Effectiveness of patient education as a stand-alone intervention for patients with chronic widespread pain and fibromyalgia: a systematic review and meta-analysis of randomized trials

OBJECTIVE

Patient education is recommended as an integral component of the therapeutic plan for the management of chronic widespread pain (CWP) and fibromyalgia (FM). The key purpose of patient education is to increase the patient's competence to manage his or her own health requirements, encouraging self-management and a return to desired everyday activities and lifestyle. The aim of this systematic review was to evaluate the evidence for the benefits and potential harms associated with the use of patient education as a stand-alone intervention for individuals with CWP and FM through randomized controlled trials (RCTs).

METHOD

On 24 November 2021 a systematic search of PubMed, MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, ClinicalTrials.gov, American College of Rheumatology, European League Against Rheumatism, and the World Health Organization International Clinical Trials Registry Platform identified 2069 studies. After full-text screening, five RCT studies were found to be eligible for the qualitative evidence synthesis.

RESULTS

Patient education as a stand-alone intervention presented an improvement in patients' global assessment (standardized mean difference 0.79, 95% confidence interval 0.13 to 1.46). When comparing patient education with usual care, no intervention, or waiting list, no differences were found for functioning, level of pain, emotional distress in regard to anxiety and depression, or pain cognition.

CONCLUSION

This review reveals the need for RCTs investigating patient education as a stand-alone intervention for patients with FM, measuring outcomes such as disease acceptance, health-related quality of life, enhancement of patients' knowledge of pain, pain coping skills, and evaluation of prioritized learning outcomes.

Echolocation click parameters of short-finned pilot whales (Globicephala macrorhynchus) in the wild

Short-finned pilot whales (Globicephala macrorhynchus) are large, deep-diving predators with diverse foraging strategies, but little is known about their echolocation. To quantify the source properties of short-finned pilot whale clicks, we made 15 deployments off the coast of Tenerife of a deep-water hydrophone array consisting of seven autonomous time-synced hydrophone recorders (SoundTraps), enabling acoustic localization and quantification of click source parameters. Of 8185 recorded pilot whale clicks, 47 were classified as being recorded on-axis, with a mean peak-to-peak source level (SL) of 181 ± 7 dB re 1 μPa, a centroid frequency of 40 ± 4 kHz, and a duration of 57 ± 23 μs. A fit to a piston model yielded an estimated half-power (-3 dB) beam width of 13.7° [95% confidence interval (CI) 13.2°-14.5°] and a mean directivity index (DI) of 22.6 dB (95% CI 22.5-22.9 dB). These measured SLs and DIs are surprisingly low for a deep-diving toothed whale, suggesting we sampled the short-finned pilot whales in a context with little need for operating a long-range biosonar. The substantial spectral overlap with beaked whale clicks emitted in similar deep-water habitats implies that pilot whale clicks may constitute a common source of false detections in beaked whale passive acoustic monitoring efforts.

Contribution of individual broilers to variation in amino acid digestibility in soybean meal and the efficacy of an exogenous monocomponent protease

A total of 72 male Ross 308 broilers were reared to day 34 on a standard wheat and soy-based diet and then offered one of the four semisynthetic experimental diets, comprising two different soybean meal sources either without or with exogenous protease (treatments therefore offered in a 2*2 factorial arrangement). Each experimental diet was fed to 18 individually housed birds from 34 to 37 D after which ileal digesta were collected and digestibility coefficients were calculated. The two soybean meal sources were found to be nutritionally divergent (P < 0.01), with one having the apparent ileal amino acid digestibility coefficient of 0.80 and the other 0.71. Exogenous protease increased (P < 0.01) apparent ileal amino acid digestibility coefficients from 0.74 to 0.77. There were no interactions between soybean meal origin and protease effect. On an individual bird level, there were substantial differences in the capacity to digest amino acids with the mean total amino acid digestibility coefficients from 0.54 to 0.80 for one of the soybean meal samples. Exogenous protease addition reduced the coefficient of variation for total amino acids from 11.4 to 9.1% in one soybean meal and from 7.7 to 6.3% in the other. It can be concluded that soybean meal digestibility varies and that some of this variance is associated with heterogeneity in the digestive capacity of broilers.

Xylanase increased the ileal digestibility of nonstarch polysaccharides and concentration of low molecular weight nondigestible carbohydrates in pigs fed high levels of wheat distillers dried grains with solubles

The objective was to study the effect of a commercially available xylanase (CAX), an experimental xylanase (EX), and EX in combination with protease (EXP) on the degradation of nondigestible carbohydrates (NDC) and apparent ileal digestibility (AID) of nutrients in wheat distillers dried grains with solubles (wDDGS). The control and 3 enzyme diets contained 96% wDDGS supplemented with vitamins, minerals, L-lysine, and chromic oxide as a digestibility marker in addition to enzyme premix. Eight ileal cannulated pigs were fed 4 experimental diets containing 96% wDDGS-a control diet or 1 of 3 diets with CAX, EX, or EXP-in a double 4 × 4 Latin square design. The experimental period lasted 7 d; adaptation lasted 4 d, and the ileal digesta were collected for 8 h on d 5 and 7, when spot samples of feces were also collected. Digesta samples were analyzed for NDC, total and soluble nonstarch polysaccharides (NSP), low molecular weight (LMW) NDC, OM, CP, fat, starch, and marker. Compared with the control diet, addition of CAX, EX, and EXP increased the AID of arabinoxylan by 32 (P < 0.001), 28 (P = 0.001), and 24% (P = 0.004), respectively. In addition, EXP increased the AID of noncellulosic polysaccharide glucose by 21% compared with the control (P = 0.005). Compared with the control, addition of EX, EXP, and CAX decreased the concentration of soluble arabinoxylan in ileal digesta by 40 (P < 0.0001), 40 (P < 0.0001), and 21% (P = 0.022), respectively. Furthermore, addition of CAX, EXP, and EX increased the concentration of LMW arabinoxylan in ileal digesta by 40 (P = 0.0001), 36 (P = 0.0006), and 24% (P = 0.023), respectively, compared with the control. Addition of EX and EXP decreased the concentration of soluble NSP of ileal digesta by 25 (P = 0.001) and 26% (P < 0.001), respectively, compared with the control diet. Addition of CAX (P < 0.0001) and EXP (P = 0.013) increased the arabinose-to-xylose ratio in the insoluble arabinoxylan fraction in ileal digesta compared with the control diet, and CAX increased the uronic acid-to-xylose ratio of the ileal insoluble NSP fraction (P < 0.0001) compared with the control diet. Enzyme addition did not affect AID of OM, CP, starch, and fat (P > 0.3). In conclusion, addition of xylanases to wDDGS diets increased the ileal digestibility of NSP and generated LMW NDC components in the small intestine of pigs but did not affect ileal digestibility of nutrients in the current study.

Normative values of eccentric hip abduction strength in novice runners: an equation adjusting for age and gender

PURPOSE

Low eccentric strength of the hip abductors, might increase the risk of patellofemoral pain syndrome and iliotibial band syndrome in runners. No normative values for maximal eccentric hip abduction strength have been established. Therefore the purpose of this study was to establish normative values of maximal eccentric hip abduction strength in novice runners.

METHODS

Novice healthy runners (n = 831) were recruited through advertisements at a hospital and a university. Maximal eccentric hip abduction strength was measured with a hand-held dynamometer. The demographic variables associated with maximal eccentric hip abduction strength from a univariate analysis were included in a multivariate linear regression model. Based on the results from the regression model, a regression equation for normative hip abduction strength is presented.

RESULTS

A SIGNIFICANT DIFFERENCE IN MAXIMAL ECCENTRIC HIP ABDUCTION STRENGTH WAS FOUND BETWEEN MALES AND FEMALES: 1.62 ± 0.38 Nm/kg (SD) for males versus 1.41 ± 0.33 Nm/kg (SD) for females (p < 0.001). Age was associated with maximal eccentric hip abduction strength: per one year increase in age a -0.0045 ± 0.0013 Nm/kg (SD) decrease in strength was found, p < 0.001. Normative values were identified using a regression equation adjusting for age and gender. Based on this, the equation to calculate normative values for relative eccentric hip abduction strength became: (1.600 + (age * -0.005) + (gender (1 = male / 0 = female) * 0.215) ± 1 or 2 * 0.354) Nm/kg.

CONCLUSION

Normative values for maximal eccentric hip abduction strength in novice runners can be calculated by taking into account the differences in strength across genders and the decline in strength that occurs with increasing age. Age and gender were associated with maximal eccentric hip abduction strength in novice runners, and these variables should be taken into account when evaluating eccentric hip abduction strength in this group of athletes.

LEVEL OF EVIDENCE

2A.

Vitamin D insufficiency in Greenlanders on a westernized fare: ethnic differences in calcitropic hormones between Greenlanders and Danes

We studied the influence of age, gender, latitude, season, diet and ethnicity on plasma 25-hydroxyvitamin D 25 OHD, PTH, 1,25-dihydroxyvitamin D, vitamin D-binding protein, bone-specific alkaline phosphatase, and osteocalcin levels in 46 Greenlanders living in Nuuk (64 degrees N) on a traditional fare (group A), 45 Greenlanders living in Nuuk on a westernized fare (group B), 54 Greenlanders (group C), and 43 Danes (Group D) living in Denmark (55 degrees N) on a westernized fare. Blood specimens were drawn both summer and winter. Vitamin D insufficiency (plasma 25 OHD <40 nmol/l) was common in all four study groups during summer (23-74%) and winter (42-81%). Compared to groups A and D, vitamin D insufficiency was significantly more frequent in groups B and C. In all groups, summer levels of 25 OHD were above winter levels. Multiple regression analysis revealed a significant effect of ethnicity. Compared to Danes, Greenlanders had higher 1,25-dihydroxyvitamin D levels, but lower 25 OHD and PTH levels despite relatively low plasma calcium concentrations. In addition to ethnicity, 25(OH)D levels were influenced by age, season (summer > winter), and diet (a traditional Inuit diet>westernized diet). Ethnic differences exist between Greenlanders and Danes. Our results suggest that Greenlanders may have an inherent lower "set-point" for calcium-regulated PTH release or an enhanced renal 1,25(OH)(2)D production. In addition to ethnicity, age, season, and diet were important determinants of vitamin D status. Changes from a traditional to a westernized fare are associated with a reduced vitamin D status in Greenlanders. Vitamin D supplementation should be considered.

Twenty-four-hour blood pressure among Greenlanders and Danes: relationship to diet and lifestyle

BACKGROUND

Greenlanders have a lower rate of cardiovascular mortality and morbidity than Danes, possibly due to lower blood pressure. However, 24-h blood pressure has never been measured in Greenlanders. The aim of this study was to compare the 24-h blood pressure of Greenlanders and Danes, and to analyse the influence of Arctic food and lifestyle on blood pressure.

METHODS

Four groups of healthy subjects were recruited for the study. Group I: Danes in Denmark consuming European food; group II: Greenlanders in Denmark consuming European food; group III: Greenlanders in Greenland consuming mainly European food; and group IV: Greenlanders in Greenland consuming mainly traditional Greenlandic food. All subjects underwent a physical examination, laboratory screening of blood and urine samples, and completed a questionnaire on diet, physical activity, smoking status, intake of alcohol, liquorices, vitamins and minerals. Twenty-four-hour blood pressure was measured.

RESULTS

It was found that 24-h diastolic blood pressure was lower in Greenlanders than in Danes for the whole 24-h period and during both day and night-time, whereas systolic blood pressure was the same (mean 24-h blood pressure with 95% CI: Danes 123/75 mmHg (120/73-127/77), Greenlanders 122/ 69 (119/68-124/70)). Among Greenlanders, blood pressure increased with age and male gender, and systolic blood pressure increased with body mass index (BMI). No association with diet was found. The difference between the two populations persisted after controlling for age, gender, BMI, outdoor temperature, and lifestyle factors.

CONCLUSION

Greenlanders have a lower 24-h diastolic blood pressure than Danes, and it is suggested that genetic factors are mainly responsible for the lower blood pressure level among Greenlanders.

Lactate dehydrogenase has no control on lactate production but has a strong negative control on formate production in Lactococcus lactis

A series of mutant strains of Lactococcus lactis were constructed with lactate dehydrogenase (LDH) activities ranging from below 1% to 133% of the wild-type activity level. The mutants with 59% to 133% of lactate dehydrogenase activity had growth rates similar to the wild-type and showed a homolactic pattern of fermentation. Only after lactate dehydrogenase activity was reduced ninefold compared to the wild-type was the growth rate significantly affected, and the ldh mutants started to produce mixed-acid products (formate, acetate, and ethanol in addition to lactate). Flux control coefficients were determined and it was found that lactate dehydrogenase exerted virtually no control on the glycolytic flux at the wild-type enzyme level and also not on the flux catalyzed by the enzyme itself, i.e. on the lactate production. As expected, the flux towards the mixed-acid products was strongly enhanced in the strain deleted for lactate dehydrogenase. What is more surprising is that the enzyme had a strong negative control ( CLDHJF1 =-1.3) on the flux to formate at the wild-type level of lactate dehydrogenase. Furthermore, we showed that L. lactis has limited excess of capacity of lactate dehydrogenase, only 70% more than needed to catalyze the lactate flux in the wild-type cells.

Toxicity and bioaccumulation of copper to black bindweed (Fallopia convolvulus) in relation to bioavailability and the age of soil contamination

The use of ecotoxicity test results obtained in the laboratory for prediction of effects of potentially toxic concentrations of chemicals in the field is hampered by several factors differing between the laboratory and the field situations. One important factor is the binding of test chemicals to soil, which is affected by the age of the contamination and soil type. The present study investigated the effect of contamination age by introducing an aging period of 1 to 12 weeks between mixing the test substance, copper sulfate, in with soil and introducing the test plant, Fallopia convolvulus (L.) A. Löve. Copper accumulation, emergence of cotyledons, and growth were assessed and related to total (boiling with HNO(3)) and 0.01 M CaCl(2)- and DTPA-extractable soil copper concentrations. Aging of the copper-contaminated soil had only small effects on bioaccumulation of copper, copper toxicity, and extractable soil copper fractions. Soil copper had no effect on emergence of cotyledons. Estimated EC(50) values for shoot and root growth averaged 280 mg Cu/kg. Effects on growth in these laboratory-treated soils were much more severe than in a study performed in soil from an old copper-contaminated field site. Neither CaCl(2)- nor DTPA-extractable copper fractions could explain all of the differences in effects between aged spiked soil and field soil. The accumulation pattern for roots and shoots of F. convolvulus indicated that excessive copper was accumulated and adsorbed mainly by the fine roots, whereby the copper concentrations of other plant parts were kept low until the plant was no longer able to maintain this regulation. An internal threshold for effects on growth of about 20 mg Cu/kg shoot dry weight was estimated, coinciding with a soil copper concentration of approximately 200 mg/kg.

Mercury accumulations in brains from populations exposed to high and low dietary levels of methyl mercury. Concentration, chemical form and distribution of mercury in brain samples from autopsies

Autopsy samples from 17 Greenlanders and 12 Danes were analysed for total and organic mercury by atomic absorption spectrophotometry, and for cellular localisation by autometallography. The concentration of total mercury in the Greenlanders (median: 174 micrograms Hg/kg wet weight brain tissue, range 59-4782, highest in cerebellum: 492) was found to be significantly higher than in the Danish group (3.7 micrograms Hg/kg w.w., range 1.2-11.8). Furthermore, the total concentration of mercury was positively correlated to age (rho = 0.56, p < 0.05), and the fraction of methyl mercury was negatively correlated to age (rho = -0.66, p < 0.01) among the Greenlanders. This suggests an age dependent accumulation of total mercury and a slow transformation of methyl mercury to inorganic mercury in the brain. The autometallographically demonstrable mercury was primarily located in glia cells.

Effects of soil copper on black bindweed (Fallopia convolvulus) in the laboratory and in the field

The present study aims to identify factors of importance to the extrapolation from laboratory toxicity test to field effects using copper and black bindweed as a model. In the laboratory the influence of Cu on seed germination and seedling survival was studied in both soil spiked with Cu in the laboratory and soil collected at a Cu-polluted site. Maternal effects were also studied. We found that seeds from Cu-stressed plants germinated more readily after a short, cold storage than control seeds, but no differences were found after a longer storage. The low germination of control seeds compared to maternal treated seeds could not be attributed to differences in thickness of the seed coat. Germination was slightly stimulated at 232 mg Cu kg-1. At the highest Cu level (i.e. 1,330 mg Cu kg-1) only 5% of the seeds germinated. Mortality of the seedlings increased with increasing Cu concentration reaching 40% at 391 mg Cu kg-1. At higher concentrations mortality decreased. Germination was not affected in laboratory tests with soil from a Cu-polluted site, but the biomass of the plants decreased with increasing Cu concentration. The distribution of the plants on a Cu-polluted site was registered in relation to soil Cu concentration. Cu was analyzed using three different extractors, i.e. HNO3, CaCl2, and DTPA. The distribution of the plant in the field was predicted from calculated lifetime effect of a given Cu soil concentration based on the laboratory tests. The results revealed that growth is more sensitive in the field than should be expected from laboratory tests due to several stressors in the former situation. Bioavailability was lower in the field soil but this was counteracted by the increased effect. Incorporating bioavailability in the prediction of field effects thus reduced the fit of the model and bioavailability measures could not be further evaluated.

Structure and genetic stability of mitochondrial genomes vary among yeasts of the genus Saccharomyces

Several yeast species/isolates belonging to the genus Saccharomyces were examined for the organization of their mtDNAs and ability to generate petite mutants. A general characteristic for all of the mtDNAs tested was that they were very A+T-rich. However, restriction patterns and inducibility of petite mutations revealed a great diversity in the organization and genetic behaviour of mtDNAs. One group of yeasts, Saccharomyces sensu stricto, contains mtDNA ranging in size from 64 to 85 kb. mtDNAs form these yeasts contain a high number of restriction sites that are recognized by the enzymes Haelll and Mspl, which cut specifically in G+C clusters. There are three to nine ori/rep sequences per genome. These yeasts spontaneously generate respiration deficient mutants. Ethidium bromide (Et-Br), at low concentrations, induces a majority of cells to give rise to petites. A second group of yeasts, Saccharomyces sensu lato, contains smaller mtDNAs, ranging in size from 23 to 48 kb, and probably only a few intergenic G+C clusters and no ori/rep sequences. These yeasts also generate petite clones spontaneously. but Et-Br, even when present at high concentrations, does not substantially increase the frequency of petites. In most petite clones from these yeasts only a small fragment of the wild-type molecule is retained and apparently multiplied. A third group, represented by Saccharomyces kluyveri, does not give rise to petite mutants either spontaneously or after induction.

Saccharomyces carlsbergensis contains two functional genes encoding the acyl-CoA binding protein, one similar to the ACB1 gene from S. cerevisiae and one identical to the ACB1 gene from S. monacensis

Saccharomyces carlsbergensis is an amphiploid, and it has previously been suggested that the genomes of S. carlsbergensis originate from S. cerevisiae and S. monacensis. We have cloned the ACB1 genes encoding the acyl-CoA binding protein (ACBP) from S. carlsbergensis, S. cerevisiae and S. monacensis. Two genes were found in S. carlsbergensis and named ACB1 type 1 and type 2, respectively. The type 1 gene is identical to the S. cerevisiae ACB1 gene except for three substitutions, one single base pair deletion and one double base pair insertion, all located in the promoter region. The type 2 gene is completely identical to the S. monacensis ACB1 gene. These findings substantiate the notion that S. carlsbergensis is a hybrid between S. cerevisiae and S. monacensis. Both ACB1 type 1 and type 2 are actively transcribed in S. carlsbergensis and transcription is initiated at sites identical to those used for transcriptional initiation of the ACB1 genes in S. cerevisiae and S. monacensis, respectively. Two polyadenylation sites, spaced 225 bp apart, are present in the S. cerevisiae ACB1 gene. The upstream polyadenylation site is used exclusively during exponential growth, whereas both sites are utilized during later stages of growth.

Ecological effects assessment of industrial sludge for microarthropods and decomposition in a spruce plantation

Effects of dried, granulated industrial sludge-containing residues of organic pesticides and precursors were assessed for microarthropod fauna and the decomposition of a spruce forest floor. The investigation was highly realistic, using large plots of about 1/2 ha, and the application was done with professional equipment. The ecological effects of the sludge were compared with the ecological effects of an inorganic fertilizer. Decreases in abundance of the microarthropods ranged from 20 to 80% of the control level after 1 year. Isotoma notabilis Schäffer was the only species that exhibited stimulation at twice the control level due to the sludge. The least affected collembolan species was Lepidocyrtus cyaneus Tullberg, a member of the surface-dwelling life forms. Sensitive species were Isotoma anglicana Lubbock and Isotomiella minor Schäffer. In subhabitats with almost no application of sludge due to a heterogeneous horizontal distribution, the microarthropods were still affected to the same degree as those in the zones of maximum application. Laboratory tests with Folsomia candida Willem gave results similar to the effects on field populations concerning the sludge but revealed no adverse effects of the fertilizer. Decomposition was stimulated to the same extent in the field by the two types of fertilizer but in the laboratory the sludge caused the largest stimulation. The effects on the microarthropod fauna are suggested to be the result of a combination of direct toxicity and changes in the microbial community due to fertilizers.

A mitochondrial molecular marker, ori-rep-tra, for differentiation of yeast species

Yeasts exhibit various mechanisms for the inheritance of their mitochondrial genomes. Differences among these mechanisms are based on variations within nuclear as well as mitochondrial genetic elements. Here we report diagnostic differences in the presence of biologically active mitochondrial intergenic sequences, ori-reptra, among related yeasts in the genera Saccharomyces, Arxiozyma, Debaryomyces, Kluyveromyces, Pachytichospora, Torulaspora, and Zygosaccharomyces. A molecular probe containing ori-rep-tra can be employed specifically for the differentiation and identification of isolates belonging to the species complex Saccharomyces sensu stricto.

A national cross-sectional study in the Danish wood and furniture industry on working postures and manual materials handling

Musculoskeletal disorders constitute a major problem in the wood and furniture industry and identification of risk factors is needed urgently. Therefore, exposures to different work tasks and variation in the job were recorded based on an observation survey in combination with an interview among 281 employees working in wood working and painting departments. A questionnaire survey confirmed high frequencies of symptoms from the musculoskeletal system: The one-year prevalence of symptoms from the low back was 42% and symptoms from the neck/shoulder was 40%. The exposure was evaluated based on: (1) classification of work tasks, (2) work cycle time, (3) manual materials handling, (4) working postures, and (5) variation in the job. Among the employees 47% performed feeding or clearing of machines, 35% performed wood working or painting materials, and 18% performed various other operations. Among the employees 20% had no variation in their job while 44% had little variation. Manual materials handling of 375 different burdens was observed, which most often occurred during feeding or clearing of machines. The weight of burdens lifted was 0.5-87.0 kg, where 2% had a weight of more than 50 kg. Among the lifting conditions 30% were evaluated as implying a risk of injury. An additional risk factor was the high total tonnage lifted per day, which was estimated to range from 132 kg to 58,800 kg. Working postures implied a risk of injury due to prolonged forward and lateral flexions of the neck, which was seen most frequently during wood working or painting materials. These data substantiate the finding that work tasks mainly during feeding or clearing of machines imply a risk of injury to the low back and a risk of injury to the neck and shoulder area mainly during wood working or painting materials. Optimal strategies for job redesign may be worked out by using these data in order to prevent occupational musculoskeletal disorders.

The dominant mutation Suppressor of black indicates that de novo pyrimidine biosynthesis is involved in the Drosophila tan pigmentation pathway

A deficiency in the production of beta-alanine causes the black (b) phenotype of Drosophila melanogaster. This phenotype is normalized by a semi-dominant mutant gene Su(b) shown previously to be located adjacent to or within the rudimentary (r) locus. The r gene codes for three enzyme activities involved in de novo pyrimidine biosynthesis. Pyrimidines are known to give rise to beta-alanine. However, until recently it has been unclear whether de novo pyrimidine biosynthesis is directly coupled to beta-alanine synthesis during the tanning process. In this report we show that flies carrying Su(b) can exhibit an additional phenotype, resistance to toxic pyrimidine analogs (5-fluorouracil, 6-azathymine and 6-azauracil). Our interpretation of this observation is that the pyrimidine pool is elevated in the mutant flies. However, enzyme assays indicate that r enzyme activities are not increased in Su(b) flies. Genetic mapping of the Su(b) gene now places the mutation within the r gene, possibly in the carbamyl phosphate synthetase (CPSase) domain. The kinetics of CPSase activity in crude extracts has been studied in the presence of uridine triphosphate (UTP). While CPSase from wild-type flies was strongly inhibited by the end-product, UTP, CPSase from Su(b) was inhibited to a lesser extent. We propose that diminished end-product inhibition of de novo pyrimidine biosynthesis in Su(b) flies increases available pyrimidine and consequently the beta-alanine pool. Normalization of the black phenotype results.

Long-term psychosocial adjustment in patients with severe burn injuries: a follow-up study

An investigation of the long-term psychosocial adjustment of patients with severe burn injuries is presented. In the selected 13-year period (1968-80) 46 patients fulfilled the entry criteria: burns covering more than 30 per cent body surface area (deep dermal or full skin thickness). Seventeen patients died early and one later. Of the remaining 28 patients, contact was made with 25 (89.3 per cent) who all participated. The observation time ranged between 7 and 21 years. The patients received a semi-standardized interview adjusted for age at the time of burn injury, a psychiatric interview and a physical examination to assess the permanent character and functional loss. The principal findings were: no correlation could be found between degree of disfiguration/function loss and the long-term psychosocial adaptation after severe burn injuries. The determinant factor was the premorbid psychiatric/psychological integration and, to some extent, support from staff and relatives.

The cerebral arterio-venous oxygen content differences (AVDO2) during halothane and neurolept anaesthesia in patients subjected to craniotomy

In 20 patients subjected to craniotomy for supratentorial cerebral tumours, the haemodynamic changes during halothane and neurolept anaesthesia were evaluated by measuring mean arterial blood pressure (MABP) and cerebral arterio-venous oxygen content differences (AVDO2) repeatedly during the operation. Ten patients were given 0.5% halothane anaesthesia and ten patients neurolept anaesthesia. MABP, AVDO2 and PaCO2 were measured after induction of anaesthesia, before and after incision, after opening and closure of the dura, at the time of extubation and 1 h later. Concerning MABP and PaCO2, no significant difference between the two groups was found. In both groups an increase in MABP was observed after incision (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group) and in the neurolept group after extubation (P less than 0.01). In both groups a decrease in AVDO2 was observed after incision (P less than 0.01) and after extubation (P less than 0.01 in the neurolept group and P less than 0.05 in the halothane group). During the operation AVDO2 values were significantly higher in the neurolept group (P less than 0.05). The results indicate that even a moderate increase in MABP after incision during neuroanaesthesia affects AVDO2 values, suggesting an increase in cerebral blood flow. The study suggests that autoregulation of cerebral blood flow might be better preserved during neurolept anaesthesia. A state of hyperperfusion of the brain after extubation was unveiled in both groups.

[Persons aged 65 years and over admitted to the medical department of a hospital in the Danish provinces with 4 specialized departments. An analysis of extra days of hospitalization related to the services for senior citizens in 4 communities]

In a retrospective investigation of year 1985, it was found that out of 438 medical patients greater than or equal to 65 years there were in all 42 patients who together were responsible for 1,543 bed-days after the time when they were considered to have concluded hospital treatment. The extra bed-days correspond to approximately 9% of the total medical bed capacity. The patients came from four communities whose coverage with nursing homes, home nursing services and home help arrangements were very different. It was found that increase in nursing home capacity was followed by decrease in the number of extra bed-days among the patients who had extra bed-days. When the number of home nurses increased, fewer elderly patients from the community concerned, were admitted who ended by having extra long hospitalization. These conditions are discussed and the results are compared with previously published investigations. It is concluded that improved cooperation between communities and hospitals, is required.

Cerebral blood flow, cerebral metabolic rate of oxygen and relative CO2 reactivity during neurolept anaesthesia in patients subjected to craniotomy for supratentorial cerebral tumours

In 10 patients subjected to craniotomy for supratentorial cerebral tumours in neurolept anaesthesia, cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured twice peroperatively by a modification of the Kety & Schmidt technique, using 133Xe. The relative CO2 reactivity was assessed indirectly as the % change of the arteriovenous oxygen difference (AVDO2) per mm change in PaCO2. The patients were premedicated with diazepam 10-15 mg perorally. For induction, thiopentone 4-6 mg/kg, droperidol 0.2 mg/kg and fentanyl 5 micrograms/kg were used, and for maintenance N2O 67% and fentanyl 4 micrograms/kg/h. During the first flow measurement the median and range of CBF was 30 ml/100 g/min (range 17-45), of AVDO2 8.0 vol % (range 4.1-9.5), and of CMRO2 2.28 ml O2/100 g/min (range 1.57-2.84). During the second CBF study, AVDO2 increased to 9.3 vol % (range 3.4-11) (P less than 0.05), and CMRO2 increased to 2.51 ml O2/100 g/min (range 1.88-3.00) P less than 0.05, while CBF was unchanged. The CO2 reactivity was present in all studies, median 1.8%/mmHg (range 0.5-15.1). The correlation coefficients between jugular venous oxygen tension/saturation, respectively, and CBF were high at tensions/saturations exceeding 4.0 kPa and 55%, indicating that hyperperfusion is easily unveiled by venous samples from the jugular vein during this anaesthesia.

DNA sequence polymorphisms in the genus Saccharomyces. V. Cloning and characterization of a LEU2 gene from S. carlsbergensis

Saccharomyces carlsbergensis strains used in the production of lager beer are structurally heterozygous in most genetic loci studied to date. Previous studies have shown that the genotype of lager yeast contains two types of genomes, one of which is derived from S. cerevisiae and the other reveals similarities to the genomes of S. bayanus and S. monacensis. Genes of homeologous chromosomes can be distinguished by characteristic restriction fragment patterns. This is true also for the LEU2 genes which encode the beta-isopropylmalate dehydrogenase and are located on chromosomes III. In the present work a LEU2 gene from S. carlsbergensis has been cloned and characterized. The cloned 2.6 kb LEU2 region complements the S. cerevisiae leu2-3 leu2-112 double mutation. The restriction endonuclease site map of the isolated S. carlsbergensis LEU2 gene is different from that of the S. cerevisiae LEU2 gene. Electrophoretic chromosome separation, as well as karl mediated transfer of single chromosomes into S. cerevisiae strains, has shown that the S. carlsbergensis specific LEU2 gene is located on a chromosome III which carries the carlsbergensis specific HIS4 gene. The cloned LEU2 gene shows preferential molecular hybridization to one of the two LEU2 structural alleles present in lager strains, an allele which is also present in type strains of S. bayanus, S. carlsbergensis, S. monacensis and S. uvarum.

Accidental death in fermentation tanks: report of two cases

Two cases of accidental drowning in fermentation tanks are described. During the fermentation different toxic gases are generated among which carbon dioxide is supposed to be most dangerous since it is colourless and odourless. Special problems concerning fermentation of slurry are pointed out and precaution during work with these tanks is recommended.