Effects of hindgut acidosis on metabolism, inflammation, and production in dairy cows consuming a standard lactation diet.

Postruminal intestinal barrier dysfunction caused by excessive hindgut fermentation may be a source of peripheral inflammation in dairy cattle. Therefore, the study objectives were to evaluate the effects of isolated hindgut acidosis on metabolism, inflammation, and production in lactating dairy cows. Five rumen-cannulated lactating Holstein cows (32.6 ± 7.2 kg/d of milk yield, 242 ± 108 d in milk; 642 ± 99 kg of body weight; 1.8 ± 1.0 parity) were enrolled in a study with 2 experimental periods (P). During P1 (4 d), cows were fed ad libitum a standard lactating cow diet (26% starch dry matter) and baseline data were collected. During P2 (7 d), all cows were fed the same diet ad libitum and abomasally infused with 4 kg/d of pure corn starch (1 kg of corn starch + 1.25 L of H2O/infusion at 0600, 1200, 1800, and 0000 h). Effects of time (hour relative to the first infusion or day) relative to P1 were evaluated using PROC MIXED in SAS (version 9.4; SAS Institute Inc.). Infusing starch markedly reduced fecal pH (5.84 vs. 6.76) and increased fecal starch (2.2 to 9.6% of dry matter) relative to baseline. During P2, milk yield, milk components, energy-corrected milk yield, and voluntary dry matter intake remained unchanged. At 14 h, plasma insulin and ß-hydroxybutyrate increased (2.4-fold and 53%, respectively), whereas circulating glucose concentrations remained unaltered. Furthermore, blood urea nitrogen increased at 2 h (23%) before promptly decreasing below baseline at 14 h (13%). Nonesterified fatty acids tended to decrease from 2 to 26 h (40%). Circulating white blood cells and neutrophils increased on d 4 (36 and 73%, respectively) and somatic cell count increased on d 5 (4.8-fold). However, circulating serum amyloid A and lipopolysaccharide-binding protein concentrations were unaffected by starch infusions. Despite minor changes in postabsorptive energetics and leukocyte dynamics, abomasal starch infusions and the subsequent hindgut acidosis had little or no meaningful effects on biomarkers of immune activation or production variables.

Energetic metabolism, milk production, and inflammatory response of transition dairy cows fed rumen-protected glucose.

Objectives were to evaluate the effects of rumen-protected glucose (RPG) supplementation on milk production, post-absorptive metabolism, and inflammatory biomarkers in transition dairy cows. Fifty-two multiparous cows were blocked by previous 305-d mature-equivalent milk (305ME) yield and randomly assigned to 1 of 2 iso-energetic and iso-nitrogenous treatments: (1) control diet (CON; n = 26) or (2) a diet containing RPG (pre-fresh 5.3% of dry matter and 6.0% of dry matter postpartum; n = 26). Cows received their respective dietary treatments from d -21 to 28 relative to calving, and dry matter intake was calculated daily during the same period. Weekly body weight, milk composition, and fecal pH were recorded until 28 d in milk (DIM), and milk yield was recorded through 105 DIM. Blood samples were collected on d -7, 3, 7, 14, and 28 relative to calving. Data were analyzed using repeated measures in the MIXED procedure (SAS Institute Inc., Cary, NC) with previous 305ME as a covariate. Fecal pH was similar between treatments and decreased (0.6 units) postpartum. Dry matter intake pre- and postpartum were unaffected by treatment, as was milk yield during the first 28 or 105 DIM. Milk fat, protein, and lactose concentration were similar for both treatments. Blood urea nitrogen and plasma glucose concentrations were unaffected by treatment; however, results showed increased concentration of circulating insulin (27%), lower nonesterified fatty acids (28%), and lower postpartum ß-hydroxybutyrate (24%) in RPG-fed cows. Overall, circulating lipopolysaccharide-binding protein and haptoglobin did not differ by treatment, but at 7 DIM, RPG-fed cows had decreased lipopolysaccharide-binding protein and haptoglobin concentrations (31 and 27%, respectively) compared with controls. Supplemental RPG improved some biomarkers of post-absorptive energetics and inflammation during the periparturient period, changes primarily characterized by increased insulin and decreased nonesterified fatty acids concentrations, with a concomitant reduction in acute phase proteins without changing milk production and composition.

Mental health outcomes at age 11 of very low birth weight infants in Ireland.

Aim To compare mental health (MH) outcomes of and service use by children born under 1500 g in Ireland with a matched control group. METHOD: Using a retrospective cohort design, semi-structured and standardised MH assessments were conducted with parents, teachers and youth. RESULTS: A total of 64 of 127 surviving children from a very low birth weight (VLBW) cohort from a National Maternity Hospital participated at a mean age of 11.6 years (s.d. 1.0), along with 51 matched controls. More VLBW children received clinical or borderline scores when rated by parents [χ 2 (1, n=114)=7.3, p=0.007] or youths [χ 2 (1, n=114)=4.83, p=0.028], but not by teachers [χ 2 (1, n=114)=1.243, p=0.463]. There was no increase in the use of MH services. A main effect of birth weight remained on the parent Strengths and Difficulties Questionnaire [F (1, 88)=5.07, p<0.05) after controlling for intelligence quotient (IQ) and socio-economic status (SES), but only on hyperactivity in males. SES, rather than IQ or birth weight, predicted identification of problems by teachers [F (1, 82)=6.99, p=0.01). Interpretations Teachers miss MH difficulties and are influenced more by SES than by IQ or birth weight. This has implications for MH service access. Initial perinatal investment needs to be matched with ongoing surveillance and psychoeducation to ensure that disorders are recognised early and offered appropriate interventions.

The risk and protective factors associated with depression and anxiety in a national sample of Irish adolescents.

OBJECTIVES: The aim of this study is to examine the risk and protective factors associated with anxiety and depression in a representative sample of Irish adolescents. METHODS: Data used in this study were drawn from a subset of the My World Survey (MWS). The MWS-Second Level (MWS-SL) subset consists of a randomised sample of 72 schools, with a final sample of 6085 students. Outcome measures were depression and anxiety. Risk and protective factors included measures within the socio-demographic, psychosocial and risk-taking domains. RESULTS: One in three adolescents experienced elevated levels of depression and anxiety. Age, gender, maternal education, family composition, parental mental health as well as the experience of racism and bereavement were associated with elevated distress. Psychosocial factors associated with depression and anxiety included optimism, personal competence, life-satisfaction, self-esteem, anger, body dissatisfaction, family competence, maternal and paternal criticism, experiencing the break-up of a romantic relationship, school and peer connectedness as well as the availability of one good adult. Finally, engaging in substance misuse was found to increase the likelihood of anxiety and depression. CONCLUSION: Since factors protecting and putting adolescents at risk of anxiety and depression exist at every level of the adolescent's ecological system, the study supports a community-based approach to youth mental health.

Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland.

OBJECTIVE: The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland. METHOD: Following ethical approval, clinicians in each of Ireland's four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition. RESULTS: A total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an 'on-going mental health service need', and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ 2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ 2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ 2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians. CONCLUSIONS: Despite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.

One size fits all? Gender as an issue in obesity.

This study investigated differences in the psychopathology of severely obese men and women in primary care in the North East of Ireland in comparison to clinical and community norms. One hundred thirty-eight participants (31.2% male and 68.8% female) were measured on eating disorders, depression, anxiety, self-concept and quality of life using standard self-report instruments. On the Eating Disorder Inventory, male and female scores on body dissatisfaction and female scores on bulimia were elevated to a degree that they did not differ significantly from clinical norms (P < 0.05). Female scores on the personal and social domains of self-concept fell significantly below community norms, whereas male scores on the same domains matched community levels. Significantly, more women than men scored in the severe range for depression and anxiety. Most female scores on the Eating Disorder Examination Questionnaire corresponded to clinical levels. Male participants reported higher quality of life overall. The findings suggest that gender differences should be considered regarding interventions, and that gender-specific treatment approaches might improve treatment outcomes. Moreover, screening for depression and anxiety ought to be part of obesity care for women.

Health locus of control and attributions of cause and blame in adjustment to spinal cord injury.

STUDY DESIGN: The Symptom Checklist 90 Revised (SCL-90-R) was used to assign participants to either a good adjustment group or a poor adjustment group. Group differences were analyzed with chi (2), t-tests and correlations on factors shown in previous research to be related to coping with spinal cord injury (SCI). OBJECTIVES: This study examines health locus of control (HLC) and attributions of cause and blame in relation to SCI. The replication of study findings in multiple settings is a cornerstone of the evidence base for developing interventions. Previous studies do not show a consensus on the role of attributions of cause and blame in persons with SCI. Similarly, their relationship to adjustment after SCI is unclear. Another attribution, HLC, is similarly analyzed in relation to adjustment. SETTING: Republic of Ireland. METHODS: Thirty people with SCI participated. They rated scales measuring psychological adjustment, locus of control (LOC) for health and attributions of cause and blame for the injury. RESULTS: The well-adjusted group had a less external HLC. In addition, participants who were well adjusted endorsed the notion they could have avoided their accident significantly more than the poorly adjusted group. Similarly, they rated the belief that they could have caused the accident at a somewhat greater level. They did not, however, blame themselves any more or any less. CONCLUSION: Results are consistent with general LOC theory, and suggest an adaptive or protective internal LOC for accepting responsibility for the injury.

Management of supracondylar fractures of the femur with Zickel supracondylar nails.

Twenty-one cases of supracondylar fracture of the femur treated at St Vincent's Hospital, Melbourne, during 1983-86, by intramedullary Zickel supracondylar nails were reviewed. The causes were high energy trauma in young patients (six), minor trauma in elderly patients (13), and metastatic malignant fracture (two). The functional results were considered excellent in 10, good in six and poor in five. There were two cases of superficial wound infection. All cases united after 3-6 months. The best functional results were in those patients below 60 years or with pathological fractures. It is concluded that internal fixation of supracondylar fractures of the femur with Zickel supracondylar nails is a successful technique and can be performed by open and closed methods. It is most useful in osteoporotic or pathological bone which is unsuitable for bone plating.

Folded free vascularized fibula transfer.

A technique of improved free vascularized fibula grafting for bone defects up to 15 cm in length is presented with three illustrative cases. By dividing a harvested free fibula graft at its midpoint without dividing its vascular pedicle, two vascularized bone lengths are produced that require only one set of anastomoses. This folded fibula provides twice the cross-sectional area of a single fibula transfer and allows biomechanically improved graft placement. This technique has been successfully used in long bone defects of the upper and lower limbs.

Medical significance of occupant restraint on road-crash victims and the role of the medical profession.

Compulsory use of seat belts has been the single most important measure in reducing the number of deaths and injuries on the road. Seat belts are most effective in reducing head and facial injuries in frontal impacts, but less so with side collisions and roll-overs. There should be no medical exemptions to the wearing of seat belts. There is little evidence that seat belts, if properly worn, cause serious injury. The reduction in road deaths and injuries applies only to car occupants: the number of deaths in motorcyclists closely parallels the number of motorcycles in use. Likewise, the pedestrian death rate remains unchanged.

Cortical bone grafts with muscle pedicles. An experimental study of survival and ability to bridge a bone gap.

A cortical bone graft on a muscle pedicle was taken from the ulna and transferred to bridge a complete defect of the radius in 16 dogs. In 14 control dogs a free graft was used, that is, one without a muscle pedicle. Union in the group with pedicle grafts was far superior to that in the group with free grafts, mainly because in those with pedicle grafts there was good subperiosteal new bone formation from active viable periosteum. In six of the pedicle grafts the viability of some osteocytes was retained over a 12-week period and in five the graft was almost completely replaced by new bone.

Total hip replacement combined with bone grafting for acetabular dysplasia causing severe osteoarthritis of the hip joint.

Over a 10 year period 18 total hip joint arthroplasties (THJA) were performed on 15 patients with disabling osteoarthritis of the hip joint secondary to congenital dislocation or subluxation. In all cases reconstruction of the deficient acetabulum was necessary in order to provide total bony containment of the acetabular prosthesis. This was achieved using a bone graft, fashioned from the femoral head and securing it above the true acetabulum. At follow-up all patients were pain free. Radiographically, there had been no loosening of the acetabular prosthesis and all grafts appear to have united. The operative technique is described in detail.