Cardiovascular or renal disease (CVRD) complication and mortality incidence for type 2 diabetics with a single or without CVRD comorbidity: a 5-year SNDS nationwide claims database cohort study

Background

Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal disease (CVRD) complications for type 2 diabetes (T2D). However, for those with a single CVRD comorbidity, the incidence of a new CVRD complication and death is not well known.

Purpose

To assess the 5-year CVRD complication and mortality incidence for T2D patients with a single CVRD comorbidity or without CVRD at baseline.

Methods

A cohort study of all T2D patients with a single CVRD or without CVRD (disease-free) at baseline (January 1st, 2014) identified and followed-up for 5 years within the French SNDS nationwide claims database. Incidence rates were estimated for 5 years and the risk of all-cause death was compared to the disease-free population using Cox proportional hazards risk model: hazard ratio (HR) with [95% confidence interval].

Results

From about 2 million T2D patients without cancer or transplantation at baseline, 76.5% were disease-free, 7.9% with a single CVRD and the others having several CVRD comorbidities history. Five-year CVRD complication and mortality incidence rates for 1,000 patient-years are presented in the table. CKD and HF were the most frequent CVRD complications for the disease-free and all CVRD comorbid populations, far ahead of MI, stroke and PAD, except PAD complication for PAD population and to a lesser degree stroke complication for stroke population. The incidence rate of all-cause death was the highest for HF+CKD patients, followed by HF patients, then PAD, stroke and CKD patients. Compared to disease-free patients with same sex and age, the HR of death was 4.3 [4.2–4.5] higher for HF+CKD patients, 2.7 [2.7–2.8], 2.1 [2.0–2.1], 2.1 [2.0–2.1], 1.9 [1.9–1.9] and 1.4 [1.3–1.4] for HF, CKD, PAD, stroke and MI patients, respectively.

Conclusions

While MI, stroke and PAD comorbidities remain major risks of complications for T2D patients, HF and CKD nowadays represent a clearly higher risk of CVRD complications and death, that needs improved preventive strategies.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Study performed with unconditional funding from AstraZeneca

Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database

AIMS/HYPOTHESIS

Using the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010.

METHODS

We used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥ 80% use time) users of insulin glargine compared with equivalent human insulin users.

RESULTS

Only type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87).

CONCLUSIONS/INTERPRETATION

There was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.

Analysis of proteins with caseinolytic activity in a human stratum corneum extract revealed a yet unidentified cysteine protease and identified the so-called "stratum corneum thiol protease" as cathepsin l2

Desquamation is described as a protease-dependent phenomenon where serine proteases with a basic pH optimum play a key role. Recently proteases with an acidic pH optimum were identified in the stratumcorneum and associated with desquamation, e.g., cathepsin D and the stratum corneum thiol protease. The purpose of this study was to investigate if human stratum corneum contains proteases different from the above, exhibiting similar properties. After gel filtration, we identified four distinct proteolytic activities in a human stratum corneum extract, a cathepsin-E-like activity (80 kDa), a cathepsin-D activity (40 kDa), a yet unknown cathepsin-L-like form (28 kDa) exhibiting the highest caseinolytic activity, and a chymotrypsin-like protein (24 kDa) containing the acidic activity of the well described stratum corneum chymotryptic enzyme. We named the new 28 kDa protease stratum corneum cathepsin-L-like enzyme. Characterization of stratum corneum cathepsin-L-like enzyme provided clear evidence that this new protease, despite its membership to the cathepsin-L-like family, is distinct from cathepsin L and from the recently described stratum corneum thiol protease. Its ability to hydrolyze corneodesmosin, a marker of corneocyte cohesion, was in favor of a role of stratum corneum cathepsin-L-like enzyme in the desquamation process. A more detailed analysis did not allow us to identify stratum corneum cathepsin-L-like enzyme at the molecular level but revealed that stratum corneum thiol protease is identical with the recently described cathepsin L2 protease. Reverse transcription polymerase chain reaction studies and the use of a specific antibody revealed that, in contrast to earlier reports, expression of stratum corneum thiol protease in human epidermis is not related to keratinocyte differentiation. Our results indicate that the stratum corneum thiol protease is probably expressed as a pro-enzyme in the lower layers of the epidermis and in part activated by a yet unidentified mechanism in the upper layers during keratinocyte differentiation.

Effects of a community-based intervention to increase activity in American Indian elders

The purpose of this study was to evaluate the efficacy of a community-based exercise course applied to a group of American Indians (AI) who, because of physician recommendation and/or self-motivation, desired to increase their physical activity. Changes in physiological measurements and self-perceived measurements were determined following a moderate-intensity exercise program implemented through a randomized controlled trial to a population of American Indian elders between the ages of 55 and 75 living in an urban area. It was hypothesized that the exercise subjects would show improvement in all of the study variables examined, including three subjective measurements in emotional health, seven subjective measurements in physical health, and several physiological indices. The subjects participated in a six-week exercise class designed for healthy elderly persons as well as for those struggling from arthritis, heart disease, obesity, and/or non-insulin dependent diabetes. Results were measured using both subjective self-perceived and objective physiological measurements; T-tests were used to analyze the data, using subjects as their own controls and using a separate control group. Following the intervention, the exercise participants significantly improved their self-perceived physical health (p = 0.001), emotional health (p = 0.023), and personal appearance (p = 0.025) when compared with baseline values. The exercise subjects also significantly increased the self-perceived frequency with which they performed chores that gave them exercise (p = 0.035) and significantly increased the self-perceived frequency that they participated in activities specifically for exercise (p = 0.023) when compared with pre-intervention measurements. A corresponding trend in objective indices was also observed: following the intervention period, exercise participants were found to significantly lower their systolic blood pressure (p = 0.046) and significantly lower their respirations (p = 0.048) as compared with initial values. Findings of this study suggest that senior Al adults who participated in the exercise program subjectively and objectively improved their health status. The authors think that this type of program would be an excellent resource for physicians to recommend to their eldrly patients in need of increased physical activity. A literature search found no previously published clinical data documenting the response of Al elders to excercises that developed flexibility, muscular strength, and muscular endurance.

Diminished levels of the putative tumor suppressor proteins EXT1 and EXT2 in exostosis chondrocytes

The EXT family of putative tumor suppressor genes affect endochondral bone growth, and mutations in EXT1 and EXT2 genes cause the autosomal dominant disorder Hereditary Multiple Exostoses (HME). Loss of heterozygosity (LOH) of these genes plays a role in the development of exostoses and chondrosarcomas. In this study, we characterized EXT genes in 11 exostosis chondrocyte strains using LOH and mutational analyses. We also determined subcellular localization and quantitation of EXT1 and EXT2 proteins by immunocytochemistry using antibodies raised against unique peptide epitopes. In an isolated non-HME exostosis, we detected three genetic hits: deletion of one EXT1 gene, a net 21-bp deletion within the other EXT1 gene and a deletion in intron 1 causing loss of gene product. Diminished levels of EXT1 and EXT2 protein were found in 9 (82%) and 5 (45%) exostosis chondrocyte strains, respectively, and 4 (36%) were deficient in levels of both proteins. Although we found mutations in exostosis chondrocytes, mutational analysis alone did not predict all the observed decreases in EXT gene products in exostosis chondrocytes, suggesting additional genetic mutations. Moreover, exostosis chondrocytes exhibit an unusual cellular phenotype characterized by abnormal actin bundles in the cytoplasm. These results suggest that multiple mutational steps are involved in exostosis development and that EXT genes play a role in cell signaling related to chondrocyte cytoskeleton regulation.

Metabolic functions of microbial nucleoside diphosphate kinases

This article summarizes research from our laboratory on two aspects of the biochemistry of nucleoside diphosphate kinase from Escherichia coli--first, its interactions with several T4 bacteriophage-coded enzymes, as part of a multienzyme complex for deoxyribonucleoside triphosphate biosynthesis. We identify some of the specific interactions and discuss whether the complex is linked physically or functionally with the T4 DNA replication machinery, or replisome. Second, we discuss phenotypes of an E. coli mutant strain carrying a targeted deletion of ndk, the structural gene for nucleoside diphosphate kinase. How do bacteria lacking this essential housekeeping enzyme synthesize nucleoside triphosphates? In view of the specific interactions of nucleoside diphosphate kinase with T4 enzymes of DNA metabolism, how does T4 multiply after infection of this host? Finally, the ndk disruption strain has highly biased nucleoside triphosphate pools, including elevations of the CTP and dCTP pools of 7- and 23-fold, respectively. Accompanied by these biased nucleotide pools is a strong mutator phenotype. What is the biochemical basis for the pool abnormalities and what are the mutagenic mechanisms? We conclude with brief references to related work in other laboratories.

Cardiac troponin I is reliable with immediate but not medium-term cardiac complications after abdominal aortic repair

BACKGROUND

The diagnosis of cardiac complications is particularly challenging in the postoperative course of non-cardiac surgery. Follow-up of patients suggests that silent or symptomatic postoperative myocardial infarction have similar short-term outcomes. Cardiac troponin I (cTnI) has been reported as being a sensitive and specific marker of these complications.

METHODS

We conducted a prospective study to determine the cut-off values of cTnI which may predict cardiac complications, i: in the postoperative period until discharge, and ii: during a 1-year period after aortic surgery. Three hundred and twenty-nine consecutive patients undergoing infrarenal aortic surgery were included over a 2-year period in a single center. cTnI was measured at recovery and on the 1st, 2nd and 3rd postoperative days. The presence or absence of cardiac complications was classified by reviewers who had no knowledge of cTnI. For evaluation of the ideal discrimination value of cTnI between the complicated and uncomplicated patient groups, we calculated receiver-operator characteristics for the mean values of the peak of cTnI.

RESULTS

Thirteen patients (4%) developed 19 postoperative cardiac complications. Thirteen patients (4%) died in the postoperative period. Nine patients (3%) developed 10 cardiac complications during the 1-year follow-up in 316 patients. In 280 patients, cTnI was below 0.5 ng/ml, in 22 patients between 0.5 and 1.5 ng/ml and the 27 remaining patients had a cTnI higher than 1.5 ng/ml. The area under the curve for postoperative cardiac complications was 0.84 (SD=0.21). A limit value of 0.54 ng/ml yielded a sensitivity of 75% and a specificity of 89%. The area under the curve for late cardiac complications was 0.45 (SD= 0.13).

CONCLUSION

A cTnI level greater than 0.54 ng/ml appears to be correlated with the occurrence of cardiac complications in the period until discharge, but no value of cTnI is predictive of late cardiac complications occurring in the 1st year after aortic surgery.

Identification and cloning of a new calmodulin-like protein from human epidermis

After separating by two-dimensional gel electrophoresis an extract of total proteins from human stratum corneum, two spots were extracted and analyzed for their peptide sequence. The resulting internal protein sequences provided evidence for the identification of a new calcium-binding protein. Cloning of the corresponding full-length cDNA was achieved by reverse transcriptase-polymerase chain reaction using two keratinocyte libraries, one from proliferating cultured keratinocytes and one from differentiated keratinocytes of reconstructed human epidermis. The cDNA had an open reading frame encoding a new calcium-binding protein of 146 amino acids, a member of the calmodulin family. We named this new protein calmodulin-like skin protein (CLSP), since reverse transcriptase-polymerase chain reaction studies of CLSP expression in 10 different human tissues revealed that this protein was particularly abundant in the epidermis where its expression is directly related to keratinocyte differentiation. Expression of the cloned cDNA in Escherichia coli yielded a recombinant protein which allowed its further characterization. rCLSP is able to bind calcium, and similarly to calmodulin, exposes thereafter hydrophobic parts which most likely interact with target proteins. Epidermal proteins retained by CaM affinity column are quantitatively and qualitatively distinct from those of the rCLSP column. Sequencing of a rCLSP affinity purified protein revealed 100% identity with transglutaminase 3, a key enzyme in terminal differentiation, indicating an important role of CLSP in this process.

Cytoskeletal abnormalities in chondrocytes with EXT1 and EXT2 mutations

The EXT genes are a group of putative tumor suppressor genes that previously have been shown to participate in the development of hereditary multiple exostoses (HME), HME-associated and isolated chondrosarcomas. Two HME disease genes, EXT1 and EXT2, have been identified and are expressed ubiquitously. However, the only known effect of mutations in the EXT genes is on chondrocyte function as evidenced by aberrant proliferation of chondrocytes leading to formation of bony, cartilage-capped projections (exostoses). In this study, we have characterized exostosis chondrocytes from three patients with HME (one with EXT1 and two with EXT2 germline mutations) and from one individual with a non-HME, isolated exostosis. At the light microscopic level, exostosis chondrocytes have a stellate appearance with elongated inclusions in the cytoplasm. Confocal and immunofluorescence of in vitro and in vivo chondrocytes showed that these massive accumulations are composed of actin bundled by 1.5-microm repeat cross-bridges of alpha-actinin. Western blot analysis shows that exostosis chondrocytes from two out of three patients aberrantly produce high levels of muscle-specific alpha-actin, whereas beta-actin levels are similar to normal chondrocytes. These findings suggest that mutations in the EXT genes cause abnormal processing of cytoskeleton proteins in chondrocytes.

The effect of vitamin B12 deficiency on older veterans and its relationship to health

OBJECTIVE

To examine the effect of vitamin B12 deficiency on older veterans and its relationship to general health and cognitive impairment.

DESIGN

Cross-sectional study.

SETTING

Oklahoma City Veterans Affairs Medical Center.

PARTICIPANTS

Data for this research were obtained from 303 ambulatory, older veterans who used the outpatient laboratories of the Oklahoma City Department of Veterans Affairs Medical Center. Subjects were included in the study if they were 65 years of age and older and if they had no known diagnosis associated with B12 deficiency. The sample in this study consisted of 301 men and 2 women aged 65 to 89 years.

MEASUREMENTS

This study used two separate measurements of vitamin B12 deficiency: (1) a strict definition of B12 deficiency (serum B12 level < laboratory norm) and (2) a broader definition of B12 deficiency (serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and methyl malonic acid (MMA) or homocysteine (HC) elevated by more than two standard deviations). The laboratory norm is 200 pg/mL. The dependent variables were measures of cognitive impairment and general health. Cognitive impairment was measured using the Folstein Mini-Mental State Examination (MMSE) and general health was measured using the RAND 36-Item Health Survey Version 1.0. The control variables for this study were the subjects' daily alcohol intake, daily intake of a vitamin/mineral supplement, annual income, and level of education.

RESULTS/CONCLUSIONS

Nineteen subjects (6%) were vitamin B12-deficient as measured by the strict definition of B12 deficiency (serum B12 level < laboratory norm), and 49 subjects (16%) were vitamin B12-deficient as measured by the broader definition of B12 deficiency (serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and MMA or HC elevated by more than two standard deviations). Vitamin B12 level decreases as age increases. Of the nine general health outcomes measured by using the RAND 36-Item Health Survey, only bodily pain is associated with vitamin B12 deficiency, and only then when B12 deficiency is measured as serum B12 level < laboratory norm, the strict definition of B12 deficiency. Vitamin B12-deficient subjects experience more bodily pain than those with normal vitamin B12 levels. There is a significant difference between B12-deficient subjects and B12 normal subjects on cognitive impairment, with B12 normal subjects indicating less cognitive impairment, only when B12 deficiency is measured as B12 level < laboratory norm, the strict definition of B12 deficiency. The broader measurement of vitamin B12 deficiency (i.e., serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and MMA or HC elevated by more than two standard deviations) is not a significant correlate of cognitive impairment and general health.

Common health problems among minority elders

This article reviews the primary health problems of African-American, Hispanic-American, Asian/Pacific Islander-American, and Native-American elders. The goal is to familiarize practicing dietitians with the differences in longevity, disease spectrum, and functional status (where data are available) for each of these ethnic groups. These data should be of assistance in making decisions regarding dietary counseling for ethnic elders. It is acknowledged that most data accumulated according to race do not accurately measure ethnicity. The degree of acculturation may vary widely among individuals. Therefore, it is recommended that dietitians solicit clients' perceptions of the factors that may contribute to illness and the barriers to implementing recommended remedies.

Lumbar muscle rhabdomyolysis after abdominal aortic surgery

Lumbar muscle rhabdomyolysis has been very rarely reported after surgery. The aim of this study was to determine its incidence and main characteristics in a large population undergoing abdominal aortic surgery. Over a 21-mo period, 224 consecutive patients, 209 male and 15 female, mean age 65 +/- 10 yr, underwent abdominal aortic surgery (aortic aneurysm in 142 patients and occlusive aortic degenerative disease in 82 patients). Surgical incision was a midline incision with exaggerated hyperlordosis in 173 patients and a flank incision with a retroperitoneal approach in 51 patients. Postoperative rhabdomyolysis was diagnosed in 20 patients. In these patients, 9 (4%) experienced severe low back pain, and lumbar muscle rhabdomyolysis was confirmed by tomodensitometry (n = 6) or muscle biopsy (n = 3). The remaining 11 patients had lower limb muscle rhabdomyolysis. Rhabdomyolysis occurred after surgery of longer duration, which involved more frequent visceral artery reimplantation, with longer duration of aortic clamping and greater intraoperative bleeding. Lumbar rhabdomyolysis occurred in younger patients who were more frequently obese. On first postoperative day, the mean creatine kinase (CK) value was greater in lumbar rhabdomyolysis than in lower limb rhabdomyolysis (17,082 +/- 15,003 vs 3,313 +/- 3,120 IU/L, P < 0.05). Acute renal failure and postoperative death did not occur in patients with lumbar muscle rhabdomyolysis. Lumbar rhabdomyolysis was not a rare event after abdominal aortic surgery (4%). This syndrome was characterized by postoperative low back pain of unusual severity, which required analgesic therapy, and induced a very high increase in CK with typical findings at tomodensitometry or muscle biopsy but was not associated with postoperative renal failure.

T4 phage gene 32 protein as a candidate organizing factor for the deoxyribonucleoside triphosphate synthetase complex

After T4 bacteriophage infection of Escherichia coli, the enzymes of deoxyribonucleoside triphosphate biosynthesis form a multienzyme complex that we call T4 deoxyribonucleoside triphosphate (dNTP) synthetase. At least eight phage-coded enzymes and two enzymes of host origin are found in this 1.5-mDa complex. The complex may shuttle dNTPs to DNA replication sites, because replication draws from small pools, which are probably highly localized. Several specific protein-protein contacts within the complex are described in this paper. We have studied protein-protein interactions in the complex by immobilizing individual enzymes and identifying radiolabeled T4 proteins that are retained by columns of these respective affinity ligands. Elsewhere we have described interactions involving three T4 enzymes found in the complex. In this paper we describe similar analysis of five more proteins: dihydrofolate reductase, dCTPase-dUTPase, deoxyribonucleoside monophosphokinase, ribonucleotide reductase, and E. coli nucleoside diphosphokinase,. All eight proteins analyzed to date retain single-strand DNA-binding protein (gp32), the product of T4 gene 32. At least one T4 protein, thymidylate synthase, binds directly to gp32, as shown by affinity chromatographic analysis of the two purified proteins. Among its several roles, gp32 stabilizes single-strand template DNA ahead of a replicating DNA polymerase. Our data suggest a model in which dNTP synthetase complexes, probably more than one per growing DNA chain, are drawn to replication forks via their affinity for gp32 and hence are localized so as to produce dNTPs at their sites of utilization, immediately ahead of growing DNA 3' termini.

Health and nutritional status of old-old African Americans

This study reports the initial results of a baseline cross-sectional evaluation of the health and nutritional status of 58 old-old African Americans, 74 years of age and older, residing in low income housing complexes in metropolitan Oklahoma City. Although the population had a high overall functional status, cognitive status, and mood, there were a number of nutritional parameters suggestive of nutritional risk. In particular, 20% of subjects had relatively low serum albumin levels, 14% had serum cholesterol levels below 160 mg/dl, and a subset of the population reported low intake during 24 hour dietary recall. The National Center and Caucus on Black Aged report that 60% of African American elders live at or below the poverty level. These study findings suggest that the present cohort of African American elders may be at nutritional risk.

Urinary incontinence in elderly females

This article reviews recent literature regarding the incidence, causes, and treatment of urinary incontinence in elderly women. Data gathering was based upon a Medline search of the medical literature from 1987 to 1993. Studies that included fifty subjects or more and that were published in a physician-oriented journal were selected for inclusion. The findings indicate that urinary incontinence is a common problem among elderly women and one that can be easily evaluated and treated, at least initially, in any physician's office.

Problems in diagnosing infections in the elderly

Elderly individuals often present with altered signs and symptoms to infectious diseases. Altered signs and symptoms may result from underlying illnesses, physiological changes of the elderly, or chemotherapy. Increased awareness of the occurrence of altered signs and symptoms can facilitate determining the medical diagnosis and treatment of the elderly.

Genetic heterogeneity of the V3 region of the HIV-1 envelope glycoprotein in Brazil. Brazilian Collaborative AIDS Research Group

OBJECTIVE

To examine the genetic heterogeneity of the V3 region of HIV-1 gp120 from 22 Brazilian HIV-1 specimens.

DESIGN

Genetic heterogeneity was examined by DNA sequencing of the C2 V3 region of the HIV-1 envelope (env) gene from polymerase chain reaction (PCR)-amplified HIV-1 DNA. Deduced amino-acid sequences were compared to determine the extent of amino-acid conservation among the Brazilian specimens. Genetic similarity among and between the Brazilian specimens and other previously published HIV-1 isolates was analyzed by principal co-ordinate and DNA parsimony methods.

METHODS

A 282 base pair (bp) region of a 1.5 kilo (k) bp PCR-amplified HIV-1 env fragment was sequenced by a Taq dye-labeled primer cycle sequencing reaction. Nucleotide sequences were used to analyze inter-specimen relationships based on overall nucleotide sequence similarity and DNA parsimony principles.

RESULTS

Amino-acid comparison showed that 15 of the 35 (43%) residues of the V3 loop were conserved among the Brazilian specimens. Nine of the 22 (40%) Brazilian specimens contained the North American-European GPGR tetrapeptide motif, while eight (36%) contained the GWGR motif, previously reported in Japanese isolates. Principal co-ordinate analysis demonstrated that 19 of the 20 examined Brazilian HIV-1 specimens were more similar to North American and Haitian isolates than to African isolates. Similar results were also obtained by DNA parsimony analysis.

CONCLUSION

The majority of the Brazilian specimens examined are more genetically related to North American and Haitian HIV-1 isolates than to African isolates. This finding and the presence of a GWGR V3 loop motif in some Brazilian isolates may be important for vaccine development.

The health status of African-American elderly

This article reviews the health status of African-American elderly, based on a computerized search of the medical literature from 1987 to 1991, as well as careful review of the report of the Secretary of Health's Task Force on Black and Minority Health. Black Americans have a higher prevalence of malignancies, diabetes, hypertension, obesity, homicide, and unintentional injury than white Americans. These problems contribute to a high mortality rate in young blacks and a greater prevalence of problems with activities of daily living in elderly blacks. Despite the high disease burden among young blacks, blacks are living progressively longer. As the number of elderly blacks increases, health-care practitioners will need to increase risk factor reduction in young-old blacks. Additionally, there will be a need for increased support of physical functioning in elderly African American.

Decisions regarding services for the frail elderly

The care of the frail elderly will become a progressive challenge in the decades to come. There are presently validated and standardized measures for assessing the frail elderly, as well as a number of options for their care. The challenge for the physician will be the proper selection of assessment instruments and care options.

Morbidity, disability, and health status of black American elderly: a new look at the oldest-old

There are over 2.5 million black Americans aged 65 and over living in the United States today, including some 258,000 persons aged 85 years and over. The post-World War II baby boom within the US black population should ensure that the numbers of persons aged 65 and over will increase into the 21st Century. If present trends continue, it is projected that the current population of black elders will also age. This means that the numbers of black persons aged 85 and over will also increase. Data from both national surveys and population-based community studies concerning the health and well-being of black elders are now becoming available. This report presents information concerning self-reported health status, chronic disease prevalence, disease-risk-factor prevalence, measures of physical functioning, and nursing home utilization rates for age groups within the black population aged 65 years and over. The availability of such data should lead to the development of targeted interventions designed to lessen impairment and prolong independent living.

Alpha-L-fucosidase isoenzyme pattern in hairy cell leukaemia

alpha-L-Fucosidase isoenzymes pattern in hairy cell leukaemia (HCL) is characterized by the disappearance of the more acidic form when compared to normal lymphocytes. Our data seem to indicate that this profile could not be related to the T or B phenotype because in normal lymphocytes (mainly T), MO cells possessing T markers, as well as lymphocytes from chronic lymphoid leukaemia (CLL) known to exhibit normal-like B phenotypes two alpha-L-fucosidase forms are identified and especially the more acidic one.

Alpha-L-fucosidase activity in normal human lymphocytes

After DEAE-Trisacryl chromatography two forms of alpha-L-fucosidase have been characterized in normal human lymphocytes. These enzymatic forms were different with respect to their optimum pH, kinetic properties and isoelectric behaviour. After neuraminidase treatment two forms are still observed with a neutral shift in pI values. These results suggest that at least two structurally different alpha-L-fucosidase units exist.

The Canadian Veterinary Research Trust Fund: Striving to meet the expectations of veterinarians

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Mushroom poisoning in a dog

The false morel (Gyromitra esculenta), a mushroom responsible for occasional fatalities in man, caused a fatal hemolytic episode in a ten week old dog. The clinical symptoms observed and the gross and histopathological findings, are discussed.

Familial renal disease in Samoyed dogs

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Visceral leishmaniasis in a dog: clinical, hematological and pathological observations

Visceral leishmaniasis was diagnosed in a dog that had been living with his owners in Spain for two years. Clinical diagnosis was somewhat delayed as the disease is largely unknown to Canada and was manifested by a nonresponsive anemia which was not easily explained on peripheral blood evaluation alone, and concomitant interstitial nephritis. On post mortem examination splenomegaly was the main gross pathological finding. Light microscopic examination of bone marrow aspirates and subsequent electron microscopic examination of splenic and hepatic tissues revealed numerous Leishman-Donovan bodies in cells of the reticuloendothelial system. Parasitized reticuloendothelial cells were seen singly or forming granulomata. These latter did not contain giant cells and were confined mainly to the liver and spleen, being sparse and single in the first but extremely numerous and coalescing in the latter. Accumulation of intrafollicular hyaline material was seen in a small number of splenic follicles. Leishman-Donovan bodies on electron microscopic examination had a trilaminar periplast, a large round nucleus with heavy blocks of marginated chromatin and two nucleoli, a short flagellum and a kinetoplast. Lymph nodes and bone marrow had numerous parasitized macrophages but no granulomata. Leishman-Donovan bodies were not detected in the lungs and kidneys both of which exhibited a chronic intersitital reaction. The comparative hematological profile as well as the importance of bone marrow and electron microscopic examinations of the spleen and liver in diagnosis are discussed. The potential public health hazard of leishmaniasis to North America and particularly to Canada is considered.

Dirofilariasis in Canada

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