Modifying the gastrointestinal ecology in alternatively raised poultry and the potential for molecular and metabolomic assessment.

Consumer demand for nonconventional poultry products continues to increase in the United States. In pasture flock and organic poultry production, probiotics and prebiotic feed additives have potential advantages because they are thought to promote intestinal health and may offer a replacement for current intervention strategies that are not considered acceptable for these production systems. Prebiotics have been demonstrated to produce effects on the gastrointestinal tract including modulation of microflora by promoting selective increases in beneficial bacteria concomitant with decreases in undesirable bacteria. In-depth assessment of microbial community changes during host growth and development as well as the establishment of beneficial microbial species by adding biologicals such as probiotics and prebiotics is important to achieve predictable and consistent improvements in chicken health and productivity. To analyze microflora shifts and metabolites produced by bacteria in the gut as well as host responses to biological additives, sophisticated molecular techniques are now available and are becoming more widely used. Polymerase chain reaction assays, denaturing gradient gel electrophoresis, and temperature gradient gel electrophoresis offer approaches for detecting microbial shifts in the gut. Likewise, the employment of microarrays and molecular analysis of gut tissues can reveal insight into gut physiological and responses to dietary and other changes. Recent application of 16S rDNA sequencing and analysis utilizing basic local alignment search tool (BLAST) and FASTA databases on poultry gut samples have the potential to provide a much more in-depth assessment of the gut microbiome. Utilizing ultra pressure liquid chromatography-mass spectroscopy profiling, metabolomic assessment of gut contents will also allow for parallel comparisons of changes in the gut contents with microbiome and physiological responses. Combining all these technologies will provide a plenary understanding of poultry gut health in alternative production systems.

Tamoxifen or surgery plus tamoxifen as primary treatment for elderly patients with operable breast cancer: The G.R.E.T.A. Trial. Group for Research on Endocrine Therapy in the Elderly.

A multicentre trial in operable breast cancer in patients aged over 70 years compared tamoxifen alone (starting with a loading dose of 160 mg on the first day) with surgery plus adjuvant tamoxifen. 473 patients were recruited with a median follow up of 36 months. Local progression occurred in 15/237 patients in the surgical arm versus 60/236 in the tamoxifen alone arm (p = 0.000). There were 48 deaths in the surgical arm and 41 in the other one (p = 0.67). Distant metastases occurred in 33/237 patients in the surgical arm versus 19/236 in the tamoxifen alone arm (p = 0.058). In elderly patients with operable breast cancer surgery is indicated. Tamoxifen alone is an adequate alternative in frail patients. A loading dose of Tamoxifen may be useful in preventing the expression of the metastatizing phenotype. In any case, delayed surgery does not prejudice the overall survival.