Dose-dependent relationship between nocturnal gastroesophageal reflux and chronic rhinosinusitis in a middle-aged population: results from the SCAPIS pilot

BACKGROUND

Gastroesophageal reflux (GER) has been associated with several upper- and lower-airway diseases. It would be plausible if nightly occurring reflux via laryngopharyngeal reflux (LPR) might affect the upper airways. Still, the role of nocturnal gastroesophageal reflux (nGER) in chronic rhinosinusitis (CRS) is not fully established. The aim of this population-based study was to investigate the association between nGER and CRS.

METHODOLOGY

This cross-sectional population-based study comprises 1,111 randomly selected subjects from Gothenburg, Sweden, aged 50-64 years. The study is based on self-reported validated questionnaires. CRS was defined according to EPOS criteria. nGER was reported in relation to frequency.

RESULTS

CRS was more common among subjects with nGER than in those without (13 vs. 4.8%). There was a dose-response association between the frequency of nGER episodes and the risk of having CRS. In the logistic regression adjusted for (age, sex, BMI, educational level, smoking, and asthma). CRS was associated with nGER, OR 1.43 and the odds ratio increased if episodes were reported "almost every night", OR 4.6.

CONCLUSIONS

The study shows an association between nocturnal GER and CRS in a middle-aged population. The revealed dose dependency supports, though does not prove causality.

Modeling vitamin B1 transfer to consumers in the aquatic food web

Vitamin B1 is an essential exogenous micronutrient for animals. Mass death and reproductive failure in top aquatic consumers caused by vitamin B1 deficiency is an emerging conservation issue in Northern hemisphere aquatic ecosystems. We present for the first time a model that identifies conditions responsible for the constrained flow of vitamin B1 from unicellular organisms to planktivorous fishes. The flow of vitamin B1 through the food web is constrained under anthropogenic pressures of increased nutrient input and, driven by climatic change, increased light attenuation by dissolved substances transported to marine coastal systems. Fishing pressure on piscivorous fish, through increased abundance of planktivorous fish that overexploit mesozooplankton, may further constrain vitamin B1 flow from producers to consumers. We also found that key ecological contributors to the constrained flow of vitamin B1 are a low mesozooplankton biomass, picoalgae prevailing among primary producers and low fluctuations of population numbers of planktonic organisms.

Source apportionment of circum-Arctic atmospheric black carbon from isotopes and modeling

Black carbon (BC) contributes to Arctic climate warming, yet source attributions are inaccurate due to lacking observational constraints and uncertainties in emission inventories. Year-round, isotope-constrained observations reveal strong seasonal variations in BC sources with a consistent and synchronous pattern at all Arctic sites. These sources were dominated by emissions from fossil fuel combustion in the winter and by biomass burning in the summer. The annual mean source of BC to the circum-Arctic was 39 ± 10% from biomass burning. Comparison of transport-model predictions with the observations showed good agreement for BC concentrations, with larger discrepancies for (fossil/biomass burning) sources. The accuracy of simulated BC concentration, but not of origin, points to misallocations of emissions in the emission inventories. The consistency in seasonal source contributions of BC throughout the Arctic provides strong justification for targeted emission reductions to limit the impact of BC on climate warming in the Arctic and beyond.

ERα expression in T lymphocytes is dispensable for estrogenic effects in bone

Estrogen treatment has positive effects on the skeleton, and we have shown that estrogen receptor alpha (ERα) expression in cells of hematopoietic origin contributes to a normal estrogen treatment response in bone tissue. T lymphocytes are implicated in the estrogenic regulation of bone mass, but it is not known whether T lymphocytes are direct estrogen target cells. Therefore, the aim of this study was to determine the importance of ERα expression in T lymphocytes for the estrogenic regulation of the skeleton using female mice lacking ERα expression specifically in T lymphocytes (Lck-ERα^-/-) and ERα^flox/flox littermate (control) mice. Deletion of ERα expression in T lymphocytes did not affect bone mineral density (BMD) in sham-operated Lck-ERα^-/- compared to control mice, and ovariectomy (ovx) resulted in a similar decrease in BMD in control and Lck-ERα^-/- mice compared to sham-operated mice. Furthermore, estrogen treatment of ovx Lck-ERα^-/- led to an increased BMD that was indistinguishable from the increase seen after estrogen treatment of ovx control mice. Detailed analysis of both the appendicular (femur) and axial (vertebrae) skeleton showed that both trabecular and cortical bone parameters responded to a similar extent regardless of the presence of ERα in T lymphocytes. In conclusion, ERα expression in T lymphocytes is dispensable for normal estrogenic regulation of bone mass in female mice.

Interleukin 4 induces apoptosis of acute myeloid leukemia cells in a Stat6-dependent manner

Cytokines provide signals that regulate immature normal and acute myeloid leukemia (AML) cells in the bone marrow microenvironment. We here identify interleukin 4 (IL4) as a selective inhibitor of AML cell growth and survival in a cytokine screen using fluorescently labeled AML cells. RNA-sequencing of the AML cells revealed an IL4-induced upregulation of Stat6 target genes and enrichment of apoptosis-related gene expression signatures. Consistent with these findings, we found that IL4 stimulation of AML cells induced Stat6 phosphorylation and that disruption of Stat6 using CRISPR/Cas9-genetic engineering rendered cells partially resistant to IL4-induced apoptosis. To evaluate whether IL4 inhibits AML cells in vivo, we expressed IL4 ectopically in AML cells transplanted into mice and also injected IL4 into leukemic mice; both strategies resulted in the suppression of the leukemia cell burden and increased survival. Notably, IL4 exposure caused reduced growth and survival of primary AML CD34⁺CD38^- patient cells from several genetic subtypes of AML, whereas normal stem and progenitor cells were less affected. The IL4-induced apoptosis of AML cells was linked to Caspase-3 activation. Our results demonstrate that IL4 selectively induces apoptosis of AML cells in a Stat6-dependent manner-findings that may translate into new therapeutic opportunities in AML.

Using accelerometry to quantify prey attack and handling behaviours in piscivorous pike Esox lucius

Accelerometer technology was used to evaluate behaviours in the teleost ambush predator pike Esox lucius foraging on crucian carp Carassius carassius. Automated rule-based estimates of prey-size determined handling time were obtained and are compared with video-recorded behaviours. Solutions to tag attachment and the limitations imposed by battery-time and data-logging capacities are evaluated.

Allochthonous matter: an important factor shaping the phytoplankton community in the Baltic Sea

It is well-known that nutrients shape phytoplankton communities in marine systems, but in coastal waters allochthonous dissolved organic matter (ADOM) may also be of central importance. We studied how humic substances (proxy of ADOM) and other variables influenced the nutritional strategies, size structure and pigment content of the phytoplankton community along a south-north gradient in the Baltic Sea. During the summer, the proportion of mixotrophs increased gradually from the phosphorus-rich south to the ADOM-rich north, probably due to ADOM-fueled microbes. The opposite trend was observed for autotrophs. The chlorophyll a (Chl a): carbon (C) ratio increased while the levels of photoprotective pigments decreased from south to north, indicating adaptation to the darker humic-rich water in the north. Picocyanobacteria dominated in phosphorus-rich areas while nanoplankton increased in ADOM-rich areas. During the winter-spring the phytoplankton biomass and concentrations of photoprotective pigments were low, and no trends with respect to autotrophs and mixotrophs were observed. Microplankton was the dominant size group in the entire study area. We conclude that changes in the size structure of the phytoplankton community, the Chl a:C ratio and the concentrations of photoprotective pigments are indicative of changes in ADOM, a factor of particular importance in a changing climate.

The sources of atmospheric black carbon at a European gateway to the Arctic

Black carbon (BC) aerosols from incomplete combustion of biomass and fossil fuel contribute to Arctic climate warming. Models-seeking to advise mitigation policy-are challenged in reproducing observations of seasonally varying BC concentrations in the Arctic air. Here we compare year-round observations of BC and its δ(13)C/Δ(14)C-diagnosed sources in Arctic Scandinavia, with tailored simulations from an atmospheric transport model. The model predictions for this European gateway to the Arctic are greatly improved when the emission inventory of anthropogenic sources is amended by satellite-derived estimates of BC emissions from fires. Both BC concentrations (R(2)=0.89, P<0.05) and source contributions (R(2)=0.77, P<0.05) are accurately mimicked and linked to predominantly European emissions. This improved model skill allows for more accurate assessment of sources and effects of BC in the Arctic, and a more credible scientific underpinning of policy efforts aimed at efficiently reducing BC emissions reaching the European Arctic.

Structural circular birefringence and dichroism quantified by differential decomposition of spectroscopic transmission Mueller matrices from Cetonia aurata

Transmission Mueller-matrix spectroscopic ellipsometry is applied to the cuticle of the beetle Cetonia aurata in the spectral range 300-1000 nm. The cuticle is optically reciprocal and exhibits circular Bragg filter features for green light. By using differential decomposition of the Mueller matrix, the circular and linear birefringence as well as dichroism of the beetle cuticle are quantified. A maximum value of structural optical activity of 560°/mm is found.

Allochthonous Carbon--a Major Driver of Bacterioplankton Production in the Subarctic Northern Baltic Sea

Heterotrophic bacteria are, in many aquatic systems, reliant on autochthonous organic carbon as their energy source. One exception is low-productive humic lakes, where allochthonous dissolved organic matter (ADOM) is the major driver. We hypothesized that bacterial production (BP) is similarly regulated in subarctic estuaries that receive large amounts of riverine material. BP and potential explanatory factors were measured during May-August 2011 in the subarctic Råne Estuary, northern Sweden. The highest BP was observed in spring, concomitant with the spring river-flush and the lowest rates occurred during summer when primary production (PP) peaked. PLS correlations showed that ∼60% of the BP variation was explained by different ADOM components, measured as humic substances, dissolved organic carbon (DOC) and coloured dissolved organic matter (CDOM). On average, BP was threefold higher than PP. The bioavailability of allochthonous dissolved organic carbon (ADOC) exhibited large spatial and temporal variation; however, the average value was low, ∼2%. Bioassay analysis showed that BP in the near-shore area was potentially carbon limited early in the season, while BP at seaward stations was more commonly limited by nitrogen-phosphorus. Nevertheless, the bioassay indicated that ADOC could contribute significantly to the in situ BP, ∼60%. We conclude that ADOM is a regulator of BP in the studied estuary. Thus, projected climate-induced increases in river discharge suggest that BP will increase in subarctic coastal areas during the coming century.

Effects of predicted climatic changes on distribution of organic contaminants in brackish water mesocosms

Predicted consequences of future climate change in the northern Baltic Sea include increases in sea surface temperatures and terrestrial dissolved organic carbon (DOC) runoff. These changes are expected to alter environmental distribution of anthropogenic organic contaminants (OCs). To assess likely shifts in their distributions, outdoor mesocosms were employed to mimic pelagic ecosystems at two temperatures and two DOC concentrations, current: 15°C and 4 mg DOCL(-1) and, within ranges of predicted increases, 18°C and 6 mg DOCL(-1), respectively. Selected organic contaminants were added to the mesocosms to monitor changes in their distribution induced by the treatments. OC partitioning to particulate matter and sedimentation were enhanced at the higher DOC concentration, at both temperatures, while higher losses and lower partitioning of OCs to DOC were observed at the higher temperature. No combined effects of higher temperature and DOC on partitioning were observed, possibly because of the balancing nature of these processes. Therefore, changes in OCs' fates may largely depend on whether they are most sensitive to temperature or DOC concentration rises. Bromoanilines, phenanthrene, biphenyl and naphthalene were sensitive to the rise in DOC concentration, whereas organophosphates, chlorobenzenes (PCBz) and polychlorinated biphenyls (PCBs) were more sensitive to temperature. Mitotane and diflufenican were sensitive to both temperature and DOC concentration rises individually, but not in combination.

Circulating prolactin and breast cancer risk among pre- and postmenopausal women in the EPIC cohort

BACKGROUND

Experimental and epidemiological evidence suggests that prolactin might play a role in the etiology of breast cancer. We analyzed the relationship of prediagnostic circulating prolactin levels with the risk of breast cancer by menopausal status, use of postmenopausal hormone replacement therapy (HRT) at blood donation, and by estrogen and progesterone receptor status of the breast tumors.

PATIENTS AND METHODS

Conditional logistic regression was used to analyze the data from a case-control study nested within the prospective European EPIC cohort, including 2250 invasive breast cancer and their matched control subjects.

RESULTS

Statistically significant heterogeneity in the association of prolactin levels with breast cancer risk between women who were either pre- or postmenopausal at the time of blood donation was observed (Phet = 0.04). Higher serum levels of prolactin were associated with significant increase in the risk of breast cancer among postmenopausal women [odds ratio (OR)Q4-Q1 = 1.29 (95% confidence interval, CI, 1.05-1.58), Ptrend = 0.09]; however, this increase in risk seemed to be confined to women who used postmenopausal HRT at blood donation [ORQ4-Q1 = 1.45 (95% CI 1.08-1.95), Ptrend = 0.01], whereas no statistically significant association was found for the non-users of HRT [ORQ4-Q1 = 1.11 (95%CI 0.83-1.49), Ptrend = 0.80] (Phet = 0.08). Among premenopausal women, a statistically non-significant inverse association was observed [ORQ4-Q1 = 0.70 (95% CI 0.48-1.03), Ptrend = 0.16]. There was no heterogeneity in the prolactin-breast cancer association by hormone receptor status of the tumor.

CONCLUSION

Our study indicates that higher circulating levels of prolactin among the postmenopausal HRT users at baseline may be associated with increased breast cancer risk.

Francisella tularensis subspecies holarctica occurs in Swedish mosquitoes, persists through the developmental stages of laboratory-infected mosquitoes and is transmissible during blood feeding

In Sweden, mosquitoes are considered the major vectors of the bacterium Francisella tularensis subsp. holarctica, which causes tularaemia. The aim of this study was to investigate whether mosquitoes acquire the bacterium as aquatic larvae and transmit the disease as adults. Mosquitoes sampled in a Swedish area where tularaemia is endemic (Örebro) were positive for the presence of F. tularensis deoxyribonucleic acid throughout the summer. Presence of the clinically relevant F. tularensis subsp. holarctica was confirmed in 11 out of the 14 mosquito species sampled. Experiments performed using laboratory-reared Aedes aegypti confirmed that F. tularensis subsp. holarctica was transstadially maintained from orally infected larvae to adult mosquitoes and that 25% of the adults exposed as larvae were positive for the presence of F. tularensis-specific sequences for at least 2 weeks. In addition, we found that F. tularensis subsp. holarctica was transmitted to 58% of the adult mosquitoes feeding on diseased mice. In a small-scale in vivo transmission experiment with F. tularensis subsp. holarctica-positive adult mosquitoes and susceptible mice, none of the animals developed tularaemia. However, we confirmed that there was transmission of the bacterium to blood vials by mosquitoes that had been exposed to the bacterium in the larval stage. Taken together, these results provide evidence that mosquitoes play a role in disease transmission in part of Sweden where tularaemia recurs.

Impacts of elevated terrestrial nutrient loads and temperature on pelagic food-web efficiency and fish production

Both temperature and terrestrial organic matter have strong impacts on aquatic food-web dynamics and production. Temperature affects vital rates of all organisms, and terrestrial organic matter can act both as an energy source for lower trophic levels, while simultaneously reducing light availability for autotrophic production. As climate change predictions for the Baltic Sea and elsewhere suggest increases in both terrestrial matter runoff and increases in temperature, we studied the effects on pelagic food-web dynamics and food-web efficiency in a plausible future scenario with respect to these abiotic variables in a large-scale mesocosm experiment. Total basal (phytoplankton plus bacterial) production was slightly reduced when only increasing temperatures, but was otherwise similar across all other treatments. Separate increases in nutrient loads and temperature decreased the ratio of autotrophic:heterotrophic production, but the combined treatment of elevated temperature and terrestrial nutrient loads increased both fish production and food-web efficiency. CDOM: Chl a ratios strongly indicated that terrestrial and not autotrophic carbon was the main energy source in these food webs and our results also showed that zooplankton biomass was positively correlated with increased bacterial production. Concomitantly, biomass of the dominant calanoid copepod Acartia sp. increased as an effect of increased temperature. As the combined effects of increased temperature and terrestrial organic nutrient loads were required to increase zooplankton abundance and fish production, conclusions about effects of climate change on food-web dynamics and fish production must be based on realistic combinations of several abiotic factors. Moreover, our results question established notions on the net inefficiency of heterotrophic carbon transfer to the top of the food web.

Fast determination of antibiotics in whole blood

There is a need for analytical methods capable of monitoring blood antibiotic levels in real time. Here we present a method for quantifying antibiotic levels in whole blood that does not require any sample pretreatment. The tests employ the enzyme penicillinase to assay for penicillin G, penicillin V and ampicillin using a flow-injected biosensor, the Enzyme Thermistor. Optimal flow rates, sample volumes and pH were determined to be 0.5 mL/min, 100 μL and 7.0, respectively. Analysis of the antibiotics diluted in buffer gave a linear range of 0.17-5.0 mM. Calibration curves prepared using blood spiked with the antibiotics gave a linear range of 0.17-2.0 mM. Linear regression values for all of the calibration curves were 0.998 or higher. Assay cycle time was 5 min. The relative standard deviation value for 100 determinations of a mock blood sample spiked with penicillin G was 6.71%. Despite the elimination of sample pretreatment, no detectable clogging or signal drift was observed. The assay provides a fast, simple, reliable analytical method for determining antibiotic concentrations in blood without the need for any sample pretreatment. This is an important first step towards developing a device capable of real-time monitoring of antibiotic levels in whole blood. The technology has the potential to significantly improve the outcomes of patients undergoing critical care.

Nutritional status and health care costs for the elderly living in municipal residential homes--an intervention study

OBJECTIVE

The aim was to study the effect of individualised meals on nutritional status among older people living in municipal residential homes and to compare the results with a control group. An additional aim was to estimate direct health care costs for both groups.

SETTING

Six different municipal residential homes in the south-east of Sweden.

PARTICIPANTS

Older people living in three residential homes constituted the intervention group n=42 and the rest constituted the control group n=67.

INTERVENTION

A multifaceted intervention design was used. Based on an interview with staff a tailored education programme about nutritional care, including both theoretical and practical issues, was carried through to staff in the intervention group. Nutritional status among the elderly was measured by Mini Nutritional Assessment (MNA), individualised meals were offered to the residents based on the results of the MNA. Staff in the control group only received education on how to measure MNA and the residents followed the usual meal routines.

MEASUREMENTS

Nutritional status was measured by MNA at baseline and after 3 months. Cost data on health care visits during 2007 were collected from the Cost Per Patient database.

RESULTS

Nutritional status improved and body weight increased after 3 months in the intervention group. Thus, primary health care costs constituted about 80% of the total median cost in the intervention group and about 55% in the control group.

CONCLUSION

With improved knowledge the staff could offer the elderly more individualised meals. One of their future challenges is to recognise and assess nutritional status among this group. If malnutrition could be prevented health care costs should be reduced.

The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care

RATIONALE, AIMS AND OBJECTIVES

The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC).

METHOD

The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured.

RESULTS

The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome.

CONCLUSIONS

Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

Endothelin-mediated gut microcirculatory dysfunction during porcine endotoxaemia

BACKGROUND

The potent vasoconstrictor endothelin-1 has been implicated in the pathogenesis of the microcirculatory dysfunction seen in sepsis. The mixed endothelin receptor antagonist tezosentan and the selective endothelin A-receptor antagonist TBC3711 were used to investigate the importance of the different endothelin receptors in modulating splanchnic regional blood flow and microvascular blood flow in endotoxaemia.

METHODS

Eighteen anaesthetized pigs were i.v. infused with endotoxin (Escherichia coli lipopolysaccharide, serotype 0111:b4) for 300 min. After 120 min, six animals received tezosentan and six animals received TBC3711. Six animals served as endotoxin-treated controls. Laser Doppler flowmetry was used to measure microcirculatory blood flow in the liver and ileum. Superior mesenteric artery flow (SMA(FI)) and portal vein flow (PV(FI)) were measured with ultrasonic flow probes, and air tonometry was used to measure Pco₂ in the ileal mucosa.

RESULTS

TBC3711 did not improve splanchnic regional blood flow or splanchnic microvascular blood flow compared with endotoxin-treated controls. Tezosentan increased PV(FI) (P<0.05), but SMA(FI) was not improved compared with the other groups. In the tezosentan group, microvascular blood flow in the ileal mucosa (MCQ(muc)) improved and mucosal-arterial Pco₂ gap decreased (P<0.05 for both) compared with endotoxin-treated controls and the TBC3711 group.

CONCLUSIONS

Tezosentan improved MCQ(muc) without any concomitant increase in SMA(FI), implying a direct positive effect on the microcirculation. TBC3711 was not effective in improving regional splanchnic blood flow or splanchnic microvascular blood flow. Dual endothelin receptor antagonism was necessary to improve MCQ(muc), indicating a role for the endothelin B-receptor in mediating the microcirculatory failure in the ileal mucosa.

Use of genetically marked minicells as a probe in measurement of predation on bacteria in aquatic environments

Minicells produced by Escherichia coli M2141 were used as probes to measure predation on pelagic bacteria in situ. The minicells, labeled with [S]methionine in one specific protein, were shown to disappear in the presence of a microflagellate (Ochromonas sp.), as seen by a decrease in the amount of labeled marker protein with time. Incubation in filtered (pore size, 0.2 mum) and autoclaved seawater did not affect the amount of labeled marker protein in the minicell. The generation time of flagellates feeding on minicells was determined to be similar to that found for flagellates grown on seawater bacteria or living E. coli NC3. Data indicate that minicells are seen as true food particles by the flagellates. The minicell probe was used in recapture experiments, in which predation in situ on pelagic bacteria was demonstrated. The rate of bacterial production showed a clear covariation with the rate of predation, both in different sea areas and in depth profiles. The obtained results (11 field experiments) showed that the rate of predation, on average, accounts for the consumption of 62% of the bacteria produced.

Has the increase in the prevalence of asthma and respiratory symptoms reached a plateau in Stockholm, Sweden?

SETTING

An increase in the prevalence of asthma has previously been reported worldwide. However, the current trend is debatable.

OBJECTIVE

To assess changes in the prevalence of asthma and respiratory symptoms in a defined study area in Stockholm, Sweden, using identical methods.

DESIGN

A questionnaire was sent by mail in 1996 and 2007 to randomly selected subjects aged 20-69 years. On both occasions, 8000 subjects received the questionnaire, with response rates of 72% and 68%, respectively. Questions on asthma, respiratory symptoms, asthma medication and possible determinants were included. Logistic regression analysis was used to assess determinants.

RESULTS

Ever asthma increased from 8.7% in 1996 to 11.0% in 2007 and physician-diagnosed asthma from 7.6% to 9.3%. The proportion of asthma patients reporting one to two symptoms increased by 14% during the study period. There were few significant changes in the prevalence of respiratory symptoms: wheeze in the previous 12 months (15.9-17.3%), wheezing with breathlessness apart from cold (3.2-4.1%) and recurrent wheeze (8.3-6.8%). There was no major difference in the risk factor pattern between the surveys.

CONCLUSION

An increase in the prevalence of asthma with few symptoms as well as an unchanged prevalence of symptoms was demonstrated, which may indicate a change in diagnostic practices.

Computerized lifestyle intervention in routine primary health care: evaluation of usage on provider and responder levels

OBJECTIVE

The aim of this study was to evaluate the use of a computerized concept for lifestyle intervention in routine primary health care (PHC).

METHODS

Nine PHC units were equipped with computers providing a lifestyle test and tailored printed advice regarding alcohol consumption and physical activity. Patients were referred by staff, and performed the test anonymously. Data were collected over a period of 1 year.

RESULTS

During the study period 3,065 tests were completed, representing 5.7% of the individuals visiting the PHC units during the period. There were great differences between the units in the number of tests performed and in the proportion of patients referred. One-fifth of the respondents scored for hazardous alcohol consumption, and one-fourth reported low levels of physical activity. The majority of respondents found the test easy to perform, and a majority of those referred to the test found referral positive.

CONCLUSION

The computerized test can be used for screening and intervention regarding lifestyle behaviours in PHC. Responders are positive to the test and to referral.

PRACTICE IMPLICATIONS

A more widespread implementation of computerized lifestyle tests could be a beneficial complement to face-to-face interventions in PHC.

The endothelin receptor antagonist tezosentan improves renal microcirculation in a porcine model of endotoxemic shock

BACKGROUND

Impaired renal microcirculation has been suggested as a factor contributing to the development of renal dysfunction in sepsis. This study was conducted to elucidate the role of endothelin-1 (ET-1)in mediating reductions in renal microcirculatory blood flow during endotoxemic shock.

METHODS

A prospective, randomized, and experimental study was performed with 16 anesthetized and mechanically ventilated pigs. After 2 h of lipopolysaccaride-induced endotoxemia, eight animals received a bolus dose of the dual endothelin receptor antagonist tezosentan (1 mg/kg), followed by a continuous infusion of 1 mg/kg/h throughout the experiment. Eight animals served as the control group. Renal microcirculation, total renal blood flow, plasma creatinine levels, cardiac index, and mean arterial pressure were measured. Plasma samples were collected for the measurement of tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), ET-1, angiotensin II, and aldosterone.

RESULTS

Endotoxin infusion resulted in a state of circulatory shock with impairment of renal microcirculation. An increase in the plasma levels of TNF-alpha, IL-6, IL-10, ET-1, angiotensin II, and aldosterone was also observed. Tezosentan attenuated the decrease in renal microcirculation and renal blood flow, and attenuated the increase in plasma creatinine. Treatment with tezosentan did not significantly affect the plasma cytokine, angiotensin II, or aldosterone response to endotoxemia.

CONCLUSION

These results indicate that treatment with the dual endothelin receptor tezosentan in endotoxemic shock attenuates the reduction of renal microcirculation and total renal blood flow independently of plasma changes in the renin-angiotensin-aldosterone system or early plasma cytokine response.