Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992-1998. Investigation Team

BACKGROUND

Increasing resistance to quinolones among campylobacter isolates from humans has been reported in Europe and Asia, but not in the United States. We evaluated resistance to quinolones among campylobacter isolates from Minnesota residents during the period from 1992 through 1998.

METHODS

All 4953 campylobacter isolates from humans received by the Minnesota Department of Health were tested for resistance to nalidixic acid. Resistant isolates and selected sensitive isolates were tested for resistance to ciprofloxacin. We conducted a case-comparison study of patients with ciprofloxacin-resistant Campylobacter jejuni isolated during 1996 and 1997. Domestic chicken was evaluated as a potential source of quinolone-resistant campylobacter.

RESULTS

The proportion of quinolone-resistant C. jejuni isolates from humans increased from 1.3 percent in 1992 to 10.2 percent in 1998 (P<0.001). During 1996 and 1997, infection with quinolone-resistant C. jejuni was associated with foreign travel and with the use of a quinolone before the collection of stool specimens. However, quinolone use could account for no more than 15 percent of the cases from 1996 through 1998. The number of quinolone-resistant infections that were acquired domestically also increased during the period from 1996 through 1998. Ciprofloxacin-resistant C. jejuni was isolated from 14 percent of 91 domestic chicken products obtained from retail markets in 1997. Molecular subtyping showed an association between resistant C. jejuni strains from chicken products and domestically acquired infections in Minnesota residents.

CONCLUSIONS

The increase in quinolone-resistant C. jejuni infections in Minnesota is largely due to infections acquired during foreign travel. However, the number of quinolone-resistant infections acquired domestically has also increased, largely because of the acquisition of resistant strains from poultry. The use of fluoroquinolones in poultry, which began in the United States in 1995, has created a reservoir of resistant C. jejuni.

Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes

BACKGROUND AND PURPOSE

Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology.

CASE DESCRIPTION

The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration.

OUTCOMES

The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day.

DISCUSSION

Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.

Induction of steroidal hydroxylase activity by plant defence compounds in the filamentous fungus Cochliobolus lunatus

We investigated the hypothesis that the endogenous role of the commercially important inducible steroid hydroxylase cytochrome P450s of fungi was in defense against plant toxophores/secondary metabolites. Two plant defense compounds, the aglycones tomatidine and solanidine, the steroidal glycoalkaloid alpha-tomatine and the triterpene saponin beta-escin were tested as inducers of 11beta/14alpha-steroid hydroxylase in the filamentous fungus Cochliobolus lunatus. The extracts of saponins from the roots of Primula veris and green oat leaves were also tested as inducers of 11beta/14alpha-hydroxylation activity in progesterone biotransformation with the same fungus. Induction of steroid hydroxylase and inhibition of activity in some cases support our hypothesis that their endogenous function is in biochemical defence against secondary metabolites. 4-Pregnene-3,11,20-trione was added as a substrate for biotransformation with C. lunatus. We isolated from culture broth 14alpha-hydroxy-4-pregnene-3,11,20-trione, and the hitherto unreported compounds, 7alpha,14alpha-dihydroxy-4-pregnene-3,11,20-trione and 7alpha-hydroxy-pregna-4,8(14)-diene-3,11,20-trione.

Molecular biology and pharmacology of galanin receptors

Galanin was first isolated 15 years ago. Diversity of galanin receptors has been suspected from the study of native tissues and functional responses to galanin and galanin-like peptides in vitro and in vivo. The recent application of molecular biologic techniques to clone galanin receptors has extended this diversity. So far, three galanin receptor subtypes, GALR1, GALR2, and GALR3, have been cloned from both human and rat. Their molecular structure, pharmacologic profiles, tissue distribution, and signal transduction properties have been partially elucidated.

GABA(B) receptors function as a heteromeric assembly of the subunits GABA(B)R1 and GABA(B)R2

The principal inhibitory neurotransmitter GABA (gamma-aminobutyric acid) exerts its effects through two ligand-gated channels, GABA(A) and GABA(C) receptors, and a third receptor, GABA(B) , which acts through G proteins to regulate potassium and calcium channels. Cells heterologously expressing the cloned DNA encoding the GABA(B)R1 protein exhibit high-affinity antagonist-binding sites, but they produce little of the functional activity expected from studies of endogenous GABA(B) receptors in the brain. Here we describe a new member of the GABA(B) polypeptide family, GABA(B)R2, that shows sequence homology to GABA(B)R1. Neither GABA(B)R1 nor GABA(B)R2, when expressed individually, activates GIRK-type potassium channels; however, the combination of GABA(B)R1 and GABA(B)R2 confers robust stimulation of channel activity. Both genes are co-expressed in individual neurons, and both proteins co-localize in transfected cells. Moreover, immunoprecipitation experiments indicate that the two polypeptides associate with each other, probably as heterodimers. Several G-protein-coupled receptors (GPCRs) exist as high-molecular-weight species, consistent with the formation of dimers by these receptors, but the relevance of these species for the functioning of GPCRs has not been established. We have now shown that co-expression of two GPCR structures, GABA(B)R1 and GABA(B)R2, belonging to the same subfamily is essential for signal transduction by GABA(B) receptors.

Partitioning of rhodanese onto GroEL. Chaperonin binds a reversibly oxidized form derived from the native protein

The mammalian mitochondrial enzyme, rhodanese, can form stable complexes with the Escherichia coli chaperonin GroEL if it is either refolded from 8 M urea in the presence of chaperonin or is simply added to the chaperonin as the folded conformer at 37 degreesC. In the presence of GroEL, the kinetic profile of the inactivation of native rhodanese followed a single exponential decay. Initially, the inactivation rates showed a dependence on the chaperonin concentration but reached a constant maximum value as the GroEL concentration increased. Over the same time period, in the absence of GroEL, native rhodanese showed only a small decline in activity. The addition of a non-denaturing concentration of urea accelerated the inactivation and partitioning of rhodanese onto GroEL. These results suggest that the GroEL chaperonin may facilitate protein unfolding indirectly by interacting with intermediates that exist in equilibrium with native rhodanese. The activity of GroEL-bound rhodanese can be completely recovered upon addition of GroES and ATP. The reactivation kinetics and commitment rates for GroEL-rhodanese complexes prepared from either unfolded or native rhodanese were identical. However, when rhodanese was allowed to inactivate spontaneously in the absence of GroEL, no recovery of activity was observed upon addition of GroEL, GroES, and ATP. Interestingly, the partitioning of rhodanese and its subsequent inactivation did not occur when native rhodanese and GroEL were incubated under anaerobic conditions. Thus, our results strongly suggest that the inactive intermediate that partitions onto GroEL is the reversibly oxidized form of rhodanese.

Suppression of the blowfly Lucilia sericata using odour-baited triflumuron-impregnated targets

Field trials were carried out in 1995 and 1996 on farms in the south-west of England to assess the extent to which odour-baited targets could be used to suppress populations of the ectoparasitic blowfly, Lucilia sericata, in sheep pastures. Targets were constructed from 41 x 41 cm squares of aluminium sheet, covered by white cloth which had been dipped in a mixture of sucrose solution (50% w/v) and the chitin synthesis inhibitor triflumuron (10% suspension concentrate). Each target was baited with approximately 300 g of liver and sodium sulphide solution (10%). Three matched sheep farms were used in the trials. In 1995, triflumuron-impregnated targets were placed around the periphery of sheep pastures at one of the farms in late June, at approximately one target per hectare. In 1996, triflumuron-impregnated targets were placed around the periphery of sheep pastures of a second of the farms in early May, at approximately five targets per hectare. Each year, five sticky targets, used to monitor the L. sericata populations, were also placed in fields at the experimental and the other two farms, which acted as controls. In 1995, the results provided some, although inconclusive, evidence that the triflumuron-impregnated targets had reduced the numbers of L. sericata relative to the populations on the two control farms. In 1996, however, the density of L. sericata on the experimental farm was reduced to almost zero and remained significantly lower than on two control farms throughout the period during which the triflumuron-impregnated targets remained in the field. The results are discussed in relation to the use of triflumuron-treated targets as a practical means of controlling L. sericata and sheep blowfly strike.

Progesterone 6-hydroxylation is catalysed by cytochrome P-450 in the moderate thermophile Bacillus thermoglucosidasius strain 12060

The moderate thermophile, Bacillus thermoglucosidasius, transforms progesterone into four metabolites. These are 6alpha- and 6beta-hydroxyprogesterone, androstenedione and testosterone. This is the first report of bacterial 6alpha-hydroxylation of steroids. The identity of the progesterone metabolites shows that there are three major types of transforming activity in this organism; C-17-C-20 lyase that cleaves the pregnane side chain of the substrate, C-17 oxidoreductase that interconverts the metabolites androstenedione and testosterone, and 6-hydroxylation. 6-hydroxylation activity was purified virtually to homogeneity and was shown to be catalysed by a cytochrome P-450 monooxygenase enzyme. This is the first report of a thermostable cytochrome P-450.

Cloned human and rat galanin GALR3 receptors. Pharmacology and activation of G-protein inwardly rectifying K+ channels

The neuropeptide galanin has been implicated in the regulation of processes such as nociception, cognition, feeding behavior, and hormone secretion. Multiple galanin receptors are predicted to mediate its effects, but only two functionally coupled receptors have been reported. We now report the cloning of a third galanin receptor distinct from GALR1 and GALR2. The receptor, termed GALR3, was isolated from a rat hypothalamus cDNA library by both expression and homology cloning approaches. The rat GALR3 receptor cDNA can encode a protein of 370 amino acids with 35% and 52% identity to GALR1 and GALR2, respectively. Localization of mRNA by solution hybridization/RNase protection demonstrates that the GALR3 transcript is widely distributed, but expressed at low abundance, with the highest levels in the hypothalamus and pituitary. We also isolated the gene encoding the human homologue of GALR3. The human GALR3 receptor is 90% identical to rat GALR3 and contains 368 amino acids. Binding of porcine 125I-galanin to stably expressed rat and human GALR3 receptors is saturable (rat KD = 0.98 nM and human KD = 2.23 nM) and displaceable by galanin peptides and analogues in the following rank order: rat galanin, porcine galanin approximately M32, M35 approximately porcine galanin-(-7 to +29), galantide, human galanin > M40, galanin-(1-16) > [D-Trp2]galanin-(1-29), galanin-(3-29). This profile resembles that of the rat GALR1 and GALR2 receptors with the notable exception that human galanin, galanin-(1-16), and M40 show lower affinity at GALR3. In Xenopus oocytes, activation of rat and human GALR3 receptors co-expressed with potassium channel subunits GIRK1 and GIRK4 resulted in inward K+ currents characteristic of Gi/Go-coupled receptors. These data confirm the functional efficacy of GALR3 receptors and further suggest that GALR3 signaling pathways resemble those of GALR1 in that both can activate potassium channels linked to the regulation of neurotransmitter release.

Effects of metyrapone on hepatic cortisone-cortisol conversion in the rat

In previous studies in human subjects metyrapone has been found to exert significant extra-adrenal effects, consistent with an effect on the 11-reductase activity of 11beta-hydroxysteroid dehydrogenase (11beta-HSD). In the present study the effects of metyrapone on cortisone metabolism by rat liver microsomes were investigated. Aliquots of microsomal preparations were incubated with NADPH cofactor and different concentrations of cortisone for a range of time intervals up to 30 min. The products of the reaction were extracted with ethyl acetate and separated using thin-layer chromatograph. Cortisol was estimated by radioimmunoassay. There was a linear increase in cortisol formation over the first 150 sec of the reaction. Over this time period metyrapone had no effect on the rate of the reaction. When the reaction was allowed to proceed for 30 min, however, metyrapone caused a 50% decrease in the amount of cortisol formed. These data suggest that metyrapone may alter cortisone-cortisol conversion by directly interacting with 11beta-HSD but in this system metyrapone does not appear to have the characteristics of a conventional enzyme inhibitor.

Below-knee residual limb shape change measurement and visualization

OBJECTIVE

The ability to measure and visualize shape change (deformation) of a residual limb within and between prostheses is an important step toward improved prosthetic fit assessment. The objective was to develop measurement and visualization methods for below-knee residual limb soft tissue shape change after donning and loading a prosthesis to detect small shape changes (30mm or less).

DESIGN

Spiral X-ray computed tomography imaging was utilized to acquire 3D volumetric data of the below-knee residual limb and prosthesis in situ from poor- and a good-fitting prostheses without and with a load. A new sum projection depth-shaded cylindrical mapping technique to measure and visualize small changes in shape was developed. From the volumetric data, the relative displacement of small lead markers placed on the residual limb's skin surface were measured using multiplanar reconstruction images and cylindrical maps. Displacement measurements averaging 15mm or less were obtained.

RESULTS

The precision and accuracy was 1mm and 2mm, respectively, when measuring the shape change or deformation of the skin surface from the sum projection cylindrical maps. The skin surface deformation was at least 7mm or greater when comparing marker locations between scans with the prostheses in situ.

CONCLUSION

These new image-based measurement and visualization methods provide a feasible means for measuring and displaying lower extremity residual limb shape change within and between different prostheses with and without loading.

"One voice-one vision" for Wisconsin pharmacy

OBJECTIVE

To describe how a new organization, reflecting a new vision and unifying the pharmacists of Wisconsin, was created by bringing together organizationally the resources and memberships of the Wisconsin Pharmacists Association and the Wisconsin Society of health-System Pharmacists.

SETTING

State of Wisconsin.

DESCRIPTION

The boards of directors of the two precursor organizations initiated an exploration of the desirability and feasibility of creating a single, new organization to represent, with a unified voice, all of Wisconsin's pharmacists. This two-year effort resulted in the creation of the Pharmacy Society of Wisconsin (PSW) on January 1, 1998.

INNOVATION

The new organization builds on the strengths and resources of two pharmacy organizations that previously represented divergent views and practice settings. PSW offers a new vision and level of service to its members and to pharmacy students. It presents a single voice to patients, other health care providers, and governmental agencies.

RESULTS

The creation of the Society was supported unanimously by the two boards of directors and by 98% of the voting membership of the two previous organizations.

CONCLUSION

Through a deliberate and extensive planning and organizational process, two vigorous professional organizations were able to recognize the importance of combining their resources into a new single organization. The pharmacists of Wisconsin responded to a call for a new vision and a unified voice. The opportunity exists for American pharmacy to examine how it will be best served by its professional organizations.

BstB7SI (R decreases CCGGY), a thermostable isoschizomer of Cfr10I, from a strain of Bacillus stearothermophilus isolated from oil-contaminated soil in Kuwait

Isolates of thermophilic bacteria from desert soil in Kuwait, heavily contaminated with crude oil, have been screened for the presence of restriction endonuclease activity. One of the isolates (B7S), identified as Bacillus stearothermophilus, showed a high level of restriction endonuclease activity when a cell-free extract was incubated with lambda bacteriophage DNA at 65 degrees C. A type II restriction endonuclease (BstB7SI) has been partially purified from this isolate. BstB7SI recognises the six-base sequence RCCGGY (R = A or G; Y = T or C) and hydrolyses the phosphodiester bond in both strands of the DNA substrate between the first and second bases of the recognition sequence 5'-R decreases CCGGY-3'producing four-base 5' overhangs. BstB7SI is therefore an isoschizomer of the mesophilic prototype restriction endonuclease Cfr10I. BstB7SI has a pH optimum of 9.7, requires 10 mM MgCl2 and 75 mM NaCl for maximum activity, and retains full enzyme activity when incubated for 5 min at temperatures up to 70 degrees C.

The relation of change in maternal interactive styles to the developing social competence of full-term and preterm children

This study evaluated the changing nature of mothers' interactive behaviors to understand alterations in children's social development across 6, 12, 24, and 40 months of age. Social skills were observed during daily activities and toy play in the home for medically high risk (HR; n = 73) and low risk (LR; n = 114) very low birthweight (VLBW) preterm and full-term (FT; n = 112) children. Variations in mothers' responses to children's changing capabilities predicted rates of change in children's social skills. For example, mothers who showed higher levels of maintaining measured across 6 to 40 months had children who displayed greater increases in initiating, but this was more apparent in daily activities than toy play and for the VLBW children compared to the FT children. Those VLBW children at the highest degrees of biological risk displayed faster gains in initiating than the other groups when their mothers provided even greater levels of support. Results demonstrate the importance of using methodologies that test more complex models of growth when evaluating parent-child relations.

Cloning and characterization of the human galanin GALR2 receptor

We present the molecular cloning and characterization of the human galanin receptor, hGALR2. hGALR2 shares 85%, 39%, and 57% amino acid identities to rGALR2, hGALR1, and hGALR3, respectively. hGALR2, along with rGALR2, can be distinguished from the other cloned galanin receptors by a tolerance for both N-terminal extension and C-terminal deletion of galanin, as well as by a primary signaling mechanism involving phosphatidyl inositol hydrolysis and calcium mobilization. By RT-PCR, GALR2 mRNA was abundant in human hippocampus, hypothalamus, heart, kidney, liver, and small intestine. A weak GALR2 mRNA signal was detected in human retina, and no signal was detected in cerebral cortex, lung, spleen, stomach, or pituitary.

Predicting cognitive-language and social growth curves from early maternal behaviors in children at varying degrees of biological risk

Growth modeling was used to examine the relation of early parenting behaviors (averaged across 6 and 12 months) with rates of change in children's cognitive-language and social response and initiating skills assessed at 6, 12, 24, and 40 months. Groups of full-term (n = 112) and very low birth weight children, divided into medically low (n = 114) and high risk (HR; n = 73), were included to evaluate whether children who vary in their rate of development are influenced in different ways by early parenting styles. Parenting behaviors that were sensitive to children's focus of interest and did not highly control or restrict their behaviors predicted greater increases and faster rates of cognitive-language and social development, with relations stronger for the HR versus the other two groups. These maternal behaviors may provide the support all infants need to establish an optimal early foundation for later development and the specific support HR children need to learn in spite of early attentional and organizational problems.

Predicting cognitive-language and social growth curves from early maternal behaviors in children at varying degrees of biological risk

Growth modeling was used to examine the relation of early parenting behaviors (averaged across 6 and 12 months) with rates of change in children's cognitive-language and social response and initiating skills assessed at 6, 12, 24, and 40 months. Groups of full-term (n = 112) and very low birth weight children, divided into medically low (n = 114) and high risk (HR; n = 73), were included to evaluate whether children who vary in their rate of development are influenced in different ways by early parenting styles. Parenting behaviors that were sensitive to children's focus of interest and did not highly control or restrict their behaviors predicted greater increases and faster rates of cognitive-language and social development, with relations stronger for the HR versus the other two groups. These maternal behaviors may provide the support all infants need to establish an optimal early foundation for later development and the specific support HR children need to learn in spite of early attentional and organizational problems.

The potential for control of the blowfly Lucilia sericata using odour-baited targets

A deterministic simulation model is used to explore the potential for control of the sheep blowfly, Lucilia sericata, using odour-baited targets. The simulations show that the ambient temperatures of 15 degrees C or 20 degrees C, 13% and 24% of the females present in a population would need to be killed per day, respectively, to prevent the population growing from its initial spring density during the summer blowfly season. In contrast, if both sexes could be sterilized, so that sterilized males were also able to disrupt the fertility of unsterilized females, only 6.5-13% of both sexes would need to be attracted and sterilized at 15 degrees C or 20 degrees C respectively. To examine whether these numbers of individuals could be attracted by targets baited with liver and sodium sulphide, mark-release-recapture studies in sheep pastures were used to quantify sticky target efficiencies. The percentage of the L.sericata population caught on any one day was shown to be positively related to average ambient temperature. At 15 degrees C each sticky target caught approximately 13% and at 20 degrees C, 41% of the females within a 20 m radius. The results indicate that, at ambient temperatures between 15 and 20 degrees C, if distributed at a density of approximately 5/ha, targets baited with liver and sodium sulphide could effectively suppress a population of L.sericata. Lower densities of targets would be required if they were able to sterilize both sexes rather than kill or if more attractive synthetic semiochemical baits could be developed.

Expression cloning of a rat hypothalamic galanin receptor coupled to phosphoinositide turnover

The neuropeptide galanin is widely distributed throughout the central and peripheral nervous systems and participates in the regulation of processes such as nociception, cognition, feeding behavior, and insulin secretion. Multiple galanin receptors are predicted to underlie its physiological effects. We now report the isolation by expression cloning of a rat galanin receptor cDNA distinct from GALR1. The receptor, termed GALR2, was isolated from a rat hypothalamus cDNA library using a 125I-porcine galanin (125I-pGAL) binding assay. The GALR2 cDNA encoded a protein of 372 amino acids exhibiting 38% amino acid identity with rat GALR1. Binding of 125I-pGAL to transiently expressed GALR2 receptors was saturable (KD = 0.15 nM) and displaceable by galanin peptides and analogues in rank order: porcine galanin approximately M32 approximately M35 approximately M40 >/= galanin-(1-16) approximately M15 approximately [D-Trp2]galanin-(1-29) > C7 >> galanin-(3-29). This profile resembles that of the rat GALR1 receptor with the notable exception that [D-Trp2]galanin exhibited significant selectivity for GALR2 over GALR1. Activation of GALR2 receptors with porcine galanin and other galanin analogues increased inositol phospholipid turnover and intracellular calcium levels in stably transfected Chinese hamster ovary cells and generated calcium-activated chloride currents in Xenopus oocytes, suggesting that the rat GALR2 receptor is primarily coupled to the activation of phospholipase C.

The role of child-centered perspectives in a model of parenting

The mediating role of mothers' child-centered perspectives was examined in a longitudinal study of 323 children. The conceptual model of parenting was tested to determine whether maternal perspectives mediated the relations between the parenting resources of social support, child-rearing history, and self-esteem and the child's developmental level with parenting behavior. This conceptual model was compared to alternative models using structural equation modeling. Results indicate that mothers' perspectives directly related to parenting behavior in two different contexts as well as mediated the relations between maternal resources and behavior. Maternal self-esteem also mediated the relation between social support and child-rearing history with child-centered perspectives. Results support the importance of examining child-centered perspectives as an influence on parental competence as well as the importance of examining how parenting resources interrelate with one another to impact parenting behavior.

Distribution of the neuropeptide Y Y2 receptor mRNA in rat central nervous system

Our group has recently reported the expression cloning of the human neuropeptide Y Y2 receptor DNA and subsequently the cloning of the rat homologue. These studies have made it possible to localize the mRNA encoding this NPY receptor subtype in rat tissues. We have, thus, carried out in situ hybridization studies, using radiolabeled oligonucleotide probes to the rat Y2 receptor mRNA, to determine the distribution of Y2 mRNA in rat brain and limited peripheral ganglia. Probe specificity was confirmed by testing antisense and sense probes in transfected cells. In rat brain, hybridization signals obtained with the antisense probes were discrete and were restricted to neuronal profiles in specific subregions of the cortex, hippocampus, amygdala, thalamus, hypothalamus, mesencephalon and pons. Among the regions exhibiting the most intense labeling were the CA3 region of the hippocampus, the arcuate nucleus of the hypothalamus and layer 3 of the piriform cortex. Other regions containing labeled neurons included the medial amygdala, the centromedial thalamic nucleus, the dorsal raphe, the dorsal motor nucleus of the vagus and the trigeminal ganglion. The present results indicate that the mRNA encoding the Y2 receptor is discretely localized in the rat brain and that the distribution is generally consistent with previous radioligand-binding studies. This study should help clarify the relationship between the Y2 receptor distribution and functional studies of NPY receptor subtype classification and provides further evidence for the involvement of the Y2 receptor in multiple physiological processes.

Lower extremity residual limb slippage within the prosthesis

OBJECTIVE

The ability to measure skin surface slippage relative to the internal wall of a lower extremity prosthesis under various loading conditions is important for evaluation of socket fit and function, and creation of finite element models. Skin surface three-dimensional (3D) shape measurements with tracking of fiducial displacements in situ under axial loading of the prosthesis have not previously been reported. Analysis of slippage within the prosthesis has been performed using a new experimental measurement method based on spiral x-ray computed tomography (SXCT) imaging.

DESIGN

Small lead markers were placed on the residuum of an adult with a below-knee amputation, and SXCT scans were obtained with the prosthesis in situ under two static axial loading conditions (44.5N and 178N). The 3D scan data were used to assess slippage with three methods: gross displacement of the tibia and distal end of the residuum; relative displacement of markers; and distance measurements between markers.

RESULTS

The markers affixed to the below-knee skin surface within the prosthesis were measured. The skin slipped from 2 to 6 mm relative to the internal prosthesis wall when an additional load of 133.5N was applied in the axial direction to the distal end of the prosthesis. The tibial remnant moved 10.0 mm distally relative to the prosthesis internal wall.

CONCLUSION

This method provides a feasible means for measuring residuum skin slippage relative to the prosthesis and skin deformation relative to tibia within an in situ prosthesis under load.

Finite element modeling and experimental verification of lower extremity shape change under load

Prediction and measurement of residuum shape change inside the prosthesis under various loading conditions is important for prosthesis design and evaluation. Residual limb surface measurements with the prosthesis in situ were used for construction of a finite element model (FEM). These surface measurements were obtained from volumetric computed tomography. A new experimental method for modeling the shape of the in situ lower residual limb was developed based on spiral X-ray computed tomography (SXCT) imaging. The p-version of the finite element method was used for estimating the material properties from known load and displacement data. A homogeneous, isotropic, linear constitutive model with accommodation of the constitutive soft and hard tissues of the residuum was evaluated with static axial loading applied to the in situ prosthesis and compared with experimental results obtained in a human volunteer. Two FEMs were created for similar coronal cross sections of the below knee residuum under two loading conditions. Agreement between observed (from SXCT) and predicted (from FEA) residual limb shape changes inside the prosthesis were maximized with a single modulus of elasticity for the residuum soft tissue of 0.06 MPa, consistent with previously published results. This methodology provides a framework to predict and objectively evaluate FEMs and determine residuum material properties by inverse methods.

Clinical illness in a wild turkey with Laminosioptes cysticola infestation of the viscera and peripheral nerves

Laminosioptes cysticola, the fowl cyst mite, was found in peripheral nerves and thoracic and abdominal viscera of an emaciated eastern wild turkey (Meleagris gallopavo) exhibiting severe torticollis, circling, loss of balance, and wing droop. Mites, sometimes accompanied by granulomatous inflammation, were abundant in brachial plexus and sciatic nerves. Mild lymphoplasmacytic perivascular cuffing was present in the cerebellum, but no direct evidence of mites or other infectious agents was found in the central nervous system. This is the first report of L. cysticola infestation in a wild turkey and of the invasion of nervous tissue by this mite.