Diverged subpopulations in tropical Urochloa (Brachiaria) forage species indicate a role for facultative apomixis and varying ploidy in their population structure and evolution

BACKGROUND

Urochloa (syn. Brachiaria) is a genus of tropical grasses sown as forage feedstock, particularly in marginal soils. Here we aimed to clarify the genetic diversity and population structure in Urochloa species to understand better how population evolution relates to ploidy level and occurrence of apomictic reproduction.

METHODS

We explored the genetic diversity of 111 accessions from the five Urochloa species used to develop commercial cultivars. These accessions were conserved from wild materials collected at their centre of origin in Africa, and they tentatively represent the complete Urochloa gene pool used in breeding programmes. We used RNA-sequencing to generate 1.1 million single nucleotide polymorphism loci. We employed genetic admixture, principal component and phylogenetic analyses to define subpopulations.

RESULTS

We observed three highly differentiated subpopulations in U. brizantha, which were unrelated to ploidy: one intermixed with U. decumbens, and two diverged from the former and the other species in the complex. We also observed two subpopulations in U. humidicola, unrelated to ploidy; one subpopulation had fewer accessions but included the only characterized sexual accession in the species. Our results also supported a division of U. decumbens between diploids and polyploids, and no subpopulations within U. ruziziensis and U. maxima.

CONCLUSIONS

Polyploid U. decumbens are more closely related to polyploid U. brizantha than to diploid U. decumbens, which supports the divergence of both polyploid groups from a common tetraploid ancestor and provides evidence for the hybridization barrier of ploidy. The three differentiated subpopulations of apomictic polyploid U. brizantha accessions constitute diverged ecotypes, which can probably be utilized in hybrid breeding. Subpopulations were not observed in non-apomictic U. ruziziensis. Sexual Urochloa polyploids were not found (U. brizantha, U. decumbens) or were limited to small subpopulations (U. humidicola). The subpopulation structure observed in the Urochloa sexual-apomictic multiploidy complexes supports geographical parthenogenesis, where the polyploid genotypes exploit the evolutionary advantage of apomixis, i.e. uniparental reproduction and clonality, to occupy extensive geographical areas.

A164 PATTERNS IN MEDICAL THERAPY AND CLINICAL OUTCOMES IN PATIENTS WITH CONCOMITANT INFLAMMATORY BOWEL DISEASE AND PRIMARY SCLEROSING CHOLANGITIS: A SINGLE CENTRE RETROSPECTIVE ANALYSIS

Background

Inflammatory bowel disease (IBD) in patients with primary sclerosing cholangitis (PSC) is characterized by pancolitis with rectal sparing and is associated with an increased risk of colorectal and biliary malignancies. Currently, pharmacologic management of IBD in the setting of PSC is the same as in IBD alone.

Aims

To assess patterns in medical therapy, and incidence of adverse outcomes in patients with concomitant IBD and PSC.

Methods

A retrospective review was conducted on all PSC-IBD patients followed between January 2010 and June 2018. The Endoscopic Mayo Score was used to grade IBD severity in PSC-ulcerative colitis (UC).

Results

69 patients were identified, 44 (63.8%) were male. The mean ages of IBD and PSC diagnosis were 28.6 (SD 14.9) and 37.0 (SD 18.9) years, respectively. The median length of follow up was 12 (range 2–49) years. 52 (75.4%) patients had UC, and 17 (24.6%) had Crohn’s disease (CD). 28 (87.5%) PSC-UC patients had pancolitis, and 4 (12.5 %) had proctitis. Among those with pancolitis, 8 (28.6%) had relative rectal sparing. 4 (14.3%) patients had more severe inflammation proximally, whereas only 1 (3.6%) had more severe distal inflammation. 23 (82.1%) patients had the same degree of inflammation throughout. 14 (93.3%) PSC-CD patients had colitis/ileocolitis and 1 (6.7%) had ileitis. Among those with PSC-UC, 16 (50.0%), 12 (37.5%), and 4 (12.5%) patients had grade 1, 2, and 3 disease, respectively. 62 (89.9%) PSC-IBD patients were treated with aminosalicylates, and 26 (37.7%) with biologics at some point in their IBD course. 26 (37.7%) were treated with aminosalicylates alone. 4 (5.8%) did not require any IBD therapy. Cholangiocarcinoma, colorectal cancer, and gallbladder cancer developed in 8 (11.6%), 1 (1.4%), and 1 (1.4%) PSC-IBD patients, respectively. 16 (23.2%) patients required partial or total colectomy. Indication for surgery was inflammation or stenosis, dysplasia, and neoplasia in 13 (81.3%), 2 (12.5%), and 1 (6.3%) patients, respectively.

Conclusions

The majority of this cohort had UC with mild disease activity. Pancolitis was common, with frequent rectal sparing and more severe right-sided inflammation. Despite the predominance of low-grade colitis, a large portion of patients required treatment with biologics. The incidence of adverse outcomes underscores the need for strict adherence to recommended surveillance practices. Low grade endoscopic activity, typical of the quiescent IBD course in PSC-IBD, may mask low grade histologic inflammation, which in turn may contribute to the increased risk of colonic neoplasia. Further studies are needed to determine the best management strategy for IBD in patients with PSC.

Funding Agencies

None

A136 PREDICTIVE FACTORS OF CIRRHOSIS IN HCV PATIENTS WITH LOW PRE-TREATMENT APRI AND/OR FIB-4 SCORES

Background

It is essential to evaluate the stage of hepatic fibrosis prior to the initiation of HCV therapy. In addition to being a major prognostic factor, the presence of cirrhosis requires monitoring for hepatocellular carcinoma (HCC), esophageal varices, and decompensated liver disease. In some cases the presence of cirrhosis may affect the choice of therapy. In tertiary hepatology clinics, transient elastography (TE) is routinely used to assess fibrosis; however access to TE is limited. Fibrosis-4 (FIB4) and AST-to-platelet ratio index (APRI) are simple, easily available non-invasive methods of fibrosis measurement based on routine serum biomarkers. Studies evaluating HCV treatment pathways have reported that the use of FIB4 and APRI are cost-effective strategies for excluding cirrhosis thereby reducing the need for TE prior to treatment. Although the NPV of these tests are well described, a minority of patients will have advanced fibrosis despite low APRI and/or FIB4 scores.

Aims

To investigate predictive factors of cirrhosis in HCV patients with low pre-treatment APRI and/or FIB-4 scores.

Methods

Retrospective observational study with data obtained from the Pacific Gastroenterology Associates (PGA), a tertiary care outpatient Gastroenterology clinic located in Vancouver, British Columbia. Inclusions: Chronic HCV patients treated between Jan 2015 to 2019, pre-treatment TE values ≥12.5 kPa, FIB-4 <1.45 and/or APRI <0.7. Exclusions: those without cirrhosis, or incomplete evaluation prior to HCV treatment. Cirrhosis was defined as those with TE ≥12.5 kPa with clinical, radiographic, or pathologic features of cirrhosis.

Results

52 patients were identified. 11 patients did not have clinical, radiographic, or pathologic features of cirrhosis and 3 patients were excluded for insufficient data. Thus, 39 patients were included in multivariate analysis. The mean age was 59 years and 66% (25/38) were male gender. 10% (4/38) were Genotype 3 (G3). Presence of G3 was not included in the multivariate analysis due to low number of observations.

Conclusions

Generally, an APRI <0.7 and FIB-4 <1.45 have good test characteristics for excluding fibrosis. Our study demonstrates that patients with obesity, dyslipidemia, excessive alcohol use, or known steatosis on ultrasound may have cirrhosis despite low serum biomarker scores. Co-existence of other liver diseases such as alcohol related or non-alcoholic fatty liver disease (NAFLD) should prompt further evaluation for fibrosis assessment beyond biomarkers as these persons may have more advanced liver disease.

Funding Agencies

None

Oral squamous carcinoma cells promote macrophage polarization in an MIF-dependent manner

BACKGROUND

Tumor-associated macrophages (TAMs) are important determinants of intratumoral immune evasion, neoangiogenesis, extracellular matrix remodeling and dysregulated tumor cell proliferation. Our prior studies revealed that macrophage-derived, but not tumor cell-derived, macrophage migration inhibitory factor (MIF), is an important determinant of TAM alternative activation and M2 polarization.

AIM

Because MIF is historically thought to initiate signaling via a receptor-dependent, outside-in mode of action, we wished to investigate the specific contributions of tumor-derived vs. macrophage-derived MIF to M2 marker expression during macrophage polarization.

DESIGN

Murine oral squamous cell-carcinoma cells (SCCVII) were co-cultured with either the RAW 264.7 mouse macrophage cell line or mouse primary bone marrow-derived macrophages in the context of MIF genetic loss/inhibition individually or in combination each cell type.

METHODS

Twelve well Transwell plates were used to co-culture SCCVII cells and RAW 264.7, MIF+/+ or MIF-/- macrophages treated with/without the small molecule MIF inhibitor, 4-iodo-6-phenylpyrimidine and incubated in the presence or absence of interleukin (IL-4) for 48 h. Macrophages were analyzed by quantitative real-time polymerase chain reaction and/or immunoblotting for relative macrophage polarization marker expression.

RESULTS

IL-4 treatment synergizes with SCCVII co-culture in inducing the expression of macrophage M2 markers and loss or inhibition of macrophage-derived MIF significantly reduces both IL-4 alone and IL-4/SCCVII co-culture-induced macrophage M2 marker expression.

CONCLUSION

These studies identify an important and dominant requirement for macrophage MIF in maximal Th2-cytokine and oral squamous carcinoma cell-induced macrophage polarization and M2 marker expression.

The effect of image guidance on dose distributions in breast boost radiotherapy

AIMS

To determine the effect of image-guided radiotherapy on the dose distributions in breast boost treatments.

MATERIALS AND METHODS

Computed tomography images from a cohort of 60 patients treated within the IMPORT HIGH trial (CRUK/06/003) were used to create sequential and concomitant boost treatment plans (30 cases each). Two treatment plans were created for each case using tumour bed planning target volume (PTV) margins of 5 mm (achieved with image-guided radiotherapy) and 8 mm (required for bony anatomy verification). Dose data were collected for breast, lung and heart; differences with margin size were tested for statistical significance.

RESULTS

A median decrease of 29 cm(3) (range 11-193 cm(3)) of breast tissue receiving 95% of the prescribed dose was observed where image-guided radiotherapy margins were used. Decreases in doses to lungs, contralateral breast and heart were modest, but statistically significant (P < 0.01). Plan quality was compromised with the 8 mm PTV margin in one in eight sequential boost plans and one third of concomitant boost plans. Tumour bed PTV coverage was <95% (>91%) of the prescribed dose in 12 cases; in addition, the required partial breast median dose was exceeded in nine concomitant boost cases by 0.5-3.7 Gy.

CONCLUSIONS

The use of image guidance and, hence, a reduced tumour bed PTV margin, in breast boost radiotherapy resulted in a modest reduction in radiation dose to breast, lung and heart tissues. Reduced margins enabled by image guidance were necessary to discriminate between dose levels to multiple PTVs in the concomitant breast boost plans investigated.

Mammogram object detection using dendronic image analysis

Breast cancer can be treated with better patient outcomes and significantly lower costs if detected early. Using the spatial dendronic structure, image masks can be obtained, showing regions in the mammogram image corresponding to the breast and lead marker. The technique is robust to noise and placement of the breast within the image. The technique not only reduces the size of the region to be analysed, but also provides the dendronic structure of the breast in which stealth-like masses can be found more easily.

Endovascular repair of thoracic aortic aneurysms: a paradigm shift in standard of care

The standard open surgical treatment of thoracic aortic aneurysms is associated with significant morbidity and mortality. Endovascular repair is less invasive and potentially less morbid for patients with multiple risk factors. The authors report their results in 9 consecutive high-risk patients treated with endovascular grafts from January 1998 through June 2000. There were 7 men and 2 women patients with an average age of 75 years. Mean aneurysm diameter was 7.1 cm. All aneurysms were repaired with Gianturco Z-stent polytetrafluoroethylene prostheses. There were no perioperative deaths. Mean length of stay was 6.3 days. Technical success was achieved in all 9 patients. Two patients had neurologic complications following repair (1 patient with transient lower extremity numbness related to spinal arthritis and 1 patient with bowel and bladder incontinence). Both patients were independent with ambulation. Mean follow-up was 15.8 months. There was no evidence of endoleak or stent migration during the follow-up period. These findings support endovascular treatment of high-risk patients with thoracic aneurysm.

Pressure profilometry of the lumbosacral disk in dogs

OBJECTIVE

To investigate the biomechanical behavior of the lumbosacral disk under compressive load in dogs, using pressure profilometry, and to investigate the relationship between pressure profile features and background and disease variables.

SAMPLE POPULATION

23 lumbosacral disks and adjacent vertebrae harvested from medium and large breed dogs.

PROCEDURE

A 1.3-mm unidirectional needle-mounted pressure transducer was inserted into the disk in a ventral-to-dorsal manner while the disk was loaded in compression by a materials testing machine. Withdrawal of the transducer resulted in a pressure profile for cranial and lateral stress. Pressure profiles were analyzed, and relationships to age and gross evidence of degeneration were investigated.

RESULTS

There was a moderate positive correlation between age and degree of nuclear degeneration (r(s) = 0.420, P = 0.046), but no relationship between age and mean nuclear pressure was detected. Mean nuclear pressure correlated negatively with severity of degenerative changes in the nucleus pulposus. Receiver operator characteristic curves to evaluate mean nuclear pressure as a diagnostic test for nuclear degeneration revealed a sensitivity and specificity of 82 and 83%, respectively. In addition, age was moderately correlated with the magnitude of stress peaks (r(s) = -0.571, P = 0.004). Stress peaks were not related to the severity of nuclear degeneration.

CONCLUSIONS AND CLINICAL RELEVANCE

Determination of the mean nuclear pressure by disk profilometry provides information on the severity of lumbosacral disk degeneration with a high degree of sensitivity and specificity. The magnitude of single stress peaks within the dorsal annulus fibrosus is correlated with age and may not necessarily reflect advancing degeneration.

Quantitative analysis of the principle soy isoflavones genistein, daidzein and glycitein, and their primary conjugated metabolites in human plasma and urine using reversed-phase high-performance liquid chromatography with ultraviolet detection

Soy isoflavones are becoming of increasing interest as nutritional agents which can be used to combat osteoporosis and hyperlipidemia, and are also being considered as potential cancer chemopreventive compounds. However, prior to their formulation and distribution as therapeutic agents, thorough pharmacokinetic and toxicological assessment needs to be completed in men and women in a variety of health conditions in order to ensure their therapeutic efficacy and safety. At this time, studies of purified soy isoflavones are possible, and are being designed to fully evaluate the pharmacological utility of these preparations. In support of these studies, quantitative analysis of soy isoflavones in biological fluids can be accomplished with a wide variety of methods and analytical instrumentation. However, the relatively ubiquitous presence of high-performance liquid chromatography with ultraviolet detection (HPLC-UV) in most analytical laboratories, the relative ease of its operation, and the lesser expense of this instrumentation as compared to more sophisticated techniques such as liquid chromatography-mass spectrometry, offers some distinct advantages for its use in pharmacokinetic studies. In this manuscript, the development and validation of an HPLC-UV method for the quantitation of the principal soy isoflavones, genistein, daidzein, and glycitein, and their primary metabolites, in human plasma and urine is described. This analytical approach allows for pharmacologically relevant concentrations of the analytes and their principle metabolites to be detected, and has been validated in close agreement with the US Food and Drug Administration's guidelines for the validation of methods to be used in support of pharmacokinetic studies.

Dietary approaches to the treatment of the overweight pediatric patient

A review of recently published studies on the dieting practices of children and adolescents examines the impact those practices are having on the overall health of youth who are overweight and those who are not. Recommendations for improving the nutritional quality of children's diets are made based on the food consumption patterns of youngsters ages 2 to 18 years. If implemented, these recommendations would lower calories, fat, saturated fat, and cholesterol, while improving nutrient density. Guidelines for the treatment of childhood overweight from four organizations are presented in chart form.

Regulation of synoviocyte phospholipase A2 and cyclooxygenase 2 by macrophage migration inhibitory factor

OBJECTIVE

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine with known actions in macrophage and T cell activation. MIF also has the unique capacity to reverse the inhibitory effects of glucocorticoids on these cells. We have recently demonstrated MIF expression in human rheumatoid arthritis (RA) synovium and cultured fibroblast-like synoviocytes (FLS), as well as the ability of FLS-derived MIF to induce monocyte release of tumor necrosis factor alpha. We investigated the effects of MIF on aspects of RA FLS activation, including the induction of phospholipase A2 (PLA2) and cyclooxygenase (COX).

METHODS

PLA2 activity was measured by 3H-arachidonic acid released from treated FLS supernatants. COX activity was measured by prostaglandin E2 enzyme-linked immunosorbent assay. Cytosolic PLA2 (cPLA2) and COX-2 messenger RNA (mRNA) were determined using semiquantitative reverse transcriptase-polymerase chain reaction.

RESULTS

Constitutive PLA2 activity was detected in RA FLS. Recombinant human MIF up-regulated PLA2 activity (P < 0.01) and cPLA2 mRNA expression, but had no effect on secretory PLA2. Recombinant human MIF up-regulated COX activity (P < 0.05) and COX-2 mRNA, but had no observable effect on COX-1. Interleukin-1beta (IL-1beta) significantly up-regulated PLA2 activity (P < 0.005) and cPLA2 mRNA expression while anti-MIF monoclonal antibody (mAb) significantly inhibited this IL-1beta-induced PLA2 activity (P < 0.02). Anti-MIF mAb significantly reduced IL-1beta-induced COX activity (P < 0.05) and COX-2 mRNA expression.

CONCLUSION

MIF exerts a proinflammatory effect on key aspects of RA FLS activation. That anti-MIF mAb inhibited IL-1beta up-regulation of FLS indicates an additional cofactor role for MIF in IL-1beta-induced FLS activation. These data suggest that MIF antagonism has important therapeutic potential in RA.

Lateral glenohumeral ligament rupture in three dogs

Three adult large breed dogs were evaluated for chronic forelimb lameness. Clinical examination localised pain to the area of the shoulder joint. Traditional imaging methods, including radiography, arthrography and ultrasonography, were unrewarding. Arthroscopy performed via a lateral portal demonstrated complete tears of the proximal part of the lateral glenohumeral ligament in all cases. Two of the three cases responded to treatment with intra-articular methylprednisolone and rest with a resolution of the lameness, while the third failed to improve. Surgical intervention in this third case involved lateral capsulorraphy, and re-examination at five weeks postoperatively showed the dog to be without lameness. Tearing of the lateral glenohumeral ligament should be considered in the differential diagnosis of shoulder lameness. Surgical stabilisation should be considered in cases refractory to conservative treatment.

Tumor growth-promoting properties of macrophage migration inhibitory factor (MIF)

First identified nearly 40 years ago, macrophage migration inhibitory factor (MIF) is a potent pro-inflammatory cytokine and is an essential component of immune and inflammatory responses. Recent studies suggest that MIF may also contribute to multiple aspects of tumor progression and neoplasia. This review will attempt to summarize these findings focusing on MIF's ability to modulate cell proliferation, tumor angiogenesis and tumor suppressor activity.

Repair of mycotic paravisceral aneurysm with a fenestrated stent-graft

PURPOSE

To report the successful endovascular repair of a mycotic paravisceral aneurysm using a fenestrated stent-graft.

METHODS AND RESULTS

A 55-year-old white female with a history of rheumatoid arthritis presented with an 8-cm paravisceral aneurysm secondary to pneumonia complicated by empyema. Intravascular ultrasound identified a defect in the aortic wall at the level of the celiac axis. Repair was accomplished with a fenestrated stent-graft that excluded the aneurysm and maintained flow to the celiac axis and superior mesenteric artery. Recovery was uneventful and the patient was discharged in 2 days. Six-month follow-up computed tomographic scanning confirmed aneurysm exclusion and flow to the celiac and superior mesenteric arteries. There was no evidence of graft infection. The patient died from a clinically diagnosed myocardial infarction 10 months after the stent-graft repair.

CONCLUSIONS

Fenestrated stent-graft repair may evolve into a useful technique for the treatment of mycotic paravisceral aneurysms.

Is there scope for improving balance between RuBP-regeneration and carboxylation capacities in wheat at elevated CO2?

Carboxylation and RuBP-regeneration capacities, which determine light-saturated photosynthetic rate, were analysed in leaves of spring wheat (Triticum aestivum L. cv. Minaret) grown under different atmospheric CO2 partial pressure (pCa) and N supply regimes. Capacities were estimated from a large number of gas exchange, Rubisco and ATP-synthase content measurements, and from these, the pCa at which the two capacities are equal was derived, to allow direct comparison with growth pCa. Acclimation of the balance between the two capacities to growth at elevated pCa in wheat was only partial and appears to occur mostly in older flag leaves and at low N. However, in contrast to conclusions drawn from previous analyses of these data, there was evidence of a specific effect of growth at 70 Pa pCa, where carboxylation capacity is reduced more than RuBP-regeneration capacity for a given leaf N content. A model was used to estimate the effects of fluctuations in PPFD and temperature in the growth environment on the optimal balance between these capacities. This showed that the observed balance between carboxylation and RuBP-regeneration capacities in young wheat leaves could be consistent with adaptation to the current, or even the preindustrial pCa.

Minimally invasive aortic surgery: endovascular stent-graft repair of abdominal aortic aneurysm

Minimally invasive surgical therapies are popular with patients and third party payors because they offer increased safety, decreased pain, as well as shorter recovery times and hospital stays when compared to standard open surgery. Minimally invasive aortic surgery is now a practical reality. Our experience with 150 endovascular stent-graft aortic aneurysm repairs at Baptist Hospital East is detailed in the following report. In our practice, stent-grafting is now the treatment of choice for infrarenal abdominal aortic aneurysms within the context of clinical trials.

Community-based rehabilitation: a development programme in Negros Occidental

This paper describes the establishment of a community-base rehabilitation (CBR) programme from its initiation to the current situation in the Philippine Republic. The impetus for the CBR project arose from an initiative of a non-government organization in the state of Negros Occidental. The administrative structure, manpower recruitment and training, and the close working relationship between government and non-government organizations are also described.

Sustained mitogen-activated protein kinase (MAPK) and cytoplasmic phospholipase A2 activation by macrophage migration inhibitory factor (MIF). Regulatory role in cell proliferation and glucocorticoid action

Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory mediator with the unique ability to counter-regulate the inhibitory effects of glucocorticoids on immune cell activation. MIF is released from cells in response to glucocorticoids, certain pro-inflammatory stimuli, and mitogens and acts to regulate glucocorticoid action on the ensuing inflammatory response. To gain insight into the molecular mechanism of MIF action, we have examined the role of MIF in the proliferation and intracellular signaling events of the well characterized, NIH/3T3 fibroblast cell line. Both endogenously secreted and exogenously added MIFs stimulate the proliferation of NIH/3T3 cells, and this response is associated with the activation of the p44/p42 extracellular signal-regulated (ERK) mitogen-activated protein kinases (MAP). The MIF-induced activation of these kinases was sustained for a period of at least 24 h and was dependent upon protein kinase A activity. We further show that MIF regulates cytosolic phospholipase A2 activity via a protein kinase A and ERK dependent pathway and that the glucocorticoid suppression of cytokine-induced cytoplasmic phospholipase A2 activity and arachidonic acid release can be reversed by the addition of recombinant MIF. These studies indicate that the sustained activation of p44/p42 MAP kinase and subsequent arachidonate release by cytoplasmic phospholipase A2 are important features of the immunoregulatory and intracellular signaling events initiated by MIF and provide the first insight into the mechanisms that underlie the pro-proliferative and inflammatory properties of this mediator.

Screening for ophthalmic disease in older subjects using visual acuity and contrast sensitivity

OBJECTIVE

Despite early interest in contrast sensitivity as a screening test for ophthalmic disease, most published opinion suggests that there is no benefit over conventional measurement of visual acuity. Taking a primary care perspective of screening, the authors evaluated the ability to discriminate those with any diagnosed ophthalmic disease in a large sample representative of the general population.

DESIGN

Retrospective analysis of a clinical, cross-sectional survey. Snellen visual acuity, contrast sensitivity (Arden plates, American Optical contrast sensitivity test), and ophthalmic diagnosis were reported previously.

PARTICIPANTS

A sample of 3283 subjects, all aged at least 50 years, were selected randomly from residents of a health district in Sydney, Australia. Ophthalmologic diagnosis (ophthalmic disease presence/absence) had been confirmed for 2522 of these subjects.

MAIN OUTCOME MEASURES

Signal detection techniques (the receiver-operating characteristics function [ROC], quality ROC [QROC], and weighted kappa coefficient of association [kappa(r)]) were used to evaluate test discriminability.

RESULTS

Because analyses of right and left eyes were almost identical, only right eye results are presented. Advantages of kappa(r) over ROC were shown. Discrimination of those with diagnosed ophthalmic disease from those without ophthalmic disease was best with Arden plate 7 (kappa0.5 = 0.93) and was better than distance Snellen visual acuity (kappa0.5 = 0.59). Arden plate 7 (6.4 cyc/deg) correctly assigned 96% of subjects at its optimal pass-fail criterion.

CONCLUSIONS

In the primary care setting, a person older than 50 years of age with reduced contrast sensitivity, as determined by Arden plate 7, requires extra care in subsequent examinations because this person is likely to have an ophthalmic disease.

Estimating the excess investment in ribulose-1,5-bisphosphate Carboxylase/Oxygenase in leaves of spring wheat grown under elevated CO2

Wheat (Triticum aestivum L.) was grown under CO2 partial pressures of 36 and 70 Pa with two N-application regimes. Responses of photosynthesis to varying CO2 partial pressure were fitted to estimate the maximal carboxylation rate and the nonphotorespiratory respiration rate in flag and preceding leaves. The maximal carboxylation rate was proportional to ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) content, and the light-saturated photosynthetic rate at 70 Pa CO2 was proportional to the thylakoid ATP-synthase content. Potential photosynthetic rates at 70 Pa CO2 were calculated and compared with the observed values to estimate excess investment in Rubisco. The excess was greater in leaves grown with high N application than in those grown with low N application and declined as the leaves senesced. The fraction of Rubisco that was estimated to be in excess was strongly dependent on leaf N content, increasing from approximately 5% in leaves with 1 g N m-2 to approximately 40% in leaves with 2 g N m-2. Growth at elevated CO2 usually decreased the excess somewhat but only as a consequence of a general reduction in leaf N, since relationships between the amount of components and N content were unaffected by CO2. We conclude that there is scope for improving the N-use efficiency of C3 crop species under elevated CO2 conditions.

Predicting wheat yields: the search for valid and precise models

Interest in predicting wheat yield in terms of physiological, cultural and meteorological variables is more than a century old. Early attempts involved statistical analyses of relationships between yield and observational data on precipitation, temperature, radiation, etc., and scientific study of physiological and cultural influences such as dates of sowing or anthesis, farming procedures and soil treatments. More recently these have been augmented by large-scale mechanistic models of phenological development, such as AFRCWHEAT, CERES and SIRIUS, incorporating some simulation facilities. All approaches implicitly involve fitting models of some sort: statistical, mechanistic or (preferably) a hybrid of these forms. Levels of success on this important matter are highly variable. After reviewing the field, we consider the results of recent efforts to contrast and evaluate the (large-scale) mechanistic approaches, using spatial/temporal methods for interpolating the required climatological input variables. The work employs a substantial database of wheat yields assembled for this purpose. After assessing the validity of the large-scale mechanistic models (with some intriguing conclusions), we then consider some results from a current approach to parsimonious hybrid modelling, based on statistical study of accessible climatological data interpreted in terms of physiological knowledge of key influences on plant development.

Membership of the University of the Third Age (U3A) and perceived well-being

To study the perceived well-being of members of the University of the Third Age (U3A) a sample of 975 members with a mean age of 67.9 +/- 6.98 years (range 50-94) was obtained from within the Greater Sydney Metropolitan Region and administered the Medical Outcomes Study (MOS) Short Form 36-item (SF-36) health survey. The SF-36 assesses eight health concepts; limitations in physical activities because of health problems; limitations in social activities because of physical or emotional problems; limitations in usual role activities because of physical health problems; bodily pain; general mental health; limitations in usual role activities because of emotional problems; vitality; and general health perception. Comparisons were made with USA normative peer groups, and the U3A sample scored as well as, or better than, their American peers. It is concluded that members of U3A had better-than-average general, physical and mental health, and that membership of U3A can, even in the very elderly, assist in conferring a much more positive perception of well-being.

Evidence for DNA-PK-dependent and -independent DNA double-strand break repair pathways in mammalian cells as a function of the cell cycle

Mice homozygous for the scid (severe combined immune deficiency) mutation are defective in the repair of DNA double-strand breaks (DSBs) and are consequently very X-ray sensitive and defective in the lymphoid V(D)J recombination process. Recently, a strong candidate for the scid gene has been identified as the catalytic subunit of the DNA-dependent protein kinase (DNA-PK) complex. Here, we show that the activity of the DNA-PK complex is regulated in a cell cycle-dependent manner, with peaks of activity found at the G1/early S phase and again at the G2 phase in wild-type cells. Interestingly, only the deficit of the G1/early S phase DNA-PK activity correlated with an increased hypersensitivity to X-irradiation and a DNA DSB repair deficit in synchronized scid pre-B cells. Finally, we demonstrate that the DNA-PK activity found at the G2 phase may be required for exit from a DNA damage-induced G2 checkpoint arrest. These observations suggest the presence of two pathways (DNA-PK-dependent and -independent) of illegitimate mammalian DNA DSB repair and two distinct roles (DNA DSB repair and G2 checkpoint traversal) for DNA-PK in the cellular response to ionizing radiation.

Perceived inhibitors to rural practice among physiotherapy students

This descriptive study was undertaken to determine perceptions of undergraduate physiotherapy students which would make them more or less likely to enter rural practice. A total of 607 self-administered questionnaires were distributed to undergraduates in The University of Sydney and 546 completed documents were returned. Students perceived the major inhibitors as social (isolation from family, friends and partner) and recreational (lack of theatre, entertainment, etc). Influences which would attract graduates to rural practice were lifestyle (relaxed, less stressful, healthier), lower cost of living, seeing more of Australia and professional autonomy. Knowledge of these perceptions will enable educators, the profession and potential employers to develop and implement strategies that will negate the negative and re-enforce the positive perceptions.

Inhibition of S-nitrosation of reduced glutathione in aerobic solutions of nitric oxide by phosphate and other inorganic anions

Reduced glutathione is nitrosated in aerobic solutions of nitric oxide under physiological conditions; however, the extent of S-nitrosation was found to be dependent on the inorganic anions present. Of nine anions tested, the bifunctional anions, arsenate, phosphate, and pyrophosphate (40 mM), inhibited the S-nitrosation reaction from 20 to 40%, whereas SO4(2-), H3BO3, SCN-, NO3-, Cl-, and acetate inhibited this reaction < or = 15%. A mechanism of inhibition is presented that involves the catalytic hydrolysis of N2O3 by the bifunctional anions; however, using [18O]phosphate as inhibitor, only 10% of the theoretically produced N2O3 was found to be hydrolyzed to nitrite via this mechanism as calculated from the loss of 18O from phosphate. We conclude that this mechanism accounts for only a minor part of the increased inhibition of S-nitrosation by these bifunctional anions.

In vitro lymphocyte blastogenic responses and cytokine production in sickle cell disease patients with acute pneumonia

BACKGROUND

Pulmonary infections continue to be a major cause of morbidity and mortality in patients with sickle cell disease (SCD).

METHODS

In this study cell-mediated immunity in vitro was evaluated in 62 SCD patients (62 steady state and 16 with acute pneumonia) and compared with 44 normal controls (30 healthy and 14 with acute pneumonia). Lymphocyte blastogenic responses to phytohemagglutinin, tetanus toxoid and Candida albicans antigen were assessed in all subjects. In addition production of tumor necrosis factor, alpha- and gamma-interferon (IFN) were assayed.

RESULTS

The results revealed comparable blastogenic responses to all three stimuli in all subjects except SCD patients with pneumonia. This group showed poor responses to all stimuli. The mean counts per minute were decreased 65 to 90% when compared with the other patients. Cytokine production of IFN-alpha and TNF was equivalent in all subjects. Conversely IFN-gamma production in both SCD groups, steady state (35 +/- 6 U/ml) and SCD with pneumonia (14 +/- 6 U/ml), was significantly decreased when compared with those in normal healthy controls (65 +/- 14 U/ml) and with pneumonia (48 +/- 17 U/ml). On analysis of individual titers 15 of 62 (24%) steady state and 10 of 16 (63%) SCD patients with pneumonia were deficient in IFN-gamma production in vitro.

CONCLUSIONS

Acute pulmonary infections seem to have a profound effect on cell-mediated immunity in SCD. IFN-gamma deficiency, along with quantitative and qualitative T cell abnormalities, may represent significant factors to explain the frequent and severe infections seen in SCD.

P/O ratios reassessed: mitochondrial P/O ratios consistently exceed 1.5 with succinate and 2.5 with NAD-linked substrates

The efficiency of ATP synthesis coupled to cell respiration, commonly referred to as the P/O ratio, has been the subject of extensive studies for more that 50 years. The general conclusion from these studies is that respiring mitochondria can convert external ADP to ATP at a maximal P/O ratio of 3 for NAD-linked substrates and 2 for succinate. However, in recent years the validity of these "integral" values has been questioned on both mechanistic and thermodynamic grounds, and a mechanistic P/O ratio of 2.5 for NAD-linked substrates and 1.5 for succinate have been concluded on the basis of experiments with isolated mitochondria. These values have been widely adopted in the scientific literature, including several recent textbooks. In this paper we report that under optimal conditions with respect to preparation and assay procedures, the P/O ratios obtained with isolated rat liver mitochondria consistently exceed 2.5 with NAD-linked substrates and 1.5 with succinate. These results, although not excluding "nonintegral" P/O ratios due to various energy-dissipating side reactions, warrant caution in accepting the reported lower values and, in general, in referring to mechanistic considerations unless the underlying molecular mechanisms are understood.

Serum interleukin-6 levels in the steady state of sickle cell disease

In patients with childhood sickle cell disease (SCD) serum interleukin-6 (IL-6) levels were measured during the steady (healthy) state of disease. The corresponding measurements were made in comparable healthy normal controls. Serum IL-6 levels were assessed via ELISA in 27 SCD patients and 19 controls. Results revealed significantly higher circulating levels of IL-6 in the SCD patients (60 +/- 7 pg/ml) compared with the healthy controls (12 +/- 5 pg/ml). IL-6 is a multifunctional cytokine that plays a central role in host defense mechanisms. The impact of high circulating levels of IL-6 may be deleterious to humoral and cell-mediated immune functions in SCD, with resultant heightened risk for morbidity.

Hepatic metabolic response to injury and sepsis

BACKGROUND

Experimental reports have indicated that hepatic oxidative and synthetic metabolism may become depressed in sepsis. Because the mechanism of infection-related liver dysfunction has not been established, further study of these functional alterations could contribute to the therapeutic management of septic organ failure syndromes. However, recently controversy has arisen over the existence of these derangements that must be reconciled before further progress in this field can be made.

METHODS

Splanchnic balance studies for the measurement of glucose output and oxygen consumption were used to assess hepatic function in fasted normal volunteers (n = 18), injured patients (n = 10), and patients with sepsis (n = 18). The liver's contribution to splanchnic metabolism was estimated from a comparison of splanchnic oxygen utilization in response to increases in the liver-specific process of glucogenesis. In addition, in vivo liver albumin production was determined by using the [14C] carbonate technique.

RESULTS

Glucose output after injury and sepsis was increased by 12.8% and 76.6%, respectively, compared with controls. On the basis of substrate balance studies, gluconeogenesis was estimated to account for 46%, 87%, and 93%, respectively, of splanchnic glucose output in each of the three groups. In patients with sepsis glucose output was also noted to be linearly related to regional oxygen consumption, indicating that these processes were coupled and increases in the respiratory activity of the splanchnic cellular mass could be accounted for by increases in new glucose output and gluconeogenic substrate clearance. The mean albumin synthetic rate increased during injury and sepsis by 22% and 29%, respectively, compared with normal volunteers.

CONCLUSIONS

These studies cast doubt on the commonly held notion that tissue respiratory dysfunction may occur during sepsis. On the contrary, hepatic function is accelerated during hyperdynamic sepsis, and evidence indicating oxidative or synthetic functional depression is lacking.

Purification, bioactivity, and secondary structure analysis of mouse and human macrophage migration inhibitory factor (MIF)

The cytokine macrophage migration inhibitory factor (MIF) has been identified to be secreted by the pituitary gland and the monocyte/macrophage and to play an important role in endotoxic shock. Despite the recent molecular cloning of a human T-cell MIF, characterization of the biochemical and biological properties of this protein has remained incomplete because substantial quantities of purified, recombinant, or native MIF have not been available. We describe the cloning of mouse MIF from anterior pituitary cells (AtT-20) and the purification of native MIF from mouse liver by sequential ion exchange and reverse-phase chromatography. For comparison purposes, human MIF was cloned from the Jurkat T-cell line and also characterized. Mouse and human MIF were highly homologous (90% identity over 115 amino acids). Recombinant mouse and human MIF were expressed in Escherichia coli and purified in milligram quantities by a simple two-step procedure. The molecular weight of native mouse MIF (12.5 kDa monomer) was identical with that of recombinant mouse MIF as assessed by gel electrophoresis and mass spectroscopy. No significant post-translational modifications were detected despite the presence of two potential N-linked glycosylation sites. Recombinant MIF inhibited monocyte migration in a dose-dependent fashion, and both recombinant and native MIF-exhibited comparable biological activities. MIF induced the secretion of tumor necrosis factor-alpha and stimulated nitric oxide production by macrophages primed with interferon-gamma. Circular dichroism spectroscopy revealed that bioactive mouse and human MIF exhibit a highly ordered, three-dimensional structure with a significant percentage of beta-sheet and alpha-helix conformation. Guanidine hydrochloride-induced unfolding experiments demonstrated that MIF is of low to moderate thermodynamic stability. These studies establish the biochemical identity of native and recombinant MIF and provide a first insight into the three-dimensional structural properties of this critical inflammatory mediator.

The macrophage is an important and previously unrecognized source of macrophage migration inhibitory factor

For over 25 years, the cytokine known as macrophage migration inhibitory factor (MIF) has been considered to be a product of activated T lymphocytes. We recently identified the murine homolog of human MIF as a protein secreted by the pituitary in response to endotoxin administration. In the course of these studies, we also detected MIF in acute sera obtained from endotoxin-treated, T cell-deficient (nude), and hypophysectomized mice, suggesting that still more cell types produce MIF. Here, we report that cells of the monocyte/macrophage lineage are an important source of MIF in vitro and in vivo. We observed high levels of both preformed MIF protein and MIF mRNA in resting, nonstimulated cells. In the murine macrophage cell line RAW 264.7, MIF secretion was induced by as little as 10 pg/ml of lipopolysaccharide (LPS), peaked at 1 ng/ml, and was undetectable at LPS concentrations > 1 microgram/ml. A similar stimulation profile was observed in LPS-treated peritoneal macrophages; however, higher LPS concentrations were necessary to induce peak MIF production unless cells had been preincubated with interferon gamma (IFN-gamma). In RAW 264.7 macrophages, MIF secretion also was induced by tumor necrosis factor alpha (TNF-alpha) and IFN-gamma, but not by interleukins 1 beta or 6. Of note, MIF-stimulated macrophages were observed to secrete bioactive TNF-alpha. Although previously overlooked, the macrophage is both an important source and an important target of MIF in vivo. The activation of both central (pituitary) and peripheral (macrophage) sources of MIF production by inflammatory stimuli provides further evidence for the critical role of this cytokine in the systemic response to tissue invasion.

MIF is a pituitary-derived cytokine that potentiates lethal endotoxaemia

Cytokines are critical in the often fatal cascade of events that cause septic shock. One regulatory system that is likely to be important in controlling inflammatory responses is the neuroendocrine axis. The pituitary, for example, is ideally situated to integrate central and peripheral stimuli, and initiates the increase in systemic glucocorticoids that accompanies host stress responses. To assess further the contribution of the pituitary to systemic inflammatory processes, we examined the secretory profile of cultured pituitary cells and whole pituitaries in vivo after stimulation with bacterial lipopolysaccharide (LPS). Here we identify macrophage migration inhibitory factor (MIF) as a major secreted protein release by anterior pituitary cells in response to LPS stimulation. Serum analysis of control, hypophysectomized and T-cell-deficient (nude) mice suggests that pituitary-derived MIF contributes to circulating MIF present in the post-acute phase of endotoxaemia. Recombinant murine MIF greatly enhances lethality when co-injected with LPS and anti-MIF antibody confers full protection against lethal endotoxaemia. We conclude that MIF plays a central role in the toxic response to endotoxaemia and possibly septic shock.

Community-based rehabilitation: does it change community attitudes towards people with disability?

To achieve the goal of 'Health for All by the Year 2000' the World Health Organization (WHO) adopted an approach to rehabilitation described as community-based rehabilitation (CBR). A major objective of CBR is to develop positive community attitudes towards people with disabilities. To determine whether this objective can be achieved, post hoc measurement of attitudes towards people with disabilities was carried out in a community in which CBR had been established and in a control community. It is shown that both groups exhibited neutral attitudes. The community exposed to CBR obtained a mean attitude score significantly (p < 0.001) closer to the positive end of the scale than did the control community. It is concluded that communities in which CBR is being carried out develop more favourable attitudes towards people with disabilities than do those in which no such programme has been implemented.

Contrast sensitivity in elderly subjects with a diagnosed ocular disease

In a random sample of 3283 subjects, 1266 right eyes and 1334 left eyes were diagnosed as having one of the following: age-related macular degeneration (ARMD), cataract, or glaucoma. In this same sample 1369 right eyes and 1312 left eyes had no ocular disease. All eyes had their contrast sensitivity measured using the Arden-type gratings manufactured by The American Optical Corporation. This is a large sample survey and although prevalence rates for the diseases examined may be inferred, this must be carried out with caution. I found for those eyes where the disease interfered with the integrity of the retina (ARMD, glaucoma) the mean contrast sensitivity scores were higher, in the middle and upper frequencies, than for those eyes with lens opacities. For frequencies above 0.4 cpd contrast sensitivities associated with diseased eyes were significantly (p < 0.001) reduced when compared to the same measures obtained on nondiseased eyes.

Prevalence of age related macular degeneration in persons aged 50 years and over resident in Australia

STUDY OBJECTIVE

The aim was to determine, employing non-invasive procedures, the prevalence of age related macular degeneration in persons 50 years of age and over.

DESIGN

A clinical investigation and a retrospective examination of ophthalmological records were employed in this study.

SETTING

The study was conducted over the period 1988 to 1990 in the Western Metropolitan Health Region of New South Wales, Australia.

PARTICIPANTS

A total sample of 3283 subjects stratified by local government area, age, and sex was obtained from the source population. It proved possible to confirm ophthalmological diagnoses in only 2522 of these subjects.

MAIN RESULTS

All data were collected using accepted ophthalmological procedures and all diagnoses were confirmed through the use of independently derived ophthalmological records. A total of 428 subjects (13.0%) had a confirmed symmetrical diagnosis of age related macular degeneration. A total prevalence for diseased eyes of 14.9% was obtained. Prevalence of diseased eyes rose from 10.4% in those 50 to 64 years of age to 31.0% in those 85 years of age and over.

CONCLUSIONS

There are several sources of error which can affect such a large sample study and are identified. Despite these, the prevalence rates obtained in this study provide normative rates for age related macular degeneration for persons 50 years of age and over.

Topography of cat medullary ventral surface hypoxic acidification

The topographic relationship between previously identified medullary ventral surface respiratory chemosensitive regions and brain surface extracellular fluid (ECF) acid production during acute hypoxia was explored in anesthetized, paralyzed, and artificially ventilated cats. Glass pH electrodes (0.8-mm diam, sheathed in stainless steel tubing) were mounted in mechanical contact with surfaces of medullary surface or adjacent pyramids, pons, spinal cord, or parietal cortex. Isocapnic hypoxia of 5 min [at arterial O2 saturation (SaO2) = 48 +/- 10%] reduced pH over rostral (Mitchell) and caudal (Loeschcke) areas by 0.12 +/- 0.09 and 0.07 +/- 0.04, respectively (n = 10, P < 0.05). Change in pH (delta pH) was proportional to desaturation with slopes 100 delta pH/delta SaO2 of 0.45 (rostral) and 0.20 (caudal) (R = 0.91 and 0.88, respectively). pH drop usually began within 3 min of hypoxia, became stable between 5 and 15 min, began to rise within 2 min of reoxygenation, and returned to control within 10 min. During equally hypoxic tests, intermediate area (Schläfke), pons, and spinal cord surfaces showed no significant acid shift. Parietal cortex ECF pH dropped more slowly but steadily by 0.079 +/- 0.034 during 20 min at SaO2 = 50% after a small but significant initial alkaline shift, and acidification of cortical surface continued for > 5 min after reoxygenation. We conclude that medullary ventral chemosensitive regions produce more lactic acid during hypoxia than neighboring brain surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

The isolated perfused rat liver as an experimental model

Intrinsic liver function may be specifically studied using the isolated perfused liver system. In this report, the metabolic characteristics of the perfused rat liver are described in response to lactate (5 mM) and ammonia (10 mM) loading. These conditions are analogous to the increased substrate availability that accompanies some acute disease states such as trauma. Glucose production (490 +/- 85 nm/gm liver/min) was constant during a 90-minute perfusion whereas albumin secretion exhibited a biphasic kinetic profile in the absence of exogenous amino acids. Liver oxygen consumption (VO2) was responsive to substrate loading as evidenced by a 20 to 60 per cent initial increase in VO2. The authors conclude that a large portion of hepatic VO2 may normally be directed toward substrate clearance. Additionally, although hepatic secretory protein synthesis persists despite the limitation of nutrient amino acid supply, the kinetics of secretion are complex.

Ligand binding properties of the human erythropoietin receptor extracellular domain expressed in Escherichia coli

We developed an assay to directly measure the ligand binding properties of the cloned human erythropoietin receptor (EpoR). The cDNA encoding the extracellular domain of the human EpoR was amplified by polymerase chain reaction and ligated into the prokaryotic expression vector pGEX3X. Synthesis in Escherichia coli was induced and a soluble glutathione S-transferase fusion protein, EREx, was purified by erythropoietin affinity chromatography. Purified EREx was bound to GSH agarose beads and used in a solid phase ligand binding assay. Specific binding of 125I-erythropoietin to EREx beads was demonstrated. A single affinity class (Kd = 1.5 nM) of the binding site was evident on Scatchard analysis. The Kd of this site is quantitatively equivalent to that of the "low" affinity cellular binding site. Kinetic analysis of ligand binding to EREx revealed both the on and off rates to be rapid, with t1/2 of 60 and 40 s, respectively. EREx ligand binding exhibits no obvious metal ion dependence or cross-competition by other hemopoietins. Antibodies to EREx block the binding of erythropoietin to the cellular EpoR. We conclude that the 66-kDa EpoR protein is capable of specific ligand binding and that no covalent modifications or associated molecules are required for this interaction. We speculate that the "high" affinity cellular binding site (Kd less than 0.2 nM) results from the interaction of the EpoR with another molecule, either additional EpoR or associated subunits, that decreases the ligand off rate.

A cross-cultural assessment of perceived health problems in the elderly

To study cross-cultural differences in perceived health problems in the elderly the Nottingham Health Profile (NHP) developed by Hunt et al. was administered to subjects from the People's Republic of China and Australia. The Australian stratum was further categorized according to cardiovascular status. Analyses of covariance (with age as the covariate) on each of the six subscales of the NHP yielded significant differences for 'Energy', 'Pain', 'Emotional reactions', 'Social isolation' and 'Physical mobility'. No differences were found for the 'Sleep' subscale. Through comparisons between the mean scores for the four strata and from normative data it is concluded that it is likely that the NHP is 'culture free' on the dimensions 'Energy', 'Pain', 'Emotional reactions', 'Social isolation' and 'Physical mobility'.

Perceived health problems in subjects with varying cardiovascular diagnoses

To study perceived health problems in subjects with differing cardiovascular status, the Nottingham Health Profile (NHP) was administered to 210 subjects 55 years of age and over. Subjects were categorized as being cardiovascular "Normals," being hypertensive, having isolated coronary artery disease, or both being hypertensive and having coronary artery disease. An analysis of variance between the four cardiovascular strata on each of the six subscales of the NHP yielded significant differences between the groups on the subscales Pain, Physical Mobility, Energy, and Social Isolation. Subsequent conservative post hoc analyses of the group means on each of these variables indicated that the group with isolated coronary artery disease differed significantly from both the hypertensives and the Normals in Physical Mobility. For the Pain subscale the subjects with isolated coronary artery disease differed significantly from those with hypertension. There were no differences among the four cardiovascular groups in perceived health problems on the subscales Emotional Reactions and Sleep.

Utility of femorofemoral bypass. Comparison of results with indications for operation

Sixty-eight patients underwent femorofemoral bypass (FFB) at the University of Louisville Affiliated Hospitals over a 9-year period from 1980 to 1989. There were patients with acute ischemia requiring emergency operation, those with chronic ischemia following failed aortic reconstruction, good-risk patients with chronic ischemia who had FFB as the procedure of choice, and poor-risk patients who were unsuitable for other procedures. Patients operated on for acute ischemia had a significant number of infectious complications, with five of eight graft failures in this group due to infection. Primary patency rates were similar in all groups, with a 5-year primary patency of 42 per cent. Overall operative mortality was 4.4 per cent. Satisfactory limb salvage rates (75%) suggest that FFB is an acceptable option for providing inflow in patients with acute ischemia or for patients with a failed previous vascular prosthesis. FFB provides adequate inflow in poor-risk patients not suitable for aortic reconstruction, but patency rates do not warrant its use as a procedure of choice in good-risk patients.

Australian caregivers of family members with dementia

This study of Australian caregivers revealed that sufferers of dementia were men and women who were cared for mainly by their spouses. A small group of caregivers had little or no personal physical and emotional support from others. Changes in health status related to the caregiving role was reported by 83% of the caregivers. There is a clear need to provide physical and emotional support for caregivers generally and for those with little or no support in particular.