Effects of surgical flow disruptions on surgeons' resources: a pilot study.

BACKGROUND: Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon's pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons' physiological resources. METHODS: Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. RESULTS: The results indicate that expert surgeons' mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p = .059) and at the end of procedures (p = .001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p = .041) and at the end (p = .026), than at the start and end of a short procedure. CONCLUSION: Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons' mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons' pool of resources.

The effect of protease and Bacillus licheniformis on nutritional value of pea, faba bean, yellow lupin and narrow-leaved lupin in broiler chicken diets.

1. This study investigated the nutritional value (digestibility of ileal crude protein and amino acids (AAs)) and the AMEN value of legumes (pea, faba bean, yellow lupin, and narrow-leaved lupin) with or without protease. 2. Two hundred, one-day-old, male Ross 308 broiler chickens were randomly allocated to ten groups. Each group received one of five different protein raw materials - either peas, faba beans, yellow lupins or narrow-leaved lupins, with or without protease produced from Bacillus licheniformis. The birds were kept in individual cages. Nutrient digestibility was calculated using the difference method. The total duration of the study was 23 d, and the study involved two phases - accommodation phase (d 1-18) and experimental phase (d 18-23). 3. The effect of protease on response traits was not consistent between the legumes. The enzyme increased the digestibility of some AAs in the pea (arginine, leucine, phenylalanine, histidine, tyrosine, alanine, and proline), faba bean (lysine, arginine, glycine, and asparagine), and yellow lupin diets (lysine, valine, and serine), but this effect was not observed in the narrow-leaved lupin diet. The change in AMEN values due to protease addition was only statistically significant for the pea diet (P < 0.05), whereas in the case of other legume species, the difference was insignificant (P > 0.05). 4. Exogenous protease increased the digestibility of AAs present in pea, faba bean, and yellow lupin seeds but not in narrow-leaved lupin diets. The AMEN value of peas increased with protease supplementation, but no effect of protease was found for the AMEN values of faba bean and both the lupin diets.

Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study.

BACKGROUND: This trial evaluated whether preoperative short-course radiotherapy and consolidation chemotherapy (CCT) were superior to chemoradiation in rectal cancers with clinical (c)T4 or fixed cT3. Previously, we reported early results showing no differences in the radical surgery rate (primary end point). In the short-course/CCT group, we observed lower acute toxicity of preoperative treatment and better overall survival (OS). We updated results to determine whether the benefit in OS was sustained and to evaluate late complications. PATIENTS AND METHODS: Patients with cT4 or fixed cT3 rectal cancer were randomized either to preoperative 5 × 5 Gy and three cycles of FOLFOX4 or to chemoradiation (50.4 Gy with bolus 5-Fu, leucovorin and oxaliplatin). RESULTS: Patients (N = 515) were eligible for analysis, 261 in the short-course/CCT group and 254 in the chemoradiation group. The median follow-up was 7.0 years. The difference in OS was insignificant [hazard ratio (HR) 0.90; 95% confidence interval (CI) 0.70-1.15; P = 0.38). However, the difference in early OS favouring short-course/CCT previously reported was observed again, being 9% at 3 years (95% CI 0.5% to 17%). This difference disappeared later; at 8 years OS was 49% in both groups. There was no difference in disease-free survival (HR 0.95; 95% CI 0.75-1.19; P = 0.65) at 8 years 43% versus 41% in the short-course/CCT group versus the chemoradiation group, respectively. The corresponding values for cumulative incidences of local failure and distant metastases did not differ and were HR = 1.08, 95% CI 0.70-1.23, P = 0.60, 35% versus 32% and HR = 1.10, 95% CI 0.68-1.23, P = 0.54, 36% versus 34%, respectively. The rate of late complications was similar (P = 0.66), grade 3+ being 11% versus 9% in the short-course/CCT group versus the chemoradiation group, respectively. CONCLUSION: The superiority of preoperative short-course/CCT over chemoradiation was not demonstrated. CLINICAL TRIAL NUMBER: The trial is registered as ClinicalTrials.gov number NCT00833131.

Influence of graded levels of meals from three lupin species on growth performance and nutrient digestibility in broiler chickens.

1. This study investigated the effect of different levels of seeds of lupin species (Lupinus angustifolius, Lupinus luteus and Lupinus albus) on broiler growth performance, nutrient digestibility and apparent metabolisable energy of poultry diets. 2. A control diet containing corn-soybean meal and test diets containing 50, 100, 150, 200 and 250 g/kg of three lupin species were fed to broiler chickens during a 35-day study period. There were 10 replicate cages of 8 broiler chickens per treatment. 3. Growth performance of the birds fed with yellow and white lupin diets was found to be similar to that of the birds in the control group. The use of narrow-leaved lupin seeds in the diet quadratically decreased the body weight gain of birds and increased feed conversion ratio during all the experimental periods (0-14, 15-35 and overall 0-35 days of age). 4. A significant interaction between lupin species and their inclusion levels for apparent metabolisable energy and apparent ileal digestibility of starch was observed, showing a negative effect of increasing levels of narrow-leaved lupin. Pearson correlation coefficients demonstrated that the presence of raffinose and non-starch polysaccharides is a key factor affecting the nutritive value of lupin, 5. Yellow and white lupins could be utilised as an alternative ingredient for soybean meal in the diet of broiler chickens without any adverse effects on growth performance. The narrow-leaved counterpart diet reduced broiler performance, and hence did not provide a satisfactory outcome.

Influence of graded inclusion of white lupin (Lupinus albus) meal on performance, nutrient digestibility and ileal viscosity of laying hens.

1. The aim of this study was to investigate the effect of white lupin (Lupinus albus) meal (WLM) addition on the intestinal viscosity, bird performance and nutrient utilisation of laying hens. 2. The experiment was conducted with 360 laying hens aged 21 weeks fed one of 6 treatments, including a corn-soybean meal control diet (CON) and 5 experimental diets containing 60, 120, 180, 240 and 300 g/kg WLM. 3. A linear increase in feed intake (p < 0.001) was observed with higher levels of WLM from 0 to 300 g/kg. Laying rate decreased quadratically (p < 0.05) and egg weight (at 6th, 12th and 18th weeks of the trial) decreased linearly with WLM inclusion from 0 to 300 g/kg. Birds fed 60 g/kg or more of WLM laid lighter eggs (p < 0.05) than CON hens. When 240 g/kg or more WLM was included into the diet, laying rate was affected negatively (p < 0.05). 4. As WLM increased from 0 to 300 g/kg, apparent metabolisable energy and pre-caecal digestibility of dry matter and crude protein decreased quadratically (p < 0.05). When 300 g/kg of WLM was used, there was a tendency (p < 0.1) to decrease pre-caecal starch digestibility. WLM dose exerted a quadratic effect (p < 0.05) on total sialic acid excretion. As WLM increased, the viscosity of ileal digesta linearly increased (p < 0.05). 5. In the 6th and 12th weeks of the experiment (p < 0.05), eggshell thickness decreased linearly when 240 g/kg of WLM was added. At the 6th, 12th and 18th weeks, a linear decrease in eggshell content was observed (p < 0.05) after WLM addition. 6. In conclusion, the graded inclusion of WLM into laying hens' diets resulted in depressed performance, AMEN and eggshell quality.

The effect of Lupinus albus seeds on digestibility, performance and gastrointestinal tract indices in pigs.

The effect of soya bean meal (SBM) substitution in the diet with white lupine (WL) seeds on performances and some parameters of the digestive tract of pigs were studied. The digestibility experiment was performed on 30 pigs using difference method combined with marker method, where one group was offered basal diet and in diet of experimental groups 25% of the basal diet was substituted with SBM or WL meal. The growth experiment was conducted on 48 pigs of approximately 20 kg body weight. The animals from the control group were fed with diet containing SBM, whereas in the experimental groups 50% or 100% of SBM was substituted with WL seeds. At the end of the experiment, eight pigs from each group were euthanized, and digesta and tissues were sampled. The apparent total tract digestibility of crude protein and dry matter was higher (p < 0.05), but crude fibre and ether extract were lower (p < 0.05) in the WL seeds than in SBM. Substituting 50% of SBM in the control diet with WL seeds did not affect significantly pig performance. Total substitution of SBM with WL seeds impacted negatively pigs growth and feed intake (p < 0.05), but it did not affect the length of villi and crypt depth. It also significantly increased ileum digesta viscosity and ammonia concentration in the ileum and caecum digesta. In the ileal digesta of animals offered WL seeds, an increased (p < 0.05) total bacterial and Enterobacteriaceae numbers were found, whereas reduced number of yeast and mould was found in the caecal digesta. The substitution of 50% SBM with WL seeds in the growing pig diet did not affect pigs' results, but the total substitution significantly decreased the performance of pigs and affected intestinal ecology.

Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study.

BACKGROUND: Improvements in local control are required when using preoperative chemoradiation for cT4 or advanced cT3 rectal cancer. There is therefore a need to explore more effective schedules. PATIENTS AND METHODS: Patients with fixed cT3 or cT4 cancer were randomized either to 5 × 5 Gy and three cycles of FOLFOX4 (group A) or to 50.4 Gy in 28 fractions combined with two 5-day cycles of bolus 5-Fu 325 mg/m(2)/day and leucovorin 20 mg/m(2)/day during the first and fifth week of irradiation along with five infusions of oxaliplatin 50 mg/m(2) once weekly (group B). The protocol was amended in 2012 to allow oxaliplatin to be then foregone in both groups. RESULTS: Of 541 entered patients, 515 were eligible for analysis; 261 in group A and 254 in group B. Preoperative treatment acute toxicity was lower in group A than group B, P = 0.006; any toxicity being, respectively, 75% versus 83%, grade III-IV 23% versus 21% and toxic deaths 1% versus 3%. R0 resection rates (primary end point) and pathological complete response rates in groups A and B were, respectively, 77% versus 71%, P = 0.07, and 16% versus 12%, P = 0.17. The median follow-up was 35 months. At 3 years, the rates of overall survival and disease-free survival in groups A and B were, respectively, 73% versus 65%, P = 0.046, and 53% versus 52%, P = 0.85, together with the cumulative incidence of local failure and distant metastases being, respectively, 22% versus 21%, P = 0.82, and 30% versus 27%, P = 0.26. Postoperative and late complications rates in group A and group B were, respectively, 29% versus 25%, P = 0.18, and 20% versus 22%, P = 0.54. CONCLUSIONS: No differences were observed in local efficacy between 5 × 5 Gy with consolidation chemotherapy and long-course chemoradiation. Nevertheless, an improved overall survival and lower acute toxicity favours the 5 × 5 Gy schedule with consolidation chemotherapy. CLINICAL TRIAL NUMBER: The trial is registered as ClinicalTrials.gov number NCT00833131.

TPM3 deletions cause a hypercontractile congenital muscle stiffness phenotype.

OBJECTIVE: Mutations in TPM3, encoding Tpm3.12, cause a clinically and histopathologically diverse group of myopathies characterized by muscle weakness. We report two patients with novel de novo Tpm3.12 single glutamic acid deletions at positions ΔE218 and ΔE224, resulting in a significant hypercontractile phenotype with congenital muscle stiffness, rather than weakness, and respiratory failure in one patient. METHODS: The effect of the Tpm3.12 deletions on the contractile properties in dissected patient myofibers was measured. We used quantitative in vitro motility assay to measure Ca(2+) sensitivity of thin filaments reconstituted with recombinant Tpm3.12 ΔE218 and ΔE224. RESULTS: Contractility studies on permeabilized myofibers demonstrated reduced maximal active tension from both patients with increased Ca(2+) sensitivity and altered cross-bridge cycling kinetics in ΔE224 fibers. In vitro motility studies showed a two-fold increase in Ca(2+) sensitivity of the fraction of filaments motile and the filament sliding velocity concentrations for both mutations. INTERPRETATION: These data indicate that Tpm3.12 deletions ΔE218 and ΔE224 result in increased Ca(2+) sensitivity of the troponin-tropomyosin complex, resulting in abnormally active interaction of the actin and myosin complex. Both mutations are located in the charged motifs of the actin-binding residues of tropomyosin 3, thus disrupting the electrostatic interactions that facilitate accurate tropomyosin binding with actin necessary to prevent the on-state. The mutations destabilize the off-state and result in excessively sensitized excitation-contraction coupling of the contractile apparatus. This work expands the phenotypic spectrum of TPM3-related disease and provides insights into the pathophysiological mechanisms of the actin-tropomyosin complex.

Effect of different doses of coated butyric acid on growth performance and energy utilization in broilers.

We recently applied four dietary treatments in experiments I and II to determine the effect of protected calcium butyrate (BP) on growth performance and nutrient digestibility in broiler chickens. A group of one-day-old male Ross 308 broiler chicks (total 960, 480 per trial) were used in the study. In experiment I, the basal diets were fed with protected BP inclusion (0.2, 0.3, or 0.4 g/kg of finished feed) (BP) or without (C). In experiment II, 4 different diets were tested: 1) basal diet with no supplementation (C), 2) basal diet supplemented with protected BP (0.3 g/kg) (BP), 3) basal diet supplemented with avilamycin (6 mg/kg, active substance) a common antibiotic growth promoter (AGP) (Av), and 4) basal diet supplemented with the combination of both avilaymicin and BP. In experiment I, considering the entire study period, the use of BP improved feed conversion ratio (P<0.05) irrespective of the dose. Apparent total tract crude fat digestibility and apparent metabolizable energy corrected for nitrogen (AMEN) were improved after BP supplementation (P<0.05). In experiment II, A or AB diets improved (P<0.05) body weight gain compared to the control treatment. The diets Av, BP, and AvB improved (P<0.05) feed conversion ratio compared to the control treatment. Birds from the treatment diet were characterized by having the thickest mucosa (P<0.05). On days 14, 35, and 42, the use of AB diets improved AMENcontent compared to the control treatment (P<0.05). The apparent ileal digestibility of amino acid data showed that Av or AvB treated birds were characterized by higher Asp, Glu, Cys, Gly, and Ala ileal digestibility than the control animals (P<0.05). The use of Av, BP, or AvB increased ileal digestibility of Thr, Ser, and Pro (P<0.05). There is an indication that BP, alone or in combination with avilamycin, improve the digestion and absorptive processes and consequently birds performance results.

Influence of graded inclusion of white lupin (Lupinus albus) meal on performance, nutrient digestibility and intestinal morphology of broiler chickens.

The aim of this study was to investigate the effect of white lupin (Lupinus albus) meal (WLM) addition on the intestinal viscosity, bird performance, nutrient utilisation and villi morphology of growing broiler chicks. The experiment was conducted with 480 broiler chicks divided into 6 dietary treatments, including a maize-soybean meal control diet (CON) and 5 experimental diets containing 100, 150, 200, 250 and 300 g/kg WLM. During the period from d 0 to 35, birds fed on 200 or higher WLM/kg were characterised by lower body weight gain and feed intake than CON. The use of 150 g of WLM/kg increased feed conversion ratio (FCR) compared to CON treatment. Apparent metabolisable energy corrected to zero N balance (AMEN) and apparent ileal digestibility of dry matter, ether extract, crude protein and starch, linearly decreased as WLM increased from 0 to 300 g/kg. There was a quadratic effect of WLM dose on sialic acid excretion. A strong negative linear correlation was found between the excretion of sialic acid and AMEN. The viscosity of ileal digesta was linearly increased as WLM increased. The effect of WLM dose on ileum villus height (VH) was linear, while that on ileum villus area (VA) was quadratic. Both parameters decreased as WLM increased from 0 to 300 g/kg. In conclusion, the use of over 150 g/kg of WLM in broiler diets depressed performance results. However, depression of nutrient utilisation was only observed when 250 or 300 g/kg of WLM was used.

Unbounded Violation of Quantum Steering Inequalities.

We construct steering inequalities that exhibit unbounded violation. The concept was to exploit the relationship between steering violation and the uncertainty relation. To this end, we apply mutually unbiased bases and anticommuting observables, known to exhibit the strongest uncertainty. In both cases, we are able to procure unbounded violations. Our approach is much more constructive and transparent than the operator space theory approach employed to obtain large violation of Bell inequalities. Importantly, using anticommuting observables we are able to obtain a dichotomic steering inequality with unbounded violation. Thus far, there is no analogous result for Bell inequalities. Interestingly, both the dichotomic inequality and one of our inequalities cannot be directly obtained from existing uncertainty relations, which strongly suggest the existence of an unknown kind of uncertainty relation.

Surgical site infections following short-term radiotherapy and total mesorectal excision: results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery.

BACKGROUND: Despite the findings of several randomized clinical studies, the role of gentamicin collagen implant (GCI) in rectal cancer surgery is unclear. Local pelvic application of GCI following preoperative radiotherapy and total mesorectal excision (TME) was evaluated to determine the risk of surgical site infections (SSI). METHODS: In this single-center trial, 176 patients with rectal cancer after preoperative, short-term radiotherapy (5 × 5 Gy) were randomized either to the study group in which GCI was used or in the control group without GCI. Prior to surgery and intraoperatively five patients were excluded from the study. The remaining 171 patients were analyzed; 86 were in the study group and 85 in the control group. RESULTS: There were no statistically significant differences in the overall rate of early postoperative complications between the study and control group: 25.6 and 34.1 % respectively; p = 0.245, relative risk (RR) 0.750 [95 % confidence interval (CI) 0.471-1.195]. The reoperation rate was similar in both groups: 12.8 versus 9.4 %; p = 0.628; RR 1.359; (95 % CI 0.575-3.212). The total rate of SSI and organ space SSI were 22.2 and 15.8 % without differences between the study and control group. In patients without anastomotic leakage, the risk of organ space SSI was significantly reduced in patients who received GCI: 2.6 versus 13.0 %; p = 0.018. CONCLUSIONS: Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage.

The effect of protease, amylase, and nonstarch polysaccharide-degrading enzyme supplementation on nutrient utilization and growth performance of broiler chickens fed corn-soybean meal-based diets.

A study was conducted to determine if amylase and protease addition would improve nutrient digestion during the first 2 wk of growth. The experimental treatments included a control corn-soybean meal-based diet and diets supplemented with either amylase or amylase plus protease. No effect of enzyme supplementation was observed on BW gain and feed conversion ratio. This was corroborated by similar ileal starch and protein digestibility values, which averaged 96.8, 96.8, and 96.9% and 83.9, 80.1, and 79.6%, respectively, for the control and for the amylase or amylase plus protease supplemented diets. Total tract digestibility of starch averaged 97.8, 97.7 and 97.7% for the 3 diets and was followed by a similar diet with AMEn values of 3,129, 3,129, and 3,106 kcal/kg. In another study, a 2(3) factorial arrangement of 8 dietary treatments was used to evaluate the effect of corn particle size (conventional or coarse vs. fine) and the addition of a nonstarch polysaccharide enzyme, amylase, or both on growth performance and nutrient utilization of broiler chickens from 1 to 21 d of age. Chickens fed a diet containing a conventionally ground corn (geometric mean diameter of 736 µm) showed higher (P < 0.001) BW gain (808 vs. 750 g/bird) and lower feed conversion ratio (1.27 vs. 1.32) than those consuming a fine corn-containing diet (geometric mean diameter of 482 µm). This was further substantiated by a lower AMEn content (2,852 vs. 2,972 kcal/kg). Addition of amylase had no effect on growth performance of chickens fed a conventional corn-containing diet, but improved BW gain, feed conversion ratio, and diet AMEn in those fed the finely ground corn, possibly due to increased starch digestion in the upper gut. Addition of nonstarch polysaccharide enzymes was effective for both diets, with the most pronounced effects observed in feed conversion ratio for the conventional corn-containing diet (1.27 vs. 1.23) and BW gain (750 vs. 789 g/bird) for the fine corn-containing diet. This was followed by the same magnitude of difference in diet AMEn content, which increased from 2,972 to 3,042 and 2,852 to 3,009 kcal/kg following enzyme addition.

Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: a phase II study.

BACKGROUND: In stage IV rectal cancer, palliative surgery is often carried out upfront. This study investigated whether the surgery can be avoided. PATIENTS AND METHODS: Forty patients with symptomatic primary rectal adenocarcinoma and synchronous distant metastases deemed to be unresectable received 5 × 5 Gy irradiation and then oxaliplatin-based chemotherapy. Before treatment, 38% of patients had a near-obstructing lesion. The palliative effect was evaluated by questionnaires completed by the patients. RESULTS: The median follow-up for living patients was 26 months (range 19-34). The median overall survival was 11.5 months. Eight patients (20%) required surgery during the course of their disease: seven patients required stoma creation and one had local excision. Thirty percent of patients had a complete resolution of pelvic symptoms during the whole course of the disease, and 35% had significant improvement. In the subgroup with a near-obstructing lesion, 23% of patients required stoma creation. In all patients, the probability of requiring palliative surgery at 2 years was 17.5% [95% confidence interval (CI) 13% to 22%), and the probability of sustained good palliative effect after radiotherapy and chemotherapy was 67% (95% CI 58% to 76%). CONCLUSION: Short-course radiotherapy and chemotherapy allowed most patients to avoid surgery, even those with a near-obstructing lesion. CLINICALTRIALS: The trial is registered with ClinicalTrials.gov: number NCT01157806.

Altering the therapeutic paradigm towards a distal bowel margin of < 1 cm in patients with low-lying rectal cancer: a systematic review and commentary.

AIM: The 1-cm rule of distal bowel clearance in patients with low-lying rectal cancer undergoing anterior resection is based mainly on pathological data showing distal intramural spread. Because clinical data are contradictory, a review that includes only cancers located ≤ 5 or ≤ 6 cm from the anal verge was carried out. METHOD: A systematic review of the literature identified seven studies that presented results in relation to a margin of ≤ 1 cm (n = 293) vs > 1 cm (n = 315). In six studies, pre- or postoperative radiotherapy was implemented, and in one study patients were treated with surgery alone. Three studies, all implementing radiotherapy, reported results related to a margin of ≤ 5 mm (n = 51) vs > 5 mm (n = 125). RESULTS: In none of the studies were the differences in local recurrence rate between the small and large margin groups statistically significant. The pooled analysis of six studies, in which patients received perioperative radiotherapy, showed a 1.2% [95% confidence interval (Cl) -4.5-7.0%] higher local recurrence rate in the ≤ 1 cm margin group compared with the > 1 cm margin group (P = 0.6). The corresponding figures for the ≤ 5 mm cut-off point were 0.5% (95% CI -7.6-8.7%, P = 0.9). The 5-year local recurrence rate in the only study in which radiotherapy had not been used was 8.6% higher in the ≤ 1 cm margin group compared with the > 1 cm margin group (P = 0.09). CONCLUSION: Clinical evidence does not support the 1-cm rule in patients with low-lying rectal cancer undergoing pre- or postoperative radiotherapy.

Acceptance of a 5-mm distal bowel resection margin for rectal cancer: is it safe?

AIM: Acceptance of a short distal bowel margin results in a higher rate of anterior resection but may compromise oncological safety. This study aimed to evaluate the safety of a 5-mm distal margin. METHOD: A retrospective analysis was carried out of 412 consecutive patients with rectal cancer treated with anterior resection with a negative circumferential resection margin. Radiotherapy was given to 63% of patients with an advanced tumour. The median follow up was 75 months. RESULTS: Fewer patients in the group with a distal margin of ≤ 5 mm had a tumour with an advanced pT stage compared to patients in the group with a distal margin of > 5 mm (P = 0.033). Two patients were converted to abdominoperineal resection because of a positive 'doughnut', leaving 410 patients, in whom 5.4% (95% CI, 0-11.3%) of the group with a distal margin of ≤ 5 mm had local recurrence at 5 years compared with 4.2% (95% CI, 2.1-6.3%) of the group with a distal margin of > 5 mm (P = 0.726). The corresponding figures for the 5-year overall survival were 82.4% (95% CI, 72.6-92.2%) vs 76.3% (95% CI, 71.8-80.8%) (P = 0.581). All four anastomotic recurrences occurred in the group with a distal margin of > 5 mm. CONCLUSION: A distal margin of ≤ 5 mm did not compromise oncological safety in patients undergoing preoperative radiation for an advanced rectal cancer.

Lyophilized Carnobacterium divergens AS7 bacteriocin preparation improves performance of broiler chickens challenged with Clostridium perfringens.

The present study aimed to investigate the effects of Carnobacterium divergens AS7 bacteriocin (divercin AS7) on growth performance, digestibility, fermentation processes, selected microbial populations, and histomorphology in broiler chickens challenged with a mixture of 3 Clostridium perfringens isolates. In total, 480 one-day-old male Ross 308 chicks were randomly assigned to 4 experimental groups (12 replicate pens of 10 birds per treatment). The diets were either nonsupplemented or supplemented with a lyophilized preparation of divercin AS7. On d 18, 19, and 20, half of the birds were challenged twice a day with the C. perfringens mixture. The C. perfringens challenge did not influence broiler BW gain but impaired feed conversion ratio from d 29 to 42 (P=0.023) and throughout the experimental period (P=0.038). Moreover, the C. perfringens challenge resulted in decreased pH levels of crop, gizzard, and ileum contents (P<0.05) and reduced the numbers of lactic acid bacteria in the ceca (P=0.01). Divercin supplementation decreased broiler feed intake from d 14 to 28 (P=0.001) but increased BW gain from d 29 to 42 (P=0.048). The divercin supplementation increased the AMEn level (P=0.015) and reduced digesta pH in crop and ileum (P=0.004 and P=0.042, respectively), but of nonchallenged birds only. Divercin supplementation, moreover, increased gizzard lactate concentrations (P=0.003). The crop concentrations of lactate and succinate and the ileum concentration of lactate were increased by divercin supplementation (P=0.005, P=0.027, and P=0.002, respectively) and C. perfringens challenge (P=0.034, P=0.053, and P=0.0002, respectively). Divercin supplementation decreased villus heights (P=0.0006) and crypt depths (P=0.044) in noninfected birds, whereas in challenged birds, villus heights (P<0.0001) were increased. In conclusion, the present study demonstrated a very complex response pattern of broilers exposed to C. perfringens challenge and dietary divercin AS7 supplementation, but it indicated that divercin AS7 may partly counterbalance the negative effects associated with C. perfringens.

Dietary divercin modifies gastrointestinal microbiota and improves growth performance in broiler chickens.

1. The aim of the present study was to investigate the effects of dietary administration of a divercin AS7 liquid preparation on broiler chicken performance, nutrient digestibility, counts of lactic acid bacteria (LAB) and coliform bacteria, as well as on the microbial activity in the gastrointestinal tract (GIT) as expressed by digesta pH and concentrations of short-chain fatty acids and lactic acid. 2. A total of 450 1-d-old male Ross 308 chickens were randomly distributed to three dietary treatments, with 15 pens per treatment and 10 birds per pen. The dietary treatments consisted of a positive control (PC) supplemented with 60 mg/kg salinomycin, a negative control (NC) without any additives, and the divercin (DIV) supplemented diet containing 0 x 2 mL/kg of the liquid divercin AS7 preparation. 3. The dietary divercin AS7 supplementation significantly increased body weight gain at 35 d compared to the NC group. Moreover, the pH of crop contents was higher and that of caecal contents lower in birds fed on the divercin supplemented diets. 4. Significantly lower counts of LAB were observed in the crops and caeca of the birds treated with divercin. Further, the divercin supplementation decreased lactic and succinic acid concentrations in the crop and ileum. 5. The present study demonstrates that the use of divercin supplemented diets can influence composition and activity of the microbiota in the broiler chicken GIT even in the lower parts that should otherwise not be targeted due to the peptide structure of the bacteriocin.

Effect of ß -glucanase and xylanase supplementation of barley- and rye-based diets on caecal microbiota of broiler chickens.

1. The aim was to investigate the effect of grain type (barley or rye) and exogenous enzymes (ß-glucanase or xylanase) on the composition of chicken caecal microbiota as examined by classical culturing and molecular techniques (fluorescent in-situ hybridisation (FISH) and terminal-restriction fragment-length polymorphism (T-RFLP)). 2. Plate counting revealed higher total numbers of anaerobic bacteria, lactic acid bacteria and yeasts in caecal contents of birds fed with rye-based diets than in birds fed with barley-based diets. 3. As assessed by FISH analysis, the most abundant bacterial groups in the broiler caeca were Clostridium coccoides-Eubacterium rectale followed by Bacteroides sp., Lactobacillus sp./Enterococcus sp., Bifidobacterium sp. and Enterobacteriaceae. For both cereal types, the enzyme supplementation significantly decreased the relative amount of Enterobacteriaceae. 4. The T-RFLP profiles indicated that the caecal microbiota of birds receiving rye-based diets was more diverse than that of birds fed on barley-based diets. 5. Irrespective of the method applied, the results indicate that the cereal type as well as the exogenous enzyme supplementation influence the microbiota in broiler chicken caeca, and may have the effect of reducing potentially pathogenic Enterobacteriaceae populations.