Stimulating thyrotropin receptor antibodies in early pregnancy

OBJECTIVES

Thyrotropin-receptor antibodies (TRAb) are used to diagnose Graves' hyperthyroidism in pregnant women. Bioassays provide a measure of thyrotropin-receptor stimulatory antibodies (TSI) specifically. The objective was to measure TSI in pregnant women for establishment of a pregnancy-specific cut-off and comparison with immunoassay measurements of TRAb.

METHODS

The retrospective Danish study was performed within the North Denmark Region Pregnancy Cohort (2011-2015) that includes stored biobank samples from early pregnancy (median week 10) with immunoassay measurements of thyroid function parameters and TRAb. TSI were measured in the same samples using the Turbo TSI bioassay (Quidel/Ortho-Clinical Diagnostics) with a recommended cut-off of 0.0241 IU/L in non-pregnant adults. A pregnancy-specific TSI cut-off (95-percentile) was established using Regression on Order Statistics.

RESULTS

The established TSI cut-off was 0.0418 IU/L (95 % CI: 0.0417-0.0419). Among women with early pregnancy hyperthyroidism (n=438), 43 women (9.8 %) were TSI positive using the established cut-off, and these women had lower TSH (median 0.008 mIU/L) compared to women with TSI levels below 0.0241 (median TSH 0.040 mIU/L) or in the range from 0.0241 to 0.0418 (median TSH 0.033 mIU/L). Among the 438 women with early pregnancy hyperthyroidism, 22 women were positive for TSI and TRAb, 388 were negative for both, and 28 women were positive for either TSI or TRAb.

CONCLUSIONS

This is the first study on TSI measurements in a large cohort of early pregnant women. A pregnancy-specific cut-off for TSI was established and agreement in the classification with immunoassay measurements of TRAb was seen in 94 % of cases.

Agreement between routinely used immunoassays for thyroid function testing in non-pregnant and pregnant adults

OBJECTIVE

Thyroid function tests are common biochemical analyses, and agreement between the routinely used immunoassays is important for diagnosis and monitoring of thyroid disease. Efforts are continuously made to align the biochemical assays, and we aimed to evaluate the agreement between immunoassays used in a clinical laboratory setting among non-pregnant and pregnant adults.

DESIGN

Cross-sectional study.

PARTICIPANTS

Serum samples were obtained from 192 blood donors (non-pregnant adults) and from 86 pregnant women in the North Denmark Region with no known thyroid disease.

MEASUREMENTS

Each sample was used for measurement of thyroid-stimulating hormone (TSH) with the routinely used automatic immunoassays in the regional Departments of Clinical Biochemistry (Alinity, Abbott Laboratories, Cobas, Roche Diagnostics, and Atellica, Siemens Healthineers) and reported as the median with 95% confidence interval (95% CI).

RESULTS

In nonpregnant adults, the level of TSH was higher with Cobas and Atellica than with Alinity as reflected by median (Alinity: 1.39 mIU/L (95% CI: 1.30-1.51 mIU/L); Cobas: 1.57 mIU/L (95% CI: 1.48-1.75 mIU/L); Atellica: 1.74 mIU/L (95% CI: 1.61-1.83 mIU/L)). Similarly, a trend was seen towards higher median TSH with Cobas than with Alinity among pregnant women (Alinity: 1.90 mIU/L (95% CI: 1.37-2.82 mIU/L); Cobas: 2.33 mIU/L (95% CI: 1.69-3.62 mIU/L)).

CONCLUSION

Results of thyroid function tests obtained with different immunoassays were not interchangeable when evaluated among pregnant and non-pregnant adults. The distinct differences are relevant for clinical decision making and emphasize the necessity of clinical laboratory information when different assays are used for diagnosis and monitoring of patients with thyroid disease.

Vancomycin-resistant Enterococcus faecium: impact of ending screening and isolation in a Danish University hospital

BACKGROUND

Substantial resources are used in hospitals worldwide to counteract the ever-increasing incidence of vancomycin-resistant and vancomycin-variable Enterococcus faecium (VREfm and VVEfm), but it is important to balance patient safety, infection prevention, and hospital costs.

AIM

To investigate the impact of ending VREfm/VVEfm screening and isolation at Odense University Hospital (OUH), Denmark, on patient and clinical characteristics, risk of bacteraemia, and mortality of VREfm/VVEfm disease at OUH. The burden of VREfm/VVEfm bacteraemia at OUH and the three collaborative hospitals in the Region of Southern Denmark (RSD) was also investigated.

METHODS

A retrospective cohort study was conducted including first-time VREfm/VVEfm clinical isolates (index isolates) detected at OUH and collaborative hospitals in the period 2015-2022. The intervention period with screening and isolation was from 2015 to 2021, and the post-intervention period was 2022. Information about clinical isolates was retrieved from microbiological databases. Patient data were obtained from hospital records.

FINDINGS

At OUH, 436 patients were included in the study, with 285 in the intervention period and 151 in the post-intervention period. Ending screening and isolation was followed by an increased number of index isolates. Besides a change in van genes, only minor non-significant changes were detected in all the other investigated parameters. Mortality within 30 days did not reflect the VREfm/VVEfm-attributable deaths, and in only four cases was VREfm/VVEfm infection the likely cause of death.

CONCLUSION

Despite an increasing number of index isolates, nothing in the short follow-up period supported a reintroduction of screening and isolation.

Defining piscine endpoints: Towards score sheets for assessment of clinical signs in fish research

The seminar 'Severity and humane endpoints in fish research' organized by the University of Bergen, the Industrial and Aquatic Laboratory, together with Fondazione Guido Bernadini, took place on 4 October 2019 in Bergen, Norway. The seminar was followed by a workshop, 'Establishing score sheets and defining endpoints in fish experiments', held on 28 January 2020, also in Bergen. The purpose of the seminar was to raise awareness about fish ethics together with severity classification and humane endpoints in fish studies, using examples from farmed fish, mainly salmonids and lumpfish. The overall aim of the workshop was to better define humane endpoints in fish experiments, as well as to discuss suggestions for development and use of score sheets for assessing clinical signs related to endpoints. Endpoints for fish should not only be based on what we know about fish diseases and the lesions they induce but should also take into consideration knowledge about fish species and life stage, fish anatomy, physiology and the general state and behaviour of the fish. For this reason, to reinforce that endpoints should come from the animal's perspective and needs, we renamed humane endpoints for fish to piscine endpoints. This paper reports the main messages from the workshop sessions including advice on development and use of score sheets.

Vitamin B12 reference intervals

INTRODUCTION

P-Vitamin B12 is a commonly used biochemical test. Evaluation of test results and diagnosis of vitamin B12 deficiency are challenging, and the role of different biochemical methods remains unclear.

METHODS

The aim of this study was to establish reference intervals for plasma vitamin B12 concentration using different immunoassays (method 1: Alinity, Abbott Laboratories; method 2: Cobas 6000, Roche Diagnostics; method 3: Atellica IM, Siemens Healthineers). Direct reference intervals were established among blood donors (n = 129) and indirect reference intervals among adult patient results of plasma vitamin B12 concentration requested by general practitioners in the North Denmark Region from 15 August to 15 October 2022 (n = 34,181). Finally, the frequency of low vitamin B12 concentration using different uniform cut-offs was evaluated.

RESULTS

Direct reference intervals (2.5-97.5 percentiles) were as follows for method 1: 168-553 pmol/l; method 2: 202-641 pmol/l; and method 3: 211-551 pmol/l. Indirect reference intervals were as follows for method 1: 133-541 pmol/l; method 2: 172-619 pmol/l; and method 3: 182-162-206 pmol/l. When different cut-offs were applied to patient results, the frequency of having a vitamin B12 concentration below 250 pmol/l differed by biochemical method: 33% (method 1), 17% (method 2) and 14% (method 3).

CONCLUSION

Measurement of plasma vitamin B12 concentration using different immunoassays revealed results and reference intervals that were not interchangeable. Clinical guidelines for the diagnosis of vitamin B12 deficiency should consider the biochemical methods used.

FUNDING

None.

TRIAL REGISTRATION

None.

OP0198-HPR DEVELOPMENT OF AN INTERDISCIPLINARY NURSE-COORDINATED SELF-MANAGEMENT INTERVENTION (INSELMA) FOR PATIENTS WITH INFLAMMATORY ARTHRITIS

Background

Up to 30% of patients with inflammatory arthritis (IA) do not respond sufficiently or tolerate the pharmacological treatment. Consequently, they may experience a substantial impact of their arthritis in everyday life. Even patients in remission or low disease activity state are at risk of substantial arthritis related symptoms and burden. These patients may need coherent interdisciplinary self-management support to manage symptoms and life with the chronic condition to increase their quality of life. A previous EULAR review on the effectiveness of self-management interventions in patients with IA (1) found that well-structured self-management programmes were lacking or were poorly reported.

Objectives

This study aimed to develop a nurse-coordinated interdisciplinary self-management intervention, delivered in routine clinical care, for patients with inflammatory arthritis and with a substantial impact of their arthritis to support their self-management ability.

Methods

The study was planned across two Danish hospitals following the British Medical Research Councils (MRC) framework for developing and evaluating Complex Interventions (2). The development process consisted of four phases: 1) a comprehensive scoping review on patients support needs and elements in self-management interventions; 2) six workshops involving health professionals (rheumatologists, nurses, physiotherapists, occupational therapists, a social worker and a psychologist) and 2 patient representatives from the two hospitals and staff from primary health care, 40 people in total; the workshops focused on ideas for the content, outline of the intervention and needs for competence development of the staff; 3) self-management, self-efficacy, health literacy and principles of Acceptance and Commitment therapy (ACT) were selected as theories to tailor the intervention and 4) development of a manual through recurrent feedback from patient research partners, clinicians and the involved researchers. Two patient research partners with IA were involved in all phases of the development of the intervention.

Results

A six month nurse-coordinated interdisciplinary self-management intervention was developed (Figure 1) consisting of: 1) an initial holistic assessment is carried out by a coordinating outpatient nurse. Patients are asked to identify up to five important activities they are unable to perform or having difficulty with in accordance with the Patient Specific Functional Scale; 2) a goal-setting and action planning process involving the patient, relatives and the coordinating nurse; 3) Ongoing support to achieve the goals. The opportunities for support include individual consultations by the coordinating nurse (telephone, online or face-to-face, 2.5 hours in total), and a maximum of four consultations by a physiotherapist and or an occupational therapist. Also, support from primary care, and an online session by a social worker about social support opportunities are offered. Two team conferences led by the coordinating nurse can be held during the intervention period. A status consultation will be held after 6 months. A manual for the initial screening, inclusion, detailing the intervention, outcomes and additional materials to support the intervention was developed. Competence development of the health professionals who are to deliver the intervention was planned and completed.

Figure 1.

Illustration of the 6-month INSELMA intervention

Conclusion

A nurse-coordinated interdisciplinary self-management intervention (INSELMA) was developed and described based on MRC’s framework for the development of Complex Interventions. The intervention is ready for feasibility testing before adaptation and test in a subsequent Randomized Controlled Trial.

References

[1]Marques et al. Effectiveness of self-management interventions in inflammatory arthritis (…). RMD Open 2021;7:e001647

[2]Skivington et al. A new framework for developing and evaluating complex interventions. (…) BMJ 2021;374:n2061

Disclosure of Interests

None declared

OP0296-HPR HEALTH AND SOCIAL CARE PROFESSIONALS’ WORK TO ACHIEVE COHERENT REHABILITATION PATHWAYS FOR PEOPLE WITH INFLAMMATORY ARTHRITIS - A QUALITATIVE INTERVIEW AND OBSERVATIONAL STUDY

Background

20-40% of people with inflammatory arthritis (IA) do not tolerate or do not have sufficient effect of their medication and experience substantial impact of their disease. They need rehabilitation to develop or restore functioning and become able to live an independent and meaningful life (1). Rehabilitation and the organisation of health and social care services are characterised by a high degree of complexity and many different professionals working across different departments, primary and secondary sectors.

Objectives

To investigate how health and social care professionals across different departments, levels and sectors work to achieve coherent rehabilitation pathways for people with IA.

Methods

In total, 26 professionals across primary and secondary health and social care participated in semi-structured interviews. These professionals were all pointed out by people with IA because they had made a significant difference to achieve coherent rehabilitation pathways for them. In addition, participant observations and informal interviews with the healthcare professionals were conducted during the rehabilitation stay. Formula stories (2) and institutional ethnography (3) guided the interpretation of data. In the findings, the term people is changed to users to underline their interactions with the professionals.

Results

The analysis derived three themes:

1) Interactions with users: the professional’s interactions with users were predominantly characterized by the ideal of focusing on the individual human being with respect for individual’s norms, values and wishes. However, this ideal was challenged when their professional knowledge contradicted the user’s norms, values and wishes.

2) Dependent interactions between professionals: expresses dependency of collaboration between professionals both internally within the same department or organization but also across organizations and sectors. Dependency on information about the user to carry out examinations, deliver care or treatment or dependency on referrals to legitimize the efforts the professionals considered necessary for the user.

3) The significance of organisation within institutional frameworks for the professionals’ work: the professionals experienced that they were not always able to meet the users demand for care due to organizational requirements for efficiency, economic cost reductions and documentation. These issues led to lack of time to prepare, implement, and follow up on communication with users and other professional partners.

Conclusion

The professionals want to meet the individual with a person-centred approach but sometimes they find it difficult to combine this with their own professional knowledge and values. The professionals are dependent on collaboration with other professionals across departments and sectors. This study shows that the institutional and organizational framework can hinder rather than promote the professionals’ intentions to create coherent rehabilitation.

References

[1]Hjortbak BR et al. Udfordringer til rehabilitering i Danmark [Challenges in rehabilitation in Denmark]. 2011.

[2]Loseke DR. The Empirical Analysis of Formula Stories. In: Holstein J, et al (ed): Varieties of Narrative Analysis. SAGE; 2012.

[3]Smith DE. Institutional ethnography. AltaMira Press; 2005.

Acknowledgements

Thanks to Tine Mechlenborg for designing the study and colleting the main part of data and to Camilla Vestergaard Aarøe for collecting some data

Disclosure of Interests

None declared

Atlantic salmon Salmo salar and ballan wrasse Labrus bergylta display different susceptibility to clonal strains of Paramoeba perurans

Amoebic gill disease (AGD), caused by the marine amoeba Paramoeba perurans, is an important disease of farmed Atlantic salmon Salmo salar L. in Norway. The use of wrasse as cleaner fish in salmon net pens raises questions about interspecies transmission of pathogens such as P. perurans. In this study, cohabitant transmission of clonal isolates of P. perurans between Atlantic salmon and ballan wrasse Labrus bergylta Ascanius was examined, using isolates originating from both salmon and wrasse. The challenges resulted in AGD in both species, although less severely in wrasse. The amoeba isolate originating from ballan wrasse was more virulent than that originating from salmon, suggesting P. perurans strain-related virulence differences. The isolate originating from salmon showed limited proliferation in bath-challenged wrasse and salmon, and limited transfer to cohabitants. Our results support previous observations suggesting that salmon may be more susceptible to P. perurans and AGD than ballan wrasse. Treatment of P. perurans infection in wrasse is challenging, as it is a strictly marine fish species. In this study, brackish water (<15‰ seawater) treatment of AGD affected salmon and wrasse was examined. Both salmon and wrasse were treated for short periods (3 h and 24 h), and treatment of wrasse over longer periods (3-5 d) was also examined. Short exposure to brackish water was not enough to remove P. perurans, although the 24 h treatment reduced amoeba levels. It was not possible to culture or detect P. perurans from wrasse exposed to brackish water for 3 d, suggesting that this treatment would be effective in controlling the parasite.

SAT0610-HPR COHERENT REHABILITATION – EXPERIENCES OF PEOPLE WITH INFLAMMATORY ARTHRITIS

Background:

20-40% of patients with inflammatory arthritis (IA) do not tolerate or do not have sufficient effect of the medication and experience considerable problems in their everyday lives. For these patients multidisciplinary rehabilitation and coherence in healthcare are of utmost importance (1). However, only little is known about coherence in healthcare among patients with inflammatory arthritis

Objectives:

To explore how persons with IA experience coherence in their rehabilitation pathways

Methods:

Semi-structured individual interviews with 11 persons with IA who had experience with rehabilitation across primary and secondary health care. Interviews were conducted in the patients’ home before admission to an inpatient rehabilitation stay, during the admission and 2-3 weeks and 4-6 months after discharge. In addition, participant observations and informal interviews were performed during admission. The analysis involved case descriptions (2) and interpretation in a thematic analysis (3).

Results:

The analysis derived a main theme“a person centered approach”, representing the importance for the person to meet professionals who listen and acknowledge the persons own views rather than focusing on the “system”, regulations and standards. In addition, 4 sub-themes were identified: 1)“empowerment and disempowerment”,covering how most patients want to be in control and take action but they may lack the energy and ability to express their needs and thus give up; 2)“Lack of communication and coordination”, involving processes between the staff in the same department, between departments or sectors. Patients feel forced to take on coordinating tasks themselves, which they do not feel qualified to perform; 3)“Interventions meant as help may be felt as restrictions”, which encompass i.e. free physical therapy delivered at times not appropriate for the patient and types of support which can lead to a feeling of social control, and finally, 4)“The system is difficult to get through”.Information about possible support are provided at random and some ask for a coordinating person.

Conclusion:

Facilitators for coherent pathways among people with IA encompass dedicated professionals working with a person-centered approach aiming to empower people. This encompass to provide relevant knowledge and enable the person to ask for the right type of help. A coordinator may facilitate coherence.

References:

[1]Aiello M, Mellor JD. Integrating health and care in the 21st century workforce. Journal of Integrated Care. 2019;27(2):100-10.

[2]Breimo JP. Bundet av bistand. En institusjonell etnografi om organisering av rehabiliteringsprosesser [Captured by Care. An Institutional Ethnography on organizing of Rehabilitation Processes]: Universitetet i Nordland; 2012.

[3]Braun V, Clarke V, Hayfield N, Terry G. Thematic Analysis. In: Liamputtong P, editor. Handbook of Research Methods in Health Social Sciences. Singapore: Springer; 2019.

Acknowledgments:

Funding from Region of Southern Denmark, Hans Christensens memorial foundation and Knud and Edith Eriksens memorial foundation

Disclosure of Interests:

Helle Feddersen: None declared, Jens Soendergaard: None declared, Bettina Munksgaard Schmidt: None declared, Lena Andersen: None declared, Jette Primdahl Speakers bureau: BMS and Pfizer

Higher self-reported severity of atopic dermatitis in adults is associated with poorer self-reported health-related quality of life in France, Germany, the U.K. and the U.S.A

Background

Better understanding of the relationship between atopic dermatitis (AD) severity and health‐related quality of life (HRQoL) could help improve knowledge of a more effective treatment for people with AD.

Objectives

To assess the relationship between AD severity and HRQoL and perception of AD symptoms in adults with moderate‐to‐severe AD in Europe and the U.S.A.

Methods

Participants for this cross‐sectional, internet‐based survey were recruited from the larger population‐based National Health and Wellness Survey. AD severity was measured by Patient‐Oriented SCORing of AD. HRQoL was measured by the five‐level EuroQol‐5D, Dermatology Life Quality Index (DLQI) and Patient‐Oriented Eczema Measure (POEM).

Results

Altogether, 1232 respondents were included: 1098 (89·1%) with moderate‐to‐severe AD [221 (20·1%) from France, 209 (19·0%) from Germany, 118 (10·7%) from the U.K. and 550 (50·1%) from the U.S.A.]. An additional 134 (10·9%) respondents with mild AD were included. Sociodemographic and clinical AD characteristics were similar between countries. In adults with moderate‐to‐severe AD, higher AD severity correlated with poorer HRQoL (Spearman's r = –0·38 and 0·61 for EQ‐5D and DLQI, respectively; both P < 0·001). AD severity was positively correlated with POEM (Spearman's r = 0·51; P < 0·001). People with moderate‐to‐severe vs. those with mild AD had poorer health outcomes (EQ‐5D, DLQI and POEM, P < 0·001 for all). These results were similar and consistent for the European and the U.S. populations separately.

Conclusions

Higher AD severity is associated with poorer HRQoL across Europe and the U.S.A. This is a burden for patients and may provide encouragement for more effective management of AD.

What's already known about this topic?

Atopic dermatitis (AD) is associated with a detrimental effect on health‐related quality of life (HRQoL), including sleep disturbance, anxiety and depression.

Limited data describing the relationship between different levels of AD severity and self‐reported HRQoL have been published.

What does this study add?

There is a positive association between increasing AD severity (Patient‐Oriented SCORing of AD) and decreasing HRQoL (EQ‐5D and Dermatology Life Quality Index) and the perception of AD symptoms (Patient‐Oriented Eczema Measure) from the patient's perspective.

AD severity according to geographic locations was explored (France, Germany, the U.K., and the U.S.A.), showing that the decreasing HRQoL associated with increasing AD severity was quite consistent between the geographic locations.

What are the clinical implications of this work?

The results of this study showed that higher AD severity is associated with poorer HRQoL from the subject’s perspective in both Europe and the US. This fact confirms that there is a burden for these patients and may provide encouragement for a more effective management of AD, especially among those with greater AD severity.

Linked Comment: Rencz. Br J Dermatol 2020; 182:1083.

Increasing severity of atopic dermatitis is associated with a negative impact on work productivity among adults with atopic dermatitis in France, Germany, the U.K. and the U.S.A

BACKGROUND

Atopic dermatitis (AD) is associated with high disease burden, with a significant physical and social impact. However, the association between disease severity and burden of disease, with work productivity and daily activities being one aspect, has not been well characterized.

OBJECTIVES

To investigate the impact of disease severity on work productivity and daily activities among adults with AD in Europe (France, Germany and the U.K.) and the U.S.A.

METHODS

The survey panel participants for this cross-sectional internet-based survey on AD were sourced from the population-based National Health and Wellness Survey (Europe 2016, U.S.A. 2015 and 2016). AD severity was determined by Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD). Work productivity and work activity impairment were assessed using the Work Productivity and Activity Impairment (WPAI) - Specific Health Problem questionnaire for AD.

RESULTS

The study survey was completed by 1098 respondents with moderate-to-severe AD and 134 with mild AD. Overall, the negative impact on work productivity (all WPAI items) was suggested to increase with increasing AD severity (PO-SCORAD) at the regional level (Europe and U.S.A.) and in the total sample. For overall work impairment due to AD, respondents with mild AD reported a mean of 2·4 h per week of potential work productivity lost, respondents with moderate AD 9·6 h and respondents with severe AD 19·0 h.

CONCLUSIONS

Higher AD severity was associated with a greater negative impact on work productivity in adults. This impact is a burden not only for the patient but also for society and may provide incentives for treatment optimization and more effective management of AD. What's already known about this topic? Atopic dermatitis (AD) is associated with a high disease burden. AD has a negative impact on several aspects of health-related quality of life, one of which is work productivity. What does this study add? By using a population of participants with AD recruited from the National Health and Wellness Survey, which collects broad and representative data from the general population, survey data could be obtained from U.S. and European populations of patients with AD. The present study suggests an increasingly negative impact on work productivity with increasing severity of AD. The data indicate no regional differences in the impact of AD severity on work productivity.

GPR55 promotes migration and adhesion of colon cancer cells indicating a role in metastasis

BACKGROUND AND PURPOSE

Tumour cell migration and adhesion constitute essential features of metastasis. G-protein coupled receptor 55 (GPR55), a lysophospholipid receptor, has been shown to play an important role in carcinogenesis. Here, we investigated the involvement of GPR55 in migration and metastasis of colon cancer cells.

EXPERIMENTAL APPROACH

Adhesion and migration assays using the highly metastatic colon cancer cell line HCT116 and an in vivo assay of liver metastasis were performed. The GPR55 antagonist CID16020046, cannabidiol, a putative GPR55 antagonist and GPR55 siRNA were used to block GPR55 activity in HCT116 colon cancer cells.

KEY RESULTS

HCT116 cells showed a significant decrease in adhesion to endothelial cells and in migration after blockade with CID16020046 or cannabidiol. The inhibitory effects of CID16020046 or cannabidiol were averted by GPR55 siRNA knock down in cancer cells. The integrity of endothelial cell monolayers was increased after pretreatment of HCT116 cells with the antagonists or after GPR55 siRNA knockdown while pretreatment with lysophosphatidylinositol (LPI), the endogenous ligand of GPR55, decreased integrity of the monolayers. LPI also induced migration in GPR55 overexpressing HCT116 cells that was blocked by GPR55 antagonists. In a mouse model of metastasis, the arrest of HCT116 cancer cells in the liver was reduced after treatment with CID16020046 or cannabidiol. Increased levels of LPI (18:0) were found in colon cancer patients when compared with healthy individuals.

CONCLUSIONS AND IMPLICATIONS

GPR55 is involved in the migratory behaviour of colon carcinoma cells and may serve as a pharmacological target for the prevention of metastasis. © 2015 The British Pharmacological Society.

Understanding the experience and manifestation of depression in people living with HIV/AIDS in South Africa

Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low- and middle-income countries despite high rates of this disorder in this population. In the current study, semi-structured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population.

Use of statins and risk of glioma: a nationwide case-control study in Denmark

Background:

Laboratory studies and a single case–control study have suggested a protective effect of statins on the risk of glioma. We wished to investigate the influence of statin use on the risk of glioma in a population-based setting.

Methods:

We conducted a nationwide case–control study in Denmark based on population-based medical registries. We identified all patients aged 20 to 85 years with a first diagnosis of histologically verified glioma during 2000–2009. These cases were matched on birth year and sex with population controls. Prior use of statins since 1995 was classified into short-term use (<5 years) and long-term use (5+ years). We used conditional logistic regression to compute odds ratios (ORs), with 95% confidence intervals (CIs), for glioma associated with statin use, adjusted for potential confounders.

Results:

A total of 2656 cases and 18 480 controls were included in the study. The risk of glioma was reduced among long-term statin users (OR=0.76; 95% CI: 0.59–0.98) compared with never users of statins, and was inversely related to the intensity of statin treatment among users (OR=0.71; 95% CI: 0.44–1.15 for highest intensity). The inverse association between long-term statin treatment and glioma risk was more pronounced among men aged ⩽60 years (OR=0.40; 95% CI: 0.17–0.91) compared with men aged 60+ years (OR=0.71; 95% CI: 0.49–1.03). An inverse association was also observed among women aged ⩽60 years (OR=0.28; 95% CI: 0.06–1.25), but not among women over age 60 years (OR=1.23; 95% CI: 0.82–1.85).

Conclusion:

Long-term statin use may reduce the risk of glioma.

Diseases of farmed Atlantic salmon Salmo salar associated with infections by the microsporidian Paranucleospora theridion

The microsporidian Paranucleospora theridion was discovered in Atlantic salmon Salmo salar suffering from proliferative gill disease in a marine farm in western Norway in 2008. The parasite develops in cells of the reticuloendothelial system, cells important for normal immune function. The aim of this study was to see if P. theridion could play a part in some of the diseases with unclear causes in salmon production in Norway, i.e. proliferative gill disease (PGI), pancreas disease (PD), heart and skeletal muscle inflammation (HSMI) and cardiomyopathy syndrome (CMS). P. theridion was present in all areas with salmon farming in Norway, but high prevalence and densities of the parasite in salmon and salmon lice were only seen in southern Norway. This region is also the main area for PGI and PD in Norway. Quantification of pathogens associated with PGI, PD, HSMI and CMS diagnoses showed that P. theridion levels are high in southern Norway, and may therefore play a role in susceptibility and disease development. However, among the different diagnoses, fish with PGI are particularly heavily infected with P. theridion. Therefore, P. theridion appears as a possible primary agent in cases with high mortality in connection with PGI in western Norway.

Life cycle assessment of three water systems in Copenhagen--a management tool of the future

Environmental life-cycle assessment (LCA) was applied to evaluate three different water systems of the water sector in Copenhagen, Denmark, including technologies within water supply, facilities recycling water and treatment of sewer overflow. In these three water systems LCA was used to evaluate the environmental impacts of each of the processes involved. The overall conclusion was that LCA is suitable as a decision support tool in the water sector as it provides a holistic evaluation platform of the considered alternatives categorised in environmental impact categories. The use of LCA in the water sector of this region has limitations since it does not yet consider impact categories assessing freshwater scarcity and ecological sustainability.

Effect of parenteral zinc sulfate on colon anastomosis repair in the rat

BACKGROUND AND AIMS

To prevent colonic anastomotic dehiscence, pharmaceutical interventions should inhibit degradation of existing submucosal collagen fibers and accelerate the synthesis of new collagen molecules. Zinc has multiple functions in collagen metabolism and was recently found beneficial in colonic anastomosis repair. We have investigated the effect of daily intraperitoneal zinc (2 mg/kg) injections on the development of the biomechanical integrity of left colon anastomoses.

MATERIALS AND METHODS

Sixty Sprague-Dawley male rats (median 245 g) were allocated to treatment with zinc sulfate in saline (n = 30) or with saline alone (n = 30) starting 1 h before the anastomoses were made. Serum zinc levels and anastomotic breaking strength were determined on postoperative days 3 (n = 30) and 7 (n = 30). The initial breaking strength or suture-binding capacity was determined in additional ten non-treated animals (277 g).

RESULTS

The breaking strength of the anastomoses decreased in the two groups combined (n = 30) by 50% (p < 0.001) on day 3 but was regained by postoperative day 7 compared with the initial anastomotic biomechanical strength. Serum zinc levels also increased from day 3 to day 7 in both intervention groups and correlated significantly with breaking strength (r = 0.57, p < 0.001). Although the median serum zinc level was 14% higher (p < 0.01) on day 7 in zinc-treated than in saline-treated animals, the breaking strength did not differ significantly between zinc-treated and saline-treated rats on either day 3 (p = 0.95) or day 7 (p = 0.70).

CONCLUSION

In contrast to previous report in rabbits, we failed to demonstrate the beneficial effects of parenteral zinc supplementation on colon anastomosis repair in a rat model.

Tissue tropism of salmonid alphaviruses (subtypes SAV1 and SAV3) in experimentally challenged Atlantic salmon (Salmo salar L.)

Diagnosis of SAV infections has traditionally been based upon clinical observations together with a set of histopathological findings in exocrine pancreas, heart and skeletal muscle, but recently, real-time RT-PCR assays have been developed as a supplement for the detection of SAV. The aim of this study was to determine tissue tropism of SAV1 and SAV3 in Atlantic salmon Salmo salar L. in order to identify the most suitable tissues for real-time RT-PCR diagnostic assays. The results indicated that the pseudobranch and the heart (ventricle) are the most useful tissues for such assays, regardless of disease status. The pyloric caecae with associated pancreatic tissue is unsuitable for diagnosis using this method. The use of real-time RT-PCR enabled viral RNA detection at all stages of the disease, including in surviving fish six months after infection. Considering the short production cycle of farmed salmonids, this suggests that surviving Atlantic salmon may become life-long asymptomatic carriers of SAV after an infection.

Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults

BACKGROUND

No population based prospective cohort study has previously assessed the impact of multiple risk factors, including Helicobacter pylori infection, on the incidence of peptic ulcer disease (PUD).

AIMS

To identify risk factors for PUD and estimate their relative impact on ulcer incidence.

SUBJECTS

Random sample of 2416 Danish adults with no history of PU.

METHODS

Sample members were interviewed in 1982 and 1994. PUs diagnosed within the observation period were verified through medical records. Information on psychosocial factors, lifestyle practices, and medication was obtained from a questionnaire completed at study entry. H pylori infection status was determined by ELISA.

RESULTS

The main risk factors for PUD were H pylori infection (odds ratio 4.3 (95% confidence interval 2.2; 8.3)), tobacco smoking (3.8 (1.7; 9.8)), and use of minor tranquillisers (3.0 (1.4; 6.6)). Intake of non-steroid anti-inflammatory drugs did not affect the incidence of PUD (0.4 (0.1; 2.3)). In those with increased antibodies to H pylori, tobacco smoking (12.7 (2.8; 56.8)) and intake of spirits (2.4 (1.1; 5.4)) increased the risk of PUD whereas moderate leisure time physical activity (0.3 (0.2; 0.7)) protected against PUD.

CONCLUSIONS

Tobacco smoking and H pylori infection are the main risk factors for PUD in Danish adults. Physical activity may protect against PUD in those infected with H pylori.

Guidelines for the practice of anesthesia in Norway

Since the first version saw the light of day in 1991 the Guidelines have occupied a central position in the Norwegian practice of anesthesia. This document comprises part of the quality management documents held in the departments of anesthesia in Norwegian hospitals. If departments of anesthesia are unable to adhere to certain specific points in the Guidelines, it is recommended that this should be documented in writing. It has been stated by central governmental bodies and patients' insurance organizations that the Guidelines will be an important factor in medico legal cases, although it is not an obligatory legal document for hospital owners. It is our objective that the document will form the foundation for quality assurance work in the departments of anesthesia in Norway. The purpose of this document is to ensure a satisfactory standard for the practice of anesthesia in Norway. 'The Guidelines for the Practice of Anesthesia in Norway' (the Guidelines) is a series of recommended guidelines. The practice of anesthesia in this context includes general anesthesia, regional anesthesia, controlled sedation, postoperative monitoring, and other observations where anesthesia personnel are required. The Guidelines apply to all doctors, nurses, and other personnel undertaking the delegated practice of anesthesia. Deviations from the Guidelines should be explained and documented in every case. The Guidelines should be adhered to in medical emergencies as far as possible. The Guidelines must not be allowed to prevent the execution of immediate and lifesaving measures. The Guidelines should be revised at regular intervals so that it is up-to-date with current legislation and medical and technological developments and practice.

Validity and use of a non-parallel insulin assay for pharmacokinetic studies of the rapid-acting insulin analogue, insulin aspart

A radioimmunoassay (RIA) for insulin was validated for reliable measurement of the human insulin analogue, insulin aspart, by correction of non-linear measurements. Specificity was equivalent for several species of insulin, except insulin aspart. A non-linear hyperbolic model fitted insulin aspart with a correction formula for non-linearity of: z = 1,503y/ (1,398 - y), where y denotes measured concentration and z denotes true concentration. Matrix-effects were insignificant for human, porcine, and canine heparin-plasma and for human and porcine serum. The coefficient of variation was below 15% for 80-800 pmol/L human and porcine insulin and for 80-600 pmol/L insulin aspart. The limit of detection for insulin aspart was 11.5 pmol/L with a lower limit of quantification of 17.5 pmol/ L. Dilution of serum with Pharmacia dilution media introduced no significant error. In conclusion, this paper demonstrates that a non-parallel radioimmunoassay can be used to estimate accurate concentrations of insulin aspart.

Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating

The aim of the study was to investigate the extent to which the symptoms experienced by advanced cancer patients were covered by the nursing records. On the day of the first contact with our palliative care department, a nursing record was taken, and on this or the following day, 56 patients filled in the questionnaires EORTC Quality of Life Questionnaire (EORTC QLQ-C30), Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS). In each patient, the symptomatology reported in the patient-completed questionnaires was compared with the symptomatology mentioned by the nurse in the nursing record. The analysis revealed good concordance concerning pain and poor physical functioning, but patients reported other symptoms or problems much more often than their nurses. Reasons for these discrepancies are discussed. It is suggested that the nurse's knowledge of the patient's symptomatology might gain from more systematic screening or from transfer of information from patient self-assessment questionnaires to the nursing records.

Development of an ELISA for vitellogenin in whole body homogenate of zebrafish (Danio rerio)

The yolk protein, lipovitellin (Lv) was purified from ovaries of mature female zebrafish (Danio rerio) by gel filtration and anion exchange chromatography. Polyclonal antibodies against Lv were raised in rabbits. Anti-Lv IgG was purified by affinity chromatography. SDS-PAGE followed by Western blotting was performed to analyse the specificity of the antibody and the immunological similarities between Lv and vitellogenin (Vtg). Anti-Lv IgG was used to develop a direct non-competitive sandwich ELISA to measure Vtg concentrations of whole body homogenate (WBH) in zebrafish. The intra- and interassay variabilities were 5.8% and 10.4%, respectively. The sensitivity was 0.2 ng Vtg x ml(-1) and the practical detection limit was 40 ng Vtg x g(-1) fish (wet weight). Adult male zebrafish were exposed to a nominal water concentration of 10 ng x l(-1) of ethinylestradiol (EE2) in a semi-static exposure system for 7 days. Compared with the control group, exposure to 10 ng EE2 x l(-1) induced a 200-fold increase in Vtg levels.