The early stages of the host response to infectious agents include a number of physiologic changes, collectively known as the acute phase response. The acute phase response is comprised of reactions localized at the site of infection, as well as the initiation of systemic responses, which include a rapid increase in the serum concentration of some proteins, known as acute phase proteins (APP). Using polyacrylamide gel electrophoresis, we detected two APP of approximately 22 and 37 kDa molecular weight in sera obtained from cattle with bovine respiratory disease (BRD). Based on their presence in the sera of sick, but not normal animals, the molecular weights, N-terminal amino acid sequence analysis, and the ability to bind hemoglobin, we identified these proteins as the alpha and beta subunits of haptoglobin. The haptoglobin molecule and the alpha subunit were isolated from serum, purified, and used to produce monoclonal and polyclonal antibodies. With these reagents, an enzyme linked immunosorbent assay was developed to measure the concentration of haptoglobin in bovine serum. Using an experimental model of BRD induced by a sequential challenge of calves with bovine herpesvirus type-1 and Pasteurella haemolytica, we observed a temporal relationship between the increase in haptoglobin concentration in serum and the onset of bacterial infection. The haptoglobin concentration ranged from undetectable in the serum of most calves prior to challenge, to greater than 1 mg ml(-1) in over one-third of the calves at the height of disease. Furthermore, the concentration of haptoglobin was associated significantly with other measures of the severity of disease. Together, these results indicate that quantification of acute phase proteins in animals with BRD could be a valuable diagnostic and prognostic aid.

Of 50 normal subjects, 23 (46%) had at least one false positive electrodiagnostic test for carpal tunnel syndrome (CTS). There were 30% of the subjects who exhibited an abnormal median to ulnar sensory amplitude ratio of less than 1.1. In 7 subjects 8 extremities (14%) revealed prolonged residual latencies, and 4 extremities in 4 subjects (8%) had a difference of 0.4 msec between the median and ulnar palmar sensory latencies. The results of this study indicate that certain reported criteria for CTS are abnormal in a high percentage of normal subjects, thereby making them of limited value in the diagnosis of CTS. Of all the criteria studied, it appears that the comparison of the median to ulnar sensory latency across the carpal tunnel is of greatest potential value. However, even here a more conservative difference of 0.5 msec between median and ulnar nerves must be used to avoid false positive tests for CTS.

The authors would like to thank those who contributed to the data collection throughout the lifetime of the study including the patients, referring health professionals, delivering artists, Kim Hill, Brenda Read-Brown, and the registered charity, Artlift. Background: This paper draws on a longitudinal study which explores the outcomes of an arts referral programme in General Practice in the South West of England since 2009. It focuses on the qualitative responses of the patient cohort during this period. Methods: Using qualitative methods, and thematic analysis, this paper explores and considers the responses from n=1297 participants who provided feedback from an open-ended questionnaire on selfreported benefits of the arts referral programme. Results: Participant reactions demonstrate that the programme provided a range of personal and social benefits that have rarely been considered or explored in comparative studies. In particular, the analysis suggests that participation provided opportunities through which participants were able to self-manage certain aspects of their health-related conditions and identify that they were able to make progress towards a better physical and /or mental health. Conclusions: The evidence suggest that arts-based referral programmes, when used by health professionals, have a range of economic, social and well-being based benefits for participants, that may not have been fully appreciated. The consequences on self-management in health and social care require further investigation.

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Thrombomodulin (TM) is an endothelial receptor that exhibits anticoagulant, antifibrinolytic and anti-inflammatory activity by inhibiting thrombin and cellular adhesion. In this study, the expression and significance of TM was examined in primary colorectal cancer and its prognostic implications explored. TM immunostaining was performed on formalin-fixed, paraffin-embedded tissue sections, from primary lesions of 200 patients with colorectal carcinoma. Institutional Ethical approval was granted and clinical data retrieved from patients' records. All normal colonic tissue expressed TM on endothelial cells. TM tumour cell expression was demonstrated in 53 (26.5%) cases and 147 (73.5%) showed no neoplastic cell staining. On univariate and multivariate analysis TM expression on tumour cells correlated significantly with tumour stage, differentiation, Jass score and 5 year survival. TM expression decreases as overall stage and tumour size increase (P ¼ 0.03). In all, 91% TM positive tumours were well differentiated and 85% of TM negative tumours were poorly differentiated (Po0.01). Five year survival rates of patients with positive and negative TM expression were 71 and 41%, respectively. Survival rate was poorer in those patients who were TM negative compared with those who were positive (Po0.01). A total of 101 (50.5%) of the cases were node negative. In this group, 5 year survival rates of patients with positive and negative TM expression were 87.5 and 37.8%, respectively, demonstrating a poorer survival rate for those who are node negative and TM negative at the time of surgery (Po0.001). This study demonstrates that loss of TM is a key indicator in tumour biology and prognosis.