The mobility of the brachycephalic canine nostril in relation to the degree of nostril stenosis.

Previous studies have shown that the most reliable external conformational risk factor of whether a brachycephalic dog will develop Brachycephalic Obstructive Airway Syndrome (BOAS) is the status of nostril stenosis, assessed as a static observation using the brachycephalic nostril grading scheme. The nostrils however are a dynamic structure, opening further when the dog is exercising, sniffing or panting. The hypothesis of this study was that brachycephalic dogs with open or mildly stenotic nostrils are more likely to have nostril mobility whilst dogs with moderately or severely stenotic nostrils are more likely to have immobile nostrils. A retrospective study of dogs presented for BOAS assessment at two UK referral centres between 2012 and 2020 was performed. Data extracted included nares stenosis status and nares mobility. A mesocephalic pilot control group was recruited from a third referral centre. Statistical analysis was performed with χ2, Cochran-Armitage, spearman's rho and linear-by-linear tests as appropriate. Of the 974 brachycephalic dogs included in the study: 124 had open nostrils (68.5% mobile); 212 mildly stenotic nostrils (58.5% mobile); 379 moderately stenotic nostrils (35% mobile) and 259 severely stenotic nostrils (19.3% mobile). The nostril stenotic status was significantly associated with nostril wing mobility (χ2 =135.55; P<0.0001). When considering open and mildly stenotic (considered acceptable) nostrils versus moderate and severely stenotic nostrils, mobility was 62% versus 25.5% (χ2= 135.88; P = <0.0001). All 27 mesocephalic dogs had nostril mobility. Brachycephalic dogs with moderate and severely stenotic nares have reduced nasal mobility compared to brachycephalic dogs with mildly stenotic and open nares. Data is further evidence that dogs with moderately and severely stenotic nares should not be bred.

Systematic review and meta-analysis of wound dressings in the prevention of surgical-site infections in surgical wounds healing by primary intention.

BACKGROUND: Postoperative surgical-site infections are a major source of morbidity and cost. This study aimed to identify and present all randomized controlled trial evidence evaluating the effects of dressings on surgical-site infection rates in surgical wounds healing by primary intention; the secondary outcomes included comparisons of pain, scar and acceptability between dressings. METHODS: Randomized controlled trials comparing alternative wound dressings, or wound dressings with leaving wounds exposed for postoperative management of surgical wounds were included in the review regardless of their language. Databases searched included the Cochrane Wounds Group Specialised Register and Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and EBSCO CINAHL from inception to May 2011. Two authors performed study selection, risk of bias assessment and data extraction, including an assessment of surgical contamination according to the surgical procedure. Where levels of clinical and statistical heterogeneity permitted, data were pooled for meta-analysis. RESULTS: Sixteen controlled trials with 2594 participants examining a range of wound contamination levels were included. They were all unclear or at high risk of bias. There was no evidence that any dressing significantly reduced surgical-site infection rates compared with any other dressing or leaving the wound exposed. Furthermore, no significant differences in pain, scarring or acceptability were seen between the dressings. CONCLUSION: No difference in surgical-site infection rates was demonstrated between surgical wounds covered with different dressings and those left uncovered. No difference was seen in pain, scar or acceptability between dressings.

Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture: a systematic review.

To review whether osteoporosis in the absence of vertebral fracture (VFX) affects health-related quality of life (HRQoL), a systematic search of the main literature databases for HRQoL in patients with osteoporosis without VFX was undertaken. This was undertaken. This identified 1,327 articles as potentially relevant to the review. After screening of abstracts and reviewing 168 articles in detail, 27 were considered relevant. HRQoL data were extracted and collated into tables and, where possible, were converted into normative scores and further analysed. Data relating to the associations between HRQoL and bone mineral density (BMD) were also collated. Of the 27 articles included, only 5 directly compared osteoporosis without VFX with a control group (BMD T-score > -1.0, without VFX). Extracted raw data from 21 articles demonstrated that patients with osteoporosis without VFX had clinically relevant reductions in role physical, general health, vitality, mental health domains and the mental component summary score, using SF36. Using Qualeffo-41, pain and physical function were worse in these patients. Also, HRQoL was related to upper femur, but not lumbar spine BMD. HRQoL data in patients with osteoporosis without VFX are limited and variable but suggest that HRQoL is adversely affected by osteoporosis in the absence of VFX. The association of lower BMD and worse HRQoL suggests that more attention should be paid to HRQoL in those without VFX. Future studies are needed to investigate HRQoL in patients with osteoporosis in the absence of fracture, controlling for co-morbidities and social and economic status.

Epigenetic reprogramming of nonreplicating somatic cells for long-term proliferation by temporary cell-cell contact.

Embryonic stem (ES) cells are potential sources of tissue regeneration; however, transplanted ES cells produce tumors in the host tissues. In addition, transplantation between genetically unrelated individuals often results in graft rejection. Although the development of patient specific stem cell lines by somatic cell nuclear transfer (SCNT) represents a means of overcoming the problem of rejection, its human application has ethical dilemmas. Adult stem (AS) cells can also differentiate into specialized cells and may provide an alternative source of cells for human applications. In common with other somatic cells, AS cells have limited capacity for proliferation and cannot be produced in large quantities without genetic manipulation. We demonstrate here that nonreplicating mammalian cells can be reprogrammed for long-term proliferation by temporary cell-cell contact through coculture of AS cells with the GM05267-derived F7 mouse cell line. Subsequent elimination of F7 cells from the co-culture allows proliferation of previously nonreplicating cells, colonies of which can be isolated to produce cell lines. We also demonstrate that the epigenetically reprogrammed AS cells, without the physical transfer of either nuclear or cytoplasmic material from other cells, are capable of long-term proliferation and able to relay signals to other nonreplicating cells to reinitiate proliferation with no addition of recombinant factors. The reported cell amplification procedure is methodologically simple and can be easily reproduced. This procedure allows the production of an unlimited number of cells from a limited number of AS cells, making them an ideal source of cells for applications involving autologous cell transplantation.

A bio-assay for effectors of osteoclast differentiation in serum from patients with bone disease.

UNLABELLED: Osteoclast differentiation and activity, and hence bone loss, depend on two opposing cytokines. Receptor activator of NF-(kappa)B ligand (RANKL) produced by osteoblasts and T-cells stimulates, while osteoprotegerin inhibits. Both of these cytokines are found in serum. Our aim was to develop a functional assay for any factors present in human serum that can affect osteoclast differentiation and to assess whether any such factors vary in diseases in which bone loss occurs. METHODS: Using a culture model of osteoclast differentiation in the presence of macrophage colony stimulating factor and soluble RANKL, we have measured the effects of different human sera on osteoclast differentiation. The production of a marker enzyme for the osteoclast, tartrate-resistant acid phosphatase (TRAP), was used to follow osteoclast differentiation. RESULTS: In general, human serum stimulates osteoclast differentiation as indicated by TRAP activity, but in patients with low bone density this stimulation was attenuated. Sera from 40 female subjects with low bone mineral density showed significantly lower TRAP cell differentiation activity than sera from the healthy female controls. CONCLUSION: We describe a functional bio-assay for factors in human serum which can affect osteoclast differentiation. This assay may have application in monitoring the effects of therapy in bone disease.

Isoforms of bone alkaline phosphatase: characterization and origin in human trabecular and cortical bone.

Alkaline phosphatase (ALP) is a glycoprotein and functions as an ectoenzyme attached to the cell membrane by a hydrophobic glycosyl-phosphatidylinositol (GPI) anchor. Three bone ALP (BALP) isoforms in human serum were separated and quantitated by high-performance liquid chromatography. B/I, a minor fraction, is composed on average of bone (70%) and intestinal (30%) ALP, and two major isoforms, B1 and B2. Treatment with GPI-specific phospholipase C (GPI-PLC) did not influence the activities or retention times for B1 and B2, indicating that the biochemical differences between B1 and B2 are likely to be due to different glycosylation patterns. The B/I fraction in serum, on average 4% of total ALP, was found to be composed of B1 and B2 isoforms, each with an intact hydrophobic GPI cell membrane anchor. We investigated the origin of these three BALP isoforms and osteocalcin in human femora from five healthy individuals (four males), mean age 51 years, obtained from a tissue bank. Bone was sampled from three sites: cortical bone, trabecular bone from the diaphysis, and trabecular bone from the greater trochanter. Trabecular bone, from both sites, had higher BALP activities compared with cortical bone. Conversely, the osteocalcin content of cortical bone was more than 3-fold greater than that of trabecular bone. Cortical bone had approximately 2-fold higher activity of B1 compared with B2, whereas trabecular bone had approximately 2-fold higher activity of B2 compared with B1. We observed a previously undescribed BALP isoform (B1x) in all bone samples. B1x was also observed in sera from some patients (60%) with severe renal insufficiency and on chronic dialysis therapy (n = 20). The isoforms of BALP may provide information relating to bone metabolism within specific bone compartments.

An epidemiological survey of methicillin-resistant Staphylococcus aureus in a tertiary referral hospital.

Over a 30-month period from July 1995 to December 1997, new detections of methicillin-resistant Staphylococcus aureus (MRSA) were prospectively studied in a tertiary referral hospital. The aims of the study were to determine the incidence of colonization of patients admitted to each of the hospital's 39 clinical units and ascertain where each patient had become colonized. Epidemiological information (time to detection, ward movement, admission to other hospitals, data on MRSA isolations in hospital wards) and phage typing were used by the hospital's infection control unit to make this determination. Routine containment procedures included cohorting, flagging and triclosan body washes. Surveillance cultures were collected infrequently. Patients known to be colonized with MRSA were excluded from orthopaedic and haematology wards. During the study period, 995 patients were found to be newly colonized. The incidence of colonization varied from nil to 72 per 1000 admissions, being highest in the main intensive care unit and in services which frequently used that unit. The incidence of colonization in elective orthopaedic surgery (< 1 per 1000) and haematology (3 per 1000) was very low. Determining the place where patients acquired MRSA was made difficult by the high frequency of endemic phage types and frequent patient transfer between wards. Epidemiological data suggested that the main intensive care unit and surgical wards nursing patients with colorectal, urological and vascular diseases were the places where most patients became colonized. MRSA was never acquired by patients nursed in wards which practised an exclusion policy towards patients known to be colonized with MRSA. Our data suggest that in tertiary referral hospitals, where MRSA is not only endemic but frequently imported from other hospitals, it is possible to establish areas where MRSA is never acquired.

Serum osteocalcin and other indices of bone formation: an 8-decade population study in healthy men and women.

In a study of 435 healthy men and women aged 17-97 yr, serum osteocalcin and alkaline phosphatase were measured together with 99TcMDP retention in women. In women, serum osteocalcin falls to a nadir at 35-39 yr, and the mean then rapidly rises 2-fold to a plateau from 50-75 yr. 99TcMDP retention falls to a minimum at 40-45 yr and then rises steadily with increasing age. Serum alkaline phosphatase rises in an indeterminate fashion from 20-25 yr onwards. Osteocalcin in men fell until age 60-70 yr and hardly changed thereafter, whereas serum alkaline phosphatase reached a minimum at age 30-40 yr and thereafter rose with age, as in women.

Differential response of serum alkaline phosphatase and serum osteocalcin in Paget's osteosarcoma.

Serum osteocalcin did not show any response to the onset of osteosarcoma in Paget's disease of bone whereas serum alkaline phosphatase increased rapidly. This suggests that osteocalcin is not useful in the diagnosis and management of Paget's osteosarcoma and does not reflect the same osteoblastic processes in bone as serum alkaline phosphatase.

Muscle mass deficits are associated with bone mineral density in men with idiopathic vertebral fracture.

INTRODUCTION AND HYPOTHESIS: The causes of idiopathic vertebral fractures (IVF) in men are poorly understood. We hypothesised that in IVF, areal bone mineral density (aBMD) deficits would be associated with reduced muscle mass. METHODS: In this case-control study, 48 men (61.5 +/- 12.1 years old) presenting with symptomatic IVF were compared with 48 healthy controls matched for age (+/-5 years) and stature (+/-5 cm). The aBMD and soft-tissue body composition were determined by dual energy X-ray absorptiometry (DXA). Muscle mass was defined as the ratio of appendicular lean mass to the square of height (ALMI). Sex hormones, IGF-I and its binding protein IGFBP-3 were measured by immunoassay. RESULTS: ALMI was significantly lower in IVF patients (8.27 +/- 0.90 vs 8.65 +/- 0.88 kg/m(2), t = 2.193, df = 47, P = 0.033 by paired sample t-test). Hierarchical regression analysis revealed that for IVF patients, ALMI explained the greatest proportion of variance in BMD at the lumbar spine, femoral neck and total hip (R (2) (change) = 16.4-22.7%, P = 0.012-0.002) and only IGFBP-3 explained variance in ALMI (R (2) (change) = 19.9%, P = 0.006). CONCLUSIONS: In men with IVF, ALMI was reduced and associated with IGFBP-3. ALMI was identified as a novel factor that explained a greater proportion of variance in BMD than either fat mass or serum biochemistry.

Evaluation of a commercially available semi-automated bioluminescence system for bacteriuria screening.

A commercially available semi-automated bioluminescence adenosine triphosphate assay system for rapid detection of significant bacteriuria was evaluated. Excellent reproducibility of results using the bioluminescence apparatus was noted, and there was no bacterial carry-over using a pre-diluter. The results obtained with 2,000 urine specimens tested by bioluminescence and a routine cultural technique were compared. The bioluminescence system gave no false negative results and a bioluminescence positive/culture negative finding of 13.6% in general specimens and 45.0% in ante-natal and maternity specimens. In the latter group, the majority of urines yielded growth of lactobacilli and/or diphtheroids (less than 10(4) organisms/ml) when subcultured on enriched media. Results indicated that bioluminescence may identify urinary tract infections in patients receiving antimicrobial therapy. The advantages of this 45 minute technique for bacteriuria screening are presented.

Bacteria in flower vase water: incidence and significance in general ward practice.

Culture of flower vase water from wards in the David Lewis Northern Hospital, Liverpool, revealed large numbers of potentially pathogenic bacteria. The types of organisms isolated may reflect the particular ecology of this hospital as they differed in some ways from those reported from other centres. The incidence of wound infections during the period of study was low (5-2 per cent) despite the regular overgrowth of bacteria in flower vases, and there did not appear to be any definite correlation between the types of bacteria isolated from flower vase water and those responsible for wound infections. The addition of hydrogen peroxide to flower vases proved a very effective antiseptic and is recommended for general use as a precautionary measure.

Plasma aluminium in a reference population: the effects of antacid consumption and its influence on biochemical indices of bone formation.

Aluminium is involved in the etiology of several complications of chronic renal failure and has been firmly established as having toxic effects on bone tissue. We have measured plasma aluminium together with serum osteocalcin, procollagen I C-terminal peptide and total alkaline phosphatase activity in healthy subjects and in a group of subjects who consumed aluminium-containing and non-aluminium containing antacid preparations, with normal renal function. Age-related healthy reference ranges for plasma aluminium are presented and the effects of chronic antacid consumption on plasma aluminium and biochemical markers of bone formation investigated. In 172 healthy subjects the mean plasma aluminium concentration was 4.4 +/- 2.9 micrograms L-1, men having a significantly greater circulating aluminium load than women (5.4 +/- 2.8 micrograms L-1 vs. 4.0 +/- 2.8 micrograms L-1 respectively (P = 0.0039)). Older men were found to have significantly higher plasma aluminium levels than younger men. Increased plasma aluminium was seen in subjects taking antacids although this was not associated with significant changes in most indices of bone formation.

Anomalous rise of serum osteocalcin following desferrioxamine treatment in aluminium intoxication.

A patient with impaired renal function, severe osteomalacia and aluminium intoxication is described. In response to Desferal (desferrioxamine) treatment, serum osteocalcin rose 8-fold whereas serum alkaline phosphatase and procollagen I peptide levels changed little. Chromatographic separation showed that the measured osteocalcin coeluted with intact osteocalcin. The osteocalcin in the serum probably comes from the liberation of pre-existing osteocalcin from the bone, concomitant with aluminium mobilisation, rather than by stimulation of de novo synthesis.