The effect of drying method temperature, collection method, and marker type on apparent ileal amino acid digestibility in 21-day-old broilers fed corn-soybean meal-barley based diet.

For accurate estimation of nutrient digestibility, an ideal drying and sampling method is required to preserve the quality of the digesta. A standard corn-soybean meal (corn-SBM) broiler starter diet was fed from d 0 to 10 before birds were placed on the experimental diets until d 21. One hundred and sixty-eight male Cobb 500 broiler chicks were used to evaluate the effect of two drying methods (freeze-dryer vs. forced air-oven) and two drying temperatures (40 vs. 55°C) (Exp 1), while ninety-six chicks were used to evaluate the effect of flushing and squeezing as well as marker types (titanium vs. chromium) on apparent ileal DM, N, Ca, P, and AA digestibility (Exp 2). There were seven (Exp 1) or eight (Exp 2) replicate cages per treatment with 6 birds/cage. Digesta from the distal two thirds of the ileum was obtained from birds following euthanasia on d 21 by squeezing (Exp 1) and squeezing or flushing (Exp 2). Samples collected were stored in the freezer at -20°C until they were either freeze-dried (FD) or oven-dried (OD) at 40 or 55°C. There were no interactions between the drying methods and drying temperatures (Exp 1) on apparent ileal DM, N, and AA digestibility. Met had the highest (92.3%) while Cys had the lowest (73.8%) digestibility value. In Exp 2, no interaction between sampling methods and marker types was observed. The effect of sampling methods was not significant except for Arg and Met where squeezing resulted in higher (P < 0.05) digestibility values. Furthermore, apparent ileal His, Ile, Cys, Ser, and Tyr digestibility tended to be higher (P < 0.1) in squeezed digesta compared to the flushed digesta. Results from these studies showed that OD ileal digesta at 40 or 55°C had no negative effect on apparent ileal AA digestibility. Likewise, marker type did not influence apparent ileal AA digestibility values.

Investigating the effect of dietary calcium levels on ileal endogenous amino acid losses and standardized ileal amino acid digestibility in broilers and laying hens.

Two studies were conducted to evaluate the effect of dietary Ca levels (low, 1% and high, 3%) on ileal endogenous amino acid losses (IEAAL) and standardized ileal amino acid digestibility (SIAAD) in broilers (BR) and laying hens (LH) fed nitrogen-free diets (NFD) and distiller's dried grain with solubles (DDGS)-based diets. A total of 384 male Cobb 500 BR and 288 LH were used in a completely randomized design (CRD) with 16 (BR) or 12 (LH) replicate cages with 6 birds/replicate. IEAAL and apparent ileal digestibility (AID) of AA were analyzed using the GLM procedure of SAS appropriate for a CRD while SIAAD values were analyzed using the GLM procedure of SAS appropriate for a 2 × 2 factorial arrangement of treatments. For BR, IEAAL and N losses (mg/kg of dry matter intake, DMI) were higher (P < 0.05) when NFD with high Ca level was fed (total AA was 39%, N was 35% higher). For most of the AA, AID was higher (P < 0.05) in BR fed DDGS-based diet with high Ca level. High dietary Ca resulted in higher (P < 0.05) SIAAD for all the AA except for Arg, Lys, Met, Cys, and Tyr. For LH, AID of AA was higher (P < 0.05) for the DDGS diet with high Ca level in 13 of the 18 AA evaluated. There was interaction (P < 0.05) between diet Ca level and correction method on LH SIAAD values for Thr, Asp, Gly, and Ser. The SIAAD values for 8 AA were higher (P < 0.05) in birds on high Ca DDGS diet. Correction with low Ca NFD resulted in higher (P < 0.05) SIAAD values for all the AA. Result from this study showed that high Ca increased total IEAAL in BR by 39% but decreased same by 27% in LH. Finally, SIAAD values were increased in BR fed high Ca DDGS-based diet while SIAAD value in LH was lower when correction was done using values from high Ca-NFD fed birds.

Examining the effect of dietary electrolyte balance, energy source, and length of feeding of nitrogen-free diets on ileal endogenous amino acid losses in broilers.

The effect of dietary electrolyte balance (DEB), energy source (ES), and length of feeding of nitrogen-free diet (NFD) on ileal endogenous amino acid (EAA) loss in mg/kg dry matter intake (DMI) was evaluated in broiler chickens. In Experiment 1, 720 chickens consisting of 15 replicate cages with 6 chickens/replicate were used. Treatments were arranged in a 2 × 2 × 2 factorial and consisted of 4 NFD with 2 levels (low or high) of DEB and 2 ES [corn starch (CS) or dextrose (DX)], and 2 sampling time-points (diets were fed for either 72 h (d 16 to 19) or 120 h (d 16 to 21). Experiment 2 used 360 chickens in a 2 × 2 factorial arrangement of treatments with 2 levels (low or high) of DEB and 2 ES (CS or DX). Diets were fed for 72 h (d 18 to 21). All birds had access to feed and water on an ad libitum basis. Data were analyzed using the GLM procedure of SAS appropriate for a completely randomized design for a factorial arrangement of treatments. For Experiment 1, there were interactions (P < 0.05) between the 3 main factors for nitrogen and all the AA except Trp. Broilers that were fed DX-based NFD with high DEB for 72 h had the highest (P < 0.05) EAA losses. In Experiment 2, there was no interaction between DEB and ES except for His and Lys. When ileal EAA losses from birds fed the low DEB, CS-based NFD were used to standardize apparent ileal digestibility values from a previous study, there was no effect of length of feeding on standardized ileal AA digestibility values. In conclusion, DX-based NFD with high DEB increased endogenous AA loses. Despite differences in ileal EAA losses from CS-based NFD, standardized ileal AA digestibility values were not influenced by the length of feeding of NFD. Based on the results from these studies, NFD could be fed for 72 h without influencing SIAAD values.

[Management of organ donation for patients with severe coma due to cerebrovascular stroke]. / Place du don d'organes chez les patients en coma grave à la suite d'un accident vasculaire cérébral.

INTRODUCTION: Organ procurement practices are tending towards the use of older or more borderline donors. In the current context of steadily decreasing availability of traumatic donors, stroke victims make up the majority of donors. In France, where organ procurement activity has stabilized following a period of growth, the possibility of organ donation after a cerebral stroke is variable and uncertain. STATE OF THE ART: Among potential donors--severe coma patients beyond therapeutic possibilities--those who are stroke victims are also those for whom emergency units often initiate the support withdrawal process early, before brain death. Yet the time to the final diagnosis of brain death is also the time necessary for intensive care before organ procurement. Several teams with expert experience in dealing with relatives in these circumstances have demonstrated the steps of the process. PERSPECTIVES: Potential donors can be admitted to intensive care units with the exclusive aim of organ removal. This strategy can be accepted only if the organ donation has a reasonable chance of success. The probability of brain death must therefore be likely and no contraindications found. The key element is open and frank communication with relatives about the severity of brain injury and the lack of therapeutic alternatives. With the relatives, it is recommended to separate the discussion of withdrawal from the question of possible opposition to organ donation. CONCLUSIONS: This approach allows both support for end-of-life patients, and fulfillment of their wishes with regards to organ donation. It enables case-by-case decision-making, after relatives have agreed on transfer to the intensive care unit for organ removal. Thus, each hospital should institute a fully cooperative care procedure where all therapeutic possibilities are evaluated in order to enable the most appropriate therapeutic approach, and, if applicable, organ procurement.

What can microdialysis tell us about the temporal and spatial generation of cytokines in allergen-induced responses in human skin in vivo?

This study examined the suitability of microdialysis to assess the time course of cytokine generation from discrete sites within the skin following intradermal injection of allergen. Cytokines were recovered using two microdialysis probes, one close to the point of allergen injection and the other 1 cm away but within the area of the late-phase induration. Skin biopsies taken at both sites were stained immunocytochemically to investigate possible relationships between cytokine generation, expression of adhesion molecules, and recruitment of neutrophils and eosinophils during the late-phase allergic response. The cytokine response to probe insertion was assessed using a single probe in the opposite arm (control). At baseline, microdialysate contained low levels of IL-1alpha, IL-5, IL-8, IL-12, GM-CSF, and TNFalpha (n=27-33). At control sites, this was followed by increases in IL-6 and IL-8 at 3 and 6 hours. Allergen increased TNFalpha levels in 3/11 individuals within 30 minutes at the injection site. Levels of IL-6 and IL-8 rose rapidly and were significantly greater (P<0.05) than that of controls at 3 and 6 hours at both injection and distant sites. Adhesion molecule expression and leukocyte infiltration were elevated only at the allergen injection site, suggesting a complex relationship between cytokine generation and cellular events in allergic inflammation. In conclusion, microdialysis can be used to distinguish temporal and spatial changes in protein profiles in the skin. Furthermore, when used in conjunction with skin biopsies, it provides novel information about the mechanisms of dermal inflammation.

[Potential advantages a new syringe pump system]. / Avantages potentiels d'un nouveau système de pousse-seringues.

OBJECTIVES: To evaluate what could be the benefit in terms of alarm suppression, of a new syringe pumps system, which allows automatic relay without alarms. PATIENTS AND METHODS: We have prospectively recorded the nature and the mode of relay of all syringe pumps for administration of drugs to patients in two ICU. The perfusion regimen was studied in 61 patients over the complete duration of their stay in two ICU. Alarms were also recorded in one ICU room, over 13 days consecutive. The records were processed off-line with an automatic detection-recognition system in order to assess the origin of each alarm. Accordingly, the amount of alarm corresponding to monitor, ventilator and syringe pumps was computed. RESULTS: We found that syringe pumps, which would provide automatic relays without alarm, would suppress 17% of alarms in ICU and automatize 65% of the relay procedures, which are usually performed often in emergency, on response to the end of perfusion alarm. CONCLUSION: New syringe pumps allow both reduction of alarms in ICU and a better management of nurse workload. Indeed syringe relay can be planned in advance.

The major and a minor class II beta-chain (B-LB ) gene flank the Tapasin gene in the B-F /B-L region of the chicken major histocompatibility complex.

We have identified the major histocompatibility complex class II beta-chain (B-LB) genes present in the B-F/B-L region of the B complex of nine well-characterized lines of chickens and have cleared up much of the confusion concerning numbers and location of B-LB genes in this region. By amplifying DNA sequences between adjacent genes, we found two B-LB genes that lie on either side of Tapasin. The dominantly expressed 'major' B-LB gene in all haplotypes lies between Tapasin and RING-3, and belongs to the B-LBII family of class II beta-chain genes. The poorly expressed 'minor' B-LB gene in all haplotypes lies between B-lec1 and Tapasin, and belongs either to the B-LBII family or to the previously unmapped B-LBVI family of class II beta-chain genes. The data suggest that the B-LBII and B-LBVI genes are two lineages of B-LB genes and we propose that they all be termed B-LB genes. The location of a third B-LB gene in the B12 haplotype (and possibly other haplotypes as well) has yet to be determined. The structural organization and expression of the class II beta-chain genes in the B-F/B-L region is similar to that of chicken class I (B-F) genes, one functional result of which is differential resistance to disease and response to vaccines.

The chicken B locus is a minimal essential major histocompatibility complex.

Here we report the sequence of the region that determines rapid allograft rejection in chickens, the chicken major histocompatibility complex (MHC). This 92-kilobase region of the B locus contains only 19 genes, making the chicken MHC roughly 20-fold smaller than the human MHC. Virtually all the genes have counterparts in the human MHC, defining a minimal essential set of MHC genes conserved over 200 million years of divergence between birds and mammals. They are organized differently, with the class III region genes located outside the class II and class I region genes. The absence of proteasome genes is unexpected and might explain unusual peptide-binding specificities of chicken class I molecules. The presence of putative natural killer receptor gene(s) is unprecedented and might explain the importance of the B locus in the response to the herpes virus responsible for Marek's diseases. The small size and simplicity of the chicken MHC allows co-evolution of genes as haplotypes over considerable periods of time, and makes it possible to study the striking MHC-determined pathogen-specific disease resistance at the molecular level.

[The beginning of anesthesia]. / Les débuts de l'anesthésie.

On October 16, 1846, the first public demonstration of etherization, at the Massachusetts General Hospital, Boston, illustrated the rise of Inhalational Anaesthesia. Pioneers were: Hickman, Wells, Morton, Davy and Long. Anaesthesia was considered an American invention. Thereafter, the development of new molecules (cocaine, hexobarbital) which can be administered by others ways (spinal puncture, intravenous injections) allowed new methods of anaesthesia to be achieved. Thus, three successive periods have illustrated the Story of Anaesthesia: Inhalational Anaesthesia (1844), Local Anaesthesia (1860), Intravenous Anaesthesia (1932).

Creating a bifunctional protein by insertion of beta-lactamase into the maltodextrin-binding protein.

Hybrid proteins were generated by inserting the penicillin-hydrolyzing enzyme, TEM beta-lactamase (Bla), into the maltodextrin-binding protein (MalE). The inserted Bla was functionally accommodated by MalE when it was placed within permissive sites. The maltose binding and penicillinase activities of purified hybrids were indistinguishable from those of the wild-type MalE and Bla proteins. Moreover, these hybrids displayed an additional unexpected property: maltose stabilized the active site of inserted Bla.

[Cancer of the gallbladder. A surgical experience. A propos of 143 cases]. / Le cancer de la vésicule biliaire. Une expérience chirurgicale. A propos de 143 cas.

The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1995 were retrospectively reviewed. Abdominal pain was the most common symptom and was present in 103 patients (72%). Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). Pre-operative diagnosis was made in 40.5% of the patients. Surgical procedures included cholecystectomy alone (16.8%), cholecystectomy with resection of the hepatic bed and lymphadenectomy (11%), cholecystectomy with biliary drainage (57.3%), and exploration with biopsy (14%). Surgery was considered as curative in 21.5% of the patients. Overall five-year survival rate was 11%. Actuarial 5-year survival rate was 100%, 29% and 23% in patients with T1, T2 and T3 tumors. The five-year survival rate was nil in patients with T4 and T5 cancers.

[Coronary artery bypass with extracorporeal circulation in a patient with hemophilia B]. / Pontages coronariens avec circulation extracorporelle chez un patient atteint d'une hémophilie B.

A 64-year-old patient with factor IX deficiency (Christmas disease) underwent quadruple coronary bypass grafting for angina pectoris. Excessive bleeding was prevented by infusion of factor IX concentrates from one day before surgery until the 19th postoperative day. The surgical procedure and the cardiopulmonary bypass were carried out in the same manner as in patients without any haemorrhagic disorder. No haemorrhagic complication occurred, neither during nor after the operation.

Primary carcinoma of the gallbladder--review of 143 cases.

BACKGROUND/AIMS: We reviewed a consecutive series of patients with primary cancer of the gallbladder and looked for specific symptoms, signs, laboratory tests, radiological examinations, operative procedures, operative findings and survival. MATERIAL AND METHODS: The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1990 were retrospectively reviewed. RESULTS: Abdominal pain was the most common symptom and present in 72% of our patients. Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). The pre-operative diagnosis was made in only 28.7 per cent of the cases. Surgical procedures included cholecystectomy alone (24 patients), cholecystectomy and resection of the hepatic bed (17 patients), and exploration with biopsy or bypass (20 patients). Only 21.5% of patients underwent curative surgery. Overall five year survival rate was 11%. For patients whose tumor was limited to the gallbladder wall (T1, T2, T3), the acturial 5-year survival rate was respectively 100%, 29% and 23%. For patients with T4 and T5 tumor, the 5 year survival rate was nil.

[Comparison of effects of aprotinin and tranexamic acid on blood loss in heart surgery]. / Comparaison des effets de l'aprotinine et de l'acide tranexamique sur le saignement en chirurgie cardiaque.

OBJECTIVES: To compare the efficacy of aprotinin (APR) and tranexamic acid (TRA) in reducing blood loss and transfusion requirements after cardiac surgery under extracorporeal circulation (ECC). STUDY DESIGN: Randomized controlled trial. PATIENTS: One hundred and four adults undergoing either coronary artery bypass grafting (CABG) (n = 55), or aortic valve replacement (AVR) (n = 49), allocated into three groups. METHODS: a) APR group (23 CABG and 20 AVR) received aprotinin, 2 x 10(6) KIU (280 mg) after induction, followed by an infusion of 0.5 x 106 KIU.h-1 (70 mg.h-1) until chest closure, with a supplement to the oxygenator prime of 2 x 10(6) KIU; b) TRA group (22 CABG and 19 AVR) received tranexamic acid, 15 mg.kg-1 between the injection of heparin (400 IU.kg-1) and the beginning of ECC, 15 mg.kg-1 after protamin injection (1.3 mg/100 IU of heparin); c) CTR group (10 CABG and 10 AVR), the control group, was not treated with an antifibrinolytic agent. The amount of blood collected from the chest tube drainage was measured at admission to ICU, as well as 4, 8 and 18 h after the insertion of drains and at the time of their removal. Packed red cells where given when the haematocrit was under 20% during ECC, 25% at the end of surgery and 30% after extubation. RESULTS: The blood loss was lower in APR group (834 +/- 448 mL) than in TRA group (1015 +/- 409 mL) (P = 0.009), and in CTR group (1416 +/- 559 ML) (P = 0.004). The rates of transfused patients in groups APR, ATR and CTR were 35, 37 and 60% respectively and the numbers of units administered per patient were 0.8, 0.8 and 1.7 respectively. In AVR cases, APR and TRA had a similar efficacy. In CABG cases, only aprotinin decreased postoperative bleeding. However there was no difference between APR and TRA concerning the transfusion requirements. In CABG cases the ECC was of shorter duration and blood loss was 1127 +/- 540 mL vs 894 +/- 422 mL in AVR cases (P = 0.03). CONCLUSIONS: Both APR and TRA decrease blood loss. APR is more efficient after CABG than TRA as far as blood loss is concerned, whereas the transfusion requirements are similar. As APR is about 100 times more expensive and carries a risk for allergic reactions, its use in a high dose regimen is only recommended for reoperations, in patients treated with salicylates and in case of sepsis.

[Postoperative analgesia after ligamentoplasty of the knee. Comparison of epidural morphine and intravenous nalbuphine]. / Analgésie postopératoire après ligamentoplastie de genou. Comparaison de la morphine péridurale et de la nalbuphine intraveineuse.

Surgery of the anterior cruciate ligament causes severe postoperative pain. This study aimed to compare efficacy and side effects of two postoperative analgesia methods, during 24 hours. Twenty healthy patients were assigned to two groups (n = 10): the patients of the first group were given by an epidural catheter 3 mg of morphine hydrochloride, every twelve hours. The patients of the second group received 2 mg h-1 of intravenous nalbuphine. The degree of pain was studied with a visual analogue scale. After the third postoperative hour, it was significantly higher in the second group, but the nalbuphine dose was low. The incidence of respiratory depression, nausea, pruritus was not statistically different between the groups, but 7/10 patients in the first group suffered of urinary retention (the first micturition was obtained 10.5 hours after the end of surgery in the first group and 5.3 h in the second one). Two patients needed an uretral catheter. These results might tend to show a greater efficactly of epidural morphine, with a higher incidence of urinary side effects.

[Hemodynamic effects of intravenous diltiazem after immediate coronary revascularization]. / Effets hémodynamiques du diltiazem intraveineux au décours immédiat d'une revascularisation coronaire.

Perioperative spasm of the internal mammary artery (IMA) may occur after coronary artery bypass surgery. Diltiazem is often used to prevent it. We studied the haemodynamic tolerance of this drug just after coronary artery bypass surgery, using an intravenous injection of 0.3 mg.kg-1 in 2 minutes. Fifteen patients were studied and the injection was performed less than one hour after the arrival of the patient in the intensive care unit. A reduction in systemic arterial blood pressure and a negative chronotropic effect was observed. There was no significant modification of cardiac output. Diltiazem used in that context has no myocardial depressant effect.

[Early diagnosis of traumatic extra-pericardial luxation of the heart. Value of tomodensitometry. Apropos of a case]. / Diagnostic précoce de la luxation extrapéricardique du coeur d'origine traumatique. Intérêt de la tomodensitométrie. A propos d'un cas.

Heart luxation is a rare complication of chest trauma. The rupture of pericardium must be diagnosed as soon as possible, particularly before prolonged orthopaedic surgery for multitrauma, as a cardiac arrest may occur during anaesthesia. This report underlines the difficulties of diagnosis in a 40-year-old patient with head trauma, chest trauma and multiple fractures. The diagnosis was suspected on unstable blood pressure and left lung atelectasis. The computed tomography showed herniation of the left ventricle. Emergency thoracotomy showed the left rupture of pericardium with complete left heart dislocation. Orthopaedic operation was carried out three days later. Computed tomography in multitrauma patients, seems to be decisive for early diagnosis of heart luxation. Emergency thoracotomy is essential.

[Comparison of the analgesic efficacy of nalbuphine and its combination with propacetamol during the immediate postoperative period in gynecologic-obstetric surgery]. / Comparaison de l'efficacité analgésique de la nalbuphine et de son association au propacétamol en phase postopératoire immédiate de chirurgie gynéco-obstétricale.

This prospective randomized single-blind study compared the efficacy of a combination of propacetamol (2 g) and a low dose of nalbuphine hydrochloride (10 mg) with nalbuphine hydrochloride (20 mg) alone, in a population of 152 white female patients after gynaecologic or obstetrical surgery, for alleviation of postoperative pain in recovery room. The drugs were administered intravenously in case of pain. The population was divided into two groups: group 1 received 20 mg of nalbuphine hydrochloride and group 2 received 2 g of propacetamol combined with 10 mg of nalbuphine hydrochloride. The pain intensity was studied with the visual analogue scale and comparisons use no parametric tests (Mann and Whitney test, Kruskall and Wallis test) and Chi2 test. Groups were similar for age, surgical and anaesthesia procedures and initial pain level. The propacetamol-nalbuphine hydrochloride 10 mg association provided a significantly better analgesia than nalbuphine 20 mg during the first two postoperative hours (p < 0.05). In group 1, the analgesia score decrease was respectively 28 +/- 25 mm (range: 33-75 mm) after 1 h and 31 +/- 25 mm (range: 26-84 mm) after 2 h. In group 2, the decrease was more important: 37 +/- 21 mm (range: 5-84 mm) after 1 h and 42 +/- 23 mm (range: 20-84 mm) after 2 h. Side effects were minimal and similar in both groups (nausea, drowsiness). It is concluded that a propacetamol-nalbuphine hydrochloride 10 mg association provides better analgesia than single dose of 20 mg of nalbuphine. This association convenient analgesia with a decreased dose of nalbuphine.