Lactational performance and nutrients digestibility response of dairy buffaloes fed diets supplemented with probiotic (Streptococcus spp.) and fibrolytic enzymes.

The current study was conducted to explore the productive performance and health status of lactating buffaloes fed diets supplemented with probiotic and/or fibrolytic enzymes. Forty multiparous lactating Egyptian buffaloes (body weight 451 ± 8.5 kg) were equally assigned to four experimental groups: (1) the first group fed control diet, (2) second experimental group fed control diet plus 4 g of probiotic/kg dry matter (DM) (probiotic), (3) third experimental group fed control diet plus 4 g of fibrolytic enzymes/kg DM (enzymes) and (4) fourth experimental group fed control diet plus 2 g of probiotic + 2 g fibrolytic enzymes/kg DM (Mix), The experiment was extended for 63 days. Nutrients digestibility was estimated, daily milk yield was recorded and milk samples were analyzed for total solids, fat protein, lactose and ash. Blood serum samples were analyzed for glucose, total protein, albumin, urea-N, aspartate transaminase, alanine transaminase and cholesterol concentrations. Results showed that adding probiotic and/or fibrolytic enzymes improved nutrients digestibility (p < 0.05). The probiotic, enzymes and mix groups did not affect (p > 0.05) concentrations of serum total protein, albumin (A), globulin (G), albumin/globulin (A/G) ratio and urea-N concentrations. An improvement in daily milk yield (p < 0.0001) and energy-corrected milk (p = 0.0146) were observed with the probiotic and mix groups compared with the control. In conclusion, this study suggests that supplementing lactating buffaloes' diets with probiotic alone or in combination with fibrolytic enzymes would improve their productive performance without adversely impacting their health.

Impact of Alpinia galanga and zinc on semen quality and some reproductive hormone constituents in California rabbit bucks.

The objective of the current study was to investigate the influence of synergism of the dry powder of Alpinia galanga rhizomes (AGR) and/or zinc sulfate in the diet on semen quality and reproductive traits of California rabbit bucks. The study was conducted in two stages. First stage: appreciation of semen characteristics, 36 California rabbit bucks (aged 5 months) with average body weights of 2980 g were divided randomly into six treatments (six individuals each). The treatment groups were: first group, control fed basal diet (C); second group, fed basal diet plus 1 g AGR/kg dry matter (DM) (AGR1); third group, fed basal diet plus 2 g AGR/kg DM (AGR2); fourth group, fed basal diet plus 200 mg Zn/litre drinking water (Zn); fifth group, fed basal diet plus 1 g AGR/kg DM and 200 mg Zn/litre drinking water (AGR1 + Zn); sixth group, fed basal diet plus 2 g AGR/kg DM and 200 mg Zn/litre drinking water (AGR2 + Zn). Second stage: the previous bucks were used to determine the efficiency of semen on reproductive fertility traits, 48 mature does (aged 6 months, nulliparous) with an average body weight of 3050 ± 20.7 g were divided randomly into six treatments and inseminated with previous groups of treated bucks. The results of the first stage, recorded high activity on gonadotropins hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH), free testosterone (FT), progesterone (P4) and oestrogen (E217ß) concentrations for AGR1 + Zn and AGR2 + Zn compared with the control group. Groups AGR1, AGR2, AGR1 + Zn and AGR2 + Zn had significantly lowered concentrations of triglycerides, total cholesterol, low-density lipoprotein, and malondialdehyde (MDA), whereas high-density lipoprotein and total antioxidant capacity (TAC) were increased significantly compared with the control group. The group supplemented with AGR with or without Zn had significantly improved ejaculate volume, advanced motility, sperm concentration, and cell integrity. Fertility rate and litter size were improved in all groups compared with the control. It was concluded that supplementing diets with Alpinia galanga and Zn significantly increased sperm percentage, motility and reproductive hormones (testosterone, FSH, LH, E217ß, P4). This suggested that this plant when used may be favourable for improved sperm quality and fertility parameters.

Oil-in-Water Nanoemulsion Can Modulate the Fermentation, Fatty Acid Accumulation, and the Microbial Population in Rumen Batch Cultures.

In this study, three oil-in-water nanoemulsions were tested in two stages: In the first stage, three levels (on the substrate dry matter (DM)), namely 3%, 6%, and 9%, of three different oils, olive oil (OO), corn oil (CO), and linseed oil (LO), in raw and nanoemulsified (N) forms were used separately in three consecutive rumen batch cultures trials. The second stage, which was based on the first stage's results, consisted of a batch culture trial that compared the raw and nanoemulsified (N) forms of all three oils together, provided at 3% of the DM. In the first stage, NOO, NCO, and NLO preserved higher unsaturated fatty acid (UFA) and less saturated fatty acid (SFA) compared to OO, CO, and LO, respectively; noticeably, NCO had UFA:SFA = 1.01, 1.16, and 1.34 compared to CO, which had UFA:SFA = 0.66, 0.69, and 0.72 when supplemented at 3%, 6%, 9% of DM, respectively. In the second stage, UFA:SFA = 1.04, 1.12, and 1.07 for NOO, NCO, NLO, as compared to UFA:SFA = 0.69, 0.68, and 0.72 for OO, CO, and LO supplemented at 3% of DM. In conclusion, oil-in-water nanoemulsions showed an ability to decrease the transformation of UFA to SFA in the biohydrogenation environment without affecting the rumen microorganisms.

Lactating buffalos' productive performance, ruminal kinetics, nutrients digestibility and oxidative status as response to supplementing diets with alpinia galanga.

The current study investigated the effect of adding different doses of galangal rhizome powder (Alpinia galanga) to the diets of lactating buffaloes on milk production, composition and in vitro ruminal fermentation kinetics. Twenty buffaloes were divided into four groups: (T1) a control diet comprising of concentrates, corn silage and rice straw at 50: 35: 15 on a DM basis, (T2) a control diet plus 15 g of galangal/animal/day and (T3) a control diet plus 30 g of galangal/animal/day and (T4) a control diet plus 45 g of galangal/animal/day. Results showed that inclusion of galangal in diets decreased (p < 0.05) the concentrations of butyrate, ammonia-nitrogen, CO2, and total protozoa count as compared with T1. Acetate concentration was lower in T4 as compared with other groups (p < 0.05). While propionate concentration was lower (p < 0.05) in T2 as compared with T1. T3 and T4 lowered (p < 0.05) methane, CO2 productions, and protozoa count. T3 increased (p < 0.05) milk yield, energy corrected milk (ECM), yield of total solids, total protein, and solids not fat (SNF) than recorded for T1. While T4 recorded the lowest values (p < 0.05) of milk yield, ECM, total solids, fat, and total protein. The current results support the hypothesis that the inclusion of galangal in lactating buffaloes' diets at 30 g per animal daily improved feed intake and milk yield.

Ovarian activity and antioxidant indices during estrous cycle of Barki ewes under effect of thyme, celery and salinomycin as feed additives.

This research aimed to examine the effects of thyme, celery and salinomycin on ovarian sex hormones, reproductive traits and antioxidant status during the estrous cycle. Seventy-five mature Barki ewes aged 2-3 years with an average weight of 40 ± 1.5 kg were assigned randomly into five groups (15 head/group). Group 1 was kept as the control; groups 2 and 3 received 20 g/head/day thyme (T) and celery (C) as dried herbs, respectively. Group 4 (T×C) received 10 g thyme + 10 g celery/head/day, and group 5 was treated with salinomycin 1 g/head/day. Blood samples were collected during follicular and luteal phases of the estrous cycle. Thyme and celery and the mixture of T×C increased (P < 0.01) estradiol-17ß (E2) during the follicular phase of the estrous cycle, while only the celery group showed a marked (P < 0.001) increase in progesterone (P4) during the luteal phase compared with the control. Salinomycin supplementation decreased (P < 0.05) E2 concentrations during the follicular and luteal phases of the estrous cycle. Supplementation with thyme and celery enhanced (P < 0.001) antioxidant capacity in the luteal phase compared with the follicular stage. The salinomycin group showed increased (P < 0.01) levels of reduced glutathione (GSH) and decreased malondialdehyde (MDA) levels compared with the control group throughout luteal phase. For the interaction between estrous phases and treatments, thyme, celery, and T×C supplementation revealed an increase (P < 0.05) in superoxide dismutase (SOD), GSH, and glutathione disulfide (GSSG) levels compared with the control group during the follicular and luteal phases. Thyme and celery supplementation improved the number of services per conception and fertilization from 1st and 2nd inseminations, respectively. In conclusion, the applied treatment had significant effects on reproductive performance and antioxidant status in ewes throughout the estrous cycle.

Feed utilization and lactational performance of Friesian cows fed beet tops silage treated with lactic acid bacteria as a replacement for corn silage.

Thirty multiparous lactating Friesian cows were used to study the effect of partial or complete replacement of corn silage with lactic acid bacteria (LAB), molasses and calcium carbonate ensiled sugar beet tops for 3 months in a complete randomized experimental design with repeated measures. A week after parturition, cows were grouped into three treatments of 10 cows each and fed a control treatment containing corn silage at 300 g/kg DM. In the other treated diets, 50% or 100% of the control corn silage was substituted with beet tops silage treated with LAB included at 150 g or 300 g per kg diet. Ensiling of beet tops with LAB decreased its contents of oxalic acid and neutral detergent and acid detergent fibers but increased its contents of non-structural carbohydrate and calcium. Without affecting daily milk production and feed efficiency, beet tops silage treated with LAB diets decreased (p < 0.05) feed intake, total ruminal volatile fatty acids, acetate and propionate concentrations, energy-corrected milk yield and concentrations of milk total solids, fat, protein and energy. In conclusion, beet tops silage treated with LAB can replace corn silage in diets of lactating cows. An inclusion rate of 15% of beet tops silage treated with LAB (replacing 50% of corn silage) in the diet was the most suitable level for lactating cows under the current experimental conditions.

Modelling incremental benefits on complications rates when targeting lower HbA1c levels in people with Type 2 diabetes and cardiovascular disease.

AIM: Glucose-lowering interventions in Type 2 diabetes mellitus have demonstrated reductions in microvascular complications and modest reductions in macrovascular complications. However, the degree to which targeting different HbA1c reductions might reduce risk is unclear. METHODS: Participant-level data for Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) participants with established cardiovascular disease were used in a Type 2 diabetes-specific simulation model to quantify the likely impact of different HbA1c decrements on complication rates. Ten-year micro- and macrovascular rates were estimated with HbA1c levels fixed at 86, 75, 64, 53 and 42 mmol/mol (10%, 9%, 8%, 7% and 6%) while holding other risk factors constant at their baseline levels. Cumulative relative risk reductions for each outcome were derived for each HbA1c decrement. RESULTS: Of 5717 participants studied, 72.0% were men and 74.2% White European, with a mean (sd) age of 66.2 (7.9) years, systolic blood pressure 134 (16.9) mmHg, LDL-cholesterol 2.3 (0.9) mmol/l, HDL-cholesterol 1.13 (0.3) mmol/l and median Type 2 diabetes duration 9.6 (5.1-15.6) years. Ten-year cumulative relative risk reductions for modelled HbA1c values of 75, 64, 53 and 42 mmol/mol, relative to 86 mmol/mol, were 4.6%, 9.3%, 15.1% and 20.2% for myocardial infarction; 6.0%, 12.8%, 19.6% and 25.8% for stroke; 14.4%, 26.6%, 37.1% and 46.4% for diabetes-related ulcer; 21.5%, 39.0%, 52.3% and 63.1% for amputation; and 13.6%, 25.4%, 36.0% and 44.7 for single-eye blindness. CONCLUSIONS: These simulated complication rates might help inform the degree to which complications might be reduced by targeting particular HbA1c reductions in Type 2 diabetes.

Design, Manufacturing, and Analysis of Periodic Three-Dimensional Cellular Materials for Energy Absorption Applications: A Critical Review.

Cellular materials offer industries the ability to close gaps in the material selection design space with properties not otherwise achievable by bulk, monolithic counterparts. Their superior specific strength, stiffness, and energy absorption, as well as their multi-functionality, makes them desirable for a wide range of applications. The objective of this paper is to compile and present a review of the open literature focusing on the energy absorption of periodic three-dimensional cellular materials. The review begins with the methodical cataloging of qualitative and quantitative elements from 100 papers in the available literature and then provides readers with a thorough overview of the state of this research field, discussing areas such as parent material(s), manufacturing methods, cell topologies, cross-section shapes for truss topologies, analysis methods, loading types, and test strain rates. Based on these collected data, areas of great and limited research are identified and future avenues of interest are suggested for the continued maturation and growth of this field, such as the development of a consistent naming and classification system for topologies; the creation of test standards considering additive manufacturing processes; further investigation of non-uniform and non-cylindrical struts on the performance of truss lattices; and further investigation into the performance of lattice materials under the impact of non-flat surfaces and projectiles. Finally, the numerical energy absorption (by mass and by volume) data of 76 papers are presented across multiple property selection charts, highlighting various materials, manufacturing methods, and topology groups. While there are noticeable differences at certain densities, the graphs show that the categorical differences within those groups have large overlap in terms of energy absorption performance and can be referenced to identify areas for further investigation and to help in the preliminary design process by researchers and industry professionals alike.

Crashworthiness of 3D Lattice Topologies under Dynamic Loading: A Comprehensive Study.

Periodic truss-based lattice materials, a particular subset of cellular solids that generally have superior specific properties as compared to monolithic materials, offer regularity and predictability that irregular foams do not. Significant advancements in alternative technologies-such as additive manufacturing-have allowed for the fabrication of these uniquely complex materials, thus boosting their research and development within industries and scientific communities. However, there have been limitations in the comparison of results for these materials between different studies reported in the literature due to differences in analysis approaches, parent materials, and boundary and initial conditions considered. Further hindering the comparison ability was that the literature generally only focused on one or a select few topologies. With a particular focus on the crashworthiness of lattice topologies, this paper presents a comprehensive study of the impact performance of 24 topologies under dynamic impact loading. Using steel alloy parent material (manufactured using Selective Laser Melting), a numerical study of the impact performance was conducted with 16 different impact energy-speed pairs. It was possible to observe the overarching trends in crashworthiness parameters, including plateau stress, densification strain, impact efficiency, and absorbed energy for a wide range of 3D lattice topologies at three relative densities. While there was no observed distinct division between the results of bending and stretching topologies, the presence of struts aligned in the impact direction did have a significant effect on the energy absorption efficiency of the lattice; topologies with struts aligned in that direction had lower efficiencies as compared to topologies without.

Effective Mechanical Properties of Periodic Cellular Solids with Generic Bravais Lattice Symmetry via Asymptotic Homogenization.

In this paper, the scope of discrete asymptotic homogenization employing voxel (cartesian) mesh discretization is expanded to estimate high fidelity effective properties of any periodic heterogeneous media with arbitrary Bravais's lattice symmetry, including those with non-orthogonal periodic bases. A framework was developed in Python with a proposed fast-nearest neighbour algorithm to accurately estimate the periodic boundary conditions of the discretized representative volume element of the lattice unit cell. Convergence studies are performed, and numerical errors caused by both voxel meshing and periodic boundary condition approximation processes are discussed in detail. It is found that the numerical error in periodicity approximation is cyclically dependent on the number of divisions performed during the meshing process and, thus, is minimized with a refined voxel mesh. Validation studies are performed by comparing the elastic properties of 2D hexagon lattices with orthogonal and non-orthogonal bases. The developed methodology was also applied to derive the effective properties of several lattice topologies, and variation of their anisotropic macroscopic properties with relative densities is presented as material selection charts.

CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA genes expression in colorectal cancer patients: novel diagnostic biomarkers.

OBJECTIVE: This study aimed to investigate the CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA mRNA expression in the blood of colorectal cancer patients in Egypt. This was performed to elucidate if there's a link between this gene expression and other clinicopathological characteristics of the tumor. PATIENTS AND METHODS: A case-control study including 50 colorectal cancer patients and 50 healthy controls was conducted. Real-time polymerase chain reaction (rt-PCR) was utilized to assess the expression of CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA mRNA in blood samples. RESULTS: Patients with colorectal cancer had significantly higher levels of mRNA for the genes CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA (p<0.001, p=0.021, p<0.001, and p<0.001, respectively) compared to controls. Remarkedly, the gene expression of AHR, TRIP13, and PIK3CA genes did not exhibit a significant correlation with the tumor stages (p=0.379, p=0.095, and p=0.526, respectively). However, there was a strong correlation between CYP24A1 and CPEB4 gene expression and tumor stages (p<0.001 and p=0.002, respectively). CONCLUSIONS: Therefore, we can conclude that increased mRNA levels of CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA in blood samples withdrawn from colorectal cancer patients could be a biomarker for the disease.

Elucidation of the role of α-lipoic acid and vitamin C in methotrexate-induced hepatoxicity in mice.

OBJECTIVE: Although methotrexate (MTX) is used to treat several malignancies and chronic inflammatory diseases, its clinical use is constrained because of its negative side effects, the most prevalent of which are hepatotoxicity and nephrotoxicity. So, this study aims to determine whether α-lipoic acid (ALA) and vitamin C can protect mice against the liver damage that methotrexate causes. MATERIALS AND METHODS: A total of 49 male mice were divided into seven groups at random. Group I received sodium bicarbonate, while groups II to VII received an intraperitoneal injection of MTX (20 mg/kg) on the tenth day, following ten days of pretreatment with ALA (60 mg/Kg), ALA (120 mg/Kg), vitamin C (100 mg/Kg), vitamin C (200 mg/Kg), ALA (60 mg/Kg), and vitamin C (100 mg/kg). RESULTS: When compared to mice in group I, mice in group II (the control group) had significantly higher levels of the enzymes malondialdehyde (MDA), alanine transaminase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) and significantly lower (p <0.05) levels of the enzymes superoxide dismutase (SOD) and glutathione (GSH). As compared to the control group, pretreatment groups with ALA and vitamin C showed a dose-dependent substantial rise (p <0.05) in GSH and SOD levels, a dose-dependent notable decrease (p <0.05) in MDA, ALT, ALP, and LDH levels, and better liver histological architecture. In order to increase the antioxidant capacity, pretreatment with ALA and vitamin C may be able to prevent MTX-induced hepatotoxicity. CONCLUSIONS: These results imply that ALA and vitamin C are useful in the treatment of MTX-induced liver damage.

A simple strategy for screening for glucose intolerance, using glycated haemoglobin, in individuals admitted with acute coronary syndrome.

Glucose intolerance is common but often remains undiagnosed and untreated in people with acute coronary syndrome. The best approach to screening for glucose intolerance post-acute coronary syndrome remains debated. The World Health Organization has recently advocated the use of HbA(1c) in diagnosing Type 2 diabetes. A screening strategy using HbA(1c) as the preferred test would be pragmatic and improve early detection and management of glucose intolerance in acute coronary care practice. In this commentary, we discuss the relevant literature and guidelines in this area and propose a simple and pragmatic algorithm based on the use of HbA(1c) to screen for glucose intolerance during and after admission with acute coronary syndrome.

Subsidence of Spinal Fusion Cages: A Systematic Review.

BACKGROUND: Although many research studies investigating subsidence of intervertebral fusion cages have been published, to our knowledge, no study has comprehensively compared cage subsidence among all lumbar intervertebral fusion (LIF) techniques. This study aimed to review the literature reporting evidence of cage subsidence linked to LIF. The amount of subsidence was compared and associated with the procedures and corresponding implants used, and the effect of cage subsidence on clinical outcomes was investigated. METHODS: For this systematic review, the MEDLINE and PubMed databases were used to identify relevant studies. Search terms included lumbar, lumbar vertebrae, lumbar spine, cage, spinal fusion, prosthesis, prosthesis implantation, implantation, implants, interbody, spacer, and subsidence. Studies included in this review were those having more than 10 patients and reporting the amount of subsidence observed using computed tomography or x-ray imaging after surgery and at follow-up visits after a minimum of 6 weeks postsurgery. Data and scale definitions related to subsidence were extracted from articles for comparison of subsidence prevalence between the 5 LIF surgical procedures. RESULTS: Forty articles were identified for inclusion. The review included data from 390 anterior lumbar intervertebral fusions (ALIFs), 2130 lateral lumbar intervertebral fusions (LLIFs), 560 posterior lumbar intervertebral fusions (PLIFs), 245 oblique lumbar intervertebral fusions (OLIFs), and 1634 transverse lumbar intervertebral fusions (TLIFs) for a total of 4959 patients who underwent LIF surgery. The minimum and maximum percentages of the number of patients having subsidence for each procedure in the included studies were as follows: ALIF stand-alone, 6% and 23.1%; LLIF stand-alone, 8.7% and 39.6%; LLIF with posterior fixation, 3.3% and 20.7%; OLIF with posterior fixation, 4.4% and 36.9%; PLIF with posterior fixation, 7.4% and 31.8%; and TLIF, 0.0% and 51.2%. CONCLUSIONS: The number of patients experiencing subsidence varied between studies within each fusion procedure. Our findings indicate that all 5 surgical methods are at risk of subsidence. Overall, ALIF without posterior fixation resulted in the lowest reported subsidence occurrence among the 5 surgical approaches. There is conflicting evidence on the association between subsidence and negative clinical outcomes. CLINICAL RELEVANCE: This review defines and compares subsidence incidence between all LIF procedures and investigates the risk of symptomatic clinical outcomes.

Feeding Corn Oil in a Nanoemulsified Form Alters the Unsaturated Fatty Acids in the Milk of Zaraibi Dairy Goats.

Oil in water nanoemulsion represents a new and unstudied form of oil supplementation to the ruminant diet; that is why the aim was to evaluate the potential of nanoemulsified corn oil in dairy goats' diets on milk productivity and fatty acid proportion. Twenty-four lactating Zaraibi goats in early lactation were randomly allocated to the following treatments: control-a basal diet without any supplementation, CO-the control diet + corn oil supplied at 3% on a dry matter basis (DM), NCO-the control diet + nanoemulsified corn oil provided at 3% on a DM basis. A completely randomized design that lasted 30 days (25 days of adaptation + 5 days of sampling) was used with eight goats in each treatment. The control diet consisted of 50% concentrate and 50% Egyptian berseem clover. The NCO increased the milk production, fat percentage, and yield compared to the CO and the control. The proportions of oleic, linoleic, and linolenic acids were higher in the NCO compared to the control and CO. The NCO had less effect on the biohydrogenation intermediates' profile than the CO; noticeably, higher proportions of unsaturated fatty acid (UFA) were associated with the NCO. In conclusion, the NCO increased milk production and decreased the transformation rate of UFA to saturated fatty acids in the biohydrogenation environment.

Effect of Cellulase Enzyme Produced from Penicilliumchrysogenum on the Milk Production, Composition, Amino Acid, and Fatty Acid Profiles of Egyptian Buffaloes Fed a High-Forage Diet.

The experiment was conducted to study the effects of supplementing a cellulase enzymes cocktail to lactating buffaloes' diet, on the nutrient intake, nutrient digestibility, and milk production performance and composition. Twenty-four lactating Egyptian buffaloes were assigned into one of the following treatments: CON-control consisted of a total mixed ration, CENZ-the total mixed ration supplemented by a commercial source of cellulase enzyme, FENZ-the total mixed ration supplemented with cellulase enzyme cocktail produced in-farm. Supplementing the diet with the in-farm source of cellulase (FENZ) had a significantly higher impact on crude protein, neutral detergent fiber, and acid detergent fiber digestibility. However, FENZ tended to increase the EE digestibility compared to CENZ. FENZ showed significantly higher nutrient digestibility percentages compared to other groups. Supplementing the diet with cellulase enzymes (CON vs. ENZ) significantly increased the daily milk yield and the fat correct milk yield; both yields were significantly higher with FENZ than all groups. Oleic, linoleic, and linolenic acid concentration were significantly higher with cellulase enzymes supplementation (CON vs. ENZ) and the conjugated linoleic acid concentration. Supplementing fungal cellulase enzyme produced on a farm-scale has improved milk productivity, fat yield, and milk fat unsaturated fatty acids profile in lactating buffaloes.

The potential impact of using glycated haemoglobin as the preferred diagnostic tool for detecting Type 2 diabetes mellitus.

AIMS: There are calls to simplify the diagnosis of Type 2 diabetes mellitus (T2DM) to reduce the burden of undiagnosed disease. Glycated haemoglobin (HbA(1c)) is therefore being considered as a preferred diagnostic tool to replace the need for an oral glucose tolerance test (OGTT), considered by many as cumbersome and inconvenient. The aim of this study was to examine the potential impact of the preferred use of HbA(1c) as a diagnostic tool on the prevalence and phenotype of T2DM. METHODS: Analysis of the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort for previously undiagnosed individuals between 40 and 75 years of age who had OGTT, repeated if within the diabetes range, and HbA(1c) results. We compared the prevalence and phenotype of subjects with T2DM based on either HbA(1c)> or =6.5% or OGTT using 1999 World Health Organization criteria. RESULTS: From the total population of 8696, we detected 291 (3.3%) with T2DM from using an OGTT, and 502 (5.8%) had HbA(1c)> or =6.5%. Of those diagnosed with T2DM by OGTT, 93 (1.2%) had HbA(1c) <6.5% and therefore would not have been classified as having T2DM using proposed criteria. Using HbA(1c) criteria resulted in 304 (3.5%) additional cases of T2DM, approximately doubling the prevalence. Of these 304 additional people, 172 (56.7%) had impaired glucose tolerance/impaired fasting glycaemia according to 1999 World Health Organization criteria. Using HbA(1c) criteria there was an increase of 2.2- and 1.4-fold in south Asians and white Europeans detected, respectively. CONCLUSIONS: Within this multi-ethnic cohort, we found that introducing HbA(1c)> or =6.5% as the preferred diagnostic test to diagnose T2DM significantly increased numbers detected with T2DM; however, some people were no longer detected as having T2DM.

Foreign body granulomas in normal ovaries.

In 100 consecutive cases in which grossly normal ovaries were removed at the time of pelvic surgery, 9% were found to contain crystalline foreign particles. An additional 9% contained cortical granulomas. In four of six cases, computer-assisted x-ray analysis of the crystalline foreign particles was successful and revealed magnesium and silicon.

Effect of oral contraception on serum bile acid.

Eighteen normal women, 20 with active urinary schistosomiasis, and 25 with past histories of viral hepatitis were given a contraceptive pill containing 0.05 mg ethinyl estradiol and 0.5 mg levonorgestrel for six consecutive cycles. Serum bile acid levels were measured by enzyme immunoassay method before and after 3 and 6 months of use. Simultaneously, conventional liver function tests (serum bilirubin, transaminases, alkaline phosphatase and albumin) were done. Serum bile acid concentration was not significantly changed by the contraceptive use in any group. The concentration of cholylglycine (the main bile acid measured) did not correlate with the values of any of the other tests. Pretreatment values of serum cholylglycine were significantly lower in the past-hepatitis group. The difference was maintained during treatment.

PIP: 18 normal women, 20 with active schistosomiasis, and 25 with past histories of viral hepatitis were given a contraceptive pill containing 0.05 mg ethinyl estradiol and 0.5 mg levonorgestrel for 6 consecutive cycles. Serum bile acids were measured by enzyme immunoassay method before and after 3 and 6 months of use. Simultaneously, conventional liver function tests (serum bilirubin, transaminases, alkaline phosphatase, and albumin) were done. Serum bile acid concentration was not significantly changed by contraceptive use in any group. The concentration of cholylglycine (the main bile acid measured) did not correlate with the values of any of the other tests. Pretreatment values of serum cholylglycine were significantly lower in the past-hepatitis group. The difference was maintained during treatment.

Diagnostic performance of using one- or two-HbA1c cut-point strategies to detect undiagnosed type 2 diabetes and impaired glucose regulation within a multi-ethnic population.

INTRODUCTION: We compared test performance and cost per case for strategies detecting diabetes on the oral glucose tolerance test (OGTT) using either (a) glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol) or (b) two HbA1c thresholds where the first cut-point 'rules out' and the second 'rules in' diabetes. HbA1c values in between the thresholds require confirmatory glucose testing for diagnosis. MATERIALS AND METHODS: We conducted an analysis of adults aged 40-75 years from the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort (Leicester, UK), from 2002 to 2008, who underwent oral glucose tolerance testing (OGTT) and HbA1c testing. RESULTS: From 8696 individuals (mean age 57.3 years, 73% white Europeans (WE) and 27% South Asians (SA)), HbA1c ≥ 6.5% produced sensitivity of 62.1% for detecting diabetes in WE and 78.9% in SA. Using two selected thresholds, HbA1c ≤ 5.8% (rule-in, 40 mmol/mol) and HbA1c ≥ 6.8% (rule-out, 51 mmol/mol) produced high sensitivity/specificity (> 91.0%) for detecting diabetes, however, 28.8% of the cohort with HbA1c 5.9%-6.7% required a subsequent glucose test. The two cut-point threshold produced a lower cost per case of diabetes detected in WE, compared to HbA1c ≥ 6.5% of £38.53 (1.89 to 86.81) per case, but was more expensive in SA by £84.50 (69.72 to 100.92) per case. Using a risk score to determine HbA1c testing, the same costs per case became £63.33 (23.33 to 113.26) in WE and £69.21 (55.60 to 82.41) in SA. CONCLUSION: Using a two-threshold strategy may have some benefits over a single cut-point; however, 28.8% of individuals required two blood tests.