Influence of dietary non-phytate phosphorous levels and phytase supplementation on the performance and bone characteristics of broilers

Precise phosphorus nutrition is important for significant reductions in both P pollution and ration costs. The influence of different levels (%) of dietary nPP fed from 0 to 20 d (0.45, 0.40, 0.35, 0.30, 0.25, compared with feeding 0.20 nPP with and without 500 F.T.U. of phytase per kg of diet) and from 21 to 36 d of age (0.414, 0.364, 0.314, 0.264, 0.214, compared with 0.164 nPP with and without 500 F.T.U. of phytase per kg of diet) were evaluate using a total of 588 day-old commercial broiler chicks. Each treatment was replicated four times in a completely randomized design. Body weight (BW), daily gain (DG), feed intake (DFI), feed conversion ratio, plasma P level and bone characteristics were determined, and from these data the P equivalency of the phytase was estimated. Feeding diets containing less than 0.40% of nPP to birds between 0 and 20d resulted in inferior BW, DFI, plasma P level and bone characteristics compared with the control. However, optimum FCR and mortality was supported at lower levels of nPP (0.25%). Between 21 and 36 d, 0.364% was enough to optimise BW, DFI, and femur ash (%); whilst only 0.314% or greater was needed to support optimum DG, toe and tibia ash and only 0.214 to 0.264% was required to optimise shank, femur and tibia lengths; FCR and survivability. A broken line analysis also showed that the nPP (%) requirement ranged from 0.267 to 0.410 and 0.272 to 0.380% during 0 to 20 and 21 to 36 d, respectively. Phytase supplementation improved performance and bone criterion and its P equivalency, depending upon the response of interest and birds age, ranged from 0.00 to 0.110%. In conclusion, the results showed that the combination of a lower level of nPP and phytase may be used to increase dietary P utilization, without severe changes in performance and bone quality

Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial

BACKGROUND: Previous studies have suggested that sigmoidectomy with primary anastomosis is superior to Hartmann's procedure. The likelihood of stoma reversal after primary anastomosis has been reported to be higher and reversal seems to be associated with lower morbidity and mortality. Although promising, results from these previous studies remain uncertain because of potential selection bias. Therefore, this study aimed to assess outcomes after Hartmann's procedure versus sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy, for perforated diverticulitis with purulent or faecal peritonitis (Hinchey III or IV disease) in a randomised trial. METHODS: A multicentre, randomised, open-label, superiority trial was done in eight academic hospitals and 34 teaching hospitals in Belgium, Italy, and the Netherlands. Patients aged between 18 and 85 years who presented with clinical signs of general peritonitis and suspected perforated diverticulitis were eligible for inclusion if plain abdominal radiography or CT scan showed diffuse free air or fluid. Patients with Hinchey I or II diverticulitis were not eligible for inclusion. Patients were allocated (1:1) to Hartmann's procedure or sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy. Patients were enrolled by the surgeon or surgical resident involved, and secure online randomisation software was used in the operating room or by the trial coordinator on the phone. Random and concealed block sizes of two, four, or six were used, and randomisation was stratified by age (<60 and ≥60 years). The primary endpoint was 12-month stoma-free survival. Patients were analysed according to a modified intention-to-treat principle. The trial is registered with the Netherlands Trial Register, number NTR2037, and ClinicalTrials.gov, number NCT01317485. FINDINGS: Between July 1, 2010, and Feb 22, 2013, and June 9, 2013, and trial termination on June 3, 2016, 133 patients (93 with Hinchey III disease and 40 with Hinchey IV disease) were randomly assigned to Hartmann's procedure (68 patients) or primary anastomosis (65 patients). Two patients in the Hartmann's group were excluded, as was one in the primary anastomosis group; the modified intention-to-treat population therefore consisted of 66 patients in the Hartmann's procedure group (46 with Hinchey III disease, 20 with Hinchey IV disease) and 64 in the primary anastomosis group (46 with Hinchey III disease, 18 with Hinchey IV disease). In 17 (27%) of 64 patients assigned to primary anastomosis, no stoma was constructed. 12-month stoma-free survival was significantly better for patients undergoing primary anastomosis compared with Hartmann's procedure (94·6% [95% CI 88·7-100] vs 71·7% [95% CI 60·1-83·3], hazard ratio 2·79 [95% CI 1·86-4·18]; log-rank p<0·0001). There were no significant differences in short-term morbidity and mortality after the index procedure for Hartmann's procedure compared with primary anastomosis (morbidity: 29 [44%] of 66 patients vs 25 [39%] of 64, p=0·60; mortality: two [3%] vs four [6%], p=0·44). INTERPRETATION: In haemodynamically stable, immunocompetent patients younger than 85 years, primary anastomosis is preferable to Hartmann's procedure as a treatment for perforated diverticulitis (Hinchey III or Hinchey IV disease). FUNDING: Netherlands Organisation for Health Research and Development.status: publishe