Sterile granulomatous panuveitis in dogs in the United Kingdom: A review of 33 cases

PURPOSE

To describe the clinical and histopathological features of a sterile granulomatous panuveitis syndrome in 33 dogs that underwent enucleation and ocular histopathology.

METHODS

Retrospective review of the medical records and ocular histopathology reports of 33 cases. Inclusion criteria were enucleation in conjunction with characteristic clinical and histopathological features.

RESULTS

Thirteen breeds were represented (including crossbreeds). Panuveitis was acute and fulminating, and secondary glaucoma was common (n = 27). Interval from initial presentation to enucleation was 99 days (median 33 days, range 5-605 days). The mean age at enucleation was 6.7 years. Ocular signs were initially unilateral (n = 18) or bilateral (n = 15). The disease became bilateral in 18/25 cases that initially underwent unilateral enucleation, resulting in enucleation or euthanasia in 9/18 (mean interval of 168 days). Seven out of 59 eyes had a good outcome following topical anti-inflammatory and systemic immunosuppressive therapy. None of the dogs had travel history nor relevant systemic signs from presentation to follow-up (mean 619 days, range 16-3012 days). Histopathology revealed histiocytic and lymphoplasmacytic panuveitis with pigment dispersion, and no infectious agents were identified on light microscopy.

CONCLUSION

To the authors' knowledge, this is the first report of a sterile granulomatous panuveitis syndrome in dogs in the UK. The clinical signs are severe, with rapid progression, and can result in bilateral enucleation or euthanasia in affected dogs. There does not appear to be an age or breed predisposition, however further research is necessary in this regard. Early and aggressive intervention, with both topical and systemic immunosuppressive therapy, is recommended to reduce the risk of blindness, enucleation, and euthanasia.

The Peripheral Neuropathy Prevalence and Characteristics Are Comparable in People with Obesity and Long-Duration Type 1 Diabetes

Introduction

Peripheral neuropathy is reported in obesity even in the absence of hyperglycaemia.

Objective

To compare the prevalence and characterise the phenotype of peripheral neuropathy in people living with obesity (OB) and long-duration type 1 diabetes (T1D).

Patients and Methods

We performed a prospective cross-sectional study of 130 participants including healthy volunteers (HV) (n = 28), people with T1D (n = 51), and OB (BMI 30–50 kg/m²) (n = 51). Participants underwent assessment of neuropathic symptoms (Neuropathy Symptom Profile, NSP), neurological deficits (Neuropathy Disability Score, NDS), vibration perception threshold (VPT) and evaluation of sural nerve conduction velocity and amplitude.

Results

Peripheral neuropathy was present in 43.1% of people with T1D (age 49.9 ± 12.9 years; duration of diabetes 23.4 ± 13.5 years) and 33.3% of OB (age 48.2 ± 10.8 years). VPT for high risk of neuropathic foot ulceration (VPT ≥ 25 V) was present in 31.4% of T1D and 19.6% of OB. Participants living with OB were heavier (BMI 42.9 ± 3.5 kg/m²) and had greater centripetal adiposity with an increased body fat percentage (FM%) (P < 0.001) and waist circumference (WC) (P < 0.001) compared to T1D. The OB group had a higher NDS (P < 0.001), VAS for pain (P < 0.001), NSP (P < 0.001), VPT (P < 0.001) and reduced sural nerve conduction velocity (P < 0.001) and amplitude (P < 0.001) compared to HV, but these parameters were comparable in T1D. VPT was positively associated with increased WC (P = 0.011), FM% (P = 0.001) and HbA1c (P < 0.001) after adjusting for age (R² = 0.547). Subgroup analysis of respiratory quotient (RQ) measured in the OB group did not correlate with VPT (P = 0.788), nerve conduction velocity (P = 0.743) or amplitude (P = 0.677).

Conclusion

The characteristics of peripheral neuropathy were comparable between normoglycaemic people living with obesity and people with long-duration T1D, suggesting that metabolic factors linked to obesity play a pivotal role in the development of peripheral neuropathy. Further studies are needed to investigate the mechanistic link between visceral adiposity and neuropathy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-022-02208-z.

AB0659 Recruitment and prevalence of mixed phenotype macrophages is prominent in Bronchoalveolar Lavage (BAL) of Systemic Sclerosis (SSc) patients with Interstitial Lung Disease (ILD)

Background

ILD is a major problem in SSc for which no disease-modifying therapies are available. Many observations suggest monocyte/macrophage involvement in SSc and might be a key component in the development of ILD. Macrophages polarize into M1 and M2 phenotypes and thereby orchestrate inflammation and subsequent fibrosis by responding to and producing a vast array of cytokines and chemokines. Differences in the levels of the chemokines might explain variations in the recruitment and activation of macrophages in affected organs. In SSc, monocytes with a mixed phenotype (expressing both M1 and M2 markers) are prominent in peripheral blood. No previous study has investigated the mixed phenotype macrophages locally on the lung level.

Objectives

a-to measure macrophage-related chemokines in BAL fluid obtained from SSc-ILD and SSc-no-ILD patients.

b-to investigate levels of M1 and M2 macrophage markers in BAL cells obtained from SSc-ILD and SSc-no-ILD patients.

Methods

A cross-sectional study in which BAL procedure was performed on 15 treatment-naïve SSc patients divided into two groups according to lung involvement determined by HRCT and lung function tests: SSc-no-ILD group and SSc-ILD group (Table 1). Levels of chemokines (CCL18, CXCL-10 and CCR2) were analysed using ELISA. mRNA expression levels of CD86 (M1; inflammatory macrophage marker) and CD206 (M2; fibrogenic macrophage marker) in cells isolated from BAL were assessed using RT-qPCR. In addition, immunofluorescence studies and flow cytometry analyses were performed to evaluate the expression of M1 (CD86) or M2 (CD206) markers in BAL macrophages.

Table 1.

Patient characteristics

no ILDILDNumber of patients87Age57 (51-68)60 (53-73)Female75%57%Raynauds phenomenon100%85%Age start of Raynauds36 (22-53)56 (41-66)Age start of non-Raynauds50 (33-60)49 (36-68)Skin thickening50%43%Digital ulcer at this moment0%29%Digital ulcer in the past38%29%Pitting scars38%43%Telangiectasia50%43%Calcinosis13%29%Cardiac25%14%Gastro-intestinal88%43%Kidney0%0%

Results

Macrophages were the predominant immune cell population in BAL of SSc patients (73%). The levels of CCL18, CCR2 and CXCL10 were slightly elevated in the SSc-ILD group compared to the SSc-no-ILD (Figure 1.1). RT-qPCR data showed that CD86 expression was elevated in the SSc-ILD group while no difference was observed in CD206 expression between the two groups (data not shown). The SSc-ILD group had higher proportions of double-positive (CD86+, CD206+) macrophages than SSc-no-ILD which, in contrast, had higher proportions of CD86+, CD206- macrophages (Figure 1.2). These results were supported by fluorescent microscopy images in which the SSc-ILD group had higher CD86 and CD206 expression than the SSc-no-ILD (Figure 1.3). Double staining clearly showed a more prevalent mixed activation of macrophages in the SSc-ILD group.

Conclusion

In this pilot study, recruitment and activation of mixed phenotype macrophages was more prominent in SSc-ILD than in SSc-no-ILD. Although levels of chemokines were not profoundly different between both groups, studying extensively the macrophage activation patterns in BAL provided novel findings regarding differences between the two groups. Since SSc is characterised by inflammatory and fibrotic phases, the mixed polarization of macrophages we showed for the first time in SSc-ILD patients on an organ level is a key aspect in such disease and could potentially serve as a target for therapeutics.

References

[1]Perelas A, Silver RM, Arrossi AV, Highland KB. Systemic sclerosis-associated interstitial lung disease. Lancet Respir Med. 2020;8(3):304-320. doi:10.1016/S2213-2600(19)30480-1

[2]Schmidt K, Martinez-Gamboa L, Meier S, et al. Bronchoalveoloar lavage fluid cytokines and chemokines as markers and predictors for the outcome of interstitial lung disease in systemic sclerosis patients. Arthritis Res Ther. 2009;11(4):R111. doi:10.1186/ar2766

Disclosure of Interests

Yehya Al-Adwi: None declared, Tji-Joong Gan: None declared, Janneke Bosma: None declared, Wayel Abdulahad: None declared, Isabella M. Atzeni: None declared, Marcel Van der Leij: None declared, Bart-Jan Kroesen: None declared, Alja J. Stel: None declared, Wim Timens: None declared, Janette Burgess: None declared, Harry van Goor: None declared, Johanna Westra: None declared, Douwe J Mulder Grant/research support from: Dr. DJ Mulder as an employee of the UMCG received research grants from Sanofi Genzyme which were paid to the UMCG

Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

OBJECTIVE

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years.

METHODS

Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML.

RESULTS

In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA.

CONCLUSION

COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

Assessing the carbon capture potential of a reforestation project

The number of reforestation projects worldwide is increasing. In many cases funding is obtained through the claimed carbon capture of the trees, presented as immediate and durable, whereas reforested plots need time and maintenance to realise their carbon capture potential. Further, claims usually overlook the environmental costs of natural or anthropogenic disturbances during the forest’s lifetime, and greenhouse gas (GHG) emissions associated with the reforestation are not allowed for. This study uses life cycle assessment to quantify the carbon footprint of setting up a reforestation plot in the Peruvian Amazon. In parallel, we combine a soil carbon model with an above- and below-ground plant carbon model to predict the increase in carbon stocks after planting. We compare our results with the carbon capture claims made by a reforestation platform. Our results show major errors in carbon accounting in reforestation projects if they (1) ignore the time needed for trees to reach their carbon capture potential; (2) ignore the GHG emissions involved in setting up a plot; (3) report the carbon capture potential per tree planted, thereby ignoring limitations at the forest ecosystem level; or (4) under-estimate tree losses due to inevitable human and climatic disturbances. Further, we show that applications of biochar during reforestation can partially compensate for project emissions.

POS0190 ASSOCIATION BETWEEN OSTEOARTHRITIS-RELATED SERUM BIOCHEMICAL MARKERS OVER 11 YEARS AND KNEE SYMPTOMS IN MIDDLE-AGED ADULTS

Background:

Serum levels of cartilage and joint-specific biochemical markers such as cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) are associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Change in these biomarkers may precede the morphological and clinical manifestations of OA and therefore have been explored as predictive markers in OA. However, few studies have evaluated the association of OA-related biomarkers with knee symptoms in general population-based middle-aged adults

Objectives:

To describe the associations between OA-related biomarkers and knee symptoms in middle-aged adults followed up over 10-13 years

Methods:

Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Serum samples from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using ELISA. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the WOMAC scale during the CDAH-3 phase. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson regression models with random effects were used to describe the above associations

Results:

The prevalence of knee pain was 46%. In the multivariable model, adjusted for age, sex, and BMI, there was a significant positive association between COMP (ɞ=1.156, 95%CI: 0.989,1.324; p=0.04), MMP-3 (ɞ=1.013, 95%CI: 1.001,1.025; p=0.02), and HA (ɞ=1.008, 95%CI: 1.002,1.015, p=0.01) with knee pain and WOMAC-total score (Table 1) in middle-aged adults. The increase in knee pain per ng/ml increase in COMP, MMP-3, and HA was 15.7%, 1.3%, and 0.8%, respectively. The overall mean biomarker levels decreased over 10-13 years; however, the mean WOMAC-total scores were higher in participants whose COMP and HA levels increased (COMP: 24 (27.31), HA: 14.20 (22.60)) compared to those in whom it decreased or remained stable (COMP: 9.84 (16.83), and HA: 8.28 (13.22)) during this period. There was a significant positive association between COMP (ɞ=1.026, 95%CI: 1.002,1.050, p=0.03) and MMP-3 (ɞ=1.020, 95%CI: 1.009,1.030, p<0.01) measured at baseline and knee pain assessed after 10-13 year in the middle-aged adults (Table 1)

Table 1.

Cross-sectional and longitudinal association between WOMAC symptoms and OA-related biomarkers

VariablesLongitudinal Biomarker at CDAH-1, knee symptom at CDAH-3Cross-sectional Biomarker at CDAH-3, knee symptom at CDAH-3Adjusted. Coef. (95%CI) p-valueAdjusted. Coef. (95%CI) p-valueCOMP (Predictor)WOMAC-total1.047 (1.035, 1.060)1.088 (1.017, 1.159)p<0.01p=0.01Stiffness1.019 (0.988, 1.051)0.877 (0.708, 1.057)p=0.23p=0.12Dysfunction1.045 (1.030, 1.061)1.040 (0.949, 1.130)p<0.01p=0.38MMP3 (Predictor)WOMAC-total1.026 (1.020, 1.031)1.017 (1.010, 1.023)p<0.01p<0.01Pain1.020 (1.009, 1.030)1.013 (1.001, 1.025)p<0.01p=0.03Stiffness1.020 (1.004, 1.035)1.004 (.987, 1.021)p=0.01p=0.66Dysfunction1.029 (1.022, 1.037)1.019 (1.010, 1.026)p<0.01p<0.01HA (Predictor)WOMAC-total0.995 (0.991, 0.999)1.007 (1.003, 1.010)p=0.01p<0.01Pain0.999 (0.991, 1.006)1.008 (1.002, 1.015)p=0.75p=0.01Stiffness0.989 (0.980, 0.998)0.997 (0.989, 1.007)p=0.03p=0.65Dysfunction1.003 (0.998, 1.009)1.015 (1.010, 1.020)p= 0.22p<0.01

Bold denotes statistically significant. Model adjusted for age, sex, and BMI

Conclusion:

OA-related biochemical markers such as COMP and MMP-3 were positively associated with knee pain in population-based middle-aged adults. These results suggest biochemical markers measured in middle-aged adults may be used as a marker of joint pain

Acknowledgements:

AS is supported by International Graduate Research Scholarship, University of Tasmania.

Disclosure of Interests:

Ambrish Singh Employee of: Has worked in the past for Abbott and Eli Lilly and Company, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones: None declared, John Burgess: None declared, Venkat Parameswaran: None declared, Changhai Ding: None declared, Benny Antony: None declared

The Clinical Usefulness of the Platelet Aggregation Test for the Diagnosis of Heparin-Induced Thrombocytopenia

The platelet aggregation test is widely used for the diagnosis of heparin-induced thrombocytopenia (HIT), a potentially serious complication of heparin therapy. We have evaluated its sensitivity and specificity in comparison with those of the 14C-serotonin release test. The sensitivity of the platelet aggregation test was found to vary with the heparin concentration and the donor of the platelets used in the test. The optimal heparin concentrations were between 0.1 and 1.0 U/ml. Using these heparin concentrations, the mean sensitivity varied from 39% (with the least reactive platelets) to 81% (with the most reactive platelets). In comparison, the sensitivity of the release test ranged from 65% to 94%. The specificities of the platelet aggregation test were 82%, 90% and 100% for the following control groups: (1) non-thrombocytopenic patients given heparin, (2) patients with thrombocytopenia due to other causes, and (3) normal controls not given heparin, respectively. The corresponding specificities for the release test was 94%, 90% and 100%. The specificities can be further increased to 100% for all controls with the adoption of a two-point system which defines a positive result as one in which platelet aggregation occurs with a low heparin concentration (0.5 U/ml) but not with 100 U heparin/ml. For optimal results, a two-point platelet aggregation test should be performed with heparin concentrations of 0.5 and 100 U/ml and using platelets of more reactive donors.

Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department

BACKGROUND

Hyperglycaemia has been associated with adverse outcomes in several different hospital populations.

AIM

The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department.

METHODS

This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression.

RESULTS

Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (β: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001).

CONCLUSION

Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.

XyliMelts time-release adhering discs for night-time oral dryness

Dry mouth can be caused by medication, CPAP use, radiation treatment and a variety of connective tissue diseases, with the prevalence increasing with age. In most individuals, daytime dryness is easily managed. However, except for a new product tested in this study, there is no product lasting longer than an hour that can be used at night to reduce the perception of oral dryness while sleeping. The purpose of this study was to assess whether a self-adhering, slowly dissolving disc that time-releases 500 mg of xylitol, cellulose gum (lubricant and humectant) and mild mint flavour (XyliMelts for Dry Mouth, OraHealth Corp.) used during sleep would reduce perceived morning oral dryness and discomfort. Fifteen subjects self-identified as having morning oral dryness were evaluated first without treatment and again with the use of XyliMelts for Dry Mouth. Measures of initial morning discomfort and perceived wetness demonstrated significant improvement. Perceived oral wetness scores increased more than threefold with the use of XyliMelts for Dry Mouth while sleeping. These findings suggest that XyliMelts for Dry Mouth may be an effective strategy for managing oral dryness that occurs at night.

Not a simple fat-soluble vitamin: Changes in serum 25-(OH)D levels are predicted by adiposity and adipocytokines in older adults

OBJECTIVE

To determine the associations between body adiposity and change in serum 25-(OH)D levels over 2.6 years, and if these associations are mediated by metabolic and inflammatory factors in older adults.

METHODS

This is a longitudinal study of 859 randomly selected subjects (mean 62 years, range 51-80, 49% women). Serum 25-hydroxyvitamin D [25-(OH)D] was assessed by radioimmunoassay at baseline and 2.6 years later. Baseline serum level of leptin was assessed by radioimmunoassay and interleukin (IL)-6 by a chemiluminescent immunoassay in the first 183 subjects.

RESULTS

In multivariable analyses, body mass index, trunk fat percentage and waist-to-hip ratio were significant predictors of increased incident vitamin D deficiency [a 25-(OH)D < 50 nmol L⁻¹ at follow-up when ≥50 nmol L⁻¹ at baseline] and decreased recovery of vitamin D deficiency [a 25-(OH)D ≥ 50 nmol L⁻¹ at follow-up when < 50 nmol L⁻¹ at baseline]. Change in 25-(OH)D levels per annum was also independently predicted by baseline leptin (β: -0.09/unit, 95% CI: -0.17, -0.03), IL-6 (β: -0.68/quartile, 95% CI: -1.35, -0.02) and total cholesterol/high-density lipoprotein (HDL) ratio (β: -0.51, 95% CI: -0.88, -0.14). The associations between body adiposity measures and change in 25-(OH)D completely disappeared after adjustment for leptin, diminished after adjustment for IL-6, but remained unchanged after adjustment for total cholesterol/HDL ratio. All associations were independent of season and sun exposure.

CONCLUSIONS

Body fat is not simply a passive reservoir for 25-(OH)D. In addition to season and sun exposure, 25-(OH)D levels appear to be determined by metabolic and, to a lesser extent, inflammatory factors, and these appear to mediate the effects of adiposity on change in 25-(OH)D.

Effects of maternal natural (RRR alpha-tocopherol acetate) or synthetic (all-rac alpha-tocopherol acetate) vitamin E supplementation on suckling calf performance, colostrum immunoglobulin G, and immune function

The objective of this study was to determine the effects of maternally supplemented natural- or synthetic-source vitamin E on suckling calf performance and immune response. In a 2-yr study, one hundred fifty-two 2- and 3-yr-old, spring-calving, Angus-cross beef cows were blocked by age, BW, and BCS into 1 of 3 isocaloric, corn-based dietary supplements containing 1) no additional vitamin E (CON), 2) 1,000 IU/d of synthetic-source vitamin E (SYN), or 3) 1,000 IU/d of natural-source vitamin E (NAT). Maternal supplementation began approximately 6 wk prepartum and continued until the breeding season. Colostrum from cows and blood from calves was collected 24 h postpartum for analysis of IgG concentration as an indicator of passive transfer and circulating alpha-tocopherol concentration. At 19 d of age, blood was collected from calves to determine the expression of CD14 and CD18 molecules on leukocytes. At 21 and 35 d of age, humoral immune response was measured by a subcutaneous injection, in the neck, with ovalbumin (20 mg; OVA) and blood samples collected weekly until d 63 of age to determine antibodies produced against OVA. At d 63 of age, calves were administered an intradermal injection of OVA (1 mg) in the neck to assess cell-mediated immunity, which was determined on d 65 of age by measuring nodule size with calipers. Circulating alpha-tocopherol concentrations were increased at both 24 h (P = 0.001) and at the day of initial OVA challenge (P < 0.001) in SYN and NAT compared with CON calves. No differences were detected (P > 0.05) for calf birth BW, ADG, or weaning BW. There were no differences (P > 0.05) in calf serum total IgG or cow colostrum total IgG at 24 h or presence of CD14 and CD18 receptors at d 19 of age. The NAT calves had a greater antigen response to OVA at d 63 than SYN calves (P = 0.01; treatment x day interaction). As an indicator of cell-mediated immunity to OVA, nodule size at 65 d of age was not affected (P = 0.92) by maternal dietary supplementation. In conclusion, calves suckling cows supplemented with natural- and synthetic-source vitamin E had increased circulating concentrations of alpha-tocopherol at 24 h, which appeared to continue throughout maternal supplementation; however, calf immune function and performance were not affected.

Effects of natural (RRR alpha-tocopherol acetate) or synthetic (all-rac alpha-tocopherol acetate) vitamin E supplementation on reproductive efficiency in beef cows

The objective was to determine the effects of natural- or synthetic-source vitamin E on reproductive efficiency in Angus-cross beef cows. In Exp. 1, one hundred fifty-two cows were fed hay and corn silage based diet and assigned to 1 of 3 dietary supplements (3 pens/treatment): 1) containing no additional vitamin E (CON), 2) formulated to provide 1,000 IU x d(-1) of synthetic-source vitamin E (SYN; all-rac or dl-alpha-tocopherol acetate), or 3) formulated to provide 1,000 IU x d(-1) of natural-source vitamin E (NAT; RRR or D-alpha-tocopherol acetate). In Exp. 2, seventy-five cows (2 reps/treatment) were assigned to similar treatments as Exp. 1; however, a vitamin-mineral supplement was offered for ad libitum intake and vitamin intake was calculated from predicted mineral intakes. Cows grazed pastures rather than being fed hay and corn silage as in Exp. 1. In Exp. 1 and 2, supplementation began 6 wk prepartum and continued until initiation of the breeding season. Blood samples were collected at calving (Exp. 1) or breeding (Exp. 2) to determine alpha-tocopherol concentration and weekly beginning 4 wk postpartum (Exp. 1) or 7 and 14 d before estrus synchronization (Exp. 2) to determine return to estrus via progesterone concentration. Cows were synchronized and bred by AI based on heat detection; nonresponding cows were time bred (AI) 66 h after PGF(2 alpha) injection, and cows returning to estrus after AI were bred by natural service. In Exp. 1, cows supplemented with NAT and SYN had greater (P < 0.001) serum concentrations of alpha-tocopherol at calving compared with CON cows. Dietary supplement did not affect (P >or= 0.55) the percentage of cows cycling before synchronization or the number of days to return to estrus by cows that resumed estrus before synchronization. Cows supplemented with SYN tended to have greater first service conception rates compared with CON and NAT (P = 0.09); however, first plus second services combined and overall conception rates were not affected (P >or= 0.23). In Exp. 2, NAT cows had greater (P = 0.002) concentrations of alpha-tocopherol at breeding, whereas there was no difference (P > 0.05) between SYN and CON. Supplementation of SYN or NAT did not affect (P >or= 0.17) days to resumption of estrus before breeding, first service, first plus second services combined, or overall conception rates. These data suggest that supplementation of SYN or NAT source vitamin E increased alpha-tocopherol concentration in cows; however, effects on reproductive efficiency are minimal.

Beyond postural drainage and percussion: Airway clearance in people with cystic fibrosis

BACKGROUND

Evidence indicates that there are no statistically significant differences in effectiveness among the airway clearance techniques (ACTs) of active cycle of breathing, autogenic drainage, positive expiratory pressure (PEP) or oscillating PEP in the short-term, but are there differences in the long-term (one year)? The objective of the study was to demonstrate non-inferiority in the long-term.

METHODS

Seventy-five people with cystic fibrosis entered the prospective, randomised controlled trial of these five different ACTs. The primary outcome measure was forced expiratory volume in one second (FEV(1)). Secondary outcome measures included exercise capacity and health related quality of life.

RESULTS

Using intention to treat, data were available on 65 subjects at the end of the study period. There were no statistically significant differences among the regimens in the primary outcome measurement of FEV(1) (p=0.35).

CONCLUSION

In different countries either one or several airway clearance regimens are used. This study provides evidence in support of current practices.

CYP2E1-Catalyzed Oxidation Contributes to the Sperm Toxicity of 1-Bromopropane in Mice1

1-bromopropane (1-BrP) induces dose- and time-dependent reproductive organ toxicity and reduced sperm motility in rodents. The contribution of cytochrome P4502E1 (CYP2E1) to both 1-BrP metabolism and the induction of male reproductive toxicity was investigated using wild-type (WT) and Cyp2e1-/- mice. In gas uptake inhalation studies, the elimination half-life of [1,2,3-(13)C]-1-BrP was longer in Cyp2e1-/- mice relative to WT (3.2 vs. 1.3 h). Urinary metabolites were identified by 13C nuclear magnetic resonance. The mercapturic acid of 1-bromo-2-hydroxypropane (2OHBrP) was the major urinary metabolite in WT mice, and products of conjugation of 1-BrP with glutathione (GSH) were insignificant. The ratio of GSH conjugation to 2-hydroxylation increased 5-fold in Cyp2e1-/- mice relative to WT. After 1-BrP exposure, hepatic GSH was decreased by 76% in WT mice vs. 47% in Cyp2e1-/- mice. Despite a 170% increase in 1-BrP exposure in Cyp2e1-/- vs. WT mice, sperm motility in exposed Cyp2e1-/- mice did not change relative to unexposed matched controls. This suggests that metabolites produced through CYP2E1-mediated oxidation may be responsible for 1-BrP-induced sperm toxicity. Both 1-BrP and 2OHBrP inhibited the motility of sperm obtained from WT mice in vitro. However, only 2OHBrP reduced the motility of sperm obtained from Cyp2e1-/- mice in vitro, suggesting that conversion of parent compound to 2OHBrP within the spermatozoa may contribute, at least in part, to reduced motility. Overall, these data suggest that metabolism of 1-BrP is mediated in part by CYP2E1, and activation of 1BrP via this enzyme may contribute to the male reproductive toxicity of this chemical.

Familial isolated hyperparathyroidism is linked to a 1.7 Mb region on chromosome 2p13.3-14

BACKGROUND

Familial isolated hyperparathyroidism (FIHP) is an autosomal dominantly inherited form of primary hyperparathyroidism. Although comprising only about 1% of cases of primary hyperparathyroidism, identification and functional analysis of a causative gene for FIHP is likely to advance our understanding of parathyroid physiology and pathophysiology.

METHODS

A genome-wide screen of DNA from seven pedigrees with FIHP was undertaken in order to identify a region of genetic linkage with the disorder.

RESULTS

Multipoint linkage analysis identified a region of suggestive linkage (LOD score 2.68) on chromosome 2. Fine mapping with the addition of three other families revealed significant linkage adjacent to D2S2368 (maximum multipoint LOD score 3.43). Recombination events defined a 1.7 Mb region of linkage between D2S2368 and D2S358 in nine pedigrees. Sequencing of the two most likely candidate genes in this region, however, did not identify a gene for FIHP.

CONCLUSIONS

We conclude that a causative gene for FIHP lies within this interval on chromosome 2. This is a major step towards eventual precise identification of a gene for FIHP, likely to be a key component in the genetic regulation of calcium homeostasis.

Investigating the capacity of an activated sludge process to reduce volatile organic compounds and odor emissions

The effects of hydrogen sulfide (H2S) diffusion into activated sludge (AS) on odor and volatile organic compound (VOC) concentrations in offgas were studied over an 8-week period. Most VOCs detected in the offgas of both aeration tanks were aromatic hydrocarbons. The VOC concentrations generally decreased when H2S was introduced to the AS compared with the control, indicating a negative effect of H2S on VOC removal. Two volatile organic sulfur compounds present in the test AS offgas showed an increase followed by a decrease during H2S peak loads. Six VOCs and odor concentration increased during the introduction of an H2S peak; however no correlation was observed between H2S and odor concentration. The increase in odor concentration resulted from the increase in the concentration of six aromatic VOCs, which had their removal slowed down during a 100-ppmv H2S peak. Activated sludge diffusion provides effective H2S removal with minimal affect on odor emissions.

Poison Control Center--based syndromic surveillance for foodborne illness

OBJECTIVES

This retrospective study evaluated the usefulness of a poison control center (PCC) data collection system in Tucson, Arizona for early detection of foodborne disease outbreaks.

METHODS

A search of a PCC database identified callers with gastrointestinal symptoms attributable to suspected foodborne illnesses whose calls were received during January 1-March 31, 2000. For each foodborne illness-related call, PCC coding was compared with a predefined diarrhea/gastroenteritis syndrome. PCC calls also were evaluated by using ZIP code, age, sex, and date of symptom onset to determine if call classifications matched any laboratory-confirmed cases reported to a county health department.

RESULTS

An independent review generally agreed with the PCC's classification of calls. When calls and cases were compared, only one potential match was identified.

CONCLUSION

Although confirmatory diagnostic information was not available, PCC calls were not duplicative of cases evaluated by the county health department, which suggests that they represent two independent data sets. PCC data might provide a useful addition to surveillance data reported to public health agencies for the early detection of foodborne disease outbreaks. These results will now be used to develop collaborative prospective surveillance systems.

Genetic testing in familial isolated hyperparathyroidism: unexpected results and their implications

Familial hyperparathyroidism is not uncommon in clinical endocrine practice. It encompasses a spectrum of disorders including multiple endocrine neoplasia types 1 (MEN1) and 2A, hyperparathyroidism-jaw tumour syndrome (HPT-JT), familial hypocalciuric hypercalcaemia (FHH), and familial isolated hyperparathyroidism (FIHP). Distinguishing among the five syndromes is often difficult but has profound implications for the management of patient and family. The availability of specific genetic testing for four of the syndromes has improved diagnostic accuracy and simplified family monitoring in many cases but its current cost and limited accessibility require rationalisation of its use. No gene has yet been associated exclusively with FIHP. FIHP phenotypes have been associated with mutant MEN1 and calcium-sensing receptor (CASR) genotypes and, very recently, with mutation in the newly identified HRPT2 gene. The relative proportions of these are not yet clear. We report results of MEN1, CASR, and HRPT2 genotyping of 22 unrelated subjects with FIHP phenotypes. We found 5 (23%) with MEN1 mutations, four (18%) with CASR mutations, and none with an HRPT2 mutation. All those with mutations had multiglandular hyperparathyroidism. Of the subjects with CASR mutations, none were of the typical FHH phenotype. These findings strongly favour a recommendation for MEN1 and CASR genotyping of patients with multiglandular FIHP, irrespective of urinary calcium excretion. However, it appears that HRPT2 genotyping should be reserved for cases in which other features of the HPT-JT phenotype have occurred in the kindred. Also apparent is the need for further investigation to identify additional genes associated with FIHP.

Detecting environmental change: science and society-perspectives on long-term research and monitoring in the 21st century

Widespread concern over the state of the environment and the impacts of anthropogenic activities on ecosystem services and functions has highlighted the need for high-quality, long-term datasets for detecting and understanding environmental change. In July 2001, an international conference reviewed progress in the field of long-term ecosystem research and monitoring (LTERM). Examples are given which demonstrate the need for long-term environmental monitoring and research, for palaeoecological reconstructions of past environments and for applied use of historical records that inform us of past environmental conditions. LTERM approaches are needed to provide measures of baseline conditions and for informing decisions on ecosystem management and environmental policy formulation. They are also valuable in aiding the understanding of the processes of environmental change, including the integrated effects of natural and anthropogenic drivers and pressures, recovery from stress and resilience of species, populations, communities and ecosystems. The authors argue that, in order to realise the full potential of LTERM approaches, progress must be made in four key areas: (i) increase the number, variety and scope of LTERM activities to help define the operational range of ecosystems; (ii) greater integration of research, monitoring, modelling, palaeoecological reconstruction and remote sensing to create a broad-scale early warning system of environmental change; (iii) development of inter-disciplinary approaches which draw upon social and environmental science expertise to understand the factors determining the vulnerability and resilience of the nature-society system to change; and (iv) more and better use of LTERM data and information to inform the public and policymakers and to provide guidance on sustainable development.

Breast tumor contamination of PBSC harvests: tumor depletion by positive selection of CD34(+) cells

BACKGROUND

Positive selection of CD34(+) cells may reduce or eliminate tumor cells contaminating PBSC harvests of breast cancer (BrCa) patients. However, to assess tumor purging accurately methods may be needed that are of higher sensitivity than standard immunocytochemistry (ICC) assays.

METHODS

BrCa-cell depletion, resulting from CD34(+) cell selection, was evaluated using a novel, highly sensitive assay based upon immunomagnetic enrichment with ICC detection in 36 BrCa patients undergoing highdose chemotherapy with autologous PBSC support.

RESULTS

The prevalence of BrCa-cell contamination was significantly lower (P = 0.0078) in selected CD34(+) cell fractions (17/35, 49%) from apheresis collections compared with CD34(-) cell fractions (25/35, 71%). In 8/34 (24%) patients, BrCa cells were detected in CD34(-) cell fractions, but not in paired CD34(+) cell fractions. Significantly lower total numbers (P < 0.0005) of BrCa cells were enumerable in CD34(+) cell fractions compared with corresponding apheresis harvests. The median total BrCa-cell content of selected CD34(+) cell fractions with measurable contamination was 22 BrCa cells (range, 6-73 BrCa cells), compared with 3297 BrCa cells (range, 10-98 400 BrCa cells) in apheresis harvests. The median log depletion of BrCa cells achieved by positive CD34(+) cell selection in specimens with detectable contamination both before and after selection was 2.2 (range, 1.7-4.0). Total pre-selection BrCa cell number was significantly predictive (P = 0.004) of residual detectable post-selection contamination.

DISCUSSION

Positive CD34(+) cell selection is an effective tumor purging strategy. The prevalence of PBSC contamination in BrCa patients is substantially higher than formerly appreciated.