Conservation of C4BP-binding Sequence Patterns in Streptococcus pyogenes M and Enn Proteins

Antigenically sequence variable M proteins of the major bacterial pathogen Streptococcus pyogenes (Strep A) are responsible for recruiting human C4b-binding protein (C4BP) to the bacterial surface, which enables Strep A to evade destruction by the immune system. The most sequence divergent portion of M proteins, the hypervariable region (HVR), is responsible for binding C4BP. Structural evidence points to the conservation of two C4BP-binding sequence patterns (M2 and M22) in the HVR of numerous M proteins, with this conservation applicable to vaccine immunogen design. These two patterns, however, only partially explain C4BP-binding by Strep A. Here, we identified several M proteins that lack these patterns but still bind C4BP, and determined the structures of two, M68 and M87 HVRs, in complex with a C4BP fragment. Mutagenesis of these M proteins led to identification of amino acids that are crucial for C4BP-binding, enabling formulation of new C4BP-binding patterns. Mutagenesis was also carried out on M2 and M22 proteins to refine or generate experimentally grounded C4BP-binding patterns. The M22 pattern was the most populated among M proteins, followed by the M87 and M2 patterns, while the M68 pattern was rare. These patterns, except for M68, were also evident in numerous M-like Enn proteins. Binding of C4BP via these patterns to Enn proteins was verified. We conclude that C4BP-binding patterns occur frequently in Strep A strains of differing M types, being present in their M or Enn proteins, or frequently both, providing further impetus for their use as vaccine immunogens.

Understanding barriers to reducing antimicrobials on Australian dairy farms: A qualitative analysis

INTRODUCTION

Reducing antibiotic use in production animal systems is one strategy which may help to limit the development of antimicrobial resistance. To reduce antimicrobial use in food-producing animals, it is important to first understand how antibiotics are used on farm and what barriers exist to decreasing their use. In dairy production systems, mastitis is one of the most common reasons for administering antimicrobials. Therefore, it is important to understand the motivations and behaviours of dairy farmers in relation to the diagnosis, treatment and prevention of mastitis.

MATERIALS AND METHODS

In this study, we interviewed a sample of dairy farmers and dairy industry professionals from the major dairying regions of eastern Australia regarding their current practices used to diagnose, treat, and control subclinical and clinical mastitis. Inductive thematic analysis was used to code interview transcripts and identify the recurrent themes.

RESULTS

Four overarching themes were identified: (1) the challenges associated with the detection and diagnosis of clinical mastitis, including with laboratory culture, (2) the motivations behind treatment decisions for different cases, (3) decisions around dry cow therapy and the role of herd recording, and (4) concerns regarding the development of antimicrobial resistance.

DISCUSSION

This study identifies several challenges which may limit the ability of Australian dairy farmers to reduce antimicrobial use on farm, such as the need for rapid and reliable diagnostic tests capable of identifying the pathogenic causes of mastitis and the difficulties associated with conducting herd recording for the implementation of selective dry cow therapy. Industry professionals were concerned that farmers were not using individual cow records to aid in treatment decisions, which could result in unnecessary antimicrobial use. The results of this study can act as the basis for future research aimed at assessing these issues across the broader Australian dairy industry.

Prevalence of Tritrichomonas foetus in beef bulls slaughtered at two abattoirs in northern Australia

Bovine trichomoniasis, caused by the protozoal parasite Tritrichomonas foetus, is a highly contagious venereal disease characterised by early pregnancy loss, abortion and pyometra. Persistently infected bulls and cows are the primary reservoirs of infection in infected herds. This research investigated the prevalence of T. foetus infection in bulls from properties located across northern Australia and New South Wales. Preputial samples were collected from 606 bulls at slaughter and tested for T. foetus using the VetMAX‐Gold Trich Detection Kit (Thermo Fisher Scientific). The apparent prevalence of T. foetus infection varied between regions, with northern regions in the Northern Territory, Queensland and Western Australia showing a prevalence of 15.4%, 13.8% and 11.4%, respectively. There was some evidence of an association between infection and postcode (P = 0.06) and increasing bull age (P = 0.054). This study confirms that T. foetus infection is likely to be present in many beef breeding herds and contributing to lower than expected reproductive performance, particularly across northern Australia.

Prevalence and spatial distribution of Coxiella burnetii seropositivity in northern Australian beef cattle adjusted for diagnostic test uncertainty

Q fever is a zoonotic disease caused by infection with Coxiella burnetii transmitted from animals including, but not limited to, cattle, sheep and goats. The infection in cattle is typically sub-clinical with some evidence suggesting associated reproductive loss. There is currently limited data on the true prevalence and distribution of coxiellosis in beef cattle across northern Australia. During this study, 2,012 sera samples from beef cattle managed on commercial farms located in Queensland and the Northern Territory were tested using an indirect immunofluorescent assay (IFA) for serological evidence of IgG antibodies against C. burnetii. Bayesian latent class models were used to estimate the true prevalence, adjusted for diagnostic test sensitivity and specificity and incorporating the hierarchical structure of the cattle within farms and regions. In this study, cattle in the Northern Territory had lower estimated true prevalence than cattle within most regions of Queensland with the exception of south-east Queensland. Results from this study have described the geographic distribution and estimated the true prevalence of antibodies to C. burnetii in a sample of extensively managed beef cattle located across the tropical grazing regions of northern Australia.

63 Impact of Endometrial Biopsy on Corpus Luteum Function

Reproductive procedures involving uterine manipulation (UM), such as transcervical embryo transfer (TET) or the collection of an endometrial biopsy (EB) may cause trauma to the endometrium resulting in release of endogenous prostaglandin F2α (PGF2α) causing premature regression of the corpus luteum (CL). This study aimed to evaluate the effect of UM and EB on corpus luteum lifespan in tropically adapted beef heifers. In Experiment 1, pre-synchronised Droughtmaster heifers (n = 9; 25.8 ± 0.4 m, live weight 391 ± 21.5 kg) were randomly selected either at Day 4 (UM4 = 5) or at Day 7 (UM7 = 4) post-oestrus for transrectal uterine manipulation and transcervical passage of the biopsy Storz® device without sample collection. In Experiment 2, pre-synchronised Charbray heifers (n = 13, 2 to 3 years old, live weight 439.8 ± 17.2) were biopsied in the horn ipsilateral to the CL at Day 4 (B4 = 6) or at Day 7 (B7 = 7) post-oestrus. In both experiments, blood samples were taken from jugular/coccygeal vein throughout the oestrus cycle on Days 3, 4, 6, 7, 9, 11, 13, 16 and 19 (Day 0 = synchronised oestrous) for progesterone (P4) analysis. Signs of heat were visually detected daily and confirmed by ovarian ultrasound. For the PGF2α metabolite 13,14-dihydro-15-keto-PGF2α (PGFM) assessment, blood samples were collected before and after uterine trauma at –24, –12, 0 h and +6, +18, +24 h (Hour 0 = UM or EB either at Day 4 or Day 7). Progesterone was assessed by liquid chromatography-mass spectrometry (LC-MS) and PGFM using an enzyme immunoassay DetectX® kit (Arbor Assays, Ann Arbor, MI, USA). The intra- and interassay coefficients of variations were 3.7% and 12.8%, respectively. A series of generalized additive mixed effect models (GAMM) were created to quantify P4 differences for UM and EB. The results showed that oestrous cycle length was not affected by UM or EB conducted at Day 4 or at Day 7, because P4 concentration remained above 1 ng mL−1 after uterine trauma during dioestrus. Also, UM and EB did not induce the release of luteolytic pulses of PGF2α. Although P4 concentration followed the normal cycling pattern throughout the oestrus cycle, the shape of the curve in EB4 and UM4 heifers showed higher concentrations of P4 compared with EB7 and UM7 heifers. In conclusion, UM and EB with Storz® device during metoestrus or early dioestrus had minimal or nil effects on CL activity. Whether lower P4 profiles affect embryo development after uterine trauma needs to be further elucidated.

The impact of CT head scans on ED management and length of stay in bizarre behavior patients

METHODS

A 5-year retrospective chart review was conducted at 3 EDs. Inclusion criteria were patients ≥18years old triaged as "mental health - bizarre behavior" (deviation from normal cognitive behaviour with no obvious cause) with a CT head scan ordered in the ED. Exclusion criteria were focal neurologic deficits on exam, alternative medical etiology (i.e. delirium, trauma) and/or pre-existing CNS disease. Clinical, demographic and administrative data were extracted with 10% of charts independently reviewed by an Emergency Physician for inter-rater reliability.

RESULTS

266 cases met study criteria. Population demographics: 49% percent female, average age 51years old, 28% homeless, 58% arrived by police or ambulance. CT head results: 1 (0.4%) case with possible acute findings, 105 (39%) with incidental findings (i.e. cerebral atrophy) that did not impact clinical management. Average time to physician assessment was 1:48 (hour:min) (sd 1:11), time to CT completion was 5:05 (sd 7:28) and an average delay of 3:17 awaiting results. Subgroup analysis revealed a net increase in ED length of stay (ED LOS) of 5:02 from obtaining neuroimaging. 85% of patients were referred to a consultant, 92% were to psychiatry.

CONCLUSIONS

CT head results prolonged ED LOS, delayed patient disposition and did not change the patient's clinical management. A prospective trial for ordering CT head scans in these patients is warranted.

Congenital bilateral anterior nasal atresia in 16 half-sibling Holstein-Friesian calves

CASE REPORT

Cases of bilateral anterior nasal atresia, sometimes referred to as arhinia or partial arhinia, are extremely rare in cattle and have only been reported as single events. This report describes the birth of 16 Holstein Friesian calves over a 3-month period, all affected with bilateral atresia of the nares and anterior nasal cavity, with 2 calves having additional severe deviation of the nasomaxillary bones and nasal septum. One affected calf was born with an anatomically normal twin. Parentage testing demonstrated that a single Holstein Friesian bull sired all cases tested.

CONCLUSION

This is the first report of multiple cases of bilateral anterior nasal atresia in cattle with evidence that demonstrates a heritable condition.

Endometrial biopsy in Bos indicus beef heifers

An endometrial biopsy allows for a comprehensive assessment of the uterine environment of a breeding female. Although routine in mares, devices used for endometrial biopsies are impracticable in heifers due to the size and structure of the cervix. This report describes the use of a human bronchoscopy biopsy device (Karl Storz^® 10366L) for collection of endometrial biopsies in Bos indicus beef heifers. The Storz^® device is smaller and thinner and enabled the collection of an endometrial biopsy in 86% of heifers (n = 44/51). The biopsied tissue was of good quality and suitable for transcriptomic assessment of the endometrium, with total RNA yield and RNA integrity number (RIN) averaging 1.3 μg (range 0.4-5.3 μg) and 7.4 (range 5.7-8.4), respectively.

63 EFFECT OF ENDOMETRIAL BIOPSY ON UTERINE HEALTH OF TROPICALLY ADAPTED BEEF CATTLE

In cattle, endometrial gene expression during the first 2 weeks after fertilization is different in cattle that conceive compared with those that fail to conceive. The potential selection of animals based on endometrial marker expression before the day of embryo transfer may improve the efficiency of bovine embryo transfer. This study aimed to evaluate the morphological and molecular changes induced by endometrial biopsy in cycling tropically adapted beef cattle. In both experiments, a single biopsy was performed on the horn ipsilateral to the corpus luteum using a circular cup biopsy forceps. The uterus was collected after slaughter, and sections were taken adjacent to the biopsy site. Five heifers were not biopsied and acted as controls. In Experiment 1, presynchronised heifers (n = 10) were biopsied on Day 7 post-oestrus (B7) and then resynchronised with cloprostenol (Estromil®, 250 μg IM) to induce oestrus (O), 2 to 3 days after injection. At Day 7 post-oestrus (D7), the reproductive tracts were collected, 10 days after biopsy (B7-O-D7). In Experiment 2, presynchronised heifers (n = 7) were biopsied on Day 4 post-oestrus (B4), and reproductive tracts were collected 3 days later (B4-D7). A quantitative scoring system was used to define histological appearance of the endometrium (1 to 25; above 16 indicates endometritis). The RNA expressions of interleukin-1-β (IL-1β) and transforming growth factor-β (TGF-β) were measured by quantitative real-time PCR (qRT-PCR). Macroscopic examination showed the uterus collected from B7-O-D7 heifers exhibited a focal, well demarcated, dark red discoloration of the endometrium (4/10) with no evidence of the biopsy site found in the remaining heifers (6/10). The biopsied uteri from B4-D7 heifers revealed no macroscopic evidence of the biopsied site (4/7), serosa congestion (2/7), and one case where a severe endometrial haemorrhage was evident (1/7). Histologically, the overall mean score was not indicative of endometritis. The RNA expression showed up-regulation of both IL-1β and TGF-β in both B7-O-D7 and B4-D7 heifers compared with non-biopsied heifers and significantly higher expression of IL-1β in B4-D7 than B7-O-D7 (P = 0.031, P < 0.05). Although in most cases there was little or no evidence of damage to the endometrium within 3 to 10 days after endometrial biopsy, there was still some evidence of up-regulation of pro-inflammatory and tissue repair genes. What effect the latter has on likelihood of conception is yet to be determined.

Genome-wide association for the outcome of fixed-time artificial insemination of Brahman heifers in northern Australia

Fixed-time AI (FTAI) is a powerful tool for genetic improvement of extensively managed beef cattle. A genomewide association study (GWAS) was conducted to investigate genes and genetic markers associated with the outcome (pregnant or not pregnant) of FTAI in 614 commercial Brahman heifers genotyped for 18,895 SNP and imputed to 51,588 SNP. The likelihood of Brahman heifers becoming pregnant after hormonal treatment to synchronize ovulation followed by FTAI was influenced by the content of their genomes, as determined by a principal component analysis. The principal component analysis involved comparisons between the studied heifers and populations of known and ancestry. The heritability of FTAI outcome was = 0.18, which is higher than for most other reproductive outcome traits. The number of SNP associated with FTAI outcome was 101 ( < 0.001, false discovery rate = 0.53). Compared with all SNP tested, associated SNP had a tendency for highly divergent allelic frequencies between and . Associated SNP were located in nearly all chromosomes, a result that shows a complex genetic architecture that is typical of highly complex traits with low heritability. Considering this and previous GWAS that examined Brahman heifer puberty and postpartum anestrus interval, 3 genomic regions emerge as important for overall Brahman heifer fertility, which mapped to chromosomes 1, 7, and 9. Further analyses, including improved genome annotation, are required to elucidate the link between these regions and heifer fertility. Additional studies are needed to confirm SNP and gene associations reported herein and further elucidate the genetics of FTAI outcome. Future GWAS should target other Braham populations and additional cattle breeds with FTAI records, including breeds with higher ancestry.

First report of a spermatic granuloma and varicocele in a marsupial: A Koala (Phascolarctos cinereus) Case Study

This study reports the first documented clinical case of a spermatic granuloma and varicocele in a marsupial. Initial clinical presentation included gross morphological changes in the left scrotal cord, epididymis and testis. Ultrasonography of the scrotum and spermatic cord, and gross and histopathological examination after hemicastration, confirmed the condition as a spermatic granuloma affecting the left caput epididymis, with a varicocele in the left proximal spermatic cord, which was causing azoospermia and infertility. Semen quality and serum testosterone secretion following a GnRH challenge was assessed prior to, and following surgery. After hemi-castration, an increase in androgen secretion to within normal reference ranges for the koala was observed with a subsequent increase in semen production and sperm quality resulting in the sire of a pouch young, 12months later.

Service Convenience

In this research, the authors assess the applicability of the SERVCON model to the e-commerce (e-service) environment in the context of student textbook purchases. Following a literature review, a survey was developed based on previous scales; items were modified to fit the e-commerce environment. The survey was administered to college students in business courses, and 281 usable responses were received. Factor analysis resulted in several items being dropped, but the six factor SERVCON model was validated in the online environment. The validated model was used to compare service convenience perceptions between students purchasing books online and students purchasing books by traditional methods (brick-and-mortar). The service convenience measures for online purchases than brick-and-mortar purchases for decision, access, benefit, transaction, and postbenefit convenience. The study validates the SERVCON model in the e-service environment, and extends work that explains consumer behavior in e-services. Traditional bookstores need to explore options to improve services in the brick-and-mortar environment. Online vendors can improve their web sites to provide better service convenience to their customers.

Effects of ceftiofur and chlortetracycline treatment strategies on antimicrobial susceptibility and on tet(A), tet(B), and bla CMY-2 resistance genes among E. coli isolated from the feces of feedlot cattle

A randomized controlled field trial was conducted to evaluate the effects of two sets of treatment strategies on ceftiofur and tetracycline resistance in feedlot cattle. The strategies consisted of ceftiofur crystalline-free acid (CCFA) administered to either one or all of the steers within a pen, followed by feeding or not feeding a therapeutic dose of chlortetracycline (CTC). Eighty-eight steers were randomly allocated to eight pens of 11 steers each. Both treatment regimens were randomly assigned to the pens in a two-way full factorial design. Non-type-specific (NTS) E. coli (n = 1,050) were isolated from fecal samples gathered on Days 0, 4, 12, and 26. Antimicrobial susceptibility profiles were determined using a microbroth dilution technique. PCR was used to detect tet(A), tet(B), and bla CMY-2 genes within each isolate. Chlortetracycline administration greatly exacerbated the already increased levels of both phenotypic and genotypic ceftiofur resistance conferred by prior CCFA treatment (P<0.05). The four treatment regimens also influenced the phenotypic multidrug resistance count of NTS E. coli populations. Chlortetracycline treatment alone was associated with an increased probability of selecting isolates that harbored tet(B) versus tet(A) (P<0.05); meanwhile, there was an inverse association between finding tet(A) versus tet(B) genes for any given regimen (P<0.05). The presence of a tet(A) gene was associated with an isolate exhibiting reduced phenotypic susceptibility to a higher median number of antimicrobials (n = 289, median = 6; 95% CI = 4-8) compared with the tet(B) gene (n = 208, median = 3; 95% CI = 3-4). Results indicate that CTC can exacerbate ceftiofur resistance following CCFA therapy and therefore should be avoided, especially when considering their use in sequence. Further studies are required to establish the animal-level effects of co-housing antimicrobial-treated and non-treated animals together.

Evaluation of the impacts of spaying by either the dropped ovary technique or ovariectomy via flank laparotomy on the welfare of Bos indicus beef heifers and cows

The welfare outcomes for Bos indicus cattle (100 heifers and 50 cows) spayed by either the dropped ovary technique (DOT) or ovariectomy via flank laparotomy (FL) were compared with cattle subjected to physical restraint (PR), restraint by electroimmobilization in conjunction with PR (EIM), and PR and mock AI (MAI). Welfare assessment used measures of morbidity, mortality, BW change, and behavior and physiology indicative of pain and stress. One FL heifer died at d 5 from peritonitis. In the 8-h period postprocedures, plasma bound cortisol concentrations of FL, DOT, and EIM cows were not different and were greater (P<0.05) than PR and MAI. Similarly, FL and DOT heifers had greater (P<0.05) concentrations than PR and MAI, with EIM intermediate. Creatine kinase and aspartate aminotransferase concentrations were greater (P<0.05) in FL and EIM heifers compared with the other treatments, with a similar pattern seen in the cows. Haptoglobin concentrations were significantly (P<0.05) increased in the FL heifers compared with other treatments in the 8- to 24-h and 24- to 96-h periods postprocedures, and in cows were significantly (P<0.05) increased in the FL and DOT compared with PR in the 24- to 96-h period. Behavioral responses complemented the physiological responses; standing head down was shown by more (P<0.05) FL cows and heifers to 3 d postprocedures compared with other treatments, although there was no difference between FL and DOT heifers at the end of the day of procedures. At this same time, fewer (P<0.05) FL and DOT heifers and cows were observed feeding compared with other treatments, although in cows there was no difference between FL, DOT, and EIM. There were no significant differences (P>0.05) between treatments in BW changes. For both heifers and cows, FL and DOT spaying caused similar levels of acute pain, but FL had longer-lasting adverse impacts on welfare. Electroimmobilization during FL contributed to the pain and stress of the procedure. We conclude that: i) FL and DOT spaying should not be conducted without measures to manage the associated pain and stress; ii) DOT spaying is preferable to FL spaying; iii) spaying heifers is preferable to spaying cows; and iv) electroimmobilization causes pain and stress and should not be routinely used as a method of restraint.

Preliminary investigation of some physiological responses of Bos indicus heifers to surgical spaying

OBJECTIVE

To determine the value of peripheral blood concentrations of cortisol, creatine phosphokinase (CPK), aspartate aminotransferase (AST), non-esterified fatty acids (NEFAs) and haptoglobin as indicators of welfare in Brahman heifers spayed by either the Willis dropped ovary technique (WDOT) or the flank laparotomy method.

DESIGN

A total of 24, 2-year-old Brahman heifers were allocated to: crush (head-bail) restraint alone (Control, n = 5); crush restraint and ear-punch (Ear-punch, n = 5); crush restraint, WDOT spay and ear-punch (WDOT, n = 9); or crush restraint, elecrtoimmobilisation, flank spay and ear-punch (Flank; n = 5). Cattle were blood sampled frequently to 8 h, and then daily to day 4 and were monitored to 42 days post-procedure. Peripheral blood concentrations of bound and unbound cortisol, CPK, AST, NEFAs and haptoglobin were determined.

RESULTS

Concentrations of plasma bound cortisol peaked in the spayed heifers 3-4 h post-procedure; values in the Flank (1603 nmol/L) and WDOT (1290 nmol/L) groups were similar and significantly greater (P < 0.05) than in the Controls (519 nmol/L). Flank heifers had elevated plasma haptoglobin levels to day 4 postprocedure. Liveweights were significantly lower in the spayed compared with the Control heifers at 21 and 42 days post-procedure, with liveweight gains also significantly reduced at day 21.

CONCLUSIONS

Bound cortisol responses in spayed heifers were elevated to 6 h post-procedure and similar in WDOT- and flank-spayed animals, indicating comparable levels of pain and stress. An inflammatory response, indicated by haptoglobin concentrations, was sustained for longer in Flank than in WDOT spayed heifers, suggesting longer-lasting adverse effects on welfare from flank spaying than WDOT spaying.

Neoadjuvant intensity-modulated radiotherapy (IMRT) in pancreatic adenocarcinoma: The Dartmouth experience

274

Background: Neoadjuvant chemoradiation may play a role in improving the resectability and overall survival (OS) of patients with pancreatic adenocarcinoma. IMRT allows higher radiation doses to regions within a tumor while minimizing the dose to surrounding normal structures.

Methods: Eighty-one patients with pancreatic adenocarcinoma completed neoadjuvant IMRT from 2003-2008. All were staged by CT scan, endoscopic ultrasound and laparoscopy. Based on defined resectability criteria, 14 were resectable (R), 38 considered borderline resectable (B) and 29 unresectable (U). Patients were categorized into 3 groups based on their neoadjuvant treatment. All patients received concurrent IMRT with gemcitabine (50mg/m2) twice weekly for 12 doses. IMRT prescription dose was 54 Gy in 28 fractions with a biologically effective dose of 64.47Gy10. All resected patients received intra-operative radiation (mean dose 14 Gy). Group 1 received neoadjuvant chemotherapy involving gemcitabine and docetaxel on days 1, 15, and 29 followed by IMRT. Group 2 received concurrent weekly cetuximab in addition to bi-weekly gemcitabine and IMRT. Group 3 received only concurrent gemcitabine twice weekly and IMRT. Four weeks after treatment completion, patients were evaluated with a CT scan in preparation for surgery.

Results: Median OS for all patients was 22 months. The overall resectability rate after neoadjuvant IMRT was 63%. 78% of B and 39% of U patients underwent resection. 80% of all patients had an R0 resection. Median OS was 23 months for R, 28 months for B and 14 months for U patients (P = 0.002). Median OS was 18 months, 27 months and 18 months respectively for patients receiving gemcitabine-IMRT, gemcitabine-cetuximab and neoadjuvant gemcitabine/docetaxel plus concurrent gemcitabine-IMRT (P = 0.20). Median OS for R0 resections were 28 months compared to 24.3 months for patients with positive margins and 11.7 months for unresectable patients (P < 0.001).

Conclusions: IMRT as part of a neoadjuvant treatment strategy for pancreatic adenocarcinoma is feasible and well tolerated. Neoadjuvant IMRT rendered a significant percentage of B patients resectable with an OS comparable to patients who were R at presentation.

[Table: see text]

Morbidity, mortality and body weight gain of surgically spayed, yearling Brahman heifers

OBJECTIVE

To determine morbidity and mortality rates in yearling heifers spayed by two methods under commercial conditions in northern Australia.

DESIGN

In study 1,600 Brahman heifers were allocated to one of three treatments: physical restraint and ear-tagging (Control); physical restraint, ovariectomy by the Willis dropped ovary technique, ear-tagging and ear-marking (WDOT); or electroimmobilisation, ovariectomy via flank incision, ear-tagging and ear-marking (Flank). Heifers were monitored post spaying. Mortalities occurred at unanticipated times, so study 2 investigated their timing and cause in similar WDOT-spayed heifers (n=574).

RESULTS

In study 1, morbidity on the day of spaying was 6.0% in the Flank and 2.7% in the WDOT group (not statistically different). Spayed heifers showed behaviours indicative of acute pain/discomfort in the 6 h post spaying. Body weights and gains were significantly lower in the spayed compared with control heifers at days 21 and 42, and 5% of flank wounds were not healed at day 42. Mortalities were 0%, 1.5% and 2.5%, respectively, for Control, WDOT (3 estimated to have occurred on day 11) and Flank (2 on the day after spaying and 1 on each of days 5, 11 and 22). In study 2, the mortality was 0.5%, all within 4 days of spaying.

CONCLUSIONS

In yearling heifers, WDOT spaying resulted in lower morbidity and short-term mortality compared with flank spaying. Both methods compromised the health and welfare of some animals for up to 4 days and body weight gains were reduced during the 6 weeks post spaying.

274. Brain gene expression changes in MHC Class II genes and Neuropilin 2 associated with the transition from acyclic to cyclic ovarian function in postpartum beef cows

The aim was to identify hypothalamic genes associated with transition from acyclic to cyclic ovarian function in postpartum cows. Ovarian status was recorded at slaughter for primiparous Brahman cows (Zebu, Bos indicus) at 27–34 days postpartum and hypothalamic tissue was obtained at the same time. Ovaries were classified as: Ov1 (n = 4), follicles 4–5 mm; Ov2 (n = 4), follicles equal or larger 10 mm without ovulation; Ov3 (n = 4), corpus haemorrhagicum or corpus luteum. Hypothalamic regions were: H1 (SC-POA, APVN, anterior hypothalamic nucleus, anterior portion of the arcuate nucleus, nearby areas of the diagonal band of Broca, and medial septum); H2 (basal hypothalamus-median eminence, ventromedial hypothalamus, posterior portion of the arcuate nucleus, and anterior part of the mammillary body). Gene expression was determined using the Agilent bovine 44k DNA microarray and differential expression (DE) was ascertained by mixed model analysis. Functional clustering of DE genes using DAVID (www.david.abcc.ncifcrf.gov) revealed an enrichment of genes linked with synaptic transmission in H1 and H3 comparing Ov1 and Ov3. Three members of the major histocompatibility complex (MHC) class II gene family (BOLA-DQA1, BOLA-DQA2 and BOLA-DQB) showed a higher expression level in Ov2 than Ov1 in H1 and H2. BOLA-DGA2 and BOLA-DQB were downregulated in Ov3 when comparing Ov2 and Ov3. MHC family members have been associated with plasticity in the brain1. Functional clusters of genes involved in cell-cell adhesion were differentially expressed when comparing Ov1 and Ov2 (H2), and Neutropilin-2 which promotes GnRH neuronal migration2 was upregulated in Ov1. The findings provide preliminary evidence that gene expression related to cellular plasticity within the basal hypothalamus-median eminence is associated with the transition from acyclic to cyclic ovarian function in the postpartum cow. (1) Håvik B et al. 2007 Neuroscience 148:925–36 (2) Cariboni A et al. 2007 TRENDS in Neurosciences 30:638–44

279. Expression of oestrogen receptor-α and modulators of steroid receptor signalling, proline-rich nuclear receptor-2 and peptidylprolyl isomerade-D, in the hypothalamus of suckled and weaned postpartum beef cows

The aim was to characterise gene expression in the hypothalamus of suckled and weaned postpartum beef cows. The hypothalamus was obtained at slaughter from 12 primiparous Brahman cows (Zebu, Bos indicus) at 27 and 34 days postpartum. Six cows were weaned 7 days or 14 days before slaughter. Hypothalamic regions used for gene expression were: H1 (SC-POA, APVN, anterior hypothalamic nucleus, anterior portion of the arcuate nucleus, nearby areas of the diagonal band of Broca, and medial septum); H2 (basal hypothalamus-median eminence, ventromedial hypothalamus, posterior portion of the arcuate nucleus, and anterior part of the mammillary body). Gene expression was determined using the Agilent bovine 44k DNA microarray and differential expression (DE) was ascertained by mixed model analysis. A total of 122 genes were DE in H1 and 84 genes were DE in H2; 41 DE genes were common to H1 and H2. Functional clustering of DE genes using DAVID (www.david.abcc.ncifcrf.gov) revealed DE gene clusters in H1 associated with signalling events and ion binding, and DE gene clusters in H2 associated with hormone activity and ligand-receptor interactions. Of the DE genes, ~25% were linked with oestrogen signalling. This included oestrogen receptor-α (ESR1) that showed lower DE in H2 for weaned cows. Two modulators of steroid receptor signalling, proline-rich nuclear receptor coactivator-2 (PNRC2)1 and peptidylprolyl isomerase D (PPID)2, showed altered expression. In weaned cows, expression level of PNRC2 was lower in H1 and H2, while that of PPID was decreased in H1. The overlapped hypothalamic regions H1 and H2 are known to contain GnRH neuron terminals and kisspeptin neurons. Weaning promotes the resumption of cyclic ovarian function in postpartum cows, and the similar shifts in DE of ESR1, PNRC2 and PPID provided further evidence of a role for oestradiol at the hypothalamus in regulating postpartum reproduction. (1) Zhou D et al. 2006 Nucleic Acids Res 34:5974–86 (2) Kumar P et al. 2001 Biochem Biophys Res Commun 284:219–25

The effect of parenteral supplementation of vitamin E with selenium on the health and productivity of dairy cattle in the UK

Recent work has suggested that the recommended intakes of vitamin E for dairy cattle need to be increased, particularly in dry cows. However, these suggestions are based on data from cattle in the USA, which may have significantly different oxidative stresses than European cattle. This study, which involved 594 cattle on three dairy farms, was designed to determine the effect of increased vitamin E supplementation on the health and fertility of UK dairy cows. Cattle were randomly allocated to receive either two intramuscular injections of 2100 mg of vitamin E (and 7 g of sodium selenite) 2 weeks before calving and on the day of calving, or no additional vitamin E supplementation. Although supplementation had no effect on milk yield, reproductive efficiency, or incidence of uterine infections, supplemented cattle had a lower risk of culling and a lower rate of mastitis. These figures were economically significant but not statistically significant at the 10% level. Supplementation reduced the incidence of retained fetal membranes from 6.5% to 3%, an effect which was almost significant at the 5% level. If these data are representative they suggest that vitamin E recommendations for UK cattle should be reassessed.

Effects of Increased Ambient Temperature During IVM and/or IVF on the In Vitro Development of Bovine Zygotes

Previous research by this group (2003) has demonstrated that heat stress during in vitro culture (IVC) significantly increased early embryo mortality. The experiments reported here examine the effects of heat treatment (HT) during in vitro maturation (IVM) and during in vitro fertilization (IVF). One 24 h cycle of HT entailed a series of 0.5 degrees C incubator temperature increases from 39 degrees C to 39.5 degrees C for 2 h, to 40 degrees C for 2 h, to 40.5 degrees C for 4 h, 41 degrees C for 4 h, 40.5 degrees C for 6 h and 40 degrees C for 6 h. This cycle mimics rectal temperatures recorded in high producing, grain fed dairy cows in hot climates. Experiment I studied the effects of one cycle of heat-treatment during IVF on the rate of cleavage of in vitro matured presumptive zygotes. Total cleavage rate in the HT group (37.8%) was lower than that of the control group (54.6%, p < 0.05). Experiment II repeated the HT of experiment I but preceded it with a cycle of HT during IVM. The total cleavage rates for control and heat treatment groups were 75.5% and 37.9%, respectively, with a significant difference of p < 0.001 identified. Experiment III examined the rates of embryonic development to >or=8-cell stage (after 72 h IVC) and to morula or blastocyst (M/B) stage (after 144 h IVC) following HT of the oocyte groups during the preceding IVM or IVF. Rates of development to >or=8-cell stage (at 72 h IVC) and to M/B stage (after 144 h IVC) for the control group were 27.5% and 35.8%. Those of IVM-only HT and IVF-only HT groups were 13.8% and 14.6%, and 8.6% and 14.3%, respectively. Both groups of heat treated embryos developed at significantly lower rates (p < 0.05) than did the control group. These results suggest that hyperthermia during oocyte maturation and/or fertilization adversely affects oocyte maturation and fertilization rates and retards further embryonic development.

A meta-analysis of the effects of Vitamin E supplementation on the incidence of retained foetal membranes in dairy cows

A meta-analysis was performed to consolidate the results of studies which have evaluated the effects of Vitamin E supplementation during the dry period on the risk of retained foetal membranes (RFM) in the dairy cow. Twenty studies demonstrated a beneficial response to Vitamin E whilst 21 found no benefit and 3 reported an increase in the incidence of RFM in treated cows. The odds ratios (OR) of the available studies exhibited significant heterogeneity, so multivariable logistic regression analysis was performed to enable the identification of factors associated with the response to Vitamin E supplementation. Our multivariable analysis included parity and Vitamin E supplementation (control/treated) in the model, because all other factors were co-linear. Results indicated that Vitamin E supplementation led to a reduction in the incidence of RFM. A second multivariable analysis was undertaken on a subset of the data including only supplemented cows to determine the influence of supplementation factors on the risk of RFM. All factors were co-linear with each other, therefore, only type of Vitamin E supplementation was included in this analysis. The regression model demonstrated that administration of the synthetic Vitamin E alpha-tocopheryl acetate was associated with a lower risk of RFM than treatment with natural Vitamin E (alpha-tocopherol) (P=0.047, OR=0.49), whereas the difference between the synthetic Vitamin E alpha-tocopherol acetate and natural Vitamin E just failed to attain statistical significance (P=0.059, OR=0.53). Overall the analyses indicate that Vitamin E supplementation during the dry period is associated with a reduced risk of RFM, and that the synthetic forms of Vitamin E are more effective than the natural compound.

Comparison between the Sperm Morphology in Semen Samples Obtained from Yearling Beef Bulls by Transrectal Massage of the Ampullae and Cauda Epididymal Dissection

As electroejaculation (EEJ) is prohibited for use on unanaesthetized animals in Sweden, there is a need for an alternative method of semen collection from bulls in the field. The aim of the present study was to evaluate the use of transrectal massage (TM) of the ampullae to collect semen from yearling beef bulls under field conditions in Sweden. Transrectal massage was performed on 52 yearling beef bulls. Volume of semen collected, duration of procedure, percentage progressively motile sperm, and sperm concentration were measured. Smears were prepared for sperm morphology examination. Semen samples were obtained from 47 of 52 bulls. Mean volume was 3.2 ml (SD +/- 3.7), mean duration of collection was 7.4 min (SD +/- 2.8), mean percentage progressively motile sperm was 43.5% (SD +/- 29.2) and mean concentration was 201.9 x 10(6) spermatozoa/ml (SD +/- 278 x 10(6)). Twenty-three of the 52 bulls were slaughtered 3-4 days after semen collection and aliquots of the cauda epididymal contents were collected for sperm morphology examination. The percentages of proximal droplets, abnormal tails and abnormal midpieces were significantly higher (p < 0.05) and the percentage of detached heads was significantly lower (p < 0.05) in the post-mortem samples compared with those in the TM samples. However, importantly there was no significant difference between the two sample types in the percentages of abnormal heads. This study demonstrates that semen can be collected from yearling beef bulls by TM. We think that TM constitutes a useful tool, when semen collection with EEJ or artificial vagina (AV) is not possible under field conditions, when included in the bull breeding soundness evaluation (BBSE) protocol. However, further studies are needed, and presently being carried out, to evaluate if semen samples collected by TM are comparable with semen samples collected by AV.

Physeal fractures of the ankle

Because the distal tibia is the third most common physeal injury, being able to assess and treat such a fracture accurately is a skill worth enhancing. Many factors contribute to the outcome of physeal injuries, but the physician's general knowledge of the physis, ability to order the right diagnostic tests, and classify the fracture can be the determining factors of quality care.

Effect of a primary care based epilepsy specialist nurse service on quality of care from the patients' perspective: results at two-years follow-up

Epilepsy specialist nurses have the potential to improve the quality of care of community-based patients with epilepsy, although evidence of their effectiveness is limited by the lack of formal or long-term evaluation. Results of a controlled trial that assessed the effectiveness of a primary care based specialist nurse-led service suggested improvements in communication and satisfaction but not health status at one-year follow-up. A second follow-up was conducted to assess the effects after two years. Patients who reported having seen the nurse at least once in the two years ('users') were compared with those who had not ('non-users'). Comparisons between users and non-users were adjusted for baseline differences. Results were based on 40% of all 595 adult patients known to have epilepsy in 14 general practices and who answered questionnaires at baseline and two years later. The new epilepsy service was used more by those with greatest needs for care. Users of the new service were significantly more likely than non-users to have discussed 8 of 11 topics asked about epilepsy [odds ratios (ORs) ranging from 2.42 to 7.91] with their general practitioner (GP), and 2 of the 11 topics with the hospital doctor (ORs 5.59, 5. 74). Service users were significantly less likely than non-users to feel their GP knew enough about epilepsy [OR 0.27, 95% confidence intervals (CI) 0.74-0.98], and significantly more likely to report epilepsy as having an adverse impact on 3 of 10 areas of everyday life (ORs ranging from 2.09 to 2.50). Users were more likely than non-users to have seen their GP for any reason in the previous year and to change their medication from use of more than one antiepileptic drug to monotherapy, although findings were not significant. Results suggest that the epilepsy specialist nurse service is not a cost-reducing substitute, particularly for general practitioner care, but it appears to improve communication and prescribing of monotherapy, and increases access for the most needy. The service may, however, have an adverse impact on patients' perceptions of the effects of epilepsy on aspects of everyday life.

Osmotic response element is required for the induction of aldose reductase by tumor necrosis factor-alpha

Induction of aldose reductase (AR) was observed in human cells treated with tumor necrosis factor-alpha (TNF-alpha). AR protein expression increased severalfold in human liver cells after 1 day of exposure to 100 units/ml TNF-alpha. An increase in AR transcripts was also observed in human liver cells after 3 h of TNF-alpha treatment, reaching a maximum level of 11-fold at 48 h. Among the three inflammatory cytokines: TNF-alpha, interleukin-1, and interferon-gamma, TNF-alpha (100 units/ml) gave the most induction of AR. Differences in the pattern of AR induction were observed in human liver, lens, and retinal pigment epithelial cells with increasing concentrations of TNF-alpha. A similar pattern of AR promoter response was observed between TNF-alpha and osmotically stressed human liver cells. The deletion of the osmotic response element (ORE) abolished the induction by TNF-alpha and osmotic stress. A point mutation that converts ORE to a nuclear factor-kappaB (NF-kappaB) sequence abolished the osmotic response but maintained the TNF-alpha response. Electrophoretic gel mobility shift assays showed two NF-kappaB proteins, p50 and p52, capable of binding ORE sequence, and gel shift Western assay detected NF-kappaB proteins p50 and p65 in the ORE complex. Inhibitors of NF-kappaB signaling, lactacystin, and MG132 abolished the AR promoter response to TNF-alpha.

Effect of a primary-care-based epilepsy specialist nurse service on quality of care from the patients' perspective: quasi-experimental evaluation

Initiatives to improve epilepsy care have emphasized the role of specialist nurses. Formal evaluation of these initiatives are scarce. Further evaluative studies are required to ascertain the optimal means of providing epilepsy care. This study aimed to assess the effect of a primary-care-based epilepsy specialist nurse service on patients' reported health status, perceived quality of life, health care use, attitudes to health care, and provision of information. A quasi-experimental follow-up questionnaire survey was sent to all 574 patients aged 16 years or over and receiving antiepileptic drugs for epilepsy, registered in 14 general practices in north-west Bristol. Patients in seven practices who received the new service (intervention patients) were compared with patients in seven practices who did not (control patients). Follow-up comparisons between intervention and control patients were adjusted for baseline differences. Response rates to the first, second and both surveys were 66.2%, 68.6% and 50.9%, respectively. Intervention patients were more likely than control patients to have discussed most epilepsy topics with general practitioners and/or hospital doctors. and were significantly more likely to have categorized general practitioner care as excellent (odds ratio (OR) 2.30, 95% confidence intervals (CI) 1.12-4.70). Intervention patients were significantly less likely than controls to have reported never missing taking their anti-epileptic drugs (OR 0.48, 95% CI0.24-0.94). There were no significant changes in measures of health status, use of other health care services, and perceived quality of life between intervention and control patients. This study provides evidence of an improvement, after 1 year, in communication and satisfaction but not health status resulting from the introduction of a primary-care-based epilepsy service.

Identification of a novel cis-element required for the constitutive activity and osmotic response of the rat aldose reductase promoter

A new and essential cis-element AEE (aldose reductase enhancer element), necessary for the constitutive activity and the osmotic stress response of rat aldose reductase transcription in a rat liver cell line, has been identified. In transient transfection assays, an increase in promoter activity, up to 3.8-fold, was observed with osmotic stress (600 mosm/kg H2O) using a luciferase reporter gene construct containing aldose reductase promoter sequence from -1,094 base pair (bp) to +23 bp. A deletion between -1,071 and -895 bp reduced the constitutive activity and abolished the osmotic response of the promoter. Exonuclease III mediated in vivo DNA footprinting and dimethyl sulfate in vivo footprinting revealed DNA protection of a 32-bp region and two guanosines (G) within this region protected from methylation, respectively. Electrophoretic gel mobility shift assays using whole liver cell extracts showed protein binding, under both normal and stressed conditions. Deletion of the sequence between the two guanosines protected by in vivo dimethyl sulfate DNA footprinting (GAAGAGTG) in a luciferase construct (-1,094 bp to +23 bp) abolished the constitutive promoter activity. One copy of AEE fused to the thymidine kinase promoter gave a maximum constitutive activity of 7.7-fold and a maximum osmotic response activity of 6. 7-fold.

Patient documentation. On the records

Documentation of patient care is frequently the Achilles heel of clinical services. The use of a multidisciplinary, semi-structured healthcare record may achieve improvements, but it needs to be coupled with appropriate strategies to overcome professional and cultural barriers to unified documentation. When implementing changes, clinical staff may overestimate their clinical information needs while underestimating the problems of its routine collection.

Photomodulation of oxidative metabolism and electron chain enzymes in rat liver mitochondria

Low-level laser irradiation has been applied in a variety of laboratory studies and clinical trials for photobiostimulation over the last three decades. Considerable skepticism exists regarding the concept of photostimulation within the medical community. One of the major difficulties with photoirradiation research is that it lacks experimentally supportable mechanisms for the alleged photobiostimulatory effects. This study was undertaken to determine whether oxidative metabolism and electron chain enzymes in rat liver mitochondria can be modulated by photoirradiation. Oxygen consumption, phosphate potential, and energy charge of rat liver mitochondria were determined following photoirradiation. Activities of mitochondrial enzymes were analyzed to assess the specific enzymes that are directly involved with the photostimulatory process. An argon-dye laser at a wave-length of 660 nm and at a power density of 10 mW/cm2 was used as a photon source. Photoirradiation significantly increased oxygen consumption (0.6 J/cm2 and 1.2 J/cm2, P < 0.05), phosphate potential, and the energy charge (1.8 J/cm2 and 2.4 J/cm2, P < 0.05) of rat liver mitochondria and enhanced the activities of NADH: ubiquinone oxidoreductase, ubiquinol: ferricytochrome C oxidoreductase and ferrocytochrome C: oxygen oxidoreductase (0.6 J/cm2, 1.2 J/cm2, 2.4 J/cm2 and 4.8 J/cm2, P < 0.05). The activities of succinate ubiquinone oxidoreductase, ATPase, and lactate dehydrogenase were not affected by photoirradiation.

Detection of calves persistently infected with bovine pestivirus in a sample of dairy calves in south-eastern Queensland

OBJECTIVE

To determine the proportion and incidence of calves persistently infected with bovine pestivirus in calves (n = 1521) supplied to the Tick Fever Research Centre and to assess the test regime to detect calves persistently infected with bovine pestivirus.

DESIGN

Calves, 1 to 6 weeks old, selected for use in the production of the tick fever vaccine were collected from 21 properties in 56 separate groups between October 1990 and December 1996. Each group was examined for the presence of calves persistently infected with bovine pestivirus.

PROCEDURE

All calves were routinely tested for antibody to bovine pestivirus and bovine pestivirus antigen using a serum neutralisation test and an antigen-capture ELISA, respectively. Pooled lymphocyte samples from calves were also monitored for bovine pestivirus by inoculation of sheep. Whole herd testing was carried out in eight herds, using a serum neutralisation test as a screen test followed by an antigen-capture ELISA of cattle with a serum neutralisation test titre of less than 32.

RESULTS

Fourteen of the 1521 calves tested (0.9%), were detected as persistently infected and the incidence ranged from 0.0 to 3.0% per year over 6 years. Persistently infected calves were found in 13 of the 59 groups and originated from 7 of the 21 herds used. In whole herd testing on the properties of origin, cattle persistently infected with bovine pestivirus were detected in four of the eight herds tested.

CONCLUSIONS

The proportion of calves persistently infected with bovine pestivirus is similar to that in other countries and indicates that bovine pestivirus could be a significant cause of economic loss in Australian cattle herds. In detecting calves persistently infected with bovine pestivirus, the combination of sheep inoculation, paired antigen-capture ELISA and serum neutralisation tests appeared to be highly sensitive and specific.

Reproductive understanding, sexual functioning and testosterone levels in men with spina bifida

PURPOSE

We assessed the sexual functioning and understanding in men with myelodysplasia.

MATERIALS AND METHODS

Of the 378 patients with myelodysplasia followed at our multidisciplinary clinic 170 are adults, including 58 men older than 18 years. A total of 57 men was available for interview. A questionnaire was administered to determine patient educational level, sexual understanding, sexual function and marital status, and serum testosterone levels were measured.

RESULTS

The majority of the patients learned about sexual reproduction from school classes with 48 (84%) having achieved a twelfth grade education or higher. A total of 41 patients (72%) accurately described the basic concepts of reproductive physiology. Penile erections were experienced by 41 men (72%) including 27 (66%) who ejaculated with erection. Three patients ejaculated without erection. Sexual intercourse was attempted by 20 men (35%). Of the 11 patients (19%) who attempted to father children 8 (14%) were successful. Twelve patients (21%) have been married, including 2 who are divorced. Serum testosterone levels in 44 patients were normally distributed.

CONCLUSIONS

Sexual reproductive understanding, and erectile and ejaculatory function are present in many men with myelodysplasia. The level of the neurological lesion was not predictive of erectile or ejaculatory function but it appears that reproductive potential is favored by lower and less severe lesions. All but 1 of the 8 patients who fathered children had an L5 or sacral neurological level lesion, each was ambulatory and none had a ventriculoperitoneal shunt at the time of conception. These data may prove useful when counseling patients and their parents about eventual sexual performance.

Patients' experience of epilepsy and health care

OBJECTIVE

The aim of this study was to assess the severity of epilepsy and its effect on patients lives, and to describe patients' use of and attitudes to health care.

METHOD

A questionnaire was sent to 595 people with epilepsy identified from 14 general practices in north-west Bristol. All patients aged 16 years and over receiving anti-epileptic medication for their epilepsy were included in the study. Areas investigated included severity of epilepsy and its effect on quality of life, anti-epileptic medication and its perceived effect, health care utilization and preferences for health care.

RESULTS

Seizure frequency was strongly associated with adverse effects of epilepsy. Attacks of epilepsy were experienced at least monthly by 20.4% (95% confidence intervals (Cl) 17.0-23.7%) of patients, 29.4% (25.4-33.4%) took more than one anti-epileptic drug, 56.1% (50.1-62.2%) reported drug side effects, 74.1% (70.3-77.8%) would prefer to receive all or most of their epilepsy care in a general practice setting, and 69.8% (63.5-76.2%) would like contact with a primary care-based epilepsy specialist nurse. During the previous year 42.4% (35.9-48.8%) of patients had not seen a doctor about their epilepsy. Of patients who had attended the general practice only 13.4% (9.6-17.2%) had regular arrangements to see their GP about epilepsy. Patients receiving both primary and secondary care had the greatest needs and wants for improved care.

CONCLUSIONS

Structured care, including regular appointments, co-ordination of primary and secondary care, and increased monitoring and discussion, may improve the quality of life of people with epilepsy, but requires evaluation.

Randomised comparative monotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed childhood epilepsy

BACKGROUND

The medical treatment of childhood epilepsy is largely influenced by clinical trials in adult patients. We know of only one randomised comparative trial (of two drugs) in newly diagnosed childhood epilepsy. We have undertaken a long-term, prospective, randomised, unmasked, pragmatic trial of the comparative efficacy and toxicity of four standard antiepileptic drugs used as monotherapy in children with newly diagnosed epilepsy.

METHODS

Between 1981 and 1987, 167 children aged 3-16 years, who had had at least two previously untreated tonic-clonic or partial seizures, with or without secondary generalisation, were randomly allocated treatment with phenobarbitone, phenytoin, carbamazepine, or sodium valproate. The protocol was designed to conform to standard clinical practice. Efficacy was assessed by time to first seizure after the start of treatment and time to achieving 1-year remission.

FINDINGS

The overall outcome with all four drugs was good. 20% of children remained free of seizures and 73% had achieved 1-year remission by 3 years of follow-up. We found no significant differences between the drugs for either measure of efficacy at 1, 2, or 3 years of follow-up. The overall frequency of unacceptable side-effects necessitating withdrawal of the randomised drug was 9%. This total included six of the first ten children assigned phenobarbitone; no further children were allocated this drug. Of the other three drugs, phenytoin (9%) was more likely to be withdrawn than carbamazepine (4%) or sodium valproate (4%). INTERPRETATION Our data will inform choice of drug and outcome with four of the standard drugs available for newly diagnosed tonic-clonic or partial seizures with or without secondary generalisation in children.

Use of tilmicosin in a severe outbreak of respiratory disease in weaned beef calves

Severe respiratory disease, associated with seroconversion to bovine respiratory syncitial virus (BRSV), caused the death of two cattle and necessitated antibiotic treatment of 70 calves (rectal temperature of 39.6 degrees C or greater) from a group of 96 (73%) during an 8-day period. Tilmicosin injection resulted in a reduction in median rectal temperature from 40.3 degrees C to 39.2 degrees C and 39.0 degrees C for the first and second days after treatment. The rectal temperature was 39.5 degrees C or lower in 72% (48 of 67) and 96% (64 of 67) of cattle 1 and 2 days after tilmicosin treatment, respectively. Ten cattle were re-treated with tilmicosin 6 to 16 days after the first treatment. Our study demonstrated that bovine respiratory syncytial virus infection could cause severe respiratory disease in a beef herd that had no previous history of BRSV-related disease. Secondary bacterial invasion after BRSV infection was controlled effectively by tilmicosin treatment but repeat antibiotic treatments were occasionally necessary due to bacterial re-infection of the respiratory tract.

Calcium intakes in individuals on diets for the management of cows' milk allergy: a case control study

Three hundred and twenty-three individuals with self-reported food allergy were recruited by media advertisements. Questionnaire information was collected on all respondents. Chocolate (57%), milk (47%), wheat (36%) and food additives (35%) were the most frequently implicated foods. The most frequently reported symptoms were itching (43%), skin rash (43%) and tiredness (43%). Food avoidance was the most common form of food allergy diagnosis (33%) with only 8% of respondents reporting food challenge in food allergy diagnosis. Self-diagnosis was reported by 34% of respondents with 29% and 24% reporting diagnosis by a general practitioner or a homeopath, respectively. Twenty-four per cent of respondents 'always' avoided and a further 57% 'nearly always' avoided the implicated food(s). A group of 38 adults with self-reported 'milk allergy' was selected for further study. Dietary assessments, using the dietary history method, were carried out on this subgroup and on age-, sex- and occupation-matched controls. The results of the dietary assessments revealed that the 'milk allergy' group had significantly higher intakes of fibre, beta-carotene, vitamin C, vitamin E, iron and folic acid (P < 0.05) and significantly lower intakes of calcium (P < 0.002) in comparison to controls. Eighteen per cent of the group used milk alternatives. Thirty-four per cent of the 'milk allergy' group took calcium-containing supplements. Even after calcium supplementation, the mean calcium intake of those who completely avoided milk was unacceptably low (441 mg/d).