Longitudinal prevalence and faecal shedding of Chlamydia pecorum in sheep

The prevalence and faecal shedding of Chlamydia spp. in sheep in Australia has not been well described. Two species-specific quantitative PCRs (qPCRs) targeting the chlamydial outer membrane protein cell surface antigen gene (ompA) were validated and used to determine the prevalence and faecal shedding of C. abortus and C. pecorum from faecal samples of lambs at three sampling times (weaning, post-weaning and pre-slaughter) from eight farms in South Australia, New South Wales, Victoria and Western Australia. A total of 3412 faecal samples were collected and screened from approximately 1189 lambs across the four states. C. abortus was not detected in any of the samples screened. The overall prevalence of C. pecorum was 1027/3412 (30.1%) and median bacterial concentrations at weaning, post-weaning and pre-slaughter were 1.8 × 10(7), 1.2 × 10(7) and 9.6 × 10(5)/g faeces, respectively. A subset of C. pecorum positive samples from each farm, (n = 48) was sequenced to confirm their identity. The present study demonstrates that C. pecorum is prevalent in Australian sheep, highlighting a need for further research on the impact of this bacterium on production.

Improving technical information use: what can be learnt from a manager's perspective?

Conservation practice reportedly suffers from low use of technical information. Understanding of factors that affect the influence of technical information on management decision-making is limited. We sought to identify leverage points for improved technical information dissemination in the New South Wales Parks and Wildlife Service, Australia, given the significant recent investments in monitoring and evaluation that had been made. We did so by exploring the inter-relationships between factors affecting the influence of different information types on management decisions. Results indicate that managers have a high inclination toward adaptive behavior, given they operate in an information poor environment. The most influential types of information were those that enabled interaction between information provider and recipient (e.g., staff experience and expertise). An analysis of the concordance in individuals' responses for different information types showed that neither accessibility nor organizational expectation of use was aligned with influence on decision-making. Alignment of responses also varied by work area. Raising expectations of information use or increasing access to particular types of information is therefore unlikely to result in an increase in influence on management decision-making. Rather than focussing on matching accessibility and expected use of particular information types, our results indicate that technical information uptake is best supported through existing peer networks tailored to specific work areas.

Effect of nutrition, body condition and liveweight change on efficacy of biological wool harvesting with epidermal growth factor (Bioclip)

This study investigated the effect of nutrition on wool harvesting efficiency of a biological wool harvesting system (Bioclip) utilising epidermal growth factor (EGF) to induce shedding of the fleece. The experiment had nine groups, each representing a different growth path based on a 3 by 3 design with three levels of nutrition (low, medium and high) fed during two periods, specifically the pre-injection period (4-weeks leading up to EGF injection) and post-injection period (4 weeks between EGF injection and wool harvesting). Sheep weight and body condition score were measured at the start and end of each period. Wool harvesting efficiency, fleece weight and body wrinkle were assessed at wool harvesting. Continuous data were analysed using general linear models and linear regression. Bivariate categorical data were analysed using Chi-squared tests and odds ratios. Wool harvesting efficiency was reduced in sheep with greater skin wrinkle (P < 0.001), poorer body condition (P < 0.001) and poorer nutrition in both pre- and post-injection periods (P < 0.001). Sheep that gained 1 kg bodyweight or 0.5 body condition score either pre- or post-injection had improved wool harvestability (P < 0.05). Sheep that lost weight post-injection were 10.2 (95% confidence interval 4.0, 25.5) times and 4 times (2.4, 6.7) more likely to have very poor harvestability compared with sheep that gained or maintained weight respectively (P < 0.001). Sheep with greater body wrinkle were 6.6 (4.1, 10.7) times more likely to have very poor harvestability than plain-bodied sheep (P < 0.001). Nutrition that ensures modest weight gain during the pre- and post-injection periods can partially overcome poorer harvestability in wrinkly sheep.

Cryptosporidium and Giardia associated with reduced lamb carcase productivity

On two extensive sheep farms in southern Western Australia, 111 (Farm A) and 124 (Farm B) female crossbred lambs (2-6 weeks old) were randomly selected and individually identified using ear tags (a numbered tag and radio-frequency tag) at marking. On five separate occasions, faecal samples were collected and live weight, body condition score (BCS), faecal consistency score (FCS), breech fleece faecal soiling score and faecal dry matter percentage (DM%) were recorded. Lamb hot carcase weight (HCW) and dressing percentage were measured at slaughter. Faecal samples were screened by PCR for Cryptosporidium (18S rRNA, actin and 60 kDa glycoprotein [gp60] loci), Giardia duodenalis (glutamate dehydrogenase [gdh] and triosephosphate isomerise [tpi]) and Campylobacter jejuni (16S rRNA). Observation of Eimeria oocysts and faecal worm egg counts (WECs) were performed using a modified McMaster technique. The WECs were adjusted for FCS for analyses. Faecal samples were screened for patent strongylid infections using PCR (specifically ITS-2 nuclear ribosomal DNA for Teladorsagia circumcincta, Trichostrongylus spp. and Haemonchus contortus). Lambs positive for Cryptosporidium at least once had lighter HCWs by 1.25 kg (6.6%) (P=0.029) and 1.46 kg (9.7%) (P<0.001) compared to lambs never positive for Cryptosporidium for Farms A and B respectively. Similarly, dressing percentages were 1.7% (P=0.022) and 1.9% (P<0.001) lower in Cryptosporidium-positive lambs on Farms A and B respectively. Lambs positive for Giardia at least once had 0.69 kg (P<0.001) lighter HCWs and 1.7% (P<0.001) lower dressing percentages compared to lambs never positive for Giardia on Farm B only. Cryptosporidium-positive lambs at the second sampling were 4.72 (P=0.010) and 3.84 (P=0.002) times more likely to have non-pelleted faeces compared to Cryptosporidium-negative lambs for Farms A and B respectively. Breech fleece faecal soiling scores of Cryptosporidium-positive lambs were 3.36 (P=0.026) and 2.96 (P=0.047) times more likely to be moderate to severe (scores 3-5), compared to negative lambs at the second sampling for Farms A and B respectively. Live weight, growth rate and BCS were inconsistently associated with protozoa detection across different samplings and farms. Adjusted WEC was correlated positively with FCS and negatively with faecal DM%, differing between sampling occasions and farms. Campylobacter jejuni prevalence was very low (<1%). Adjusted WEC were not correlated with carcase attributes, growth rates or live weights. This study is the first to quantify productivity consequences of naturally acquired protozoa infections in lambs managed under extensive farming conditions.

Cryptosporidium and Giardia associated with reduced lamb carcase productivity

On two extensive sheep farms in southern Western Australia, 111 (Farm A) and 124 (Farm B) female crossbred lambs (2-6 weeks old) were randomly selected and individually identified using ear tags (a numbered tag and radio-frequency tag) at marking. On five separate occasions, faecal samples were collected and live weight, body condition score (BCS), faecal consistency score (FCS), breech fleece faecal soiling score and faecal dry matter percentage (DM%) were recorded. Lamb hot carcase weight (HCW) and dressing percentage were measured at slaughter. Faecal samples were screened by PCR for Cryptosporidium (18S rRNA, actin and 60 kDa glycoprotein [gp60] loci), Giardia duodenalis (glutamate dehydrogenase [gdh] and triosephosphate isomerise [tpi]) and Campylobacter jejuni (16S rRNA). Observation of Eimeria oocysts and faecal worm egg counts (WECs) were performed using a modified McMaster technique. The WECs were adjusted for FCS for analyses. Faecal samples were screened for patent strongylid infections using PCR (specifically ITS-2 nuclear ribosomal DNA for Teladorsagia circumcincta, Trichostrongylus spp. and Haemonchus contortus). Lambs positive for Cryptosporidium at least once had lighter HCWs by 1.25 kg (6.6%) (P=0.029) and 1.46 kg (9.7%) (P<0.001) compared to lambs never positive for Cryptosporidium for Farms A and B respectively. Similarly, dressing percentages were 1.7% (P=0.022) and 1.9% (P<0.001) lower in Cryptosporidium-positive lambs on Farms A and B respectively. Lambs positive for Giardia at least once had 0.69 kg (P<0.001) lighter HCWs and 1.7% (P<0.001) lower dressing percentages compared to lambs never positive for Giardia on Farm B only. Cryptosporidium-positive lambs at the second sampling were 4.72 (P=0.010) and 3.84 (P=0.002) times more likely to have non-pelleted faeces compared to Cryptosporidium-negative lambs for Farms A and B respectively. Breech fleece faecal soiling scores of Cryptosporidium-positive lambs were 3.36 (P=0.026) and 2.96 (P=0.047) times more likely to be moderate to severe (scores 3-5), compared to negative lambs at the second sampling for Farms A and B respectively. Live weight, growth rate and BCS were inconsistently associated with protozoa detection across different samplings and farms. Adjusted WEC was correlated positively with FCS and negatively with faecal DM%, differing between sampling occasions and farms. Campylobacter jejuni prevalence was very low (<1%). Adjusted WEC were not correlated with carcase attributes, growth rates or live weights. This study is the first to quantify productivity consequences of naturally acquired protozoa infections in lambs managed under extensive farming conditions.

Core neuropsychological characteristics of children and adolescents with 22q11.2 deletion

BACKGROUND

The 22q11.2 deletion syndrome (22qDS) confers high risk for intellectual disability and neuropsychological/academic impairment, although a minority of patients show average intelligence. Intellectual heterogeneity and the high prevalence of psychiatric diagnoses in earlier studies may have obscured the prototypical neuropsychological profile in 22qDS.

METHODS

We examined intelligence, memory, reading and mathematical processes in 31 children/adolescents with 22qDS, selected for educational underachievement and an absence of psychiatric diagnoses, using standardised, psychometrically matched instruments that specify how typical a score is for a given intelligence quotient (IQ).

RESULTS

Corroborating earlier findings, verbal IQ was significantly superior to performance IQ; verbal memory and basic reading were relative strengths; and visual/spatial memory was a relative weakness. All four findings transcended performance characteristics that are typical of low-IQ individuals. Rote learning yielded the highest score; reading comprehension, numerical operations and mathematical reasoning were among the lowest-performed academic domains. Albeit in the expected direction, performance in the respective components could not be clearly differentiated from what is IQ-appropriate.

CONCLUSIONS

A superiority of verbal intelligence over non-verbal intelligence, relative strengths in verbal memory and basic reading, and a relative weakness in visual/spatial memory are likely to be core characteristics of children/adolescents with 22qDS, transcending performance features that are typical of individuals with low IQ.

A novel anaesthetic regimen for surgical procedures in guineapigs

A combination of tiletamine/zolazepam, xylazine and butorphanol provides deep surgical, long-duration anaesthesia in guineapigs with a smooth induction and recovery period. The described dosages mainly affect the respiratory functions and blood gas parameters, with a minor-to-moderate effect on the cardiovascular system.

The prevalence of reading and spelling difficulties among inmates of institutions for compulsory care of juvenile delinquents

Recent studies have focused on reading and writing disabilities among inmates in prisons and at juvenile institutions. Some studies in Sweden have demonstrated that more than half of the delinquents have serious reading difficulties, and for immigrants the situation is even worse. However, these studies have focused on small groups. Furthermore, little attention has been paid to different types of reading and writing difficulties. The main purpose of this investigation was to estimate the prevalence of reading and writing disabilities in juvenile institutions. The study analyses gender differences and differences between immigrants and Swedish pupils. The study included 163 pupils from 22 institutions and used three tests of literacy skills: word identification, spelling and reading comprehension. More than 70% showed some problems in reading and spelling. However, only 11% had serious difficulties. Moreover, the results showed that comprehension ability among immigrant boys was lower than among Swedish boys, despite the same level of word reading skill. The high prevalence of reading and writing disabilities seems primarily to be related to social and cultural factors, home backgrounds, limited school attendance and poor self-esteem rather than to constitutional problems of a dyslexic nature. The implication of this conclusion may be important for the intervention process.

Optimum bedside cardiac monitoring

Correct electrode placement is critical to obtaining accurate information from any monitoring lead. The choice of lead should be based on the goals of monitoring for a specific patient population and on the individual patient's clinical situation. When using a 5-wire monitoring cable, arm electrodes should be placed on the shoulders; leg electrodes, on the lower thorax or hip area; and the chest electrode, in the desired V lead position. When using a 3-wire system, lead placement depends on which lead is desired for monitoring. If arrhythmia diagnosis is the goal of monitoring, lead V1 is the best lead; lead V6 is the next best lead. If ST segment monitoring for ischemia or reocclusion following percutaneous coronary interventions is the goal, the best lead depends on the coronary artery involved. Multiple lead monitoring is superior to single lead monitoring. If two leads are available, V1 and lead III or aVF (or a limb lead with maximal ST segment displacement) are good choices. If three leads are available, leads V1, III, and aVF are the best choices. Continuous 12-lead monitoring is available and offers several advantages.

The dystroglycan complex is necessary for stabilization of acetylcholine receptor clusters at neuromuscular junctions and formation of the synaptic basement membrane

The dystrophin-associated protein (DAP) complex spans the sarcolemmal membrane linking the cytoskeleton to the basement membrane surrounding each myofiber. Defects in the DAP complex have been linked previously to a variety of muscular dystrophies. Other evidence points to a role for the DAP complex in formation of nerve-muscle synapses. We show that myotubes differentiated from dystroglycan-/- embryonic stem cells are responsive to agrin, but produce acetylcholine receptor (AChR) clusters which are two to three times larger in area, about half as dense, and significantly less stable than those on dystroglycan+/+ myotubes. AChRs at neuromuscular junctions are similarly affected in dystroglycan-deficient chimeric mice and there is a coordinate increase in nerve terminal size at these junctions. In culture and in vivo the absence of dystroglycan disrupts the localization to AChR clusters of laminin, perlecan, and acetylcholinesterase (AChE), but not rapsyn or agrin. Treatment of myotubes in culture with laminin induces AChR clusters on dystroglycan+/+, but not -/- myotubes. These results suggest that dystroglycan is essential for the assembly of a synaptic basement membrane, most notably by localizing AChE through its binding to perlecan. In addition, they suggest that dystroglycan functions in the organization and stabilization of AChR clusters, which appear to be mediated through its binding of laminin.

Adverse effects on growth rates in rats caused by buprenorphine administration

As a routine postoperative treatment, a single dose of buprenorphine was given to rats at a dose of 0.05 mg/kg subcutaneously. However, some rats developed abnormal secretions around the nose and mouth and some animals died 3-5 days after surgery and analgesic treatment. At autopsy a yellow fibrous mass was found in the stomach and intestines. Observations of animals given buprenorphine revealed an abnormal ingestion of bedding material. This caused a disturbance to normal digestion, with gastric distension, weight loss or decreased growth rate, constipation and occasionally death. In this study rats were monitored for 6 days following surgery and analgesic treatment. A comparison of growth rates was made between rats given saline and buprenorphine or nalbuphine and between animals kept on bedding or grid floors for the first 24h after treatment. Of the animals held on bedding, the buprenorphine-treated animals did not lose weight as the other animals did, but had on the other hand a decreased growth rate during the measuring period of 6 days after surgery. When denied access to bedding for the first 24 h after surgery, rats given saline or nalbuphine had a reduced weight gain over the first 24 h, similar to the groups held on bedding. Rats held on grid floors and given buprenorphine continued to gain weight for the first 24 h. From day 3, there was no significant difference between the groups, which all gained weight.

The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia

BACKGROUND

Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia.

OBJECTIVE

We attempted to determine the effect of finasteride on scalp skin and serum androgens.

METHODS

Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.

RESULTS

Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

CONCLUSION

In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

Ontario Medical Association position paper on health effects of ground-level ozone, acid aerosols and particulate matter

This review of the evidence of the health effects of air pollutants focuses on research conducted in Ontario. Seven key Ontario studies are cited. These findings are highly significant for people living in the Great Lakes basin (and particularly the Windsor-Quebec corridor), where high levels of certain air pollutants (eg, ground-level ozone and ultra-fine particles) occur more frequently than in other parts of Canada. The issue is a serious one, requiring an integrated and comprehensive approach by many stakeholders, including the active involvement of organized medicine. It is important that the health effects of these air pollutants are understood. Governments must act to reduce emission levels through statue and regulation bolstered by noncompliance penalties. The findings of research have included the following: in a Toronto study, a 2% to 4% excess of respiratory deaths were attributable to pollutant levels; children living in rural Ontario communities with the highest levels of airborne acids were significantly more likely to report at least one episode of bronchitis, as well as to show decreases in lung function; and have been linked to increases in pollutants, emergency room visits and hospitalizations in Ontario. Every Ontarian is affected by air pollutants, although he or she may be unaware of the asymptomatic effects such as lung and bronchial inflammation. This health problem is preventable; while physicians know of the adverse health impacts of air pollution and they are concerned, individually they now focus on the treatment of symptoms. The major recommendations of the report are as follows: Enactment of more stringent sulphur and nitrogen oxide emission limits, including a provincewide sulphur dioxide reduction of 75% from current cap levels, and the maximum allowable nitrogen oxides emission limits of 6000 tonnes annually from Ontario Hydro. New transportation sector emission limits that should include California-level standards for light and heavy duty vehicles, reductions from off-road engines, an expanded vehicle inspection and maintenance program, and tougher standards for sulphur-in-fuel content. Petitioning the United States Environmental Protection Agency administrator under Section 115 of the United States Clear Air Act to require reductions in the American emission of sulphur dioxide and nitrogen oxides, which damage the health of Canadian residents and their environment. Physician advice to patients about the risks of smog exposure, physician support for more health effects research on air pollution, and physician promotion of the development of air pollution-related health education materials. The recommendations discussed in this paper will, if acted upon, lead to a significant reduction in the overall burden of illness from air pollutants, especially in children and the elderly. These recommendations have been selected from a review of recommendations made by various authorities, and are those that the OMA feels a particular responsibility to support.

alpha-Dystroglycan functions in acetylcholine receptor aggregation but is not a coreceptor for agrin-MuSK signaling

alpha-dystroglycan (alpha-DG) is an agrin-binding protein that has been implicated in acetylcholine receptor (AChR) clustering, but it is unclear whether it acts as a coreceptor involved in initial agrin signaling or as a component involved in later events. To investigate its role, we have generated antisense derivatives of the C2 mouse muscle cell line, which have reduced alpha-DG expression. When compared with wild-type cells, the alpha-DG-deficient myotubes have a dramatic reduction in the number of spontaneous and agrin-induced AChR clusters. Several findings suggest that this decrease in AChR clustering is likely not because of a defect in agrin signaling through the MuSK receptor tyrosine kinase. Compared with wild-type cells, the alpha-DG-deficient cell lines showed only a transient reduction in the level of agrin-induced MuSK tyrosine phosphorylation and no reduction in AChR beta-subunit tyrosine phosphorylation. Additionally, agrin-induced phosphorylation of MuSK in wild-type myotubes was not decreased using agrin fragments that lack the domain primarily responsible for binding to alpha-DG. Finally, neural agrin-induced phosphorylation of MuSK was unaffected by treatments such as excess muscle agrin or anti-alpha-DG antibodies, both of which block agrin-alpha-DG binding. Together, these results suggest that alpha-DG is not required for agrin-MuSK signaling but rather that it may play a role elsewhere in the clustering pathway, such as in the downstream consolidation or maintenance of AChR clusters.

Laminin and alpha-dystroglycan mediate acetylcholine receptor aggregation via a MuSK-independent pathway

Specific isoforms of laminin (LN) are concentrated at neuromuscular junctions (NMJs) where they may participate in synaptic organization or function. In myotubes from C2 cells, LN is concentrated within the majority of spontaneous acetylcholine receptor (AChR) aggregates. Neural agrin substantially increases this colocalization, suggesting that agrin can recruit LN into AChR aggregates. Addition of LN to C2 myotubes induces a more than twofold increase in the number of AChR aggregates. These aggregates have a larger size and are more dense than are those induced by agrin, suggesting that LN is involved in the growth and/or stabilization of AChR aggregates. Consistent with this hypothesis, an antiserum to LN reduces the size of individual AChR aggregates but increases their number. In C2 myotubes, extracellular matrix receptors containing the integrin beta1 subunit are poorly colocalized with AChR aggregates, suggesting that integrins may not be involved in LN-induced aggregation. In contrast, almost all AChR aggregates are associated with dystroglycan immunoreactivity, and monoclonal antibody (mAb) IIH6 against alpha-dystroglycan (alpha-DG), a LN and agrin receptor, causes a concentration-dependent inhibition of LN-induced aggregation. Moreover, S27 cells, which lack a functional alpha-DG, and two C2-derived cell lines expressing antisense DG mRNA fail to aggregate AChRs in response to LN. Finally, LN-induced AChR aggregation does not involve the phosphorylation of the muscle-specific tyrosine kinase receptor (MuSK) or the AChR beta subunit. We hypothesize that the interaction of LN with alpha-DG contributes to the growth and/or stabilization of AChR microaggregates into macroaggregates at the developing NMJ via a MuSK-independent mechanism.

A novel herpesvirus amplicon system for in vivo gene delivery

For gene therapy approaches to succeed, improved vector systems are needed that combine a large carrying capacity with high transduction efficiency in vivo. Towards this goal, we have developed a novel herpes simplex virus (HSV) amplicon vector, pHE, which contains an HSV-1 replication origin (ori S) and packaging sequence that permit vector replication and packaging into HSV-1 capsids. The vector also contains the Epstein-Barr virus (EBV) unique latent replication origin (ori P) sequence and a modified EBNA-1 gene to allow the vector to be maintained as an episome in transfected E5 helper cells. This system allows for efficient packaging of high-titer vector since the E5 cells are first selected for the presence of the pHE vector before helper virus infection. The infectious pHE vector has efficient transgene expression in a variety of human cell lines in vitro. Stereotactic injection of pHE vector supernatant into the rat brain resulted in high, localized reporter gene expression. Finally, the pHE vector could carry a stable 21 kb DNA payload into HSV virions. This pHE vector system should have a broad range of gene transfer applications.

Laminin-induced clustering of dystroglycan on embryonic muscle cells: comparison with agrin-induced clustering

The effect of laminin on the distribution of dystroglycan (DG) and other surface proteins was examined by fluorescent staining in cultures of muscle cells derived from Xenopus embryos. Western blotting confirmed that previously characterized antibodies are reactive in Xenopus. In control cultures, alphaDG, betaDG, and laminin binding sites were distributed as microclusters (<1 microm2 in area) over the entire dorsal surface of the muscle cells. Treatment with laminin induced the formation of macroclusters (1-20 microm2), accompanied by a corresponding decline in the density of the microclusters. With 6 nM laminin, clustering was apparent within 150 min and near maximal within 1 d. Laminin was effective at 30 pM, the lowest concentration tested. The laminin fragment E3, which competes with laminin for binding to alphaDG, inhibited laminin-induced clustering but did not itself cluster DG, thereby indicating that other portions of the laminin molecule in addition to its alphaDG binding domain are required for its clustering activity. Laminin-induced clusters also contained dystrophin, but unlike agrin-induced clusters, they did not contain acetylcholine receptors, utrophin, or phosphotyrosine, and their formation was not inhibited by a tyrosine kinase inhibitor. The results reinforce the notion that unclustered DG is mobile on the surface of embryonic muscle cells and suggest that this mobile DG can be trapped by at least two different sets of molecular interactions. Laminin self binding may be the basis for the laminin-induced clustering.

Dystroglycan in the cerebellum is a laminin alpha 2-chain binding protein at the glial-vascular interface and is expressed in Purkinje cells

Dystroglycan is a core component of the dystrophin receptor complex in skeletal muscle which links the extracellular matrix to the muscle cytoskeleton. Dystrophin, dystrophin-related protein (DRP, utrophin) and dystroglycan are present not only in muscles but also in the brain. Dystrophin is expressed in certain neuronal populations while DRP is associated with perivascular astrocytes. To gain insights into the function and molecular interactions of dystroglycan in the brain, we examined the localization of alpha- and beta-dystroglycan at the cellular and subcellular levels in the rat cerebellum. In blood vessels, we find alpha-dystroglycan associated with the laminin alpha 2-chain-rich parenchymal vascular basement membrane and beta-dystroglycan associated with the endfeet of perivascular astrocytes. We also show that alpha-dystroglycan purified from the brain binds alpha 2-chain-containing laminin-2. These observations suggest a dystroglycan-mediated linkage between DRP in perivascular astrocytic endfeet and laminin-2 in the parenchymal basement membrane similar to that described in skeletal muscle. This linkage of the astrocytic endfeet to the vascular basement membrane is likely to be important for blood vessel formation and stabilization and for maintaining the integrity of the blood-brain barrier. In addition to blood vessel labelling, we show that alpha-dystroglycan in the rat cerebellum is associated with the surface of Purkinje cell bodies, dendrites and dendritic spines. Dystrophin has previously been localized to the inner surface of the plasma membrane of Purkinje cells and is enriched at postsynaptic sites. Thus, the present results also support the hypothesis that dystrophin interacts with dystroglycan in cerebellar Purkinje neurons.

The estrogen receptor locus is associated with a major gene influencing litter size in pigs

Identification of individual major genes affecting quantitative traits in livestock species has been limited to date. By using a candidate gene approach and a divergent breed cross involving the Chinese Meishan pig, we have shown that a specific allele of the estrogen receptor (ER) locus is associated with increased litter size. Female pigs from synthetic lines with a 50% Meishan background that were homozygous for this beneficial allele produced 2.3 more pigs in first parities and 1.5 more pigs averaged over all parities than females from the same synthetic lines and homozygous for the undesirable allele. This beneficial ER allele was also found in pigs with Large White breed ancestory. Analysis of females with Large White breed background showed an advantage for females homozygous for the beneficial allele as compared to females homozygous for the other allele of more than 1 total pig born. Analyses of growth performance test records detected no significant unfavorable associations of the beneficial allele with growth and developmental traits. Mapping of the ER gene demonstrated that the closest known genes or markers were 3 centimorgans from ER. To our knowledge, one of these, superoxide dismutase gene (SOD2), was mapped for the first time in the pig. Analysis of ER and these linked markers indicated that ER is the best predictor of litter size differences. Introgression of the beneficial allele into commercial pig breeding lines, in which the allele was not present, and marker-assisted selection for the beneficial allele in lines with Meishan and Large White background have begun.

Platelet refractoriness and alloimmunization in pediatric oncology and bone marrow transplant patients

BACKGROUND

The purposes of this study were to determine the overall incidence of platelet refractoriness and alloimmunization among multiply transfused children on a medical oncology and bone marrow transplant service and to evaluate the effect of routine white cell reduction in blood components on that incidence.

STUDY DESIGN AND METHODS

The platelet transfusion records of 128 consecutive children admitted to the hospital and requiring blood component support for the treatment of disease were evaluated retrospectively. Mean corrected count increments (CCIs) for each patient were calculated for all random-donor platelet transfusions given within 7 days of the routine weekly testings of the patient's serum for lymphocytotoxic antibodies (LCTAbs). Mean CCIs for HLA-matched platelet transfusions were calculated separately for the patients receiving them.

RESULTS

Thirty-one patients (24%) had or developed persistently positive LCTAbs (patient's serum reacted with > or = 3/10 panel lymphocytes); 22 (71%) of these patients had a mean CCI < 7.5 to random-donor platelet transfusions. In contrast, of the 97 patients with negative or transiently positive LCTAbs, only 25 (26%) had a mean CCI < 7.5. The overall incidence of platelet refractoriness (CCI < 7.5) was 37 percent. Patients with acute myelogenous leukemia had a significantly (p < 0.01) reduced incidence (17%) of low CCIs, with or without positive LCTAbs, as compared to patients with other malignant or nonmalignant disorders (41%). No difference in the incidence of LCTAbs or low CCIs was seen in patients undergoing allogeneic or autologous bone marrow transplant or receiving drug therapy only. Among the 24 patients who received HLA-matched platelets, only those with positive LCTAbs showed a significant improvement in CCIs over that achieved with random-donor platelet transfusions. Routine white cell reduction in red cell and platelet components with third-generation white cell filters was performed prior to transfusion in 73 of the patients. There was no significant difference between the incidence of LCTAbs and/or low CCIs in this group and that in the 55 children receiving unfiltered transfusions.

CONCLUSION

Alloimmunization and platelet refractoriness occur in pediatric oncology and bone marrow transplant patients, but the incidence--particularly in children with acute myelogenous leukemia--appears to be low. The detection of LCTAbs predicts a poor response to random-donor platelet transfusion, but most such patients show improved CCIs with HLA-matched platelets. Routine use of white cell-reduction filters has thus far failed to eliminate alloimmunization in children requiring prolonged blood component support.

Distribution of alpha-dystroglycan during embryonic nerve-muscle synaptogenesis

The distribution of alpha-dystroglycan (alpha DG) relative to acetylcholine receptors (AChRs) and neural agrin was examined by immunofluorescent staining with mAb IIH6 in cultures of nerve and muscle cells derived from Xenopus embryos. In Western blots probed with mAb IIH6, alpha DG was evident in membrane extracts of Xenopus muscle but not brain. alpha DG immunofluorescence was present at virtually all synaptic clusters of AChRs and neural agrin. Even microclusters of AChRs and agrin at synapses no older than 1-2 h (the earliest examined) had alpha DG associated with them. alpha DG was also colocalized at the submicrometer level with AChRs at nonsynaptic clusters that have little or no agrin. The number of large (> 4 microns) nonsynaptic clusters of alpha DG, like the number of large nonsynaptic clusters of AChRs, was much lower on innervated than on noninnervated cells. When mAb IIH6 was included in the culture medium, the large nonsynaptic clusters appeared fragmented and less compact, but the accumulation of agrin and AChRs along nerve-muscle contacts was not prevented. It is concluded that during nerve-muscle synaptogenesis, alpha DG undergoes the same nerve-induced changes in distribution as AChRs. We propose a diffusion trap model in which the alpha DG-transmembrane complex participates in the anchoring and recruitment of AChRs and alpha DG during the formation of synaptic as well as nonsynaptic AChR clusters.

Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience

OBJECTIVES

To describe the frequency and patterns of infection caused by methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) infections in a single nursing home population and to determine the effect of MRSA's entry into the facility on subsequent experience with both MSSA and MRSA infections.

DESIGN

Observational and descriptive. Surveillance data on nursing home-acquired infections were reviewed to identify all patients with MSSA and MRSA infections occurring during the 5-year period from 1987 to 1991. The medical records of these patients were reviewed retrospectively to collect additional information about the patients and their infections.

SETTING AND PATIENTS

A 120-bed Veterans' Affairs nursing home care unit (NHCU) whose residents predominantly were elderly men with severe underlying diseases and functional impairments.

RESULTS

During the 5-year study period, 40 MSSA and 28 MRSA infections were acquired by NHCU residents. Twelve to 19 S aureus infections occurred each year. S aureus accounted for 13% to 17% of all NHCU-acquired infections during the years of study, occurring with a frequency of 0.29 to 0.47 infections per 1,000 resident-care days. MRSA infections, first detected in 1988, accounted for an increasing percentage of S aureus infections in subsequent years, but this increase had little effect on the facility's overall infection rates, the composite S aureus infection rates, or the types of infections observed. MSSA and MRSA infections acquired in the NHCU were comparable. Both affected patients with severe underlying diseases and functional impairments. Pneumonia, urinary tract infections, skin and soft tissue infections, and conjunctivitis were the types of infections observed most frequently, accounting for 28%, 25%, 22%, and 15% of all S aureus infections, respectively. Four bacteremic infections occurred in the MSSA group, and five in the MRSA group (P = .47). Four of the MSSA and three of the MRSA infections resulted in death (P = 1.0). Nine of the MSSA and 12 of the MRSA infections resulted in the patient's transfer to the associated acute care hospital for additional care (P = .13).

CONCLUSIONS

In the NHCU setting, MSSA and MRSA infections were similar in terms of the types of residents affected, the sites involved, and the frequency of adverse outcomes. The entry of MRSA into the facility appeared to have no effect on the subsequent experience with NHCU-acquired infections caused by S aureus.

Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective

OBJECTIVES

To determine the effect of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a nursing home on the subsequent MRSA caseload in a closely affiliated hospital.

DESIGN

Observational and descriptive; routine and special MRSA surveillance data for nursing home and hospital were reviewed for a four-year period (1988 to 1991) as were records regarding patient transfers from nursing home to hospital.

SETTING

The 120-bed nursing home care unit (NHCU) and the geographically separate 434-bed acute care facility (hospital) of the Portland Veterans' Affairs Medical Center (PVAMC).

PATIENTS

Veterans hospitalized in the acute care division of NHCU.

RESULTS

Following the introduction of MRSA into the NHCU in December 1987, it quickly disseminated. Two to 32 newly colonized or infected patients were recognized in each quarter of the study period. Facility-wide prevalence surveys on two occasions disclosed MRSA colonization rates of 34% and 10%. During the study period, 15 to 54 (mean: 37.6) patients were transferred each quarter from the NHCU to the hospital of the PVAMC. The number of MRSA cases transferred ranged from 0 to 16 per quarter (mean: 5.4). During the same period, the total number of MRSA cases in the hospital increased, rising from 7 cases in 1987 to 16 in 1988, 48 in 1989, 34 in 1990, and 35 in 1991. The percentage of hospital MRSA cases accounted for by NHCU transfers was 0% in 1988, 38% in 1989, 12% in 1990, and 11% in 1991.

CONCLUSIONS

Despite the steady flow of patients between the NHCU and the hospital, the MRSA outbreak in the NHCU was associated with only a modest increase in the MRSA caseload at the affiliated hospital.

Treatment of female androgenetic alopecia with minoxidil 2%

The safety and efficacy of minoxidil 2% for the treatment of female androgenetic alopecia was assessed in a 32-week double-blind placebo-controlled trial. Thirty-three women aged 22 to 44 years with hair loss classified as Ludwig's grade I or II were enrolled, and 28 completed the trial. Before the administration of treatment, mean nonvellus hair counts were taken within a 1-cm2 target area of the scalp. For the 15 patients in the minoxidil group, the mean count was 169 hairs compared with 161 hairs for the 13 patients in the placebo group. At the completion of the trial, the patients treated with minoxidil 2% had a mean nonvellus hair count of 195 hairs versus a mean hair count of 177 for patients in the placebo group; 60% (9) of the patients in the minoxidil group showed minimal to moderate hair growth compared with 46% (6) of the patients in the placebo group. No serious side effects were encountered during this study, nor any significant changes in safety parameters. There were no dropouts due to medical events related to minoxidil 2%.

Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit

OBJECTIVE

To evaluate the effect of antimicrobial therapy on patients and staff colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a skilled nursing facility and to assess the role of the environment as a potential reservoir for MRSA in the nursing home setting.

DESIGN

As part of a comprehensive program to control an MRSA outbreak in a nursing home, patients and staff colonized with MRSA received 1 of 3 antimicrobial decolonization regimens depending upon the site and extent of colonization. Followup cultures were performed during therapy and on days 2, 7, 14, and 30 following the completion of therapy. Cultures of the patients' inanimate environment (pajamas, sheet, and floor) were obtained during and after therapy. Antimicrobial susceptibility tests were performed on 54 MRSA isolates obtained before and 44 MRSA isolates recovered after therapy.

SETTING

A 120-bed Veterans Affairs nursing home care unit.

PARTICIPANTS

Thirty-six patients and 7 staff nurses colonized with MRSA at 1 or more sites.

INTERVENTION

Decolonization therapy with rifampin, trimethoprim-sulfamethoxazole, and clindamycin used alone or in various combinations for 5 or 10 days in conjunction with other infection control measures employed to combat the MRSA outbreak.

RESULTS

Twenty (56%) of the 36 NHCU patients were either persistently colonized or became recolonized with MRSA during the 30-day followup period. Positive cultures on day 3 during therapy frequently identified patients who subsequently exhibited persistent or recurrent colonization. Before therapy, 92% of MRSA isolates were susceptible to rifampin, whereas only 43% of the isolates obtained after therapy were susceptible. Sixteen (80%) of 20 patients with persistent or recurrent colonization had rifampin-resistant strains of MRSA isolated after therapy. Twenty-three (18%) of 125 environmental cultures obtained during and after therapy from patients who exhibited persistent or recurrent colonization were positive for MRSA, in contrast to 9 (8%) of 107 from patients who were successfully decolonized.

CONCLUSIONS

The decolonization component of the outbreak control program was judged to be ineffective and potentially hazardous because colonization persisted or recurred in more than half of the patients, and substantial antimicrobial resistance was noted in MRSA stains isolated after therapy. Resistance, especially to rifampin, and possibly re-acquisition of MRSA from other human or environmental sources were 2 factors that appeared to impede the decolonization effort.

A double-blind, vehicle-controlled study of clobetasol propionate 0.05% (Temovate) scalp application in the treatment of moderate to severe scalp psoriasis

The efficacy and safety of clobetasol propionate 0.05% scalp application was evaluated in 378 patients with moderate to severe scalp psoriasis in a double-blind vehicle-controlled parallel group study. After 2 weeks of twice-daily applications, 81% receiving active drug versus 22% receiving vehicle had clearing of 50% or greater. Complete clearing was seen in 26% with active drug and 1% with vehicle. Local side effects were primarily burning or stinging in 11% and 10% of patients treated on an active or a vehicle regimen, respectively. The morning cortisol levels of 168 patients were checked at baseline and again after 2 weeks of drug therapy. Subnormal morning plasma cortisol values were seen in 5% of the patients receiving active drug and in 5% receiving vehicle; 13% of those taking active drug versus 5% taking vehicle had a 50% or greater decrease in morning cortisol at the 2-week visit compared with baseline values. Clobetasol propionate 0.05% scalp application appears to be a safe and an effective treatment for scalp psoriasis.

Methicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans' Affairs nursing home and a review of the literature

OBJECTIVES

To delineate the spread of methicillin-resistant Staphylococcus aureus (MRSA) in a nursing home care unit (NHCU), determine its consequences, and discuss this experience in the context of reports from other nursing homes.

DESIGN

Observational and descriptive; routine and special surveillance for MRSA, including a facility-wide prevalence survey; characterization of MRSA isolates by disk diffusion and agar dilution susceptibility studies and restriction enzyme analysis of plasmid (REAP) DNA.

SETTING AND PATIENTS

A 120-bed skilled nursing facility that is an integral part of the Veterans' Affairs Medical Center (VAMC), Portland, Oregon. The patients are predominantly elderly men with severe underlying diseases and functional impairments.

RESULTS

An asymptomatic carrier brought MRSA into the NHCU in December 1987. During the next 15 months, 24 additional MRSA cases were detected. A prevalence survey conducted in March 1989 indicated that 39 (34%) of the 114 patients and 8 (7%) of the 117 employees were colonized or infected with MRSA. All strains were resistant to ciprofloxacin. REAP DNA indicated that 37 of 41 strains recovered in the March survey had identical patterns. Although 16 episodes of MRSA infection occurred in NHCU residents during 1988 through 1989, the outbreak had little effect on overall patterns of infectious morbidity and mortality in the facility. The outbreak, however, did result in an increased MRSA caseload at the medical center's acute-care division.

CONCLUSIONS

During the last three years, MRSA colonization and infection have become common in the NHCU at the Portland VAMC; this experience parallels that reported by several nursing homes in other parts of the country.

Congenital hearing loss in Jervell and Lange-Nielsen syndrome

Jervell and Lange-Nielsen syndrome is an autosomal recessive hereditary condition that presents with cardiac abnormalities characterized by a prolonged Q-T electrocardiographic pattern and congenital severe-to-profound auditory deficits. This paper describes the auditory history of twin boys born out of consanguinity and diagnosed with this syndrome. Both infants were products of the neonatal intensive care unit (NICU) and failed initial ABR screening. Diagnostic evaluation demonstrated profound hearing loss and developmental delays for each infant. Because sudden death is a consequence, audiologists are advised to recognize signs and symptoms associated with this syndrome.

Incidence and impact of infection in a nursing home care unit

In this study we examined the frequency of infection and its consequences in a Veterans Administration medical center nursing home care unit during its first 9 months of operation. A total of 231 patients were enrolled and were followed up for an average stay of 115 days. Sixty-nine infections occurred in 50 patients and yielded a period prevalence rate of 22% and an infection incidence rate of 2.6 infections per 1000 days of patient care. Symptomatic urinary tract infections, pneumonia, and skin and soft tissue infections accounted for 41%, 32%, and 17% of the infections, respectively. Staphylococci, streptococci, and aerobic gram-negative bacilli were the most common bacterial isolates. Thirty-four episodes of infection (49%) required administration of parenteral antibiotics in the nursing home care unit, and 21 episodes (30%) necessitated transfer to the acute care hospital for management. Infection caused one death and contributed to the death of 4 of the 55 other patients who died during the study period.

Hearing loss in Stickler's syndrome: a family case study

Stickler's syndrome is an autosomal dominant hereditary condition that presents with pathognomonic facial features, dysplasia, myopia and auditory deficits. This paper describes the auditory history of a family with Stickler's syndrome. Given the expressive variability, a complete audiologic and otologic evaluation is encouraged when Stickler's syndrome is suspected.