sTREM-1 is elevated in cystic fibrosis and correlates with proteases.

BACKGROUND: sTREM-1 (soluble triggering receptor expressed on myeloid cells-1) is a novel inflammatory marker that may be of clinical use in cystic fibrosis (CF). Dysregulation of the TREM pathway has been demonstrated in other inflammatory diseases and modulation in animal models has therapeutic benefit. We hypothesised that sTREM-1 could act as a biomarker of disease in cystic fibrosis. METHODS: Plasma from 17 patients with CF (stable and pre and post pulmonary exacerbation) and eight healthy volunteers was analyzed for sTREM-1 and proteases (matrix metalloproteinase-8 (MMP-8), MMP-9, and human neutrophil elastase HNE). RESULTS: sTREM-1 Levels were elevated in stable CF subjects compared to controls (148 pg/ml (130-160) [median(IQR)] vs. 87 (55-118) (P < 0.01)) but were not further increased during pulmonary exacerbation nor decreased after antibiotic treatment in CF. Protease levels were increased in CF plasma compared to controls: MMP-8 = 3.1 ng/ml (1.5-7.6) vs. 0.3 (0.18-0.53) (P < 0.01) (Wilcoxon); MMP-9 = 170 ng/ml (124-282) vs. 49 (39-90) (P < 0.01); HNE = 30.2 ng/ml (22.7-30.9) vs. 17.5 (11.2-22.2) (P < 0.05). sTREM-1 correlated positively with protease levels lnMMP-8 r2 = 0.55 (P = 0.08), lnMMP-9 r2 = 0.61(P < 0.05), lnHNE r2 = 0.35 (P < 0.05). CONCLUSIONS: sTREM-1 is constitutively elevated in CF and positively correlates with protease levels. Modulation of this pathway may be of therapeutic benefit to patients with CF. Pediatr Pulmonol. 2017;52:467-471. © 2017 Wiley Periodicals, Inc.

Ethical planning for an influenza pandemic.

A U.K. Pandemic Influenza Contingency Plan was developed in 2006 but little research has since been carried out as to how ethically acceptable it will be to society. A survey containing two hypothetical scenarios was distributed to 1,018 hospital staff. The survey considered their attitudes to the professional and ethical responsibilities of healthcare workers, and to resource allocation on the intensive care unit (ICU). Of those distributed, 406 (40%) surveys were returned. During a pandemic, 320 (79%) healthcare professionals would continue to work and 339 (83%) felt it would be unprofessional for doctors to leave work. Only 218 (54%) chose the same patient for the last ICU bed. Most staff surveyed felt they should (professionally) and would (voluntarily) work during a pandemic despite high personal risk. A wide diversity of opinion existed regarding resource allocation of ICU beds. These ethical issues require open debate to ensure U.K. pandemic plans are ethically acceptable and practically applicable.

Abusers of alcohol and narcotics: who are they?

Problem drinking among addicts was studied by interviewing 781 narcotic addicts on entrance to treatment. Hierarchical multiple regression analysis (MRA) assessed the ability of 56 demographic, childhood, psychological, social, and drug history measures to predict abstinence, alcohol consumption among nonabstainers, and alcohol-related problems among heavy drinkers. MRA explained 33% of lifetime problem-drinking variance. Best predictors were traumatic events and hyperactivity in childhood, residential instability, psychopathology, and seriousness of drug problems. It was concluded that problem-drinking addicts may differ from other addicts in kind as well as in degree. The findings suggest that problem drinking in narcotic addicts may serve as a marker for some serious psychological problems, that drug treatment professionals therefore should be trained in alcohol abuse identification and treatment, and that psychiatric consultation for these addicts should be available.

Alcohol and drug abuse treatment in three different populations: is there improvement and is it predictable?

Prior research had shown that alcohol and drug abuse treatments were effective and that the results of treatments could be predicted from pretreatment information regarding the patient's employment, family, and especially psychiatric problems. However, this research had been conducted entirely with adult male service veterans, largely from lower socioeconomic strata. Three treatment centers were included in the present study to examine these conclusions with other populations containing adolescents, females, and patients from higher socioeconomic strata. Data from the Addiction Severity Index was collected at treatment admission and again at independent follow-up, 6 months later. Results confirmed prior observations. Both alcohol and drug abuse treatments showed substantial improvements in the chemical use problems of their patients and in the important areas of employment, criminal behavior, family relations, and psychological health. As in earlier reports, a global measure of the nature and extent of pretreatment psychiatric problems was the single best predictor of treatment response for both alcoholics and drug-dependent samples.

New data from the Addiction Severity Index. Reliability and validity in three centers.

The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.

Mortality of treated alcoholics and drug addicts: the benefits of abstinence.

A study of 2-yr treatment outcome and of mortality in the following 8 yr was conducted on all first admissions to Eagleville Hospital in 1970 (503 alcoholics and 221 drug addicts; 9% women). The average age of the alcoholics was 41.6 vs 23.0 for the drug addicts. Status (misusing vs not misusing) 2 yr after admission for treatment or at death was ascertained for 92% of the subjects. The 108 known deaths occurred in 18.5% of the alcoholics and 6.8% of the addicts. Death rates per 1000 person yr at risk were compared with expected general population rates, controlling for age, race and sex. Overall, mortality per 1000 person yr was 25.9 for alcoholics and 8.8 for addicts, each higher than expectancy (p less than .001). Ratios of observed to expected rates were similar (2.5 and 3.1, respectively). Excess mortality occurred only among those misusing alcohol or drugs at 2 yr; nonmisusers had expected death rates. Disease and violent deaths were excessive among alcoholics, but only violent deaths exceeded expectancy among drug addicts. Of the 108 deaths, 66 were excess deaths, attributable to substance misuse and the associated way of life. However, among the 254 who were not misusing on follow-up, 19 died rather than the 51 who would have died if their mortality had been that of the persistent misusers.

Effectiveness of educational efforts in implementing mastitis control procedures in commercial dairy herds.

One hundred-fifty diarymen in north-eastern Ohio, whose herds had a history of persistently high Wisconsin Mastitis Test scores, were invited to participate in this project, with 43 agreeing to do so. These dairymen were divided into two experimental groups and one control group to determine the effectiveness of two intensities of educational effort on adoption of mastitis control procedures and to demonstrate the effectiveness of mastitis control recommendations. A teat dipping and dry cow therapy program was adopted by more herds in the group with intense educational effort than in the intermediate or control group. Percents of herds in each group utilizing this program in 1977 (start of project), 1978, and 1979 were 8, 75, and 92 for the intense group; 30, 50, and 50 for the intermediate group; and 10, 27, and 27 for the control group. Prevalence of infection declined more rapidly in the intense group with 42, 28, and 24% of cows infected; 39, 25, and 30% in the intermedia, and 56, 35, and 42% in the control group in 1977, 1978, and 1979. Those herds adopting a teat dipping and dry cow therapy program had infection prevalence of 41, 25, and 20% of cows; bulk tank Wisconsin Mastitis Test scores of 15.5, 14.7, and 11.4; and milk production per cow per day of 18.4, 18.4, and 17.5 kg in 1977, 1978, and 1979.

Dairy herd reproductive health programs compared with traditional practices.

Reproductive herd health programs have been advocated for many years, and rational approaches that are cost effective have been demonstrated. Dissemination of this information to dairymen can help create a demand for veterinary service. Similarly, the information can be utilized by veterinarians to encourage dairy clients to utilize profitable practices and programs. The study described demonstrated an improvement in biologic goals when a reproductive herd health program was incorporated into the management scheme. The program achieved economic success by reducing costs related to reproduction.

Practical mastitis control in the field.

Research has shown the effectiveness of teat dipping and medically treating all nonlactating cows to control mastitis. However, there is a problem of getting dairy-men to accept the program. Improved educational programs might be helpful. Some means of visual evaluation is essential to acceptance. Use of indirect tests for estimating cell content can be helpful in evaluating control efforts and in demonstrating results. More intense coordinated effort by professional persons advising dairy-men is necessary.

Influence of estrus detection on days open in dairy herds.

Data from 10 herds on a herd reproductive status program supported estimates of lost reproductive days per cow per year due to conception failure and missed heat as 23 and 10 days. The corresponding estimates from Ohio Dairy Herd Improvement were 14.7 and 40.3 days. The correlation within the 10 herds between days lost due to failure to conceive and total days open was .38 and between days lost due to missed heats and total days open .92.