Grazing management of mixed alfalfa bermudagrass pastures.

Rotational grazing management is commonly recommended to improve persistence of legumes interseeded into bermudagrass, but impacts on animal performance are poorly understood. Steers (n = 365, BW = 249 ± 22.9 kg) grazed mixed alfalfa (Medicago sativa L.)/bermudagrass (Cynodon dactylon [L.] Pers.) pastures (n = 10; 1.6-ha) with either continuous grazing (CONT) or rotational grazing (ROT) management over 3 yr. Initial stocking rate was set at 6.25 steers/ha. When forage allowance of CONT became limiting in mid-July each year, 2 randomly selected steers were removed from all pastures to maintain equal stocking rates in CONT and ROT. Rotational grazing pastures were divided into 8 paddocks with 3-d grazing and 21-d rest between grazing events. Initial, final, and interim (28-d) BW were collected following a 16-h removal from feed and water. Data were analyzed as a repeated measures experiment with completely random design using the mixed procedure of SAS (SAS Inst. Inc., Cary, NC) using pasture within treatment by year in the random statement. Across years, steer BW did not differ (P ≥ 0.47) at the midpoint or end of the grazing season. Daily BW gains during the early summer period tended (P = 0.10) to be 0.11 kg greater for CONT than ROT in yr 1, but did not differ (P ≥ 0.24) in yr 2 and 3. In the late summer, ADG was 0.15 kg less (P < 0.01) for CONT than ROT in yr 1, were not different (P = 0.23) in yr 2, and were 0.29 kg less (P < 0.01) for CONT than ROT in yr 3. Over the entire experimental period, ADG did not differ (P ≥ 0.67) in yr 1 or 2, but tended (P = 0.09) to be 0.10 kg greater for ROT than CONT in yr 3. Forage mass of ROT was greater (P < 0.01) than CONT throughout the grazing season. Because stocking rates were maintained at the same level, ROT pastures provided greater (P < 0.01) forage allowance during the grazing season than CONT explaining differences in ADG between treatments. Alfalfa stand percentage did not differ (P = 0.79) at the beginning of the experiment, but was less (P ≤ 0.03) for CONT than ROT at all other sampling dates. These data indicate that at equal stocking rates, ROT can maintain greater alfalfa persistence, forage nutritive quality, and forage allowance compared with continuous grazing and provided increased animal performance during the late summer when the alfalfa stand was reduced in CONT pastures.

Western diet increases cardiac ceramide content in healthy and hypertrophied hearts.

BACKGROUND AND AIMS: Obesity and cardiac left ventricular hypertrophy (LVH) are recognised independent risk factors in the development of heart failure (HF). However, the combination of these factors may exacerbate the onset of cardiovascular disease by mechanisms as yet unclear. LVH leads to significant cellular remodelling, including alterations in metabolism which may result in an inappropriate accumulation of lipids and eventual lipotoxicity and apoptosis. The aim of the study was to determine the impact of dietary manipulation on cardiac metabolism in the obese and hypertrophied heart. METHODS AND RESULTS: LVH was induced via aortic constriction (AC) in an experimental model of cardiac hypertrophy and animals subjected to 9 weeks of dietary manipulation with either a standard, high fat, or a sucrose containing Western-style diet (SD, HFD and WD, respectively). This latter diet resulted in accelerated weight gain in both LVH/AC and control animals. LVH was greater in AC animals fed a WD, and both control and AC animals from this diet showed a significant reduction in cardiac fatty acid oxidation and increased triacylglycerol content. Ceramide content was significantly increased in the WD groups, with no additional effect of LVH. Comparison with a model of HF induced by exposure to Doxorubicin and WD showed exacerbated remodelling of cardiac ceramide species leading to increased C16 and C18 content. CONCLUSIONS: These findings highlight the inappropriate accumulation and re-distribution of cardiac ceramide species in a diet-induced model of obesity and LVH, potentially increasing susceptibility to cell death. The combination of increased fat and sugar leads to greater pathological remodelling and may explain why this diet pattern is consistently linked with poor cardiovascular outcomes.

A chondrocyte infiltrated collagen type I/III membrane (MACI® implant) improves cartilage healing in the equine patellofemoral joint model.

UNLABELLED: Autologous chondrocyte implantation (ACI) has improved outcome in long-term studies of joint repair in man. However, ACI requires sutured periosteal flaps to secure the cells, which precludes minimally-invasive implantation, and introduces complications with arthrofibrosis and graft hypertrophy. This study evaluated ACI on a collagen type I/III scaffold (matrix-induced autologous chondrocyte implantation; MACI(®)) in critical sized defects in the equine model. METHODS: Chondrocytes were isolated from horses, expanded and seeded onto a collagen I/III membrane (ACI-Maix™) and implanted into one of two 15-mm defects in the femoral trochlear ridge of six horses. Control defects remained empty as ungrafted debrided defects. The animals were examined daily, scored by second look arthroscopy at 12 weeks, and necropsy examination 6 months after implantation. Reaction to the implant was determined by lameness, and synovial fluid constituents and synovial membrane histology. Cartilage healing was assessed by arthroscopic scores, gross assessment, repair tissue histology and immunohistochemistry, cartilage glycosaminoglycan (GAG) and DNA assay, and mechanical testing. RESULTS: MACI(®) implanted defects had improved arthroscopic second-look, gross healing, and composite histologic scores, compared to spontaneously healing empty defects. Cartilage GAG and DNA content in the defects repaired by MACI implant were significantly improved compared to controls. Mechanical properties were improved but remained inferior to normal cartilage. There was minimal evidence of reaction to the implant in the synovial fluid, synovial membrane, subchondral bone, or cartilage. CONCLUSIONS: The MACI(®) implant appeared to improve cartilage healing in a critical sized defect in the equine model evaluated over 6 months.

A standardized nutrition approach for very low birth weight neonates improves outcomes, reduces cost and is not associated with increased rates of necrotizing enterocolitis, sepsis or mortality.

OBJECTIVE: To assess how a standard practice for nutrition support in very low birth weight (VLBW) neonates would impact on their hospital course. STUDY DESIGN: This was a prospective, single center, before vs after comparison of a non-standardized approach to nutrition in VLBW neonates to a standardized approach. Standardization of feeding initiation, feeding volume and caloric advancement, management of feeding aspirates (residuals), use of starter parenteral nutrition (PN), use of breast milk and donor breast milk, initiation and discontinuation of intravenous (IV) intralipids, documentation of protein use, and utilization of percutaneously inserted central venous catheters were performed. Multiple outcome measures were evaluated. Fisher's exact, Mann-Whitney U-tests and χ(2) tests were used for statistical analysis. RESULT: Sixty-nine infants in the pre-standardization (non-standardized) group were compared with 154 infants in the standardized approach group. Analysis was performed for each group as a whole. Statistically significant improvements were seen in multiple areas for the standardized group including the day of life birth weight was regained (P<0.0005), use of breast milk as the initial feeding (P<0.0001), use of starter PN on admission (P<0.0001), earlier time for initiation of PN (P<0.0001), decreased use of PN overall (P<0.0001), enteral protein use (P<0.0001), earlier time for initiation of IV intralipids (P<0.002), day of life for full enteral feeds (P<0.0005) and first day for initiation of enteral feeds (P<0.0001). Fewer infants born microcephalic at birth remained so at discharge in the standardized group as compared with the pre-standardized group (P<0.02). Similarly, less infants born small for gestational age at birth remained so at discharge in the standardized group as compared with the pre-standardized group (P<0.05). Two cases of necrotizing enterocolitis (NEC) occurred in the pre-standardization group and one in the standardized group. No coagulase-negative Staphlococcal infections or line infections occurred during the entire study period. Two cases of sepsis occurred in the pre-standardization group, both in infants <750 g. No cases of sepsis occurred in the standardized group. Cost savings were remarkable from decreased PN usage in the standard group. CONCLUSION: Implementation of a standardized approach to nutrition in VLBW infants reduces the use of PN thereby reducing cost, causes a more rapid regain of birth weight, decreases the number of babies that are small for gestational age and microcephalic at discharge, and decreases the time to full enteral feeds. No adverse increases in mortality, sepsis, NEC, coagulase-negative Staphlococcal infections or line infections occurred.

Quercetin improves the postthaw characteristics of cryopreserved sex-sorted and nonsorted stallion sperm.

Excessive reactive oxygen species generation during sex sorting and cryopreservation of stallion sperm leads to DNA fragmentation, lipid peroxidation, and motility loss. In this study we investigated whether antioxidant supplementation during sex sorting and cryopreservation could ameliorate the effects of reactive oxygen species on stallion sperm. In experiment 1, the postthaw characteristics of stallion sperm (N = 9) cryopreserved in the presence or absence of catalase (200 U/mL), cysteine (0.2 mg/mL), or quercetin (0.15 mM) was examined. Motility and acrosome integrity were assessed at 0, 1, and 3 hours after thawing. The sperm chromatin structure assay (SCSA; detectable DNA fragmentation index [DFI], mean DFI, and DFI) was used to assess DNA integrity immediately after thawing. Quercetin increased the total postthaw motility (25.3% vs. 20.9%; P < 0.05), but there was no beneficial effect of catalase or cysteine. Based on these results, the effect of quercetin during cryopreservation on the postthaw zona binding ability of sperm was assessed using a heterologous (bovine) zona binding assay. Quercetin increased the number of sperm bound per oocyte (13.6 vs. 9.2; P < 0.05) compared with the control. In experiment 2, the effect of quercetin (0.15 mM) in the media used during semen storage and transport, Hoechst 33342 staining and cryopreservation of stallion sperm (N = 9) was investigated. Motility, acrosome integrity, and viability were assessed at 0, 1, and 3 hours after thawing and SCSA was performed at 0 hours after thawing. Quercetin supplementation during sex sorting and cryopreservation improved DNA integrity (SCSA; detectable DFI of 54.9% vs. 74.6%, P < 0.05; mean DFI of 270.2 vs. 288.1, P < 0.05; and DFI of 26.3% vs. 28.5%, P < 0.05) compared with control sex-sorted sperm. There was no beneficial effect of quercetin on the motility, acrosome integrity, or viability of sex-sorted sperm. In conclusion, quercetin significantly improved the motility and zona binding ability of cryopreserved stallion sperm, and reduced DNA fragmentation in sex-sorted, cryopreserved stallion sperm.

Nitrogen isotopes as indicators of NO(x) source contributions to atmospheric nitrate deposition across the midwestern and northeastern United States.

Global inputs of NO(x) are dominated by fossil fuel combustion from both stationary and vehicular sources and far exceed natural NO(x) sources. However, elucidating NO(x) sources to any given location remains a difficult challenge, despite the need for this information to develop sound regulatory and mitigation strategies. We present results from a regional-scale study of nitrogen isotopes (delta15N) in wet nitrate deposition across 33 sites in the midwestern and northeastern U.S. We demonstrate that spatial variations in delta15N are strongly correlated with NO(x) emissions from surrounding stationary sources and additionally that delta15N is more strongly correlated with surrounding stationary source NO(x) emissions than pH, SO4(2-), or NO3- concentrations. Although emission inventories indicate that vehicle emissions are the dominant NO(x) source in the eastern U.S., our results suggest that wet NO3- deposition at sites in this study is strongly associated with NO(x) emissions from stationary sources. This suggests that large areas of the landscape potentially receive atmospheric NO(y) deposition inputs in excess of what one would infer from existing monitoring data alone. Moreover, we determined that spatial patterns in delta15N values are a robust indicator of stationary NO(x) contributions to wet NO3- deposition and hence a valuable complement to existing tools for assessing relationships between NO3- deposition, regional emission inventories, and for evaluating progress toward NO(x) reduction goals.

Sugars consumption by 379 11-12-year-old English children in 1990 compared with results in 1980.

The amount of sugars consumed by young adolescents was assessed in 1990 using the same methods as those employed in a similar survey in 1980. The children were the same age (mean 11 years 6 months) and from the same seven schools in both survey. In 1980, 405 children completed the study and 379 in 1990. Information was collected using two 3-day dietary diaries, each child being interviewed by a dietitian upon completion of a diary. The dietitian in this study was calibrated closely with the dietitian who undertook the 1980 study so as to ensure comparable diet evaluation methods. Total sugars consumption was unchanged (117 g/day in 1980, 118 g/day in 1990) but consumption of non-milk extrinsic sugars increased (83 g/day in 1980, 90 g/day in 1990) and milk and intrinsic sugars decreased (34 g/day in 1980, 28 g/day in 1990) between the two surveys. In 1990, non-milk extrinsic sugars contributed 17% to total dietary energy intake, while milk and intrinsic sugars contributed 5%. There was little difference in percent contributions between the sexes, but some social-class trends were apparent. Confectionery provided 33% and soft drinks provided 27% of non-milk extrinsic sugars, these two dietary sources providing 60% of non-milk extrinsic or 46% of total sugars intake. These levels of consumption are considerably higher than those currently recommended in the UK.

The effect of the optimal use of rapid-acting insulin analogues on insulin secretion in Type 2 diabetes.

The abnormal glucose tolerance of Type 2 diabetes is characterized by post-prandial hyperglycaemia. We aimed to examine whether the restoration of a more physiological insulin profile using rapid-acting insulin analogues might, through effects on glucose toxicity, improve endogenous insulin secretion rate (ISR) and secondly improve markers of vascular risk. Eighteen people with insulin-treated Type 2 diabetes were recruited into a single centre, cross-over, open-labeled study. The order of pre-meal unmodified human insulin or insulin aspart was randomized: treatment periods lasted at least 8-12 weeks after which ISR was assessed by stepped low-dose glucose infusion and fasting markers of vascular risk measured. Glucose control was good (HbA(1c) 6.94+/-0.12 (+/-S.E.)% versus 7.07+/-0.13%, NS) with insulin aspart and human insulin. Mean post-prandial self-monitored blood glucose concentration was also good particularly with insulin aspart (7.5+/-0.41 mmol/l versus 8.19+/-0.34 mmol/l) but the difference did not reach statistical significance. Over 160 min ISR did not differ between insulin aspart and human insulin and there was also no change in various markers of vascular risk. In conclusion a meal-time+basal insulin regimen gave close to normal post-prandial blood glucose control with both the insulin aspart and human insulin regimens, such that no difference in ISR or markers of vascular risk could be demonstrated.

Selective recruitment of single motor units in human flexor digitorum superficialis muscle during flexion of individual fingers.

Flexor digitorum superficialis (FDS) is an extrinsic multi-tendoned muscle which flexes the proximal interphalangeal joints of the four fingers. It comprises four digital components, each with a tendon that inserts onto its corresponding finger. To determine the degree to which these digital components can be selectively recruited by volition, we recorded the activity of a single motor unit in one component via an intramuscular electrode while the subject isometrically flexed each of the remaining fingers, one at a time. The finger on which the unit principally acted was defined as the 'test finger' and that which flexed isometrically was the 'active' finger. Activity in 79 units was recorded. Isometric finger flexion forces of 50% maximum voluntary contraction (MVC) activated less than 50% of single units in components of FDS acting on fingers that were not voluntarily flexed. With two exceptions, the median recruitment threshold for all active-test finger combinations involving the index, middle, ring and little finger test units was between 49 and 60% MVC (60% MVC being the value assigned to those not recruited). The exceptions were flexion of the little finger while recording from ring finger units (median: 40% MVC), and vice versa (median: 2% MVC). For all active-test finger combinations, only 35/181 units were activated when the active finger flexed at less than 20% MVC, and the fingers were adjacent for 28 of these. Functionally, to recruit FDS units during grasping and lifting, relatively heavy objects were required, although systematic variation occurred with the width of the object. In conclusion, FDS components can be selectively activated by volition and this may be especially important for grasping at high forces with one or more fingers.

Elevated plasma non-esterified fatty acid levels and insulin secretion in non-diabetic relatives of type 2 diabetic patients.

OBJECTIVE: High non-esterified fatty acid (NEFA) levels impair glucose-stimulated insulin secretion from islets derived from non-diabetic Zucker rats that are genetically predisposed to diabetes. We therefore examined the effect of elevated plasma NEFA levels on insulin secretion in non-diabetic first-degree relatives of type 2 diabetic patients who are at increased risk of developing diabetes. SUBJECTS AND STUDY DESIGN: Normal glucose tolerant relatives (n = 9) and control subjects with no family history of diabetes were pair-matched for age, sex, body mass index (BMI), insulin sensitivity and early insulin response during an oral glucose tolerance test (OGTT). Plasma NEFA levels were raised from 0 to 340 minutes by the infusion of 20% Intralipid and heparin. From 180 minutes, insulin secretion rates (IRSs) were assessed by stepped low-dose glucose infusion. RESULTS: The mean (geometric mean +/- 95% CI) NEFA levels were comparable between relatives and control subjects (2.7 [2.1-3.6] and 2.1 [1.7-2.7] mmol/l, paired analysis, NS). Similarly, plasma glucose levels achieved at each glucose infusion step were comparable between the groups. However, there were no significant differences between the groups for ISR throughout the study. CONCLUSIONS: Sustained elevation of plasma non-esterified fatty acid levels does not decrease insulin secretion in non-diabetic relatives of type 2 diabetic patients, and is therefore unlikely to be important in the development of the impaired pancreatic beta-cell function in type 2 diabetes mellitus.

Dietary intake of folate by adolescents and the potential effect of flour fortification with folic acid.

The UK Department of Health recently recommended that flour be fortified with folic acid, at 2400 microg/kg. The objectives of the present paper were: to determine the consequence of this on folic acid intake of adolescents; to determine the level of fortification necessary to achieve an intake of 400 microg/d in adolescent girls (the amount recommended periconceptionally); to estimate the consequence of fortification on folic acid intake of high flour consumers; and to report on folate intake of adolescents. Dietary intake of folate and flour were determined by analysis of an existing database of the diets of 379 English adolescents. The folic acid intake that would result from white flour fortification with folic acid at 2400 microg/kg was determined and the level of folic acid fortification necessary to achieve an intake of 400 microg/d in girls from this source was also calculated. Without flour fortification, 6.9 % of girls failed to reach the UK lower reference nutrient intake for total folate. Fortification of white flour with folic acid at 2400 microg/kg would result in an additional folic acid intake of 191(sem 6) microg/d in girls. To ensure 97 % of girls received 400 microg/d from white flour, white flour would need to be fortified at a level of 10 430 microg/kg, resulting in intakes of 1260 microg/d from flour in the highest (97.5 centile) female white flour consumers and 1422 microg/d from flour in the highest (97.5 centile) male white flour consumers.

Photographic scoring of gingival overgrowth.

BACKGROUND: A wide range of methods have been employed to determine the severity of gingival overgrowth resulting in uncertainty regarding the prevalence of the side-effect. There is no simple, non-invasive, objective, blind method for assessing gingival overgrowth. AIM: This article aims to describe a method which is suitable for use in large-scale population studies. MATERIALS AND METHODS: Photographs were taken of the anterior, buccal gingivae and teeth of 925 patients medicated with calcium channel blockers. In addition, each patient was ascribed a clinical gingival overgrowth score. 100 patients had repeat photographs, and a further 10 patients had alginate impressions taken. The models were scored for severity of gingival overgrowth using a described technique. The slides were scored using a modification of this technique. RESULTS: When photographic and study model scores were compared, photographic scores were consistently higher, and as a result, a photographic score of 38.6% was considered to represent a significant overgrowth. There was good agreement between clinically determined scores and photographic scores (kappa=0.71). CONCLUSIONS: The results indicate that this method is suitable for large-scale population studies where it also has the advantage of providing a continuous scale of gingival changes for subsequent statistical analysis.

Non-diabetic relatives of Type 2 diabetic families: dietary intake contributes to the increased risk of diabetes.

AIMS: Non-diabetic first degree relatives of Type 2 diabetic patients are at increased risk of developing diabetes and cardiovascular disease. This is assumed to reflect a shared genetic predisposition. The aim of this study was to test the hypothesis that lifestyle factors, specifically dietary factors, are also important to the increased risk in non-diabetic relatives. METHODS: Dietary intake was assessed using a validated food frequency questionnaire in 149 non-diabetic first degree relatives (age 20-65 years) from families of North European extraction with two or more living Type 2 diabetic family members, and 143 age- and sex-matched control subjects from the background population with no family history of diabetes. RESULTS: Relatives reported higher absolute intakes of total fat (mean (95% confidence intervals) 83 (76-91) vs. 71 (66-76) g/day, P = 0.01), saturated fat (SFA; 39 (36-43) vs. 33 (30-36) g/day, P < 0.01) and cholesterol (391 (354-427) vs. 318 (287-349) mg/day, P < 0.01), and a lower intake of non-starch polysaccharide (P < 0.05). Considered as percentage of total daily energy intake, relatives had higher intakes of total fat (P < 0.01) and SFA (P < 0.02), and a lower intake of carbohydrate (P < 0.02). These differences remained after exclusion of suspected under- and over-reporters of dietary intake. CONCLUSIONS: Non-diabetic relatives of Type 2 diabetic patients were found to consume diets that will promote rather than prevent the development of diabetes and cardiovascular disease. This suggests that the increased risk to non-diabetic relatives is therefore not entirely genetic, and there is scope for decreasing the risk through lifestyle modification.

Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model.

BACKGROUND: In cases such as incisional hernia repair, polypropylene mesh (PPM) can be exposed to the underlying viscera and cause adhesions to the mesh. In this study, a composite prosthesis that was designed to be less susceptible to adhesion formation than PPM was evaluated in a rabbit incisional hernia repair model. MATERIALS AND METHODS: A 5 x 7-cm full-thickness defect was created in the abdominal wall of 30 female New Zealand White rabbits. Ten animals each were repaired with PPM, Bard Composix (PP/ePTFE), or Sepramesh biosurgical composite-a polypropylene mesh coated on one side with chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC). The animals were sacrificed after 28 days and the overall performance, including adhesion formation and tissue integration by histology and mechanical testing, was evaluated. RESULTS: In the Sepramesh group, there was a significant reduction in the percentage of surface area covered by adhesions and a significant increase in the percentage of animals with no adhesions compared to standard materials. The tissue integration strength and overall cellular response were similar in all groups. A partially remesothelialized peritoneal surface was often apparent overlying the Sepramesh implant. CONCLUSIONS: Sepramesh biosurgical composite effectively repaired abdominal wall defects in rabbits and reduced adhesion development to the mesh compared to the use of a PPM and a PP/ePTFE composite.

Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation.

OBJECTIVES: The objectives of this study were to investigate the impact of prosthetic rehabilitation of the shortened dental arch on the intake of nutrients, non-starch polysaccharide (NSP) fruits and vegetables (dietary fibre), and to compare dietary intakes between patients receiving bilateral resin-bonded bridges with patients receiving conventional partial dentures. METHODS: As part of an ongoing randomised clinical trial to compare the effectiveness of bilateral resin bonded bridges with conventional partial dentures, the diets of 40 partially dentate patients were assessed prior to and at 3 and 12 months following treatment with bilateral resin-bonded bridge-work or a lower partial denture. RESULTS: At baseline, three months post treatment and one year post treatment there were no significant differences in the intake of nutrients between groups. A significant increase in the percentage of energy from fat was observed in the patients fitted with a lower partial denture. Apart from this, prosthetic rehabilitation did not result in any other change in the intake of nutrients or in the amount of fruits and vegetables consumed. Levels of intake of NSP, fruits and vegetables were low in both groups of patients on all occasions measured. CONCLUSIONS: Prosthetic rehabilitation of the severely shortened dental arch does not result in dietary improvements. Dietary advice that takes into account all the factors that influence food choice (such as taste, cost and cooking skills) needs to be considered in this at risk group.

The influence of (R)- and (S)-warfarin, vitamin K and vitamin K epoxide upon warfarin anticoagulation.

The contribution of (R)- and (S)-warfarin enantiomers, vitamin K and vitamin K epoxide and patient factors to inter-individual variability in daily warfarin requirements were examined in a group of 73 patients. Simple correlation analysis showed a significant positive relationship between INR values and plasma (S)-warfarin concentrations (r = 0.25; p = 0.038). Multivariate analysis for relationships with INR demonstrated a highly significant positive relationship between INR and (S)-warfarin (p = 0.004) and plasma vitamin K epoxide concentrations (p = 0.028), and a significant negative relationship between INR and plasma vitamin K concentrations (p = 0.034). Twenty five percent of variation in INR could be explained by these variables (adjusted R2 = 0.25). Correlation analysis of data showed that warfarin dosage was significantly and negatively correlated with patient age (r = -0.42; p <0.0001). Patient age accounted for 25% of variation in warfarin dosage requirements (R2 = 0.25). The combined effects of age and vitamin K appear to account for much of the inter-individual variability in warfarin dosage requirements.

In vivo degradation of tungsten embolisation coils.

It has been suggested that tungsten embolisation coils in intracranial aneurysms may dissolve in situ. These coils are also used, in much larger quantities, for the occlusion of larger vessels outside the cranium. This study was performed to investigate whether tungsten embolisation coils may become degraded in vivo and to examine whether this is radiographically evident on medium-term follow-up. 10 patients who had undergone aortic stent-graft repair of an abdominal aortic aneurysm (8 male and 2 female, mean age 69.7 years) and 10 age- and sex-matched controls were studied. The study group had also received an average of 64 cm of tungsten coil either to prevent or to treat an endoleak. Whole blood, serum and urine tungsten levels were assayed. Immediate post-operative and follow-up abdominal radiographs were reviewed by two consultant vascular radiologists to detect visible changes in the coils. Whole blood, serum and urine levels of tungsten were highly and significantly elevated (p < 0.001) in the study group compared with the controls. No radiographic changes in the coils were seen at an average of 16.7 months. In conclusion, tungsten embolisation coils dissolve in humans but radiographic changes are not apparent on medium-term follow-up. The clinical significance of these findings is uncertain but long-term follow-up is needed.

Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study.

BACKGROUND: The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively. METHODS: The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community-based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity. RESULTS: More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females. CONCLUSIONS: The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect.

Evaluation of a sugar-free medicines campaign in north east England: quantitative analysis of medicines use.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of a sugar-free medicines campaign using suitable prescribing and purchasing indicators. BASIC RESEARCH DESIGN: Quantitative analysis of sugar-free medicine use, before (1995) and after (1996) the campaign. CLINICAL SETTING: Two test and two control districts in north east England. PARTICIPANTS: General medical practitioners (GPs) and community pharmacists. INTERVENTION: A 12-month campaign involving development and distribution of information packs designed to increase the proportion of prescriptions dispensed sugar-free for paediatric use. MAIN OUTCOME MEASURES: Changes in the proportion of the following which were sugar-free: (a) for target prescribed medicines (i) number of prescriptions dispensed. (ii) number of prescribed daily amounts (PDA); (b) for target over the counter (OTC) medicines, (i) number of bottles sold, (ii) number of standard daily amounts (SDA) sold. RESULTS: Quantitative analysis of prescriptions and OTC sales showed statistically highly significant changes towards sugar-free prescribing and dispensing of prescribed medicines but only small increases in the proportion of some sugar-free OTC sales. CONCLUSIONS: The impact of the campaign was shown to be greatest in changing prescribing habits of GPs with less effect on OTC medicine use. The outcome measures used were suitable for quantitative evaluation of the campaign. POST-CAMPAIGN DEVELOPMENT: Sustainable changes in GPs' prescribing behaviour can be facilitated by software suppliers' modifications to computing software used for prescription writing.