Plumage Response of Young Turkeys to Diets with Increased Methionine to Lysine Ratios at Three Dietary Arginine Levels

A 2 × 3 factorial experiment was conducted to evaluate the effects of two dietary methionine levels (Met; 30% and 45% of Lys content) and three arginine levels (Arg; 90%, 100%, and 110% of Lys content) on plumage development in 4- and 16-week-old female turkeys. One-day-old turkey poults were assigned to six groups (eight replicate pens per group and 18 birds per pen) and fed experimental diets containing 1.6%, 1.5%, 1.3%, and 1.0% of Lys in four successive four-week periods. After weeks 4 and 16 of feeding, eight turkeys per group were selected for plumage evaluation. Feathers were collected from the outer side of one thigh and from an area of 4 cm2 in the interscapular region. Plumage was evaluated based on an established pattern of five feather development stages in turkeys, from stage I (pinfeathers covered in sheaths) to stage V (mature feathers). An increase in the Met inclusion rate to 45% of Lys content had no significant effect on feather growth in 4-week-old turkeys, but it accelerated the development of feathers in 16-week-old birds. A lower percentage of stage II (p = 0.035), stage III (p = 0.019), and stage IV (p = 0.003) immature feathers, and a higher percentage of stage V (mature) feathers (p = 0.001) were observed. Methionine exerted a greater effect on the development of thigh feathers (p = 0.001) than interscapular feathers (p = 0.074). Unlike Met, different Arg concentrations had no influence on plumage development in turkeys. Overall, the present results indicate that supplemental Met has a potential for accelerating feather development in 16-week-old turkeys via an increased supply of total sulfur amino acids.

Cutaneous Mucormycosis of the Interscapular Region in an Immunocompetent Patient

Mucormycosis is an invasive fungal infection caused by opportunistic fungi of the phylum Glomeromycotan, subphylum Mucormycotina, mainly affecting individuals with immunosuppression. Cutaneous mucormycosis is the third most common clinical form of the disease preceded by pulmonary and rhinocerebral mucormycosis. The usual factors predisposing to this infection are individuals who are immunocompromised with conditions like HIV, haematological malignancies, and diabetes mellitus, but a significant proportion of patients are immunocompetent. The agents of mucormycosis are abundantly present in nature and are transmitted to the skin by direct inoculation. It may be due to needle sticks, stings, and bites by animals, motor-vehicle accidents, natural disasters, and burn injuries. The clinical presentation is non-specific, but an indurated plaque that rapidly evolves to necrosis (eschar) is a common finding. The infection can invade locally, and also penetrate into the adjacent fat, muscle, fascia, and bone, or become disseminated. It is difficult to diagnose because of the non-specific presentation of mucormycosis. Biopsy and culture should be performed. Treatment consists of multidisciplinary management, including surgical debridement, use of antifungal drugs (amphotericin B and posaconazole), and reversal of underlying risk factors, when possible. Mortality rates are significant, ranging from 4% to 10% in localised mucormycosis infection, but are lower than the other forms of the disease. The authors present a case here of a 38-year-old immunocompetent male with cutaneous mucormycosis at the interscapular region.

MORPHOLOGY OF HUMAN ADIPOSE TISSUE

The risk of developing metabolic complications in obesity depends on the topography of excess adipose tissue. Adipose tissue is the main source of energy and also performs an endocrine function secreting substances that affect the sensitivity of tissues to insulin. The article describes the characteristics of histological preparations of adipose tissue samples taken from the omentum of middle-aged human cadavers with no confirmed diseases of the digestive system and of subcutaneous adipose tissue samples from interscapular region in the human dead foetuses. Microscopy of sections of adipose tissue from the omentum and subcutaneous adipose tissue from the interscapular region of the foetus revealed that it consisted of lobes and microvessels. Lobes of adipose tissue of a human large omentum consist of polygonal white adipocytes containing in their cytoplasm a nucleus displaced to the periphery and a fat drop. The subcutaneous adipose tissue taken from the interscapular region of the foetus consists of brown adipocytes with a nucleus located in the centre of the cytoplasm and surrounded by numerous fat droplets. Brown adipocytes when compared with white adipocyted are smaller and rounded in shape. Brown adipose tissue predominates in women than in men. Brown adipose tissue is not active all the time, but only at low ambient temperatures. In women, brown adipocytes are more saturated with mitochondria than in men. Adipose tissue of a human omentum can be a source of graft implant for restoring abdominal organ defects during extensive surgical operations.

Severe Pulmonary Air Leak Complicating Neonatal Resuscitation

Air leaks are an important respiratory morbidity in neonates and can result from positive pressure breaths administered at birth. The presentations can vary from being asymptomatic to severe respiratory distress and hypoxaemia. This report is about a term boy who presented with respiratory distress immediately after birth, following resuscitation. He also had a diffuse swelling in the nape of the neck and interscapular region with crepitus on palpation. Serial chest radiographs initially revealed a pneumomediastinum and a subcutaneous emphysema, followed later by a right-sided pneumothorax. After chest drain insertion and supportive care, the air leaks resolved, with no residual complications. Severe air leaks with multi-site air tracking can rarely complicate positive pressure administration at birth, requiring timely intervention to optimise outcomes.

The RET C611Y mutation causes MEN 2A and associated cutaneous lichen amyloidosis

Background Cutaneous lichen amyloidosis (CLA) has been reported in some multiple endocrine neoplasia type 2A (MEN 2A) families affected by specific germline RET mutations C634F/G/R/W/Y or V804M, as a characteristic of the clinical manifestation in ‘MEN 2A with CLA’, one of four variants of MEN 2A, which was strictly located in the scapular region of the upper back. Patient Findings This study reports a large south-eastern Chinese pedigree with 17 individuals carrying the MEN 2A-harboring germline C611Y (c.1832G>A) RET mutation by Sanger sequencing. One individual presented MEN 2A-related clinical features, including typical CLA in the interscapular region; another individual exhibited neurological pruritus and scratching in the upper back but lacked CLA skin lesions. Both subjects presented with CLA or pruritic symptoms several years before the onset of medullary thyroid carcinoma (MTC) and/or pheochromocytoma. The remaining 15 RET mutation carriers did not exhibit CLA; of these, one presented with MTC and pheochromocytoma, nine with MTC only, two with elevated serum calcitonin and three younger subjects with normal serum calcitonin levels. This family’s clinical data revealed a later diagnosis of MTC (mean age, 45.9 (range: 23–73) years), a lower penetrance of pheochromocytoma (2/17, 11.8%) and CLA (1/17, 5.9%). However, no hyperparathyroidism and Hirschsprung disease were reported in this family. Summary and Conclusions This is the first description of a family with MEN 2A-related CLA due to a germline RET C611Y mutation, which might exhibit a novel and diversified genotype–phenotype spectrum in MEN 2A.

T4 SYNDROME

T4 syndrome is a rare and perhaps underestimated clinical subject that deserves attention. It is a syndrome of pain and pathology in different areas: upper back, scapulas, interscapular region, arms, forarms, hands, cervical and lumbar spines. Symptoms can occur on one side or on both sides. The purpose of this article is to present current knowledge contained in the literature about the T4 syndrome and to supplement the theoretical information w i t h p r a c t i c a l a s p e c t s o f t h e examination of the region.

Tissue Integration of Synthetic Grafts and the Impact of Soft-Tissue Infection – An Experimental Model

Objective: Starting with the ‘Vinyon-N-revolution’ of the 50’s, there has been a constant interest in understanting tissue integration, or the so-called graft healing process, as well as its relationship with infection. In this study we present an experimental animal model designed to assess tissue integration of different graft materials, and their reaction to the presence of infection.Methods: Synthetic grafts (knitted Dacron®, woven Dacron®, silver-impregnated Dacron® and Gore-Tex®) were implanted subfascially in the interscapular region of Wistar rats. Animals were divided into a control group and an infected group, with infection induced using bacterial suspensions of standard strains of Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Implants were retrieved at 2 and 4 weeks postoperatively in the control group and at 1, 2 and 3 weeks postoperatively in theinfected group. Retrieved grafts were assessed bacteriologically and morpho-pathologically.Results: All microorganisms produced clinically evident infections, with positive blood cultures in case of E. coli. Staphylococci produced more massive infections on Dacron® grafts, except for the silver-impregnated version, while E. coli produced more significant infections on Gore-Tex® grafts. Morpho-pathologically Dacron® grafts behaved poorly, with ocassional complete structural compromise, and no difference between the conventional and the silver-impregnated type. The Gore-Tex® graft showed a consistent structural resistance throughout the study period.Conclusions: Although the silver-impregnated graft inhibited bacterial growth, it was poorly tolerated by the host tissue. In contrast, Gore-Tex® grafts showed more massive infection, especially with E. coli, but kept their structural integrity surprisingly well.