Airway constriction pattern is a central component of asthma severity: the role of deep inspirations

Measurements of lung resistance and elastance (RL and EL) from 0.1 to 8 Hz reflect both the mean level and pattern of lung constriction. The goal of this study was to establish a relation between a deep inspiration (DI) and the heterogeneity of constriction in healthy versus asthmatic subjects. Constriction pattern was assessed from measurements of the RL and EL from 0.1 to 8 Hz in seven healthy subjects and in 12 asthmatics. These data were acquired before and after a DI and before and after a standard methacholine challenge versus a modified challenge in which a DI is prohibited. Generally, avoidance of a DI increased responsiveness. In healthy subjects and in those with mild-to-moderate baseline asthma a bronchial challenge, especially during self-inhibited DI, produced a heterogenous pattern of constriction inclusive of randomly distributed airway closures or near closures. Nevertheless, such subjects were able to reopen their airways via a DI. In contrast, in subjects with severe baseline asthma, there is a more extreme heterogeneous constriction pattern with random airway closures even at baseline. Further, there is no residual bronchodilatory effect of a DI either before or after bronchial challenge. We conjecture that inflammation and wall-remodeling facilitate a dangerous degree of heterogeneous constriction inclusive of airway closures or near closures, and contribute to the prevention of a DI from having a residual bronchodilatory effect.

Selected contribution: airway caliber in healthy and asthmatic subjects: effects of bronchial challenge and deep inspirations

In 9 healthy and 14 asthmatic subjects before and after a standard bronchial challenge and a modified [deep inspiration (DI), inhibited] bronchial challenge and after albuterol, we tracked airway caliber by synthesizing a method to measure airway resistance (Raw; i.e., lung resistance at 8 Hz) in real time. We determined the minimum Raw achievable during a DI to total lung capacity and the subsequent dynamics of Raw after exhalation and resumption of tidal breathing. Results showed that even after a bronchial challenge healthy subjects can dilate airways maximally, and the dilation caused by a single DI takes several breaths to return to baseline. In contrast, at baseline, asthmatic subjects cannot maximally dilate their airways, and this worsens considerably postconstriction. Moreover, after a DI, the dilation that does occur in airway caliber in asthmatic subjects constricts back to baseline much faster (often after a single breath). After albuterol, asthmatic subjects could dilate airways much closer to levels of those of healthy subjects. These data suggest that the asthmatic smooth muscle resides in a stiffer biological state compared with the stimulated healthy smooth muscle, and inhibiting a DI in healthy subjects cannot mimic this.

Dynamics of fetal circulatory responses to hypoxia and asphyxia

This review will focus on the dynamic changes of the fetal circulation, the distribution of organ blood flow during normoxemia, and that during hypoxia and asphyxia caused by various experimental perturbations. Furthermore, the relation between oxygen delivery and tissue metabolism during oxygen lack as well as evidence to support a new concept will be presented along with the principal cardiovascular mechanisms involved. Finally, blood flow and oxygen delivery to the principal fetal organ will be examined and discussed in relation to organ function. The fetal circulatory response to hypoxaemia and asphyxia is a rapid centralization of blood flow in favour of the brain, heart, and adrenals and at the expense of almost all peripheral organs, particularly of the lungs, carcass, skin and scalp. This response is qualitatively similar but quantitatively different under various experimental conditions. However, at the nadir of severe acute asphyxia the circulatory centralization cannot be maintained. Then there is circulatory de-centralization, and the fetus will experience severe brain damage if not expire unless immediate resuscitation occurs. Future work in this field will have to concentrate on the important questions, what factors determine this collapse of circulatory compensating mechanisms in the fetus, how does it relate to neuronal damage, and how can the fetal brain be pharmacologically protected against the adverse effects of asphyxia?

Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR

Throat swabs from 61 patients, aged 18-32 years, with non-streptococcal tonsillitis (NST) and 92 healthy controls were examined for the presence of Fusobacterium necrophorum DNA using a novel TaqMan-based real-time quantitative PCR assay for F. necrophorum subspecies. The assay was based on the gyrB subunit gene, and detected F. necrophorum DNA in 48% of patients with NST and in 21% of controls (p <0.001). F. necrophorum subsp. funduliforme was the only subspecies found in both patients and controls. The load of F. necrophorum DNA on swabs from patients with NST was significantly higher than that on swabs from controls (p <0.001). Furthermore, patients with recurrent NST had a significantly higher load of F. necrophorum DNA compared to patients with acute NST (p 0.04). In addition, 26 patients with tonsillitis and group C streptococci (GCS) had a significantly higher load of F. necrophorum DNA compared to the NST group (p <0.001). It was concluded that F. necrophorum subsp. funduliforme is present in small numbers as part of the normal human throat flora, and that F. necrophorum in large quantities may cause tonsillitis, especially recurrent tonsillitis. In addition, the study suggests that the concomitant presence of GCS may aggravate F. necrophorum tonsillitis.

The Brucella abortus CcrM DNA methyltransferase is essential for viability, and its overexpression attenuates intracellular replication in murine macrophages

The CcrM DNA methyltransferase of the alpha-proteobacteria catalyzes the methylation of the adenine in the sequence GAnTC. Like Dam in the enterobacteria, CcrM plays a regulatory role in Caulobacter crescentus and Rhizobium meliloti. CcrM is essential for viability in both of these organisms, and we show here that it is also essential in Brucella abortus. Further, increased copy number of the ccrM gene results in striking changes in B. abortus morphology, DNA replication, and growth in murine macrophages. We generated strains that carry ccrM either on a low-copy-number plasmid (strain GR131) or on a moderate-copy-number plasmid (strain GR132). Strain GR131 has wild-type morphology and chromosome number, as assessed by flow cytometry. In contrast, strain GR132 has abnormal branched morphology, suggesting aberrant cell division, and increased chromosome number. Although these strains exhibit different morphologies and DNA content, the replication of both strains in macrophages is attenuated. These data imply that the reduction in survival in host cells is not due solely to a cell division defect but is due to additional functions of CcrM. Because CcrM is essential in B. abortus and increased ccrM copy number attenuates survival in host cells, we propose that CcrM is an appropriate target for new antibiotics.

Freehand ultrasound elastography of breast lesions: clinical results

We developed a freehand method for ultrasound elastography, which can be applied during a routine sonographic examination with off-line calculation of strain images (elastograms). Forty-eight patients with 53 breast lesions were examined and, after biopsy or operation, histologic reports were available for all lesions. The correlation coefficient of time delay estimates was used as a quality criterion for the subsequent calculation of elastograms. Beyond the qualitative evaluation of elastograms, we suggested a semiquantitative approach. For that purpose, the elastogram of each lesion was normalized to an overall strain of 1% (i.e., the average strain in the image was set to 1%). After normalization, we determined mean strain values inside and outside of each lesion, respectively. Defining solid lesions as benign and malignant lesions except for fibrous mastopathy, we found significant difference in strain between solid lesions and their surrounding tissue. However, that result must not be misunderstood to suggest that it was possible to distinguish benign from malignant lesions in general. Still, we address the potential of ultrasound elastography to improve the detection and localization of breast lesions as well as their differential diagnosis. Besides, we developed a freehand applicator for further studies, which guarantees a homogeneous axial compression regardless of the experience of the examiner.

Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium

BACKGROUND

Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer.

METHODS

We used original data from 21 studies, which included 12 390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype.

RESULTS

Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30-34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99-1.23); BMI: ⩾35, pHR: 1.12 (95% CI: 1.01-1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5 kg m(-2)) and endometrioid subtypes (pHR: 1.08 per 5 kg m(-2)), and more modest for the high-grade serous (pHR: 1.04 per 5 kg m(-2)) subtype, but only the association with high-grade serous cancers was significant.

CONCLUSIONS

Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.

Antibiotic treatment of pneumonia and bronchiolitis. A prospective randomised study

Routine administration of antibiotics in the treatment of pneumonia and bronchiolitis in infants and small children was evaluated in an open randomised prospective trial. From 1979-82 136 children between the age of 1 month and 6 years were allocated to one of two treatment groups shortly after their admission to a paediatric ward. Group A patients were to be given antibiotics but those in group B were not. None of the children had received antibiotics before hospital admission. A viral infection was diagnosed in 38 of the 72 patients from group A and in 34 of the 64 patients from group B. Respiratory syncytial virus was detected in 84% of these patients. Samples of tracheal secretions showed no differences between the groups in respect of cytology and bacterial flora. Nor were there any significant differences in the course of acute disease, the frequency of fever relapse and pulmonary complications. Fifteen patients from group B were subsequently treated with antibiotics: two of these developed secondary purulent infections of the middle ear and one showed a slight pleural effusion. These results do not support the routine use of antibiotics in infants and small children admitted to hospital with pneumonia and bronchiolitis.

Influence of Alcohol on the Behavior of Sodium Dodecylsulfate Micelles

The effect of medium chain alcohol molecules on the size and shape of sodium dodecylsulfate micelles, and on the self-diffusion coefficient of the surfactant and alcohol, has been investigated by means of small angle neutron scattering (SANS), and Fourier transform pulsed field gradient spin echo (FT-PGSE) nuclear magnetic resonance measurements. All measurements were done in D2O containing a sodium chloride concentration of 0.4 mol/kg, and a surfactant concentration of 0.04 mol/kg. The alcohols used were 1-propanol, 1-butanol, and 1-pentanol. The data obtained from the different techniques agrees qualitatively. The results show that propanol successively breaks down the micelles while pentanol brings about a structural change toward large wormlike aggregates. Butanol shows a highly complex behavior on the structure of the micelles and can decrease and increase the size of the aggregates, depending on the added alcohol concentration range. All analyzed solutions show a distribution of the alcohol between the aqueous bulk solution and the palisade layer of the micelles, resulting in an increased "hydration" of D2O in the micellar surface. Moreover, the structural changes of the micelles indicate that butanol and pentanol solubilize in the micellar core in the high molality range, near the end of the solubility limit. Propanol is apparently too hydrophilic to do so. Copyright 1998 Academic Press.

Invasive listeriosis in Denmark 1994-2003: a review of 299 cases with special emphasis on risk factors for mortality

Listeriosis is a rare, but serious, foodborne infection which, in the invasive form, presents as bloodstream (BS) infection, an infection of the central nervous system (CNS), a maternofetal infection or a focal infection. The disease is notifiable in Denmark. This paper reviews the results of the Danish surveillance of invasive listeriosis from 1994 to 2003, excluding maternofetal cases. In total, 299 invasive cases of listeriosis were reported. Two-thirds of the cases were caused by isolates of serogroup 1/2, and one-third by serogroup 4. Most (70%) cases had conditions known to predispose to listeriosis. More patients with BS infection were predisposed because of concurrent underlying illness than were patients with CNS infection. Half of the patients were aged > 70 years, and 21% died of the disease. There was no change in the case fatality rate (CFR) during the 10-year period. The CFR was identical for men and women. BS and CNS infection caused the same incidence of mortality, but no mortality was observed in patients with focal infections at normally sterile body sites. In a multivariate analysis, isolates belonging to serogroup 4 were associated with a higher CFR than were isolates of serogroup 1/2. In patients aged < 70 years, underlying conditions predisposing to disease were related strongly to mortality, which was not the case in patients aged > 70 years. The underlying conditions associated most strongly with mortality in the younger age group were non-haematological malignancies.

Risk factors for listeriosis in Denmark, 1989-1990

Dietary risk factors for listeriosis were examined, and the risk levels of listeriosis according to specific underlying diseases were evaluated, in order to study the basis for prevention. Questionnaires from 50 listeriosis patients and 40 matching control persons were analysed. Unpasteurized milk was a risk food for sporadic listeriosis, and an outbreak of a European epidemic strain of Listeria monocytogenes was obviously linked to a blue-mould cheese or a hard cheese. Leukaemia, AIDS and renal transplantation were found to be associated with > 1000-fold risk of acquiring listeriosis, compared with healthy persons. As a part of prevention, persons running a high risk of contracting listeriosis should be individually informed about food hygiene and risk foods.

Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma: implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study

BACKGROUND

Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa.

METHODS

Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival.

RESULTS

FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94).

CONCLUSIONS

FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.

Management of Acanthamoeba keratitis. A case report and review of the literature

A recalcitrant corneal ulcer resulted in an extensive corneal opacity requiring penetrating keratoplasty. Histopathologic studies and subsequent cultures established the diagnosis of Acanthamoeba keratitis. A second transplant was performed due to a culture-proven recurrence of the keratitis in both the recipient and the graft, with progressive thinning. This has remained clear for six months on systemic ketoconazole and topical miconazole drops. This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.

Structural, physicochemical, and pasting properties of starches from potato plants with repressed r1-gene

The aim of this work was to investigate the effect on starch molecular and physicochemical properties of down regulation of the R1 protein in potato (Solanum tuberosum L. cv. "Dianella") tubers. Most prominent is a 90% suppression of the phosphate content in the isolated potato tuber starch. The amylopectin chain length distribution profile as determined by HPAEC/PAD was not affected, but the amylose content was increased in the most down-regulated plants. The pasting properties of the transgenic starch revealed a pronounced decrease in peak viscosity and increased setback viscosity as measured using a rapid Visco analyzer. The starch gels displayed an increased hardness and stickiness with a maximum at 1.7 nmol of Glc-6P mg-1 of starch compared to the control lines. At very low phosphate levels (1.4 nmol of Glc-6P mg-1 of starch), the gel hardness was decreased as a result of increased gel brittleness. The increase in gel brittleness is believed to be an effect of an increased proportion of free amylopectin blocklets in the starch as determined by SEC/RI. The possible links between the structural and physicochemical parameters are discussed.

Prevalence of amblyopia in old people without previous screening and treatment. An evaluation of the present prophylactic procedures among children in Denmark

An epidemiological study of amblyopia was performed among old people without previous screening and treatment. The study revealed a prevalence of 2.9% (strabismic in 2.3%, anisometropic in 0.6%). Present residual amblyopia among Danish school children is about 1% according to literature. The rate of cure of amblyopia by the present Danish system of prophylaxis and treatment is estimated to be 60-70%.

Chest X-ray appearances in pneumonia and bronchiolitis. Correlation to virological diagnosis and secretory bacterial findings

Chest X-ray findings were related to virus diagnosis, age and secretory bacterial findings in 128 infants and children under 7 years of age with clinical pneumonia and bronchiolitis. They belonged to a cohort examined in connection with the introduction of rapid methods for virological diagnosis. Seventy-six children had a virus infection diagnosed by examination of nasopharyngeal secretion and/or by serological methods. Thirty-seven of these children were classified as having pathogenic bacteria of importance in the respiratory tract. Four groups were compared: virus infected children with or without bacteria in the secretion and the corresponding virus negative groups. The X-rays were normal significantly more often in the virus positive/bacteria negative group compared with the other groups. Alveolar pneumonia appearing as lobar or segmental consolidations ("lobar" pneumonia) was observed with equal frequency and without relation to bacterial findings in the virus positive and the virus negative groups. But it was more often observed in the respiratory syncytial virus (RSV) infected children under 6 months of age compared with the older RSV children. In comparison disperse alveolar infiltrations ("bronchopneumonia") mostly appeared in the virus positive group. Interstitial pneumonia and peribronchitis were often present together in children over 6 months of age. There was no significant difference in the X-ray appearances in the groups with and without bacterial findings in the tracheal secretion except for a higher frequency of normal chest radiographs in the bacteria negative group.

Heterologous expression and characterization of wild-type and mutant forms of a 26 kDa endochitinase from barley (Hordeum vulgare L.)

To investigate structure-function relationships in plant chitinases, we have developed a heterologous expression system for the 26 kDa endochitinase from Hordeum vulgare L. (barley). Escherichia coli cells harbouring the gene in a T7 RNA polymerase-based expression vector synthesized completely insoluble recombinant protein under standard induction conditions at 37 degrees C. However, a concentration of soluble recombinant protein of approx. 15 mg/l was achieved by inducing bacteria at low temperature (15 degrees C). Recombinant endochitinase was purified to homogeneity and shown to be structurally and functionally identical to the seed protein. An average of three disulphide bonds are present in the recombinant enzyme, consistent with the number found in the natural form. The seed and recombinant proteins showed the same specific activity towards a high-molecular-mass substrate and exhibited similar anti-fungal activity towards Tricoderma reesei. Site-directed mutagenesis was used to replace residues that are likely to be involved in the catalytic event, based on structural similarities with lysozyme and on sequence alignments with related chitinases. The Glu67-->Gln mutation resulted in a protein with undetectable activity, while the Glu89-->Gln mutation yielded an enzyme with 0. 25% of wild-type specific activity. This suggests that two acidic residues are essential for catalytic activity, similar to the situation with many other glycosyl hydrolases. Examination of conserved residues stretching into the proposed substrate binding cleft suggests that Asn124 also plays an important functional role.

The use of arts interventions for mental health and wellbeing in health settings

Aims:

This literature review aims to illustrate the variety and multitude of studies showing that participation in arts activities and clinical arts interventions can be beneficial for citizens with mental and physical health problems. The article is focused on mental health benefits because this is an emerging field in the Nordic countries where evidence is demanded from national health agencies that face an increasing number of citizens with poor mental health and a need for non-medical interventions and programmes.

Methods:

A total of 20 articles of interest were drawn from a wider literature review. Studies were identified through the search engines: Cochrane Library, Primo, Ebscohost, ProQuest, Web of Science, CINAHL, PsycINFO, PubMed and Design and Applied Arts Index. Search words included the following: arts engagement + health/hospital/recovery, arts + hospital/evidence/wellbeing, evidence-based health practice, participatory arts for wellbeing, health + poetry/literature/dance/singing/music/community arts, arts health cost-effectiveness and creative art or creative activity + health/hospital/recovery/mental health. The inclusion criteria for studies were (1) peer review and (2) empirical data.

Results:

The studies document that participation in activities in a spectrum from clinical arts interventions to non-clinical participatory arts programmes is beneficial and an effective way of using engagement in the arts to promote holistic approaches with health benefits. Engagement in specially designed arts activities or arts therapies can reduce physical symptoms and improve mental health issues.

Conclusion:

Based on the growing evidence of the arts as a tool for enhancing mental health wellbeing, and in line with the global challenges in health, we suggest that participatory arts activities and clinical arts interventions are made more widely available in health and social settings. It is well-documented that such activities can be used as non-medical interventions to promote public health and wellbeing.

Poly (glycerol sebacate) elastomer supports bone regeneration by its mechanical properties being closer to osteoid tissue rather than to mature bone

Mechanical load influences bone structure and mass. Arguing the importance of load-transduction, we investigated the mechanisms inducing bone formation using an elastomeric substrate. We characterized Poly (glycerol sebacate) (PGS) in vitro for its mechanical properties, compatibility with osteoprogenitor cells regarding adhesion, proliferation, differentiation under compression versus static cultures and in vivo for the regeneration of a rabbit ulna critical size defect. The load-transducing properties of PGS were compared in vitro to a stiffer poly lactic-co-glycolic-acid (PLA/PGA) scaffold of similar porosity and interconnectivity. Under cyclic compression for 7days, we report focal adhesion kinase overexpression on the less stiff PGS and upregulation of the transcription factor Runx2 and late osteogenic markers osteocalcin and bone sialoprotein (1.7, 4.0 and 10.0 folds increase respectively). Upon implanting PGS in the rabbit ulna defect, histology and micro-computed tomography analysis showed complete gap bridging with new bone by the PGS elastomer by 8weeks while minimal bone formation was seen in empty controls. Immunohistochemical analysis demonstrated the new bone to be primarily regenerated by recruited osteoprogenitors cells expressing periostin protein during early phase of maturation similar to physiological endochondral bone development. This study confirms PGS to be osteoconductive contributing to bone regeneration by recruiting host progenitor/stem cell populations and as a load-transducing substrate, transmits mechanical signals to the populated cells promoting differentiation and matrix maturation toward proper bone remodeling. We hence conclude that the material properties of PGS being closer to osteoid tissue rather than to mineralized bone, allows bone maturation on a substrate mechanically closer to where osteoprogenitor/stem cells differentiate to develop mature load-bearing bone.

SIGNIFICANCE OF SIGNIFICANCE

The development of effective therapies for bone and craniofacial regeneration is a foremost clinical priority in the mineralized tissue engineering field. Currently at risk are patients seeking treatment for craniofacial diseases, traumas and disorders including birth defects such as cleft lip and palate, (1 in 525 to 714 live births), craniosynostosis (300-500 per 1,000,000 live births), injuries to the head and face (20 million ER visits per year), and devastating head and neck cancers (8000 deaths and over 30,000 new cases per year). In addition, approximately 6.2 million fractures occur annually in the United States, of which 5-10% fail to heal properly, due to delayed or non-union [1], and nearly half of adults aged 45-65 have moderate to advanced periodontitis with associated alveolar bone loss, which, if not reversed, will lead to the loss of approximately 6.5 teeth/individual [2]. The strategies currently available for bone loss treatment largely suffer from limitations in efficacy or feasibility, necessitating further development and material innovation. Contemporary materials systems themselves are indeed limited in their ability to facilitate mechanical stimuli and provide an appropriate microenvironment for the cells they are designed to support. We propose a strategy which aims to leverage biocompatibility, biodegradability and material elasticity in the creation of a cellular niche. Within this niche, cells are mechanically stimulated to produce their own extracellular matrix. The hypothesis that mechanical stimuli will enhance bone regeneration is supported by a wealth of literature showing the effect of mechanical stimuli on bone cell differentiation and matrix formation. Using mechanical stimuli, to our knowledge, has not been explored in vivo in bone tissue engineering applications. We thus propose to use an elastomeric platform, based on poly(glycerol sebacate (PGS), to mimic the natural biochemical environment of bone while enabling the transmission of mechanical forces. In this study we report the material's load-transducing ability as well as falling mechanically closer to bone marrow and osteoid tissue rather than to mature bone, allowed osteogenesis and bone maturation. Defying the notion of selecting bone regeneration scaffolds based on their relative mechanical comparability to mature bone, we consider our results in part novel for the new application of this elastomer and in another fostering for reassessment of the current selection criteria for bone scaffolds.

Risk of thyroid cancer after exposure to fertility drugs: results from a large Danish cohort study

BACKGROUND

Findings from the few epidemiological studies that have investigated thyroid cancer risk after fertility drugs have been inconclusive. Using data from the largest cohort of infertile women to date, we examined the effects of fertility drugs on thyroid cancer risk.

METHODS

A cohort of 54 362 women with infertility problems referred to Danish fertility clinics in the period 1963-1998 was established. A detailed data collection including information about type and amount of treatment was conducted. Using case-cohort techniques, we calculated rate ratios (RRs) of thyroid cancer associated with different fertility drugs after adjustment for age at first live birth.

RESULTS

A total of 29 thyroid cancers were identified during follow-up through 2000. Use of clomiphene [RR = 2.28; 95% confidence interval (CI): 1.08-4.82] or progesterone (RR = 10.14; 95% CI: 1.93-53.33) was associated with an increased thyroid cancer risk, although the latter estimate was based on few cases. When stratifying for parity status, the risk was primarily associated with clomiphene (RR = 3.09; 95% CI: 1.21-7.88) in parous women. No significantly increased risk was found after use of gonadotrophins, hCG or GnRH. We observed no association with number of cycles of use or years since first use (latency).

CONCLUSIONS

Clomiphene and possibly progesterone may increase thyroid cancer risk, particularly among parous women. Longer follow-up is needed to confirm our findings.

A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses

AIMS

To evaluate the effect of an intervention to reduce work related skin problems in gut cleaning departments in Danish swine slaughterhouses. The intervention consisted of an evidence based prevention programme and a documented method for implementation.

METHODS

Randomised controlled intervention study with a one year follow up. The intervention included educational activities and evidence based recommendations. The effect of the intervention was evaluated by telephone interviews using a standardised questionnaire based on the Nordic Occupational Skin Questionnaire (NOSQ-2002) with modified and additional questions on exposure, preventive measures, information, and discussions on prevention of skin problems, etc.

RESULTS

A total of 644 (87.5%) responded at the baseline interview and 622 (71.6%) at the one year follow up interview. A total of 495 participated in both interviews (67.3%). In the intervention departments the frequency of eczema on hands or forearms within the past three months at follow up was reduced significantly from 56.2% at baseline to 41.0% at follow up, while a slight non-significant increase was observed in the comparison departments (from 45.9% to 50.2%). The intervention activities resulted in more frequent use of protective gloves in general and the use of cotton gloves worn underneath rubber and plastic gloves. At follow up three times as many in the intervention departments used the recommended high fat skin care products introduced as part of the intervention activities. At follow up, discussion of skin problems was increased in the intervention group while no changes were observed in the comparison group.

CONCLUSIONS

A significant 27% relative reduction of occupational eczema in a high risk group was feasible through implementation of an evidence based prevention programme.

Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study

STUDY QUESTION

Do women who don't succeed in giving birth after an infertility evaluation have a higher risk of psychiatric disorders compared with women who do?

SUMMARY ANSWER

The results indicated that being unsuccessful in giving birth after an infertility evaluation could be an important risk factor for psychiatric disorders.

WHAT IS KNOWN ALREADY

Several studies have investigated the association between fertility treatment and psychological distress, but the results from these studies show substantial variation and lack of homogeneity that may be due to methodological limitations.

STUDY DESIGN, SIZE AND DURATION

A retrospective cohort study was designed using data from a cohort of 98 320 Danish women evaluated for fertility problems during 1973-2008 and linked to several Danish population-based registries. All women were followed from the date of first infertility evaluation until date of hospitalization for the psychiatric disorder in question, date of emigration, date of death or 31 December 2008, whichever occurred first. Owing to the precise linkage between the infertility cohort and the Danish population-based registries, using the unique Danish personal identification number, virtually no women were lost to follow-up.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

Information on reproductive status for all women in the infertility cohort was obtained by linkage to the Danish Medical Birth Registry. A total of 53 547 (54.5%) women gave birth after the initial infertility evaluation, whereas 44 773 (45.5%) women did not gave birth after the evaluation. To determine psychiatric disorders diagnosed in the women after enrolment in the infertility cohort, the cohort was linked to the Danish Psychiatric Central Registry. A total of 4633 women were hospitalized for a psychiatric disorder. The Cox proportional hazard regression model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between parity status after the initial infertility evaluation and risk of hospitalization for various groups of psychiatric disorders, including 'all mental disorders' and six main discharge subgroups labelled: 'alcohol and intoxicant abuse', 'schizophrenia and psychoses', 'affective disorders', 'anxiety, adjustment and obsessive compulsive disorders', 'eating disorder' and 'other mental disorders'.

MAIN RESULTS AND THE ROLE OF CHANCE

The incidence rate for all mental disorders was 393 cases per 100 000 person-years among women who did not succeed in giving birth after the infertility evaluation but only 353 cases per 100 000 person-years among women who succeeded in giving birth after the infertility evaluation. Women not giving birth after the infertility evaluation had an increased risk of hospitalization for all mental disorders (HR 1.17, 95% CI 1.11; 1.25), alcohol and intoxicant abuse (HR 2.02, 95% CI 1.69; 2.41), schizophrenia and psychoses (HR 1.46, 95% CI 1.17; 1.82) and other mental disorders (HR 1.42, 95% CI 1.27; 1.58) compared with women who gave birth after the infertility evaluation. In contrast, the risk of affective disorders (HR 0.90, 95% CI 0.81; 0.99) was decreased among women not giving birth after the infertility evaluation. Finally, the risk of anxiety, adjustment and obsessive compulsive disorders (HR 1.07, 95% CI 0.97; 1.17) as well as of eating disorders (HR 1.40, 95% CI 0.88; 2.22) was not significantly affected by parity status after the infertility evaluation.

LIMITATIONS, REASON FOR CAUTION

As only psychiatric conditions warranting hospitalization could be included in the present study, the true incidence of all psychiatric disorders among women with fertility problems is likely to be somewhat underestimated. Furthermore, since detailed information on fertility treatment was not available for all cohort members the association between different modalities of assisted reproductive techniques and risk of psychiatric disorders was not assessed.

WIDER IMPLICATIONS OF THE FINDINGS

Clinicians and other healthcare personnel involved in diagnosis and treatment of women with fertility problems should be aware of the potential risk modification of psychiatric disorders associated with unsuccessful fertility treatment. Hence, our results may point to new aspects of follow-up of women with fertility problems who are unsuccessful in giving birth in order to prevent or identify and treat these possible psychological side effects.

STUDY FUNDING/COMPETING INTEREST(S)

The study was supported by the Danish Cancer Society (award number: 96 222 54). All authors report no conflicts of interest.

[Diphenols and caramel compounds in roasted coffees of different varieties. II. (author's transl)]

Eleven diphenols and seven caramel compounds were extracted from roasted coffee with pentane/ether (1 + 1), silylated with BSTFA, characterized, and semiquantified by GC-MS. Seven phenols and five caramel components were identified for the first time in roasted coffee. Robusta coffee contained the highest amounts of phenols and maltol. Arabica showed higher amounts of furaneol (2.5-dimethyl-4-hydroxy-3(2H)-furanone), isomaltol, 5-hydroxymaltol, and 5-hydroxy-5.6-dihydromaltol.

Lead concentrations in human plasma, urine and whole blood

OBJECTIVES

Blood-lead levels (B-Pb), and to some extent urinary lead (U-Pb), are the most employed measures of lead exposure and risk. However, the small fraction of lead present in plasma (usually below 1% of that in blood) is probably more relevant to lead exposure and toxicity. Nevertheless, the lead content of plasma lead (P-Pb) has only seldom been used, mainly due to analytical limitations, which have now been overcome. We examined P-Pb in occupationally exposed subjects, as well as its relationship with B-Pb and U-Pb.

METHODS

Blood samples were obtained from 145 male workers, 110 of whom were employed in lead work. After a simple dilution of plasma, P-Pb was determined by inductively coupled plasma mass spectrometry. The detection limit was 0.04 microg/l, and the imprecision was 5%.

RESULTS

The lead concentration ranges were 0.20-37 microg/l for P-Pb, 0.9-176 microg/l (density adjusted) for U-Pb, and 9-930 microg/l for B-Pb. A close exponential relation was obtained between B-Pb and P-Pb. When B-Pb was plotted versus log P-Pb, a straight line (log P-Pb = 0.00225 x B-Pb - 0.58; r = 0.97) was obtained. Both the relation between U-Pb and P-Pb and that between U-Pb and B-Pb showed a large scattering (r = 0.78 in both cases). The relation to B-Pb appeared to be exponential, while that to P-Pb appeared to be linear.

CONCLUSIONS

The low detection limit and good precision of P-Pb determinations make it possible to use P-Pb in assessments of lead exposure and risk. Furthermore, in relative terms, P-Pb is a more sensitive measure than B-Pb, especially at high lead levels. This development is of importance for studies of exposure, possibly also for studies of risks.