Ion Heating and Flow Driven by an Instability Found in Plasma Couette Flow

We present the first observation of instability in weakly magnetized, pressure dominated plasma Couette flow firmly in the Hall regime. Strong Hall currents couple to a low frequency electromagnetic mode that is driven by high-β (>1) pressure profiles. Spectroscopic measurements show heating (factor of 3) of the cold, unmagnetized ions via a resonant Landau damping process. A linear theory of this instability is derived that predicts positive growth rates at finite β and shows the stabilizing effect of very large β, in line with observations.

Contrast Staining may be Associated with Intracerebral Hemorrhage but Not Functional Outcome in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy

To evaluate the incidence of post-interventional contrast staining (PICS) in acute ischemic stroke (AIS) Chinese patients who were treated with endovascular thrombectomy (ET) and investigate potential association of PICS with functional outcome and intracerebral hemorrhage (ICH). This observational study was based on a single-center prospective registry study. AIS patients who underwent ET from January 2013 to February 2017 were recruited into this study. All patients had dual-energy CT (DECT) scan of the head at 12 to 24 hours post-ET. The primary outcome was the incidence of PICS. Secondary outcomes were total ICH, symptomatic ICH (sICH), 3-month functional outcome, and long-term functional outcome. One hundred and eighty patients were enrolled in this study. PICS was detected in 50 patients (28%) based on the post-interventional CT scan. We first used basic statistical analyses, showing that the incidence of both total ICH (60% vs. 25%, p<0.001) and sICH (18% vs. 8%, p=0.044) were higher in patients with PICS than those without, and fewer patients achieved no disability (mRS≤1) in the PICS group compared to the control group at both 3-month and long-term follow-up (p<0.01 each). However, multivariate regression analysis further revealed that PICS only increased total (adjusted odds ratio, 7.38; 95% confidence interval 1.66 to 32.9; p=0.009) but not sICH risk. Furthermore, the logistic regression analyses did not show statistical difference in good clinical outcomes or mortality between the two groups. PICS is a common phenomenon in Chinese AIS patients. It is associated with total ICH after ET, but it seems to have no effect on functional outcome and sICH. Further large-scale studies are warranted to validate these results.

Cux1 promotes cell proliferation and polycystic kidney disease progression in an ADPKD mouse model

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common monogenic hereditary disorders in humans characterized by fluid-filled cysts, primarily in the kidneys. Cux1, a cell cycle regulatory gene highly expressed during kidney development, is elevated in the cyst-lining cells of Pkd1 mutant mice, and in human ADPKD cells. However, forced expression of Cux1 is insufficient to induce cystic disease in transgenic mice or to induce rapid cyst formation after cilia disruption in the kidneys of adult mice. Here we report a double mutant mouse model that has a conditional deletion of the Pkd1 gene in the renal collecting ducts together with a targeted mutation in the Cux1 gene (Pkd1CD;Cux1tm2Ejn). While kidneys isolated from newborn Pkd1CD mice exhibit cortical and medullary cysts, kidneys isolated from newborn Pkd1CD;Cux1tm2Ejn-/- mice did not show any cysts. Because Cux1tm2Ejn-/- are perinatal lethal, we evaluated Pkd1CD mice that were heterozygote for the Cux1 mutation. Similar to the newborn Pkd1CD;Cux1tm2Ejn-/- mice, newborn Pkd1CD;Cux1tm2Ejn+/- mice did not show any cysts. Comparison of Pkd1CD and Pkd1CD;Cux1tm2Ejn+/- mice at later stages of development showed a reduction in the severity of PKD in the Pkd1CD;Cux1tm2Ejn+/- mice. Moreover, we observed an increase in expression of the cyclin kinase inhibitor p27, a target of Cux1 repression, in the rescued collecting ducts. Taken together, our results suggest that Cux1 expression in PKD is not directly involved in cystogenesis but promotes cell proliferation required for expansion of existing cysts, primarily by repression of p27.

Phenothiazines Enhance Mild Hypothermia-induced Neuroprotection via PI3K/Akt Regulation in Experimental Stroke

Physical hypothermia has long been considered a promising neuroprotective treatment of ischemic stroke, but the treatment's various complications along with the impractical duration and depth of therapy significantly narrow its clinical scope. In the present study, the model of reversible right middle cerebral artery occlusion (MCAO) for 2 h was used. We combined hypothermia (33-35 °C for 1 h) with phenothiazine neuroleptics (chlorpromazine & promethazine) as additive neuroprotectants, with the aim of augmenting its efficacy while only using mild temperatures. We also investigated its therapeutic effects on the Phosphatidylinositol 3 kinase/Protein kinase B (PI3K/Akt) apoptotic pathway. The combination treatment achieved reduction in ischemic rat temperatures in the rectum, cortex and striatum significantly (P < 0.01) faster than hypothermia alone, accompanied by more obvious (P < 0.01) reduction of brain infarct volume and neurological deficits. The combination treatment remarkably (P < 0.05) increased expression of p-Akt and anti-apoptotic proteins (Bcl-2 and Bcl-xL), while reduced expression of pro-apoptotic proteins (AIF and Bax). Finally, the treatment's neuroprotective effects were blocked by a p-Akt inhibitor. By combining hypothermia with phenothiazines, we significantly enhanced the neuroprotective effects of mild hypothermia. This study also sheds light on the possible molecular mechanism for these effects which involves the PI3K/Akt signaling and apoptotic pathway.

Cross species proteomics

Proteomics has advanced in leaps and bounds over the past couple of decades. However, the continuing dependency of mass spectrometry-based protein identification on the searching of spectra against protein sequence databases limits many proteomics experiments. If there is no sequenced genome for a given species, then cross species proteomics is required, attempting to identify proteins across the species boundary, typically using the sequenced genome of a closely related species. Unlike sequence searching for homologues, the proteomics equivalent is confounded by small differences in amino acid sequences, leading to large differences in peptide masses; this renders mass matching of peptides and their product ions difficult. Therefore, the phylogenetic distance between the two species and the attendant level of conservation between the homologous proteins play a huge part in determining the extent of protein identification that is possible across the species boundary. In this chapter, we review the cross species challenge itself, as well as various approaches taken to deal with it and the success met with in past studies. This is followed by recommendations of best practice and suggestions to researchers facing this challenge as well as a final section predicting developments, which may help improve cross species proteomics in the future.

Changes in mitotic rate and GFAP expression in the primary olfactory axis of streptozotocin-induced diabetic rats

Many diabetic individuals develop anosmia but the mechanism(s) causing the dysfunction in the olfactory system is (are) unknown. Glial fibrillary acidic protein expression is reduced in diabetic retinopathy and is also reduced, with unknown consequences, in other brain regions of diabetic rats. We used immunohistochemistry and immunoblotting from untreated control and streptozotocin-induced type 1 (insulin dependent) diabetic rats to investigate main olfactory epithelial mitotic rate and glial fibrillary acidic protein expression in the lamina propria of the sensory epithelium and in the olfactory bulb. Numbers of bromodeoxyuridine-positive cells were significantly lower in the diabetic sensory epithelium compared to non-diabetic controls. Immunohistochemical observations suggested a qualitative difference in glial fibrillary acidic protein expression in both regions examined especially in the olfactory bulb external plexiform layer and the lamina propria. Immunoblot analysis confirmed that the diabetic olfactory bulb and lamina propria expressed less glial fibrillary acidic protein compared to the non-diabetic control group. The lower expression levels in the olfactory bulb external plexiform layer suggested by immunohistochemistry do not reflect a change in the number of astrocytes since the numbers of S100B(+) cells were not different between the two groups.

Candidacy of LPS-based glycoconjugates to prevent invasive meningococcal disease: Developmental chemistry and investigation of immunological responses following immunization of mice and rabbits

Glycoconjugates were prepared by covalently linking the immunogenic protein carrier CRM(197) to O-deacylated lipopolysaccharide (LPS) derived from Neisseria meningitidis (strain H44/76), immunotype L3 galE LPS. This mutant strain elaborates a truncated LPS structure that displays immunological epitopes characteristic of 76% of Group B meningococcal (NmB) strains. CRM(197) was covalently linked either to the reducing glucosamine residue of the lipid A region of the O-deacylated LPS or to a 2-keto-3-deoxy-octulosonic acid (Kdo) residue in the inner core region of the O-deacylated LPS. In both rabbits and mice a much stronger IgG response to the immunising antigen was generated in those animals that received conjugates linked via the lipid A region. Sera from mice that were immunized with these conjugates were assayed for their reactivity with LPS, both mutant and wild-type, of several homologous and heterologous NmB strains. Sera obtained from mice immunized with conjugates in which the carrier protein was linked via the Kdo moiety were only able to react with O-deacylated, but not fully acylated (native), LPS from the homologous strain. However, sera obtained from mice that were immunized with conjugates, in which the carrier protein was coupled to the lipid A region, reacted predominately with inner core epitopes that contained phosphoethanolamine at the same 3-position of the distal heptose residue (HepII) of the inner core LPS as was present on the immunising antigen. Additionally it was observed that sera from rabbits immunised with lipid A linked conjugates, unlike the mice responses, were generally not as specific for LPS antigens that contained phosphoethanolamine at the same 3-position as was present on the immunising antigen, but showed a broader inner core recognition, whereas those rabbits that received the Kdo-linked conjugates gave only a very weak non-specific response to all immunotypes. Finally, the sera from two out of six mice that had received lipid A linked conjugates had bactericidal activity against L3 wild-type NmB strain 8047 and one of these was able to passively protect against meningococcal infection in an infant rat model. This study demonstrates evidence towards the proof-in-principle that by using Nm inner core LPS conjugates coupled via the lipid A region with an intact phosphoethanolamine at the O-3 position of the HepII of the inner core LPS, it is possible to elicit functional and protective antibodies against meningococcal infection.

An investigation of the ability of the glutaraldehyde test to distinguish between acute and chronic inflammatory disease in horses

The Glutaraldehyde test (GT), a rapid and inexpensive test, has been utilized empirically for many years in bovine practice for diagnosing inflammatory diseases. GT is used primarily to demonstrate increased serum concentrations of fibrinogen and globulin. Glutaraldehyde binds with free amino groups in fibrinogen and immunoglobulin to create a clot in a first degree chemical reaction. The clotting time of the GT estimates the content of proteins produced in response to inflammation. The applicability of GT for diagnosing inflammation in the horse has never been investigated. The objective of this study was to determine the ability of GT to distinguish between acute and chronic inflammatory disease in horses. Thirty-seven horses with suspected inflammatory diseases were evaluated using the GT, history, complete clinical examination and routine blood analysis. GT-times, laboratory results and clinical outcome were compared statistically. Horses that were determined to be acutely affected (based on history, clinical examination and routine blood analysis) tended to have a negative GT (75%). Results of the GT did not correlate with blood fibrinogen concentration. Positive GT also predicted a fatal outcome in 69% of the clinical cases. The results of this trial indicate that GT can be a useful screening test to distinguish between acute and chronic inflammatory disease in horses.

Electron heat transport measured in a stochastic magnetic field

New profile measurements have allowed the electron thermal diffusivity profile to be estimated from power balance in the Madison Symmetric Torus where magnetic islands overlap and field lines are stochastic. The measurements show that (1) the electron energy transport is conductive not convective, (2) the measured thermal diffusivities are in good agreement with numerical simulations of stochastic transport, and (3) transport is greatly reduced near the reversal surface where magnetic diffusion is small.

Long-term survival following intensive care: subgroup analysis and comparison with the general population

This study aimed to compare the very long-term survival of critically ill patients with that of the general population, and examine the association among age, sex, admission diagnosis, APACHE II score and mortality. In a retrospective observational cohort study of prospectively gathered data, 2104 adult patients admitted to the intensive care unit (ICU) of a teaching hospital in Glasgow from 1985 to 1992, were followed until 1997. Vital status at five years was compared with that of an age- and sex-matched Scottish population. Five-year mortality for the ICU patients was 47.1%, 3.4 times higher than that of the general population. For those surviving intensive care the five-year mortality was 33.4%. Mortality was greater than that of the general population for four years following intensive care unit admission (95% confidence interval included 1.0 at four years). Multivariate analysis showed that risk factors for mortality in those admitted to ICU were age, APACHE II score on admission and diagnostic category. Mortality was higher for those admitted with haematological (87.5%) and neurological diseases (61.7%) and septic shock (62.9%). A risk score was produced: Risk Score = 10 (age hazard ratio + APACHE II hazard ratio + diagnosis hazard ratio). None of the patients with a risk score > 100 survived more than five years and for those who survived to five years the mean risk score was 57. Long-term survival following intensive care is not only related to age and severity of illness but also diagnostic category. The risk of mortality in survivors of critical illness matches that of the normal population after four years. Age, severity of illness and diagnosis can be combined to provide an estimate of five-year survival.

Sheared poloidal flow driven by mode conversion in tokamak plasmas

A two-dimensional integral full-wave model is used to calculate poloidal forces driven by mode conversion in tokamak plasmas. In the presence of a poloidal magnetic field, mode conversion near the ion-ion hybrid resonance is dominated by a transition from the fast magnetosonic wave to the slow ion cyclotron wave. The poloidal field generates strong variations in the parallel wave spectrum that cause wave damping in a narrow layer near the mode conversion surface. The resulting poloidal forces in this layer drive sheared poloidal flows comparable to those in direct launch ion Bernstein wave experiments.

Measurement of internal magnetic field fluctuations in a reversed-field pinch by Faraday rotation

Magnetic field fluctuations (and the associated current perturbation) have been measured in the core of a high-temperature reversed-field pinch using a newly developed fast-polarimetry system. Radial magnetic field fluctuation levels of approximately 1% are measured in standard-reversed-field pinch discharges which increase to approximately 4% during the sawtooth crash (enhanced dynamo). The fluctuation level is reduced fourfold for high-confinement plasmas where the core-resonant tearing modes are suppressed.

Syndromal versus contextualized personality assessment: differentiating environmental and dispositional determinants of boys' aggression

Two studies examined how "syndromal" approaches to assessment confound differences between individuals in the person and situation variables that contribute to their behavior. In a field study, a widely used instrument was found to be sensitive to the base rates of boys' aggression but, as expected, did not discriminate between boys who were similar in their behavior base rates but different in their social environments and how they responded to them. A laboratory experiment replicated this finding and demonstrated that social observers discriminated between targets on the basis of their functional properties even though syndrome scores did not. The results clarify how syndromal methods can obscure situational factors, conflict with people's social knowledge, and reinforce the view that syndromes exist "in the individual" rather than in person-environment interactions. Implications for developing more contextually sensitive instruments are discussed.

Evaluation of the rat stifle joint after transection of the cranial cruciate ligament and partial medial meniscectomy

Osteoarthritis (OA) was induced in the rat stifle joint by partial medial meniscectomy (PMM) and transection of the cranial cruciate ligament (CCL). At 10 weeks after destabilization, joint morphologic and pathologic changes were observed, scored, and compared. The intact rat stifle joint was observed in a mid-saggital plane. Articular cartilage of the distal portion of the femur and proximal portion of the tibia had thicker and thinner sites, and the thicker sites were located caudally on the distal portion of the femur and centrally on the proximal portion of the tibia. The two separate triangular portions of the medial meniscus observed in the mid-saggital plane contained a center of ossification in the cranial portion and fibrocartilage in the caudal portion. The synovium was one to three cells thick, and contained rare inflammatory cells. Although lesions were more severe in stifles after PMM, both treatments produced OA lesions that closely simulated OA lesions of other species. Lesions consistent with idiopathic OA included chondrocytic clones with increased metachromasia around them, chondrocytic death, loss of metachromasia, fibrillation, fissuring, erosion of articular cartilage, osteophyte formation, and variable synovial inflammation. The results indicate that PMM and CCL transection in the rat are useful in vivo models for study of the etiopathogenesis of OA and therapeutic efficacy of anti-arthritic drugs and treatment concepts.

Syndromal versus contextualized personality assessment: differentiating environmental and dispositional determinants of boys' aggression

Two studies examined how "syndromal" approaches to assessment confound differences between individuals in the person and situation variables that contribute to their behavior. In a field study, a widely used instrument was found to be sensitive to the base rates of boys' aggression but, as expected, did not discriminate between boys who were similar in their behavior base rates but different in their social environments and how they responded to them. A laboratory experiment replicated this finding and demonstrated that social observers discriminated between targets on the basis of their functional properties even though syndrome scores did not. The results clarify how syndromal methods can obscure situational factors, conflict with people's social knowledge, and reinforce the view that syndromes exist "in the individual" rather than in person-environment interactions. Implications for developing more contextually sensitive instruments are discussed.

Use of surgery and electron beam irradiation, with or without chemotherapy, for treatment of vaccine-associated sarcomas in cats: 78 cases (1996-2000)

OBJECTIVE

To evaluate responses of cats with vaccine-associated sarcomas to treatment with surgery and radiotherapy, with or without adjunctive chemotherapy.

DESIGN

Retrospective study.

ANIMALS

76 cats (78 tumors).

PROCEDURE

Medical records were reviewed. Factors potentially associated with survival time, time to recurrence, and time to development of metastases were evaluated.

RESULTS

Following excision, electron beam radiation, and, in some cases, chemotherapy, 32 (41%) cats experienced recurrence, and 9 (12%) cats developed metastases. One- and 2-year survival rates were 86 and 44%, respectively. Median survival time from onset of disease was 730 days (range, 30 to 2,014 days). Median disease-free interval was 405 days (range, 30 to 925 days). Cats that underwent only 1 surgery prior to radiotherapy had a lower recurrence rate than did cats that underwent > 1 surgery and had a significantly longer disease-free interval. Survival time and disease-free interval decreased as time between surgery and the start of radiotherapy increased. Cats that developed metastases had significantly shorter survival times and disease-free intervals than did cats that did not develop metastases. Castrated male cats had a significantly shorter survival time than did spayed female cats. Cats with larger tumors prior to the first surgery had shorter survival times. Twenty-six cats received chemotherapy in addition to surgery and radiotherapy. Whether cats received chemotherapy was not associated with recurrence rate, metastasis rate, or survival time.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that excision followed by electron beam irradiation may be beneficial for treatment of cats with vaccine-associated sarcomas. Extent of excision prior to radiotherapy did not seem to be associated with recurrence rate.

Detection limits for time-resolved coherent two-dimensional vibrational spectroscopy

Coherent two-dimensional vibrational spectroscopy is performed using doubly vibrationally enhanced four-wave mixing in dilute solutions of carbon disulfide using an ultrafast (< or = 1 ps) laser pulse system. The nonresonant electronic background and singly resonant coherent anti-Stokes Raman scattering contributions are suppressed by delaying the excitation pulses. With this suppression, we measured detection limits of 8 x 10(-5) M CS2 in bromochloromethane.

Embryo tolerance and maternal control of the marsupial environment in Armadillidium vulgare (Isopoda: Oniscidea)

Marsupial development in terrestrial isopods subjects embryos to potential physiological stresses, including desiccation, osmotic variation, and high ammonia concentrations. In this study, we investigated tolerance of osmotic extremes, total ammonia, and pH in developmental stages of Armadillidium vulgare cultured in vitro. Marsupial stages were classified as stage 1 (chorionated eggs), stage 2 (having shed the chorion), and stage 3 (mancas). All stages showed wide but differing tolerance ranges. Stage 1 eggs possess the greatest ammonia tolerance, with high 7-d survival in 150 mM total ammonia, and a wide pH tolerance range. Mancas show the widest osmotic tolerance (100-1,400 mosm x kg(-1)) and display proficient hemolymph osmoregulation over this range. Stage 2 eggs reveal the narrowest tolerance ranges for all three parameters but still qualify as eurytopic. Silver staining revealed two distinct ion-transporting tissues in the developmental stages: a median band on the vitelline membrane of stage 1 and stage 2 eggs, corresponding in location to the embryonic dorsal organ, and the posterior three pairs of pleopodal endopodites in mancas. Gravid females do not downregulate ammonia but show efficient regulation of marsupial fluid pH and downregulation of osmolality during dehydration, both of which will provide additional protection to the marsupial young.

Early childhood television viewing and adolescent behavior: the recontact study

In this Monograph, we report the follow-up of 570 adolescents who had been studied as preschoolers in one of two separate investigations of television use. The primary goal of the study was to determine the long-term relations between preschool television viewing and adolescent achievement, behavior, and attitudes. Using a telephone interview and high school transcripts, we assessed adolescent media use; grades in English, science, and math; leisure reading; creativity; aggression; participation in extracurricular activities; use of alcohol and cigarettes; and self-image. In each domain, we tested theories emphasizing the causal role of television content (e.g., social learning, information processing) as contrasted with those theories positing effects of television as a medium, irrespective of content (e.g., time displacement, pacing, interference with language). The results provided much stronger support for content-based hypotheses than for theories emphasizing television as a medium; moreover, the patterns differed for boys and girls. Viewing educational programs as preschoolers was associated with higher grades, reading more books, placing more value on achievement, greater creativity, and less aggression. These associations were more consistent for boys than for girls. By contrast, the girls who were more frequent preschool viewers of violent programs had lower grades than those who were infrequent viewers. These associations held true after taking into account family background, other categories of preschool viewing, and adolescent media use. One hypothesis accounting for the sex differences is that early experiences, such as television viewing, have greater effects when they counteract normative developmental trends and predominant sex-typed socialization influences than when they reinforce them. Adolescents in the study used both television and print media to support ongoing interests. Television content (e.g., entertainment, sports, or world events) predicted extracurricular activities, role models, and body image. The only evidence for possible effects of television as a medium was the positive relation of total viewing to obesity for girls. The medium of television is not homogeneous or monolithic, and content viewed is more important than raw amount. The medium is not the message: The message is.

The relations of early television viewing to school readiness and vocabulary of children from low-income families: the early window project

For two cohorts of children from low- to moderate-income families, time-use diaries of television viewing were collected over 3 years (from ages 2-5 and 4-7 years, respectively), and tests of reading, math, receptive vocabulary, and school readiness were administered annually. Relations between viewing and performance were tested in path analyses with controls for home environment quality and primary language (English or Spanish). Viewing child-audience informative programs between ages 2 and 3 predicted high subsequent performance on all four measures of academic skills. For both cohorts, frequent viewers of general-audience programs performed more poorly on subsequent tests than did infrequent viewers of such programs. Children's skills also predicted later viewing, supporting a bidirectional model. Children with good skills at age 5 selected more child-audience informative programs and fewer cartoons in their early elementary years. Children with lower skills at age 3 shifted to viewing more general-audience programs by ages 4 and 5. The results affirm the conclusion that the relations of television viewed to early academic skills depend primarily on the content of the programs viewed.

Radiation therapy in the treatment of canine and feline thymomas: a retrospective study (1985-1999)

A retrospective study was performed of 17 dogs and seven cats with various stages of thymoma treated with radiation alone or as an adjunctive therapy. Analysis revealed an overall response rate of 75% (15/20 evaluable cases). Partial (i.e., >50% reduction in tumor size) and complete (i.e., no detectable tumor) responses were included. Complete responses were rare (4/20). Three of five animals with stable disease (i.e., <50% change in tumor size) had improvements in clinical signs, despite lack of measurable response. A median survival time of 248 days (range, 93 to 1,657+ days) was achieved in dogs, and a median survival time of 720 days (range, 485 to 1,825+ days) was achieved in cats. Radiation therapy appears to be useful in the management of invasive thymomas in dogs and cats.

An in vivo/in vitro comparison with a leuprolide osmotic implant for the treatment of prostate cancer

An osmotically driven implantable system was designed and characterized for the delivery of leuprolide over a year-long duration. Leuprolide has been used in the treatment of prostate cancer since the 1980s. The DUROS implant consists of a titanium alloy cylinder, measures 4 mm in diameter by 45 mm in length and holds approximately 150 microl of formulation. Stability studies indicated that leuprolide was stable, as a solution formulation in DMSO, for several years at 37 degrees C. In vitro release rate testing, at weekly intervals, showed zero-order delivery for 1 year. DUROS implants demonstrated release rates that were reproducible and similar to one another after storage at 25 degrees C for 18 months prior to testing. In vivo studies, with implants placed subcutaneously, revealed delivery rates comparable to those observed under in vitro conditions. Leuprolide stability was also comparable between in vivo and in vitro conditions. Steady leuprolide serum levels produced by the implant resulted in the desired pharmacodynamic efficacy endpoint of testosterone suppression, both in canines and in humans. The good agreement between in vivo/in vitro delivery rates was as expected for a delivery system based on the principles of osmosis.

Immunization with recombinant Opc outer membrane protein from Neisseria meningitidis: influence of sequence variation and levels of expression on the bactericidal immune response against meningococci

The opc gene from Neisseria meningitidis was cloned into the pRSETA vector, and recombinant protein was expressed at high levels in Escherichia coli. The protein was readily purified by affinity chromatography and used for immunization with conventional Al(OH)3 adjuvant or after incorporation into liposomes and Zwittergent micelles. The resulting sera were analyzed for their ability to recognize purified recombinant protein and "native" protein in an enzyme immunoassay with outer membranes and by whole-cell immunofluorescence. Immunization with Al(OH)3 induced high levels of antibodies which reacted with the purified protein but did not recognize whole cells. In contrast, liposomes and micelles induced antibodies which reacted with the native protein in whole cells. The addition of monophosphoryl lipid A (MPLA) to either liposomes or micelle preparations increased the magnitude of the immune response and induced a wider range of immunoglobulin subclasses. This was associated with the ability of the sera to induce complement-mediated killing of the homologous strain. The most effective bactericidal activity was observed with Opc protein incorporated into liposomes containing MPLA. The magnitude of the bactericidal effect was strongly influenced by the level of expression of the Opc protein and was abolished by limited variation in the sequence of the protein expressed by heterologous strains.

The cost-effectiveness of fluoridating water supplies in New Zealand

OBJECTIVE

Tooth decay has been substantially reduced in New Zealand, and the difference in caries rates between fluoridated and non-fluoridated areas has narrowed. We investigated whether it is cost-effective to fluoridate water supplies that are now non-fluoridated.

METHODS

The net cost of fluoridation was based on the cost of fluoridating a water supply minus the averted costs of treating decay. A range of population sizes was considered. The main analysis was conducted from a societal perspective, using a real discount rate of 5%. Fluoridation was assumed to occur continuously between the years 2000 and 2030. Other assumptions were a Maori population proportion of 15%, no new decay after age 34, and no further dental cost savings after age 45. Information on averted decay in 4 to 12 year old New Zealand children (29,000 receiving fluoridated water and 47,000 receiving non-fluoridated water) was available; information on averted decay in adults was obtained from a study in the United States. Sensitivity analyses investigated the effects of varying the Maori population proportion, the discount rate, and the number of fluoride injection sites.

RESULTS

Fluoridation was cost-saving (dental cost savings exceeded fluoridation costs) for communities above about a thousand people. The true break-even community size may be lower. For smaller communities, fluoridation may be considered cost-effective depending on the non-monetised value assigned to an averted decayed surface.

CONCLUSIONS AND IMPLICATIONS

Fluoridation remains very cost-effective, and is particularly so for communities with high proportions of children, Maori, or people of low socio-economic status.

A contextual analysis of externalizing and mixed syndrome boys: when syndromal similarity obscures functional dissimilarity

A contextualized approach to psychopathology that focuses on children's responses to events rather than overall behavior output was examined. Teachers rated boys in special education classrooms using a standardized syndromal instrument and one that assessed boys' social environments and their responses to them. Externalizing and mixed (aggressive and withdrawn) syndrome groups showed distinctive response patterns that could not be derived from syndrome scores, with externalizers showing aggression in response to aversive events, and mixed boys showing contextually anomalous responses to positive events. The externalizing and mixed groups each consisted of functionally distinct subgroups that were not detected using syndrome measures. The results clarify how syndromal measures can confuse psychologically distinct children and demonstrate the utility of a teacher-report method that is efficient to administer and sensitive to contextual influences.

Height outcome in congenital adrenal hyperplasia caused by 21-hydroxylase deficiency: a meta-analysis

OBJECTIVE

To investigate adult heights attained by patients with 21-hydroxylase deficiency and to perform a meta-analysis of height outcomes reported in this population.

STUDY DESIGN

A retrospective chart review of our patients >5 years of age (n = 65) who were followed up from 1978 to 1998 for 21-hydroxylase deficiency was conducted. Final height (FH) SD scores and target height (TH) SD scores were determined. The impact of sex, time of diagnosis, and compliance was assessed. Meta-analysis of results from 18 studies was performed; TH was available for 204 of 561 patients.

RESULTS

Mean FH SD score-TH SD score for our 65 patients was -1.03. For the meta-analysis, mean weighted FH SD score for all 561 patients was -1.37, whereas weighted mean FH SD score-TH SD score for the 204 patients for whom TH was available was -1.21. No difference in outcome was seen for males compared with females, although a statistically significant difference was seen for patients identified early versus late.

CONCLUSIONS

Adult height in patients with 21-hydroxylase deficiency is often within 1 SD of TH. Early diagnosis and good compliance appear to improve the outcome. Rather than pursuing alternate therapies for congenital adrenal hyperplasia, efforts may instead be focused on early detection and improved compliance with traditional medical therapy.

Evaluation of chicken infectious anemia virus and associated risk factors with disease and production losses in broilers

A case-control study was performed to determine the significance of chicken infectious anemia virus (CIAV) as a risk factor associated with secondary disease in commercial broilers and to identify the significance of production losses associated with CIAV. The study also examined the relationship between bursal and thymic atrophy and the presence of CIAV. Cases were defined as submissions to the Alabama Veterinary Diagnostic Laboratories with a history of clinical disease and with a diagnosis of coccidiosis, gangrenous dermatitis, or respiratory disease. Controls were selected from submissions with neither a history of disease nor evidence of disease on necropsy. CIAV was detected in fresh tissues by polymerase chain reaction. Both thymic atrophy and the detection of CIAV were significantly associated with a disease case (P < 0.05). Bursal atrophy was a significant risk factor associated with the detection of CIAV in a submission (P < 0.05). Whereas CIAV was associated with disease cases that showed production losses in both percentage of livability and percentage of condemnations (P < 0.05), detection of CIAV alone was not associated with detectable losses in production or flock performance.

Evaluation of fibrin sealants in cutaneous wound closure

Human fibrin sealant (HFS) and bovine fibrin sealant (BFS) were delivered as preformulated fibrinogen-thrombin mixtures that are light activated. These formulations were evaluated in the healing of incised cutaneous wounds in beagle dogs. Four groups were differentiated by sealant type and study duration with group: BFS for 10 days, HFS for 10 days, BFS for 30 days, and HFS for 30 days. Healing was evaluated by noting incidences of open wounds, laser Doppler perfusion imaging (LDPI), planimetry, breaking strength, and histopathology. In the absence of tension, both sealants tended to hold wound edges together; however, HFS tended to be better than its controls and BFS. Both sealants augmented suture closure, necessitating fewer sutures for wound closure. At 5 and 30 days BFS wounds had more perfusion than HFS wounds, indicating more inflammation. At 10 and 30 days BFS wounds had larger scar areas than their controls, while scar areas of HFS wounds were smaller than either BFS wounds or controls. Breaking strengths indicated that HFS wounds were stronger than their controls and BFS wounds. Histologically, mild to moderate chronic-active inflammation was observed in wounds receiving either sealant, and this persisted longer in BFS wounds. Overall, HFS had positive qualities, thus showing potential for functional and cosmetic wound closure.

Relationship between motor and language activation using fMRI

The authors examined laterality ratios (i.e., [L-R]/[L+R]) from functional MRI (fMRI) scans obtained in 12 healthy volunteers during unimanual left- and right-hand finger movements and during a verb generation language task. The language and right-hand motor asymmetry ratios were correlated (rho = 0.71, p = 0.005) as were the left- and right-hand ratios (rho = -0.68, p = 0.008). Subjects with greater relative left hemisphere lateralization of language exhibit greater relative unilateral hemisphere activation during right-hand movements.

Doubly vibrationally enhanced four wave mixing: the optical analog to 2D NMR

We report the development of the four wave mixing vibrational analog to 2D NMR and demonstrate its spectral selectivity, sensitivity to the interactions causing mode coupling, and ability to spectrally resolve isotopic mixtures. The method discriminates against uncoupled vibrational modes and isolates the features that are associated with intra- or intermolecular interactions.

Role of rpoS in acid resistance and fecal shedding of Escherichia coli O157:H7

Acid resistance (AR) is important to survival of Escherichia coli O157:H7 in acidic foods and may play a role during passage through the bovine host. In this study, we examined the role in AR of the rpoS-encoded global stress response regulator sigma(S) and its effect on shedding of E. coli O157:H7 in mice and calves. When assayed for each of the three AR systems identified in E. coli, an rpoS mutant (rpoS::pRR10) of E. coli O157:H7 lacked the glucose-repressed system and possessed reduced levels of both the arginine- and glutamate-dependent AR systems. After administration of the rpoS mutant and the wild-type strain (ATCC 43895) to ICR mice at doses ranging from 10(1) to 10(4) CFU, we found the wild-type strain in feces of mice given lower doses (10(2) versus 10(3) CFU) and at a greater frequency (80% versus 13%) than the mutant strain. The reduction in passage of the rpoS mutant was due to decreased AR, as administration of the mutant in 0.05 M phosphate buffer facilitated passage and increased the frequency of recovery in feces from 27 to 67% at a dose of 10(4) CFU. Enumeration of E. coli O157:H7 in feces from calves inoculated with an equal mixture of the wild-type strain and the rpoS mutant demonstrated shedding of the mutant to be 10- to 100-fold lower than wild-type numbers. This difference in shedding between the wild-type strain and the rpoS mutant was statistically significant (P </= 0.05). Thus, sigma(S) appears to play a role in E. coli O157:H7 passage in mice and shedding from calves, possibly by inducing expression of the glucose-repressed RpoS-dependent AR determinant and thus increasing resistance to gastrointestinal stress. These findings may provide clues for future efforts aimed at reducing or eliminating this pathogen from cattle herds.

Quality controls for bovine viral diarrhea virus-free IVF embryos

Introduction of bovine viral diarrhea virus (BVDV) with cumulus-oocyte-complexes (COCs) from the abattoir is a concern in the production of bovine embryos in vitro. Further, International Embryo Transfer Society (IETS) guidelines for washing and trypsin treatment of in-vivo-derived bovine embryos ensure freedom from a variety of pathogens, but these procedures appear to be less effective when applied to IVF embryos. In this study, COCs were exposed to virus prior to IVM, IVF and IVC. Then, virus isolations from cumulus cells and washed or trypsin-treated nonfertile and degenerated ova were evaluated as quality controls for IVF embryo production. The effect of BVDV on rates of cleavage and development was also examined. All media were analyzed prior to the study for anti-BVDV antibody. Two approximately equal groups of COCs from abattoir-origin ovaries were washed and incubated for 1 h in minimum essential medium (MEM) with 10% equine serum. One group was incubated in 10(7) cell culture infective doses (50% endpoint) of BVDV for 1 h, while the other was incubated without virus. Subsequently, the groups were processed separately with cumulus cells, which were present throughout IVM, IVF and IVC. Cleavage was evaluated at 4 d and development to morulae and blastocysts at 7 d of IVC. After IVC, groups of nonfertile and degenerated ova or morulae and blastocysts were washed or trypsin-treated, sonicated and assayed for virus. Cumulus cells collected at 4 and 7 d were also assayed for virus. Anti-BVDV antibody was found in serum used in IVM and IVC but not in other media. A total of 1,656 unexposed COCs was used to produce 1,284 cleaved embryos (78%), 960 embryos > or = 5 cells (58%), and 194 morulae and blastocysts (12%). A total of 1,820 virus-exposed COCs was used to produce 1,350 cleaved embryos (74%), 987 embryos > or = 5 cells (54%), and 161 morulae and blastocysts (9%). Rates of cleavage (P = 0.021), cleavage to > or = 5 cells (P = 0.026) and development to morula and blastocyst (P = 0.005) were lower in the virus-exposed group (Chi-square test for heterogeneity). No virus was isolated from any samples from the unexposed group. For the exposed group, virus was always isolated from 4- and 7-d cumulus cells, from all washed nonfertile and degenerated ova (n = 40) and morulae and blastocysts (n = 57) and from all trypsin-treated nonfertile and degenerated ova (n = 80) and morulae and blastocysts (n = 91). Thus, virus persisted in the system despite the presence of neutralizing antibody in IVM and IVC media, and both washing and trypsin treatment were ineffective for removal of the virus. Presence of virus in 4- and 7-d cumulus cells as well as in nonfertile and degenerated ova were good indicators of virus being associated with morulae and blastocysts.

Functional MRI cerebral activation and deactivation during finger movement

OBJECTIVE

To examine interhemispheric interactions of motor processes by using functional MRI (fMRI).

BACKGROUND

Despite evidence of interhemispheric inhibition from animal, clinical, and transcranial magnetic stimulation (TMS) studies, fMRI has not been used to explore activation and deactivation during unilateral motor tasks. fMRI changes associated with motor activity have traditionally been described by comparing cerebral activation during motor tasks relative to a "resting state." In addition to this standard comparison, we examined fMRI changes in the resting state relative to a motor task.

METHODS

Thirteen healthy volunteers performed self-paced sequential finger/thumb tapping for each hand. During fMRI data acquisition, four epochs were obtained; each comprised of 30 seconds of rest, 30 seconds of right hand activity, and 30 seconds of left hand activity. Resultant echoplanar images were spatially normalized and spatially and temporally smoothed.

RESULTS

As expected, hand movements produced activation in the contralateral sensorimotor cortex and adjacent subcortical regions and, when present, the ipsilateral cerebellum. However, hand movement also produced a significant deactivation (i.e., decreased blood flow) in the ipsilateral sensorimotor cortex and subcortical regions, and when present, the contralateral cerebellum. Conjunction analysis demonstrated regions that are activated by one hand and deactivated by the contralateral hand.

CONCLUSION

Unilateral hand movements are associated with contralateral cerebral activation and ipsilateral cerebral deactivation, which we hypothesize result from transcallosal inhibition.

Effects of overexpression of growth hormone-releasing hormone on the hypothalamo-pituitary-gonadal function in the mouse

In this investigation, the neuroendocrine alterations induced by high, chronic circulating levels of endogenous growth hormone (GH) were studied in transgenic mice with ectopic overexpression of the human growth hormone-releasing hormone (h-GH-RH) gene. In comparison with their normal littermates, transgenic h-GH-RH mice had elevated plasma levels of GH, prolactin (PRL), and corticosterone. In addition, they had elevated body, liver, kidney, spleen, and pituitary weights compared with normal mice. Testis and seminal vesicle weights were also increased in transgenic mice. Although basal plasma luteinizing hormone (LH) levels, plasma estradiol levels in females, and plasma testosterone levels in males did not differ significantly between normal and transgenic animals, the LH response to castration was severely impaired in transgenic mice of both sexes. Among the biogenic amines studied in the hypothalamus, only dopamine concentrations were significantly lower in transgenic animals compared with their normal littermates. This decrease in hypothalamic dopamine may be related to the hyperprolactinemia in transgenic animals. In vitro, pituitaries from transgenic mice released significantly higher amounts of GH, and although the basal release of LH was not different in both normal and transgenic mice, the response to gonadotropin-releasing hormone was significantly smaller in transgenic mice. Cultured anterior pituitary cells from transgenic mice secreted high quantities of GH and PRL in vitro, but these quantities significantly decreased from 1 to 8 wk in culture. These results show that high, persistent levels of circulating endogenous GH induce alterations in neuroendocrine functions related to the hypothalamo-pituitary-gonadal and the hypothalamo-pituitary-adrenal axes.

The prevalence of Aeromonas species in feces of horses with diarrhea

Feces collected from 40 horses with diarrhea and 34 horses without diarrhea were examined to determine if an association existed between isolation of Aeromonas spp. and diarrhea. Samples were also examined for Salmonella spp., and identification of viruses and parasite ova. Neither Salmonella spp. nor Aeromonas spp. were isolated from the feces of 34 control horses. Aeromonas spp. were isolated from feces of 22 of 40 (55%) horses with diarrhea. Salmonella spp. were isolated from feces of 8 (20%) horses, and of these, 5 (12.5%) were also positive for Aeromonas spp. Twenty-nine isolates of Aeromonas spp. were recovered from the feces of 22 diarrheic horses. Of these isolates, more than 80% were susceptible on in vitro testing to amikacin, ceftiofur, chloramphenicol, and gentamicin. All isolates were susceptible to enrofloxacin. Diarrheic horses positive for Aeromonas were significantly (P = .04) older than diarrheic horses negative for Aeromonas spp. A significantly greater number of fecal samples were positive for Aeromonas spp. during March through August than samples examined in other months (P = .014). Results of this study indicate that Aeromonas spp. should be considered as a cause of diarrhea in horses.

Transgenic mice overexpressing the growth-hormone-releasing hormone gene have high concentrations of tachykinins in the anterior pituitary gland

According to recent reports, substance P (SP) is localized in the anterior pituitary gland within subsets of thyrotropes and somatotropes, although earlier electron-microscopic studies described the presence of this tachykinin in mammotropes and gonadotropes. Transgenic mice overexpressing the growth-hormone-releasing hormone (GHRH) gene have markedly enlarged pituitary glands, due to hyperstimulation of the somatotropes. Therefore, we speculated that if somatotropes are able to synthesize tachykinins, these peptides should be greatly increased in the anterior pituitary of transgenic GHRH mice. We found that, in accordance with our working hypothesis, both SP and neurokinin A (NKA) were markedly increased in the anterior pituitary gland of male and female transgenic mice, compared with their respective normal controls. In male transgenic mice, NKA was 13.6- and SP 20.2-fold higher than in the anterior pituitary from normal mice. In female transgenic mice, NKA was 40- and SP 100-fold higher than in the anterior pituitary from normal female mice. In male transgenic mice, NKA and neuropeptide K (NPK) contents in the anterior pituitary showed no significant changes between 26 and 50 days of age but significantly increased between 50 days and 5 months of age. The concentration of NKA in the anterior pituitary did not show significant differences between 26 days and 5 months of age, but NPK concentrations in the anterior pituitary significantly decreased with age. In female transgenic mice, NKA content and concentration in the anterior pituitary increased after 35 days of age, but NPK concentrations significantly decreased after 26 days of age. Triiodothyronine markedly decreased anterior pituitary tachykinins, but ovariectomy and estrogen administration failed to significantly affect tachykinin concentrations in the anterior pituitary of transgenic mice. Tachykinin immunostaining was detected in some somatotropes, but tachykinins were also present in cells that were not GH positive. These findings indicate that hyperstimulated somatotropes contain increased stores of tachykinins and that these cells are a source of tachykinins in the anterior pituitary. Tachykinin stores in the anterior pituitary of transgenic mice were affected by thyroid hormones but seem to be insensitive to estrogens. The GHRH transgenic mice may be an interesting model to study the regulation of tachykinin stores in the anterior pituitary gland.

The prevalence of Aeromonas species in feces of horses with diarrhea

Feces collected from 40 horses with diarrhea and 34 horses without diarrhea were examined to determine if an association existed between isolation of Aeromonas spp. and diarrhea. Samples were also examined for Salmonella spp., and identification of viruses and parasite ova. Neither Salmonella spp. nor Aeromonas spp. were isolated from the feces of 34 control horses. Aeromonas spp. were isolated from feces of 22 of 40 (55%) horses with diarrhea. Salmonella spp. were isolated from feces of 8 (20%) horses, and of these, 5 (12.5%) were also positive for Aeromonas spp. Twenty-nine isolates of Aeromonas spp. were recovered from the feces of 22 diarrheic horses. Of these isolates, more than 80% were susceptible on in vitro testing to amikacin, ceftiofur, chloramphenicol, and gentamicin. All isolates were susceptible to enrofloxacin. Diarrheic horses positive for Aeromonas were significantly (P = .04) older than diarrheic horses negative for Aeromonas spp. A significantly greater number of fecal samples were positive for Aeromonas spp. during March through August than samples examined in other months (P = .014). Results of this study indicate that Aeromonas spp. should be considered as a cause of diarrhea in horses.

How young children spend their time: television and other activities

Time-use diaries were collected over a 3-year period for 2 cohorts of 2- and 4-year-old children. TV viewing declined with age. Time spent in reading and educational activities increased with age on weekdays but declined on weekends. Time-use patterns were sex-stereotyped, and sex differences increased with age. As individuals' time in educational activities, social interaction, and video games increased, their time watching entertainment TV declined, but time spent playing covaried positively with entertainment TV. Educational TV viewing was not related to time spent in non-TV activities. Maternal education and home environment quality predicted frequent viewing of educational TV programs and infrequent viewing of entertainment TV. The results do not support a simple displacement hypothesis; the relations of TV viewing to other activities depend on the program content, the nature of the competing activity, and the environmental context.

Developmental psychopathology and the reciprocal patterning of behavior and environment: distinctive situational and behavioral signatures of internalizing, externalizing, and mixed-syndrome children

In contrast to assessment approaches that conceptualize traits as generalized response tendencies, this research develops a conditional approach that conceptualizes traits as patterns of relations between contexts and behaviors. Using extensive observations of social interactions, this study investigated internalizing, externalizing, and mixed-syndrome children identified by T. M. Achenbach's (1993) measures. Children in these groups differed in the patterning of their responses to social contexts and in the likelihood of encountering them. Mixed-syndrome children showed a distinctive behavior pattern consisting of aggressive and withdrawn responses to nonaversive contexts. The results demonstrate how measures of overall tendencies confound person and environment influences and obscure differences between children that are revealed by contextualized measures. The need to incorporate contexts more fully into clinical assessment is discussed.

Nonpharmacologic management strategies

Nonpharmacologic management strategies for Parkinson's disease should focus on educating the patient and family, empowering them to take control over the disease through physical, occupational and speech therapy, exercise, and good nutrition. An educated understanding of psycho-social resources will enable the patient and family to develop strategies to cope with life style changes encountered in the successful management of Parkinson's disease.

Developmental psychopathology and the reciprocal patterning of behavior and environment: distinctive situational and behavioral signatures of internalizing, externalizing, and mixed-syndrome children

In contrast to assessment approaches that conceptualize traits as generalized response tendencies, this research develops a conditional approach that conceptualizes traits as patterns of relations between contexts and behaviors. Using extensive observations of social interactions, this study investigated internalizing, externalizing, and mixed-syndrome children identified by T. M. Achenbach's (1993) measures. Children in these groups differed in the patterning of their responses to social contexts and in the likelihood of encountering them. Mixed-syndrome children showed a distinctive behavior pattern consisting of aggressive and withdrawn responses to nonaversive contexts. The results demonstrate how measures of overall tendencies confound person and environment influences and obscure differences between children that are revealed by contextualized measures. The need to incorporate contexts more fully into clinical assessment is discussed.

Surgical reduction of ileal impactions in the horse: 28 cases

OBJECTIVE

To evaluate the seasonal influence, signalment, type of hay consumed, clinical examination findings, and outcome after surgery for horses with ileal impaction.

STUDY DESIGN

A retrospective study.

RESULTS

Between 1988 and 1993, 28 horses had surgical correction of ileal impaction. There was a significantly higher rate of ileal impaction during the Fall (September-November, P = .0041 ). Mean duration of clinical signs of abdominal pain before referral was 15 hours. Transrectal palpation was used to localize the impaction in 11 horses. The ileal impaction was reduced by extraluminal massage aided by admixing of intestinal fluid oral to the impaction or injection of fluids intraluminally and then movement of the ingesta into the cecum alone in 24 horses. A total of 26 horses recovered from surgery; 24 horses were discharged from the hospital and eventually returned to previous use. Two horses had fatal postoperative complications: jejunocecostomy dehiscence and development of extensive small intestine adhesions after manual reduction of the impaction. One horse initially treated by manual reduction required jejunocecostomy twice for management of recurrent ileal impaction. Follow-up information was obtained for 21 horses, of which 20 were alive 1 year or longer after surgery. A total of 27 of 28 horses were fed Coastal Bermudagrass hay as the primary type of hay consumed. A total of 9 horses continued to be fed Coastal Bermudagrass hay as the only roughage source, whereas 6 horses were fed Coastal Bermudagrass with at least 50% other hay, and in 6 horses, Coastal Bermudagrass hay was entirely eliminated from the diet.

CONCLUSION AND CLINICAL RELEVANCE

Ileal impactions can be successfully reduced by celiotomy and extraluminal massage and injection techniques to soften the ingesta for passage into the cecum without enterotomy or bypass techniques in most horses. Changes in weather and feeding practices in the Fall may account for an increased risk of ileal impaction in horses in the southeastern United States at that time of year.

Gains in life expectancy from medical interventions--standardizing data on outcomes

BACKGROUND

The gain in life expectancy is an important measure of the effectiveness of medical interventions, but its interpretation requires that it be placed in context. The interpretation of gains in life expectancy is particularly problematic for preventive interventions, for which the gains are often just weeks or even days when averaged across the entire target population.

METHODS

We tabulated the gains in life expectancy from a variety of medical interventions as reported in 83 published sources and categorized them according to target population and disease. We considered prevention in populations at average risk for particular diseases, prevention in populations at elevated risk, and treatments in populations with established disease.

RESULTS

The gains in life expectancy from preventive interventions in populations at average risk ranged from less than one month to slightly more than one year per person receiving the intervention, but the gains were as high as five years or more if the prevention was targeted at persons at especially high risk. The gains in life expectancy from treatments of established disease ranged from several months (for coronary thrombolysis and revascularization to treat heart disease) to as long as nine years (for chemotherapy to treat advanced testicular cancer).

CONCLUSIONS

A gain in life expectancy from a medical intervention can be categorized as large or small by comparing it with gains from other interventions aimed at the same target population. A gain in life expectancy of a month from a preventive intervention targeted at populations at average risk and a gain of a year from a preventive intervention targeted at populations at elevated risk can both be considered large. The framework we developed for standardizing gains in life expectancy can be used in the interpretation of data on the outcomes of interventions.

Evaluation of the effects of omega-3 fatty acid-containing diets on the inflammatory stage of wound healing in dogs

OBJECTIVES

To ascertain the effects of dietary omega-3 (n-3) fatty acids on biochemical and histopathologic components of the inflammatory stage of wound healing.

ANIMALS

30 purpose-bred Beagles.

PROCEDURE

Dogs were allotted to 5 groups of 6. Each group was fed a unique dietary fatty acid ratio of omega-6 to n-3--diet A, 5.3:1; diet B, 10.4:1; diet C, 24.1:1; diet D, 51.6:1; and diet E, 95.8:1. Dogs were fed once daily for 12 weeks, then biopsy specimens were taken from 4-day-old wounds of each dog and analyzed by gas chromatography-mass spectrometry for: prostaglandin E2 (PGE2) metabolites, and ratios of omega-6 to n-3 fatty acids, arachidonic acid (AA) to eicosapentaenoic acid (EPA), adrenic acid to docosahexaenoic acid, and PGE2 to prostaglandin E3 (PGE3) metabolites.

RESULTS

Qualitative analysis was carried out on AA, EPA, adrenic acid, docosahexaenoic acid, and the major metabolite from the PGE2 and PGE3 pathway. These molecules were further quantified with respect to diet to determine significant differences. By analysis of the AA-to-EPA ratio, diet A was different from diets D and E and diets B and C were different from diet E (P < 0.05). By analysis of the PGE2-to-PGE3 metabolite ratio, diet A was different from diet E (P < 0.05). Though biochemical analysis indicated dietary dependence, histopathologic data indicated no significant difference with respect to diet groups.

CONCLUSION

The biochemical component of the inflammatory stage of wound healing can be manipulated by diet.

CLINICAL RELEVANCE

Omega-3 fatty acid-enriched diets can be used to control inflammation associated with dermatologic conditions.

Assessment of current techniques for determining tracheal luminal stenosis in dogs

OBJECTIVE

To assess the accuracy of current antemortem and postmortem techniques for determining tracheal luminal stenosis.

ANIMALS

15 dogs.

PROCEDURE

Percentage of tracheal luminal stenosis (PTLS) was determined by 6 methods, using measurements obtained by radiography, tracheoscopy, and necropsy after selected tracheostomy techniques were performed. To calculate PTLS, dorsoventral tracheal diameter was measured from preoperative and postoperative lateral cervical radiographic views. Preoperative or normal tracheal segments adjacent to the stenotic area were used to obtain normal tracheal diameter measurements. Planimetrically determined cross-sectional area (CSA), obtained from pre- and postoperative tracheoscopic photographs, was used to calculate PTLS. The CSA of tracheal specimens obtained at necropsy was determined, using the formula for an ellipse. Percentage of luminal stenosis was calculated, using CSA of the stenotic site and of segments craniad and caudad to the site obtained at necropsy or at surgery. All methods were compared with the control method of planimetrically determined CSA of sections obtained at necropsy of the tracheostomy and segments craniad and caudad to the site.

RESULTS

Correlation was poor for radiographic and tracheoscopic techniques (r = 0.146 to 0.458, P > 0.05) The formula for an ellipse accurately predicted PTLS when measurements obtained at surgery (r = 0.516, P = 0.049) or segments craniad and caudad (r = 0.853, P < 0.001) to the site were used.

CONCLUSION

Antemortem methods of assessing PTLS did not correlate with control planimetric methods. Methods using CSA determined by tracheal diameter were weakly correlated to control planimetric techniques.

CLINICAL RELEVANCE

Accurate measurement of the degree of tracheal stenosis cannot be made in clinical patients using current techniques.

Are methods for estimating QALYs in cost-effectiveness analyses improving?

OBJECTIVES

The objectives of this study were to examine variations in the methods used by researchers to estimate QALYs in published cost-effectiveness analyses, and to investigate whether the methods have improved over time.

DATA AND METHODS

Using a MEDLINE search, the authors identified 86 original cost-effectiveness analyses, published between 1975 and 1995, that used QALYs as the measure of effectiveness. For each study, they recorded the health-state classification system, the source of the preference weights, the measurement technique, and the discount rate. The methods used were compared with the recommendations of the U.S. Panel on Cost-Effectiveness in Health and Medicine.

RESULTS

Only 20% of the studies used "generic" health-state classification systems (e.g., health utilities index); 21% relied on community-based weights; 40% used formal measurement techniques (e.g., time-tradeoff method); and 88% discounted both future costs and QALYs. There was little evidence that methods had improved over time.

CONCLUSIONS

The results illustrate extensive variation in the construction of QALYs in cost-effectiveness analyses and reveal that most studies have not adhered to practices now recommended by leaders in the field. There is a need for more methodologic rigor and consistency if the results of such studies are to be compared and used for purposes of allocating resources.

Osteonecrosis after contact neodymium:yttrium aluminum garnet arthroscopic laser meniscectomy

OBJECTIVE

The purpose of this report is to describe two cases of osteonecrosis that occurred after arthroscopic meniscectomy with a contact neodymium:yttrium aluminum garnet laser system. The patients developed increasing knee pain and disability 5 months and 6 months after laser meniscectomy. MR imaging showed subchondral osteonecrosis in the femoral condyle and tibial plateau immediately adjacent to the site of laser meniscectomy in both patients. One patient required a total knee replacement to alleviate knee symptoms, and the other patient required a tibial osteotomy and surgical elevation of collapsed tibial articular surface.

CONCLUSION

To our knowledge, this complication of laser arthroscopic meniscectomy has not been reported in the radiology literature. The clinical and MR imaging features of this important complication are described and possible causative mechanisms are discussed.