A collaborative planning process to develop future scenarios for wastewater systems

Wastewater infrastructure has a long lifetime and is subject to changing conditions and demands. When plans are made to upgrade or build new infrastructure, transdisciplinary planning processes and a robust analysis of future conditions are needed to make sustainable choices. Here, we provide a stepwise collaborative planning process in which future scenarios are developed together with local stakeholders and expert groups. The process was implemented at one of the largest wastewater treatment plants (WWTPs) in Scandinavia. With a combination of workshops and the use of a web-based digital tool, future scenarios including flows, pollutant loads, and treatment requirements could be created. Furthermore, sustainability prioritizations affecting the WWTP, were identified. The future scenarios developed for the WWTP in the case study, predict stricter and new regulations, constant or lower future loads and ambiguous future flows. The highest ranked sustainability priority was low resource and energy consumption together with low CO₂ footprint. The quantified future scenarios developed in the planning process were used as input to a process model to show the consequences they would have on the WWTP in the case study. Applying this collaborative process revealed future scenarios with many, sometimes conflicting, expectations on future WWTPs. It also highlighted needs for improvements of both the collection system and the WWTP.

Traffic-related microplastic particles, metals, and organic pollutants in an urban area under reconstruction

In urban environments, particularly areas under reconstruction, metals, organic pollutants (OP), and microplastics (MP), are released in large amounts due to heavy traffic. Road runoff, a major transport route for urban pollutants, contributes significantly to a deteriorated water quality in receiving waters. This study was conducted in Gothenburg, Sweden, and is unique because it simultaneously investigates the occurrence of OP, metals, and MP on roads and in stormwater from an urban area under reconstruction. Correlations between the various pollutants were also explored. The study was carried out by collecting washwater and sweepsand generated from street sweeping, road surface sampling, and flow-proportional stormwater sampling on several occasions. The liquid and solid samples were analyzed for metals, polycyclic aromatic hydrocarbons (PAH), oxy-PAH, aliphatics, aromatics, phthalates, and MP. The occurrence of OP was also analyzed with a non-target screening method of selected samples. Microplastics, i.e. plastic fragments/fibers, paint fragments, tire wear particles (TWP) and bitumen, were analyzed with a method based on density separation with sodium iodide and identification with a stereo microscope, melt-tests, and tactile identification. MP concentrations amounted to 1500 particles/L in stormwater, 51,000 particles/L in washwater, and 2.6 × 10⁶ particles/kg dw in sweepsand. In stormwater, washwater and sweepsand, MP ≥20 μm were found to be dominated by TWP (38%, 83% and 78%, respectively). The results confirm traffic as an important source to MP, OP, and metal emissions. Concentrations exceeding water and sediment quality guidelines for metals (e.g. Cu and Zn), PAH, phthalates, and aliphatic hydrocarbons in the C₁₆-C₃₅ fraction were found in most samples. The results show that the street sweeper collects large amounts of polluted materials and thereby prevents further spread of the pollutants to the receiving stormwater.

Norovirus Dynamics in Wastewater Discharges and in the Recipient Drinking Water Source: Long-Term Monitoring and Hydrodynamic Modeling

Norovirus (NoV) that enters drinking water sources with wastewater discharges is a common cause of waterborne outbreaks. The impact of wastewater treatment plants (WWTPs) on the river Göta älv (Sweden) was studied using monitoring and hydrodynamic modeling. The concentrations of NoV genogroups (GG) I and II in samples collected at WWTPs and drinking water intakes (source water) during one year were quantified using duplex real-time reverse-transcription polymerase chain reaction. The mean (standard deviation) NoV GGI and GGII genome concentrations were 6.2 (1.4) and 6.8 (1.8) in incoming wastewater and 5.3 (1.4) and 5.9 (1.4) log₁₀ genome equivalents (g.e.) L^-1 in treated wastewater, respectively. The reduction at the WWTPs varied between 0.4 and 1.1 log₁₀ units. In source water, the concentration ranged from below the detection limit to 3.8 log₁₀ g.e. L^-1. NoV GGII was detected in both wastewater and source water more frequently during the cold than the warm period of the year. The spread of NoV in the river was simulated using a three-dimensional hydrodynamic model. The modeling results indicated that the NoV GGI and GGII genome concentrations in source water may occasionally be up to 2.8 and 1.9 log₁₀ units higher, respectively, than the concentrations measured during the monitoring project.

IgE-mediated basophil tumour necrosis factor alpha induces matrix metalloproteinase-9 from monocytes

BACKGROUND

IgE-mediated activation of mast cells has been reported to induce the release of tumour necrosis alpha (TNF-α), which may display autocrine effects on these cells by inducing the generation of the tissue remodelling protease matrix metalloproteinase-9 (MMP-9). While mast cells and basophils have been shown to express complementary and partially overlapping roles, it is not clear whether a similar IgE/TNF-α/MMP-9 axis exists in the human basophil. The purpose of this study was thus to investigate whether IgE-mediated activation of human basophils induces TNF-α and MMP-9 release.

METHODS

Human peripheral blood mononuclear cells (PBMC), isolated basophils and monocytes were stimulated up to 21 h with anti-IgE. Mediator releases were assessed by ELISA, and surface expressions of mediators were detected by flow cytometry. Upregulation of cytokine production was detected by Western blot and polymerase chain reaction (PCR).

RESULTS

IgE-mediated activation of basophils induced the synthesis and release of both TNF-α and MMP-9 from PBMC. In contrast, IgE-mediated activation of purified basophils induced the release and cellular expression of TNF-α but not MMP-9. Isolated monocytes did not release MMP-9 upon anti-IgE stimulation, but MMP-9 release was induced by stimulating monocytes with supernatants from activated basophils, and this release was inhibited by anti-TNF-α neutralizing antibodies.

CONCLUSION

Our results strongly indicate that human basophils release TNF-α following IgE-dependent activation and that this cytokine subsequently stimulates MMP-9 release from monocytes. These findings support a direct involvement of basophils in inflammation as well as suggesting a role for the basophil in tissue remodelling.

Partitioning of polycyclic aromatic hydrocarbons, alkylphenols, bisphenol A and phthalates in landfill leachates and stormwater

Partitioning of organic pollutants is essential to their fate, mobility and removal from water and soil. To study the partitioning behavior of selected alkylphenols, bisphenol A, phthalates and polycyclic aromatic hydrocarbons (PAHs), a method for separating the truly dissolved and colloidal phase of organic pollutants was developed, verified and applied to samples of landfill leachate and stormwater from urban areas and waste-sorting sites. Alkylphenols, bisphenol A, phthalates and PAHs were detected in all the untreated samples (total concentrations), most of the filtered samples and frequently in the colloid-bound phase. Concentrations of alkylphenols and PAHs in urban stormwater were one order of magnitude lower than in the landfill leachates and stormwater from waste-sorting sites. The difference between total, dissolved and colloid-bound concentrations in the water samples was not statistically significant for any phenols or phthalates, but for three of the PAHs; naphthalene (mostly dissolved), phenanthrene and fluoranthene (mostly particulate). These results indicate that in landfill leachates and stormwaters, organic pollutants are predominantly attached to colloids and/or truly dissolved in contrast to their expected strong sorption to particulate matter. Occurrence and concentrations of pollutants in dissolved and colloid-bound phases correlated negatively with the K(OW). However, even highly hydrophobic compounds were frequently detected in filtered samples, i.e. the dissolved phases, and it is suggested that the organic content in the colloids decreases the compounds' partition to particles. The results confirm that the K(OW) values of specific organic pollutants well describe the compounds partition-binding process to dissolved organic carbon (DOC) colloids. Our findings call for a re-assessment of the organic pollutants' mobility and associated risks. This knowledge can also serve as a base for selecting efficient treatment methods for stormwater and landfill leachates.

Levels of selenium in blood and tissues associated with some selenium deficiency diseases in New Zealand sheep

Whole bloods from weaned lambs with severe selenium responsive unthriftiness usually contain <5 ng Se/ml. Mildly or moderately affected lambs have blood levels of 5-10 ng/ml. Selenium responsive infertility in ewes appears to be associated with whole blood selenium levels below 10 ng/ml.

Is pain prophylaxis in minor gynaecological surgery of clinical value? a double-blind placebo controlled study of paracetamol 1 g versus lornoxicam 8 mg given orally

Methods: In a prospective randomised placebo controlled double-blind study 210 ASA I-II women scheduled for elective termination of pregnancy received 1 g paracetamol, 8 mg lornoxicam or placebo orally 60 min before anaesthesia which was standardised with propofol, fentanyl and oxygen in nitrous oxide 1:2. Postoperative pain was assessed by VAS-score at 30 and 60 min after end of surgery and at discharge as primary endpoints. Need for rescue medication and time to discharge were secondary endpoints. Results: All patients had an uncomplicated course. Overall pain intensity was low, however, the patients pretreated with lornoxicam had significantly less pain after surgery, no difference could however, be seen in need for rescue medication or time to discharge between the three groups. Conclusion: General pain prophylaxis may be argued in minor gynaecological surgical procedures where postoperative pain is of low intensity. If general prophylaxis is to be given in minor gynaecological surgery, a non steroidal anti-inflammatory (NSAID) such as lornoxicam, seems more efficacious as compared to a standard dose of 1 g paracetamol.

[Preoperative adrenergic beta receptor blockade and anesthesia. II. Effect on peroperative anxiety and cardiovascular response in epidural anesthesia]

The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural anesthesia. The study was double-blind and placebo controlled. Twenty non-consecutive patients were randomized to receive either metoprolol 100 mg or placebo orally 1-2 hours before anaesthesia. Patients receiving metoprolol scored statistically significantly better on anxiety, and general feeling. The average height of the epidural block was ThVIII. The average blood pressure was reduced by 5% during the first 45 minutes in both groups. The average maximum falls in mean blood pressure from preanaesthetic to the lowest measured after the epidural were 14% (metoprolol) and 7% (placebo). The heart rates were significantly lower after metoprolol. In conclusion, the patients felt subjectively better after metoprolol and no significant differences were found in blood pressure after metoprolol compared to placebo.

Predictive value of islet cell and insulin autoantibodies for type 1 (insulin-dependent) diabetes mellitus in a population-based study of newly-diagnosed diabetic and matched control children

Most studies evaluating immune markers for prediction of Type 1 (insulin-dependent) diabetes mellitus have focused on first degree relatives, although only 10% of newly-diagnosed patients have an affected first degree relative. The Swedish Childhood Diabetes Register identifies 99% of all diabetic children at diagnosis. In this population-based study, islet cell antibodies and insulin autoantibodies in 0-14-year-old Swedish consecutively-diagnosed patients and control subjects were analysed to define their sensitivity and specificity. Over 16 months (1986-1987), 515 Swedish children developed diabetes. Plasma samples were obtained from 494 (96%) patients, and 420 matched control children. Among patients, the frequency of islet cell antibodies was 84% (415 of 494), insulin autoantibodies 43% (145 of 334); 40% (135 of 334) were positive for both and 88% (294 of 334) were positive for one or both. Among control children, 3% (14 of 420) had islet cell antibodies, 1% (4 of 390) insulin autoantibodies, and 4% (16 of 390) had either autoantibody marker. The predictive value of finding a patient with the disease was only 7% since 4% of the control children were antibody-positive and the cumulative incidence rate up to 15 years of age is 0.38%. None of the autoantibody-positive (n = 21) or negative control children developed diabetes during 3 to 5 years of follow-up. Longitudinal investigations of islet cell or insulin-autoantibody-positive healthy children are necessary to accurately determine the conversion rate from marker positivity to disease onset.

A high linear growth is associated with an increased risk of childhood diabetes mellitus

Insulin release and growth are intimately connected. The aim of the present study was to investigate height and weight in diabetic children from birth to onset of Type 1 (insulin-dependent) diabetes mellitus compared to that in referent children. Data on height and weight were collected from mailed questionnaires and from growth records obtained from the child health clinics and schools in 337 recent-onset diabetic children, 0-14 years old, and from 517 age-, sex-, and geographically matched referent children. A total of 9002 paired height and weight observations were collected. The anthropometric development of the children was expressed as standard deviation scores using the National Center for Health Statistics/Centers for Disease Control (NCHS/CDC) growth reference material. On the average, the diabetic children were consistently taller than the referent children, a finding more pronounced among the boys. The diabetic boys were significantly taller from 7 to 1 years before the clinical onset of the disease, regardless of age at onset. A similar tendency was found for the girls. When mean height from 5 to 1 years before onset was used as a possible risk factor for diabetes, a linearly increasing trend in the odds ratio was found for diabetes in boys (odds ratio = 1.0; 1.57; 2.46 for height standard deviation score values less than 0; 0-1 and greater than 1, respectively; p = 0.002 for trend). A similar, but statistically not significant, tendency was found for girls (odds ratio = 1.0; 1.44; 1.43). As regards height increment from birth similar trends in odds ratios were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of pre-operative metoprolol on cardiovascular and catecholamine response and bleeding during hysterectomy

The effect of a pre-operative dose of metoprolol on the catecholamine and cardiovascular responses to tracheal intubation and surgery, cardiac complications and intra-operative blood loss, were studied in patients undergoing elective hysterectomy during general anaesthesia. The study was double-blind and placebo controlled. The patients received metoprolol 100 mg or placebo orally 1-25 h before anaesthesia. In patients given metoprolol, heart rate and mean arterial pressure were lower during the first 45 min of anaesthesia. Plasma adrenaline and noradrenaline concentrations increased in both groups in response to tracheal intubation and surgery, but were higher after metoprolol. The incidence of arrhythmias was less after metoprolol. The mean operative blood loss was greater in the placebo group (486 +/- 170 ml (SEM) compared to 231 +/- 43 ml (SEM) after metoprolol). We conclude that oral premedication with metoprolol attenuates the hypertensive response to tracheal intubation and reduces both arrhythmias and operative blood loss.

The Swedish Childhood Diabetes Study--a multivariate analysis of risk determinants for diabetes in different age groups

In a nationwide incident case-referent study stepwise univariate analysis has revealed several risk determinants for childhood diabetes mellitus. In a multivariate analysis we have determined the set of risk determinants that would independently predict childhood Type 1 (insulin-dependent) diabetes. Possible interactions between the risk determinants and differences in risk profiles with different ages at onset were also examined. Reported familial insulin-treated and non-insulin-treated diabetes were significant risk factors in all age groups, as was also a low frequency of milk intake. The frequency of infections and a high intake of foods rich in nitrosamine tended to interact (OR 11.8, p = 0.053) indicating a synergistic effect. A Cox regression analysis revealed that stressful life events during the last year was the only variable that tended to affect the age at onset (p = 0.055). This indicated that psychological stress may rather precipitate than induce Type 1 diabetes. A short breast-feeding duration (OR = 3.81), and an increased body height (OR = 3.82) contributed significantly to the predictive model in only the youngest age group (0-4 years). An increased frequency of infections in the year preceding onset (OR = 2.15) and no vaccination against measles (OR = 3.33) contributed significantly to the model only in the age group 5-9 years. Various nutrients had different impacts on the risk of developing Type 1 diabetes in different age groups. It is concluded that in the genetically susceptible child, risk factors which are associated with eating habits, frequency of infections, vaccination status, growth pattern and severe psychological stress affect the risk of developing diabetes independently of each other.(ABSTRACT TRUNCATED AT 250 WORDS)

The Swedish childhood diabetes study: indications of severe psychological stress as a risk factor for type 1 (insulin-dependent) diabetes mellitus in childhood

This study is part of a nationwide case-referent study. All recent-onset Type 1 (insulin-dependent) diabetic children aged 0-14 years in Sweden were invited to participate. Referent subjects matched for age-, sex- and geographical distribution were selected. In all, 338 patients and 528 referent subjects took part. Life events during the last year prior to clinical onset of Type 1 diabetes were recorded on a questionnaire. The total frequency of life events did not differ between diabetic and referent children. However, qualitatively the life events reported by diabetic children revealed a tendency to increased severity. Events related specifically to actual or threatened losses within the family--events that may affect children differently in different age groups--were reported with a significantly higher frequency by diabetic patients than by referent subjects, aged 5-9 years. The relative risk that such events in fact comprise a risk factor for Type 1 diabetes was 1.82 (95% confidence limits 1.09, 3.03). The relative risk was significantly increased even when standardized for possible confounding factors such as age, sex and indices of social status of the family. We conclude that stressful life events, related to actual or threatened losses within the family, occurring in the vulnerable age group of 5-9 years, are associated with the onset of childhood Type 1 diabetes. Such stressful events may in fact be a risk factor for the disease.

The Swedish childhood diabetes study. Vaccinations and infections as risk determinants for diabetes in childhood

In a nationwide incident case referent study we have evaluated vaccinations, early and recent infections and the use of medicines as possible risk determinants for Type 1 (insulin-dependent) diabetes mellitus in childhood. A total of 339 recently onset diabetic and 528 referent children, age 0-14 years, were included. Information about infections was collected from a mailed questionnaire and about vaccinations from childhood health care centres and schools. When vaccinations were considered as possible risk factors for diabetes, a significant decrease in relative risk estimated as odds ratio (OR) was noted for measles vaccination (OR = 0.69; 95% confidence limits 0.48-0.98). For vaccination against tuberculosis, smallpox, tetanus, whooping cough, rubella and mumps no significant effect on OR for diabetes was found. The odds ratios for Type 1 diabetes for children exposed to 0.1-2 or over 2 infections during the last year before diagnosis of diabetes revealed a linear increase (OR = 1.0, 1.96 and 2.55 for 0, 1-2 and over 2 infections, respectively). The trend was still significant when standardized for possible confounders such as age and sex of the children, maternal age and education and intake of antibiotics and analgetics. In conclusion, a protective effect of measles vaccination for Type 1 diabetes in childhood is indicated as well as a possible causal relationship between the onset of the disease and the total load of recent infections.

[Primary treatment of traumatically dislocated teeth]

A case of successful replantation of a traumatically exarticulated tooth is presented. Avulsed teeth should be replanted immediately after the accident. If this is not possible, the periodontal tissue of the tooth should be protected from drying. Milk has been demonstrated to be a good medium in which the periodontal tissue can survive for as long as six hours whereas teeth stored in the buccal cavity must be replanted in the course of one, or at the latest two hours. Antibiotic treatment should be instituted immediately after replantation, and tetanus prophylaxis should be administered after the usual guidelines. Endodontic treatment should be performed after 10-14 days.

Immunoreactive trypsin(ogen) in the sera of children with recent-onset insulin-dependent diabetes and matched controls. The Swedish Childhood Diabetes Group

To evaluate the exocrine pancreatic function at the time of diagnosis of insulin-dependent diabetes mellitus, we determined immunoreactive anodal and cathodal trypsin(ogen) levels in sera from almost all children (n = 375) 0-14 years of age in Sweden in whom diabetes developed during 1 year, and in sex-, age-, and geographically matched control subjects (n = 312). The median level of anodal trypsin(ogen) was 5 (quartile range, 3-7) micrograms/L in children with newly diagnosed diabetes, compared with a median level of 7 (quartile range, 4-8) micrograms/L in control subjects (p less than 0.0001). Similarly, the median level of cathodal trypsin(ogen) was 8 (quartile range, 4-10) micrograms/L in children with diabetes, compared with a median level of 11 (quartile range, 7-15) micrograms/L in control subjects (p less than 0.0001). The median of the individual ratios between cathodal and anodal trypsin(ogen) was 1.4 in the diabetic patients and 1.7 in the control children (p less than 0.001). In a multivariate test, however, only the decrease in cathodal trypsin(ogen) concentration was associated with diabetes. The levels of trypsin(ogen)s did not correlate with levels of islet cell antibodies, present in 81% of the diabetic children. Several mechanisms may explain our findings, for example, similar pathogenetic factors may affect both the endocrine and exocrine pancreas simultaneously, a failing local trophic stimulation by insulin on the exocrine cells may decrease the trypsinogen production, and there may be an increased elimination of trypsin(ogen) because of higher filtration through the kidneys in the hyperglycemic state.

Effect of metoprolol and diazepam on pre-operative anxiety

A double-blind study of 98 patients who underwent elective hysterectomy or orthopaedic surgery was conducted to evaluate the effect of metoprolol or placebo combined with diazepam given 1-3 hours before surgery. Evaluation was by anaesthetists and by visual analogue scoring by the patients. The anaesthetists found that patients who received metoprolol were significantly less anxious (p less than 0.005) and better sedated (p less than 0.001) before induction of anaesthesia. The patients who received metoprolol found themselves more calm compared with placebo patients. Arterial blood pressure and heart rate were reduced by metoprolol compared to placebo. Metoprolol may be a valuable drug for premedication.

Estimating children's eating habits. Validity of a questionnaire measuring food frequency compared to a 7-day record

A questionnaire measuring food frequency was validated against 7-day records of food intake in a group of 30 children, 2-16 years of age. Special emphasis was given to the ability of the questionnaire to estimate frequency of intake of foods of particular interest in diabetes mellitus. Fifteen children had insulin-dependent diabetes; 15 were healthy. Comparison of the two methods regarding frequency of foods with high content of sucrose, protein, fat, fibres, nitrite or vitamin C showed a correlation of 0.52-0.76. The frequency of intake of some staple foods was often overestimated by the questionnaire, while the frequency of meat, sausage and some sweet snacks was underestimated. The use of the questionnaire to identify high or low consumers of the mentioned nutrients showed a rather low sensitivity (0.38-0.50), but a high specificity (0.86-1.0) when compared with results of the 7-day record. In our limited sample of subjects no systematic differences were found comparing sexes or diabetic and healthy children. A food frequency questionnaire may, in spite of some important reservations, be a useful tool for screening purposes when more time-consuming and resource-demanding methods cannot be used.

The Swedish childhood diabetes study III: IgM against coxsackie B viruses in newly diagnosed type 1 (insulin-dependent) diabetic children--no evidence of increased antibody frequency

Sera from essentially all Swedish children aged 0-14 years with Type 1 (insulin-dependent) diabetes mellitus with onset during an autumn period (October-December 1985) and a late spring period (May-June 1986) were selected. In all, 98 patients were analysed for IgM antibodies against coxsackie B virus serotypes 1 through 5 by a mu-antibody capture radio immunoassay technique. Sera from 94 referent children matched for age, sex and residential area, collected during the same period, were also analysed. During the autumn period, 10 out of 67 (15%) diabetic children were IgM positive while 14 out of 75 (19%) of the healthy referent children demonstrated positivity. During the late spring period only one out of 31 (3%) children with diabetes and two out of 19 (10%) referent children were IgM positive. In the diabetic patients, five were coxsackie B2 positive while coxsackie B1, 3, 4 and 5 were represented by one to three patients each. Eight referent children were coxsackie B4 positive, six were B3 positive and two B2 positive, while no referent children were positive against coxsackie B1 and 5. During these two periods in late 1985 and early 1986 these data demonstrate no evidence of increased antibody frequency against coxsackie B virus 1 through 5 at the onset of childhood diabetes in Sweden.

Postspinal headache in young and elderly patients. Two randomised, double-blind studies that compare 20- and 25-gauge needles

In two randomised, double-blind studies of elderly patients with a mean age of 68.9 (range 21-88) years and young patients, mean age 29.4 (range 20-40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20- and 25-gauge, were comparable in both studies with regard to number, sex, age and type of surgery. The incidence of postspinal headache in young patients was 27.6% when a 20-gauge needle was used and 12.6% with a 25-gauge needle. There was no significant difference in either the incidence of headache in the elderly patients (10.8% and 7.8%, respectively) or between the sexes. It is concluded that it does not matter if a 20- or a 25-gauge needle is used for spinal analgesia in elderly patients with regard to postspinal headache, but if spinal analgesia is indicated in young patients a fine needle is preferred.

Mental function in elderly men after surgery during epidural analgesia

To evaluate whether there is a difference in mental function after general anaesthesia and epidural analgesia, a homogeneous group of 40 elderly men (age between 60 and 80) undergoing transurethral prostatectomy was studied. The study was prospective, randomised and double blind. Patients with all types of complications believed to impair mental function were excluded. Long-term, short-term, verbal and visual memory were tested preoperatively, and 4 days, and 3 weeks postoperatively. In conclusion, we found a significant and equal decline in test performance on the fourth postoperative day. Three weeks postoperatively, however, both groups had returned to or exceeded preoperative levels of performance.

Islet cell and other organ-specific autoantibodies in all children developing type 1 (insulin-dependent) diabetes mellitus in Sweden during one year and in matched control children

The majority (about 90%) of children developing Type 1 (insulin-dependent) diabetes mellitus do not have a first-degree relative with the disease. Nearly all (389/405, 96%) children (0-14 years) in Sweden, who developed diabetes during one year, were therefore studied to compare islet cell, thyroid peroxidase, thyroglobulin, and gastric H+, K+-ATPase antibodies with 321 age, sex, and geographically matched, but non-related, control children. Islet cell (cytoplasmic) antibodies were found in 81% (316/389) of the patients and in 3% (9/321) of the control children (p less than 0.001). The median islet cell antibody levels were 70 (range 3-8200) Juvenile Diabetes Foundation (JDF) Units in the islet cell antibody positive patients, and 27 (range 17-1200) JDF Units in the control children (NS). Autoantibodies against thyroid peroxidase (8%), thyroglobulin (6%), and gastric H+, K+-ATPase (3%) were all increased in the patients compared with the control children, being 2% (p less than 0.001), 2% (p less than 0.01), and 0.3% (p less than 0.01), respectively. During an observation time of 20-34 months, two of the nine islet cell antibody positive control children developed Type 1 diabetes, after 8 and 25 months respectively, while the others remained healthy and became islet cell antibody negative. None of the islet cell antibody negative control children developed diabetes during the same time of observation. This first investigation of an unselected population of diabetic children and matched control children shows: that islet cell antibodies are strongly associated with newly diagnosed childhood diabetes, that other autoantibodies are more frequent among diabetic children than control children, and that the frequency of islet cell antibodies in the background population of children is higher than previously documented, and could also be transient, underlining that factors additional to islet cell antibodies are necessary for the later development of Type 1 diabetes.

Pre-operative assessment of anxiety and measurement of arterial plasma catecholamine concentrations. The effect of oral beta-adrenergic blockade with metoprolol

A double-blind study of 40 patients who underwent elective hysterectomy was conducted to evaluate the role of arterial plasma catecholamine concentrations as an objective index of anxiety, and to assess the effect of pre-operative oral treatment with a beta-adrenoceptor blocking drug. The patients were premedicated with diazepam and either metoprolol or placebo 2-3 hours before surgery. The effect on anxiety was evaluated by the anaesthetist and by visual analogue scoring by the patients. Using pooled data, a significant decrease in both adrenaline and noradrenaline concentrations was demonstrated after premedication, but no difference was found between the groups. In general, patients were less anxious after premedication, but patients who received metoprolol had greater relief of anxiety (p = 0.0007). A significant change in perceived anxiety was found in patients who received metoprolol, but there was no significant change in the placebo group. The correlation between the observers' assessment and the patients' visual analogue scores was poor, but some correlation was found between the assessed relief of anxiety and the changes in visual analogue score. We could not demonstrate any correlations between anxiety and catecholamine concentrations, between relief of anxiety and changes in catecholamine concentrations, or haemodynamics and catecholamine concentrations.

The Swedish childhood diabetes study--social and perinatal determinants for diabetes in childhood

Using the Swedish childhood diabetes register, a nationwide, case-referent study was performed from September 1, 1985 to August 31, 1986. Based on the information from a mailed questionnaire sent to all incident diabetic children and for each diabetic child - two referent children matched according to age, sex, and county, we have analysed perinatal events and aspects of the social environment as possible risk factors for Type 1 (insulin-dependent) diabetes in childhood. A significantly larger proportion of the mothers of the diabetic children were older than 40 years compared to those of the referent children (33% and 24%, p = 0.01 respectively). A smaller percentage of mothers of the diabetic children had a high educational level compared to mothers of referent children (10% and 15%, p = 0.03 respectively) and 39% of the fathers of the diabetic children were manual workers compared to 31% of the fathers of referent children (p = 0.03). Perinatal events did not differ between diabetic and referent children. In children 0-6 years, the duration of breast-feeding was significantly shorter in diabetic children than among referent children (median duration for diabetic children 5 months compared to 6 months for referent children p = 0.03). When considering the presence of Type 1 diabetes among relatives, maternal age over 40 years, low educational level of the mother, and the father being a manual worker as risk factors, the presence of 1 to 4 of any of these risk factors increased the relative risk for Type 1 diabetes cumulatively from 1.2-7.5.(ABSTRACT TRUNCATED AT 250 WORDS)

The Swedish childhood diabetes study--results from a nine year case register and a one year case-referent study indicating that type 1 (insulin-dependent) diabetes mellitus is associated with both type 2 (non-insulin-dependent) diabetes mellitus and autoimmune disorders

From July 1, 1977 to July 1, 1986, 3,503 incident cases of Type 1 (insulin-dependent) diabetes mellitus were registered in the Swedish childhood diabetes study. Using data from this register and from a case-referent study, including all incident Type 1 diabetic children in Sweden during one year and, for each patient, two referent children matched according to age, sex and county, we have studied the associations between Type 1 diabetes and familial Type 1 and Type 2 (non-insulin-dependent) diabetes, thyroid, adrenal, allergic, rheumatic, heart and bowel disease. The mean annual incidence per 100,000 during the nine year period was 25.1 for boys and 23.5 for girls. In 8.5% of the patients, one parent had Type 1 diabetes, 73% of whom were fathers. Fifty-six of the patients (1.7%) had a parent with Type 2 diabetes. The prevalence of parental Type 1 diabetes tended to be higher in patients with younger age at onset; whereas, the opposite was found for patients with parental Type 2 diabetes. In the case-referent study, the age-adjusted odds ratio for Type 1 diabetes when a first and/or second degree relative had Type 1 diabetes was 5.5 (95% confidence limits 4.0-7.7), and in accordance with the findings of the case register, the odds ratio tended to be highest in patients with the youngest age at onset. Season at onset of the patients was not associated with parental Type 1 diabetes. The odds ratio for Type 1 diabetes was significantly increased 3.3 (95% confidence limits: 2.3-4.6) when Type 2 diabetes was reported in relatives (three generations).(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of lost residual beta-cell function in short term diabetic children

Using the country-wide Swedish childhood diabetes register 526 children, who had had diabetes for 6-30 months were traced for measurements of 24-hour urinary C-peptide. Lost beta-cell function was defined as a 24-hour urinary C-peptide excretion per kg body weight less than 10% of the mean for healthy children (less than 0.025 nmol/kg). The estimated cumulative incidence of lost beta-cell function was 0.64 at 30 months. The incidence of lost beta-cell function did not differ by sex. Neither was there any significant variation in season at onset for cases with lost beta-cell function. A significant age dependency was shown for the cumulative incidence of lost beta-cell function with the highest incidence in the young age groups, i.e. a reversed age dependency compared to that of clinical onset. In contrast to the clinical onset of diabetes no significant geographical variation was found for lost beta-cell function when comparing standardized morbidity ratios. The urinary C-peptide excretion was significantly correlated to age at onset but not to degree or duration of ketonuria at onset. It is concluded that there are striking differences when comparing the epidemiology of lost beta-cell function to that of clinical onset in terms of age, sex, seasonal and geographical variations. The timing of clinical onset may thus partly be determined by factors different from those determining the rate of fall in beta-cell function.

The epidemiology of diabetes in Swedish children 0-14 years--a six-year prospective study

Since 1 July 1977, all newly diagnosed diabetic children in Sweden aged 0-14 years have been reported to a central register. During the first 6 years, 2300 newly diagnosed diabetic children out of a population of 1.6 million children were registered. The degree of certainty was close to 100%. The mean of the yearly incidence rate for the whole 6 year period was 23.6 per 100000. The prevalence of insulin dependent diabetes mellitus on 1 July 1980 was 1.48 per 1000 and 1.52 on 1 July 1983. Comparing the first and second 3-year periods, an increase was found (22.7-25.1 per 100000). This increase was consistent when analyzing incidence rates by age, sex, and geographical distribution. Cumulative incidence rates revealed a risk of developing diabetes by the age of 15 years of 3.6 per thousand for boys and 3.2 per thousand for girls. The higher incidence for boys was consistent throughout the study period. Seasonal variations in the incidence rate were also consistent, showing yearly incidence peaks in the autumn and winter months. Incidence peaks were noted for both sexes in the pubertal ages. Age- and sex-standardized morbidity ratios varied significantly within the country. 12.8% of the probands had a first degree relative with Type 1 diabetes, and it was twice as common that this relative was a father as a mother. The high and rapidly increasing incidence of Type 1 diabetes in a genetically stable population such as Sweden calls for case-control studies directed towards the identification of environmental pathogens.

Local toxicity of different drugs after intramuscular or intralipomatous injection in pigs: serum concentrations after three different formulations of cis(Z)-clopenthixol

Findings made by computerized tomography scanning of pelvis of patients suggested that the majority of injections intended to be intramuscular in fact are delivered in the fat tissue. This finding has raised the question what difference it makes when drugs are injected intramuscularly or intralipomatously. We have studied local toxicity after intramuscular or intralipomatous injection of different drugs in pigs, which have a subcutaneous layer of fat comparable to that of man. The pigs were killed 1, 3, 7 or 14 days after injection of antibiotics, vitamins, neuroleptics, diazepam, digoxin, pentazocine, sulphadimidine and vehicles. The tissues at the injection site were examined macro- and microscopically. In another series of experiments an aqueous or two different oily preparations of the neuroleptic drug cis(Z)-clopenthixol were given intramuscularly or intralipomatously to pigs and a series of blood samples were taken for drug level determination. The tissue examinations showed that all drugs causing local muscle damage after intramuscular injection caused considerably less extensive damage with a faster regeneration after intralipomatous injection. The pharmacokinetic study showed that there was virtually no difference between plasma-concentration-time curves after intramuscular or intralipomatous injection. Our findings indicate that intralipomatous injection of irritating drugs is better tolerated than intramuscular injection since intralipomatous injection causes less local toxicity. Our findings also suggest that the pharmacokinetics are not different. However, further studies are required to substantiate whether the findings are of general relevance.

Epidemiological aspects of the natural history of childhood diabetes

Studies in identical twins have shown only a 50% concordance for type 1 diabetes, indicating that environmental factors are of major importance. Prospective studies in twins and siblings of type 1 diabetics provide evidence of a long prediabetic phase. Environmental factors, inducing a pathological immune response in genetically susceptible individuals, may thus act long before the clinical onset. In Sweden a high and increasing incidence of childhood diabetes has been shown, with peak incidence rates at puberty in both boys and girls. The incidence rate is higher for boys than for girls. Significant geographical and seasonal variations are clearly indicated. The epidemiology of lost beta-cell function shortly after clinical onset differs significantly from the epidemiology of clinical onset as to sex and geographical and seasonal distribution. Environmental factors that affect the clinical onset of type 1 diabetes may thus differ from factors affecting the beta-cell function after onset. Factors affecting the peripheral insulin sensitivity should therefore be taken into consideration also when discussing the natural history of type 1 diabetes.

Intramuscular injections and muscle damage: effects of concentration, volume, injection speed and vehicle

An intramuscular injection was given to rabbits with the needle inserted in the longissimus dorsi muscle. The muscle tissue at the injection site was examined post-mortem 3 days after the injection and areas of necrotic muscle tissue were dissected for weighing. With a fixed dose of the neuroleptic drug cis(Z)-clopenthixol it was shown that a small volume of a concentrated solution caused less muscle damage than a larger volume of a relatively less concentrated solution. Injection speed, on the other hand, was not an important factor. Aqueous solutions of neuroleptic drugs caused local muscle damage which was diminished or prevented by oily vehicles.

Serum alpha-fetoprotein--a biochemical indicator of prenatal hypothyroidism

Serum alpha-fetoprotein (AFP) was analysed at 10-30 days of age in infants with positive TSH screening tests for congenital hypothyroidism. These levels were significantly higher in infants with true positive screening tests than in those with false positive tests; 27 of 43 infants with congenital hypothyroidism had serum AFP levels above the age-related reference range. The postnatal rate of elimination of AFP from serum did not differ in hypothyroid and euthyroid infants, indicating that the difference in serum AFP was due to more extensive synthesis in hypothyroid individuals. The level of serum AFP was inversely correlated with the roentgenological skeletal maturation index. It is postulated that increased serum AFP is caused by prenatal hypothyroidism and that analysis of serum AFP is a valuable tool to identify those infants with congenital hypothyroidism who are at risk of neuropsychological sequelae.

Physiotherapists in ergonomics

Recently, physiotherapy students in Denmark have been spending part of their hospital training period in a factory environment, studying working postures and work methods. It is concluded that physiotherapists so trained can provide patients with a better service and treatment through their improved knowledge of the causes of illness.

The influence of minerals and protein on the nephrocalcinosis potential for rats of semisynthetic diets

Nephrocalcinosis is a common finding in rats, particularly in females fed a semisynthetic diet. In the present study groups of rats were fed a semisynthetic diet with varying levels of minerals and with lactalbumin instead of casein as the protein source. Adjustment in the Ca, P, and Mg content of the diet caused a marked decrease in renal calcification. The change of protein source alone led to a complete disappearance of calcium deposits in the kidneys.

Metabolic control in 131 juvenile-onset diabetic patients as measured by HbA1c: relation to age, duration, C-peptide, insulin dose, and one or two insulin injections

Glycosylated hemoglobin A (HbA1c), considered to reflect long-term metabolic control of diabetes, was analyzed in 131 patients, aged 2 5/12-19 6/12 yr, with juvenile-onset diabetes. Using stepwise multiple regression HbA1c, fasting blood glucose and plasma 3-hydroxybutyrate were analyzed as dependent variables versus independent variables such as age of the patients, duration of the disease, level of plasma immunoreactive C-peptide (IRCP), insulin dose, and number of insulin injections (one or two) per day. HbA1c was inversely related only to IRCP concentration. A low but significant, positive correlation was found between HbA1c and the duration of diabetes. Stepwise addition of the other independent variables did not further increase the fraction of explained variance. HbA1c was also correlated with a subjective rating score of the metabolic control performed by the treating physician. Fasting plasma glucose was significantly related to HbA1c but not to any of the independent variables. Fasting 3-hydroxybutyrate showed an inverse correlation to the age of the patient. The present study showed that in juvenile-onset diabetic patients, endogenous insulin secretion as reflected by IRCP was the factor best correlated with a low level of HbA1c. After the cessation of endogenous insulin secretion, there is a progressive deterioration of metabolic control and multiple injections of insulin rather than one or two per day may be needed to reach optimal control in the patients.

Polycystic changes in rat kidney induced by biphenyl fed in different diets

Groups of rats were fed biphenyl at various dose levels in a semisynthetic diet and in a commercial chow. The effect levels for induction of polycystic kidney lesions were established by means of urinalysis, organ weight changes, light and electron microscopy, and enzyme histochemistry. The no-effect level, was less than 50 mg/kg bw./day and 300 mg/kg bw./day, when feeding the semisynthetic diet and the commercial chow respectively. This difference in effect level due to the diet is an indication that the diet is of great influence on the results of toxicological experiments.

Drug excretion into eggs. An autoradiographic study

Ulberg's whole-body autoradiographic technic has been used to illustrate the distribution pattern, the uptake to the oocytes and the excretion into the egg-white of 14C-trimethroprim, 3H-tetracycline and 14C-urea in Japanese quails. Marked differences were found in the uptake by the follicular epithelium between the oocytes of different size. Furthermore it is observed, that the part of the compound which reaches the yolk remains there, while the rest of the compound is excreted from the body. In the oviduct, the compounds showed variations in the distribution pattern between the differen parts, apparently according to the passive diffusion concept. Some of the drugs showed peculiar localisation in high concentrations as in the retina and in the pecten of the quails eye.

Influence of diet and strain of rat on kidney damage observed in toxicity studies

The laboratory animal is susceptible to biological variation due to a variety of causes. Thus genetic variation and nutrition have become recognized to influence the reaction of the animal to experimental procedures. Severe kidney injury was observed at our institute in preliminary studies with 1% butylated hydroxytoluene (BHT) incorporated in a semisynthetic diet fed to Wistar rats for one month. These lesions together with nephrocalcinosis, a common finding in rats fed a semisynthetic diet might suggest that the animals in our experiment were predisposed to kidney damage. In order to show the influence of the rat strain and the type of diet a study was performed with both Wistar and Sprague-Dawley rats fed a semisynthetic or commercial diet mixed with 1% BHT. It was observed that the semisynthetic diet had a marked effect on the severity of the kidney lesions and that the lesions were independent of the rat strain used. In addition, an apparent sex variation was found.

Tissue damage at the infection site after intramuscular injection of drugs in hens

1. Injection sites were examined on the 7th d after intramuscular injection of vehicles alone or containing antibiotics or chemotherapeutics. 2. Eight out of 13 preparations caused necroses, the largest of which were seen after injection of tetracyclines and sulphonamides.