The iron-chelating potential of silybin in patients with hereditary haemochromatosis.

Milk thistle contains silybin, which is a potential iron chelator. We aimed to determine whether silybin reduced iron absorption in patients with hereditary haemochromatosis. In this crossover study, on three separate occasions, 10 patients who were homozygous for the C282Y mutation in the HFE gene (and fully treated) consumed a vegetarian meal containing 13.9 mg iron with: 200 ml water; 200 ml water and 140 mg silybin (Legalon Forte); or 200 ml tea. Blood was drawn once before, then 0.5, 1, 2, 3 and 4 h after the meal. Consumption of silybin with a meal resulted in a reduction in the postprandial increase in serum iron (AUC±s.e.) compared with water (silybin 1726.6±346.8 versus water 2988.8±167; P<0.05) and tea (silybin 1726.6±346.8 versus tea 2099.3±223.3; P<0.05). In conclusion, silybin has the potential to reduce iron absorption, and this deserves further investigation, as silybin could be an adjunct in the treatment of haemochromatosis.

Basic science and clinical application of stem cells in veterinary medicine.

Stem cells play an important role in veterinary medicine in different ways. Currently several stem cell therapies for animal patients are being developed and some, like the treatment of equine tendinopathies with mesenchymal stem cells (MSCs), have already successfully entered the market. Moreover, animal models are widely used to study the properties and potential of stem cells for possible future applications in human medicine. Therefore, in the young and emerging field of stem cell research, human and veterinary medicine are intrinsically tied to one another. Many of the pioneering innovations in the field of stem cell research are achieved by cooperating teams of human and veterinary medical scientists.Embryonic stem (ES) cell research, for instance, is mainly performed in animals. Key feature of ES cells is their potential to contribute to any tissue type of the body (Reed and Johnson, J Cell Physiol 215:329-336, 2008). ES cells are capable of self-renewal and thus have the inherent potential for exceptionally prolonged culture (up to 1-2 years). So far, ES cells have been recovered and maintained from non-human primate, mouse (Fortier, Vet Surg 34:415-423, 2005) and horse blastocysts (Guest and Allen, Stem Cells Dev 16:789-796, 2007). In addition, bovine ES cells have been grown in primary culture and there are several reports of ES cells derived from mink, rat, rabbit, chicken and pigs (Fortier, Vet Surg 34:415-423, 2005). However, clinical applications of ES cells are not possible yet, due to their in vivo teratogenic degeneration. The potential to form a teratoma consisting of tissues from all three germ lines even serves as a definitive in vivo test for ES cells.Stem cells obtained from any postnatal organism are defined as adult stem cells. Adult haematopoietic and MSCs, which can easily be recovered from extra embryonic or adult tissues, possess a more limited plasticity than their embryonic counterparts (Reed and Johnson, J Cell Physiol 215:329-336, 2008). It is believed that these stem cells serve as cell source to maintain tissue and organ mass during normal cell turnover in adult individuals. Therefore, the focus of attention in veterinary science is currently drawn to adult stem cells and their potential in regenerative medicine. Also experience gained from the treatment of animal patients provides valuable information for human medicine and serves as precursor to future stem cell use in human medicine.Compared to human medicine, haematopoietic stem cells only play a minor role in veterinary medicine because medical conditions requiring myeloablative chemotherapy followed by haematopoietic stem cell induced recovery of the immune system are relatively rare and usually not being treated for monetary as well as animal welfare reasons.In contrast, regenerative medicine utilising MSCs for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. Therefore, MSCs from either extra embryonic or adult tissues are in the focus of attention in veterinary medicine and research. Hence the purpose of this chapter is to offer an overview on basic science and clinical application of MSCs in veterinary medicine.

[Conclusions and recommendations of a WHO expert consultation meeting on iron supplementation for infants and young children in malaria endemic areas]. / Conclusions et recommandations à l'issue de la consultation de l'OMS sur la lutte contre la carence martiale chez le nourrisson et le jeune enfant dans les pays d'endémie palustre.

This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.

Effects of hay intake and feeding sequence on variables in faeces and faecal water (dry matter, pH value, organic acids, ammonia, buffering capacity) of horses.

To investigate effects of hay intake and feeding sequence on indicators of the microbial activity within the hindgut, six horses were fed 1.00 kg oats plus 0.50, 0.67, 0.83 or 1.00 kg hay/100 kg body weight (BW) x day, each for 14 days. Oats was offered either 30 min prior to hay (OA) or in the reversed sequence (HA) in a 2 x 8-week crossover design. Because typically exercised horses should be subjected to the study, faeces was used as substrate. Faecal dry matter (DM), the faecal waters' short-chain fatty acids (SCFA, in mmol/1) and molar percentages (mol%) of propionate and iso-butyrate were highest with OA (p < 0.01). Acetate mol%, acetate-propionate quotient (A/P) and buffering capacities 1 and 2 (BC1: current pH to pH 6; BC2: pH 6 to 5) of the faecal water were highest with HA (p < 0.01). While the hay intake rose, faecal pH, acetate mol%, A/P, BC1 and BC2 (the latter with HA only) increased (p < 0.05), but DM, SCFA and propionate mol% declined (p < 0.05). The hay-induced rise in A/P and BC1 was much higher with HA than with OA. L-Lactate and ammonia were unaffected by the feeding sequence and hay intake. In conclusion, hay intake and feeding sequence influence the microbial activity within the hindgut, although the concentrate level remains consistent. In horse rations with 1.00 kg oats/100 kg BW x day amounts of at least 0.83 kg hay/100 kg BW x day and offering the hay first seem to have the potency to protect the hindgut content from acidification. Behavioural abnormality was not observed any longer first with 1.00 kg hay/100 kg BW x day.

[Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia]. / Spontane Dissektion der A. iliaca externa auf dem Boden einer fibromuskulären Dysplasie.

Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia. A case of spontaneous dissection of the external iliac artery due to fibromuscular dysplasia is presented. In a 45-year-old man with a history of sudden onset of intermittent claudication a dissection of the right external iliac artery was found by duplex ultrasound. The patient, who was first treated with conservative therapy, subsequently required operative treatment because of further progression of the dissection. Considering the age of the patient a retrograde thrombendarterectomy manoeuver over guide wire was performed. Angiographic control at the end of operation demonstrated a good reconstructive result without any changes in the right common iliac artery and the aorta. Histopathological examination of the removed material showed fibromuscular dysplasia of the media. In the postoperative course the patient was clinically asymptomatic with ankle/brachial pressure indices of 1.0 on both legs. But shortly after discharge the intermittent claudication in the right leg recurred. Angiography and duplex ultrasound revealed focal stenosis of the right common iliac artery as well as retrograde dissection of the right common iliac artery extending into the distal aorta. Conservative therapy was recommended to the patient by the local hospital and no further progression of clinical and duplex findings within the last six months was found.

The steady-state levels of oxidative DNA damage and of lipid peroxidation (F2-isoprostanes) are not correlated in healthy human subjects.

Oxidative damage to DNA in human tissues can be determined by measuring multiple products of oxidative damage to the purine and pyrimidine bases using gas chromatography-mass spectrometry (GC-MS). Oxidative damage to lipids (lipid peroxidation) can be quantitated by the mass spectrometry-based determination of F2-isoprostanes, specific end-products of the peroxidation of arachidonic acid residues in lipids. For both DNA base damage products and 8-epi prostaglandin F2alpha (PGF2alpha), there is a wide variation in levels between different healthy human subjects. We measured multiple products of oxidative damage to DNA bases in white cells, and 8-epi PGF2alpha in plasma, from blood samples obtained from healthy human subjects in the UK and in Portugal. No correlation of 8-epi PGF2alpha levels with levels of any modified DNA base (including 8-hydroxyguanine) was observed. We conclude that no single parameter can be measured as an index of "oxidative stress" or "oxidative damage" in vivo.

Effect of dietary quercetin on oxidative DNA damage in healthy human subjects.

The effect of dietary intake of flavonols (predominantly quercetin) on oxidative DNA damage was studied in thirty-six healthy human subjects (sixteen men, twenty women). The study was a randomised crossover study, comprising two 14 d treatments of either a low-flavonol (LF) or high-flavonol (HF) diet with a 14 d wash-out period between treatments. Subjects were asked to avoid foods containing flavonols, flavones and flavanols during the LF dietary treatment period and to consume one 150 g onion (Allium cepa) cake (containing 89.7 mg quercetin) and one 300 ml cup of black tea (containing 1.4 mg quercetin) daily during the HF dietary treatment. A 7 d food diary was kept during each dietary period and blood samples were taken after each dietary treatment. Products of oxidative damage to DNA bases were measured in DNA from leucocytes. The study had more than 95% power to detect a change of 20% in DNA damage products Plasma vitamin C and plasma quercetin concentrations were also measured. No significant differences in intake of macronutrients or assessed micronutrients, measured DNA base damage products, or plasma vitamin C were found between the HF and LF dietary treatments. The plasma quercetin concentration was significantly higher after the HF dietary treatment period (228.5 (SEM 34.7) nmol/l) than after the LF dietary treatment period (less than the limit of detection, i.e. <66.2 nmol/l). These findings do not support the hypothesis that dietary quercetin intake substantially affects oxidative DNA damage in leucocytes.

China: the soyabean-pork dilemma.

In 1996 the population of China reached 1.23 billion, 22% of the world population, and is expected to increase to 1.5 billion by 2020. As China has only 7% of the world's arable land such population increases are likely to have an important impact on food supply in China and the world. Projections of the potential impact are discussed. The restructuring of Chinese agriculture at the end of the 1970s has led to dramatic increases in agricultural production and food consumption, in particular of animal products, fruit and vegetables. Along with these rapid changes there is evidence of a nutrition transition in which diseases associated with affluence are becoming more prevalent than deficiency diseases. This transition has led to concern about the evolving dietary pattern. The replacement of legumes, including soyabean, by meat and other animal products as rich sources of protein and other nutrients has been controversially argued on grounds of nutritional health, ecological impact, economic effects and world food supply. These arguments are reviewed and the pressures internal and external to China concerning the production and consumption of animal v. legume products are presented. It is concluded that nutritional policies to promote the consumption of soyabean are unlikely to be effective in the context of an increasingly free and global market.

[Aneurysms of the subclavian artery in thoracic outlet syndrome]. / Aneurysmen der Arteria subclavia bei Thoracic outlet syndrom.

The true subclavian artery aneurysm is a rare but dangerous complication of TOS. During a 20 years time period we observed 18 patients with subclavian artery aneurysms. 12 of these patients showed cervical ribs. Half of the patients (n = 9) presented with a critical ischemia of an upper extremity, nine patients were operated on electively. The acute ischemia makes the desobliteration of the outflow tract necessary first. The next step ist the transaxillary exarticulation of the first rib and the resection of the aneurysm. The reconstruction of the subclavian artery is performed by using autologous vein material or PTFE prostheses. In two cases both with an acute embolic critical ischemia major amputations were unavoidable. 13 patients could be reexamined in 1996: 11 bypasses proved to be functioning, 2 were definitely occluded.

Vitamin A and carotenoid status in rural China.

Vitamin A status of 260 groups of twenty-five males or twenty-five females, aged 35-64 years, surveyed in twenty-four provinces of the People's Republic of China, was assessed by measuring plasma retinol. retinol-binding protein and beta-carotene concentrations. Direct measurements of food intake over a 3 d period and questionnaire data on the frequency of consumption of vegetables, fruits, animal products and other dietary items were also used. Vitamin A status appeared to be low only in specific counties but in general was satisfactory or only marginally deficient. Plasma beta-carotene levels were strikingly low in comparison with Western levels despite generous vegetable consumption suggesting that intake of vitamin A precursors may have been adequate but not abundant enough to maintain high circulating plasma levels of beta-carotene. Plasma beta-carotene, for both males and females, was significantly correlated with the frequency of consumption of green vegetables. Plasma retinol, for males, was highly correlated with meat, fish, oil and alcohol consumption expressed both in quantity or frequency of consumption. Higher levels of plasma retinol, together with lower levels of plasma beta-carotene in males compared with females, suggest that men consume more animal products or may have higher retinol requirements and therefore a higher rate of conversion of beta-carotene to retinol.

Relationship between feeding pattern and body mass index in 220 free-living people in four age groups.

OBJECTIVE: To assess the relationship between feeding pattern and body mass index in free-living humans. DESIGN AND SUBJECTS: Feeding pattern was assessed from 220 7-day weighed dietary records. 187 records were obtained from three separate existing studies, and reanalysed. These studies contained data on three age groups in the British population; Elderly group (n = 88), Middle-aged group (n = 40), Working age group (n = 59). A separate study of 13-14 year olds living in Croydon was conducted from which 33 usable diet records were collected to produce a fourth, Adolescent group. RESULTS: 'Nibbling' and greater energy intakes at breakfast were associated with a lower body mass index (BMI) in the Adolescent group. In the Middle-aged group, greater energy intakes at breakfast and lower energy intakes during the evening were associated with a lower BMI. However, when diet records which produced unreasonably low energy intakes were removed from the analysis, these relationships disappeared except for energy intakes at breakfast and BMI in the Adolescent group. CONCLUSION: It is suggested that the relationship between feeding pattern and BMI observed in the Adolescent and Middle-aged groups was caused by underestimation of 'habitual' energy intake from snacks and the omission of breakfast by females and those who were overweight. The lack of relationship in the Working age group was attributed to the fact that more individuals in this group appeared to report valid diet records. Reported energy intake was directly related to BMI in the Working age group, but was not related to BMI in the other three age groups. It is concluded that feeding pattern is not a major factor in determining BMI in humans. Also, since snacks have a relatively high sugar and low fat composition compared with meals, it is suggested that biased under-reporting of snacks by the obese could produce spurious results from free-living studies which show that obesity is related to the proportion of energy from fat in the diet.

Chicken extract stimulates haemoglobin restoration in iron deficient rats.

Chicken essence is widely used as a traditional remedy for several ailments including anaemia. To test this claim for objective evidence, a series of experiments was carried out in anaemic rats by supplementing iron deficient diets with either liquid or lyophilised essence, which contains mainly protein and peptides (83 mg/ml) and free amino acids (3.1 mg/ml), very little iron (1 microgram/ml), and no fat. Haemoglobin returned to normal significantly more rapidly in rats supplemented with ad libitum liquid BEC over a period of up to 27 days compared with controls fed only water in addition to the ad libitum iron deficient diet. Haemoglobin was also significantly increased after 1 week in animals fed ad libitum diets supplemented with lyophilised chicken essence than with controls fed the unsupplemented diet. The effect was greater with supplementation at the level of 0.2% than at 1% lyophilised essence. The results indicate that the effects were mediated by increased appetite and by enhanced availability of food iron. These studies provide objective evidence for the traditional belief that chicken essence remedies anaemia.

Post-prandial thermogenesis with ephedrine, caffeine and aspirin in lean, pre-disposed obese and obese women.

OBJECTIVE: To determine whether or not aspirin further potentiates the greater post-prandial thermogenesis induced by ephedrine with caffeine. DESIGN: Determination of the acute metabolic rate response to the following treatments: 1050 kJ liquid meal (M); meal plus ephedrine (30 mg) and caffeine (100 mg) (MEC) or meal plus ephedrine, caffeine and aspirin (300 mg) (MECA). SUBJECTS: Lean, pre-disposed obese and obese women (n = 10 each group). MEASUREMENTS: Pre- and post-treatment metabolic rate determinations via indirect calorimetry. Post-treatment measurements made at 20 min intervals for a total of 160 min. RESULTS: In all groups, metabolic rate increased significantly more following the MEC or MECA, compared to the meal only (p < 0.05). The obese group had a significantly greater absolute increase in metabolic rate following the MECA and MEC compared to both the lean and pre-disposed obese groups (p < 0.05). Metabolic rate remained elevated at the end of the 160 min following all treatments. CONCLUSION: Aspirin does not further potentiate the acute thermic effect of ephedrine and caffeine with a meal. However, the full thermogenic response was not measured and longer duration studies are necessary to confirm these results.

[The effect of very low and moderate fiber levels on metabolism in the cecum of growing rabbits]. / Der Einfluss von sehr niedrigen und mittleren Fasermengen auf den Stoffwechsel im Blinddarm des wachsenden Kaninchens.

Investigations with 15N'-labelled urea were carried out to find out the influence of the amount of fibre on the reflux of 15N' into the caecum to take part in the caecal metabolism. Two pelleted diets, containing 9.7% (group 1 with 23% oat hulls) and 2.2% (Group 2 without oat hulls) crude fibre, with urea with 60 atom% 15N-excess (15N) used as marker were given to three White New Zealand rabbits each group. Group 1 and 2 consumed 109 and 72 g fresh matter per rabbit and day, respectively. Daily 15N'-intake per rabbit was 307 mg in group 1 and 279 mg in group 2. Most of 15N' was eliminated directly via the urine. The daily faecal excretion in group 1 and 2 was 5.3 and 2.3 mg 15N', respectively. Only about 20 to 30% of 15N' and volatile fatty acids in the caecum and higher amounts of 15N' in muscles were found. The animals of this group consumed nearly the total amount of faeces by caecotrophy. Therefore 24 g of group 2 was still satisfying compared to 33 g live weight gain/rabbit and day of group 1. It is concluded that the animals of group 2 could compensate the low fibre level within a period of about 20 days by a more efficient utilization, the consumption of crude protein and starch being 18 and 12% lower than in group 1, respectively. Feed intake and health status were not evidently affected. The results are in contradiction to the common knowledge.

Sources of energy from meals versus snacks in 220 people in four age groups.

OBJECTIVES: To assess meals versus snacks in terms of their contribution to total daily energy intake (TDI), macronutrient composition, and food commodity profile. DESIGN AND SUBJECTS: Meals and snacks were assessed from 220 7-day weighed dietary records. 187 records were obtained from three separate existing studies, and reanalysed. These studies contained data on three different age groups in the British population; elderly group (n = 88), middle-aged group (n = 40), young adult group (n = 59). A separate study of 13-14-year-olds living in Croydon was conducted from which 33 usable diet records were collected (adolescent group). RESULTS: Boys in the adolescent group consumed more of their TDI as snacks (29.0%) compared with men in the young adult (18.9%) and elderly groups (16.6%), but not the middle-aged group (25.8%). Females consumed about the same percentage of their TDI as snacks; adolescent group 23.6%, young adult group 19.4%, middle-aged group 21.4%, elderly group 17.9%. Meals were higher in protein and fat, and lower in total sugars, compared with snacks. Chocolate confectionery, crisps and fizzy drinks and squashes were popular snack foods in the adolescent group. Unlike snacks, the food commodity profiles of meals were similar in all age groups. CONCLUSIONS: This study shows that foods and drinks consumed as snacks by the British public, including the elderly, have a relatively high total sugar composition. These results add to the concern relating snack foods with dental caries.

Effect of habitual exercise on daily energy expenditure and metabolic rate during standardized activity.

To assess whether long-term habitual exercise affects energy expenditure even on a nontraining day, 24-h energy expenditure (24-h EE) and metabolic rate of sedentary, moderately active, and highly active males (n = 10 per matched group), were measured in a room respirometer on two separate occasions: sedentary and standardized mild-exercise protocols. Twenty-four--hour EE was greatest in the highly active group, second highest in the moderately active group, and lowest in the sedentary group on both experimental days (sedentary day: 9908 +/- 344, 9328 +/- 357, and 8669 +/- 227 kJ/d; exercise day: 11915 +/- 395, 11609 +/- 328, and 11063 +/- 370 kJ/d, respectively). Differences were significant between the 24-h EE (P < 0.01), waking (P < 0.03), and sleeping metabolic rate (P < 0.01) of the highly active group compared with the sedentary group. However, when expressed per unit lean body mass (LBM), group values on both experimental days were not significantly different. Therefore, we found no evidence that habitual exercise, at a high or moderate level, leads to a significant prolonged stimulation of metabolic rate per unit active tissue. However, the increased LBM associated with exercise does increase daily energy expenditure by 8-14%.

Femoropopliteal and femorotibial greater saphenous vein "in situ" reconstructions in non selected patients. Life table analysis.

594 non selected "in situ" reconstructions were analyzed retrospectively using the life table method. Especially after immediate occlusion the cumulative patency rate is unsatisfactory (33.1% vs 62.3% after 6 years). Patency rates are influenced by the anastomotic site and mainly by run off conditions. The number of patent tibial arteries seems to be the most important determinant. These results prove to be statistically significant.

Transcranial Doppler monitoring during induction of anesthesia: effects of propofol, thiopental, and hyperventilation in patients with large malignant brain tumors.

Disturbed autoregulation and CO2 reactivity have been reported in patients with brain tumors. Therefore, we decided to monitor the cerebrovascular effects of anesthetic drugs and hyperventilation. Transcranial Doppler sonography (TCD) can measure noninvasively alterations of flow velocities (v) and cross-sectional vessel area (VA) in large brain arteries. Twenty-eight patients with large malignant brain tumors in the territory of the middle cerebral artery (MCA) randomly received propofol or thiopental for induction and maintenance of anesthesia. Mean arterial pressure (MAP), heart rate (HR), and TCD parameters (vMCA and VA of the tumor or nontumor side) were determined at six data points (DP). The first measurements (MAP, HR, and TCD of the nontumor side) were performed before (DP I) and 60 s after (DP II) induction of anesthesia with either 2 mg/kg propofol or 4 mg/kg thiopental. After intubation and normoventilation (50% O2 in air), 0.05-0.1 mg/kg midazolam and an alfentanil infusion (100 micrograms/kg x h) were initiated. Then MAP, HR, vMCA, and VA of the tumor side were analyzed before (DP III) and 60 s after (DP IV) either propofol (1 mg/kg) or thiopental (2 mg/kg) were given. Finally, the effects of hyperventilation on HR, MAP, vMCA, and VA (tumor side) were determined (DP V and VI). Mean +/- SD, thiopental or propofol reactivity (non-tumor and tumor side) and CO2 reactivity (tumor side) were calculated; statistical comparison between DP I and II, III and IV, and V and VI was performed by paired t tests (p < 0.05). Unpaired t tests were used to evaluate differences between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of large-dose vitamin A supplementation on childhood diarrhoea, respiratory disease and growth.

One hundred and seventy-two 0.5-3.0-year-old children in a mountainous area of northern Hebei Province of China were randomly assigned to a vitamin A supplementation group (n = 98) or a control group (n = 74) for a 1 year double-blind study. Capsules containing 200,000 IU vitamin A and 40 IU vitamin E were given to the children in the experimental group 3 and 9 months after baseline examination. During the 12 month study period, there was a significant reduction in the incidence of diarrhoea (P < 0.01) and respiratory disease (P < 0.01) in the children of the experimental group compared to the control. Risk of diarrhoea and respiratory disease were respectively 2.5 and 3.4 times higher in the control children. Serum retinol and IgA levels of the treatment group were significantly higher than that of control group (P < 0.01) 7 weeks after first supplementation. There was no significant difference in saliva IgA level between groups. No significant differences in growth were observed. It was concluded that supplementation with large doses of vitamin A decreased the incidence and severity of diarrhoea and respiratory disease in these children, possibly through enhanced activity of the immune system, but had no effect on growth over 1 year.