AB1100 COVID-19 VACCINATION IN A REAL-LIFE SETTING OF A RHEUMATOLOGICAL OUTPATIENT CENTER

Background

Since approvement of the first vaccines against COVID-19 in European in 12/2020, a large vaccination (VAC) campaign was started. Patients with inflammatory diseases (ID) were graded as higher risk. Many of our patients used the possibility and got vaccinated. Until know, there is few knowledge about the efficacy and safety of VAC in patients with ID. There are some reports of less VAC response in patients with ID (1). Many antibody (AB) studies are ongoing but monitoring of AB status is not recommended by official recommendations (1,2). Nevertheless, AB testing is commonly used in daily care in outpatient centers (OC).

Objectives

To evaluate in a real life setting of a single rheumatological OC how many patients have been vaccinated against COVID-19, how many of these did not develop AB and search for possible explanations.

Methods

All consecutive patients of the routine follow up visits from 03/2021 to 12/2021 were retrospectively evaluated if VAC and an AB testing (e.g. ELISA-tests) was done ≥4 weeks after the 2nd VAC was documented. All AB tests were classified for AB levels (Ratio <0,8 negative, >0,8 Ratio < 4,5 low to moderate, Ratio ≥ 4,5 high level). The group of patients without AB was specified.

Results

N=1206 persons were questioned. N=23/1206 (1.9%) patients refused a VAC. N=1183/1206 (98.1%) have got a VAC. N=984/1183 (83.2%) were had an ID, n=199/1183 (16.8%) were healthy persons (HP). In n=608/1138 (51%) an AB status after ≥4 weeks after VAC was available. N=14/608 (20%) HP developed all but one high AB levels. 1 HP had a low to moderate AB level. In n=595/1183 (50%) patients with ID an AB status was available. N=438/595 (74%) patients developed high AB levels, n=126/595 (21%) low to moderate, n=30/595 (5%) had no AB. Mean age in the group without any AB was 69years (range 38-95). N=27/30 (90%) patients received ≥1 DMARD (disease modifying antirheumatic drug), n=3/30 patients were not treated with DMARD, n=2/3 of these patients received Prednisolone (P) instead. N=4/30 received Rituximab (RTX), n=1/30 Abatacept (ABA), n=1/30 MMF (3g), n=1/30 Azathioprine in combination with high P (55mg), n=15(50%) MTX alone or in combination, n=24/30(80%) P (range mg 1-55, mean 5,7). One 52y old patient without any AB did receive nether a DMARD nor P. N=3/30 patients got both vaccinations with Vaxzevira (V), n=25/30 (83,3%) Comirnaty (C), n=1/30 Spikevax, n=1/30 first V, second C. 1 patient, treated with ABA has been vaccinated with 2 doses of C. A AB testing 4 months later did not reveal any antibodies. This patient came down with COVID-19 5 months after complete VAC and died.

Conclusion

There is very high number of VAC (98,1%) in a real life setting of a rheumatological OC. Many patients (95%) developed low to high AB levels after 2 VAC, independently which agent was used. Otherwise, we must be aware of the small group of patients (5%) without developing any AB. Unfortunately, our group was too small to find significant risk factors (RF). But RF seems to be the age, therapy with RTX, ABA and P. This is in line with reported RF in clinical studies (1). Furthermore, we see lower levels in elderly patients who get vaccinated with C. This could be biased by the fact that, in the first months of the VAC campaign, C was used in patients with higher age and the 2nd C-VAC was given 3 weeks after 1st VAC. Retrospectively, this interval seems to be too short. Thus now, the 2nd VAC is given 4-6 weeks after 1st VAC. In conclusion it is still unclear, which levels of AB make VAC effective and which patients will develop AB levels. AB levels should be evaluated to pick out patients with VAC gap, since the high risk of fatal course of COVID-19-disease. The booster campaign and 3rd VAC will change the current state again, therefore revaluation will be necessary.

References

[1]Kroon FPB et al, Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations. ARD 07.12.2021 online first.

[2]https://dgrh.de/Start/Wissenschaft/Forschung/COVID-19/Handlungsempfehlungen-der-DGRh-im-Rahmen-der-COVID-19-Pandemie.html

Disclosure of Interests

Stephanie Gabriele Werner Speakers bureau: Abbvie, Janssen, Pfizer, Grant/research support from: Abbvie, Pfizer, Leander Moll: None declared, Antje Uhlenberg-Moll: None declared, Sabine Mettler: None declared, Hans-Eckhard Langer Speakers bureau: Pfizer, Abbvie, Medac, Janssen, Bristol

AB1139 SARS-CoV2- INFECTION AFTER VACCINATION AGAINST COVID-19 IN PATIENTS WITH RHEUMATIC DISORDERS IN A REAL LIFE SETTING OF A RHEUMATOLOGICAL OUTPATIENT CENTER

Background

Coronavirus SARS-CoV-2 and its associated disease COVID-19 have become a worldwide pandemic since its first case in 12/2019. Since approvement of the first vaccines against COVID-19 in Europe in 12/2020 a large vaccination campaign was started. Our patients with inflammatory diseases (ID) were graded as higher risk, thus an early vaccination was possible. Many of our patients used the possibility and got vaccinated. Until now, there is few knowledge about the efficacy and safety of vaccination in patients with rheumatic disorders. There are some reports of less vaccination response in patients with ID (1). First reports of those patients with rheumatological disorder and infection with SARS-CoV2 are available (1,2). Nevertheless, there is few knowledge about SARS-CoV2-infection in patients with ID after vaccination against COVID-19, yet.

Objectives

The aim of our study was to evaluate, how many patients got infected with SARS-CoV2 after vaccination against COVID-19 and the course of the disease.

Methods

All consecutive patients of the routine follow up visits from 07/2021 to 01/2022 in our rheumatological outpatient center were questioned for SARS-CoV2-infection. In case of infection, they were questioned for vaccination status and the course of the disease.

Results

N=1206 patients could be evaluated. N=1183/1206 (98.1%) vaccinations were documented. N=12/1183 (1%) patients got infected with SARS-CoV2 after at least 2 doses of vaccination against COVID-19. N=1/12 (8.3%) patient got infected after 3 doses of vaccination. N=3/12 (25%) received 2 doses Vaxzevira (AstraZeneca), n=2/12 (16,7) patients 1st dose Vaxzevira, 2nd dose Comirnaty (Biontech), n=7 /58.3%) patients two doses Comirnaty. In n=8/12 (66.7%) patients antibody levels were available. N=7/8 (87,5%) patients developed high antibody levels after 2 vaccinations. N=1/8 (21,5%) patient developed any antibodies against SARS-CoV2 after 2 doses of Comirnaty, measured ≥4 months after 2nd vaccination dose. This patient was treated with Abatacept. This patient came down with COVID-19 5 months after complete vaccination and died after long-standing highly intensive care. All other patients developed a mild to moderate course of COVID-19, without need of hospitalizing.

Conclusion

There is a very high number of patients (98,1%), who got vaccinated in a real life setting of our rheumatological outpatient center. We have seen only a low number of SARS-CoV2-infections (1%). Most patients developed high antibody levels after vaccination and fortunately had a mild to moderate course of COVID-19 in case of SARS-CoV2-infection, independently from the different vaccination agents. Nevertheless, 1 patient came down with COVID-19 5 months after complete vaccination and died after long-standing highly intensive care. This patient did not develop any antibodies after vaccination. In conclusion, vaccination seems to be effective in patients with rheumatological disorders. However, we must be aware of the small group of patients without antibody development, since they are at risk to have a fatal course. Yet, antibody testing is not recommended in routine clinical care by official recommendations, largely because it is still unknown which level of antibodies predicts protection (3). The booster campaign and 3rd vaccinations will change the current state again, but a revaluation and further studies will be necessary.

References

[1]Kroon FPB, Najm A, et al, Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations, ARD 07.12.2021 online first

[2]Werner SG, Höhenrieder P, Chatelain R, Langer HE. INCIDENCE AND OUTCOME OF COVID-19 IN ROUTINE RHEUMATOLOGY CARE: DATA FROM A SINGLE OUTPATIENT CENTER IN GERMANY. Ann Rheum Dis. 2021, S. Volume 80, page 910.

[3]https://dgrh.de/Start/Wissenschaft/Forschung/COVID-19/Handlungsempfehlungen-der-DGRh-im-Rahmen-der-COVID-19-Pandemie.html

Disclosure of Interests

Stephanie Gabriele Werner Speakers bureau: Pfizer, Abbvie, Janssen, Grant/research support from: Pfizer, Leander Moll: None declared, Antje Uhlenberg-Moll: None declared, Sabine Mettler: None declared, Hans-Eckhard Langer Speakers bureau: Pfizer, Abbvie, Medac, Janssen, Bristol

Incidence, possible risk factors and therapies for pseudopregnancy on Dutch dairy goat farms: a cross-sectional study

Pseudopregnancy is a frequently diagnosed reproductive disorder in (dairy) goats. This cross-sectional study evaluates the incidence, possible risk factors and therapies for pseudopregnancy on Dutch dairy goat farms. Two questionnaires, one for farmers and one for veterinarians, were designed and included questions about general farm demographics, breeding management, hormonal oestrous induction, treatment, measures for reduction and stress moments in dairy goats in the period June 1, 2016-May 31, 2017. In total, 43 farmers (21.5 per cent response rate) and 27 veterinarians (22.5 per cent response rate) completed the questionnaire. The annual incidence of pseudopregnancy varied between 1 and 54 per cent per farm, with a mean annual incidence of 17 per cent (95 per cent CI 0.14 to 0.21). In this study, we found a significant association between incidence of pseudopregnancy and a higher percentage of goats with an extended lactation (p<0.0001) and between incidence of pseudopregnancy and the number of ultrasound examinations per year (p<0.0001). The recommended therapy in literature consists of two administrations of prostaglandins. This was only correctly applied by 10 per cent of the farms. On 52 per cent of the farms, an overdose was used comparing to the recommended dose in literature.

Presence and species identity of rumen flukes in cattle and sheep in the Netherlands

The purpose of the study was to gain knowledge about the prevalence and identity of rumen flukes (RF) in cattle and sheep in the Netherlands. Routine faecal examinations of diagnostic submissions between May 2009 and September 2014 showed a mean annual herd or flock RF prevalence of 15.8% for cattle and 8.0% for sheep. Prevalence in cattle was higher after 2012 than before, which may reflect a change in detection method as well as an increase in true prevalence. During November and December 2014, an abattoir survey was conducted to allow for scoring of rumen fluke burden and to obtain specimens for molecular species characterization. Over 8 visits to 5 abattoirs in areas deemed to pose a high risk for trematode infection, 116 cows and 41 sheep from 27 herds and 10 flocks were examined. Prevalence of RF was higher in beef cattle than in dairy cattle and higher in cattle than in sheep. Median fluke burden was >100 specimens per animal for most positive animals. Using a semi-quantitative RF density score as a gold standard, sensitivity and specificity of a modified quantitative Dorsman egg counting method were estimated at 82.6% and 83.3%, respectively. Of 14 collected adult rumen flukes, twelve (8 bovine and 4 ovine specimens) were identified as Calicophoron daubneyi. The other two, of bovine origin, were identified as Paramphistomum leydeni, which was unexpected as in other European countries all recently collected rumen flukes in both cattle and sheep were identified as C. daubneyi. The findings implicate that multiple rumen fluke species, intermediate host species and transmission cycles may play a role in rumen fluke infections in the Netherlands.

Risk factors for malformations and impact on reproductive performance and mortality rates of Schmallenberg virus in sheep flocks in the Netherlands

In Northwestern Europe, an epizootic outbreak of congenital malformations in newborn lambs due to infection with Schmallenberg virus (SBV) started at the end of 2011. The objectives of this study were to describe clinical symptoms of SBV infection, the effect of infection on mortality rates, and reproductive performance in sheep, as well as to identify and quantify flock level risk factors for SBV infections resulting in malformations in newborn lambs. A case-control study design was used, with 93 case flocks that had notified malformed lambs and 84 control flocks with no such lambs. Overall animal seroprevalence in case flocks was estimated at 82.0% (95% CI: 74.3–87.8), and was not significantly different from the prevalence in control flocks being 76.4% (95% CI: 67.2–83.6). The percentages of stillborn lambs or lambs that died before weaning, repeat breeders, and lambs with abnormal suckling behaviour were significantly higher in case flocks compared to control flocks. However, effect of SBV infection on mortality rates and reproductive performance seemed to be limited. Multivariable analysis showed that sheep flocks with an early start of the mating season, i.e. before August 2011 (OR = 33.1; 95% CI: 10.0–109.8) and in August 2011 (OR = 8.2; 95% CI: 2.7–24.6) had increased odds of malformations in newborn lambs caused by SBV compared to sheep flocks with a start of the mating season in October 2011. Other flock-level risk factors for malformations in newborn lambs were purchase of silage (OR 5.0; 95% CI: 1.7–15.0) and flocks with one or more dogs (OR = 3.3; 95% CI: 1.3–8.3). Delaying mating until October could be a potential preventive measure for naïve animals to reduce SBV induced losses. As duration of immunity after infection with SBV is expected to last for several years, future SBV induced congenital malformations are mainly expected in offspring of early mated seronegative animals.

Neuronal overexpression of insulin receptor substrate 2 leads to increased fat mass, insulin resistance, and glucose intolerance during aging

The insulin receptor substrates (IRS) are adapter proteins mediating insulin's and IGF1's intracellular effects. Recent data suggest that IRS2 in the central nervous system (CNS) is involved in regulating fuel metabolism as well as memory formation. The present study aims to specifically define the role of chronically increased IRS2-mediated signal transduction in the CNS. We generated transgenic mice overexpressing IRS2 specifically in neurons (nIRS2 (tg)) and analyzed these in respect to energy metabolism, learning, and memory. Western blot (WB) analysis of nIRS2 (tg) brain lysates revealed increased IRS2 downstream signaling. Histopathological investigation of nIRS2 (tg) mice proved unaltered brain development and structure. Interestingly, nIRS2 (tg) mice showed decreased voluntary locomotoric activity during dark phase accompanied with decreased energy expenditure (EE) leading to increased fat mass. Accordingly, nIRS2 (tg) mice develop insulin resistance and glucose intolerance during aging. Exploratory behavior, motor function as well as food and water intake were unchanged in nIRS2 (tg) mice. Surprisingly, increased IRS2-mediated signals did not change spatial working memory in the T-maze task. Since FoxO1 is a key mediator of IRS2-transmitted signals, we additionally generated mice expressing a dominant negative mutant of FoxO1 (FoxO1DN) specifically in neurons. This mutant mimics the effect of increased IRS2 signaling on FoxO-mediated transcription. Interestingly, the phenotype observed in nIRS2 (tg) mice was not present in FoxO1DN mice. Therefore, increased neuronal IRS2 signaling causes decreased locomotoric activity in the presence of unaltered exploratory behavior and motor coordination that might lead to increased fat mass, insulin resistance, and glucose intolerance during aging independent of FoxO1-mediated transcription.

Demography of Q fever seroprevalence in sheep and goats in The Netherlands in 2008

At the end of 2007, the first year of what later turned out to be one of the largest Q fever outbreaks in the world with ultimately almost 3500 human patients notified in three years time, dairy goats were suspected to be the possible cause. However, current information on the Q fever prevalence in small ruminants in The Netherlands was lacking. A serological survey, using an indirect ELISA, was carried out in 15,186 sheep and goats in The Netherlands in 2008. In total, 2.4% (95% CI: 2.2-2.7) of the sheep and 7.8% (95% CI: 6.9-8.8) of the goats was seropositive for antibodies against Coxiella burnetii. In 14.5% (95% CI: 12.5-16.5) of the sheep flocks and 17.9% (95% CI: 14.2-21.5) of the goat herds at least one seropositive animal was found. In sheep flocks with at least one seropositive sheep, the within herd seroprevalence was 14.8% (95% CI: 12.6-17.0). In goat herds with at least one seropositive goat, the within herd seroprevalence was 29.0% (95% CI: 24.6-33.3). The seropositive sheep were equally distributed across the country. The seroprevalence in goats in the south-eastern part of The Netherlands, the area where most of the human Q fever cases were notified, was significantly higher than the seroprevalence in goats in the rest of The Netherlands. Dairy sheep and dairy goats had a significantly higher chance of being seropositive than non-dairy sheep and goats. During pregnancy and in the periparturient period, small ruminants tested significantly more often seropositive than in the early- or non-pregnant period. The seroprevalence as well as the true prevalence among small ruminants in The Netherlands were lower than prevalences reported elsewhere. The seroprevalence among sheep was also lower than reported in an earlier Dutch study in 1987. The Q fever seroprevalence was highest in pregnant and periparturient dairy goats in the south-eastern part of The Netherlands, which coincides with the region with the highest human incidence of Q fever.

Coxiella burnetii in bulk tank milk samples from dairy goat and dairy sheep farms in The Netherlands in 2008

In 2007, a human Q fever epidemic started, mainly in the south eastern part of The Netherlands with a suspected indirect relation to dairy goats, and, to a lesser degree, to dairy sheep. This article describes the Q fever prevalences in Dutch dairy goat and dairy sheep bulk tank milk (BTM) samples, using a real-time (RT) PCR and ELISA. Results of BTM PCR and ELISA were compared with the serological status of individual animals, and correlations with a history of Q fever abortion were determined. When compared with ELISA results, the optimal cut-off value for the RT-PCR was 100 bacteria/ml. In 2008, there were 392 farms with more than 200 dairy goats, of which 292 submitted a BTM sample. Of these samples, 96 (32.9 per cent) were PCR positive and 87 (29.8 per cent) were ELISA positive. All farms with a history of Q fever abortion (n=17) were ELISA positive, 16 out of 17 were also PCR positive. BTM PCR or ELISA positive farms had significantly higher within-herd seroprevalences than BTM negative farms. In the south eastern provinces, the area where the human Q fever outbreak started in 2007, a significantly larger proportion of the BTM samples was PCR and ELISA positive compared to the rest of The Netherlands. None of the BTM samples from dairy sheep farms (n=16) were PCR positive but three of these farms were ELISA positive. The higher percentage of BTM positive farms in the area where the human Q fever outbreak started, supports the suspected relation between human cases and infected dairy goat farms.

Central FoxO3a and FoxO6 expression is down-regulated in obesity induced diabetes but not in aging

BACKGROUND

Recent data suggest that insulin-like growth factor (IGF)-1 resistance in neurons prolongs longevity. In C. elegans this effect is mediated via DAF-16 the ortholog of the mammalian FoxO transcription factors. 3 different FoxO transcription factors (FoxOs) are expressed in rodent CNS: FoxO1, FoxO3a and FoxO6.

METHODS

To define whether the different FoxOs are region-, sex- and age-specifically expressed, we analyzed FoxO mRNA levels in different brain regions from 6, 16, 60 and 100 weeks old mice using realtime-PCR. In addition, we fed mice a high fat diet (HFD) to experimentally induce obesity and diabetes and analyzed FoxO mRNA in the different brain regions.

RESULTS

Interestingly, FoxO1 was predominantly expressed in the hippocampus whereas FoxO3a was quantitatively the most abundant FoxO in the neocortex. During aging, FoxO1 expression peaked in all brain regions at 16 weeks and FoxO6 showed its highest expression at 60 weeks in the parietal and occipital cortex. In 6 weeks old mice FoxO6 expression was higher in male compared to female mice in the hippocampus and all cortical regions. Surprisingly, in HFD animals FoxO3a was significantly less expressed in the cerebellum and all cortical regions compared to control animals. Even more dramatic, FoxO6 expression dropped about 80% in all brain regions in response to HFD.

CONCLUSION

Thus, FoxOs in the CNS showed a highly distinct expression, which in addition was age- and sex-dependent. In contrast to FoxO1, FoxO3a and FoxO6 were specifically diminished in the CNS of HFD animals possibly contributing to the reduced lifespan observed in these animals.

[How widespread is resistance to invermectin among gastrointestinal nematodes in sheep in The Netherlands?]

In Autumn 2009, a faecal egg count reduction test (FERCT) was carried out on three sheep farms. Groups of 8-11 lambs were treated with ivermectin or moxidectin, with a 14-day interval between treatment and sampling. Ivermectin resistance was present on all three farms. Treatment with ivermectin resulted in a reduction in faecal egg numbers of 94.6%, 63%, and 59%. On two farms, 14 days after treatment pooled faecal samples yielded predominantly larvae of Hamonchus contortus (100% and 98%, respectively). On the third farm, H. contortus and (probably) Teladorsagia circumcincta were resistant to ivermectin (64% and 36% of the larvae, respectively). Treatment with moxidectin resulted in a 100% reduction in egg output in sheep on all three farms. More sensitive culture techniques failed to detect any larvae in samples taken from two farms, but a few Ostertagia-type larvae, probably of T. circumcincta, were detected in samples from the third farm. It can be concluded that gastrointestinal nematodes in sheep from these three farms were resistant to ivermectin, whereas resistance to moxidectin was not detected.

Aspects of the epidemiology, research, and control of lentiviral infections of small ruminants and their relevance to Dutch sheep and goat farming

In 1862, the veterinarian Loman reported the first sheep in The Netherlands with symptoms associated with lentiviral infection, although at the time the symptoms were ascribed to ovine progressive pneumonia. In the following century, similar cases were reported by South African, French, American, and Icelandic researchers. Extensive research into the pathology, aetiology, and epidemiology of this slowly progressive and ultimately fatal disease was initiated in several countries, including the Netherlands. Studies of the causative agents--maedi visna virus (MVV) in sheep and caprine arthritis encephalitis virus (CAEV) in goats, comprising the heterogeneous group of the small ruminant lentiviruses (SRLV)--prompted the development of diagnostic methods and the initiation of disease control programmes in many European countries including the Netherlands, as a pioneer in 1982, and in the U.S.A. and Canada.

An experimental study on triclabendazole resistance of Fasciola hepatica in sheep

The efficacy of triclabendazole in sheep experimentally infected with Fasciola hepatica was studied. Two groups of 12 lambs were infected with a susceptible (S) or a resistant (R) strain of F. hepatica. Eight weeks after infection, six lambs of each group (ST and RT) were treated with triclabendazole (10mg/kg). The other lambs were used as untreated controls (SC and RC). The parameters studied were: GLDH, gamma-GT, ELISA measuring antibodies against recombinant cathepsin-L(1) and eggs per gram faeces (epg). The lambs were slaughtered 16 weeks after infection and the number of flukes counted. The GLDH, gamma-GT levels and the OD value of the ELISA decreased as a result of the treatment in group ST. Patent infections were observed in all animals of groups SC, RT and RC. In group ST, occasionally a few eggs were found in five lambs. The percentage of flukes was 31.3 in SC and 37.6 in RC. In the treated groups ST and RT, the percentage of flukes was 0.06 and 33.6, respectively. These results corresponded to efficacies of 99.8% in the susceptible and 10.8% in the resistant strain. Since the resistant strain was isolated from a mixed cattle and sheep farm, it confirms the presence of triclabendazole resistance in the Netherlands.

Resistance of Fasciola hepatica against triclabendazole in cattle and sheep in The netherlands

In the winter of 1998/1999, sheep on a farm in the province of North Holland, The Netherlands, died from subacute and chronic liver fluke disease despite four previous treatments with triclabendazole (TCBZ). Faecal examinations of sheep and cattle on the farm showed high number of liver fluke eggs. In a randomised clinical trial, the fluke egg output was monitored weekly for 3 weeks in sheep which were treated with TCBZ or with closantel; in dairy cows treated with TCBZ or with clorsulon; and in heifers treated with TCBZ or clorsulon. The results showed a significant reduction of 99.7, 98.1 and 99.2%, respectively, in fluke egg output at 21 days in all non-TCBZ treated animals. TCBZ treatment produced percentage decreases of 15.3, 4.3 and 36.6%, respectively. These results are highly indicative of the presence of TCBZ-resistant Fasciola hepatica in sheep and cattle on this farm.

Effect of cobalt supplementation on serum vitamin B12 levels, weight gain and survival rate in lambs grazing cobalt-deficient pastures

The effect of cobalt supplementation on serum vitamin B12, growth rate and survival rate was measured in controlled field experiments with Texel twin lambs of the same sex, grazing cobalt-deficient pastures. The non-supplemented lambs had lower serum vitamin B12 concentrations than their supplemented brothers or sisters. During the experiments more lambs died in the non-supplemented than in the supplemented group. At the end of the experiments supplemented lambs weighed (mean live weight) 7.2, 9.5, and 11.0 kg more than non-supplemented lambs in 1991, 1992, and 1993, respectively. Sex-related differences in weight gain and survival rate were observed.

The effect of cobalt supplementation on the immune response in vitamin B12 deficient Texel lambs

The effect of cobalt supplementation on the immune reactivity in vitamin B12 deficient lambs was measured by comparing the humoral and cell-mediated immune responses against bovine herpes virus type 1 and Mycobacterium paratuberculosis. In addition, faecal egg counts were performed after natural infection with gastrointestinal nematodes. The experiments were performed with registered Texel twin lambs of the same sex. One lamb of each twin received three cobalt pellets divided over the grazing period. The non-supplemented lambs had lower serum vitamin B12 levels than their supplemented brother or sister. Our results demonstrate significantly lower lymphoblastic responses against Mycobacterium paratuberculosis in non-supplemented lambs compared with supplemented lambs 4 weeks after paratuberculosis vaccination. Vitamin B12 deficient lambs in this study had significant higher faecal egg counts than their supplemented brother or sister after natural infection with gastrointestinal nematodes. No differences were found in total and differential white blood cell counts, in total protein, albumin, alpha-, beta- and gamma-globulin and in antibody production against bovine herpes virus type 1 and Mycobacterium paratuberculosis.

Where to go to become a managed care expert

When it comes to finding your way through the thicket of managed care options and opportunities that are springing up across the country, knowledge is power. Here's a handy reference that lists places you can turn to increase your knowledge of managed care.

Premotor cortical ablations in monkeys: contralateral changes in visually guided reaching behavior

In rhesus monkeys (Macaca mulatta), ablation of the premotor and supplementary motor areas and the adjoining rostral half of the precentral gyrus impairs the capacity of the contralateral arm to reach around a transparent obstacle to a visible food reward, and results in a tendency of this arm to reach around a transparent obstacle to a visible food reward, and results in a tendency of this arm to reach straight to where the food is visible. This may reflect a disinhibition of brainstem pathways which steer the arm and hand straight ot a visual target.