Targeting improved resilience in Merino sheep - Correlations between immune competence and health and fitness traits

Resilience can be defined as the ability of an animal to remain productive in the face of diverse environmental challenges. Several factors contribute to an animal's resilience including its ability to resist disease, cope with climatic extremes and respond to stressors. Immune competence, a proxy trait for general disease resistance, is expected to contribute to an animal's resilience. This research aimed to develop a practical method to assess immune competence in Merino sheep which would not restrict the future sale of tested animals, and to estimate genetic parameters associated with the novel trait. We also aimed to explore associations between immune competence and other industry-relevant disease resistance and fitness-related traits and to assess the ability of immune competence phenotypes to predict health outcomes. Here, the ability of Merino wethers (n = 1 339) to mount both an antibody-mediated and cell-mediated immune response was used to define their immune competence phenotype. For that purpose, antigens in a commercial vaccine were administered at the commencement of weaning and their responses were assessed. Univariate sire models were used to estimate variance components and heritabilities for immune competence and its component traits. Bivariate sire models were used to estimate genetic correlations between immune competence and a range of disease resistance and fitness-related traits. The heritability of immune competence and its component traits, antibody-mediated immune response and cell-mediated immune response were estimated at 0.49 ± 0.14, 0.52 ± 0.14 and 0.36 ± 0.11, respectively. Immune competence was favourably genetically correlated with breech flystrike incidence (-0.44 ± 0.39), worm egg count (-0.19 ± 0.23), dag score (-0.26 ± 0.31) and fitness compromise (-0.35 ± 0.24) but not fleece rot (0.17 ± 0.23). Results suggest that selection for immune competence has the potential to improve the resilience of Merino sheep; however, due to the large standard errors associated with correlation estimates reported here, further studies will be required in larger populations to validate associations between immune competence and disease resistance and fitness traits in Australian Merino sheep.

Insight into development of a mentorship program in a professional pharmacy organization

INTRODUCTION

The American Association of Colleges of Pharmacy Pharmacy Practice Section appointed a task force charged with developing a formal, national mentorship program for association section members. This manuscript provides insight into the creation of a mentorship program in a professional organization.

METHODS

Eighteen task force volunteers were divided into four sub-teams, along with a chair and vice chair. Sub-team responsibilities were segmented into the following: (1) mission and vision development, (2) structure and content, (3) assessment and impact, and (4) dissemination and scholarship. Task force members were surveyed to generate recommendations for creating a formal mentorship program within a professional organization and reflect on the process.

RESULTS

Seven of 14 eligible task force members completed the questionnaire (50% response rate). Most participants were mid-career, involved in a range of development aspects, and represented both committee members and leadership within the task force. The average time commitment was 15-19 hours over the year. The most common resource utilized was published literature and guidance documents. Identified needs included validated assessment tools, a wider range of exemplary programs to review, and guidance on broader organizational support. Strengths included organization and sub-team structure. Areas for improvement included coordination between sub-teams and resources available. Participants noted the challenges of creating a program to meet the diverse needs of a large membership.

CONCLUSIONS

This manuscript demonstrates the feasibility and evidence-based approach in creation of a mentorship program within a national organization.

Risk factors for development of initial Clostridioides difficile infection

OBJECTIVES

The purpose of this study was to identify risk factors for initial complicated Clostridioides difficile infection (CDI).

METHODS

This retrospective cross-sectional study included adult patients with initial episodes of CDI who received ≥72 h of CDI-active antimicrobials. Patients were categorised into one of two groups: complicated CDI or uncomplicated CDI. A total of 513 patients were screened for inclusion, with complicated CDI patients exhibiting abnormal abdominal CT findings or experiencing death within 30 days post-CDI diagnosis.

RESULTS

A total of 203 patients met the inclusion criteria, comprising 143 (70.4%) with uncomplicated CDI and 60 (29.6%) with complicated CDI. Complicated CDI patients were more likely to have been exposed to fluoroquinolones (48.3% vs. 30.8%; P = 0.017) and to carbapenems for a longer duration prior to CDI diagnosis (7 days vs. 3 days; P = 0.019). They were more likely to receive oral vancomycin (65.0% vs. 46.9%; P = 0.018) and rectal vancomycin (5.0% vs. 0%; P = 0.025) compared with uncomplicated CDI patients. Logistic regression identified previous fluoroquinolone exposure increased the risk of complicated CDI, while previous abdominal surgery decreased the risk.

CONCLUSION

Almost one-third of included patients experienced a complicated episode of CDI as their initial episode. Further research is warranted to elucidate the extent of influence of prior antibiotics on the development of complicated CDI.

Sustained Virologic Response of Patients Hospitalized Compared With Those Not Hospitalized During Treatment for Hepatitis C Virus With Direct-Acting Antivirals

BACKGROUND

Direct-acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) have resulted in great success through high attainment of sustained virologic response (SVR). Risk factors for DAA treatment failure are important to identify because of worsened outcomes with failure and high treatment cost.

OBJECTIVE

We sought to identify whether hospitalization during treatment affects SVR. The primary outcome was the difference in SVR at 12 weeks after treatment.

METHODS

This multicenter, single health system retrospective cohort review compared achievement of SVR between patients hospitalized during DAA treatment for HCV with those not hospitalized during treatment.

RESULTS

Patients in the hospitalized cohort (n = 94) had more severe disease at baseline than nonhospitalized patients (n = 167) as indicated through higher Model for End-Stage Liver Disease (MELD) scores, Fibrosis-4 scores, and imaging-suggested or biopsy-confirmed cirrhosis. Patients hospitalized during treatment had lower SVR rates compared with those not hospitalized (87.2% vs 95.2%; P = 0.043) but failed to reach significance when inpatient mortality was excluded on secondary analysis (91.1% vs 95.2%; P = 0.195). Patients who were hospitalized and did not achieve SVR had higher MELD scores, were more likely to have intensive care unit stay, and had longer hospital stay compared with those who achieved SVR. Of 94 patients, 93 provided home supply of DAAs during hospitalization.

CONCLUSION AND RELEVANCE

Patients hospitalized during DAA treatment for HCV had reduced rates of SVR. This reduced SVR rate may be driven by inpatient mortality and severity of liver disease. Patient education to bring home supply of medication for use during admission is an effective intervention.

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

The elderly population can be divided into three distinct age groups: 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Despite evidence of a shift in leading causes for mortality in the elderly from infectious diseases to chronic conditions, infections are still a serious cause of death in this population. These patients are at increased risk due to weakened immune systems, an increased prevalence of underlying comorbidities, and decreased physiologic reserves to fight infection. Additionally, elderly patients, especially adults in institutional settings, are at an increased risk of colonization and subsequent infection with methicillin-resistant Staphylococcus aureus at a rate that is five times higher than in younger individuals, causing an increase in empiric and definitive vancomycin use. Elderly patients have unique characteristics that make dosing vancomycin a challenge for clinicians, such as increased volume of distribution and decreased renal function. Using the best available evidence, it is recommended to initiate lower empiric maintenance doses and monitor vancomycin serum concentrations earlier than steady state to accurately calculate drug elimination and make appropriate dose adjustments.

Managing acute bacterial skin and skin structure infections: Focus on new lipoglycopeptides

Acute bacterial skin and skin structure infections (ABSSSI) are some of the most commonly encountered infections worldwide. Hospitalizations as a result of ABSSSI are associated with high mortality. This article discusses the role of oritavancin and dalbavancin, two new lipoglycopeptides, in the context of the other I.V. available standard therapy options.

A standardized method for quantifying consistent individual differences in schooling behaviour

A method for quantifying consistent individual differences in schooling behaviour is presented. This method, which utilizes a school of models, improves on previous methods by removing the unwanted variation that is introduced by live stimulus fish while still providing the physiological experience of schooling to the focal fish. Three-spined stickleback Gasterosteus aculeatus observed in the model school assay exhibited consistent individual differences in schooling behaviour.

Elbasvir/Grazoprevir: A Review of the Latest Agent in the Fight against Hepatitis C

Hepatitis C virus (HCV) is estimated to affect up to 150 million people worldwide. Despite worldwide prevalence, treatment modalities prior to 2011 remained suboptimal, with low virologic response rates and intolerable side effect profiles. Fortunately, the landscape of treatment for chronic hepatitis C has rapidly evolved since the introduction of HCV NS3/4 protease inhibitors in 2011. Elbasvir, a NS5A inhibitor, combined with grazoprevir, a NS3/4A protease inhibitor, is the latest FDA-approved therapy for patients with genotype 1 or 4 chronic hepatitis C, with or without compensated cirrhosis. This review will focus on the current literature and clinical evidence supporting elbasvir/grazoprevir as first-line therapy in patients with genotypes 1 and 4 chronic hepatitis C.

Acute hepatic injury with amphotericin B deoxycholate in an immunocompetent patient

Amphotericin B deoxycholate (AmBd) is rarely used due to its adverse effect profile, which includes nephrotoxicity, infusion-related reactions, and hepatotoxicity. The incidence of hepatotoxicity related to AmBd is 18–23%, but the reports of this adverse effect are mainly in immunocompromised patients receiving chemotherapy. We report a case of AmBd-related acute hepatic injury in an immunocompetent male with multiple medical problems. The patient initially had acute hepatic injury likely caused by poor nutritional status and a diagnosis of failure to thrive, but was recovering. He was also diagnosed with bilateral renal fungal mycetomas and received systemic treatment initially with micafungin and then fluconazole after urine cultures returned with the growth of Candida glabrata. Therapy was expanded to systemic AmBd when the fungal balls persisted. The patient subsequently developed hepatic re-injury with 1 dose of AmBd, and the therapy was discontinued. Caution should be exerted when utilizing AmBd in treating patients with previous hepatic injury.

Pathways to Improve Student Pharmacists' Experience in Research

OBJECTIVE

To describe the implementation of a student research program and to provide outcomes from the initial 4 years' experience.

DESIGN

Students conducted individual research projects in a 4-year longitudinal program (known as Pathway), with faculty member advising and peer mentoring. A prospective assessment compared perceptions of those who completed the Pathway program with those of students who did not. Descriptive statistics, t tests, and analysis of variance (ANOVA) were used.

ASSESSMENT

The class of 2013 was the first to complete the Pathway program. In the Pathway assessment project, 59% (n=47) of students who responded reached self-set goals. Pathway students agreed that this research experience improved their ability to work/think independently, evaluate literature, and distinguish themselves from other students.

CONCLUSION

The Pathway program helped students understand the research process and reach other self-set goals.

Pharmacologic therapy for nonalcoholic fatty liver disease in adults

Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of triglycerides in hepatocytes in the absence of excessive alcohol intake, ranging in severity from simple steatosis to nonalcoholic steatohepatitis (NASH). Nonalcoholic steatohepatitis can ultimately progress to cirrhosis and hepatocellular carcinoma. NAFLD is associated with cardiometabolic risk factors and is the most common chronic liver disease among adults in the Western Hemisphere. Although simple steatosis is generally considered a self-limiting disease, evidence suggests an increased risk of cardiovascular disease, and, less conclusively, mortality, among individuals with NAFLD and/or NASH. The current standard of care for the treatment of patients with NAFLD focuses on lifestyle interventions, particularly diet and exercise. There is a lack of consensus regarding the most effective and appropriate pharmacologic therapy. A PubMed search was conducted using the medical subject heading terms "fatty liver" and "steatohepatitis." This review focuses on the current pharmacologic options available for treating adults with NAFLD and/or NASH. Continued investigation of drugs or combinations that improve NAFLD progression is crucial. Clinicians, particularly pharmacists, must take an active role in identification and appropriate selection of pharmacotherapy for NAFLD.

p38 MAPK activation, JNK inhibition, neoplastic growth inhibition, and increased gap junction communication in human lung carcinoma and Ras-transformed cells by 4-phenyl-3-butenoic acid

Human lung neoplasms frequently express mutations that down-regulate expression of various tumor suppressor molecules, including mitogen-activated protein kinases such as p38 MAPK. Conversely, activation of p38 MAPK in tumor cells results in cancer cell cycle inhibition or apoptosis initiated by chemotherapeutic agents such as retinoids or cisplatin, and is therefore an attractive approach for experimental anti-tumor therapies. We now report that 4-phenyl-3-butenoic acid (PBA), an experimental compound that reverses the transformed phenotype at non-cytotoxic concentrations, activates p38 MAPK in tumorigenic cells at concentrations and treatment times that correlate with decreased cell growth and increased cell-cell communication. H2009 human lung carcinoma cells and ras-transformed rat liver epithelial cells treated with PBA showed increased activation of p38 MAPK and its downstream effectors which occurred after 4 h and lasted beyond 48 h. Untransformed plasmid control cells showed low activation of p38 MAPK compared to ras-transformed and H2009 carcinoma cells, which correlates with the reduced effect of PBA on untransformed cell growth. The p38 MAPK inhibitor, SB203580, negated PBA's activation of p38 MAPK downstream effectors. PBA also increased cell-cell communication and connexin 43 phosphorylation in ras-transformed cells, which were prevented by SB203580. In addition, PBA decreased activation of JNK, which is upregulated in many cancers. Taken together, these results suggest that PBA exerts its growth regulatory effect in tumorigenic cells by concomitant up-regulation of p38 MAPK activity, altered connexin 43 expression, and down-regulation of JNK activity. PBA may therefore be an effective therapeutic agent in human cancers that exhibit down-regulated p38 MAPK activity and/or activated JNK and altered cell-cell communication.

A clinical pathway for community-acquired pneumonia: an observational cohort study

BACKGROUND

Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.

METHODS

Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.

RESULTS

Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).

CONCLUSIONS

Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.

Early exposure to nonlethal predation risk by size-selective predators increases somatic growth and decreases size at adulthood in three-spined sticklebacks

Predation has an important influence on life history traits in many organisms, especially when they are young. When cues of trout were present, juvenile sticklebacks grew faster. The increase in body size as a result of exposure to cues of predators was adaptive because larger individuals were more likely to survive predation. However, sticklebacks that had been exposed to cues of predators were smaller at adulthood. This result is consistent with some life history theory. However, these results prompt an alternative hypothesis, which is that the decreased size at adulthood reflects a deferred cost of early rapid growth. Compared to males, females were more likely to survive predation, but female size at adulthood was more affected by cues of predators than male size at adulthood, suggesting that size at adulthood might be more important to male fitness than to female fitness.

Severe citrate toxicity complicating volunteer apheresis platelet donation

We report a case of severe citrate toxicity during volunteer donor apheresis platelet collection. The donor was a 40-year-old female, first-time apheresis platelet donor. Past medical history was remarkable for hypertension, hyperlipidemia, and depression. Reported medications included bumetanide, pravastatin, and paroxetine. Thirty minutes from the start of the procedure, the donor noted tingling around the mouth, hands, and feet. She then very rapidly developed acute onset of severe facial and extremity tetany. Empirical treatment with intravenous calcium gluconate was initiated, and muscle contractions slowly subsided over approximately 10 to 15 minutes. The events are consistent with a severe reaction to calcium chelation by sodium citrate anticoagulant resulting in symptomatic systemic hypocalcemia. Upon additional retrospective analysis, it was noted that bumetanide is a loop diuretic that may cause significant hypocalcemia. We conclude that careful screening for medications and underlying conditions predisposing to hypocalcemia is recommended to help prevent severe reactions due to citrate toxicity. Laboratory measurement of pre-procedure serum calcium levels in selected donors may identify cases requiring heightened vigilance. The case also illustrates the importance of maintaining preparedness for managing rare but serious reactions in volunteer apheresis blood donors.

Behavioural differences between individuals and two populations of stickleback (Gasterosteus aculeatus)

Behavioural syndromes are correlations between behaviours in different functional contexts. Behavioural syndromes are attracting the attention of evolutionary biologists because they mean that different behaviours might not be free to evolve independently of one another. In a landmark study, Huntingford (1976) showed that individual stickleback which were bold toward predators were also aggressive toward conspecifics and active in an unfamiliar environment. Here, I revisited the activity-aggression-boldness syndrome in stickleback and tested the hypothesis that correlations between behaviours might act as evolutionary constraints. I measured a suite of behaviours on wild-caught individuals and their offspring from two different populations and calculated heritabilities and genetic correlations between the different behaviours. I found that these behaviours were phenotypically and genetically correlated in one population but not another. On average, boldness and aggression were negatively related to each other across the populations. These results suggest that behavioural syndromes don't always act as evolutionary constraints.

Chemically induced magnetism and magnetoresistance in La(0.8)Sr(1.2)Mn(0.6)Rh(0.4)O(4)

It is shown by magnetometry and microSR spectroscopy that short-range magnetic interactions between the Mn cations in the nonmetallic K(2)NiF(4)-like phase La(0.8)Sr(1.2)Mn(0.6)Rh(0.4)O(4) become significant below approximately 200 K. Negative magnetoresistance (rho/rho(0) approximately 0.5 in 14 T at 108 K) is apparent below this temperature. Neutron diffraction has shown that an applied magnetic field of 5 T is sufficient to induce saturated (3.38(7)mu(B) per Mn) long-range ferromagnetic ordering of the atomic moments at 2 K, and that the induced ordering persists up to a temperature of 50 K in 5 T. Spin glass behavior is observed below 20 K in the absence of an applied field. The induced magnetic ordering is attributed to the subtle changes in band structure brought about by the external field, and to the controlling influence of Rh(3+) over the relative strength of competing magnetic exchange interactions.

A novel conserved cochlear gene, OTOR: identification, expression analysis, and chromosomal mapping

We have identified a novel cochlear gene, designated OTOR, from a comparative sequence analysis of over 4000 clones from a human fetal cochlear cDNA library. Northern blot analysis of human and chicken organs shows strong OTOR expression only in the cochlea; very low levels are detected in the chicken eye and spinal cord. Otor and Col2A1 are coexpressed in the cartilaginous plates of the neural and abneural limbs of the chicken cochlea, structures analogous to the mammalian spiral limbus, osseous spiral lamina, and spiral ligament, and not in any other tissues in head and body sections. The human OTOR gene localizes to chromosome 20 in bands p11.23-p12.1 and more precisely to STS marker WI-16380. We have isolated cDNAs orthologous to human OTOR in the mouse, chicken, and bullfrog. The encoded protein, designated otoraplin, has a predicted secretion signal peptide sequence and shows a high degree of cross-species conservation. Otoraplin is homologous to the protein encoded by CDRAP/MIA (cartilage-derived retinoic acid sensitive protein/melanoma inhibitory activity), which is expressed predominantly by chondrocytes, functions in cartilage development and maintenance, and has growth-inhibitory activity in melanoma cell lines.

Identification with a recombinant antibody of an inner-ear cytokeratin, a marker for hair-cell differentiation

Extensive biochemical characterization of cells in the inner ear has been hampered by a lack of tools with which to identify inner-ear proteins. By using a single-chain antibody fragment isolated from a bacteriophage-displayed library, we have identified a cytokeratin that is abundant in nonsensory cells of the frog inner ear. Although the progenitors of hair cells exhibit strong immunoreactivity to this cytokeratin, the signal declines in immature hair cells and vanishes as the cells mature. The correlation between diminished immunoreactivity and hair-cell differentiation indicates that the cytokeratin is down-regulated during the transition from a nonsensory to a sensory cell and suggests that the marker is an early index of hair-cell differentiation.

Localization of a gene for otosclerosis to chromosome 15q25-q26

Among white adults otosclerosis is the single most common cause of hearing impairment. Although the genetics of this disease are controversial, the majority of studies indicate autosomal dominant inheritance with reduced penetrance. We studied a large multi-generational family in which otosclerosis has been inherited in an autosomal dominant pattern. Five of16 affected persons have surgically confirmed otosclerosis; the remaining nine have a conductive hearing loss but have not undergone corrective surgery. To locate the disease-causing gene we completed genetic linkage analysis using short tandem repeat polymorphisms (STRPs) distributed over the entire genome. Multipoint linkage analysis showed that only one genomic region, on chromosome 15q, generated a lod score >2.0. Additional STRPs were typed in this area, resulting in a lod score of 3.4. STRPs FES (centromeric) and D15S657 (telomeric) flank the 14. 5 cM region that contains an otosclerosis gene.

Fatal human melioidosis in south-eastern Queensland

Two simultaneous human cases of fatal melioidosis in temperate south-eastern Queensland involved patients who had had pre-existing multisystem illnesses, had sustained cutaneous lesions before illness onset, and died from overwhelming sepsis. Onset of disease was preceded by unseasonably heavy rainfall. These and other features of these cases suggest that the source of infection was local, in which case the endemicity of Burkholderia pseudomallei in temperate regional Australia may be broader than is currently recognised, and melioidosis may need to be considered in at-risk patients in these areas, as well as in tropical and subtropical areas, who present with severe pneumonia and septicaemia.

Sexual maturation in male prairie voles: effects of the social environment

The effects of various social contexts on sexual maturation in captive male prairie voles were investigated. Sexual maturity was assessed as the ability of a young male to produce urine capable of activating a diestrous adult female into estrus, as females remain anestrus until they ingest a male urinary chemosignal. In five experiments the postweaning social environments of developing males were manipulated (e.g., presence or absence of dam, sire, or junior litter, exposure to unfamiliar adult voles, social isolation) to determine if the age at which males begin to produce potent urine was sensitive to social effects. In general, there was no difference in the age of potent urine production as a function of social environment. Findings are discussed in the context of dispersal, inbreeding avoidance, and mate acquisition.

Ongoing results of excimer laser photorefractive keratectomy for myopia: subjective patient impressions

We present the results of a survey carried out by independent researchers to determine the subjective success rate of a series of excimer laser photorefractive keratectomy procedures to correct myopia. Thirty patients, selected at random from a group of 300, had received treatment to both eyes with a minimum of six months follow-up on the second eye. Forty-four patients, selected at random from a group of 120, had received treatment to one eye only with five months of follow-up. The results show a high level of satisfaction with the results of the procedure.

Deletion (11)(q14.1q21)

We report on a 4-year-old girl with moderate developmental delay, horseshoe kidney, bilateral duplication of the ureters with right upper pole obstruction, hydronephrosis and nonfunction, and subsequent Wilms tumor of the right lower pole. She had an interstitial deletion of the long arm of chromosome 11 involving the region 11(q14.1q21).

Rectal wall contractility in healthy subjects and in patients with chronic severe constipation

OBJECTIVE

The aim of this study was to identify differences in rectal wall contractility between healthy volunteers and patients with chronic severe constipation.

SUMMARY BACKGROUND DATA

Whether motor function of the rectum contributes to slow-transit constipation is unknown. Measurements of rectal contractility have been performed traditionally with perfused catheters or microtransducers. The rectal barostat is a new technique that quantifies the volume of air within an infinitely compliant intrarectal bag maintained at constant pressure; decreases in bag volume therefore reflect increases in rectal muscular contractility (tone). Increases in volume reflect decreased contractility.

METHODS

Fifteen healthy volunteers (ten women and five men; mean age, 36 years) and eight patients (seven women and one man; mean age, 44 years) were studied. Barostat recordings were made for 1 hour before and after a meal. Randomly, neostigmine (0.5 mg) or glucagon (1 unit) was then given intravenously. After 1 hour, the other medication was given.

RESULTS

The fasting rectal volume was similar in the patient and control groups (113 +/- 7 mL vs. 103 +/- 4 mL, respectively; p > 0.05). Compared with controls, constipated patients had a significantly lower reduction in rectal volume after a meal (constipated, 35 +/- 8% vs. controls, 65 +/- 7%; p < 0.05) and after neostigmine administration (constipated, 39 +/- 6% vs. controls, 58 +/- 6%; p < 0.05). Moreover, constipated patients had a smaller increase in rectal volume after glucagon administration than did controls (28 +/- 6% vs. 64 +/- 18%, respectively; p < 0.05.

CONCLUSIONS

Changes in rectal wall contractility in response to feeding, a cholinergic agonist, and a smooth muscle relaxant were decreased in constipated patients. These findings suggest that an abnormality of rectal muscular wall contractility is present in constipated patients.

Fecal short-chain fatty acid concentrations and effect on ileal pouch function

Random stool samples were obtained from 14 ileal pouch-anal anastomosis (IPAA) patients 43 +/- 5 (mean +/- SEM) months after surgery, and the concentrations of individual short-chain fatty acids (SCFAs) were determined by gas liquid chromatography. Stool frequency was determined from a diary recorded for 15 days prior to stool sampling. The frequency, amplitude, and duration of phasic contractions (PCs) within the pouch following infusion of a physiologic concentration of SCFAs and normal saline randomly into the pouch of six IPAA patients were determined manometrically. The mean total SCFA concentration after IPAA did not differ significantly from normal stools (83 +/- 20 mM after IPAA vs. 97 +/- 10 mM for controls; P > 0.05). In the IPAA patients, regression analysis demonstrated an inverse relationship between stools per day and total SCFA concentration (r = 0.73; P < 0.001). Moreover, no change in frequency (3.0 +/- 0.9 vs. 3.2 +/- 0.8 PCs/30 minutes), amplitude (26 +/- 5 vs. 25 +/- 4 mmHg), or duration (23 +/- 3 vs. 26 +/- 2 seconds) of PCs was found after SCFA infusion compared with saline control (P > 0.1). These findings demonstrate that SCFAs are present in ileal pouch effluent and that stool frequency may be related to fecal SCFA concentration. Also, the normal contractile response of the terminal ileum to SCFAs does not occur in the ileal pouch.

Dentistry is making a career comeback

Technology took some of the bloom off dentistry as a career choice. Ironically, it's the same force that has given new status to the profession and made dentistry the career of the future.

The effect of stool consistency on rectal and neorectal emptying

Although stool consistency is considered to be an important component of anorectal continence, its effect on rectal emptying has never been quantitated. In 12 healthy volunteers and 12 patients after ileal pouch-anal anastomosis (IPAA) (46 +/- 5 months after the operation; mean +/- SEM), perfused anal manometry was performed; movements of the anorectal angle were quantitated scintigraphically; and rectal capacity and compliance were measured by air insufflation of an intrarectal balloon at three infusion rates. The efficiency of rectal evacuation of three consistencies (5 percent, liquid; 7.5 percent semisolid gel; 11.25 percent solid gel; w/w) of Tc99m labeled artificial stool (aluminum magnesium silicate gel) was quantitated by gamma camera imaging. No abnormalities of pelvic floor function were demonstrated in either controls or patients. The mean neorectal capacity and compliance of patients with IPAA did not differ from control, (capacity; IPAA: 215 +/- 22 ml vs. control; 245 +/- 29 ml; compliance; IPAA: 5.5 +/- 0.7 ml/cm H2O vs. control; 6.6 +/- 0.7 ml/cm H2O; P greater than 0.05). In controls, the percentage of the 7.5 percent consistency evacuated (81 +/- 5 percent, mean +/- SEM) was significantly more than the percentage evacuation of either the 5 percent consistency (67 +/- 7 percent) or the 11.25 percent consistency (77 +/- 2 percent) (P less than 0.05). After IPAA, the mean overall percent evacuation of the three stool consistencies was significantly less than control (52 +/- 6 percent after IPAA; 75 +/- 5 percent control, P less than 0.05). However, there was no significant difference in neorectal emptying between the liquid, the semisolid gel and the solid gel (56 +/- 6, 55 +/- 6, 51 +/- 9 percent, respectively, P greater than 0.1). We concluded that in healthy subjects but not in patients after IPAA, stool consistency affected the efficiency of evacuation of enteric content.

Variations in muscle tone of the human rectum: recordings with an electromechanical barostat

Rectal wall tone (the contractile state of the rectal tunica muscularis) should mediate accommodation and influence rectal emptying. Such changes in tone however can be only inferred from changes in baseline pressure recorded with conventional manometry. We used an isobaric volumetric device, the rectal electromechanical barostat, to quantify variations in tone of the rectal wall in response to feeding and to perturbations in response to the pharmacological agents neostigmine and glucagon. The barostat quantitates muscular wall tone indirectly by measuring its reciprocal, e.g., the volume of air within a flaccid intraluminal bag that is maintained at a constant and preselected pressure, by an electronic feedback mechanism. The barostat as well as a three-channel perfused manometric catheter were positioned in the rectum of 14 healthy volunteers. Three patterns of changes were observed: 1) respiratory fluctuations, 2) rapid volume waves, and 3) slow volume changes. Rectal tone varied little during fasting; rapid or slow changes in intrabag volume were infrequent. Ingestion of a standard meal was followed by a significant decrease in barostat bag volume (85 +/- 6 ml fasting vs. 50 +/- 8 ml fed, P less than 0.05). Pharmacological agents also induced predictable responses; neostigmine decreased bag volume and induced phasic pressure activity, whereas glucagon abolished phasic pressure activity and increased barostat bag volume. Perfused manometric catheters showed no concomitant changes in baseline pressure. We concluded that a rectal barostat measured variations in human rectal tone, which were not recorded by conventional manometric techniques. These changes in rectal tone might have important functional significance.

Gallstone pancreatitis

Gallstone pancreatitis is a disease of high mortality (11%) and significant morbidity (42%). An analysis of 66 patients with this disease revealed the importance of an early aetiological diagnosis; 66% of our patients had evidence of previous biliary disease. Most patients were elderly and the severity of their disease could be predicted using Ranson's predictive indices. Surgery was immediate (within 48 hours) in 11 (17%) patients, early (two-14 days) in 16 (24%) and delayed in 27 (41%) patients. Some patients refused surgery. Our study suggests that very ill patients require immediate surgery--often cholecystostomy alone--and that although in the majority symptoms should settle on conservative treatment, definitive surgery should be carried out at the time of the initial admission. Further delay increases morbidity, mortality and expense.

Ceramometal crowns and bridges. Focus on failures

There are numerous factors that can have an adverse or beneficial effect upon the esthetic appearance of a ceramometal restoration. Some of these factors are beyond the influence of the dentist unless he or she is aware of them. As knowledgable practicing dentists, they have the ability to prescribe for their patients in such a manner as to achieve greater success and, in turn, greater patient acceptance and recognition. These are the rewards of a successful crown and bridge practice, and the ceramometal restoration is the basic state of the art prosthesis in present use. Knowing how to take a shade under the proper lighting conditions is generally well taught as part of the dental school curriculum, but the knowledge that shade guides are manufactured with built in idiosyncrasies of color variations from guide to guide is an enlightening experience. O'Brien of the Department of Dental Materials at the University of Michigan School of Dentistry clearly demonstrated the variabilities of color intensities between porcelain manufacturers. Laboratory technicians have been frustrated by the inconsistency of shades of porcelains from one lot number to another. It is now more fully understood that fluorescence is an important factor in patient satisfaction, as patients observe and have their restorations seen under differing lighting conditions. The type of alloy used in the ceramometal combination can have an effect upon the esthetic result. The wider use of silver-palladium alloys requires that the porcelain employed be of a nongreening nature, or else the final glazed prosthesis will give off a greenish cast. The ability of the opaque to block out the metal substructure while blending with the gingival and incisal shades eliminates the graying out, which can be esthetically objectionable to the patient. However, one of the most important considerations in aesthetic ceramometal restorations is the correct anatomy, placement, and harmonious blending with the oral and facial features and coloring of the patient. It would be comforting if we could all agree on a definition of esthetics. There is perhaps no more important aspect of marketing the ceramometal restoration to the patient than arrive, in advance, on a common ground and understanding of what the esthetic goals of the case are in realistic terms.(ABSTRACT TRUNCATED AT 400 WORDS)

Prostaglandins cause an increase in serum acute-phase proteins in man, which is diminished in systemic sclerosis

The prostaglandin E1 increases the plasma concentration of acute-phase proteins in man and decreases the concentration of certain carrier proteins. This response is greatly diminished in patients with systemic sclerosis, a chronic inflammatory disease leading to fibrosis. These findings pose new questions about the mediation of the acute-phase response and its role in controlling the inflammatory process.

Acute phase serum proteins in syngeneic and allogeneic mouse pregnancy

The levels of two murine acute phase proteins, serum amyloid P component (SAP) and haptoglobin, have been measured in the serum of C57BL/10 female mice during syngeneic and allogeneic pregnancy. Both syngeneic and allogeneic pregnancy resulted in alterations in the levels of these proteins as compared to those observed in virgin females. Syngeneic mating resulted in an increase in concentration of both proteins during the final 3 days of pregnancy. During allogeneic pregnancy, SAP levels, after a transient increase on day 4, rose from days 6-8 and, after remaining relatively stable, increased from day 12 to reach maximum levels on day 18 of pregnancy. Levels fell dramatically during the immediate post-partum period. In contrast, although levels of haptoglobin also increased from days 6-8, for the remainder of pregnancy these increased levels remained stable. The implications of these findings are discussed in relation to the mechanisms of regulation of acute phase reactants and the immunological relationship between the mother and fetus.

[Clinical study on a new acetylsalicylic acid/paracetamol preparation with gastric acid resistant coating (Safapryn), and on two various phenylbutazone dosages in patients with primary chronic polyarthritis as based on a new evaluation method]

The authors describe a simple non-crossover-blind test for the evaluation of subjective indices. A table for recording pains during the 14 days' study is described. The patient's satisfaction with the treatment and the number of days until withdrawal from the trial are recorded. The statistical procedure takes into consideration differences between the treatment groups and makes possible a valuable comparison with drugs tested in other clinical trials. The three dose schedules of antirheumatic treatment were tested on 122 patients and the results compared with those of 342 patients treated with the 6 other antirheumatic drugs (enteric-coated aspirin, paracetamol, indomethacin, flurbiprofen, mefenamic acid, and prednisolone) and those of 41 patients who received placebos. The results show that Safapryn (3,6 g aspirin + 3.0 g paracetamol daily) compared with 3.9 g enteric coated aspirin does not offer any advantage in its analgesic effect, although it gives rise to fewer side effects. Phenylbutazone (3000 mg) was almost as effective as 15 mg prednisolone daily. Between the effects of this dosage of phenylbutazone and other non-steroidal antirheumatic drugs, however, no significant difference could be detected. 50 mg phenylbutazone daily and placebo treatment could not be distinguished. The authors thank the Arthritis and Rheumatism Council for Research in Great Britain for its financial support. One of the authors (PL) was a Merck, Sharp, and Dohme Research Fellow and another one (PMB) received a Robins research scholarship.