Broiler chicken response to xylanase and fermentable xylooligosaccharide supplementation.

A study was conducted to determine the effect of dietary fiber (DF), xylanase (XYL), xylooligosaccharides (XOS), and a combination of XYL and xylooligosaccharides (STBIO) on chicken growth performance, N-corrected apparent metabolizable energy (AMEn), and nutrient availability, characteristics of the gastrointestinal tract (GIT), and cecal content of short-chain fatty acids (SCFA). A 35-day experiment was performed on 1,920 as hatched Ross 308 broiler chicks, reared in 96 pens and fed ad libitum. Experimental diets were split into 2 phases: starter (0-21 d) and finisher (22-35 d). There were 2 basal diets, first contained 54% maize and in the second, 5% of the maize was replaced by wheat bran as DF. The diets were split into 4 batches: one of them was used as a control, and each of the others were supplemented either with XYL or XOS or with the STBIO. Each diet was fed to 12 pens following randomization. The data were analyzed in GenStat (20th edition) by ANOVA using a 2 × 4 factorial design. The addition of STBIO improved feed conversion ratio (FCR) and increased weight gain (WG) from 21 to 35 d and from 0 to 35 d (P < 0.05). The inclusion of DF had a negative effect on N and fat retention coefficients at 35 d as well as AMEn and dry matter retention at 21 and 35 d. At 21 d, neutral detergent fiber (NDF) retention was increased when xylanase and STBIO were added to the diet (P < 0.001) and at d 35 the highest retention was noted when the diet was supplemented with DF and XYL or STBIO (P = 0.001). There was no dietary effect on jejunum histomorphometry (P > 0.05). The addition of DF increased the concentration of cecal SCFA in particular valeric and propionic acid at 35-day-old birds (P < 0.05). It can be concluded that addition of STBIO in diet could provide benefits in terms of fiber degradation, WG, and feed efficiency.

Dietary microbial muramidase improves feed efficiency, energy and nutrient availability and welfare of broilers fed commercial type diets containing exogenous enzymes.

1. The aim of this study was to evaluate the effect of graded levels of the microbially derived feed lysozyme, muramidase (MUR) on feed intake (FI), weight gain (WG), feed conversion ratio (FCR), European Performance Index (EPI), dietary N-corrected apparent metabolisable energy (AMEn), footpad dermatitis score (FPD) and other welfare variables, when fed to broilers from 0 to 42d age. 2. A four-phase dietary programme and four experimental pelleted diets were used; a control diet (following breeder recommendations without MUR supplementation), and three diets based on the control diet supplemented with 25,000, 35,000 and 45,000 LSU (F)/kg of MUR, respectively. In addition, all experimental diets contained exogenous xylanase, phytase and a coccidiostat. Each diet was fed to birds in 24 pens (20 male Ross 308 chicks in each pen) following randomisation. Dietary AMEn was determined at 21 d of age, and FPD was evaluated at the end of the study. Data were analysed by ANOVA, using orthogonal polynomials for assessing linear and quadratic responses to MUR activity. 3. The inclusion of MUR did not change FI (P > 0.05), but increased WG in a linear manner (P < 0.05) and reduced FCR in a quadratic manner, with optimum WG and FCR observed in birds fed approximately 35 000 LSU (F)/kg. In accordance with the improvement in FCR, 35 000 LSU (F)/kg MUR supplementation produced the highest EPI (P < 0.05). FPD score was linearly decreased with increased addition of MUR (P < 0.05). Dietary AMEn responded in a quadratic fashion to the MUR inclusion, as the highest values were obtained with the highest inclusion rate (P < 0.05). 4. In conclusion, the results showed that inclusion of MUR improved feed efficiency and the foot health of birds.

Advantage of four-electrode over two-electrode defibrillators.

Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock.

Thresholdless nanoscale coaxial lasers.

The effects of cavity quantum electrodynamics (QED), caused by the interaction of matter and the electromagnetic field in subwavelength resonant structures, have been the subject of intense research in recent years. The generation of coherent radiation by subwavelength resonant structures has attracted considerable interest, not only as a means of exploring the QED effects that emerge at small volume, but also for its potential in applications ranging from on-chip optical communication to ultrahigh-resolution and high-throughput imaging, sensing and spectroscopy. One such strand of research is aimed at developing the 'ultimate' nanolaser: a scalable, low-threshold, efficient source of radiation that operates at room temperature and occupies a small volume on a chip. Different resonators have been proposed for the realization of such a nanolaser--microdisk and photonic bandgap resonators, and, more recently, metallic, metallo-dielectric and plasmonic resonators. But progress towards realizing the ultimate nanolaser has been hindered by the lack of a systematic approach to scaling down the size of the laser cavity without significantly increasing the threshold power required for lasing. Here we describe a family of coaxial nanostructured cavities that potentially solve the resonator scalability challenge by means of their geometry and metal composition. Using these coaxial nanocavities, we demonstrate the smallest room-temperature, continuous-wave telecommunications-frequency laser to date. In addition, by further modifying the design of these coaxial nanocavities, we achieve thresholdless lasing with a broadband gain medium. In addition to enabling laser applications, these nanoscale resonators should provide a powerful platform for the development of other QED devices and metamaterials in which atom-field interactions generate new functionalities.

Correlation between pathological distal esophageal acid exposure and ineffective esophageal motility.

AIM: To assess the correlation between esophageal dysmotility, characterized as inefficient esophageal motility (IEM), and the presence of pathological acid reflux due to a structurally defective lower esophageal sphincter (LES), hiatus hernia. (HH), or esophagitis in patients with suspected gastroesophageal reflux disease (GERD). METHODS: 311 patients referred for GERD diagnostic procedures in a gastroesopahgeal motility laboratory were included in the study. Patients underwent an interview regarding their clinical symptoms, upper endoscopy (UE), stationary esophageal manometry, and 24-h esophageal pH-metry. The following risk factors of patients in the negative pH-metry group were compared to those in the positive pH-metry group: IEM, defective LES, HH, and esophagitis. The association between IEM and positive pH-metry results was first assessed by means of univariate analysis and later determined with multivariate logistic regression analysis. RESULTS: Out of the total of 311 studied patients, 208 met the inclusion criteria; 88 had normal and 120 had positive pH-metry results. Univariate analysis revealed that the occurrence of IEM, defective LES, and HH was significantly greater in the positive pH-metry group. Following logistic regression analysis, the occurrence of IEM remained significantly greater in the positive pH-metry group. CONCLUSIONS: IEM is associated with the presence of abnormal acid reflux, as assessed by 24-h esophageal pH-metry, regardless of the presence of defective LES, HH, or esophagitis.

Current concepts in the anatomy and origin of pharyngeal diverticula.

The role of this paper is to present the current concepts in anatomy and etiopathogenesis of pharyngeal diverticula. Precise anatomical considerations highly emphasizing the weak anatomic areas which predispose the pouch formation are discussed. Focus exposed in details will also be given upon the structural and functional characteristics of the upper esophageal sphincter as well as to its physiological states, architecture and dynamic functions. A brief review of historical and current perspectives regarding the origin of pharyngeal diverticula has also been given. Special attention is given to the abnormal cricopharyngeal function in patients with pharyngeal pouches in the terms of altered UES compliance, importance of gastroesophageal reflux and histopathologic changes of cricopharyngeal muscle.

Surgical experience of the national institution in the treatment of Zenker's diverticula.

AIM: To review the 8-year experience of the Department of Esophagogastric Surgery, First Surgical University Hospital in Belgrade in the surgical management of Zenker's diverticula (ZD). METHODS: Between January 2000 and January 2009, 52 patients underwent surgical procedure for the treatment of ZD. Complete preoperative workup including the symptom evaluation and large variety of structural and functional diagnostic procedures were conducted before the surgery. After the operative treatment patients underwent detailed follow-up in regular intervals up to 3 years. RESULTS: Preoperative evaluation marked higher incidence of hiatal hernia and pathologic gastroesophageal reflux (GER) among the patients with ZD then in normal population. According to the preoperative evaluation and size of diverticula, as well as due to the intraopertive findings, a variety of surgical procedures were performed, including myotomy alone (n = 2), diverticulopexy and myotomy (n = 36) and diverticulectomy and myotomy (n = 14). Regardless of the operative treatment no salivary cervical fistulas were observed. Late and early postoperative results revealed low incidence in postoperative transitory dysphagia or regurgitation. CONCLUSION: The results of this study show that the open surgical procedures are safe and effective in the treatment of ZD. Cricopharyngeal myotomy remains the essential focus of treatment, while the choice of resecting or suspending the diverticulum is brought upon its size. Complete preoperative investigation must be conducted in ZD patients, and the role of pathologic GER must be taken into account when we discuss the origin of this disorder.

Gastroesophageal reflux in infants and children.

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and the most frequent reason why infants are referred to the pediatric gastroenterologist, affecting as much as 30% of the pediatric population. Presenting features of GERD in infants and children are quite variable and follow patterns of gastrointestinal and extra-esophageal manifestations that vary between individual patients and may change according to age. Patients may be minimally symptomatic, or may exhibit severe esophagitis, bleeding, nutritional failure, or severe respiratory problems. GERD is also complex for the diagnostic techniques required to assess its repercussions or explain its origin. Although different abnormalities in motility variables, such as lower eso-phageal sphincter (LES) function, esophageal peristalsis and gastric motor activity can contribute to the development of GERD, the degree of esophageal acid exposure represents the key factor in its pathogenesis. Esophageal pH monitoring, based on both the detection of acid reflux episodes and the measurement of their frequency and duration, has been regarded as the most sensitive and specific diagnostic tool for diagnosing reflux disease. The aim of this paper is to give a concise review for the clinicians encountering this specific disease in infants and children.

Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience.

The objective of this article was to analyze 40 years of experience of colon interposition in the surgical treatment of caustic esophageal strictures from the standpoints of our long-term personal experience. Colon interposition has proved to be the most suitable type of reconstruction for esophageal corrosive strictures. The choice of colon graft is based on the pattern of blood supply, while the type of anastomosis is determined by the stricture level and the part of colon used for reconstruction. In the period between 1964 and 2004, colon interposition was performed in 336 patients with a corrosively scared esophagus, using the left colon in 76.78% of the patients. In 87.5% a colon interposition was performed, while in the remaining patients an additional esophagectomy with colon interposition had to be done. Hypopharyngeal strictures were present in 24.10% of the patients. Long-term follow-up results were obtained in the period between 1 to up to 30 years. Early postoperative complications occurred in 26.48% of patients, among which anastomosic leakage was the most common. The operative mortality rate was 4.16% and late postoperative complications were present in 13.99% of the patients. A long-term follow up obtained in 84.82% of the patients found excellent functional results in 75.89% of them. We conclude that a colon graft is an excellent esophageal substitute for patients with esophageal corrosive strictures, and when used by experienced surgical teams it provides a low rate of postoperative morbidity and mortality, and long-term good and functional quality of life.

[Hiatal hernia of the esophagus and GERD as a cause of hemorrhage].

Bleeding complications arise in 1/4 of patients with hiatal hernia and GERD, and are the cause in 10% of all acute and 1/3 of chronic foregut bleedings. Most common bleeding disorders directly related to hiatal hernia and GERD are: hiatal hernia ulcers, erosive esophagitis, esophageal ulcers, peptic strictures and Barrett esophagus. The aim of this review article is to point out a significance of proper diagnosis and treatment for conditions bonded with hiatal hernia and GERD which can lead to severe esophageal bleedings. Detailed etiology, incidence, diagnostic algorithm and treatment of Cameron lesions, prolapse gastropathy, erosive esophagitis, peptic esophageal ulcers and postoperative complications related to hiatal hernia and GERD are presented in this article.

Surgical treatment and clinical course of patients with hypopharyngeal carcinoma.

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.

Primary esophageal motility disorders (concise review for clinicians).

Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Some, such as achalasia, are diseases with a well defined pathology, characteristic manometric features, and good response to treatments directed towards the palliation of symptoms. Other disorders, such as diffuse esophageal spasm and nutcracker esophagus, have no well defined pathology and could represent a range of motility abnormalities associated with subtle neuropathic changes, gastresophageal reflux and anxiety states. On the other hand, hypocontracting esophagus is generally caused by weak musculature commonly associated with gastresophageal reflux disease. Although manometric patterns have been defined for these disorders, the relation with symptoms is poorly defined and in some cases the response to medical or surgical therapy unpredictable. The aim of this paper is to present a wide spectrum of the primary esophageal motility disorders, as well as to give a concise review for the clinicians encountering these specific diseases.

[The influence of Helicobacter pylori eradication on appearance of gastro-oesophageal reflux disease].

UNLABELLED: Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric acid regurgitation through the incompetent lower oesophageal sphincter in oesophagus. Etiopathogenesis of GERD is multifactorial. AIM OF THIS STUDY: to establish the relationship between Helicobacter pylori eradication and appearance or aggravating of present GERD. If this relationship exist, the aim is to estimate its level and clinical consequences. MATERIAL AND METHODS: 50 Helicobacter pylori positive patients with different endoscopic findings (ulcer disease, gastritis and non-ulcer dyspepsia) to whom eradication of Helicobacter pylori was done, were following next 6 months. Questionnaire, uppear GI endoscopy with verification changes of oesophagus in accordance to LA classification, histopathological examination of gastric and oesophageal mucosal biopsy specimens, and oesophageal manometry have been done to all patients. These examinations have been done before Helicobacter pylori eradication and one, three. six and none months after that. RESULTS: non statistical significant difference was found among the appearance or aggravating of present GERD in all patients during the following period (Cochran Q test; p=0,408). Non statistical significant difference was found among the endoscopic types of oesophagitis (LA classification) in all patients during the following 6 months (Friedman test; p=0,058). Non statistical significant difference was found among the changes of histopathological findings on distal oesophagus, too (Friedman test; p=0,217). CONCLUSION: Eradication od Helicobacter pylori infection does not cause the appearance or aggravating of present GERD. The presence of mildly form of GERD, or aggravating of present GERD is transitory, and haven't the statistical signification.

The significance of lymphonodal micrometastasis in the patients with gastric adenocarcinoma.

Micrometastasis is defined as microscopical deposit of malignant cells, less than 2mm in diameter, separated from the primary tumor. This does not include discontinous growth in peritumoral region, but include microinolvement of regional lymph nodes. The literature on micrometastases, with special resperct to nodal micrometastasis, and their implications in gastric adenocarcinoma have been reviewed. Immunohistochemical detection offer the best accuracy for detection of nodal micrometastasis. Molecular techniques are more sensitive than method of immunohistochemical detection, but methods are compromised with false positive results caused by various sources of biological contamination. It is more than obvious that there is no definite agreement neither about risk factors, nor definitive clinical significance of micrometastatic node involvement in the patients with gastric adenocarcinoma. At present, the role of occult lymph node involvement proved its significance in two major fields: defining criteria for limited surgical dissection in the patients with early (sm) carcinoma in respect to detection of micrometastatic tissue in sentinel lymph node, and distinguishing the category of pN0 (Mi+) patients with potential benefit of postoperative adjuvant therapy.

The chemical composition of some Lauraceae essential oils and their antifungal activities.

The antifungal activity of Aniba rosaeodora, Laurus nobilis, Sassafras albidum and Cinnamomum zeylanicum essential oils were investigated against 17 micromycetes. Among the tested fungal species were food poisoning, spoilage fungi, plant and animal pathogens. In order to determine fungistatic and fungicidal concentrations (MIC and MFC) macrodilution and microdilution tests were used. Linalool was the main component in the essential oil of A. rosaeodora, while 1.8-cineole was dominant in L. nobilis. In sassafras essential oil safrole was the major component and in the oil of C. zeylanicum the main component was trans-cinnamaldehyde. The essential oil of cinnamon showed the strongest antifungal activity.

[Strategy in the treatment of hypopharyngeal and cervical esophageal carcinoma]. / Strategija u lecenju karcinoma hipofarinksa i cervikalnog jednjaka.

In the period between January 1st, 1978 and January 1st, 2003, 82 unselected patients with hypopharyngeal and cervical esophageal squamocellular carcinoma were treated at the Department of Esophagogastric Surgery, First University Surgical Hospital, Clinical Center of Serbia. In 43 (52.4%) patients operated with curative intent, radical surgical en-block resection and functional neck dissection has been performed. In 26 (60.5%) patient reconstruction was performed with stomach, in 11 (25.6%) left colon, and 6 (14%) free jejunal transfer. The overall 2-year and 5-year survival rate were 55.88% (19 patients) and 26.47% (9 patients), respectively. No patient undergoing nutritive gastrostomy and radiotherapy was alive after two years. At present surgery looks like the treatment of choice for hypopharyngeal and cervical esophageal carcinoma, providing a definitive palliation of dysphagia and better long-term survival. Free jejunal transfer has become the standard technique for reconstruction of the pharynx and hypopharynx especially with proximal lesions, whereas, gastric tube interposition is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when the resection extends below the thoracic inlet or when there is a presence of synchronous carcinoma of theesophageal.

Isolated choroidal metastasis from primary adenocarcinoma of the distal esophagus: a case report.

We present a case of a 41-year-old male patient who, 1 year after transhiatal esophagectomy and transmediastinal gastroplasty for an adenocarcinoma of the distal esophagus, presented with an isolated metastasis in the choroids of the left eye. Because of pains caused by secondary glaucoma, enucleation of the left eyeball had to be performed as the treatment of choice. At 1 year after surgery of the eye, the secondaries in both adrenal glands were revealed. Despite the applied chemotherapy, the patient died with signs of generalized disease 3 years after the initial surgery.

[History of surgery of stomach and cardial carcinoma]. / Istorijat hirurgije karcinoma zeluca i kardije.

Despite the marked decline in incidence during last 50 years, gastric cancer remains significant cause of mortality and morbidity worldwide. According to data in 1984. incidence in Yugoslavia was 35 per 100,000. In the United States, where incidence is not high, 24,000 new cases and 13,300 deaths had been estimated for the year 1992. Despite fact that modern diagnostic and surgical concept changed perspective for significant number of the patients with gastric carcinoma, most authors agree that Gastric cancer may be the most seriously mismanaged malignancy from a surgical perspective in the USA ... (Paul H. Sugarbaker, M.D, April 1999.) Analyzing medical literature, with special respect to domestic literature, authors analyzed historical data of gastric cancer surgery.

[History of the evolution of surgical treatment of gastroesophageal reflux disease]. / Istorijska evolucija hirurskog lecenja gastroezofagealne refluksne bolesti.

The GERD has probably existed since the beginning of mankind but it took several millennia since any perception or knowledge of this disease started to evolve. Homo est quod est--the man is what he eats is an old Latin proverb and heartburn has been one of the most common documented symptoms in humans in the last two centuries. The term peptic esophagitis has been introduced in 1935, but the evolution of knowledge of pathogenesis, incidence, complications and way of treatment of GERD has been quite slow. In the last decade several new aspects of these problem have evolved and probably explained many unanswered questions of this very common and sometimes severe disease.