Measuring Intracompartmental Pressures in the Lower Leg: Assessing the Use of Unilateral Measurements in Patients with Bilateral Symptoms.

The purpose of the present study was to evaluate whether unilateral intracompartmental pressure (ICP) measurements correctly represent the contralateral ICP value in patients suspected to have bilateral chronic exertional compartment syndrome (CECS) in the anterior compartment of the leg. Methods: A retrospective cohort study was performed that included military service members who had been referred to a secondary care department for bilateral anterolateral exercise-related leg pain. The obtained ICP values were utilized to assess 2 possible measurement strategies to perform unilateral ICP measurements: the right-leg strategy (i.e., always testing the right leg) and the most-symptomatic-leg strategy (i.e., always testing the most symptomatic). The diagnostic cutoff value for CECS in this cohort was 35 mmHg in the first minute after provocation. Four outcome categories were created to describe the pressure classification of the second leg if only 1 leg would have been measured: correct (category 1: both values ≥35 mmHg; category 2: both values <35 mmHg) or incorrect (category 3: measured leg, ≥35 mmHg and contralateral leg, <35 mmHg; category 4: measured leg, <35 mmHg and contralateral leg, ≥35 mmHg). Results: A total of 442 patients (884 legs) were included. In 88% of patients, the unilateral value would have correctly diagnosed the other symptomatic leg, whereas in 12% of patients, the contralateral leg would have been diagnosed incorrectly. The right-leg strategy had a slightly smaller proportion of cases in which the contralateral leg would have been incorrectly diagnosed (7% compared with 8% for the most symptomatic leg strategy). In 89% of the 390 patients in categories 1 and 2, the ICP values deviated by >5 mmHg from the 35-mmHg cutoff value compared with 40% of the 52 patients in categories 3 and 4. Conclusions: In military service members with bilateral chronic anterolateral exertional pain, a unilateral ICP measurement seems to be justified, especially among those with pressure values >5 mmHg above or below the diagnostic cutoff value. When a unilateral pressure measurement is within 5 mmHg above or below the cutoff value, a bilateral ICP measurement may be warranted. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study.

OBJECTIVES: Dyslipidaemia is common in perinatally HIV-infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs. METHODS: We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TC:HDL-C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)- or darunavir/ritonavir (DRV/r)-based antiretroviral therapy (ART) from an older PI-based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r- or DRV/r-based ART with the rate of change in lipids, adjusted for potential confounders. RESULTS: From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL-C. (ß = -0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL-C, LDL-C, or TG change. CONCLUSIONS: A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL-C ratio in PHIV youth, potentially impacting long-term cardiovascular disease risk.

A review of the Acanthocephala parasitising freshwater fishes in Australia.

The acanthocephalan fauna of Australian freshwater fishes was documented from field surveys, a literature survey and examination of specimens registered in Australian museums. From the 4030 fishes, representing 78 of the 354 Australian freshwater fish species (22%), examined for infection seven species of acanthocephalan were recovered. These species comprised five endemic species, three in endemic genera, two species in cosmopolitan genera, one species not fully identified and 1 putative exotic species recovered from eight species of fish. Of these Edmonsacanthus blairi from Melanotaenia splendida, was the only acanthocephalan found at a relatively high prevalence of 38·6%. These findings are indicative of a highly endemic and possibly depauperate acanthocephalan fauna. Species richness was higher in the tropical regions than the temperate regions of the country. Exotic acanthocephalan species have either not been introduced with their exotic hosts or have been unable to establish their life cycles in Australian conditions. Consequently, acanthocephalans have not yet invaded endemic Australian fish hosts.

Current status of parasitic ciliates Chilodonella spp. (Phyllopharyngea: Chilodonellidae) in freshwater fish aquaculture.

Freshwater fish farming contributes to more than two-thirds of global aquaculture production. Parasitic ciliates are one of the largest causes of production loss in freshwater farmed fishes, with species from the genus Chilodonella being particularly problematic. While Chilodonella spp. include 'free-living' fauna, some species are involved in mortality events of fish, particularly in high-density aquaculture. Indeed, chilodonellosis causes major productivity losses in over 16 species of farmed freshwater fishes in more than 14 countries. Traditionally, Chilodonella species are identified based on morphological features; however, the genus comprises yet uncharacterized cryptic species, which indicates the necessity for molecular diagnostic methods. This review synthesizes current knowledge on the biology, ecology and geographic distribution of harmful Chilodonella spp. and examines pathological signs, diagnostic methods and treatments. Recent advances in molecular diagnostics and the ability to culture Chilodonella spp. in vitro will enable the development of preventative management practices and sustained freshwater fish aquaculture production.

Three new species of blood flukes (Digenea: Aporocotylidae) infecting pufferfishes (Teleostei: Tetraodontidae) from off Bali, Indonesia.

We describe three new species of blood flukes (Aporocotylidae) and propose their classification within the genus Psettarium Goto & Ozaki, 1929. All three species were collected from the circulatory systems of pufferfishes caught off Bali, central Indonesia. Psettarium pulchellum n. sp. was found in the gills of both the narrow-lined puffer (Arothron manilensis de Procé) and the spiny blaasop (Tylerius spinosissimus Regan), while P. ogawai n. sp. and P. jimbaranense n. sp. were found in the gills of the reticulated puffer (Arothron reticularis Bloch & Schneider). The morphological characteristics of these taxa necessitated emendation of the diagnosis for the genus Psettarium, to accommodate the presence of an oral sucker, multiple or entirely post-caecal testes and a degenerate posterior testis. Features such as proportion of body length occupied by the oesophagus, and posterior caeca being ≥7× the length of anterior caeca, are no longer regarded as useful genus-level characters. Additionally, Sasala nolani is reassigned to this genus as Psettarium nolani n. comb. In phylogenetic analyses of the 28S and ITS2 rDNA regions, all three new taxa form a well-supported clade, together with Psettarium sinense and Psettarium nolani n. comb., the two other species of tetraodontid-infecting aporocotylids for which comparative rDNA data were available. The short branch lengths within this clade, despite dramatic morphological differences between the five species, suggest that rapid morphological diversification has occurred among the tetraodontid-infecting aporocotylids. The genus Psettarium has long been considered problematic. Further commentary is given on the history of this genus and how the issues presented might be resolved.

Longevity loss among cured tuberculosis patients and the potential value of prevention.

BACKGROUND: Evidence of substantial, quantifiable and preventable burdens of mortality hazard even after anti-tuberculosis treatment and cure would be a compelling, concrete, and useful measure of the value of prevention. METHODS: We compared years of potential life lost between a cohort of 3 933 cured tuberculosis (TB) patients and 9 166 persons with latent tuberculous infection. We constructed a regression model to predict the expected years of potential life lost in each cohort and for demographic subgroups. RESULTS: Among decedents, a history of fully treated TB is associated with a predicted average 3.6 more years of potential life loss than a comparable population without active TB. Greater longevity losses were predicted among those identified as White and Hispanic than among Black and Asian counterparts. CONCLUSION: We found significant differences in predicted longevity of treated TB survivors relative to a similar group without active TB. These excess losses are substantial: a total of 14 158 life-years or the equivalent of more than 188 75-year lifespans. These findings illustrate an important opportunity cost associated with each preventable TB case - an average of 3.6 potential years of life. We conclude that substantial preventable mortality burdens remain despite adequate anti-tuberculosis treatment, a compelling rationale for more widespread and systematic use of prevention.

Evidence for extensive cryptic speciation in trematodes of butterflyfishes (Chaetodontidae) of the tropical Indo-West Pacific.

Molecular data from the cytochrome c oxidase subunit I (cox1) mitochondrial DNA gene and the second internal transcribed spacer (ITS2) nuclear rDNA region were used to test the current morphologically-based taxonomic hypothesis regarding species of Monorchiidae (Hurleytrematoides) from chaetodontid and tetraodontid fishes from six sites in the tropical Indo-West Pacific (TIWP): Heron and Lizard Islands off the Great Barrier Reef (GBR, Australia), Moorea (French Polynesia), New Caledonia, Ningaloo Reef (Australia) and Palau. The 16 morphospecies analysed differed from each other by a minimum of 55bp (9.1%) over the mitochondrial cox1 and 8bp (1.6%) over the ITS2 DNA regions. For two species, Hurleytrematoides loi and Hurleytrematoides sasali, specimens from the same host species in sympatry differed at levels comparable to those between pairs of distinct morphospecies for both cox1 and ITS2 sequences. We take this as evidence of the presence of combinations of cryptic species; however, we do not propose new species for these taxa because we lack identified morphological voucher specimens. For seven species, Hurleytrematoides coronatum, Hurleytrematoides deblocki, Hurleytrematoides faliexae, H. loi, Hurleytrematoides morandi, H. sasali and Hurleytrematoides sp. A, samples from some combinations of localities had base pair differences that were equal to or greater than differences between some pairs of distinct morphospecies for one or both cox1 and ITS2 sequences. For three species, H. coronatum, H. loi and H. morandi, one haplotype differed from every other haplotype by more than the morphospecies benchmark. In these cases morphological specimens could not be distinguished by morphology. These data suggest extensive cryptic richness in this genus. For the present we refrain from dividing any of the morphospecies. This is because there is a continuum of levels of intra- and interspecific genetic variation in this system, so that distinguishing the two would be largely arbitrary.

Discovery of an opportunistic starfish pathogen, Orchitophrya stellarum, in captive blue crabs, Callinectes sapidus.

Histophagous scuticociliate infections were discovered in blue crabs, Callinectes sapidus, held in research facilities at the Virginia Institute of Marine Science. Ciliates were observed infecting every tissue examined including the gills, heart, muscle, hepatopancreas, and epidermis. Hemolymph smears and histological tissue sections indicated a morphological similarity to Mesanophrys chesapeakensis, the only recorded histophagous ciliate infecting blue crabs. However, subsequent analysis of the ribosomal ITS region (ITS1-5.8S-ITS2) of the ciliate indicated the parasite was Orchitophrya stellarum, a parasitic ciliate previously reported infecting sea stars from Europe, Australia, and North America. A simple Polymerase Chain Reaction (PCR-RFLP) assay was developed to detect and differentiate between O. stellarum and M. chesapeakensis. Its application confirmed the presence of O. stellarum infecting blue crabs held in an additional research facility in Maryland. For growth studies, cultures of O. stellarum grew optimally on 10% blue crab serum in crustacean saline held at 10-20°C. A field survey of blue crabs collected during the winters of 2011-2012 and sea stars (Asterias forbesi) during the winter of 2010 from the Chesapeake Bay and eastern shore of Virginia did not identify additional infected individuals.

Unicapsula species (Myxosporea: Trilosporidae) of Australian marine fishes, including the description of Unicapsula andersenae n. sp. in five teleost families off Queensland, Australia.

A survey of the myxosporean fauna of Australian marine fishes revealed the presence of three previously unreported species of Unicapsula (Multivalvulida: Trilosporidae) from sites off Southeast Queensland, off Lizard Island on the Great Barrier Reef, Queensland, and from Jurien Bay in Western Australia. Morphometric data (spore, polar capsule and caudal appendage dimensions) combined with Bayesian inference and maximum likelihood analyses of small subunit (SSU) and large subunit (LSU) ribosomal DNA (rDNA) were used for species identification and to explore relationships among these taxa. The four species of Unicapsula for which DNA data are now available for comparative purposes (Unicapsula andersenae n. sp., Unicapsula pflugfelderi, Unicapsula seriolae and Unicapsula pyramidata) formed a well-supported monophyletic sister clade to the other major multivalvulidan group, the Kudoidae. The combined morphometric and genetic diagnostic approach identified an undescribed taxon, U. andersenae n. sp., from the muscle of Argyrosomus japonicus, Acanthopagrus australis and Eleutheronema tetradactylum off the Southeast Queensland coast and in Lutjanus russellii and Sillago ciliata off Lizard Island. Intra-specific variation within U. andersenae n. sp. varied from 2-4 (0.2-0.4%) nucleotides over the SSU region to 2-20 (0.3-3.2%) over the LSU region. Inter-specific variation between U. andersenae n. sp. and the other three species for which genetic sequence data are now available ranged from 15-66 (3-6.5%) nucleotides over the SSU region to 103-120 (17.6-21.2%) nucleotides over the LSU region. The host distribution observed here for U. andersenae n. sp. (five fish species from five different fish families) represents the broadest specificity known for a single species of Unicapsula. U. pyramidata Naidjenova & Zaika 1970, whose spore morphology and presence of caudal appendages immediately distinguish it from other species, was recovered from the nemipterid, Scolopsis monogramma, off Lizard Island. U. seriolae Lester 1982 is reported here from Yellowtail Kingfish, Seriola lalandi, from sites off Queensland and from Jurien Bay, Western Australia. Comparative genetic analyses also revealed that an unidentified species of Unicapsula from Epinephelus septemfasciatus off Japan whose rDNA sequence data are available on GenBank is consistent with U. seriolae. This suggests that U. seriolae may also exhibit low host specificity and may be distributed widely throughout the Indo-West Pacific region. In comparison to other myxozoan genera, it is clear that the species richness of Unicapsula spp. falls well below that displayed by either Ceratomyxa spp. or Kudoa spp. The discovery of a further new species of Unicapsula in Australia now brings the total worldwide number of formally described Unicapsula species to a modest 11. Nonetheless, this taxon remains of significant interest to commercial and recreational fisheries through the potential production of macroscopic pseudocysts in fish muscle and post-mortem muscle liquefaction, both of which can render fish fillets unpalatable and unmarketable.

The ghost of parasites past: eggs of the blood fluke Cardicola chaetodontis (Aporocotylidae) trapped in the heart and gills of butterflyfishes (Perciformes: Chaetodontidae) of the Great Barrier Reef.

We explored the distribution of Cardicola chaetodontis in chaetodontid fishes from the Great Barrier Reef. We found just four infections of adult worms in 238 individuals of 26 chaetodontid species. By contrast, eggs were present in hearts of 75 fishes (31·5%) and 19 of 26 chaetodontid species (all Chaetodon species). In 10 cases eggs contained moving miracidia; all the others were dead and degenerating. Eggs were sought in the gills of 51 individual fish. There were 17 cases of eggs being present in gills while present in the heart, but also 13 cases where eggs were absent from gills but present in the heart, suggesting that eggs remain longer in heart tissue than in gills. ITS2 rDNA sequences from two adult worms and eggs extracted from gills of five fishes (all different species) were identical to previously reported sequences of C. chaetodontis except for a single base-pair difference in two samples. We conclude that aporocotylid eggs trapped in fish heart tissues may inform understanding of the distributions and host ranges of aporocotylids, especially where adult prevalence is low. The low host-specificity of C. chaetodontis contrasts with higher specificity of trematodes of chaetodontids that have trophic transmission.

Molecular characterization of "Candidatus Similichlamydia latridicola" gen. nov., sp. nov. (Chlamydiales: "Candidatus Parilichlamydiaceae"), a novel Chlamydia-like epitheliocystis agent in the striped trumpeter, Latris lineata (Forster).

Histological analysis of gill samples taken from individuals of Latris lineata reared in aquaculture in Tasmania, Australia, and those sampled from the wild revealed the presence of epitheliocystis-like basophilic inclusions. Subsequent morphological, in situ hybridization, and molecular analyses were performed to confirm the presence of this disease and discovered a Chlamydia-like organism associated with this condition, and the criteria set by Fredericks and Relman's postulates were used to establish disease causation. Three distinct 16S rRNA genotypes were sequenced from 16 fish, and phylogenetic analyses of the nearly full-length 16S rRNA sequences generated for this bacterial agent indicated that they were nearly identical novel members of the order Chlamydiales. This new taxon formed a well-supported clade with "Candidatus Parilichlamydia carangidicola" from the yellowtail kingfish (Seriola lalandi). On the basis of sequence divergence over the 16S rRNA region relative to all other members of the order Chlamydiales, a new genus and species are proposed here for the Chlamydia-like bacterium from L. lineata, i.e., "Candidatus Similichlamydia latridicola" gen. nov., sp. nov.

Molecular characterization of "Candidatus Parilichlamydia carangidicola," a novel Chlamydia-like epitheliocystis agent in yellowtail kingfish, Seriola lalandi (Valenciennes), and the proposal of a new family, "Candidatus Parilichlamydiaceae" fam. nov. (order Chlamydiales).

Three cohorts of farmed yellowtail kingfish (Seriola lalandi) from South Australia were examined for Chlamydia-like organisms associated with epitheliocystis. To characterize the bacteria, 38 gill samples were processed for histopathology, electron microscopy, and 16S rRNA amplification, sequencing, and phylogenetic analysis. Microscopically, the presence of membrane-enclosed cysts was observed within the gill lamellae. Also observed was hyperplasia of the epithelial cells with cytoplasmic vacuolization and fusion of the gill lamellae. Transmission electron microscopy revealed morphological features of the reticulate and intermediate bodies typical of members of the order Chlamydiales. A novel 1,393-bp 16S chlamydial rRNA sequence was amplified from gill DNA extracted from fish in all cohorts over a 3-year period that corresponded to the 16S rRNA sequence amplified directly from laser-dissected cysts. This sequence was only 87% similar to the reported "Candidatus Piscichlamydia salmonis" (AY462244) from Atlantic salmon and Arctic charr. Phylogenetic analysis of this sequence against 35 Chlamydia and Chlamydia-like bacteria revealed that this novel bacterium belongs to an undescribed family lineage in the order Chlamydiales. Based on these observations, we propose this bacterium of yellowtail kingfish be known as "Candidatus Parilichlamydia carangidicola" and that the new family be known as "Candidatus Parilichlamydiaceae."

The imperative to prevent and treat childhood obesity: why the world cannot afford to wait.

In the past 20 years, the prevalence of obesity in the United States increased almost 50% among adults and by 300% in children. Today, 9.7% of all U.S. infants up to 2 years old have abnormally high weight-for-recumbent length; 25% of children under age 5 are either overweight or obese; and 17% of adolescents are obese. Ethnic disparities in the rates of obesity are also large and apparent in childhood. Further, 44% of obese adolescents have metabolic syndrome. Obese children tend to become obese adults; thus, in a decade, young adults will likely have much higher risks of chronic disease, which has tremendous implications for the healthcare system. However, early childhood may be the best time to prevent obesity. Teachers' healthy eating choices are positively associated with changes in body mass index percentiles for children, for example. In addition, 8 million children attend afterschool programs, which can successfully promote health and wellness and successfully treat obesity. This childhood epidemic of obesity and its health-related consequences in adolescents should be a clinical and public health priority. However, this major public health problem cannot be managed solely in clinical settings. Rather, public health strategies must be integrated into home and family, school and community-based settings.

Taxonomic approaches to and interpretation of host specificity of trematodes of fishes: lessons from the Great Barrier Reef.

The taxonomy of trematodes of Great Barrier Reef (GBR) fishes has been studied in some detail for over 20 years. Understanding of the fauna has been informed iteratively by approaches to sampling, understanding of morphology, the advent of molecular methodology and a feed-back loop from the emergent understanding of host specificity. Here we analyse 658 host-parasite combinations for 290 trematode species, 152 genera and 28 families from GBR fishes. These are reported from 8 orders, 38 families, 117 genera and 243 species of fishes. Of the 290 species, only 4 (1·4%) have been reported from more than one order of fishes and just 23 (7·9%) infect more than one family; 77·9% of species are known from only one genus, and 60% from only one species of fish. Molecular studies have revealed several complexes of cryptic species and others are suspected; we conclude that no euryxenous host distribution should be accepted on the basis of morphology only. The occurrence of individual trematode species in potential hosts is patchy and difficult to predict reliably a priori or explain convincingly a posteriori. These observations point to the need for a vigorous iterative interaction between the accretion of host specificity data and its interpretation.

Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: the prospective, P2C2 human immunodeficiency virus multicenter study.

OBJECTIVE: Many children with human immunodeficiency virus-1 (HIV-1) have chronic problems with growth and nutrition, yet limited information is available to identify infected children at high risk for growth abnormalities. Using data from the prospective, multicenter P2C2 HIV study, we evaluated the relationships between maternal and infant clinical and laboratory factors and impaired growth in this cohort. METHODS: Children of HIV-1-infected women were enrolled prenatally or within the first 28 days of life. Failure to thrive (FTT) was defined as an age- and sex-adjusted weight z score < or =-2.0 SD. Maternal baseline covariates included age, race, illicit drug use, zidovudine use, CD4+ T-cell count, and smoking. Infant baseline predictors included sex, race, CD4+ T-cell count, Centers for Disease Control stage, HIV-1 RNA, antiretroviral therapy, pneumonia, heart rate, cytomegalovirus, and Epstein-Barr virus infection status. RESULTS: The study cohort included 92 HIV-1-infected and 439 uninfected children. Infected children had a lower mean gestational age, but birth weights, lengths, and head circumferences in the 2 groups were similar. Mothers of growth-delayed infants were more likely to have smoked tobacco and used illicit drugs during pregnancy. In repeated-measures analyses of weight and length or height z scores, the means of the HIV-1-infected group were significantly lower at 6 months of age (P <.001) and remained lower throughout the first 5 years of life. In a multivariable Cox regression analysis, FTT was associated with a history of pneumonia (relative risk [RR] = 8.78; 95% confidence interval [CI]: 3.59-21.44), maternal use of cocaine, crack, or heroin during pregnancy (RR = 3.17; 95% CI: 1.51-6.66), infant CD4+ T-cell count z score (RR = 2.13 per 1 SD decrease; 95% CI: 1.25-3.57), and any antiretroviral therapy by 3 months of age (RR = 2.77; 95% CI: 1.16-6.65). After adjustment for pneumonia and antiretroviral therapy, HIV-1 RNA load remained associated with FTT in the subset of children whose serum was available for viral load analysis. CONCLUSIONS: Clinical and laboratory factors associated with FTT among HIV-1-infected children include history of pneumonia, maternal illicit drug use during pregnancy, lower infant CD4+ T-cell count, exposure to antiretroviral therapy by 3 months of age (non-protease inhibitor), and HIV-1 RNA viral load.

Description of ciliary body anatomy and identification of sites for transscleral cyclophotocoagulation in the equine eye.

OBJECTIVE: To determine the most appropriate anatomical location for diode laser probe placement to accurately photoablate the equine ciliary body using a contact, transscleral approach. DESIGN: Original research. PROCEDURES: Forty-two freshly enucleated adult equine eyes were evaluated. The horizontal, medial vertical, central vertical, and lateral vertical lengths of the cornea were measured from limbus to limbus. Needles were inserted perpendicular to the sclera at specific distances posterior to the external limbus at the 1, 2, 4, 5, 6, 7, 8, 10, 11 and 12 o'clock positions. The per cent frequency that needles penetrated internal anatomical regions (lens, lens zonules, pars plicata, anterior, middle, and posterior pars plana, ora ciliaris retinae, or retina), when inserted at 2, 4, 6, and 8 mm posterior to the limbus, were calculated for all eyes combined, for right vs. left, for males vs. females, and for three age groups. The internal distance from the limbus to the anterior pars plana, and from the anterior pars plana to the ora ciliaris retinae were also measured in six of the horses (12 eyes). Mean distances and standard deviations were computed for all parameters. RESULTS: Average corneal sizes and standard deviations were: 30.24 mm +/- 1.53 (horizontal); 24.69 mm +/- 1.52 (central vertical); 22.79 mm +/- 1.49 (medial vertical); and 19.79 mm +/- 1.55 (lateral vertical). Internal distances of the pars plicatas ranged from 5.33 mm +/- 0.49 to 10.67 mm +/- 1.15. Internal distances of the pars planas ranged from 0.33 mm +/- 0.49 to 3.17 mm +/- 0.39. High probabilities of penetrating the pars plicata correspond to positions 4 mm posterior to the external limbus dorsotemporal 10, 11 o'clock (OD), and 1, 2 o'clock (OS), dorsonasal 1 o'clock (OD) and 11 o'clock (OS), and ventrotemporal 5-7 o'clock (OU). Low probabilities of penetrating the pars plicata correspond to positions ventronasal 4 o'clock (OD), 8 o'clock (OS) and dorsonasal 2 o'clock (OD), 10 o'clock (OS) at 4 and 6 mm posterior to the external limbus as well as ventrotemporal 4 o'clock (OS), 8 o'clock (OD) at 6 mm posterior to the external limbus. CONCLUSIONS: Transscleral cyclophotocoagulation may be a viable alternative to medical therapy for control of intraocular pressure in horses with glaucoma. Overall, the most accurate anatomical position on the sclera for cyclophotocoagulation of the equine eye is 4-6 mm posterior to the limbus, avoiding the nasal quadrants. Accurate transscleral cyclophotocoagulation should optimize the therapeutic outcome and minimize potential side-effects such as retinal detachment and cataract formation.

Disinhibition and expectancy in risk for alcohol use: comparing black and white college samples.

OBJECTIVE: This study tested several predictions of the "acquired preparedness" model in both black and white samples of college students. The acquired preparedness model holds that trait disinhibition affects alcohol-related learning and, ultimately, alcohol use. This model maintains that the reward focus typical of disinhibited individuals increases the likelihood of forming overly positive expectancies about the effects of alcohol. Alcohol expectancy, then, acts as a mediator of the relationship of disinhibition and drinking behavior. METHOD: Participants (N = 479, 341 women) were 279 white and 200 black college students. Self-reported alcohol expectancy, disinhibition and drinking behavior were assessed. Covariance structure analysis was used to test hypotheses separately for each sample, controlling for socioeconomic status. RESULTS: Black participants scored significantly lower on disinhibition, expectancy and drinking. However, invariance testing indicated that the relationships between these variables were not different across groups. Results were consistent with the stated hypotheses in both samples--alcohol expectancy functioned as a mediator of the disinhibition-drinking relationship. Results did not differ across expectancy content. CONCLUSIONS: These results provide support for the validity of the acquired preparedness model. Despite mean differences in risk and drinking levels between black and white samples, psychosocial learning appears to mediate the influence of disinhibition on drinking for both groups.

Inhibition of growth of methane-producing bacteria of the ruminant forestomach by hydroxymethylglutaryl-SCoA reductase inhibitors.

Two hydroxymethylglutaryl-SCoA (HMG-CoA) reductase inhibitors, mevastatin and lovastatin, inhibited the in vitro growth and production of CH4 of strains of Methanobrevibacter isolated from the rumen. Mevastatin or lovastatin did not inhibit growth of species of rumen bacteria that are essential for fermenting cellulose, starch and other plant polysaccharides to acetate, propionate, and butyrate. Approximately 4 nmol of lovastatin per milliliter resulted in 50% growth inhibition of Methanobrevibacter strain ZA10 and concentrations > or =10 nmol per milliliter completely inhibited growth and CH4 formation. Results of in vitro growth studies suggest that supplementation of ruminant feeds with HMG-CoA inhibitors could decrease ruminant methane production and increase the efficiency of feed utilization by domestic ruminants.

The effect of protease inhibitor therapy on growth and body composition in human immunodeficiency virus type 1-infected children.

OBJECTIVE: To determine the effect of protease inhibitors (PIs) on growth and body composition in children with human immunodeficiency virus type 1 (HIV-1) infection. BACKGROUND: HIV-1-infected children have chronic problems with both linear growth and weight gain. Viral load may directly influence growth and nutritional status of HIV-1-infected children with reduction of viral load improving the nutritional condition. DESIGN/METHODS: Data from 67 patients who initiated PI therapy between 1996 and 1999 and who were enrolled in a prospective, longitudinal study of growth and nutrition in HIV-1-infected children were analyzed. Outcomes included pre-PI versus post-PI measures of height, weight, weight-for-height, triceps skinfold thickness, and arm muscle circumference. Predictor covariates included age, race, gender, Tanner stage, CD4 z score, Centers for Disease Control and Prevention stage, route of infection, plasma HIV-1 RNA, other antiretroviral therapy, recommended daily allowances for calories, treatment with megestrol acetate, and PI therapy. RESULTS: Sixty-seven children were followed for a median of 2.4 years with a total of 362 visits (median: 5 visits; range: 1-12). During follow-up, they received PIs for a median of 5 months. Fifty-one percent were girls, 54% black, 15% Hispanic, and 25% white. The mean age at first visit was 6.8 years. In a univariate analysis, weight z score (-0.67 to -0.35) and weight/height z score (0.25-0.76) improved on PI therapy. Using repeated-measures regression analysis, controlling for the above named covariates, PI treatment showed a significant effect on weight z score (increase in z score by 0.46), weight/height z score (increase in z score by 0.49), and arm muscle circumference (increase in percentile by 11.5). A borderline effect was found for height z score (increase in z score by 0.17) and no effect was found for triceps skinfold thickness. In a separate analysis, PI therapy increased CD4 counts twofold and reduced plasma HIV-1 RNA copies by 79%. CONCLUSION: In addition to a significant reduction in viral load, PI therapy in children has a positive effect on several growth parameters, including weight, weight/height, and muscle mass.