Feed form and perch design do not interact to production performance, gastrointestinal tract traits, behaviour and welfare of laying hens reared in enriched cages.

1. It was hypothesised that perch material and design may affect utility and maintenance energy demand in laying hens, affecting their feed form preferences and daily feed consumption. Accordingly, perch design and feed form on hen performance, gastrointestinal tract functions and some behavioural and welfare-related traits were studied in laying hens (ATAK-S) reared in enriched colony cages from 24 to 40 weeks of age.2. The experiment was a 2 × 2 factorial investigating two perch materials and design (circular steel or mushroom-shaped plastic) and feed form (mash or crumble). A total of 396 hens were randomly assigned to one of the four treatment groups with nine replicates each (11 birds per replicate).3. Except for feeding behaviour and prevalence of foot pad dermatitis at 40 weeks of age, the modification of the perch design did not have a significant effect on the traits examined. Mushroom-shaped plastic perches reduced feeding behaviour (p < 0.01) and the incidence of foot pad dermatitis at 40 weeks of age (p < 0.001).4. Performance traits were not affected by feed form. Intake, final body weight and FCR for crumble-fed laying hens were greater than those fed mash (p < 0.01).5. Hens fed mash had higher (p < 0.01) relative gizzard weights along with lower (p < 0.05) pH values, pancreatic chymotrypsin, amylase and lipase activities (p < 0.05), and duodenal absorption surface areas (p < 0.01). Ultimately, this gave higher protein digestibility (p < 0.05) compared to those receiving crumble.6. In conclusion, in enriched cage rearing systems, mashed feed was preferred over crumble to efficiently maintain productive performance. Compared to circular steel, plastic mushroom-shaped perches were associated with better footpad health and welfare.

Effects of sunflower meal supplementation in the diet on productive performance, egg quality and gastrointestinal tract traits of laying hens.

1. A trial was conducted to study the effects of additional dietary fibre (DF), resulting from partial replacement of soybean meal (SBM) with high-fibre sunflower meal (SFM), on egg production and gastrointestinal tract (GIT) traits in laying hens. 2. A total of 480 Nick Chick white laying hens (21 weeks of age) were randomly assigned to three dietary treatments and fed for 24 weeks. The hens were fed either the control diet based on corn and SBM, which contained 30 g/kg crude fibre (CF) without SFM, or test diets containing 40 g more CF/kg from adding 47 g/kg SFM or 50 g more CF/kg from adding 97 g SFM/kg. Each dietary treatment was replicated eight times (20 hens per replicate). 3. Body weight (P < 0.05), egg production rate (P < 0.05), egg weight (P < 0.01) and egg mass (P < 0.01) linearly increased but feed conversion ratio linearly decreased (P < 0.01) with increasing SFM supplementation. Feed intake, cracked/broken egg ratios and shell less egg ratios were comparable amongst the groups. 4. The egg quality indices were not influenced by dietary treatments, except for the Haugh units, which decreased (linear, P < 0.01; quadratic P < 0.05) when SFM was added. 5. Digestive organ size was not affected by the dietary treatments, but caecum length increased in hens fed SFM (P < 0.05). Digesta pH in the ileum and caecum was reduced linearly (P < 0.01) with SFM supplementation. 6. Small intestine morphology traits improved with 47 g SFM/kg supplementation, whereas negative effects were observed with 97 g SFM/kg. 7. Productive performance of laying hens improved with 40 or 50 g/kg more CF in feed, mostly from SFM supplementation. It was concluded that this performance increase was attributed mostly to the increase in fat content, rather than DF level, when high-fibre SFM was included in layer diets.

Influence of sunflower meal utilisation on growth performance and digestive tract traits of white strain pullets fed from 29 to 112 d of age.

1. A trial was conducted to study the effects of partial replacement of sunflower meal (SFM) for soybean meal (SBM) on growth performance and gastrointestinal tract traits (GIT) in pullets.2. A total of 600 pullets (29 d of age) was randomly assigned to three dietary treatments and fed for 84 d. The birds were fed a practical diet with a low level of crude fibre (CF; LF) or test diets containing a medium or high level of CF (MF and HF) by partial (50% to 75%) replacement of SBM with SFM. Accordingly, the grower diets contained 29, 40 and 51 g CF/kg, which corresponded to 31, 45 and 59 g CF/kg in developer diets. Each dietary treatment was replicated 8 times (25 pullets per replicate).3. Body weight did not differ significantly among treatments at d 29, 84 and 112 d but increased (P < 0.05) with SFM supplementation at d 54. From 29 to 112 d of age, daily feed and energy intake linearly increased (P < 0.01) with SFM supplementation, but body weight gain and feed conversion ratios were comparable amongst the groups.4. Digestive organ size was not affected by the dietary treatments, but gizzard weight increased in pullets fed MF and HF diets (P < 0.01). Digesta pH in the gizzard, duodenum, jejunum and ileum were reduced linearly (P < 0.01) with SFM supplementation, while a quadratic response was observed for proventriculus pH (P < 0.05).5. Small intestine morphology traits improved with a moderate level of CF intake, whereas no benefit was observed with a high level of CF consumption.6. The results showed that use of SFM up to 140 g/kg can be recommended for pullets fed diets based on corn and soybean meal. However, smaller intestinal absorptive capacity with higher SFM supplementation may occur.

Influence of the particle size and form of feed on growth performance, digestive tract traits and nutrient digestibility of white egg-laying pullets from 1 to 112 D of age.

The influence of the grinding and physical form of diets on growth performance, gastrointestinal tract (GIT) development and nutrient digestibility was studied in layer pullets from hatch to 112 d of age. Diet formed a 2 × 2 factorial with 2 hammer mill screen sizes to grind cereals (4 and 8 mm) and 2 forms (mash and crumble). A total of 864 1-day-old layer chickens were randomly assigned to 1 of the 4 treatment groups with 8 replicates (27 birds per replicate). Cumulatively, pullets fed crumbles consumed less feed (P < 0.05) and had better feed conversion ratio (FCR; P < 0.01) than those fed mash. Coarse grinding cereals (CG) improved FCR (P < 0.05) without significant change in cumulative feed consumption compared to that of fine grinding (FG). With regard to body weight gain (BWG), pullets benefited from crumbles from 1 to 56 d of age (P < 0.01). There were interactions (P < 0.05) between screen size and feed form in relation to FCR (1 to 28 d) and overall BWG. At 112 d of age, the relative weight (RW, g/100 g body weight) of the crop, gizzard, pancreas, and liver of crumble-fed birds were lower (P < 0.05) than those for birds fed mash. Pullets fed coarsely ground feed had higher RW of the crop, proventriculus, gizzard, liver, and caecum compared to those fed finely ground feed. Compared to mash feeding, pullets fed crumbles increased (P < 0.05) total tract digestibility of ether extract and crude protein and the activities of pancreatic amylase and lipase. Digestibility of ether extract (P < 0.05) and pancreatic amylase activity (P < 0.01) were higher in birds fed a CG diet than in birds fed the FG regimen. Regarding the nutrition of egg-laying pullets, crumbles might be preferred to mash feed when the main objective is to improve FCR. Data also suggested that cereals used for pullet feed can be ground more coarsely than is in current practice.

Influence of feed particle size and feed form on productive performance, egg quality, gastrointestinal tract traits, digestive enzymes, intestinal morphology, and nutrient digestibility of laying hens reared in enriched cages.

A total of 640 Lohmann LSL hens were randomly allotted to 4 dietary treatments arranged in 2 × 2 factorial with 2 feed particle sizes (fine and coarse) and 2 feed forms (mash and crumble). The 2 particle sizes were achieved by grinding whole corn and wheat in the hammer mill to pass through 4- and 8-mm sieves. The laying hen diet was isonutritive, and each diet was fed to 8 enriched cages of 20 hens from 21 to 52 wk of age. Screen size and feed form did not affect feed intake, egg production, egg weight, egg mass, and quality traits of the eggs, except for yolk color score, which decreased with crumbling of the feed. Feed conversion ratio was greater (P < 0.01) in hens fed the coarsely ground diet than in hens fed the finely ground diet. Crumbling the feed increased (P < 0.01) feed intake and feed conversion ratio compared to those after mashing. The relative weight of the liver and length of the small intestines were greater (P < 0.05) in hens fed crumble than in hens fed mash. Finely grinding cereals decreased (P < 0.01) the pancreas and gizzard weight compared to those after coarse grinding. The pH of digestive organs showed significant responses to feed form. Crumbling resulted in increased (P < 0.01) pancreatic activities of amylase, while lipase secretion was not affected by the manipulations in screen size and feed form. Ileal villus measurements (villus height, villus height/crypt depth ratio, villus surface area) were greater (P < 0.01) in hens fed crumble than in hens fed mash, whereas particle size had no effect. Total tract digestibility coefficients of crude ash and ether extracts were improved narrowing screen size from 8 to 4 mm. Data illustrated that grinding cereals to pass through a 4-mm screen could improve the efficiency of feed conversion. However, feeding crumbles provided no benefit to productive performance and egg quality, although the absorptive capacity of laying hens increased.

Effects of a meal feeding regimen and the availability of fresh alfalfa on growth performance and meat and bone quality of broiler genotypes.

1. The aim of this study was to identify a feeding regimen that encourages good pasture use in slow (SG) and fast (FG) growing broiler genotypes under free-range management. 2. SG and FG birds fed on either an ad libitum (ADB) or a meal feeding (MEF) programme were given free outdoor access with or without fresh alfalfa from day 22 to 72 and from day 22 to 45, respectively. In two consecutive trials, 800 birds of each genotype were included in a factorial design using groups of 40 birds replicated 5 times. 3. Fresh alfalfa consumption did not improve growth performance and meat quality attributes, whereas the feeding regimen had significant implications. When compared with their ad libitum-fed counterparts, meal-fed birds showed a significantly lower body weight at a considerably lower feed consumption rate, leading to a more favourable feed conversion ratio (FCR) during the course of the experiment. 4. The MEF regimen with a strong feed limitation significantly increased crop and gizzard weight in both genotypes. In FG birds, water holding capacity, drip loss, cooking loss and pH 45 in the breast and thigh meat were adversely affected by MEF; however, feed restriction demonstrated benefits with significant decreases in muscle fat accumulation. In SG birds, decreases in protein and dry matter content of the breast and thigh muscle with meal feeding were conclusive. 5. In both genotypes, there was no treatment-related effect on meat yield, mineral composition of the meat or bone mechanical properties. 6. In conclusion, MEF, irrespective of alfalfa intake, may provide a viable method to decrease FCR; it may be able to contribute to the production of chickens with lean carcasses but it was not capable of improving overall meat quality.

Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy.

BACKGROUND/OBJECTIVES: Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. DESIGN: Retrospective cohort study. SETTING: University hospital in Turkey. PARTICIPANTS: 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. MEASUREMENTS: "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. RESULTS: The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. CONCLUSIONS: A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.

Effects of enhancing vitamin D status by 25-hydroxycholecalciferol supplementation, alone or in combination with calcium and phosphorus, on sternum mineralisation and breast meat quality in broilers.

1. The aim of the present study was to examine the effects of improving vitamin D status in broiler diets by supplementary 25-hydroxycholecalciferol (25OHD3), alone or in combination with calcium (Ca) and available phosphorus (aP), on live performance, sternum mineralisation and breast meat quality in broilers. 2. A total of 936 1-d-old Ross 308 broilers were used in the study. After gender determination at the hatchery, chicks from each sex were randomly distributed into three dietary treatments. The following dietary treatments were used in the experiment from hatch to 38 d: (1) A control diet formulated to meet all of the nutrient requirements of broiler chicks according to the management guide; (2) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3; and (3) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3 plus Ca + aP. 3. Improvement in vitamin D status by 25OHD3 supplementation, alone or in combination with Ca and aP, had no effect on body weight and feed conversion ratio of broilers. 4. The serum 25OHD3 concentration significantly increased with 25OHD3 and 25OHD3 plus Ca + aP supplementation (P < 0.05), whereas the ionised Ca and Mg concentrations remained unchanged. 5. Sternum absolute weight, ash content and the concentrations of Ca and P significantly increased (P < 0.01) with supplementation of 25OHD3, alone or in combination with Ca + aP. 6. Supplemental 25OHD3, alone or in combination with Ca + aP, slightly increased pH24 (P = 0.05) and decreased (P < 0.01) squeezable water loss in breast meat, whereas it had no significant effect on lightness, yellowness and sarcoplasmic protein solubility. 7. In conclusion, the results suggested that enhancing vitamin D status by 25OHD3 supplementation alone or in combination with Ca + aP may improve sternum structure and mineral accretion. Furthermore, supplemental 25OHD3, even in a nutritionally complete diet, may offer an effective way to improve protein solubility in female broilers.

The association between gastroesophageal flap valve function and gastroesophageal reflux symptoms.

BACKGROUND AND STUDY AIMS: Upper gastrointestinal endoscopic examination is usually the first step in the evaluation of patients with suspected gastroesopageal reflux disease. The primary aim of this study was to investigate the association between gastroesophageal flap valve function (GEFV) and gastroesophapgeal reflux symptoms in patients undergoing routine upper endoscopy. Patients and methods: 1507 patients were included into the study and the GEFV graded I to IV as follows: Hill I-II: normal GEFV, and Hill III-IV: abnormal GEFV. RESULTS: Patients in abnormal GEFV group had a higher incidence of reflux symptoms compared to normal GEFV group (53.4% vs 47.4% for heartburn p=0.03 and 53.2% vs 42.4% for regurgitation, p<0.01). In abnormal GEFV patients, esophagitis was more common compared to those with normal GEFV (32.6% vs 11.1%, p<0.01). Presence of heartburn and regurgitation (n =556) correlated with Hill III-IV grades (n = 184/556), (sensitivity: 33%, p = 0.003). In contrast, 24.6% (157/638) of patients without reflux symptoms were in abnormal GEFV group. In patients undergoing endoscopy because of reflux symptoms, Grade III-IV valve was detected more commonly in patients with reflux symptoms compared to patients without reflux symptoms (p = 0.01). CONCLUSIONS: Patients with abnormal valves (Hill grades III and IV) but without reflux symptoms, esophagitis and hiatal hernia should be evaluated individually by means of the presence of gastroesophageal reflux disease which means that GEFV is not a good indicator of reflux disease.

Comparative evaluation of dietary supplementation with mannan oligosaccharide and oregano essential oil in forced molted and fully fed laying hens between 82 and 106 weeks of age.

The aim of this study was to investigate the efficacy of feed-grade preparations of mannan oligosaccharides ( MOS: ) and oregano essential oil ( OEO: ) in forced molted or fully fed 82-week-old, laying hens. A 2 × 3 factorial experiment investigated the influence of molting vs. full feeding and dietary supplements [i.e., unsupplemented control, MOS (1 g/kg) diet, and OEO (24 mg/kg) diet] on production parameters, egg quality, serum stress indicators, blood constituents, tibial characteristics, liver antioxidant status, and cecal microflora composition. A total of 864 Single Comb White Leghorn hens were randomly assigned to 6 treatments, each with 6 replicates of 24 hens each, and studied for 25 wk. Hens were fed a molt diet containing of 50% alfalfa and 50% wheat bran ( AA+WB: ) for 12 d, then returned to the laying ration. Results indicate that molt vs. full feed impacted more on most variables measured than supplementation or supplement type. Significant (P < 0.01) interactions between molting and diet were observed for the egg production, egg weight, egg mass, and feed conversion ratio ( FCR: ). In fully fed hens, MOS supplementation improved (P < 0.01) the egg production, egg weight, and FCR, and an OEO addition significantly improved the egg production and FCR in forced molted hens. Molting improved egg quality despite the significant regression in ovary and oviduct weight (P < 0.01), though supplements showed no influence. The bone ash (P < 0.01) and mineral content (P < 0.05) of molted hens were significantly lower than those of fully fed counterparts; however, poor mineralization was not reflected in the bones' mechanical properties. No significant differences were observed among treatments for hematological characteristics. Both the MOS and particularly the OEO supplementation improved (P < 0.01) liver antioxidant status and mitigated the significant increase in cecal pathogenic bacteria after molt. Our results indicate that full feeding with an aa+wb diet is an effective non-feed-removal method for molted hens, the benefit of which can be improved with MOS and OEO supplementation.

Effect of anticoccidial monensin with oregano essential oil on broilers experimentally challenged with mixed Eimeria spp.

Essential oil of oregano ( OEO: ) has proven to be a potential candidate for controlling chicken coccidiosis. The aim of the current study is to determine whether OEO and an approved anticoccidial, monensin sodium ( MON: ), as in-feed supplements could create a synergism when combined at low dosages. Day-old broiler chickens were separated into six equal groups with six replicate pens of 36 birds. One of the groups was given a basal diet and served as the control ( CNT: ). The remaining groups received the basal diet supplemented with 100 mg/kg MON, 50 mg/kg MON, 24 mg/kg OEO, 12 mg/kg OEO, or 50 mg/kg MON + 12 mg/kg OEO. All of the chickens were challenged with field-type mixed Eimeria species at 12 d of age. Following the infection (i.e., d 13 to 42), the greatest growth gains and lowest feed conversion ratio values were recorded for the group of birds fed 100 mg/kg MON (P < 0.05), whereas results for the CNT treatment were inferior. Dietary OEO supplementations could not support growth to a level comparable with the MON (100 mg/kg). The MON programs were more efficacious in reducing fecal oocyst numbers compared to CNT and OEO treatments (P < 0.05). Serum malondialdehyde and nitric oxide concentrations were decreased (P < 0.01), whereas superoxide dismutase (P < 0.05) and total antioxidant status (P < 0.01) were increased in response to dietary medication with MON and OEO. All MON and OEO treatments conferred intestinal health benefits to chickens by improving their morphological development and enzymatic activities. The results suggest that OEO supported the intestinal absorptive capacity and antioxidant defense system during Eimeria infection; however, it displayed little direct activity on the reproductive capacity of Eimeria This might be the reason for inferior compensatory growth potential of OEO compared to that MON following the challenge. Combination MON with OEO was not considered to show promise for controlling chicken coccidiosis because of the lack of a synergistic or additive effect.

The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses.

OBJECTIVE: The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). METHODS: Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. RESULTS: The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. CONCLUSION: With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies.

Sexual dysfunctions in HCV patients and its correlations with psychological and biological variables.

The frequency of sexual dysfunction (SD) is not very well known in patients with chronic hepatitis C. In this study, the prevalence of SD and its correlations with psychological and biological variables was assessed in 46 HCV positive patients. The mean age of patients was 46.4+/-9.4 y; the mean duration of HCV infection was 43.4+/-34.0 months; 52% were male; 89% were living with a spouse. SD was assessed using the Arizona Sexual Experiences Scale (ASEX), the level of anxiety and depression measured with the Hospital Anxiety and Depression Scale (HADS). Biochemical parameters were also assessed. Overall, as indicated by ASEX criteria, SD was observed in 35% of our patients. Of 24 males, 21% described SD; problems with drive (25%), arousal (17%) and erection (17%) were the most frequent complaints. Of 22 female patients, 50% described SD; problems with drive (55%) arousal (50%), and reaching orgasm (59%) were the most frequent complaints. Total ASEX scores were correlated with age (P<0.07, significant at trend level), education (P<0.001), and was higher in female patients (P<0.02). After controlling for the effects of age, sex, education, duration of HCV and marital status, depression levels could still significantly predict the SD (P<0.05). Moreover, even after controlling the effects of all other variables, gamma glutamyl transpeptidase (GGT) levels could predict the SD status of the patients (P<0.05). Our results indicate that the prevalence of SD was 35% in HCV-infected patients and the level of depression and GGT levels were predictive of patients SD status.

Does immune activation continue during an attack-free period in familial Mediterranean fever?

Although some information is available regarding immune activation in familial Mediterranean fever (FMF), little is known about either peripheral blood T cell activation marker expression or the T cell proliferative response to phytohaemagglutinin (PHA). In the present study, we aimed to investigate the percentages of peripheral blood lymphocyte subsets, T cell expression of cellular activation markers (CD25, CD69, HLA-DR), the T cell response to PHA and serum levels of soluble interleukin-2 receptor (sIL-2R) and interleukin (IL)-10 in patients with FMF. Forty patients with FMF were enrolled into the study. Control groups were sex- and age-matched and consisted of 20 healthy blood donors and 15 patients with inactive Behcet's disease. The patients with FMF in an attack period had higher levels of sIL-2R than those in an attack-free period, and also in comparison with both control groups. The levels of sIL-2R were also found to be higher in patients with FMF in an attack-free period than those in both control groups. The mean levels of IL-10 were found to be lower in patients with FMF in an attack-free period than those in an attack period and were also lower than those in the healthy controls. In an acute attack period, the absolute counts of CD3+HLA-DR+, CD4+CD69+, CD8+CD25+ and CD8+CD69+ T cells in peripheral blood samples were also higher than those in both control groups. Both the percentages and absolute counts of CD4+CD69+ T cells in peripheral blood samples of patients with FMF in an attack-free period were slightly but significantly higher than those in the healthy controls. In conclusion, our study indicates that the T cell system is abnormally activated in patients with FMF in both the attack and attack-free period and that decreased IL-10 levels may create a tendency to perpetuate subclinical immune activation in the attack-free period.

Metformin in the treatment of patients with non-alcoholic steatohepatitis.

BACKGROUND: Increased insulin resistance is the major pathogenic mechanism in the development of non-alcoholic steatohepatitis. AIM: To investigate the therapeutic effect of metformin, a well-known insulin-sensitizing agent, in the treatment of non-alcoholic steatohepatitis. METHODS: Thirty-six patients with non-alcoholic steatohepatitis were randomized into two groups. The first group was given lipid and calorie-restricted dietary treatment alone, and the second group was given metformin 850 mg b.d. plus dietary treatment, for 6 months. The changes in biochemical, sonographic and histological parameters were compared. RESULTS: The mean serum alanine/aspartate aminotransferase, insulin and C-peptide levels decreased and the index of insulin resistance improved significantly from baseline in the group given metformin. The mean changes in these parameters in the metformin group were significantly greater than those in the group given dietary treatment alone. Although more patients in the metformin group showed improvement in the necro-inflammatory activity, compared with the group given dietary treatment alone, no significant differences in necro-inflammatory activity or fibrosis were seen between the groups. CONCLUSION: The data suggest that improvement of the insulin sensitivity with metformin may improve the liver disease in patients with non-alcoholic steatohepatitis.

Gonadotropin treatment increases homocysteine levels in idiopathic hypogonadotropic hypogonadism: an indirect effect mediated by changes in body composition.

The main objective of the present study was to examine the alterations in plasma total homocysteine (tHcy) concentrations during a testosterone-deficient state and after gonadotropin treatment for 6 Months in patients with idiopathic hypogonadotropic hypogonadism (IHH). Thirty-five newly diagnosed male patients with IHH (mean age 21.34+/-1.53 years) and 29 age- and body mass index-matched healthy males (mean age 21.52+/-1.77 years) were recruited into the study. Pretreatment levels of free testosterone (1.51+/-0.66 pg/ml), estradiol (21.37+/- 4.37 pg/ml), FSH (0.91+/-0.24 IU/l) and LH (1.25+/- 0.53 IU/l) were lower than controls (25.17+/-3.06 pg/ml, 31.00+/-4.96 pg/ml, 3.14+/-1.62 IU/l and 4.83+/-1.65 IU/l respectively) (P<0.001). They increased significantly after treatment (18.18+/-1.59 pg/ml, 27.97+/- 4.25 pg/ml, 2.41+/-0.27 IU/l and 2.79+/-0.19 IU/l respectively) (P<0.001). Patients with IHH had lower tHcy levels than controls (10.14+/-1.34 and 12.58+/- 2.29 micro mol/l respectively) (P<0.001). Plasma tHcy concentrations increased significantly (12.63+/-1.44 micromol/l) after 6 months of treatment (P<0.001). As compared with the controls, pretreatment levels of serum creatinine (63.54+/-13.01 vs 82.84+/-16.69 micromol/l), hemoglobin (12.98+/-0.56 vs 13.83+/-0.71 g/dl) and hematocrit (39.29+/-2.01 vs 41.38+/-1.95%) were significantly lower (P<0.001), and they increased significantly following treatment (80.24+/-11.93 micromol/l, 13.75+/-0.49 g/dl and 41.26+/-1.78% respectively) (P<0.001). The pretreatment folic acid and vitamin B(12) levels were significantly higher in patients when compared with controls (14.87+/-5.68 vs 12.52+/-4.98 nmol/l, P=0.034 and 289.75+/-92.34 vs 237.59+/-108.17 pmol/l, P=0.002 respectively). They decreased significantly after treatment (11.29+/-3.31 nmol/l and 228.51+/-54.33 pmol/l respectively) (P<0.001). The univariate and multivariate regression analysis results showed that only changes in creatinine, creatinine clearance, vitamin B12 and folic acid were independently associated with changes in tHcy levels in patients with IHH. In conclusion, the increase in plasma tHcy concentrations following gonadotropin treatment seems to be largely independent of changes in androgen levels.

Comparison of the efficacy of medium chain triglycerides with long chain triglycerides in total parenteral nutrition in patients with hematologic malignancies undergoing peripheral blood stem cell transplantation.

BACKGROUND AND AIMS: The purpose of this randomized study was to compare the efficacy of medium chain triglycerides (MCT) plus long chain triglycerides (LCT) with LCT alone in total parenteral nutrition (TPN) solutions in patients with various hematologic malignancies who underwent a hematopoietic peripheral blood stem cell (PBSC) transplantation. METHODS: Of 36 patients entering into this study, 18 received MCT + LCT (group I) and the remaining 18 received LCT alone (group II) in TPN solutions. Patients were comparable regarding age, gender, donor-recipient gender, diagnosis, body weights, blood group differences and number of infused CD34(+) cells/kg. Post - transplant parameters such as duration of platelet and neutrophil engraftment, coagulation parameters, number of days of febrile neutropenia and antibiotic administration, plasma glucose, triglyceride, cholesterol and albumin levels, graft-versus-host disease (GVHD) and first 100 day mortality were compared in both groups. RESULTS: Median days of neutrophil >0.5 x 10(9)/l and platelet of >20 x 10(9)/l in group I and group II were 15 (range, 8-21), 11 (10-29) and 14 (range, 9-31), 13 (9-18) respectively (P>0.05). Median days of febrile neutropenia in group I and II were 10 (range, 4-23) and 7 (2-13) respectively (P=0.01). Median days of antibiotic administration in group I and II were 12 (range, 6-22) and 8 (4-25) respectively (P=0.04). Pre, peri- and post-transplant coagulation parameters such as PT, aPTT, and fibrinogen did not differ significantly between two groups (P>0.05), as well as plasma glucose, triglyceride, cholesterol, albumin levels, GVHD and first 100 day mortality. CONCLUSION: There was no difference between patients receiving MCT + LCT (group I) and LCT alone (group II) in TPN solutions regarding duration of engraftment and coagulation parameters, but numbers of median days of febrile neutropenia and days of antibiotic administration were significantly shorter in patients receiving LCT alone (group II) than those receiving MCT + LCT (P<0.01 and 0.04 respectively).

Insignificant role of hepatitis G virus infection in patients with liver enzyme elevations of unknown etiology.

Hepatitis G virus (HGV) may cause acute and chronic infection in humans but its role in parenchymal liver injury and chronic hepatitis is obscure. In this study, the importance of HGV was investigated in patients with elevated aminotransferases alanine transaminase/aspartate transaminase (ALT/AST) levels of unknown etiology. We included 56 patients with elevated ALT/ AST levels of unknown etiology and 81 healthy controls in the study. HGV RNA was investigated by the reverse transcription polymerase chain reaction. The other possible causes of transaminase elevation were excluded with detailed biochemical and serologic tests. Liver biopsy was performed on 47 patients for histologic examination. HGV RNA was detected in only two patients (3.3%) and in one control (1.2%). There was no statistical difference between the groups. Liver biopsy revealed minimal inflammatory changes and steatosis in HGV RNA-positive patients. These observations indicated that HGV prevalence is not different from that of the general population in patients with liver transaminases elevation of unknown etiology. The role of this novel virus in the pathogenesis of chronic liver injury of unknown etiology appears insignificant in our geographic area.

Erythrocyte antioxidant activity and trace element levels in Behçet's disease.

Selenium (Se), zinc (Zn), copper (Cu), and antioxidant enzyme (superoxide dismutase [SOD] and glutathione peroxidase [GSH-Px]) levels in sera were detected in Behçet patients. Age and sex matched controls were used to find out if oxidative stress takes place in the etiopathogenesis of Behçet's disease. Superoxide dismutase levels were found to be lower in the whole patients group when compared to controls. In whole patients and inactive patients' group Zn and Se levels were found to be higher, but not different in the active patients group when compared to controls. No significant difference was found between the groups as Cu and glutathione peroxidase levels were taken into consideration. According to the results of the present study, SOD level is low in Behçet's disease patients' sera independent from the phase of the disease, and as a result of decreased SOD activity, increased production of free oxygen radicals may play a role in the etiopathogenesis of the disease.