Effects of two wintering practices on behavioral and physiological indicators of welfare of non-lactating, pregnant dairy cattle in a pasture-based system

In countries with pasture-based dairy systems and relatively cold winters, such as New Zealand, it is common to manage pregnant, nonlactating cows on forage crop paddocks rather than pasture due to slow pasture growth rates. Wintering dairy cattle on grazed crops can compromise welfare if wet and muddy underfoot conditions occur, which can reduce lying. This study investigated behavioral and physiological indicators of welfare of cows under 2 wintering practices: cows managed on and grazed kale crop (Brassica oleracea), and cows managed on pasture with baled hay. Following dry-off (d 0), 80 cows were randomly assigned to one of the 2 wintering practices (40 cows/practice) and monitored between d 4 and d 32 (phase 1). During this period, lying and stepping behavior was continuously recorded using leg-based accelerometers. Blood samples were obtained at d 0 and 32 for measurements of thyroxine (T4), nonesterified fatty acids (NEFA), white blood cells (WBC), and red blood cells (RBC). All data for phase 1 were presented descriptively due to the lack of treatment replication. Daily mean air temperature during this period was 5.2°C (range: 0.0 to 10.7°C), and rainfall was 1.1mm/d (range: 0 to 5.6mm/d). Between d 4 and 32, cows in both groups spent similar amounts of time lying (pasture with hay cows: 8.9h/24h ± 2.57, kale crop cows: 8.7h/24h ± 3.06, mean ± SEM). Both groups reduced their lying on wet and cold days and there was evidence of rebound lying once unfavorable weather conditions stopped. Cows on kale crop had numerically higher NEFA and lower WBC compared with cows managed on pasture, although most physiological values were within normal ranges. In a second phase of the study (d 34 and 35), cows were managed under controlled, replicated conditions in the 2 wintering practices using typical on-farm stocking rates (2 or 4 cows per group in the pasture with hay and kale crop treatments, respectively; n = 10 groups/treatment). During this period, cow behavior, skin and surface temperatures, hygiene scores, feed intakes and ground conditions were measured. Weather conditions during the 48-h exposure were mostly cold and dry (mean air temperature: 7.8°C, range: -2.2 to 20.5°C). Cows managed on pasture with hay spent more time lying down on the first day of exposure, however, this was likely due to less space being available to kale cows on this day. Cows managed on pasture with hay ruminated more than cows on kale crop on both days of observations (Day 1: 37.9% vs 30.9% of observations, Day 2: 36.8% vs 28.7% of observations for pasture with hay and kale crop groups, respectively) and were lying more often in postures indicative of greater thermal comfort. Cows managed on pasture with hay had higher skin and surface temperatures compared with cows on kale crop, whereas cows on kale crop had dirtier coats. Results suggest that opportunities for thermal comfort were greater for cows managed on pasture with hay bales, which may be due to increased rumination activities and more insulated lying areas.

Bipolar androgen therapy plus olaparib in men with metastatic castration-resistant prostate cancer

BACKGROUND

Bipolar androgen therapy (BAT) results in rapid fluctuation of testosterone (T) between near-castrate and supraphysiological levels and has shown promise in metastatic castration-resistant prostate cancer (mCRPC). Its clinical effects may be mediated through induction of DNA damage, and preclinical studies suggest synergy with PARP inhibitors.

PATIENTS AND METHODS

This was a single-center, Phase II trial testing olaparib plus BAT (T cypionate/enanthate 400 mg every 28 days) with ongoing androgen deprivation. Planned recruitment was 30 subjects (equal proportions with/without homologous recombination repair [HRR] gene mutations) with mCRPC post abiraterone and/or enzalutamide. The primary objective was to determine PSA50 response (PSA decline ≥50% from baseline) rate at 12-weeks. The primary analysis utilized the entire (intent-to-treat [ITT]) cohort, with those dropping out early counted as non-responders. Secondary/exploratory analyses were in those treated beyond 12-weeks (response-evaluable cohort).

RESULTS

Thirty-six patients enrolled and 6 discontinued prior to response assessment. In the ITT cohort, PSA50 response rate at 12-weeks was 11/36 (31%; 95% CI 17-48%), and 16/36 (44%, 95% CI 28-62%) had a PSA50 response at any time on-study. After a median follow-up of 19 months, the median clinical/radiographic progression-free survival in the ITT cohort was 13.0 months (95% CI 7-17). Clinical outcomes were similar regardless of HRR gene mutational status.

CONCLUSIONS

BAT plus olaparib is associated with high response rates and long PFS. Clinical benefit was observed regardless of HRR gene mutational status.

Index serum hyaluronic acid independently and accurately predicts mortality in patients with liver disease

BACKGROUND

Hyaluronic acid is a recognised noninvasive marker of liver fibrosis. However, its prognostic ability has not been extensively studied.

AIMS

To investigate the ability of an index serum hyaluronic acid measurement to independently predict transplant-free survival in patients with liver disease of varying aetiology and severity.

METHODS

This was a retrospective single-centre cohort study. Serum hyaluronic acid was measured at the discretion of the attending clinicians, in patients attending the liver clinic, to assess disease severity. Patients with a hyaluronic acid measurement between 1995 and 2010 were identified. Patient characteristics at the point of hyaluronic acid measurement were recorded from medical records. Follow-up was from date of index hyaluronic acid measurement to date of death, date of transplant or censor date (July 01, 2015). Primary outcomes were all-cause and liver-related mortality. Kaplan-Meier analysis was used to compare survival in 3 patient groups with hyaluronic acid levels of <100 μg/L, 100-300 μg/L and >300 μg/L. Survival models were constructed using Cox proportional hazard and prediction accuracy was assessed by Harrell's C-statistic.

RESULTS

Five hundred and eighty nine patients fulfilled inclusion criteria. Median follow-up was 5.6 years (range 0.1-19.7). Transplant-free survival was significantly different between patients with hyaluronic acid <100 μg/L, 100-300 μg/L and >300 μg/L for liver-related as well as all-cause mortality (P < 0.001). Hyaluronic acid level was an independent predictor of survival (liver-related: HR 1.39, 95% CI 1.20-1.60, P < 0.001; all-cause: HR 1.04, 95% CI 1.02-1.06, P = 0.001). The liver-related prediction accuracy of hyaluronic acid was 0.74 (Standard error 0.03).

CONCLUSION

Index hyaluronic acid measurement can accurately and independently predict liver-related and all-cause mortality in patients with liver disease.

Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease

BACKGROUND

Validated diagnostic tools that are accurate, cost effective and acceptable to patients are required for disease stratification and monitoring in NAFLD.

AIMS

To investigate the performance and cost of multiparametric MRI alongside existing biomarkers in the assessment of NAFLD.

METHODS

Adult patients undergoing standard of care liver biopsy for NAFLD were prospectively recruited at two UK liver centres and underwent multiparametric MRI, blood sampling and transient elastography withing 2 weeks of liver biopsy. Non-invasive markers were compared to histology as the gold standard.

RESULTS

Data were obtained in 50 patients and 6 healthy volunteers. Corrected T1 (cT1) correlated with NAFLD activity score (ρ = 0.514, P < .001). cT1, enhanced liver fibrosis (ELF) test and liver stiffness differentiated patients with simple steatosis and NASH with AUROC (95% CI) of 0.69 (0.50-0.88), 0.87 (0.77-0.79) and 0.82 (0.70-0.94) respectively and healthy volunteers from patients with AUROC (95% CI) of 0.93 (0.86-1.00), 0.81 (0.69-0.92) and 0.89 (0.77-1.00) respectively. For the risk stratification of NAFLD, multiparametric MRI could save £150,218 per 1000 patients compared to biopsy. Multiparametric MRI did not discriminate between individual histological fibrosis stages in this population (P = .068).

CONCLUSIONS

Multiparametric MRI accurately identified patients with steatosis, stratifies those with NASH or simple steatosis and reliably excludes clinically significant liver disease with superior negative predictive value (83.3%) to liver stiffness (42.9%) and ELF (57.1%). For the risk stratification of NAFLD, multiparametric MRI was cost effective and, combined with transient elastography, had the lowest cost per correct diagnosis.

Technical note: Preliminary evaluation of an automated indwelling rumen temperature bolus measurement system to detect pyrexia in preweaned dairy calves

Indwelling rumen temperature bolus (RTB) systems have the potential to offer a convenient and timely method of detecting pyrexia, indicative of active infectious disease. The aim of this pilot study was to evaluate the utility of using RTB systems in preweaned dairy calves. First, an in vitro study was performed to evaluate the accuracy of the RTB in its immediate environment. Thirteen RTB were immersed in a hot water bath (WB). Variably collected RTB temperatures were then matched to WB temperatures, which varied from 36 to 41°C, with 1h spent at each temperature. Second, an in vivo study was performed to evaluate the ability of the RTB to predict a rectal thermometer (RT) temperature. Ten healthy heifer calves less than 1wk of age were administered an RTB. Rectal thermometer and matched RTB temperatures were taken hourly, over a 6-h period, 1 day per week during wk 1, 3, 5, 7, and 9 of age. During each 6-h observation period, calves were offered both water and milk feedings and temperatures recorded every 15min for 1h thereafter. For both studies, the relationship between RTB and one of WB (in vitro) or RT temperature (in vivo) was described by calculating a concordance correlation coefficient (CCC) and by use of a multivariable linear regression model with repeated measures. For the in vivo study, the model also controlled for week and breed. Diagnostic test characteristics were calculated for the ability of individual RTB measures to detect pyrexia (RT ≥39.5°C). For the in vitro study, the association between the RTB and a known temperature was strong (CCC=0.95), but the RTB measures underestimated the temperature of the water bath by 0.43±0.08°C. For the in vivo study, the association between RT and the RTB temperature measurement in a calf was weaker (CCC=0.29); the average RTB temperature was 0.33±0.06°C lower than the RT temperature. The sensitivity (29%) and positive predictive value (17%) of using individual RTB measures to detect a fever was low. The results of this pilot study suggest that an individual RTB measurement may not be a good diagnostic test to detect pyrexia in calves.

Different Brain Responses to Pain and Its Expectation in the Dental Chair

A dental appointment commonly prompts fear of a painful experience, yet we have never fully understood how our brains react to the expectation of imminent tooth pain once in a dental chair. In our study, 21 patients with hypersensitive teeth were tested using nonpainful and painful stimuli in a clinical setting. Subjects were tested in a dental chair using functional near-infrared spectroscopy to measure cortical activity during a stepwise cold stimulation of a hypersensitive tooth, as well as nonpainful control stimulation on the same tooth. Patients’ sensory-discriminative and emotional-cognitive cortical regions were studied through the transition of a neutral to a painful stimulation. In the putative somatosensory cortex contralateral to the stimulus, 2 well-defined hemodynamic peaks were detected in the homuncular orofacial region: the first peak during the nonpainful phase and a second peak after the pain threshold was reached. Moreover, in the upper-left and lower-right prefrontal cortices, there was a significant active hemodynamic response in only the first phase, before the pain. Subsequently, the same prefrontal cortical areas deactivated after a painful experience had been reached. Our study indicates for the first time that pain perception and expectation elicit different hemodynamic cortical responses in a dental clinical setting.

Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region

Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions aimed at increasing personal accomplishment be implemented for both groups of nurses. An investigation of perceived job control and the use of social support would also be insightful.

The advancement of a new human factors report--'The Unique Report'--facilitating flight crew auditing of performance/operations as part of an airline's safety management system

This paper presents the findings of research relating to the specification of a new human factors report, conducted as part of the work requirements for the Human Integration into the Lifecycle of Aviation Systems project, sponsored by the European Commission. Specifically, it describes the proposed concept for a unique report, which will form the basis for all operational and safety reports completed by flight crew. This includes all mandatory and optional reports. Critically, this form is central to the advancement of improved processes and technology tools, supporting airline performance management, safety management, organisational learning and knowledge integration/information-sharing activities. Specifically, this paper describes the background to the development of this reporting form, the logic and contents of this form and how reporting data will be made use of by airline personnel. This includes a description of the proposed intelligent planning process and the associated intelligent flight plan concept, which makes use of airline operational and safety analyses information. Primarily, this new reporting form has been developed in collaboration with a major Spanish airline. In addition, it has involved research with five other airlines. Overall, this has involved extensive field research, collaborative prototyping and evaluation of new reports/flight plan concepts and a number of evaluation activities. Participants have included both operational and management personnel, across different airline flight operations processes. Statement of Relevance: This paper presents the development of a reporting concept outlined through field research and collaborative prototyping within an airline. The resulting reporting function, embedded in the journey log compiled at the end of each flight, aims at enabling employees to audit the operations of the company they work for.

A unique presentation of antiphospholipid antibody syndrome in pregnancy

Primary antiphospholipid antibody syndrome (APS) is a protean disease with many manifestations including venous and arterial thrombosis, recurrent foetal loss, preeclampsia, intrauterine growth retardation, cardiac valvular disease, glomerulonephritis, thrombocytopaenia and livedo reticularis. We report an interesting case of a 19-year-old woman where the diagnosis of primary APS was initially made in the peripartum period.

An advocacy project to fluoridate toothpastes in Nepal

AIMS

To describe a recent health promotion project undertaken by the United Mission to Nepal Oral Health Programme (UMN OHP) to increase the availability and consumption of affordable, fluoridated toothpaste in Nepal.

METHOD

The process of advocating for the fluoridation of toothpastes in Nepal is based on Tearfund's advocacy cycle.

RESULTS

The project achieved health promotion outcomes including healthy corporate and public policies and organisational practice and intermediate outcomes such as increased availability and consumption of affordable fluoridated toothpaste. Prior to implementation of the advocacy project in 1997, availability and consumption of fluoridated toothpaste was negligible. By March 2002 total market share of fluoridated toothpaste was approximately 90%. This represents an annual tonnage of 900 tons of fluoridated toothpaste.

CONCLUSIONS

The health promotion activity of advocacy for the fluoridation of toothpastes in Nepal achieved measurable gains in health promotion outcomes and intermediate outcomes. Gains in health and social outcomes will take longer to evaluate but based on epidemiological evidence and the experience of other countries increased availability of affordable fluoridated toothpaste will have a significant and ongoing impact on the oral health of the people of Nepal.

Caries experience of 5-6-year-old and 12-13-year-old schoolchildren in central and western Nepal

OBJECTIVE

To describe and analyse the caries experience and caries prevalence in the deciduous dentition of 5-6-year-old schoolchildren and in the permanent dentition of 12-13-year-old schoolchildren in western and central Nepal.

DESIGN

Non-randomised cross-sectional surveys conducted by trained and calibrated examiners.

SETTING

Surveys were conducted in private and government rural and urban schools at 10 sites along the Terai and the foothills in eight districts of western and central Nepal.

SUBJECTS

A total of 2,177, 5-6-year-old and 3,323, 12-13-year-old schoolchildren from urban and rural areas were examined under WHO Pathfinder methodology.

OUTCOME MEASURES

Prevalence of caries and dental caries experience (dmft/DMFT).

RESULTS

The caries prevalence and mean dmft score of 5-6-year-olds was 67% and 3.3 (urban 64% and 2.9; rural 78% and 4.0). The caries prevalence and mean DMFT score of 12-13-year-olds was 41% and 1.1 (urban 35% and 0.9; rural 54% and 1.5). The d/D-component constituted almost the entire dmft/DMFT index.

CONCLUSION

The recorded prevalence of untreated dental caries in schoolchildren requires an appropriate oral health response based primarily on prevention and health promotion. Foremost in this regime would be the promotion and use of accessible and affordable fluoridated toothpaste.

Structural insights into the hydrolysis of cellular nitric oxide synthase inhibitors by dimethylarginine dimethylaminohydrolase

Nitric oxide synthase is inhibited by asymmetric NG-methylated derivatives of arginine whose cellular levels are controlled in part by dimethylarginine dimethylaminohydrolase (DDAH, EC 3.5.3.18). Levels of asymmetric NG,NG-dimethylarginine (ADMA) are known to correlate with certain disease states. Here, the first structure of a DDAH shows an unexpected similarity to arginine:glycine amidinotransferase (EC 2.1.4.1) and arginine deiminase (EC 3.5.3.6), thus defining a superfamily of arginine-modifying enzymes. The identification of a Cys-His-Glu catalytic triad and the structures of a Cys to Ser point mutant bound to both substrate and product suggest a reaction mechanism. Comparison of the ADMA-DDAH and arginine-amidinotransferase complexes reveals a dramatic rotation of the substrate that effectively maintains the orientation of the scissile bond of the substrate with respect to the catalytic residues. The DDAH structure will form a basis for the rational design of selective inhibitors, which are of potential use in modulating NO synthase activity in pathological settings.

Navigating ambulatory referral: a standardized process

Significant funding and structure changes to healthcare in Ontario in the mid-90's led The Hospital for Sick Children in Toronto to examine patient referral processes. In an effort to streamline access and encourage more appropriate referrals, the hospital tested and implemented three major changes. This article outlines these changes using the PDSA (Plan, Do, Study, Act) improvement framework and summarizes the results from this project.

Overcoming inhibitions: subversion of CKI function by viral cyclins

DNA tumour viruses deregulate the mammalian cell cycle to provide a better environment for their replication. Studies of such deregulation have led to the identification of key regulatory steps that normally control the G1-S phase transition of the cell cycle. The balance between the activities of G1-specific cyclin-CDK complexes and their inhibitors is critical. Recent studies suggest that certain herpesviruses disrupt this balance: the viruses encode a cyclin that generates active complexes even in the presence of high inhibitor levels.

Evaluation for tooth stabilization and treatment of traumatized teeth

Thorough evaluation and correct treatment of traumatized teeth improve their chances for survival. This article provides an overview clinical evaluation and how best to treat the tooth that has been traumatized. The rationale and techniques for tooth stabilization of the traumatized tooth will also be presented.

Age-specific distribution of plasma amino acid concentrations in a healthy pediatric population

Reference values were determined for 23 plasma free amino acids from measurements done in 148 healthy children ranging from 0 to 18 years of age. Amino acid analysis was performed by ion-exchange chromatography. We propose a graphic form of presenting the age-specific distribution of plasma amino acid concentrations where the 10th, 50th, and 90th quantiles are illustrated. Although each amino acid possesses its own pattern of distribution, we can identify five different profiles. Nine amino acids (alanine, arginine, asparagine, methionine, ornithine, phenylalanine, proline, threonine, and tyrosine) demonstrate a decrease in their concentrations during the first year of life; their concentrations then tend to increase throughout childhood and adolescence. Nine others (cystine, glutamine, glycine, histidine, isoleucine, leucine, lysine, tryptophan, and valine) show a steady increase throughout infancy, childhood, and adolescence. Five amino acids (aspartic acid, citrulline, glutamic acid, serine, and taurine) do not follow these two common profiles. For the first time, quantile curves are produced to illustrate the age-dependent variation of amino acid concentrations from infancy to adulthood. This alternative way of presenting amino acid concentrations may facilitate the follow-up of patients with inborn errors of amino acid metabolism.

The incidence of gastroesophageal reflux with the laryngeal mask: a comparison with the face mask using esophageal lumen pH electrodes

To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophageal reflux, we randomly assigned 55 patients having elective surgery to receive standardized anesthesia with the LMA or with conventional face mask (FM) plus airway. A pH-sensitive probe with two electrodes, 10 cm apart, was passed nasally into the esophagus 1 h before induction of anesthesia, and recordings were made continuously until 30 min after surgery. At the distal electrode, 30 cm from the anterior nares, there was a significant difference in the incidence of reflux: 53.6% with the LMA versus 22.2% with the FM (P < 0.05). At the level of the proximal electrode, 20 cm from the anterior nares, there was no difference between groups. Multiple reflux events, defined as two or more reflux events before, during, or after anesthesia, were significantly more frequent in the LMA group (P < 0.05). Reflux events continued in the postanesthesia care unit (PACU) in both groups with no significant difference between groups. There was no clinical evidence of aspiration of gastric contents in either group. Use of the LMA appears to result in increased reflux to the level of the mid to upper esophagus, and is associated with a more frequent incidence of multiple reflux events than use of the FM.

Epidermal growth factor binding induces a conformational change in the external domain of its receptor

To study the properties of the extracellular epidermal growth factor (EGF) binding domain of the human EGF receptor, we have infected insect cells with a suitably engineered baculovirus vector containing the cDNA encoding the entire ectodomain of the parent molecule. This resulted in a correctly folded, stable, 110 kd protein which possessed an EGF binding affinity of 200 nM. The protein was routinely purified in milligram amounts from 1 litre insect cell cultures using a series of three standard chromatographic steps. The properties of the ectodomain were studied before and after the addition of different EGF ligands, using both circular dichroism and fluorescence spectroscopic techniques. A secondary structural analysis of the far UV CD spectrum of the ectodomain indicated significant proportions of alpha-helix and beta-sheet in agreement with a published model of the EGF receptor. The ligand additions to the receptor showed differences in both the near- and far-UV CD spectra, and were similar for each ligand used, suggesting similar conformational differences between uncomplexed and complexed receptor. Steady-state fluorescence measurements indicated that the tryptophan residues present in the ectodomain are buried and that the solvent-accessible tryptophans in the ligands become buried on binding the receptor. The rotational correlation times measured by fluorescence anisotropy decay for the receptor-ligand complexes were decreased from 6 to 2.5 ns in each case. This may indicate a perturbation of the tryptophan environment of the receptor on ligand binding. Ultracentrifugation studies showed that no aggregation occurred on ligand addition, so this could not explain the observed differences from CD or fluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Structure-function relationships of growth factors and their receptors

The primary amino acid sequences of several receptor tyrosine kinases have recently made it possible to deduce similarities in the molecular organization of these large multidomain proteins. This has allowed a classification of these receptors into three groups (see Waterfield this Issue and for review in Ref.1). Class I includes the EGF receptor and the neu proto-oncogene, Class II includes the insulin and insulin-like growth factor 1 (IGF-1) receptors, and Class III the platelet derived growth factor (PDGF) and the colony stimulating factor 1 (CSF-1) receptors. The conformation of the ligands for the Classes I and II receptors have been defined using X-ray diffraction, 2-D nuclear magnetic resonance (NMR) and knowledge based modelling procedures. It seems that the ligands are more diverse in sequence than the receptor tyrosine kinases so they cannot be classified as rigorously. However, certain features are common to all growth factors (so far defined) which form compact, globular structures and this allows a discussion of possible interactions between the ligand and receptor; but in the absence of a molecular structure for any of the receptors, we can only review biochemical evidence and deductions from predictive and modelling studies. Various models for the signal transduction process are discussed in the light of current work on receptor interactions.

The influence of collateral vascularisation on haemodynamic performance during abdominal aortic surgery

The extent of periaortic collateral vascularisation has been proposed as a possible mechanism of an altered haemodynamic response to infra-renal aortic cross-clamp in patients undergoing by-pass grafting for aorto-iliac occlusive disease (AOD) compared with patients undergoing abdominal aortic aneurysm (AAA) resection. The haemodynamic responses following clamping, during the clamp time and following clamp release were studied in 18 patients undergoing AAA resection and 12 patients undergoing bypass grafting for AOD. The role of preoperative aortography in predicting cardiovascular performance during aortic vascular surgery was assessed. During the cross-clamp period LVSWI and CI decreased while SVR increased in the AAA group while the AOD group showed an improved CI, stable LVSWI and reduced SVR, which correlated with the extent of periaortic vascularisation on preoperative aortography. Chronic collateral circulation associated with AOD may permit continuous lower extremity perfusion during aortic cross-clamp. The extent of periaortic collateralisation may influence the choice of monitoring techniques and anaesthetic management.

Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis

Since 1977, 184 patients with colitis or polyposis underwent colectomy with endorectal ileal pullthrough in two stages with a temporary ileostomy. Five had an S reservoir, three had a J reservoir, and 15 had no reservoir; 97 patients had a lateral reservoir constructed at the second operation and 64 had one constructed at the first operation. Ten patients with no reservoir and one with a J reservoir underwent conversion to a lateral reservoir because of stool frequency. Three patients with an S reservoir and six (3.5%) of 172 patients with a lateral reservoir underwent a permanent ileostomy. Over 65% of complications occurred in the first 50 patients. Late reservoir shortening was necessary in 34 patients. Of the last 110 patients, 107 are functioning well with a mean of six bowel movements per day. A short lateral reservoir (less than 15 cm) constructed at the first operation produces the fewest complications and best results.

Calcium channel blockade does not offer adequate protection from perioperative myocardial ischemia

This study aimed to detect the difference in hemodynamic and electrocardiographic responses during the prebypass period in patients undergoing coronary bypass grafting who were receiving beta-adrenergic blocking drugs, calcium entry blocking drugs, or both beta-adrenergic and calcium entry blocking drugs. Electrocardiographic evidence of myocardial ischemia was noted significantly more frequently in patients receiving calcium entry blocking drugs alone at induction of anesthesia (P less than 0.03), skin incision (P less than 0.05), and sternotomy (P less than 0.002). Heart rate at sternotomy was significantly higher in patients receiving calcium entry blocking drugs (P less than 0.02) as compared to patients receiving beta-adrenergic blocking drugs or the combination of both drugs. In conclusion, patients treated with calcium entry blocking drugs alone had significantly higher incidence of perioperative ischemic ECG changes compared with patients receiving beta-adrenergic blocking drugs alone or in combination with calcium channel blocking drugs.

Construction of an ileal reservoir in patients with a previous straight endorectal ileal pull-through

A decade has passed since Martin and associates presented the first series of endorectal ileal pull-through (PT) procedures with straight ileoanal anastomosis for treatment of ulcerative colitis and polyposis. During the ensuing years, several medical centers have reported their results using the PT. Although some children have experienced good results, the majority of adults and children have had severe problems associated with high stool frequency, urgency, and incontinence. Between 1977 and 1987, 12 patients underwent colectomy and straight PT for ulcerative colitis or familial polyposis under the direction of a single surgeon. In this group, the average number of stools varied from six to 45 movements per 24 hours (mean, 18). In seven patients, high stool frequency (mean, 24 per 24 hours), partial fecal incontinence, and urgency that led to moderate to severe limitation in physical, social, work, and sexual activities made it necessary to convert the straight PT to an ileal reservoir. For each of these patients, the ileal PT segment was separated from the rectal muscle cuff, a lateral isoperistaltic reservoir was constructed, and the ileoanal anastomosis was re-established in a one-stage operation. One additional patient decided to return to a conventional ileostomy. All seven patients who underwent conversion to a PT with reservoir had no major complications, and each improved markedly in their clinical status. Daytime stool frequency was reduced by a mean of approximately 50%, whereas nocturnal frequency was decreased by a mean of 60%. Incontinence and fecal urgency were relieved significantly. In conclusion, for patients who develop problems with a straight PT procedure and who desire to avoid a permanent ileostomy, conversion to a PT with a lateral ileal reservoir is a valuable alternative with low risk and a high likelihood of success.

The product-selective blot: a technique for measuring enzyme activities in large numbers of samples and in native electrophoresis gels

A method termed "product-selective" blotting has been developed for screening large numbers of samples for enzyme activity. The technique is particularly well suited to detection of enzymes in native electrophoresis gels. The principle of the method was demonstrated by blotting samples from glutaminase (EC 3.5.1.2) or glutamate synthase (EC 1.4.7.1) reactions into an agarose gel embedded with ion-exchange resin under conditions favoring binding of product (glutamate) over substrates and other substances in the reaction mixture. After washes to remove these unbound substances, the product was measured using either fluorometric staining or radiometric techniques. Glutaminase activity in native electrophoresis gels was visualized by a related procedure in which substrates and products from reactions run in the electrophoresis gel were blotted directly into a resin-containing "image gel." Considering the selective-binding materials available for use in the image gel, along with the possible detection systems, this method has potentially broad application.

The effect of different dietary levels of Ca and P on the plasma Ca, inorganic P and Mg as well as the ash, Ca, P and Mg content of cervical vertebrae and total body of sheep

Six 14 month old rams were divided equally into three groups and received either a high Ca (1,102% Ca : 0,192% P : 0,128% Mg), control (0,322% Ca : 0,311=P : 0,128% Mg) or high P (0,127% Ca : 1,043% P: 0,130% Mg) diet in pellected form for 150 days. 2. Dry mass and ash % of the third cervical vertebra decreased as Ca intake decreased while fat % increased. There was a highly significant negative correlation (= -0,992) between bone ash% and bone fat %. Bone P and Mg showed no particular trends. 3. Total body Ca and P as well as % body Ca and P all decreased with a decrease in dietary Ca and increase in dietary P intake. Body Mg showed no particular trend. 4. The results suggest that while plasma values may be useful in assessing the P intake of sheep on natural pastures, bone and total body P may not be.