Latent tuberculosis in pregnant women: a patient perspective

SETTING: Screening and treatment for latent tuberculosis (LTBI) in pregnant women remains controversial, although studies suggest there is a significantly increased risk of progression to active disease in the postpartum period. Studies have also shown that adherence to postpartum follow-up and treatment of LTBI is poor. To our knowledge, the reasons for this have not been investigated. We therefore identified pregnant women originating from high-burden tuberculosis (TB) countries now living in the Stockholm region, and screened and treated them for LTBI.OBJECTIVE: To explore how women diagnosed with LTBI during pregnancy understood and experienced their diagnosis and treatment.DESIGN: Sixteen semi-structured interviews with women on treatment for LTBI were analysed using content analysis with an inductive approach.RESULTS: None of the women were familiar with LTBI and assumed they had active TB, causing anxiety about who they might have infected and how it would affect the baby, as well as the fear of being stigmatised. They showed great ability to search for and understand information regarding their condition. Once treatment was initiated, they were motivated to complete it.CONCLUSION: Our findings suggest that the key factors was to provide treatment along with reliable information about LTBI to help patients overcome their concerns and misconceptions.

Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: a retrospective cohort study

AIM

This was to examine healthy children and adolescents treated under general anaesthesia (GA) and a matched control group not receiving GA to compare treatment and preventive care received prior to GA treatment.

METHODS

This retrospective cohort study included 71 healthy subjects and 213 age- and gender-matched control subjects. The treatment group had been consecutively referred from the Public Dental Health Service (PDS) in Stockholm to the Department of Paediatric Dentistry, Eastman Institute, Stockholm during 2006-2007. Data was extracted from the patient records at the PDS, including variables such as number of dental visits, treatment/prophylaxis prior to GA, number of missed and cancelled appointments, and number of decayed teeth.

RESULTS

On average, the treatment group had significantly more decayed teeth (p < 0.001) than the control group. Furthermore, the treatment group had significantly more restorations (p < 0.01), had visited the dentist significantly more often (p < 0.001), and had undergone significantly more behaviour management treatment and preventive treatment (p < 0.001). In the treatment group 65% of the children and adolescents, had received no behaviour management treatment and 48%, no preventive treatment.

CONCLUSIONS

In the Stockholm PDS, over half of the children and adolescents referred by general dentists to paediatric specialists had no behaviour management treatment and nearly half, no preventive treatment, despite receiving significantly more operative treatment compared with matched controls. General dentists should target high caries-risk patients for additional behaviour management and preventive care to reduce the need for treatment under GA.

Extravasal albumin concentration modulates contractile responses of renal afferent arterioles

AIM

Afferent arterioles (AA) hold a key position in the regulation of renal blood flow and glomerular filtration rate. Being the effector site of tubuloglomerular feedback, the afferent arteriole contributes to the renal handling of sodium and fluid. Dehydration goes along with increased renal interstitial protein concentration. Here, the hypothesis was tested that extravasal protein concentration directly modulates afferent arteriolar tone, a mechanism which may contribute to body fluid volume control.

METHOD

The effect of increased extravasal albumin concentration on the vascular reactivity was investigated in renal AA and interlobar arteries of mice, in rat renal AA and in pancreatic islet arterioles.

RESULTS

Albumin (2 and 4% in the bath solution) significantly potentiated the contractile response of renal afferent arterioles induced by angiotensin II and adenosine, as well as their combination, compared to the control situation (0.1% albumin). Albumin did not influence the contractility of larger renal vessels or pancreatic islet arterioles. Mimicking the increase in the osmolality induced by 4% albumin by applying mannitol to the bath solution also increased the response of renal arterioles to Ang II. However, the effect was smaller compared to that of albumin. The nitric oxide bioavailability, measured by DAF-FM fluorescence, was reduced in afferent arterioles exposed to 4% albumin.

CONCLUSION

The protein-induced modulation of AA tone is mediated by the increased osmolality as well as by NO scavenging. The results suggest a possible contribution of these mechanisms to the control of extracellular fluid volume via adjustment of renal blood flow and glomerular filtration rate.

Effectiveness of internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care

OBJECTIVE

Guided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care.

METHOD

We conducted a cohort study investigating all patients (n = 570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR).

RESULTS

Participants made large improvements from screening and pretreatment assessments to posttreatment (Cohen's d range on the PDSS-SR = 1.07-1.55). Improvements were sustained at 6-month follow-up.

CONCLUSION

This study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

The α2-adrenoceptor antagonist yohimbine normalizes increased islet blood flow in GK rats: a model of type 2 diabetes

Overexpression of α2A-adrenoceptors contributes to type 2 diabetes in GK rats. We aimed to investigate if α2-adrenoceptor inhibition affected islet blood flow in these rats. Anesthetized GK and Wistar-F rats were given the α2-adrenoceptor inhibitor yohimbine (2.5 mg/kg BW) intravenously. The GK rats had higher blood glucose and serum insulin concentrations than WF rats. Yohimbine affected neither of these values in WF rats, but decreased blood glucose and increased serum insulin concentrations in GK rats. Total pancreatic and islet blood flows, measured with microspheres, were increased in GK when compared to WF rats. Yohimbine affected none of the blood flow values in WF rats, whereas islet blood flow in GK rats was reduced to values similar to those seen in WF rats. Overexpression of α2-adrenoceptors may contribute to the increased islet blood flow seen in GK rats, and may be eligible for pharmacologic intervention.

Two-week treatment with the β₃-adrenoceptor antagonist SR59230A normalizes the increased pancreatic islet blood flow in type 2 diabetic GK rats

The Goto-Kakizaki (GK) rat, a type 2 diabetes model, has increased pancreatic islet and white adipose tissue (WAT) blood flow, and this can be normalized by acute administration of SR59230A, a β₃ -adrenoceptor antagonist. We now implanted osmotic pumps which allowed a constant release of saline or SR59230A (0.6 mg/kg × day) for 2 weeks. A decrease in islet blood flow was seen also after 2 weeks of continuous SR59230A treatment in the GK rat. However, no improvement in glucose tolerance was seen in the GK rats. Neither did SR59230A affect insulin secretion from isolated islets in vitro. WAT blood flow was not affected by the 2-week SR59230A treatment. Thus, the increased islet blood flow seen in the GK rat can be normalized for up to 2 weeks, which opens the possibilities for further studies on the long-term functional role on the islet blood flow increase in this type 2 diabetes model.

Differentiating neural crest stem cells induce proliferation of cultured rodent islet beta cells

AIMS/HYPOTHESIS

Efficient stimulation of cycling activity in cultured beta cells would allow the design of new strategies for cell therapy in diabetes. Neural crest stem cells (NCSCs) play a role in beta cell development and maturation and increase the beta cell number in co-transplants. The mechanism behind NCSC-induced beta cell proliferation and the functional capacity of the new beta cells is not known.

METHODS

We developed a new in vitro co-culture system that enables the dissection of the elements that control the cellular interactions that lead to NCSC-dependent increase in islet beta cells.

RESULTS

Mouse NCSCs were cultured in vitro, first in medium that stimulated their proliferation, then under conditions that supported their differentiation. When mouse islet cells were cultured together with the NCSCs, more than 35% of the beta cells showed cycle activity. This labelling index is more than tenfold higher than control islets cultured without NCSCs. Beta cells that proliferated under these culture conditions were fully glucose responsive in terms of insulin secretion. NCSCs also induced beta cell proliferation in islets isolated from 1-year-old mice, but not in dissociated islet cells isolated from human donor pancreas tissue. To stimulate beta cell proliferation, NCSCs need to be in intimate contact with the beta cells.

CONCLUSIONS/INTERPRETATION

Culture of islet cells in contact with NCSCs induces highly efficient beta cell proliferation. The reported culture system is an excellent platform for further dissection of the minimal set of factors needed to drive this process and explore its potential for translation to diabetes therapy.

Systemic up-regulation of TLR4 causes lipopolysaccharide-induced augmentation of nasal cytokine release in allergic rhinitis

BACKGROUND

Allergic rhinitis is a systemic disorder, and it is clinically well recognized that it can be aggravated by infection. Activation of the innate immune system constitutes a critical element in the process. Toll-like receptors (TLRs) comprise a part of the innate immune system, and lipopolysaccharide (LPS)-induced activation of TLR4 represents bacterial-induced interactions in various model systems. The present study examines how TLR2 and TLR4 expression is affected by symptomatic allergic rhinitis, and if LPS added upon allergen affects nasal cytokine release.

METHODS

In patients with pollen-induced allergic rhinitis and healthy non-allergic volunteers, nasal lavage (NAL), peripheral blood and bone marrow were sampled before and during the pollen season. TLR2 and TLR4 expression was determined flow cytometrically. Changes in the TLR receptor expression pattern were evaluated by a nasal challenge with allergen followed by LPS, or vice versa. Symptoms along with cells and cytokines in NAL were analyzed.

RESULTS

TLR4 expression increased in leukocytes in NAL, peripheral blood and bone marrow during symptomatic allergic rhinitis. A similar increase was seen for TLR2 in neutrophils in blood. Nasal challenge with allergen followed by LPS augmented the release of IL-4, IL-5, IL-10, IL-13, IFN-γ and TNF-α.

CONCLUSION

A systemic up-regulation of TLR4 in symptomatic allergic rhinitis may explain why LPS preceded by allergen increases nasal cytokine release.

Neural crest stem cells increase beta cell proliferation and improve islet function in co-transplanted murine pancreatic islets

AIMS/HYPOTHESIS

Long-term graft survival after islet transplantation to patients with type 1 diabetes is insufficient, necessitating the development of new strategies to enhance transplant viability. Here we investigated whether co-transplantation of neural crest stem cells (NCSCs) with islets improves islet survival and function in normoglycaemic and diabetic mice.

METHODS

Islets alone or together with NCSCs were transplanted under the kidney capsule to normoglycaemic or alloxan-induced diabetic mice. Grafts were analysed for size, proliferation, apoptosis and insulin release. In diabetic recipients blood glucose levels were examined before and after graft removal.

RESULTS

In mixed transplants NCSCs actively migrated and extensively associated with co-transplanted pancreatic islets. Proliferation of beta cells was markedly increased and transplants displayed improved insulin release in normoglycaemic mice compared with those receiving islet-alone transplants. Mixed grafts survived successfully and partially restored normoglycaemia in alloxan-induced diabetic mice.

CONCLUSIONS/INTERPRETATION

Co-grafting of NCSCs with pancreatic islets improved insulin release in mixed transplants and enhanced beta cell proliferation, resulting in increased beta cell mass. This co-transplantation model offers an opportunity to restore neural-islet interactions and improve islet functions after transplantation.

Reversal of high pancreatic islet and white adipose tissue blood flow in type 2 diabetic GK rats by administration of the beta3-adrenoceptor inhibitor SR-59230A

Previous studies have shown that the Goto-Kakizaki (GK) rat, a nonobese type 2 diabetes model, has an increased white adipose tissue (WAT) and islet blood flow when compared with control rats. The aim of the study was to examine if these increased blood flow values in GK rats could be affected by the beta(3)-adrenoceptor antagonist SR-59230A. We measured organ blood flow with a microsphere technique 10 min after administration of SR-59230A (1 mg/kg body wt), or the corresponding volume of 0.9% NaCl solution (1 ml/kg body wt) in rats anaesthetized with thiobutabarbital. The GK rat had an increased blood flow in all intra-abdominal adipose tissue depots except for the sternal fat pad compared with Wistar-Furth (WF) rats. However, no differences were seen in the blood perfusion of subcutaneous white or brown adipose tissue. The blood flow was also increased in both the pancreas and in the islets in the GK rat compared with WF rats. SR-59230A treatment affected neither WAT nor pancreatic blood flow in WF rats. In GK rats, on the other hand, SR-59230A decreased both WAT and islet blood flow values to values similar to those seen in control WF rats. The whole pancreatic blood flow was not affected by SR-59230A administration in GK rats. Interestingly, the brown adipose tissue blood flow in GK rats increased after SR-59230A administration. These results suggest that beta(3)-adrenoceptors are involved in regulation of blood flow both in islet and in adipose tissue.

Reduction of isoniazid bioavailability in normal men by concomitant intake of food

The influence of food intake on the bioavailability of isoniazid (INH) has been examined in nine healthy male volunteers. INH was administered as a single oral dose, both in fasting state and together with a standardized breakfast. Numerous venous blood samples were obtained 5 min-6 hours after the INH ingestion, and the concentrations of unmetabolized INH in serum were assessed by spectrophotometry. The observations indicate that both the peak concentration and the total amount of INH absorbed are greatly reduced when the drug is ingested together with food. Hence it is recommended that, in the treatment of tuberculosis with INH, the drug should be given on an empty stomach. The data may also have some bearing on the use of INH for assessing acetylation rates and estimating dosages of hydralazine and related drugs.

Resistin increases islet blood flow and decreases subcutaneous adipose tissue blood flow in anaesthetized rats

AIM

Resistin is an adipokine which has been suggested to participate in the induction of insulin resistance associated with type 2 diabetes. The aim of the present study was to investigate whether acute administration of resistin influences tissue blood perfusion in rats.

METHODS

Resistin was administered as an intravenous infusion of 7.5 microg h(-1) (1.5 mL h(-1)) for 30 min to rats anaesthetized with thiobutabarbital. A microsphere technique was used to estimate the blood flow to six different depots of white adipose tissue (WAT), brown adipose tissue (BAT), as well as to the pancreas, islets, duodenum, colon, kidneys, adrenal glands and liver.

RESULTS

Resistin administration led to an increased blood flow to the pancreas and islets and a decrease in subcutaneous WAT and BAT. Intra-abdominal white adipose tissue blood flow and that to other organs were not affected.

CONCLUSION

Acute administration of resistin markedly affects the blood perfusion of both the pancreas and subcutaneous white adipose tissue depots. At present it is unknown whether resistin exerts a direct effect on the vasculature, or works through local or systemic activation of endothelial cells and/or macrophages. The extent to which this might contribute to the insulin resistance caused by resistin is yet unknown.

Genetic variation in the PTH pathway and bone phenotypes in elderly women: evaluation of PTH, PTHLH, PTHR1 and PTHR2 genes

INTRODUCTION

Parathyroid hormone (PTH) is a key regulator of calcium metabolism. Parathyroid hormone-like hormone (PTHrP) contributes to skeletal development through regulation of chondrocyte proliferation and differentiation during early bone growth. Both PTH and PTHrP act through the same receptor (PTHR1). A second receptor, PTHR2, has been identified although its function is comparatively unknown. PTH hyper-secretion induces bone resorption, whereas intermittent injection of PTH increases bone mass. To explore the effects of genetic variation in the PTH pathway, we have analysed variations in PTH, PTHLH, PTHR1 and PTHR2 in relation to bone mass and fracture incidence in elderly women.

MATERIALS AND METHODS

This study includes 1044 elderly women, all 75 years old, from the Malmö Osteoporosis Prospective Risk Assessment study (OPRA). Single nucleotide polymorphisms (SNPs) from 4 genes and derived haplotypes in the PTH signaling pathway were analysed in 745-1005 women; 6 SNPs in the PTH gene and 3 SNPs each in the PTHLH, PTHR1 and PTHR2 genes were investigated in relation to BMD (assessed at baseline), fracture (434 prevalent fractures of all types over lifetime, self-reported and 174 incident fractures up to 7 years, X-ray verified) and serum PTH.

RESULTS AND CONCLUSION

Individually, SNPs in the 4 loci did not show any significant association with BMD. Neither were PTHLH, PTHR1 and PTHR2 polymorphisms associated with fracture. Three of 5 common haplotypes, accounting for >98% of alleles at the PTH locus, were identified as independent predictors of fracture. Haplotype 9 (19%) was suggestive of an association with fractures of any type sustained during lifetime (p=0.018), with carriers of one or more copies of the haplotype having the lowest incidence (p=0.006). Haplotypes 1 (13%) and 5 (37%) and 9 were suggestive of an association with fractures sustained between 50 and 75 years (p=0.02, p=0.013 and p=0.034). Carriers of haplotypes 1 and 5 were more likely to suffer a fracture (haplotype 1, p=0.045; haplotype 5, p=0.008). We conclude, that while further genotyping across the gene is recommended, in this cohort of elderly Swedish women, polymorphisms in PTH may contribute to the risk of fracture through mechanisms that are independent of BMD.

Hemodynamic effect of iopromide in pancreas-duodenum transplanted rats

BACKGROUND

Radiological contrast media (CM) have been suggested to be able to impair pancreatic microcirculation, especially in acute pancreatitis.

PURPOSE

To evaluate the effects of the low-osmolar CM iopromide on total pancreatic and especially islet blood perfusion after whole pancreas transplantation.

MATERIAL AND METHODS

Rats receiving a pancreas-duodenum transplantation 2 days earlier, i.e., with graft pancreatitis, were injected with iopromide. Blood perfusion measurements were then made with a microsphere technique.

RESULTS

The graft blood perfusion was decreased in control rats when compared to the endogenous pancreas. Administration of iopromide increased both total pancreatic and islet blood perfusion in the grafted pancreas, but not in the endogenous gland. No effects on blood perfusion to either the native or transplanted duodenum were seen after iopromide administration.

CONCLUSION

Iopromide increases the blood perfusion of a whole pancreas transplant 2 days after implantation, i.e., when graft pancreatitis is present. The consequences of this CM-induced hyperperfusion for graft pancreatic function remain to be established.Key words: Intravascular contrast media; islet blood perfusion; graft pancreatitis;pancreas transplantation; pancreatic blood perfusion

Radiological contrast media and pancreatic blood perfusion in anesthetized rats

BACKGROUND

Radiological contrast media (CM) have been suggested to be able to impair pancreatic microcirculation.

PURPOSE

To evaluate the effects of an iso-osmolar (iodixanol, 290 mOsm/kg H2O) and a low-osmolar (iopromide, 660 mOsm/kg H2O) CM on total pancreatic and islet blood perfusion.

MATERIAL AND METHODS

Thiobutabarbital-anesthetized rats were injected with iodine equivalent doses (600 mg I/kg body weight) of iodixanol or iopromide. Saline or low-osmolar mannitol (660 mOsm/kg H2O) solutions served as control substances. Blood perfusion measurements were then carried out with a microsphere technique.

RESULTS

Iso-osmolar iodixanol had no effects on blood perfusion. Low-osmolar iopromide increased total pancreatic blood perfusion, whereas islet blood perfusion was unchanged. No differences were seen when mannitol solutions were given.

CONCLUSION

Neither an iso-osmolar nor a low-osmolar CM affected pancreatic islet blood perfusion, whereas the low-osmolar CM increased total pancreatic blood perfusion. The absence of hemodynamic effect of low-osmolar mannitol suggests that the hyperosmolality per se of iopromide versus iodixanol does not induce the hemodynamic effect. The consequences of the effect of iopromide for pancreatic function remain to be established.

Lipopolysaccharide administration to the allergic nose contributes to lower airway inflammation

BACKGROUND

Allergic rhinitis (AR) is an inflammatory reaction not confined to a single local compartment, but rather involving the whole airway system. Allergens known to induce AR are not always the sole trigger of the inflammatory reaction as infections and organic dust might also cause exacerbations of rhinitis and associated conditions.

OBJECTIVE

To examine the effects of intranasal lipopolysaccharide (LPS) exposure, as a surrogate for upper airway bacterial infections, in patients with symptomatic AR.

METHODS

Fourteen patients with a history of moderate to severe pollen-induced AR were challenged intranasally with LPS. After 3-6 weeks, the same patients were challenged again, first with allergen and 24 h later with LPS. Nasal symptom scores, nasal lavage leucocyte counts and nasal airway resistance were assessed at 6-24 h after each provocation along with measurements of nitric oxide (NO) levels in the nose and lung.

RESULTS

Six hours after the LPS challenge, an increased level of leucocytes could be obtained in the lavage fluid, but no symptoms were experienced and no increase in nasal resistance could be recorded. The NO production in the upper and lower airways was similar before and 6 h after the provocation. In contrast, in patients exposed to pollen before the LPS challenge, both the nasal and the pulmonary NO levels were enhanced. This was accompanied by an increase in leucocytes.

CONCLUSION

The present study demonstrates a priming effect of allergen on the nasal response to LPS as well as the presence of a systemic link between airway mucosal sites in the upper and lower airways. This suggests that exogenously derived signals, like upper airway infections, can interfere with the initiation, maintenance and progression of asthma.

Improved vascular engraftment and function of autotransplanted pancreatic islets as a result of partial pancreatectomy in the mouse and rat

AIMS/HYPOTHESIS

The few patients subjected to autotransplantation of pancreatic islets after pancreatectomy usually become normoglycaemic after using islets from the resected organ only, whereas allogeneic recipients usually require at least two grafts to retain normoglycaemia. Previous experimental studies have demonstrated that islets transplanted to non-pancreatectomised recipients acquire a markedly decreased blood vessel density, which leads to a hypoxic microenvironment. The aim of the present study was to test the hypothesis that autotransplanted islets have better vascular engraftment and function as a result of the pancreatic surgery involved.

MATERIALS AND METHODS

In the present study, athymic mice and inbred rats were subjected to a 60% pancreatectomy and transplanted with human or rat islets, respectively, 4 days later. Control animals underwent sham surgery. Blood flow, oxygen tension, vascular density and endocrine volume in the islet grafts were measured 1 month after transplantation. Separate grafts were used for perfusion experiments and for assessment of beta cell proliferation and endocrine cellular apoptosis at different time periods after transplantation.

RESULTS

Islet grafts in partially pancreatectomised recipients had an increased blood flow, oxygen tension, blood vessel density and endocrine mass 1 month post-transplantation compared with control animals. They also exhibited increased insulin release in perfusion experiments performed 1 month post-transplantation, and decreased cellular apoptosis early after transplantation.

CONCLUSIONS/INTERPRETATION

The present study shows that the pancreatectomy procedure itself has beneficial effects on the engraftment of transplanted human and rat islets. Our results provide an additional explanation, besides diminished immunological responses, of the much better outcome of islet autotransplantations compared with allogeneic transplantations in the clinic.

Dextran sulfate sodium-induced colitis generates a transient thymic involution--impact on thymocyte subsets

One of the most widely used animal models for inflammatory bowel disease (IBD) is the dextran sulfate sodium (DSS)-induced colitis. We have previously reported that 5 days administration of DSS in C57Bl/6J mice induces a colonic inflammation that progresses into chronicity after DSS removal, whereas in BALB/cJ mice the inflammation resolves within 4 weeks post-DSS. Here we show that both thymic size and thymocyte numbers dramatically decreased in the acute phase of inflammation in C57Bl/6 mice, 7 days after DSS withdrawal. Mature, CD4(+) and CD8(+) single positive (SP) CD69(lo) CD62L(hi) thymocytes were enriched in these mice, accompanied by a major decrease in the number of immature double positive (DP) thymocytes. However, the different maturation stages within the DP thymocyte subset were unchanged between healthy and inflamed C57Bl/6J mice. Interestingly, as the inflammation progressed into the chronic phase, the thymus recovered and 2 weeks after the acute inflammatory phase all the thymic parameters investigated in this study were restored to normal. In contrast, BALB/cJ mice only develop mild thymic alterations. Nevertheless, we found that within the double negative (DN) thymocytes an increased frequency and also total numbers of CD44(+) CD25(-) (DN1) cells correlated with the severity of colitis, and that the frequency of CD44(-) CD25(-) (DN4) thymocytes decreased proportionally in the acute phase in BALB/cJ mice. Our observations suggest that the thymic effects are intimately connected to the intestinal inflammatory response in colitis regardless of the inflammatory stimuli.

Pancreatic islet blood flow during euglycaemic, hyperinsulinaemic clamp in anaesthetized rats

AIMS

Previous studies have demonstrated that pancreatic islet blood flow is crucially dependent on blood glucose concentration. Thus, hyperglycaemia increases and hypoglycaemia decreases islet blood perfusion, by a combination of nervous and metabolic signals. The aim of the present study was to evaluate if hyperinsulinaemia, without associated hypoglycaemia, affects islet blood flow.

METHODS

Thiobutabarbital-anaesthetized Wistar-Furth rats were subjected to an euglycaemic, hyperinsulinaemic clamp, that is they were infused for 60 min with either saline, insulin (18 mU kg(-1) min(-1)), glucose (27 mg kg(-1) min(-1)) or both glucose and insulin. This was followed by islet blood flow measurements with a microsphere technique.

RESULTS

Animals receiving only glucose doubled their blood glucose and serum insulin concentrations, whereas rats receiving only insulin had blood glucose concentrations <2 mmol L(-1) and a 10-fold increase in serum insulin concentrations. Animals given simultaneous glucose and insulin had normal blood glucose concentrations but a 10-fold increase in serum insulin concentrations. Total pancreatic blood flow was unaffected in all animals. Islet blood flow was increased in hyperglycaemic and decreased in hypoglycaemic rats compared with control rats. Islet blood flow did not differ between clamped and control rats.

CONCLUSIONS

Serum insulin concentration per se does not affect islet blood flow, whereas the ambient blood glucose concentration is of major importance in this context.

Carbon monoxide and pancreatic islet blood flow in the rat: inhibition of haem oxygenase does not affect islet blood perfusion

OBJECTIVE

To determine whether carbon monoxide, a known gaseous vasorelaxator, affects pancreatic islet blood flow in rats.

MATERIAL AND METHODS

Sprague-Dawley rats were anaesthetized with thiobutabarbital and injected intravenously with the haem oxygenase inhibitor tin-protoporphyrin IX dichloride (SnPP; 4, 10 or 20 mg/kg body-weight). After 15 min, blood flow measurements were performed using a microsphere technique.

RESULTS

There was a slight increase in mean arterial blood pressure with the highest dose of SnPP. No effects on total pancreatic, islet, duodenal, colonic, renal or adrenal blood flow were seen with any of the applied doses.

CONCLUSIONS

The findings of this study suggest that the haem oxygenase-carbon monoxide system is likely to be of limited importance in the regulation of blood perfusion to the pancreas, the islets of Langerhans or any of the other studied organs.

A perfusion protocol for highly efficient transduction of intact pancreatic islets of Langerhans

AIMS/HYPOTHESIS

Successful gene transfer to pancreatic islets might be a powerful tool for dissecting the biological pathways involved in the functional impairment and destruction of beta cells in type 1 diabetes. In the long run, such an approach may also prove useful for promoting islet graft survival after transplantation in diabetic patients. However, efficient genetic modification of primary insulin-producing cells is limited by the specific compact structure of the pancreatic islet. We present here a whole-pancreas perfusion-based transduction procedure for genetic modification of intact pancreatic islets.

MATERIALS AND METHODS

We used flow cytometry analysis and confocal microscopy to evaluate the efficiency of in vitro and perfusion-based transduction protocols that use adenoviral and lentiviral vectors expressing green fluorescent protein. Islet cell viability was assessed by fluorescence microscopy and beta cell function was determined via glucose-stimulated insulin secretion.

RESULTS

In intact rat and human pancreatic islets, adenoviral and lentiviral vectors mediated gene transfer to about 30% of cells, but they did not reach the inner cellular mass within the islet core. Using the whole-pancreas perfusion protocol, we demonstrate that at least in rodent models the centrally located insulin-producing cells can be transduced with high efficiency, while preserving the structural integrity of the islet. Moreover, islet cell viability and function are not impaired by this procedure.

CONCLUSIONS/INTERPRETATION

These results support the view that perfusion-based transduction protocols may significantly improve the yield of successfully engineered primary insulin-producing cells for diabetes research.

Islets transplanted intraportally into the liver are stimulated to insulin and glucagon release exclusively through the hepatic artery

Not much is known about the physiology of intraportally transplanted islets. One reason for this is that it is difficult to study such islets, since they are scattered throughout the liver. We employed a perfusion technique to characterize the functional properties of syngeneic intrahepatic 1-month-old islet grafts, and compared them to islets transplanted beneath the kidney capsule, as well as native islets. The cellular composition of the islet grafts was also examined. Glucose and arginine administered through the hepatic artery, but not through the portal vein, induced insulin release from the intraportally implanted islets. Moreover, arginine, only when administered through the hepatic artery, induced glucagon release from the same islets. The first phase of glucose-stimulated insulin release from both islets transplanted to the liver and kidney was delayed, and less prominent when compared to the pancreas. Intraportally transplanted islets contained fewer glucagon-positive cells than islets transplanted to the kidney and native islets. Our findings demonstrate that intraportally transplanted islets respond with insulin and glucagon to secretagogues, but only when stimulated through the hepatic artery. Whether intrahepatic islets may sense other substances than glucose or arginine occurring in high concentrations in the portal vein following intestinal uptake remains to be studied.

Lymphatic vessels in pancreatic islets implanted under the renal capsule of rats

Transplantation of pancreatic islets necessitates an engraftment process, including revascularization of the graft. Studies of graft vasculature have demonstrated that islets become revascularized during the first post-transplant week through an angiogenic process. If this also involves lymphatic vessels is unknown. The aim of the present study was to functionally evaluate if lymphatic vessels, which are absent in endogenous islets, form after islet transplantation. To achieve this, inbred Wistar-Furth rats were transplanted with 250 syngeneic islets under the renal capsule. Intra-vital microscopy of the graft in combination with interstitial injection of Evans Blue was performed 1 week, 1 month or 9-12 months later. In all animals studied, there was drainage through intra-graft lymphatic capillaries emptying into larger lymphatic vessels associated with the renal capsule. The number was slightly lower 1 week post-transplantation. Most of the lymphatic capillaries were present in the graft stroma, rather than interspersed among the endocrine cells. In some animals, we were able to demonstrate dye in regional lymph nodes. We conclude that unlike endogenous islets, islet grafts develop a lymphatic drainage. Its functional importance and characteristics remain to be established. However, it can be speculated that immune reactions may be facilitated by the presence of lymphatic vessels.

Placental dysfunction in Suramin-treated rats – a new model for pre-eclampsia

Impaired placentation and oxidative stress are proposed to play major roles in the pathogenesis of placental dysfunction and pre-eclampsia. This study was carried out to evaluate if inhibited angiogenesis by Suramin injections in early pregnancy may cause a condition resembling pre-eclampsia in rats. Rats of two different Sprague-Dawley strains, U and H, were given intraperitoneal injections of Suramin or saline in early pregnancy. The outcome of pregnancy was evaluated on gestational day 20. Suramin injections caused increased blood pressure and decreased renal blood flow in the U rats. In both rat strains Suramin decreased the placental blood flow and caused fetal growth retardation. In both strains the placental concentration of the isoprostane 8-epi-PGF2alpha was increased, indicating oxidative stress. The serum concentration of Endothelin-1 was increased in the U rats. The U strain had a lower basal placental blood flow, and the effects of Suramin were more pronounced in this strain. We conclude, that Suramin injections to pregnant rats cause a state of placental insufficiency, which partly resembles human pre-eclampsia. The induction of this condition is at least partly mediated by oxidative stress, and is subject to varied genetic susceptibility.

Polymerized alpha-antitrypsin is present on lung vascular endothelium. New insights into the biological significance of alpha-antitrypsin polymerization

AIMS

The damage to lung tissue in chronic obstructive pulmonary disease (COPD) may involve the progressive loss of pulmonary vascular endothelial cells. Endothelial binding of alpha1-antitrypsin (alpha1-AT) derived from plasma has been identified, and alpha1-AT deficiency is a known genetic risk factor associated with alpha1-AT polymerization and COPD development. Therefore, in the present study we aimed to investigate if alpha1-AT is present on the lung vascular endothelium, and if it is in a polymeric form.

METHODS AND RESULTS

Postmortem paraffin-embedded tissue specimens from 15 COPD (chronic bronchitis and emphysema) cases with and without Z alpha1-AT (Glu342Lys) deficiency and from 10 cases without signs of COPD were studied. Immunohistochemistry was performed using the streptavidin-biotin method with a monoclonal ATZ11 antibody specific for polymeric alpha1-AT, and polyclonal antibodies against human alpha1-AT and neutrophil elastase. Vascular endothelium showed intense staining for alpha1-AT with the ATZ11 antibody in all cases; however, intensity of staining in patients with alpha1-AT deficiency was greater. No endothelial staining was observed with the anti-elastase antibody.

CONCLUSIONS

This is the first demonstration that alpha1-AT bound to the vascular endothelium of lungs is in a polymeric form, which also suggests a possible previously unknown role for polymeric alpha1-AT in vivo.

Gene profiling reveals decreased expression of uteroglobin and other anti-inflammatory genes in nasal fluid cells from patients with intermittent allergic rhinitis

BACKGROUND

Intermittent allergic rhinitis (IAR) results from interactions between a large number of pro- and anti-inflammatory mediators. Little is known about anti-inflammatory mediators in IAR. DNA microarrays allow simultaneous analysis of the whole transcriptome in a sample.

OBJECTIVE

To identify anti-inflammatory transcripts in nasal fluid cells from patients with IAR during season and from healthy controls.

METHODS

Nasal lavage fluids were obtained from 15 patients with symptomatic birch/and or grass pollen-induced IAR and 28 healthy controls. RNA was extracted from the nasal fluid cells and pooled into one patient- and one control pool. These were analysed with DNA microarrays containing more than 44,927 genes and variants.

RESULTS

Seventeen thousand three hundred and fifty three genes were expressed in the controls and 17 928 in the patients. One thousand five hundred and seventy nine of the genes had higher expression in patients than in controls, and 1570 had lower expression in patients. Out of 189 up-regulated inflammatory genes, 187 were pro-inflammatory and two were anti-inflammatory. These genes regulated key steps of inflammation, ranging from influx of leukocytes to immunoglobulin production. By comparison, out of 49 down-regulated inflammatory genes, 36 were pro-inflammatory and 13 were anti-inflammatory. The anti-inflammatory gene that decreased most in expression in the patients was uteroglobin (also known as Clara Cell protein 16, CC16). The nasal fluid concentrations of uteroglobin protein were significantly lower in patients than in controls, 5.43+/-1.53 and 12.93+/-2.53 ng/mL, respectively (P<0.05).

CONCLUSION

IAR is associated with decreased expression of uteroglobin and other anti-inflammatory genes.

Neuronal nitric oxide synthase and splanchnic blood flow in anaesthetized rats

AIMS

To evaluate to what extent the neuronal form of constitutive nitric oxide synthase (nNOS) contributes to the blood perfusion of splanchnic organs, including the islets of Langerhans.

METHODS

The nNOS inhibitor 7-nitroindazole (300 mg kg(-1) i.p.) was administered to anaesthetized Sprague-Dawley rats, some of which were pre-treated with the ganglionic blocker hexamethonium (20 mg kg(-1) i.v.) The blood perfusion of the splanchnic organs, including the pancreatic islets was then measured with a microsphere technique.

RESULTS

Nitroindazole decreased total pancreatic, duodenal and renal blood flow, whereas pancreatic islet, colonic and adrenal blood flows were unchanged. A slight increase in mean arterial blood pressure was seen after nitroindazole treatment. Nitroindazole did not affect blood glucose or serum insulin concentrations. In separate experiments, hexamethonium affected none of the studied blood flow values, suggesting that the effects of nNOS-inhibition were not mediated from the nervous system.

CONCLUSION

Nitric oxide derived from the activity of nNOS contributes to the blood perfusion in the upper portions of the gastrointestinal tract, viz. the parts supplied by the cranial mesenteric artery, and the kidneys, whilst no effects are seen on colonic or adrenal blood flow. Pancreatic islet blood flow was unaffected by nNOS inhibition, thereby suggesting that NO derived from the other isoforms of NOS maintains the high basal islet blood perfusion.

Assessment of environmental tobacco smoke exposure: urinary cotinine concentrations in children are strongly associated with the house dust concentrations of nicotine at home

In the present study the possibility of using nicotine in house dust as an index of environmental tobacco smoke (ETS) exposure was evaluated in an environmental investigation of 23 children with asthma. A standardized procedure for house dust sampling of nicotine with a filter holder connected to a vacuum cleaner, for a defined time and area was developed (F-nicotine). Also, house dust sampling was carried out from the vacuum cleaner bags of the homes (VC-nicotine). There was a larger variation in VC-nicotine (13-655, median 66 microg/g) compared with F-nicotine (15-393 median 156 microg/g). There were statistically significant associations between an inquiry data based ETS exposure index on the one hand, and urinary cotinine concentrations in children (U-cotinine), F-nicotine and VC-nicotine of their homes, on the other. The strong correlation between U-cotinine and F-nicotine (rs = 0.93; P < 0.0001) indicates that the new standardized house dust sampling method should be useful in ETS exposure assessment. However, further validation by a larger sample size with repeated measurements in the same homes is needed.

Pancreatic islet blood flow during pregnancy in the rat: an increased islet mass is associated with decreased islet blood flow

Increased blood perfusion of pancreatic islets is seen during various conditions of increased demand for insulin secretion. Pregnancy confers an increased need for insulin secretion, met by increased islet mass and volume as well as a decreased threshold for glucose-induced insulin secretion. In the present study, whole pancreatic and islet blood flow were studied with a microsphere technique in Wistar rats on days 15, 18 and 20 of pregnancy and days 2 and 7 post-partum. There were no changes in total pancreatic blood flow during pregnancy and the first post-partum week. Total blood perfusion through islet tissue expressed as flow per weight of whole pancreas was higher at day 15 of pregnancy. When islet blood flow was expressed per gram of islet tissue there was a decrease at day 18 of pregnancy. This decrease of islet blood flow was concomitant to a short-lived increase of the islet mass at the end of pregnancy. We conclude that upregulation of insulin output during late pregnancy does not specifically include increased net blood perfusion through the islets. One possible reason for this might be lack of synchronization between the proliferation of endocrine cells and angiogenesis, resulting in a relative decrease in islet vascular density in the islets.

Hypoglycaemia induces decreased islet blood perfusion mediated by the central nervous system in normal and Type 2 diabetic GK rats

AIMS/HYPOTHESIS

The aim of this study was to evaluate the effects of induced hypoglycaemia on pancreatic-islet blood flow in normal rats and in the GK rat, an animal model of Type 2 diabetes which normally has an increased islet blood perfusion.

METHODS

A 50% reduction in blood glucose concentrations was achieved by intravenous administration of a rapidly acting insulin (15 IU/kg body weight). Blood flows were measured by a non-radioactive microsphere technique.

RESULTS

A pronounced decrease in islet blood flow was observed in all animals, but preferentially in the Type 2 diabetic GK rats. When a similar dose of insulin was given to whole-pancreas transplanted rats only islet blood flow in the native pancreas was decreased, whereas that of the transplanted, i.e. denervated, pancreas was unchanged. Administration of 2-deoxy-D-glucose, which induces intracellular glucopenia especially in neurons, also decreased islet blood flow despite a systemic hyperglycaemia.

CONCLUSION/INTERPRETATION

Hypoglycaemia leads to a preferential decrease in pancreatic-islet blood perfusion. The effect is probably mediated by the central nervous system, since 2-deoxy D-glucose-induced neuronal glucopenia caused a similar decrease in blood flow. The effects of islet blood flow are not likely to be mediated by nervous stimulation of the adrenal glands, with an associated release of catecholamines, because the transplanted pancreas was not affected by hypoglycaemia. The decreased islet blood perfusion could possibly diminish the output of insulin from the islets, thereby preventing a further decrease in blood glucose concentrations.

Anomalies of subjective experience in schizophrenia and psychotic bipolar illness

OBJECTIVE

Contemporary psychopathology, as a result of behaviourally dominated epistemological stance, downplays anomalies of the patient's subjectivity. This neglect has probably deleterious consequences for research in the causes and the boundaries of the schizophrenia spectrum conditions. The purpose of this study is to explore frequency of qualitative, not-yet-psychotic, anomalies of subjective experience in patients with residual schizophrenia and psychotic bipolar illness in remission.

METHOD

The patients were examined with the Danish version of the Bonn Scale for the Assessment of Basic Symptoms (BSABS). Anomalies of experience were condensed into rational scales with good internal consistencies.

RESULTS

Diagnosis of schizophrenia was associated with elevated scores on the scales measuring perplexity (loss of immediate meaning), disorders of perception, disorders of self-awareness, and marginally so, disorders of cognition.

CONCLUSION

These findings, in conjunction with those from other, methodologically similar studies, suggest that certain anomalies of subjective experience aggregate significantly in schizophrenia. These experiential anomalies appear to be relevant for early differential diagnosis and therefore potentially useful in the preonset detection of the schizophrenia spectrum illness.

Unaltered oxygen tension in rat pancreatic islets despite dissociation of insulin release and islet blood flow

The present study investigated the importance of a tightly regulated islet blood flow for an optimal oxygenation of the islet tissue during different demands for insulin release. Glucose and/or a non-specific nitric oxide synthase inhibitor (L-NNA) were infused intravenously in non-pretreated or vagotomized rats and the animals were subjected to measurements of islet blood flow, oxygen tension and serum insulin concentrations. Islet blood flow was measured using a non-radioactive microsphere technique, tissue oxygen tension was recorded with Clark microelectrodes and insulin concentrations were determined by enzyme-linked immunosorbent assay technique. Administration of L-NNA (0.3 mg kg(-1) min(-1)) for 10 min halved basal islet blood flow, but did not affect serum insulin concentrations. Glucose administration (10 mg kg(-1) min(-1)) induced a marked increase in islet blood flow, which could be prevented by vagotomy or L-NNA. The serum insulin concentrations increased in all glucose-infused animals. The islet tissue oxygen tension remained similar in all animals despite these interventions. Reasons other than oxygenation of the islet tissue must explain the normally existing tight regulation of islet blood flow.

Socioeconomic environmental factors and hospitalization for acute bronchiolitis during infancy

Bronchiolitis is a major cause of hospitalization during infancy. The aim of this study was to evaluate the influence of socioeconomic factors on the hospitalization of infants with bronchiolitis. All infants below 1 y of age living in the city of Malmö, Sweden, and hospitalized at the University Hospital. Malmö, owing to bronchiolitis during the years 1998 and 1999 were identified. The bronchiolitis hospitalization rates (BHRs) were determined for the infants living in each of the 10 different administrative residential areas of Malmö and correlated with socioeconomic factors (percentage of immigrants, per capita income, unemployment rate and households receiving social benefit) in the respective residential areas. The severity of the disease on admission and during hospital care was assessed by comparing oxygen saturation, days with supplemental oxygen and length of stay. BHR varied more than fourfold between the 10 residential areas. BHR varied significantly with per capita income and the percentage of immigrants. Infants living in the area with the highest social burden were hospitalized almost twice as often as those from the rest of the city, but the severity of disease was similar.

CONCLUSION

The association between socioeconomic factors and hospitalization indicates that these factors may have a significant influence on the hospitalization rate in bronchiolitis during infancy.

Patterns in midwives' and expectant/new parents' ways of relating to each other in ante- and postnatal consultations

Patterns in midwives' and expectant/new parents' ways of relating to each other in ante- and postnatal midwifery consultations were described by means of qualitative content analysis of 58 video-recorded consultations in a Swedish primary care setting. The midwives appeared to steer the consultations by adopting a basic pattern and occasionally including other patterns. Of the five patterns disclosed, three were revealed as basic and named 'the respectful gardener and her developing plants', 'the propagandist teacher and her ignorant pupils' and 'the steering inspector and the representatives of the population at disposal'. The midwives related in individually oriented ways in the first pattern while the latter two indicated generalized ways of relating. The expectant/new mothers were more active in the two additional patterns 'the mediating counsellor and the discreet seekers of guidance' and 'the personal women-friends'. The expectant/new fathers mostly had a minor role, only appearingly actively involved within the 'gardener' pattern. Midwives need to reflect over their ways of relating as these influence how expectant/new parents deal with the information given and their satisfaction with the care.

Suffering from care as expressed in the narratives of former patients in somatic wards

To illuminate patients' experiences of suffering from care, ten former patients in somatic wards narrated a desirable care episode (n = 39) and an undesirable care episode (n = 51). The interviews were analysed using a phenomenological hermeneutic method inspired by Ricoeur's philosophy. Four themes were found: having a good rest, suffering through, searching for autonomy and being cared for by attentive and committed staff. The findings were interpreted in light of Eriksson's description of suffering, which describes three kinds of suffering: 'suffering of life', 'suffering of illness' and 'suffering of caring'. Although not mentioned explicitly, it was evident that cases of suffering from care were indicated in the patients' narratives. The themes were related to the patients' states of health, their experience of the care situation and their descriptions of themselves, and could be understood as related to the acts of the 'drama of suffering' described by Eriksson. The study highlights the need for the patient to find a co-actor in the drama of suffering in order to prevent suffering from care, i.e. prevent hindrance to the patient in her/his struggle against the 'suffering of illness' and the 'suffering of life'. The patients must be seen as the directors of their own dramas of suffering.

Graft vascular function after transplantation of pancreatic islets

Endogenous pancreatic islets have a dense glomerular-like angioarchitecture, which ensures an optimal delivery of oxygen and nutrients to the islet cells, provides signals from other cells in the body and disposes secreted hormones. Transplantation of isolated islets means that their vascular connection is interrupted. The islet grafts therefore depend upon endothelial cells and microvessels originating in the implantation organ for derivation of a new vascular system. A re-establishment of islet blood-flow occurs within 7-14 days after transplantation, mainly through vascular sprouting. The newly formed blood vessels acquire the morphological characteristics of those in endogenous islets. In intraportally transplanted islets to the liver, the islets become revascularized almost exclusively from tributaries to the hepatic artery. Exocrine contamination of the transplanted islets could hamper the revascularization process, whereas neither cryopreservation nor immunosuppressive drugs like cyclosporin, prednisolon and RS-61443 have any essential effects on the angiogenesis. Investigators have noticed improvements in islet graft survival and function by means of basic fibroblast growth factor (bFGF), acidic FGF and endothelial cell growth factor exposure of the grafts. The functional properties of transplanted islets are largely unknown, but evidence from experimental islet transplantation suggests that both the blood perfusion and the tissue oxygen tension of the grafted islets are chronically decreased, indicating an insufficient vascular system. In order to achieve optimal condition for survival and function of transplanted beta cells, it is important to ascertain whether impairments in vascular function are present also after clinical islet transplantations as well.

The H2-Ab gene influences the severity of experimental allergic encephalomyelitis induced by proteolipoprotein peptide 103-116

Immunization of H2(p) and H2(q) congenic C3H mouse strains with the PLP 103-116 peptide elicited two distinct experimental allergic encephalomyelitis (EAE) disease courses. C3H.Q (H2(q)) mice developed an acute-phase disease with classical ascending paralytic signs whereas C3H.NB (H2(p)) developed a highly variable disease course with symptoms originating from CNS above the spinal chord. C3H.Q lacks functional H2-E molecules and share H2-Aalpha with C3H.NB. To examine if the differences found at positions 85, 86, 88, and 89 in the Abeta-chains account for disease susceptibility, H2(q) mice were made transgenic with the Ab(p) gene. The Ab(p)-transgenic mice on the C3H.Q background developed a more severe disease course, demonstrating the importance of class II. However, the onset was not affected and the disease showed a classical ascending paralysis similar to the C3H.Q suggesting that the observed brain symptoms were related to nonclass II genes. Inhibition studies performed on affinity purified MHC class II molecules indicated that the PLP 103-116 peptide bound to A(p) with slightly higher affinity than to A(q). Both A(q) and A(p) formed long-lived stable complexes (t(1/2)>24 h) with the PLP 103-116 peptide, but a higher amount of the peptide was loaded on to A(p) compared with A(q). An F2 gene segregation experiment, in which the low PLP 103-116 binding A(r) molecule and the high binding A(p) molecule could be compared for the influence on the disease susceptibility, indicated a role for both peptide binding affinity and non-MHC genes. Based on our results, we conclude that the H2-Ab gene controls severity of EAE but not necessarily the onset or type of disease course and that affinity of the disease-promoting peptide for the class II molecule is a critical pathogenic factor.

Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and "behavioural disturbances", and on her care providers

AIM

The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her.

METHODS

Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis.

FINDINGS

The main findings are that the interaction between a woman with severe dementia and "behavioural disturbances" and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.

Enhancement of collagen-induced arthritis in female mice by estrogen receptor blockage

OBJECTIVE

To determine whether estrogen-mediated suppression of collagen-induced arthritis (CIA) in mice acts via the nuclear estrogen receptors (ERs).

METHODS

CIA was induced in noncastrated normal (B10.Q x DBA/1)F1 (QD) female mice. The mice were treated with the ER antagonist ICI 182,780, which binds to both ERalpha and ERbeta, either on days 2, 6, 10, and 14 or on days 14, 18, 22, and 26 after type II collagen (CII) immunization. The effects of treatment and development of arthritis were correlated with the estrus cycle by inspection of vaginal smears (VS). By a combination of treatments with both estriol (E3) and ICI 182,780 during the time of expected onset of CIA in castrated QD female mice, the protective effect of E3 in CIA was analyzed.

RESULTS

Treatment with ICI 182,780 of QD female mice immunized with CII triggered an earlier onset of arthritis during the period when the estrus cycle was blocked. The arthritis-modulating effect of ICI 182,780 was even obtained at doses that were insufficient to block estrus cycling, as observed in the VS response. E3 is an estrogen with low estrogenic potency but with a relatively potent antiarthritis effect. Doses of ICI 182,780 that were suboptimal for blocking estrus cycling blocked the E3-mediated suppression of CIA in castrated female mice.

CONCLUSION

These findings show that estrogen-induced suppression of CIA is mediated via the nuclear ERs and is operating at physiologic, possibly even subphysiologic, levels of estrogens.

Being overwhelmed by the feeling of having a home and family. One aspect of the meaning of being dependent on care: a study of one patient and two of his nurses

RATIONALE

This article is part of an ongoing study which aims at disclosing the meaning of being dependent on care. From a larger body of data, interviews with one patient and two of his nurses were selected to study.

AIM

The aim was to deepen understanding of the meaning of being dependent on care when this appears desirable for the patient.

METHODS

A phenomenological-hermeneutic approach was used to interpret the material. Interviews were recorded and transcribed verbatim.

FINDINGS/DISCUSSION

The interpretation discloses the meaning of being dependent on care as an overwhelming, unfamiliar feeling of having a home and family. The patient is beguiled into believing he is the ruler in an established relationship and his dependency on care gives him an opportunity to be surrounded by loving, altruistic, helpful people. Being dependent on care is overwhelming and irresistible, i.e. coveted, but simultaneously it is like walking on thin ice, i.e. treacherous. The irresistible desire concerns being unconditionally cared about. The danger is that this 'family membership' will not last. It is brought to the patient because of his dependency on care and it is based on his terms. There is reflection about the patient being unprepared for dealing with his own world of loneliness.

Microcirculation of human pancreatic islets transplanted under the renal capsule of nude mice

BACKGROUND

The aim was to measure the capillary blood pressure in transplanted human islets.

METHODS

Human islets were isolated at the Central Unit of the beta-cell Transplant in Brussels, Belgium. After transport to our laboratory, the islets were implanted under the renal capsule of normoglycemic nude mice. Two weeks later the capillary and venous blood pressures in the islet graft and adjacent renal parenchyma were measured with a micropuncture technique.

RESULTS

Capillary blood pressure was approximately 5-8 mmHg in both graft and renal capillaries: twice as high as in native islets. Venous blood pressures were similar (4-5 mmHg) in the veins draining the graft and in the renal interlobular veins. All veins leading from the graft emptied into the renal parenchyma, that is, into interlobular veins.

CONCLUSIONS

The capillary hypertension seen in transplanted human islets is probably necessary to secure adequate drainage through the renal veins. Whether this contributes to the poor results of long-term islet graft survival is unknown.

Relationship between oral health and mortality in cardiovascular diseases

BACKGROUND, AIMS

The purpose of the study was to investigate the relationship between periodontal health and fatal cardiovascular diseases (CVD).

METHODS

The investigation was conducted on a sample of 1393 individuals in the County of Stockholm. The subjects were examined in an epidemiological study in 1970 with respect to dental health. At a follow-up in 1997, the mortality rate of the sample during the years 1970-1996 was registered as well as cause of death according to the death certificate. Stepwise logistic regression analysis was performed in order to evaluate the influence of the investigated variables on the incidence of death from CVD.

RESULTS

The interactional effect between plaque and oral health score (a sum of scores for number of missing teeth, apical lesions, caries lesions and marginal bone loss), adjusted for age, gender, smoking and CVD at baseline, was significantly correlated to fatal coronary events. For individuals younger than 45 years of age, the age-adjusted incidence odds ratio of death due to CVD was 2.7 (p=0.04) if subjects with mean marginal bone loss of >10% were compared with subjects with mean marginal bone loss < or =10 %. If the stratum of individuals <45 years of age is confined to smokers, the odds ratio was found to be 3.4 (p=0.03).

CONCLUSION

Dental health was found to be a risk indicator of death due to CVD, especially in combination with another risk factor, smoking habits.