Human sociality in the times of the Covid-19 pandemic: A systematic examination of change in greetings

Using multimodal conversation analysis this article examines embodied and tactile greetings in social interaction, documenting their change during the Covid-19 pandemic. Recognizing social interaction as foundational for human sociality, we consider greetings as a crucial normative, organizational, and ritual practice for mutually engaging in intersubjective action. Analyses use video recordings made in Switzerland (featuring (Swiss-)German and English as a lingua-franca), focusing on embodied greetings of acquainted people in public spaces at the age of Covid19-a historical moment in which physical proximity and contact are targeted by official measures restricting social interactions. Studying a range of tactile embodied greetings, the paper shows how they change from routine greetings to hesitated, suspended yet still completed ones, and to projected but resisted and refused ones. Furthermore, it reveals some 'new' practices of greeting (elbow/feetbumps, hugs-in-the-air) and their non-straightforward and accountable character, as well as how they sediment and normalize during the pandemic.

Recycling of MSWI-bottom ash in paved constructions in Sweden - A risk assessment

This paper presents results from a risk assessment of recycling pre-treated bottom ash from municipal solid waste incineration as a subbase layer in certain asphalt paved constructions in Sweden. Based on a model for assessing environmental and health risks at contaminated areas, previously developed by the Swedish EPA and by the Swedish Geotechnical Institute, target values for total content and porewater concentrations were calculated. Three different construction sizes and geometries were considered; a 1 km long road of 10 and 20 m width, respectively, and an application of 100 × 300 m. Additionally, different technical solutions of the use of bottom as in road embankments were considered. Compared to risk assessments conducted in other countries, target values are generally higher, but in the same order of magnitude. Total lead concentrations in dust potentially emitted during construction and demolition of the bottom ash is identified as a critical factor. It requires particular attention when planning for or carrying out groundwork constructions with pre-treated bottom ash. As exposure to dust and bioavailaibility of lead in bottom ash are likely to be overestimated by the underlying risk model, higher target values for lead in bottom ash should be possible for the envisaged construction purposes without affecting the general risk level. As no data is available on actual dust production and deposition by constructing and demolishing subbase layers of pre-treated bottom ash, this should be a part of future studies in order to narrow down lead target values.

Body fat mass and the proportion of very large adipocytes in pregnant women are associated with gestational insulin resistance

Background/Objectives:

Pregnancy is accompanied by fat gain and insulin resistance. Changes in adipose tissue morphology and function during pregnancy and factors contributing to gestational insulin resistance are incompletely known. We sought to characterize adipose tissue in trimesters 1 and 3 (T1/T3) in normal weight (NW) and obese pregnant women, and identify adipose tissue-related factors associated with gestational insulin resistance.

Subjects/Methods:

Twenty-two NW and 11 obese women were recruited early in pregnancy for the Pregnancy Obesity Nutrition and Child Health study. Examinations and sampling of blood and abdominal adipose tissue were performed longitudinally in T1/T3 to determine fat mass (air-displacement plethysmography); insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR); size, number and lipolytic activity of adipocytes; and adipokine release and density of immune cells and blood vessels in adipose tissue.

Results:

Fat mass and HOMA-IR increased similarly between T1 and T3 in the groups; all remained normoglycemic. Adipocyte size increased in NW women. Adipocyte number was not influenced, but proportions of small and large adipocytes changed oppositely in the groups. Lipolytic activity and circulating adipocyte fatty acid-binding protein increased in both groups. Adiponectin release was reduced in NW women. Fat mass and the proportion of very large adipocytes were most strongly associated with T3 HOMA-IR by multivariable linear regression (R²=0.751, P<0.001).

Conclusions:

During pregnancy, adipose tissue morphology and function change comprehensively. NW women accumulated fat in existing adipocytes, accompanied by reduced adiponectin release. In comparison with the NW group, obese women had signs of adipocyte recruitment and maintained adiponectin levels. Body fat and large adipocytes may contribute significantly to gestational insulin resistance.

Angiogenic factors in relation to clinical effect in a phase II trial of weekly paclitaxel

BACKGROUND

Several anticancer agents including paclitaxel have an inhibitory effect on angiogenesis.

AIMS

To compare the overall response rate and time to progression with changes in circulating angiogenic factors during palliative treatment with weekly paclitaxel.

MATERIAL AND METHODS

Patients with metastatic BC, ECOG 0-2, received weekly paclitaxel, concomitant with trastuzumab if HER2+ BC (n = 7). Circulating vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were determined at base-line and before start of new course.

RESULTS

Fifty-five of 63 included patients were evaluable. The overall response rate including stable disease ≥24 weeks (CR + PD + SD) was obtained in 25 of the evaluable patients (45%). The median time to progression (TTP) was 5.3 months and overall survival (OS) 16.7 months. Patients with triple negative breast cancer (TNBC) showed a trend towards higher base-line VEGF compared with hormone receptor positive or HER2+ tumours and had shorter TTP. Significant differences in VEGF and bFGF levels at 12 weeks were found between patients with longer versus shorter TTP (VEGF: p = 0.046, bFGF: p = 0.005) and between patients gaining versus lacking clinical benefit (VEGF: p = 0.05, bFGF: p = 0.02).

CONCLUSIONS

The clinical utility of circulating VEGF may be a useful tool for monitoring treatment efficacy.

A pain model with a neuropathic somatosensory lesion: Morton neuroma

A randomized, double-blind, three-period cross-over study was performed to characterize the sensory phenotype and pain demographics in patients with Morton neuroma (n=27) and to explore the effects of local administration (2mL) of placebo and lidocaine (1 and 10mg/mL) around the neuroma. Using the pain quality assessment scale (PQAS), the highest rating was seen for unpleasant pain and intensity of deep pain and the lowest for sensitive skin. Ongoing pain was reported in 32% of patients. Patients reported mild to moderate average pain, and that pain had interfered with sleep only marginally. Quantitative sensory testing (QST) measurements in the innervation territory showed hypophenomena or hyperphenomena in all patients, indicating that all had neuropathy. There was no particular QST modality that appeared to be specifically affected. Even the high-dose lidocaine resulted in limited effects on nerve-impulse conduction as judged by the effect on QST variables. However, both doses of lidocaine significantly reduced pain after step-ups, compared to placebo, indicating that lidocaine in this setting affected predominantly impulse generation and not impulse conduction. Following placebo treatment, pain after step-ups was similar in patients with and without hyperalgesia, indicating that the presence of hyperalgesia does not affect the pain intensity evoked by step-ups or walking. This pain model in patients with Morton neuroma allows investigation of drugs in a cross-over design and provides an opportunity to explore drug effects on both pain and QST variables. Commonly, neuromas are surgically removed and can be characterized in depth in vitro, thereby allowing close links to be established between pathophysiology and drug effect.

Tolerability of extended-release quetiapine fumarate compared with immediate-release quetiapine fumarate in older patients with Alzheimer's disease with symptoms of psychosis and/or agitation: a randomised, double-blind, parallel-group study

OBJECTIVE

The objective of this study was to assess the safety and tolerability of extended-release quetiapine fumarate (quetiapine XR) compared with quetiapine immediate-release (quetiapine IR) in older patients with Alzheimer's disease with symptoms of psychosis and/or agitation.

METHODS

This was a 6-week, double-blind, double-dummy, randomised study. Of the 109 patients screened, 100 were randomised to receive quetiapine XR (n = 68) or quetiapine IR (n = 32), at doses of 50 and 25 mg/day, respectively. Treatment was escalated to 100 mg/day by Day 4. At Day 8, a flexible-dose (50-300 mg/day) period began when dose adjustment was made at the investigator's discretion. The primary variable was incidence and type of adverse events (AEs). Secondary variables included efficacy and other safety assessments.

RESULTS

Mean daily doses were 143.6 and 142.0 mg in the quetiapine XR and quetiapine IR groups, respectively. Ninety patients completed the study; only one withdrew (in the quetiapine XR group) because of an AE. Laboratory evaluations identified severe neutropaenia (one patient), mild neutropaenia (three patients) and eosinophilia (five patients); however, these were not reported, as AEs and confounding factors, such as patient age, concomitant illness and medication, made it difficult to determine any relationship to quetiapine treatment. Numerical improvements from baseline were seen across both treatment groups in Neuropsychiatric Inventory frequency × severity total, Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory, Clinical Global Impression-Severity of Illness and Clinical Global Impression-Improvement scores.

CONCLUSION

Quetiapine XR dosed up to 300 mg/day was generally well tolerated, with a similar profile to that of quetiapine IR.

Minor amputation in patients with diabetes mellitus and severe foot ulcers achieves good outcomes

OBJECTIVE

To analyse the outcome of minor amputations (through, or distal to, the ankle joint) in patients with diabetes.

METHOD

All diabetic patients in a defined population undergoing one or more minor amputation between 1982 and 2006 were investigated according to a standardised protocol and were followed until final outcome (healing or death). A total of 410 consecutive amputations in 309 patients with a median age of 73 (32-93) years were identified.

RESULTS

In 94% of amputations, deep infection (39%) and/or gangrene (55%) was present. Severe peripheral vascular disease or critical limb ischaemia was present in 61% of amputations. 261/410 (64%) of the amputations healed at a level below the ankle joint; 69/410 (17%) healed after a re-amputation above the ankle joint; in 76/410 of amputations (19%), the patient died before healing could occur. In surviving patients, 79% of the amputations healed below the ankle. Median healing time for amputations that healed below the ankle was 26 (2-250) weeks; 21% of amputations required a re-amputation above the ankle. None of the analysed parameters excluded the possibility of healing below the ankle.

CONCLUSION

In this population-based survey, the goal of avoiding major amputation was achieved in almost two thirds of minor amputations, but at the price of long healing times. In almost all amputations, the patient had deep infection and/or gangrene. In spite of this, 64% of all amputations, and 79% of amputations in surviving patients, healed at a level below the ankle. This indicates that minor amputations in these patients are worthwhile.

DECLARATION OF INTEREST

None.

Abstract P3-10-29: Health-Related Quality of Life (HRQoL) as Prognostic Factor for Time to Progression (TTP) and Survival in Women with Metastatic Breast Cancer

Background: Prognostic factors provide important information for women with breast cancer and they are used for information on the prognosis and choice of treatment. In early breast cancer, stage, malignancy grade and hormone receptor status are used regularly as prognostic factors, while age, performance status, sites of metastasis and disease-free interval (DFI) influence the outcome in metastatic disease.

The aim of the present paper was to investigate the role of HRQoL (physical, role, emotional, cognitive, and social functioning, global quality of life, fatigue and pain) at randomization as independent prognostic factors to predict time to progression (TTP) and survival. Material and methods: In the TEX trial, 287 patients with documented locally advanced or distant metastatic breast cancer were randomized to either ET (epirubicin and paclitaxel) or TEX (epirubicin, paclitaxel and capecitabine). Treatment was repeated every 3 weeks. The EORTC QLQ-C30 questionnaire was used to assess baseline HRQoL data before randomization into the trial. Data on TTP and survival were collected from the study database.

Results

A total of 252 (88%) of the patients recruited within the trial completed questionnaires before randomization. A multivariate analysis shows that the HRQoL variables fatigue, pain and role functioning was related to prolonged survival (P&lt;0. 01). Clinical variables included in the multivariate model were age, bone metastases, and treatment arm. Analyses of the relationship between HRQoL and TTP (time to progression) will be presented.

Conclusions: The present study shows that HRQoL variables, i.e. role functioning, fatigue and pain could contribute as important predictors of the outcome and may influence the choice of therapy in situations when two treatments are equally effective.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-29.

A two‐year follow‐up of work capacity in early rheumatoid arthritis: a study of multidisciplinary team care with emphasis on vocational support

OBJECTIVE

To explore changes in sick leave patterns and work ability in patients with early rheumatoid arthritis (RA). The patients received active team support focusing on vocational rehabilitation, in addition to treatment with disease-modifying anti-rheumatic drugs (DMARDs).

METHODS

This is an observational study of 110 patients with early RA aged 18-60 years and not permanently disabled. All patients were monitored regularly during a 2-year period by a team comprising a nurse, an occupational therapist, a physiotherapist, a rheumatologist, and a social worker. Intervention included work-site visits and rehabilitation meetings with the employer and the official from the local social insurance office in addition to DMARD treatment and different individual treatments, and support from the team members.

RESULTS

The number of patients working full-time increased from 65 to 74 (14%), those with full-time work disability decreased from 37 to 13 (65%), and patients working part-time increased from 8 to 23 (65%). This change was already evident during the first year.

CONCLUSION

Active vocational support in addition to DMARD treatment may prevent or delay work disability in patients with early RA.

Controlled compression and liposuction treatment for lower extremity lymphedema

In 1987 we noticed excess adipose tissue in a patient with arm lymphedema and later, objective studies confirmed this clinical finding in patients with non-pitting arm lymphedema following breast cancer. A prospective study was begun in 1993, and its long-term results (15 years) shows overall complete reduction of the excess volume in patients with non-pitting arm lymphedema and that adipose tissue dominates the excess volume. Encouraged by these results we operated on a patient with primary and secondary elephantiasis of the leg. The edema was first transferred from a pitting to a non-pitting state by controlled compression therapy. Then liposuction was performed to remove the remaining excess adipose tissue, and complete reduction was finally achieved. The patient wears compression garments continuously and during the 11 years of followup, no recurrence has occurred. This paper explains our philosophical approach: a pitting lymphedema first should be treated conservatively to remove excess fluid, then liposuction can be performed to remove remaining excess volume bothersome to the patient.

Effect of NXY-059, a novel neuroprotectant, on the pharmacokinetics of a single dose of digoxin in healthy subjects

OBJECTIVE

NXY-059 is a novel free-radical trapping neuroprotectant. Digoxin treatment is common in acute ischaemic stroke, the intended patient population for NXY-059. Since both digoxin and NXY-059 are eliminated primarily renally, with a substantial contribution by active renal secretion, and because digoxin has a narrow therapeutic window, this open, randomised, crossover, two-period study investigated whether NXY-059 affects the pharmacokinetics (PK) of digoxin.

RESEARCH DESIGN AND METHODS

Twenty-two healthy subjects received 0.5 mg oral digoxin 2 h after the start of 60-h intravenous infusions of NXY-059 and placebo separated by a 14-day washout. Blood and urine were collected for 60 h. Digoxin concentrations were measured by a novel liquid chromatography-mass spectrometry assay.

MAIN OUTCOME MEASURES

The ratio of the geometric mean (90% confidence interval) between NXY-059 and placebo for the digoxin area under the concentration-versus-time curve was 0.91 (0.83-0.99) and was within the predefined range for no interaction (0.80-1.25). No safety concerns were raised in the study. No serious adverse events were recorded. The most common adverse event was headache with similar frequencies in the two treatments.

CONCLUSIONS

NXY-059 had no clinically significant effect on the PK of digoxin.

Quality of life following liposuction and conservative treatment of arm lymphedema

Arm lymphedema can produce an additional burden from a psychosocial point of view. Although edema reduction through treatment can be an advantage in terms of reduced weight of the arm and simplified clothing needs, the purpose of the present study was to register changes in psychosocial parameters during one year after treatment. Thirty-five patients underwent liposuction combined with postoperative CCT (Controlled Compression Therapy), while 14 received CCT alone. Edema volume and range of motion in the shoulder joint were measured and effects on quality of life were assessed with various questionnaires. Liposuction+CCT removed the arm lymphedema completely, whereas CCT alone reduced it by half. The treatments improved range of motion in the shoulder joint and patients' quality of life in relationship to the volume reduction. Liposuction+CCT improves patients' quality of life, particularly qualities related to the volume reduction and hence qualities associated with everyday activities. CCT is beneficial too, but the effect is less obvious than when combined with surgery, probably because the edema reduction is less. The consequences of arm lymphedema for more psychologically oriented qualities and social life in general seem to be less serious and we found few notable effects of treatment in these domains.

Intensity of smoking and smoking cessation in relation to risk of cataract extraction: a prospective study of women

The authors investigated the association of smoking and smoking cessation with the incidence of cataract extraction in a population-based prospective cohort study. A total of 34,595 women aged 49-83 years in the Swedish Mammography Cohort were followed from September 1997 through June 2002. Information on smoking, diet, and other lifestyle factors was collected through a self-administered questionnaire. A total of 2,128 cases of age-related cataract extraction were identified. Relative risks were estimated as rate ratios using Cox proportional hazards models. The authors observed a significant dose-response association between intensity of smoking and risk of cataract extraction (among current smokers, p for trend = 0.02; among past smokers, p for trend = 0.0002). After cessation of smoking, the risk decreased with time. Among women with a moderate lifetime smoking intensity (6-10 cigarettes/day), the relative risk was not significantly different from the risk among never smokers 10 years after smoking cessation. Among women who had smoked more intensively (>10 cigarettes/day), after 20 years of nonsmoking the increased risk became small and no longer statistically significant in comparison with never smokers (for trend over time, p < 0.0001). This prospective study confirmed smoking as a risk factor for cataract, with a dose response for smoking intensity. Smoking cessation predicts reduced risk over time, but a longer period of time is needed with a higher smoking intensity.

[The EQUAL-ESTRO external quality control laboratory in France]

PURPOSE

The EQUAL-ESTRO laboratory was set up in 1998 to perform external audits of radiotherapy beams for all the European centres. Until the end of the year 2003, it was funded by EC projects. The external quality control is based on measurements performed with thermoluminescent dosimeters (TLD) sent by postal mail to the participating centre in order to be irradiated on axis in reference conditions and in conditions close to clinical conditions for photon and electron beams. The EQUAL-ESTRO laboratory also started in 2002, a new TLD control allowed to check the dosimetry of complex clinical fields for photon beams with multileaf collimator (MLC). New geometric and dosimetric checks have also been developed for brachytherapy.

MATERIAL AND METHODS

The participating centre irradiates TLDs (7LiF: Na, mg, Ti, TLD 937 [Philitec]) in water at a dose of 2 Gy, calculated with the TPS used clinically, following the EQUAL-ESTRO protocol.

RESULTS

Since the beginning of the activities, 46% of the French radiotherapy centres and 55% of the European radiotherapy centres applied to participate to the EQUAL quality control programme. In France, the EQUAL-ESTRO laboratory checked, from 1998 and June 2004, 283 photon beams, 180 electron beams and 61 photon beams with MLC. For all the French beams checks, the following results have been observed: for the photon beams, the results show that about 1% of the measured doses in the reference conditions on axis have been detected outside the tolerance level (deviation between the measured dose and the stated dose > +/- 5%) after a first or a second check. For points checked in photon beams with wedge filter, 2.5% of the beams checked show a deviation > +/- 5% after a first or a second check. For the electron beams, the check has been set up in January 1999. For the 180 electron beams checked, 5% of the measured doses in the reference conditions have been found outside the tolerance level (> +/- 5%).

CONCLUSION

These results show clearly the importance of the quality control in radiotherapy in the frame of an external audit. This audit should now be a part of a quality assurance programme in the radiotherapy centres in addition to the internal quality control as planned in the French law (02/03/2004) concerning the external quality control conditions of the radiotherapy treatment units.

Progress in allogeneic bone marrow and peripheral blood stem cell transplantation for multiple myeloma: a comparison between transplants performed 1983-93 and 1994-98 at European Group for Blood and Marrow Transplantation centres

Out of 690 allogeneic matched sibling donor transplants for multiple myeloma reported to the European Group for Blood and Marrow Transplantation (EBMT) registry, 334 were performed during the period 1983-93 (all with bone marrow) and 356 during 1994-98 [223 with bone marrow and 133 with peripheral blood stem cells (PBSCs)]. The median overall survival was 10 months for patients transplanted during the earlier time period and 50 months for patients transplanted with hone marrow during the later period. The use of PBSCs was associated with earlier engraftment but no significant survival benefit compared to bone marrow transplants during the same time period. The improvement in survival since 1994 with the result of a significant reduction in transplant-related mortality, which was 38%, 21% and 25% at 6 months and 46%, 30% and 37% at 2 years during the earlier period, and the later period with bone marrow and PBSCs respectively. Reasons for the reduced transplant-related mortality appeared to be fewer deaths owing to bacterial and fungal infections and interstitial pneumonitis, in turn a result of earlier transplantation and less prior chemotherapy. Better supportive treatment and more frequent use of cytokines may also play a role. The improvement in survival was not directly related to the increased use of PBSCs.

Effect of thyroid hormone supplementation on survival of euthyroid dogs with congestive heart failure due to systolic myocardial dysfunction: a double-blind, placebo-controlled trial

Nineteen euthyroid dogs of 12 breeds with echocardiographic signs of dilated cardiomyopathy (DCM) and radiographic and clinical signs of congestive heart failure (CHF) were evaluated in a randomised, double-blind, and placebo-controlled study. The dogs received either thyroxine or placebo as an adjunct to digoxin, furosemide and propranolol. The group assignment of individual dogs and serum concentrations of thyroid hormones remained unknown to owners and investigators during the entire study period. Dogs were evaluated clinically and with electrocardiography (ECG), thoracic radiography, echocardiography and measurement of total thyroxine (tT4) and thyroid stimulating hormone (TSH) before beginning of the trial, and then one week, 2 months, 6 months and yearly after initial examination, and, when applicable, at the time of euthanasia. End-point of the study was euthanasia (n = 17) due to severe congestive heart failure or sudden death (n = 2). Survival times ranged from 17 to 1030 days (median 187 days) in the placebo group, and from 18 to 1000 days (median 73 days) in the treatment group. There was no statistically significant difference in survival times between the treatment group and the placebo group (p = 0.46). Post mortem and histopathologic examinations revealed the attenuated wavy fiber type of DCM in 11 dogs, and myocardial infarcts, arteriosclerosis and chronic valvular disease in one dog. In conclusion, there was a wide range in survival times of dogs treated with digoxin, furosemide and propranolol. Adding thyroid hormones to the treatment did not significantly influence survival.

Assessing urinary albumin excretion in pre-eclamptic women: which sample to use?

OBJECTIVE

To evaluate whether the gold standard of 24-hour urine collection for measuring albumin excretion in pre-eclamptic women could be substituted by shorter collection periods.

DESIGN

Prospective study.

SETTING

Fetal maternity ward, university hospital.

PARTICIPANTS

Thirty women with pre-eclampsia and a positive urinary test strip for protein of at least 2+.

METHODS

From each woman, within a 25-hour period, three spot, two 12-hour (day and night) and one 24-hour urine sample were collected. Urine albumin concentrations in milligrammes per litre were analysed by rate nephelometry on a Beckman Array protein system. The urinary albumin concentrations in the spot and the 12-hour samples were compared with the concentration in the 24-hour urine collection.

MAIN OUTCOME MEASURES

Urinary albumin concentrations in spot and 12-hour samples measured against the standard 24-hour albumin excretion.

RESULTS

Albumin concentrations in the day and night collection fitted closely with the concentrations of the 24-hour collection. The median difference between the 24-hour and the day collection was -3 mg/L (interquartile range -264 to 116 mg/L). The median difference between the 24-hour and the night collection was 17 mg/L (interquartile range -186 to 210 mg/L). The association of urinary albumin concentration in the 24-hour collection and the spot samples was much weaker. Of the spot urine samples, the albumin concentration in the sample taken on the morning after admission to hospital was closest to the 24-hour urinary albumin excretion, with a median difference of -62 mg/L (interquartile range -1131 to 285 mg/L).

CONCLUSION

The gold standard of 24-hour urinary excretion for assessment of albuminuria in pre-eclamptic women can be substituted with a 12-hour collection. Spot urine samples were inaccurate and are therefore not recommended for quantification of albumin excretion.

The ghrelin cell: a novel developmentally regulated islet cell in the human pancreas

OBJECTIVES

Ghrelin, an endogenous ligand of the growth hormone secretagogue receptor (GHS-R), was recently identified in the stomach. Ghrelin is produced in a population of endocrine cells in the gastric mucosa, but expression in intestine, hypothalamus and testis has also been reported. Recent data indicate that ghrelin affects insulin secretion and plays a direct role in metabolic regulation and energy balance. On the basis of these findings, we decided to examine whether ghrelin is expressed in human pancreas. Specimens from fetal to adult human pancreas and stomach were studied by immunocytochemistry, for ghrelin and islet hormones, and in situ hybridisation, for ghrelin mRNA.

RESULTS

We identified ghrelin expression in a separate population of islet cells in human fetal, neonatal, and adult pancreas. Pancreatic ghrelin cells were numerous from midgestation to early postnatally (10% of all endocrine cells). The cells were few, but regularly seen in adults as single cells at the islet periphery, in exocrine tissue, in ducts, and in pancreatic ganglia. Ghrelin cells did not express any of the known islet hormones. In fetuses, at midgestation, ghrelin cells in the pancreas clearly outnumbered those in the stomach.

CONCLUSIONS

Ghrelin is expressed in a quite prominent endocrine cell population in human fetal pancreas, and ghrelin expression in the pancreas precedes by far that in the stomach. Pancreatic ghrelin cells remain in adult islets at lower numbers. Ghrelin is not co-expressed with any known islet hormone, and the ghrelin cells may therefore constitute a new islet cell type.

Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years

BACKGROUND

Patients with coeliac disease are advised to keep to a lifelong gluten-free diet to remain well. Uncertainty still exists as to whether this gives a nutritionally balanced diet.

AIM

To assess the vitamin nutrition status of a series of coeliac patients living on a gluten-free diet for 10 years.

METHODS

Thirty adults with coeliac disease (mean age, 55 years; range, 45-64 years; 60% women), in biopsy-proven remission following 8-12 years of dietary treatment, were studied. We measured the total plasma homocysteine level, a metabolic marker of folate, vitamin B-6 and vitamin B-12 deficiency, and related plasma vitamin levels. The daily vitamin intake level was assessed using a 4-day food record. Normative data were obtained from the general population of the same age.

RESULTS

Coeliac patients showed a higher total plasma homocysteine level than the general population, indicative of a poor vitamin status. In accordance, the plasma levels of folate and pyridoxal 5'-phosphate (active form of vitamin B-6) were low in 37% and 20%, respectively, and accounted for 33% of the variation of the total plasma homocysteine level (P < 0.008). The mean daily intakes of folate and vitamin B-12, but not of vitamin B-6, were significantly lower in coeliac patients than in controls.

CONCLUSIONS

Half of the adult coeliac patients carefully treated with a gluten-free diet for several years showed signs of a poor vitamin status. This may have clinical implications considering the linkage between vitamin deficiency, elevated total plasma homocysteine levels and cardiovascular disease. The results may suggest that, when following up adults with coeliac disease, the vitamin status should be reviewed.

Living with coeliac disease: controlled study of the burden of illness

BACKGROUND

Coeliac patients improve vastly when started on a gluten-free diet. After 10 years. however, women show a lower level of subjective health than men do. We investigated whether this could be explained by differences in the perceived disease burden.

METHODS

We studied 68 coeliac patients (34 women) (mean age 57 years, range 32-75) and matched type-2 diabetes controls treated for a mean of 10 years. They were examined by a 9-item Burden of Illness (BI) protocol comprising perceived worries, restrictions and subjective outcome. The subjective health was assessed with the Short Form 36 Health Survey (SF-36) questionnaire.

RESULTS

The importance of complying with the diet was ranked similarly high by male and female coeliac patients. However, women were less satisfied with the outcome at 10 years than men were, and expressed more concern about the impact on socializing with friends and having to abstain from important things in life. None of these aspects distinguished male and female diabetic patients. Coeliac women showed a higher BI sum score than men did, and this was inversely related to their SF-36 General health, Vitality and Mental Health scores.

CONCLUSIONS

Coeliac women adhering to the treatment regimen for several years perceive the disease burden to be worse than men do. In the light of similar differences in their quality of life, inquiry is warranted into the way coeliac men and women are coping with the disorder.

Adult skeletal profile in isolated cleft palate: a comparison of the von Langenbeck and Wardill procedures for primary repair of the palate

Sixty-four adult patients operated on for isolated cleft palate were evaluated with regard to facial skeletal morphology using conventional radio-cephalometry. Dental occlusion was assessed clinically. Forty-two had had a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at 18 months. The mean error of the method was 0.7 degree for angular, and 0.9 mm for linear, measurements. The group with clefts had less maxillary prognathism (s-n-ss), more maxillary inclination (NSL/NL), more retroclined lower incisors (ILI/ML), and shorter total and upper facial heights (n-gn, n-sp) compared with the reference group. Multiple regression analysis was used to evaluate differences between the two treatment regimens. Explanatory variables in addition to surgical technique were sex, severity of cleft, and presence of a velopharyngeal flap. Only one variable, lower incisor inclination (ILI/ML), was different for the two regimens. Ten (24%) in the von Langenbeck group had a lateral cross-bite compared with one (5%) in the Wardill group. Other variables in a multivariate regression analysis were affected by sex and severity of cleft to various degrees. This study showed no obvious differences in facial skeletal morphology that could be attributed to surgical technique. Factors other than technique, including sex, age, and severity of cleft merit attention.

Effects of harmine on dopamine output and metabolism in rat striatum: role of monoamine oxidase-A inhibition

In vivo microdialysis was used to investigate the effects of acute injections of harmine on extracellular concentrations of dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxindoleacetic acid (5-HIAA) in the striatum of awake rats. Administration of harmine in doses of 0.5, 2.5, and 10 mg/kg (i.p.) elicited a dose-dependent increase of the dopamine efflux to 152, 173, and 243% and a decrease in DOPAC to 52, 36, and 10%, and HVA to 67, 45, and 20% throughout, respectively; 5-HIAA concentrations were decreased to 81, 74, and 72% only. In contrast to D-amphetamine, which also increases dopamine release and decreases its metabolites, the stimulatory action of harmine on dopamine release in the striatum was totally abolished in the presence of tetrodotoxin (1 microM). Similar to monoamine oxidase (MAO)-A inhibitors, harmine potentiated the stimulatory effect of D-amphetamine (10 microM), infused by reverse microdialysis in the striatum, on dopamine release. Pre-treatment with the benzodiazepine receptor antagonist flumazenil (5 mg/kg, i.p.) did not modulate the effect of harmine on striatal dopamine release and metabolism. Administration of the reversible MAO-A inhibitor, moclobemide (20 mg/kg, i.p.), induced an increase in dopamine to 256% and a decrease in DOPAC, HVA, and 5-HIAA to 30, 24, and 62%, respectively, reproducing a pattern similar to that of harmine. Taken together, these results indicate that harmine affects the brain dopamine system probably by acting as a MAO-A inhibitor and not as an inverse agonist for the benzodiazepine receptors.

The expression of hormone-sensitive lipase in clonal beta-cells and rat islets is induced by long-term exposure to high glucose

Hormone-sensitive lipase (HSL) is expressed and enzymatically active in beta-cells and has been proposed to be involved in the generation of the lipid-derived signal that seems to be necessary for glucose-stimulated insulin secretion. In this study, we investigated whether the expression of HSL in INS-1 cells and in rat islets is affected by exposure to high glucose concentrations. Incubation of INS-1 cells in 25 mmol/l glucose for 16 and 32 h induced HSL protein expression twofold, whereas no effect was observed after 4 and 8 h of incubation. The HSL activity, defined as the diglyceride lipase activity inhibited by anti-rat HSL antibodies, constituted approximately 25% of total diglyceride lipase activity and was induced to a similar extent as HSL protein levels. The glucose effect at 16 h on HSL protein expression level was confirmed in freshly isolated rat islets. Exposure of INS-1 cells to different glucose concentrations for 16 h showed that the inductive effect on HSL protein levels was maximum at 20 mmol/l glucose (2- to 2.5-fold). Northern blot analysis demonstrated a more than threefold elevation of HSL mRNA levels. The induction was blocked by actinomycin D, and the half-life of the transcript seemed to be unchanged by high glucose, suggesting a transcriptional nature of the glucose effect on HSL gene expression. The nonmetabolizable glucose analog 2-deoxyglucose, which has no mitogenic effect, induced HSL approximately 1.3-fold, whereas mannose was similar to glucose, stimulating HSL expression 1.7- to 2-fold. The results suggest that HSL is involved in the beta-cell responses to hyperglycemia and also in generating the lipid signal that is needed in stimulus-secretion coupling.

Surgical treatment of hidradenitis suppurativa

Hidradenitis suppurativa is a skin disease involving the apocrine sweat glands which often becomes chronic. The aetiology is not completely known, but the mainstays of medical treatment are antibiotics, which gives temporary relief but do not essentially alter the course of the disease. We describe our results of treating 138 affected patients by radical excision of the diseased areas between 1978 and 1999. Postoperative follow-up ranges from 3 months to 21 years; we compiled data from the patients' casenotes and circulated a questionnaire, which 116 patients completed. Median age at onset of disease was 23 years and the interval before radical surgery was 10 years. Altogether 367 affected sites were excised; most cases required skin grafting. There were no serious surgical complications. In 38 patients (33%) the disease recurred to some degree, and 14 of them required further operation. Six patients had a subsequent operation to improve the aesthetic result. Ninety-six of the patients (83%) answered that they would recommend the procedure to other patients under similar circumstances. In our opinion excision and skin grafting is a valuable treatment in cases of severe hidradenitis suppurativa.