Bovine medicine: Whats´s your diagnosis?

INTRODUCTION: Two Angus calves housed in the Swiss Alps for two months were presented with brisket edema, jugular distension, and diarrhea. Hematological and biochemical examination included elevated concentration of erythrocytes and increased activity of liver enzymes. Ultrasonography revealed small amount of pleural effusion hepatomegaly and congested caudal vena cava. The diagnosis of congestive heart failure secondary to high-altitude disease was confirmed in pathology.

INTRODUCTION: Deux veaux Angus alpés dans les Alpes suisses depuis deux mois ont été présentés avec un œdème du poitrail, une stase jugulaire et de la diarrhée. Les examens hématologiques et biochimiques ont révélé une concentration élevée d'érythrocytes ainsi qu'une augmentation de l'activité des enzymes hépatiques. L'échographie a révélé un petit épanchement pleural, une hépatomégalie et une veine cave caudale congestionnée. Le diagnostic d'insuffisance cardiaque congestive secondaire à un mal des montagnes a été confirmé par la pathologie.

Improving compliance with isolation measures in the operating room: a prospective simulation study comparing the effectiveness and costs of simulation-based training vs video-based training.

BACKGROUND: Different isolation measures are required according to the routes of transmission of pathogens. Few studies have compared different forms of hygiene training in terms of efficiency and/or improvement of perception towards hygiene measures. This study aimed to evaluate the benefits of different forms of isolation training in the operating room, and their respective effects on the perception of hygiene measures by comparing simulation training with video-based training. METHODS: This multi-centre, prospective, randomized, controlled trial compared hygiene knowledge, psychological safety and perception of training among healthcare workers after in-centre simulation training and conventional video-based training. RESULTS: Neither type of training led to a significant improvement in knowledge or perceived psychological safety (F=0.235, P=0.629, η2=0.003). Participants in the simulation group reported higher levels of willingness to speak up in the depicted scenario compared with participants who received video-based training. Participants perceived the simulation-based training significantly more positively than the video-based training. CONCLUSION: Clear definition of the goals of training based on the pre-existing level of knowledge of the participants is crucial. For future studies, it would be interesting to investigate the long-term effect and continuing benefits concerning the implementation of hygiene regulations after different types of training.

Balloon valvuloplasty of valvular pulmonary stenosis in a neonatal foal.

In a 1-day old filly with a loud heart murmur, transthoracic echocardiography revealed right ventricular hypertrophy associated with severe pulmonary valvular stenosis and a transvalvular pressure gradient (between right ventricle and pulmonary artery) of 125 mmHg. Computed tomographic angiography confirmed the finding, with no evidence of other relevant concurrent abnormalities. Balloon valvuloplasty was performed using a single balloon technique. The foal recovered well from anaesthesia. Following the procedure, the right ventricle-pulmonary artery transvalvular gradient decreased to 38 mmHg. At follow up examinations after 1 month, 1 year and 2 years, the filly showed normal exercise capacity and echocardiography confirmed the persistent substantial improvement in the transvalvular outflow gradient.

Band alignment investigations of heterostructure NiO/TiO2 nanomaterials used as efficient heterojunction earth-abundant metal oxide photocatalysts for hydrogen production.

Earth-abundant NiO/anatase TiO2 heteronanostructures were prepared by a straightforward one-pot sol-gel synthetic route followed by a suitable thermal post-treatment. The resulting 0.1-4 wt% NiO-decorated anatase TiO2 nanoparticles were characterized by X-ray diffraction, electron microscopy, Raman and UV-visible spectroscopy and N2 sorption analysis, and showed both nanocrystallinity and mesoporosity. The careful determination of the energy band alignment diagram by a suitable combination of XPS/UPS and absorption spectroscopy data revealed significant band bending at the interface of the p-n NiO/anatase TiO2 heterojunction nanoparticles. Furthermore, these heterojunction photocatalysts exhibited an improved photocatalytic activity in H2 production by methanol photoreforming compared to pure anatase TiO2 and commercial P25. Thus, an average H2 production rate of 2693 µmol h-1 g-1 was obtained for the heterojunction of a 1 wt% NiO/anatase photocatalyst, which is one of the most efficient NiO/anatase TiO2 systems ever reported. An enhanced dissociation efficiency of the photogenerated electron-hole pairs resulting from an internal electric field developed at the interface of the NiO/anatase TiO2 p-n heterojunctions is suggested to be the reason of this enhanced photocatalytic activity.

Efficacy of omeprazole powder paste or enteric-coated formulation in healing of gastric ulcers in horses.

BACKGROUND: GastroGard, an omeprazole powder paste formulation, is considered the standard treatment for gastric ulcers in horses and is highly effective. Gastrozol, an enteric-coated omeprazole formulation for horses, has recently become available, but efficacy data are controversial and sparse. OBJECTIVES: To investigate the efficacy of GastroGard and Gastrozol at labeled doses (4 and 1 mg of omeprazole per kg bwt, respectively, PO q24h) in healing of gastric ulcers. ANIMALS: 40 horses; 9.5 ± 4.6 years; 491 ± 135 kg. METHODS: Prospective, randomized, blinded study. Horses with an ulcer score ≥1 (Equine Gastric Ulcer Council) were randomly divided into 2 groups and treated for 2 weeks each with GastroGard followed by Gastrozol (A) or vice versa (B). After 2 and 4 weeks, scoring was repeated and compared with baseline. Plasma omeprazole concentrations were measured on the first day of treatment after administration of GastroGard (n = 5) or Gastrozol (n = 5). RESULTS: Compared with baseline (squamous score (A) 1.65 ± 0.11, (B) 1.98 ± 0.11), ulcer scores at 2 weeks ((A) 0.89 ± 0.11, (B) 1.01 ± 0.11) and 4 weeks ((A) 1.10 ± 0.12, (B) 0.80 ± 0.12) had significantly decreased in both groups (P < .001), independent of treatment (P = .7). Plasma omeprazole concentrations were significantly higher after GastroGard compared with Gastrozol administration (AUCGG = 2856 (1405-4576) ng/mL × h, AUCGZ = 604 (430-1609) ng/mL × h; P = .03). The bioavailability for Gastrozol was 1.26 (95% CI 0.56-2.81) times higher than for GastroGard. CONCLUSIONS AND CLINICAL IMPORTANCE: Both Gastrozol and GastroGard, combined with appropriate environmental changes, promote healing of gastric ulcers in horses. However, despite enteric coating of Gastrozol, plasma omeprazole concentrations after single labeled doses were significantly higher with GastroGard.

Acinar cell carcinoma of exocrine pancreas in two horses.

Two horses were presented with non-specific clinical signs of several weeks' duration and were humanely destroyed due to a poor prognosis. At necropsy examination, both horses had multiple small, white nodules replacing pancreatic tissue and involving the serosal surface of the abdominal cavity, the liver and the lung. Microscopically, neoplastic cells were organized in acini and contained abundant (case 1) or sparse (horse 2) intracytoplasmic zymogen granules. Immunohistochemically, both tumours expressed amylase and pan-cytokeratin, but not insulin or neuron-specific enolase. In case 2, a low percentage of neoplastic cells expressed glucagon and synaptophysin. The presence of zymogen granules was confirmed in both cases by electron microscopy and occasional fibrillary or glucagon granules were observed in cases 1 and 2, respectively. A diagnosis of pancreatic acinar cell carcinoma was established in both horses.

Difficidin and bacilysin produced by plant-associated Bacillus amyloliquefaciens are efficient in controlling fire blight disease.

Representatives of Bacillus amyloliquefaciens were shown to possess biocontrol activity against fire blight, a serious disease of orchard trees caused by Erwinia amylovora. Genome analysis of B. amyloliquefaciens FZB42 identified gene clusters responsible for synthesis of several polyketide compounds with antibacterial action. We show here that the antibacterial polyketides difficidin and to a minor extent bacillaene act efficiently against E. amylovora. Surprisingly, a mutant strain blocked in the production of difficidin (CH8 Deltadfn) inhibited growth of E. amylovora and suppressed fire blight disease nearly in the same range as the wild type. In addition, a sfp mutant (CH3 Deltasfp) unable to synthesize non-ribosomally lipopeptides and polyketides did still suppress growth of E. amylovora, suggesting that besides action of polyketides another antagonistic principle exist. A double mutant (RS06 Deltasfp Deltabac) devoid in polyketide and bacilysin synthesis was unable to suppress growth of E. amylovora indicating that the additional inhibitory effect is due to production of bacilysin, a dipeptide whose synthesis does not depend on Sfp. We propose to use B. amyloliquefaciens strains with enhanced synthesis of difficidin and/or bacilysin for development of biocontrol agents efficient against fire blight disease.

Estadificación de pacientes con cáncer mamario: rol del cintigrama óseo y de la ecotomografía hepática / Staging in breast cancer patients: the role of bone scintigraphy and hepatic echotomography

Los estudios de estadificación en casos nuevos de pacientes con cáncer de mamas son variables, máxime en aquellas con enfermedad temprana (estadios I y II). A menudo, se realizan rutinariamente cintigrama óseo y ecotomografía hepática sin que existan evidencias sustentables de su utilidad. Con el objeto de determinar el valor del cintigrama óseo y de la ecotomografía hepática en los estudios de estadificación conducentes a detectar metástasis, se realizó un estudio retrospectivo de pacientes con cáncer de mama manejadas en el Hospital de Valdivia. De un total de 105 pacientes que reunieron los requisitos de este estudio una vez realizado el diagnóstico inicial del cáncer, 7 (6,7 por ciento) resultaron tener metástasis; además, 10 pacientes presentaron síntomas clínicos o signos sugerentes de enfermedad metastásica o anormalidades en las pruebas hepáticas o en la radiografía de tórax. Considerando la estadificación inicial se encontró 68 (64,8 por ciento) pacientes en estadios tempranos y 37 (35,2 por ciento) enfermas en estadios avanzados. De los 95 casos que pudieron acceder al estudio imagenológico, presentaron metástasis el 1,5 por ciento (1/68) de los estadios tempranos y el 16,2 por ciento (6/37) de los estadios locales y/o regionalmente avanzados, lo que dio en el análisis estadístico que esta diferencia numérica fuera significativa (x2= 8,1; pvalue= 0,004). En 9,8 por ciento (5/51) de las pacientes se diagnosticó enfermedad metastásica exclusivamente con los resultados de los cintigramas óseos y el 1,3 por ciento (1/76) fue diagnosticado solamente con ecotomografía hepática. ninguna paciente en estadio T1-2 NO presentó diseminación sistémica. Nuestros resultados confirman que en las pacientes con cáncer de mama en estadios tempranos confirmados patológicamente, el cintigrama óseo y la ecotomografía hepática de rutina tienen bajo rendimiento.

Functional interaction of the active zone proteins Munc13-1 and RIM1 in synaptic vesicle priming.

Synaptic neurotransmitter release is restricted to active zones, where the processes of synaptic vesicle tethering, priming to fusion competence, and Ca2+-triggered fusion are taking place in a highly coordinated manner. We show that the active zone components Munc13-1, an essential vesicle priming protein, and RIM1, a Rab3 effector with a putative role in vesicle tethering, interact functionally. Disruption of this interaction causes a loss of fusion-competent synaptic vesicles, creating a phenocopy of Munc13-1-deficient neurons. RIM1 binding and vesicle priming are mediated by two distinct structural modules of Munc13-1. The Munc13-1/RIM1 interaction may create a functional link between synaptic vesicle tethering and priming, or it may regulate the priming reaction itself, thereby determining the number of fusion-competent vesicles.

Reduced cerebral vasomotor reactivity as an indicator of postoperative confusion.

Surgical intervention in elderly patients carries a high risk. A frequent problem with surgery in these patients is the occurrence of a temporary confusional state, which increases both the risk of postoperative complications and the need for intensive care. We hypothesised that, in part, temporary confusional state results from cerebral hypoxia occurring in response to blood pressure fluctuations during surgery. To assess whether disruption of autoregulation of cerebral blood vessels plays a role in temporary confusional state, we studied 31 patients over 55 years of age, using the Doppler-carbon dioxide test. We determined whether vasomotor reactivity could be used diagnostically to identify those patients most likely to experience temporary confusional state. Blood flow velocity in the middle cerebral artery was detected using Doppler ultrasound, and hypercapnia was induced by breathing carbon dioxide until an end-tidal concentration of 8.0% by volume was reached. Vasomotor reactivity was calculated on the basis of the changes in blood flow velocity in response to the increase in carbon dioxide. Temporary confusional state was assessed using the Syndrome Short Test (Syndrom-Kurztest). We found that resting blood flow velocity was inversely related to age (p < 0.05). In addition, there was a significant inverse correlation between vasomotor reactivity and temporary confusional state (p < 0.05). These data indicate that vasomotor reactivity, as measured by the Doppler-carbon dioxide test, is a reliable tool to identify patients at risk for postoperative psychological disturbances.

Effect of loperamide on jejunal electrolyte and water transport, prostaglandin E2-induced secretion and intestinal transit time in man.

Jejunal perfusion was performed in 12 healthy volunteers to evaluate the dose dependent effects of loperamide on intestinal absorption, stimulated secretion and transit. In 6 volunteers intestinal perfusion of the jejunal segment with isotonic NaCl solution was followed by addition of loperamide in increasing doses (2-8 mg.l-1). The volunteers were pretreated with 1 mg.l-1 prostaglandin E2 (PgE2) in the perfusate before addition of 4 mg.l-1 loperamide. Phenolsulphonphtalein (PSP) boluses (2 ml) were given to measure mean transit time (MTT). Loperamide 2 mg.l-1 converted the minor secretion after perfusion with the standard solution (water -145 ml.min-1, Na -0.09 and Cl -0.04 mmol.min-1) to absorption (water 0.93 ml.min-1, Na 0.23, Cl 0.25 mmol.min-1) within 15 min. Higher doses of loperamide did not increase absorption. The addition of PgE2 induced net secretion of water (-4.48 ml.min-1) and electrolytes (Na -0.57, Cl -0.51 mmol.min-1). Loperamide 4 mg.l-1 significantly diminished the PgE2-induced net secretion by approximately 50%. Loperamide dose dependently increased the MTT from 6 (2 mg.l-1) to 13.3 min (8 mg.l-1). MTT was still delayed 60 min after a wash out period (10.5 min). It is concluded that loperamide had a dual effect or intestinal activities stimulating absorption and prolonging intestinal transit time with rising doses.

Phase I metabolism of imipramine by microsomes of small intestine in comparison with metabolism by liver microsomes.

The metabolism of imipramine was investigated by the incubation of C-14 labelled compound in Krebs-Ringer bicarbonate buffer with microsomes of small intestine and of liver from guinea pigs. Imipramine and its metabolites were extracted with chloroform, separated by TLC and determined quantitatively by direct scanning with a TLC Linear Analyzer. With intestinal microsomes, the following metabolites could be identified: DMI, 2-OH-IMP, IMP-N-oxide. DMI is the main metabolite. The same metabolites appeared after incubation with liver microsomes, but the proportions were different: the N-oxide formation was predominant, followed by N-demethylation and hydroxylation. The formation of DMI and 2-OH-IMP seems to follow Michaelis-Menten kinetics, both in assays with intestinal and with liver microsomes. The liver/intestine ratio of DMI and 2-OH-IMP formation is proportional to the cytochrome P-450 ratio in the microsomes, in contrast to N-oxide formation.

[Valve lesions of the right heart associated with use of indwelling pulmonary artery catheters (author's transl)]. / Klappenschäden des rechten Herzens nach Anwendung von Pulmonalarterienverweilkathetern.

Pulmonary artery chatheterisation by means of flow-directed balloon-tipped catheters has proved a valuable aid in assessing haemodynamic parameters of critically ill patients. Serious complications are reported to be uncommon. On postmortem examination of 8 patients, in whom flow-directed balloon-tipped catheters were employed, and whose catheters were dissected in situ, there were 5 instances of non-bacterial thrombotic endocarditis (NBTE) and 4 of focal valvular bleeding. This is a much more frequent incidence of valvular lesions than has been reported previously. The pathogensis of NBTE is briefly disicussed, and attention is drawn to potential long-term complications. We suppose that valvular diseases of the right side of the heart will gain in significance due to the increasing use of flow-directed balloon-tipped pulmonary artery catheters.

Behavioral states and state-related heart rate and motor activity patterns in the newborn infant and the fetus ante partum. A comparative study. III. Analysis of sleep state-related motor activity patterns.

Evaluation of fetal movements revealed a striking difference of motor activity during assumed quiet sleep and active sleep in the fetus. Furthermore, motor activity was found to be enhanced in post-term fetuses. Consequences for the methods of fetal acceleration determination (FAD) and daily fetal movement count (DFMC) are discussed.