Search

Hepatic parenchymal disease, including chronic viral hepatitis, has traditionally been considered a relative contraindication to islet transplantation as the islets are infused into the recipient’s liver. We present a case study of a patient with treated chronic hepatitis C infection (HCV) who safely received an autologous islet transplant following total pancreatectomy with excellent clinical outcomes. The patient was a 60-year-old woman diagnosed with debilitating abdominal pain secondary to chronic pancreatitis and with preserved islet function. She had previously been treated >10 years prior to surgical evaluation with interferon monotherapy for 1 year that led to sustained virologic response, including at the time of surgical evaluation for total pancreatectomy and islet autotransplantation (TPIAT). She underwent comprehensive preoperative evaluation of the liver, including liver biopsy, which showed no significant portal inflammation or fibrosis. Following a multidisciplinary meeting and discussion of the potential risks for the patient, the decision was made to proceed with TPIAT. The patient underwent a standard total pancreatectomy, and an autologous islet dose of 6638 islet equivalents/kg body weight was infused into the liver via the portal vein. Portal vein pressure was monitored throughout the infusion with a transient peak pressure of 27 cm H2O (basal pressure of 14 cm H2O) and final pressure of 23 cm H20 at 10 min post-infusion. Aside from a transient transaminitis, liver enzymes were normal at the time of hospital discharge. At greater than 1 year of follow-up, the patient has improved quality of life, with reduction in narcotic analgesia, remains insulin independent (with normal islet function), and has normal liver function. This case illustrates that islet autotransplant into the liver can be safely performed and suggests that carefully selected patients with liver disease may be eligible for TPIAT.

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Buchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.

The main objective of this work was to investigate the effects of feeding Lys-deficient diets on muscle biochemical characteristics, particularly intramuscular fat concentration and fatty acid profile, in a fatty (Iberian) and a conventional pig genotype (Landrace × Large White [LDW]) maintained in identical experimental conditions. Performance and plasma metabolite changes were also monitored. Twenty-eight barrows of 10 kg initial BW, 14 of Iberian and 14 of LDW breed, were randomly assigned to each of 2 experimental diets in a 2 × 2 factorial arrangement (2 breeds × 2 diets). Seven pigs were allocated to each treatment combination. Diets (isonitrogenous and isoenergetic; 200 g CP/kg DM and 14.7 MJ ME) based on barley, corn, corn gluten meal, and soybean meal, with identical composition, except for their Lys content (10.9 g/kg for the diet adequate in Lys and 5.2 g/kg for the diet deficient in Lys), were assayed. Pigs were housed in individual 2 m pens and fed at 85% of ad libitum intake of the Iberian genotype, of greater intake capacity. Daily feed allowance was based on BW individually measured each week. At 25 kg BW, pigs were slaughtered by exsanguination after electrical stunning. Blood samples were taken and longissimus dorsi and biceps femoris muscles were rapidly dissected and stored frozen prior to analysis. Performance was reduced in both pig breeds when fed Lys-deficient diets, particularly in LDW pigs (breed × diet interaction, < 0.05). Intramuscular fat content increased in longissimus dorsi of Iberian ( < 0.05) and in biceps femoris of both pig genotypes ( < 0.01) when fed Lys-deficient diets. Oleic acid increased ( < 0.05) and PUFA acid decreased ( < 0.01) in longissiumus dorsi and biceps femoris of pigs of both genotypes fed Lys-deficient diets. The proportion of oxidative fibers ( < 0.001) and free carnitine content ( < 0.05) increased in longissimus dorsi of both pigs types fed Lys-deficient diets. Plasma creatinine was greater in LDW pigs compared with Iberian pigs ( < 0.01). Urea and total cholesterol increased in pigs consuming Lys-deficient diets ( < 0.01). The plasma free carnitine concentration was higher in Iberian pigs than in LDW pigs ( < 0.059). No changes in plasma carnitine status due to dietary Lys supply were detected. Feeding Lys-deficient diets could be a suitable strategy for increasing intramuscular fat content in fatty and lean pigs.

Thirty entire male Iberian (IB) pigs of 12 kg initial BW were used to study the effects of dietary protein-to-energy ratio on performance, body protein accretion, and tissue composition. Two nutritional regimes were supplied at 3 stages of growth (Phase I, from 12 to 30 kg BW; Phase II, from 30 to 45 kg BW; and Phase III, from 45 to 100 kg BW): the first regime (RefP/E) was formulated to provide optimum protein-to-energy ratios for castrated IB pigs at several stages of growth from 10 to 100 kg BW; the second (IncP/E), for which an overall increase of 2.5 g digestible protein/MJ ME was provided, would allow an increased potential for lean tissue growth presumably well above that expected for the entire male of an obese pig breed. The pigs were surgically castrated at 45 kg BW and slaughtered at about 100 kg BW. In Phases I and II, in which feed was provided ad libitum, no significant differences between dietary treatments in ADG (580 ± 10 and 740 ± 11 g, on average, respectively), G:F (0.475 ± 0.004 and 0.362 ± 0.005, on average, respectively), and gain:ME intake ratio (37.8 ± 0.4 and 26.1 ± 0.4 g/MJ, on average, respectively) were found ( > 0.05). After surgical castration, for the entire fattening period (Phase III), ADFI was fixed and highly restricted. A lower gain:ME intake ratio (14.0 vs. 15.1 g/MJ; 0.05). In contrast, in the fattening stage, similar daily rates of N retention ( > 0.05) were found, in spite of the observed differences in digestible N intake ( < 0.001). We concluded that the protein (lysine) requirements of the IB boar growing from 12 to 30 kg BW and from 30 to 45 kg BW are met with the supply of 11.5 and 10.2 g digestible protein of ideal AA pattern/MJ ME (0.80 and 0.71 g digestible lysine/MJ ME), respectively. As surgical castration is programmed to be abandoned in European Union by 1 January 2018, this information will be important for the efficient production of the immunologically castrated IB pig, at the earlier stages of growth.

Objectives A selective therapy for pancreatitis is total pancreatectomy and islet autotransplantation. Outcomes and geographical variability of patients who had total pancreatectomy (TP) alone or total pancreatectomy with islet autotransplantation (TPIAT) were assessed. Methods Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample database. Weighed univariate and multivariate analyses were performed to determine the effect of measured variables on outcomes. Results Between 2002 and 2013, there were 1006 TP and 825 TPIAT in patients with a diagnosis of chronic pancreatitis, and 1705 TP and 830 TPIAT for any diagnosis of pancreatitis. The majority of the TP and TPIAT were performed in larger urban hospitals. Costs were similar for TP and TPIAT for chronic pancreatitis but were lower for TPIAT compared with TP for any type of pancreatitis. The trend for TP and TPIAT was significant in all geographical areas during the study period. Conclusions There is an increasing trend of both TP and TPIAT. Certain groups are more likely to be offered TPIAT compared with TP alone. More data are needed to understand disparities and barriers to TPIAT, and long-term outcomes of TPIAT such as pain control and glucose intolerance need further study.

The Mediterranean diet is associated with a low incidence of physiologic and metabolic non-communicable diseases such as hypertension, obesity, and insulin resistance. These chronic diseases are closely related to oxidative status, which is determined by the balance between oxidant and antioxidant levels. The Mediterranean diet is rich in foods with important antioxidant properties, such as fruits and extra virgin olive oil. The aim of this work was to establish the relationship between dietary patterns, the total intake of polyphenols, and the levels of 8-isoprostanes in urine, as a marker of lipid peroxidation, in a group of healthy Spanish women. The main sources of dietary polyphenols were fruits, vegetables, pulses, nuts, and extra virgin olive oil. There was a significant and positive correlation between the estimated intake of polyphenols, total polyphenols excreted in urine, adherence to the Mediterranean diet, and the intake of specific food groups. A positive correlation was established between the total polyphenols in urine and the intake of raw extra virgin olive oil. However, a negative correlation was established between the amount of 8-isoprostanes in urine, total intake of polyphenols, adherence to the Mediterranean diet, and the intake of fruits and nuts. These results indicate an association between oxidative status and the intake of foods that are typical of the Mediterranean diet, in healthy women. Furthermore, the results demonstrate the use of urine 8-isoprostanes as a marker of adherence to the Mediterranean diet., This research was funded by University of Jaén (Plan de Apoyo a la I+D+i de la Universidad de Jaén. Acción 1_2017), © The Author(s).

© The Author(s)., The health benefits of extra virgin olive oil (EVOO) are related to its chemical composition and the presence of bioactive compounds with antioxidant properties. The aim of this study was to evaluate antioxidant compounds (pigments, coenzyme Q10 (CoQ10) and phenolic compounds) and antioxidant properties of EVOO from the same region comparing different cultivars (Hojiblanca and Arbequina), harvest year and crop stage. Antioxidant properties of oils were studied before and after a gastrointestinal digestion process, by in vitro assays (DPPH, ABTS and FRAP) and antioxidant markers in Caco-2 cells (reactive oxygen species production). The content of bioactive compounds measured was significantly affected by cultivar and harvest year (except for carotenoids) and by the crop stage (except for coenzyme Q10). Higher amounts of coenzyme Q10 were observed in Hojiblanca than in Arbequina EVOO. Total phenol content and antioxidant properties were also different depending on cultivar and harvest year and the in vitro digestion process strongly improved antioxidant marker values. Antioxidant potential in bioaccessible fractions was mainly related to the content of coenzyme Q10 and phenolic compounds in EVOO. Chemometric analysis showed that the oils were clearly classified by cultivars, harvest and crop stage, according to the chemical composition and antioxidant activity analyzed in the present study

The health benefits of extra virgin olive oil (EVOO) are related with its chemical composition and the presence of bioactive compounds with antioxidant properties. The aim of this study was evaluate antioxidant compounds (pigments, CoQ10 and phenolic compounds) and antioxidant properties of EVOO from the same region comparing different cultivars (Hojiblanca and Arbequina), harvest year and crop stage. Antioxidant properties of oils were studied before and after a gastrointestinal digestion process, by in vitro assays (DPPH, ABTS and FRAP) and antioxidant markers in Caco-2 cells (reactive oxygen species production). The content of bioactive compounds measured was significantly affected by cultivar and harvest year (except for carotenoids) and by the crop stage (except for coenzyme Q10). Higher amount of coenzyme Q10 was observed in Hojiblanca than in Arbequina EVOO. Total phenol content and antioxidant properties were also different depending on cultivar and harvest year and the in vitro digestion process strongly improved antioxidant marker values. Antioxidant potential in bioaccessible fractions was mainly related with content of coenzyme Q10 and phenolic compounds in EVOO. Chemometric analysis showed that the oils were clearly classified by cultivars, harvest and crop stage, according with chemical composition and antioxidant activity analyzed in the present study

The main characteristics of the Iberian breed, an autochthonous pig breed of the Iberian Peninsula, are presented in this chapter along with the results of a literatura review on productive traits. Reproductive performance was estimated by sow age at first parturition, litters per sow and year, piglets alive per litter, piglet weight at birth and at weaning, percentage of stillborn per litter, mortality at weaning, lactation length and farrowing interval. For growth performance, average daily gain and daily feed intake during lactation and in different growing phases are provided. Carcass traits were evaluated by age and weight at slaughter, hot carcass weight, carcass yield, backfat thickness measurements, muscle thickness and loin eye area. Meat quality traits of longissimus muscle (pH, objective colour measurements and intramuscular fat) were also assessed. The main part of the studies considered simulated practical production conditions in Iberian pig rearing although others evaluated a defined growing period, sometimes quite far from the usual comercial slaughter weight of this breed. Therefore, some figures should be interpreted with caution. Although a considerable number of studies on Iberian pig were included in the current review, scientific papers on reproductive performance and some meat quality parameters are still rather scarce., The research was conducted within the project TREASURE, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 634476. The content of this paper reflects only the author’s view, and the European Union Agency is not responsible for any use that may be made of the information it contains.

The COVID-19 pandemic poses unprecedented and unique challenges to gastroenterologists eager to maintain clinical practice, patients’ health, and their own physical/mental well-being. We aimed to estimate the prevalence and critical determinants of psychological distress in gastroenterologists during the COVID-19 pandemic.

Betaine and conjugated linoleic acid (CLA) may improve pig performance and increase lean mass, but the mechanisms are not well understood. Gastrointestinal tract, pancreas, spleen and mesenteric fat comprise portal-drained viscera (PDV). Nutrient and energy availability of productive tissues may be compromised by PDV because of its anatomical situation and elevated oxygen consumption. The objective of this study was to determine if the use of betaine, CLA, or both in the diet affects the net portal appearance (NPA) of proteinogenic amino acids (AA; essential and non-essential AA) in Iberian pigs. Sixteen Iberian growing barrows (19 kg body weight (BW)) were randomly assigned to one of four experimental treatments (4 pigs/treatment): basal diet (control; barley and soybean meal-based (145 g crude protein (CP)/kg dry matter (DM) and 14.7 MJ metabolizable energy (ME)/kg DM)) supplemented or not with 5 g/kg betaine, 10 g/kg CLA, or 5 g/kg betaine +10 g/kg CLA. Three catheters were placed in each pig: in carotid artery and portal vein for blood sampling, and in ileal vein for para-aminohippuric acid (PAH) infusion to measure portal plasma flow (PPF). Blood samples were taken into heparinized tubes simultaneously from carotid artery and portal vein at 0, 0.5, 1, 1.5, 2, 3 and 6 h after feeding 1200 g of diet. Blood was centrifuged, haematocrit determined, and plasma stored until PAH and AA analyses. The PPF tended to be greater (15.0%, P=0.095) for control diet compared with the other three diets. Supplementation with betaine increased NPA of essential (59%, P, This study was financed by grant AGL2009-08916. Ministry of Science and Innovation (Spain).

Wild-growing mushrooms could be a potential source of mineral elements The aim of this study was to analyze the mineral composition of 18 species of wild-growing mushrooms collected in a natural park from the Spanish southeast (province of Granada). Ca, Mg, K, Na, Fe, Cu and Zn, were determined by flame atomic absorption spectroscopy and P was analyzed colorimetrically by the vanadomolybdate procedure; the accuracy of methods was assessed by the use of certified reference materials. The contribution of mushrooms consumption to the mineral daily recommended intakes was calculated. Although large variations were observed between species, the most abundant mineral elements in the analyzed mushrooms were K and P, with average contents of 29.3 ± 8.1 and 8.60 ± 4.8 g/kg dry matter (dm), respectively. Low Na concentrations were observed (26.5–579 mg/kg dm), with the only exception of Amanita ovoidea, and high Fe values, exceeding in some cases 1000 mg/kg dm (such as in Lactarius deliciosus and Morchella conica). Mushrooms may be significant contributors of K and P in the human diet and also good sources of trace elements, especially Cu and Fe, providing negligible quantities of Na. Strong correlations were observed for Ca/Mg and Cu/Zn contents in the mushrooms analyzed., This work was supported with fundings of the Spanish National Research Council (CSIC, Spanish Government).

Acute biliary pancreatitis (ABP) is associated with increased rates of morbidity in pregnancy. Because there is a paucity of population-based studies evaluating ABP in pregnancy, we sought to investigate clinical outcomes in hospitalized pregnant women on a national level.By using the Nationwide Readmission Database (2011-2014), we identified all women (age ≥18 years) with an index admission for ABP in the United States. Multivariate and propensity-score matched analyses were performed to evaluate the impact of pregnancy on the clinical outcomes of early readmission and severe acute pancreatitis (SAP) in ABP.There were 7787 hospitalizations for ABP in pregnant women during the study period. The rate of 30-day readmission was 16.26%; 57% of these early readmissions were due to adverse events of ABP. Compared with nonpregnant women with ABP, ERCP (21.1% vs 25.2%; P .001) and cholecystectomy (52.8% vs 55.2%; P = .02) were performed less frequently during pregnancy. Propensity-score matched analysis revealed an increased risk of 30-day readmissions in pregnancy (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.67-2.30), whereas there was no difference in the risk of SAP (OR, 1.09; 95% CI, 0.76-1.57). Multivariate analysis demonstrated that weekend admission (OR, 1.40; 95% CI, 1.10-1.79) and1 week of hospitalization (OR, 1.75; 95% CI, 1.24-2.48) increased the risk of 30-day readmission, whereas ERCP (OR, 0.40; 95% CI, 0.27-0.57) and cholecystectomy (OR, 0.13; 95% CI, 0.10-0.18) reduced the odds of early readmission in pregnancy.Pregnant women with ABP less frequently undergo timely endoscopic biliary decompression and cholecystectomy. These modifiable factors can potentially lower early readmissions in pregnant women.

This study analyzes quality traits of longissimus lumborum and gluteus medius in surgically castrated (SC) males, inmunocastrated (IC) males and IC female Iberian pigs reared in intensive conditions (n = 18/sex). Vaccination with Improvac® was applied at 18 and 26 weeks of age and slaughtering at 31 weeks. At such conditions, notable sex differences were found. Both muscles of IC males were less red (P IC females > SC males in both muscles. It was concluded that meat quality traits differed between inmunocastrated and surgically castrated male Iberian pigs., This work has been funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 634476 (project acronym TREASURE). The content of this paper reflects only the author's view and the European Union Agency is not responsible for any use that may be made of the information it contains. We gratefully acknowledge Dr. Candek-Potokar from Agricultural Institute of Slovenia the analysis of androstenone and skatole in backfat samples.

In pig production, factors such as nutritional system and genotype affect quality characteristics of meat. This study was aimed to evaluate differences in nutritional composition and colour of meat between Iberian (IB) and Landrace × Large White (LLW) pigs reared under identical nutrition and management conditions. Nutrient composition, mineral content, fatty acid profile and instrumental colour of two muscles (longissimus thoracis and biceps femoris) were examined at two growing stages (50- and 115-kg weight). Significant differences were found in relation to genotype. IB muscles contained higher amounts of intramuscular fat, dry matter, monounsaturated fatty acids, iron and zinc, and were redder (higher a∗ value) and with less colour saturation (lower hue angle), than those from LLW pigs. Significant relationships between colour coordinates with the mineral content and the lipid profile of muscles were found: redness was mainly linked to iron, zinc and monounsaturated fatty acids levels, whereas yellowness was positively related with copper, polyunsaturated fatty acids and linoleic acid level. The results of the present study support that muscles from the IB pig genotype have special characteristics, which may enhance the overall quality of meat compared with conventional or high-lean porcine breeds, even under identical management system, due to its particular fat composition and colour attributes.

This work aims at establishing dietary Lys requirements [g Lys/kg crude protein (CP, N × 6.25)] of post-weaned Iberian piglets based on responses on growth performance, carcass nutrient deposition and plasma metabolites. Sixty piglets (10.7 ± 0.1 kg initial BW) were randomly assigned into six isoenergetic diets based on corn, barley and soybean meal. Diets contained increasing Lys concentrations at a constant dietary CP content (165 ± 0.7 g/kg DM). l -Lys HCl was added at the expense of corn starch providing Lys:CP ratios (g/kg) of 43, 47, 52, 57, 64 and 72 g/kg. Other amino acids and nutrients remained constant. Six additional piglets were slaughtered at the start of the experiment to estimate initial carcass composition. Piglets were individually housed in 2 m 2 pens in an environmentally controlled room until slaughter (25.3 ± 0.4 kg BW) to analyze carcass composition. Average daily gain, G:F and Gain:ME intake (g/MJ) increased linearly (P

Background: Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. Objective: The objective of this article is to describe the complications including colon perforations associated with sameday CTC in a cohort who had polypectomies but an incomplete colonoscopy. Design: We conducted a retrospective study. Setting: Our study took place in a single, tertiary referral center. Patients: We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. Interventions: Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. Main outcome measurements: Our main outcome measurements included perforation rate with long-term follow-up. Results: A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were � 5mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. Limitations: Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. Conclusions: Radiologists’ apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of sameday CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.

A feeding, digestibility, and balance trial was performed to determine the effect of the incorporation of increasing amounts of soybean protein concentrate (SPC) to a basal acorn diet at a fixed energy intake on the rate of growth, protein deposition (PD), and carcass traits of heavy Iberian (IB) pigs. Sixteen purebred IB barrows (103.9 ± 0.9 kg initial BW) were used. The pigs were individually confined and allocated to 4 groups of 4 pigs each. Whole acorns were provided with slight restriction to minimize acorn kernel (AK) remains. Water was freely available. The incorporation of SPC raised the available CP from 49.1 g/kg DM (1.91 g total Lys/kg DM) in AK up to 135 g/kg DM (7.24 g total Lys/kg DM). After 72 d of trial, the pigs achieved 134.4 ± 1.3 kg BW and were then slaughtered. Average daily BW gain increased with increasing dietary CP (linear, P < 0.001; quadratic, P < 0.01), with a plateau at dietary CP concentrations (provided by AK and SPC) beyond 72.2 and 100 g/kg DM, respectively, for which an ADG of 449 g was achieved. There was a linear and quadratic effect of dietary CP and Lys level on the apparent digestibility of CP (linear, P < 0.001; quadratic, P < 0.05) and on the efficiencies of utilization of total N (retained N/N intake; linear, P < 0.001; quadratic, P < 0.001) and N apparently absorbed (retained N/apparent digestible N; linear, P < 0.05; quadratic, P = 0.067). Protein deposition ranged between −4.59 g/d in pigs not provided with SPC to 61.4 g/d in pigs fed the greatest level of SPC inclusion. The lowest daily intake of total Lys resulting in maximum PD (69.5 g/d) at the fixed level of energy intake observed (2.36 × ME maintenance requirements) was 21.0 g. Hot carcass and cold carcass weights, but not carcass yield, increased when feeding the daily ration containing 100 g SPC and leveled off thereafter (linear, P < 0.01; quadratic, P < 0.01). An average increase of 8.3% and 8.7% was obtained, respectively. The provision of SPC had no effect on back fat thickness. Primal cuts, but not yield (except for loin), increased (sirloin: linear, P < 0.05; loin: linear, P < 0.001; quadratic, P < 0.05; ham: linear, P < 0.05) or showed a tendency to increase (butt lean: linear, P = 0.068; quadratic, P = 0.077; ribs: quadratic, P = 0.067; shoulder: quadratic, P = 0.064) with the provision of dietary protein. No effect of the level of incorporation of SPC to the diet was observed on CP, total fat, total ash, and energy contents or on relative fatty acid profile of loin and sirloin.

Total pancreatectomy (TP) with islet autotransplantation (IAT) is a highly selected treatment for severe pain associated with chronic pancreatitis (CP) after exhausting medical and endoscopic therapies. The effect of duration of CP on TP-IAT has not been clarified.Retrospective review of a consecutive cohort undergoing TP-IAT was performed. Patients were classified according to islet dose of2500 IEQ/kg, 2500 to 5000 IEQ/kg, and5000 IEQ/kg. Islet yield and metabolic outcomes were compared to disease duration of CP.A total of 76 CP patients underwent TP-IAT. Longer disease duration was associated with lower islet yield transplanted (Spearman's correlation = -0.24; p = 0.04) for total cohort. Highest absolute value of the coefficient was found in patients with hereditary CP when study subjects were classified by the etiology of CP (correlation = -0.72; p = 0.02). Higher islet yields were significantly associated with better metabolic outcomes (7.6 ± 1.1 vs 6.6 ± 1.1% of HbA1c post-TPIAT in patients with2500 and5000 IEQ/kg transplanted, respectively; p = 0.04).The duration of CP could affect islet yield and metabolic outcomes. The time since the diagnosis of CP should be considered when selecting patients for islet autotransplantation.

Objective To review all cases of parenteral support (PS)-dependent patients with short bowel syndrome (SBS) treated with teduglutide (Gattex, Shire) and to evaluate its efficacy and adverse effects. Methods This is a retrospective descriptive cohort of SBS patients treated with teduglutide. Demographics, bowel length, primary diagnosis, PS volume/duration, teduglutide dose, and side effects were collected prospectively. Results Six SBS patients (4 females, 2 males) received teduglutide. Mean age was 46.3 years (range 26-71). SBS etiology was vascular (n = 3), multiple resections (n = 2), and strangulation (n = 1). Length of residual small bowel was between 30-120 cm. The bowel anatomy was colon present (n = 3) and stoma n = 3 (ileostomy, 2; colostomy, 1). PS duration was 1.5-14 years. Weekly PS volume was mean 7.7 liters/week (1-14). Number of PS days per week ranged 1-7 days. Mean duration of teduglutide therapy was 31 months (24-36). All patients achieved ≥20% reduction in PS weekly volume within 6 months. PS was weaned in all patients. Adverse effects included abdominal bloat/discomfort (n = 3), stoma enlargement (n = 3), bowel obstruction (n = 1), and congestive heart failure (n = 1). Conclusions All PS-dependent SBS patients treated with teduglutide were weaned off PS. Patients with colon in continuity and lower PS weekly volume requirements were weaned off PS sooner than those with end-stomas and higher PS volume requirements. Teduglutide was well tolerated. Additional clinical studies of teduglutide in SBS patients with marginal PS requirements are needed.

Objectives Precolonoscopy dietary regimens often are restricted to clear liquids; however, the superiority of a clear liquid diet (CLD) for bowel preparation quality is ambiguous. We performed a meta-analysis of randomized trials comparing bowel preparation outcomes between a low-residue diet (LRD) or regular diet (RD) compared with a CLD. Methods MEDLINE, clinicaltrials.gov, Cochrane Central Register, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Web of Science databases were used to conduct a search for randomized controlled trials from 1976 to March 2015. Of 122 relevant references, 12 studies met our inclusion criteria, 7 studies of which were classified as being of high quality. Pooled estimates of bowel preparation quality were defined as adequate versus inadequate. Secondary outcomes included tolerability, willingness to repeat bowel preparation, adverse events, and adenoma detection rate. Pooled estimates of relative risk (RR) were used for dichotomous variables and standardized mean difference for continuous variables. Results In the high-quality studies, there were no differences in bowel preparation quality among the LRD/RD and CLD groups (RR 0.98; 95% confidence interval [CI] 0.93-1.04). Analysis of secondary outcomes included all of the studies. Tolerability (RR 1.04, 95% CI 1.01-1.08) and willingness to repeat favored the liberalized diet arm (RR 1.08, 95% CI 1.01-1.16). There was no significant difference in the adenoma detection rate, whereas hunger was more common in the CLD group. Conclusions An LRD/RD provided no difference in bowel preparation quality as compared with a CLD. As such, it may be reasonable for patients without risk factors for poor preparation to undergo an LRD until lunch the day before their colonoscopy given that bowel preparation tolerability and willingness to repeat were greater among groups with a liberalized diet.

Background and study aims: Adverse events associated with overtube-assisted enteroscopy are similar to those with routine endoscopy. Our endoscopy quality program identified a number of respiratory adverse events resulting in emergency resuscitation efforts. The aim is to report all adverse events identified by quality monitoring and outcomes of adverse events associated with overtube-assisted enteroscopy. Methods: A retrospective study used data prospectively obtained from consecutive patients undergoing overtube-assisted enteroscopy between December 2008 and July 2012. Patient characteristics, medical history, procedure indication, and procedure outcomes, including diagnosis, endoscopic therapy, and complications, were obtained. Results: In 432 overtube-assisted enteroscopies, 15 adverse events (most frequently hypoxemia, 9 /15, 60 %) occurred in 14 patients (3.2 % of total cohort; 12 were outpatients) mostly during antegrade enteroscopy. Four patients required endotracheal intubation and 4 /12 outpatients required intensive care. The procedure was aborted in 13 /14 patients, and only 1 of 10 patients scheduled for repeat antegrade enteroscopy returned. There was no mortality. Based on the frequency of adverse events, and in consultation with anesthesia providers, from August 2012 all antegrade overtube-assisted enteroscopies at our institution were done with general anesthesia. From then till September 2013, 145 antegrade and 52 retrograde overtube-assisted enteroscopies have been done, with no adverse events. Conclusions: Monitoring of endoscopy practice identified adverse events associated with overtube-assisted enteroscopy. The peer-review prompted a change in practice: all patients undergoing antegrade overtube-assisted enteroscopy at our institution now have endotracheal intubation which has dramatically decreased the rate of respiratory adverse events. The impact of endoscopic quality measurements on practices, procedures, and outcomes will be of further interest.

The effects of increasing proportions of olive oil soap stocks (OSS) in diets for crossbred Iberian barrows on productive parameters, nutrient digestibility and N balance were studied. Twenty four Iberian × Duroc 50:50 growing barrows of 46.7 ± 0.60 kg initial BW were placed in individual pens and allotted to 4 dietary treatments in which olive oil soap stocks replaced 0 (diet A), 25 (diet B), 50 (diet C) and 75 (diet D) g/kg of a basal diet based on barley, corn, soyabean meal and wheat middlings. Crude fat content of diets increased from 20.8 to 86.6 g/kg with OSS inclusion. At the finishing stage of growth, 16 pigs were randomly allotted to two homogeneous groups of eight pigs each. Two experimental diets were prepared by mixing at equal proportions diets A and B, and diets C and D. In both experiments, daily feed allowance was fixed at 0.90× ad libitum intake, which was given in two equal meals (0900 and 1500 h). The inclusion of OSS in the diet of the growing pigs did not affect the average daily gain and gain:feed, being 765 ± 18.6 g and 0.296 ± 0.007, respectively. However, the ratio gain:metabolizable energy (ME) intake (g/MJ) decreased linearly on increasing the level of OSS dietary inclusion (P

The effects of dietary protein content on the rates of gain and protein deposition were studied in Iberian (IB) × Duroc (DU) 50:50 barrows at 2 stages of growth [10.6 ± 0.2 (n = 28) and 60.0 ± 0.4 (n = 24) kg initial BW]. Two feeding, digestibility, and N-balance trials were performed. At each stage of growth, they were allocated in individual pens and given restrictedly (at 0.9 × ad libitum intake) one of 4 pelleted diets of similar energy concentration (13.8 to 14.5 MJ ME/kg DM), formulated to provide 4 different (ideal) CP contents (236, 223, 208, and 184 g CP/kg DM in the first trial, and 204, 180, 143, and 114 g CP/kg DM in the second trial). Feed allowance was offered in 2 daily equal meals. The average concentration of Lys was 6.59 ± 0.13 g /100 g CP for all diets. Whatever the stage of growth, average daily BW gain and gain to feed ratio were unchanged by increases in dietary CP content (477 ± 7 and 1,088 ± 20 g, and 0.475 ± 0.027 and 0.340 ± 0.113, respectively, in the first and second trial). In pigs growing from 10 to 27 kg BW, the average rate of N retention increased linearly (P < 0.01) on increasing the protein content in the diet up to a break point, so a linear-plateau dose response was observed. Pigs fed diets providing 208 to 236 g/kg DM did not differ in rate of protein deposition (PD). A maximum value of 87 (13.93 g N retained × 6.25) g PD/d was obtained when the diet supplied at least 208 g CP/kg DM. The broken-line regression analysis estimated dietary CP requirements at 211 g ideal CP (15.2 g total Lys)/kg DM. In the fattening pigs, there was a quadratic response (P < 0.01) in the rate of N retention as dietary CP content increased. Maximum N retention (18.7 g/d) was estimated from the first derivative of the function that relates the observed N retained (g/d) and dietary CP content (g/kg DM). This maximum value would be obtained by feeding a diet containing 185 g ideal CP (13.3 g total Lys)/kg DM and represents the maximum capacity of the IB × DU 50:50 pigs for protein accretion (i.e., 117 g PD/d). Consequently, cross breeding of IB dams with Duroc sires alters the metabolic response to dietary CP supply by increasing the potential of the crossbred to accrete protein and by modifying the pattern of PD response with BW.

The assays described are part of the doctoral thesis of Ascension Rueda, from the Official Doctoral Program “Nutrition and Food Sciences” of the Granada University., Virgin argan oil is an emergent oil that is being introduced into specialized international markets as a healthy and luxury food. In order to compare the fatty acid composition of argan oil with that of the eleven other vegetable edible oils, a combination of gas chromatography as analytical technique and multivariate discriminant analysis was applied. This analysis takes into account the conjoint effect of all the variables analyzed in the discrimination between oils and also shows the contribution of each variable to oils characterization. The model correctly classified 100% oil samples. According to the fatty acid composition, argan oil showed closest similarity firstly with sesame oil and secondly with high oleic sunflower oil. Olive oil was close to avocado oil and almond oil, followed by argan oil. Thus, similarities and differences between vegetable oils based on their fatty acid profile were established by the application of multivariate discriminant analysis. This method was proven to be a useful tool to study the relationships between oils according to the fat composition and to determine the importance of the fatty acid variables on the oils classification., This work was supported by the research group AGR141 of Junta de Andalucía and a Project of Plan Propio de Investigación de la Universidad de Granada.

Intussusception after pancreaticoduodenectomy (Whipple procedure) is exceedingly rare. We present a case of retrograde jejunal intussusception into the gastric lumen in a patient who previously underwent Whipple procedure. Diagnostic endoscopy may serve to confirm intussusception, identify a potential lead point, and, in some cases, endoscopically reduce the intussusception. Ultimately, however, surgical management is recommended due to a high rate of recurrence along with the potential to detect a lead point and associated malignancy.