POS0957 THE PREVALENCE AND FACTORS RELATED TO SLEEP APNOEA IN ANKYLOSING SPONDYLITIS

Background:

An increased prevalence of obstructive sleep apnoea (OSA) has been suggested in ankylosing spondylitis (AS), but few controlled studies have been performed.

Objectives:

We thus aimed to study the prevalence of OSA in patients with AS compared to controls and to study if disease-related and non-disease-related factors were determinants of OSA in AS patients.

Methods:

One hundred and fifty-five patients with AS were included in the Backbone study that investigates severity and comorbidities in AS. Controls were recruited from the Swedish CardioPulmonary bioImage Study (SCAPIS). Participants were asked to be examined with a home sleep-monitoring device during one night’s sleep to evaluate the presence of OSA. For each AS patient, 45-70 years, four controls were matched for sex, age, weight and height. OSA was defined as an apnoea-hypopnea-index ≥5 events/hour.

Results:

In total, 63/155(40.6%) patients with AS were examined with a home sleep-monitoring device out of which 46 patients were 45-70 years and therefore matched (mean age 57.2±7.5years, 30(65.2%) men) with 179 controls (mean age 57.2±4.5years, 123(68.7%) men). Twenty-two out of 46(47.8%) patients with AS vs. 91/179(50.8%) controls had OSA, p=0.72. No differences measurements evaluating OSA were noted in AS vs. controls. In logistic regression analysis, based on all 63 examined AS-patients, several AS-related variables were associated with OSA but after adjusting for age and sex, only higher age and BMI, remained to be significant determinants of OSA, Table 1.

Table 1.

Univariable and age- and sex-adjusted logistic regression analyses with obstructive sleep apnoea as dependent variable in 63 patients with ankylosing spondylitis.

VariablesUnivariable logistic regression analyses, Odds Ratio (95%CI)PAge- and sex-adjusted logistic regression analyses,Odds Ratio (95%CI)PSex, male1.9(0.6-5.5)0.251.5(0.4-4.8)0.53Age1.1(1.0-1.2)0.0021.1(1.0-1.2)0.002BMI1.4(1.1-1.7)0.0011.6(1.2- 2.2)0.001Duration of symptoms1.1(1.0-1.1)0.0281.0(0.9-1.1)0.79BASMI1.9(1.3-2.9)0.0021.5(0.9 -2.5)0.87BASFI1.4(1.0-2.0)0.0381.3(0.9-2.0)0.88≥1 Syndesmophyte3.9(1.3-12.2)0.0173.0(0.8-11.3)0.10mSASSS1.0(1.0-1.1)0.0471.0(0.98-1.05)0.25Metabolic syndrome4.3(1.5-12.9)0.0081.4(0.3-6.6)0.69Epworth Sleep Scale1.2(1.0-1-3)0.0231.2(1.0-1.4)0.29

Conclusion:

In this case-control study, patients with AS did not have a higher prevalence of OSA compared to controls. AS patients with OSA had higher BMI and were older compared to patients without OSA.

Disclosure of Interests:

None declared.

Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA(2)LEN survey

BACKGROUND

Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors for sleep disturbance among patients with asthma, in a large population-based set of material.

METHOD

In 2008, a postal questionnaire was sent to a random sample of 45 000 adults in four Swedish cities. The questionnaire included questions on insomnia, asthma, rhinitis, weight, height, tobacco use and physical activity.

RESULTS

Twenty-five thousand six hundred and ten subjects participated. Asthma was defined as either current medication for asthma or at least one attack of asthma during the last 12 months, and 1830 subjects (7.15%) were defined as asthmatics. The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics (47.3% vs 37.2%, <0.0001). In the subgroup reporting both asthma and nasal congestion, 55.8% had insomnia symptoms compared with 35.3% in subjects without both asthma and nasal congestion. The risk of insomnia increased with the severity of asthma, and the adjusted OR for insomnia was 2.65 in asthmatics with three symptoms compared with asthmatics without symptoms. Nasal congestion (OR 1.50), obesity (OR 1.54) and smoking (OR 1.71) also increased the risk of insomnia.

CONCLUSION

Insomnia remains a common problem among asthmatics. Uncontrolled asthma and nasal congestion are important, treatable risk factors for insomnia. Lifestyle factors, such as smoking and obesity, are also risk factors for insomnia among asthmatics.

Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

BACKGROUND

Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region.

METHODS

We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK).

RESULTS

Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome.

CONCLUSION

Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.

Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey

BACKGROUND

Hormone replacement therapy (HRT) and obesity both appear to increase the risk of asthma. A study was undertaken to investigate the association of HRT with asthma and hay fever in a population of perimenopausal women, focusing on a possible interaction with body mass index (BMI).

METHODS

A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway, and Sweden in 1999-2001, and 8588 women aged 25-54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46-54 years of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed.

RESULTS

HRT was associated with an increased risk for asthma (OR 1.57 (95% CI 1.07 to 2.30)), wheeze (OR 1.60 (95% CI 1.22 to 2.10)), and hay fever (OR 1.48 (95% CI 1.15 to 1.90)). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR 2.41 (95% CI 1.21 to 4.77); wheeze OR 2.04 (95% CI 1.23 to 3.36)) than in heavier women (asthma: p(interaction) = 0.030; wheeze: p(interaction) = 0.042). Increasing BMI was associated with more asthma (OR 1.08 (95% CI 1.05 to 1.12) per kg/m2). This effect was only found in women not taking HRT (OR 1.10 (95% CI 1.05 to 1.14) per kg/m2); no such association was detected in HRT users (OR 1.00 (95% CI 0.92 to 1.08) per kg/m2) (p(interaction) = 0.046). Menopause was not significantly associated with asthma, wheeze, or hay fever.

CONCLUSIONS

In perimenopausal women there is an interaction between HRT and BMI in the effects on asthma. Lean women who were HRT users had as high a risk for asthma as overweight women not taking HRT. It is suggested that HRT and overweight increase the risk of asthma through partly common pathways.

Obesity and nocturnal gastro-oesophageal reflux are related to onset of asthma and respiratory symptoms

Several studies have identified obesity as a risk factor for asthma in both children and adults. An increased prevalence of asthma in subjects with gastro-oesophageal reflux (GOR) and obstructive sleep apnoea syndrome has also been reported. The aim of this investigation was to study obesity, nocturnal GOR and snoring as independent risk factors for onset of asthma and respiratory symptoms in a Nordic population. In a 5-10 yr follow-up study of the European Community Respiratory Health Survey in Iceland, Norway, Denmark, Sweden and Estonia, a postal questionnaire was sent to previous respondents. A total of 16,191 participants responded to the questionnaire. Reported onset of asthma, wheeze and night-time symptoms as well as nocturnal GOR and habitual snoring increased in prevalence along with the increase in body mass index (BMI). After adjusting for nocturnal GOR, habitual snoring and other confounders, obesity (BMI >30) remained significantly related to the onset of asthma, wheeze and night-time symptoms. Nocturnal GOR was independently related to the onset of asthma and in addition, both nocturnal GOR and habitual snoring were independently related to onset of wheeze and night-time symptoms. This study adds evidence to an independent relationship between obesity, nocturnal gastro-oesophageal reflux and habitual snoring and the onset of asthma and respiratory symptoms in adults.

Overexpression and characterization of the chromosomal aminoglycoside 2'-N-acetyltransferase of Providencia stuartii

The gene coding for aminoglycoside 2'-N-acetyltransferase Ia [AAC(2')-Ia] from Providencia stuartii was amplified by PCR and cloned. The resulting construct, pACKF2, was transferred into Escherichia coli for overexpression of AAC(2')-Ia as a fusion protein with an N-terminal hexa-His tag. The fusion protein was isolated and purified by affinity chromatography on Ni(2+)-nitrilotriacetic acid agarose and gel permeation chromatography on Superdex 75. Comparison of the specific activity of this enzyme with that of its enterokinase-digested derivative lacking the His tag indicated that the presence of the extra N-terminal peptide does not affect activity. The temperature and pH optima for activity of both forms of the 2'-N-acetyltransferase were 20 degrees C and pH 6.0, respectively, while the enzymes were most stable at 15 degrees C and pH 8.1. The Michaelis-Menten kinetic parameters for AAC(2')-Ia at 20 degrees C and pH 6.0 were determined using a series of aminoglycoside antibiotics possessing a 2'-amino group and a concentration of acetyl coenzyme A fixed at 10 times its K(m) value of 8.75 microM. Under these conditions, gentamicin was determined to be the best substrate for the enzyme in terms of both K(m) and k(cat)/K(m) values, whereas neomycin was the poorest. Comparison of the kinetic parameters obtained with the different aminoglycosides indicated that their hexopyranosyl residues provided the most important binding sites for AAC(2')-Ia activity, while the enzyme exhibits greater tolerance further from these sites. No correlation was found between these kinetic parameters and MICs determined for P. stuartii PR50 expressing the 2'-N-acetyltransferase, suggesting that its true in vivo function is not as a resistance factor.

Isolated sternal fracture--a swing-related injury in two children

Isolated fracture of the sternum is an uncommon injury in a child. We report two cases of sternal fracture following falls from swings, which illustrate the mechanisms of injury in sternal fracture. One fracture resulted from a flexion compression injury of the thoracic spine, which has very rarely been reported in children. Sternal fracture should be considered in the differential diagnosis of acute chest pain in a child where there has been an activity involving hyperflexion force.

Bladder diverticulum simulating a pelvic metastasis on a Tc-99m HDP bone scan

Carcinoma of the prostate was diagnosed in a 74-year-old man. A Tc-99m HDP bone scan was performed as part of the initial staging process. The findings on the bone scan were normal except for an area of increased tracer uptake projected over the left sacroiliac joint, which was seen best on the anterior view. When this was investigated further, the findings of a plain radiograph were inconclusive. Computed tomography showed a large diverticulum projecting from the left side of the bladder; the tracer retained within this diverticulum had produced the findings on the bone scan.

Autonomic cardiovascular regulation in patients with obstructive sleep apnoea: a study based on spectral analysis of heart rate variability

The aim of this study was to assess the function of the autonomic nervous system in patients with obstructive sleep apnoea syndrome (OSAS). The study was designed as a cross-sectional case-control study. Fifty-one patients were included, and the findings were compared with those in 66 controls. Spectral analysis of heart rate variability (HRV) during supine rest, during controlled breathing and after tilting was performed in each patient and control case. The patients performed overnight sleep recordings the night before the HRV recordings. Individuals with an apnoea-hypopnoea index (AHI) above 20 were regarded as OSAS patients and those with AHI lower than 20 as snorers. Differences in HRV and blood pressure between patients and controls were analysed by multiple linear regression with age, body mass index and sex as independent variables. During free and controlled breathing there was a significant decrease in indices reflecting vagal modulation, indicating parasympathetic dysfunction in OSAS patients compared with controls. The mid-frequency component was also significantly reduced in OSAS patients after tilting but not in the lying position. This may be related to the parasympathetic dysfunction, but could also indicate a decreased sympathetic reserve capacity. We found no significant relation between AHI and indices of vagal modulation in the patient group. Our findings show an autonomic dysfunction in patients with OSAS. The dysfunction involves the parasympathetic system, and may be related to the increased cardiovascular mortality and malignant arrhythmia described in OSAS.

Chemically synthesized ubiquitin extension proteins detect distinct catalytic capacities of deubiquitinating enzymes

We have used solid-phase chemistry to synthesize proteins equivalent to a human ubiquitin precursor (ubiquitin-52-amino-acid ribosomal protein fusion; UBICEP52) and representative of isopeptide-linked ubiquitin-protein conjugates [ubiquitin-(epsilonN)-lysine]; these proteins were precisely cleaved by a purified recombinant Drosophila deubiquitinating enzyme (DUB), UCH-D. Along with the previously synthesized ubiquitin-(alphaN)-valine, these synthetic proteins were used as substrates to assess the catalytic capacities of a number of diverse DUBs expressed in Escherichia coli: human HAUSP; mouse Unp; and yeast Ubps 1p, 2p, 3p, 6p, 11p, and 15p and Yuh1p. Distinct specificities of these enzymes were detected; notably, in addition to UCH-D, isopeptidase activity [ubiquitin-(epsilonN)-lysine cleavage] was only associated with Yuh1p, Unp, Ubp1p, and Ubp2p. Additionally, human placental 26S proteasomes were only able to cleave UBICEP52 and ubiquitin-(epsilonN)-lysine, suggesting that 26S proteasome-associated DUBs are class II-like. This work demonstrates that the synthetic approach offers an alternative to recombinant methods for the production of small proteins in vitro.

Site-directed mutagenesis and molecular modeling identify a crucial amino acid in specifying the heparin affinity of FGF-1

Heparin potentiates the mitogenic activity of FGF-1 by increasing the affinity for its receptor and by extending its biological half-life. During the course of labeling human FGF-1 with Na(125)I and chloramine T, it was observed that the protein lost its ability to bind to heparin. In contrast, bovine FGF-1 retained its heparin affinity even after iodination. To localize the region responsible for the lost heparin affinity, chimeric FGF-1 proteins were constructed from human and bovine FGF-1 expression constructs and tested for their heparin affinity after iodination. The results showed that the C-terminal region of human FGF-1 was responsible for the loss of heparin affinity. This region harbors a single tyrosine residue in human FGF-1 in contrast to a phenylalanine at this position in bovine FGF-1. Mutating this tyrosine residue in the human FGF-1 sequence to phenylalanine did not restore the heparin affinity of the iodinated protein. Likewise, changing the phenylalanine to tyrosine in the bovine FGF-1 did not reduce the ability of the iodinated protein to bind to heparin. In contrast, a mutant human FGF-1 that has cysteine-131 replaced with serine (C131S) was able to bind to heparin even after iodination while bovine FGF-1 (S131C) lost its binding affinity to heparin upon iodination. In addition, the human FGF-1 C131S mutant showed a decrease in homodimer formation when exposed to CuCl(2). Molecular modeling showed that the heparin-binding domain of FGF-1 includes cysteine-131 and that cysteine-131, upon oxidation to cysteic acid during the iodination procedures, would interact with lysine-126 and lysine-132. This interaction alters the conformation of the basic residues such that they no longer bind to heparin.

Knowing what to remember and forget: a developmental study of cue memory in intentional forgetting

These experiments are the first to investigate children's encoding and use of information about a memory cue in Bjork's (1972) intentional forgetting task. In Experiment 1, children in Grades 2, 4, and 6 and college students were given cues to either remember or forget after the presentation of each picture. Recall and recognition tests of pictures and cues followed. The procedure in Experiment 2 was identical to that in Experiment 1 except that the list of presentation pictures was altered for some children (Grades 3 and 4) and adolescents (Grades 8 and 9) so that remember and forget cues were associated with particular taxonomic categories. In Experiment 3, the testing component was modified so that children (Grades 2, 3, and 4) and college students were asked to recall only the cue associated with each picture. The results indicated that (1) children as young as second graders encode the cue associated with each picture, although to a lesser extent than do college students, (2) much improvement in intentional forgetting is still occurring during adolescence, (3) only adults adequately cluster their recall by cue, (4) associating remember and forget cues with items from different categories does not increase the differentiation between cues, and (5) eliminating picture recall and recognition has minimal effects on the magnitude of cue judgments. These results suggest that children's difficulties on intentional forgetting tasks stem, at least in part, from their poorer encoding of information about whether an item should be remembered or forgotten.

The ultrasound diagnosis of posterior shoulder dislocation associated with Erb's palsy

A case is presented of an infant with Erb's palsy whose posterior dislocation of the humeral head was identified using high-resolution ultrasound following non-diagnostic plain radiographs. Posterior dislocation is associated with Erb's palsy but the diagnosis can be delayed. We suggest the early use of ultrasound in patients with Erb's palsy, as this technique is a safe, quick and reliable method of excluding posterior dislocation.

Capillary electrophoresis assay for ubiquitin carboxyl-terminal hydrolases with chemically synthesized ubiquitin-valine as substrate

Ubiquitin is expressed in eukaryotic cells as precursors, fused via its carboxyl terminus either to other ubiquitin sequences in linear polyubiquitin arrays or to specific ribosomal proteins. In some of the polyubiquitin fusions a single amino acid (e.g., valine in humans) is attached to the carboxyl terminus. These gene products are rapidly (probably cotranslationally) cleaved by ubiquitin carboxyl-terminal hydrolase (UCH) enzymes; therefore, although ubiquitin precursors are suitable substrates for assays of UCH activity, they are difficult to isolate from nucleated cells. While the recombinant approach allows the production of ubiquitin precursors in prokaryotic cells (which do not contain the ubiquitin system), proteins produced in this manner require purification and may also be susceptible to modification by bacterial enzymes, e.g., adventitious proteolysis. As an alternative we have chemically synthesized human ubiquitin-valine. In the assay described here the cleavage of ubiquitin-valine to ubiquitin (77 and 76 residue proteins, respectively) by a purified recombinant Drosophila UCH was monitored by capillary electrophoresis. Mass spectrometry verified the precise cleavage of ubiquitin-valine, confirming that this synthetic protein is a UCH substrate. Synthetic ubiquitin-valine may serve as a generic substrate for UCHs allowing the purification and identification of new members of this enzyme family.

Case report: ultrasound diagnosis of unsuspected necrotizing enterocolitis

We report a case of portal and systemic venous gas detected in a neonate without clinical or radiographic evidence of necrotizing enterocolitis who then subsequently developed unequivocal clinical and radiographic signs of this condition. These findings are discussed in relation to previous reports in the literature.

Patterns of accreditation performance in army family practice residencies

Army leadership emphasizes training in all segments of its population, including family medicine. Standards for medical professional training, however, are provided by a civilian agency, the Accreditation Council for Graduate Medical Education (ACGME). In order to search for performance patterns, the authors reviewed the last two accreditation documents of each Army Family Practice residency. After independently scoring the documents against the written standards, the scores were compared with the actual written findings from the ACGME Residency Review Committee. The authors discuss patterns and trends resulting from this analysis, and recommend areas for future growth in the military training of family physicians.

99Tcm-mercapto acetyl triglycine in paediatric renal tract disease

The use of 99Tcm-mercapto acetyl triglycine (99Tcm-MAG3), a new hippuran substitute, has been reported widely in adults but not in children. Our experience of its use in 100 infants and children for renography and indirect micturating cystography (IMC) is reported. The average age was 5.6 years. 65 patients completed IMC studies and nine patients had 99Tcm-dimercaptosuccinic acid (99Tcm-DMSA) scans performed on the same day. The majority of patients were referred for the investigation of urinary tract infection. 32 kidneys were found to be scarred on 99Tcm-MAG3 scans, 17 kidneys and ureters refluxed on IMC and 14 kidneys were obstructed. The results of 99Tcm-MAG3 scans were compared with those of other urinary tract investigations including ultrasound, micturating cystography (MCUG), intravenous urography (IVU) and 99Tcm-DMSA scintigraphy. No kidney which was scarred had a normal 99Tcm-MAG3 scan. All significant degrees of dilatation or obstruction on IVU or ultrasound were also detected by 99Tcm-MAG3. 99Tcm-MAG3 gave more information than any other single imaging modality and we believe it represents an ideal initial screening test in the investigation of urinary tract infection in older toilet-trained children.

Evidence for involvement of glycoprotein-CD45 phosphatase in reversing glycoprotein-CD3-induced microtubule-associated protein-2 kinase activity in Jurkat T-cells

Ligation of CD3/TCR on T-cells induces transient activation of lymphoid MAP-2 kinase (MAP-2K), a 43 kDa serine kinase which itself is a substrate of an unidentified tyrosine kinase (pp43). The reversibility of the MAP-2K response agrees with removal of tyrosine phosphates from pp43. Since both activity as well as tyrosine phosphorylation of MAP-2K could be prolonged by Na3VO4, a phosphotyrosine phosphatase inhibitor, we studied the effect of the common CD45 isoform, which is a member of the CD45 phosphatase family, on MAP-2K activity in vivo and in vitro. We demonstrate the ability of purified CD45 phosphatase to remove tyrosine phosphates from partially purified lymphoid MAP-2K. Utilizing the approach of heterologous receptor aggregation, we also showed that CD45 could inhibit the induction of MAP-2K activity in intact Jurkat cells during CD3 or CD3 + CD4 stimulation. We therefore suggest that this phosphatase may control the activity of lymphoid MAP-2K in vivo.

Activation of MAP-2 kinase activity by the CD2 receptor in Jurkat T cells can be reversed by CD45 phosphatase

We have recently characterized a serine kinase in T lymphocytes which phosphorylates microtubule-associated protein-2 (MAP-2) in vitro. This kinase is activated in a rapidly reversible fashion during ligation of CD3/Ti by a process which involves tyrosine phosphorylation of the enzyme itself. We show that the stimulatory anti-CD2 mAb combination, anti-(T11(2) + T11(3), stimulates MAP-2K activity in Jurkat cells with kinetics that are more prolonged than during anti-CD3 treatment. The principal difference is not in the rate of response induction, but in the decline of the response beyond the peak, to which end anti-CD2 stimulation resembles the sustained phytohaemagglutin (PHA) response. Parallel immunoblotting, utilizing anti-phosphotyrosine antibodies, also revealed differences in the rate at which tyrosine phosphorylation of pp43 (MAP-2K) disappears after induction. In spite of these differences, CD2 was absolutely dependent on the presence of CD3 for inducing a MAP-2K response in Jurkat cells. These results indicate that, even though CD2 and CD3 are using a common signalling pathway in Jurkat cells, additional differences such as the involvement of a tyrosine phosphatase may have to be considered in response generation. We also demonstrate that the common CD45 isoform, when cross-linked to CD2 by mAb, could inhibit the MAP-2K response during both induction as well as the disappearing phase of the response.

Bias effects of socioeconomic status and sex in decision making in speech-language pathology

Within the area of speech-language pathology there is a paucity of literature that specifically addresses the issue of bias in the referral, assessment, and placement of children in programs for the remediation of speech-language disorders. The purpose of this study was to examine the issue of bias [i.e., sex and socioeconomic status (SES)] as it related to decision making in speech-language pathology. Certified speech-language pathologists completed a questionnaire survey in which information regarding the referral and assessment of a hypothetical case study child was presented. Only the sex of the child and the parents' occupations were varied. Factor analysis and subsequent analyses of variance revealed a significant difference with regard to the SES main effect (p less than .006) for Factor 2 (Alternative Home and School Intervention Strategies). That is, it was found that regardless of sex, low SES children were viewed as more likely than high SES children to be recommended for alternative home and school intervention strategies for the remediation of speech-language delays.

Passive immunisation of children with bovine colostrum containing antibodies to human rotavirus

The efficacy of a 10-day course of bovine colostrum with high antibody titre against the four known human rotavirus serotypes in protecting children against rotavirus infection was examined in patients admitted to hospital. Children aged 3 to 15 months were blocked in pairs according to ward accommodation (ie, isolation or open area). Each block contained 1 treated and 1 control child. The allocation to treatment or control (an artificial infant formula) was randomised. 9 of 65 control children but none of 55 treated children acquired rotavirus infection during the treatment period (p less than 0.001). The importance of protecting against rotavirus infection was highlighted by the fact that parents of symptomatic rotavirus-positive children sought medical attention seven times more often than did parents of symptomatic rotavirus-negative children (p less than 0.05).

Passive immunisation of children with bovine colostrum containing antibodies to human rotavirus

The efficacy of a 10-day course of bovine colostrum with high antibody titre against the four known human rotavirus serotypes in protecting children against rotavirus infection was examined in patients admitted to hospital. Children aged 3 to 15 months were blocked in pairs according to ward accommodation (ie, isolation or open area). Each block contained 1 treated and 1 control child. The allocation to treatment or control (an artificial infant formula) was randomised. 9 of 65 control children but none of 55 treated children acquired rotavirus infection during the treatment period (p less than 0.001). The importance of protecting against rotavirus infection was highlighted by the fact that parents of symptomatic rotavirus-positive children sought medical attention seven times more often than did parents of symptomatic rotavirus-negative children (p less than 0.05).

Intraoperative assessment of left ventricular heterogeneity

To evaluate regional differences in thickness and systolic function of human myocardium perfused by angiographically normal coronary arteries in valvular and ischemic heart disease, we performed intraoperative epicardial M-mode mapping of ventriculographically normal wall regions (perfused by normal coronary arteries) in 22 subjects undergoing either coronary bypass surgery for stenoses in other vessels (n = 15) or mitral (n = 5) and/or aortic valve replacement (n = 4). In patients in whom both anterior and inferior walls were ventriculographically normal and normally perfused (n = 6), comparison of the two walls showed the anterior wall to be thicker at both end diastole and end systole, but there was no difference in the percentage of systolic thickening. Analysis of myocardium along the long axis revealed apical sites to be thinner than basal sites at both end diastole and end systole. Percentage of systolic thickening was also increased at apical sites. In patients in whom only the anterior wall was normal, a similar decrease in anterior wall thickness was noted at the apex. Thus systematic regional heterogeneity along both the left ventricular major and minor axes is found in the chronically diseased human heart as it is in the normal heart. Assessment of myocardial structure and function and of the effects of therapeutic interventions must take this heterogeneity into account.

Embolisation of hypernephromas: a simple technique using ethanol

Experience of the embolisation of hypernephromas with 95% ethanol is described in 10 patients. An initial technique using 95% ethanol diluted with contrast has been modified. A single injection of 15 ml of undiluted 95% ethanol through a balloon occlusion catheter is now recommended. We conclude that this is a quick, easy and safe method of embolising hypernephromas.