Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study.

BACKGROUND: Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. METHOD: A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. RESULTS: The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). CONCLUSION: In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.

Sn2+ Doping: A Strategy for Tuning of Fe3O4 Nanoparticles Magnetization Dipping Temperature/Amplitude, Irreversibility, and Curie Point.

Doped magnetite (SnxFe3-2/3xO4) nanoparticles (NPs) (12-50 nm) with different amount of Sn2+ ions (x) were synthesized using co-precipitation method. Sn2+ doping reduces the anticipated oxidation of Fe3O4 NPs to maghemite (γ-Fe2O3), making them attractive in several magnetic applications. Detailed characterizations during heating-cooling cycles revealed the possibility of tuning the unusual observed magnetization dipping temperature/amplitude, irreversibility, and Curie point of these NPs. We attribute this dip to the chemical reduction of γ-Fe2O3 at the NPs surfaces. Along with an increase in the dipping temperature, we found that doping with Sn2+ reduces the dipping amplitude, until it approximately disappears when x = 0.150. Based on the core-shell structure of these NPs, a phenomenological expression that combines both modified Bloch law (M = M0[1 - γ(T/TC)]ß) and a modified Curie-Weiss law (M = - α[1/(T - TC)δ]) is developed in order to explain the observed M-T behavior at different applied external magnetic fields and for different Sn2+ concentrations. By applying high enough magnetic field, the value of the parameters γ and δ ≈ 1 which are the same in modified Bloch and Curie-Weiss laws. They do not change with the magnetic field and depend only on the material structure and size. The power ß for high magnetic field was 2.6 which is as expected for this size of nanoparticles with the core dominated magnetization. However, the ß value fluctuates between 3 and 10 for small magnetic fields indicating an extra magnetic contribution from the shell structure presented by Curie-Weiss term. The parameter (α) has a very small value and it turns to negative values for high magnetic fields.

Salt creeping as a self-amplifying crystallization process.

Salt creeping is a ubiquitous phenomenon in which crystals precipitate far from an evaporating salt solution boundary, which constitutes a major problem in outdoor electronics, civil engineering, artworks, and agriculture. We report a novel experimental approach that allows to quantitatively describe the creeping mechanism and demonstrate its universality with respect to different salts. We show that there exists a critical contact angle below which salt creeping occurs, provided also the nucleation of multiple crystals is favored. The precipitation of new crystals happens ahead of the contact line by the meniscus that progressively advances over the crystals forming also nanometric precursor films. This enlarges the evaporative area, causing an exponential increase in the crystal mass in time. The self-amplifying process then results in a spectacular three-dimensional crystal network at macroscopic distances from the solution reservoir. These findings also allow us to control the creeping by using crystallization modifiers.

Transcriptome analysis of embryonic domains in Norway spruce reveals potential regulators of suspensor cell death.

The terminal differentiation and elimination of the embryo-suspensor is the earliest manifestation of programmed cell death (PCD) during plant ontogenesis. Molecular regulation of suspensor PCD remains poorly understood. Norway spruce (Picea abies) embryos provide a powerful model for studying embryo development because of their large size, sequenced genome, and the possibility to obtain a large number of embryos at a specific developmental stage through somatic embryogenesis. Here, we have carried out global gene expression analysis of the Norway spruce embryo-suspensor versus embryonal mass (a gymnosperm analogue of embryo proper) using RNA sequencing. We have identified that suspensors have enhanced expression of the NAC domain-containing transcription factors, XND1 and ANAC075, previously shown to be involved in the initiation of developmental PCD in Arabidiopsis. The analysis has also revealed enhanced expression of Norway spruce homologues of the known executioners of both developmental and stress-induced cell deaths, such as metacaspase 9 (MC9), cysteine endopeptidase-1 (CEP1) and ribonuclease 3 (RNS3). Interestingly, a spruce homologue of bax inhibitor-1 (PaBI-1, for Picea abies BI-1), an evolutionarily conserved cell death suppressor, was likewise up-regulated in the embryo-suspensor. Since Arabidopsis BI-1 so far has been implicated only in the endoplasmic reticulum (ER)-stress induced cell death, we investigated its role in embryogenesis and suspensor PCD using RNA interference (RNAi). We have found that PaBI-1-deficient lines formed a large number of abnormal embryos with suppressed suspensor elongation and disturbed polarity. Cytochemical staining of suspensor cells has revealed that PaBI-1 deficiency suppresses vacuolar cell death and induces necrotic type of cell death previously shown to compromise embryo development. This study demonstrates that a large number of cell-death components are conserved between angiosperms and gymnosperms and establishes a new role for BI-1 in the progression of vacuolar cell death.

Enfermedad de Crohn ileal. Reporte de un caso / Ileal Crohn's Disease. A case report

El término Enfermedad Inflamatoria Intestinal (EII) incluye a un grupo de entidades clínicas que se caracterizan por ser procesos inflamatorios crónicos de etiología desconocida, y afectar primordialmente, aunque no de forma exclusiva, al intestino. Actualmente se reconocen varias entidades que se engloban en este concepto: Colitis Ulcerosa (CU), Enfermedad de Crohn (EC), Colitis Inclasificada (CI), Colitis Microscópica (CM) y Reservoritis (Pouchitis). La Enfermedad de Crohn puede afectar a cualquier tramo del intestino, siendo la localización más frecuente la Ileal y Colónica en forma simultánea. El proceso inflamatorio en la EC es transmural y sus síntomas fundamentales son la diarrea generalmente crónica y/o el dolor abdominal. Presentamos el caso de una mujer joven con una EC que compromete exclusivamente al ileon terminal, en la que se realizó el diagnóstico de EC ileal por la clínica, la endoscopía y la anatomía patológica, que respondió satisfactoriamente a la terapéutica instaurada, y se revisa el concepto de la EC con énfasis en su diagnóstico.

The term Inflammatory Bowel Disease (IBD) includes a group of clinical entities that are characterized by chronic inflammatory processes of unknown etiology, and primarily, but not exclusively, affecting the intestine. Currently, several entities are included in this concept: Ulcerative Colitis (UC), Crohn's Disease (CD), Unclassified Colitis (UC), Microscopic Colitis (CM) and Reservoritis (Pouchitis). Crohn's Disease can affect any part of the intestine, with the most frequent location being ileal and colonic simultaneously. The inflammatory process in CD is transmural and its fundamental symptoms are usually chronic diarrhea and/or abdominal pain. We present the case of a young woman with a CD that exclusively compromises the terminal Ileon, in whom the diagnosis of ileal CD was performed with the clinical data, the endoscopic procedure and the pathological study, who responded satisfactorily to the established therapy, and the concept of CD with an emphasis on its diagnosis is reviewed.

Influence of Atomic Hydrogen, Band Bending, and Defects in the Top Few Nanometers of Hydrothermally Prepared Zinc Oxide Nanorods.

We report on the surface, sub-surface (top few nanometers) and bulk properties of hydrothermally grown zinc oxide (ZnO) nanorods (NRs) prior to and after hydrogen treatment. Upon treating with atomic hydrogen (H*), upward and downward band bending is observed depending on the availability of molecular H2O within the structure of the NRs. In the absence of H2O, the H* treatment demonstrated a cleaning effect of the nanorods, leading to a 0.51 eV upward band bending. In addition, enhancement in the intensity of room temperature photoluminescence (PL) signals due to the creation of new surface defects could be observed. The defects enhanced the visible light activity of the ZnO NRs which were subsequently used to photocatalytically degrade aqueous phenol under simulated sunlight. On the contrary, in the presence of H2O, H* treatment created an electronic accumulation layer inducing downward band bending of 0.45 eV (~1/7th of the bulk ZnO band gap) along with the weakening of the defect signals as observed from room temperature photoluminescence spectra. The results suggest a plausible way of tailoring the band bending and defects of the ZnO NRs through control of H2O/H* species.

Self-organization of gold nanoparticles on silanated surfaces.

The self-organization of monolayer gold nanoparticles (AuNPs) on 3-aminopropyltriethoxysilane (APTES)-functionalized glass substrate is reported. The orientation of APTES molecules on glass substrates plays an important role in the interaction between AuNPs and APTES molecules on the glass substrates. Different orientations of APTES affect the self-organization of AuNps on APTES-functionalized glass substrates. The as grown monolayers and films annealed in ultrahigh vacuum and air (600 °C) were studied by water contact angle measurements, atomic force microscopy, X-ray photoelectron spectroscopy, UV-visible spectroscopy and ultraviolet photoelectron spectroscopy. Results of this study are fundamentally important and also can be applied for designing and modelling of surface plasmon resonance based sensor applications.

Supplementation of direct-fed microbials as an alternative to antibiotic on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens.

An experiment was conducted to investigate the supplementation of direct-fed microbials (DFM) as an alternative to antibiotics on growth performance, immune response, cecal microbial population, and ileal morphology of broiler chickens. A total of 800 one-day-old male broiler chicks (Ross × Ross) were randomly allotted to 4 dietary treatments with 4 replicate pens per treatment (50 birds/replicate pen). The 4 dietary treatments fed for 35 d were a corn-soybean meal basal diet (control); control plus 0.1% virginiamycin, as an antibiotic growth promoter (AGP); control plus 0.1% direct-fed microbials that contained Lactobacillus reuteri (DFM 1); and control plus 0.1% direct-fed microbials that contained a mixture of L. reuteri, Bacillus subtilis, and Saccharomyces cerevisiae (DFM 2). Results showed that dietary AGP and DFM supplementation significantly increased (P < 0.05) the BW gain of broilers during 0 to 21 d. The feed intake was reduced, whereas the feed conversion was improved significantly when birds were fed DFM 2 at 0 to 7 d of age. The white blood cell and monocyte levels were significantly higher in the DFM 2 group compared with the control. In addition, feeding DFM significantly (P < 0.05) increased the plasma immunoglobulin levels where a higher level was observed in DFM 2 compared with those of the other treatments. Neither DFM nor AGP treatments affected the cecal Lactobacillus and Salmonella content; however, cecal Escherichia coli content significantly decreased in broiler chickens fed DFM and AGP. The ileal villus height, and width and total thickness of muscularis externa were significantly increased when birds were fed DFM compared with AGP and control. These results indicate that the dietary supplementation of DFM increases the growth performance of birds at an early age, stimulates the immune response, decreases the number of E. coli, and improves the ileal morphology of broiler chickens. Thus, DFM that contained a mixture of several beneficial microorganisms could be a viable alternative to antibiotics in the broiler diets.

Influence of feeding increasing levels of dry corn distillers grains plus solubles in whole corn grain-based finishing diets on total tract digestion, nutrient balance, and excretion in beef steers.

Four crossbred steers (average BW = 478 ± 33 kg) were used in a 4 × 4 Latin square design to determine the effects of dietary concentration of dry corn distillers grains plus solubles (DDGS) in whole corn-based finishing diets on total tract digestion and nutrient balance and excretion. The DDGS were fed at 0% (control), 16.7%, 33.3%, and 50% of dietary DM. All diets contained 10% (DM basis) alfalfa/grass haylage and were formulated to meet or exceed the estimated requirements for CP. Steers were fed the experimental diets ad libitum for a 14-d adaptation period followed by a 5-d period for fecal and urine collection. Increasing concentration of DDGS in diets from 0 to 50% of DM linearly decreased (P < 0.05) total tract DM and starch digestibility (from 77.8 to 72.9%, and 89.2 to 81.5%, respectively). Daily N and P intakes linearly increased (P = 0.06 and P = 0.01, respectively) with increasing DDGS concentration. Fecal and urinary N, P, S, Mg, and K excretion linearly increased (P < 0.05) with increasing DDGS concentration; however, Se and Na excretion did not differ (P > 0.38) among treatments. Retention (g/d; intake minus urinary and fecal excretion) of N did not differ (P > 0.16) among treatments. Retention of P tended (P = 0.07) to linearly increase and retention of S (g/d) linearly increased (P = 0.004), with increasing DDGS concentration. There were no effects (P > 0.16) of dietary treatment on digestion and retention of Se, Mg, K, and Na. Plasma P and S concentrations increased (P = 0.03 and 0.01, respectively) with increasing DDGS concentration. These data indicate that feeding DDGS up to 50% of dietary DM in whole corn grain-based finishing diets does not have a negative effect on nutrient retention but decreases digestibility. Total excretion of N, P, Ca, Mg, S, and K increased as DDGS concentration increased.

miRNA-214 modulates radiotherapy response of non-small cell lung cancer cells through regulation of p38MAPK, apoptosis and senescence.

BACKGROUND: Radio- and chemotherapy (RT/CT) resistance hampers success in combating small and non-small cell lung cancers (SCLC/NSCLC). The underlying molecular mechanisms of RT/CT resistance of LCs are multifactorial and have been understood in part hitherto. miRNAs, key regulators of mRNAs, are well-recognised oncomirs; however, their role in regulating RT response remains poorly understood. METHODS: Six human NSCLC and five SCLC cell lines with different SF2 values were investigated. Using microarray we examined whether expression of miRNAs is linked to the RT resistance of NSCLCs or SCLCs. Obtained data were validated by quantitative real-time PCR. Apoptosis and senescence were analysed using siRNA transfection, western blot and flow cytometry. RESULTS: miRNA-21, miRNA-1827, miRNA-214, miRNA-339-5p, miRNA-625, miRNA-768-3p, miRNA-523-3p, miRNA-1227, miRNA-324-5p, miRNA-423-3p, miRNA-1301 and miRNA-1249 are differentially expressed in LC cells. miRNA-214 is upregulated in RT-resistant NSCLC cells relative to radiosensitive counterparts. Considering miRNA-214 as a putative regulator of RT resistance, we demonstrate that knockdown of miRNA-214 in radioresistant NSCLCs sensitised them to RT by stimulation of senescence. Consistently, overexpression of miRNA-214 in radiosensitive NSCLCs protected against RT-induced apoptosis. Protection was mediated by p38MAPK, as downregulation of this kinase could reverse the miRNA-214 overexpression-induced resistance of NSCLC cells. CONCLUSION: miRNA profiling of LC revealed putative RT resistance signalling circuits, which might help in sensitisation of LC to RT.

Impact of ethnic variation and residential segregation on long-term survival following myocardial perfusion SPECT.

BACKGROUND: Ethnic characteristics of a neighborhood may impact upon all-cause mortality (ACM). It is not known whether this consideration remains a risk modifier among those being evaluated for CAD. METHODS: 6,477 pts (60 ± 13 years, male 38%) residing in NYC with normal or abnormal stress SPECT studies were assessed for ACM during a mean follow-up of 9 ± 3.8 years. Baseline CAD risk factors and ethnic characteristics of patient neighborhoods were considered. Zip-codes with >70% of one ethnicity was considered to be predominant of that ethnicity. RESULTS: There were 573 (20%) Hispanics (HS), 765 (27%) African-Americans (AA), and 250 (30%) Caucasians (CC) residing in areas >70% of their own ethnicity. Compared to CC, the risk for ACM was lower in HS (hazard ratio (HR) 0.68, 95% CI 0.57-0.8, P < .0001) and similar among AA (HR 1.1, 95% CI 0.95-1.41, P = .2). Among HS, there was a lower ACM among those residing in HS areas compared to those residing in a non-HS areas (HR 0.7 95% CI 0.56-0.9, P = .03) despite a lower median household income ($27,838 ± 3,328 vs $37,751 ± 17,036; P < .0001). This survival difference was not seen in CC and AA. CONCLUSION: Among patients referred for nuclear SPECT studies for suspected CAD, HS ethnicity was an independent predictor of a favorable prognosis. Among HS, the ethnic characteristic of patients' neighborhoods was an independent predictor of ACM. These results imply that ethnic social support is a potentially powerful modifier of patient outcomes among certain patient groups.

Anti-EGFR (cetuximab) combined with irinotecan for treatment of elderly patients with metastatic colorectal cancer (mCRC).

PURPOSE: This study was conducted to test the efficacy and toxicity of cetuximab and irinotecan as a biweekly regimen in treatment of elderly patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: Forty-nine elderly patients (≥65 years) with mCRC who progressed after at least one previous line of treatment were enrolled into this study from May 2008 to January 2011. All recruited patients received cetuximab 500 mg/m(2) and irinotecan 180 mg/m(2) every 2 weeks. RESULTS: Thirty-seven patients (76 %) were men, and 76 % of patients had colonic cancer in origin. Median age was 69 years. Median overall survival time was 7 months, and median progression-free survival was 4 months. Grade 3-4 skin rash occurred in 20 % of patients, grade 3-4 diarrhea in 18 % of patients, and neutropenia in 28 % of patients. CONCLUSION: Cetuximab combined with irinotecan when administered biweekly is safe and effective for treatment of pretreated elderly patients with mCRC.

Effect of dietary zinc proteinate supplementation on growth performance, and skin and meat quality of male and female broiler chicks.

1. An experiment was conducted to evaluate the effect of dietary zinc proteinate (ZP) supplementation on growth performance and on skin and meat quality of male and female broiler chicks. 2. A total of 240 1-d-old male and 240 1-d-old female broiler chicks were randomly distributed into 24 floor pens (12 replicate pens/sex; 20 birds/pen) and were given either 0 (Control diet) or 40 mg/kg ZP (ZP 40), resulting in a 2 × 2 factorial arrangement of treatments. 3. The growth performance of male and female broiler chicks was not affected by the ZP supplementation, but the males showed significantly higher growth performance than did females. 4. ZP supplementation increased the total thickness of skin in both sexes, and males had thicker skin than females. It also increased the collagen content of skin, but not that of meat. Males had higher skin collagen contents than did females, but no sex difference was found in the meat collagen contents. 5. ZP supplementation did not affect the shear force values of skin and meat; however, males had higher shear force values of back skin than females. ZP supplementation increased the zinc contents of thigh meat and plasma in both sexes. Males had higher zinc contents in back skin than females. 6. It is concluded that dietary ZP supplementation could increase the skin quality of broiler chicks in both sexes, particularly in female broilers, without any effect on growth performance. Male broilers have better growth performance and skin quality than females.

Effect of heating system using a geothermal heat pump on the production performance and housing environment of broiler chickens.

A geothermal heat pump (GHP) is a potential heat source for the economic heating of broiler houses with optimum production performance. An investigation was conducted to evaluate the effect of a heating system using a GHP on production performance and housing environment of broiler chickens. A comparative analysis was also performed between the GHP system and a conventional heating system that used diesel for fuel. In total, 34,000 one-day-old straight run broiler chicks were assigned to 2 broiler houses with 5 replicates in each (3,400 birds/replicate pen) for 35 d. Oxygen(,) CO(2), and NH(3) concentrations in the broiler house, energy consumption and cost of heating, and production performance of broilers were evaluated. Results showed that the final BW gain significantly (P < 0.05) increased when chicks were reared in the GHP broiler house compared with that of chicks reared in the conventional broiler house (1.73 vs. 1.62 kg/bird). The heating system did not affect the mortality of chicks during the first 4 wk of the experimental period, but the mortality markedly increased in the conventional broiler house during the last wk of the experiment. Oxygen content in the broiler house during the experimental period was not affected by the heating system, but the CO(2) and NH(3) contents significantly increased (P < 0.05) in the conventional broiler house compared with those in the GHP house. Fuel consumption was significantly reduced (P < 0.05) and electricity consumption significantly increased (P < 0.05) in the GHP house compared with the consumption in the conventional house during the experiment. The total energy cost of heating the GHP house was significantly lower (P < 0.05) compared with that of the conventional house. It is concluded that a GHP system could increase the production performance of broiler chicks due to increased inside air quality of the broiler house. The GHP system had lower CO(2) and NH(3) emissions with lower energy cost than the conventional heating system for broiler chickens.

Effect of sex and dietary organic zinc on growth performance, carcass traits, tissue mineral content, and blood parameters of broiler chickens.

Zinc (Zn) is an essential mineral for animal development and function. A study was carried out to evaluate the effect of sex and dietary organic zinc (OZ) on growth performance, carcass traits, tissue mineral content, and blood parameters of broiler chickens. A total of 240 1-day-old male and 240 female broiler chicks (Cobb × Cobb) were assigned to two dietary levels of OZ (2 × 2 factorial) with six replicates per treatment (20 birds/replicate pen). The OZ supplementation levels were 0 and 25 ppm. Results showed that OZ supplementation did not affect the growth performance of male and female broilers, but the males showed significantly better (P < 0.05) growth performance than females did. Similarly, OZ supplementation did not affect the thickness of both the back and thigh skin of male and female broilers; however, males had thicker skin than females. Dietary OZ supplementation did not affect collagen contents in the skin and meat samples. Male broilers had higher skin collagen contents than females, but no sex difference was found in meat collagen contents. OZ supplementation did not affect the shear force values of skin and meat samples. Male broilers had higher shear force values of back skin than females, but not in the meat samples. Dietary OZ supplementation increased (P < 0.05) the thigh meat Zn content in both sexes. The plasma Ca content was significantly (P < 0.05) increased by dietary OZ supplementation; however, other blood parameters were not affected by dietary OZ supplementation. Males had higher plasma glucose and cholesterol content than females. It is concluded that dietary OZ supplementation at the level of 25 ppm does not affect the growth performance and skin quality of broiler chickens but increases the Zn content in thigh meat and Ca content in plasma of broiler chickens. Male broilers had better growth performance and skin quality than females.

Bioequivalence assessment of two formulations of ibuprofen.

BACKGROUND: This study assessed the relative bioavailability of two formulations of ibuprofen. The first formulation was Doloraz(®), produced by Al-Razi Pharmaceutical Company, Amman, Jordan. The second forumulation was Brufen(®), manufactured by Boots Company, Nottingham, UK. METHODS AND RESULTS: A prestudy validation of ibuprofen demonstrated long-term stability, freeze-thaw stability, precision, and accuracy. Twenty-four healthy volunteers were enrolled in this study. After overnight fasting, the two formulations (test and reference) of ibuprofen (100 mg ibuprofen/5 mL suspension) were administered as a single dose on two treatment days separated by a one-week washout period. After dosing, serial blood samples were drawn for a period of 14 hours. Serum harvested from the blood samples was analyzed for the presence of ibuprofen by high-pressure liquid chromatography with ultraviolet detection. Pharmacokinetic parameters were determined from serum concentrations for both formulations. The 90% confidence intervals of the ln-transformed test/reference treatment ratios for peak plasma concentration and area under the concentration-time curve (AUC) parameters were found to be within the predetermined acceptable interval of 80%-125% set by the US Food and Drug Administration. CONCLUSION: Analysis of variance for peak plasma concentrations and AUC parameters showed no significant difference between the two formulations and, therefore, Doloraz was considered bioequivalent to Brufen.

Supplementation of graded levels of organic zinc in the diets of female broilers: effects on performance and carcase quality.

Zinc is an essential trace element. The objective of this research was to investigate the effects of various levels of organic zinc (OZ) supplementation on growth performance and carcase quality of female broiler chickens. A total of 3200 1-d-old female broiler chicks were randomly allotted to 16 floor pens with 200 birds per pen. A maize-wheat-soyabean meal basal diet (Control) was formulated and 20 mg/kg OZ (20 OZ), 40 mg/kg OZ (40 OZ), and 80 mg/kg OZ (80 OZ) were added to the basal diet to form 4 dietary treatments with 4 replicates per treatment. The OZ source was zinc proteinate which contained 15% zinc. Results showed no significant difference between the treatments in growth performance. A significant increase in thigh skin epidermis and dermis thickness was shown in the OZ supplementation groups; however, no effect was found on the thickness of back skin epidermis and dermis. Collagen contents in breast and thigh meats were not influenced by OZ supplementation but a significant increase in collagen content was found in the back and thigh skin. This increase in collagen content was significantly greater in the back and thigh skin of OZ 80 than with OZ 20. Shear force value and zinc concentration in skins and meat were not significantly influenced by supplementation with OZ. It is concluded that dietary OZ does not improve growth performance of broilers; however, it could increase skin thickness by increasing collagen content in skin, thereby improving carcase quality.

sRAGE in diabetic and non-diabetic critically ill patients: effects of intensive insulin therapy.

INTRODUCTION: Hyperglycemia represents an independent prognostic factor in critically ill non-diabetic patients but not in those with diabetes. In this context, there is an ongoing debate on the benefit of an intensive insulin therapy, particularly in diabetic patients. We tested the hypothesis that expression of the receptor for advanced glycation end-products (RAGE), an important signal transduction receptor that elicits long-lasting nuclear factor kappa B (NF-κB) activation, may underlie this difference. RAGE expression is regulated by multiple ligands, including high mobility group box-1 (HMGB-1), and is reflected by its released soluble form (sRAGE). METHODS: A predesigned analysis was conducted of prospectively collected samples from 76 hyperglycemic critically ill patients (33 type-2 diabetes, 43 non-diabetes) aged ≥ 18 years with blood glucose of > 6.1 mmol/L enrolled in a randomized controlled trial comparing intensive insulin therapy with conventional insulin therapy. sRAGE and its ligand HMGB-1 together with IL-6, and soluble thrombomodulin (as markers of inflammation and endothelial cell injury, respectively) were evaluated in ICU, at Days 1, 3, 5 and 7. Plasma samples from 18 healthy subjects were used as controls. RESULTS: Both diabetic and non-diabetic hyperglycemic patients showed increased plasma sRAGE, HMGB-1 and soluble thrombomodulin levels at the time of admission to ICU. Plasma IL-6 concentration was only increased in non-diabetic patients. Plasma levels of sRAGE were higher in diabetic compared with non-diabetic patients. Intensive insulin therapy resulted in a significant decrease of sRAGE and thrombomodulin at Day 7, in diabetic but not in non-diabetic patients. Circulating sRAGE levels correlated positively with IL-6 and soluble thrombomodulin levels and inversely with HMGB-1. Multivariate regression analysis demonstrated that sRAGE remains independently correlated with HMGB-1 only in diabetic patients. Neither sRAGE nor any inflammatory markers are associated with mortality. CONCLUSIONS: These findings support the hypothesis that sRAGE release, time-course and response to intensive insulin therapy differ between hyperglycemic diabetic and non-diabetic critically ill patients. Whether this difference underlies the dissimilarity in clinical outcome of hyperglycemia in these two conditions warrants further studies.

Effects of treatment on exercise tolerance, cardiac function, and mortality in heart failure with preserved ejection fraction. A meta-analysis.

OBJECTIVES: We sought to determine whether pharmacologic interventions changed exercise capacity, diastolic function, and mortality in a meta-analysis of trials in heart failure with preserved ejection fraction. BACKGROUND: Treatment strategies for heart failure with preserved ejection fraction remain unproven despite several large-scale trials. METHODS: Trials were included in the systematic review where clear comparisons between trial drug and diuretic or placebo were available. Exercise tolerance was assessed by treadmill time, and changes in diastolic function were quantified by transmitral flow (E/A ratio). The primary outcome was all-cause mortality. Weighted mean differences (MDs) and relative risks (RRs), along with their corresponding 95% confidence intervals (CIs), were computed using random-effects models for continuous and dichotomous variables, respectively. The impact of potential covariates was assessed by meta-regression. RESULTS: Data from 53,878 patients enrolled in 30 published reports were collated, including 18 randomized controlled trials (n = 11,253) and 12 observational studies (n = 42,625). In the randomized controlled trials, exercise tolerance was improved by combined therapy (n = 183; weighted MD = 51.5; 95% CI: 27.3 to 75.7; p < 0.001), whereas E/A ratio was not (n = 472; weighted MD = -0.01, 95% CI: -0.02 to 0.02; p = 0.54) even after accounting for baseline E/A (p = 0.87). Over a mean follow-up of 18.6 months, all-cause mortality was not improved by therapy in randomized controlled trials (RR: 0.99, 95% CI: 0.92 to 1.06; p = 0.70), despite accounting for baseline ejection fraction (p = 0.72). In observational reports, there was a reduction in all-cause mortality with therapy in the unadjusted analyses (RR: 0.80, 95% CI: 0.66 to 0.97; p = 0.27), but not after adjustment for clinical and demographic data (RR: 0.93, 95% CI: 0.84 to 1.02; p = 0.10). CONCLUSIONS: Pharmacotherapy of heart failure with preserved ejection fraction demonstrates a quantifiable improvement in exercise tolerance but not mortality.

Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial.

BACKGROUND: Nutritional support has been recognized as an essential part of intensive care unit management. However, the appropriate caloric intake for critically ill patients remains ill defined. OBJECTIVE: We examined the effect of permissive underfeeding compared with that of target feeding and of intensive insulin therapy (IIT) compared with that of conventional insulin therapy (CIT) on the outcomes of critically ill patients. DESIGN: This study had a 2 × 2 factorial, randomized, controlled design. Eligible patients were randomly assigned to permissive underfeeding or target feeding groups (caloric goal: 60-70% compared with 90-100% of calculated requirement, respectively) with either IIT or CIT (target blood glucose: 4.4-6.1 compared with 10-11.1 mmol/L, respectively). RESULTS: Twenty-eight-day all-cause mortality was 18.3% in the permissive underfeeding group compared with 23.3% in the target feeding group (relative risk: 0.79; 95% CI: 0.48, 1.29; P = 0.34). Hospital mortality was lower in the permissive underfeeding group than in the target group (30.0% compared with 42.5%; relative risk: 0.71; 95% CI: 0.50, 0.99; P = 0.04). No significant differences in outcomes were observed between the IIT and CIT groups. CONCLUSION: In critically ill patients, permissive underfeeding may be associated with lower mortality rates than target feeding. This trial was registered at controlled-trials.com as ISRCTN96294863.