Efficiency of Manchega Sheep Milk Intended for Cheesemaking and Determination of Factors Causing Inefficiency

Understanding the factors that determine and regulate cheese yield would allow, through deterministic parametric efficiency models, the determination of the most appropriate milk characteristics for the industry, and the estimation of a technological value for these characteristics. The present study aims to evaluate coagulation performance of Manchega sheep milk intended for cheesemaking and explores two models to determine milk technological efficiency. For this purpose, 1200 Manchega sheep milk samples were collected, and analyses were performed for composition, milk coagulation properties (MCP), somatic cell count (SCC), and milk color values. A first model was built based on curd yield (CE) and a second one based on dry curd yield (DCE). GLM and MANCOVA analyses were used to identify the factors that determine curd yield efficiency, which mainly depended on pH, casein, and lactose content and, to a lesser extent, on the speed of coagulation and curd firmness. When comparing both models, differences were linked to the water retention capacity of the curd. Based on this, the DCE model was considered much more accurate for prediction of coagulation efficiency in a wider variety of cheeses, as it does not seem to be affected by moisture loss.

GHG Emissions from Dairy Small Ruminants in Castilla-La Mancha (Spain), Using the ManleCO2 Simulation Model

Simple Summary

Greenhouse gas emissions from ruminants contribute to global warming. “ManleCO₂” is an empirical model that simulates different management aspects in dairy sheep and goat farming, linking milk production to farming and environmental health. The carbon footprint of 1 L of fat- and protein-corrected milk varied from 2.01 to 5.62 kg CO₂e. Simulation scenarios showed a higher reduction in GHG emissions associated with animal feeding strategies and a lower reduction associated with farming management strategies. ManleCO₂ may provide useful information for planning and developing different strategies that might support the reduction of GHG emissions at the dairy sheep and goat farm level.

Abstract

The first goal of this work was the description of a model addressed to quantify the carbon footprint in Spanish autochthonous dairy sheep farms (Manchega group), foreign dairy sheep farms (foreigners group: Lacaune and Assaf breeds), and Spanish autochthonous dairy goat farms (Florida group). The second objective was to analyze the GHG emission mitigation potential of 17 different livestock farming practices that were implemented by 36 different livestock farms, in terms of CO₂e per hectare (ha), CO₂e per livestock unit (LU), and CO₂e per liter of fat- and protein-corrected milk (FPCM). The study showed the following results: 1.655 kg CO₂e per ha, 6.397 kg CO₂e per LU, and 3.78 kg CO₂e per liter of FPCM in the Manchega group; 12.634 kg CO₂e per ha, 7.810 CO₂e kg per LU, and 2.77 kg CO₂e per liter of FPCM in the Foreigners group and 1.198 kg CO₂e per ha, 6.507 kg CO₂e per LU, and 3.06 kg CO₂e per liter of FPCM in Florida group. In summary, purchasing off-farm animal feed would increase emissions by up to 3.86%. Conversely, forage management, livestock inventory, electrical supply, and animal genetic improvement would reduce emissions by up to 6.29%, 4.3%, 3.52%, and 0.8%, respectively; finally, an average rise of 2 °C in room temperature would increase emissions by up to 0.62%.

Derivation of multivariate indices of milk composition, coagulation properties, and curd yield in Manchega dairy sheep

This study approaches the interrelation patterns between composition of milk and whey, curd yield, chromaticity, syneresis, and technological quality of Manchega sheep milk using multivariate factor analysis. In addition, the effect of the main husbandry components (flock, prolificacy, season of the year, stage of lactation, and parity) on the common latent factors that define the pattern of variation of Manchega milk was assessed. For this purpose, 1,200 individual Manchega ewe milk samples from 4 different flocks registered under the Protected Designation of Origin Queso Manchego were analyzed (50 ewes/flock). Samples were collected in 2 different seasons of the year (spring and autumn) and at 3 time points per season: early, mid-, and late lactation. The obtained results suggested that curd yield mainly depends on milk composition, and the retention of water in the curd is related to coagulation traits. Thus, composition and moisture content could be useful indicators to assess the efficiency and quality of milk intended for cheesemaking, regardless of the analysis of coagulation properties. Finally, in terms of husbandry, a direct effect of flock and stage of lactation was observed on all analyzed factors, with a lower influence of season and parity.

Farming Practices Influence Antibiotic Resistance and Biogenic Amine Capacity of Staphylococci from Bulk Tank Ewe's Milk

Staphylococci are one of the main microorganisms responsible for intramammary infections in sheep, causing important economic losses for farmers and eventually health problems in humans, especially by the consumption of dairy products made with raw milk containing toxic compounds, such as biogenic amines or antibiotic resistant bacteria. This study aimed to check the presence and safety of staphylococci in bulk tank ewe's milk from different farms, and to determine the relationship between the presence of these staphylococci and farming practices, by applying nonlinear canonical correlation models (OVERALS). Two-hundred and fifty-nine staphylococci from milk samples from eighteen farms were genotyped and representative isolates of the major clusters were identified as belonging to Staphylococcus (S.) aureus, S. epidermidis, S. arlettae, S. lentus, S. simulans, and S. chromogenes species. Identified isolates were assayed in terms of their safety, by evaluating resistance to antimicrobial drugs and the aminobiogenic capacity, using both phenotypic and genetic assays. Antibiotic resistance phenotypic assay revealed that 82.9% were resistant to some antibiotics, although in the genotypic assay only the genes tetM, ermB, ermC, and grlA were detected. Fifty-three percent were high biogenic amine (BA) producers, being putrescine the most produced amine. A lowered risk of finding antibiotic-resistant and BA-producing staphylococci is related to some farming methods such as enrolling in a breeding program, use of good farming practices, postdipping teat disinfection, hygienic livestock housing, or periodic check of the milking machine.

Dominant Yeast Community in Raw Sheep's Milk and Potential Transfers of Yeast Species in Relation to Farming Practices

Yeasts are always present in any type of cheese, as well as in the factories where it is produced. However, the role of the yeast community in the cheese making process, as well as the routes of contamination used by yeast species to contaminate milk from the dairy farm environment, are not well known. The objectives of this study were to broaden the knowledge of the dominant yeast community in Manchega sheep's milk and to assess the contamination routes of the yeast species depending on the farm practices. Milk, teat surface (collected from ten ewes per farm), feed, and air (collected in milking parlours and livestock housing) samples were collected from 12 typical farms in Castilla-La Mancha, Spain with differences in farming practices, and the yeast species were identified using DNA sequencing methods. To evaluate whether certain farming practices have an effect on the distribution of species of yeast in the milk samples, a mixed model was used. The results showed that most of the dominant yeast species (mainly belonging to the genus Candida) found in milk were also found in the other samples, indicating a microbial transfer from the farm environment to the milk. Furthermore, the statistical model showed that factors influencing yeast counts in milk were the presence of yeasts in the milking parlour, the use of silage, and the frequency of acid treatment for cleaning the milking machines. In conclusion, milk contamination from the yeast species present in the dairy farm environment is related to certain farming practices such as the use of silage and the daily use of acid in the cleaning of the milking machines, which favours the presence of desirable microbiota in milk.

Factors Affecting Levels of Airborne Bacteria in Dairy Farms: A Review

This review attempts to reflect the importance of different factors that affect the environmental quality of dairy farms and must, therefore, be taken into account when considering the importance of environmental microbiology as a tool in the improvement of the quality of milk and dairy products. The effect of a factor such as temperature is vital for the dairy farm environment, especially when the temperatures are extreme, because a proper choice of temperature range improves the quality of the air and, thus, animal welfare. Similarly, the appropriate level of relative humidity in the environment should be taken into consideration to avoid the proliferation of microorganisms on the farm. Air quality, well-designed livestock housing, proper hygienic practices on the farm, stocking density, and the materials used in the livestock houses are all important factors in the concentration of microorganisms in the environment, promoting better welfare for the animals. In addition, a ventilation system is required to prevent the pollution of the farm environment. It is demonstrated that proper ventilation reduces the microbial load of the environment of dairy farms, enhancing the quality of the air and, therefore, the wellbeing of the animals. All this information is very useful to establish certain standards on dairy farms to improve the quality of the environment and, thereby, achieve better quality milk and dairy products.

Metataxonomic and immunological analysis of milk from ewes with or without a history of mastitis

Mastitis is a highly prevalent condition that has a great impact on milk production and animal welfare, and often requires substantial management efforts. For this reason, it is generally considered an important threat to the dairy industry. Many microbial, host, and environmental factors can protect against, predispose to, or influence the development of mastitis. The objective of this work was to characterize the milk microbiota of Manchega ewes, and to compare samples from animals with and without a history of mastitis. We analyzed milk samples from 36 ewes belonging to 2 different farms (18 ewes from each farm) using culture-dependent and culture-independent techniques. We also analyzed several immune compounds to investigate associations of mastitis with 3 main variables: farm; history of mastitis or no mastitis; and parity number. Both culture-dependent and culture-independent techniques showed that ewe milk harbored a site-specific complex microbiota and microbiome. Staphylococcus epidermidis was the main species driving the difference between farm A (where it was the dominant species) and B (where it was not). In contrast, samples from farm B were characterized by the presence of a wide spectrum of other coagulase-negative staphylococci. Some of these species have already been associated with subclinical intramammary infections in ruminants. Of the 10 immune compounds assayed in this study, 3 were related to a history of mastitis [IL-8, IFN-γ, and IFN-gamma-induced protein 10 (IP-10)]. Increases in IL-8 concentrations in milk seemed to be a feature of subclinical mastitis in sheep, and in this study, this immune factor was detected only in samples from ewes with some episodes of mastitis and from the group with the highest somatic cell count. We also observed a positive correlation between the samples with the highest somatic cell count and IFN-γ and IP-10 levels. Our results suggest that these 3 compounds could be used as biomarkers for the negative selection of mastitis-prone animals, particularly when somatic cell count is very high.

[Resident of emergency attitude towards patients-physician relationship at the Hospital de Clínicas- Asunción, Paraguay]

INTRODUCTION

The doctor-patient relationship is reaching great importance in recent times, is highlighted their importance in areas as varied as satisfaction, compliance, perception of professional competence, the frequency of legal issues relating to malpractice and even the prognosis of the disease or the general health of the patient.

OBJECTIVE

To evaluate the doctor-patient relationship from the point of view of residents of emergency unit.

METHODS

An observational, descriptive study. The sample consisted of 36 doctors from different areas of the Emergency Rooms of the Hospital de Clínicas- Asunción, Paraguay. The patient-physician relationship was evaluated using an instrument developed by RA Chavarria-Islas et al. with four indicators: Respect, Information, Consent and Dedication.

RESULTS

69.4% of residents have a regular patient-physician relationship; despite the 2.78% has a good relationship, 25% bad relationship and 2.78% a very bad relationship.

CONCLUSION

Gaps in doctor-patient relationship were found in this study.. It is interesting to invest greater efforts to enhance the doctor-patient relationship as one of the edges to improve health care, which is vital in emergency care.

Comparison of three CIDR-based fixed-time AI protocols in beef heifers

Several effective fixed-time AI (FTAI) protocols have been developed to facilitate AI in beef heifers that circumvent the need for estrus detection. Among these are the 5-d CO-Synch + controlled intravaginal progesterone insert (CIDR) protocol (5dCO), PGF2α (PG) 6-d CIDR protocol (PG-6dCIDR), and 14-d CIDR-PG protocol (14dCIDR-PG). Although each of these protocols varies in duration and approach to synchronizing estrus and ovulation, each has been reported as an effective method to facilitate FTAI in beef heifers. Therefore, the objective of this study was to compare FTAI pregnancy rates in beef heifers synchronized with these 3 CIDR-based protocols. Virgin beef heifers (n = 801) at 4 locations were synchronized with 1 of 3 protocols: 1) 5dCO, an injection of GnRH (100 μg) and insertion of a CIDR on d -5, PG (25 mg) and CIDR removal on d 0 with a second injection of PG (>4 h after CIDR removal) on d 0 and FTAI at 72 h after CIDR removal, 2) PG-6dCIDR, PG (25 mg) on d -9, GnRH (100 μg) and insertion of a CIDR on d -6, PG and CIDR removal on d 0, and FTAI at 66 h after CIDR removal, or 3) 14dCIDR-PG, a 14-d CIDR insert from d -30 to -16, PG (25 mg) on d 0, and FTAI at 66 h after PG. All heifers received an injection of GnRH (100 μg) concurrent with FTAI. Timing of treatment initiation was offset to allow all heifers to receive FTAI concomitantly and at random. Pregnancy success was determined between 35 and 40 d after FTAI by transrectal ultrasonography. Blood samples were collected before the beginning of each protocol and at the initiation of each protocol to determine estrous cycling status (77%). Data were analyzed using the GLIMMIX procedures of SAS. As expected, because of the duration of protocols, fewer heifers in the 14dCIDR-PG treatment were pubertal at initiation of synchronization than in the 5dCO (P < 0.05) and PG-6dCIDR (P = 0.10) treatments. Fixed-time AI pregnancy success did not differ between treatments (P = 0.14; 62.6%, 56.9%, and 53.3% for 5dCO, PG-6dCIDR, and 14dCIDR-PG, respectively). However, heifers that had reached puberty by initiation of synchronization had greater (P < 0.01) pregnancy success compared to heifers that were prepubertal (60.7% and 47.3%, respectively). In summary, all 3 protocols had similar FTAI pregnancy success, and puberty status had the greatest impact on pregnancy success.

Outgrowth inhibition of Clostridium beijerinckii spores by a bacteriocin-producing lactic culture in ovine milk cheese

In the manufacture of model cheeses, ovine milk was deliberately contaminated with spores of Clostridium beijerinckii INIA 63, a wild isolate from Manchego cheese with late blowing defect, and inoculated with nisin- and lacticin 481-producing Lactococcus lactis subsp. lactis INIA 415 as starter, to test its potential to prevent the late blowing defect, or with L. lactis subsp. lactis INIA 415-2, a spontaneous mutant not producing bacteriocins. Cheeses made individually with the lactococcal strains, without clostridial spores, served as controls. Cheese made with clostridial spores and L. lactis subsp. lactis INIA 415-2 showed late blowing defect after 120days of ripening. Spoilt cheese also showed lower concentrations of lactic acid, and higher levels of acetic, propionic and butyric acids, and of other volatile compounds such as 2-propanol and 1-butanol, than control cheese. In addition, cheese made with the bacteriocin producer did not show any late blowing symptoms, despite its spore counts similar to those of blown cheese, pointing to outgrowth inhibition of C. beijerinckii spores by bacteriocins. Besides, cheese made with the bacteriocin producer showed similar concentrations of lactic acid and volatile compounds than control cheese. Inclusion of L. lactis subsp. lactis INIA 415 in starter cultures seems a feasible method to prevent late blowing defect in cheese without altering its sensory characteristics.

WUS and STM-based reporter genes for studying meristem development in poplar

We describe the development of a reporter system for monitoring meristem initiation in poplar using promoters of poplar homologs to the meristem-active regulatory genes WUSCHEL (WUS) and SHOOTMERISTEMLESS (STM). When ~3 kb of the 5' flanking regions of close homologs were used to drive expression of the GUSPlus gene, 50-60% of the transgenic events showed expression in apical and axillary meristems. However, expression was also common in other organs, including in leaf veins (40 and 46% of WUS and STM transgenic events, respectively) and hydathodes (56% of WUS transgenic events). Histochemical GUS staining of explants during callogenesis and shoot regeneration using in vitro stems as explants showed that expression was detectable prior to visible shoot development, starting 3-15 days after explants were placed onto callus inducing medium. A minority of WUS and STM events also showed expression in the cambium, phloem, or xylem of regenerated, greenhouse grown plants undergoing secondary growth. Based on microarray gene expression data, a paralog of poplar WUS was detectably up-regulated during shoot initiation, but the other paralog was not. Both paralogs of poplar STM were down-regulated threefold to sixfold during early callus initiation. We identified 15-35 copies of cytokinin response regulator binding motifs (ARR1AT) and one copy of the auxin response element (AuxRE) in both promoters. Several of the events recovered may be useful for studying the process of primary and secondary meristem development, including treatments intended to stimulate meristem development to promote clonal propagation and genetic transformation.

Assessment of metal contamination in dregded sediments using fractionation and Self-Organizing Maps

Although total metal content is frequently the initial approach for measuring pollution, no information is provided about mobility and environmental risk. In this paper, a metal fractionation (sequential extraction) technique and artificial neural networks (Self-Organizing Maps, SOMs) have been used jointly to evaluate the pollution level of the sediments dredged from the dry dock of a former shipyard in the Bilbao estuary (Bizkaia, Spain). The load pollution index (LPI) for the upper, middle and bottom layers of the sediments was 7.65, 8.22 and 10.01, respectively, for six metals (Cu, Mn, Ni, Cr, Pb and Zn). This showed that upper sediments were less polluted than the lower ones. Consequently, a reduction in the pollution level of metal discharged into the river in recent years was confirmed. According to fractionation results, the most mobile minor elements were Cu, Pb and Zn, as they are mainly associated with the non-residual fractions. The statistical approach of Self-Organizing Maps (SOMs) revealed that Ni, Pb and Zn amounts in the residual fraction followed the same pattern associated with simultaneous discharges of slags into the river. However, other hazardous discharge sources are responsible for the high accumulation of those metals in the non-residual fractions.

Neural networks as a tool for control and management of a biological reactor for treating hydrogen sulphide

Based on an experimental database consisting of 194 daily cases, artificial neural networks were used to model the removal efficiency of a biofilter for treating hydrogen sulphide (H2S). In this work, the removal efficiency of the reactor was considered as a function of the changes in the air flow and concentration of H2S entering the biofilter. In order to obtain true representative values, the removal efficiencies (outputs) were measured 24 h after each input was changed. A MLP (multilayer perceptron 2-2-1) model with two input variables (unit flow and concentration of the contaminant fed into the biofilter) rendered good prediction values with a determination coefficient of 0.92 for the removal efficiency within the range studied. This means that the MLP model can explain 92% of the overall variability detected in the biofilter corresponding to a wide range of operating conditions.

Antioxidant vitamins increase the collagen content and reduce MMP-1 in a porcine model of atherosclerosis: implications for plaque stabilization

Degradation of extracellular matrix, particularly interstitial collagen, promotes plaque instability and contributes to restenosis after vascular injury. We have explored the effects of vitamins C and E on the collagen content and metalloproteinase-1 (MMP-1) expression after angioplasty in hypercholesterolemic pigs. Iliac angioplasty was performed on 18 minipigs divided into three diet groups: a normal-cholesterol (NC), a high-cholesterol (HC) and a high-cholesterol plus vitamins C+E (HCV). Four weeks later, after sacrifice, the vascular collagen content and MMP-1 protein expression, along with the plasma caseinolytic activity and lipid peroxidation, were measured. MMP-1 was also determined in arterial rings stimulated with native low-density lipoproteins (LDL) isolated from experimental groups. Cholesterol-rich diet augmented plasma lipid peroxidation (P<0.05), reduced the collagen content and increased vascular MMP-1 expression after injury (P<0.05). Enhanced caseinolytic activity (identified as MMP-1) was also observed in HC plasma samples and in supernatants from arterial rings incubated with HC-LDL. Vitamins C and E markedly increased neointimal collagen content (P<0.01), reduced the hypercholesterolemia-induced changes in vascular MMP-1 (P<0.05) and diminished plasma and ex vivo caseinolytic activity. Vitamins C and E may help stabilize atherosclerotic plaque after angioplasty and favor vascular remodeling by increasing collagen content and reducing vascular MMP-1 expression in porcine hypercholesterolemia.

Hyperhomocysteinemia in liver cirrhosis: mechanisms and role in vascular and hepatic fibrosis

Numerous clinical and epidemiological studies have identified elevated homocysteine levels in plasma as a risk factor for atherosclerotic vascular disease and thromboembolism. Hyperhomocysteinemia may develop as a consequence of defects in homocysteine-metabolizing genes; nutritional conditions leading to vitamin B(6), B(12), or folate deficiencies; or chronic alcohol consumption. Homocysteine is an intermediate in methionine metabolism, which takes place mainly in the liver. Impaired liver function leads to altered methionine and homocysteine metabolism; however, the molecular basis for such alterations is not completely understood. In addition, the mechanisms behind homocysteine-induced cellular toxicity are not fully defined. In the present work, we have examined the expression of the main enzymes involved in methionine and homocysteine metabolism, along with the plasma levels of methionine and homocysteine, in the liver of 26 cirrhotic patients and 10 control subjects. To gain more insight into the cellular effects of elevated homocysteine levels, we have searched for changes in gene expression induced by this amino acid in cultured human vascular smooth muscle cells. We have observed a marked reduction in the expression of the main genes involved in homocysteine metabolism in liver cirrhosis. In addition, we have identified the tissue inhibitor of metalloproteinases-1 and alpha1(I)procollagen to be upregulated in vascular smooth muscle cells and liver stellate cells exposed to pathological concentrations of homocysteine. Taken together, our observations suggest (1) impaired liver function could be a novel determinant in the development of hyperhomocysteinemia and (2) a role for elevated homocysteine levels in the development of liver fibrosis.

Determination of the beta-blocker atenolol in plasma by capillary zone electrophoresis

A capillary zone electrophoretic method was optimised for the determination of the beta-blocker atenolol in plasma. Separation was performed in an uncoated silica capillary of 58.5 cm (effective length 50 cm) x 75 microm I.D., and detection was at 194 nm. The effects of the buffer (concentration and pH), the injection time, the voltage applied and the plasma clean-up procedure were studied. The determination of atenolol was achieved in less than 3 min, using an electrolyte of 50 mM H3BO3-50 mM Na2B4O7 (50:50, v/v) pH 9, injected hydrodynamically for 4 s at 50 mbar and applying a voltage of +25 kV. This method was applied to the determination of atenolol in plasma of nine hypertensive patients (male and female, aged from 39 to 73 years). Atenolol concentrations found vary from 30 to 585 ng/ml.

Correlation of lycopene measured by HPLC with the L, a, b color readings of a hydroponic tomato and the relationship of maturity with color and lycopene content

Tomatoes (Lycopersicon esculentum cv. Laura) were separated, according to the ripening stage, by a sensory panel into seven groups, and color was measured on the tomato surface with a Minolta Chroma meter. The L, a, b, hue, chroma, and lycopene content were plotted against the maturity stages of the tomatoes, and several good correlations were found. The a/b ratio and the lycopene content were the parameters that allowed six of seven maturity groups in the tomato to be statistically distinguished. The lycopene content, measured by HPLC, was also correlated with the color measurements, and the a, a/b, and (a/b)(2) color factors produced the best regressions. An estimation of the lycopene content in tomatoes can be achieved by using a portable chroma meter, with a possible field usage application. Equations to calculate the lycopene content of tomatoes based on the color readings are reported.

Quality comparison of hydroponic tomatoes (Lycopersicon esculentum) ripened on and off vine

There is a general belief that the quality of tomatoes ripened on vine is better than tomatoes ripened off the vine, influencing among other parameters, the price of this commodity. We compared the quality of hydroponic tomatoes ripened on and off vine by chemical, physical, and sensory evaluation to find what attributes are affected and to what extent. Lycopene, beta-carotene, total and soluble solids, moisture content, ascorbic acid, acidity, pH, texture, and color were analyzed. Tomatoes ripened on vine had significantly more lycopene, beta-carotene, soluble and total solids, higher a* and lower L*, and were firmer. However, a 100-judge panel rated only the color and overall liking of the vine-ripened tomatoes as more intense than the fruit ripened off vine. Therefore, the chemical and physical differences were mostly not large enough to influence the panelist's perception. The characterization of tomatoes ripened on and off vine may help to guide post-harvest handling and treatment and to improve the quality of tomatoes ripened off vine.

Generalized Griffith criterion for dynamic fracture and the stability of crack motion at high velocities

We use Eshelby's energy momentum tensor of dynamic elasticity to compute the forces acting on a moving crack front in a three-dimensional elastic solid [Philos. Mag. 42, 1401 (1951)]. The crack front is allowed to be any curve in three dimensions, but its curvature is assumed small enough so that near the front the dynamics is locally governed by two-dimensional physics. In this case the component of the elastic force on the crack front that is tangent to the front vanishes. However, both the other components, parallel and perpendicular to the direction of motion, do not vanish. We propose that the dynamics of cracks that are allowed to deviate from straight line motion is governed by a vector equation that reflects a balance of elastic forces with dissipative forces at the crack tip, and a phenomenological model for those dissipative forces is advanced. Under certain assumptions for the parameters that characterize the model for the dissipative forces, we find a second order dynamic instability for the crack trajectory. This is signaled by the existence of a critical velocity V(c) such that for velocities V<V(c) the motion is governed by K(II)=0, while for V>V(c) it is governed by K(II) not equal to 0. This result provides a qualitative explanation for some experimental results associated with dynamic fracture instabilities in thin brittle plates. When deviations from straight line motion are suppressed, the usual equation of straight line crack motion based on a Griffiths-like criterion is recovered.

Depression and social support in elderly patients with cardiac disease

BACKGROUND

Depression is common among patients with cardiac disease. A number of psychosocial factors may affect the relationship between physical health and depression. There is evidence from the psychiatric literature suggesting that negative life events and social support are important factors in the development and outcome of depression. It is unknown if these factors are important in the context of depression in medically ill patients. Thus it is important to examine the relationship among social support, negative life events, and the presence of depression in elderly patients with cardiac disease.

METHODS

Patients with coronary artery disease were assessed with the Duke Depression Evaluation Schedule for the Elderly. This includes the mood and anxiety disorder section of the Diagnostic Interview Schedule modified for Diagnostic and Statistical Manual of Mental Disorders diagnoses, life events, and multidimensional assessment of social support. Two hypotheses were tested: (1) the number of concurrent negative life events will be higher in patients with coronary artery disease with major depression than those without depression, and (2) social support will be less in patients with major depression than in those without.

RESULTS

Presence of major depression was associated with increased negative life events and lowered subjective social support after accounting for age, sex, and race.

CONCLUSIONS

The finding that subjective social support and negative life events are related to major depression suggests that even in the context of medical illness, social factors are still important in the development of major depression.

ERCP and sphincterotomy in the context of laparoscopic cholecystectomy: academic and community practice patterns and results

OBJECTIVE

To study the effect of practice setting and practitioner experience on the use and results of ERCP and sphincterotomy in the context of laparoscopic cholecystectomy.

METHODS

Data were collected on 780 ERCPs performed before or after laparoscopic cholecystectomy. Biliary endoscopists at four academic centers and 33 community-based gastroenterologists of varying experience participated.

RESULTS

Indications for perioperative ERCP were similar in academic centers and community practice, but academic experts performed a significantly higher proportion of postoperative procedures. Success rates were high for all participants, although the least experienced group of community-based gastroenterologists had a significantly lower rate of success with sphincterotomy. Complication rates did not vary significantly among participants.

CONCLUSIONS

Experienced community-based gastroenterologists can perform ERCP and sphincterotomy in the context of laparoscopic cholecystectomy with results comparable to those of academic experts. Gastroenterologists with a life-time experience of fewer than 200 ERCPs have lower success rates for sphincterotomy than more experienced practitioners in either practice setting. ERCP performed in community or academic settings can provide safe and effective management of common bile duct stones and biliary leaks or strictures that occur after laparoscopic cholecystectomy.

Multiple cholesterol embolization syndrome: a lethal complication of vascular procedures. Report of two histologically proven cases

Two cases of multiple cholesterol embolization syndrome (MCES) leading to death are presented. Rarely described and labeled as a "great masquerader", its presence in the medical literature is growing, since it is best diagnosed, but despite the high frequency with which MCES may occur, only a few cases are reported. This syndrome is not universally recognised.

[Approaches to low-income groups' sexuality: a comparative study of women in three low-income contexts in Peru]

"This work...examines the cultural dimension of sexuality and fertility of women from [low-income] sectors in Peru. It intends to explain the cultural processes that fall into the intermediate variables of fertility, such as marriage rate, contraception, breastfeeding and...abortion. These dimensions of sexual and reproductive life are analyzed according to two explanatory dimensions: generation and cultural context of socialization. The general hypothesis is that a cultural process of homogenization of the values and behaviors has been taking place over sexuality, in such a way that the younger generations will show similar standard behaviors and values no matter their context of socialization; in the meantime, in the older groups there will exist contextual differences in these dimensions." (SUMMARY IN ENG)

The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study

Recent evidence suggests that electroconvulsive therapy (ECT) efficacy depends upon both electrode placement and the degree to which stimulus dosage exceeds seizure threshold (T), and not simply on surpassing a minimum seizure duration as has been assumed. In light of these findings and studies reporting ictal electroencephalogram (EEG) differences between bilateral and unilateral ECT, we performed this 19-subject intraindividual crossover study of the effects of dose and electrode placement on the ictal EEG. We found ictal EEG evidence of greater seizure intensity with bilateral than unilateral ECT and with higher dosage (2.25 T) compared with barely suprathreshold stimuli. Seizure duration was not longer with bilateral than unilateral ECT and actually decreased with increased dose. A number of ictal EEG variables separated the unilateral 2.25 T and unilateral T conditions, which reportedly differ in efficacy, and therefore, these EEG measures show promise as markers of treatment adequacy.

Bradykinin generation by dialysis membranes: possible role in anaphylactic reaction

Several recent reports have described a high incidence of anaphylactic reactions in patients being dialyzed with high-flux membranes while simultaneously using angiotensin-converting enzyme inhibitors. Many of these reports implicate polyacrylonitrile (PAN) as the membrane commonly involved in these reactions. To elucidate potential mechanisms of these anaphylactic reactions, whether dialysis membranes can activate the Hageman factor-dependent (contact) pathways as assessed by the in vitro generation of activated Hageman factor (Hfa), as well as the formation of kallikrein and subsequent bradykinin generation was examined. Both cuprophane (CUP) and PAN membranes were able to activate Hageman factor and convert prekallikrein to kallikrein as measured by an ELISA against kallikrein-C1-inactivator complexes. Subsequently, the active kallikrein was able to cleave bradykinin from its endogenous substrate, high-molecular-weight kininogen. However, it was found that the PAN membrane consistently led to an earlier and significantly higher formation of Hfa and kallikrein when compared with CUP. Importantly, there was also a pronounced but transient generation of bradykinin by the PAN membrane, in contrast to slower bradykinin formation by CUP, with both normal and uremic blood. It was proposed that the early and vigorous bradykinin generation induced by the contact of blood with PAN could explain, in part, the pathogenesis of the reported anaphylactoid reactions.

PMA-sensitive protein kinase C is not necessary in TRH-stimulated prolactin release from female rat primary pituitary cells

In GH3 cells and other clonal rat pituitary tumor cells, TRH has been shown to mediate its effects on prolactin release via a rise of cytosolic Ca2+ and activation of protein kinase C. In this study, we examined the role of protein kinase C in TRH-stimulated prolactin release from female rat primary pituitary cell culture. Both TRH and PMA stimulated prolactin release in a dose-dependent manner. When present together at maximal concentrations, TRH and PMA produced an effect which was slightly less than additive. Pretreatment of rat pituitary cells with 10(-6) M PMA for 24 hrs completely down-regulated protein kinase C, since such PMA-pretreated cells did not release prolactin in response to a second dose of PMA. Interestingly, protein kinase C down-regulation had no effect on TRH-induced prolactin release from rat pituitary cells. In contrast, PMA-pretreated GH3 cells did not respond to a subsequent stimulation by either PMA or TRH. Pretreatment of rat pituitary cells with TRH (10(-7) M, 24 hrs) inhibited the subsequent response to TRH, but not PMA. Forskolin, an adenylate cyclase activator, stimulated prolactin release by itself and in a synergistic manner when incubated together with TRH or PMA. The synergistic effects of forskolin on prolactin release was greater in the presence of PMA than TRH. Down-regulation of protein kinase C by PMA pretreatment abolished the synergistic effect produced by PMA and forskolin but had no effect on those generated by TRH and forskolin. sn-1,2-Dioctanylglycerol (DOG) pretreatment attenuated the subsequent response to DOG and PMA but not TRH. The effect of TRH, but not PMA, on prolactin release required the presence of extracellular Ca2+. In conclusion, the mechanism by which TRH causes prolactin release from rat primary pituitary cells is different from that of GH3 cells; the former is a protein kinase C-independent process whereas the latter is at least partially dependent upon the activation of protein kinase C.

[Effects of caffeine on post-extrasystolic potentiation and mechanical restitution in mammalian papillary muscle]

The excitation-contraction coupling theory postulates that the main source of activator calcium is the sarcoplasmic reticulum that releases calcium in response to an electrical stimulus. This happens to be true in skeletal muscle, but recently several discrepancies have been raised about the validity of this hypothesis in cardiac muscle. These discrepancies are related to morphological as well as physiological data. The new information postulates that sarcoplasmic reticulum in cardiac muscle does not supply calcium as a main source in physiological conditions. The aim of the present paper was to evaluate the sarcoplasmic reticulum role in the supply of activator calcium in excitation-contraction coupling. A series of experiments were performed using the mechanical restitution and the post-extrasystolic potentiation models in the presence of caffeine, which is known to provoke functional elimination of the sarcoplasmic reticulum. It was observed that caffeine diminished the post-extrasystolic potentiation when 1 mM was used. At higher dose (4mM) the post-extrasystolic potentiation was completely abolished. On the other hand the late part of mechanical restitution is also abolished by caffeine. The amount of calcium that recirculates seems to increase in the presence of caffeine. The results obtained seem to support the idea that the sarcoplasmic reticulum has only a minor role in the supply of activator calcium, when physiological stimulation rates are used.

The relationship of plasma gonadotrophins and steroid concentrations to body growth in girls

Plasma concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17 alpha-hydroxyprogesterone (17 alpha-OHP), 17 beta-oestradiol (Oe2) and progesterone (P) were measured in 352 healthy girls aged 6.0 to 15.9 years, as a function of age (CA), weight, height and calculated lean body mass (LBM) and total body fat (TBF). The earliest hormonal changes were a fall in mean plasma FSH concentrations together with a small but significant rise in plasma Oe2 well in advance of any sign of pubertal development. The next changes were a progressive rise in plasma FSH and 17 alpha-OHP concentrations without further increments in plasma Oe2; these changes corresponded to a mean body weight of 29.8 kg, a mean height of 132.0 cm (initiation of the adolescent growth spurt), a mean LBM of 24.7 kg and a mean TBF of 5.1 kg. The last events were a progressive rise in plasma LH and Oe2 and less marked in P, which occurred in association with a mean body weight of 40.0 kg, a mean height of 142.0 cm (time of peak velocity of weight and height gain), a mean LBM of 31.8 kg and a mean TBF of 9.1 kg. Significant quadratic equations were disclosed between plasma FSH and LH versus CA, weight, height and LBM, and a significant linear correlation was observed between each gonadotrophin and TBF. These results show an association, not necessarily causal, between a 'critical level' of body composition and hormonal changes at the start of the adolescent growth spurt, as well as with late hormonal events at the time of peak velocity in weight and height gain. On the other hand, LBM rather than TBF seems more closely associated with the initiation and progression of puberty.

The relationship of plasma gonadotropins and androgen concentrations to body growth in boys

Plasma concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17 alpha-hydroxyprogesterone (17α-OPH), androstenedione (Δ4) and testosterone (T) were measured in 543 healthy boys aged 6.0 to 15.9 years (with weight and height between the 3rd and 97th percentile for Mexican standards) as a function of chronologic age (CA), weight, height, surface area (SA) and calculated lean body mass (LBM) and total body fat (TBF).

The earliest hormonal event was a clear rise in plasma 17α-OHP, either prior or simultaneously to at steady increase in plasma FSH, far ahead of any sign of puberty. These changes were closely followed by a continuous rise in plasma Δ4. Thereafter, there was a prolonged period of low but progressively increasing plasma FSH levels in the face of constantly low LH levels. However, a brisk rise in plasma LH and FSH occurred at a mean weight of 35.4 kg, at a height of 144.5 cm and when LBM was 32.0 kg. Simultaneously, plasma 17α-OHP began to fall, Δ4 reached a plateau and soon after, a marked rise in plasma T was documented. When plasma LH and FSH concentrations were plotted against CA, weight, height, SA and LBM a significant quadratic equation was disclosed in each case. Both gonadotrophins did not correlate with TBF. Multiple variance analysis demonstrated that LBM and SA had the most marked effect on LH, while LBM was the most important variable affecting plasma FSH concentrations. The present data suggest the association between a "critical level" of body composition and the major hormonal events in boys, regardless of a cause-effect relationship. A critical level of LBM (20–23 kg) and not of TBF was attained at time of the initial hormonal changes, as well as at the time of the major changes in plasma gonadotrophins (32–35 kg).

The treatment of heroin addiction: naltrexone alone and with behavior therapy

Recently, narcotic antagonists (drugs which block the euphoric effects of opiates) and behavior therapy have both been proposed as possible treatments for heroin addiction. In the present study the effectiveness of one particular antagonist, naltrexone, was examined under two conditions: (1) when administered alone, and (2) when administered in conjunction with behavior therapy. Measures of treatment effect included number of days on naltrexone, number of weeks in the program, reported side effects, and number of dirty urines in each treatment. While data initially indicated a superiority of the combined treatment program, this superiority faded over time. Results are discussed in terms of program start-up effects (especially when using experimental drugs), terms of process versus outcome measurement, and in terms of societal pressure operating against the success of heroin treatment in minority populations with poor job skills.

Comparison of two naltrexone treatment programs: naltrexone alone versus naltrexone plus behavior therapy

During a period of one year naltrexone was given to twenty-nine subjects. Fifteen of these subjects concurrently participated in a comprehensive behavior therapy program. The subjects in this naltrexone/behavior therapy group were maintanine on naltrexone for nearly twice as long as naltrexone group clients who received no therapy. If the chances for readdiction are reduced by increased time on naltrexone, then the data states the naltrexone should be dispensed as part of a broader therapeutic strategy. Follow-up data, which will be collected during the next year will test the validity of this hypothesis.