Patients' experiences of the recovery period 3 months after gastrointestinal cancer surgery

It is known that patients who have undergone gastrointestinal surgery as a result of a tumour experience changes in weight and intake of food and fluid. Several studies have highlighted patients' experiences owing to cancer, but there is a lack of knowledge about the recovery period from the patients' perspective. The purpose of this research is to describe patients' experiences of the recovery period 3 months after surgery. Data was collected by inviting four women and six men, between 52 and 84 years of age, to participate in an interview or dialogue 3 months after surgery. The study takes a hermeneutic approach. The framework for interpretation is the theory "Man's search for meaning" and further theories about suffering. The recovery period is characterized by feelings of being "down in the depths", lonely, abandoned and disappointed, but also feelings of support. Some patients regained strength and energy and reached a turning point, while others did not. Patients' suffering is seen as being in limbo, a fight between lack of freedom and freedom, including feelings of hope and doubts.

Sleep habits and sleep problems among a community sample of schoolchildren

Sleep habits, sleep problems and subjective depth of sleep among 1413 schoolchildren aged 6.2-10.9 y were examined via a questionnaire, answered by the child and parent together. Total sleep time was approximately 10.5 h, with no difference between the sexes. Of 887 children who reported that they were awoken at night, parents considered that 75% were superficial sleepers and 25% were deep sleepers. The prevalence of frequent insomnia, sleepwalking and daytime sleepiness was 13, 7 and 4%, respectively. Logistic regression analyses indicated that onset insomnia was associated with fear of sleeping alone, bone pains, hypnagogic myoclonias, rhythmic movement disorder, enuresis, nocturia, confusion when awoken at night, nightmares, bodily movements during sleep, interrupted sleep, daytime sleepiness and daytime headache or stomach ache. Somnambulism was associated with rhythmic movement disorder, somniloquy, spontaneous confused arousals, nocturia and confusion when awoken at night. Increased risk of daytime sleepiness was found among children with fear of sleeping alone, onset insomnia, rhythmic movement disorder, spontaneous confused arousals, snoring, confusion when awoken, nightmares, bodily movements during sleep and headache or stomach ache.

CONCLUSION

The results support the notion that onset insomnia is a problem with a predominantly psychological and behavioural background, while sleepwalking is a disorder of arousal without major psychological implications. The mechanisms behind daytime sleepiness seem to be multifactorial.

Glycosaminoglycan-lipoprotein interaction

Glycosaminoglycans (GAGs) bound to various proteoglycans (PGs) present in the cardiovascular system have been proposed to perform a wide range of functions. These include conferring viscoelastic properties; interacting with and modulating growth factors and enzymes; and as receptors and co-receptors in lipoprotein metabolism. Binding of apoB-100 lipoproteins, particularly low density lipoproteins (LDL), to GAGs of extracellular matrix PGs in arteries has been proposed to be an initiating event in development of atherosclerosis. This study was initiated with the aim of getting an overview of the binding patterns of different lipoprotein subclasses with individual GAG categories. We thus evaluated the interaction of lipoproteins with GAGs commonly found in the cardiovascular system using a gel mobility-shift assay developed for this purpose. The same procedure was used to measure lipoproteins binding to metabolically [(35)S]-labeled whole PGs prepared from three cell types, arterial smooth muscle cells, THP-1 macrophages and from HepG2 cells. The effect of GAG composition on PGs on lipoprotein binding was evaluated by enzymatic degradation of the carbohydrate chains. Heparan sulfate was found to bind beta very low density lipoproteins (beta-VLDL) and a chylomicron remnant model (beta-VLDL+apoE), but not LDL. Dermatan sulfate was found to bind LDL, but not beta-VLDL or the chylomicron remnant model. Chondroitin sulfate and heparin were found to bind all lipoproteins tested (LDL, beta-VLDL and beta-VLDL+apoE) although with different affinities. We can conclude that each lipoprotein subclass tested binds a specific assortment of the GAGs tested. The observations made contribute to the understanding of new and complex mechanisms by which carbohydrate and lipid metabolism may be linked.

Changes in matrix proteoglycans induced by insulin and fatty acids in hepatic cells may contribute to dyslipidemia of insulin resistance

Insulin resistance and type 2 diabetes are associated with elevated circulating levels of insulin, nonesterified fatty acids (NEFAs), and lipoprotein remnants. Extracellular matrix proteoglycan (PG) alterations are also common in macro- and microvascular complications of type 2 diabetes. In liver, extracellular heparan sulfate (HS) PGs contribute to the uptake of triglyceride-rich lipoprotein remnants. We found that HepG2 cells cultured with 10 or 50 nmol/l insulin or 300 micromol/l albumin-bound linoleic acid changed their PG secretion. The glycosaminoglycans (GAGs) of the secreted PGs from insulin-treated HepG2 cells were enriched in chondroitin sulfate (CS) PGs. In contrast, cells exposed to linoleic acid secreted PGs with decreased content of CS. Insulin caused a moderate increase in mRNA for versican (secreted CS PG), whereas linoleic acid markedly decreased mRNA for versican in HepG2 cells, as did the peroxisomal proliferator-activated receptor-alpha agonist bezafibrate. The effects of insulin or linoleic acid on syndecan 1, a cell surface HS PG, were similar to those on versican, but less pronounced. The livers of obese Zucker fa/fa rats, which are insulin-resistant and have high levels of insulin, NEFAs, and triglyceride-rich remnants, showed increased expression of CS PGs when compared with lean littermates. These changes in PG composition decreased the affinity of remnant beta-VLDL particles to PGs isolated from insulin-treated HepG2 cells and obese rat livers. The results indicated that insulin and NEFAs modulate the expression of PGs in hepatic cells. We speculate that in vivo this exchange of CS for HS may reduce the clearance of remnant beta-VLDLs and contribute to the dyslipidemia of insulin resistance.

Improved diagnostic classification of alcohol abusers by combining carbohydrate-deficient transferrin and gamma-glutamyltransferase

BACKGROUND

Biochemical markers can provide objective evidence of high alcohol consumption. However, currently available markers have limitations in their diagnostic performance.

METHODS

The diagnostic values of the most frequently used markers [carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), aspartate aminotransferase, alanine aminotransferase, and mean corpuscular volume] were studied in an analysis of six different clinical studies (n = 1412) on alcohol abusers and social drinkers. The purpose of the analyses was to determine whether a combination of markers would improve the diagnosis of subjects.

RESULTS

Discrimination between alcohol abusers and social drinkers, as measured by the areas under nonparametric ROC plots, was significantly better (P<0.001) for the new combined marker [gamma-CDT = 0.8. ln(GGT) + 1.3. ln(CDT)] than for any of the separate markers or combination of CDT or GGT with other markers. The cutoff values for gamma-CDT (6.5) can be taken to be the same among males and females.

CONCLUSIONS

The combined variable gamma-CDT is a powerful tool to discriminate alcohol abusers from social drinkers and is recommended for clinical use.

Microemulsion formed by alkyl polyglucoside and an alkyl glycerol ether with weakly charged films

We have studied the effects on phase equilibria of a nonionic surfactant mixture-water-oil system when replacing small amount of surfactant molecules by ionic surfactant, sodium dodecyl sulfate (SDS). The nonionic surfactant system contains dodecyl-beta-D-maltoside (C(12)AG2) and iso-octyl glyceryl ether (i-C(8)GE) as cosurfactant, water and cyclohexane at constant water to oil ratio of 60/40 (w/w). Adding a small amount of SDS has large impact on the phase behavior. Clear liquid crystalline phase and upper microemulsion phase are added to the phase sequence at high i-C(8)GE/(C(12)AG2+i-C(8)GE) ratio. We also compare the phase equilibria of pure dodecyl maltoside system with polyglucosides mixture system.

Heating of food and haemoglobin adducts from carcinogens: possible precursor role of glycidol

Studies of adducts from reactive compounds to haemoglobin (Hb) by gas chromatography-tandem mass spectrometry according to the N-alkyl Edman method reveals the occurrence of N-(2,3-dihydroxypropyl)valine (diHOPrVal) at levels of 1-2 pmol/g Hb, in persons without known exposure. The hypothesis that this background originates from glycidol or related compounds during heating of food was tested in experiments with rats. Animals fed fried animal feed for 30 or 72 days showed an increase of the diHOPrVal level by about 50% compared with controls. Several arguments, such as the formation of reactive oxiranes by heat-induced dehydration of glycol configurations in glycerol and sugars, support the idea that glycidol (or e.g. glycidyl esters) are precursors of the adduct. In Hb samples, reduced for stabilisation of aldehyde adducts, relatively high levels of adducts determined as diHOPrVal were found, although without significant relation to frying of the feed. There is thus no indication that reduction in vivo of, for example, the Schiff base from glyceraldehyde, is a pathway for formation of the diHOPrVal. The background level of diHOPrVal in humans Hb is low, and the cancer risk associated with exposure to the specific alkylator-probably glycidol-formed in cooking, is therefore presumably low. The result implies, however, that low-molecular mass mutagenic oxiranes formed during the heating of food should be studied further.

Dose response of laboratory markers to alcohol consumption in a general population

The dose response to alcohol use of carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and their combination (gamma-CDT) was studied in an age- and gender-stratified, random sample from Finland in 1997. A linear association with a threshold between alcohol consumption and the three markers was observed. Body mass index was negatively associated with CDT and positively with GGT Age was positively associated with GGT and gamma-CDT In conclusion, CDT appears to be an early phase marker of alcohol consumption. The combined marker, gamma-CDT, was less associated with factors such as body mass index but more strongly correlated with alcohol consumption than were the two markers separately.

Effect of hormone balance on carbohydrate-deficient transferrin and gamma-glutamyltransferase in female social drinkers

BACKGROUND

Carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) are the most commonly used markers for alcohol abuse, but their sensitivity and specificity are lower and have different reference values among females compared with males. In the present study, we evaluated the effect of women's hormone balance on these two alcohol markers, as well as on their mathematical combination, named gamma-CDT.

METHODS

An age-stratified random sample of 3962 women, between 25-74 years old, was drawn from the normal population. Pregnancy, the use of oral contraceptives, intrauterine device for contraception, hormone replacement therapy, and hormone treatment for infertility were considered. A comparison between fertile, peri- and postmenopausal women was also done.

RESULTS

Existing pregnancy increased CDT levels but decreased GGT values. Lower CDT and higher GGT levels were observed among those women using oral contraceptives and in postmenopausal women compared with women at the fertile stage. gamma-CDT was not influenced by hormone balance.

CONCLUSIONS

The different hormonal status had an opposite effect on CDT and GGT. Women who were close to late menopause had levels of both markers closer to the values of men. It must be pointed out that the findings presented here are based on measurements of absolute CDT values and that no measurements of total transferrin were done. gamma-CDT, not influenced by hormone balance, indicates promising clinical utility among women.

Effects of selenium deficiency on the formation and detoxification of endogenous electrophiles in rats

Selenium deficiency could be expected to lead to enhanced lipid peroxidation through loss of selenium-dependent glutathione peroxidase activity. Such a relation has, however, been difficult to verify. In the present study, the influence of selenium deficiency in rats on in vivo doses of some endogenously occurring low-molecular mass aldehydes and epoxides was determined. In vivo doses were measured by mass-spectrometric analysis according the N-alkyl Edman method of reaction products (adducts) with N-terminal valines in hemoglobin. Despite variations between experiments, the adduct levels of acetaldehyde and malonaldehyde were shown to be significantly higher in rats fed a selenium-deficient diet than in controls fed a selenium-adequate diet. No significant effect was found for the other aldehydes measured. In contrast, the in vivo doses of endogenous ethylene oxide and propylene oxide were lowered in selenium-deficient rats, indicating a 1.7-times faster detoxification rate. This was verified by the lower adduct levels in selenium-deficient rats following intraperitoneal administration of these epoxides at moderate doses. In conclusion, the results seem to reflect the complex changes of induced and reduced enzyme activities in response to selenium deficiency. Measurement of reactive compounds through their adducts to hemoglobin has shown its ability to elucidate the effects of selenium deficiency per se.

Enhanced clinical utility of gamma-CDT in a general population

BACKGROUND

The use of a combination of markers to detect excessive alcohol consumption has been reported to provide better sensitivity in the diagnosis of alcohol abuse than single markers. However, the optimal combination of markers for the diagnosis of alcohol abuse has not yet been found. The aim of this study was to compare the diagnostic value of carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) to discriminate among heavy drinkers (>280 g/week), moderate drinkers (105-280 g/week), and light drinkers (<105 g/week). Their mathematical combination, named gamma-CDT, which has been found to be a strong marker of alcohol abuse in a former study, was also evaluated.

METHODS

The study was conducted in a group of 6962 subjects (3974 males and 2988 females), between the ages of 25 and 74 years, who participated in a large cross-sectional risk factor survey carried out in five geographic areas in Finland. In each study area, an age- and gender-stratified random sample was drawn from the general population. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic curves were used to evaluate the performance of CDT, GGT, and gamma-CDT.

RESULTS

For both sexes, the combined marker had the highest specificity (95%) and sensitivity in detecting heavy drinkers. In all cases, gamma-CDT had the highest area under ROC plots. Our results also showed that GGT and CDT have similar, and rather low, sensitivity but high specificity in a general population.

CONCLUSIONS

Compared with single markers, a significant improvement of sensitivity was obtained when the combination of both markers was used, especially in females.

Desmopressin resistant enuresis: pathogenetic and therapeutic considerations

PURPOSE

We tested the role of the bladder in the pathogenesis of desmopressin resistant enuresis by evaluating the influence of urine production on the timing of the enuretic event and the response to anticholinergic medication.

MATERIALS AND METHODS

We gave 33 children with monosymptomatic nocturnal enuresis resistant to the standard 0.4 mg. oral dose of desmopressin 0.4 and 0.8 mg. desmopressin and placebo tablets for 5 nights each in a double-blind crossover fashion. The time of enuresis or nocturia was documented. All 9 children who had at least 1 dry treatment period during the randomized portion of the study then received open label treatment with 0.8 mg. desmopressin. Nonresponders to this regimen and the remainder of the children were offered anticholinergic treatment.

RESULTS

Average time between bedtime and voiding was 5.0, 5.6 and 5.0 hours during the nights with placebo, and 0.4 and 0.8 mg. desmopressin, respectively (p = 0.12). Of the 9 children subsequently treated with 0.8 mg. desmopressin 5 became completely dry. Of the remaining 28 children given anticholinergic treatment 20 responded.

CONCLUSIONS

Antidiuresis does not delay the enuretic event in children with desmopressin resistant enuresis. This finding and the favorable response to anticholinergic medication favor the hypothesis that these children have nocturnal bladder instability. A subgroup of enuretic children responds to high but not normal doses of desmopressin.

Quantitative measurements of Ostwald ripening using time-resolved small-angle neutron scattering

Using a unique method we present accurate quantitative measurements of the Ostwald ripening of an emulsion system. Time-resolved small-angle neutron scattering monitors the time evolution of the average radius and number density of the emulsion drops. The results qualitatively agree with the current theory of Ostwald ripening but there is a quantitative, experimentally significant, discrepancy of a factor of 1.7. We argue that these accurate experiments, performed on a well characterized system, provide a most useful basis for testing further refinements of the theory.

Thermodynamics of a nonionic sponge phase

Different suggestions for the mechanism governing the narrow stability of the L(3) (sponge) phase have led to a series of debates in recent years. There have been several models developed to describe such a mechanism via thermodynamics. To date, experimental data are insufficient to test present theories. In this study, we revisit the sponge phase with two series of thermodynamic data performed on the well-characterized C(12)E(5)-n-decane-H(2)O system. These thermodynamic data sets stem from phase equilibrium and static light scattering experiments designed to link system-specific parameters such as the temperature dependence of the spontaneous curvature H(o) and the two bending moduli kappa and (-)kappa, which have only been loosely connected in earlier experiments. The use of a well-characterized system is important in that it allows usage of molecular descriptors from earlier studies to reduce fit parameters. Another advantage for using this system is that its phase behavior is analogous to a two-component system which, from an experimental standpoint, is more practical to perform accurate measurements and, from a theoretical standpoint, more simple to model. In the present investigation, we use these tools to quantitatively test parameters obtained by different experimental techniques and assumptions inherited in theoretical models designed to interpret them.

Serum sialic acid in a random sample of the general population

BACKGROUND

The serum sialic acid (SA) concentration has been reported to be a potentially useful but nonspecific disease marker. We wanted to study which factors influence SA concentration in a well-characterized healthy population.

METHODS

SA was determined in 97 women and 96 men with a colorimetric Warren method.

RESULTS

The mean +/- SD concentrations of SA were 634 +/- 109 (95% confidence interval, 612-656) and 630 +/- 106 (95% confidence interval, 608-651) mg/L for women and men, respectively. The serum SA showed a significant positive association with body mass index and with systolic and diastolic blood pressure among both women and men. SA also correlated significantly with the use of contraceptive pills and age among women and with smoking among men.

CONCLUSIONS

Our study suggests that SA does not increase with age in men but appears to increase with female menopause. The strong positive association with blood pressure may explain why SA predicts cardiovascular mortality.

Lipid mediators that modulate the extracellular matrix structure and function in vascular cells

Treatment with moderate levels of albumin-bound, nonesterified fatty acids (NEFA) induce important alterations of the structure and functionality of proteoglycans secreted by endothelial cells and arterial smooth muscle cells. In endothelial cell monolayers, the reduction on relative amount and sulfation of heparan sulfate proteoglycans is associated with an increased permeability to albumin. In smooth muscle cells, NEFA-albumin complex increased the expression of the genes for the core proteins of the proteoglycans syndecan, decorin and perlecan. This effect appears mediated by peroxisome proliferator-activated receptor gamma (PPARg). The matrix produced by the cells treated with NEFA-albumin had a higher affinity with low-density lipoproteins (LDLs). We speculate about the possibility that under dyslipidemias associated with increased exposure of vascular cells to NEFA, like in type 2 diabetes, similar alterations may contribute to associated macrovascular and microvascular complications.

Depth of sleep and sleep habits among enuretic and incontinent children

In order to evaluate differences in sleep factors between children with wetting problems and dry children, questionnaire data were obtained from 1,413 schoolchildren between the ages of 6 and 10 y. The analyses were performed using logistic regression, and adjusted odds ratios (ORs) were calculated to approximate the relative risk. Current enuresis was associated with a subjectively high arousal threshold, pavor nocturnus, nocturia and confusion when awoken from sleep (ORs 2.7, 2.4, 2.1 and 3.4, respectively), whereas children with current incontinence often experienced bedtime fears, onset insomnia or nocturia (ORs 2.4, 2.3 and 2.7, respectively). Children exhibiting urinary urgency were overrepresented among both children with current enuresis (OR 2.5) and those with current incontinence (OR 17.2). It is concluded that impaired arousal mechanisms and bladder instability are aetiological factors underlying nocturnal enuresis.

Fatty acids modulate the composition of extracellular matrix in cultured human arterial smooth muscle cells by altering the expression of genes for proteoglycan core proteins

In diabetes-associated microangiopathies and atherosclerosis, there are alterations of the extracellular matrix (ECM) in the intima of small and large arteries. High levels of circulating nonesterified fatty acids (NEFAs) are present in insulin resistance and type 2 diabetes. High concentrations of NEFAs might alter the basement membrane composition of endothelial cells. In arteries, smooth muscle cells (SMCs) are the major producers of proteoglycans and glycoproteins in the intima, and this is the site of lipoprotein deposition and modification, key events in atherogenesis. We found that exposure of human arterial SMCs to 100-300 micromol/albumin-bound linoleic acid lowered their proliferation rate and altered cell morphology. SMCs expressed 2-10 times more mRNA for the core proteins of the proteoglycans versican, decorin, and syndecan 4 compared with control cells. There was no change in expression of fibronectin and perlecan. The decorin glycosaminoglycan chains increased in size after exposure to linoleic acid. The ECM produced by cells grown in the presence of linoleic acid bound 125I-labeled LDL more tightly than that of control cells. Darglitazone, a peroxisome proliferator-activated receptor (PPAR)-gamma ligand, neutralized the NEFA-mediated induction of the decorin gene. This suggests that some of the NEFA effects are mediated by PPAR-gamma. These actions of NEFAs, if present in vivo, could contribute to changes of the matrix of the arterial intima associated with micro- and macroangiopathies.