Palm kernel meal in broiler diets: effect on chicken performance and health

An increase in the production of palm kernel meal (PKM) coupled with the concern for continued availability of conventional feedstuffs in some parts of the world has led to research to establish the maximum inclusion level of palm kernel meal in broiler diets. The results suggested that palm kernel meal has no anti-nutritional properties and thus its inclusion is safe up to at least 40% in the diet, provided the diet is balanced in amino acids and metabolisable energy. Although feed digestibility is decreased due to high dietary fibre when PKM is included in the diet, the feed intake is increased. This makes total digestible nutrient intake relatively high. beta-mannan is the main component of palm kernel meal non-starch polysaccharide (NSP). Both mannose and manno-oligosaccharides have been reported to act as prebiotics. The inclusion of palm kernel meal in the diet improves the immune system of birds and reduces pathogenic bacteria and increases the population of nonpathogenic bacteria in the intestine. These two benefits should be considered as strong recommendations for using palm kernel meal in broiler diets, particularly in palm kernel meal producing countries, not only for increasing bird productivity but also to improve chicken health. Selective enzyme addition increases feed efficiency and digestibility as well as decreasing the moisture content of faeces.

Intracardiac echo guided valvuloplasty of a stenotic tricuspid prosthetic valve in a patient with idiopathic hypereosinophilic syndrome

A 52-year-old male with idiopathic hypereosinophilic syndrome (HES) was transferred to our institution following the development of acute respiratory failure and shock. He had previously undergone tricuspid valve replacement with bioprosthetic valves on two occasions: the initial surgery for severe native tricuspid valve stenosis and the redo surgery for severe prosthetic valve stenosis and regurgitation. Conventional imaging assessment using transoesophageal echocardiography was suboptimal and comprehensive assessment of prosthetic valve function was aided by the use of intracardiac echocardiography (ICE). ICE provided high quality 2D imaging of the prosthesis demonstrating thrombus-like material coating the inner surfaces of the prosthetic valve stents effectively forming a tunnel-like obstruction. Unusual hemodynamics secondary to severe tricuspid stenosis were demonstrated by CW Doppler with intermittent signal fusion resulting from blunted respiratory variation in the markedly elevated right atrial pressure relative to right ventricular pressure. Successful balloon valvuloplasty was performed with ICE proving highly valuable in guiding balloon position as well as monitoring the efficacy of the subsequent inflations.

Accuracy of strain rate techniques for ientification of viability at dobutamine stress echo: A follow-up study after revascularization

Background. Myocardial viability (VM) assessment based on wall motion scoring (WMS) with dobutamine echo (DbE) is difficult and subjective. New quantitative techniques such as strain rate imaging (SRI) correspond with isotopic techniques but their ability to predict functional recovery (FR) after revascularization is unclear. Methods. Stable post-MI pts (n=43, age 63±9, EF 36±6%) underwent SRI during DbE. WMS evidence of VM was based on lowdose augmentation at DbE. SR, end-systolic strain (ESS), post-systolic strain (PSS) and timing were analyzed at rest and low dose in abnormal segts. Pts were followed for 9±12 months; FR was defined as segt improvement on post-revascularization images. Results: Of 180 segts with abnormal resting function, 83 showed FR and 97 did not. Resting parameters were not predictive of recovery; resting post-systolic shortening had a sensitivity and specificity

Can myocardial contrast echo provide incremental benefit to exercise echo? Implications of the intensity and duration of hyperaemia

Background. Stress myocardial contrast echo (MCE) is technically challenging with exercise (Ex) because of cardiacmovementandshort duration ofhyperemia.Vasodilators solve these limitations, but are less potent for inducing abnormal wall motion (WM). We sought whether a combined dipyridamole (DI; 0.56 mg/kg i.v. 4 min) and Ex stress protocol would enable MCE to provide incremental benefit toWManalysis for detection of CAD. Methods. Standard echo images were followed by real time MCE at rest and following stress in 85 pts, 70 undergoing quantitative coronary angiography and 15 low risk pts.WMAfrom standard and LVopacification images, and then myocardial perfusion were assessed sequentially in a blinded fashion. A subgroup of 13 pts also underwent Ex alone, to assess the contribution of DI to quantitative myocardial flow reserve (MFR). Results. Significant (>50%) stenoses were present in 43 pts, involving 69 territories. Addition of MCE improved SE sensitivity for detection of CAD (91% versus 74%, P = 0.02) and better appreciation of disease extent (87% versus 65%territories, P=0.003), with a non-significant reduction in specificity. In 55 territories subtended by a significant stenosis, but with no resting WM abnormality, ability to identify ischemia was also significantly increased by MCE (82% versus 60%, P = 0.002). MFR was less with Ex alone than with DIEx stress (2.4 ± 1.6 versus 4.0 ± 1.9, P = 0.05), suggesting prolongation of hyperaemia with DI may be essential to the results. Conclusions. Dipyridamole-exercise MCE adds significant incremental benefit to standard SE, with improved diagnostic sensitivity and more accurate estimation of extent of CAD.

Determinants of visual 2-D echo assessment of left ventricular wall motion: Comparison with myocardial thickening on cardiac magnetic resonance imaging

Background: left ventricular wall motion on 2d echo (2de) is usually scored visually. we sought to examine the determinants of visually assessed wall motion scoring on 2de by comparison with myocardial thickening quantified on MRI. Methods: using a 16 segment model, we studied 287 segments in 30 patients aged 61+/ -11 years (6 female), with ischaemic LV dysfunction (defined by at least 2 segments dysfunctional on 2de). 2de was performed in 5 views and wall motion scores (WMS) assigned: 1 (normal) 103 segments, 2 (hypokinetic) 93 segments, 3 (akinetic) 87 segments. MRI was used to measure end systolic wall thickness (ESWT), end diastolic wall thickness (EDWT) and percentage systolic wall thickening (SWT%) in the plane of the 2de and to assess WMS in the same planes visually. No patient had a clinical ischemic event between the tests. Results: visual assessment of wall motion by 2de and MRI showed moderate agreement (kappa = 0.425). Resting 2de wall motion correlated significantly (p