Mechanoenergetic coupling in heart failure with preserved, mid-range and reduced left ventricular ejection fraction

Background

Heart failure (HF) classification based on left ventricular ejection fraction (LVEF) can vary because of changes in filling pressures, afterload, and contractile function. 11C-acetate positron emission tomography (PET) provides a load-independent measure of myocardial external efficiency (MEE) by simultaneous assessment of myocardial oxygen consumption (MVO2), cardiac work, left ventricular mass (LVM), end-systolic wall stress (ESWS), and myocardial blood flow (MBF).

Purpose

We aimed to characterize mechanoenergetic derangements in patients with HF and to study its interrelation with age, sex and obesity.

Methods

MEE was measured in 121 participants with 11C-acetate PET, and LVEF was acquired with echocardiography. We investigated healthy controls (n=20) and patients with HF and reduced LVEF <40% (HFrEF; n=25), mid-range LVEF 40–49% (HFmrEF; n=23), as well as patients with asymptomatic aortic valve stenosis (AS) and LVEF ≥50% (AS-asymp; n=38), and symptomatic AS and LVEF ≥50% (defined as HF with preserved LVEF (HFpEF); n=15).

Results

MEE declined in tandem with reduced LVEF from HFpEF and HFmrEF to HFrEF (p=0.041, p<0.001, and p<0.001 versus control, respectively; Figure 1). Impaired MEE was aggravated with increasing LVM (p=0.001) due to a disproportionate increase in overall left ventricular MVO2. In a multivariate analysis, female sex (p<0.001), a lower body mass index (p<0.001), and advanced age (p=0.01) were associated with a lower MEE (Figure 2). HFpEF, HFmrEF, and HFrEF patients had distinct energetic profiles involving MEE, MVO2, MBF, ESWS, and LVM (Figure 2).

Conclusions

Mechanoenergetic uncoupling was evident in every clinical state within the HF syndrome and associated with left ventricular hypertrophy and progressive systolic dysfunction. Sex, age, and obesity impacted myocardial energetics. To date, the present study is the largest investigation of mechanoenergetic coupling across several categories of patients with heart failure. 11C-acetate PET extends our pathophysiological comprehension of the HF syndrome beyond LVEF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationThe Lundbeck Foundation Relationship between LVEF and MEEMyocardial energetics in heart failure

Reduced glucose tolerance and insulin resistance induced by steroid treatment, relative physical inactivity, and high-calorie diet impairs the incretin effect in healthy subjects

AIMS/HYPOTHESIS

The loss of incretin effect in patients with type 2 diabetes mellitus may be secondary to impaired glucose homeostasis. We investigated whether reduced glucose tolerance and insulin resistance induced by steroid treatment, relative physical inactivity, and high-calorie diet in healthy young males would impair the incretin effect.

METHODS

The incretin effect was measured using 75 g oral glucose tolerance test (OGTT) and isoglycemic iv glucose infusion (IIGI) in 10 healthy Caucasian normal glucose-tolerant male subjects without any family history of diabetes [age 24 + or - 3 yr (mean + or - sd); body mass index 23 + or - 2 kg/m(2); glycosylated hemoglobin 5.4 + or - 0.1%] before and at the end of a 12-d period with oral administration of prednisolone (37.5 mg once daily), high-calorie diet, and relative physical inactivity.

RESULTS

The 12-d intervention period resulted in significant increases in body weight [79 + or - 5 vs. 80 + or - 6 kg (mean + or - sd), P = 0.03] and fasting plasma glucose (5.1 + or - 0.1 vs. 5.6 + or - 0.2 mm, P = 0.016), whereas insulin sensitivity (Matsuda index 17.6 + or - 1.7 vs. 9.2 + or - 1.0, P = 0.0001) decreased. Glucose tolerance [as assessed by the 120-min plasma glucose value after OGTT (4.9 + or - 1.1 vs. 7.8 + or - 2.5 mm, P < 0.0001) and area under curve (AUC) (152 + or - 45 vs. 384 + or - 53 mm.4 h, P = 0.002)] during the OGTT deteriorated. Also, the incretin effect [incretin effect (percent) = 100% x (AUC(insulin,OGTT) - AUC(insulin,IIGI))/AUC(insulin,OGTT))] deteriorated (72 + or - 5 vs. 43 + or - 7%, P = 0.002). An increase in glucose-dependent insulinotropic polypeptide response during OGTT, but no significant changes in glucagon-like peptide-1 or glucagon responses, was observed after glucose homeostatic dysregulation.

CONCLUSIONS/INTERPRETATION

Impairment of the incretin effect can be elicited by a short period of reduced glucose tolerance and insulin resistance in healthy male subjects not disposed for type 2 diabetes.

Treatment of type 2 diabetes with glucagon-like peptide-1 receptor agonists

The incretin system is an area of great interest for the development of new therapies for the management of type 2 diabetes. Existing antidiabetic drugs are often insufficient at getting patients to glycaemic goals. Furthermore, current treatment modalities are not able to prevent the continued ongoing decline in pancreatic beta-cell function and, lastly, they have a number of side effects including hypoglycaemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of pharmacological agents, which improve glucose homeostasis in a multifaceted way. Their effects include potentiation of glucose-stimulated insulin secretion, glucose-dependent inhibition of glucagon secretion and reduction in gastric emptying, appetite, food intake and body weight. Additionally, preclinical data suggest that they may preserve beta-cell mass and function. The incidence of hypoglycaemia with GLP-1 receptor agonists is low, the compounds have clinically relevant effects on body weight, and data are suggesting beneficial effects on cardiovascular risk factors. Exenatide was released in 2005 for the treatment of type 2 diabetes and liraglutide is expected to be approved by the Food and Drug Administration in US and the European Medical Agency in Europe for use in 2009. In this review, the available data on the two drugs are presented and discussed.

Absence of high‐affinity calreticulin autoantibodies in patients with systemic rheumatic diseases and coeliac disease

Calreticulin has been reported to be an autoantigen in various autoimmune connective tissue diseases and in coeliac disease. Previous studies have used incubation buffers with low salt and low detergent concentrations (low stringency conditions) with serum albumin or other proteins as a blocking agent. Using these conditions we found a relatively high level of non-specific binding in many sera. Antibodies to proteins that are used as blocking reagents in ELISA (bovine serum albumin (BSA), ovalbumin, skimmed milk powder) are frequently present in sera, and these may cause false-positive results. Moreover, the low isoelectric point of calreticulin and its chaperone properties may give rise to false-positive results under low stringency conditions. We report that the use of a simple buffer without protein (50 mM Tris, pH 7.5, 1% Tween 20, 0.3 M NaCl) removes most of the problems with unwanted binding (high stringency conditions). Using the high stringency conditions, we screened sera from 107 patients with systemic lupus erythematosus, sera from patients with other systemic autoimmune diseases and from children with coeliac disease for the presence of high-affinity calreticulin autoantibodies by immunoblotting and ELISA. None of the sera contained high-affinity calreticulin antibodies. It is concluded that calreticulin is not a common autoantigen in patients with autoimmune connective tissue diseases or coeliac disease.

Pharmacological characterization of mouse GPRC6A, an L-alpha-amino-acid receptor modulated by divalent cations

BACKGROUND AND PURPOSE

GPRC6A is a novel member of family C of G protein-coupled receptors with so far unknown function. We have recently described both human and mouse GPRC6A as receptors for L-alpha-amino acids. To date, functional characterization of wild-type GPRC6A has been impaired by the lack of activity in quantitative functional assays. The aim of this study was thus to develop such an assay and extend the pharmacological characterization of GPRC6A.

EXPERIMENTAL APPROACH

We have engineered a novel cell-based inositol phosphate turnover assay for wild-type mouse GPRC6A based on transient co-expression with the promiscuous Galpha(qG66D) protein, known to increase receptor signalling sensitivity. This assay allowed for measurements of L-alpha-amino acid potencies. Furthermore, in combination with an assay measuring inward currents at Ca(2+)-activated chloride channels in Xenopus oocytes, the divalent cation-sensing ability of the receptor was examined.

KEY RESULTS

Using our novel assay, we demonstrate that the basic L-alpha-amino acids ornithine, lysine, and arginine are the most potent agonists at wild-type mouse GPRC6A. Using two different assay systems, we show that divalent cations do not activate the G(q) signalling pathway of mouse GPRC6A per se but positively modulate the amino-acid response.

CONCLUSIONS AND IMPLICATIONS

This is the first reported assay for a wild-type GPRC6A successfully applied for quantitative pharmacological characterization of amino acid and divalent cation responses at mouse GPRC6A. The assay enables further search for GPRC6A ligands such as allosteric modulators, which may provide essential information about the physiological function of GPRC6A.

Energy intake and milk production in mink (Mustela vison)--effect of litter size

Energy intake and milk production were measured in 12 mink dams raising litters of 3, 6 and 9 kits one to four weeks post partum by means of balance experiments and measurements of milk intake of the kits by the water isotope dilution technique. The dams were fed ad libitum on a conventional wet mink diet (DM: 323 g/kg; CP: 173 g/kg; ME: 4.4 MJ/kg). Milk samples collected from dams with corresponding litter sizes and lactation weeks, and body composition of kits nursed by these dams, were analysed for content of DM, ash, N and fat. The ME and drinking water consumption were higher in dams nursing 9 kits than in dams nursing 3 kits. The N and water balances as well as the live weight of dams were not affected by litter size. Daily milk production was higher in dams nursing 9 kits than in dams nursing 3 kits. The DM, N and fat content of the milk increased during lactation, but were not affected by litter size. Individual kit live weight was higher in litters of 3 than in litters of 6 and 9 kits four weeks post partum. The DM and fat content of the kits were lowest in kits from litters of 9 kits, whereas these kits had the highest protein content. Daily ME for maintenance of kits and the efficiency of utilisation of ME in milk for body gain were estimated to 356 kJ/kg0.75, kp approximately 0.53 and kf approximately 0.71, respectively. In conclusion, daily milk production increased with increasing litter size, but not in proportion to the number of kits, indicating that milk production limits the growth rate of the young. In the fourth week of lactation, milk production was not different between dams nursing 6 or 9 kits, indicating a maximum capacity.

Effect of supplementation with the antioxidant astaxanthin on reproduction, pre-weaning growth performance of kits and daily milk intake in mink

The study comprised two parts. Firstly, the effects of dietary supplementation with an algal meal (Novasta) with a high astaxanthin content on ovulation rate (number of corpora lutea, implantation rate, number, mass and length of fetuses) of breeding female mink were evaluated. Secondly, reproductive outcome (number of live and stillborn kits), kit growth rate and milk intake were studied. Both studies were performed on standard brown female mink (n = 20; control (n = 10) and experimental (n = 10)) housed under conventional farm conditions. Experimental animals were supplied with 5.35 mg astaxanthin per day (0.25 g algal meal (Novasta)). The numbers of corpora lutea, implantation sites and fetuses appeared to be higher in the group that was given astaxanthin but the effect was not significant. The differences between treated and control mink were 1.4 (corpora lutea), 0.9 (implantation sites) and 1.2 (litter size). The percentage of stillborn kits was reduced by 6.3 (P < 0.005). The milk intake as measured by use of the isotopic water dilution technique was not affected by treatment group. Milk intake increased from about 19 g in week 1 of lactation to about 30 g per kit per day in week 4 of lactation. Kit weight gain was not affected by the experimental treatment.

[Acute myeloid leukemia. Therapeutic results 1985-1994]

In a retrospective study we evaluate the treatment and outcome of 421 adults admitted to our department with acute myeloid leukemia (AML) during the 10 year period from 1985-1994. Younger patients (< or = 55 years) had a significantly better prognosis than elderly patients (> 55 years), partly because more younger patients had remission-induction therapy (81% versus 39%) and their complete remission (CR) rate was higher (69% versus 41%). In patients achieving CR the long-term survival (five years) was 40% for younger and 26% for elderly patients. Nineteen patients received autologous bone marrow transplantation (BMT) and eight an allogeneic BMT in first CR. Five patients treated with allogeneic BMT are still relapse-free, whereas autologous BMT, in comparison to conventional chemotherapy alone, did not improve the five-year relapse-free survival (29 versus 27%). Our data illustrate that in a non-selected material of AML patients the long-term survival (five years) has only slightly improved. The effect of autologous BMT cannot be evaluated in this retrospective setting.

Anticoagulant properties of rabbit lungs in tissue thromboplastin-induced intravascular coagulation

This study was conducted in order to examine possible anticoagulant properties of the lungs during tissue thromboplastin-induced intravascular coagulation. Rabbit brain tissue thromboplastin (n = 17) or saline (n = 6 + 3) was infused above the right atrium (n = 11 + 3) of the heart or in the arcus aorta (n = 6) for a period of 120 min in non-pregnant New Zealand rabbits. Rabbits infused with tissue thromboplastin responded with significantly (p < 0.05) more excessive changes in a number of haemodynamic variables (heart rate, PaO2,PaCO2, blood pH etc.) compared with rabbits infused with saline. Similarly, the prothrombin time (p < 0.05) and the activated partial thromboplastin time (p < 0.05) were significantly more prolonged in rabbits receiving tissue thromboplastin compared with control animals. Also the concentration of blood platelets (p < 0.05), plasma fibrinogen (p < 0.05), antithrombin (p < 0.05), and protein C (p < 0.05) decreased significantly in thromboplastin-treated animals compared with control animals. In all these haemostatic variables there was a common trend that animals infused with tissue thromboplastin in the arcus aorta responded more excessively than animals infused in the right atrium of the heart, and these deviations were statistically significant for fibrinogen (p < 0.05) and prothrombin time (p < 0.05). Similarly, animals infused with tissue thromboplastin in the arcus aorta had an increased number of microthrombi in the lungs and kidneys compared with animals receiving tissue thromboplastin above the right atrium. As the lungs are the first pass organ when you infuse above the right atrium the results from this study suggest that the lungs play a key role in protecting the organism against excessive tissue thromboplastin-induced activation of coagulation.

Risk factors for central nervous system involvement in non-Hodgkins-lymphoma--a multivariate analysis

A consecutive cohort of patients with NHL was examined to identify the factors predictive of CNS-involvement with Cox's proportional hazards model in a multivariate analysis. Twenty-seven cases of CNS-involvement were found among 498 patients with NHL. Only 3 of 96 patients with low-grade lymphomas had CNS involvement, all occurring after transformation into high-grade lymphoma. In univariate analysis of 402 patients with intermediate or high-grade lymphoma, lymphoblastic histology (including Burkitt's lymphoma), age <35 years, B-symptoms, stage IV disease, testis involvement and bone marrow involvement were found to be statistically significant risk factors. Lymphoblastic histology was found to be strongly correlated to age younger than 35 years. In the multivariate analysis only lymphoblastic histology, stage IV disease and B-symptoms were found to be significantly associated with CNS involvement. It is concluded that CNS prophylaxis should be considered in all patients with lymphoblastic histology and in patients with stage IV B lymphomas other than those of low-grade types.

Translocation (1;16) identified by chromosome painting, and PRimed IN Situ-labeling (PRINS). Report of two cases and review of the cytogenetic literature

We used the molecular cytogenetic in situ techniques chromosome painting and PRimed IN Situ labeling (PRINS) to elaborate the cytogenetic observations in two cases of the rare aberration der(16)t(1;16), which occurs in a wide variation of hematologic and nonhematologic malignancies [1-3]. Review of the literature showed that, in contrast to the chromosome 1 breakpoint, the breakpoint on chromosome 16 is associated with diagnosis as well as patient age.

[The relation of birth weight and gestational age in a group of infants in Jutland with special reference to diagnosing infants with intrauterine growth retardation]

The relationship between birthweight (BW) and gestational age (GA) in 14,276 Danish children with GA of 35 to 42 completed weeks was illustrated employing 10%, 50% and 90% percentile curves. The curves were sex-specific. The number of light for dates (LFD) children defined by means of the 10% percentile (BW below 10th percentile) was 1,351 compared to 848 children when using the curve currently employed. The latter curve was based upon foreign children and moreover was not sex-specific. It is concluded that sex-specific and updated curves representing the population studied are mandatory in the diagnosis of LFD-children.

[Demonstration of urogenital Chlamydia infection by means of the Chlamydiazyme test]

Abbott's recently introduced Chlamydiazyme test which is based on the Elisa principal and cell culture technique was employed with the object of demonstrating urogenital infection with Chlamydia trachomatis in 150 persons. Neither of the methods were optimal. The Chlamydiazyme test had a lower sensitivity and specificity than the cell culture method.

[Breech presentation deliveries]

A total of 5,519 consecutive single deliveries at term were analysed for maternal and foetal factors associated with breech presentation (UK). The protocol in this department for breech deliveries which permits vaginal delivery of foetuses estimated to be between 2,400 and 3,800 g in cases where the pelvis was considered to be clinically normal, was also evaluated. Breech presentation was found in 173 cases. In 102 of these circumstances were present which permitted trial of vaginal delivery. Seventy-seven were delivered vaginally. An increased frequency of low Apgar scores (less than 8) after one minute was demonstrated among infants delivered vaginally in the breech presentation on comparison with infants delivered by Caesarean section, whereas low scoring after five minutes occurred with the same frequency. One infant died during delivery. Follow-up of infants delivered in breech presentation (mean period of observation two years) showed developmental disturbances in three of the vaginally delivered infants and in five of those delivered abdominally. Two of the infants delivered abdominally had severe cerebral paresis and psychomotor retardation without evidence of intrauterine or severe neonatal asphyxia. On comparison with the population delivered in cephalic presentation (HST), significantly increased frequencies of primiparity and light-for-dates infants were found in the breech presentations. Low Apgar score after one minute was significantly more frequent in breech presentations while low Apgar scoring after five minutes occurred with the same frequency. The perinatal mortality rates in breech and cephalic presentations were 17.3 and 4.7 per 1,000 respectively. Following correction for lethal malformations, the rates were 5.8 and 3.8 per 1,000, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Danazol in the treatment of ureteral endometriosis

We report 2 cases of ureteral endometriosis in which initial hormonal management, including danazol, failed to reverse or to stop the progressing ureteral stenosis. After reviewing the various methods of treatment presented in the literature we conclude that solid documentation of the effect of danazol against ureteral endometriosis is lacking. To preserve kidney function we recommend resection of the affected portion of the ureter.

First-line diagnosis based on immunological phenotyping in suspected acute leukemia: a prospective study

In a prospective analysis of the diagnostic value of immunophenotyping in acute leukemias (ALs), all patients admitted to a pediatric and a haematological department suspected of AL were examined consecutively with a selected panel of monoclonal antibodies (Mabs) against leucocyte differentiation antigens during an 8-month period. A total of 189 samples obtained from blood, bone marrow, spinal fluid and lymph nodes in 120 cases were all analysed blindly. The results were correlated with a routine morphological/cytochemical evaluation. Differing results were obtained in seven out of 38 cases in which the immunologically defined diagnosis was acute myeloid leukemia (AML), and in one out of 21 cases with the primary diagnosis acute lymphoid leukemia (ALL). Immunological phenotyping disclosed two cases of hybrid leukemia, one case of biphenotypic and one case of bilineal leukemia. No evidence of malignancy was found in 36 cases, 30 cases of blood and bone marrow and six cases of spinal fluids, in every case in accordance with the pathological examination. These results demonstrate that a first-line immunological evaluation of bone marrow, blood and spinal fluid from patients suspected of AL is highly capable of discriminating between different malignant and nonmalignant haematological diseases and also between various types of leukemias. The immunological methods do, however, require a sufficient amount of material which was a limiting factor in 14 out of 120 examinations, mainly from patients treated with several cycles of cytostatics. It is concluded that immunophenotyping can be used as a first-line diagnostic tool in malignant haematological diseases.

Antibiotic elimination of group-B streptococci in urine in prevention of preterm labour

The presence of group-B streptococci in the urine of pregnant women seems to be associated with preterm labour. Urine samples from 4122 women at 27-31 weeks' gestation were examined for bacteria. Group-B streptococci were found in the urine of 69 women. In a double-blind, controlled study these patients were given either penicillin (10(6) IU three times daily for 6 days; 37 patients) or placebo (32 patients). The rates of primary rupture of the membranes (11% v 53%; p less than 0.001) and preterm labour (5.4% v 38%; p less than 0.002) were significantly lower in the penicillin group than in the placebo group. These results suggest that treatment and follow-up to prevent recolonisation in pregnant women with group-B streptococci in the urine may reduce the frequency of preterm labour in these patients.

Short stature in Scandinavian women. An obstetrical risk factor

We have carried out a case-controlled study on relations between short stature (i.e. less than 156 cm tall) and problems with childbirth in Danish women. Data obtained from 182 pregnant, short women (short mothers) were compared with those obtained from a control group of 2116 pregnant women who were between 166 and 175 cm tall (control mothers). The prevalence rate for acute cesarean section was three-fold greater in short mothers than in controls, and the prevalence rate for elective cesarean section was twice as high in short mothers as in controls. Moreover, the prevalence rates of intra-uterine asphyxia, intra-uterine growth retardation and low Apgar scores were higher in babies of short mothers than in those of control mothers, despite the increased level of obstetric intervention in the former group. Since the findings show that short stature in pregnant women is an obstetrical risk factor, we recommend that it should be given attention in order to detect early signs of intra-uterine asphyxia and to apply the best form of active management of labor if necessary.

Bed rest in twin pregnancy

A total of 146 twin pregnancies were studied to evaluate the importance of bed rest. A significantly reduced frequency of preterm delivery was found after bed rest in hospital as compared to bed rest at home or no bed rest at all. An increase in gestational age and in birth weight was seen after bed rest. No effect was found on the intrauterine increase of fetal weight per time. Early routine ultrasound is recommended, so that effective bed rest may be instituted in due time.

Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis

A total of 116 women were referred for hysterosalpingography because of primary or secondary infertility. Chlamydia trachomatis was isolated from the cervix of four (3.4%) of the patients whereas Mycoplasma hominis was isolated from 39 (33.6%) of them. Four patients developed acute pelvic inflammatory disease after hysterosalpingography; two of them were chlamydia culture-positive and developed a significant chlamydial antibody response during the course of the disease. One of the other two patients, who developed upper genital-tract infection, was culture positive for M. hominis and developed a significant antibody response to this micro-organism. The results indicate that C. trachomatis should be sought in patients before hysterosalpingography and, if detected, appropriate antibiotic cover should be instituted before the procedure.

The impact of large Y chromosome on pregnancy, foetus and birth

In a current investigation of children born in the Arhus area (Denmark) chromosome examinations were made in 6,691 newborns. Of these children, 170 boys had a large Y chromosome (2.6%). The present material was examined using a bi-variate stratified analysis to eliminate social and simple biological factors that could act as confounders. No increased frequency of malformations was found, and birth weight and length was nearly equal in the probands and the controls. A significantly increased frequency of prostaglandin stimulation of labour was found for the mothers of the Yq+ boys. Differences in the frequency of mechanical disproportion or abnormal presentation could not explain this. The Yq+ boys suffered more frequently from intrauterine asphyxia leading to acute Caesarean section. This finding cannot be explained by long-standing placenta problems alone. A possible mechanism which could link these findings together is suggested, and it is concluded that the boys with Yq+ most probably should be regarded as being at a certain risk at the time of birth.

Leukocyte counts and microbiologic cultivation in the diagnosis of puerperal mastitis

In order to study the value of leukocyte counts and quantitative microbiologic cultivation of milk in the diagnosis of puerperal mastitis, 491 milk samples from nursing women were examined. In milk samples from mammary glands without inflammatory symptoms, leukocyte counts were less than 10(6)/ml of milk, and the milk was sterile or harbored less than 10(3) bacteria/ml. Samples from mammary glands with inflammatory symptoms could be divided into three groups. In one group, leukocyte counts were less than 10(6)/ml of milk, and cultivation results were similar to those of mammary glands without symptoms. The symptoms persisted for an average of 2.1 days. These cases were considered as milk stasis. In another group, the leukocyte counts were greater than 10(6)/ml of milk, but the milk was sterile or contaminated by skin flora bacteria. Average duration of symptoms was 5.3 days. These cases were considered as noninfectious inflammation of the breast. In the third group, leukocyte counts were greater than 10(6)/ml of milk and bacteria occurred in numbers of greater than 10(3)/ml, which suggests the presence of infectious mastitis. In these cases only antibiotic treatment should be recommended.

Protective effect of implanted autologous splenic tissue in splenectomized rats exposed to i.v. Streptococcus pneumoniae

The protective effect of splenic implantation or hemisplenectomy on the survival rate was studied in 34 Wistar rats inoculated intravenously with 8.5 x 10(6) CFU Streptococcus pneumoniae type 25, 4 months prior to the bacterial challenge, different surgical procedures were performed, dividing the animals into 5 equally large groups: (1) sham operation, (2) hemisplenectomy, (3) splenectomy with a 100% reimplantation, (4) splenectomy with a 50% reimplantation, and (5) splenectomy without reimplantation. The observation period after the bacterial inoculation was 13 d. Differences in mean survival rates were found: (1) 13 d, (2) 10.6 d, (3) 7.1 d, (4) 5.6 d, and (5) 3.1 d. The increasing survival rates correlated with increasing weights of the residual splenic tissue. This animal study indicates that residual splenic tissue may account for a lesser tendency to infection.

Acute fatty liver of pregnancy with complicating disseminated intravascular coagulation

A description is given of acute fatty liver of pregnancy in a 26-year-old primigravida who survived. Complicating disseminated intravascular coagulation was diagnosed at parturition, and the importance of early diagnosis of this is emphasized. A suggestion for treatment is given as a possible means of improving the prognosis in this mostly fatal disease.

Incidence of chromosome abnormalities in newborn children. Comparison between incidences in 1969-1974 and 1980-1982 in the same area

As part of an ongoing study of the influence of environmental factors on pregnancy, childbirth, and fetuses, comparisons have been made between incidences in 1969-1974 and in 1980-1982 of chromosome aberrations in liveborn children in the same area of Denmark. The incidence of chromosome aberrations in the first period was 2.6 per 1000, compared with 41. per 1000 during the latter period. However, the difference was mainly due to an increase in inversions, and this in turn was due to a difference in chromosome staining methods between the two periods. It is concluded that the Danish study and similar studies in the United States, Canada, and Scotland indicate that early detection of chromosome aberrations by chromosome examination at birth is indicated in order to be able to inform and counsel parents of children with chromosome aberrations. Chromosome examination at birth is also of importance in the diagnosis of structural inheritable chromosome aberrations and consequent family investigation and genetic counseling.

Chromosome abnormalities in newborn children. Physical aspects

A chromosome examination was made on 11,148 consecutively live-born children: 93 had a chromosome abnormality and 192 a chromosome variant. The physical aspects of the children with chromosome abnormalities and variants were compared with those of the children with normal karyotypes. Children with aneuploid or unbalanced chromosome abnormalities were more immature or not fully developed at birth than those with normal karyotypes. Birth weight was lower in children with all types of chromosome abnormalities, including reciprocal translocations and chromosome variants. The low birth weight in children with chromosome variants was mainly due to the low birth weight of children with G variants. These children were also subject to a higher frequency of special delivery treatment. Heart disorders were increased in children with aneuploid or unbalanced chromosome abnormalities. The frequency of foetal erythroblastosis was increased in children with short Y as well as in children with acentric fragments. Neonatal mortality was higher in children with aneuploid or unbalanced chromosome abnormalities than in children with normal karyotypes.

Electro-optical multichannel spectrometer for transient resonance Raman and absorption spectroscopy

An optical multichannel system is described, used for time-dependent absorption measurements in the gas phase and the liquid phase and for resonance Raman spectroscopy of short-lived transient species in the liquid phase in pulse radiolysis. It consists of either an image converter streak unit or an image intensifier coupled to a TV camera with computerized data handling. The system enables the recording of time-dependent absorption spectra or resonance Raman spectra of short-lived radicals and excited states with single electron and light pulses.

The penetration of antibody-covered spermatozoa into cervical mucus and egg white

Autoantibodies to sperm membrane antigens may cause infertility in men. The antibodies can often be revealed in seminal plasma and the antifertility effect seems mainly to be due to hampered penetration into cervical mucus of antibody-covered spermatozoa. Recently, egg white has been used instead of cervical mucus in penetration tests. We have, therefore, compared the concentration of sperm autoantibodies in serum and seminal plasma to the ability of spermatozoa to penetrate into cervical mucus and egg white, respectively. With sperm from ten normospermic men with antibodies to sperm there was a correlation between the maximal penetration in the two different media and the cases with poor penetration were equally well revealed in cervical mucus and egg white. Penetration experiments with normal spermatozoa, treated with selected antibody-containing sera confirmed that the penetration-inhibiting effect of autoantibodies is revealed in egg white. Thus, the use of egg white in penetration tests can be of value in evaluation of cases with immunological infertility.

Fertility in women with Turner's syndrome. Case report and review of literature

A successful pregnancy in a woman with Turner's syndrome with a 45,X/46,XX karyotype is described. The literature contains reports of a total of nine pregnancies in seven women with a 45,X karyotype and 56 pregnancies in 23 women with mosaicism and a 45,X cell line, as well as a 46,XX and/or 47,XXX cell line. Fifteen of the latter 56 pregnancies ended in spontaneous abortion (27 per cent), and four ended in the delivery of a stillborn child; 12 of the 37 liveborn infants (32 per cent) had a physical or mental abnormality, and 8 (22 per cent) had a chromosome abnormality. Three had Down's syndrome, and five had a 45,X cell line. Due to the relatively high (8 per cent) incidence of Down's syndrome among liveborn infants of women with Turner's syndrome, amniocentesis for fetal karyotyping should be advised.

Response of pulmonary (circulating) megakaryocytes to experimentally induced consumption coagulopathy in rabbits

The effects of slow temporary infusion of a tissue thromboplastin solution into the superior vena cava on pulmonary as well as circulating megakaryocytes were studied in 40 rabbits (2-48 hours after infusion) and related to 6 noninfused and 7 infused with normal saline. This is a simple and specific method of inducing a fall in blood platelet levels and thereby an activation of thrombocytopoiesis and megakaryocytopoiesis. The induced intravascular coagulation is probably counterbalanced by an activated fibrinolysis allowing the animals to survive the infusion and thereby offering the possibility of studying the long-term effects. An increase to about 300% of the normal values in circulating as well as pulmonary megakaryocytes was found 20 and 24 hours after the onset of the infusions respectively. The number of circulating and pulmonary megakaryocytes, showing great individual variations, however, dropped to normal levels within 28 hours after onset of the infusions, which means that megakaryocytes remain detectable for less than eight hours in the lungs. No increase was found in pulmonary megakaryocytes in the control (saline infused) group. In our opinion the entrance of megakaryocytes from the bone marrow into the blood circulation in an incidental event, the number in the circulation reflecting the activity of megakarycocytopoiesis. This experiment supports our suggestion that intravascular coagulation is one of the major pathophysiological mechanisms leading to an increase in pulmonary megakaryocytes.