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.

Mechanical "cough" cardiopulmonary resuscitation during cardiac arrest in dogs.

Hemodynamic findings during ventricular fibrillation (VF) and closed-chest cardiopulmonary resuscitation (CPR) are similar to those described during VF and vigorous coughing. Interventions during CPR that mimic the physiologic events of coughing (high intrathoracic pressure and high intraabdominal pressure) improve perfusion during VF and CPR. An external circulatory assist apparatus was devised to emulate cough physiology, i.e., simultaneous pulsatile increases in intrathoracic pressure (pneumatic vest), intraabdominal pressure (abdominal binder) and airway pressure (high-pressure airway inflation). In this study, vest/binder CPR was compared with conventional CPR during 30 minutes of VF and artificial support in 18 randomized dogs. Defibrillation and long-term (more than 24 hours) survival were chosen as end points. During VF and artificial support, aortic and right atrial (RA) pressures, the instantaneous aortic-RA pressure difference (coronary perfusion pressure) and blood gas levels were measured. After 30 minutes of VF and administration of 1 mg of epinephrine, countershock was attempted. Systolic aortic and RA pressures, mean aortic-RA pressure difference and blood gas levels were not significantly different between dogs that were successfully resuscitated and those that were not. However, peak diastolic coronary perfusion pressure (peak diastolic aortic-RA pressure) for survivors averaged 23 +/- 6 mm Hg, but only 6 +/- 10 mm Hg for nonsurvivors (p less than 0.001). A peak diastolic coronary perfusion pressure 16 mm Hg or greater had a positive and negative predictive value for a successful outcome of 1.00. Only 1 of 9 conventional CPR dogs survived 24 hours; 7 of 9 dogs supported with the vest/binder device were alive and neurologically normal at 24 hours (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of level of antibodies to bovine virus diarrhoea virus (BVDV) in bulk tank milk as a tool in the diagnosis and prophylaxis of BVDV infections in dairy herds.

An indirect ELISA has been evaluated for determination of the level of antibodies to BVDV in individual milk samples and recently in bulk tank milk from dairy herds. As part of an epidemiological study, bulk milk and individual milk samples from all cows in 15 dairy herds were analysed for antibodies to BVDV two times one year apart. There was an excellent correlation between the level of antibodies in the bulk tank milk and the prevalence of BVDV antibody positive cows. The mean prevalence of BVDV antibody positive cows in the 15 dairy herds was 45.5% (188/413) at the first sampling and 46.2% (191/413) one year later. Seven of the herds had no, or only a low number of antibody positive cows. In contrast, between 52 to 100% of the cows in seven other herds were antibody positive to BVDV. In the 15th herd all cows without antibodies at the first sampling were antibody positive to BVDV one year later, indicating a recently introduced BVDV infection in this herd. Analysis of bulk milk samples for BVDV antibodies is now routinely used in Sweden as a tool in diagnosis and prophylaxis of BVDV infections in dairy herds. The importance and advantages of this diagnostic technique, that has made it possible to establish BVDV-free dairy herds, is discussed.

Serum C-reactive protein levels after total hip and knee arthroplasty.

Any operation induces an elevation in the level of serum C-reactive protein (CRP). After hip and knee arthroplasty the maximal values are seen on the second and third postoperative days, after which the CRP decreases rapidly. There is no difference between patients with cemented or uncemented prostheses. Major postoperative complications may cause a further increase in CRP levels at one and two weeks.

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.

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.

Relationship between the levels of antibodies to bovine viral diarrhoea virus in bulk tank milk and the prevalence of cows exposed to the virus.

A positive relationship was found between the prevalence of cows in a herd which were antibody-positive for bovine viral diarrhoea virus (BVDV) and the level of antibodies to the virus in bulk tank milk as determined by an indirect enzyme-linked immunosorbent assay (ELISA). In herds with an ELISA absorbance value of up to 0.20 there were very few or no antibody-positive cows, whereas in herds with an ELISA absorbance value of at least 0.81, 87 to 100 per cent of the lactating cows were antibody-positive to BVDV. An analysis of the level of antibodies to BVDV in milk samples from Sweden and Finland showed that of 123 Swedish herds, 83.7 per cent had detectable antibodies to BVDV in their bulk milk whereas only 3.1 per cent of the 291 Finnish samples were antibody-positive. The incidence of BVDV infection in 105 herds in one area of Sweden was determined by analysing two samples of bulk tank milk taken one year apart. The infection had apparently occurred recently in five of these dairy herds.

Winter dysentery diagnosed by farmers in dairy herds in central Sweden: incidence, clinical signs and protective immunity.

The occurrence of winter dysentery, diagnosed by farmers and defined as an outbreak of diarrhoea among at least 30 per cent of adult cattle in a herd, was monitored in 256 dairy herds in an area of central Sweden. The cumulative incidence of winter dysentery between April 1988 and March 1989 was 28.5 per cent. A typical outbreak lasted for one to two weeks and 74 per cent of the outbreaks occurred between November and January. A decrease in milk yield was reported in 90 per cent of the affected herds and the cows showed respiratory signs in 57 per cent of them. There was a significant (P < 0.05) association between the occurrence of fever and coughing. In 31 per cent of the outbreaks the farmer also noticed diarrhoea among the calves. One-third of the affected herds had experienced an outbreak within the previous four years and 18 per cent had at least one further outbreak during the following two years. There was a significantly (P < 0.05) lower disease score in herds that had had an outbreak within the previous four years than in herds which had had a less recent or no previous outbreak, indicating the development of temporary immunity to the causative agent.

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.

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.

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.

Bovine coronavirus as the causative agent of winter dysentery: serological evidence.

Sera from 9 dairy herds with epizootic enteritis (winter dysentery) were examined for antibodies to bovine coronavirus (BCV) and bovine virus diarrhoea virus (BVDV). Cows in 8 of the 9 herds seroconverted to BCV alone, while the animals in the ninth herd, which showed severe symptoms of the disease, seroconverted both to BCV and BVDV. The BCV antibodies, which were present in high titres 1 year postinfection, were transferred to the offspring via the colostrum and were then detectable in sera of calves until these were approximately 5 months old. A serological survey of 549 Swedish heifers showed that 61% of the animals were reactors to BCV. The prevalence of seroreactors to BCV was equally distributed over Sweden but was commonly either high or low in herds. In conclusion, BCV is commonly detected in animals suffering from winter dysentery. A co-infection with BVDV appears to aggravate the disease.

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.

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.

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.

Automated external defibrillators--experiences with their use and options for their further development.

The purpose of this session at the Wolf Creek IV Conference was to explore future improvements in automatic external defibrillators (AEDs). Rather then conduct a general brain-storming session where any and all ideas are encouraged, participant comments were based on either direct personal experience or based on the experience of others. This article captures the comments in the words of the speakers. Generic improvements in AEDs such as making them smaller, lighter, less expensive, more reliable, and easy to use are always desired. The importance of data collection and analysis was stressed. Of particular concern was the importance of time and time interval measurements. System clock and defibrillator clock synchronization is desired. Concern over liability was voiced by many. The role of the American Heart Association was discussed by both panel members and members of the audience.