 years.

Can Kunxian Capsule, a Novel Tripterygium Preparation be Used as an Adjuvant Treatment of Early Recurrent Focal Segmental Glomerular Sclerosis After Renal Transplantation? A Case Report

Focal segmental glomerular sclerosis (FSGS) tends to recur after kidney transplantation, particularly when genetic testing is negative. Once the recurrence happens, the renal graft function can rapidly become impaired, following a massive urine protein loss. Despite intensive plasmapheresis and high-dose rituximab treatment, the complete remission rate remains below 50%. The Kunxian capsule, representing a new generation of tripterygium preparation, has shown promising results in controlling proteinuria in patients with IgA nephropathy. It is unclear whether Kunxian capsule treatment would also produce a favorable response in cases of FSGS recurrence. Here we report favorable results with this approach in a patient with early recurrent FSGS after kidney transplantation; we treated this patient successfully with a Kunxian capsule, a low dose of rituximab (200 mg), and reduced sessions of plasmapheresis. Complete remission, with a 90% reduction in total urine protein (0.81 g/24 h vs 8.3 g/24 h), was achieved within 2 weeks post-treatment. Of interest, the complete remission state in this patient has been maintained over 20 months with continuous administration of Kunxian capsules after the cessation of plasmapheresis. The potential mechanisms involved here include direct podocyte protection and the anti-inflammatory and immunosuppressive properties of triptolide in the Kunxian capsule. Our case may offer a new reference option for treating recurrent FSGS in the future.

Para-Acetamidobenzoylglutamate Is a Suitable Indicator of Folate Catabolism in Rats

The amount of biologically active folate excreted in the urine corresponds to a small fraction of the recommended dietary allowance, suggesting that a large amount of folate is excreted as its catabolites. A strategy of assessing folate requirement by measuring the daily urinary levels of products of folate catabolism depends on the demonstration of an exclusive mechanism of breakdown as well as a suitable marker of the catabolic process. Rats were given [3H] and [14C]folic acid by gastric intubation daily for 10 d to simulate normal dietary intake of the vitamin. Total urine was collected throughout this period as well as for the following 10 d. Reverse-phase HPLC of the radiolabeled urinary products revealed the presence of a variety of intact folates as well as products of C9-N10 scission of the folate molecule, pteridines, para-aminobenzoylglutamate and para-acetamidobenzoylglutmate. We detected no other N10-containing catabolites, nor did we find the oxidized folate derivative ‘4α-hydroxy-5-methyltetrahydrofolate’. Of all the urinary folate metabolites, only para-acetamidobenzoylglutmate persisted at high levels up to 10 d after radiolabel treatment was withdrawn. We conclude that folate catabolism occurs exclusively through C9-N10 cleavage and that measurement of urinary para-acetamidobenzoylglutmate provides a suitable indicator of daily folate turnover.

Time-course effects of different fiber-rich ingredients on energy values, microbiota composition and SCFA profile in growing pigs.

This study was to investigate time-course effects of different types of dietary fiber on the energy values, fecal microbiota and short-chain fatty acid (SCFA) concentration in growing pigs. A total of 24 barrows (initial body weight, 19.8±0.5kg) were assigned to 4 dietary treatments based on body weight (BW) in a completely randomized design, including a basal diet (CON) and 3 fiber-rich diets replacing corn, soybean meal and soybean oil in the CON diet with 20% sugar beet pulp (SBP), defatted rice bran (DFRB) or soybean hull (SBH), respectively. Fresh feces were sampled on d 7, 14 and 21, followed by 5d total feces and urine collections. The results showed that there were no differences in DE and ME between any of the fiber ingredients on d 7, 14 or 21. However, fiber inclusion decreased the DE and ME of the diet (P<0.05) regardless of the time effect. Principal coordinate analysis (PCoA) revealed distinctly different microbial communities on the DFRB diet and SBH diet across different times (P<0.05) and the fecal microbiota of the 4 diet groups demonstrated notably distinct clusters at each time point (P<0.05). With adaptation time increased from 7 to 21d, cellulose-degrading bacteria and SCFA-producing bacteria (e.g., Ruminococcaceae _UCG-014, Rikenellaceae _RC9_gut_group and Bifidobacterium) increased in the fiber inclusion diets, and pathogenic genera (e.g., Streptococcus and Selenomonas) were increased in the basal diet (P<0.05). Furthermore, the gut microbiota of growing pigs adapted more easily and quickly to the SBP diet compared to the DFRB diet, as reflected by the concentration of propionate, butyrate, isovalerate and total SCFA which increased with time for growing pigs fed the DFRB diet (P<0.05). Collectively, our results indicated at least 7d adaptation was required to evaluate the energy values of fiber-rich ingredients, as the hindgut microbiota of growing pigs may need more time to adapt to a high fiber diet, especially for insoluble dietary fiber.

Nitrogen and energy losses and methane emissions from beef cattle fed diets with gradual replacement of maize silage and concentrate with grass silage and corn-cob mix.

Diets based on large proportions of grassland-based feed are uncommon in forage-based intensive beef production, thus contradicting governmental or commercial strategies to promote the use of grassland-based feed in ruminant production systems. Compared with typical maize silage/concentrate diets, grassland-based diets are associated with impaired nitrogen (N) and energy utilisation because of the comparably lower energy and higher CP content of these feeds. However, quantitative studies concerning the effects of increased dietary proportions of grassland-derived feeds on N and energy losses and utilisation and on methane emissions are missing and the compensation potential of using a limited proportion of an energy-rich forage is unknown. Therefore, we tested five diets with varying types and proportions of forage and concentrate. Three diets consisted of grass silage, maize silage, and concentrate in ratios of, g/kg DM, 100:600:300 (G100; control), 300:500:200 (G300), and 500:300:200 (G500), respectively. Two diets were composed of grass silage, corn-cob mix (CCM), and concentrate in ratios of, g/kg DM, 500:300:200 (G500CCM), and 750:150:100 (G750CCM), respectively. A high-protein concentrate (270g CP/kg DM) was fed to G100, whereas a low-protein concentrate (140g CP/kg DM) was used in the remaining diets. Diets were fed throughout the entire fattening period to groups of six Limousin-crossbred bulls each. When weighing 246±18kg, each animal underwent a 7-day total daily faeces and urine collection, which was followed by measuring methane emissions in respiration chambers for 48h. Total DM intake was similar across all diets, whereas the N intake varied (P<0.05). Urinary N loss (g/day) was the highest for G750CCM (28.2) and G100 (26.6) and lowest for G500CCM (15.2) and G300 (16.9) (P<0.001). Energy utilisation was comparable among all groups. Metabolisable energy intake decreased numerically only with increasing proportions of grass silage in the diet. Substituting maize silage with CCM counteracted the loss in metabolisable energy intake. Absolute methane emissions were not different across the groups, but methane emission intensity (mg/g body protein retention) varied (P<0.05), being numerically lower for G100 (349) and G500CCM (401) compared with the other groups (488 on average). In conclusion, the results show that the grass silage proportion in beef cattle diets can be substantially increased when strategically combined with energy-dense forages, such as CCM. This also limits the need for concentrate and additional protein sources; in addition, the associated urinary N emissions, which are potentially noxious to the environment, are avoided.

Catabolism highly influences ICU-acquired hypernatremia in a mainly trauma and surgical cohort

PurposeTo further analyse causes and effects of ICU-acquired hypernatremia. MethodsThis retrospective, single-centre study, analysed 994 patients regarding ICU-acquired hypernatremia. Non-hypernatremic patients (n = 617) were compared to early-hypernatremic (only before ICU-day 4; n = 87), prolonged-hypernatremic (before and after ICU-day 4; n = 169) and late-hypernatremic patients (only after ICU-day 4; n = 121). Trends in glomerular filtration rate (eGFR), urea-to-creatinine ratio (UCR), fraction of urea in total urine osmolality and urine sodium were compared. Risk factors for i) the development of hypernatremia and ii) mortality were determined. ResultsThirty-eight percent (n = 377) developed ICU-acquired hypernatremia. Specifically in the prolonged- and late-group, decreased eGFRs and urine sodium but increased UCR and fractions of urea in urine osmolality were present. Decreased eGFR was a risk factor for the development of hypernatremia in all groups; disease severity and increased catabolism particularly in the prolonged- and late-hypernatremic group. Increased age, SAPS-III and signs of catabolism but not the development of hypernatremia itself was identified as significant risk factor for mortality. ConclusionsLate- and prolonged-hypernatremia is highly related to an increased protein metabolism. Besides excessive catabolism, initial disease severity and a decrease in renal function must be considered when confronted with ICU-acquired hypernatremia.

The impact of the interaction between dietary total phosphorus level and efficacy of phytase on the performance of growing-finishing pigs

Two experiments were conducted to investigate the interaction between dietary total phosphorus (P) level and phytase on the performance of growing-finishing pigs. In experiment 1, a total of 96 growing pigs [Duroc × Landrace × Yorkshire (barrows, initial body weight (BW) = 39.1 ± 0.5 kg), 8 pigs per treatment] were used in a 5-d total fecal and urine collection study to determine the apparent total tract digestible (ATTD) P release value of phytase in 2 dietary standardized total tract digestible (STTD) P levels (1.49 vs 2.87 g/kg of STTD P) with 0, 250, 500, 750, 1000, and 1250 FTU/kg of phytase. The results indicated that there was an interaction between P level and phytase in the determination of coefficient of apparent total tract digestibility of P (P < 0.01). The determined P release curves were STTD P = −1.4 phytase2 × 10−6 + 20.8305 phytase × 10−3 + 6.88392 × 10−2, R² = 0.9766 [1] in low-P diets, and STTD P = −1.2 phytase2 × 10−6 + 20.2754 phytase × 10−3 + 1.86325 × 10−2, R² = 0.9965 [2] in high-P diets. In experiment 2, a total of 1344 growing pigs [Duroc × Landrace × Yorkshire (initial BW = 69.4 ± 0.6 kg), 28 pigs per pen] were used in a 35-d growth performance study. The study had 4 dietary treatments which included low-P (1.0 g/kg of STTD P) diet group, high-P (1.9 g/kg of STTD P) diet group, low-P diet + 1100 FTU/kg phytase group, and high-P diet + 250 FTU/kg phytase group. The two treatments with phytase were formulated to the same STTD P level using the P release value of phytase determined by equation [1] from Experiment 1. The results showed that the treatment with 1100 FTU/kg phytase had greater gain to feed ratio compared to the treatment with 250 FTU/kg phytase, 1.0 g/kg total STTD P group and 1.9 g/kg total STTD P group (P < 0.05). In conclusion, the determination of P release of phytase may be impacted by the total P level in the diet. The P release value determined in low-P diets may not be accurate for the diet formulation when dietary total P level is greater.

Determination and prediction of digestible energy, metabolizable energy, and standardized ileal digestibility of amino acids in barley for growing pig

Two experiments were performed to determine the digestible energy (DE), metabolizable energy (ME) and standardized ileal digestibility coefficients (SIDC) of amino acids (AA) in barley for pigs, and to develop prediction equations for the DE, ME and SIDC of AA based on its chemical composition. In Exp. 1, twenty-two castrated male pigs (29.5 ± 1.3 kg) were allotted to a replicated 11 × 3 incomplete Latin square design, including 11 diets and 3 consecutive periods. A corn-soybean meal basal diet and 10 test diets containing 400 g/kg of each barley at the expense of corn and soybean meal were prepared, and all diets had a constant ratio of corn to soybean meal. Each period includes 7 d of adaption and 5 d of total feces and urine collection. The DE and ME contents were measured by the total collection method. In Exp. 2, twenty-two ileal-cannulated pigs (30.5 ± 2.1 kg) were used in a duplicated 11 × 3 incomplete Latin square design with 11 diets and three 7-day periods. Titanium dioxide (3 g/kg) was added to all diets as indicator and ieal digesta were collected on d 6 and 7 of each period. Barley was the sole nitrogen source in 10 barley diets and a nitrogen-free diet was used for the endogenous nitrogen losses. The results showed great variations in ether extract (EE), calcium (Ca), ash, acid detergent fiber (ADF) and crude fiber (CF) among samples of barley. On an air-dry basis, the DE and ME in barley for pigs were 12.26 (11.29–13.58) MJ/kg and 11.87 (10.95–13.15) MJ/kg, respectively. The optimal prediction equations for DE and ME were: DE (MJ/kg) = −23.594 + 0.358 crude protein (CP) + 0.043 EE (R2 =0.95) and ME (MJ/kg) = 0.338 + DE - 0.014 ADF (R2 =0.99), respectively. The SIDC of lysine (Lys), methionine (Met), threonine (Thr), and tryptophan (Trp) in barley were 0.767 (0.731–0.809) g/kg, 0.825 (0.803–0.872) g/kg, 0.809 (0.793–0.822) g/kg, and 0.794 (0.760–0.858) g/kg, respectively. The best-fit prediction equations for SIDC of Lys, Met, Thr and Trp in barley fed to pigs were: SIDC Lys = 0.721 + 0.002 EE (R2 =0.79), SIDC Met = 1.045–0.00041 total starch (R2 =0.69), SIDC Thr = 0.739 + 0.001 ADF (R2 =0.69) and SIDC Trp = 1.468–0.006 CP - 0.001 neutral detergent fiber (R2 =0.99), respectively. The study confirms the large variations in chemical composition of different sources of barley, which contributes to the differences of DE, ME and SIDC of AA in barley fed to pigs and the fiber fraction can be used as key predictors.

Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis.

Loop diuretics continue to be a crucial component of pharmacological treatment, to eliminate extra fluid and enhance symptom control in acute decompensated heart failure (ADHF). Understanding the loop diuretics' more efficient form of administration would be very beneficial in improving the management of people's ADHF, resulting in a quicker resolution of symptoms and a notable decrease inmorbidity. To assess the outcomes of intravenous continuous infusion with bolus injection of loop diuretics for patients with ADHF, this meta-analysis was carried out. The current meta-analysis was conducted as per the Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension (PRISMA) guidelines. A search was carried out on PubMed and EMBASE databases for studies comparing continuous infusion with intermittent bolus injection of furosemide in patients with congestive heart failure without restriction on the language of publication from 1January 2001 to 31July 2022. The primary outcome of the meta-analysis was all-cause mortality and loss of body weight (kg). Pre-defined secondary outcomes included length of hospital stay (LOS) in days, brain natriuretic peptide(BNP) reduction (pg/ml), number of patients with hypokalemia, and urine output at 24 hours (ml). A total of nine articles were included in this meta-analysis enrolling 713 patients. No significant difference was reported between patients who received intermittent bolus injections and continuous infusion of furosemide in regards to all-cause mortality, LOS, total urine output, the incidence of hypokalemia, and change in BNP. However, the reduction of body weight was greater in the continuous infusion group compared to bolus administration. In conclusion, in the current meta-analysis of nine randomized controlled trials (RCTs), continuous infusion of furosemide seemed to have a greater reduction of body weight. However, no significant difference was there in 24-hrs urine output. However, we cannot conclude that intravenous continuous infusion has a better diuretic effect compared to bolus administration.

Effect of supplementing rumen-protected methionine, lysine, and histidine to low-protein diets on the performance and nitrogen balance of dairy cows

Lowering the dietary protein content can reduce N excretions and NH3 emissions from manure and increase milk N efficiency of dairy cows. However, milk yield (MY) and composition can be compromised due to AA deficiency. Methionine and Lys are known as first limiting EAA for dairy cows, and recently His is also mentioned as limiting, especially in grass-based or low-protein diets. To examine this, a trial was conducted with a 3-wk pre-experimental adaptation period (diet 16.5% crude protein), followed by a depletion period of 4 wk, in which 39 cows (average ± standard deviation: 116 ± 29.3 d in milk, 1.8 ± 1.2 lactations, 638 ± 73.2 kg of body weight, and 32.7 ± 5.75 kg MY/d) received a low-protein diet (CTRL) (14.5% crude protein). Then, taking into account parity, His plasma concentration, and MY, cows were randomly assigned to 1 of 3 treatment groups during the rumen-protected (RP) AA period of 7 wk; (1) CTRL; (2) CTRL + RP-Met + RP-Lys (MetLys); (3) CTRL + RP-Met + RP-Lys + RP-His (MetLysHis). Products were dosed, assuming requirements for digestible (d) Met, dLys, and dHis being, respectively, 2.4%, 7.0%, and 2.4% of intestinal digestible protein. In the cross-back period of 5 wk, all cows received the CTRL diet. During the last week of each period, a N balance was conducted by collecting total urine and spot samples of feces. Total feces production was calculated using the inert marker TiO2. Statistical analysis was performed with a linear mixed model with cow as random effect and data of the last week of the pre-experimental period used as covariate for the animal performance variables. No effect of supplementing RP-Met and RP-Lys nor RP-Met, RP-Lys, and RP-His on feed intake, milk performance, or milk N efficiency was observed. However, the plasma AA profile indicated additional supply of dMet, dLys, and dHis. Nevertheless, evaluation of the AA uptake relative to the cow's requirements showed that most EAA (exclusive Arg and Thr) were limiting over the whole experiment. Only dHis was sufficiently supplemented during the RP-AA period due to an overestimation of the diet's dMet and dLys supply in the beginning of the trial. The numerically increased milk urea N and urinary N excretion when RP-Met, RP-Lys, and RP-His were added to the low-protein diet suggest an increased catabolism of the excess His.

Effects of low-fat dried distillers grains on nutrient intake and digestibility in high-concentrate diets

This study aimed to evaluate the effect of including levels of low-fat dried distillers grains without soluble (DDG) in high-concentrate diets on intake and digestibility. Four rumen-cannulated Nellore cattle received four dietary treatments in a 4×4 Latin square experimental design. Treatments included diets without DDG (D0) and varying inclusion levels of DDG at 150 g/kg (D150), 300 g/kg (D300), and 450 g/kg (D450). Four periods of total feces and urine collection were performed to estimate nutrient intake and digestibility and estimate nitrogen balance. Collections of omasum digesta were used to estimate ruminal degradability. The ruminal emptying technique was performed to estimate the ruminal rates of ingestion, passage, and digestion (kd). The inclusion of DDG reduced the intake of total digestible nutrients (TDN) (P < 0.01), dry matter (DM) (P = 0.02), organic matter (OM) (P = 0.02), non-fiber carbohydrates (NFC) (P < 0.01) and ether extract (EE) (P = 0.06). The intake of neutral detergent fiber (NDF) increased linearly (P < 0.01), whereas CP had a quadratic pattern (P = 0.02). The total digestibility in kg/d of DM (P < 0.01), OM (P < 0.01), NFC (P < 0.01) and EE (P = 0.02) decreased linearly. The total digestibility in kg/d of the NDF increased linearly (P < 0.01) and the CP had a quadratic pattern (P = 0.01). The kd of DM (P = 0.01), OM (P < 0.01) decreased linearly and NDF increased linearly (P < 0.01). The amount of N retained did not change (P = 0.72), but the intake of metabolizable protein increased (P = 0.03). Therefore, the inclusion of low-fat DDG in finishing diets reduces TDN intake and reduces the digestibility of almost all nutrients.

A Prescription Digital Therapeutic to Support Unsupervised Buprenorphine Initiation for Patients With Opioid Use Disorder: Protocol for a Proof-of-Concept Study.

Home-based (unsupervised) buprenorphine initiation is considered safe and effective, yet many patients report barriers to successful treatment initiation. Prescription digital therapeutics (PDTs) are software-based disease treatments regulated by the US Food and Drug Administration (FDA). The reSET-O PDT was authorized by the FDA in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder (OUD). A prototype PDT (PEAR-002b) designed for use with reSET-O was developed to assist in unsupervised buprenorphine initiation. The primary objective of this pilot study is to evaluate the acceptability of PEAR-002b in individuals with OUD who use it to support buprenorphine initiation, their unsupervised buprenorphine initiation success rate, and their medication adherence. Ten adults with OUD will be recruited for acceptability and feasibility testing. Outcomes will be assessed using week-1 visit attendance, participant interviews and satisfaction surveys, and urine drug screening (UDS). Three tools will be used in the study: PEAR-002b, reSET-O, and EmbracePlus. PEAR-002b includes a new set of features designed for use with reSET-O. The mechanism of action for the combined PEAR-002b and reSET-O treatment is a program of medication dosing support during week 1 of the initiation phase, cognitive behavioral therapy, and contingency management. During the medication initiation phase, participants are guided through a process to support proper medication use. PEAR-002b advises them when to take their buprenorphine based on provider inputs (eg, starting dose), self-reported substance use, and self-reported withdrawal symptoms. This study also administers the EmbracePlus device, a medical-grade smartwatch, to pilot methods for collecting physiologic data (eg, heart rate and skin conductance) and evaluate the device's potential for use along with PDTs that are designed to improve OUD treatment initiation. Home buprenorphine initiation success will be summarized as the proportion of participants attending the post-buprenorphine initiation visit (week 1) and the proportion of participants who experience buprenorphine initiation-related adverse events (eg, precipitated withdrawal). Acceptability of PEAR-002b will be evaluated based on individual participants' ratings of ease of use, satisfaction, perceived helpfulness, and likelihood of recommending PEAR-002b. Medication adherence will be evaluated by participant self-report data and confirmed by UDS. UDS data will be summarized as the mean of individual participants' proportion of total urine samples testing positive for buprenorphine or norbuprenorphine over the 4-week study. This project was funded in September 2019. As of September 2022, participant enrollment is ongoing. This is the first study to our knowledge to develop a PDT that assists with unsupervised buprenorphine initiation with the intent to better support patients and prescribers during this early phase of treatment. This pilot study will assess the acceptability and utility of a digital therapeutic to assist individuals with OUD with unsupervised buprenorphine initiation. ClinicalTrials.gov NCT05412966; https://clinicaltrials.gov/ct2/show/NCT05412966. PRR1-10.2196/43122.

The effects of phthalate exposure on metabolic parameters in polycystic ovary syndrome

Background-aimPhthalates are known as endocrine disrupting chemicals which are present in wide-range of products. The objective of the study was to investigate whether phthalate exposure may attribute to the metabolic syndrome development in women with polycystic ovary syndrome (PCOS). MethodThe cross-sectional study involved 60 women in reproductive age with confirmed PCOS. Anthropometric and biochemical measurements were examined together with detected levels of ten phthalate metabolites measured by GC–MS in morning urine samples. ResultsIn this study at least one phthalate metabolite was detected in 51.7% of samples. Total phthalate metabolites urine concentrations were positively associated with BMI, waist circumference, waist-to-height-ratio (WtHR), leptin serum levels as well as lipid accumulation product (LAP) and visceral adiposity index (VAI). Mono-methyl-phthalate (MMP) levels was significantly correlated with WtHR, LAP and VAI. Additionally, total phthalate metabolites levels were significantly linked with fasting plasma glucose and HOMA index, whereas MMP concentrations were associated with fasting plasma glucose and insulin levels. Total cholesterol (TC) level was statistically significantly higher among PCOS women with detected phthalate metabolites compared to those without phthalates. The sum of all phthalates was correlated with LDL and triglyceride levels as well as TC/HDL. MMP concentrations were linked positively with TC, LDL and triglyceride levels as well as with TC/HDL. It is noteworthy that MMP concentrations were positively associated with testosterone serum levels while the total phthalate metabolites concentrations were also linked but with moderate significance. ConclusionsThe increased phthalate metabolites concentrations may interfere with obesity, glucose and lipid impairment in PCOS women. Additionally, testosterone serum levels can be disrupted by MMP.

Influence of fiber type and carbohydrase supplementation on nutrient digestibility, energy and nitrogen balance, and physiology of sows at mid and late gestation.

Carbohydrase supplementation in grow-finish pig diets improves energy, nutrient digestibility, and gastrointestinal function, but their efficacy in gestation diets is understudied. The experimental objective was to evaluate the efficacy of a multicarbohydrase to improve digestion, energetics, and various physiological functions in gestating sows fed soluble and insoluble fiber diets. On day 28 of gestation, 36 sows (186 ± 4.6 kg body weight), blocked by parity, were randomly assigned to a 2 × 2 factorial arrangement of dietary treatments (n = 9). Factors included fiber type of insoluble (IF; 20% dried distiller grains with solubles) or soluble fiber (SF; 20% sugar beet pulp) and with (+) or without (-) enzyme (0.05%, Rovabio Advance P10; Adisseo, Antony, France). Diets were fed from days 28 to 109 of gestation at a feeding level of 2.1 kg (SID-Lys 11 g/d and 4.5 net energy-Mcal/d). Two separate 9-d metabolism periods were conducted on days 50 to 59 (mid) and 99 to 108 (late) of gestation. During each period, days 1 to 3 served as an adaptation period, days 4 to 7 total urine and feces were collected (96-h) and followed by a 48-h lactulose-mannitol study. Serum and plasma were collected on days 50 and 99. Data were analyzed as repeated records using a linear mixed model with block as a random effect and fiber type, enzyme, and period and their interactions as fixed effects. Sows fed SF+ had increased serum IL-1ra (Fiber × Enzyme P = 0.035), and IL-2 (Fiber × Enzyme P = 0.042). In the presence of IF, multicarbohydrases increased serum lipopolysaccharide-binding protein, but not when supplemented with SF (Fiber × Enzyme P = 0.028). Circulating IL-8 and TNF-α were decreased in sows fed multicarbohydrases (P < 0.05). Multicarbohydrase supplementation increased the apparent total tract digestibility (ATTD) of gross energy (GE), dry matter, and neutral detergent fiber by 2.8%, 3.4%, and 8.3%, respectively (P < 0.05). Compared to IF-, the ATTD of hemicellulose was 5.3% greater in sows fed IF+ but did not differ from SF- and SF+ (Fiber × Enzyme P = 0.037). Sows fed IF+ had the greatest ATTD of insoluble dietary fiber (Fiber × Enzyme P = 0.011). Sows fed multicarbohydrases excreted less energy in their urine (519 vs. 469 GE kcal/d; Enzyme P = 0.033) and in their feces (985 vs. 900 GE kcal/d; Enzyme P = 0.003). This resulted in an improvement in both digestible energy (Enzyme P < 0.01) and metabolizable energy (Enzyme P = 0.041), irrespective of fiber type. In conclusion, multicarbohydrase supplementation increased the digestibility and energetic contribution of fiber, irrespective of adaptation time or fiber type, but modulation of inflammatory responses was unique to dietary fiber type.