Functional domains of the C-terminus of the rat angiotensin AT1A receptor

Previous work has shown that truncating the carboxyl terminus (C-terminus) of the rat angiotensin AT1A receptor to 309 amino acids abolished G-protein coupling and receptor internalization. This suggests that domains responsible for these functions lie beyond amino acid 309 of the C-terminus. The objective of this study was to determine the effect on angiotensin AT1A receptor function and regulation of deleting 41 amino acids from the C-terminus, which include the putative protein kinase C phosphorylation sites. Using site directed mutagenesis, the codon for Tyr319 was converted to a stop codon and the resulting truncated receptor permanently expressed in cultured human kidney cells. The properties of the truncated receptor were compared to those of the full length receptor. Expression of the truncated receptor was confirmed by sodium dodecyl sulphate polyacrylamide gel electrophoresis analysis of photolabelled membrane preparations. Angiotensin II activation of both full length and truncated receptors resulted in mobilization of inositol phosphates. However, whereas this was associated with rapid internalization of the full length receptor, the truncated receptor failed to internalize. Furthermore, pretreatment of cells with phorbol 12-myristate 13-acetate, a direct activator of protein kinase C, markedly attenuated the full length, but no the truncated receptor's ability to mobilise inositol phosphates. Thus, we conclude that the domain between amino acids 309 & 318 is important for G-protein coupling; that amino acids beyond 318 regulate internalization and one or more of the putative protein kinase C phosphorylation sites, present in the C-terminus of the angiotensin At1A receptor, actively regulate the receptor.

Fibrin D-dimer, haemostatic factors and peripheral arterial disease

Several haemostatic factors have been shown to have a predictive role in cardiovascular disease, although their relationship with prevalent peripheral arterial disease is not well reported. Using a random sample of 1592 men and women aged 55-74 years from Edinburgh, Scotland, we examined the relationship of von Willebrand factor (vWF), tissue plasminogen activator (t-PA) and fibrin D-dimer antigens and factor VII activity to peripheral arterial disease. t-PA antigen and fibrin D-dimer showed significant linear trends of increased levels with increasing severity of disease in both sexes (p < or = 0.01) and vWF showed a similar pattern in men only (p < or = 0.01). On multivariate analysis, fibrin D-dimer was independently related to the risk of intermittent claudication (p < or = 0.01) and, among men, to the extent of arterial narrowing in the lower limb, as measured by the ankle brachial pressure index, (ABPI) (p < or = 0.001). These results are further evidence of a role for intravascular fibrin deposition in the development of peripheral atherosclerosis.

Determinants of fibrin D-dimer in the Edinburgh Artery Study

There is growing evidence that fibrin D-dimer is associated with coronary and peripheral atherosclerosis. Using data from the Edinburgh Artery Study, we examined the distribution of fibrin D-dimer in 1592 men and women 55 to 74 years old and assessed its relationship with a range of cardiovascular risk factors. Fibrin D-dimer levels were higher in women than in men (P < or = .05) and increased with age (P < or = .001). Current cigarette smokers had higher levels than ex-smokers, who, in turn, had higher levels than those who had never smoked. On multiple regression analyses with age and plasma fibrinogen as covariates, only lifetime smoking in men and systolic blood pressure in women were independent predictors of fibrin D-dimer levels. Since fibrin D-dimer does not appear to be independently related to many of the common cardiovascular risk factors, it may be a useful index of the thrombotic contribution to arterial disease.

The production and characterization of murine monoclonal antibodies to human Gadd45 raised against a recombinant protein

The production of two different murine monoclonal antibodies to human Gadd45, a protein that is induced in response to DNA damage, is reported. Antibodies were generated in a SJL mouse using a recombinant form of the human Gadd45 protein. Monoclonal antibody 4TCYA1, which recognizes the denatured form of human Gadd45 in Western blots, was selected based upon the recognition of Gadd45 induced by functional p53 in the human myeloid leukemia cell line, ML-1. A second monoclonal antibody, designated 30T.14, immunoprecipitates native human Gadd45 in lysates produced from RKO cells, a colorectal carcinoma cell line that expresses relatively high basal levels of Gadd45, as well as from cell lysates made from ML-1 cells after exposure to ionizing irradiation (IR). Since 4TCYA1 fails to immunoprecipitate Gadd45, and 30T.14 fails to bind to IR-induced Gadd45 in immunoblotting, these two monoclonal antibodies probably recognize different epitopes.

Risk factor profile of nonsmokers with peripheral arterial disease

Cigarette smoking is a very common and important risk factor for peripheral arterial disease (PAD) such that a history of never having smoked is unusual in diseased subjects. The aim of this study was to determine whether never smokers with PAD had a unique risk factor profile that put them at particularly high risk of disease. The study population was derived from the Edinburgh Artery Study, which is a cross-sectional random sample survey of 1592 men and women aged fifty-five to seventy-four years. PAD was measured by means of the WHO questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test. Cigarette smoking was measured by use of a standardized questionnaire. In the 561 subjects who had never smoked, 32 (5.7%) had PAD as compared with 12.3% in ex-smokers and 17.8% in current smokers. The never smokers with disease were slightly older and were more likely to be female than the current smokers. They had a higher body mass index, serum cholesterol (non-HDL), HDL cholesterol, systolic and diastolic blood pressure, and glucose intolerance, although a statistically significant difference (P < 0.01) between never and current smokers was found only for body mass index. The risks of disease associated with each risk factor were not significantly different. The authors conclude that a unique risk factor profile for disease was not apparent among subjects who had never smoked, although never smokers were more likely to be women and to have higher levels of other risk factors.

Sustainability of a successful health and nutrition program in a remote aboriginal community

OBJECTIVE

To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang).

DESIGN

Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community.

SETTING

A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison.

RESULTS

The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang "rebounded" in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang.

CONCLUSIONS

The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.

Tissue-plasminogen activator, plasminogen activator inhibitor and risk of peripheral arterial disease

In this population-based case-control study, we examined the relationship between the fibrinolytic variables tissue-plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI) activity, cardiovascular risk factors and peripheral arterial disease. Cases and controls were selected from the Edinburgh Artery Study, a random sample survey of men and women, aged 55-74 years. Mean levels of t-PA antigen and PAI activity were significantly elevated in 121 cases compared to 126 controls. The increased risks of peripheral arterial disease with increasing PAI activity and t-PA antigen levels were partly mediated by interactions with serum triglycerides, high density lipoprotein (HDL) cholesterol and cigarette smoking. For example, adjustment for triglycerides significantly reduced the odds of disease for PAI activity from 1.41 (95% confidence intervals 1.08, 1.86) to 1.24 (0.93, 1.65) and from 1.47 (1.09, 1.98) to 1.34 (0.99, 1.82) for t-PA antigen. We conclude that impaired fibrinolytic potential (raised PAI activity and t-PA antigen) is associated with peripheral atherosclerosis and that this relationship is partly influenced by lipids and cigarette smoking.

Effects of endolymphatic duct occlusion on the structure and function of the endolymphatic sac in the adult guinea pig

The endolymphatic sac (ELS) has been shown to respond rapidly to sudden disruptions in fluid balance such as labyrinthectomy or systemic administration of hyperosmolar agents. The present study was designed to determine the ELS response to slower changes in fluid dynamics by occluding the endolymphatic duct (ELD), thereby interrupting the longitudinal flow of endolymph to the ELS. Morphologic studies and autoradiographic techniques were used to evaluate the effects of ELD obstruction on the structure and function of the ELS after 48 hours. There were no significant changes in cellular morphology and a slight decrease in the incorporation of radiolabeled glucose when compared with normal ELS cells. We conclude that it is rapid change in fluid balance that triggers the ELS response, which is not seen with disruption of longitudinal flow.

[The relationship between serum uric acid and the prognosis of children admitted to pediatric intensive care unit]

To investigate the relationship between hyperuricemia and the prognosis of acute ill children, we evaluated the usefulness of serum uric acid (SUa) and urinary uric acid concentration on admission as prognostic indices in 94 consecutive children admitted to a pediatric intensive care unit. Patients with hyperuricemia (13.1 +/- 5.6 mg/dl) had a higher mortality (13/26, 50% vs 7/68, 10%, P < 0.001), lower blood pH (7.20 +/- 0.18 vs 7.37 +/- 0.10, p < 0.05), lower systolic blood pressure (85 +/- 24 vs 102 +/- 28 mmHg, p < 0.05) and lower body temperature (36.6 +/- 0.8 vs 37.4 +/- 1.0 degrees C, p < 0.05) than did patients with normouricemia (5.0 +/- 1.5 mg/dl). There are no significant difference in uric acid and sodium excretion between hyperuricemic and normouricemic patients. We concluded that elevated serum uric acid on admission is associated with a higher mortality in pediatric ICU patients, therefore it may be used as an important prognostic index to evaluate patients' outcome in acute ill children. Hyperuricemia should also alert physicians to the possibility of profound cell injury caused by various etiology.

Geographical variations in plasma viscosity and relation to coronary event rates

Plasma viscosity is reported to be predictive of coronary heart disease (CHD) and stroke. To find out whether regional differences in CHD event rates correlate with differences in plasma viscosity, we compared plasma viscosity in a high-risk area for CHD (Glasgow Multinational Monitoring of Trends and Determinants in Cardiovascular Disease [MONICA] and Scottish Heart Health Study population surveys, 1985/86; n = 1166) and in a lower-risk area (MONICA Augsburg survey, 1984/85; n = 3258) in men and women aged 25-64 years. Mean plasma viscosity (37 degrees C) was 1.261 (SD 0.067) mPa s in Augsburg and 1.327 (0.093) mPa s in the west of Scotland for men, and 1.248 (0.066) mPa s and 1.318 (0.087) mPa s, respectively, for women. The unadjusted difference of the means between the west of Scotland and Augsburg was 0.066 (95% CI from weighted regression 0.058-0.073) mPa s for men and 0.070 (0.062-0.078) mPa s for women. Adjustment for age, smoking behaviour, total and high-density-lipoprotein cholesterol, systolic and diastolic blood pressure, and body-mass index had no effect on these differences. Age-standardised coronary event rates in 1985-87 were at least two times higher among men, and four times higher among women, in MONICA Glasgow than in MONICA Augsburg. This large geographical difference in plasma viscosity might partly explain the differences in CHD event rates between these populations. Further studies are needed on the determinants of plasma viscosity, and on its potential roles in atherosclerosis, thrombosis, and ischaemia.

Survival tucker: improved diet and health indicators in an aboriginal community

The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the 'store-turnover' method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three-monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B6 and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store-turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost-effectiveness and generalisability.

The influence of additive and nonadditive gene action on lifetime yields and profitability of dairy cattle

Additive and nonadditive genetic effects on lifetime yields of milk and milk components and lifetime profitability were estimated from 5070 cattle in a Holstein pureline, an Ayrshire-based pureline, and 10 crossbred groups of these purelines. Lifetime yields of milk, fat, protein, and lactose and lifetime milk value and annualized discounted net returns were analyzed. Lifetime yields, lifetime milk value, and annualized discounted net returns of the Holstein x Ayrshire-based line F1 and an F1 x (F1 x F1) cross were not significantly different from those for the Holstein pureline. Net reproductive rate for F1 females was 9% greater than that of contemporary Holsteins. The Holstein pureline was superior to the Ayrshire-based pureline for direct additive genetic merit for all traits. Heterosis for the lifetime traits ranged from 16.6% for lifetime milk yield to 20.6% for annualized discounted net returns. Cytoplasmic maternal effect on annualized discounted net return was significant and favored the Ayrshire-based line. Potential economic benefit may derive from development of a crossbred cow that is superior to Holsteins. Maximum exploitation of additive and nonadditive genetic effects on lifetime yields and profitability appears to favor a rotational crossbreeding system with two breeds.

[Analysis of renal water excretion in full-term newborn infants]

The response of renal water excretion was studied in 33 healthy 1-2 day-old and 6-7 day-old full-term newborn infants. With increasing milk intake (fluid intake) in 6-7 day-old newborn infants, there was not only a significant increase of urine flow, urinary sodium excretion was also significantly increased with urine amount (p < 0.01). There was no significant differences of serum osmolality and serum sodium between 1-2 day-old and 6-7 day-old newborn infants, but there was a significant decrease of urine osmolality (p < 0.01) in 6-7 day-old infants. It is suggested that following high fluid (milk) intake full-term infants are capable of adaptively excreting large urine volume and more dilute urine.

[Effect of hydrochlorothiazide on renal calcium and sodium excretion of different ages (III)]

Thirty normal students, including students in senior high, junior high and elementary schools were the subjects for hydrochlorothiazide test. Ten cases, in each age group, were given oral hydrochlorothiazide 2 mg/kg for three consecutive days. The significant natriuretic action was only observed on the first day during the period of oral hydrochlorothiazide, there was no obvious difference among the three age groups. The urinary calcium excretion of elementary and junior high school students is less than that of senior high school students. It is suggested that there is more effective hypocalciuric action for elementary and junior high school students than for senior high school students during the period of oral hydrochlorothiazide.

Apparent dietary intake in remote aboriginal communities

Apparent per capita food and nutrient intake in six remote Australian Aboriginal communities using the 'store-turnover' method is described. The method is based on the analysis of community-store food invoices. The face validity of the method supports the notion that, under the unique circumstances of remote Aboriginal communities, the turnover of foodstuffs from the community store is a useful measure of apparent dietary intake for the community as a whole. In all Aboriginal communities studied, the apparent intake of energy, sugars and fat was excessive, while the apparent intake of dietary fibre and several nutrients, including folic acid, was low. White sugar, flour, bread and meat provided in excess of 50 per cent of the apparent total energy intake. Of the apparent high fat intake, fatty meats contributed nearly 40 per cent in northern coastal communities and over 60 per cent in central desert communities. Sixty per cent of the apparent high intake of sugars was derived from sugar per se in both regions. Compared with national Australian apparent consumption data, intakes of sugar, white flour and sweetened carbonated beverages were much higher in Aboriginal communities, and intakes of wholemeal bread, fruit and vegetables were much lower. Results of the store-turnover method have important implications for community-based nutrition intervention programs.

[Effect of diuretics on renal sodium excretion of different ages (I)]

Ninety normal students including 30 cases in senior high, 30 cases in junior high and 30 cases in elementary schools were the subjects for diuretic test. Thirty cases in each age group were divided into three subgroups. Students in each subgroup were given one of three oral diuretic drugs (acetazolamide 10 mg/kg, furosemide 2 mg/kg, hydrochlorothiazide 2 mg/kg) for three consecutive days. Although there was an increased urinary sodium excretion among the three different age groups during the period of oral hydrochlorothiazide, it showed no significant difference among the three age groups (P > 0.05). There was more increased urinary sodium excretion for students of senior high school during the period of oral furosemide and acetazolamide than for students of junior high school and of elementary school. The largest, successive natriuretic action was observed in students of senior high school during the period of oral furosemide. It is suggested that there is more effective natriuretic action for students of senior high school during the period of oral acetazolamide and furosemide than for students of junior high and of elementary school.

[Effect of furosemide on renal magnesium and calcium excretion of different ages (II)]

Thirty normal students, including senior high, junior high and elementary school, were the subject for furosemide test. Ten cases, in each age group, were given oral furosemide 2 mg/kg for three consecutive days. The result showed there were increasing urinary magnesium and calcium excretion among the three different age groups after oral furosemide (P < 0.05). Successive increase of urinary magnesium and calcium excretion of senior high school students is more obvious than those of junior high and elementary school students. It is suggested that there is more effective action on renal magnesium and calcium excretion for senior high school students after oral furosemide than that for the junior high and elementary school students. It is obvious that increasing dosage of furosemide would induce more calcium excretion than magnesium excretion among students of the three age groups. Therefore, it encouraged to drink the proper amount of water to decrease the incidence of hypercalciuric stone when furosemide should be used.

A possible suicide by diltiazem overdose

This report describes a possible suicide by overdosage with diltiazem. The decreased, a 39-year-old male who had been under treatment for an unidentified heart condition, was discovered on the bathroom floor in his residence. Comprehensive drug screens performed on available postmortem specimens revealed the presence of 6.9 mg/L diltiazem, 0.182 g/100 mL ethanol, and a trace of propranolol in blood, and 4.7 mg/L diltiazem and 0.251 g/100 mL ethanol in urine.

Urinary mineral excretion among normal Taiwanese children

Prompted by a large population of children with renal stones seen in 20 of our country's teaching hospitals over the past 10 years, this study of urinary mineral excretion in normal children was performed. Fasting urine from 1,072 normal Taiwanese school children and 24-h urine collections from 125 children separated into three age groups were analysed for calcium (Ca), phosphate, magnesium (Mg), uric acid, sodium (Na) and creatinine (Cr). Fasting Ca/Cr ratios were not different between the sexes. Ca/Cr ratios were higher in the 17- to 18-year age group as were 24-h urinary Ca excretions. Urinary Mg/Cr ratios were higher in girls than boys and 24-h urinary Mg excretion was highest in the younger age groups. Urinary Mg excretion in Taiwanese children is 54%-86% lower than previously reported in Caucasian children. Both uric acid/Cr ratios and 24-h urinary uric acid excretion were highest in the youngest children. Urinary Na/Cr ratios and 24-h urinary Na excretion were higher in the two younger age groups. There was no correlation between 24-h urinary Ca and Na excretion.

Role of areca nut in the causation of oral submucous fibrosis: a case-control study in Pakistan

A case-control study on chewing and smoking habits and oral submucous fibrosis (OSF) was undertaken in Karachi in 1989/90. Cases were patients detected with fibrous bands and leathery mucosa and hospital-based controls were matched by age and sex. Information on habits was collected by personal interview of 157 cases and 157 controls. Despite overall female preponderance, a substantial number of young men were enlisted. The male/female risks were found to be similar. Immigrants from India to Pakistan (Mohajir) had a similar risk status to local Punjabis. No differences between risks were found when comparing the three age categories, 21, 21-40, 41-60 yr. Among the cases, an increased risk was observed for areca nut chewing. This habit when practised alone appeared to have the highest risk (RR 154), followed by pan with or without tobacco (RR 64, 32 respectively). Logistic regression and discriminant analysis showed that daily consumption rates appeared to be more important with respect to risk than lifetime duration of habit. Tobacco habits were more prevalent amongst those 15 cases who presented with concurrent carcinoma and OSF: We conclude that areca nut chewing has a causal relationship with OSF: additional tobacco insult may be necessary for subsequent carcinoma development.

Use of a 7-day diary for urinary symptom recording

A cohort of 254 men, aged 40-79 years, was followed up at 1 year in a community-based survey of benign prostatic hyperplasia. Immediately after completing a questionnaire about the occurrence of 12 urinary symptoms over the previous month, the men were invited to keep a prospective diary asking about the same symptoms over 7 consecutive days in order to assess the amount of day-to-day variation in symptoms and to examine to what extent the findings reflected those of the retrospective questionnaire. The majority of men reported minor degrees of daily fluctuations in symptoms. Only modest correlations existed between the diary mean and maximum score for each symptom and the corresponding retrospective questionnaire score. Where repeated assessments of urinary symptom status are considered necessary a prospective diary may be more appropriate than a retrospective questionnaire.

Physician reaction to price changes: an episode-of-care analysis

Physicians may respond to fee reductions in a variety of ways. This episode-of-care analysis examines the impact of surgical fee reductions (mandated by the Omnibus Budget Reconciliation Acts [OBRAs] of 1986-87) on the overall pattern and cost of health care services provided in association with the surgical procedure itself. The study focuses on six procedure groups: cataract extractions; total hip replacement; total knee replacement; coronary artery bypass graft (CABG) surgery; upper gastrointestinal (GI) endoscopy; and prostatectomy. Only two of these procedures give significant evidence for the existence of a service volume offset to the fee reductions.

Repair of chronic tympanic membrane perforations using epidermal growth factor: progress toward clinical application

In an earlier study, epidermal growth factor (EGF) was shown to be effective in healing chronic tympanic membrane (TM) perforations in the chinchilla. The original protocol required rimming of the perforation's epithelial edge, application of a paper patch, placement of a Gelfoam pledget, and then administration of EGF solution. To develop a simple outpatient method of healing chronic TM perforations, an attempt was made to simplify the treatment protocol while preserving efficacy. In the modified experimental protocol, a large Gelfoam pledget was placed over the chronic perforation in contact with the residual TM, without mechanical disruption of the perforation edge or use of a paper patch. Then EGF in phosphate buffered saline (PBS) was applied to the Gelfoam pledget (50 microL of 0.5 mg EGF/mL PBS). A series of control ears received Gelfoam pledgets and PBS. Complete closure of the TM perforation was achieved in 80 percent (12/15) of treated ears but in only 20 percent (3/15) of controls (p < 0.01), results similar to those obtained with the original protocol. At long-term follow-up, 4 to 9 months after treatment, EGF-healed TMs were histologically similar to normal TMs, both in their overall thickness and in the relative proportions of the three component layers. In contrast, the few spontaneously healed TMs from the control group were less than half the thickness of normal TMs. To ascertain the optimal EGF concentration for therapeutic effect, a dose ranging study was undertaken.(ABSTRACT TRUNCATED AT 250 WORDS)

[A clinical study for promoting quality nursing care in a university hospital]

The purpose of this study was to develop a new nursing unit which can meet changing health care needs, enhance patients' satisfaction and nurses' job satisfaction, and finally guarantee quality nursing care with present manpower. For this, one medical unit was selected as a unit for quality care. And one medical unit which is similar in staffing and patients' characteristics was selected as a control unit. To assess present problems and identify the remedies to the problems a hospital-wide survey and a workshop were performed. According to the survey results, educational programs and improvement of the facilities and equipment supply system, managerial support for interdepartmental cooperation and intensification of bed-side nursing care were adopted as main principles for operating model unit. This model unit was operated for 3 months from Sep. 1, 1992 to Nov. 30, 1992. To evaluate the effectiveness of the model unit, direct/indirect nursing care hours, patients' satisfaction to nursing care, nurses' job satisfaction, and quality care index were measured. Direct/indirect nursing care hours were compared with that of the control unit, and patients' and nurses' satisfaction and quality care index were measured before and after operating model unit and compared with each other. The results of the study were as follows; 1. In the model unit mean direct nursing care hours per each shift was 146.88 minutes and indirect nursing care hours was 354.72 minutes. The ratio of the direct nursing care hour to indirect nursing hour was 29.6:70.4 and that of the control unit was 26.9:73.1. Direct nursing care hour in model unit was longer than that of the control unit. But, the difference was not significant. In subcategories of direct nursing care, the time spent in mobility and exercise, conservation of body temperature, hygiene, and communication and health education were longer than that of the control unit. 2. Indirect nursing care hour in model unit was shorter than that of the control unit. But, the difference was not significant. In subcategories of indirect nursing care, the time spent in drug management and ward arrangement was shorter than that of the control unit. 3. Patients' satisfaction to nursing care was increased significantly after operating the model unit (T = -3.48, P = 0.002) and satisfaction to subcategories of physical comfort measure, psychological care, and unit management components were significantly higher than before.(ABSTRACT TRUNCATED AT 400 WORDS)

Plasma fibrinogen in women: relationships with oral contraception, the menopause and hormone replacement therapy

Plasma fibrinogen was measured in 4837 women aged 25-64 years as part of the Scottish Heart Health Study and Scottish MONICA population surveys. The relationships of oral contraceptive use, the menopause and hormone replacement therapy were examined. Univariate analyses found that women with a history of oral contraceptive use, premenopausal women and those on hormone replacement therapy all had significantly lower fibrinogen levels than women who had never used oral contraceptives, postmenopausal women and non-hormone replacement users respectively. These differences persisted after age standardization. On multivariate analysis, menopausal status and hormone replacement therapy had independent effects on fibrinogen levels. Together with the common risk factors, 9.9% of the total variation in plasma fibrinogen levels was explained. However, less than 1% of this was from the combined menopausal and hormonal factors. These results confirm a postmenopausal rise in fibrinogen level which may be relevant to an increased risk of coronary heart disease. In addition, a protective effect with hormone replacement therapy is noted, although this was probably due to selection bias.

Fibrinogen in relation to personal history of prevalent hypertension, diabetes, stroke, intermittent claudication, coronary heart disease, and family history: the Scottish Heart Health Study

OBJECTIVE

To determine the relations of plasma fibrinogen to family history of premature heart disease, personal history of hypertension, diabetes, stroke, coronary heart disease, and to presence of intermittent claudication.

DESIGN

Random population survey across 22 local government districts in Scotland.

PARTICIPANTS

10,359 men and women aged 40 to 59 years. Plasma fibrinogen was measured in 8824.

MAIN OUTCOME MEASURE

Plasma fibrinogen concentration.

RESULTS

Persons with a family history of heart disease or a personal history of high blood pressure, diabetes, stroke, or presence of intermittent claudication all had higher plasma fibrinogen concentrations than those without. When compared with participants without cardiovascular or related disease (men: 2.27 (SE = 0.01) g/l, n = 3367; women 2.34 (0.01) g/l, n = 3096), predefined cases of either myocardial infarction (men: 2.51 (0.02) g/l, n = 248; women: 2.63 (0.04) g/l, n = 72) or angina (men: 2.45 (0.02) g/l, n = 394; women: 2.50 (0.02) g/l, n = 398) had significantly higher plasma fibrinogen concentrations (p < 0.001). After adjustment for 10 other coronary risk factors, there was a noticeable linear trend in the odds ratios for myocardial infarction across all quartiles (quarters) of plasma fibrinogen concentrations in both sexes. Similarly, the risk of angina increased linearly with increasing fibrinogen concentrations, although the test for a linear trend was NS among women.

CONCLUSIONS

This large population study confirms that plasma fibrinogen is not only a risk factor for coronary heart disease and stroke, but it is also raised with family history of premature heart disease and with personal history of hypertension, diabetes, and presence of intermittent claudication.

Genetics of growth, feed intake, and milk yield in Holstein cattle

Heritabilities, genetic and phenotypic correlations among growth, forage consumption, and BW changes of heifers and feed consumption, BW changes, and yields of first lactation cows were estimated. Data were from 1266 Holstein progeny of 74 sires born from 1972 to 1985 at three Agriculture Canada research herds. Heavier heifers at 26 wk consumed more feed from 26 to 34 wk than smaller heifers but gained the same BW. The BW gain and feed consumption heritabilities were .17 and .23, respectively; genetic correlation was .44, and phenotypic correlation was .27. During first lactation, feed intake from 8 to 16 wk and measures of milk yield are very tightly intercorrelated both phenotypically and genetically (.78 to .98). Precalving BW gain and BW at calving were genetically uncorrelated with measures of milk yield (-.09 to +.05). Loss of BW during the first 8 wk of first lactation was moderately heritable (.29) and correlated genetically and phenotypically with measures of milk yield in early lactation (.32 to .39) and feed consumption (.26). From 8 to 16 wk, average BW changes were small and had low heritability and weak phenotypic correlations with measures of milk yield or feed intake. The BW at 26 wk and BW gain from 26 to 34 wk were very poor indicators of early first lactation milk yield. Heifer feed intake was weakly correlated phenotypically (-.07 to .16) but moderately genetically correlated (.17 to .23) with early first lactation milk yield and feed consumption.

Adipose tissue fatty acids in Scottish men and women: results from the Scottish Heart Health Study

The fatty acid composition of adipose tissue from 4114 men and women across 22 districts of Scotland is described. A biopsy of subcutaneous adipose tissue was obtained from the upper arm using a skin biopsy punch. Overall the proportion of saturated fatty acids was lower in women and those of monounsaturated and polyunsaturated higher than in men. There were significant effects of age on adipose tissue fatty acid composition, particularly in women, where the proportion of saturated fatty acids decreased and that of monounsaturated fatty acids increased with advancing age. The fatty acid composition of adipose tissue varied among the districts studied. The district standardised mortality ratio for coronary heart disease was positively correlated with the district mean oleic acid value and inversely correlated with the district mean linoleic acid value. This paper supports the importance of adipose tissue fatty acids as indicators of risk factor status for coronary heart disease.

Evaluation of various measures of and factors influencing feed efficiency of dairy cattle

Early part records for milk yield and feed consumption of 2230 first lactation purebred and crossbred dairy cows were analyzed to evaluate various measures of feed efficiency. Corrected milk yield was estimated by adjusting the second 8 wk of milk yield for differences in weight of TDN consumed during wk 9 to 16, percentage of TDN derived from concentrate, and BW.75. Corrected milk yield is an estimate assuming that cows are the same size and consume the same amount of feed. Hence, it represents an expression of feed efficiency. Net feed efficiency, gross efficiency, corrected milk yield, and wk 9 to 16 milk were analyzed simultaneously. Coefficient of determination for net efficiency (.51) and gross efficiency (.72) were lower than that of milk (.82), whereas corrected milk yield had a coefficient of determination similar to that of milk. Hence, the use of ratios to define feed efficiency was less accurate than using corrected milk yield. Effects of genetic groups, stations, season of freshening, year of freshening, and heterosis were similar for gross efficiency and corrected milk yield, but different from those for milk. Therefore, corrected milk yield performed the same function as feed efficiency with higher accuracy.

Rheological determinants of blood pressure in a Scottish adult population

OBJECTIVES

To examine the relationship of blood pressure with haematocrit, plasma viscosity, whole blood viscosity and plasma fibrinogen.

DESIGN

A random population sample of 1264 men and women aged 25-64 years from the west of Scotland, UK.

RESULTS

Strong correlations between age, body mass index and blood pressure were noted: these were higher for women than men. Blood viscosity, haematocrit and plasma viscosity correlated with blood pressure independently of age, body mass index and smoking status. No evidence was found for an effect of erythrocyte rigidity upon blood pressure; plasma fibrinogen showed an inverse correlation with blood pressure and the rheological variables on multivariate analysis.

CONCLUSIONS

Our findings support the role of blood viscosity in determining blood pressure as suggested by other, smaller studies. The magnitude of the effect upon blood pressure levels across the normal range of blood viscosity was of clinical importance. Further studies of factors that influence blood and plasma viscosity may help in the understanding of the aetiology of essential hypertension and its management.

Approximate accuracy of genetic evaluation under a single-trait animal model

A method to approximate breeding value accuracy under a single-trait animal model was developed. Meyer's method was extended to account explicitly for the covariance between contemporaries, the distribution of relatives across herds, exact relationships between animals, and some cases of close in-breeding. The procedure comprised five steps. The diagonal term of each animal in the mixed model equations was progressively adjusted for 1) the herd-year-season effect, 2) contemporaries, 3) progeny and contemporaries of progeny, 4) mates, and 5) parents and parents of contemporaries, before being inverted and expressed in term of repeatability. The efficiency of this method and Meyer's method was compared with two examples. The proposed method appeared to be more efficient, particularly when herds were small, progeny concentrated in a few herds, and animals inbred. Estimates of repeatability from both methods were biased upward and remained sensitive to the number of generations included in the analysis. However, because of its ease of use, Meyer's method, with simple adjustments for repeatability level and inbreeding, can be recommended.

[A study of serum phosphorus and renal phosphate excretion in children of different age groups]

To further elucidate the data of high serum phosphorus concentration reported for foreign children, this study compared the values of serum phosphorus concentration in ethnic Chinese children with foreigners' results, and investigated the potential causes of high serum phosphorus concentration. This study included 33 healthy term male neonates from 2-3 days to 5-7 days old, 1,094 children of 6-18 years old (elementary school-senior high school) and 62 adults. A total of 1,189 persons were studied. Value of serum phosphorus concentration showed no significant difference between boys and girls, and no age dependency; there was notable change in serum phosphorus concentration in growing children of different ages. The mean values of serum phosphorus concentration of neonates aged 2-3 days and 5-7 days (7.20 mg/dl and 7.65 mg/dl, respectively) were the highest; boys aged 6-11 years 5.15-5.50 mg/dl and girls aged 6-11 years 5.14-5.28 mg/dl were the second; boys aged 12-18 years 4.31-4.94 mg/dl and girls aged 12-18 years 4.44-4.96 mg/dl were the lowest. These findings are similar to the conclusions of foreign reports that the older the subjects of the study, the less their serum phosphorus concentration. The maximal transport rates of tubular phosphate reabsorption were determined from a Walton-Bijvoet nomogram using the side-rule method they recommend. The renal phosphate threshold concentration of neonates aged 2-3 days 8.41 mg/100 ml GFR and 5-7 days 7.76 mg/dl GFR was also the highest; boys aged 6-11 years 5.84-6.32 mg/dl GFR and girls aged 6-11 years 5.82-6.10 mg/dl GFR and 5.44-6.10 mg/dl GFR was the second; adult males 3.51 mg/dl GFR and adult females 3.62 mg/dl GFR was the lowest. Increased intestinal absorption of phosphorus, low GFR and low clearance of phosphorus might be the contributing factors to cause high serum phosphorus concentration. Although high renal phosphate threshold capacity is important, increased absorption of phosphorus by G-I tract seems to be another factor in accordance with the need of phosphorus of the growing body cells.

Cigarette smoking and employment status

The smoking habits and health knowledge of the unemployed and the full-time workers were investigated in a cross-sectional study of over 10,000 men and women throughout Scotland. For both sexes (age range 40-59 years), the proportion of current smokers and ever smokers was found to be considerably higher among the unemployed. Only a small part of the difference could be explained by standardisation for social class. The unemployed smokers had began to smoke at an earlier age, with significantly more smoking whilst still at school. Amongst current smokers, the unemployed males reported smoking fewer cigarettes a day, whereas unemployed women smoked more than their full-time counterparts. The reported levels were confirmed by the biochemical measures of smoking; serum thiocyanate and expired air carbon monoxide levels. In contrast to their differences in smoking habit, the two groups were very similar in their knowledge of the hazards of smoking. Smoking habits among the unemployed reflect a complex interaction of financial and both current and previous social factors. Such relationships present a particular challenge to health promotion campaigns.

Alcohol consumption and unemployment among men: the Scottish Heart Health Study

There is growing concern about the relationship between health-related behaviour and employment status. Data from the Scottish Heart Health Study included information on the self-reported drinking habits of 4170 full-time employed and 479 unemployed men. This enabled the patterns of alcohol consumption in the unemployed to be compared to those of the full-time workers. There were appreciable differences in both frequency and quantity of reported alcohol consumption between the two groups and a higher percentage of the unemployed reported being non-drinkers. Nevertheless, the unemployed drinkers drank more alcohol than those in employment, even after standardization for both age and social class (27.9 units vs 20.7 units per week). Binge drinking was common in both groups, but the proportion was higher among the unemployed (58.8% of the unemployed reported drinking more than eight units in any day in the previous week compared to 33.5% among the full-time workers). In an attempt to validate these findings and to assess the possible health consequences of heavy drinking, serum gamma-glutamyltransferase levels were analysed. Overall, the unemployed were found to have higher levels, this finding being largely influenced by the excess of heavy drinkers. The reasons behind these differences in drinking behaviour between the employed and unemployed need to be identified before any cause and effect hypotheses can be generated, and counselling given where needed.

Control of blood pressure in Scotland: the rule of halves

OBJECTIVE

Audit of detection, treatment, and control of hypertension in adults in Scotland.

DESIGN

Cross sectional survey with random population sampling.

SETTING

General practice centres in 22 Scottish districts.

SUBJECTS

5123 Men and 5236 women aged 40-59 in the Scottish heart health study, randomly selected from 22 districts throughout Scotland, of whom 1262 men and 1061 women had hypertension (defined as receiving antihypertensive treatment or with blood pressure above defined cut off points).

MAIN OUTCOME MEASURE

Hypertension (assessed by standardised recording, questionnaire on diagnosis, and antihypertensive drug treatment) according to criteria of the World Health Organisation (receiving antihypertensive treatment or blood pressure greater than or equal to 160/95 mm Hg, or both) and to modified criteria of the British Hypertension Society.

RESULTS

In half the men with blood pressure greater than or equal to 160/95 mm Hg hypertension was undetected (670/1262, 53%), in half of those in whom it had been detected it was untreated (250/592, 42%), and in half of those receiving treatment it was not controlled (172/342, 50%). In women the numbers were: 486/1061, 46%; 188/575, 33%; and 155/387, 40% respectively. Assessment of blood pressure according to the British Hypertension Society's recommendations showed an improvement, but in only a quarter of men and 42% of women was hypertension detected and treated satisfactorily (142/561, 215/514 respectively).

IMPLICATIONS

The detection and control of hypertension in Scotland is unsatisfactory, affecting management of this and other conditions, such as high blood cholesterol concentration, whose measurement is opportunistic and selective and depends on recognition of other risk factors.

Plasma fibrinogen and coronary risk factors: the Scottish Heart Health Study

Plasma fibrinogen was measured in a sample of 8824 men and women aged 40-59 years participating in the Scottish Heart Health Study, and related to cardiovascular risk factors. Women had higher fibrinogen levels than men. In both sexes, multivariate analysis showed that fibrinogen was positively associated with age, smoking, total cholesterol and body mass index and negatively associated with alcohol consumption. Among women, early menopause and systolic blood pressure were also associated with fibrinogen levels. Univariate analyses showed weak positive associations with fish consumption for both sexes although only male white fish consumption entered the final model. Women with a history of contraceptive pill usage had significantly lower fibrinogen levels. The relationship between fibrinogen and physical activity was complex, and could largely be explained by smoking. These findings support the hypothesis that raised fibrinogen is one mechanism by which several major risk factors may promote coronary heart disease. However, known risk factors explained, at most, 10% of the total variance in fibrinogen levels among the general population.

Relationships of milk protein types to lifetime performance

Data from 889 cows at five research stations of Agriculture Canada were used to study the effects of alpha s1-casein, beta-casein, kappa-casein, and beta-lactoglobulin loci on herdlife and total yield over fixed parities (one, two, and three parity) and to a fixed age (36, 48, and 61 mo). Actual yields of all cows were utilized to compute total milk regardless of lactational length. The model consisted of station, breed, year of birth, season of birth, and milk protein types with age at first calving as a covariate. Of the four milk protein types studied, only the kappa-casein locus had significant effects on fixed parity and fixed age total milk and herdlife. Cows with BB kappa-casein type outproduced those with AB or AA kappa-casein types in three parity total milk by 963 and 1657 kg, respectively. Considering total milk accumulated up to 61 mo of age in life, cows with BB kappa-casein type outperformed their counterparts with AB or AA kappa-casein types by 1050 and 1923 kg, respectively. Complete replacement of A by B allele at kappa-casein locus would result in an increase of 1657 kg in three parity total milk and an increase of 1923 kg in 61-mo total milk. The moderate gene frequency of kappa-casein B allele in the current dairy population can be increased to improve lifetime total milk to the benefit of the dairy industry.

Class I alleles of the bovine major histocompatibility system and their association with economic traits

A total of 179 Holstein cows from the Agriculture Canada Research Branch herd at Ottawa and 271 progeny-tested Canadian Holstein bulls were typed for 37 lymphocyte antigens. Each antigen appears to be controlled by a distinct, codominant allele of the bovine lymphocyte antigen (BoLA)-A locus, which is a class I locus of the bovine major histocompatibility system. Only 10 and 16 alleles were present in Holstein cows and bulls, respectively. The association between bovine lymphocyte antigens and economically important traits was examined in gene substitution models. Separate models were used for the cow and bull data. The substitution of the W6.1 allele for the W10 allele was associated with increased protein yield in the milk in both analyses. The results were also consistent with a previous report that the presence of the W10 allele was associated with increased fat percentage compared with some, but not all, of the other alleles. However, more research is necessary to confirm these findings and to determine the biological mechanisms underlying these associations.

Digibind: emergency treatment for digitalis toxicity

Digitalis is a commonly prescribed cardiovascular agent. The advent of Digibind constitutes an important pharmacologic breakthrough for the toxicities encountered with the use of this drug.

Hyperbaric oxygen therapy in clinical application. A report of a 12-year experience

Hyperbaric oxygen (HBO) has become a useful treatment in clinical diseases. All the treatment profiles (Death/Time) were performed under the safe limit of unit pulmonary toxicity dose (UPTD). Between June 1976 and December 1987, we had treated 1288 cases with HBO. The effective rates (cure or improvement) were 97.5% for decompression sickness, 96.3% for chronic osteomylitis, 90% for chronic skin ulcer, 89.4% for crush injury, 81.3% for gas intoxication, 76.1% for burn injury, 73.3% for cerebrovascular accident, 57.1% for gas gangrene, 50% for retinal artery insufficiency, and 45.5% for head or spinal cord injury. Only 3 patients suffered from oxygen toxicity and relieved immediately. To the serious decompression sickness, the comparative study between the conventional treatment table and our modified table revealed increased cure rate(25.8% versus 50.0%, P less than 0.05), and decreased recurrence rate (16.1% versus 4.1%, P less than 0.05). In burn patients with 35-70% area involved and 15-45 years of age, the comparative analysis showed a reduced mortality rate of 6.8% for the HBO treated group as opposed to 14.8% for the non-HBO treated group, P less than 0.05.

Experience with the Exeter total hip replacement since 1970

The satisfactory long-term radiographic appearances with the use of the collarless, smooth, polished, tapered stem encourage its continued use. With the same stem geometry shortly to become available with interchangeable heads, the capacity for the surgeon to change the bearings when polythene wear starts to become marked should address what certainly will emerge as one of the major long-term problems of total hip arthroplasty.

Multiple degree of freedom object recognition using optical relational graph decision nets

Multiple degree of freedom object recognition concerns objects with no stable rest position with all scale, rotation, and aspect distortions possible. We assume that the objects are in a fairly benign background, so that feature extractors are usable. In-plane distortion invariance is provided by use of a polar-log coordinate transform feature space, and out-of-plane distortion invariance is provided by linear discriminant function design. Relational graph decision nets are considered for multiple degree of freedom pattern recognition. The design of Fisher linear discriminant functions and synthetic discriminant functions for use at the nodes of binary and multidecision nets is discussed. Case studies are detailed for two-class and multiclass problems. Simulation results demonstrate the robustness of the processors to quantization of the filter coefficients and to noise.

Factors affecting length of herdlife in purebred and crossbred dairy cattle

The proportional hazards model with censoring was used to assess the effects of breeding value, disease, calving, size, and udder and lactation traits on length of herdlife of 3881 heifers in five herds. Data were recorded over 10 yr from three lines: a Holstein line, an Ayrshire-based line, and a crossbred line. Influences on survival were assessed from data collected at birth, 34, 50, and 82 wk, first freshening, and at 112 and 308 d postpartum. Median estimated herdlife (age at 50% culling) was 3.9 yr for animals alive at first freshening and increased to 4.3 yr for those that completed a first lactation (308 d postpartum). Herds differed greatly in the pattern of culling after freshening. Crossbred females had 21 wk longer median estimated herdlife than the mean of the purelines at 308 d postpartum. Individual milk yield was positively associated with longevity and had the greatest impact on length of herdlife. Abortion and fertility measured as days to last insemination were negatively associated with length of herdlife. Large heifers tended to have increased longevity. High feed intake postpartum was associated with reduced length of herdlife. Objective measures of conformation, which included measurements of the udder, were not important in determining herdlife.

Growth and feed efficiency of pureline and crossline dairy heifers

Data on 3957 heifers from the Holstein H line, Ayrshire-based A line, and C line (crossbreds between H and A lines) were used. Growth, feed consumption, and feed efficiency from 26 to 34 wk were examined. The full model included the fixed effects of herd, year of birth, season of birth, and additive, maternal, and heterotic genetic effects with 26-wk weight as a covariate. Heterotic and maternal effects were not significant. Adjusted for the 26-wk weight covariate, H line heifers gained 3 kg more than A line heifers with C line heifers intermediate. Adjusted for 26 and 34-wk weight covariates, H line heifers ate 2 kg less TDN than A line heifers and, hence, were more efficient. Correlations among traits were estimated using the residual variance-covariance matrix from the full model. Body weight at 34 wk was correlated with 26-wk weight (r = .88) but essentially independent of rate of gain (r = .02). It was correlated with feed consumed (r = .51) and negatively associated with gain/feed consumed (r = -.25). Gain was correlated (r = .84) with gain/feed consumed but mildly so (r = .28) with feed consumed. Feed consumption was negatively correlated (r = -.25) with gain/feed consumed when the 26-wk weight covariate was included but became much larger (r = -.95) when both 26 and 34 wk weight covariates were included. Although genetic differences in feed consumption and feed efficiency of growing heifers exist, these are small and closely associated with weights and weight gains.

Age and Zebu-Holstein additive and heterotic effects on lactation performance and reproduction in Brazil

Data of 6482 lactations from 14 crossbred (Holstein x Zebu) herds in Brazil were used to study breed additive and heterosis effects for first, second, third, and first to fifth lactation milk yields, age at first calving, calving interval, and milk yield divided by calving interval, as well as the effect of age at calving on milk yield. Holstein additive expressed as deviation from Zebu and heterosis effects were highly significant for all traits. For each percentage of Holstein gene contribution an increase of 10.02, 12.02, 12.51, and 12.15 kg of milk were expected for first, second, third, and first to fifth lactation yields, respectively. Corresponding heterosis effects on those traits were 3.80, 3.39, 4.02, and 3.90 kg of milk for each percentage of heterozygosity. Replacement of pure Zebu genes by Holstein genes reduced age at first calving by 6 mo and shortened calving interval by 37 d. Holstein x Zebu heterotic effect decreased age at first calving by 2 mo and calving interval by 39 d. Holstein additive and heterosis effects for milk yield divided by calving interval were 3.4 and 1.3 kg of milk/d, respectively. Fitting breed additive and heterozygosity effects accounted for 99% of the genetic effects except for first to fifth lactation milk yield.

Intercorrelations among milk production traits and body and udder measurements in Holstein heifers

Data from 1341 Holstein heifers of 71 sires were used to study heritabilities of and genetic and phenotypic correlations among milk production traits (308-d milk, front and rear half yields), body measurements (heart girth, withers height, body length, and rump length), udder measurements (front teat length and diameter, rear teat length and diameter, teat distance and udder height), and age at first calving. Genetic and phenotypic parameters were estimated by the multitrait restricted maximum likelihood method. Multitrait estimates of heritability ranged from .37 to .47 for first lactation yield traits, from .19 to .51 for body measurements, and from .08 to .41 for udder measurements. Age at first calving averaged 22.3 mo with a heritability estimate of .11. Milk production traits were all positively correlated with body measurements, suggesting that high producing heifers would be taller, larger, and longer than low producing heifers. Multitrait estimates of genetic and phenotypic correlations between udder height and yield traits were all negative, suggesting that high producing heifers tend to have lower udders. Of four body measurements studied, rump length showed the greatest genetic correlations with yield traits. Among six udder measurements, udder height exhibited the highest degree of associations with yield traits. Thus, rump length and udder height merit greater attention for prediction of lactational performance.