Caesarean birth and risk of subsequent preterm birth: a retrospective cohort study

OBJECTIVE

To determine the risk of spontaneous and medically indicated preterm birth associated with mode of birth in previous term-born pregnancy.

DESIGN

Retrospective cohort study.

SETTING

Two UK maternity units.

POPULATION OR SAMPLE

A total of 16 340 women with first two consecutive singleton births and the first birth at term.

METHODS

Retrospective cohort study using routinely collected clinical data.

MAIN OUTCOME MEASURES

Incidence of spontaneous preterm birth and medically indicated preterm birth at less than 37 weeks of gestation after term birth, in relation to mode of birth in first pregnancy. Subgroup analysis on cervical dilatation at the time of first caesarean birth.

RESULTS

Compared with vaginal birth, emergency caesarean birth at full dilatation was associated with an increase in spontaneous preterm birth (2.3% vaginal birth versus 4.5% full dilatation caesarean; adjusted odds ratio [aOR] 3.29, 95% CI 2.02-5.13, P < 0.001). Elective caesarean, emergency caesarean at <4 cm dilatation, and emergency caesarean at 4-9 cm dilatation were associated with increased medically indicated preterm birth (0.8% vaginal births versus 1.9% elective caesarean, 3.3% <4 cm caesarean, 1.3% 4-9 cm caesarean; aOR 2.30, 95% CI 1.19-4.15, P = 0.009; aOR 4.68, 95% CI 2.98-7.24, P < 0.001; and aOR 2.43, 95% CI 1.43-4.00, P = 0.001, respectively).

CONCLUSIONS

Term caesarean in the first stage of labour or performed prelabour is associated with medically indicated preterm birth. Term caesarean in the second stage of labour is associated with spontaneous preterm birth.

TWEETABLE ABSTRACT

Caesarean in the second stage of labour is associated with spontaneous preterm birth.

Lessons learned evaluating the baby friendly spaces program for south Sudanese refugees in Gambella, Ethiopia: strengthening research and programmatic partnerships to address maternal and child health and psychosocial needs in humanitarian emergencies

Background

During humanitarian crises, women and children are particularly vulnerable to morbidity and mortality. To address this problem, integrated child health interventions that include support for the well-being of mothers must be adapted and assessed in humanitarian settings. Baby Friendly Spaces (BFS) is a holistic program that aims to improve the health and wellbeing of pregnant and lactating women and their children under two years of age by providing psychosocial support and enhancing positive infant and young child-care practices. Using a mixed-methods, pre-post design, this study explored ways to strengthen the implementation and acceptability of the BFS program, and assess outcomes associated with participation among South Sudanese mothers and their children living in the Nguenyyiel refugee camp in Gambella, Ethiopia.

Discussion

A stronger evidence-base for integrated maternal and child health interventions, like BFS, in humanitarian emergencies is needed, but effectively conducting this type of research in unstable settings means encountering and working through myriad challenges. In this paper we discuss lessons learned while implementing this study, including, challenges related to ongoing local political and tribal conflicts and extreme conditions; implementation of a new digital data monitoring system; staff capacity building and turnover; and measurement were encountered. Strategies to mitigate such challenges included hiring and training new staff members. Regular weekly skype calls were held between Action Against Hunger Paris headquarters, the Action Against Hunger team in Gambella and Johns Hopkins’ academic partners to follow study implementation progress and troubleshoot any emerging issues. Staff capacity building strategies included holding brief and focused trainings continuously throughout the study for both new and current staff members. Lastly, we engaged local Nuer staff members to help ensure study measures and interview questions were understandable among study participants.

Conclusions

Research focused on strengthening program implementation is critically important for improving maternal and child health in humanitarian emergencies. Research in such settings demands critical problem-solving skills, strong supervision systems, flexibility in timeline and logistics, and tailor-made training for program and research staff members and context- adapted strategies for retaining existing staff.

Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review

Background

Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC).

Methods

We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated.

Results

We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions.

Conclusions

Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0728-z) contains supplementary material, which is available to authorized users.

The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial

Background

Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo.

Methods

Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women’s treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment.

Results

Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen’s D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen’s D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment.

Conclusions

Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors’ mental health.

Trial registration

ClinicalTrials.gov NCT01385163.

Electronic supplementary material

The online version of this article (10.1186/s13031-018-0142-4) contains supplementary material, which is available to authorized users.

Caregiver mental health and HIV-infected child wellness: perspectives from Ugandan caregivers

Prior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families.

Foamy virus infection in primates

Foamy viruses (FV), the oldest known genus of Retroviridae, are unique among the retroviruses in having no disease association. It is not known why FV are non-pathogenic while infection by their closest relatives can be deadly. This may be related to the estimated 60 million years of coevolution of FV and their primate hosts. We review the current state of knowledge of FV infection, including information about the sites of viral replication and host immune responses, and discuss the role these may play in establishing persistent yet non-pathogenic infections. Whether FV has pathologic consequences in immunosuppressed hosts has not been thoroughly investigated. As most primates in HIV/SIV research are coinfected with FV, investigation into possible interactions between these viruses is of interest. The use of FV as a vector for gene therapy is also discussed.

Expanded tissue targets for foamy virus replication with simian immunodeficiency virus-induced immunosuppression

Foamy viruses (FV) are the oldest known genus of retroviruses and have persisted in nonhuman primates for over 60 million years. FV are efficiently transmitted, leading to a lifelong nonpathogenic infection. Transmission is thought to occur through saliva, but the detailed mechanism is unknown. Interestingly, this persistent infection contrasts with the rapid cytopathicity caused by FV in vitro, suggesting a host defense against FV. To better understand the tissue specificity of FV replication and host immunologic defense against FV cytopathicity, we quantified FV in tissues of healthy rhesus macaques (RM) and those severely immunosuppressed by simian immunodeficiency virus (SIV). Contrary to earlier findings, we find that all immunocompetent animals consistently have high levels of viral RNA in oral tissues but not in other tissues examined, including the small intestine. Strikingly, abundant viral transcripts were detected in the small intestine of all of the SIV-infected RM, which has been shown to be a major site of SIV (and human immunodeficiency virus)-induced CD4+ T-cell depletion. In contrast, there was a trend to lower viral RNA levels in oropharyngeal tissues of SIV-infected animals. The expansion of FV replication to the small intestine but not to other CD4+ T-cell-depleted tissues suggests that factors other than T-cell depletion, such as dysregulation of the jejunal microenvironment after SIV infection, likely account for the expanded tissue tropism of FV replication.

Nutrition support for bone marrow transplant patients

BACKGROUND

Bone marrow transplantation involves the administration of toxic chemotherapy and infusion of marrow cells. After treatment, patients can develop a poor appetite, mucositis and gastrointestinal failure, leading to malnutrition. To prevent this, parenteral nutrition (PN) support is the first choice but is associated with an increased risk of infection. Enteral nutrition (EN) is an alternative, as is the addition of substrates e.g. glutamine to enteral and parenteral solutions. However, the relative effectiveness of these treatments is not clear.

OBJECTIVES

To determine the efficacy of EN or PN support for patients receiving a bone marrow transplant.

SEARCH STRATEGY

Trials were identified by searching the Cochrane Library (Issue 4, 2000 ), MEDLINE (1966-2000), EMBASE (1988-2000) and CINAHL (1982-2000 ). Reference lists of identified trials and conference proceedings were searched for relevant reports. Date of the most recent search: 2000.

SELECTION CRITERIA

RCTs that compared one form of nutrition support with another, or control, for bone marrow transplant patients were included.

DATA COLLECTION AND ANALYSIS

Thirty five reports were identified, 11 were excluded. Two reviewers extracted data from 24 studies; 16 were allocated to four interventions: oral glutamine versus placebo; PN and glutamine versus standard PN; PN versus IV hydration; PN versus EN. Eight studies were other interventions. Data were collected on participants' characteristics; adverse effects; neutropaenia; % change in body weight; graft versus host disease; and survival. Trialists were contacted for unreported data.

MAIN RESULTS

Two studies (82 subjects) found that glutamine mouthwash reduced days of neutropaenia (6.82 days, 95% CI (1.67-11.98) p=0.009) compared with placebo. Three studies (103 subjects) showed that patients receiving PN with glutamine had a reduced hospital stay, 6.62 d (95% CI 3.47, 9.77, P=0.00004) compared with patients receiving standard PN. Two studies (73 subjects) indicated that patients receiving PN plus glutamine had a reduced incidence of positive blood cultures (OR 0.23, 95% CI 0.08-0.65, p=0.006) compared to those receiving standard PN. One study, (25 subjects) showed patients receiving PN had a higher incidence of line infections (odds ratio 21.23, 95% CI 4.15,108.73, P=0.0002) compared to those receiving standard IV fluids. There were no evaluable data to compare PN with EN.

REVIEWER'S CONCLUSIONS

Lack of evaluable data means that the relative effectiveness of EN versus PN cannot be evaluated. Further studies and missing data from completed trials need to be retrieved. Studies comparing PN with glutamine versus standard PN suggest that patients leave hospital earlier, and experience a reduced incidence of positive blood cultures, than those receiving standard PN. Patients with gastrointestinal failure should consider PN with the addition of glutamine if enteral feeding is not possible.

The ratio of insoluble to soluble fiber components in soybean hulls affects ileal and total-tract nutrient digestibilities and fecal characteristics of dogs

An experiment was conducted to evaluate the effects of soybean hulls (SH) containing varying ratios of insoluble:soluble fiber (I:S) on nutrient digestibilities and fecal characteristics of dogs. Ileally cannulated dogs (n = 6) were fed seven diets in a 6 x 7 Youden square arrangement of treatments. The seven diets included five SH-containing diets with I:S of 1.9, 2.7, 3.2, 5.2 or 7.2 and two diets containing either beet pulp (BP) or no supplemental fiber (control). Ileal digestibilities of DM, OM, CP, total dietary fiber (TDF), fat and gross energy (GE) were lower (P < 0.05) for dogs fed diets containing supplemental fiber compared with dogs fed the control diet. Fiber inclusion had a modest negative effect (P < 0.05) on total-tract DM, OM, fat and GE digestibilities compared with the control diet. Ileal digestibilities of DM and OM by dogs fed the SH treatments responded quadratically (P < 0.05) to I:S, with digestibility coefficients decreasing as the I:S approached 3.2. Highest ileal digestibilities were observed for diets with an I:S of 1.9 and 7.2. Similarly, a quadratic response (P < 0.05) was observed for digestibility of total amino acids at the ileum. Fecal outputs were lower (P < 0.001) when dogs consumed the control diet vs. fiber-containing diets. Among the SH-containing diets, there was a linear increase in fecal output as I:S increased (P = 0.031). The I:S in the diet affects DM and OM digestibilities at the ileum and affects fecal output, indicating that optimization of this ratio is desirable.

In vitro fermentation characteristics of native and processed cereal grains and potato starch using ileal chyme from dogs

Two in vitro experiments were conducted to evaluate the ability of small intestinal bacteria of dogs to ferment native and extruded cereal grains and potato starch and cereal grain and potato flours. Substrates included barley, corn, potato, rice, sorghum, and wheat. In addition to testing native grains and flours, extruded substrates also were tested. Substrates were extruded at low temperatures (LT; 79 to 93 degrees C) and high temperatures (HT; 124 to 140 degrees C) using a Wenger extruder (model TX-52). Substrates varied widely in concentrations of rapidly digestible starch (RDS), slowly digestible starch (SDS), resistant starch (RS), and total starch (TS). Extrusion of most substrates at HT vs LT resulted in increased RDS and decreased RS concentrations. Organic matter disappearance (OMD) values attributed to microbial fermentation for a 5-h period were as high as 27% for native extruded substrates (LT potato starch) and 39% for potato flour. Average OMD was higher for cereal and potato flours than for native extruded substrates (29.9 vs 25.4%). Average molar percentages of short-chain fatty acids produced from all substrates fermented for 5 h were 73, 14, and 13% (acetate, propionate, and butyrate, respectively). Average lactate production for substrates ranked as follows: flours > native and extruded cereal grains and potato starch (0.33 and 0.18 mmol/g OM, respectively). In vitro microbial fermentation of starches by ileal bacteria can be substantial and is affected by differences in starch source, fraction, and processed form.

Starch and fiber fractions in selected food and feed ingredients affect their small intestinal digestibility and fermentability and their large bowel fermentability in vitro in a canine model

The digestion of legumes, cereal grains, cereal and potato flours and grain-based foods in dogs was studied using two in vitro model systems. The first simulated the stomach and small intestine through the additions of acid and enzymes and large bowel fermentation through use of fecal inocula from dogs, and the second simulated small intestinal fermentation using canine ileal chyme as the bacterial source. All substrates were analyzed for total dietary fiber (TDF) including insoluble and soluble components, and starch fractions: rapidly digestible starch, slowly digestible starch, resistant starch (RS) and total starch. Legumes had high TDF and RS concentrations (mean 36.5 and 24.7%, respectively), resulting in lower ileal digestible starch and total digestible starch concentrations (mean 21 and 31%, respectively). Seventy-four percent of the TS in the cereal grains group was rapidly digestible starch plus slowly digestible starch compared with the flour group, where the corresponding value was 95%. This related to the processing of cereals to flours, in which TDF and RS concentrations were reduced markedly. This increased ileal digestible starch concentrations in the flour group (65%) versus the cereal grains group (60%). Ileal digestion of starch in grain-based food products like macaroni and spaghetti was high (96 and 92%, expressed as a percentage of TS, respectively). Fermentation of substrates with ileal microflora was influenced by substrate chemical composition, with the flour group exhibiting the highest organic matter disappearance values. The legume group had a high total short-chain fatty acid concentration (7.8 mmol/g organic matter fermented), perhaps as a result of fermentation of TDF as well as starch components. A database such as this one provides information about utilization of foods and feeds in the dog and potentially in humans.

Selected animal and plant protein sources affect nutrient digestibility and fecal characteristics of ileally cannulated dogs

The objective of this study was to compare ileal and total tract nutrient digestibilities and fecal characteristics of dogs fed selected animal and plant protein sources incorporated into grain-based diets. Four crude protein sources--soybean meal (SBM), poultry meal (PM), poultry by-product meal (PBPM), and beef and bone meal (BBM)--were fed to four ileal cannulated dogs in a 4 x 4 Latin square design. Intakes of dry matter, organic matter, crude protein, and fat by dogs were similar. Total dietary fiber (TDF) intake was highest for the SBM treatment compared to other treatments. Ileal digestibilities of DM, OM, CP, fat, and TDF were not affected by treatment. Total tract digestibility of DM was lower for the BBM and SBM diets, while OM digestibility was lower for the SBM treatment only. Total tract CP digestibility was similar for BBM, PBPM, and SBM treatments and was higher for the PM treatment. As-is fecal excretion [g/d] was greater when dogs received the SBM treatment. Fecal output on a DM basis was higher for the SBM treatment compared to the other treatments. All diets were well utilized by the dogs as assessed by ileal and total tract digestibility data and fecal characteristics.

Evaluation of selected high-starch flours as ingredients in canine diets

Cereal grains represent 30 to 60% of the DM of many companion animal diets. Once incorporated into a diet, the starch component of these grains can provide an excellent source of ME. However, crystallinity and form of starch are variable and can cause incomplete digestion within the gastrointestinal tract. Diets fed in this experiment included one of six high-starch flours as the main source of carbohydrate. The flours originated from barley, corn, potato, rice, sorghum, and wheat. The diets were extruded and kibbled. Starch fraction concentrations of flours consisted of nearly 100% rapidly digestible starch (RDS) and slowly digestible starch (SDS) combined. Starch fraction concentrations of diets paralleled concentrations in flours. Flours varied widely in concentrations of CP, fat, starch, and total dietary fiber. Ileal OM and CP digestibilities were lowest for the potato flour treatment (74 and 64%, respectively). Ileal and total tract starch digestibilities were different (P<.05) among treatments; however, the starch component of all diets was nearly completely digested (>99%). Total tract digestibility of DM and OM was lowest for sorghum (80 and 84%, respectively) compared to all other diets. Crude protein digestibility was highest for corn (87%). Wet fecal weights tended (P<.08) to be greatest for dogs fed the barley treatment (175 g/d). However, dry fecal weights (dried at 55 degrees C) were greatest for dogs consuming the sorghum diet (51 g/d). Fecal scores were consistently greater (i.e., looser stools) for the barley treatment. Any of these flours could be used without negative effects on digestion at either the ileum or in the total tract. Fecal consistency data for dogs consuming the barley treatment indicate that diets containing large amounts (>50%) of barley may not be advantageous for dog owners who house their animals indoors for most of the day.

Soybean hulls as a dietary fiber source for dogs

In Exp. 1, soybean hull samples were obtained from nine sources across the United States and analyzed for nutrient content to determine their suitability for inclusion in dog diets. Compositional data revealed variation in both the amount of total dietary fiber (TDF; 63.8 to 81.2%) in the soybean hulls and the ratio of insoluble:soluble fiber (5.0:1 to 15.4:1). Crude protein content varied widely among sources, ranging from 9.2 to 18.7%. An in vivo trial (Exp. 2) was conducted using a premium dog diet containing 3.0, 4.5, 6.0, 7.5, or 9.0% soybean hulls (DM basis). There was a negative linear effect (P < .05) of soybean hull inclusion in the diet on DM, OM, TDF, and GE total-tract digestibilities, as well as on calculated ME. Crude protein and fat digestibilities were unaffected by treatment. Based on these results, ileally cannulated dogs were fed diets containing 6.0, 7.5, or 9.0% soybean hulls (DM basis) in addition to diets containing either 0% supplemental fiber or 7.5% beet pulp (Exp. 3). Nutrient digestion at the ileum was unaffected by inclusion of supplemental fiber. Total tract digestion of DM, OM, and GE was lower ( P < .05) for diets containing supplemental fiber when compared with the diet containing 0% fiber. Crude protein and fat digestibilities were unaffected by treatment. There was no difference in nutrient digestibility between those diets containing soybean hulls and a diet containing beet pulp. Soybean hull inclusion in the diet resulted in a negative linear effect (P < .05) on calculated ME, in addition to lowering ME (P < .05) when compared with the 0% fiber control diet. Calculated ME for dogs fed a 7.5% beet pulp-containing diet was lower (P < .05) than that for dogs fed the soybean hull-containing diets. Results indicate that soybean hulls can be an effective dietary fiber source in dog diets.

Apparent digestibility and glycaemic responses to an experimental induced viscosity dietary fibre incorporated into an enteral formula fed to dogs cannulated in the ileum

The purpose of this study was to evaluate the apparent digestibility and postprandial glycaemic responses of ileal-cannulated dogs when fed an experimental induced viscosity dietary fibre (IVF) incorporated into a liquid enteral formula. Dietary treatments were: (1) control; (2) Glucerna; (3) Glytrol; (4) IVF; and (5) Jevity. Diets varied in concentrations of crude protein (CP), fat, starch and total dietary fibre (TDF). Dry matter and starch intakes by dogs fed the Glucerna and Glytrol treatments were lower (P<0.05) than for those consuming the other diets. However, daily intakes of CP and fat followed a reverse trend. Digestibility of nutrients at the ileum was high (>80%) for all dietary treatments. Mineral absorption proximal to the ileum and from the total tract was not significantly different among treatments. Mean incremental area under the serum glucose response curves for dogs fed Glytrol, Glucerna, and IVF treatments were lower (P<0.05) than the control treatment. Induced viscosity fibre appears to have no negative effects on nutrient digestion throughout the gastrointestinal tract. Its ability to moderate serum glucose concentrations would make it a potentially good choice for a diabetic liquid formula.

Apparent digestibility of a debranched amylopectin-lipid complex and resistant starch incorporated into enteral formulas fed to ileal-cannulated dogs1

The purpose of this study was to evaluate apparent digestibility in ileal-cannulated dogs fed enteral diets containing a debranched amylopectin-lipid complex (V-complex) or resistant starch. Six ileal-cannulated dogs were randomized into a replicated 3 x 3 Latin square design for determination of digestibility of three experimental treatments. Dietary treatments were as follows: 1) control; 2) V-complex; and 3) resistant starch. Diets were similar in chemical composition. Apparent digestibility of dry matter (DM), organic matter (OM) and carbohydrate by dogs fed the control diet was higher (P < 0.05) than for dogs consuming the other diets. Mean apparent digestibilities of carbohydrate for the control, V-complex and resistant starch diets were 89, 76 and 43%, respectively. Both DM and carbohydrate digestibility were lower (P < 0.05) for resistant starch compared with V-complex. Fecal dry and wet weights for dogs fed the control diet were lower (P < 0.05) than for those receiving either the resistant starch or V-complex treatments. Dogs fed the V-complex diet produced approximately 90 g less feces per day than dogs fed resistant starch. Dietary incorporation of V-complex to replace traditional carbohydrates may be beneficial for diabetic patients because of the decreased digestibility and subsequent glucose absorption rate. Furthermore, incorporation of resistant starch into enteral formulas may improve gastrointestinal tract health status as a result of increased fecal bulk, potential dilution of toxins in the intestinal lumen and greater production of short-chain fatty acids.

Raw and rendered animal by-products as ingredients in dog diets

Approximately 25 to 40% of the DM in premium dog diets is animal by-product. However, limited information is available regarding the composition and digestibility of these by-products, especially small intestinal digestibility. The effects of raw and rendered animal by-products incorporated into dog diets on nutrient digestion at the ileum and in the total tract were studied in this experiment. Diets fed contained various animal by-products including a rendered beef meat and bone meal (RMBM); fresh beef (FB); poultry by-product meal (PBPM); fresh poultry (FP); a plant-based control protein source, defatted soy flour (DS); and an animal-based control protein source, dehydrated whole egg (WE). The diets were extruded and kibbled. By-products varied widely in concentrations of OM, CP, amino acids, and fat. Nutrient intakes were numerically higher for FB than for all other treatments. All nutrient intakes were higher (P < .03) for the FB treatment than for the RMBM treatment. Digestibilities of DM, OM, CP, fat, and GE at the ileum were higher (P < .06) when dogs were fed diets containing FP than when fed diets containing PBPM. Amino acids were highly digestible at the ileum; however, digestibilities of all amino acids except cystine were higher (P < .04) for the diets incorporating FP vs PBPM. Total tract digestion was different among treatments for DM (P < .02), OM (P < .01), and GE (P < .02), and diets containing animal by-products were similar in total tract digestibility, greater than the DS control, and lower than the WE control. Rendering of poultry, but not beef, seemed to have a slight negative influence on small intestinal, but not total tract, digestibility by dogs.

Nutrient digestion by ileal cannulated dogs as affected by dietary fibers with various fermentation characteristics

We studied the effects of dietary fibers with various fermentation characteristics on nutrient digestion at the distal ileum and in the total tract of dogs. The following high-protein (34%), high-fat (23%) diets were fed: 1) a control treatment (CON) with 0% supplemental fiber; 2) beet pulp (BP), 7.5%; 3) low-cellulose mixture (LCM), 2.5% cellulose + 5.0% pectin; 4) high-cellulose mixture (HCM), 5.0% cellulose + 2.5% pectin; or 5) Solka Floc (SF), 7.5% cellulose. Nutrient intakes by fiber-supplemented dogs were similar among treatment groups but greater (P < .05) than for dogs fed the control diet. Digestion of nutrients at the distal ileum was similar among groups except for fat: the dogs fed BP digested less fat than those fed the other sources of dietary fiber. Digestion of amino acids at the distal ileum was similar for all groups, except for lysine, which increased (P < .05) in digestibility as dietary cellulose concentration increased. Dogs consuming LCM had lower apparent ileal digestibility values for all nutrients, including most amino acids, than dogs consuming HCM or SF. Total tract digestion of DM and OM by dogs fed supplemental fiber was less (P < .05) than for dogs fed the control diet. The BP treatment was higher than other fiber treatments in total tract digestion of OM (P < .10) and total dietary fiber (P < .05). Total tract digestibilities of all nutrients exhibited either linear or quadratic responses to dietary cellulose concentrations. Apparent ileal and total tract nutrient digestion was influenced by the source of dietary fiber consumed.

Induction of Leydig cell adenomas by ammonium perfluorooctanoate: a possible endocrine-related mechanism

Ammonium perfluorooctanoate (C8) produced an increased incidence of Leydig cell adenomas in Crl:CD BR (CD) rats fed 300 ppm for 2 years. A hormonal (nongenotoxic) mechanism was examined since C8 was negative in short-term tests for genotoxicity. Adult male CD rats were gavaged with either 0, 1, 10, 25, or 50 mg/kg C8 for 14 days. In addition, a control group was pair-fed to the 50 mg/kg C8 group. A dose-dependent decrease in body and relative accessory sex organ (ASO) weights was seen, with the relative ASO weights of the 50 mg/kg group significantly less than those of the pair-fed control. Serum estradiol levels were elevated in the 10, 25, and 50 mg/kg C8-treated animals. Estradiol levels in the 50 mg/kg C8 group were 2.7-fold greater than those in the pair-fed control. The increase in serum estradiol levels occurred at the same dose levels as the increase in hepatic beta-oxidation activity. A statistically significant downward trend with dose was seen in serum testosterone levels when compared with the ad libitum control. However, when the 50 mg/kg C8-treated rats were compared with their pair-fed control, no significant differences were seen. Challenge experiments, which can identify the presence and location of a lesion in an endocrine axis, were undertaken to clarify the significance of this downward trend in serum testosterone following C8 exposure. In the challenge experiments, adult CD rats were gavaged with either 0 or 50 mg/kg C8 for 14 days. One hour before termination, rats received either a human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH), or naloxone challenge. Following hCG challenge, serum testosterone levels in the 50 mg/kg C8 were significantly decreased (50%) from those in the ad libitum controls. Similar decreases, although not significant, were seen in serum testosterone following GnRH and naloxone challenge. The challenge experiments suggest that the decrease in serum testosterone following C8 exposure is due to a lesion at the level of the testis. In addition, progesterone, 17 alpha-hydroxyprogesterone, and androstenedione were examined in the 50 mg/kg C8-treated males following hCG challenge. A 60% decrease was observed in androstenedione levels in the C8-treated animals from those in the ad libitum controls; no other differences were seen. These data suggest that the decrease in serum testosterone following hCG challenge may be due to a decrease in the conversion of 17 alpha-hydroxyprogesterone to androstenedione. The observed effects described above can be attributed to the elevated serum estradiol levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Duck hepatitis B virus: a model to assess efficacy of disinfectants against hepadnavirus infectivity

The efficacy of three proprietary glutaraldehyde disinfectants and their component bases was assessed using the duck hepatitis B virus (DHBV) model. Inactivation of infectivity of undiluted serum containing 10(6.8) ID50/ml DHBV was assessed after a mixture with an equal volume of disinfectant had stood at room temperature for 10 min. A dried spill of infectious serum was simulated using sterile filter paper disks, saturated with serum containing DHBV, dried and then exposed to test disinfectant for 10 min. Residual infectivity, and hence the reduction in virus titre, was determined by inoculation of dilutions of the treated samples into 1-day-old ducklings. A greater than 3 log10 reduction in virus titre could be demonstrated for the disinfectants as well as for some of their component bases. Disinfectant activity varied according to the method of viral presentation but a reduction of exposure time from 10 to 2.5 min did not diminish activity. The experimental protocol permits a comparative and quantitative assessment of the efficacy of both established and new disinfectants.

Postexposure treatment of experimental DHBV infection: a new therapeutic strategy

The therapeutic efficacy of antiviral agents for postexposure prophylaxis to hepadnavirus infection has been studied using acyclovir and foscarnet in the duck hepatitis B virus (DHBV) model. A total of 112 Pekin-Aylesbury ducks were inoculated with DHBV at 11 days post-hatch. Three days later, groups of these birds were injected intraperitoneally twice daily for 10 days with acyclovir (25 mg/kg) or foscarnet (250 mg/kg) or phosphate-buffered saline. Serum samples were taken before, during, and up to 4 weeks post-treatment and were analysed for DHBV DNA by dot hybridization. Liver tissue obtained at sacrifice was examined for viral DNA and for histological changes. At completion of treatment with acyclovir, 21 of 22 ducks were not viremic, compared with 6 of 26 control birds (P less than 0.001). Four weeks after withdrawal of acyclovir, 12 of 20 ducks remained nonviremic, compared with 2 of 23 controls (P less than 0.01). In liver tissue, viral DNA was detected in 10 of 19 treated ducks, compared with 21/24 controls (P less than 0.01). Histological changes of hepatitis were present in more of the control birds than in the treated group. The results with foscarnet treatment were similar, although a smaller inoculum of DHBV was used and fewer control birds became infected. The administration of antiviral agents soon after exposure prevented productive infection in approximately 50% of birds. Therefore, the use of a safe antiviral agent such as acyclovir, which can be given orally, should be considered in post-exposure prophylaxis against human hepatitis B virus (HBV) infection.

Torque-velocity relationships of the knee extensor and flexor muscles in individuals sustaining injuries of the anterior cruciate ligament

Muscle deficits in 58 patients with chronic anterior cruciate ligament (ACL) insufficiency were evaluated after completion of a 6 month rehabilitation program. Quadriceps and hamstring torques were measured on a modified Cybex II isokinetic dynamometer. Twenty-nine of our patients were tested just prior to undergoing ACL reconstruction, and patients who were continuing to tolerate their conditions served as controls. For the surgical group, significant quadriceps deficits (P less than 0.01) were found for all speeds and at both the 30 and 60 degrees positions. The nonsurgical group had significant deficits at the 30 degrees position at 180 degrees/sec, and at 60 degrees for the 0 degree/sec and 30 degrees/sec. However, in comparing the two groups no significant differences were noted. Regarding hamstring deficits in the surgical group, significant deficits were seen only at 30 degrees of flexion at 180 degrees/sec. The nonsurgical group had similar deficits. Of interest was the observation that the hamstring:quadriceps (H:Q) ratio was found to be both speed-position dependent. Overall, no correlation was found between the presence of strength deficits following a rehabilitation program and the need for surgery.

Celiac disease in monozygous twin boys. Asynchronous presentation

A 13-year-old boy presented when his weight gain fell behind that of his monozygous twin brother. Following investigation, he was found to have gluten-sensitive enteropathy on jejunal biopsy. Investigation of his symptom-free brother showed biopsy evidence of the condition with changes similar to those of the clinically affected boy. Following treatment with a gluten-free diet, the boys achieved a similar weight after 15 months.

Disseminated eosinophilic infiltration of a newborn infant, with perforation of the terminal ileum and bile duct obstruction

A preterm boy died 4 days after delivery from septicaemia which at necropsy was found to be due to perforation of an eosinophilic lesion of the terminal ileum. Eosinophilic infiltration was also found in kidney, lymph node, bone marrow, portal tracts of liver, gall bladder, and bile duct with associated obstruction of the cystic duct and mucocele of the gall bladder. No allergic cause for the infiltrate was found in either the infant or his mother. Eosinophilic infiltration of neonatal spleen, lymph node, intestinal mucosa, epicardium, thymus, pancreas, portal tracts of the liver, and skin has been reported but the aggressive behaviour of the infiltrate in this patient bears more resemblance to the eosinophilic gastroenteritis that has been described in older children and adults.

The morphology of serotonin-induced renal lesions in the rat

The progress of serotonin-induced renal lesions was studied over a period of 6 mth following a single intraperioneal injection of 40 mg/kg serotonin. The predominant lesion was ischaemic necrosis of tubules of patchy distribution. Parahilar areas were usually spared and a narrow subcapsular strip was less severely affected than deeper parts. The early tubular lesions appeared to be an accelerated form of the lesion of complete renal ischaemia. The necrotic tubules were soon relined by epithelium from surviving segments and became dilated. This phase of dilatation corresponded approximatly with the period of diuresis following serotonin injection and was followed by collapse and atrophy of tubules. Possible mechanisms concerned in the sequential appearance of tubular dilatation and collapse were discussed. Many collapsed tubules eventually atrophied and were associated with basement membrane thickening and round cell infiltration. Reflux of necrotic proximal tubule cytoplasm into glomerular capsular spaces occurred in the early stages of the lesion. This lesion is not specific for serotonin nephropathy and can be produced by allowing normal rat kidney to autolyse.

The retroverted gravid uterus and its effect on the outcome of pregnancy

Among 1954 pregnant women who booked before the end of the 14th week of gestation the uterus was retroverted in 220 (11.2%). The incidence of bleeding in early pregnancy and spontaneous abortion was significantly higher in the retroverted group. Only three patients (1.4%) with a retroverted gravid uterus developed acute retention of urine. Patients with retroverted uteri did not have a higher incidence of previous infertility, nor any increase in the incidence of common obstetric abnormalities.