Implementation of an integrated community approach in deprived neighbourhoods: a theory-based process evaluation using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND: We investigated the implementation process of an Integrated Community Approach (ICA) applied in four low socio-economic status neighbourhoods in Maastricht, the Netherlands. The ICA is a Population Health Management initiative and aims to improve population health, quality of care, professional's satisfaction and decrease costs of care. This study addresses the facilitators and barriers for implementing the ICA from a stakeholder perspective, including steering group members, professionals and citizens. METHODS: We conducted a mixed-methods study using a triangulation of methods to investigate the implementation from 1 December 2016 to 31 December 2020. The Consolidated Framework for Implementation Research guided data collection and data-analysis for evaluating the implementation process. In total, 77 interviews, 97 observations, seven focus groups, 65 collected documents and two surveys with open-ended questions were conducted. RESULTS: Facilitators for implementation were the use of citizen science to bring residents' needs into sharp focus, the integration of the ideology of Positive Health into the working routines of the professionals and leadership at the steering group level to overcome barriers in the ICA. The existing accounting and financial infrastructure obstructed combining budgets at neighbourhood level. CONCLUSIONS: Engaging citizens and professionals at an early stage is an important facilitator for implementation. The use of a shared vision on health also worked as a facilitator since it created a shared language among professionals, which is important in Population Health Management initiatives where multiple professionals are expected to collaborate. TRIAL REGISTRATION: NTR 6543; registration date, 25 July 2017.

Androgen Deprivation therapy for Oligo-recurrent Prostate cancer in addition to radioTherapy (ADOPT): study protocol for a randomised phase III trial.

BACKGROUND: More than 60% of oligo-recurrent prostate cancer (PCa) patients treated with metastasis-directed radiotherapy (MDRT) develop biochemical recurrence within 2 years. This recurrence rate emphasises the need for improved treatment and patient selection. In line with the treatment of primary PCa, the efficacy of MDRT may be enhanced when combined with androgen-deprivation therapy (ADT). Furthermore, the availability of PSMA PET/CT offers an excellent tool for optimal patient selection for MDRT. This phase III randomised controlled trial will investigate the role of the addition of ADT to MDRT in oligo-recurrent PCa patients selected with PSMA PET/CT to enhance oncological outcome. METHODS: Two hundred and eighty patients will be randomised in a 1:1 ratio to the standard treatment arm (MDRT alone) or the experimental arm (MDRT + 6 months ADT). Patients with biochemical recurrence after primary treatment of PCa presenting with ≤ 4 metastases will be included. The primary endpoint is the 2.5-year metastases progression-free survival (MPFS). Secondary endpoints are acute and late toxicity, quality of life, biochemical progression-free survival, overall survival, and the sensitivity of the PSMA PET/CT for detecting oligometastases at low PSA-levels. So far, between March 2020 and December 2021, one hundred patients have been included. DISCUSSION: This phase III randomised controlled trial will assess the possible benefit of the addition of 6 months ADT to MDRT on metastases progression-free survival, toxicity, QoL and survival in PCa patients with 1-4 recurrent oligometastatic lesions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04302454 . Registered 10 March 2020.

Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol.

BACKGROUND: Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases. METHODS: The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of < 1.0 ng/mL and a recent negative PSMA PET/CT scan. Participants will be randomised in a 1:1 ratio between the conventional fractionated treatment arm (35 × 2 Gy) and the experimental hypofractionated treatment arm (20 × 3 Gy). The primary endpoint is the 5-year progression-free survival after treatment. The secondary endpoints include toxicity, quality of life and disease specific survival. DISCUSSION: Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov (Identifier: NCT04642027 ). Registered on 24 November 2020 - Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants.

Chest X-ray in the follow-up of renal cell carcinoma.

PURPOSE: To evaluate the value of chest X-ray in the follow-up of surgically treated T1-3N0M0 renal cell carcinoma. METHODS: We performed retrospective analysis of patients that underwent surgical treatment of a localized renal cell carcinoma (T1-3N0M0) between January 1993 and July 2010. Data on frequency and results of performed chest X-rays were collected from patients' records. RESULTS: In 17.5 years, 249 patients with a T1-3N0M0 renal cell carcinoma underwent a radical or partial nephrectomy. In 221 patients, 823 chest X-rays were performed during a median follow-up of 3.3 years (range 0.5-17 years). In 19 patients, a pulmonary recurrence occurred, of which 10 were not detected by the regular follow-up. Of the 9 patients that were diagnosed with a pulmonary recurrence with a chest X-ray during follow-up, 7 were asymptomatic at the time of diagnosis, and the chest X-ray has led to the detection; 0.85 % of the performed chest X-rays (7/823) have led to the detection of asymptomatic lung metastases. CONCLUSIONS: Due to the low yield of chest X-ray for detection of asymptomatic pulmonary recurrences, it has very low clinical value in the follow-up after nephrectomy for T1-3N0M0 renal cell carcinoma.

[The working alliance in inpatient treatment for personality disorders and its connection with patient characteristics: an exploratory study]. / De werkalliantie in klinische psychotherapie voor persoonlijkheidsstoornissen en gehechtheid.

BACKGROUND: The working alliance between therapist and patient has been investigated frequently, but much less is known about the working alliance in specific patient groups in specific settings. AIM: To obtain insight into the characteristics of the working alliance in intensive inpatient psychotherapy involving patients with severe personality disorders, and to pay special attention to patient characteristics such as diagnosis and attachment. METHOD: At the end of the first phase of treatment we collected, on the basis of questionnaires, information about the working alliance and attachment of 60 patients with a severe personality disorders who had received inpatient psychotherapy. RESULTS: Working alliances with therapist and team were found to be weaker than in outpatient populations; working alliances with the therapist proved to be stronger than working alliances with the treatment team. Cluster C patients developed a better working alliance with the treatment team than did cluster B patients, particularly in the domain of treatment goals. Patients in this study turned out to be attached more anxiously and 'avoidantly' than patients in general outpatient populations; no correlation was found between patients' attachment and the strength of the working alliance. However, when a distinction was made between patients with extreme scores and patients with average scores, results showed that the more anxiously patients felt attached, the higher were their scores for their working alliance with the treatment team. CONCLUSION: It is more difficult to establish a working alliance with patients who have a severe personality disorder than with patients suffering from a less severe personality disorder. Patients with a severe personality disorder seemed to show a higher degree of anxious attachment and to have a more critical attitude to the working alliance.

Outcomes of transurethral resection of the prostate in benign prostatic hyperplasia comparing prostate size of more than 80 grams to prostate size less than 80 grams.

BACKGROUND: Benign prostatic hyperplasia is a condition occurring in elderly men in which the prostate gland is enlarged, hence the condition also known as benign enlargement of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms. Transurethral resection of prostate (TURP) still remains the gold standard modality of surgical treatment of obstructive lower urinary tract symptoms due to Benign hyperplasia. OBJECTIVES: The objective of this study was to evaluate the outcomes of TURP in large prostate (>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety and complications. METHODS: A total of 65 cases included in this prospective study, which were operated by a single surgeon with conventional monopolar TURP using standard technique. Intra -operative and post-operative complications, pre and post- operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, time to removal of catheter and hospital stay were evaluated between small and large prostate gland volumes. RESULTS: Out of 65 cases, 30 were with large prostate size i.e. 80 grams or more (group 1), and 35 cases were with small prostate size than 80 grams size (group 2). Mean age was 71.8 SD ± 6.9 years in group 1 and 68.2 SD ± 12.7 years in group 2. The mean preoperative volume of prostate was 88.8 grams (range 80-115 grams) in group 1 and 40.3 (range 20-65 grams) in group 2. The mean preoperative post void residual volume of urine (PVRU) was 244 ml SD ± 190.8 ml in group 1 and 117 ml ± 70.3 ml in group 2. Mean resection time in group 1 was 110 (range 90-130) minutes and in group 2 it was 90 minutes (range 55-115) minutes. There were quite satisfactory improvements in IPSS and QoL. No significant complications were observed except TUR syndrome in 2 cases from group 2, which were managed well in postoperative period. CONCLUSION: With meticulous resection and intra-operative haemostasis using continuous out flow resectoscope, conventional monopolar TURP is equally safe and effective in large size prostate as compare in small size.

Outcomes of extra corporeal shock wave lithotripsy in renal and ureteral calculi.

BACKGROUND: Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. OBJECTIVE: The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. METHOD: In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. RESULT: Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10 mm, 10-15 mm and > 15 mm was 97%, 97% and 90%. CONCLUSION: ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5 cm.

Effect of dietary treatments on performance, oocysts shedding and lesion scores in broiler chickens experimentally challenged with Eimeria infection.

Although anticoccidials effectively control coccidiosis, a needed reduction in the reliance on antimicrobials in animal production leads to the exploration of alternative compounds. The present study aimed to test five different dietary treatments to counteract the negative impact of coccidiosis on broiler chickens' health and performance. 1-day-old male Ross 308 broilers (n = 960) were randomly assigned to one of eight treatments, with six cages per treatment (20 birds/cage). To the diet of the broiler chickens of treatments (Trt) 1-5, a synbiotic was added from d0-10. From d10-28, birds of Trt1 and Trt2 were fed synbiotics, whereas birds of Trt3 were fed diets with glutamine, and birds of Trt4 and Trt5 were fed diets with a combination of ß-glucans and betaine. From d28-35 onwards, birds of Trt1 were fed a diet with a synbiotic, whereas birds of Trt2-4 received diets with glutamine, and birds of Trt5 were fed a non-supplemented diet. Birds of the positive control group (PC; Trt6) were fed a standard diet supplemented with an anticoccidial (Decoquinate). The challenged negative control (NCchall; Trt7) and non-challenged negative control (NC) Trt8 were fed a standard diet without anticoccidial or other dietary treatment. At 7 days (d) of age, all birds were inoculated with 1 023, 115, and 512 sporulated oocysts of E. acervulina, E. maxima, and E. tenella, respectively, except for Trt8. Body weight gain (BWG), feed intake, and feed conversion ratio were assessed for each feeding phase (d0-10, d10-28 and d28-35) and overall experimental period (d0-35). Oocyst shedding, Eimeria lesion scores, cecal length, and relative weight were assessed at d13, d22, d28 and d35. Additionally, oocyst shedding was determined at d9 and d17. Litter quality was evaluated at d27 and d34, and footpad lesions at d34. During the starter (d0-10) and finisher (d28-35) periods, performance did not differ between the treatments. During the grower period (d10-28), Trt6 (PC) and Trt8 (NC) chickens had the highest BWG of all treatments (P < 0.001). Dietary treatment had no effect on litter quality and severity of footpad lesions. In the PC group (Trt6), low oocyst excretion and lesion scores were found. When comparing Trt1-5 with NCchall (Trt7), none of the treatments significantly reduced oocyst output or lesion scores. In conclusion, in this experiment, none of the dietary treatments performed similar or better compared to the PC group (Trt6) regarding performance or reducing Eimeria oocyst shedding or lesion scores.

Complement mediated renal inflammation induced by donor brain death: role of renal C5a-C5aR interaction.

Kidneys retrieved from brain-dead donors have impaired allograft function after transplantation compared to kidneys from living donors. Donor brain death (BD) triggers inflammatory responses, including both systemic and local complement activation. The mechanism by which systemic activated complement contributes to allograft injury remains to be elucidated. The aim of this study was to investigate systemic C5a release after BD in human donors and direct effects of C5a on human renal tissue. C5a levels were measured in plasma from living and brain-dead donors. Renal C5aR gene and protein expression in living and brain-dead donors was investigated in renal pretransplantation biopsies. The direct effect of C5a on human renal tissue was investigated by stimulating human kidney slices with C5a using a newly developed precision-cut method. Elevated C5a levels were found in plasma from brain-dead donors in concert with induced C5aR expression in donor kidney biopsies. Exposure of precision-cut human kidney slices to C5a induced gene expression of pro-inflammatory cytokines IL-1 beta, IL-6 and IL-8. In conclusion, these findings suggest that systemic generation of C5a mediates renal inflammation in brain-dead donor grafts via tubular C5a-C5aR interaction. This study also introduces a novel in vitro technique to analyze renal cells in their biological environment.

Preclinical evaluation of a novel ¹¹¹In-labeled bombesin homodimer for improved imaging of GRPR-positive prostate cancer.

Rational-designed multimerization of targeting ligands can be used to improve kinetic and thermodynamic properties. Multimeric targeting ligands may be produced by tethering multiple identical or two or more monomeric ligands of different binding specificities. Consequently, multimeric ligands may simultaneously bind to multiple receptor molecules. Previously, multimerization has been successfully applied on radiolabeled RGD peptides, which resulted in an improved tumor targeting activity in animal models. Multimerization of peptide-based ligands may improve the binding characteristics by increasing local ligand concentration and by improving dissociation kinetics. Here, we present a preclinical study on a novel radiolabeled bombesin (BN) homodimer, designated (111)In-DOTA-[(Aca-BN(7-14)]2, that was designed for enhanced targeting of gastrin-releasing peptide receptor (GRPR)-positive prostate cancer cells. A BN homodimer was conjugated with DOTA-NHS and labeled with (111)In. After HPLC purification, the GRPR targeting ability of (111)In-DOTA-[Aca-BN(7-14)]2 was assessed by microSPECT imaging in SCID mice xenografted with the human prostate cancer cell line PC-3. (111)In labeling of DOTA-[(Aca-BN(7-14)]2 was achieved within 30 min at 85 °C with a labeling yield of >40%. High radiochemical purity (>95%) was achieved by HPLC purification. (111)InDOTA-[Aca-BN(7-14)]2 specifically bound to GRPR-positive PC-3 prostate cancer cells with favorable binding characteristics because uptake of 111In-DOTA-[Aca-BN(7-14)]2 in GRPR-positive PC-3 cells increased over time. A maximum peak with 30% radioactivity was observed after 2 h of incubation. The log D value was -1.8 ± 0.1. (111)In-DOTA-[Aca-BN(7-14)]2 was stable in vitro both in PBS and human serum for at least 4 days. In vivo biodistribution analysis and microSPECT/CT scans performed after 1, 4, and 24 h of injection showed favorable binding characteristics and tumor-to-normal tissue ratios. This study identifies (111)In-DOTA-[(Aca-BN(7-14)]2 as a promising radiotracer for nuclear imaging of GRPR in prostate cancer.

Potential risk factors associated with contact dermatitis, lameness, negative emotional state, and fear of humans in broiler chicken flocks.

The objectives of this study were to 1) identify determinants of poor welfare in commercial broiler chicken flocks by studying the associations between selected resource-based measures (RBM, potential risk factors), such as litter quality and dark period, and animal-based welfare indicators (ABM), such as foot pad dermatitis and lameness, and 2) establish the breadth of effect of a risk factor by determining the range of animal welfare indicators associated with each of the risk factors (i.e., the number of ABM related to a specific RBM). Eighty-nine broiler flocks were inspected in 4 European countries (France, Italy, the United Kingdom, and the Netherlands) in a cross-sectional study. The ABM were contact dermatitis (measured using scores of foot-pad dermatitis and hock burn, respectively), lameness (measured as gait score), fear of humans (measured by the avoidance distance test and the touch test), and negative emotional state (measured using qualitative behavior assessment, QBA). In a first step, risk factors were identified by building a multiple linear regression model for each ABM. Litter quality was identified as a risk factor for contact dermatitis. Length of dark period at 3 wk old (DARK3) was a risk factor for the touch test result. DARK3 and flock age were risk factors for lameness, and the number of different stockmen and DARK3 were risk factors for QBA results. Next, the ABM were grouped according to risk factor and counted. Then, in a second step, associations between the ABM were investigated using common factor analysis. The breadth of a risk factor's effect was judged by combining the number (count) of ABM related to this factor and the strength of association between these ABM. Flock age and DARK3 appeared to affect several weakly correlated ABM, thus indicating a broad range of effects. Our findings suggest that manipulation of the predominant risk factors identified in this study (DARK3, litter quality, and slaughter age) could generate improvements in the related ABM and thereby enhance the birds' overall welfare status.

Buprenorphine as a safe alternative to methadone in a patient with acquired long QT syndrome: a case report.

A 52-year-old man with a medical history of intravenous drug abuse was admitted to our hospital with syncope due to torsades de pointes (TdP). Two days earlier, he had used methadone. The electrocardiogram showed a prolonged corrected QT interval (QTc) of 600 ms. Continuous telemetry observation showed multiple episodes of TdP. The patient was diagnosed with bradyarrhythmia-induced TdP with acquired long QT syndrome resulting from methadone use. The QTc normalised within 2 weeks after discontinuation of the methadone. In this case of a patient with opioid dependency, there is a reasonable risk of repeated methadone use. Therefore, implantable cardioverter defibrillator or pacemaker implantation is justified but risky because of possible infections when using intravenous drugs. Given the high mortality rates seen in untreated illicit opioid users, this patient needs an alternative pharmacological treatment. Buprenorphine is an opiate-receptor agonist associated with less QTc prolongation. The patient was referred to a rehab clinic and treated with an oral combination of buprenorphine and naloxone (Suboxone). During this therapy, his QTc remained normal.

Urinary bladder carcinoma: impact of smoking, age and its clinico-pathological spectrum.

BACKGROUND: Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. OBJECTIVE: The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. METHOD: A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. RESULTS: Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. CONCLUSION: The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade.

Enhancing their quality of life: environmental enrichment for poultry.

Providing environmental enrichments that increase environmental complexity can benefit poultry welfare. This Poultry Science Association symposium paper is structured around four themes on 1) poultry preferences and affective states 2) species-specific behavior, including play behavior and the relationship between behavior, activity level and walking ability, 3) environmental enrichment and its relationship with indicators of welfare, and 4) a case study focusing on the application of enrichments in commercial broiler chicken production. For effective enrichment strategies, the birds' perspective matters most, and we need to consider individual variation, social dynamics, and previous experience when assessing these strategies. Play behavior can be a valuable indicator of positive affect, and while we do not yet know how much play would be optimal, absence of play suggests a welfare deficit. Activity levels and behavior can be improved by environmental modifications and prior research has shown that the activity level of broilers can be increased, at least temporarily, by increasing the environmental complexity. However, more research on impacts of enrichments on birds' resilience, on birds in commercial conditions, and on slow(er)-growing strains is needed. Finally, incorporating farmers' expertise can greatly benefit enrichment design and implementation on commercial farms.

Host genotype affects endotoxin release in excreta of broilers at slaughter age.

Host genotype, early post-hatch feeding, and pre- and probiotics are factors known to modulate the gut microbiome. However, there is a knowledge gap on the effect of both chicken genotype and these dietary strategies and their interplay on fecal microbiome composition and diversity, which, in turn, can affect the release of endotoxins in the excreta of broilers. Endotoxins are a major concern as they can be harmful to both animal and human health. The main goal of the current study was to investigate whether it was possible to modulate the fecal microbiome, thereby reducing endotoxin concentrations in the excreta of broiler chickens. An experiment was carried out with a 2 × 2 × 2 factorial arrangement including the following three factors: 1) genetic strain (fast-growing Ross 308 vs. slower growing Hubbard JA757); 2) no vs. combined use of probiotics and prebiotics in the diet and drinking water; and 3) early feeding at the hatchery vs. non-early feeding. A total of 624 Ross 308 and 624 Hubbard JA757 day-old male broiler chickens were included until d 37 and d 51 of age, respectively. Broilers (N = 26 chicks/pen) were housed in a total of 48 pens, and there were six replicate pens/treatment groups. Pooled cloacal swabs (N = 10 chickens/pen) for microbiome and endotoxin analyses were collected at a target body weight (BW) of 200 g, 1 kg, and 2.5 kg. Endotoxin concentration significantly increased with age (p = 0.01). At a target BW of 2.5 kg, Ross 308 chickens produced a considerably higher amount of endotoxins (Δ = 552.5 EU/mL) than the Hubbard JA757 chickens (p < 0.01). A significant difference in the Shannon index was observed for the interaction between the use of prebiotics and probiotics, and host genotype (p = 0.02), where Ross 308 chickens with pre-/probiotics had lower diversity than Hubbard JA757 chickens with pre-/probiotics. Early feeding did not affect both the fecal microbiome and endotoxin release. Overall, the results suggest that the chicken genetic strain may be an important factor to take into account regarding fecal endotoxin release, although this needs to be further investigated under commercial conditions.

Footpad dermatitis in Dutch broiler flocks: prevalence and factors of influence.

In some European countries, footpad dermatitis (FPD) is measured as an indicator of broiler welfare. Prevalence and seasonal variation of FPD was determined within broiler flocks (fast-growing breeds) in the Netherlands. Samples were taken from 386 Dutch flocks at 8 slaughterhouses during a period of one year. Prevalence of footpad dermatitis was related to background information gathered using a food chain certification scheme to identify possible factors of influence. On average, 35.5% of the broilers had no lesions, whereas 26.1% and 38.4% had mild or severe lesions, respectively. Season, age, thinning of flocks, slaughter age, breed, slaughterhouse, and the interaction between thinning and slaughter age significantly affected severity of FPD. Peak flock FPD scores occurred in flocks where 1-d-old chicks were placed in March and December, whereas flocks placed in warm months, between June and August, displayed lower flock FPD scores. Generally, birds sent to slaughter when thinning a flock displayed less severe FPD than birds from completely depopulated flocks. Severity of FPD decreased with age. Because poultry farmer, hatchery, veterinary practice, and feed manufacturer were included in the model as random factors, it was only possible to assess their contribution relative to each other. The broiler farmer had the largest contribution. Also, a large contribution was found for hatchery, perhaps indicating that broiler quality is important. No relationship was observed between FPD and mortality. Across farms, less severe FPD was observed on farms using antibiotics. However, within farms, FPD was more common in flocks where antibiotics had been used compared with flocks that did not require antibiotic treatment. In conclusion, footpad dermatitis was frequently observed in Dutch fast-growing broiler flocks, and many factors had significant effects on severity of FPD, such as breed, thinning of flocks, age at slaughter, slaughter plant, and hatchery.

The impact of changing toward higher welfare broiler production systems on greenhouse gas emissions: a Dutch case study using life cycle assessment.

In the Netherlands, the Dutch Retail Broiler (DRB) and Better Life one Star (BLS) production systems have been introduced with the aim to improve broiler welfare. Simultaneously, retailers set targets for reduction of greenhouse gas (GHG) emissions in the whole broiler production chain. The GHG emissions of DRB and BLS may differ from conventional systems because of differences in slaughter age, feed intake, and diet composition. The aim of this study was to estimate GHG emissions of the conventional, DRB, and BLS production systems. A deterministic, spreadsheet based model was developed that included the breeder, hatchery, and broiler farm stages. First, the model calculates feed intake of different diets and energy use, based on performance objectives and literature. Selection of feed ingredients for the different types of diets was based on least cost formulation with nutritional constraints for each diet. Second, GHG emissions were estimated from cradle to broiler farm gate for processes along the broiler production chain by using life cycle assessment, and expressed as kg CO2-equivalents per kg live weight (kg CO2-eq/kg LW). Results showed that BLS (3.55 kg CO2-eq/kg LW) had lower GHG emissions compared to conventional (3.65 kg CO2-eq/kg LW) and DRB (3.98 kg CO2-eq/kg LW) at the broiler farm gate. Emissions from land use change (LUC) from feed production, mainly from soybean products, had highest impact on total GHG emissions (>50%) for the systems and these soybean products had the lowest inclusion in the diets of the BLS production system. Sensitivity analyses showed that variation in slaughter weight and feed intake could result in overlap of GHG emissions between systems. When soybean products were sourced from a country with low LUC emissions, conventional (1.37 kg CO2-eq/ kg LW) had the lowest GHG emissions and BLS (1.79 kg CO2-eq/kg LW) the highest. This study showed that origin of and including or excluding LUC emissions from soybean production results in different conclusions for achieving the GHG emissions reduction targets set by retailers.

Effects of organic macro and trace minerals in fast and slower growing broiler breeders' diet on offspring growth performance and tibia characteristics.

This study was designed to evaluate effects of source of macro and trace minerals (inorganic vs. organic) in fast and slower growing broiler breeders' diets on egg and hatchling mineral content and on offspring tibia morphological, biophysical, and mechanical characteristics. After 10 wk feeding the breeders (at 30 wk of age), eggs were collected and incubated. Eggs and hatchlings were analysed on mineral content. Male chickens were assigned to 32 pens with 12 chickens per pen. At approximately 1,700 and 2,600 gram BW, three chickens per pen were slaughtered. Tibia characteristics were determined. Organic minerals in the broiler breeder diet resulted in higher Fe and Se concentration in the egg and in higher Se concentration in the hatchling. Despite effects of mineral source on mineral concentration in the eggs and hatchlings were limited, organic minerals in the slower-growing broiler breeder diet resulted in higher offspring BW (d 42, Δ = 115 g; P = 0.03) and advanced tibia development (higher thickness (∆ = 0.38 cm; P < 0.001), osseous volume (∆ = 5.1 cm3; P = 0.01), and mineral density (Δ = 0.13 g/cm3; P = 0.03) at 2,600 g BW), but this was not observed in fast-growing chickens. This suggests that 1) the difference in feed intake of the breeders between strains might affect offspring performance, which might indicate that current slower-growing breeder diets might be suboptimal in minerals or that transgenerational mineral availability in slower growing chickens appears to be more effective on bone development, which might be related to time available for bone development. 2) transgenerational mineral availability in offspring appears to play a role via other mechanisms than via absolute mineral concentrations.

Nutritional interventions to support broiler chickens during Eimeria infection.

Different combinations of gut health-promoting dietary interventions were tested to support broilers during different stages of Eimeria infection. One-day-old male Ross 308 broilers (n = 720) were randomly assigned to one of 6 dietary treatments, with 6 pens per treatment and 20 birds per pen, for 35 d. At 7 d of age (d7), all birds were inoculated with 1000, 100, and 500 sporulated oocysts of E. acervulina, E. maxima, and E. tenella, respectively. A 4-phase feeding schedule was provided. The dietary treatments (TRT) 1 to 4 included the basal diet supplemented with multispecies probiotics from d0 to 9 and coated butyrate and threonine from d28 to 35 but received four different combinations of prebiotics and phytochemicals from d9 to 18 and d18 to 28. The basal diet for the positive control (PC, TRT5) included diclazuril as a anticoccidial. The negative control (NC, TRT6) contained no anticoccidial. Performance was assessed for each feeding phase, and oocyst output, Eimeria lesion scores, cecal weight, litter quality, and footpad lesions were assessed at d14, d22, d28, and d35. Body weight gain (BWG) and feed intake (FI) were not affected by dietary treatment. PC broilers had the best feed conversion ratio (FCR) of all treatments from d0 to 35 (P < 0.001). None of the dietary treatments resulted in better litter quality or reduced footpad lesions compared to the PC. Moreover, the PC was most effective in reducing oocyst output and lesion scores compared to all other treatments. However, broilers that received the multispecies probiotics (d0 to 9), saponins (d9 to 18), saponins, artemisin, and curcumin (d18 to 28), and coated butyrate and threonine (d28 to 35) had the best FCR (P < 0.001) and lowest oocyst output and lesion scores compared to other dietary treatments. This study suggests that although the tested compounds did not perform as well as the anticoccidial, when applied in the proper feeding period, they may support bird resilience during coccidiosis infection.

Cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy, a randomized controlled trial (CAPTURE) protocol.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment method for large kidney stones. Its aim is to achieve a stone-free status, since any residual fragments (RFs) after PCNL are likely to cause additional morbidity or stone growth. Enhancing intraoperative detectability of RFs could lead to increased stone-free rates and decreased re-intervention rates. Cone beam computed tomography (CBCT) has recently been introduced in urology as a feasible method for intraoperatively imaging RFs. The aim of this trial is to determine the added value of CBCT in percutaneous nephrolithotomy, by measuring differences in stone-related morbidity for patients with procedures in which a CBCT is used versus patients with procedures without the use of CBCT. METHODS: The CAPTURE trial is an investigator-initiated single-center, randomized controlled trial (RCT) in adult patients who have an indication for percutaneous nephrolithotomy. A contemporary percutaneous nephrolithotomy is performed. Once the surgeon is convinced of a stone-free status by means of fluoroscopy and nephroscopy, randomization allocates patients to either the study group in whom an intraoperative CBCT scan is performed or to the control group in whom no intraoperative CBCT scan is performed. The main endpoint is the stone-free status as assessed four weeks postoperatively by low-dose non-contrast abdominal CT, as a standard follow-up procedure. Secondary endpoints include the number of PCNL procedures required and the number of stone-related events (SREs) registered. The total study population will consist of 320 patients that undergo PCNL and are eligible for randomization for an intraoperative CBCT scan. DISCUSSION: We deem a randomized controlled trial to be the most effective and reliable method to assess the efficacy of CBCT in PCNL. Though some bias may occur due to the impossibility of blinding the urologist at randomization, we estimate that the pragmatic nature of the study, standardized circumstances, and follow-up methods with pre-defined outcome measures will result in a high level of evidence. TRIAL REGISTRATION: Netherlands Trial Register (NTR) NL8168 , ABR NL70728.042.19. Registered on 15 October 2019. Prospectively registered.