Short communication: comparison of virulence factors in Klebsiella pneumoniae strains associated with multiple or single cases of mastitis.

Klebsiella pneumoniae mastitis in dairy cattle is generally due to an opportunistic infection from the environment, resulting in large heterogeneity among mastitis-causing strains within a herd. However, in mastitis outbreaks in 4 herds, several strains of K. pneumoniae were identified as the cause of infection in multiple cows, suggesting increased ability to either cause disease or evade host defenses. In this study, differences in capsule formation and immune evasion were compared in 5 pairs of K. pneumoniae strains, where one strain in each pair was associated with multiple cases of mastitis and the other with a single case of mastitis. Production of capsular polysaccharide, ability to evade killing by polymorphonuclear neutrophilic leukocytes (PMNL), and the relationship between the 2 were evaluated for each strain grown in broth or milk. Growth of isolates in skim milk increased capsule size and ability to evade killing by PMNL, depending on strain type. Specifically, strains associated with multiple cases of mastitis had increased capsule size in skim milk. Strains associated with single cases of mastitis were better able to evade killing by PMNL when grown in skim milk. Our results, although preliminary, suggest that the 2 groups of strains may constitute different subpopulations of K. pneumoniae. However, our findings do not indicate that capsule or evasions of killing by PMNL explain increased mastitis outbreaks with Klebsiella. Further work will explain the enhanced ability of some strains to cause mastitis in dairy cows.

Short communication: analysis of immune function in lactating dairy cows fed diets varying in phosphorus content.

The aim of this study was to evaluate the effect of varying dietary P on bovine immune function. Nine first- or second-lactation Holstein cows were fed diets varying in P in a 3 x 3 Latin square design. Diets were formulated to contain either low (0.34%, no supplementary P), medium (0.43%), or high (0.52%) P. All 3 diets were formulated to meet or exceed current NRC requirements for P content. Between d 21 and 26 of each period, blood samples were collected and serum inorganic P concentration, lymphocyte proliferation, and neutrophil bactericidal activity were measured. Serum P increased with increasing dietary P intake and was greatest in the first lactation compared with subsequent lactations. There was a stage of lactation-dependent increase in lymphocyte proliferation after stimulation with concanavalin A, phytohemagglutinin, or pokeweed mitogen. However, dietary P did not alter lymphocyte proliferation or neutrophil bactericidal activity in vitro. In conclusion, decreasing dietary P to reduce manure P content and the risk of P losses from farms to surface water does not have an adverse effect on the innate or cell-mediated immune responses of lactating dairy cattle.

Body Mass Index and Operating Times in Vascular Procedures.

INTRODUCTION: The influence of body mass index (BMI) on operating times in central and peripheral vascular surgical procedures was investigated. REPORT: A national cohort of Danish patients who underwent a vascular procedure between 1983 and 2012 was used for analysis. Data were analysed with pairwise comparisons of BMI groups for operating times using the independent samples Kruskall-Wallis test. DISCUSSION: A total of 3,255 carotid endarterectomies; 6,885 central vascular procedures; and 4,488 peripheral bypasses were included for the analysis. Median operating times for carotid endarterectomy and central vascular procedures were, respectively, 5 and 15 minutes longer in obese patients than in normal weight patients. This represents a 7% and 10% increase in median operating times, respectively. Linear and multi-adjusted linear regressions were conducted adjusting for confounders, showing a significant correlation between BMI and operating time. Obesity significantly increased the operating times in carotid endarterectomy and central vascular procedures. These may have ramifications for the individual operative stress but not necessarily on logistical operation planning.

The association between diabetic complications and exercise capacity in NIDDM patients.

OBJECTIVE: Exercise capacity has been used as a noninvasive parameter for predicting cardiovascular events. It has been demonstrated previously in NIDDM patients that several risk factors (i.e., obesity, smoking, hypertension, and African-American race) are associated with an impaired exercise capacity. We studied 265 male and 154 female NIDDM patients who underwent graded exercise testing with expired gas analyses to determine the possible influences of diabetic neuropathy, nephropathy, and retinopathy on exercise capacity. RESEARCH DESIGN AND METHODS: Univariate and multiple linear regression analyses were performed to determine the relationship between diabetic neuropathy, urinary albumin excretion (UAE), and retinopathy with respect to peak oxygen consumption (VO2). Neuropathy was assessed by neurological symptom and disability scores, autonomic function testing, and quantitative sensory exams involving thermal and vibratory sensation. Three categories of UAE were used: normal albuminuria (< 20 micrograms/min), microalbuminuria (20-200 micrograms/min), and overt albuminuria (> 200 micrograms/min). Retinopathy was assessed by stereoscopic fundus photographs. Multiple linear regression analyses were then performed controlling for age, sex, length of diagnosed diabetes, duration of hypertension, race and ethnicity, GHb, BMI, and smoking to determine whether there was an independent effect of these diabetic complications on exercise capacity. RESULTS: Univariate analyses revealed that the presence of diabetic retinopathy (P = 0.03), neuropathy (P = 0.002), microalbuminuria (P = 0.04), and overt albuminuria (P = 0.06) were associated with a lower peak VO2. Multiple linear regression analyses were performed to determine independent relationships with peak VO2. The results revealed that increasing retinopathy stage (Parameter estimate [PE] = -0.59 +/- 0.3 ml.kg-1.min-1; P = 0.026) and increasing UAE stage (PE = -0.62 +/- 0.3 ml.kg-1.min-1; P = 0.04) were associated with a decrease in peak VO2. CONCLUSIONS: In the present study of NIDDM subjects, a significant independent association was demonstrated between diabetic nephropathy and retinopathy with exercise capacity. These results were obtained controlling for age, sex, length of diagnosed diabetes, hypertension, race, and BMI. Thus the findings in this large NIDDM population without a history of coronary artery disease indicate a potential pathogenic relationship between microvascular disease and exercise capacity.