Partial replacement of soybean meal with full-fat black soldier fly larvae meal in plant-based nursery diets did not influence fecal Escherichia coli colony forming units or improve fecal consistency when pigs were weaned into non-disinfected pens.

At weaning, one hundred pigs (21 d of age; 6.96 ±â€…0.23 kg BW) were used to determine the effect of partially replacing soybean meal (SBM) in corn- and SBM-based nursery diets on growth performance, fecal scores, Escherichia coli (E. coli) colony forming units (CFU), and cecal mucosal microbial profile when weaned into non-disinfected nursery pens. Pens were randomly assigned to one of four dietary treatments (n = 5): high-complexity (contained highly digestible animal proteins and 10.8% SBM) with and without 3,000 ppm ZnO (HC + and HC-, respectively; representative of commercial diets), low-complexity (corn- and SBM-based; 31.8% SBM; LC), or LC with 30% inclusion of full-fat black soldier fly larvae meal (BSFLM) to partially replace SBM (LCFL; 8.0% SBM). Diets were fed for 14 d (phase I), followed by 4 wk of a common corn-SBM diet (phase II). Fecal E. coli CFU and cecal mucosal microbial 16s rRNA community profiles were assessed 7 d after weaning. During phase I, pigs fed LC and LCFL had lower average daily gains (P < 0.05) than pigs fed HC + and HC-, which were not different. Average daily feed intake was not different for pigs fed LC and LCFL, but lower than for pigs fed HC- (P < 0.001); pigs fed HC + had greater feed intake in phase I vs. all other treatment groups (P < 0.001). Upon nursery exit, only pigs fed LCFL had lower BW than pigs fed HC- (P < 0.05), with intermediate values observed for HC + and LC. Day 3 fecal scores were greater for pigs fed LCFL vs. HC + (P < 0.05) and day 7 E. coli CFU were greater for all treatment groups vs. HC + (P < 0.001). Pigs fed HC- (P < 0.01), LC (P < 0.05), and LCFL (P < 0.05) had lower alpha diversity for cecal mucosal microbiota compared to HC+. At the genus level, pigs fed LC had lower Lactobacillus relative abundance vs. pigs fed HC + (P < 0.01). Therefore, BSFLM can partially replace SBM without sacrificing growth performance vs. nursery pigs fed corn- and SBM-based diets, but both groups had reduced phase I growth performance vs. pigs fed highly digestible diets containing animal proteins when weaned into non-disinfected pens. The BSFLM did not influence fecal E. coli CFU or improve fecal consistency after weaning and therefore, is less effective at minimizing digestive upsets vs. HC + diets.

The anti-aging protein alpha-Klotho in systemic sclerosis patients: does a relationship to telangiectasia exist?

OBJECTIVE: The anti-aging protein alpha-Klotho has been reported to have an emerging role in the pathogenesis of systemic sclerosis (SSc). More studies are needed to approach this issue. This study aimed to assess the serum levels of α­Klotho in SSc patients compared to healthy controls, and to correlate them with the disease parameters. METHODS: Forty-two SSc patients were included in this study. History taking, clinical examination, and related investigations were performed. The modified Rodnan skin score (mRss) was used to assess skin tightness in SSc patients. Twenty-seven age- and sex-matched healthy participants served as controls. Serum α­Klotho was assessed in the two groups. RESULTS: SSc patients comprised 39 females and 3 males; mean age was 42.2 ± 12.1 years and mean disease duration 8.5 ± 6.3 years. Serum α­Klotho levels were decreased in scleroderma patients in comparison to healthy controls (p < 0.001). Scleroderma patients who had higher frequencies of telangiectasias and digital ischemic lesions had higher serum α­Klotho levels (p = 0.01 and p = 0.04, respectively). By simple regression, only telangiectasias were significantly associated with higher α­Klotho levels (p = 0.01). No other significant relationships were found between serum α­Klotho and SSc disease parameters. CONCLUSION: Scleroderma patients had significantly lower serum α­Klotho levels than healthy controls. Higher α­Klotho levels were significantly associated with telangiectasias. An imbalance in serum α­Klotho levels may be involved in systemic sclerosis. Further longitudinal studies in a larger population of systemic sclerosis patients may provide a clearer clue for its role.

Teaching the teacher: An ethical model for international surgical missions.

Concerns linger about how to provide equitable global health care and how to address the great unmet health care needs in many countries. The burden of outreach mostly falls on universities. Universities and educational institutions by design are capable of defining the necessary directions for change. The challenge for universities participating in global health care and education is creating and sustaining robust health systems tailored to each community by evaluating the existing system and taking note of stakeholders, opinion leaders, and the availability of sustained resources in the milieu of the rapidly changing global health care structures.4 The model described here is rooted in educational theory and based on the belief that sharing surgical knowledge is the most effective way to improve access to necessary care for underserved patient populations. Positive changes can be made by developing relationships among health care personnel and new approaches to educational problems. This positive outcome was largely due to the development of new attitudes by professionals and their approach to education and collaboration. Development of a systemic approach to global health care problems is a daunting task. The solution is neither simple nor easy, and the active participation of the assisted party is highly encouraged. *

Endoscopic identification of the jejunum facilitates minimally invasive jejunostomy tube insertion in selected cases.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG), direct percutaneous endoscopic jejunostomy, and laparoscopic feeding tube insertion are established techniques for placing a feeding tube. However, these techniques may be difficult or contraindicated after previous gastric or upper abdominal surgery. METHODS: A total of 10 patients underwent minimally invasive jejunostomy tube insertion via endoscopic identification of the jejunum. The indications for the procedure were dysphagia, poor nutritional status, prolonged intensive care unit (ICU) admission, and gastroparesis. Eight of the patients had undergone previous upper abdominal surgeries and were rejected for either PEG or direct percutaneous jejunostomy. With the patients under general anesthesia, esophagogastroduodenoscopy was performed. The jejunum was identified and intubated. A small abdominal incision (1 in.) was made. The proximal jejunum was identified easily by the light and digital palpation of the endoscope. The jejunum was delivered in the wound, and the jejunostomy tube was inserted using Witzel's technique. The wound was closed. RESULTS: All the patients tolerated the procedure well. The mean time for the procedure was 29 +/- 13 min. There was no mortality related to the procedure and no complications. Jejunal feeding started on the first postoperative day. CONCLUSION: The use of intraoperative endoscopy facilitated identification of the jejunum. Easy, safe, and quick, the procedure saved the patient a formal laparotomy and extensive manipulation.

The lateral paramedian: revisiting a forgotten incision.

Incisional hernia is a potential complication of all abdominal incisions and still remains a significant problem financially and medically. Presently, there is a lack of general consensus among surgeons in regard to the optimal treatment. The midline incision is the most common used abdominal incision and it carries a high incidence of incisional hernia (up to 15%). The paramedian incision was known to lead to a small incidence of incisional hernias. This discussion is meant to bring the paramedian incision back to the picture as a hope to decrease the incidence of incisional hernia.

Erythropoietin-induced deep vein thrombosis in myelodysplastic syndrome.

We report a rare case of deep vein thrombosis (DVT) secondary to erythropoietin (EPO) in an 89-year-old patient with myelodysplastic syndrome (MDS). The incidence of EPO-induced thrombotic episode increases with an absolute increase of hemoglobin (Hb) beyond >12 gm/dL or rate of increase of Hb level >1 gm/dL every 2 weeks.

Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance.

Most intra-abdominal and other types of fluid collections are now successfully drained percutaneously under image guidance. The utility of percutaneous drainage of tuberculous abscesses, especially those associated with osseous changes, is, however, less well established. Six patients with tuberculous iliopsoas abscesses were successfully managed by percutaneous drainage combined with antituberculous therapy. The abscesses were bilateral in one patient and unilateral in the other five. Drainage was by needle aspiration under ultrasound (US) guidance in one patient, and by catheter under CT guidance in the other patients. Three patients had associated osseous changes. There were no procedural complications. Tuberculous iliopsoas abscess can be successfully treated by percutaneous drainage and appropriate antituberculous therapy.