Prognostic Relevance of Preoperative Immune, Inflammatory, and Nutritional Biomarkers in Patients Undergoing Gastrectomy for Resectable Gastric Adenocarcinoma: An Observational Multicentre Study.

Background: The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection. Methods: This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage. Results: High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23-2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36-3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58-0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24-2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49-4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p < 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS. Conclusions: High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.

Using in feed xylanase or stimbiotic to reduce the variability in corn nutritive value for broiler chickens.

This study investigated the effects of xylanase and stimbiotic (fiber fermentation enhancer) on the response of broiler chickens fed different corn varieties and determine correlations between variables of interest. Four corn genetic varieties were selected based on their range in nutrient composition. Diets containing 600 g/kg of each corn were supplemented with 0 or 100 g/ton of xylanase or stimbiotic. A total of 1,152 one-day-old male broiler chicks (Ross 308) were divided into 12 treatments, each with 8 pens and 12 birds per pen, for a 21-day study. On d 21, performance parameters were measured, and the ileal energy and organic matter (OM) digestibility and cecal xylanase activity determined. Stimbiotic supplementation improved mFCR compared with all other treatments. There was a treatment by corn variety interaction for body weight (BW), BW gain and coefficient of variation (CV) of BW (P ≤ 0.05). Birds fed corn Variety 1 (highest neutral dietary fiber, protein and soluble arabinoxylan content) supplemented with stimbiotic had the highest BW, while Variety 2 control diet had the lowest. The BW CV in corn Variety 2 was the highest, which improved with stimbiotic supplementation. The BW CV in corn Variety 1 responded better to stimbiotic than xylanase. There were no treatment differences on BW CV in corn Varieties 3 and 4. The lowest OM digestibility was observed in birds fed corn Variety 1 with xylanase, and the highest value was associated with corn Variety 3 with xylanase (highest total arabinoxylan). Xylanase and stimbiotic supplementation increased the endogenous xylanase activity regardless of the corn variety (P ≤ 0.05). Positive correlations between corn fiber contents and phytic acid and the arabinose:xylose ratio were seen, while nonstarch polysaccharide content was negatively correlated with apparent metabolizable energy. In conclusion, corn variety influenced nutrient digestibility and broiler chicken growth. The response to supplementation with xylanase or stimbiotic varied based on the nutritional profile of corn with regards to improvements in digestibility and performance in broiler chickens.

A New Approach to Detecting and Measuring Changes in the Feeding Behaviour Habits of Group-Housed Growing-Finishing Pigs.

The present work aims to estimate the methods of repeatability and of a new non-parametric approach based on typifying individuals into classes and quantifying (%) the pigs in a group that show similar feeding behaviour habits (FBHs) in consecutive periods ("maintenance"). Both methods were estimated over six consecutive 14-day periods in two trials of group-housed growing-finishing pigs (n = 60 each). The first trial started in summer and ended in autumn, and pigs were fed a pelleted diet (HT-P). The second trial started in spring and ended in summer, and the same diet was fed mash (TH-M). The average daily feed intake obtained the lowest repeatability and maintenance values, and it progressively decreased as pigs grew, independent of environmental conditions or physical feed form, whereas the maintenance and repeatability of the number of feeder visits and the visit size decreased when environmental conditions changed from temperate to hot, and mash-fed pigs had higher maintenance and repeatability values for the time spent eating than pellet-fed pigs. In conclusion, the new approach (maintenance) is a tool that is complementary to the classic repeatability concept and is useful for analysing the evolution of FBHs across periods of time at the individual level.

Porcine Digestible Peptides (PDP) in Weanling Diets Regulates the Expression of Genes Involved in Gut Barrier Function, Immune Response and Nutrient Transport in Nursery Pigs.

This study was conducted to investigate the effects of dietary supplementation of porcine digestible peptides (PDP), spray-dried plasma (SDP), or a combination of both, on growth performance and the expression of genes related to intestinal function of weaned pigs. A total of 180 piglets (trial 1) and 198 piglets (trial 2) were used to evaluate the partial substitution of soybean ingredients with 2% SDP or 2% PDP (trial 1), and with 3% SDP or the combination of 1% SDP and 2% PDP (SDP-PDP; trial 2) during the pre-starter period (0-14 days). The gene expression of 56 genes was quantified in a qPCR platform in jejunum and ileum samples obtained from piglets 14 d after weaning (trial 2). Piglets fed SDP, PDP and SDP-PDP had a higher body weight (BW), average daily gain (ADG) and feed efficiency (G:F) than the soybean control on day 14 (p < 0.05). In addition, the combination of SDP and PDP upregulated ten genes in jejunum samples (p < 0.05) related to intestinal function. More research is needed to confirm that gene expression upregulation by PDP in combination with SDP has an impact on intestinal function and to elucidate its underlying mechanisms.

Interrelationships between sex and dietary lysine on growth performance and carcass composition of finishing boars and gilts.

The main goals of this study were to determine whether boars and gilts respond differently to the standardized ileal digestible lysine to net energy ratio (SID Lys:NE) and model the response to optimize growth performance. A total of 780 finishing pigs, 390 boars and 390 gilts [Pietrain NN × (Landrace × Large White)], with an initial individual body weight of 70.4 ± 9.2 for boars and 68.7 ± 8.0 kg for gilts, were used in a 41-d dose-response experiment. Pens (13 pigs per pen) were randomly allocated to a dietary treatment (2.64, 3.05, 3.46, 3.86, 4.27 g SID Lys/Mcal NE) by block and sex, with six replicates per treatment and sex. Two isoenergetic diets (2,460 kcal NE/kg), representing the extreme SID Lys:NE, were formulated and then mixed. Pigs were individually weighed at days 0, 22, and 41, when the experiment finished. The differential effect of SID Lys:NE on growth performance and carcass composition between sexes was analyzed with orthogonal polynomial contrasts to compare the linear and quadratic trends in each sex. In addition, broken-line linear (BLL) models to optimize average daily gain (ADG), including average daily feed intake (ADFI) as a covariate, were fitted when possible. As expected, boars had a greater ADG and feed efficiency (G:F; P < 0.001) than gilts, but there was no evidence of differences in ADFI (P = 0.470). Increasing SID Lys:NE had a greater linear impact on boars ADG (P = 0.087), G:F (P = 0.003), and carcass leanness (P = 0.032). In contrast, gilts showed a greater linear increase in SID Lys intake per kg gain (P < 0.001) and feed cost per kg gain (P = 0.005). The best fitting BLL models showed that boars maximized ADG at 3.63 g SID Lys/Mcal NE [95% confidence interval (CI): (3.32 to 3.94)], although another model with a similar fit, compared with the Bayesian information criterion, reported the optimum at 4.01 g SID Lys/Mcal NE [95% CI: (3.60, 4.42)]. The optimum to maximize ADG for gilts was estimated at 3.10 g SID Lys/Mcal NE [95% CI: (2.74, 3.47)]. Thus, the present study confirmed that boars and gilts have a different linear response to SID Lys:NE, explained by the greater protein deposition potential of boars. Likewise, BLL models indicated that boars require a higher SID Lys:NE to maximize ADG from 70 to 89 kg. These results suggest that split feeding of finishing boars and gilts could be beneficial in terms of both performance and cost return.

Potential risk factors related to pig body weight variability from birth to slaughter in commercial conditions.

The aim of this observational study is to identify risk factors associated with body weight (BW) variability in three data sets (DS) in commercial conditions. A total of 1,009 (DS1), 460 (DS2), and 1304 (DS3) male and female crossbreed pigs (Pietrain × [Landrace × Large White]), respectively, were included in each trial. Pigs were periodically weighed until slaughter. Then, variables such as length of gestation, length of lactation, parity, litter size, sex, birth BW, and ADG were considered. Pigs remaining on the farm after two loads to the slaughterhouse were defined as last group of animals sent to slaughterhouse (LGS). Descriptive statistics of variability were calculated, and a risk analysis approach was used to look for the factors related to LGS. A multiple logistic regression was performed to identify all variables that were significant (P < 0.05). The risk ratio (RR), odds ratio (OR), and population attributable risk (PAR) were calculated for all of the significant variables after transforming all of them into binary factors using the 25th percentile as the cut-off point. Results showed that the major part of the variability (as CV) comes from birth (20% to 25%) and increased only a little during lactation and 14-d post weaning. From this point onwards, CV tended to decrease, as pigs got closer to the marketing weight (down 11.5% to 12.7%). Regarding the indicators selected, RR, OR, and PAR presented similar trends in the three DS studied. Therefore, for the variables finally included, these indicators had their minimum values at the start of the cycle and then gradually increased at the end. Those results, based on an epidemiological approach, suggest that the closer to the end of the cycle the greater the probability for a light piglet of being/becoming LGS. It might be explained by the shorter available time to efficiently implement preventive measures aimed to improve the performance of delayed pigs and, thus, reducing variability.Those results, based on an epidemiological approach, make sense as the probability for a light piglet to be a LGS increases the closer to the end of the cycle, due to the short time to implement preventive measures and increase the performance of delayed pigs and reduce variability. The differential PAR associated with both, the nursery and the growing period, was 1.7% and 1.5% for DS1, 5.1% and 3.1% for DS2, and 3.7% and 2.8% for DS3. For the lactation period, the results were 4.3% for DS2 and 4.5% for DS3. Results suggest that the most critical periods, in relation to retardation of growth in swine, are lactation and nursery. Implementing measures that maintain risk factors under or above thresholds, especially in the initial phases of growth, will reduce the percentage of LGS pigs and positively affect the overall homogeneity of the batch.

Successful liver transplantation despite donor-transmitted ESBL-producing Klebsiella pneumoniae infection: Case report and review of the literature.

Donor-derived bacterial infection is a recognized complication of solid organ transplantation. Patients admitted to the intensive care unit are increasingly exposed to infection with multidrug-resistant microorganisms. However, no specific recommendations are available about their suitability as donors. We report a case of donor-transmitted extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a liver recipient, and review the related literature.

A cause of porto-mesenteric pneumatosis not secondary to intestinal ischemia.

The finding of portal pneumatosis may be related to multiple etiologies such as intestinal inflammatory diseases, intestinal infectious diseases, chemotherapy and radiotherapy treatments or advanced stages of intestinal ischemia. The gold standard for diagnosis is computed tomography, and once the findings are observed, proper differential diagnosis must be asserted to prevent unnecessary laparotomies.

Causa de neumatosis porto-mesentérica no secundaria a isquemia intestinal / A cause of porto-mesenteric pneumatosis not secondary to intestinal ischemia

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Liver dysfunction associated with artificial nutrition in critically ill patients.

INTRODUCTION: Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients. METHODS: We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratio of more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280 IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l. RESULTS: Seven hundred and twenty-five of 3,409 patients received artificial nutrition: 303 received total parenteral nutrition (TPN) and 422 received enteral nutrition (EN). Twenty-three percent of patients developed liver dysfunction: 30% in the TPN group and 18% in the EN group. The univariate analysis showed an association between liver dysfunction and TPN (p < 0.001), Multiple Organ Dysfunction Score on admission (p < 0.001), sepsis (p < 0.001), early use of artificial nutrition (p < 0.03), and malnutrition (p < 0.01). In the multivariate analysis, liver dysfunction was associated with TPN (p < 0.001), sepsis (p < 0.02), early use of artificial nutrition (p < 0.03), and calculated energy requirements of more than 25 kcal/kg per day (p < 0.05). CONCLUSION: TPN, sepsis, and excessive calculated energy requirements appear as risk factors for developing liver dysfunction. Septic critically ill patients should not be fed with excessive caloric amounts, particularly when TPN is employed. Administering artificial nutrition in the first 24 hours after admission seems to have a protective effect.