A36 NON-PSYCHOTROPIC PHYTOCANNABINOIDS ATTENUATE VISCERAL HYPERSENSITIVITY IN DEXTRAN SULFATE SODIUM (DSS)-INDUCED COLITIS

Background

The inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, are complex chronic diseases that affect an increasing proportion of the population. Abdominal pain is a major clinical symptom, but current treatments are limited and a source of frustration for patients, many of whom seek alternatives such as cannabis. Cannabis contains many compounds with therapeutic potential that do not have the prohibitive psychotropic effects of tetrahydrocannabinol. These non-psychotropic cannabinoids (npCBs) have a variety of effects including analgesia and anti-inflammatory actions and show potentiating effects when administered in combination. The range of actions of these compounds potentially allows for their development as novel therapeutics for treatment of pain in IBD.

Aims

To investigate the analgesic effects of cannabichromene (CBC), cannabidiol (CBD), cannabidivarin (CBDV), and cannabigerol (CBG), individually and in combination, in the treatment of colitis-evoked visceral hypersensitivity.

Methods

The analgesic effects of the npCBs were investigated in an acute dextran sodium sulfate model of colitis. Abdominal pain was quantified by electromyographic recordings of the reflexive contraction of the external oblique muscles in response to colorectal distension. Activation of the spinal cord was assessed using immunohistochemistry for the neuronal activity marker c-Fos in neurons of the spinal dorsal horn.

Results

CBD reduced pain responses in the functional assay and spinal cord c-Fos activity in a dose-dependent manner. A single intraperitoneal injection of 10 mg/kg, 30 minutes prior to application of the noxious stimulus, reduced pain responses to the level of non-DSS treated control animals. CBDV, and CBG were found to be ineffective in either assay at doses of 1, 5, and 10 mg/kg.

Conclusions

These results suggest CBD may be a promising therapeutic agent in the treatment of colitis–induced visceral hypersensitivity with rapid translational value due to the legalization of cannabis and rapidly growing cannabis industry in Canada. Additionally, CBDV, CBC, and CBG will be further investigated for their analgesic effects and any potentiating effects from administration of multiple npCBs examined.

Funding Agencies

Alberta Innovates

Enhanced laser-driven proton acceleration using nanowire targets

Laser-driven proton acceleration is a growing field of interest in the high-power laser community. One of the big challenges related to the most routinely used laser-driven ion acceleration mechanism, Target-Normal Sheath Acceleration (TNSA), is to enhance the laser-to-proton energy transfer such as to maximize the proton kinetic energy and number. A way to achieve this is using nanostructured target surfaces in the laser-matter interaction. In this paper, we show that nanowire structures can increase the maximum proton energy by a factor of two, triple the proton temperature and boost the proton numbers, in a campaign performed on the ultra-high contrast 10 TW laser at the Lund Laser Center (LLC). The optimal nanowire length, generating maximum proton energies around 6 MeV, is around 1–2 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\upmu$$\end{document}μm. This nanowire length is sufficient to form well-defined highly-absorptive NW forests and short enough to minimize the energy loss of hot electrons going through the target bulk. Results are further supported by Particle-In-Cell simulations. Systematically analyzing nanowire length, diameter and gap size, we examine the underlying physical mechanisms that are provoking the enhancement of the longitudinal accelerating electric field. The parameter scan analysis shows that optimizing the spatial gap between the nanowires leads to larger enhancement than by the nanowire diameter and length, through increased electron heating.

Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls

Background and aim

We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls).

Methods

The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age.

Results

Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (>28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95].

Conclusion

This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital

The Use of Light Rail or Light Rapid Transit Systems by Individuals with Severe Visual Impairments

This study investigated the relationship between use of light rapid or light rail transit (LRT) systems by persons with severe visual impairments and independence in orientation and mobility. It found that orientation and mobility training on LRT systems would resolve many of the difficulties that users of the systems encountered. Modification that would make the systems more easily accessible to visually impaired travelers are suggested.

P1224Statin treatment in children with familial hypercholesterolemia in Scandinavia

Introduction

New European guidelines recommend that patients with familial hypercholesterolemia (FH) should initiate treatment with statins at age 8–10 years. The number of children using statins has not yet been investigated. The aim of the present study was to describe the number of statin users <19 years of age in the Scandinavian countries: Sweden, Denmark and Norway.

Methods

In the Scandinavian countries, statins are only available by prescription, and there are national registries for the use of perscriptional drugs. In the present study, we assumed that the number of children using statins is equivalent to a positive FH diagnosis in these countries. Using the estimated frequency of FH of 1:250, we calculated the number of expected children with FH per year. Next, the percentage of all FH children who were treated according to the national registries were calculated. We also calculated changes between 2006 and 2016.

Results

As shown in Table 1, 1086 children 5–19 years in Scandinavia used statins in 2016. In the ages 10–19 years, statins were more frequent used in Norwegian FH children than in children from Denmark and Sweden (Figure 1). Nevertheless, the number of children aged 5–19 years using statins increased from about 2% to 4% between 2006 and 2016 in Sweden and Denmark (n=109 and n=136 respectively) and from about 5% to 10% in Norway (n=340).

Discussion

We observed a modest increase in statin users aged 5–19 years in the Scandinavian countries during a 10-year period. Nevertheless, our findings indicate that it will take decades to implement the current Statin-recommendation. Possible reasons for the difference in the degree of treatment between the countries will be discussed during the presentation, in particular with respect to genetic testing and cascade screening.

Table 1. Statin use according to age and gender Age (year) Male, N (%) Female, N (%) Both Sexes, N (%) 5–9 36 (3) 30 (3) 67 (6) 10–14 158 (15) 127 (12) 294 (27) 15–19 327 (30) 395 (36) 725 (67) 0–19 521 (48) 552 (51) 1086 (100)

Figure 1. Percent of FH children using statins

Conclusions

Despite increased statin use during the last years, there is still a severe undertreatment of children with FH in the Scandinavian countries.

P818Incidence of coronary heart disease in patients with familiar hypercholesterolemia compared to age- and sex- matched controls

Background

Familial hypercholesterolemia (FH) is caused by mutations leading to high levels of low-density lipoprotein cholesterol (LDL-C) in the blood. The primary aim was to describe mutations in a large sample of individuals with FH, and compare risk of first-time hospitalization for coronary heart disease (CHD) and acute myocardial infarction (AMI) between FH mutation carriers and healthy controls. The secondary aim was to compare risk of death and re-hospitalization among FH mutation carriers and controls with a first event of CHD and AMI.

Methods

This study is a prospective matched cohort study comprising a sample of 5691 persons with FH and 119 511 age- and sex- matched controls randomly selected from the general Norwegian population. Information on CHD and AMI were obtained from Norwegian Patient Registry, the Cardiovascular Disease in Norway project and the Norwegian Cause of Death Registry. Endpoints are defined according to the International Classification of Diseases, version 9 (ICD9) or version 10 (ICD10). Risk among persons with FH will be compared to healthy controls in terms of hazard ratios (HR) from Cox regression with follow-up time calculated from time of FH-diagnosis for the person with FH in each matched set.

Results

In total 51.8% (n=61866) of the combined sample were women with mean age 49.0±20.3 years, whereas 48.2% (n=57645) were men with mean age 46.8±19.6 years. There were 236 different FH mutations registered among the FH mutation carriers. The most frequent mutation was 313+1g>A, that accounted for 20.7% (n=1178) of the total, followed by C210G with 12.1% (n=690). Results for incidence of CHD, AMI, and mortality after CHD and AMI and readmission rates are not yet available but will be presented at the conference.

Acknowledgement/Funding

The study is funded by South-Eastern Norway Regional Health Authority

Optimization of soft X-ray phase-contrast tomography using a laser wakefield accelerator

X-ray phase-contrast imaging allows for non-invasive analysis in low-absorbing materials, such as soft tissue. Its application in medical or materials science has yet to be realized on a wider scale due to the requirements on the X-ray source, demanding high flux and small source size. Laser wakefield accelerators generate betatron X-rays fulfilling these criteria and can be suitable sources for phase-contrast imaging. In this work, we present the first phase-contrast images obtained by using ionization injection-based laser wakefield acceleration, which results in a higher photon yield and smoother X-ray beam profile compared to self-injection. A peak photon yield of 1.9 × 10¹¹ ph/sr and a source size of 3 μm were estimated. Furthermore, the current laser parameters produce an X-ray spectrum mainly in the soft X-ray range, in which laser-plasma based phase-contrast imaging had yet to be studied. The phase-contrast images of a Chrysopa lacewing resolve features on the order of 4 μm. These images are further used for a tomographic reconstruction and a volume rendering, showing details on the order of tens of μm.

Concomitant medication among persistent opioid users with chronic non-malignant pain

BACKGROUND

Recent guidelines for opioid treatment of chronic non-malignant pain discourage co-medication with benzodiazepines and benzodiazepine-related hypnotics, whereas co-medication with non-opioid analgesics and co-analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1-year periodic prevalence of co-medication with benzodiazepines, benzodiazepine-related hypnotics, non-opioid analgesics, co-analgesics and antidepressants in persistent opioid users with chronic non-malignant pain.

METHODS

The study is based on data from the Norwegian Prescription Database, covering all drugs dispensed to outpatients in 2008. Concomitant medication levels were compared between users in two definitions of persistent opioid use, all Norwegian adults dispensed opioids in 2008 and the Norwegian background population.

RESULTS

Of the Norwegian adult population studied, 1.2% met the criteria of persistent opioid use based on prescription pattern and prescription level. Sixty percent of persistent opioid users were dispensed a benzodiazepine or benzodiazepine-related hypnotic in amounts indicating regular use, with 15% dispensed a high amount of both classes. Sixty-two percent of persistent opioid users were dispensed one or more non-opioid analgesics, 47% an antidepressant and 33% were dispensed an antiepileptic drug.

CONCLUSION

Approximately 60% of persistent opioid users also receive benzodiazepines or benzodiazepine-related hypnotics in amounts indicating regular use. This is in conflict with recent guidelines for the treatment of chronic non-malignant pain and may indicate that these users are at an increased risk of developing problematic opioid use.

Differential patterns of opioid use: defining persistent opioid use in a prescription database

AIM

The aim of this study was to develop definitions to identify persons with clinically different patterns of persistent opioid use based on data from prescription databases.

METHODS

The study is based on data from the Norwegian Prescription Database using all dispensed opioid prescriptions during 2005-2008. Three definitions of persistent opioid use were developed using the following patient criteria: different levels of dispensed opioid amounts, number of prescriptions and the number of quarters out of the year in which prescriptions were dispensed. The three definitions each have some typical patient characteristics attached to them. The strict definition describes a typical patient using opioids to achieve a continuous serum concentration in the therapeutic range, the intermediate definition represents a typical patient using opioids daily but not around the clock and the wide definition describes a typical patient who uses opioids most of the days. To study whether the definitions accurately represent long-term use, the patient population was followed for 3 years, and the retention rate within each definition was measured.

RESULTS

The point prevalence of persistent opioid use in Norway (4,681,134 inhabitants) as defined by the strict, intermediate and wide definitions was 0.16% (n = 7663), 0.50% (n = 23,498) and 1.08% (n = 50,791), respectively, as of 31 December 2007. At the end of the 3-year study period, the retention within any of the definitions was 83%, 84% and 68% for patients who met the criteria of the strict, intermediate and wide definitions, respectively.

CONCLUSION

In the patient populations identified by the three definitions, a high rate of retention was observed, indicating that the proposed definitions can identify patients with long-term persistent use of opioids.

Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses

AIM

Defined daily dose (DDD) is the most common measurement unit used in drug consumption studies. The DDD for opioids may not reflect their relative clinical potencies. The aim of this study was to explore whether opioid consumption data may be interpreted differently when adding oral morphine equivalent (OMEQ) dose as a measurement unit compared with using DDD.

METHODS

The equianalgesic ratio of each opioid relative to morphine was tabulated. Data on opioid consumption expressed in DDD were converted to OMEQs using the equianalgesic ratios. The opioid consumption was compared in three different study settings: clinical data from an opioid switching study, trends within one country and a comparison between countries.

RESULTS

Using DDD, the opioid consumption in Norway between 2004-2008 increased of 6.7%, while the increase was 23.6% using OMEQ. While DDD/1000 inhabitants/day showed that Sweden had the highest consumption of opioids among the Nordic countries, OMEQ/1000 inhabitants/day showed that Denmark had the highest consumption. In the switching study DDD indicated a reduction in analgesic dosing and OMEQ an increase when switching from WHO step II to III.

CONCLUSION

OMEQ reflects clinical dosing better than DDD, and can give additional insight into opioid consumption when combined with DDD. Using OMEQ can also lead to different conclusions in opioid consumption studies compared with using DDD alone.

Increase in interleukin-6 and fibrinogen after exposure to dust in tunnel construction workers

OBJECTIVES

To see if there is any change in blood concentrations of interleukin-6 (IL-6) and fibrinogen during a working shift in tunnel construction workers.

METHODS

12 Tunnel construction workers were followed up during a 24 hours period after returning from a 9 day work free period. The first blood sample was taken on Monday afternoon before starting the shift. Another was taken around midnight after 8 hours of work, and another the next afternoon after about 12 hours of rest. Exposure to respirable dust was measured by personal samplers.

RESULTS

The exposure of the workers to respirable dust, in terms of an 8 hour time weighted average, varied between 0.3 and 1.9 mg/m(3). For IL-6, there was an increase in the median serum concentration from 1.14 ng/l before starting the shift to 4.86 ng/l after 8 hours of work (p=0.002). For fibrinogen, there was an increase in the median concentration from 3.40 g/l before entering the shift to 3.70 g/l 24 hours later (p=0.044). There was a positive correlation between values of IL-6 at the end of the working shift and the fibrinogen concentrations the next afternoon (Pearson's R=0.73, p=0.007). The observed increase in IL-6 was significant for both smokers and non-smokers.

CONCLUSION

The study shows an increase in both IL-6 and fibrinogen concentrations during a working shift for both smoking and non-smoking tunnel construction workers.

Tegaserod coadministration does not alter the pharmacokinetics of theophylline in healthy subjects

Tegaserod (HTF 919), a selective 5-HT4 receptor partial agonist, is in development for the treatment of functional gastrointestinal motility disorders. Tegaserod has been found to inhibit cytochrome P-450 (CYP) 1A2, for which theophylline is a prototype substrate. This study was designed to assess the effect of tegaserod on the single-dose pharmacokinetic and safety profile of theophylline. Eighteen subjects were enrolled in a randomized, open-label, two-period crossover study. After an overnight fast, subjects were randomized to receive one of two treatments: (1) a single dose of controlled-release formulation of theophylline (Theo-Dur, 600 mg) on day 1 or (2) a single dose of tegaserod (6 mg) on day 1, concomitant administration of tegaserod (6 mg) and theophylline (600 mg) on the morning of day 2, followed by an additional dose of tegaserod (6 mg) 12 hours later. Four to 10 days later, the subjects received the alternative treatment regimen. The pharmacokinetic parameters of theophylline, including AUC, Cmax, and t(1/2lambda z), were similar for both treatment regimens, although the tmax of theophylline was statistically different between the treatments. Except for a decrease in partial metabolic formation clearance from theophylline to 1-methyluric acid, which is unlikely to be clinically relevant, there were no statistically significant differences in renal clearance of theophylline and partial metabolic formation clearances following the combined treatment compared with theophylline alone. The results of the current study indicate that no dose adjustment is required when drugs metabolized via CYP1A2 are coadministered with tegaserod.

Exposure to organic solvents in the offset printing industry in Norway

The purpose of this study was to document the conditions regarding solvent exposure at offset printing offices in Norway at present and to study the variation of exposure between printing office technologies. Measurements were made at seven offset printing offices. The measurements consisted of five to 10 whole day personal exposure measurements at each office performed over a period of 2 months. Variables that may influence the level of exposure were registered by the occupational hygienist at the end of each measuring day using a check list. The influence of the variables on the "additive factor" was examined by linear regression analysis.The main contributor to the "additive factor" was isopropanol. The exposure to isopropanol sometimes exceeded the Norwegian TLV. The exposure decreased when a separate exhaust ventilation was used. The exposure increased when the machine had automatic cleaning. The variables automatic cleaning and separate exhaust ventilation explained 59% of the variation in the "additive factor". The results of this study indicate that the most important source of solvent exposure in printing offices at present is the moisturizer used in the printing machines. We think it is worth giving attention to this exposure and making efforts to reduce it.

Lung function disturbances and chest X-ray abnormalities among marine engineers

BACKGROUND

The purpose of the study was to investigate to what extent marine engineers who are exposed to mineral oil mist in the engine rooms of ships have lung function disturbances and chest X-ray abnormalities.

METHODS

A previous study examined a cohort of 492 seamen from which we received 169 full-scale (40 x 40 cm) chest radiographs. Among these films were 68 from marine engineers and 101 from seamen who had never worked as engineers (controls). Spirometric data were obtained from 44 engineers and from 71 of the controls. The chest X-rays were classified independently by two certified B-readers, using the ILO classification.

RESULTS

Only 7% of the seamen had parenchymal or pleural changes. The only statistically significant difference between the two groups for the chest X-ray findings was for all comments made by the ILO readers which were termed "any symbol" (9.3% for the engineers and 0.6% for the controls; RR = 14.6 (95% CI 1.1-75.5)) and the FEV% (FEV1/FVC x 100) for the spirometric values (82.8 (SD = 10.8) for the engineers and 86.6 (SD = 8.0) for the controls; P = 0.03).

CONCLUSIONS

The results of the study indicate a slight lung function impairment and an increase in chest X-ray abnormalities, other than small opacities, among the marine engineers.

Measurements of mineral oil mist, hydrocarbon vapor, and noise in engine rooms of ships

The purpose of this study was to determine the concentrations of oil mist and hydrocarbon vapor to which marine engineers are currently exposed. Measurements were also taken of the sound level in the engine room and the control rooms. Area mist concentration measurements were performed in 21 ferries, 2 cargo ships, and 1 westamaran (an express ship with two keels). Measurements were also performed for four different tasks where exposures above area level were expected. The area level of oil mist in the engine rooms of the different ships varied from not detectable to 0.53 mg/m3 (mean 0.24 mg/m3). The levels of hydrocarbons in the different ships varied from 0.2 to 14.5 mg/m3. The sound level varied from 96 to 108 dB(A) in the engine rooms, and from 70 to 90 dB(A) in the control room. When compared to other studies, it is supposed that the exposure to noise and mineral oil mist in the engine rooms of ships may represent a risk of adverse health effects for workers on Norwegian ships. The sound level may cause neurogenic hearing loss when appropriate hearing protection is not used.

Exposure to mineral oil mist and respiratory symptoms in marine engineers

The purpose of the study was to see if marine engineers have an increased prevalence of respiratory symptoms, and if so whether it can be related to occupational exposures. A self-administered questionnaire was sent to 700 male seamen from three Norwegian ferry companies. Of the 492 respondents, 169 were currently working as marine engineers and 295 had never worked as marine engineers. The outcomes of cough and wheezing, chronic bronchitis, severe dyspnea, any dyspnea, and mucous membrane irritation (MMI) were defined from the questionnaire. Age and smoking-adjusted prevalences of these respiratory conditions were compared between the groups. Logistic regression was used to further elucidate the explanatory variables. The exposure assessment indicated an exposure (TWAC) to oil mist for marine engineers in the range from 0.12 to 0.74 mg/m3 (mean 0.45 mg/m3) When comparing current marine engineers with those who had never worked as marine engineers, the prevalence ratios were 1.38 (95% CI 1.0-1.9) for MMI, 1.53 (95% CI 1.2-1.9) for any dyspnea, and 1.63 (95% CI 1.0-2.6) for severe dyspnea. The differences remained for some of the symptoms after controlling for self-reported former asbestos exposure in the regression analysis. The increased prevalence of respiratory symptoms found among marine engineers in this investigation may partly be explained be oil-mist exposure, or more probably by a combination of past asbestos exposure and past and present oil-mist exposure.

Skin disorders in ship's engineers exposed to oils and solvents

Ship's engineers are exposed to mineral oil and solvents in their work. This study was intended to investigate if the ship's engineers had an increased prevalence of skin disorders and whether any such increased risk could be linked to exposure to mineral oils and solvents. A self-administered questionnaire was sent to 700 male seamen from 3 Norwegian ferry countries. Of the 492 respondents, 169 were currently working as ship's engineers and 295 had never worked as ship's engineers. The outcomes eczema, acne, dry skin, and dermatitis and hand dermatitis were defined from the questionnaire. Prevalences of these skin disorders were compared between the groups. Logistic regression was used to elucidate explanatory variables further. When comparing current ship's engineers with those who had never worked as ship's engineers, the crude prevalence ratios were 1.7 (95% CI 1.1-2.7) for dry skin, 1.7 (95% CI 1.1-2.5) for any dermatitis, 1.3 (95% CI 0.66-2.67) for acne and 1.2 (CI 0.61-2.27) for eczema. The risk of these symptoms increased for the engineers in the regression analysis, after controlling for age, self-reported use of Stoddard solvent, and the use of fuel oil as hand cleansing agent. The increased prevalence of skin disorders found among ship's engineers in this investigation may be explained by direct contact with mineral oils and solvents.

Relationships of quality-of-life measures to long-term lifestyle and drug treatment in the Treatment of Mild Hypertension Study

OBJECTIVES

To compare 5 antihypertensive drugs and placebo for changes in quality of life (QL). To assess the relationship of lifestyle factors and change in lifestyle factors to QL in participants with stage I diastolic hypertension.

METHODS

The Treatment of Mild Hypertension Study (TOMHS) was a randomized, double-blind, placebo-controlled clinical trial with minimum participant follow-up of 4 years. It was conducted at 4 hypertension screening and treatment academic centers in the United States. The cohort consisted of 902 men and women with hypertension, aged 45 to 69 years, with diastolic blood pressures less than 100 mm Hg. Informed consent was obtained from each participant after the nature of the procedures had been fully explained. Sustained nutritional-hygienic intervention was administered to all participants to reduce weight, to reduce dietary sodium and alcohol intake, and to increase physical activity. Participants were randomized to take (1) acebutolol (n = 132); (2) amlodipine maleate (n = 131); (3) chlorthalidone (n = 126); (4) doxazosin mesylate (n = 134); (5) enalapril maleate (n = 135); or placebo (n = 234). Changes in 7 QL indexes were assessed based on a 35-item questionnaire: (1) general health; (2) energy or fatigue; (3) mental health; (4) general functioning; (5) satisfaction with physical abilities; (6) social functioning; and (7) social contacts.

RESULTS

At baseline, higher QL was associated with older age, more physical activity, lower obesity level, male gender, non-African American race, and higher educational level. Improvements in QL were observed in all randomized groups, including the placebo group during follow-up; greater improvements were observed in the acebutolol and chlorthalidone groups and were evident throughout follow-up. The amount of weight loss, increase in physical activity, and level of attained blood pressure control during follow-up were related to greater improvements in QL.

CONCLUSIONS

In patients with stage I hypertension, antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL. The diuretic chlorthali-done and the cardioselective beta-blocker acebutolol appear to improve QL the most. Success with lifestyle changes affecting weight loss and increase in physical activity relate to greater improvements in QL and show that these interventions, in addition to contributing to blood pressure control, have positive effects on the general well-being of the individual.

Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS)

Problems with sexual function have been a long-standing concern in the treatment of hypertension and may influence the choice of treatment regimens and decisions to discontinue drugs. The Treatment of Mild Hypertension Study (TOMHS) provides an excellent opportunity for examination of sexual function and effects of treatment on sexual function in men and women with stage I diastolic hypertension because of the number of drug classes studied, the double-blind study design, and the long-term follow-up. TOMHS was a double-blind, randomized controlled trial of 902 hypertensive individuals (557 men, 345 women), aged 45 to 69 years, treated with placebo or one of five active drugs (acebutolol, amlodipine maleate, chlorthalidone, doxazosin maleate, or enalapril maleate). All participants received intensive lifestyle counseling regarding weight loss, dietary sodium reduction, alcohol reduction (for current drinkers), and increased physical activity. Sexual function was ascertained by physician interviews at baseline and annually during follow-up. At baseline, 14.4% of men and 4.9% of women reported a problems with sexual function. In men, 12.2% had problems obtaining and/or maintaining an erection; 2.0% of women reported a problem having an orgasm. Erection problems in men at baseline were positively related to age, systolic pressure, and previous antihypertensive drug use. The incidences of erection dysfunction during follow-up in men were 9.5% and 14.7% through 24 and 48 months, respectively, and were related to type of antihypertensive therapy. Participants randomized to chlorthalidone reported a significantly higher incidence of erection problems through 24 months than participants randomized to placebo (17.1% versus 8.1%, P = .025). Incidence rates through 48 months were more similar among treatment groups than at 24 months, with nonsignificant differences between the chlorthalidone and placebo groups. Incidence was lowest in the doxazosin group but was not significantly different from the placebo group. Incidence for acebutolol, amlodipine, and enalapril groups was similar to that in the placebo group. In many cases, erection dysfunction did not require withdrawal of medication. Disappearance of erection problems among men with problems at baseline was common in all groups but greatest in the doxazosin group. Incidence of reported sexual problems in women was low in all treatment groups. In conclusion, long-term incidence of erection problems in treated hypertensive men is relatively low but is higher with chlorthalidone treatment. Effects of erection dysfunction with chlorthalidone appear relatively early and are often tolerable, and new occurrences after 2 years are unlikely. The rate of reported sexual problems in hypertensive women is low and does not appear to differ by type of drug. Similar incidence rates of erection dysfunction in placebo and most active drug groups caution against routine attribution of erection problems to antihypertensive medication.

Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS)

BACKGROUND

Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study (TOMHS), a 4-year, randomized clinical trial (N = 902). This report describes the lifestyle intervention program used in TOMHS, presents data on the lifestyle changes observed, and focuses on the effect of weight loss on blood pressure and blood lipid levels.

METHODS

Participants were randomly assigned to receive either placebo or one of five different antihypertensive medications. All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake and to increase physical activity.

RESULTS

Substantial changes from baseline levels were achieved for all lifestyle intervention variables. Mean weight change was -10.5 lb (-5.6%) at 1 year, -8.5 lb (-4.5%) at 2 years, -7.4 lb (-4.0%) at 3 years, and -5.7 lb (-3.0%) at 4 years. At 4 years, 70% of participants remained below baseline weight and 34% maintained a weight loss of 10 lb or greater. Mean change in urinary sodium excretion was -12.5 mmol/8 hr (-23%) at 1 year, -10.7 mmol/8 hr (-20%) at 2 years, -8.4 mmol/8 hr (-16%) at 3 years, and -4.6 mmol/8 hr (-9%) at 4 years. Alcohol intake declined by 1.6 drinks/week among drinkers at 4 years. Reported leisure physical activity increased by 86% at 1 year and remained 50% above baseline at 4 years. Beneficial changes in blood pressure and serum lipids were associated with these changes.

CONCLUSIONS

These results support a role for lifestyle interventions as the initial treatment for stage 1 hypertension and demonstrate that such interventions can be successfully implemented in the clinical setting.

Irritant cutaneous reactions to N-methyl-2-pyrrolidone (NMP)

Several workers in a small electrotechnical company in Norway experienced irritant reactions of the skin after a few days of working with the solvent N-methyl-2-pyrrolidone (NMP). Due to concern about the health risk of commonly-used organic solvents, the company had chosen to use NMP when one of its products had to be treated with a solvent. After 2 days of work with NMP, 10 of the 12 involved workers displayed acute irritant contact dermatitis of the hands. According to published reports, NMP is not considered to be particularly irritant to the skin. The Safety Data Sheet of a Norwegian sales firm contained no information on cutaneous hazards, but the Safety Data Sheet of an American producer of NMP stated the risk of severe dermatitis upon prolonged contact. NMP seems to be more irritant to the human skin than reported thus far.

Population-derived comparisons of ambulatory and office blood pressures. Implications for the determination of usual blood pressure and the concept of white coat hypertension

BACKGROUND

Ambulatory blood pressures (BPs) have generally been reported to be lower than office blood pressures, but population-based data are lacking.

METHODS

To better characterize ambulatory and office BP relationships, we explored the interrelationships of BPs measured in the office by mercury sphygmomanometry, 24-hour ambulatory BP measured with a portable device, and echocardiographic left ventricular mass in a random sample of 50 men aged 51 to 72 years drawn from a much larger pool. Office BP was based on the mean of 10 measurements performed over five visits.

RESULTS

Among all participants, mean 24-hour ambulatory and mean office BPs were highly correlated: r (systolic/diastolic) = .90/.79; and both mean 24-hour and mean awake ambulatory BPs were significantly higher than mean office BPs. For the subsample not receiving antihypertensive therapy, mean ambulatory and office BPs were similar in terms of their associations with Penn left ventricular mass index (LVMI). No association between BP and left ventricular mass was observed among the subjects receiving antihypertensive medication.

CONCLUSIONS

We conclude that a single session of 24-hour ambulatory BP monitoring is unlikely to improve the determination of usual BP in older white men beyond that achievable with BP carefully measured over five separate office visits; and that white coat hypertension is rare in this population.

Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group

Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. Change in smoking status (quitters vs nonquitters) was not independently associated with change in diastolic blood pressure or the subsequent use of antihypertensive medication for smokers who were normotensive at entry. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.01), although the groups had similar baseline diastolic blood pressure levels. Weight gain subsequent to cessation probably contributed to this excess incidence of hypertension in quitters. Stepped-care antihypertensive therapy lowered diastolic blood pressure similarly for hypertensive quitters and nonquitters. Weight increases of 6 lb or more by the 72-month visit occurred in 47% of quitters vs 25% of nonquitters (P less than 0.01); quitters did not differ from nonquitters in their change in total kilocalories from baseline to the 72-month visit. Quitters who gained 6 lb or more tended to be less obese at baseline, be less physically active, and smoke more cigarettes per day than those who did not gain this amount. Finally, quitters relative to nonquitters experienced an adjusted increase of 2.4 mg/dl high-density lipoprotein cholesterol, but no difference in total or low-density lipoprotein cholesterol. The implications for intervention are discussed as they relate to the common, but not inevitable, increase in weight subsequent to cessation.

Racial and ethnic modifiers of the salt-blood pressure response

The relation between sodium and blood pressure is a centuries-old question. A substantial body of epidemiological and experimental data has accumulated that strongly implicates NaCl as having a causal role in the genesis of arterial hypertension. Prospective studies that have been performed in diverse populations that have manipulated NaCl exposure by diet or infusion have repeatedly documented an NaCl pressor effect. Further, similar studies in biracial populations have also demonstrated a greater prevalence of "salt sensitivity" in blacks compared with whites. The reasons for this observation are not entirely clear; however, intrinsic or hypertension-induced renal abnormalities that limit natriuretic capacity, reduced Na+,K(+)-ATPase pump activity, other membrane ion transport disturbances, differential exposure to psychological stressors, greater insulin resistance, and dietary factors (reduced Ca+ and K+ intake) have all been suggested as possibly playing a role. Salt sensitivity appears to be a widespread phenomenon. However, it is critically important to determine what factors account for racial differences in salt sensitivity. Moreover, the prevalence of salt sensitivity in the general population is unknown. Current definitions of salt sensitivity are varied and unidirectional. In comparison with bidirectional criteria (blood pressure increase with salt loading and blood pressure decrease with salt restriction), they are probably inadequate to identify salt-sensitive individuals who manifest less extreme blood pressure change after dietary sodium or plasma volume manipulations. More sensitive criteria for diagnosing salt sensitivity will facilitate a better understanding of racial and ethnic differences in the prevalence of salt sensitivity.

Sodium chloride raises blood pressure in normotensive subjects. The study of sodium and blood pressure

The effects of dietary sodium on blood pressure in normotensive adults is not well characterized. The Study of Sodium and Blood Pressure (SNaP) is a randomized, double-blind crossover trial using a placebo or 96 meq sodium in 4-week treatment periods separated by a 2-week washout period. Before capsule treatment periods, participants were instructed in a low sodium diet for 10 weeks to reduce urinary sodium excretion to less than 35 meq/8 hr. The low sodium diet was continued throughout the capsule treatment periods. Participants (n = 48; 47 white, 1 black) were 79% male and had an average age of 52 years, a body mass index of 27.6, and a baseline blood pressure of 131/84 mm Hg. Baseline overnight urinary sodium excretion was 51 meq/8 hr and 19 meq/8 hr after the low sodium diet run-in period, before the capsule treatment periods began. Resting, seated blood pressure was measured twice at each visit in a standard fashion. Differences between sodium and placebo treatment periods were as follows: systolic blood pressure, 123.9 versus 120.3 mm Hg, respectively (p less than 0.001); diastolic blood pressure, 78.7 versus 76.4 mm Hg, respectively (p = 0.005); and sodium excretion, 51.3 versus 30.9 meq/8 hr, respectively (p less than 0.001). Both systolic and diastolic blood pressures increased significant amounts in normotensive adults on a low sodium diet supplemented with 96 meq/day sodium. Long-term effects and dose-response relations need further study.

Interaction between chlorhexidine digluconate and sodium lauryl sulfate in vivo

Chlorhexidine (CH) is cationic and it forms salts of low solubility with anions such as phosphate, sulfate and carboxyl. Toothpastes contain anionic detergents, one of the most widely used being sodium lauryl sulfate (SLS). The aim of the present study was to examine the possible interaction between CH and the anion SLS in vivo. The interference of SLS on the antiplaque potential of CH was investigated. The study was performed according to a single blind cross over design, and the effect of the interval between prerinsing with an aqueous solution of SLS and the subsequent rinsing with CH was examined. The antiplaque effect was examined by the use of the Silness and Löe plaque-index. The results showed that even a 30-min interval between SLS- and CH-rinsing gave a significantly reduced antiplaque effect of CH, whereas the neutralizing effect of SLS disappeared after 2 h. It can thus be concluded that SLS is not compatible with CH, even when these compounds are introduced separately in the oral cavity. The time between toothbrushing and a CH rinse should at least be 30 min, if a reduction in the antimicrobial effect is to be avoided.

Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure?

Cigarette smoking histories, reported depth of inhalation, number of pipe and cigars (PC) smoked, serum thiocyanate (SCN) and expired air carbon monoxide (CO) levels were examined in PC male smokers enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). Serum SCN levels for all PC smokers were higher than for non-smokers and lower than for current cigarette smokers. Levels were related to the amount of product smoke. Prior cigarette smokers had higher SCN levels when compared to PC users who had never smoked cigarettes, smoked a larger number of tobacco products per day, and reported inhaling into the chest more often. Prospective data on baseline cigarette smokers demonstrated that smokers who stopped all tobacco products had a greater drop in SCN and CO than those who switched to PC. The findings strongly suggest that cessation of all tobacco products is the best strategy for decreasing exposure to tobacco smoke.

Duration of REM sleep latency as predictor of effect of antidepressant therapy. A preliminary report

Twenty-three depressed patients were treated with antidepressant drugs or ECT. Thirteen of the depressions were clinically of the endogenous type, and all these patients responded well to therapy. Ten patients suffered from atypical depression; of these only seven reacted favourably to therapy. EEG showed that patients who were cured had short REM latencies, whereas the three patients who did not respond in a satisfactory way had long REM latencies. These findings suggest that in depressions duration of REM latency may be correlated to respond to antidepressant therapy.

Sleep deprivation therapy in depression

A study of sleep deprivation therapy was made in 62 females and 15 males, aged 20-72, with monopolar (60 patients) and bipolar (17 patients) types of manic-depressive psychosis. Of these patients, 30 had suffered only the current depression, 29 a maximum of five depressions, and 18 more than five depressions before the sleep deprivation therapy. Twenty-five patients had been treated with antidepressant drugs for less than 10 days, 12 patients for 10-24 days, and 36 patients for more than 24 days. Twenty-four patients were treated with one sleep deprivation, 29 patients with one sleep deprivations per week (average 1.59), and 24 patients with two sleep deprivations per week (average 2.5). The effect of the sleep deprivation therapy was evaluated clinically and by means of Cronholm-Ottosson's rating scale. The effect was found good and lasting in 29%, good but temporary in 38%, and poor in 32% of the cases. The best results were achieved with twice-weekly treatments, the poorest results with once-weekly treatment. The results were equal in monopolar and bipolar cases and were independent of the number of previous depressions as well as antidepressant drug treatment. No side effects have been observed, in particular no conversion to mania. The results of the present investigation indicate that depression and sleep disturbances are symptoms produced by a common factor which, however, it as yet unknown. Sleep deprivation therapy is seen to have at least some effect on all cases of endogenous depression. Sleep deprivation therapy has no side effects and is more quick-acting than any other treatment procedure hitherto known. It should therefore be considered the first treatment offer to all endogenously depressed patients in whom immediate ECT is not necessitated.