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Several newer hormonal contraceptive agents have become available in recent years. Many of them are slight variations on previous agents. In this article, we review the advantages, side effects, and practical considerations of hormonal contraceptives approved in the last few years.

As a growing percentage of Americans will be reaching their elderly years in the next decade, the prevalence of osteoporosis and its effects will have an even greater impact on the healthcare system. Advancements in bone research and development of newer treatments have allowed for the establishment of more refined guidelines and a growing awareness of the need to prevent, screen, and diagnose osteoporosis. Thus, more women are now being screened with dual x-ray absorptiometry scans (DXA) than ever before. The importance of a true understanding of the test results obtained from such screening is paramount. In our institution, recommendations to consider a secondary evaluation are made by the DXA interpreters when the Z-score is low. Few, if any, studies have evaluated the rates of physician and patient adherence with specific recommendations provided on the bone density report.To assess compliance with such recommendations provided in DXA interpretations, we investigated the number of ordering providers who actually pursued these advisements.We found that among providers ordering DXAs, primary care providers did not pursue recommendations to pursue a secondary workup as often as their subspecialty counterparts. We also found a significant amount of vitamin D deficiency/insufficiency and primary hyperparathyroidism in the population evaluated.Primary care providers should be further educated on treatable secondary causes of osteoporosis as opposed to an often reflexive response of prescribing a pharmacological antiresportive agent without other consideration.

Replication of porcine circovirus type 2 (PCV2) in pigs, as measured by spliced capsid mRNA (Cap mRNA) and viral DNA, was investigated following experimental infection. Peripheral blood mononuclear cells (PBMCs), and tissue from bronchial lymph nodes (BLN), inguinal lymph nodes (ILN), tonsils, lungs, liver, kidneys, spleen and thymus from infected pigs on different days post-infection (DPI) were assessed. PCV2 replication differed dramatically between tissues from the same infected pig. The virus actively replicated in most tested tissues at 14DPI in association with increased PCV2 associated lesions and PCV2 antigen levels, although no clinical signs correlated with PCV2 associated disease were observed in infected pigs during the course of the study. The PCV2 Cap mRNA was detected only at 13DPI in PBMCs from infected pigs, suggesting replication of the virus in circulating blood is transient and not a major site for PCV2 replication in vivo. Evaluation of the Cap mRNA and viral DNA synthesis in T and B lymphocyte and monocyte populations from PBMCs and BLN at various intervals post-inoculation revealed replication of PCV2 in all cell subpopulations; however, viral replication in B lymphocytes was greater than observed in mononuclear cells isolated from BLN at 14DPI indicating that B lymphocytes may be an important cell population for PCV2 replication. These findings further our understanding of the cell types permissive for PCV2 replication and the pathogenesis of PCV2 infection in vivo.

Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs. Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds. Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)[.greaterequal] 30 from the general internal medicine clinics of a large tertiary care facility. Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period. AA women cited culture specific barriers to weight loss more so than did C women. AA women and C women also differed on how health care professionals could help them with weight loss. These findings have implications for nursing's role in the design of culturally relevant weight-loss programs.

Mycoplasma hyopneumoniae, the causative agent of swine enzootic pneumonia and a major component of the porcine respiratory disease complex, continues to confound swine producers despite control programmes worldwide. The disease is chronic and self-limiting, but the host is subject to immunopathological changes that potentiate respiratory disease associated with other pathogens. The response ofM. hyopneumoniaeto environmental stress is of interest because of its relevance to virulence mechanisms in other bacterial pathogens. One of these stressors, iron deprivation, is a prominent feature of the host innate immune response, and most certainly impacts growth of mycoplasmasin vivo. To study this, microarray technology was applied to the transcriptome analysis ofM. hyopneumoniaeduring iron deprivation. An array consisting of 632 of the 698 ORFs in the genome was used to compare the mRNA isolated from organisms grown under normal laboratory conditions with that from organisms subjected to iron deprivation with the chelator 2,2′-dipyridyl. This analysis identified 27 genes that were either up- or down-regulated in response to low-iron growth conditions (PM. hyopneumoniaecan respond to changes in environmental conditions, but the mechanism employed remains unknown.

Objective To characterize the association between infectious mononucleosis (IM), a frequent clinical manifestation of primary Epstein–Barr virus infection after childhood, and the risk for multiple sclerosis (MS). Methods We conducted a systematic review and meta-analysis of case–control and cohort studies of IM and MS. Results The combined relative risk of MS after IM from 14 studies was 2.3 (95% confidence interval, 1.7–3.0; p < 10−8). Potential sources of heterogeneity (ie, study design, MS definition, and latitude) barely influenced our results. Interpretation We conclude that Epstein–Barr virus infection manifesting as IM in adolescents and young adults is a risk factor for MS. Ann Neurol 2006; 59:499–503

The purpose of this study was to determine the effects of plasmid-mediated growth hormone releasing hormone (GHRH) supplementation on the clinical outcomes of pigs vaccinated against and challenged with either Mycoplasma hyopneumonia (M. hyo) and/or with porcine reproductive and respiratory syndrome (PRRS) virus. Before the first vaccination, pigs received a single i.m. injection of 0.625 mg of a porcine GHRH-expressing plasmid followed by electroporation of the injection site. Pigs were vaccinated at 2-wk intervals, challenged with either M. hyo and/or PRRS virus 2-wk after the second vaccination, and necropsied at 17 and 36 d after challenge. Clinical parameters associated with M. hyo challenge were improved with the GHRH treatment. Average daily gain between challenge and necropsy was improved (P = 0.04). Respiratory scores for M. hyo-challenged pigs tended to be lower in GHRH-treated animals compared to controls, and coughing scores were improved by the treatment (P = 0.01). Macroscopic lesions associated with M. hyo infection pneumonia were fewer in the group that received the GHRH-expressing plasmid. No differences between treatment groups in the macroscopic pneumonia associated with PRRS virus were observed. No differences in serum antibodies to M. hyo or PRRS virus were observed with GHRH treatment. Nevertheless, IgG in the bronchioalveolar lavage was increased by the GHRH treatment in M. hyo-challenged animals (P0.03). The results of this study suggest that GHRH supplementation before vaccination may enhance the protection against M. hyo-induced pneumonia and that a single dose of GHRH-expressing plasmid was sufficient to elicit an improved clinical outcome in this disease challenge model.

To determine whether there is an effect of the timing of vaccination on porcine circovirus type 2 (PCV-2) replication and PCV-2-associated lesions, 78 pigs were randomly assigned to eight groups: group 1 (10 pigs) was vaccinated with a commercial Mycoplasma hyopneumoniae vaccine at two and four weeks of age, group 2 (nine pigs) was vaccinated at four and six weeks of age, group 3 (10 pigs) at six and eight weeks of age and group 4 (10 pigs) at eight and 10 weeks of age; group 5 (nine pigs) was vaccinated once with a double dose at four weeks of age, and group 6 (10 pigs) was vaccinated once with a double dose at eight weeks of age. Groups 7 and 8, both of 10 pigs, were not vaccinated. At eight weeks of age, the pigs in groups 1 to 7 were inoculated with PCV-2. Fourteen days after they had been inoculated, the pigs in groups 1, 4 and 5 had significantly (P

International audience; Inflammation is an important manifestation of respiratory disease in domestic animals. The respiratory system is mucosal in nature and has specific defense mechanisms used to control invasion by microbes and environmental elements. Inflammation can be beneficial or detrimental to the host. This article broadly discusses the primary mediators and mechanisms of inflammation within the respiratory tract of domestic animals. The role of cells, chemokines, cytokines and mediators in both acute and chronic inflammation are addressed. The pathogenesis of the initial insult determines the type of inflammation that will be induced, whether it is acute, chronic or allergic in origin. Maintenance of the microenvironment of cytokines and chemokines is critical for pulmonary homeostasis. Uncontrolled inflammation in the respiratory tract can be life threatening to the animal. The understanding of the mechanisms of inflammation, whether due to microbes or through inappropriate immune activation such as those occurring with allergies, is required to develop successful intervention strategies and control respiratory disease in animals.

Bacterial pathogens undergo stress during host colonization and disease processes. These stresses result in changes in gene expression to compensate for potentially lethal environments developed in the host during disease. Mycoplasma hyopneumoniae colonizes the swine epithelium and causes a pneumonia that predisposes the host to enhanced disease from other pathogens. How M. hyopneumoniae responds to changing environments in the respiratory tract during disease progression is not known. In fact, little is known concerning the capabilities of mycoplasmas to respond to changing growth environments. With limited genes, mycoplasmas are thought to possess only a few mechanisms for gene regulation. A microarray consisting of 632 of the 698 open reading frames of M. hyopneumoniae was constructed and used to study gene expression differences during a temperature shift from 37°C to 42°C, a temperature swing that might be encountered during disease. To enhance sensitivity, a unique hexamer primer set was employed for generating cDNA from only mRNA species. Our analysis identified 91 genes that had significant transcriptional differences in response to heat shock conditions ( P < 0.01) with an estimated false-discovery rate of 4 percent. Thirty-three genes had a change threshold of 1.5-fold or greater. Many of the heat shock proteins previously characterized in other bacteria were identified as significant in this study as well. A proportion of the identified genes (54 of 91) currently have no assigned function.

Shared medical appointments (SMAs) are a new way to deliver woman-focused interdisciplinary care for midlife women. SMAs are a series of one physician to one patient encounters with other patient observers. The women's health physician addresses each woman's unique medical needs individually but in the context of a shared setting. The major focus is on delivering individual medical care with the benefits of additional time spent educating women patients and answering questions.

Pandemic influenza strains originate in nonhuman species. Pigs have an important role in interspecies transmission of the virus. We examined multiple swine-exposed human populations in the nation's number 1 swine-producing state for evidence of previous swine influenza virus infection.We performed controlled, cross-sectional seroprevalence studies among 111 farmers, 97 meat processing workers, 65 veterinarians, and 79 control subjects using serum samples collected during the period of 2002-2004. Serum samples were tested using a hemagglutination inhibition assay against the following 6 influenza A virus isolates collected recently from pigs and humans: A/Swine/WI/238/97 (H1N1), A/Swine/WI/R33F/01 (H1N2), A/Swine/Minnesota/593/99 (H3N2), A/New Caledonia/20/99 (H1N1), A/Panama/2007/99 (H3N2), and A/Nanchang/933/95 (H3N2).Using multivariable proportional odds modeling, all 3 exposed study groups demonstrated markedly elevated titers against the H1N1 and H1N2 swine influenza virus isolates, compared with control subjects. Farmers had the strongest indication of exposure to swine H1N1 virus infection (odds ratio [OR], 35.3; 95% confidence interval [CI], 7.7-161.8), followed by veterinarians (OR, 17.8; 95% CI, 3.8-82.7), and meat processing workers (OR, 6.5; 95% CI, 1.4-29.5). Similarly, farmers had the highest odds for exposure to swine H1N2 virus (OR, 13.8; 95% CI, 5.4-35.4), followed by veterinarians (OR, 9.5; 95% CI, 3.6-24.6) and meat processing workers (OR, 2.7; 95% CI, 1.1-6.7).Occupational exposure to pigs greatly increases workers' risk of swine influenza virus infection. Swine workers should be included in pandemic surveillance and in antiviral and immunization strategies.

Porcine reproductive and respiratory syndrome virus (PRRSV) continues to be responsible for financial losses in the swine industry worldwide. It remains undetermined whether genetic variability of the host in susceptibility to PRRSV exists and if this variability can be exploited to help control this important disease. The objective of this study was to determine if an in vitro flow cytometry (FACS) assay that detects the percentage of monocyte-derived macrophages (MDM) infected with PRRSV could be utilized to demonstrate genetic variability in the susceptibility between distinct lines of pigs. Over 400 growing pigs from six genetic lines maintained in a single commercial breeding herd were screened using an in vitro FACS assay. From this initial screening, two genetically diverse lines of pigs that were also divergent in their FACS results were selected for further study. An additional 264 pigs from these two lines were subsequently tested for in vitro susceptibility to PRRSV. As in the preliminary screening, the Large White line had significantly higher average percent positive MDM over the Duroc-Pietrain synthetic line. This report suggests a genetic component for susceptibility to PRRSV exists and that the in vitro assay may be useful in predicting the relative susceptibility to PRRSV in large groups of animals.

Mycoplasma hyopneumoniae, the cause of enzootic pneumonia, remains an important pathogen in the swine industry. This small, complex organism colonizes the ciliated cells of the respiratory tract, resulting in little exposure to the immune system. Confirming the presence ofM. hyopneumoniae, as well as identifying its role in respiratory disease and pneumonia, remains challenging to the veterinary profession. While culture of the organism remains the gold standard for identification, the use of serology, the polymerase chain reaction and various assays to detect the presence ofM. hyopneumoniaein tissue is common in diagnostic laboratories. Because of the roleM. hyopneumoniaeplays in increasing the severity of pneumonia associated with concurrent bacterial and viral infections, understanding the pathogenesis and diagnostic assays available is critical for developing effective intervention strategies to control respiratory disease on a herd basis.

Sixty-seven pigs were randomly assigned to four groups. Group 1 served as negative control pigs, group 2 pigs were inoculated with Mycoplasma hyopneumoniae (M. hyopneumoniae), group 3 pigs were dually-inoculated with M. hyopneumoniae and porcine circovirus type 2 (PCV2) and group 4 pigs were inoculated with PCV2. Dual-infected pigs had moderate dyspnea, lethargy, and reduced weight gain. The overall severity of PCV2- associated microscopic lesions in lung and lymphoid tissues were significantly (p

Monkeypox with extensive lesions was diagnosed in a prairie dog that was involved in a recent human outbreak of monkeypox in the Midwestern United States. Gross lesions included oral ulcers, pulmonary consolidation, enlarged cervical and thoracic lymph nodes, and multifocal, small, white umbilicated plaques in the gastrointestinal wall. Microscopic lesions were extensive in the lungs and consisted of fibrinonecrotic bronchopneumonia with vasculitis and poorly defined eosinophilic intracytoplasmic inclusion bodies in cells thought to be alveolar epithelial cells, histiocytes, and fibroblasts. Multifocal necrotizing lesions, often accompanied by myxedema, were also present in most of the other examined organs. Aggregates of pox viral particles were observed within lesions by transmission electron microscopy. Monkeypox virus infection was confirmed by real-time polymerase chain reaction and virus culture at the Centers for Disease Control and Prevention. This report highlights the difficulties of rapid diagnosis of exotic or emerging diseases and further substantiates the prairie dog as an animal model of monkeypox.

Induction of the proinflammatory cytokines interleukin-1 (IL-1) (α and β), IL-6, IL-8, IL-10, IL-12, and tumor necrosis factor alpha (TNF-α) in pulmonary alveolar macrophages (PAMs) was assessed following experimental infection with porcine reproductive and respiratory syndrome virus (PRRSV) and/orMycoplasma hyopneumoniaeby using in vivo and in vitro models. The in vivo model consisted of pigs infected with PRRSV and/orM. hyopneumoniaeand necropsied at 10, 28, or 42 days postinfection. Pigs infected with both pathogens had a greater percentage of macroscopic lung lesions, increased clinical disease, and slower viral clearance than pigs infected with either pathogen alone. The pigs infected with both PRRSV andM. hyopneumoniaehad significantly increased levels of mRNA for many proinflammatory cytokines in PAMs collected by bronchoalveolar lavage (BAL) at all necropsy dates compared to those in uninfected control pigs. Increased levels of IL-1β, IL-8, IL-10, and TNF-α proteins in BAL fluid, as measured by enzyme-linked immunosorbent assay, confirmed the increased cytokine induction induced by the pathogens. An in vitro model consisted ofM. hyopneumoniae-inoculated tracheal ring explants cultured with PRRSV-infected PAMs. PAMs were harvested at 6 or 15 h postinfection with either or both pathogens. The in vitro study detected increased IL-10 and IL-12 mRNA levels in PAMs infected with PRRSV at all time periods. In addition, IL-10 protein levels were significantly elevated in the culture supernatants in the presence ofM. hyopneumoniae-inoculated tracheal ring explants. The increased production of proinflammatory cytokines in vivo and in vitro associated with concurrentM. hyopneumoniaeand PRRSV infection may play a role in the increased rates of pneumonia associated with PRRSV infection. The increased levels of IL-10 may be a possible mechanism that PRRSV andM. hyopneumoniaeuse to exacerbate the severity and duration of pneumonia induced by PRRSV and modulate the respiratory immune response.

Although alternatives exist, hormone therapy remains the most effective treatment for menopausal symptoms such as hot flashes, and it is the only treatment approved by the US Food and Drug Administration (FDA) for this indication. The FDA recommends using the lowest effective dose of hormones. New low-dose preparations and new dosage forms of hormone therapy are available.

Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), is characterized by physical and behavioral symptoms that cause marked social impairment during the last half of the menstrual cycle. Symptoms are believed to result from the interaction of central neurotransmitters and normal menstrual hormonal changes. Treatment usually begins with lifestyle changes, over-the-counter medications, and if needed, selective serotonin reup-take inhibitors. Physicians should be aware of the risks of many of the alternative therapies commonly touted in the popular press.

The complement fixation (CF) test is the current reference serologic test for the diagnosis of Mycoplasma pneumoniae infection. However, it is reported to be insensitive and nonspecific, and it is labor intensive. To determine if a faster and more sensitive diagnosis of M. pneumoniae could be obtained, we examined 50 paired serum samples from patients with suspected M. pneumoniae infection by the CF test and two commercial rapid antibody detection kits, the Remel M. pneumoniae immunoglobulin G (IgG)-IgM antibody test system (Remel, Lenexa, Kans.) and the Seradyn Color Vue M. pneumoniae IgG-IgM kit (Seradyn, Indianapolis, Ind.). The Remel test, a 5-min qualitative immunobinding assay, detected antibodies in three patient serum samples with CF titers of 32 and in all but one sample with titers of > or = 64. The Seradyn test, a 40-min qualitative agglutination test, was less sensitive than CF or Remel. The Seradyn test was positive in 68% of cases, compared with 94 and 96% of cases tested by CF or Remel, respectively. Both commercial tests are faster and less technically demanding to perform than is the CF test.

We present an electronically tunable local oscillator from 630-675 GHz with upcoming extension to 600-720 GHz using a 13.33-16.00 GHz source followed by a /spl times/45 multiplier chain. Output power measurements show >30 /spl mu/W from 630-675 GHz. FTS and receiver noise measurements using this LO are also presented.

The objective of this study was to determine whether vaccination with bacterins commonly used in the USA, when administered at a time typical of US protocol, enhances porcine circovirus type 2 (PCV2) replication and the incidence and severity of clinical signs and lesions characteristic of postweaning multisystemic wasting syndrome (PMWS) in conventional pigs. Sixty-one pigs free of PCV2 were randomly assigned to four groups. Groups 1 ( n = 15) and 2 ( n = 15) pigs served as sham-inoculated negative controls. Groups 3 ( n = 14) and 4 ( n = 17) pigs were inoculated intralymphoid with PCV2 field isolate ISU-40895. Pigs in groups 2 and 4 were vaccinated with Actinobacillus pleuropneumoniae (APP) and Mycoplasma hyopneumoniae ( M. hyopneumoniae) bacterins 21 days before and again 1 day before inoculation with PCV2. Mild transient respiratory disease and diarrhea were observed from 13 to 34 days postinoculation (DPI) in pigs in groups 3 and 4. Half the pigs from each group were necropsied at 22 and 34 DPI, respectively. Moderately enlarged, tan-colored lymph nodes were observed in the majority of pigs in groups 3 and 4. There was a significantly ( P < 0.05) longer length of viremia (2.14 ± 0.26 versus 4.44 ± 0.23 weeks), a higher copy number of the PCV2 genome in serum, a wider range of tissue distribution of PCV2 antigen, and an increased severity of lymphoid depletion in pigs vaccinated with commercial APP and M. hyopneumoniae vaccines and inoculated with PCV2 compared with PCV2-inoculated unvaccinated pigs. Swine producers and veterinarians may need to consider changes in vaccination protocols in herds with recurrent PCV2-associated PMWS.

In countries with high HIV rates, diagnosis of lower respiratory disease etiology is both challenging and clinically important.To determine the etiology of lower respiratory tract disease among persons with suspected tuberculosis (TB) and abnormal chest X-rays in a setting with very high HIV seroprevalence.Cross-sectional prevalence data from a prospective cohort of predominantly hospitalized adults with suspected TB in Botswana, January-December 1997.Of 229 patients, 86% were HIV-positive and 71% had a pathogen identified. TB was confirmed in 52%, 17% had acute mycoplasma pneumonia, 3% had Pneumocystis carinii, 27% grew a bacterial pathogen from sputum and 8% from blood. Ninety-four per cent of TB diagnoses were made through expectorated sputum and only 5% of TB cases were diagnosed by sputum induction alone. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis had positive and negative predictive values of 94% and 59%, respectively. Male sex, cough2 weeks, and tuberculin skin testor = 5 mm were independently associated with culture-positive TB among persons with negative acid-fast bacilli smears. Co-infection with two or more pathogens occurred in 25%.Mycoplasma pneumoniae infection was quite common despite clinical suspicion of TB, and sputum induction and PCR did not significantly improve our ability to diagnose TB, although clinical presentation had some predictive value.

Agouti-related protein (AGRP) and proopiomelanocortin (POMC) genes encode secreted hypothalamic factors regulated by metabolic state in mammals and are involved in energy homeostasis. The zebrafish, Danio rerio, is a model system for forward genetics in verte-brates: POMC and AGRP in this organism have not been well characterized. Toward this end, AGRP and POMC were cloned from zebrafish. Zebrafish AGRP cDNA encodes a 127-amino-acid protein 36% and 40% identical to human and mouse AGRP, respectively. Zebrafish POMC cDNA encodes a 222-amino-acid preprohormone. Sequence identity to the mammalian ortholog is about 50%. Zebrafish AGRP and POMC transcripts were detected at 24 h post-fertilization (hpf) by RTPCR, and in situ hybridization demonstrated zebrafish AGRP mRNA exclusively in hypothalamus and POMC mRNA in hypothalamus and pituitary. Fasting did not alter POMC transcript levels, while AGRP transcripts were significantly upregulated. The ratio of AGRP/POMC transcripts in adult brain was increased up to threefold by fasting. These results demonstrate that the melanocortin system is regulated by metabolic state in zebrafish, and this finding thus provides a vertebrate system for the genetic analysis of the role of the melanocortin system in energy homeostasis.

By anticipating issues of mobility, physicians can help older women lead more independent and satisfying lives. Osteoarthritis is a major cause of physical disability in older women. Aerobic exercise, resistance training, and judicious analgesic use can be well-tolerated interventions that reduce pain and disability. Reducing the risk of injurious falls is paramount given the prevalence of osteoporosis. Interventions that may reduce fall risk include minimizing the use of sedative-hypnotic agents, providing training in transfer skills (balance and gait training), and adapting the home environment.

The importance of statins for the prevention and treatment of coronary artery disease (CAD), the recent paradoxical effects of hormone replacement therapy on prevention of CAD, and the role of nontraditional risk factors in CAD in women are examined.

The water vapor monitoring system (WVMS) is a ground based broad band microwave (22.235 GHz) radiometer that analyzes emission spectra from the mesosphere to determine water vapor mixing ratios. This paper emphasizes the technical details of the instrument, experimental techniques, comparison of alternate techniques, and especially accuracy and calibration issues. >

Although the results of the Women's Health Initiative showed an increased risk of breast cancer in women taking hormone replacement therapy (HRT), the absolute risk is very low. We discuss limitations of the study, questions that remain, and how to discuss the study with women at average risk and high risk for breast cancer.

As women live longer and anticipate good health during their later years, cancer screening becomes increasingly complex. Physicians receive discordant recommendations from medical societies, task forces, Medicare, and special interest groups about which cancers merit screening, how screening should be performed, the frequency of screening, and when screening should be discontinued. Female patients may receive confusing recommendations from their friends, the lay press, the Internet, and their own doctors. Given the proliferation of opinions and the limited data regarding the efficacy of cancer screening in older women, physicians must help their patients understand the potential benefits, limitations, and consequences of various cancer screenings for each individual woman.

The Women's Health Initiative found that the risks of hormone replacement therapy (HRT) exceeded its benefits in a large group of older postmenopausal women, but did not consider the efficacy of HRT in relieving vasomotor symptoms. Another recent study found that low-dose HRT was as effective as standard-dose HRT while causing fewer side effects. Smaller studies suggest that HRT may improve depression. HRT is not to be used for cardiovascular risk reduction. Genetic testing may point the way to more rational use of HRT.

Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the incidence of fracture is higher in women than in men. Risk factors for osteoporotic fractures in postmenopausal women include family history of bone fracture, ethnicity, and weight127 pounds. Densitometry is used to diagnose osteoporosis and can be performed at intervals to monitor bone density during treatment. The older woman's diet should, in general, include 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D. Estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and exogenous parathyroid hormone are pharmacologic therapy options that can preserve and increase bone mass and reduce the risk of fracture.

We investigated the effects of intact pathogenic Mycoplasma hyopneumoniae , nonpathogenic M. hyopneumoniae , and Mycoplasma flocculare on intracellular free Ca 2+ concentrations ([Ca 2+ ] i ) in porcine ciliated tracheal epithelial cells. The ciliated epithelial cells had basal [Ca 2+ ] i of 103 ± 3 nM ( n = 217 cells). The [Ca 2+ ] i increased by 250 ± 19 nM ( n = 47 cells) from the basal level within 100 s of the addition of pathogenic M. hyopneumoniae strain 91-3 (300 μg/ml), and this increase lasted ∼60 s. In contrast, nonpathogenic M. hyopneumoniae and M. flocculare at concentrations of 300 μg/ml failed to increase [Ca 2+ ] i . In Ca 2+ -free medium, pathogenic M. hyopneumoniae still increased [Ca 2+ ] i in tracheal cells. Pretreatment with thapsigargin (1 μM for 30 min), which depleted the Ca 2+ store in the endoplasmic reticulum, abolished the effect of M. hyoneumoniae . Pretreatment with pertussis toxin (100 ng/ml for 3 h) or U-73122 (2 μM for 100 s), an inhibitor of phospholipase C, also abolished the effect of M. hyopneumoniae . The administration of mastoparan 7, an activator of pertussis toxin-sensitive proteins G i and G o , increased [Ca 2+ ] i in ciliated tracheal cells. These results suggest that pathogenic M. hyopneumoniae activates receptors that are coupled to G i or G o , which in turn activates a phospholipase C pathway, thereby releasing Ca 2+ from the endoplasmic reticulum. Thus, an increase in Ca 2+ may serve as a signal for the pathogenesis of M. hyopneumoniae .

To determine whether recipient HLA phenotypes are correlated with an increased or decreased risk of alloantibody sensitization in end-stage renal disease (ESRD) candidates for first or repeat kidney transplantation; we analyzed 19440 kidney allograft recipients consisting of 13,216 Caucasians and 6224 non-Caucasians transplanted between 10/87 and 11/98 at South-Eastern Organ Procurement Foundation (SEOPF) member institutions. Relative risk values and 95% confidence limits were obtained using Wolfe's method. Logistic regression was used to adjust for covariates that influence sensitization, i.e. ethnicity, gender, age, pregnancies, transfusions, primary/repeat transplant and living versus cadaver donor. Univariate analysis of the entire cohort indicated that nine HLA allelotypes (DR1,4,7; B8,12,40; A1,2,11) were associated with a significantly reduced risk of sensitization, and five allelotypes (B42,B53; A 10,19,36) were associated with an increased risk of PRA responses. Corrected for the number of statistical comparisons, recipients with DR1, DR4, A1 or A2 were 15% less likely to be sensitized per allelotype. Recipients with B42, B53 or A36 were at increased risk of preformed antibodies, after correction of the P value, for an average of 38% increased risk per allelotype. In the multivariate analysis, HLA phenotypes identified as independent risk factors associated with protection against sensitization were DR1,4,7; B12(44,45); and A1,2, with an average reduced risk of 9% per allelotype. The only independent susceptibility allelotype was A36 with an increased risk of 29%. The A10 (25,26,34,66) group reached borderline significance. We also looked for HLA-DR,-B,-A combinations that could potentially represent protective or at risk haplotypes/genotypes. Stepwise logistic regression identified five combinations associated with protection: DR1-B35-A3; DR1-B35-A2; DR1-B44-A2; DR4-B44-A2; DR7-B57-A1 (RR range 0.83-0.63) with 27% average reduced risk per combination. Phenotype combinations associated with an increased risk of sensitization were: DR2-B44-A2; DR2B53-A2; DR3-B8-A1: DR3-B42-A30; DR6-B42-A30; DR11-B53-A30 (RR range 2.76-1.48) with an average increased risk of 70% per combination. This study provides strong evidence that HLA-linked genes influence the anti-HLA PRA response. The magnitude of the altered PRA response risk in DR-B-A combinations was approximately twice that of the allelotypes at individual loci. HLA-DR genes seemed to contribute most of the altered risk. The correlations between DR types and PRA responsiveness are consistent with the DR types previously regarded as predictors of kidney graft survival. The magnitude of increased PRA risk attributable to an allelotype or combination was approximately twice that associated with a decreased risk. We conclude that some HLA class II-linked genes modulate the PRA response in a clinically significant manner. This immune response gene (Ir) regulation probably operates through polymorphic HLA molecules in their physiologic roles of antigen processing and presentation to helper T cells.

Menopause is an excellent time to reassess a female patient’s health habits and the need for health maintenance measures.

Background & Aim: Sleep deprivation and poor quality sleep are associated with various metabolic derangements. A recent study revealed that sleep deprivation increases a risk of NAFLD. In this study, we aimed to assess whether sleep deprivation and poor quality sleep are associated with clinical and histologic features of NAFLD. Methods: We analyzed 689 adult patients with clinical diagnosis of NAFLD who were enrolled in the Duke NAFLD Clinical Database study and had liver biopsy. Information on demography, body mass index (BMI), co-morbidity, laboratory data, current sleep duration and sleep difficulty was collected at the time of biopsy. Liver biopsies were scored for steatosis, lobular inflammation, ballooning, portal inflammation, and fibrosis according to the NASH CRN scoring system. Sleep deprivation was defined as self-reported sleep less than 7 hours per day, while sleep difficulty was defined by either physician's diagnosis or answering yes to at least one of the 4 screening questions for sleep difficulty. Sleep apnea was defined by physician's diagnosis. Sleep duration, sleep difficulty and sleep apnea were then associated with BMI, serum uric acid, presence of diabetes or glucose intolerance (DM/GI), hypertension (HTN), and hyperlipidemia (HL), and histologic grades/stage of NAFLD using Chi-square tests, ANOVA, and multiple linear (logistic) regression models. Results: Average and SD of age and BMI were 48±11 years and 40±10 kg/m2 in this population. 33% were men, 83% Caucasian. 82% had histologic diagnosis of NAFLD while the rest had minimal histologic findings. 22% had advanced fibrosis. Sleep deprivation, sleep difficulty, and sleep apnea were noted in 35.5%, 67%, and 41% of the population. After adjusting for age, gender, and other sleep conditions, sleep deprivation was associated with a higher serum uric acid (p

Background Databases of medical claims can be valuable resources for cardiovascular research, such as comparative effectiveness and pharmacovigilance studies of cardiovascular medications. However, claims data do not include all of the factors used for risk stratification in clinical care. We sought to develop claims-based algorithms to identify individuals at high estimated risk for coronary heart disease (CHD) events, and to identify uncontrolled low-density lipoprotein (LDL) cholesterol among statin users at high risk for CHD events. Methods We conducted a cross-sectional analysis of 6,615 participants ≥66 years old using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study baseline visit in 2003–2007 linked to Medicare claims data. Using REGARDS data we defined high risk for CHD events as having a history of CHD, at least 1 risk equivalent, or Framingham CHD risk score >20%. Among statin users at high risk for CHD events we defined uncontrolled LDL cholesterol as LDL cholesterol ≥100 mg/dL. Using Medicare claims-based variables for diagnoses, procedures, and healthcare utilization, we developed algorithms for high CHD event risk and uncontrolled LDL cholesterol. Results REGARDS data indicated that 49% of participants were at high risk for CHD events. A claims-based algorithm identified high risk for CHD events with a positive predictive value of 87% (95% CI: 85%, 88%), sensitivity of 69% (95% CI: 67%, 70%), and specificity of 90% (95% CI: 89%, 91%). Among statin users at high risk for CHD events, 30% had LDL cholesterol ≥100 mg/dL. A claims-based algorithm identified LDL cholesterol ≥100 mg/dL with a positive predictive value of 43% (95% CI: 38%, 49%), sensitivity of 19% (95% CI: 15%, 22%), and specificity of 89% (95% CI: 86%, 90%). Conclusions Although the sensitivity was low, the high positive predictive value of our algorithm for high risk for CHD events supports the use of claims to identify Medicare beneficiaries at high risk for CHD events.

The objective of this article is to summarize the current state of knowledge of the complex interaction of porcine reproductive and respiratory syndrome virus (PRRSV) and porcine pulmonary intravascular macrophages (PIMs). PIMs play an important role in pulmonary surveillance, and in the past few years we have investigated their role in PRRSV infection. PRRSV antigens and nucleic acids have been demonstrated in PIMs bothin vitroandin vivo. Examination of cultured PIMs infected with PRRSV revealed the accumulation of viral particles in the smooth-walled vesicles. PRRSV-infected PIMsin vitroyielded a virus titer similar to pulmonary alveolar macrophages. PRRSV infection induces either apoptosis or cell lysis of PIMs. Thein vitrobactericidal activity of PRRSV-infected PIMs is significantly decreased. Phagocytic activity of PIMs, as measured by pulmonary copper clearance, is significantly decreased in PRRSV-infected pigs. This evidence supports the hypothesis that PRRSV-induced damage to PIMs results in increased susceptibility to bacteremic diseases. Recent studies with PRRSV andStreptococcus suiscoinfection confirmed that PRRSV predisposes pigs toS. suisinfection and bacteremia. These results could explain the increase in bacterial respiratory diseases and septicemias observed in PRRSV-infected pigs.

Decisions to begin or continue hormone replacement therapy (HRT) are individualized, depending on a woman's anticipated benefits and risks from HRT. Estrogen, especially when begun early in menopause, has been shown to be beneficial in the prevention and treatment of osteoporosis. Potential risks of HRT include gallbladder disease, thromboembolism, and breast cancer. Systemic or topical estrogen can improve postmenopausal vaginal atrophy, vasomotor symptoms, and cervical cytologic changes. Treatment of other urogynecologic changes, such as vulval dystrophy and urinary incontinence, can relieve symptoms and improve the older woman's quality of life.

Life expectancy of women is greater than that of men at every age. Thus, an older woman is more likely than a man to be living without a spouse and living alone. It is important in caring for an older woman to establish how well she is functioning physically and cognitively and in what activities she may need assistance. Given the high prevalence of dementia with advanced age, screening for dementia should be considered in women over age 75. Although their risk of suicide is lower, older women are more likely to be depressed than older men, regardless of race, ethnic background, or economic status. Late-life depression is treatable, and screening should be considered in the presence of a major life change, recent stroke, or MI.