Rare variants in KDR, encoding VEGF Receptor 2, are associated with tetralogy of Fallot

PURPOSE

Rare genetic variants in KDR, encoding the vascular endothelial growth factor receptor 2 (VEGFR2), have been reported in patients with tetralogy of Fallot (TOF). However, their role in disease causality and pathogenesis remains unclear.

METHODS

We conducted exome sequencing in a familial case of TOF and large-scale genetic studies, including burden testing, in >1,500 patients with TOF. We studied gene-targeted mice and conducted cell-based assays to explore the role of KDR genetic variation in the etiology of TOF.

RESULTS

Exome sequencing in a family with two siblings affected by TOF revealed biallelic missense variants in KDR. Studies in knock-in mice and in HEK 293T cells identified embryonic lethality for one variant when occurring in the homozygous state, and a significantly reduced VEGFR2 phosphorylation for both variants. Rare variant burden analysis conducted in a set of 1,569 patients of European descent with TOF identified a 46-fold enrichment of protein-truncating variants (PTVs) in TOF cases compared to controls (P = 7 × 10-11).

CONCLUSION

Rare KDR variants, in particular PTVs, strongly associate with TOF, likely in the setting of different inheritance patterns. Supported by genetic and in vivo and in vitro functional analysis, we propose loss-of-function of VEGFR2 as one of the mechanisms involved in the pathogenesis of TOF.

Transcriptome alterations in myotonic dystrophy skeletal muscle and heart

Myotonic dystrophy (dystrophia myotonica, DM) is a multi-systemic disease caused by expanded CTG or CCTG microsatellite repeats. Characterized by symptoms in muscle, heart and central nervous system, among others, it is one of the most variable diseases known. A major pathogenic event in DM is the sequestration of muscleblind-like proteins by CUG or CCUG repeat-containing RNAs transcribed from expanded repeats, and differences in the extent of MBNL sequestration dependent on repeat length and expression level may account for some portion of the variability. However, many other cellular pathways are reported to be perturbed in DM, and the severity of specific disease symptoms varies among individuals. To help understand this variability and facilitate research into DM, we generated 120 RNASeq transcriptomes from skeletal and heart muscle derived from healthy and DM1 biopsies and autopsies. A limited number of DM2 and Duchenne muscular dystrophy samples were also sequenced. We analyzed splicing and gene expression, identified tissue-specific changes in RNA processing and uncovered transcriptome changes strongly correlating with muscle strength. We created a web resource at http://DMseq.org that hosts raw and processed transcriptome data and provides a lightweight, responsive interface that enables browsing of processed data across the genome.

Results from 10 years of breast screening in Wales

Objective To present results from 10 years of breast screening in Wales, including rates of interval cancers.

Setting All women aged 50–64 years in Wales; approximately 250 000 in each screening round.

Methods Breast Test Wales (BTW) began mammographic screening in 1989 as part of the National Breast Screening Programme. Two view mammography was introduced at the inception of the Welsh programme for all prevalent screens. Single view mammography was subsequently performed for incident screens. Interval cancers were identified by matching details from the BTW administrative screening database with the BTW database of all incident breast cancers for residents in Wales.

Results For the first and second round prevalent screens, the cancer detection rate was 8.6 per 1000 and 7.4 per 1000 screened, respectively. The interval cancer rates following round one were 4.9 per 10 000 in the first 12 months, 9.0 per 10 000 between 12 and 24 months, and 11.6 per 10 000 between 24 and 36 months after screening. For the second round incident screens the detection rate was 4.6 per 1000 and the standardised detection ratio was 0.89, but the interval cancer rates in the first year after incident screens were not statistically different from those following prevalent screens. There was no change in the proportion of invasive breast cancers which were <15 mm in diameter, or in the grades of invasive cancer between the first and second rounds, prevalent or incident screens.

Conclusions Breast Test Wales has achieved the standards set by the National Health Service Breast Screening Programme. Taking two views at the prevalent screen gave high sensitivity and may have resulted in the low standardised detection ratio at subsequent incident screens.

Bounds for moment generating functions and for extinction probabilities

Suppose that we have a non-negative, real valued random variable x, whose distribution is governed by some unknown moment generating function M(t). Suppose further that we are given certain moments of x, then the question to be discussed in this paper is : can we find a sharp upper bounding function for the m.g.f.? It will be shown that this is usually possible both in the single variate case and in its natural extension to the multivariate case.

The Nottingham Prognostic Index: five- and ten-year data for all-cause survival within a screened population

INTRODUCTION

The Nottingham Prognostic Index (NPI) is an established prognostication tool in the management of breast cancers (BCs). Latest ten-year survival data have demonstrated an improved outlook for each NPI category and the latest UK five- and ten-year survival from BC has been reported to be 85% and 77%, respectively. We compared survival of each NPI category for BCs diagnosed within the national breast screening service in Wales (Breast Test Wales (BTW)) to the latest data, and reviewed its validity in unselected cases within a screened population.

METHODS

All women screened between 1998 and 2001 within BTW were included. The NPI score for each cancer was calculated using the size, nodal status, and grade of the primary tumour. Survival data (all-cause) were calculated after ten years of follow-up.

RESULTS

In the three-year screening period, 199,082 women were screened. A total of 1,712 cancers were diagnosed, and 1,546 had data available for calculating the NPI. Overall five-year and ten-year survival was 94% and 82%, respectively.

CONCLUSIONS

Overall five-year and ten-year survival (all-cause) has improved even when compared with UK data for BC-specific survival. We found that the NPI remains valid for BC treatment, and that our data provide a reference for updating the all-cause survival of women diagnosed with BCs within a screened population.

A randomized controlled trial of the efficacy and safety of saxagliptin as add-on therapy in patients with type 2 diabetes and inadequate glycaemic control on metformin plus a sulphonylurea

AIMS

To evaluate the efficacy and safety of saxagliptin as add-on therapy in adults with type 2 diabetes with inadequate glycaemic control on metformin plus a sulphonylurea.

METHODS

In this 24-week, multicentre, randomized, parallel-group, double-blind study, outpatients aged ≥18 years with type 2 diabetes, body mass index ≤40 kg/m(2) and inadequate glycaemic control, received saxagliptin 5 mg or placebo once-daily added to background medication consisting of a stable maximum tolerated dose of metformin plus a sulphonylurea. The primary end point was change in glycated haemoglobin (HbA1c) from baseline to week 24. Safety and tolerability assessments included adverse events (AEs), hypoglycaemia and body weight.

RESULTS

A total of 257 patients were randomized, treated and included in the safety analysis (saxagliptin, n = 129; placebo, n = 128); 255 were included in the efficacy analysis (saxagliptin, n = 127; placebo, n = 128). HbA1c reduction was greater with saxagliptin versus placebo [between-group difference in adjusted mean change from baseline, -0.66%; 95% confidence interval (CI), -0.86 to -0.47 (7 mmol/mol, -9.4 to -5.1); p < 0.0001]. The proportion of patients with ≥1 AE was 62.8% with saxagliptin and 71.7% with placebo. In the saxagliptin and placebo groups, rates of reported hypoglycaemia were 10.1 and 6.3%, respectively, and rates of confirmed hypoglycaemia (symptoms + glucose < 2.8 mmol/l) were 1.6 and 0%. Mean change in body weight was 0.2 kg for saxagliptin and -0.6 kg for placebo (p = 0.0272).

CONCLUSION

Addition of saxagliptin 5 mg/day in patients inadequately controlled on metformin and sulphonylurea effectively improved glycaemic control and was well tolerated.

A common variant in the PTPN11 gene contributes to the risk of tetralogy of Fallot

BACKGROUND

Tetralogy of Fallot (TOF) is the commonest cyanotic form of congenital heart disease. In 80% of cases, TOF behaves as a complex genetic condition exhibiting significant heritability. As yet, no common genetic variants influencing TOF risk have been robustly identified.

METHODS AND RESULTS

Two hundred and seven haplotype-tagging single nucleotide polymorphisms in 22 candidate genes were genotyped in a test cohort comprising 362 nonsyndromic British white patients with TOF together with 717 unaffected parents of patients and 183 unrelated healthy controls. Single nucleotide polymorphisms with suggestive evidence of association in the test cohort (P<0.01) were taken forward for genotyping in an independent replication cohort comprising 392 cases of TOF, 218 unaffected parents of patients, and 1319 controls. Significant association was observed for 1 single nucleotide polymorphism, rs11066320 in the PTPN11 gene, in both the test and the replication cohort. Genotype at rs11066320 was associated with a per-allele odds ratio of 1.34 (95% confidence interval [CI], 1.19 to 1.52; P=2.9 × 10(-6)) in the total cohort of TOF cases and controls; this remained highly significant after Bonferroni correction for 207 analyses (corrected P=0.00061). Genotype at rs11066320 was responsible for a population-attributable risk of TOF of approximately 10%.

CONCLUSIONS

Common variation in the linkage disequilibrium block including the PTPN11 gene contributes to the risk of nonsyndromic TOF. Rare mutations in PTPN11 are known to cause the autosomal dominant condition Noonan syndrome, which includes congenital heart disease, by upregulating Ras/mitogen-activated protein kinase (MAPK) signaling. Our results suggest a role for milder perturbations in PTPN11 function in sporadic, nonsyndromic congenital heart disease.

Two-view mammography at the incident round has improved the rate of screen-detected breast cancer in Wales

AIM

To investigate whether pre-invasive and invasive cancer detection rates were improved in Wales after the introduction of two views at incident screens.

METHODS

The records of women attending follow-up screening for 2 years before and 2 years after the introduction of two-view incident screening were analysed. Cancer detection rates were compared before and after introduction of two view screening.

RESULTS

At the incident round 98,752 women had one and 95,464 had two views. Five hundred and fifty-five cancers were detected with one view and 744 with two, an increased detection rate from 5.6 to 7.8 cancers per 1000 women screened (p=0.01). Two hundred and thirty-nine small cancers were detected with one view and 323 with two, increasing the detection rate from 2.4 to 3.4 per 1000 women screened (p=0.05).

CONCLUSIONS

Two-view mammography at incident rounds detects more cancers and more favourable prognosis small cancers than single-view mammograms.

Clinical and molecular aspects of the myotonic dystrophies: a review

Type 1 myotonic dystrophy or DM1 (Steinert's disease), which is the commonest muscular dystrophy in adults, has intrigued physicians for over a century. Unusual features, compared with other dystrophies, include myotonia, anticipation, and involvement of other organs, notably the brain, eyes, smooth muscle, cardiac conduction apparatus, and endocrine system. Morbidity is high, with a substantial mortality relating to cardiorespiratory dysfunction. More recently a second form of multisystem myotonic disorder has been recognized and variously designated as proximal myotonic myopathy (PROMM), proximal myotonic dystrophy (PDM), or DM2. For both DM1 and DM2 the molecular basis is expansion of an unstable repeat sequence in a noncoding part of a gene (DMPK in DM1 and ZNF9 in DM2). There is accumulating evidence that the basic molecular mechanism is disruption of mRNA metabolism, which has far-reaching effects on many other genes, in part through the induction of aberrant splicing, explaining the multisystemic nature of the disease. The unstable nature of the expansion provides a molecular explanation for anticipation. This review emphasizes the clinical similarities and differences between DM1 and DM2. It examines current views about the molecular basis of these disorders, and contrasts them with other repeat expansion disorders that have increasingly been recognized as a cause of neurological disease.

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales

OBJECTIVES

The aim of this study was to estimate the effect of service screening, as provided by the NHS breast screening programme, on breast cancer mortality in Wales. Furthermore, we wished to ascertain whether a reduction in breast cancer mortality consistent with that observed in the randomised screening trials was being achieved.

SETTING

The NHS Breast Screening Programme in Wales, managed by Breast Test Wales, with headquarters in Cardiff.

METHODS

A case-control study design with 1:2 matching. The cases were deaths from breast cancer in women aged 50-75 years at diagnosis who were diagnosed after the instigation of screening in 1991 and who died after 1998. The controls were women who had not died of breast cancer or any other condition during the study period. One was from the same GP practice and the other from a different GP practice within the same district, matched by year of birth.

RESULTS

Based on 419 cases, the odds ratio for risk of death from breast cancer for women who have attended at least one routine screen compared to those never screened was 0.62 (95% confidence interval [CI] 0.47-0.82, p=0.001). After excluding cases diagnosed prior to 1995 and adjusting for self-selection bias, the estimated mortality reduction was 25% (odds ratio=0.75, 95% CI 0.49-1.14, p=0.09).

CONCLUSION

The Breast Test Wales screening programme is achieving a reduction in breast cancer mortality of 25% in women attending for screening, which is consistent with the results of the randomized controlled trials of mammographic screening.

The relevance of reported symptoms in a breast screening programme

AIM

Although the National Health Service (NHS) Breast Screening Programme is aimed at asymptomatic women, inevitably patients attending screening report symptoms. The study aim was to assess the usefulness of recall based on clinical symptoms.

MATERIALS AND METHODS

Information on breast symptoms is recorded at screening and radiologists can make recall decisions based on mammography and symptom history. We identified 1394 women with significant symptoms, between 1991 and 1996. The majority (54%) complained of a lump, 21% had breast distortion, 18% breast pain alone and 6% reported nipple discharge.

RESULTS

Of the 1394 women, 262 were recalled because of mammographic suspicion and of these, 45% had breast cancer. The other 1132 women had symptoms and benign mammograms and 44% of these were recalled. Seven breast cancers were diagnosed; all had complained of a breast lump. In two the cancer would have been seen on two-view mammography. Of 638 not recalled, five women went on to develop an interval cancer.

CONCLUSION

The results indicate that collecting details on symptoms is useful given the high rate of breast cancer in those with mammographic abnormality. When mammography is benign, however, the low rate of cancer detection means recall should be selective based on only the most relevant symptoms.

Network therapy for addiction: bringing family and peer support into office practice

Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the Internet in dissemination.

Office abortion services for women: private physician providers

Research suggests that private physician providers of office abortions and the women who seek their services are not included in nationwide surveys of abortion statistics. This study describes the demographic characteristics of private physicians and the prevalence of abortions performed in their offices in Los Angeles County, California, a state in which office abortions are prohibited by law. Factors that influence physicians' decisions to provide the service, as well as the age and ethnicity of the office abortion recipients, are examined. Of 1,004 California Medical Association members who practiced obstetrics and gynecology in Los Angeles County during 1990, 49% returned anonymous, confidential surveys. Seventy percent of physicians had performed at least one abortion in California, and 29% were currently providing this service in their offices. Physician gender, age, ethnicity, and religion were associated with performing abortions. The average abortion patient was not young and ethnic, but White, middle-class, and in her mid- to late twenties. The implications of these findings are discussed.

Characterization of a YAC and cosmid contig containing markers tightly linked to the myotonic dystrophy locus on chromosome 19

Myotonic dystrophy (DM) is caused by a defect in an unknown gene that maps to 19q13.3, flanked by the tightly linked markers ERCC1 on the proximal side and D19S51 on the distal side. We report the isolation and characterization of overlapping YAC and cosmid clones around D19S51 for the construction of a physical map around this locus. The resulting contig contains the markers D19S51 and D19S62 (another new marker tightly linked to the DM locus) and the distal breakpoint of a radiation hybrid cell line used in the physical mapping of the DM region. We have compared the restriction maps of the YACs and cosmids with that of the genome to investigate the fidelity of these clones.

Temporal effects of plasmapheresis on serum proteins in horses

The temporal response of blood and serum proteins to chronic plasmapheresis was determined in 8 horses used in a commercial antibody enterprise. Plasmapheresis of between 4 and 11 L induced significant decreases in total protein, albumin, and IgG values. With the exception of a high hematocrit value for the first postplasmapheresis blood sample, there were no changes in erythrocyte or leukocyte measurements, and no changes in the proportions of serum protein in an electrophoretic profile. Regression equations generated for recovery of proteins after plasmapheresis indicated a return to preplasmapheresis values of total protein and albumin at approximately 1 month. Complications of repeated plasmapheresis were not detected when plasma extractions were done between 7 and 19 times at 30-day intervals.

Human glandular Kallikrein genes: genetic and physical mapping of the KLK1 locus using a highly polymorphic microsatellite PCR marker

We describe a highly polymorphic microsatellite repeat sequence, KLK1 AC, which is located 3' to the human glandular kallikrein gene (KLK1) at 19q13.3-13.4. A multiplex PCR was developed to simultaneously genotype the KLK1 AC repeat length polymorphism and a similar repeat at the adjacent APOC2 locus at 19q13.2. Genotypes from these two loci in the 40 large kindred pedigrees from the Centre d'Etude du Polymorphisme Humain were used in conjunction with the background genetic map to establish a multipoint linkage map. The KLK1 locus was also localized physically using somatic cell hybrid DNA templates for polymerase chain reaction analysis. Both genetic and physical mapping studies are consistent with the assignment cen-APOC2-KLK1-D19522-qter. The linkage map places KLK1 approximately 10 cM distal to APOC2. These markers therefore flank the myotonic dystrophy gene and may be useful for diagnosis.

Evidence against linkage of von Recklinghausen neurofibromatosis and chromosome 19 markers

In this paper we report the study of the segregation of three chromosome 19 markers known to be linked to myotonic dystrophy in nine families with von Recklinghausen neurofibromatosis. Clear evidence against linkage was found for all three markers excluding the von Recklinghausen neurofibromatosis gene from the myotonic dystrophy region of chromosome 19.

Four restriction fragment length polymorphisms revealed by probes from a single cosmid map to chromosome 19

We have discovered and characterized a compound polymorphic locus on chromosome 19, defined by an arbitrary genomic DNA segment cloned into a cosmid vector. Four different restriction fragment length polymorphisms with minor allele frequencies equal to or greater than 10% are revealed by Southern hybridization of subclones of cosmid 1-13 with TaqI, MspI, BamHI, and HindIII digests of human DNAs. Seventy-two percent of unrelated individuals are heterozygous at one or more loci, and seven of the 24 possible haplotypes occur with frequencies of 3%-38%. Using a somatic cell hybrid panel, we have mapped this locus to 19p13.2----19q13.3, whereas in situ hybridization suggests the probe is on 19p. Taken together, these results suggest localization to 19p13.2----19cen. The locus revealed by probes from cosmid 1-13 has been designated D19S11.

Bilateral laryngeal paralysis in the horse

Four two-year-old Thoroughbreds suffered an acute gastrointestinal illness shortly after dosing with mineral oil which was thought to have been contaminated with an organophosphate compound. Three weeks later all four were noted to be dyspnoeic and endoscopic examination showed that they had developed bilateral laryngeal paralysis. Two of the horses died during severe bouts of dyspnoea six and eight months later and the third was killed shortly thereafter. Examination of the left and right recurrent laryngeal nerves from these horses showed a severe loss of myelinated fibres distally, especially in the left nerve. A similar but less severe lesion was seen in other long peripheral nerves, including the phrenic and digital nerves of the third horse. The spinal cord in two horses showed evidence of mild axonal degeneration which was not related to a particular tract or location. The fourth horse had bilateral laryngeal paralysis two years later. The acute clinical signs and delayed neurological sequelae seen in these horses were strongly suggestive of accidental organophosphate toxicity.

Uterine culture in mares

A guarded, sterile swab is used to obtain samples for uterine culture. With the mare in stocks, the tail bandage and the perineum washed, the culture rod is introduced into the vagina with a gloved hand. After the rod is guided through the cervix, the guard cap is dislodged and the swab is rubbed along the endometrium, after which the rod is extracted. Samples for uterine culture should only be obtained during full estrus. Swabs should be directly plated onto agar within 2 hours of collection. Blood agar is appropriate for initial screening, but use of specialized types of agar expedites identification of microbes. Plates are incubated at 37 C and inspected for growth every 12 hours. The type and number of bacterial colonies should be coupled with the history and clinical signs in deciding on the necessity and type of treatment. Pure, heavy bacterial growth is usually accompanied by clinical signs of infection. Interpretation of the significance of moderate bacterial growth may be aided by cytologic examination of endometrial smears, made by rolling the swab onto a glass slide and staining with Diff - Quik . Large numbers of neutrophils indicate the need for antibiotic therapy. Mixed bacterial growth and variable numbers of neutrophils usually indicate faulty sampling technic. Microaerophilic or anaerobic cultures may aid diagnosis in cases of equivocal aerobic culture results.

Depressive mood in male college students. Father-son interactional patterns

This study was designed to investigate the interrelationship of sets of paternal and adolescent factors in explaining depressive mood in normal male adolescents. Two hundred forty-six male college students and their fathers were administered separate, written questionnaires assessing the personality attributes of both fathers and sons and the socialization practices of the fathers. Results of regression analyses indicated that of three hypothesized models (independent, mediational, interdependent) the mediational model was consistent with the data. Thus, we found that the father's personality attributes and his socialization techniques are related to the son's personality, which, in turn, is related to the son's depressive mood. In addition, certain personality attributes of the son interacted synergistically with those of his father to produce more frequent reports of depressive mood in the son.

Pre-renal azotaemia in a pony with an oesophageal obstruction

A case of pre-renal azotaemia is described in a 12 year old pony resulting from oesophageal obstruction of 8 days duration. Blood urea nitrogen, creatinine, calcium, inorganic phosphate, sodium, potassium, chloride and bicarbonate concentrations were monitored throughout the recovery period. After relief of the obstruction normal blood concentrations were quickly restored.

Arrested bone growth and mineral maturation in sub-totally nephrectomized rats

1. Young, sub-totally nephrectomized rats were used to study the altered mineral metabolism of renal failure and its effects on bone growth and mineral maturation.

2. Rats killed at 4 weeks after sub-total nephrectomy demonstrated less bone growth than the age-matched control animals. These differences diminished in successive 4 week periods and were not significant at 12 weeks after operation.

3. The major differences in bone mineral composition between the uraemic rats and the control rats were: (i) lower CO23;− concentrations, and (ii) higher PO34;− and HPO24;− concentrations.

4. These differences are consistent with the view that bone mineral matures by the conversion of an acidic calcium phosphate precursor into a carbonate-containing apatite, an essential feature of this conversion being the replacement of PO34;− or HPO24;− by CO23;−. By this definition, uraemic rats at 4 weeks after operation contained more immature bone mineral than the control rats. These differences corresponded to the changes in bone weight, and were similarly unaffected at 12 weeks after operation.

5. The effects observed were transient and were reversed as renal function recovered. If renal failure is sustained, however, as in patients with end-stage renal disease, the maturation defect could become a feature of renal bone disease. Specific aetiological factors are discussed, but not identified.

Serum IgE levels in forty families studied for two or three years

Serum IgE levels have been measured over two to three years in 210 individuals. In one-fifth IgE levels remained remarkably constant, in one-quarter they rose and in half they fell. A rise was usually associated with the development of fresh atopic disease, exacerbation of established disease or dependence on symptomatic treatment. A fall was associated with a diminution in the severity of symptoms occurring spontaneously as a result of good environmental control or of appropriate immunotherapy. Sequential IgE levels provide confirmatory evidence of the success of either environmental control or of immunotherapy.

Distribution of calcium in the rat due to chronic renal failure

During the 12 weeks following 5/6 nephrectomy in rats with moderate uremia (creatinine 0.7-1.2 mg/100 ml, BUN 53-89 mg/100 ml), no significant increases in total soft tissue calcification were observed. The calcium concentration of skeletal muscle remained unchanged at 4, 8, and 12 weeks after surgery. A slight but not significant increase in skin calcium was found. However, a significant decrease in cardiac calcium was found for the uremic animals. Total body calcium as determined by neutron activation analysis was significantly lower in the uremic rat when compared with the age-matched animal. However, when normalized for body weight, the total calcium content in uremic rats did not differ from the controls. Similar findings were observed for the absolute calcium content of the tibia and when normalized for weight. Furthermore, a highly significant linear relationship (r = 0.92, p less than 0.001) was established between absolute levels of total body calcium and tibia calcium which was identical for control and uremic groups.

Effect of graded doses of cortisol on total body calcium in rats

Male rats with an average body weight of 250 g were injected (sc) daily for 4 wk with 0.05, 0.20, 0.75, or 3.00 mg of cortisol acetate. Intact and adrenalectomized control animals were injected daily with 0.1 ml of vehicle (corn oil). Total body calcium (TBCa) was measured weekly in each rat by in vivo neutron activation analysis. The gain is body weight of rats treated with 0.75 mg cortisol was significantly less than controls, and the animals treated with 3.00 mg cortisol lost weight. In spite of these differences in body weight, the TBCa of all rats increased to an equal degree from an average of 1.93 g to 2.81 g in 4 wk. In addition, there were no significant differences in tibial ash calcium. However, calcium (mg) per unit length (mm) of tibia was increased in rats treated with the higher doses of cortisol; thus bone density was increased. These results demonstrate that the TBCa increases even when rats are subjected to cortisol. This is explained in part by the normal rate of intestinal calcium absorption in cortisol-treated rats.

Osteoporosis in a six year old pony

A case of what can be presumed to be secondary nutritional hyperparathyroidism, due to high phosphorus diet, in a six year old pony is discussed. The findings are compared to those found when the disease occurs in young growing horses.