Assessment of the effect of methionine supplementation and inclusion of hydrolyzed wheat protein in milk protein-based milk replacers on the performance of intensively fed Holstein calves.

The objectives of this study were to compare 2 milk replacers containing only milk proteins with or without supplemental Met, and to compare a milk replacer containing hydrolyzed wheat protein at 4.5% of dry matter (DM) and supplemental Lys and Met against the 2 all-milk-protein formulas, by assessing their effect on the growth performance, efficiency, and plasma urea nitrogen of pre-weaning Holstein calves. Thus, 57 Holstein calves were allotted to the following 3 treatments: (1) a skim milk plus whey protein concentrate-based milk replacer (SMWP) containing about 2.6% Lys and 0.6% Met on a DM basis; (2) SMWP + M based on skim milk and whey proteins, containing about 2.6% Lys, and supplemental Met to reach 0.9% on a DM basis; and (3) a skim milk plus whey protein concentrate plus 4.5% of the DM as hydrolyzed wheat protein based milk replacer (HWP + LM) where the wheat protein replaced 50% of the whey protein concentrate, and also contained supplemental Lys and Met to match the profile of SMWP + M (i.e., Lys 2.6 and Met 0.9% on DM basis). No difference in any of the responses was observed by supplementing the milk protein based formula with Met or when hydrolyzed wheat protein was added to the formula. Results indicate that (1) a milk replacer based on skim milk protein and whey protein with a Lys concentration of ~2.6% does not benefit from Met supplementation, and (2) milk replacer containing 4.5% of the DM as hydrolyzed wheat protein and supplemented with Lys and Met can support the same growth performance as milk protein-based formulas.

Application of the Dental Hygiene Human Needs Conceptual Model and the Oral Health-Related Quality of Life Model to the dental hygiene curriculum in Japan.

This paper reports the incorporation of the Dental Hygiene Human Needs Conceptual Model (DHHN) and the Oral Health-Related Quality of Life Model (OHRQL) into a dental hygiene curriculum in Japan. A simulated patient practice was offered to 67 dental hygiene students. In the practice activity, all students were introduced to the use of an OHRQL assessment tool. A DHHN assessment tool was utilized additionally only by the experimental student group. The statistical analysis of the post-practice survey showed that the OHRQL instrument was more helpful in assessment and problem identification than the DHHN instrument. By contrast, text-based analysis of dental hygiene diagnostic statements showed that the experimental group identified more domains of patients' human needs deficits than the control group. This suggested the possibility that the DHHN model helped them to see patients from broader perspectives. However, it was difficult for students to design care plans attending to the domains of the models. Also, in considerations to the cultural issues, the validity and equivalence of the Japanese versions of both models should be further investigated. Within the limitation of the present study, the results suggested that incorporation of the combination of the DHHN and OHRQL models can be useful in a dental hygiene curriculum, as each tool helps students expand the perspective from which they view client. Further improvements in learning strategies should facilitate the effective utilization of these models.

Lower costs associated with hematopoietic cell transplantation using reduced intensity vs high-dose regimens for hematological malignancy.

We compared inpatient and outpatient costs alongside clinical outcomes associated with hematopoietic cell transplantation between 2000 and 2003 with high-dose regimens (HDCT, n=185) and with reduced intensity regimens (RICT, n=90) from human leukocyte antigen (HLA)-matched donors for patients with hematological malignancies. With a comparable median follow-up of 3 years, long-term clinical outcomes, including cumulative incidence of chronic graft-vs-host disease, disease-free survival and overall survival, were similar between the two groups. In the univariate analysis, median costs for the first 100 days ($104,380 vs $42,149) and 1 year ($128,253 vs $80,499) in the HDCT group were higher than those in the RICT group. Median days of hospitalization are also higher for HDCT recipients (39 vs 21), although the number of outpatient clinic visits for HDCT recipients were fewer compared to that for RICT recipients (16 vs 25) during the first year. Adjusting for patient characteristics, RICT recipients had approximately 16 fewer days of hospitalization and cost $53,030 less than HDCT recipients within the first year after transplantation. Our data suggest that substantially lower costs and fewer days of hospitalization within the first year after RICT procedures can be obtained with no compromise of long-term clinical outcomes compared to HDCT procedures.

Radiologic assessment of metastases to the thyroid gland.

PURPOSE: We reviewed the radiologic and clinical data in patients with metastatic disease to the thyroid gland and assessed the role of radiologic techniques in this disorder. METHOD: The findings on US (n = 11), CT (n = 7), MRI (n = 6), palpation or US-guided fine needle aspiration (FNA) biopsy, and clinical records were reviewed in 11 cases of pathologically verified metastatic tumors of the thyroid gland. RESULTS: Five patients had palpable thyroid nodules and six had nonpalpable nodules discovered incidentally with imaging procedures. Three patients had no known malignancies at the time of diagnosis of thyroid tumors. Correct diagnosis was obtained in 10 of the 11 cases with FNA biopsy. Thyroid metastases were detected in all of the cases with US and MRI and six of the seven cases with CT. Thyroid metastases were solitary (n = 5) or multiple (n = 6), and about half of them measured <2 cm in diameter. These tumors typically had well defined margins and no calcification and sometimes had cystic portions. Multiple nodules within the same patient were radiologically quite similar to each other. On US, metastases appeared as hypoechoic or markedly hypoechoic areas without halo, on CT as low density areas, and on MRI as areas of varying signal intensities. Half of the metastases showed hypointensity on either T2-weighted images or gadolinium-enhanced T1-weighted images. The tumors involved lymph nodes in 10 cases and other remote organs in 5. Level I or II or parotid nodes were involved in six cases. CONCLUSION: These radiologic features may alert clinicians to a possibility of metastatic thyroid cancer. US combined with US-guided FNA biopsy is suitable for early diagnosis of metastases to the thyroid gland.

[Clinical problems of alcoholics with a history of methamphetamine abuse].

The authors studied the clinical problems of alcoholics with a history of methamphetamine abuse as compared with alcoholics with no history. The samples were in- and out-patients of Kanagawa Prefectural Center of Psychiatry, Serigaya Hospital, from January to December 1992. This study covered 26 alcoholics who had abused methamphetamine from 1 to 40 years before, with an average age at admission was 43.5 years. This compared with a 50.4 year average for 89 alcoholics who had no history of methamphetamine abuse. Hepatitis C antibodies (HCVAb) were significantly more commonly observed in ex-methamphetamine abusers than in non-abusers (73.1% vs. 18.0%). Hepatitis B antigens (HBsAg) were no more common among abusers than non-abusers (0% vs. 2.2%). Blood transfusion history tended to be greater in ex-methamphetamine abusers than non-abusers (38.5% vs. 29.2%) but the difference did not reach conventional levels of statistical significance. Ex-abusers often wore tattoos (23.1%) whereas none of the non-abusers did, a significant difference. Significantly more ex-methamphetamine abusers were diagnosed as suffering from alcoholic hallucinosis than non-abusers (42.3% vs. 7.9%). As more ex-methamphetamine abusers than non-abusers were living alone (61.5% vs. 31.5%), were on welfare (61.5% vs. 23.8%), and living in skid-row areas (15.4% vs. 5.6%), the authors concluded that their living conditions were unstable.

[A study of factors in medical insurance records associated with participation in health examinations].

Factors in medical insurance records of two groups classified as participants and nonparticipants in a multiphasic health examination (MHE) conducted in a rural town in Kyoto prefecture were compared. The purpose of this study was to clarify how the conditions of medical care influenced the participation in the MHE. The factors were days of consultation, total insurance points and days of consultation classified by specific disease and the area of the medical facility. Participants were examined at least once in 1987-1988 and nonparticipants were never examined in the corresponding period. The data were obtained from the medical insurance records of outpatients for the period from April 1986 thru March 1987. The medical care bills of 170 males and 201 females aged 30-69 were randomly sampled from National Health Insurance records (unit = family), and those of 55 males and 88 females aged 70 and over were from the Medical Service for the Aged (unit = person). These samples were about one forth of target population respectively. Both older participants and older nonparticipants of both sexes had more consultation days and more total insurance points than the corresponding younger subjects. Nonparticipants of both sexes aged 70 and over had more consultation days and more total insurance points than participants; female nonparticipants aged 50-69 had slightly more consultation days and those aged 30-49 also had more insurance points. Nonparticipants tended to have previous medical care for hypertension or ischemic heart disease, which the MHE is responsible for discovering.(ABSTRACT TRUNCATED AT 250 WORDS)

Modified Blalock-Taussig shunt operation without cardiac catheterization: two-dimensional echocardiographic preoperative assessment in cyanotic infants.

Between May 1981 and December 1983, 25 infants with cyanotic congenital heart defects underwent 26 Blalock-Taussig shunt operations without cardiac catheterization and angiocardiography. In these infants, the diagnosis was established by 2-dimensional echocardiography (2-D echo) supplemented with clinical findings, chest x-ray and electrocardiography. The right and left pulmonary artery measurements, a prerequisite for a shunt operation, determined by 2-D echo were compared with those at surgery and had an excellent correlation (r = 0.94). No infant died as a consequence of an early shunt failure, and only 1 died of postoperative pyothorax. In conclusion, 2-D echo may eliminate the need for invasive investigation in selected patients undergoing the Blalock-Taussig anastomosis.