A randomized, triple-blinded controlled clinical study with a novel disease-modifying drug combination in equine lameness-associated osteoarthritis

Objective

This study aimed to test a novel treatment combination (TC) (equivalent to sildenafil, mepivacaine, and glucose) with disease-modifying properties compared to Celestone® bifas® (CB) in a randomized triple-blinded phase III clinical study in horses with mild osteoarthritis (OA). Joint biomarkers (reflecting the articular cartilage and subchondral bone remodelling) and clinical lameness were used as readouts to evaluate the treatment efficacy.

Methods

Twenty horses with OA-associated lameness in the carpal joint were included in the study and received either TC (n = 10) or CB (n = 10) drug intra-articularly-twice in the middle carpal joint with an interval of 2 weeks (visit 1 & 2). Clinical lameness was assessed both objectively (Lameness locator) and subjectively (visually). Synovial fluid and serum were sampled for quantification of the extracellular matrix (ECM) neo-epitope joint biomarkers represented by biglycan (BGN²⁶²) and cartilage oligomeric matrix protein (COMP¹⁵⁶). Another two weeks later clinical lameness was recorded, and serum was collected for biomarkers analysis. The overall health status was compared pre and post-intervention by interviewing the trainer.

Results

Post-intervention, SF BGN²⁶² levels significantly declined in TC (P = 0.002) and COMP¹⁵⁶ levels significantly increased in CB (P = 0.002). The flexion test scores improved in the TC compared to CB (P =0.033) and also had an improved trotting gait quality (P =0.044). No adverse events were reported.

Conclusion

This is the first clinical study presenting companion diagnostics assisting in identifying OA phenotype and evaluating the efficacy and safety of a novel disease-modifying osteoarthritic drug.

Synergies between Fibrillated Nanocellulose and Hot-Pressing of Papers Obtained from High-Yield Pulp

To extend the application of cost-effective high-yield pulps in packaging, strength and barrier properties are improved by advanced-strength additives or by hot-pressing. The aim of this study is to assess the synergic effects between the two approaches by using nanocellulose as a bulk additive, and by hot-pressing technology. Due to the synergic effect, dry strength increases by 118% while individual improvements are 31% by nanocellulose and 92% by hot-pressing. This effect is higher for mechanical fibrillated cellulose. After hot-pressing, all papers retain more than 22% of their dry strength. Hot-pressing greatly increases the paper's ability to withstand compressive forces applied in short periods of time by 84%, with a further 30% increase due to the synergic effect of the fibrillated nanocellulose. Hot-pressing and the fibrillated cellulose greatly decrease air permeability (80% and 68%, respectively) for refining pretreated samples, due to the increased fiber flexibility, which increase up to 90% using the combined effect. The tear index increases with the addition of nanocellulose, but this effect is lost after hot-pressing. In general, fibrillation degree has a small effect which means that low- cost nanocellulose could be used in hot-pressed papers, providing products with a good strength and barrier capacity.

Salivary Biglycan-neo-epitope-BGN262: a novel surrogate biomarker for equine osteoarthritic sub-chondral bone sclerosis and to monitor the effect of short-term training and surface arena

Objective

We aimed to delineate a novel soluble Biglycan Neo-epitope-BGN262 in saliva from young reference and osteoarthritic horses in conjunction with the influence of short-term training exercise, riding surface hardness, circadian rhythm, and feeding on its soluble levels.

Design

A custom-made inhibition ELISA was used for the quantification of BGN262 in saliva. Cohort 1: A cross-sectional study comprising reference (N ​= ​19) and OA horses (N ​= ​9) with radiographically classified subchondral bone sclerosis. Receiver operating characteristic curve analysis was performed to evaluate the robustness of BGN262. Cohorts 2 (N ​= ​5) & 3 (N ​= ​7): Longitudinal studies of sampling during a short-term training exercise (sand-fibre) and a cross-over design of short-training exercise on 2 different riding arenas (sand and sand-fibre), respectively. Capillary western immunoassay was used to determine the BGN262 molecular size in a selection of saliva samples collected from cohort 1.

Results

Cohort 1: Salivary BGN262 levels were significantly higher in the OA group. The Receiver operating characteristic curve analysis showed an area under the curve of 0.8304 [0.6386 to 1.022], indicating a good separation from the reference group. Cohorts 2 & 3: Salivary BGN262 levels significantly changed during the exercise on sand and sand-fibre arena, with a trend towards higher levels for sand-fibre. The size of the BGN262 fragment determined by Capillary western assay was 18 ​kDa.

Conclusions

The data presented show saliva BGN262 levels as a novel biomarker in evaluating the influence of exercise, and interaction with riding arenas alongside assessing osteoarthritis severity.

Nerve growth factor in the equine joint

Nerve growth factor (NGF) is a neurotrophin with many functions. In humans, it is involved in inflammation, nerve growth, apoptosis and pain signalling. Increased concentrations of NGF in synovial fluid has been shown in humans and dogs with osteoarthritis. Despite osteoarthritis being a common problem in horses, no studies have previously been published on NGF in the equine joint. The aim of this study was to quantify NGF in equine synovial fluid from healthy joints, acutely inflamed septic joints and joints with structural changes associated with osteoarthritis. A secondary aim was to identify the localisation of NGF and its two receptors, TrkA and p75^NTR, in healthy and osteoarthritic articular cartilage. NGF concentrations in synovial fluid from osteoarthritic joints (n = 27), septic joints (n = 9) and healthy joints (n = 16) were determined by ELISA. In addition, articular cartilage from osteoarthritic and healthy joints was examined for NGF, TrkA and p75^NTR using immunohistochemistry staining. NGF was present in equine synovial fluid and articular cartilage. Compared to synovial fluid from healthy joints, NGF concentration was higher in synovial fluid from joints with structural osteoarthritic changes (P = 0.032) or acute septic inflammation (P = 0.006). In articular cartilage with severe osteoarthritic changes, there was more abundant positive immunohistochemistry staining for NGF and its receptors than in normal articular cartilage. Further studies should focus on identifying precursor forms of NGF, and on receptor expression and downstream signalling of TrkA and P75^NTR in health and disease.

The sphingosine-1-phosphate receptor S1PR1 restricts sprouting angiogenesis by regulating the interplay between VE-cadherin and VEGFR2

Angiogenesis, the process by which new blood vessels arise from preexisting ones, is critical for embryonic development and is an integral part of many disease processes. Recent studies have provided detailed information on how angiogenic sprouts initiate, elongate, and branch, but less is known about how these processes cease. Here, we show that S1PR1, a receptor for the blood-borne bioactive lipid sphingosine-1-phosphate (S1P), is critical for inhibition of angiogenesis and acquisition of vascular stability. Loss of S1PR1 leads to increased endothelial cell sprouting and the formation of ectopic vessel branches. Conversely, S1PR1 signaling inhibits angiogenic sprouting and enhances cell-to-cell adhesion. This correlates with inhibition of vascular endothelial growth factor-A (VEGF-A)-induced signaling and stabilization of vascular endothelial (VE)-cadherin localization at endothelial junctions. Our data suggest that S1PR1 signaling acts as a vascular-intrinsic stabilization mechanism, protecting developing blood vessels against aberrant angiogenic responses.

Ontogenetic development and spatial distribution of the ileal apical sodium-dependent bile acid transporter and the ileal lipid-binding protein in apoE knockout and C57BL/6 mice

BACKGROUND

Although apoE-/- mice are characterized by hypercholesterolemia, the bile acid enterohepatic circulation, which plays a crucial role in cholesterol homeostasis, has not been examined in these mice. The differences between apoE-/- and C57BL/6 mice in expression of the ileal ASBT and ILBP and in intestinal bile acid absorption were studied.

METHODS

The intestinal tissues of the fetal, neonatal and post-weaning mice were processed for immunohistochemistry. Body retention and fecal excretion of 75SeHCAT were measured. The bile acid pool size and its composition were analysed by HPLC.

RESULTS

In apoE-/- and C57BL/6 mice, the bile acid pool size was 75 +/- 13 and 78 +/- 13 micromol/ 100 g body weight, respectively, while the ratio of cholic acid/beta-muricholic acid was 1.8 +/- 0.3 and 1.4 +/- 0.3 (P < 0.05), respectively. The daily body retention of 75SeHCAT was 48% = 1.8% in C57 black mice and 58.4% +/- 2.7% in apoE-/- mice (P < 0.05). In both mouse strains, ASBT expression in the small intestine was found in the near-term fetal and post-weaning mice, while ILBP expression was found in all postnatal mice. In the post-weaning mice, ILBP expression was limited to the distal 25%-30% of the small intestine, while ASBT expression was limited to the distal 18%.

CONCLUSIONS

The bile acid enterohepatic circulation in apoE-/- mice probably does not differ greatly from that in C57BL/6 mice.

Differences in surface-exposed antigen expression between Helicobacter pylori strains isolated from duodenal ulcer patients and from asymptomatic subjects

We have analyzed possible qualitative and quantitative differences in antigen expression between Helicobacter pylori strains isolated from the antrum and different locations in the duodenum of 21 duodenal ulcer (DU) patients and 20 asymptomatic subjects (AS) by enzyme-linked immunosorbent assay (ELISA) and inhibition ELISA. Almost all antral and duodenal strains grown in vitro expressed the N-acetyl-neuroaminyllactose-binding hemagglutinin, flagellins (subunits FlaA and FlaB), urease, a 26-kDa protein, and a neutrophil-activating protein. In 75% of both the DU patients and the AS, antral H. pylori strains expressed either the blood group antigen Lewis y (Le(y)) alone or together with the Le(x) antigen. However, duodenal H. pylori strains of DU patients expressed Le(y) antigen more frequently than corresponding strains of AS (P < 0.05). Presence of Le(y) on H. pylori was related to the degree of active duodenitis (P < 0.05). Duodenal H. pylori strains isolated from AS were significantly more often Lewis nontypeable than duodenal strains of DU patients (P < 0.01). Presence of H. pylori blood group antigen-binding adhesin (BabA) was significantly higher on both antral and duodenal strains isolated from DU patients than on corresponding strains isolated from AS (P < 0.05). BabA-positive duodenal H. pylori strains isolated from DU patients were associated with active duodenitis more frequently than corresponding strains isolated from AS (P < 0.01). Infection with H. pylori strains positive for Le(y) and BabA in the duodenum is associated with development of duodenal ulcer formation.

A comparative study of two methods for the measurement of alcohol consumption in the general population

BACKGROUND

One of the major methodological problems in measuring alcohol consumption in a general population and in selected groups is underreporting.

METHODS

The present study is based on a general health questionnaire survey of a random sample of about 4000 adults aged 20-74 years in an inner-city area in each of two major Swedish cities in 1991. The questionnaire included items both about alcohol consumption frequency and the usual amount of intake--the commonly used quantity-frequency (QF) method--and other questions about the consumption during work-days and weekends during a 'normal week'--the period-specific normal week (PSNW) method.

RESULTS

With a few exceptions, the reported mean consumption and the proportion of high consumers was higher with the latter approach, irrespective of sex, age, socio-demographic factors, smoking and health status, i.e. for variables which are commonly used as confounders or effect modifiers. The differences between the methods was greater among women. The internal non-response rate was higher with the PSNW method but the non-responders had a comparatively low consumption, when measured with the QF method.

CONCLUSION

The PSNW method has higher validity and greater precision for the measurement of alcohol consumption and, thus, is superior to the QF method. The sex differences are notable and warrant further studies focusing on sex-related modes of answering.

Cerebral dysfunction in fibromyalgia: evidence from regional cerebral blood flow measurements, otoneurological tests and cerebrospinal fluid analysis

Measurements of regional cerebral blood flow (rCBF), analysis of cerebrospinal fluid, auditory brain stem responses (ABR) and oculomotor tests were performed in 19 patients with fibromyalgia. The results from the rCBF measurements showed a normal flow level with slight but significant focal flow decreases in dorsolateral frontal cortical areas of both hemispheres. The ABR results showed signs of dysfunction at least at the brain stem level and the oculomotor tests showed high frequency of pathology. The cerebrospinal fluid analysis showed discrete changes in the cell differential count. Possible explanations for the involvement of the central nervous system in fibromyalgia are discussed.

Isoprenoid modification of proteins distinct from membrane acyl proteins in the prokaryote Acholeplasma laidlawii

Isoprenylation is an important posttranslational modification that affects the activity, subunit interactions and membrane anchoring of different eukaryotic proteins. The small, cell-wall-less prokaryote Acholeplasma laidlawii has more than 20 membrane acyl-proteins enriched in myristoyl and palmitoyl chains. Radioactive mevalonate, a precursor to isoprenoids, was incorporated into several specific membrane proteins of 20 to 45 kDa and two soluble proteins of 23-25 kDa, respectively. No acyl proteins and none of the polar acyl lipids became labelled but these are all labelled by radioactive fatty acids. Mevalonate was incorporated mainly into a minor neutral, non-saponifiable lipid which migrated just above a C30-isoprenoid (squalene) on TLC-plates. The isoprenoid chains could not be released by mild alkaline hydrolysis from most of the isoprenylated proteins, although this procedure releases acyl chains from lipids and all acylated proteins. Isoprenylated proteins were enriched in the detergent phase upon partition with the non-ionic detergent Triton X-114. This behaviour is similar to the acyl proteins of this organism and indicates that the isoprenoid chains give the proteins a hydrophobic character.

Membrane protein acylation. Preference for exogenous myristic acid or endogenous saturated chains in Acholeplasma laidlawii

Mycoplasmas are small bacteria without a cell wall, often found as surface parasites on eukaryotic cells. Of the more than 200 membrane proteins from Acholeplasma laidlawii resolved by two-dimensional PAGE, 23 were covalently modified with acyl chains. These acyl proteins had lower pI values than average and were all labelled by different exogenously supplied radioactive fatty acids attached by O-ester bonds. The fatty acids were selectively incorporated in the order myristic acid (14:0) greater than palmitic acid (16:0) greater than stearic acid (18:0) greater than oleic acid (18:1). However, endogenously synthesised saturated fatty acids, most of which were 16:0, were preferred over the supplied ones. A fraction of the exogenous 14:0 was elongated to 16:0. Absence of saturated fatty acids increased the incorporation of 18:1. The maximum extent of modification was one acyl chain for protein T2, on the exterior surface and two acyl chains for protein D12, spanning them membrane. Exogenously supplied fatty acids were incorporated into membrane lipids in proportion to their occurrence. However, the acylated proteins always contained 8-10 times more saturated chains than did the lipids. When exogenously supplied, all A. laidlawii polar membrane lipids could donate acyl chains to the acylated proteins but the neutral fraction (fatty acids and diacylglycerol) was most efficient. An incorporation into the acylated proteins of labelled cysteine, but not glucose or glycerol, was observed. Acylated proteins with different chains interacted similarly with a Triton X-114 detergent phase, and no full-size proteins (or acylated fragments) were released from cells by proteolytic enzymes. The results indicate an anchoring with peptide segments in addition to the acyl chains. Both 14:0 and 16:0 were attached at one end of both T2 and D12, but the N-terminal methionine of T2 was not acylated. The extent of modification and preference for saturated chains in the A. laidlawii membrane acylated proteins is more similar to eukaryotic than to eubacterial proteins.

Comparison of 30 microgram and 120 microgram gentamicin disks for the prediction of gentamicin resistance in Enterococcus faecalis

Single strain regression analysis was performed on PDM II medium for E. faecalis with 10, 30 and 120 micrograms gentamicin disks using E. faecalis, strain ATCC 29212 as the reference. This method permits the calculation of zone diameters corresponding to different MIC values for different disk contents. The lack of discrimination between normal low-level resistant strains and high-level resistance using the 10 micrograms disk was confirmed. However, both the 30 micrograms and 120 micrograms disks seemed to provide a separation of the normal low-level gentamicin-resistant population from strains with increased resistance. Since the 30 micrograms disk is used routinely in some countries, there should be no need for an extra high content disk in these laboratories. This was confirmed when 96 clinical isolates of E. faecalis were analysed and the results of routine disk diffusion tests were compared with the MIC values. Two of the strains showed high-level gentamicin resistance (greater than 2000 mg/l) and produced no zone of inhibition. The other 94 isolates showed gentamicin MIC values between 4-16 mg/l, and 72 of the MIC results were 8 mg/l. The zone diameters for these strains ranged between 15 and 25 mm with a mean of 18.2 and a median value of 18 mm. In order to include statistical considerations of the zone size populations for setting of breakpoints, a study of gentamicin zone size distributions was performed for several bacterial species. Inhibition zone diameter values around the 30 micrograms gentamicin disk for 2079 clinical isolates of E. faecalis, 2268 S. aureus, 3201 E. coli and 547 strains of P. mirabilis from different years were plotted as histograms. Tests for agreement with a Gaussian distribution showed that the histograms were slightly peaked and skewed towards higher zone values. Parametric and non-parametric statistical tests were compared and the results showed that means and medians were very similar and that parametric fractile estimations at the lower end of the histogram populations were conservative and could be used in view of a slightly lower rate of false resistance. The 1% parametric fractile of 12 mm was selected as a suitable breakpoint for the identification of normal, low-level resistant isolates of E. faecalis using the standardized disk test of the Swedish Reference Group for Antibiotics.

Reproduction and level of intelligence

The study was conducted in a representative Swedish rural-urban population sample of 3,064 persons. The IQ factor was determined directly by a single well established procedure. No systematic association between IQ level and the mean number of children was found.

Septicaemia with coagulase negative staphylococci in a neonatal intensive care unit. Risk factors for infection, and antimicrobial susceptibility of the bacterial strains

Septicaemia caused by coagulase negative staphylococci is a problem in the neonatal intensive care units (NICU). The very low birthweight (VLBW) infants are at a special high risk because of their immature host defense. In this study the potential risk factors were compared between the VLBW septicaemia patients and the VLBW infants who had not contracted septicaemia in the NICU. The factor most clearly related with septicaemia was the use of umbilical artery catheters. The strategy against neonatal septicaemia includes restriction of the use of intravascular catheters. Also enhancement of the host defense by immunoglobulin therapy is considered. The coagulase negative staphylococci were multiresistant to antibiotics. The combination of netilmicin and benzylpenicillin covered the bacteria found in septicaemia cases in the NICU, and is now the standard treatment in suspected cases. Coagulase negative staphylococci are treated with vancomycin or netilmicin.

Topology and acylation of spiralin

Of the 51 polypeptides detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the plasma membrane of the helical mollicute Spiroplasma melliferum, 21 are acylated, predominantly with myristic (14:0) and palmitic (16:0) chains. This is notably the case for spiralin, the major membrane protein of this bacterium, which contains an average of 0.7 acyl chains per polypeptide, attached very probably by ester bonds to alcohol amino acids. The amphiphilicity of spiralin was demonstrated by the behavior of the protein in charge-shift electrophoresis, its incorporation into liposomes, and its ability to form in the absence of lipids and detergents, globular protein micelles (diameter, approximately 15 nm). The presence of epitopes on the two faces of the cell membrane, as probed by antibody adsorption and crossed immunoelectrophoresis, and the strong interaction between spiralin and the intracytoplasmic fibrils show that spiralin is a transmembrane protein. The mean hydropathy of the amino acid composition of spiralin (-0.30) is on the hydrophilic side of the scale. Surprisingly, the water-insoluble core of spiralin micelles, which is the putative membrane anchor, has a still more hydrophilic amino acid composition (mean hydropathy, -0.70) and is enriched in glycine and serine residues. Taking into account all these properties, we propose a topological model for spiralin featuring a transbilayer localization with hydrophilic domains protruding on the two faces of the membrane and connected by a small domain embedded within the apolar region of the lipid bilayer. In this model, the membrane anchoring of the protein is strengthened by a covalently bound acyl chain.

Acoustic neuroma surgery in northern Finland

A series of 40 patients with acoustic neuromas were operated on using the suboccipital or the translabyrinthine approach. Some patients were operated on using both routes. The series extends back to 1977 and contain predominantly large tumours. There was no mortality in the translabyrinthine series of 14 patients. In the suboccipitally treated series of 29 patient, 3 were previously treated using translabyrinthine approach. In this series there was one death directly due to sequelae of neuroma extirpation and in another, additional causes were present. Preoperative facial pareses were frequent. There were several additional pareses in the translabyrinthine series and also several additional in the suboccipital series. Facial pareses were operated on by a plastic surgeon and they did not markedly detract from working capacity. Only 2 patients in the total series had small tumours and useful preoperative hearing. Cochlear function was preserved in them.

Histopathological and immunohistochemical changes in neurosurgically resected epileptic foci

Neurosurgical resection of an epileptic focus was performed in eleven patients suffering from drug resistant focal epilepsy. The clinical result was favourable in nine cases and corresponds to the earlier results. The routinely processed biopsy specimens obtained from the brain resections were stained with haematoxylin-eosin and with specific antisera to GFAP, S-100, NSE, laminin, and fibronectin using the peroxidase-antiperoxidase technique. The main pathological finding was gliosis in eight cases, neuronal degeneration in two cases, and a vascular malformation in one case. The anti-GFAP as a specific marker of astrocytes made the astroglial proliferation clearly visible, demonstrating an astroglial scar in four cases and a moderately to strongly increased amount of astroglial cells in another four cases. Anti-S-100 and anti-fibronectin are not as specific markers. They stained both neurones and glial cells with comparable results to that of anti-GFAP but with a lower specificity and sensitivity. Anti-NSE showed decreased amounts of neurones in most of the heavily gliotic lesions and also stained glial cells in some cases. Anti-laminin stained the pial and vascular basement membranes and revealed an increased vasculature in two cases. From these results, it appears that GFAP immunostaining is a highly demonstrative means for the visualization of astrogliosis in epileptic lesions and may be of help in identifying slight focal changes. An exact demonstration of neuronal loss or other neuronal changes still waits for a more specific marker than NSE. A favourable clinical outcome after neurosurgery seems to be associated with the patients showing a clearly gliotic brain lesion in one temporal lobe.

Cloning and expression of Acholeplasma laidlawii membrane acyl proteins in Escherichia coli

Many integral membrane proteins in Acholeplasma laidlawii are enriched in hydrophilic amino acid residues and covalently modified with fatty acids. In order to understand how these proteins are inserted and anchored in the bilayer, we have cloned several of the major A. laidlawii proteins in Escherichia coli: 900 recombinant clones containing 4-kbp DNA fragments, inserted into the BamHI site of the plasmid pAT 153, were screened with antibodies. With antimembrane antibodies, 26 positive clones were detected, and with a mixture of five different monospecific antibodies, another 7 clones were obtained. Immunological analysis of the colonies in situ verified that antigens for A. laidlawii membrane proteins D12, T2, T3, T4a, and unidentified proteins were produced in separate clones. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) followed by immunoblotting showed several fragments [25 to 94 kilodalton (kDa)] for each of these proteins, some of which were even visible on Coomassie Blue-stained gels. It is concluded that A. laidlawii membrane proteins can be efficiently expressed in E. coli.

Amphiphilic properties of spiralin, the major surface antigen of spiroplasmas. A preliminary report

Spiralin, a 28-kDa (kilodalton) polypeptide, is the major antigen of Spiroplasma citri and S. melliferum in which it usually represents more than 20% of total membrane protein. The amino acid compositions of the spiralins purified from both spiroplasma species unambiguously show that these proteins are homologous. In addition, several lines of evidence indicate that such a protein is present in the menbrane of S. apis. A 25-kDa polypeptide antigenically related to S. citri spiralin has also been purified from the membrane of the nonhelical variant ASP-1. The spiralin of S. melliferum B88 has been used as a model for extensive characterization. This antigen binds detergent under nondenaturing conditions, can be incorporated into liposomes, and forms protein micelles upon gentle removal of detergent. Digestion of the micelles with trypsin leads to the precipitation of an insoluble material containing a major polypeptide of 3.9 kDa. The amino acid composition of this fragment is different from that of intact spiralin. It is highly enriched in glycine and serine and, as an insoluble peptide, exhibits an unexpectedly high polarity index (PI = 51.4%). Screening for acyl proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunodetection in the membrane of S. melliferum indicates that spiralin is actually acylated. This set of properties is evidence that spiralin is an intrinsic membrane protein and strongly suggests that acylation triggers or facilitates integration of the molecule into the lipid bilayer of the spiroplasma membrane.

Selective acylation of membrane proteins in Acholeplasma laidlawii

In membranes of the cell-wall-less prokaryote Acholeplasma laidlawii most proteins are of the integral type. A substantial fraction of these proteins are enriched in hydrophilic amino acid residues. Approximately 20 different major as well as minor proteins were found to be covalently modified with acyl chains. The same set of proteins are acylated when cells are grown in different fatty-acid-supplemented media. In individual proteins the ratio of palmitoyl/oleoyl acyl chains was 12-14 times larger than the acyl chain ratio in polar membrane lipids. The transmembrane protein D12 has close to two acyl chains per molecule. Proteins T2 and T4a, localized in the outer and inner leaflet of the membrane, respectively, occur each as pairs with a difference in relative molecular mass within each pair of approximately 2000. Each of these proteins as well as the other acyl proteins, except the light form of T4a, has close to one acyl chain per molecule. The extent of acylation was increased for certain proteins and decreased for others by treatment with globomycin or phenethylalcohol. The relative amounts of the T2 and T4a pairs were affected by these drugs. It is concluded that the mechanism of acylation is different from that in Escherichia coli lipoprotein and Bacillus penicillinase. The mean hydrophobicity [Kyte & Doolittle (1982) J. Mol. Biol. 157, 105-132] of the A. laidlawii acyl proteins are similar to those of other bacterial acyl proteins but significantly lower than for non-acylated integral membrane proteins, supporting an anchoring function of the acyl chains. The number of membrane acyl proteins in A. laidlawii and two other mycoplasmas are at least twice that in other bacteria.

Use of the antimicrobial removal device prior to blood culture in patients on antibiotic therapy

The efficacy of the antimicrobial removal device in facilitating isolation of bacteria from blood containing antibiotics was evaluated in a multicenter study. Blood specimens from 143 patients who had culture-proven septicemia and had been on antibiotic treatment for at least 24 hours were recultured with and without the aid of the device. Septicemia persisted in 33 of the patients and use of the device improved the isolation rates: 63% of the gram-positive bacteria and 32% of the gram-negative bacteria were isolated only with the aid of the device. Use of the device was an advantage in 10 of 13 cases where the antibiotic concentration in the bottles exceeded the MIC for the infecting microorganism but in only 5 of 19 cases where the concentration was lower than the MIC. It is concluded that the antimicrobial removal device may be useful in patients already on antibiotic treatment, but that its use is limited by the cost and the amount of work involved.

Relation of social problems and habitual vulnerability to medical cases

This paper deals with two aspects of the concept of illness: the relation of illness to social problems and the connection between illness and habitual vulnerability. A frame of reference is given, and on that basis some studies will be reported that throw light on the problems just mentioned.

Depression: factors related to 10-year prognosis

The 10 years' course of a series of 83 moderately severe depressions is presented, as well as factors governing the clinical and work prognosis. Depression was the fundamental disturbance in 75 cases during the index period. The depression was endogenous in 67 cases, reactive in eight, and neurotic in six cases. In the follow-up the drop-out from personal examination was 6.4%. Twenty per cent of the patients had been (almost) entirely free from symptoms of depression during the period of observation, 5% had been continuously depressive. There were no suicides. Twenty-seven patients felt some decrease in working capacity during the depressions, but only seven were unable to continue their previous work and three had changed work to prevent relapses. Fourteen of the patients had been sick-listed for more than 1 year of the observation period. Favourable factors for long-term course were: high intellectual capacity (for work prognosis, W), afraid of hurting others (W), white collar work (W), slight depression of mood during index period (for clinical course, C), favourable immediate outcome after index period (W). Unfavourable factors for long-term course were: low intellectual capacity (W), hysteroid personality (C), syntonic personality (W), asthenic personality, sensitivity to praise (C), tendency to feel under observation (W), and some symptoms during the index period: tendency to seclusion (C), ideas of reference (C), dryness of mouth (C), difficulty in falling asleep (C), dreamlike feeling (C), supplicating attitude (C). The implications of the results for nosology, care, and prevention of depressive states are discussed.

Predisposition for mental syndromes: A study comparing predisposition for depression, neurasthenia and anxiety state

A hypothesis of selective predisposition for drepression, neurasthenic syndrome and anxiety states has been tested in a prospective study. The primary material for the investigation consisted of 4,000 city inhabitants who had registered a private car. Almost all of these could be invited to a group investigation by questionnaire in the autumn of 1959. Out of those invited, 83% participated, and out of these, 3,019 were males (the secondary material). Six years later, the registers of public psychiatric out- and in-patient units in the city were examined as to the appearance in 1960 or later of the men in the secondary material. One hundred and fourteen of these men were found in the registers. For each of these men ten controls, matched for age, were chosen from the rest of the secondary material. Thirty-seven of the patients had had a depression and 17 a neurasthenic syndrome as the main diagnosis, and 17 had an anxiety state as the main or secondary diagnosis. As independent factors were chosen the Sjöbring personality factors sub-validity (psychasthenic traits), sub-stability (syntonia) and sub-solidity (hysteroid habitual attitude), as well as subclinical phenomena related to the neurasthenic, depressive and anxiety syndromes. It was not possible to show a specific predisposing power of the background factors investigated. Psychasthenic premorbid personality, however, was significantly related to depression, and also showed a strong tendency to an association with neurasthenic syndrome and anxiety states.

Short-term psychiatric care from a theoretical planning and empirical point of view

The main factors governing the consumption of mental care are the existence of illness, the subjective need for care (demand) and the objective need. Since there is no close relationship between diagnosis and need of care, the latter should be estimated separately in health planning studies. There is reason to include mental vulnerability (30% of a stratified normal population) in the health planning program, mainly as a factor requiring secondary prevention (e.g. crisis intervention) or tertiary prevention (e.g. prophylaxis against recurrences) and preferably also for primary prevention. Figures on the discrepancy between demand and need are given. This discrepancy is quantitatively small (6% in a mental out-patient material) but qualitatively important. The effect of health care availability on the later demand for care is demonstrated in a series of emergency patients, 68% of the cases being recidivists. The view is favoured that the need for hospital care should be measured stepwise: first among the outpatients in the same specialty, then if possible among the clientèle of the GP and in other specialties. There is considerable overlapping between mental and physical symptoms among psychiatric patients. The after care could in many cases be given by GPs. The number of these must, though, be increased and their training in minor psychiatry supplemented.

Suicide in Gothenburg. Demographic and social factors and availment of care of the suicide cases in 1968, with some views on prevention

The relative importance of suicide as a cause of death, especially among younger persons, underlines the urgency of preventive measures. This study covers the fatal cases in a Swedish city of 450 000 inhabitants in 1968, 71 men and 30 women. Loneliness is closely associated with suicide, with high rates among divorced and widowed and among the elderly. “Sick-listing” is common in the material during the years preceding the suicide. Incomes are not lower than for the population in general, but half of the men are in debt at the time of death. In the critical phase, care had been given in only few cases. This is valid for psychiatric out-and inpatient care, all medical care leading to “sick-listing”, and for social care. Preventive measures must be encouraged at all levels. The needs of old people must be met, including psychiatric care, early cases must be detected and special care facilities must be created.