Arrowleaf clover improves lamb growth rates in late spring and early summer compared with subterranean clover pastures in south-west Victoria

The profitable production of lamb from pasture-based systems is dependent on high levels of pasture production being efficiently utilised by sheep of superior genetic merit. Pastures that can extend the pasture-growing season and provide high quality feed in late spring and summer have the potential to increase production efficiency and the proportion of lambs that meet market specifications. In this paper we tested the hypothesis that arrowleaf clover (cv. Arrotas), a cultivar selected for late maturity, would supply feed of higher nutritive value than conventional annual legumes and perennial ryegrass mixtures during December and January and this would improve lamb growth rates over this period. Two experiments were conducted to compare the nutritive value of pasture and growth rates of lambs grazing arrowleaf clover, subterranean clover (cv. Leura) or subterranean clover/perennial ryegrass mixtures at different stocking rates during late spring and early summer in south-west Victoria. In the second experiment an arrowleaf clover/perennial ryegrass treatment was also included. Lambs were removed from the plots when they could no longer maintain liveweight. Arrowleaf clover extended the growing season by 4–6 weeks and provided feed of significantly higher digestibility than subterranean clover during December and January. The digestibility of arrowleaf and perennial ryegrass was comparable, but arrowleaf had significantly higher crude protein content during this period. Lambs grazing arrowleaf clover at stocking rates up to 24 lambs/ha grew at or above 100 g/day until the end of January, whereas lambs grazing subterranean clover and perennial ryegrass mixed pastures could not maintain weight by mid-to-late December in both years and were removed from the pastures. At the highest stocking rates total lamb production from arrowleaf clover monoculture pastures in late spring and early summer was ~400 kg liveweight/ha, and was more than double that achieved from the subterranean clover and perennial ryegrass/subterranean clover mixed pastures. The perennial ryegrass/arrowleaf clover mixed pastures in the second experiment produced a similar quantity of lamb per hectare as the arrowleaf clover monoculture pastures at the same stocking rate. In this paper we demonstrated that late-maturing arrowleaf clover can be a profitable, special purpose lamb-finishing pasture. Arrowleaf clover was most suited to more elevated parts of the landscape where estimated carrying capacity was 20 to 40% greater than that from lower lying parts of the landscape that were more subject to water logging and weed infestation. The risks of including arrowleaf clover pastures into the farming system could be reduced by direct drilling arrowleaf clover, which has relatively poor winter production, into existing perennial ryegrass pastures.

Interim Analysis of a Randomized Phase II Study of the Novel Ii-Key Hybrid HER2/Neu Peptide (AE37) Vaccine To Prevent Breast Cancer Recurrence: United States Military Cancer Institute Clinical Trials Group Study I-05

BACKGROUND: CD4+ T helper peptides from HER2/neu have been evaluated in vaccine trials. The Ii-Key addition, a 4-amino-acid (LRMK) modification, increases vaccine potency when compared to unmodified class II epitopes. We present results of a prospective, randomized, single-blinded phase II clinical trial of the Ii-Key hybrid HER2/neu peptide (AE37) + GM-CSF immunoadjuvant vaccine versus GM-CSF alone in the adjuvant setting in disease-free, high risk breast cancer (BCa) patients to prevent recurrence.METHODS: Disease-free, high risk BCa patients who have completed standard adjuvant therapy were enrolled and randomized to receive six monthly inoculations of either 500 mcg of AE37 with 62.5 or 125 mcg of GM-CSF (Peptide group; PG) or 62.5 or 125 mcg of GM-CSF alone (adjuvant group; AG). Toxicity was assessed after each inoculation using National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 (CTCAE). Immunologic response was monitored using delayed type hypersensitivity reactions (DTH) and 3H-thymidine proliferative assays for both hybrid AE37 (LRMK+HER2/neu:776-790) and AE36 (unmodified HER2/neu:776-790) peptides. Patients were clinically, radiographically, and pathologically monitored for recurrence of BCa.RESULTS: Thus far, 120 (49 PG, 71 AG) of the planned 200 patients have completed the primary series. The PG and AG have similar demographic/prognostic characteristics (Table 1). Toxicity profiles in the PG and AG were almost identical with no grade 4-5 local toxicities and no grade 3-5 systemic toxicities in either arm. Median DTH reaction to AE36 and AE37 increased significantly from baseline at 1 month after completion of the primary series in the PG group (AE36: 0.0±0.8 cm to 15.3 ±2.1 cm; AE37: 0.0±0.7 cm to 24.5±2.6 cm; p<0.0001) and did not change in the AG group (AE36: 0.0±0.5 cm to 0.0±1.4 cm; AE37: 0.0±0.7 cm to 0.0±1.6 cm; p>0.05). Median proliferation response to AE36 and AE37 increased significantly from baseline at 3, 6, and 12 months after the start of the vaccine series in the PG (p<0.015) and did not change significantly in the AG. At a median follow up of 13 months, there have been no (0.0%) recurrences in the PG (0/49) compared to 7.0% (5/71) in the AG (p=0.08).CONCLUSIONS: The modified peptide AE37 is safe with mild toxicities observed primarily due to the GM-CSF immunoadjuvant. AE37 elicits a strong HER2/neu-specific in-vivo and ex-vivo immune response to the modified and unmodified peptides. Importantly, the AE37 peptide vaccine may protect against BCa recurrences. peptideadjuvantp valueN=4971 Age (median)49520.06Node Positive75.5%62.1%0,16Grade 348.9%57.8%0.44Tumor ≥2 cm55.1%56.1%1ER/PR negative38.8%40.9%0.84HER2 over-expressor59.2%60.6%1 

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3183.

NOTE: This abstract was accepted for presentation at the Symposium after the Abstract Book went to press.

How strong is the association between abdominal obesity and the incidence of type 2 diabetes?

BACKGROUND

Quantitative evidence on the strength of the association between abdominal obesity and the incidence of type 2 diabetes was assessed.

METHODS

Systematic review of longitudinal studies assessing the relationship between measures reflecting abdominal obesity and the incidence of type 2 diabetes.

RESULTS

There was a strong association between measures reflecting abdominal obesity and the incidence of type 2 diabetes, the pooled odds ratio was 2.14 (95% CI: 1.70-2.71; p < 0.0001). Waist circumference (WC) was at least as good as other measures in predicting outcome.

CONCLUSIONS

There is a strong association between measures reflecting abdominal obesity and the development of type 2 diabetes. Reducing WC may reduce the risk of developing type 2 diabetes.

Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London

BACKGROUND AND OBJECTIVE

Chlamydia trachomatis infection is a common sexually transmitted infection with serious sequelae. Excellent access to testing, treatment and contact tracing are an essential part of strategies to control it. With traditional sexual health services over-stretched, community pharmacies are well placed to provide this service. They have the potential to improve access by offering chlamydia testing and treatment from high street venues with long opening hours. This study evaluated the feasibility and acceptability to users and pharmacists of this service in independent community pharmacies.

METHOD

A chlamydia testing and treatment service was offered in three community pharmacies in two inner London boroughs for a 3-month pilot. Data on the feasibility and acceptability of the new service were collected via a survey of client experience, in-depth semistructured interviews with clients and pharmacists, and structured evaluation reports completed by professional patients paid to visit the pharmacies.

RESULTS

83 tests were taken with eight (9.5%) of these positive for C trachomatis. Of those tested, 94% (n = 73) were women and 71% (n = 56) were from ethnic minorities. 80 clients completed the questionnaires and 24 clients were interviewed. Most clients heard about the service from the pharmacist when requesting emergency contraception and 16% (n = 13) would not otherwise have been tested. Clients valued the speed and convenience of the service and the friendly, non-judgmental approach of the pharmacist. Confidentiality when asking for the service at the counter was suboptimal, and the pharmacist trained to deliver the service was not always available to provide it.

CONCLUSIONS

Chlamydia testing and treatment in community pharmacies is feasible and acceptable to users. The service increases access among young women at high risk of sexually transmitted infection but not among young men.

A 31-phosphorus neurospectroscopy study of omega-3 long-chain polyunsaturated fatty acid intervention with eicosapentaenoic acid and docosahexaenoic acid in patients with chronic refractory epilepsy

The aim of this study was to determine whether supplementation with the n-3 long-chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid in patients with chronic refractory epilepsy is associated with beneficial changes in cerebral biochemistry. In a 3-month pilot randomized double-blind placebo-controlled study, three patients received eicosapentaenoic acid and docosahexaenoic acid daily and four received a placebo. 31-Phosphorus neurospectroscopy showed a decrease in phosphodiesters, an increase in gammaNTP and an increase in the broadband component in the active group over this period, while the opposite changes occurred in the placebo group. Therefore, in chronic refractory epilepsy, omega-3 supplementation may be associated with reduced membrane phospholipid breakdown in the brain, an improvement in brain energy metabolism, and an increased level of phospholipids in membranes and/or vesicle bilayers in cells in the brain. The unfavourable biochemical changes observed in the placebo group may be a feature of chronic intractable epilepsy.

Delirium in vascular surgery

Delirium is common in many surgical settings. Patients undergoing elective vascular surgery may be at particular risk of developing delirium, and may have modifiable aetiological factors that can be addressed by pre-operative interventions. We decided to review the literature regarding the incidence and aetiology of delirium in elective vascular surgical patients.

METHODS

We searched medical databases, journals and bibliographies to identify relevant studies. We used predetermined quality criteria for appraisal of the quality of incidence and aetiological studies.

RESULTS

Four studies were identified as relevant to the review. The incidence of delirium ranged from 29.1% to 39.2%. The significant aetiological factors identified were age, pre-operative cognitive impairment, depressive symptoms, inter-operative blood transfusion and previous amputation.

CONCLUSIONS

Delirium is common in people undergoing elective vascular surgery. Further research is required to examine the effect on outcome of delirium, and the effect of psychiatric and geriatric medicine interventions in this setting.

Interventions for preventing delirium in hospitalised patients

BACKGROUND

Delirium is a common mental disorder with serious adverse outcomes in hospitalised patients. It is associated with increases in mortality, physical morbidity, length of hospital stay, institutionalisation and costs to healthcare providers. A range of risk factors has been implicated in its aetiology, including aspects of the routine care and environment in hospitals. Prevention of delirium is clearly desirable from patients' and carers' perspectives, and to reduce hospital costs. Yet it is currently unclear whether interventions for prevention of delirium are effective, whether they can be successfully delivered in all environments, and whether different interventions are necessary for different groups of patients.

OBJECTIVES

Our primary objective was to determine the effectiveness of interventions designed to prevent delirium in hospitalised patients. We also aimed to highlight the quality and quantity of research evidence to prevent delirium in these settings.

SEARCH STRATEGY

We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 28th September, 2005. As the searches in MEDLINE, EMBASE, CINAHL and PsycINFO for the Specialized Register would not necessarily have picked up all delirium prevention trials, these databases were searched again on 28th October, 2005. We also examined reference lists of retrieved articles, reviews and books. Experts in this field were contacted and the Internet searched for further references and to locate unpublished trials.

SELECTION CRITERIA

Randomised controlled trials evaluating any interventions to prevent delirium in hospitalised patients.

DATA COLLECTION AND ANALYSIS

Data collection and quality assessment were performed by three reviewers independently and agreement reached by consensus.

MAIN RESULTS

Six studies with a total of 833 participants were identified for inclusion. All were conducted in surgical settings, five in orthopaedic surgery and one in patients undergoing resection for gastric or colon cancer. Only one study of 126 hip fracture patients comparing proactive geriatric consultation with usual care was sufficiently powered to detect a difference in the primary outcome, incident delirium. Total cumulative delirium incidence during admission was reduced in the intervention group (OR 0.48 [95% CI 0.23, 0.98]; RR 0.64 [95% CI 0.37, 0.98]), suggesting a 'number needed to treat' of 5.6 patients to prevent one case. The intervention was particularly effective in preventing severe delirium. In logistic regression analyses adjusting for pre fracture dementia and Activities of Daily Living impairment, there was no reduction in effect size, OR 0.6, but this no longer remained significant [95% CI 0.3,1.3]. There was no effect on the duration of delirium episodes, length of hospital stay, and cognitive status or institutionalisation at discharge. There was also no significant difference in cumulative delirium incidence between treatment and control groups in a sub-group of 50 patients with dementia (RR 0.9 [95% CI 0.59, 1.36]). In another trial of low dose haloperidol prophylaxis, there was no difference in delirium incidence but the severity and duration of a delirium episode, and length of hospital stay were all reduced. We identified no completed studies in hospitalised medical, care of the elderly, general surgery, cancer or intensive care patients. In outcomes, no studies examined for death, use of psychotropic medication, activities of daily living, psychological morbidity, quality of life, carers or staff psychological morbidity, cost of intervention and cost to health care services. Outcomes were only reported up to discharge, with no studies reporting medium or longer-term effects.

AUTHORS' CONCLUSIONS

Research evidence on effectiveness of interventions to prevent delirium is sparse. Based on a single study, a programme of proactive geriatric consultation may reduce delirium incidence and severity in patients undergoing surgery for hip fracture. Prophylactic low dose haloperidol may reduce severity and duration of delirium episodes and shorten length of hospital admission in hip surgery. Further studies of delirium prevention are needed.

Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes

BACKGROUND

Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM.

METHODS

A retrospective analysis was performed from January 1993 to December 2002 of all children with blunt pancreatic injuries from the trauma registries of 7 designated level 1 pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Injuries were graded I to V, and ductal injury was defined as grades III to V. Parameters included mechanism of injury, injury severity score (ISS), organ grade, Glasgow Coma Scale score, and outcome. Data were analyzed by Fisher exact test and Mann-Whitney U test, with mean values +/- SD and significance of P < .05.

RESULTS

Pancreatic injuries were present in 173 (9.2%) of 1823 patients. Of these, 43 (26.0% [43/173]) required an operation. Valid morbidity data was obtained in 118 of 173 patients. ISS was significantly higher in all patients treated operatively. Patients with an injury of grade III to V failed NOM more frequently than all patients with pancreatic injury (P =.0169). Length of stay was longer, and the incidence of pseudocysts, drainage procedures, and pancreatitis was higher in NOM patients, although not significant.

CONCLUSIONS

Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.

Post-transplant hypophosphatemia: Tertiary 'Hyper-Phosphatoninism'?

Hypophosphatemia is a common complication of kidney transplantation. Tertiary hyperparathyroidism has long been thought to be the etiology, but hypophosphatemia can occur despite low parathyroid hormone (PTH) levels and can persist after high PTH levels normalize. Furthermore, even in the setting of normal allograft function, hypophosphatemia, and hyperparathyroidism, calcitriol levels remain inappropriately low following transplantation, suggesting that mechanisms other than PTH contribute. Fibroblast growth factor-23 (FGF-23) induces phosphaturia, inhibits calcitriol synthesis, and accumulates in chronic kidney disease. We performed a prospective, longitudinal study of 27 living donor transplant recipients to test the hypotheses that excessive FGF-23 accounts for hypophosphatemia and decreased calcitriol levels following kidney transplantation. Hypophosphatemia <2.5 mg/dl developed in 85% of subjects, including one who had previously undergone parathyroidectomy; 37% developed phosphate < or =1.5 mg/dl. The mean pre-transplant FGF-23 level was 1,218+/-542 RU/ml. Within the first week following transplantation, mean levels decreased to 557+/-579 RU/ml, which were still above normal. FGF-23 was independently associated with serum phosphate (P < 0.01), urinary excretion of phosphate (P < 0.01), and calcitriol levels (P < 0.01); PTH was not independently associated with any of these parameters. We calculated area under the curve for FGF-23 and PTH between the pre- and first post-transplant levels as a summary measure of early exposure to these phosphaturic hormones. An area under the FGF-23 curve greater than the median was associated with a relative risk of developing hypophosphatemia < or =1.5 mg/dl of 5.3 (P = 0.02) compared with lower levels. Increased area under the PTH curve was not associated with greater risk of hypophosphatemia. Excessive FGF-23 exposure in the early post-transplant period appears to be more strongly associated with post-transplant hypophosphatemia than PTH.