The state of the art in beyond 5G distributed massive multiple-input multiple-output communication system solutions

Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal pro- cessing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on be- yond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.

Nighttime pasture access: Comparing the effect of production pasture and exercise paddock on milk production and cow behavior in an automatic milking system

With increasing intensification of the dairy sector in many countries and with the introduction of automatic milking, exercise paddocks combined with full indoor feeding, as an alternative to production pasture, are being used as a compromise between farm economics and cow welfare. This study examined whether there are production benefits for high-producing dairy cows in an alternative system that uses pasture at a level of approximately 50% of the total roughage intake in the diet. In an automatic milking system with 12-h night access to the outdoor environment, we compared milk production and behavior of cows in 2 systems: an exercise paddock combined with ad libitum grass silage indoor feeding and a production pasture combined with a restricted daytime grass silage ration. There were 20 cows in the former and 21 cows in the latter system, with the treatments running in parallel. The experiment started in late June with no complete darkness during the night, and lasted for 12 wk, with 5.6 h of darkness at the end. We therefore also explored the effect of night length on milk production and behavior parameters. All cows showed strong motivation for going outdoors and grazing when pasture access was given in early evening, but after a few hours both groups went to the barn and did not return to the pasture area during the remaining night. As the season progressed and nights became longer, cows on the exercise paddock treatment reduced time spent outdoors and grazing time, whereas they increased time spent resting outdoors. The group on exercise paddock had a greater milk yield (kg of milk) over the experimental period than the production pasture group. The latter group also showed a greater drop in milk yield over the duration of the trial. Thus, for cows milked in an automatic milking system and offered nighttime outdoor access, no milk production benefits were observed in offering production pasture with restricted indoor silage allowance instead of an exercise paddock with ad libitum silage. We therefore suggest that automatic milking farmers with similar production levels and automatic milking-management systems as in the present experiment, who wish to include grazed grass as part of the dairy cow diet, should ensure that cows have pasture access in the afternoon and evening.

Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

BACKGROUND

The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment.

METHOD

Patients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment.

RESULTS

The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P < 0·001), fewer admissions (29·5 versus 42·8 per cent; P < 0·001), and fewer negative explorations (1·6 versus 3·2 per cent; P = 0·030) and operations for non-perforated appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020).

CONCLUSION

AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov).

Printed dose-recording tag based on organic complementary circuits and ferroelectric nonvolatile memories

We have demonstrated a printed electronic tag that monitors time-integrated sensor signals and writes to nonvolatile memories for later readout. The tag is additively fabricated on flexible plastic foil and comprises a thermistor divider, complementary organic circuits, and two nonvolatile memory cells. With a supply voltage below 30 V, the threshold temperatures can be tuned between 0 °C and 80 °C. The time-temperature dose measurement is calibrated for minute-scale integration. The two memory bits are sequentially written in a thermometer code to provide an accumulated dose record.

Inhibition of sodium-linked glucose reabsorption normalizes diabetes-induced glomerular hyperfiltration in conscious adenosine A₁-receptor deficient mice

AIM

Glomerular hyperfiltration is commonly observed in diabetics early after the onset of the disease and predicts the progression of nephropathy. Sustained hyperglycaemia is also closely associated with kidney hypertrophy and increased electrolyte and glucose reabsorption in the proximal tubule. In this study, we investigated the role of the increased tubular sodium/glucose cotransport for diabetes-induced glomerular hyperfiltration. To eliminate any potential confounding effect of the tubuloglomerular feedback (TGF) mechanism, we used adenosine A₁-receptor deficient (A1AR(-/-)) mice known to lack a functional TGF mechanism and compared the results to corresponding wild-type animals (A1AR(+/+)).

METHODS

Diabetes was induced by an intravenous bolus injection of alloxan. Glomerular filtration rate (GFR) was determined in conscious mice by a single bolus injection of inulin. The sodium/glucose cotransporters were inhibited by phlorizin 30 min prior to GFR measurements.

RESULTS

Normoglycaemic animals had a similar GFR independent of genotype (A₁AR(+/+) 233 ± 11 vs. A₁AR(-/-) 241 ± 25 μL min(-1)), and induction of diabetes resulted in glomerular hyperfiltration in both groups (A₁AR(+/+) 380 ± 25 vs. A₁AR(-/-) 336 ± 35 μL min(-1); both P < 0.05). Phlorizin had no effect on GFR in normoglycaemic mice, whereas it reduced GFR in both genotypes during diabetes (A₁AR(+/+) 365 ± 18 to 295 ± 19, A₁AR(-/-) 354 ± 38 to 199 ± 15 μL min(-1); both P < 0.05). Notably, the reduction was more pronounced in the A₁AR(-/-) (P < 0.05).

CONCLUSION

This study demonstrates that increased tubular sodium/glucose reabsorption is important for diabetes-induced hyperfiltration, and that the TGF mechanism is not involved in these alterations, but rather functions to reduce any deviations from a new set-point.

Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model--impact on all-cause emergency department revisits

WHAT IS KNOWN AND OBJECTIVE

Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death.

METHODS

This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention.

RESULTS AND DISCUSSION

No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.86-1.04]or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared with 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0.608).

WHAT IS NEW AND CONCLUSION

Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re-hospitalizations or mortality over 6-month follow-up.

Multiple strategies for quality improvement and patient safety--money alone is not the answer, nor is trust. Conclusions of the 6th EQuiP Invitational Conference April 2011

On 7-9 April 2011 the 6th EQuiP Invitational Conference took place in Copenhagen. Key note lectures were delivered by Professor Frede Olesen (Denmark), Professor Andreas Christian Soennichsen (Austria), Professor Martin Roland (UK) and Professor Richard Roberts (US), and a key note panel discussion was held on the pros and cons of pay-for-performance led by Doctors Iona Heath (UK) and José Braspenning (The Netherlands). In addition, there were 9 workshops and 23 oral presentations. Videos of many presentations as well as PowerPoint and other materials can be found at EQuiP's website: http://www.equip.ch .

L1₀ FePtCu bit patterned media

Chemically ordered 5 nm-thick L1₀ FePtCu films with strong perpendicular magnetic anisotropy were post-patterned by nanoimprint lithography into a dot array over a 3 mm-wide circumferential band on a 3 inch Si wafer. The dots with a diameter of 30 nm and a center-to-center pitch of 60 nm appear as single domain and reveal an enhanced switching field as compared to the continuous film. We demonstrate successful recording on a single track using shingled writing with a conventional hard disk drive write/read head.

Pharmacokinetics of thalidomide in patients with impaired renal function and while on and off dialysis

There is a renewed interest in thalidomide for use in malignancies and systemic inflammatory diseases. Reduced renal function is not uncommon among patients with these disease states but the pharmacokinetics has not been fully investigated. The aim of this study was to investigate the pharmacokinetics of thalidomide in haemodialysis patients while on and off dialysis and in myeloma patients with varying degrees of renal function.

Two studies were performed. To establish the pharmacokinetics of thalidomide in patients with mild to moderate renal failure, blood samples were taken over 12 weeks from 40 patients with multiple myeloma. A second study was performed in six patients with end-stage renal disease both on a non-dialysis day and before and during a haemodialysis session. Thalidomide concentration was determined by HPLC. A one-compartment open model with first-order absorption and elimination was used to fit total thalidomide concentration to population pharmacokinetics and statistical models using the NONMEM program. Clearance and volumes were slightly below 10 L h−1 and 1 L kg−1, respectively, in both patient groups. The inter- and intra-patient variability was low. Clearance was doubled during dialysis. There was no correlation between thalidomide clearance and renal function. In conclusion, the pharmacokinetics of thalidomide in patients with renal failure are very similar to values reported by others for patients with normal renal function. Although clearance during dialysis is doubled, thalidomide dose need not be changed for patients with decreased kidney function. There is also no need for a supplementary dose due to haemodialysis.

TIARA: treatment initiatives after radiological accidents

This paper describes the objectives, and reviews the progress, of the European project 'Treatment Initiatives After Radiological Accidents' (TIARA). TIARA forms part of the 'Preparatory Action for Security Research' (PASR) launched by the European Commission in 2004. The Preparatory Action is intended to reach preliminary conclusions on the needs for the security of EU citizens. It prepared a comprehensive Security Research Programme as part of the Commission's Seventh Framework Programme proposal, which was adopted in 2006 and launched in 2007. The principal purpose of TIARA is to constitute a European network that will participate in facilitating the management of a crisis in the event of the malevolent dispersal of radionuclides into the public environment.

Retinal function and histopathology in rabbits treated with Topiramate

PURPOSE

To evaluate retinal function and histopathology in rabbits treated orally with the anti-epileptic drug topiramate.

METHODS

Six rabbits were treated with a daily oral dose of topiramate during a period of eight months. Six rabbits receiving water served as controls. Blood samples were analyzed for determination of topiramate serum levels in order to ensure successful drug exposition. Standardized full-field electroretinograms (ERGs) were performed before treatment and then at 2, 3 and 8 months during the treatment period. After terminating treatment the rabbits were sacrificed and the morphology of the sectioned retina was studied.

RESULTS

After eight months of treatment the full-field ERG demonstrated normal rod function in treated and control rabbits, but the light adapted 30 Hz flicker b-wave amplitude was significantly reduced in the treated rabbits. This was the case for both the light adapted (Wilcoxon signed ranks test, P = 0.046) and the dark adapted (Wilcoxon signed ranks test, P = 0.028) 30 Hz flicker response from the treated rabbits. Retinal immunohistology revealed a severe accumulation of GABA in amacrine cells and in the inner plexiform layer in 4 of 6 treated rabbits compared to the controls.

CONCLUSIONS

Topiramate, orally administrated to rabbits, may cause a significant reduction of the retinal function demonstrated by the reduced b-wave amplitude in the full-field ERG, as well as changes in immunohistology characterized by a severe accumulation of GABA in the inner retina. The retinal dysfunction and the morphological changes indicate that topiramat may damage the retina, similarly to vigabatrin (another anti-epileptic drug).

Fixed partial prostheses supported by 2 or 3 implants: a retrospective study up to 18 years

PURPOSE

The purpose of this study was to evaluate and compare the long-term performance of fixed partial prostheses supported by 2 or 3 implants.

MATERIALS AND METHODS

All patients treated with fixed partial prostheses supported by either 2 or 3 implants during the period 1985 to 1998 were included in this retrospective report. Annual clinical follow-up examinations were performed, with special attention to stability of the prostheses and peri-implant and occlusal conditions. Radiographic examination was performed when the prostheses were delivered (year 0) and subsequently at 1-year, 5-year, and 10-year examinations.

RESULTS

A total of 178 patients had received fixed partial prostheses (FPPs) during this period of whom 123 (77 women and 46 men) were available for follow-up (mean age = 65 years, range 32-91). These 123 patients received a total of 146 implant-supported FPPs (63 two-implant- and 83 three-implant-supported) supported by 375 implants. The mean observation periods for the 2- and 3-implant-supported restorations were 9.6 years and 9.4 years (range, 5 to 18 years), respectively. Survival rates for the 2- and 3-implant-supported prostheses were 96.8% and 97.6%, respectively. The implant survival rate after loading was 98.4% for both groups. The mean bone loss at the 5-year follow-up was 0.3 mm for the 2 groups. No significant differences in bone loss (P > .05), implant failure rate (P > .05), or incidence of mechanical complications (P > .05) were found between the 2 prosthesis designs. The complications differed, significantly, with more loose gold and abutment screws in the 2-implant-supported group (P < .05) and more porcelain fractures in the 3-implant-supported group (P < .05).

CONCLUSION

The 2-implant-supported partial prostheses exhibited long-term clinical performance comparable to prostheses supported by 3 implants.

Periodontal Disease in Patients From the Original Kostmann Family With Severe Congenital Neutropenia

BACKGROUND

Patients with Kostmann syndrome (severe congenital neutropenia [SCN]) typically normalize their absolute neutrophil count (ANC) upon granulocyte colony-stimulating factor (G-CSF) therapy. However, although they no longer experience life-threatening bacterial infections, they frequently still have recurrent gingivitis and even severe periodontitis, often starting in early childhood.

METHODS

We studied the periodontal disease in the four surviving patients belonging to the family originally described by Kostmann. Their odontological records, x-rays, color photos, bacterial cultures, serum antibodies to oral bacteria, and histopathological examinations were reviewed. The data were also correlated to previous investigations on their antibacterial peptides and molecular biology.

RESULTS

Three patients had periodontal disease, despite normal ANC and professional dental care, and had neutrophils deficient in antibacterial peptides. One of these patients also had a heterozygous mutation in the neutrophil elastase gene, had severe periodontal disease and overgrowth of the periodontal pathogen Actinobacillus actinomycetemcomitans in the dental flora, and 15 permanent teeth had been extracted by the age of 27. One bone marrow-transplanted patient had no periodontal disease.

CONCLUSIONS

Normalized ANC levels are not sufficient to maintain normal oral health in SCN patients, and because neutrophils are important for first-line defense and innate immunity, the deficiency of the antibacterial peptide LL-37 probably explains their chronic periodontal disease. Professional dental care is still important for SCN patients, despite treatment with G-CSF and normal ANC levels. Whether antibacterial peptides play a role in the pathogenesis of periodontitis in other patients remains to be elucidated.

Kin-biased distribution in brown trout: an effect of redd location or kin recognition?

A wide range of animals have been reported to show kin-biased behaviours, such as reduced aggressiveness and increased food sharing among relatives. However, less is known about whether wild animals also associate with relatives under natural conditions, which is a prerequisite to facilitate kin-biased behaviours and hence kin selection. We tested, by means of microsatellite polymorphism, correlations between pair-wise relatedness and pair-wise metric distance in wild brown trout (Salmo trutta L.) under natural conditions in two streams. Our data show that young-of-the-year as well as older trout found close together also had a higher genetic relatedness in one of the two streams, whereas no relationship was found in the other stream. Very few half and full siblings were found in the second stream and under these conditions it is unlikely that kin-biased behaviours will receive positive selection. We discuss the underlying mechanisms for the observed structure and we specifically address the issue of whether the grouping of related individuals could reflect dispersal from the same spawning redds, or if it reflects active association with relatives, possibly conferring kin-selected advantages.

Nitrogen Balance, Microbial Protein Production, and Milk Production in Dairy Cows Fed Fodder Beets and Potatoes, or Barley

Fourteen multiparous midlactation dairy cows were used in a change-over experiment with 3 periods and 3 diets to evaluate the effects of fodder beets and potatoes on N metabolism, microbial protein production, and milk production. A basal ration of alfalfa/grass silage offered ad libitum, 1 kg of grass hay and 1 kg of heat-treated rapeseed cake was supplemented with 5 kg DM of either rolled barley/raw potatoes 80:20 (BAP), fodder beets/raw potatoes 80:20 (BEP) or rolled barley (BA). Urine and feces were collected quantitatively from 8 cows and ruminal samplings, and evacuations were performed on 4 cannulated cows. Intake and production did not differ between BAP and BA, but the BEP diet lowered intake of both silage and total ration by 0.9 kg DM. Daily yield of energy-corrected milk (ECM) was decreased by 1.7 and 2.3 kg compared with BAP and BA, respectively. Milk urea concentration was 1 mM lower with the BEP diet. The proportion of feed N recovered in milk was 20 to 21% for all diets. With the BEP diet, urinary N amount and proportion were reduced correspondingly to the lower total N intake. Fecal N amount remained unchanged, and hence nitrogen apparent digestibility decreased by 5 percentage units with the BEP diet. Microbial protein production, assessed by allantoin excretion, tended to be highest with the BAP diet. Acetate proportion of VFA was lowered by the BEP diet, while proportions of propionate and butyrate both tended to increase. Different fermentation patterns, probably related to differences in rumen microbiota, could explain why changes in energetic efficiency and milk composition reported in the literature did not occur in the actual experiment when roots replaced barley. Compared with barley, roots appeared to have a greater negative effect on silage intake in conjunction with a prewilted silage with high intake potential allowed ad libitum and this decreased milk production by a magnitude corresponding to the lower intake of ME.

Methylation changes in the human IGF2 p3 promoter parallel IGF2 expression in the primary tumor, established cell line, and xenograft of a human hepatoblastoma

Hepatoblastoma (HB) is a rare malignant embryonal liver tumor. Its pathogenesis has been associated with altered regulation of the IGF2 and H19 genes, and previous studies have suggested a correlation between abnormal methylation and altered expression of these genes in hepatoblastoma. Upregulation of the activity of the IGF2 promoter P3 has previously been shown to be tightly correlated with demethylation in hepatoblastoma. Here, we have used bisulfite genomic sequencing to characterize the methylation pattern of the IGF2 promoter P3 in the hepatoblastoma-derived cell line Hep T1, in the original tumor from which Hep T1 is derived, and in nude mouse xenografts of the Hep T1 cell line. The results show a clear difference in methylation pattern of the most proximal region of the IGF2 P3 promoter between the primary tumor, the cell line, and the xenografts. RNase protection and mRNA in situ hybridization revealed that variations in methylation patterns was paralleled by the levels of IGF2 P3 mRNA, which was detectable in the primary tumor and xenografts, but not in the cell line. Furthermore, it was demonstrated that H19 was reactivated and demethylated in the HepT1 cell line by 5-azaCytidine, in contrast to IGF2 P3, which was not demethylated or reactivated. We suggest that methylation of the proximal IGF2 P3 is important for its regulation.

A retrospective analysis of factors associated with multiple implant failures in maxillae

This retrospective study was designed to verify the factors that influence implant failures. Six prosthodontic clinics in Sweden participated in the study, and together they included a total of 54 patients treated between January 1988 and December 1996. All patients were completely edentulous in the maxilla, and received either a fixed prosthesis or an overdenture supported by at least 4 implants (Brånemark System). Half of the patients belonged to the study group, and an inclusion criterion for this group was that they had lost at least half of their implants. To reduce bias, the patients in the control group were matched to the study group, i.e. they were selected so that both groups were as identical as possible. The results of the study indicate that the control group had a better initial bone support than the study group. Furthermore, the patients in the study group suffered from circumstances that could induce implant failure, such as bruxism, personal grief, depression, as well as addictions to cigarettes, alcohol and/or narcotics. On the study form the clinicians were asked to give their own opinion of the reason for implant failure. The answers given could easily be grouped into 5 different topics, and this experience can be useful to improve patient selection. This study suggests that there are certain factors of importance to consider to prevent a cluster phenomenon of implant failures i.e. lack of bone support, heavy smoking habits and bruxism.

A furnace forin situX-ray diffraction studies of insertion processes in electrode materials at elevated temperatures

A furnace is described forin situX-ray diffraction studies, in transmission mode, of structural changes in electrode materials for Li-ion (polymer) batteries in the ambient to 300°C temperature range. The method exploits the thin flat-cell geometry of the lithium-polymer battery concept. The flat sample is able to oscillate about a horizontal axis in its own plane in the X-ray beam, to provide better averaging during the diffraction experiment. The use of the device is demonstrated in a study of lithium intercalation in graphite (a commonly used anode material in lithium-ion batteries) during electrochemical cycling and storage at 70°C.

Clinical pharmacology of thalidomide

BACKGROUND

Thalidomide has a chiral centre, and the racemate of (R)- and (S)-thalidomide was introduced as a sedative drug in the late 1950s. In 1961, it was withdrawn due to teratogenicity and neuropathy. There is now a growing clinical interest in thalidomide due to its unique anti-inflammatory and immunomodulatory effects.

OBJECTIVE

To critically review pharmacokinetic studies and briefly review pharmacodynamic effects and studies of thalidomide in consideration of its chemical and stereochemical properties and metabolism.

METHODS

Literature search and computer simulations of pharmacokinetics.

RESULTS

Rational use of thalidomide is problematic due to lack of basic knowledge of its mechanism of action, effects of the separate enantiomers and metabolites and dose- and concentration-effect relationships. Due to its inhibition of tumour necrosis factor-alpha and angiogenesis, racemic thalidomide has been tested with good effect in a variety of skin and mucous membrane disorders, Crohn's disease, graft-versus-host disease, complications to human immunodeficiency virus and, recently, in multiple myeloma. Adverse reactions are often related to the sedative effects. Irreversible toxic peripheral neuropathy and foetal malformations are serious complications that can be prevented. The results of several published pharmacokinetic studies can be questioned due to poor methodology and the use of non-stereospecific assays. The enantiomers of thalidomide undergo spontaneous hydrolysis and fast chiral interconversion at physiological pH. The oral bioavailability of thalidomide has not been unequivocally determined, but available data suggest that it is high. Absorption is slow, with a time to maximum plasma concentration of at least 2 h, and may also be dose-dependent; however, that of the separate enantiomers may be faster due to higher aqueous solubility. Estimation of the volume of distribution is complicated by probable hydrolysis and chiral inversion also in peripheral compartments. A value of around 11/kg is however plausible. Plasma protein binding is low with little difference between the enantiomers. Elimination of thalidomide is mainly by pH-dependent spontaneous hydrolysis in all body fluids with an apparent mean clearance of 10 l/h for the (R)- and 21 l/h for the (S)-enantiomer in adult subjects. Blood concentrations of the (R)-enantiomer are consequently higher than those of the (S)-enantiomer at pseudoequilibrium. The mean elimination half-life of both enantiomers is 5 h. One hydroxylated metabolite has been found in low concentrations in the blood. Since both enzymatic metabolism and renal excretion play minor roles in the elimination of thalidomide, the risk of drug interactions seems to be low.

CONCLUSIONS

The interest in and use of thalidomide is increasing due to its potential as an immunomodulating and antiangiogenic agent. The inter-individual variability in distribution and elimination is low. Apart from this, its use is complicated by the lack of knowledge of dose- or concentration-effect relationships, possible dose-dependent oral absorption and of course by its well-known serious adverse effects.

Expression levels of insulin-like growth factor binding proteins and insulin receptor isoforms in hepatoblastomas

Hepatoblastoma, a rare pediatric liver tumour, is a poorly understood disease. While expression studies for some members of the Insulin-like growth factor axis have been studied in hepatoblastoma, a systematic analysis of the IGF-axis has not been carried out. We have examined a series of hepatoblastomas with matched normal liver tissue for gene expression differences with emphasis on members of the insulin-like growth factor binding proteins. The expression profiles obtained reveal that the expression of these genes are altered in these tumors. The results indicate that the IGF-axis is seriously disturbed in the tumors.

Gender differences in risk factors for suicide in Denmark

BACKGROUND

Gender is one of the most frequently replicated predictors for suicide.

AIMS

To identify risk factors for suicide among males and females and to investigate whether risk factors for suicide differ by gender.

METHOD

A time-matched nested case-control design was performed using Danish longitudinal register databases to obtain 811 suicide cases and 79 871 controls. Data were analysed using conditional logistic regression.

RESULTS

A history of hospitalised mental illness was the most marked risk factor for suicide for both genders. Unemployment, retirement, being single and sickness absence were significant risk factors for men, whereas having a child <2 years old was significantly protective for women. The relative risks for suicide differed significantly between genders according to psychiatric admission status and being the parent of a child <2 years. However, adjustment for these factors did not eliminate the gender difference in suicide risk.

CONCLUSIONS

Risk factors for suicide differed by gender and gender differences could not be explained by differential exposure to known risk factors.

Expression of genes involved with cell cycle control, cell growth and chromatin modification are altered in hepatoblastomas

Hepatoblastoma is a rare pediatric liver tumor. While much progress has been made in the treatment of the disease, very little is known about the moleculer events underlying the pathogenesis of this disease. We sought to investigate a series of hepatoblastomas for alterations in gene expression patterns with emphasis on important cell regulatory genes, including chromatin modifying enzymes, cyclin dependent kinase inhibitors, growth factors, oncogenes and cell cycle regulators. Total RNA was extracted from a series of sporadic hepatoblastomas with matched normal liver, some unmatched tumors and fetal livers, and gene expression was measured for various genes using RNase Protection Analysis (RPA). The results of this analysis show that the expression of many important regulatory genes are distinctly altered in these tumors, and a subset of tumors can be distinguished on the basis of these gene expression differences and histopathological features. Because the molecular events underlying the pathogenesis of this rare tumor are so poorly understood, this study represents a first step in determining some of the possible mechanisms involved which may provide future avenues of research.

Intravenous formulations of the enantiomers of thalidomide: pharmacokinetic and initial pharmacodynamic characterization in man

Thalidomide, a racemate, is coming into clinical use as an immunomodulating and antiinflammatory drug. These effects may chiefly be exerted by S-thalidomide, but the enantiomers are interconverted in-vivo. Thalidomide is given orally, although parenteral administration would be desirable in some clinical situations. The aim of this study was to prepare solutions of the enantiomers of thalidomide for intravenous administration and to investigate their pharmacokinetics and sedative effects following infusion in man. Solubility and stability of the enantiomers in 5% glucose solution was investigated. After a dose-determination experiment in one subject, six healthy male volunteers received R- and S-thalidomide separately by 1-h infusions in a randomized double-blind cross-over study. Blood was sampled over 22h and sedative effects were recorded. Blood concentrations of the enantiomers were determined by stereospecific HPLC. A four-compartment model consisting of a two-compartment model for each enantiomer, with elimination from both compartments, connected by rate constants for chiral inversion was fitted to the concentration data, while the sedative effects were correlated with the blood concentrations of R- and S-thalidomide by means of logistic regression. The enantiomers of thalidomide were chemically stable in solution for at least a week at room temperature. The infusions were well tolerated. Sedation, which was the only observed effect, was related to the blood concentration of R-thalidomide. Inter-individual variation in the disposition of the enantiomers was modest (e.g. terminal half-lives ranged between 3.9 and 5.3h). Pharmacokinetic modelling predicted that varying the infusion time of a fixed dose of S-thalidomide between 10 min and 6h would have little influence on the maximal blood concentration of formed R-thalidomide. To our knowledge this is the first time that thalidomide has been administered intravenously.

Altered expression of members of the IGF-axis in hepatoblastomas

Previous reports have demonstrated that expression of insulin-like growth factor 2 (IGF2) is altered in hepatoblastoma. Using RNAase protection analysis (RPA), we examined the gene expression for IGF1, IGF2, IGF1R, M6P/IGF2R, IGFBP-1 and IGFBP-2 in a series of hepatoblastomas with corresponding normal liver from the same individuals. The results show that the expression of the IGF-axis members included in the present study are altered between tumour and normal, and indicate that the IGF-axis may be involved in hepatoblastoma development.

Species names in phylogenetic nomenclature

Linnaean binomial nomenclature is logically incompatible with the phylogenetic nomenclature of de Queiroz and Gauthier (1992, Annu. Rev. Ecol. Syst. 23:449-480): The former is based on the concept of genus, thus making this rank mandatory, while the latter is based on phylogenetic definitions and requires the abandonment of mandatory ranks. Thus, if species are to receive names under phylogenetic nomenclature, a different method must be devised to name them. Here, 13 methods for naming species in the context of phylogenetic nomenclature are contrasted with each other and with Linnaean binomials. A fundamental dichotomy among the proposed methods distinguishes those that retain the entire binomial of a preexisting species name from those that retain only the specific epithet. Other relevant issues include the stability, uniqueness, and ease of pronunciation of species names; their capacity to convey phylogenetic information; and the distinguishability of species names that are governed by a code of phylogenetic nomenclature both from clade names and from species names governed by the current codes. No method is ideal. Each has advantages and drawbacks, and preference for one option over another will be influenced by one's evaluation of the relative importance of the pros and cons for each. Moreover, sometimes the same feature is viewed as an advantage by some and a drawback by others. Nevertheless, all of the proposed methods for naming species in the context of phylogenetic nomenclature provide names that are more stable than Linnaean binomials.

Methylation, gene expression and the chromatin connection in cancer (review)

The mechanisms by which cells regulate gene expression are often altered in tumors. Modulating aspects of the components responsible for the nuclear packaging of DNA is one means by which the cell can control transcription, either by packaging the DNA such that access to specific sites of transcription is blocked or by modifying the DNA itself to prevent transcription factor binding. One such DNA modification is the methylation of cytosines. In addition, histone acetylation status has been linked recently through a large number of studies to the regulation of gene expression. Expressed genes are located in highly acetylated chromatin. The acetylation status of nucleosomes (the basic packaging unit of chromatin), is regulated by a group of enzymes, histone acetyltransferases (HATs), and histone deacetylases (HDACs). These two elements, methylation and histone acetylation have also been linked together, whereby methylation is used to direct gene repression through a histone deacetylase complex. Methylation, HATs, and HDACs have been shown to be altered in tumors. We present an overview of the current knowledge surrounding these elements in cancer, and in the final sections describe the likelihood of alterations of the histone modifying apparatus in hepatocellular carcinoma.

Perceived problems of pharmacotherapy: a problem detection study among physicians and nurses at a Swedish university hospital

As a first step toward obtaining quality assurance regarding use and handling of drugs at Malmö University Hospital, a problem detection study (PDS) was performed, drug related problems being collected from nurses, physicians and pharmacists. Problem questionnaires relevant for physicians (67 items) and nurses (82 items) were prepared and sent to chief physicians and head nurses for distribution to colleagues. The problems identified covered all aspects of drug use and handling such as availability, prescription, dispensing, information and monitoring. Fifty-six per cent (79/141) of the physicians and 68 per cent (88/130) of the nurses responded. The main problems were related to information, chart order sheets and follow up. The item 'Uncertain whether patients take their medicine correctly after discharge' scored highest among physicians. The two main problems for the nurses were that 'newly licensed drugs and drugs used on a named-patient basis are not included in FASS' (the Swedish national formulary). The problem detection technique proved useful for the identification of drug-related problems, and the results will provide a basis for further improvement in quality assurance in pharmacotherapy at the hospital.

‘Misplacement’ of elderly people in the caring organisation: reasons and alternatives

The degree of misplacement in the care organisation was studied in a repeated cross-sectional study (788 persons in 1993 and 1538 in 1988, 65 years and older) in Sundsvall, an industrial city in the middle of Sweden. The overall misplacements were 23% both in 1988 and 1993. Misplacements were most frequent in the homes for the aged (about 50%). At the nursing homes, misplacement decreased from 27 to 12% between 1988 and 1993, while it has increased in home care from 8 to 27%. Almost half of the misplacements in home care needed nursing home or psychogeriatric care. The main conclusion is that the care organisation is not working optimally. The number of misplacements reflects an exhausted care situation. The concept of misplacement is probably valuable, but its usefulness must be evaluated in further studies.

Myocardial sarcoidosis in forensic medicine

Sudden death is the most common manifestation of myocardial sarcoidosis, which is often clinically silent. The disease is rarely encountered in forensic medicine, but the diagnosis is important because it may change the interpretation of the manner of death and thus have insurance implications. Six cases of myocardial sarcoidosis diagnosed at autopsy are reported, and the significance of the findings is discussed.