Production and characterization of antibodies for the specific determination of the opioid peptide Met5-Enkephalin-Arg6-Phe7

Endogenous opioids serve as modulators of neuroendocrine and immune system processes, the investigation of which calls for high-specificity radioimmunoassays (RIAs). This study focuses on the development and use of a specific radioimmunoassay for the opioid peptide Met5-Enkephalin-Arg6-Phe7 (MEAP), the C-terminus part of proenkephalin A. Antibodies were raised in four rabbits and investigated in terms of titre, avidity and specificity, followed by finding ideal conditions for these antibodies in RIA. MEAP concentrations were determined in crude extracts of rat hypothalamus, dorsal root ganglia, adrenals and ankle using this standardized assay after an oxidizing process. At reverse-phase high-pressure liquid chromatography (HPLC), the position of immunoreactive material from rat hypothalamus eluted as two peaks out of which one was compatible with that of synthetic MEAP. All rabbits exhibited individual differences in relative immune response and time of its onset. The avidity constant was 10 times higher on a molar basis for ab 4108 compared with ab 4182. There was no cross-reactivity for ab 4182 to related peptides, such as enkephalins and dynorphin B, and negligible background values for ab 4108. The relative levels ofimmunoreactive MEAP from the CNS versus peripheral tissues contrasted in accordance with current knowledge. It is suggested that reports with RIA results should include characterization of antibodies, extraction procedures, standard curves and compositions of buffers. Furthermore, the results should preferably be expressed in relation to total protein content.

Health care use during 20 years following bariatric surgery

CONTEXT

Bariatric surgery results in sustained weight loss; reduced incidence of diabetes, cardiovascular events, and cancer; and improved survival. The long-term effect on health care use is unknown.

OBJECTIVE

To assess health care use over 20 years by obese patients treated conventionally or with bariatric surgery.

DESIGN, SETTING, AND PARTICIPANTS

The Swedish Obese Subjects study is an ongoing, prospective, nonrandomized, controlled intervention study conducted in the Swedish health care system that included 2010 adults who underwent bariatric surgery and 2037 contemporaneously matched controls recruited between 1987 and 2001. Inclusion criteria were age 37 years to 60 years and body mass index of 34 or higher in men and 38 or higher in women. Exclusion criteria were identical in both groups.

INTERVENTIONS

Of the surgery patients, 13% underwent gastric bypass, 19% gastric banding, and 68% vertical-banded gastroplasty. Controls received conventional obesity treatment.

MAIN OUTCOME MEASURES

Annual hospital days (follow-up years 1 to 20; data capture 1987-2009; median follow-up 15 years) and nonprimary care outpatient visits (years 2-20; data capture 2001-2009; median follow-up 9 years) were retrieved from the National Patient Register, and drug costs from the Prescribed Drug Register (years 7-20; data capture 2005-2011; median follow-up 6 years). Registry linkage was complete for more than 99% of patients (4044 of 4047). Mean differences were adjusted for baseline age, sex, smoking, diabetes status, body mass index, inclusion period, and (for the inpatient care analysis) hospital days the year before the index date.

RESULTS

In the 20 years following their bariatric procedure, surgery patients used a total of 54 mean cumulative hospital days compared with 40 used by those in the control group (adjusted difference, 15; 95% CI, 2-27; P = .03). During the years 2 through 6, surgery patients had an accumulated annual mean of 1.7 hospital days vs 1.2 days among control patients (adjusted difference, 0.5; 95% CI, 0.2 to 0.7; P < .001). From year 7 to 20, both groups had a mean annual 1.8 hospital days (adjusted difference, 0.0; 95% CI, -0.3 to 0.3; P = .95). Surgery patients had a mean annual 1.3 nonprimary care outpatient visits during the years 2 through 6 vs 1.1 among the controls (adjusted difference, 0.3; 95% CI, 0.1 to 0.4; P = .003), but from year 7, the 2 groups did not differ (1.8 vs 1.9 mean annual visits; adjusted difference, -0.2; 95% CI, -0.4 to 0.1; P = .12). From year 7 to 20, the surgery group incurred a mean annual drug cost of US $930; the control patients, $1123 (adjusted difference, -$228; 95% CI, -$335 to -$121; P < .001).

CONCLUSIONS

Compared with controls, surgically treated patients used more inpatient and nonprimary outpatient care during the first 6-year period after undergoing bariatric surgery but not thereafter. Drug costs from years 7 through 20 were lower for surgery patients than for control patients.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01479452.

Evaluation of Monte Carlo-based calibrations of HPGe detectors for in situ gamma-ray spectrometry

The aim of this work was to evaluate the use of Monte Carlo-based calibrations for in situ gamma-ray spectrometry. We have performed in situ measurements at five different sites in Sweden using HPGe detectors to determine ground deposition activity levels of (137)Cs from the 1986 Chernobyl accident. Monte Carlo-calculated efficiency calibration factors were compared with corresponding values calculated using a more traditional semi-empirical method. In addition, results for the activity ground deposition were also compared with activity densities found in soil samples. In order to facilitate meaningful comparisons between the different types of results, the combined standard uncertainty of in situ measurements was assessed for both calibration methods. Good agreement, both between the two calibration methods, and between in situ measurements and soil samples, was found at all five sites. Uncertainties in in situ measurements for the given measurement conditions, about 20 years after the fallout occurred, were found to be in the range 15-20% (with a coverage factor k=1, i.e. with a confidence interval of about 68%).

Uncertainty in HPGe detector calibrations for in situ gamma-ray spectrometry

Semi-empirical methods are often used for efficiency calibrations of in situ gamma-ray spectrometry measurements with high-purity germanium detectors. The intrinsic detector efficiency is experimentally determined for different photon energies and angles of incidence, and a suitable expression for the efficiency is fitted to empirical data. In this work, the combined standard uncertainty of such an efficiency function for two detectors was assessed. The uncertainties in individual efficiency measurements were found to be about 1.9 and 3.1% (with a coverage factor k = 1, i.e. with a confidence interval of about 68%) for the two detectors. The main contributions to these uncertainties were found to originate from uncertainties in source-to-detector distance, source activity and full-energy peak count rate. The standard uncertainties of the fitted functions were found to be somewhat higher than the uncertainty of individual data points, i.e. 5.2 and 8.1% (k = 1). With the introduction of a new expression for the detector efficiency, these uncertainties were reduced to 3.7 and 4.2%, i.e. with up to a factor of two. Note that this work only addresses the uncertainty in the determination of intrinsic detector efficiency.

Effects of bariatric surgery on mortality in Swedish obese subjects

BACKGROUND

Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality.

METHODS

The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%).

RESULTS

The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29).

CONCLUSIONS

Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

Mortality, mental disorders and addiction: a 5-year follow-up of 82 homeless men in Stockholm

A 5-year follow-up study was performed on 82 homeless men, with mental problems, who had been contacted by an outreach team run by the Social welfare administration of Stockholm 1995/1996. Data have been collected from the Cause of Death Register, death certificates, forensic autopsy reports, hospital medical reports, Hospital Discharge Register, interviews with social workers and with those men who were able to participate. The standardized mortality ratio (SMR) was 4.7 times higher than expected. The highest mortality was found in the group where drug addiction was dominant; 46% had died. In the group of men with severe psychiatric disorders, with diagnosis such as schizophrenia, none had died. Compared with the others, they had spent less time in homelessness. Among the survivors, 75% were still homeless at the follow-up in spite of considerable treatment interventions from the social services and health authorities. Residential institutions or treatment seemed to have some protective effect concerning misuse, diseases and injuries. Among the still homeless, the mental health problems combined with substance use problems had increased with 17%. The life and housing situation for the whole group seemed not to have improved, even if fewer of them were staying in hostels for homeless people.

Transfer of 137Cs from Chernobyl debris and nuclear weapons fallout to different Swedish population groups

Data from measurements on the body burden of (134)Cs, (137)Cs and (40)K in various Swedish populations between 1959 and 2001 has been compiled into a national database. The compilation is a co-operation between the Departments of Radiation Physics in Malmö and Göteborg, the National Radiation Protection Authority (SSI) and the Swedish Defense Research Agency (FOI). In a previous study the effective ecological half time and the associated effective dose to various Swedish populations due to internal contamination of (134)Cs and (137)Cs have been assessed using the database. In this study values of human body burden have been combined with data on the local and regional ground deposition of fallout from nuclear weapons tests (only (137)Cs) and Chernobyl debris (both (134)Cs and (137)Cs), which have enabled estimates of the radioecological transfer in the studied populations. The assessment of the database shows that the transfer of radiocesium from Chernobyl fallout to humans varies considerably between various populations in Sweden. In terms of committed effective dose over a 70 y period from internal contamination per unit activity deposition, the general (predominantly urban) Swedish population obtains 20-30 microSv/kBq m(-2). Four categories of populations exhibit higher radioecological transfer than the general population; i.) reindeer herders ( approximately 700 microSv/kBq m(-2)), ii.) hunters in the counties dominated by forest vegetation ( approximately 100 microSv/kBq m(-2)), iii.) rural non-farming populations living in sub-arctic areas (40-150 microSv/kBq m(-2)), and iv.) farmers ( approximately 50 microSv/kBq m(-2)). Two important factors determine the aggregate transfer from ground deposition to man; i.) dietary habits (intakes of foodstuff originating from natural and semi-natural ecosystems), and ii.) inclination to follow the recommended food restriction by the authorities. The transfer to the general population is considerably lower ( approximately a factor of 3) for the Chernobyl fallout than during the 1960s and 70s, which is partly explained by a higher awareness of the pathways of radiocaesium to man both by the public and by the regulating authorities, and by the time-pattern of the nuclear weapons fallout during the growth season in Sweden.

Ecological half-time and effective dose from chernobyl debris and from nuclear weapons fallout of 137Cs as measured in different Swedish populations

The fallout in Sweden of radiocesium from nuclear weapons tests during the 1960's (137Cs) and from the Chernobyl accident in 1986 (134Cs and 137Cs) has transferred to humans through different ecological pathways. Data from whole-body burden measurements of 134Cs, 137Cs, and 40K in various Swedish populations between 1964 and 2002 have been compiled. This database enables an evaluation of the temporal and geographical dependence of the transfer of radiocesium from ground deposition to humans and the associated absorbed dose. The body burdens of 137Cs gradually decrease after the peak values reached in 1965 from nuclear weapons fallout and in 1987 from the Chernobyl fallout, but at a varying rate depending on the population. Assuming a dual exponential decrease, a short-term component of typically 1-2 y and a long-term component of 5-10 y are found in urban populations in Sweden. Among reindeer herders and hunters the effective ecological half-time is mono-exponential with a half-time of 5-7 y. The estimated time-integrated effective dose to an individual during a period of 50 y from the Chernobyl fallout is, on average, approximately 10 mSv for reindeer herders, which is 10-100 times higher than the estimated dose received by urban populations in the three major Swedish urban areas (Malmö, Göteborg, and Stockholm).

Comparative estimations of 137Cs distribution in a boreal forest in northern Sweden using a traditional sampling approach and a portable NaI detector

Field-portable detectors have been frequently used in routine monitoring and hazard assessment studies. However, there have been few thorough attempts to evaluate their potential as an alternative to the traditional procedure of collecting samples and analysing them in the laboratory. Thus, in this study the two approaches were compared in terms of their utility for monitoring (137)Cs activity in the Nyänget catchment in northern Sweden. The objectives were: (i) to determine the (137)Cs activity in soils associated with three types of vegetation, (ii) to map the geographical distribution of (137)Cs using the portable NaI detector connected to a GPS system (GDM-40), (iii) to identify (137)Cs anomalies in the catchment, and (iv) to compare the measurements obtained with the NaI detector and traditional sampling followed by laboratory analysis. Our results demonstrate that the GDM-40 has very good potential for making (137)Cs inventories and for detecting (137)Cs anomalies within large areas. The GDM-40 measurements identified differences between different hydrological areas that were not determined with the soil sampling method. The GDM-40 method is much faster than a traditional soil sampling method. However, soil sampling cannot be totally excluded because it is needed to calibrate the GDM-40. The agreement between the (137)Cs activity values obtained by the two approaches was 20% which is good in the field where so many factors vary.

In situ gamma-ray spectrometry for environmental monitoring: a semi empirical calibration method

In situ gamma spectrometry using high-purity germanium (HPGe) detectors is a frequently used method for the determination of radionuclide ground deposition levels. Such measurements do, however, require an efficiency calibration based on detector sensitivity and parameters such as soil density and vertical activity distribution. In this work, a novel expression is used for the detector efficiency, incorporating both the influence of photon energy and incidence angle. Detector-specific efficiency data are determined empirically. For the theoretical calculation of the photon fluence at the detector, a three-layer model of finite thickness is developed for the description of soil density and vertical activity distribution. In order to facilitate the calibration of in situ measurements, a PC program has been developed to enable rapid, on-site calculations of radionuclide ground deposition levels. The semi empirical calibration method was tested on in situ measurements with two different detectors, and the results show good agreement with results obtained from traditional soil sampling.

Cost of in-patient care over 7 years among surgically and conventionally treated obese patients

OBJECTIVE

Bariatric surgery improves cardiovascular risk factors and quality of life, but few studies have directly addressed the relation between obesity treatment and hospitalization costs. This prospective controlled study compares in-patient care between surgically and conventionally treated obese patients.

RESEARCH METHODS AND PROCEDURES

A total of 962 surgically and conventionally treated obese patients from the intervention study, Swedish Obese Subjects, were followed for 6 years. Changes in days of hospitalization and hospitalization costs were analyzed. Information on hospitalizations for each subject were obtained from the Swedish Hospital Discharge Register.

RESULTS

After 6 years, weight change was -16.7% in the surgical group and +0.9% in the control group (p < 0.0001). The cumulated hospital stay over 6 years was 23.4 days in the surgical group and 6.9 days in the control group (p < 0.0001). The average hospital cost for the surgical intervention was US$4300. Incremental costs that could be attributable to obesity surgery averaged US$1200 per year. After exclusion of hospitalizations for the surgical intervention and conditions common after bariatric surgery, there were no significant differences between the groups in number of hospital days or hospitalization costs.

DISCUSSION

Our experience from bariatric surgery indicates that average weight reductions of 16% will not reduce hospitalization costs over 6 years. Costs of bariatric surgery are limited and seem to be motivated given the marked improvements of cardiovascular risk factors, cardiac structure, and function and health-related quality of life.

Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study

BACKGROUND

Obesity is associated with increased morbidity rates and pharmaceutical costs. To what extent various medication costs are affected by intentional weight loss is unknown.

METHODS

A cross-sectional comparison of the use of prescribed pharmaceuticals was conducted in 1286 obese individuals in the Swedish Obese Subjects (SOS) intervention study and 958 randomly selected reference individuals. Medication changes for 6 years after bariatric surgery were evaluated in 510 surgically and 455 conventionally treated SOS patients.

RESULTS

Compared with the reference group, obese individuals were more often taking diabetes mellitus, cardiovascular disease, nonsteroidal anti-inflammatory and pain, and asthma medications (risk ratios ranging from 2.3-9.2). Average annual costs for all medications were 1400 Swedish kronor (SEK) (US $140) in obese individuals and 800 SEK (US $80) in the reference population (P<.001). Average yearly medication costs during follow-up were 1849 (US $185) in surgically treated patients (weight change -16%) and 1905 SEK (US $190) in weight-stable conventionally treated patients (P =.87). The surgical group had lower costs for diabetes mellitus (difference: -94 SEK/y (-US $9]) and cardiovascular disease medications (difference: -186 SEK/y (-US $19]) but higher costs for gastrointestinal tract disorder (difference: +135 SEK/y [US $13]) and anemia and vitamin deficiency medications (difference: +50 SEK/y [US $5]).

CONCLUSIONS

Use and cost of medications are markedly increased in obese vs reference populations. Surgical obesity treatment lowers diabetes mellitus and cardiovascular disease medication costs but increases other medication costs, resulting in similar total costs for surgically and conventionally treated obese individuals for 6 years.

Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy

Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status I-II patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were randomized into one of two groups: Group P (Placebo) and Group R (0.5% Ropivacaine). Twenty milliliters of normal saline or ropivacaine, respectively, were injected intraperitoneally at the end of surgery via a catheter placed in the bed of the gall bladder. Postoperatively, intermittent injections (10 mL) of the study solution were given when required for pain. Ketobemidone 1-2 mg was given IV as rescue medication. Pain was assessed using a visual analog scale at 1, 2, 3, 4, 8, 12, 16, and 20 h after surgery and once each day for 1 wk at rest (deep pain), shoulder and incision sites, and pain during coughing. Recovery was assessed by the time to transfer from Phase 1 to 2, the ability to walk, drink, and eat, and the ability to void. Plasma concentrations of ropivacaine were measured in eight patients. Time to ability to walk, defecation, driving a car, and return to normal activities were also recorded through a questionnaire sent home with the patient. During the first 4 postoperative h, patients in Group R had lower scores for deep pain and during coughing compared with Group P (P < 0.05). No differences were found in the postoperative consumption of ketobemidone. Median times to recovery at home were similar between the groups. By the seventh day, 93% of the patients had returned to normal activities of daily living. We conclude that the early postoperative pain after ambulatory laparoscopic cholecystectomy could be relieved using intermittent injections of ropivacaine 0.5% into the bed of the gall bladder.

IMPLICATIONS

Early postoperative pain can be relieved by intermittent injections of ropivacaine 0.5% through a catheter placed in the bed of the gall bladder after ambulatory laparoscopic cholecystectomy.

Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study

BACKGROUND

Although intentional weight reduction improves obesity-related comorbidities, the associations between weight reduction, medication and related costs are rarely studied. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects.

METHODS

In the intervention study Swedish Obese Subjects, 510 surgically and 455 conventionally treated obese patients have so far been followed for 6 y. Changes in the use and costs of medication were analyzed in relation to treatment and weight change.

RESULTS

In comparison with controls, larger fraction of surgically treated patients discontinued the use of medication for CVD and diabetes at 2 and 6 y (risk ratios 0.56-0.77). Among subjects not initially on medication, surgery reduced the frequency of started treatments (risk ratios 0.08-0.80). Relative weight loss >or=10% was necessary to reduce costs of medication for CVD and diabetes among subjects with such treatment at baseline. To reduce initiation of new treatment against the two conditions, weight loss >or=15% was required. Over 6 y, the average annual cost for diabetes and CVD medication increased by 463 SEK (96%) in subjects with weight loss <5%, and decreased by 39 SEK(8%) in the weight loss group >or=15%.

CONCLUSION

Long-term intentional weight loss is associated with reduced medication and medication costs for diabetes and CVD. The effects appear to be more marked among subjects who are initially on medication for these conditions, whereas greater weight reduction is needed to prevent new subjects from starting on medication.

Seasonal and long-term variations in 137Cs among adults from Swedish hunter families

To study seasonal variations in 137Cs, whole-body content measurements of adults from Swedish hunter families have been performed in autumn 1997 and spring 1998. Measurements were performed in three locations, By, Harbo and Gävle, geographically close (within 100 km of each other) but with large differences in ground deposition levels. The hunter families at these three locations were previously measured in 1994. The measured persons were also asked for their frequency of intake of moose, roe-deer, reindeer, freshwater fish, mushrooms and berries. A statistically significant lower frequency of intake of mushrooms and berries in By, moose, roe deer and mushrooms in Harbo, and moose in Gävle was found in springtime compared to autumn. In one of the locations, there was a statistically significant lower average 137Cs whole-body content in spring 1998 than in autumn 1997 while in the other two locations no such effects could be seen. The 137Cs whole-body content has decreased by 37% from 1994 and to 1998 (including physical decay) correlated to an effective ecological half time of 6 years.

Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study

OBJECTIVES

To analyse sick leave and disability pension among surgically and conventionally treated obese patients.

DESIGN

A prospective study over five years. Differences in sick leave and disability pension were analysed using multiple and logistic regressions. Possible confounding factors were analysed and controlled for.

SETTING

Nine counties in Sweden.

SUBJECTS

369 surgically treated patients and 371 matched obese controls, included in the Swedish Obese Subjects (SOS) study. At baseline, mean body mass index (BMI) was 42 kg/m2 in surgical patients and 41 kg/m2 in controls. After four years of treatment, weight reduction was 20% among surgical patients while the control patients kept their initial weight.

INTERVENTION

Gastric bariatric surgery.

MEASUREMENTS

Days of sick leave plus disability pension, and days of disability pension.

RESULTS

In the year prior to treatment, adjusted average number of days of sickness due to sick leave plus disability pension was similar in surgical patients and controls. Compared with controls, the surgical group had 35% more days of sickness during the first year after initiation of treatment, but 10-14% fewer days during years 2-3. During year four, days of sickness tended to be lower in the surgical group (P = 0.07). In the sub-group, aged above the median, surgical patients had 14-18% fewer days of sickness than controls, during years 2-3 after initiation of treatment This difference did not occur in the group below median age.

CONCLUSION

Surgical treatment of obesity results in a reduction of sick leave and disability pension, compared to controls, particularly in subjects aged 47-60 y.

Behavioural anxiolytic effects of low-dose anabolic androgenic steroid treatment in rats

The use of anabolic androgenic steroids (AAS) in supratherapeutic doses has been associated with aggressive behaviour as well as with severe affective and psychotic symptoms. These symptoms usually follow a chronic exposure for several months. However, AAS also may have milder effects with hypomania-like features such as an increase in confidence, energy and self-esteem. We have studied the short-term effects on male rat behaviour in a modified open-field test of the AAS Metenolon administered three times at a low dose (0.01 mg/kg/week x 3). The control rats showed indications of increased timidity and aversive learning following retesting, a reaction that was absent in the AAS-treated rats. The AAS-treated rats showed less fear or anticipatory anxiety compared to control animals. Furthermore, the suppressed marking behaviour and altered morphological allometric relationships were compatible with a modified social and sexual competence in the AAS treated rats.

Radioactive cesium in Swedish hunters

The whole-body content of radiocesium has been measured in Swedish men and women from households where at least one member is a hunter. Measurements were performed at 5 locations in Sweden where the ground deposition levels ranged from 7 to 80 kBq m(-2). The average whole body content of 137Cs varied between 0.3 and 1.9 kBq for women and 0.6 and 4.7 kBq for men, depending on the deposition level. The transfer factor for 137Cs, relating ground deposition to activity concentration in humans, was less dependent on deposition level for the hunter families than for previously studied populations. The transfer factor varied between 0.4 and 1.1 Bq kg(-1)/kBq m(-2), and was dependent on ground deposition and sex.

Changes in mortality, arrests, and hospitalizations in nonvoluntarily treated heroin addicts in relation to methadone treatment

This study analyzes the mortality, hospitalizations, and arrests in a cohort of severe intravenous heroin users divided into three groups: those in methadone treatment, those discharged from treatment, and those who never received treatment. The study population consists of 101 heroin users, of whom 56 were HIV-seropositive. Because of intensive drug misuse, they underwent coercive residential treatment in Stockholm during the 3-year period 1986-1988. The mortality was lower in the methadone group, and all seven deaths were related to HIV-infection. Outside the program, 24 of 29 persons died from external violence and poisoning.

Olfactory cues from an oxytocin-injected male rat can induce anti-nociception in its cagemates

We recently demonstrated an olfactorily induced tail skin temperature drop in saline-injected rats exposed to an oxytocin-injected cagemate, an effect abolished by olfactory impairment. Treatment with oxytocin may induce both nociceptive and anti-nociceptive effects. The contrasting effects likely depend on the model and dosage used. Here we report an increased hindpaw withdrawal latency in response to nociceptive heat following the subcutaneous administration of oxytocin (1 mg/kg). An increased withdrawal response latency was also found in the untreated cagemates of an oxytocin-treated rat. The anti-nociceptive effect was abolished in oxytocin-antagonist-injected cagemates. Our results suggests that an olfactorily induced oxytocinergic mechanism is activated in the cagemates of an oxytocin-injected rat promoting anti-nociception.

Mortality and causes and manner of death among drug addicts in Stockholm during the period 1981-1992

A cohort of 1640 hospitalized drug addicts was studied over an 8-year period, and consisted of 678 heroin users, 578 amphetamine users and 384 users of other drugs. In total, 234 addicts were HIV-positive, most of them heroin users. During the observation period, 214 deaths occurred in the cohort. The total mortality was 2.2% annually. Death linked to injection of heroin was the main cause of death not only among heroin users but also among subjects classified as users of amphetamines or other drugs. During the observation period, a total of 222 addicts (115 of whom were HIV-positive) entered the methadone programme. No deaths occurred among the HIV-negative subjects who were participating in the methadone programme. A total of 15 HIV-positive subjects died while taking part in the programme--13 of these subjects from natural causes (mostly HIV/AIDS).

Olfactory cues from an oxytocin-injected male rat can reduce energy loss in its cagemates

Rats can recognize the odor of a stressed conspecific and react with stress themselves. Stress mobilizes energy, causing increased core temperatures and energy loss by radiation from the naked tail. Oxytocin administered in high doses (1 mg/kg, s.c.) reduces a rat's tail skin temperature and thereby the radiated energy loss. While administration of this high dose of oxytocin induces sedation low doses induce anxiolysis. This study demonstrates that the cagemates of an oxytocin-treated (1 mg/kg s.c.) rat, which themselves have not received any oxytocin-treatment, show energy conservation, apparent as reduced tail skin temperature. This effect was blocked by olfactory impairment. The temperature reduction in the cagemates probably reflects an oxytocin-mediated olfactorily activated stress inhibitory mechanism.

High-dose anabolic androgenic steroids modulate concentrations of nerve growth factor and expression of its low affinity receptor (p75-NGFr) in male rat brain

The effects of treatment with a high dose of nandrolone or testosterone on nerve growth factor (NGF) levels and NGF low-affinity receptor (p75-NGFr) distribution in the brain were analyzed. Nandrolone, subcutaneously injected in rats for several weeks, caused an increase of NGF levels in the hippocampus and septum and a decrease in the hypothalamus. The number of p75-NGFr-immunoreactive neurons and the p75-NGFr expression levels were reduced in the septum and vertical and horizontal Broca's bands. Testosterone injections caused an increase of NGF levels in the hippocampus, septum, and occipital cortex and induced an upregulation of p75-NGFr in the forebrain NGF target regions. This testosterone effect suggests that nandrolone and testosterone affect brain NGF target cells by a different mechanism(s). Nandrolone may interfere with NGF transport and/or utilization by forebrain neurons, causing an altered p75-NGFr expression and NGF accumulation as a consequence. Since NGF is known to maintain forebrain neurons and to regulate neurobehavioral functions, including memory, learning, and defensive behavior, it is possible to hypothesize that this neurotrophin may play a role in the mechanism of action of anabolic androgenic steroids (AAS) in the brain and be associated with endocrine and behavioral dysfunctions occurring due to AAS abuse.

A comparison of iron absorption from single meals and daily diets using radioFe (55Fe, 59Fe)

The purpose of the present study was to compare two measures of Fe absorption, one from single meals and the other from daily diets. Ten ileostomy subjects were given the same low-fibre composite diet for all three meals each day for five consecutive days. After 3 weeks the experiment was repeated with a high-fibre diet. The morning meal constituted one-seventh of the total daily diet intake, the mid-day meal two-sevenths and the evening meal four-sevenths of the total daily diet intake. On days 4 and 5 of each diet period the morning meal was labelled with 55Fe and all three meals were labelled with 59Fe. The activities retained in the subjects 19 d later showed the Fe absorption from the low-fibre diet measured from the morning meals to be almost 80% greater than the average Fe absorption measured from all meals during the same 2 d. With the high-fibre diet the absorption from the morning meals was less than 50% greater than the average for all meals but the difference was not significant. We suggest that all meals of the day should be labelled with radioFe in order to avoid inflating the measures of Fe absorption.

Massage-like stroking of the abdomen lowers blood pressure in anesthetized rats: influence of oxytocin

The aim of this study was to determine how massage-like stroking of the abdomen in rats influences arterial blood pressure. The participation of oxytocinergic mechanisms in this effect was also investigated. The ventral and/or lateral sides of the abdomen were stroked at a speed of 20 cm/s with a frequency of 0.017-0.67 Hz in pentobarbital anesthetized, artificially ventilated rats. Arterial blood pressure was recorded with a pressure transducer via a catheter in the carotid artery. Stroking of the ventral, or both ventral and lateral sides of the abdomen for 1 min with a frequency of 0.67 Hz caused a marked decrease in arterial blood pressure (approx. 50 mmHg). After cessation of the stimulation blood pressure returned to the control level within 1 min. The maximum decrease in blood pressure was achieved at frequencies of 0.083 Hz or more. Stroking only the lateral sides of the abdomen elicited a significantly smaller decrease in blood pressure (approx. 30 mmHg decrease) than stroking the ventral side. The decrease in blood pressure caused by stroking was not altered by s.c. administration of an oxytocin antagonist (1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin, 1 mg/kg) directed against the uterine receptor. In contrast, the administration of 0.1 mg/kg of oxytocin diminished the effect, which was antagonized by a simultaneous injection of the oxytocin antagonist. These results indicate that the massage-like stroking of the abdomen decreases blood pressure in anesthetized rats. This effect does not involve intrinsic oxytocinergic transmission. However, since exogenously applied oxytocin was found to diminish the effect of stroking, oxytocin may exert an inhibitory modulatory effect on this reflex arc.

The oxytocin antagonist 1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin reverses the increase in the withdrawal response latency to thermal, but not mechanical nociceptive stimuli following oxytocin administration or massage-like stroking in rats

In this study the effect of exogenous oxytocin and of massage-like stroking on the withdrawal latency responses to heat and mechanical nociceptive stimulation were investigated in rats. A hot-plate test and the Randall-Selitto test were used to assess the withdrawal responses. Exogenous oxytocin (0.1-1 mg/kg) and stroking (a low frequency mechanical stimulation) significantly increased the withdrawal latencies in response to mechanical and to thermal nociceptive stimuli. The effect of oxytocin and of stroking in the hot-plate test was reversed by the oxytocin antagonist (1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin) directed against the uterine receptor. In contrast, the antagonist did not affect the prolonged response latency in the mechanical nociceptive stimulation test following either exogenous oxytocin or stroking. These results support the view that (1) oxytocin administration affects directly or indirectly nociceptive related behaviour in response to heat stimulation, and (2) massage-like stroking may have an anti-nociceptive effect via activation of oxytocinergic mechanisms. Since the response to mechanical stimulation was not blocked by the antagonist the mechanisms mediating the withdrawal latency to heat and mechanical stimulation could be different.

Anti-nociceptive effects of oxytocin in rats and mice

The existence of neural opioid-mediated networks that are specific for the modulation of nociception is well established. Parallel non-opioid pathways exist, but their underlying physiology is little known. We now report that oxytocin administered intraperitoneally to rats, and intraperitoneally or intracisternally to mice has an anti-nociceptive effect, which is related to the activation of descending anti-nociceptive pathways. This anti-nociceptive effect can be reversed by an oxytocin antagonist but not by the opioid antagonist naloxone. The anti-nociceptive effect of oxytocin is not directly dependent on the activation of serotonergic pathways or to changes in temperature. Our data indicate that the oxytocinergic system has a modulatory function on nociception.

Mortality in alcohol-related diseases in Sweden during 1971-80 in relation to occupation, marital status and citizenship in 1970

A new Swedish population register, created by linking Census data to the Cause of Death Registry and covering over 99% of the population, has been used to study the relationship between occupational category, marital status and citizenship in 1970 and mortality in closely alcohol-related diseases during 1971-1980 for the ages 25-64 years. Age-standardized rate ratios (SRR) have been computed for mortality in alcoholism, alcohol intoxication and alcohol psychosis ("AAA") and in liver cirrhosis. SRR-values for both diagnose categories and both sexes were higher than average among not gainfully employed (SRR = 3.71 among males and SRR = 1.96 among females in 1976-80 for "AAA"), among employees in the service sector, engine-drivers and unskilled workers and increased in liver cirrhosis among artists and authors. Among females there were smaller variations in mortality for occupational groups than among males. The SRR-values showed a tendency to be higher in 1976-80 than in 1971-75, probably due to health-related selection to some extent. The alcohol-related mortality was also increased among divorced, widows (SRR = 1.37 for "AAA" and 2.81 for liver cirrhosis in 1976-80) and widowers and among never married males. SRR was much higher among Finnish citizens in Sweden (SRR for "AAA" = 3.85 among males and 2.35 among females in 1976-80) than among males and females living in Finland (SRR for "AAA" = 1.13 among males and 0.36 among females) and also higher than among immigrants from other countries, summed (SRR for "AAA" = 0.62 among males and 0.64 among females).(ABSTRACT TRUNCATED AT 250 WORDS)

Validation of diagnoses on death certificates for male alcoholics in Stockholm

The mortality and the causes of death have been studied in a cohort consisting of 1548 male alcoholics in Stockholm. During the period 1969-1981 there were 542 cases of death in this population. The mortality rates were triple those for males in Stockholm generally. Using the official causes of death there was a highly significant excess mortality in the following diagnostic groups: Cancer in the upper digestive region, primary hepatic cancer, cirrhosis in the liver, pancreatitis, pneumonia, alcoholism and alcoholic poisoning, suicides and other causes of violent death as well as ischemic heart disease. The underlying and contributing causes of death on the death certificates were reclassified according to ICD-rules using clinical records and autopsy protocols. It was found that the underlying cause of death was incorrect in 21.8% of the cases. Important information was withheld in further 19.8%. After validation there was no longer any excess mortality in ischemic heart disease. The number of alcohol-related diagnoses, i.e. alcoholic cardiomyopathy, cirrhosis and fatty liver with alcoholism and alcoholic intoxication, was much greater. It is concluded that there is a underreporting of alcohol-related diseases and injuries which has a great influence on the reliability of death statistics.

A prospective randomized comparison of gastric bypass and gastroplasty. Complications and early results

Fifty-seven morbidly obese patients were randomized to gastric bypass (29) or gastroplasty (28) and observed for 24 months postoperatively. Operating time and hospital stay were longer and peroperative and postoperative complications somewhat more common in the bypass than in the gastroplasty group. But weight loss at 1 year was significantly greater and failures significantly fewer after gastric bypass. Four gastroplasties were converted to bypass after 18-24 months because of failure to lose weight. Gastric bypass was judged to be much the preferable of the two operations. Dumping occurred in some patients with bypass but not after gastroplasty. Dumping was not associated with greater weight loss. Peroperatively measured pouch volume showed significant correlation with weight loss after gastroplasty, but not after bypass. Peroperative pouch volume and postoperatively measured stoma diameter were co-acting factors, which in multiple regression analysis could explain observed variance in weight loss to about 40% after gastroplasty, but to a negligible degree after gastric bypass.

Has mortality related to alcohol decreased in Sweden?

In Sweden sales of alcohol dropped 17% from 1976 to 1982. Similarly, comparison of data from 1979 and 1982 shows that the mortality from cirrhosis of the liver declined appreciably, by 28% in men and 29% in women. During 1979-82 mortality from pancreatitis also declined noticeably, by 30% in men and 36% in women. By contrast, no decrease occurred in mortality from alcoholic psychosis, alcoholism, or alcohol intoxication. The decrease in mortality from cirrhosis of the liver and pancreatitis is probably explained by a decrease in the consumption of alcohol among an important subgroup of high consumers of alcohol. The lack of a decrease in mortality from alcoholic psychosis, alcoholism, and alcohol intoxication may be because such diagnoses are often made in socially deteriorated, more dependent alcoholic subjects who have not been able to reduce their consumption.

The use of con A Sepharose as an affinity adsorbent in a simple assay of serum sialyl and fucosyltransferase and its application in tumour diagnosis

A considerably simplified assay for recording sialyl- and fucosyltransferase in human serum is presented. Serum samples incubated with labeled nucleotide-sugar and glycosylated endogenous acceptor molecules were adsorbed to Con A Sepharose and quantitated by scintillation counting. The results correlated with those of a much more time consuming acid precipition method, and displayed a higher diagnostic sensitivity due to the improved specificity of the method and the combined recording of the two activities. A correlation between serum sialyl- and fucosyltransferase activities as well as quantitative agreement between the amount of incorporated sialic acid and fucose indicated that rhe endogenous acceptor molecules were rate-limiting for transfer and may themselves have diagnostic potential.