Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial

BACKGROUND

Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage).

METHODS

This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree".

RESULTS

Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability,  > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded.

CONCLUSIONS

The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.

Nuclear Magnetic Resonance Derived Biomarkers for Evaluating Cardiometabolic Risk in Youth and Young Adults Across the Spectrum of Glucose Tolerance

Youth with obesity have an increased risk for cardiometabolic disease, but identifying those at highest risk remains a challenge. Four biomarkers that might serve this purpose are "by products" of clinical NMR LipoProfile^® lipid testing: LPIR (Lipoprotein Insulin Resistance Index), GlycA (inflammation marker), BCAA (total branched-chain amino acids), and glycine. All are strongly related to insulin resistance and type 2 diabetes (T2DM) in adults (glycine inversely) and are independent of biological and methodological variations in insulin assays. However, their clinical utility in youth is unclear. We compared fasting levels of these biomarkers in 186 youth (42 lean normal glucose tolerant (NGT), 88 obese NGT, 23 with prediabetes (PreDM), and 33 with T2DM. All four biomarkers were associated with obesity and glycemia in youth. LPIR and GlycA were highest in youth with PreDM and T2DM, whereas glycine was lowest in youth with T2DM. While all four were correlated with HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LPIR had the strongest correlation (LPIR: r = 0.6; GlycA: r = 0.4, glycine: r = -0.4, BCAA: r = 0.2, all P < 0.01). All four markers correlated with HbA1c (LPIR, GlycA, BCAA: r ≥ 0.3 and glycine: r = -0.3, all P < 0.001). In multi-variable regression models, LPIR, GlycA, and glycine were independently associated with HOMA-IR (Adjusted R² = 0.473, P < 0.001) and LPIR, glycine, and BCAA were independently associated with HbA1c (Adjusted R² = 0.33, P < 0.001). An LPIR index of >44 was associated with elevated blood pressure, BMI, and dyslipidemia. Plasma NMR-derived markers were related to adverse markers of cardiometabolic risk in youth. LPIR, either alone or in combination with GlycA, should be explored as a non-insulin dependent predictive tool for development of insulin resistance and diabetes in youth.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov, identifier NCT:02960659.

Fat and protein metabolism in growing steers fed either grass silage or dried grass

Cattle fed grass silage diets have been reported to have high carcass fat:protein ratios. The effect of grass silage and dried grass diets, fed at different levels of intake to ensure a range of equivalent metabolisable energy intakes (MEI) from 1 .1 x metabolisable energy requirement for maintenance to ad libitum, on fat and protein metabolism in twenty-four Hereford x Friesian steers was investigated. After about 84 d of dietary treatment rates of whole-body fat and protein metabolism were measured, as were rates of lipogenesis in omental, perirenal and subcutaneous adipose tissue. Carcass composition was determined. Animals fed silage had greater (P<0 .001) carcass fat:protein ratios than animals fed dried grass at equivalent levels of MEI. Animals fed silage had lower (P<0 .001) rates of protein gain. Rates of leucine entry and oxidation were lower (P<0 .001) in animals fed silage, but there was no dietary difference in the rate of whole-body protein synthesis. There was no dietary difference in the rate of carcass fat gain, but rates of lipogenesis in perirenal adipose tissue were significantly (P=0 .007) higher in animals fed silage. There was no dietary difference in the rate of palmitate and glycerol entry or palmitate oxidation. There were no interactions between MEI and diet, indicating that increments of energy were utilised with the same efficiency from both diets. It was concluded that the high carcass fat:protein ratios of young growing steers was due to limited rates of protein accretion and not to elevated rates of carcass fat accretion.

Grating-enhanced through-wafer optical microprobe for microelectromechanical system high-resolution optical position feedback

We present modeling and experimental results from the use of a 1310-nm-wavelength through-wafer optical microprobe in conjunction with a microstructure grating to monitor the motion of a lateral comb resonator stage. The optical signal that results from shuttle interaction with the microprobe beam exhibits a peak-to-valley dynamic range that corresponds to 2-microm microstructure displacement, facilitating submicrometer positional resolution on digitization. This signal was used to achieve microstructure positional feedback and effective microsystem model parameter extraction, which are essential for structure control and model-based fault detection.

Collagen expression and biomechanical response to human recombinant transforming growth factor beta (rhTGF-beta2) in the healing rabbit MCL

We investigated biomechanical and collagen expression in a healing bilateral rabbit medial collateral ligament (MCL) model to human recombinant transforming growth factor beta (rhTGF-beta2) at three and six weeks. Each rabbit had rhTGF-beta2 in a bioabsorbable pellet administered in one side, with the contralateral side serving as control (no rhTGF-beta2). All MCL healed with rhTGF-beta2 producing a profoundly increased scar mass at three weeks which decreased in size toward control at six weeks. In-situ hybridization demonstrated collagen expression (type I and III) no different than control at three weeks, but by six weeks elevated expression of type I was seen. Biomechanical analysis at three weeks showed no effect of rhTGF-beta2 on structural properties. However, at six weeks rhTGF-beta2 significantly inhibited both the maximum load (p < 0.05) and energy absorbed (p < 0.05) with no change in stiffness. Despite increased type I collagen expression and profound increase in early scar mass, rhTGF-beta2 did not improve the structural properties. Whether the dose or mode of delivery is responsible for decline in structural properties cannot be determined in this design. We hypothesize investigations of healing ligaments to cytokines should have biologic and biomechanical properties correlated in the same study at a minimum of two time points.

In vivo macrophage recruitment by murine intervertebral disc cells

SUMMARY

An in vivo murine experiment was conducted to measure the capacities of viable intervertebral disc cells to recruit inflammatory cells. The objective was to determine whether compounds secreted from viable cells induce inflammation or whether inflammation in disc herniation simply requires exposure to structural cell or matrix components. Three tissue preparations were inserted into the right lower peritoneal cavity of male mice: tissue with viable annulus fibrosus and nucleus pulposus cells, tissue with viable annulus fibrosus cells, or devitalized annulus fibrosus and nucleus pulposus tissue. Controls included sham-operated and nonoperated groups. Mice were killed 1, 2, or 7 days after surgery. Macrophage recruitment occurred after exposure to viable disc tissue but not after exposure to devitalized disc components; recruitment increased over time. Viable disc cells play a role in the etiology of inflammation in disc herniation.

In vivo measurement of lipogenesis in ruminants using [1-(14)C]acetate

A method for the measurement of the rate of lipogenesis in ruminants using a continuous intravenous infusion of [1-(14)C]acetate and measuring the rate of [1-(14)C]acetate incorporation into adipose tissue lipid was evaluated. Subcutaneous adipose tissue samples obtained by biopsy over the course of a 6 h continuous intravenous infusion of [1-(14)C]acetate into a wether and a steer maintained in a 'metabolic steady state' demonstrated that the incorporation of [1-(14)C]acetate into subcutaneous adipose tissue lipid was linear for the duration of the infusion period. Subsequent measures of rates of [1-(14)C]acetate incorporation into adipose tissue lipid were made on adipose tissue samples taken at a single time point during the infusion period. The technique was used to measure rates of lipogenesis in the subcutaneous adipose tissue of fourteen Hereford x Friesian steers that had been fed a pelleted diet of dried grass at a range of metabolizable energy (ME) intakes from 1.1 x ME requirement for maintenance to ad libitum for 11 weeks. Rates of lipogenesis increased linearly with increasing ME intake. It was concluded that the method is an effective technique for measuring rates of lipogenesis in specific adipose tissue depots in vivo in ruminants.

Maternal nutrition alters the expression of insulin-like growth factors in fetal sheep liver and skeletal muscle

We investigated the influence of maternal dietary restriction between days 28 and 80 of gestation followed by re-feeding to the intake of well-fed ewes up to 140 days of gestation (term is 147 days) in sheep, on expression of mRNA for insulin-like growth factor (IGF)-I, IGF-II and growth hormone receptor (GHR) in fetal liver and skeletal muscle. Singleton bearing ewes either consumed 3.2-3.8 MJ/day of metabolisable energy (ME) (i.e. nutrient restricted - approximately 60% of ME requirements, taking into account requirements for both ewe maintenance and growth of the conceptus) or 8.7-9.9 MJ/day (i.e. well fed - approximately 150% of ME requirements) between days 28 and 80 of gestation. All ewes were then well fed (150% of ME requirements) up to day 140 of gestation and consumed 8-10.9 MJ/day. At days 80 and 140 of gestation, five ewes were sampled from each group and fetal tissues taken. There was no difference in fetal body weight or liver weights between groups at either sampling date, or skeletal muscle (quadriceps) weight at 140 days. IGF-I mRNA abundance was lower in livers of nutrient-restricted fetuses at day 80 of gestation (nutrient restricted 2.35; well fed 3.70 arbitrary units), but was higher than well-fed fetuses at day 140 of gestation, after 60 days of re-feeding (restricted/re-fed 4.27; well fed 2.83;s.e.d. 0.98 arbitrary units, P=0.061 for dietxage interaction). IGF-II mRNA abundance was consistently higher in livers of nutrient-restricted fetuses (80 days: nutrient restricted 7.78; well fed 5.91; 140 days: restricted/re-fed 7.23; well fed 6.01;s.e.d. 1.09 arbitrary units, P=0.061 for diet). Nutrient restriction had no effect on hepatic GHR mRNA abundance, but re-feeding of previously nutrient-restricted fetuses increased GHR mRNA compared with continuously well-fed fetuses (80 days: nutrient restricted 70.6; well fed 75.1; 140 days: restricted/re-fed 115.7; well fed 89.4;s.e.d. 10.13 arbitrary units, P=0.047 for dietxage interaction). In fetal skeletal muscle, IGF-I mRNA abundance was not influenced by maternal nutrition and decreased with gestation age (P<0.01). IGF-II mRNA abundance was higher in skeletal muscle of nutrient-restricted fetuses compared with well-fed fetuses at day 80 of gestation (nutrient restricted 16.72; well fed 10.53 arbitrary units), but was lower than well-fed fetuses after 60 days of re-feeding (restricted/re-fed 7.77; well fed 13.72;s.e.d. 1.98 arbitrary units, P<0.001 for dietxage interaction). There was no effect of maternal nutrition or gestation age on fetal skeletal muscle GHR expression. In conclusion, maternal nutrient restriction in early to mid gestation with re-feeding thereafter results in alterations in hepatic and skeletal muscle expression of IGF-I, IGF-II and/or GHR in the fetus which may subsequently relate to altered organ and tissue function.

Growth factor modulation of distraction osteogenesis in a segmental defect model

A model was established in 39 dogs to investigate the growth factor modulation of regenerate bone in distraction osteogenesis. A segment of the diaphysis of the radius was resected unilaterally. An osteotomy was made proximal to the segmental defect to create a transport segment. A monolateral external fixator was applied. After a latency period, the segment was transported across the defect. One week after the transport assembly contacted the distal pin clamp, an ipsilateral osteotomy of the proximal ulna was performed. In 20 dogs, transforming growth factor-beta was injected into the regenerate bone halfway through the transport period. Four dogs were sacrificed before docking, when the regenerate bone was still immature. In specimens harvested halfway through the transport period, evidence was found of intramembranous ossification during distraction. In specimens harvested after the transport assembly contacted the distal pin clamp, evidence was found that the mature regenerate formed by endochondral ossification. Therefore, a combined mechanism of ossification is proposed for this segmental defect model that includes mechanical stimulus for bone differentiation. The one-time administration of transforming growth factor-beta retarded the formation of a stable, united regenerate. It is concluded that transforming growth factor-beta caused an effect opposite to that which was desired.

The effect of ageing on nutrient digestibility by cats fed beef tallow-, sunflower oil- or olive oil-enriched diets

Nutrient digestibility and absorption decline with age in several mammalian species. The aim of this study was to compare apparent fat digestibility of different dietary fats in young and senior cats. Three diets enriched with either beef tallow (high in saturated fatty acids), olive oil (high in monounsaturated fatty acids) or sunflower oil (high in polyunsaturated fatty acids) were fed to 6 young (3.0+/-0.9y) and 6 senior (11.6+/-1.4y) cats at 300kJ metabolisable energy/kgBW0.75/d in a 3*3 Latin square design. Food and faecal samples collected over two consecutive 7d periods were analysed for fat, protein, moisture, ash, gross energy and fatty acid content. Apparent digestibilities of fat and energy were significantly lower (P=0.03) in senior cats compared to young cats (fat: 0.922 compared to 0.944; energy: 0.848 compared to 0.885, for senior and young cats, respectively) in all three diets. Senior cats exhibited a lower apparent digestibility for all fatty acid groups compared to the younger cats (saturated: 0.932 compared to 0.952; monounsaturated: 0.964 compared to 0.982; polyunsaturated: 0.980 compared to 0.987, for senior and young cats, respectively). Saturated fatty acids had the lowest apparent digestibility in both young and senior cats, and shorter chain fatty acids were digested more easily than the longer chain fatty acids. These results suggest that the age-related reduction in apparent fat digestibility was a general phenomenon affecting all fatty acids, and was not due to one particular fatty acid group.

Gastrointestinal transit times in young and old cats

Ageing results in a decrease in apparent nutrient digestibility in the gastrointestinal (GI) tract. The aim of this study was to investigate whether the rate of gastric emptying or total GI transit times differed between young (3.0+/-0.9 years) and senior (11.6+/-1. 4 years) cats. Gastric emptying rates were measured using [1-(13)C]octanoic acid and total transit times with chromium oxide. No significant differences (P>0.05) were observed in either the rate of gastric emptying or total transit time between young and senior cats although senior cats exhibited a larger variability in total transit time compared to the younger cats (35.71+/-14.06 and 26. 46+/-5.80 h, respectively). The results of this study indicate that the observed reduction in nutrient digestibility in ageing cats is not due to alterations in the rate of passage of digesta through the GI tract.

Quantitative proton magnetic resonance spectroscopy of the subcortical white matter in motor neuron disease

BACKGROUND

Using proton magnetic resonance spectroscopy, the authors have previously demonstrated a reduction in the N-acetyl aspartate/(creatine and phosphocreatine) (NAA/(Cr + PCr)) ratio in the motor region in bulbar-onset MND patients, attributed to neuronal loss or dysfunction leading to a reduction in NAA. We have expanded this analysis to evaluate absolute concentrations of NAA, (Cr + PCr) and choline-containing compounds (Cho) in the subcortical white matter in the motor region in 16 MND patients (8 with bulbar onset and 8 with limb onset) and 8 healthy, age-matched controls.

METHODS

Single voxel 1H-MRS was performed using a PRESS localization sequence. Metabolite concentrations were determined using the water signal as an internal standard.

RESULTS

We found no differences in the concentrations of NAA ([NAA]), (Cr + PCr) ([Cr + PCr]) or Cho ([Cho]) in the motor region on comparing the total MND group and controls (P > 0.3). No difference was found in [NAA] in the bulbar-onset group compared with the limb-onset group (P = 0.70), but [Cr + PCr] was significantly higher in the bulbar-onset group (P = 0.04).

CONCLUSIONS

Our results suggest that [Cr + PCr] may be affected by the pathological process in MND, and this should be considered in the interpretation of metabolite peak area ratios. The elevated (Cr + PCr) may represent gliosis in the subcortical white matter in the motor cortex region.

Distinct hyperintense MRI signal changes in the corticospinal tracts of a patient with motor neuron disease

Neuroimaging in motor neuron disease (MND) is currently performed to exclude other pathologies, though abnormalities may be seen which are consistent with the diagnosis. We report a patient with rapidly progressive MND exhibiting extensive changes on a variety of contemporary magnetic resonance images, which is most likely to represent severe corticospinal tract degeneration.

Diffusion tensor MRI assesses corticospinal tract damage in ALS

BACKGROUND

A number of neurophysiologic and neuroimaging techniques have been evaluated in the research setting to assess upper motor neuron (UMN) damage in ALS. Changes in tissue structure in the CNS modify the diffusional behavior of water molecules, which can be detected by diffusion tensor MRI.

OBJECTIVES

To explore the hypothesis that degeneration of the motor fibers in ALS would be reflected by changes in the diffusion characteristics of the white matter fibers in the posterior limb of the internal capsule and that these changes could be detected by diffusion tensor MRI.

METHODS

We studied 22 patients with El Escorial definite, probable, or possible ALS-11 with limb onset (mean age 54.5 +/- 10.7 years) and 11 with bulbar onset (mean age 49.6 +/- 11.7 years)-and compared them with 20 healthy, age-matched controls (mean age 46.0 +/- 12.6 years). We assessed central motor conduction time (CMCT), threshold to stimulation, and silent period using transcranial magnetic stimulation. Diffusion tensor MRI was performed using a 1.5-T GE Signa system (Milwaukee, WI) fitted with Advanced NMR hardware and software capable of producing echo planar MR images. Data were acquired from seven coronal slices centered to include the posterior limb of the internal capsule. Maps of the mean diffusivity, fractional anisotropy, and T2-weighted signal intensity were generated.

RESULTS

There were no differences between the subject groups on measures of CMCT, threshold to stimulation, and silent period. However, the CMCT correlated with clinical measures of UMN involvement. We found a significant increase in the mean diffusivity and reduction in fractional anisotropy along the corticospinal tracts between the three subject groups, most marked in the bulbar-onset group. The fractional anisotropy correlated with measures of disease severity and UMN involvement, whereas the mean diffusivity correlated with disease duration.

CONCLUSION

The results support the use of diffusion tensor MRI in detecting pathology of the corticospinal tracts in ALS.

Comparative biomechanics of hybrid external fixation

OBJECTIVE

To compare the elastic stiffness, in several loading modes, of commercially available hybrid external fixation systems.

DESIGN

Laboratory investigation using a polyvinylchloride pipe periarticular tibia fracture model.

SETTING

Simulated periarticular fractures were created in an in vitro tibia fracture model. Instrumented specimens and intact controls were elastically tested in a biomaterials testing system.

INTERVENTION

Groups of simulated periarticular tibia fractures were stabilized with one of six different hybrid external fixator designs.

MAIN OUTCOME MEASUREMENTS

Elastic stiffness of each specimen was measured in compression, torsion, flexion bending, extension bending, and varus/valgus bending.

RESULTS

Fixators with multiple levels of fixation in the periarticular fragment, regardless of design, were stiffer than those with one level. Specifically, the EBI Ring Connector fixator was stiffer than all others in all modes of testing. The Ace, Synthes, Smith & Nephew Richards, and How medica fixators were mechanically similar. The Zimmer Torus fixator was the least stiff fixator tested.

CONCLUSIONS

Fixators with multiple levels of fixation in the periarticular fragment, regardless of design, were stiffer than those with one level. The choice of which hybrid external fixator to use should be made based not only on stiffness but also on ease of clinical application, patient comfort, customer support from the manufacturer, and cost. Clinical investigation of the efficacy of each of these devices is warranted.

Effect of gastric inhibitory polypeptide on bovine fat metabolism

Gastric inhibitory polypeptide (GIP), a hormone secreted by the gastrointestinal tract in response to nutrient absorption, exerts anabolic effects on adipose tissue in some species. Cattle fed on grass silage diets tend to deposit more fat than animals fed on dried forages. We investigated the effect of diet on blood GIP concentrations in cattle. Plasma concentrations tended to be higher in cattle fed grass silage alone or supplemented with fishmeal (0.61 ng/ml) compared with animals fed dried grass/barley (0.43 ng/ml, P > 0.1) and were inversely correlated with plasma insulin concentrations (r = -0.727, P < 0.01). The effects of increasing concentrations (0, 0.1, 1.0, 10.0 nM) of GIP and glucagon-like peptide-1 (GLP-1) on basal and insulin-stimulated lipogenesis in bovine adipose tissue in vitro were investigated after 4 and 24 h of incubation. No conclusive effects were obtained with either peptide. Subsequently, the effect of exogenous administration of GIP (10 or 50 ng/kg liveweight per min) on whole-body fat metabolism was investigated in two steers in vivo. Plasma concentration and flux rate of palmitate was increased by GIP only at the higher infusion level suggesting lipolysis and possibly fatty acid re-esterification was stimulated at high concentration. We conclude that although gut peptides may regulate nutrient utilisation, it is unlikely that they play a major role in promoting fat accretion in cattle. However, the small number of animals used in these studies indicates the need for caution and further studies are warranted.

The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty

We examined the effects of vancomycin on the compressive strength and fatigue life of bone cement and the pharmacokinetics and antimicrobial activity against methicillin-resistant Staphylococcus aureus of vancomycin eluted from bone cement, both alone and in combination with tobramycin. Two cements, Palacos and Simplex, were tested. Three antibiotic preparations were tested: lyophilized vancomycin (vancomycin-L), vancomycin powder (vancomycin-P), and tobramycin powder (Lilly, Indianapolis, IN). Although antibiotics did not significantly affect compressive strength, the fatigue life of bone cement was significantly decreased with vancomycin. Thus, fatigue testing revealed effects on cement strength not apparent by compression testing. Vancomycin-P had a substantially less detrimental effect on fatigue strength than vancomycin-L. Vancomycin-P elutes less efficiently than tobramycin. Although relatively little vancomycin-P eluted from bone cement, it retained biologic activity.

Analysis of the structural behavior of the pelvis during lateral impact using the finite element method

In this study, three-dimensional finite element models were created from computer tomography data to study lateral impact fractures of the pelvis. The models reflect the complex geometry and material properties of the pelvis. The models were compared to published experimental results for validation. Dynamic analyses of the pelvic structure were performed for different peak forces in the range of 5520 to 15550 N to correspond to the velocities and impulses of real world accidents. The locations of structurally significant regions of the pelvis were identified based upon the stress distribution and upon the energy stored by the pelvis to failure. The impact force which induced fracture of the pelvic bone was 8610 N. The region which failed first in left lateral impact was the right pubic ramus. The fracture pattern was a variant of the lateral compression pelvic injury. The results suggest that the anterior structures of the pelvis are the most sensitive regions. The energy absorbed by the pelvis prior to failure was 8.98 J. The finite element method may be used to determine the strength and energy-absorbing capability of the pelvis for lateral impact loading.

The biomechanics of hybrid external fixation

OBJECTIVE

The objective of this study was to ascertain which factors determine the rigidity of a hybrid external fixation frame in a tibial periarticular fracture model.

DESIGN

Laboratory investigation using a polyvinylchloride pipe periarticular tibia fracture model.

SETTING

Simulated periarticular tibia fractures were created in a tibia model. Instrumented specimens were tested in a biomaterials testing system.

INTERVENTION

Groups of simulated periarticular tibia fractures were stabilized with one of nine different external fixation constructs with components from one manufacturer.

MAIN OUTCOME MEASUREMENTS

Elastic stiffness was measured for each specimen in compression, torsion, flexion bending, extension bending, and varus and valgus bending.

RESULTS

The four-ring Ilizarov fixator was the stiffest in all modes of testing. There was a trend toward increasing stiffness with an increasing number of rings. Fixators constructed with multiple levels of fixation in the periarticular fragment were stiffer in all modes of testing. The additional spacing between wires gained by the use of a single thick carbon ring or the use of a drop wire three centimeters from a single ring did not increase stiffness in this model. Frame modifications intended to augment the bar-to-ring connection did not increase stiffness. The use of rings mounted with half-pins instead of a unilateral bar mounted with half-pins for diaphyseal fixation increased the stiffness of the frame only in torsional testing.

CONCLUSIONS

Although the ideal stiffness of an external fixator is unknown, our results show that the addition of more than one level of fixation in the periarticular fragment increases the stiffness of hybrid external fixators in this periarticular tibia fracture model. Augmentation of the ring-to-bar connection did not significantly affect the stiffness of the frame.

A proton magnetic resonance spectroscopic study in ALS: correlation with clinical findings

OBJECTIVE

To evaluate neuronal dysfunction in the motor region subcortical white matter in ALS using volumetric localized proton magnetic resonance spectroscopy (1H-MRS).

METHODS

Sixteen patients with E1 Escorial definite, probable, or possible ALS and eight healthy age-matched control subjects were studied. The ALS patients were divided into those with limb onset (n = 8) and those with bulbar onset (n = 8). Measurements of the metabolic ratios N-acetylaspartate (NAA)/creatine and phosphocreatine (Cr+PCr), NAA/choline (Cho), and Cho/(Cr+PCr) were correlated with clinical assessments.

RESULTS

We found no differences in the metabolic peak area ratios in the motor region when comparing the total ALS group and the control subjects. However, correlations were found between the NAA/(Cr+PCr) ratio and the E1 Escorial category (p = 0.03), the ALS severity scale (p = 0.01), and the Medical Research Council score (p = 0.06). No correlations were found between the NAA/(Cr+PCr) ratio and the Ashworth Spasticity Scale, reflex score, or disease duration (p > 0.16). Bulbar-onset patients had a lower NAA/(Cr+PCr) ratio in the motor region compared with limb-onset patients (p = 0.03).

CONCLUSION

In vivo 1H-MRS of the subcortical white matter in the motor region is unlikely to be sensitive enough to detect early disease changes in ALS because there is considerable overlap between the metabolic peak area ratios from patients with ALS and normal control subjects. However, changes in the NAA/(Cr+PCr) metabolic peak area ratios correlate with clinical measures of disease severity, and this measure may be useful in monitoring disease progression.

The interaction between nutritional status and growth hormone in young cattle: differential responsiveness of fat and protein metabolism

The effect of dietary intake level on in vivo plasma leucine and plasma palmitate flux rates and on the response to a bolus injection of bovine growth hormone (GH) was investigated in six young steers. Animals were fed on a pelleted diet of dried grass-barley (0.7:0.3, w/w) in quantities sufficient to supply 0.8, 1.2, 1.6, 2.0, 2.4 or 2.65 x maintenance energy requirement, offered in hourly portions. Continuous intravenous infusions of [1-13C]leucine or [1-13C]palmitate were used to determine the flux of amino acid and fatty acid through the plasma pool before, immediately (1-3 h) after and 22-24 h after a subcutaneous injection of bovine GH (0.55 mg/kg body weight). Hourly blood samples were taken for 27 h to monitor the temporal responses of circulating hormones and metabolites following GH administration. The animal on the lowest plane of nutrition had elevated plasma GH and reduced insulin-like growth factor-1 concentrations compared with those fed on higher intake levels. Plasma leucine flux and leucine concentration increased with intake while palmitate flux and plasma non-esterified fatty acid (NEFA) concentrations were inversely related to intake. Leucine flux rate decreased in the animals fed on the two highest intake levels in response to GH 22-24 h after administration, but plasma leucine concentrations were reduced in all animals at this time. Only the animal fed on the lowest intake level showed an immediate response to GH (within 3 h of administration) with increased palmitate flux and plasma NEFA concentrations but a lipolytic response was apparent in other animals 22-24 h post-administration although the magnitude of the response was markedly reduced at high intakes. We conclude that lipid and protein metabolism are differentially responsive to GH and nutritional status.

An unusual consequence of stereotactic colloid cyst aspiration: case report

The removal of a colloid cyst of the third ventricle by stereotactic cyst aspiration is frequently performed as an alternative to a transcortical-transventricular or transcallosal operative route. A consequence of a CT-guided stereotactic aspiration, where residual colloid cyst material has been dislodged into the lateral ventricle and likened to an intraventricular mouse, is described.

Evaluation of bovine-derived bone protein with a natural coral carrier as a bone-graft substitute in a canine segmental defect model

The efficacy of a bone-graft substitute (bovine-derived bone protein in a carrier of natural coral) in the healing of a segmental defect of a weight-bearing long bone was evaluated. Twenty dogs, divided into two groups, underwent bilateral radial osteotomies with creation of a 2.5 cm defect. On one side of each dog, the defect was filled with autogenous cancellous bone graft. Contralateral defects received, in a blinded randomized fashion, cylindrical implants consisting of natural coral (calcium carbonate) or calcium carbonate enhanced with a standard dose of bovine-derived bone protein (3.0 mg/implant; 0.68 mg bone protein/cm3). The limbs were stabilized with external fixators, and all animals underwent monthly radiographs. They were killed at 12 (group 1) or 24 (group 2) weeks, and regenerated bone was studied by biomechanical testing and histology. Radiographic union developed in all 20 radii with autogenous cancellous bone grafts and in all 10 of the radii with the composite implants. None of the radii with implants of calcium carbonate alone showed radiographic evidence of union. This represented a statistically significant difference between implant types. In addition, calcium carbonate implants both with and without bone protein demonstrated radiographic evidence of near total resorption of the radiodense carrier by 12 weeks. This resorption facilitated radiographic evaluation of healing. Mean values for biomechanical parameters of radii with the composite implants exceeded those for the contralateral controls at 12 and 24 weeks; the difference was statistically significant at 12 weeks. Histology revealed scant residual calcium carbonate carrier at either time in the defects with calcium carbonate implants; however, a moderate amount was present in defects with the composite implants. In these specimens, the residual carrier was completely surrounded by newly formed bone that may have insulated the calcium carbonate from further degradation. The present study used a carrier of granular calcium carbonate reconstituted with bovine type-I collagen to deliver an osteoinductive protein to the defect site. This carrier is of nonhuman origin (eliminating the risk of disease transmission or antigenicity) and resorbs rapidly. In this model, bovine-derived bone protein in a natural coral carrier performed consistently better than the gold standard autogenous cancellous bone graft in terms of the amount of bone formation and strength of the healed defect. This may have implications for removal of hardware or resumption of weight-bearing in certain clinical situations. These data also indicate that coralline calcium carbonate alone represents a poor option as a bone-graft substitute in this critical-sized segmental defect model.

Bovine-derived bone protein as a bone graft substitute in a canine segmental defect model

OBJECTIVES

To evaluate the efficacy of a bone graft substitute in healing of a segmental defect of a weight-bearing long bone.

DESIGN

An established canine model was used to perform a blinded, prospective, randomized study of the performance of bone graft substitute implants. This performance was compared with that of an accepted treatment modality (autograft) in a paired fashion.

SETTING

An accredited animal research facility.

SUBJECTS AND INTERVENTION

Twenty-eight dogs underwent bilateral radial osteotomies with creation of a 2.5-centimeter defect. On one side, the defect in every dog was filled with autogenous cancellous bone graft (ABG). Contralateral defects received, in a blinded, randomized fashion, cylindrical implants of demineralized bone matrix (DBM) allograft or DBM plus a constant dose (3.0 milligrams) of bovine-derived bone protein (DBM + BP). The defects were stabilized by external fixation. Subjects underwent monthly radiographs and were killed at six, twelve, or twenty-four weeks. Regenerate bone was studied by biomechanical testing and histology. Six animals were studied to determine the dose-response characteristics of the protein preparation. Three received implants containing 0.3 milligram of BP (group 1) and three received 1.0 milligram of BP (group 2). These animals were killed at twelve weeks of follow-up.

RESULTS

All twenty-eight ABG radii (100 percent) progressed to radiographic union, as did thirteen of thirteen (100 percent) DBM + BP radii compared with only four of fifteen (27 percent) of DBM radii. The difference between union rates was statistically significant (p < 0.05). Mean values for most biomechanical parameters of DBM + BP radii exceeded those of their contralateral ABG controls at twelve and twenty-four weeks, whereas those for DBM implants did not. Histology revealed microscopic evidence of normal bone healing in all ABG and DBM + BP radii, whereas most DBM radii demonstrated nonunions. In the dose-response arm of the study, six of six ABG radii (100 percent) achieved union; zero of three (0 percent) of group 1 and two of three (67 percent) of group 2 radii achieved grossly stable unions. Biomechanical testing was consistent with radiographic results, indicating that the 3.0-milligram dose was the most effective of those studied.

CONCLUSIONS

The DBM + BP composite implants were more effective at healing critical-sized segmental defects than DBM alone in this canine model when a 3.0-milligram per implant dose of BP was used. Biomechanical and histologic properties of the regenerated bone formed by DBM + BP implants was comparable to that of cancellous autograft.

Generation of X-rays from Comet C/Hyakutake 1996 B2

The instability resulting from the relative motion of newly picked-up cometary photoions and the solar wind generates lower hybrid waves that are capable of accelerating electrons to the keV range of energies. These electrons may be responsible for the x-rays from comet C/Hyakutake 1996 B2 seen by the Rontgen X-ray Satellite. The inferred x-ray photon power depends on the electron energy, with keV electrons providing values of photon power two orders of magnitude greater than 100 eV electrons. These observations and in particular, spectral resolution of the x-rays, should provide more insight into the composition of the comet.

The spinal nail: a new implant for short-segment anterior instrumentation of the thoracolumbar spine

The biomechanics of a new spinal implant were evaluated and its dependence on an anterior strut graft was determined. Six fresh-frozen adult porcine spines were used. An L3 corpectomy was created. The spinal nail was inserted intraosseously into the middle column of the L2-L4 vertebral bodies in a trough. Implant drill holes were made for proximal and distal locking bolts in L2 and L4. A locking plate bridged the L2 and L4 trough and anchored the exposed ends of the locking bolts. Testing was performed in axial compression, torsion, and flexion. The axial and torsional stability of the spine instrumented with the spinal nail are similar to results with other devices when used with anterior strut grafting. The axial and flexural stiffnesses of the instrumented spine are independent of strut grafting. This study suggests that this device may be useful for reconstruction of the anterior spine because of instability.

Chromosome preparations of both direct and long-term cultures from the same fragment of chorionic villi

A simplified method is described for processing both direct preparations and long-term cultures from the same fragment of chorionic villi. Enzyme separation of the outer trophoblast layers (used for direct preparations) from the inner mesenchymal core (used to initiate long-term cultures) facilitates the utilization of the same fragments for the two procedures, without jeopardizing the success of either method. This has proved useful in cases where the sample was so small that only one method of chromosome preparation may have been possible using other techniques.

Effect of long-term electrical stimulation on vascular supply and fatigue in chronically ischemic muscles

Fast skeletal muscles of Sprague-Dawley rats [tibialis anterior (TA) and extensor digitorum longus (EDL)] were subjected to ischemia by unilateral ligation of the common iliac artery. In some animals, ischemia was combined with indirect electrical stimulation at 10 Hz either for 3 x 2 h (strenuous activity) or for 7 x 10-min bouts/day (mild activity). After 2 wk, muscle blood flow and fatigue were measured during 5-min isometric supramaximal twitch contractions at 4 Hz. Terminal arteriole diameters were assessed in TA by intravital microscopy at rest and during contractions. Vascular perfusion pressure in the muscles was estimated from measurements in the carotid and saphenous arteries below the site of ligation. Capillary supply was expressed in TA and EDL as capillary-to-fiber ratio on the basis of histochemical staining for capillaries. Strenuous stimulation of ischemic muscles increased their atrophy, failed to restore blood flow, and actually worsened fatigue. In contrast, mild stimulation improved perfusion pressure, increased capillary-to-fiber ratio in the glycolytic part of TA, restored dilatation of terminal arterioles during muscle contractions, and improved blood flow and muscle fatigue so that they were no longer significantly different from control muscles. Thus, an attenuated intermittent protocol may be indicated in the treatment of muscle ischemia.

Awareness of sexual partners' HIV status as an influence upon high-risk sexual behaviour among gay men

OBJECTIVE

To evaluate the extent to which 'high-risk' sexual behaviour is influenced by awareness of partners' HIV status among gay men.

DESIGN

Structured interviews and collection of saliva samples for anonymous linked testing for HIV-1 antibodies.

SETTING

Genitourinary medicine clinics and the gay community.

SUBJECTS

Men (n = 677) who reported sexual contact with another man in the last 5 years.

RESULTS

The majority of respondents (63%) had had an HIV-antibody test. Analysis of data showed that in 15% of the respondents' 1380 partnerships, HIV status was known by both parties. However, the majority of partnerships involved only safe sex. Only 26% of the partnerships in which unprotected penetrative anal sex had occurred involved mutual knowledge of HIV status and was most likely to occur with regular rather than non-regular/causal partners. Logistic regression revealed that this latter association could not be explained in terms of mutual HIV status knowledge.

CONCLUSIONS

Despite widespread HIV testing, the majority of gay men engaging in high-risk sex are unaware of their partner's HIV status.

Influence of diet and beta-agonist administration on plasma concentrations of growth hormone and insulin-like growth factor-1 in young steers

The effect of feeding grass silage or a forage-concentrate (dried grass-barley) diet ad lib. to young cattle on growth rate, plasma growth hormone (GH) and insulin-like growth factor-1 (IGF-1) concentrations was examined. The effect of including the beta-adrenergic agonist cimaterol in the forage-concentrate diet was also investigated. Significantly higher growth rates were observed in animals fed on the forage-concentrate diet than in those fed on the silage diet (P < 0.001), and these were further enhanced by dietary inclusion of cimaterol (P < 0.05). Plasma GH levels were higher in the silage-fed animals (P < 0.001) but IGF-1 levels were significantly lower (P < 0.001) than in the forage-concentrate-fed animals. Cimaterol had no effect on mean plasma GH and IGF-1 concentrations. Nevertheless, plasma IGF-1 levels correlated positively with growth rate across all three treatments (r 0.84, P < 0.001, n 17). Spectral analysis of the GH data obtained for each animal was used to determine whether regular periodicities could be detected in the 24 h profile and whether they differed between the three treatment groups. Regular periodicities of four-five cycles/d were detected in the averaged GH profiles of the silage-fed and the control forage-concentrate-fed animals. In contrast, in animals given cimaterol regular GH cycles were not detectable at any of the frequencies tested. This suggests that cimaterol disrupts the rhythm of GH secretion without altering the overall mean concentrations. The data also suggest that due to an inadequate nutrient supply, the GH-IGF-1 regulatory mechanism was uncoupled in the cattle fed on silage, which may have contributed to the poor growth response of these animals.

Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation

Burst fractures of the lumbar spine that are located below the thoracolumbar junction present a challenge when operative management is indicated. Short-segment instrumentation offers the advantage of incorporating fewer motion segments in the fusion, but may not provide adequate long-term stabilization. The goal of this study was to assess the axial stiffness and torsional rigidity of several short-segment instrumentation procedures. Compressive axial stiffness and torsional rigidity were measured in six intact porcine lumbar spines (L1-L5). A corpectomy was performed to simulate a burst fracture injury and decompression. Posterior instrumentation, posterior instrumentation with an anterior strut (a wood block), and anterior instrumentation with an anterior strut one level above and one level below the fracture site were applied as treatment strategies. VSP plates (Acromed, Cleveland, OH) for posterior instrumentation and the Kaneda system (Acromed, Cleveland, OH) for anterior instrumentation were used. Load-displacement and torque-angle plots were generated and used to calculate 144 estimates of axial stiffness and 144 estimates of torsional rigidity for these constructs. These analyses showed that, in comparison with the intact spine, posterior instrumentation alone was an average of 76% less stiff axially, posterior instrumentation with an anterior strut was 3% more stiff (not significantly different from intact), and anterior instrumentation with an anterior strut was 15% more stiff. Posterior instrumentation alone was an average of 30% less rigid in torsion, posterior instrumentation with an anterior strut was 26% less rigid, and anterior instrumentation with an anterior strut was 24% less rigid than the intact spine.(ABSTRACT TRUNCATED AT 250 WORDS)

Can changes in microcirculation explain capillary growth in skeletal muscle?

Capillary growth (increase in capillary/fibre (C/F) ratio by 20%) was elicited in skeletal muscles either by long-term increase in blood flow (5 weeks administration of prazosin in drinking water, 50 mg/l) or 7 days electrical stimulation (8 h/day at 10 Hz). Mechanisms that could explain it ((a) increased interaction of blood components with endothelial cells (due to increased haematocrit or decreased intermittency of flow); (b) increased velocity of flow and thus shear stress; (c) increased capillary diameters and thus wall tension) were studied in vivo. Red blood cell velocity (Vrbc), vessel diameters and intermittency of capillary flow were measured in superficially located capillaries in rat tibialis anterior muscles about 18 hours after the last treatment, in prazosin treated and chronically stimulated animals, and also in animals where red blood cell interaction with capillary endothelium was increased by elevating haematocrit from 43.2 +/- 1.7% to 60.9 +/- 0.72% by 11 weeks administration of CoCl2. Animals of comparable size and sex were used as controls. Capillaries in chronically stimulated muscles had increased Vrbc at rest (0.42 +/- 0.06 mm/s vs 0.27 +/- 0.04 in control muscles) and somewhat wider diameters, although the intermittency of flow was not different from control muscles. Capillaries in prazosin treated rats had a lower intermittency of flow, similar diameters and considerably higher Vrbc (0.53 +/- 0.06 mm/s) than control animals. CoCl2 treatment resulted in a similar intermittency of flow, did not alter capillary diameters or Vrbc and did not result in an increase in C/F ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of gall bladder dynamics, cholecystokinin release and the development of gallstones during octreotide therapy for acromegaly

The development of gallstones is a well recognized complication of therapy with the long-acting somatostatin analogue, octreotide in patients with acromegaly. A group of nine acromegalic patients was treated with octreotide at doses of 300-600 micrograms daily for 8 months and the changes in fasting and post-prandial cholecystokinin release, and gall bladder motor function (determined by a radiosotopic technique) were assessed at regular intervals. In addition the development of any gallstones was determined by serial ultrasonography. Fasting cholecystokinin levels showed no significant change over 6 months, whereas the post-prandial levels demonstrated a significant decrease (p less than 0.01) during therapy, yet remained significantly higher than fasting levels. Twenty-four hours after commencing therapy gall bladder ejection fraction was decreased by 57 +/- 23 per cent and gall bladder ejection rate decreased by 63 +/- 19 per cent compared to the pretreatment values, whereas after 6 months' therapy a marked reduction in gall bladder ejection fraction (greater than 35 per cent) and gall bladder ejection rate (greater than 40 per cent) persisted in only four of nine patients. Three of these four patients with persistently impaired gall bladder motor function were subsequently shown to have developed either gallstones or biliary sludge during the course of therapy. We conclude that treatment with octreotide is associated with an impaired post-prandial release of cholecystokinin in all acromegalic patients, but gallstones only develop in those patients who, in addition, have evidence of a persistently impaired gall bladder motor response to cholecystokinin.

The evaluation of patients with a suspected pituitary microadenoma: computer tomography compared to magnetic resonance imaging

OBJECTIVES

To perform a prospective study to compare the ability of magnetic resonance imaging (MRI) and computer assisted tomography (CT) to predict the position of a tumour within the pituitary fossa and to assess the clarity of the image generated by the two modalities in patients with suspected pituitary microadenomas.

DESIGN

Nineteen patients were investigated with CT and MRI scans and underwent trans-sphenoidal exploration of the pituitary fossa. Both scans were assessed blind and independently by three neuroradiologists, A, B, and C; A and B examined the CT scans and B and C the MRI scans. The predicted site was then compared to the size and position of the tumour at surgery.

PATIENTS

Twenty-five patients were recruited and had both CT and MRI scans, 19 subsequently underwent trans-sphenoidal exploration of the pituitary fossa and formed the study population.

RESULTS

The joint opinions of A and B of the CT scans were correct in 10/19, and those of B and C of the MRI scans were correct in 17/19 cases, P = 0.008. Observer agreement was used to assess the clarity of the image. A and B agreed about the site of the tumour on the CT scan in 14 of 19 cases (Kappa statistic 0.556); B and C agreed on the MRI scans in 19/19 cases (Kappa statistic 1), P = 0.025. After the exclusion of five cases found to be macroadenomas at surgery, the joint opinions of A and B of the CT scans were correct in 8/14, and those of B and C of the MRI scans were correct in 12/14 cases, P = 0.133. A and B agreed about the site of the tumour on the CT scan in 12/14 cases (Kappa statistic 0.653), B and C agreed on the MRI scans in 14/14 cases (Kappa statistic 1, no significant difference).

CONCLUSIONS

In the assessment of suspected pituitary microadenomas MRI is the imaging technique of choice in view both of its greater diagnostic accuracy and the avoidance of radiation exposure.

Effect of β-agonists on expression of calpain and calpastatin activity in skeletal muscle

Administration of beta-adrenergic agonists to domestic species can lead to skeletal muscle hypertrophy, probably by reducing the rate of myofibrillar protein breakdown. Myofibrillar breakdown is associated with the calcium-dependent proteinase system (calpains I,II and calpastatin) whose activity also changes during beta-agonist treatment. A number of growth trials using the agonists cimaterol and clenbuterol with cattle, sheep, chicken and rat are reported which suggest a general mechanism whereby beta-agonists reduce calpain I activity, but increase calpain II and calpastatin activity in skeletal muscle. Parallel changes in specific mRNAs indicate that changes in gene expression or stabilisation of mRNA could in part explain the changes in activity.

Ovarian actinomycosis presenting as acute peritonitis

A patient with acute peritonitis due to ovarian actinomycosis and the association of this disease with the intrauterine contraceptive device is discussed. Because adequate treatment requires prolonged antibiotics the diagnosis should be sure. Unfortunately if antibiotics are given pre-operatively culture is usually unsuccessful and thus careful examination of all removed material is essential. As many of these women are of child bearing age surgical intervention should aim to preserve fertility wherever possible.

Consequences of an interference fit on the fixation of porous-coated tibial components in total knee replacement

A linearly elastic, axisymmetrical finite-element model was developed in an attempt to explain observed long-term patterns of growth of bone into tibial components. This model, which represents a portion of the tibial tray, one peg, and the surrounding cancellous bone, was used to examine two conditions of fixation in the immediate postoperative period. The first was characterized by the use of an interference fit for initial fixation of the component and the second, by the use of an interference fit with the hole in the bone deeper than the length of the peg. Two conditions of long-term fixation were also examined. In one, the bone was assumed to have grown into all of the porous coating. In the other, the bone was assumed to have grown only into the peg, and a layer of fibrous tissue was assumed to have developed between the tray and the bone. An interference fit between the peg and the cancellous bone produced considerable residual radial stresses in the bone. These stresses provide conditions that are favorable for ingrowth of bone into the pegs because the bone at the interface is stressed, and these stresses inhibit relative motion at the bone-peg interface. However, the interference fit of the peg relieved the stresses in the cancellous bone under the tray of the implant. Lack of stress at this interface is consistent with relative motion and subsequent formation of a layer of fibrous tissue. Deepening of the hole for the peg in the cancellous bone did not diminish the effects of the interference fit. Stresses in the bone under the metal tray were relieved when a layer of fibrous tissue under the tibial tray was represented in the model.

Endocrine function, psychiatric and clinical consequences in patients with macroprolactinomas after long-term treatment with the new non-ergot dopamine agonist CV205-502

Although bromocriptine is the mainstay of treatment of macroprolactinomas, its therapeutic usefulness may be limited by poor tolerance, lack of consistent reduction in serum prolactin levels and tumour size, and the necessity for multiple dosing. Consequently new dopamine agonists have been developed, including the long acting non-ergot agonist CV205-502 which has been shown to date to be consistently effective in reducing serum PRL levels and causing tumour shrinkage. Twelve patients were treated for periods of up to 24 months with CV205-502 in doses ranging from 0.075 mg to 1.65 mg once daily. Clinical and psychiatric assessments, biochemical parameters, tumour size determination, and anterior pituitary function tests were performed regularly. Tumour shrinkage was noted in all patients, and varied from 11 per cent reduction to complete disappearance of tumour. Prolactin levels became normal in seven patients and were reduced by more than 90 per cent in the remaining five. Normal menstruation resumed in six of the eight women, one of whom conceived after one year of therapy; libido returned in all patients. Psychiatric complications occurred in three patients necessitating withdrawal of therapy in one. Significant weight loss was noted in 11 of 12 patients. Triglyceride concentrations fell from 1.5 +/- 0.1 to 1.0 +/- 0.1 mmol/l at 12 months (p = 0.006), and cholesterol fell from 6.3 +/- 0.4 to 5.3 +/- 0.3 mmol/l (p = 0.04). The mean TSH response 20 min following TRH injection fell from 14.3 +/- 2.9 to 8.7 +/- 1.3 mU/l at 2 months (p = 0.027). There was a significant increase in the peak growth hormone response to the insulin stress test from basal median (25th-75th centiles) values of 15 (4.4-25.5) mU/l to 24.5 (9-37) mU/l at 2 months (p less than 0.01) and 31 (19.3-63.5) at 12 months (p less than 0.005). CV205-502 is highly effective in the medical management of patients with macroprolactinomas, reducing prolactin levels and tumour size and restoring normal anterior pituitary function. It is, however, associated with the important side effects of weight loss and psychiatric complications which should be drawn to the attention of clinicians.

Nutritional and endocrinological manipulation of lean deposition in forage-fed steers

The effect of supplementing grass silage with fishmeal on growth, muscle composition and the rate of muscle protein synthesis was investigated in young Friesian steers with and without oestradiol implants. The effect of the beta-adrenergic agonist cimaterol was simultaneously investigated in animals fed on silage alone. Treatments lasted for 9 or 10 weeks. Fishmeal supplementation significantly increased animal growth rates (P less than 0.001) and the weights of three dissected muscles (P less than 0.001) compared with the silage-fed controls. These effects were further enhanced in animals also implanted with oestradiol. Muscle weights expressed as a proportion of body-weight were increased by fishmeal, suggesting that protein deposition had been enhanced. No further increase in the proportional muscle weights was obtained with oestradiol. Muscle dry matter content tended to be increased in both implanted and non-implanted animals receiving fishmeal compared with controls, but the proportions of protein, fat and ash were relatively constant. The intramuscular lipid composition was slightly altered by fishmeal. Muscle protein fractional synthetic rates (FSR), measured by continuous infusion of [3H]tyrosine, were increased by fishmeal in all three muscles of both implanted and non-implanted animals. There were no differences, however, due to oestradiol, over non-implanted fishmeal animals. This suggests that oestradiol may increase muscle accretion by reducing protein degradation rate. Cimaterol significantly increased longissimus dorsi (P less than 0.05) and vastus lateralis (P less than 0.01) muscle weights but had no effect on semitendinosus muscle weight or live-weight gain. The proportion of protein was increased (P less than 0.001) and the fat content reduced (P less than 0.05) in all three muscles but intramuscular lipid composition was not markedly affected. Whilst methylhistidine: creatinine excretion was reduced by cimaterol, FSR were increased in the l. dorsi and v. lateralis muscles suggesting beta-agonists have effects on both protein synthesis and protein degradation.

Skeletal muscle microcirculation: the effects of limited blood supply and treatment with torbafylline

The effects of one and two week arterial occlusion on the microcirculation of fast glycolytic skeletal muscle (rat tibialis anterior) were assessed by direct observation. Ligation of the right common iliac artery resulted in a greater proportion of the capillary population exhibiting intermittent flow, and reduction of capillary diameters. Terminal arterioles showed a lack of responsiveness to acute contractions of the muscle, while those in control muscles dilated. Acute infusion of torbafylline reduced the heterogeneity of flow by reducing the population of capillaries with intermittent flow and the time spent stationary by red cells. It also improved the pO2 at the muscle surface. Chronic oral administration of torbafylline for one week, started one week post-ligation, resulted in a similar response of the arterioles to muscle contractions as in control muscles and marginally improved the heterogeneity of flow.

CV205-502, a new non-ergot dopamine agonist, reduces prolactinoma size in man

Seven patients with large prolactin-secreting pituitary adenomas were treated for 8 weeks with once-daily doses of the new, potent, non-ergot, long-acting dopamine agonist CV205-502. In five patients previous treatment with bromocriptine had failed to control their disease or been poorly tolerated and had therefore ceased. In all seven patients serum prolactin levels fell over the 8-week period of CV205-502 treatment with the decrease ranging from 33 to 99%. Associated with this decline in prolactin all patients showed symptomatic improvement with two of the five women beginning to menstruate and the two patients with visual field impairment showing marked improvement. Tolerance of the drug, with doses at 8 weeks ranging from 0.075 to 0.3 mg, was excellent with only minimal and transient side-effects being noted in three patients in none of whom was discontinuation of therapy necessary. In one patient noncompliance after 6 weeks of therapy was associated with a rapid return of her serum prolactin towards pretreatment levels. In all seven patients the clinical and biochemical improvement was accompanied by a marked reduction in tumour size.