Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)].

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants: a cohort study.

BACKGROUND: Impaired intestinal microcirculation seems to play an important role in the pathogenesis of necrotizing enterocolitis (NEC). A previous study showed that a SrSO2 < 30% is associated with an increased risk of developing of NEC. We aimed to determine the clinical usefulness of the cut off < 30% for SrSO2 in predicting NEC in extremely preterm neonates. METHODS: This is a combined cohort observational study. We added a second cohort from another university hospital to the previous cohort of extremely preterm infants. SrSO2 was measured for 1-2 h at days 2-6 after birth. To determine clinical usefulness we assessed sensitivity, specificity, positive and negative predictive values for mean SrSO2 < 30. Odds ratio to develop NEC was assessed with generalized linear model analysis, adjusting for center. RESULTS: We included 86 extremely preterm infants, median gestational age 26.3 weeks (range 23.0-27.9). Seventeen infants developed NEC. A mean SrSO2 < 30% was found in 70.5% of infants who developed NEC compared to 33.3% of those who did not (p = 0.01). Positive and negative predictive values were 0.33 CI (0.24-0.44) and 0.90 CI (0.83-0.96), respectively. The odds of developing NEC were 4.5 (95% CI 1.4-14.3) times higher in infants with SrSO2 < 30% compared to those with SrSO2 ≥ 30%. CONCLUSIONS: A mean SrSO2 cut off ≥ 30% in extremely preterm infants between days 2-6 after birth may be useful in identifying infants who will not develop NEC.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande.

We report a search for cosmic-ray boosted dark matter with protons using the 0.37 megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1 MeV/c^{2} to 300 MeV/c^{2}.

An investigation into the influence of age on the standardized amino acid digestibility of wheat and sorghum in broilers.

Standardized ileal digestibility coefficients (SIDC) of nitrogen (N) and amino acids (AA) in wheat and sorghum at 6 different ages (d 7, 14, 21, 28, 35, and 42) of broilers were determined. Two assay diets were formulated to contain 93.8% of each grain as the sole source of AA in the diet. Titanium dioxide (0.5%) was added as an indigestible marker. Each assay diet was fed to 6 replicate cages housing 14 (d 7), 12 (d 14), 10 (d 21), 8 (d 28), 8 (d 35), and 6 (d 42) birds per cage for 4 d prior to ileal digesta collection. The apparent ileal digestibility coefficients (AIDC) were standardized by using the age-appropriate basal endogenous AA losses. In the case of wheat, AIDC of N and all AA increased (linear or quadratic, P < 0.05 to 0.001) with advancing age. No age effect was noticed on the SIDC of N, average of indispensable (IAA) and dispensable AA (DAA), though the average of total AA (TAA) tended (linear, P = 0.09) to increase as birds grew older. In sorghum, the AIDC of N, average of IAA and DAA were unaffected (P > 0.05) by age. The SIDC of N, average SIDC of IAA, DAA and TAA were higher at d 7, reduced at d 14 and then plateaued. Among the IAA, the SIDC of Arg, His, Ile, Leu, Lys, Thr, Val, and the SIDC of all individual DAA (except Cys) decreased with age (linear or quadratic, P < 0.05 to 0.001) with higher values at d 7. The higher SIDC values determined at d 7 were due to higher EAA losses during wk 1. The results showed that broiler age influences AA digestibility and this may need be considered in practical feed formulations. The age effect is variable depending on the grain type and specific AA.

High steam-conditioning temperature during the pelleting process impairs growth performance and nutrient utilization in broiler starters fed barley-based diets, regardless of carbohydrase supplementation.

The influence of supplemental carbohydrase (Carb) and conditioning temperature (CT) on growth performance, nutrient utilization and intestinal morphometry of broilers (d 1-21) fed barley-based diets was examined in a 2 × 3 factorial arrangement, evaluating 2 levels of Carb (0 and 150 g/tonne of feed) and three CT (60, 74, and 88°C). A total of 288, 1-day-old male broilers (8 birds/cage; 6 cages/treatment) were used. The activities of endo-1,4-ß- glucanase, endo-1,3 (4)-ß-glucanase and endo-1,4-ß-xylanase in the Carb were 800 BGU/g, 700 BGU/g and 2,700 XU/g, respectively. On d 21, ileal digesta was collected for the determination of nutrient digestibility. There was no significant interaction between Carb and CT for any tested parameter. Supplemental Carb, regardless of CT, increased weight gain (WG; P < 0.05) and reduced feed per gain (F/G; P < 0.001) by 30 g/bird and 6.5 points, respectively. Increasing CT to 88°C reduced (P < 0.05) WG, but increased (P < 0.05) F/G compared to the diets conditioned at 60° and 74°C. Regardless of CT, Carb enhanced (P < 0.05) the digestibility of starch and AMEn by 1.15% and 32 kcal/kg, respectively. Compared to the diets conditioned at 60° and 74°C, CT at 88°C reduced (P < 0.05) digestibility of dry matter, nitrogen, phosphorus, gross energy, and AMEn. Birds fed diets conditioned at 88°C showed lower (P < 0.05) starch digestibility compared to those fed diets conditioned at 60°C. Conditioning at 88°C increased (P < 0.05) jejunal digesta viscosity by 10.2% compared to diets conditioned at 60° and 74°C. Overall, Carb supplementation improved WG, F/G, starch digestibility and AMEn in broilers fed barley-based diets, irrespective of CT applied. Conditioning barley-based diets at 88°C impaired the ability of birds to utilize nitrogen, starch, phosphorus and energy, and consequently deteriorated WG and F/G. The lack of significant interactions between Carb and CT indicated that negative impacts caused by high CT on bird performance and nutrient utilization occurred regardless of Carb enzyme supplementation. Supplemental Carb per se could not remedy the adverse effects of high CT.

Basal ileal endogenous amino acid flow in broiler chickens as influenced by age.

The current study was carried out to measure the basal ileal endogenous amino acid (EAA) flow in male broilers (Ross 308) at different ages (d 7, 14, 21, 28, 35, and 42), following the feeding of a nitrogen-free diet. Titanium dioxide (5 g/kg) was included as an indigestible marker. The nitrogen-free diet was offered for four days prior to ileal digesta collection to 6 replicate cages housing 14 (d 3-7), 12 (d 10-14), 10 (d 17-21), 8 (d 24-28), 8 (d 31-35), and 6 (d 38-42) birds per cage. The basal EAA flow was calculated as g/kg DM intake. The amino acid (AA) profile of endogenous protein, expressed as g/100 g protein, was also calculated. The basal endogenous flow of nitrogen and all individual and total AA decreased quadratically (P < 0.05 to 0.001), with flows being higher on d 7, then decreasing on d 14, plateauing until d 35 and decreasing further on d 42. The concentrations of Trp, Cys, and Gly in the endogenous protein increased linearly (P < 0.01 to 0.001) with advancing age, whereas a linear decrease (P < 0.001) was noted for Lys. A quadratic influence (P < 0.05 to 0.001) was observed for the concentrations of Ile, Leu, Met, Val, and Asp. These changes in the endogenous protein profile may be attributed to variations in the contribution of endogenous sources with age but delineating the exact contribution of different sources is complicated. Overall, the current findings suggest that the basal ileal EAA flow is influenced by broiler age and age-specific EAA flows may need to be considered to standardize the AA digestibility.

Use of gene expression profiling to identify candidate genes for pretherapeutic patient classification in acute appendicitis.

BACKGROUND: Phlegmonous and gangrenous appendicitis represent independent pathophysiological entities with different clinical courses ranging from spontaneous resolution to septic disease. However, reliable predictive methods for these clinical phenotypes have not yet been established. In an attempt to provide pathophysiological insights into the matter, a genomewide gene expression analysis was undertaken in patients with acute appendicitis. METHODS: Peripheral blood mononuclear cells were isolated and, after histological confirmation of PA or GA, analysed for genomewide gene expression profiling using RNA microarray technology and subsequent pathway analysis. RESULTS: Samples from 29 patients aged 7-17 years were included. Genomewide gene expression analysis was performed on 13 samples of phlegmonous and 16 of gangrenous appendicitis. From a total of 56 666 genes, 3594 were significantly differently expressed. Distinct interaction between T and B cells in the phlegmonous appendicitis group was suggested by overexpression of T cell receptor α and ß subunits, CD2, CD3, MHC II, CD40L, and the B cell markers CD72 and CD79, indicating an antiviral mechanism. In the gangrenous appendicitis group, expression of genes delineating antibacterial mechanisms was found. CONCLUSION: These results provide evidence for different and independent gene expression in phlegmonous and gangrenous appendicitis in general, but also suggest distinct immunological patterns for the respective entities. In particular, the findings are compatible with previous evidence of spontaneous resolution in phlegmonous and progressive disease in gangrenous appendicitis.

Standardized ileal amino acid digestibility of protein sources for broiler chickens is influenced by the feed form.

The aim of present study was to determine the influence of the feed form (FF) on standardized ileal digestibility (SID) of nitrogen (N) and amino acids (AA) in 3 protein sources (PS) for broiler chickens. Six diets were tested in a 3 × 2 factorial arrangement of treatments involving 3 PS (meat and bone meal [MBM], soybean meal [SBM], and canola meal [CM]) in mash and pelleted forms. The basal endogenous N and AA losses were determined by offering a N-free diet in the mash form. From day 1 to 18, the birds were offered a broiler starter diet. The diets and the N-free diet were randomly assigned to 6 replicate cages (8 birds per cage) and fed from day 19 to 23. The ileal digesta were collected on day 23. The SID of N was higher (P < 0.05) in SBM followed by MBM and CM. The average SID of AA in SBM and MBM were similar (P > 0.05), and greater (P < 0.05) than that in CM. The FF had no influence (P > 0.05) on the SID of indispensable AA, the only exception being His, which was reduced (P < 0.05) by pelleting. Pelleting, however, resulted in reduction (P < 0.001) in the SID of all dispensable AA and average of AA. The AA most affected by pelleting was Cys, with a 15.4% decrease in the SID. The standardized ileal digestible contents of protein and the average of indispensable AA and dispensable AA were higher in MBM than in SBM, with CM being the lowest. Pelleting decreased (P < 0.05) the digestible protein and total digestible AA contents. These findings reveal that the FF has a substantial impact on AA digestibility estimates of feed ingredients and it must be considered in AA digestibility assays of ingredients with high protein and AA contents.

The interactive influence of barley particle size and enzyme supplementation on growth performance, nutrient utilization, and intestinal morphometry of broiler starters.

The influence of barley particle size and enzyme supplementation on performance, nutrient and energy utilization, and intestinal morphometry of broiler starters (day 1-21) fed pelleted barley-based diets was evaluated. Two barley particle sizes (fine and coarse) and 4 enzyme treatments (nonsupplemented [control], carbohydrase [0.15 g/kg of feed; Carb], phytase [0.10 g/kg; Phy] and combination of carbohydrase and phytase [0.15 and 0.10 g/kg, respectively; Carb + Phy]) were evaluated in a 2 × 4 factorial arrangement. Fine and coarse barley particles were achieved by grinding whole barley in a hammer mill to pass through 2.0 and 8.0 mm screens, respectively. A total of 384, 1-day-old male broilers (8 birds/cage; 6 cages/treatment) were used. Supplemental enzymes tended (P = 0.056) to increase the weight gain of birds with a synergetic effect from Carb + Phy. The response of feed intake to supplemental enzymes interacted (P < 0.05) with barley particle size, as Phy increased feed intake only in fine barley diets. Both coarse particles and supplemental Carb, either individually or in combination with Phy, reduced feed per gain (P < 0.001). Digestibility of DM, nitrogen, and fat was greater in birds fed coarse barley diets (P < 0.05). Dry matter, starch, fat, and phosphorus digestibility values were improved by supplemental enzymes (P < 0.05). Coarse barley (P < 0.05) and Carb (P < 0.001), either individually or in combination, increased the AMEn. Coarse barley reduced the gizzard pH (P < 0.001). Birds fed diets with supplemental enzymes had shorter jejunum (P < 0.05). Neither the barley particle size nor supplemental enzymes (P > 0.05) affected the jejunal digesta viscosity. In summary, feeding coarse barley particles and supplemental Carb improved the feed efficiency and nutrient and energy utilization. The effects of barley particle size on measured parameters suggest that the particle size effect was preserved even after pelleting. The combination of Carb and Phy tended to improve the weight gain but caused no further improvements in nutrient utilization.

Total colonic aganglionosis: multicentre study of surgical treatment and patient-reported outcomes up to adulthood.

BACKGROUND: Surgery for total colonic aganglionosis (TCA) is designed to preserve continence and achieve satisfactory quality of life. This study evaluated a comprehensive group of clinical and social outcomes. METHODS: An international multicentre study from eight Nordic hospitals involving examination of case records and a patient-reported questionnaire survey of all patients born with TCA between 1987 and 2006 was undertaken. RESULTS: Of a total of 116 patients, five (4·3 per cent) had died and 102 were traced. Over a median follow-up of 12 (range 0·3-33) years, bowel continuity was established in 75 (73·5 per cent) at a median age of 11 (0·5-156) months. Mucosectomy with a short muscular cuff and straight ileoanal anastomosis (SIAA) (29 patients) or with a J pouch (JIAA) (26) were the most common reconstructions (55 of 72, 76 per cent). Major early postoperative complications requiring surgical intervention were observed in four (6 per cent) of the 72 patients. In 57 children aged over 4 years, long-term functional bowel symptoms after reconstruction included difficulties in holding back defaecation in 22 (39 per cent), more than one faecal accident per week in nine (16 per cent), increased frequency of defaecation in 51 (89 per cent), and social restrictions due to bowel symptoms in 35 (61 per cent). Enterocolitis occurred in 35 (47 per cent) of 72 patients. Supplementary enteral and/or parenteral nutrition was required by 51 (55 per cent) of 93 patients at any time during follow-up. Of 56 responders aged 2-20 years, true low BMI for age was found in 20 (36 per cent) and 13 (23 per cent) were short for age. CONCLUSION: Reconstruction for TCA was associated with persistent bowel symptoms, and enterocolitis remained common. Multidisciplinary follow-up, including continuity of care in adulthood, might improve care standards in patients with TCA.

ANTECEDENTES: La cirugía de la aganglionosis colónica total (total colonic aganglionosis, TCA) está diseñada para preservar la continencia y lograr una calidad de vida satisfactoria. Este estudio evaluó un gran número de resultados clínicos y sociales. MÉTODOS: Se realizó un estudio internacional multicéntrico en ocho hospitales nórdicos en el que se incluyeron las historias clínicas de todos los pacientes nacidos con TCA entre 1987 y 2006. Se invitó a los pacientes y a sus cuidadores a responder una encuesta sobre la función intestinal, el crecimiento y las necesidades nutricionales, así como la repercusión social de la enfermedad a largo plazo. RESULTADOS: De un total de 116 pacientes, 5 (4,3%) habían fallecido y 102 respondieron la encuesta. Con una mediana de seguimiento de 12 años (rango 0,5-33), se había restablecido la continuidad intestinal en 75/102 (74%) a una mediana de edad de 11 meses (0,5-156). La mucosectomía con un manguito muscular corto y anastomosis ileoanal directa (short muscular cuff and straight ileo-anal anastomosis, SIAA) n = 29 o con reservorio en J (JIAA) n = 26 (55/72, 76%) fueron las reconstrucciones más habituales. Las complicaciones postoperatorias precoces que precisaron una intervención quirúrgica fueron muy poco frecuentes, pero se presentaron en 4/72 (5%) pacientes. Los síntomas a largo plazo relacionados con la función intestinal tras la reconstrucción, valorados en 57 niños mayores de cuatro años, fueron la dificultad para retener la defecación en 14 (25%), la encopresis en 21 (37%), las pérdidas fecales > 1/semana en 9 (16%) y el aumento de la frecuencia de defecación en 51 (89%). A largo plazo, se desarrolló una enterocolitis en 35/72 (47%) pacientes. Se precisó de nutrición enteral y/o parenteral suplementaria en algún momento del período de seguimiento en 51/93 (55%) pacientes. En los pacientes que respondieron a la encuesta entre 2 y 20 años (n = 56) de edad, se detectó un índice de masa corporal menor en 20 (35%) y una altura baja en 13 (23%) para su edad. En 35/57 (61%) pacientes mayores de 4 años con restauración del tránsito intestinal había restricciones sociales debido a los síntomas intestinales, de los que en 10 (17%) casos fueron moderadas o graves. CONCLUSIÓN: La reconstrucción de una TCA se asocia con síntomas intestinales persistentes y la enterocolitis sigue siendo frecuente. Un seguimiento multidisciplinario, incluso en la edad adulta, podría mejorar los resultados en la cirugía de la TCA.

The effect of graded inclusions of waxy starch hull-less barley and a multi-component exogenous carbohydrase on the growth performance, nutrient digestibility and intestinal morphometry of broiler chickens.

1. A 21-d experiment was conducted to investigate the effect of graded inclusions of waxy starch hull-less (WSHL) barley and a multi-component exogenous carbohydrase on the growth performance, nutrient digestibility and intestinal morphometry of broiler chickens. Five levels of WSHL barley inclusion (0, 65, 130, 195 and 260 g/kg) in a wheat-based diet, and two levels of enzyme supplementation (0 and 150 g/tonne of feed) were evaluated in a 5 × 2 factorial arrangement of 10 dietary treatments. All diets were equivalent in metabolisable energy and digestible amino acid content. A total of 400, one-d-old male broilers (five cages/treatment; eight birds/cage) were used in the experiment. 2. Regardless of enzyme supplementation, feed intake declined (P < 0.001) with increasing inclusion of WSHL barley. Increasing levels of WSHL barley (P < 0.001) and supplemental enzyme (P < 0.01) increased gain to feed ratio. 3. Birds fed diets with 0 g/kg WSHL barley showed the lowest (P < 0.001 to 0.01) digestibility for all nutrients except starch. Only starch digestibility was improved (P < 0.05) by enzyme supplementation. The nitrogen-corrected apparent metabolisable energy improved with increasing inclusion of WSHL barley (P < 0.001) and supplemental enzyme (P < 0.001). Increasing inclusion of WSHL barley increased the relative weight of gizzard (P < 0.001) and reduced jejunal digesta viscosity (P < 0.01). Supplemental enzyme (P < 0.001) reduced digesta viscosity. 4. All levels of WSHL barley inclusion improved digestibility of dry matter, nitrogen and fat, whilst energy utilisation improved at inclusions of 130 g/kg WSHL and above, probably due to lowered digesta viscosity and better development of the gizzard. Gain to feed ratio, starch digestibility, energy utilisation and jejunal digesta viscosity can benefit from carbohydrase supplementation in wheat-based diets, regardless of barley inclusion level.

Microcirculation and haemodynamics after infraclavicular brachial plexus block using adrenaline as an adjuvant to lidocaine: a randomised, double-blind, crossover study in healthy volunteers.

We evaluated the effect of adrenaline on human skin microcirculation (nutritive and sub-papillary) and systemic cardiovascular variables after it was added to lidocaine in infraclavicular brachial plexus blocks. Twelve healthy, non-smoking male volunteers were included, each attending two study sessions 2 weeks apart, and they were studied using a crossover design. In both sessions, they received an ultrasound-guided infraclavicular brachial plexus block in the non-dominant arm with 0.4 ml.kg-1 lidocaine, 15 mg.ml-1 with or without adrenaline 5 µg.ml-1 . Microcirculation was assessed by laser Doppler fluxmetry (sub-papillary blood flow), capillary video microscopy (nutritive blood flow) and continuous temperature measurements. Heart rate and arterial pressure were recorded continuously and non-invasively. Median (IQR [range]) sub-papillary blood flow increased substantially 30 min after the brachial plexus block, from 8.5 (4.4-13.5 [2.9-28.2]) to 162.7 (111.0-197.8 [9.5-206.7]) arbitrary units with adrenaline (p = 0.017), and from 6.9 (5.3-28.5 [1.8-42.1] to 133.7 (16.5-216.7 [1.0-445.0] arbitrary units without adrenaline (p = 0.036). Nutritive blood flow (functional capillary density, capillaries.mm-2 , measured at the dorsal side of the hand) decreased in the blocked extremity when adrenaline was used as adjuvant, from median (IQR [range]) 45 (36-52 [26-59]) to 38 (29-41 [26-42]), p = 0.028, whereas no significant change occurred without adrenaline. Median finger skin temperature (°C) increased by 44% (data pooled) with no significant differences between the groups. No significant changes were found in the systemic cardiovascular variables with or without adrenaline. We conclude that lidocaine infraclavicular brachial plexus blocks caused an increase in skin sub-papillary blood flow. The addition of adrenaline produced stronger and longer lasting blocks, but decreased the nutritive blood flow.

Influence of inclusion level of barley in wheat-based diets and supplementation of carbohydrase on growth performance, nutrient utilisation and gut morphometry in broiler starters.

1. The influence of barley inclusion level and supplementation of a multi-component non-starch polysaccharide degrading enzyme on performance and nutrient utilisation in broilers was investigated. Normal-starch hulled barley was evaluated with five levels of inclusion (0, 141, 283, 424 and 565 g/kg) in a wheat-based diet and two levels of enzyme supplementation (0 and 150 g/tonne of feed; a 5 × 2 factorial arrangement of 10 dietary treatments). All diets were equivalent in metabolisable energy and digestible amino acid contents. A total of 400, one-d old male broilers (five cages/treatment; eight birds/cage) were used in the experiment.2. Regardless of enzyme supplementation, weight gain (WG) increased up to 283 g/kg of barley and was reduced afterwards (P < 0.01). Increasing levels of barley resulted in greater (P < 0.001) gain per feed (G/F). Enzyme addition increased WG (P < 0.05) and G/F (P < 0.001) at each barley inclusion level.3. Birds fed diets with 0 and 565 g/kg barley showed the lowest and highest (P < 0.001to 0.05) digestibility for all nutrients measured, respectively. Digestibility of all nutrients was improved by enzyme supplementation at each barley inclusion level (P < 0.05). The nitrogen-corrected apparent metabolisable energy improved with increasing inclusion of barley (P < 0.001) and supplemental enzyme (P < 0.01). Increasing inclusion of barley increased the relative weight of gizzard (P < 0.001) and reduced jejunal digesta viscosity (P < 0.001). Supplemental enzyme (P < 0.001) reduced digesta viscosity.4. The optimum inclusion level of barley, with respect to growth performance, was 283 g/kg of diet. Increasing barley inclusion improved nutrient and energy utilisation, possibly through lowered digesta viscosity and better function of the gizzard. Feed efficiency and nutrient and energy utilisation can benefit from carbohydrase supplementation in barley-based diets, regardless of barley inclusion level.

Nutritional evaluation of two barley cultivars, without and with carbohydrase supplementation, for broilers: metabolisable energy and standardised amino acid digestibility.

1. Two experiments were conducted to assess the nitrogen-corrected apparent metabolisable energy (AMEn; Exp. 1; 288 Ross 308 male broilers at d 14; 36 cages with eight birds each) and coefficient of standardised ileal digestibility (CSID) of amino acids (AA; Exp. 2; 336 Ross 308 male broilers at d 21; 42 cages with eight birds each) of two barley cultivars for broilers in comparison to wheat, without or with a multi-component non-starch polysaccharide (NSP) degrading enzyme. A 3 × 2 factorial arrangement of treatments was used in both experiments with three types of grains (normal starch hulled barley [NSH], waxy starch hull-less barley [WSHL], and wheat) and two levels of enzyme supplementation (0 and 200 g/tonne of feed). Enzyme supplemented diets contained 406 and 128 of endo-1, 4-ß-xylanase and endo-1, 3 (4)-ß-glucanase units per kg of feed, respectively. 2. Analysis showed that the starch content was higher in NSH (610 g/kg) than in wheat (537 g/kg) and WSHL (554 g/kg), and the composition of starch differed markedly among the grain types. The ß-glucan content was considerably higher in WSHL (68.6 g/kg) compared to NSH (38.5 g/kg) and wheat (7.74 g/kg). The contribution of soluble fraction to the total non-starch polysaccharides was higher in WSHL (38.2%) compared to NSH and wheat (17.1% and 13.3%, respectively). 3. A significant (P < 0.01) interaction was observed between the grain type and enzyme supplementation for AMEn. The WSHL, with the highest content of ß-glucan, showed the greatest response to enzyme supplementation for AMEn. 4. Birds fed wheat- and WSHL-based diets had the highest and lowest CSID of nitrogen and most of AA, respectively, with NSH diets being intermediate. Regardless of grain type, enzyme supplementation increased (P < 0.05) the CSID of nitrogen. 5. These data suggest that ß-glucan content plays an important role in determining the digestibility of nutrients in barley for broilers, resulting in a better feeding value for NSH over WSHL. Supplementation of a multi-component NSP-degrading enzyme can improve the feeding value of barley in broiler diets by increasing the digestibility with the effect being more pronounced in WSHL barley.

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013.

BACKGROUND: The long-term incidence of acute appendicitis has been reported to be declining in Europe and North America. Recent reports, however, indicate stabilized or even increased rates. The aim of this study was to investigate the present epidemiology of acute appendicitis and appendicectomy in a population-based cohort of Swedish children. METHODS: The Swedish National Patient Register was queried for all children with acute appendicitis and/or appendicectomy in 1987-2013. Population-based incidence rates were calculated. Rates were age- and sex-adjusted, and analysed for temporal and regional trends. RESULTS: Some 56 774 children with acute appendicitis were identified, of whom 53 478 (94·2 per cent) underwent appendicectomy. The incidence rate of acute appendicitis declined by 43·7 per cent over 26 years, from 177·7 to 100·1 per 100 000 person-years between 1987 and 2013. The most significant reduction was for non-perforated appendicitis, from 138·5 to 68·4 per 100 000 person-years between 1987 and 2009. The incidence rate of perforated appendicitis decreased from 28·0 to 19·9 per 100 000 person-years and negative appendicectomies reduced from 48·5 to 3·6 per 100 000 person-years during the study interval. CONCLUSION: The incidence rates of acute appendicitis and negative appendicectomy have reduced markedly in Swedish children over time, with significantly different trends amongst non-perforated appendicitis and perforated appendicitis. The full explanation for the observed findings is unclear.

Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprung's disease.

For the surgical treatment of Hirschsprung's disease, several surgical techniques are used to resect the distal aganglionic colon. Two frequently used techniques are the Duhamel procedure and the transanal endorectal pull-through procedure. During the '8th Pediatric Colorectal Course' in Nijmegen, November 2015, a workshop was organized to share experiences of both techniques by several experts in the field and to discuss (long term) outcomes. Specifically, the objective of the meeting was to discuss the main controversies in relation to the technical execution of both procedures in order to make an initial assessment of the limitations of available evidence for clinical decision-making and to formulate a set of preliminary recommendations for current clinical care and future research.

Nutritional regulation of the anabolic fate of amino acids within the liver in mammals: concepts arising from in vivo studies.

At the crossroad between nutrient supply and requirements, the liver plays a central role in partitioning nitrogenous nutrients among tissues. The present review examines the utilisation of amino acids (AA) within the liver in various physiopathological states in mammals and how the fates of AA are regulated. AA uptake by the liver is generally driven by the net portal appearance of AA. This coordination is lost when demands by peripheral tissues is important (rapid growth or lactation), or when certain metabolic pathways within the liver become a priority (synthesis of acute-phase proteins). Data obtained in various species have shown that oxidation of AA and export protein synthesis usually responds to nutrient supply. Gluconeogenesis from AA is less dependent on hepatic delivery and the nature of nutrients supplied, and hormones like insulin are involved in the regulatory processes. Gluconeogenesis is regulated by nutritional factors very differently between mammals (glucose absorbed from the diet is important in single-stomached animals, while in carnivores, glucose from endogenous origin is key). The underlying mechanisms explaining how the liver adapts its AA utilisation to the body requirements are complex. The highly adaptable hepatic metabolism must be capable to deal with the various nutritional/physiological challenges that mammals have to face to maintain homeostasis. Whereas the liver responds generally to nutritional parameters in various physiological states occurring throughout life, other complex signalling pathways at systemic and tissue level (hormones, cytokines, nutrients, etc.) are involved additionally in specific physiological/nutritional states to prioritise certain metabolic pathways (pathological states or when nutritional requirements are uncovered).

Patients with lymphatic malformations who receive the immunostimulant OK-432 experience excellent long-term outcomes.

AIM: Sclerotherapy is the primary treatment for lymphatic malformations. The aim of this study was to evaluate the long-term outcome in patients with lymphatic malformations treated with the immunostimulant OK-432 as a sclerosant. METHODS: Between 1998 and 2013, we enrolled 131 of 138 eligible patients treated with OK-432 for lymphatic malformations in a retrospective study. The malformations were categorised according to the International Society for the Study of Vascular Anomalies. The outcome was assessed with a clinical examination and a questionnaire. RESULTS: The lymphatic malformations were localised to the head/neck (60%), the trunk (20%) and the extremities (6%) or involved with more than one region (14%). Patients with microcystic (10%), macrocystic (21%) and mixed lymphatic malformations (69%) underwent a median number of three, two and two injection treatments, respectively. The median age at the first injection was 3.4 years. Good or excellent clinical outcomes were seen in 70% of the patients. The number of injections, previous treatment and lesion localisation, but not time to follow-up and cyst size, predicted the clinical outcome. CONCLUSION: OK-432 treatment resulted in a successful outcome in 70% of patients with lymphatic malformations. The long-term outcome was comparable to the short-term outcome.

Fatty acid profile differs between organic and conventionally produced cow milk independent of season or milking time.

Differing amounts of fresh forage and concentrates fed, and level of input contributes to the differences reported in fatty acid (FA) composition of organic and conventionally produced cow milk. In many previous studies designed to investigate this phenomenon, comparisons were made between grazed organic cows and housed conventional cows. In the present study, we have investigated differences between organic and conventional milk produced using year-round pasture grazing, as practiced in New Zealand. The FA composition was determined in milk sampled at morning and evening milking in both spring and autumn. Samples were taken from 45 cows from the Massey University organic herd and compared with 50 cows from the corresponding conventional herd grazed and managed similarly at the same location. Forty-three out of 51 analyzed FA were influenced by season, whereas 28 were different between production systems. In addition, one-half were also different due to time of milking. Levels of linoleic acid and α-linolenic acid were higher in organic milk, whereas conjugated linoleic acid (CLA) and vaccenic acid were higher in conventional milk. The first 3 FA (linoleic acid, α-linolenic acid, and CLA) were more abundant in milk harvested during autumn, and the CLA concentration was also significantly influenced by time of milking. Our results confirm reports that the FA profile is affected by season and time of milking, and we also showed an effect due to the production system, when both sets of cows were kept continuously on pasture, even after taking milking time and seasonal effect into account.

Invited review: organic and conventionally produced milk-an evaluation of factors influencing milk composition.

Consumer perception of organic cow milk is associated with the assumption that organic milk differs from conventionally produced milk. The value associated with this difference justifies the premium retail price for organic milk. It includes the perceptions that organic dairy farming is kinder to the environment, animals, and people; that organic milk products are produced without the use of antibiotics, added hormones, synthetic chemicals, and genetic modification; and that they may have potential benefits for human health. Controlled studies investigating whether differences exist between organic and conventionally produced milk have so far been largely equivocal due principally to the complexity of the research question and the number of factors that can influence milk composition. A main complication is that farming practices and their effects differ depending on country, region, year, and season between and within organic and conventional systems. Factors influencing milk composition (e.g., diet, breed, and stage of lactation) have been studied individually, whereas interactions between multiple factors have been largely ignored. Studies that fail to consider that factors other than the farming system (organic vs. conventional) could have caused or contributed to the reported differences in milk composition make it impossible to determine whether a system-related difference exists between organic and conventional milk. Milk fatty acid composition has been a central research area when comparing organic and conventional milk largely because the milk fatty acid profile responds rapidly and is very sensitive to changes in diet. Consequently, the effect of farming practices (high input vs. low input) rather than farming system (organic vs. conventional) determines milk fatty acid profile, and similar results are seen between low-input organic and low-input conventional milks. This confounds our ability to develop an analytical method to distinguish organic from conventionally produced milk and provide product verification. Lack of research on interactions between several influential factors and differences in trial complexity and consistency between studies (e.g., sampling period, sample size, reporting of experimental conditions) complicate data interpretation and prevent us from making unequivocal conclusions. The first part of this review provides a detailed summary of individual factors known to influence milk composition. The second part presents an overview of studies that have compared organic and conventional milk and discusses their findings within the framework of the various factors presented in part one.