The effect of improving cow productivity, fertility, and longevity on the global warming potential of dairy systems

This study compared the environmental impact of a range of dairy production systems in terms of their global warming potential (GWP, expressed as carbon dioxide equivalents, CO(2)-eq.) and associated land use, and explored the efficacy of reducing said impact. Models were developed using the unique data generated from a long-term genetic line × feeding system experiment. Holstein-Friesian cows were selected to represent the UK average for milk fat plus protein production (control line) or were selected for increased milk fat plus protein production (select line). In addition, cows received a low forage diet (50% forage) with no grazing or were on a high forage (75% forage) diet with summer grazing. A Markov chain approach was used to describe the herd structure and help estimate the GWP per year and land required per cow for the 4 alternative systems and the herd average using a partial life cycle assessment. The CO(2)-eq. emissions were expressed per kilogram of energy-corrected milk (ECM) and per hectare of land use, as well as land required per kilogram of ECM. The effects of a phenotypic and genetic standard deviation unit improvement on herd feed utilization efficiency, ECM yield, calving interval length, and incidence of involuntary culling were assessed. The low forage (nongrazing) feeding system with select cows produced the lowest CO(2)-eq. emissions of 1.1 kg/kg of ECM and land use of 0.65 m(2)/kg of ECM but the highest CO(2)-eq. emissions of 16.1t/ha of the production systems studied. Within the herd, an improvement of 1 standard deviation in feed utilization efficiency was the only trait of those studied that would significantly reduce the reliance of the farming system on bought-in synthetic fertilizer and concentrate feed, as well as reduce the average CO(2)-eq. emissions and land use of the herd (both by about 6.5%, of which about 4% would be achievable through selective breeding). Within production systems, reductions in CO(2)-eq. emissions per kilogram of ECM and CO(2)-eq. emissions per hectare were also achievable by an improvement in feed utilization. This study allowed development of models that harness the biological trait variation in the animal to improve the environmental impact of the farming system. Genetic selection for efficient feed use for milk production according to feeding system can bring about reductions in system nutrient requirements, CO(2)-eq. emissions, and land use per unit product.

Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children

OBJECTIVE

Dysphagia can lead to chronic aspiration and pulmonary disease. The objective of this study was to compare change in swallowing function in pediatric patients with dysphagia who received neuromuscular electrical stimulation (NMES) to a control group who received usual oral motor training and dietary manipulations without NMES.

STUDY DESIGN

Retrospective analysis of change in Functional Oral Intake Scale (FOIS) level derived from videofluoroscopic swallowing studies performed before and after NMES (treatment group: N = 46) compared to control group (control group: N = 47). Children were classified into two groups based on the etiology of their dysphagia (primary vs. acquired). NMES took place in a tertiary medical center for an average of 22 treatment sessions over 10 weeks. An independent t-test was used to test for differences in the change in FOIS level between groups. An analysis of covariance was run within groups to assess the relationship between diagnosis and change in FOIS level.

RESULTS

Both groups improved in their FOIS level (P < 0.01) but the amount of change was not different (P = 0.11). Only the treatment group who had acquired dysphagia improved more than the similar subgroup of control children (P = 0.007).

CONCLUSION

NMES treatment of anterior neck muscles in a heterogeneous group of pediatric patients with dysphagia did not improve the swallow function more than that seen in patients who did not receive NMES treatment. However, there may be subgroups of children that will improve with NMES treatment.

Outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface dissemination from ovarian neoplasms

BACKGROUND

Few data exist on the treatment of peritoneal surface dissemination (PSD) from ovarian cancer (OC) with hyperthermic intraperitoneal chemotherapy (HIPEC). This work represents a review of the authors' institution's experience with HIPEC for PSD from OC.

METHODS

Fifty-one patients with OC treated with HIPEC between 1996 and 2009 were identified in a prospectively managed database. All patients underwent maximal tumor debulking followed by HIPEC with mitomycin C, carboplatin, or paclitaxel.

RESULTS

The median survival in this cohort was 29 months. When stratified by resection status, patients undergoing R0 and R1 resections experienced longer median survival than those who underwent R2 resections (47 vs 12 months, P = .0002). Intraoperative blood loss ≤ 400 mL resulted in greater 5-year survival than blood loss > 400 mL (60% vs 15%, P = .025).

CONCLUSIONS

This experience demonstrates that long-term survival is anticipated in patients who undergo complete cytoreduction followed by HIPEC for PSD from OC. These findings not only highlight the potential utility of HIPEC in the treatment of OC but also underscore the importance of maximal cytoreduction followed by HIPEC in this cohort of patients.

Sequential plasma lactate concentrations as prognostic indicators in adult equine emergencies

BACKGROUND

Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate.

HYPOTHESIS

Prognosis for survival is decreased in horses with a delayed return to normal [LAC].

ANIMALS

Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement.

METHODS

Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]deltaT) was calculated from changes in [LAC] between sampling points.

RESULTS

Median [LAC] was significantly (P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60-18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30-13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17-1.43) at admission to 49.90 (6.47-384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]deltaT was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24-72 hours (- 0.47, P = .001) and 48-72 hours (- 0.07, P = .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors.

CONCLUSIONS AND CLINICAL IMPORTANCE

These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]deltaT can be a useful prognostic indicator in horses.

Climate response times: dependence on climate sensitivity and ocean mixing

The factors that determine climate response times were investigated with simple models and scaling statements. The response times are particularly sensitive to (i) the amount that the climate response is amplified by feedbacks and (ii) the representation of ocean mixing. If equilibrium climate sensitivity is 3 degrees C or greater for a doubling of the carbon dioxide concentration, then most of the expected warming attributable to trace gases added to the atmosphere by man probably has not yet occurred. This yet to be realized warming calls into question a policy of "wait and see" regarding the issue of how to deal with increasing atmospheric carbon dioxide and other trace gases.

Climate impact of increasing atmospheric carbon dioxide

The global temperature rose by 0.2 degrees C between the middle 1960's and 1980, yielding a warming of 0.4 degrees C in the past century. This temperature increase is consistent with the calculated greenhouse effect due to measured increases of atmospheric carbon dioxide. Variations of volcanic aerosols and possibly solar luminosity appear to be primary causes of observed fluctuations about the mean trend of increasing temperature. It is shown that the anthropogenic carbon dioxide warming should emerge from the noise level of natural climate variability by the end of the century, and there is a high probability of warming in the 1980's. Potential effects on climate in the 21st century include the creation of drought-prone regions in North America and central Asia as part of a shifting of climatic zones, erosion of the West Antarctic ice sheet with a consequent worldwide rise in sea level, and opening of the fabled Northwest Passage.

A qualitative analysis of lay beliefs about the aetiology and prevalence of autistic spectrum disorders

INTRODUCTION

There has been a dramatic increase in the prevalence of autistic spectrum disorders (ASD) in the last 20 years. The reasons for this are disputed. The consensus among epidemiologists and other experts is that greater case load is due to changes in diagnostic practice rather than reflecting changing aetiological factors leading to a true increase in incidence. We set out to examine lay views concerning the aetiology and prevalence of ASD and whether they conflict with or support this consensus position.

METHODS

Over 100 unsolicited communications (letters e-mail and several telephone calls) were received by a UK epidemiological study of ASD. We carried out a qualitative analysis of all correspondence in order to examine spontaneously expressed lay beliefs about the prevalence and aetiology of ASD.

RESULTS

The majority of correspondents suggested theories about environmental causes of ASD. This study demonstrates the strength of lay belief that the true incidence of autism is rising, and this is due to risks from modern technologies and changing lifestyles.

CONCLUSION

This study based on unsolicited data highlights the contrast between lay explanations of increasing prevalence and the consensus opinion of medical experts. It also demonstrates how many people in direct contact with ASD have important information to share.

Colon cancer and low lymph node count: who is to blame?

OBJECTIVE

To identify the factors that contribute to the disparity in the number of lymph nodes examined for curative colon cancer resections.

DESIGN

Our prospectively accrued cancer registry was analyzed for all colon cancer resections performed in a consecutive 52-month period (January 1, 2003, through April 30, 2007).

SETTING

The study was performed at an 851-bed community hospital. Seventeen surgeons performed colon resections, with the number of resections varying from 1 to 154. Ten pathologists and 3 pathology assistants evaluated the specimens.

PATIENTS

A total of 430 patients met the inclusion criteria and underwent surgical resection. Only patients with colon cancer were included in the study; patients with rectal cancers, in situ disease only, T4 tumors, and stage IV disease at the time of diagnosis were excluded to ensure a uniform group of patients, all undergoing resection with curative intent.

MAIN OUTCOME MEASURES

Age of the patient; the surgeon, pathologist, and pathology technician; stage of disease; and year of surgery were analyzed.

RESULTS

No statistical difference was found in the number of lymph nodes retrieved based on the surgeon (P = .21), pathologist (P = .11), or pathology technician (P = .26). Age of the patient, primary site of the tumor, stage, and year of surgery were all significantly associated with number of lymph nodes retrieved (P <.001).

CONCLUSIONS

The origin of a low lymph node count appears multifactorial. Inadequate lymph node retrieval for colon cancer resections cannot uniformly be attributed to 1 factor, such as the surgeon.

Effect of breeding for milk yield, diet and management on enteric methane emissions from dairy cows

Enteric methane production from livestock is an important source of anthropogenic greenhouse gas emissions. The aim of the present study was to (1) assess the effect of long-term breeding for kilograms of milk fat plus protein production and (2) investigate the influence of parity, genetic line and diet on predicted enteric methane emissions of Holstein Friesian dairy cows. Analyses were based on 17 years of experimental data for lactating and dry cows, housed and at pasture. Restricted maximum likelihood (REML) was used to assess the effects of parity, genetic line and diet on the predicted enteric methane output of lactating and dry cows. A non-linear equation based on metabolisable energy intake (MEI) was used to predict daily enteric methane output. The present study found that selection for kilograms of milk fat plus protein production, zero-grazing low-forage diets and maintaining persistently high-yielding older cows can reduce a cow’s enteric methane emissions per kilogram milk by up to 12%, on average. Comparing the first 5 years to the most recent 5 years of the study period showed that large savings of 19% and 23% in enteric methane per kilogram milk were made in cows selected for milk fat plus protein or selected to remain close to the average genetic merit for milk fat plus protein production for all animals evaluated in the UK, respectively. Additionally, management to minimise the length of the drying-off period can help reduce enteric methane emissions during a cow’s lactation period.

Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7-12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3-4; age 7-9 years) and older children (school years 5-7; age 9-12 years). Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% (P < 0.001) in the younger group and from 27.6% to 25.1% (P = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.

The hemodynamic effects of intravenous digoxin-binding fab immunoglobulin in severe preeclampsia: a double-blind, randomized, clinical trial

OBJECTIVE

An endogenous digitalis-like factor (EDLF) has been implicated in the pathophysiology of preeclampsia (PE). This hypothesis is supported by two cases of preeclampsia in which administration of digoxin immune Fab (DIF) reduced mean arterial pressure (MAP).

STUDY DESIGN

To study this observation further, we performed a double-blind, placebo-controlled, randomized clinical trial to examine the effects on MAP of intravenous DIF given after delivery in 26 subjects with severe preeclampsia. Treating obstetricians were blinded to subject assignment and were allowed to use standard antihypertensive drugs during the trial.

RESULTS

The primary outcome, a significant difference in blood pressure between the two groups over the 24-h period of observation after the intervention, was not supported. However, mean MAP was significantly lower in the DIF-treated subjects for the first 4 h after therapy as compared with controls (P=0.05). Six subjects (46.2%) in the placebo arm were given conventional antihypertensive medications by their obstetrician for blood pressure >160 mm Hg systolic or >110 mm Hg diastolic, compared with zero subjects in the treatment arm (P=0.01). A trend towards increased creatinine clearance was observed in DIF-treated subjects (137.6+/-42.6 versus 104.1+/-43.4, P=0.07).

CONCLUSION

These results support the hypothesis that EDLF contributes to the elevated blood pressure in preeclampsia and suggests a possible role for DIF as a treatment for this condition.

Relationship between intraoperative femoral head bleeding and development of avascular necrosis after acetabular fracture surgery

The purpose of this study was to determine whether the presence or absence of bleeding after drilling of the femoral head can be used to predict the development of avascular necrosis (AVN) after operative treatment of acetabular fractures. A computerized medical record search from 1996 to 2005 of all patients with an operatively treated acetabular fracture yielded 146 patients who had an intraoperative assessment of the vascularity of their femoral head and 72 of whom were available for a minimum of 12 months of follow-up. The average time to the development of AVN was 99.6 weeks with a range of 21-290 weeks. Eleven of the patients in the analysis eventually developed AVN. The p value is not significant at. 092. Although the difference between groups is not significant, it does appear that there is a relationship between femoral head bleeding and the development of avascular necrosis.

Early rattles, purrs and whistles as predictors of later wheeze

BACKGROUND

Asthma is a common condition characterised by wheeze. Many different respiratory sounds are interpreted by parents as "wheeze" in young children.

AIM

To relate different respiratory sounds reported as wheeze in 2-year-olds to asthma outcomes at age 5 years.

METHODS

As part of a longitudinal cohort study, parents completed respiratory questionnaires for their children at 2 and 5 years of age. Parents who reported wheeze were given options to describe the sound as rattling, purring or whistling.

RESULTS

Of the 1371 2-year-olds surveyed, 210 had current wheeze, of whom 124 had rattle, 49 purr and 24 whistle. Children with whistle at 2 years were more likely to have mothers with asthma, and children with rattle and purr were more likely to be exposed to tobacco smoke. Wheeze status was ascertained at age 5 years in 162 (77%) children with wheeze at 2 years of age. Whistle persisted in 47% of affected children, rattle in 20%, and purr in 13% (p = 0.023). At 5 years of age, asthma medication was prescribed in 40% with whistle, 11% with rattle, and 18% with purr at 2 years of age (p = 0.017).

CONCLUSIONS

This study shows different risk factors and outcomes for different respiratory sounds in 2-year-olds: compared with other respiratory sounds, whistle is likely to persist and require asthma treatment in future.

Psychosocial assessment of expectant fathers

BACKGROUND

Comprehensive antenatal psychosocial assessment of mothers prior to the birth is established in many regions. While the influence of fathers on infant and maternal well-being is also recognised as commencing before birth, the early identification of needs among expectant fathers has not been addressed.

METHODS

The current study surveyed fathers attending antenatal classes in public and private hospitals (n=307) in New South Wales, Australia, using psychosocial questions derived from the questions commonly asked in assessments of mothers.

RESULTS

The most frequent responses suggest that fathers, at the time of the birth, have needs in regard to their ability to cope with the stresses of new parenthood and the skills and knowledge to care for their new baby.

LIMITATIONS

Conclusions from the study are limited in their application to the population of expectant fathers by the low response rate and the low numbers of low-income, ethnic-background, and indigenous fathers in the sample.

CONCLUSION

Assessment of fathers by psychosocial questions similar to mothers is advised to detect fathers who may require assistance and parenting education for fathers in infant care.

The evaluation of tailored and web-based information for new fathers

BACKGROUND

Information and advice on infant health and development have been shown to be well received by new parents and to lead to more confident and nurturing parenting. However, in spite of the accumulating evidence highlighting the importance of fathers to the well-being of their families, fathers rarely access and utilize 'parenting' information. Tailored information for fathers delivered via email and Internet may provide an alternate route for support for fathers. This study aimed to assess father's readiness to utilize electronic information tailored to father's role.

METHODS

Two hundred and fifty-three fathers from antenatal classes in two Australian cities were offered email and web-based information on seven topics: baby play, breastfeeding, post-natal depression, father-infant bonding, sex after birth, work-family balance and fussy babies. Of 137 who completed consent forms, a total of 105 fathers selected three topics and 67 fathers provided 149 topic evaluations.

RESULTS

Most respondents were from managerial, professional or skilled occupations and had higher educational qualifications than the general population of fathers. The most popular topics were those that related to father-infant interaction (baby games and father-infant bonding), and the least popular were breastfeeding and sex after the birth. Respondents rated the information as satisfactory and most (78%) indicated that it changed their approach to fathering. Although the websites provided were available through the Internet, few fathers had previously accessed them.

CONCLUSIONS

Information tailored to new father's perspectives provided through email or Internet may increase new fathers' access to useful knowledge and support. Important health topics such as breastfeeding may not currently be perceived as particularly relevant to fathers in the antenatal period. Portals designed to filter existing websites could facilitate the use of parenting information by new fathers.

A phase I trial of oxaliplatin for intraperitoneal hyperthermic chemoperfusion for the treatment of peritoneal surface dissemination from colorectal and appendiceal cancers

BACKGROUND

Cytoreductive surgery with intraperitoneal hyperthermic chemoperfusion (IPHC) has evolved into a promising approach for peritoneal surface malignancy. A large body of literature suggests that oxaliplatin has excellent cytotoxicity against colorectal cancer. Therefore, we undertook a phase I evaluation of IPHC with oxaliplatin for peritoneal dissemination from colorectal and appendiceal cancers to establish the dose-limiting toxicity (DLT) and the maximum tolerated dose (MTD).

METHODS

Cohorts of three patients underwent cytoreductive surgery followed by a 2-h IPHC with escalating doses of oxaliplatin at a target outflow temperature of 40 degrees C. The initial peritoneal oxaliplatin dose was 200 mg/M(2) with increases planned in 50 mg/M(2 )increments. Plasma and perfusate samples were collected during the IPHC and evaluated using emission spectrometry techniques. Normal tissue and tumor samples were collected before and after the IPHC for analysis. DLT was defined as a grade 3 toxicity lasting 5 days.

RESULTS

Fifteen patients were enrolled at two dose levels. Peritoneal fluid areas under the curve (AUCs) were above those of plasma. Additionally, intratumoral oxaliplatin was similar to that of surrounding normal tissue. Dose-limiting toxicities at 250 mg/M(2 )were observed in two of three patients enrolled in this study.

CONCLUSION

We found that IPHC with 200 mg/M(2 )of oxaliplatin is well tolerated and is the MTD for a 2-h chemoperfusion. Higher doses are not feasible with this perfusion protocol given the significant toxicities associated with 250 mg/M(2 )oxaliplatin. Based on the data from this phase I study, we propose to conduct further studies with oxaliplatin delivered at 200 mg/M(2).

Production and utilization of interleukin-15 in malignant catarrhal fever

Malignant catarrhal fever (MCF) is an often fatal lymphoproliferative disease of ungulates caused by either alcelaphine herpesvirus-1 (AlHV-1) or ovine herpesvirus-2 (OvHV-2). The pathogenesis of MCF is poorly understood, but appears to involve an auto-destructive pathology whereby cytotoxic lymphocytes destroy areas of a variety of tissues. The cytokine interleukin-15 (IL-15) is involved in the development and maintenance of cytotoxic lymphocytes and may therefore have a role in the pathogenesis of MCF. Virus-infected large granular lymphocytes (LGLs) were obtained from the tissues of rabbits infected with AlHV-1 or OvHV-2. These cells exhibited a similar proliferative response to IL-15 and to IL-2 in culture, but their content of the activated cytotoxic enzyme (BLT-esterase) was maintained at higher levels in the presence of IL-15 compared with IL-2. The LGLs did not express IL-15 mRNA or produce IL-15 protein. By contrast, there was abundant expression of IL-15 mRNA and protein in affected tissues. IL-15 production was associated with necrotic lesions of the mesenteric lymph node and appendix of OvHV-2-infected rabbits, but was not found in the same tissues of rabbits infected with AlHV-1 in which there were no necrotic lesions. The cellular source of the IL-15 was predominantly lymphoid cells that did not express B cell or monocyte-macrophage markers. Only a few IL-15+ cells (<10%) co-localized with pan-T cells or CD8+ T cells. The abundance of IL-15 in tissue with lesions of MCF suggests that this cytokine may have a role in the pathogenesis of MCF.

The A5 gene of alcelaphine herpesvirus 1 encodes a constitutively active G-protein-coupled receptor that is non-essential for the induction of malignant catarrhal fever in rabbits

Many gammaherpesviruses encode G-protein-coupled receptors (GPCRs). Several in vivo studies have revealed that gammaherpesvirus GPCRs are important for viral replication and for virus-induced pathogenesis. The gammaherpesvirus alcelaphine herpesvirus 1 (AlHV-1) is carried asymptomatically by wildebeest, but causes malignant catarrhal fever (MCF) following cross-species transmission to a variety of susceptible species. The A5 ORF of the AlHV-1 genome encodes a putative GPCR. In the present study, we investigated whether A5 encodes a functional GPCR and addressed its role in viral replication and in the pathogenesis of MCF. In silico analysis supported the hypothesis that A5 could encode a functional GPCR as its expression product contained several hallmark features of GPCRs. Expression of A5 as tagged proteins in various cell lines revealed that A5 localizes in cell membranes, including the plasma membrane. Using [35S]GTPgammaS and reporter gene assays, we found that A5 is able to constitutively couple to alpha i-type G-proteins in transfected cells, and that this interaction is able to inhibit forskolin-triggered cAMP response element-binding protein (CREB) activation. Finally, using an AlHV-1 BAC clone, we produced a strain deleted for A5 and a revertant strain. Interestingly, the strain deleted for A5 replicated comparably to the wild-type parental strain and induced MCF in rabbits that was indistinguishable from that of the parental strain. The present study is the first to investigate the role of an individual gene of AlHV-1 in MCF pathogenesis.

Immunohistochemical study of experimental malignant catarrhal fever in rabbits

Malignant catarrhal fever (MCF) is an often-fatal lymphoproliferative disease of a variety of ungulates that occurs worldwide. It is caused by either of the highly related but distinct gammaherpesviruses alcelaphine herpesvirus-1 (AlHV-1, wildebeest reservoir) or ovine herpesvirus-2 (OvHV-2, sheep reservoir). MCF in rabbits is an excellent model as it closely resembles the disease in susceptible ungulates that include cattle, deer and bison. In this study, newly available and previously characterized monoclonal antibodies specific for rabbit leucocyte differentiation molecules were used to perform a detailed immunohistochemical examination of both AlHV-1 MCF and OvHV-2 MCF in rabbits. Differences in the MCF caused by the two viruses included: less tissue necrosis and more lymphoid cell accumulations in AlHV-1 MCF compared with OvHV-2 MCF, and in particular marked tissue necrosis in the mesenteric lymph node, appendix and liver of OvHV-2-infected animals when compared with either other tissues in OvHV-2 MCF or AlHV-1 MCF lesions in any tissue. In both AlHV-1 MCF and OvHV-2 MCF, lymphoid cell accumulations in lymphoid and non-lymphoid tissues consisted mainly of T-cells with a corresponding absence of B-cells. CD8(+) T-cells accounted for a proportion of these in the non-lymphoid tissues, but there was evidence for the accumulation of an unidentified T-cell subset/subsets as well. This study extends our understanding of the mechanisms of immuno-pathogenesis of MCF.

Investigation of the role of ENPP1 and TNAP genes in chondrocalcinosis

OBJECTIVES

Extracellular inorganic pyrophosphate (ePPi) inhibits certain forms of pathological mineralization while promoting others. Three molecules involved in ePPi regulation are important candidates for the development of calcium pyrophosphate dihydrate chondrocalcinosis (CPPD CC). These include ANKH, ectonucleotide pyrophosphatase (ENPP1) and TNAP. We have previously showed that genetic variation in ANKH is a cause of autosomal dominant familial CC and also some sporadic cases of CPPD CC. We now investigate the possible role of ENPP1 and TNAP in CPPD CC.

METHODS

Exons, untranslated regions (UTR) and exon-intron boundaries of ENPP1 and TNAP were sequenced using ABI Big Dye chemistry on automated sequencers. Sixteen variants were identified (3 in ENPP1 and 13 in TNAP) and were subsequently genotyped in 128 sporadic Caucasian CPPD CC patients and 600 healthy controls using a combination of polymerase chain reaction/restriction fragment-length polymorphism analysis or using Taqman. Allele and genotype frequencies were compared between cases and controls using the chi(2) test. Linkage disequilibrium, haplotype and the single nucleotide polymorphism-specific analyses were also performed. This study had 80% power to detect an odds ratio of 2.2 or more at these loci.

RESULTS

No difference was observed in the allele or genotype frequencies between patients and controls at either ENPP1 or TNAP.

CONCLUSIONS

Polymorphisms of ENPP1 and TNAP are not major determinants of susceptibility to CC in the population studied. Further studies of the aetiology of sporadic CPPD CC are required to determine its causes.

Very high dose inhaled corticosteroids: panacea or poison?

Perspective on the paper by Paton et al (see page 808)

Genetic diversity within and between European pig breeds using microsatellite markers

An important prerequisite for a conservation programme is a comprehensive description of genetic diversity. The aim of this study was to use anonymous genetic markers to assess the between- and the within-population components of genetic diversity for European pig breeds at the scale of the whole continent using microsatellites. Fifty-eight European pig breeds and lines were analysed including local breeds, national varieties of international breeds and commercial lines. A sample of the Chinese Meishan breed was also included. Eleven additional breeds from a previous project were added for some analyses. Approximately 50 individuals per breed were genotyped for a maximum of 50 microsatellite loci. Substantial within-breed variability was observed, with the average expected heterozygosity and observed number of alleles per locus being 0.56 [range 0.43-0.68] and 4.5 respectively. Genotypic frequencies departed from Hardy-Weinberg expectations (P < 0.01) in 15 European populations, with an excess of homozygotes in 12 of them. The European breeds were on average genetically very distinct, with a Wright F(ST) index value of 0.21. The Neighbour-Joining tree drawn from the Reynolds distances among the breeds showed that the national varieties of major breeds and the commercial lines were mostly clustered around their breeds of reference (Duroc, Hampshire, Landrace, Large White and Piétrain). In contrast, local breeds, with the exception of the Iberian breeds, exhibited a star-like topology. The results are discussed in the light of various forces, which may have driven the recent evolution of European pig breeds. This study has consequences for the interpretation of biodiversity results and will be of importance for future conservation programmes.

Genetic diversity in European pigs utilizing amplified fragment length polymorphism markers

The use of DNA markers to evaluate genetic diversity is an important component of the management of animal genetic resources. The Food and Agriculture Organisation of the United Nations (FAO) has published a list of recommended microsatellite markers for such studies; however, other markers are potential alternatives. This paper describes results obtained with a set of amplified fragment length polymorphism (AFLP) markers as part of a genetic diversity study of European pig breeds that also utilized microsatellite markers. Data from 148 AFLP markers genotyped across samples from 58 European and one Chinese breed were analysed. The results were compared with previous analyses of data from 50 microsatellite markers genotyped on the same animals. The AFLP markers had an average within-breed heterozygosity of 0.124 but there was wide variation, with individual markers being monomorphic in 3-98% of the populations. The biallelic and dominant nature of AFLP markers creates a challenge for their use in genetic diversity studies as each individual marker contains limited information and AFLPs only provide indirect estimates of the allelic frequencies that are needed to estimate genetic distances. Nonetheless, AFLP marker-based characterization of genetic distances was consistent with expectations based on breed and regional distributions and produced a similar pattern to that obtained with microsatellites. Thus, data from AFLP markers can be combined with microsatellite data for measuring genetic diversity.

Characteristics of sudden death in hemodialysis patients

Hemodialysis (HD) is an intermittent procedure during which large fluid and electrolyte shifts occur. We hypothesized that sudden death occurrences in HD patients are related to the timing of HD, and that they occur more frequently in the 12 h period starting with dialysis and in the 12 h period at the end of the dialysis-free weekend interval. In a retrospective study, 228 patient deaths were screened to determine if they met the criteria for sudden death. Information was obtained from clinic charts, dialysis center records, and interview of witnesses of the death event. There were 80 HD patients who met the criteria for sudden death. A bimodal distribution of death occurrences was present, with a 1.7-fold increased death risk occurring in the 12 h period starting with the dialysis procedure and a threefold increased risk of death in the 12 h before HD at the end of the weekend interval (P=0.011). Patients with sudden death had a high prevalence of congestive heart failure and coronary artery disease. Only 40% of patients experiencing sudden death were receiving beta-blockers, and the prior monthly serum potassium value was less than 4 mEq/l in 25%. Sudden death is temporally related to the HD procedure. Every other day HD could be beneficial in preventing sudden death. Careful attention to the usage of beta-blockers and to the maintenance of normal serum potassium values is indicated in HD patients at risk for sudden death.

From psychiatric ward to the streets and shelters

The issue of discharge from hospital ward to the streets is seldom explored in the literature, but all too commonly experienced by individuals experiencing psychiatric disorders. The Community University Research Alliance on Housing and Mental Health sought to determine how frequently people were discharged from psychiatric wards to shelters or the street in London, Ontario, Canada. A number of data sources were accessed to determine instances of discharges to shelters or the street. Data were analysed to determine the number of moves occurring between hospital and shelter or no fixed address. All datasets revealed the problem of discharge to shelters or the street occurred regularly. All data sources used have the difficulty of likely underestimating the extent of the problem. This type of discharge occurred at least 194 times in 2002 in London, Ontario, Canada. Policies that contribute to this problem include income-support policies, the reduction in psychiatric hospital beds and the lack of community supports. Without recognition, this problem is at risk of remaining invisible with no further improvements to the situation.

The childhood asthma epidemic

A case of delayed rather than mistaken diagnosis

Measurement of glut-1 expression using tissue microarrays to determine a race specific prognostic marker for breast cancer

BACKGROUND

African-American women (AAW) have more adverse tumor characteristics than non-African American women (non-AAW) and there is a need for a specific predictive marker for AAW recurrence. Tumors with higher grade and proliferative activity are associated with overexpression of the glucose transporter (Glut-1). An examination of Glut-1 expression relative to recurrence and no recurrence was conducted on both groups to determine if it predicts prognosis and could predict a race specific prognosis.

METHODS

A breast cancer data set containing clinical information including race and biological characteristics was generated between 1991 and 1996. Tissue samples were selected from this group with similar characteristics in both racial groups for a retrospective analysis of Glut-1 expression using tissue microarrays (TMAs). Mean Glut-1 expression for intensity and percent of tumor cells staining was determined using standard immunohistochemistry.

RESULTS

Clinical and biological differences were noted in the original data set between AAW and non-AAW. No significant difference between races was noted in mean Glut-1 values using a subset which had similar characteristics. The mean Glut-1 did not predict recurrence but a rounded score did indicate that higher levels of Glut-1 expression was indicative of a lower disease free survival (p = 0.063). The actual average mean for AAW with no recurrence was significantly lower than any other group (p = 0.04). Conclusions. TMA analysis for Glut-1 expression may be useful to predict disease free survival but it does not predict race specific recurrence.

Amplification of surface temperature trends and variability in the tropical atmosphere

The month-to-month variability of tropical temperatures is larger in the troposphere than at Earth's surface. This amplification behavior is similar in a range of observations and climate model simulations and is consistent with basic theory. On multidecadal time scales, tropospheric amplification of surface warming is a robust feature of model simulations, but it occurs in only one observational data set. Other observations show weak, or even negative, amplification. These results suggest either that different physical mechanisms control amplification processes on monthly and decadal time scales, and models fail to capture such behavior; or (more plausibly) that residual errors in several observational data sets used here affect their representation of long-term trends.

Deprivation, smoking, and quality of life in asthma

AIMS

To explore associations of deprivation and smoking, with prevalence of asthma, wheeze, and quality of life.

METHODS

Survey, using International Study of Asthma and Allergies in Childhood (ISAAC) methodology, of children aged 13-14 years attending Scottish schools previously surveyed in 1995.

RESULTS

4665/5247 (89%) pupils completed questionnaires. 3656/4665 (78.4%) had missed school for any reason in the last 12 months, 587 (12.6%) because of asthma or wheeze. Compared to children with 1-3 wheeze attacks per year, those with >12 attacks in the last year were more likely to have missed school, twice as likely to have missed physical education in the last month, to report interference with home activities, or to have visited accident and emergency departments, and three times more likely to have been hospitalised. Deprivation was not independently associated with self-reported asthma or wheeze, but was associated with school absence, either for any reason or specifically for asthma or wheeze, but not with use of services such as accident and emergency visits, doctor visits, or hospital admissions. Active smoking was associated with wheezy symptoms, and active and passive smoking with use of medical services. These associations were independent of wheeze severity, treatment taken, and other associated atopic conditions. Smoking also had an impact on school absence and home and school activities.

CONCLUSIONS

Deprivation does not affect the prevalence of asthma or wheeze. Exposure to cigarette smoke was associated with the increased use of services. Deprivation and smoking have independent adverse effects on the quality of life in subjects with asthma or wheeze.

Childhood asthma in the Highlands of Scotland--morbidity and school absence

BACKGROUND

The prevalence of childhood asthma in Scotland is one of the highest in the world. The morbidity secondary to allergic diseases is significant in terms of costs to the nation and effects on the family including the child.

AIMS

The aims of this study were to describe the prevalence of asthma, eczema and hay fever in the Highlands of Scotland and in the Shetland Isles and to examine factors in relation to quality of life and social deprivation.

METHOD

A total population survey of 12 year old children using a parent completed questionnaire.

RESULTS

86.3% (2658/3080) returned questionnaires. Of the 2549 questionnaires analysed, 476 (18.7%) reported asthma ever, 362 (14.2%) wheeze in last 12 months, 508 (19.9%) reported hay fever ever and 555 (21.8%) reported eczema ever. Of the children reporting asthma or wheeze, 35.4% (229/647) had missed school because of asthma or wheeze, 38.0% (246/647) had missed physical education. 62.5% (354/566) of subjects with wheeze ever reported sleep disturbance. Deprivation measured by DEPCAT scores was associated with maternal smoking and bronchitis in the child but not with allergic diseases.

CONCLUSION

Compared with previous studies, the prevalence of asthma was unchanged but eczema has increased in Highland adolescents. Allergic disease has a significant impact on school attendance and physical activity. Deprivation was associated with maternal smoking and bronchitis in the child but not with allergic diseases. The impact of allergic diseases in rural areas may be different from urban areas.

Association of CCR5Delta32 with reduced risk of childhood but not adult asthma

BACKGROUND

A number of potential candidate genes have been implicated in the pathogenesis of asthma. A 32 base pair deletion in the CCR5 gene renders this chemokine receptor non-functioning and has been shown to be associated with a reduced prevalence of asthma in childhood. The mechanism may be related to impairment of pathogen entry into cells and modified host inflammatory response. We sought to determine the influence of the CCR5Delta32 mutation on asthma and allergy in the transition from childhood to adulthood.

METHODS

627 individuals first studied as part of a whole population schoolchildren cohort in 1989 when aged 8-12 years were followed up 10 years later for respiratory and allergy symptoms and laboratory markers of atopy. CCR5Delta32 status was also characterised and the association with childhood and adulthood symptoms determined.

RESULTS

The follow up sample was representative of the original cohort except for a slightly greater prevalence of symptomatic individuals. As children, none who were homozygous for the CCR5Delta32 mutation had a current physician's diagnosis of asthma. In multivariate analysis and controlling for known confounders, the protective effect of carrying the allele in childhood was highly significant (OR 0.31, 95% CI 0.14 to 0.72, p=0.006). There was no protective association with "current asthma" as classified in adulthood within the same population. Subjective or laboratory markers of atopy in childhood or adulthood were not associated with the CCR5Delta32 mutation. Methacholine bronchial hyperresponsiveness in adulthood was also unrelated to gene carrier status.

CONCLUSIONS

In a population with a high allelic frequency for the CCR5Delta32 mutation, a significant protection against childhood asthma is evident which is independent of atopy. This protection is lost in the transition between childhood and early adulthood. The contribution of different genetic candidates to the expression of asthma may change with advancing maturity and confound the interpretation of association and linkage studies unless age is taken into account.

Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis

HYPOTHESIS

Certain clinicopathologic factors predict improved survival after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis.

DESIGN

Prospective clinical trial.

SETTING

Surgical oncology service at a university academic hospital.

PATIENTS

A population of 109 consecutive patients with peritoneal carcinomatosis treated between December 1991 and November 1997.

INTERVENTION

All patients underwent resection of gross disease followed by 2-hour intraoperative perfusion of mitomycin C (20-40 mg) into the peritoneal cavity at a temperature of 40.5 degrees C.

MAIN OUTCOME MEASURES

Clinicopathologic factors that independently predicted improved overall survival rates.

RESULTS

Overall survival at 1 and 3 years was 61% and 33%, respectively. With median follow-up of 52 months, median overall survival was 16 months. Four factors were significant independent predictors of improved survival by multivariate analysis: nonadenocarcinoma histologic features (P =.001), the appendix as a primary site (P =.003), the absence of hepatic parenchymal metastases (P =.01), and complete resection of all gross disease (R1/0 resection) (P<.001). Patients with an R1/0 resection vs an incomplete resection of gross disease (R2 resection) had 3-year overall survival of 68% vs 21% (P<.001).

CONCLUSIONS

Patients with peritoneal carcinomatosis have a uniformly poor prognosis. However, in select patients, the natural history of this disease condition may be altered by using the multimodality approach of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. These results require confirmation in prospective randomized studies.

Inhaled corticosteroids and adrenal insufficiency

Inhaled steroids are safe at normal doses, but beware very high doses, especially of fluticasone

Cellular basis of diabetic nephropathy: 1. Study design and renal structural-functional relationships in patients with long-standing type 1 diabetes

This study was designed to elucidate the cellular basis of risk of or protection from nephropathy in patients with type 1 diabetes. Entry criteria included diabetes duration of > or =8 years (mean duration, 22.5 years) and glomerular filtration rate (GFR) >30 ml x min(-1) x 1.73 m(-2). Patients were classified, on the basis of the estimated rate of mesangial expansion, as "fast-track" (upper quintile) or "slow-track" (lower quintile). A total of 88 patients were normoalbuminuric, 17 were microalbuminuric, and 19 were proteinuric. All three groups had increased glomerular basement membrane (GBM) width and mesangial fractional volume [Vv(Mes/glom)], with increasing severity from normoalbuminuria to microalbuminuria to proteinuria but with considerable overlap among groups. Vv(Mes/glom) (r = 0.75, P < 0.001) and GBM width (r = 0.63, P < 0.001) correlated with albumin excretion rate (AER), whereas surface density of peripheral GBM per glomerulus [Sv(PGBM/glom)] (r = 0.50, P < 0.001) and Vv(Mes/glom) (r = -0.48, P < 0.001) correlated with GFR. Vv(Mes/glom) and GBM width together explained 59% of AER variability. GFR was predicted by Sv(PGBM/glom), AER, and sex. Fast-track patients had worse glycemic control, higher AER, lower GFR, more hypertension and retinopathy, and, as expected, worse glomerular lesions than slow-track patients. Thus, there are strong relationships between glomerular structure and renal function across the spectrum of AER, but there is considerable structural overlap among AER categories. Given that normoalbuminuric patients may have advanced glomerulopathy, the selection of slow-track patients based on glomerular structure may better identify protected patients than AER alone.