Do acute elevations of serum creatinine in primary care engender an increased mortality risk?

Background: The significant impact Acute Kidney Injury (AKI) has on patient morbidity and mortality emphasizes the need for early recognition and effective treatment. AKI presenting to or occurring during hospitalisation has been widely studied but little is known about the incidence and outcomes of patients experiencing acute elevations in serum creatinine in the primary care setting where people are not subsequently admitted to hospital. The aim of this study was to define this incidence and explore its impact on mortality. Methods: The study cohort was identified by using hospital data bases over a six month period. Inclusion criteria: People with a serum creatinine request during the study period, 18 or over and not on renal replacement therapy. The patients were stratified by a rise in serum creatinine corresponding to the Acute Kidney Injury Network (AKIN) criteria for comparison purposes. Descriptive and survival data were then analysed. Ethical approval was granted from National Research Ethics Service (NRES) Committee South East Coast and from the National Information Governance Board. Results: The total study population was 61,432. 57,300 subjects with ‘no AKI’, mean age 64.The number (mean age) of acute serum creatinine rises overall were, ‘AKI 1’ 3,798 (72), ‘AKI 2’ 232 (73), and ‘AKI 3’ 102 (68) which equates to an overall incidence of 14,192 pmp/year (adult). Unadjusted 30 day survival was 99.9% in subjects with ‘no AKI’, compared to 98.6%, 90.1% and 82.3% in those with ‘AKI 1’, ‘AKI 2’ and ‘AKI 3’ respectively. After multivariable analysis adjusting for age, gender, baseline kidney function and co-morbidity the odds ratio of 30 day mortality was 5.3 (95% CI 3.6, 7.7), 36.8 (95% CI 21.6, 62.7) and 123 (95% CI 64.8, 235) respectively, compared to those without acute serum creatinine rises as defined. Conclusions: People who develop acute elevations of serum creatinine in primary care without being admitted to hospital have significantly worse outcomes than those with stable kidney function

Evaluation of elicitation methods to quantify Bayes linear models

The Bayes linear methodology allows decision makers to express their subjective beliefs and adjust these beliefs as observations are made. It is similar in spirit to probabilistic Bayesian approaches, but differs as it uses expectation as its primitive. While substantial work has been carried out in Bayes linear analysis, both in terms of theory development and application, there is little published material on the elicitation of structured expert judgement to quantify models. This paper investigates different methods that could be used by analysts when creating an elicitation process. The theoretical underpinnings of the elicitation methods developed are explored and an evaluation of their use is presented. This work was motivated by, and is a precursor to, an industrial application of Bayes linear modelling of the reliability of defence systems. An illustrative example demonstrates how the methods can be used in practice

Unveiling the influence of adaptation time on xylanase and arabinoxylan-oligosaccharide efficacy: a study on nutrient digestibility, viscosity, and scanning electron microscopy in the small and large intestine of growing pigs fed insoluble fiber

The experiment objective was to evaluate the impact of xylanase over time on viscosity and digestibility in growing pigs fed corn-based fiber. Twenty gilts with an initial body weight of 30.6 ± 0.2 kg (n = 5 per dietary treatment) were fitted with t-cannulae in the medial jejunum and terminal ileum, housed individually, and randomly assigned to one of four dietary treatments: low-fiber control (LF) with 10.4% total dietary fiber (TDF), 30% corn bran high-fiber control (HF; 26.4% TDF), HF + 100 mg xylanase/kg (XY; Econase XT 25P; AB Vista, Marlborough, UK), and HF + 50 mg arabinoxylan-oligosaccharide/kg (AX). Gilts were limit fed for three 17 d periods (P1, P2, P3); each included 5 d adaptation, 2 d fecal collection, 3 d ileal collection, 3 d jejunal collection, and 4 d related rate of passage study. Data were analyzed as repeated measures using a linear mixed model with surgery date as a random effect, and dietary treatment, period, and their interaction as fixed effects. Jejunal and ileal digesta viscosity did not differ among dietary treatments or periods (P > 0.10). There was a dietary treatment × period interaction for the apparent jejunal digestibility (AJD) of dry matter (DM), gross energy (GE), insoluble dietary fiber (IDF), neutral detergent fiber (NDF), total arabinoxylan (T-AX), total non-starch polysaccharide (T-NSP), and TDF (P 0.05). In P1, LF had the greatest AJD of DM (15.5%), and relative to HF and AX, XY decreased it (9.3%, 10.1 %, and 6.3%, respectively). In P2, the AJD of DM in XY was greater than HF (11.7% vs. 9.1%) but did not differ from AX (10.5%). Relative to HF, in P3, XY increased AJD of DM (11.7 vs 15.3%), and AX decreased it (7.2%). For the AJD of NDF, AX performed intermediately in P1; in P2, relative to HF, XY, and AX increased the AJD of NDF (8.4%, 13.1%, and 11.7%, respectively), and in P3, XY, and LF did not differ (13.6 vs. 14.4%). A similar response was observed for the AJD of IDF and TDF, except for XY having the greatest AJD of IDF, T-AX, T-NSP, and TDF in P3 (P This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited

Volatile basic nitrogen measurement in digesta using a Berthelot reaction in automated Skalar instrumentation

The undigested nitrogenous fraction entering the hindgut of chickens is further metabolized by microbiota present producing volatile basic metabolites including amines and ammonia (NH3). Ammonia increases pH and may result in overgrowth of Clostridium perfringens further producing toxic metabolites that cause dysbacteriosis or necrotic enteritis (NE). There are few reports in chickens examining the production and concentration of nitrogenous metabolites in the hindgut. A Berthelot reaction using an automated flow, reaction and spectrophotometric instrumentation to detect volatile basic nitrogen in the form of NH3 from cecal contents was carried out. In the Berthelot reaction, NH3 in the sample is chlorinated to monochloramine using dichloroisocyanuric acid that then reacts with salicylate to form 5-aminosalicylate which is stable under alkaline conditions (pH 12 to 13). After oxidation and oxidative coupling, a coloured complex is formed that can be measured at 660 nm. Cecal contents were collected and pooled from 2 birds per pen with 48 pens total in each of 3 experiments and stored in sealed containers at −20 °C prior to analysis. Experiment 1 compared samples collected from birds fed either no meat and bone meal (MBM) or 6% MBM from d 0 to 14, and samples collected from birds fed either no MBM or 5% MBM from d 14 to 42. All birds were challenged with Eimeria on d 9 and C. perfringens on d 14 and 15. Experiment 2 compared cecal contents from birds fed either 0.5% or 0.9% calcium (Ca), and Exp. 3 compared unchallenged with NE challenge on d 16 and 29. Results demonstrated an increase (

Supplementation of xylo-oligosaccharides to suckling piglets promotes the growth of fiber-degrading gut bacterial populations during the lactation and nursery periods

Modulating early-life microbial colonization through xylo-oligosacharides (XOS) supplementation represents an opportunity to accelerate the establishment of fiber-degrading microbial populations and improve intestinal health. Ninety piglets from 15 litters were orally administered once a day from d7 to d27 of lactation with either 5 mL of water (CON) or 5 mL of a solution containing 30 to 60 mg of XOS (XOS). Supplementation ceased at weaning (d28) when all piglets were fed the same commercial pre-starter diet. Growth performance did not differ between treatments during the experimental period (d7 to d40). Piglet's fecal microbiota (n = 30) shifted significantly from the end of lactation (d27) to nursery period (d40) exhibiting an increase in microbial alpha diversity. Animals supplemented with XOS showed higher richness and abundance of fiber-degrading bacteria and short-chain fatty acid (SCFA) production at d27 and d40. Additionally, the predicted abundance of the pyruvate to butanoate fermentation pathway was increased in the XOS group at d40. These results show that supplementation of XOS to lactating piglets promotes fiber-degrading bacterial populations in their hindgut. Moreover, differences observed in the nursery period suggest that XOS can influence the microbiota in the long-term

Dietary xylanase and live yeast supplementation influence intestinal bacterial populations and growth performance of piglets fed a sorghum-based diet

This study was to evaluate the effect of xylanase supplementation and the addition of live yeast, Saccharomyces cerevisiae, on growth performance and intestinal microbiota in piglets. One hundred and eighty commercial crossbred 23-d-old piglets (PIC 417) were sorted by initial BW and allocated to 3 treatments: control (CTR) diet, CTR diet supplemented with xylanase at 16,000 birch xylan units/kg (XYL) and XYL diet supplemented with live yeast (2 × 10 10 CFU/g) at 1 kg/t (XYL + LY). Each treatment had 10 replicates, with 6 animals each. A sorghum-based diet and water were available ad libitum for 42 d of the study. Average daily gain (ADG) and average daily feed intake (ADFI) were measured from 0 to 42 d (23- to 65-d-old) and feed conversion ratio (FCR) calculated. At the end of the study, bacterial identification through 16S rRNA (V3 to V4) sequencing of the ileal and caecal digesta from one piglet per replicate was performed. No treatment effects were observed on ADFI. Pigs offered the live yeast in addition to the xylanase had increased ADG compared with those supplemented with xylanase alone (XYL + LY vs. XYL; P = 0.655). FCR was improved with XYL and XYL + LY compared with CTR (P = 0.018). Clostridiaceae counts in the ileum tended to reduce by 10% with XYL and 14% with XYL + LY compared to CTR (P = 0.07). XYL and XYL + LY increased the counts of Lactobacillaceae in the caecum compared with CTR (P < 0.0001). Dietary supplementation of live yeast combined with xylanase improved growth performance and microbial balance of piglets during the nursery phase

Influence of particle size and xylanase in corn-soybean pelleted diets on performance, nutrient utilization, microbiota and short-chain fatty acid production in young broilers

The objective of this study was to investigate the effects of particle size and xylanase supplementation in corn-based pellet diets on the performance and digestive traits in young broilers. A total of 512 male Ross 308 broilers were used in a 21-day study. The treatments were designed in a 4 × 2 factorial arrangement with four levels of geometric mean diameter (Dgw) of corn (540, 660, 1390, and 1700 µm), and two levels of xylanase (0 or 16,000 BXU/kg diet). Feeding coarse corn diets (1390 and 1700 µm Dgw) and xylanase supplementation showed an inferior coefficient of variation of body weight. Higher gizzard weight, microbiome alpha-diversity, and clustered separately beta-diversity (p < 0.05) were observed in birds fed coarse diets. The addition of xylanase promoted changes in relative bacteria abundance, increasing Lachnospiraceae, Defluviitaleaceae, Bacteroidaceae, Bacillaceae, Eggerthellaceae, and Streptococcaceae families in the 1700 µm group, and Christensenellaceae and Lachnospiraceae families in the 540 µm Dgw group. In conclusion, xylanase supplementation and particle size of corn interact in the intestinal environment, showing changes in microbial composition. Coarse diets and xylanase supplementation showed improved body weight homogeneity, which might be related to a better gut development and microbiota modulation

The effects of exogenous xylanase supplementation on the in vivo generation of xylooligosaccharides and monosaccharides in broilers fed a wheat-based diet

1.This study aimed to quantify xylanase-induced changes in soluble monosaccharides, xylooligosaccharides (XOS) and volatile fatty acid (VFA) contents of the different sections of the GIT and whether these relate to altered bird performance. 2.An in vitro digestion of the wheat-based diet was carried out with the xylanase (Econase XT at 16,000BXU/kg diet) to compare the in vitro and in vivo generation of these XOS and monosaccharides. For the in vivo study, 80 male Ross 508 broiler chicks were split into two groups fed a wheat-based diet with or without Econase XT (16,000BXU/kg diet) for 21 days. 3.There were no effects of Econase XT inclusion on growth performance characteristics, likely a result of the high-quality wheat diet and corresponding high performance of the control group (FCR average of 1.45 in controls), but also the relatively young age (from 4 to 26 days of age).4.Econase XT supplementation increased the xylotetraose (X4) content in the colon (p=0.046, enzyme x GIT section interaction) and the xylose contents in the colon and caeca (p[less than]0.001, enzyme x GIT section interaction).5. The trend for increased acetate proportion in the caeca of Econase XT treated birds (p=0.062) suggests that the XOS generated were subsequently fermented in the caeca, potentially impacting upon the types of microbiota present.6. The present study suggests that wheat arabinoxylan degradation is enhanced by xylanase supplementation, which may increase the production of beneficial VFA in the caeca, and thereby potentially modulate the caecal microbiome, but without affecting bird performance (at this early stage)

Over-processed meat and bone meal and phytase effects on broilers challenged with subclinical necrotic enteritis: Part 3. Bone mineralization and litter quality

This study was conducted to determine the effect of necrotic enteritis (NE), phytase level and meat and bone meal (MBM) processing on bone mineralization of broilers and litter quality. Ross 308 male broiler chicks (n = 768) were allotted to 48 pens with 16 birds each. There were 8 dietary treatments in a 2 × 2 × factorial arrangement. Factors were NE challenge (no or yes), phytase level (500 or 5,000 FTU/kg), and MBM (as-received or over-processed). Half of the birds were challenged with field strains of Eimeria spp. at d 9 and 108 CFU per mL of Clostridium perfringens strain EHE-NE18 on d 14 and 15. The middle toe, tibia and femur of 2 birds per pen were excised at d 16 and 29 for determination of ash, breaking strength (BS) and bone mineralization. At d 42, all were assessed for hock burns and litter was scored and assessed for dry matter (DM). At d 16, challenged birds had lower toe ash (P P P P P P P P P P P = 0.058) and fewer hock burns than those unchallenged (

Over-processed meat and bone meal and phytase effects on broilers challenged with subclinical necrotic enteritis: Part 1. Performance, intestinal lesions and pH, bacterial counts and apparent ileal digestibility

This feeding study investigated the hypothesis that over-processing of meat and bone meal (MBM) would impair the performance, gut health and ileal digestibility of nutrients in birds challenged with necrotic enteritis (NE). The effect of phytase (500 vs. 5,000 FTU/kg) was also examined using manufacturers recommended matrix values for 500 FTU for both levels. Ross 308 male broilers (n=768) were assigned to 8 diets, with 6 replicate pens per diet and 16 birds per replicate pen using a randomized design with a factorial arrangement of treatments. Factors were NE challenge (no or yes), MBM (as received or over-processed), and phytase level (500 or 5,000 FTU/kg). Half of the birds were challenged with 5,000 oo-cysts offield strains of Eimeria acervulina and Eimeria brunetti, and 2,500 oocysts of Eimeria maxima on d 9 and 108 CFU/mL of Clostridium perfringens strain EHE-NE18 on d 14 and 15 post-hatch. Challenge × MBM interactions were detected for weight gain (WG), feed conversion ratio (FCR) and feed intake (FI) at d 14, 21 and 28, showing that challenged birds fed over-processed MBM had decreased WG (PPPPP&gt;0.05) at d 28. Birds fed low phytase had increased livability (0.05) at d 28. Birds fed low phytase had increased livability (PPPPPPPPPLactobacillus spp. (PC. perfringens(