Trend of the burden of chronic illnesses: using the Canadian Community Health Survey.

OBJECTIVES: Burden of illnesses has been described in the literature using the health-related quality of life (HRQoL) in people with chronic conditions. However, the studies reporting trends of burden are sparse. The aim of this study was to explore the trends of burden of chronic illness from the perspective of HRQoL. STUDY DESIGN: This was a secondary analysis of administrative database. METHODS: Seven data sets of the Canadian Community Health Survey from 2001 to 2014 were obtained for the analysis. Multiple linear and logistic regression models were used on each data set to assess the burden of illness on the Health Utilities Index Mark III (HUI3), life satisfaction (LS), and perceived health (PH). RESULTS: People with the effect of stroke constantly had low scores on the HUI3, LS, and PH. Regression analyses revealed that arthritis, back problem, and mood disorder have greater impact on the HUI3 score. Effect of stroke, mood disorder, and anxiety disorder stably had the largest negative impact on LS, while chronic obstructive pulmonary disease (COPD), effect of stroke, and cancer had the largest effect on PH. CONCLUSION: This study identified that arthritis, back pain, mood disorder, effect of stroke, and COPD constantly have high burden on health outcomes compared with other chronic condition over the past decade.

Edwardsiella tarda Infection Triggering Acute Relapse in Pediatric Crohn's Disease.

Crohn's disease exacerbations can often be associated with bacterial infections causing gastroenteritis. We report a child who experienced exacerbation of his Crohn's disease associated with a positive stool culture for Edwardsiella tarda (E. tarda). Endoscopy showed features of moderate inflammation similar to exacerbation of Crohn's disease. The patient was treated simultaneously with intravenous steroids and antibiotics, and his symptoms resolved. This case report highlights the importance of clinicians being able to promptly recognize and treat concurrent bacterial infections in Crohn's disease exacerbations.

Effects of dietary supplementation of microencapsulated Enterococcus fecalis and the extract of Camellia oleifera seed on laying performance, egg quality, serum biochemical parameters, and cecal microflora diversity in laying hens.

The aim of this study was to investigate the effects of microencapsulted Enterococcus faecalis (MEF) and the extract of Camellia oleifera seed (ECOS) on laying performance, serum biochemical parameters, and cecal microflora diversity in laying hens. A total of 180 Hy-Line Brown laying hens, 26-wk-old, were randomly allocated to 6 treatments with 10 replicates and 3 hens per replicate. Dietary treatments were as follows: (A) control group, basal diet; (B) basal diet + 100 mg MEF/kg diet (1 × 1010 cfu/g MEF); (C) basal diet + 300 mg ECOS/kg diet; (D) basal diet + 100 mg MEF/kg diet + 300 mg ECOS/kg diet; (E) basal diet + 500 mg ECOS/kg diet; (F) basal diet + 100 mg MEF/kg diet + 500 mg ECOS/kg diet. The results showed that diets supplemented with MEF and ECOS had no significant effects on laying rate, average egg size, average daily feed intake, feed conversion ratio, eggshell thickness, albumen height, and yolk color (P > 0.05), but had significant effects on egg shape index, eggshell strength, and Haugh unit (P < 0.05) during whole feeding phases. Compared to the control group, the serum IgA and IgG levels of birds in Group F significantly increased (P < 0.05). The serum total cholesterol, low-density lipoprotein cholesterol, total triglyceride, and blood urea nitrogen levels of birds in Group D and Group F significantly reduced (P < 0.05), and the high-density lipoprotein cholesterol level of birds in Group D and Group F significantly increased (P < 0.05). At the phylum level, Firmicutes decreased (P < 0.05) and Bacteroidetes increased (P < 0.05) in the birds of Group D. Ruminococcus and Bacteroides were significantly affected by dietary treatments (P < 0.05), and Bacteroides in the birds of Group D significantly increased at the genus level. Therefore, diet supplemented with MEF and ECOS can significantly improve serum biochemical parameters and increase cecal microflora diversity.

The effects of dietary supplementation of microencapsulated and the extract of seed on growth performance, immune functions, and serum biochemical parameters in broiler chickens.

This experiment was conducted to investigate the effects of microencapsulted (MEF) and the extract of seed (ECOS) on growth performance, immune functions, and serum biochemical parameters in broiler chickens. A total of 240 1-d-old male broilers were randomly allotted into 6 treatments with 8 replicates/treatment and 5 broilers in each cage. The dietary treatments included 1) a basal diet without antibiotic (group A), 2) the basal diet + 1 g MEF/kg diet (1 × 10 cfu/g MEF; group B), 3) the basal diet + 300 mg ECOS/kg diet (group C), 4) the basal diet + 300 mg ECOS/kg diet + 1 g MEF/kg diet (group D), 5) the basal diet + 500 mg ECOS/kg diet (group E), and 6) the basal diet + 500 mg ECOS/kg diet + 1 g MEF/kg diet (group F). The feeding experiment included 2 phases: the starter phase from Day 1 through 21 and the grower phase from Day 22 through 42. The results showed that a diet supplemented with MEF and ECOS had no significant effect on ADG, ADFI, feed conversion ratio, and average BW during the whole experimental period ( > 0.05), but group F showed an improving trend in growth performance. Serum IL-2, IgA, and IgG levels and spleen index were significantly affected by dietary treatment ( < 0.05). Serum IgA and IgG levels and spleen index in group F were significantly higher than in the group A ( < 0.05), and the IL-2 level was significantly decreased ( < 0.05) on Days 21 and 42. Compared with the group A, diets supplemented with MEF and ECOS can significantly decrease total cholesterol, low-density lipoprotein cholesterol, triglycerides, and blood urea nitrogen levels ( < 0.05) and increase the high-density lipoprotein cholesterol level on Days 21 and 42. Concentrations of serum biochemical parameters were significantly increased in group F ( < 0.05). In summary, the results indicated that dietary supplementation of MEF and/or ECOS had no significant effect on growth performance but significantly increased spleen index and the levels of serum IgA and IgG and improved serum lipid metabolism. The 1 g MEF/kg diet (1 × 10 cfu/g diet) plus 500 mg ECOS/kg diet was the optimum supplemental dose in this experiment.

Evaluation of pilot-scale microencapsulation of probiotics and product effect on broilers.

This study was conducted to evaluate the pilot-scale production of microencapsulated in a 500-L fermenter using emulsion and gelation and to assess the effect of the products on the growth performance, antioxidant activity, immune function, and cecal microbiota in Arbor Acres broilers. A total of seven hundred 1-d-old male Arbor Acres broilers were randomly assigned to 7 dietary treatments with 5 replicate pens per treatment and 20 broilers per pen. The dietary treatments were as follows: 1) basal diet (CON), 2) basal diet containing 0.1% Aureomycin (ANT), 3) basal diet containing unencapsulated at a dose of 1 × 10 cfu/kg of feed (P1), 4) basal diet containing unencapsulated at a dose of 1 × 10 cfu/kg of feed (P2), 5) basal diet containing 0.01% empty microcapsules (CAP), 6) basal diet containing microencapsulated at a dose of 1 × 10 cfu/kg of feed (CAPP1), and 7) basal diet containing microencapsulated at a dose of 1 × 10 cfu/kg of feed (CAPP2). The feeding experiment included 2 phases: the starter phase from d 1 to 21 and the grower phase from d 22 to 42. The results showed that a 500-L fermenter could produce 20.73 ± 4.05 kg of microcapsules with an approximate diameter of 549 µm. The feeding experiment showed that ADG of broilers in CAPP1 was significantly ( < 0.05) greater than that in CON and CAP throughout the feeding period, whereas the ratio of feed to gain (G:F) was significantly ( < 0.05) lower. Broilers in P1, P2, CAPP1, and CAPP2 had significantly ( < 0.05) greater levels of total superoxide dismutase, catalase, IgG, and cluster of differentiation 3 than those in CON. Furthermore, broilers in CAPP1 had significantly ( < 0.05) greater richness and diversity of intestinal microorganisms, particularly of , than those in all other dietary treatments. In summary, our results indicate that large-scale microencapsulation of microbial cells can be achieved using emulsion and initial gelation and that the dietary administration of microencapsulated can significantly enhance the growth performance, immune function, cecum microbial community, and overall health of broilers.

Effects of pre-encapsulated and pro-encapsulated Enterococcus faecalis on growth performance, blood characteristics, and cecal microflora in broiler chickens.

The effects of microencapsulation of Enterococcus faecalis on the growth performance, antioxidant activity, immune function, and cecal microbiota in broilers were investigated. Broilers (1-day-old) were assigned randomly as follows: 5 treatments, 5 replicate pens per treatment, and 20 broilers per pen. Treatments included (1) a basal diet (CON), (2) CON + Aureomycin (1 g/kg of diet) (ANT), (3) CON + free non-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (FREE), (4) CON + pro-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (PRO), and (5) CON + pre-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (PRE). Feedings included starter (1 to 21 d) and grower (21 to 42 d) phases. In the starter phase, the ANT and the PRE groups had greater (P < 0.05) ADG than the CON groups, and the feed conversion ratio (FCR) for these 2 groups was decreased (P < 0.05). In the finisher phase, the PRE and PRO groups had greater (P < 0.05) ADG than the CON group and their FCR was decreased significantly (P < 0.05). During the entire feeding period, only the PRE group showed greater (P < 0.05) ADG and lower (P < 0.05) FCR. On day 21, only birds in the PRE group had greater (P < 0.05) total antioxidant capacity and number of Lactobacillus than the CON group. On day 42, The PRE group showed greater (P < 0.05) superoxide dismutase than the CON group. Serum IgA and IgM concentrations were increased (P < 0.05) in the PRE group. Serum IL-6 in the PRE group was greater (P < 0.05) than in the other groups with the exception of ANT. At the phylum level, Firmicutes was enriched (P < 0.05) and Proteobacteria was depleted (P < 0.05) only in the PRE group. At the genus level, only the PRE diets increased (P < 0.05) the number of both Lactobacillus and Enterococcus. The results indicate that pre-encapsulation assists the efficient functioning of probiotics in broilers.

Effects of microencapsulated Enterococcus fecalis CG1.0007 on growth performance, antioxidation activity, and intestinal microbiota in broiler chickens.

We performed a series of trials to assess the effect of dietary supplementation with microencapsulated Enterococcus fecalis CG1.0007 on growth performance, antioxidation activity, and intestinal microbiota in Arbor Acres broiler chickens ("broilers"). A total of 150 1-d-old broilers were assigned randomly to 5 feeding treatments (a control group fed the basal diet, 3 groups fed the basal diet plus various concentrations of microencapsulated CG1.0007, and 1 group fed the basal diet plus an antibiotic). Changes in important genera of intestinal bacteria were studied using 16S rRNA gene-based PCR-denaturing gradient gel electrophoresis (DGGE) profiling and real-time quantitative PCR analysis of fecal samples. During the course of the 42-d experimental period, ADG of the birds fed the high and intermediate concentrations of microcapsules were significantly greater (9.90 and 9.50%, respectively) and the ratios of feed to gain fed were significantly lower (4.40 and 4.00%, respectively) compared with the control group. The total antioxidant capacity and the content of malondialdehyde and superoxide dismutase in the microcapsule-treated groups showed significant changes in terms of antioxidation. The numbers of Lactobacillus and Bifidobacterium were significantly greater in the microcapsule-treated groups than in the control group. Cluster analysis indicated that the DGGE bacterial profiles were related to the feeding treatments and revealing the diversity and richness of the intestinal microbiota associated with supplementation of microcapsules. In summary, our results indicate that dietary addition of microencapsulated E. fecalis CG1.0007 enhanced the growth performance of the broilers and improved their health.

Techniques for liver resection: a review.

Improvement in surgical outcomes of liver resection has been achieved in the past decade. Among other factors, a gradual change of technology platforms and refinement of surgical techniques have played significant roles. In this review, the various surgical approaches, operative techniques, operative instruments, and adjunctive measures as applied in liver resection are described, along with discussion of the pros and cons of each of these attributes. A brief description of laparoscopic liver resection is also included to address this important and emerging area in liver surgery.

True phosphorus digestibility and the endogenous phosphorus outputs associated with brown rice for weanling pigs measured by the simple linear regression analysis technique.

The objectives of this study were to determine true phosphorus (P) digestibility, degradability of phytate-P complex and the endogenous P outputs associated with brown rice feeding in weanling pigs by using the simple linear regression analysis technique. Six barrows with an average initial body weight of 12.5 kg were fitted with a T-cannula and fed six diets according to a 6 × 6 Latin-square design. Six maize starch-based diets, containing six levels of P at 0.80, 1.36, 1.93, 2.49, 3.04, and 3.61 g/kg per kg dry-matter (DM) intake (DMI), were formulated with brown rice. Each experimental period lasted 10 days. After a 7-day adaptation, all faecal samples were collected on days 8 and 9. Ileal digesta samples were collected for a total of 24 h on day 10. The apparent ileal and faecal P digestibility values of brown rice were affected ( P < 0.01) by the P contents in the assay diets. The apparent ileal and faecal P digestibility values increased from - 48.0 to 36.7% and from - 35.6 to 40.0%, respectively, as P content increased from 0.80 to 3.61 g/kg DMI. Linear relationships ( P < 0.05), expressed as g/kg DMI, between the apparent ileal and faecal digestible P and dietary levels of P, suggested that true P digestibility and the endogenous P outputs associated with brown rice feeding could be determined by using the simple regression analysis technique. There were no differences ( P>0.05) in true P digestibility values (57.7 ± 5.4 v. 58.2 ± 5.9%), phytate P degradability (76.4 ± 6.7 v. 79.0 ± 4.4%) and the endogenous P outputs (0.812 ± 0..096 v. 0.725 ± 0.083 g/kg DMI) between the ileal and the faecal levels. The endogenous faecal P output represented 14 and 25% of the National Research Council (1998) recommended daily total and available P requirements in the weanling pig, respectively. About 58% of the total P in brown rice could be digested and absorbed by the weanling pig. Our results suggest that the large intestine of the weanling pigs does not play a significant role in the digestion of P in brown rice. Diet formulation on the basis of total or apparent P digestibility with brown rice may lead to P overfeeding and excessive P excretion in pigs.

The evolution of stigmata of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study.

BACKGROUND AND STUDY AIMS: Stigmata of hemorrhage in bleeding peptic ulcers have prognostic characteristics. In the present study, the evolution of these stigmata was studied prospectively using daily endoscopic examinations. PATIENTS AND METHODS: From January 1989 to October 1989, 778 consecutive patients with bleeding peptic ulcers underwent endoscopy within 24 hours of admission. The bleeding peptic ulcers were assigned by three endoscopists to five categories, those with: a) active bleeding, b) a nonbleeding visible vessel, c) adherent clot, d) dot, or e) a clean base. Actively bleeding ulcers were treated by epinephrine injection. Ulcers with nonbleeding visible vessels, adherent clots, or dots were left untreated. Daily endoscopic examinations were carried out for three subsequent days, or until the ulcer base became clean. RESULTS: On day 0, there were 56 actively bleeding ulcers (7%), 62 ulcers with visible vessels (8%), 104 with adherent clots (13%), 182 with flat dots (23%), and 374 with a white base (48%). On the subsequent three days, 24 of 62 ulcers with visible vessels (39%), 30 of 104 with adherent clots (29%), 24 of 182 with dots (13%), and 19 of 374 with a clean base (5%) on day 0 re-bled endoscopically or clinically, or both. The overall rebleeding risk was 9.9%, 4.9%, and 2.7% on days 1, 2, and 3, respectively. CONCLUSIONS: Stigmata of hemorrhage in bleeding peptic ulcers are predictive of rebleeding. They represent intermediate phases in the evolution of bleeding vessels into clean-based ulcers. The associated rebleeding risk diminishes as the vessel disappears from the ulcer base.

Common bile duct stones become smaller after endoscopic biliary stenting.

BACKGROUND AND STUDY AIMS: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones that cannot be extracted at one session. We compared the sizes of the CBD stones after a period of stenting. PATIENTS AND METHODS: Over a 6-year period, a total of 444 patients with large CBD stones (> 2 cm diameter) or difficult CBD stones were managed in our endoscopy unit, of which 46 were treated by endoscopic stenting. Twenty-eight had second ERCP for stone removal after a median period of 63 days (range 17-1002 days). The largest diameter of the stones and the CBD (after correction of magnification) before and after stenting were compared using the Wilcoxon signed test. RESULTS: Before stenting the largest diameters of CBD stones were 11-46 mm (mean 24.9 mm) and decreased to 5-46 mm (mean 20.1 mm) after stenting. The difference in stone sizes was statistically significant although the CBD diameter pre- and post-stenting was not significantly different. The reduction in stone sizes was not significantly correlated with the duration of stenting. CONCLUSION: CBD stones became smaller after stenting. As the difficulty of stone extraction increases with stone size, a period of stenting may make subsequent removal easier for patients with large or difficult CBD stones.

Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative study of immune effects.

PURPOSE: Our aim was to test the hypothesis that laparoscopic-assisted resection for colorectal cancer has an immunologic advantage over traditional open surgery. METHODS: Sixteen patients with colorectal cancer were randomized to undergo laparoscopic-assisted resection or open surgery. Basic patient data were recorded, and serum interleukin-6 levels, relative proportions of lymphocytes, and human leukocyte antigen-DR expression on monocytes were determined at specific time intervals. RESULTS: Operating time was longer for laparoscopic-assisted resection (P=0.02), but analgesic requirements were less (P=0.04). All patients exhibited the following: interleukin-6 levels increased to a maximum at 4 hours and returned to preoperative levels within 48 hours. This response appeared greater for open resection (mean peak level, 313 vs. 173 pg/ml; P=0.25). Relative granulocytosis (P < 0.001) was seen within 48 hours, which was offset by a decrease in percentage of lymphocytes (P < 0.001). Changes in lymphocyte subfractions were most significant seven days postsurgery: natural killer cells decreased (P=0.003); T cells increased (P=0.008), with elevation in the CD4/CD8 ratio (P=0.003). B cells were largely unchanged at all time periods. Human leukocyte antigen-DR expression on monocytes was significantly less at 48 hours postsurgery (P < 0.001). All changes were reversed within three weeks of surgery. There were no differences when comparing laparoscopic-assisted resection with open surgery. CONCLUSIONS: Both laparoscopic-assisted resection and open surgery affect the immune response. It would appear that laparoscopic-assisted resection does not have an immunologic advantage over open surgery in patients with colorectal cancer.

Planning criteria for multicentre, multilingual telemedicine conferences.

The international telemedicine conference Chinese TeleMed 96 was held in November 1996. This three-way teleconference included delegates in London (where the international telemedicine conference TeleMed 96 was taking place) and medical staff from one Beijing hospital and one Hong Kong medical faculty. In total, over 1000 health-care personnel across eight time-zones participated. The event demonstrated that the quality of teleconferencing technology was suitable for medical teaching, for providing medical consultations to remote locations and for stimulating medical exchanges. In general, planning a telemedicine conference requires a longer lead time, a wider representation of expertise in the organizing committee and more financial resources than conventional conferences. It is recommended that the aim and format of a telemedicine conference be determined at least one year before the target date. Criteria for improving the preparation of such conferences have been identified and a set of guidelines for future conference organizers has been drawn up.

Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres.

PURPOSE: To evaluate the efficacy of intraarterial 90yttrium (90Y) microspheres in nonresectable hepatocellular carcinoma (HCC). METHODS AND MATERIALS: Patients with nonresectable HCC, but without extrahepatic disease, who also had lung shunting < 15% and tumor-to-normal ratio > or =2, as determined by simulation using (99m)technetium macroaggregated albumin, were entered into the study. The radiation dose delivered to the lungs, tumor, and normal liver was estimated by a partition model. 90Y microspheres were infused into the hepatic artery at the time of hepatic angiography or through an implanted arterial portacatheter under fluoroscopy. Repeated treatments were given for residual or recurrent tumor. Response to treatment was monitored by serum alpha-fetoprotein or ferritin levels, together with serial computed tomography. RESULTS: Seventy-one patients, including 20 patients with postoperative recurrence, were initially treated with an activity of 0.8 to 5.0 Giga-Becquerel (GBq) (21.6-135.1 mCi) (median 3.0 GBq or 81.1 mCi) of 90Y microspheres. There was a 50% reduction in tumor volume in 19 (26.7%) patients after the first treatment. However, the overall objective response in terms of changes in alpha-fetoprotein levels was 89% [partial response (PR) 67%, complete response (CR) 22%] among the 46 patients with raised pretreatment levels. The serum ferritin level in the other 25 patients dropped by 34 to 99% after treatment. Treatment was repeated in 15 patients. The maximum number of treatments was 5 and the maximum total activity was 13.0 GBq (351.4 mCi), given in 3 treatments. The estimated radiation doses to the nontumorous liver ranged from 25 to 136 Gy (median 52 Gy) in the first treatment and the highest total radiation dose was estimated to be 324 Gy. For the tumors, the estimated radiation doses ranged from 83 to 748 Gy (median 225 Gy) in the initial treatment and the highest cumulative dose reached was 1580 Gy. The residual tumors were resected in 4 patients. Two of these had complete histological remission, but only occasional viable tumor cells were found in the necrotic centers of the tumors resected from the other 2 patients. The median survival of the 71 patients was 9.4 months (range 1.8 to 46.4 months). Treatment was well tolerated and there was no bone-marrow toxicity, or clinical evidence of radiation hepatitis or pneumonitis. CONCLUSIONS: Selective internal radiation therapy using 90Y microspheres is effective for selected cases of nonresectable HCC and is well tolerated. The objective response rate in terms of drop in tumor marker levels is higher than that based on reduction in tumor volume shown by computed tomography. The nontumorous liver appears more tolerant to internal radiation than external beam radiation. Selective internal radiation treatment may convert nonresectable tumors to resectable ones.

Laparoscopic resection of splenic artery aneurysm.

A new, lateral approach was used for the laparoscopic resection of splenic artery aneurysm. This approach was found to be convenient and straightforward.

System approach for a multicenter, multilingual international telemedicine conference.

Chinese Telemed 96, a three way international telemedicine conference was successfully held in November 1996. Over 1,000 physicians, allied health professional and medical students participated in this conference in Beijing, Hong Kong and London. This program demonstrated that the quality of telecommunication technology was suitable for the Chinese University of Hong Kong, Faculty of Medicine to use it in facilitating medical consultations and sharing expertise among widely dispersed colleagues. The consensus of Hong Kong participants was that the audiovideo and telecommunication technology used in this conference were adequate. In order to improve overall quality, however, a better co-ordination of the technical support across sites is required. Other felt that the conference suffers from the shortage of highly trained technical staff required to support the communication system. However, following the total evaluation of this conference, it is concluded that while technical support, site and location are important factors in a good telemedicine conference, a well run telemedicine conference is more dependent on a sound planning process and its execution.

Laser therapy for multiple biliary papillomatosis via choledochoscopy.

BACKGROUND: Multiple biliary papillomatosis is a rare tumour of the biliary tract but is capable of multicentric malignant transformation. The complete removal of these tumours is difficult because it involves a field change of the biliary tract. METHODS: Exploration with choledochoscopy is a prerequisite for thorough assessment of the extent of involvement. Incorporation of laser ablation via a laser-delivering fibre with choledochoscopy permits complete removal of the tumour. RESULTS: Repeated laser therapy via choledochoscopy through the T-tube tract enables complete ablation of the tumour which changes the outlook of the prognosis. This is confirmed on subsequent cholangiography. CONCLUSIONS: Laser therapy via choledochoscopy is a satisfactory mode of treatment for multiple biliary papillomatosis. It enables complete and precise ablation of the tumour which certainly changes the prognosis of this condition.