Effects of routine treatment with nonsteroidal anti-inflammatory drugs at calving and when lame on the future probability of lameness and culling in dairy cows: A randomized controlled trial.

Claw horn lesions (CHL) are reported as the most common cause of lameness in intensive dairy systems. Despite their prevalence, the underlying pathological mechanisms and preventive strategies for CHL remain poorly understood. Recent advances have pointed to the role of inflammation in disease aetiopathogenesis. Moderating inflammation from first calving may lead to long-term benefits and a viable intervention for treating and preventing disease. We conducted a 34-mo randomized controlled trial to investigate the effects of routine treatment with the nonsteroidal anti-inflammatory drug ketoprofen at calving and during treatment for lameness, on the future probability of lameness and culling, caused by exposure to normal farm conditions. A cohort of dairy heifers were recruited from a single, commercial dairy herd between January 8, 2018, and June 22, 2020, and randomly allocated to one of 4 treatment groups before first calving. The lactating herd was lameness scored every 2 wk on a 0 to 3 scale, to identify animals that became lame (single score ≥2a) and hence required treatment. Animals in group 1 received a therapeutic trim and a hoof block on the sound claw (if deemed necessary) every time they were treated for lameness. Animals in group 2 received the same treatment as group 1 with the addition of a 3-d course of ketoprofen (single dose daily) every time they were treated for lameness. Animals in group 3 received the same treatment as group 2 with the addition of a 3-d course of ketoprofen (single dose daily) starting 24 to 36 h after each calving. Animals in group 4 received a 3-d course of ketoprofen (single dose daily) every time they were identified with lameness. No therapeutic trim was administered to this group, unless they were identified as severely lame (a single score ≥3a). Animals were followed for the duration of the study (ending October 23, 2020). Probability of lameness was assessed by a lameness outcome score collected every 14 d. Data on culling was extracted from farm records. One hundred thirty-two animals were recruited to each group, with data from 438 animals included in the final analysis (111 in group 1, 117 in group 2, 100 in group 3, and 110 in group 4). Mixed effect logistic regression models were used to evaluate the effect of treatment group on the ongoing probability of lameness. Compared with the control group (group 1), animals in group 3 were less likely to become lame (odds ratio: 0.66) and severely lame (odds ratio: 0.28). A Cox proportional hazards survival model was used to investigate the effect of treatment group on time to culling. Compared with group 1, animals in groups 2 and 3 were at reduced risk of culling (hazard ratios: 0.55 and 0.56, respectively). The lameness effect size we identified was large and indicated that treating a cohort of animals with the group 3 protocol, would lead to an absolute reduction in population lameness prevalence of approximately 10% and severe lameness prevalence of 3%, compared with animals treated in accordance with conventional best practice (group 1).

A history of lameness and low body condition score is associated with reduced digital cushion volume, measured by magnetic resonance imaging, in dairy cattle.

Claw horn lesions (CHL) are the result of a failing of the functional anatomy of the hoof in dairy cows. The digital cushion is understood to be a vital structure in the prevention of CHL. Claw horn lesions have previously been shown to lead to pathological change to the pedal bone; however, their effects on the digital cushion are unknown. The primary aim of this study was to examine associations between the history of CHL through an animal's life and the structure of the digital cushion at slaughter using magnetic resonance imaging. The retrospective cohort study resulted in the scanning of 102 pairs of hindfeet, collected from adult Holstein dairy cows culled from a research herd, using a 3-Tesla research-grade magnetic resonance imaging scanner. Volume and fat measurements were calculated for each digital cushion within each claw from a modified Dixon Quant sequence. Animal-level variables were constructed around the animals' lactating lifetime, with lameness scores and body condition score collected at least every 2 wk. The combined volume of digital cushion in the lateral claws was used as the outcome variable in multivariable linear models. The volume of the digital cushion was negatively associated with the number of lameness events or CHL recorded. Furthermore, animals with body condition score >3, culled later in lactation, or of a greater body weight were more likely to have a higher volume of digital cushion in the lateral claws. We propose that the observations made in the current study are the effects of a range of factors broadly associated with genetic, developmental, and disease-related inputs. Our understanding of how we can select for genetically more robust animals and how we can precondition the hoof before first calving needs to be improved to reduce the risk of future CHL in adult dairy cattle. Furthermore, understanding optimal treatment regimens and their effect on hoof anatomy may reduce the recurrence of CHL in the current lactation and future lactations.

Morphology, adipocyte size, and fatty acid analysis of dairy cattle digital cushions, and the effect of body condition score and age.

The digital cushion is an essential part of maintaining a healthy foot, working to dissipate foot strike and body weight forces and lameness from claw horn disruption lesions. Despite the importance of the digital cushion, little is known about the basic anatomy, adipocyte morphology, and fatty acid composition in relation to age, limb position, and body condition score. In total, 60 claws (from 17 cows) were selected and collected from a herd, ensuring that body condition score data and computed micro-tomography were known for each animal. Digital cushion tissue underwent histological staining combined with stereology, systematic random sampling, and cell morphology analysis, in addition to lipid extraction followed by fatty acid analysis. The results describe digital cushion architecture and adipocyte sizes. Adipocyte size was similar across all 4 claws (distal left lateral and medial and distal right lateral and medial) and across the ages (aged 2-7 yr); however, animals with body condition score of 3.00 or more at slaughter had a significantly increased cell size in comparison to those with a score of less than 2.50. Of 37 fatty acid methyl esters identified, 5 differed between either the body condition score or different age groups. C10:0 capric acid, C14:0 myristic acid, C15:0 pentadecanoic acid, and C20:0 arachidic acid percentages were all lesser in lower body condition score cows, whereas C22:1n-9 erucic acid measurements were lesser in younger cows. Saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid percentages were not altered in the different claws, ages, or body condition score groups. Triglyceride quantities did not differ for claw position or age but had decreased quantities in lower body condition score animals. Digital cushion anatomy, cellular morphology, and fatty acid composition have been described in general and also in animals with differing ages, body condition scores, and in the differing claws. Understanding fat deposition, mobilization, and composition are essential in not only understanding the roles that the digital cushion plays but also in preventing disorders and maintaining cattle health and welfare.

Predictors of community-associated Staphylococcus aureus, methicillin-resistant and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in primary-care settings.

Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31-17·45], male gender (aOR 1·74, 95% CI 1·06-2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03-0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01-4·09).

Living near a freeway is associated with lower bone mineral density among Mexican Americans.

UNLABELLED: We hypothesized that chronic exposures to traffic combustion products may lower bone mineral density (BMD). We found that proximity to freeways was associated with reduced BMD. Our findings suggest that traffic-related pollution may contribute to the occurrence of osteopenia and osteoporosis. INTRODUCTION: Adults residing in rural areas have been linked with higher BMD. We aimed to determine if this difference is due in part to air pollution by examining the relationships between traffic metrics and ambient air pollution with total body and pelvic BMD. METHODS: Mexican American adults (n = 1,175; mean 34 years; 72 % female) who had participated in the BetaGene study of air pollution, obesity, and insulin resistance were included in this analysis. Total body and pelvic BMD were estimated using dual-energy X-ray absorptiometry. Traffic and ambient air pollutant exposures were estimated at residences using location and ambient monitoring data. Variance component models were used to analyze the associations between residential distance to the nearest freeway and ambient air pollutants with BMD. RESULTS: Residential proximity to a freeway was associated with lower total body BMD (p-trend = 0.01) and pelvic BMD (p-trend = 0.03) after adjustment for age, sex, weight, and height. The adjusted mean total body and pelvic BMD in participants living within 500 m of a freeway were 0.02 and 0.03 g/cm(2) lower than participants living greater than 1,500 m from a freeway. These associations did not differ significantly by age, sex, or obesity status. Results were similar after further adjustment for body fat and weekly physical activity minutes. Ambient air pollutants (NO2, O3, and PM2.5) were not significantly associated with BMD. CONCLUSIONS: Traffic-related exposures in overweight and obese Mexican Americans may adversely affect BMD. Our findings indicate that long-term exposures to traffic may contribute to the occurrence of osteoporosis and its consequences.

Use of antidepressant agents and the risk of type 2 diabetes.

PURPOSE: To determine whether there is an association between antidepressant use and the risk of developing type 2 diabetes. METHODS: This study was a retrospective cohort analysis using the Texas Medicaid prescription claims database. Data were extracted for new users of either antidepressant agents (exposed) or benzodiazepines (unexposed) from January 1, 2002 through December 31, 2009. Patients aged 18-64 years without a prior history of diabetes were included. Cox proportional hazards regression was used to examine the association between diabetes incidence among exposed and unexposed groups, while controlling for demographic and clinical covariates. RESULTS: Among the total study population (N = 44,715), the majority were in the exposed (N = 35,552) versus the unexposed (N = 9,163) group. A total of 2,943 patients (6.6%) developed type 2 diabetes during the follow-up period. Antidepressant use was associated with an increase in the risk of diabetes when compared to benzodiazepine use (adjusted hazard ratio [HR] 1.558, 95% confidence interval [CI] 1.401-1.734). The association was observed with tricyclic antidepressants (TCAs; HR 1.759, 95% CI 1.517-2.040), serotonin-norepinephrine reuptake inhibitors (SNRIs; HR 1.566. 95% CI 1.351-1.816), selective serotonin reuptake inhibitors (SSRIs; HR 1.481, 95% CI 1.318-1.665), and "other" antidepressants (HR 1.376; 95% CI 1.198-1.581). CONCLUSIONS: The results of this study suggest that antidepressant use is associated with an increased risk of diabetes. This association was observed with use of TCAs, SNRIs, SSRIs, and "other" antidepressants.

Hydraulics of Asteroxylon mackei, an early Devonian vascular plant, and the early evolution of water transport tissue in terrestrial plants.

The core of plant physiology is a set of functional solutions to a tradeoff between CO(2) acquisition and water loss. To provide an important evolutionary perspective on how the earliest land plants met this tradeoff, we constructed a mathematical model (constrained geometrically with measurements of fossils) of the hydraulic resistance of Asteroxylon, an Early Devonian plant. The model results illuminate the water transport physiology of one of the earliest vascular plants. Results show that Asteroxylon's vascular system contains cells with low hydraulic resistances; these resistances are low because cells were covered by scalariform pits, elliptical structures that permit individual cells to have large areas for water to pass from one cell to another. Asteroxylon could move a large amount of water quickly given its large pit areas; however, this would have left these plants particularly vulnerable to damage from excessive evapotranspiration. These results highlight a repeated pattern in plant evolution, wherein the evolution of highly conductive vascular tissue precedes the appearance of adaptations to increase water transport safety. Quantitative insight into the vascular transport of Asteroxylon also allows us to reflect on the quality of CO(2) proxy estimates based on early land plant fossils. Because Asteroxylon's vascular tissue lacked any safety features to prevent permanent damage, it probably used stomatal abundance and behavior to prevent desiccation. If correct, low stomatal frequencies in Asteroxylon reflect the need to limit evapotranspiration, rather than adaptation to high CO(2) concentrations in the atmosphere. More broadly, methods to reveal and understand water transport in extinct plants have a clear use in testing and bolstering fossil plant-based paleoclimate proxies.

Effectiveness of research training workshop taught by traditional and video-teleconference methods in a developing country.

The developing countries are currently facing a double burden of communicable and non-communicable diseases. Physician-scientists, trained in patient care and research skills are crucial in performing cutting-edge clinical research in the developing countries. A major unmet challenge has been the lack of local expertise and the increasing problem of 'brain drain'. The current study was an effort to present and assess a model of research training to health-care professionals in Pakistan in order to increase the research skills. The objective of the current study was to assess the effectiveness of two different methods of research training. An epidemiologic research training workshop was offered to health-care professionals in Pakistan by face-to-face (F2F) and video-teleconferencing (VTC) methods. A total of 38 F2F and 18 VTC participants were included in the workshop which was conducted by research faculty from the University of Pittsburgh. To assess knowledge, pre- and post-test were done. Within each group, paired sample T-test showed significant improvement in scores after the completion of workshop (p<0.001 for F2F and VTC). In the F2F group, mean scores increased from 11.13 (pre-test) to 15.08 (post-test) and in the VTC group, scores increased from 10.67 (pre-test) to 13.22 (post-test). Two sample T-test was found statistically significant (p<0.001). We present a model for training physicians in public health by providing in-house research skills training which can be used to strengthen the local capacity and reduce increasing problems of brain drain.

Recirculating gravel filters: high-performance treatment at low cost for two small communities.

Wastewater from small communities often has a greater environmental impact than conventional on-site treatment systems can mitigate, yet the flow rate is too low to achieve economies of scale with municipal treatment processes. As a result, the cost of wastewater treatment is often beyond the financial means of the community, in terms of capital costs and annual operational costs. The recirculating gravel filter (RGF) is an attached-growth treatment process for wastewater from small communities. In the RGF process, pre-settled wastewater is recirculated through a gravel filter bed, while a biofilm on the filter media oxidizes the organic matter and ammonia. Effluent from the RGF process has equivalent or lower concentrations of BOD5, TSS and ammonia nitrogen as effluent from other wastewater treatment processes typically employed in small communities. Two small communities in Washington State, USA, have selected the RGF process for wastewater treatment, due to low operational costs, simplicity of equipment, and high effluent quality. For the two communities, the RGF wastewater treatment facilities were estimated to have somewhat lower construction costs and significantly lower annual operational costs than the alternatives evaluated. Low annual operational expenses are important for wastewater system sustainability in small communities.

Use of antihypertensive medications among United States veterans newly diagnosed with hypertension.

OBJECTIVES: Most patients with hypertension need combination therapy to reach adequate blood pressure control. The objective of this study was to assess type, duration of, and adherence to antihypertensive therapies among veterans, focusing on the use of combination therapies. RESEARCH DESIGN AND METHODS: The design of the study was a retrospective cohort analysis of electronic medical and pharmacy records from the Central Texas Veterans Health Care System (CTVHCS). Data were extracted for adults newly identified with hypertension between 1995 and 2003. Drug utilization was measured as a time-dependent variable; thus, the use of combination therapies was captured for any given day for each patient in the sample. Medication adherence was assessed using medication possession ratios (MPR), calculated by the number of days of therapy dispensed to a patient divided by the number of days between subsequent prescriptions. RESULTS: The average age of the participants (n = 11 187) was 60.7 (standard deviation (SD): 12.7). Half (50.1%) of the patients could be categorized as having controlled blood pressure. Veterans were followed for an average of 3.6 years (total of 51 549 person-years). Overall, 29 561 treatment episodes were identified, an average of about 2.6 per patient. Over 40% (41.6%) of these episodes involved one medication only, but patients frequently used dual (26.9%) and three or more (15.9%) therapies in combination. The frequency of prescribed antihypertensive therapies, as well as the length of, and adherence to, these therapies were described. Descriptively, medication adherence appeared to be lower among patients who received therapy for longer duration, indicating higher probability of missed doses and more frequent therapy changes. CONCLUSIONS: New information can be gained on the utilization of antihypertensive medications by using time-dependent variables. Understanding the type of combination therapies, the length of and adherence to these therapies, along with the observed blood pressure control rates will provide important new insights into the management of hypertensive patients. Limitations of the study arise primarily from the use of electronic medical records and the information that is contained within the datasource, and generalizability of the findings beyond the study sample.

Host-specific variation in infection by toxigenic fungi and contamination by mycotoxins in pearl millet and corn.

Pearl millet is widely consumed in regions of Africa and Asia, and is increasingly being grown as an alternative grain in drought-prone regions of the United States. Pearl millet and corn were grown in dryland conditions at Tifton, Georgia, USA and grains were compared for pre-harvest infection by potentially toxigenic fungi and contamination by mycotoxins. Corn hybrids Agripro 9909 and Pioneer 3146, and pearl millet Tifgrain 102 were grown in 2000 and 2001; pearl millet HGM 100 was included in the test in 2001. Hybrids were sown on multiple planting dates in each year to induce variation in flowering time. Host species differed in the frequency of isolation of potentially toxigenic fungal species in both years. Across years, corn hybrids were more prone to infection by Aspergillus flavus Link (maximum isolation frequency = 8.8%) and Fusarium moniliforme Sheldon sensu lato (maximum isolation frequency = 72.8%), with corresponding greater concentrations of aflatoxins (maximum concentration = 204.9 microg kg(-1)) and fumonisins (maximum concentration = 34,039 microg kg(-1)). Pearl millet was more prone to infection by F. semitectum Berk. & Ravenel (maximum isolation = 74.2%) and F. chlamydosporum Wollenweb & Reinking (maximum isolation = 33.0%), and contamination by moniliformin (maximum contamination = 92.1 microg kg(-1)). Beauvericin (maximum concentration = 414.6 microg kg(-1)) was present in both hosts. Planting date of corn affected aflatoxin and beauvericin contamination in 2000, and fumonisin concentration in 2001. The observed differences in mycotoxin contamination of the grains, which are likely due to host-specific differences in susceptibility to pre-harvest mycoflora, may affect food safety when the crops are grown under stress conditions.

Root-Knot Nematode Resistance in Pearl Millet From West and East Africa.

Resistance to Meloidogyne incognita is important to provide stability to pearl millet production and to reduce nematode populations that can damage crops grown in rotation with pearl millet. The objectives of this study were to determine whether resistance to M. incognita exists in pearl millet from West and East Africa, and to determine if heterogeneity for resistance exists within selected cultivars. Resistance was assessed as nematode egg production per gram of root in greenhouse trials. Seventeen pearl millet cultivars of diverse origin were evaluated as bulk (S0) populations. All African cultivars expressed some level of resistance. P3Kollo was among the least resistant of the African cultivars, Zongo and Gwagwa were intermediate, and SoSat-C88 was among the most resistant. Thirty selfed (S1) progeny selections from SoSat-C88, Gwagwa, Zongo, and P3Kollo were evaluated for heterogeneity of resistance within cultivar. Reactions were verified in 13 S2 progeny of each of the four cultivars. In S1 evaluations, each of these cultivars was heterogeneous for resistance. Progeny reaction varied from highly resistant to highly susceptible. Patterns of apparent segregation of resistance varied among the four cultivars. Discreet resistant and susceptible phenotypes were identified in Zongo progeny, and it was estimated that two dominant genes for resistance segregated in this cultivar. Averaged across progenies, egg production on the four cultivars was less (P ≤ 0.001) than on the susceptible hybrid HGM-100, but was not different from resistant hybrid TifGrain 102. Reproduction of M. incognita on the S2 progeny tended to confirm the results from inoculations of S1 progeny. Heritability of nematode reproduction (standardized as the ratio of the value to HGM-100) determined by parent-offspring regression was 0.54. Realized heritability determined by divergent selection was 0.87.

Fusarium species of the Gibberella fujikuroi complex and fumonisin contamination of pearl millet and corn in Georgia, USA.

This study was designed to identify and compare the Fusarium species of the Gibberella fujikuroi complex on pearl millet (Pennisetum glaucum (L.) R. Br) and corn (Zea mays L.) crops grown in southern Georgia, and to determine their influence on potential fumonisin production. Pearl millet and corn samples were collected in Georgia in 1996, 1997 and 1998. Three percent of the pearl millet seeds had fungi similar to the Fusarium species of the G. fujikuroi species complex. One hundred and nineteen representative isolates visually similar to the G. fujikuroi species complex from pearl millet were paired with mating population A (Fusarium verticillioides (Sacc.) Nirenberg), mating population D (F. proliferatum (Matsushima) Nirenberg) and mating population F (F. thapsinum (Klittich, Leslie, Nelson and Marasas) tester strains. Successful crosses were obtained with 50.4%, 10.1% and 0.0% of these isolates with the A, D and F tester strains, while 39.5 of the isolates did not form perithecia with any tester strains. Two of the typical infertile isolates were characterized by DNA sequence comparisons and were identified as Fusarium pseudonygamai (Nirenberg and O'Donnell), which is the first known isolation of this species in the United States. Based on the pattern of cross-compatibility, conidiogenesis, colony characteristics and media pigmentation, a majority of the infertile isolates belong to this species. Fumonisins FB(1) and FB(2) were not detected in any of the 81 pearl millet samples analyzed. The species of the G. fujikuroi species complex were dominant in corn and were isolated from 84%, 74% and 65% of the seed in 1996, 1997 and 1998, respectively. Representative species of the G. fujikuroi species complex were isolated from 1996 to 1998 Georgia corn survey (162, 104 and 111 isolates, respectively) and tested for mating compatibility. The incidence of isolates belonging to mating population A (F. verticillioides) ranged from 70.2% to 89.5%. Corn survey samples were assayed for fumonisins, and 63% to 91% of the 1996, 1997 and 1998 samples were contaminated. The total amount of fumonisins in the corn samples ranged from 0.6 to 33.3 microg/g.

Testicular pain as the initial presentation of testicular neoplasms.

OBJECTIVES: Testicular neoplasms are reported to present with testicular pain in 0.01-10% of patients. The diagnosis of tumour may, therefore, not be considered immediately with this mode of presentation, leading potentially to delays in diagnosis and poorer prognosis or scrotal exploration for suspected torsion. The objective of this study was to assess the incidence of pain as the presentation of testicular neoplasms. PATIENTS AND METHODS: A retrospective case note analysis of all patients undergoing radical orchidectomy over an 11-year period in Hull, UK was performed. Data on presenting symptoms, histology and clinical stage were collected. RESULTS: It was found that 23.5% of all patients analysed (27 of 115) presented with testicular pain, but that this did not appear to correlate with any particular histological sub-type of neoplasm or stage of disease. However, those presenting with germ cell tumours and testicular pain were more likely to suffer disease relapse than those presenting with painless testicular enlargement (1 6% compared to 2.6%). CONCLUSIONS: Testicular neoplasms should be considered earlier in patients presenting with testicular pain, as this may be more common than previously reported.

Fungi Associated with the Stalk Rot Complex of Pearl Millet.

Stalk rot is frequently observed in maturing, rust-infected pearl millet (Pennisetum glaucum). Fungi were isolated from internal stalk tissue, and their association with node discoloration and rust infection at different stages of plant maturity was determined to gain a greater understanding of stalk rot etiology. In 1995, stalk rot was observed in a breeding population of pearl millet. Stalks of 10 rust-infected plants were collected on each of three dates during grain fill. Frequency of symptomatic, discolored nodes was higher in the later sampling dates. Stalk sections from 119 discolored nodes were surface sterilized and plated onto agar media. Fungi most frequently isolated from symptomatic nodes were Bipolaris setariae (isolated from 47% of discolored nodes), Fusarium semitectum (28.6%), and F. moniliforme sensu lato (23.5%). Isolation frequency of these fungi differed (P < 0.05) with sampling date. In 1996 and 1997, the hybrid HGM 100 was evaluated at two dates of planting in each year. Ten stalks were sampled at each of four growth stages: panicle emergence, stigma emergence, milk, and hard dough. A total of 140 stalks was assessed for rust severity and for internal stalk discoloration at the nodes. The frequency of discolored nodes increased with plant maturation and was correlated (P < 0.01) with severity of rust infection. All nodes were plated on an agar medium, and a total of 1,512 isolates from 30 fungal genera or species were isolated from the 1,540 nodes of the sampled stalks. F. moniliforme was isolated most frequently (isolated from 23.5% of all nodes). Frequency of isolation of F. moniliforme from nodes within stalks increased with advancing maturity in the earlier dates of planting, but was not correlated with rust infection. B. setariae (isolated from 9.2% of all nodes) was more frequently isolated from plants at the dough stage in three plantings, and was correlated (P < 0.01) with rust severity. Trends in the frequency of isolation of other fungi were inconsistent between planting dates or among growth stages. Frequency of isolation of F. semitectum (isolated from 11.0% of all nodes) and Alternaria spp. (6.9% of all nodes) was correlated (P < 0.05) with rust severity. Frequency of isolation of Curvularia spp. (isolated from 7.0% of all nodes) was negatively correlated (P < 0.05) with rust severity. Isolation of Alternaria spp. and B. setariae was more frequently associated with node discoloration than was isolation of the other fungi. Stalk rot of pearl millet is the result of a complex of several fungi whose incidence was influenced by rust infection, plant maturation, and environmental factors associated with differences among years and dates of planting.

Evaluation of Pearl Millet Grain Hybrids for Resistance to Meloidogyne spp. and Leaf Blight Caused by Pyricularia grisea.

Pearl millet, Pennisetum glaucum, has potential as a grain crop in the southeastern United States. Our objectives were to (i) determine the resistance and/or tolerance of pearl millet hybrids to Meloidogyne incognita race 3 and M. arenaria race 1; (ii) compare reproduction of Meloidogyne spp. on pearl millet and corn; and (iii) determine the disease severity of leaf blight caused primarily by Pyricularia grisea. In a field naturally infested with M. incognita, experimental pearl millet hybrids with inbreds 114 and 117 as the pollinators had fewer numbers of second-stage juveniles and more severe leaf blight than did HGM-100, a nematode-susceptible hybrid; hybrids with inbred 115 as the pollinator were similar to HGM-100 in both nematode numbers and foliar disease severity. Grain yields in pearl millet were greater in plots treated with 1,3-dichloropropene than in control plots and were negatively correlated with leaf blight severity. In a greenhouse experiment, both M. incognita and M. arenaria produced fewer eggs on pearl millet hybrids with pollinators 114, 117, 101, 102, and 103 than on hybrid HGM-100. Reproduction of M. incognita was less on the resistant pearl millet hybrids than on corn. Because both M. incognita and P. grisea can reduce grain yield of pearl millet, hybrids developed for the southeastern United States should be resistant to both pathogens.

Inpatient utilization of medical services associated with peripheral arterial disease-related inpatient procedures in the Department of Defense.

The objective of this study was to describe the inpatient procedural medical care utilization the first 10 years after initial inpatient confirmation of peripheral arterial disease (PAD). A retrospective review was carried out of the computer records of all the army beneficiaries of the Department of Defense healthcare system since 1971. Over 8000 subjects with an initial inpatient confirmation of PAD between January 1, 1980 and December 31, 1985 were reviewed for 10 years following the initial visit. The utilization of PAD-related invasive procedures gradually increased over the first 8 years, and rose sharply in the ninth and tenth years after initial diagnosis, while the utilization of examination procedures was highest in the first, fifth to seventh, ninth and tenth years. Procedures involving bypass and amputation had the highest utilization among invasive procedures, while procedures involving arteriography and ultrasonography accounted for 88% of all examination procedures. Bypass and repair of vessel procedures gradually rose throughout the 10 years after initial diagnosis, while amputations and skin grafts remained relatively constant. Procedures involving arteriography rose until year 5 and then tapered off, while utilization of ultrasonography rose in year 7 and tapered off. These results suggest that PAD-related studies should consider the progression of the disease past the fifth year after the initial inpatient visit for PAD when measuring a change in outcomes.

Rhabdomyolysis and HMG-CoA reductase inhibitors.

OBJECTIVE: To review rhabdomyolysis and discuss the role of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) and their interactions with other agents in precipitating this condition, and to present case reports of statin-induced rhabdomyolysis. DATA SOURCE: Relevant clinical literature was accessed using MEDLINE (January 1985-October 2000). The following search terms were used: rhabdomyolysis, adverse events, drug interactions, statins, and HMG-CoA reductase inhibitors. DISCUSSION: Rhabdomyolysis occurs when extensive muscle damage results in the release of cellular contents into systemic circulation. Major complications include acute renal failure, cardiac abnormalities, and compartment syndrome. Treatment of rhabdomyolysis is supportive, with the primary aim of preventing renal and cardiac complications. Statin monotherapy or combination therapy may result in myopathy, which rarely progresses to rhabdomyolysis. The mechanism for drug interactions with the statins involves their property of lipid or water solubility. This characteristic determines the degree of hepatoenteric or renal metabolism of the statins. All statins except pravastatin undergo metabolism via the cytochrome P450 enzyme system. Other pharmacologic agents that are also metabolized via this pathway may interact with the statins and cause rhabdomyolysis. The risk of statin-induced rhabdomyolysis is increased significantly when statins are used concomitantly with such drugs as fibrates, cyclosporine, macrolide antibiotics, and azole antifungals. CONCLUSIONS: Rhabdomyolysis is a rare but clinically important adverse event of statin monotherapy or combination therapy. Thorough understanding of this condition may help prevent or minimize adverse health outcomes in patents receiving statin therapy.