Prececal amino acid digestibility and phytate degradation in broiler chickens when using different oilseed meals, phytase and protease supplements in the feed.

The purpose of this study was to investigate the effects of phytase and protease supplementation on prececal (pc) amino acid (AA) digestibility, phytate (InsP6) degradation, and MEn concentration in diets using 3 oilseed meals as main protein sources in broiler chicken feed. The broiler chicken diets, which lacked mineral phosphorus, contained either soybean meal (SBM), SBM and rapeseed meal (SBM/RSM), or SBM and sunflower meal (SBM/SFM) as main protein sources. Diets were not supplemented with enzymes or supplemented with 1,500 or 3,000 FTU phytase/kg, or with 1,600 mg protease/kg. For diets containing SBM as the main protein source, the effects of phytase supplementation with and without monocalcium phosphate were also investigated. Data were obtained during 2 subsequent runs from days 14 to 22 and from days 23 to 31. Each diet was tested using 8 replicates with 4 replicates per run. For pc AA digestibility, no significant interactions were observed between main protein sources, enzyme supplementation, or addition of monocalcium phosphate except for Cys. Supplementation of 1,500 FTU phytase/kg increased pc digestibility of all AA. No differences in pc AA digestibility were observed between 1,500 and 3,000 FTU phytase/kg supplementation treatments. Prececal disappearance of InsP6 and pc P digestibility were greater in the high phytase supplementation treatment. Protease supplementation increased pc digestibility of all AA except for Cys when SBM/RSM was the main protein source. Supplementation of protease and 3,000 FTU phytase/kg increased MEn concentrations. The effect of phytase on pc AA digestibility was fully expressed at a lower supplementation level than needed for a maximized pc InsP6 disappearance and MEn concentration.

Effects of protease and phytase supplements on small intestinal microbiota and amino acid digestibility in broiler chickens.

The objective of this study was to determine the effects of protease origin and dosage on the prececal (pc) amino acid (AA) digestibility and the influence on composition of the microbial community in the small intestine. In addition, the effects of phytase supplementation were investigated. A total of 8 dietary treatments were included. The basal diet contained mainly corn and soybean meal. Three protease products were added to the basal diet, each at the level recommended by the supplier and at an 8-fold level. Phytase was supplemented in another dietary treatment. Each dietary treatment was allocated to 8 replicates of 15 birds each. The experimental diets were offered from day 15 to 21 for ad libitum consumption. The effect of protease supplementation on the pc AA digestibility depended on the protease product type and the amount supplemented. The pc AA digestibility was significantly increased by 1 protease product when supplemented at high level and when phytase was supplemented. In all the other treatments, protease supplementation had no significant influence or it decreased pc AA digestibility, when compared with the treatment with no enzymes added. In general, Firmicutes was the most abundant phylum among the ileal microbiota across all the treatments. Significant effects on microbiota composition were observed at the genus level for some but not all protease treatments and phytase supplementation. The genera Streptococcus, Lactobacillus, and uncultured Clostridiaceae were responsible for these differences. Furthermore, microbial networks established for each diet showed either high or low number of intergeneric interactions, but without a consistent enzyme effect. We conclude that enzyme supplementation effects were evident in the terminal small intestine microbiota composition, and to a lesser extent, in pc AA digestibility. However, the changes in microbiota composition and pc AA digestibility could not be correlated, indicating absence of a causal relationship.

Variability of amino acid digestibility of lupin and pea grains in caecectomised laying hens.

1. The objective of this study was to investigate the variations in amino acid (AA) digestibility of lupin and pea grains in caecectomised laying hens. The relationship between AA digestibility and chemical constituents of the grains was determined. 2. Twelve variants of lupins and peas were each added to a basal diet at a concentration of 300 g/kg, at the expense of maize starch. The lupin and pea variants were separately investigated in two subsequent trials. Each trial consisted of two 7 × 7 Latin squares, each comprising the basal diet and six diets with lupins or peas. 3. Fourteen caecectomised laying hens (LSL-classic) were individually housed in metabolism cages and 120 g/d of experimental diets were provided for eight days. During the last four days, excreta were collected quantitatively and feed intake was recorded. A regression approach was used to determine the AA digestibility of the lupin and pea variants. 4. Amino acid digestibility of the lupins and peas was high, although significant differences in AA digestibility among the lupins and peas were detected. The digestibility of lysine was in the range of 0.87-0.91 and 0.87-0.93 for lupins and peas, respectively. The digestibility of methionine in lupins and peas varied between 0.80-0.88 and 0.72-0.90. Variations in AA digestibility in peas were more pronounced than in lupins. 5. Significant correlations between chemical constituents of lupins, such as alkaloids, and AA digestibility were detected in some cases, without a consistent pattern. In peas, tannin concentration and the insoluble protein fraction were negatively correlated with digestibility of some AAs, but only when one colour flower variant was considered. Trypsin inhibitor activity in peas was negatively correlated with AA digestibility, particularly for the white flower variants.

Variability in amino acid digestibility and metabolizable energy of corn studied in cecectomized laying hens1.

To optimize the use of corn grain in diets for laying hens, differences in amino acid (AA) digestibility and metabolizable energy among different corn samples should be considered in feed formulation. The present study investigated the variability of AA digestibility and AMEn concentration of 20 corn samples in cecectomized laying hens. Corn grains were characterized based on their physical properties (thousand seed weight, test weight, grain density, and extract viscoelasticity), chemical composition (proximate nutrients, AA, minerals, and inositol phosphates), gross energy concentration, and in vitro solubility of nitrogen to study any relationship with AA digestibility or AMEn. The animal study comprised 4 Latin squares (6 × 6) distributed between 2 subsequent runs. Cecectomized LSL-Classic hens were individually housed in metabolism cages and fed either a basal diet containing 500 g/kg cornstarch or one of 20 corn diets, each replacing the cornstarch with one corn batch, for 8 days. During the last 4 d, feed intake was recorded and excreta were collected quantitatively. A linear regression approach was used to calculate AA digestibility of the corn. The digestibility of all AA differed significantly between the 20 corn batches, including Lys (digestibility range 64 to 85%), Met (86 to 94%), Thr (72 to 89%), and Trp (21 to 88%). The AMEn of the corn batches ranged between 15.7 and 17.1 MJ/kg DM. However, consistent correlations between AA digestibility or AMEn and the physical and chemical characteristics of the grains were not detected. Equations to predict AA digestibility or AMEn based on the grain's physical and chemical characteristics were calculated by multiple linear regressions. The explanatory power (adjusted R2;) of prediction equations was below 0.6 for the majority of AA and AMEn, and, thus, was not sufficiently precise for practical use. Possible explanations for the variation in AA digestibility and AMEn beyond the determined characteristics are discussed. In conclusion, AA digestibility and AMEn of corn grain is high in laying hens, but varies among different corn samples, with physical and chemical characteristics not suitable for explaining these variations.

Variability in amino acid digestibility of triticale grain from diverse genotypes as studied in cecectomized laying hens.

Triticale, an anthropogenic hybrid grain, is increasing in importance as a feed grain for laying hens. However, our limited knowledge of its nutritional qualities and their impact on hen performance prevents optimization of its use. The present study investigated the digestibility of amino acids ( AA: ) in triticale grain in laying hens, and additionally examined relationships between AA digestibility and chemical and physical characteristics of the grain. Twenty genotypes of triticale were grown under standardized agronomic and environmental conditions and were characterized according to their physical properties (thousand-seed weight, test weight, falling number, extract viscoelasticity), chemical composition (proximate nutrients, non-starch polysaccharides, AA, minerals, inositol phosphates) and gross energy concentration. Additionally, the in vitro solubility of nitrogen was determined. The animal trial comprised 4 Latin Squares (6 × 6) distributed among 2 subsequent runs. Twelve cecectomized LSL-Classic hens were individually housed in metabolism cages and either fed a basal diet containing 500 g/kg cornstarch or one of 20 triticale diets, each replacing the cornstarch with one triticale genotype, for 8 d. During the last 4 d, feed intake was recorded and excreta were collected quantitatively. Amino acid digestibility of the triticale genotypes was calculated by linear regression. The digestibility of all AA differed significantly between the 20 genotypes, including Lys (digestibility range 68 to 80%), Met (77 to 86%), Thr (68 to 78%) and Trp (74 to 83%). However, AA digestibility only correlated with characteristics of the grain in few cases, without a consistent pattern among AA. Equations to predict AA digestibility based on the grain's physical and chemical characteristics were calculated by multiple linear regression. The explanatory power (adjusted R2;) of these prediction equations was below 0.7 for most AA and thus not sufficiently precise to be suitable for practical application. In conclusion, AA digestibility of triticale grain is high overall in laying hens but varies significantly between crop genotypes. This variation could not be well explained by physical and chemical characteristics of the grain.

Optimization of in vitro inhibition of HT-29 colon cancer cell cultures by Solanum tuberosum L. extracts.

Secondary metabolites in potato have been reported to possess bioactive properties, including growth inhibition of cancer cells. Because potatoes are widely consumed globally, potential health benefits may have broad application. Thus we investigated growth inhibition of HT-29 colon cancer cell cultures by extracts from 13 diverse genetic breeding clones. Extracts from three pigmented selections (CO97226-2R/R, CO97216-1P/P, CO04058-3RW/RW) inhibited growth of in vitro HT-29 cell cultures more effectively than other clones tested. While inhibition was highest from pigmented selections and pigmented tuber tissue sectors, not all pigmented breeding lines tested had appreciable inhibitory properties. Thus, inhibition was not uniquely linked to pigmentation. Immature tubers had the highest inhibitory properties, and in most cases mature tubers retained very low inhibition properties. Flowers and skins inhibited strongly at lower extract concentrations. An extract consisting of 7.2 mg mL⁻¹ cell culture medium was the lowest effective concentration. While raw tuber extracts inhibited most effectively, a few clones at higher concentrations retained inhibition after cooking. Heated whole tubers retained higher inhibition than heated aqueous extracts. While all aqueous extracts from the two tuber selections (CO97216-1P/P and CO97226-2R/R) inhibited HT-29 cell cultures, inhibition was significantly enhanced in purple pigmented tubers of CO97216-1P/P prepared cryogenically as liquid nitrogen powders compared to extracts from freeze dried samples. Upregulation of caspase-3 protease activity, indicative of apoptosis, was highest among the most inhibitory clone samples. The unique sectorial red pigment expressing selection (CO04058-3RW/RW) provided a model system that isolated expression in pigmented sectors, and thus eliminated developmental, environmental and genetic confounding.

Effect of donor animals and their diet on in vitro nutrient degradation and microbial protein synthesis using grass and corn silages.

Two nonlactating cows and two wether sheep, all fitted with a permanent cannula into the rumen, were fed either hay plus concentrate, grass silage or corn silage to study the effect of the donor animal and its diet on in vitro fermentation and microbial protein synthesis. Rumen inoculum was obtained before the morning feeding. Grass silage or corn silage was incubated in a semi-continuous rumen simulation system for 14 days. Four replicated vessels were used per treatment. Degradation of crude nutrients and detergent fibre fractions as well as microbial protein synthesis and the production of volatile fatty acids were studied. Additionally, total gas and methane production was measured with a standard in vitro gas test. Gas production and methane concentration was higher when the inoculum used was from sheep than that from cows. The donor animal also affected the degradation of organic matter and ether extract as well as the amount of propionate and butyrate, and the acetate-to-propionate ratio. The effect of the diet fed to the donor animal on fermentation was much greater than the effect of the donor animal itself. Feeding hay plus concentrate resulted in higher gas production and degradation of acid detergent fibre, but in lower degradation of ether extract and reduced microbial protein synthesis. Additionally, the pattern of volatile fatty acids changed significantly when the diet of the donor animals was hay plus concentrate or one of the silages. These results show that in vitro fermentation and microbial protein synthesis is different when based on inoculum from either cattle or sheep. The diet fed to the donor animal is more important than the animal species and is probably mediated by an adjusted microbial activity. With regard to standardized feed evaluations, these results further support the need to harmonize in vitro approaches used in different laboratories.

Flexible sigmoidoscopy.

Flexible sigmoidoscopy remains a common tool used for the periodic screening of colorectal cancer. Most organizations recommend screening at three- to five-year intervals beginning at age 50 for persons with average risk. Extensive training in endoscopic maneuvering, colorectal anatomy and pathologic recognition is required. Most physicians report comfort performing the procedure unsupervised after 10 to 25 precepted sessions. The procedure involves the insertion of the sigmoidoscope through the anus and distal rectum and advancement of the scope tip to an average depth of 48 to 55 cm in the sigmoid colon. Once the sigmoidoscope has been appropriately advanced, the scope is slowly withdrawn, allowing for the inspection of colon mucosa during withdrawal. Polyps less than 5 mm in diameter should be biopsied. Polyps 5 to 10 mm or greater can be assumed to be adenomatous, and follow-up colonoscopy for complete polypectomy is required. Diverticulosis, hemorrhoids, nonspecific colitis and pseudomembranes may also be encountered during inspection. Use of preprocedural benzodiazepines can be helpful in reducing patient discomfort. 2001;63:1375-80,1383-4,1385-8.)

Endometrial biopsy.

Endometrial biopsy is an office procedure that serves as a helpful tool in diagnosing various uterine abnormalities. The technique is fairly easy to learn and may be performed without assistance. The biopsy is obtained through the use of an endometrial suction catheter that is inserted through the cervix into the uterine cavity. Twirling the catheter while moving it in and out of the uterine cavity enhances uptake of uterine tissue, which is aspirated into the catheter and removed. Endometrial biopsy is useful in the work-up of abnormal uterine bleeding, cancer screening, endometrial dating and infertility evaluation. Contraindications to the procedure include pregnancy, acute pelvic inflammatory disease, and acute cervical or vaginal infections. Postoperative infection is rare but may be further prevented through the use of prophylactic antibiotic therapy. Intraoperative and postoperative cramping are frequent side effects.

Superficial fungal infection of the skin. Where and how it appears help determine therapy.

Superficial fungal infections of the skin are a common presentation in clinical practice. Any skin surface, the mucous membranes, nail plates, and nail beds can be affected. Tinea pedis is the most common fungal infection and may affect up to 70% of the adult population worldwide. Ubiquitous candidal organisms are found in the oral flora of many healthy persons and result in infection in the presence of certain host factors or immunodeficiency disorders. Onychomycosis has had an increasing incidence worldwide, and it now accounts for almost half of all nail disorders. These and many other infections can have varying presentations as well as features that resemble nonfungal disorders. Therefore, it is important that primary care physicians are familiar with the many cutaneous fungal infections and their differential diagnosis to ensure that appropriate therapy is selected.

Office management of digital mucous cysts.

Digital mucous cysts are solitary, clear, or flesh-colored nodules that develop on the dorsal digits between the distal interphalangeal joint and the proximal nail fold. There are two types of digital mucous cysts: one type is associated with degenerative changes in the distal interphalangeal joint, and the second type is independent of the joint and arises from metabolic derangement of fibroblasts that produce large quantities of hyaluronic acid. The two types are clinically indistinguishable. The cysts can be asymptomatic, or they can cause pain, tenderness, or deformity of the nail. Aggressive surgical techniques to remove osteophytes from the joint can produce low recurrence rates. Other procedures to eliminate cysts, such as a simple surgical technique, cryosurgical destruction, or repeated needling, can be performed in an office setting.

Variability in code selection using the 1995 and 1998 HCFA documentation guidelines for office services. Health Care Financing Administration.

BACKGROUND: Documentation guidelines have been developed by the Health Care Financing Administration (HCFA) to promote consistent selection of physician evaluation and management (E & M) codes. Our goals were to determine whether medical providers and auditors agree in their assignment of office codes using 1995 and 1998 guidelines and to ascertain if the code levels assigned are affected by auditor experience and training. METHODS: A total of 1,069 established patient charts from private family physician offices were reviewed by a family practice faculty physician, a family practice resident physician, and a professional coder. The main outcome measures were the agreement between the auditors and the medical care provider on code selection and the degree to which documentation supported the code selected. RESULTS: All auditors agreed with the medical provider code selection in only 15.2% (1995 guidelines) and 29.2% (1998 guidelines) of visits. Professional coders were more likely than faculty physicians or resident physicians to agree with the code assigned by the medical provider (51.7% vs 40.7% and 39.6%, P <.001). Documentation adequately supported the most common office code selection, 99213, in 92.7% (1995) and 91.0% (1998) of the charts reviewed. Concurrence among all auditors was only 31.0% (1995) and 44.3% (1998). CONCLUSIONS: Interobserver differences exist in the assignment of E & M codes by auditors using both 1995 and 1998 HCFA guidelines. The 1998 documentation guidelines produce greater agreement among auditors. The documentation supported the level of code billed in the majority of established patient office visits.

Rosacea.

Rosacea is a common skin disorder most often seen in individuals between the ages of 30 and 60. The condition frequently produces erythema, papules, pustules, and edema of midfacial skin. Ocular rosacea occurs in a high percentage of patients, and is a major cause of red eye. A variety of treatments exist that can eliminate pustules, but no therapy is highly effective in eliminating the vascular flushing associated with rosacea.

Chondrodermatitis nodularis chronica helicis.

Chondrodermatitis nodularis chronica helicis is a painful nodule of the external ear. These uncommon lesions are most often encountered on the helix in white men older than 40 years, although they also rarely occur on the antihelix in women. The lesions frequently present with exquisite tenderness that interferes with sleep. While the cause of this dermal inflammatory process is not known, long-term trauma or sun damage may play a role. Recurrences often complicate treatment if all sites of inflammation are not eradicated. Surgical treatment is generally recommended, either by wide excision or by deep shave and treatment of the underlying cartilage.

The physician's role in the political process.

I recently had the privilege of eating breakfast with Michigan Supreme Court Justice Clifford W. Taylor. Justice Taylor was appointed to the Supreme Court in 1997 by Governor Engler, and he is the 100th justice named to the state's highest court. He has been a strong supporter of medicine in his past decisions as a Court of Appeals judge. He is up for re-election in 1998.