Achieving more with less: lessons from country-level analyses of caesarean delivery and perinatal outcomes in Europe

Background

There is consensus that caesarean delivery (CD) is a lifesaving procedure for both mother and child in emergency situations and that CD without medical indication should be avoided. However, the rate that optimally balances the risks and benefits of CD is unresolved. In 1985, the World Health Organization concluded that the CD rate should be no more than 10-15%; subsequent reviews relating CD rates to infant mortality show no benefits at the country-level for rates higher than 15-19%. However, stillbirth has not been investigated because comparable international stillbirth data are not readily available.

Methods

We conducted an ecological study in 25 European countries from 2015 to 2019 utilizing data from routine birth data sources aggregated using the Euro-Peristat PHIRI federated data analysis protocol. We assessed country-level associations between CD rates and perinatal outcomes (singleton preterm birth, stillbirth at ≤ 24 weeks’ gestational age, neonatal death) for all years using Pearson correlations, adjusted for clustering of years within country. Correlations were also estimated between linear trends over time in the indicators.

Results

The median [range] of CD rates was 23.1% [16.2 to 56.9] in 21 participating countries, while these were 6.9% [5.3 to 11.9] for preterm birth, 3.3 per 1000 total births [1.8 to 7.6] for stillbirth and 1.9 per 1000 live births [0.7 to 6.1] for neonatal mortality. The CD rate was not associated with the stillbirth rate (cluster-adjusted rho: -.01, P=.94) or with the neonatal mortality rate (rho:.27, P=.27). However, there was a strong positive correlation with the preterm birth rate (rho:.81, P<.001). Results were similar in time trend analyses.

Conclusions

Higher CD rates were not associated with lower stillbirth or neonatal mortality rates, but were strongly correlated with higher preterm birth rates. This study suggests no benefits and indicates potential harms for higher CD rates in Europe.

Systemic exposure to inhaled beclometasone/formoterol DPI is age and body size dependent

AIM

Prescription of inhaled corticosteroids to children with asthma is recommended at half the nominal dose of adults in order to reduce the risk of systemic side effects. However, there is a lack of pharmacokinetic trials supporting such dose reduction regimens. Therefore, we aimed to compare the systemic exposure to the active ingredients of a fixed dose combination of beclometasone-dipropionate (BDP) and formoterol after dry powder inhaler (DPI) administration in children, adolescents and adults.

METHODS

The pharmacokinetic profiles of formoterol and beclometasone-17-monopropionate (B17MP; active metabolite of BDP) were evaluated over 8 h from two independent studies comprising children (6-11yrs, n = 27), adolescents (12-17 yrs, n = 28) and adults (≥18 yrs, n = 30) receiving a single, fixed dose of BDP/formoterol (children: 200 μg/24 μg, adolescents and adults: 400 μg/24 μg) via DPI.

RESULTS

The systemic exposure (AUC) for children versus adults was almost doubled for formoterol and similar for B17MP despite the halved BDP dose administered in children. In adolescents the AUC for formoterol and B17MP were approximately one third higher than in adults for both compounds. Upon normalization for the BDP/formoterol dose in the three populations the AUC and peak concentration (C(max)) correlated inversely with age and body surface area of the patients (r ≤ -0.53; p < 0.0001).

CONCLUSION

The systemic exposure to the active ingredients of BDP/formoterol administered as DPI correlates inversely with age and body size suggesting that dry powder dosage regimens should be adjusted for age and body size to avoid high systemic drug levels in children.

Total and cause-specific mortality rates in a prospective study of community-acquired hepatitis C virus infection in northern Norway

Knowledge of the natural course and especially the total and cause-specific mortality of community-acquired chronic HCV infection is limited. The aims of our study were to determine the total and cause-specific mortality in patients infected with chronic hepatitis C in a community-based setting in northern Norway. This prospective cohort study included 1010 HCV-positive patients diagnosed with recombinant immunoblot assay between 1 January 1990 and 1 January 2000, with a median observation time from diagnosis to follow-up of 7 years. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Time and cause of death were ascertained from the Norwegian Causes of Death Register. Age-adjusted death rates and standardised mortality ratios (SMRs) were compared with those of the general Norwegian population. In total, 122 deaths were recorded. The Kaplan-Meier estimate of survival was 88% at 14 years. The SMR in the cohort relative to the general population was 6.66. Most of the excess deaths in both genders were because of liver-related causes, those associated with a drug-using lifestyle and suicide. The statistically significant increase in SMRs ranged from 4.2 for death by cancer in women to 64.6 for liver disease in women. There was no statistically significant increase in SMRs from cardiovascular disease in either gender or from cancer in men. In conclusion, our study shows that the death rate in patients infected with hepatitis C is 6.66 times higher than in the general Norwegian population.

Acute effects of casein on postprandial lipemia and incretin responses in type 2 diabetic subjects

BACKGROUND AND AIMS

Exaggerated and prolonged postprandial lipemia is potentially atherogenic and associated with type 2 diabetes. Limited data exist regarding the influence of dietary protein on postprandial lipemia in type 2 diabetes. We investigated, over 8-h, the acute effects of casein alone or in combination with carbohydrate on postprandial lipid and incretin responses to a fat-rich meal in type 2 diabetes.

METHODS AND RESULTS

Eleven type 2 diabetic subjects ingested four test meals in random order: an energy-free soup plus 80 g of fat (control-meal); control-meal plus 45 g carbohydrates (CHO-meal); control-meal plus 45 g of casein (PRO-meal); and PRO-meal plus 45 g carbohydrates (CHO+PRO-meal). Triglyceride and retinyl palmitate responses were measured in plasma and in a chylomicron-rich and chylomicron-poor fraction. We found no significant differences in triglyceride responses to PRO- and CHO+PRO-meal compared to the control-meal. However, the addition of casein to the CHO-meal reduced the raised triglyceride response in the chylomicron-rich fraction. Retinyl palmitate responses did not differ significantly between meals in the chylomicron-rich fraction, whereas the PRO-meal increased retinyl palmitate in the chylomicron-poor fraction. PRO- and PRO+CHO-meal increased insulin and glucagon compared to the control-meal. PRO+CHO-meal increased the glucose-dependent insulinotropic peptide response while no change in glucagon-like peptide-1 responses was detected.

CONCLUSIONS

The data presented suggest that casein per se did not modulate the postprandial triglyceride response in type 2 diabetes. When added to carbohydrate, casein suppressed the triglyceride response in the chylomicron-rich fraction, increased insulin and glucagon but did not affect the incretin responses.

Environmental changes in the North Atlantic Region: SCANNET as a collaborative approach for documenting, understanding and predicting changes

The lands surrounding the North Atlantic Region (the SCANNET Region) cover a wide range of climate regimes, physical environments and availability of natural resources. Except in the extreme North, they have supported human populations and various cultures since at least the end of the last ice age. However, the region is also important at a wider geographical scale in that it influences the global climate and supports animals that migrate between the Arctic and all the other continents of the world. Climate, environment and land use in the region are changing rapidly and projections suggest that global warming will be amplified there while increasing land use might dramatically reduce the remaining wilderness areas. Because much of the region is sparsely populated--if populated at all--observational records of past environmental changes and their impacts are both few and of short duration. However, it is becoming very important to record the changes that are now in progress, to understand the drivers of these changes, and to predict future consequences of the changes. To facilitate research into understanding impacts of global change on the lands of the North Atlantic Regions, and also to monitor changes in real time, an EU-funded network of research sites and infrastructures was formed in 2000: this was called SCANNET--SCANdinavian/North European NETwork of Terrestrial Field Bases. SCANNET currently consists of 9 core sites and 5 sites within local networks that together cover the broad range of current climate and predicted change in the region. Climate observations are well replicated across the network, whereas each site has tended to select particular environmental and ecological subjects for intensive observation. This provides diversity of both subject coverage and expertise. In this paper, we summarize the findings of SCANNET to-date and outline its information bases in order to increase awareness of data on environmental change in the North Atlantic Region. We also identify important gaps in our understanding and identify where the roles of existing infrastructures and activities represented by SCANNET can facilitate future research, monitoring and ground-truthing activities.

The prevalence of antibiotic resistance in bacterial respiratory pathogens from Norway is low

OBJECTIVES

To determine the degree of bacterial susceptibility to the most commonly used drugs for respiratory infections in Norway, and to find if bacterial resistance is emerging.

METHODS

Clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and group A streptococci from respiratory tract specimens and from the eye were collected from different parts of Norway during two study periods. During the first period (1993-1994), three laboratories, covering 15% of the Norwegian population, participated. During the second study period in 1997, five laboratories, covering 27% of the population, collected respiratory isolates. In total, 494 isolates of S. pneumoniae, 696 isolates of H. influenzae and 694 isolates of group A streptococci were included in the study. The study population comprised children and adults attending hospital and general practice. Bacterial susceptibility was determined by the E test, and breakpoints were according to the National Committee for Clinical Laboratory Standards (NCCLS).

RESULTS

The prevalence of bacterial resistance was low, and we observed no significant increase in bacterial resistance between the two study periods. In 1997, only 0.6% of pneumococci had decreased susceptibility to penicillin, 1.6% of group A streptococci were resistant to erythromycin, and 6.7% of all isolates of H. influenzae produced beta-lactamase.

CONCLUSIONS

The prevalence of antibiotic resistance in respiratory pathogens in Norway is low.

Evaluation of 12 commercial tests for detection of Epstein-Barr virus-specific and heterophile antibodies

Ten microbiological departments in Norway have participated in a multicenter evaluation of the following commercial tests for detection of Epstein-Barr virus (EBV)-specific and heterophile antibodies: CAPTIA Select viral capsid antigen (VCA)-M/G/EBNA (Centocor Inc.), Enzygnost anti-EBV/immunoglobulin M (IgM) and IgG (Dade Behring), Vironostika EBV VCA IgM/IgG/EBNA enzyme-linked immunosorbent assay (ELISA) (Organon Teknika), SEROFLUOR immunofluorescence assay and EBV Combi-Test (Institute Virion Ltd.), anti-EBV recombinant IgM- and IgG-early antigen/EBNA IgG ELISA (Biotest Diagnostics), EBV IgM/IgG/EBNA ELISA (Gull Laboratories), Paul-Bunnell-Davidsohn test (Sanofi Diagnostics Pasteur), Monosticon Dri-Dot (Organon Teknika), Avitex-IM (Omega Diagnostics Ltd.), Alexon Serascan infectious mononucleosis test (Alexon Biomedical Inc. ), Clearview IM (Unipath Ltd.), and Cards+/-OS Mono (Pacific Biotech, Inc.). The test panel included sera from patients with primary EBV infection, immunocompromised patients with recent cytomegalovirus infection, healthy persons (blood donors), and EBV-seronegative persons. Among the tests for EBV-specific antibodies the sensitivity was good, with only small differences between the different assays. However, there was a greater variation in specificity, which varied between 100% (Enzygnost) and 86% (Biotest). Tests for detection of heterophile antibodies based on purified or selected antigen (Avitex, Alexon, Clearview IM, and Cards+/-OS Mono) were more sensitive than the Paul-Bunnell-Davidsohn and Monosticon tests.

[Practical approach to otitis media with methicillin-resistant yellow Staphylococci]

Methicillin-resistant Staphylococcus aureus (MRSA) are multiresistant bacteria, known to cause nosocomial infections. We present a report on a two and a half year-old, recently adopted, child, who suffered from otitis media with discharge. The child was treated with penicillin in Norway without success. Culture revealed methicillin-resistant S aureus. Methicillin-resistant S aureus were also found in the noses of the adoptive parents. After a second unsuccessful course of antibiotics the child was admitted to the Ear, nose, and throat department and was subsequently treated with intravenous vancomycin, mastoidectomy and eradication of the nasal methicillin-resistant S aureus carriage. The admittance to the Ear, nose, and throat department was carefully planned. All departments concerned were thoroughly briefed. The patient was given vancomycin intravenously for 18 days, partly as an out-patient. Subsequent control cultures from the patient and the adoptive parents have all been negative. No one dealing with the patient has been infected. The case illustrates the importance of thorough planning and co-operation between different departments.

Risedronate increases bone mass in an early postmenopausal population: two years of treatment plus one year of follow-up

This double-blind, placebo-controlled study was undertaken to determine 1) the efficacy of oral risedronate for prevention of bone loss in healthy, early postmenopausal patients with normal bone mass, 2) the effect on bone mass when treatment was stopped, and 3) the safety and tolerance of risedronate in this population. A group of 111 patients were randomized to oral placebo, risedronate 5 mg daily, or risedronate 5 mg cyclically, for 2 yr followed by 1 yr off treatment. Measurements included percentage change from baseline in lumbar spine bone mineral density (BMD) at 24 months; percentage change from baseline in BMD of the femoral neck, trochanteric region, and Ward's triangle region of the proximal femur; and changes in biochemical markers of bone turnover. After 2 yr, there was a mean increase in BMD of the lumbar spine of 1.4% from baseline and of 5.7% vs. placebo in the risedronate 5 mg daily group. There were decreases from baseline in BMD of 1.6% and 4.3% in the risedronate 5 mg cyclic and placebo groups, respectively. By the end of 24 months, trochanteric bone mass at the hip increased by 5.4% in the risedronate 5 mg daily group and by 3.3% in the risedronate 5 mg cyclic group vs. placebo. Bone mass was maintained at the femoral neck in the 2 active-treatment groups vs. a 2.4% mean loss with placebo. During the treatment-free follow-up, bone turnover increased toward baseline in both risedronate groups. By the end of that year, lumbar spine bone mass in all 3 groups was lower than at baseline. Oral risedronate was well tolerated. We conclude that risedronate (5 mg daily) increases bone mass and risedronate (5 mg cyclic) appears to prevent bone loss in early postmenopausal women with normal BMD.

Positive effects of physiotherapy on chronic pain and performance in osteoporosis

The aim of this placebo-controlled, randomized, single-masked study was to establish the effects of a 10-week ambulatory exercise programme for osteoporotic patients on pain, use of analgesics, functional status, quality of life, balance and muscle strength. Fifty-three ambulatory postmenopausal women with at least one spinal crush fracture and pains within the last 3 years were randomized for physiotherapeutic training twice a week for 10 weeks or no training. The training included general training of balance and muscle strength, with stabilization of the lumbar spine. The participants were tested at baseline, week 5 and week 10 with a balance test, muscle strength test and questionnaires on pain, use of analgesics, functional status and quality of life. Twelve weeks after the supervised training had finished (week 22) they answered the same questionnaires. The study groups were comparable at baseline. The training group had a significant reduction in use of analgesics (p = 0.02) and pain level (p = 0.01) during the training period. Distribution of functional score improved; the improvement was reduced at week 22. Quality of life score improved significantly throughout the study (p = 0.0008), even after week 22. Balance improved non-significantly (p = 0.08). Quadriceps muscle strength improved significantly after 5 weeks (p = 0.04). Back extensor muscle strength improved almost significantly (p = 0.09). In conclusion, this training programme for osteoporotic patients improved balance and level of daily function and decreased experience of pain and use of analgesics. Quality of life was improved even beyond the active training period.

Effect of vitamin D treatment in hypoparathyroid patients: a study on calcium, phosphate and magnesium homeostasis

AIM

This study was undertaken to examine the effects of long-term vitamin D treatment on calcium, phosphate and magnesium homeostasis at organ level in hypoparathyroid patients.

METHODS

Fifteen vitamin D-treated hypoparathyroid patients were studied, eight of the patients in a combined 47Ca kinetic and calcium, phosphate and magnesium balance study. Results were compared with a matched control group of 12 normal individuals.

RESULTS

All the patients had normal serum levels of calcium, phosphate and magnesium. Absolute intestinal calcium absorption was increased (P < 0.0001). Urinary calcium excretion was normal, but active tubular calcium reabsorption (TmCa/glomerular filtration rate) was low (P< 0.001). Bone resorption rates and bone mineralization rates were very low (P < 0.001 and P < 0.05). Twenty-four-hour urinary hydroxyproline excretion and serum cross-linked carboxyterminal telopeptide of type I were in the upper normal range. Serum alkaline phosphatase was normal, but serum carboxyterminal propeptide of human type I procollagen and serum osteocalcin were significantly reduced (P < 0.05). Calcium balance was positive and significantly different from controls (P < 0.001). All parameters from phosphate homeostasis were normal. Intestinal magnesium absorption was low though not significantly different from normal (P = 0.06). Urinary excretion of magnesium was not significantly higher than normal, but renal magnesium reabsorption was reduced (P <0.001). Magnesium balance was low, though the difference was not significant (P < 0.06).

CONCLUSION

Long-term vitamin D treatment in hypoparathyroid patients resulted in a positive calcium balance. Bone turnover was very low. Results of bone markers and resorption rate were conflicting. Vitamin D treatment apparently normalized the abnormalities previously found in phosphate homeostasis of hypoparathyroid patients. Magnesium homeostasis was disturbed, with a more negative balance compared with normal subjects, implying a state of magnesium deficiency in these patients.

Bioavailability of calcium supplements and the effect of Vitamin D: comparisons between milk, calcium carbonate, and calcium carbonate plus vitamin D

Our aim was to examine a regimen for calcium supplementation because various factors seem to be important for its bioavailability, and to examine the effect of adding vitamin D to the supplement. The participants were 20 healthy women aged 28-59 y (chi: 38 y). During the 3-d periods and 1 d before, the participants were consuming a calcium and energy-balanced diet as similar to their usual daily diet as possible. The study was designed as a randomized, placebo-controlled, partly blinded crossover study divided into four periods of 3 d each: 1) three tablets containing 1000 mg CaCO3/d, 2) three tablets containing 1000 mg CaCO3 plus 5 micrograms (200 IU) vitamin D/d, 3)1 L more milk than in the usual daily diet, and 4) three placebo tablets daily. Bioavailability of the different calcium-supplement regimens were evaluated by changes in 24-h urinary excretion of calcium, phosphate, and magnesium. A significant increase in urinary calcium excretion was found during all periods of supplementation compared with the placebo period (P<0.01). Excretion of calcium in the calcium carbonate period was not significantly higher that that in the milk period, but calcium carbonate plus vitamin D resulted in significantly higher calcium excretion compared with that in the milk period. We conclude that the examined calcium carbonate regimen is at least as good a calcium supplement as milk, and that addition of 600 IU vitamin D/d promptly resulted in an increase in urinary calcium excretion after an increase in calcium absorption, even in healthy women.

Bone histomorphometry in hypoparathyroid patients treated with vitamin D

Parathyroid hormone (PTH) and vitamin D are both active regulators of bone remodeling. Several studies, mostly in animals and in vitro, have suggested that the two hormones act synergistically or interdependently. The aim of the present study was therefore to describe the actions of vitamin D alone on bone remodeling in the absence of circulating PTH. Bone biopsies were obtained from 12 patients with vitamin D-treated hypoparathyroidism and from 13 age- and gender-matched normal controls. Mean total resorption rate was reduced (0.9 vs. 3.8 mu m/day,p < 0.001), the resorption period was prolonged (80.8 vs. 25.7 days, p < 0.001), and the resorption depth was reduced (41.7 vs. 55.3 mu m, p < 0.001). The fractional active and the total eroded surface were not significantly reduced. The fractional formation surface was reduced (5.2 vs. 12.5 mu m, p < 0.001). Trends toward prolongation of the formation period and reduction of the final wall thickness were found. The balance between resorption depth and final wall thickness was not significantly different from normal (0.96 vs. -4.4 mu m). The quiescent period was prolonged (7.6 vs. 1.7 years, p < 0.001) and the activation frequency was reduced (0.13 vs. 0.6 year(-1), p < 0.001). The structural parameters, trabecular bone volume, trabecular thickness, marrow space star volume, and trabecular star volume, remained unchanged. In the absence of PTH, Vitamin D alone is not able to normalize bone resorption and bone turnover in hypoparathyroid patients.

Responses of spring wheat (Triticum aestivum L.) to ozone produced by either electric discharge and dry air or by UV-lamps and ambient air

The aim of the present study was to examine if ozone produced similar effects on spring wheat growth with and without small amounts of nitrogen oxides. Two methods were used to produce ozone: the first method consisted of dry pressurized air fed to an electric discharge generator generating the byproducts, N2O5 and N2O, the second method consisted of ambient air fed to UV-lamps. Two spring wheat cultivars (Triticum aestivum L. cvs Minaret and Eridano) were exposed in small open-top chambers to charcoal-filtered air, non-filtered ambient air, and non-filtered ambient air with the addition of ozone for 8 h (0900 to 1700 h) daily, for five weeks. Plants were harvested every week. The growth of Minaret was shown to be more sensitive to O3 than that of Eridano. Leaf senescence increased with increasing ozone level in both cultivars. The total above-ground biomass dry weight decreased with increasing ozone concentration in Minaret, but not in Eridano. The Minaret plants reacted with more damaged leaf dry weight and inhibition of growth when O3 was produced by UV-lamps than when O3 was produced by air fed to an electric discharge generator. This could be explained by more nitrogen content per plant but not by increased nitrogen concentration in plant tissue in plants exposed to increased O3 and small amounts of incidental nitrogen oxides.

Effects of ozone on 14C translocation velocity and growth of spring wheat (Triticum aestivum L.) exposed in open-top chambers

Growth and yield were reduced but (14)C translocation velocity was not affected by increasing levels of ozone in spring wheat exposed in open top chambers to the following treatments: charcoal filtered air (CF), non-filtered ambient air (NF), or NF with addition of 30 microl litre(-1) ozone, 8 h daily (NFO). Destructive harvests were performed at anthesis and at maturity. Parts of the flag leaf or the second leaf were exposed to (14)CO(2) in small cuvettes for 5 min before, during and after anthesis. The translocation velocity was followed by autoradiography and scintillation counting of the plants frozen and lyophilized at different times after labelling. The label was transported at the same velocity in all the treatments. Ozone induced changes in carbon allocation or partitioning should probably be explained as amounts of carbon transported (mg s(-1)), rather than as transportation velocity (mm s(-1)). The amount translocated may be governed by source conditions under O(3) stress: reduced healthy green biomass and photosynthesis, but perhaps also by impairment of phloem loading because of membrane damage.

Lithium stimulates the first meiotic division in mouse oocytes

Cumulus enclosed oocytes, cumulus enclosed oocytes denuded of their cumulus and cumulus free oocytes from 21 day old unstimulated mice were cultured for 18 hours in control medium supplemented with lithium chloride, dbcAMP and forskolin at various concentrations. In control medium 66% of the cumulus enclosed oocytes, 93% of the denuded oocytes, and 94% of the cumulus free oocytes resumed meiosis (germinal vesicle breakdown), whereas the levels of polar body formation were 27%, 12% and 39%, respectively. In the presence of lithium significantly more cumulus enclosed oocytes and cumulus free oocytes resumed meiosis and formed a polar body, whereas lithium had no effect on the denuded oocytes. Forskolin and dbcAMP stimulated resumption of meiosis and cumulus expansion in the cumulus enclosed oocytes and inhibited resumption of meiosis in the cumulus free oocytes. Lithium more or less eliminated this inhibitory effect of both forskolin and dbcAMP in the cumulus free oocytes. The results indicate (i) that activation of the cAMP second messenger path in the cumulus cells induces them to synthesize a meiosis inducing substance(s) which stimulates the oocyte to resume meiosis, and (ii) that other second messenger systems than the cAMP pathway, e.g. the phosphatidylinositol cycle, are involved in resumption of meiosis and polar body formation. We conclude that lithium enhances the capability of mouse oocytes for resumption of meiosis and polar body formation.

Treatment of psoriasis vulgaris with topical calcipotriol has no short-term effect on calcium or bone metabolism. A randomized, double-blind, placebo-controlled study

The purpose of this double-blind, placebo-controlled study was to examine whether the vitamin D analogue calcipotriol, topically applied to psoriatic skin lesions, had any effect on calcium or bone metabolism. Thirty-four outpatients with psoriasis vulgaris were randomized to treatment with either calcipotriol ointment (50 micrograms/g) or vehicle ointment twice daily for 3 weeks. The patients were put on a calcium energy fixed diet and examined once weekly. The mean amount of calcipotriol ointment used was 40.3 g/week (range 8.2-95.4 g/week). The results of biochemical markers on calcium and bone metabolism showed no significant differences between the two groups. No correlation was found between the amount of ointment used and changes in parameters on calcium and bone metabolism during the 3-week treatment. It is concluded that calcipotriol ointment (50 micrograms/g), applied in doses of 8.2-95.4 g/week for 3 weeks to psoriatic skin lesions, has no effect on calcium or bone metabolism.

Distribution of hydroxylated vitamin D metabolites [25OHD3 and 1,25(OH)2D3] in domestic pigs: evidence that 1,25(OH)2D3 is stored outside the blood circulation?

1. The distribution of 25-hydroxycholecalciferol (25OHD3) and 1,25-dihydroxycholecalciferol [1,25(OH)2D3] in various organs from domestic pigs was examined by HPLC. 2. Plasma levels of both metabolites corresponded to those found in healthy human subjects. 3. Tissue concentrations of 25OHD3 in fat, kidney, liver, and intestinal mucosa were low (< 1/3 of plasma levels), whereas tissue concentrations of 1,25(OH)2D3 exceeded plasma levels by factors 3-7, adipose tissue concentrations being the highest. 4. Substantial amounts of activated vitamin D are stored outside the blood-streams and may actively participate in vitamin D and calcium homeostasis.

Total number of particles in a bounded region estimated directly with the nucleator: granulosa cell number in ovarian follicles

OBJECTIVE

Our objective was to evaluate the precision of the "nucleator" with regard to estimation of the number of granulosa cells in individual follicles and the average number of granulosa cells per follicle in a group of follicles.

STUDY DESIGN

Nine murine ovarian follicles embedded in plastic were oriented isotropically with the "orientator" by Mattfeldt, cut into 20 microns serial sections, and stained with hematoxylin. In each follicle the number of granulosa cells was estimated in two ways, both unbiased: (1) with the nucleator principle in the section that contains the nucleolus of the oocyte and (2) in the complete set of follicle sections with the "fractionator" principle. Estimates with the fractionator were interpreted as "true" values. Therefore the precision (CE) of the nucleator estimates could be calculated.

RESULTS AND CONCLUSION

The nucleator provides precise estimates of the number of granulosa cells in one complete follicle: CE = 0.12. The amount of effort is minimal, because estimation is based on roughly 50 granulosa cells. The precision of the procedure with regard to estimation of the average number of granulosa cells in a group of follicles depends mainly on the biologic variation (CVbiol = 0.71).

Effects of air pollutants on the growth and antioxidative system of Norway spruce exposed in open-top chambers

Grafted Norway spruce trees were subjected to exposure beginning in April 1988, to one of four different air treatments in open-top chambers: Charcoal filtered air (CF), non-filtered air (NF), non-filtered air with the addition of O(3) during summer (NFO), and SO(2) plus NO(2) during winter (NFOSN). CF trees were considered as the reference group. No effects on growth parameters were observed. Samples of the two youngest needle year classes were taken late in November 1989 for enzyme determinations. The activity of ascorbic acid peroxidase (A-POD) increased the same level in all treatments, and activities of catalase and dehydroascorbic acid reductase (DHA-R) increased only in NF and NFO treatments. A higher level of activity in the NFOSN treatment was observed only for glucose-6-phosphate-dehydrogenase (Glc-6-P-DH) and non-specific peroxidase (POD). Isoelectric focusing of POD showed a changed pattern in the NFOSN treatment. Neither activity nor isoelectric focusing of superoxidase dismutase (SOD) was changed in any of the treatments.

Back transporting infants from neonatal intensive care units to community hospitals for recovery care: effect on total hospital charges

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent stimulation of CO2 assimilation and stomatal conductance by summer ozone fumigation in Norway spruce

CO(2) assimilation rate, stomatal conductance and chlorophyll content of current and previous years' needles of Norway spruce were measured in May 1988, 205 days after the cessation of ozone fumigation during the summer of 1987. Rates of assimilation were consistently higher for both needle year age classes for ozone fumigated trees in comparison to control trees, although only statistically significant for part of the day for current year's needles. A 26% and 48% stimulation, overall, in mean daily rates of assimilation for current and previous years' needles of ozone fumigated trees was observed. This was due to an enhanced apparent quantum yield and light saturated rate of assimilation of ozone fumigated trees. The temperature response regression of assimilation versus temperature was also greater, such that at any given temperature, assimilation was higher for ozone treated trees than control trees. Stomatal conductance was greater for ozone fumigated trees than the controls, but this was only marginally statistically significant. Moreover, there was a consistent increase in chlorophyll content in both year classes in ozone-treated trees. These results are discussed in relation to a possible long term effect of ozone fumigation upon the processes of conifer winter hardening and spring de-hardening.

Persistent effects of ozone on needle water loss and wettability in Norway spruce

Four-year-old, seed-grown trees of Norway spruce (Picea abies (L.) Karst.) were exposed in open-top chambers to charcoal-filtered air (8 h daily mean 54 microg O(3) m(-3)) over three consecutive summers (1986-1988). In mid-May 1988, before the third season of fumigation and more than 7 months after exposure to ozone the previous summer had terminated, daily rates of transpiration from intact shoots and water loss from excised needles were measured together with the amount of wax on the needle surface. In mid-July, 92 days after the beginning of the third year of exposure, the wettability of needles was assessed by measuring the contact angle of water droplets on the surface of needles. Exposure to 156 microg O(3) m(-3) resulted in a 16% increase in daily transpiration in current year's needles and a 28% increase in 1-year old needles. These effects were associated with slower stomatal closure in response to increasing water deficit in the needles previously exposed to 156 microg m(-3) ozone. The long-lasting nature of such ozone-induced effects could predispose trees to drought and winter desiccation. No significant effects of ozone were found on the amount of wax covering the needle surface, but a marked increase in the wettability of needles exposed to ozone was observed. The far reaching physiological consequences of these effects in the field and the possibility that similar disturbances may contribute to the decline of high-altitude forests of Norway spruce in Europe are discussed.

Single and double loop formation when deoR repressor binds to its natural operator sites

Distal effects on the in vivo repression of the deo operon are thought to be mediated by the deoR repressor with DNA loop formation. Such loops are easily observed by electron microscopy when the oligomeric deoR repressor is added to a DNA fragment carrying the three genetically defined operators at their chromosomal distances. Upon binding of deoR to any two operators, single loops are formed, 280, 600, and 880 bp in size. With the deo operon, double loops are also formed, which are the combination of the 280 bp and 600 bp loops and the result of simultaneous binding of the protein to its three sites. The formation of both single and double loops is consistent with the long-range effects observed in vivo and with the cooperative involvement of all three operator sites in the repression.

Purification and characterization of the deoR repressor of Escherichia coli

The deoR gene, which encodes the deor repressor protein in Escherichia coli, was fused to the strong Ptrc promoter in plasmid pKK233-2. The Ptrc promoter is kept repressed by lacI repressor to prevent cell killing. Induction of the Ptrc--deoR fusion plasmid resulted in the accumulation of 4% of the soluble protein as deoR protein. The deoR repressor protein was purified to 80% purity using conventional techniques; it has a mass of 28.5 kd and appears to exist as an octamer in solution. The deoR repressor is shown by DNase I footprinting to bind to the 16 bp palindromic sequence in the Pribnow box region of the deoP1 promoter. Also, the deoR repressor binds cooperatively in vitro to a DNA template with two deoR binding sites separated by 224 bp in keeping with the conclusion from genetic experiments that more than one operator is required for efficient repression of the deo operon.

Nonspecific psychological distress, psychosocial stressors and delusional psychosis. A comparison with psychiatrically symptom free surgical controls

The purpose of the study was to examine patients with delusional psychosis regarding characteristic personality traits as illustrated by nonspecific psychological distress, and psychosocial stress prior to onset of the psychosis. The design of the study was a comparison of first-admitted psychiatric patients with delusional psychosis and psychiatrically symptom free surgical controls. Patients with delusional psychosis reported significantly more psychosocial stress than controls during the 3 months prior to admission. They also reported significantly higher mean values than controls on the subscales named poor self-esteem, helplessness-hopelessness, dread, sadness, anxiety and approval of rule breaking on the schedule of nonspecific psychological distress. In discriminating patients with delusional psychosis and surgical controls, approval of rule breaking, helplessness-hopelessness, and severity of psychosocial stressors were the most informative variables. Patients with delusional psychosis will be followed up in order to analyze if nonspecific psychological distress and psychosocial stressors are of importance for the prediction of the course and the outcome.

Prediction of survival in adults with acquired Bi- or pancytopenia

In a retrospective study of 44 adults with acquired bi- or pancytopenia without evidence of any causal disorder, the survival curve suggested the existence of a subgroup of short survivors, mainly with aplastic anaemia, with death within 4 months. The initial values of 14 single clinical, blood and bone marrow variables were significantly associated with survival less than 4 months. Stepwise multiple logistic regression analyses identified 2 combinations of variables displaying significant simultaneous associations with short survival: (i) increased % of non-myeloid bone marrow cells and haemorrhagic manifestations initially; (ii) increased % of non-myeloid marrow cells, circulating erythroblasts and no history of any drug exposure. The predictive capacities of a resulting estimate of the probability of short survival and of previously introduced prognostic indices were approximately equal. The frequency of a correct prediction of a survival shorter than 4 months was in the range of 0.71-0.78 and that of longer survival in the range of 0.74-0.94.

The applicability of simple blood and bone marrow variables in prediction of acute leukaemia in patients with acquired bi- or pancytopenia

A retrospective study of 44 patients presenting with acquired bi- or pancytopenia (B/PC) and no evidence of any causal disorder was carried out. 12 patients developed acute non-lymphoblastic leukaemia after 2-51 months. Compared to the nonleukaemic subjects the preleukaemic patients at the onset of B/PC had significantly higher counts of myeloblasts and other myelopoietic cells in the bone marrow, more cellular marrows due to more dense cellularities of all compartments, higher blood granulocyte and monocyte counts, more pronounced anisocytosis, and in some cases a small number of circulating myeloblasts. A stepwise multiple logistic regression analysis identified 3 combinations of variables displaying significant simultaneous association with subsequent leukaemic transformation. Among these the combination of marrow myeloblast percentage and blood granulocyte count might be applicable to early prospective identification of patients with preleukaemic B/PC.