Maternal Depressive Symptom Trajectories and Psychosocial Functioning in Young Adults: A 27-year Longitudinal Study

Introduction

Maternal depression is a well-known risk factor for child development. Longitudinal studies extending from pregnancy to adulthood, however, are rare.

Objectives

The aim of the study was to investigate whether maternal high depressive symptom trajectories (chronic or intermittent depressive symptom patterns) from pregnancy to the adolescence of the children predict lower adaptive functioning or higher levels of emotional or behavioural symptoms in young adults.

Methods

The sample comprised 329 first-time mothers from maternity centres in Tampere, Finland. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4–5 years, 8–9 years and 16–17 years after delivery. A model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. Adaptive functioning and problems of the children (n = 144) were assessed by the Adult Self Report forms (Achenbach & Rescorla) at the age of 27 years.

Results

High maternal depressive symptom trajectories did not predict self-reported lower adaptive functioning of the children in adulthood. However, children of mothers with chronic or intermittent depressive symptom patterns reported higher levels of internalising problems as well as symptoms of depression and anxiety in young adulthood than the children of mothers with very low or low stable symptom patterns.

Conclusions

High maternal depressive symptom trajectories predict higher levels of emotional symptoms of children in young adulthood. The mechanisms of intergenerational transmission are important topics for further research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

P2786Current ESC guidelines for normal ascending aortic diameter: prevalence of aortic dilatation increases to 20% in a consecutive coronary CTA population

Introduction

Epidemiological studies on the prevalence of ascending aortic (AA) dilatation are scanty.

Purpose

To clarify prevalence of AA dilatation according to ESC 2014 guidelines and to study its risk factors.

Methods

This retrospective study included 1000 consecutive patients scheduled for diagnostic coronary artery computer tomography angiography (CCTA) with low to moderate pretest probability for coronary artery disease (CAD). AA diameter was measured at 3 planes; sinus valsalva, sinotubular junction and tubular part. Threshold for AA dilatation was set to >40 mm (ESC 2014). Traditional risk factors for AA dilatation were collected from medical records.

Aortic size index (ASI) was used as a comparative measurement. ASI is defined as the ratio between aortic diameter and body surface area (BSA). The threshold for AA dilatation was set to upper limit of normal distribution exceeding two standard deviations (95%).

Heart-aorta angle (HAA, Figure) was measured as one suggestive risk factor.

Results

Patients' mean age was 52.9±9.8 years, 66.5% were women. The prevalence of AA dilatation in the whole study population was 20.4% according to ESC 2014 guidelines. When patients with hypertension (n=445) or coronary calcifications or stenosis in CCTA (n=375) were excluded, the prevalence of AA dilatation was 14.5% in the population of normotensive patients without CAD (n=380).

According to the normal-distributed ASI values the threshold for normal dimension of sinus valsalva was defined as 23.5 mm/m2 and for tubular part 22.7 mm/m2 for normotensive patients without CAD. Using these thresholds, the prevalence of AA dilatation was 7.8% in the whole population and 7.1% in normotensive patients without CAD.

Smaller HAA was associated to AA dilatation. Median HAA was 125.6° (range: 119.2–131.5°) in patients with dilated AA and 130.1° (123.7–136.4°) in patients with non-dilated AA (p<0.001).

Higher BSA was associated to larger AA dimensions. Risk factors for AA dilatation (according to ESC criteria) were male gender, BAV, hypertension and smoking (p<0.01).

Figure 1

Conclusions

The prevalence of AA dilatation proved to be relatively high in this consecutive CCTA population when using ESC 2014 guidelines. Body size is associated to AA dimensions; thus, it seems reasonable to include BSA in the definition of AA dilatation.

Acknowledgement/Funding

Oiva Vaittinen will grant, Aarne Koskelo Foundation

Left atrial appendage morphology and relative contrast agent concentration in patients undergoing coronary artery CTA

AIM

To evaluate whether certain morphological features of the left atrial appendage (LAA) would influence the LAA/ascending aorta (AA) radiodensity ratio, as a reflection of the blood flow conditions in the LAA.

MATERIALS AND METHODS

Eight-hundred and eight consecutive patients undergoing computed tomography angiography (CCTA) were evaluated. Of these, 749 had no history of atrial fibrillation and none had suffered acute stroke. The LAA/AA radiodensity ratio, and the length, lobe number, and morphological classification of LAAs were assessed.

RESULTS

The distribution of morphological classes for LAAs were: windsock 62.3%, cactus 18.6%, chicken wing 10.0%, and cauliflower 9.2%. The mean LAA/AA radiodensity ratio was 0.87±0.14 (range 0.22-1.44). Female gender (p=0.001), elevated body mass index (BMI; r=-0.129; p=0.003), and diabetes (p=0.03) were associated with lower LAA/AA radiodensity ratios, while heart failure (p=0.017), significant coronary artery stenosis (p=0.010), and LAAs with multiple lobes (p=0.018), exhibited higher LAA/AA radiodensity ratios. Multiple regression analysis revealed that a short one-lobed cauliflower morphology was an independent predictor (p=0.007) of a decreased LAA/AA radiodensity ratio.

CONCLUSION

A decline in the LAA/AA radiodensity ratio may reflect decreased blood flow in the LAA, paralleling spontaneous echo contrast in transoesophageal echocardiography. Thus, CCTA might be of value in recognising LAA structures that predispose to decreased blood flow.

Automated image analysis detects aging in clinical-grade mesenchymal stromal cell cultures

BACKGROUND

Senescent cells are undesirable in cell therapy products due to reduced therapeutic activity and risk of aberrant cellular effects, and methods for assessing senescence are needed. Early-passage mesenchymal stromal cells (MSCs) are known to be small and spindle-shaped but become enlarged upon cell aging. Indeed, cell morphology is routinely evaluated during MSC production using subjective methods. We have therefore explored the possibility of utilizing automated imaging-based analysis of cell morphology in clinical cell manufacturing.

METHODS

An imaging system was adopted for analyzing changes in cell morphology of bone marrow-derived MSCs during long-term culture. Cells taken from the cultures at the desired passages were plated at low density for imaging, representing morphological changes observed in the clinical-grade cultures. The manifestations of aging and onset of senescence were monitored by population doubling numbers, expression of p16INK4a and p21Cip1/Waf1, β-galactosidase activity, and telomeric terminal restriction fragment analysis.

RESULTS

Cell area was the most statistically significant and practical parameter for describing morphological changes, correlating with biochemical senescence markers. MSCs from passages 1 (p1) and 3 (p3) were remarkably uniform in size, with cell areas between 1800 and 2500 μm2. At p5 the cells began to enlarge resulting in a 4.8-fold increase at p6-9 as compared to p1. The expression of p16INK4a and activity of β-galactosidase had a strong correlation with the increase in cell area, whereas the expression of p21Cip1/Waf1 reached its maximum at the onset of growth arrest and subsequently decreased. Mean telomere length shortened at an apparently constant rate during culture, from 8.2 ± 0.3 kbp at p1, reaching 6.08 ± 0.6 kbp at senescence.

CONCLUSIONS

Imaging analysis of cell morphology is a useful tool for evaluating aging in cell cultures throughout the lifespan of MSCs. Our findings suggest that imaging analysis can reproducibly detect aging-related changes in cell morphology in MSC cultures. These findings suggest that cell morphology is still a supreme measure of cell quality and may be utilized to develop new noninvasive imaging-based methods to screen and quantitate aging in clinical-grade cell cultures.

Medical surveillance for occupational asthma-how are cases detected?

Background

In Finland, medical surveillance, including spirometry, is periodically performed for workers who are exposed to agents capable of causing occupational asthma (OA). Although it has been shown that surveillance can detect OA at an early stage, few studies have assessed its benefits or the role of surveillance spirometry.

Aims

To assess the role of surveillance and spirometry in detecting OA and to evaluate the quality of spirometry.

Methods

We retrospectively reviewed the medical files of patients in health surveillance programmes who were diagnosed with sensitizer-induced OA at the Finnish Institute of Occupational Health in 2012‒14. We collected information on work exposure, respiratory symptoms, healthcare visits that initiated the diagnostic process, first spirometry and other diagnostic tests.

Results

Sixty files were reviewed. Medical surveillance detected 11 cases (18%) and 49 cases (82%) were detected at doctors' appointments that were not related to surveillance. The median delay from the onset of asthma symptoms to diagnosis was 2.2 years. Delay did not differ between these groups. No cases were detected on the basis of abnormal spirometry without respiratory symptoms. However, five patients (8%) initially reported solely work-related rhinitis symptoms. Spirometry was normal in half of the cases and quality criteria were fulfilled in 86% of the tests.

Conclusions

Fewer than one in five OA cases were detected through medical surveillance. Investigations were initiated by respiratory symptoms. No asymptomatic worker was referred because of abnormal spirometry. Our results highlight the importance of work-related nasal symptoms in detecting OA.

Collection, processing and testing of bone, corneas, umbilical cord blood and haematopoietic stem cells by European Blood Alliance members

BACKGROUND AND OBJECTIVES

A questionnaire study was carried out in collaboration with the European Blood Alliance (EBA) Tissues and Cells (T&C) working group. The aim was to assess the level of involvement and commonality of processes on the procurement, testing and storage of bone, corneas, umbilical cord blood (UCB) and haematopoietic stem cells (HSC) in order to identify different practices and to explore whether recommendations can be made for harmonization.

MATERIALS AND METHODS

An online questionnaire was used for data collection in 2011, and 43 replies were received covering 71 product answers from 13 countries.

RESULTS AND CONCLUSIONS

Estimated percentages of tissue and cell banking covered by EBA member blood banks as a proportion of all collections of each individual country varied markedly. There were also major differences in the amounts of products collected and discarded and in proportions tissues provided for grafting. However, discarding of certain collections also reflects the practice of increasing the likelihood of the very best units being used for transplantation. Harmonization of possible practices should focus on matching supply with demand and on identifying the most efficient operators. This could allow for the development of practices for minimizing unnecessary collections.

Towards a global system of vigilance and surveillance in unrelated donors of haematopoietic progenitor cells for transplantation

Safety of living donors is critical to the success of blood, tissue and organ transplantation. Structured and robust vigilance and surveillance systems exist as part of some national entities, but historically no global systems are in place to ensure conformity, harmonisation and the recognition of rare adverse events (AEs). The World Health Assembly has recently resolved to require AE/reaction (AE/R) reporting both nationally and globally. The World Marrow Donor Association (WMDA) is an international organisation promoting the safety of unrelated donors and progenitor cell products for use in haematopoietic progenitor cell (HPC) transplantation. To address this issue, we established a system for collecting, collating, analysing, distributing and reacting to serious adverse events and reactions (SAE/R) in unrelated HPC donors. The WMDA successfully instituted this reporting system with 203 SAE/R reported in 2011. The committee generated two rapid reports, reacting to specific SAE/R, resulting in practice changing policies. The system has a robust governance structure, formal feedback to the WMDA membership and transparent information flows to other agencies, specialist physicians and transplant programs and the general public.

The Nordic prescription databases as a resource for pharmacoepidemiological research--a literature review

PURPOSE

All five Nordic countries have nationwide prescription databases covering all dispensed drugs, with potential for linkage to outcomes. The aim of this review is to present an overview of therapeutic areas studied and methods applied in pharmacoepidemiologic studies using data from these databases.

METHODS

The study consists of a Medline-based structured literature review of scientific papers published during 2005-2010 using data from the prescription databases in Denmark, Finland, Iceland, Norway, and Sweden, covering 25 million inhabitants. Relevant studies were analyzed in terms of pharmacological group, study population, outcomes examined, type of study (drug utilization vs. effect of drug therapy), country of origin, and extent of cross-national collaboration.

RESULTS

A total of 515 studies were identified. Of these, 262 were conducted in Denmark, 97 in Finland, 4 in Iceland, 87 in Norway, and 61 in Sweden. Four studies used data from more than one Nordic country. The most commonly studied drugs were those acting on the nervous system, followed by cardiovascular drugs and gastrointestinal/endocrine drugs. A total of 228 studies examined drug utilization and 263 focused on the effects and safety of drug therapy. Pregnant women were the most commonly studied population in safety studies, whereas prescribers' adherence to guidelines was the most frequent topic of drug utilization studies.

CONCLUSIONS

The Nordic prescription databases, with their possibility of record-linkage, represent an outstanding resource for assessing the beneficial and adverse effects of drug use in large populations, under routine care conditions, and with the potential for long-term follow-up.

End-stage renal disease and critical limb ischemia: a deadly combination?

OBJECTIVES

This study was planned to evaluate the prognostic impact of end-stage renal disease (ESRD) in patients with critical leg ischemia (CLI) undergoing infrainguinal revascularization.

MATERIALS AND METHODS

1425 patients who underwent infrainguinal revascularization for CLI were the subjects of the present analysis. Ninety-five patients had ESRD (eGFR < 15 ml/min/m²), and of them 66 (70%) underwent percutaneous transluminal angioplasty and 29 (30%) underwent bypass surgery.

RESULTS

ESRD patients had significantly lower overall survival (at 3-year, 27.1% vs. 59.7%, p < 0.0001), leg salvage (at 3-year, 57.7% vs. 83.0%, p < 0.0001), and amputation free survival (at 3-year, 16.2% vs. 52.9%, p < 0.0001) than patients with no or less severe renal failure. The difference in survival was even greater between 86 one-to-one propensity matched pairs (at 3-year, 23.1% vs. 67.3%, p < 0.0001). ESRD was an independent predictor of all-cause mortality (RR 2.46, 95%CI 1.85-3.26). Logistic regression showed that age ≥ 75 years was the only independent predictor of 1-year all-cause mortality (OR 4.92, 95%CI 1.32-18.36). Classification and regression tree analysis showed that age ≥ 75 years and, among younger patients, bypass surgery for leg ulcer and gangrene were associated with significantly higher 1-year mortality

CONCLUSIONS

Lower limb revascularization in patients with CLI and end-stage renal failure is associated with favourable leg salvage. However, these patients have a very poor survival and this may jeopardize any attempt of revascularization. Further studies are needed to identify ESRD patients with acceptable life expectancy and who may benefit from lower limb revascularization.

Predictors of Failure of Endovascular Revascularization for Critical Limb Ischemia

Background and Aims:

To characterize predictors of failure when treating critical limb ischemia (CLI) patients with an endovascular intervention as the first-line strategy.

Patients and Methods:

This retrospective, registry-based study included 217 consecutive patients with 240 chronic critically ischemic limbs treated with infrainguinal percutaneous transluminal angioplasty (PTA) during 2006–2007 at Helsinki University Central Hospital, Finland. The primary outcome measures were death, major (above-ankle) amputation, and the need for surgical re-intervention within 6 months after the primary procedure. The secondary outcome measures were overall major amputation and survival rates as well as the overall need for surgical or any other (surgical or endovascular) type of re-intervention. Predictors of outcome endpoints were identified with a univariate screen, and a Cox regression model was used in the multivariate analysis.

Results:

Compared to ulcer, gangrene was significantly more strongly associated with amputation within 6 months post-procedurally as well as during the whole follow-up period (p ≤ 0.028). The patient's inability to walk upon hospital arrival was a significant predictor of death, amputation and surgical re-intervention. Mediasclerotic ankle-brachial index (ABI) was an independent predictor of amputation as well as endovascular re-interventions.

Conclusions:

The strong predictors of poor outcome after endovascular revascularization for patients with CLI are cardiac morbidity, the inability to ambulate upon hospital arrival, and gangrene as a manifestation of CLI. The risk of amputation seems to be significantly higher for gangrene than for ulcer and this matter should be taken into account in the clinical classifications for CLI.

Side-to-side differences in bone strength in master jumpers and sprinters

INTRODUCTION

This study evaluated side-to-side difference in tibial bone structure, calf muscle cross-sectional area (CSA) and hopping force in master athletes as a result of training for sports with different magnitudes of inter-leg loading difference.

METHODS

Tibial bone parameters (at 4%, 14%, 38% and 66% tibial length proximal to distal end), muscle CSA (at 66% tibial length) and hopping forces of both legs of 51 master athletes (conditioned jumpers, conditioned triple jumpers, unconditioned jumpers, hurdlers and sprinters) were examined using pQCT. In epiphyseal 4% slice bone CSA (Ar.tot), total BMC (vBMC.tot), trabecular BMC (vBMC.tb) cortical BMC (vBMC.ct), and trabecular BMD (vBMD.tb) were measured. In diaphyseal slices, Ar.tot, vBMC.ct, cortical density (vBMD.ct), cross-sectional moment of inertia (CSMI) and calf muscle CSA (MuscA) were examined.

RESULTS

In conditioned jumpers, side-to-side differences in favour of take-off leg were found in 4% slice in vBMC.tb (+4.1%) (P<0.05). A side-to-side difference was found in 66% slice vBMC.ct and CSMI (both P<0.05), with conditioned jumper (+2.8% and 6.6%) and triple jumper (+2.7% and 7.2%) values higher than other groups.

CONCLUSION

The results suggest that regular training in high-impact sports with uneven lower limb loading results in side-to-side differences in skeletal adaptation independent of age and gender, suggesting that high-impact exercise is effective in maintaining bone strength throughout human lifespan.

The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot

AIMS/HYPOTHESIS

The aim of the study was to stratify the risk of diabetic patients with leg ulcer or gangrene undergoing infrainguinal revascularisation for critical limb ischaemia.

METHODS

The study cohort included 732 revascularisation procedures performed in 597 diabetic patients with ulcer or gangrene. Logistic regression and CART analysis were used for identification of predictors of 1-year outcome.

RESULTS

Logistic regression showed that chronic kidney disease (CKD) class (OR 1.38, 95% CI 1.16, 1.65) was an independent predictor of 1-year leg salvage (area under the receiver operating characteristic [ROC] curve 0.60, 95% CI 0.54, 0.65). The terminal nodes of the CART for 1-year leg salvage were CKD classes 4-5, the level (infrapopliteal vs femoropopliteal revascularisation), type of revascularisation (bypass surgery vs percutaneous transluminal angioplasty) and gangrene (area under the ROC curve 0.62, 95% CI 0.57, 0.68). Logistic regression showed that pulmonary disease (OR 1.76, 95% CI 1.11, 2.78), CKD class (OR 1.43, 95% CI 1.24, 1.65), foot gangrene (OR 1.76, 95% CI 1.21, 2.60) and patient age (OR 1.02, 95% CI 1.01, 1.04) were independent predictors of 1-year amputation-free survival (area under the ROC curve 0.65, 95% CI 0.60, 0.69). The terminal nodes of the CART for 1-year amputation-free survival were CKD classes 3-5, patient's age of ≥ 75 years and foot gangrene (area under the ROC curve 0.64, 95% CI 0.60, 0.68).

CONCLUSIONS/INTERPRETATION

CKD is a formidable risk factor for poor intermediate outcome after infrainguinal revascularisation in diabetic patients with foot ulcer or gangrene. CART analysis indicates that foot gangrene is also a significant risk factor for adverse outcome.

Infrainguinal percutaneous transluminal angioplasty or bypass surgery in patients aged 80 years and older with critical leg ischaemia

Background

Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and bypass surgery in these patients.

Methods

Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or bypass surgery (307) for CLI between 2000 and 2007 were included in this study.

Results

After 2 years PTA achieved better results than bypass surgery (leg salvage: 85·4 versus 78·7 per cent, P = 0·039; survival: 57·7 versus 52·3 per cent, P = 0·014; amputation-free survival (AFS): 53·0 versus 44·9 per cent, P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and bypass surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity score-matched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48·9 per cent; P = 0·008).

Conclusion

When feasible, a strategy of PTA first appears to achieve better results than infrainguinal bypass surgery in patients aged 80 years and older.

Clinical and immunological overlap between autoimmune lymphoproliferative syndrome and common variable immunodeficiency

Autoimmune lymphoproliferative syndrome (ALPS) is mainly caused by defects in the CD95 pathway. Raised CD3+TCRαβ+CD4-CD8- double negative T cells and impaired T cell apoptosis are hallmarks of the disease. In contrast, the B cell compartment has been less well studied. We found an altered distribution of B cell subsets with raised transitional B cells and reduced marginal zone B cells, switched memory B cells and plasma blasts in most of 22 analyzed ALPS patients. Moreover, 5 out of 66 ALPS patients presented with low IgG and susceptibility to infection revealing a significant overlap between ALPS and common variable immunodeficiency (CVID). In patients presenting with lymphoproliferation, cytopenia, hypogammaglobulinemia and impaired B cell differentiation, serum biomarkers were helpful in addition to apoptosis tests for the identification of ALPS patients. Our observations may indicate a role for apoptosis defects in some diseases currently classified as CVID.

A practice-based study of the variation of diagnostics of dental caries in new and old patients of different ages

Data mining of digital dental records provides possibilities for analysing the variation between dentists when diagnosing caries. A total of 71,317 male and 82,302 female subjects visited the health centres in Vantaa and Kemi during the 'digital era' (1994-2005). As subjects were classified as 'new patients' at the first examination, all re-examinations of the same subjects thereafter by the same dentist produced 'old patients'. A mean number of decayed surfaces (DS) was counted as a function of the age of the subject during the follow-up. The significance of the difference between old and new patients was determined by the Mann-Whitney test for each age cohort at the cross sections, and for the whole follow-up. Caries was seen to affect new patients more than the old ones in both health centres after the age of 20 years. The mean DS values were the same, reaching about 1 for new and old patients at the age of 15 years. The mean DS had a peak for new patients in both health centres at the age of 25 years and another peak around 45-50 years in Kemi. With a few exceptions there was a significant difference between the DS values of new and old patients at most cross sections and for the whole follow-up time. Evidently dentists examine new patients more carefully than their old patients. After the age of 18 years patients may have changed their dentists because they have finished the free-of-charge treatment period.

Integrins as receptors for extracellular matrix proteins in human cornea

Extracellular matrix (ECM) proteins form distinct protein families that play a role during tissue maturation, wound healing and maintenance of tissue architecture. Recent studies show that there are tissue type-specific variations in their expression. ECM proteins function by complexing with each other and also by interacting with their cellular receptors, called integrins. Integrins are heterodimeric membrane glycoproteins that are partly cell type-specifically expressed in human tissues. Like other stratified epithelia, corneal epithelium expresses alpha 2 beta 1, alpha 3 beta 1, alpha 6 beta 1, 4, and alpha v beta 1 integrins that mediate attachment to the basement membrane and cell-cell interactions.

Effect of protein source on amino acid supply, milk production, and metabolism of plasma nutrients in dairy cows fed grass silage

This study conducted according to a 4 x 4 Latin square with 28 d periods and four ruminally cannulated Finnish Ayrshire cows investigated the effect of protein supplements differing in amino acid (AA) profile and rumen undegradable protein content on postruminal AA supply and milk production. Mammary metabolism of plasma AA and other nutrients were also studied. The basal diet (Control; 13.4% crude protein) consisted of grass silage and barley in a ratio of 55:45 on a dry matter basis. The other three isonitrogenous diets (17.0% crude protein) were control + fishmeal (FM), control + soybean meal (SBM), and control + corn gluten meal (CGM). The protein supplements replaced portions of dry matter of the control diet maintaining the silage to barley ratio constant for all diets. Dry matter intake was limited to 95% of the preexperimental ad libitum intake and was similar (mean 19.8 kg/d dry matter) across the diets. Protein supplements increased milk, lactose, and protein yields but did not affect yields of energy-corrected milk or milk fat. Milk protein yield response was numerically lowest for diet SBM. Protein supplements increased milk protein concentration but decreased milk fat and lactose concentrations. Microbial protein synthesis and rumen fermentation parameters were similar across the diets, except for an increased rumen ammonia concentration for diets supplemented with protein feeds. Protein supplements increased N intake, ruminal organic matter and N, and total tract organic matter, N, and neutral detergent fiber digestibilities. Protein supplements also increased N and AA flows into the omasum, with SBM giving the lowest and CGM the highest flows. This was associated with an unchanged microbial N flow and a higher undegraded dietary N flow. The omasal flows of individual AA reflected differences in total N flow and AA profile of the experimental diets. Differences in AA flows did not always reflect plasma AA concentrations. The results indicated that AA supply of dairy cows fed a grass silage-cereal diet can be manipulated using protein supplements differing in ruminal protein degradability and AA profile. Lower milk production response to SBM than that to FM and CGM appeared to be related mainly to lower N and AA supplies arising from a high ruminal protein degradability of SBM. Histidine appeared to be the first limiting AA for milk protein synthesis on the control diet. Mammary gland may regulate AA uptake according to requirements.

Supplementing barley or rapeseed meal to dairy cows fed grass-red clover silage: II. Amino acid profile of microbial fractions

Four ruminally cannulated dairy cows were used to examine the effect of diet on the AA composition of rumen bacteria and protozoa, and the flow of microbial and nonmicrobial AA entering the omasal canal. Cows were offered grass-red clover silage alone, or that supplemented with 5.1 kg DM of barley, 1.9 kg DM of rapeseed meal, or 5.1 kg DM of barley and 1.9 kg DM of rapeseed meal according to a 4 x 4 Latin square design with a 2 x 2 factorial arrangement of treatments. During the first 10 d of each period, cows had free access to silage and, thereafter intake was restricted to 95% of ad libitum intake. Postruminal digesta flow was assessed using the omasal canal sampling technique in combination with a triple marker method. Liquid- (LAB) and particle- (PAB) associated bacteria were isolated from digesta in the reticulorumen and protozoa from digesta entering the omasal canal. Microbial protein flow was determined using 15N as a microbial marker. Flows of AA entering the omasal canal were similar in cows fed silage diets supplemented with barley or rapeseed meal. However, rapeseed meal increased nonmicrobial AA flow while barley increased the flow of AA associated with LAB and protozoa. Diet had negligible effects on the AA profile of microbial fractions. Comparison of AA profiles across diets indicated differences between LAB and PAB for 10 out of 17 AA measured. Rumen bacteria and protozoa were found to be different for 14 out of 15 AA measured. For grass silage-based diets, energy and protein supplementations appear to alter postruminal AA supply through modifications in the proportionate contribution of microbial and nonmicrobial pools to total protein flow rather than as a direct result of changes in the AA profile of microbial protein.

Evaluation of isoleucine, leucine, and valine as a second-limiting amino acid for milk production in dairy cows fed grass silage diet

Five Finnish ruminally cannulated Ayrshire cows were used in a 5 x 5 Latin square trial with 14-d periods to determine whether branched-chain amino acids (AA) are the second- or colimiting AA for milk protein synthesis on grass silage-cereal based diet. Mammary metabolism of AA as well as AA supply from the basal diet were also studied. Grass silage (17.5% crude protein) was given ad libitum with 9 kg/d as a cereal-based concentrate (13.8% crude protein). Treatments were basal diet without AA infusion (Control), abomasal infusion of AA mixture of His, Ile, Leu, and Val at 8.5, 14.9,27.9, and 18.3 g/d, respectively, AA mixture minus Ile, AA mixture minus Leu, and AA mixture minus Val. Glucose was infused on all treatments at 250 g/d. Amino acid infusions had no effect on dry matter intake (mean 19.2 kg/d), yields of milk (mean 25.3 kg/d), energy-corrected milk (mean 25.9 kg/d), milk protein (mean 807 g/d), lactose (mean 1261 g/d), or fat (mean 1056 g/d). Milk composition was not affected by the treatments. Plasma concentrations of His and Val responded to AA infusions but concentration of Ile increased only on treatment AA mixture minus Leu, and concentration of Leu only on treatment AA mixture minus Ile. Infusion of AA mixture of His, Ile, Leu, and Val decreased plasma concentrations of Arg, Lys, Met, Phe, and Tyr. Amino acid infusions did not affect concentrations of plasma urea and energy metabolites or AA utilization by the mammary gland. Based on unchanged production parameters, the supply of His or branched-chain AA seemed not to be limiting under the current dietary conditions. Changes in plasma AA concentrations suggest either antagonism between individual AA in absorption or increased partitioning of AA into the muscle tissues. About 75% of omasal canal nonammonia nitrogen flow (427 g/d) was of microbial origin, and AA profiles of microbial protein and omasal canal digesta were fairly similar. Postruminal AA supply seems to be dependent on the basal diet, but variation may exist even within the similar basal diets.

Rheological properties of creams with four different surfactant combinations - effect of storage time and conditions

Changes in the rheological properties of four o/w cream formulations differing in the combination of surfactants were studied. The non-ionic surfactants used were soybean derivatives, polyethylene glycol 10 and 25 soya sterol, and sorbitol derivatives, sorbitan monooleate and trioleate. Combinations of the soybean and sorbitol derivatives were used. The rheological properties were tested during a 28-day storage period at three different storage conditions (cold, room temperature and accelerated conditions). In addition to dynamic and static rheological tests, droplet size distributions and conductivities of the creams were also determined. The consistency of the creams containing polyethylene glycol 10 soya sterol decreased during storage. Despite the greatest decreases in consistency, the creams containing polyethylene glycol 10 soya sterol exhibited the most viscoelastic structures with linear viscoelastic behaviour. Storing the creams for 28 days in the three different storage conditions made the differences in the consistency of the formulations smaller. All three storage conditions were involved when the conditions of the most viscoelastic cream of each formulation was specified. In the case of linearly viscoelastically behaving creams containing polyethylene glycol 10 soya sterol, all the rheological tests correlated with the droplet size distributions and the conductivity tests.

Concentrations of polychlorinated dibenzo-p-dioxins and furans in fish downstream from a Ky-5 manufacturing

Concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were studied in seven fish species, burbot (Lota lota), pike (Esox lucius), perch (Perca fluviatilis), pikeperch (Stizopedion lucioperca), bream (Abramis brama), salmon (Salmo salar) and Baltic herring (Clupea harengus membras) in River Kymijoki and its estuary polluted by Ky-5 manufacturing. The fish were caught at 14 localities along the river and its estuary. The selected species represent different trophic levels and/or inhabit different environments. The concentrations of PCDD/Fs were low, in most samples below 1 pg g(-1) ITEQ (NATO/CCMS 1988) fresh weight (fw) in muscle, except salmon and Baltic herring. These two species graze at the open sea and consequently accumulate contaminants at a large area in the Baltic Sea. The lipid content in salmon and Baltic herring was an order of magnitude higher than in other species. PCDD/Fs in fish muscle showed only slightly elevated levels in the Kymijoki area and its estuary as compared to the levels in the same species in Finnish freshwaters and sea areas. The concentration of the main impurities of the fungicide Ky-5 was higher in the Kymijoki River downstream the Ky-5 manufacturing place compared to the up-stream locations. The PCDD/F concentrations in fish liver and spawn were 10-100 times higher than the concentration in muscle, because of the much higher lipid concentrations of these organes. Consequently, the tolerable daily intake values could be as much as 100 times smaller (M. Korhonen, M. Verta, T. Vartiainen, Organohalog. Comp. 32 (1997) 305-310; P. Mikkelson, J. Paasivirta, H. Kiviranta, Organohalog. Comp. 39 (1998) 59-62).

Patient-perceived problems, compliance, and the outcome of hypertension treatment

OBJECTIVE

To study the associations between the outcome of antihypertensive therapy with both patient-perceived problems and patient initiated modification of dosage instructions.

DESIGN AND METHODS

In this cross-sectional survey, all chronic hypertensives aged less than 75 years (n = 971) visiting nine Finnish pharmacies between May and September of 1996 were asked to participate. Of the 866 agreeing to participate, 482 returned the questionnaire (56%). After excluding persons with missing data, the final study population consisted of 428 hypertensive patients. Information on problems with treatment, the modification of dosage instructions, and blood pressure levels was based on patient self-reports.

RESULTS

Two-thirds (68%) of the study population reported suffering from one or more problems. The most common problems were symptoms of high blood pressure and adverse drug effects. Thirty-one percent of the male respondents and 21% of the female respondents reported having modified their dosage instructions. Only 36% of the patients had reached the goal blood pressure (< 160/90 mmHg). Patients having problems with hypertension treatment were significantly more likely to have modified their dosage instructions than those without problems (3+ problems, adjusted OR = 4.8). Not reaching goal blood pressure levels was significantly associated with both high number of patient-perceived problems (3+ problems, adjusted OR = 2.1) and modification of dosage instructions (adjusted OR = 1.9).

CONCLUSION

The poor outcome in antihypertensive therapy is associated with both patient-perceived problems and patient initiated modification of dosage instructions.

Immunohistochemical localization of laminin and fibronectin isoforms in human placental villi

We studied the localization of laminin alpha1, alpha2, alpha3, alpha5, beta1, beta2, and gamma1 chains and extradomain A- (EDA), EDB-, and oncofetal fibronectin by immunohistochemistry in human placental villi during placental development. The laminin alpha2, alpha5, beta1, beta2, and gamma1 chains were detected in the trophoblastic basement membrane (BM) at all stages of gestation, suggesting the presence of laminin-2, -4, -10, and -11 trimers. The laminin alpha1 chain was selectively found at sites where the villous BM was in contact with proliferating cells in trophoblastic islands or columns. EDA-Fn, but not other Fn isoforms, was found in the trophoblastic BM during the first trimester. The laminin alpha2, beta1, beta2, and gamma1 chains were detected in the villous stroma and capillaries throughout placental development, while the laminin alpha5 chain emerged distinctly during development. Extensive EDA-Fn immunoreactivity was found in first-trimester villous stroma, but distinctly fewer Fn isoforms were seen in the villous stroma during the later stages of gestation. Our results also suggest that, during the formation of new villi, laminins are not found in trophoblastic sprouts before the ingrowth of the villous mesenchyme. Rather, laminins may be deposited at the villous epithelial-mesenchymal interface. Furthermore, the results show that distinct changes occur in the localization of various laminin and Fn isoforms during the maturation of villous trophoblastic and capillary BMs.

Responses to graded postruminal doses of histidine in dairy cows fed grass silage diets

Five Finnish Ayrshire cows were used in a 4 x 4 Latin square experiment designed to study the effects of graded doses of postruminal His infusion on milk production, arterial concentrations, and mammary uptakes of plasma amino acids (AA) as well as utilization of added His. Grass silage (16.9% CP) was given ad libitum with 8 kg of cereal-based concentrate per day (11.3% CP). Treatments were abomasal or duodenal infusions of 250 g of glucose/d in combination with 0, 2, 4, or 6 g of His/d. Infusions did not affect dry matter intake (mean 18 kg/d). Infusion of His increased milk yield linearly from 27.0 to 28.8 kg/d, protein yield from 861 to 919 g/d and lactose yield from 1345 to 1457 g/d. Milk fat yield and content changed in a cubic manner (1240, 1167, 1296, and 1177 g/d and 4.60, 4.16, 4.60, and 4.09). Infusion of His had no influence on milk protein or lactose concentrations. Arterial Lys and His concentrations increased linearly, but other AA concentrations were unaffected as well as calculated arteriovenous differences and mammary AA uptakes. The extraction of His decreased linearly with an increasing amount of His. The utilization of added His (28%) was not affected by the level of infusion, and mammary AA uptake seemed to be regulated by an inverse relationship between arteriovenous difference of essential AA and calculated mammary plasma flow. This experiment confirmed that His is the first-limiting AA on grass silage-cereal based diets.

Posttranslational modifications and beta/gamma chain associations of human laminin alpha1 and laminin alpha5 chains: purification of laminin-3 from placenta

Laminins assemble into trimers composed of alpha, beta, and gamma chains which posttranslationally are glycosylated and sometimes proteolytically cleaved. In the current paper we set out to characterize posttranslational modifications and the laminin isoforms formed by laminin alpha1 and alpha5 chains. Comparative pulse-chase experiments and deglycosylation studies in JAR cells established that the M(r) 360,000 laminin alpha1 chain is glycosylated into a mature M(r) 400,000 band while the M(r) 370,000 laminin alpha5 chain is glycosylated into a M(r) 390,000 form that upon secretion is further processed into a M(r) 380,000 form. Hence, despite the shorter peptide length of alpha1 chain in comparison with the alpha5 chain, secreted alpha1 assumes a larger size in SDS-PAGE due to a higher degree of N-linked glycosylation and due to the lack of proteolytic processing. Immunoprecipitations and Western blotting of JAR laminins identified laminin alpha1 and laminin alpha5 chains in laminin-1 and laminin-10. In placenta laminin alpha1 chain (M(r) 400,000) and laminin alpha5 chain (M(r) 380, 000/370,000 doublet) were found in laminin-1/-3 and laminin-10/-11. Immunohistochemically we could establish that the laminin alpha1 chain in placenta is deposited in the developing villous and trophoblast basement membrane, also found to contain laminin beta2 chains. Surprisingly, a fraction of the laminin alpha1 chain from JAR cells and placenta could not be precipitated by antibodies to laminin beta1-beta3 chains, possibly pointing to an unexpected complexity in the chain composition of alpha1-containing laminin isoforms.

Unaltered distribution of laminins, fibronectin, and tenascin in celiac intestinal mucosa

Extensive remodeling of the extracellular matrix (ECM) occurs in inflammatory tissues. The celiac lesion in the small intestine is characterized by inflammation accompanied by profound morphological alterations. We used immunohistochemistry to determine the distribution of laminin, fibronectin, and tenascin isoforms in small intestinal biopsies of untreated patients with celiac disease. In normal mucosa, the distribution of laminin isoforms defines three epithelial basement membrane (BM) zones. We found that the organization of these zones was maintained in the celiac mucosa. Thus, components of laminin-5 (alpha3 and beta3) were found in the surface epithelial BM, laminin alpha2 chain was found selectively at crypt bottoms, and laminin alpha5 chain was the sole alpha-type chain in middle crypt BMs. Likewise, the distribution of fibronectin and tenascin resembled that of the normal gut. The organization of pericryptal fibroblasts and lamina propria smooth muscle strands, as defined by immunostaining for alpha-smooth muscle actin, also remained unchanged in the celiac mucosa. Unexpectedly, major ECM changes were not detected in the celiac lesion.

Determination of optimal combination of surfactants in creams using rheology measurements

The effect of surfactant on the rheological properties of some cream formulations was studied. Two surfactants from two different series were combined to determine the combination which yielded the most viscoelastic structure for creams. The surfactants were the soybean derivatives soya sterol, polyethylene glycol 10 soya sterol and polyethylene glycol 25 soya sterol and the sorbitol derivatives sorbitan monooleate and sorbitan trioleate. The rheological properties of the creams were studied using oscillation stress sweep, oscillation frequency sweep and viscosity tests. Droplet size distribution and conductivity of the creams were also determined. The combination polyethylene glycol 10 soya sterol and sorbitan trioleate yielded the most viscoelastic structure with linearly viscoelastic behaviour.

Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol

BACKGROUND

The magnitude of the influence of the apolipoprotein (apo) E genotype on the lipid response to different cholesterol-lowering diet modifications has been controversial.

OBJECTIVE

The aim of the study was to investigate the effect of apo E genotype on serum lipid response to the separate modification of dietary fat and cholesterol.

DESIGN

A prospective study design with the 3 main apo E genotype groups (3/3, 3/4, and 4/4; n = 15 in each group) was used. Groups were matched for sex, age, body mass index, menopausal status, and baseline serum cholesterol concentration. Subjects followed 3 different diets in fixed order: 1) a standardized baseline diet (38% fat, 300 mg cholesterol/d), 2) a modified National Cholesterol Education Program (NCEP) diet (34% fat, 265 mg cholesterol/d), and 3) the modified NCEP diet + cholesterol (566 mg cholesterol/d). Subjects were middle-aged (50.9 +/- 8.0 y) and mildly hypercholesterolemic (6.55 +/- 1.05 mmol/L).

RESULTS

The genotype groups differed in their total cholesterol response to the NCEP diet; the mean (95% CI) decrease being greatest, -14.1% (-19.8%, -8.6% ), in subjects with apo E genotype 4/4 (P = 0.03, analysis of variance). The increase in total cholesterol after addition of 300 mg cholesterol was also greatest in subjects with apo E 4/4 [10.4% (5.8%, 15.1%)] (P = 0.03, analysis of variance).

CONCLUSIONS

Apo E genotype modified the lipid response to changes in both dietary fat and cholesterol in mildly hypercholesterolemic subjects; the response was greatest in subjects with apo E genotype 4/4 and even a moderate increase in dietary cholesterol resulted in a 10% elevation in serum total cholesterol in them.

Isolation and characterization of cDNA for a plant mitochondrial phosphate translocator (Mpt1): ozone stress induces Mpt1 mRNA accumulation in birch (Betula pendula Roth)

We have isolated by DDRT-PCR (differential-display reverse-transcription polymerase chain reaction) and cDNA library screening a 1.3 kb cDNA corresponding to a strongly ozone-inducible transcript from birch (Betula pendula Roth). Nucleotide sequence analysis suggests that it encodes a mitochondrial phosphate translocator protein (Pic), the first one isolated from plants. The isolated birch mitochondrial phosphate translocator cDNA (designated Mpt1) contains an open reading frame of 1092 bases encoding a 364 amino acid polypeptide. The deduced protein is 66% similar to bovine Pic isoform B. Comparison of the N-terminal amino acid sequence to known mammalian Pic proteins and the existence of an in-frame stop codon upstream of the initiation codon suggest that the isolated cDNA is full-length. Southern hybridization analysis of birch genomic DNA shows that Mpt1 is a single-copy gene. Accumulation of Mpt1 mRNA during oxidative stress imposed by ozone is detectable already at 2 h and it is at maximum ca. 12 h after the beginning of an 8 h ozone exposure (150 ppb). A second O3 peak at 48-56 h did not increase transcript levels further. O3 exposure for 2 h was sufficient for Mpt1 induction. Birch Mpt1 transcript levels remain at moderately low level during leaf development and is lower in roots and leaves when compared to young shoots undergoing wood formation and lignification.

Expression of type IV collagen alpha1(IV)-alpha6(IV) polypeptides in normal and developing human kidney and in renal cell carcinomas and oncocytomas

Type IV collagen trimer is a major component of basement membranes (BMs). It is composed of polypeptides named alpha1(IV)-alpha6(IV) chains. Chains alpha1,2(IV) are widely expressed in BMs while alpha3(IV)-alpha6(IV) are more restricted in human tissues. We have now studied by immunohistochemical means the distribution of collagen IV chains in fetal and adult human kidney, in oncocytomas, in renal cell carcinomas (RCCs) and their metastases and in experimental xenografts of human tumors. alpha1,2(IV) chains were found in all BMs of fetal and adult kidney as well as of renal tumors, while alpha3(IV)-alpha6(IV) chains were found in BMs of distal segments of developing and mature tubules. alpha3(IV)-alpha5(IV) chains were seen also in BMs of developing fetal glomeruli after the capillary loop stage. Most of the RCCs and their metastases showed occasional expression of alpha3(IV)-alpha6(IV) with papillary variants showing only expression of alpha5(IV) chain. There was a distinct expression of alpha3(IV)-alpha5(IV) chains in BMs of 3 oncocytomas. In 2 of them a variable expression of the alpha6(IV) chain was seen. In 3 of 4 xenografts, immunoreactivity for human-specific monoclonal antibody (MAb) for alpha1,2(IV) was seen in the BM-like structures. No alpha3-alpha6(IV) was seen in any of the xenografts, while polyclonal antiserum for type IV collagen presented immunoreactivity in BMs of all xenografts. Our results show that oncocytomas and most of the RCCs express scarce variants of type IV collagen containing alpha3(IV)-alpha6(IV) chains. In experimental xenograft tumors, both implanted RCC cells and host stromal cells have a capacity to produce type IV collagen.

The distribution of laminins and fibronectins is modulated during extravillous trophoblastic cell differentiation and decidual cell response to invasion in the human placenta

We studied the distribution of laminin (Ln) alpha1-alpha3, beta1-beta3, and gamma1 chains, and of the extradomain-A (EDA) and EDB and the oncofetal epitope of fibronectin (Onc-Fn) in extravillous trophoblastic cells and decidua in the human placenta by immunohistochemistry. We found that the transition from villous to extravillous trophoblast was accompanied by emergence of immunoreactivity for EDA-, EDB-, and Onc-Fn among the cells. Furthermore, whereas the villous trophoblastic basement membrane (BM) contains Ln alpha1, alpha2, beta1, beta2, and gamma1 chains, immunoreactivity for Ln alpha1, beta1, and gamma1, but not for Ln alpha2 and beta2 chains, was detected in association with extravillous trophoblastic cells. Interestingly, although immunoreactivity for the Ln alpha1, alpha2, beta1, beta2, and gamma1 chains was detected in all decidual cell BMs, EDB-Fn and Onc-Fn were detected only in decidua that had been invaded by the trophoblast. In summary, our results describe distinct changes in the distribution of Ln and Fn isoforms during the differentiation of villous trophoblast into extravillous trophoblastic cells. Furthermore, EDB- and Onc-Fn are preferentially found in decidua that has been invaded by the trophoblast, indicating that the deposition of these Fn isoforms reflects a decidual cell response to invasion.