Effects of slow- v. fast-digested protein supplementation combined with mixed power training on muscle function and functional capacities in older men.

Ageing leads to a progressive loss of muscle function (MF) and quality (MQ: muscle strength (MS)/lean muscle mass (LM)). Power training and protein (PROT) supplementation have been proposed as efficient interventions to improve MF and MQ. Discrepancies between results appear to be mainly related to the type and/or dose of proteins used. The present study aimed at determining whether or not mixed power training (MPT) combined with fast-digested PROT (F-PROT) leads to greater improvements in MF and MQ in elderly men than MPT combined with slow-digested PROT (S-PROT) or MPT alone. Sixty elderly men (age 69 (sd 7) years; BMI 18-30 kg/m2) were randomised into three groups: (1) placebo + MPT (PLA; n 19); (2) F-PROT + MPT (n 21) and (3) S-PROT + MPT (n 20) completed the intervention. LM, handgrip and knee extensor MS and MQ, functional capacity, serum metabolic markers, skeletal muscle characteristics, dietary intake and total energy expenditure were measured. The interventions consisted in 12 weeks of MPT (3 times/week; 1 h/session) combined with a supplement (30 g:10 g per meal) of F-PROT (whey) or S-PROT (casein) or a placebo. No difference was observed among groups for age, BMI, number of steps and dietary intake pre- and post-intervention. All groups improved significantly their LM, lower limb MS/MQ, functional capacity, muscle characteristics and serum parameters following the MPT. Importantly, no difference between groups was observed following the MPT. Altogether, adding 30 g PROT/d to MPT, regardless of the type, does not provide additional benefits to MPT alone in older men ingesting an adequate (i.e. above RDA) amount of protein per d.

Differences in muscle adaptation to a 12-week mixed power training in elderly men, depending on usual protein intake.

INTRODUCTION: Normal aging is often associated with a decline of muscle mass (MM), strength (MS) and quality (MQ: MS/MM), leading to functional incapacities. This aging-related deterioration of muscles may involve a decreased protein intake. Mixed power training has been recently shown to induce positive effects on MM, MS and MQ. However, to our knowledge, no study has examined if muscle adaptations following mixed power training could be influenced by the daily amount of protein ingested in elderly men. METHODS: Twenty-one men completed the intervention and were divided into 2 groups based on their usual protein intake: PROT 1.1- (<1.1 g·kg-1·d-1 [n = 10; 73 ±â€¯3 years]) and PROT 1.2+ (>1.2 g·kg-1·d-1 [n = 11; 73 ±â€¯3 years]). Body composition (DXA: lean and fat masses), MS (1-maximal repetition on leg-press and handgrip strength), MQ (MS/body mass and MS/lower limb lean mass), functional capacities (Short Physical Performance Battery/Senior Fitness Test), dietary intake (3-day food record) and energy expenditure (accelerometer; 7 days) were measured. Mixed power training intervention consisted in power and functional exercises (12 weeks; 3 times/week; 1 h/session). RESULTS: Lower limb MS increase in the PROT 1.2+ group was greater from that of the PROT 1.1- group when normalized to lower limbs lean mass (p = 0.036). In addition, a trend for greater gain in lower limb MS normalized to body mass (p = 0.053) was observed in the PROT 1.2+. CONCLUSION: To optimize mixed power training effects on muscle function, healthy older men should ingest daily at least 1.2 g·kg-1·d-1 of protein. These beneficial effects of a higher usual protein intake were observed especially for MQ, which is one of the best predictors of functional capacities in older adults.

Nano-silver in drinking water and drinking water sources: stability and influences on disinfection by-product formation.

Nano-silver is increasingly used in consumer products from washing machines and refrigerators to devices marketed for the disinfection of drinking water or recreational water. The nano-silver in these products may be released, ending up in surface water bodies which may be used as drinking water sources. Little information is available about the stability of the nano-silver in sources of drinking water, its fate during drinking water disinfection processes, and its interaction with disinfection agents and disinfection by-products (DBPs). This study aims to investigate the stability of nano-silver in drinking water sources and in the finished drinking water when chlorine and chloramines are used for disinfection and to observe changes in the composition of DBPs formed when nano-silver is present in the source water. A dispersion of nano-silver particles (10 nm; PVP-coated) was used to spike untreated Ottawa River water, treated Ottawa River water, organic-free water, and a groundwater at concentrations of 5 mg/L. The diluted dispersions were kept under stirred and non-stirred conditions for up to 9 months and analyzed weekly using UV absorption to assess the stability of the nano-silver particles. In a separate experiment, Ottawa River water containing nano-silver particles (at 0.1 and 1 mg/L concentration, respectively) was disinfected by adding sodium hypochlorite (a chlorinating agent) in sufficient amounts to maintain a free chlorine residual of approximately 0.4 mg/L after 24 h. The disinfected drinking water was then quenched with ascorbic acid and analyzed for 34 neutral DBPs (trihalomethanes, haloacetonitriles, haloacetaldehydes, 1,1 dichloro-2-propanone, 1,1,1 trichloro-2-propanone, chloropicrin, and cyanogen chloride). The results were compared to the profile of DBPs obtained under the same conditions in the absence of nano-silver and in the presence of an equivalent concentration of Ag(+) ions (as AgNO3). The stability of the nano-silver dispersions in untreated Ottawa River water, with a dissolved organic carbon concentration of 6 mg/L, was significantly higher than the stability of the nano-silver dispersions in distilled, organic-free water. Nano-silver particles suspended in the groundwater agglomerated and were quickly and quantitatively removed from the solution. Our data confirm previous observations that natural dissolved organic matter stabilizes nano-silver particles, while the high-ionic strength of groundwater appears to favor their agglomeration and precipitation. As expected, nano-silver was not stable in Ottawa River water through the chlorination process, but survived for many days when added to the Ottawa River water after treatment with chlorine or chloramines. Stirring appeared to have minimal effect on nano-silver stability in untreated and treated Ottawa River water. The profile of DBPs formed in the presence of nAg differed significantly from the profile of DBPs formed in the absence of nAg only at the 1 mg/L nAg concentration. The differences observed consisted mainly in reduced formation of some brominated DBPs and a small increase in the formation of cyanogen chloride. The reduced formation of brominated congeners may be explained by the decrease in available bromide due to the presence of Ag(+) ions. It should be noted that a concentration of 1 mg/L is significantly higher than nAg concentrations that would be expected to be present in surface waters, but these results could be significant for the disinfection of some wastewaters with comparably high nano-silver concentrations.

Relationship between different protein intake recommendations with muscle mass and muscle strength.

OBJECTIVE: The purpose of the present study was to examine the relationship between two different levels of protein intake (0.8 vs.1.2 g/kg body weight/day) with muscle mass and muscle strength. METHOD: Seventy-two postmenopausal women were recruited. Body composition (bioelectrical impedance analysis), muscle strength (dynamometer), energy metabolism (indirect calorimetry) and dietary intake (dietary journal) were measured. We divided the women into two groups. Women with a protein intake of ≥ 1.2 g/kg body weight/day were placed in the Protein ≥ 1.2 group (n = 35), whereas women with a protein intake of 0.8-1.19 g/kg body weight/day were categorized in the Protein 0.8-1.19 group (n = 32). RESULTS: No significant difference was observed between groups for age, height, skeletal muscle mass, resting energy expenditure, total energy expenditure, carbohydrate and lipid intake. Significant differences between groups were observed for body mass index (p < 0.001), fat mass (p < 0.001) and muscle strength (hand grip and knee extensors) (p < 0.001). More specifically, the Protein ≥ 1.2 group presented a higher muscle strength as well as a lower body mass index and fat mass compared to the Protein 0.8-1.19 group. In addition, the group with a protein intake of ≥ 1.2 g/kg body weight/day presented significantly higher energy intake (p = 0.002), and essential (p < 0.001) and non-essential (p < 0.001) amino acid intake. Interestingly, when muscle strength was adjusted for essential or non-essential amino acids, differences in muscle strength persisted. CONCLUSION: The present study indicates higher levels of muscle strength in postmenopausal women with a protein intake of ≥ 1.2 g/kg body weight/day compared to 0.8-1.19 g/kg body weight/day despite no differences in muscle mass.

Insular ischemic stroke: clinical presentation and outcome.

BACKGROUND: The insula is a small but complex structure located in the depth of the sylvian fissure, covered by the frontal, parietal and temporal operculum. Ischemic strokes limited to the insula are rare and have not been well studied. Our objective is to better define the clinical presentation and outcome of insular ischemic strokes (IIS). METHODS: We reviewed the institutional prospective, consecutive stroke database from two centers to identify patients with IIS seen between 2008 and 2010. We also searched the Medline database using the keywords insula(r), infarction and stroke to identify previously published IIS cases confirmed by MRI. Minimal extension to an adjacent operculum or subinsular area was accepted. Clinicoradiological correlation was performed by distinguishing IIS involving the anterior (AIC) or posterior insular cortex (PIC). We collected clinical, demographic and radiological data. The outcome was determined using the modified Rankin Scale (mRS). RESULTS: We identified 7 patients from our institutions and 16 previously published cases of IIS. Infarcts were limited to the AIC (n = 4) or the PIC (n = 12) or affected both (n = 7). The five most frequent symptoms were somatosensory deficits (n = 10), aphasia (n = 10), dysarthria (n = 10), a vestibular-like syndrome (n = 8) and motor deficits (n = 6). A significant correlation was found between involvement of the PIC and somatosensory manifestations (p = 0.04). No other statistically significant associations were found. IIS presentation resembled a partial anterior circulation infarct (n = 9), a lacunar infarct (n = 2) or a posterior circulation infarct (n = 2). However, most cases presented findings that did not fit with these classical patterns (n = 10). At the 6 month follow up, mRS was 0 in 8/23 (35%) patients, 1-2 in 7/23 (30%) and unknown in 8/23 (35%). CONCLUSIONS: IIS presentation is variable. Due to the confluence of functions in a restricted region, it results in multimodal deficits. It should be suspected when vestibular-like or motor but especially somatosensory, speech or language disturbances are combined in the same patient. The outcome of IIS is often favorable. Larger prospective studies are needed to better define the clinical presentation and outcome of IIS.

Effects of chromium propionate on growth, carcass traits, and pork quality of growing-finishing pigs.

An experiment was conducted to determine the effect of dietary Cr propionate (CrProp) on growth, carcass traits, and pork quality of crossbred finishing gilts. Dietary treatments were 0 or 200 ppb Cr (as CrProp; as-fed basis), and each treatment was replicated four times with five gilts per replicate pen. Gilts were fed diets containing 0.82% lysine from 73 to 80 kg BW and 0.64% lysine from 80 to 115 kg BW. At the end of the trial, carcass and pork quality data were collected from four gilts per replicate. Average daily gain, ADFI, and G:F were not affected (P = 0.76 to 0.96) by CrProp. Before delivery at the abattoir, shrink loss was determined after an 18-h fast (fasting shrink) and after hauling (shipping shrink) pigs for 2.66 h (209.2 km). Fasting, shipping, and overall shrink were not affected (P = 0.14 to 0.39) by CrProp. Carcass length was increased (P = 0.03) in pigs fed CrProp. Loin muscle area, 10th-rib backfat thickness, average backfat thickness, dressing percent, muscle score, fat-free lean, and percent lean were not affected (P = 0.18 to 0.95) by CrProp. Twenty-four-hour loin pH was increased (P = 0.10) in pigs fed CrProp, but 45-min loin and ham pH and 24-h ham pH were not affected (P = 0.39 to 0.83) by CrProp. Subjective (color, marbling, firmness, and wetness) and objective (Commission Internationale de l'Eclairage L*, a*, b*) assessments of the loin muscle (at the 10th-rib interface) were not affected (P = 0.62 to 0.99) by CrProp. Forty-eight-hour drip (P = 0.10) and 21-d purge loss (P = 0.01) were decreased in pigs fed CrProp, but cook and total loss (drip + cook loss) and shear force were not affected (P = 0.35 to 0.53) by CrProp. Plasma cortisol, glucose, and lactate concentrations were not affected (P = 0.28 to 0.97) by CrProp after transportation or during exsanguination. These data indicate that CrProp may improve some aspects of pork quality (loin pH, drip and purge loss) but not growth performance or carcass traits.

Effect of microbial phytase addition with or without the trace mineral premix in nursery, growing, and finishing pig diets.

Two experiments were conducted to determine the interactive effects of phytase with and without a trace mineral premix (TMP) in diets for nursery, growing, and finishing pigs on growth performance, bone responses, and tissue mineral concentrations. Pigs (initial and final BW of 5.5 and 111.6 kg [Exp. 1] or 5.4 and 22.6 kg [Exp. 2]) were allotted to treatments on the basis of BW with eight (Exp. 1) or six (Exp. 2) replications of six or seven pigs per replicate pen. Pigs were started on the diets the day of weaning (average of 18 d). In both experiments, the treatments were with or without 500 phytase units/kg of diet and with or without the TMP in a 2 x 2 factorial arrangement. The Ca and available P concentrations were decreased by 0.10% in diets with phytase. The nursery phase consisted of Phase I (7 d), Phase II (14 d), and Phase III (13 d) periods. In Exp. 1, 26 of 52 pigs fed the diet without the TMP and without phytase had severe skin lesions and decreased growth performance; therefore, pigs fed this diet were switched to the positive control diet. In Exp. 2, the treatment without the TMP and without phytase had 12 replications instead of six. At the end of Phase III, half these replications were switched to the positive control diet and half were switched to the diet without the TMP but with phytase. In Exp. 1 during Phases II and III and in the overall data, pigs fed the diet without the TMP had decreased ADG and ADFI, but the addition of phytase prevented these responses (phytase x TMP; P < 0.02). Growth performance was not affected by diet during the growing-finishing period. Coccygeal bone Zn and Na concentrations were decreased (P < 0.09) in pigs fed the diet without the TMP, and adding phytase increased (P < 0.03) Zn and Fe concentrations. In Exp. 2 during Phases I and II, pigs fed the diet without the TMP had decreased ADG, but the addition of phytase prevented this response (phytase x TMP; P < 0.10). Pigs fed the diet without the TMP had decreased (P < 0.10) ADG (Phase II and overall), ADFI (Phases II and III and in the overall data), and G:F (Phase III). Coccygeal bone Zn and Cu concentrations were decreased (P < 0.09) in pigs fed the diet without the TMP, and adding phytase increased (P < 0.03) Zn concentration in the bones. These data indicate that removing the TMP in diets for nursery pigs decreases growth performance and bone mineral content, and that phytase addition to the diet without the TMP prevented the decreased growth performance.

A regional evaluation of chromium tripicolinate supplementation of diets fed to reproducing sows.

A cooperative research study involving 353 litters was conducted at three stations to determine the effects of graded levels of supplemental Cr from chromium tripicolinate (CrPic) on reproductive performance of sows and preweaning performance of their pigs. Primiparous and multiparous sows were fed fortified corn-soybean meal diets with supplemental levels of 0, 200, 600, or 1,000 ppb Cr (as-fed basis). Each station used at least three of the supplemental Cr levels, with two of those levels being 0 and 200 ppb. Station effects were observed for sow gestation weight gain, lactation weight change, lactation feed intake, litter size at birth and weaning, and pig weight at birth and weaning (P = 0.001 to 0.087). Supplemental Cr increased the number of pigs born live per litter (9.49, 9.82, 10.94, and 10.07; quadratic, P = 0.05) and sow lactation weight change (-0.2, 0.8, -4.1, and -3.9 kg; linear, P = 0.01) but decreased individual birth weight of total pigs born (1.61, 1.57, 1.47, and 1.56 kg; quadratic, P = 0.10). Tissues were obtained from a subset of sows from one station after they had completed three parities on the study. The content of Cr in the adrenal gland (16.4, 20.0, 34.0, and 48.4 ppb), kidney (35.8, 56.4, 132.6, and 176.0 ppb), and liver (22.8, 37.4, 87.6, and 92.2 ppb) was increased linearly (P = 0.001 to 0.005) by increasing CrPic supplementation. The results suggest that the supplementation level that maximizes the biological response is above that currently allowed. Additionally, supplementation of Cr at 1,000 ppb (five times currently permitted supplementation levels) was not detrimental to sow performance, even when fed continuously for three parities. There may be merit to continued research to evaluate higher supplementation rates.

Effects of microbial phytase, low calcium and phosphorus, and removing the dietary trace mineral premix on carcass traits, pork quality, plasma metabolites, and tissue mineral content in growing-finishing pigs.

An experiment was conducted to determine the effects of phytase addition, reduced Ca and available P (aP), and removing the trace mineral premix (TMP) on growth performance, plasma metabolites, carcass traits, pork quality, and tissue mineral content in growing-finishing swine. One hundred twenty cross-bred pigs (initial and final BW of 22 and 109 kg, respectively) were allotted to five dietary treatments on the basis of weight within gender in a randomized complete block design. There were three replications of barrows and three replications of gilts, with four pigs per replicate pen. The dietary treatments were as follows: 1) corn-soybean meal (C-SBM), 2) C-SBM with reduced Ca and aP, 3) C-SBM with reduced Ca and aP plus 500 phytase units/kg of diet, 4) Diet 1 without the TMP, and 5) Diet 3 without the TMP. The Ca and aP were reduced by 0.10% in the low Ca and aP diets and the diets with added phytase. Daily gain, hot carcass weight, dressing percent, kilograms of carcass lean, bone ash percent, and bone strength were decreased (P = 0.10), but liver and kidney weight were increased (P = 0.10) in pigs fed diets with reduced Ca and aP; adding phytase reversed these responses (P = 0.10). The Commission Internationale de I'Eclairage L* was decreased (P = 0.09) in pigs fed the low Ca and aP diet plus phytase relative to those fed the control diet. Removing the TMP had no effect on overall growth performance, but it increased (P = 0.03) 10th-rib backfat thickness and fasting glucose and decreased (P = 0.03) carcass length and ham weight. Liver weight and liver weight as a percentage of final BW were not affected when phytase was added to the control diet, but removing the TMP increased liver weight and liver weight as a percentage of final BW; adding phytase reversed these responses (phytase x TMP, P = 0.06). Removing the TMP decreased (P = 0.08) Zn concentrations in the bone, muscle, and liver, and Cu and Fe concentrations in the bile but increased (P = 0.08) Mn concentrations in the bile and liver of pigs. The addition of phytase reversed the negative effects of the reduced Ca and aP diets. These data indicate that removing the TMP in diets for growing-finishing pigs has no negative effects on growth performance or pork quality, but it had negative effects on carcass traits and had variable effects on tissue mineral content.

Effect of mannan oligosaccharides on growth performance of weanling pigs.

Four experiments were conducted to evaluate the effects of mannan oligosaccharides (provided by Bio-Mos [BM], a product containing a minimum of 28% glucomannoprotein from S. cerevisiae) on growth performance of nursery pigs. Treatments were replicated with five to six pens of four to five pigs each. Initial BW ranged from 4.7 to 5.4 kg, and pigs were weaned at 16 to 20 d of age. Experiments 1, 2, and 4 consisted of Phase 1 (7 to 8 d), Phase 2 (12 to 14 d), and Phase 3 (7 to 8 d) periods, but Exp. 3 consisted only of Phase 1 (7 d) and 2 (14 d) periods. The diets for Phase 1, 2, and 3 contained 1.6, 1.5, and 1.1% Lys, respectively. The treatments in Exp. 1 were 0, 0.20, and 0.30% BM, which did not affect growth performance. The treatments in Exp. 2 were two levels of excess Zn (0 and 3,000 ppm) and three levels of BM (0, 0.20, and 0.30%) in a 2 x 3 factorial. Excess Zn increased (P < 0.08) ADG and ADFI in Phase 2 and 3 and overall. The 0.20% BM addition increased ADG (Phase 3 and overall) and ADFI (Phase 2 and overall) in the absence of excess Zn but did not affect or decreased these response variables in the presence of excess Zn (Zn x BM quadratic, P < 0.08). Experiment 3 was similar to Exp. 2, but the 0.30% BM addition was not used. Excess Zn decreased (P < 0.09) ADG in Phase 1 but increased (P < 0.09) ADG and ADFI in Phase 2. The BM decreased (P < 0.03) overall ADFI but increased Phase 2 and overall ADG and gain:feed (GF) in the absence of excess Zn but not in the presence of excess Zn (Zn x BM, P < 0.07). The BM decreased ADFI during Phase 2, but the decrease was greater in pigs fed excess Zn (Zn x BM, P < 0.07). Experiment 4 evaluated the interactive effects of the antibiotic (oxytetracycline and neomycin) and BM and of Zn and BM. Antibiotic (no excess Zn) increased (P < 0.01) ADG and ADFI in Phases 2 and 3 and overall. The BM addition decreased ADG and GF in Phase 2 when the antibiotic was not in the diet but increased ADG when the antibiotic was in the diet (antibiotic x BM, P < 0.05). Excess Zn increased (P < 0.07) ADG and ADFI during Phases 2 and 3 and overall. In Phase 2, the 0.20% BM decreased GF when excess Zn was not added to the diet but increased GF when Zn was included (Zn x BM, P < 0.03). Mannan oligosaccharides improved pig performance in some instances during Phase 2 when fed in combination with an antibiotic and no excess dietary Zn, but it had no effect or negative effects in the presence of excess Zn or in the absence of an antibiotic.

Effect of feather meal as a source of valine for lactating sows.

An experiment was conducted to evaluate feather meal as a source of Val in lactating sow diets. Sows (five farrowing groups; mean parity = 2.34) were allotted to one of two dietary treatments on the basis of ancestry, parity, and weight and date of d 110 of gestation. The treatment diets included 1) corn-soybean meal lactation diet (n = 40) or 2) corn-soybean meal lactation diet with 2.5% feather meal (n = 39). The diets were formulated on an equal Lys basis. All litters were adjusted to 10 pigs within 24 h after farrowing, and all sows weaned at least nine pigs. Sows were bled at 110 d of gestation and at weaning, and serum urea N was determined. Backfat thickness was determined ultrasonically at 110 d of gestation and at weaning. Serum urea N and backfat thickness at d 110 of gestation were used as covariates for serum urea N and backfat thickness at weaning, respectively. The litter response criteria (weaning weight, litter weight gain, and percentage survival) were not affected (P > .10) by feather meal. The sow response criteria (weaning weight, weight loss per day, weaning backfat thickness, change in backfat thickness, ADFI, and days to estrus) were not affected (P > .10) by feather meal. Sows fed feather meal had increased (P < .01) serum urea N and tended (P = .15) to have decreased sow weaning weight. Following the initial analysis of the data, the data set was split into two groups: 1) sows with litters gaining less than 2.17 kg/d (n = 19 and 20 for control and feather meal diets, respectively) and 2) sows with litters gaining more than 2.17 kg/d (n = 21 and 19 for control and feather meal diets, respectively). These two groups were analyzed separately. In sows with litters gaining less than 2.17 kg/d, the litter and sow criteria were not affected (P > .10) by treatment. In sows with litters gaining more than 2.17 kg/d, sow weaning weight was decreased (P < .04) and sow weight loss (P < .02) and serum urea N (P < .01) were increased in sows fed feather meal. Feather meal (as a source of Val) did not improve litter weight gain, but it increased serum urea N.

[Hypertrichosis and gingival hypertrophy regression in renal transplants following the substitution of cyclosporin by tacrolimus]. / Régression de l'hypertrichose et de l'hypertrophie gingivale chez des greffés rénaux suite à la substitution de la cyclosporine par le tacrolimus.

Gingival Hyperplasia (GH) and hypertrichosis (HT) are two sides effects associated with the usage of cyclosporine (CyA) but not with tacrolimus (FK 506). The aim of this study is to evaluate the efficacy and security of the conversion from CsA to FK 506 to treat those two complications. From August 1996 to May 1997, 15 patients (9 males, 6 females) aged from 23 to 63 years old (38 +/- 14, mean +/- SD) were switched from CsA to FK 506, 12 for GH, 2 for HT and one for combined presentation. FK 506 was first initiated at a dose of 0.15 mg/kg/day and then adjusted to a level target of 8 ng/ml. The conversion was done on an out patient basis at average 35 (5-83) months after transplantation. Patients were followed prospectively for 12 months. There was a significant reduction in GH in all patients within 3 months. Five out 13 patients had a complete resolution of GH within three months of conversion, 9/12 within 6 months and all by 12 months. HT resolved completely within 6 months. No rejection episode occurred and the serum creatinin remain stable over one year post conversion. Conversion from CsA to FK 506 is thus a safe and valid option to treat CsA induced GH and HT.

Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of perineal massage during pregnancy for the prevention of perineal trauma at birth. STUDY DESIGN: Pregnant women with (n = 493) and without (n = 1034) a previous vaginal birth from 5 hospitals in the province of Québec, Canada, participated in this single-blind, randomized, controlled trial. All participants received oral and written information on the prevention of perineal trauma. Women in the experimental groups were requested to perform a 10-minute perineal massage daily from the 34th or 35th week of pregnancy until delivery. RESULTS: Among participants without a previous vaginal birth, 24.3% (100/411) from the perineal massage group and 15.1% (63/417) from the control group were delivered vaginally with an intact perineum, for a 9.2% absolute difference (95% confidence interval 3.8%-14.6%). The incidence of delivery with an intact perineum increased with compliance with regular practice of perineal massage (chi2 for trend 13.2, P = 0.0003). Among women with a previous vaginal birth, 34.9% (82/235) and 32.4% (78/241) in the massage and control groups, respectively, were delivered with an intact perineum, for an absolute difference of 2.5% (95% confidence interval -6.0% to 11.0%). There were no differences between the groups in the frequency of sutured vulvar and vaginal tears, women's sense of control, and satisfaction with the delivery experience. CONCLUSION: Perineal massage is an effective approach to increasing the chance of delivery with an intact perineum for women with a first vaginal delivery but not for women with a previous vaginal birth.