Effect of aflatoxin culture on intestinal function and nutrient loss in laying hens.

The negative effects of aflatoxins (AFLA) on hepatic necrosis and total tract digestibility of energy, N, and amino acids have been well documented. However, the question remains if this is an effect on nutrient metabolizability alone or an effect on the intestine, or both, resulting in increased endogenous nutrient loss or reduced nutrient retention, or both. Therefore, a 2-wk feeding study with a crude AFLA culture was conducted with laying hens to measure endogenous losses and digestive functionality of the intestine. Hy-Line W36 hens were fed 1 of 4 experimental diets containing a crude AFLA culture from 20 to 22 wk of age. Diets were analyzed to contain 0, 0.6, 1.2, or 2.5 mg/kg of AFLA B(1). Dietary AFLA concentration had no effect on BW, egg production, or feed intake. Intestinal crypt depth (but not villus length) increased linearly with increasing AFLA concentration. Similarly, specific activity of the intestinal disaccharidase, maltase, increased quadratically by feeding up to 1.2 mg/kg of AFLA and declined at 2.5 mg/kg of AFLA (P 0.05), sialic acid excretion increased quadradically such that it was increased 12% when 0.6 and 1.2 mg/kg of AFLA was fed versus the control (P

The nutritional value of high-protein corn distillers dried grains for broiler chickens and its effect on nutrient excretion.

Two experiments were conducted with a co-product of corn endosperm fermentation. The first experiment determined nutrient digestibility of high-protein corn distillers dried grains (HP-DDG; 54% CP) after feeding semipurified diets from 15 to 22 d of age. The AMEn of HP-DDG was 2,526 kcal/kg, whereas standardized ileal Lys, Met, and Thr digestibilities were 73.0, 84.9, and 73.0%, respectively. In a second experiment, an industry control diet (I) regimen was compared with that of either an approximate 25 or 50% replacement for the level of 48% CP soybean meal (SBM) inclusion in the diet utilizing the amino acid digestibility and AMEn determined from the first experiment. From 0 to 14, 14 to 28, and 28 to 42 d of age, the HP-DDG in the 50% SBM replacement diet was added at 25, 23.5, and 21% of the diet, respectively. To meet digestible amino acid needs, the diet containing 50% SBM replacement with HP-DDG contained 3.2, 3.6, and 4.4% units more CP than the I diet regimen from 1 to 14, 14 to 28, and 28 to 42 d of age, respectively. Dietary replacement of up to 50% of SBM inclusion with HP-DDG had no effect on bird performance at 14 or 42 d of age or breast fillet yield at 42 d of age; however, it decreased BW gain and increased feed:gain ratio from 14 to 28 d of age. Birds consuming a diet with 50% replacement of SBM with HP-DDG consumed 17.1% more N compared with those consuming I diets. This additional N and fiber consumed resulted in birds being fed the 50% replacement for SBM diet excreting 21.9 and 31.8% more manure DM and N, respectively. Due in large part to the amino acid profile and digestibility of HP-DDG, use of this feedstuff as a large proportion of the diet is feasible but results in more manure and manure N from broilers.

Supplementation of Avizyme 1502 to corn-soybean meal-wheat diets fed to turkey tom poults: the first fifty-six days of age.

A study was designed to determine the effects of enzyme supplementation on poults fed commercially based diets that included corn, soybean meal, and ground wheat with meat and bone meal (0 to 21 d) or Pro-Pak (22 to 56 d). Day-old turkey poults (n = 3,850) were divided into 35 pens and fed 1 of 5 dietary treatments for 56 d. Treatments were a positive control, a negative control (corn matrix adjustment of 140 kcal), and negative control diets supplemented with Avizyme 1502 at 250, 500, or 750 g/tonne. Feed intake, live weight gain, feed conversion ratio, and mortality were measured for the periods 0 to 21 d, 21 to 42 d, and 42 to 56 d, as well as for the cumulative 0 to 56 d. The 0- to 21-d period was further divided into subperiods (0 to 4 d, 4 to 8 d, 8 to 12 d, 12 to 16 d, 16 to 21 d) to evaluate early nutritional development. Ileal contents along with duodenal, jejunal, and ileal sections (n = 7/treatment) were sampled to determine apparent digestibility and morphology. In most instances, production response differences between the positive and negative controls were not significant, making definitive interpretation of enzyme addition difficult. Energy and protein ileal digestibilities of the negative control diets were lower than those of the positive control diet at 4, 8, 12, 16, and 42 d. Enzyme supplementation significantly improved energy and protein beyond that of the PC diet on d 42. Villus height and crypt depth did not respond to dietary treatment, although there was a significant interaction of age by treatment on jejunal villus height. The similarity between the controls, as well as the high inclusion of CuSO(4), may be responsible for the low response with enzyme inclusion.

Functional MR imaging of regional brain activation associated with the affective experience of pain.

OBJECTIVE: Current models propose that the experience of pain includes both sensory and affective components. Our purpose was to use functional MR imaging to determine areas of the brain engaged by the affective dimension of pain. SUBJECTS AND METHODS: Twelve healthy adults underwent functional MR imaging using a gradient-echo echoplanar technique while a cold pressor test, consisting of cold and pain tasks, was applied first to one foot and then to the other. The cold task involved the application of cold water (14-20 degrees C) that was not at a painful level. For the pain task, the water temperature was then lowered to a painful temperature (8-14 degrees C) and subsequently to the pain threshold (3-8 degrees C). Images acquired at room temperature before the cold and pain tasks served as a baseline task. Composite maps of brain activation were generated by comparing the baseline task with the cold task and the cold task with the pain task. The significance of signal changes was estimated by randomization of individual activation maps. RESULTS: Cold-related activation (p < 0.01) was found in the postcentral gyrus bilaterally, laterally, and inferiorly to the primary motor-sensory area of the foot and at a site near the second somatosensory site. Activation also occurred in the frontal lobe (the bilateral middle frontal gyri and the right inferior frontal gyrus), the left anterior insula, the left thalamus, and the superior aspect of the anterior cingulate gyrus (seen at one slice location). Pain-related activation (p < 0.01) included the anterior cingulate gyrus (seen at four slice locations); the superior frontal gyrus, especially on the right; and the right cuneus. CONCLUSION: Compared with the basic sensory processing of pain, the affective dimension of pain activates a cortical network that includes the right superior frontal gyrus, the right cuneus, and a large area of the anterior cingulate gyrus.

Evaluation of therapeutic strategies: a new method for balancing risk and benefit.

OBJECTIVE: A patient-specific drug safety-efficacy index was developed that combined objective clinical trial information about dose-related efficacy and toxicity with subjective perspectives on efficacy-toxicity trades. METHODS: Patient preferences were systematically assessed using the probability tradeoff technique (PTT). Toxicity ranges over which a drug's efficacy exceeded the patient's minimally acceptable efficacy represented ranges of "surplus efficacy." These can be related to the dose interval in which a drug delivers this surplus efficacy. Seventy surplus efficacy functions (for 7 hypothetical drugs and 10 hypothetical preference curves) were simulated. RESULTS: The analysis showed that index values change markedly by dose and patient preference, suggesting that different patients will benefit from different drugs depending on the dose prescribed and each patient's subjective assessment of the efficacy/toxicity tradeoff. In most situations, drugs achieve positive surplus efficacy only over limited dose ranges. The model was sensitive to different preference curves and discriminated well among drugs with different efficacy or safety profiles. CONCLUSION: This index provides a new, systematic approach to choosing a specific therapeutic intervention and dosage, when known risks and benefits are reconciled against patient-specific preferences among an array of therapeutic alternatives.

Cost-effectiveness of primary and secondary prevention in cardiovascular diseases.

UNLABELLED: INTRODUCTION, AIMS, AND METHODS: Industrial countries' societies are challenged to counter the increasing costs of health care. The preponderance of cardiovascular diseases in middle-aged people demands new strategies to reduce the extremely high rates of early deaths and increased morbidity and thus to avert considerable costs. Prevention programmes are appropriate means to combine therapeutic needs with health economic goals. A review of techniques of economic evaluation is given, from which a critical appraisal of cost-effectiveness analyses in primary and secondary prevention with HMG-CoA reductase inhibitors in coronary heart disease follows. Our own analysis of cost-effectiveness of primary prevention based on the clinical results of the WOSCOP study is also presented. RESULTS AND CONCLUSIONS: Long-term treatment with HMG-CoA reductase inhibitors is effective (30% mortality reduction), safe and tolerable. With a cost-effectiveness ratio of DM15,000-25,000/life-year saved ($9000-15,000) it can be recommended for secondary prevention. The application of statins in primary prevention has also proved to be clinically effective. But with a cost-effectiveness ratio of DM330,000/life-year saved ($195,000) they cannot be generally advocated in patients with hypercholesterolaemia. However, the treatment has to be considered for high risk patients. Aspirin prevention seems to be an alternative in patients without additional risk factors.

[Consequences of new patient discharge guidelines on the cost structure of radioiodine therapy]. / Auswirkungen der neuen Entlassungsrichtwerte auf die Kostenstruktur der Radioiodtherapie.

AIM: Consequences of the new recommendations by the Federal German Radiation Protection Committee (SSK) for patient discharge guidelines (residual activity of 250 MBq for I-131) were calculated for duration of stay and radioiodine therapy cost management. METHODS: For 601 consecutively admitted patients with hyperthyreosis, actual duration of stay and duration of stay according to previous guidelines (from 1993) were calculated, as well as duration of stay according to recommended values. Following BPflV statutes, cost-analysis considered the cause and volume of goitre, and by using sensitivity analyses included a range of diagnostics, service assessment, and duration of stay. RESULTS: Duration of stay following I-131 therapy (in Germany) is expected to fall by 35-50% (average future stay 4.0 +/- 2.8 days), average costs from DM 4,452 to DM 3,680 (-17.4%). Not including pretreatment diagnostics, cost reduction (service assessment 17-24%) was estimated at 21-25%. Compared to strumectomy, I-131 therapy costs are expected to be lower for goitres (Graves' disease) up to at least 60 ml, toxic nodules of at least 25 ml, and toxic multinodular goitres of at least 90 ml. CONCLUSION: In the future, I-131 therapy will be more cost-effective even with larger goitres. Since reimbursement is determined by the duration of stay, new reimbursement procedures are discussed in this paper.

[Cost minimization analysis for the definitive therapy of hyperthyroidism: comparison of goiter resection with radioiodine therapy]. / Kostenminimierungsstudie zur definitiven Therapie der Hyperthyreose: Vergleich zwischen Strumaresektion und Radiojodtherapie.

AIM: Cost-analysis of strumaresection and radioiodine treatment in patients with hyperthyreosis. METHOD: Matched by age, sex, comorbidity, volume of goiter, and entity of hyperthyreosis 18 patients of a clinic of surgery, and 28 patients of a clinic of nuclear medicine were analysed by the reimbursed costs, and by a retrospective calculation of the real costs. RESULTS: Based on the rate for the reimbursed costs the radioiodine treatment (6450 DM) was more favourably than the strumaresection (7562 DM); based on the calculation of the real costs including regional specialities there was a minimal difference in favour of the strumaresection (5185 DM versus 5562 DM) because of the selection of large goiters (median 53 ml), the longer hospitalisation after radioiodine treatment due to legal reasons (12.5 days), and the frequent controls before and after the radioiodine treatment. Most important cost-factor of the radioiodine treatment was the volume of goiter, most important cost-factor of the strumaresection was the age of the patient. The treatment of Graves disease was more expensive than that of autonomy in surgery as well as in nuclear medicine. CONCLUSION: In order to achieve cost-minimization, radioiodine treatment should be prefered in cases of small goiters or in older patients.