Long-term predictors of stroke in a cohort of people aged 70 years

This paper aims at studying the development and the risk factors for stroke prospectively during a 6-year follow-up in the Turku Elderly Study, Turku, Finland. The study cohort consisted of 1032 people aged 70 years at baseline. The stroke events (ICD-9 codes 430-434) were identified by computer linkage from the hospital discharge and death registers, and from a follow-up questionnaire. During the 6 years of follow-up, 71 patients (6.9%) suffered a stroke. Previous stroke (RR 5.82), history of transient ischemic attack (RR 4.14), diabetes mellitus (RR 2.50), poorly controlled hypertension (RR 2.42), smoking (RR 1.94) and male sex (RR 1.65) were independent risk factors for stroke. Atrial fibrillation, cardiac failure and previous myocardial infarction did not appear to be significant independent predictors of stroke in the elderly. The risk of stroke in the elderly population appears to be strongly related to the concomitant clinical disease, and this should be remembered when identifying persons at increased risk of stroke. Poorly controlled hypertension was associated with an increased risk of stroke. Thus, achieving a good control of blood pressure in elderly hypertensives receiving treatment has the potential to prevent strokes.

Unusual 9-->10 rearrangement of the substituted cage carbon in the ferratricarbollide series. Synthesis of the isomeric complexes [2-eta 5-(C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (where X = H2N, MeHN, Me2N, and ButHN)

Treatment of the zwitterionic amine tricarbollides of general formula 7-L-nido-7,8,9-C3B8H10 (1) (where L = Me2HN (1c) and ButH2N (1d)) with [(eta 5-C5H5)Fe(CO)2]2 in refluxing mesitylene resulted in the formation of a mixture of the known compounds [2-(eta 5-C5H5)-9-X-closo-2,1,7,9-FeC3B8H10] (2) (where X = H2N (2a), Me2N (2c), and ButHN (2d)) and a series of new, isomeric ferratricarbollylamines [2-(eta 5-C5H5)-10-X-closo-2,1,7,10-FeC3B8H10] (3) (where X = H2N (3a), Me2N (3c), and ButHN (3d)) in moderate yields. Complexes of type 3 (where X = H2N (3a), MeHN (3b), Me2N (3c), and ButHN (3d)) were also obtained readily by heating complexes of type 2 (where X = H2N (2a), MeHN (2b), Me2N (2c), ButHN (2d), and Bu(t)(Me)N (2e)) at ca. 300 degrees C for 10 min. All the complexes of type 3 contain reactive amine functions in meta positions with respect to the metal center. The observed 9-->10 rearrangement of the substituted cluster carbon is quite unexpected and is believed to result from higher thermodynamic stability of the 10-substituted isomers. The structures of all compounds of type 3 were established by high-field NMR spectroscopy and mass spectrometry, and that of 3d was determined by an X-ray diffraction study.

Lactobacilli and Streptococci activate NF-kappa B and STAT signaling pathways in human macrophages

Gram-positive bacteria induce the production of several cytokines in human leukocytes. The molecular mechanisms involved in Gram-positive bacteria-induced cytokine production have been poorly characterized. In this work we demonstrate that both nonpathogenic Lactobacillus rhamnosus GG and pathogenic Streptococcus pyogenes (group A streptococci) induce NF-kappa B and STAT DNA-binding activity in human primary macrophages as analyzed by EMSA. NF-kappa B activation was rapid and was not inhibited by a protein synthesis inhibitor cycloheximide, suggesting that these bacteria could directly activate NF-kappa B. STAT1, STAT3, and IFN regulatory factor-1 DNA binding was induced by both bacteria with delayed kinetics compared with NF-kappa B. In addition, streptococci induced the formation of IFN-alpha-specific transcription factor complex and IFN-stimulated gene factor-3 (ISGF3). STAT1 and STAT3 activation and ISGF3 complex formation were inhibited by cycloheximide or by neutralization with IFN-alpha/beta-specific Abs. Streptococci were more potent than lactobacilli in inducing STAT1, ISGF3, and IFN regulatory factor-1 DNA binding. Accordingly, only streptococci induced IFN-alpha production. The activation of the IFN-alpha signaling pathway by streptococci could play a role in the pathogenesis of these bacteria. These results indicate that extracellular Gram-positive bacteria activate transcription factors involved in cytokine signaling by two mechanisms: directly, leading to NF-kappa B activation, and indirectly via cytokines, leading to STAT activation.

[The nursing care of a dying patient on the health center ward--the relatives' point of view]

The purposes of the study were to find out relatives' opinions about the care of dying patients as well as to find out how relatives assess the nursing care which was given to their nearest on the hospital wards. In order to collect the data for the study, the family members of patients (N = 628) who had died not more than one year before in the hospital, were interviewed. The interviewing was done by sending a questionnaire to every other relative (N = 314), 210 of which (62%) answered the questions. The answers to the structured questions were analyzed with the SAS-software and open-ended questions by the content analysis method. The relatives found that the hospital ward was quite a suitable environment for the nursing care of a dying patient. They found visiting hours flexible but they wished that they had the possibility to rest or stay over night in the hospital. The health care professionals responsible for the care of dying patients were considered to succeed in the field of the patient's rest and hygiene, but they took less well care of patient's physical exercise and dental hygiene. The relatives were satisfied with the pain relief the patient got. According to the relatives, examinations, medication, nursing interventions or the "futile" care given did not cause additional suffering. Although the nurses did not response to patients' spiritual well-being or needs of affections, they were able to make the patients happy with their kindness, presence and with good basic care. The relatives were best informed about patients' every day well-being, medication as well as practical matters concerning the time after the death of the patient. If the patient was transferred to another hospital for the terminal care, the relatives found, however, that they didn't get enough information of the situation. The health care professionals did not console the relatives for their grief and they had not been encouraged to participate in the care of their family members.

Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme

AIMS/HYPOTHESIS; The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying Type II (non-insulin-dependent) diabetes mellitus in subjects with impaired glucose tolerance, to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance.

METHODS

A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were randomised to either a control or intervention group. The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits. The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aimed at reducing weight, the intake of saturated fat and increasing the intake of dietary fibre. Intervention subjects were also guided individually to increase their physical activity.

RESULTS

During the first year, weight loss in the first 212 study subjects was 4.7 +/- 5.5 vs 0.9 +/- 4.1 kg in the intervention and control group, respectively (p < 0.001). The plasma glucose concentrations (fasting: 5.9 +/- 0.7 vs 6.4 +/- 0.8 mmol/l, p < 0.001; and 2-h 7.8 +/- 1.8 vs 8.5 +/- 2.3 mmol/l, p < 0.05) were significantly lower in the intervention group after the first year of intervention. Favourable changes were also found in blood pressure, serum lipids and anthropometric indices in the intervention group.

CONCLUSION/INTERPRETATION

The interim results show the efficacy and feasibility of the lifestyle intervention programme.

Patient’s and general practitioner’s different views on patient’s depression

Differences between patient's and general practitioner's view on patient's depressive syndromes was investigated in a prospective birth cohort study of 70 year old people (n=1032) in Turku City, Finland. The aim of this study was to find factors which are typical for people having depressive syndromes in old age and help medical and nursing staff to identify depressive syndromes in the general aged people. The study consisted of a structural postal questionnaire including patient's perception of his depression, an interview made by a public health nurse included mini-mental state examination (MMSE) and the self-rating depression scale of Zung, an interview and comprehensive clinical examination by a general practitioner. Out of the 847 persons who completed the depression test, 12.6% showed symptoms of depressive syndrome. The views of those who scored more than 45 points in the Zung depression scale on their own depressiveness differed from the general practitioner's opinion. In the general practitioner's examination and interview 58% of the subjects had no depressive symptoms even though the test results indicated that they were depressed. The depressed group stood out most clearly in two questions: Do you feel you are needed and do you have future plans? When the same questions were repeated 5 years later, the difference was still statistically significant between depressed and non-depressed group (P<0.0001). The data indicated that medical and nursing staff should take self-assessments seriously and look into them in closer detail. General practitioners and nurses should learn to ask right questions and use short depression scale systematically in order to facilitate the detection of depressive syndromes.

Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts

The prevalences of lowered mood and cognitive impairment, and their combination were investigated in 1993 random subjects of five birth cohorts (at age of 65, 70, 75, 80 and 85 years). The frequency of a high Zung-score (> 45), indicating depressive symptoms, in the five age groups was 11%, 13%, 20%, 16%, and 36%, respectively. The corresponding figures for a low MMSE-score (Mini Mental State Examination < 24) were 11%, 9%, 25%, 46%, and 60%; the respective frequencies of subjects fulfilling both criteria simultaneously were 2%, 3%, 8%, 12% and 24%, respectively. Overall, about 30% of the subjects with a low MMSE-score had a high Zung-score. However, more than half of the old subjects (over 75 years) with a high Zung-score also had low MMSE-scores. The data indicate that the combination of impaired cognition and lowered mood doubles in frequency by five-year intervals after the age of 70 years in the general aged population, and that this condition is present in one of four subjects at the age of 85 years.

Interferon-alpha activates multiple STAT proteins and upregulates proliferation-associated IL-2Ralpha, c-myc, and pim-1 genes in human T cells

Interferon-alpha (IFN-alpha) is a pleiotropic cytokine that has antiviral, antiproliferative, and immunoregulatory functions. There is increasing evidence that IFN-alpha has an important role in T-cell biology. We have analyzed the expression of IL-2Ralpha, c-myc, and pim-1 genes in anti-CD3-activated human T lymphocytes. The induction of these genes is associated with interleukin-2 (IL-2)-induced T-cell proliferation. Treatment of T lymphocytes with IFN-alpha, IL-2, IL-12, and IL-15 upregulated IL-2Ralpha, c-myc, and pim-1 gene expression. IFN-alpha also sensitized T cells to IL-2-induced proliferation, further suggesting that IFN-alpha may be involved in the regulation of T-cell mitogenesis. When we analyzed the nature of STAT proteins capable of binding to IL-2Ralpha, pim-1, and IRF-1 GAS elements after cytokine stimulation, we observed IFN-alpha-induced binding of STAT1, STAT3, and STAT4, but not STAT5 to all of these elements. Yet, IFN-alpha was able to activate binding of STAT5 to the high-affinity IFP53 GAS site. IFN-alpha enhanced tyrosine phosphorylation of STAT1, STAT3, STAT4, STAT5a, and STAT5b. IL-12 induced STAT4 and IL-2 and IL-15 induced STAT5 binding to the GAS elements. Taken together, our results suggest that IFN-alpha, IL-2, IL-12, and IL-15 have overlapping activities on human T cells. These findings thus emphasize the importance of IFN-alpha as a T-cell regulatory cytokine.

Long-term effects of diltiazem and atenolol on blood glucose, serum lipids, and serum urate in hypertensive patients. Swedish-Finnish Study Group

The purpose of this long-term treatment study was to evaluate health-related quality of life by comparing the effects of diltiazem and atenolol on some important metabolic parameters.

SUBJECTS, MATERIAL AND METHODS

In a Swedish-Finnish long-term multicenter study 256 patients with mild to moderate hypertension were randomized to treatment with diltiazem retard (D) (n = 127) or atenolol (A) (n = 129). Doses could be increased and additional captopril medication be given to achieve adequate blood pressure (BP) reduction. The treatment in group D lasted for two years while group A was treated for 1 year and then was given D for another 2 years.

RESULTS

After 1 year BP was significantly reduced in both groups and to a similar degree. The BP reduction was maintained during the rest of the study. After 1 and 2 years, HDL had increased significantly (p < 0.001) in group D. There was a corresponding significant reduction of the LDL/HDL ratio. In group A there were no changes after 1 year regarding lipoprotein levels. After the switch to D, group A showed similar improvements regarding HDL and the LDL/HDL ratio as the original D group.

CONCLUSION

It is concluded that D and A are equally effective in lowering BP. However, long-term treatment with D, but not with A, has a favorable effect on HDL concentrations and the LDL/HDL ratio. According to these findings D affects the risk factor profile in hypertension.

Inverse correlation between serum testosterone and leptin in men

Besides its role in the regulation of energy balance, leptin seems to be involved in linking energy stores to the reproductive system. A gender-dependent difference exists in plasma leptin concentration and leptin messenger ribonucleic acid expression in rodents and humans. This difference does not seem to be explained simply by differences in the amount of body fat between genders. To elucidate the relationship of endogenous testosterone and leptin, we studied the serum leptin concentrations in 269 elderly nondiabetic men. In addition, to assess whether exogenously administered testosterone could influence leptin production, we followed the serum levels of leptin in 10 healthy men during a 12-month treatment with 200 mg testosterone enanthate, i.m., weekly for contraceptive purposes. We found that the serum leptin concentration correlated inversely (r = -0.39; P < 0.001) with that of testosterone in elderly men. This inverse correlation was still present when body mass index and plasma insulin were included in the analysis. The administration of testosterone to young men suppressed serum leptin from the pretreatment level of 3.4 +/- 1.4 to 1.9 +/- 0.6 micrograms/L during the therapy. After cessation of testosterone injections, serum leptin concentration returned back to the pretreatment level. It is concluded that testosterone has a suppressive effect on leptin production, as reflected by circulating levels of this hormone.

The proximal interferon-stimulated response elements are essential for interferon responsiveness: a promoter analysis of the antiviral MxA gene

Interferon (IFN)-inducible human MxA protein mediates resistance against influenza and several other RNA viruses. The MxA gene is under the control of type I IFN and, in certain cell types, is also directly activated by viruses. Here we show that in human macrophages, MxA mRNA levels are upregulated by very low doses of IFN-alpha in a dose-dependent manner. A similar, albeit much weaker, dose-dependent induction was seen with IFN-gamma. The induction was rapid and independent of protein synthesis. Interleukin-6 (IL-6) or tumor necrosis factor-alpha (TNF-alpha) did not influence MxA mRNA levels alone or in combination with IFNs, in spite of the presence of putative response elements of these cytokines in the MxA promoter. We show that the promoter of the MxA gene contains two functional IFN-stimulated response elements (ISRE) near the transcription start site and one homologous ISRE-like element, which is apparently nonfunctional, further upstream. The two proximal ISRE sites are essential for IFN-alpha-induced transcription and appear to be binding sites for IFN-stimulated gene factor 3 complex. In addition, EMSA and DNAse I footprinting analysis demonstrated that Spl binds with high affinity to a region encompassing nucleotides -25 and -50 and, thus, may provide means of interaction with the basal transcriptional machinery.

Ambulatory 24-hour blood pressure recordings in patients with Parkinson's disease with or without fludrocortisone

Orthostatic hypotension is often associated with patients suffering from Parkinson's disease. Only few studies have been published about the ambulatory blood pressure in patients with Parkinson's disease. Fludrocortisone has been used in management of orthostatic hypotension. This study was made to determine the Circadian rhythm of blood pressure in healthy elderly people, in Parkinson's disease patients without orthostatic hypotension and Parkinson's disease patients with fludrocortisone medication for orthostatic hypotension. Ambulatory 24-hour blood pressure recordings were made in 20 elderly Parkinson's disease patients and 21 healthy elderly persons. Eight of the Parkinson's disease patients were on fludrocortisone (Florinef) therapy because of orthostatic hypotension. The mean daytime systolic blood pressure of Parkinson's disease patients without fludrocortisone was 123 mmHg and the mean nighttime systolic blood pressure was 121 mmHg. There was no significant difference between daytime and nighttime systolic blood pressure (Figure 1). Diastolic blood pressure in this group was significantly higher during the day (68 mmHg) than at night (63 mmHg) (Figure 2). The daytime blood pressure of control patients was 135/74 mmHg and at night 127/69 mmHg (Figures 1, 2). The blood pressure of Parkinson's disease patients with fludrocortisone was higher at night (156/83 mmHg) than during the day (134/77 mmHg) (Figures 1, 2). The daytime and nighttime systolic and diastolic blood pressure was significantly lower by non-fludrocortisone Parkinson patients than the blood pressure of fludrocortisone Parkinson patients (Figures 1, 2).

CONCLUSION

The Parkinson's disease patients were non-dippers and with fludrocortisone the blood pressure was higher at night than on day. On day, the blood pressure of the Parkinson's disease patients with fludrocortisone elevated to the level of controls.

Regulation of IRF and STAT gene expression by retinoic acid

Retinoic acid has antiproliferative and differentiative effects on many cell types. However, the molecular mechanisms involved in ATRA (all-trans retinoic acid) -dependent growth inhibition and cell differentiation are poorly understood. On the other hand, several different cytokine specific transcription factors such as signal transducers and activators of transcription (STAT) and interferon regulatory factors (IRF) are known to be instrumental in mediating differentiative, growth regulatory and antiproliferative effects in cells. The IRF family consists of six different proteins, of which IRF-1 has been demonstrated to have antiproliferative and tumor suppressive functions. We have shown that ATRA activates IRF-1 gene expression in several myeloid leukemia cell lines (HL-60, NB4, THP-1, U937), all of which respond to ATRA by growth inhibition. In addition, during ATRA-induced myeloid differentiation, gene expression of STAT1, STAT2, and p48 was upregulated. These proteins are involved in IFN-alpha specific signaling. ATRA-induced expression of IRF and/or STAT transcription factors may be one of the molecular mechanisms mediating growth inhibition by ATRA.

Inverse association of serum cholesterol with plasma insulin in the elderly. Cross-sectional and prospective analyses

Cross-sectional studies have suggested that high plasma insulin is associated with relatively low levels of low density lipoprotein (LDL)-cholesterol. The present study was aimed at re-testing this association in a 70-year-old age cohort (N = 1023), and testing whether it could be caused by excessive mortality of hyperinsulinemic subjects with high LDL-cholesterol. A reverse U-shaped association between LDL-cholesterol and fasting plasma insulin was confirmed. LDL-cholesterol, HDL-cholesterol and total cholesterol were lowest in the highest insulin quarter. These associations remained after adjustment for diabetes, obesity and general health status. The combination of high LDL-cholesterol (> 4.25 mmol/L, 75th percentile) and high insulin (> 10 IU/L, 50th percentile) was not associated with excess 5-year mortality in this age cohort. Nor was it associated with excess mortality in four other elderly age cohorts (N = 1188), in which similar associations of cholesterol and insulin have been demonstrated. Thus, the inverse association of LDL-cholesterol with fasting insulin in the elderly is not caused by selective over mortality.

Atrial fibrillation in older stroke patients: association with recurrence and mortality after first ischemic stroke

OBJECTIVES

The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older.

DESIGN

A population-based study.

SETTING

The cities of Turku and Kuopio in Finland.

PARTICIPANTS

The study cohort consisted of 2635 consecutive patients aged 75 years and older, with a first ischemic stroke, registered in the FINMONICA Stroke Register.

MEASUREMENTS

28-day and 1-year stroke mortality, causes of death, and recurrence of stroke.

RESULTS

There were 767 stroke patients with AF (mean age 82.2) and 1868 patients without AF (mean age 81.4). Mortality was higher in the AF group both 28 days (33.9% vs 28.1%, P = .003) and 1 year after the attack (52.7% vs 43.0%, P < .001). The age- and sex-adjusted relative risk of death at 28 days was 1.25 in the AF group (95% confidence interval (CI) 1.04-1.50, P = .018), and at 1 year it was 1.41 (95% CI 1.18-1.67, P < .001). In a Cox proportional hazards model, 1-year mortality risk comparing the AF-group with non-AF group was 1.24 (95% CI 1.10-1.39, P < .001). The strongest risk factor predicting 1-year mortality was recent myocardial infarction (MI) (RR 1.90, 95% CI 1.49-2.42). Myocardial infarction was more often the underlying cause of death in the AF group during the period of 28 days, but not from 28 days up to 1 year. The 1-year recurrence rate among those alive at day 28 was 11.5% in the AF group and 9.4% in the non-AF group (P = .240).

CONCLUSION

Recent MI and AF are independent negative prognostic factors in older patients with stroke. Although the relative risk estimates attributable to AF are of the same magnitude in older as in middle-aged stroke patients, the much higher prevalence of AF in the older patients emphasizes its absolute impact on the mortality and recurrence after the first ischemic stroke in the age group 75 years and older. The treatment of coexisting cardiac disease also has the potential to prevent deaths and recurrent stroke events in older persons.

Interferons up-regulate STAT1, STAT2, and IRF family transcription factor gene expression in human peripheral blood mononuclear cells and macrophages

IFN signaling is mediated by binding of IFNs to their receptors and subsequent activation of Janus tyrosine kinase (JAK)-STAT signaling pathway. Stimulation of cells with IFN-alpha leads to the assembly of IFN-stimulated gene factor 3 transcription factor complex formed by STAT1, STAT2, and p48 protein. IFN-gamma signaling is mediated by homodimeric STAT1 protein. Although these signaling molecules are expressed constitutively, there is also evidence of transcriptional regulation by IFNs. We have characterized the expression of STAT and IFN regulatory factor (IRF) family transcription factors in primary human blood mononuclear cells and macrophages in response to IFN-alpha and IFN-gamma stimulation. We show that IFN-alpha and IFN-gamma rapidly and efficiently enhanced STAT1, STAT2, p48, and IRF-1 gene expression. IFN-gamma induced IRF-1 gene expression more strongly than IFN-alpha. Stimulation experiments in the presence of protein synthesis inhibitor, cycloheximide, suggested that these genes were activated directly by IFNs. IRF-2 gene was apparently only weakly responsive to IFNs in these cells. When macrophages were pretreated with low doses of IFN-gamma and then stimulated with IFN-alpha, clearly enhanced formation of specific transcription factor complexes was detected. This suggests that higher intracellular levels of STAT1, STAT2, and p48 protein may result in enhanced signal transduction for cytokines utilizing these transcription factors.

Interferons up-regulate STAT1, STAT2, and IRF family transcription factor gene expression in human peripheral blood mononuclear cells and macrophages

IFN signaling is mediated by binding of IFNs to their receptors and subsequent activation of Janus tyrosine kinase (JAK)-STAT signaling pathway. Stimulation of cells with IFN-alpha leads to the assembly of IFN-stimulated gene factor 3 transcription factor complex formed by STAT1, STAT2, and p48 protein. IFN-gamma signaling is mediated by homodimeric STAT1 protein. Although these signaling molecules are expressed constitutively, there is also evidence of transcriptional regulation by IFNs. We have characterized the expression of STAT and IFN regulatory factor (IRF) family transcription factors in primary human blood mononuclear cells and macrophages in response to IFN-alpha and IFN-gamma stimulation. We show that IFN-alpha and IFN-gamma rapidly and efficiently enhanced STAT1, STAT2, p48, and IRF-1 gene expression. IFN-gamma induced IRF-1 gene expression more strongly than IFN-alpha. Stimulation experiments in the presence of protein synthesis inhibitor, cycloheximide, suggested that these genes were activated directly by IFNs. IRF-2 gene was apparently only weakly responsive to IFNs in these cells. When macrophages were pretreated with low doses of IFN-gamma and then stimulated with IFN-alpha, clearly enhanced formation of specific transcription factor complexes was detected. This suggests that higher intracellular levels of STAT1, STAT2, and p48 protein may result in enhanced signal transduction for cytokines utilizing these transcription factors.

Regulation of HLA class I and II expression by interferons and influenza A virus in human peripheral blood mononuclear cells

HLA class I and II molecules play a central role in regulating host immune responses against microbial infections because they present foreign antigens to CD8+ and CD4+ T lymphocytes, respectively. Many cytokines, especially interferons (IFN), are known to upregulate human leucocyte antigen (HLA) class I and II gene expression, but the kinetics, expression levels and viral regulation of HLA genes in primary human cells have not been well documented. Stimulation of peripheral blood mononuclear cells (PBMC) with IFN-alpha and IFN-gamma resulted in a 1.5- to twofold increase in HLA class I and beta 2-microglobulin expression in lymphocytes and monocytes. Lymphocytes did not express any detectable HLA class II either basally or after IFN induction. In monocytes, instead, a high basal class II expression was found and it was further induced by IFN-alpha (up to twofold) and especially by IFN-gamma (up to fivefold). In granulocyte-macrophage colony-stimulating factor (GM-CSF) differentiated human macrophages, basal HLA class I and II protein expression levels were high but IFN-gamma stimulation was able to further enhance their expression. Accordingly, class I and II mRNA expression was elevated by IFN-gamma, whereas IFN-alpha practically had no effect on HLA class I mRNA levels. Influenza A virus infection of macrophages resulted in temporary increases in HLA class I, beta 2-microglobulin and class II antigen expression. Neutralization of virus-induced IFN production by antibodies against type I and II IFNs prevented the virus-induced upregulation of HLA antigens. At late times of infection, as analysed by steady-state mRNA expression, both HLA class I and II mRNA were strongly reduced. These results suggest that IFNs are important regulators of HLA genes and responsible for a temporary increase in HLA antigen expression during influenza A virus infection.

Metabolic effects of spirapril and atenolol: results from a randomized, long-term study

Thirty-seven patients with mild to moderate hypertension were randomized in a double-blind, parallell-group study to receive either 6 mg of spirapril or 50 mg of atenolol. After 6 weeks of treatment, the daily dose of spirapril was increased to 12 mg and the daily dose of atenolol to 100 mg, if the target diastolic pressure < or = 90 mmHg was not achieved. The total treatment period was 12 months for both drugs. There were no changes in the lipid levels in the spirapril treatment group whereas the concentration of apoprotein A1 decreased significantly (p < 0.05) in the group treated with atenolol when compared with baseline. There was a tendency in the levels of serum cholesterol and triglycerides to increase and in the level of HDL cholesterol to decrease in the atenolol treatment group compared with baseline. Fasting blood glucose levels did not change significantly in the treatment group when compared with baseline. The 2-hour blood glucose level in the glucose tolerance test increased significantly after the 12-month therapy with both spirapril (p < 0.05) and atenolol (p < 0.05) when compared with baseline levels. There was also a tendency in the 2-hour insulin levels to increase in both the spirapril and the atenolol treatment group after the 12-month treatment period. In conclusion, spirapril had no effect on lipid metabolism whereas atenolol had some untoward effects. In the group treated with atenolol fasting blood glucose levels increased, but both spirapril and atenolol increased the 2-hour blood glucose levels in the glucose tolerance test.

Retinoic acid induces signal transducer and activator of transcription (STAT) 1, STAT2, and p48 expression in myeloid leukemia cells and enhances their responsiveness to interferons

IFNs are antiproliferative cytokines that have growth-inhibitory effects on various normal and malignant cells. Therefore, they have been used in the treatment of certain forms of cancer, such as chronic myelogenous leukemia and hairy cell leukemia. However, there is little evidence that IFNs would be effective in the treatment of acute myelogenous leukemia, and molecular mechanisms underlying IFN unresponsiveness have not been clarified. Here we have studied the activation and induction of IFN-specific transcription factors signal transducer and activator of transcription (STAT) 1, STAT2, and p48 in all-trans-retinoic acid (ATRA)-differentiated myeloid leukemia cells using promyelocytic NB4, myeloblastic HL-60, and monoblastic U937 cells as model systems. These cells respond to ATRA by growth inhibition and differentiation. We show that in undifferentiated NB4 cells, 2',5'-oligoadenylate synthetase and MxB gene expression is not activated by IFN-alpha, possibly due to a relative lack of signaling molecules, especially p48 protein. However, during ATRA-induced differentiation, steady-state STAT1, STAT2, and especially p48 mRNA and corresponding protein levels were elevated both in NB4 and U937 cells, apparently correlating to an enhanced responsiveness of these cells to IFNs. ATRA treatment of NB4 cells sensitized them to IFN action as seen by increased IFN-gamma activation site DNA-binding activity or by efficient formation of IFN-alpha-specific ISGF3 complex and subsequent oligoadenylate synthetase and MxB gene expression. Lack of p48 expression could be one of the mechanisms of promyelocytic leukemia cell escape from growth-inhibitory effects of IFN-alpha.

Problem of antimicrobial resistance of fecal aerobic gram-negative bacilli in the elderly

In this study, we assessed the magnitude of risk (odds ratio [OR]) of patients being colonized with fecal aerobic gram-negative bacilli in two geriatric hospitals compared with the community, and we associated the use of antimicrobial agents with bacterial resistance. One fecal sample was collected from each of 341 patients, aged 60 years or older, during the hospital stay or when visiting the outpatient service. Samples were collected in 1988 and 1993 to 1994. The aerobic gram-negative bacilli from all samples were examined for resistance to seven antimicrobials by a replica plating method. The long-term-hospitalized patients had a significantly higher risk of being colonized with bacilli resistant to ampicillin (OR, 14.3; 95% confidence interval [95% CI], 6.0 to 34.1), cefuroxime (OR, 7.5; 95% CI, 2.7 to 20.8), trimethoprim (ORs, 22.3; 95% CI, 8.6 to 57.8), and tetracycline (OR, 5.2; 95% CI, 2.4 to 10.9) than the outpatients. The respective ORs among the short-term-hospitalized patients compared with the outpatients were 4.0 (95% CI, 1.9 to 8.4), 7.5 (95% CI, 2.7 to 20.8), 5.5 (95% CI, 2 to 14), and 2.0 (95% CI, 1 to 4). In 1993 to 1994 compared with 1988, in both hospitals there was a significantly increased risk of colonization by bacilli resistant to ampicillin (OR, 3.1; 95% CI, 1.9 to 5.1), cefuroxime (OR, 3.8; 95% CI, 2.1 to 6.7), and tetracycline (OR, 1.6; 95% CI, 1.0 to 2.5). However, the total use of antimicrobial agents increased only among the patients of the short-term-care hospital.

Antimicrobial resistance of fecal aerobic gram-negative bacilli in different age groups in a community

We measured the occurrence of antimicrobial resistance in fecal aerobic gram-negative bacilli by age in community subjects. For none of the eight antimicrobial agents studied were there any statistically significant differences in the carriage rates of resistance in different age groups. Bacterial resistance was common in all age groups, including the children, and occurred for all antimicrobial agents tested.

Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland

A prospective study of male soccer injuries among 12 teams playing at the highest competition level was carried out in Finland in 1993. Overall, two out of three players were injured during the whole season. The injury incidence per 1000 playing hours among injured players and all players during games was higher than during practice, 14.2 vs. 11.3 and 2.3 vs. 1.8, respectively. The lower extremity was involved in 76% of the injuries. Thigh injuries were most frequent (22%), whereas overuse injuries were scarce (6%). Eighteen per cent of the injured players needed surgery and in most cases (58%) the reason for surgery was a knee injury. Sixteen per cent of all injured players were absent from soccer for more than 1 month after the injury. The mean absence time was 17 days for all and 84 days for operatively treated players.