Prevalence of raised Yersinia enterocolitica antibody titre in unselected, adult populations in Denmark during 12 years

Yersinia enterocolitica biotype 4, serotype 0:3 is by far the most common human pathogenic Yersinia enterocolitica subtype in Scandinavia. It is extraordinarily immunologically specific, and an elevated antibody titre greater than or equal 80-160 is known to indicate acute infection. This titre was measured in five population surveys conducted in 1967-78, including 3278 examined adult men and women. The prevalence of titre elevation greater than or equal to was 1.0% in 1967. In 1978 it was significantly higher, 7.7%, and also the individual course of the titre in a ten-year longitudinal survey showed a significant increase in this prevalence, indicating an increasing incidence of infection. Significant sex and age differences were seen, women and younger subjects being more frequently affected than men and older subjects. The prevalence of elevated titre showed a seasonal variation with a maximum in the spring and autumn.

Measurement of the energetics of metal film growth on a semiconductor: Ag/Si(100)-(2 x 1)

The first direct calorimetric measurements of the energetics of metal film growth on a semiconductor surface are presented. The heat of adsorption of Ag on Si(100)-(2 x 1) at 300 K decreases from approximately 347 to 246 kJ/mol with coverage in the first monolayer (ML) due to overlap of substrate strain from nearby Ag islands. It then rises quickly toward the bulk sublimation enthalpy (285 kJ/mol) as 3D particles grow. A wetting layer grows to 1.0 ML, but is metastable above approximately 0.55 ML and dewets when kinetics permit. This may be common when adsorbate islands induce a large strain in the substrate surface nearby.

Three-dimensional whole body imaging of spin probes in mice by time-domain radiofrequency electron paramagnetic resonance

Imaging of stable paramagnetic spin probes in phantom objects and in vivo was evaluated using a RF time domain EPR spectrometer/imager operating at 300 MHz. Projections were collected using static magnetic field gradients and images were reconstructed using filtered back-projection techniques. Results from phantom objects containing approximately 10(17) spins of stable paramagnetic probes with single narrow EPR spectra provide three-dimensional spatial images with resolution better than 2 mm. When the spin probe was administered to mice, the spin probe accumulation was temporally observed in the thoracic, abdominal, and pelvic regions. A three-dimensional image (from 144 projections) from a live mouse was collected in 5 min. Using fiducial markers, the spin probe accumulation in organs such as liver, kidney, and bladder could be observed. Differences in the oxygen status between liver and kidney were observed from the EPR images from mice administered with spin probe, by treating the time-domain responses with convolution difference approach, prior to image reconstruction. The results from these studies suggest that, with the use of stable paramagnetic spin probes and time-domain RF EPR, it is possible to perform in vivo imaging on animals and also obtain important spatially resolved physiologic information.

["The consultation lab"--training clinical communication]

Discourse is the doctor's most essential tool. Since 1992, 500 Danish GPs have participated in "The consultation process I" and videosupervision in Greece. Participants are divided into groups of six. Each group works in a virtual consultation lab in which doctor-patient role plays are videotaped and supervised according to a specific matrix. In this experimental setting we have further sophisticated the nine phases (the P-R-A-C-T-I-C-A-L model) of the consultation process and improved our matrix for group supervision of video sessions. Typical individual pitfalls in doctor-patient communication have been demonstrated. Participant doctors were allowed to freely explore individual styles, and then establish how they were perceived by their "patients'"; they have learned how patient experience of a consultation varies. Furthermore, the courses helped to create networks: several groups met later, and a great many of these GPs have joined medical student tutoring. This way, the courses have contributed to more efficient work practices and job satisfaction, to professional advances, and to a lasting of the quality of upgrading in general practice.

Postembryonic ontogeny of the spadefoot toad, Scaphiopus intermontanus (Anura: Pelobatidae): skeletal morphology

Postembryonic skeletal ontogeny of the pelobatid frog Scaphiopus intermontanus is described based on a developmental series of cleared-and-stained, whole-mount specimens. The focus is on laboratory-reared individuals fed a herbivorous diet as larvae. Although there is variation in the timing of ossification of individual skeletal elements relative to developmental stages based on external morphological criteia, the sequence of skeletal development generally is conservative. Compared with its close relative, S. bombifrons, ossifications that occur during prometamorphosis tend to be slightly delayed in S. intermontanus; however, cranial bones that ossify during late metamorphic climax in S. intermontanus are delayed until post-metamorphosis in S. bombifrons. The differences in timing between the two species are consistent, however, with differences observed between two developmental series of S. intermontanus raised at two different temperatures. Noteworthy features of skeletal development in S. intermontanus include: 1) presence of palatine ossifications that form from independent centers of ossification and soon fuse with the postnarial portion of the vomers to form the compound vomeropalatine bones; 2) compound sphenethmoid that may arise from four or more endochondral centers of ossification and one dorsal, dermal center of ossification; and 3) presence of transverse processes and vestigal prezygapophyses on the first postsacral vertebra. The morphology of the larval orbitohyoideus and interhyoideus muscles is compared. The record of skeletal ontogeny and muscle morphology presented herein for the herbivorous larval morph can serve as a baseline for comparisons with the ontogeny of the carnivorous larval morph of Scaphiopus.

Telephone consultations at the emergency service, Copenhagen County: analysis of doctor-patient communication patterns

BACKGROUND

Experience from 10 telephone consultation courses in 1995, arranged for the emergency service in Copenhagen County, has demonstrated that this type of communication requires specific skills on the doctor's part, especially because the doctor cannot see the patient, patients are frequently in some sort of 'crisis' and, on the basis of limited information, the doctor in charge has to arrive at a prompt diagnosis in order to advise or refer the patient.

METHODS

Using video-supervised role-play we compiled and organized the experience of 152 doctors. During the courses we developed principles to help doctors to optimize the information output and reliability of their telephone consultations. The doctors playing their 'patients" role had the opportunity to experience the situation from the patient's point of view and were later able to give the 'doctor' valuable feed-back.

RESULTS AND CONCLUSIONS

This 'experimental consultation procedure' constitutes a new research method, at the interface between educational and traditional scientific research. The process in question is a feed-back one, in which findings can be applied and tested instantly, or with little delay, to produce new results. These can be put to use in practical clinical work and tested in new 'laboratory experiments'.

P-R-A-C-T-I-C-A-L: a step-by-step model for conducting the consultation in general practice

BACKGROUND

It has been shown that when patients are unable to express all their major concerns, they are less likely to follow the physician's prescribed treatment plan and they are less satisfied. On the other hand, the GP has a limited amount of time to elicit all the appropriate information and must ask certain questions about the biological aspects of the illness in order to carry out her professional responsibilities. By acting in a patient-centred way, first enabling the patient to express himself, the GP can make maximum use of patients' ability for problem formulation and solution.

METHODS

We describe a model, for which the mnemonic, P-R-A-C-T-I-C-A-L, will help the practitioner to remember its nine steps. The model uses a chronological succession of strategies during the consultation that balances the voices of medicine and the lifeworld. In overview, the GP takes the patient, step by step, first through an exploration and clarification of his views of the illness, then expands the problem by further examination (e.g. the physical examination), a negotiation about the final model of the illness that includes both diagnosis and management, a discussion of the treatment plan, and finally a moment of reflection to prepare for the next visit.

[Attitude of Danish patients and physicians to information on cancer. A questionnaire study]

This survey reports the attitude towards information of cancer patients as regards diagnosis and prognosis among gastroenterologists and patients (not suffering from cancer). The questions were based on a case history (a patient with colonic cancer). Most doctors informed their patients openly, and most patients expected that. Younger doctors in particular were more restrictive than patients as regards information of the spouse.

HIV infections and AIDS in Danish general practice--the role of the GP in AIDS prevention

The occurrence and geographical distribution of HIV infections and AIDS (HIV/AIDS) in Danish general practice were examined in a questionnaire study sent to a 10% random sample of the GPs. Response rate was 92%. In 1988, a total of 2969 patients were tested, median 10 patients per GP. GPs had 148 HIV-positive patients (66 in Greater Copenhagen) and 60 AIDS patients (27 in Greater Copenhagen). In Greater Copenhagen 37% of the GPs had neither HIV nor AIDS patients, vs. 71% in the rest of the country. Instruction in infection prophylaxis was usually initiated by the GPs, while HIV testing was mainly on the patient's initiative. 52% of GPs indicated a change in their routine, particularly with respect to sterilization of instruments and avoidance of direct contact with blood. An extrapolation of the results of this study indicates that about 1,500 of the estimated 2,000 HIV positive patients in Denmark are known by general practitioners.

Integrated health work with 'the new family'

In this Copenhagen practice couples receive antenatal and postnatal care in group sessions. The health care professionals believe they provide a better service. Parents learn from shared experiences and benefit from the social network that is established.

Medical students experience early patient contact in general practice. A description and evaluation of a new course in the medical curriculum

In the first year of the medical curriculum at the University of Copenhagen, a new discipline has been introduced, in which general practice has the key position in providing experiences of early patient contact to the students. The course consists of three principal elements: student-patient contacts in the patient's home; lessons with the general practitioner; and lessons at the Institute of General Practice. The compulsory course is completed by a student's report, and the first course has been evaluated by qualitative analysis of these reports and by questionnaires to the students and GPs. The results indicate that it is possible to provide considerable improvement of the medical education as regards communication skills and understanding of the patients' perceptions, by letting the student establish contact with a patient in the very beginning of the curriculum. General practice provides an appropriate setting for this education for both teachers and patients.

Ultrastructure and histochemistry of the vas deferens of the salamander Rhyacotriton olympicus: adaptations for sperm storage

The vas deferens of the salamander Rhyacotriton olympicus is composed of (1) a peritoneal epithelium, (2) connective tissue with fibroblasts, melanophores, circular smooth muscle, capillaries, and unmyelinated nerves within a collagenous matrix, and (3) an inner layer of cuboidal epithelium partially covered by ciliated squamous cells at the lumen. The lumen and apical cytoplasm of both epithelial cell types contain strongly PAS-positive granules. The cuboidal cells contained numerous swollen rough endoplasmic reticulum cisternae, mitochondria, and apical dense granules suggesting a high degree of secretory activity possibly involved in sperm maintenance. Fewer mitochondria, rough endoplasmic reticula, and granules in squamous cells suggest less secretory activity. Squamous cells may protect the cuboidal cells from possible abrasion by sperm masses and/or their cilia may aid in distributing secretory products in the lumen.

Comparison of a fluorescent monoclonal antibody assay and a tissue culture assay for routine detection of infections caused by Chlamydia trachomatis

The applicability of a commercial direct immunofluorescent monoclonal antibody assay for detection of Chlamydia trachomatis elementary bodies was studied on endocervical smears from 506 women attending a venereal disease clinic. The aim of this prospective examination was to simulate a daily routine. The results were compared to those of a well-functioning tissue culture assay. The overall positivity was 22.7%. Based on a positivity criterion of greater than or equal to 1 elementary body in the fluorescent antibody assay, the two assays agreed in 84.8% of the cases. In 50 specimens the antibody assay was positive and the culture assay negative, whereas in 23 the culture assay was positive and the antibody assay negative. The positive predictive value was 63.8%. Most of the discrepancies were found in specimens containing few elementary bodies or inclusions. Based on a criterion of greater than or equal to 10 elementary bodies, the positive predictive value was 70.9%, but the sensitivity fell to 67.5%.

The determination of specific IgA-antibodies to Yersinia enterocolitica and their role in enteric infections and their complications

Specific serum IgA-antibodies, mainly produced in the lymphoid tissue of the gastrointestinal tract (GALT) might exhibit some special characteristics deviating from IgM- and IgG-antibodies: they do not agglutinate nor fix complement. They cannot be determined by usual routine antibody techniques; indirect methods must be used. An antiglobulin-assay was used in an extensive investigation over a two-year period on sera from 8,445 patients to determine IgA-antibodies specific to Yersinia enterocolitica, serotype 3. Y. enterocolitica agglutinins were found in 965 patients, 508 of them with significant titres of greater than or equal to 80. 347 of the 2,111 patients with low titres (10 to 40) had a significantly elevated amount of IgA antibodies. The diagnoses of the IgA-positive patients fell into three groups: acute infections, acute reactive complicatory inflammations, mainly arthritis, chronic inflammatory connective tissue diseases. The IgA-antibody pattern was: In early samples from patients with acute enteric infections they might be the only antibodies present following, largely, during the course of the disease the agglutinating IgM and IgG antibodies, except in patients with long-lasting or chronic complications where IgA antibodies were elevated. It is concluded that determination of specific antibodies of IgA class in cases of Y. enterocolitica infections is an important diagnostic test and, moreover, of prognostic value in the evaluation of chronicity.

The prevalence of antibodies to hemolytic Streptococci and Yersinia enterocolitica in Danish school children and among hospitalized patients

Serological investigations in infections caused by hemolytic streptococci and by Yersinia enterocolitica (Y. ent.) can be diagnostically decisive. Here are presented the results of 2 extensive serologic investigations of a population of school children (n = 929) and of hospitalized patients (n = 2121). It is shown that only very high titers of streptococcal antibodies were of diagnostic value in single samples as most other titers had the same distribution and frequency in the healthy population. Titers of antibodies to Y. ent. were elevated 5 times more often in the hospital patients than in the healthy population. Antibodies to Y. ent. were approximately at the same level in all age groups in contrast to the streptococcal antibodies, which decreased with age. In about 4% of the 2121 patients investigated elevated antibody titers to both bacteria were found simultaneously. The differential diagnosis may be difficult in such cases especially if they exhibit symptoms of rheumatic fever.

Microfilaments interacting with heavy meromyosin and deoxyribonuclease I in cells of the ovarian follicle of a lizard

Two types of filaments (microfilaments 4--6 nm in diameter, and intermediate filaments 7--10 nm in diameter) are common in the surface epithelial cells and theca fibroblasts of vitellogenic ovarian follicles of the lizard Anolis carolinensis. Heavy meromyosin (HMM), which forms complexes with actin filaments, interacts only with the microfilaments of theca fibroblasts. After myosin extraction of follicles no filaments disappeared, but when this treatment was followed by incubation with deoxyribonuclease I (DNA-ase I), which depolymerizes F-actin to G-actin, microfilaments disappeared from the theca fibroblasts. It is concluded that microfilaments in theca fibroblasts are actin-like and may contract to provide the mechanism of expulsion for the oocyte during ovulation. The intermediate filaments of the surface epithelial cells and theca fibroblasts may serve as a skeletal system for the large (up to 8 mm in diameter) vitellogenic follicle.

Yersinia enterocolitica infections and rheumatic diseases

Yersinia enterocolitica (Y. ent.) infections are rather frequently complicated by acute reactive inflammation in the connective tissue, especially in the joints. At this stage of the disease the specific diagnosis can be obtained either by bacterial isolation and identification from the feces and/or mesenterial lymph nodes, or by serological methods. Serodiagnostics are frequently the only method during the complication phase, since the bacteria have often disappeared from the feces by this stage of the disease. Specific Y. ent. serodiagnostics are benefitted by the fact that no antisera cross-react with the serotype 3 thermostable O-antigen. A titre of greater than or equal to 80 is therefore highly indicative of a recent or current Y. ent. infection. In the absence of other known arthritogenic agents the Y. ent. antibodies are highly indicative of the Y. ent. etiology of a current disease. The Y. ent. complications affect most inflammatory reactive diseases, acute as well as chronic. In an area in which Y. ent. infections are endemic, Y. ent. is the most frequent cause of acute and chronic arthritis. The present results indicate that not all cases of acute Y. ent. arthritis remit, but some persist, usually with an intermittent course, and develop into rheumatoid arthritis or allied conditions. This suggests a common pathogenic mechanism in most inflammatory rheumatic diseases. It is proposed that the time has come for a classification of these diseases based on their etiology, in order to replace the present symptom-based treatment with a causal one, and to institute prophylactic measures. The pathology is not exclusive to Y. ent., but can presumably also be brought about by other bacteria, such as gonococci, meningococci, salmonellae, shigellae, and brucellae, possibly by their content of lipopolysaccharide.

Oocyte-follicle cell relationships in a starfish

The follicle cells which surround the oocytes of starfish are known to both release the hormone 1-methyladenine and to respond to it by an active movement which forms a component of the spawning response to the hormone. In Patiria miniata these flagellated cells are located peripheral to the oocyte and have long cytoplasmic processes which penetrate the vitelline layer to the egg surface to form an adhering zonule-like junction. Within the follicle cell cytoplasm are located elongate filamentous bands which appear to represent a component of the contractile mechanism that mediates follicle cell response to 1-methyladenine. These bands do not resemble the filaments of vertebrate smooth muscle cells (quantity, distribution and size of filaments; lack of dense bodies in the filament mass), nor the contractile units of the superficial epithelium of lower vertebrate follicles.

Yersinia enterocolitica infection and sarcoidosis. A report of seven cases

Sarcoidosis of recent onset was diagnosed during a Yersinia enterocolitica infection in seven patients at the Copenhagen County Hospitals during a 3 1/2 year period. In all cases the diagnosis was made from clinical symptoms and confirmed by chest X-ray and biopsy. In five of the patients a fourfold rise or decrease was measured in the antibody titre against Yersinia enterocolitica, serotype 3, confirming an acute infection. In another two patients this titre remained significantly elevated greater than or equal to 80, indicating chronic infection. Five patients experienced joint symptoms and four erythema nodosum, symptoms common to both yersiniosis and sarcoidosis. A follow-up examination 14 to 41 months after the debut of sarcoidosis showed total remission (including chest X-ray and respiratory function) in five of the seven patients. Recent research has shown that Yersinia enterocolitica following the early stage of the infection causes granulomatous lesions in lymph follicles, and this aetiology should thus be considered as a differential diagnosis to sarcoidosis.

Cell-mediated immunity of Yersinia enterocolitica serotype 3 in patients with thyroid diseases

The cellular immunity to Yersinia enterocolitica serotype 3 and crude human thyroid extract in 64 patients with thyroid diseases and 25 controls was studied by the leucocyte migration test. In the patient group as a whole and in patients with Graves' disease and nontoxic diffuse goitre a significantly reduced leucocyte migration towards Yersinia was found when compared with the controls. In controls the migration index was not related to the presence or titre of circulating yersinia antibodies, whereas the migration index of patients with yersinia antibodies was lower than the migration index of patients without yersinia antibodies as well as that of the controls. The leucocyte migration inhibition in two patients with recent yersinosis was normal during the recovery phase. In the presence of thyroid extract leucocyte migration inhibition differed only significantly in Graves' disease. However, a significantly positive correlation between inhibition of migration by thyroid extract and by Yersinia was found, while no correlation could be demonstrated in the controls. The cell-mediated immunity towards Yersinia in thyroid diseases thus demonstrated adds further evidence to the association between Yersinia and thyroid disease.

HLA antigens in Graves' disease

HLA typing of 86 patients with Graves' disease was performed for the A, B, C and D series antigens. An increased frequency of HLA-B8 (47 per cent) and Dw3 (51 per cent) compared with controls (23.7 and 21 per cent, respectively) was observed. The increase of B8 and Dw3 was almost exclusively found in a group of 48 patients with relapse of disease, whereas the frequency of B8 and Dw3 in patients without relapse did not differ significantly from that of the control group. No association with the presence of exophthalmos, thyroid antibodies, or antibodies to Yersinia enterocolitica serotype 3 could be found.

Structure and function of the amphibian follicular epithelium during ovulation

Low concentrations of cytochalasin B (CCB) are known to inhibit ovulation in the frog, Hyla regilla. Examination of amphibian thecal cell ultrastructure reveals filaments (average diameter 71 A) arranged in bundles parallel to the surface of the oocyte. These filaments are often associated with hemidesmosome-like plaques on the basal plasmalemma, While individual filaments appear unaltered morphologically by CCB (1-5 microgram/ml), their organization into bundles, apparent relationship to the hemidesmosomes, and the highly contorted configuration of the thecal cells after oocyte expulsion, suggest that a nonmuscular contractile system residing within the follicle plays a fundamental role in ovulation. Our data suggest that the flattened epitheloid thecal cells shorten all axes that run parallel to the oocyte surface via filament bundle contractions, while they remain tightly bound together by macular attachment plaques. These cells thus increase in height to become cuboidal-low columnar in shape; the area covered by the base of each is greatly reduced. As this "thecal sac" decreases in size, the compression generated by the contractile mechanism forces the oocyte through the enzymatically weakened apex of the follicle and ovulation results.

Yersinia enterocolitica infection and thyroid diseases

The frequency of agglutinating antibodies to Yersinia enterocolitica (Y. ent.) serotype 3 and 9 has been studied in sera from patients with various thyroid diseases. No antibodies to Y. ent. serotype 9 were found. Titres (≧ 10) of Y. ent. serotype 3 antibodies were found significantly more frequently in thyroid patients than in controls. In patients with Graves' disease the frequency was 59.5 per cent compared with 16.6 and 27.7 % in the two control groups (P < 0.0005). High titres (≧ 80) were significantly increased in patients with Graves' disease and diffuse nontoxic goitre when compared with the control groups. The prevalence of Y. ent. antibodies decreased with the duration of the disease. In patients with recurrent Graves' disease high titres of Y. ent. antibodies were found in 25 per cent compared with 11 per cent in patients with the first attack of Graves' disease (P < 0.05).

No correlation with age, sex, exophthalmos or the presence of antibodies to thyroid antigens was found. As the O antigen of Y. ent. serotype 3 is specific the detection of these antibodies suggest an infection with Y. ent. and possibly an association between this infection and thyroid disorders, in particular Graves' disease.