Traumatic injuries associated with horseback riding.

BACKGROUND: According to the Center for Disease Control and Prevention (CDC), an estimated 30 million people ride horses each year in the United States. Horseback riding related injuries are common, with an estimated 50,000 emergency room visits annually. The popularity of recreational horseback riding has increased in South Florida and the incidence of associated traumatic injuries is a reflection of this. MATERIAL AND METHODS: Retrospective review of patients admitted to a state designated Level I trauma center that sustained horseback riding associated injuries between January 2000 and December 2003. Information extracted from the Trauma Center's data base included demographics, mechanism of injury and toxicology screening. RESULTS: During the review period, twenty-seven patients were identified. There were 12 men and 15 women. The average age was 36 years. The injuries occurred during pleasure riding in 23 patients and thoroughbred related activities in 4 patients. Multiple severe injuries were common and documented in 24 patients. All patients required hospitalization with an average stay of 5 days. Five patients had a positive toxicology screen on admission. No deaths were documented in this review. CONCLUSION: Horseback riding related injuries tends to be serious. Alcohol and recreational drugs may contribute to exacerbate the extent of these injuries. The use of proper protective equipment, instructions for safe riding, and discouraging drug and alcohol use during riding activities should be emphasized.

Characterization of factors affecting attachment of Bifidobacterium species to amylomaize starch granules.

AIMS: Two human-derived Bifidobacterium strains, PL1 and PL2, were tested for their ability to attach to amylomaize starch granules, and factors affecting binding were assessed. METHODS AND RESULTS: Good binding to granules was observed when the strains were grown on maltose or amylomaize starch, but not on glucose. Binding activity was localized to cell wall components and was sensitive to treatment with proteolytic enzymes. Several methodologies were employed to confirm these observations, including studies using radiolabelled cells, dot blot assays and scanning electron microscopy (SEM) analysis. CONCLUSION: Results from this study indicated that binding of strains PL1 and PL2 to amylomaize starch granules was mediated by a cell wall-associated proteinaceous factor that was induced when the strains were grown on starch or a related substrate, but not glucose. SIGNIFICANCE AND IMPACT OF THE STUDY: Attachment of probiotic strains to starch or other dietary fibres is believed to offer a selective advantage in the host intestine and may even prolong viability in adverse food environments. Therefore, characterizing the mechanisms of attachment has commercial implications in the design of synbiotic products.

Evaluation of microencapsulation of a Bifidobacterium strain with starch as an approach to prolonging viability during storage.

AIMS: To optimize a spray coating process for the production of encapsulated microspheres containing viable Bifidobacterium cells and to determine whether the readily gelatinized modified starch coating used in this study improved bacterial survival in foods or under acid conditions. METHODS AND RESULTS: An air inlet temperature of 100 degrees C was demonstrated to be optimal for the spray drying process, as it afforded good drying, low outlet temperatures (45 degrees C) and resulted in less than 1 log reduction in bifidobacteria numbers during drying. Maximum recovery yields of 30% were obtained after optimizing the air aspiration conditions. The average size of the Bifidobacterium PL1-containing starch microparticles was determined by scanning electron microscopy to be of the order of 5 microm. The starch-coated cells did not display any enhanced viability compared with free PL1 cells when exposed to acid conditions for 6 h or in two dry food preparations over 20 d storage at ambient temperature (19-24 degrees C). Determination of 1491 nucleotides of the 16S rRNA gene from PL1 indicated that it shared 97% homology with a previously sequenced Bifidobacterium ruminantium strain. CONCLUSIONS: Our data demonstrated that, although spray drying is a valuable process for encapsulating bifidobacteria, further work is required to ascertain a more appropriate coating material that will protect this strain against adverse environmental conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: The production of small, uniformly coated microspheres containing viable bifidobacteria using an affordable and industrially convenient process, such as spray drying, has commercial implications for the production of probiotic products. Although popular for use as a coating polymer by the food industry, this study indicated that modified starches might not be suitable for use as an encapsulating material for probiotic strains.

Molecular characterisation of a 5.75-kb cryptic plasmid from Bifidobacterium breve NCFB 2258 and determination of mode of replication.

A small cryptic plasmid originating from Bifidobacterium breve NCFB 2258 was cloned and its complete nucleotide sequence determined. pCIBb1 is a circular DNA molecule, 5750 bp in size with a GC composition of 57%. Computer-assisted analysis identified 10 possible open reading frames (ORFs), seven of which could be assigned no function from homology searches. One ORF, rep (380 amino acids), was postulated to encode a replication protein similar to known replication proteins of rolling circle replicons, particularly those of the pC194 family. Demonstration of single-stranded forms of the plasmid in cell lysates that could be specifically degraded by S1 nuclease provided experimental evidence to substantiate a replication mechanism via single-stranded intermediates. Two other ORFs, par (199 amino acids) and an ftsK-like gene (286 amino acids), were assigned putative functions based on the presence of conserved motifs in their deduced proteins.

Evaluation of bifidobacteria for the production of antimicrobial compounds and assessment of performance in cottage cheese at refrigeration temperature.

Twelve strains of bifidobacteria were identified which exhibited a broad spectrum of antagonistic activity against both Gram-positive and Gram-negative indicators, especially Pseudomonas species, using deferred antagonism spot plate assays. Inhibitory action was shown to be unrelated to hydrogen peroxide production and not solely dependent on acidity. However, attempts to detect inhibitory activity in cell-free supernatant fluids from these strains were unsuccessful. The production of inhibitory compound(s) by Bifidobacterium infantis NCFB 2255 was shown to be an unstable trait resulting in phenotypic alternation between production and non-production. Results from food trials using commercial cottage cheese which was inoculated with the inhibitor-producing strains of Bif. infantis NCFB 2255 and Bif. breve NCFB 2258 indicated that levels of Pseudomonas were reduced, but this observation was species-dependent. The viability of bifidobacteria themselves during storage in cottage cheese at refrigeration temperature was found to be a strain variable trait.

Hypertension education: an important and neglected part of the diabetes education curriculum?

This review highlights the important role of hypertension education in reducing the impact of hypertension on the development and progression of diabetes-related complications. Hypertension is commonly associated with diabetes mellitus and can significantly affect the progression of the complications of diabetes. Lifestyle changes similar to those recommended for diabetes management can result in a lowering of blood pressure and can be maintained on a long-term basis to benefit patients with diabetes and mild hypertension. Recently, a team approach in a hypertension clinic model similar to the team approach for diabetes treatment was shown to be effective in diabetes management. Increased awareness of hypertension education may contribute greatly to reducing the complications of diabetes. Hypertension education should be an important component of the diabetes education curriculum.

alpha 1-antitrypsin deficiency-associated panniculitis: resolution with intravenous alpha 1-antitrypsin administration and liver transplantation.

Panniculitis is a rare complication of alpha 1-antitrypsin (A1AT) deficiency that is characterized by acute inflammatory infiltrate and fat necrosis. Different treatment strategies are used to provide symptomatic relief. Here we describe two patients with homozygous A1AT deficiency who developed panniculitis and were successfully treated with A1AT replacement. The patient who received a liver transplant experienced complete resolution of the skin lesions. The patient who received A1AT intravenously showed complete response, but the skin lesions recurred when the levels of A1AT fell below 50 mg/100 ml. Panniculitis secondary to A1AT deficiency can be successfully treated with liver transplantation or intravenous infusion of A1AT.

Determination of genetic diversity within the genus Bifidobacterium and estimation of chromosomal size.

Pulsed-field gel electrophoresis was proven to be an efficient means of differentiating 25 strains of Bifidobacterium obtained from culture collections. XbaI, SpeI, DraI restriction enzyme profiles indicated genomic heterogeneity among strains. When seven human isolates of bifidobacteria were compared using the same methods, two individual banding patterns were obtained. However, despite its discriminatory potential, pulsed-field gel electrophoresis was shown to be of no value in taxonomic identification. Genomic sizes estimated for eight Bifidobacterium strains ranged from 1.5 Mb to 2.1 Mb.

Ischemic colitis secondary to venous thrombosis. A rare presentation of cytomegalovirus vasculitis following renal transplantation.

Gastrointestinal complications occur after renal transplantation in up to 16% of patients. Cytomegalovirus (CMV) vasculitis can affect the gastrointestinal tract with significant manifestations, including colonic ulceration, bleeding, and perforation. We present a case of CMV vasculitis in a renal transplant patient that caused middle and left colic vein thrombosis and resultant ischemic colitis. There was no evidence of arterial involvement. To our knowledge, this is the first reported case of ischemic colitis secondary to large vein thrombosis associated with CMV infection.

Digital clubbing associated with polymyositis and interstitial lung disease.

Clubbing of the fingers is commonly associated with interstitial lung diseases (ILDs). Although ILD occurs in as many as 40% of patients with polymyositis/dermatomyositis (PM/DM), clubbing of the digits has never been reported to occur in patients with PM/DM and ILD. We report the first case of clubbing associated with PM/DM and ILD.

Continued mapping of chromosome 2 genes.

This report describes our continued efforts to elucidate the genetic fine structure of the central portion of the mouse chromosome (Chr) 2. Mice from our panel of 28 Chr 2 congenic strains were tested: 1) for the presence of the antigens which stimulate Chr 2-reactive lymphocyte clones in mixed lymphocyte reaction (MLR); 2) for the antigens of histocompatibility (H) genes H-42a and H-45a as determined by allograft rejection; and 3) for their ability to respond to the H-Y antigen in a cell-mediated lysis assay. The results obtained in this study have allowed additional mapping of immunologically involved Chr 2 genes. The gene encoding the antigen which stimulates lymphocyte clone 1C11 can be considered wholly different from other Chr2 H genes on the basis of chromosomal recombination. We have assigned the symbol H-48 to this gene. The following gene order has been established: [H-3, B2m, pa], we, [H-42, H-48,] H-45, IR-H-Y, Hd-1, un, H-13, Aw. The order of the bracketed genes is not known. H-44 maps centromeric to IR-H-Y. The genes encoding the antigens that stimulate lymphocyte clones 2G7, 2C10, 1F6, 1B10, and 1H10 map centromeric to H-45.

Rare inflammatory and hereditary connective tissue diseases.

Polyarteritis nodosa developing during gestation has an extremely grave prognosis. To an uncertain extent, this results from a delay in recognition and therapy. The diagnosis of PAN is complicated by the expanded differential of common conditions associated with pregnancy such as pre-eclampsia and toxemia which can present with similar symptoms and signs. On the other hand, the pregnant woman with known, quiescent disease has a much better prognosis with only one of four women experiencing exacerbation. In women with Behcet's disease, convincing reports of both pregnancy-related flares and remissions involving primarily mucocutaneous manifestations are found in the literature. Gestational exacerbation of the more serious manifestations including chorioretinitis, vasculitis and CNS disease does not appear to be a problem. Also, a significant effect on fetal development or survival is not evident. The pregnant woman with the Marfan syndrome and pre-existing cardiovascular disease, particularly dilatation of the aortic root, has a substantially increased risk of developing a major complication during gestation most commonly aortic aneurysm, dissection, rupture or insufficiency. Echocardiographic determination of the aortic root diameter is prognostic with a decreased risk at a diameter of 40 mm or less. A diameter of greater than 40 to 45 mm constitutes a significant contraindication to pregnancy. All pregnancies in patients with the Marfan syndrome are considered high risk and frequent evaluations and echocardiograms are required. The EDS patient is subject to a wide range of gestational complications resulting from the basic connective tissue defect manifested clinically by hyperextensible skin, joint hypermobility, connective tissue and vascular fragility, and poor wound healing. The most serious complications occur in type I EDS (gravis) and type IV (ecchymotic) and include extensive perineal tears and hematoma after vaginal delivery, uterine prolapse and rupture, difficulty in suturing wounds and controlling hemorrhage after cesarean section, spontaneous rupture of major arteries, and bowel perforation. Management of the pregnant patient with the EDS must be individualized after identification of the particular type.

Acid-base curve and alignment nomograms for swine blood.

To construct acid-base curves and alignment nomograms for swine blood, we added known amounts of acid or base to aliquots of swine blood with three different concentrations of hemoglobin. Pairs of blood samples were equilibrated at two different CO2 partial pressures, and blood pH was measured. Data were analyzed by computer, and mean values were created for complete data of four swine. Curve and alignment nomograms were constructed by computer. The resultant nomograms for swine blood differ from those constructed by Siggaard-Andersen for human blood, most importantly at base-excess values of +10 to +25 mmol/l. The possible reasons for the observed differences are discussed and, although not completely resolved, may be related in large measure to the accuracy of pH determination and the methodology of nomogram construction.

Oxygen-linked hydrogen ion binding of canine blood.

Decrease in hemoglobin oxygen saturation without change of true blood base-excess results in an increase in calculated base-excess because of differences in acidity between oxy- and deoxyhemoglobin. We have determined the mean +/- SE canine base-excess correction coefficient to be 0.43 +/- 0.01 mmol base per mmol heme, a value approximately 34% higher than the corresponding value for human hemoglobin.

Long term variations in trypanosome infection rates in highly infected tsetse flies on a cattle route in south-western Nigeria.

One thousand, nine hundred and ninety-seven male and 1988 female Glossina morsitans submorsitans were dissected at Ogbomosho, on a trade cattle route in south-western Nigeria, from June 1970 to August 1973. Of male flies, 1307 (65-45%) were infected by Trypanosoma vivax trypanosomes, 66 (3-31%) by the subgenus Nannomonas (congolense group) and three (0.15%) by the subgenus Trypanozoon (brucei group). Of flies, 1236 (62-17%) had T. vivax infections, 80 (4-02%) had infections of the subgenus Nannomonas and two (0.10%) had infections of the subgenus Trypanozoon, The great majority of T. vivax infections were mature, while a high proportion (10% in males and 22% in females) of infections of the subgenus Nannomonas were immature. No infection with the subgenus Trypanozoon was found after October 1971. Overall infection rates, for male and female flies respectively, rose from 77% and 80% in June 1970 to peak values of 91% ad 90% in April and June 1971 and thereafter declined to lowest values of 37% and 43% in 1973. The incidence of T. vivax infections was the major component of the rises and falls in overall infection rate. During the period of peak infection rates (April-June 1971), all female flies over about 40 days old were infected. It was assumed that all these had T. vivax infections; some also had subgenus Nannomonas infections and one also had an infection of the subgenus Trypanozoon. Of 72 specimens of G. tachinoides dissected at Ogbomosho from June 1970 to August 1972, 20 (27-8%) were infected by trypanosomes, 19 with T. vivax and one with immature subgenus Nannomonas. In this species, also, infection rate was related to the age of the fly. Of 43 specimens of G. m. submorsitans dissected at Ilorin, north of Ogbomosho on the same cattle route, in February 1975, seven (16-3%) had T. vivax infections. One of two specimens of G. tachinoides dissected here at the same time had an immature infection of the subgenus Nannomonas. In G. m. submorsitans, variations in age structure of the population did not account for the temporal fluctuations in infection rates. It appeared that since 1970 events further north, especially tsetse eradication and the natural decline of tsetse populations (due probably to drought) reduced the trypanosomiasis risk to cattle proceeding southwards. The declining infection rates at Ogbomosho, after 1971, reflected this.