Whole blood long-chain n-3 fatty acids as a measure of fish oil compliance in children with acute lymphoblastic leukemia: a pilot study

Long-chain n-3 fatty acids (n-3 LCPUFA) may prevent chemotherapy-induced hyperlipidemia in children with acute lymphoblastic leukemia (ALL). However, compliance could be a problem and intake-biomarker correlations may be affected by bodyweight and blood transfusions. We assessed whole blood n-3 LCPUFA three times during the first 83 days of treatment in six 1-17-year-old children with ALL, who received 2.4-4.9 g/d n-3 LCPUFA depending on bodyweight. Mean compliance was 73%, which resulted in a 2.5-fold increase in blood n-3 LCPUFA irrespective of blood transfusions. The correlation between relative blood content of n-3 LCPUFA and intake in g/d across the study period was strong (r=0.76, p=0.001). When n-3 LCPUFA was expressed in absolute concentrations and intake per kg bodyweight the correlation decreased (r=0.39, p=0.164) and was driven by baseline values. Thus, relative content of n-3 LCPUFA in blood reflects fish oil compliance in children with ALL despite blood transfusions and differences in bodyweight.

A PDRMIP multi-model study on the impacts of regional aerosol forcings on global and regional precipitation

Atmospheric aerosols such as sulfate and black carbon (BC) generate inhomogeneous radiative forcing and can affect precipitation in distinct ways compared to greenhouse gases (GHGs). Their regional effects on the atmospheric energy budget and circulation can be important for understanding and predicting global and regional precipitation changes, which act on top of the background GHG-induced hydrological changes. Under the framework of the Precipitation Driver Response Model Inter-comparison Project (PDRMIP), multiple models were used for the first time to simulate the influence of regional (Asian and European) sulfate and BC forcing on global and regional precipitation. The results show that, as in the case of global aerosol forcing, the global fast precipitation response to regional aerosol forcing scales with global atmospheric absorption, and the slow precipitation response scales with global surface temperature response. Asian sulphate aerosols appear to be a stronger driver of global temperature and precipitation change compared to European aerosols, but when the responses are normalised by unit radiative forcing or by aerosol burden change, the picture reverses, with European aerosols being more efficient in driving global change. The global apparent hydrological sensitivities of these regional forcing experiments are again consistent with those for corresponding global aerosol forcings found in the literature. However, the regional responses and regional apparent hydrological sensitivities do not align with the corresponding global values. Through a holistic approach involving analysis of the energy budget combined with exploring changes in atmospheric dynamics, we provide a framework for explaining the global and regional precipitation responses to regional aerosol forcing.

Rapid adjustments cause weak surface temperature response to increased black carbon concentrations

We investigate the climate response to increased concentrations of black carbon (BC), as part of the Precipitation Driver Response Model Intercomparison Project (PDRMIP). A tenfold increase in BC is simulated by 9 global coupled-climate models, producing a model-median effective radiative forcing (ERF) of 0.82 (ranging from 0.41 to 2.91) Wm-2, and a warming of 0.67 (0.16 to 1.66) K globally and 1.24 (0.26 to 4.31) K in the Arctic. A strong positive instantaneous radiative forcing (median of 2.10 Wm-2 based on five of the models) is countered by negative rapid adjustments (-0.64 Wm-2 for the same five models), which dampen the total surface temperature signal. Unlike other drivers of climate change, the response of temperature and cloud profiles to the BC forcing is dominated by rapid adjustments. Low-level cloud amounts increase for all models, while higher-level clouds are diminished. The rapid temperature response is particularly strong above 400 hPa, where increased atmospheric stabilization and reduced cloud cover contrast the response pattern of the other drivers. In conclusion, we find that this substantial increase in BC concentrations does have considerable impacts on important aspects of the climate system. However, some of these effects tend to offset one another, leaving a relatively small global warming of 0.47 K per Wm-2 - about 20 % lower than the response to a doubling of CO2. Translating the tenfold increase in BC to the present-day impact of anthropogenic BC (given the emissions used in this work) would leave a warming of merely 0.07 K.

PDRMIP: A Precipitation Driver and Response Model Intercomparison Project, Protocol and preliminary results

As the global temperature increases with changing climate, precipitation rates and patterns are affected through a wide range of physical mechanisms. The globally averaged intensity of extreme precipitation also changes more rapidly than the globally averaged precipitation rate. While some aspects of the regional variation in precipitation predicted by climate models appear robust, there is still a large degree of inter-model differences unaccounted for. Individual drivers of climate change initially alter the energy budget of the atmosphere leading to distinct rapid adjustments involving changes in precipitation. Differences in how these rapid adjustment processes manifest themselves within models are likely to explain a large fraction of the present model spread and needs better quantifications to improve precipitation predictions. Here, we introduce the Precipitation Driver and Response Model Intercomparison Project (PDRMIP), where a set of idealized experiments designed to understand the role of different climate forcing mechanisms were performed by a large set of climate models. PDRMIP focuses on understanding how precipitation changes relating to rapid adjustments and slower responses to climate forcings are represented across models. Initial results show that rapid adjustments account for large regional differences in hydrological sensitivity across multiple drivers. The PDRMIP results are expected to dramatically improve our understanding of the causes of the present diversity in future climate projections.

Clinical Stage I Carcinoma of the Cervix

Using MR imaging with a body coil parametrial invasion was determined prospectively in 169 consecutive patients considered on the basis of clinical examination to have carcinoma confined to the cervix. After radical hysterectomy correlation with histologic examination was performed for the left and right parametrium separately. The criterion for parametrial invasion was a high-signal-intensity lesion with disruption of the full thickness of the cervical stroma combined with areas of abnormal signal intensity within the parametrial region on T2-weighted images. Histologic examination showed that 18 parametria in 13 patients were invaded by tumor. MR had an overall accuracy of 93%, a sensitivity of 89%, and a specificity of 93% in demonstrating parametrial involvement. Positive and negative predictive values were 43% and 99%. The main weakness of MR was 21 false-positive tests. This represents a limitation when MR is performed with a body coil.

Evaluation of the aerosol vertical distribution in global aerosol models through comparison against CALIOP measurements: AeroCom phase II results

The ability of 11 models in simulating the aerosol vertical distribution from regional to global scales, as part of the second phase of the AeroCom model intercomparison initiative (AeroCom II), is assessed and compared to results of the first phase. The evaluation is performed using a global monthly gridded data set of aerosol extinction profiles built for this purpose from the CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarization) Layer Product 3.01. Results over 12 subcontinental regions show that five models improved, whereas three degraded in reproducing the interregional variability in Z _{α0-6 km}, the mean extinction height diagnostic, as computed from the CALIOP aerosol profiles over the 0-6 km altitude range for each studied region and season. While the models' performance remains highly variable, the simulation of the timing of the Z _{α0-6 km} peak season has also improved for all but two models from AeroCom Phase I to Phase II. The biases in Z _{α0-6 km} are smaller in all regions except Central Atlantic, East Asia, and North and South Africa. Most of the models now underestimate Z _{α0-6 km} over land, notably in the dust and biomass burning regions in Asia and Africa. At global scale, the AeroCom II models better reproduce the Z _{α0-6 km} latitudinal variability over ocean than over land. Hypotheses for the performance and evolution of the individual models and for the intermodel diversity are discussed. We also provide an analysis of the CALIOP limitations and uncertainties contributing to the differences between the simulations and observations.

Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study

Background

Identification of prognostic factors for persistent pain and disability are important for better understanding of the clinical course of chronic unilateral lumbar radiculopathy and to assist clinical decision-making. There is a lack of scientific evidence concerning prognostic factors. The aim of this study was to identify clinically relevant predictors for outcome at 52 weeks.

Methods

116 patients were included in a sham controlled clinical trial on epidural injection of glucocorticoids in patients with chronic unilateral lumbar radiculopathy. Success at follow-up was ≤17.5 for visual analogue scale (VAS) leg pain, ≤22.5 for VAS back pain and ≤20 for Oswestry Disability Index (ODI). Fifteen clinically relevant variables included demographic, psychosocial, clinical and radiological data and were analysed using a logistic multivariable regression analysis.

Results

At follow-up, 75 (64.7%) patients had reached a successful outcome with an ODI score ≤20, 54 (46.6%) with a VAS leg pain score ≤17.5, and 47 (40.5%) with a VAS back pain score ≤22.5.

Lower age (OR 0.94 (CI 0.89–0.99) for each year decrease in age) and FABQ Work ≥34 (OR 0.16 (CI 0.04-0.61)) were independent variables predicting a successful outcome on the ODI.

Higher education (OR 5.77 (CI 1.46–22.87)) and working full-time (OR 2.70 (CI 1.02–7.18)) were statistically significant (P <0.05) independent predictors for successful outcome (VAS score ≤17.5) on the measure of leg pain. Lower age predicted success on ODI (OR 0.94 (95% CI 0.89 to 0.99) for each year) and less back pain (OR 0.94 (0.90 to 0.99)), while higher education (OR 5.77 (1.46 to 22.87)), working full-time (OR 2.70 (1.02 to 7.18)) and muscle weakness at baseline (OR 4.11 (1.24 to 13.61) predicted less leg pain, and reflex impairment at baseline predicted the contrary (OR 0.39 (0.15 to 0.97)).

Conclusions

Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. These results should be validated in further studies before being used to inform patients.

Trial registration

Current Controlled Trials ISRCTN12574253. Registered 18 May 2005.

Remote sensing of aerosols in the Arctic for an evaluation of global climate model simulations

In this study Moderate Resolution Imaging Spectroradiometer (MODIS) Aqua retrievals of aerosol optical thickness (AOT) at 555 nm are compared to Sun photometer measurements from Svalbard for a period of 9 years. For the 642 daily coincident measurements that were obtained, MODIS AOT generally varies within the predicted uncertainty of the retrieval over ocean (ΔAOT = ±0.03 ± 0.05 · AOT). The results from the remote sensing have been used to examine the accuracy in estimates of aerosol optical properties in the Arctic, generated by global climate models and from in situ measurements at the Zeppelin station, Svalbard. AOT simulated with the Norwegian Earth System Model/Community Atmosphere Model version 4 Oslo global climate model does not reproduce the observed seasonal variability of the Arctic aerosol. The model overestimates clear-sky AOT by nearly a factor of 2 for the background summer season, while tending to underestimate the values in the spring season. Furthermore, large differences in all-sky AOT of up to 1 order of magnitude are found for the Coupled Model Intercomparison Project phase 5 model ensemble for the spring and summer seasons. Large differences between satellite/ground-based remote sensing of AOT and AOT estimated from dry and humidified scattering coefficients are found for the subarctic marine boundary layer in summer.

KEY POINTS

Remote sensing of AOT is very useful in validation of climate models.

Accuracy of physical examination for chronic lumbar radiculopathy

Background

Clinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.

Methods

A total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.

Results

The prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.

Conclusions

The accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.

Modic type I changes and recovery of back pain after lumbar microdiscectomy

PURPOSE

To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation.

METHODS

Cohort study of 178 consecutive patients operated with lumbar microdiscectomy. Preoperative MRI scans were evaluated by two independent neuroradiologists. Primary outcome measure was the visual analogue scale (VAS) for back pain. Secondary outcome measures were; VAS for leg pain, physical function (Oswestry disability index), and health-related quality of life (EQ-5D), self-reported benefit of the operation and employment status. The presence of MC I was used as exposition variable and adjusted for other risk factors in multivariate analyses.

RESULTS

The Modic classification showed a high inter-observer reproducibility. Patients with MC I had less improvement of back pain 12 months after surgery, compared to those who had no or other types of MC, but this negative association no longer showed statistical significance when adjusted for smoking, which remained the only independent risk factor for persistent back pain.

CONCLUSIONS

Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.

Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

OBJECTIVE

To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks).

DESIGN

Multicentre, blinded, randomised controlled trial.

SETTING

Outpatient multidisciplinary back clinics of five Norwegian hospitals.

PARTICIPANTS

Between October 2005 and February 2009, 461 patients assessed for inclusion (presenting with lumbar radiculopathy >12 weeks). 328 patients excluded for cauda equina syndrome, severe paresis, severe pain, previous spinal injection or surgery, deformity, pregnancy, ongoing breast feeding, warfarin therapy, ongoing treatment with non-steroidal anti-inflammatory drugs, body mass index >30, poorly controlled psychiatric conditions with possible secondary gain, and severe comorbidity.

INTERVENTIONS

Subcutaneous sham injections of 2 mL 0.9% saline, caudal epidural injections of 30 mL 0.9% saline, and caudal epidural injections of 40 mg triamcinolone acetonide in 29 mL 0.9% saline. Participants received two injections with a two week interval.

MAIN OUTCOME MEASURES

Primary: Oswestry disability index scores. Secondary: European quality of life measure, visual analogue scale scores for low back pain and for leg pain.

RESULTS

Power calculations required the inclusion of 41 patients per group. We did not allocate 17 of 133 eligible patients because their symptoms improved before randomisation. All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time. For the sham group (n = 40), estimated change in the Oswestry disability index from the adjusted baseline value was -4.7 (95% confidence intervals -0.6 to -8.8) at 6 weeks, -11.4 (-6.3 to -14.5) at 12 weeks, and -14.3 (-10.0 to -18.7) at 52 weeks. For the epidural saline intervention group (n = 39) compared with the sham group, differences in primary outcome were -0.5 (-6.3 to 5.4) at 6 weeks, 1.4 (-4.5 to 7.2) at 12 weeks, and -1.9 (-8.0 to 4.3) at 52 weeks; for the epidural steroid group (n=37), corresponding differences were -2.9 (-8.7 to 3.0), 4.0 (-1.9 to 9.9), and 1.9 (-4.2 to 8.0). Analysis adjusted for duration of leg pain, back pain, and sick leave did not change this trend.

CONCLUSIONS

Caudal epidural steroid or saline injections are not recommended for chronic lumbar radiculopathy. Trial registration Current Controlled Trials ISRCTN No 12574253.

Birth weight and melanoma risk: a population-based case-control study

We investigated whether lower birth weight was associated with lower risk of melanoma later in life. This population-based case–control study included all incident cases of histologically verified invasive melanoma diagnosed until 31 December 2003 in the Norwegian population born between 1967 and 1986 (n=709). The control group without malignant disease was established by random sampling from the same source population as the cases (n=108 209). Data on birth weight, gender, mother's residence and parental age at the time of birth were collected from the Medical Birth Registry of Norway and data on cancer from the Cancer Registry of Norway. The Mantel–Haenszel test of linear trend showed no trend in risk across the birth weight categories: individuals in the highest quartile of birth weight (⩾3860 g) had an odds ratio (OR) of 1.19 (95% confidence interval, CI: 0.77–1.84) compared to individuals with birth weight <2500 g. The adjusted OR was 0.81 (95% CI: 0.52–1.26) for birth weight below 2500 g (exposed). Though not statistically significant, the results suggest that low birth weight might influence the risk of melanoma later in life.

[Health status of patients on waiting lists]

BACKGROUND

The waiting lists for hospital admission are used as arguments for more resources to hospitals. Concern is expressed that the attention given to waiting list patients has the effect that less resources are devoted to other groups of patients. This article reports on a study of whether waiting list patients are in poorer health that persons who are not on a waiting list.

MATERIAL AND METHODS

A random sample of 5,000 Norwegian citizens were drawn to be included in Statistics Norway's 1998 quality and standard of life survey. Interviews were obtained with 3,449 persons. Binomial and multinomial logistic analyses were used.

RESULTS

Individuals in poor health have a higher probability of being on a hospital waiting list than have persons in good health. We did not find any relationship between state of health and a patient's experienced waiting time.

INTERPRETATION

Our findings reject the assertion of arbitrariness regarding the selection of patients to hospital waiting lists. The lack of effect of state of health on experienced waiting time could be interpreted in several ways.

An epidemiological study of cancer in adult twins born in Norway 1905-1945

We have identified 23 334 individuals (40%) of twins born in Norway 1905-45 where both twins were alive in 1960 without malignant disease. These were linked to the Cancer Registry of Norway. A reduced risk of malignant disease was demonstrated among twins for all tumour sites combined; standardized incidence rate (SIR): 0.90 (95% CI 0.85-0.94) in females and 0.95 (95% Cl 0.90-0.99) in males. In both sexes, we observed a significant reduced incidence of malignant melanomas of the skin. The incidence of colorectal cancer tended to be reduced for both sexes. In females, the incidence of tumours of the central nervous system and lungs were reduced. We consider our findings are real, but cannot explain them.

Cellulose powder from Cladophora sp. algae

The surface are and crystallinity was measured on a cellulose powder made from Cladophora sp. algae. The algae cellulose powder was found to have a very high surface area (63.4 m2/g, N2 gas adsorption) and build up of cellulose with a high crystallinity (approximately 100%, solid state NMR). The high surface area was confirmed by calculations from atomic force microscope imaging of microfibrils from Cladophora sp. algae.

The effect of capitation on GPs' referral decisions

In the Norwegian capitation trial, the payment system for general practitioners (GPs) has been changed; a practice allowance component has been replaced by a capitation component and the fee-per-item component constitutes a smaller part of a GPs practice income than previously. From the theoretical modelling of GPs' referral decisions, we predict that the replacement of the practice allowance by a capitation component will increase the rate of referrals to specialists. This hypothesis is supported by an exploratory empirical study with data from a sample of GPs participating in the experiment.

Clinical response of salaried consultants to economic incentives

Several studies have found a relation between economic incentives and physicians' clinical decisions. The bulk of these studies deals with data from private organisations providing medical care. The purpose of the present study is to explore whether a similar relationship is valid in a system where hospital care is provided by salaried physicians in the public sector. A distinction is made between medical and economic prioritysetting. If the relative fees influence the proportion of outpatient surgery or the compositions of treatments, economic prioritysetting is said to take place. Data were collected from a sample of Norwegian hospitals. The main findings of the empirical section can be summarised in two points: (i) Economic prioritysetting seems to be applied in the choice between inpatient and outpatient surgical treatment for patients with an identical diagnosis. (ii) Medical priority setting seems to be applied in the priority among patients with different diagnoses.

Trends for invasive squamous cell neoplasia of the skin in Norway

Over the period 1966-1995, based on 11,662 patients, the incidence of squamous cell carcinoma of the skin increased three to four times in Norway mainly as a result of an increased number of localized tumours. In men, cancer of the auricle was the second most common site; in women the incidence was low.

CP/MAS 13C-NMR spectroscopy applied to structure and interaction studies on cellulose I

Solid-state Cross-Polarization Magic Angle Spinning Carbon-13 Nuclear Magnetic Resonance (CP/MAS 13C-NMR) has been used to investigate the structure and interactions of cellulose I. The use of spectral fitting for the extraction of information from CP/MAS 13C-NMR spectra is reviewed and results obtained are discussed. Examples are shown where the method has been used to monitor the structural changes occurring in wood cellulose during kraft pulping. The effects observed on the cellulose and hemicelluloses are further investigated using a model system. Assignments of signal intensities originating from xylan-cellulose interactions are made.

[Waiting lists as results of statistic coincidences]

Queues and waiting lists in the health services are central issues in the political debate in Norway. By means of a simulation programme (Powersim), we demonstrate some elementary properties of queuing. We show that stochastic entry to the service and stochastic need for service can produce queues. We also show that a queue-free service will need an unrealistically high and abundant capacity.

Intraepithelial and invasive squamous cell neoplasia of the vulva: trends in incidence, recurrence, and survival rate in Norway

OBJECTIVE

To characterize time trends in incidence of intraepithelial and invasive vulvar neoplasia, transition of intraepithelial vulvar neoplasia to invasive cancer, and survival rate based on a total population.

METHODS

The Cancer Registry of Norway was used to identify all Norwegian inhabitants diagnosed during 1956-1990 with squamous cell carcinoma of the vulva, and all those with intraepithelial vulvar neoplasia diagnosed during 1973-92.

RESULTS

The incidence rate of intraepithelial neoplasia increased three-fold from 1973-77 to 1988-92, and 3.4% changed into invasive disease. Multivariate analyses identified age as a significant variable. The age-adjusted incidence rate for squamous cell carcinoma was constant for the whole period. The ratio between recurrence and the total number of invasive cancer varied from 21% to 31%. The 5-year survival rates have not changed significantly over the period. Age was revealed as a strong prognostic factor, showing an excess death rate by increasing age.

CONCLUSION

The incidence of vulvar intraepithelial neoplasia has increased substantially over the last 40 years, but that of invasive vulvar cancer has not changed appreciably.

Recurrence of endometrial carcinoma and the value of routine follow up

OBJECTIVE

To identify women treated for endometrial carcinoma with increased risk for recurrent disease, to examine how and when recurrences are discovered, and to assess the clinical benefit of routine follow up investigations.

DESIGN

Retrospective case analysis.

SETTING

Hordaland county, Norway.

POPULATION

All women treated for endometrial carcinoma in a demographically well defined area, in a 10-year period (1981-1990).

METHODS

Data concerning patient characteristics and course of the disease were collected through review of the medical records, correspondence with the primary physician and from the Norwegian Cancer Registry. Univariate and multivariate survival analysis.

RESULTS

After curative surgical treatment 249 women diagnosed with endometrial carcinoma were followed for a median period of 9 years (range 4-16) or until death. Among these 249 radically treated patients, 47 had recurrent disease, 32 within the first two years. Ten of the recurrences were diagnosed at routine follow up, but only four were asymptomatic. In our follow up programme, one asymptomatic recurrence was detected for every 653 routine consultations. A low risk group, with FIGO Stage IA/IB or patient age below 60 years at primary operation was identified in multivariate recurrence-free survival analysis. No asymptomatic recurrences were found in this group.

CONCLUSIONS

Low risk women should be considered for an alternative, less frequent follow up. The sensitivity for current practice of routine follow up in detecting asymptomatic recurrences is so low that other beneficial effects should be documented to defend the large resources spent on this programme.

Marijuana-positive urine test results from consumption of hemp seeds in food products

Commercially available snack bars and other foodstuffs prepared from pressed hemp seeds were ingested by volunteers. Urine specimens were collected for 24 h after ingestion of the foodstuffs containing hemp seeds and tested for marijuana using an EMIT immunoassay and gas chromatography-mass spectrometry (GC-MS). Specimens from individuals who ate one hemp seed bar demonstrated little marijuana immunoreactivity, and only one specimen screened positive at a 20-ng/mL cutoff. Specimens from individuals who ate two hemp seed bars showed increased immunoreactivity, and five specimens screened positive at a 20-ng/mL cutoff. A single specimen yielded a quantitative GC-MS value (0.6 ng/mL), but it failed to meet reporting criteria. Several specimens from individuals who ate three cookies made from hemp seed flour and butter screened positive at both 50- and 20-ng/mL cutoffs. Two specimens produced quantitative GC-MS values (0.7 and 3.1 ng/mL), but they failed to meet reporting criteria. Several specimens also tested positive with an FDA-approved on-site marijuana-screening device. Hemp seeds similar to those used in the foodstuffs did not demonstrate the presence of marijuana when tested by GC-MS. In this study, ingestion of hemp seed food products resulted in urine specimens that screened positive for marijuana. No specimens gave a GC-MS quantitative value above the limit of detection for marijuana.

The effect of a private sector on the waiting time in national health service

This article examines the effect of a private sector on the waiting time associated with treatment in a public hospital. Without rationing of waiting-list admissions, a private sector is shown to result in a longer waiting time if the demand for a public treatment is sufficiently elastic with respect to the waiting time. When waiting-list admissions are rationed, the waiting time is shown to increase if the public sector consultants are permitted to work in the private sector in their spare time.

The effect of NaO Li Su on memory functions and blood chemistry in elderly people

In traditional Chinese medicine a mixture of bee pollen, radix polygoni multiflore, semen ziziphi spinosae, radix salviae multiorhizae, fructus schisandrae and fructus ligustris lucidae, known as NaO Li Su, has a reputation as a remedy against declining memory functions. In the present study the effect of the preparation on failing memory was assessed in 100 elderly Danish volunteers who complained of a deteriorating memory. The study was a double-blind placebo controlled cross-over trial. The effect was evaluated after treatment periods of 3 months' duration by a battery of psychological and biochemical tests. No desirable effects on memory functions were achieved by the active treatment. Increases in the number of red blood cells and in the serum creatinine levels were seen after active treatment. In the subgroup initially showing a number of red blood cells below the median a significant positive correlation was found between changes in the number of red blood cells and changes in the Wechsler Memory Scale scores.

Squamous cell carcinoma of the penis and of the cervix, vulva and vagina in spouses: is there any relationship? An epidemiological study from Norway, 1960-92

Four hundred and twenty-three wives of 671 men with cancer of the penis were compared with 444 wives of 569 men who did not have this disease. The risk among the wives of patients with cancer of the penis of preinvasive and invasive cancer of the neck of the uterus was 1.75 (95% CI 0.42-7.37).

[Acromion resection for shoulder impingement syndrome. Results after an open and a percutaneous surgical method]

Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome. Artroscopic acromioplasty is regarded as a technically demanding procedure. Since 1988 we have developed a closed percutaneous acromioplasty using motorized instruments. The purpose of this randomised clinical trial was to compare the results of open and closed percutaneous acromioplasty. We found a significant improvement in shoulder score, but no differences between the group treated with the open procedure and the group treated with the closed procedure.

Abnormal intestinal motor patterns explain enteric colonization with gram-negative bacilli in late radiation enteropathy

BACKGROUND & AIMS

Bacterial overgrowth and intestinal pseudo-obstruction may succeed abdominal radiotherapy, and absence of intestinal migrating motor complex (MMC) has been reported in bacterial overgrowth. The aims of this study were to address the relationship between intestinal patterns of motility and gastrointestinal microflora and to elucidate the pathogenesis of late radiation enteropathy.

METHODS

Forty-one consecutive female patients with symptoms of late radiation enteropathy were examined by prolonged ambulatory manometry, culture of gastric and duodenal samples with quantification of gram-negative bacilli (GNB) by the glucose gas test, the [14C]D-xylose breath test, and determination of pH and short-chain fatty acids in gastric juice.

RESULTS

The intensity of MMC explained 61% (P < 0.001) and 71% (P < 0.001) of the variability of GNB in the stomach and duodenum, respectively, corresponding to the severity of disease. Abnormal MMC index and presence of irregular bursts were the best predictors of GNB (86%; P < 0.001, multiple regression). Fasting gastric pH explained gastric bacterial counts (63%; P < 0.001) but did not predict GNB.

CONCLUSIONS

Impaired motility emerges as a causal factor for gastrointestinal colonization with GNB, whereas hypochlorhydria facilitates unspecific gastric colonization. Abnormal motility and GNB in the proximal small intestine are essential factors in the pathogenesis of severe late radiation enteropathy.

IS1032 from Acetobacter xylinum, a new mobile insertion sequence

IS1031 elements constitute a family of related insertion sequences (IS) in Acetobacter xylinum strains. A new IS1031-related element, IS1032, was isolated from A. xylinum ATCC 23770. Southern hybridization analysis showed that one or more sequences similar to IS1032 are present in most of the A. xylinum strains examined. In addition, one copy was detected in Acetobacter aceti ATCC 15973. The transposition of IS1032 was evident from the appearance of an extra insertion in a spontaneous exopolysaccharide-negative mutant of A. xylinum ATCC 23770. IS1032 consists of 916 bp and has imperfect terminal inverted repeats of 14 bp (IR-Left) and 16 bp (IR-Right). A 3-bp target sequence is duplicated upon insertion. IS1032 displays a single open reading frame, encoding a putative 276-amino-acid protein sharing 58% identity with the corresponding protein encoded by IS1031. Thus, IS1032 is a member of the IS1031 family in A. xylinum. A striking degree of nucleotide sequence similarity between IS1032 and ISRm4 from Rhizobium meliloti was found. Furthermore, the IS1031-family transposases also display stretches of amino acid sequence similarities with putative transposases encoded by IS elements from other species.

Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging

In patients with malignant pelvic tumors, radiation-induced insufficiency fractures of the sacrum may be mistaken for metastasis. Magnetic resonance (MR) imaging was performed in 18 patients with this condition, and the findings were studied retrospectively. The diagnosis was confirmed with at least one additional imaging modality in 16 patients, whereas the other two patients underwent clinical follow-up at 13 and 20 months without evidence of metastasis. In 17 patients, the lesions were consistent with edema and had diffuse low signal intensity on T1-weighted images and diffuse high signal intensity on short-inversion-time inversion-recovery images, thereby simulating metastasis. In one patient, bilateral sacral wing fractures were demonstrated directly as fairly well-defined linear zones. The alae sacri were involved in all patients; 16 patients had bilateral lesions. Awareness of this clinical entity and of the high sensitivity of MR imaging for demonstrating edema caused by the fracture should prevent confusion with metastatic disease and inappropriate treatment.

A theory of hospital waiting lists

The noncooperative character of resource allocation in a national health service may contribute to excessive waiting lists. A theory of hospital waiting lists is derived from this idea. Waiting lists imply loss of efficiency; the hospital's resources are drawn away from medical work. Although there is scope for Pareto improvements, the structure of budget allocation may prevent these improvements from being achieved. Some reforms of the institutional structure are suggested.

Clinical stage I carcinoma of the cervix. Value of MR imaging in determining invasion into the parametrium

Using MR imaging with a body coil parametrial invasion was determined prospectively in 169 consecutive patients considered on the basis of clinical examination to have carcinoma confined to the cervix. After radical hysterectomy correlation with histologic examination was performed for the left and right parametrium separately. The criterion for parametrial invasion was a high-signal-intensity lesion with disruption of the full thickness of the cervical stroma combined with areas of abnormal signal intensity within the parametrial region on T2-weighted images. Histologic examination showed that 18 parametria in 13 patients were invaded by tumor. MR had an overall accuracy of 93%, a sensitivity of 89%, and a specificity of 93% in demonstrating parametrial involvement. Positive and negative predictive values were 43% and 99%. The main weakness of MR was 21 false-positive tests. This represents a limitation when MR is performed with a body coil.

Flow cytometric DNA measurements in squamous cell carcinoma of the vulva: an important prognostic method

One hundred and thirty-one squamous cell carcinomas of the vulva were examined by FCM-DNA measurements. Samples were prepared from paraffin-embedded tissue. Of these, 66 were found to be diploid, 52 aneuploid and 13 could not be evaluated. The 5-year crude survival rate was 62% for the diploid and 23% for the aneuploid tumors (P < 0.001). The aneuploid tumors without lymph node (LN) metastases showed a 5-year cancer-related survival rate of 44% as compared to 58% for the diploid tumors with LN metastases. In a multivariate Cox regression analysis the most important independent prognostic parameters were (1) LN involvement (P < 0.0001), (2) tumor ploidy (P = 0.0001) and (3) tumor size (P = 0.0039). By using ploidy and lymph node involvement in this way as prognostic factors we are able to identify high- and low-risk groups of patients. We strongly believe that these results should lead to a different attitude towards therapy in vulva cancer patients.