[Are children subject to family reunification in Denmark a risk group requiring special attention?]

INTRODUCTION

The aim was to evaluate the actual health conditions of children subject to family reunification at the time of their introductory examination at their Danish school and to estimate whether these children represent any health risk to others at the school. The focus was the children's somatic disease pattern and not the behavioural and psychopathological aspects.

MATERIALS AND METHODS

A prospective analysis was carried out of children subject to family reunification who started school in Copenhagen in the school year, 1999/2000. This analysis is based on a family interview with the aid of a translator and an objective medical examination.

RESULTS

In the school year 1999/2000, 148 children were examined. They were aged between 5 and 18 years. The children had emigrated from 25 different countries. Fifty-five children live with only one biological parent. Eighteen point five per cent of the children have earlier had one or more diseases. Most of them (91.2%) were assessed as having good general health and sensomotoric development according to their age. Among the 148 children examined, 48% have had one or more diagnoses made.

DISCUSSION

On the basis of the experience obtained in this study, more resources must be allocated for better examination.

CONCLUSION

In the light of the pattern of disease, it cannot be concluded that the children constitute a risk of infection for other children and adults at school. The results of this study call attention to a need for prospective studies on the health conditions of the children subject to family reunification on their arrival in Denmark.

[Hormone replacement therapy reduces the risk of forearm fracture in postmenopausal women. Results of the Danish Osteoporosis Prevention Study]

In a prospective, controlled, comprehensive cohort trial of 2,016 healthy early postmenopausal women aged 45-58 years we studied fracture prevention through the use of oestrogen. There were two main study arms: a randomised arm (randomised to HRT [n = 502] or not [n = 504]) and a non-randomised arm (on HRT [n = 221] or not [n = 789] by own choice). After five years, an intention-to-treat analysis (n = 2,016) showed a reduction in the overall fracture risk (RR = 0.73, 95% CI: 0.50-1.05) and in the forearm fracture risk (RR = 0.45, 95% CI: 0.22-0.90) with oestrogen. Restriction of the analysis to women who had adhered to their initial allocation of either oestrogen (n = 395) or no oestrogen (n = 977) showed a significant reduction in both the overall fracture risk (RR = 0.61, 95% CI: 0.39-0.97) and the risk of forearm fractures (RR = 0.24, 95% CI: 0.09-0.69). We conclude that it is possible to reduce the number of forearm fractures in early postmenopausal women by the use of oestrogen as primary prevention.

Chemokines, natural killer cells and granulocytes in the early course of Leishmania major infection in mice

In the present study the early recruitment of leukocytes into the infected skin and into the draining lymph node (LN) was investigated after subcutaneous infection of mice with Leishmania major promastigotes. Flow cytometric analysis of cells recovered from the infected skin revealed that GR-1+ granulocytes were present as early as 10 h after infection, thus representing the first leukocyte population to be recruited to the site of infection. The migration of granulocytes was shown to be associated with a rapid mRNA expression of the neutrophil-attracting chemokine KC in the infected skin. Moreover, L. major promastigotes were found to produce factor(s) that are chemotactic for human neutrophils in vitro. Experiments with human neutrophils revealed that these cells are able to phagocytose the parasites. Natural killer (NK) cells appeared at the site of infection 24 h after infection. The migration of NK cells in resistant mice was found to correlate with the expression of the NK cell-activating chemokine IP-10. Treatment of susceptible BALB/c mice with recombinant mouse IP-10 resulted in a significantly increased NK cell cytotoxic activity in the draining LN. These data suggest that both the early chemokine gene expression and the production of chemotactic factors by the parasites themselves regulate the site-directed migration and activation of cells of the innate immune response, and suggest a role of chemotactic factors in the early defense against the parasites.

Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters

The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs, MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical spine involvement. Radiographic parameters were erosions of the dens or intervertebral joints, disc-space narrowing, horizontal and vertical atlantoaxial subluxation, subluxations below C2, and the diameter of the spinal canal. The MR features evaluated were presence of dens and atlas erosion, brainstem compression, subarachnoid space encroachment, pannus around the dens, abnormal fat body caudal to the clivus, cervicomedullary angle, and distance of the dens to the line of McRae. Muscle weakness was associated with a tenfold increased risk of neurologic dysfunction. Radiographic parameters were not associated. On MR images atlas erosion and a decreased distance of the dens to the line of McRae showed a fivefold increased risk of neurologic dysfunction. Subarachnoid space encroachment was associated with a 12-fold increased risk. Rheumatoid arthritis patients with muscle weakness and subarachnoid space encroachment of the entire cervical spine have a highly increased risk of developing neurologic dysfunction.

Decreasing overflow from the Nordic seas into the Atlantic Ocean through the Faroe Bank channel since 1950

The overflow of cold, dense water from the Nordic seas, across the Greenland-Scotland ridge and into the Atlantic Ocean is the main source for the deep water of the North Atlantic Ocean. This flow also helps drive the inflow of warm, saline surface water into the Nordic seas. The Faroe Bank channel is the deepest path across the ridge, and the deep flow through this channel accounts for about one-third of the total overflow. Previous work has demonstrated that the overflow has become warmer and less saline over time. Here we show, using direct measurements and historical hydrographic data, that the volume flux of the Faroe Bank channel overflow has also decreased. Estimating the volume flux conservatively, we find a decrease by at least 20 per cent relative to 1950. If this reduction in deep flow from the Nordic seas is not compensated by increased flow from other sources, it implies a weakened global thermohaline circulation and reduced inflow of Atlantic water to the Nordic seas.

Inhibitory and blocking monoclonal antibody epitopes on merozoite surface protein 1 of the malaria parasite Plasmodium falciparum

Merozoite surface protein 1 (MSP-1) is a precursor to major antigens on the surface of Plasmodium spp. merozoites, which are involved in erythrocyte binding and invasion. MSP-1 is initially processed into smaller fragments; and at the time of erythrocyte invasion one of these of 42 kDa (MSP-1(42)) is subjected to a second processing, producing 33 kDa and 19 kDa fragments (MSP-1(33) and MSP-1(19)). Certain MSP-1-specific monoclonal antibodies (mAbs) react with conformational epitopes contained within the two epidermal growth factor domains that comprise MSP-1(19), and are classified as either inhibitory (inhibit processing of MSP-1(42) and erythrocyte invasion), blocking (block the binding and function of the inhibitory mAb), or neutral (neither inhibitory nor blocking). We have mapped the epitopes for inhibitory mAbs 12.8 and 12.10, and blocking mAbs such as 1E1 and 7.5 by using site-directed mutagenesis to change specific amino acid residues in MSP-1(19) and abolish antibody binding, and by using PEPSCAN to measure the reaction of the antibodies with every octapeptide within MSP-1(42). Twenty-six individual amino acid residue changes were made and the effect of each on the binding of mAbs was assessed by Western blotting and BIAcore analysis. Individual changes had either no effect, or reduced, or completely abolished the binding of individual mAbs. No two antibodies had an identical pattern of reactivity with the modified proteins. Using PEPSCAN each mAb reacted with a number of octapeptides, most of which were derived from within the first epidermal growth factor domain, although 1E1 also reacted with peptides spanning the processing site. When the single amino acid changes and the reactive peptides were mapped onto the three-dimensional structure of MSP-1(19), it was apparent that the epitopes for the mAbs could be defined more fully by using a combination of both mutagenesis and PEPSCAN than by either method alone, and differences in the fine specificity of binding for all the different antibodies could be distinguished. The incorporation of several specific amino acid changes enabled the design of proteins that bound inhibitory but not blocking antibodies. These may be suitable for the development of MSP-1-based vaccines against malaria.

Comparison of quantitative ultrasound and dual X-ray absorptiometry in estrogen-treated early postmenopausal women

Identifying individuals at risk of developing osteoporosis is important in order to initiate early treatment. Many new techniques have been proposed as alternatives for DXA-scanning. Some of these alternatives certainly have advantages, but none have so far been demonstrated to predict fractures better, or even to identify individuals at risk of osteoporosis as well as with the standard method. In this study, comprising a group of women from the Danish Osteoporosis Prevention Study, we wished to investigate whether a technique based on quantitative ultrasound (QUS) could identify individuals with low BMC/BMD as measured by dual X-ray absorptiometry (DXA). Furthermore, we wished to test whether the method could detect differences between untreated individuals and those treated with hormone replacement therapy. We found that QUS could detect differences between the treated and untreated groups, but it was unable to identify women with low BMD, although it might be able to identify persons not at risk of osteoporosis. Low QUS values should be followed by a regular DXA measurement to confirm the presence of osteoporosis.

Substantial allozyme diversity in the freshwater crayfish Parastacoides tasmanicus supports extensive cryptic speciation

Allozyme electrophoretic studies on the freshwater crayfish genus Parastacoides Clark suggest the presence of several cryptic species within this morphologically conservative taxon. Two independent allozyme studies were undertaken to assess the validity of the current taxonomy of this monotypic genus. An initial study examined 42 individuals from 10 sample sets for allozyme variation at 22 putative loci, and a subsequent study surveyed an additional 72 specimens from 20 sample sets at 16 putative loci. Both studies revealed the same general outcomes, namely: (1) several instances of sympatric species diagnosable at multiple allozyme loci; (2) numerous examples of putative allopatric species with significant levels of genetic divergence (25–81% fixed difference, 0.30–1.67 Nei distance) well beyond those found between conspecific populations of any parastacid; (3) broad genetic affinities among putative species are inconsistent with currently recognised morphotypes; and (4) low levels of within-population genetic variability, typical of parastacids. Although it is not possible to determine how many species are represented on the basis of these two preliminary studies, the allozyme data nevertheless indicate that an absolute minimum of 11 species and perhaps as many as 19 species are likely to be present in the genus. They indicate the need for a thorough taxonomic revision of the genus using both molecular and morphological data.

[Incidence of methicillin-resistant Staphylococcus aureus among Kosovar-Albanian refugees at the refugee-center in Randers]

INTRODUCTION

With the emergence of the war in Kosova, Europe faced a massive problem dealing with the refugees. The Danish quota was 3,000 refugees. Their health care was organised by the Danish Red Cross in collaboration with the District Hospital of Randers (DHR), the University Hospital of Arhus, and the Psychiatry Unit of the County of Arhus. The aim of the present retrospective study was to describe the prevalence of MRSA in this group of refugees.

MATERIALS AND METHODS

Nasal screening culture for MRSA was performed on the first 50 refugees arriving at Randers. On admission to the DHR, the Kosovar-Albanian refugees were isolated until the MRSA culture showed negative.

RESULTS

MRSA causing serious nosocomial infections has become a major problem in hospitals worldwide, with a higher incidence in the southern part of Europe than in Denmark. The initial nasal screening revealed no MRSA positive cultures. During the course of the subsequent 14 months, we found eight Kosovar-Albanian refugees infected with/colonised by MRSA (Table 1). We observed no spread of MRSA to other patient groups.

CONCLUSION

We conclude that 1) the results of the initial screening of 50 refugees did not predict the succeding high incidence of MRSA; 2) the usual treatment with mupirocin nasal ointment and chlorhexidine wash did not prevent either reinfection or spread of MRSA in the refugee centre; 3) the rigorous isolation and screening strategy at DHR prevented the spread of MRSA to other patients and staff.

Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women - results of the Danish Osteoporosis Prevention Study

OBJECTIVES

To study the fracture reducing potential of hormonal replacement therapy (HRT) in recent postmenopausal women in a primary preventive scenario.

METHODS

Prospective controlled comprehensive cohort trial: 2016 healthy women aged 45-58 years, from three to 24 months past last menstrual bleeding were recruited from a random sample of the background population. Mean age was 50. 8+/-2.8 years, and the number of person years followed was 9335.3. There were two main study arms: a randomised arm (randomised to HRT; n=502, or not; n=504) and a non-randomised arm (on HRT; n=221, or not; n=789 by own choice). First line HRT was oral sequential oestradiol/norethisterone in women with intact uterus and oral continuous oestradiol in hysterectomised women.

RESULTS

After five years, a total of 156 fractures were sustained by 140 women. There were 51 forearm fractures in 51 women. By intention-to-treat analysis (n=2016), overall fracture risk was borderline statistically significantly reduced (RR=0.73, 95% CI: 0.50-1.05), and forearm fracture risk was significantly reduced (RR=0.45, 95% CI: 0.22-0.90) with HRT. Restricting the analysis to women who had adhered to their initial allocation of either HRT (n=395) or no HRT (n=977) showed a significant reduction in both the overall fracture risk (RR=0.61, 95% CI: 0.39-0.97) and the risk of forearm fractures (RR=0.24, 95% CI: 0.09-0.69). Compliance with HRT was 65% after five years.

CONCLUSIONS

It is possible to reduce the number of forearm fractures and possibly the total number of fractures in recent postmenopausal women by use of HRT as primary prevention.

Acute pain management

We encounter patients with acute pain many times each day, and few aspects of veterinary practice offer such an opportunity to help so many in such a profoundly rewarding way. As emphasized here and elsewhere, we now have excellent tools with which to help these animals, and the biggest impediment to optimal treatment of their pain is often our own difficulty in recognizing its presence. Perhaps the single most important aspect of treating acute pain is to cultivate an ability to see past our personal biases and expectations which may limit treatment and to rediscover the common sense we had about pain before we entered the profession. By rededicating ourselves to seeking out, preventing, and relieving pain, we not only perform a vital service for our patients but also elevate our profession even as we reap financial and spiritual rewards for our efforts. What could be better?

Mitogenesis in glioblastoma multiforme cell lines: a role for NGF and its TrkA receptors

Neurotrophins have definitive roles in the growth/maintenance of neuronal populations, but their function in malignant gliomas is unknown. The ability for nerve growth factor (NGF) to serve as a mitogenic agent was investigated in several human glioblastoma multiforme (GBM) cell lines, including U251, U87, and U373. In a serum-free medium, the addition of NGF (200 ng/ml) to these cell lines increased cell counts over controls, after 3 days in culture by 9%, 16%, and 33%, respectively. Dose-dependent increases in cell counts and [3H]thymidine uptake were found in the more rigorously investigated U373 cell line. Proteins for both the high affinity NGF-specific tyrosine kinase binding site (p140TrkA; TrkA) and the low affinity neurotrophin (p75NTR) receptor were present in all three GBM cell lines. TrkA mRNA was identified in U373 (only cell line studied). NGF-stimulated proliferation was inhibited in a dose-dependent fashion by K252a, a blocker of Trk-induced receptor kinases. NGF, measured by ELISA, was detectable in all GBM cell lines even after 7 days of growth in serum-free medium. These data suggest that GBM cell growth can be enhanced by NGF acting via Trk receptor phosphorylation. Future studies of antiproliferative therapies should consider agents directed against intracellular Trk signaling cascades.

Carcinoma in situ of the breast: correlation of histopathology to immunohistochemical markers and DNA ploidy

In a consecutive and unselected series of 178 cases of carcinoma in situ of the breast (CIS), comprising both ductal (DCIS) and lobular type (LCIS), and a series of 48 cases of invasive carcinoma (IC) with predominance of DCIS, the association between histopathology, immunohistochemical markers (ER, PgR, MIB-1, c-erbB-2, and p53), and DNA ploidy was investigated, in order to discriminate biologically different groups. In DCIS, significant correlation was shown between large nuclear size and comedonecrosis, both of which showed also strong association to DNA aneuploidy, high proliferation activity, low steroid receptor content, and overexpression of c-erbB-2 and p53 factors that may indicate an aggressive behavior. Small nuclear CIS, whether LCIS or DCIS, on the contrary, were DNA diploid with low proliferation, and no cases showed overexpression of c-erbB-2 and p53. Heterogeneity with respect to the investigated parameters was also a frequent finding that may reflect a development complexity. In IC, comparison of the DCIS and the invasive component showed similar patterns. No significant differences were shown between DCIS without and with invasion. This may indicate that none of the investigated parameters on its own are essential for the event of invasion.

Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency

BACKGROUND

Calcium and vitamin D homeostasis seem to be abnormal in patients with exocrine pancreatic dysfunction resulting from cystic fibrosis. Only a few studies have evaluated and described bone mineral metabolism in patients with chronic pancreatitis and pancreatic insufficiency.

METHODS

Thirty-two patients with chronic pancreatitis and residual exocrine pancreatic function (group 1) and 26 patients with pancreatic exocrine insufficiency (i.e., meal-stimulated intraduodenal lipase <10% of lowest normal range and steatorrhea) (group 2) were studied. Serum levels of total calcium, phosphate, 25 (OH)D, 1.25(OH)2D, alkaline phosphatase, and parathyroid hormone were measured. Bone mineral density (BMD), bone mineral content (BMC), lean body mass (LBM), and fat mass (FM) were measured using a dual-energy X-ray absorptiometry (DXA) scanner.

RESULTS

Alcohol was a causative factor in 79% of the patients. Fifty-six percent in group 1 and 69% in group 2 had Z-scores of the BMD < -1. The mean Z-score was -1.16 +/- 1.29 in group 1 and -1.32 +/- 0.90 in group 2. The mean Z-score of the BMC was -1.02 +/- 1.17 vs -1.39 +/- 0.987. In both groups mean 25 (OH)D and mean 1.25(OH)2D were below reference range. Plasma concentrations of albumin-corrected calcium, alkaline phosphatase, and parathyroid hormone were in the upper range of the reference range. Mean Z-scores of LBM were -0.69 +/- 1.34 in group 1 vs -1.01 +/- 1.12 in group 2 and Z-scores of FM were -0.27 +/- 1.70 in group 1 vs -0.95 +/- 1.01 in group 2 (p <0.05).

CONCLUSION

Patients with chronic pancreatitis, in particular patients with advanced disease and steatorrhea, are at risk of developing significant bone loss. Despite normal body mass index the patients are characterized by loss of lean body mass and fat mass. The present study shows that these patients have decreased serum levels of vitamin D metabolites and low bone mass.

Are magnetic resonance flexion views useful in evaluating the cervical spine of patients with rheumatoid arthritis?

OBJECTIVE

To determine whether MR imaging in flexion adds value relative to imaging in the neutral position with respect to displaying involvement of the subarachnoid space, brainstem and spinal cord.

DESIGN AND PATIENTS

T1-weighted MR images of the cervical spine in 42 rheumatoid arthritis patients with cervical spine involvement were obtained and analyzed prospectively. We assessed changes between images obtained in the neutral position and following active flexion, especially horizontal atlantoaxial and subaxial motion, presence or absence of brainstem compression, subarachnoid space involvement at the atlantoaxial and subaxial level and the cervicomedullary angle. Vertical atlantoaxial subluxation and the amount of pannus were correlated with motion and change in subarachnoid space.

RESULTS

The flexion images showed horizontal atlantoaxial motion in 21 patients and subaxial motion in one patient. The flexion view displayed brainstem compression in only one patient. Involvement of the subarachnoid space increased at the atlantoaxial level in eight (19%) patients (P=0.004) and at the level below C2 in five (12%) patients (P=0.03). There were no patients with a normal subarachnoid space in neutral position and compression in the flexed position. The cervicomedullary angle changed significantly with flexion. Vertical atlantoaxial subluxation and the amount of pannus did not show a significant correlation with motion or subarachnoid space involvement.

CONCLUSION

MR imaging in the flexed position shows a statistically significant narrowing of the subarachnoid space at the atlantoaxial level and below C2. Cord compression is only observed on flexion views if the subarachnoid space in neutral position is already decreased. MR imaging in the flexed position might be useful, since subarachnoid space involvement may be an indicator for the development of neurologic dysfunction.

Serglycin secreted by leukocytes is efficiently eliminated from the circulation by sinusoidal scavenger endothelial cells in the liver

This study was undertaken to determine the fate of the circulating chondroitin sulfate proteoglycan serglycin. The human monocytic cell line THP-1 was cultured under serum-free conditions in the presence of [35S]sulfate. The conditioned medium was harvested and 35S-macromolecules were purified by Q-Sepharose anion-exchange chromatography and Superose 6 gel chromatography. After labeling with 125I, the purified material was treated with chondroitinase ABC and subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis. A major band with mr of approximately 14 kDa appeared, consistent with the core protein of serglycin. The identity of the proteoglycan was confirmed by amino-terminal amino acid sequencing. Purified serglycin, labeled either with [35S]sulfate or 125I and fluorescein isothiocyanate, was injected intravenously into rats. The blood content of radiolabeled serglycin fell by 50% from 1 to 2.4 min after injection, indicating an initial t1/2 of 1.4 min or shorter. Approximately 90% of the recovered radioactivity was localized in the liver, 5% in the blood, and 5% altogether in urine, kidneys, and spleen about 30 min after injection. Isolation of liver cells at the same time point showed that 70% of the radioactivity was taken up by the sinusoidal scavenger endothelial cells, and 23 and 7% by the hepatocytes and Kupffer cells, respectively. When excess amounts of unlabeled hyaluronan was coinjected with radiolabeled serglycin, the elimination of serglycin was significantly inhibited, indicating that the hyaluronan receptor on the sinusoidal scavenger endothelial cells is responsible for the elimination of serglycin.

Changes in PGF2alpha secretion during prolonged luteal phase in mares

The aim of this study was to characterize changes in PGF2alpha secretion in mares with persistent corpora lutea that were induced by administering altrenogest during oestrus. In Expt 1, PGF2alpha secretion was compared among mares undergoing normal oestrous cycles (n=7) and mares undergoing prolonged luteal phases (n=6), using the mean 15-ketodihydro-PGF2alpha (PGFM) plasma concentrations, peak PGFM concentrations and number of PGFM surges each day, from day 12 to day 16 of the luteal phase. In Expt 2, oxytocin-induced PGF2alpha secretion was characterized on days 13 and 16 of the luteal phase in mares undergoing normal oestrous cycles (n=6) and in mares undergoing prolonged luteal phases (n=7) by comparing the oxytocin-induced increase in PGFM concentration and total PGF2alpha secretion. In Expt 1, mean PGFM concentrations, peak PGFM concentrations and number of PGFM surges per day were significantly lower in mares undergoing prolonged luteal phases than in mares undergoing normal luteal phases. In Expt 2, the area under the curve for PGFM ng (90 min)(-1) was similar for both groups on day 13 but was significantly lower on day 16 in mares undergoing prolonged luteal phases than in mares undergoing normal luteal phases. No change in total PGF2alpha secretion was observed between day 13 and 16 for mares undergoing normal luteal phases, but a significant decrease was observed from day 13 to day 16 in mares undergoing prolonged luteal phases. On days 13 and 16, the increase in PGFM concentration 5 min after oxytocin administration was significantly higher in mares undergoing normal luteal phases than in mares undergoing prolonged luteal phases. The increase in PGFM concentration 5 min after oxytocin administration was similar on days 13 and 16 for mares undergoing normal luteal phases, but tended to be less on day 16 in mares undergoing prolonged luteal phases. These results indicate that failure of luteolysis in mares undergoing induced prolonged luteal phases is due to decreased uterine sensitivity to oxytocin stimulation or decreased uterine ability to secrete prostaglandin.