An experiment was designed to determine the response of milk protein production and N utilization in dairy cows to supplementation of a predominantly rumen-undegradable protein (RUP) mixture with a fixed amino acid (AA) pattern and the response to the amount of feed intake. The experiment was designed as a 6 x 6 Latin square with a 3 x 2 factorial arrangement of treatments. The factors were three concentrations of RUP supplement (4.5, 14.9, and 29.1% of dry matter intake) and two levels of feed intake restriction (10 and 20%) of the basal diet. The supplement was designed to approximate a postruminal AA pattern that was similar to bovine caseins for Met, Lys, Phe, His, and Thr. Measurements were made during the last 5 d of each 21-d period. Milk protein production responded linearly as the concentration of RUP supplement in the treatment diet increased within the given range. The difference in feed intake restriction did not affect milk protein production. Efficiency of N utilization for milk production exceeded 30% for cows fed the lowest RUP supplement. Results indicated that there is an opportunity to increase milk protein production by using RUP formulations that are balanced for AA while minimizing waste N excretion.

Six multiparous Holstein cows were used in a 6 x 6 Latin square to investigate the ability of the Cornell Net Carbohydrate and Protein System to predict accurately rumen microbial yield, plasma urea N, and milk urea N. Estimations for microbial protein yield were compared with the measured excretion of purine derivative N in urine. A 3 x 2 factorial arrangement of treatments was adopted. Three concentrations of a rumen-undegradable protein (RUP) supplement (4.5, 14.9, and 29.1% of dry matter intake) and two levels of feed restriction (90 and 80% of ad libitum intake) were the corresponding factors. No effect of concentration of RUP supplement or feed restriction was detected on the excretion of purine derivative N in urine (mean, 18.5 g/d). Conversely, the Cornell system predicted a linear decrease in metabolizable protein from bacteria as the concentration of the RUP supplement increased. The Cornell system also predicted a significant reduction in metabolizable protein of microbial origin as feed restriction was increased. Measured values and values derived from the Cornell system for plasma and milk urea N increased linearly as the concentration of the RUP supplement increased. The Cornell system overpredicted milk urea N for cows consuming the highest RUP concentration. Predictions by the Cornell Net Carbohydrate and Protein System were of limited value because the empirical nature of the model is insufficiently rigorous to yield accurate predictions under the conditions described herein.

BackgroundFrequent attenders (FAs), defined as patients reporting a disproportionate number of visits to general practitioners (GPs), may represent up to one-third of GP patients responsible for a high burden of care not always justified by the severity of the medical condition. The aim of this study was to explore sociodemographic and clinical characteristics of FAs of GP in Italy with particular attention to functional impairment.MethodsA total sample of 75 FAs (defined as individuals who had consulted GPs 15 times or more during 2015) of GPs of three primary care centers (Pisa, Livorno, and Lucca) in Italy were enrolled and assessed by sociodemographic scale, Structured Clinical Interview for DSM-5 (SCID-5), global functioning (Global Assessment of Functioning [GAF]), illness behavior and perceived health (Illness Behavior Inventory), and somatic comorbidity (Cumulative Illness Rating Scale).ResultsMost of the sample were females, middle aged, married, or cohabiting, with low levels of education. One-third of FAs was low functioning (LF; GAF score <70), with no differences in the sociodemographic variables. Approximately 70.3% of the patients reported a current SCID diagnosis, in particular, major depressive disorder, somatic symptom disorders, and panic disorder, all being more frequent in LF patients. Half of the patients were taking a psychopharmacological therapy, mostly benzodiazepines (BDZs).ConclusionMost FAs were female with current medical disorders, and LF. All claimed to be worried about their own health and perceived themselves as more impaired also regarding the health perception and social role. LF patients were, or had been more likely to be under psychopharmacological treatment. FAs seem to constitute a special population that should be carefully evaluated for mental disorders and appropriate treatment.

The aims of the present study were to evaluate, in the city of Pisa: (1) the prevalence of rheumatoid arthritis; (2) the reliability of the prevalence estimated by primary care physicians, using the rheumatologist's diagnosis as the "gold standard" and (3) the economic impact of the disease. The Tuscany registry of primary care physicians constituted the framework from which a sample of subjects was selected. The rheumatoid arthritis (RA) subjects >18 years followed by each primary care physician constituted the population studied. Each general practitioner (GP) was asked to fill out a questionnaire regarding their patients affected by RA and to send it to the tertiary rheumatologic centre, where the diagnosis was confirmed/discarded, the clinical and epidemiological data were collected in a standardized form and a number of data for the estimation of costs were gathered. The estimated prevalence of RA was 5.1 per thousand (CI, 4.4-5.7). The reliability of general practitioners in the diagnosis of rheumatoid arthritis was on the whole 69%. However, when an analysis of every physician was carried out, a high degree of heterogeneity in the prevalence of RA per physician was found. Overall, the mean annual cost per patient with RA was estimated at about 5,878 euro (euro; median, 6,434 euro; inter quartile range, 669-7,052 euro), with a high variability mainly dependent on the degree of patient disability. More than 90% of the overall annual cost per patient was due to the medical and non-medical direct components of costs. The prevalence of RA in Tuscany seems highly comparable with similar prevalence studies in Italy. The annual cost per patient with RA was highly variable and strictly dependent on the level of disability. More than 90% of the overall cost was due to the direct burden of costs.

Four soya bean (Glycine max Merr) inbreds, two of which (Williams 82 and Amsoy 71) capable of synthesising the Kunitz trypsin inhibitor (high trypsin inhibitory activity (TIA)) and two (L8 1-4590 and L83-4387), nearly isogenic to the former but lacking this particular function (low TIA) were used. In-vitro trials were performed to evaluate the residual TIA of flours incubated with runem fluid and the possible effect of proteinase inhibitors on rumen microbial fermentation, estimated by gas production. Only a slow fall in TIA was observed after short incubation times (5-10Y0 at 2 h and 10-18% at 6 h), but after this period the rate of decline of TIA accelerated to give residual TIA of about 50% after 12 h and undetectable values after 48 h. Significant differences between genetic backgrounds were observed only at 2 h, when the Williams 82 background had a faster initial loss of TIA (89.1 versus 97.5% of the original activity, P < 0.01). Different patterns of TIA degradation were observed according to the presence/absence of the Kunitz inhibitor: inbreds lacking the Kunitz inhibitor initially had a higher residual TIA (95.9 versus 90.7%, P c 0.01) while at 12 and 24 h the residual TIA was considerably lower with respect to the other inbreds (45.4 versus 60.8 and 10.7 versus 20.4, respectively, P < 0.01). Gas production after 2 and 6 h of incubation was similar across treatments, whereas slightly but consistently more (P < 0.05) gas was produced at longer incubation times for inbreds lacking the Kunitz inhibitor. The results indicated that the proteinase inhibitors contained in raw soya bean are degraded at a much slower rate than previous nylon bag studies have suggested and that the presence of the Kunitz inhibitor leads to a higher residual TIA after rumen degradation and slightly lower microbial gas production.