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Background: Due to centralization and super-specialization in medicine, hospital mergers are increasingly common. Their effect on postoperative outcomes in highly specialized surgical departments is unclear. As quality metrics often worsen after major organizational changes, preservation of quality of care during an hospital merge is of the utmost importance. Objective: To evaluate the effect of a merger of two Dutch university hospitals on quality of surgical care, volume, and timeliness of care. Methods: The upper gastro-intestinal and hepato-biliary-pancreatic sections merged on the 27th of January 2020 and the 31th of May 2021 respectively. Outcomes of all adult surgical patients were compared six months before and six months after the merger. Short-term quality metrics, volume, and timeliness of care were assessed. Results: Overall, a cohort of 631 patients were included of whom 195 were upper gastro-intestinal (97 prior to the merger, 98 after the merger) and 436 (223 prior to the merger, 213 after) hepato-biliary-pancreatic patients. There were no differences in mortality, readmission, number and severity of complications, volume, and timeliness of care six months post-merger as compared to before merger. Conclusion: This study shows that a hospital merger of two university hospitals can be performed without jeopardizing patient safety and while benefitting from centralization of highly specialized care and enhancement of medical research. Key message: This study investigated the impact of a merger of two Dutch university hospitals on quality of care, timeliness of care, and volume. It showed no deterioration in the evaluated short-term quality metrics, volume or timeliness for upper GI and HPB surgery, suggesting that a hospital merger of two university hospitals can be performed safely, while benefitting from centralization of highly specialized care and enhancement of medical research.

A multi-suckling (MS) system for sows and piglets has been developed aiming to improve animal welfare. In this system, large variation in BW gain exists between piglets up to weaning at 9 weeks of age. We aimed to study the causes of variation in BW gain and DM intake of solid feed (DFI) (piglet + sow feed) of piglets during lactation in the MS system. A total of 15 sows and 60 focal piglets across three batches were studied. Individual intake of piglet and sow feed was measured by the dual marker method, and multiple variables were recorded. Multiple linear regression analysis with forward selection was conducted on BW gain and DFI after correcting for piglet sex and batch, using multiple explanatory variables including genetic background, birthweight (BiW), DM feed intake, behaviours and number of skin lesions. These factors jointly explained less than 45 % and 21 % of the variation in BW gain and DFI, respectively. In weeks 2–4, variation in BW gain was mainly explained by BiW (12.0 %) and play and nosing behaviours (7.6 %). In weeks 4–6 and 6–8, it was largely explained by DM intake of piglet feed with 15.1 % and 25.9 %, respectively. Individual variation in DFI in weeks 2–4 was explained by the presence at front and middle teats during suckling bouts (2.9 %), in weeks 4–6 by BiW (9.6 %), and in weeks 6–8 by the number of skin lesions (5.1 %). The unexplained variation in BW gain and DFI warrants further investigation.

Accurate estimation of individual feed intake (FI) of pigs could help better understand the variation in performance between individual animals. We studied dual marker methods to estimate individual FI in pigs. This method is based on the measurement of the ratio between two indigestible markers in faeces. Twelve 6.5-week-old individually housed male pigs were assigned to one of three oral dosing treatments supplying 180 mg of ytterbium chloride (YbCl3)/day and 111 mg of dotriacontane (C32)/day as reference markers, either once (R1), three times (R3) or five times (R5) daily. Pigs were offered a diet containing 0.46 g/kg of chromium chloride (CrCl3) and 0.15 g/kg of hexatriacontane (C36) as in-feed markers. The experiment lasted for 10 days: days −5 to 0: adaptation; days 1–3: dosing of reference marker; days 2–4: total faecal collection. Spot faecal samples were taken on day 3 at 1200 h, 1700 h and on day 4 at 0700 h. Pigs were fed restrictedly three times daily, at 133.6 g/kg BW0.60. Individual measured FI was recorded daily and was compared to predicted FI using the ratio of the dual marker pairs (Yb:Cr and C32:C36), both in total faecal collection and spot samples. Due to unequal variance, R1 pigs were omitted from the statistical treatment comparison. When using total faecal collection samples, the absolute prediction error (APE) (predicted FI minus measured FI) in R3 and R5 pigs was numerically lower than in R1 pigs, regardless of the marker pair used. The APE measured by C32:C36 was numerically lower than measured by Yb:Cr at all frequencies, and significantly (P = 0.039) in R3 pigs (C32:C36: 0.15 ± 0.02 kg/day; Yb:Cr: 0.29 ± 0.04 kg/day). This was related to a larger difference in faecal recovery between Yb and Cr compared with C32 and C36. Daily total faecal collection revealed that for R3 pigs, starting faecal collections 2 days after the onset of provision of the reference marker improved the APE when compared with starting after 1 day. When using C32:C36 to predict feed intake, pooled, but not single spot samples gave similar APEs compared with total faecal collections. Therefore, we recommend dosing the reference marker three times per day for 2 days on days 1 and 2, combined with pooled spot faecal sampling collected on days 3 and 4. In this way, absolute prediction errors of 10%-15% of simultaneously measured intakes of multiple nutrient resources in a complex housing system are feasible using the dual marker technique.

The low feed intake and stress associated with abrupt weaning in conventional pig farming often result in poor post-weaning performance, which is related to impaired intestinal function. We investigated effects of housing conditions before weaning on performance around weaning of relatively light and heavy piglets. Before weaning, piglets were housed either with five sows and their litters in a multi-suckling (MS) system or in pens with individually housed sows in farrowing crates (FC). After weaning at 4 weeks of age (day 0), 16 groups of four piglets (two light and two heavy litter-mates) were housed under equal conditions in enriched pens. Mannitol (day −5 and day 5) and galactose (day 5) were orally administered as markers for gastrointestinal carbohydrate absorption, and after 20 min a blood sample was taken (sugar absorption test). In addition, BW, feed intake and faecal consistency as an indicator for diarrhoea, were assessed frequently during 2 weeks post-weaning. Pre-weaning housing, weight class and their interaction did not affect post-weaning faecal consistency scores. Weight gain over 2 weeks did not differ between pre-weaning housing treatments, but MS piglets gained more (0.67±0.12 kg) than FC piglets (0.39±0.16 kg) between days 2 and 5 post-weaning, P=0.02), particularly in the ‘heavy’ weight class (interaction, P=0.04), whereas feed intake was similar for both treatments. This indicates a better utilisation of the ingested feed of the MS piglets compared with the FC piglets in the early post-weaning period. Pre-weaning mannitol concentrations were unaffected by pre-weaning housing, weight class and their interaction. On day 5 post-weaning, however, MS piglets had a lower plasma concentration of mannitol (320 v. 592 nmol/ml, SEM=132, P=0.04) and galactose (91 v. 157 nmol/ml, SEM=20, P=0.04) than FC piglets, regardless of weight class. In conclusion, MS and FC piglets differed in aspects of post-weaning gastrointestinal carbohydrate absorption and in weight gain between days 2 and 5 after weaning, but pre-weaning housing did not affect feed intake, weight gain and measures of faecal consistency over the first 2 weeks after weaning.

Chemogenetics uses engineered proteins that are controlled by small molecule actuators, allowing in vivo functional studies of proteins with temporal and dose control, and include Designer Receptors Exclusively Activated by Designer Drugs (DREADDs). One major class of DREADDs are mutated muscarinic receptors that are unresponsive to acetylcholine, and are activated by administration of clozapine N-oxide (CNO). However, CNO is available in only small amounts and large scale studies involving animals and multiple cohorts are prohibitively expensive for many investigators. The precursor, clozapine, is also expensive when purchased from specialist suppliers. Here we report: • A simple extraction method of clozapine from commercial tablets; • A simple preparation of CNO from clozapine, and for the first time its single-crystal X-ray structure; and • That the CNO prepared by this method specifically activates the DREADD receptor hM3Dq in vivo.This method provides large quantities of CNO suitable for large-scale DREADD applications that is identical to commercial material. Method name: Preparation and application of clozapine N-oxide (CNO), Keywords: G-protein-coupled receptor (GPCR), Chemical-genetics, Chemical synthesis

Commercial use of group housing systems for lactating sows is limited, but the recent transition to group housing during gestation in the EU may result in a renewed interest in such systems. Therefore, this review aims to identify key factors that may contribute to the success or failure of group housing of lactating sows in comparison with individual housing by describing the variety in group housing systems and discussing animal behaviour and performance compared with individual housing. Group housing systems can be divided in multi-suckling (MS) systems, in which sows are grouped with their litters, and get-away (GA) systems, which include a separate communal area accessible to sows only. These systems differ in many aspects regarding management and layout but, compared with individual housing, generally provide more environmental complexity, more freedom of movement for the sows and more freedom to express behaviours related to, for example, maternal care and social interactions. Group housing poses several risks, such as disrupted nursing and an increased level of crushing during the MS phase, and in the GA systems there is a risk for early cessation of nursing. On the other hand, pre-weaning mingling of litters clearly benefits piglet social development and may improve adaptation to the post-weaning situation. In addition, group-housed sows may show lactational ovulation, which provides opportunities for insemination during an extended lactation period, which benefits the piglets. Gradual transitions in social and physical environment around gestation, farrowing, grouping and weaning seem to be key success factors for group housing systems during lactation. In addition, selection of suitable sows and quality of stockmanship seem important.

Pig farms in the Netherlands producing boars have different levels of boar taint prevalence, as assessed by sensory evaluation with the human nose at the slaughter line. With a questionnaire to 152 Dutch pig producers (response rate 59%), farm and management characteristics were identified that are potentially associated with farm-level boar taint prevalence. Lower farm-level boar taint prevalence was associated with a smaller group size, a smaller pen surface per boar, newer housing equipment, not practicing restricted feeding in the last period before delivery, a longer fasting period before slaughter, a higher stocking weight and a lower fraction of boars from purebred dam line sows or from Pietrain terminal boars. These characteristics can be used to develop farm-level intervention strategies to control boar taint. More research effort is needed to establish causal relationships.

To unravel the underlying mechanisms that explain the positive effects of prefermented cereals on in vivo gastrointestinal (GI) architecture and function, an in vitro experiment using a human small intestinal epithelial cell model (Caco-2) was performed. A range of dilutions (0% to 10%) of the supernatants of three liquid experimental diets, as well as Na-lactate were used in an in vitro experiment to assess their effect on cellular growth, metabolism, differentiation and mucosal integrity using Caco-2. The experimental diets contained, in addition to a protein rich basal diet (60%), (1) a liquid control diet (C) containing 40% of a mixture of barley and wheat (ratio 3 : 1) or (2) a liquid diet (F) containing 40% prefermented barley and wheat or (3) C with the addition of the fermentation end-products (organic acids and ethanol) in concentrations similar to those in the fermented diet (FP). For F, the mixture of barley and wheat was fermented at 35°C for 48 h. Parallel to the in vitro experiment, 18 groups of eight weanling pigs were assigned to one of the experimental diets during a 14-day in vivo experiment. Each group was fed restrictively. The results of the in vitro experiment showed that the lowest dose of both F- and FP-supernatants had no clear effects on the cell proliferation, but incubation with 5% and 10% of the F- and FP-supernatants decreased the cell numbers at day 19. DNA, RNA, protein and glycoprotein synthesis in differentiated Caco-2 cells were stimulated by incubation with the lower concentrations (0.5% to 2.5%) of F- and FP-supernatants whereas the higher concentrations (5% and 10%) had no effect. Both the F- and FP-supernatants decreased the specific sucrase–isomaltase activity in a dose-dependent manner, but the effects on the specific aminopeptidase activities were less clear. Mucosal integrity initially decreased after incubation with the highest F- and FP-supernatants and started to recover between 24 and 48 h. The results of the in vivo experiment showed no dietary effects (P > 0.1) on GI morphology and brush-border enzyme activities at day 5 or at day 14. Time related changes in GI characteristics followed a normal pattern. In conclusion, the supernatants of diets containing either prefermented cereals or their fermentation end-products clearly modulate cellular growth, metabolism, differentiation and mucosal integrity in an in vitro model, although these effects were not observed in the in vivo characteristics measured in weanling pigs.