Protected biofactors and antioxidants reduce the negative consequences of virus and cold challenge by modulating immunometabolism via changes in the interleukin-6 receptor signaling cascade in the liver.

Protected biofactors and antioxidants (PBA), and protected biofactors and antioxidants with protected organic acids and essential oils (PBA+POAEO) have been shown to have benefits in stressed or challenged birds. Here, we describe the immunometabolic changes observed in the liver of Ross 308 broilers during feed supplementation and brief physiological stress. These studied additives contain protected essential oils, organic acids, and vitamins which may have protective effects on the liver. Thus, we aimed to determine the signaling changes induced by these supplements and the resultant immunometabolic effects in the liver. All birds received a 2X dose of live bronchitis vaccine at d 0 and a 48-h cold challenge by reducing the temperature from 30 to 32°C, to 20 to 23°C on d 3 to 5. Control birds were fed a standard diet without supplementation. Liver samples were collected to evaluate the effects of these treatments on cytokine gene expression and protein phosphorylation via kinome peptide array. ANOVA was used for statistical analysis of the gene expression data (significance at a p-value of 0.05), and PIIKA2 was used for statistical evaluation and comparative analysis of the kinome peptide array data. At d 15, the kinome peptide array analysis and gene expression data showed stimulation of the interleukin 6 receptor (IL-6R) signal transduction for host protection via heightened immune response while inducing immune modulation and reducing inflammation in both supplement treated groups. Significant changes were observed via IL-6R signaling in the metabolic profiles of both groups compared to control and no significant differences when compared to each other. In the liver, these 2 feed additives induced immunometabolic changes predominantly via the IL-6 receptor family signaling cascade. Differences between the 2 treated groups were predominantly in the metabolic pathways, centered around the mTOR pathway and the proteins AMPK, mTOR and S6K, with a more anabolic phenotype following the addition of essential oils.

Protected biofactors and antioxidants reduce the negative consequences of virus and cold challenge while enhancing performance by modulating immunometabolism through cytoskeletal and immune signaling in the jejunum.

The aim of this study was to evaluate the effectiveness and mechanism of action of 2 feed additives in reducing the impacts of virus and temperature stressors. We determined the effects of protected biofactors and antioxidants (P(BF+AOx)), and protected biofactors and antioxidants with protected organic acids and essential oils (P(BF+AOx)+P(OA+EO)) on the immune and metabolic health of Ross 308 broiler chickens. These biofactors and antioxidants were derived from vitamins, and Aspergillus niger, Aspergillus oryzae and Bacillus subtilis fermentation extracts. All Ross 308 chickens were exposed to a double-dose of live bronchitis vaccine at d 0 and environmentally challenged by reducing the temperature from 32°C to 20°C at d 3 for 48 h. Control birds were fed without feed additives in the diet. Performance data and jejunum samples were collected to evaluate the effects of these treatments on growth, cytokine expression, and protein phosphorylation via kinome peptide array. ANOVA was used for statistical analysis of the performance and gene expression data (p-value of 0.05), and PIIKA2 was used for statistical evaluation and comparison of the kinome peptide array data. The P(BF plus;AOx) and P(BF+AOx)+P(OA+EO) treatments significantly increased bird weight gain and decreased feed conversion. The kinome peptide array data analysis showed increased activity of cytoskeletal, cell growth and proliferation proteins, and metabolic signaling in the jejunum of P(BF+AOx)+P(OA+EO) treated chickens. There was a significant decrease in IL-6 gene expression in the jejunum of P(BF+AOx)+P(OA+EO) samples compared to control at d 15. P(BF+AOx)+P(OA+EO) treatments in the jejunum showed strong immunomodulatory effects, perhaps to control inflammation. P(BF+AOx)+P(OA+EO) improves gut health via growth and metabolic signaling in the jejunum while inducing stronger immunomodulation.

A protected complex of biofactors and antioxidants improved growth performance and modulated the immunometabolic phenotype of broiler chickens undergoing early life stress.

We evaluated the supplementation of a protected complex of biofactors and antioxidants [P(BF+AOx)] on growth performance, antioxidant activity, expression of immune-related genes, and immunometabolic phenotype of broilers submitted to early life stressors. The treatments were a nutritionally complete basal diet supplemented or not with P(BF+AOx) (Jefo Nutrition Inc., Saint-Hyacinthe, QC, Canada) from 1 to 14 d of age. 720 one-day old male Ross 308 chickens were placed into pens of 30 birds (12 replicates/treatment). Birds were double-vaccinated against infectious bronchitis (IB; MILDVAC-Ma5T) at the hatchery and submitted, on d 3, to an acute reduction on environmental temperature (from 32° C to 20°C) for 48 h. Feed intake (FI), body weight gain (BWG), and feed conversion ratio (FCR) were calculated weekly. On d 7 and 15, samples were collected for expression of immune-related genes and kinome array analysis, and serum to evaluate the antioxidant status. Data were analyzed by ANOVA using SAS (SAS 9.4). From d 1 to 21 and d 1 to 28, the dietary supplementation of P(BF+AOx) significantly increased BWG (P < 0.05) by 3.6 and 3.8%, respectively, and improved FCR (P < 0.05) by 1.2 and 1.8%, respectively. From d 1 to 35, dietary supplementation enhanced BWG (P = 0.03) by 4%. Serum glutathione reductase activity on d 15 was higher in birds fed diets supplemented with P(BF+AOx) compared to the control diet-fed birds (P = 0.04). Dietary supplementation reduced the expression of IL-1ß (P = 0.03) in the lungs on d 7. On d 15, dietary supplementation increased the expression of IL-6 (P = 0.02) and IL-10 (P = 0.03) in the liver. It was observed that, via decreased phosphorylation, catalase was activated in the jejunum and liver, and the phosphorylation of immunoregulatory or proinflammatory proteins was decreased. Other important cellular signaling pathways were also changed in the liver and jejunum due to the supplementation. The supplementation of P(BF+AOx) improves growth performance by promoting a general anti-inflammatory and antioxidant response in chickens undergoing early life stress.

[Correction of a post-traumatic femoral length difference using an intramedullary distraction nail]. / Korrektur einer posttraumatischen femoralen Beinverkürzung mit einem intramedullären Distraktionsmarknagel.

AIM: For the operative adjustment of a leg length shortening and for correcting an angular deformity, an external fixator is the most frequently used technique today. This method may, however, be complicated by painful soft tissue and muscle fixations, pin infections and psychic strain as well as by long treatment duration with the external fixator. The intramedullary skeletal kinetic distractor (ISKD) is an internal lengthening nail, which promises a postoperative course without further complications. METHOD: We used the ISKD nail in a 28-year-old traumatised motorcyclist, in whom, after removal of a comminuted femur bone fragment, a leg length shortening of 8 cm resulted. RESULTS: After uneventful healing of all fractures and having performed implant removal, we implanted an ISKD nail for femoral lengthening. The following distraction resulted, without considerable complications, in a complete compensation of the leg difference. CONCLUSIONS: The ISKD nail is a suitable procedure to compensate for post-traumatic leg length differences, which exhibits, in contrast to the frequently used external fixator, a largely uncomplicated course. It cannot be used to correct a gross transverse or rotational deformity.

Cleaner LASIK is possible.

LASIK (laser in situ keratomileusis) surgery is the most frequently performed refractive procedure for correcting nearsightedness, farsightedness, and astigmatism. Its popularity increased over the late 1990's, rapidly replacing Radial Keratotomy (RK). The LASIK operation and excimer laser surface ablation procedures gained the rapid acceptance of refractive physicians and patients over the RK procedure because of greater predictability, precision, safety, and stable vision. In the mid 90's, when doctors first began performing LASIK, it was referred to implicitly as the "FLAP and ZAP" procedure. This of course was an overly confident misstatement as unfamiliar complications began to appear. One of the ultimate goals in performing any surgical procedure is to minimize less than desirable outcomes arising from both infectious and non-infectious contaminants entering the surgical field. This is especially true of all corneal procedures, such as LASIK, where the normal mechanisms for fighting contaminations are diminished.

Clinical and radiographic scores in haemophilic arthropathies: how well do these correlate to subjective pain status and daily activities?

Haemophilic patients who reached adulthood before the establishment of prophylactic treatment frequently show multiple and substantial arthropathies. The aim of this study was to determine to what extent haemophiliac's subjective impairment due to arthropathies correlates with objective clinical and radiographic parameters. By means of a questionnaire and a visual analogue scale, we consulted 79 haemophiliacs concerning their joint-pain status, how these were treated and to what extent their daily activities had been affected. Using a scoring system suggested by the Advisory Committee of the World Federation of Haemophilia, clinical evaluation was performed. Radiographs of 60 patients were assessed by means of the Petterson scale. The results were statistically compared. We found a significant correlation between pain intensity and clinical pathology as well as between pain intensity and radiographic joint damage for both knees and for the right ankle. The number of painful joints correlated well with the number of clinically/radiographically affected joints. The more pronounced the objective damage to joints, the more frequently patients claimed to have constant pain, depressive episodes and a dependency on pain-relieving medication. The more pronounced the objectively assessed damage to the knee and ankle joint, the higher the likelihood that the patient suffers from severe joint pain and reduction of activity. Treatment of painful symptoms from arthropathies is often insufficient. Scores and questionnaires may help to define the haemophiliacs pain status more clearly, thereby offering a possibility of assessment and long-term observation.

Cardiac surgery in octogenarians; peri-operative outcome and long-term results.

AIMS: Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older. METHODS AND RESULTS: Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2.8%) and 41 (58%); aortic valve replacement: 6 (8.5%), 2 (2.8%) and 32 (45.7%); aortic valve replacement+CABG: 8 (26.5%), 1 (3.8%) and 14 (46.6%); mitral valve repair/replacement: 3 (25%), 1 (8.3%) and 5 (41.6%). Multivariate predictors (P<0.05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65.8+/-8.8%; aortic valve replacement, 63.6+/-7.1%; aortic valve replacement+CABG, 62.4+/-6.8%; mitral valve repair/replacement, 57.1+/-5.6%; and total, 63.0+/-5.6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice. CONCLUSION: Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good.

AANA journal course: update for nurse anesthetists--the ruddy globule: the erythrocyte--its biology, chemistry, and functional variations.

Red blood cells were first observed in the mid-1600s and termed ruddy globules for their conspicuous shape and color. Since that time, the functional significance of this extraordinary membranous pouch of proteins and electrolytes has been carefully detailed. The architecture of the red blood cell, the biochemistry of hemoglobin, the mechanics of the oxygen-hemoglobin affinity-altering diphosphoglycerate compounds, and the variants of hemoglobin are reviewed. Far from being a simple transport vehicle of oxygen to and from tissues, the red blood cell is a multifunctional entity whose absence would make life as we know it impossible.

Contribution of erythrocytes and plasma in threonine and lysine transfer across the portal drained viscera and the liver in pigs. Effect of threonine and lysine dietary supply.

Contributions of erythrocytes and plasma to threonine and lysine transport across the PDV and the liver were determined in growing pigs successively fed a threonine deficient diet and a control well-balanced diet (experiment 1) or a lysine deficient or a well-balanced diet (experiment 2). The animals were surgically prepared for insertion of chronic catheters in the mesenteric vein (MV), the portal vein (PV), a hepatic vein (HV) and the carotid artery (CA). Plasma and whole blood AA concentrations in PV, HV and CA and PV and HV blood flows were determined during 6 hours of para-aminohippuric acid constant infusion. During this period the pigs were continuously fed (1 meal per hour). The contribution of plasma to lysine and threonine transport was higher in pigs fed the well balanced diets. More than 50% of threonine and lysine appearing in the PV and in the HV are transported by the plasma. Our results suggest that erythrocytes are probably little involved in lysine and threonine transfer across the liver and digestive tract of pig continuously fed.

[Sub-valvular aortic stenosis by a discrete membrane]. / La sténose sous-valvulaire aortique d'origine membraneuse.

We report the case of a 55 year old patient presenting a discrete obstructive sub-aortic membrane. After clinical examination, complete echocardiographic evaluation and cardiac catheterisation, an operative procedure was decided and the sub-aortic membrane was resected. The results were satisfactory but the literature reports risks of re-obstruction of the left ventricular outflow tract. The article points out the importance of an early diagnosis and further stresses the major role played by transoesophageal echocardiography in the evaluation of the patient.

Aortic valve replacement in the octogenarians: perioperative outcome and clinical follow-up.

OBJECTIVES: To determine long-term results of aortic valve replacement (AVR) in patients 80 years old or older, and assess the factors influencing perioperative outcome. METHODS: Data were reviewed on 83 consecutive octogenarians, undergoing aortic valve replacement between 1992 and 1997. There were 66 women and 17 men (mean age: 82.8 years). Fifty-seven patients (69%) were in New York Heart Association (NYHA) class III-IV and six had previous myocardial infarction. Three patients had previous percutaneous aortic valvuloplasty. There were 19 urgent procedures (23%). Coronary artery bypass grafting (CABG) was performed on 21 patients (25%). Possible influence of preoperative and operative variables on early and late mortality was performed with univariate and multivariate statistical analysis, and survival was estimated with the Kaplan-Meier method. RESULTS: Operative mortality was 13% (9% for AVR, 24% for AVR-CABG). Postoperative complications were respiratory failure in 19 patients, atrial fibrillation in 19, hemodialysis in four, myocardial infarction in four and stroke in two patients. Five patients required pacemaker insertion for permanent atrioventricular block. Median hospital stay and intensive care unit stay were 19.8 +/- 12.2 days and 7.9 +/- 3.4 days, respectively. Multivariate predictors of hospital death (P < 0.05) were percutaneous aortic valvuloplasty, NYHA class IV, and urgent procedure. Mean follow-up was 26.5 months. Survival at 1, 2, and 5 years was 98.5 +/- 1.4% (63 patients at risk), 93.4 +/- 3.2% (47 patients at risk), and 78.2 +/- 6.9% (six patients at risk), respectively. Preoperative myocardial infarction and urgent procedure were independent predictors of late death. At most recent follow-up, 91% were angina free and 81% were in class I-II. CONCLUSIONS: Aortic valve replacement in octogenarians can be performed with acceptable mortality. These results stress the importance of early operation on elderly patients with aortic valve disease. Both long-term survival and functional recovery are excellent.

Cefalosporinas orales. Revisión bibliográfica / Orals cephalosporins. Bibliography reviewing

Dado el uso cada vez más frecuente de los antibióticos orales para el tratamiento de infecciones ligeras y moderadas, tanto de pacientes hospitalizados como ambulatorios, con garantía de eficacia, buena tolerancia, escasas reacciones adversas, mínima necesidad de monitorización y disminución de los costos, se revisa una familia antimicrobiana representativa de lo antes expuesto: la cefalosporina. Se destacan las diferentes generaciones, farmacocinesia, aspecto antimicrobiano, uso clínico, dosis recomendadas, entre otros aspectos (AU)