European consensus statement on expert colposcopy

BACKGROUND

Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease.

AIMS

To provide expert guidance on complex colposcopy cases through published evidence and expert consensus.

MATERIAL & METHODS

Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics.

RESULTS & DISCUSSION

The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.

Quality of life from cytoreductive surgery in advanced Ovarian cancer: investigating association with disease burden and surgical complexity in the international, prospective, SOCQER2 cohort study

OBJECTIVE

To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach DESIGN: Prospective multicentre observational study SETTING: United Kingdom, Kolkata, India, and Melbourne, Australia gynaecological cancer surgery centres.

PARTICIPANTS

Patients undergoing surgical resection for late stage ovarian cancer. Exposure Low, intermediate or high Surgical Complexity Score (SCS) surgery MAIN OUTCOMES AND MEASURES: Primary: EORTC-QLQ-C30 Global score change. Secondary: EORTC OV28, progression free survival.

RESULTS

Patients' pre-operative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n=88) in the low, 4.0 (SD 2.1, n=55) in the intermediate and 4.3 (SD 2.1, n=52) in the high SCS group after 6 weeks (p=0.048) and 4.3 (SD 2.1, n=51), 5.1 (SD 2.2, n=41) and 5.1 (SD 2.2, n=35) respectively after 12 months (p=0.133). In a repeated measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups, p= 0.840 but there was a small statistically significant improvement in all groups over time (p<0.001). The high SCS group experienced small to moderate decreases in physical (p=0.004), role (p=0.016) and emotional (p=0.001) function at 6 weeks post-surgery which resolved by 6-12 months.

CONCLUSIONS AND RELEVANCE

Global QoL of patients undergoing low, intermediate, and high SCS surgery improved at 12 months post operation and was no worse in patients undergoing extensive surgery.

Introducing human papillomavirus (HPV) primary testing in the age of HPV vaccination: projected impact on colposcopy services in Wales

OBJECTIVE

To determine the demand for colposcopy in the Cervical Screening Wales programme after the introduction of human papillomavirus (HPV) cervical screening, which coincided with the start of screening of women vaccinated against HPV types 16/18.

DESIGN

The study used a computational model that assigns screening and screening-related colposcopy events to birth cohorts in individual calendar years.

SETTING

Cervical Screening Wales.

POPULATION

Women aged 25-64 years from birth cohorts 1953-2007.

METHODS AND MAIN OUTCOME MEASURES

We estimated the numbers of colposcopies and high-grade cervical intraepithelial lesions (CIN2+) within Cervical Screening Wales in 2018-32, using official population projections for Wales and published estimates of the effects of HPV screening and vaccination.

RESULTS

Vaccination will reduce the number of colposcopies by 10% within the first 3-4 years after the national roll-out of HPV screening, and by about 20% thereafter. The number of screening colposcopies is estimated to increase from 6100 in 2018 and peak at 8000 (+31%) in 2021, assuming current screening intervals are maintained. The numbers of CIN2+ lesions follow similar patterns, stabilising at around 1000 diagnoses per year by 2026, approximately 60% lower than at present. Extending the screening intervals to 5 years for all women shows similar trends but introduces peaks and troughs over the years.

CONCLUSIONS

Vaccination will not fully prevent an increase in colposcopies and detected CIN2+ lesions during the first 2-3 years of HPV-based screening but the numbers are expected to decrease substantially after 5-6 years.

TWEETABLE ABSTRACT

HPV-based cervical screening will initially increase colposcopy referral. In 6 years, this increase will be reversed, partly by HPV vaccination.

European consensus statement on essential colposcopy

This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.

Seasonal fluxes of carbon monoxide from an intensively grazed grassland in Scotland

Fluxes of carbon monoxide (CO) were measured using a fast-response quantum cascade laser absorption spectrometer and the eddy covariance method at a long-term intensively grazed grassland in southern Scotland. Measurements lasted 20 months from April 2016 to November 2017, during which normal agricultural activities continued. Observed fluxes followed a regular diurnal cycle, peaking at midday and returning to values near zero during the night, with occasional uptake observed. CO fluxes correlated well with the meteorological variables of solar radiation, soil temperature and soil moisture content. Using a general additive model (GAM) we were able to gap fill CO fluxes and estimate annual fluxes of 0.38 ± 0.046 and 0.35 ± 0.045 g C m^-2 y^-1g C m^-2 y^-1 for 2016 and 2017, respectively. If the CO fluxes reported in this study are representative of UK grasslands, then national annual emissions could be expected to be in the order of 61.91 (54.3-69.5) Gg, which equates to 3.8% (3.4-4.3%) of the current national inventory total.

Effects of fatty acid glyceride product SILOhealth 104 on the growth performance and carcass composition of broiler chickens

Butyric acid is the primary energy source for colonocytes, and has shown potential as an alternative to in-feed antibiotics, due to its antimicrobial activity and positive effects on production performance traits of broiler chickens. SILOhealth 104 (SILO S.P.A., Florence, Italy) is a commercial product mainly containing mono- and di-glycerides of butyrate with a small portion of propionic, caprylic, capric, and lauric acid mono- and di-glycerides. Its effects on broiler performance and carcass composition have yet to be evaluated. Four-hundred-eighty day-old male Ross 308 birds were divided into different dietary treatment groups with equal starting weights and fed a diet containing 0, 500, 1,000, 2,000, or 3,000 ppm of SILOhealth 104 for 35 days. There were no significant differences in overall average daily gain or feed: gain ratio with the addition of SILOhealth 104 to the diets (P > 0.05). At 5 wk of age, abdominal fat weight was reduced in birds supplemented with SILOhealth 104 in a dose-responsive manner (P < 0.05), while breast muscle weight increased with supplementation, with significant increases in 2,000 ppm and 3,000 ppm birds compared to controls (P < 0.05). A significant reduction in gene expression of both forkhead box protein O4 and myostatin, 2 factors that can inhibit protein synthesis, was found in the breast muscle of all SILOhealth 104 treated birds (P < 0.05). In addition, gene expression in the adipose tissue, including acetyl-CoA carboxylase alpha and lipoprotein lipase, which are associated with lipid metabolism, was significantly decreased and increased, respectively, by the supplementation of SILOhealth 104 (P < 0.05). These data suggest that the components of SILOhealth 104 can positively affect the deposition of muscle, while reducing abdominal fat deposition in broiler chickens.

Effects of supplementation level and feeding schedule of butyrate glycerides on the growth performance and carcass composition of broiler chickens

Mixed mono- and tributyrate glycerides have been used for effective delivery of butyrate to the gut to benefit broilers. However, limited information is available on the efficacy of butyrate glycerides individually and in combination with different levels and feeding schedules. The present study has first investigated the effects of monobutyrin at inclusion levels of zero, 500, 1,000, 2,000, and 3,000 ppm on the performance of broilers, and second, the effects of its combination with tributyrin. In the monobutyrin trial, there were no overall significant differences in average daily gain or feed efficiency. However, 2,000 ppm birds had significantly decreased abdominal fat deposition compared to controls (P ≤ 0.05), and the breast muscle deposition increased in a dose-response manner to the supplementation of monobutyrin (P ≤ 0.05). The combination trial tested 5 treatment groups: control, 500 ppm tributyrin + 500 ppm monobutyrin (5T5M), 500 ppm tributyrin + 500 ppm monobutyrin staggered (5T5Ms), 500 ppm tryibutyrin + 2,000 ppm monobutyrin (5T20M), or 500 ppm tributyrin + 2,000 ppm monobutyrin staggered (5T20Ms). In staggered groups, birds were fed tributyrin for one wk followed by 2 wk of monobutyrin, after which the feed was butyrate glyceride free. The non-staggered groups had constant inclusions levels through the 5 weeks. There were no significant differences in average daily gain or feed efficiency among groups. At 5 wk of age, all treatment groups except for 5T5Ms had significantly lower relative abdominal fat weight compared to control birds (P ≤ 0.05), although 5T5Ms birds demonstrated a trend for a decrease (P = 0.095). Relative breast muscle weight was significantly increased only in 5T5M birds over control birds at 5 wk of age (P ≤ 0.05). Serum biochemistry revealed significant changes in factors relating to muscle growth and fat deposition (P ≤ 0.05). These results indicate a consistent shift in lipid metabolism with the addition of butyrate glycerides and that the deposition of breast muscle may be highest with the incorporation of butyrate glycerides at a moderate level for the duration of development.

Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications)

Background:

There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.

Methods:

Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.

Results:

Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).

Conclusions:

This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

The effect of dietary alterations during rearing on feather condition in broiler breeder females

In commercial production, broiler breeders are severely feed restricted to maintain healthy BW. This restriction can induce stereotypic behavior, including feather pecking, which has negative welfare implications for both the victim and performer. It has been suggested that the problem may be symptomatic of chronic hunger or the frustration of feeding motivation. In this study, we determined whether feather condition, as an indirect measure of feather pecking, could be improved via dietary manipulation. Six dietary treatments were tested, each with 5 replicate pens of 9 to 12 birds. Control diets (C) were fed on a daily or skip-a-day (SAD) basis. Alternative diets included soybean hulls as a bulking ingredient and calcium propionate (CaP) as an appetite suppressant of either a feed grade (F) or purified (P) quality. Both alternative diets were fed on either a daily or SAD basis. Five or 6 birds were randomly chosen from each pen and feather scored at 10, 14, 20, 26, and 36 wk of age. Six body parts (neck, back, wings, legs, vent area, tail) were given a score from 0 to 5 (0 = no feather damage, and 5 ≥ 50% feather loss with tissue damage). Scores were summed for each bird and averaged for each pen. Data were analyzed with room and feeding frequency as main factors and diet as the subfactor with repeated measures. There was an interaction between diet and time (P < 0.01) with the feather condition of the C birds worsening more quickly in comparison with the F and P birds. There was an interaction between feeding frequency and time (P = 0.015), with SAD-fed birds scoring better than daily-fed birds at 20, 26, and 36 wk. This interaction could indicate that SAD feeding increased satiety after the birds became accustomed to the schedule. Because feather condition was better with the alternative diets, this may indicate a reduction in stereotyped feather pecking with these diets. This suggests that the alternative diets increase satiety compared with the control diets.

The effect of dietary alterations during rearing on growth, productivity, and behavior in broiler breeder females

Parent stocks of meat birds are severely feed restricted to avoid obesity-related health and fertility problems. This restriction often leads to chronic hunger, accompanied by stereotypic behavior. Research based in the United Kingdom has shown that using diets containing fiber and appetite suppressants may relieve some of the symptoms of hunger. However, few data are available regarding North American-sourced ingredients or nondaily feeding regimens. This study investigated the effects of 2 alternative diets, in combination with 2 feeding frequencies on growth, productivity, and behavior in broiler breeders. Six dietary treatments were tested, each with 5 replicate pens of 12 or 13 birds. Control diets consisted of a commercial crumble, fed on a daily or skip-a-day (SAD) basis. Alternative diets included soybean hulls as a fiber source, and calcium propionate as an appetite suppressant of either a feed-grade or purified quality, fed on either a daily or SAD basis. Birds were weighed weekly and egg production was recorded daily. Video cameras were used to record behavior during and following the morning feeding bout every 2 wk from 11 to 28 wk. Data were analyzed with a mixed model ANOVA, with repeated measures. Diet, feeding frequency, time, or an interaction of the 3 had significant effects on all observed behavior during rearing. These differences appeared to diminish during lay, with most stereotypic behavior no longer present. Very little object pecking and aggression was observed during and immediately following feeding bouts; however, daily-fed control birds still displayed this behavior more often, especially during rearing (P = 0.015). During feeding bouts, SAD birds feather pecked (P = 0.003) and rested more (P = 0.0002) than daily-fed birds. Control birds feather pecked most often (P = 0.033) after feeding bouts. Overall, the feed-grade diet appeared most effective at reducing hunger-related behavior, and the control diet appeared the least effective. There was little conclusive evidence to show that daily feeding was more effective at reducing hunger.

Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology

Background:

Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting.

Methods:

A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication.

Results:

Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3).

Conclusion:

This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.

Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS)

OBJECTIVE

To estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound.

METHODS

This was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasound-detected abnormal adnexal (unilocular, multilocular, unilocular solid and multilocular solid, solid) morphology on their first scan. Women were followed up through the national cancer registries and by postal questionnaires. Absolute risks of EOC and borderline, Type I and Type II EOC within 3 years of initial scan were calculated.

RESULTS

Of 48 053 women who underwent ultrasound examination and had complete scan data, 4367 (9.1% (95% CI, 8.8-9.3%)) had abnormal adnexal morphology. Median follow-up was 7.09 (25(th) -75(th) centiles, 6.03-7.92) years. Forty-seven (32 borderline or Type I, 15 Type II) were diagnosed with EOC. The overall absolute risk of EOC associated with abnormal adnexal morphology was 1.08% (95% CI, 0.79-1.43%); for borderline and Type I it was 0.73% (95% CI, 0.5-1.03%); and for Type II it was 0.34% (95% CI, 0.33-0.79%). In the subgroup (n = 741) with solid elements (unilocular solid, multilocular solid and solid) overall absolute risk was 4.45% (95% CI, 3.08-6.20%), for borderline and Type I it was 3.1% (95% CI, 1.9-4.6%) and for Type II it was 1.3% (95% CI, 0.6-2.4%). 11 982 women had both ovaries visualized and normal annual scans throughout the 3-year follow-up period. In this group, no borderline or Type I and eight Type II cancers were diagnosed.

CONCLUSION

Asymptomatic postmenopausal women with ultrasound-detected adnexal abnormalities with solid elements have a 1 in 22 risk for EOC. Despite the higher prevalence of Type II EOC, the risk of borderline or Type I cancer in women with ultrasound abnormalities seems to be higher than does the risk of Type II cancer. This has important immediate implications for patients with incidental adnexal findings as well as for any future ultrasound-based screening.

Future considerations in poultry nutrition

Following is invited commentary on the symposium "A Crystal Ball Look into the Future of…" delivered July 16, 2011, at the Poultry Science Association's 100th annual meeting, St. Louis, Missouri. The symposium examined various aspects that will impact the future of poultry production over the next 10 to 20 yr. Topics included genetics, nutrition, incubation, and bird health. This paper deals with various aspects of future issues affecting global feeding and nutrition of poultry.

Cervical cancer incidence in young women: a historical and geographic controlled UK regional population study

Background:

The commencing age of cervical screening in England was raised from 20 to 25 years in 2004. Cervical cancer incidence in young women of England is increasing. It is not clear if this is due to either greater exposure to population risk factors or reduced cervical screening.

Methods:

We measured if the relative risk of cervical cancer in younger women (20–29 years) of the north-east of England (NE) differed to that of women aged 30yrs and above since 2004. We also measured average annual percentage change (AAPC) in the 3 yr moving average incidence for all age-groups. Regional screening coverage rate and population risk factors were reviewed. Comparisons were made with Wales where screening continues to commence from the age of 20 yrs.

Results:

Cervical cancer incidence in women aged 20–29 increased annually by an average of 10.3% between 2000 and 2009. The rise in women aged 30–39 was less steep (3.5%/year) but no significant rise was observed in women aged 40–49. Socioeconomic factors remained stable or improved during the time period except for the incidence of chlamydia, herpes simplex and in particular, genital warts, which increased significantly in young women. Data from Wales show similar results.

Conclusion:

The incidence of cervical cancers in young women of the NE is increasing. The rise in incidence is unrelated to the change in screening policy in 2004. Close monitoring of incidence in young women and a greater attempt to reverse the current decline in screening coverage of women aged 25–29 years are recommended.

Antimicrobial activity of butyrate glycerides toward Salmonella Typhimurium and Clostridium perfringens

The antimicrobial activities of n-butyric acid and its derivatives against Salmonella Typhimurium and Clostridium perfringens were studied. n-Butyric acid and its derivatives (monobutyrin and a mixture of mono-, di-, and tri-glycerides of butyric acid) were added at different concentrations (ranging from 250 to 7,000 mg/kg to a media inoculated with either Salmonella Typhimurium or C. perfringens. The antimicrobial activity of butyric acid against C. perfringens was measured at 2 bacterium concentrations and 2 inoculations involving ambient aerobic or anaerobic conditions. The most effective antimicrobial activity for Salmonella Typhimurium was observed with n-butyric acid, with 90% inhibition rate at a concentration of 1,500 mg/kg. Although minimal inhibition for Salmonella Typhimurium was observed with butyric acid glycerides, lipase addition to a mixture of mono-, di-, and triglycerides of butyric acid increased (P < 0.01) antimicrobial activity of these derivatives. Antimicrobial activity of butyric acid and its derivative against C. perfringens was higher when using a moderate initial inoculation concentration (10(5)) compared with a higher initial concentration (10(7)) of this bacterium. At a lower inoculation of C. perfringens (10(5)), >90% inhibition rate by all butyric acid glycerides was observed with prior aerobic inoculation at 2,000 mg/kg, whereas using anaerobic inoculation, only 50% monobutyrin maintained >90% inhibitory effect at 3,000 mg/kg. The antimicrobial effect of monobutyrin against C. perfringens was generally higher (P < 0.01) for 50% monobutyrin than for 100% monobutyrin. Either a mixture of butyric acid derivatives or 50% monobutyrin decreased (P < 0.01) C. perfringens in a media containing intestinal contents whereas only 50% monobutyrin decreased (P < 0.01) Salmonella Typhimurium within a media containing cecal contents from mature Leghorns. These results show that n-butyric acid and 50% monobutyrin could be used to control Salmonella Typhimurium or C. perfringens in poultry species.

Light intensity can influence plasma FSH and age at sexual maturity in domestic pullets

1. Shaver White and ISA Brown pullets were reared to 140 d in cage groups of 8 on a 10-h photoperiod of incandescent light and maintained at an illuminance of 3 or 25 lux, or transferred from 3 to 25 lux or from 25 to 3 lux at 63 or 112 d of age. 2. Plasma follicle stimulating hormone (FSH) concentration at 63 and 112 d was higher in both breeds for pullets maintained at an illuminance of 25 lux compared with 3 lux. After 2-4 d, and relative to constant-illuminance controls, plasma FSH increased significantly for ISA Brown transferred from 3 to 25 lux at 63 d and for Shaver White transferred at 112 d. Irrespective of genotype, plasma FSH for pullets given a decrease in illuminance at 63 or 112 d showed a tendency for less change than did constant-illuminance controls. 3. There was no significant difference in sexual maturity for ISA Brown maintained on 3 or 25 lux, but Shaver White pullets exposed to constant 3 lux matured later than those maintained on 25 lux. Shaver White matured later following an increase from 3 to 25 lux at 63 and 112 d, and earlier subsequent to a decrease from 25 to 3 lux at 112 d. ISA Brown pullets were not significantly affected by a change in illuminance at 63 or 112 d, though their responses were in the same direction as Shaver White. 4. Changes in plasma FSH in the 2- to 4-d period following a change in illuminance at 63 or 112 d were not significantly correlated with sexual maturity.

A questionnaire study of women's views regarding the effectiveness of serum Down screening in north west Wales

Questionnaires were circulated to 300 women awaiting mid-trimester anomaly scanning in north west Wales to determine women's views of the adequacy of counselling, availability of pretest scanning, method of receiving test results and whether the Down screening process in general was acceptable. Seventy-five per cent of respondents had serum Down screening; 80.3% of women agreed or strongly agreed that counselling prior to antenatal testing for Down syndrome was adequate; 80.7% of women agreed or strongly agreed that the consequences of a high risk result were explained before testing; 88.7% of women agreed or strongly agreed that they had a choice as to whether screening was accepted or not; 81.7% of women agreed or strongly agreed that they were involved in the decision process; and 40.0% of women having Down testing did not have previous ultrasound biometry. Routine pretest ultrasound scanning remains a resource priority.

Dietary lipids differentially affect membranes from different areas of rooster sperm

The present work aimed to compare the effect of dietary flax with other oil sources on rooster sperm membranes and on semen characteristics. White Leghorn roosters (16 per diet) were fed 1 of 4 treatments: control diet (CON), or a diet containing corn oil (CORN), fish oil (FISH), or flax seed (FLAX) as the lipid source. Semen from 4 birds (30 wk old) of each treatment was pooled, the sperm head (HM) and body membranes (BM) were isolated, and lipids were extracted and analyzed. Aspects of lipid composition tested were as follows: percentage of individual fatty acids (C14:0 to C24:1) in total fatty acids, percentage of fatty acid categories [saturated, monounsaturated, polyunsaturated (PUFA), n-3 and n-6 PUFA, and n-6:n-3 ratio] within total fatty acids, and percentage of phospholipids [phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol, phosphatidylserine, and sphingomyelin] in total phospholipids. Sperm characteristics evaluated were as follows: volume, concentration, viability, percentage of motile cells, average path velocity, track speed, progressive velocity, lateral head displacement, straightness, and linearity. Diet did not affect membrane phospholipid ratios in either membrane but modified major fatty acids within certain phospholipids. Birds fed FISH and CORN showed, respectively, the highest and the lowest n-3 in sperm, causing reciprocal significant changes in n-6:n-3 ratio. Feeding FLAX caused intermediate effects in n-3, with values significantly lower than FISH but higher than CORN in HM (PC, PE, and phosphatidylinositol) and PC in BM (P < 0.05). In the PE phospholipids, FISH, followed by FLAX, increased n-3 in BM and decreased n-6 PUFA in HM. Sperm concentration was specifically correlated with the amount of 20:4n-6 in FLAX and 22:4n-6 in CON. In FLAX diets, straightness correlated with C18:0, n-3, and n-6:n-3 ratio. Diets containing distinct lipid sources differentially modify the lipid contents of HM and BM, with minor effects on sperm characteristics. Flax seed produced changes similar to fish oil and could be used as a substitute.

Development and evaluation of a dynamic model of calcium and phosphorus flows in layers

Phosphorus is an essential nutrient involved in most metabolic processes. Most of the interest in Ca metabolism relates to eggshell formation. Although the eggshell is composed of Ca carbonate, metabolism of both Ca and P is closely related such that a deficiency in one can interfere with proper utilization of the other. To understand Ca and P metabolism properly, modeling can be of paramount importance. A new dynamic and mechanistic model of P and Ca metabolism in layers has been developed to simulate diurnal changes in Ca and P and the hourly requirement of the layer for those minerals. The model consists of 8 state variables representing Ca and P pools in the crop, stomachs, plasma, and bone. The flow equations are described by Michaelis-Menten or mass action forms. An experiment that measured Ca and P uptake in layers fed different Ca concentrations during shell-forming days was used for model evaluation. The experiment showed that Ca retained in body and egg decreased from 62.5 to 50.5% of Ca intake when the Ca in diet was increased from 25 to 45 mg/g of feed. The model simulations were in agreement with the trend. Predictions of Ca retention in bone and egg were 63.2, 56.1, and 55.3% for low, medium, and high dietary Ca concentrations. The experimental results showed that P retention in body and egg increased significantly from 11.5% of absorbable P intake at the lowest Ca inclusion concentration to 24.1% at the highest. The model also predicted an increase in P retention in bone and egg from 8.4 to 25.4% of absorbable P intake at the lowest and highest concentration of Ca inclusion, respectively. The advantage of the model is that absorption and utilization can be monitored on an hourly basis and that adjustments can be made accordingly. The model successfully showed how the availability of one mineral affects the utilization of the other and is a useful tool to evaluate feeding strategies aimed at reducing P excretion to the environment in poultry manure.

Review: Energy partitioning in broiler chickens

In commercial nutrition and in research studies, metabolizable energy (ME) is the standard measure of energy used in describing energy requirements and diets for poultry. The provision of dietary energy will influence the intake of all other nutrients. Broilers exhibit an outstanding ability to control their energy intake by adjusting their feed intake as diet energy concentration changes. There is still considerable debate on the accuracy, precision and usefulness of different procedures used for determining ME values of diets and ingredients. ME intake is generally partitioned into energy retained (ER) in body tissues (mainly as fat and protein) and as heat production (HP): ME = HP + ER. There are few reported estimates of HP and its components, fasting heat production (FHP), heat production due to physical activity and the thermic effect of feeding (TEF). Requirements for maintenance (MEm), including major components of FHP and physical activity, are established at around 155 kcal kg BW0.60. We recentlyreported that maintenance requirements for young broilers based on kg BW0.75 were 8% lower than the values estimated using kg BW0.60, and that BW raised to the exponent 0.60, was a more precise estimator. Gross energy retained in the body as fat (TERF) and protein (TERP), together contribute most of the total energy retained (TER) in the body. Efficiency of ME utilization above maintenance varies from 70 to 84% for lipid deposition in adult birds and between 37 and 85% in growing birds. Key words: Energy, broiler, metabolic rate, energy retention

Assessment of the nitrogen correction factor in evaluating metabolizable energy of corn and soybean meal in diets for broilers

Three experiments were carried out to determine AME and AMEn of corn and soybean meal (SMB) in diets for growing broilers. In experiments 1 and 2, ingredient-specific basal diets or a combination of these basal diets with corn and SBM were prepared. For corn, the substitution was 25, 50, or 75% of the total diet, whereas SBM substitution was at 10, 20, or 30%. In experiment 1, birds were fed the experimental diets continuously from 0 to 33 d, and AME and AMEn were determined during 9 to 12 d and 30 to 33 d of age. In experiment 2, birds were fed the experimental diets only around the time of the collection period. The AMEn of corn was 95 to 97% of corresponding AME, whereas for SBM, AMEn was 93 to 88% of AME. Linear regression was used as an alternative method of calculating ingredient energy values resulting in a significant regression of diet AME and AMEn content on inclusion level, for each period of time and for each ingredient (corn and SBM). Based on varying inclusion levels of test ingredients in the diet, the extrapolated AME and AMEn of corn were estimated more precisely (R2 = 0.90 to 0.95) than those of SBM (R2 = 0.57 to 0.85), suggesting that the variability of AME and AMEn is better explained by a linear regression of AME or AMEn on percentage of inclusion. For corn, AME and AMEn were little affected by age, and the effect of N correction was consistent at around 3%. Determined energy values of SBM were more variable. Experiment 3 was conducted to assess the effect of formulating diets based on either AME or AMEn on broiler performance. A 2-sample t-test was implemented examining AME vs. AMEn formulation. The analyses for numerous production and carcass traits were nonsignificant except for the case of less abdominal fat in birds fed diets formulated to AME rather than AMEn (P < 0.01). These results showed that the use of the N correction imposed a penalty to corn of 3 to 5% and SBM of 7 to 12%.

Partitioning of retained energy in broilers and birds with intermediate growth rate

An experiment was conducted to study energy retained (TER) as fat (TERF) and protein (TERP) in 3 strains of birds with different growth rate; commercial broilers, Barred Plymouth Rock, and Leghorns. Birds were fed ad libitum a diet providing 3,100 kcal of AMEn/kg and 20% CP from 0 to 42 d. Body composition, TER, TERF, and TERP were determined at 0, 7, 10, 15, 19, 23, 28, 33, 37, and 42 d of age. The TER, TERF, and TERP were derived from whole body analyses. Linear and nonlinear models (quadratic, allometric, and Gompertz equation) were used as a means to characterize observed patterns of energy deposition. The TER, TERF, and TERP increased quadratically (P < 0.001) over time in all 3 strains of birds. Over 42 d, broilers deposited a constant proportion (50%) of body energy as fat and protein (P < 0.001). When applying the Gompertz equation to relate empty BW (EBW) to time, the estimated value for EBW at maturity of the broilers was unrealistically high (11.1 kg) and estimated poorly (SE 5.5 kg). Quadratic equations may be used as an alternative for Gompertz equations to represent growth of EBW, TER, TERF, or TERP vs. time in chickens between 0 and 42 d of age. Within the BW ranges that were evaluated in this study, allometric functions or Gompertz equations can be used to relate TERF and TERP to EBW, but model parameters differ between bird strains. Based on the Gompertz equation and in broilers, the maximum rate of TERF and TERP was reached at 1.16 and 1.22 kg of EBW, respectively, and then declines slowly as BW increases. Quantifying and partitioning TER as TERF and TERP as major components of ME requirements can be used to establish models that have economic consequences to the broiler industry.

Irradiation of poultry feed II. Effect on nutrient composition

Irradiation offers a potential method for effective microbial control of poultry feed. Birds fed such irradiated diets are not adversely affected and radiation status of the diet is unchanged. While radiation at 25–35 kGy is likely to raise feed temperature by only 5°C during processing, there seems to be loss in potency of certain nutrients. Most reports indicate loss in potency of all fat-soluble vitamins, and there are less consistent reports regarding thiamine and pyridoxine. At 25–35 kGy irradiation there will be around 15% loss of potency of these vitamins. Irradiation also causes increased peroxidation of fats, although this effect can be controlled by appropriate inclusion of antioxidants. There are no consistent reports of irradiation having any effect on protein quality or amino acid status of diets.

Relevance of nitrogen correction for assessment of metabolizable energy with broilers to forty-nine days of age

An experiment was conducted to reevaluate the concept of using AME vs. AME(n) values for broiler diets. Growing male broilers and adult Leghorn roosters were fed either a single standard diet from 0 to 49 d or a series of starter (0 to 21 d), grower (21 to 35 d), and finisher (35 to 49 d) diets. Apparent ME and AME(n) were determined during 4 to 7, 11 to 14, 18 to 21, 25 to 28, 32 to 35, 39 to 42, and 46 to 49 d of age. Using the single diet after 7 d, the broiler consistently derives higher AME than do roosters. This same effect was seen with the multiple diet series for broilers. However when N correction is applied, the converse situation is seen, in that roosters consistently attain higher AME(n) than do broilers at any given age. Using a single diet, rooster AME and AME(n) values were unaffected by time, whereas broilers exhibit a quadratic relationship for both AME and AME(n) through 49 d. Nitrogen retention of roosters was rarely different from zero (P > 0.05). For broilers, there was a significant (P < 0.01) increase in grams of N retained each day over time, although when expressed as a percentage of N intake, there was decline over time, especially after 28 d of age. The N correction imposes a 4 to 5% reduction on the AME value of a single diet. When a commercial series of diets was used, the correction declined from 5.3% at 7 d to 3.8% at 49 d, reflecting the decline in protein content of the diet and the decline in N retention over time. This information suggests that if AME rather than AME(n) values are accepted, then roosters provide a good estimate of values applicable for broiler nutrition, because values are little different. Because there was less variance in energy values expressed as AME(n) rather than AME, it appears that there was sufficient bird-to-bird variation in growth, N retention, or both, to warrant the use of the correction factor.

Effect of dietary lutein and flax on performance, egg composition and liver status of laying hens

Lutein is considered a protective nutrient against age-related macular degeneration in humans. An experiment was designed to study the long-term effect of feeding lutein in combination with flaxseed on layer performance, egg parameters, and lutein deposition in eggs and tissues. Laying hens were fed diets with 0 or 10% flax supplemented with 0, 125 or 250 ppm lutein for 11 consecutive 28-d periods beginning at 18 wk of age. Early production was reduced (P < 0.01) by feeding diets with 10% flax and when supplemented with 250 ppm lutein. Diet treatments had no effect on feed intake, egg weight or eggshell deformation. Addition of lutein to the diets significantly (P < 0.01) increased yolk color, and lutein content in the egg, liver, and the preen gland. Egg lutein content increased (P < 0.01) from a basal level of 0.10 mg to 1.60 mg 60g-1 egg by addition of lutein to the diet. Liver fat was lower (P < 0.05) in hens fed 10% flaxseed. Liver hemorrhage score was dramatically reduced (P < 0.01) in birds fed lutein. Key words: egg composition, flaxseed, lutein, layers

A semi-centennial report on the participants depicted in Joel Babb's portrait, 'the first successful kidney transplantation'

Joseph Murray performed the first successful human kidney transplant on December 23, 1954. Forty-three years later, he along with participants Francis Moore and Leroy Vandam, commissioned a painting of the event from artist Joel Babb (1). To document this unique record of medical history, we identify all those present at the operation and depicted in the portrait, describe how the artist created the work, explain irregularities and inaccuracies in the painting, provide a 50-year follow-up on everyone involved, and comment on any influence this landmark event may have had on their subsequent careers.