Evaluation of laboratory and on-farm tests to estimate colostrum quality for dairy cows

The objectives of this study were to evaluate different analytical methods to determine colostrum quality in dairy cattle, including one laboratory-based method (ELISA) and 4 on-farm tests. We hypothesized that the colostral IgG concentration using different analytical methods, such as ELISA (mg/mL), digital Brix refractometer (% Brix), colostrometer (specific gravity and mg/mL), an outflow funnel (seconds), and a lateral flow assay (mg/mL), were highly correlated with the reference method, radial immunodiffusion (RID; mg/mL) and would generate comparable results. Colostrum samples were collected from 209 Holstein Friesian cows on 2 commercial dairy farms in Germany. Colostrum weight and colostrum temperature were measured. Test characteristics, such as optimum thresholds, sensitivity, specificity, and area under the curve (AUC) were determined using a receiver operating characteristic curve analyses for each test. Out of 209 colostrum samples assessed by RID, 186 (89%) samples had high quality (≥50 mg IgG/mL), while 23 colostrum samples (11%) showed poor quality with IgG concentrations less than 50 mg/mL. The mean IgG concentration (±SD) was 101.3 ± 45.9 mg/mL and the range was 6.0 to 244.3 mg/mL. The Pearson correlation coefficient (r) between RID and ELISA was r = 0.78. In comparison to RID, Pearson correlation coefficients for the on-farm tests were: r = 0.79 (digital Brix refractometry), r = 0.58 (colostrometer: specific gravity), r = 0.61 (colostrometer: temperature corrected), r = 0.26 (outflow funnel) and r = 0.43 (lateral flow assay), respectively. The optimal threshold to identify high-quality colostrum using ELISA was 50.8 mg/mL with sensitivity 91.3%, specificity 92.3%, and AUC of 0.94. For the on-farm tests sensitivity ranged from 95.7% (Brix refractometry) to 60.9% (lateral flow assay). Specificity ranged from 88.6% (lateral flow assay) to 75.9% (colostrometer: temperature corrected). The AUC ranged from 0.93 (Brix refractometry) to 0.73 (outflow funnel). Based on the AUC, ELISA (0.94) and Brix refractometry (0.93) can be considered highly accurate. In conclusion, the ELISA is accurate to assess colostrum quality. Regarding the on-farm tests only the digital Brix refractometer and the colostrometer were adequate to determine colostrum quality.

Colostrum insulin supplementation does not influence immunoglobulin G absorption in neonatal Holstein bulls

Since insulin has been demonstrated to suppress IgG absorption in other neonatal species, we had the objective to delineate how colostral insulin concentrations affect IgG absorption in neonatal bovines. We enrolled Holstein bull calves (n = 48; body weight = 46.3 ± 0.84 kg) at birth and randomized them by birth order to receive (1) colostrum that contained basal insulin concentrations (12.9 μg/L; n = 16), or colostrum that had been supplemented with an exogenous insulin to increase the insulin concentration to either (2) 5 times (70.0 μg/L; n = 16) or (3) 10 times (149.7 μg/L; n = 16) that of the basal colostrum. Gross colostrum composition (crude fat: 4.1 ± 0.06%; crude protein: 11.7 ± 0.05%; lactose: 1.9 ± 0.01%; IgG: 63.9 ± 1.19 g/L) was similar between treatments and calves were fed (7% body weight, 3.1 ± 0.06 L) their treatments at 2, 14, and 26 h postnatal. Serum was collected at 0, 30, 60, 90, 120, 180, 240, 360, 480, and 600 min postprandial respective to the first and second colostrum feeding and analyzed for IgG concentration. The incremental area under the curve (I-AUC) and apparent efficiency of absorption (AEA) were calculated for the 10-h periods following the first and second colostrum meal. Serum IgG concentrations over time, I-AUC, and AEA were statistically analyzed as a complete randomized design. Colostrum insulin concentration did not affect serum IgG concentrations or the I-AUC or AEA after calves were fed colostrum at 2 and 14 h postnatal. High colostral insulin content is not detrimental or promotive to IgG absorption in neonatal Holstein bulls.

Evaluating different methods of serum collection to detect failed transfer of passive immunity in newborn calves via refractometry

The objective of the study was to compare 4 different methods of serum collection to assess failed transfer of passive immunity (FTPI) in dairy calves. We hypothesized that centrifuged serum, filtered serum and clotted serum at room temperature, and clotted serum at refrigerator temperature measured with Brix refractometry would highly correlate with IgG concentration assessed by radial immunodiffusion (RID; gold standard) in centrifuged serum. Blood samples were collected from 321 newborn dairy calves. In centrifuged serum (r = 0.88), serum clotted at room temperature (20.2°C ± 6.47; r = 0.86), serum clotted at refrigerator temperature (7.6°C ± 0.91; r = 0.87), and filtered serum (r = 0.70), total solids (TS) in % Brix, and IgG concentrations measured with RID were highly correlated. Regarding the refractometry results among the different serum types, the TS results of serum clotted at room temperature, clotted at refrigerator temperature, and filtered serum showed high correlation coefficients compared with the TS results of centrifuged serum (r = 0.99, r = 0.98, and r = 0.89), respectively. The test characteristics of clotted serum were as accurate as centrifuged serum and generate comparable results. Filtered serum was slightly less accurate. All serum types are valid methods to detect an FTPI in dairy calves, if the specific Brix thresholds for each serum type are considered. Nevertheless, serum clotted at refrigerator temperature should not be the preferred method to avoid the risk of hemolysis.

Hot topic: Accuracy of refractometry as an indirect method to measure failed transfer of passive immunity in dairy calves fed colostrum replacer and maternal colostrum

Serum total protein (STP) refractometry is a widely used indicator of failed transfer of passive immunity (FTPI), defined as serum IgG concentrations of <10 mg/mL or STP levels <5.2 g/dL measured at 24 h of life. However, recent reports have demonstrated that refractometry could be inaccurate at estimating serum IgG concentrations and FTPI when calves are fed colostrum replacer (CR). The objective of this study was to evaluate the accuracy of STP measurements to estimate FTPI in calves fed CR compared with calves fed maternal colostrum. Blood was collected from dairy calves fed maternal colostrum (n = 927) or colostrum-derived CR (n = 1,258) and analyzed for STP and serum IgG. Serum total protein was measured with a digital refractometer, whereas radial immunodiffusion was used to determine IgG concentrations. Calves fed maternal colostrum had a mean STP of 5.80 ± 0.72 (standard deviation) g/dL and a mean IgG concentration of 22.81 ± 10.14 mg/mL, respectively, whereas calves fed CR had a mean STP and IgG concentration of 5.14 ± 0.50 g/dL and 12.78 ± 4.60 mg/mL, respectively. Rates of FTPI for calves fed maternal colostrum or CR were 4.2% and 27.26%, respectively. Calves were considered to have FTPI if their IgG postcolostrum feeding was <10 mg/mL. Logistic and linear regression analyses were performed to determine cutoff points and existent relationships between STP and IgG. Serum total protein and IgG for calves fed maternal colostrum were highly correlated. In contrast, STP and IgG for calves fed CR were lowly correlated. A receiver operator characteristic curve analysis demonstrated that an STP cutoff point that could predict FTPI when calves are fed CR would be 4.9 g/dL (sensitivity = 0.68; specificity = 0.75). This study suggests that current cutoff points used for STP inflates the number of calves estimated to have FTPI when they are fed CR.

Validation of Brix refractometers and a hydrometer for measuring the quality of caprine colostrum

On-farm assessment of caprine colostrum quality is important for goat farmers; the ability to quickly recognize whether colostrum is suitable to feed to kids helps achieve successful passive transfer of immunity. The study compared the use of optical and digital Brix refractometers and a hydrometer against the international gold standard radial immunodiffusion (RID), using both fresh and frozen samples. A locally available ELISA methodology was included for comparison. A total of 300 samples were collected from 2 farms (farm 1: n = 157, collected by research staff within 24 h of parturition; farm 2: n = 143, collected by the farmer within 12 h of parturition). Farm 1 provided doe age for a subset of samples (n = 86). Samples were tested fresh and then frozen for shipment and repeated testing. Specific gravity was measured using a hydrometer in a subset of samples (n = 22) from farm 2. Because no gold standard thresholds are currently available for caprine colostrum, RID-derived values of 30, 40, and 50 g/L IgG were used as potential "good quality" thresholds. Pearson (ρ) and Lin's concordance correlation coefficients (CCC) were calculated for comparison of methods. Optimum thresholds were established maximizing the Youden index and minimizing the "distance closest to the top left corner" of the receiver operator characteristic curves. Brix values were correlated with RID (optical Brix, fresh: ρ = 0.73; digital Brix, fresh: ρ = 0.71; digital Brix, frozen: ρ = 0.76) and with each other (range: ρ = 0.93 to 0.99; CCC = 0.91 to 0.99). Specific gravity measured by the hydrometer yielded a strong relationship with RID (ρ = 0.83) and with Brix values (range: ρ = 0.88 to 0.90). The ELISA method was not correlated with Brix methods (range: ρ = 0.02 to 0.09) or RID (ρ = 0.20). Depending on the colostrum IgG threshold, the hydrometer yielded high Youden indices (range: 0.78 to 0.93) and low distance closest to the top left corner criteria (0 to 0.05) at a threshold of 1.047 specific gravity. For all RID IgG thresholds, the best Brix threshold (regardless of type or whether the sample was fresh or frozen) was 18 or 19%, with the highest Youden indices (range: 0.47 to 0.61) and lowest distance to the top left corner criteria (range: 0.09 to 0.16); however, we recommend 19%, because this reduces the potential of feeding poor-quality colostrum. The ELISA method was the poorest predictor of colostrum concentration. Age was not found to affect colostrum quality; however, the sample size of this subset was small. Hydrometers are inexpensive and easy to use, whereas Brix methods use only a small amount of colostrum; we suggest that either method could be used on-farm.

Evaluation of different analytical methods to assess failure of passive transfer in neonatal calves

The objective of this study was to evaluate different analytical methods of assessing failure of passive transfer (FPT) in neonatal calves. We hypothesized that 3 different media (i.e., centrifuged serum, centrifuged plasma, filtered plasma) and different analytical methods [i.e., ELISA, capillary electrophoresis (CE), Brix refractometer, and handheld optical refractometer] would be highly correlated with the gold standard radial immunodiffusion (RID) and would generate comparable results. Serum and plasma blood samples were collected from Holstein Friesian calves (n = 216) aged 1 to 7 d, from 2 commercial dairy herds in northeast Germany. The RID analysis showed that 59 of 216 calves (27%) had serum IgG concentrations of <10 mg/mL and 157 calves (73%) had serum concentrations of ≥10 mg/mL. The mean IgG concentration (± standard deviation) was 17.1 ± 9.8 mg/mL, and the range was 0.8 to 47.8 mg/mL. In serum, the correlation between RID and CE was r = 0.97, and between RID and ELISA was r = 0.90; CE and ELISA were also highly correlated (r = 0.89). Both refractometry methods were highly correlated with RID using centrifuged serum, centrifuged plasma, or filtered plasma (Brix refractometer: r = 0.84, 0.80, and 0.78, respectively; handheld optical refractometer: r = 0.83, 0.81, and 0.80, respectively). We determined test characteristics (optimum thresholds, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve) for CE, ELISA, and the handheld optical and digital refractometers using receiver operating characteristic curve analyses with RID as the reference value. Optimal thresholds for assessing FPT using plasma were higher than for serum, regardless of the method of plasma harvesting. The 4 different devices had comparable areas under the curve, irrespective of the medium used. All analytical methods can be used to assess FPT.

P851 Carney"s complex: a rare cause of Atrial myxoma

Funding Acknowledgements

Nil

We present the case of a 53 year old lady who presented to the cardiology services with palpitations. She denied any symptoms of syncope or chest pain but described frequent short episodes of palpitations. Her background medical history at this point included a pituitary macroadenoma with panhypopituitarism requiring transphenoidal hypophysectomy, a follicular adenoma with left thyroid lobectomy and peripheral neuropathy. An echocardiogram was arranged and this showed a large left atrial mobile myxoma with good LV function and no other structural abnormalities. Her ECG showed sinus rhythm with no ischaemic changes and normal electrical intervals. She was admitted and transferred to a tertiary centre where the myxoma was successfuly excised. Her palpitations settled post procedure and holter monitoring didn"t pick up any malignant dysrrhythmias. She was referred to a genetics centre for investigation for Carneys complex which can predispose patient to endocrine and nonendrocrine tumours including pituitary, thyroid and as in our case a cardiac myxoma. This was confirmed on genetic testing and as her mother was found to also have a cardiac myxoma it raised the suspicion of an inherited mutation. Follow-up echo at 2 years post-op showed no recurrence of atria myxoma and patient was stable from a cardiovascular perspective.

Preweaned heifer management on US dairy operations: Part II. Factors associated with colostrum quality and passive transfer status of dairy heifer calves

Passive transfer of immunity is essential for the short- and long-term health of dairy calves. The objective of this study was to evaluate factors associated with colostrum quality and passive transfer status of US heifer calves. This study included 104 operations in 13 states that participated in the calf component of the National Animal Health Monitoring System's Dairy 2014 study. This 18-mo longitudinal study included 1,972 Holstein heifer calves from birth to weaning. Multivariable mixed linear regression models were selected using backward elimination model selection after univariate screening to determine which factors were associated with colostrum IgG and serum IgG concentrations. The mean colostrum IgG concentration was 74.4 g/L with 77.4% of colostrum samples having IgG concentrations >50 g/L. The final model for colostrum IgG included colostrum source and a categorized temperature-humidity index value (cTHI) for the month before calving. Mean colostrum IgG concentrations were highest for dams in third and higher lactations (84.7 g/L) and lowest for commercial colostrum replacers (40.3 g/L). Colostrum IgG concentrations were highest for cTHI ≥70 (72.6 g/L) and lowest for cTHI <40 (64.2 g/L). The mean serum IgG concentration was 21.6 g/L, with 73.3% of calves having serum IgG concentrations >15 g/L. The final model for serum IgG concentration included region, heat treatment of colostrum, colostrum source, timing to first feeding, volume of colostrum fed in the first 24 h, age of the calf at blood sampling, and colostrum IgG concentration. Mean serum IgG concentrations were highest for calves that received colostrum from first-lactation dams (25.7 g/L) and lowest for calves fed commercial colostrum replacer (16.6 g/L). Serum IgG concentrations were higher for calves fed heat-treated colostrum (24.4 g/L) than for calves fed untreated colostrum (20.5 g/L). Serum IgG concentration was positively associated with the volume of colostrum fed in the first 24 h and colostrum IgG concentration, and negatively associated with the number of hours from birth to colostrum feeding and age (days) at blood collection. Dairy producers should be encouraged to measure the quality of colostrum before administering it to calves and to measure serum IgG or a proxy such as serum total protein or Brix to evaluate passive immunity and colostrum management programs.

The development of a non-invasive model to predict the presence of non-alcoholic steatohepatitis in patients with non-alcoholic fatty liver disease

BACKGROUND

Non-alcoholic steatohepatitis (NASH) is an advanced and aggressive form of non-alcoholic fatty liver disease (NAFLD), which remains difficult to diagnose without a liver biopsy. Hyperferritinemia has increasingly been associated with the presence of NASH. Hence, we sought to explore the relationship between ferritin and NASH and to develop a composite model based on ferritin to predict the presence of NASH.

METHODS

A total of 405 patients with biopsy-proven NAFLD were enrolled in the study. Comparison was explored to assess differences between patients with and without NASH, upon which a scoring model was established using variables found to be independent predictors of NASH.

RESULTS

Among all patients with NAFLD, 291 (72%) had biopsy-proven NASH, and 114 (28%) had non-NASH. Mean age was 48 ± 12 years, and 56% were female. Ferritin was significantly higher in NASH compared with non-NASH patients (184 vs 126, respectively; P < 0.001) but lacked diagnostic accuracy for predicting NASH alone (area under the curve [AUC 0.62]). The addition of other significant variables such as aspartate aminotransferase, body mass index, platelet count, diabetes, and hypertension to ferritin improved the prediction of NASH with an AUC 0.81 (95% confidence interval: 0.76-0.86). Internal validation of the model using imputed data sets demonstrated that AUC did not change materially.

CONCLUSIONS

While higher ferritin was significantly associated with NASH, ferritin alone lacked diagnostic accuracy to predict NASH. However, incorporating several easily obtainable variables with ferritin allowed the construction of a novel scoring system that can be easily applied in the clinical setting to guide management of NAFLD.

Renin-angiotensin system and fibrosis in non-alcoholic fatty liver disease

BACKGROUND & AIMS

Therapeutic options are limited for patients with non-alcoholic fatty liver disease (NAFLD). One promising approach is the attenuation of necroinflammation and fibrosis by inhibition of the renin-angiotensin system (RAS). We explored whether the risk of fibrosis was associated with the use of commonly used medications in NAFLD patients with hypertension. Specifically, we sought to determine the association between RAS blocking agents and severity of hepatic fibrosis in NAFLD patients with hypertension.

METHODS

Cross-sectional study where clinical information including demographics, anthropometry, medical history, concomitant medication use, biochemical and histological features were ascertained in 290 hypertensive patients with biopsy proven NAFLD followed at two hepatology outpatient clinics. Stage of hepatic fibrosis was compared in patients with and without RAS blocker use. Other risk factors for fibrosis were evaluated from the electronic medical records and patient follow-up.

RESULTS

Baseline characteristics of hypertensive patients treated with and without RAS blockers were similar except for less ballooning (1.02 vs. 1.31, P = 0.001) and lower fibrosis stage (1.63 vs. 2.16, P = 0.002) in patients on RAS blockers On multivariate analysis, advancing age (OR: 1.04; 95%CI: 1.01-1.06, P = 0.012) and presence of diabetes (OR: 2.55; 95%CI: 1.28-5.09, P = 0.008) had an independent positive association, while use of RAS blockers (OR: 0.37; 95%CI: 0.21-0.65, P = 0.001) and statins (OR: 0.52; 95%CI: 0.29-0.93, P = 0.029) had a negative association with advanced fibrosis.

CONCLUSION

Hypertensive patients with NAFLD on baseline RAS blockers had less advanced hepatic fibrosis suggesting a beneficial effect of RAS blockers in NAFLD.

Clinical spectrum of non-alcoholic fatty liver disease in diabetic and non-diabetic patients

BACKGROUND

While non-alcoholic fatty liver disease (NAFLD) has been well characterised in patients with diabetes mellitus (DM), less is known about NAFLD in non-DM patients. We investigated the clinical characteristics of NAFLD patients with and without DM and accuracy of the NAFLD fibrosis score (NFS) in these two NAFLD groups.

METHODS

Clinical, biochemical and histological variables were evaluated in this prospective cross-sectional study of 503 patients with biopsy proven NAFLD. Comparisons between patients with and without DM were analysed. NFS was correlated with liver histology to assess its robustness in patients with and without DM.

RESULTS

There were 503 biopsy proven NAFLD patients with 48% of the cohort being diabetic. Relative to patients without DM, patients with DM were older (52 vs. 46 years, p < 0.001), with higher proportion of females (70% vs. 54%, p < 0.001), higher BMI (37 vs. 35, p = 0.009), higher prevalence of hypertension (73% vs. 44%, p < 0.001), higher prevalence of NASH (80.2% vs. 64.4%; p < 0.001) and advanced fibrosis (40.3% vs. 17.0%; p < 0.001). A considerable amount of patients without DM still had NASH (64%) and advanced fibrosis (17%). The clinical utility of the NFS differed between NAFLD patients with and without DM, with sensitivity to exclude advanced fibrosis being 90% of NAFLD patients with DM but only 58% of patients without DM.

CONCLUSION

Patients with DM have more severe NAFLD based on histology. However, NASH and advanced fibrosis also occur in a considerable proportion of NAFLD patients without DM. The lower utility of the NFS in NAFLD patients without DM emphasises the heterogeneous nature of the NAFLD phenotype.

Racial Differences in Selection of Ideal Body Size by Adolescent Females

Cultural differences may partially account for the fact that more black women than white women are overweight in the United States. This study measured perceptions of ideal body size among 93 black and 80 white females, 14-17 years old, who were randomly selected from three public high schools in a southeastern state. The subjects' height and weight were measured along with their estimates of their mother's body size, weight control attitudes, and demographic variables. Blacks preferred a significantly larger body size than whites when asked to select ideal body size (p = 0.045). Subjects who estimated their mother's size to be larger, also selected a larger ideal body size (p = .047). Those who perceived themselves as too fat were more likely to skip meals to help control their weight, compared with those who perceived themselves as normal or too thin (p = .003). Approximately 30% of the sample was overweight or obese. There were not significant racial differences in weight or BMI. These results suggest that overweight is more acceptable among black females than among white females and may help explain why more black females are obese.

Body size dissatisfaction among male and female triathletes

Body size dissatisfaction was assessed among 583 male and female triathletes residing in the USA. The males perceived themselves to be larger than their calculated body mass index (BMI discrepancy index: -1.92) and desired to be larger (BMI discrepancy index: -0.7), whereas the females perceived themselves to be smaller than their calculated BMI (BMI discrepancy index: 1.67) and desired to be much smaller (BMI discrepancy index: 3.61). The male triathletes categorised as underweight showed no discrepancy between their perceived and desired BMI, whereas 10% of the females in the underweight category desired to be larger than perceived and 13% desired to be smaller. Among the males whose BMI fell into the healthy range, 8.0% indicated a desire to be larger than perceived and 19.3% desired to be smaller; the majority of female triathletes in the healthy BMI category desired to be smaller, with only 2.4% desiring to be larger.

Sub-clinical eating disorder characteristics among male and female triathletes

The characteristics of sub-clinical eating disorders were assessed in 583 male and female triathletes. We found that 28% of the females and 11% of the males scored below the mid-point of the range for the Eating Attitude Test-26 (EAT-26) construct Preoccupation with Food and Weight, and respectively 39% and 23% scored below the mid-point of the range for the construct Calorie Control. All of the subjects indicated dissatisfaction with their actual body mass index (BMI). The study participants revealed attempts to reduce body weight by means of energy restriction, severe limitation of food groups and excessive exercise, in addition to controlling their food intake on the basis of strict dietary rules. The triathlon seems to be a sport that is susceptible to a higher prevalence of disordered eating. Further studies are needed to investigate its real prevalence and the factors contributing to it.

Assessment of dental practitioners in the secondary and tertiary prevention of eating disorders

A questionnaire based upon the transtheoretical model and the health belief model was utilized to investigate dental practitioners' involvement in the secondary and tertiary prevention of eating disorders. Findings indicate that respondents are in the precontemplation or contemplation stages in identification, oral treatment, referral, and case management behaviors. Many are not completely aware of the health implications and oral manifestations of disordered eating and barriers were identified which may stand in the way of secondary and tertiary prevention. This pilot study provides a framework for the development of effective programming to increase the proportion of dental practitioners involved in prevention of eating disorders. To move the dental professionals toward assessment, referral, and case management, barriers to action must be removed.

The pharmacological properties of the novel selective 5-HT3 receptor antagonist, alosetron, and its effects on normal and perturbed small intestinal transit in the fasted rat

The purpose of this study was to investigate the pharmacological properties of the novel, selective 5-HT3 receptor antagonist, alosetron, and its effects on transit time in both the normal and perturbed small intestine of the rat. Alosetron concentration-dependently inhibited radioligand binding in membranes containing rat and human 5-HT3 receptors with estimated pKi values of 9.8 (n = 3) and 9.4 (n = 6), respectively. In selectivity studies alosetron had little or no significant affinity for any of the many other receptors and ion channels studied. Alosetron potently antagonized the depolarization produced by 5-HT in the rat vagus nerve (estimated pKB value of 9.8, n = 25). In anaesthetized rats, i. v. administration of alosetron inhibited 2-methyl-5-HT induced bradycardia (Bezold Jarisch index) at 1 and 3 microg kg-1, with an agonist dose ratio of approximately 3.0 at 1.0 microg kg-1, = 3-5). Alosetron administered via the duodenum also inhibited this reflex, with duration of action that was significantly longer than that seen with ondansetron (120-60 min, respectively, n = 6). Alosetron had no significant effect on normal small intestinal propulsion in the rat, but fully reversed the increase in intestinal propulsion (96%, n = 3) produced by egg albumin challenge. Alosetron is a highly selective 5-HT3 antagonist which normalizes perturbed small intestinal propulsion. Previous clinical data in IBS patients together with the transit data provide a good rationale for further studies with alosetron in IBS patients.

Residential detoxification for substance abusers with HIV/AIDS. Walden House Detoxification Program

Substance abusers with HIV/AIDS have a complex array of problems that are not easily addressed in outpatient or long-term residential programs. A new but promising treatment modality is residential detoxification for substance abusers with HIV/AIDS, such as described by this paper. The purpose of the program is profiled, as well as its general components and the aspects that address the special needs of HIV clients. Data indicating the successes and limitations of the program are presented, along with recommendations for further addressing the needs of substance abuses with HIV/AIDS.

Physician office-based diabetes care: comparison to guidelines for care

Over the past decade, we have seen a significant increase in hospitalizations in South Carolina for the major complications of diabetes: myocardial infarcts (+68 percent), amputations (+61 percent), end stage renal disease (+85 percent), diseases of blood vessels (+100 percent), and eye complications (+52 percent). Many of these late stage complications can be prevented or their progression slowed down by early recognition and institution of intensive, well-defined preventive strategies. Independent surveys reviewed above indicate that such preventive practices are not being fully utilized in South Carolina. As one key example, less than 50 percent of people with diabetes receive self-management education. A number of simple and relatively inexpensive laboratory and physical examinations which would trigger preventive and remedial therapy are also performed at less than adequate frequency. The challenge is for all to use these examinations to guide therapy and to continue to monitor and intervene to prevent complications of diabetes. The DSC Board of South Carolina has developed a Ten Year Strategic Plan with nine major goals to improve diabetes care and outcomes in South Carolina. To improve office-based care of diabetes in South Carolina, all health professionals must assume responsibility for closely monitoring each person with diagnosed diabetes and assure that glycemic control is optimized. Early signs of complications must be recognized and interventions to limit their progression utilized. Screening of high-risk individuals to identify the estimated one-third of persons with diabetes who are undiagnosed, targeted education programs to the primary care professionals who deliver the majority of care to individuals with diabetes, implementation of the proven, cost-effective measures that can prevent (postpone) the complications of diabetes, monitoring of the health care delivery system and addressing the potential barriers to adequate care for all persons with diabetes are essential steps to decrease the burden of diabetes for South Carolinians (Table 1).

Factors associated with weight change among clients of a residential weight control program indicating binge and nonbinge traits

The long-term effects of a 12- and 26-day residential weight control program on weight change were determined in 187 men and women, 1 to 5 years after treatment. Subjects completed a paper/pencil questionnaire assessing current diet, weight control techniques, exercise behaviors, behavior modification techniques, binge eating, and dieting behavior. General linear modeling was used to investigate the association between behaviors maintained posttreatment and current weight among subjects who demonstrated behaviors indicative of binge traits (BT) and nonbinge traits (NBT). Results indicate that dissimilar variables are predictive of weight change in the BT and NBT groups. Engaging in exercise behaviors and reduced attempts at dieting lead to greater weight loss in NBT individuals. The use of preplaning techniques was found to be indicative of greater weight loss in BT individuals. These findings suggest the importance of identifying individuals who indulge in binge-eating behaviors prior to intervention in order to deliver the appropriate treatment methods.

Black and white adolescent females' perceptions of ideal body size

A stratified, random sample of 344 White and Black adolescent females participated in a survey of ideal body size beliefs, which included responses to a questionnaire and a series of nine female and male body size drawings. Using SES and race as independent variables and BMI (kg/m2) as a covariate. Black females preferred a significantly heavier ideal female body size than Whites. They also perceived their parents and both male and female friends would select as ideal a significantly heavier female body size than White subjects. Black subjects' body size preferences were significantly more influenced by family members than were White subjects, who were significantly more influenced by their peer group. These findings suggest a greater social approval of increasing weight and body size for Black adolescent females, a desire for a smaller size by White adolescent females, and cultural differences in the influencing factors that help to communicate these body size preferences.

Biracial differences in physical activity and body composition among women

Overweight among black females is almost two times as frequent as among white females. Genetics, caloric intake, and physical activity have been identified as possible explanatory factors. This study assessed the differences in physical activity and body composition in 76 white and 66 black adult females. Black women had significantly higher (p = .0001) percent body fat (32.2 +/- 7.1) than white women (27.7 +/- 6.5) with a similar difference in weight (4.4 kg) approaching significance (p = .055). Physical activity was assessed using a structured 24-hour recall instrument. A purposive sampling design was implemented to control for age, education and occupation. A summary physical activity value unit for the 24-hour period revealed a significantly greater mean value for white females (41.93 +/- 4.7) than for black females (40.01 +/- 3.9) suggesting white females were more physically active (p = .02) although this was not a function of biracial differences in play/recreation and exercise/sport type of activities. Although both black and white females were found to be sedentary (MET value < or = 2) over 90 percent of the time, black women are significantly more sedentary (p = .03). Biracial differences in discretionary non-exercise oriented activities may contribute to different rates of overweight observed between black and white women.

Schedule-induced polydipsia in rats with gastric fistulas

We have investigated the development and maintenance of schedule-induced polydipsia (SIP) when ingested water (and food) was allowed to drain from the stomach. Fourteen male Long-Evans rats were prepared with permanent gastric cannulas and, after recovery, their body weight was reduced to 80%. Water intake was measured, with cannulas open or closed, during 42 daily 1-h sessions in which 45-mg food pellets were delivered one per minute. Allowing ingested material to drain from the stomach impaired the development of SIP and reduced the polydipsia in rats in which SIP had already been established. In contrast, opening the gastric fistulas increased drinking in these rats when all the food pellets were provided at once or after water deprivation. The opposite effects of gastric drainage on dehydration and schedule-induced drinking is consistent with the view that SIP is not a fluid-regulating phenomenon. It is not clear, however, how these unexpected findings fit current hypotheses to explain SIP that are based on oral, neural excitatory, or emotional mechanisms.

Psychological and behavioral differences among females classified as bulimic, obligatory exerciser and normal control

The compulsion to maintain a lean body shape while living in a society obsessed with food may encourage the use of dieting, binge eating and purging behaviors in young women. The body of literature on bulimia nervosa (Boskind-Lodahl and Sirlin 1977; Fairburn and Cooper 1984; Katzman and Wolchik 1984; Scott 1988) clearly establishes its relationship to the current American fashion for thinness and the value placed on physical attractiveness for self-esteem. This notion promotes a multitude of weight control strategies ranging from self-starvation (Humphrey 1983; Brownell and Foreyth 1986) to cigarette smoking (Klesges and Klesges 1988), many of which may have a profound influence on maintenance of good health. Similar to weight control, exercise behavior could be viewed as falling on a continuum from reasonable efforts to maintain physical fitness to a preoccupation with exercise that is far out of proportion to the expected benefits of a 30-minute, three to five day a week routine. Characteristics of obligatory exercise have been described by several researchers and include maintaining a rigid schedule of intense exercise; resisting temptation to lapse into nonexercising; feelings of guilt and anxiety when the exercise schedule is violated; compensatory increase in exercise to make up for lapses; pushing oneself even when tired, ill, or injured; mental preoccupation with exercise; and detailed recordkeeping on exercise (Yates et al. 1983; Blumenthal et al. 1984; Nudelman et al. 1988). In a competitive society, obsessive exercise behaviors may be linked to the development of rigid dietary guidelines while one strives toward the "optimal" lean-fat ratio of body composition.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic and molecular investigation of a balanced Xq13q translocation in a patient with retinoblastoma

We report on a 4-year-old girl with retinoblastoma and de novo balanced translocation [46,X,t (X;13) (q23;q13)]. Unilateral retinoblastoma was discovered at age 9 months along with developmental delay and several manifestations of Turner syndrome. Chromosome studies showed an X/13 translocation and an X inactivation pattern showing the translocated X chromosome active in all 50 cells examined. Standard Southern blot analysis and pulsed field gel electrophoresis using a 3.8 kb EcoR1 fragment of the cDNA probe to the 3' end of the RB1 locus demonstrated a normal genomic pattern. The results of the cytogenetic and molecular analysis suggests that the RB1 locus has not been disrupted by the chromosome rearrangement. This case is the fifth report of an X/13 translocation associated with a retinoblastoma.

Design and synthesis of metabolically stable atrial natriuretic factor analogs. Amino- and carboxy-terminal stabilization

Two analogs of rat atrial natriuretic factor, rANF7-28-NH2 and [Mpr7,Ala20,D-Arg27]rANF7-27-NH2, were prepared by the solid-phase method. These peptides had 2-fold and 7-fold less affinity, respectively, than rANF1-28 in binding to membranes prepared from cultured aortic smooth muscle cells, and both peptides were 5-fold less potent than rANF1-28 in relaxing serotonin-contracted rabbit aortic rings. rANF7-28-NH2 was rapidly degraded by rat kidney homogenates but [Mpr7,Ala20,D-Arg27]rANF7-27-NH2 had enhanced stability against rat kidney homogenate degradation. However, this in vitro stability did not translate into an extended duration of action in vivo.

Blood Lipid and ECG Responses to Carbohydrate Loading

Carbohydrate loading is so popular that spaghetti is now the premarathon meal. Dr. Blair studied whether this practice has adverse effects on cardiovascular function.