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Medical Forum / General / Nutrition / July 2008Recycled fats used as animal feed
http://www.darlingii.com/FatsnOils.aspx says: "Feed grade fat, or yellow grease, is also produced through the rendering process, but is more commonly produced by recycling the used cooking oil we pick up from restaurants and food processing facilities. This product is used as a high-energy liquid feed additive in livestock and pet foods." Do others see a problem with this? -- Ron "http://www.darlingii.com/FatsnOils.aspx says: "Feed grade fat, or yellow grease, is also produced through the rendering process, but is more commonly produced by recycling the used cooking oil we pick up from restaurants and food processing facilities. This product is used as a high-energy liquid feed additive in livestock and pet foods." Do others see a problem with this?" As it is an effort to recycle a by product there is nothing that jumps out. What do you have in mind? > "http://www.darlingii.com/FatsnOils.aspx says: > "Feed grade fat, or yellow grease, is also produced through the [quoted text clipped - 7 lines] > As it is an effort to recycle a by product there is nothing that jumps > out. What do you have in mind? Probably closing the loop by feeding an animal with its own species, providing a pathway for spreading an infectious agent. > "http://www.darlingii.com/FatsnOils.aspx says: > "Feed grade fat, or yellow grease, is also produced through the [quoted text clipped - 7 lines] > As it is an effort to recycle a by product there is nothing that jumps > out. What do you have in mind? "Probably closing the loop by feeding an animal with its own species, providing a pathway for spreading an infectious agent." What agent would survive the temperature of boiling tallow? > "Probably closing the loop by feeding an animal with its own species, > providing a pathway for spreading an infectious agent." > > What agent would survive the temperature of boiling tallow? Prions remain infectious even after exposure to much higher temperatures. > "Probably closing the loop by feeding an animal with its own species, > providing a pathway for spreading an infectious agent." > > What agent would survive the temperature of boiling tallow? "Prions remain infectious even after exposure to much higher temperatures." They do not appear in rendered fat. > > "Probably closing the loop by feeding an animal with its own species, > > providing a pathway for spreading an infectious agent." [quoted text clipped - 5 lines] > > They do not appear in rendered fat. What's your source for that? > "Prions remain infectious even after exposure to > much higher temperatures." > > They do not appear in rendered fat. "What's your source for that?" They are found in brain and spinal tissue. > > "Prions remain infectious even after exposure to > > much higher temperatures." [quoted text clipped - 4 lines] > > They are found in brain and spinal tissue. And the intestines. Also note that the brain and spinal cord are about half fat. Why wouldn't they be rendered along with the offal and scraps? You seem to have reached a conclusion based on incorrect assumptions. > > "Prions remain infectious even after exposure to > > much higher temperatures." [quoted text clipped - 4 lines] > > They are found in brain and spinal tissue. "And the intestines. Also note that the brain and spinal cord are about half fat. Why wouldn't they be rendered along with the offal and scraps? You seem to have reached a conclusion based on" incorrect assumptions." They are in the intestines only if recently ingested. If intended for human consumption brain and spinal tissue are reserved and not allowed to mix with other products. On Jul 28, 5:54 pm, ferr...@ironcity.com wrote: > > > "Prions remain infectious even after exposure to > > > much higher temperatures." [quoted text clipped - 14 lines] > human consumption brain and spinal tissue are reserved and not allowed to > mix with other products. It is a fair bet that the whole animal is rendered. They aren't going to trim animals that are already beginning to rot. Rendering plants are noted for their powerful odor. A rendering operations of the past would render just about anything that has walked the earth even roadkill. And this is likely still true somewhere. > They are in the intestines only if recently ingested. =A0If intended for > human consumption brain and spinal tissue are reserved and not allowed to > mix with other products. "It is a fair bet that the whole animal is rendered. They aren't going to trim animals that are already beginning to rot. Rendering plants are noted for their powerful odor. A rendering operations of the past would render just about anything that has walked the earth even roadkill. And this is likely still true somewhere." Then you would lose your bet. The ag dept. is always nagging packers to avoid even over zealous removel of tissue too close to the spinal cord. Cooking tallow is rendered mostly from meat trimmings and some other parts secondairly such as bone. On Jul 29, 5:34 am, ferr...@ironcity.com wrote: > > They are in the intestines only if recently ingested. =A0If intended for > > human consumption brain and spinal tissue are reserved and not allowed [quoted text clipped - 11 lines] > Cooking tallow is rendered mostly from meat trimmings and some other parts > secondairly such as bone. Then it is a reform and certainly has not been a practice in the past. On Jul 29, 10:21 am, "trigonometry1...@gmail.com |" <trigonometry1...@gmail.com> wrote: > On Jul 29, 5:34 am, ferr...@ironcity.com wrote: > [quoted text clipped - 15 lines] > > Then it is a reform and certainly has not been a practice in the past. Meat packers aren't like the rendering plant that formerly was in a nearby town that processed dead, rotting, and sick cattle and horses. Nor can we assume all meat is watched over by the USDA as there are other nations with various regs and levels of enforcement. Indeed, I am left wondering just how separate meat packing plants are from rendering operations. Without having a complete knowledge of every reg and every pathway into which scraps, spinal parts, nervous tissue and etc are directed, I will have some concern. In my experience when someone says "all is better", it isn't or it only changed later. As the saying goes "the dead optimism got what he deserved, the dead pessimist got what he expected." Trig > "Feed grade fat, or yellow grease, is also produced through the > rendering process, but is more commonly produced by recycling the used [quoted text clipped - 3 lines] > > Do others see a problem with this? Induction of lipid peroxidation in biomembranes by dietary oil components. Prooxidant formation and resulting lipid peroxidation are supposed to be involved in the pathogenesis of various diseases including cancer. Cancer risk is possibly influenced by the composition of diet with high intake of fat and red meat being harmful and high consumption of fruits and vegetables being protective. Since dietary oils may contain potential prooxidants, the aim of the present study was to prove (i) whether oxidative stress in biomembranes may be induced by dietary oils and if, (ii) which impact it has on the viability and proliferation of cultured colon (carcinoma) cells. Lipid hydroperoxide content in dietary oils increased after heating. Linoleic acid hydroperoxide (LOOH) and/or oils with different hydroperoxide contents induced lipid peroxidation in liposomes, erythrocyte ghosts and colon cells. Upon incubation with liposomes, both LOOH and heated oil induced lipid peroxidation only in the presence of iron and ascorbate. LOOH was sufficient to start lipid peroxidation of erythrocyte ghosts. LOOH incorporates into the lipid bilayer decreasing membrane fluidity and initiating lipid peroxidation in the lipid phase. When cultured cells (IEC18 intestinal epithelial cells, SW480 and HT29/HI1 colon carcinoma cells) were exposed to LOOH, they responded by cell death both via apoptosis and necrosis. Cells with higher degree of membrane unsaturation were more susceptible and antioxidants (vitamin E and selenite) were protective indicating the involvement of oxidative stress. Thus, peroxidation of biomembranes can be initiated by lipid hydroperoxides from heated oils. Dietary consumption of heated oils may lead to oxidative damage and to cell death in the colon. This may contribute to the enhanced risk of colon cancer due to regenerative cell proliferation. PMID: 12963000 The study cited appears to be: Food and Chemical Toxicology, Volume 41, Number 11, November 2003 , pp. 1481-1489(9). And yes, this is a major problem, but you don't have to eat meat (an if you do, you don't have to cook it, but rather can freeze it for more than two weeks first)! And you don't have to use such oils. I use butter and coconut oil, and I don't cook with either one. Mostly, I just make tea and coffee with high heat, nothing else. You can also eat organic, which may or may not help. In any case, you can minimize this problem, probably significantly. > You can also eat organic, which may or may not help. From http://orgprints.org/10175/01/NJAS_54-2_207-222.pdf Dioxins in organic eggs: a review Eggs contribute for about 4% to the daily dioxin intake of humans. Research among layer farms in the Netherlands and other EU countries has shown that organic eggs contain more dioxin than conventional ones and that a significant number of organic farms produce eggs with a dioxin content that exceeds the EU standard. The hens’ intake of dioxins from various sources leads to an increase in the dioxin content of organic eggs. These sources include plants, feed, soil, worms and insects, and compared with hens on conventional and free- range farms, organic hens make more use of these sources due to better access to the outdoor run. Plants appear to be relatively unimportant as a source of dioxins. Also commercial organic feed generally has very low dioxin contents, but not much is known about non-commercial feed. Consumption of worms and insects and particularly ingestion of soil are important causes of high dioxin levels in eggs. Management interventions, like a reduction of the time the hens spend outside, may decrease the dioxin levels in organic eggs but at the same time may interfere with the image of the organic production system. ... > You can also eat organic, which may or may not help. http://www.justgourmet.org/2008/dioxin-levels-significantly-higher-in-organic-milk/ Dioxin Levels Significantly Higher in Organic Milk Coal-fired electricity stations send dioxins into the air as the smoke is dispersed. Also, dioxins come from all types of factory wastes, commercial incineration, traffic pollution, industrial emissions, fires, and many other chemical and industrial processes. Tests show dioxins to be the most potent carcinogen known to man. Many studies show that dioxins cause serious illness in humans, including a variety of cancers, kidney disease, birth defects, poor health and premature death. Unfortunately, dioxins are just about everywhere in nature because they get carried by weather patterns, rain, ocean currents, and wind to all parts of the globe. Dioxins settle on pastures, and on plants and grains that form part of the food chain for animals and humans. Although there is little we can do to escape dioxins altogether, we can minimize the amount that goes into our body by avoiding certain foods. Dioxins are found in equal measure in both organic and non- organic food. Dioxins do not come from pesticides or fertilizers - they come from the environment at large and even from the water supply. Our bodies can usually cope with a low level of dioxins. Some get flushed out instead of being absorbed into the body to cause illness. We can reduce the amount of dioxins we get by avoiding foods high in dioxins. The question is: which food is highest in dioxins? Weight for weight, dairy milk has by far the highest amount of dioxins than any other food or drink. All mammals produce milk for feeding to their babies (including humans). The dioxins in the mother’s body get concentrated in her breast milk. This occurs, because all nutrients (including dioxins) get concentrated in breast milk as a way of providing good rich nourishment to the new born. Consequently, just about all human breast milk has an undesirable concentration of dioxins. But a baby stops breastfeeding after a few months so the level of dioxins received by the baby drops off. Another factor is that human milk has a much lower concentration of dioxins compared to dairy milk. But for a milk consumer it’s a different story. Over time, the daily consumption of dairy milk results in a dangerous build up of dioxins in the body, causing below-par health, serious disease, and premature death. There are plenty of studies showing that dairy milk has the highest concentration of dioxins compared to any other food product: ‘Dioxins penetrate the environment via air, water and soil and are then incorporated in food chains. The major source of human exposure to dioxins (90%) is consumption of .dairy products.’ (Professor Rocz Panstw, Zakl Hig, 1999, 50:3). ‘The primary source of dioxins is food, especially .dairy products.’ (Chemosphere, 1998 Oct, 37:9). ‘The lipophilic nature of dioxins.may result in relatively high concentrations of dioxin contamination in dairy products.’ (Journal of Animal Science, 1998 Jan, 76:1). ‘Cows’ milk is ideal for assessing levels because these compounds adhere to fat and are transferred to and eliminated in the milk of the lactating animal.’ (Linda Fitzpatrick, Cork Harbour Alliance for a Safe Environment, 2005). All types of dairy milk contain dioxins in varying amounts, including organic milk. But over eighty percent of organic milk sold in the world is UHT milk (Long Life milk). In the Americas and most of Europe just about all organic milk is UHT milk. With UHT milk you receive significantly more dioxins than regular pasteurized milk because more dioxins become absorbed instead of being excreted. This happens because the micronized fat globules in UHT milk are very much smaller than in non-UHT milk. Consequently, more dioxins from the milk get into the bloodstream. > > You can also eat organic, which may or may not help. > [quoted text clipped - 78 lines] > are very much smaller than in non-UHT milk. Consequently, more dioxins > from the milk get into the bloodstream. The dioxins would be coming in part from the coated bleached paperboard. So I'll suggest it is not the size of fat globules but the packaging and length of storage of the milk in contact with this type of packaging. > > ... micronized fat globules in UHT milk ... > [quoted text clipped - 3 lines] > and length of storage of the milk in contact with this type of > packaging. Evaluation of milk fat-globule membrane (MFGM) emulsion for oral administration: absorption of alpha-linolenic acid in rats and the effect of emulsion droplet size. The performance of milk fat-globule membrane (MFGM) emulsion as an oral dosage form was evaluated in rats using [14C]alpha-linolenic acid as a lipophilic model solute. For emulsions prepared by homogenization alone, the area under the plasma concentration versus time curve (AUC) after oral administration tended to be larger for MFGM emulsion, 35.0 +/- 2.5 micrograms eq.h/ml (mean +/- S.E., n = 3), than for Tween 80 emulsion, 28.5 +/- 0.6 micrograms eq.h/ml at p < 0.1, though the peak plasma concentration (Cmax) and the time required to reach Cmax (Tmax) were not significantly different. The absorption in the intestinal loop was not significantly different between the two emulsions, either. Thus, MFGM emulsion, compared with Tween 80 emulsion, did not show an obvious advantage or enhancement in the oral and intestinal absorption of alpha-linolenic acid, except for a slight increase in AUC. However, MFGM could be a good alternative to a synthetic emulsifier for oral use, considering that it is of natural origin and may be safer. In addition, it was shown that the AUC, as well as the absorption in the intestinal loop, was decreased for a MFGM emulsion in which the droplet size was reduced by sonication, presumably because of the observed decrease in alpha-linolenic acid concentration in the water phase, which was assumed to be the result of an increased distribution of alpha-linolenic acid, due to its amphipathic nature, to the increased oil-water interface. PMID: 7920450 Status of the PCDD and PCDF contamination of commercial milk caused by milk cartons. Within the scope of this study, possible migration of polychlorinated dibenzodioxins and -furans (PCDDs/PCDFs) from cartons (produced using bleached cardboard) into cow's milk was investigated. Three different types of carton were examined. The milk samples were taken at different times of storage and analysed for PCDDs/PCDFs. In contrast to a similar study carried out in 1990, the I-TEQ-results of all cartons analysed may be considered very low. No significant migration of toxic (2,3,7,8-chlorine-substituted) PCDDs/PCDFs could be observed. This is due to the very low PCDD/PCDF concentrations in modern cardboards as a result of the elemental chlorine-free (ECF) bleaching processes used. As far as the milk samples are concerned, no influence of the cardboards (according to the I-TEQ data) could be ascertained. I-TEQ concentrations in milk did not noticeably change during storage times of three, six and eight days. The I-TEQ-data obtained for all milk samples was found to be in the range typical of background concentrations in cow's milk in Germany. Although 1,2,7,8-TCDF is not included in the calculation of the TEQ (no 2,3,7,8-chlorine- substitution), analysis of this congener in cardboard samples was also carried out as a matter of general interest for cardboard investigations and an indicator of pulp bleaching with free chlorine. PMID: 16434079 Newspapers and newspaper ink contain agonists for the ah receptor. Ligand-dependent activation of the aryl hydrocarbon receptor (AhR) pathway leads to a diverse array of biological and toxicological effects. The best-studied ligands for the AhR include polycyclic and halogenated aromatic hydrocarbons, the most potent of which is 2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD). However, as new AhR ligands are identified and characterized, their structural and physiochemical diversity continues to expand. Our identification of AhR agonists in crude extracts from diverse materials raises questions as to the magnitude and extent of human exposure to AhR ligands through normal daily activities. We have found that solvent extracts of newspapers from countries around the world stimulate the AhR signaling pathway. AhR agonist activity was observed for dimethyl sulfoxide (DMSO), ethanol, and water extracts of printed newspaper, unprinted virgin paper, and black printing ink, where activation of luciferase reporter gene expression was transient, suggesting that the AhR active chemical(s) was metabolically labile. DMSO and ethanol extracts also stimulated AhR transformation and DNA binding, and also competed with [(3)H]TCDD for binding to the AhR. In addition, DMSO extracts of printed newspaper induced cytochrome P450 1A associated 7- ethoxyresorufin-O-deethylase activity in zebrafish embryos in vivo. Although the responsible bioactive chemical(s) remain to be identified, our results demonstrate that newspapers and printing ink contain relatively potent metabolically labile agonists of the AhR. Given the large amount of recycling and reprocessing of newspapers throughout the world, release of these easily extractable AhR agonists into the environment should be examined and their potential effects on aquatic organisms assessed. PMID: 18203687 Industrial chemical contamination of foods. The chemical contamination of foods via industrial activity is varied and widespread with regard to both chemical and occurrence. Such contamination can arise by accident, by intent from regular ongoing industrial activity, and even from subsequent use of manufactured products themselves. The key factors in assessing whether a problem exists within a particular country are recognition and awareness that a problem can exist and the capability to define the extent and severity of the problem. Both factors are heavily dependent on the availability of well-equipped food control laboratories staffed by dedicated and competent personnel. In some situations the analytical techniques required are 'state of the art' involving sophisticated and expensive separations and determinations with extensive quality control procedures. In others, the techniques are much less complicated. In both, however, the production of valid data is paramount. To illustrate some of these differences in approach, details of ongoing Canadian programmes on polychlorinated dibenzo- dioxins and -furans in effluents from pulp and paper mills and on the migration of chemicals from packaging materials are presented. PMID: 8504868 Environmental contamination by polychlorinated dibenzo-p-dioxins and dibenzofurans associated with pulp and paper mill discharge.. Sludge from seven pulp and paper mills was analysed for 2,3,7,8-TCDD. The level of contamination ranged from not detectable (1 pg/g) to over 400 pg/g. Analyses for other planar polychlorinated contaminants indicated high levels of contamination by other PCDDs and PCDFs. Polychlorinated xanthenes and xanthones were identified as potential interferences in these analyses. PMID: 2957005 > > > ... micronized fat globules in UHT milk ... > [quoted text clipped - 112 lines] > Polychlorinated xanthenes and xanthones were identified as potential > interferences in these analyses. PMID: 2957005 Whether this is meaningful or not, polycoated bleached paperboard can have other issues such as the use of clays that can prove to be too radioactive for the Japanese government regulators but are no issue for the government of the U.S.A. And I'd suppose their maybe some issues with some of the polymers besides the LDPE. Some no doubt contain sugars, urea, and "Melthane" with possible interesting results. Understand I referring not to just milk carton stock but also other like products used in food packagings whether this is for pre-cut precooked french fries, fruit flavored turnovers, frozen fish,etc. > .... but you don't have to eat meat ... http://www.foodsafety.gov/~lrd/dioxinqa.html How can I reduce my personal dioxin levels? ... Overall, the best strategy for lowering the risk of dioxins while maintaining the benefits of a good diet is to follow the recommendations in the Federal Dietary Guidelines to choose fish, lean meat, poultry, and low or fat free (skim) dairy products and to increase consumption of fruits, vegetables and whole grain products. Lean meat includes meats that are naturally lower in fat, and meat where visible fat has been trimmed. For fish and poultry you can reduce fat by removing the skin. Reducing the amount of butter or lard used in the preparation of foods and cooking methods that reduce fat (such as oven broiling) will also lower the risk of exposure to dioxin. These strategies help lower the intake of saturated fats as well as reduce the risk of exposure to dioxin... http://www.mindfully.org/Food/Dioxins-Food-Chain-USDA2000.htm What are the major sources of dioxin and related compounds in the human diet? Dioxins are lipophilic compounds which accumulate in the fat of animals. The types of foods which tend to have the highest dioxin concentrations are dairy products, meat and poultry, eggs, fish, and animal fats (Eduljee and Gair, 1996). Green vegetables, fruits and grains are the types of foods with the lowest dioxin concentrations. Schecter et al. (1997) measured dioxins in pooled food samples that were collected in 1995 at supermarkets across the U.S. The pooled sample of fresh water fish had the highest level of dioxins (1.43 TEQ1), followed by butter (1.07 TEQ), hotdog/bologna (0.54 TEQ), ocean fish (0.47 TEQ), cheese (0.40 TEQ), beef (0.38 TEQ), eggs (0.34 TEQ), ice cream (0.33 TEQ), chicken (0.32 TEQ), pork (0.32 TEQ), milk (0.12 TEQ), and vegetables, fruits, grains and legumes (0.07 TEQ). A person’s intake of dioxins through the diet therefore, depends on the relative intake of foods with high or low levels of contamination and the quantity consumed. For example, Patandin et al. (1999) investigated the dietary intake of a group of preschool children in The Netherlands and found that dairy products contributed about 50% of their intake of dioxins and related compounds, while meat/meat products and processed foods contributed about 20% and 25%, respectively (Patandin et al. 1999). > "Feed grade fat, or yellow grease, is also produced through the > rendering process, but is more commonly produced by recycling the used [quoted text clipped - 3 lines] > > Do others see a problem with this? "Induction of lipid peroxidation in biomembranes by dietary oil components. Prooxidant formation and resulting lipid peroxidation are supposed to be involved in the pathogenesis of various diseases including cancer." How is this of concern given the tallow intended for animal consumption? On Jul 28, 12:33 pm, ferr...@ironcity.com wrote: > > "Feed grade fat, or yellow grease, is also produced through the > > rendering process, but is more commonly produced by recycling the used [quoted text clipped - 11 lines] > > How is this of concern given the tallow intended for animal consumption? I want dogs to be healthy and long lived. The best way is to just go ahead and cook for the dogs and cats. Clearly damaged fats are going to be a health problem for an animal just as in a human. The boichemistry isn't all that different. Granted human detox plants toxins better than either do dogs or cats. I've seen the used oil bound for animal feed. I was the guy who loaded the truck when it came into the food processing plant back in my pre-college days. It had been heated for a week and was black and no longer even fit for Scotch Treat Brand. Some of the used old "oil" was a mix of animal lard mixed with hydrogenated veg oil. > cooking oil ... from restaurants and food processing facilities > ... used as ... feed additive in livestock and pet foods." > Do others see a problem with this? Lipid hydroperoxides from processed dietary oils enhance growth of hepatocarcinoma cells. Linoleic acid, one of the major fatty acid in dietary oils, is an important source for hydroperoxides that may be formed in the presence of oxygen during food processing. Oxidized oils are absorbed in the intestine, transported as chylomicrones to the liver, and may affect unaltered hepatic cells as well as the process of hepatocarcinogenesis. We have studied the effects of linoleic acid hydroperoxides (LOOH) on growth and gene expression of cultured human hepatocellular carcinoma cells (HCC-1.2). The addition of LOOH to the medium of HCC-1.2 carcinoma cells caused dose-dependent cell loss and enhanced lactate dehydrogenase (LDH)-release. Under subtoxic conditions, LOOH induced intracellular hydrogen peroxide production, a decrease of glutathione content, elevated expression of the AP-1 components c-fos and c-jun as well as of the anti-apoptotic enzyme heme oxygenase 1 (HO-1). Furthermore, the cells were pushed by LOOH into the cell cycle as indicated by increased proportion of cells in the S- or G2/M-phase. The unoxidized linoleic acid was not active. Application of SnPPIX, a HO-1 inhibitor, decreased the viability of HCC-1.2 cells, indicating the protective role of HO-1 induction. This is the first evidence that lipid hydroperoxides of dietary origin may be an important driving force for carcinogenesis in the liver. PMID: 18293301 > [cooking oil from restaurants and food processing facilities > used as feed in livestock and pet foods. problem?] Concentrations of cholesterol oxidation products in raw, heat- processed and frozen-stored meat of broiler chickens fed diets differing in the type of fat and vitamin E concentrations. The present study was performed to investigate the effect of dietary fat and vitamin E on concentrations of cholesterol oxidation products (COP) in broiler muscle. A total of 144 1-d-old broiler chicks were fed diets with either palm oil, soyabean oil or linseed oil and vitamin E concentrations of 20, 40 or 200 mg/kg for 35 d. COP concentrations were analysed in raw, heat-processed (180 degrees C, 20 min) and frozen-stored (-20 degrees C, 6 months) breast and thigh muscles. COP concentrations were influenced by dietary vitamin E concentration, dietary fat, treatment and type of muscle (P<0.001). Increasing the dietary vitamin E concentration generally reduced the concentration of COP. This effect was strongest in broilers fed linseed oil and weakest in broilers fed palm oil; the effect of vitamin E was also stronger in heated muscles than in raw or frozen- stored muscles. Moreover, the concentration of COP in thigh muscle was more strongly influenced by dietary vitamin E than that in breast muscle. COP concentrations in muscles were on average highest in broilers fed linseed oil and lowest in broilers fed palm oil, but the effect of the dietary fat also depended on the vitamin E concentration, the treatment and the type of muscle. In conclusion, our study shows that dietary fat and vitamin E influence the concentrations of total COP in broiler muscle. However, the effects of these factors were not only influenced by interactions between each other, but also depended on the treatment of the muscle and the type of muscle. PMID: 15975162 |
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