Effects of Dietary ß-Carotene on the Melanization Response and Growth Rate of Trichoplusia ni (Lepidoptera: Noctuidae).

Animals rely on carotenoids as fundamental precursors for hormones and antioxidants, and animals must acquire carotenoids from their diet. Previous research has shown that insects often absorb carotenoids in amounts proportional to those in their diet, and that carotenoids play key roles in multitrophic interactions. The consumption of diets that provide high levels of antioxidant compounds is associated with high levels of immune responses; however, it is unknown whether individual carotenoids directly influence immune response. Here, the objective of this study was to examine the effect of the carotenoid ß-carotene on melanization, a measure of immune response, and growth rate of Trichoplusia ni Hübner (Lepidoptera: Noctuidae). To fulfill the objective, a low, medium, and high concentration of ß-carotene, representing the range found in typical host plants, were mixed in an artificial diet, and immune response and growth rate were assessed in fifth instar larvae. Immune response was induced by injection of chromatography beads in to the abdomen of the larvae, and percent melanization was measured after injection. Melanization was greatest when larvae were reared on high ß-carotene diets. Mass was measured at 5 and 10 d to assess growth rate. Larvae reared on high ß-carotene diets initially gained little mass, but after 10 d larvae reared on no and high ß-carotene diets were larger than those reared on other diets. This research has shown that ß-carotene has the potential to influence the immune response and growth rate of T. ni.

The significance of petroleum bitumen in ancient Egyptian mummies.

Mummification was practised in ancient Egypt for more than 3000 years, emerging from initial observations of buried bodies preserved by natural desiccation. The use of organic balms (and other funerary practices) was a later introduction necessitated by more humid burial environments, especially tombs. The dark colour of many mummies led to the assumption that petroleum bitumen (or natural asphalt) was ubiquitous in mummification; however, this has been questioned for more than 100 years. We test this by investigating 91 materials comprising balms, tissues and textiles from 39 mummies dating from ca 3200 BC to AD 395. Targeted petroleum bitumen biomarker (steranes and hopanes) analyses by gas chromatography-mass spectrometry selected ion monitoring (GC-MS SIM, m/z 217 and 191) showed no detectable bitumen use before the New Kingdom (ca 1550-1070 BC). However, bitumen was used in 50% of New Kingdom to Late Period mummies, rising to 87% of Ptolemaic/Roman Period mummies. Quantitative determinations using (14)C analyses reveal that even at peak use balms were never more than 45% w/w bitumen. Critically, the dark colour of balms can be simulated by heating/ageing mixtures of fats, resins and beeswax known to be used in balms. The application of black/dark brown balms to bodies was deliberate after the New Kingdom reflecting changing funerary beliefs and shifts in religious ideology.This article is part of the themed issue 'Quantitative mass spectrometry'.

Effects of dried plum supplementation on bone metabolism in adult C57BL/6 male mice.

Dietary supplementation of dried plum (DP) prevents bone loss and restores bone mass in osteopenic animal models. This study was designed to determine the effects of DP supplementation on bone metabolic activity over time using adult (6-month-old) male C57BL/6 mice (n = 40) receiving control (CON = AIN93 M) or CON+DP 25 % (w/w) diets for 4 or 12 weeks. After 4 weeks of treatment, animals consuming the DP diet had a higher whole-body bone mineral density, vertebral trabecular bone volume (BV/TV), and femoral cortical thickness compared to the CON animals. In the distal metaphysis of the femur, BV/TV was increased in the DP-treated animals, but only after 12 weeks. Bone histomorphometric analyses revealed that DP decreased osteoblast surface (67 %) and osteoclast surface (62 %) at 4 weeks, but these surfaces normalized to the CON animals by 12 weeks. Coincident with these changes, the mineralizing surface (MS/BS) and cancellous bone formation rate (BFR/BS) were reduced at 4 weeks in the DP group compared to the CON, but by 12 weeks of DP supplementation, BFR/BS (~twofold) and MS/BS (~1.7-fold) tended to be increased (p < 0.10). The relative abundance of RNA for key regulators of osteoblast and osteoclast differentiation and indicators of osteoblast activity were reduced in the DP group at 4 weeks with no difference between groups at 12 weeks. These results indicate that supplementing the diet with DP initially suppressed cancellous bone turnover, but a biphasic response occurs over time, resulting in a positive effect on bone mass and structure.

Reproductive mode evolution in nematodes: insights from molecular phylogenies and recently discovered species.

The Phylum Nematoda has long been known to contain a great diversity of species that vary in reproductive mode, though our understanding of the evolutionary origins, causes and consequences of nematode reproductive mode change have only recently started to mature. Here we bring together and analyze recent progress on reproductive mode evolution throughout the phylum, resulting from the application of molecular phylogenetic approaches and newly discovered nematode species. Reproductive mode variation is reviewed in multiple free-living, animal-parasitic and plant-parasitic nematode groups. Discussion ranges from the model nematode Caenorhabditis elegans and its close relatives, to the plant-parasitic nematodes of the Meloidogyne genus where there is extreme variation in reproductive mode between and even within species, to the vertebrate-parasitic genus Strongyloides and related genera where reproductive mode varies across generations (heterogony). Multiple evolutionary transitions from dioecous (obligately outcrossing) to hermaphroditism and parthenogenesis in the phylum are discussed, along with one case of an evolutionary transition from hermaphroditism to doioecy in the Oscheius genus. We consider the roles of underlying genetic mechanisms in promoting reproductive plasticity in this phylum, as well as the potential evolutionary forces promoting transitions in reproductive mode.

Variation in GIGYF2 is not associated with Parkinson disease.

OBJECTIVE: A recent study reported that mutations in a gene on chromosome 2q36-37, GIGYF2, result in Parkinson disease (PD). We have previously reported linkage to this chromosomal region in a sample of multiplex PD families, with the strongest evidence of linkage obtained using the subset of the sample having the strongest family history of disease and meeting the strictest diagnostic criteria. We have tested whether mutations in GIGYF2 may account for the previously observed linkage finding. METHODS: We sequenced the GIGYF2 coding region in 96 unrelated patients with PD used in our original study that contributed to the chromosome 2q36-37 linkage signal. Subsequently, we genotyped the entire sample of 566 multiplex PD kindreds as well as 1,447 controls to test whether variants in GIGYF2 are causative or increase susceptibility for PD. RESULTS: We detected three novel variants as well as one of the previously reported seven variants in a total of five multiple PD families; however, there was no consistent evidence that these variants segregated with PD in these families. We also did not find a significant increase in risk for PD among those inheriting variants in GIGYF2 (p = 0.28). CONCLUSIONS: We believe that variation in a gene other than GIGYF2 accounts for the previously reported linkage finding on chromosome 2q36-37.

Treatment compliance among prenatal care patients with substance abuse problems.

There is an insufficient number of substance abuse treatment programs available to pregnant women; however, even when women do enroll in treatment, they often choose not to comply with particular components of their treatment. To better understand what factors are associated with a woman's likelihood of compliance with treatment, this study assesses 244 pregnant, substance-using women enrolled in a specialized substance abuse treatment program. Women who complied with treatment referrals are compared with those who did not comply with referrals on various factors including their sociodemographic characteristics, types of substance use before and during pregnancy, experiences of violence before and during pregnancy, and prior substance use treatment. Bivariate analysis found that outpatient treatment compliance was more likely among women who smoked cigarettes before pregnancy, women who had received previous substance abuse treatment, and women whose partner had received previous substance abuse treatment. Outpatient treatment compliance did not vary by sociodemographic characteristics, any other type of substance use, or the women's experiences of violence. Inpatient treatment compliance was more likely among women who received prior substance abuse treatment; however, no other characteristic was found to be associated with inpatient treatment compliance. Logistic regression analyses, which controlled for various factors, suggested that past experiences with substance abuse treatment by the woman or her partner were significantly associated with treatment referral compliance. These findings suggest that the previous treatment experiences of women and their partners are important factors in shaping a successful substance abuse treatment program for pregnant women.

Postexposure rabies prophylaxis protocol for domestic animals and epidemiologic characteristics of rabies vaccination failures in Texas: 1995-1999.

OBJECTIVE: To determine whether postexposure rabies prophylaxis (PEP) in domestic animals, as mandated by the state of Texas, has continued to be effective and to evaluate PEP and preexposure rabies vaccination failures from 1995 through 1999. DESIGN: Retrospective study. ANIMALS: 830 unvaccinated domestic animals (621 dogs, 78 horses, 71 cats, and 60 cattle) that received PEP and 4 animals (3 dogs and 1 horse) that had preexposure rabies vaccination failure. PROCEDURE: Zoonotic incident case reports from 1995 through 1999 were reviewed for information regarding unvaccinated domestic animals that received PEP according to state protocol after exposure to a rabid animal; reports were also reviewed for information regarding preexposure rabies vaccination failures. The PEP recommendations were to immediately vaccinate the animal against rabies, isolate the animal for 90 days, and administer booster vaccinations during the third and eighth weeks of the isolation period. Rabies vaccines used in the PEP protocol were administered via the route prescribed by the USDA. RESULTS: From 1995 through 1999, 830 animals received PEP; 4 failures were recorded. Additionally, 4 preexposure rabies vaccination failures were recorded. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicate that an effective PEP protocol for unvaccinated domestic animals exposed to rabies includes immediate vaccination against rabies, a strict isolation period of 90 days, and administration of booster vaccinations during the third and eighth weeks of the isolation period. This PEP schedule has proven to be effective for control of rabies in domestic animals.

Who gets screened during pregnancy for partner violence?

CONTEXT: Despite recommendations to screen prenatal care patients for partner violence, the prevalence of such screening is unknown. OBJECTIVES: To estimate the statewide prevalence of partner violence screening during prenatal care among a representative sample of North Carolina women with newborns and to compare women screened for partner violence with women not screened. DESIGN, SETTING, AND PARTICIPANTS: This investigation examines data gathered through the North Carolina Pregnancy Risk Assessment Monitoring System, a random sample of more than 2600 recently postpartum women who were delivered of newborns between July 1997 and December 1998. MAIN OUTCOME MEASURES: Self-reports of violence, health service factors, and sociodemographic characteristics. ANALYSIS: The prevalence of screening was computed, and odds ratios and 95% confidence intervals were used to examine bivariate and multivariable associations between being screened for partner violence and other factors. RESULTS: Thirty-seven percent of women reported being screened for partner violence during prenatal care. Logistic regression analysis found that women were more likely to be screened if they received prenatal care from (1) a public provider paid by a public source; (2) a private provider paid by a public source; or (3) a public provider paid by a private source. CONCLUSIONS: These findings suggest that the majority of prenatal care patients in North Carolina are not screened for partner violence. Screening appears to be most highly associated with whether a woman is a patient in the public sector or the private sector, and with the source of payment for prenatal care. Arch Fam Med. 2000;9:1093-1099

Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: A five-year experience.

PURPOSE: We developed and applied a method for providing regional spinal cord hypothermia with epidural cooling (EC) during thoracoabdominal aneurysm (TAA) repair. Preliminary results indicated significant reduction in spinal cord ischemic complications (SCI), compared with historical controls, and a 5-year experience with EC was reviewed. METHODS: From July 1993 to September 1998, 170 patients with thoracic aneurysms (n = 14; 8.2%) or TAAs (types I and II, n = 83 [49%]; type III, n = 66 [39%]; type IV, n = 7 [4.1%]) were treated with EC. An earlier aneurysm resection was noted in 44% of patients, an emergent operation was noted in 20% of patients, and an aortic dissection was noted in 16% of patients. The EC was successful (mean cerebrospinal fluid [CSF] temperature at cross-clamp, 26.4 +/- 3 degrees C) in 97% of cases, with all 170 patients included in an intention-to-treat analysis. The operation was performed with a clamp/sew technique (98% patients) and selective (T(9) to L(1) region) reimplantation of intercostal vessels. Clinical and EC variables were examined for association with operative mortality and SCI by means of the Fischer exact test, and those variables with a P value less than.1 were included in multivariate logistic regression analysis. RESULTS: The operative mortality rate was 9.5% and was weakly associated (P =.07) with SCI; postoperative cardiac complications (odds ratio [OR], 35. 3; 95% CI, 5.3 to 233; P <.001) and renal failure (OR, 32.2; 95% CI, 6.6 to 157; P <.001) were the only independent predictors of postoperative death. SCI of any severity occurred in 7% of cases (type I/II, 10 of 83 [12%]; all other types, 2 of 87 [2.3%]), versus a predicted (Acher model) incidence of 18.5% for this cohort (P =. 003). Half the deficits were minor, with good functional recovery, and devastating paraplegia occurred in three patients (2.0%). Independent correlates of SCI included types I and II TAA (OR, 8.0; 95% CI, 1.4 to 46.3; P =.021), nonelective operation (OR, 8.3, 95% CI, 1.8 to 37.7; P =.006), oversewn T(9) to L(2) intercostal vessels (OR, 6.1; 95% CI, 1.3 to 28.8; P =.023), and postoperative renal failure (OR, 23.6; 95% CI, 4.4 to 126; P <.001). These same clinical variables of nonelective operations (OR, 7.7; 95% CI, 1.4 to 41.4; P =.017), oversewn T(9) to L(2) intercostal arteries (OR, 9.7; 95% CI, 1.5 to 61.2; P =.016), and postoperative renal failure (OR, 20.8; 95% CI, 3.0 to 142.1; P =.002) were independent predictors of SCI in the subgroup analysis of high-risk patients, ie, patients with type I/II TAA. CONCLUSION: EC has been effective in reducing immediate, devastating, total paraplegia after TAA repair. A strategy that combines the neuroprotective effect of regional cord hypothermia, avoiding the sacrifice of potential spinal cord blood supply, and postoperative adjuncts (eg, avoidance of hypotension, CSF drainage) appears necessary to minimize SCI after TAA repair.

Violence in the lives of pregnant teenage women: associations with multiple substance use.

Using data from a consecutive sample of approximately 700 prenatal patients aged 12 to 19, the extent of violence and substance use in the lives of these women was examined, as were associations between violence and substance use. The findings show that 29% of the study participants had been victims of violence, with 15% experiencing physical violence only, 5% sexual violence only, and 9% both physical and sexual violence. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression analyses showed that, after controlling for confounding factors, victims were more likely than nonvictims to use cigarettes, alcohol, and illicit drugs, with victims of both physical and sexual violence being the most likely to use each type of substance. Ordinal logistic regression analysis found that, compared to nonvictims, violence victims were more likely to have more severe patterns of substance use (use multiple types of substances), with victims of both physical and sexual violence being the most likely to be multiple substance users. These findings underline the importance of both violence and substance use as health concerns among our youth.

A conserved LIM protein that affects muscular adherens junction integrity and mechanosensory function in Caenorhabditis elegans.

We describe here the molecular and functional characterization of the Caenorhabditis elegans unc-97 gene, whose gene product constitutes a novel component of muscular adherens junctions. UNC-97 and homologues from several other species define the PINCH family, a family of LIM proteins whose modular composition of five LIM domains implicates them as potential adapter molecules. unc-97 expression is restricted to tissue types that attach to the hypodermis, specifically body wall muscles, vulval muscles, and mechanosensory neurons. In body wall muscles, the UNC-97 protein colocalizes with the beta-integrin PAT-3 to the focal adhesion-like attachment sites of muscles. Partial and complete loss-of-function studies demonstrate that UNC-97 affects the structural integrity of the integrin containing muscle adherens junctions and contributes to the mechanosensory functions of touch neurons. The expression of a Drosophila homologue of unc-97 in two integrin containing cell types, muscles, and muscle-attached epidermal cells, suggests that unc-97 function in adherens junction assembly and stability has been conserved across phylogeny. In addition to its localization to adherens junctions UNC-97 can also be detected in the nucleus, suggesting multiple functions for this LIM domain protein.

The effect of implementing a more comprehensive screening for substance use among pregnant women in North Carolina.

OBJECTIVES: Substance use during pregnancy causes significant morbidity and mortality. Screening for substance use provides opportunity for intervention and treatment, but is often overlooked in prenatal care with today's fiscal climate and preconceived ideas about who uses substances. The purpose of this study was to determine the effect of implementing a more comprehensive screening procedure for identifying substance-using pregnant women. METHODS: Two hundred randomly selected prenatal patients screened using the old procedure for substance use during pregnancy were compared to 400 randomly selected patients screened after implementation of a new, more detailed screening procedure. The old screening approach included three check-boxes concerning substance use during pregnancy: one for "Smoking/alcohol," one for "Drug use (any)," and one for "Drug addiction/alcoholism." The new screening procedure included more detailed questions about the frequency of cigarette, alcohol, and illegal drug use during pregnancy. RESULTS: Compared with the old approach, the new screening protocol increased reporting of smoking/alcohol use from 21% to 72% (relative risk = 2.63, 95% confidence interval = 2.231, 3.108); reporting of any drug use from 12% to 18% (relative risk = 1.07, 95% confidence interval = 1.002, 1.150); and reporting of alcoholism/drug abuse from 0% to 6% (relative risk = 1.06, 95% confidence interval = 1.038, 1.090). CONCLUSIONS: Our study suggests that more detailed screening using direct questions concerning the amount and frequency of substance use increases reporting of prenatal substance use as compared to screening approaches using only "yes/no" style check boxes.

Systematic review of risk factors for urinary tract infection in adults with spinal cord dysfunction.

Recurrent urinary tract infections (UTIs) occur frequently in persons with neurogenic bladders due to spinal cord dysfunction, resulting in increased morbidity and cost. The authors conducted a systematic review to identify risk factors for UTI using controlled clinical trials, cohort, and cross-sectional studies that assessed risk factors for UTI and included bacteriuria or UTI as an outcome. Twenty-two studies met the inclusion criteria. Quality assessment revealed important methodological deficiencies. Two studies provide evidence supporting increased bladder residual volume as a risk factor. Most of the retrieved studies investigated method of drainage with the consistent finding that persons using intermittent catheterization had fewer infections than those with indwelling catheters. There is conflicting evidence over the value of sterile or "no touch" catheter techniques compared with clean intermittent catheterization. There is insufficient evidence to assess risk due to psychosocial, behavioral, and hygiene factors; sex; level of function; and time since injury.

Gene-trapping to identify and analyze genes expressed in the mouse hippocampus.

Mice harboring random gene-trap insertions of a lacZ (beta-galactosidase)-neomycin resistance fusion cassette (beta-geo) were analyzed for expression in the hippocampus. In 4 of 15 lines reporter gene activity was observed in the hippocampal formation. In the obn line, enzyme activity was detected in the CA1-3 hippocampal subfields, in hpk expression was restricted to CA1, but in both lines reporter activity was also present in other brain regions. In the third line, kin, reporter activity was robustly expressed throughout the stratum pyrimidale of CA1-3, with only low-level expression elsewhere. The final line (glnC) displayed ubiquitous expression of the reporter and was not analyzed further. Fusion transcripts for the first three lines were characterized; all encode polypeptides with features of membrane-associated signalling proteins. The obn fusion identified a human cDNA (B2-1) encoding a pleckstrin homology (PH) domain, while hpk sequences matched the Epstein-Barr Virus (EBV) inducible G-protein coupled receptor, EBI-1. kin identified an alternative form of the abl-related nonreceptor tyrosine kinase c-arg. Electrophysiological studies on mice homozygous for the insertions revealed normal synaptic transmission, paired pulse facilitation and paired-pulse depression at Schaffer collateral-commissural CA1 synapses, and normal long-term potentiation (LTP) in obn and kin. hpk mice displayed an increase in hippocampal CA1 long-term potentiation (LTP), suggesting a role for this receptor in synaptic plasticity.

Heat-related illnesses.

Heat-related illnesses cause 240 deaths annually. Although common in athletes, heat-related illnesses also affect the elderly, persons with predisposing medical conditions and those taking a variety of medications. Symptoms range from mild weakness, dizziness and fatigue in cases of heat edema, to syncope, exhaustion and multisystem complications, including coma and death, in cases of heat stroke. Milder heat-related symptoms can be treated with hydration, rest and removal from the hot environment. Heat stroke, a life-threatening problem, must be treated emergently. Prompt recognition is critical since rapid cooling is the cornerstone of treatment and must not be delayed. Fluid resuscitation with dextrose and normal or half-normal saline is also important. These therapies should be instituted while the patient is being stabilized. Heat illness may be prevented by recognizing which individuals are at risk, using appropriate hydration and paying attention to acclimatization and environmental conditions. Preventive care should include drinking plenty of fluids before, during and after activities, gradually increasing the time spent working in the heat and avoiding exertion during the hottest part of the day.

Geriatric evaluation is a useful adjunct to traditional medical care of the frail older patient.

GEMU evaluation is most helpful in complicated cases where frail elderly patients appear likely to require custodial nursing home care in the near future. The best results and most significant reductions in subsequent mortality have occurred in less ill or more recently debilitated elders with a reasonable chance of returning to modified self-care in the home or in assisted living situations. Adapting these principles in an effective, cost-efficient manner for outpatient care is the focus of the majority of current investigations of CGA/GEM. Unfortunately, this option will not be universally available even after the proper parameters for its use are determined. Furthermore, better geriatric assessment and earlier intervention could logically prevent or forestall the patient's functional decline, dependency, and the need for placement. Toward that goal, the reader is referred to a practical guide to efficient outpatient geriatric assessment for general internists and other primary care providers, published by Dr. D.B. Reuben in 1996. A number of questionnaires and rapid screening techniques are included, which make these assessments less cumbersome and thus feasible in this era of austere Medicare reimbursement. However, when managing the care of outpatients with multiple impediments to independent living or hospitalized patients who are partially dependent upon others and are likely to require nursing home placement at (or shortly after) discharge, careful consideration should be given to referral for formal GEM, even if travel to a metropolitan area is required.

Results of an oral rabies vaccination program for coyotes.

OBJECTIVE: To determine effectiveness of large-scale distribution of an oral rabies vaccine contained in a palatable bait for halting expansion of a canine rabies epizootic in coyotes (Canis latrans). DESIGN: Prospective study. ANIMALS: 98 coyotes during prevaccination surveillance and 449 coyotes and 60 other wild animals during postvaccination surveillance. PROCEDURE: A vaccinia recombinant oral rabies vaccine was inserted into an edible bait for coyotes that also contained tetracycline as a biomarker. Vaccine units were then distributed via aircraft, using automated distribution equipment and flight plans developed by incorporating global positioning system equipment. The target area was along the northern edge of an area that had an epizootic of canine rabies. This area was identified through previously conducted epidemiologic surveillance of rabies cases. During postvaccination surveillance, dental specimens were examined for biomarker evidence of bait acceptance, and serum samples were analyzed for rabies neutralizing antibodies. RESULTS: Samples from 449 coyotes were obtained during postvaccination surveillance. Seroconversion was detected in 39 of 96 (40.6%) coyotes that had evidence of tetracycline biomarker. Additionally, the number of rabies cases in the target area decreased, and expansion of the epizootic area ceased. CLINICAL IMPLICATIONS: Mass distribution of an oral rabies vaccine in a palatable bait is an effective means to halt expansion of a rabies epizootic involving coyotes.

Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries.

CONTEXT: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and enhance outcomes, but knowledge of the prognostic importance of the initial electrocardiogram (ECG) is limited. OBJECTIVE: To assess the independent value of the initial ECG for short-term risk stratification after acute myocardial infarction. DESIGN: Retrospective analysis of the Global Utilization of Streptokinase and t-PA (alteplase) for Occluded Coronary Arteries (GUSTO-I) clinical trial database. SETTING: A total of 1081 hospitals in 15 countries. PATIENTS: From the 41 021 patients enrolled in the overall study, we selected those who presented within 6 hours of chest pain onset with ST-segment elevation and no confounding factors (paced rhythms, ventricular rhythms, or left bundle-branch block) on the ECG performed before thrombolysis was administered (n=34 166). MAIN OUTCOME MEASURE: Ability of initial ECG to predict all-cause mortality at 30 days. RESULTS: Most ECG variables were associated with 30-day mortality in a univariable analysis. In a multivariable analysis combining the initial ECG variables and clinical predictors of mortality, the sum of the absolute ST-segment deviation (both ST elevation and ST depression: odds ratio [OR], 1.53; 95% confidence interval [CI], 1.38-1.69), ECG, heart rate (OR, 1.49; 95% CI, 1.41-1.59), QRS duration (for anterior infarct: OR, 1.55; 95% CI, 1.43-1.68), and ECG evidence of prior infarction (for new inferior infarct: OR, 2.47; 95% CI, 2.02-3.00) were the strongest ECG predictors of mortality. A nomogram based on the multivariable model produced excellent discrimination of 30-day mortality (C-index, 0.830). CONCLUSIONS: In patients presenting with myocardial infarction accompanied by ST-segment elevation, components of the initial ECG help predict 30-day mortality. This information should be valuable in early risk stratification, when the opportunity to reduce mortality is greatest, and may help in assessing outcomes adjusted for patient risk.

Molecular epidemiology of rabies epizootics in Texas.

BACKGROUND: Texas is in the midst of two independent epizootics of rabies, involving coyotes (Canis latrans) and domestic dogs (Canis familiaris) in southern Texas and grey foxes (Urocyon cinereoargenteus) in west central Texas. The domestic dog/coyote (DDC) and grey for (TF) rabies virus variants cannot be differentiated by antigenic typing with currently available monoclonal antibodies. These two variants also cannot be distinguished from a third variant, Sonora dog (SD) rabies, that is not enzootic in Texas, but occasionally occurs in animals along the western border with Mexico. OBJECTIVES: To determine a method for the differentiation of the DDC. TF and SD variants, which is essential for epidemiologic monitoring of the Oral Rabies Vaccination Program (ORVP), a program instituted to control rabies in coyotes and grey foxes in Texas. STUDY DESIGN: Primers complementary to nucleoprotein sequence of either the DDC or TF rabies virus permit specific reverse transcription and amplification by polymerase chain reaction. In addition, general primers, which recognize a broad range of rabies variants, used in conjunction with a restriction digest for the differentiation of DDC, TF of SD rabies virus were investigated. RESULTS AND CONCLUSIONS: Of 122 specimens tested with specific primers. 111 (91%) were specifically identified as either DDC (33 samples) or TF (78 samples). Overly stringent conditions, enzyme inhibitors, or limiting RNA may account for the 11 non-amplifications. Amplification of RNA under less stringent conditions, with primers recognizing a broad range of rabies variants followed by digestion with either restriction enzyme Desulfovibrio desulfuricans I (Dde I) or Haemophilus influenzae Rf. (HinfI), was used to identify the 11 isolates that did not amplify with specific primers (6 DDC, 4 TF and 1 SD). In addition to these 11 isolates, the less stringent method of amplification, followed by enzyme digestion has identified a total of 125 additional specimens (26 DDC, 94 TF and 5 SD) that were not tested by variant-specific amplification. These data provide a means to track the spread of the different rabies virus variants and allow the ORVP to plan its vaccine disbursement by defining the two epizootic boundaries.