Visceral adipose tissue, adiponectin levels and insulin resistance are related to atherosclerosis as assessed by whole-body magnetic resonance angiography in an elderly population

OBJECTIVE

The principal aim of this study was to determine whether the amount of visceral adipose tissue (VAT) is more related than subcutaneous adipose tissue (SAT) to atherosclerosis assessed by whole-body MRA (WBMRA). A further objective was to investigate whether traditional risk factors, inflammation, or adipokines could explain the hypothesized relationship between VAT and atherosclerosis.

METHODS

Men and women aged 70 were recruited from the general population into the Prospective Investigation of The Vasculature in Uppsala Seniors (PIVUS) and 306 of them underwent WBMRA in a clinical 1.5-T scanner. The arterial tree was assessed for degree of stenosis or occlusion and a total atherosclerotic score (TAS) was established. Information on risk factors and BMI and on SAT and VAT, segmented on an axial MR scan was collected. Adiponectin, leptin, and high sensitive C-reactive protein (hsCRP) were measured in serum. HOMA index was used as a marker of insulin resistance.

RESULTS

VAT was related to TAS independently of gender, total obesity (BMI), amount of SAT, hsCRP and also to the traditional risk factors included in the Framingham risk score (FRS) in an elderly population. Adiponectin or the HOMA insulin resistance, but not leptin or VAT, together with FRS was significantly related to TAS in a multiple censored regression model.

CONCLUSION

Adiponectin attenuated the relationship between VAT and TAS, suggesting that adiponectin and insulin resistance is an important link between visceral adiposity and atherosclerosis.

Assessment of lipids in skeletal muscle by high-resolution spectroscopic imaging using fat as the internal standard: comparison with water referenced spectroscopy

The main purpose of the study was to compare proton (1H) single-voxel MR spectroscopy (MRS) with high-spatial-resolution spectroscopic imaging (MRSI) to determine the lipid content in human skeletal muscle. Unsuppressed water line was used as a concentration reference in the processing of single-voxel spectra. The spectrum from yellow bone marrow with a 100% fat content and probe with the vegetable oil served as internal and external reference for high-spatial-resolution MRSI, respectively. Very good correlation was found between lipid concentrations measured by water referenced single-voxel MRS and high-spatial-resolution MRSI with yellow bone marrow as the internal standard. Excellent correlation was found between total lipid concentrations estimated by high-spatial-resolution MRSI with vegetable oil as the external fat standard and yellow bone marrow as the internal reference. From comparison of single-voxel MRS and MRSI approaches, it follows that relaxation correction of the reference water and methylene fat line is inevitable in processing the standard single-voxel spectra. The high-resolution MRSI approach is recommended to avoid the problem of relaxation corrections and enables using vegetable oil as the external fat standard.

Multiple phospholipase activation by OX(1) orexin/hypocretin receptors

We investigated coupling of OX(1) receptors to phospholipase activation and diacylglycerol generation in Chinese hamster ovary (CHO) cells using both biochemical and fluorescence "real-time" methods. The results indicate that at lowest orexin-A concentrations (highest potency), diacylglycerol generated results from phospholipase D activity. At 10-100-fold higher orexin-A concentrations, phospholipase C is activated, likely hydrolyzing phosphatidylinositol (PI) or phosphatidylinositol monophosphate (PIP) but not phosphatidylinositol bisphosphate (PIP(2)). At further 7-fold higher orexin-A concentrations, PIP(2) is hydrolyzed, releasing both diacylglycerol and inositol-1,4,5-trisphosphate. Thus, OX(1) orexin receptors connect to multiple phospholipase activities, apparently composed of at least one phospholipase D and two different phospholipase C activities. At low agonist concentrations, diacylglycerol and phosphatidic acid are the preferred products, and interestingly, it seems that even the primarily activated phospholipase C mainly works to increase diacylglycerol and not inositol-1,4,5-trisphosphate.

A high-density SNP linkage scan with 142 combined subtype ADHD sib pairs identifies linkage regions on chromosomes 9 and 16

As part of the International Multi-centre ADHD Genetics project we completed an affected sibling pair study of 142 narrowly defined Diagnostic and Statistical Manual of Mental Disorders, fourth edition combined type attention deficit hyperactivity disorder (ADHD) proband-sibling pairs. No linkage was observed on the most established ADHD-linked genomic regions of 5p and 17p. We found suggestive linkage signals on chromosomes 9 and 16, respectively, with the highest multipoint nonparametric linkage signal on chromosome 16q23 at 99 cM (log of the odds, LOD=3.1) overlapping data published from the previous UCLA (University of California, Los Angeles) (LOD>1, approximately 95 cM) and Dutch (LOD>1, approximately 100 cM) studies. The second highest peak in this study was on chromosome 9q22 at 90 cM (LOD=2.13); both the previous UCLA and German studies also found some evidence of linkage at almost the same location (UCLA LOD=1.45 at 93 cM; German LOD=0.68 at 100 cM). The overlap of these two main peaks with previous findings suggests that loci linked to ADHD may lie within these regions. Meta-analysis or reanalysis of the raw data of all the available ADHD linkage scan data may help to clarify whether these represent true linked loci.

Ankle brachial index <0.9 underestimates the prevalence of peripheral artery occlusive disease assessed with whole-body magnetic resonance angiography in the elderly

BACKGROUND

Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies.

PURPOSE

To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly.

MATERIAL AND METHODS

WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side.

RESULTS

There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one > or =50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a > or =50% stenosis in the pelvic or leg arteries.

CONCLUSION

An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population.

The risk of myocardial infarction and sudden cardiac death amongst snuff users with or without a previous history of smoking

OBJECTIVES

To investigate the risk of a first myocardial infarction (MI) and sudden cardiac death (SCD) amongst male snuff users.

DESIGN

We used a prospective incident case-referent study design nested in the population-based Västerbotten Intervention Program and the Northern Sweden MONICA study.

SUBJECTS

Tobacco habits and cardiovascular risk factors were assessed at baseline screening and compared in 525 male MI cases (including 93 SCD cases) and 1798 matched referents.

RESULTS

Myocardial infarction occurred on average 4 years and 2 months after the baseline screening. No increased risk for MI was found amongst snuff users without a previous history of smoking compared with nontobacco users after adjustments for body mass index, leisure time physical activity, educational level and cholesterol level (OR 0.82; 95% CI, 0.46-1.43). For snuff users with a previous history of smoking, the adjusted OR was 1.25 (95% CI, 0.80-1.96). Significantly increased risk for MI was found in current smokers with or without current snuff use. For SCD cases with survival time<24 h, the adjusted OR for snuff users without previous history of smoking was 1.18 (95% CI, 0.38-3.70) and for cases with survival time<1 h the OR was 0.38 (95% CI, 0.08-1.89).

CONCLUSIONS

We found no increased risk for MI amongst snuff users without a previous history of smoking. Amongst snuff users with a previous history of smoking, the tendency towards an increased risk for MI may reflect the residual risk from former smoking. This study does not support the hypothesis that the risk for SCD is increased amongst snuff users.

Patient acceptance of a novel electronic auto-injector device to administer recombinant human growth hormone: results from an open-label, user survey of everyday use

OBJECTIVE

To measure the user acceptance of a electronic auto-injector device (easypod) for recombinant human growth hormone (r-hGH) administration.

STUDY DESIGN AND METHODS

This was an open-label, uncontrolled study in which participants (n = 61) were trained to use the device to administer subcutaneous recombinant human growth hormone (r-hGH). Participants' opinions on the device were recorded by questionnaire and/or telephone interview during training and after 15 and 60 days of use. Opinions on the device were also collected from nurses or physicians who trained the participants in device use.

RESULTS

After 60 days, 98% (54/55) of responders reported a 'good' or 'very good' overall impression of the device. The pre-programmed dose feature, skin sensor, on-screen instructions, display of remaining dose, confirmation of injected dose and automatic needle attachment were identified by the majority of participants as 'very useful'. Participants were reported to have easily understood the injection process, and 87% (48/55) expressed a preference to continue use of the device. The device had a good safety profile, and no adverse events were reported during the study or follow-up periods.

CONCLUSIONS

Participants had a good overall impression of the device and the majority expressed a preference to continue its use. The combination of features offered by the device make it user-friendly, and such ease of use may facilitate greater adherence to treatment, in turn improving therapy outcomes.

Automated and reproducible segmentation of visceral and subcutaneous adipose tissue from abdominal MRI

OBJECTIVES

(1) To develop a fully automated algorithm for segmentation of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), excluding intermuscular adipose tissue (IMAT) and bone marrow (BM), from axial abdominal magnetic resonance imaging (MRI) data. (2) To evaluate the algorithm accuracy and total method reproducibility using a semi-automatically segmented reference and data from repeated measurements.

BACKGROUND

MRI is a widely used in adipose tissue (AT) assessment. Manual analysis of MRI data is time consuming and biased by the operator. Automated analysis spares resources and increase reproducibility. Fully automated algorithms have been presented. However, reproducibility analysis has not been performed nor has methods for exclusion of IMAT and BM been presented.

METHODS

In total, 49 data sets from 31 subjects were acquired using a clinical 1.5 T MRI scanner. Thirteen data sets were used in the derivation of the automated algorithm and 36 were used in the validation. Common image analysis tools such as thresholding, morphological operations and geometrical models were used to segment VAT and SAT. Accuracy was assessed using a semi-automatically created reference. Reproducibility was assessed from repeated measurements.

RESULTS

Resulting AT volumes from the automated analysis and the reference were not found to differ significantly (2.0+/-14% and 0.84+/-2.7%, given as mean+/-s.d., for VAT and SAT, respectively). The automated analysis of the repeated measurements data significantly increased the reproducibility of the VAT measurements. One athletic subject with very small amounts of AT was considered to be an outlier.

CONCLUSIONS

An automated method for segmentation of VAT and SAT and exclusion of IMAT and BM from abdominal MRI data has been reported. The accuracy and reproducibility of the method has also been demonstrated using a semi-automatically segmented reference and analysis of repeated acquisitions. The accuracy of the method is limited in lean subjects.

Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces

Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.

Correlation of femoral artery flow velocity waveform with ipsilateral iliac artery stenoses assessed with magnetic resonance imaging

BACKGROUND

Magnetic resonance (MR) permits quantitative flow velocity measurements that could be used to detect changes in the curve profile downstream of a high-grade stenosis.

PURPOSE

To assess whether MR flow measurements can be used to detect iliac artery stenoses.

MATERIAL AND METHODS

Contrast-enhanced magnetic resonance angiography (MRA) and quantitative flow measurements in the lower aorta and proximal femoral arteries were performed in 29 patients with suspected iliac artery stenoses. Stenoses were graded into five degrees: 0%, 1-49%, 50-74%, 75-99%, and 100% diameter reduction. The femoral artery waveforms were evaluated qualitatively by two independent reviewers regarding peak systolic velocity (PSV), aortofemoral difference in time-to-peak (DeltaTTP), systolic acceleration (SA), curve-shape index (CSI), and the presence of an early diastolic flow reversal. The correlation between these parameters and the degree of stenosis was assessed.

RESULTS

A significant correlation with degree of stenosis was observed for the qualitative flow waveform evaluations, with a high degree of interobserver agreement (kappa = 0.84). A significant correlation was also found between degree of stenosis and PSV, DeltaTTP, SA, CSI, and presence of diastolic flow reversal. The flow velocity pattern, however, remained unchanged, both qualitatively and quantitatively, up to a stenosis degree of at least 75%.

CONCLUSION

Iliac artery stenoses cause femoral artery flow waveform changes that can be detected with MRI, but only at high-grade levels.

The exactness of left ventricular segmentation in cine magnetic resonance imaging and its impact on systolic function values

PURPOSE

To evaluate the impact of exactness of the segmentation of the left ventricle (LV), using cine magnetic resonance imaging (MRI).

MATERIAL AND METHODS

Steady-state free-precession cine MRI was performed on 100 randomly selected subjects. Myocardial borders were outlined on short-axis images using three methods: method 1 was computer assisted, excluding papillary muscles from the left ventricular mass (LVM); method 2 was similar but included papillary muscles; and method 3 was manually traced including papillary muscles. LV end-systolic (ES) and end-diastolic (ED) masses and volumes, ejection fraction (EF), stroke volume (SV), and cardiac output (CO) were calculated from these measurements. The difference between the ES and ED LVM was used to estimate the exactness of the methods.

RESULTS

Method 3 was the most exact, and method 1 was the least exact. The three methods generated differing EF, SV, and CO measurements. With an ES-ED LVM difference exceeding 20 g, the mean SV measurement error was 8.8+/-3.6 ml.

CONCLUSION

Manual tracing proved more exact than computer-assisted quantification. Exactness had an impact on EF, SV, and CO measurements, and the ES-ED LVM difference can be used to identify assessments that would benefit from more exact segmentation.

Comparative renal, hepatic, and bone marrow toxicity of Cisplatin and radioactive Cisplatin (191Pt) in Wistar rats

The aim of the study was to investigate the possibility to increase the therapeutic gain of the cytotoxic agent, cisplatin, by incorporation of radioactive platinum. In this study, we investigated how organs at risk (i.e., kidneys, bone marrow, and liver) are affected by treatment with 191Pt-cisplatin, compared to treatment with conventional cisplatin. Rats (total, n = 69) were divided into three groups and given 5 mg/kg 191Pt-cisplatin and 5 mg/kg nonradioactive cisplatin or saline. The weight of the animals and blood samples, including analysis of creatinine, bilirubin, alanine and aspartate aminotransferases and platelet count, was followed for 6 weeks after treatment. Histopathology examinations of kidney and liver tissues were performed. An initial decrease in weight gain was seen from 3 days after treatment with cisplatin and 191Pt-cisplatin and for 1 week onward; thereafter, the weight gain continued, following the same pattern as for the control group. Concentration of plasma creatinine was increased for both cisplatin groups but with no significant difference between treatment groups. No other significant differences in effect parameters were found. There was no increase in toxicity for radioactive cisplatin on liver, kidneys, and bone marrow, compared to conventional cisplatin. Further experimental and clinical studies on preparations of this type are thus warranted.

Regulation of OX1 orexin/hypocretin receptor-coupling to phospholipase C by Ca2+ influx

BACKGROUND AND PURPOSE

Orexin (OX) receptors induce Ca2+ elevations via both receptor-operated Ca2+ channels (ROCs) and the "conventional" phospholipase C (PLC)-Ca2+ release-store-operated Ca2+ channel (SOC) pathways. In this study we assessed the ability of these different Ca2+ influx pathways to amplify OX1 receptor signalling to PLC in response to stimulation with the physiological ligand orexin-A.

EXPERIMENTAL APPROACH

PLC activity was assessed in CHO cells stably expressing human OX1 receptors.

KEY RESULTS

Inhibition of total Ca2+ influx by reduction of the extracellular [Ca2+] to 1 microM effectively inhibited the receptor-stimulated PLC activity at low orexin-A concentrations (by 93% at 1 nM), and this effect was gradually reduced by higher orexin-A concentrations. A similar but weaker inhibitory effect (84% at 1 nM) was obtained on depolarization to approximately 0 mV, which disrupts most of the driving force for Ca2+ entry. The inhibitor of the OX1 receptor-activated ROCs, tetraethylammonium chloride (TEA), was somewhat less effective than the reduction in extracellular [Ca2+] at inhibiting PLC activation, probably because it only partially blocks ROCs. The partial inhibitor of both ROCs and SOCs, Mg2+, and the SOC inhibitors, dextromethorphan, SKF-96365 (1-[beta-(3-(4-methoxyphenyl)propoxy)-4-methoxyphenethyl]-1H-imidazole HCL) and 2-APB (2-aminoethoxydiphenyl borate), inhibited PLC activity at low concentrations of orexin-A, but were not as effective as TEA.

CONCLUSIONS AND IMPLICATIONS

Both ROCs and SOCs markedly amplify the OX(1) receptor-induced PLC response, but ROCs are more central for this response. These data indicate the crucial role of ROCs in orexin receptor signalling.

The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 other genes

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, starting in early childhood and persisting into adulthood in the majority of cases. Family and twin studies have demonstrated the importance of genetic factors and candidate gene association studies have identified several loci that exert small but significant effects on ADHD. To provide further clarification of reported associations and identify novel associated genes, we examined 1,038 single-nucleotide polymorphisms (SNPs) spanning 51 candidate genes involved in the regulation of neurotransmitter pathways, particularly dopamine, norepinephrine and serotonin pathways, in addition to circadian rhythm genes. Analysis used within family tests of association in a sample of 776 DSM-IV ADHD combined type cases ascertained for the International Multi-centre ADHD Gene project. We found nominal significance with one or more SNPs in 18 genes, including the two most replicated findings in the literature: DRD4 and DAT1. Gene-wide tests, adjusted for the number of SNPs analysed in each gene, identified associations with TPH2, ARRB2, SYP, DAT1, ADRB2, HES1, MAOA and PNMT. Further studies will be needed to confirm or refute the observed associations and their generalisability to other samples.

Macrophage uptake of ultra-small iron oxide particles for magnetic resonance imaging in experimental acute cardiac transplant rejection

PURPOSE

To discriminate between acutely rejecting and non-rejecting transplanted hearts using a blood pool contrast agent and T2* magnetic resonance imaging (MRI) in a clinical 1.5T scanner.

MATERIAL AND METHODS

Allogeneic and syngeneic heterotopic heart transplantations were performed in rats. One allogeneic and one syngeneic group each received either the ultra-small iron oxide particle (USPIO), at two different doses, or no contrast agent at all. MRI was performed on postoperative day 6. Immediately after the MR scanning, contrast agent was injected and a further MRI was done 24 h later. Change in T2* was calculated.

RESULTS

No significant difference in change in T2* could be seen between rejecting and non-rejecting grafts in either of the doses, or in the control groups. There was a difference between the allogeneic group that received the higher contrast agent dose and the allogeneic group that did not receive any contrast agent at all.

CONCLUSION

In our rat model, measurements of T2* after myocardial macrophage uptake of AMI-227 in a clinical 1.5T scanner were not useful for the diagnosis of acute rejection.

Relations between high ponderal index at birth, feeding practices and body mass index in infancy

OBJECTIVE

We compared feeding practices between infants of high ponderal index (PI) at birth (PI above the 90th percentile) and normal PI at birth (PI between 10th and 90th percentiles), and examined how birth size and infant feeding practices were related to body mass index (BMI) at 12 months.

DESIGN

In a cohort of 3000 infants invited to participate in a national Norwegian dietary survey, 1825 participated both at 6 and 12 months of age, and the present study included those born full term and with a PI (weight/length3) at birth > or =10th percentile (n=1441). Data on feeding practices were collected by food-frequency questionnaires, and anthropometrical data were measured by health-care personnel.

RESULTS

A lower proportion of infants born with high PI were exclusively breastfed for at least 4 months compared with infants born with normal PI (37 and 47%, respectively; P=0.03). Earlier introduction of solid foods and higher consumption of some foods were also observed among infants of high PI. In a multivariate analysis, adjusted mean BMI (kg/m2) at 12 months was higher for infants of high PI at birth than for infants of normal PI (17.6 and 17.0, respectively; P<0.001) and higher for infants exclusively breastfed <3 months than for infants exclusively breastfed > or =3 months (17.5 and 17.2, respectively; P=0.001).

CONCLUSIONS

High PI at birth was associated with a shorter duration of exclusive breastfeeding. Furthermore, high PI at birth and short-term exclusive breastfeeding were both associated with higher BMI at 12 months.

Lipoprotein profiles in plasma and interstitial fluid analyzed with an automated gel-filtration system

BACKGROUND

High-quality methods for lipoprotein characterization are warranted in studies on various metabolic diseases.

MATERIALS AND METHODS

An automated system for size-exclusion chromatography (SEC) of lipoproteins using commercially available components is described. Cholesterol or triglyceride content in separated lipoproteins from plasma and interstitial fluid (IF) was continuously determined on-line using microlitre sample volumes.

RESULTS

The lipoprotein assay showed a good concordance with the classic ultra-centrifugation/precipitation technique using fresh or frozen samples. Determination of lipoproteins in IF obtained from vacuum-induced skin blisters from 18 healthy subjects revealed that very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol levels were 18%, 19% and 25%, respectively, of concomitant plasma concentrations. The size-exclusion chromatography (SEC) system also allows for triglyceride determination on-line and it could be shown that the system is advantageous for an accurate determination of triglycerides in conditions when there are high levels of glycerol, e.g. in mice and in patients with hyperglycerolaemia (pseudo-hypertriglyceridaemia).

CONCLUSIONS

The described system should be of value in studies where detailed lipoprotein analysis is warranted and particularly when significant sample series with small volumes are available. Our data also suggest that there is a 4-5.5-fold concentration gradient between plasma and IF for the three major plasma lipoproteins.

Quantification of intramyocellular lipids in obese subjects using spectroscopic imaging with high spatial resolution

Quantification of intramyocellular lipids (IMCL) in obese subjects by single-voxel spectroscopy (SVS) or conventional spectroscopic imaging (SI) often fails due to overlap of IMCL spectral lines by extramyocellular lipids (EMCL), and signal contamination from subcutaneous fat and bone marrow. This study demonstrates that these problems can be solved by high-resolution SI with 128 phase-encoding steps and a read gradient during acquisition. The small voxels obtained in this way facilitated differentiation between EMCL and IMCL. This method offers the possibility of studying different muscle groups and the variation of lipids within one muscle.

The amount of informal and formal care among non-demented and demented elderly persons-results from a Swedish population-based study

BACKGROUND

Developed countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited.

OBJECTIVES

To describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample.

METHODS

The population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument.

RESULTS

The amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the cognitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care.

CONCLUSIONS

Informal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.

Experimental disease models for the assessment of meningococcal vaccines

Animal infection models are valuable for the development and preclinical assessment of meningococcal vaccines in the absence of clear in vitro correlates of protection for protein-based serogroup B vaccines. It is only in animal models that interactions of the organism with the innate, humoral and cellular immune systems can be assessed. However, humans are the only natural host for Neisseria meningitidis and there is no ideal disease model using laboratory animals that mimics the course of human disease. The two most widely used models are intraperitoneal (i.p.) infection of adult mice or infant rats. The mouse i.p. infection model requires an exogenous iron source (e.g. human transferrin) to obtain a lethal bacteraemic infection and can be used to assess both active and passive immunisation. The virulence of wild-type and knockout mutants can also be compared. i.p. infection of infant rats has been used to assess passive protection provided by sera raised against vaccine candidates or human vaccine sera. However, the duration of bacteraemia is short, mortality is low and active protection cannot be assessed. Recent developments using transgenic mice expressing human CD46 give hope that improved models will be developed.