Metabolic profiling was performed using nuclear magnetic resonance (NMR)-based metabolomics to explore panoramic changes in ketosis metabolism in dairy cows, and to further understand changes in metabolites when ketosis occurred. According to clinical signs and plasma levels, 81 multiparous Holstein cows from a dairy farm were divided into clinical ketosis, subclinical ketosis and healthy control groups during 7-21 d after calving. Different metabolites were identified by NMR and combined with multivariate statistical analysis to determine the pathway. There were 29 metabolites obtained, including three carbohydrates, six lipids, 14 amino acids and six other metabolites. Consulting a database and the metabolite analysis showed that these metabolites were mainly related to amino acid, fat and carbohydrate metabolisms. The results indicated that metabolomics revealed changes in the occurrence and development of dairy cow ketosis, and also that the different metabolites could be potential markers and indicators to diagnose ketosis. ARTICLE HISTORY
Aspiration of a tooth in maxillofacial injuries is a known complication necessitating prompt recognition and early treatment to minimize potentially serious and, sometimes, even fatal consequences. Here, we report a rare and unusual case in its presentation, the patient having aspirated 2 permanent teeth after maxillofacial, cervical vertebrae, and thoracic region crush injuries due to a motor vehicle accident. The diagnosis of teeth aspiration was delayed until 2 weeks after the event. An aspirated anterior tooth was expectorated by the patient himself, and the other aspirated anterior tooth was removed by flexible bronchoscopy. The paper also emphasizes that clinicians must be aware of dental injury resulting from maxillofacial injuries and account for all teeth as part of their evaluation, keeping an open mind as to where a missing tooth might be located. A rapid diagnosis depends on high clinical suspicion, clinical signs, and radiologic findings.
A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) actually benefit from a DPI of ≤ 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1–3 has not been consistent. We systematically searched MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, as well as the bibliographies of articles identified in the search, for eligible randomized controlled trials that had investigated the effects of LPD (prescribed DPI < 0.8 g/kg/day) versus control diet on the progression of DKD. Nine trials that included 506 participants and follow-up periods varying from 4.5 to 60 months were included in the subsequent systematic review and meta-analysis. The data showed that patients with DKD who consumed < 0.8 g protein/kg/day had a significantly reduced decline in glomerular filtration rate (GFR) (mean difference [MD] 22.31 mL/min/1.73 m 2 , 95% confidence interval [CI] 17.19, 27.42; P < 0.01) and a significant decrease in proteinuria (standard mean difference [SMD] − 2.26 units, 95% CI − 2.99, − 1.52; P < 0.001) versus those on the control diet. The benefits of LPD to patients with DKD at CKD stages 1–3 were a markedly decreased proteinuria (SMD − 0.96 units, 95% CI − 1.81, − 0.11; P = 0.03) and slight but significant decreases in glycated hemoglobin (− 0.42%) and cholesterol levels (− 0.22 mmol/L). Our meta-analysis indicated that a DPI of < 0.8 g/kg/day was strongly associated with a slow decline in GFR and decreased proteinuria in the patients with DKD. Patients with CKD stages CKD 1–3 benefited from LPD in terms of a marked decrease of proteinuria and slight but significant improvements in lipid and glucose control. Electronic supplementary material The online version of this article (10.1007/s13300-020-00952-5) contains supplementary material, which is available to authorized users.
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