A cost-utility study of elective haemorrhoidectomies in Canada

AIM

The aim was to estimate the 10-year cost-utility of haemorrhoidectomy surgery with preference-based measures of health using Canadian health utility measures and costs.

METHODS

Patients undergoing elective haemorrhoidectomies by general and colorectal surgeons in British Columbia, Vancouver, between September 2015 and November 2022, completed preoperatively and postoperatively the EuroQol five-dimension five-level health-related quality of life questionnaire (EQ-5D-5L). Quality-adjusted life years (QALYs) attributable to surgery were calculated by discounting preoperative and postoperative health utility values derived from the EQ-5D-5L. Costs were measured from a health system perspective which incorporated costs of hospital stay and specialists' fees. Results are presented in 2021 Canadian dollars.

RESULTS

Of 94 (47%) patients who completed both the preoperative and postoperative questionnaires, the mean gain in QALYs 10 years after surgery was 1.0609, assuming a 3.5% annual discounting rate. The average cost of the surgery was $3166. The average cost per QALY was $2985 when benefits of the surgery were assumed to accrue for 10 years. The cost per QALY was higher for women ($3821) compared with men ($2485). Participants over the age of 70 had the highest cost per QALY ($8079/QALY).

CONCLUSIONS

Haemorrhoidectomies have been associated with significant gains in health status and are inexpensive relative to the associated gains in quality of life based on patients' perspectives of their improvement in health and well-being.

Signal transducer and activator of transcription (STAT) 1 and STAT3 are expressed in the human ovary and have Janus kinase 1-independent functions in the COV434 human granulosa cell line

Ovarian granulosa cells are fundamental for oocyte maintenance and maturation. Recent studies have demonstrated the importance of members of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling pathway in the granulosa cell population of mouse and horse ovaries, with perturbation of JAK1 signalling in the mouse shown to impair oocyte maintenance and accelerate primordial follicle activation. The presence and role of the JAK/STAT pathway in human granulosa cells has yet to be elucidated. In this study, expression of JAK1, STAT1 and STAT3 was detected in oocytes and granulosa cells of human ovarian sections from fetal (40 weeks gestation) and premenopausal ovaries (34-41 years of age; n=3). To determine the effects of JAK1 signalling in granulosa cells, the human granulosa-like cell line COV434 was used, with JAK1 inhibition using ruxolitinib. Chemical inhibition of JAK1 in COV434 cells with 100nM ruxolitinib for 72h resulted in significant increases in STAT3 mRNA (P=0.034) and p-Y701-STAT1 protein (P=0.0117), demonstrating a role for JAK1 in modulating STAT in granulosa cells. This study implicates a conserved role for JAK/STAT signalling in human ovary development, warranting further investigation of this pathway in human granulosa cell function.

Two alternative methods for the retrieval of somatic cell populations from the mouse ovary

Many modern techniques employed to uncover the molecular fundamentals underlying biological processes require dissociated cells as their starting point/substrate. Investigations into ovarian endocrinology or folliculogenesis, therefore, necessitate robust protocols for dissociating the ovary into its constituent cell populations. While in the mouse, methods to obtain individual, mature follicles are well-established, the separation and isolation of single cells of all types from early mouse follicles, including somatic cells, has been more challenging. Herein we present two methods for the isolation of somatic cells in the ovary. These methods are suitable for a range of applications relating to the study of folliculogenesis and mouse ovarian development. First, an enzymatic dissociation utilising collagenase and a temporary, primary cell culture step using neonatal mouse ovaries which yields large quantities of granulosa cells from primordial, activating, and primary follicles. Second, a rapid papain dissociation resulting in a high viability single cell suspension of ovarian somatic cells in less than an hour, which can be applied from embryonic to adult ovarian samples. Collectively these protocols can be applied to a broad array of investigations with unique advantages and benefits pertaining to both.

Health and quality of life among a cohort of patients having lateral internal sphincterotomy for anal fissures

AIM

The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health-related quality of life of patients is detrimentally affected by the condition, or which aspects of self-perceived health status improve after lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. Knowledge gained from this study may also identify gaps in an individual patient's episode of care.

METHOD

Patients were prospectively identified when they consented to surgical treatment of their anal fissure and were contacted by phone to participate. Participants completed a number of patient-reported outcomes preoperatively and 6 months postoperatively. Faecal incontinence-related quality of life, pain and depression were measured at both time points. The severity of faecal incontinence was measured at both times.

RESULTS

Participants reported high levels of pain preoperatively. Postoperatively, improvement in pain exceeded the threshold of clinical relevance (P < 0.01). Thirty-five per cent of participants reported significant effects of faecal incontinence preoperatively, while 26% did so postoperatively. Participants with multiple comorbidities were more likely to report faecal incontinence postoperatively than preoperatively.

CONCLUSION

This study reports that lateral internal sphincterotomy improved pain symptoms without adverse effects on continence. Not all domains of health-related quality of life were similarly positively affected by anal fissure repair.

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004-2012: database study

Little is known about post-acute care following hip fracture surgery. We investigated discharge destinations from surgical hospitals for nine Canadian provinces. We identified significant heterogeneity in discharge patterns across provinces suggesting different post-acute recovery pathways. Further work is required to determine the impact on patient outcomes and health system costs.

INTRODUCTION

To examine discharge destinations by provinces in Canada, adjusting for patient, injury, and care characteristics.

METHODS

We analyzed population-based hospital discharge abstracts from a national administrative database for community-dwelling patients who underwent hip fracture surgery between 2004 and 2012 in Canada. Discharge destination was categorized as rehabilitation, home, acute care, and continuing care. Multinomial logistic regression modeling compared proportions of discharge to rehabilitation, acute care, and continuing care versus home between each province and Ontario. Adjusted risk differences and risk ratios were estimated.

RESULTS

Of 111,952 previously community-dwelling patients aged 65 years or older, 22.5% were discharged to rehabilitation, 31.6% to home, 27.0% to acute care, and 18.2% to continuing care, with significant variation across provinces (p < 0.001). The proportion of discharge to rehabilitation ranged from 2.4% in British Columbia to 41.0% in Ontario while the proportion discharged home ranged from 20.3% in Prince Edward Island to 52.2% in British Columbia. The proportion of discharge to acute care ranged from 15.2% in Ontario to 58.8% in Saskatchewan while the proportion discharged to continuing care ranged from 9.3% in Manitoba and Prince Edward Island to 22.9% in New Brunswick. Adjusting for hospital type changed the direction of the provincial effect on discharge to continuing care in two provinces, but statistical significance remained consistent with the primary analysis.

CONCLUSIONS

Discharge destination from the surgical hospital after hip fracture is highly variable across nine Canadian provinces. Further work is required to determine the impact of this heterogeneity on patient outcomes and health system costs.

Time to surgery after hip fracture across Canada by timing of admission

The extent of Canadian provincial variation in hip fracture surgical timing is unclear. Provinces performed a similar proportion of surgeries within three inpatient days after adjustment. Time to surgery varied by timing of admission across provinces. This may reflect different approaches to providing access to hip fracture surgery.

INTRODUCTION

The aim of this study was to compare whether time to surgery after hip fracture varies across Canadian provinces for surgically fit patients and their subgroups defined by timing of admission.

METHODS

We retrieved hospitalization records for 140,235 patients 65 years and older, treated surgically for hip fracture between 2004 and 2012 in Canada (excluding Quebec). We studied the proportion of surgeries on admission day and within 3 inpatient days, and times required for 33%, 66%, and 90% of surgeries across provinces and by subgroups defined by timing of admission. Differences were adjusted for patient, injury, and care characteristics.

RESULTS

Overall, provinces performed similar proportions of surgeries within the recommended three inpatient days, with all provinces requiring one additional day to perform the recommended 90% of surgeries. Prince Edward Island performed 7.0% more surgeries on admission day than Ontario irrespective of timing of admission (difference = 7.0; 95% CI 4.0, 9.9). The proportion of surgeries on admission day was 6.3% lower in Manitoba (difference = - 6.3; 95% CI - 12.1, - 0.6), and 7.7% lower in Saskatchewan (difference = - 7.7; 95% CI - 12.7, - 2.8) compared to Ontario. These differences persisted for late weekday and weekend admissions. The time required for 33%, 66%, and 90% of surgeries ranged from 1 to 2, 2-3, and 3-4 days, respectively, across provinces by timing of admission.

CONCLUSIONS

Provinces performed similarly with respect to recommended time for hip fracture surgery. The proportion of surgeries on admission day, and time required to complete 33% and 66% of surgeries, varied across provinces and by timing of admission. This may reflect different provincial approaches to providing access to hip fracture surgery.

Waiting for surgery: is waiting bad for anyone or everyone?

PURPOSE

For Canadians, as in many countries, waiting for elective surgery is expected. The duration of the wait raises questions about the maximum amount of time patients should wait for their surgery. The primary objective of this study was to test for a relationship between the length of time patients waited for elective hernia repair surgery and change in patients' self-reported health.

METHODS

This study was based on a prospectively recruited longitudinal cohort of patients waiting for elective hernia repair surgery. Participants completed the PHQ-9, PEG, EQ-5D(3L) generic instruments, and the condition-specific COMI-hernia. Multivariate regression models explored associations between patient-reported outcomes and potential confounders, including age, sex, socio-economic status, and medical comorbidities.

RESULTS

There were 118 participants and the modal age group was 61-70 years. The average wait time for participants was 22.5 weeks. There were no relationships between the duration of participants' wait for hernia repair and the change in patients' self-reported health for hernia-specific outcomes or overall health-related quality of life.

DISCUSSION

There are gains in health-related quality of life to be realized by prioritizing symptomatic patients. Participants with greater pre-operative depression, pain, and hernia-related symptoms experienced an improvement in health prior to surgery, though more clarity is needed on the mechanisms that led to improved health.

CONCLUSION

Many countries face problems with wait lists for elective surgery-and few have effective processes for triaging patients. This study shows that duration of time on the wait list was not associated with change in hernia patients' self-reported health.

Damaging legacy: maternal cigarette smoking has long-term consequences for male offspring fertility

STUDY QUESTION

What are the effects on fertility of cigarette smoke-induced toxicity on male offspring exposed during the gestational/weaning period?

SUMMARY ANSWER

Maternal cigarette smoke exposure during the gestational/weaning period causes long-term defects in male offspring fertility.

WHAT IS KNOWN ALREADY

Cigarette smoke is a well-known reproductive toxicant which is particularly harmful to both fetal and neonatal germ cells. However, recent studies suggest a significant portion of young mothers in the developed world still smoke during pregnancy. In the context of male reproductive health, our understanding of the effects of in utero exposure on offspring fertility is limited.

STUDY DESIGN, SIZE, DURATION

In this study, 27 C57BL/6 5-week-old female mice were exposed via the nose-only to cigarette smoke (treatment) or 27 were exposed to room air (control) for 6 weeks before being housed with stud males to produce litters. In the treatment group, smoke exposure continued throughout mating, pregnancy and lactation until weaning of pups at 21 days post birth. Male offspring were examined at post-natal days 3, 6, 12, 21 and 98 (adult).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Approximately 108 maternal smoke-exposed C57BL/6 offspring and controls were examined. Spermatogenesis was examined using testicular histology and apoptosis/DNA damage was assessed using caspase immunohistochemistry and TUNEL. Sertoli cell morphology and fluctuations in the spermatogonial stem cell population were also examined using immunohistochemistry. Microarray and QPCR analysis were performed on adult testes to examine specific long-term transcriptomic alteration as a consequence of maternal smoke exposure. Sperm counts and motility, zona/oolemma binding assays, COMET analysis and mitochondrial genomic sequencing were also performed on spermatozoa obtained from adult treated and control mice. Fertility trials using exposed adult male offspring were also performed.

MAIN RESULTS AND THE ROLE OF CHANCE

Maternal cigarette smoke exposure caused increased gonocyte and meiotic spermatocyte apoptosis (P < 0.01) as well as germ cell depletion in the seminiferous tubules of neonatal and juvenile offspring. Aberrant testicular development characterized by abnormal Sertoli and germ cell organization, a depleted spermatogonial stem cell population (P < 0.01), atrophic seminiferous tubules and increased germ cell DNA damage (P < 0.01) persisted in adult offspring 11 weeks after exposure. Microarray analysis of adult offspring testes associated these defects with meiotic germ cell development, sex hormone metabolism, oxidative stress and Sertoli cell signalling. Next generation sequencing also revealed a high mitochondrial DNA mutational load in the testes of adult offspring (P < 0.01). Adult maternal smoke-exposed offspring also had reduced sperm counts with spermatozoa exhibiting morphological abnormalities (P < 0.01), affecting motility and fertilization potential. Odf2, a spermatozoa flagellum component required for coordinated ciliary beating, was also significantly down-regulated (P < 0.01) in maternal smoke-exposed adult offspring, with aberrant localization along the spermatozoa flagellum. Adult maternal smoke-exposed offspring took significantly longer to impregnate control females and had a slight but significant (P < 0.01) reduction in litter size.

LIMITATIONS, REASONS FOR CAUTION

This study examined only one species (mouse) using a smoking model which only simulates human cigarette smoke exposure.

WIDER IMPLICATIONS OF THE FINDINGS

This study represents the first comprehensive animal model of maternal smoking on male offspring reproductive function, suggesting that exposure during the gestational/weaning period causes long-term defects in male offspring fertility. This is due to a compromised spermatogonial stem cell population resulting from gonocyte apoptosis and impaired spermatogenic development. This results in significant germ cell damage and Sertoli cell dysfunction, impacting germ cell number, tubule organization, DNA damage and spermatozoa in adult offspring. This study strengthens the current literature suggesting that maternal exposure impairs male offspring fertility, which is currently debated due to conflicting studies.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by the Australian Research Council, Hunter Medical Research Institute, National Health and Medical Research Council of Australia and the Newcastle Permanent Building Society Charitable Trust. The authors declare no conflict of interest.

Scrambled and fried: cigarette smoke exposure causes antral follicle destruction and oocyte dysfunction through oxidative stress

Cigarette smoke is a reproductive hazard associated with pre-mature reproductive senescence and reduced clinical pregnancy rates in female smokers. Despite an increased awareness of the adverse effects of cigarette smoke exposure on systemic health, many women remain unaware of the adverse effects of cigarette smoke on female fertility. This issue is compounded by our limited understanding of the molecular mechanisms behind cigarette smoke induced infertility. In this study we used a direct nasal exposure mouse model of cigarette smoke-induced chronic obstructive pulmonary disease to characterise mechanisms of cigarette-smoke induced ovotoxicity. Cigarette smoke exposure caused increased levels of primordial follicle depletion, antral follicle oocyte apoptosis and oxidative stress in exposed ovaries, resulting in fewer follicles available for ovulation. Evidence of oxidative stress also persisted in ovulated oocytes which escaped destruction, with increased levels of mitochondrial ROS and lipid peroxidation resulting in reduced fertilisation potential. Microarray analysis of ovarian tissue correlated these insults with a complex mechanism of ovotoxicity involving genes associated with detoxification, inflammation, follicular activation, immune cell mediated apoptosis and membrane organisation. In particular, the phase I detoxifying enzyme cyp2e1 was found to be significantly up-regulated in developing oocytes; an enzyme known to cause molecular bioactivation resulting in oxidative stress. Our results provide a preliminary model of cigarette smoke induced sub-fertility through cyp2e1 bioactivation and oxidative stress, resulting in developing follicle depletion and oocyte dysfunction.

Intracellular signalling during female gametogenesis

Female reproductive potential is dictated by the size of the primordial follicle pool and the correct regulation of oocyte maturation and activation--events essential for production of viable offspring. Although a substantial body of work underpins our understanding of these processes, the molecular mechanisms of follicular and oocyte development are not fully understood. This review summarizes recent findings which have improved our conception of how folliculogenesis and oocyte competence are regulated, and discusses their implications for assisted reproductive techniques. We highlight evidence provided by genetically modified mouse models and in vitro studies which have refined our understanding of Pi3k/Akt and mTOR signalling in the oocyte and have discovered a role for Jak/Stat/Socs signalling in granulosa cells during primordial follicle activation. We also appraise a novel role for the metal ion zinc in the regulation of meiosis I and meiosis II progression through early meiosis inhibitor (Emi2) and Mos-Mapk signalling, and examine studies which expand our understanding of intracellular calcium signalling and extrinsic Plcζ in stimulating oocyte activation.

Suppressor of cytokine signaling 4 (SOCS4): moderator of ovarian primordial follicle activation

Mammalian ovarian primordial follicle activation and regulation is considered as one of the most important stages of folliculogenesis and as such requires exquisite control. Selection of quiescent follicles to enter the growing pool determines the rate of supply of maturing follicles over the female reproductive lifespan. To coordinate this process a range of positive and negative input signals contribute to determine follicle fate. This study demonstrates that the cytokine Leukemia Inhibitory Factor (LIF) activates the Janus Kinase 1/Signal Transducers and Activators of Transcription 3 (JAK1/STAT3) signaling pathway in pre-granulosa cells and positively regulates primordial follicle activation. Negative regulation of the JAK/STAT pathway is controlled by the suppressor of cytokine signaling 4 (SOCS4) protein, which target members of negative feedback loops, Cardiotrophin like Cytokine (CLC), Poly (rC) Binding Protein 1 (PCBP1), and Cytosolic Malate Dehydrogenase (MDH1) to suppress follicle growth and development.

Poststroke depression and treatment effects on functional outcomes

BACKGROUND

Poststroke depression (PSD) is common after stroke; however, the relationship to poststroke function is inconclusive. Our objectives were to 1) determine the relationship between PSD at baseline (1 month poststroke) and function (12 weeks later) and 2) assess the impact of depression improvement on 12-week function among those with depression at baseline.

METHODS

We completed a secondary analysis of data from a cohort study of participants with and without PSD. We used logistic regression to identify factors associated with 12-week functional dependence for 1) all 367 participants and 2) the 174 participants with PSD.

RESULTS

In the PSD cohort, 3 characteristics were found to be independently associated with 12-week dependence: increased medical comorbidity (odds ratio [OR] 1.10, 95%confidence interval [CI] 1.02-1.22), increased stroke severity (OR 1.42, 95% CI 1.19-1.69), and increased baseline depression severity (OR 1.13, 95% CI 1.03-1.23). Depression severity was significantly different between those considered dependent and independent at 12 weeks (entire cohort, PHQ-9 7.31 vs 5.18, p = 0.008; depressed cohort, PHQ-9 9.94 vs 7.27, p = 0.019).

CONCLUSION

Among study participants with PSD, the severity of depression symptoms at baseline was associated with dependence; however, our results are inconclusive as to whether improvement of depression is independently associated with functional recovery at 12 weeks. Even if the treatment and improvement of PSD does not directly influence functional recovery poststroke, it is essential for PSD to be identified and treated due to its high symptom burden and association with other negative health and social outcomes.

126. JAK/STAT SIGNALLING IN FOLLICULOGENESIS

Primordial follicle activation marks the first stage of pre-pubertal ovarian folliculogenesis, and is therefore fundamental to female fertility. Entry into development is initiated by a group of pleiotropic cytokines and growth factors, originating in and acting upon both the oocyte and granulosa support cells of the ovarian follicle through the Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) signalling pathway. Pivotal to this process is the transcriptional regulation of target genes via STAT complexes and negative regulation by the Suppressors of Cytokine Signalling (SOCS) family of proteins. Preliminary evidence indicates that STAT3 facilitates the activation of primordial follicles, while SOCS4 counterbalances the activity of STAT3, mediating the controlled release of primordial follicles into the growing pool throughout reproductive life. Leukemia Inhibitory Factor (LIF) has been previously demonstrated as a key granulosa cell derived cytokine involved in inducing primordial follicle activation. Through both quantitative gene expression (qPCR) and immunoblotting we have demonstrated that LIF can significantly upregulate STAT3 mRNA production (~2-fold) as well as increase STAT3 protein phosphorylation within neonatal mouse ovarian explants culture. Furthermore, through the generation of a recombinant SOCS4 protein construct, and its use in subsequent protein-protein pull-downs, we were able to multiple targets involved in oocyte maturation, STAT3 interactions, and JAK/STAT signaling. These targets were also found to be significantly upregulated via qPCR analysis in neonatal mouse ovaries treated with LIF. These results support our current model for the involvement of STAT3 and SOCS4 in a basic negative feedback loop within the JAK/STAT signalling pathway that results in the regulation of primordial follicle activation and development.

Characterisation of rhizobia from African acacias and other tropical woody legumes using Biolog and partial 16S rRNA sequencing

A Biolog (sole carbon source utilisation) user database of tropical and temperature rhizobial strains was created and used in conjunction with the partial 16S rRNA sequencing method to characterise 12 rhizobial isolates from African acacias and other tropical woody legumes. There was close agreement between the two methods but also some significant discrepancies. A high degree of diversity was shown in the relatively small sample of isolates, with 4 out of 5 of the currently proposed rhizobial genera represented. This is the first time Biolog has shown congruence with genotypic fingerprinting using a wide selection of rhizobial reference and test strains.

Visible continuous-wave laser transitions in Pr(3+):YLF and femtosecond pulse generation

Fourteen new cw, visible laser transitions have been observed in Pr(3+):YLF, several of which have exhibited modest tunability. The (3)P(0) - (3)H(6) transition near 613 nm has been shown to have a tunable linewidth of ~1 nm, which, for the first time to our knowledge, has permitted the direct production of femtosecond pulses in the visible from a cw solid-state laser by Kerr-lens mode locking.

Self-starting Kerr-lens mode-locked femtosecond Cr(4+):YAG and picosecond Pr(3+):YLF solid-state lasers

We have observed true self-starting Kerr-lens mode locking in two distinct solid-state laser systems operating at room temperature by optimizing the cavity geometry to maximize the amplitude modulation with respect to the intracavity power variation. Pulses of 15 ps have been obtained from a Pr(3+):YLF laser system operating at 607 nm, and 53-fs pulses have been obtained from Cr(4+):YAG at 1.54 microm.

A multicenter randomized, placebo-controlled trial of surfactant therapy for respiratory distress syndrome

We carried out a multicenter randomized, placebo-controlled trial to evaluate the efficacy and safety of surfactant in the treatment of respiratory distress syndrome. The study population was made up of newborn infants weighing 750 to 1750 g who were receiving assisted ventilation with 40 percent or more oxygen. The eligible infants received a single dose of either surfactant (100 mg of phospholipid per kilogram of body weight [4 ml per kilogram]) or an air placebo (4 ml per kilogram), administered into the trachea within eight hours of birth by an investigator not involved in the clinical care of the infant. When compared with the infants who received the placebo (n = 81), the infants who were treated with surfactant (n = 78) had a 0.12 greater average increase in the ratio of arterial to alveolar oxygen tension (P less than 0.0001), a 0.20 greater average decrease in the fractional inspiratory oxygen concentration (P less than 0.0001), and a 0.26-kPa greater average decrease in the mean airway pressure (P less than 0.0001) during the 72 hours after treatment. Pneumothorax was less frequent among the infants treated with surfactant than in the control group (13 percent vs. 37 percent; P = 0.0005). There were no statistically significant differences between the groups in the proportion of infants in each of five ordered clinical-status categories on day 7 (P = 0.08) or day 28 (P = 0.75) after treatment. There were also no significant differences between the groups in the frequency of bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or periventricular-intraventricular hemorrhage. In each group, 17 percent of the infants died by day 28. We conclude that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 72 hours after treatment and decreases the frequency of pneumothorax, but that it does not significantly improve clinical status later in the neonatal period and does not reduce neonatal mortality. Further study of different surfactant regimens and patient-selection criteria will be required to determine whether this initial improvement can be translated into reductions in mortality or serious morbidity.

Occurrence of nodulation in the Leguminosae

Reports of nodulation in the Leguminosae are examined in the light of current views on the taxonomy of the family. In the subfamily Caesalpinioideae, nodulation is largely restricted to the tribe Caesalpinieae and the genus Chamaecrista from the Cassieae. All nodules studied have rhizobia retained within infection threads during the nitrogen fixing period. In the Mimosoideae, nodulation is general, except for 4 groups within the tribe Mimoseae, and a very few species of Acacia. The only tribe from the Papilionoideae which appears not to nodulate is the Dipterygeae, although the monogeneric Euchresteae has not been examined. A number of genera in the Swartzieae do not nodulate. Taking tile family as a whole, nodulation appears to be very uniform - certain sections nodulate, others do not.

Calcium-oxalate crystals and crystal cells in determinate root nodules of legumes

Early reports of the presence of calciumoxalate crystals in the cortices ofPhaseolus vulgaris root nodules have been confirmed. Crystals were found in all six genera examined (Cajanus, Desmodium, Glycine, Lespedeza, Phaseolus, Vigna) that have determinate nodules and export ureides. They were absent from six genera examined that have indeterminate nodules and export amides. The possible physiological significance of these structures is discussed.

High malformation rates and decreased mortality in infants of diabetic mothers managed after the first trimester of pregnancy (1956-1978)

Over a period of 23 years we accumulated data on 182 pregnant juvenile diabetic subjects during pregnancy, labor, and delivery. Diabetic subjects were evaluated generally after the first trimester of pregnancy. Data examined included diabetic class, maternal complications of pregnancy, and infant morbidity and mortality. Data were analyzed in two periods-before and after 1970. In the second period, maternal polyhydramnios and acidosis rates improved, neonatal problems of homeostasis did not change significantly, and combined fetal and neonatal losses fell from 34.7% to 16.4%. The neonatal malformation rate, however, increased from 1.4% to 16.8% and was not influenced by maternal age or diabetic class.

The effect of bilateral medial meniscectomy on articular cartilage of the hip joint

Bilateral medial meniscectomy of the knee joint was undertaken in 4 mature greyhounds. Four greyhounds of similar age served as nonsurgical controls. Six months after meniscectomy, all animals were sacrificed and femoral head articular cartilage (FHC) examined for collagen, uronic acid, galactosamine, glucosamine and hyaluronic acid (HA) content. The sequential extractability of proteoglycans (PG) with non-dissociative (0.5 M GuHCl) and dissociative (0.4 M GuHCl) solvents was also investigated. The levels of collagen, uronic acid, galactosamine and glucosamine of the FHC of the meniscectomized group remained normal relative to FHC taken from the control greyhounds but the level of HA was significantly depressed (p less than 0.05). The amount of PG extracted by 0.5 M GuHCl from the FHC of the meniscectomized group was 2.5 X that extracted from control cartilage. In addition, subsequent extraction of the residues with 4.0 M GuHCl only released half the amounts of PG extracted from control FHC under the same conditions.

The effects of postoperative joint immobilization on articular cartilage degeneration following meniscectomy

Bilateral medial meniscectomy was performed in 12 mature greyhounds. One knee joint of half the group was immobilized by a Kirschner splint for a period of 5 weeks immediately following meniscectomy, after which the device was removed and the animals were allowed free movement for a further 21 weeks before sacrifice. Three greyhounds served as controls. While the collagen levels of articular cartilage from the femoral condyles and tibial plateaus of meniscectomized animals were the same as that of controls, differences were found for proteoglycan (PG) content and extractability using nondissociative conditions (0.5 M guanidinium hydrochloride (GuHCl) but not dissociative conditions (4.0 M GuHCl). With nondissociative conditions, twice as much PG was extracted from medial femoral condyle of meniscectomized animals encouraged to bear weight on joints immediately after surgery compared to that from controls or animals in whom joints were immobilized after surgery. Proteoglycans from medial tibial plateau cartilage of the free contralateral joints of the immobilized group were more readily extracted using 0.5 M GuHCl and also showed a statistically significant depression of uronic acid levels relative to both controls and tissues of other surfaces. The data suggest that postoperative management of meniscectomy in the human may be more important than has hitherto been recognized.

Animals as an Energy Source in Third World Agriculture

Agricultural development programs have so far been largely unable to meet the food needs of the world's poorest. Increased food production can be achieved only from more intensive agriculture, which requires greater energy inputs per farm worker. Problems of technological infrastructure and escalating oil prices appear to preclude the spread of mechanization to Third World agriculture at this time. Efficient utilization of grazing animals in specific integrated farming systems could not only increase energy inputs through draft and transportation but also increase the yield of high-grade products and by-products from the renewable energy of biomass. An approach to development based on animal agriculture systems is suggested that might initiate a self-sustaining, more productive agriculture requiring only small inputs of fossil-fuel energy.

Neonatal hotline telephone network

By simplifying the process by which telephone contacts are made, improved communications were established between a university-affiliated newborn intensive care center and some of the community hospital nurseries that it serves as a regional resource. Initiation of the improved system of communications was associated with a significant improvement in the survival of infants transferred from the community hospitals to the regional care facility.

Prune-belly syndrome associated with Potter (renal nonfunction) syndrome

Three fatal cases of prune-belly syndrome were associated with nonrenal features of Potter syndrome. The abdominal muscle hypoplasia is thought to be a result of large kidneys compression the developing abdominal musculature during a critical phase of fetal development. Thus, Potter syndrome and prune-belly syndrome may coexist when nonfunctioning large kidneys result in oligohydramnios. A teratogenic role of cytomegalovirus inclusion disease and other viruses is possible in the pathogenesis of these syndromes.

Computer-assisted newborn intensive care

A minicomputer has been programmed to aid in the intensive care of high-risk newborn babies. The computer provides 24-hour on-line access to physiologic and environmental data and controls the heating of infant incubators. The control algorithm limits fluctuations in the incubator chamber and protects the infant against escape from neutral thermal conditions. The mortality rate for 105 infants cared for using the computerized systems was significantly reduced when compared to that of 105 matched high-risk infants cared for using standard non-computer-assisted techniques in the same nursery setting.

Essential (hereditary or senile) tremor

Sixteen cases (eight in males and eight in females) of essential (hereditary or senile) tremor were collected over a two-year period. Ten patients had near relatives with a similar disorder. All but one patient had a tremor of the upper limbs which was absent when the arms were at rest, but which appeared on movement, and was made worse by emotion. The severity of the tremor varied considerably from patient to patient, and often was temporarily lessened by alcohol. The tremor involved the head and neck in six subjects and the legs in two. One subject has associated neurological abnormalities probably due to cerebral arteriosclerosis. Otherwise no neurological abnormality except tremor was present in any patient. No patient showed evidences of Parkinsonism. To the time of collection of the series the tremor had been present for periods of between one and 62 years. Many patients with essential tremor are not severely enough affected to warrant therapy. Propranolol, a beta-adrenergic blocking agent, appears to reduce the tremor in at least some patients who need treatment.

Decreased colonization of newborn infants with Staphylococcus aureus 80/81: Cincinnati General Hospital, 1960-1972

The changing pattern of colonization of newborn infants with Staphylococcus aureus was studied by examination of 25,662 nasal and umbilical cultures obtained at weekly intervals from 9,216 infants during 1960-1972. The frequency of colonization of infants in the newborn nursery with S. aureus 80/81 decreased significantly during 1963-1965 and has remained low since that time. This change in colonization was unrelated to the use of hexacholorophene for bathing infants or to changes in sensitivity to the commonly used systemic antibiotics, penicillin and kanamycin. A similar decrease occurred with S. aureus lysed by the group 2 phages, but this decrease rebounded to the earlier level after cessation of hexacholorphene use.

Geochemistry and multiple sclerosis: a hypothesis

A hypothesis is presented and evidence is adduced to show that high-risk areas of multiple sclerosis are related to the ability of the soils of the locality to obtain and fix molybdenum perferentially to copper. Soil conditons capable of such partition are known to be present characteristically in cool temperate zones and are significantly present in acid podsols of these regions. On the other hand, under tropical and subtropical conditions, molybdenum is normally highly mobile and leached from the environment. Copper may also be leached but can accumulate in caliche deposits. This hypothesis is notopposed to the theory of a viral aetology of multiple sclerosis, but rather seeks to show that certain individuals, if exposed to trace element imbalance at a critical period in life, may be rendered susceptible to a slow virus infection.

Buccal absorption of ergotamine

The rate of disappearance of ergotamine from the mouth after buccal administration has been studied in seven subjects. Allowance has been made for non-absorptive losses of the drug due to experimental technique. The absorption of ergotamine across the buccal mucosa appears to be a passive process, pH-dependent but independent of ergotamine concentration or the simultaneous presence of caffeine. Because of the low solubility of ergotamine at the pH of saliva, it is unlikely that therapeutically useful amounts of the drug would have absorbed across the buccal mucosa even after the drug had been in the mouth for five minutes.