Genetic resistance determinants to fusidic acid and chlorhexidine in variably susceptible staphylococci from dogs

BACKGROUND

Concern exists that frequent use of topically-applied fusidic acid (FA) and chlorhexidine (CHX) for canine pyoderma is driving clinically relevant resistance, despite rare description of FA and CHX genetic resistance determinants in canine-derived staphylococci. This study aimed to determine minimum inhibitory concentrations (MICs) and investigate presence of putative resistance determinants for FA and CHX in canine-derived methicillin-resistant (MR) and -susceptible (MS) staphylococci. Plasmid-mediated resistance genes (fusB, fusC, fusD, qacA/B, smr; PCR) and MICs (agar dilution) of FA and CHX were investigated in 578 staphylococci (50 MR S. aureus [SA], 50 MSSA, 259 MR S. pseudintermedius [SP], 219 MSSP) from Finland, U.S.A., North (NUK) and South-East U.K. (SEUK) and Germany. In all isolates with FA MIC ≥64 mg/L (n = 27) fusA and fusE were amplified and sequenced.

RESULTS

FA resistance determinants (fusA mutations n = 24, fusB n = 2, fusC n = 36) were found in isolates from all countries bar U.S.A. and correlated with higher MICs (≥1 mg/L), although 4 SP isolates had MICs of 0.06 mg/L despite carrying fusC. CHX MICs did not correlate with qacA/B (n = 2) and smr (n = 5), which were found in SEUK SA, and SP from NUK and U.S.A.

CONCLUSIONS

Increased FA MICs were frequently associated with fusA mutations and fusC, and this is the first account of fusB in SP. Despite novel description of qacA/B in SP, gene presence did not correlate with CHX MIC. Selection pressure from clinical use might increase prevalence of these genetic determinants, but clinical significance remains uncertain in relation to high skin concentrations achieved by topical therapy.

Non-tuberculous Mycobacteria can Cause Disseminated Mycobacteriosis in Cats

Mycobacteriosis caused by non-tuberculous mycobacteria (NTM) is a rising concern in human medicine both in immunocompromised and immunocompetent patients. In cats, mycobacteriosis caused by NTM is considered mostly to be a focal or dermal infection, with disseminated disease mostly caused by Mycobacterium avium. We describe three cases of disseminated mycobacteriosis in cats, caused by Mycobacterium malmoense, Mycobacterium branderi/shimoidei and M. avium, with no identified underlying immunosuppression. In all cases, extracellular mycobacteria were seen in the pulmonary epithelium, intestinal lumen and glomerular tufts, which could affect the shedding of the organism. The present study highlights the importance of mycobacteriosis as a differential even in immunocompetent animals. Considering the close relationship of owners and pets and the potential presence of free mycobacteria in secretions, cats should be considered as a possible environmental reservoir for mycobacteria.

Serum C-reactive protein as a diagnostic biomarker in dogs with bacterial respiratory diseases

Background

C‐reactive protein (CRP) is a major acute‐phase protein in dogs. Serum concentrations are low in healthy animals, but increase rapidly after inflammatory stimuli.

Objective

The aim of the study was to investigate CRP concentrations in various respiratory diseases of dogs and to determine if CRP can be used as a biomarker in the diagnosis of bacterial respiratory diseases.

Animals

A total of 106 privately owned dogs with respiratory diseases (17 with bacterial tracheobronchitis [BTB], 20 with chronic bronchitis [CB], 20 with eosinophilic bronchopneumopathy [EBP], 12 with canine idiopathic pulmonary fibrosis [CIPF], 15 with cardiogenic pulmonary edema [CPE], and 22 with bacterial pneumonia [BP]) and 72 healthy controls.

Methods

The study was conducted as a prospective cross‐sectional observational study. CRP was measured in serum samples. Diagnosis was confirmed by clinical and laboratory findings, diagnostic imaging, and selected diagnostic methods such as cytological and microbiological analysis of respiratory samples, echocardiography, and histopathology.

Results

Dogs with BP had significantly higher CRP concentrations (median, 121 mg/L; interquartile range, 68–178 mg/L) than dogs with BTB (23, 15–38, P = .0003), CB (13, 8–14, P < .0001), EBP (5, 5–15, P < .0001), CIPF (17, 10–20, P < .0001), or CPE (19, 13–32, P < .0001) and healthy controls (14, 8–20, P < .0001). Dogs with BTB had significantly higher CRP concentrations than dogs with CB (P = .001) or EBP (P < .0001) and healthy controls (P = .029).

Conclusion and Clinical Importance

These results indicate that CRP has potential for use as an additional biomarker, especially in the diagnostics of BP.

The effect of a short-term hypocaloric diet on liver gene expression and metabolic risk factors in obese women

BACKGROUND AND AIMS

Most gene expression studies examining the effect of obesity and weight loss have been performed using adipose tissue. However, the liver also plays a central role in maintaining energy balance. We wanted to study the effects of a hypocaloric diet on overall hepatic gene expression and metabolic risk factors.

METHODS AND RESULTS

The study subjects were middle-aged, obese women. The diet intervention subjects (n=12) were on a hypocaloric, low-fat diet for 8 weeks with a daily energy intake of 5.0 MJ (1200 kcal), while the control subjects (n=19) maintained their weight. Liver biopsies were taken at the end of the diet period during a gallbladder operation. Hepatic gene expression was analyzed using microarrays by comparing the gene expression profiles from four subjects per group. A global decrease in gene expression was observed with 142 down-regulated genes and only one up-regulated gene in the diet intervention group. The diet resulted in a mean weight loss of 5% of body weight. Triglyceride and fasting insulin concentrations decreased significantly after the diet.

CONCLUSIONS

The global decrease in hepatic gene expression was unexpected but the results are interesting, since they included several genes not previously linked to weight reduction. However, since the comparison was made only after the weight reduction, other factors in addition to weight loss may also have been involved in the differences in gene expression between the groups. The decrease in triglyceride and fasting plasma insulin concentrations is in accordance with results from previous weight-loss studies.

Severe hypoglycemia during intensive insulin therapy

BACKGROUND

Tight glycemic control reduces mortality in surgical intensive care patients and in long-term medical intensive care patients. A large study on intensive insulin therapy was prematurely discontinued due to safety issues. As the safety of intensive insulin therapy has been questioned, we screened all patients during a 17-month period to reveal the incidence of hypoglycemia and its effects on the outcome of the patients.

METHODS

All patients treated between February 2005 and June 2006 in two intensive care units (ICUs) of a tertiary care teaching hospital were included in the study. A nurse-driven intensive insulin therapy with a target blood glucose level of 4-6 mmol/l had been introduced earlier. The patients were divided into two groups according to the presence of severe hypoglycemia (<or=2.2 mmol/l).

RESULTS

One thousand two hundred and twenty-four patients (1124 treatment periods) were included. During the study period, 61,203 blood glucose measurements were performed, 2.6% of which were below and 52.6% above the target range. Severe hypoglycemia (glucose <or=2.2 mmol/l) occurred in 25 patients (36 measurements). The incidence was 0.06% of the measurements and 2.3% of the patients. The median age, sex, Acute Physiology And Chronic Health Evaluation II, Simplified Acute Physiology Score II, diagnosis category, ICU or hospital length of stay did not differ between the groups. The hospital mortalities were 25% and 15% in patients with or without severe hypoglycemia, respectively (P=0.16).

CONCLUSION

Severe hypoglycemia during intensive insulin therapy is rare in clinical practice compared with previous clinical trials.

Streptococcus pneumoniae isolates resistant to telithromycin

The telithromycin susceptibility of 210 erythromycin-resistant pneumococci was tested with the agar diffusion method. Twenty-six erm(B)-positive isolates showed heterogeneous resistance to telithromycin, which was manifested by the presence of colonies inside the inhibition zone. When these cells were cultured and tested, they showed stable, homogeneous, and high-level resistance to telithromycin.

Wavelet-based reconstruction for limited-angle X-ray tomography

The aim of X-ray tomography is to reconstruct an unknown physical body from a collection of projection images. When the projection images are only available from a limited angle of view, the reconstruction problem is a severely ill-posed inverse problem. Statistical inversion allows stable solution of the limited-angle tomography problem by complementing the measurement data by a priori information. In this work, the unknown attenuation distribution inside the body is represented as a wavelet expansion, and a Besov space prior distribution together with positivity constraint is used. The wavelet expansion is thresholded before reconstruction to reduce the dimension of the computational problem. Feasibility of the method is demonstrated by numerical examples using in vitro data from mammography and dental radiology.

Prevalence and molecular genetics of macrolide resistance among Streptococcus pneumoniae isolates collected in Finland in 2002

The prevalence and mechanisms of macrolide resistance among 1,007 clinical pneumococcal isolates collected in Finland were investigated. Of these, 217 (21.5%) were resistant to erythromycin and 11% to clindamycin. Among the erythromycin-resistant isolates, mef(E) was present in 95 isolates (44%), mef(A) was present in 12 isolates (6%), and erm(B) was present in 90 isolates (41%). A double mechanism, mef(E) and erm(B), was detected in five isolates (2%). Ribosomal mutation was detected in 14 (6%) macrolide-resistant isolates in which no other determinant was found. Based on the telithromycin MICs, two groups of isolates were formed: 83.3% of the isolates belonged to a major group for which the telithromycin MIC range was < or =0.008 to 0.063 microg/ml, and 16.7% belonged to a minor group for which the telithromycin MIC range was 0.125 to 8 microg/ml. All except three isolates in the minor population carried a macrolide resistance gene.

Prescribing antimicrobial agents for dogs and cats via university pharmacies in Finland--patterns and quality of information

The aim of our study was to evaluate antimicrobial use in dogs and cats in Finland. Information on veterinary prescriptions was gathered from University Pharmacies (n=17) over a one-month period, April 2001. A total of 2719 prescriptions for veterinary use were delivered, of which the majority were for dogs (70%, n=1898) and cats (14%, n=384). The most prescribed therapy group was per-oral antimicrobial agents (53%, n=1449), of which 16% (n=237) were medicines approved for humans. The most commonly used substances for dogs and cats were betalactams, 66% and 78%, respectively. The proportion of fluoroquinolones was 3-5%. The average duration of the treatment periods was 10 days with the exception of treatment of cats with macrolide-lincosamides, where the mean period was 20 days. Indication was mentioned only in 37% of the prescriptions.

Survey of condition-based prescribing of antimicrobial drugs for dogs at a veterinary teaching hospital

A database of the prescriptions of antimicrobial drugs for the treatment of common infectious diseases in dogs at the Finnish Veterinary Teaching Hospital was searched to determine to what extent national guidelines were being followed. Twenty-two per cent of 5918 dogs were treated orally with antimicrobial drugs. The most commonly used drugs were beta-lactams (49 per cent) of which cephalexin and amoxycillin-clavulanate were most widely prescribed. The usage of fluoroquinolones was only 2.8 per cent. The prescription of antimicrobials for pyoderma was contrary to Finnish guidelines, but the use of cephalexin or amoxycillin-clavulanate as first-line drugs instead of macrolides or lincosamides or trimethoprim-sulphonamides was acceptable because of the presence of resistance by canine staphylococci. The drug most commonly used to treat acute urinary tract infections was trimethoprim-sulphonamide, in agreement with the guidelines. Antimicrobial drugs were used excessively after surgical procedures, and for treating acute gastrointestinal disturbances and small wounds and traumas.

Perceived stress, pain and work performance among non-patient working personnel with clinical signs of temporomandibular or neck pain

The aim of the present study was to assess the associations between different types of perceived stress, pain and work performance among non-patients with clinical signs of muscle pain in the head/neck region. One-fifth (n = 241) of the 1339 media employees who had participated in a previous survey (Ahlberg J. et al., J Psychosom Res 2002; 53: 1077-1081) were randomly selected for standardized clinical examinations. Altogether 49% (n = 118) of these subjects had clinical signs of temporomandibular and/or neck muscle pain and were enrolled in the present study. The mean age of the study sample was 46.9 years (s.d. 6.6) and the female to male distribution 2:1. Of the 118 employees 46.5% reported that the pain problem interfered with their ability to work. Perceived ability to work was not significantly associated with age, gender or work positions. According to logistic regression, reduced work performance was significantly positively associated with continuous pain [odds ratio (OR) 4.38; 95% CI 1.21-15.7], level of perceived pain severity (OR 1.30; 95% CI 1.04-1.63), and health stress (OR 2.08; 95% CI 1.22-3.54). The results of this study indicated an association between specific self-reported stress regarding health and work issues, pain and work performance. From a preventive perspective this indicates a need for increased awareness about these associations on not only individual level but also at the organizational level and in health care.

Reported bruxism and biopsychosocial symptoms: a longitudinal study

OBJECTIVES AND METHODS

In this follow-up study of 30-50-year-old employees (n = 211) of the Finnish Broadcasting Company (YLE), respondents completed questionnaires in both 1999 and 2000 containing items on demographic data, tobacco use, levels of perceived bruxism, affective disturbance, sleep disturbance, somatic symptoms, pain symptoms and temporomandibular disorder (TMD) symptoms.

RESULTS

Bruxism was significantly more prevalent among smokers (P = 0.005). Age, marital status, and gender were not associated with bruxism. Subjects in the frequent bruxism group (n = 74) reported the TMD-related painless symptoms, affective disturbance and early insomnia significantly more often than average. In the multivariate analyses, clustered pain symptoms (P = 0.001), TMD-related painless symptoms (P = 0.004) and smoking (P = 0.012) were significantly positively associated with frequent bruxism, when the independent effects of age and gender were controlled for.

CONCLUSIONS

It was concluded that successful management of TMD necessitates smoking cessation, as tobacco use may both amplify the patient's pain response and provoke bruxism. Psychosocial factors and perceived stress should not be ignored, however.

Stationary-phase acid and heat treatments for improvement of the viability of probiotic lactobacilli and bifidobacteria

AIMS

To investigate whether sublethal treatments of stationary-phase probiotic cultures enhance their survival during lethal treatments and to adapt these treatments to the fermenter-scale production of probiotic cultures.

METHODS AND RESULTS

Conditions for acid and heat pretreatments were screened for three Lactobacillus and two Bifidobacterium strains. Strains were sublethally treated both at laboratory scale and at fermenter scale in a strain-specific manner and exposed to a subsequent lethal treatment. At laboratory scale viability improvement was detected in each strain. However, improvement was more pronounced in the Lactobacillus than in the Bifidobacterium strains. At fermenter scale three strains were tested: for the two Lactobacillus strains a marked improvement in viability was obtained whereas for the Bifidobacterium strain the improvement was either minor or not detected.

CONCLUSIONS

Development of treatments for viability enhancement of probiotic strains is feasible, but strain-specific optimization is necessary to obtain notable improvements.

SIGNIFICANCE AND IMPACT OF THE STUDY

Strain-specific treatments were developed for the viability enhancement of stationary-phase probiotic cells both at laboratory and fermenter scale. These results can be utilised in the production of probiotic cultures with improved viability.

Antimicrobial resistance in Staphylococcus spp., Escherichia coli and Enterococcus spp. in dogs given antibiotics for chronic dermatological disorders, compared with non-treated control dogs

The aim of this study was to evaluate antimicrobial resistance in canine staphylococci, Escherichia coli and enterococci, which were isolated from 22 dogs with pyoderma and a history of previous antibiotic treatment, compared to bacterial isolates from 56 non-treated control dogs. Two isolates of each bacterial species per dog were investigated, if detected. Staphylococcal isolates from dogs with pyoderma (35 isolates) were more resistant to sulphatrimethoprim than the isolates from controls (56 isolates) (57% vs. 25%, p < 0.004). Multiresistance in staphylococci was also more common in dogs with pyoderma (29% vs. 9%, p = 0.02). A similar trend among isolates of E. coli was detected (24 and 74 isolates from treated and control dogs, respectively), but the differences were not significant. Resistance for macrolide-lincosamides was approximately 20% among staphylococci in both groups. Resistance to ampicillin among enterococci was 4%-7%. The age of the dogs might have an impact on resistance: multiresistance among staphylococcal isolates from younger dogs (< or = 5 years) was more common than in older dogs (26 years) (24%, vs. 0%, 63 and 27 isolates, respectively, p = 0.02). Staphylococci in younger dogs were more resistant to tetracycline (48% vs. 11%, p < 0.001) and sulphatrimethoprim (48% vs. 15%, p < 0.01) than those in older dogs. In contrast, the isolates of E. coli from older dogs tended to be more resistant, although a significant difference was detected only in resistance to tetracycline (13% vs. 2% of 40 and 50 isolates respecthely, p = 0.04)). The results of this small study indicate that resistance in canine staphylococci in the capital area of Finland is comparable with many other countries in Europe. Resistance in indicator bacteria, E. coli and enterococci, was low.

Reported bruxism and stress experience

The aim of the study was to analyze whether perceived bruxism was associated with stress experience, age, gender, work role, and occupational health care use among a nonpatient multiprofessional population. Altogether, 1784 (age 30-55 years) employees of the Finnish Broadcasting Company were mailed a self-administered questionnaire covering demographics, perceived bruxism, total stress experience and the use of health care services provided by the company. The response rate was 75% (n = 1339, 51% men) and mean age was 46 years (SD = 6) in both genders. There were no significant differences in demographic status by age and gender. Bruxism and stress experiences did not significantly vary with regard to category of work, but both were significantly more frequent among women (P < 0.05). In all work categories frequent bruxers reported more stress, and the perceptions were significantly differently polarized between the groups (P < 0.001). According to logistic regression, frequent bruxism was significantly positively associated with severe stress experience (Odds ratio = 5.00; 95% CI = 2.84-8.82) and female gender (Odds ratio = 2.26; 95% CI = 1.43-3.55). Frequent bruxism was also significantly positively associated with the numbers of occupational health care and dental visits (P < 0.01), and slightly negatively associated with increasing age and work in administration (P < 0.05). It was concluded that bruxism may reveal ongoing stress in normal work life.

Distinct biopsychosocial profiles emerge among nonpatients

OBJECTIVES

The cross-sectional study comprised 30- to 55-year-old permanent employees (N=1784) of the Finnish Broadcasting Company (YLE).

METHODS

The participants (N=1339, response rate 75%) completed standardised questionnaires covering demographic items, physical health, work performance, stress symptoms, pain and musculoskeletal symptoms, and overall biopsychosocial health.

RESULTS

Physical symptoms (present often or continually) were reported by 15%, psychosomatic by 19% and psychosocial by 14%. The intercorrelations between 73 biopsychosocial variables revealed nine factors explaining 54.5% of variance for intrapersonal profiles and four factors explaining 59.2% of variance for interpersonal profiles. The Cronbach alphas for reliability ranged from.76 to.83. Three distinct biopsychosocial cluster profiles were found: Cluster 1 (n=290, 27%) loaded positively with the somatic and psychosocial variables, Cluster 2 (n=558, 51%) loaded negatively with the various biopsychosocial symptoms, and Cluster 3 (n=235, 22%) loaded positively with anxiety.

CONCLUSION

Discriminant function analysis confirmed that this cluster solution correctly classified 95.2% of the subjects in a nonpatient multiprofessional population, which supports the biopsychosocial approach also in work life issues.

Plasma concentrations of the flavonoids hesperetin, naringenin and quercetin in human subjects following their habitual diets, and diets high or low in fruit and vegetables

OBJECTIVES

To determine the fasting plasma concentrations of quercetin, hesperetin and naringenin in human subjects consuming their habitual diets, and diets either high or low in fruit and vegetables. To investigate whether plasma concentrations of flavanones can serve as biomarkers of their intake.

DESIGN

This was a cross-over, strictly controlled dietary intervention consisting of a 2 week baseline period, and two 5 week dietary periods with a 3 week wash-out period in between. The low-vegetable diet contained few fruit and vegetables and no citrus fruit. The high-vegetable diet provided various fruits and vegetables daily including on average one glass of orange juice, one-half orange and one-half mandarin.

SUBJECTS

Thirty-seven healthy females.

RESULTS

The high-vegetable diet provided 132 mg of hesperetin and 29 mg of naringenin. The low-vegetable diet contained no flavanones. The mean plasma hesperetin concentration increased from 12.2 nmol/l after the low-vegetable diet to 325 nmol/l after the high-vegetable diet. The respective increase for naringenin was from <73.5 nmol/l for all subjects to a mean value of 112.9 nmol/l. The mean plasma quercetin concentration was 52 nmol/l after the baseline period, during which habitual diets were consumed, and it did not change significantly during the intervention. Interindividual variation in the plasma levels of hesperetin and naringenin was marked and, after the baseline and wash-out periods, and the low-vegetable diet, a majority of the samples had plasma flavanone levels below the limit of detection. After the high-vegetable diet, hesperetin and naringenin were detectable in 54 and 22% of all samples. Quercetin was detectable in nearly all samples after all study periods.

CONCLUSION

Hesperetin, naringenin and quercetin are bioavailable from the diet, but the plasma concentrations of hesperetin and naringenin are poor biomarkers of intake.

Efficacy and pharmacokinetics of enrofloxacin and flunixin meglumine for treatment of cows with experimentally induced Escherichia coli mastitis

The efficacy of flunixin alone and together with enrofloxacin in treatment of experimental Escherichia coli mastitis was compared using six cows. The cross-over study design was used. Pharmacokinetics of flunixin and enrofloxacin were also studied in these diseased cows. The response of each cow was similar after the first and second challenge and the individual reaction seemed to explain the severity of clinical signs. The most important predictive factor for outcome of E. coli mastitis was a heavy drop in milk yield. Treatment with enrofloxacin and flunixin enhanced elimination of bacteria, but the difference from those receiving flunixin alone was not significant. Two cows, which had received no antimicrobial treatment (Group 1), were killed on day 4 postchallenge. One cow was killed after the first and the other after the second challenge. Cows receiving combination therapy produced 0.9 L more milk per day during the study period than cows which had only received flunixin (P < 0.05). Based on our findings, antimicrobial treatment might be beneficial in the treatment of high-yielding cows in early lactation. The absorption of enrofloxacin was delayed after subcutaneous administration, the mean apparent elimination half-life being about 23 h, whereas after i.v. administration elimination t(1/2) was only 1.5 h. The majority of the antimicrobial activity in milk originated from the active metabolite, ciprofloxacin, which could be measured throughout the 120-h follow-up period after the last subcutaneous administration. No differences were present in the pharmacokinetic parameters of flunixin between treatment groups: mean elimination half-life was 5.7-6.2 h, volume of distribution 0.43-0.49 L/kg and clearance 0.13-0.14 L h/kg. No flunixin or merely traces were detected in milk: one of the three cows had a concentration of 0.019 mg/L 8 h after administration.

Endothelial nitric oxide synthase gene Glu298Asp polymorphism and blood pressure, left ventricular mass and carotid artery atherosclerosis in a population-based cohort

OBJECTIVE

Decreased production of endothelial nitric oxide (NO) is associated with different cardiovascular pathology. We studied the association between the Glu298Asp polymorphism of the NO producing gene, endothelial nitric oxide synthase (eNOS), and hypertension, left ventricular mass (LVM) and carotid artery intima-media thickness (IMT) in a population-based cohort of hypertensive and control subjects.

DESIGN

Cross-sectional case-control study.

SETTING

District around Oulu University Hospital, Northern Finland.

SUBJECTS AND METHODS

The study population consisted of 600 middle-aged hypertensive subjects (300 men and 300 women) and 600 controls (300 men and 300 women) living in the City of Oulu. The hypertensive subjects were randomly selected by age stratification from the Social Insurance Institute register for reimbursement of antihypertensive medication. For each hypertensive subject, an age- and sex-matched control was randomly selected from the national health register. The overall participation rate was 87.8%. In the present study a total of 1024 subjects were screened. Echocardiographic examinations were performed by a trained cardiologist and carotid ultrasonographic examinations by a trained radiologist.

RESULTS

The genotype distributions and allele frequencies between the hypertensive and control subjects and the relationship between the Glu298Asp variant and blood pressure, LVM and carotid artery IMT were determined. No differences in genotype distribution or allele frequencies were found between the hypertensive and control groups (the frequency of the Asp allele 0.299 vs. 0.288, respectively). Also, we could not find any association between the eNOS genotype and the measured cardiovascular complications.

CONCLUSIONS

The Glu298Asp variant of the eNOS gene does not seem to be a major risk factor for cardiovascular alterations in the general population.

Polymorphisms of key enzymes in homocysteine metabolism affect diet responsiveness of plasma homocysteine in healthy women

High plasma total homocysteine (tHcy), low dietary intake of folate and other B vitamins, and genetic polymorphisms related to metabolism of homocysteine may interactively contribute to the risk of cardiovascular disease. We investigated whether known mutations in genes regulating homocysteine metabolism affect the responsiveness of serum folate and plasma tHcy to high intake of natural folate from food. Healthy females (n = 37) aged 22-57 y volunteered to participate in a crossover dietary intervention with two 5-wk diet periods (low and high folate diets). Concentrations of serum and RBC folate, serum vitamin B-12 and plasma tHcy were measured at baseline and at the end of each diet period. The prevalences of C677T transition of methylenetetrahydrofolate reductase (MTHFR) gene, 844ins68 of cystathionine beta-synthase (CBS) gene and A2756G mutation of methionine synthase (MS) gene were determined. Compared with the low folate diet, the high folate diet increased the serum folate concentration by 85% (P < 0.001), 77% (P < 0.001) and 55% (P < 0.05) in the subjects with the genotypes C/C (n = 19), C/T (n = 13) and T/T (n = 5), respectively, of the MTHFR gene. Also, the plasma tHcy of the subjects with the genotypes C/C, C/T and T/T was decreased by 11% (P < 0.001), 15% (P < 0.01) and 18% (P < 0.05), respectively, during the high folate diet period. The subjects carrying the G2756 allele of the MS gene (n = 15) had a more extensive reduction (P < 0.05) of plasma tHcy during the high folate diet period than the subjects with the genotype A/A (n = 22). The 844ins68 of CBS gene did not affect plasma tHcy concentrations or diet responsiveness. In conclusion, diet responsiveness of plasma homocysteine may be genetically regulated.

Weight loss reduces expression of SREBP1c/ADD1 and PPARgamma2 in adipose tissue of obese women

Weight loss in obese patients, even if moderate, is clearly beneficial for health and implies a reduction in either adipocyte number or volume. This can be regulated by the key adipose transcription factors, sterol-regulatory-element binding protein-1c/adipocyte differentiation and determination factor-1 (SREBP1c/ADD1), peroxisome proliferator-activated receptor-gamma2 (PPARgamma2) and CCAAT-enhancer binding protein-alpha (C/EBPalpha). which regulate the adipocyte metabolism and differentiation process. The present study was undertaken to obtain insights into the expression of these transcription factors during moderate weight loss in humans. In addition, the adipose depot-related differences and the relation to adipose lipoprotein lipase (LPL) expression and plasma lipids were studied. Using quantitative reverse transcription polymerase chain reaction (RT-PCR), the total amount of each adipose transcription factor messenger ribonucleic acid (mRNA) was determined in the subcutaneous or omental adipose tissue after a controlled, 2-month, bodyweight-reduction trial in 11 obese middle-aged women and 17 comparable obese controls. Weight loss (6% of body weight) was associated with reduced serum insulin and plasma triacylglycerols. Adipose tissue PPARgamma2 and SREBP1c/ADD1 mRNA were lower in the weight-loss group than in controls (by 30% and 28%, respectively), whereas the C/EBPalpha mRNA level did not change. Moreover, PPARgamma2 mRNA was lower only in the subcutaneous adipose depot and was related to both adipose tissue lipoprotein lipase (LPL) mRNA and improvement in plasma triacylglycerols in the weight-loss group. Our results suggest a functional role for SREBP1c/ADD1 and PPARgamma2 in the control of energy metabolism in human adipose tissue.

Apolipoprotein B gene polymorphisms and serum lipids: meta-analysis of the role of genetic variation in responsiveness to diet

BACKGROUND

The genetic variance determining plasma lipid and lipoprotein concentrations may modify individual responsiveness to alterations in dietary fat and cholesterol content.

OBJECTIVE

The aim was to examine the role of apolipoprotein (apo) B DNA polymorphisms in responsiveness of plasma lipids and lipoproteins to diet.

DESIGN

A controlled dietary intervention study was conducted in 44 healthy, middle-aged subjects with a 3-mo baseline, a 1-mo fat-controlled, a 1-mo high-fat, and a 1-mo habitual diet period. We also conducted a meta-analysis of all published dietary trials, including our own.

RESULTS

In our own dietary study, the apo B XbaI restriction-site polymorphism affected the responsiveness to diet of the plasma LDL-cholesterol concentration (P < 0.05, repeated-measures analysis of variance). Especially during the high-fat diet, homozygous absence of the XbaI restriction site (X(-)/X(-)) was associated with a greater increase in LDL cholesterol (44 +/- 5%) than was X(+)/X(+) (27 +/- 7%) or X(+)/X(-) (40 +/- 5%). The high-fat diet also induced a larger increase in plasma LDL cholesterol in subjects with the R(-)/R(-) genotype (homozygous absence of the EcoRI restriction site) (59 +/- 10%) than in those with the R(+)/R(-) (39 +/- 6%) or R(+)/R(+) (36 +/- 4%) genotype. The M(+)/M(+) genotype (homozygous presence of the MspI restriction site) was also more responsive (41 +/- 3% increase in LDL cholesterol) than the M(+)/M(-) genotype (27 +/- 10% increase). The meta-analysis supported the finding of the significant role of the EcoRI and MspI polymorphisms, but not that of the XbaI polymorphism.

CONCLUSIONS

The present study indicated that the apo B EcoRI and MspI polymorphisms are associated with responsiveness to diet.

A link between the epidemic of ectopic pregnancy and the "baby-boom" cohort

In order to demonstrate the detailed profile of the recent epidemic of ectopic pregnancy and the subsequent decrease of the disease, the authors analyzed the changes in 5-year age groups and by 5-year age cohorts in Finland. The results describe a link between the epidemic of ectopic pregnancy and the so-called "baby boom" cohort (from 1945 to 1954) in the 1970s and 1980s, when these large age groups were in their most fertile period. The authors conclude, through its risk factors, that ectopic pregnancy is strongly correlated with age and that it exemplifies how the changes caused by large age groups play a role in the rise and fall in occurrence of certain diseases.

Expression of interleukin-6 (IL-6) receptor gene in acute myeloblastic leukemia and response of leukemic cells to exogenous IL-6. A comparative study between cell line cells and corresponding native cells

As interleukin (IL-6) ahs been reported to have diverse effects on acute myeloblastic leukemia (AML) blast cell growth, we investigated whether the level of IL-6 receptor (IL-6R) expression by blast cells is associated with their susceptibility to proliferate in response to exogenous IL-6. For absolute quantification of IL-6R transcript numbers, we established a quantitative IL-6R reverse transcription polymerase chain reaction (RT-PCR) method with an internal RNA standard. In the present work, two types of AML blast cells were investigated, namely autonomously growing cell line cells (n = 8) and non cultured native blast cells (n = 20), including those from which the cell lines originate. The native blast cells expressed an average of 2.8 x 10(7) +/- 1.9 x 10(7) IL-6R transcripts in one microgram of total cellular RNA, whereas the expression by the cell line cells was significantly more abundant, the value being 8.3 x 10(7) +/- 2.8 X 10(7) (P < 0.001). The proliferation responses were evaluated by exposing the cells to IL-6 (1000 U/ml) in a clonogenic cell culture assay and, in the case of the cell line cells, in a long-term suspension culture assay as well. None of the autonomously growing cell lines responded to exogenous IL-6, whereas the native blast cell showed either stimulatory, inhibitory or neutral responses. Thus, the IL-6R expression level did not predict whether the cells proliferated in response to exogenous IL-6, which shows that IL-6R quantification cannot be used as a screening test prior to possibly applying this cytokine to clinical use in AML therapy.

Tubal patency and fertility outcome after expectant management of ectopic pregnancy

OBJECTIVE

To study tubal patency and fertility outcome of patients with expectantly managed ectopic pregnancy (EP).

DESIGN

A prospective study.

SETTING

Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland.

PATIENT(S)

Thirty patients who wanted to become pregnant again were treated successfully by expectant management of EP.

INTERVENTION(S)

Patients were examined with posttreatment hysterosalpingography, and they filled out a questionnaire about their subsequent pregnancies.

MAIN OUTCOME MEASURE(S)

Free passage through open lumen showing tubal patency; number of full-term pregnancies and EPs revealing relative rate of subsequent fertility.

RESULT(S)

A free passage through the diseased tube was seen in 93% of the cases (28 of 30). Two of the 24 patients (8.4%) who wanted to become pregnant had an obstruction in the diseased tube. One (4.2%) of them had a normal opposite tube and later had a normal pregnancy. The other (4.2%) had an obstruction in both tubes and subsequently had a repeat EP. One of the 6 patients had an EP (this patient did not want to become pregnant and did not use contraception). However, her posttreatment hysterosalpingography was normal. In total, the subsequent pregnancy rate was 88% (21 of 24), and the rate of repeat EP was 4.2% (1 of 24).

CONCLUSION(S)

Patients who are treated with expectant management have a good long-term fertility outcome. Spontaneous regression of EP does not lead to increased harm or damage to the tube, i.e., the risk for repeat EP is low.

Laparoscopic instillation of hyperosmolar glucose vs. expectant management of tubal pregnancies with serum hCG < or = 2500 mIU/mL

OBJECTIVE

To compare expectant management with local instillation of 50% glucose solution for tubal pregnancies with a serum hCG level < or = 2500 mIU/mL.

DESIGN

Prospective, non-randomized, comparative clinical study.

SETTING

Two university departments.

PATIENTS

One hundred and twenty-eight patients with laparoscopically-confirmed tubal pregnancy and serum hCG < or = 2500 mIU/mL.

INTERVENTIONS

Eighty patients in Graz were treated with laparoscopic instillation of 50% glucose solution and 48 patients in Turku were followed expectantly.

MAIN OUTCOME MEASURES

Resolution of hCG excretion, need for further interventions.

RESULTS

Seventy-four of the 80 patients (92%) in the glucose group (32 of 33 with an initial hCG < or = 250 mIU/mL and 42 of 47 with hCG 251-2500 mIU/mL) and 36 of 48 (75%) patients in the expectant group (19 of 23 with an initial hCG < or = 250 mIU/mL and 17 of 25 with hCG 251-2500 mIU/mL) had resolution of the pregnancy with no further intervention (p=0.008, chi-square test, odds ratio 0.24).

CONCLUSIONS

Glucose instillation is superior to expectant management for patients with early tubal pregnancy.

The effect of sour milk as a postmilking teat dip for mastitis prevention in a dairy herd

In a preliminary in vitro study, the growth of Staphylococcus aureus was totally inhibited during incubation for 24 h at 35 degrees C-37 degrees C in a solution of cooked commercial milk with 1% of uncooked commercial sour milk ("A piimä"). In a subsequent clinical trial, "A piimä" sour milk with 5% glycerol was used as a postmilking teat dip from February to June. Quarterly milk samples were drawn once a month aseptically from 133 cows. Percentages of pathogen positive samples and somatic cell count (SCC) from teats dipped with the sour milk were compared with those dipped with a commercial iodine teat dip and those of undipped controls. During March-June there were fewer isolations of S. aureus (2.09%) and coagulase-negative staphylococci (2.52%) in the sour-milk group than in the control group (3.09% and 4.07%, respectively). In iodine group, there were fewer isolations of S. aureus (0.83%) but more isolations of coagulase-negative staphylococci (5.26%) than in the control group. During the study period, the percentages of bacterial isolates did not differ statistically significantly between treatments, p = 0.291. The percentage of quarters with a SCC over 125,000 at the end of the study was one third lower in the sour-milk group than in the control group (16.67% and 26.23% respectively) but the difference was not statistically significant (p = 0.074). The results indicate that a sour-milk teat-dip preparation can inhibit new intra mammary infections (IMI).

Apolipoprotein E phenotype and diet-induced alteration in blood pressure

The purpose of the study was to answer the following two questions. First, are the diet-induced changes in the plasma cholesterol concentration associated with a change in blood pressure? Second, is the possible diet-induced change in blood pressure related to the apolipoprotein E (apo E) phenotype? Two hundred employees of our hospital volunteered and among those, 23 subjects with the apo E3 (E3,3) and 21 with the apo E4 phenotype (E4,3 or 4,4) were selected. The apo E groups were age- and sex-matched. Study subjects were healthy, had normal body weights, and their mean (+/-SD) age was 37.9 +/- 7.7 y. The total energy derived from dietary fat was 37%, 26%, and 38% during the baseline, low-fat, and high-fat diet periods, respectively. The two intervention diets were consumed by the study subjects for 4 wk at a time. During the trial blood pressure was measured once a week with an automatic device under standardized conditions. Systolic, diastolic, and mean arterial pressures were significantly reduced during the low-fat diet period compared with baseline, but not compared with the high-fat diet period among the apo E4 subjects only (-6%, -4.5%, and -6%, respectively). The high-fat diet was associated with elevation of blood pressure among 70% of study subjects. A slight but significant positive correlation was noted between the plasma total cholesterol concentration and blood pressure, more so among the apo E4 subjects. Furthermore, age was correlated with blood pressure response in apo E4 subjects. In conclusion, both the systolic and diastolic blood pressures were significantly altered during the different diet periods. The dietary response of blood pressure seemed to differ between subjects with the apo E4 and those with the apo E3 phenotype.

Ethanol-induced redistribution of cholesteryl ester transfer protein (CETP) between lipoproteins

Since alcohol drinking reduces the concentration and activity of plasma cholesteryl ester transfer protein (CETP), we investigated the effects of alcohol on its synthesis and secretion by perfusing rabbit livers for 4 hours in the absence or presence of ethanol. The quantity of CETP mRNA in the perfused livers did not differ between the control and ethanol (25 mmol/L or 50 mmol/L) perfusions. CETP activity was determined by incubating [3H]cholesteryl ester-labeled human LDL and unlabeled human HDL with the perfusion medium after removing the endogenous VLDL (secreted by the perfused liver) by ultracentrifugation. CETP activity in the perfusion medium increased at a linear rate that was not affected by ethanol. When the VLDL was removed by precipitation with polyethylene glycol or a heparin-Sepharose column instead of ultracentrifugation, practically no CETP activity was detected in the ethanol perfusions, whereas these procedures did not affect CETP activity in the control perfusions. Inhibition of ethanol oxidation by 4-methylpyrazole resulted in CETP activity similar to that of the controls. We conclude that ethanol does not affect the synthesis or secretion of CETP, but its oxidation may alter the distribution of CETP in lipoproteins. CETP seems to be present in VLDL as well as in HDL, and since VLDL is more rapidly catabolized with HDL, this may explain the low plasma CETP concentration associated with alcohol consumption.

The effect of sour milk as a postmilking teat dip for mastitis prevention in a dairy herd

In a preliminary in vitro study, the growth of Staphylococcus aureus was totally inhibited during incubation for 24 h at 35 degrees C-37 degrees C in a solution of cooked commercial milk with 1% of uncooked commercial sour milk ("A piimä"). In a subsequent clinical trial, "A piimä" sour milk with 5% glycerol was used as a postmilking teat dip from February to June. Quarterly milk samples were drawn once a month aseptically from 133 cows. Percentages of pathogen positive samples and somatic cell count (SCC) from teats dipped with the sour milk were compared with those dipped with a commercial iodine teat dip and those of undipped controls. During March-June there were fewer isolations of S. aureus (2.09%) and coagulase-negative staphylococci (2.52%) in the sour-milk group than in the control group (3.09% and 4.07%, respectively). In iodine group, there were fewer isolations of S. aureus (0.83%) but more isolations of coagulase-negative staphylococci (5.26%) than in the control group. During the study period, the percentages of bacterial isolates did not differ statistically significantly between treatments, p = 0.291. The percentage of quarters with a SCC over 125,000 at the end of the study was one third lower in the sour-milk group than in the control group (16.67% and 26.23% respectively) but the difference was not statistically significant (p = 0.074). The results indicate that a sour-milk teat-dip preparation can inhibit new intra mammary infections (IMI).

Clinical and CT correlates in the diagnosis of intracranial tumours

The correlation between clinical and CT findings in cerebral tumours was prospectively studied in 1191 consecutive referrals for cerebral CT. CT revealed a mass lesion in 51 cases (4.3%): 32 neoplasms, five haematomas and one abscess. The diagnostic specificity of CT for neoplasmic tumours was 86% (32 of 37). The clinical suspicion of a cerebral neoplasm was correct in 25 cases (78%) and the clinical localisatory hypothesis was correct in 20 cases (63%) of the neoplasms. A cerebral tumour was found in 5% (11 out of 226) of patients investigated for their first seizure and in 1% (two of 207) investigated for headache without clinical signs.

Magnitude of dietary effects on plasma cholesterol concentration: role of sex and apolipoprotein E phenotype

The effects of fat-controlled, low-cholesterol and high-fat, high-cholesterol diets pursued for 4 weeks on plasma lipids and lipoproteins were studied in 44 healthy middle-aged subjects (22 women and 22 men). All the calories were supplied from the hospital kitchen. When the subjects were switched from the fat-controlled, low-cholesterol diet to the high-fat, high-cholesterol diet the average increase in total cholesterol was 1.2 mmol/l (28%), ranging from 0.2 to 2.7 mmol/l (4-56%). At the same time the average increase in LDL cholesterol was 1.0 mmol/l (39%), ranging from 0.1 to 2.4 mmol/l (3-90%). Interestingly, the men responded to the dietary changes more sensitively than the women. The increase in total cholesterol from the low-fat to the high-fat diet was 31% for the men and 25% for the women (P less than 0.05), the corresponding increases in LDL cholesterol being 42% and 37%, respectively (P less than 0.05). A marked increase in HDL cholesterol was observed when the subjects were switched from the low-fat to the high-fat diet, the increase being 30% for the men and 20% for the women. The absolute and percentage lipid changes on the two diets were equal in the subjects with the common apolipoprotein E phenotype 3/3 and in those homozygous and heterozygous for the epsilon 4 allele (E4/4 and E4/3).(ABSTRACT TRUNCATED AT 250 WORDS)

Childlessness in Helsinki

Childlessness in Finland is analyzed using data collected by questionnaire from 4,730 women living in Helsinki who participated in a cervical cancer screening program in 1981-1982. "About half (48%) of the women aged 30 had no children. In the age group of 35 years, 28% were nulliparous as were 24% of the women aged 40."

Neutralizing antibodies to bovine herpesvirus 1 in reindeer

Serum samples from cattle and reindeer in Lapland were examined for neutralizing antibodies to the IBR/IPV virus. All the bovine sera tested were negative. The reindeer sera were tested using 2 different virus neutralization methods differing in the serum-virus incubation time prior to inoculation into tissue culture tubes. 12.6 % of the samples tested with a preincubation of 1 h at 37°C were positive, whereas 23 % of those tested with a preincubation time of 24 h at 37°C were positive. The fairly high prevalence of antibodies to IBR/IPV in the reindeer population in Finland indicates the occurrence of the IBR/IPV virus or a closely related cross-reacting herpesvirus.

Hazards involved in the use of furazolidone for the prevention of salmonellosis in broiler chickens

The purpose of this work was to study the effects of interrupted, continuous and post-salmonella inoculation treatment with furazolidone in the feed on the colonization of Salmonella infantis in the intestines of chickens, as well as the influence of furazolidone in vitro on the effect of a mixed culture used for the prevention of salmonellosis in chickens.It was shown that chickens given interrupted treatment with 0.01% furazolidone had significantly more salmonellas in the caeca than either chickens fed continuously with this drug or chickens without any treatment. The use of 0.01% furazolidone after inoculation with Salmonella infantis had no effect on Salmonella infantis in the caeca of chickens.The mixed bacterial culture from the normal intestinal flora lost its preventive effect on salmonellosis when cultured with 0.01% furazolidone.