The food for feed concept. Performance of broilers fed hotel food residues.

1. In recent times the use of food waste in animal diets has gained considerable attention because of the increasing demand to cover the needs of human population and the high prices of conventional, arable based, animal feeds.2. The aim of the present study was to investigate the effect of adding dried human food waste to the diet of meat-type chickens (broilers). Two hundred, one-day-old broilers were divided into two treatment groups, with 10 replicate pens containing 10 birds per pen. The duration of the study was 42 days. In the control (C), the diet did not contain any food waste, whereas in the second treatment (T) food waste residues from hotels made up 15% of the diet. Diets had similar crude protein and metabolisable energy content.3. Feed intake and body weight were recorded in order to calculate weight gain and feed conversion ratio (FCR). Carcase and breast muscle yield, the weight of selected internal organs and the level of selected biochemical and haematological parameters were determined. Quality of breast muscle meat was assessed.4. Broilers fed the control treatment consumed more feed and gained more weight compared to broilers fed waste; however, the FCR was similar. No major differences were seen for internal organ weights and haematological parameters, although some differences were observed in colour traits and shear force of meat. It was concluded that there is a potential for use of food waste in broiler diets.

Wolf Rock lighthouse: past developments and future survivability under wave loading.

Lighthouses situated on exposed rocky outcrops warn mariners of the dangers that lurk beneath the waves. They were first constructed when approaches to wave loading and structural response were relatively unsophisticated, essentially learning from previous failures. Here, we chart the evolution of lighthouses on the Wolf Rock, situated between Land's End and the Isles of Scilly in the UK. The first empirical approaches are described, followed by design aspects of the present tower, informed by innovations developed on other rocky outcrops. We focus on a particular development associated with the automation of lighthouses: the helideck platform. The design concept is described and the structure then scrutinized for future survivability, using the latest structural modelling techniques of the entire lighthouse and helideck. Model validation data were obtained through a complex logistical field operation and experimental modal analysis. Extreme wave loading for the model required the identification of the 250-year return period wave using a Bayesian method with informative prior distributions, for two different scenarios (2017 and 2067). The structural models predict responses of the helideck to wave loading which is characterized by differential displacements of 0.093 m (2017) and 0.115 m (2067) with associated high tension forces and plastic strain. This article is part of the theme issue 'Environmental loading of heritage structures'.

A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients.

AIM: Various surgical techniques are available for the management of pilonidal sinus, but there is still controversy concerning the optimal surgical approach. The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus. METHOD: Patients suffering from pilonidal sinus were operated on with sinus laser therapy (SiLaT) in our institute. SiLaT was applied under local anaesthesia after a small skin incision of 0.5-1 cm and careful cleaning of the sinus tracts with a curette. A radial fibre connected to a diode laser set at a wavelength of 1470 nm was then introduced into the tracts. The laser energy was delivered in continuous mode. RESULTS: Two-hundred and thirty-seven patients (183 male, median age 24 years, range 14-58) suffering from pilonidal sinus were operated on using the SiLaT laser procedure in our referral Institute and prospectively evaluated. A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30-70 days). A second treatment was offered for patients failing in the first session; this was successful in 78.3% (18/23). The duration of the procedure ranged between 20 and 30 min and had limited morbidity (wound infection in 7.2%, 17 of 237). CONCLUSION: SiLaT proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus. Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques.

The role of bentonite binders in single or concomitant mycotoxin contamination of chicken diets.

Concomitant presence of mycotoxins is more likely to appear than a single mycotoxicosis since many mycotoxigenic fungi grow and produce their toxic metabolites under similar conditions. The present study was designed to evaluate the efficacy of 4 mycotoxin binders to protect meat-type chickens against single and concomitant administration in the feed of two mycotoxins, namely aflatoxin B1 (AFB1) and ochratoxin A (OTA) both at concentration of 0.1 mg/kg. A total of 440 as hatched, d-old, Ross 308 broilers were reared for 42 d. There were 11 dietary treatments. Chickens were fed on either an uncontaminated basal diet, basal diet and AFB1, basal with concomitant presence of AFB1 and OTA, basal diet and three binders A, B and C (1%) with or without AFB1 or basal diet and binder D (0.5%) with or without concomitant presence of AFB1 and OTA. Performance, carcass yield and several biochemical parameters were examined. Mycotoxin concentration in liver and breast muscle samples was determined. Broiler performance under concomitant mycotoxin contamination was poorer than that under single mycotoxicosis. Mycotoxin presence increased relative heart weight compared to that of broilers fed on uncontaminated diets. Only OTA and not AFB1 was detected and only in the liver. OTA concentration was four-fold lower in broilers fed on a diet with binder compared to those fed on contaminated diets without binder. In conclusion, the study revealed that binder composition and presence or not of multiple toxins may be important factors for optimum broiler performance under mycotoxicosis.

Liquid based cytology and HPV DNA testing in a Greek population compared to colposcopy and histology.

Screening for cervical cancer in Greece is still unorganised and based on self- motivation. The purpose of this study was to evaluate the accuracy of cytological findings from a large observational population sample, originating from Western Athens, in association with reflex DNA test, colposcopic estimation, and final histologic diagnosis. The rate of invasive carcinoma, both squamous cell and adenocarcinoma, is indicative of a largely unscreened population. In this study, the estimated overall prevalence of human papilloma virus (HPV) was 41.1%, with HPV positivity at 37.4% of cytologically normal women. HPV testing did not seem to improve sensitivity of cytology for atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LGSIL) cases in identifying CIN 2+ lesions, but outperformed cytology in detecting CIN3+ for cytological high-grade squamous intraepithelial lesion (HGSIL) cases. For HGSIL cases sensitivity of colposcopy for detecting CIN3+ was comparable to cytology.

Clinical role of HER-2/neu expression in colorectal cancer.

PURPOSE: To evaluate the HER-2/neu expression and its relationship with clinicopathological parameters and prognosis in colorectal cancer patients. METHODS: A total of 51 colorectal cancer patients who underwent resection with curative intent from January 2005 to March 2006 were included in this study. Patients were regularly followed up and survival data were obtained as of as April 2011. HER-2/neu protein expression was evaluated from tissue samples from the primary tumor using a semiquantitative standardized immunohistochemical staining kit. Staining intensity was scored as faint (1+), weak to moderate (2+) and moderate to strong (3+). RESULTS: Forty-nine (96.1%) patients showed 1+ staining, 2 (3.9%) 2+, while no case was strongly positive (3+) for HER-2/neu. No apparent association was noted between HER-2/neu expression and patients' age, gender, tumor location, tumor grade, stage and survival. CONCLUSION: Moderate (2+) overexpression of HER-2/neu was detected in a small proportion of colorectal cancer patients. Considering the low rate of HER-2/neu overexpression in colorectal cancer, studies with larger sample sizes using standardized tests are essential to understanding the biologic role of HER-2/neu in this disease.

Procalcitonin in patients with colorectal cancer.

PURPOSE: Bacterial translocation (BT) is common in colon cancer patients and may be associated with increased occurrence of septic complications as well as with adverse oncologic outcomes. The aim of the present study was to correlate the BT detectable through peritoneal lavage culture or identified by abnormal inflammatory parameters with the clinicopathologic parameters and the short-term prognosis in a prospective series of patients. METHODS: Fifty-four consecutive patients with histologically proven colorectal cancer were included in this prospective study. White blood cells (WBC), erythrocyte sedimentation rate (ESR) and serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined and cultures from peritoneal lavage were collected immediately after laparotomy. RESULTS: Positive PCT was detected in 31 (55.3%) patients while positive cultures were obtained in 6 (11%) patients. Significant positive correlation of PCT with inflammation markers was noticed. Patients with distant metastases had higher serum PCT levels than patients without distant metastases (p=0.01). Borderline statistical significance was found between PCT and tumor grade (p=0.09). PCT was not correlated with the cultures of the lavage or the outcome. CONCLUSION: PCT is an adequate inflammatory marker, able to preoperatively discriminate patients with bacterial systemic inflammatory reaction due to BT. However, the clinical consequence of BT may be minimal as is shown by the lack of association of PCT or positive peritoneal lavage cultures with time to discharge, complications and short-term survival.

The role of selenium in cadmium toxicity: interactions with essential and toxic elements.

1. The study was part of a project designed to investigate if organic selenium (Se) can ameliorate the toxic effects of cadmium (Cd). The main objective of the present study was to investigate, in the chicken, the interactions between Se, Cd and the following elements: Sb, Ca, Cr, Co, Cu, Fe, Pb, Mg, Mn, Mo, Ni, V and Zn. 2. A total of 300 1-d-old chickens (broilers) were randomly distributed among 4 dietary treatments with 5 replicate pens per treatment. In T1, chickens were fed on a diet with 0·3 mg/kg added Se, without added Cd. In T2, chickens were fed on a diet with 0·3 mg/kg Se and 10 mg/kg Cd. In T3, chickens were fed on a diet with 0·3 mg/kg Se and 100 mg/kg of Cd added and in T4 treatment, chickens were fed on a diet with 3 mg/kg Se and 100 mg/kg Cd added. Se was added as Se-yeast. Cd was added as cadmium chloride (CdCl2). On d 28 and 42, two chickens per replicate pen were killed for collection of whole blood, liver, kidney and breast muscle samples. Samples were analysed by ICP-MS. The data were analysed using a multivariate linear model. 3. While low Cd concentrations in the diet led only to an increase of Cd concentration in the examined tissues, addition of high concentrations of Cd increased the concentration of Cd, Cu, Sb and V and decreased that of Se, Mn and Fe. Addition of high Se concentrations did not significantly reduce Cd concentration. 4. Prior to model application, correlations of 78 elements were noted, while after model application 39 correlations were noted. Most notably, Cd was correlated with Ca, Co, Cu and Mg, while Se was correlated with Mn. 5. The present study revealed several correlations between essential, probably essential and toxic elements illustrating the importance of the balance between pro-oxidants and antioxidants.

Supranutritional selenium level affects fatty acid composition and oxidative stability of chicken breast muscle tissue.

A total of 128 broilers were used to investigate the effect of selenium (Se) on fatty acid (FA) composition and oxidative stability of lipids in the breast muscle tissue. There were 4 replicates of 4 dietary treatments: T1 (basal diet with no added Se), T2 (T1 with 0.15 mg Se added per kg diet), T3 (T1 with 0.3 mg Se added per kg diet) and T4 (T1 with 3.0 mg Se added per kg diet). A yeast source was used for added Se. Breast muscle tissue was collected from two chickens per replicate pen for the determination of Se concentration by ICP-MS, FA profile by GC and lipid oxidation using thiobarbituric acid reactive substances method. Addition of supranutritional Se levels to chicken diets leads to the production of Se-enriched meat. Consumption of 100 g of breast meat from chickens fed diets supplemented with 0.15, 0.3 and 3 mg Se per kg of diet can provide 26, 41 and 220 µg of Se, respectively. Long-chain polyunsaturated fatty acids namely C20:3n-6, C20:4n-6, C20:5n-3, C22:5n-3 and C22:6n-3 increased linearly (p = 0.047, p < 0.001, p = 0.023, p = 0.003 and p = 0.002, respectively) as the Se inclusion levels in the diets increased. At slaughter, a linear decrease in lipid oxidation (p = 0.019) was observed with Se addition, possibly attributed to the antioxidant properties of Se. Addition of supranutritional Se to chicken diets, at levels well below those causing toxicity, leads to production of Se-enriched meat, protection of health-promoting long-chain FA like C20:5n-3 and C22:6n-3 and protection of meat quality from oxidation at day 1 after slaughter.

The value of TOP2A, EZH2 and paxillin expression as markers of aggressive breast cancer: relationship with other prognostic factors.

INTRODUCTION: The immunocytochemical expression of topoisomerase II alpha (TOP2A), enhancer of zeste homologue 2 (EZH2) and paxillin has recently gained increasing attention. Although previous studies have commented on the clinical usefulness of these markers, their role remains controversial. AIM: The purpose of the study was to investigate the expression of TOP2A, EZH2 and paxillin in relation to classic prognostic parameters and their significance as prognostic markers in imprints of resected breast carcinomas. METHODS: Imprint smears from 55 patients who underwent surgical treatment for primary carcinoma in our department between 2005 and 2006 were studied immunocytochemically with the use of TOP2A, EZH2 and paxillin antibodies. RESULTS: The expression of TOP2A correlated with higher histologic grade, tumor size and negative PR expression. High intensity staining for EZH2 expression was associated with higher histologic grade, negative ER and PR expression and positive Ki-67 expression. The expression of paxillin showed no correlation with estrogen/progesterone and HER2 expression nor with tumor grade and stage. CONCLUSION: Our data indicate that TOP2A and EZH2 expression are related to a more aggressive tumor phenotype. The expression of paxillin failed to correlate with any of the studied clinicopathologic factors. Further studies are needed to verify these results.

Analysis of clinical and molecular associations of triple negative breast cancers in node-negative patients.

INTRODUCTION: Therapeutic modalities in node-negative breast cancer patients remain a matter of controversy. Various prognostic factors have been proposed to help select those patients that would most likely benefit from adjuvant therapy. In view of this notion the triple negative phenotype (hormone receptors and HER2 negative tumors) has gained increasing attention. AIM: To evaluate the clinicopathologic characteristics of triple negative (TN) tumors in node-negative invasive breast carcinomas. METHODS: We retrospectively analyzed the archival pathology tissues of 160 patients with node-negative invasive carcinomas, diagnosed and treated in two surgical departments in Greece from 1999 to 2006. Statistical analysis was used to examine the association between TN tumors and other clinicopathological factors. RESULTS: Triple negative breast cancers correlated with higher histologic grade, mitotic activation index and Ki-67 expression (p < 0.05). Moreover TN tumors were correlated with negative staining for bcl-2 (p < 0.05). CONCLUSION: In node-negative breast cancer patients, triple negativity is associated with aggressive biologic behavior. Further studies are required to better understand the clinical implications of these findings.

The value of proliferation indexes in breast cancer.

INTRODUCTION: During the past several years, the Ki-67 antigen has gathered great interest in its role as a prognostic marker. Nevertheless, despite the large number of published papers, the role of Ki-67 in clinical practice remains controversial. AIM: To evaluate the association between Ki-67 immunoreactivity and other clinicohistopathological parameters. METHODS: We retrospectively analyzed the archival pathology tissues of 356 patients, diagnosed and treated in our department, from 2002 to 2006. Statistical analysis was used to examine the association between Ki-67 expression and other clinicopathological factors. RESULTS: The expression of Ki-67 was correlated with the mitotic count, tumor grade and size and p53, HER2 and EGFR expression. Furthermore Ki-67 expression was significantly related with nodal status and inversely associated with hormonal expression. Moreover, invasive carcinomas appeared to have greater proliferation values than in situ carcinomas, while invasive ductal carcinomas were correlated with higher Ki-67 expression compared to lobular cancers. CONCLUSION: The expression of Ki-67 appears to be a valuable method of proliferation measurement that could prove helpful in clinical practice. Further research is warranted in order to standardize the methodology and to reach uniformity in regard with the optimal cut-off value.

Effects of different dietary phytase activities on the concentration of antioxidants in the liver of growing broilers.

One-hundred and fifty male chickens were used to evaluate the effects of different activities (0, 250, 500, 12 500 FTU/kg) of phytase on their performance and antioxidant concentration in the liver. The chicks were housed in 30 cages and were allocated to six replicates of five dietary treatments. All diets were formulated to be adequate in energy and protein (12.90 MJ/kg metabolizable energy, 214 g/kg crude protein), however, the negative control (NC) was lower in available P compared with the positive control (PC) (2.5 vs. 4.5 g/kg diet). The other three diets were the NC supplemented with phytase at 250, 500 and 12 500 FTU/kg (NC + 250, NC + 500 and NC + 12 500 FTU respectively). The concentration of antioxidants in the liver of the birds was determined using HPLC at 21 days of age. Low P diets (NC) reduced weight gain, however, supplementation with phytase improved weight gain to the extent that it was better than the PC at the 12 500 FTU treatment (p < 0.05). Feed conversion ratio was also improved by the high level of phytase supplement more than other treatments (p < 0.05). Feed consumption was not affected either by dietary phosphorus concentration or by different phytase supplementation. The antioxidant data showed that the unsupplemented diet with low phosphorus (NC) decreased the concentration of coenzyme Q(10) and retinol-linoleate in the liver compared with that of birds on the adequate phosphorus treatment (PC). Phytase supplementation, especially at the higher doses (500 and 12 500 FTU) increased the level of coenzyme Q(10) to the same level as the PC treatment. In addition, the highest dose (12 500 FTU) of phytase increased retinol concentration in the liver of chickens compared with those on the NC treatment. The highest inclusion level of phytase increased the alpha-tocopherol level in the liver compared with the lower levels of phytase (NC + 250 and NC + 500 FTU).

Differences in colorectal cancer patterns between right and left sided colorectal cancer lesions.

PURPOSE: Colorectal carcinomas that arise proximal (right) or distal (left) to the splenic flexure exhibit different clinical and biological characteristics. Although various hypotheses have been proposed to explain these differences, their origin remains unclear. In this study we investigated the clinicopathologic differences between left and right colon tumors and comment on the possible explanatory theories behind them. METHODS: This study included a total of 388 retrospectively collected cases of colorectal cancer, surgically treated from 1999 to 2004. Differences of patients' demographic data and tumor micro- and macroscopic characteristics between left and right-sided tumors were investigated and analysed. RESULTS: Patients with right-sided colon cancer were significantly older (mean age 70 vs. 68 years; p<0.05) and had more lymph nodes examined than patients with left colon tumors (mean number of nodes 18.9 vs. 12.6; p<0.05). There was a lower proportion of T1 stage right-sided tumors (3.1 vs. 5%) and a higher proportion of stage T2-4 (96.9 vs. 95%) compared with left-sided tumors (p<0.001 for x2 test of all T stages). Furthermore, right-sided tumors had a higher mean width and depth (4.3 vs. 3.8 cm and 1.8 vs. 1.6 cm, respectively; p<0.05). Finally, there was a higher percentage of poorly differentiated right colon tumors (41.4 vs. 17.5%; p<0.001). CONCLUSION: Right-sided colon tumors affect older patients and are diagnosed at more advanced disease stages. The underlying mechanisms that provoke these differences remain unclear. Further studies are needed in order to better understand the true nature of these differences and their possible clinical implications.

Tissue distribution of rare earth elements in wild, commercial and backyard rabbits.

Rare Earth Elements (REEs), La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu, Sc, and Y, & two actinides, Th and U were assessed in muscle and liver tissues of wild, backyard and commercially raised rabbits through ICP-MS. Higher concentrations were found in liver in comparison to muscle tissue. Liver of wild rabbits accumulates all studied elements beyond Tm. Backyard rabbits do not show any statistically significant accumulation while commercial accumulate all beyond La, Ce, Pr, Nd, Gd and Tb. Wild rabbits were with the highest amounts for most of these elements. The different living and rearing environments of wild, backyard and commercial rabbits may affect accumulation, fate and transfer of REEs in rabbits' tissues. A dataset for establishing reference values of REEs in Lemnos island wild rabbits' is shown and the literature gap on safety limits for REEs is discussed.

Robot-assisted resection of ectopic kidney in children: An anatomical illustration.

INTRODUCTION: Failure of kidney migration during embryonic life results in an ectopic kidney, with an incidence varying from 1 in 500 to 1 in 1200. Pelvic kidney can be a rare cause of recurrent urinary tract infection (UTI), warranting nephrectomy in some cases. MATERIAL AND METHODS: A 7-year-old girl with a history of recurrent UTIs and vaginal discharge was diagnosed with a dysplastic afunctional ectopic kidney located in the pelvis, with ureter draining into the cervix or vaginal wall. RESULTS: A robot-assisted approach was chosen, with side docking of the robot to allow concurrent vaginoscopic/hysteroscopic exploration. A uterus bicornis was found. The ectopic ureter was dissected toward its drainage in the vaginal wall, where it was sutured and resected. The dysplastic kidney and ureter were removed. Compared to pure laparoscopic approach, dissection deep into the pelvis toward the vaginal wall is aided by the robotic dexterity and facilitates complete resection of the structure, which avoids leaving a ureteric stump into the vaginal wall. CONCLUSIONS: Robot-assisted surgery is a safe and effective option for resection of ectopic kidneys with ectopic ureter in children. Dissection up until the vaginal wall in children is aided by robotic dexterity, making this kind of surgery the ideal indication for robotic-assisted surgery.

The selenium levels of mothers and their neonates using hair, breast milk, meconium, and maternal and umbilical cord blood in Van Basin.

The objective of the present study is to calculate linear regressions between a mother and her child with respect to their selenium concentration (ng/g) in the following traits: maternal blood and umbilical cord blood, maternal and child hair, maternal milk and child umbilical cord blood, maternal milk and meconium, maternal blood plasma, and child meconium. The data were collected at Research Hospital of the University of Yüzüncü Yil from 30 pairs of mothers and their newborn baby. The mean maternal serum Se level in 30 mothers was 68.52 +/- 3.57 ng/g and cord plasma level was 119.90 +/- 18.08 ng/g. The Se concentration in maternal and neonatal hair was 330.84 +/- 39.03 and 1,124.76 +/- 186.84 ng/g, respectively. The Se concentration of maternal milk at day 14 after delivery was determined as 68.63 +/- 7.78 ng/g (n = 13) and the concentration of Se was 418.90 +/- 45.49 ng/g (n = 22) for meconium of neonatal. There was no significant difference between maternal blood and milk Se levels. However, hair Se concentration was significantly higher than milk and maternal blood Se level. For each trait comparison, the average absolute difference in log(10)-transformed Se concentration was calculated between a mother and her child. The observed average absolute difference was compared with a test distribution of 1,000 resampled bootstrap averages where the number of samples was maintained but the relationship between a mother and her child was randomized among samples (alpha = 0.05).

Dietary organic selenium addition and accumulation of toxic and essential trace elements in liver and meat of growing rabbits.

The effects of dietary organic selenium (Se) addition at 0.1, 0.5 and 2.5 mg/kg vs. an unsupplemented basal diet (BD) on the accumulation of some toxic and essential trace elements were studied in the liver and muscle tissues of growing rabbits. Dietary Se addition increased liver and muscle Se concentration linearly (P < .001), and decreased linearly Cd, As, Ni and Cr (P < .001) in liver, as well as As (P < .01) and Cd (P < .001) in muscle. Muscle Cu and Zn contents were significantly lower (P < .05) in rabbits fed 2.5 mg Se/kg diet compared to the other 3 groups. Selenium was negatively correlated with Cr, Ni, Cd and As (P < .01) in liver, and with Cu (P < .05) and Cd (P < .01) in muscle. In conclusion, dietary Se supplementation decreased the accumulation of toxic (Cd and As) and potentially toxic (Cr and Ni) trace elements in rabbits. However, at excessive quantities may negatively affect essential trace elements.

Avoiding hypoglycemia: the use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge.

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. AIM: This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. DESIGN: Non-randomized, prospective and observational study. METHODS: During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. RESULTS: All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean ±SD) was 6.4 ± 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 ± 0.3 vs. 0.4 ± 0.6; P = 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 ± 0.78 vs. 1.84 ± 1.55; P = 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P = 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. CONCLUSIONS: CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies.

Prospective research on infants with mild encephalopathy: the PRIME study.

OBJECTIVE: To determine short-term outcomes of infants with evidence of hypoxia-ischemia at birth and classified as mild neonatal encephalopathy (NE) at <6 h of age. STUDY DESIGN: Prospective multicenter study. Mild NE was defined as ⩾1 abnormal category in modified Sarnat score. Primary outcome was any abnormality on early amplitude integrated electroencephalogram (aEEG) or seizures, abnormal brain magnetic resonance imaging (MRI) or neurological exam at discharge. RESULTS: A total of 54/63 (86%) of enrolled infants had data on components of the primary outcome, which was abnormal in 28/54 (52%): discontinuous aEEG (n=4), MRI (n=9) and discharge exam (n=22). Abnormal tone and/or incomplete Moro were the most common findings. MRI abnormalities were confined to cerebral cortex but two infants had basal ganglia and/or thalamus involvement. The 18 to 24 months follow-up is ongoing. CONCLUSIONS: A larger than expected proportion of mild NE infants with abnormal outcomes was observed. Future research should evaluate safety and efficacy of neuroprotection for mild NE.