[Surgical treatment of coronary heart disease in elderly patients].

Current approaches to the provision of effective medical aid to elderly patients with cardiovascular diseases are discussed. Clinical characteristics of such patients, concomitant pathologies, the strategy and extent of cardiosurgical treatment and postoperative therapy are described The original observations are compared with literature data concerning the immediate postoperative outcomes, clinical features, and peculiarities ofsurgical intervention in the patients of this age group.

[Plastic surgery of the mitral valve in patients with coronary heart disease].

Modern approaches to cardiosurgical plastic intervention on the mitral valve in case of its ischemic insufficiency are discussed. Etiology of this condition, indications for surgery, and the history of such operations are described. It is concluded that plastic surgery of the mitral valve is the method of choice for the treatment of patients with coronary heart disease.

Perceived barriers/facilitators to a healthy lifestyle among diverse adolescents with overweight/obesity: A qualitative study.

Objective: Effectiveness of behavioural obesity treatments in adolescents is modest. Thus, incorporating participant feedback may lead to improvement of intervention acceptability. This qualitative study's objective was to assess perceived barriers/facilitators to weight loss and healthy lifestyles among diverse adolescents with overweight/obesity (OW/OB). Methods: Adolescents ages 14-19 with BMI ≥ 85th percentile participated in focus groups and identified perceived barriers/facilitators to weight loss and healthy lifestyles. Results: Ten sex-stratified focus groups (n = 41; n = 13 males, n = 28 females) were conducted in 2018 and 2019. Females reported experiencing weight struggles, whereas males often stated no struggles with weight, despite all participants meeting criterion for OW/OB. Barriers included eating behaviours, family members and internal motivation, with additional barriers of physical activity, friends, time and support cited in females. Facilitators included parental, familial and peer support of healthy eating and exercise, modelling behaviours, internal motivation and organized sports. Two additional findings regarding adolescents' perceived barriers/facilitators include substantial overlap and sex differences of perceived barriers/facilitators. Conclusions: Adolescent males and females with OW/OB experience weight status differently, affecting their perceived barriers/facilitators to weight loss and healthy lifestyles. Tailoring weight management interventions to the unique needs of adolescent females versus adolescent males has the potential to improve intervention quality and effectiveness.

Comparison of phagocytosis and chemiluminescence by blood and mammary gland neutrophils from multiparous and nulliparous cows.

Neutrophils were isolated from the blood and mammary gland of 3 multiparous lactating cows and 3 nulliparous heifers. Neutrophil function was evaluated by phagocytosis and luminol-dependent chemiluminescence. Peroxidase activity was detected by use of transmission electron microscopy. Compared with that for blood neutrophils, percentage of phagocytosis was 9.6% lower for neutrophils isolated from the mammary gland of lactating cows, but this difference was not observed between neutrophils isolated from the mammary gland and from the blood heifers. Similarly, after subtraction of chemiluminescence values in the absence of zymosan, phagocytosing neutrophils from the mammary gland of lactating cows had lower chemiluminescence than did those from the blood of such cows. For heifers, however, chemiluminescent activity by phagocytosing neutrophils obtained from the mammary gland was similar to that of blood neutrophils. Chemiluminescent activity of resting neutrophils from the mammary gland of lactating cows pretreated with cytochalasin B was not inhibited, compared with that of nontreated resting neutrophils (controls). This was attributed to xanthine oxidase activity. Transmission electron microscopy of mammary gland neutrophils from lactating cows revealed peroxidase-positive material associated with milk-fat globule membranes and with phagosomes containing zymosan. Results indicated that ingestion of fat and casein by neutrophils isolated from milk caused a decrease in phagocytic and chemiluminescent activity. Also, luminol-dependent chemiluminescence was not a reliable measure of milk neutrophil function, because of interference by xanthine oxidase.

Relationship between penetrability of the papillary duct (teat) and phagocytic capability in lactating dairy cows.

To determine whether there is a reciprocal relationship between penetrability of the papillary duct of the teat (streak canal) and phagocytic capability, 3 cows with highly penetrable papillary ducts and 3 with ducts highly resistant against penetration were identified, using a penetrability assay. Leukocytes harvested from milk from these cows were tested for their capability to phagocytose Staphylococcus aureus. Phagocytic capability was found to be independent of the ability of microorganisms to gain access to the interior of the mammary gland.

Determination of phagocytosis of 32P-labeled Staphylococcus aureus by bovine polymorphonuclear leukocytes.

A procedure for the measurement of phagocytosis by bovine polymorphonuclear leukocytes (PMN) of 32P-labeled Staphylococcus aureus was modified so that a larger number of samples could be compared in a single run, and smaller volumes of sample, PMN, and 32P-labeled S aureus could be used. Results were highly reproducible, with a coefficient of variation between duplicate determinations of less than or equal to 2%. Lysostaphin was prepared from the supernatant of S staphylolyticus and was compared with a commercially available preparation. Effects of lysostaphin on PMN and influence of incubation media on release of 32P from 32P-labeled S aureus by lysostaphin were examined.

Effect of antibiotics and vehicles on bovine mammary polymorphonuclear leukocyte morphologic features, viability, and phagocytic activity in vitro.

Effects of antibiotics and antibiotic vehicles on polymorphonuclear leukocytes (PMNL) isolated from bovine mammary glands were studied in vitro. Amikacin, dicloxacillin, erythromycin, gentamicin, lincomycin, nitrofurantoin, novobiocin-penicillin, polymyxin B, rifampin, tetracycline, or tiamulin was added to culture medium at 1 mg/ml and chloramphenicol was added at 4 mg/ml. Drug concentrations were equivalent to those detected in milk immediately after injection into the mammary gland. Vehicles included mineral oil and peanut oil, each at a dilution of 1:100 in culture medium. The PMNL morphologic features, viability, and phagocytic activity were evaluated. In comparison with the phosphate-buffered saline solution (PBSS) control, significant (P less than 0.05) alterations in normal cell morphologic features were observed in PMNL cultured with tetracycline, nitrofurantoin, erythromycin, polymyxin B, rifampin, novobiocin-penicillin, chloramphenicol, tiamulin, or peanut oil. Viabilities of PMNL cultured with chloramphenicol, novobiocin-penicillin, or tiamulin were significantly (P less than 0.05) reduced when compared with those of PBSS controls. Addition of Staphylococcus aureus to culture medium enhanced morphologic alterations and reduced viabilities of PMNL. Phagocytosis of S aureus by PMNL was significantly (P less than 0.05) depressed in medium containing novobiocin-penicillin, amikacin, rifampin, chloramphenicol, tiamulin, or peanut oil in comparison with that of PMNL incubated in PBSS.

Relationship between immunoglobulin concentrations in milk and phagocytosis by bovine neutrophils.

Using bovine neutrophils and radio-labelled Staphylococcus aureus, skim milk samples taken at 4 stages of lactation from the 4 mammary quarters of 48 cows were used in an in vitro phagocytosis assay. Immunoglobulin (Ig) isotype concentrations in the milk samples were estimated by use of an ELISA procedure. To determine associations of Ig concentrations with phagocytosis, correlations, simple regressions, and partial regressions were calculated. Simple correlations were computed between each Ig isotype and phagocytosis percentage for each lactation number stage of lactation category. Ranges of these correlations for IgM, IgG1, IgG2, and IgA were 0.33 to 0.60; -0.16 to 0.43; 0.04 to 0.46; and -0.30 to 0.36, respectively. Correlations for concentrations of IgG2 and IgM with percentage of phagocytosis tended to be slightly higher for samples from older cows, in contrast to the correlations calculated for IgA and IgG1. Multiple regression of percentage of phagocytosis calculated simultaneously on concentrations of the 4 Ig isotypes in the sample indicated that IgM, followed by IgG2 and IgA, was most closely associated with phagocytosis. Partial regression calculated on concentration of IgG1 was not significant. Addition of bacteriologic status of the quarter and somatic cell concentration in the milk sample did not increase accuracy of predicting percentage of phagocytosis, compared with use of Ig concentrations alone. These results supported the attribution of unique modes of action to IgM and IgG2 in promoting phagocytosis by neutrophils.

Reduced survival of neonates due to vitamin A deficiency during pregnancy in the guinea pig.

Neonatal vitamin A stores are limited even in well-nourished full-term infants and are yet smaller in the premature infant. The object of this experiment was to determine whether vitamin A deficiency could be induced in pregnant guinea pigs and, if so, whether it would affect vitamin A status of the neonate. Adult (600 g) guinea pigs were fed a casein-agar diet that was vitamin A deficient (AD). Controls (vitamin A adequate) were orally dosed weekly with 2 mg of retinyl palmitate. Weight gains of dams and birth weights of neonates did not differ. No external signs of deficiency were observed. Six of eight AD and seven of eight vitamin A-adequate dams carried pregnancy to term (greater than or equal to Day 64). One AD dam died during delivery. Liver retinol concentrations were below the detection limit (less than 3 micrograms/g) for all AD neonates and dams and in postpartum serum of AD dams. Of neonates born greater than or equal to Day 64, 15 of 18 AD were dead or moribund compared with 4 of 22 vitamin A adequate. The unexpectedly severe effect on the neonate indicates that the guinea pig will be a sensitive model for investigating the affect of poor maternal vitamin A status on neonatal vitamin A-dependent functions. However, a less severe maternal deprivation should be used for such studies.

Differentiation and Enumeration of Somatic Cells in Goat Milk.

Non-leukocytic cell-like particles commonly observed in goat milk were examined ultrastructurally and cytochemically. Transmission electron microscopy indicated that these particles were generally membrane-bound and anucleate. They contained granular material in the dilated cisternae of the endoplasmic reticulum and homogeneous electron translucent inclusions that resembled lipid. Histochemical and fluorescent staining indicated that the particles contained large amounts of protein, some lipid, but no deoxyribonucleic acid. Several methods routinely used for estimating somatic cell counts in cow milk were compared to determine which one would give accurate estimates of somatic cell counts in goat milk. No significant difference was found (P> .05) among methods which specifically measure deoxyribonucleic acid. These included Membrane Filter-DNA, direct microscopic somatic cell counts using Pyron in Y-methyl green stain, and Fossomatic cell counts. Results of the Wisconsin Mastitis Test did not differ significantly from Fossomatic cell counts. Because Coulter electronic counts and direct microscopic somatic cell counts using Levowitz-Weber stain could not differentiate between the cell-like particles and the actual leukocytes, these methods resulted in elevated cell counts that were highly variable. Results indicate that only those counting methods that are specific for deoxyribonucleic acid can distinguish cell-like particles from somatic cells, and thereby give reliable estimates of somatic cell numbers in goat milk.

Cytospin centrifuge in differential counts of milk somatic cells.

A procedure was developed for a cytospin centrifuge to concentrate cells from milk onto microscope slides in a circle with 6 mm diameter. Differential somatic cell counts with cytospin were compared to the conventional hand smearing technique to ascertain variation in differential counts. Milk samples were from each of 30 cow quarters, 10 within each of three total milk somatic cell count ranges of less than .7, .7 to 1.5, and more than 1.5 x 10(6)/ml. Two prepared from each sample. All smears were air dried; and stained with modified Wright's stain, the first 200 cells were counted. Differential cell counts from smears prepared by the two procedures were not different. Variation between duplicate smears in differential cell counts was less for cytospin technique. Cytospin can be used to obtain rapid and accurate differential cell counts in milk over a wide range of total somatic cell counts.

Interdialytic weight gain correlates with glycosylated hemoglobin in diabetic hemodialysis patients.

Most of the excess mortality and morbidity in diabetic end-stage renal disease patients is ascribed to diabetes-associated cardiovascular disease, which is accelerated by uremia. We compared the interdialytic weight gain in 33 diabetic patients (group 1) undergoing maintenance hemodialysis in an ambulatory facility retrospectively over 3 months, with 25 randomly selected nondiabetic hemodialysis patients (group 2); in addition, we assessed glycemic control in the diabetic subjects using glycosylated hemoglobin (HbA1c). Interdialytic weight gain was expressed as a percentage of the immediately preceding postdialysis weight, and a mean was calculated for each subject. In all subjects, predialysis serum aldosterone, plasma renin activity, and the interdialytic change in serum sodium were measured. Both groups received an equivalent amount of dialysis using a cellulose membrane (mean +/- SD of thrice weekly dialysis: group 1 = 3.8 +/- 0.35 hours, group 2 = 3.86 +/- 0.3 hours; P < 0.5) and had similar predialysis serum creatinine, hematocrit, and serum albumin levels. Group 1 patients had a mean age of 56.5 +/- 11.4 years (age range, 30 to 71 years) and group 2 had a mean age of 55.8 +/- 15.4 years (age range, 29 to 76 years) (P < 0.84). Mean (+/- SD) duration on maintenance hemodialysis was 18.7 +/- 15.3 months (range, 2 to 84 months) for group 1 and 21 +/- 28.9 months (range, 3 to 156 months) for group 2 (P < 0.9). Interdialytic weight gain was 30% greater in group 1 (4.2% +/- 0.19%) than in group 2 (3.2% +/- 0.2%) (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of parity, stage of lactation, and intramammary infection on concentration of somatic cells and cytoplasmic particles in goat milk.

Aseptic foremilk samples (about 15 ml) were collected biweekly for four samplings and then monthly throughout lactation from 35 does in three herds on Dairy Herd Improvement test. Bacteriology, direct microscopic somatic cell counts, and cytospin differential cell counts were performed on all samples. Milk yield was obtained from monthly Dairy Herd Improvement records. Thirty-nine percent of udder halves were infected, and coagulase negative staphylococci were the most frequent isolates (201 of 205). Somatic cell counts were influenced by lactation number, stage of lactation, and intramammary infection. Also, infection of one udder half increased somatic cells in the corresponding uninfected mammary half of the same animal. Cytoplasmic particles were not affected by stage of lactation or by intramammary infection but were greater for goats in first lactation. Milk yield was influenced by lactation number, stage of lactation, and intramammary infection.

Gouty arthritis in end-stage renal disease: clinical course and rarity of new cases.

We studied 201 end-stage renal disease (ESRD) patients sustained on maintenance hemodialysis (MD) (n = 164) and chronic ambulatory peritoneal dialysis (CAPD) (n = 37) to determine (1) the frequency of acute attacks of gouty arthritis (GA) in those ESRD patients who had GA before dialytic therapy, and (2) the incidence of new-onset GA in hyperuricemic long-term (> 12 years) ESRD patients on MD. The 2-month mean of predialysis serum uric acid levels was calculated for each subject and the prevalence of hyperuricemia ascertained. There were 25 patients on MD for more than 12 years, and this group was evaluated and analyzed separately from those patients on dialytic therapy for less than 12 years; the mean of each of their predialysis uric acid values was calculated for each subject for at least 60% of the time they have been on dialysis. Patients who had GA before or after initiation of dialytic therapy were identified, and the frequency of acute attacks of GA determined. The presence of treated hypertension in each subject was noted. Thirteen of 201 patients had clinically active GA before commencing dialytic therapy, and each recalled a minimum of two painful attacks of GA per year before the initiation of ESRD therapy. Mean duration of ESRD for these 13 patients was 25 +/- 3.8 months; painful attacks of GA have not recurred in nine patients (70%), and the frequency of attacks declined by 50% in the remaining four patients (30%), despite persistent hyperuricemia in all 13.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors affecting ability of skim milk to support phagocytosis by bovine polymorphonuclear leukocytes.

Milk samples from quarters were collected from 48 Holstein cows at 1.5, 3, 21, and 35 wk postpartum and at 1 wk after drying off. Foremilk samples were obtained for bacteriological examination, somatic cell count of milk, and for assay of phagocytosis. Thirty-two cows in first lactation and 16 in third lactation produced by two criteria of sire selection (high milk versus multiple trait) were studied. In vitro phagocytosis was assayed four times on each original quarter milk sample, yielding 3,840 determinations. Variance components were large for cow-associated variation. Cow, stage X cow, and cow X sample dilution were 18.7, 20.6, and 6.0% of total variance. Phagocytosis was 9% higher in skim milk from third lactations than from first. Phagocytosis was highest in dry period samples, followed by 1.5, 35, 3, and 21-wk postpartum samples. Milk somatic cell count tended to be related more closely to phagocytosis than was current bacteriological status of the quarter. Skim milk from genetically higher producing cows was less conducive to phagocytosis than skim milk from genetically lower producing cows, possibly because of dilution.

[Computed tomography in the diagnosis of colorectal cancer]. / Komp'iuternaia tomografiia v diagnostike kolorektal'nogo raka.

In order to study the potentialities of computerized tomography (CT) in the diagnosis of colorectal cancer and assessment of its spreading, 107 patients (subsequently operated on) were investigated. CT of the colon was performed against a background of a contrast study per os, CT of the rectum was performed against a background of inserting a thin wall latex balloon and rated inflation of it with air. Comparison of the results of this investigation with operative findings led to a description of CT semeiotics of colorectal cancer, and a study of the signs of spreading to various organs and structures as well as of metastatic involvement of the regional lymph nodes and liver. The use of CT for colorectal cancer in combination with other methods of examination helped choose the optimum therapeutic tactics and define the volume of operation.