Use of cloprostenol as an abortifacient in the llama (Lama glama).

As part of a larger project investigating the development and heritability of choanal atresia glama), it was necessary to develop a protocol for aborting llamas at various stages of gestation. Twenty-seven animals between 4 and 7 mo of gestation were successfully aborted a total of 53 times following two 250 microg intramuscular injections of cloprostenol at 24 h intervals. Abortion was induced once in 10 animals and multiple times (range 2 to 5) in 17 animals. Twenty-four animals (45.2%) aborted 3 d following the first injection, with 20 animals (37.7%) aborting 4 d post prostaglandin administration. Other animals aborted at 2 d (n=6, 11.3%), 5 d (n=2, 3.8%), and 7 d (n=1, 1.9%) following drug administration. Forty-nine (92.5%) of the abortions occurred following a single series of injections, while 4 animals (7.5%) aborted following a second series of injections. No confirmed pregnant animals failed to abort following the second series of cloprostenol injections. Conception rates in animals rebred 2 to 4 wk following an abortion were comparable to those of untreated animals in the research herd. Unlike the severe hypertension and death that has been reported following dinoprost tromethamine administration in the llama, no adverse reactions were observed in this study following cloprostenol administration. The results demonstrate that llamas can be safely and effectively aborted up to 7 mo of gestation (normal full term gestation = 342 +/- 10 days) without adverse effects on subsequent fertility.

SF-36 as a predictor of health states.

BACKGROUND: There are a number of claims that Medical Outcomes Study Short Form 36 (MOS SF-36) mean scores can be used to discriminate between healthy and nonhealthy persons and determine various levels of health. OBJECTIVES: The purpose of this study was to evaluate the ability of the SF-36 to predict whether or not respondents reported health problems. METHODS: We used structural equation modeling (SEM) techniques to evaluate the SF-36 and its ability to discriminate between those who reported health problems or reported physician-determined illness and those who did not in a sample from the 1990 National Survey of Functional Health Status (NHS). RESULTS: The correlation between physician-determined illness and Physical Health was -.404, resulting in 16.32% shared variance. The correlation between reported health problems and Physical Health was -.360, resulting in 12.96% shared variance. These correlations are markedly lower than those to the eight first-order scales or between Physical and Mental Health (r = .889). Mental Health could not predict physician-determined illness or reported health problems independent of Physical Health. CONCLUSIONS: The SF-36 is relatively poor at accounting for the health status of respondents. There are significant paths but the variance accounted for in absolute and relative terms is small. Physical Health does a much better job of accounting for general mental health than it does for perceived health problems or physician-determined illness. These findings suggest that the SF-36 may not discriminate well between healthy and nonhealthy groups and that objective measures of health status may be required in conjunction with the use of the SF-36.

Medical outcomes study short form 36: testing and cross-validating a second-order factorial structure for health system employees.

OBJECTIVE: To test the factorial validity of the SF-36. DATA SOURCE: Sample data collected in 1995 and 1996 using telephone interviews with health system employees as part of a study of health status. METHODS OF ANALYSIS: Confirmatory factor analysis and structural equation modeling techniques were used to evaluate the data. PRINCIPAL FINDINGS: The results of this study suggest that (1) Mental Health and Physical Health are not independent; (b) Mental Health cross-loads onto Physical Health; (c) general health loads onto Mental Health instead of Physical Health; (d) many of the error terms are correlated; (e) the physical function subscale is not reliable across the samples or the "age" or "education" subgroups; and (f) the mental health subscale path from Mental Health is not reliable across some subgroups. This hierarchical factor pattern was replicated across both samples. CONCLUSIONS: This study supports the second-order factorial structure of the SF-36. Adding the covariance path between the variables Physical Health and Mental Health improved model fit. Two paths from the second-order latent variables to the first-order latent variables differ from the original hypothesized structure of the SF-36. Health perception was influenced by Mental Health rather than Physical Health, and mental health was influenced by both Mental Health and Physical Health. This cross-loading suggests that the perception of Physical Health greatly affects mental health. Scale instabilities in the SF-36 across subgroups suggest that a comparison of mean scores or summary scores is inappropriate. Data interpretation can be improved if multigroups structural equation modeling is used.

Blood mineral and vitamin E concentrations in llamas.

OBJECTIVE: To establish reference values for blood concentrations of total calcium (Ca), inorganic phosphorus (P), iron (Fe), copper (Cu), zinc (Zn), selenium (Se), and vitamin E (Vit E) in clinically normal llamas. ANIMALS: 270 llamas ranging in age from < 1 month to > 15 years and grouped by age, sex, pregnancy status, and stage of gestation. Selected llamas were from 21 farms in Oregon, did not have previous health problems, and met specific health criteria on examination. PROCEDURE: Serum and blood samples were obtained and analyzed for concentrations of Ca, P, Fe, Cu, Se, Zn, and Vit E, and total iron binding capacity (TIBC) and percentage of transferrin saturation (% Sat). Mean differences by age, sex, pregnancy status, and stage of gestation, as well as all interactions, were compared to establish reference values. RESULTS: Mean values and reference ranges for most of the minerals and vitamins were similar to previously reported values. Male versus female differences were not identified for any measurements. Age was a significant variable for Ca, P, Fe, and Se concentrations, as well as Ca-to-P ratio and TIBC. Identified age-based effects were modeled by use of linear regression. Copper and Zn concentrations and % Sat did not differ as a function of age. Serum Vit E concentration was influenced by an age by sex interaction and stage of gestation. CONCLUSIONS: Age was found to be an important variable influencing many blood nutrient concentrations in healthy llamas. CLINICAL RELEVANCE: Clinical diagnosis of metabolic disease may be improved with use of age-based reference values, especially for neonates.

Methods of evaluation in outcomes research.

UNLABELLED: This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members; payers for health services; and healthcare executives. GOAL: To provide basic information on the methods used and computer software available for evaluating invariant factorial structures, such as those found in health status measurement tools. OBJECTIVES: 1. Discuss why comparison of mean scores may not be appropriate when interpreting humanistic outcomes results. 2. Identify alternative methods for evaluating data from health status measurement tools, such as the SF-36. 3. Define validity, reliability, and structure. 4. Understand the value of structural equation modeling when using health status measurement tools, such as the SF-36. 5. Describe the statistical software used to perform structural equation modeling.

Morphometric evaluation of growth in llamas (Lama glama) from birth to maturity.

Normal growth characteristics of llamas (Lama glama) were evaluated from conception until 1 week after parturition in pregnant females (study 1) and from 1 month after birth to maturity (study 2). In study 1, pregnant multiparous llamas (n = 10) were measured at monthly intervals from conception until 1 week after parturition; in study 2, llamas (n = 270) were measured once. Body weight of pregnant llamas (study 1) did not increase significantly until after the eighth month of pregnancy. Llamas of study 2 reached mature height, length, thoracic circumference, and weight at 18, 24, 36, and 36 months of age, respectively. From 1 month of age to maturity, the growth characteristics of males, nonpregnant females, and females during the first 8 months of pregnancy did not differ. Correlations (r2) between height, length, and thoracic circumference related to body weight for all but the pregnant llamas during the last 3 months of pregnancy were 0.822, 0.834, and 0.948, respectively. The equation describing thoracic circumference as a predictor of body weight was: Weight (kg) = (1.005 x 10(-3)) x circumference (cm)2.424.

Comparison of ionic and non-ionic contrast agents in cardiac catheterization: the effects of ventriculography and coronary arteriography on hemodynamics, electrocardiography, and serum creatinine.

We compared two nonionic contrast agents (ioxaglate and iohexol) with an ionic agent (Renografin-76) on the effects of ventriculography and coronary arteriography on the hemodynamics, electrocardiography, and serum creatinine in one hundred consecutive patients. Patients were randomized to nonionic or ionic groups and were further evaluated regarding the effect of fluid loading prior to catheterization. The ionic agent more often produced subjective reactions (rash, nausea/vomiting). Following ventriculography, both ionic and non-ionic agents produced an increase in left ventricular end diastolic pressure and this effect was undetermined by fluid loading. Nonionic agents decreased aortic diastolic pressure following ventriculography and this effect was unaltered by fluid loading. In contrast, the ionic agent produced profound hemodynamic changes (drop in both systolic and diastolic pressures) following coronary arteriography and these effects were blunted by prior fluid loading. The ionic agent produced significantly greater heart rate slowing and prolongation of the QT interval than the nonionic agents, suggesting that the latter are potentially less arrhythmogenic. Comparing the two non-ionic agents, we found that both decreased aortic diastolic pressure and increased left ventricular end diastolic pressure following ventriculography. Iohexol produced greater heart rate slowing than did ioxaglate, though the increase was minor compared to the ionic agent. Neither nonionic agent appeared to significantly affect serum creatinine. In conclusion, the two nonionic agents appeared to offer significant advantages over the ionic agent in ventriculography and coronary arteriography.

Erythrocyte dyscrasia, anemia, and hypothyroidism in chronically underweight llamas.

A syndrome characterized by anemia, erythrocyte dyscrasia, low body weight, and hypothyroidism was observed in 8 llamas (Lama glama). At initial examination (1 to 23 months of age; median, 7.5 months), llamas (3 males, 5 females) were markedly underweight (29 to 55 kg; median, 36 kg) and anemic (PCV, 12.9 to 25.5% [median, 19%]). Five of the llamas became progressively more anemic over time; in 2 of them, PCV decreased to less than 10%. Erythrocyte changes included severe poikilocytosis, anisocytosis, asymmetric distribution of hemoglobin within the cytoplasm, and cytoplasmic extensions from one or both poles. Six llamas had moderate to severe valgus deformities of the carpus. All llamas had low baseline serum thyroxine concentration and diminished response to thyrotropin administration. Baseline and post-thyrotropin triiodothyronine concentrations did not have consistent patterns. Five llamas were hypophosphatemic and 7 had low serum iron concentration (iron concentration was not determined in 1 llama). Orally administered iron supplementation did not induce clinical improvement. Because 3 of the affected llamas were full sisters, a genetic basis for the problem has to be considered. It was not possible to evaluate the familial relationship of the other 5 affected llamas. Although the underlying cause of the problem was not established, the prognosis for affected llamas is guarded to poor.

The use of metronidazole in management of methylmalonic and propionic acidaemias.

Gut bacteria have been implicated as an important source of propionate in children with inborn errors of propionate metabolism. We have investigated the value of oral metronidazole (10-20 mg/kg per day) in five children with methylmalonic acidaemia (MMA) and four with propionic acidaemia (PA). Urinary excretion of propionate metabolites fell significantly during the treatment in all subjects, the mean decrease being 41% (range 12-76, P less than 0.01), while mean plasma propionate was reduced from 45.0 mumol/l to 25.1 mumol/l (P less than 0.05). Substantial reduction of the gut bacterial population was confirmed by lactulose breath hydrogen tests and by stool culture, and stool propionate concentration was reduced in most subjects. Clinical improvement was noted in three children. These results suggest that long-term antimicrobial therapy may offer significant clinical benefit to children with inborn errors of propionate metabolism.

Virulence factors of Clostridium difficile.

In addition to the two major toxins of Clostridium difficile--toxins A and B, which represent the major virulence factors--a number of other putative virulence factors have been described. These factors include fimbriae and the ability to associate with gut cells/mucus, the production of a capsule, the secretion of a range of hydrolytic enzymes, the production of other toxins (such as an actin-specific ADP-ribosyltransferase by some strains), and the controversial possibility of the production of a second enterotoxin. The extent to which these additional putative virulence factors are involved in the pathogenesis of C. difficile-related gut disease remains to be elucidated.

Purification and characterisation of Clostridium difficile toxin A by bovine thyroglobulin affinity chromatography and dissociation in denaturing conditions with or without reduction.

Highly purified toxin A of Clostridium difficile was obtained by bovine thyroglobulin affinity chromatography followed by two sequential anion-exchange chromatography steps on Q Sepharose FF and Mono Q. After Q Sepharose FF chromatography of a thyroglobulin affinity-purified toxin A preparation, two major peaks of cytotoxicity representing toxins A and B were detected. The homogeneity of the final toxin A preparation obtained from Mono Q anion-exchange fast protein liquid chromatography was ascertained by gel electrophoresis developed by silver stain. The mol. wt of toxin A in non-denaturing conditions was estimated to be 520-540 Kda by native polyacrylamide gel electrophoresis (PAGE) developed by silver stain. In contrast, with sodium dodecyl sulphate (SDS)-PAGE under reducing or non-reducing conditions, a major band of 240 Kda and 10 minor and 27 faint bands (non-reduced conditions), or four minor and 31 faint bands (reduced conditions) were detected after silver staining. In two-dimensional PAGE, the seven minor bands of greater than 240 Kda obtained by non-reducing SDS-PAGE migrated to the 240-Kda position after reduction with beta-mercaptoethanol.

Sexual dimorphism of erythropoietin-degrading activity in mouse submaxillary gland extracts.

In the course of investigation of submaxillary gland (SG) extracts from mice as a possible source of extra-renal erythropoietin (EPO) we have extended our previous studies of the degradation of EPO added to SG and kidney extracts. The discrepancy between estimates of EPO obtained with two radioimmunoassays (RIAs) differing only in time of incubation with 125I-labeled recombinant human EPO (r-HuEPO) (20 h and 72 h) has been used as an indicator of tracer degradation occurring during the RIA incubation. Degradation of 125I-labeled r-HuEPO by male mouse SG extracts was not prevented by addition of inhibitors of monodeiodinases or proteolytic enzymes. Degradation of added 125I-labeled r-HuEPO was monitored using gel filtration fast protein liquid chromatography. SG extracts from male and androgen-treated female mice both degraded tracer r-HuEPO to a greater extent than extracts from female mice. Tracer degradation increased with time and tissue concentration and could give rise to invalid estimates of EPO in SG extracts by RIA. In contrast, none of the kidney extracts degraded r-HuEPO. Recovery of mouse serum EPO added to and incubated with male mouse SG or kidney extracts was 13% and 93%, respectively, estimated by RIA under conditions that excluded degradation of the RIA tracer antigen.

Contribution of gut bacterial metabolism to human metabolic disease.

Metronidazole, an antibiotic with specific activity against anaerobic bacteria, was of clinical and biochemical benefit in two patients with methylmalonic aciduria. The virtual elimination of propionic acid from the stool suggested that propionic acid derived from faecal bacterial metabolism contributes substantially to methylmalonate production. These findings point to a novel avenue of treatment for these disorders of intermediary metabolism, and indicate the importance of microbial gut flora in normal human metabolism.

Characterisation of anaerobic curved rods (Mobiluncus spp.) isolated from the urogenital tract.

Thirty-two strains of anaerobic curved rods isolated from vaginal secretions and one isolated from seminal fluid were examined. Growth of all strains on solid media was superior to growth in liquid media, and at 37 degrees C they grew both anaerobically and in O2 5% in N2; they also grew anaerobically at 33 degrees C but not at 42 degrees C. No growth factors were identified, but strains grew more profusely at pH values above 5 X 0. The strains were screened in 80 biochemical tests, and for their susceptibility to 30 different antimicrobial agents. Most of the tests did not differentiate between the strains, but they were divided into four groups on the basis of cell morphology, metronidazole susceptibility, beta-galactosidase activity and arginine and hippurate hydrolysis. Group 1 consisted of 19 strains conforming to the species M. curtisi; group 2 consisted of five strains conforming to the species M. mulieris; group 3 consisted of five strains that resembled M. curtisi morphologically, and group 4 consisted of four strains that resembled M. mulieris morphologically, but the strains in the latter two groups reacted differently in at least one of the three major differential biochemical tests. Of three strains of M. curtisi and three of M. mulieris chosen at random, one of M. mulieris had a SDS-PAGE and fast-protein liquid chromatography protein profile indistinguishable from that of M. curtisi. We conclude that further efforts are required to clarify the taxonomic status of the genus Mobiluncus.

Analysis of latex agglutination test for Clostridium difficile toxin A (D-1) and differentiation between C difficile toxins A and B and latex reactive protein.

Virulent toxigenic and avirulent non-toxigenic strains of Clostridium difficile gave a positive result in the latex agglutination test (LAT) for C difficile toxin A (D-1). Similar concentrations of latex agglutinating antigen were produced by these strains in vivo. Positive reactions were also given by C sporogenes, proteolytic C botulinum Types A, B, and A/F, and Bacteroides assaccharolyticus. The latex agglutinating antigen was denatured by boiling for 10 minutes, but not by heating at 56 degrees C for 30 minutes. The reaction was abolished by incubation of test material with crude C difficile antitoxin but not with other clostridial antitoxins or specific antitoxin to C difficile toxin A. The latex agglutinating antigen present in C difficile eluted between 0.39% and 0.47% M sodium chloride, and that produced by the other clostridia, between 0.35% and 0.43% M sodium chloride by fast protein liquid chromatography. The latex agglutinating antigen of C difficile was neither cytotoxic nor mouse lethal and was distinct from toxin A and toxin B. In the analysis of faecal specimens from patients with diarrhoea the latex agglutination test correlated better with the presence of C difficile than with toxin B and detected both toxigenic and non-toxigenic strains. The latex agglutination test should only be used in the laboratory as an alternative to culture for C difficile and not as a method for the detection of C difficile toxins.

Ventilation conditions and air-borne bacteria and particles in operating theatres: proposed safe economies.

Concentrations of air-borne bacteria and particles have been measured in turbulently ventilated operating theatres in full flow, half flow and zero flow conditions. Increased air-borne challenge produced by human activity and by mechanical cleaning procedures is demonstrated: die-away of this contamination is shown to be related to the ventilation rate. Ventilation can be reduced or turned off at night and during weekends, and cleaning can also be carried out, without increased risk of infection if full flow is restored one hour prior to preparation for surgery. Areas surrounding the theatres should remain at positive pressure with regard to the general hospital environment during low or no flow periods. The implementation of such energy-saving policies will substantially reduce theatre running costs without introducing infection hazards.

Microbial and metabolic profile of achlorhydric stomach: comparison of pernicious anaemia and hypogammaglobulinaemia.

The microbial flora and some of its metabolites and enzymes in the stomach were compared in patients with achlorhydria, pernicious anaemia, and primary hypogammaglobulinaemia and in patients with dyspepsia with normal gastric acidity. Detailed analysis of the flora of the gastric juice and of the mucosa from the antrum, body, and fundus in six patients with hypogammaglobulinaemia (mean pH 8.2), seven patients with pernicious anaemia (mean pH 7.3), and five patients with dyspepsia (mean pH 1.9) yielded 22 different genera of bacteria, mainly from the patients with achlorhydria, the most common being streptococci, micrococci, staphylococci, veillonella, and lactobacilli. A similar flora was found associated with the mucosa at all three sites. Various metabolites were also looked for. beta Glucoronidase and C14 lipase were found in patients with hypogammaglobulinaemia but not in those with pernicious anaemia or dyspepsia. Volatile fatty acids were not found. Relatively high concentrations of ethanol were found in the patients with hypogammaglobulinaemia compared with those with pernicious anaemia (p = 0.02). Similar concentrations of dimethylamine were found in all three groups, but the concentrations of trimethylamine were much higher in patients with pernicious anaemia and hypogammaglobulinaemia. The high concentrations of some microbial enzymes and ethanol differentiated the group with hypogammaglobulinaemia from the rest, and these may bear some relation to the high incidence of gastric cancer in patients with hypogammaglobulinaemia.

Detection of anaerobic wound infection by analysis of pus swabs for volatile fatty acids by gas-liquid chromatography.

Swabs were able to absorb enough extractable volatile fatty acids from broth cultures of anaerobic organisms for detection and analysis by gas-liquid chromatography (GLC). Similarly, volatile fatty acids were often detected in swabs dipped into liquid pus. Fifty-three liquid pus specimens were then investigated fully to determine if GLC analysis of swab samples gave the same result as microbial culture of the specimens and GLC analysis of the liquid pus. Anaerobic bacteria failed to grow from 36 and volatile fatty acids were not extracted from swabs of 31 of these pus samples but were extracted from swabs of five. Anaerobic bacteria were isolated from 17 of the specimens, and in 15, volatile fatty acids were also detected in the swab samples; in two, volatile fatty acids were absent from both swab samples and liquid pus. In this study, results by culture and GLC analysis of swabs were similar in 87% of specimens.