Water temperature and dietary histidine affect cataract formation in Atlantic salmon (Salmo salar L.) diploid and triploid yearling smolt.

The aim of the present study was to investigate cataract development in diploid (2N) and triploid (3N) Atlantic salmon smolts and post-smolts at two water temperatures (10 and 16 °C) given diets with different histidine supplementation (LH, 10.4 and HH, 13.1 g kg-1 ) before and after seawater transfer. In freshwater, a severe cataract outbreak was recorded in both ploidies reared at 16 °C. The cataract score was significantly higher in triploids compared to diploids, and the severity was lower in both ploidies fed the HH diet. The cataract development at 10 °C was minor. Low gill Na+ , K+ -ATPase activity in fish reared at 16 °C before seawater transfer was followed by osmoregulatory stress with elevated plasma electrolyte concentrations and high mortality in sea water. Both diploids and triploids reared at 10 °C developed cataracts during the seawater period, with higher severities in triploids than diploids and a reduced severity in the fish fed the HH diet. The findings of this study demonstrate the importance of environmental conditions in the husbandry of Atlantic salmon, and particularly triploids, with regard to smoltification and adjusted diets to mitigate cataract development in fresh and sea water.

Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial.

We carried out a prospective randomized trial in 38 patients to compare intravenous regional anaesthesia with local anaesthesia in endoscopic carpal tunnel release using the Agee single-portal technique. There was no significant difference in reported pain during surgery. Immediately after surgery, patients in the local anaesthesia group reported significantly less pain in the hand and at the tourniquet. Two hours after surgery, patients in the local anaesthesia group reported significantly less hand pain. Moreover, significantly fewer patients in the local anaesthetic group required additional analgesics during the first 2 hours after operation. We conclude that local anaesthesia reduces post-operative pain in endoscopic carpal tunnel release compared with intravenous regional anaesthesia.

Reassessment of the putative role of BLK-p.A71T loss-of-function mutation in MODY and type 2 diabetes.

AIMS/HYPOTHESIS: MODY is believed to be caused by at least 13 different genes. Five rare mutations at the BLK locus, including only one non-synonymous p.A71T variant, were reported to segregate with diabetes in three MODY families. The p.A71T mutation was shown to abolish the enhancing effect of BLK on insulin content and secretion from pancreatic beta cell lines. Here, we reassessed the contribution of BLK to MODY and tested the effect of BLK-p.A71T on type 2 diabetes risk and variations in related traits. METHODS: BLK was sequenced in 64 unelucidated MODY samples. The BLK-p.A71T variant was genotyped in a French type 2 diabetes case-control study including 4,901 cases and 4,280 controls, and in the DESIR (Data from an Epidemiological Study on the Insulin Resistance Syndrome) and SUVIMAX (Supplementation en Vitamines et Mineraux Antioxydants) population-based cohorts (n = 6,905). The variant effects were assessed by logistic and linear regression models. RESULTS: No rare non-synonymous BLK mutations were found in the MODY patients. The BLK p.A71T mutation was present in 52 normoglycaemic individuals, making it very unlikely that this loss-of-function mutation causes highly penetrant MODY. We found a nominal association between this variant and increased type 2 diabetes risk, with an enrichment of the mutation in the obese diabetic patients, although no significant association with BMI was identified. CONCLUSIONS/INTERPRETATION: No mutation in BLK was found in our MODY cohort. From our findings, the BLK-p.A71T mutation may weakly influence type 2 diabetes risk in the context of obesity; however, this will require further validation.

Patient specific biomodel of the whole aorta - the importance of calcified plaque removal.

BACKGROUND: The use of anatomical models produced by 3D printing technique (rapid prototyping, RP) is gaining increased acceptance as a complementary tool for planning complex surgical interventions. This paper describes a method for creating a patient specific replica of the whole aorta. METHODS: Computed tomography angiography (CTA) DICOM-data was converted to a three-dimensional computer aided design-model (CAD) of the inner wall of the aorta representing the lumen where the calcified plaque contribution was removed in a multi-step editing-manoeuvre. The edited CAD-model was used for creating a physical plaster model of the true lumen in a 3D-printer. Elastic and transparent silicon was applied onto the plaster model, which was then removed leaving a silicon replica of the aorta. RESULTS: The median (interquartile range) difference between diameters obtained from CTA- and RP plaster-model at 19 predefined locations was 0.5 mm (1 mm) which corresponds to a relative median difference of 4.6% (7.0%). The average wall thickness of the silicone model was 3.5 mm. The elasticity property and performance during intervention was good with an acceptable transparency. CONCLUSIONS: The integration of RP-techniques with CAD based reconstruction of 3D-medical imaging data provides the needed tools for making a truly patient specific replica of the whole aorta with high accuracy. Plaque removal postprocessing is necessary to obtain a true inner wall configuration.

Liver transplantation for hepatocellular carcinoma--is there a risk of recurrence caused by intraoperative blood salvage autotransfusion?

BACKGROUND/AIMS: The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC). METHODS: In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group). RESULTS: Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group. CONCLUSION: Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.

The effect of water temperature on vertebral deformities and vaccine-induced abdominal lesions in Atlantic salmon, Salmo salar L.

This study investigates the effects of water temperature (T) on vaccine-induced abdominal lesions (i.p. injection with oil-adjuvant vaccine) and vertebral deformities in Atlantic salmon. Quadruple groups of vaccinated (V) or unvaccinated (U) underyearling smolts were reared in tanks under four different temperature regimes for 6 weeks in fresh water (FW) followed by 6 weeks in sea water (SW). The four different T regimes were 10 °C FW-10 °C SW (10-10), 10 °C FW-16 °C SW (10-16), 16 °C FW-10 °C SW (16-10) and 16 °C FW-16 °C SW (16-16). After the temperature regimes were finished, the fish were group-tagged and transferred to a common sea cage for on-growth until harvest size. At termination, weight was significantly affected by both T and V, while lesion score and deformities were affected by T only. The weight difference between the largest and smallest U group was 20.3% (16-10 U: 2.4 kg, 10-16 U: 1.89 kg), while the largest difference between U and V fish within a T regime was 28.7% (16-16 U: 2.1 kg, 16-16 V: 1.5 kg). Fish from the 16-16, 16-10 and 10-16 regimes had a significant higher lesion score than those from the 10-10 regime. Fish from the 10-16 and 16-16 regimes displayed a significantly higher prevalence of vertebral deformities (palpation : 13-27%, radiology: 88-94%) than fish from the 10-10 and 16-10 regimes (palpation: 2-3%, radiology: 27-65%). Vertebra number 26 (located beneath the dorsal fin) was the most frequently affected vertebra in smolts, while vertebra number 43 (located above the anal fin) was most frequently affected in adults.

Evaluation of reproductive/developmental and repeated dose (subchronic) toxicity and cytogenetic effects in rats of a roofing asphalt fume condensate by nose-only inhalation.

A Type III Built-up Roofing Asphalt (BURA) fume condensate was evaluated for subchronic systemic toxicity and reproductive/developmental toxicity screening in Wistar rats, by OECD protocol 422 and OECD cytogenetic protocol 474. Animals were exposed by nose-only inhalation to target concentrations of 30, 100 and 300 mg/m³ total hydrocarbons (actual concentrations, 30.0, 100.1 and 297.3 mg/m³). The study was performed to assess potential hazards from asphalt fumes to which humans could be exposed during application. No adverse effects were seen for spermology, reproductive or developmental parameters or early postnatal development of offspring from day 1 to 4 postpartum. BURA fume condensate did not induce any significant increases in micronucleus frequency in polychromatic erythrocytes of rat bone marrow nor was neurobehavioral toxicity observed at any dose. Systemic effects were slight and seen at doses above those measured at work sites. The systemic NOAEC of 100 mg/m³ for males was based on decreased body weight gain, food consumption and increased absolute and relative lung wet weight correlated with slight histological changes in the lung, primarily adaptive in nature at 300 mg/m³. The female NOAEC of 30 mg/m³ was based on a statistically significant increase in relative wet lung weight at higher doses, correlated with slight histopathologic effects in the lungs at the highest dose. However, no increase in relative lung weight was seen in breeding females at 100 mg/m³.

National guidelines for treatment of jaundice in the newborn.

UNLABELLED: Jaundice is the most common reason for instituting treatment in otherwise healthy as well as sick newborn infants. Herein, we describe the process employed in Norway to forge agreement on a set of treatment guidelines that are now used across the country. The Norwegian Pediatric Association was a key resource in this process, which involved contacts with all paediatric departments in Norway. We have also performed an international survey regarding the use of such national guidelines, showing that the majority of those queried confirm having national guidelines. The evidence base for any neonatal jaundice guideline is weak; therefore, it is not surprising that the various guidelines differ both in format and in specifics. In the Norwegian guidelines, treatment indications are based on bilirubin concentrations and related to birth weight. Postnatal age is also factored in because jaundice develops gradually during the first 3-4 days before it levels off. CONCLUSION: Following the introduction of these guidelines, fewer babies in Norway receive phototherapy, and no cases of chronic kernicterus have been reported during this period.

Dietary fatty acids and inflammation in the vertebral column of Atlantic salmon, Salmo salar L., smolts: a possible link to spinal deformities.

Vegetable oils (Vo) are an alternative to fish oil (Fo) in aquaculture feeds. This study aimed to evaluate the effect of dietary soybean oil (Vo diet), rich in linoleic acid, and of dietary fish oil (Fo diet) on the development of spinal deformities under bacterial lipopolysaccharide (LPS)-induced chronic inflammation conditions in Atlantic salmon, Salmo salar L. Fish [25 g body weight (BW)] were fed the experimental diets for 99 days. On day 47 of feeding (40 g BW), fish were subjected to four experimental regimes: (i) intramuscular injections with LPS, (ii) sham-injected phosphate-buffered saline (PBS), (iii) intraperitoneally injected commercial oil adjuvant vaccine, or (iv) no treatment. The fish continued under a common feeding regime in sea water for 165 more days. Body weight was temporarily higher in the Vo group than in the Fo group prior to immunization and was also affected by the type of immunization. At the end of the trial, no differences were seen between the dietary groups. The overall prevalence of spinal deformities was approximately 14% at the end of the experiment. The Vo diet affected vertebral shape but did not induce spinal deformities. In groups injected with LPS and PBS, spinal deformities ranged between 21% and 38%, diet independent. Deformed vertebrae were located at or in proximity to the injection point. Assessment of inflammatory markers revealed high levels of plasma prostaglandin E2 (PGE2) in the Vo-fed and LPS-injected groups, suggesting an inflammatory response to LPS. Cyclooxigenase 2 (COX-2) mRNA expression in bone was higher in fish fed Fo compared to Vo-fed fish. Gene expression of immunoglobulin M (IgM) was up-regulated in bone of all LPS-injected groups irrespective of dietary oil. In conclusion, the study suggests that Vo is not a risk factor for the development of inflammation-related spinal deformities. At the same time, we found evidence that localized injection-related processes could trigger the development of vertebral body malformations.

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains.

OBJECTIVE: To determine whether the addition of low-cost reflecting curtains to a standard phototherapy unit could increase effectiveness of phototherapy for neonatal jaundice. DESIGN: Randomised controlled clinical trial. SETTING: Level-one nursery of the Hospital Universiti Sains Malaysia, Kelantan, Malayasia. PATIENTS: Term newborns with uncomplicated neonatal jaundice presenting in the first week of life. INTERVENTIONS: Phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n = 50) was compared with single phototherapy without curtains (control group, n = 47). MAIN OUTCOME MEASURES: The primary outcome was the mean difference in total serum bilirubin measured at baseline and after 4 h of phototherapy. The secondary outcome was the duration of phototherapy. RESULTS: The mean (standard deviation) decrease in total serum bilirubin levels after 4 h of phototherapy was significantly (p<0.001) higher in the study group (27.62 (25.24) micromol/l) than in the control group (4.04 (24.27) micromol/l). Cox proportional hazards regression analysis indicated that the median duration of phototherapy was significantly shorter in the study group (12 h) than in the control group (34 h; chi(2) change 45.2; p<0.001; hazards ratio 0.20; 95% confidence interval 0.12 to 0.32). No difference in adverse events was noted in terms of hyperthermia or hypothermia, weight loss, rash, loose stools or feeding intolerance. CONCLUSION: Hanging white curtains around phototherapy units significantly increases efficacy of phototherapy in the treatment of neonatal jaundice without evidence of increased adverse effects.

The clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults.

BACKGROUND: Previous studies have described cross-reactivity between fresh fruits, vegetables and pollen. However, no data demonstrates the clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults with and without symptoms in the pollen season. OBJECTIVE: The aim of this study was to estimate the clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults and to examine the diagnostic value of skin-prick test (SPT), histamine release and specific IgE compared with the outcome of oral challenge. METHODS: In total, 936 unselected adults (female : male 479 : 457, median age 33.7 years) were examined for pollen sensitization and clinical cross-reactivity with pollen-related fruits and vegetables by questionnaire, SPT, histamine release, specific IgE and oral challenge. RESULTS: The prevalence of pollen sensitization was 23.8% (n = 223). The probability of a clinical reaction to pollen-related foods in the respective pollen-sensitized groups was: 24% (birch), 4% (grass), 10% (mugwort), 35% (birch + grass), 8% (grass + mugwort) and 52% (birch + grass + mugwort). The odds ratio of a clinical reaction to pollen-related fruits and vegetables in symptomatic pollen-sensitized adults was as high as four times (birch + grass) the odds ratio of a clinical reaction in asymptomatic pollen-sensitized adults. CONCLUSION: This study not only demonstrates a high prevalence of clinical reactions to fruits and vegetables in pollen-sensitized adults, but also a discrepancy between the prevalence of sensitization to fruits and vegetables and the clinical relevance in different pollen-sensitized groups with symptoms in the pollen season as a significant factor.

A short introduction to the new principle of binding ration calcium with sodium zeolite.

This paper summarise the development of the new principle of preventing parturient hypocalcaemia by reducing the bioavailability of ration calcium with calcium binders, based on the idea that a negative calcium balance would stimulate natural defence mechanisms against threatening hypocalcaemia. Synthetic sodium zeolite was selected as a first choice among the many calcium binders available commercially, such as polyphosphates, citrate, EDTA and it derivatives. Testing was done on non-pregnant rumen fistulated cows in the first place, followed by cows in late lactation. Encouraged by the tendencies seen in these animals, the final proof of concept was done on pregnant dry cows fed a supplement of synthetic sodium zeolite A from 4 weeks before expected calving until calving. By analysis of blood calcium levels, this supplementation was shown to have a stabilizing effect during the critical period shortly after calving.

The effect of zeolite A supplementation in the dry period on blood mineral status around calving.

This article summarizes the results obtained in 6 separate studies concerned with the effect of zeolite A supplementation in the dry period on blood calcium, magnesium and phosphorus status around calving. The experiments were conducted on 5 different farms, and comprised a total of 117 cows. Two of the experiments (exp. 5 and 6) were conducted under extensive farming conditions whereas the rest (exp. 1-4) were conducted on intensively driven farms. All cows included in the experiments had completed at least 2 lactations. The cows were allocated as either untreated control cows or zeolite treated experimental cows according to expected date of calving and parity. The experimental cows were fed between 0.5 and 1.0 kg of zeolite A per day during the last 2 to 4 weeks of the dry period. Blood samples were drawn on the day of calving and day one and two after calving (all experiments), three weeks before the expected date of calving (exp. 1 and 2) and one week after calving (exp. 3 and 4). The zeolite supplementation significantly increased the mean serum Ca level on the day of calving. The efficiency of the zeolite supplementation to prevent hypocalcaemia (serum Ca < 2.00 mmol/l) on the day of calving was calculated. Efficiencies varied ranging from 3 to 100%, with a mean efficiency of 58%. The zeolite-calcium ratio (g of zeolite per cow per day/g of dietary calcium per cow per day) was calculated in each experiment. From the results it seemed, that zeolite-calcium ratios below 5 did not effectively prevent parturient hypocalcaemia, whereas ratios of 10 to 20 proved very efficient in preventing hypocalcaemia. There was apparently no additional effect from feeding zeolite for 4 instead of 2 weeks prepartum. Feeding zeolite in the dry period significantly decreased plasma phosphate before as well as after calving. The phosphate level was normalized within one week after calving. Plasma magnesium was significantly lower among the experimental cows on the day of calving, but stayed within the normal range of plasma magnesium. The control cows on the other hand experienced hypermagnesemia after calving.

Aspects of physiological effects of sodium zeolite A supplementation in dry, non-pregnant dairy cows fed grass silage.

The objective of the present study was to monitor serum and urine biochemical changes in dairy cows during and after oral administration of a synthetic sodium aluminium-silicate (zeolite A). A prospective longitudinal study involving four non-pregnant and non-lactating cows was chosen. Cows were randomly allocated to either a control or experimental group. The period of observation was three weeks. During the first week (period 1) cows were maintained on basic ration for the purpose of recording baseline values. During the second week (period 2) control cows were fed a basic diet (grass silage), while cows in the experimental group were fed the basic diet and supplemented with 1 kg zeolite pellets once daily. During the third week (period 3) both groups were fed the basic ration only and observed for any persistent effects after zeolite withdraw. Daily sampling included blood and urine. Selected physiological parameters were compared between groups during period 2 and 3, whereas mean values from period 1, 2 and 3 were compared within the groups. Zeolite supplementation revealed a significant influence on calcium homeostasis. A slight decrease in serum Ca and in renal excretion of calcium was observed in the experimental group at initiation of supplementation, whereas an increment in these parameters was recorded after withdrawal of zeolite supplementation. It is assumed, that zeolite caused a reduction in the availability of dietary calcium during supplementation, which possibly elicited an activation of calcium mobilisation. The influence of zeolite on calcium homeostasis was not evident from monitoring serum concentration of calcium regulating hormones (PTH, 1,25(OH)2D3, 25(OH)VitD) or renal excretion of markers of bone resorption. Enhanced active intestinal calcium absorption and bone resorption was therefore considered insignificant in the calcium mobilisation under the conditions of this experiment. The origin of the increased amount of Ca, which was observed in serum and urine after zeolite withdraw, is at present unknown, but it is suggested, that the readily mobilized Ca-pool in bone was a contributing factor. An effect of zeolite on phosphate and magnesium homeostasis in the experimental group was evidenced from the values of serum concentration and fractional excretion, which during supplementation were significant lower than in the control group. The influence of zeolite on phosphorus and magnesium is presumed to result from a combination of interference of zeolite with intestinal absorption and a marginal dietary supplementation of these minerals.

Evaluation of the optimum dose of growth hormone (GH) for restoring bone mass in adult-onset GH deficiency: results from two 12-month randomized studies.

OBJECTIVE: To establish the optimum GH dose for restoring bone mineral density (BMD) in adult-onset GH deficiency (GHDA). DESIGN: Two separate randomized, controlled clinical trials. PATIENTS: Fifty-eight adults aged 45.1 (20-64) years with severe GHDA were followed in two 12-month studies. In the first study, patients were randomized to placebo or GH 1.7 IU/m2/day and in the second study GH 0.5 IU/m2/day or 1.0 IU/m2/day. MEASUREMENTS: BMD of the spine, hip, forearm and whole body was measured at 0 and 12 months. Alkaline phosphatase (AP) and collagen markers serum C-terminal propeptide of type I collagen (PICP), type I collagen telopeptide (ICTP) and N-terminal propeptide of type III collagen (PIIINP) were measured at baseline and every 3 months. RESULTS: Biochemical markers of skeletal and soft tissue collagen increased significantly and remained elevated throughout the study period. BMD changes depended on site, dose and gender. In placebo-treated patients, spinal BMD declined by 2.5%. At the low and medium doses, BMD increased by 2.4 and 3.1%, respectively, while a nonsignificant 0.2% decrease was seen with high dose. Forearm BMD decreased by 4.9% (P < 0.05) with high-dose treatment but remained unchanged at lower doses. Males showed larger gains in BMD, but the dose-response relationship was similar in males and females. CONCLUSION: A GH dose of 0.5-1.0 IU/m2/day (4-9 micro g/kg/day) stimulated bone remodelling and increased BMD over 12 months in patients with severe GHDA, irrespective of gender. A higher dose (1.7 IU/m2/day congruent with 15 micro g/kg/day) was associated with initial declines in forearm and whole-body BMD.

The effect of zeolite A supplementation in the dry period on periparturient calcium, phosphorus, and magnesium homeostasis.

One potential way of preventing parturient hypocalcemia in the dairy cow is to feed dry cow rations very low in calcium (<20 g/d); but, because it is difficult to formulate rations sufficiently low in calcium, this principle has been almost abandoned. Recent studies have shown, however, that it is possible to prevent milk fever, as well as subclinical hypocalcemia, by supplementing the dry cow ration with sodium aluminium silicate (zeolite A), which has the capacity to bind calcium. The aim of this study was to further evaluate the effect, if any, of such supplementation on other blood constituents, feed intake, and milk production in the subsequent lactation. A total of 31 pregnant dry cows about to enter their third or later lactation were assigned as experimental or control cows according to parity and expected date of calving. The experimental cows received 1.4 kg of zeolite pellets per d (0.7 kg of pure zeolite A) for the last 2 wk of pregnancy. Blood samples were drawn from all cows 1 wk before the expected date of calving, at calving, at d 1 and 2 after calving, and 1 wk after calving. Additionally, a urine sample was drawn 1 wk before the expected date of calving. Zeolite supplementation significantly increased the plasma calcium level on the day of calving, whereas plasma magnesium as well as inorganic phosphate was suppressed. Serum 1,25(OH)2D was significantly increased 1 wk before the expected date of calving among the experimental cows, whereas there was no difference in the urinary excretion of the bone metabolite deoxypyridinoline between the two groups. Feed intake was decreased among the zeolite-treated cows during the last 2 wk of pregnancy. No effect was observed on milk yield, milk fat, and milk protein in the subsequent lactation. The mechanisms and interactions involved in zeolite supplementation are discussed in relation to the observed improvement in parturient calcium homeostasis and to the observed depression in blood magnesium and inorganic phosphate.

Milk fever control principles: a review.

Three main preventive principles against milk fever were evaluated in this literature review, and the efficacy of each principle was estimated from the results of controlled investigations. Oral calcium drenching around calving apparently has a mean efficacy of 50%-60% in terms of milk fever prevention as well as prevention of milk fever relapse after intravenous treatment with calcium solutions. However, some drenches have been shown to cause lesions in the forestomacs. When using the DCAD (dietary cation-anion difference) principle, feeding rations with a negative DCAD (measured as (Na + K)-(Cl + S)) significantly reduce the milk fever incidence. Calculating the relative risk (RR) of developing milk fever from controlled experiments results in a mean RR between 0.19 and 0.35 when rations with a negative versus positive DCAD are compared. The main drawback from the DCAD principle is a palatability problem. The principle of feeding rations low in calcium is highly efficient in milk fever prevention provided the calcium intake in the dry period is kept below 20 g per day. Calculating the relative risk (RR) of developing milk fever from controlled experiments results in a very low mean RR (between 0 and 0.20) (daily calcium intake below versus above 20 g/d). The main problem in implementing the low-Ca principle is difficulties in formulating rations sufficiently low in calcium when using commonly available feeds. The use of large doses of vitamin D metabolites and analogues for milk fever prevention is controversial. Due to toxicity problems and an almost total lack of recent studies on the subject this principle is not described in detail. A few management related issues were discussed briefly, and the following conclusions were made: It is important to supply the periparturient cow with sufficient magnesium to fulfil its needs, and to prevent the dry cows from being too fat. Available information on the influence of carbohydrate intake, and on the effect of the length of the dry period and prepartum milking, is at present insufficient to include these factors in control programmes.

Effects of 12 months of GH treatment on cortical and trabecular bone content of IGFs and OPG in adults with acquired GH deficiency: a double-blind, randomized, placebo-controlled study.

To investigate the effects of 12 months of GH treatment on cortical and trabecular bone content of IGFs, iliac crest bone biopsies were obtained from 25 patients with GH deficiency (9 women and 16 men; ages, 21-61 yr; mean, 46 yr) who were randomized to sc injections with GH (2 IU/m(2).d) or placebo for 12 months. Levels of IGF-I, IGF-II, IGF binding protein (IGFBP)-3, IGFBP-5, osteocalcin, OPG, RANKL, and total protein were determined in extracts obtained after EDTA and guanidine hydrochloride extraction. Calcium was determined after HCl hydrolysis. Comparing changes during GH or placebo treatment, significant increases were observed during GH substitution for cortical and trabecular bone content of IGF-I [mean difference vs. placebo (mean +/- SEM), 97 +/- 30 and 72 +/- 38%] and OPG (mean difference vs. placebo, 109 +/- 59 and 51 +/- 19%). Also, a significant decline was found for cortical osteocalcin (mean difference vs. placebo, -49 +/- 22%) during GH treatment. In conclusion, our results indicate that long-term GH treatment increases the accumulation of IGF-I and OPG in cortical and trabecular bone in patients with GH deficiency, and this may in turn lead to an increase in bone mass and improved skeletal biomechanical competence.

High-dose proton-pump inhibitors as a diagnostic test of gastro-oesophageal reflux disease in endoscopic-negative patients.

BACKGROUND: To evaluate a high dose of a proton-pump inhibitor as a diagnostic test in endoscopy-negative patients presenting with symptoms indicating gastro-oesophageal reflux disease. METHODS: 64 patients were studied in a prospective, randomized, double-blind study, using a cross-over design. After a run-in period with the diary registration of basic GORD symptoms and recording of the consumption of antacid tablets, the patients were given either 60 mg of lansoprazole once daily or placebo in randomized order. Symptoms were recorded, as well as antacid tablets taken in order to relieve pain. GORD was determined by 24-h oesophageal pH monitoring. The test was considered positive when consumption of antacid tablets was reduced > or = 75% compared to pretreatment. RESULTS: In the GORD group, 29 (85%) tested positive during active treatment compared to 3 (9%) when on placebo. Corresponding figures for the non-GORD patients were 50% and 27%, giving a test sensitivity and specificity of 85% and 73%, respectively. During active treatment, VAS scores for acid regurgitation, heartburn and over all were significantly lowered in GORD patients, compared to heartburn only in the non-GORD group. CONCLUSIONS: 60 mg lansoprazole once daily for 5 days is an easy to use method for diagnosing GORD in endoscopy-negative patients. Using 24-h oesophageal pH monitoring as the reference method, the sensitivity was relatively high, while the specificity was lower. Further studies are needed to determine how a PPI could be used as a diagnostic test in GORD.