Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification

Objective

The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification.

Methods

In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility.

Results

A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion).

Conclusion

Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.

Consequences of two or four months of finishing feeding of culled dry dairy cows on carcass characteristics and technological and sensory meat quality

Finishing feeding was evaluated as a way to improve carcass-, meat- and eating quality of culled dairy cows. In total, 125 Danish Friesian cows were purchased from commercial dairy herds. Cows were culled for various typical reasons at different stages of lactation, were non-pregnant and had milk yield at culling ranging from 1 to 25kg/d and had LW varying from 330 to 778kg. Cows were housed in tie-stalls and had free access to barley straw and water during a 7-d drying-off period. Cows were allocated to three equal treatment groups based on parity, LW, BCS, and culling reason. A control group (C) was slaughtered immediately after drying-off (n=43), a group (F2) was finishing-fed for 63 days (n=41), and a group (F4) was finishing-fed for 126 days (n=41). In the finishing period, cows had free access to a TMR (10.6 MJ ME and 130g CP per kg of DM). Cows on treatment, F2 and F4 gained 1.16±0.05kg/d in the finishing period. Compared with C-cows, F2- and F4-cows had 56 and 97kg higher carcass weight, 10% and 21% larger Longissimus muscle area, and 14 and 70% more backfat, respectively, at time of slaughter. EUROP conformation scores were 2.2 (C), 3.4 (F2) and 4.4 (F4) and EUROP fat scores were 1.9, 3.0 and 3.7. Finishing feeding increased IMF, improved meat flavour and colour, and tended to reduce shear force value and improve tenderness and juiciness. The F4 cows also had higher fat trim than C- and F2-cows. Cows were divided into two parity groups (1st parity and older cows). Compared with 1st parity cows, older cows ate 12% more feed, had similar daily gain, were heavier, and had higher BCS and fatness including IMF. The results show that it is possible to dry-off and finish-feed culled dairy cows resulting in larger muscles, increased fatness, improved overall carcass quality and better technological as well as sensory quality characteristics.

Antiparkinsonian agents and long-term neuroleptic treatment. Effect of G 31.406, orphenadrine, and placebo on parkinsonism, schizophrenic symptoms, depression and anxiety

The need for medication with anticholinergic antiparkinsonian drugs was examined in 118 schizophrenic patients under long-term neuroleptic treatment. It was found that 1) none of 18 patients under treatment with low mg potency neuroleptics (chlorprothixene, clozapine, and thioridazine) had any need for anticholinergics; 2) of 60 patients under treatment with short-acting high mg potency neuroleptics (perphenazine greater than 16 mg daily and haloperidol greater than 2 mg daily) nine patients (15%) required medication with anticholinergics, whereas 3) of 40 patients under treatment with long-acting (depot) neuroleptics, 17 (43%) had a need for anticholinergic medication; and 4) no patient factors predisposing to the need for continued antiparkinsonian treatment could be identified. In an additional double-blind cross-over study of 12 patients presenting persisting neuroleptic-induced parkinsonism, it was found that G 31.406 (a new potentially antiparkinsonian drug), compared with placebo, had an antiparkinsonian effect (P less than 0.01) as well as an antidepressant effect (P less than 0.05). G 31.406 resulted in an improvement in anxiety and schizophrenia-score in some patients. Compared with placebo, orphenadrine had a more questionable effect on parkinsonism (0.05 less than P less than 0.01) and no significant effect on mental symptoms. There were no significant differences between the effects of G 31.406 and orphenadrine.