Effect of different ratios of phytogenic feed additives on growth performance, nutrient digestibility, intestinal barrier integrity, and immune response in weaned pigs challenged with a pathogenic Escherichia coli.

This study was conducted to investigate the effects of supplementing different ratios of phytogenic feed additives (PFA) to weaned pigs challenged with pathogenic Escherichia coli on growth performance, nutrient digestibility, intestinal barrier integrity, and immune response, and to determine the optimal mixing ratio for post-weaning diarrhea (PWD) prevention. A total of 48 4-wk-old weaned pigs with initial body weight of 8.01 ± 0.39 kg were placed in individual metabolic cages, and then randomly assigned to eight treatment groups. The eight treatments were as follows: a basal diet without E. coli challenge (negative control, NC), a basal diet with E. coli challenge (positive control, PC), PC with supplementing 0.1% mixture of 20% bitter citrus extract (BCE), 10% microencapsulated blend of thymol and carvacrol (MEO), and 70% excipient (T1), PC with supplementing 0.1% mixture of 10% MEO, 20% premixture of grape seed and grape marc extract, green tea, and hops (PGE), and 60% excipient (T2), PC with supplementing 0.1% mixture of 10% BCE, 10% MEO, 10% PGE, and 70% excipient (T3), PC with supplementing 0.1% mixture of 20% BCE, 20% MEO, and 60% excipient (T4), PC with supplementing 0.1% mixture of 20% MEO, 20% PGE, and 60% excipient (T5), and PC with supplementing 0.1% mixture of 10% BCE, 20% MEO, 10% PGE, and 60% excipient (T6). The experiments progressed in 16 days, including 5 days before and 11 days after the first E. coli challenge (day 0). In the E. coli challenge treatments, all pigs were orally inoculated by dividing a total of 10 mL of E. coli F 18 for three consecutive days from day 0 postinoculation (PI). Compared with the PC group, the PFA2 and PFA6 groups significantly increased (P < 0.05) feed efficiency and decreased (P < 0.05) diarrhea during the entire period. At day 11 PI, the PFA6 group significantly improved (P < 0.05) gross energy digestibility compared to the PFA1 group. The PFA6 group significantly decreased (P < 0.05) tumor necrosis factor α (TNF-α) and interleukin-6 in serum and increased (P < 0.05) the villus height to crypt depth ratio (VH:CD). The PFA2 significantly decreased (P < 0.05) the relative protein expression of calprotectin in the ileum. In conclusion, improvements in growth performance, diarrhea reduction, and immunity enhancement are demonstrated when 10% BCE, 20% MEO, 10% PGE, and 60% excipient are mixed.

Phytogenic feed additives (PFA) include various herbs and spices, such as essential oils and polyphenols. Flavonoids and polyphenols contained in PFA are generally known to have antioxidant and antibacterial actions and based on this, PFA is considered an alternative to antibiotics in the swine industry. Pathogenic Escherichia coli infection is one of the most important causes of post-weaning diarrhea (PWD) in pigs. PWD causes intestinal damage, which leads to severe diarrhea, reduced growth performance, and mortality in weaned pigs, resulting in significant financial loss to the swine industry. Therefore, this study was conducted to investigate the effects of supplementing different ratios of PFA to weaned pigs challenged with E. coli and determine the optimal mixing ratio for PWD prevention. Our study results showed that growth performance was improved when supplementing a mixture of 10% bitter citrus extract (BCE), 20% microencapsulated blend of thymol and carvacrol (MEO), 10% premixture of grape seed and grape marc extract, green tea, and hops (PGE), and 60% excipient. Also, the effect of improving the immune response and intestinal morphology was shown. In conclusion, a mixture of 10% BCE, 20% MEO, 10% PGE, and 60% excipients is considered the optimal mixing ratio.

CFD study on vesicoureteral reflux in the urinary tract with double J stent.

OBJECTIVE: This study investigates the effects of vesicoureteral reflux (VUR) in the upper and lower urinary tracts with and without ureteral stenosis and with a double J stent (DJS). METHODS: The entire length of the urinary tract with an implanted DJS was modeled. To assess the possibility of VUR, the measured values were used as boundary conditions for the baseline, the maximum cystometric bladder capacity (MCBC) during the filling phase, and maximum vesical pressure during the voiding phase were computed. The flow rates, flow patterns, wall shear stress (WSS) distribution, impact force induced by reflux urination, and helicity of the bladder were investigated for the urinary system. RESULTS: The flow from the bladder to the renal pelvis was detected at maximum vesical pressure (75 cmH2O) during the voiding phase, and a small amount (1.09 mL/s) of VUR was noted at the MCBC during the filling phase. The WSS increased when the reflux was large. Helicity within the bladder varied with the stenosis as well as opening and closing of the urethra. The reflux within the stent was reduced by 40% by inserting a ball into the stent. CONCLUSION: The main VUR factor was the opening and closing of the vesicoureteric junction by the detrusor muscle. The largest urine reflux (11.7 mL/s) to the kidney occurred when the detrusor muscle was relaxed. SIGNIFICANCE: Ureteral stenosis affected the VUR and reduced urine reflux. Ball insertion in the stent reduced urine reflux through the stent lumen.

A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study.

BACKGROUND: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. OBJECTIVE: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). METHODS: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. RESULTS: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. CONCLUSIONS: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research.

Relationship Between Isokinetic Muscle Strength and Functional Tests in Chronic Ankle Instability.

Isokinetic muscle strength measurements and functional tests are usually performed to evaluate ankle condition in chronic ankle instability (CAI), yet there is no clear demonstration of the relationship between isokinetic muscle strength and functional tests. The objective of this study was to evaluate the relationship between isokinetic muscle strength and functional tests in CAI. Between April 2014 and August 2016, 103 patients with unilateral CAI were studied. Single-leg balance, single-heel raise, and single-leg squat tests were performed for static balancing assessment. Single-leg hop, double-leg jump, and sidestep tests were performed for dynamic balancing assessment. The isokinetic muscle strength of both ankles was measured using a dynamometer. The involved ankle showed lower muscle strength in inversion than the uninvolved ankle, while eversion, dorsiflexion, and plantarflexion muscle strength had no significant differences between ankles. There were significant correlations between the isokinetic muscle strength of inversion and the single-leg balance test, single-heel raise test, and sidestep test (Pearson's r; 0.246, 0.514, and 0.229 at 30°/second; 0.288, 0.473, and 0.239 at 180°/second, respectively). The single leg balance, single heel raise, and sidestep tests are useful to assess not only ankle functional performance but also isokinetic muscle strength. Among these tests, the single heel raise test was the most reliable test to reflect muscle strength deficiency in CAI.

Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures.

PURPOSE: Several different Krackow stitch configurations have been used for acute Achilles tendon rupture repair. Although several biomechanical studies compared different Krackow stitch configurations, to our knowledge, no previous studies compared the clinical outcome of these different suture methods. Therefore, in this study, we aimed to compare the clinical outcomes and complications of the two-stranded single and four-stranded double Krackow techniques. METHODS: Sixty-eight consecutive patients who underwent open repair by using the four-stranded double Krackow (33 patients, group A) or the two-stranded single Krackow (35 patients, group B) techniques between September 2011 and August 2014 were reviewed retrospectively. The isokinetic strength of plantar flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer 3 and 6 months after surgery. Clinical outcomes were evaluated 3, 6, and 12 months post-operatively. RESULTS: No significant differences were found between the groups regarding patient demographics or activity levels prior to treatment. Significant differences in the Achilles tendon Total Rupture Score, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, or the four-point Boyden scale were not found at any time during follow-up. Rerupture occurred only in one patient from group A. No significant differences were observed between the groups regarding the isokinetic plantar flexion and dorsiflexion strength at any time or any test speed. CONCLUSION: Equally favourable clinical outcomes and isokinetic muscle strength and a low complication rate were achieved with the two-stranded single Krackow technique as compared with the four-stranded double Krackow technique for acute Achilles tendon rupture repair. LEVEL OF EVIDENCE: III.

Pelvic lymph node status assessed by 18F-fluorodeoxyglucose positron emission tomography predicts low-risk group for distant recurrence in locally advanced cervical cancer: a prospective study.

PURPOSE: To develop a prediction model to identify a low-risk group for distant recurrence in patients with locally advanced cervical cancer treated by concurrent chemoradiation. METHODS AND MATERIALS: Prospectively, 62 patients with locally advanced cervical cancer were recruited as a training cohort. Clinical variables and parameters obtained from positron emission tomography (PET) and magnetic resonance imaging were analyzed by logistic regression. For the test set, 54 patients were recruited independently. To identify the low-risk group, negative likelihood ratio (LR) less than 0.2 was set to be a cutoff. RESULTS: Among the training cohort, multivariate logistic analysis revealed that advanced International Federation of Gynecology and Obstetrics (FIGO) stage and a high serum squamous cancer cell (SCC) antigen level were significant risk factors (p=0.015 and 0.025, respectively). Using the two parameters, criteria to determine a low-risk subset for distant recurrence were postulated: (1) FIGO Stage IIB or less and (2) pretreatment SCC<2.4 (Model A). Positive pelvic node on PET completely predicted all cases with distant recurrence and thus was considered as another prediction model (Model B). In the test cohort, although Model A did not showed diagnostic performance, Model B completely predicted all cases with distant recurrence and showed a sensitivity of 100% with negative LR of 0. Across the training and test cohort (n=116), the false negative rate was 0 (95% confidence interval 0%-7.6%). CONCLUSIONS: Positive pelvic node on PET is a useful marker in prediction of distant recurrence in patients with locally advanced cervical cancer who are treated with concurrent chemoradiation.

Preoperative prediction model of lymph node metastasis in endometrial cancer.

BACKGROUND: We aimed to develop a preoperative prediction model identifying the low-risk group for lymph node metastasis in endometrial cancer. METHODS: In 110 patients who underwent preoperative magnetic resonance imaging and serum CA-125 test, logistic analysis was performed to identify predictors. The coefficients obtained from logistic regression were used to construct a scoring system, and a receiver operator characteristic curve was created. RESULTS: Lymph node metastases were found in 14 (12.7%) of 110 patients. After multivariate logistic regression analysis, histologic grade, preoperative CA-125 levels, disease extent, and myometrial invasion assessed by magnetic resonance imaging were selected as viable predictors. The scoring system was internally validated using bootstrapping (P < 0.001), and receiver operator characteristic curve yielded the area under the curve of 0.902. The patients with the score of 0 or 1 (57.3%) were identified as a low-risk group, and no nodal metastasis was observed among them (negative predictive value, 100%: 95% confidence interval, 94.3%-100%). CONCLUSION: The current study suggests that preoperative prediction system to identify the risk of lymph node metastasis is feasible. This model may be useful in preoperative counseling about cost and benefit of systemic lymph node dissection.