Effects of increased grazing intensity during the early and late grazing periods on the welfare of spring-calving, pasture-based dairy cows

The objective of this study was to identify potential effects of increased grazing intensity, characterized by differing pasture availability and stocking rate, on indicators of welfare during both early and late grazing periods. Seventy spring-calving, pasture-based Holstein-Friesian and cross-bred dairy cows, averaging 35 ± 16 d in milk on the first day of data collection, were assigned to 3 treatments (20-26 cows/treatment) representing a range in grazing intensity: LO (high pasture availability, 980 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), MOD (medium pasture availability, 720 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), and HI (low pasture availability, 570 kg DM/ha opening cover, 3.25 cows/ha, 80:20% pasture:concentrate diet); representative of current, best practice and proposed production levels respectively for this system. Welfare indicators were locomotion score, digital dermatitis and white line disease, rumen fill, ocular and nasal discharge, integument damage to the neck-back and hock regions, and lying time. Data were collected during a 5-wk early grazing period in spring (EG) and a 7-wk late grazing period in autumn (LG). Average daily lying time was recorded for 8 to 10 focal cows per treatment. Results demonstrated only minor treatment effects. Cows on MOD [odds ratio (OR) = 3.11] and HI (OR = 1.95) were more likely to display nasal discharge compared with LO. Cows on MOD tended to have more damage to the skin on the neck-back region than LO (OR = 4.26). Total locomotion score (maximum = 25) was greater on LOW (7.1 ± 0.20) compared with HI (6.5 ± 0.19). Average lame cow prevalence for EG and LG respectively was 15.3 ± 3.12% and 39.2 ± 3.00% (LO), 20.0 ± 2.58% and 24.2 ± 5.69% (MOD), and 14.9 ± 4.79% and 17.0 ± 3.44% (HI). Cows on HI were less likely to have impaired walking speed than either LO (OR = 0.24) or MOD (OR = 0.29). Cows on both HI (OR = 0.36) and MOD (OR = 0.40) were less likely to display impaired abduction or adduction compared with those on LO. An interaction between treatment and period revealed longer lying times for cows on LO (10.6 h/d ± 0.39) compared with both MOD and HI (8.7 ± 0.43 and 8.4 ± 0.41 h/d) during EG only. The greatest effects were across grazing periods, with all indicators except rumen fill and locomotion score demonstrating improvements from EG to LG. This suggests cows were able to cope well with increasing levels of grazing intensity, and that regardless of treatment, a greater number of days on pasture led to improvements in welfare indicators.

Field Pea (Pisum sativum) Germplasm Screening for Seedling Ascochyta Blight Resistance and Genome-Wide Association Studies Reveal Loci Associated with Resistance to Peyronellaea pinodes and Ascochyta koolunga

Ascochyta blight is a damaging disease that affects the stems, leaves, and pods of field pea (Pisum sativum) and impacts yield and grain quality. In Australia, field pea Ascochyta blight is primarily caused by the necrotrophic fungal species Peyronellaea pinodes and Ascochyta koolunga. In this study, we screened 1,276 Pisum spp. germplasm accessions in seedling disease assays with a mix of three isolates of P. pinodes and 641 accessions with three mixed isolates of A. koolunga (513 accessions were screened with both species). A selection of three P. sativum accessions with low disease scores for either pathogen, or in some cases both, were crossed with Australian field pea varieties PBA Gunyah and PBA Oura, and recombinant inbred line populations were made. Populations at the F3:4 and F4:5 generation were phenotyped for their disease response to P. pinodes and A. koolunga, and genotypes were determined using the diversity arrays technology genotyping method. Marker-trait associations were identified using a genome-wide association study approach. Trait-associated loci were mapped to the published P. sativum genome assembly, and candidate resistance gene analogues were identified in the corresponding genomic regions. One locus on chromosome 2 (LG1) was associated with resistance to P. pinodes, and the 8 Mb genomic region contains 156 genes, two of which are serine/threonine protein kinases, putatively contributing to the resistance trait. A second locus on chromosome 5 (LG3) was associated with resistance to A. koolunga, and the 35 Mb region contains 488 genes, of which five are potential candidate resistance genes, including protein kinases, a mitogen-activated protein kinase, and an ethylene-responsive protein kinase homolog.

Improving young pig welfare on-farm: The Five Domains Model

Considering welfare through the "neonatal and nursery pig perspective" is an exciting approach, and one that resonates with consumers. Overlaying this with the Five Domains Model, as we suggest in this review, points to practical on-farm improvements that provide each pig the opportunity to experience positive mental states. The Five Domains Model is broken into physical and functional states, that includes Domain 1 Nutrition, Domain 2 Physical Environment, Domain 3 Health and, Domain 4 Behavioral Interaction, and Domain 5 Mental State. The Five Domains Model can build on the breadth and depth of swine welfare science to highlight opportunities to improve welfare on-farm. In Domain 1 management of increasingly large litters is considered, with examples of sow vs. artificial rearing, colostrum quality and quantity, and creep feed management strategies. Efforts can result in positive mental states such as feeling full and content and the ability to experience pleasure of drinking and food tastes/smells. Domain 2 considers space complexity and access to key resources, along with thermal and physical amenities, to promote feelings of physical comfort. Domain 3 considers pig health in three broad, yet inter-linking categories, (a) congenital and hereditary health, (b) environmental pathogen load and, (c) colostrum quality and quantity, and its effect on the microbiome. Improvements can result in a pig that displays vitality and feels healthy. Domain 4 provides the pig opportunities to express its rich behavioral repertoire, specifically positive social interactions, play, and exploration. These efforts can result in pigs feeling calm, safe, comfortable, having companionship, engaged, interested and rewarded. In conclusion, using the Five Domains Model can highlight numerous opportunities to improve current and future housing and management through the "neonatal and nursery pig perspective" with a focus on inducing positive mental states that can result in improved quality of life and welfare state.

Effect of dietary L-carnitine supplementation to sows during gestation and/or lactation on sow productivity, muscle maturation and lifetime growth in progeny from large litters

Genetic selection for increased sow prolificacy has resulted in decreased mean piglet birth-weight. This study aimed to investigate the effect of L-carnitine (CAR) supplementation to sows during gestation and/or lactation on sow productivity, semitendinosus muscle (STM) maturity, and lifetime growth in progeny. Sixty-four sows were randomly assigned to one of four dietary treatments at breeding until weaning; CONTROL (0mg CAR/d), GEST (125mg CAR/d during gestation), LACT (250mg CAR/d during lactation), and BOTH (125mg CAR/d during gestation & 250mg CAR/d during lactation). The total number of piglets born per litter was greater for sows supplemented with CAR during gestation (17.3 v 15.8 ± 0.52; P<0.05). Piglet birth-weight (total and live) was unaffected by sow treatment (P>0.05). Total myofibre number (P=0.08) and the expression level of selected myosin heavy chain genes in the STM (P<0.05) was greater in piglets of sows supplemented with CAR during gestation. Pigs from sows supplemented with CAR during gestation had lighter carcasses at slaughter than pigs from non-supplemented sows during gestation (83.8 v 86.7 ± 0.86kg; P<0.05). In conclusion, CAR supplementation during gestation increased litter size at birth without compromising piglet birth-weight. Results also showed that the STM of piglets born to sows supplemented with CAR during gestation was more developed at birth. However, carcass weight at slaughter was reduced in progeny of sows supplemented with CAR during gestation. The CAR supplementation strategy applied during gestation in this study could be utilized by commercial pork producers to increase sow litter size and improve offspring muscle development.

Artificial rearing affects the emotional state and reactivity of pigs post-weaning

Artificial rearing involves removing piglets from their mother at seven days of age and feeding them milk replacer until weaning. Earlylife rearing conditions can influence piglets' mental development, as reflected by their emotional state and reactivity. This study compared the post-weaning emotional state and reactivity of pigs which were either sow-reared or artificially reared pre-weaning. Behavioural tests (startle test, novel object test, human-animal relationship test and open door test) were conducted one week post-weaning (weaner 1, 34 [± 0.6] days old), one week after movement to weaner 2 (69 [±1.2] days old) and to finisher (100 [± 1.3] days old) stages. Qualitative Behavioural Assessments (QBA) were conducted on the same days in weaner 2 and finisher stages. QBA descriptors were computed by PCA and all other data were analysed using linear models. Artificially reared pigs were less fearful of human contact in weaner 1 (45.1 [± 8.43] vs 81.3 [± 7.89]%) and finisher (25.8 [± 5.19] vs 45.7 [± 6.00]%) stages; but there was no difference in the other tests. Artificially reared pigs had a higher QBA score (more positive) than sow-reared pigs in weaner 2 (54.49 [± 10.102] vs 17.88 [± 9.94]) but not in finisher (70.71 [± 8.860] vs 52.76 [± 9.735]) stage. In conclusion, artificially reared pigs appeared to have a more positive emotional state transiently post-weaning and a lower fearfulness towards humans, which are likely mediated by their pre-weaning conditions. These data emphasise the need to consider the entire life of the animals to fully evaluate the long-term impacts of a rearing system.

An investigation into the effectiveness of compressed straw blocks in reducing abnormal behaviour in growing pigs

The provision of manipulable material to pigs is a legal requirement to ensure their good welfare. Loose straw is edible, chewable, investigable and manipulable, and has been proven to be effective in reducing abnormal behaviour. However, it is incompatible with slatted systems and therefore not a viable option for many intensive units. Thus, there is a need to identify enrichment materials that are as effective as loose straw and compatible with slatted floors. This study investigated the viability of using compressed straw blocks on a commercial farm in terms of cost and effectiveness in reducing biting relative to plastic hanging toys. A total of 880 slaughter pigs were used, among which half (n = 440, 8 groups) were provided with commercial pig toys (TOY) and the other half (n = 440, 8 groups) were provided compressed straw blocks (STRAW BLOCK). Animals were separated according to sex to investigate whether there was a higher propensity to tail and ear bite depending on sex. Pigs were monitored from weaning to slaughter, with tails being examined post scalding and any condemnations recorded at the abattoir. Throughout their life, the tails and ears of all pigs were examined individually, and behavioural observations of each pig group were conducted fortnightly. Salivary cortisol was also obtained from a subsample of pigs from each group every fortnight to monitor stress levels. The highest straw usage was recorded in the second weaner stage (39 to 67 days after weaning). Enrichment type or sex had no effect on tail lesion scores or cold carcass weight recorded at the abattoir. There was also no effect of enrichment type or sex on body, tail, or ear lesion scores during either the weaner (0 to 39 days after weaning) or finisher stage (67 to145 days after weaning). Female pigs showed more biting behaviour than males, and female pigs that were provided STRAW BLOCK performed better than those provided TOY. In both the weaner and finisher accommodation, more instances of interaction were recorded with TOY pens as enrichment than with STRAW BLOCK, but the interaction duration was not recorded. There was no effect of sex on either stage. More instances of aggression were observed with the TOY than with STRAW BLOCK in the weaner stage (P < 0.05). Enrichment type or sex had no effect on cortisol levels. Thus, relative to plastic hanging toys, compressed straw blocks provided in this manner did not benefit pig welfare.

Stimulation of HIV-specific T cell clonotypes using allogeneic HLA

We hypothesized that HIV-specific CD8 T cell clonotypes can be stimulated by allogeneic HLA molecules. Multiple HIV-specific CD8 T cell clones were derived from 12 individuals with chronic HIV infection, specific for 13 different HIV Gag antigens and restricted to 7 different HLA molecules. The generated T cell clones were assayed for alloreactivity against a panel of single HLA class I expressing cell lines (SALs). HIV-specific T cells recognising at least one allogeneic HLA molecule could be identified from 7 of 12 patients tested. Allorecognition was associated with IFNγ cytokine production, CD137 upregulation and cytotoxicity, suggesting high avidity allo-stimulation. Allo-HLA recognition by HIV-specific T cells was specific to the HIV target peptide/HLA restriction and TCR TRBV usage of the T cells. HIV-specific T cells do crossreact against allogeneic HLA molecules in an epitope and TRBV specific manner. Therefore allo-HLA stimulation could be exploited to induce or augment HIV-specific T cell responses.

Rapid rise in incidence of Irish paediatric inflammatory bowel disease

AIMS

To describe the change in incidence of paediatric inflammatory bowel disease (IBD) observed at the National Centre for Paediatric Gastroenterology, Hepatology and Nutrition, and to determine whether the presenting disease phenotype and disease outcomes have changed during the past decade.

METHODS

The annual incidence of IBD in Irish children aged <16 years was calculated for the years 2000-2010. Two subsets of patients, group A (diagnosed between 1 January 2000 and 31 December 2001), and group B (diagnosed between 1 January and 31 December 2008) were phenotyped according to the Paris Classification. Phenotype at diagnosis and 2-year follow-up were then compared.

RESULTS

406 new cases of IBD were identified. The incidence was 2.5/100 000/year in 2001, 7.3 in 2008 and 5.6 in 2010, representing a significant increase in the number of new cases of Crohn's disease (CD) and ulcerative colitis (UC). There were 238 cases of CD; 129 of UC; and 39 of IBD unclassified. Comparing groups A and B, no differences were found in disease location at diagnosis or, for CD, in its behaviour.

CONCLUSIONS

There has been a substantial and sustained increase in the incidence of childhood UC and CD in Ireland over a relatively short period of time. However, disease phenotype at diagnosis has not changed. At 2 years follow-up, CD appears to progress less frequently than in some neighbouring countries. These variations remain unexplained. Prospective longitudinal studies will help to elucidate further the epidemiology of childhood IBD.

Risk factors for early post-operative psychiatric symptoms in patients undergoing epilepsy surgery for temporal lobe epilepsy

OBJECTIVE

De-novo psychiatric symptoms may develop within 3 months after a temporal lobectomy for epilepsy. The objective of this study was to identify presurgical risk factors for psychiatric symptoms.

METHODS

Twenty-seven patients who had a temporal lobectomy for epilepsy were included. Twenty-four had hippocampal sclerosis or gliosis, and three had cavernous haemagiomata. Twelve had operations on the left, and 15 on the right side. Twenty-four patients were rendered free of seizures (SZ) with loss of awareness, three had early post-operative convulsions, one continued to have habitual SZ.

RESULTS

Nine patients (33%) developed low mood, anxiety and emotional lability within 3 months after surgery. Patients with early post-operative psychiatric symptoms were younger (27.9/34.8 years, P = 0.01), and more anxious on the presurgical Hospital Anxiety and Depression Scale (12/8.44, P = 0.02) than patients without post-operative psychiatric symptoms. There was also an association between right temporal lobectomies and early post-surgical symptoms (P = 0.02 Fisher's exact test).

CONCLUSION

Potential risk factors were age, anxiety and operation on the right side. Larger studies are required to determine if these risk factors are independent.

The effect of out-wintering pad design on hoof health and locomotion score of dairy cows

This study compared locomotion, hoof health, and lameness of dairy cows confined in either indoor free stalls (FS) or 1 of 3 out-wintering pad (OWP) designs. Out-wintering pad treatments were 1) uncovered OWP with a concrete feed apron (UP); 2) covered OWP with a concrete feed apron (CO); and 3) uncovered OWP on top of which grass was ensiled so that the cows could self-feed (SP). Cows were assigned to treatment at drying off using a randomized complete block design. They remained on treatment until calving, when they were turned out to pasture. Sole lesions, heel erosion, dermatitis, and claw hardness on both hind feet were scored according to severity at assignment to treatment, at calving, and 9 and 14 wk postpartum. Locomotion score was recorded weekly after calving for 14 wk. Incidence of clinical lameness was recorded during the treatment period and in the subsequent lactation. Treatment had no effect on sole lesion score, but scores increased over time (calving = 5.5 +/- 1.3, wk 9 = 10.8 +/- 1.3, wk 14 = 14.2 +/- 1.3, mean +/- SE). Self-fed cows had higher heel erosion scores (6.4 +/- 0.4) than FS and CO cows (4.7 +/- 0.4 and 4.7 +/- 0.4, respectively) at calving. Cows on SP had the highest dermatitis scores [1.14 (0-2) mean (interquartile range)] and FS cows the lowest [0.51 (0-0)]. Hooves were hardest at assignment to treatment (43.9 +/- 0.6) with a significant reduction in hardness at calving (40.0 +/- 0.6). The hooves of CO cows were harder than those of SP and UP cows (CO = 43.3 +/- 0.7, SP = 41.7 +/- 0.7, UP = 41.7 +/- 0.7, Shore D scale). There was no treatment effect on locomotion scores or lameness incidence. Higher dermatitis scores and heel erosion in SP may be due to exposure to excreta and moisture, because the SP treatment had no manure removal system at the feed face. In FS, the alleys and the feed face were cleaned regularly by automatic scraper, explaining the lower dermatitis scores recorded indoors. Providing shelter for OWP likely reduced exposure to environmental moisture. This ensured that the hooves of CO cows remained as hard as those of FS cows. Low correlations between hardness and pathologies indicate that other factors are involved in the development of hoof pathologies. Confining dry dairy cows on OWP does not increase locomotion scores or lameness incidence.

Effects of mixing on drinking and competitive behavior of dairy calves

Group housing provides increased access to space and social interactions for calves while reducing labor costs for producers. However, group housing necessarily requires that calves be mixed and no research to date has addressed the effects of mixing on behavior of milk-fed dairy calves. The objective of this study was to monitor the feeding and competitive behavior of individual dairy calves (n = 8) after introduction into an established group of older calves fed ad libitum by a computer-controlled milk feeder. Milk feeding was monitored for 2 d before introduction into the new group and both milk feeding and competitive behaviors were monitored for 4 d after mixing. Mean (+/- SE) milk consumption before mixing was 9.7 +/- 0.7 kg/d, dropped slightly on the day of mixing to 8.6 +/- 0.6 kg/d, but increased on d 1 to 3 after mixing to 11.1 +/- 0.3 kg/d. Calves visited the feeder less frequently on the day of mixing (6.0 +/- 1.8 visits/d) than on either the days before mixing (20.3 +/- 2.5 visits/d) or the days after mixing (25.3 +/- 6.9 visits/ d). The mean duration of feeder visits and mean milk consumption per visit increased from 4 min 15 s +/- 21 s and 0.53 +/- 0.06 kg per visit before mixing to 8 min 17 s +/- 1 min 28 s and 1.87 +/- 0.51 kg per visit on the day of mixing. Competitive displacements from the milk-feeding stall were rare. In summary, feeding behavior of young calves is altered on the day of mixing, but calves are able to maintain milk intake when using a milk feeder fitted with a stall that prevents calves from displacing one another.

Spatial localization and properties of pacemaker potentials in the canine rectoanal region

The present study investigated the spatial organization of electrical activity in the canine rectoanal region and its relationship to motility patterns. Contraction and resting membrane potential (E(m)) were measured from strips of circular muscle isolated 0.5-8 cm from the anal verge. Rapid frequency [25 cycles/min (cpm)] E(m) oscillations (MPOs, 12 mV amplitude) were present across the thickness of the internal anal sphincter (IAS; 0.5 cm) and E(m) was constant (-52 mV). Between the IAS and the proximal rectum an 18 mV gradient in E(m) developed across the muscle thickness with the submucosal edge at -70 mV and MPOs were replaced with slow waves (20 mV amplitude, 6 cpm). Slow waves were of greatest amplitude at the submucosal edge. Nifedipine (1 micro M) abolished MPOs but not slow waves. Contractile frequency changes were commensurate with the changes in pacemaker frequency. Our results suggest that changing motility patterns in the rectoanal region are associated with differences in the characteristics of pacemaker potentials as well as differences in the sites from which these potentials emanate.

Direct lung delivery of para-aminosalicylic acid by aerosol particles

Para-aminosalicylic acid (PAS), a tuberculostatic agent, was formulated into large porous particles for direct delivery into the lungs via inhalation. These particles possess optimized physical properties for deposition throughout the respiratory tract, a drug loading of 95% by weight and physical stability over 4 weeks at elevated temperatures. Upon insufflation in rats, PAS concentrations were measured in plasma, lung lining fluid and homogenized whole lung tissue. Systemic drug concentrations peaked at 15 min, with a maximum plasma concentration of 11+/-1 microg/ml. The concentration in the lung lining fluid was 148+/-62 microg/ml at 15 min. Tissue concentrations were 65+/-20 microg/ml at 15 min and 3.2+/-0.2 microg/ml at 3h. PAS was cleared within 3 h from the lung lining fluid and plasma but was still present at therapeutic concentrations in the lung tissue. These results suggest that inhalation delivery of PAS can potentially allow for a reduction in total dose delivered while providing for higher local and similar peak systemic drug concentrations as compared to those obtained upon oral PAS dosing. Similar particles could potentially be used for the delivery of additional anti-tuberculosis agents such as rifampicin, aminoglucosides or fluoroquinolones.

Electrical activity induced by nitric oxide in canine colonic circular muscle

Nitric oxide generates slow electrical oscillations (SEOs) in cells near the myenteric edge of the circular muscle layer, which resemble slow waves generated by interstitial cells of Cajal (ICCs) at the submucosal edge of this muscle. The properties of SEOs were studied to determine whether these events are similar to slow waves. Rapid frequency membrane potential oscillations (MPOs; 16 +/- 1 cycles/min and 9.6 +/- 0.2 mV) were recorded from control muscles near the myenteric edge. Sodium nitroprusside (0.3 microM) reduced MPOs and initiated SEOs (1.3 +/- 0.3 cycles/min and 13.4 +/- 1.4 mV amplitude). SEOs were abolished by the guanylate cyclase inhibitor 1H-[1,2,4]-oxadiazolo-[4,3-a]-quinoxaline-1-one (10 microM). MPOs were abolished by nifedipine (1 microM), whereas SEO frequency increased and the amount of depolarization decreased. BAY K 8644 (1 microM) prolonged SEOs and reduced their frequency. SEOs were abolished by Ni(2+) (0.5 mM), low Ca(2+) solution (0.1 mM Ca(2+)), cyclopiazonic acid (10 microM), and the mitochondrial uncouplers antimycin (10 microM) and carbonyl cyanide p-trifluoromethoxyphenylhydrazone (1 microM). Oligomycin (10 microM) was without effect. These effects are similar to those described for colonic slow waves. Our results suggest that nitric oxide-induced SEOs are similar in mechanism to slow waves, an activity not previously thought to be generated by myenteric pacemakers.

Significance of white matter abnormalities in patients with closed head injury

Neuroimaging in patients with closed head injury (CHI) may frequently reveal abnormalities of white matter. Because white matter abnormalities may be seen in patients aged over 40 years even without CHI, the significance of these abnormalities in patients with CHI is questionable and needs to be assessed in the context of relevance to clinical outcome. The aims of this study were to determine the relative incidence of white matter abnormalities in a group of patients with CHI, and to assess the impact (if any) of these abnormalities on clinical outcome. Sixty-three patients with CHI underwent neuroimaging with magnetic resonance imaging (MRI) and regional cerebral blood flow (rCBF) single photon emission tomography (SPET) approximately 6 months after trauma. Seven patients had white matter abnormalities on MRI scanning. There are no rCBF SPET criteria for defining abnormal perfusion to the white matter. The SPET scans ranged from normal (one patient) and abnormal perfusion to frontal, temporal or parietal lobes in these patients (n = 6). Patients were assessed for outcome after undergoing appropriate rehabilitation programmes with indices of reintegration into the community, activities of daily living, disability, and their cognitive ability to perform tasks. This assessment was conducted 2 years after initial trauma. Of these seven patients with abnormal MRI of the white matter, one performed poorly and six had moderate to good clinical outcome. When individual lobar perfusion is considered, abnormal perfusion to the frontal or temporal lobes was significantly associated with poorer outcome (P < 0.005). In conclusion, white matter abnormalities detected by MRI are frequently associated with cortical perfusion defects identified by SPET (6/7 or 86%). However, when these white matter abnormalities were accompanied by perfusion defects in the frontal and temporal lobes, these were statistically significant in predicting poorer outcome.

Acute inspiratory stridor: a presentation of myasthenia gravis

We present a rare presentation of myasthenia gravis as acute inspiratory stridor in a 16-year-old girl. Prompt diagnosis and medical treatment avoided the need for tracheostomy. Although an uncommon cause, myasthenia gravis should be included in the differential diagnosis of stridor.

The utility of nasal bone radiographs in nasal trauma

A prospective study was performed to assess the value of nasal bone radiographs taken in the accident and emergency department. The study population consisted of 100 consecutive patients who had nasal bone radiographs in our accident and emergency (A&E) department following trauma. We looked at the casualty officers', radiologists' and ENT surgeons' assessment of the cases. Thirty months later we reviewed the patients' notes to identify the number who sought medico-legal reports on their injury in that interval. We found sporting injuries to be the commonest mechanism of injury, followed closely by accidental falls. The remaining third was made up predominantly of cases of personal assault and road traffic accidents. Only two patients had a naso-pharyngeal history recorded on their visit to A&E. Thirty-five patients were referred to ENT out-patients, only 24 kept their appointment. Thirty-one of the 35 ENT referrals were felt to have a fracture demonstrated on their radiographs. However, 19 of those discharged were also thought to have an X-ray-proven fracture. Thirty months later only two patients had requested a medico-legal report. We demonstrate that the decisions regarding treatment of nasal trauma are based on clinical findings and that nasal bone radiography has no place in the decision making process and should therefore be abandoned.

An audit of the E.N.T. casualty service at the Royal Victoria Eye and Ear Hospital

The only specialised Accident and Emergency unit for ENT in Ireland is at The Royal Victoria Eye and Ear Hospital, Dublin. This provides a service for the entire Republic, operating on a 9 am to 5 pm, Monday to Friday, basis. The aim of the present study was to define the role of this specialised unit. A prospective study of the service over a one month period was conducted. During this time 779 patients were seen of which 350 (45%) were new patients and 429 (55%) were return patients. Fifty two per cent were self referred, 35% were referred by their General Practitioners, 8% by other hospitals and 5% from other sources. The most common diagnosis was otitis externa (21% of new patients and 63% of returns), followed by ear wax (15% of new patients), and epistaxis (9% of new patients). Five per cent of patients required removal of foreign bodies from their ear, nose or oesophagus, and 3% received treatment for trauma to these regions. Of note during this period six new cases of head and neck cancer were detected. From these figures it is the authors' opinion that many of the problems seen could have been dealt with by General Practitioners or as non-emergency referrals to the out-patient department. This indicates the need for further training for primary care physicians and expansion of the present outpatients services. The specialised casualty service should continue to exist to provide a genuine emergency service and valuable training in the speciality.

Cloning genes from an inner ear cDNA library

A rat inner ear complementary DNA (cDNA) library containing 1.9 x 10(6) recombinants was constructed and evaluated. Inserts averaged 2.0 (+/- 2.1) kilobases in length. A subset of inserts was screened for site of expression. Two cDNA transcripts were isolated based on cochlear expression restricted to the spiral ganglion. One transcript showed a high degree of homology to several long interspersed DNA elements, neuron-specific nuclear transcripts thought to be involved in gene regulation. The second transcript showed no homology to known sequences and appears to encode a neuron-specific protein of about 248 amino acids. The library can be used to identify proteins important for inner ear function and disease.

Depression following laryngectomy. A pilot study

When a group of 10 patients who had received surgery for carcinoma of the larynx were compared with 10 control patients who had received radiotherapy for carcinoma of the larynx, four of the former but none of the latter were found to be suffering from depression, a statistically significant difference. Depression was associated with poor communication skills and geographical isolation. Psychiatric intervention is recommended for patients undergoing mutilating forms of surgery.

The regulatory domain of protein kinase C beta 1 contains phosphatidylserine- and phorbol ester-dependent calcium binding activity

Certain isoforms of protein kinase C (PKC) require both Ca2+ and phospholipid for optimum activity. However, little is known about the nature of the interaction between PKC and Ca2+. The present study demonstrates that the isolated regulatory domain of PKC beta 1, when synthesized as a fusion protein in Escherichia coli, binds 45Ca2+ with high affinity, but only in the presence of phosphatidylserine or 12-O-tetradecanoyl-phorbol-13-acetate. This binding is highly selective for Ca2+ since it is preferentially inhibited by excess non-radioactive Ca2+ when compared with the cations Mg2+, Mn2+, Na+, or K+. It appears, therefore, that the binding of Ca2+ to PKC requires a complex tertiary structure in the regulatory domain.

Protein kinase C isozymes epsilon and alpha in murine erythroleukemia cells

Protein kinase C (PKC) has a role in signal transduction during hexamethylene bisacetamide (HMBA)-induced differentiation of murine erythroleukemia cells (MELC). Separation of MELC PKC isozymes by hydroxylapatite chromatography yields a major peak (III) and a minor peak (II) of PKC activity, previously reported to contain the PKC alpha and beta isozymes, respectively. In the present study, we confirm that peak III activity is PKC alpha but show that peak II contains PKC epsilon and little or no PKC beta. Immunoblot analysis with isozyme-specific anti-alpha and anti-epsilon PKC antibodies detected PKC alpha in peak III and PKC epsilon in peak II. Peak III activity was markedly enhanced (up to 20-fold) by phosphatidylserine, diolein, and Ca2+, whereas addition of these cofactors to the reaction mixture stimulated peak II activity only 2- to 4-fold. RNase protection analysis of MELC RNA showed that PKC alpha and PKC epsilon RNAs were in a ratio of approximately 2:1, but PKC beta RNA was barely detectable. Taken together, these data indicate that MELC contain PKC alpha and PKC epsilon but little or no PKC beta.

1 alpha,25-dihydroxyvitamin D3-induced regulation of protein kinase C gene expression during HL-60 cell differentiation

The human promyelocytic leukemia cell line HL-60 differentiates in vitro when treated with various inducers. It has previously been shown that protein kinase C (PKC) isozymes are modulated during granulocytic differentiation of HL-60 cells induced by dimethyl sulfoxide or retinoic acid (M. Makowske, R. Ballester, Y. Cayre, and O.M. Rosen, J. Biol. Chem., 263: 3402-3410, 1988; K. Hashimoto, A. Kishimoto, H. Aihara, I. Yasuda, K. Mikawa, and Y. Nishizuka, FEBS Left., 263: 31-34, 1990). HL-60 responds to 1 alpha, 25-dihydroxyvitamin D3 (1,25-(OH)2D3) or to 12-O-tetradecanoylphorbol-13-acetate by giving rise to monocytic cells. In the present study, we demonstrate that treatment of HL-60 cells with 1,25-(OH)2D3 causes dramatic increases in PKC-alpha and PKC-beta protein levels detected by immunoblotting with PKC isoform-specific antibodies and in Ca(2+)- and phospholipid-dependent protein kinase activity. We also observed a transient increase in the steady-state levels of PKC-alpha and PKC-beta mRNA species in Northern blotting experiments, with maximal induction occurring 48 h after addition of 1,25-(OH)2D3. Analyses of 1,25-(OH)2D3-induced PKC mRNA expression by nuclear run-on transcription experiments suggest that the observed increases in PKC mRNA levels may occur by a posttranscriptional mechanism(s). In contrast to the transient increases in PKC mRNA levels, the increases in PKC Mr 80,000 protein species and in PKC enzyme activity were progressive in HL-60 cells treated with 1,25-(OH)2D3 between 1 and 5 days, thus implying the existence of a further up-regulation of PKC proteins occurring at the translational and/or posttranslational levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital arteriovenous malformation of the scalp with high output cardiac failure: a case report

A 19-year-old man was diagnosed with a rapidly enlarging arteriovenous malformation of the scalp and a mild degree of cardiomegaly. Operation to excise the large fistula took place under general anesthesia. Both external carotid arteries and their branches were controlled to prevent intraoperative hemorrhage, and dissection took place down to the periosteum. A split skin graft from the thigh was applied to the scalp defect. The patient recovered well with no further evidence of dyspnea or high output cardiac failure.

Intravenous pentoxifylline in the treatment of rest pain: a preliminary report

Twenty patients with ischemic rest pain were treated with intravenous pentoxifylline, 1,200 mg daily, for up to three weeks. Ten patients obtained sufficient relief to avoid surgical intervention. Seven of these had complete or near complete relief of rest pain, but the other three required continuing analgesia. Transcutaneous oxygen measurements showed a significant increase after the course of treatment. There were marked gastrointestinal side effects in six patients, necessitating early withdrawal from the study. Three of these six patients had shown a favorable response to medication prior to withdrawal. These preliminary results suggest that pentoxifylline may provide a sufficient increase in tissue oxygen availability to avoid, or at least postpone, surgical intervention. A double blind controlled study is required to further assess the efficacy of this drug as an intravenous treatment.

Cesarean section and perinatal outcome: response from the House of Horne

A direct comparison between Parkland Memorial Hospital in Dallas, Texas, and the National Maternity Hospital in Dublin, Ireland, on the basis of limited numbers taken from one year only (1983) led to the conclusion that the liberal use of cesarean section in Dallas was associated with a sevenfold decrease in intrapartum fetal deaths and a twofold decrease in neonatal seizures. However, when the scope of the survey is extended to include the year before (1982) and the year after (1984), a different picture emerges. During this extended period there were almost four times as many cesarean sections performed in Dallas with no significant difference in overall perinatal mortality, while for two of three years the incidence of neonatal seizures was twice as high in Dallas when compared with Dublin. The fact that high cesarean rates continue to rely on evidence of such a tenuous nature must remain a matter of concern.

Active management of labor as an alternative to cesarean section for dystocia

There is general agreement that a solution to the problem of dystocia would go a long way toward resolving the contentious issue of high cesarean birth rates that have become such a prominent feature of obstetric practice in recent years. At the National Maternity Hospital in Dublin, one of the largest obstetric units in Western Europe, this situation has been averted through a coordinated policy of early detection and effective treatment of abnormal uterine action over a period of 15 years. During 1980 the number of births was 8742, the incidence of cesarean section was 4.8%, and mothers were assured of delivery within 12 hours after admission to the labor unit. It is proposed that these results could be reproduced elsewhere.

Improvement in perinatal mortality rate attributed to spontaneous preterm labor without use of tocolytic agents

A retrospective study of the influence of spontaneous preterm labor on perinatal mortality rate over a period of 15 years was conducted at the National Maternity Hospital, Dublin. As the perinatal mortality rate from all causes declined from 48 to 16 per 1,000 births, the rate attributed to spontaneous preterm labor declined in the same proportion, from 10 to three per 1,000 births. Review of the circumstances of death attributed to spontaneous preterm labor in each case indicates that improvement in this area was due mainly to a natural reduction in incidence and, to a lesser degree, to better care of the neonate. Pharmacologic agents recommended for the purpose of averting spontaneous preterm labor made no contribution, because none was used. Natural improvement in the evolution of a disease may lead to exaggerated claims for the benefits of treatment; experience with perinatal death attributed to spontaneous preterm labor in this large unit suggests that current enthusiasm for tocolytic agents may well be misplaced.

Correlation of decrease in perinatal mortality and increase in cesarean section rates

During what has proved to be a critical period in the practice of modern obstetrics, 1965 to 1980, when cesarean birth rates increased dramatically in centers across the United States from less than 5 to more than 15%, the number of infants born in the National Maternity Hospital, Dublin, was 108,987. Although the incidence of cesarean section remained virtually unchanged at 4.2, 4.2, 4.2, and 4.8% in 1965, 1970, 1975, and 1980, respectively, perinatal mortality continued to fall from 42.1 to 36.5, 24.0, and 16.8 per 1000 infants born at 500 g or more. These results do not support the contention that the expansion in cesarean birth rates has contributed significantly to reduced perinatal mortality in recent years. Consideration of indications shows that the threefold difference in cesarean birth rate which now exists between Dublin and similar centers across the United States can be accounted for almost entirely by a different approach to management of labor in nulliparous women, compounded by rigid adherence to precept "once a section, always a section.

Traumatic intracranial haemorrhage in firstborn infants and delivery with obstetric forceps

Exclusive of breech presentation, traumatic intracranial haemorrhage was demonstrated at necropsy on 27 occasions in 36 420 consecutive firstborn infants. All 27 were forceps deliveries. The main conclusion is that serious injury to the forecoming head at birth is almost invariably a direct effect of forceps. The relevance of this conclusion to some aspects of contemporary obstetric practice is discussed briefly.

Active management of labour: care of the fetus

A prospective study of 1000 consecutive primigravidae was conducted to assess the relevance of the colour of the liquor to the welfare of the child. The results showed that clear liquor early in labour virtually ensures the birth of a healthy infant, provided the duration of labour is limited and delivery is effected without trauma; and, conversely, that meconium--or no liquor--marks the fetus who may suffer death or brain damage during normal labour. Special techniques were reserved for the second group of cases.