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Prebiotics are non-digestible carbohydrates that selectively stimulate the growth of beneficial bacteria. Prebiotic supplementation into poultry diets results in a decreased rate of pathogenic bacteria colonisation in the gastrointestinal tract. It also enhances production of volatile fatty acids and lactic acid, which provide the bird with energy. This results in improved host gastrointestinal health and productive performance. Oligosaccharides are the most notable prebiotics in poultry nutrition. Examples of prebiotic oligosaccharides include xylo-oligosaccharides, fructo-oligosaccharides, and galacto-oligosaccharides. Oligosaccharides are derived from hydrolysis of non-starch polysaccharides (NSP). They are manufactured from plant sources, synthesised by physiochemical methods or enzymatic processes. The effects of oligosaccharides occur primarily in the caeca; oligosaccharides bypass the small intestine and reach the caeca, where they are readily fermented by beneficial bacteria, such as those in family Lactobacillaceae and Bifidobacteriaceae. Caeca function is generally poorly understood, despite extensive reviews and studies in this field. A deeper understanding of the factors that influence ability of the caeca to effectively utilise oligosaccharides is warranted. This would allow new prebiotic products and NSP- degrading enzymes to be developed, targeted to specific diets and scenarios. This is required, given the lack of consistency observed in the outputs derived from different studies assessing oligosaccharide efficacy in poultry diets. A key hinderance to progression in this field is that authors rarely analyse the oligosaccharide content and composition in the test diets and products, or in the bird's gastrointestinal tract. This review examines the mechanisms behind how oligosaccharides induce prebiotic effects in poultry, by identifying the role of the caeca in NSP digestion and identifying the impact of oligosaccharides on caeca microbiota and short-chain fatty acid composition. Supplementing prebiotics, specifically short-chain sugars called oligosaccharides, into poultry diets has been shown to improve bird gastrointestinal health and productivity. However, bird responses to these oligosaccharides are inconsistent among research studies, suggesting that it may not always be economically beneficial to supplement them into poultry diets. This review examines the mechanisms behind how oligosaccharides induce prebiotic effects in poultry, to better understand how to the achieve the greatest benefits from using them, aiding development of new prebiotic products. [ABSTRACT FROM AUTHOR]

Understanding the order of limiting amino acids (AA) in reduced-protein (RP) diets for laying hens will facilitate precise feed formulation and ensure that AA requirements are met cost-effectively. The order of the first three limiting AAs—lysine (Lys), methionine (Met), and threonine (Thr)—has been well established in RP laying hen diets. This study aimed to determine the priority order of eight additional limiting AAs (critically important AAs) when formulating wheat–sorghum-based RP diets for laying hens: tryptophan (Trp), valine (Val), isoleucine (Ile), arginine (Arg), leucine (Leu), histidine (His), phenylalanine (Phe), and glycineequivalent (Gly). A total of 330 Hy-Line Brown laying hens were randomly assigned to 11 dietary treatments (30 replicates of individual birds per treatment) from 20 to 39 weeks of age (WOA). Treatments were a standard-protein (17.24% CP) diet as the control (SP); a reduced-protein (15.00% CP) diet with sufficient levels of Lys, Met, and Thr but insufficient levels of the eight experimental essential AA (RP); a reduced-protein diet with sufficient levels of all essential AAs (RP-EAA); and eight subsequent dietary treatments of the RP-EAA diet with one of the experimental essential AAs removed: Trp (RP-EAA-Trp), Val (RP-EAA-Val), Ile (RP-EAA-Ile), Arg (RP-EAA-Arg), Leu (RP-EAA-Leu), His (RP-EAA-His), Phe (RP-EAA-Phe), and Gly (RP-EAA-Gly). Eggs were collected and weighed daily, and feed intake and feed conversion ratio (FCR) were calculated weekly. External and internal egg quality was measured at 29 and 39 WOA. Nutrient digestibility, serum uric acid concentration, caecal microbiota composition, and tibia parameters were measured at 40 WOA. Overall, hens fed the RP-EAA-Val, RP-EAA-Ile, and RP diets presented significantly lower egg mass compared to hens fed the SP, RP-EAA-His, and RP-EAA-Gly diets (p < 0.001). Hens fed the RP diet and RP-EAA-Val diet had a higher FCR compared to those offered the RP-EAA, RP-EAA-Leu, RP-EAA-Phe, and RP-EAA-Gly diets (p = 0.046). Lower protein intake and excretion were observed in hens offered the RP diets compared to hens fed the SP diet (p = 0.001 and 0.018, respectively). Based on the egg mass, Ile may be considered the fourth and Val the fifth limiting AA, after Lys, Met, and Thr, in laying hens fed wheat–sorghum-based RP diets during peak lay. However, if ranked based on FCR, Val may be considered the fourth limiting AA, followed by Trp, Ile, Arg, and His as the co-fifth limiting AAs. Leu, Phe, and Gly may be considered as non-essential AAs for laying hens fed RP diets. [ABSTRACT FROM AUTHOR]

Background: Administrative coding of out‐of‐hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain. Aim: To characterize the prevalence and type of non‐informative diagnoses in a young cardiac arrest population. Methods: Hospital discharge diagnoses provided to a statewide OHCA registry were characterised as either 'informative' or 'noninformative.' Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared. Results: Of 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019). Conclusion: Almost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at‐risk family care, data sampling strategies, international statistics and research funding. [ABSTRACT FROM AUTHOR]

Background: Lithium is a first-line pharmacotherapy for the treatment of bipolar disorder, but long-term use is associated with nephrotoxicity. However, as dialysis effectively eliminates lithium, it remains a pharmacotherapeutic option for patients on dialysis. This systematic review seeks to evaluate the dosing, safety, efficacy, and monitoring of lithium in patients receiving dialysis. Method: A PubMed database search performed May 5th, 2020, identified 535 article titles. After exclusion criteria were applied, a total of 15 articles were included in this systematic review. Results: In 18 patients receiving dialysis, lithium was primarily used for the treatment of mood disorders. The majority of patients received 300–900 mg lithium carbonate thrice-weekly following dialysis, but several alternative lithium salts and dosing strategies were utilized. The pharmacokinetic properties of lithium in dialysis are not well understood and can be complicated by a serum lithium "rebound effect" following dialysis, due to a two-compartment volume of distribution. Additionally, presence of residual diuresis in some patients may be reason to administer lithium more frequently than thrice-weekly following dialysis. Lithium was shown to be an effective pharmacotherapy in all patients, with many demonstrating rapid improvement after drug initiation. Five patients experienced an adverse event on lithium, but only one patient required lithium discontinuation. Conclusion: Lithium may be used in patients on dialysis, with close monitoring of pre-dialysis serum lithium concentrations for at least two weeks after treatment initiation, followed by a lower frequency after stabilization to ensure therapeutic concentrations and reduce toxicity risk. [ABSTRACT FROM AUTHOR]