Development, implementation and evaluation of a multinational FLS mentorship programme in Latin America.

Realising the benefits of systematic secondary fracture prevention requires supporting local sites to get started and becoming effective. We here describe the development, implementation and impact of a regional fracture liaison service (FLS) mentorship programme in Latin America that led to 64 FLS getting started and coverage of 17,205 patients. INTRODUCTION: Despite treatments and service models to deliver effective secondary fracture prevention, most patients are left untreated after a fragility fracture. To improve the capability to get FLS started and more effective, we describe the development, implementation and evaluation of an international programme to develop national communities of FLS mentors as part of the Capture the Fracture Partnership in Latin America. METHODS: The IOF regional team and the University of Oxford developed the curriculum and associated resources for training mentors in setting up FLS, service improvement and mentorship. Mentors were selected during a preparatory meeting, trained using live online sessions followed by regular mentor-led post-training meetings. The programme was evaluated using a pre-training needs assessment and post-training evaluation based on Moore's outcomes. RESULTS: The mentorship programme was initiated in Mexico, Brazil, Colombia and Argentina. The mentors were multidisciplinary, including orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology and internal medicine. There was 100% participation in training sessions and reported satisfaction with the training. Since the initiation of the training programme, 22 FLS have been set up in Mexico, 30 in Brazil, 3 in Colombia and 9 in Argentina, in comparison with two in Chile and none in any other LATAM countries that were not involved in the mentorship programme. This equates to approximately 17,025 additional patients identified from 2019 to 2021 after initiation of mentorship. The mentors have engaged with 58 FLS for service development. Post-training activities include two published national best practice guidelines and other country-specific resources for FLS in the local language. CONCLUSION: Despite the COVID pandemic, the mentorship pillar of the Capture the Fracture Partnership has developed a community of FLS mentors with measurable improvement in national FLS provision. The programme is a potentially scalable platform to develop communities of mentors in other countries.

Voriconazole-induced periostitis.

Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients. Chronic use of this medication can generate, as an adverse effect, a multifocal, asymmetric, diffuse and nodular periosteal reaction, associated with severe and disabling skeletal pain and elevated alkaline phosphatase and serum fluoride. Radiography is the imaging technique of choice for periostitis diagnosis. In general, clinical manifestations and radiographic findings disappear, when the drug is discontinued. We report the clinical case of a 44 year-old woman diagnosed with acute myeloid leukemia, who developed an invasive fungal infection treated with voriconazole after a stem cell transplant. Nine months after starting antifungal treatment, she manifested symptoms and radiological signs compatible with periostitis. Due to clinical suspicion, we decided to suspend voriconazole, with consequent resolution of clinical manifestations and radiological findings.

Valor nutritivo de pastagens de Coastcross-1 em consórcio com diferentes leguminosas de ciclo hibernal / Nutritive value of coastcross-1 pastures mixed to different cool season legumes

Objetivou-se com esta pesquisa avaliar três sistemas forrageiros constituídos por Coastcross-1 (CC) + 100kg de N/ha/ano + ervilhaca comum; CC + 100kg de N/ha/ano + trevo vesiculoso; e CC + 200kg de N/ha/ano. Durante o período experimental (345 dias), foram realizados treze pastejos. O delineamento experimental utilizado foi o inteiramente ao acaso, com três tratamentos (sistemas forrageiros), três repetições (piquetes) em parcelas subdividas no tempo (valores médios dos pastejos em cada estação do ano). Para avaliação, foram utilizadas vacas em lactação da raça Holandesa. Amostras de simulação de pastejo foram coletadas para análise de proteína bruta (PB), fibra em detergente neutro (FDN) e ácido (FDA), digestibilidade in situ da matéria seca (DISMS) e da matéria orgânica (DISMO) e os nutrientes digestíveis totais (NDT). Os valores médios para PB, FDN, FDA, DISMS, DISMO e NDT foram de 18,1; 16,7 e 17,6%; 57,8; 58,9 e 58,7%; 26,5; 26,5 e 26,7%; 79,6; 78,9 e 80,6%; 79,8; 79,1 e 80,6%; 72,1; 71,4 e 72,7%, respectivamente. Melhores resultados de valor nutritivo foram obtidos no inverno, em especial para o consórcio de Coastcross-1 com ervilhaca.

The aim of this research was to evaluate three grazing systems with Coastcross-1 (CC) + 100kg N/ha/year + common vetch; CC + 100kg N/ha/year + arrowleaf clover; and CC + 200kg N/ha/year. Thirteen grazing cycles were performed during the experimental period (345 days). The experimental design was completely randomized with three treatments (grazing systems), three replicates (paddocks) in completely split-plot time (average values of grazing season). Lactating Holstein cows were used in the evaluation. Forage mass and botanical composition were evaluated. Samples from the hand-plucking method were collected to analyze crude protein (CP), neutral detergent fiber (NDF) and acid (ADF), in situ digestibility of dry matter (ISDMD) and organic matter (ISOMD) and total digestible nutrients (TDN). The averages of CP, NDF, ADF, ISDMD, ISOMD and TDN were 18.1, 16.7 and 17.6 %; 57.8, 58.9 and 58.7 %; 26.5, 26.5 and 26.7 %; 79.6, 78.9 and 80.6 %; 79.8, 79.1 and 80.6 %; 72.1, 71.4 and 72.7 %, respectively. Better results for nutritive value were found during winter, especially on Coastcross-1 mixed with common vetch.

Produtividade de sistemas forrageiros consorciados com leguminosas / Productivity of grazing systems mixed with forage legumes

O objetivo desta pesquisa foi avaliar três sistemas forrageiros (SF) com capim elefante (CE) + azevém (AZ) + espécies de crescimento espontâneo (ECE); CE + AZ + ECE + amendoim forrageiro (AM); e CE + AZ + ECE + trevo vermelho (TV), usando-se a mesma área, sob pastejo rotacionado, no decorrer do ano agrícola. O CE foi estabelecido em linhas afastadas a cada 4m. No período hibernal, fez-se o estabelecimento do AZ entre as linhas do CE; o TV foi semeado e o AM foi preservado, considerando-se os respectivos SF. O delineamento experimental foi o inteiramente ao acaso, com três tratamentos (SF), duas repetições (piquetes) e avaliações independentes (ciclos de pastejos). Para avaliação, foram utilizadas vacas da raça Holandesa em lactação, que receberam suplementação alimentar com concentrado à razão de 1% do peso corporal/dia. Foram avaliados a massa de forragem, os componentes botânicos do pasto e estruturais do CE e a taxa de lotação. Durante o período experimental, foram efetuados oito ciclos de pastejo. Sistemas forrageiros que envolvem gramíneas e leguminosas de diferentes ciclos proporcionam a utilização da área durante todo o ano agrícola em pastejo rotativo com bovinos leiteiros. Considerando-se a predominância das avaliações em cada pastejo, os sistemas forrageiros consorciados apresentam melhor resultado tanto paras as variáveis de massa de forragem quanto para a taxa de lotação.

The objective of this research was to evaluate three grazing systems (GS) with elephant grass (EG) + ryegrass (RG) + spontaneous growing species (SGS); EG + RG + SGS + forage peanut (FP); and EG + RG + SGS + red clover (RC), in order to use the area in rotational grazing during the agricultural year. EG was planted in rows with a distance of 4m between each row. In the cool-season, RG was sowed between EG rows and FP was preserved on GS. The experimental design was completely randomized with three treatments (GS), two replicates (paddocks) and independent evaluations (grazing cycles). For the evaluation lactating Holstein cows receiving 1% of BW/day feed supplement concentrate were used. The herbage mass, botanical composition of pasture, structural component of EG and stocking rate were evaluated. Eight grazing cycles were performed during the experimental period. Grazing systems involving grass and legume forage in different cycles provided the use of the area during the agricultural year in rotational grazing with dairy cattle. Considering the predominance of the evaluations in each grazing, the mixed grazing systems have better results for both forage mass and stocking rate variables.

High-fidelity simulation for continuing education in nurse anesthesia.

Simulation represents a true paradigm shift in teaching and learning that has revolutionized healthcare education. However, few continuing education opportunities for anesthesia providers exist using simulation of any type. This article explores the usefulness of high-fidelity simulation (HFS) as a valuable tool for continuing education and reports the results of a needs assessment conducted among 22 practicing nurse anesthetists. The questions related to their exposure to HFS and asked them to rank their experience with 11 anesthesia events. Next, respondents were asked to rank a similar list of anesthesia events that would be useful for continuing education using simulation. Of participants, 71% ranked advanced cardiac life support scenarios, anesthesia machine mishaps, and malignant hyperthermia as highly effective choices for using HFS. Eighty-one percent of participants identified that they envision simulation as a valuable tool to assess competency, but respondents had mixed written responses when asked if simulation should be used for recertification. This needs assessment represents a beginning, grassroots attempt to establish nurse anesthetists' perceptions related to using HFS as a tool for continuing education.

Emerging issues for the postbariatric surgical patient.

Millions of individuals in the United States and around the world are overweight or obese. Bariatric surgery is now considered an evidenced-based choice for sustainable long-term weight loss and may reduce obesity-related comorbidities such as diabetes and obstructive sleep apnea. As bariatric surgical procedures increase, it can be expected that intensive care unit (ICU) admissions will increase as well. An emerging ICU population includes postbariatric patients either immediately after undergoing bariatric surgery or returning for subsequent surgical procedures. Massive weight loss following surgery leads to an excess of lax, overstretched skin, causing physical discomfort and psychosocial problems. It is important to understand the complex pathophysiological changes that occur in order to care for this growing population of patients. This review addresses the growing and evolving issues related to the complex nature of the postbariatric ICU patients.

Parathyroid carcinoma presenting as a giant mediastinal retrotracheal functioning cyst.

Parathyroid carcinoma is a rare malignancy of the parathyroid glands, and is the cause of primary hyperparathyroidism in fewer than one percent of cases. Symptoms are mainly due to local compression or hypercalcaemia secondary to markedly elevated parathyroid hormone levels. A minority of patients remain asymptomatic. Mediastinal parathyroid cysts are infrequent and may or may not be functioning. We present an 84-year-old woman with a giant functioning cystic parathyroid carcinoma located in the middle mediastinum. We performed a thorough MEDLINE and LILACS database search on published cases of parathyroid carcinoma and functioning parathyroid cysts, and found no case report with identical features to the one presented here.

Increased FDG bone marrow uptake after intracoronary progenitor cell therapy.

UNLABELLED: Patients with coronary artery disease who undergo FDG, PET for therapy monitoring after intracoronary progenitor cell infusion (PCT) show an increased bone marrow uptake in some cases. AIM of the study was to evaluate the systemic bone marrow glucose metabolism in this patient group after PCT. PATIENTS, METHODS: FDG bone marrow uptake (BMU), measured as standardized uptake value (SUVmax) in the thoracic spine, was retrospectively evaluated in 23 control patients who did not receive PCT and in 75 patients who received PCT 3 +/- 2.2 days before PET scanning. Five out of them were pretreated with granulocyte colony-stimulating factor (G-CSF) 5 days prior to PCT and 10 +/- 1.2 days before PET scanning. In 39 patients who received only PCT without G-CSF and underwent PET therapy monitoring 4 months later, baseline and follow up bone marrow uptake were measured. Leucocytes, C-reactive protein (CRP) levels and the influence of nicotine consumption were compared with the BMU. RESULTS: In patients (n = 70) who received PCT without G-CSF, BMU median (1.3) was slightly, but significantly higher than in the controls (1.0) (p = 0.02) regardless nicotine consumption. BMU did not change significantly 4 months later (1.2) (p = 0.41, n.s.). After G-CSF pretreatment, patients showed a significantly higher bone marrow uptake (3.7) compared to patients only treated with PCT (1.3) (p = 0.023). Leucocyte blood levels were significantly higher in patients with a BMU > or =2.5 compared to patients with a bone marrow SUVmax <2.5 (p<0.001). CRP values did not correlate with the BMU (rho -0.02, p = 0.38). CONCLUSION: Monitoring PCT patients, a slightly increased FDG BMU may be observed which remains unchanged for several months. Unspecific bone marrow reactions after PCT may be associated with increased leucocyte blood levels and play a role in the changed systemic glucose BMU. In addition, pretreatment with G-CSF shows an intense amplification of BMU.

The influence of thyroglobulin on functional imaging in differentiated thyroid cancer.

AIM: Recombinant human thyroid stimulating hormone (rhTSH) for an exogenous stimulation of TSH and consequent thyroglobulin (hTG) synthesis has reinitiated a discussion about the usefulness of diagnostic procedures for the follow-up of differentiated thyroid cancer (DTC). METHOD: Fifty consecutive patients with DTC who received whole-body iodine scintigraphy (WBS) and positron emission tomography (PET) were evaluated. RESULTS: The work-up was normal in 18/50. In 32 patients, functional imaging detected DTC. In 44% exogenous TSH stimulation with rhTSH was used and thyroxin was withdrawn in the others. The hTG under stimulation ranged from 0.8 to 5.004 ng x ml(-1). It was below 2 ng x ml(-1) in four (12.5%) patients. In total, 91 tumour sites were identified by positron emission tomography (PET) and 47 sites by WBS. PET and WBS showed corresponding uptake in 38% of lymph node, 48% of parenchymal and 43% of bone metastases. PET detected additional 53% of lymph node (WBS 9%), 38% of parenchymal (WBS 14%) and 28.5% of bone metastases. CONCLUSION: It is concluded that PET is more sensitive than WBS for the detection of DTC. The follow-up of DTC patients with hTG levels alone misses a significant number of true positive cases. Its use should therefore be restricted to selected low risk patients only.

Paraneoplastic syndromes: detection of malignant tumors using [(18)F]FDG-PET.

AIM: Paraneoplastic syndromes (PS) comprise a variety of clinical symptoms and diseases associated with underlying malignancy. Differentiation towards benign autoimmune diseases is necessary due to different therapeutic options. This diagnostic challenge includes cost- and time-consuming methods and is not successful in many cases. The aim of this study was the evaluation of [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) for detecting or ruling out malignancy in these patients. METHODS: In this retrospective work-up a total of 30 patients with suspected PS (m:f = 17:13, mean age 55, range 22-76 years) were examined with [(18)F]FDG-PET between 1996 and 2001. Diagnoses were erythrodermia, cerebellar degeneration, dermatomyositis, polyneuropathia and others. PET scans were compared to histopathological (n=14), radiological and follow up data (mean follow up 3.6 years, range 1-6 years). RESULTS: In 7 out of 30 patients (23%) an underlying malignancy was detected. Six out of 7 malignant neoplasms showed a distinctly increased glucose consumption. One benign neoplasm caused increased tracer uptake, another PET positive patient refused biopsy and showed no growth of a malignant tumour during clinical follow up of 28 months. The remaining 21 patients without suspicious glucose consumption did not demonstrate a malignancy in other diagnostic modalities or during subsequent clinical follow-up. CONCLUSION: [(18)F]FDG-PET seems to be a useful tool in the diagnostic work-up of patients with suspected paraneoplastic syndrome.

Monitoring the efficacy of iodine-131-MIBG therapy using fluorine-18-FDG-PET.

BACKGROUND: The purpose of this study was to assess the potential of fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) for monitoring the efficacy of iodine-131 metaiodobenzylguanidine (131I-MIBG) therapy in neuroendocrine tumours. METHODS: A total of seven 131I-MIBG therapies with 3.7 to 10.2 GBq were carried out in three patients suffering respectively from a phaeochromocytoma, a paraganglioma and a metastatic neuroendocrine tumour of an unknown primary. The post-therapeutic whole-body scintigrams were compared with the results of six 18F-FDG-PET studies performed at the time of the therapies. One patient received three PET scans prior to each one of the MIBG therapies, and one patient was studied twice. RESULTS: 18F-FDG uptake in tumour sites seemed to correlate well with tumour differentiation, showing no uptake in one patient with a highly differentiated neuroendocrine tumour, and moderate-to-intense uptake in the two other patients with metastatic disease. Those tumour sites that had a simultaneous positive uptake in both the MIBG scintigram and the PET scan showed response to therapy as a continuous reduction in MIBG uptake over time. They also showed a qualitative decrease in FDG accumulation during the follow-up. This was associated with a decrease in the mean and maximum standard uptake values of more than 50 % in some metastases, while the X-ray computed tomography showed no decrease in tumour volume. Two patients revealed additional metastases that were unknown on the basis of prior diagnostic or therapeutic PET scans and radiological follow-up. CONCLUSIONS: It may be concluded from these cases that 18F-FDG-PET is a valuable tool for an initial metabolic staging of neuroendocrine tumours prior to 131I-MIBG therapy, as it can reveal tumour sites beyond the reach of radioisotope therapy. It may also be of importance in assessing therapeutic potential in those tumour sites that do show positive MIBG uptake.

[Positron-emission tomography in oncology]. / Pozitronno-émissionnaia tomografiia v onkologii.

This review analyses clinical results, new trends and recommendations of the leading medical centers concerning application of positron-emission tomography (PET) with F-18 fluorodeoxyglucose (F18 FDG) in cancer patients. This method of radionuclide visualization has been widely introduced for the last decade in diagnosis of cancer of unknown primary location, or CUP-syndrome, bronchogenic cancer of the lungs, cancer of the head and neck, malignant lymphoma and melanoma, colorectal and neuroendocrine cancer. Efficacy of this procedure, physiological grounds, performance are considered. Potentialities of F18 FDG PET are demonstrated in tumor screening, detection of metastases, recurrences after surgical, radiation or drug antitumor treatment or monitoring. In combination with CT, MRT, USI and other techniques, F18 FDG PET raises accuracy of the diagnosis of pathological changes at any stage of cancer with resulting improvement in further therapeutic and follow-up efficacy.

Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study.

The aim of this study was to evaluate the clinical use of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in medullary thyroid cancer (MTC) on the basis of comparison with findings obtained using indium-111 pentetreotide (SMS), pentavalent technetium-99m dimercaptosuccinic acid (DMSA), technetium-99m sestamibi (MIBI), computed tomography (CT) and magnetic resonance imaging (MRI). One hundred FDG-PET examinations in 85 patients (40 males, 45 females) with elevated tumour marker levels and/or pathological findings on other imaging methods were evaluated retrospectively. Eighty-two patients were examined after total thyroidectomy, and the remaining three patients prior to surgery. Overall, 181 lesions could be identified with at least one of the imaging techniques. Fifty-five lesions were confirmed histologically. FDG-PET detected 123 of 181 sites, which is a lesion detection probability of 68%. In the 55 cases with histological confirmation, we found 32 true positive, 3 false positive, 11 true negative and 9 false negative lesions using FDG-PET, resulting in a sensitivity of 78% and a specificity of 79%. Sensitivity and specificity were, respectively, 25% and 92% for SMS, 33% and 78% for DMSA, 25% and 100% for MIBI, 50% and 20% for CT and 82% and 67% for MRI. Compared with morphological techniques and functional imaging methods with single-photon emitters, FDG-PET showed the highest lesion detection probability for MTC tissue, with a high sensitivity and specificity. It is concluded that FDG-PET is a useful method in the staging and follow-up of MTC.

Thrombocyte HLA molecules retain nonrenewable endogenous peptides of megakaryocyte lineage and do not stimulate direct allocytotoxicity in vitro.

The origin and the function of HLA class I molecules present on the surface of human platelets are still unclear. In particular, it is controversial which fraction of these class I molecules represents integral membrane components derived from the megakaryocyte-platelet lineage versus soluble plasma HLA molecules acquired by adsorption. Results of the present study show that HLA-A2 ligands isolated from platelets possess the same peptide motif as described for HLA-A2-associated peptides obtained from nucleated cells. Sequencing of these platelet-derived peptides reveals that they originate mainly from ubiquitously expressed proteins also present in the megakaryocyte-platelet lineage. Moreover, one of these peptides derives from the GPIX protein, which is specifically expressed by platelets and their precursors. Platelet HLA molecules are unstable in vitro at 37 degrees C, but can be partially stabilized by addition of exogenous beta(2)-microglobulin and HLA class I binding peptide, suggesting that platelets cannot load HLA molecules with endogenous peptides. In in vitro experiments platelets were used to stimulate peripheral blood mononuclear cells. No allospecific cytotoxicity was observed after primary stimulation, or secondary restimulation, with allogenic resting or activated platelets, even in the presence of additional third-party helper activity. These data indicate that HLA class I molecules from platelets cannot directly induce allogenic CD8(+) cytotoxic T-cell response in vitro.

Nonclassical HLA-G molecules are classical peptide presenters.

BACKGROUND: The physiological functions of the classical HLA (human leukocyte antigen) molecules, HLA-A, HLA-B and HLA-C, are to present peptides to T cells and to inhibit the activity of natural killer cells. In contrast, the functions of nonclassical HLA-molecules, such as HLA-E, HLA-F and HLA-G, remain to be established. The expression of HLA-G is largely limited to the placental trophoblast, where it might mediate protection of the fetus from rejection by the mother. Achieving the aim of understanding the function of HLA-G should be facilitated by information on the biochemical properties of HLA-G molecules, especially on their potential ability to act as peptide receptors. RESULTS: To study peptide presentation by HLA-G, we used stably transfected LCL721.221 cells as a source of HLA-G molecules and analysed the spectrum of extracted peptides by individual and pool sequencing. Our results indicate that HLA-G molecules, like classical HLA molecules, are associated with a wide array of peptides derived from cellular proteins. Peptides presented by HLA-G usually consisted of 9 amino acids, and adhered to a specific sequence motif, with anchor residues at position 2 (isoleucine or leucine), position 3 (proline) and the carboxy-terminal position 9 (leucine). Thus, the HLA-G peptide ligand motif follows the principles of classical HLA motifs, although it displays its own unique features. Peptide-binding assays indicated that two of the three anchor residues were sufficient for binding, and that the three natural HLA-G ligands that we identified bound, not only to HLA-G, but also to HLA-A2. This was not surprising, because the binding pockets of HLA-A2 and HLA-G overlap in their ability to recognize anchor residues at positions 2 and 9. Likewise, some, but not all, HLA-A2 peptide ligands could also bind to HLA-G. CONCLUSIONS: Nonclassical HLA-G molecules present peptides essentially in the same way as classical HLA molecules do. We determined the peptide motif that is specifically recognized by HLA-G; its basic features are described by the sequence XI/LPXXXXXL: This information should help to elucidate the physiological role of HLA-G molecules at the fetal-maternal interface. Most likely, this role is to protect fetal cells from lysis by natural killer cells, and possibly to present foreign peptides to a class of T cells that has not yet been identified.

Methylchloroisothiazolone-induced growth inhibition and lethality in Escherichia coli.

Exposure of log phase Escherichia coli cells to inhibitory levels of 5-chloro-2-methyl-isothiazolin-3-one (MCI) results in rapid bacteriostasis and a delayed onset of bactericidal activity. Inhibition of respiration occurs within the same time frame as bacteriostasis, and is followed by a decline in intracellular ATP levels. In vitro and in vivo experiments suggest that growth inhibition is the result of selective inhibition of particular targets, with succinate dehydrogenase being identified as a possible target. Such selectivity was not anticipated from this highly reactive molecule. MCI-induced lethality is positively correlated with a loss of reduced protein sulphydryls (r2 = 0.79). A greater than equimolar loss of reduced protein sulphydryls, compared with the number of MCI molecules added, and a reduction in killing by MCI after induction of the OxyR regulon suggest that free radical generation may have a role in the antibacterial activity of MCI. We present an examination of the in vivo effects of MCI exposure on bacterial cells, and evidence that the isothiazolones exhibit selectivity in their cellular targets and antimicrobial effects.

Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group.

BACKGROUND: A prospective study of patients undergoing coronary artery bypass graft surgery (CABG) was conducted to examine differences in hospital mortality by sex. Outcome data on 3055 CABG patients undergoing operation between 1987 and 1989 were examined for differences in patient, disease, and treatment factors. METHODS AND RESULTS: Odds ratios (OR), risk differences, and 95% confidence intervals (CI95%) were calculated. Mortality rates for women (7.1%) and men (3.3%) differed, the OR (women versus men) being 2.23 (CI95%, 1.58 to 3.15). Women were older, more often diabetic, and had more urgent or emergent surgery; adjustment yielded an OR (women versus men) of 1.75 (CI95%, 1.17 to 2.63). Body surface area (BSA) was associated with risk of death in both sexes (P = .007) and positively associated with coronary artery luminal diameters. After adjustment for BSA, sex was no longer significantly associated with mortality (OR [women versus men] of 1.18; CI95%, 0.72 to 1.95). Internal mammary artery (IMA) grafting was performed less frequently among women than men (64.8% versus 78.4%, P < .001). Smaller BSA and absence of IMA grafting were each associated with increased risk of death (RD) from heart failure. Risk of death from heart failure (RD [women minus men] = 2.05; CI95%, 0.89 to 3.22) and hemorrhage (RD [women minus men] = 0.63; CI95%, 0.13 to 1.13) was greater among women; these accounted for 71.1% of the sex-specific difference in mortality rates. CONCLUSIONS: Excess risk of hospital mortality among women having CABG was largely the consequence of death from heart failure and, to a lesser extent, from hemorrhage. Smaller BSA (probably because of its association with coronary artery luminal diameter) and the absence of IMA grafting were each associated with increased risk of death from heart failure.

[The cervical vertebral column of horses--a clinico-radiological study]. / Untersuchungen an der Halswirbel-säule des Pferdes--eine klinisch-radiologische Studie.

For various anamnestic reasons the cervical vertebral column of 78 horses was examined radiologically. Statistical comparisons showed that male "warmbloods" were more frequently affected than was expected. Our horses were older than comparable animals in the international literature. Independently of their history the radiologic diagnosis of "cervical spondylarthrosis" was established in 56 horses. Arthrosis and other conditions were clinically manifested by spinal ataxia (44 horses) or mechanical impairment of the neck's mobility (21 horses). 10 of the arthrotic patients had synovial cysts causing compression of the spinal cord. 79 percent of all dorsal intervertebral arthrotic joints were found in the caudal column (C6/7 to C7/Th1). With 38 percent, C6/7 was the most frequently affected joint. Clinical and radiological findings could be compared with patho-anatomic results in 29 horses. The correlation was satisfactory.