Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial

BACKGROUND

Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known.

OBJECTIVE

This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI).

STUDY DESIGN

Of the 161 eligible children at SRT study-end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut-off ≥7) and uroflowmetry, at five (T2) and ten years (T3) after study-end. T1 was the SRT study-end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores.

RESULTS

BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p = 0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p = 0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p = 0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups.

DISCUSSION

The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort.

CONCLUSION

In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.

Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants

INTRODUCTION

Urinary tract infection (UTI) is a common disease in infants. The initial evaluation includes imaging to identify risk factors for permanent renal damage, such as malformation and renal parenchymal involvement of the infection i.e. pyelonephritis. 99mTc-Dimercaptosuccinic acid (DMSA) scintigraphy is a well-established method for detection of pyelonephritis and renal damage, but has limitations in availability, spatial resolution, and detection of congenital malformations. Diffusion weighted magnetic resonance imaging (DWI) has been shown to have a high sensitivity for detection of pyelonephritis in children without the use of invasive procedures, contrast agents or ionizing radiation. How this method performs in young infants during non-sedated free breathing remains, however, to be investigated.

OBJECTIVE

To prospectively assess the feasibility and performance of DWI for detection of pyelonephritis in non-sedated free breathing infants.

METHODS

32 children <6 months of age with first-time symptomatic UTI were examined with DWI and DMSA scintigraphy. The DWI examination was performed using a free breathing protocol without the use of sedation. Pyelonephritic lesions were registered for both methods by independent observers. Agreement between DWI and DMSA was evaluated. Consensus diagnosis was determined and compared to the DWI findings.

RESULTS

The MRI and DMSA examinations were completed in 25 infants, with a median age of 1.7 (0.7-5.5) months. Focal uptake reductions were detected on the DMSA images in 12 (24%) of the 50 kidneys. The DWI method demonstrated a fair to good agreement with DMSA, k = 0.50 (p < 0.0001). The consensus diagnosis was pyelonephritis in eight (16%) of the 50 kidneys. DWI detected seven of the eight kidneys with pyelonephritis. No false positive findings were detected with DWI compared to consensus diagnosis.

DISCUSSION

This study has shown an agreement between DWI and DMSA scintigraphy in the detection of pyelonephritis. Further validation of the performance of DWI, using a consensus diagnosis as a reference, confirmed the potential of the method. This feasibility study included a limited number of patients and the results need to be confirmed in a prospective study of a larger cohort.

CONCLUSION

Free breathing DWI is a promising method for detection of pyelonephritic lesions in non-sedated infants.

Renal swelling indicates renal damage in infants with their first urinary tract infection

AIM

We used ultrasound to evaluate renal swelling as a predictor of acute and permanent renal damage in infants with their first urinary tract infection (UTI).

METHODS

The cohort at the Queen Silvia Children's Hospital, Gothenburg, Sweden, comprised 101 infants with their first UTI at a mean age of 3.9 ± 3.0 months. Acute and follow-up ultrasounds were carried out a few days and one month after treatment started, and a ^99m technetium dimercaptosuccinic acid (DMSA) scan was carried out after one month and after a year if the first scan was abnormal.

RESULTS

The acute ultrasounds showed that renal length and volume, calculated as standard deviation scores (SDS), were 1.39 ± 1.43 SDS and 1.30 ± 1.08 SDS. We found that 52% of the one-month DMSA scans and 25% of the one-year DMSA scans were abnormal. Renal length (p = 0.0026) and initial volume (p = 0.0005) on the ultrasound predicted acute renal damage at the one-month DMSA scan and initial renal length (p = 0.030) predicted permanent renal damage at the one-year DMSA scan.

CONCLUSION

Renal swelling was associated with renal damage. Although the diagnostic performance compared with the DMSA scan was weak, renal swelling may help clinicians to make decisions about further investigations and follow-ups of infants with UTIs.

Ultrasound is an effective and noninvasive method of evaluating renal swelling in infants with their first urinary tract infection

AIM

This study evaluated renal swelling in infants with a first urinary tract infection (UTI) by correlating renal length and volume with C-reactive protein (CRP) and body temperature.

METHODS

Ultrasounds were carried out on 104 infants at The Queen Silvia Children's Hospital, Gothenburg, Sweden - 58 boys (mean age 3.3 months) and 46 girls (mean age 4.8 months) - during the acute phase of their UTI. A second scan was performed on 94 of them 4 weeks later. Renal length and volume were computed to standard deviation scores (SDS).

RESULTS

The mean renal length and volume at the first ultrasound were 1.90 SDS (±1.54) and 1.67 SDS (±1.13) for the larger kidney and 0.86 SDS (±1.01) and 0.84 SDS (±0.90) for the smaller kidney. There was a significant decrease in renal length and volume between the two ultrasounds, with a mean difference of 0.96 SDS (±1.24) and 1.07 SDS (±1.10) for the larger kidney (p < 0.0001). The length and volume of the larger kidney correlated with CRP (p < 0.001), but only the renal length correlated with fever (p < 0.001).

CONCLUSION

Early ultrasound determined renal swelling in infants with a UTI and may be a valuable noninvasive way of identifying infants with renal parenchymal involvement.

Feeding range of age 1+ year Eurasian perch Perca fluviatilis in the Baltic Sea

Using the widespread Eurasian perch Perca fluviatilis as a model organism, feeding ranges were investigated using stable-isotope ratios (δ¹⁵ N and δ¹³ C) and body condition. Differences were found between closely located sampling sites in a littoral area without obvious migration barriers, indicating that individual fish had small feeding ranges. Body condition differences between sampled stations were consistent over 4 years. Such sedentary behaviour is important to consider in, e.g. fisheries management and environmental monitoring, as local catch regulations may be meaningful or geographic stability in sampling locations may reduce noise in data.

Successful treatment of severe ABO antibody-mediated rejection using bortezomib: a case report

BACKGROUND

Our program for ABO-incompatible renal transplantation includes antigen-specific immunoadsorption (extracorporeal columns with the A or B trisaccharides), rituximab, and standard maintenance immunosuppression. Anti-A or -B titers ≤ 8 in the indirect antiglobulin test (IAT) against panel A1 or B RBC are acceptable for transplantation.

CASE REPORT

A previously healthy, 15-month-old girl was diagnosed with Wilms' tumor and proteinuria. Denys-Drash syndrome was confirmed. Bilateral nephrectomy was performed. At 3.5 years of age she received an ABO-incompatible renal transplant from her father (A1 to O). The anti-A titers before transplantation were low. She was treated preoperatively with rituximab, immunoadsorption, immunoglobulin and mycophenolate mofetil (MMF). The maintenance immunosuppression protocol included basiliximab, tacrolimus, MMF, and prednisolone. The initial postoperative course was uncomplicated with rapid normalization of serum creatinine. The anti-A titers started to increase on postoperative day 5 (8 NaCl/16 IAT). Despite daily immunoadsorptions the titers rose to 1024 NaCl/1024 IAT on day 9. Renal function deteriorated and hemodialysis was started. A renal biopsy on day 9 showed acute severe antibody-mediated rejection. Additional treatment with bortezomib was given and after 2 doses the titers started to decline, renal allograft function improved and hemodialysis was stopped. On day 21 posttransplant the titers went down, creatinine was 28 μmol/L, and no more immunoadsorptions were performed.

CONCLUSION

By using bortezomib, we were able to successfully reverse a severe ABO antibody-mediated rejection.

Foraging, bioenergetic and predation constraints on diel vertical migration: field observations and modelling of reverse migration by young-of-the-year herring Clupea harengus

Diel vertical migration (DVM) of young-of-the-year (YOY) herring Clupea harengus and one of their major predators, pikeperch Sander lucioperca, was examined using bottom-mounted hydroacoustics in Himmerfjärden, a brackish bay of the Baltic Sea, in summer. In contrast to previous studies on DVM of C. harengus aggregated across size and age classes, YOY C. harengus showed a reverse DVM trajectory, deeper at night and, on average, shallower during the day. This pattern was observed consistently on five acoustic sampling occasions in 3 years and was corroborated by two out of three trawl surveys. Large acoustic targets (target strength >-33 dB, probably piscivorous S. lucioperca >45 cm) showed a classic DVM trajectory, shallow at night and deeper during the day. Variability in YOY C. harengus vertical distribution peaked at dawn and dusk, and their vertical distribution at midday was distinctly bimodal. This reverse DVM pattern was consistent with bioenergetic model predictions for YOY C. harengus which have rapid gut evacuation rates and do not feed at night. Reverse DVM also resulted in low spatial overlap with predators.

Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden

The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.

Effects of the swimbladder parasite Anguillicola crassus on the migration of European silver eels Anguilla anguilla in the Baltic Sea

In a mark-recapture study in 2006, migrating European Anguilla anguilla silver eels were caught, tagged and released in the Baltic Sea and recaptures in commercial pound nets examined for possible effects on migration of infection with the swimbladder parasite Anguillicola crassus. The overall recapture rate was 36%. The prevalence of infection was lowest at the northernmost sampling site. There were no significant differences between infected and uninfected A. anguilla in condition indices, body fat content and estimated migration speeds. Parasite infection intensity levels were significantly negatively correlated with times and distances covered between release and recapture, but did not correlate with migration speed. It appears that more heavily infected A. anguilla were relatively more vulnerable to recapture in pound nets. It is hypothesized that parasite-induced damage to the swimbladder inhibited vertical migrations and infected A. anguilla tended to migrate in shallower coastal waters, relatively close to the shore.

The influence of age on the distribution of morphine and morphine-3-glucuronide across the blood-brain barrier in sheep

BACKGROUND AND PURPOSE

The effect of age on the distribution of morphine and morphine-3-glucuronide (M3G) across the blood-brain barrier (BBB) was studied in a sheep model utilizing intracerebral microdialysis. The effect of neonatal asphyxia on brain drug distribution was also studied.

EXPERIMENTAL APPROACH

Microdialysis probes were inserted into the cortex, striatum and blood of 11 lambs (127 gestation days) and six ewes. Morphine, 1 mg x kg(-1), was intravenously administered as a 10 min constant infusion. Microdialysis and blood samples were collected for up to 360 min and analysed using liquid chromatography-tandem mass spectrometry. The half-life, clearance, volume of distribution, unbound drug brain : blood distribution ratio (K(p,uu)) and unbound drug volume of distribution in brain (V(u,brain)) were estimated.

KEY RESULTS

Morphine K(p,uu) was 1.19 and 1.89 for the sheep and premature lambs, respectively, indicating that active influx into the brain decreases with age. Induced asphyxia did not affect transport of morphine or M3G across the BBB. Morphine V(u,brain) measurements were higher in sheep than in premature lambs. The M3G K(p,uu) values were 0.27 and 0.17 in sheep and premature lambs, indicating a net efflux from the brain in both groups.

CONCLUSIONS AND IMPLICATIONS

The morphine K(p,uu) was above unity, indicating active transport into the brain; influx was significantly higher in premature lambs than in adult sheep. These results in sheep differ from those in humans, rats, mice and pigs where a net efflux of morphine from the brain is observed.

Differential effects of the N-methyl-d-aspartate receptor antagonist MK-801 on different stages of object recognition memory in mice

The aim of the present study was to evaluate the effects of systemic administration of the N-methyl-d-aspartate (NMDA) receptor antagonist MK-801 on different stages of non-spatial object recognition memory processing in mice. To this end we used the object recognition test, where the animal is tested for its ability to discriminate between an old, familiar, and a novel object. MK-801 (0.1 or 0.2 mg/kg) or saline was administered 1) 30 min before or 2) directly after the first, introductory, session or 3) 30 min before the recognition session. Memory retention was evaluated 1.5 h after the introductory session. MK-801 appeared to decrease memory retention when given prior to the introductory session, but not when given directly after the introductory session or before the recognition session, where MK-801 instead induced an increased interest for the novel object. These results suggest that activation of NMDA receptors is a requisite for encoding of recognition memory in mice but not for consolidation and retrieval processes. The increased interest for the novel object showing up when MK-801 was given directly after the introductory session or before the recognition session may reflect a facilitation of retention. Alternatively, the phencyclidine-like, psychotogenic properties of MK-801 could result in an amplification of the perceived salience of the novel object, and/or anxiolytic mechanisms could result in neophilic effects.

Endometrial expression of the estrogen-sensitive genes MMP-26 and TIMP-4 is altered by a substitution protocol without down-regulation in IVF patients

BACKGROUND

The aim of this study was to analyse the effects of an estradiol (E(2))-progesterone substitution protocol on the endometrial expression of estrogen-sensitive genes during the peri-implantation period.

METHODS

Peripheral blood and endometrial biopsies were obtained from 13 infertile women both in a natural cycle (NC), on days 5 and 7 after ovulation (NC5, NC7), and in an artificial (substituted) cycle (AC), on days 5 and 7 of progesterone addition (AC5, AC7). Estrogen receptor-alpha (ERalpha) and progesterone receptor (PR) were assayed by immunohistochemistry. Matrix metalloproteinase-26 (MMP-26) mRNA and tissue inhibitor of metalloproteinase-4 (TIMP-4) mRNA were semiquantitatively assessed in tissue sections using in situ hybridization (ISH) and quantified in tissue extracts using real-time PCR.

RESULTS

Levels of both E(2) and progesterone were higher in the peripheral blood in AC than in NC. Also on day AC5, expressions of ERalpha, PR and MMP-26 mRNA (focally) were increased in the epithelium and TIMP-4 mRNA in the stroma. Expression levels of these genes dropped significantly between AC5 and AC7, but not between NC5 and NC7. Abnormally high levels in AC5 samples suggest overstimulation with E(2), and the rapid decrease between AC5 and AC7 suggests overstimulation with progesterone.

CONCLUSIONS

In ACs, increased levels of E(2) in the blood exaggerate the endometrial expression of estrogen-sensitive genes, whereas higher levels of progesterone in the blood in the secretory phase exaggerate the drop in expression of these genes. Dramatic variations in the gene expression may not be optimal for the implantation process.

Early Recurrence of Nephrotic Syndrome (Immunoglobulin M Nephropathy) After Renal Transplantation Successfully Treated With Combinations of Plasma Exchanges, Immunoglobulin, and Rituximab

In contrast to focal segmental glomerulosclerosis, which is well known to recur early in a renal graft, there are only few cases described with recurrence of immunoglobulin M (IgM) nephropathy after transplantation. We herein describe a patient with early recurrence of IgM nephropathy. A 15-year-old boy with nephrotic syndrome (IgM nephropathy) proceeding to end-stage renal disease was on dialysis before living related renal transplantation. Native kidneys were not removed. Standard immunosuppression including steroids, tacrolimus, and mycophenolate mofetil yielded initially good graft function with the s-creatinine falling to 73 micromol/L. Proteinuria was present on day 1, increasing to 20 g/L after 3 days. S-creatinine increased to 158 micromol/L and urine production diminished. A graft biopsy showed no rejection or glomerulopathy but protein vacuoles were seen within tubular cells indicating massive proteinuria. Treatment with plasma exchanges, immunoglobulin, and steroids was started. Hemodialysis was necessary. Proteinuria improved to 3.5 g/L, but s-creatinine continued to rise and a second graft biopsy showed vascular rejection (Banff type IIA). The patient was treated with antithymocyte globulin and further plasma exchanges. A single dose of rituximab was given. Five months after transplantation the s-creatinine was 67 micromol/L and there was no proteinuria. In this case early recurrence of nephrotic syndrome occurred on the first posttransplant day in combination with later occurring vascular rejection. Successful treatment included a combination of plasma exchanges, rituximab, immunoglobulin, and antithymocyte globulin.

Endometrial TIMP-4 mRNA is expressed in the stroma, while TIMP-4 protein accumulates in the epithelium and is released to the uterine fluid

We have previously reported that endometrial mRNA expression of both tissue inhibitors of metalloproteinase-4 (TIMP-4) and matrix metalloproteinase-26 (MMP-26) peaks in the early secretory phase, which implies a role in implantation. The objective of this study was to compare the distribution of TIMP-4 and MMP-26 in endometrial tissue and uterine fluid over the menstrual cycle. Endometrial tissue was analysed with in situ hybridization and immunohistochemistry to localize mRNA and protein for TIMP-4 and MMP-26 in the same set of samples. TIMP-4 mRNA was quantified in separated stromal and epithelial cells using real-time PCR. Uterine fluid was analysed with western blotting. TIMP-4 mRNA was exclusively localized to the stroma, whereas MMP-26 mRNA was expressed by epithelial cells. TIMP-4 protein was only occasionally found in the stroma but was consistently present in granules of the apical part of luminal and glandular epithelial cells. TIMP-4, but not MMP-26, was demonstrated in uterine fluid. Thus, TIMP-4 is produced in the stroma only, secreted by stromal cells, taken up by epithelial cells, accumulated in apical granules and finally secreted to the uterine fluid. Maximal expression of MMP-26, and its strongest inhibitor TIMP-4, in the early and mid-secretory phase suggests a role during implantation. MMP-26 is stored in epithelial cells in its active form, is not released spontaneously and is controlled by TIMP-4 in both stroma and uterine fluid.

Transplanted children's experiences of daily living: children's narratives about their lives following transplantation

Transplantation is often an appropriate choice of treatment for children with end-stage renal, liver, heart or lung disease. Over the last decade, mortality and morbidity figures have been relatively stable and quality of life fairly good in children who have undergone organ transplantation. Few studies however, have focused on the experiences of transplantation from the child's perspective. The child's view is an important factor when evaluating the 'true' outcome and quality of life after transplantation. The aim of the present study was to illuminate the meaning of transplanted children's experiences of daily living. Unstructured interviews were carried out with 18 children and adolescents, aged 4-18 yr, who had undergone organ transplantation. Their narratives were transcribed and interpreted using a phenomenologic-hermeneutic method inspired by the philosophy of Ricoeur. Two main themes emerged: Being satisfied with life, with the themes: being able to live a normal life; someone who cares; coping with one's new life; and being dissatisfied with life, with the themes: not being able to live a normal life; lacking someone who cares; not being respected; existential thoughts. Most of the children and adolescents were of the opinion that they lived a normal life while the rest strived to achieve a normal life. Social support and mental support were of great importance and, when lacking, had negative consequences. Multi-disciplinary co-operation between healthcare professionals and between the healthcare system, the school and the family is crucial in order to optimize the outcome and quality of life after organ transplantation in children.

The effect of limited lateral resolution in the measurement of implant surface roughness: A computer simulation

The surface roughness of dental implants affects the bone response elicited. Surface roughness is generally described by a range of surface texture parameters. The aim of the present study was to use computerized simulation to investigate the extent to which the lateral resolution of an instrument/method limits the accuracy of certain surface roughness parameters. The lateral resolution was defined as the pixel size of a profiling system. A surface roughness was simulated by a trigonometric function with random periodicity and amplitude. The function was divided into an array of pixels simulating the pixels of the profiling system. The mean height value for each pixel was used to calculate the surface roughness parameters. It was found that the accuracy of all the surface roughness parameters investigated decreased with increasing pixel size. This tendency was most pronounced for mean slope and developed length ratio; amounting to about 80% of their true values for a pixel size of 20% of the true mean high-spot spacing. It was concluded that the lateral resolution of an instrument/method severely compromises the precision of surface roughness parameters measured for roughness features with a mean high-spot spacing less than five times the lateral resolution.

[MMP-26 expression in endometrial explants treated with estradiol and progesterone]

OBJECTIVE

To examine possible estrogen dependent endometrial expression of MMP-26 in vitro.

DESIGN

Experimental study.

SETTING

Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden.

METHODS

We studied MMP-26 mRNA in 14 normal endometrial samples obtained from the proliferative phase of the menstrual cycle. Samples were cultured for five days either with estradiol alone or in combination with progesterone. Samples cultured with ethanol represented control groups. MMP-26 mRNA expression was examined in frozen samples using in situ hybridization. Immunohistochemistry was used to study the presence of estrogen and progesterone receptors in endometrial explants.

RESULTS

MMP-26 mRNA expression was highest in fresh (non cultured) samples. Signal intensity decreased during the first two days of culture and was negligable in the following days. Nuclear intensity for estrogen and progesterone receptor was high after five days of culture.

CONCLUSION

We did not find MMP-26 mRNA in vitro expression to be directly estrogen dependent.

Matrix metalloproteinase-26 (matrilysin-2) expression is high in endometrial hyperplasia and decreases with loss of histological differentiation in endometrial cancer

OBJECTIVE

Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Recently, MMP-26 (endometase), a novel matrilysin-type member of the MMP family, was cloned from an endometrial tumor. This study examines the expression of MMP-26 mRNA in hyperplastic, premalignant and malignant endometrial samples, and compares with normal endometrial tissue.

METHODS

Endometrial carcinoma samples (19) were histologically classified as well, intermediately and poorly differentiated. Samples with hyperplasia (n = 15) were classified as simple, complex, or complex with atypia. Normal endometrial specimens (n = 39) were classified according to an ideal 28-day menstrual cycle and subsequently grouped in the early, middle, and late parts of the cycle. All samples were analyzed using in situ hybridization and real time PCR. The probes used for in situ hybridization and real time PCR recognized non-overlapping sequences. MMP-26 protein was localized by immunohistochemistry.

RESULTS

MMP-26 mRNA was exclusively localized in the epithelial component of normal, hyperplastic, premalignant, as well as malignant samples. It was not found in the stroma of any tissue category. Quantifications with real time PCR as well as semi-quantifications of the in situ hybridization signal revealed maximal levels in normal tissue at midcycle and in endometrial hyperplasia both with and without atypia. The amount of MMP-26 mRNA decreased progressively with loss of histological differentiation in malignant samples. Immunostaining localized MMP-26 in epithelial glandular and luminal cells, in vessel walls, and in tumor cells. Since the pattern of MMP-26 expression mimicked that of ER-alpha, we searched the MMP-26 promoter region for a potential estrogen response element (ERE). A sequence at position -130 to -116 had high homology to the consensus sequence of an ERE. Based on these observations, we suggest that ER-alpha is involved in regulation of the MMP-26 gene.

CONCLUSIONS

MMP-26 mRNA is selectively localized in the epithelial compartment of normal, hyperplastic, and malignant endometrial tissue. Expression is high in normal and hyperplastic endometria, but is downregulated in the late part of the cycle and in malignant tumors. The expression pattern of MMP-26 mRNA mimics that of ER-alpha, and the promoter region of the MMP-26 gene has a potential ERE.

Endometrial TIMP-4 mRNA is high at midcycle and in hyperplasia, but down-regulated in malignant tumours. Coordinated expression with MMP-26

We have previously reported that endometrial expression of matrix metalloproteinase (MMP)-26 mRNA comes to a maximum in the early secretory phase. Since tissue inhibitor of metalloproteinase (TIMP)-4 is a potent inhibitor of MMP-26, the objective of this study was to identify the pattern of TIMP-4 mRNA expression in the normal endometrial cycle. We also evaluated hyperplastic, pre-malignant (atypical hyperplasia) and malignant endometrial tissue. Endometrial TIMP-4 mRNA was localized in tissue sections using in situ hybridization, and quantified in tissue extracts using real-time PCR. Estrogen receptor alpha (ERalpha) was assayed in the same set of samples using immunohistochemistry. In situ hybridization demonstrated TIMP-4 mRNA in the stroma of both normal and pathological tissues. TIMP-4 mRNA increased in the proliferative phase to a maximum in the early secretory phase, and then decreased in the late part of the cycle. Expression was comparable in normal and hyperplastic (including atypical) endometrial samples, whereas lower levels were detected in malignant tumours. Since this general pattern of expression suggests estrogen dependence, we evaluated ERalpha in our samples. Tissue sections from the normal proliferative phase, hyperplasia and pre-malignant atypical hyperplasia tissue stained strongly for ERalpha, whereas weak staining was seen in the secretory phase and in malignant tumours. Thus, low level of ERalpha was accompanied by down-regulated TIMP-4 mRNA, supporting the hypothesis that ERalpha contributes to regulation of the TIMP-4 gene. In addition, we identified a putative estrogen response element (ERE) in the promoter region of the TIMP-4 gene at position -930 to -916. Similarities in the cyclic patterns of TIMP-4 mRNA and MMP-26 mRNA, together with the fact that TIMP-4 is a potent inhibitor of MMP-26, suggest a functional relationship, and furthermore a role in human implantation.

[Novel matrix metalloproteinases in cycling endometrium]

OBJECTIVE

To examine the expression pattern of some novel matrix metalloproteinases (MMPs) in cycling endometrium.

DESIGN

Experimental study.

SETTING

Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden.

METHODS

We studied MMP-12, -16, -17, -19 and -26 mRNA in 39 normal endometrial samples obtained across the menstrual cycle. Based on histological examination, all specimens were classified according to an ideal 28 day menstrual cycle as early (n=8), mid (n=6) and late (n=7) proliferative phase, early (n=4), mid (n=4) and late (n=8) secretory phase and menstrual (n=3) phase. Cycle variation was examined in frozen samples using in situ hybridization.

RESULTS

Three distinct pattern of MMP mRNA expression were detected in cycling endometrium. MMP-12 was expressed predominantly in perimenstrual period, MMP-16, -17 and 19 were expressed throughout the cycle and MMP-26 was found to be maximal in periovulatory period.

CONCLUSION

Different endometrial expression patterns of novel MMPs during menstrual cycle may indicate their specific roles for menstruation, endometrial growth and remodelling and implantation.

Protective effect of breastfeeding against urinary tract infection

AIM

To assess the possible protective effect of exclusive breastfeeding against first-time febrile urinary tract infection (UTI) in children.

METHODS

Two children's hospitals and local child health centres in the Göteborg area, Sweden, participated in a prospective case-control study. In total, 200 consecutive cases (89M, 111F), aged 0-6y, presenting with first-time febrile UTI were enrolled. The mean +/- SD age was 0.98 +/- 1.15 y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure.

RESULTS

Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long-term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated.

CONCLUSION

A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.

Management of children with dilating vesico-ureteric reflux in Sweden

AIM

To evaluate the management and outcome of children with dilating vesico-ureteric reflux diagnosed before 2 y of age.

METHODS

This retrospective, multicentre study was part of a programme for quality assurance in Sweden. A total of 2309 unselected children, aged 0-2 y, were investigated after the first urinary tract infection. Voiding cystourethrography was performed in a total of 1953 children, of whom 584 had reflux. Of these children, 303 (119 boys and 184 girls) had reflux with dilatation (grade 3-5).

RESULTS

Follow-up after 4-6 y was reported in 272 of the 303 children. Spontaneous regression of dilating reflux occurred in more than half of the patients and was significantly more frequent in boys than in girls (p = 0.047). In children with grade 3 reflux and grade 4-5 reflux, there were pyelonephritic recurrences in 18% and 45% of the boys and 28% and 70% of the girls, respectively (p < 0.001). One hundred and eighty-one children (65%) were managed conservatively, 58 (21%) were treated with subureteric injection and 33 (12%) with ureteric reimplantation. There were considerable differences in treatment strategies between centres.

CONCLUSION

This study of an unselected cohort of children with urinary tract infection and dilating reflux showed spontaneous resolution of dilating reflux in more than half of the subjects and more often in boys than in girls. Pyelonephritic recurrences were more common in girls than in boys, and more frequent in grade 4-5 reflux than in grade 3. The results indicate important differences between the sexes and that boys and girls should be assessed separately when treatment strategies are studied.

The implant thread as a retention element in cortical bone: the effect of thread size and thread profile: a finite element study

Assuming that high stress peaks in the bone can trigger bone resorption a screw-shaped bone implant should be given such a design that the peak stresses arising in the bone, as a result of a certain load, are minimized. Using idealized assumptions the aim of the study was to analyse the effect of variations of the size and the profile of the thread of an axially loaded, screw-shaped, bone implant upon the magnitude of the stress peaks in cortical bone. The investigation was performed by means of axisymmetric finite element analysis. It was found that the shape of the thread profile has a profound effect upon the magnitude of the stresses in the bone and that very small threads of a favourable profile can be quite effective.

Differential neurochemical properties of central serotonergic transmission in Roman high- and low-avoidance rats

The selective breeding of Roman high- (RHA/Verh) and low-avoidance (RLA/Verh) rats for rapid versus poor acquisition of active avoidant behaviour has produced two behavioural phenotypes with different performances in a variety of animal models of anxiety, in which RLA/Verh rats are consistently more fearful than RHA/Verh rats. In addition, these two lines display different functional properties of brain neurotransmitters like serotonin (5-HT), known to be involved in the expression of anxiety- and depression-related behaviours. Therefore, we used brain microdialysis and [3H]-citalopram binding autoradiography to characterize further the neurochemical properties of 5-HTergic transmission in the two lines. No significant line-related differences were detected in the basal 5-HT output in the frontoparietal cortex (FPCx). In contrast, the increase in the cortical 5-HT output elicited by the systemic administration or the local application, via reverse dialysis, of chlorimipramine and fluoxetine was more robust in RHA/Verh than in RLA/Verh rats. Moreover, the binding signal of [3H]-citalopram to 5-HT re-uptake sites was more intense in the FPCx of RHA/Verh rats than in their RLA/Verh counterparts. These findings suggest that the functional tone of the 5-HTergic projection to the FPCx is stronger in the RHA/Verh line relative to the RLA/Verh line. It is proposed that RLA/Verh rats may be used as a model with heuristic value for studying the role of 5-HTergic transmission in anxiety and in the anxiolytic effects of monoamine re-uptake inhibitors.

Epithelial expression of matrix metalloproteinase-26 is elevated at mid-cycle in the human endometrium

The human endometrium is a dynamic tissue, which undergoes extensive tissue remodelling during the menstrual cycle. Due to their involvement in such processes, several well-characterized matrix metalloproteinases (MMP) have previously been studied in the endometrium. MMP-26 is a newly described matrilysin. We studied MMP-26 mRNA in 39 normal endometrial samples obtained across the menstrual cycle. Tissue distribution and cycle variation was examined using in-situ hybridization, Northern blot analyis and real time PCR. The probes for Northern blot analysis and real time PCR recognized non-overlapping sequences. MMP-26 was localized exclusively in epithelial cells of both glands and the luminal surface. Expression increased during the proliferative phase to a maximum at mid-cycle, then decreased to non-detectable levels in the late secretory and menstrual phases. Expression of MMP-26 mRNA in endometrial tissue explants in vitro required stimulation with both estradiol and progesterone. The tissue content of c-jun mRNA was assayed, since c-jun, as part of the enhancer complex AP-1, may be involved in regulation of MMP-26 gene transcription. The pattern of c-jun expression over the menstrual cycle was similar to that of MMP-26. Epithelial expression in the peri- and post-ovulatory stages of the menstrual cycle suggests the involvement of MMP-26 in reproductive processes.

Antibiotic treatment for five days is effective in children with acute cystitis

Short courses of antibiotics are often recommended to treat children with acute cystitis despite lack of firm evidence to support such management. The aim of this study therefore was to analyse the short-term outcome of such treatment. The retrospective analysis included 300 children (252F, 48M) fulfilling the criteria of first-time acute cystitis and managed according to a protocol recommending 5 d treatment. In 214 (71%) the treatment was given according to the protocol and in the others for 7 or 10 d. Nitrofurantoin was used in 150 (50%) and trimethoprim without or with sulfonamide in 129 (43%). The short-term results were excellent with 96% of the children being free from symptoms at the first follow-up visit after a median of 6 d. Only 2 girls had persisting bacteriuria and thus the frequency of bacteriological treatment failure was 1%. Recurrence within 30 d occurred in 4 girls (2%).

CONCLUSION

A 5 d treatment with antibiotics is adequate in children with acute cystitis. Routine follow-up visits after a first acute cystitis may not be necessary, providing that the bacteria causing the infection are sensitive to the prescribed antibiotic and that there is no history of defective bladder or bowel emptying.

Surface roughness parameters as predictors of anchorage strength in bone: a critical analysis

The surface roughness of a bone implant was defined parametrically. The values of the parameters defining the surface were varied. Some traditionally used surface roughness parameters were calculated. By means of a theoretical model the bone-implant interfacial shear strength was estimated. No simple correlation between the values of the surface roughness parameters and the estimated interfacial shear strength was found. It was concluded that the value of the traditional surface roughness parameters as predictors of interfacial shear strength is limited. If however a change of the surface topography of an implant is restricted to scale a positive correlation was found between the theoretical interfacial shear strength and some surface roughness parameters. It is suggested that the bone-implant interfacial shear strength in the general case be estimated by means of strength analyses based upon a study of the size, shape and density of the individual elements constituting the rough surface.

Detection of urographic scars in girls with pyelonephritis followed for 13-38 years

We report the detection and progression of renal scars in girls prospectively followed from their first recognized urinary tract infection. There were 107 infection-prone subjects with a median age of 7.1 years at the first and 21.7 years at the last urography. Of 51 females who ultimately had lesions, 38 had established scars at the first urography. In 18 subjects, new scars were found in previously undamaged kidneys, 5 already with unilateral scarring. There had been a normal urography after the 5th birthday in 8 of those with later scarring. Worsening of scarring was seen in 10 of the 38 subjects with established scars. The renal damage was in most cases slight or moderate. By stepwise logistic regression analysis, grade of reflux and number of pyelonephritic attacks correlated with scarring, and number of pyelonephritic attacks with new scars and worsening of the lesions. In summary, of the females who ultimately had renal lesions, one-third developed new scars. In most of those with established scars at the first urography, the focal character of lesions suggests that most were also acquired. Since reflux and number of pyelonephritic attacks were identified as risk factors, prevention of renal deterioration should be possible.

Ambulatory blood pressure 16-26 years after the first urinary tract infection in childhood

OBJECTIVE

To evaluate blood pressure in a population-based cohort with urographic renal scarring after childhood urinary tract infection.

DESIGN

Follow-up investigation 16-26 years after the first recognized urinary tract infection.

SETTING

University out-patient clinic for children with urinary infections serving the local area.

PATIENTS

From the original cohort of 1221 consecutive children with first urinary tract infection diagnosed during 1970-1979, 57 of 68 with non-obstructive renal scarring participated as well as 51 matched subjects without scarring.

MAIN OUTCOME MEASURE

24 h ambulatory blood pressure.

RESULTS

Acceptable blood pressure monitorings were obtained from 53 individuals with and 47 without scarring. There were no significant differences between the two groups even when only patients with the most extensive scarring (individual kidney clearance < 30 ml/min per 1.73 m2) or patients with bilateral scarring were compared with the non-scarring group. Mean systolic or diastolic blood pressure above +2 SD were found in 5/53 (9%) and 3/47 (6%) in the scarring and non-scarring group, respectively. Plasma renin activity, angiotensin II and aldosterone concentrations were not significantly different, but atrial natriuretic protein was significantly higher in the scarring group (P = 0.004).

CONCLUSION

This study demonstrates a low risk of hypertension two decades after childhood urinary tract infection. It should be stressed that the patients with renal scarring were under close supervision throughout childhood. Those with scarring had higher concentrations of atrial natriuretic protein which might indicate a counter-regulation mechanism.

Renal function 16 to 26 years after the first urinary tract infection in childhood

OBJECTIVE

To evaluate renal function in a population-based cohort with urographic renal scarring after childhood urinary tract infection (UTI).

DESIGN

Follow-up investigation 16 to 26 years after the first recognized UTI.

SETTING

Outpatient university clinic for children with UTI serving the local area.

PATIENTS

From the original cohort of 1221 consecutive children with first UTI diagnosed during 1970 to 1979, 57 (41 females and 16 males; mean age, 24.5 years) of 68 with nonobstructive renal scarring participated as well as 51 (38 females and 13 males; mean age, 24.9 years) matched subjects without scarring.

MAIN OUTCOME MEASURE

Glomerular filtration rate (GFR) measured by chromium 51-EDTA clearance, expressed as milliliters per minute per 1.73 square meters.

RESULTS

Median GFR was 99 in both those with and without renal scarring. In patients with unilateral scarring, the total GFR remained unchanged over the years whereas the individual GFR of the scarred kidneys declined significantly from 46 to 39. In 7 patients with bilateral scarring, the GFR declined from 94 to 84 (P = .14); compared with those with unilateral scarring, the GFR was significantly lower at follow-up (P = .007). Median urinary albumin-creatinine ratio was 1.2 and 0.6 mg/mmol in those with scarring and those without, respectively (P = .30).

CONCLUSIONS

The GFR 2 decades after the first recognized UTI in childhood was well preserved. However, a significant reduction of individual renal GFR in the unilaterally scarred kidneys indicates that further follow-up is required. Although there were few patients with bilateral scarring, a more serious prognosis can be expected among them.

Elemental composition of Mysis mixta (Crustacea, Mysidacea) and energy costs of reproduction and embryogenesis under laboratory conditions

Mysis mixta were reared under laboratory conditions (temperature: 9-10 degrees C; salinity: 7 per thousand, ad libitum food). Dry weight, ash, total carbon and nitrogen content of mysids (muscle tissue, eggs, and embryos of different developmental stages) have been analyzed. We found significant variations in ash content and elemental composition during growth and maturation for both sexes. The proportion of carbon in abdominal muscle decreased gradually from juveniles with body weight of 3-4 mg (42.9%) to males and gravid females ( approximately 40.0%). The nitrogen content was relatively constant (11.4% in average) with significant differences only between juveniles (11.3%) and mature females (11.6%). In embryos, carbon and nitrogen content were highest in early stages (58.6 and 14.3%, respectively). By the end of the marsupial development, carbon had decreased to 51.4% and nitrogen to 12.6%. The C:N ratio reflected the change in somatic carbon content, and the ratio decreased 6.2% from juveniles to gravid females, indicating lipids to be an energy source during maturation and reproduction. The weight-specific female investment in reproduction increases with body size. In gravid females, intersegmental growth during brooding period was observed, while males appear to store energy only for copulation and die after mating. Ontogenetic variation in body composition has implications for elemental budgets of M. mixta, its value as prey for fish and in modeling energy and nutrient cycling.

Primary and acquired renal scarring in boys and girls with urinary tract infection

OBJECTIVES

To determine when pyelonephritic renal scarring was detected in children with urinary tract infection (UTI) and characterize those with primary and acquired scarring, respectively.

STUDY DESIGN

A population-based cohort of 1221 children (989 girls and 232 boys) with first recognized symptomatic UTI, aged 0 to 15 years, were diagnosed and followed up prospectively at a single children's hospital; 652 had febrile UTI. Seven hundred fifty-three were evaluated by urography. Renal scarring was classified as primary or acquired, the latter without signs of scarring at the first investigation. To evaluate the frequency of recurrent UTI in those with acquired scarring, a comparison with group-matched children without scarring was performed.

RESULTS

A total of 74 children without obstruction had renal scarring (acquired in 40). Primary scarring was found in 18 of 21 (86%) of the boys and 16 of 53 (30%) of the girls (P <.001). The majority of boys with scarring had dilated reflux (67%) in contrast to girls (23%). Recurrent UTI was rare in boys, whereas girls with acquired scarring had significantly more febrile recurrences than girls without scarring.

CONCLUSIONS

Most boys had primary, probably congenital, reflux-associated renal damage, whereas most girls had acquired scarring related to recurrences of febrile UTI.

Implant-Abutment Interface: Biomechanical Study of Flat Top versus Conical

BACKGROUND

Overloading has been identified as a primary factor behind dental implant failure. The peak bone stresses normally appear in the marginal bone. The anchorage strength is maximized if the implant is given a design that minimizes the peak bone stress caused by a standardized load. Clinical studies have shown that it is possible to obtain a marginal bone level close to the crest of the implant. Different implant systems make use of different designs of the implant-abutment interface. Different implant-abutment interfaces imply that the functional load is distributed in different ways upon the implant. According to Saint-Venant's principle, this will result in different stress patterns in the marginal bone when this reaches levels close to the implant crest.

PURPOSE

One aim of the study was to theoretically investigate if a conical implant-abutment interface gives rise to a changed stress pattern in the marginal bone, as compared to a flat top interface, for an axially loaded mandibular titanium implant, the neck of which is provided with retention elements giving effective interlocking with the bone. Further aims were to investigate if the way in which the axial load is distributed on the flat top and on the inner conus respectively affects the stress pattern in the marginal bone. The pertinent stress was considered to be the bone-implant interfacial shear stress. It was assumed that the marginal bone reached the level of the implant-abutment interface.

METHOD

The investigation was performed by means of axisymmetric finite element analysis.

RESULTS

The conical implant-abutment interface of the type studied brought about a decrease in the peak bone-implant interfacial shear stress as compared to the flat top interface of the type studied. This peak interfacial shear stress was located at the top marginal bone for the flat top implant-abutment interface whereas it was located more apically in the bone for the conical implant-abutment interface. The way in which the axial load was distributed on the flat top and on the inner conus respectively affected the peak interfacial shear stress level.

CONCLUSION

The design of the implant-abutment interface has a profound effect upon the stress state in the marginal bone when this reaches the level of this interface. The implant with the conical interface can theoretically resist a larger axial load than the implant with the flat top interface.

Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux

PURPOSE

We studied the urodynamic pattern in asymptomatic infants who are siblings of children with vesicoureteral reflux.

MATERIALS AND METHODS

Cystometry and perineal electromyography were performed with voiding cystourethrography in 16 male and 21 female infant siblings screened for reflux at age 0.2 to 7.3 months (median 1.1).

RESULTS

Vesicoureteral reflux was present in 25% of the male and 10% of the female infants. In those without vesicoureteral reflux unstable bladder contractions were noted in 8% of the male and 16% of the female subjects. In these infants median maximum voiding detrusor pressure was 127 (range 84 to 211) and 72 cm. water (range 42 to 240), respectively, and median bladder capacity was 20 ml. (range 10 to 49 and 10 to 120, respectively). Maximum voiding detrusor pressure was significantly higher in male than in female infants (p <0.01). Perineal electromyography was interpretable in 13 of the 16 male and 16 of the 21 female infants overall. All but 1 female subject had increased activity during voiding, which was also present intermittently in all subjects.

CONCLUSIONS

Our study of asymptomatic siblings of children with vesicoureteral reflux has provided results that may be used as reference data for normal urodynamics in early infancy. Instability was rare. Bladder capacity was lower than expected with a predicted capacity at birth of approximately 20 ml. Maximum voiding pressure was high, especially in male subjects. The urodynamic voiding pattern suggests physiological dyscoordination, probably due to immature detrusor-sphincter function.

Medical or surgical management for children with vesico-ureteric reflux?

A critical survey of the literature on treatment of children with vesico-ureteric reflux was carried out in order to create a basis for the new Swedish management policy. There are few studies that meet modern standards of scientific methodology and provide adequate patient numbers. The only large investigations that randomized patients to operative or non-operative treatment were the Birmingham Reflux Study and the International Reflux Study in Children. In these studies, long-term outcome of renal status and renal function, as well as the number of recurrent infections, were independent of treatment modality. Although pyelonephritic recurrences were less common in the surgically managed group, this did not influence appearance of renal damage. There is no evidence to indicate clear superiority of either medical or surgical management. Further studies are needed to address such questions as the optimal duration of antibacterial prophylaxis and the effect of a dilating reflux that persists into adulthood.

Vesico-ureteric reflux: occurrence and long-term risks

The prevalence of vesico-ureteric reflux in the general population is unknown, but it is increased in risk groups, such as children with symptomatic urinary tract infection, schoolgirls with asymptomatic bacteriuria, first-degree relatives of patients with reflux and children with prenatal dilatation of their upper urinary tract. Children and adults with pyelonephritic renal scarring are at risk of serious long-term complications, e.g. hypertension and renal failure. Modern paediatric care, with early detection and treatment of urinary tract infections and reflux during childhood and adolescence, may improve long-term prognosis. In the adult patient with established pyelonephritic renal scarring, careful control of hypertension may retard the rate of progression, and angiotensin converting enzyme inhibitors may have renal protective properties.

The implant neck: smooth or provided with retention elements. A biomechanical approach

A combined three-dimensional and axisymmetric finite element analysis was made of the effect upon the peak interfacial shear stress of providing an axially loaded mandibular dental implant with retention elements all the way up to the crest of the implant as opposed to a smooth neck. The effect of increased wall thickness of the implant and of using bi-cortical fixation as opposed to uni-cortical fixation was also studied. Retention elements at the implant neck were found to bring about a major decrease in the peak interfacial shear stress. Increased wall thickness and bi-cortical fixation also resulted in decreased peak interfacial shear stress but this effect was minor. The interpretation of this was that all these three measures increase the capacity of the implant to carry axial loads. Thus from a biomechanical viewpoint it appears to be advantageous to provide the neck of screw-shaped implants with retention elements, for example a rough surface of suitable micro-architecture and/or a micro-thread. It is furthermore suggested that retention elements at the implant neck will counteract marginal bone resorption in accordance with Wolff's law. This paper is a revision of: Hansson, S. (1997) Some steps to improve the capacity of dental implants to resist axial loads. In: Hansson, S., ed. Towards an optimized dental implant and implant bridge design: A biomechanical approach. Thesis. Göteborg: Chalmers University of Technology.

Minimum incidence and diagnostic rate of first urinary tract infection

OBJECTIVE

To study awareness of urinary tract infections (UTIs) by determining the diagnostic rate of first UTI in children <2 years of age and to estimate the minimum incidence.

METHODS

Twenty-six of a total of 43 pediatric centers participated in the study. Sixty-four percent of the total childhood population <2 years of age was covered. The number of all children included in the study was used to calculate the diagnostic rate. Only UTI confirmed by either suprapubic aspiration (any growth) or midstream or bag samples with >/=100 000 bacteria/mL, together with a positive nitrite reaction, was used to estimate the minimum incidence.

RESULTS

The mean diagnostic rate was 1.5% for boys (range, 0.7%-3.0%) and 1.7% for girls (range, 0.7%-2.9%). The diagnostic rate was significantly higher in June than in December. The mean incidence was 1.0% for both boys and girls (range, 0.3%-3.0% and 0.4%-2.9%, respectively). The minimum cumulative incidence at 2 years of age was estimated to be 2.2% for boys and 2.1% for girls.

CONCLUSION

This study suggests a high UTI awareness in Sweden as indicated by a higher diagnostic rate and, despite stricter diagnostic criteria, a higher incidence of UTI in children <2 years of age than previously reported. It is suggested that a high UTI awareness may reduce chronic renal failure because of pyelonephritic renal scarring.

The relation between surface roughness and interfacial shear strength for bone-anchored implants. A mathematical model

A rough bone implant surface was conceptualized as being built up of pits of different sizes and of different shapes. Hypotheses were formulated regarding the mechanical strength of the interfacial bone based upon the present knowledge of the character of the tissues adjacent to endosseous implants and the mechanical characteristics of different bone constituents. A surface roughness parameter was derived, the pit effectivity factor (fpe), which describes how effective the individual pits of the rough surface are as retention elements with regard to shear. Another surface roughness parameter was defined, the pit density factor (fpd), the value of which depends upon how densely packed the pits are. The interfacial shear strength of a rough implant surface with known microgeometry can be estimated by means of these two surface roughness parameters. The effectiveness of pits of different sizes and of different shapes was investigated using this model.

Non-neuronal dopamine in the gastrointestinal system

1. Dopamine (DA) is a protective agent in the gastrointestinal (GI) tract in both rats and humans. Therefore, we have studied the site of DA production in rat and human GI tract using a variety of techniques, including immunocytochemistry (ICC), in situ hybridization histochemistry, reverse transcription-polymerase chain reaction, HPLC, western blotting and immunoelectron microscopy. 2. We found very high concentrations of DA that persisted after chemical sympathectomy (CS) in the gastric juice, the stomach mucosa and in the pancreas. Both the stomach mucosa and the pancreas also had tyrosine hydroxylase (TH) activity, most of which remained after CS. Double-labelling ICC showed that acid-producing parietal cells and the exocrine pancreas must also be capable of producing DA. 3. We isolated rat stomach parietal cells by cell fractionation and found that both DA and TH activity are present in isolated (denervated) parietal cells. These cells also have other features of aminergic cells: they are immuno- (and mRNA) positive for the DA plasma membrane transporter and vesicular monoamine transporter(s). In both gastric and duodenal mucosa, we demonstrated the presence of significant amounts of the D5 receptor that could serve as a target for locally produced DA. 4. Because DA, its biosynthetic enzymes and its transporters are also found in parietal cells in the human stomach, a mucosal protective system involving DA could be important clinically.

Urinary tract infections in children below two years of age: a quality assurance project in Sweden. The Swedish Pediatric Nephrology Association

The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2-y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long-term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.

The association between nerve conduction velocity and the compound action potential amplitude during ischemic blocking

It is not known in detail how the compound sensory nerve action potential amplitude and conduction velocity are associated in nerve ischemia or in other conditions like carpal tunnel syndrome. Ischemia was produced by inflating a tourniquet around the upper arm in five healthy subjects. When median sensory nerve conduction velocities and action potential amplitudes were recorded from the third digit, they decreased in parallel, thereby resembling the blocking process during wrist flexion in healthy subjects. The area under the action potential decreased earlier with longer distances during the ischemic blocking process. A theoretical model is presented in which the area under the compound nerve action potential is determined by the probability for the single fibre action potential to propagate through the internodal distance. This in turn is associated with the internodal conduction time.

High tissue content of urokinase plasminogen activator (u-PA) is associated with high stromal expression of u-PA mRNA in poorly differentiated serous ovarian carcinoma

Urokinase plasminogen activator (u-PA) plays a pivotal role in tissue degradation during tumor spread and metastasis. We have quantitated u-PA in tissue homogenates of 31 serous ovarian tumors and localized u-PA and its mRNA in tissue sections of 26 serous ovarian tumors. The content of u-PA was higher in malignant than in benign tumors, with the highest levels being found in poorly differentiated cancers. In tissue sections, the u-PA mRNA was hybridized with a radiolabeled RNA probe. Signals were almost exclusively found in the epithelium in benign and borderline tumors and in well-differentiated cancers. Poorly differentiated tumors and metastases exhibited prominent stromal expression of u-PA mRNA, whereas epithelial expression was weak or absent. Immuno-histochemical staining co-localized u-PA antigen with its mRNA in the epithelium of benign and borderline tumors and in well-differentiated cancers. Poorly differentiated malignant tumors showed extensive immunostaining in the epithelium in addition to stromal staining. The u-PA mRNA-expressing and u-PA-immunostained cells in the stroma were not tumor cells since no cells in the stroma were positive for cytokeratin. Poorly differentiated tumors had increased numbers of stromal macrophages (CD68), and they co-localized with some of the u-PA-positive cells. The presence of u-PA antigen and the absence of u-PA mRNA in tumor epithelium of poorly differentiated tumors and metastases together with the presence of u-PA mRNA in the stroma suggests production in stromal cells and subsequent binding to receptor sites in tumor cells.