Commitment to Hypertension Control During the COVID-19 Pandemic: Million Hearts Initiative Exemplars

Hypertension is a major risk factor for cardiovascular diseases, but 3 of 4 US adults do not have their blood pressure adequately controlled. Million Hearts (US Department of Health and Human Services) is a national initiative that promotes a set of priorities and interventions to optimize delivery of evidence-based strategies to manage cardiovascular disease, including hypertension. The COVID-19 pandemic, however, has disrupted routine care and preventive service delivery. We identified examples of clinical and health organizations that adapted services and care processes to continue a focus on monitoring and controlling hypertension during the pandemic. Eight Hypertension Control Exemplars were identified and interviewed. They reported various adapted care strategies including telemedicine, engaging patients in self-measured blood pressure monitoring, adapting or implementing medication management services, activating partnerships to respond to patient needs or expand services, and implementing unique patient outreach approaches. Documenting these hypertension control strategies can help increase adoption of adaptive approaches during public health emergencies and routine care.

Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models

Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

Sex Differences in Pulmonary Eicosanoids and Specialized Pro-Resolving Mediators in Response to Ozone Exposure

Ozone (O3) is a criteria air pollutant known to increase the morbidity and mortality of cardiopulmonary diseases. This occurs through a pulmonary inflammatory response characterized by increased recruitment of immune cells into the airspace, pro-inflammatory cytokines, and pro-inflammatory lipid mediators. Recent evidence has demonstrated sex-dependent differences in the O3-induced pulmonary inflammatory response. However, it is unknown if this dimorphic response is evident in pulmonary lipid mediator metabolism. We hypothesized that there are sex-dependent differences in lipid mediator production following acute O3 exposure. Male and female C57BL/6J mice were exposed to 1 part per million O3 for 3 hours and were necropsied at 6 or 24 hours following exposure. Lung lavage was collected for cell differential and total protein analysis, and lung tissue was collected for mRNA analysis, metabololipidomics, and immunohistochemistry. Compared to males, O3-exposed female mice had increases in airspace neutrophilia, neutrophil chemokine mRNA, pro-inflammatory eicosanoids such as prostaglandin E2, and specialized pro-resolving mediators (SPMs) such as resolvin D5 in lung tissue. Likewise, precursor fatty acids (arachidonic and docosahexaenoic acid; DHA) were increased in female lung tissue following O3 exposure compared to males. Experiments with ovariectomized females revealed that loss of ovarian hormones exacerbates pulmonary inflammation and injury. However, eicosanoid and SPM production were not altered by ovariectomy despite depleted pulmonary DHA concentrations. Taken together, these data indicate that O3 drives an increased pulmonary inflammatory and bioactive lipid mediator response in females. Furthermore, ovariectomy increases susceptibility to O3-induced pulmonary inflammation and injury, as well as decreases pulmonary DHA concentrations.

Characteristics of Health Care Practices and Systems That Excel in Hypertension Control

Approximately 1 in 3 US adults has hypertension, but only half have their blood pressure controlled. We identified characteristics of health care practices and systems (hereinafter practices) effective in achieving control rates at or above 70% by using data collected via applications submitted from April through June 2017 for consideration in the Million Hearts Hypertension Control Challenge. We included 96 practices serving 635,000 patients with hypertension across 34 US states in the analysis. Mean hypertension control rate was 77.1%; 27.1% of practices had a control rate of 80% or greater. Although many practices served large populations with multiple risk factors for uncontrolled hypertension, high control rates were achieved with implementation of evidenced-based strategies.

Widespread recent increases in county-level heart disease mortality across age groups

PURPOSE

Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group.

METHODS

Using a Bayesian statistical model and National Vital Statistics Systems data, we estimated overall rates and percent change in heart disease mortality from 2010 through 2015 for four age groups (35-44, 45-54, 55-64, and 65-74 years) in 3098 US counties.

RESULTS

Nationally, heart disease mortality declined in every age group except ages 55-64 years. County-level trends by age group showed geographically widespread increases, with 52.3%, 58.5%, 69.1%, and 42.0% of counties experiencing increases with median percent changes of 0.6%, 2.2%, 4.6%, and -1.5% for ages 35-44, 45-54, 55-64, and 65-74 years, respectively. Increases were more likely in counties with initially high heart disease mortality and outside large metropolitan areas.

CONCLUSIONS

Recent national trends have masked local increases in heart disease mortality. These increases, especially among adults younger than age 65 years, represent challenges to communities across the country. Reversing these trends may require intensification of primary and secondary prevention-focusing policies, strategies, and interventions on younger populations, especially those living in less urban counties.

Low body mass not vitamin D receptor polymorphisms predict osteoporosis in patients with inflammatory bowel disease

BACKGROUND

Osteoporosis is a recognized complication of inflammatory bowel disease (IBD). Aim To investigate the role of environmental factors and vitamin D receptor (VDR) variants on the prevalence of osteoporosis.

METHODS

DEXA scans and case note review were performed on 440 IBD patients from 1997 to 2006. All the IBD patients and 240 healthy controls were genotyped for VDR variants Taq-1 and Apa-1 using PCR-RFLP.

RESULTS

Osteoporosis and osteopenia rates were 15% and 18% for IBD, 16% and 18% for Crohn's disease (CD) and 13% and 19% for ulcerative colitis, respectively. On univariate analysis of the CD patients, low body mass index (BMI, <18.5) and smoking status (P = 0.008 and 0.005 respectively) were associated with osteoporosis and osteopenia. Low BMI was also associated with osteoporosis on multivariate analysis in CD (P = 0.021, OR 5.83, CI 1.31-25.94). No difference was observed between Taq-1 and Apa-1 VDR polymorphisms in IBD, CD, ulcerative colitis and healthy controls. However, CD males were more likely to carry the variant Taq-1 polymorphism than healthy controls males (P = 0.0018, OR 1.94, CI 1.28-2.92) and female CD patients (P = 0.0061, OR 1.60, CI 1.17-2.44).

CONCLUSIONS

In this well-phenotyped cohort of IBD patients, a relatively low prevalence of osteoporosis was observed. Low BMI was the only independent risk factor identified to be associated with osteoporosis.

Report from the CDC. Pap test intervals used by physicians serving low-income women through the National Breast and Cervical Cancer Early Detection Program

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the Centers for Disease Control and Prevention (CDC), provides breast and cervical cancer screening to low-income women who are uninsured or underinsured. For women with three consecutive annual Pap tests with normal findings, the NBCCEDP supports extending the screening interval to every 3 years. Thirteen telephone focus groups were conducted with physician providers in 17 states and the District of Columbia to investigate familiarity with NBCCEDP's triennial Pap test policy, the Pap test intervals actually used, and the factors influencing screening interval selection. No participants were familiar with NBCCEDP's triennial Pap test policy, and none reported routinely extending the screening interval after three consecutive annual Pap tests with normal findings. Two patterns of screening interval use were reported: annual screeners continued performing yearly Pap tests, and selective extended screeners offered an extended interval to select patients. Annual and selective extended screeners reported that both unique and common factors influenced the screening intervals they used. The NBCCEDP has established its cancer screening priorities to focus limited resources on the goal of providing services to eligible women who have rarely or never been screened. Increased efforts are needed to educate physicians about the science supporting an extended Pap screening interval and overcome the barriers associated with its adoption.

Clinical breast examination: practical recommendations for optimizing performance and reporting

Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer.

The effect of DXA scanning on clinical decision making by general practitioners: a randomized, prospective trial of direct access versus referral to a hospital consultant

The objective of the study was to assess the impact of direct access DXA scanning (DADS) upon GPs' management decisions in patients considered to be at risk of osteoporosis. It was designed as a randomized, prospective, parallel group trial, set within the primary care environment and a university teaching hospital. The participants were 330 patients aged 31 to 89 years from 18 general practices in Edinburgh. Patients were randomized to either DADS or to the current system of specialist referral (controls). The primary outcome measure was frequency of change of management after DXA scanning. Secondary outcome measures were: change in health status, adherence to therapy, clinical events and resource use at one-year follow-up. The primary outcome was that 60% each of DADS patients (98/165) and controls (99/165) had changes in management following DXA scanning. In 30% of patients (12/41) in whom GPs had proposed changing management even in the absence of a scan, different therapy was chosen after the scan (no difference between DADS and control groups). There was an improvement in health utility (p =0.014 for both groups combined), differing slightly between the two groups even after age correction (p =0.014). 68% of the DADS group and 70% of controls were adherent to therapy after one year. In terms of clinical events, at one year there was one major adverse event (control group patient), 5 new fractures in the DADS group and 3 in controls - there were no hip fractures in this study. With regard to resource use, there were 24 referrals to hospital specialist after DXA scanning among the DADS group, vs 12 among controls (p < 0.05). The total number of visits to health professionals was 525 in DADS and 585 in controls (p=ns); mean waiting time from randomization to receipt of report/clinic letter was 4 weeks for DADS vs 13 weeks for controls( p < 0.0001). In conclusion, DXA scanning resulted in management change in at least 60% of cases. Direct access does not result in a clinical outcome significantly different from a consultant led service, and is more economically efficient than the current model of hospital referral.

Structure of complement receptor (CR) 2 and CR2-C3d complexes

Using X-ray crystallography, we have determined the structure of the first two short consensus repeats (SCRs) of human complement receptor (CR) 2 in complex with C3d. These studies revealed: (i) a primary site of interaction for C3d within SCR2 of CR2, (ii) a hydrophobic patch holding SCR1 to SCR2 in a rigid V-shape, (iii) a dimer formed by interactions between SCR1 of each molecule, (iv) several non-linear sequences on C3d that interact with CR2 and (v) mutations of C3d amino acids within the co-crystal interface that resulted in decreased binding. In addition, a polymorphism that results in decreased C3d binding and introduces a new glycosylation site predicted to disrupt the dimer interface was found in the New Zealand White autoimmune mouse strain. Although the co-crystal complex results are in agreement with a subset of prior studies, our additional findings, which demonstrate an extended SCR1-SCR2 structure in solution and differences in the kinetics of ligand-receptor interactions with longer forms of CR2, have suggested a more complex receptor-ligand interaction. To characterize this interaction further, several approaches directed at the determination of solution phase interactions as well as the analysis of the three-dimensional structure of CR2 alone and key CR2 mutants will be necessary.

Solution structures of complement components by X-ray and neutron scattering and analytical ultracentrifugation

The short consensus/complement repeat (SCR) domain (also known as the complement control protein domain) is the most abundant domain type in the complement system. Crystal and NMR structures for proteins that contain single and multiple SCR domains have now been published. These contain inter-SCR linkers of between three and eight residues, and the structures show much variability in inter-SCR orientations. X-ray and neutron scattering, combined with analytical ultracentrifugation and constrained modelling based on known subunit structures will yield a medium-resolution structure for the protein of interest. The fewer parameters that are associated with the structure of interest, the more defined the structure of interest becomes. These solution studies have been applied to several SCR-containing proteins in the complement system, most notably Factor H with 20 SCR domains, a complement receptor type 2 fragment with two SCR domains, and rat complement receptor-related protein (Crry) which contains five SCR domains. The results show great conformational variability in the inter-SCR orientation, and these will be reviewed. Even though the rotational orientation cannot be modelled, it is nonetheless possible to measure the degree of extension of the multi-SCR proteins and, from this, to obtain functionally useful results.

Total and regional bone density in male runners, cyclists, and controls

PURPOSE

Male athletes who were runners (N = 12), cyclists (N = 14), or both (N = 13) were compared with nonexercising age-matched controls (N = 23) for total and regional bone mineral density (BMD). All athletic subjects had competed for a minimum of 3 yr and trained for a minimum of 4 h x wk(-1). Runners undertook no cycling and cyclists undertook no running training.

METHODS

All subjects were scanned for whole body and L1-L4 spine BMD using a Hologic QDR 1000W scanner (Hologic Inc., Bedford, MA).

RESULTS

There were no differences in age, height, weight, body mass index (BMI), % fat, or hours of training between any of the athletic groups (P > 0.05), although compared with controls, runners and cyclists had lower body mass index (P < 0.01) and all athletic groups had lower % fat (P < 0.001). Compared with controls, runners had greater total and leg BMD (P < 0.05), cyclists had reduced spine BMD (P = 0.05), and athletes of the "both" group had greater total (P < 0.05) and arm BMD (P < 0.01).

CONCLUSION

Running is associated with increased bone density, particularly in the leg, whereas cycling is associated with a mild decrease in bone density in the spine. In athletes who do both, running exerts a stronger influence than cycling.

Establishing nursing research priorities on a paediatric haematology, oncology, immunology and infectious diseases unit: a Delphi survey

For research to be successfully integrated and applied to practice, ownership and identification must come from those who are most likely to implement research into practice. This was one of the reasons for undertaking a Delphi survey to identify and rank the research priorities for clinical nursing research in a paediatric haematology, oncology, immunology and infectious diseases unit. The 'Nurses' Research Group' initiated the survey as a first step towards developing a strategy for evidence-based nursing. Four members of the research group volunteered to establish a working party to undertake the survey. This paper describes a four-round Delphi survey. The survey questionnaire was sent to all nursing staff on the unit. The initial process identified 151 research topics/themes. Through a process of refinement the priority list was reduced to 89. Repeat rounds were completed, culminating in the identification of four top priority areas of: symptom management, negotiation of care between the child and family, quality-of-life issues and retention of staff. The findings indicate directions for future clinical nursing research that will benefit specialist nurses, children and young people and their families. This paper provides a detailed account of the method, procedure and outcomes of the Delphi survey. The limitations of the Delphi survey method are also addressed and in this survey these included time (the length of time it took to complete the survey and time needed to complete each questionnaire), maintaining motivation of respondents, and the influence of researchers working in the research setting.

Sub-regional tissue morphometry in male athletes and controls using dual X-Ray absorptiometry (DXA)

Athletes have traditionally been evaluated for body composition by percent fat, percent muscle, and somatotype. Since the late 1980s, dual X-ray absorptiometry (DXA) has offered total and regional body composition of bone mineral content (BMC), lean tissue and fat, but studies involving athletes are rare (11) and have not included regional tissue distribution. In the present study, DXA was used to compare a total of 121 male subjects belonging to 9 different athletic groups and controls. ANOVA showed total tissue percent BMC, lean tissue, and fat were significantly different between the various athletic groups (p <.001). Regional differences in tissue distribution between different athletic groups affect BMC and lean tissue (p <.001), but not fat (p >.05). However, athletes of the leanest groups had different fat distribution to that of nonexercising controls (p <.01). It appears that fat distribution is nonspecific in its response to exercise, while lean and BMC distributions show highly specific adaptations to specific sports.

Hemophilia and AIDS in married men: functioning of family members. Hemophilia PAC Project

Aspects of functioning in families of 137 hemophilic men who, in 50% of cases, were also HIV seropositive were examined in terms of psychological and physical functioning and economic pressure. Results indicated that HIV-seropositive status, but not severity of hemophilia, was associated with poorer psychological and physical functioning of the husband, a poorer mother-child relationship, less support from outside the family for both spouses, and greater economic pressure on the family.

Attitudes, practices, and infection risks of hemophilia treatment center nurses who teach infection control for the home

OBJECTIVE

To examine the practices toward infection control training and to assess the attitudes about, and risks for, exposures to blood among hemophilia treatment center (HTC) nurses who teach home infusion therapy (HIT).

DESIGN AND POPULATION

Written and telephone interview surveys of the 153 nurses who teach HIT at federally funded HTCs.

MAIN OUTCOME MEASURES

Hemophilia treatment center nurses' teaching practices and infection control messages taught, and frequency of exposures to blood.

RESULTS

The response rate to the written nurses' survey was 60% and to the telephone interview 88%. Nurses taught patients a median of three HIT sessions totaling 4 hours of instruction. Reevaluation of patients' HIT practices took place every 6 months by 22% and every 12 months by 59% of nurses. Nurses frequently reported teaching proper use of a sharps disposal container (99%) and gloves (93%), but less often reported teaching patients to wash hands after infusions (26%) and to report needlestick injuries to HTCs (11%). The respondents identified several barriers to effective infection control as it is practiced in the home by patients. Although at least 30% of HTC nurses recalled having had percutaneous exposure to blood, they considered their risk for hepatitis B infection low but greater than for infection with the human immunodeficiency virus (HIV).

CONCLUSIONS

While some important infection control messages are stressed during HIT teaching, others may be underemphasized. Failure to instruct patients about all infection control precautions may be related to nurse educators' perception of low to moderate personal risk for hepatitis B and HIV infection. Patients receiving HIT, and those who assist them, need to be fully aware of, and to have reinforced periodically, universal infection control strategies in the home.

Characterization of lipoprotein lipase activators from equine plasma

Equine plasma lipoproteins were fractionated into VLDL, LDL-1, LDL-2 and HDL by density gradient ultracentrifugation. From each lipoprotein fraction, five apo C like peptides of approx. M(r) 1400, 10000, 9500, 9000 and 8000 were detected by SDS-polyacrylamide gel electrophoresis. After partial purification by Sephadex G-75, one fraction, showing a strong activation of lipoprotein lipase, was further purified by Mono Q anion exchange column. Two of the apo C like peptides (M(r) 10000 and 8000) activated the bovine milk lipoprotein lipase in vitro; only one (M(r) 9500) inhibited the lipolytic activity. This work confirms that many mammals present two apo C-II components with different molecular weights.

Bioelectrical impedance analysis in the measurement of the body composition of surgical patients

The evaluation of nutritional status in surgical patients remains a difficult problem. Bioelectrical impedance analysis (BIA) is a new method of body composition analysis which is easily performed at the bedside. This study determined the accuracy of BIA in the measurement of total body water (TBW) and potassium (TBK) in a heterogeneous group of surgical patients. The resistance and reactance components of impedance were measured with a whole body impedance analyser. Tritiated water dilution and whole body monitoring were the reference methods for TBW and TBK analysis. With the BIA technique the coefficient of variation for the estimation of TBW was 8.1 per cent and for TBK was 6.4 per cent. Allowing for the errors of the reference methods these results show that BIA is of limited value in the estimation of TBW but may provide a useful index of TBK.

The effect of isoprinosine and levamisole on factors relevant to protection of calves against respiratory disease

Experiments to characterize the effects of two immunomodulators, namely, isoprinosine and levamisole, on factors relevant to the resistance of calves to respiratory infection were undertaken. Daily oral doses of isoprinosine decreased the influx of neutrophils into the respiratory tract, increased membrane immunoglobulin and complement receptor expression on cells from bronchoalveolar lavage samples and decreased the severity of respiratory disease. Additional intravenous doses produced similar effects on neutrophil migration to the respiratory tract and on membrane receptor expression, but the changes were no greater than those seen with oral isoprinosine alone. No significant changes in the anti-bacterial activity of cells in bronchoalveolar lavage samples followed isoprinosine treatment. In vitro incubation of pulmonary alveolar macrophages harvested from normal calves with isoprinosine increased their expression of immunoglobulin and complement receptors. Levamisole did not affect neutrophil migration to the lower respiratory tract or membrane receptor expression by pulmonary alveolar macrophages after in vivo or in vitro treatment. The immunomodulatory effects of isoprinosine beneficially increase the resistance of calves to respiratory disease, and are potentially useful in the control of infectious diseases of farm animals.

Calibration of a prompt neutron activation analysis facility for the measurement of total body protein

Prompt neutron activation analysis with 252Cf has been used to measure total body protein. Since simultaneous irradiation and detection generated a high count rate at the detectors the nucleonic system was optimised to reduce distortions in the gamma ray energy spectrum. Tissue-equivalent phantoms were used to calibrate the apparatus. A total of 53 studies was performed on 39 normal subjects. Ratios of total body protein to fat-free mass agreed well with those from other centres and with cadaver studies. Duplicate measurements of 14 subjects gave a coefficient of variation of +/- 2.9% for a measurement of total body protein, which is close to that calculated from the known errors of the technique of +/- 2.7%. The whole body dose equivalent was 0.17 mSv.

Factors responsible for the introduction and spread of Campylobacter jejuni infection in commercial poultry production

Campylobacter jejuni and related thermophilic campylobacters were not found in a hatchery or in chicks aged less than seven days. However, an increasing proportion of chicks aged two weeks and older shed campylobacters in their droppings. It was shown that a likely source of C jejuni for young chicks was the environment in the immediate vicinity of the rearing houses, and that infection could readily be introduced on the footwear and clothing of farm staff. Thermophilic campylobacters were found in the air, litter and drinking water containers in the rearing and finishing houses.

Absorbed dose from 14C xylose and 14C mannose

Tissue distribution and excretion studies have been performed in rats and mice for up to 1 week after oral administration of 14C xylose and 14C mannose. The effective dose-equivalent is calculated to be 15 microSv/MBq for xylose and 120 microSv/MBq for mannose. Since there was no clearance of mannose during the period of the study, the effective dose-equivalent for mannose is almost entirely dependent upon the assumptions made about expected lifetime exposure.

Ageing changes in the bovine kidney

A study of macroscopically normal bovine kidneys from three age groups (neonatal calves, 2.5- to 3-year-old bullocks and cull cows), with no abnormalities on urine analysis, was carried out by light microscopy, immunofluorescence and electron microscopy. There was a slight increase in the proportion of involuted nephrons with increasing age but the proportion of nephrons affected was not greater than 10 per cent in any age group. In contrast to the findings of earlier workers, no evidence of diffuse proliferative glomerulonephritis was found in the material examined. It was concluded that the above techniques should be applied to the investigation of renal disease in cattle, as has already been done in man and small domestic animals.

Effects of formalin footbathing on foot disease and claw quality in dairy cows

Two experiments on the effect of routine footbathing in 5 per cent formalin in preventing foot diseases and improving claw horn quality of dairy cows are described. Treatment four times a week significantly (P less than 0.05) reduced the incidence of interdigital lesions but had no significant effect on the incidence of the individual interdigital lesions or on the incidence of individual or overall diseases of the claw horn. A two year study using a divided footbath demonstrated significant improvements in some aspects of claw quality in digits footbathed in formalin. Formalin treated digits had a lower incidence and severity of erosio ungulae (P less than 0.001) a lower moisture content (P less than 0.001) and a reduced severity of haemorrhage of the sole at some sites in the claw compared with untreated digits. Formalin treatment, however, had no significant effect on the incidence of either clinical or subclinical lesions of the claw horn. The improvement in the horn quality of claws treated with formalin for six months did not increase with a further year of treatment.

Gastrointestinal flora in iron-deficient piglets

The pH and microflora of the contents of the stomach and small intestine were studied in iron-treated and iron-deficient piglets. Compared with their iron-treated littermates, the gut contents at several sites in iron-deficient animals had a higher pH and contained greater numbers of coliforms, lactobacilli, total aerobes and total anaerobes. The possible relationship of these findings to previous findings in such animals and to their high incidence of diarrhoea is discussed.

Long-term effects of cold cardioplegic myocardial protection in the rat

The long-term histologic effects of the use of two cold cardioplegic solutions (St. Thomas' and saline) were studied and compared in a model of heterotopic cardiac transplantation in rats of isogeneic strain. After cold cardioplegic arrest, hearts were stored for varying times ("minimal," 30, or 90 minutes) in one of the solution prior to transplantation, giving a total of six groups (five animals in each group). Early assessment of myocardial injury 48 hours after transplantation was by the uptake of technetium 99m pyrophosphate and by measurement of serum creatine kinase activity. Late assessment of myocardial injury at 3 months after transplantation was by quantitative histologic examination. The findings indicated that significant myocardial fibrosis occurred in hearts stored in both solutions for the longest storage period (90 minutes) and that St. Thomas' cardioplegic formula conferred better myocardial protection after 90 minutes' storage than did cold saline, as judged by the degree of histologic injury at 3 months (p less than 0.025). Significant correlation was found between long-term histologic changes at 3 months and the uptake of technetium 99m pyrophosphate (p less than 0.001) and serum creatine kinase activity (p less than 0.05) assessed at 48 hours. Uptake of technetium 99m pyrophosphate and increased serum creatine kinase activity was demonstrated 48 hours after injury in animals having no detectable histologic injury at 3 months. These observations indicate that there may be technetium 99m pyrophosphate uptake and enzyme release from reversibly damaged myocardial cells.

Intestinal absorption and structure in iron deficient piglets

Absorption of D xylose by iron deficient piglets from three litters was as rapid as in their iron treated littermates, except when they were affected by diarrhoea. The dry matter content of the faeces of iron deficient piglets was marginally decreased, but the fat content of the faeces was significantly increased in two tests out of four. Diarrhoea in iron deprived piglets was associated with a small decrease in dry matter content and a large increase in fat content of the dry matter of the faeces and in fat excreted per kg bodyweight. Frank villous atrophy was evident histologically in iron deficient piglets which had diarrhoea when they were killed. Morphometric analysis of small intestinal specimens showed a significant decrease in villous length, villus-to-crypt ratio and mucosal complexity among iron deficient piglets. Crypt depth was not reduced.

Abattoir survey of bovine kidney disease

A survey of the prevalence and type of renal disease was carried out at a Dublin abattoir in 1979-80. Of 4166 cattle surveyed, 173 (4.2 per cent) had kidneys rejected for gross abnormalities. The rejection rate was 7.7, 1.7, 2.2 and 28 per cent for cows, bullocks, heifers and bulls, respectively. The most common reason for rejection was focal interstitial nephritis (60.1 per cent of rejected kidneys). Other lesions included cysts (26.0 per cent), pigmentation (6.4 per cent), pyelonephritis (3.5 per cent), amyloidosis (2.9 per cent), glomerulonephritis (0.6 per cent), renal atrophy (0.6 per cent) and agonal haemorrhage.

A study of cold cardioplegic myocardial protection in rats: an experimental model using the uptake of technetium 99m pyrophosphate and enzyme activity as parameters of injury

This study compares the use of St Thomas' cardioplegia and cold saline cardioplegia at 4 degrees C for protection against global myocardial ischaemia in a model of heterotopic cardiac transplantation in rats of isogeneic strain. The parameters of myocardial injury applied were the uptake of Technetium 99m pyrophosphate (Tc 99m Pyp) in the transplanted heart and the measurement of serum total creatine kinase (CK) and creatine kinase MB (CK:MB) isoenzyme activity. The findings indicate that St Thomas' cardioplegic solution confers improved myocardial protection compared with normal saline as judged by statistically significant differences between: (a) the uptake of Tc 99m Pyp between the two solutions at 30 min storage: and (b) the peak total serum creatine kinase enzyme activity at 90 min storage. Excellent correlation was present between the uptake of Tc 99m Pyp and peak total serum creatine kinase activity. Further application of this model is described.

Gastric structure and function in iron-deficient piglets

Gastric motility, secretion and structure were studied in piglets which were weaned at two weeks of age and reared in iron-free cages on a low-iron diet. Piglets which were not given iron parenterally rapidly developed iron deficiency anaemia. Gastric motility was studied fluoroscopically after dosing the piglets with barium sulphate. Gastric secretion was studied in piglets with gastric cannulae after stimulation with betazole hydrochloride. There was no difference between iron-treated and iron-deprived pigs in the motility of the stomach but in iron-deprived animals there was marked impairment of acid and chloride secretion from an early age and histological evidence of atrophic gastritis.