Historical and current perspectives on the treatment, control and pathogenesis of milk fever in dairy cattle

Milk fever has been recognised in cattle for about 215 years and its clinical signs have not changed since they were described by Victorian veterinary surgeons in the mid-nineteenth century. It was only 80 years ago that abnormal parathyroid gland function was associated with the pathogenesis of the hypocalcaemia characteristic of the disease, and the current basis for its treatment with intravenous calcium salts was established. Although this treatment is effective, most recent research has focused on preventing the disease through an understanding of the endocrine control of extracellular calcium homeostasis. In the 1970s the synthetic vitamin D analogue 1alpha-hydroxycholecalciferol was developed for intramuscular injection before a cow calved, but variable results encouraged other preventive strategies to be considered, including restricting the dietary intake of calcium, and manipulating the dietary cation-anion balance of cows before they calved. Currently, the role of extracellular calcium receptors in the parathyroid gland is under investigation as a preliminary step to devising more effective treatments and/or preventive methods for milk fever.

Development of a nasal cast model to test medicinal nasal devices

Bespak, a division of Consort Medical plc, and Queen's University Belfast have developed a viable and unique in-vitro testing capability for nasal drug delivery devices. The aim was to evaluate and optimize current and conceptual drug delivery devices by quantifying the deposition of drug in the various distinct regions of the nasal cavity. The development of this test apparatus employed computed tomography (CT) scan data of the human nasal cavity to construct an accurate representation of the human nasal airways. An investigation of suitable materials and manufacturing technologies was required, together with extensive analytical method development. It is possible for this technique to be further developed in an attempt to create a standardized apparatus based on nasal geometry that can be used to compare accurately deposition from drug delivery devices. This paper presents the issues encountered in the development of this test apparatus, including manufacturing and material limitations, investigation and choice of suitable materials, laboratory testing considerations, and the steps required to validate the analytical process.

Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery

BACKGROUND

Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety.

OBJECTIVE

To investigate an audiovisual distraction (Bedscapes) on pain and anxiety during minor surgery for the correction of ingrown toenail.

METHOD

In a randomised controlled trial, patients (N=152) with ingrown toenails requiring surgical correction under local anaesthesia were allocated to receive Bedscapes+standard care or standard care alone. Pain levels due to local anaesthetic injection were assessed post-procedure, and anxiety levels were assessed pre- and post-procedure in both groups. Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group, and one-to-one interviews were held with four podiatrists.

RESULTS

Participants with high pre-procedure anxiety scores experienced greater pain on injection, and older patients reported lower pain than younger patients, regardless of group allocation. Bedscapes did not reduce pain or anxiety, and was apparently no more effective than interpersonal interaction between podiatry staff and the patient.

CONCLUSIONS

Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.

Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system

OBJECTIVE

This study examines the distribution of selected sexually transmitted infections (STIs) in older people (aged >/=45 years) attending genitourinary medicine (GUM) clinics in the West Midlands, UK.

METHODS

Analysis of data from the regional enhanced STI surveillance system for the period 1996-2003. Selected STIs were chlamydia, genital herpes, genital warts, gonorrhoea and syphilis.

RESULTS

Altogether, 4445 STI episodes were reported among older people during the study period. Between 1996 and 2003 older people accounted for 3.7% and 4.3%, respectively, of all GUM clinic attendances. The rate of STIs in older people more than doubled in 2003 compared with 1996 (p<0.0001). Rates for all five selected diagnoses were significantly higher in 2003 compared to 1996. A significantly increasing trend over time was seen overall (p<0.0001) and for each of the selected diagnoses. Overall, males and those aged 55-59 years of age were significantly more likely to be affected.

CONCLUSIONS

This study provides evidence of significant increases in attendance at GUM clinics by older people. Although it is recognised that young people should remain the focus of sexual health programmes, the results indicate that sexual risk-taking behaviour is not confined to young people but also occurs among older people. There is therefore a need to develop and implement evidence-based multifaceted sexual health programmes that while aiming to reduce STI transmission among all age groups should include interventions aimed specifically at older people and address societal and healthcare attitudes, myths and assumptions about sexual activity among older people.

Perfusion fMRI detects deficits in regional CBF during memory-encoding tasks in MCI subjects

OBJECTIVE

To determine how memory-encoding tasks elicit functional perfusion change in subjects with amnestic mild cognitive impairment (aMCI).

METHODS

Twelve subjects with aMCI and 14 age-matched cognitively normal (CN) subjects were recruited for this study. Arterial spin-labeling perfusion MRI (ASL-MRI) was employed to measure regional cerebral blood flow (CBF) during both control and encoding task conditions.

RESULTS

Experimental results demonstrated that hypoperfusion occurred in the right precuneus and cuneus in the aMCI group, and not the CN group, during the control state. During the memory-task performance, the difference in these regional hypoperfusion areas extended to the posterior cingulate. These regional perfusion rates correlated with the Mini-Mental State Examination and the Rey Auditory Verbal Learning Test scores. In addition, a CBF percentage increase (22.7%) occurred in the right parahippocampus region during the memory-encoding task performance in the CN group, with approximately no change in the aMCI group.

CONCLUSION

Subjects with amnestic mild cognitive impairment had significant regional cerebral hypoperfusion and lacked the dynamic capability to modulate their regional cerebral blood flow responses to the challenge of the functional tasks.

Zeolite collapse and polyamorphism

The phenomenology of zeolite collapse is outlined, drawing on recent synchrotron x-ray diffraction experiments and computer simulations of low density cage structures like zeolite A and zeolite Y. Attention is drawn to the importance of polyamorphism in destabilizing this type of microporous crystal and its role in order-disorder as well as amorphous-amorphous transitions, together with associated differences in entropy and density between polyamorphic phases and the precursor zeolite. Magic angle spinning NMR and inelastic x-ray scattering are used to highlight changes in structural order and mechanical rigidity between the starting zeolite and the final high density polyamorph. In conclusion, two-level systems detected with inelastic neutron scattering are described and their involvement in dictating the dynamics of the collapse of zeolitic cage structures.

Studies of male reproduction in captive African wild dogs (Lycaon pictus)

Implementation of assisted breeding in the captive African wild dog is restricted by a current lack of knowledge on their reproductive physiology and the apparent difficulty of effectively manipulating the complex social dynamic of the pack in order to conduct reproductive procedures. In this study, we describe protocols for the safe and repeated capture and restraint of the African wild dog (n=7) as well as techniques for assessment of male reproductive function, semen collection and preservation. In a serendipitous finding, captive African wild dogs appeared to display significant seasonal change in male reproduction. Testicular volume and tone, spermatorrhea and the ability to collect semen by electroejaculation all increased significantly during late summer and then subsequently declined by early spring. While there were no detectable seasonal changes in testosterone concentration in the population as whole, the alpha-dominant male in both years of the study, had a highly elevated testosterone concentration compared to subordinate males. Semen collection by electroejaculation during the late summer was most effective in peri-pubertal males (15 months) when all seven electroejaculates were of adequate quality for cryopreservation. In the second breeding season (27 months), there were numerous changes in the pack hierarchy and electroejaculation was not as successful (3/7). The characteristics of electroejaculated semen collected in the breeding season are described for seven animals including the first descriptions and incidence of sperm abnormalities in the species. Semen (n=7) was frozen using a Tris-citrate fructose buffer and final egg yolk and glycerol concentration of 20% and 4%, respectively. Sperm were loaded into 0.25 mL straws, frozen in liquid nitrogen vapor and then thawed at 37 degrees C. Initial post-thaw survival of spermatozoa was encouraging (% motile: 31.8+/-5.8%; rate: 2.8+/-0.3; % intact plasma membranes: 33.4+/-5.3% and the % of damaged acrosomes: 4.4+/-1.5%) but following 2 h incubation at 37 degrees C, post-thaw survival declined markedly.

The role of neoadjuvant chemotherapy in muscle invasive bladder cancer and correlation of clinical outcome with translational studies

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Background The aim of this study was to investigate the outcome in patients with muscle-invasive bladder cancer (MIBC) receiving neo-adjuvant chemotherapy (neo-CT) prior to organ-preservation (chemo-radiation) or cystectomy. Additional translational studies were performed. Methods Patients with stage T2-T4, N0, M0 TCC bladder with calculated GFR =40ml/min were eligible. Neo-CT comprised gemcitabine (1,000 mg/m2 d1, d8, q21) plus cisplatin (35 mg/m2 d1, d8, q21) for 4 cycles . Following chemotherapy (CT) patients underwent surgery or radiotherapy (RT) with or without chemotherapy (CRT) treatment based on response to neo-CT and clinician and patient preference. Serial blood samples were collected for proteomic analysis. Results 20 patients have been recruited : 18 males 2 females; median age 70 years (range 47–86); stage T2; 9, T3A; 7, T3B; 4, all G3. 1 patient progressed before CT. 61 cycles of CT have been administered. Treatment has been well tolerated with only 1 neutropenic sepsis episode. 3 of 20 patients developed early progression and did not receive radical treatment. For the remaining 17 patients, choice of definitive treatment (surgery vs. RT/CRT) was based on response to neo-CT. 6 patients with residual disease at post-neo CT cystoscopy underwent surgery. 11/19 (58%) patients had a complete response (CR) to neo-CT, 9 of whom were treated by RT/CRT and 2 patients with pCR declined radical treatment (both alive at 10 and 19 months follow-up (FU)). At median FU of 12 months, 3/6 patients treated surgically and 2/9 patients treated by RT/CRT have died. 1-year survival by intention to treat analysis was 70%. We have used SELDI using the IMAC protein chip array to generate proteomic profiles of the patient sera collected to date. Although the number of samples is limited, the data suggest that there are changes in the pre- chemotherapy serum proteome of 3 patients that developed early progression (relative to 8 patients with CR to neo-CT ). Conclusions Neo-CT is active and well tolerated in MIBC. Proteomic profiling may further improve patient selection. Early data show serum proteome analysis can detect markers of early progression, and may therefore help select patients for different modalities more appropriately. Recruitment is ongoing.

No significant financial relationships to disclose.

The use of alternative medicine in pediatric patients with atopic dermatitis

Alternative medicine has been defined as forms of therapy or examination that have no scientific basis and for which no effective or diagnostic reliability has been demonstrated by scientific methods. The use of complementary or alternative medicine is increasing and controlled clinical trials on the subject are few. We performed a questionnaire-based study of 80 pediatric patients with atopic dermatitis. This questionnaire assessed the duration of treatment, the reason(s) for trying alternative therapy, the approximate cost and the success of the treatment, the duration of the childhood eczema, and whether the child had ever required hospital admission for eczema. Of the total, 34 (42.5%) patients had used alternative medicine. Herbal remedies and homeopathy were used most often. Most treatments were reported to show no benefit and in three instances deterioration was reported. This study has prompted us to enquire routinely regarding alternative medicine use. Alternative therapies are subject to minimal regulation and have been associated with serious side effects. We would recommend enquiries regarding alternative medicine use in all pediatric dermatology patients.

Return of collective rotation in 157Er and 158Er at ultrahigh spin

A new frontier of discrete-line gamma-ray spectroscopy at ultrahigh spin has been opened in the rare-earth nuclei (157,158) Er. Four rotational structures, displaying high moments of inertia, have been identified, which extend up to spin approximately 65 variant Planck's over 2pi and bypass the band-terminating states in these nuclei which occur at approximately 45 variant Planck's over 2pi. Cranked Nilsson-Strutinsky calculations suggest that these structures arise from well-deformed triaxial configurations that lie in a valley of favored shell energy which also includes the triaxial strongly deformed bands in (161-167) Lu.