Pine needle abortions in cattle due to consumption of Pinus ponderosa in Argentina: Case reports

Two outbreaks of pine needle abortions in cattle are here reported for the first time in Argentina. The cases occurred in Chubut and Neuquén provinces in the Patagonia region, causing 29.6% and 9% of abortions in each herd respectively. In both outbreaks, the dams were in the last third of gestation, and, due to a period of cold, snow and lack of available forage, they gained access to Pinus ponderosa and Pinus contorta forests. No pathological lesions, serological, molecular, or microbiological evidence of infectious causes were observed in any of the six fetuses analyzed. Microhistological analysis of feces confirmed higher presence of fragments of Pinus spp. needles in the diet of affected dams than in that of non-affected ones (12.2 vs 3.0%). Moreover, toxicological analysis showed higher tetrahydroagathic acid in the sera of affected dams than in that of non-affected ones (10.05 vs 2.81 ppm). In addition, this acid was detected in different fetal fluids (3.6-8.1 ppm) of the six fetuses analyzed. Interestingly, isocupressic acid was detected only in needles of P. ponderosa, and its content was lower than that found in other areas of the world (0.31 and 0.5% in Chubut and Neuquén respectively). These results confirm that the consumption of P. ponderosa by dams could have been the cause of these abortion outbreaks, a fact that should be considered as differential diagnosis in abortions of cattle, especially in silvopastoral systems of Argentina.

P-102 Progesterone luteal-phase support during IUI cycle should be added depending on women age and/or on previous mid-luteal progesterone assessment to promote live births

Study question

To determine the Mid-luteal progesterone (MLP) threshold which could condition live-birth (LB) after IUI, and effects of additional progesterone luteal-phase support (LPS) in subsequent cycles.

Summary answer

MLP threshold is age-dependant. LPS should only be used if previous MLP is below the age related threshold, as its inappropriate use reduces LB rate.

What is known already

Progesterone is essential to prepare and maintain the uterus suitable for a possible pregnancy. During IUI, it is not clear if LPS is beneficial to obtain a live birth, and whether it should be introduced systematically or only in women with a low MLP assessment during a previous cycle.

Study design, size, duration

In an audit purpose, we performed a retrospective uni-centric analysis of 705 IUl cycles performed from January 2015 to March 2020 in couples which fertility work-up concluded to unexplained infertility, mild male infertility or PCOS with no pregnancy after 3 cycles of clomiphene citrate. Our primary outcome was LB.

Participants/materials, setting, methods

IUI was performed after ovarian stimulation with gonadotrophins. MLP was assessed using immuno assay method, days 7 post-IUI. LPS (Cyclogest® 200 mg/day) was added when consultant considered former cycle’s MLP was too low. MLP thresholds were defined without LPS using a ROC Curve, considering subgroups of patient’s age. LB rate was analyzed using Multivariate Gill Andersen models to take into account repetitions of IUI cycles. Prognostic factors for LBR were investigated using a Cox model.

Main results and the role of chance

Women were 33.6±3.9 years old. We obtained 99 (14%) LB.

In women who didn’t receive LPS, regardless of their age, MLP threshold was 57.5 nmo/l (AUC=0.57). Multivariate logistic regression modeling identified MLP assessment as a significant prognostic factor for obtaining LB after IUI (OR = 1.668, CI95%[1.023; 2.721], p = 0.0402).

When also considering women’s age, a cut-off of 36 years old was computed which allowed more fitted age-related MLP thresholds for obtaining LB after IUI. In women <36 years old, MLP threshold was 39.5 nmol/l (AUC=0.57) whereas it was 60.5 nmol/L (AUC=0.57) for age ≥36. Age-related thresholds were more predictive of LB than initial age independent threshold according to Akaike Criteria (1168.48 versus 1198.96, respectively).

Using the whole population (i.e. receiving or not LPS), the multivariate analysis highlighted that, compared to women with MLP above their age related threshold who (appropriately) didn’t receive LPS:

- Women below their age-related MLP threshold who appropriately receive LPS had similar LB rate: OR = 0.5474, CI95%[0.1857-1.6138], p = 0.2747. - Women below their age-related MLP threshold who didn’t receive LPS (inappropriately) had a significantly lower LB rate: OR = 0.4794, CI95%[0.2727-0.8427], p = 0.0106. - Women above their age-related MLP threshold who received LPS (inappropriately) had a significantly lower LB rate: OR = 0.5627, CI95%[0.3302-09587], p = 0.0433.

Limitations, reasons for caution

Because of the retrospective design of our study and because of the limited number of included couples, our results should be considered with caution. Confirmation is needed with further prospective studies with a larger number of participants.

Wider implications of the findings

Our study highlight for the first time the impact of age on the LPS strategy after IUI, and emphases the need for personalized fertility medicine based on previous MLP assessment when considering LPS.

Trial registration number

No needed, NHS Audit

Expectations and experiences of practising veterinarians throughout an 8-week mindfulness-based stress reduction programme

AIMS

To explore practising veterinarians' expectations of an 8-week mindfulness training programme, their perceived barriers to participating in the programme, their experiences of the programme and the extent to which they continued to engage in mindfulness practices following training.

METHODS

Participants were 10 companion animal veterinarians practising in Auckland, New Zealand. All took part in an 8-week mindfulness-based training programme. A longitudinal qualitative design was used: data were collected by structured interviews prior to the programme, upon completion of the programme and 3 months after completion. Data were analysed using thematic analysis to identify recurring themes, or patterns, within the data.

RESULTS

Before commencing the programme, participants generally thought mindfulness training would provide some benefits for wellbeing but were otherwise not clear on what to expect. The main concerns about taking part were time constraints and apprehensions about potentially having to share personal information, and consequently how they might be perceived by other participants. On completion of the training programme, the opportunity to share experiences within the group with the support of a trained facilitator was reported as the most valuable aspect of the programme, rather than the mindfulness practices themselves. At the 3-month follow-up, participants reported they had learnt some useful techniques for managing stressful thoughts and situations, but despite the perceived benefits, few were still practicing mindfulness techniques.

CONCLUSIONS AND CLINICAL RELEVANCE

Training in mindfulness practices may have some value for helping practicing veterinarians manage their wellbeing, but it is not a complete solution in itself. Participants reported that the greatest benefits came from facilitated peer support.

P14.18 Patient and Public Involvement to define patient-centred outcomes from National Cancer Datasets

BACKGROUND

GlioCova uses linked national cancer data on all 51 000 adult patients with a primary brain tumour in England (2013 - 2018) to understand patterns of care, treatment, and outcomes in patients with glioma (http://wwwf.imperial.ac.uk/blog/gliocova/). A key aim is the use of patient and carer input in defining patient-centered outcomes. We have held multiple Patient & Public Involvement (PPI) sessions with patients and carergivers and data analysts to understand what patient and caregivers want to know about brain tumours.

MATERIAL AND METHOD

We used a modified Delphi method. The online PPI sessions (Zoom) consisted of two presentations, open discussions, and Q&As. We made the sessions as interactive as possible by using Mentimeter and an interactive online white board (Explain Everything). Pre-reading material was circulated via email. Attendees (6–14 per session) covered a wide range of ages (30–75), diagnoses (GBM, recurrent gliomas, low grade gliomas, ependymoma); patients, caregivers, neuro-oncology staff, data analysts and basic scientists. Work was conducted in line with the INVOLVE PPI guidance.

RESULTS

We identified four questions that were of interest to patients and had correlates in the data:

Patients and caregivers were also interested in the impact of diet, quality of life, social life, and exercise. However, these data cannot be answered using the current national data.

CONCLUSION

Our PPI work has helped us to identify and prioritise questions to ask of the data. Ongoing PPI work will provide a wider perspective and identify knowledge gaps for future research. Patients and caregivers report feeling empowered, being part of a team, feeling like they had given something back and done something meaningful for the research community and other patients. Patients and caregivers also felt that they had an enriched understanding of the data that is collected. As this process is an iterative process, we will hold more PPI sessions to identify and prioritise topics to analyse.

Cytotoxic T lymphocyte antigen-4 regulates development of xenogenic graft versus host disease in mice via modulation of host immune responses induced by changes in human T cell engraftment and gene expression

Graft versus host disease (GvHD) is a major clinical problem with a significant unmet medical need. We examined the role of cytotoxic T lymphocyte antigen-4 (CTLA-4) in a xenogenic GvHD (xeno-GvHD) model induced by injection of human peripheral mononuclear cells (hPBMC) into irradiated non-obese diabetic (NOD) SCID gamma (NSG) mice. Targeting the CTLA-4 pathway by treatment with CTLA-4 immunoglobulin (Ig) prevented xeno-GvHD, while anti-CTLA-4 antibody treatment exacerbated the lethality and morbidity associated with GvHD. Xeno-GvHD is associated with infiltration of hPBMCs into the lungs, spleen, stomach, liver and colon and an increase in human proinflammatory cytokines, including interferon (IFN)-γ, tumor necrosis factor (TNF)-α and interleukin (IL)-5. Infiltration of donor cells and increases in cytokines were attenuated by treatment with CTLA-4 Ig, but remained either unaffected or enhanced by anti-CTLA-4 antibody. Further, splenic human T cell phenotyping showed that CTLA-4 Ig treatment prevented the engraftment of human CD45⁺ cells, while anti-CTLA-4 antibody enhanced donor T cell expansion, particularly CD4⁺ (CD45RO⁺ ) subsets, including T box transcription factor TBX21 (Tbet)⁺ CXCR3⁺ and CD25⁺ forkhead box protein 3 (FoxP3) cells. Comprehensive analysis of transcriptional profiling of human cells isolated from mouse spleen identified a set of 417 differentially expressed genes (DEGs) by CTLA-4 Ig treatment and 13 DEGs by anti-CTLA-4 antibody treatment. The CTLA-4 Ig regulated DEGs mapped to down-regulated apoptosis, inflammasome, T helper type 17 (Th17) and regulatory T cell (T_reg ) pathways and enhanced Toll-like receptor (TLR) receptor signaling, TNF family signaling, complement system and epigenetic and transcriptional regulation, whereas anti-CTLA-4 antibody produced minimal to no impact on these gene pathways. Our results show an important role of co-inhibitory CTLA-4 signaling in xeno-GvHD and suggest the therapeutic utility of other immune checkpoint co-inhibitory pathways in the treatment of immune-mediated diseases driven by hyperactive T cells.

Widening access to veterinary education: descriptive analysis of ethnicity, societal representation and educational background of applicants to veterinary education in Aotearoa New Zealand

AIMS

To describe the ethnicity of domestic applicants for selection into the professional phase of veterinary education in Aotearoa New Zealand from 2003 to 2019, and to compare this with the ethnic composition of New Zealand society. This study also aims to explore whether there are differences in the demographic features and educational background of Māori applicants compared to non-Māori applicants that may be relevant to widening access to veterinary education.

METHODS

This study was conducted with a Kaupapa Māori research methodology. Data for all applicants to the Bachelor of Veterinary Science programme at Massey University (Palmerston North, NZ) from 2003 to 2019 were retrieved from the university's Student Management System and the School of Veterinary Science selection application databases. Self-identified ethnicity was analysed in four time periods (2003-2006, 2007-2012, 2013-2016, 2017-2019) defined by factors that might influence whether an individual chose to apply for selection into the veterinary programme. Gender, age, previous university experience, decile and type of high school, and being first in family to attend university were compared between Māori and non-Māori.

RESULTS

From 2003 to 2019, 3,819 individuals submitted 4,802 applications for selection into the veterinary programme. Across all time periods, applicants who identified as Māori (274/4,802; 5.7%) or Pacific (56/4,802; 1.2%) were underrepresented compared to the New Zealand population (Māori 16.5%; Pacific 8.1%), while applicants who identified as European (4,035/4,802; 84%) were over-represented (70.2% of the New Zealand population). The proportion of Māori (p = 0.82) and Pacific (p = 0.31) applicants did not change over time, while the proportion of European applicants decreased from 853/968 (88.1%) to 823/977 (84.2%; p < 0.001). Compared to non-Māori, Māori applicants were more likely to have attended a lower decile school (p < 0.001), have attended a state rather than private or overseas school (p = 0.003) and to have been the first in their family to attend university (p = 0.001).

CONCLUSIONS

Māori are underrepresented in the veterinary applicant pool and veterinary profession in comparison to the New Zealand population. Additionally, Māori applicants differed from non-Māori applicants in pre-university factors that are barriers to university attendance. Implementing activities and processes aimed at widening veterinary programme access with the eventual goal of improving the ethnic representation of the veterinary workforce needs to be a priority for the university and profession.

Effects of feeding graded levels of black spruce needles and branches on beef cow performance and health during mid to late gestation

Pregnant beef cows (56; 727 ± 102 kg body weight) in their second trimester were used to examine black spruce (BSP) needles and branches for replacing alfalfa silage in wintering cow diets. Five dietary treatments assessed BSP inclusion rates (0%, 15%, 22.5%, 30%, and 37.5% in the diet) for 92 d up until 2 wk before start of calving using a randomized complete block design (10–12 cows per treatment). There were linear decreases (P < 0.001) in total weight gain, average daily gain, and dry matter intakes (DMI) as amounts of dietary BSP increased. Low DMI feeding BSP may be attributed to palatability issues and lower rates of digestion. Changes in body condition score increased (P < 0.003) as dietary BSP increased. These effects are supported by corresponding linear decreases (P < 0.001) for changes in rump fat cover and increases (P < 0.001) in serum non-esterified fatty acids as dietary BSP increased. After feeding the test diets, there were no dietary treatment differences (P > 0.42) for calf birth and weaning weights as well as cow pregnancy and culling rates. Based on this study, incorporation of BSP into gestating cow diets cannot be recommended.

A Fibromyxoid Stromal Response is Associated with Muscle Invasion in Canine Urothelial Carcinoma

Canine urothelial carcinoma (UC) is the most common type of cancer of the lower urinary tract and tends to affect elderly neutered female dogs, with a high predisposition for Scottish terriers. Tumour stroma, inflammation and necrosis are poorly characterized in canine UC and their role as prognostic factors is unknown. The aims of this study were to (1) assess histologically 381 canine UCs, with emphasis on myxoid tumour stroma, inflammation and necrosis and (2) assess possible associations between these features and the available epidemiological data as well as bladder wall muscle invasion. In 103 of 381 (27%) cases, the stroma was mixed collagenous and myxoid (fibromyxoid), which was strongly associated with invasive growth of muscle (P <0.0001). Peritumoural and intratumoural inflammation was present in 308 of 345 (89%) and 287 of 381 (75%) cases, respectively, and was mostly mild and lymphoplasmacytic. One hundred and fifteen of the 381 (30%) cases showed a variable eosinophilic inflammation and 58 of 381 (15%) presented with formations of one or several lymphoid follicles. Twenty-four percent (91 of 381) of cases had tumour necrosis, which was typically mild. In 83 of 91 (91%) cases, the necrosis was comedo-like. Moderate to severe tumour necrosis was associated with the presence of moderate to predominant fibromyxoid tumour stroma (P <0.02). The results of this study indicate that fibromyxoid stroma is common in canine UC and is a strong indicator for invasive growth of muscle, which is consistent with a poor prognosis. Based on histomorphology, tumour necrosis in canine UC is best described as comedonecrosis.

Best-Link Matching of Scottish Health Data Sets

Methods are described used to link the Community Health Index and the National Health Service Central Register (NHSCR) in Scotland to provide a basis for a national patient index. The linkage used a combination of deterministic and probability matching techniques. A best-link principle was used by which each Community Health Index record was allowed to link only to the NHSCR record with which it achieved the highest match weight. This strategy, applied in the context of two files which each covered virtually the entire population of Scotland, increased the accuracy of linkage approximately a thousand-fold compared with the likely results of a less structured probability matching approach. By this means, 98.8% of linkable records were linked automatically with a sufficient degree of confidence for administrative purposes.

The safety and efficacy of benzbromarone in gout in Aotearoa New Zealand

BACKGROUND

Benzbromarone is a potent uricosuric but is not widely available due to concerns about hepatotoxicity. In Aotearoa New Zealand, benzbromarone has been available since April 2013, subject to funding restrictions, for patients with inadequate urate-lowering response or intolerance to allopurinol and probenecid.

AIM

To assess the safety and efficacy of benzbromarone in a real-life setting.

METHODS

All patients who received funding for benzbromarone from 1 April 2013 to 30 September 2014 were identified. Prescribers were sent a questionnaire for each individual. Information on demographics, efficacy of previous urate-lowering drugs and reasons for discontinuation were collected. Specific information about the dose, effect on serum urate, adverse effects and liver function tests after commencing benzbromarone was recorded.

RESULTS

Completed questionnaires were returned for 123 of 164 (75%) patients. Mean (SD) serum urate prior to benzbromarone was 0.57 (0.12) mmol/L, and estimated glomerular filtration rate was 50.3 (22.8) mL/min/1.73 m(2) . The median dose of benzbromarone was 100 mg/day (25-200 mg/day). Six months after commencing benzbromarone, mean (SD) serum urate was 0.35 (0.12) mmol/L. Benzbromarone-related adverse events included rash (n = 4), diarrhoea (n = 9), nausea (n = 6) and urate stones (n = 3). Liver function test abnormalities were uncommon and tended to be mild. There were 14 patient deaths; none was considered related to benzbromarone. Allopurinol had been prescribed prior to benzbromarone in 117 of 123 patients; median maximum allopurinol dose was 200 mg/day (range 25-600 mg/day), and 19% patients received allopurinol >300 mg/day.

CONCLUSION

Benzbromarone provides useful urate-lowering efficacy and does not appear unsafe in patients with gout. Urate-lowering therapy prescribing requires further optimisation.

Preliminary investigation of urine N-telopeptide concentration as a biomarker of bone resorption in dogs receiving glucocorticoids

OBJECTIVES

The influence of glucocorticoid therapy on bone resorption in dogs using a urine N-telopeptide assay was investigated.

MATERIALS AND METHODS

Thirty-one dogs receiving oral glucocorticoids and 31 age-matched healthy control dogs were enrolled. Urine N-telopeptide concentration was measured using a commercially available immunoassay and results were expressed as a ratio against urinary creatinine concentration. Dogs receiving glucocorticoids were divided into three subgroups based on daily glucocorticoid dose and three subgroups based on treatment duration. Urine N-telopeptide concentration was then compared between groups.

RESULTS

Urine N-telopeptide concentration was significantly higher in dogs receiving glucocorticoids compared to the control group.

CLINICAL SIGNIFICANCE

This preliminary study demonstrates significant increase in urine N-telopeptide concentration in dogs receiving glucocorticoid therapy compared to control dogs. Further studies are needed to assess whether this increase in urine N-telopeptide concentration correlates with decreases in bone mineral density as has been identified in humans.

Identification of imidazo[1,2-b]pyridazine TYK2 pseudokinase ligands as potent and selective allosteric inhibitors of TYK2 signalling

As a member of the Janus (JAK) family of non-receptor tyrosine kinases, TYK2 mediates the signaling of pro-inflammatory cytokines including IL-12, IL-23 and type 1 interferon (IFN), and therefore represents an attractive potential target for treating the various immuno-inflammatory diseases in which these cytokines have been shown to play a role. Following up on our previous report that ligands to the pseudokinase domain (JH2) of TYK2 suppress cytokine-mediated receptor activation of the catalytic (JH1) domain, the imidazo[1,2-b]pyridazine (IZP) 7 was identified as a promising hit compound. Through iterative modification of each of the substituents of the IZP scaffold, the cellular potency was improved while maintaining selectivity over the JH1 domain. These studies led to the discovery of the JH2-selective TYK2 inhibitor 29, which provided encouraging systemic exposures after oral dosing in mice. Phosphodiesterase 4 (PDE4) was identified as an off-target and potential liability of the IZP ligands, and selectivity for TYK2 JH2 over this enzyme was obtained by elaborating along selectivity vectors determined from analyses of X-ray co-crystal structures of representative ligands of the IZP class bound to both proteins.

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation

Background

Iron deficiency causes long-term adverse consequences for children and is the most common nutritional deficiency worldwide. Observational studies suggest that iron deficiency anemia protects against Plasmodium falciparum malaria and several intervention trials have indicated that iron supplementation increases malaria risk through unknown mechanism(s). This poses a major challenge for health policy. We investigated how anemia inhibits blood stage malaria infection and how iron supplementation abrogates this protection.

Methods

This observational cohort study occurred in a malaria-endemic region where sickle-cell trait is also common. We studied fresh RBCs from anemic children (135 children; age 6–24 months; hemoglobin < 11 g/dl) participating in an iron supplementation trial (ISRCTN registry, number ISRCTN07210906) in which they received iron (12 mg/day) as part of a micronutrient powder for 84 days. Children donated RBCs at baseline, Day 49, and Day 84 for use in flow cytometry-based in vitro growth and invasion assays with P. falciparum laboratory and field strains. In vitro parasite growth in subject RBCs was the primary endpoint.

Findings

Anemia substantially reduced the invasion and growth of both laboratory and field strains of P. falciparum in vitro (~ 10% growth reduction per standard deviation shift in hemoglobin). The population level impact against erythrocytic stage malaria was 15.9% from anemia compared to 3.5% for sickle-cell trait. Parasite growth was 2.4 fold higher after 49 days of iron supplementation relative to baseline (p < 0.001), paralleling increases in erythropoiesis.

Interpretation

These results confirm and quantify a plausible mechanism by which anemia protects African children against falciparum malaria, an effect that is substantially greater than the protection offered by sickle-cell trait. Iron supplementation completely reversed the observed protection and hence should be accompanied by malaria prophylaxis. Lower hemoglobin levels typically seen in populations of African descent may reflect past genetic selection by malaria.

Funding

National Institute of Child Health and Development, Bill and Melinda Gates Foundation, UK Medical Research Council (MRC) and Department for International Development (DFID) under the MRC/DFID Concordat.

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P. falciparum laboratory and field strains invade and grow less efficiently in RBCs from anemic children.

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Deficits in invasion and growth for erythrocytic stage P. falciparum are reversed when RBCs are used from anemic children receiving iron supplementation for 49 and 84 days.

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The population level impact of protection against malaria from anemia was greater than that for sickle-cell trait.

The long-term consequences of anemia are severe, and it is easily treatable. However, concerns remain about the safety of iron supplements, particularly for children in malaria-endemic countries lacking adequate access to health services. We used RBCs from Gambian children before, during, and after 12 weeks of daily iron supplementation for in vitro P. falciparum assays. P. falciparum invasion and growth was decreased in anemic RBCs and increased after 49 days of iron supplementation relative to baseline (p < 0.001), paralleling increases in young RBCs, which the parasite prefers. The parasite growth protection from anemia was substantial, providing greater population level impact than sickle-cell trait.

Increased urinary dopamine excretion in association with bilateral carotid body tumours - clinical, biochemical and genetic findings

This report describes a rare case of a patient with increased urinary dopamine excretion in association with bilateral carotid body tumours. Excretion of adrenaline, noradrenaline, metadrenaline, normetadrenaline and 4-hydroxy-3-methoxymandelic acid (HMMA) were within the reference ranges, and an 123I-meta-iodobenzylguanidine (MIBG) scan showed uptake in the neck masses, with no other abnormal uptake anywhere else in the body. The patient is being managed conservatively as the tumours are not amenable to resection on account of their size and vascularity. There are only four previous case reports of dopamine-secreting tumours of the carotid body described in the literature, all of whom were women. The tumours were unilateral in three cases and bilateral in the fourth case. Familial cases of carotid body tumours have a higher prevalence of bilateral tumours than non-familial cases. Recent reports in the literature have suggested that a significant number of patients with extra-adrenal catecholamine-secreting paragangliomas have a genetic mutation in one of the identified susceptibility genes for catecholamine-secreting tumours, despite having no other affected family members, and a mutation has been found in the succinate dehydrogenase gene for this patient.

Understanding the CD28/CTLA-4 (CD152) pathway and its implications for costimulatory blockade

T cell activation is a key event in the adaptive immune system and vital in the generation of protective cellular and humoral immunity. Activation is required to generate CD4 effector T cell responses and provide help for B cell and cytotoxic T cell responses. While defective T responses to foreign antigen result in infectious pathology, over-reactive T cell responses against self-antigens result in autoimmunity and, in a transplantation setting, tissue rejection. Understanding how T cell activation is normally regulated is critical to therapeutic intervention and the CD28/CTLA-4 (CD152) pathway represents the initial activation checkpoint in molecular terms. In particular, while the CTLA-4 pathway is well established as an essential regulator of self-reactivity, its mechanism of action is still uncertain. Such mechanistic issues are important given its central position in T cell activation and the increasing number of therapeutic modalities aimed at manipulating the CD28/CTLA-4 pathway. Here, we provide an updated view of CTLA-4 biology, reviewing the established features of the system and highlighting its interplay with CD28. We then discuss how recent progress in our understanding of this pathway affects our interpretations following intervention.

Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting

OBJECTIVE

Each year in the US ∼50 000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). The objective of this study is to compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program.

STUDY DESIGN

Retrospective review (2007 to 2009). Infants were born to mothers maintained on methadone in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 patients) was inpatient, whereas the combined group (46 patients) was outpatient.

RESULT

Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, gestational age (GA) and the incidence of prematurity (34 and 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25 days; P<0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21 days, P<0.01), the cumulative methadone dose was similar (3.6 vs 3.1 mg kg(-1), P=0.42). Follow-up information (at least 3 months) was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ≤72 h from hospital discharge. Breastfeeding was more common among infants in the combined group (24 vs 8% P<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (34 to 36 weeks GA) was the only predictor for hospital readmission for NAS in both groups (P=0.02, OR 5). Average hospital cost for each infant in the combined group was $13 817 less than in the traditional group.

CONCLUSION

A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long-term benefits of the combined approach on infants and their families.

Measurement of an exceptionally weak electron-phonon coupling on the surface of the topological insulator Bi2Se3 using angle-resolved photoemission spectroscopy

Gapless surface states on topological insulators are protected from elastic scattering on nonmagnetic impurities which makes them promising candidates for low-power electronic applications. However, for widespread applications, these states should have to remain coherent at ambient temperatures. Here, we studied temperature dependence of the electronic structure and the scattering rates on the surface of a model topological insulator, Bi2Se3, by high-resolution angle-resolved photoemission spectroscopy. We found an extremely weak broadening of the topological surface state with temperature and no anomalies in the state's dispersion, indicating exceptionally weak electron-phonon coupling. Our results demonstrate that the topological surface state is protected not only from elastic scattering on impurities, but also from scattering on low-energy phonons, suggesting that topological insulators could serve as a basis for room-temperature electronic devices.

Photoemission spectroscopy of magnetic and nonmagnetic impurities on the surface of the Bi2Se3 topological insulator

Dirac-like surface states on surfaces of topological insulators have a chiral spin structure that suppresses backscattering and protects the coherence of these states in the presence of nonmagnetic scatterers. In contrast, magnetic scatterers should open the backscattering channel via the spin-flip processes and degrade the state's coherence. We present angle-resolved photoemission spectroscopy studies of the electronic structure and the scattering rates upon the adsorption of various magnetic and nonmagnetic impurities on the surface of Bi2Se3, a model topological insulator. We reveal a remarkable insensitivity of the topological surface state to both nonmagnetic and magnetic impurities in the low impurity concentration regime. Scattering channels open up with the emergence of hexagonal warping in the high-doping regime, irrespective of the impurity's magnetic moment.

Electronic structure of the topological insulator Bi2Se3 using angle-resolved photoemission spectroscopy: evidence for a nearly full surface spin polarization

We performed high-resolution spin- and angle-resolved photoemission spectroscopy studies of the electronic structure and the spin texture on the surface of Bi2Se3, a model TI. By tuning the photon energy, we found that the topological surface state is well separated from the bulk states in the vicinity of kz = Z plane of the bulk Brillouin zone. The spin-resolved measurements in that region indicate a very high degree of spin polarization of the surface state, ~0.75, much higher than previously reported. Our results demonstrate that the topological surface state on Bi2Se3 is highly spin polarized and that the dominant factors limiting the polarization are mainly extrinsic.

Diphasic postsynaptic potential: a chemical synapse capable of mediating conjoint excitation and inhibition

Two identified interneurons in each buccal ganglion of Aplysia can mediate conjoined excitation and inhibition to a single follower cell. A single presynaptic action potential in one of these interneurons produces a diphasic, depolarizing-hyperpolarizing synaptic potential apparently as a result of a single transmitter acting on two types of postsynaptic receptors in the follower cell. These receptors produce synaptic potentials with differing reversal potentials, ionic conductances, time courses, rates of decrement with repetition, pharmacological properties, and functional consequences. The excitatory receptor controls a sodium conductance, the inhibitory receptor controls a chloride conductance. Both components of the synaptic potentials can be produced by iontophoretic application of acetylcholine on the cell body of the follower cell, and each component is differentially sensitive to different cholinergic blocking agents.

Evaluation of anti-IL-6 monoclonal antibody therapy using murine type II collagen-induced arthritis

Interleukin-6 is a multifunctional cytokine that is critical for T/B-cell differentiation and maturation, immunoglobulin secretion, acute-phase protein production, and macrophage/monocyte functions. Extensive research into the biology of IL-6 has implicated IL-6 in the pathophysiology and pathogenesis of RA. An anti-murine IL-6 mAb that neutralizes mouse IL-6 activities was tested in animal model of collagen-induced arthritis. Prophylactic treatment with anti-IL-6 mAb significantly reduced the incidence and severity of arthritis compared to control mAb treated mice. The mitogenic response of B and T cells isolated from the lymph nodes of anti-IL-6 treated mice was significantly reduced compared to cells isolated from control mAb treated mice. The overall histopathology score for paws from the anti-IL-6 treated mice was significantly reduced when compared to paws from mice treated with control mAb, including both inflammatory (synovitis and pannus) and erosive (erosions and architecture) parameters. Reduced loss of cartilage matrix components was also observed in the anti-IL-6 treated mice. Collectively, these data suggest that IL-6 plays a major role in the pathophysiology of rheumatoid arthritis, and thus support the potential benefit of anti-IL-6 mAb treatment in rheumatoid arthritis patients.

Mimosa tenuiflora as a cause of malformations in ruminants in the northeastern Brazilian semiarid rangelands

Craniofacial anomalies, eye malformations, and permanent flexures of the forelimbs are common malformations seen in ruminants grazing semiarid rangelands of Northeastern Brazil. To investigate the cause of these malformations, we fed 2 suspected plants, Mimosa tenuiflora or Prosopis juliflora, to groups of 4 pregnant goats each. Fresh green M. tenuiflora was collected daily and fed ad libitum to 4 goats in group 1 throughout pregnancy. This treatment group also received a supplemental feed concentrate equivalent to 1% body weight. Four goats in group 2 received a ration with 70% of P. juliflora pods and 30% hay throughout pregnancy. Four control goats were fed supplemental feed concentrate (1% body weight) and hay ad libitum throughout pregnancy. Goats treated with P. juliflora pods and the control goats delivered 9 normal kids. The four goats that were fed M. tenuiflora during pregnancy delivered 4 kids, 3 of which had abnormalities similar to those observed in field cases, including cleft lip, unilateral corneal opacity, ocular bilateral dermoids, buphthalmos with a cloudy brownish appearance of the anterior chamber due to an iridal cyst, and segmental stenosis of the colon. Malformations induced experimentally by M. tenuiflora were similar to those observed in field cases, suggesting that M. tenuiflora is a cause of the field cases observed in the Brazilian semiarid rangelands.

The effects of indomethacin tocolysis on the postnatal response of the ductus arteriosus to indomethacin in extremely low birth weight infants

BACKGROUND

Antenal indomethacin reportedly decreases the responses of a symptomatic patent ductus arteriosus (sPDA) to postnatal indomethacin treatment. Whether a similar exposure affects the responses to indomethacin prophylaxis is unknown.

OBJECTIVE

To evaluate the clinical responsiveness of ductus arteriosus to indomethacin prophylaxis and to the treatment of sPDA in extremely low birth weight (ELBW) infants following indomethacin tocolysis.

METHODS

Retrospective cohort study of 58 ELBW infants whose mothers received indomethacin tocolysis (study) and 58 ELBW infants whose mothers did not (controls), matched by gender, gestational age (GA), birth weight and postnatal sPDA management (prophylaxis or early treatment).

RESULTS

Indomethacin was used as a tocolytic at a median dose of 250 mg, for a duration of 2 days, and ending 1 day before delivery. Study and control mothers were comparable in demographics, antenatal steroid use, cesarean delivery, but were different in the incidence of preeclampsia and preterm labor. Study and control infants were similar in birth weight, GA, indomethacin prophylaxis, early sPDA treatment, mortality, necrotizing enterocolitis, severe intraventricular hemorrhage and stage 3-5 retinopathy of prematurity. Seventeen of 43 study and 16 of 43 control infants who received indomethacin prophylaxis developed sPDA and were combined with early treatment sPDA infants (15 to each group). Two of 32 study and two of 31 control infants underwent surgical ligation whereas the remaining were treated with indomethacin. Sixteen of 30 (53%) and 13 of 29 (45%) were successfully treated and did not require ligation. Study infants were divided according to their mothers' indomethacin total dose (28 infants received <or=225 mg and 30 infants received >225 mg). Both subgroups were demographically and clinically comparable and their response to indomethacin prophylaxis and treatment were similar.

CONCLUSION

In ELBW infants, exposure to indomethacin tocolysis does not affect the clinical responsiveness of the ductus arteriosus to prophylaxis or that of the sPDA to indomethacin treatment.

123 CRYOPROTECTANT EXPOSURE AFFECTS THE PROTEOME OF THE MOUSE METAPHASE II OOCYTE

The ability to routinely cryopreserve oocytes will have a significant impact on human- and domestic animal-assisted reproduction, and on wildlife conservation. However, success with oocyte cryopreservation has been relatively limited. Previous studies have shown that slow freezing alters mouse oocyte physiology, including the proteome. To improve cryopreservation techniques, it is vital to investigate the effects of the cryopreservation procedure on oocyte physiology. It was therefore the aim of this study to determine at which stage of the slow freezing procedure the proteome was affected, or whether exposure to the cryoprotectant (1,2-propanediol; PrOH) alone was responsible for cellular perturbations. Metaphase II (MII) oocytes were collected from superovulated F1 (C57BL/6 x CBA) mice at 13 h post-hCG. Denuded MII oocytes were randomly allocated to treatments that mimic parts of the slow freezing protocol: (A) 37�C for 20 min (control), (B) room temperature for 20 min (temperature control), (C) 1.5 M PrOH exposure for 20 min (i.e. the equilibration and dehydration step), and (D) 1.5 M PrOH exposure and seeding (i.e. the equilibration, dehydration, and seeding step). Oocytes were then collected in groups of 5 (n = 12 replicates per group), extracted, processed, and analyzed by time-of-flight mass spectrometry. Statistical analysis was performed with the Mann-Whitney non-parametric test. Oocytes maintained at room temperature for 20 min displayed a protein profile similar to that of oocytes incubated at 37�C. The protein expression profile was altered when oocytes were exposed to PrOH for twenty min, with several proteins showing at least a two-fold change of expression level. A similar effect on protein expression was also observed with 20 min of PrOH exposure plus seeding. On comparison with control oocytes, those exposed to PrOH (with or without seeding) had a significantly (P &lt; 0.05) lower abundance of 6 proteins and up-regulation of 4 proteins. Analysis of the mouse MII oocyte at different stages of the slow freezing protocol revealed that there is negligible impact on protein expression when oocytes are maintained at room temperature for 20 min. However, PrOH exposure at room temperature for the same amount of time induces significant perturbation of the oocytes&apos; proteome. These data demonstrate that temperature changes per se (during cooling to room temperature and seeding) impact negligibly on the oocyte proteome, whereas exposure of oocytes to 1.5 M PrOH alone, which mimics the equilibration phase of slow freezing, significantly alters the proteome. The detrimental effect on the oocyte proteome suggests that chronic exposure to PrOH during slow freezing negatively impacts oocyte cryopreservation. To conclude, analyzing the effects of cryopreservation on cell physiology is pivotal for allowing the selection of appropriate techniques and implementing appropriate modifications. This study was supported by a grant from Vitrolife.

Isocupressic acid, an abortifacient component of Cupressus macrocarpa

Anecdotal reports suggest that abortion occurs in New Zealand cattle after ingestion of macrocarpa (Cupressus macrocarpa). The clinical signs observed are similar to those seen in abortions caused by ponderosa pine (Pinus ponderosa Laws). Isocupressic acid has been identified as an abortifacient component of the needles of ponderosa pine. Macrocarpa collected from the Palmerston North area contained 0.89% and 1.24% isocupressic acid, compared to 1.70% isocupressic acid in Ponderosa pine needles from Oregon in the United States as analysed by the USDA-ARS Poisonous Plant Research Laboratory. These findings support observations that macrocarpa causes abortion in late gestation cattle in New Zealand and suggest the causal agent is probably isocupressic acid.

Tinnitus and psychological morbidity: a cross-sectional study to investigate psychological morbidity in tinnitus patients and its relationship with severity of symptoms and illness perceptions

This study investigates the relationship between tinnitus and psychological morbidity using a cross-sectional survey design from patients of an outpatient audiology department in a typical District General Hospital. The results suggest that a significant number of tinnitus patients suffer from psychological problems both during and more unfortunately after routine treatment for their tinnitus. Anxiety was found to be the main psychological problem. In conclusion, this study suggests that, while further research is needed, many tinnitus patients require psychological treatment and this has implications for the staffing of audiology units in District General Hospitals.

135 REGULATION OF GLUCOSE METABOLISM TO DECREASE LIPID CONTENT OF IN VIRTO-PRODUCED BOVINE EMBRYOS

Our objective was to improve normality of embryos produced in vitro with regulators of carbohydrate metabolism at doses optimized in earlier experiments. Eight- to 16-cell embryos were produced in vitro in the G1/G2 system (chemically defined sequential medium with recombinant human serum albumin), and then cultured 3 days in G2 containing metabolic regulators as follows: phenazine ethosulfate (PES), 0.3 μM; NaN3, 27 μM; 2,4-dinitrophenol (DNP), 30 μM; and control. The following responses were analyzed by ANOVA in 2 to 4 replicates of 8–12 embryos each: glucose uptake and metabolism (uptake measured by microfluorometry of medium after incubating an embryo 3 h; metabolism measured as 3H2O released after incubating an embryo 3 h in medium containing 5-3H glucose), % of glucose metabolized via the pentose phosphate pathway (PPP rate), lactate production, glycolysis (% of lactate produced from glucose taken up on a molar basis), lipid accumulation (number of >2 μM Sudan Black B positive granules/103 μm2), % live Day 14 embryos recovered from embryos transferred to recipients at Day 7, and average surface area of embryos collected. In vivo-derived embryos were included as a second control for lipid evaluation. PES-treated embryos had higher glucose metabolism (P < 0.05) and lower glucose uptake (P < 0.01) than embryos in NaN3 and tended to have a higher PPP rate (P < 0.11) than controls; however, glycolysis was higher for PES than other treatments (P < 0.01) (Table 1). Lipid accumulation of embryos from PES was markedly lower than any other in vitro treatments (P < 0.01), but higher than in vivo embryos (3.31 ± 2.78 lipid granules) (P < 0.01). NaN3- and DNP-treated embryos both accumulated lipid similar to in vitro controls. No treatment differences were found in developmental competence when Day 7 embryos were transferred to recipients and recovered 1 week later (43 to 54% live embryos recovered), nor were there any significant differences (P > 0.1) in surface area. Embryos exposed to PES at the compaction and post-compaction stages accumulated much less lipid than controls or embryos exposed to other metabolic regulators, making this a very promising treatment. PES oxidizes NADPH; the molecular mechanism of PES appears to involve increased flux of glucose through the PPP while decreasing availability of NADPH for fatty acid synthesis. Table 1. Response of embryos to metabolic regulators

An outbreak of viral gastroenteritis following environmental contamination at a concert hall

In January 1999, an outbreak of viral gastroenteritis affected more than 300 people who attended a metropolitan concert hall over a 5-day period. Norwalk-like virus (NLV) was confirmed in faecal samples by reverse transcription polymerase chain reaction assay. The index case was a concert attendee who vomited in the auditorium and adjacent male toilet. Gastrointestinal illness occurred among members of 8/15 school parties who attended the following day. Children who sat on the same level of the auditorium as the index case were much more likely to be ill than those seated elsewhere (relative risk 7.1, 95% confidence interval 5.4-9.2. P < 0.001). The majority of other reported cases had not been present on the evening of the vomiting incident. Disinfection procedure was poor and the disinfectant used contained no sodium hypochlorite. Transmission most likely occurred through direct contact with contaminated fomites. The outbreak has implications for disinfection procedures following vomiting incidents at public venues.

Occupational injuries of physiotherapists in North and Central Queensland

The National Occupational Health and Safety Commission of Australia has identified musculoskeletal injuries in the health industry as a key area of concern. There is little data available on injuries to physiotherapists. This study aimed to investigate the nature, prevalence, job risk factors and consequences of occupational injuries, with particular focus on musculoskeletal injuries, experienced by physiotherapists in North and Central Queensland. A work-related musculoskeletal injury was defined as pain lasting more than three days that the respondent felt was cause by their work as a physiotherapist. Fifty-five per cent of respondents had experienced a work-related injury and 40% had experienced injury in the previous year. The most injured body areas were the low back, hands and neck. Over half (56%) of the initial episodes of injury occurred within five years of graduation. The job risk factors of most concern to injured respondents were sustained demanding postures, manual therapy techniques, repetition, working while injured and excessive workloads. Injured respondents chose to work while injured and not to take time off on workers' compensation or have surgery. Following injury, 38 of respondents changed work settings. Most injured physiotherapists modified their techniques to continue working. Further research is needed to develop effective preventative strategies.

Optimal dosing of penicillin G in the third trimester of pregnancy for prophylaxis against group B Streptococcus

OBJECTIVE

We wanted to determine the optimal dose of intravenous penicillin (PCN) in the third trimester of pregnancy for the prophylaxis of group B Streptococcus.

STUDY DESIGN

Healthy women in the third trimester with a singleton pregnancy were recruited. Eligibility included no previous penicillin or cephalosporin allergy and no history of renal disease. We obtained a baseline 24-hour urine collection for total protein concentration and creatinine clearance. Two intravenous catheters were placed, and 1 million units of penicillin G (PCN G) sodium was infused through one catheter. Serial blood samples were obtained through the second catheter at 1, 5, 15, 30, 60, 90, 120, 150, 180, 210, and 240 minutes. Serum was stored at -80 degrees C until assays were performed. Reverse-phase high-performance liquid chromatography was used to determine serum concentrations.

RESULTS

Fifteen patients met the requirements for eligibility. The average 24-hour urine sample for total protein concentration was 187 mg/dL (range, 11-252), and creatinine clearance was 191 mL/min (range, 137-245). Average maximum serum concentration (C(max)) was 67 microg/mL (range, 34-132) and was reached within 5 minutes. Average serum PCN concentration was 12 microg/mL (range, 9-25) after 4 hours of urine collection.

CONCLUSION

The C(max) was 67 microg/mL (670 x minimum inhibitory concentration). One million units of intravenous PCN G exceeds MIC in the treatment of GBS. The dosing interval should be 4 hours to ensure anti-GBS activity in all patients. More frequent dosing does not increase activity. Current recommendations for GBS prophylaxis which use PCN G should be modified pending future studies of neonatal PCN concentrations.

Dynamic publication model for neurophysiology databases

We have implemented a pair of database projects, one serving cortical electrophysiology and the other invertebrate neurones and recordings. The design for each combines aspects of two proven schemes for information interchange. The journal article metaphor determined the type, scope, organization and quantity of data to comprise each submission. Sequence databases encouraged intuitive tools for data viewing, capture, and direct submission by authors. Neurophysiology required transcending these models with new datatypes. Time-series, histogram and bivariate datatypes, including illustration-like wrappers, were selected by their utility to the community of investigators. As interpretation of neurophysiological recordings depends on context supplied by metadata attributes, searches are via visual interfaces to sets of controlled-vocabulary metadata trees. Neurones, for example, can be specified by metadata describing functional and anatomical characteristics. Permanence is advanced by data model and data formats largely independent of contemporary technology or implementation, including Java and the XML standard. All user tools, including dynamic data viewers that serve as a virtual oscilloscope, are Java-based, free, multiplatform, and distributed by our application servers to any contemporary networked computer. Copyright is retained by submitters; viewer displays are dynamic and do not violate copyright of related journal figures. Panels of neurophysiologists view and test schemas and tools, enhancing community support.

Drug use patterns among high school athletes and nonathletes

This study examined drug use patterns and perceptions of drug intervention programs among adolescent interscholastic athletes and nonathletes. In particular, it explored the issue of whether participation in high school athletics is related to a healthier lifestyle and decreased use of recreational drugs and ergogenic aids. One thousand five hundred fifteen Massachusetts high school students completed a 150-item survey that assessed illicit and nonillicit substance use. Chi-square analyses revealed that athletes were significantly less likely to use cocaine and psychedelics, and were less likely to smoke cigarettes, compared with nonathletes. Conversely, nonathletes were less likely to use creatine than were athletes. There was no difference in the use of anabolic steroids and androstenedione between athletes and nonathletes. Descriptive analyses appear to indicate that drug interventions for athletes are falling short of their objectives. This study suggests that athletes have a healthier lifestyle and that the efficacy of intervention programs must be further examined.