Tallo: A global tree allometry and crown architecture database

Data capturing multiple axes of tree size and shape, such as a tree's stem diameter, height and crown size, underpin a wide range of ecological research-from developing and testing theory on forest structure and dynamics, to estimating forest carbon stocks and their uncertainties, and integrating remote sensing imagery into forest monitoring programmes. However, these data can be surprisingly hard to come by, particularly for certain regions of the world and for specific taxonomic groups, posing a real barrier to progress in these fields. To overcome this challenge, we developed the Tallo database, a collection of 498,838 georeferenced and taxonomically standardized records of individual trees for which stem diameter, height and/or crown radius have been measured. These data were collected at 61,856 globally distributed sites, spanning all major forested and non-forested biomes. The majority of trees in the database are identified to species (88%), and collectively Tallo includes data for 5163 species distributed across 1453 genera and 187 plant families. The database is publicly archived under a CC-BY 4.0 licence and can be access from: https://doi.org/10.5281/zenodo.6637599. To demonstrate its value, here we present three case studies that highlight how the Tallo database can be used to address a range of theoretical and applied questions in ecology-from testing the predictions of metabolic scaling theory, to exploring the limits of tree allometric plasticity along environmental gradients and modelling global variation in maximum attainable tree height. In doing so, we provide a key resource for field ecologists, remote sensing researchers and the modelling community working together to better understand the role that trees play in regulating the terrestrial carbon cycle.

Big-sized trees and species-functional diversity pathways mediate divergent impacts of environmental factors on individual biomass variability in Sri Lankan tropical forests

In tropical forests, several studies have explored the effects of environmental factors and tree species diversity as well as functional trait diversity and trait composition on aboveground biomass (AGB) stock. However, these abiotic and biotic effects on individual biomass variability (BioVar) are still largely unexplored, which limits our understanding of the plant-plant interactions for species coexistence. Here, we used the Partial Least Squares Structural Equation Models (PLS-SEMs), and other complementary analyses, on data from 189 tropical forest plots in Sri Lanka, to test the linkages amongst climate (a latent variable of solar radiation and potential evapotranspiration), soil (pH and cation exchange capacity), plot (plot size and stand density) conditions, big-sized trees, species-functional diversity, and BioVar. The PLS-SEMs showed that climate conditions decreased BioVar directly but increased indirectly via integrative promoting direct effects on soil conditions, species-functional diversity and big-sized trees. In contrast, soil conditions increased BioVar directly but decreased indirectly via integrative suppressing direct effects on species-functional diversity and big-sized trees. Interestingly, we found that the divergent indirect effects of climate and soil conditions on BioVar via big-sized trees mattered when the direct effect of big-sized trees on species-functional diversity was considered as compared to the reverse effect in PLS-SEMs. Also, the indirect positive effect of plot properties on BioVar was nearly equal to the direct effect because plot properties affected big-sized trees as similar as or lower than species-functional diversity. The positive effect of species-functional diversity on BioVar was mediated by the structural attributes of big-sized trees, indicating increased plant species co-existence. This study suggests that individual tree biomass variability (i.e., BioVar) should be considered for managing natural tropical forests in the context of the plant-plant interactions for species coexistence.

Water, Forests, People: The Swedish Experience in Building Resilient Landscapes

A growing world population and rapid expansion of cities increase the pressure on basic resources such as water, food and energy. To safeguard the provision of these resources, restoration and sustainable management of landscapes is pivotal, including sustainable forest and water management. Sustainable forest management includes forest conservation, restoration, forestry and agroforestry practices. Interlinkages between forests and water are fundamental to moderate water budgets, stabilize runoff, reduce erosion and improve biodiversity and water quality. Sweden has gained substantial experience in sustainable forest management in the past century. Through significant restoration efforts, a largely depleted Swedish forest has transformed into a well-managed production forest within a century, leading to sustainable economic growth through the provision of forest products. More recently, ecosystem services are also included in management decisions. Such a transformation depends on broad stakeholder dialog, combined with an enabling institutional and policy environment. Based on seminars and workshops with a wide range of key stakeholders managing Sweden's forests and waters, this article draws lessons from the history of forest management in Sweden. These lessons are particularly relevant for countries in the Global South that currently experience similar challenges in forest and landscape management. The authors argue that an integrated landscape approach involving a broad array of sectors and stakeholders is needed to achieve sustainable forest and water management. Sustainable landscape management-integrating water, agriculture and forests-is imperative to achieving resilient socio-economic systems and landscapes.

Quantitative analysis of phantom studies of 111In and 68Ga imaging of neuroendocrine tumours

Background

Nuclear medicine imaging of neuroendocrine tumours is performed either by SPECT/CT imaging, using ¹¹¹In-octreotide or by PET/CT imaging using ⁶⁸Ga-radiolabelled somatostatin analogs. These imaging techniques will give different image quality and different detection thresholds for tumours, depending on size and activity uptake. The aim was to evaluate the image quality for ¹¹¹In-SPECT and ⁶⁸Ga-PET imaging, i.e. the smallest volume possible to visualize for different source-to-background activity ratios. The accuracy of quantification of lesion volume and activity was also investigated to develop an objective evaluation for radionuclide therapy eligibility.

The phantom study was performed using the NEMA IEC Body Phantom with six hot spheres having inner diameters of 10, 13, 17, 22, 28, and 37 mm, filled with either ⁶⁸Ga or ¹¹¹In with sphere-to-background ratios (SBRs) of no background activity, 5:1, 2.5:1, and 1.25:1. Activity ratios of 1.25:1 and 2.5:1 are clinically found for lesions close to the liver and spleen. Clinical acquisition and reconstruction protocols were applied. Line profiles were drawn to evaluate the smallest detectable volume within a given SBR. Recovery curves based on threshold-based VOIs, threshold-based VOIs adapted to the background and CT-based ROIs were obtained for all SBRs and sphere diameters, allowing for quantification.

Results

The 10-mm sphere was not possible to detect in SPECT images. It was detectable in PET images for SBRs of 2.5:1 and higher. In a background corresponding to the activity uptake in the liver, spheres larger than 22–37 mm were detectable in the ¹¹¹In-SPECT images and spheres larger than 13–22 mm were detectable in the ⁶⁸Ga-PET images. The maximum activity concentration was accurately quantified for spheres larger than 22 mm in the PET images; however, the quantification was impaired by sphere size and background activity.

Conclusions

It was not possible to detect the 10-mm sphere in any of the SPECT images. In a background corresponding to the activity uptake in the liver, spheres larger than approximately 30 mm were visible in the ¹¹¹In-SPECT images and spheres larger than approximately 17 mm were visible in the ⁶⁸Ga-PET images. Sphere diameter and background activity strongly affect the possibility of a correct quantification.

Disentangling the effects of species diversity, and intraspecific and interspecific tree size variation on aboveground biomass in dry zone homegarden agroforestry systems

The biodiversity - aboveground biomass relationship has been intensively studied in recent decades. However, no consensus has been arrived to consider the interplay of species diversity, and intraspecific and interspecific tree size variation in driving aboveground biomass, after accounting for the effects of plot size heterogeneity, soil fertility and stand quality in natural forest including agroforests. We tested the full, partial and no mediations effects of species diversity, and intraspecific and interspecific tree size variation on aboveground biomass by employing structural equation models (SEMs) using data from 45 homegarden agroforestry systems in Sri Lanka. The full mediation effect of either species diversity or intraspecific and interspecific tree size variation was rejected, while the partial and no mediation effects were accepted. In the no mediation SEM, homegarden size had the strongest negative direct effect (β=-0.49) on aboveground biomass (R²=0.65), followed by strong positive direct effect of intraspecific tree size variation (β=0.32), species diversity (β=0.29) and interspecific tree size variation (β=0.28). Soil fertility had a negative direct effect on interspecific tree size variation (β=-0.31). Stand quality had a significant positive total effect on aboveground biomass (β=0.28), but homegarden size had a significant negative total effect (β=-0.62), while soil fertility had a non-significant total effect on aboveground biomass. Similar to the no mediation SEM, the partial mediation SEMs had explained almost similar variation in aboveground biomass because species diversity, and intraspecific and interspecific tree size variation had non-significant indirect effects on aboveground biomass via each other. Our results strongly suggest that a multilayered tree canopy structure, due to high intraspecific and interspecific tree size variation, increases light capture and efficient utilization of resources among component species, and hence, support the niche complementarity mechanism via plant-plant interactions.

Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events

OBJECTIVE/BACKGROUND

The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery.

METHODS

This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated.

RESULTS

Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%.

CONCLUSION

This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.

Effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomized trial

OBJECTIVES

Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay.

METHODS

An antibiotic checklist for patients treated with intravenous antibiotics was introduced in nine Dutch hospitals in a stepped wedge cluster randomized trial. Prophylaxis was excluded. We included a random sample before (baseline), and all eligible patients after (intervention) checklist introduction. Baseline and intervention outcomes were compared. Primary endpoint was length of stay (LOS), analysed by intention to treat. Secondary endpoints, including QI performances, QI sum score (performance on all QIs per patient), and quality of checklist use, were analysed per protocol.

RESULTS

Between 1 November 2014 and 1 October 2015 we included 853 baseline and 5354 intervention patients, of whom 993 (19%) had a completed checklist. The LOS did not change (baseline geometric mean 10.0 days (95% CI 8.6-11.5) versus intervention 10.1 days (95% CI 8.9-11.5), p 0.8). QI performances increased between +3.0% and +23.9% per QI, and the percentage of patients with a QI sum score above 50% increased significantly (OR 2.4 (95% CI 2.0-3.0), p<0.001). Higher QI sum scores were significantly associated with shorter LOS. Discordance existed between checklist-answers and actual performance.

CONCLUSIONS

Use of an antibiotic checklist resulted in a significant increase in appropriateness of antibiotic use, but not in a reduction of LOS. Low overall checklist completion rates and discordance between checklist-answers and actual provided care might have attenuated the impact of the checklist.

Individual tree size inequality enhances aboveground biomass in homegarden agroforestry systems in the dry zone of Sri Lanka

Individual tree size variation, which is generally quantified by variances in tree diameter at breast height (DBH) and height in isolation or conjunction, plays a central role in ecosystem functioning in both controlled and natural environments, including forests. However, none of the studies have been conducted in homegarden agroforestry systems. In this study, aboveground biomass, stand quality, cation exchange capacity (CEC), DBH variation, and species diversity were determined across 45 homegardens in the dry zone of Sri Lanka. We employed structural equation modeling (SEM) to test for the direct and indirect effects of stand quality and CEC, via tree size inequality and species diversity, on aboveground biomass. The SEM accounted for 26, 8, and 1% of the variation in aboveground biomass, species diversity and DBH variation, respectively. DBH variation had the strongest positive direct effect on aboveground biomass (β=0.49), followed by the non-significant direct effect of species diversity (β=0.17), stand quality (β=0.17) and CEC (β=-0.05). There were non-significant direct effects of CEC and stand quality on DBH variation and species diversity. Stand quality and CEC had also non-significant indirect effects, via DBH variation and species diversity, on aboveground biomass. Our study revealed that aboveground biomass substantially increased with individual tree size variation only, which supports the niche complementarity mechanism. However, aboveground biomass was not considerably increased with species diversity, stand quality and soil fertility, which might be attributable to the adaptation of certain productive species to the local site conditions. Stand structure shaped by few productive species or independent of species diversity is a main determinant for the variation in aboveground biomass in the studied homegardens. Maintaining stand structure through management practices could be an effective approach for enhancing aboveground biomass in these dry zone homegarden agroforestry systems.

Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement

Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.

Introduction of embryonic stem cells into vein grafts reduces intimal hyperplasia in mice

AIM

Atherosclerosis with its cardiovascular events including cardiac and peripheral ischemia represents the main cause of death in the developed countries. Although interventional treatments like percutaneous transluminal angioplasty or stents are increasingly applied for the treatment of peripheral arterial disease, they are not always technically applicable or durable and bypass surgery is needed. Compared to synthetic grafts, vein grafts show a better patency especially when used for the lower leg as well as a lower risk for infection compared to synthetic grafts. Still the long-term patency rates are unsatisfactory due to accelerated intimal hyperplasia, a thickening of the vessel wall. The aim of this study was to elucidate, if the implantation of embryonic stem cells into vein grafts can reduce the development of intimal hyperplasia in a mouse in vivo model.

METHODS

In this study we implanted LacZ-tagged (ROSA26) murine embryonic stem cells into decellularized vein grafts. Control groups were: 1) untreated veins; 2) decellularized veins; 3) decellularized veins with gel and plastic film; and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film. Six weeks after insertion into the carotid artery of mice, the grafts were excised and analyzed immunohistochemically, morphologically, and by x-gal staining and compared to the control groups. The Mann-Whitney U test was used to compare groups. Statistical significance was indicated by a value of P<0.05.

RESULTS

Decellularized veins with implanted stem cells showed significantly less intimal thickening compared to all control groups (intimal hyperplasia vs. luminal circumference mean±SD 7.3±3.5 µm, median 8 µm). The control groups: 1) untreated veins (60.3±25.5 µm, median 58.5 µm); 2) decellularized veins (53.9±22.4 µm, median 48.4 µm); 3) decellularized veins with gel and plastic film (70.6±22.4 µm, median 72.6 µm); and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film (73.5±18.1 µm, median 73.6 µm) all showed the same high degree of intimal hyperplasia.

CONCLUSION

This study demonstrates that embryonic stem cells have a therapeutic competence to favourably modulate intimal hyperplasia in vivo.

Endovascular treatment of descending thoracic aortic disease. A single center experience

AIM

Aim of the study was to assess if endovascular treatment is a feasible alternative in patients with descending thoracic aortic disease.

METHODS

Seventy-three patients were admitted for stent-grafting of descending thoracic aortic disease during the period 1997-2008. The majority of the patients had aneurysm (35) or type B dissection (21), but also traumas, penetrating ulcers and other conditions were treated. Sixteen (22%) were unfit for open surgery. Thirty-four (47%) of the patients were symptomatic and 18 had rupture. The primary technical success rate was 96%.

RESULTS

Early mortality (<30 days) for the whole group was 3%. Early endoleak (<30 days) was identified in 11 patients (15%) of whom 4 (5%) had a secondary procedure. In addition, two trauma patients required insertion of a new stent-graft due to stent-graft collapse. Two patients had stroke, one had paraplegia and two paraparesis. Mean follow-up was 3.1 years (range 0-12 years). Late endoleak (>30 days) was identified in 5 patients (7%) treated by 6 secondary procedures. One patient (1.7%) had an explant. Two patients have had extensions of endografts due to increasing diameter of the aorta at the distal end of the stent-graft.

CONCLUSION

Endovascular treatment seems to be a viable alternative in patients with descending thoracic aortic disease.

Homegardens as a multi-functional land-use strategy in Sri Lanka with focus on carbon sequestration

This paper explores the concept of homegardens and their potential functions as strategic elements in land-use planning, and adaptation and mitigation to climate change in Sri Lanka. The ancient and locally adapted agroforestry system of homegardens is presently estimated to occupy nearly 15 % of the land area in Sri Lanka and is described in the scientific literature to offer several ecosystem services to its users; such as climate regulation, protection against natural hazards, enhanced land productivity and biological diversity, increased crop diversity and food security for rural poor and hence reduced vulnerability to climate change. Our results, based on a limited sample size, indicate that the homegardens also store significant amount of carbon, with above ground biomass carbon stocks in dry zone homegardens (n = 8) ranging from 10 to 55 megagrams of carbon per hectare (Mg C ha(-1)) with a mean value of 35 Mg C ha(-1), whereas carbon stocks in wet zone homegardens (n = 4) range from 48 to 145 Mg C ha(-1) with a mean value of 87 Mg C ha(-1). This implies that homegardens may contain a significant fraction of the total above ground biomass carbon stock in the terrestrial system in Sri Lanka, and from our estimates its share has increased from almost one-sixth in 1992 to nearly one-fifth in 2010. In the light of current discussions on reducing emissions from deforestation and forest degradation (REDD+), the concept of homegardens in Sri Lanka provides interesting aspects to the debate and future research in terms of forest definitions, setting reference levels, and general sustainability.

REDD+ readiness implications for Sri Lanka in terms of reducing deforestation

Any system to compensate countries for reduced emissions from deforestation and forest degradation (REDD+) requires a historical reference level against which future performance can be measured. Here we examine the possibilities Sri Lanka, a small forest country with limited data on forest carbon stocks, has to get ready for REDD+. We construct a historical reference level using available forest inventory data combined with updated 2008 and 2009 in situ carbon density data for Sri Lankan forests. Furthermore, we use a combination of qualitative and quantitative data to attribute the clearing of Sri Lankan forests in the latest years for which national forest inventory data are available, 1992-1996, to various proximate drivers and to estimate the opportunity cost of forest conservation. We estimate that baseline deforestation emissions in Sri Lanka amounted to 17MtCO(2)yr(-1) in the 1992-1996 period, but conclude that it is challenging for Sri Lanka to produce a robust and accurate reference level due to the lack of nationally based inventories. We find that the majority of forest clearing (87%) is due to small-scale, rainfed farming, with the two other major drivers being rice and tea cultivation. Further, Sri Lankan revenues from REDD+ participation could be substantial, but they are sensitive to REDD+ policy transaction cost, highly uncertain timber revenues, and particularly the carbon price paid for emission reductions. The latter needs to be higher than $5-10/tCO(2) if there are to be substantial incentives for Sri Lanka to participate in REDD+. There is, however, a large gap in the knowledge of deforestation drivers that needs to be filled if Sri Lanka is to formulate an effective policy response to forest degradation in REDD+. For successful REDD+ implementation in Sri Lanka to happen, technological assistance, readiness assistance, and continued political momentum are crucial.

Effect of multilayer high-compression bandaging on ankle range of motion and oxygen cost of walking

OBJECTIVE

To evaluate the effects of multilayer high-compression bandaging on ankle range of motion, oxygen consumption and subjective walking ability in healthy subjects.

METHOD

A volunteer sample of 22 healthy subjects (10 women and 12 men; aged 67 [63-83] years) were studied. The intervention included treadmill-walking at self-selected speed with and without multilayer high-compression bandaging (Proforeº), randomly selected. The primary outcome variables were ankle range of motion, oxygen consumption and subjective walking ability.

RESULTS

Total ankle range of motion decreased 4% with compression. No change in oxygen cost of walking was observed. Less than half the subjects reported that walking-shoe comfort or walking distance was negatively affected.

CONCLUSION

Ankle range of motion decreased with compression but could probably be counteracted with a regular exercise programme. There were no indications that walking with compression was more exhausting than walking without. Appropriate walking shoes could seem important to secure gait efficiency when using compression garments.

Findings on how adolescents cope with cancer--a matter of methodology?

OBJECTIVES

The various conclusions drawn from previous studies on how adolescents cope with cancer might partly be explained by methodological issues. The aim was to explore how adolescents recently diagnosed with cancer report that they cope with disease- and treatment-related distress in response to closed- and open-ended questions, respectively.

METHODS

Adolescents diagnosed with cancer 4-8 weeks ago (N=56) answered closed- and open-ended questions over the telephone about which coping strategies they use to cope with physical concerns, personal changes, feelings of alienation, and worries.

RESULTS

In response to closed-ended questions, most adolescents reported using emotion-focused coping (Accepting and Minimising) while, in response to open-ended questions, meaning-based (i.e. Positive thinking) and problem-focused (i.e. Problem solving) coping were most often mentioned. A majority reported using Minimising and Seeking support in response to closed-ended questions, but very few adolescents mentioned using these strategies in response to open-ended questions.

CONCLUSIONS

Adolescents' reports of how they cope with disease- and treatment-related distress vary depending on antecedent closed- and open-ended questions. Responses to closed-ended questions appear to be more indifferent to aspects of distress than responses to open-ended questions. Strategies representing meaning-based coping should be included in future studies investigating how adolescents recently diagnosed with cancer cope with disease- and treatment-related distress.

Improved patency and reduced intimal hyperplasia in PTFE grafts with luminal immobilized heparin compared with standard PTFE grafts at six months in a sheep model

AIM

The aim of this study was to compare the performance of polytetrafluoroethylene (PTFE) grafts with luminal coating of immobilized heparin to that of standard PTFE grafts at six months.

METHODS

Twenty-eight common carotid arteries in fourteen sheep were bypassed with heparin-coated PTFE grafts (6 mm diameter, 6 cm length) on one side and standard PTFE grafts on the other. The grafts were explanted after six months. The thickness of intimal hyperplasia (IH) in open grafts was measured with histomorphometrical methods.

RESULTS

Two of 14 heparinized PTFE grafts and nine of 14 grafts in the control PTFE-group were occluded at explantation (P=0.006). Six-month patency rates for heparinized PTFE grafts and for standard PTFE grafts were 86% and 36%, respectively. Mean graft anastomotic IH thickness in open grafts were 0.074 mm for heparinized PTFE grafts and 0.259 mm for PTFE-grafts (P=0.006).

CONCLUSION

PTFE grafts with luminal coating containing immobilized heparin had significantly better patency and recruited less intimal hyperplasia than standard PTFE grafts at six months.

Participation in age-related activities and influence of cultural factors–comments from youth and parents of children with postnatal post infectious hemiplegia in Stockholm, Sweden

PURPOSE

To investigate whether children with postnatal post-infectious hemiplegic cerebral palsy, and their parents, felt that participation in activities typical for the child's age and gender was affected. To identify factors, intra- and extra-personal that influenced disability with emphasis on factors related to immigration.

METHOD

Interviews with six youths and 15 caregivers regarding the child's ability to participate in age-related activities, the consequences of disability in their home country compared to Sweden, and whether immigration influenced being a parent to a disabled child.

RESULTS

All reported large difficulties participating in age-related activities. Positive and negative differences in participation in different cultures were described. War, culture, eating habits, hygiene habits, and school could differ and create difficulties when in Sweden. Language skills and intra personal factors influenced information gathering and participation in parental activities.

CONCLUSIONS

Surprisingly large difficulties in participation may separate those with a postnatal post-infectious aetiology from hemiplegia of other aetiologies. High degrees of additional impairments may influence participation more than the physical disability. Language skills and cultural factors influence ability to seek and gain information. A mutual process where both Swedes and immigrants know traditions of care for disabled in both places may create understanding and improved dialogue.

Are there any positive consequences of childhood cancer? A review of the literature

The aim was to investigate whether there are any positive consequences of childhood cancer. Studies published 1990-2005 reporting survivors' descriptions of positive consequences of childhood cancer were identified through a search in the databases CINAHL, PsycINFO, and PubMed. According to a manifest content analysis, positive consequences were referred to three themes: life values, relations to others, and relation to self. A second search in the same databases was conducted to identify studies investigating whether survivors of childhood cancer differ from comparison groups with regard to variables assigned to these themes. In these studies, no conclusions about positive consequences with regard to the theme life values can be drawn, as only one study was identified. In addition, only a small minority of findings from comparative studies indicate that childhood cancer has any positive consequences with regard to relations to others and relation to self. A majority of the results indicate that survivors do not differ from comparison groups, whereas some findings highlight that friendship and marital status are areas of concern, and parenthood and sexuality are areas of potential concern. It is recommended that survivors of childhood cancer are followed up by a multi-professional team, focusing not only on the survivors' health status but also on relations to family, friends, and partners.

Photodynamic Therapy Reduces Intimal Hyperplasia in Prosthetic Vascular Bypass Grafts in a Pig Model

BACKGROUND

Bypass surgery has a failing frequency of 30% during the first year, mainly due to intimal hyperplasia (IH). This negative effect is most pronounced in artificial grafts. Photodynamic therapy (PDT) is a technique in which light activates photosensitizer dyes to produce free-radicals resulting in an eradication of cells in the vascular wall. The aim of this study was to determine the effectiveness of PDT to reduce IH in a preclinical porcine PTFE bypass model.

MATERIAL AND METHODS

Ten pigs were used. After a pilot PDT dosimetry study (n=3) PTFE grafts were bilaterally placed into the circulation as bypasses from the common to the external iliac arteries (n=7). The right sides served as controls (C). Before implantation of the left grafts, the arterial connecting sites of the left distal anastomoses were PDT-treated. The arteries were pressurized at 180 mmHg for 5 minutes with the photosensitizer Methylene Blue (330 microg/ml), and thereafter endoluminally irradiated with laser light (lambda = 660 nm, 100 mW/cm(2), 150 J/cm(2)). After 4 weeks the specimens were retrieved and formalin fixed. Cross sections through the midportions of the distal anastomoses and the grafts were used for histology, immunohistochemistry to identify inflammatory cells and morphometric evaluation (n=7).

RESULTS

No systemic side effects and no graft occlusions were noted. PDT-treated anastomoses showed reduced IH in the mid-portions of the anastomoses (Area of IH: microm(2)/microm graft: C: 6970+/-1536, PDT: 2734+/-2560; P<0.005) as well as in the grafts (C: 5391+/-4031, PDT: 777+/-1331; P<0.02). The number of inflammatory cells per microscopic field was increased after PDT (C: 24+/-16, PDT: 37+/-15; P<0.009).

CONCLUSIONS

Adjuvant PDT, performed in an endovascular fashion, was a safe method to reduce prosthetic graftstenosis in a preclinical setting. This study underscores the clinical potential of PDT to inhibit the development of clinical bypass graftstenosis.

Age and gender differences in VO2max in Swedish obese children and adolescents

AIM

To describe age and gender differences in estimated maximum oxygen uptake (VO2max) and participation in organized physical activity in Swedish obese children and adolescents, and compare the results with an age-matched reference group representative of the general population.

METHODS

Two hundred and nineteen obese children (102 boys, 117 girls, aged 8-16 years, Body Mass Index (BMI) 24.3-57.0 kg.m-2) performed a submaximal bicycle ergometry test and an interview concerning participation in organized physical activity.

RESULTS

The obese children had lower relative VO2max (p<0.001) than the reference group. In contrast to the reference group no age or gender differences were detected in the obese children aged 11-13 years and 14-16 years. With increased age (after 11 years) the obese children participated less in organized physical activity than the reference group (p<0.001). In obese adolescents, participation in organized physical activity in leisure time explained 7% and BMI 45% of the variance in relative VO2max.

CONCLUSION

The obese children had lower relative VO2max, and participated less in organized physical activity than the reference group. The variance in relative VO2max was primarily explained by BMI. Obese adolescents, especially boys, were found to be at risk of physical inactivity.

Discovery of highly potent small molecule kallikrein inhibitors

Uncontrolled kallikrein activation is involved in diseases such as hereditary angioedema, bacterial septic shock and procedures such as cardiopulmonary bypass. Here we report a series of small molecule compounds that potently inhibit kallikrein activity in vitro. Kinetic studies indicate that some of these compounds are slow binding inhibitors of kallikrein with Ki final less than a nanomolar. The ability of these compounds to inhibit the activity of kallikrein was further confirmed in a plasma model by quantitating the release of bradykinin, an endogenous cleavage product of plasma kallikrein. To understand the inhibitory mechanism of the selected compounds toward kallikrein, the interactions between the selected compounds and kallikrein was explored using molecular modeling based on the information of crystal structures of TF/FVIIa and kallikrein. The information presented in the current study provides an initial approach to develop more selective and therapeutically useful small molecule inhibitors.

Positive and negative consequences with regard to cancer during adolescence. Experiences two years after diagnosis

OBJECTIVES

The purpose was to explore negative and positive consequences of cancer during adolescence experienced two years after diagnosis.

METHODS

Two years after diagnosis 38 persons, 15-21 years old, were asked two questions over the telephone: What, if anything, is bad for you due to the cancer disease? and What, if anything, is good for you due to the cancer disease? The answers were analysed by content analysis.

RESULTS

Four categories of negative experiences were identified: a problematic body; unpleasant thoughts and feelings; outside the circle of friends; and difficulties with schoolwork. Six categories of positive experiences were identified: a more positive view of life; good self-esteem; knowledge and experience with regard to disease and hospital care; good relations; broader perspectives; and material gains.

CONCLUSIONS

Two years after diagnosis those struck by cancer during adolescence experience not only a number of negative, but also positive, consequences of the cancer disease and its treatment.

Physical activity, body composition and physical self-esteem: a 3-year follow-up study among adolescents in Sweden

AIMS

To measure physical activity by means of daily pedometer steps, body composition, expressed as body mass index (BMI) and bioelectrical impedance as percent body fat, and perceived physical self-esteem and additionally, to evaluate eventual predictors for a healthy lifestyle i.e., highly physically active, normal weighted and a high physical self-esteem in a follow-up group.

METHODS

During autumn 2000 physical activity level was assessed and BMI was calculated in 871 children aged 7-14 in south eastern Sweden and in 501 of these, physical self-esteem were also assessed. During autumn 2003 a total of 375 adolescents aged 15-18 were assessed using the same methodology and additionally percent body fat was measured. Ninety-three of these adolescents (46 girls), were also measured in 2000 and they formed the follow-up group.

RESULTS

In the follow-up group a significant increase in BMI and stability in physical self-esteem in boys and girls, and in boys a significant decrease in daily steps was found 3 years later. Strongest predictor to be highly physically active, maintain normal BMI and high self-esteem 3 years later, i.e., to have a healthy lifestyle, was for girls increased self-esteem and for boys a decreased BMI.

CONCLUSION

Consequently, for a healthy lifestyle, promoting physical self-esteem in girls and weight control in boys is of great importance in early adolescence.

Healing of PTFE Grafts in a Pig Model Recruit Neointimal Cells from Different Sources and Do Not Endothelialize

OBJECTIVES

The aim of this study was to analyze the cellular sources for the neointima and the cell type that is lining the lumen in artificial grafts implanted in pigs.

MATERIALS AND METHODS

We used polytetrafluoroethylene grafts as bypasses from the common to the external iliac arteries. The animals were sacrificed after 1, 4, 7, 14, 21, 30, 60 and 90 days. Morphological, immunohistochemical and electron microscope assessments were made.

RESULTS

After 7 days a circumferential neoadventitia was formed. At day 14 isolated cellular islets of proliferating cells were observed on the luminal side of the graft without connection to the neoadventitia or the adjacent arteries. In the anastomotic regions at day 14 we observed an isolated neointima in contact with the adjacent artery. The cells lining the lumen had characteristics of both smooth muscle cells and endothelial cells.

CONCLUSIONS

Our study suggests that in artificial porcine grafts, the perivascular tissue, the blood and the adjacent artery contribute to the formation of the neointima. The luminal surface is covered by a hybrid cell with both smooth muscle cell and endothelial cell properties.

Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study

The aim of this prospective follow-up study was to determine if gait measurements and/or clinical measurements could detect differences in treatment outcome between two surgical interventions in patients with knee osteoarthritis (OA). The patients were followed for 5 years after surgery. Forty patients, 55-70 years of age, with unilateral knee OA were included. The patients were treated either with a high tibial osteotomy (HTO) (n=18) or a unicompartmental knee arthroplasty (UKA) (n=22). Clinical outcome measures were the British Orthopaedic Association (BOA) score, pain during walking, passive range of knee motion (PROM) and patients' subjective opinion. The gait variables were free walking speed, step frequency, step length and single and double-stance phase for each leg. The patients were examined before surgery and 3 months, 1 year and 5 years after surgery. The time-distance variables of gait could detect differences in treatment outcome, 3 months after surgery, while the clinical outcome measures, as given here, could not detect any differences between the two groups of patients. Measurements of free walking speed could be recommended for clinical evaluation, after surgical interventions, in patients with knee OA.

Influence of physical activity on urinary leakage in primiparous women

The impact of physical activity on urinary leakage (UL) has previously been considered, but not in relation to first pregnancy and delivery. The aim of this study was to describe physical activity and urinary leakage before, during and after the first childbirth. The subjects who were invited to participate in the study were taken consecutively from nine maternity clinics in the northwest part of Stockholm County, and the study group included 665 primiparous women. The mean age of the women was 28 (range 17-43) years. The women answered one questionnaire during the 36th gestation week and another 1 year post partum. Physical activity/exercises were classified according to their impact on the pelvic floor, and the women were divided into three groups: high-impact exercise (n=327), low-impact exercise (n=84) and the inactive group (n=254). The results showed a high intensity and frequency of physical activity in the participating primiparous women. Risk factors for UL were symptoms of a dysfunctional pelvic floor and connective tissue disorders and high-impact physical activity before pregnancy, while low-impact activity seemed to promote continence. If urinary leakage was present before pregnancy, it persisted in most women during pregnancy and 1 year post partum.

Validity of the EK scale: a functional assessment of non-ambulatory individuals with Duchenne muscular dystrophy or spinal muscular atrophy

BACKGROUND AND PURPOSE

The EK scale comprises ten categories (EK 1-10), each contributing to an overall picture of function in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The purpose of the present study was to investigate content and construct validity of the EK scale as a tool to discriminate between levels of functional ability in individuals with DMD or spinal muscular atrophy (SMA) who were non-ambulatory.

METHOD

Data from a sample of 56 subjects with DMD and 38 with SMA, who were non-ambulatory, were obtained from four separate studies. The relationship of functional ability by use of the EK scale and (1) muscle strength, (2) contractures, (3) forced vital capacity and (4) years of wheelchair dependency were assessed. All items of the EK scale were used except the one representing severe hypoventilation.

RESULTS

Regression analyses showed that the EK sum was the most significant explanatory variable (p < 0.05) of all variables measured to explain muscle strength in both DMD and SMA subjects. The individual categories of EK (1-10) all contributed as significant explanatory variables (p < 0.05) to the other variables measured.

CONCLUSIONS

The categories and items of the EK scale were relevant and valid as means of discriminating between levels of functional performance in the population studied which was evidence of content and construct validity.

Prevalence of urinary leakage in nulliparous women with respect to physical activity and micturition habits

In order to survey the influence of physical activity and micturition habits on urinary leakage (UL) in women before their first pregnancy, a study including 725 women attending nine maternity clinics in the northwest area of Stockholm was performed. During the 36th gestational week the women answered a questionnaire regarding the pre-pregnancy situation regarding UL, micturition habits and physical activity. Thirty-nine percent of the women, mean age of 28 (range 17-43) years, had experienced occasional UL. Of these, the majority (79%) had symptoms of stress urinary leakage and 21% had urge symptoms. Two percent were incontinent according to the definition of the International Continence Society (ICS). In a multivariate analysis age, inability to interrupt the urine flow and high-impact physical activity turned out to be independent risk factors for UL and thus should be observed together with traditional factors concerning UL in nulliparous women.

Superantigens from Staphylococcus aureus induce procoagulant activity and monocyte tissue factor expression in whole blood and mononuclear cells via IL-1 beta

BACKGROUND

Staphylococcus aureus is one of the most common bacteria in human sepsis, a condition in which the activation of blood coagulation plays a critical pathophysiological role. During severe sepsis and septic shock microthrombi and multiorgan dysfunction are observed as a result of bacterial interference with the host defense and coagulation systems.

OBJECTIVES

In the present study, staphylococcal superantigens were tested for their ability to induce procoagulant activity and tissue factor (TF) expression in human whole blood and in peripheral blood mononuclear cells.

METHODS AND RESULTS

Determination of clotting time showed that enterotoxin A, B and toxic shock syndrome toxin 1 from S. aureus induce procoagulant activity in whole blood and in mononuclear cells. The procoagulant activity was dependent on the expression of TF in monocytes since antibodies to TF inhibited the effect of the toxins and TF was detected on the surface of monocytes by flow cytometry. In the supernatants from staphylococcal toxin-stimulated mononuclear cells, interleukin (IL)-1 beta was detected by ELISA. Furthermore, the increased procoagulant activity and TF expression in monocytes induced by the staphylococcal toxins were inhibited in the presence of IL-1 receptor antagonist, a natural inhibitor of IL-1 beta.

CONCLUSIONS

The present study shows that superantigens from S. aureus activate the extrinsic coagulation pathway by inducing expression of TF in monocytes, and that the expression is mainly triggered by superantigen-induced IL-1 beta release.

Increased plasma homocysteine levels without signs of vitamin B12 deficiency in patients with multiple sclerosis assessed by blood and cerebrospinal fluid homocysteine and methylmalonic acid

OBJECTIVE

The aim of this study was to evaluate if multiple sclerosis (MS) is associated with vitamin B12 (cobalamin) deficiency.

METHODS

We measured serum vitamin B12, plasma folate, serum methylmalonic acid (MMA), plasma homocysteine (tHcy) and also cerebrospinal fluid (CSF) MMA and tHcy in 72 patients with MS and 23 controls.

RESULTS

The mean plasma tHcy level was significantly increased in MS patients (11.6 micromol/L) compared with controls (7.4 micromol/L) (P = 0.002). Seven patients showed low serum vitamin B12 levels but only one of them had concomitant high plasma tHcy. None of them showed high serum MMA. Plasma or blood folate levels did not differ between MS patients and controls. We found no significant differences in mean values or frequency of pathological tests of serum B12, serum MMA, mean corpuscular volume (MCV), haemoglobin concentration, CSF tHcy or CSF MMA between patients and healthy subjects. There were no correlations between CSF and serum/plasma levels of MMA or tHcy. Serum vitamin B12, serum MMA, plasma tHcy, CSF Hcy or CSF MMA were not correlated to disability status, activity of disease, duration of disease or age.

CONCLUSIONS

The relevance of the increased mean value of plasma tHcy thus seems uncertain and does not indicate functional vitamin B12 deficiency. We can not, however, exclude the possibility of a genetically induced dysfunction of the homocysteine metabolism relevant for the development of neuroinflammation/degeneration. Our findings indicate that, regardless of a significant increase in plasma tHcy in MS patients, the MS disease is not generally associated with vitamin B12 deficiency since we did not find any other factors indicating vitamin B12 deficiency. Analysis of CSF MMA and CSF tHcy, which probably reflects the brain vitamin B12 status better than serum, are not warranted in MS. We conclude that B12 deficiency, in general, is not associated with MS.

Adults with cerebral palsy: walking ability after progressive strength training

The purpose of this study was to evaluate effects of a progressive strength training programme on walking ability in adults with cerebral palsy. Ten individuals with spastic diplegia (seven males, three females; mean age 31, range 23-44 years) participated twice a week over 10 weeks. Seven individuals with spastic diplegia (four males, three females; mean age 33, range 25-47 years) who did not receive strength training served as controls. All individuals were ambulatory but motor ability ranged from functional walkers to individuals who always required walking aids and used a wheelchair regularly. Significant improvements were seen in isometric strength (hip extensors p=0.006, hip abductors p=0.01), and in isokinetic concentric work at 30 degrees/s (knee extensors p=0.02) but not in eccentric work. Results also showed significant improvements in Gross Motor Function Measure (GMFM) dimensions D and E (p=0.005), walking velocity (p=0.005), and Timed Up and Go (p=0.01). There was no increase in spasticity for those who underwent strength training. Individuals in the control group did not show any significant improvement in any measured variable. The groups were small, however, and there was no significant difference between the groups in any measured variable. These findings suggest that a 10-week progressive strength training programme improves muscle strength and walking ability without increasing spasticity.

The kinase insert domain-containing receptor (KDR) is regulated by shear stress

OBJECTIVE

Intimal hyperplasia develops in areas with low shear stress. The aim of the present study was to investigate if the mRNA expression of vascular endothelial growth factor (VEGF), Fms-like tyrosine kinase-1 receptor (Flt-1) and kinase insert domain-containing receptor (KDR) is regulated by shear stress.

DESIGN

Endothelial cells from human umbilical veins were in an in vitro system subjected to different levels of shear stress during 1 and 12 h. The mRNA expression of VEGF, Flt-1 and KDR was measured with RT-PCR. eNOS served as positive control and actin as housekeeping gene.

RESULTS

The KDR expression was isolated upregulated 3-4 times after 12 h exposure to high shear stress.

CONCLUSION

The genetic expression of KDR is upregulated by shear stress and this response is time dependent.

Changes in middle cerebral artery blood flow after carotid endarterectomy as monitored by transcranial Doppler

OBJECTIVE

By using transcranial Doppler (TCD) it is possible to measure blood flow velocities within the circle of Willis. In this study, TCD was performed before and after carotid endarterectomy (CEA) with the aim to describe cerebral hemodynamics after normalization of the carotid artery blood flow.

METHODS

Thirty CEA patients were consecutively entered into the TCD study, whereas 15 patients were referred for postoperative TCD for various clinical reasons. All 45 patients were investigated by using TCD: first preoperatively, then during the first few days after CEA before discharge from the hospital, and finally 3 to 12 months later. In addition, all patients underwent duplex investigation of the internal carotid artery the day before surgery and 3 months postoperatively. For the analysis, the patients were divided into two groups, one with (S-group), suspected postoperative neurologic complications/symptoms and another one without (C-group). Six patients were assigned to the S-group and 37 to the C-group, the latter including two patients who underwent bilateral CEAs.

RESULTS

In the whole study group,a significant postoperative increase in systolic flow velocity was recorded bilaterally in the middle cerebral artery (MCA) as measured some days after surgery. The patients in the S-group showed high blood flow velocities mainly in the MCA on the ipsilateral side. A contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion (n = 9) if the late follow-up investigation was chosen as a reference value. Twenty patients in the C-group formed a subgroup with high blood pressure and/or headache postoperatively (CB-group) The other 19 patients were referred to as the CA-group. The CB- and S-groups showed more pronounced vessel disease in internal carotid artery on the contralateral side combined with lower collateral capacity in the circle of Willis compared to the CA-group. In the S-group the mean +/- standard deviation peak systolic velocity in ipsilateral MCA increased from a preoperative value of 0.71 +/- 0.22 m/sec to 2.23 +/- 0.72 m/sec (P <.005). In the CB-group, we observed a bilateral MCA blood flow velocity increase from 0.72 +/- 0.18 to 1.35 +/- 0.56 m/sec (P <.0001) on the ipsilateral side and from 0.82 +/- 0.37 to 1.28 +/- 0.66 m/sec (P < 0.001) on the contralateral side. In the CA-group, we observed minor bilateral blood flow velocity increases in the MCA, from 0.79 +/- 0.25 m/sec to 1.03 +/- 0.33 m/sec on the ipsilateral (P <.001) and from 0.70 +/- 0.17 m/sec to 0.93 +/- 0.26 m/sec on the contralateral side (P <.005). At the follow-up 3 to 12 months after surgery, the MCA flow velocities had returned to normal.

CONCLUSIONS

Soon after surgery, blood flow velocity increases often bilaterally in the MCA. However a contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion if the late follow-up investigation was chosen as a reference value. The clinical significance of bilateral flow velocity increases is uncertain, but very high blood flow velocities might be a signal for cerebrovascular hyperperfusion. In those patients, increased postoperative surveillance is recommended.

Prostate-specific antigen for prostate cancer staging in a population-based register

OBJECTIVE

Previous studies have shown a relationship between serum prostate-specific antigen (PSA) level and prostate tumour volume. Reports based on selected case series have also indicated that serum PSA may be used for staging, although a varying prevalence of metastasizing tumours complicates the interpretation of these studies. In order to determine the accuracy of the serum level of PSA in predicting the presence of metastases we performed a prospective cohort study of a geographically defined population of men with prostate cancer.

METHODS

Serum level of PSA and the results of investigations for regional lymph node and distant metastases were recorded for all 8328 men with prostate cancer registered in the Swedish National Prostate Cancer Register 1996-1997.

RESULTS

The prevalence of lymph node metastases among men who had undergone lymph node exploration was 4%, 16% and 33% for well, moderately and poorly differentiated tumours. The corresponding prevalence of distant metastases was 12%, 30% and 48%. With serum PSA <20 ng/ml as a cut-off point the negative likelihood ratios for well and moderately differentiated tumours were found to be 0.47 and 0.45 for lymph node metastases and 0.24 and 0.18 for distant metastases, resulting in post-test probabilities >92% for the exclusion of metastases. In men with poorly differentiated tumours, the negative likelihood ratio would need to be even lower to safely exclude disseminated disease.

CONCLUSION

For well to moderately differentiated tumours, further investigations to assess the presence of metastases may be omitted with no great risk for understaging if serum PSA <20 ng/ml.

Prostate-specific antigen as surrogate for characterizing prostate cancer subgroups

OBJECTIVE

To evaluate how serum prostate-specific antigen (PSA) levels in a population-based cohort of men with prostate cancer vary with age and intensity in the diagnostic activity and to describe the treatment selection processes associated with PSA level.

MATERIAL AND METHODS

All men in the Swedish National Prostate Cancer Register diagnosed during 1996-1997 were included. In 1996 the register included 19 counties, covering 61% of the Swedish male population, and in 1997 21 counties with 79% of the Swedish male population.

RESULTS

A total of 8328 men were registered. PSA levels were missing in 341 cases. With increasing PSA there was a shift towards more advanced and poorly differentiated tumours. PSA at diagnosis increased with age, with the exception of patients younger than 50 years who had higher PSA values. The mean logarithm of PSA correlated negatively with the percentage of localized tumours (p < 0.005) and the age-adjusted incidence (p < 0.05) in each respective county in 1997. PSA was higher in men receiving radiotherapy compared with those treated with radical prostatectomy as well as in the group treated with bilateral orchiectomy compared with those receiving GnRH-analogues.

CONCLUSIONS

If PSA is used as a surrogate measure of extent of tumour volume in a population of prostate cancer patients, our findings indicate that age distribution and differences in incidence (possibly due to variation in diagnostic activity) should be taken into account. In our cohort there was a selection process, probably in part guided by PSA level, when choosing type of curative or palliative treatment.

Prevalence of stress incontinence in nulliparous elite trampolinists

During trampoline jumping the pelvic floor is exposed to high forces. There has been a general belief that physically fit women have a strong pelvic floor as a result of their regular training, thus preventing urinary incontinence. The aim of this study was to survey the prevalence of stress urinary incontinence in female elite trampolinists. The prevalence of urinary incontinence was assessed by a questionnaire, sent to all 35 elite trampolinists (mean age 15, range 12-22 years) in Sweden. Eighty percent of the trampolinists reported involuntary urinary leakage, but only during trampoline training. The leakage started after 2.5 (range 1-4) years of training. Age (P < 0.001), duration of training (P = 0.04), and training frequency (P = 0.01) were significantly associated with leakage. All women above 15 years of age (n = 23) reported urinary leakage (P < 0.001). Eighteen incontinent women continued the study and their leakage was verified by a pad test. The leakage averaged 28 g during a jump session. The muscle strength was measured with perineometry in 10 women and showed good strength in the pelvic floor muscles.

Perceived disability and observed functional limitations in obese women

OBJECTIVE

To describe perceived disability in obese women.

DESIGN

Comparisons of perceived disability in obese women and in a normal-weight reference group regarding activities of daily life (ADL), mobility, housework and professional work as well as comparisons of perceived disability and observed functional limitations reported in a previous study.

SUBJECTS

Fifty-seven consecutively selected obese female outpatients, mean age 44 y (body mass index (BMI) 37 kg/m2) and 22 voluntary referents, mean age 49 y (BMI 22 kg/m2).

MAIN OUTCOME MEASURES

A pain questionnaire (for background data) and a disability questionnaire, which is new, detailed and specific with test-retest stability and content- and criterion-referenced validity. Comparisons of results from the questionnaire and a functional test regarding observations of similar functional limitations.

RESULTS

The obese women perceived disability to a much higher extent (P<0.003) than did the normal-weight women. The main problems concerned occupational work in strenuous positions, strain and pain, sports, walking outdoors or on stairs, and moderate housework requiring squatting, stooping or lifting. Rising from sofas, pedicure and stress incontinence were problematic. The correlation between perceived disability and functional limitations was fairly good (r(s)=0.56) but ranged widely (r(s)=0.14-0.61). Within the group of obese women the disability neither correlated to BMI nor age, rather to lower-body pain.

CONCLUSION

The disability questionnaire conveyed new and detailed information of disability problems in everyday life in obese women. It highlighted the difference between the disability these women may perceive and the functional limitations we can observe and measure. This result is of great clinical relevance in the care of obese women.

Lung clearance in children with Duchenne muscular dystrophy or spinal muscular atrophy with and without CPAP (continuous positive airway pressure)

Bronchiolar clearance was studied in 7 boys in the age range of 8 to 17 years, 6 with Duchenne muscular dystrophy (DMD) and 1 with spinal muscular atrophy type II (SMA-II). These boys had healthy lungs but a severely reduced muscular strength (wheelchair dependent). In 6 of the boys, clearance was studied twice, at one occasion as a control and at the other occasion following treatment with continuous positive airway pressure (CPAP). A control group of healthy adults was used. In the clearance examinations, 6-microm Teflon particles, labeled with III In was inhaled extremely slowly, 0.05 L/s. This gives a deposition mainly in the bronchioles. Lung retention was measured after 0,24,48, and 72 hours. A model for deposition of particles in the adult lung was scaled down to represent the children in this study. Deposition in various airway generations was calculated to be similar in children and adults. Also the measured retentions were similar in the boys and the adults. In the clearance experiments during CPAP treatment, there was a significantly lower retention after 72 hours (but not after 24 and 48 hours) than in the control experiments. Theresults indicate that a severe reduction of muscular strength, and thereby a reduction of mechanical movement of the lung, does not affect clearance from large and small airways. However, some effect of clearance from small airways cannot be excluded due to the short measuring period. The small but significant effect of the CPAP treatment might have potential clinical importance and suggest that bronchiolar clearance can be affected by some form of mechanical force.

Mucosal output of eotaxin in allergic rhinitis and its attenuation by topical glucocorticosteroid treatment

BACKGROUND

Eotaxin is a chemokine that attracts and activates eosinophils. The present study examines the occurrence of eotaxin in nasal mucosal surface liquids in patients with seasonal allergic rhinitis without allergen exposure and during repeat allergen challenge with and without topical glucocorticosteroid treatment. The number of subepithelial eosinophils and mucosal outputs of bulk plasma (alpha2-macroglobulin) and eosinophil cationic protein (ECP) are also examined.

METHODS

Twelve patients underwent daily allergen challenges for 6 days. Separately, 14 patients, who were receiving budesonide and placebo in a parallel group design, also underwent allergen challenge for 6 days. Nasal biopsies were obtained before and 24 h after the allergen challenge series, and lavages were carried out before and 15 min after selected allergen challenges.

RESULTS

At baseline nasal lavage fluid levels of eotaxin correlated to levels of alpha2-macroglobulin and ECP. After the first allergen challenge there was a correlation between nasal lavage fluid levels of eotaxin and ECP. Repeat allergen exposure increased the mucosal output of eotaxin (P <0.05) and ECP (P <0.01) as well as eosinophil numbers (P <0.01), but no correlation was found between increased eosinophil numbers and eotaxin. Budesonide reduced eotaxin levels during repeat allergen challenge (P <0.05).

CONCLUSIONS

Repeat allergen exposure in allergic rhinitis is associated with increased mucosal output of eotaxin. Topical budesonide attenuates this effect, suggesting the possibility that inhibitory effects on mucosal eotaxin may contribute to anti-eosinophilic actions of topical glucocorticosteroids.

Staphylococcus aureus induces release of bradykinin in human plasma

Staphylococcus aureus is a prominent human pathogen. Here we report that intact S. aureus bacteria activate the contact system in human plasma in vitro, resulting in a massive release of the potent proinflammatory and vasoactive peptide bradykinin. In contrast, no such effect was recorded with Streptococcus pneumoniae. In the activation of the contact system, blood coagulation factor XII and plasma kallikrein play central roles, and a specific inhibitor of these serine proteinases inhibited the release of bradykinin by S. aureus in human plasma. Furthermore, fragments of the cofactor H-kininogen of the contact system efficiently blocked bradykinin release. The results suggest that activation of the contact system at the surface of S. aureus and the subsequent release of bradykinin could contribute to the hypovolemic hypotension seen in patients with severe S. aureus sepsis. The data also suggest that the contact system could be used as a target in the treatment of S. aureus infections.