Importance of patellofemoral and tibiofemoral cartilage lesions on trajectory of self-reported outcomes in patients at high risk of knee OA: 4-6 years follow-up of patients undergoing meniscal surgery

OBJECTIVE

We evaluated whether patient-reported outcome trajectories (i.e., changes over time) differed by intraoperative compartmental cartilage lesion pattern over 4-6 years following arthroscopic meniscal surgery.

METHODS

In this ancillary study of the Knee Arthroscopy Cohort Southern Denmark cohort, we intraoperatively categorized cartilage lesions as isolated patellofemoral, isolated tibiofemoral, or combined patellofemoral/tibiofemoral. Participants completed the Knee injury and Osteoarthritis Outcome Score (KOOS) pre-operatively, at 3 and 12 months, and at 4-6 years post-operatively and reported overall satisfaction at final follow-up. Our main outcome was KOOS₄ (grand mean of four subscale means). We evaluated whether KOOS₄ scores changed over time according to cartilage lesion patterns using adjusted mixed linear regression. We also estimated probability of treatment satisfaction using logistic regression.

RESULTS

Of 630 participants with complete cartilage scores, 280 (44%) were women, mean (standard deviation) age was 49 (13) years, and BMI was 27.3 (4.4) kg/m². KOOS₄ scores at baseline were slightly lower in all lesion groups compared to the no lesion group, yet only the combined group was statistically significantly lower. KOOS₄ trajectories were similar across cartilage lesion patterns, but by final follow-up, adjusted mean KOOS₄ scores were 6.8 (95% CI 2.2, 11.4) to 9.8 (1.1, 18.5) points lower in groups with cartilage lesions compared to the no lesion group. Probability of patient-reported satisfaction did not differ statistically by group.

CONCLUSIONS

Though KOOS₄ scores were slightly lower in groups with arthroscopically assessed cartilage lesions compared to the no lesion group, trajectories were similar across all groups.

Geographic hierarchical population genetic structuring in British European whitefish (Coregonus lavaretus) and its implications for conservation

The European whitefish Coregonus lavaretus complex represents one of the most diverse radiations within salmonids, with extreme morphological and genetic differentiation across its range. Such variation has led to the assignment of many populations to separate species. In Great Britain, the seven native populations of C. lavaretus (two in Scotland, four in England, one in Wales) were previously classified into three species, and recent taxonomic revision resurrected the previous nomenclature. Here we used a dataset of 15 microsatellites to: (1) investigate the genetic diversity of British populations, (2) assess the level of population structure and the relationships between British populations. Genetic diversity was highest in Welsh (HO = 0.50, AR = 5.29), intermediate in English (HO = 0.41–0.50, AR = 2.83–3.88), and lowest in Scottish populations (HO = 0.28–0.35, AR = 2.56–3.04). Population structure analyses indicated high genetic differentiation (global FST = 0.388) between all populations but for the two Scottish populations (FST = 0.063) and two English populations (FST = 0.038). Principal component analysis and molecular ANOVA revealed separation between Scottish, English, and Welsh populations, with the Scottish populations being the most diverged. We argue that the data presented here are not sufficient to support a separation of the British European whitefish populations into three separate species, but support the delineation of different ESUs for these populations.

Reproducibility of the stability-based classification for ankle fractures

BACKGROUND

Classification of ankle fracture is important when deciding for operative or conservative treatment. This study rates the reproducibility of ankle stability assessment and compares it with the classification by Lauge-Hansen and Arbeitsgemeinschaft für Osteosyntesefragen (AO) in adult patients with primary ankle fractures.

METHODS

A total of 496 consecutive ankle fractures were included, and the X-ray images were reviewed 2 times by 2 medical students, 2 residents, and 1 consultant in orthopedic traumatology. The raters were blinded to each other and to their own results. Unweighted Kappa statistics were used to assess reproducibility.

RESULTS

Overall mean (95% CI) interrater Kappa results were 0.65 (0.64; 0.68) for Lauge-Hansen, 0.62 (0.60; 0.63) for AO and 0.61 (0.57; 0.62) for the stability assessment. The intrarater results ranged from a mean Kappa of 0.64-0.80 for the medical students, 0.65-0.81 for the residents and 0.82-0.84 for the consultant.

CONCLUSION

The stability assessment has substantial to almost-perfect agreement which is comparable to the Lauge-Hansen and AO classifications.

Histopathological characterisation of retinal lesions associated to Diplostomum species (Platyhelminthes: Trematoda) infection in polymorphic Arctic charr Salvelinus alpinus

The eye represents an immune privileged organ where parasites can escape host reactions. This study provides the first systematic evidence of the pathology associated with Diplostomum sp. infection in the eye retina of fish (i.e. Arctic charr). Histological sections showed that the trematodes caused mechanical disengagement between the retinal pigmentary epithelium and the neurosensory retina, with damaged cones and rods in the outer segment and epithelium reduced to a single layer of pigmentary cells. The metacercariae were “floating” in possibly fluid-filled vesicles together with several round cells, mostly located in the anterio-dorsal and anterio-ventral areas of the eye near the iris. The round cells may indicate internal retinal damage repair mechanisms, without connections to the general immune system. Metacercariae intestines contained pigmented cellular debris indicating that they feed on retinal epithelium. These retinal lesions may have similar vision effects as focal retinal detachment in vertebrates. Diplostomum metacercaria alters fish visual acuity but may in a lesser degree lead to a severe or total visual impairment because of repairing mechanisms. The pathology in the retina seems thereby to be dependent on fish size, age and dose.

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Histological description of the distribution of Diplostomum in the eye of Arctic charr Salvelinus alpinus.

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Metacercaria specifically located in spaces formed between the retinal pigmentary epithelium and the neurosensory retina.

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Lesions display closer similarities with those observed in retinal detachment in other species.

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Changes in the frequency and distribution of the lesions between morphs are suggested.

[Slipped capital femoral epiphysis is diagnosed too late]

Slipped capital femoral epiphysis (SCFE) is a serious orthopaedic hip disease in the adolescent population. It has a prevalence of 10.8 per 100.000 children and usually occurs in children 9-16 years of age. Despite focus on delay of the diagnosis, no improvements have been made. An adolescent complaining of stress-related pain in the hip, groin, thigh or knee should be suspected of having SCFE, until an X-ray has excluded this diagnosis. Delayed diagnosis may have serious consequences in terms of further displacement of the femoral head and risk of increased avascular necrosis.

Are hybrids between Atlantic salmon and brown trout suitable long-term hosts of Gyrodactylus salaris during winter?

The monogenean parasite Gyrodactylus salaris poses serious threats to many Atlantic salmon populations and presents many conservation and management questions/foci and challenges. It is therefore critical to identify potential vectors for infection. To test whether hybrids of native Atlantic salmon (Salmo salar) × brown trout (Salmo trutta) are suitable as reservoir hosts for G. salaris during winter, infected hybrid parr were released into a natural subarctic brook in the autumn. Six months later, 23.9% of the pit-tagged fish were recaptured. During the experimental period, the hybrids had a sixfold increase in mean intensity of G. salaris, while the prevalence decreased from 81% to 35%. There was high interindividual hybrid variability in susceptibility to infections. The maximum infrapopulation growth rate (0.018 day^-1 ) of G. salaris throughout the winter was comparable to earlier laboratory experiments at similar temperatures. The results confirm that infrapopulations of G. salaris may reproduce on a hybrid population for several generations at low water temperatures (~1 °C). Wild salmon-trout hybrids are undoubtedly susceptible to G. salaris and represent an important reservoir host for the parasite independent of other co-occurring susceptible hosts. Consequently, these hybrids may pose a serious risk for G. salaris transmission to nearby, uninfected rivers by migratory individuals.

A simplified method to estimate Diphyllobothrium spp. infection in salmonids

Some fish parasites constitute severe management problems as they may cause mortality of their fish host or are important zoonoses of humans. Parasite assessments are therefore critical to keep track of infections. If conventional sampling techniques can be simplified, parasite assessments might be easier to obtain, less time-consuming and more extensive. In this study, we compare the assessed number of Diphyllobothrium spp. cysts (CYST) with the counted number of Diphyllobothrium spp. plerocercoid larvae recovered using a conventional digestive technique (LARV). The aim was to determine the potential of using CYST as a simplified methodology for assessing Diphyllobothrium spp. infection in salmonids. In total, 365 brown trout and 424 Arctic charr were sampled from nine lakes in subarctic Norway. Strong correlation, significant linear relationship and large amount of explained variation were found between log₁₀ CYST and log₁₀ LARV in both fish species. The method had a slight, but not significant tendency to work better in charr compared to trout. In addition, absolute difference between CYST and LARV increased at parasite intensities >100 indicating that the method has reduced functionality when estimating parasite intensity in heavily infected salmonid populations. However, overall, using this simplified and less time-consuming methodology, a good indication of Diphyllobothrium spp. intensity, abundance and prevalence was obtained. We suggest that this method provides a sound proxy of the Diphyllobothrium spp. burden and have the potential to be used in parasite assessment during fish monitoring and fisheries management surveys, particularly if the time and resources for detailed parasite studies are not available.

[PARASITES FAUNA OF THE LAKE KRONOTSKOE CHARRS (SALVELINUS), KAMCHATKA]

The new data on the parasites fauna of the Lake Kronotskoe sympatric charr forms (genus Salvelinus (Nilsson) Richardson, 1836) is presented. Parasites fauna of Bigmouth and Smallmouth charr forms are described for the first time. The information about Longhead charr, Nosed charr and White charr parasites is added. 29 species of parasites from 9 classes were found: Oligohymenophorea, Myxosporea, Monogenea, Trematoda, Cestoda, Nematoda, Acantocephala, Crustacea and Hirudinea. Longhead charr was the most intensively infected by Proteocephalus longicollis (Zeder, 1800) (abundance 306.0) and Neoechinorhynchus salmonis Ching, 1984 (abundance 230.0). White charr was mostly infected by Crepidostomum Braun, 1900 (abundance 242.2) and P. longicollis (abundance 183.4). Nosed charr group that feed on gammarids was infected mostly by Crepidostomum spp. (abundance 3461.3), Cyathocephalus truncatus (Pallas, 1781) (abundance 179.9) and Cystidicola farionis Fisher, 1798 (abundance 169.0); while Chironomidae consumers group was infected mostly by Diplostomum Nordmann, 1832 (abundance 62.3) and Phyllodistomum umblae (Fabricius, 1780) (abundance 27.3). Bigmouth charr was infected mostly by P. longicollis (abundance 17.0) and Eubolhrium salvelini Schrank, 1790 (abundance 11.0), Smallmouth charr form — by P. longicollis (abundance 67.0) and Diplostomum sp. (abundance 64.2). Sympatric flock of charrs form the Lake Kronotskoe (Kamchatka) is the most polymorphic for the genus Salvelinus in Eurasia. According to the parasitological analysis this flock consists six ecological forms.

Effects of fish species composition on Diphyllobothrium spp. infections in brown trout - is three-spined stickleback a key species?

Subarctic populations of brown trout (Salmo trutta) are often heavily infected with cestodes of the genus Diphyllobothrium, assumedly because of their piscivorous behaviour. This study explores possible associations between availability of fish prey and Diphyllobothrium spp. infections in lacustrine trout populations. Trout in (i) allopatry (group T); (ii) sympatry with Arctic charr (Salvelinus alpinus) (group TC); and (iii) sympatry with charr and three-spined stickleback (Gasterosteus aculeatus) (group TCS) were contrasted. Mean abundance and intensity of Diphyllobothrium spp. were higher in group TCS compared to groups TC and T. Prevalence, however, was similarly higher in groups TCS and TC compared to group T. Zero-altered negative binomial modelling identified the lowest probability of infection in group T and similar probabilities of infection in groups TC and TCS, whereas the highest intensity was predicted in group TCS. The most infected trout were from the group co-occurring with stickleback (TCS), possibly due to a higher availability of fish prey. In conclusion, our study demonstrates elevated Diphyllobothrium spp. infections in lacustrine trout populations where fish prey are available and suggests that highly available and easily caught stickleback prey may play a key role in the transmission of Diphyllobothrium spp. parasite larvae.

Inter and intra-population phenotypic and genotypic structuring in the European whitefish Coregonus lavaretus, a rare freshwater fish in Scotland

This study revealed between-lake genetic structuring between Coregonus lavaretus collected from the only two native populations of this species in Scotland, U.K. (Lochs Eck and Lomond) evidenced by the existence of private alleles (12 in Lomond and four in Eck) and significant genetic differentiation (FST = 0·056) across 10 microsatellite markers. Juvenile C. lavaretus originating from eggs collected from the two lakes and reared in a common-garden experiment showed clear phenotypic differences in trophic morphology (i.e. head and body shape) between these populations indicating that these characteristics were, at least partly, inherited. Microsatellite analysis of adults collected from different geographic regions within Loch Lomond revealed detectable and statistically significant but relatively weak genetic structuring (FST = 0·001-0·024) and evidence of private alleles related to the basin structure of the lake. Within-lake genetic divergence patterns suggest three possibilities for this observed pattern: (1) differential selection pressures causing divergence into separate gene pools, (2) a collapse of two formerly divergent gene pools and (3) a stable state maintained by balancing selection forces resulting from spatial variation in selection and lake heterogeneity. Small estimates of effective population sizes for the populations in both lakes suggest that the capacity of both populations to adapt to future environmental change may be limited.

Transmission dynamics of the monogenean Gyrodactylus salaris under seminatural conditions

Tracking individual variation in the dynamics of parasite infections in wild populations is often complicated by lack of knowledge of the epidemiological history of hosts. Whereas the dynamics and development of Gyrodactylus salaris Malmberg, 1957, on Atlantic salmon, Salmo salar L., are known from laboratory studies, knowledge about infection development on individual wild fishes is currently sparse. In this study, the dynamics of an infection of G. salaris on individually marked Atlantic salmon parr was followed in a section of a natural stream. During the 6-week experiment, the prevalence increased from 3.3 to 60.0%, with an average increase in intensity of 4.1% day(-1) . Survival analyses showed an initially high probability (93.6%) of staying uninfected by G. salaris, decreasing significantly to 37% after 6 weeks. The results showed that even at subarctic water temperatures and with an initially low risk of infection, the parasite spread rapidly in the Atlantic salmon population, with the capacity to reach 100% prevalence within a short summer season. The study thus track individual infection trajectories of Atlantic salmon living under near-natural conditions, providing an integration of key population parameters from controlled experiments with the dynamics of the epizootic observed in free-living living populations.

[Traumatic cervical disc prolapse with severe neurological impact]

A 51-year-old male drove into a ditch on his scooter. Immediately after the trauma the patient complained of neck pain and decreased ability to feel and move his extremities. An initial trauma computed tomography (CT) of the columna showed normal conditions. Because the patient had neurological deficiencies, magnetic resonance imaging of the columna was performed 12 days later, and a disc prolapse at the C3/C4 level with spinal cord compression was visible. Despite decompression the patient did not recover. Traumatic cervical disc prolapse is a rare and positionally dangerous condition, which can be present despite a CT showing normal conditions.

High rate of complications following volar plating of distal radius fractures

INTRODUCTION

Fracture of the distal radius (DRF) is one of the most common fractures treated by orthopaedic surgeons. The most common operative treatments of these fractures are open reduction and internal fixation. The incidents and types of complications associated with the use of these operations have not been studied in detail.

MATERIAL AND METHODS

We performed a retrospective study documenting types of complications and their occurrence in a group of patients who received open reduction and internal fixation. Our definition of a complication was a case in which the patient had one or more complications which required an operation, or suffered from complex regional pain syndrome, or skin healing problems lasting more than four weeks from the operation.

RESULTS

A total of 165 patients were included. In all, 39 complications in 30 wrists were registered: i.e. 18% had a minimum of one complication.

CONCLUSION

Our finding that 18% suffer from a serious complication when treated using a volar locking plate must be taken into consideration when surgeons choose between conservative or operative treatment for DRF treatment. A few other studies have looked at the incidents of complications and have reported similar results.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

[Snapping pes syndrome with a loose bone fragment is a rare cause for medial knee pains]

A case of a patient with snapping pes syndrome following a blunt trauma to the knee is presented. Snapping pes syndrome is a painful catching experienced at the posteromedial corner of the knee from pes anserinus when moving from flexion to extension. Since the accident ten years ago the patient experienced a painful snapping phenomenon on the inner side of the knee. MRI and arthroscopies found no explanation. Ultrasound revealed that the semitendinosus snapped over a bony fragment during extension of the knee. Removal of the fragment resulted in remission.

Validation of the Ottawa ankle rules in a Danish emergency department

INTRODUCTION

The Ottawa ankle rules (OAR) is a tool physicians may use to determine whether or not to perform an x-ray after an ankle or midfoot distortion or blunt trauma to these structures. The rationale of using the OAR is to exclude a fracture by means of clinical examination without resort to x-rays, and thereby limiting the use of x-rays, time, costs, etc. The principle of the OAR is that an ankle x-ray is only required when there is bone tenderness along the distal six centimetres of the posterior part of the medial or lateral malleolus, or when the patient is unable to bear weight immediately after the accident and in the emergency department (ED). Similarly, an x-ray of the midfoot is required only when there is bone tenderness at the base of the 5th metatarsal or the navicular bone, or when the patient is unable to bear weight immediately after the accident and also in the ED. Our hypothesis was that by introducing the OAR, we would reduce the use of x-rays without increasing the number of missed fractures.

MATERIAL AND METHODS

The study was designed as an intervention study with 882 patients in the control group and 1,014 patients in the intervention group. The intervention consisted of several OAR implementation measures.

RESULTS

Before use of the OAR, 62% had an x-ray taken. This proportion was reduced to 57% with the introduction of the OAR. We registered a significant reduction (p < 0.001) in x-ray without increasing the number of missed fractures.

CONCLUSION

The OAR may reduce the number of x-rays and possibly also save costs and time if implemented in Denmark.

[Münchhausen's syndrome--a diagnosis to remember]

We hereby report a case of self mutilation against the right upper extremity in a 26-year-old male. The condition started after a minor trauma. After a few days the diagnosis compartment syndrome was suspected and a fasciectomy of the forearm was performed. The patient subsequently claimed that he had experienced further symptoms. Despite countless investigations, it was not possible to identify the course of the patient's symptoms. It has become clear that the patient suffers from >>Münchhausen's syndrome<<.

Experiments to test if allopatric Salvelinus alpinus are suitable year-round hosts of Gyrodactylus salaris (Monogenea)

There has been an increased focus on Salvelinus alpinus as a potential long-term host to Gyrodactylus salaris and, here, both susceptibility to G. salaris and ability to sustain a parasite population seasonally, was tested using fry and parr of S. alpinus from the River Skibotnelva, northern Norway. Fry were highly susceptible. Gyrodactylus salaris survived on allopatric S. alpinus parr during the 5 month-long winter when water temperatures were c. 1 degrees C. Salvelinus alpinus fry also maintained a pulse of G. salaris infection for over 155 days from early May until autumn. Gyrodactylus salaris are thus able to reproduce and survive on S. alpinus for long periods and at low water temperatures. In spring, newly hatched fry of S. alpinus may serve as an important host to maintain a G. salaris metapopulation within a river system. The results suggest that S. alpinus are adequate long-term hosts of G. salaris independent of the presence of the co-occurring highly susceptible S. salar.

[Surgical treatment of tennis elbow]

INTRODUCTION

Surgical treatment of lateral epicondylitits (LE) has not been investigated sufficiently to allow general guidelines, nor has non-invasive treatment produced sufficiently good results. We present the results of 31 mini-tenotomies performed to treat lateral epicondylitis.

MATERIALS AND METHODS

We performed a retrospective follow-up study of 31 elbows treated with mini-tenotomy for LE. The average period with symptoms was 125 weeks, the average follow-up 73 weeks. The mini-tenotomies were performed under local anaesthesia and the extensor aponeurosis was cut close to the epicondyl.

RESULTS

A total of 27 of 31 patients reported that their LE had become much better or that all the pain had gone. The Quick DASH score decreased from 66 preoperatively to 13 at the follow-up (p < 0.001). Surgery achieved its maximal effect on average four weeks after surgery. Two patients experienced that the pain came back.

CONCLUSION

A prospective randomised investigation is warranted; yet, the present results indicate that mini-tenotomy could be a promising treatment for a selected group with isolated LE.

Constrained liners for recurrent dislocations in total hip arthroplasty

This study reports the results and complications from treating recurrent hip dislocations with a constrained liner (CL) after total hip arthroplasty (THA). Forty patients who had a CL inserted as a secondary prophylactic treatment were retrospectively reviewed after a median observation period of 27 months (range 7-77 months). During the observation period five patients had to be revised: one for deep infection and four on account of re-dislocations. Our results indicate that patients with recurrent THA dislocations can be treated with a CL and has a satisfactory low complication rate and a relatively low risk of re-dislocation.

Parallel evolution of ecomorphological traits in the European whitefishCoregonus lavaretus(L.) species complex during postglacial times

The extensive phenotypic polymorphism in the European whitefish has triggered evolutionary research in order to disentangle mechanisms underlying diversification. To illuminate the ecological distinctiveness in polymorphic whitefish, and evaluate taxonomic designations, we studied nine Norwegian lakes in three watercourses, which each harboured pairs of divergent whitefish morphs. We compared the morphology and life history of these morphs, documented the extent of genetic differentiation between them, and contrasted the niche use of sympatric morphs along both the habitat and resource axes. In all cases, sympatric morphs differed in the number of gill rakers, a highly heritable trait related to trophic utilization. Individual growth rate, age and size at maturity, diet and habitat use also differed between morphs within lakes, but were remarkably similar across lakes within the same morph. Microsatellite analyses confirmed for all but one pair that sympatric morphs were significantly genetically different, and that similar morphs from different lakes likely have a polyphyletic origin. These results are most compatible with the process of parallel evolution through recurrent postglacial divergence into pelagic and benthic niches in each of these lakes. We propose that sparsely and densely rakered whitefish sympatric pairs may be a likely case of ecological speciation, mediated in oligotrophic lakes with few trophic competitors.

Selective predation on parasitized prey--a comparison between two helminth species with different life-history strategies

In Lake Fjellfrøsvatn, northern Norway, the larval helminths Cyathocephalus truncatus and Cystidicola farionis use Gammarus lacustris as intermediate hosts and Arctic charr (Salvelinus alpinus) as final hosts. There was sampled 1,433 live G. lacustris from the lake and 1,964 G. lacustris from stomach contents of the charr. Prevalence of infection were, respectively, 0.49% and 3.72% for C. truncatus, and 0.21% and 0.20% for C. farionis. Usually, only 1 parasite was present in each host, and the 2 parasite species never co-occurred. Gammarus lacustris amphipods parasitized by C. truncatus were positively selected by the Arctic charr and were consumed approximately 8 times as often as were the unparasitized amphipods or the amphipods infected with C. farionis. This suggests that G. lacustris amphipods infected with C. truncatus larvae are more susceptible to predation than noninfected specimens, probably because of parasite-induced alterations in behavior or visibility. Alternatively, this could also be explained by selection toward the largest G. lacustris specimens observed, which are also the most frequently parasitized amphipods. However, the data show clearly that this was not a result of size-selective predation by the charr. In contrast, the presence of C. farionis did not increase the susceptibility to predation of its intermediate host. The discrepancy between the 2 helminth species supports the hypothesis that parasite-increased susceptibility to predation is related to the life history strategies of the parasites.

Parasite communities in two sympatric morphs of Arctic charr, Salvelinus alpinus (L.), in northern Norway

In this study from Fjellfrøsvatn, an oligotrophic lake in northern Norway, the parasite communities in two sympatric Arctic charr populations were compared. The dwarf morph, which inhabits the profundal zone, exhibited the lowest parasite diversity, seven species, and 72% of these charr harboured only one or two parasite species. In contrast, 10 parasite species were encountered in the larger normal charr, and between 5 and 8 species were present in 73% of these fish, which also utilised a broader food and habitat niche. Proteocephalus sp. was by far the most abundant species in the dwarf charr, probably because this morph fed intensively upon the benthic copepod Acanthocyclops gigas. On the other hand, parasites that are transmitted with littoral benthic prey (i.e., Phyllodistomum umblae, Cyathocephalus truncatus, Cystidicola farionis, and Crepidostomum spp.) were almost absent in the dwarf charr, though they were common in the normal morph. Also, Diphyllobothrium spp. were more prevalent in the normal charr, and this was attributed to their feeding upon limnetic copepods in the pelagic zone. The only recorded parasite with a direct life cycle, the copepod Salmincola edwardsii, had relatively similar abundances in the two morphs. The considerable differences in parasite community structure and abundance between the two charr populations were closely related to differences in the width and composition of the habitat and food niches between the morphs.

Patterns of coverage. Uniform versus graded density

The goal of hair restoration surgery is undetectability. Anything that is unnatural or draws attention to itself is to be avoided. In extensive baldness (Norwood V1-V11) various patterns of coverage with grafting can be constructed. Principally they fall into either the graded or uniform density approaches. If the goal is to provide coverage of the entire area of extensive baldness, the uniform density approach offers the less noticeable result because it draws no attention to any particular part of the balding scalp. If the goal is to provide only frontal forelock reconstruction, both approaches are advocated. In less than ideal grooming situations such as in the wind, exercise, or swimming however, the uniform density approach appears to offer a less noticeable result.

Fear of injections and report of negative dentist behavior among Caucasian American and Taiwanese adults from dental school clinics

Fear of injections and reports of negative dentist behavior and associations with dental anxiety and avoidance of treatment were explored among 951 adults from dental school clinics in Iowa City, Iowa and Taipei, Taiwan. Use and fear of anesthetic injections and negative dentist behavior were assessed by written questionnaire to test associations with demographics, overall dental anxiety (Dental Anxiety Scale or "DAS") and utilization behaviors. Frequency and logistic regression analyses showed that use of dental anesthetics for routine treatment was much greater overall among caucasian Americans than Taiwanese, as was fear of injections. Taiwanese and Americans with high dental anxiety (DAS 12) had similar high fear of injections, but inspite of similar fears about dental drilling, high anxiety Taiwanese reported using much less local anesthesia for routine treatments than did high anxiety Americans. Report of condescending remarks to patients ("put downs") by dentists was mainly an American phenomenon associated with high dental anxiety. Avoidance of appointment making was high for persons afraid of injections and for Americans reporting negative dentist behavior. Avoidance was highest in subjects with high dental anxiety. That predominant characteristics or etiologies of dental anxiety can differ by cultural differences in dental health care systems, dentist beliefs and/or expectations of patients within those systems was discussed in relation to the literature.

Isolation of border disease virus from twin lambs in Alberta

We describe herein a field case of border disease (BD) in twin lambs. Both lambs were unthrifty, stunted, and one exhibited nervous signs characteristic of BD, with tremors of the head, neck, hind legs, and pelvis. Hairiness of the coat and excessive pigmentation, often seen in lambs with BD, were not observed. A noncytopathic virus, which showed cross-reactivity with bovine viral diarrhea (BVD) virus antiserum and BVD virus monoclonal antibodies, was isolated repeatedly from leukocytes from one lamb and from tissues of the other. Although the source of the virus is unknown, our results suggest that the dam of the affected twins had been infected during pregnancy. We used the BD virus isolated to inoculate pregnant ewes and experimentally reproduce the disease in a newborn lamb. Our findings indicate that leukocytes, rather than serum, should be utilized for BD virus isolation. Further, it is recommended that BD virus, rather than BVD virus, be used in serum neutralization tests when screening sheep for antibody titers.

Neurotensin-induced contractions in venous smooth muscle

Synthetic neurotensin was shown to be a powerful contractant of the isolated rat portal vein. Concentration-dependent increases in basal tension and frequency of spontaneous contractions were obtained in response to single dose (10-1000 nM, final bath concentrations). The responses reached maxima within 2 min and differed in this respect from comparable responses to angiotensin II, substance P and bradykinin, which were maximal after 2-4 min. The "apparent affinity" for neurotensin (pD2 = 7.5 +/- 0.3, S.D., n = 10) was about 10 times less than for angiotensin II while higher than for both the other peptides and for norepinephrine. The "intrinsic activity" was 0.75 (+/- 0.13, S.D., n = 6) relative to angiotensin II during the first 2 min of the response. A pronounced degree of tachyphylaxis was observed; repetition of the neurotensin dose at the lower range of concentrations (1-10 nM) within 2-4 min was completely ineffective. The results suggest that there is a specific neurotensin receptor in the tissue and that neurotensin-induced contractions may play a part in redistributing the blood flow in the gastrointestinal region following release of this peptide from the ileum into the portal circulation.