Sleep and wakefulness in preadolescent children with deficits in attention, motor control and perception

In 10 children with deficits in attention, motor control and perception (DAMP), the relation between daytime vigilance and night-time sleep quality was examined with polygraphic sleep recordings, multiple sleep latency tests and measurements of reaction times. Two girls and eight boys, 6-12 years of age were studied. Eighteen normal children served as controls. Normal sleep regulation and sleep quality was found, but the children with DAMP tolerated the recording procedure less well than the controls. Most patients did not suffer from increased daytime sleepiness, but at MSLT 3, patients had short sleep latencies as in daytime hypersomnolence. Reaction times were significantly longer among the patients than among the controls. It is proposed that the findings may be related to functional changes in the forebrain.

Three-dimensional structure of the apo form of the N-terminal EGF-like module of blood coagulation factor X as determined by NMR spectroscopy and simulated folding

The three-dimensional structure of a 42-residue fragment containing the N-terminal EGF-like module of blood coagulation factor X was determined by means of 2D NMR spectroscopy and computer simulation. The spectroscopic data consisted of 370 NOE distances and 27 dihedral angle constraints. These were used to generate peptide conformations by molecular dynamics simulation. The simulations used a novel functional form for the constraint potentials and were performed with two time steps to ensure rapid execution. Apart from preliminary runs to aid assignment of NOEs, 60 runs resulted in 13 accepted structures, which have two antiparallel beta sheets, no alpha helices, and five tight turns. There is no hydrophobic cluster. The root mean square deviation for the backbone of the 13 conformations is 0.65 +/- 0.11 A against their mean conformation. About half of the side chains have well-defined structure. The overall conformation is similar to that of murine EGF.

Sources of information, experiences and opinions on sexuality, contraception and STD protection among young Swedish students

The aim of the investigation was to study sources of information on sexuality, contraceptives and STDs among young people as well as their experiences of and opinions on the matter. A questionnaire was distributed to 192 high-school pupils in the Stockholm area. The mean age of the participants was 17.4 years. The majority stated that school teachers and individual reading are the best sources of information. Female students more often relied on friends and family members than male students. Among those who had had their sexual debut, many stated that condom use was hard to practice.

Sleep and wakefulness after treatment for craniopharyngioma in childhood; influence on the quality and maturation of sleep

Craniopharyngiomas are situated in immediate vicinity of sleep regulating structures in the basal forebrain area, and the tumor and its treatment might influence the regulation of sleep and wakefulness. In 10 patients treated for craniopharyngioma nighttime sleep quality and daytime vigilance were examined with polygraphic sleep records and multiple sleep latency tests (MSLT). Two girls and 8 boys, 7.1-22.9 years of age, were studied after a follow-up time of 1.5-16.1 years postoperatively. The results were compared to those of 18 normal children. The regulation of the ultradian sleep rhythm was normal but the ability to maintain nighttime sleep was severely disturbed. The patients had an increased number of awakenings and spent long time awake during two recorded nights. Two patients had excessive daytime somnolence during this examination, one after severe sleep disturbance, the other without any known cause. The pattern of sleep and vigilance did not change in puberty in the expected fashion. The disturbances may well have an impact on the psychosocial situation of the patients.

Sexual behaviour among youth clinic visitors in Sweden: knowledge and experiences in an HIV perspective

OBJECTIVE

To study the knowledge and experience of sexuality, contraception and sexually transmitted diseases among sexually active adolescents in Sweden.

SUBJECTS

Youth clinic visitors.

SETTING

Seventy-four youth clinics from all over the country of Sweden.

METHODS

A questionnaire with 17 multiple choice and nine open questions was distributed to all visitors at participating youth clinics during a 2-month period.

RESULTS

A total of 9277 young persons answered the questionnaire. Their mean age was 17.5 years. Ninety-three percent were females. Knowledge on STD and STD protection was wide-spread and good. Chlamydia and HIV was recognised as STDs by 90% and 87% respectively. More than 99% knew of the condom method as a means for STD protection. Knowledge on contraceptive methods for pregnancy protection was also good. Ninety-three percent of the investigated adolescents had had coitus. Nine percent had experienced pregnancies and 17% STDs. The mean number of life-time sexual partners was 3.2.

CONCLUSIONS

In spite of good knowledge on preventive measures among Swedish youth clinic visitors their sexual behaviour carriers risks for future health. Further interventions are needed to minimise these risks.

Immunohistochemical localization of platelet-derived growth factor receptors in the porcine uterus during the oestrous cycle and pregnancy

The distribution of alpha- and beta-type receptors for PDGF was studied immunohistochemically in the uterus of cycling and pregnant pigs with well-documented hormonal status in order to determine a possible steroid hormone-dependence of its expression. Peroxidase-antiperoxidase (PAP) labelling at light microscopical level was done with rabbit polyclonal antisera recognizing either both alpha- and beta-type receptors (PDGFR-1), or selectively beta-type (PDGFR-3). Immunoreactivity to the PDGF-receptors of alpha- and beta-type (PDGFR-1) was present in all endometrial samples examined, being located principally on subepithelial stromal and endothelial cells, the wall of endometrial blood vessels and in the fetal placenta (trophoblast and adjoining blood capillaries). In the myometrium, the major reactive cells were the non-vascular smooth muscle cells, and to some extent, also those of the tunica media of major uterine vessels. No dramatic variations in the intensity of the reaction were noticed during the oestrous cycle. A very intense immunoreactivity was present at early pregnancy and at term, i.e. under major oestrogenic influence. The immunoreactivity to the PDGF-receptor antiserum R-3 (against beta-type) was similarly localized as that showed for R-1 antiserum, while of a weaker intensity. The results indicate the presence of PDGF receptors (alpha- and beta-type) in the endo- and myometrium of cycling and pregnant pigs, and that their expression seems to be accentuated under oestrogenic influence.

Family planning and prevention strategies for sexually transmitted diseases

Fertility regulation and prevention of sexually transmitted diseases (STDs) are recognized pillars in fertility health work. The HIV epidemic has made it clear that there are people at risk for STDs all over the world. Both STDs and unwanted pregnancies are negative consequences of the same behavior, i.e., unprotected intercourse. From the perspective of the individual the risks with unprotected intercourse vary over time and with actual life-style. To meet the needs of the individuals the concept of contraceptive counselling needs to be expanded. Clinics where gynecologists and midwives join forces together with venerologists and social workers are being developed in Sweden. The goal for the clinics is to give an integrated message on STD and pregnancy protection.

Chlamydia test monitoring during therapy

Forty-eight women with chlamydial cervicitis were followed with chlamydial culture and antigen tests (immunofluorescence and enzyme immunoassays) during the course of therapy to study the rate of disappearance of viable organisms and chlamydial antigen. On treatment day 2, two-thirds of the patients were positive by one or more of the tests while 81% were negative by all tests on day 4. All screening methods used had turned negative on the 6th day of therapy. The antigens were found to persist somewhat longer than viable organisms. This persistance should, however, be of no clinical significance.

The gamma-carboxyglutamic acid and epidermal growth factor-like domains of factor X. Effect of isolated domains on prothrombin activation and endothelial cell binding of factor X

Factor Xa is the enzymatically active constituent of the prothrombinase complex, which catalyzes the conversion of prothrombin to thrombin. We have isolated fragments, from tryptic digests of factor X, that consists of the gamma-carboxyglutamic acid (Gla) region linked to one or two epidermal growth factor (EGF)-like domains. Calcium ion binding measurements indicated that these fragments have a native conformation. The factor X-GlaEGF fragments inhibit factor Xa-induced blood clotting in a manner suggesting that they compete with factor Xa for phospholipid binding sites. The same conclusion was reached when thrombin generation was studied in a system of purified components (factor Xa, factor Va, prothrombin, phospholipid, and Ca2+). There was no evidence for a strong interaction between the EGF-like domains of factor Xa and factor Va in either system. However, experiments in the purified system without phospholipid indicated a direct, albeit weak, interaction between the Gla region of factor Xa and factor Va and between the COOH-terminal EGF-like domain of factor Xa and factor Va. Using domain-specific Fab fragments, we have confirmed that the conformation of the serine protease region alters dramatically upon activation of factor X. Furthermore, we have demonstrated that the conformation of the Gla region is affected by the activation, whereas the EGF-like domains appear to be unaltered. The association constant for factor X binding to endothelial cells was two orders of magnitude lower than that for binding of factor IX to these cells. Binding of the Gla and GlaEGF fragments suggested Gla-mediated binding to phospholipid rather than binding to a specific receptor.

Protein structural requirements for Ca2+ binding to the light chain of factor X. Studies using isolated intact fragments containing the gamma-carboxyglutamic acid region and/or the epidermal growth factor-like domains

Coagulation factor X is a multidomain proenzyme of a serine protease. Calcium ions bind to the vitamin K-dependent gamma-carboxyglutamic acid (Gla) residues and to a site in the NH2-terminal of two epidermal growth factor (EGF)-like domains. To study structure-function relationships in the NH2-terminal part of factor X and to determine the structure of isolated domains, we have developed methods that allow the subsequent isolation of the first or both EGF-like domains with or without an attached Gla domain from controlled proteolytic digests of the protein. The Ca2(+)-induced changes of the intrinsic protein fluorescence were measured to elucidate whether the isolated fragments retain their native conformation. Changes in the fluorescence caused by Ca2+ binding were found to result from perturbations of the environment of the Trp residue in position 41. Calcium ion binding to the Gla-containing region linked to the NH2-terminal EGF-like domain was identical with that to intact factor X, indicating a native orientation of the ligand binding groups in the fragment. In contrast, the isolated Gla peptide had a lower affinity for Ca2+, suggesting that the NH2-terminal EGF-like domain serves as a scaffold for the folding of the Gla region. Similarly, the presence of the Gla region was found to increase the affinity of the Gla-independent site in the first EGF-like domain for Ca2+. The metal ion-induced resistance against chymotryptic cleavage COOH-terminal of Tyr-44 in intact factor X is similar in the isolated fragment that contains the Gla region linked to one EGF-like domain, indicating a native conformation of the fragment in the presence of Ca2+. Furthermore, the Gla-independent metal ion binding site binds Ca2+ but does not appear to bind Mg2+.

Sexual experience, abortion and sexually transmitted diseases among young women at a contraceptive clinic

All visitors who during one year visited a contraceptive clinic in the Solna district of Stockholm County and were below the age of 26 were asked to fill in a questionnaire and offered a test for C. trachomatis. Three hundred and six women (97%) participated. Ninety percent had at some time used oral contraceptives and 91% had experience of condom use. One-fifth of the whole group had undergone one or more legal abortions, and one fourth had experience of a sexually transmitted disease (STD). The most common STD experienced was chlamydia, followed by condyloma. The actual prevalence of chlamydia in the group was 6%. Sexual contacts were often made early in on-going steady relations. Forty-two percent admitted casual sex, but the number of life-time partners was five or less among the majority.

Plasma lipolytic activity and substrate oxidation after intravenous administration of heparin and a low molecular weight heparin fragment

This study examines the effects of heparin and a low molecular weight heparin (LMWH) fragment on plasma lipolytic activity and substrate oxidation. Indirect calorimetry was performed continuously in healthy male subjects receiving a constant infusion of fat emulsion (0.2 g min-1) and glucose (0.8 g min-1) during a period of 4 h. After 2 h an infusion of heparin (n = 6) or LMWH (n = 6) (100 antifactor Xa units kg-1) or saline (n = 6) was given over 1 h. Plasma concentration of the fat emulsion decreased by 76 +/- 5% with heparin and by 12 +/- 7% with LMWH (P less than 0.01). In the case of LMWH the initial fall was followed by a consistent rise in fat emulsion concentration for the entire remaining study period. Compared to the control experiments, plasma FFA increased five times with heparin and three times with LMWH (P less than 0.05). The average respiratory quotient (RQ) and energy expenditure (EE) increased constantly during the study period and did not differ significantly between the groups. In all groups the average increase in glucose oxidation was 40-50%, while fat oxidation decreased to a comparable extent. Infusions of heparin and LMWH had no effect on RQ or EE. A microcalorimetric study on isolated rat adipocytes in buffer solutions containing glucose, fat emulsion, heparin or LMWH was also made. The heat output from the adipocytes was not influenced by the presence of heparin or LMWH. In conclusion, infusion of heparin resulted in a pronounced increase in FFA availability, whereas LMWH exerted a less marked lipolytic effect. However, the heparin-induced elevations in plasma FFA were not accompanied by measurable rises in lipid oxidation rate.

1H NMR assignment and secondary structure of the Ca2(+)-free form of the amino-terminal epidermal growth factor like domain in coagulation factor X

Blood coagulation factor X is composed of discrete domains, two of which are homologous to the epidermal growth factor (EGF). The N-terminal EGF like domain in factor X (fX-EGFN), residues 45-86 of the intact protein, contains a beta-hydroxylated aspartic acid and has one Ca2(+)-binding site. Using 2D NMR techniques, we have made a full assignment of the 500-MHz 1H NMR spectrum of Ca2(+)-free fX-EGFN. On the basis of this assignment and complementary NOESY experiments, we have also determined the secondary structure of Ca2(+)-free fX-EGFN in water solution. Residues 45-49 are comparatively mobile, whereas residues 50-56 are constrained by two disulfide bonds to one side of an antiparallel beta-sheet involving residues 59-64 and 67-72. Another antiparallel beta-sheet involves residues 76-77 and 83-84. A small, parallel beta-sheet connects residues 80-81 and 55-56 and thereby orients the two antiparallel beta-sheets relative to each other. Four beta-turns are identified, involving residues 50-53, 56-59, 64-67, and 73-76. Residues 78-82 adopt an extended bend structure. On the basis of secondary structure and the location of the three disulfide bonds, we find that Asp 46, Asp 48, and Hya 63 are sufficiently close to each other to form a Ca2(+)-binding site. However, the amino terminus of the Ca2(+)-free form of fX-EGFN is not part of a triple-stranded beta-sheet as in other EGF like peptides. Differences and similarities between fX-EFGN and murine EGF with respect to secondary structure and conformational shifts are discussed.

Placental transfer of glucose and amino acids in intrauterine growth retardation: studies with substrate analogs in the awake guinea pig

After experimentally inducing growth retardation by unilateral uterine artery ligation in midpregnancy, placental blood flow (PBF) (microsphere technique) and placental transfer of 14C-aminoisobutyric acid (AIB) and 3H-methylglucose (MG) were studied at d 44, 50, or 63 of gestation in 19 chronically catheterized awake guinea pigs. At d 44, fetal wt (FW) and placental wt were reduced by 16 and 18%, respectively, in the ligated horn and FW/PBF was increased by 122%. Placental efficiency to transfer MG and AIB (fetal dpm/g placenta) was maintained in the ligated horn, feto-placental extraction (feto-placental dpm/PBF) was increased, and placental transfer of the substrate analogs (fetal dpm/g fetus) was unchanged. At d 50 and 63, placental wt and FW were reduced in proportion (approximately 40%) in the growth-retarded group and FW/PBF was increased by 80 and 51%, respectively. Placental transfer of AIB was reduced by 33% at d 50 and by 18% at d 63. In addition, placental efficiency to transfer AIB was reduced by 36% at d 50 and by 22% at d 63 in the growth-retarded group. Fetal uptake of MG per g fetus was slightly reduced (-6%) at d 50 of gestation, but unaffected at d 63. Extraction of MG from the maternal PBF was increased, whereas the wt-specific transfer capacity of the placenta was unaltered.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of sexually transmitted diseases and abortions--the present situation for medical care of sexually transmitted diseases in Sweden

In Sweden, the high numbers of infections with Chlamydia trachomatis and human papillomavirus and the threat of human immunodeficiency virus has been the origin of an ongoing change in the care for people with sexually transmitted diseases (STDs). This is based on the view that traditional STDs, HIV, and abortions are different consequences of the same thing--unprotected intercourse--so prevention of one means prevention of the others and they should always be considered together. There is a growing understanding that epidemiological aspects of STD have to be improved. To attain these goals, new measures are taken at different levels. Central organization committees are created in the counties for the management of STD care. Youth clinics are given better resources. A new kind of department for problems related to sexuality is developed with contributions primarily from gynecology and venereology. The well-established Swedish tradition for sex education is reinforced.

Release of lipoprotein lipase and hepatic lipase activities. Effects of heparin and a low molecular weight heparin fragment

Unfractionated heparin and a low molecular weight heparin fragment (LMWH, mean molecular weight 5000) were compared with respect to the ability to release lipoprotein lipase (LPL) and hepatic lipase (HL) from tissue binding sites. The investigations were carried out in vivo and in vitro in man and in the rat. The in vivo release of LPL activity was greater with heparin in both species. The release of HL activity was equal with both heparins in man, but greater with unfractionated heparin in the rat. In the in vitro studies the LMWH fragment consistently released more LPL activity from the tissues investigated, i.e. fat, skeletal muscle and heart muscle. With isolated adipocytes, however, we could not demonstrate any difference between the two heparins with respect to their lipase-releasing effect. In liver tissue homogenate the two heparins showed the same ability to release HL activity. It is concluded that not only biochemical differences between the two heparins are of importance for the difference in the lipolytic effect. The possibility of different rheological behaviours of the two heparins in the capillary lumen, which might partly explain the greater in vivo lipolytic effects of heparin, is discussed. It is suggested that LMWH enters the tissue preparation more readily in vitro, thereby exerting a greater lipase-releasing effect than heparin.

Immunoglobulin contents in cervical secretions of women with chlamydial cervicitis

Contents of albumin, IgG, IgA and secretory IgA (S-IgA) were determined in secretions of 16 women with chlamydial cervicitis (study group) and 13 women with vulvovaginal candidiasis (control group). The amounts of respective protein in cervical secretions were higher among the women with chlamydial infection representing both an increased transudation and an increased local production of antibodies in the infected cervix. Specific chlamydial antibodies of IgG, IgA and S-IgA class were found significantly more often in the study group. Comparing the IgG/IgA ratios in serum and secretions gave indications for an active local secretion of specific IgA antibodies. This was also supported by the demonstration of specific S-IgA.

The ligamentum infundibulo-cornuale in the pig: morphological and physiological studies of the smooth muscle component

The ligamentum infundibulo-cornuale (LIC) in the pig runs along the anterolateral side of the tubal isthmus, connecting the uterotubal junction and the edge of the infundibulum and has a comparatively well-developed muscular component running under the mesothelium. The well-vascularized smooth muscle cells held close cell-to-cell contacts and received innervation by adrenergic and cholinergic-like nerve terminals. Isolated LIC preparations, collected during oestrus showed a rhythmic spontaneous motility in vitro, the frequency and the relative amplitude of the contractions being highest during the preovulatory period. In vitro, noradrenaline and adrenaline elicited contractile (alpha) and relaxatory (beta) responses, while isoprenaline induced only beta-responses, as demonstrated by pretreatment with selective blockers. Oxytocin, PGF2 alpha and PGE2 always increased the muscular activity of the LIC. Indomethacin inhibited, in a concentration-dependent and reversible manner, the spontaneous motility of the porcine LIC, which could be fully restored by PGF2 alpha, indicating an endogenous local synthesis of prostaglandins in the tissue. The present results suggest that, in the pig, the LIC consists of a well-arranged, richly innervated bulk of smooth muscle which shows rhythmic spontaneous activity at the time of ovulation that could assist ova pick-up.

Calcium binding to the isolated beta-hydroxyaspartic acid-containing epidermal growth factor-like domain of bovine factor X

Coagulation factor X is a vitamin K-dependent protein composed of discrete domains or modules. A proteolytically modified derivative of factor X that lacks the NH2-terminal gamma-carboxyglutamic acid (Gla)-containing region retains one Ca2+ binding site. To localize this Gla-independent Ca2+ binding site and to facilitate future studies aimed at elucidating structure-function relationship in the factor X molecule, we have devised a method to isolate the first beta-hydroxyaspartic acid (Hya)-containing epidermal growth factor (EGF)-like domain from proteolytic digests of bovine factor X performed under strictly controlled conditions. The EGF-like domain, corresponding to residues 45-86 in bovine factor X, was obtained in more than 50% recovery, and was at least 98% homogeneous as judged by NH2-terminal sequence analysis. Ca2+ binding to the isolated EGF-like domain was studied by 1H NMR spectroscopy. On binding of Ca2+ to the domain the resonances from Tyr-68 centered at 6.8 ppm were affected. The Ca2+ concentration dependence of the chemical shift was used to calculate the Ca2+ binding constant, resulting in a K alpha of 4 X 10(3) M-1 at pH 8.5 and 1 X 10(3) M-1 at pH 7.4, the higher value presumably reflecting an increase in negative surface charge due to deprotonation of a histidine residue with a pK alpha of 7.4. The NMR spectra gave no evidence of a conformational change in the EGF-like domain between pH 6 and 8.5.

Sleep and wakefulness in normal preadolescent children

Eighteen healthy children, 9 boys and 9 girls, between 8 and 12 years of age were examined with polygraphic sleep records, multiple sleep latency tests (MSLTs), and measurements of reaction times. Sleep was recorded at home on Oxford Medilog 9 channel cassette tape recorders (Oxford Medical Systems, Abingdon, U.K.) and sleep staging was performed from the screen of the display unit. Two consecutive nights were recorded. MSLT was done in the laboratory. The subjects were given 30 min to fall asleep on four occasions during the day after the last recorded night of sleep. Reaction times were measured repeatedly between each MSLT trial. More slow wave sleep was found in this study compared to others. Also, the first night effect was slight. It is proposed that this is due to the fact that the recordings were performed at home. The initial sleep cycle was incomplete in almost all subjects. A sleep stage with traits of both rapid eye movement (REM) and non-REM could be seen in this cycle, probably representing an abortive REM period. MSLT confirmed the low daytime sleepiness in healthy preadolescent children. A sleep latency of 10 min or less on two or more sleep trials, or a daily mean sleep latency of less than 20 min, is rarely seen in this age group. The reaction times were within normal limits for the age of the subjects. Nighttime sleep values, daytime sleep latencies, and reaction times were not correlated in these normal-sleeping children.

Secretory IgA against herpes simplex virus in cervical secretions

A recently developed method to recover proteins from cervical secretions was combined with methods to detect minute concentrations of herpes simplex virus (HSV) type specific antibodies to measure the concentrations of locally produced antibodies in women with genital infections. Forty nine women attending a sexually transmitted disease (STD) clinic were included. Cervical secretions were obtained by suction into a plastic catheter. Soluble proteins were recovered from the secretions by elution with hyperosmolar sodium chloride. A rabbit antibody to human secretory component, which was conjugated to horseradish peroxidase, was used to measure secretory IgA (S-IgA) that was HSV type specific. For comparison, HSV type specific IgG was measured in serum samples from the patients. Of the 49 women, 16 yielded detectable HSV type 2 (HSV 2) S-IgA in secretions. Twelve of them also reacted to the HSV type common antigen, but only five had HSV 2 IgG detectable in their serum. S-IgA against HSV was found in significantly more women with a clinical diagnosis of acute cervicitis than in others. This could be explained by a general increase in local antibody production and immunity triggered by previous contacts with HSV. It is concluded that local mucosal immunity to HSV 2 can be detected in women who do not have a specific humoral antibody response to the virus. For seroepidemiological studies of infection with HSV 2 this local immunity may be considered to be a factor that gives an underestimation of the true incidence of HSV 2 infection.

Aspects of the history of rheumatoid arthritis in the light of recent osteo-archaeological finds

Rheumatoid arthritis (RA) is one of our most common disabling diseases today. Whether or not RA also existed in ancient times has been questioned and debated in recent years. Supporters of the view of recent onset claim that evidence of the existence of RA in antiquity can be found neither in old literature nor in paintings--and most important--convincing paleopathological finds are lacking. The following presentation reviews the results of an examination of skeletons found during an excavation of a neolithic burial place in the island of Gotland, Sweden. In two skeletons there were marked peripheral changes in both large and small joints. These changes are compatible with in vivo presence of a chronic aseptic polyarthritis. Different diagnostic possibilities for such polyarticular joint disease are discussed. It is suggested that RA might be the most probable alternative although other possibilities cannot be excluded.

A case-control study of oral contraceptive use in women with adenocarcinoma of the uterine cervix

To evaluate oral contraceptive (OC) use as a possible cause of the changed ratio between adenocarcinoma and squamous cell carcinoma of the uterine cervix a case-control study was performed. The OC use among 23 women with adenocarcinoma of the uterine cervix was compared with that of a matched group of 46 women with squamous cell carcinoma. No differences in percentage of OC use, duration of such use or period of OC use in relation to diagnosis could be demonstrated between the two groups compared.

Plasma lipolytic activity after subcutaneous administration of heparin and a low molecular weight heparin fragment

The effect of heparin and a low molecular weight heparin fragment (LMWH, mean molecular weight 4000-6000) on plasma anticoagulation and lipolysis was studied in eight healthy men. The activities of antifactor Xa (antiFXa), lipoprotein lipase (LPL), hepatic lipase (HL) and plasma levels of free fatty acids (FFA) were analysed after the injection of 5000 antiFXa units of heparin or LMWH subcutaneously. In comparison with heparin, the administration of LMWH resulted in a significantly higher antiFXa activity (p less than 0.001) but a lower release of LPL and HL (p less than 0.001), which did not increase plasma FFA. It is concluded that subcutaneous injection of LMWH in men elicits an adequate anticoagulant effect measured as antiFXa activity but has a negligible effect on plasma lipolytic activity.

Postoperative water and electrolyte changes in skeletal muscle: a clinical study with three different intravenous infusions

Twenty-seven patients admitted for cholecystectomy were matched for age and sex in three groups for different perioperative fluid therapies over a period of 3 days. Group I was given an acetated half-isotone "balanced" saline solution with the addition of 2.5% glucose, Group II an acetated Ringer solution and Group III an isotonic glucose solution. Percutaneous muscle biopsies were performed before and on the third day after surgery for the determination of water content and the concentration of sodium, potassium, magnesium and chloride in skeletal muscle. The cumulative balance of sodium and potassium was measured daily during the study. In all three groups a significant increase in the total muscle water content was demonstrated. The concentration of sodium and chloride in skeletal muscle increased significantly in Groups II and III, whereas the concentration of potassium decreased in all groups. The cumulative sodium balance was positive in Groups I and II; the potassium balance was negative in all groups. In conclusion, the patients given the balanced saline solution showed the least change in water content and electrolyte concentrations in skeletal muscle.

Plasma kinetics of lipoprotein lipase and hepatic lipase activities induced by heparin and a low molecular weight heparin fragment

Intravenous injections of conventional heparin and a low molecular weight heparin fragment (LMWH, mean molecular weight 4000-6000) were given to six male volunteers at doses of 10, 50 and 100 U (antiFXa)/kg body wt. The plasma kinetics of lipoprotein lipase (LPL) and hepatic lipase (HL) were analysed. The peak values, as well as the accumulated release of LPL activity, were dose dependent and were twice as high after heparin as after LMWH. The plasma half-life of LPL activity followed first order kinetics and was similar for both heparin preparations when given in comparable doses. The peak values and the plasma half-life of HL activity were the same for heparin and LMWH in the clinically relevant doses (50 and 100 U (antiFXa)/kg). Compared with LMWH, the total release of HL was twice as large after the heparin injections, possibly due to mobilization of an additional enzyme pool by the conventional heparin. It is concluded that the use of LMWH as an anticoagulant is associated with a lower plasma lipolytic activity than with standard heparin.

Plasma clearance of fat emulsion during continuous heparin infusion

Intravenous fat tolerance was tested in two groups of patients given a continuous i.v. infusion of heparin for several days. One group of 11 patients with deep vein thrombosis (DVT) of the leg was given 25,000-35,000 IU heparin daily for 4-5 days. The other group comprised 10 patients who had central venous catheters (CVC) for total parenteral nutrition. These patients were given 20,000 IU heparin daily for 6 days as prophylaxis against CVC-related thrombosis. In the DVT group heparinization was associated with a 44% decrease in plasma fat removal capacity (P less than 0.05). This reduction persisted for 2 days after the discontinuation of heparin therapy. In the CVC group the plasma fat removal capacity decreased by 29% during heparinization (P greater than 0.05, NS). During heparinization activated partial thromboplastin time was more than three times the basal value in the DVT group but less than twice those in the CVC group. One week after the heparin therapy the serum triglyceride levels were higher in both groups compared with initial values (DVT group: 1.2 +/- 0.2 s.e. mean vs. 1.7 +/- 0.3 mmol/l; P less than 0.05. CVC group: 1.0 +/- 0.1 vs. 1.4 +/- 0.2 mmol/l; NS). The possibility that full-dose heparinization reduces plasma fat removal capacity and that this may be due to a partial depletion of lipoprotein lipase stores is discussed.

Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects

A total of 149 children aged 13-17 years were examined. 83 were mildly and 66 severely mentally retarded. These children, especially the severely retarded ones, are representative of all mentally retarded children born in 1966-1970 and living in Göteborg, Sweden. 64% of the severely mentally retarded and 57% of the mildly mentally retarded children were suffering from a handicapping psychiatric condition. Autism-like 'psychotic behaviour' was common in the severely retarded. 0.2% of the total child population aged 13-17 years suffering from the combination of mental retardation and 'psychotic behaviour'. Epilepsy was associated with psychiatric abnormality, but Down's syndrome was generally not so associated.

Actinomyces israelii-associated salpingitis

Actinomyces israelii was identified in samples from the oviducts of 4/100 women with salpingitis diagnosed by laparoscopy. All four cases healed on 'routine' treatment. Possible pathogenic mechanisms for the development of actinomycosis are discussed.

Effect of zinc and other cations on the release of the eosinophil cationic protein

The eosinophil cationic protein, ECP, is a unique eosinophil granule constituent, which is released extracellularly after exposure of the eosinophils to a non-phagocytosable surface such as complement-coated Sephadex beads. The ECP is released to some extent even in the absence of Ca2+ and Mg2+, though both these cations augment the release reaction tested alone, and an optimal release is observed only in the presence of 2 mmol/l Ca2+ and 2 mmol/l Mg2+ in the medium. Zn2+ at concentrations from 0.25-4.0 mmol/l inhibited the release of ECP in a dose-dependent fashion, with or without Ca2+ and Mg2+ in the medium. Mn2+ had dual effects, stimulating the ECP release in the absence of Mg2+ and Ca2+, and inhibiting the release in the presence of these cations. Li1+ caused minor inhibition of ECP release, but only in the absence of Ca2+ and Mg2+. The inhibitory effect of Zn2+ was immediate and reversible after washing of the cells, suggesting that the inhibition is due to interaction with the plasma membrane functions.

Isolation of leukaemia-associated inhibitor (LAI)-producing cells from normal peripheral blood

LAI, leukaemia-associated inhibitor, has previously been shown to be produced by a subpopulation of null cells in myeloid leukaemia, and has the capacity to suppress the proliferation of normal granulopoietic stem cells, CFU-GM, in vitro. In the present study, low density mononuclear cells from normal peripheral blood were separated into adherent/non-adherent, phagocytic/non-phagocytic, T-lymphocytes/non-T cells, and Fc-receptor positive and negative cells in search for LAI-producing cells in normal blood. Cell fractions enriched for NK-cells were isolated from Percoll gradients and NK-activity and LAI-production were assayed in the different fractions. Anti-Leu-2, anti-Leu-3, and anti-HLA-DR were used to deplete mononuclear cells of cells positive for these monoclonals using a panning technique. It is concluded from these studies that normal LAI-producing cells belong to a non-adherent, non-phagocytic, non-T, non-B, Fc-receptor positive population which does not express NK-activity, and which is Leu-2, Leu-3 and HLA-DR negative. The results imply that LAI may be a novel feedback regulator of the proliferative rate of granulopoietic stem cells and that LAI is produced by a small subpopulation of cells in both blood and bone marrow.

Lipolytic and anticoagulant activities of a low molecular weight fragment of heparin

Low molecular weight heparin (LMWH) and standard heparin were given intravenously to six healthy subjects receiving a continuous infusion of Intralipid. After infusion, antifactor Xa, antithrombin II and coagulation activity (Normotest) were the same for both heparins. Activated partial thromboplastin time increased significantly, but the increase was much higher after standard heparin (+473%) than after LMWH (+48%). The increase in lipoprotein lipase activity was less pronounced after LMWH infusion. This resulted in a smaller decrease in Intralipid-triglyceride concentration and a smaller increase in both plasma FFA concentration and Intralipid fractional removal rate compared to standard heparin. This study shows that the plasma lipolytic potential of LMWH is weaker than that of standard heparin when given in doses with equipotent anticoagulation. LMWH may therefore be preferable to standard heparin as an antithrombotic agent in clinical situations where a high plasma lipolytic activity may be disadvantageous.

Study of precipitation reactions to Actinomyces israelii antigens in uterine secretions

Uterine secretions were obtained from 110 women and analysed by counterimmunoelectrophoresis for the occurrence of precipitation reactions against Actinomyces israelii antigens. Precipitation reactions were found in secretions from seven women and a correlation was found between these reactions and long term use of plastic intrauterine devices. The precipitating components could not be proved to be immunoglobulins; neither could identity be shown with IgG precipitins in reference serum. The nature and the importance of the precipitating components are discussed.

Clinical evaluation of precipitin tests for genital actinomycosis

A precipitin test system for antibodies against Actinomyces israelii, comprising a combination of counterimmunoelectrophoretic and crossed immunoelectrophoretic gel techniques, was evaluated for its clinical usefulness in diagnosing genital actinomycosis. A total of 263 serum samples from healthy women and women with proven actinomycosis, A. israelii-associated salpingitis, other gynecological infections, or miscellaneous gynecological diseases were analyzed. Six different precipitins could be detected. Five precipitins were defined as specific for actinomycosis, whereas one was found to occur nonspecifically in women with gynecological infections. The specificity of the test system for the detection of cases of genital actinomycosis was 98%, and the sensitivity was 83%. The accuracy was 100% for negative prediction and 45% for positive prediction. Thus, the test was shown to be valuable for a noninvasive diagnosis of genital actinomycosis.