Neuroproteomic Analysis after SARS-CoV-2 Infection Reveals Overrepresented Neurodegeneration Pathways and Disrupted Metabolic Pathways

Besides respiratory illness, SARS-CoV-2, the causative agent of COVID-19, leads to neurological symptoms. The molecular mechanisms leading to neuropathology after SARS-CoV-2 infection are sparsely explored. SARS-CoV-2 enters human cells via different receptors, including ACE-2, TMPRSS2, and TMEM106B. In this study, we used a human-induced pluripotent stem cell-derived neuronal model, which expresses ACE-2, TMPRSS2, TMEM106B, and other possible SARS-CoV-2 receptors, to evaluate its susceptibility to SARS-CoV-2 infection. The neurons were exposed to SARS-CoV-2, followed by RT-qPCR, immunocytochemistry, and proteomic analyses of the infected neurons. Our findings showed that SARS-CoV-2 infects neurons at a lower rate than other human cells; however, the virus could not replicate or produce infectious virions in this neuronal model. Despite the aborted SARS-CoV-2 replication, the infected neuronal nuclei showed irregular morphology compared to other human cells. Since cytokine storm is a significant effect of SARS-CoV-2 infection in COVID-19 patients, in addition to the direct neuronal infection, the neurons were treated with pre-conditioned media from SARS-CoV-2-infected lung cells, and the neuroproteomic changes were investigated. The limited SARS-CoV-2 infection in the neurons and the neurons treated with the pre-conditioned media showed changes in the neuroproteomic profile, particularly affecting mitochondrial proteins and apoptotic and metabolic pathways, which may lead to the development of neurological complications. The findings from our study uncover a possible mechanism behind SARS-CoV-2-mediated neuropathology that might contribute to the lingering effects of the virus on the human brain.

A lysosomal enigma CLN5 and its significance in understanding neuronal ceroid lipofuscinosis

Neuronal Ceroid Lipofuscinosis (NCL), also known as Batten disease, is an incurable childhood brain disease. The thirteen forms of NCL are caused by mutations in thirteen CLN genes. Mutations in one CLN gene, CLN5, cause variant late-infantile NCL, with an age of onset between 4 and 7 years. The CLN5 protein is ubiquitously expressed in the majority of tissues studied and in the brain, CLN5 shows both neuronal and glial cell expression. Mutations in CLN5 are associated with the accumulation of autofluorescent storage material in lysosomes, the recycling units of the cell, in the brain and peripheral tissues. CLN5 resides in the lysosome and its function is still elusive. Initial studies suggested CLN5 was a transmembrane protein, which was later revealed to be processed into a soluble form. Multiple glycosylation sites have been reported, which may dictate its localisation and function. CLN5 interacts with several CLN proteins, and other lysosomal proteins, making it an important candidate to understand lysosomal biology. The existing knowledge on CLN5 biology stems from studies using several model organisms, including mice, sheep, cattle, dogs, social amoeba and cell cultures. Each model organism has its advantages and limitations, making it crucial to adopt a combinatorial approach, using both human cells and model organisms, to understand CLN5 pathologies and design drug therapies. In this comprehensive review, we have summarised and critiqued existing literature on CLN5 and have discussed the missing pieces of the puzzle that need to be addressed to develop an efficient therapy for CLN5 Batten disease.

The impact of age and high-risk human papillomavirus (hrHPV) status on the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women with persistent hrHPV-positive, cytology-negative screening samples: a prospective cohort study

OBJECTIVE

To establish the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent high-risk human papillomavirus (hrHPV) cytology-negative screening sample according to hrHPV genotype, age at referral and colposcopic performance.

DESIGN

Prospective cohort study.

SETTING

Single colposcopy clinic linked to a population-based screening programme.

POPULATION

Women referred with persistent hrHPV cytology-negative routine screening samples.

METHODS

Prospective study with descriptive statistics from a single colposcopy unit between June 2014 and July 2019.

MAIN OUTCOME MEASURES

Prevalence of hrHPV genotypes and CIN2+, positive predictive value for colposcopic impression, and inadequate colposcopic examinations.

RESULTS

A total of 3107 women were referred. Prevalence of CIN2+ was highest for persistent HPV16 infections (10.7%) compared with HPV18 (3.6%) or HPVO (4.7%). Prevalence of CIN2+ declined with age (25-34 years 14.2% to 55-64 years 1.1%) whereas the percentage of women with an inadequate colposcopic examination increased (25-34 years 0.9% to 55-64 years 29.5%). High-grade colposcopic impression fell over time during the study from 16.1 to 5.1%. The positive predictive value for colposcopic impression of CIN2+ was affected by hrHPV genotype (57.3% for HPV16 versus 32.1% for nonHPV16). The adjunctive use of electrical impedance spectroscopy detected an extra 42 cases of CIN2+, which was irrespective of hrHPV genotype.

CONCLUSIONS

Primary hrHPV cervical screening increases detection of CIN2+; however, low specificity results in more women being referred to colposcopy with a low prevalence of CIN2+. Colposcopy performs poorly in some groups, particularly with HPVO infections and women over 50 years of age. An appropriate threshold for referral to colposcopy in primary hrHPV screening has not been established.

TWEETABLE ABSTRACT

Low prevalence of CIN2+ in HPV-positive negative cytology samples. HPV genotype, age and prevalence of CIN2+ affect colposcopic performance.

Electric Rydberg-Atom Interferometry

An electric analogue of the longitudinal Stern-Gerlach matter-wave interferometer has been realized for atoms in Rydberg states with high principal quantum number n. The experiments were performed with He atoms prepared in coherent superpositions of the n=55 and n=56 circular Rydberg states in a zero electric field by a π/2 pulse of resonant microwave radiation. These atoms were subjected to a pulsed inhomogeneous electric field to generate a superposition of momentum states before a π pulse was applied to invert the internal states. The same pulsed inhomogeneous electric field was then reapplied for a second time to transform the motional states to have equal momenta before a further π/2 pulse was employed to interrogate the final Rydberg state populations. This Hahn-echo microwave pulse sequence, interspersed with a pair of equivalent inhomogeneous electric field pulses, yielded two spatially separated matter waves. Interferences between these matter waves were observed as oscillations in the final Rydberg state populations as the amplitude of the pulsed electric field gradients was adjusted.

Severe hyponatraemia in foals: clinical findings, primary diagnosis and outcome

OBJECTIVE

To evaluate severe hyponatraemia in foals presenting as medical emergencies to an intensive care unit (ICU) in order to determine the prevalence, clinical findings, primary diagnosis and outcome.

DESIGN

Retrospective case study of records from Thoroughbred foals aged less than 3 months presenting to an ICU as medical emergencies in 2002-12; foals with severe hyponatraemia (serum sodium <122 mmol/L) on admission laboratory data were identified. Data retrieved included signalment, clinical findings, laboratory results, primary diagnosis, treatment and outcome.

RESULTS

Severe hyponatraemia was identified in 69/1718 Thoroughbred foals (4%) presenting to the ICU during the study period. Of the 69 foals, 11 (15.9%) presented with neurological signs attributable to hyponatraemic encephalopathy and 7 of these foals had seizures; other neurological signs included obtundation, ataxia and apparent blindness. The three most common primary diagnoses of the 69 foals with severe hyponatraemia were renal disease (18/69, 26.1%), enterocolitis (16/69, 23.2%) and uroperitoneum (15/69, 21.7%). Treatment was directed at the primary disease and correction of the hyponatraemia. A total of 50 of the 69 foals (72.5%) with severe hyponatraemia survived to hospital discharge and 38 of them (76%) survived at least 12 months following discharge.

CONCLUSION

The prevalence of severe hyponatraemia in this study population was 4%. The majority of foals with severe hyponatraemia did not demonstrate direct clinical manifestations as a result of the low serum sodium concentration. The outcome of foals with severe hyponatraemia was mostly favourable.

Influence of a triclosan toothpaste on periodontopathic bacteria and periodontitis progression in cardiovascular patients: a randomized controlled trial

BACKGROUND AND OBJECTIVE

Triclosan/copolymer toothpaste is effective in controlling plaque and gingivitis and in slowing the progression of periodontitis. This study describes its influence on microbiological and clinical outcomes, over a 5-year period, in patients with established cardiovascular disease (CVD).

MATERIAL AND METHODS

Four-hundred and thirty-eight patients were recruited from the Cardiovascular Unit at The Prince Charles Hospital, Brisbane, Australia, and randomized to triclosan or placebo groups. Six sites per tooth were examined annually for probing pocket depth and loss of attachment. These outcomes were analysed, using generalized linear modelling, in 381 patients who had measurements from consecutive examinations. Concurrent load of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Tannerella forsythia and Porphyromonas gingivalis was determined, using quantitative real-time PCR, in 437 patients with baseline plaque samples. Group comparisons were expressed as geometric means. The chi-square test was used to test for differences between the two groups of patients with regard to the proportion of patients with different numbers of bacterial species.

RESULTS

There was no difference in general health or periodontal status between the groups at baseline. There was a significant reduction in the number of interproximal sites showing loss of attachment between examinations, by 21% on average (p < 0.01), in the triclosan group compared with the placebo group. The prevalence of patients with F. nucleatum and A. actinomycetemcomitans was high and remained relatively constant throughout the 5 years of the study. In contrast, the prevalence of T. forsythia and P. gingivalis showed more variability; however, there was no significant difference between the groups, at any time point, in the prevalence of any organism. A significant difference in the geometric means for P. gingivalis (p = 0.01) was seen at years 1 and 4, and for F. nucleatum (p = 0.01) and in the total bacterial load (p = 0.03) at year 2; however, these differences were not statistically significant following a Bonferroni correction for multiple comparisons. There was no difference between the groups in the geometric means for each organism at year 5.

CONCLUSION

Within the limitations of the study, these data suggest that the use of triclosan/copolymer toothpaste significantly slowed the progression of periodontitis in patients with CVD but that it had little influence on key subgingival periodontopathic bacteria in these patients over the 5 years of the study.

A national audit of standards of care for women with vulval conditions and survey of attitudes to nurse practitioners in vulval services in the UK

This national audit assessed whether UK specialist vulval clinics adhere to the British Society of Vulval Diseases (BSSVD) document 'Standards of care for women with vulval conditions' published in 2013 and benchmarked clinician attitudes towards nurse practitioners in vulval services. Audit standards were based on the BSSVD guidance. All BSSVD and British Society for Colposcopy and Cervical Pathology or BSCCP members were surveyed via two electronic questionnaires. Results demonstrate that the majority of specialist vulval clinics in the UK are non-compliant with the standards set out for specialist vulval services. The majority of clinicians would support the introduction of clinical nurse specialists to vulval services, but there is need for development of a national training programme. In conclusion, significant improvements are required in provision of patient information, guidelines, access to multidisciplinary services, multidisciplinary team or MDT processes and data recording in UK specialist vulval services.

The importance of ultrasonographic pneumatosis intestinalis in equine neonatal gastrointestinal disease

REASONS FOR PERFORMING STUDY

Recognising the presence of a necrotising component of the gastrointestinal disease may be clinically useful in ill equine neonates.

OBJECTIVES

To study the importance of abdominal sonograms in neonatal foals suffering from gastrointestinal conditions and to describe the clinical features of necrotising gastrointestinal disease.

HYPOTHESIS

There is a subgroup of neonates with sonographically detectable pneumatosis intestinalis (PI), reflecting a necrotising disease.

METHODS

Records of foals aged < or = 7 days hospitalised from 2005 to 2009 with signs of gastrointestinal disease were evaluated (n = 89). The association of sonographic, clinical and clinicopathological signs with necrotising gastrointestinal disease and outcome was determined.

RESULTS

PI was imaged in 19 foals. Twenty-seven foals were classified as having necrotising gastrointestinal disease based on the presence of gastrointestinal signs (colic, diarrhoea, gastric reflux or abdominal distension) and sonographic PI (n = 19), surgical (n = 2) or pathological (n = 6) evidence of gastrointestinal necrosis. There was a difference between survival rate in foals with and without necrotising disease (33.3 and 69.4%, respectively, P = 0.005) or foals with and without PI detected sonographically (36.8 and 72.1%, respectively, P = 0.023). PI was the only sonographic finding associated with outcome. Prematurity, the presence of blood in the faeces, gastric reflux, abdominal distension, abnormal echogenicity of the colon and the lowest white blood cell count during hospitalisation were associated with necrotising gastrointestinal disease (P < 0.05).

CONCLUSIONS AND POTENTIAL RELEVANCE

Abdominal sonograms have prognostic value in neonatal gastrointestinal disease. PI and the presence of necrotising gastrointestinal disease were common and associated with a poor prognosis.

Retrospective study of dystocia in mares at a referral hospital

REASONS FOR PERFORMING STUDY

The period between the onset of dystocia and its resolution has an important bearing on fetal outcome. There are few published data on which to base decisions regarding optimum management of cases in practice.

OBJECTIVES

To evaluate and compare the effects of a coordinated dystocia management protocol (CDMP) with that of a previous protocol of random management on time to resolution and outcome in both an emergency dystocia referral population of mares (referred emergency cases: EM) and in a population of mares residing in hospital due to high risk pregnancy (HRP) concerns that then experience dystocia at parturition.

METHODS

Retrospective study performed at a university hospital referral centre of cases presenting from 1991-2004 divided into Group 1 (pre-CDMP) and Group 2 (CDMP).

RESULTS

Medical records of 71 cases with dystocia were retrieved and data recorded. For referred emergency cases (EM), time from hospital presentation to resolution decreased significantly by 32 min (P = 0.03) after institution of CDMP. Survival rate of mares at discharge was 86%. Survival of EM foals was low, with 10% in Group 1 and 13% in Group 2, surviving to discharge. For EM foals delivered alive, survival to discharge was 30% and 43% in Groups 1 and 2, respectively. Median Stage II was significantly (P < 0.001) different at 71 and 282 min for EM foals delivered alive vs. those not alive at delivery, respectively. Median duration of Stage II was also significantly (P < 0.001) different between EM foals surviving and not surviving to discharge, at 44 and 249 min, respectively. Survival of HRP dystocia foals to discharge was 79%.

CONCLUSIONS

Although CDMP reduced the time from presentation at the hospital to resolution significantly for EM, total duration of Stage II for EM was unchanged, as was foal outcome.

POTENTIAL RELEVANCE

Very early referral of mares with dystocia to referral centres with dystocia management protocols may improve fetal outcome as increased duration of Stage II in the horse affects fetal outcome negatively.

Prospective evaluation of coagulation in critically ill neonatal foals

BACKGROUND

Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals.

HYPOTHESIS

Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome.

ANIMALS

Foals <72 hours old admitted to a neonatal intensive care unit.

METHODS

Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals.

RESULTS

Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P= .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P= .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P= .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3-70, P= .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values.

CONCLUSIONS AND CLINICAL IMPORTANCE

Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock.

P53 and bcl-2 assessment in serous ovarian carcinoma

The study objective was to determine the prognostic value of assessment of staining of p53 and bcl-2 in a well-selected group of serous ovarian carcinomas. Immunohistochemical detection was used to identify both p53 and bcl-2 positive tumors. One hundred thirty-two tumors were analyzed for positivity of staining, grade of staining intensity, and for p53 alone, percent expression rates. These were analyzed alongside traditional clinicopathologic parameters for their ability to predict overall survival (OS), disease-free survival (DFS), and response to chemotherapy (CR). Univariate COX analysis revealed percent p53 expression (P = 0.012) and p53 grade (P = 0.01) to be significant predictors of DFS. Neither the p53 nor bcl-2 measurement parameters were found significant for OS or prediction of CR. On multivariate analysis, incorporating clinicopathologic parameters, p53 parameters did not retain independent significance for any outcome measure. As in primary reported studies, bcl-2 was not found to be of clear independent prognostic value in this group of ovarian tumors. If mutation of p53 and its consequent overexpression is an early event in ovarian tumorigenesis, then p53 assessment may prove useful prognostically in the assessment of either low-grade ovarian carcinomas, as a possible indicator for progression, or in early-stage ovarian tumors, as a marker of tumor aggression or likelihood of recurrence. p53 analysis of a larger group of stage I ovarian tumors would be desirable to further explain the potential association with DFS.

The prognostic value of nuclear morphometric analysis in serous ovarian carcinoma

The objective of this study was to determine whether nuclear morphometric data can predict survival, disease progression, and chemotherapeutic response in ovarian serous carcinoma. Nuclear morphometric parameters were determined from archival hematoxylin and eosin sections of 132 serous tumors. Clinicopathologic and morphometric parameters were evaluated as to their individual and independent prognostic value and prediction of chemotherapy response. Nuclear parameters were found to strongly correlate with extent of disease residuum, tumor grade, and FIGO stage. Univariate analysis revealed stage, grade, preoperative CA125, presence of ascites, extent of disease residuum, standard deviation of nuclear area (SDNA), nuclear perimeter (NP), SDNP, nuclear length (NL), nuclear breadth (NB), orthoferet, and equivalent diameter (ED) to be significant predictors of overall survival (OS) and disease-free survival (DFS). Grade, stage, extent of disease residuum, presence of ascites, SDNA, NP, NL, NB, and orthoferet were found to be significant predictors of chemotherapy response. Multivariate analysis revealed extent of disease residuum (P <or= 0.01) and ED (P = 0.002) to be significant predictors for OS. FIGO stage (P <or= 0.01) and ED (P = 0.039) were significant predictors of DFS. NL (P = 0.041) and extent of residual disease (P = 0.003) were the strongest predictors of chemotherapy response with correct classification rates of 68.8% and 70.3%, respectively. In all stages, nuclear morphometry was easy to perform and highly reproducible. Independent prognostic significance was achieved for OS and DFS analysis. Results also suggest that nuclear morphometry can provide significant information to predict chemotherapy response in platinum-treated serous ovarian cancer.

Acquisition and loss of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia over a 5-year period: effect of a triclosan/copolymer dentifrice

OBJECTIVES

The present study describes the natural history of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia over a 5-year period and the effect of a triclosan/copolymer dentifrice on these organisms in a normal adult population.

MATERIAL AND METHODS

Subgingival plaque samples were collected from 504 adult volunteers. Probing pocket depths (PPD) and relative attachment levels were measured using an automated probe. Participants were matched for disease status (CPI), plaque index, age and gender, and allocated to receive either a triclosan/copolymer or placebo dentifrice. Re-examination and subgingival plaque sampling was repeated after 1, 2, 3, 4 and 5 years. P. gingivalis, A. actinomycetemcomitans and P. intermedia were detected and quantitated using an enzyme linked immunosorbent assay. Logistic regression and generalised linear modelling were used to analyse the data.

RESULTS

This 5-year longitudinal study showed considerable volatility in acquisition and loss (below the level of detection) of all three organisms in this population. Relatively few subjects had these organisms on multiple occasions. While P. gingivalis was related to loss of attachment and to PPD >/=3.5 mm, there was no relationship between A. actinomycetemcomitans or P. intermedia and disease progression over the 5 years of the study. Smokers with P. gingivalis had more PPD >/=3.5 mm than smokers without this organism. There was no significant effect of the triclosan dentifrice on P. gingivalis or A. actinomycetemcomitans. Subjects using triclosan were more likely to have P. intermedia than those not using the dentifrice; however this did not translate into these subjects having higher levels of P. intermedia and its presence was uniform showing no signs of increasing over the course of the study.

CONCLUSION

The present 5-year longitudinal study has shown the transient nature of colonisation with P. gingivalis, A. actinomycetemcomitans and P. intermedia in a normal adult population. The use of a triclosan-containing dentifrice did not lead to an overgrowth of these organisms. The clinical effect of the dentifrice would appear to be independent of its antimicrobial properties.

The effect of a triclosan-containing dentifrice on the progression of periodontal disease in an adult population

OBJECTIVES

The aim of the present study was to determine the effect of unsupervised, long-term use of a 0.3% triclosan/2% copolymer dentifrice on the progression of periodontal disease in a general adult population.

METHODS

Five hundred and four volunteers were enrolled in a double-blind, controlled clinical trial. Participants were matched for disease status, plaque index, age and gender. At the baseline examination, probing pocket depths and relative attachment levels were recorded and participants were assigned to either the test or control group. Re-examinations took place after 6, 12, 24, 36, 48 and 60 months. Subgingival plaque samples were collected at each examination and assayed for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia. A generalised linear model was used to analyse the data, with a number of covariates thought to influence the responses included as the possible confounding effects.

RESULTS

The triclosan/copolymer dentifrice had a significant effect in subjects with interproximal probing depths > or =3.5 mm, where it significantly reduced the number of sites with probing depths > or =3.5 mm at the following examination, when compared with the control group (p<0.001). Furthermore, this effect increased with increasing numbers of affected sites. There was no effect of the triclosan/copolymer dentifrice in individuals without probing depths > or =3.5 mm at the previous examination. Other factors significantly affecting probing pocket depths (PPD) included increasing age, smoking and presence of P. gingivalis. PPD > or =3.5 mm were positively associated with loss of attachment some 2 years later.

CONCLUSION

This study showed that in a normal adult population, unsupervised use of a triclosan/copolymer dentifrice is effective in slowing the progression of periodontal disease.

Increased visual after-effects in migraine following pattern adaptation extend to simultaneous tilt illusion

Much previous research into visual processing in migraine supports a model of abnormal cortical processing, in between the headache attacks, that is characterised by hyperexcitability, heightened responsiveness, a lack of habituation and/or a lack of intra-cortical inhibition. Shepherd (2001) reported two adaptation studies that challenged this view, one using the tilt after-effect, the second using the motion after-effect. Models of cortical function in migraine based on hyperexcitability and a lack of inhibition lead to specific predictions in an adaptation study: there should have been smaller after-effects in people with migraine than in people without. Both experiments, however, revealed larger after-effects in the migraine group than in the control group. Here, these results are extended to the simultaneous tilt illusion and an identical pattern of results was obtained: there were consistently larger effects in the migraine group than in the control group. The results from the three experiments are not consistent with a lack of inhibition in migraine. The results are discussed in terms of alternative models of cortical function, including a lack of excitation and reduced central energy reserves.

A longitudinal study of interleukin-1 gene polymorphisms and periodontal disease in a general adult population

BACKGROUND

Cross-sectional studies have demonstrated that a specific polymorphism (allele 2 of both IL-1A +4845 and IL-1B +3954) in the IL-1 gene cluster has been associated with an increased susceptibility to severe periodontal disease and to an increased bleeding tendency during periodontal maintenance. The aim of the present study was to investigate the relationship between IL-1 genotype and periodontitis in a prospective longitudinal study in an adult population of essentially European heritage.

METHODS

From an ongoing study of the Oral Care Research Programme of The University of Queensland, 295 subjects consented to genotyping for IL-1 allele 2 polymorphisms. Probing depths and relative attachment levels were recorded at baseline, 6, 12, 24, 36, 48 and 60 months using the Florida probe. Periodontitis progression at a given site was defined as attachment loss > or =2 mm at any observation period during the 5 years of the study and the extent of disease progression determined by the number of sites showing attachment loss. Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia were detected using ELISA.

RESULTS

38.9% of the subjects were positive for the composite IL-1 genotype. A relationship between the IL-1 positive genotype and increased mean probing pocket depth in non-smokers greater than 50 years of age was found. Further, IL-1 genotype positive smokers and genotype positive subjects with P. gingivalis in their plaque had an increase in the number of probing depths > or =3.5 mm. There was a consistent trend for IL-1 genotype positive subjects to experience attachment loss when compared with IL-1 genotype negative subjects.

CONCLUSION

The results of this study have shown an interaction of the IL-1 positive genotype with age, smoking and P. gingivalis which suggests that IL-1 genotype is a contributory but non-essential risk factor for periodontal disease progression in this population.

Visual cortex excitability in migraine with and without aura

OBJECTIVES

Previous research using transcranial magnetic stimulation has produced equivocal findings concerning thresholds for the generation of visual phosphenes in migraine with aura. These studies were methodologically varied and did not systematically address cortical excitability in migraine without aura. We therefore studied magnetophosphene thresholds in both migraine with aura and migraine without aura compared with headache-free controls.

METHODS

Sixteen subjects with migraine with aura and 12 subjects with migraine without aura were studied and compared with 16 sex- and age-matched controls. Using a standardized transcranial magnetic stimulation protocol of the occipital cortex, we assessed the threshold stimulation intensity at which subjects just perceived phosphenes via a method of alternating course and fine-tuning of stimulator output.

RESULTS

There were no significant differences across groups in the proportion of subjects seeing phosphenes. However, the mean threshold at which phosphenes were reported was significantly lower in both migraine groups (migraine with aura=47%, migraine without aura=46%) than in controls (66%). Moreover, there was no significant correlation between individual phosphene threshold and the time interval to the closest migraine attack.

CONCLUSION

Our findings confirm that the occipital cortex is hyperexcitable in the migraine interictum, both in migraine with and without aura.

Bacterial isolates from blood and their susceptibility patterns in critically ill foals: 543 cases (1991-1998)

OBJECTIVE

To assess microorganisms isolated from blood specimens obtained from critically ill neonatal foals and to evaluate their antimicrobial susceptibility patterns.

DESIGN

Retrospective study.

ANIMALS

543 neonatal foals.

PROCEDURE

Medical records of foals that were < 1 month old and were admitted to a referral neonatal intensive care unit were reviewed for results of bacteriologic culture of blood and antimicrobial susceptibility patterns.

RESULTS

At least 1 microorganism was isolated from 155 of 543 (28.5%) foals. Escherichia coli was the most commonly isolated bacterium. A single gram-positive organism was detected in 49 foals. Although 90% of the E coli isolates were susceptible to amikacin, some gram-negative and gram-positive organisms had resistance against multiple antimicrobials.

CONCLUSIONS AND CLINICAL RELEVANCE

Gram-negative bacteria remain the most common isolates from blood of neonatal foals; however, gram-positive organisms were also found, and with greater prevalence than reported elsewhere. Susceptibility patterns may vary, and resistance to multiple antimicrobials may develop. This is especially true for organisms such as Enterobacter spp and Enterococcus spp. Prudent empirical treatment for neonatal sepsis should include broad-spectrum antimicrobials.

A Brassica oleracea gene expressed in a variety-specific manner may encode a novel plant transmembrane receptor

The species Brassica oleracea includes several agricultural varieties characterized by the proliferation of different types of meristems. Using a combination of subtractive hybridization and PCR (polymerase chain reaction) techniques we have identified several genes which are expressed in the reproductive meristems of the cauliflower curd (B. oleracea var. botrytis) but not in the vegetative meristems of Brussels sprouts (B. oleracea var. gemmifera) axillary buds. One of the cloned genes, termed CCE1 (CAULIFLOWER CURD EXPRESSION 1) shows specific expression in the botrytis variety. Preferential expression takes place in this variety in the meristems of the curd and in the stem throughout the vegetative and reproductive stages of plant growth. CCE1 transcripts are not detected in any of the organs of other B. oleracea varieties analyzed. Based on the nucleotide sequence of a cDNA encompassing the complete coding region, we predict that this gene encodes a transmembrane protein, with three transmembrane domains. The deduced amino acid sequence includes motifs conserved in G-protein-coupled receptors (GPCRs) from yeast and animal species. Our results suggest that the cloned gene encodes a protein belonging to a new, so far unidentified, family of transmembrane receptors in plants. The expression pattern of the gene suggests that the receptor may be involved in the control of meristem development/arrest that takes place in cauliflower.

Suppression of perception in migraine: evidence for reduced inhibition in the visual cortex

BACKGROUND

Results from transcranial magnetic stimulation (TMS) studies of visual cortex have confirmed visual cortical hyperexcitability in patients with migraine. It has been speculated that this may be due to deficient intracortical inhibitory tone. However, the TMS induction of phosphenes relies on the reporting of a subjective experience, and may thus be subject to bias.

METHODS

Seven migraineurs with visual aura and seven sex- and age-matched controls were studied. Fifty-four different three-letter combinations were briefly displayed and followed by a magnetic pulse at 40, 70, 100, 130, 160, and 190 msec. Subjects were required to report as many letters as they thought they had recognized.

RESULTS

In the migraine group, the mean proportion of correctly identified letters was significantly higher at 100 msec, as was the proportion of trials with two or three letters correctly reported. The time window in which perceptual suppression could be introduced was narrower in migraineurs compared to controls.

CONCLUSION

These findings suggest that inhibitory systems are activated to a lesser extent by TMS pulses in patients. This observation is in agreement with the hypothesized deficiency of intracortical inhibition of the visual cortex, at least in migraineurs with aura.

Cortical hyperexcitability is cortical under-inhibition: evidence from a novel functional test of migraine patients

Recent studies of the visual cortex in patients with migraine have generally concluded that migraine (particularly migraine with aura) is associated with a state of functional cortical hyperexcitability. The mechanisms giving rise to this hyperexcitability have hitherto been unclear. This paper reports two studies that used a novel investigative technique, derived from basic research in vision science, to examine specific deficits of inhibitory processing in primary visual cortex. The technique is termed the metacontrast test, and it examines visual masking under highly specified conditions. In Study 1, 12 migraine with aura patients (MA), 12 age-matched migraine without aura patients (MO) and 12 age- and sex-matched headache-free control subjects (C) were compared using the metacontrast test. MA patients were significantly less susceptible to visual masking in the metacontrast test than both MO and C groups: this result is highly consistent with a deficit in cortical inhibitory processing in MA patients. Study 2 examined MA patients taking a variety of migraine prophylactics, again using the metacontrast test. Test results normalized in those MA patients taking sodium valproate, but not in those taking other prophylactics. Sodium valproate is a GABA-A agonist that is known to cross the blood-brain barrier: GABA-ergic networks act as the primary inhibitory mechanism in visual cortex. Taken together, the results of these studies argue that cortical hyperexcitability, at least in MA patients, is likely to be a result of deficient intracortical inhibitory processes.

Ante-dependence modeling in a longitudinal study of periodontal disease: the effect of age, gender, and smoking status

BACKGROUND

It is generally accepted that periodontal disease progresses by a series of bursts that are interspersed by periods of stability or even gain of attachment. In order to analyze longitudinal data on a patient's disease experience, it is necessary to use models which accommodate serial dependence. Ante-dependence between the results of a series of periodontal examinations over time can be modeled using a Markov chain. This model describes temporal changes in patients' levels of disease in terms of transition probabilities, which allow for both regression and progression of the disease. The aim of the present study was to demonstrate the use of a Markov chain model to analyze data from a longitudinal study investigating the progression of periodontal disease in an adult population.

METHODS

The study population consisted of 504 volunteers; however, only 456 were included in the analysis because the remaining 48 subjects did not give consecutive data. Subjects were examined at baseline, 6 months, and 1, 2, and 3 years. Probing depths (PD) were recorded using an automated probe. Disease was defined as four or more sites with PD > or = 4 mm. Markov chain modeling was used to determine the effect of age, gender, and smoking on the natural progression and regression (healing) of periodontal disease.

RESULTS

Smoking and increasing age had no effect on the progression of disease in this population, but did have a significant effect (P values < or = 0.05) in reducing the regression of disease; i.e., their effect on disease appears to be inhibition of the natural healing process. Gender had no significant effects.

CONCLUSIONS

These results demonstrate how ante-dependence modeling of longitudinal data can reveal effects that may not be immediately apparent from the data, with smoking and increasing age being seen to inhibit the healing process rather than promote disease progression.

Prevalence of Clostridium perfringens enterotoxin and Clostridium difficile toxin A in feces of horses with diarrhea and colic

OBJECTIVE

To determine prevalence of clostridial enterotoxins in feces of horses with diarrhea and colic, and to determine whether an association exists between detection of clostridial enterotoxins in feces and development of diarrhea as a complication of colic.

DESIGN

Prospective case series and case-control study.

ANIMALS

174 horses with diarrhea, colic, or problems not related to the gastrointestinal tract.

PROCEDURE

Horses were assigned to 1 of 4 groups: colic with diarrhea (group 1; n = 30); colic without diarrhea (group 2; 30); diarrhea without colic (group 3; 57); and control (group 4; 57). Feces were evaluated by use of ELISA to detect Clostridium perfringens enterotoxin (CPE) and C difficile toxin A (TOXA). Frequency of detection of CPE or TOXA in groups 1 and 3 was compared with that in groups 2 and 4, respectively.

RESULTS

Prevalence of enteric clostridiosis in horses in group 3 was 25%. Clostridium perfringens enterotoxin was detected in 9 of 57 (16%), TOXA in 8 of 57 (14%), and both toxins in 3 of 57 (5%) fecal samples collected from these horses. Neither toxin was detected in feces of the age-matched horses in group 4. Clostridial enterotoxins were detected in feces of 7 of 60 (12%) horses with colic (groups 1 and 2), however, a significant association was not found between detection of enterotoxins in feces and development of diarrhea as a complication of colic.

CONCLUSIONS AND CLINICAL RELEVANCE

Clostridia are important etiologic agents of diarrhea in horses. Additionally, changes in intestinal flora of horses with colic may allow for proliferation of clostridia and elaboration of enterotoxins regardless of whether diarrhea develops.

Histologic study of pulp capping using chlorhexidine in dogs

This histological study was conducted to compare the pulp reactions to chlorhexidine and calcium hydroxide. Twenty permanent premolar teeth of beagle dogs were mechanically exposed under aseptic conditions. The pulp was then capped with one of the following: chlorhexidine 0.2% on the left side and calcium hydroxide (dycal) on the right side of the same dog. Maxillary second premolars were extracted from each dog three weeks after the pulp capping procedure. Maxillary third premolars and mandibular first premolars were extracted at 6 weeks and 9 weeks respectively. The mandibular second premolars were extracted three months after the pulp capping procedure. The specimens were fixed in 10% formalin and decalcified in 5% formic acid. Serial sections, 7 microns thick, were prepared and stained with hematoxylin and eosin. Teeth treated with chlorhexidine or with calcium hydroxide were well tolerated by the dental pulp at 3 and 6-week intervals. Pulps treated showed satisfactory pulp reaction and the odontoblastic layer appeared to be normal and in its configuration. Inflammatory response was not present at the 6-week time interval. At nine weeks, the inflammatory response was severe in those teeth treated with calcium hydroxide. There were no remarkable histological differences among the treatment groups at 12 and 15 weeks. These specimens showed complete loss of pulpal architecture. Regressive changes were seen and microscopic specimens revealed presence of spaces and intertwining bundles of films in the pulp.

Cognitive processing in migraine: a failure to find facilitation in patients with aura

Recent interest in cognitive processing in migraine has been based on the assumption that cortical hyperexcitability in migraine with aura may manifest itself in the form of response time advantages in migraine as compared to controls. The study reported here attempted to replicate and extend the findings of Wray and colleagues (Brain 1995;118: 25-35). Using identical cognitive tasks, three experiments failed to find differences between migraine with aura patients and controls: furthermore, an additional group of patients without aura were also statistically indistinguishable from controls with respect to response times. Error rates were consistently high across experiments, indicating that subjects were responding at or near chance levels. These findings cast doubt on the utility of straightforward cognitive psychological methods for the study of cortical hyperexcitability in migraine. Some theoretical difficulties concerning the interpretation of response times in the context of migraine pathophysiology are discussed.

Ankle and thigh skin surface temperature changes with repeated ice pack application

OBJECTIVE

Most of the research on cold applications has been performed on nonexercising supine subjects during a single cold pack application. Most athletic injuries occur during exercise, which increases skin temperature. Exercise before ice application will also increase ankle skin temperature during the rewarming phase. The purpose of this study was to examine the effects of activity on subsequent ice pack applications and rewarming using standard immediate care procedures.

DESIGN AND SETTING

Three experimental conditions (20-, 30-, and 40-minute ice pack applications) were applied to 12 subjects in a repeated measures design. Subjects rode a bicycle ergometer for 15 minutes before ice application to the ankle and opposite thigh, and were active (walking with crutches, simulated showering and dressing) for 20 minutes following application. Subjects rested with the limb elevated for an additional 40 minutes. Ice packs were then reapplied for the appropriate time (20, 30, or 40 minutes) followed by 60 minutes of rest with the limb elevated.

SUBJECTS

Twelve (8 males, 4 females) college-aged volunteers. Only subjects with good-to-high fitness levels were accepted for this study.

MEASUREMENTS

Ankle skin, thigh skin, and atmospheric temperatures were measured every minute using an Isothermex (Columbus Instruments, Columbus, OH).

RESULTS

Thigh temperature changes during the first ice application were greater during the 30- and 40-minute conditions than the 20-minute condition. Ankle and thigh temperature changes during the first ice application and rewarming, and for the entire trial were greater during the 40-minute condition than the 20-or 30-minute conditions. Throughout the first ice application and rewarming, and the entire trial, thigh temperature changes were greater during the 30-minute condition than the 20-minute condition.

CONCLUSIONS

During immediate care procedures following injury, ice packs should be reapplied immediately following showering, changing clothes, and returning home.

Evidence for a high rate of false-positive results with the indirect fluorescent antibody test for Ehrlichia risticii antibody in horses

OBJECTIVE

The original objective was to determine seroprevalence of Ehrlichia risticii antibody among horses in California. On the basis of the unexpected results of the survey, an investigation into the accuracy and reproducibility of results of the indirect fluorescent antibody (IFA) test for E risticii was carried out.

DESIGN

Prospective, seroprevalence study.

ANIMALS

Healthy horses (n = 655) and horses with clinical signs of equine monocytic ehrlichiosis (EME; n = 514) from various regions of California.

PROCEDURE

The IFA test was performed. Results were compared with results of an ELISA and with results of western immunoblot analysis.

RESULTS

Overall, 104 of 655 (15.9%) healthy horses had evidence of an antibody response. However, 84 of 514 (16.3%) horses with clinical signs of EME also had positive test results, and of the 8 seropositive diseased horses for which paired (acute and convalescent) samples had been submitted, only 1 had a rise in antibody titers between the acute and convalescent samples. Comparison of results for the IFA test, ELISA, and western immunoblot analysis revealed a high rate of false-positive results for the IFA test. Subsequent studies suggested that routine vaccination of horses with non-E risticii vaccines may have contributed to the false-positive reactions.

CLINICAL IMPLICATIONS

The data failed to provide conclusive evidence of E risticii infection among California horses. Owing to the high percentage of false-positive test results, caution is advised when using the IFA test to diagnose EME in horses or to determine the necessity for E risticii vaccination.

Hyperlipidemia, hyperlipemia, and hepatic lipidosis in American miniature horses: 23 cases (1990-1994)

The medical records of 23 American Miniature Horses with hyperlipidemia, hyperlipemia, or hepatic lipidosis were reviewed. The most common clinical signs were anorexia and lethargy. The mean duration of clinical signs was 2.4 days. A primary disease was identified in 19 cases. Enterocolitis was the most common primary disease (n = 10). Intentional feed restriction, as part of treatment for colic, resulted in hyperlipemia in 2 horses and hyperlipidemia in 1. Four horses had primary hyperlipemia, 3 of which had signs of hepatoencephalopathy secondary to hepatic lipidosis. Dextrose, heparin, and insulin were the most common treatments. The overall survival was 61% (14/23). All horses with peak serum triglyceride concentrations > 1,200 mg/dl died or were euthanatized, whereas all but 1 with peak serum triglyceride concentrations < 1,200 mg/dl survived. These findings suggest that when American Miniature Horses, like other ponies and donkeys, are in a negative energy balance, they can rapidly develop hyperlipidemia or hyperlipemia. Early detection and treatment may improve survival.

Systemic candidiasis in four foals

Four foals were admitted to the neonatal intensive care unit in the first 2 days of life with problems related to birth hypoxia (neonatal maladjustment syndrome, renal failure, necrotizing enterocolitis) and sepsis. Foals were hospitalized for an extended period (35 to 70 days) and received treatment with several broad spectrum antimicrobial agents. Invasive monitoring and treatment procedures included intravenous catheterization, urinary catheterization, and parenteral nutritional and ventilatory support. In each foal, infections of undetermined cause developed, and systemic candidiasis was diagnosed after Candida albicans was isolated from specimens obtained from 1 or more internal sites. The 3 foals in which treatment was attempted responded well to IV administration of amphotericin B and/or oral administration of fluconazole, and were discharged from the hospital.

Ventilatory support of the neonatal foal

Many sick neonatal foals have respiratory failure secondary to perinatal hypoxia, sepsis, or pneumonia. These foals require ventilatory support to prevent respiratory embarrassment and other complications associated with chronic hypoxia and hypercapnia. This article discusses practical aspects of ventilatory therapy, such as choosing a candidate for mechanical ventilation, choosing the proper ventilatory mode, placing a foal on a ventilator, maintaining a foal on mechanical ventilation, and weaning from mechanical ventilation. This article details some of the techniques that have been developed based on experiences with mechanical ventilation of neonatal foals and encourages other clinicians to consider ventilatory therapy as a feasible option.

Studies on oral transmission of Potomac horse fever

Eight normal ponies placed in direct contact with ponies experimentally infected with Ehrlichia risticii for 30 to 90 days did not develop signs of Potomac horse fever. They also did not seroconvert, and they remained susceptible to IV infection. One of 8 ponies that were force fed fresh feces from infected ponies while in direct contact with ponies experimentally infected with E. risticii developed Potomac horse fever and seroconverted. The other 7 remained asymptomatic, did not seroconvert, and were susceptible to IV infection. Six of 9 ponies inoculated with E. risticii via nasogastric intubation and oral drench developed Potomac horse fever and seroconverted. The other 3 remained asymptomatic and did not seroconvert. One of these latter ponies and 2 normal ponies that were inoculated via oral drench only developed Potomac horse fever and seroconverted. The high fever, maximum clinical score for decreased feed intake, depressed mental attitude, decreased borborygmal sounds, severity of diarrhea, and the length of illness of the orally infected ponies was not significantly different from those of IV infected control ponies, although the signs occurred significantly later (P < .05).

Potomac horse fever

E. risticii, the cause of classic Potomac horse fever, is now known to produce two disease syndromes: EEC and EEA. The pathogen appears to commonly infect horses based on seroepidemiologic studies; however, the method of transmission remains unknown. The most common clinical disease is EEC, commonly called Potomac horse fever, which presents a wide spectrum of clinical signs. Diagnosis is currently dependent on serology, which frequently does not lead to a definitive diagnosis and at best results in a retrospective diagnosis. A new diagnostic approach, polymerase chain reaction, may offer a rapid and accurate diagnostic test but is yet to be proven. Antimicrobials found to be highly effective in treating EEC include intravenous oxytetracycline and the oral combination of erythromycin and rifampin. Without an understanding of the mode of transmission, prevention of EEC will remain impossible. Although two commercial bacterins are available, vaccination does not result in complete protection. EEA is a recently recognized clinical syndrome caused by E. risticii. After recovery from EEC, pregnant mares may abort. Based on histologic examination, the aborted fetus appears to be a victim of an ehrlichial colitis as well as placentitis. The effect of antimicrobials and vaccination on the occurrence of EEA has yet to be investigated.

Effect of treatment with oxytetracycline during the acute stages of experimentally induced equine ehrlichial colitis in ponies

Eighteen ponies were inoculated IV with Ehrlichia risticii-infected P388D1 mouse monocyte cells. Twenty-four hours after onset of fever (rectal temperature > 38.8 C), 9 ponies were treated with oxytetracycline (6.6 mg/kg of body weight, IV, q 24 h) for 5 days. The remaining 9 ponies served as infected nontreated controls. Mean scores of the following variables were not significantly different between groups on the day treatment was begun: rectal temperature, diarrhea, borborygmal sounds, feed intake, mental attitude, and evidence of a hyperresonant area in the abdomen. All ponies were observed for progression of clinical signs typical of ehrlichial colitis. Within 12 hours of initiation of treatment, only 1 treated pony had a rectal temperature > 38.8 C and most rectal temperatures were < 38.3 C. In contrast, only 2 control ponies had rectal temperatures < 38.8 C (mean rectal temperature values were significantly, P = 0.01, different between groups). In the treatment group, 4 ponies had no signs of depression after the first day of treatment, and only 1 had signs of depression after the second day of treatment (mean scores between groups were significantly different, P = 0.01). Feed intake remained normal in 4 treated ponies and improved in 4 of the remaining 5 after treatment began. Most of the control ponies had a progressive decrease in their feed intake during the observation period (mean scores between groups were significantly, P = 0.01, different). Three ponies in the control group and 2 ponies in the treatment group developed diarrhea before the treatment observation period began.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of treatment with erythromycin and rifampin during the acute stages of experimentally induced equine ehrlichial colitis in ponies

Sixteen healthy ponies were inoculated IV with Ehrlichia risticii-infected P388D1 mouse monocytes. Of the 16 ponies, 15 developed clinical signs of equine ehrlichial colitis. Twenty-four hours after onset of fever (rectal temperature > 38.8 C), 7 ponies were treated with 25 mg of erythromycin stearate/kg of body weight and 10 mg of rifampin/kg, given orally every 12 hours for 5 days. The remaining 8 ill ponies served as nontreated controls. All ponies were observed for progression of clinical signs typical of equine ehrlichial colitis. Within 12 hours of initiation of treatment, 4 of the 7 treated ponies had rectal temperature < 38.4 C and, within 24 hours, 6 of the 7 ponies had rectal temperature < 38.3C. In contrast, all control ponies had rectal temperature > 39.2 C at 24 hours (P < 0.05). Of the 7 treated ponies, 4 no longer had signs of mental depression after the second day of treatment, and only 1 of the 7 ponies had mild signs of depression after the third day of treatment. In contrast, control ponies had high mental depression score during the observation period (P < 0.05). Feed intake improved in ponies of the treatment group, with feed intake of 4 of the 7 ponies returning to normal; the other 3 ponies were only mildly anorectic by the second day of treatment. Control ponies progressively decreased their feed intake during the observation period (P < 0.05). One control pony and 2 treated ponies developed diarrhea before the treatment/observation period began. Only 1 treated pony developed diarrhea after treatment began. Of the 8 control ponies, 7 developed diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the effects of intragastric infusions of equal volumes of water, dioctyl sodium sulfosuccinate, and magnesium sulfate on fecal composition and output in clinically normal horses

A Latin square design was used to compare the effects of laxatives and a corresponding volume of water on gastrointestinal tract function in 4 healthy horses. Horses were intragastrically infused with each of the following: dioctyl sodium sulfosuccinate (DSS; 50 mg/kg of body weight); magnesium sulfate (0.5 g/kg--low dosage); magnesium sulfate (1.0 g/kg--high dosage); and an equal volume of water (6 L) given as a control infusion. From 5 to 33 hours after the high dosage of magnesium sulfate, feces were slightly softer than usual in all horses. In 1 horse, DSS caused mild colic, hyperpnea, and diarrhea from 0.3 to 3 hours after administration. After all laxative treatments and the control infusion, fecal output, fecal water, number of defecations, and fecal water percentage were greater during the first 6 and 12 hours, compared with each subsequent 6-hour period (P less than 0.05). The high dosage of magnesium sulfate had greater effect on fecal output and fecal water than did the low dosage and control infusion (P less than 0.05). However, this effect preceded arrival of the liquid transit marker, polyethylene glycol, and magnesium at their highest concentrations in feces by 12 to 18 hours. Compared with the control infusion, none of the laxative treatments affected excretion of polyethylene glycol and plastic particulate markers, nor did they increase water consumption. It was concluded that the response to intragastric infusions may involve reflex mechanisms in the gastrointestinal tract and that these responses could be used for treatment of colon impactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric leiomyosarcoma in a horse

Gastric leiomyosarcoma was diagnosed in a 12-year-old Thoroughbred gelding. The horse was examined because of anorexia, weight loss, and intermittent fever of 1.5 months' duration. Antemortem diagnostic testing was extensive, but a definitive diagnosis could not be reached with noninvasive methods. Exploratory celiotomy confirmed an intra-abdominal mass, and the horse was euthanatized. Necropsy revealed a firm mass associated with the distal portion of the esophagus, cranial two thirds of the stomach, and visceral surface of the liver. The histopathologic diagnosis was leiomyosarcoma.

Echocardiographic diagnosis of an anomaly of the tricuspid valve in a male pygmy goat

A 3-year-old male pygmy goat was evaluated because of a grade III/V plateau pansystolic murmur that was auscultated over the tricuspid valve area and a grade II/V plateau pansystolic murmur that was auscultated over the left heart base. Echocardiography revealed a large right atrium and ventricle, an atrial septal defect, and a dysplastic tricuspid valve displaced apically into the right ventricle. Contrast echocardiography and color-flow Doppler echocardiography revealed flow from right to left through the atrial septal defect and severe tricuspid regurgitation. A diagnosis of tricuspid valve dysplasia and severe tricuspid regurgitation was made. This anomaly (Ebstein's anomaly) of the tricuspid valve should be considered in goats that have systolic, with or without diastolic, murmurs over the tricuspic valve. Two-dimensional echocardiography can confirm the diagnosis of the anomaly. The associated tricuspid regurgitation and interatrial right-to-left shunt flow can be detected and semiquantitated by use of contrast, continuous wave, and color-flow Doppler echocardiography.

Azathioprine for treatment of immune-mediated thrombocytopenia in two horses

Azathioprine, a thiopurine antimetabolite used in the treatment of immune-mediated thrombocytopenia in human beings and dogs, was used in 2 cases of immune-mediated thrombocytopenia in horses that failed to respond to corticosteroid therapy alone. Platelet counts were increased to acceptable values in both horses. One horse returned to a successful racing career, and the other was euthanatized after developing renal disease and mild laminitis.

Ulcerative duodenitis with luminal constriction in two horses

Proximal enteritis was diagnosed on the basis of clinical signs of disease in 2 Standard-bred yearlings from the same farm. Large volumes of fluid were repeatedly obtained during gastric decompression. The horses did not respond to treatment with IV administered fluids, antimicrobial agents, cimetidine, and metoclopramide. Postmortem findings confirmed severe focal chronic active duodenitis with stricture formation. An etiologic agent was not identified.

Resistance to development of equine ehrlichial colitis in experimentally inoculated horses and ponies

Fourteen ponies and 3 horses were inoculated with Ehrlichia risticii 2 to 20 months after a similar initial inoculation. Although all 17 had clinical signs of equine ehrlichial colitis after the first inoculation, 16 of 17 remained clinically normal following the second inoculation. The remaining pony had a transient fever and developed signs of depression. Before the initial inoculation, none of the animals had a detectable antibody titer to E risticii. All animals developed titers after the initial infection; however, a significant change of titer did not develop after reinoculation in most animals.