Safety and Effectiveness of Bypassing Oral Immunotherapy Buildup With an Initial Phase of Sublingual Immunotherapy for Higher-Risk Food Allergy

BACKGROUND

Because of its favorable safety, sublingual immunotherapy (SLIT) for food allergy has been proposed as an alternative treatment for those in whom oral immunotherapy (OIT) is of higher risk-older children, adolescents, adults, and those with a history of severe reactions. Although safe, SLIT has been shown to be less effective than OIT.

OBJECTIVE

To describe the safety of multifood SLIT in pediatric patients aged 4 to 18 years and the effectiveness of bypassing OIT buildup with an initial phase of SLIT.

METHODS

Patients aged 4 to 18 years were offered (multi)food SLIT. Patients built up to 2 mg protein SLIT maintenance over the course of 3 to 5 visits under nurse supervision. After 1 to 2 years of daily SLIT maintenance, patients were offered a low-dose oral food challenge (OFC) (cumulative dose, 300 mg protein) with the goal of bypassing OIT buildup.

RESULTS

Between summer 2020 and winter 2023, 188 patients were enrolled in SLIT (median age, 11 years). Four patients (2.10%) received epinephrine during buildup and went to the emergency department, but none experienced grade 4 (severe) reaction. A subset of 20 patients had 50 low-dose OFCs to 300 mg protein and 35 (70%) OFCs were successful, thereby bypassing OIT buildup.

CONCLUSIONS

In combination with very favorable safety of SLIT, with no life-threatening reactions and few reactions requiring epinephrine, we propose that an initial phase of SLIT to bypass supervised OIT buildup be considered for children in whom OIT is considered to be of higher risk.

Safety and effectiveness of the Canadian food ladders for children with IgE-mediated food allergies to cow's milk and/or egg

BACKGROUND

Food ladders are tools designed to facilitate home-based dietary advancement in children with food allergies through stepwise exposures to increasingly allergenic forms of milk and egg. Several studies have now documented safety and efficacy of food ladders. In 2021, we published a Canadian adaptation of the previously existing milk and egg ladders originating in Europe using foods more readily available/consumed in Canada. Our study adds to the growing body of evidence supporting food ladder use and provides safety and effectiveness data for our Canadian adaptation of the milk and egg ladders.

METHODS

Surveys were distributed to families of children using the Canadian Milk Ladder and/or the Canadian Egg Ladder at baseline, with follow up surveys at 3 months, 6 months, and 12 months. Data were analyzed using REDCap and descriptive and inferential statistics are presented.

RESULTS

One hundred and nine participants were started on milk/egg ladders between September 2020 and June 2022. 53 participants responded to follow up surveys. Only 2 of 53 (3.8%) participants reported receiving epinephrine during the study. Severe grade 4 reactions (defined according to the modified World Allergy Organization grading system) were not reported by any participants. Minor cutaneous adverse reactions were common, with about 71% (n = 10/14) of respondents reporting cutaneous adverse reactions by 1 year of food ladder use. An increasing proportion of participants could tolerate most foods from steps 2-4 foods after 3, 6, and 12 months of the food ladder compared to baseline.

CONCLUSION

The Canadian food ladders are safe tools for children with cow's milk and/or egg allergies, and participants tolerated a larger range of foods with food ladder use compared to baseline.

Optimizing vitamin D status in polycystic ovary syndrome: a systematic review and dose-response meta-analysis

CONTEXT

Polycystic ovary syndrome (PCOS) is a common and complex endocrine disorder in women of reproductive age. Vitamin D supplementation is a promising complementary therapy for PCOS, yet there is no consensus on an optimal dose, leading to a lack of evidence-based supplementation guidelines.

OBJECTIVE

The objective of this study was to conduct a vitamin D dose-response meta-analysis among women with PCOS.

DATA SOURCES

MEDLINE, CINAHL, and EMBASE databases from inception to November 2022 were searched for relevant articles.

DATA EXTRACTION

Study screening and bias assessment were conducted by 2 independent reviewers. Eight relevant studies were identified; data for serum 25(OH)D (nmol/L) at baseline and at 12 weeks in each intervention group (mean ± SD) and vitamin D dose were extracted.

DATA ANALYSIS

Estimates across studies were used to create a pooled curve, using restricted cubic splines with knots at the 10th, 50th, and 90th percentiles of the distribution of doses, to estimate the mean difference in effect for serum 25(OH)D at each dose compared with 0 IU/day. Sensitivity analyses were conducted fixing knots at 4000 IU/day and 7000 IU/day, which were a priori identified as potentially important thresholds, and to assess model fit and estimate heterogeneity. The pooled analysis demonstrated strong evidence of a dose-response relationship (P < .001), suggesting an increasing effect with increasing dose. An initial increase in serum 25(OH)D was evident until doses of approximately 3000 IU/day; this was followed by a plateau in effect between approximately 3000 IU/day and 5000 IU/day. The effect of supplementation with >5000 IU/day was unclear, given the minimal data at higher doses. The curve produced robust results for moderate doses (3000 IU/day to 4000 IU/day), which were not sensitive to model specification.

CONCLUSION

Women with PCOS are responsive to vitamin D supplementation, but the benefit of providing doses of >3000 IU/day appears minimal. Further data is required to determine dose-response at doses of >5000 IU/day, and whether higher intakes provide a clinically meaningful advantage in this population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021259396.

Cow’s milk alternatives for children with cow’s milk allergy and beyond

Cow’s milk allergy (CMA) is one of the most common food allergies in the first years of life, with worldwide prevalence estimated to range from 2% to 5%. While the majority of children with CMA will eventually develop tolerance to cow’s milk proteins (it is estimated that &gt;75% of children with CMA develop tolerance to cow’s milk proteins by the age of 3 years, and &gt;90% develop tolerance by the age of 6 years), the selection of an appropriate cow’s milk (CM) alternative for those with CMA is vital to ensure adequate growth and development during childhood. The increasing number of CM alternative products on the commercial market with markedly different nutritional content and micronutrient fortification adds a layer of complexity that can be challenging for both families and clinicians to navigate. This article aims to provide guidance and clarity to Canadian paediatricians and primary care clinicians on recommending the most appropriate, safe, and nutritionally optimal CM alternatives for individuals with CMA, and beyond.

Patient selection for milk and egg ladders using a food ladder safety checklist

A food ladder is a form of home-based dietary advancement therapy that gradually increases exposure to an allergenic food through the gradual introduction of egg or milk containing food with increasing quantity and allergenicity from extensively heated forms, such as baked goods, to less processed products. While widely considered safe, the food ladder is not risk-free and most of the egg and milk ladder studies only included preschoolers with mild egg and milk allergies, and with no or well-controlled asthma. We propose a Food Ladder Safety Checklist to assist with patient selection using “4 A's” based on available evidence for food ladders, including Age, active or poorly controlled Asthma, history of Anaphylaxis, and Adherence.

Canadian food ladders for dietary advancement in children with IgE-mediated allergy to milk and/or egg

Food ladders are clinical tools already widely used in Europe for food reintroduction in milk- and egg-allergic children. Previously developed milk and egg ladders have limited applicability to Canadian children due to dietary differences and product availability. Herein we propose a Canadian version of cow’s milk and egg food ladders and discuss the potential role that food ladders may have in the care of children with IgE-mediated allergies to cow’s milk and/or egg, as either a method of accelerating the acquisition of tolerance in those who would outgrow on their own, or as a form of modified oral immunotherapy in those with otherwise persistent allergy.

Determinants of fatty acid content and composition of human milk fed to infants born weighing <1250 g

BACKGROUND

Infants born at very low birth weight (VLBW) are vulnerable to deficits in fatty acids (FAs) but little is known of factors that influence the intakes or composition of their human milk feeds.

OBJECTIVES

We aimed to identify sources of variability in the fat composition of human milk fed to VLBW infants and examine the impact of milk source (mother's own or donor) on fat and FA intakes.

METHODS

Serial samples of mother's milk (n = 476) and donor milk (n = 53) fed to infants born weighing <1250 g (n = 114 infants from 100 mothers) were collected [Optimizing Mothers' Milk for Preterm Infants (OptiMoM) randomized clinical trial]. Fat and FA were analyzed using a mid-infrared human milk analyzer and GC with flame ionization detection.

RESULTS

At full enteral feeding, donor milk is estimated to provide 1.3 g · kg-1 · d-1 less total fat than mature mother's milk (recommended intake: 4.8 g · kg-1 · d-1), and 5-9 mg · kg-1 · d-1 less DHA (22:6n-3) and arachidonic acid (20:4n-6) (estimated average requirement: 55-60 and 35-45 mg · kg-1 · d-1, respectively) than colostrum or transitional milk. Similar deficits were observed in measured intakes of a subset of OptiMoM infants. In multivariable-adjusted models, maternal ethnicity had medium to large [≥0.5 SD score (SDS)] effects on DHA, SFAs, and MUFAs. Mothers with prepregnancy BMI in overweight and obese categories had higher milk total fat (β: 0.35; 95% CI: 0.10, 0.61 and β: 0.46; 95% CI: 0.16, 0.77 SDS, respectively). Those with BMI ≥30 in addition had higher proportions of SFAs (β: 0.61; 95% CI: 0.33, 0.89 SDS) and lower DHA (β: -0.54; 95% CI: -0.89, -0.20 SDS). Other factors, such as gestational age and income, were also associated with FA composition.

CONCLUSIONS

The fat and FA content of human milk fed to VLBW infants is variable. Care must be taken to ensure fat and FA intakes meet recommendations, particularly when feeding a high proportion of donor milk.This trial was registered at clinicaltrials.gov as NCT02137473.

Detectable Unmetabolized Folic Acid and Elevated Folate Concentrations in Folic Acid-Supplemented Canadian Children With Sickle Cell Disease

Sickle cell disease (SCD) is an inherited hemoglobinopathy caused by a variant (rs344) in the HBB gene encoding the β-globin subunit of hemoglobin. Chronic hemolytic anemia and increased erythropoiesis and RBC turnover in individuals with SCD can result in increased needs for folate and other B-vitamins. We assessed B-vitamin status, and the distribution of folate forms, including unmetabolized folic acid (UMFA), in Canadian children with SCD supplemented with 1 mg/d folic acid (current routine practice). Non-fasted serum and plasma samples were analyzed for concentrations of folate, and vitamins B-2, B-6, and B-12. Eleven individuals (45% male; SCD type: HbSS n = 8, HbSC n = 2, HbSβ⁰-Thal n = 1), with a median (IQR) age of 14 (7, 18) years, were included. Total folate concentrations were 3-27 times above the deficiency cut-off (10 nmol/L), and 64% of children had elevated folate levels (>45.3 nmol/L). UMFA (>0.23 nmol/L) was detected in all children, and 36% of participants had elevated levels of UMFA (>5.4 nmol/L). All children were vitamin B-12 sufficient (>150 pmol/L), and the majority (55%) had sufficient B-6 status (>30 nmol/L). Among this sample of Canadian children with SCD, there was limited evidence of B-vitamin deficiencies, but UMFA was detectable in all children.

Can Automated Hematology Analyzers Predict the Presence of a Genetic Hemoglobinopathy? An Analysis of Hematological Biomarkers in Cambodian Women

Genetic hemoglobinopathies are the most common single-gene disorder worldwide. Some automated hematology analyzers have the capability of flagging individuals who may have hematological disorders based on complete blood count (CBC) biomarkers. We aimed to evaluate the accuracy of a hematology analyzer in identifying genetic hemoglobinopathies in Cambodian women and to determine which hematological biomarkers are the best predictors. A CBC was completed using a Sysmex XN-1000 analyzer and hemoglobinopathies were determined with capillary hemoglobin electrophoresis for 808 nonpregnant Cambodian women. Sysmex XN-1000 Interpretive Program (IP) messages, which flag potential hematological disorders, were produced from CBC results. Then, 2 × 2 tables were used to determine sensitivity and specificity of the IP message “Hemoglobin defect” to detect a genetic hemoglobinopathy. Receiver operating characteristic (ROC) analyses assessed the diagnostic ability of six CBC biomarkers to predict a genetic hemoglobinopathy. In total, 74% of women had a hemoglobinopathy (predominantly Hb E and α-thalassemia). “Hb defect” IP message sensitivity and specificity for genetic hemoglobinopathy detection were 10.4% and 98.6%, respectively. Variable selection strategies yielded a two-variable model including mean corpuscular volume (MCV) and red blood cell (RBC) count (AIC = 99.83, AUC^ROC = 0.98 (95% CI: 0.97, 0.99)) for the prediction of a homozygous EE disorder. Sensitivity and specificity values do not justify the use of Sysmex XN-1000 IP flag messages for identification of genetic hemoglobinopathies in Cambodian women. Development of an algorithm based on MCV and RBC biomarkers may optimize the screening ability of automated hematology analyzers.

Regression to the Mean: A Statistical Phenomenon of Worthy Consideration in Anemia Research

BACKGROUND

Regression to the mean (RTM) is a statistical phenomenon where second measurements are more likely to be closer to the mean. This is particularly observed in those with baseline values further from the mean. Anemic individuals (hemoglobin <120 g/L) are often recruited when evaluating iron supplementation programs, as they are more likely to elicit a greater hemoglobin response; however, they are also at greater risk for RTM as their baseline values are lower than the overall population mean.

OBJECTIVE

The aim was to calculate and apply RTM to a previously conducted iron supplementation trial of women in Cambodia at increasingly severe baseline anemia cutoffs (hemoglobin <120 g/L, <115 g/L, and <110 g/L).

METHODS

Women received either 60 mg/d iron (n = 191) or placebo (n = 185) for 12 wk. Hemoglobin was measured at baseline and at 12 wk (endline), and change in hemoglobin was calculated in each group for each cutoff. RTM was calculated in the placebo group at each cutoff and applied to the change observed at each cutoff in the iron group to obtain the RTM-free effect.

RESULTS

In the placebo group, mean change in hemoglobin increased as cutoffs became more extreme (0.9 g/L to 1.9 g/L in those with baseline hemoglobin <120 g/L and <110 g/L, respectively). RTM estimates similarly increased: 1.0 g/L (<120 g/L), 1.3 g/L (<115 g/L), and 1.8 g/L (<110g/L). When applying RTM to the iron group, we found that ∼10% of the "treatment effect" could be attributable to RTM at each cutoff. However, iron supplementation was still effective in increasing hemoglobin, with an increased effect in those with lower baseline values, as proven by the RTM-free effect at each cutoff: 8.7 g/L (<120 g/L), 10.9 g/L (<115 g/L), and 13.6g/L (<110 g/L).

CONCLUSIONS

RTM may have accounted for ∼10% of the observed change in hemoglobin following iron supplementation; however, appropriate use of a placebo group in the statistical analyses of the trial controls for this potential RTM effect.

The Homozygous Hemoglobin EE Variant Is Associated with Poorer Riboflavin Status in Cambodian Women of Reproductive Age

BACKGROUND

Riboflavin is required for erythropoiesis, which is increased in people with hemoglobinopathies due to increased hemolysis and erythrocyte turnover. Dietary intake and status of riboflavin is poor in Cambodia, where hemoglobinopathies are common.

OBJECTIVE

We assessed the association between genetic hemoglobin disorders and riboflavin status in women of reproductive age in Cambodia.

METHODS

Venous blood samples from 515 Cambodian women of reproductive age, 18-45 y, were analyzed for biomarker status of riboflavin [erythrocyte glutathione reductase activation coefficient (EGRac)], genetic hemoglobin (Hb) disorders, and hematological indices. Linear regression analysis was used to estimate the association between EGRac with Hb, ferritin, and Hb genotypes. EGRac was log transformed in the analyses, and the regression coefficients represent the geometric mean differences.

RESULTS

Genetic Hb disorders were present in 57% of the population, with the homozygous hemoglobin E variant (Hb EE) occurring in ∼10% of women (n = 53). Deficient (EGRac ≥1.40) or marginal riboflavin status (EGRac ≥1.30 and <1.40) was observed in 92% (n = 475) of women. The variant Hb EE genotype was associated with 18% (95% CI: 9%, 28%) higher geometric mean EGRac values than the normal Hb AA genotype (P < 0.001).

CONCLUSIONS

Although riboflavin biomarker deficiency or marginal status is widely prevalent in Cambodian women, lower riboflavin status was observed more frequently in women with the Hb EE genotype than in women with normal Hb AA. The relation between genetic Hb disorders and riboflavin warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01593423 and NCT02481375.

Folic acid supplementation in children with sickle cell disease: study protocol for a double-blind randomized cross-over trial

Background

Sickle cell disease (SCD) is a genetic disorder which causes dysfunctional red blood cells (RBC) and is thought to increase requirements for folate, an essential B vitamin, due to increased RBC production and turnover in the disease. High-dose supplementation with 1–5 mg/d folic acid, synthetic folate, has been the standard recommendation for children with SCD. There is concern about whether children with SCD need such high doses of folic acid, following mandatory folic acid fortification of enriched grains in Canada, and advancements in medical therapies which extend the average lifespan of RBCs. In animal and human studies, high folic acid intakes (1 mg/d) have been associated with accelerated growth of some cancers, and the biological effects of circulating unmetabolized folic acid (UMFA), which can occur with doses of folic acid ≥ 0.2 mg/d, are not fully understood. The objective of this study is to determine efficacy of, and alterations in folate metabolism from high-dose folic acid in children with SCD during periods of folic acid supplementation versus no supplementation.

Methods

In this double-blind randomized controlled cross-over trial, children with SCD (n = 36, aged 2–19 years) will be randomized to either receive 1 mg/d folic acid, the current standard of care, or a placebo for 12 weeks. After a 12-week washout period, treatments will be reversed. Total folate concentrations (serum and RBC), different folate forms (including UMFA), folate-related metabolites, and clinical outcomes will be measured at baseline and after treatment periods. The sum of the values measured in the two periods will be calculated for each subject and compared across the two sequence groups by means of a test for independent samples for the primary (RBC folate concentrations) and secondary (UMFA) outcomes. Dietary intake will be measured at the beginning of each study period.

Discussion

As the first rigorously designed clinical trial in children with SCD, this trial will inform and assess current clinical practice, with the ultimate goal of improving nutritional status of children with SCD.

Trial registration

ClinicalTrials.govNCT04011345. Registered on July 8, 2019

Review: Effects of fibre, grain starch digestion rate and the ileal brake on voluntary feed intake in pigs

Grains rich in starch constitute the primary source of energy for both pigs and humans, but there is incomplete understanding of physiological mechanisms that determine the extent of digestion of grain starch in monogastric animals including pigs and humans. Slow digestion of starch to produce glucose in the small intestine (SI) leads to undigested starch escaping to the large intestine where it is fermented to produce short-chain fatty acids. Glucose generated from starch provides more energy than short-chain fatty acids for normal metabolism and growth in monogastrics. While incomplete digestion of starch leads to underutilised feed in pigs and economic losses, it is desirable in human nutrition to maintain consistent body weight in adults. Undigested nutrients reaching the ileum may trigger the ileal brake, and fermentation of undigested nutrients or fibre in the large intestine triggers the colonic brake. These intestinal brakes reduce the passage rate in an attempt to maximise nutrient utilisation, and lead to increased satiety that may reduce feed intake. The three physiological mechanisms that control grain digestion and feed intake are: (1) gastric emptying rate; (2) interplay of grain digestion and passage rate in the SI controlling the activation of the ileal brake; and (3) fermentation of undigested nutrients or fibre in the large intestine activating the colonic brake. Fibre plays an important role in influencing these mechanisms and the extent of their effects. In this review, an account of the physiological mechanisms controlling the passage rate, feed intake and enzymatic digestion of grains is presented: (1) to evaluate the merits of recently developed methods of grain/starch digestion for application purposes; and (2) to identify opportunities for future research to advance our understanding of how the combination of controlled grain digestion and fibre content can be manipulated to physiologically influence satiety and food intake.

Assessment and validation of a defined fluid restriction protocol in the use of subcutaneous desmopressin for children with inherited bleeding disorders

INTRODUCTION

Despite the availability of subcutaneous desmopressin (1-deamino-8-d-arginine vasopressin, SC-DDAVP) as a haemostatic agent for children with mild bleeding disorders, few publications specifically address the safety or efficacy of this mode of administration.

AIM

Our aim was to assess whether a defined fluid restriction protocol was effective in preventing hyponatremia in children receiving perioperative SC-DDAVP, and to document adequate biological and clinical response in this setting.

METHODS

We retrospectively analysed a cohort of children with mild bleeding disorders prescribed SC-DDAVP over a 5-year period following institution of a 'two-thirds maintenance' fluid restriction protocol.

RESULTS

Sixty-nine patients received SC-DDAVP following this protocol, including 15 with mild haemophilia A, 49 with von Willebrand disease (VWD) and five with platelet storage pool disorder. In patients who underwent formal preoperative assessment a complete or partial response was observed in 28/29 with type 1 VWD and 14/15 with mild haemophilia A. Perioperative SC-DDAVP provided excellent haemostasis in all patients, with no requirement for factor concentrate or blood products. Mild asymptomatic hyponatremia was detected in seven children who received multiple doses of DDAVP (lowest sodium 129 mmol L(-1) ); however, adherence to the prescribed fluid restriction protocol was questionable in six of these cases. Symptomatic hyponatremia was not observed.

CONCLUSION

Subcutaneous desmopressin was well-tolerated, with no serious side-effects observed, and good biological responses in preoperative trials. A two-thirds maintenance fluid regimen was effective at preventing symptomatic hyponatremia in our cohort, and is now the standard protocol for fluid restriction post-DDAVP administration in our centre.

Knowledge, perceptions, and consumption of whole grains among university students

PURPOSE

Differences in knowledge, perceptions, and consumption of whole grains were compared between students who had taken an introductory university nutrition course and those who had not.

METHODS

The sample consisted of two groups: 109 students who had completed a nutrition course and 61 who had not. The two samples were drawn from second-year nursing students and students in second-year psychology courses, respectively. All students completed a 25-item questionnaire. Chi-square tests were used to identify associations between completion of a nutrition course and responses.

RESULTS

Nutrition education students had more knowledge of whole grain recommendations, of whole grains available in stores, and of whole grains as a factor in disease risk reduction (p<0.05). In contrast, non-nutrition education students had more knowledge of whole grain health claims, reported a greater preference for the taste of whole grains, and had a greater than mean intake of whole grain cereals (p<0.05).

CONCLUSIONS

This prelimary study indicates that completion of an introductory nutrition course has a greater influence on positive perceptions of whole grains than on students' consumption frequency or knowledge of whole grains. Further study may provide more information on nutrition education and whole grains.

Mechanical properties and structure of the biological multilayered material system, Atractosteus spatula scales

During recent decades, research on biological systems such as abalone shell and fish armor has revealed that these biological systems employ carefully arranged hierarchical multilayered structures to achieve properties of high strength, high ductility and light weight. Knowledge of such structures may enable pathways to design bio-inspired materials for various applications. This study was conducted to investigate the spatial distribution of structure, chemical composition and mechanical properties in mineralized fish scales of the species Atractosteus spatula. Microindentation tests were conducted, and cracking patterns and damage sites in the scales were examined to investigate the underlying protective mechanisms of fish scales under impact and penetration loads. A difference in nanomechanical properties was observed, with a thinner, stiffer and harder outer layer (indentation modulus ∼69 GPa and hardness ∼3.3 GPa) on a more compliant and thicker inner layer (indentation modulus ∼14.3 GPa and hardness ∼0.5 GPa). High-resolution scanning electron microscopy imaging of a fracture surface revealed that the outer layer contained oriented nanorods embedded in a matrix, and that the nanostructure of the inner layer contained fiber-like structures organized in a complex layered pattern. Damage patterns formed during microindentation show complex deformation mechanisms. Images of cracks identify growth through the outer layer, then deflection along the interface before growing and arresting in the inner layer. High-magnification images of the crack tip in the inner layer show void-linking and fiber-bridging exhibiting inelastic behavior. The observed difference in mechanical properties and unique nanostructures of different layers may have contributed to the resistance of fish scales to failure by impact and penetration loading.

Fermentation in the large intestine of single-stomached animals and its relationship to animal health

The phasing out of antibiotic compounds as growth promoters from the animal industry means that alternative practices will need to be investigated and the promising ones implemented in the very near future. Fermentation in the gastrointestinal tract (GIT) is being recognized as having important implications for health of the gut and thus of the host animal. Fermentation in single-stomached animals occurs to the largest extent in the large intestine, mainly because of the longer transit time there. The present review examines the micro-ecology of the GIT, with most emphasis on the large intestine as the most important site of fermentative activity, and an attempt is made to clarify the importance of the microfloral activity (i.e. fermentation) in relation to the health of the host. The differences between carbohydrate and protein fermentation are described, particularly in relation to their endproducts. The roles of volatile fatty acids (VFA) and NH3 in terms of their relationship to gut health are then examined. The large intestine has an important function in relation to the development of diarrhoea, particularly in terms of VFA production by fermentation and its role in water absorption. Suggestions are made as to feeds and additives (particularly those which are carbohydrate-based) which could be, or are, added to diets and which could steer the natural microbial population of the GIT. Various methods are described which are used to investigate changes in microbial populations and reasons are given for the importance of measuring the kinetics of fermentation activity as an indicator of microbial activity.

The blocking of reinforcement control

Two experiments were conducted to extend the blocking effect to the reinforcement of a response. A delayed reinforcement contingency was presented to subjects with or without a previously pretrained response available during the delay interval. The interpolated response had no scheduled effect on delivery of the reinforcer, but its availability reduced strengthening of the initial response, which completely extinguished for some subjects. The results were interpreted as support for blocking as a fundamental principle of behavior, and as evidence against the principle of reinforcement being stated solely in terms of temporal proximity between response and reinforcer.

Elicited responding to signals for reinforcement: the effects of overall versus local changes in reinforcement probability

Pigeons were studied on a three-component multiple schedule where all reinforcement was independent of responding. Two components were cued by different keylights and were associated with different rates of reinforcement. The third was always a no-key period associated with extinction. After a few sessions, pecking was elicited by the keylights signalling the reinforcement and continued to be maintained indefinitely. The duration and sequence of the three components were varied to determine if the primary controlling variable was differences in the overall probability of reinforcement, or if it was the immediate change in reinforcement signalled by the onset and/or offset of the stimulus. Both variables were found to control behavior. When 30-sec components were used, the primary controlling variable was the overall probability of reinforcement, but when 3-min components were used, overall probability had little effect. Control by local changes in reinforcement also occurred, although the type of local control varied both across subjects and experimental conditions. Some behaviors were controlled more by the change in reinforcement signalled by the onset of the stimulus, while others were controlled more by the change signalled by the offset of the stimulus.

Determinants of contrast in the signal-key procedure: Evidence against additivity theory

Two experiments are reported that challenge the interpretation of previous results with the signal-key procedure, in which the discriminative stimuli are located on a response key different from the key associated with the operant response requirement. Experiment 1 replicated the procedure of Keller (1974), and found that contrast effects on the operant key occurred reliably for only one of four subjects. High rates to the signal key initially occurred for only one subject, but modifications of the procedure produced substantial rates to the signal key for all subjects. In all cases, however, signal-key behavior was greatly reduced by the addition of a changeover delay which prevented reinforcement within 2 seconds of the last peck to the signal key, suggesting that signal-key pecking was maintained primarily by adventitious reinforcement. Experiment 2 modified the signal-key procedure by using three response keys, so that the discriminative stimuli on the signal key controlled different responses during all phases of training. With this modification, reliable contrast effects on the operant key occurred for all subjects, suggesting that the failure to find contrast in previous studies has been due to the confounding of changes in the discrimination requirements with changes in relative rate of reinforcement. The results challenge the additivity theory of contrast, and suggest that "elicited" behavior plays a minor role, if any, in the determination of contrast effects in multiple schedules.

Behavioral contrast as a function of the temporal location of reinforcement

Pigeons were trained on a multiple variable-interval variable-interval schedule of reinforcement. One component was then changed to a variation of a fixed-interval schedule in which the same rate of reinforcement was obtained as previously but the location of the reinforcer was fixed within the component. The effects of different temporal locations were compared. An increase in response rate for the unchanged variable-interval component (behavioral contrast) occurred when the reinforcer was located in the middle or at the end of the FI component, but response suppression occurred when it was located at the beginning of the component. The pattern of results cannot be explained by any previous theories of contrast. The overall response rates, and the pattern of local rates within the components, were consistent with the hypothesis that the major determinant of the contrast effect was the transition to a lower reinforcement rate following the unchanged component.

The failure of stimulus control after presence-absence discrimination of click-rate

Pigeons were trained to discriminate a slow click-rate from its absence, or to discriminate it from a faster click-rate. Subsequent click-rate generalization tests produced the usual steepened gradients after the intradimensional discrimination but produced flat gradients after presence/absence discrimination. The occurrence of stimulus control only after intradimensional discrimination, combined with previous results showing stimulus control sometimes after nondifferential reinforcement and sometimes after presence/absence discrimination, argues for a reformulation of the problem of stimulus control. A theoretical framework, relying upon blocking effects inherent in the different discrimination procedures, was presented to account for the diversity of results.

Effects on choice of reinforcement delay and conditioned reinforcement

Pigeons chose between fixed-interval schedules of different durations presented in the terminal links of concurrent-chains schedules. The pair of schedules was always in the ratio of 2:1, but the absolute duration of the fixed intervals varied. In one set of conditions, the different terminal-link schedules were associated with different keylight stimuli (cued conditions). In a second set of conditions, the different terminal-link schedules were associated with the same stimulus (uncued conditions). Results from the cued conditions replicated previous findings that preference for the shorter fixed-interval schedule increased with fixed-interval duration. Preferences in the uncued conditions were lower than in the corresponding cued conditions but also increased with fixed-interval length. In addition, the degree of control under the uncued conditions was correlated with the extent to which the schedule during the terminal link was discriminated immediately upon entry into the terminal link. The pattern of results in both conditions was inconsistent with the notion that choice behavior matches relative immediacy of reinforcement. Reanalysis of previous evidence for matching (Chung and Herrnstein, 1967) showed that matching in fact did not occur, as the preferences of their subjects for the shorter of two delays also increased with the absolute size of the delays.

Non-spatial delayed alternation by the pigeon

Pigeons were trained on a non-spatial delayed alternation task in which the color not pecked on the previous trial was correct. When varying delays were interposed between trials, alternation accuracy decreased as a function of delay, but remained greater than chance with a 45-sec delay. Successful alternation on the longer delays was accomplished without behavioral mediation of the delay intervals. Also, during initial testing when a position cue was available in addition to the color cue after incorrect trials, alternation accuracy was greater after a preceding incorrect trial than after a correct trial. When the position cue was removed, no differences occurred as a function of the outcome of the preceding trial.

A re-examination of local contrast in multiple schedules

Pigeons were presented with multiple schedules of alternating 90-sec components. When components in which grain was never presented alternated with components in which grain was presented on a variable-interval schedule, the average rate of responding in the variable-interval components increased, showing overall positive behavioral contrast. Unlike previous reports, this study found that the response rates for all birds increased toward the end of the variable-interval components as training proceeded. This increase in local response rate disappeared when the multiple schedule was composed solely of variable-interval components and reappeared when the variable-interval components were again alternated with extinction. This finding cannot be predicted or explained by recent theories of behavioral contrast based on autoshaping, and thus questions their sufficiency. We suggest that this local response-rate increase results from the predictable change from high to low density of reinforcement at the end of the fixed-duration component. Thus, the present effect apparently illustrates a different type of interaction between components of a multiple schedule than that described by previous theories of contrast. In a given procedure, either or both types of interaction may occur; neither provides a complete account of behavioral contrast.

Probability learning as a function of momentary reinforcement probability

Pigeons were trained on a probability learning task where the overall reinforcement probability was 0.50 for each response alternative but where the momentary reinforcement probability differed and depended upon the outcome of the preceding trial. In all cases, the maximum reinforcement occurred with a "win-stay, lose-shift" response pattern. When both position and color were relevant cues, the optimal response pattern was learned when the reinforcement probability for repeating the just-reinforced response was 0.80 but not when the probability was 0.65. When only color was relevant, learning occurred much more slowly, and only for subjects trained on large fixed ratio requirements.

Inverse relations between preference and contrast

Pigeons were trained on a multiple schedule in which two target components with identical reinforcement schedules were followed by either the same-valued schedule or by extinction. Response rate increased in both target components but was higher in the target component followed by extinction, replicating previous findings of positive anticipatory contrast. A similar design was used to study negative contrast, in that the two target components were followed either by the same-valued schedule or by a higher valued schedule. Negative contrast occurred equally, on average, in both target components, thus failing to demonstrate negative contrast that is specifically anticipatory in nature. When the stimuli correlated with the two target components were paired in choice tests, the pattern of preference was in the opposite direction. For the positive contrast procedure, no significant preference between the two target stimuli was evident. But for the negative contrast procedure, preference favored the stimulus followed by the higher valued schedule. The results demonstrate a functional dissociation between positive and negative contrast in relation to stimulus value. More generally, the results demonstrate an inverse relation between response rate and preference and challenge existing accounts of contrast in terms of the concept of relative value.

Changeover behavior and preference in concurrent schedules

Pigeons were trained on a multiple schedule of reinforcement in which separate concurrent schedules occurred in each of two components. Key pecking was reinforced with milo. During one component, a variable-interval 40-s schedule was concurrent with a variable-interval 20-s schedule; during the other component, a variable-interval 40-s schedule was concurrent with a variable-interval 80-s schedule. During probe tests, the stimuli correlated with the two variable-interval 40-s schedules were presented simultaneously to assess preference, measured by the relative response rates to the two stimuli. In Experiment 1, the concurrently available variable-interval 20-s schedule operated normally; that is, reinforcer availability was not signaled. Following this baseline training, relative response rate during the probes favored the variable-interval 40-s alternative that had been paired with the lower valued schedule (i.e., with the variable-interval 80-s schedule). In Experiment 2, a signal for reinforcer availability was added to the high-value alternative (i.e., to the variable-interval 20-s schedule), thus reducing the rate of key pecking maintained by that schedule but leaving the reinforcement rate unchanged. Following that baseline training, relative response rates during probes favored the variable-interval 40-s alternative that had been paired with the higher valued schedule. The reversal in the pattern of preference implies that the pattern of changeover behavior established during training, and not reinforcement rate, determined the preference patterns obtained on the probe tests.

Color alternation learning in the pigeon under fixed-ratio schedules of reinforcement

Pigeons were trained on a non-spatial delayed alternation task in which the correct stimulus was that color not responded to on the preceding trial. Subjects required to emit either 15 or 30 pecks to the correct stimulus within a trial learned the task, those required to emit only one or five pecks did not. Also, alternation was learned more easily after an incorrect than after a correct trial. Later experiments showed that a minimum fixed-ratio value was required for successful color alternation to occur, even though no fixed-ratio requirement was necessary when a position cue was available. The mechanism of the fixed-ratio effects derived from the pigeons' tendency to repeat their response in the presence of the color reinforced on the last trial. Whereas subjects trained on larger fixed-ratios corrected this error tendency within a trial, subjects trained on smaller fixed ratios did not.

The effects of unsignalled delayed reinforcement

Pigeons' pecks were reinforced according to a variable-interval schedule. A delay-of-reinforcement procedure was then added to the schedule, or a yoked-control procedure was arranged where the reinforcers occurred independently of responding according to the same variable-interval schedule. During the delay-of-reinforcement procedure, the first peck after a reinforcer was scheduled began a delay timer and the reinforcer was delivered at the end of the interval. No stimulus change signalled the delay interval and responses could occur during it, so that the obtained delays were often shorter than those scheduled. Responding under this procedure was highly variable but, in general, behavior was substantially reduced even with the shortest delay used, 3 sec. In addition, the rates maintained by delayed reinforcement were only slightly greater than those maintained by the yoked-control procedure, suggesting that adventitious pairings of response and reinforcer were responsible for some of the maintenance of behavior that did occur. The results challenge recent conceptions of reinforcement as involving response-reinforcer correlations and re-emphasize the role of temporal proximity between response and reinforcer.

The following schedule of reinforcement as a fundamental determinant of steady state contrast in multiple schedules

Two experiments investigated whether steady-state interactions in multiple schedules depend exclusively on the following schedule of reinforcement. Experiment 1 used a four-component multiple schedule in which two components were associated with the same constant schedule of reinforcement, and where rate of reinforcement was varied in the component that followed one of these. Contrast effects were reliable only in the component that preceded the point of reinforcement variation, although some contrast did occur otherwise. In those instances where contrast other than the following-schedule effect did occur, it was accounted for by the effect of the preceding schedule, an effect for which there were consistent individual differences among subjects, and which varied with component duration. Experiment 2 used a three-component schedule, in which reinforcement rate was varied in the middle component. The results were consistent with Experiment 1, as the following-schedule effect was the only consistent effect that occurred, although an effect of the preceding schedule did occur for some subjects under some conditions, and was especially evident early in training. The conclusion from both experiments is that there is no general effect of relative rate of reinforcement apart from the sum of the effects of the preceding and following schedules, and that the following-schedule effect is the fundamental cause of steady-state interactions.

Another look at contrast in multiple schedules

Recent research on multiple schedule interactions is reviewed. Contrary to formulations that view contrast as the result of elicited behavior controlled by the stimulus-reinforcer contingency (e.g., additivity theory), the major controlling variable is the relative rate of reinforcement, which cannot be reduced to some combination of stimulus-reinforcer and response-reinforcer effects. Other recent theoretical formulations are also reviewed and all are found to face serious counterevidence. The best description of the available data continues to be in terms of the "context of reinforcement," but Herrnstein's (1970) formulation of the basis of such context effects appears to be inadequate. An alternative conception is provided by Catania's concept of "inhibition by reinforcement," by which rate of responding is inversely related to the average rate of reinforcement in the situation. Such a conception is related to Gibbon's recent scalar-expectancy account of autoshaping and Fantino's delay-reduction model of conditioned reinforcement, suggesting that a common set of principles determines several diverse conditioning phenomena. However, the empirical status of such a description remains uncertain, because recent evidence shows that schedule interactions are temporally asymmetric, depending primarily upon the conditions of reinforcement that follow a schedule component.

Interscalene block using ultrasound guidance: impact of experience on resident performance

BACKGROUND

We evaluated the weekly progress of anesthesiology residents performing an interscalene block with ultrasound guidance (UG) for block success rates and for the specific time intervals: (i) time to image the brachial plexus and (ii) time from insertion of the block needle until motor stimulation occurred. Our primary objective was to characterize the influence of experience over the course of the regional anesthesia rotation on the performance of a UG interscalene block by anesthesiology residents.

METHODS

Residents conducted an interscalene block with UG under the supervision of attending anesthesiologists experienced in this technique. Block efficacy, time intervals required to perform the block, and acute complications were recorded. We compared success rates over the course of the rotation, and analyzed process time data with respect to trainee level of experience, week of the trainee rotation, and patient body habitus.

RESULTS

Twenty-one trainees conducted 222 blocks over a consecutive 7-month period. Block success rate was 97.3%, and did not change significantly over the course of the 4-week rotation. Total block time and imaging time significantly decreased over the 4-week rotation, while the needle insertion-to-stimulation time did not change. Slower imaging time was predicted by obesity.

CONCLUSION

The success rates for a UG interscalene block provided by supervised residents were initially high, and remained so throughout the 4-week rotation. Trainees required less time to image the nerves and to perform the block over the course of the rotation.

Characterization of the bone marrow immunofluorescence test in childhood autoimmune neutropenia

The bone marrow immunofluorescenece test (BMIFT) demonstrates autoantibodies to granulocytes and their precursors on fresh-frozen bone marrow slides. It may be used to differentiate childhood autoimmune neutropenia (AIN) from other causes of childhood neutropenia, even when circulating neutrophil counts are low. We sought to characterize the diagnostic utility of the BMIFT in childhood AIN. All BMIFT requests for investigation of children with neutropenia between January 1998 and May 2007 were reviewed. Patients were classified as AIN or nonautoimmune causes. Baseline demographic data, results of BMIFT, granulocyte immunofluorescence testing and bone marrow findings were collected from clinical records and the institutional laboratory database. Seventy-six children had BMIFT performed for investigation of neutropenia. There were 45 patients diagnosed with AIN, 28 with nonimmune neutropenia and three failed tests. The median age of children with AIN was 1.2 years (range 0.3-15.3), compared with 3.6 years (range 0.1-15.7) in the nonautoimmune group. The median neutrophil count in AIN was 0.3 x 10(9)/l (0.9 x 10(9)/l in nonautoimmune). BMIFT was positive in 24 of 45 patients with AIN and 0 of 28 with nonautoimmune neutropenia (sensitivity 53%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value 57%). Ten patients had other autoimmune diatheses at diagnosis. The BMIFT is a simple, highly specific test with excellent PPV and thus is a clinically useful test to confirm AIN in children.

Effects of added fermentable carbohydrates in the diet on intestinal proinflammatory cytokine-specific mRNA content in weaning piglets

There is increasing evidence showing that dietary supplementation with prebiotics can be effective in the treatment of intestinal inflammation. Because weaning time is characterized by rapid intestinal inflammation, this study investigated the effect of a diet supplemented with a combination of 4 fermentable carbohydrates (lactulose, inulin, sugarbeet pulp, and wheat starch) on the mRNA content of proinflammatory cytokines in newly weaned piglets. Cytokines (IL-1beta, IL-6, IL-8, IL-12p40, IL-18, and tumor necrosis factor-alpha) were analyzed using a semiquantitative reverse-transcription PCR technique on d 1, 4, and 10 in the ileum and colon of piglets fed either a test diet (CHO) or a control diet. In addition to the diet, the effect of enforced fasting on cytokine mRNA content was also evaluated. No effect of fasting was observed on the pro-inflammatory cytokine mRNA content. Our results showed that the CHO diet induced an up-regulation of IL-6 mRNA content in the colon of piglets 4 d postweaning. This up-regulation was specific for the animals fed the CHO diet and was not observed in animals fed the control diet. An increase in IL-1beta mRNA content was also observed on d 4 postweaning in all of the piglets. Correlations between proinflammatory cytokines and the end-products of fermentation indicated that the regulation of cytokines may be linked with some of the fermentation end-products such as branched-chain fatty acids, which are in turn end-products of protein fermentation.

Effect of inclusion of fermentable carbohydrates in the diet on fermentation end-product profile in feces of weanling piglets

An in vivo experiment was conducted to monitor the changes in fermentation end products in the feces of weaning piglets due to the inclusion of selected fermentable carbohydrates in the diet. The experiment involved 3 groups of 16 piglets each. Specially raised piglets (neither antibiotics nor creep feeding) were weaned abruptly at 4 wk of age. The piglets were offered 1 of 2 dietary treatments [a control diet (CON), or a fermentable carbohydrate-enriched diet (CHO)] and were subjected to 1 of the 2 fasting treatments (fasting for 2 d at the beginning of the experimental period or nonfasting). Fecal samples were collected per rectum every day during the experimental period. Piglets were slaughtered at the end of the 10-d experimental period, and digesta samples were collected from different parts of the gastrointestinal tract (GIT): the first half of the small intestine, the second half of the small intestine, the cecum, and colon. The DM, VFA profile, and ammonia concentrations were analyzed from the fecal and digesta samples. Daily feed intake was also recorded. There was no difference in concentrations of VFA in feces between the treatment groups. Ammonia concentration was lower (P < 0.05) in piglets fed the CHO diet compared with those fed the CON diet in both feces and digesta from different parts of GIT. Fasting had no effect on fermentation end products in feces. This study demonstrated that the inclusion of fermentable carbohydrates in weanling diets reduces protein fermentation along the GIT and also reduced the fecal concentration of ammonia.

Use of the in vitro cumulative gas production technique for pigs: An examination of alterations in fermentation products and substrate losses at various time points1

An experiment was conducted to examine changes in VFA and ammonia concentrations at different time points using 4 fermentable carbohydrate-rich feed ingredients as substrates and feces of unweaned piglets as inoculum. Fecal inoculum was collected, pooled, and mixed from 9 specially raised (no creep feed or antibiotics) crossbred piglets at 3 wk of age. Inulin, lactulose, molasses-free sugar beet pulp, and wheat starch were used as substrates and were fermented in vitro for 72 h (3 replicates per substrate). Cumulative gas production was measured as an indicator of the kinetics of fermentation. In addition, 3 bottles of substrate per time point with similar contents (amounts of substrate, inoculum, and media) were incubated but were allowed to release their gas throughout incubation. For these latter bottles, fermentation fluid was sampled at incubation time points including every hour between 1 and 24 h and at 48 h, and fermentation end products (VFA, lactate, and ammonia) and OM disappearance were measured. Dry matter and ash were analyzed from the postfermentative samples. The pH of the contents from these bottles was also recorded. The correlation in time between fermentation end products and cumulative gas produced was determined. The results showed that the prolongation of fermentation to 72 h, especially in the case of fast-fermenting inulin and lactulose, may lead to a different end product profile (P < 0.001) compared with the profile observed at the time at which most of the substrate has disappeared. Therefore, we concluded that the fermentation product profile at the end of in vitro fermentation at a specific time point cannot be used to compare fermentability of carbohydrate sources with different fermentation kinetics in terms of gas production.

A new simplified immediate prognostic risk score for patients with acute myocardial infarction

BACKGROUND

Immediate risk stratification of patients with myocardial infarction in the emergency department (ED) at the time of initial presentation is important for their optimal emergency treatment. Current risk scores for predicting mortality following acute myocardial infarction (AMI) are potentially flawed, having been derived from clinical trials with highly selective patient enrollment and requiring data not readily available in the ED. These scores may not accurately represent the spectrum of patients in clinical practice and may lead to inappropriate decision making.

METHODS

This study cohort included 1212 consecutive patients with AMI who were admitted to the Mayo Clinic coronary care unit between 1988 and 2000. A risk score model was developed for predicting 30 day mortality using parameters available at initial hospital presentation in the ED. The model was developed on patients from the first era (training set--before 1997) and validated on patients in the second era (validation set-during or after 1997).

RESULTS

The risk score included age, sex, systolic blood pressure, admission serum creatinine, extent of ST segment depression, QRS duration, Killip class, and infarct location. The predictive ability of the model in the validation set was strong (c = 0.78).

CONCLUSION

The Mayo risk score for 30 day mortality showed excellent predictive capacity in a population based cohort of patients with a wide range of risk profiles. The present results suggest that even amidst changing patient profiles, treatment, and disease definitions, the Mayo model is useful for 30 day risk assessment following AMI.

Duration of smoking abstinence as a predictor for non-small-cell lung cancer survival in women

BACKGROUND

Previous studies have attempted to investigate the impact of smoking cessation on lung cancer survival but have been limited by small numbers of former smokers and incomplete data.

METHODS

Over a six-year period, 5229 patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) were enrolled in a prospective cohort of whom 2052 were former smokers. Patient's characteristics were obtained from medical records and a baseline interview. Vital status was determined through multiple sources. Cox proportional hazards models were used to estimate the effect of smoking abstinence on post-diagnosis mortality.

RESULTS

For all patients with NSCLC, the median survival among never, former, and current smokers was 1.4 years, 1.3 years, and 1.1 years, respectively (P < 0.01). Female NSCLC patients had a significantly lower risk of mortality with a longer duration of smoking abstinence (RR per 10 years of smoking abstinence = 0.85; 95% CI: 0.75, 0.97). No effect of smoking abstinence on mortality was observed for women with SCLC or for men with either histologic group.

CONCLUSIONS

The identification of smoking history as a prognostic factor in lung cancer survival supports previous research suggesting a direct biologic effect of smoking on survival. However, this effect may vary by sex and type of lung cancer.

Effects of mushroom and herb polysaccharides, as alternatives for an antibiotic, on growth performance of broilers

(1) This in vivo trial was conducted to study the effects of polysaccharide extracts of two mushrooms, Lentinus edodes (LenE) and Tremella fuciformis (TreE), and a herb, Astragalus membranaceus (AstE) on growth performance, and the weights of organs and the gastrointestinal tract (GIT) of broiler chickens. (2) Three extracts (LenE, TreE and AstE) were supplemented at inclusion rates of 0.5, 1, 2, 3 and 4 g/kg from 7 to 14 d of age and compared with an antibiotic treatment group (20 mg/kg, virginiamycin (VRG) as well as a group of non-supplemented birds. (3) Body weight (BW) gain, feed intake and feed conversion ratio (FCR) of the extract-supplemented groups were not significantly different from those of the antibiotic group. Significant effects of type of extract and concentration on growth performance were found from 7 to 28 d of age. Generally, birds fed with LenE showed higher BW gain and lower FCR from 7 to 28 d of age than those fed with TreE and AstE and 2 g/kg LenE was considered the optimal inclusion rate for enhanced broiler growth. However, the extracts had no significant effect on the relative weights of organs and GIT compared with the antibiotic group. (4) The birds fed the extracts showed better growth performance than the non-supplemented birds, but were not significantly different from those fed VRG. Of the three extracts, LenE appeared to be a potential growth promoter. Future studies are needed to investigate whether the extracts can be used as alternatives for antibiotic growth promoters in challenged birds, and to elucidate the mechanisms for potentially enhanced growth performance in poultry.

Effect of a Chinese herb medicine formulation, as an alternative for antibiotics, on performance of broilers

1. A total of 720 female broiler chicks was used to test the effects of 4 dietary concentrations of a Chinese herbal medicine (CHM) formulation (0.25, 0.5, 1 and 2g/kg), as an alternative for virginiamycin (VRG), on growth performance in broilers. 2. A total of 72 birds from non-supplemented, VRG and 0.5 g/kg CHM groups was selected and killed and the relative weights of the intestinal segments were assessed. 3. The CHM dietary treatments produced increased body weight gain at 7 to 21 d of age but not at 21 to 28 d of age compared with the non-supplemented and VRG groups. The CHM groups had a higher feed intake and a higher feed conversion ratio (FCR) than the VRG group between 21 and 28 d. 4. The dissection results showed that the liver colour of the birds in the CHM group varied less between animals than that of the VRG and the non-supplemented groups. Neither CHM nor VRG had any significant effects on either liver or intestinal tract weights. 5. It was concluded that the birds of the CHM group had better growth performance from d 7 to 21 but not thereafter. Further experiments are needed to elucidate the mechanisms underlying enhanced growth performance by CHM in broilers.

Real-time PCR detection of lactic acid bacteria in cecal contents of eimeria tenella-lnfected broilers fed soybean oligosaccharides and soluble soybean polysaccharides

This experiment was conducted to test whether dietary soybean meal oligosaccharides (SMO) and water-soluble polysaccharides (SMP) can assist broiler chickens in resisting Eimeria tenella, and to determine the survival of lactic acid bacteria in cecal contents postinfection. All birds received a soybean meal-free diet. The 6 experimental treatments were as follows: positive (COR) and negative (COW) control groups, 2 groups fed diets containing either 1% SMO or 0.5% SMP from 1 to 11 d of age; a vaccinated group (VAC), and an anticoccidial medicated group (ANT). Chickens of all treatments except COW were orally infected with 1000 sporulated oocysts of E. tenella on d 15. Fecal oocyst shedding was monitored per treatment group between d 5 and 13 postinfection. Lactic acid bacteria (LAB) in cecal contents were evaluated by a real-time PCR technique on d 7 postinfection. The results showed that the SMO and SMP groups had a lower number of oocysts per gram of feces during the monitoring period than the COR group. Threshold cycles were 22.21, 27.68, 13.99, 14.92, 12.97, and 14.85, for COW, COR, SMO, SMP, VAC, and ANT groups, respectively; specific PCR products were confirmed by the results of melting curve analysis and agarose gel electrophoresis. The results suggest that these LAB communities were promoted by SMO and SMP and have a competitive exclusion function when broiler chickens are infected with E. tenella.

Effects of Mushroom and Herb Polysaccharides on Cellular and Humoral Immune Responses of Eimeria tenella-Infected Chickens

We investigated the effects of polysaccharide extracts from 2 mushrooms, Lentinus edodes (LenE) and Tremella fuciformis (TreE), and an herb, Astragalus membranaceus (AstE), on cellular and humoral immune responses of Eimeria tenella-infected chickens. A total of 150 broiler chicks were assigned to 5 treatment groups: 3 groups were infected with E. tenella and fed with extracts (LenE, TreE, and AstE), and 2 control groups were infected with or without E. tenella. The 3 extracts were given at the level of 1 g/kg of the diet from 8 to 14 d of age. Specific systemic and cecum mucosal antibody production, proliferation of splenocytes, and peripheral T and B lymphocytes were measured during the 3 wk following Eimeria infection. A significantly higher production of specific IgA, IgM (at d 14 and 21 postinfection), and IgG (at d 21 postinfection) were detected in the Eimeria-infected groups fed with the extracts than in the infected group not fed with the extracts. Of the 3 extracts, TreE stimulated a slightly higher production of specific IgM (P = 0.052), and a significantly higher IgG production at 21 d postinfection. The cecal antibody production showed a similar trend to that of serum antibodies. The overall mean levels of cecal-specific IgA and IgG of the groups fed with extracts were significantly higher at 14 and 21 d postinfection compared with the group not fed with extracts. Of the 3 extracts, the AstE-fed group showed the highest IgG production at d 7 postinfection. Both TreE- and LenE-fed groups had significantly higher IgM and IgG levels compared with the AstE group at d 21 postinfection. The extract-fed groups also showed a significantly higher antigen-specific proliferation of splenocytes at 14 and 21 d postinfection compared with the group not fed with the extracts. The overall mean of erythrocyte rosette-forming cells (ERFC %) (at d 14 and 21) and erythrocyte-antibody-complement cells (EAC %) (at d 14) of the groups fed with the extracts was significantly higher compared with the group not fed the extracts. It is concluded from this study that supplementation with mushroom and herb extracts resulted in enhancement of both cellular and humoral immune responses in E. tenella-infected chickens.

Effects of mushroom and herb polysaccharides, as alternatives for an antibiotic, on the cecal microbial ecosystem in broiler chickens

An in vivo experiment was conducted to study the potential prebiotic effects of mushroom and herb polysaccharide extracts, Lentinus edodes extract (LenE), Tremella fuciformis extract, and Astragalus membranaceus Radix extract, on chicken growth and the cecal microbial ecosystem, as compared with the antibiotic Apramycin (APR). This investigation was carried out in terms of a dose-response study. The chickens were naturally infected with avian Mycoplasma gallisepticum prior to the experiment. The BW gain, cecal pH, viscosity, and predominant microbial populations were measured 1 wk after the extract and APR treatments. The extracts and APR significantly stimulated growth of the chickens infected with avian Mycoplasma gallisepticum. The average BW gain of the groups fed with the extracts was significantly lower than that of the antibiotic group. The extracts had no significant effect on cecal pH. However, cecal viscosity and microbial populations were significantly affected by feeding extracts and antibiotic. In contrast to APR, the extracts stimulated the number of the potentially beneficial bacteria (bifidobacteria and lactobacilli), while reducing the number of the potentially harmful bacteria (Bacteroides spp. and Escherichia coli). Of the 3 extracts, LenE was associated with the most cecal bifidobacteria and lactobacilli. With each increase in the LenE dose, birds tended to have higher BW gain and total aerobe and anaerobe counts. Numbers of predominant cecal bacteria, in particular, E. coli, bifidobacteria, and lactobacilli, were significantly increased with increases in the LenE dose. It would seem that these specific mushroom and herb polysaccharide extracts hold some promise as potential modifiers of intestinal microbiota in diseased chickens.

In vitro fermentation characteristics of two mushroom species, an herb, and their polysaccharide fractions, using chicken cecal contents as inoculum

In vitro fermentabilities of two mushrooms (Lentinus edodes--LenS; Tremella fuciformis--TreS), an herb (Astragalus membranaceus--AstS), and their polysaccharide fractions (LenE, TreE, and AstE) were investigated using microflora from chicken ceca. Polysaccharides were extracted using the hot water method. The mushrooms had lower polysaccharide yields (8 to 10%) than the herb (31%). Fermentation kinetics were determined using the in vitro cumulative gas production technique. End-products, such as gas, volatile fatty acids (VFA), and ammonia, were also determined. The gas profiles of intact materials were similar for AstS and LenS. The TreS had a diphasic digestion pattern. The extracts had similar profiles to the intact materials though gas production rates were faster. Intact materials tended to produce less VFA than the extracts though LenS and AstE had the highest total VFA production overall. Intact materials contained more protein than the extracts, and therefore resulted in more branched-chain fatty acids and ammonia. Fermentation kinetics and end-point products demonstrated differences in availability of substrates between the mushrooms and herb. These medicinal mushroom and herb materials, particularly their polysaccharide extracts, show promise in altering microbial activities and composition in chicken ceca. In vivo experiments are necessary for confirmation of this hypothesis.

Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction

BACKGROUND

While right ventricular myocardial infarction is associated with increased in-hospital morbidity and mortality, prognostic risk factors for in-hospital and long-term mortality are poorly defined.

OBJECTIVES

To evaluate the prognostic value of TIMI (Thrombolysis in Myocardial Infarction) risk score analysis in patients with right ventricular myocardial infarction (RVI).

DESIGN

Retrospective analysis of a community population.

SETTING

Mayo Clinic Coronary Care Unit.

PATIENTS

One hundred and two patients with RVI from 580 consecutive patients from Rochester, Minnesota admitted to the Coronary Care Unit with acute inferior or lateral wall myocardial infarction from January 1988 through March 1998.

MEASUREMENT

Combined TIMI risk score analysis with in-hospital and long-term mortality.

RESULTS

In-hospital morbidity (RVI: 54.9% vs non-RVI: 22.2%; P<0.001) and mortality (RVI: 21.6% vs non-RVI: 6.9%;P <0.001) were increased in patients with RVI. The TIMI risk score predicted risk (per one point increase in TIMI score) for in-hospital mortality (OR 1.23, 95% CI 1.02-1.51, P=0.037) and long-term mortality (OR 1.57, 95% CI 1.25-1.96, P<0.001). Patients with RVI whose TIMI risk score was >or=4 had significantly worse long-term survival compared to those patients with RVI and TIMI score <4 (P=0.006).

CONCLUSIONS

In-hospital morbidity and mortality, and long-term mortality are increased by right ventricular infarction and can be accurately predicted by the initial TIMI risk score.

Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial

OBJECTIVE

To determine the effect of intercessory prayer, a widely practiced complementary therapy, on cardiovascular disease progression after hospital discharge.

PATIENTS AND METHODS

In this randomized controlled trial conducted between 1997 and 1999, a total of 799 coronary care unit patients were randomized at hospital discharge to the intercessory prayer group or to the control group. Intercessory prayer, ie, prayer by 1 or more persons on behalf of another, was administered at least once a week for 26 weeks by 5 intercessors per patient. The primary end point after 26 weeks was any of the following: death, cardiac arrest, rehospitalization for cardiovascular disease, coronary revascularization, or an emergency department visit for cardiovascular disease. Patients were divided into a high-risk group based on the presence of any of 5 risk factors (age = or >70 years, diabetes mellitus, prior myocardial infarction, cerebrovascular disease, or peripheral vascular disease) or a low-risk group (absence of risk factors) for subsequent primary events.

RESULTS

At 26 weeks, a primary end point had occurred in 25.6% of the intercessory prayer group and 29.3% of the control group (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.60-1.14]; P=.25). Among high-risk patients, 31.0% in the prayer group vs 33.3% in the control group (OR, 0.90 [95% CI, 0.60-1.34]; P=.60) experienced a primary end point. Among low-risk patients, a primary end point occurred in 17.0% in the prayer group vs 24.1% in the control group (OR, 0.65 [95% CI, 0.20-1.36]; P=.12).

CONCLUSIONS

As delivered in this study, intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit.

Differences in normal values for murine white blood cell counts and other hematological parameters based on sampling site

OBJECTIVE AND DESIGN

The effect of blood sampling site on the hemogram and neutrophil adhesion molecules was examined in BALB/c mice.

MATERIALS AND METHODS

Blood samples were drawn from the tail, eye, and heart during anesthesia with ketamine and xylazine. Cell numbers were quantified with an automated counter and flow cytometry was used to quantify CD11b and CD18.

RESULTS

Total white blood cell (WBC) counts were highest from tail, lower from eye, and significantly lower from heart blood. In general, differences between tail and heart counts reflected changes in all cell types. RBCs, platelets and hematocrits were significantly increased in tail compared to heart blood. Although CD18 levels were not different, CD11b was significantly higher on neutrophils from tail compared to heart blood.

CONCLUSIONS

In anesthetized BALB/c mice, sampling site readily influences blood counts and neutrophil CD11b. The findings underscore the need to standardize sampling site when measuring these parameters.