Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people.

Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.

Blood profiles in dairy cows with displaced abomasum.

An observational study was carried out in Swedish dairy herds to investigate differences between cows with and without displaced abomasum (DA), in concentrations of glucose, insulin, fructosamine, nonesterified fatty acids (NEFA), ß-hydroxybutyrate, cholesterol, haptoglobin, increased enzyme activity of aspartate aminotransferase and glutamate dehydrogenase, and the revised Quantitative Insulin Sensitivity Check Index (RQUICKI). A secondary aim was to study how blood profiles for DA cows vary with time in relation to calving. Sixty-nine DA cows within 2 to 56 d postpartum, in 60 herds, were clinically examined and blood samples were drawn at the time DA was diagnosed. At the same time, 104 healthy control cows matched by herd and stage of lactation were also sampled. The blood parameters were studied using mixed linear models, including herd as a random effect, and DA (case or control), parity, breed, sampling time in relation to calving, other diseases, and the interaction between DA and time as fixed effects. Concentrations were higher in DA cows than in control cows for NEFA (least squares means 1.36 vs. 0.34 mmol/L), ß-hydroxybutyrate (1.56 vs. 0.90 mmol/L), aspartate aminotransferase (1.96 vs. 0.97 µkat/L), glutamate dehydrogenase (197 vs. 78 µkat/L), and haptoglobin (0.76 vs. 0.17 g/L), whereas concentrations were lower in DA cows than in control cows for insulin (3.61 vs. 8.48 mU/L) and cholesterol (3.04 vs. 3.75 mmol/L). Glucose (2.83 vs. 2.79 mmol/L) and fructosamine (266 vs. 252 µmol/L) concentrations were similar in both groups; however, a tendency toward lower RQUICKI values (0.42 vs. 0.46) in the DA cows was found, indicating reduced insulin sensitivity. For most blood parameters, differences between DA cows and controls remained constant over time. Seventy-two percent of the DA cows had at least one other disease in the period from 1 wk antepartum to 1 wk after the DA was diagnosed. Haptoglobin could potentially be used to detect treatable infectious or inflammatory conditions in the early postpartum period, possibly reducing the incidence of DA. Consequently, there were major changes in blood profiles in cows with DA compared with healthy control cows, indicating a negative energy balance, liver cell damage, and an inflammatory response. The results contribute to an understanding of the metabolic changes in DA cows.

An observational study on early-lactation metabolic profiles in Swedish organically and conventionally managed dairy cows.

The aim of this observational study was to compare indicators of energy balance in early lactation in organically managed dairy cows (OMC) and conventionally managed dairy cows (CMC) under field conditions. The diets of OMC and CMC differ as a consequence of the rules and principles of organic dairy farming. The study was based on clinical examinations and blood samples from cows within the range from 2 wk prepartum to 6 wk postpartum, collected from 20 organic and 20 conventional dairy farms with 3 visits at each farm. The farms were located in a southeastern area of Sweden and ranged in size from 45 to 120 cows. The blood parameters selected to reflect energy metabolism were nonesterified fatty acids, beta-hydroxybutyrate, glucose, and insulin. At clinical examination body condition score was registered. The shape of the lactation curve in early lactation was modeled to assess potential differences that could explain the blood parameter profiles. The conventionally managed cows increased their milk yield faster than OMC within the first 2 wk of lactation. Blood nonesterified fatty acid concentrations were similar between the management types, but with a tendency of lesser concentrations in OMC, primarily in early lactation. Postcalving beta-hydroxybutyrate concentrations were constantly lesser in OMC during the first 6 wk of lactation. An interaction between season and insulin concentration necessitated stratification on season. During spring the profiles overlapped, but there was a significant difference in the first 4 d post-calving, when organically managed cows had greater insulin concentrations and in d 30 to 34 when conventionally managed cows had greater insulin concentrations. During fall the profiles overlapped completely and there was no significant difference at any point in time. Glucose concentrations tended to decrease slightly postcalving followed by a gradual elevation to a concentration just under the precalving concentration during the study period. Body condition scores decreased slightly over the study period. No differences were found between the management types with regard to glucose concentrations or registered body condition score. In conclusion, the OMC did not show a greater extent of mobilization of body tissue than CMC as expressed by our study variables. Hence, OMC adjusted the production amount according to feed intake.

Mononuclear cell subsets in bronchoalveolar lavage fluid during Dictyocaulus viviparus infection of calves: a potential role for gamma/delta TCR-expressing cells in airway immune responses?

Mononuclear cell populations in the lungs of calves infected with Dictyocaulus viviparus were studied during primary infection and reinfection in order to identify cells involved in development of protective immunity to parasitic bronchitis. Three groups of calves were either inoculated with 500 third-stage larvae at both weeks 0 and 10 (n = 6), inoculated only at week 10 (n = 6), or remained uninfected (n = 3). The animals were monitored weekly by collection of bronchoalveolar lavage fluid (BALF), blood and faeces. Among mononuclear BALF-cell populations, the gamma/delta TCR-expressing cells showed a pronounced transient increase in proportion as well as in relative cell size 2 weeks post primary infection, whereas CD4-, CD8-, Ig- and CD14-expressing cells showed no significant differences related to the infection. The increase in gamma/delta TCR-expressing cells coincided with significantly increased proportions of eosinophils and recovery of adult worms in BALF. After reinfection, gamma/delta TCR-expressing cells increased again, but not until week 3 post inoculation, whereas eosinophils were increased by week 2 and reached higher levels than after primary infection. After reinfection, establishment of D. viviparus was less successful than after primary infection. In conclusion, these results indicate a role for gamma/delta TCR-expressing lymphocytes in the pathogenesis of D. viviparus infection.

Indirect transmission of bovine viral diarrhoea virus at calving and during the postparturient period.

Two trials were designed to investigate whether bovine viral diarrhoea virus (BVDV) could be transmitted after the birth of persistently infected calves, even if they were removed immediately after birth. In trial 1, 11 calves were actively exposed to fetal fluids and uterine lochia collected from cows that had delivered calves persistently infected with type 1 BVDV. One calf that was exposed to a sample taken on the day of calving seroconverted. In trial 2, six calves were housed in stables where persistently infected calves were being born and then removed immediately from their dams and from the stable unit within two to three hours. One of four calves in close contact with the cows after delivery seroconverted and one of two calves housed within the same stable unit became infected.

Experimental infection of cows with bovine viral diarrhoea virus in early pregnancy - findings in serum and foetal fluids.

Nineteen pregnant cows were experimentally infected with bovine viral diarrhoea virus (BVDV) between day 74 and 81 of pregnancy. All cows became infected and developed serum antibodies. Sixteen of the cows delivered persistently infected (PI) offspring, whereas the remaining three gave birth to calves with detectable serum antibodies and free from BVDV. The 16 cows with PI foetuses developed higher levels of antibodies in serum during pregnancy than did their three peers carrying non-PI calves. Multivariate analysis showed that the antibody levels in these two groups of cows were significantly different from day 135 of pregnancy. Foetal fluid was successfully collected from 18 of the 19 infected cows and from five uninfected control cows between 10 and 24 days before delivery by use of a percutaneous, blind puncture technique. No negative effects were observed in the cows or their offspring. BVDV was isolated and detected with an immunoperoxidase test in foetal fluid from 13 of the 16 cows carrying PI foetuses, and from 15 of the cows when a quantitative fluorescent polymerase chain reaction (PCR) technique was used. The negative sample in the PCR assay was positive for BVDV antibodies. The number of viral copies per microlitre in foetal fluids varied between 103 and 1080 in the positive samples. All samples taken from the cows carrying non-PI foetuses were negative for BVDV in both assays. In this experiment, examination of either serum or foetal fluids could identify the cows carrying a PI foetus. Examination of serum for BVDV antibodies was a reliable indicator of a PI foetus if the serum was collected during the last 2 months of pregnancy. For examination of foetal fluids, both viral and serological analyses should be performed. For viral analysis, PCR should be the test of choice. High levels of BVDV antibodies in conjunction with a negative result in the PCR may be indicative of a false-negative virus result. Further experience with the method of collection of foetal fluids is necessary for evaluation of its safety. Investigation of pregnant cows in order to discover a PI offspring before it is born could be a useful tool in control and eradication of BVDV.

The acute phase response in calves experimentally infected with bovine viral diarrhoea virus and/or Mannheimia haemolytica.

The aim of this investigation was to study differences and similarities in the acute phase response of calves experimentally infected in the respiratory tract with either bovine viral diarrhoea virus (BVDV) or Mannheima haemolytica (Mh), or with a combination of both (BVDV/Mh). A non-inoculated control group was also included. The acute phase response was measured by serum or plasma concentrations of the acute phase proteins (APPs) haptoglobin, serum amyloid A (SAA) and fibrinogen, and of cortisol, prostaglandin F2alpha-metabolite and interferon-alpha (IFN-alpha) activity. Clinical symptoms were also recorded and were most severe in the BVDV/Mh group. The symptoms were mild to moderate in the BVDV group, while none, or very mild symptoms were observed in the Mh group. In all inoculated groups, a significant acute phase response was observed, with elevated values of haptoglobin, SAA and fibrinogen, while the control group remained unaffected throughout the study. In general, the magnitude of the response was similar, but the duration of elevated concentrations of APPs was significantly longer in the BVDV/Mh group than in the BVDV group, reflecting the duration of the clinical symptoms. However, in the single infection groups, the APP response and the clinical symptoms were not correlated. The IFN-alpha activity increased in all BVDV-inoculated animals, but no response in cortisol and PGF2alpha-metabolite concentrations was observed after infection. Basal levels of serum concentrations of haptoglobin, SAA and fibrinogen were established and may be used for evaluating calf health in herds. The duration of elevated haptoglobin, SAA and fibrinogen values did not differ significantly within groups indicating that their value as indicator of disease is equal.

International collaboration in mass disasters involving foreign nationals within the EU: medico-legal investigation of Finnish victims of the Milan Linate airport SAS SK 686 aircraft accident on 8 October 2001.

Identification of and investigation into the cause of death of foreign nationals in mass disasters are generally conducted according to the jurisdiction of the country in which the disaster occurs. However, such identification can be achieved only through co-operation with the authorities of the victims' countries of residence. On October 8th 2001 at Linate airport in Milan, Italy, an MD87 SAS airplane with 110 crew members and passengers on board collided on the ground with a Cessna Citation II jet with 2 pilots and 2 passengers. The plane then caught fire after having crashed into an airport baggage hangar causing the death of 4 other victims among the groundstaff. The accident claimed a total of 118 victims of 9 nationalities. Based on our experience from investigation of the Finnish victims, we explore how current national legislations of the EU member states and varying compliance with existing recommendations may influence the medico-legal investigation of a mass disaster. Legislative measures and further harmonisation of medico-legal procedures in connection with mass disasters within the EU are needed.

Transmission of bovine viral diarrhoea virus by unhygienic vaccination procedures, ambient air, and from contaminated pens.

Knowing how bovine viral diarrhoea virus (BVDV) infection spreads via indirect contacts is required in order to plan large-scale eradication schemes against BVDV. In this study, susceptible calves were exposed to BVDV by an unhygienic vaccination procedure, by ambient air and from contaminated pens. Primary BVDV infection was observed in two calves vaccinated with a vaccine against Trichophyton spp that had been contaminated by smearing nasal secretion from a persistently infected (PI) calf on the rubber membrane and penetrating it twice with a hypodermic needle. Four other calves, housed in pairs in two separate housing units near a PI calf for one week--at distances of 1.5 and 10 m, respectively--became infected without having direct contact with the PI calf. Furthermore, two of the three calves housed in a pen directly after removal of a PI calf, but without the pen being cleaned and disinfected, also contracted primary BVDV infection, whereas two calves that entered such a pen four days after removal of another PI calf, did not. In herds where most animals are seronegative to BVDV, indirect airborne transmission of BVDV or contact with a contaminated housing interior may be an important factor in spreading of the virus, once a PI animal is present. However, the spreading of BVDV within herds can be stopped by identifying and removing PI animals and also by ensuring that susceptible breeding animals do not become infected during this procedure. In contrast, injectables contaminated with BVDV may prove to be a significant vector for spreading the infection, not only within an infected herd but, most importantly, also between herds. In our opinion, it is questionable whether medicine bottles, once opened and used within an infected herd, should be used in other herds. In any case, prior knowledge of a herd's BVDV status will help practising veterinarians and technicians to undertake appropriate hygienic measures.

The Oswestry Low Back Pain Disability Questionnaire. a two-year follow-up of spine surgery patients.

BACKGROUND AND AIMS: So far there is no golden standard for the measurement of functional disability in spinal problems. The Oswestry index can be used to monitor the response to treatment and rehabilitation. It is based on a patient's subjective impression of his or her own state of disability. The purpose of this prospective study is to give a graphic presentation of the behaviour of the Oswestry index in different spine surgery groups. MATERIAL AND METHODS: The material includes 193 discectomy and decompressive operations. 37 of these patients had been operated earlier. The patients were observed for two years after the index operation through the mail with the Oswestry questionnaire. RESULTS: Before an operation the average Oswestry index corresponded to severe disability on average. After successful treatment the Oswestry index dropped by 20-40 points on average. The more complex the problem the higher the postoperative lines remained. CONCLUSIONS: The results compared well with those of earlier studies. The graphs presented in this study may help the treating clinician to make conclusions on how his or her patients are doing on average after surgery.

Insemination of susceptible heifers with semen from a non-viraemic bull with persistent bovine virus diarrhoea virus infection localized in the testes.

Bulls shedding bovine viral diarrhoea virus (BVDV) in semen and simultaneously having a high concentration of circulating antibodies may cause reproductive problems and spread the viral infection within cattle populations. To investigate this in detail, three heifers were inseminated with BVDV-infected semen from a non-viraemic, seropositive Holstein-Friesian bull, named 'Cumulus'. One control heifer was inseminated with semen from a healthy bull that was free of BVDV. All four heifers remained clinically healthy throughout the experiment. The conception succeeded in the control animal and in two of the three heifers inseminated with semen containing BVDV. The heifer with the failed conception was the only one that became systemically infected with BVDV. This animal was deemed non-pregnant by ultrasonic examination on day 34 after insemination and showed no signs of subsequent oestrus during the entire experimental period. At slaughter, 42 days after insemination, there were no histopathological changes in the ovaries and virus was not detected in ovarian tissue. The fact that seronegative dams served with semen from persistently infected bulls have occasionally produced persistently infected calves together with the present findings and the fact that non-viraemic, seropositive bulls can constantly shed BVDV, suggest that the use of semen from such bulls in BVDV-free herds could have far-reaching consequences, especially if it led to the birth of persistently infected (P1) calves.

Acrylamide and N-methylolacrylamide poisoning in a herd of Charolais crossbreed cattle.

Seven beef cattle from a herd accidentally exposed to acrylamide and N-methylolacrylamide while grazing were observed for eight months. They showed clinical signs of impaired nerve function, mainly in the hindlegs, with varying degrees of weakness and ataxia. The animals were irritable, nervous and hypersensitive to touch. Both pupils of the most badly affected animal were dilated and it had poor pupillary light responses; it also showed signs of axonal neuropathy. Selected haematological and clinical chemistry variables were normal. The severity of the neurological signs was correlated with the concentrations of haemoglobin adducts of acrylamides. The animals recovered substantially after their exposure. The gestations of four of the animals which were in calf proceeded normally.

Hip arthroscopy in osteoarthritis. A review of 68 patients.

BACKGROUND AND AIMS: A few studies have investigated therapeutic effect of hip arthroscopy in osteoarthritis, and therefore the use of hip arthroscopy in osteoarthritis has remained controversial. The aim of this study was to evaluate diagnostic and therapeutic aspects of hip arthroscopy in primary osteoarthritis. MATERIAL AND METHODS: During a time period from 1995 to 1999, a total of 68 patients had an arthroscopic evaluation of primary hip osteoarthritis at the Päijät-Häme Central Hospital, Lahti, Finland. The mean (range) follow-up was 1.3 (0.3 to 4) years. Arthroscopy was diagnostic in 38 (56%), while six (9%) patients received either long-lasting anaesthetic or prednisolone, and in 24 (35%) debridement was possible. Partial synovectomy was performed in two (3%). RESULTS: Three months after the arthroscopy, 49 (72%) patients reported that their hip pain had decreased. One year after the arthroscopy, 18 (26%) patients stated that their hip pain was less pronounced than before the arthroscopy. The severity of hip osteoarthritis in preoperative x-rays correlated significantly (p = 0.035) with the subjective result: the milder the osteoarthritis, the more often patients reported that their hip pain had decreased after arthroscopy. No association was observed between age, sex, modified Outerbridge grade of chondropathy, or whether a debridement was done or not and the symptomatic relief after the arthroscopy. CONCLUSIONS: Hip arthroscopy with or without debridement of loose cartilage may, at least temporarily, reduce the pain of mild or moderate osteoarthritis of the hip. Still, repeated arthroscopies had no therapeutic effect.

Osteosynthesis and allogeneic bone grafting in complex osteoporotic fractures.

Thirty patients with osteoporotic fractures were treated operatively. An allogeneic bone transplant was used in combination with a conventional osteosynthesis in each patient. The bone graft was pulverized in a bone mill and used as a substitute graft to fill the bone defect, add stability, and enhance bone union. Fractures healed without complications in 20 patients. The osteosynthesis failed in 4 patients. The fracture failed to unite in an additional 3 patients. One deep infection occurred. A biopsy taken from the allogeneic bone at plate removal after fracture union demonstrated mature bone and new bone formation. The use of pulverized allograft bone for large bone defects in patients with osteoporotic fractures yields acceptable results with no adverse effects.

Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study.

In a prospective, randomized study, 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications, or range of motion. Although there was more soaked dressing requiring reinforcements in the groups without drainage, as a result of this study, we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis.

Lack of virus transmission from bovine viral diarrhoea virus infected calves to susceptible peers.

None of 14 calves not previously exposed to BVDV became infected after being forced to have nose-to-nose contact with a group of 5 calves primarily infected with BVDV. These were 5 male calves primarily infected with a type I BVDV strain, after nose-to-nose contact with a persistently viraemic calf. All 5 became infected and were clinically affected. They were slightly depressed and pyretic at 8-9 days post-infection, with a body temperature of up to 41.6 degrees C, but no medical treatment was required. Seroconversions to BVDV were detected in these calves at 14 to 21 days post-infection. The 14 healthy calves, proved to be free from BVD virus--as well as antibodies, were introduced 2 by 2 into the group of 5 primarily infected calves on days 4, 7, 14, 21, 28, 35 and 42 after the 5 calves had been in contact with the persistently BVDV-infected calf. Each pair of calves stayed within the primarily infected group for 2 days. None of these 14 calves seroconverted to BVDV.

Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting.

We did a prospective study to compare the results of treatment of subcapital fractures of the fifth metacarpal bone by closed reduction and splinting or by functional treatment. Twenty-nine consecutive patients were randomly divided into the two treatment groups (functional n = 14, and reposition and splinting n = 15). The results of treatment were satisfactory in both groups. Functionally treated patients recovered their grip force and range of movement of the affected hand a little sooner. All fractures in both groups had united within three months. There were no complications. We conclude that subcapital fractures of the fifth metacarpal bone can successfully be treated without closed reduction and splinting.

Biodegradable screw fixation of the syndesmosis together with metallic osteosynthesis. Preliminary experience of 7 ankles.

BACKGROUND AND AIMS: In ankle fractures with separation of the tibiofibular mortise a metallic syndesmosis screw is generally used. As a rule, this transfixing screw is removed by a separate operation 6 to 8 weeks later. Usually the fracture fixation implants are removed by a second operation later on. In order to eliminate separate removal of the transfixing screw, we used a biodegradable syndesmosis screw in a pilot clinical study. PATIENTS AND METHODS: We treated seven consecutive patients with malleolar fractures and separation of the syndesmosis by an ordinary metallic plating and screw fixation of the fractures and biodegradable polyglycolic acid (PGA) screw transfixation of the syndesmosis. RESULTS AND CONCLUSIONS: All the patients ended up with an acceptable result and stable ankle mortise. One of the ankles, which was the only one fixed by two transfixing PGA screws instead of one screw, had transient sinus formation and intraosseal osteolysis. The final result was good also in this case. The ankle mortise can be fixed safely by biodegradable screws in connection with metallic osteosynthesis of malleolar fractures. Thus a separate removal of the transfixing material is possible to eliminate.