Unlocking the Hidden Dimensions of Cancer Care: Cross-Cultural Adaptation and Feasibility Study of ESAS-FS, Assessing Spiritual Pain and Financial Distress in a Spanish-speaking Population with Advanced Cancer

INTRODUCTION

Spiritual pain and financial distress are two important dimensions of cancer care that are often overlooked. Both dimensions can have a significant impact on the quality of life of patients with cancer and their families.

METHODS

This study conducted a cross-cultural adaptation, feasibility study, and psychometric properties of the Edmonton Symptom Assessment System-Financial and Spiritual (ESAS-FS) in a Spanish-speaking population with advanced cancer. The ESAS-FS is a patient-reported outcome measure that assesses 12 symptoms, including spiritual pain and financial distress.

RESULTS

In the cross-cultural adaptation process, the terms "spiritual pain" and "financial distress" were refined to "sufrimiento espiritual" and "preocupación por asuntos económicos" respectively, with strong professional consensus and high patients' acceptancy (relevant questions 80%, appropriate terms 91%). A cohort of 100 onco-hematologic patients revealed that 70% experienced spiritual pain (mean 2.9/10), while 49% reported financial distress (mean 2.2/10). Symptomatic analyses illustrated significant associations of spiritual pain with various symptoms like fatigue, drowsiness, and depression. Similarly, financial distress correlated notably with drowsiness, depression, and anxiety. Moreover, a distinct correlation was observed between spiritual pain and financial distress.

CONCLUSION

The findings of this study suggest that the ESAS-FS is a valuable tool for assessing spiritual pain and financial distress in Spanish-speaking patients with advanced cancer. The tool can be used to identify patients who are experiencing these dimensions of distress and to provide them with appropriate care.

An analysis of the experiences of bereaved relatives and health care providers following palliative sedation: a study protocol for a qualitative international multicenter case study

BACKGROUND

Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries.

METHODS

This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis.

DISCUSSION

The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.

Molecular analysis in cytological samples obtained by endobronchial or oesophageal ultrasound guided needle aspiration in non-small cell lung cancer

INTRODUCTION

Cytological samples obtained by endobronchial ultrasound (EBUS) are capital for diagnosis, staging and molecular profile in non-small cell lung carcinoma (NSCLC).

OBJECTIVE

To assess the success rate of complete, partial and individual of molecular analysis in samples obtained by EBUS-guided transbronchial needle aspiration (TBNA) and/or by oesophageal ultrasound-guided fine needle aspiration with an echobronchoscope (EUS-B-FNA) in patients with NSCLC.

METHODS

Prospective study including 90 patients with non-squamous NSCLC, or non-smoking squamous. Cytological samples were classified into two groups. Group 1: PEN membrane slide and/or cell blocks for the determination of mutations of EGFR, KRAS, ERBB2 and BRAF. Group 2: silane coated slides or cell blocks for rearrangements of ALK, ROS1 and MET amplification.

RESULTS

The success rate was 78.6% for 4 molecular alterations (EGFR, KRAS, ALK and ROS1), and 44% for 7 determinations. The individual success rate for EGFR was 97%, KRAS 96.3%, ALK 85%, ROS1 82.3%, ERBB2 71.4%, BRAF 67.7% and MET 81.1%. There were no significant differences (p=0.489) in the number of molecular analyses (1-3 vs. 4) in group 1, depending on the types of samples (cell block vs. PEN membrane slide vs. cell block and PEN membrane slide).

CONCLUSIONS

In patients with NSCLC, the cytological material obtained by ultrasound-guided needle aspiration is sufficient for individual and partial molecular analysis in the vast majority of cases. Membrane slides such as cell blocks are valid samples for molecular analysis.

Evaluation of the intraoperative human papillomavirus test as a marker of early cure at 12 months after electrosurgical excision procedure in women with cervical high-grade squamous intraepithelial lesion: a prospective cohort study

OBJECTIVE

To evaluate if the intraoperative human papillomavirus (IOP-HPV) test has the same prognostic value as the HPV test performed at 6 months after treatment of high-grade squamous intraepithelial lesion (HSIL) to predict treatment failure.

DESIGN

Prospective cohort study.

SETTING

Barcelona, Spain.

POPULATION

A cohort of 216 women diagnosed with HSIL and treated with loop electrosurgical excision procedure (LEEP).

METHODS

After LEEP, an HPV test was performed using the Hybrid Capture 2 system. If this was positive, genotyping was performed with the CLART HPV2 technique. The IOP-HPV test was compared with HPV test at 6 months and with surgical margins.

MAIN OUTCOME MEASURE

Treatment failure.

RESULTS

Recurrence rate of HSIL was 6%. There was a strong association between a positive IOP-HPV test, a positive 6-month HPV test, positive HPV 16 genotype, positive surgical margins and HSIL recurrence. Sensitivity, specificity, and positive and negative predictive values of the IOP-HPV test were 85.7, 80.8,24.0 and 98.8% and of the HPV test at 6 months were 76.9, 75.8, 17.2 and 98.0%.

CONCLUSION

Intraoperative HPV test accurately predicts treatment failure in women with cervical intraepithelial neoplasia grade 2/3. This new approach may allow early identification of patients with recurrent disease, which will not delay the treatment. Genotyping could be useful in detecting high-risk patients.

TWEETABLE ABSTRACT

IOP-HPV test accurately predicts treatment failure in women with CIN 2/3.

Impact of the baseline study with penile doppler ultrasound in patients with prostate cancer before radical prostatectomy

INTRODUCTION

Given the high prevalence of erectile dysfunction in male population between 40-70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study.

MATERIAL AND METHODS

Prior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered.

RESULTS

According to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3-4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (P<.0001) between categorized EF-IIEF (normal, mild/moderate/severe) and the EHS value. Between PDUS (normal vs. pathologic) and EHS (3-4 vs. 1-2) statistically significant association (P=.005) was found. Just 35.3% of patients with EHS 3-4 showed normal PDUS. Correlation between the PDUS and the EF-IIEF (≥26 vs.<26) was statistically significant (P=.043). Moreover, only 38.6% of patients with EF-IIEF≥26 had a normal PDUS.

CONCLUSIONS

In order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role.

[Good care for patients who die in intensive care units in Spain. A study based on international care quality indicators]

BACKGROUND

Good care for patients who die in intensive care should be pursued in the same way that excellence is sought in other clinical aspects.

OBJECTIVE

To assess the quality of clinical care given to patients who die in intensive care units (ICU) in Spain. Methodos. A retrospective observational cohort study of patients who died in the ICU based on a Spanish sample. Inclusion criteria were patients older than 18 years who died in ICU after a minimum stay of 24 hours. Consecutive admissions without exclusions were analyzed. Excellence criteria in intensive care were assessed by quality indicators and measures, related to end-of-life care, developed by the Robert Wood Johnson Foundation Critical Care Workgroup.

RESULTS

Two hundred and eighty-two patients from 15 Spanish ICU were included. A median of 13% was observed in the achievement of the indicators. Almost all clinical records assessed both the patients' decision making capacity (96%) and their communication with families (98%), while a plan of care goals was achieved in only 50% of them. Only two ICU had open visiting policies. Distress assessment (48%) was better than that of pain assessment (28%). The absence of protocol for the withdrawal of life-sustaining treatments was observed in thirteen ICU. The indicators of emotional and spiritual support were achieved in less than 10%.

CONCLUSIONS

The quality of end-of-life care in the participating ICU needs to be improved. The study identifies shortcomings and indicates existing resources in clinical practice from which a gradual improvement plan, adapted to the situation in each hospital, can be designed. The analysis, inexpensive in its implementation, offers an opportunity for improvement, a goal recommended by most professional societies of intensive care medicine. Key words. End-of-life care. Intensive care. Critical care. Palliative care. Quality improvement.

Identification of oestrogen, progesterone receptor and human epidermal growth factor receptor 2 expression in mediastinal metastases of breast cancer obtained by endobronchial ultrasound-guided transbronchial needle aspiration

BACKGROUND

In breast cancer patients, the expression statuses of oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are crucial in the choice of treatment. Receptor expression in metastatic lesions can differ from the primary tumour. The aim of our study was to analyse the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to obtain samples allowing the identification of ER, PR and HER2 expression in patients with mediastinal metastases of breast cancer.

PATIENTS AND METHODS

The clinical files of all patients with a final diagnosis of breast cancer mediastinal metastases diagnosed by EBUS-TBNA in our institution were retrospectively analysed. The ability of EBUS-TBNA to obtain samples that allowed hormone receptor and HER2 expression analysis was calculated.

RESULTS

Twenty-four patients were included. ER, PR and HER2 assessments could be performed in 22, 20 and 22 patients, respectively. In 20 of the 24 patients it was possible to investigate all three types of receptor expression. In the remaining four cases, where ER, PR or HER2 expression tests could not be performed, it was due to a lack of tissue. In cases with adequate results for EBUS-TBNA and the primary tumour agreement was greater for ER (16/19) and HER2 (12/14) than PR (8/17). Based on receptor status, there was a change in the choice of treatment for five patients.

CONCLUSION

In patients with breast cancer mediastinal metastases, ER, PR and HER2 expression can be assessed in samples obtained by EBUS-TBNA whenever a sufficient tissue sample is collected.

Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease

BACKGROUND

Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of future models for integrated PC in Europe.

METHODS

Cochrane, PubMed, EMBASE, CINAHL, AMED, BNI, Web of Science, NHS Evidence. Five journals and references from included studies were hand-searched. Two reviewers screened the search results. Studies with adult patients with advanced cancer/chronic disease from 1995 to 2013 in Europe, in English, French, German, Dutch, Hungarian or Spanish were included. A narrative synthesis was used.

RESULTS

14 studies were included, 7 models for chronic disease, 4 for integrated care in oncology, 2 for both cancer and chronic disease and 2 for end-of-life pathways. The results show a strong agreement on the benefits of the involvement of a PC multidisciplinary team: better symptom control, less caregiver burden, improvement in continuity and coordination of care, fewer admissions, cost effectiveness and patients dying in their preferred place.

CONCLUSION

Based on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.

Barriers to the development of palliative care in Western Europe

The Eurobarometer Survey of the EAPC Task Force on the Development of Palliative Care in Europe is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe.

AIM

To identify barriers to the development of palliative care in Western Europe.

METHOD

A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe.

ANALYSIS

Data from the Eurobarometer Survey were analysed thematically by geographical region and by the degree of development of palliative care in each country.

RESULTS

From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) lack of palliative care education and training programmes; (ii) lack of awareness and recognition of palliative care; (iii) limited availability of/knowledge about opioid analgesics; (iv) limited funding; (v) lack of coordination amongst services; and (vi) uneven palliative care coverage.

CONCLUSION

Findings from the EAPC Eurobarometer Survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed.

[Coordinating efforts in complex clinical cases: added value of palliative care at a university teaching hospital]

Palliative care is generally understood on caring for terminal patients in chronic settings but more recently these units are developing also in acute care settings or university hospitals as consultants teams. We report the case of a complex patient with rectal adenocarcinoma and four problems of difficult approach: uncontrolled neuropathic pain despite opioids treatment, systemic infection, depression with intense demoralisation and open surgery wound. We show the measures adopted and how an excellent inter-departmental collaboration under the co-ordination of palliative medicine consultant team helped to resolve the untenable situation.

Effect of enzyme addition on the nutritive value of high oleic acid sunflower seeds in chicken diets

Two experiments were conducted to evaluate the effects of enzyme addition in chicken diets containing high oleic acid sunflower seeds (HOASS). In the first experiment (4 to 21 d of age), enzyme addition (lipase, phospholipase, and a combination of these) was used at the inclusion level of 1 g/kg in diets containing HOASS (250 g/kg) compared with a control corn-soybean diet. Weight gain, feed consumption, relative liver weight, fat digestibility, and amylase, lipase, serum lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) activities were reduced, and feed conversion, relative duodenum, jejunum, ileum, and ceca lengths, plasma uric acid, cholesterol, and glucose concentrations were increased in the unsupplemented HOASS diet compared with the control diet. The addition of enzymes to the HOASS diet increased weight gain, feed consumption, relative pancreas and liver weights, fat digestibility, amylase and lipase activities, plasma uric acid, calcium, serum LDH and CPK, and total protein concentration and reduced feed conversion, relative spleen weight, relative duodenum, jejunum, ileum, and ceca lengths, plasma cholesterol, and glucose compared with the unsupplemented HOASS diet. In the second experiment (0 to 21 d of age), the same enzymes (0.5 g/kg each) were included in diets containing 150 g/kg of HOASS compared with a conventional sunflower meal diet (150 g/kg). The HOASS diet did not affect performance but reduced relative pancreas and abdominal fat weights and relative duodenum and ceca lengths, and increased crude fat, CP, and essential and nonessential amino acid digestibilities (except Ser, which was reduced) compared with the control diet. The addition of enzymes in the HOASS diet increased weight gain, feed consumption, and relative pancreas weight and reduced feed conversion, CP, and essential and nonessential amino acid digestibilities compared with the unsupplemented HOASS diet. In conclusion, the addition of 250 g of HOASS/kg in the diets caused a negative effect on performance, digestive organ sizes, fat and protein digestibilities, and pancreatic enzymes and modified blood parameters. However, the inclusion of HOASS at 150 g/kg improved some of these parameters and amino acid digestibilities. The enzyme addition counteracted some of these effects.

The management of constipation in palliative care: clinical practice recommendations

Constipation is one of the most common problems in patients receiving palliative care and can cause extreme suffering and discomfort. The aims of this study are to raise awareness of constipation in palliative care, provide clear, practical guidance on management and encourage further research in the area. A pan-European working group of physicians and nurses with significant experience in the management of constipation in palliative care met to evaluate the published evidence and produce these clinical practice recommendations. Four potentially relevant publications were identified, highlighting a lack of clear, practical guidance on the assessment, diagnosis and management of constipation in palliative care patients. Given the limited data available, our recommendations are based on expert clinical opinion, relevant research findings from other settings and best practice from the countries represented. Palliative care patients are at a high risk of constipation, and while general principles of prevention should be followed, pharmacological treatment is often necessary. The combination of a softener and stimulant laxative is generally recommended, and the choice of laxatives should be made on an individual basis. The current evidence base is poor and further research is required on many aspects of the assessment, diagnosis and management of constipation in palliative care.

Time-course of c-Jun N-terminal kinase activation after cerebral ischemia and effect of D-JNKI1 on c-Jun and caspase-3 activation

The c-Jun N-terminal kinase (JNK) signaling pathway plays a critical role in ischemic brain injury. The d-retro-inverso form of c-Jun N-terminal kinase-inhibitor (D-JNKI1), a cell-permeable inhibitor of JNK, powerfully reduces neuronal death induced by permanent and transient ischemia, even when administered 6 h after the ischemic insult, offering a clinically relevant window. We investigated the JNK molecular cascade activation in rat cerebral ischemia and the effects of D-JNKI1 on this cascade. c-Jun activation starts after 3 h after ischemia and peaks at 6 h in the ischemic core and in the penumbra at 1 h and at 6 h respectively. The 6 h c-Jun activation peak correlates well with that of P-JNK. We also examined the activation of the two direct JNK activators, MAP kinase kinase 4 (MKK4) and MAP kinase kinase 7 (MKK7). MKK4 showed the same time course as JNK in both core and penumbra, reaching peak activation at 6 h. MKK7 did not show any significant increase of phosphorylation in either core or penumbra. D-JNKI1 markedly prevented the increase of P-c-Jun in both core and penumbra and powerfully inhibited caspase-3 activation in the core. These results confirm that targeting the JNK cascade using the TAT cell-penetrating peptide offers a promising therapeutic approach for ischemia, raising hopes for human neuroprotection, and elucidates the molecular pathways leading to and following JNK activation.

Effects of citric acid and microbial phytase on amino acid digestibility in broiler chickens

1. Two experiments with growing chickens were carried out to study the effects of the inclusion of a microbial phytase (Natuphos 5000) and citric acid (CA) in maize-soybean-based diets on the performance and apparent ileal digestibility (AID) of crude protein (CP) and amino acids (AA). In both experiments the diets were formulated to contain the same amounts of energy and protein. 2. In the first experiment, data were analysed as a 2 x 2 factorial arrangement with two concentrations of available phosphorus (AP) from one day to 3 weeks of age (3.5 and 2.2 g/kg) and for 3 to 6 weeks (2.7 and 1.4 g/kg), and two inclusions of commercial phytase (0 and 500 FTU/kg) in each period. The AID of CP and dispensable and indispensable AA were not modified by the AP content of the diet. Addition of phytase improved the AID of CP and dispensable and indispensable AA only at low AP levels. 3. In the second experiment, data were analysed as a 3 x 2 factorial arrangement with three concentrations of citric acid (0, 20 and 50 g/kg) and two inclusions of commercial phytase (0 and 750 FTU/kg). Diets were formulated with deficient contents of AP (2.5 g/kg). Performance was not affected by commercial phytase addition. The addition of CA reduced the weight gain but did not modify the feed intake and gain:feed. In general, the AID of CP and dispensable and indispensable AA were not affected by CA addition. Commercial phytase increased the apparent ileal digestibility of crude protein but had no effect on AID of dispensable and indispensable AA. 4. In conclusion, the present work showed that microbial phytase enhanced AA digestibility in maize-soy-based diet only at very low AP concentrations, and that CA had no affect on the AID of CP and dispensable and indispensable AA. No synergism between CA and microbial phytase was detected.

Protein value for ruminants of a sample of whole cottonseed

The effective ruminal degradability (ED) of dry matter (DM), crude protein (CP) and amino acids, and the effective intestinal digestibility (IED) of DM and CP of a sample of whole cottonseed was measured using in situ and rumen outflow rate techniques in three wethers cannulated in the rumen and duodenum. The microbial contamination of rumen incubated residues was corrected by a continuous rumen infusion of15NH3as microbial marker and rumen solid associated bacteria as reference sample. Microbial contamination resulted in an overestimation of the undegradable fraction of DM (0·291v. 0·275;P<0·05) and CP (0·071v. 0·037;P<0·01) and a small underestimation of ED of DM (0·500v. 0·512;P=0·09) and CP (0·755v. 0·779;P=0·052). A proportion of 0·1 of the ruminal undegraded CP was of microbial origin and for essential amino acids this proportion varied from 0·042 to 0·150. Differences in ED between amino acids modified the amino acid profile, with an important reduction (0·2;P<0·01) in the proportion of lysine. Apparent intestinal digestibility of the insoluble fraction of this food, measured with the mobile nylon bag technique, showed large reductions (P<0·001) with the increase of the ruminal incubation time between 0 and 72 h: from 0·392 to 0·026 for DM and from 0·851 to 0·099 for CP. These evolutions fitted an exponential function with a previous lag. The IED was estimated either by integration of these equations and those describing the ruminal degradation and rumen outflow or by incubation through the intestines of a sample pooled to be representative of rumen flow of the undegraded food. The two methods gave similar values for both DM (0·222v. 0·203) and CP (0·659v. 0·658).

Effect of Dietary Grape Pomace and Vitamin E on Growth Performance, Nutrient Digestibility, and Susceptibility to Meat Lipid Oxidation in Chickens

Grape pomace (GP) is a source of polyphenols with powerful antioxidant capacity. An experiment was conducted to investigate the effect of inclusion of GP at levels of 5, 15, and 30 g/kg and alpha-tocopheryl acetate (200 mg/kg) in a corn-soybean basal diet on growth performance, protein and amino acid digestibilities; antioxidant activity of diet, serum and excreta, lipid oxidation of breast and thigh meats during refrigerated storage, and liver vitamin E concentration. Growth performance and protein and amino acid digestibilities were not affected among the different treatments. Total intake and digestibility of extractable polyphenols in the birds fed the GP diet were increased compared with birds fed supplemented and unsupplemented vitamin E diets. Antioxidant activity in vitamin E and GP diets and excreta exhibited higher scavenging free radical capacity than the control diet using 3-ethylbenzthiazoline-6-sulfonic acid and ferric reducing antioxidant power methods. Lipid oxidation (malondialdehyde concentration) in breast and thigh meats was lower in the birds fed the supplemented vitamin E diet than the control diet after 1, 4, and 7 d of refrigerated storage. Results showed a linear reduction of lipid oxidation in breast and thigh meats at 4 and 7 d with increasing content of GP in the diet. Oxidative stability in breast and thigh meats at 1, 4, and 7 d of storage was equivalent or less effective in GP diets compared with the vitamin E diet. A linear increase was observed in liver alpha-tocopherol concentration with increasing content of GP in the diet, but it was inferior to the supplemented vitamin E diet. In conclusion, the results showed that a dietary inclusion rate up to 30 g/kg of GP did not impair chickens growth performance and protein and amino acids digestibilities and increased antioxidant activity in diet and excreta. Grape pomace and vitamin E diets reduced the lipid oxidation of meat during refrigerated storage and increased liver alpha-tocopherol concentration, although these effects were greater, in some cases, by adding vitamin E to the diet.

Effect of dietary high-oleic acid sunflower seed, palm oil and vitamin E supplementation on broiler performance, fatty acid composition and oxidation susceptibility of meat

1. A study was conducted to evaluate the effect of inclusion of two fat sources: high-oleic acid sunflower seed (HOASS; 0, 50, 100, 150 and 200 g/kg diet) and palm oil (PO), and dietary supplementation of vitamin E (alpha-tocopheryl acetate, 200 mg/kg diet) on performance, fatty acid composition and susceptibility to oxidation of white and dark chicken meat during refrigerated storage. Female chicks (3 to 6 weeks) were given one of 5 diets containing 90 g/kg of added fat with increasing monounsaturated fatty acid (MUFA) content, adjusted by progressively replacing PO by HOASS. 2. Body weight gain and gain:food ratio of birds were depressed in diets containing the highest proportions of HOASS (150 and 200 g/kg). Relative abdominal fat was reduced in birds fed diets including HOASS, except in the diet containing 100 g HOASS/kg. The inclusion of alpha-tocopheryl acetate improved body weight gain and gain:food ratio. 3. According to the fatty acid profile of the diets, saturated and polyunsaturated fatty acid (SFA and PUFA, respectively) contents were significantly reduced and MUFA content was significantly increased in white and dark chicken meats when the saturated oil, PO, was replaced progressively by HOASS in the diet. The inclusion of alpha-tocopheryl acetate increased PUFA content in both meats. 4. After 4 and 7 d of refrigerated storage, white and dark meat samples obtained from birds fed on diets containing HOASS had significantly lower thiobarbituric acid reacting substance (TBARS) values than those derived from the PO diet. The addition of alpha-tocopheryl acetate significantly reduced the lipid oxidation in white and dark meat. 5. Overall, the results showed that increasing MUFA content of chicken meat by replacing dietary PO with HOASS (up to 100 g/kg) did not adversely affect broiler performance and reduced the susceptibility of meat to oxidation during refrigerated storage. Dietary alpha-tocopherol supplementation improved chicken performance and was effective in protecting lipid meat from oxidation.

Phosphorylation-dependent dimerization and subcellular localization of islet-brain 1/c-Jun N-terminal kinase-interacting protein 1

Islet-brain 1 [IB1; also termed c-Jun N-terminal kinase (JNK)-interacting protein 1 (JIP-1] is involved in the apoptotic signaling cascade of JNK and functions as a scaffold protein. It organizes several MAP kinases and the microtubule-transport motor protein kinesin and relates to other signal-transducing molecules such as the amyloid precursor protein. Here we have identified IB1/JIP-1 using different antibodies that reacted with either a monomeric or a dimeric form of IB1/JIP-1. By immunoelectron microscopy, differences in the subcellular localization were observed. The monomeric form was found in the cytoplasmic compartment and is associated with the cytoskeleton and with membranes, whereas the dimeric form was found in addition in nuclei. After treatment of mouse brain homogenates with alkaline phosphatase, the dimeric form disappeared and the monomeric form decreased its molecular weight, suggesting that an IB1/JIP-1 dimerization is phosphorylation dependent and that IB1 exists in several phospho- forms. N-methyl-D-aspartate receptor activation induced a dephosphorylation of IB1/JIP-1 in primary cultures of cortical neurons and reduced homodimerization. In conclusion, these data suggest that IB1/JIP-1 monomers and dimers may differ in compartmental localization and thus function as a scaffold protein of the JNK signaling cascade in the cytoplasm or as a transcription factor in nuclei.

Role of the JNK pathway in NMDA-mediated excitotoxicity of cortical neurons

Excitotoxic insults induce c-Jun N-terminal kinase (JNK) activation, which leads to neuronal death and contributes to many neurological conditions such as cerebral ischemia and neurodegenerative disorders. The action of JNK can be inhibited by the D-retro-inverso form of JNK inhibitor peptide (D-JNKI1), which totally prevents death induced by N-methyl-D-aspartate (NMDA) in vitro and strongly protects against different in vivo paradigms of excitotoxicity. To obtain optimal neuroprotection, it is imperative to elucidate the prosurvival action of D-JNKI1 and the death pathways that it inhibits. In cortical neuronal cultures, we first investigate the pathways by which NMDA induces JNK activation and show a rapid and selective phosphorylation of mitogen-activated protein kinase kinase 7 (MKK7), whereas the only other known JNK activator, mitogen-activated protein kinase kinase 4 (MKK4), was unaffected. We then analyze the action of D-JNKI1 on four JNK targets containing a JNK-binding domain: MAPK-activating death domain-containing protein/differentially expressed in normal and neoplastic cells (MADD/DENN), MKK7, MKK4 and JNK-interacting protein-1 (IB1/JIP-1).

Nutritional Evaluation of Raw and Extruded Kidney Bean (Phaseolus vulgaris L. var. Pinto) in Chicken Diets

An experiment was conducted to study the effect of inclusion of different concentrations (0, 100, 200, and 300 g/kg) of raw kidney bean and extruded kidney bean in broiler chick (0 to 21 d of age) diets on performance, digestive organ sizes, protein and amino acid digestibilities, intestinal viscosity, cecal pH, and blood parameters. Data were analyzed as a 3 x 2 factorial arrangement with 3 levels of kidney bean with and without extrusion. Positive control without kidney bean was used. Increasing the kidney bean content in the diet reduced weight gain and consumption, and increased the feed-to-gain ratio. Relative pancreas, liver, and jejunum weights, and intestinal viscosity were increased in response to increasing kidney bean concentration in the diet. The inclusion of different concentrations of kidney bean did not affect the apparent ileal digestibility of essential and nonessential amino acids, except for Met, Phe, and Cys, which were increased. Increasing kidney bean in the diet did not affect blood parameters, except for total protein, which was increased, and for androstenedione and testosterone, which were reduced. Extrusion significantly improved weight gain, feed consumption, and feed conversion. Relative pancreas, liver, and jejunum weights were reduced and spleen weight, cecal and intestinal viscosity were increased by extrusion. Apparent ileal digestibility of crude protein and all essential and nonessential amino acids were improved by extrusion. Like-wise, extrusion increased significantly the concentrations of cholesterol, triglycerides, glucose, and testosterone. We concluded that the inclusion of kidney bean in chicken diets cause a negative effect on performance and CP and amino acid digestibilities, and modified digestive organ sizes, intestinal viscosity, cecal pH, and some blood parameters. These effects were counteracted by the extrusion of kidney bean. However, the inclusion of extruded kidney bean in a chick diet resulted in poorer performance compared with that obtained with a corn-soybean diet.

Effects of feeding growing broiler chickens with practical diets containing sweet lupin (Lupinus angustifolius) seed meal

1. Two experiments with growing broiler chickens were carried out to study the effects of the inclusion in their diets of whole or dehulled lupin (Lupinus angustifolius) seed meal on productive and physiological parameters. The effects of the addition of a commercial protease (1 g/kg, Bio-Feed Pro, Novo. Nordisk, Madrid) were also tested. 2. Diets were formulated to contain the same amounts of energy (12.55 kJ/g) and protein (210 g/kg). Raw whole (not heat treated) or dehulled sweet (low in alkaloids) lupin seed meal (400 and 320 g/kg, respectively) were used to formulate the lupin-based diets, and the protein content was completed with either defatted soybean or casein. 3. Final body weight and feed intake of chickens fed diets containing whole lupin seed meal (400 g/kg) were lower than controls, but gain:feed ratios were not different. The presence of soybean or casein in the diet did not affect productive parameters. Birds fed dehulled (320 g/kg) instead of whole lupin seed meal had similar body weight, feed intake and gain:feed values to controls. The addition of a commercial protease (1 g/kg, Bio-Feed Pro CT) to whole lupin/soy or whole lupin/casein diets tended to increase feed intake and final weight of the birds. 4. Plasma uric acid concentration was higher, and plasma cholesterol and triglycerides lower, in chicks fed whole lupin but not in those fed dehulled lupin seed meal. Plasma amino acid concentrations were not different from controls in birds fed lupin diets. 5. Apparent ileal digestibility of amino acids was not different from controls for the different lupin diets. The relative weight of the liver was higher than controls in lupin-fed birds, but not in those fed enzyme supplemented lupin-based diets. Liver concentrations of DNA tended to rise, while those of glycogen tended to decrease and liver RNA was lower in lupin-fed chicks.

Effect of whole and demucilaged linseed in broiler chicken diets on digesta viscosity, nutrient utilisation and intestinal microflora

1. A study was undertaken to evaluate the effects of the inclusion of linseed or demucilaged linseed in the diet on the performance, fat and fatty acid digestibilities, metabolisability of gross energy and intestinal microflora. 2. The dietary inclusions were 80 and 160 g/kg for linseed and 160 g/kg for demucilaged linseed. Diets were given to chickens from 1 to 23 d of age. 3. Incorporation of linseed in the diet, particularly at 160 g/kg, depressed weight gain and food utilisation. Digestibility of fat and single fatty acids and dietary metabolisable energy were reduced. 4. Inclusion of linseed in the diet markedly increased the viscosity of ileal digesta. Microbial activity in the ileum and caeca was not greatly affected, but there was a significant increase in the number of lactobacilli. 5. The antinutritional effects caused by feeding linseed were partially overcome by substituting demucilaged linseed for linseed in the diet. 6. Results from the current study suggest that the viscous properties of mucilage are a major factor in the observed antinutritional effects of linseed through increasing intestinal viscosity. Such effects might also be mediated by the gut microflora.

Effects of microbial phytase supplementation on mineral utilization and serum enzyme activities in broiler chicks fed different levels of phosphorus

An experiment was conducted to study the effect of microbial phytase (Natuphos 500) supplementation in chicks (0 to 6 wk of age) fed different levels of nonphytate phosphorus (nPP) on performance, mineral retention, bone and plasma minerals and serum enzyme activities. Data were analyzed as a 2 x 2 factorial arrangement with two levels of nPP for age periods of 1-d-old to 3 wk (0.35 and 0.22%) and 3 to 6 wk (0.27 and 0.14%) and two levels of phytase (0 and 500 U/kg) in each period. A positive control, adequate in nPP and Ca without phytase, was used. The low-nPP diets caused a negative effect on the performance (P < 0.05) compared to the normalnPP diet. Phytase had a favorable effect on weight gain at 3 wk (P < 0.004) and 6 wk (P < 0.0475) of age and on feed consumption only at 3 wk (P < 0.0106). Feed efficiency was not affected at any stage by addition of phytase. Performances of chicks fed with 0.35 and 0.27% nPP and phytase were comparable to those obtained with the normal-nPP diets. Decreasing nPP content in the diet increased (P < 0.0001) P retention at 3 and 6 wk of age, increased Mg retention at 6 wk, and decreased (P < 0.0001) Ca and Zn retentions at 3 and 6 wk, respectively. Phytase supplementation increased (P < 0.0001) Ca, P, Mg, and Zn retention at 3 and 6 wk of age. Likewise, the decrease in nPP content in the diet caused a significant reduction of tibia ash (P < 0.0023) and Mg content (P < 0.0001) in tibia ash and reduced liver (P < 0.0240), spleen (P < 0.0176), and tibia (P < 0.0001) weights. Similarly, Ca (P < 0.0369) and Zn (P < 0.0181) contents in tibia ash were increased in response to decreasing nPP levels in the diet. Phytase supplementation increased tibia weight (P < 0.0019), tibia ash (P < 0.0021), and Mg (P < 0.0339) and Zn (P < 0.0353) concentrations and reduced (P < 0.0161) the relative liver weight. By decreasing nPP levels in the diet, plasma Ca (P < 0.0001), Mg (P < 0.0001) and Zn (P < 0.0048) concentrations, and alkaline phosphatase (ALP) activity (P < 0.0299) increased, and plasma P content (P < 0.0001), aspartate aminotransferase (AST) activity (P < 0.0001), and total protein (TP) content (P < 0.0050) were reduced. Phytase supplementation increased plasma P level (P < 0.0001) and serum AST activity (P < 0.0049), reduced plasma Ca (P < 0.0001) and Mg (P < 0.0050) contents, and reduced serum alanine aminotransferase (ALT) (P < 0.0048), ALP (P < 0.0001) and lactate dehydrogenase (LDH) (P < 0.0192) activities. Plasma Zn was not affected by phytase supplementation. These results demonstrated that microbial phytase supplementation to low-P diets improved performance; P, Ca, Mg, and Zn use; and tibia weight and relative liver weight in broiler chickens. Likewise, serum AST, ALT, ALP, and LDH activities, as well as TP concentration, were also affected by phytase supplementation.

Effect of inclusion level of linseed on the nutrient utilisation of diets for growing broiler chickens

1. Diets containing linseed at inclusions of 0, 80, 120 and 160 g/kg were evaluated for digestibility of nutrients and AMEn content with male broiler chickens. 2. Increasing the concentration of linseed decreased the retention of nitrogen and the digestibility of amino acids, crude fat and fatty acids of diets. 3. Dietary AMEn (MJ/kg) was also affected by the rate of inclusion of linseed, values decreasing from 14.39 to 12.49. 4. In general, a linear regression model explained the relationship between dietary linseed content and nutritive parameters. However, the quadratic response found for the digestibility of several amino acids and fatty acids indicated a non-additive change in their digestibility. 5. Viscosity ofjejunal digesta was markedly increased by each increment of linseed in the diets. This is attributable to the presence of mucilage in linseed and it might explain many of the results obtained in this study.

Effect of several germination conditions on total P, phytate P, phytase, and acid phosphatase activities and inositol phosphate esters in rye and barley

Two assays were conducted to study the evolution of rye and barley phosphatases (phytase and acid phosphatase) and the degradation of its substrates (inositol phosphate esters) during seed germination. In this manner we could obtain a low-phytate, endogenous phosphatase rich ingredient to be used in animal nutrition. In the first assay, the seeds were soaked for 1 and 14 h and germinated for 3 and 5 days with and without the addition of gibberellic acid (GA3). In the second assay, the seeds were soaked for 1 h and germinated for 1, 3, and 5 days with GA3. Phytase (up to 5739 and 3151 U x kg(-1)) and acid phosphatase (up to 18288 and 3151 U x g(-1)) activities, and IP6 (6.09 and 6.01 mg x g(-1)), IP5 (0.48 and 0.48 mg x g(-1)), and IP4 (0.13 and 0.06 mg x g(-1)) were detected in ungerminated rye and barley, respectively. The germination process caused a significant increase of Phy and AcPh activities in rye (up to 112 and 213%) and barley (up to 212 and 634%) and a reduction in the phytate phosphorus content (up to 84 and 58%, respectively). Phytate phosphorus content was affected only by soaking time in the case of rye. Finally, during the course of germination, IP6 and IP5 were rapidly degraded in rye (88 and 79%) and barley (67 and 52%), and IP4 was only a short-living intermediate, which was increased during hydrolysis and degraded to IP3. In conclusion, a marked increase of Phy and AcPh activities in rye and barley with a concomitant decrease in phytate phosphorus content and an increase in the content of lower inositol phosphates were observed during the rye and barley germination.