The Role of Autoantibodies in Companion Animal Cardiac Disease

Clinical studies exploring the role of autoimmune diseases in cardiac dysfunction have become increasingly common in both human and veterinary literature. Autoantibodies (AABs) specific to cardiac receptors have been found in human and canine dilated cardiomyopathy, and circulating autoantibodies have been suggested as a sensitive biomarker for arrhythmogenic right ventricular cardiomyopathy in people and Boxer dogs. In this article, we will summarize recent literature on AABs and their role in cardiac diseases of small animals. Despite the potential for new discoveries in veterinary cardiology, current data in veterinary medicine are limited and further studies are needed.

Delayed-release rapamycin halts progression of left ventricular hypertrophy in subclinical feline hypertrophic cardiomyopathy: results of the RAPACAT trial

OBJECTIVE

Feline hypertrophic cardiomyopathy (HCM) remains a disease with little therapeutic advancement. Rapamycin modulates the mTOR pathway, preventing and reversing cardiac hypertrophy in rodent disease models. Its use in human renal allograft patients is associated with reduced cardiac wall thickness. We sought to evaluate the effects of once-weekly delayed-release (DR) rapamycin over 6 months on echocardiographic, biochemical, and biomarker responses in cats with subclinical, nonobstructive HCM.

ANIMALS

43 client-owned cats with subclinical HCM.

METHODS

Cats enrolled in this double-blinded, multicentered, randomized, and placebo-controlled clinical trial were allocated to low- or high-dose DR rapamycin or placebo. Cats underwent physical examination, quality-of-life assessment, blood pressure, hematology, biochemistry, total T4, urinalysis, N-terminal pro-B-type natriuretic peptide, and cardiac troponin I at baseline and days 60, 120, and 180. Fructosamine was analyzed at screening and day 180. Echocardiograms were performed at all time points excluding day 120. Outcome variables were compared using a repeated measures ANCOVA.

RESULTS

No demographic, echocardiographic, or clinicopathologic values were significantly different between study groups at baseline, confirming successful randomization. At day 180, the primary study outcome variable, maximum LV myocardial wall thickness at any location, was significantly lower in the low-dose DR rapamycin group compared to placebo (P = .01). Oral DR rapamycin was well tolerated with no significant differences in adverse events between groups.

CLINICAL RELEVANCE

Results demonstrate that DR rapamycin was well tolerated and may prevent or delay progressive LV hypertrophy in cats with subclinical HCM. Additional studies are warranted to confirm and further characterize these results.

Patient Perception of Physician Attire Before and After the COVID-19 Global Pandemic Began

Introduction: This study evaluated patient preference of physician attire both before and after the coronavirus disease 2019 (COVID-19) global pandemic began. The primary outcome was patient preference of physician attire in 2017 compared to 2022 survey cohorts. Methods: An observational cross-sectional study performed at a single-site academic institution in the United States using patient survey materials. In total, 339 patients were included in the study, 161 from 2017 and 178 from 2022. Key Points: There was a statistically significant decrease in patient preference for formal attire in the clinical settings of primary care, hospital, and overall. Male patient preference for formal attire declined in primary care, emergency room, and overall; whereas female patient preference for formal attire declined in the hospital setting. For all genders, the odds ratio was statistically significantly lower in the settings of primary care clinic, hospital, and overall clinical settings. Conclusions: Patient preference for physicians wearing formal attire has decreased significantly since the COVID-19 global pandemic began.

Evaluation of autoantibodies to desmoglein-2 in dogs with and without cardiac disease

Autoantibodies to desmoglein-2 have been associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) in people. ARVC is a common disease in the Boxer dog. The role of anti-desmoglein-2 antibodies in Boxers with ARVC and correlation with disease status or severity is unknown. This prospective study is the first to evaluate dogs of various breeds and cardiac disease state for anti-desmoglein-2 antibodies. The sera of 46 dogs (10 ARVC Boxers, 9 healthy Boxers, 10 Doberman Pinschers with dilated cardiomyopathy, 10 dogs with myxomatous mitral valve disease, and 7 healthy non-Boxer dogs) were assessed for antibody presence and concentration via Western blotting and densitometry. Anti-desmoglein-2 antibodies were detected in all dogs. Autoantibody expression did not differ between study groups and there was no correlation with age or body weight. In dogs with cardiac disease, there was weak correlation with left ventricular dilation (r = 0.423, p = 0.020) but not left atrial size (r = 0.160, p = 0.407). In ARVC Boxers there was strong correlation with the complexity of ventricular arrhythmias (r = 0.841, p = 0.007) but not total number of ectopic beats (r = 0.383, p = 0.313). Anti-desmoglein-2 antibodies were not disease specific in the studied population of dogs. Correlation with some measures of disease severity requires further study with larger populations.

Dermatology Residency Applicant Self-Reported Stressors and Coping Mechanisms by Sex, Race, and Geographic Region during the 2020-2021 Application Cycle

OBJECTIVES

Our aim was to identify self-reported stressors and coping mechanisms during the 2020-2021 application cycle by dermatology residency applicants. We hypothesized that coronavirus disease 2019 (COVID-19) would be the most reported stressor.

METHODS

During the 2020-2021 application season, the Mayo Clinic Florida Dermatology residency program sent a supplemental application to each applicant requesting that they describe a challenging life situation and how they handled it. Comparisons of self-reported stressors and self-expressed coping mechanisms according to sex, race, and geographic region were performed.

RESULTS

The most common stressors reported were academic (18.4%), family crisis (17.7%), and COVID-19 (10.5%). The most frequent coping mechanisms expressed were perseverance (22.3%), seeking community (13.7%), and resilience (11.5%). The coping mechanism of diligence was observed more often in females than in males (2.8% vs 0.0%, P = 0.045). First in medicine was more often observed in Black or African American students (12.5% vs 0%, P = 0.001), immigrant experience was more often observed in Black or African American and Hispanic students (16.7% and 11.8% vs 3.1%, P = 0.021), and natural disaster was reported more often in Hispanic students (26.5% vs 0.5%, P < 0.001) as compared with White applicants. By geography, applicants in the northeastern United States were more likely to report the COVID-19 pandemic as a stressor (19.5%, P = 0.049), and the natural disaster stressor was more often reported by applicants from outside the continental United States (45.5%, P < 0.001).

CONCLUSIONS

Stressors reported by dermatology applicants in the 2020-2021 cycle included academic, family crisis, and the COVID-19 pandemic. The type of stressor reported varied by race/ethnicity and geographic location of the applicant.

Association of diet with clinical outcomes in dogs with dilated cardiomyopathy and congestive heart failure

INTRODUCTION

Dilated cardiomyopathy (DCM) in dogs has been associated with feeding of grain-free (GF), legume-rich diets. Some dogs with presumed diet-associated DCM have shown improved myocardial function and clinical outcomes following a change in diet and standard medical therapy.

HYPOTHESIS

Prior GF (pGF) diet influences reverse cardiac remodeling and clinical outcomes in dogs with DCM and congestive heart failure (CHF).

ANIMALS AND METHODS

A retrospective study was performed with 67 dogs with DCM and CHF for which diet history was known. Dogs were grouped by diet into pGF and grain-inclusive (GI) groups. Dogs in the pGF group were included if diet change was a component of therapy. Survival was analyzed using Kaplan-Meier curves and the Cox proportional-hazards model.

RESULTS

The median survival time was 344 days for pGF dogs vs. 253 days for GI dogs (P = 0.074). Statistically significant differences in median survival were identified when the analysis was limited to dogs surviving longer than one week (P = 0.033). Prior GF dogs had a significantly worse outcome the longer a GF diet was fed prior to diagnosis (P = 0.004) or if they were diagnosed at a younger age (P = 0.017). Prior GF dogs showed significantly greater improvement in normalized left ventricular internal diastolic diameter (P = 0.038) and E-point septal separation (P = 0.031) measurements and significant decreases in their furosemide (P = 0.009) and pimobendan (P < 0.005) dosages over time compared to GI dogs.

CONCLUSIONS

Prior GF dogs that survived at least one week after diagnosis of DCM, treatment of CHF, and diet change had better clinical outcomes and showed reverse ventricular remodeling compared to GI dogs.

Ambulatory electrocardiography, heart rate variability, and pharmacologic stress testing in cats with subclinical hypertrophic cardiomyopathy

The utility of ambulatory electrocardiography (AECG) to evaluate cats with subclinical hypertrophic cardiomyopathy (HCM) for arrhythmias and heart rate variability (HRV) is not well defined but may provide information regarding risk stratification. This prospective study used AECG to evaluate ectopy and HRV in subclinical HCM cats compared to healthy controls and is the first to implement a pharmacologic cardiac stress test. Twenty-three purpose-bred, Maine coon cross cats (16 HCM, 7 control) underwent 48-h of continuous AECG. Terbutaline (0.2-0.3 mg/kg) was administered orally at 24 and 36 h. Heart rate, ectopy frequency and complexity and HRV parameters, including standard deviation of normal R-R intervals (SDNN), were compared pre-terbutaline and post-terbutaline and across phenotype, genotype and sex. Genotype for an HCM-causative mutation was significantly associated with the frequency of supraventricular (P = 0.033) and ventricular (P = 0.026) ectopy across all cats. Seven HCM cats and zero healthy cats had a sinus arrhythmia. Mean heart rate was significantly higher post-terbutaline (p < 0.0001). HCM cats had significantly greater HRV compared to controls (SDNN: p = 0.0006). Male cats had significantly higher HRV (SDNN: p = 0.0001) and lower mean heart rates (p = 0.0001). HRV decreased post-terbutaline (SDNN: p = 0.0008) and changes in HRV observed between sexes were attenuated by terbutaline.

Comparative Assessment of Heart Rate Variability Obtained via Ambulatory ECG and Polar Heart Rate Monitors in Healthy Cats: A Pilot Study

Chronic exposure to stressful environments can negatively impact cats' health and welfare, affecting behavioral, autonomic, endocrine, and immune function, as with cats in shelters. Low-stress handling practices likely improve shelter cat welfare, but data supporting improved outcomes remain limited. Cardiac activity, particularly heart rate variability (HRV), is an indicator of stress and emotional state in humans and non-human animals, tracking important body functions associated with stress responsiveness, environmental adaptability, mental, and physical health. HRV studies in cats are limited, involving mainly anesthetized or restrained cats. This pilot study tested the feasibility of obtaining HRV data from unrestrained cats, using a commercially available cardiac monitoring system (Polar H10 with chest strap), compared with data from a traditional ambulatory electrocardiogram. Simultaneous data for the two systems were obtained for five adult cats. Overall, the Polar H10 monitor assessments of HRV were lower than the true HRV assessment by ambulatory ECG, except for SDNN. Correlation between the two systems was weak. Possible reasons for the lack of agreement between the two methods are discussed. At this time, our results do not support the use of Polar H10 heart rate monitors for studies of HRV in cats.

Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease

OBJECTIVES

Feline arterial thromboembolism (ATE), an often devastating outcome, was recently shown to affect 11.3% of cats with hypertrophic cardiomyopathy over 10 years. Current American College of Veterinary Internal Medicine guidelines recommend the use of clopidogrel in cats at risk for ATE, with addition of a factor Xa inhibitor in very high risk or post-ATE cases. To date, no studies have examined the safety or efficacy of this combined antithrombotic therapy. This retrospective case series aimed to assess the frequency and type of adverse events that occurred in cats prescribed dual clopidogrel and rivaroxaban therapy. Secondary aims were to evaluate indications for dual therapy and clinical outcome.

METHODS

The study included 32 cats prescribed clopidogrel (18.75 mg PO q24h) and rivaroxaban (2.5 mg PO q24h) on an outpatient basis over a 5-year period.

RESULTS

Cats were prescribed dual therapy for at least one of the following: ATE event (n = 18), presence of an intracardiac thrombi (n = 17) or presence of spontaneous echocardiographic contrast (SEC) (n = 16). Five cats experienced adverse effects that could be attributed to medications, a median of 13 days from initiation (epistaxis, hematemesis, hematochezia or hematuria). No cat required hospitalization as a result of these events. Median survival time from onset of therapy was 257 days (interquartile range [IQR] = 38-497) for all cats, 502 days (IQR = 171-663) for ATE cats, 725 days (IQR = 133-856) for cats with an ATE to two or more limbs and 301 days (IQR = 221-431) for cats with only one limb affected. Recurrence rate of ATE while on dual therapy was 16.7%; no cat newly developed an ATE while on dual therapy.

CONCLUSIONS AND RELEVANCE

Dual antithrombotic therapy with clopidogrel and rivaroxaban resulted in a low reported incidence of adverse events. Cats placed on dual therapy for an ATE event experienced a low rate of recurrence and effective thromboprophylaxis was achieved in cats with intracardiac thrombi or SEC.

Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease

OBJECTIVES

Feline arterial thromboembolism (ATE), an often devastating outcome, was recently shown to affect 11.3% of cats with hypertrophic cardiomyopathy over 10 years. Current American College of Veterinary Internal Medicine guidelines recommend the use of clopidogrel in cats at risk for ATE, with addition of a factor Xa inhibitor in very high risk or post-ATE cases. To date, no studies have examined the safety or efficacy of this combined antithrombotic therapy. This retrospective case series aimed to assess the frequency and type of adverse events that occurred in cats prescribed dual clopidogrel and rivaroxaban therapy. Secondary aims were to evaluate indications for dual therapy and clinical outcome.

METHODS

The study included 32 cats prescribed clopidogrel (18.75 mg PO q24h) and rivaroxaban (2.5 mg PO q24h) on an outpatient basis over a 5-year period.

RESULTS

Cats were prescribed dual therapy for at least one of the following: ATE event (n = 18), presence of an intracardiac thrombi (n = 17) or presence of spontaneous echocardiographic contrast (SEC) (n = 16). Five cats experienced adverse effects that could be attributed to medications, a median of 13 days from initiation (epistaxis, hematemesis, hematochezia or hematuria). No cat required hospitalization as a result of these events. Median survival time from onset of therapy was 257 days (interquartile range [IQR] = 38-497) for all cats, 502 days (IQR = 171-663) for ATE cats, 725 days (IQR = 133-856) for cats with an ATE to two or more limbs and 301 days (IQR = 221-431) for cats with only one limb affected. Recurrence rate of ATE while on dual therapy was 16.7%; no cat newly developed an ATE while on dual therapy.

CONCLUSIONS AND RELEVANCE

Dual antithrombotic therapy with clopidogrel and rivaroxaban resulted in a low reported incidence of adverse events. Cats placed on dual therapy for an ATE event experienced a low rate of recurrence and effective thromboprophylaxis was achieved in cats with intracardiac thrombi or SEC.

Reference intervals for radiographic, echocardiographic and N-terminal pro B-type natriuretic peptide values in healthy kittens

OBJECTIVES

Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient population. The purpose of this study was to generate RIs for echocardiographic and radiographic quantification of cardiac size in healthy kittens.

METHODS

In total, 88 kittens aged 6-16 weeks were enrolled in this study. Physical examination, and radiographic and echocardiographic evaluations were performed without sedation. Thoracic radiographs and echocardiographic images were measured to establish RIs for vertebral heart score (VHS), cardiac thoracic ratio (CTR) and multiple echocardiographic variables. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured. Statistical correlations between echocardiographic parameters and age, body weight and sex were all evaluated and RIs were generated.

RESULTS

Low-grade heart murmurs were appreciated in 26/88 kittens (29.5%). Kittens had a median VHS of 9.5 vertebrae (95% RI 8.0-10.9) and a median CTR of 67.2% (95% RI 54.4-79.8%). Measured NT-proBNP levels were comparable to healthy adult cats with a median of 31 pmol/l (upper reference limit 75 pmol/l). Multiple moderate-to-strong correlations between body weight and age with various echocardiographic parameters were observed and allometric scaling was performed for body weight. RIs for echocardiographic parameters were generated based on patient weight using allometric scaling formulas. Tricuspid valve regurgitation was a common finding and was present in 37.5% (n = 33) of the kittens.

CONCLUSIONS AND RELEVANCE

This study establishes RIs for thoracic radiograph assessment, echocardiography and cardiac biomarkers in kittens, which fills a critical gap in the veterinary literature. The VHS reported in this study is higher than previously reported for adult cats.

Heart Rate and Heart Rate Variability of Rhesus Macaques (Macaca mulatta) Affected by Left Ventricular Hypertrophy

Hypertrophic cardiomyopathy (HCM) is frequently associated with sudden cardiac death, presumably due to the development of malignant arrhythmias. The risk of sudden cardiac death due to HCM has been reported to be predicted by assessing electrocardiographic (ECG) changes including frequencies and complexities of arrhythmias as well as heart rate variability (HRV) as an assessment of autonomic balance. Sudden cardiac death in association with naturally-occurring left ventricular hypertrophy (LVH) has been reported in a colony of rhesus macaques and is under investigation as a potential non-human primate model of human HCM. In the present study, 10 rhesus macaques with LVH and 10 without the signs of LVH confirmed by an echocardiographic examination were recruited for assessing ECG and HRV parameters. ECG morphology on 10-s, 6-lead ECG analysis, and the frequency and complexity of arrhythmias as well as HRV on 20-h ambulatory ECG Holter analyses were assessed. On the standard 10-s 6-lead ECG analysis, P wave and QRS complex duration as well as the QRS complex amplitude were significantly increased in the LVH-affected rhesus macaques compared to control rhesus macaques. Analysis of 20-h Holter monitoring revealed no statistically significant differences in the frequency or the complexity of arrhythmias between the LVH and the control groups. Several HRV parameters were smaller in the LVH group than the control group throughout the majority of Holter recordings showing periods of reduced variability, however, no statistically significant differences were achieved across groups and/or time points. These findings indicate that ECG analysis and Holter monitoring of rhesus macaques are feasible and that ECG morphological changes in association with LVH could be used as a possible component of an antemortem screening tool. The rhesus macaques of this study did not reveal clear indications of risk for sudden cardiac death. Further studies are necessary to determine the etiology of sudden cardiac death due in LVH affected rhesus macaques and identify if any parameters of arrhythmia assessment or HRV can be used to predict the development of sudden cardiac death.

Role of induced negative and positive emotions in sensitivity to itch and pain in women

BACKGROUND

Itch and pain are common symptoms in skin disease. It has been suggested that negative emotions may play a role in itch and pain. To date, however, the role of emotions has only been studied for pain in experimental studies, not yet for itch.

OBJECTIVES

To investigate the effects of negative and positive emotions on the sensitivity to itch and pain.

METHODS

Film fragments were used to induce a negative or positive emotional state in healthy women. Itch and pain were induced using the following somatosensory stimuli: electrical stimulation, histamine iontophoresis and the cold pressor test.

RESULTS

Results showed that the scores for itch and pain evoked by histamine and the cold pressor test, respectively, were significantly higher in the negative than in the positive emotion condition, whereas tolerance thresholds to electrical stimulation and the cold pressor test, and stimulus unpleasantness scores did not differ between the two conditions.

CONCLUSIONS

These findings for the first time indicate in an experimental design that emotions play a role in sensitivity to somatosensory sensations of both itch and pain.

A case report on fixation instability in Parkinson's disease with bilateral deep brain stimulation implants

We report on fixation instabilities in a patient diagnosed with Parkinson's disease (PD). This patient underwent deep brain stimulation (DBS) surgery bilaterally in the vicinity of the subthalamic nuclei (STN). Examination of the eye movements of this patient revealed marked fixation instability compared with a healthy age matched control. The eye movements occurring during fixation differed from other reports of fixation instabilities in that they interrupted fixation for only brief durations. These interruptive saccades (IS) had saccade-like amplitude velocity relationships. The frequency of these IS was higher in the patient with PD than in the healthy age matched control. Furthermore, the frequency of the IS in the patient reduced toward control with application of bilateral DBS in the vicinity of the STN. From our observations we conclude that fixation ability may be altered in PD and improved with DBS.

Patterns, incidence and predictive factors for pain after interventional radiology

AIM

To evaluate prospectively the pattern, severity and predictive factors of pain after interventional radiological procedures.

MATERIALS AND METHODS

All patients undergoing non-arterial radiological interventional procedures were assessed using a visual-analogue scale (VAS) for pain before and at regular intervals for 24 h after their procedure.

RESULTS

One hundred and fifty patients (87 men, mean age 62 years, range 18-92 years) were entered into the study. Significant increases in VAS score occurred 8 h after percutaneous biliary procedures (+47.7 mm, SD 14.9 mm; p=0.001), 6 h after central venous access and gastrostomy insertion (+23.7 mm, SD 19.5 mm; p=0.001 and +28.4 mm, SD 9.7 mm; p=0.007, respectively) and 4h after oesophageal stenting (+27.8 mm, SD 20.2 mm, p=0.001). Non-significant increases in VAS pain score were observed after duodenal and colonic stenting (duodenal: +5.13 mm, SD 7.47 mm; p=0.055, colonic: +23.3 mm, SD 13.10 mm, p=0.250) at a mean of 5h (range 4-6h). Patients reported a significant reduction in pain score for nephrostomy insertion (-28.4mm, SD 7.11 mm, p=0.001). Post-procedural analgesia was required in 99 patients (69.2%), 40 (28.0%) requiring opiates. Maximum post-procedural VAS pain score was significantly higher in patients who had no pre-procedural analgesia (p=0.003).

CONCLUSION

Post-procedural pain is common and the pattern and severity of pain between procedures is variable. Pain control after interventional procedures is often inadequate, and improvements in pain management are required.

6,6′-Bis(2-hydroxyphenyl)-2,2′-bipyridine manganese(III) complexes: A novel series of superoxide dismutase and catalase mimetics

A series of novel manganese(III) complexes is described based on a 6,6'-bis(2-hydroxyphenyl)-2,2'-bipyridine template. These complexes show superoxide dismutase and catalase activity. The effect of the aromatic substitution pattern on the SAR is described.

Vision readiness at Seymour Johnson Air Force Base

Ensuring that our forces are vision ready, i.e., they have the appropriate visual acuity, optical devices, and eye health to perform their mission, is essential on today's battlefield. A study was conducted at Seymour Johnson Air Force Base to determine the prevalence of vision readiness in a deploying fighter squadron. Of the 204 personnel screened, 59 wore glasses or contact lenses. Of these 59, 15 individuals (25%) were optically ready and 44 individuals (75%) were not optically ready to deploy. Optical readiness is defined as having the correct type and number of optical devices. Of the 15 individuals (25%) who were optically ready, 13 (87%) had had a professional eye examination within 12 months. Of the 44 individuals (75%) who were not optically ready, 36 (82%) had been examined within 1 year. Pearson's chi 2 test (chi 2 = 1.59, degrees of freedom = 3, significance = 0.66) indicated that there was no significant association between readiness and the date of the last examination. This study reveals that although personnel are having regular periodic professional eye examinations, optometry personnel, commanders, and deploying airmen must take a more active role in ensuring that our forces are vision ready.

Bacteria associated with pyothorax of dogs and cats: 98 cases (1989-1998)

OBJECTIVE

To determine the organisms most commonly isolated from pleural fluid from dogs and cats with pyothorax.

DESIGN

Retrospective study.

ANIMALS

51 dogs and 47 cats.

PROCEDURE

Results of bacteriologic culture of pleural fluid samples obtained by means of thoracentesis were obtained from medical records. To obtain information on in vitro antimicrobial susceptibility of organisms commonly isolated from dogs and cats, records of all dogs and cats examined during 1998 were reviewed, and information was obtained on identity and in vitro antimicrobial susceptibility of aerobic organisms isolated from samples other than urine or urinary tract samples.

RESULTS

Median ages of dogs and cats were 4 years. Bacteria were isolated from pleural fluid samples from 47 of 51 (92%) dogs and 45 of 47 (96%) cats. Obligate anaerobic bacteria were isolated from 28 dogs and 40 cats. A mixture of obligate anaerobic and facultative bacteria was isolated from 17 dogs and 20 cats. Samples from cats most often yielded a member of the nonenteric group (most commonly members of the genus Pasteurella), whereas those from dogs more often yielded a member of the family Enterobacteriaceae (most commonly E coli).

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that antimicrobial agents chosen for the initial treatment of dogs and cats with pyothorax should be active against a mixture of obligate anaerobic and facultative bacteria.

Signal transduction by B and T cells early after bone marrow transplantation: B cell calcium flux responses are intact whereas lack of CD4 cells accounts for impaired T cell responses

We previously found that intracellular ionized calcium ([Ca2+]i) flux responses after anti-CD3 crosslinking of CD3/TCR on T cells from allogeneic and autologous bone marrow transplant (BMT) recipients were impaired, Yamagami et al. J Clin Invest 1990; 86: 1347-1351. In contrast to the earlier study, this study focuses on identifying the T cell subset(s) responsible for the defects and determining if B cell responses are defective in BMT recipients early after BMT. In 37 recipients after anti-CD3 stimulation of PBL, a mean of 25.9% responding T cells was observed. This was significantly lower than the mean of 43.6% responding T cells in PBL from 21 normals (P < 0.001). The proportion of responding T cells in PBL (T PBL) increased in the recipients with time after BMT. By 6 months after BMT, the mean percent of responding T PBL approached the normal range. On the other hand, a mean of 8.1% responding B cells in anti-IgM crosslinked PBL from 24 recipients was not different from the mean of 7.4% responding B cells in anti-IgM crosslinked PBL from 16 normals (P = 0.6). Four color flow cytometry was used to identify subpopulations of lymphocytes. Enriched B cells were tested by gating out CD3+ and CD56+ cells to confirm the results of unfractionated PBL. In 8 recipients, the mean percent responding B cells was 36.6% and was not different from 6 normals (mean = 41.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

The anatomy of the inferior petrosal sinus, glossopharyngeal nerve, vagus nerve, and accessory nerve in the jugular foramen

PURPOSE

To define the variations of the courses of the cranial nerves and the inferior petrosal sinuses as they enter and traverse the jugular foramen.

METHODS

Thirty-nine cadaveric specimens containing the jugular foramen were scanned with 1-mm contiguous axial and coronal CT sections. Each specimen was dissected to evaluate the position of the cranial nerves and inferior petrosal sinus as they entered the jugular foramen.

RESULTS

The glossopharyngeal nerve entered the most superior, anterior, and medial aspect of the jugular foramen and descended in the anterior portion of the jugular foramen, often within a groove. The vagus and accessory nerves could not be separated by CT. They entered the jugular foramen most often anterior or anterior and inferior to the jugular spine of the temporal bone and descended in a position ranging from medial to anterior to the jugular vein. The inferior petrosal sinus most often coursed inferior to the horizontal portion of the glossopharyngeal nerve and entered the jugular system in the jugular foramen, at the exocranial opening or below the skull base. A pars nervosa and pars venosa could be identified only at the endocranial opening, where the jugular spine separated the pars nervosa containing the inferior petrosal sinus and three cranial nerves from the pars venosa containing the jugular vein.

CONCLUSION

Our evaluation demonstrated anatomic variation in the area of the jugular foramen.

The short-term effects of a fire safety education program for the elderly

The high risk of fire death and injury among elderly people is well documented. To be effective, fire safety education must reach older adults in the settings in which they reside: nursing homes and other long-term care institutions, board and care homes, and independent living facilities including the person's own home. Training must also be targeted at the people who are responsible for fire safety. In the case of the nursing home or board and care home, the responsible people are the staff and owners. In the case of the majority of older adults who live independently in their homes, it is either the individual or family members. These programs must also be comprehensive. A fire safety education curriculum was developed by a group of experts in a variety of related fields including fire safety, gerontology, health care industry, developmental disabilities, research, and instructional design. Older adults were included in each planning session. Based on that curriculum, workshops and workshop materials were developed for each of the three target populations: staff of health care facilities, staff and owners of board and care homes, and elderly people living independently in their homes. Materials included both print and audiovisuals. A pilot test of each workshop was conducted to test the short-term effects of the programs. Results indicated significant gains in knowledge for all groups and a significant improvement in positive attitudes toward fire safety for most participants. Measures of effects of the programs on intentions to change fire safety practices indicated a potential for change. Results also showed that the measured traits, knowledge of fire safety and attitudes toward fire safety, were relatively stable.