Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide.

BACKGROUND AND AIMS: In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-h, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS: A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS: The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Addition of crude glycerin to pig diets: sow and litter performance, and metabolic and feed intake regulating hormones.

The continued growth in biofuel production has led to a search for alternative value-added applications of its main by-product, crude glycerin. The surplus glycerin production and a higher cost of feedstuffs have increased the emphasis on evaluating its nutritive value for animal feeding. The aim of this research was to evaluate the effect of the dietary addition of crude glycerin on sow and litter performance, and to determine the serum concentrations of hormones related to energy metabolism and feed intake in sows during gestation and lactation. A total of 63 sows were assigned randomly to one of three dietary treatments, containing 0, 3 or 6% crude glycerin (G0, G3 and G6, respectively) added to a barley-soybean meal-based diet. During gestation, none of the dietary treatments had an effect on performance, while during lactation, glycerin-fed sows consumed less feed than those fed the control diet (3.8 v. 4.2kg DM/day; P=0.007). Although lactating sows fed the G3 diet had a higher BW loss than those fed the control diet (���20.6 v. ���8.7 kg; P=0.002), this difference was not reflected in litter performance. In gestation, the inclusion of glycerin did not affect blood concentrations of insulin or cortisol. However, pregnant sows fed diets supplemented with glycerin showed lower concentrations of acyl-ghrelin and higher concentrations of leptin (���55 and +68%, respectively; P<0.001). In lactating sows, there were no differences between dietary treatments for any of the hormones measured. Pre-prandial acyl-ghrelin concentrations were positively correlated with cortisol concentrations during gestation (r=0.81; P=0.001) and lactation (r=0.61; P=0.015). In conclusion, the inclusion of up to 6% crude glycerin did not affect the performance of sows during the gestation period; however it had a negative effect on the feed intake and weight loss of lactating sows. Moreover, further research is needed to elucidate the potential relationship between glycerin inclusion levels in the diet and the serum concentrations of hormones related to feed intake and energy balance control.

Crude glycerine inclusion in Limousin bull diets: animal performance, carcass characteristics and meat quality.

Three hundred and six Limousin young bulls (7±1months of age, initial body weight 273±43kg) were used to evaluate the effect of crude glycerine supplementation on animal performance, carcass characteristics and meat quality. Animals were assigned to three different diets: Control (0% of crude glycerine), G2 and G4 (2 and 4% of crude glycerine, respectively). The diets were administrated ad libitum for 240days (final body weight 644±24kg). Average daily weight gain, average daily feed intake, the gain:feed ratio, ultrasound measures in vivo, carcass characteristics, pH, water holding capacity, drip losses, and cooking losses were not affected (P>0.05) by diets. Diet decreased C16:0 (P<0.01) and C16:1 (P<0.05) contents in meat. The G4 meat showed lower C12:0, C14:0, C17:0, C18:0, C18:1, C18:2, C18:3, c9,t11-c18:2, C20:0 and C20:4 levels (P<0.05) than control. Glycerine increased desirable fatty acid percentages (P<0.05) in intramuscular fat.

The effects of different thermal treatments and organic acid levels in feed on microbial composition and activity in gastrointestinal tract of broilers.

Thermal treatments of feed and organic acids are known to affect the gastrointestinal microbiota in chickens. The present study evaluated the effect of different thermal processes including pelleting (P), long-term conditioning at 85°C for 3 min (L), expanding at 110°C (E110), and 130°C for 3 to 5 s (E130) as well as organic acid (63.75% formic acid, 25.00% propionic acid, and 11.25% water) inclusion levels (0, 0.75, and 1.5%) on gastrointestinal microbiota in broilers. In total, 960 one-day-old chicks were randomly assigned to 8 replicates using a 3 × 4 factorial arrangement. At d 35, bacterial cell numbers in the crop, ileum, and cecum, and bacterial metabolites in the crop, gizzard, ileum, and cecum were determined. The inclusion of 1.5% organic acids increased cell numbers of all clostridial clusters in the crop. The organic acid supplementation increased the propionic acid concentration in the crop and gizzard and there was a decrease in lactic acid concentration. In the ileum, the 0% organic acid group had the highest numbers of Lactobacillus spp. and enterobacteria. Inclusion of 1.5% organic acids increased ileal acetate concentration. Increasing the feed processing temperature led to an increase of lactobacilli in the crop and ileum, whereas clostridia and enterobacteria seemed unaffected. Similarly, lactate concentrations increased in the ileum, but short-chain fatty acids remained identical. In the crop, an increase for acetate was found for the E130 group compared with all other thermal treatments. In conclusion, our study demonstrated that thermal treatments and organic acid supplementation to broiler diets more markedly influenced the bacterial status of the crop compared with the downstream segments and their effects decreased along the length of gastrointestinal tract. Whereas organic acids markedly modified bacterial composition and activity in the crop, expansion increased lactobacilli and lactate in the crop and ileum.

Effect of crude glycerin on feed manufacturing, growth performance, plasma metabolites, and nutrient digestibility of growing-finishing pigs.

Three experiments were conducted to determine the effects of dietary addition of crude glycerin on pellet production efficiency and to evaluate its effect on growth performance and digestibility in growing-finishing pigs. Three dietary treatments were created by addition of 0, 2.5, or 5% crude glycerin to barley-soybean meal-based diet, and 4 batches of each dietary treatment (2 each for grower and finisher diets) were prepared. In the manufacturing process, crude glycerin supplementation linearly increased the feeder speed and production rate (P < 0.05), resulting in a 20 to 29% improvement in the feed production rate compared with the control. Production efficiency (kg/kWh) increased linearly (P < 0.05) as the level of crude glycerin in feed increased. A growth experiment was performed with 240 barrows (30 ± 1 kg initial BW) using a 2-phase feeding program over a 12-wk period with 4 pens per treatment and 20 pigs per pen. On the last day of the growth experiment, blood samples were collected to determine circulating glucose, fructosamine, and IGF-1 concentrations. Overall growth performance was not affected (P > 0.05) by dietary treatment, and there was no effect (P > 0.05) of dietary treatment on any plasma metabolite measured. A digestibility experiment involving 9 male pigs housed in metabolic cages was used to determine the coefficients of apparent fecal digestibility and N and mineral balances. Pigs were assigned to 1 of the 3 diets in each feeding period using a 3 × 3 Latin square arrangement of treatments (43 ± 3 and 74 ± 3 kg initial BW in the growing and finishing periods, respectively). In both feeding periods, fecal digestibility of OM and ether extract were affected by dietary treatment, increasing linearly (P < 0.05) with increasing crude glycerin levels. However, neither CP digestibility nor N retention was affected by the glycerin content in either the growing or finishing period. Digestibilities and balance of Ca and P showed opposite tendencies with the variations in crude glycerin content, which either decreased or increased depending on the feeding period. In conclusion, adding crude glycerin to the diet before pelleting improved feed mill production efficiency. The addition of crude glycerin up to 5% in the diet of growing-finishing pigs had no effect on growth performance, blood metabolites, nutrient digestibility, and N balance, but more studies are needed to determine how crude glycerin affects mineral metabolism and balance.