Effects of a multi-strain Bacillus subtilis-based direct-fed microbial on immunity markers and intestinal morphology in diets fed to weanling pigs.

The objective of this experiment was to evaluate the effects of a multi-strain Bacillus subtilis-based direct-fed microbial (DFM) on nursery pig health as indicated by intestinal mucosal and blood plasma immunological markers and intestinal morphology. Eighty pigs, of equal number of barrows and gilts (initial BW: 7.0 ±â€…0.60 kg), weaned at 21 ±â€…1 d of age were randomly allotted to sixteen pens, with five pigs per pen. Two dietary treatments were implemented, a basal control (CON) and a basal control plus DFM (CDFM). Both diets were corn, soybean meal, and distillers dried grains based and were formulated to meet or exceed all nutritional requirements (NRC, 2012) and manufactured on site. Diets were fed for 42 d. On d 21 and 42 of the experiment, one pig per pen was randomly selected and euthanized, with equal number of males and females represented. Blood samples were collected prior to euthanasia for assessment of plasma concentrations of immunoglobulin A (IgA) and intestinal fatty acid binding protein. Segments of the gastrointestinal tract including duodenum, jejunum, ileum, ascending and distal colon were removed for analysis of intestinal morphology, and levels of interleukin 6, interleukin 10 (IL-10), and tumor necrosis factor alpha. Jejunal villus height was greater in the CDFM pigs as compared with CON pigs (P = 0.02) and ascending colon crypt depth tended to be greater on d 21 (P = 0.10). Compared to CON, CDFM significantly increased overall plasma IgA (P = 0.03) (0.58 vs. 0.73 0.05 mg/mL, respectively), while it tended to increase plasma IgA (P = 0.06) on d 21 (0.34 vs. 0.54 ±â€…0.07 mg/mL, respectively) and tended to increase overall IL-10 (P = 0.10) in the jejunum (113 vs. 195 ±â€…35 pg/mL, respectively). Addition of a multi-strain Bacillus subtilis-based DFM may have an early benefit to nursery pig health status, observed through specific changes in morphology and both systemic and localized immunological markers.

Effects of a multi-strain Bacillus subtilis-based direct-fed microbial on weanling pig growth performance and nutrient digestibility.

A study was conducted to evaluate the effects of a multi-strain Bacillus subtilis-based direct-fed microbial (DFM) on growth performance and apparent nutrient digestibility of nursery pigs. Eighty pigs, of equal number of barrows and gilts (initial body weight: 7.0 ± 0.60 kg), were weaned at 21 ± 1 d and randomly allotted to 1 of the 16 pens, with 5 pigs per pen. Two dietary treatments were implemented, a basal control (CON) and a control plus DFM (CDFM). Both diets were corn, soybean meal, and distillers dried grains based. Diets were fed for 42 d and growth performance measures were recorded weekly. On days 21 and 42 of the experiment, one pig per pen, with equal number of males and females, was randomly selected and euthanized. Digestibility of nitrogen (N), amino acids (AA), and energy were evaluated within the duodenum, jejunum, ileum, and ascending and distal colon. Relative to CON, CDFM tended to increase ADG during week 2 (P = 0.08) and significantly increased ADFI during week 2 (P = 0.04) and week 3 (P = 0.02). In addition, CDFM decreased the gain to feed ratio (G:F) during week 6 relative to CON (P = 0.04). Within the jejunum, pigs fed the DFM had greater digestibility of tryptophan (P = 0.04) and cysteine (P = 0.04) and tended to have greater digestibility of lysine (P = 0.07), methionine (P = 0.06), and threonine (P = 0.08), relative to CON. The content pH in the ascending colon did not differ between CDFM and CON. Compared with CON, apparent total tract digestibility (ATTD) of energy did not differ from CDFM, whereas ATTD of nitrogen of CDFM was lower (P = 0.05). The addition of a multi-strain B. subtilis-based DFM appears to impact growth performance, AA, and N digestibility depending upon the location in the gastrointestinal tract, with primary AA differences occurring within the mid-jejunum.

Expanding the phenotype of CRB2 mutations - A new ciliopathy syndrome?

Recessive CRB2 mutations were recently reported to cause both steroid resistant nephrotic syndrome and prenatal onset ventriculomegaly with kidney disease. We report two Ashkenazi Jewish siblings clinically diagnosed with ciliopathy. Both presented with severe congenital hydrocephalus and mild urinary tract anomalies. One affected sibling also has lung hypoplasia and heart defects. Exome sequencing and further CRB2 analysis revealed that both siblings are compound heterozygotes for CRB2 mutations p.N800K and p.Gly1036Alafs*43, and heterozygous for a deleterious splice variant in the ciliopathy gene TTCB21. CRB2 is a polarity protein which plays a role in ciliogenesis and ciliary function. Biallelic CRB2 mutations in animal models result in phenotypes consistent with ciliopathy. This report expands the phenotype of CRB2 mutations to include lung hypoplasia and uretero-pelvic renal anomalies, and confirms cardiac malformation as a feature. We suggest that CRB2-associated disease is a new ciliopathy syndrome with possible digenic/triallelic inheritance, as observed in other ciliopathies. Clinically, CRB2 should be assessed when ciliopathy is suspected, especially in Ashkenazi Jews, where we found that p.N800K carrier frequency is 1 of 64. Patients harboring CRB2 mutations should be tested for the complete range of ciliopathy manifestations.

Surgically treated humeral shaft fractures following shoulder arthroplasty.

BACKGROUND: We reviewed a consecutive series of patients with a humeral fracture around either an anatomic or a reverse shoulder prosthesis treated with either open reduction and internal fixation (ORIF) or revision shoulder arthroplasty. The purposes of the study were to (1) describe the treatment of these fractures by either method, (2) report the outcomes, and (3) assess the validity of a current classification system. METHODS: Indications for surgery were a displaced unstable fracture, a fracture around a loose humeral stem, or a patient who was unable to tolerate conservative treatment. Outcomes were reported for two groups (patients treated with revision arthroplasty and those treated only with ORIF) and included American Shoulder and Elbow Surgeons (ASES) scores, radiographic evidence of fracture union, and complications. RESULTS: The mean ASES score for the entire cohort was 50.3 (95% confidence interval: 41.2 to 59.5). Thirty-five of the thirty-six fractures healed, in a mean of 7.2 months (range, 3.25 to 13.5 months). Complications occurred in fourteen (39%) of the thirty-six patients. Our ability to classify these fractures with a previously defined system had a low interobserver reliability (mean kappa, 0.37; range, 0.24 to 0.50) and a high intraobserver reliability (mean kappa, 0.69; range, 0.52 to 0.89). CONCLUSIONS: Periprosthetic fracture around a humeral stem implant is a difficult clinical problem involving complex decision-making. Fracture union occurred in 97% of our patients. Complications were frequent, and a reoperation was required in 19% of the patients. More than half of the patients in our study had a loose humeral component that required revision.

Precontoured superior locked plating of distal clavicle fractures: a new strategy.

BACKGROUND: The ideal management of fractures of the distal third of the clavicle remains a topic of debate. Locked plating is a new treatment method but is not yet widely studied. QUESTIONS/PURPOSES: We therefore determined union rates, function, and complications treated with locked plating. PATIENTS AND METHODS: We retrospectively reviewed 20 patients with Neer Type II distal clavicle fractures. All patients were treated with superior locked plating augmented with suture cerclage or screw fixation into the coracoid when there were concerns with screw purchase in the lateral fragment. Union was assessed radiographically and function was reported in terms of American Shoulder and Elbow Surgeons (ASES) scores and motion. Sixteen of 20 patients were followed for a minimum of 1 year; four of the patients with less than 1 year followup were included only for reporting of complications. The 16 patients were followed a minimum of 12 months (average, 30.7 months; range, 13-87 months). RESULTS: Union occurred in 15 of 16 (94%) patients. Average forward elevation and external rotation were 165.6° (range, 115°-180°) and 58.8° (range, 20°-90°), respectively. The average ASES score at the most recent followup was 79.0 (range, 33.3-100). Complications occurred in two patients. One patient developed an infected nonunion and a second patient sustained a peri-implant fracture. CONCLUSIONS: Acute unstable distal clavicle fractures can be treated with superior locking plates with union rates, ASES scores, and ROM that are comparable to similar studies in the literature. The treatment method described allows supplemental fixation such as suture augmentation or a coracoclavicular screw. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Luggage tag technique of anatomic fixation of displaced acromioclavicular joint separations.

UNLABELLED: Acromioclavicular joint dislocations are common injuries in active individuals. Most of these injuries may be treated nonoperatively. However, many techniques have been described when surgical management is warranted. A recent biomechanical study favors anatomic reconstruction of the conoid and trapezoid ligaments and the acromioclavicular joint capsule, as opposed to the traditional technique of excision of the lateral end of clavicle and transfer of the coracoacromial ligament to the intramedullary canal of the distal clavicle. We present a modification of the anatomic fixation technique using a luggage tag method, which places a graft under the base of the coracoid. This procedure has been associated with few redisplacements of the distal clavicle, reliable pain relief, and minimal postoperative morbidity. We found the luggage tag technique provides anatomic fixation of the distal clavicle and restoration of coronal and sagittal plane stability to the injured acromioclavicular joint. This procedure should reduce the possibility of coracoid fracture and decreases the risk of hardware complications associated with reconstruction techniques that violate the base of the coracoid process. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

An in vitro comparison of microleakage between Resilon and gutta-percha with a fluid filtration model.

This investigation compared microleakage of teeth obturated with gutta-percha and teeth obturated with Resilon by using a fluid filtration model. Forty-six human, single-rooted, mandibular premolars were studied. Teeth were randomly assigned to 2 experimental groups of 21 teeth each, designated as group G (gutta-percha) and group R (Resilon). Two control groups, both containing 2 teeth, served as positive and negative controls. Group G, gutta-percha and AH 26 sealer, and group R, Resilon and Epiphany sealer, were obturated by using warm vertical condensation. The specimens were tested for microleakage with an in vitro fluid filtration apparatus at 10 psi at 4 intervals: 1, 7, 30, and 90 days. A two-way repeated measures analysis of variance model with fixed effects for group, time, and group by time interaction was used to analyze microleakage data. This study demonstrated that canals obturated with Resilon and Epiphany sealer leaked statistically less than canals obturated with gutta-percha and AH 26 sealer at day 1 (P < .0014), day 7 (P < .0002), day 30 (P < .0015), and day 90 (P < .0170). The mean fluid microleakage for both group G and group R increased from day 1 to day 90. The results showed that Resilon is a suitable replacement for gutta-percha as a root canal filling material on the basis of its increased resistance to fluid microleakage.