Skeletal muscle fitness and physiology as determinants of firefighter performance and safety: a narrative review.

Firefighters routinely perform tasks that are reliant on their muscular fitness, which includes muscular strength, power and endurance. Separately, firefighters can present with unique skeletal muscle physiology characteristics due to the strenuous nature of this occupation. This review aims to summarise muscular fitness and physiology as determinants of a firefighter's ability to perform occupation-specific tasks, identify the relevance of both muscular fitness and physiology to a firefighter's risk for sustaining a work-related injury, and address the contributions of muscular fitness and physiology on a firefighter's ability to recover from tasks and their readiness for performing subsequent or future tasks. The presented evidence reveals muscular fitness can determine a firefighter's capacity to perform their job effectively, while also influencing risk for occupational injury. Collectively, this review indicates exercise training emphasising improvements in muscular strength, power, and endurance (i.e. resistance training) should be encouraged in this occupation.

This review addressed muscular fitness and physiology in firefighters. Current evidence suggests firefighter task performance and risk for injury is associated with high levels of muscular fitness. Additionally, firefighters undergo unique changes in muscle morphology and physiology that can negatively affect the ability to safely perform occupation-specific tasks repeatedly.

Sudden Cardiac Death in People With Schizophrenia: Higher Risk, Poorer Resuscitation Profiles, and Differing Pathologies.

BACKGROUND: People with schizophrenia account for approximately 1.0% of the population and seem to experience increased rates of sudden cardiac death (SCD). OBJECTIVES: This study sought to determine characteristics of increased SCD in people with schizophrenia. METHODS: The End Unexplained Cardiac Death (EndUCD) prospective state-wide registry compared people aged 15 to 50 years with and without schizophrenia who experienced SCD within a 2-year time period and were referred for forensic evaluation. RESULTS: We identified 579 individuals, of whom 65 (11.2%) had schizophrenia. Patients with schizophrenia were more commonly smokers (46.2% vs 23.0%; P < 0.0001), consumed excess alcohol (32.3% vs 21.4%; P = 0.05), and used QTc-prolonging medications (69.2% vs 17.9%; P < 0.0001). They were less likely to arrest while exercising (0.0% vs 6.4%; P = 0.04). Unfavorable arrest-related factors included lower rates of witnessed arrest (6.2% vs 23.5%; P < 0.0001), more likely to be found in asystole (92.3% vs 73.3%; P < 0.0001), and being more likely to be found as part of a welfare check after a prolonged period of time (median 42 hours vs 12 hours; P = 0.003). There was more frequent evidence of decomposition, and they more commonly underwent autopsy (41.2% vs 26.4%; P = 0.04 and 93.8% vs 82.5%; P = 0.05), with a diagnosis of nonischemic cardiomyopathy being more common (29.2% vs 18.1%; P = 0.04). CONCLUSIONS: People with schizophrenia account for 11% of young SCD patients referred for forensic investigations, exceeding population rates by 11-fold. They have a higher preexisting cardiac risk factor burden, unfavorable resuscitation profiles, and higher rates of nonischemic cardiomyopathy. Strategies targeting biopsychosocial support may deliver not only psychological benefits, but also help to decrease unwitnessed cardiac arrest.

Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry.

BACKGROUND: Administrative coding of out-of-hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain. AIM: To characterize the prevalence and type of non-informative diagnoses in a young cardiac arrest population. METHODS: Hospital discharge diagnoses provided to a statewide OHCA registry were characterised as either 'informative' or 'noninformative.' Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared. RESULTS: Of 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019). CONCLUSION: Almost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at-risk family care, data sampling strategies, international statistics and research funding.

MK2 Inhibitors as a Potential Crohn's Disease Treatment Approach for Regulating MMP Expression, Cleavage of Checkpoint Molecules and T Cell Activity.

Crohn's Disease (CD) and Ulcerative Colitis (UC) are the two major forms of inflammatory bowel disease (IBD), which are incurable chronic immune-mediated diseases of the gastrointestinal tract. Both diseases present with chronic inflammation that leads to epithelial barrier dysfunction accompanied by loss of immune tolerance and inflammatory damage to the mucosa of the GI tract. Despite extensive research in the field, some of the mechanisms associated with the pathology in IBD remain elusive. Here, we identified a mechanism by which the MAPK-activated protein kinase 2 (MK2) pathway contributes to disease pathology in CD by regulating the expression of matrix metalloproteinases (MMPs), which cleave checkpoint molecules on immune cells and enhance T cell activity. By utilizing pharmaceuticals targeting MMPs and MK2, we show that the cleavage of checkpoint molecules and enhanced T cell responses may be reduced. The data presented here suggest the potential for MK2 inhibitors as a therapeutic approach for the treatment of CD.

Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry.

AIMS: The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS: A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION: Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.

Obesity in young sudden cardiac death: Rates, clinical features, and insights into people with body mass index >50kg/m2.

Objective: To contextualize obesity rates in young sudden cardiac death (SCD) against the age-matched national population, and identify clinical and pathologic features in WHO class II and III obesity. Methods: A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019-2021. Body mass indices (BMIs) of patients 18-50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI<30kg/m2) were compared. Clinical characteristics of people with BMI>50kg/m2 were assessed. Results: 504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p<0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p<0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p<0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or history of alcohol abuse (18.8% vs 26.9%, p=0.030). Patients with BMI>50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease. Conclusion: Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI>50 kg/m2 died from LVH, with fewer than 10% dying from coronary disease.

Abductive statistical methods improve the results of calibration curve bioassays: An example of determining zinc bioavailability in broiler chickens.

In this paper, we discuss the theory behind calibration curve experiments and their application to a zinc (Zn) bioavailability study with broiler chickens. Seven replicates of 16 male commercial broiler chicks were fed starter diets for 14 days. Six diets had different levels of a potential Zn source and one was a positive control with standard industry levels of Zn for comparison. Four commonly used methods of calculating bioavailability means and confidence intervals (CI) from a calibration curve (standard curve) experiment to estimate the bioavailability of a new zinc source in broiler chickens were compared. The methods compared were the following: 1) the Counter-Intuitive Method uses a multiple-range test to compare unknown test and standard samples; 2) the Intuitive Method uses standard linear regression and inverts the equation to predict Zn bioavailability for each replicate of test samples; 3) the Abductive Method uses Graybill's Equation, based on theory and observation, to estimate CI's; and 4) the Sophistic Method uses reverse regression, and calculates Zn bioavailability values directly from the equation. The Counter-Intuitive Method only gives information about which standards the test samples are, or are not, significantly different from respectively (average available Zn not predicted). The Intuitive Method ignores error about the standard curve and theoretically cannot estimate the CI directly ( X ¯ ± SEM  = 107.5 ± 15.8 mg Zn/kg). The Sophistic Method underestimates and overestimates the test sample mean values above and below the mean of the standards, respectively ( X ¯  = 96.6 mg Zn/kg). The Abductive Method has an advantage over the other methods: The mean prediction estimation is consistent with theory (107.5 ± 6.1 mg Zn/kg; X ¯ ± SEM ). When test or "unknown" samples are near the mean of the standard samples, the CI is smaller than when near the extremes of the calibration curve. When calibration curve error is small (R 2 > approximately 0.95), there is little advantage to using the Abductive Method, but when calibration curve error is larger, as in many bioassays with growing animals, the Abductive Method improves the accuracy of the CI calculations. The Abductive Method was used to demonstrate the influence of the number of replicate samples on experimental power and cost.

Ileal profile of non-starch polysaccharides and oligosaccharides in response to exogenous enzymes in broiler chickens offered wheat- or maize-based diets under subclinical necrotic enteritis challenge.

The present study evaluated the impacts of fibre-degrading enzymes on the profiles of non-starch polysaccharides (NSP) and oligosaccharides (OS) in the ileum of broiler chickens offered wheat- or maize-based diets under subclinical necrotic enteritis (NE) challenge. A 2 × 2 × 4 factorial arrangement of treatments was used. Factors were the following: NE challenge, no or yes; diet type, wheat- or maize-based; and supplemental enzymes, control (no enzyme), family 10 xylanase (XYN10), family 11 xylanase (XYN11) or ß-mannanase (MAN). Birds in the challenged group were inoculated with Eimeria on d 9 and Clostridium perfringens on d 14 and 15. A 3-way interaction (P = 0.047) occurred on overall (d 0 to 16) weight gain. When NE was present, all the supplemental enzymes increased weight gain in birds fed the wheat-based diet; whereas in those fed the maize-based diet supplemental XYN10 and XYN11 decreased weight gain. When NE was absent, birds fed the wheat-based diet supplemented with XYN10 or MAN presented increased weight gain compared to non-supplemented birds, but no improvements with enzyme addition were observed in birds fed the maize-based diet. A 3-way interaction (P = 0.002) was observed on insoluble NSP level in the ileum. When NE was absent, all the supplemental enzymes reduced the ileal level of insoluble NSP, regardless of diet type. In the challenged birds, supplementing XYN10 and MAN reduced insoluble NSP level in the ileum, but only in birds fed the wheat-based diet. Ileal soluble NSP level was reduced by supplemental XYN11 and MAN, but only in birds fed the wheat-based diet, resulting in a 2-way diet type × enzyme interaction (P < 0.001). Ileal OS arabinose (P = 0.030) level was highest in birds offered the wheat-based diet supplemented with XYN11. Collectively, supplementation of NSP-degrading enzymes to the wheat-based diet enhanced bird performance regardless of NE challenge, with XYN11 significantly increasing oligosaccharide release. However, enzyme addition did not improve growth performance in birds fed maize-based diet, with supplemental XYN10 and XYN11 impeding weight gain when NE was present.

Improving sorghum digestion in broilers by targeting fermentation of xylan.

This study was to examine if it is possible to accelerate sorghum digestion in broiler chickens by targeting fermentation of the xylan. Cobb 500 broilers (n = 960, 80 birds per treatment) were fed 12 sorghum-soybean meal-based dietary treatments fed as 3 phases (starter d 0 to 12, grower d 13 to 23, finisher d 24 to 35), with 8 replicate pens of 10 birds per treatment. For half of the treatments (n = 6), 10% of the sorghum in the diet was directly replaced with 10% wheat bran, as a source of fermentable fibre. The diets were supplemented with either 0, 50 or 2,000 mg/kg xylo-oligosaccharides (XOS), with or without xylanase application. Body weight gain (BWG), feed intake (FI) and feed conversion corrected for mortality (cFCR) was determined at d 0 to 35, and male and female body weight were measured on d 35. On d 35, ileum and caeca samples were collected from 2 birds per pen, for determination of caecal cellulase and xylanase activity, microbiota composition and short chain fatty acid (SCFA) concentration, and ileal XOS concentration. Supplementation with 2,000 mg/kg XOS caused increased BWG at d 0 to 35 (P = 0.007) and enhanced caecal propionic, valeric and succinic acid concentration (P < 0.05). Wheat bran increased FI (P = 0.018) and BWG (P = 0.016), as well as caecal Bifidobacteria concentration (P < 0.001). Ileal XOS concentration was greatest when feeding combined wheat bran, 2,000 mg/kg XOS, and xylanase, resulting in increased caecal total SCFA, acetic acid and butyric acid concentration, and xylanase and cellulase activity (P < 0.05). Results from this study present that feed efficiency in birds fed sorghum-based diets is improved as a consequence of supplementing with fermentable fibre, xylanase and XOS.

Non-starch polysaccharide-degrading enzymes may improve performance when included in wheat- but not maize-based diets fed to broiler chickens under subclinical necrotic enteritis challenge.

The present study investigated whether supplementing fibre-degrading enzymes can ameliorate the severity of subclinical necrotic enteritis (NE) in broiler chickens offered wheat- or maize-based diets. A total of 1,544 mixed-sex broiler chickens were assigned to 16 experimental treatments as a 2 × 2 × 4 factorial arrangement of treatments. The factors were the following: NE challenge, yes or no; diet type, wheat- or maize-based; and enzyme supplementation, control (no enzyme), family 10 xylanase (XYN10), family 11 xylanase (XYN11) or ß-mannanase (MAN). Each treatment was replicated 6 times, with 16 birds per replicate pen. A three-way challenge × diet type × enzyme interaction occurred for body weight at 21 d of age (P = 0.025) and overall feed conversion ratio (P = 0.001). In the non-challenged birds fed the wheat-based diet, supplementing MAN increased d 21 body weight compared to the control. In challenged birds fed the maize-based diet, supplemental XYN11 impeded body weight and overall FCR compared to the control. Birds offered the maize-based diet presented heavier relative gizzard weights at both 16 and 21 d of age (P < 0.001) and reduced liveability (P = 0.046) compared to those fed the wheat-based diet. Enzyme supplementation reduced ileal and jejunal digesta viscosity at 16 d of age only in birds fed the wheat-based diet (P < 0.001). XYN11 increased ileal digesta viscosity in birds fed the maize-based diet, and MAN reduced it in birds fed the wheat-based diet at 21 d of age (P = 0.030). Supplementing XYN11 improved ileal soluble non-starch polysaccharides (NSP) digestibility in birds fed the wheat-based diet compared to non-supplemented birds (P < 0.001). Birds fed the wheat-based diet displayed a higher abundance of Bifidobacterium, Lactobacillus and Enterobacteriaceae and butyric acid in the caeca at 16 d of age compared to birds fed the maize-based diet (P < 0.05). In conclusion, supplemental XYN11 exacerbated the negative impact of NE on growth performance in birds fed the maize-based diet. Supplementing wheat-based diets with fibre-degrading enzymes ameliorates production losses induced by NE.

Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry).

Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.

Artificial gut and the applications in poultry: A review.

Artificial gut models including both the gastric and intestinal phases have been used in poultry research for decades to predict the digestibility of nutrients, the efficacy of feed enzymes and additives, and caecal fermentation. However, the models used in the past are static and cannot be used to predict interactions between the feed, gut environment and microbiome. It is imperative that a standard artificial gut model for poultry is established, to enable these interactions to be examined without continual reliance on animals. To ensure the validity of an artificial model, it should be validated with in vivo studies. This review describes current practices in the use of artificial guts in research, their importance in poultry nutrition studies and highlights an opportunity to develop a dynamic gut model for poultry to reduce the number of in vivo experiments.

Higher rates but similar causes of young out-of-hospital cardiac arrest in rural Australian patients.

OBJECTIVE: To determine whether young rural Australians have higher rates or different underlying causes of out-of-hospital cardiac arrest (OHCA). DESIGN: A case-control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non-cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non-cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. SETTING: A state-wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). PARTICIPANTS: Victorians aged 1-50 years old experienced an OHCA between April 2019 and April 2020. MAIN OUTCOME MEASURES: Rates and underlying causes of OHCA in young rural and metropolitan Victorians. RESULTS: Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101-235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71-251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. CONCLUSION: Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA.

The flow of non-starch polysaccharides along the gastrointestinal tract of broiler chickens fed either a wheat- or maize-based diet.

The present study characterised the types and amounts of non-starch polysaccharides (NSP) remaining undigested along the gastrointestinal tract (GIT) of broiler chickens offered a typical wheat- or maize-based diet. One-day old Cobb 500 mixed-sex chicks were assigned to 24 pens, with 10 birds/pen and 12 pens/treatment. Birds were offered the experimental diets in 3 phases (starter, day 0 to 10; grower, day 11 to 24 and finisher, day 25 to 35). Excreta and digesta samples from the crop, gizzard, duodenum, jejunum, ileum and caeca were collected at 12 and 35 days of age, and analysed for the NSP flow. The wheat-based diet contained higher levels of soluble NSP than the maize-based diet, whereas insoluble NSP levels were similar between the 2 diets. Detailed analysis of NSP constituents revealed that arabinoxylans were the primary NSP in the wheat-based diet, mostly in insoluble form. Pectins were the predominant NSP in the maize-based diet, followed by arabinoxylans. Overall, birds offered the wheat-based diet presented higher levels of soluble NSP remaining in all gut sections compared to birds offered the maize-based diet, at both 12 and 35 days of age (P < 0.050). Accumulation of insoluble NSP in the gizzard was noted in birds fed both diets, but was more pronounced in birds offered the maize-based diet compared to the wheat-based diet, at both 12 and 35 days of age (P < 0.001). The present study highlights marked differences in the amounts and types of NSP delivered to the different gut sections when feeding wheat-compared to maize-based diets, particularly in the gizzard and the lower GIT of birds.

Protease supplementation reduced the heat increment of feed and improved energy and nitrogen partitioning in broilers fed maize-based diets with supplemental phytase and xylanase.

An experiment was conducted to explore the effects of digestible amino acid (dAA) concentrations and supplemental protease on live performance and energy partitioning in broilers. Ross 308 male broilers (n = 288) were distributed into 24 floor pens and offered 1 of 4 dietary treatments with 6 replicates from 1 to 35 d of age. Dietary treatments consisted of a 2 × 2 factorial arrangement with dAA concentrations (standard and reduced [34 g/kg below standard]) and supplemental protease (without or with) as the main factors. At 1, 15, 28, and 35 d of age, feed and broilers were weighed to determine live performance. From 20 to 23 d of age, a total of 32 birds (2 birds/chamber, 4 replicates) were placed in closed-calorimeter chambers to determine respiratory exchange (heat production, HP), apparent metabolisable energy (AME), retained energy (RE), and net energy (NE). From 29 to 35 d of age, supplemental protease in the reduced-dAA diet decreased broiler feed conversion ratio (FCR) by 5.6 points, whereas protease supplementation in the standard-dAA diet increased FCR by 5.8 points. The indirect calorimetry assay revealed that supplemental protease decreased (P < 0.05) the heat increment of feed (HIF) by 0.22 MJ/kg. Also, from 20 to 23 d of age, broilers offered the reduced-dAA diet with supplemental protease had a higher daily body weight gain (BWG) (+10.4%), N intake (+7.1%), and N retention (+8.2%) than those offered the standard-dAA with supplemental protease. Broilers offered the reduced-dAA without supplemental protease exhibited a 3.6% higher AME-to-crude protein (CP) ratio than those offered other treatments. Protease supplementation in the standard- and reduced-dAA diets resulted in 2.7% and 5.6% lower AME intake-to-N retention ratios, respectively, compared with the unsupplemented controls. Reduced-dAA increased (P < 0.05) AME intake (+4.8%), RE (+9.8%), NE intake (+5.8%), NE intake-to-CP ratio (+3.0%), and RE fat-to-RE ratio (+8.6%). Protease supplementation increased (P < 0.05) respiratory quotient (+1.2%) and N retention-to-N intake ratio (+2.2%), NE-to-AME ratio (+1.9%), and reduced HP (-3.6%), heat increment (-7.4%), and NE intake-to-N retention (-2.5%). In conclusion, protease positively affected FCR and energy partitioning in broilers; responses were most apparent in diets with reduced-dAA concentrations.

Dietary Soluble Non-Starch Polysaccharide Level Influences Performance, Nutrient Utilisation and Disappearance of Non-Starch Polysaccharides in Broiler Chickens.

This study evaluated the effect of dietary soluble non-starch polysaccharides (sNSP) on performance and nutrient utilisation in broilers from d 0 to 35. Cobb 500 broilers (n = 480, 80 birds per treatment) were fed either wheat- or corn-soybean meal-based diets formulated to contain either a high, medium, or low sNSP content, in a 2 × 3 factorial arrangement, fed as Starter (d 0−14) and Grower (d 14−35). Birds fed the low sNSP level presented greater BWG at d 0−14 and lower feed intake at d 14−35 compared to birds fed the medium sNSP level (p < 0.005). At d 14, birds fed the high sNSP level presented greater ileal and total tract starch digestibility and total tract sNSP degradability and insoluble NSP degradability, compared to feeding the low sNSP level. At d 35, total tract DM and metabolisability of gross energy was greater in birds fed the medium sNSP level compared to those fed the high or low sNSP level (p < 0.005). Generally, bird performance and nutrient utilisation was greater in birds fed the corn-based diets compared to the wheat-based diets. These results illustrate that dietary sNSP level and composition influences bird performance and nutrient digestibility.

Predictors and outcomes of in-hospital referrals for forensic investigation after young sudden cardiac death.

BACKGROUND: Forensic investigations are recommended following sudden cardiac death (SCD) to determine cause of death and identify living relatives at potential risk. Not all young SCD patients are referred to coronial services. OBJECTIVE: The purpose of this study was to identify referral rates, predictors, and outcomes of young SCD patients who die in-hospital following out-of-hospital cardiac arrest (OHCA). METHODS: A prospective 2-year analysis of in-hospital deaths following OHCA in Victoria, Australia, was conducted using a statewide registry combining data from ambulance, hospital, and forensic resources. RESULTS: OHCA caused 26.3% of all deaths (n = 1301) in Victorians aged 1-50 years. Rates of prehospital and in-hospital referral to coronial services were 95.0% and 59.5%, respectively. Factors independently predicting in-hospital coronial referral were age <40 years, death in the emergency department, and rural status (odds ratios 4.07, 8.91, and 3.43, respectively). Establishing a diagnosis of coronary disease in-hospital substantially reduced odds of coronial referral (odds ratio 0.07). Of 107 SCD patients referred to the coroner from hospitals, 25 (23.3%) had illicit substances identified on toxicologic analysis. Eighty-one patients (75.7%) underwent autopsy, with cause of death determined in 65 cases (80.2%). Sixteen deaths (19.8%) remained unascertained after autopsy and ancillary investigations. CONCLUSION: More than one-fourth of young Victorian deaths result from OHCA. Approximately half of patients dying in-hospital following OHCA are referred to the coroner. Patients referred are younger, more likely to die in the emergency department, and reside rurally. Forensic assessment identifies high rates of illicit drug use in young SCD patients and provides a definitive cause of death for most patients.

Intracoronary IgG4-related disease as an unusual cause of sudden cardiac arrest: a case series.

BACKGROUND: IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition classically causing retroperitoneal fibrosis, aortitis, thyroiditis, or pancreatitis. Diagnosis includes the presence of lymphoplasmacytic infiltrate (with >40% ratio IgG4+:IgG plasma cells) and fibrosis. Cardiac involvement may include aortic, pericardial, or coronary disease. Coronary manifestations encompass obstructive intra-luminal lesions, external encasing pseudo-tumour on imaging, or lymphoplasmacytic arteritis. CASE SUMMARY: Case 1: A fit and healthy 50-year-old man was found deceased. His only known medical condition was treated Hashimoto's thyroiditis. Post-mortem examination demonstrated an isolated severe stenosis of the left anterior descending (LAD) coronary artery without histopathological evidence of acute myocardial infarction. Coronary plaque histopathology showed florid IgG4-positive plasma cell infiltrate throughout all layers of the artery with dense fibrous tissue connective tissue stroma, all features consistent with coronary artery IgG4-RD. Case 2: A 48-year-old man collapsed at work. Computed tomography scan 1 week prior reported an ill-defined para-aortic retroperitoneal soft tissue density. No cardiac symptoms were reported in life. Post-mortem examination showed coronary arteritis and peri-arteritis with sclerosing peri-aortitis in the LAD. There was myocardial fibrosis of the anterior left ventricle and focal myocarditis of the right ventricle. DISCUSSION: IgG4-related disease presenting as sudden cardiac death without any preceding symptoms is very rare (six prior cases identified on literature review). Reported targeted successful interventions for intracoronary IgG4-RD diagnosed in life have included steroid therapy and B cell depleting therapy (i.e. rituximab). If cardiac symptoms are present in a patient with known IgG4-RD, cardiac investigations should be promptly arranged.

Characterisation of undigested components throughout the gastrointestinal tract of broiler chickens fed either a wheat- or maize-based diet.

This study was to characterise the undigested nutrients present along the gastrointestinal tract of birds offered common wheat- or maize-based diets, with the goal of optimising utilisation of enzymes to enhance digestive efficiency. Wheat- and maize-based diets were offered to 240 mixed-sex broilers (10 birds/pen; n = 12) from 1 to 35 d post-hatch. Digestibility of dry matter, starch, crude protein and non-starch polysaccharides (NSP) were measured in the crop, gizzard, duodenum, jejunum, ileum, caeca and excreta at d 12 and 35 post-hatch. Analysis of nutrient levels in the excreta presented that more than 30% of nutrients provided in the feed was wasted, irrespective of wheat or maize diet type. On average, 92 g/kg crude protein, 92 g/kg insoluble NSP and 14 g/kg oligosaccharides were not utilised by birds at d 12 post-hatch. The quantity of water-insoluble NSP in the small intestine at d 12 was lower in birds offered the wheat-based diet compared to those fed the maize-based diet (P < 0.05), with the reverse being true for water-soluble NSP (P < 0.001). On average, 84 g/kg crude protein, 79 g/kg insoluble NSP and 9 g/kg oligosaccharides remained in the excreta at 35 d of age. At this time period, accumulation of feed in the gizzard was noted for birds offered both diets, but was more pronounced in those offered the maize-based diet (P < 0.001). Birds offered the maize-based diet demonstrated improved utilisation of oligosaccharides compared to those fed the wheat-based diet at both d 12 and 35 (P = 0.087 and P = 0.047, respectively). Protein utilisation in the jejunum and ileum was greater in birds offered the wheat-based diet compared to those fed the maize-based diet (P = 0.004 and P < 0.001, respectively). Thus, while both diets supported standard growth performance of birds, the degree and flow of nutrient disappearance along the gastrointestinal tract was influenced by cereal type and bird age.