Solid-state synthesis and physico-chemical characterization of modified smectites using natural clays from Burkina Faso

Solid-state intercalation was applied to prepare organo-smectites using cationic surfactants and natural clays containing smectite at various surfactant/smectite ratios. The surfactants enter the interlayers of smectites causing a swelling of the clays. The used clays were collected in Siétougou and Diabari villages located in the eastern part of Burkina Faso. The solid-state intercalation was successful for all four surfactants applied, n-dodecyltrimethylammonium bromide, (n-C12H25(CH3)3NBr), n-tetradecyltrimethylammonium bromide, (n-C14H29(CH3)3NBr), n-hexadecyltrimethylammonium bromide (n-C16H33(CH3)3NBr) and di-n-dodecyldimethyl­ammonium bromide ((n-C12H25)2(CH3)2NBr) at different levels of the cation exchange capacity (CEC). The synthesized organo-smectites were characterized regarding relative density, structural and textural properties. XRPD data showed a systematic increase of the basal spacing of the unit cell of the smectite up to >38 Å at 2.0-CEC loading of the surfactant. This increase indicates that the surfactants penetrated into the smectite interlayers with the surfactants being arranged parallel to the layers at low concentrations and almost perpendicular at high ones. FTIR spectra of the organo-smectites showed a decrease in the intensities of the water bands at around 1630 cm-1 and 3400 cm-1, and new specific bands close to 2920 cm-1 and 2850 cm-1 were assigned to the asymmetric and symmetric stretching of CH2 groups of the surfactants, respectively.                     KEY WORDS: Smectite, Organo-smectite, Surfactant, Intercalation   Bull. Chem. Soc. Ethiop. 2021, 35(1), 43-59. DOI: https://dx.doi.org/10.4314/bcse.v35i1.4

Ti n+1C n MXenes with fully saturated and thermally stable Cl terminations

MXenes are a rapidly growing family of 2D materials that exhibit a highly versatile structure and composition, allowing for significant tuning of the materials properties. These properties are, however, ultimately limited by the surface terminations, which are typically a mixture of species, including F and O that are inherent to the MXene processing. Other and robust terminations are lacking. Here, we apply high-resolution scanning transmission electron microscopy (STEM), corresponding image simulations and first-principles calculations to investigate the surface terminations on MXenes synthesized from MAX phases through Lewis acidic melts. The results show that atomic Cl terminates the synthesized MXenes, with mere residual presence of other termination species. Furthermore, in situ STEM-electron energy loss spectroscopy (EELS) heating experiments show that the Cl terminations are stable up to 750 °C. Thus, we present an attractive new termination that widely expands the MXenes' functionalization space and enables new applications.

Quality Indicators of Nutritional Care Practice in Elderly Care

OBJECTIVES

The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes.

DESIGN

Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities.

MEASUREMENTS

Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care.

RESULTS

Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems.

CONCLUSION

Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Self-assembled SnO2 micro- and nanosphere-based gas sensor thick films from an alkoxide-derived high purity aqueous colloid precursor

Tin oxide is considered to be one of the most promising semiconductor oxide materials for use as a gas sensor. However, a simple route for the controllable build-up of nanostructured, sufficiently pure and hierarchical SnO2 structures for gas sensor applications is still a challenge. In the current work, an aqueous SnO2 nanoparticulate precursor sol, which is free of organic contaminants and sorbed ions and is fully stable over time, was prepared in a highly reproducible manner from an alkoxide Sn(OR)4 just by mixing it with a large excess of pure neutral water. The precursor is formed as a separate liquid phase. The structure and purity of the precursor is revealed using XRD, SAXS, EXAFS, HRTEM imaging, FTIR, and XRF analysis. An unconventional approach for the estimation of the particle size based on the quantification of the Sn-Sn contacts in the structure was developed using EXAFS spectroscopy and verified using HRTEM. To construct sensors with a hierarchical 3D structure, we employed an unusual emulsification technique not involving any additives or surfactants, using simply the extraction of the liquid phase, water, with the help of dry butanol under ambient conditions. The originally generated crystalline but yet highly reactive nanoparticles form relatively uniform spheres through self-assembly and solidify instantly. The spheres floating in butanol were left to deposit on the surface of quartz plates bearing sputtered gold electrodes, producing ready-for-use gas sensors in the form of ca. 50 μm thick sphere-based-films. The films were dried for 24 h and calcined at 300 °C in air before use. The gas sensitivity of the structures was tested in the temperature range of 150-400 °C. The materials showed a very quickly emerging and reversible (20-30 times) increase in electrical conductivity as a response to exposure to air containing 100 ppm of H2 or CO and short (10 s) recovery times when the gas flow was stopped.

A coordinated cross-disciplinary research initiative to address an increased incidence of narcolepsy following the 2009-2010 Pandemrix vaccination programme in Sweden

In response to the 2009-2010 influenza A(H1N1)pdm09 pandemic, a mass vaccination programme with the AS03-adjuvanted influenza A(H1N1) vaccine Pandemrix was initiated in Sweden. Unexpectedly, there were a number of narcolepsy cases amongst vaccinated children and adolescents reported. In this review, we summarize the results of a joint cross-disciplinary national research effort to investigate the adverse reaction signal from the spontaneous reporting system and to better understand possible causative mechanisms. A three- to fourfold increased risk of narcolepsy in vaccinated children and adolescents was verified by epidemiological studies. Of importance, no risk increase was observed for the other neurological and autoimmune diseases studied. Genetic studies confirmed the association with the allele HLA-DQB1*06:02, which is known to be related to sporadic narcolepsy. Furthermore, a number of studies using cellular and molecular experimental models investigated possible links between influenza vaccination and narcolepsy. Serum analysis, using a peptide microarray platform, showed that individuals who received Pandemrix exhibited a different epitope reactivity pattern to neuraminidase and haemagglutinin, as compared to individuals who were infected with H1N1. Patients with narcolepsy were also found to have increased levels of interferon-gamma production in response to streptococcus-associated antigens. The chain of patient-related events and the study results emerging over time were subjected to intense nationwide media attention. The importance of transparent communication and collaboration with patient representatives to maintain public trust in vaccination programmes is also discussed in the review. Organizational challenges due to this unexpected event delayed the initiation of some of the research projects, still the main objectives of this joint, cross-disciplinary research effort were reached, and important insights were acquired for future, similar situations in which a fast and effective task force may be required to evaluate vaccination-related adverse events.

Risks of neurological and immune-related diseases, including narcolepsy, after vaccination with Pandemrix: a population- and registry-based cohort study with over 2 years of follow-up

OBJECTIVES

To investigate the association between vaccination with Pandemrix and risk of selected neurological and immune-related diseases including narcolepsy.

DESIGN

Population-based prospective cohort study using data from regional vaccination registries and national health registries.

SETTING

Seven healthcare regions in Sweden comprising 61% of the Swedish population.

SUBJECTS

Study population of 3,347,467 vaccinated and 2,497,572 nonvaccinated individuals (vaccination coverage ≈ 60%) followed between 2009 and 2011 for 6.9 million person-years after exposure and 6.0 million person-years without exposure.

MAIN OUTCOME MEASURE AND ANALYSIS

First recorded diagnosis of neurological and immune-related diseases. Relative risks [hazard ratios (HRs) with 95% confidence intervals (CIs)] assessed using Cox regression, adjusted for covariates.

RESULTS

For all selected neurological and immune-related outcomes under study, other than allergic vaccine reactions (for which we verified an expected increase in risk) and narcolepsy, HRs were close to 1.0 and always below 1.3. We observed a three-fold increased risk of a diagnosis of narcolepsy (HR: 2.92, 95% CI: 1.78-4.79; that is, four additional cases per 100,000 person-years) in individuals ≤ 20 years of age at vaccination and a two-fold increase (HR: 2.18, 95% CI: 1.00-4.75) amongst young adults between 21 and 30 years of age. The excess risk declined successively with increasing age at vaccination; no increase in risk was seen after 40 years of age.

CONCLUSIONS

For a large number of selected neurological and immune-related diseases, we could neither confirm any causal association with Pandemrix nor refute entirely a small excess risk. We confirmed an increased risk for a diagnosis of narcolepsy in individuals ≤ 20 years of age and observed a trend towards an increased risk also amongst young adults between 21 and 30 years.

Assessment of PCDD/Fs levels in soil at a contaminated sawmill site in Sweden--a GIS and PCA approach to interpret the contamination pattern and distribution

Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-p-furans (PCDD/Fs) were analysed in soil from a Swedish sawmill site where chlorophenols (CPs) had been used more than 40 years ago. The most contaminated area at the site was the preservation subarea where the PCDD/F WHO2005-TEQ level was 3450 times higher than the current Swedish guideline value of 200 ng TEQ/kg soil for land for industrial use. It was also shown that a fire which destroyed the sawmill might have affected the congener distribution at the concerned areas. To get a broader picture of the contamination both GIS (spatial interpolation analysis) and multivariate data analysis (PCA) were applied to visualize and compare PCDD/F levels as well as congener distributions at different areas at the site. It is shown that GIS and PCA are powerful tools in decisions on future investigations, risk assessments and remediation of contaminated sites.

Metal leaching from MSWI bottom ash as affected by salt or dissolved organic matter

In order to manage municipal solid waste incineration (MSWI) bottom ash safely, risk assessments, including the prediction of leaching under different field conditions, are necessary. In this study, the influence of salt or dissolved organic matter (DOM) in the influent on metal leaching from MSWI bottom ash was investigated in a column experiment. The presence of salt (0.1M NaCl) resulted in a small increase of As leaching, whereas no impact on leachate concentration was found when lakewater DOM (35.1mg/l dissolved organic carbon) was added. Most of the added DOM was retained within the material. Further, X-ray spectroscopy revealed that Cu(II) was the dominating form of Cu and that it probably occurred as a CuO-type mineral. The Cu(2+) activity in the MSWI bottom ash leachate was most likely determined by the dissolution of CuO together with the formation of Cu-DOM complexes and possibly also by adsorption to (hydr)oxide minerals. The addition of lake DOM in the influent resulted in lower saturation indices for CuO in the leachates, which may be due to slow CuO dissolution kinetics in combination with strong Cu-DOM complexation.

Mechanisms of heavy metal sorption on alkaline clays from Tundulu in Malawi as determined by EXAFS

Chromium(III), copper(II), zinc(II), cadmium(II), mercury(II) and lead(II) cations are among the most common heavy metal pollutants in industrial waste waters. In our continued work on cost effective wastewater heavy metal removal agents and methods using local material, this study examines the interactions of chromium(III), copper(II), zinc(II), cadmium(II), mercury(II) and lead(II) cations with natural mixed clay minerals from Tundulu in Malawi using extended X-ray absorption fine structure (EXAFS) spectroscopy. The mixed clays were previously characterised and found to contain illite, low ordered kaolinite, mixed layer minerals and the non-clay mineral carbonate fluoroapatite with a mean pH(PZC) of 9.63. The EXAFS analyses provided qualitative evidence that oxygen atoms occupy the first coordination shells in all the studied central atoms. The metal species on the clay mineral surfaces seem to be adsorbates and/or precipitates of hydrolysis products. Chromium(III) forms a polynuclear hydrolysis complex on the mineral surface with Cr-O bond and Cr...Cr distances of 2.00 and 3.03 A, respectively, which is indicative of a chain structure with edge sharing CrO(6) octahedra. Copper(II) is bound to phosphate groups on the surface at low pH and has a first shell of coordinated oxygen atoms with Jahn-Teller distortion as revealed by different Cu-O bonds of 1.96 A for the equatorial ones, at 2.30 and 2.65 A for the axial oxygens, and a Cu-P distance at 3.29 A is distinguished as well. Upon treatment at neutral pH copper(I) oxide seems to be the main precipitation product on the clay surface. At neutral pH zinc(II) forms also polynuclear hydrolysis complexes with Zn-O bond and Zn...Zn distances of 2.01 and 3.11A, respectively, which shows the presence of edge sharing ZnO(4) tetrahedra. Cadmium(II) is adsorbed to the clay surfaces as a six-coordinated CdO(6) complex in octahedral fashion, but it is not possible to distinguish if cadmium is hydrated or partly hydrolysed. Mercury(II) is present as linear O-Hg-O units but without any observable Hg...Hg distance at high pH showing that mercury(II) is hydrolysed but not present as mercury(II) oxide. At low pH, linear O-Hg-Hg-O units are present showing that mercury(II) is reduced to mercury(I). No precise chemical environment around the lead(II) could be obtained for the lead(II) treated clays due to formation of different hydrolysis structures with multiple coordination numbers by lead(II) salts on the mixed clays.

What is the harm-benefit ratio of Cox-2 inhibitors?

BACKGROUND

Selective cyclooxygenase-2 (Cox-2) inhibitors, developed to reduce the risk of NSAID-related gastrointestinal (GI) complications, have been associated with an increased risk of cardiovascular events. Our objective was to determine the balance of potential harm and benefit related to Cox-2 inhibitors' exposure.

METHODS

The study population included patients aged 40+ years who received a prescription for Cox-2 inhibitors and were included in the General Practice Research Database. The incidence of upper GI events, myocardial infarction (MI) and stroke was estimated in this cohort. It was assumed that patients had experienced the upper GI and cardiovascular effects, as observed in clinical trials [relative rate (RR) of 0.49 for upper GI and 1.86 for MI]. Simulation methodology was used to estimate attributable risks, i.e. the difference between exposed and unexposed event probabilities.

RESULTS

The study population included 155,439 Cox-2 users. The number of upper GI events prevented by Cox-2 inhibitors was 179, while the number of excess MI cases was 83 per 10,000 patients treated for 4 years. A strong association was found between extent of GI benefit and cardiovascular harm. There was a large difference in the frequency of benefit over harm in only 6% of the patients (difference of 1% or more); 23% of the patients had more harm than benefit, including those with a history of ischaemic heart disease.

CONCLUSIONS

The benefit of Cox-2 inhibitors in reducing the frequency of upper GI events may be offset by their cardiovascular harm, particularly in patients with risk factors for cardiovascular disease.

Endometriosis and the risk of cancer with special emphasis on ovarian cancer

BACKGROUND

Several observations of the coexistence of endometriosis and cancer have been published. One study concerning endometriosis patients from 1969 to 1986 showed an overall relative cancer risk of 1.2 and relative risks for breast cancer, ovarian cancer and non-Hodgkin's lymphoma to be 1.3, 1.9 and 1.8, respectively. The aim of this study was to see whether these risk ratios stand in an extended study with longer follow-up.

METHODS

Women discharged from a hospital, with a diagnosis of endometriosis from 1969 to 2000, were identified using the National Swedish Inpatient Register. Data were linked to the National Swedish Cancer Register to identify cases of cancer. Data on hysterectomies and oophorectomies were available. Standardized incidence ratios (SIR) were calculated.

RESULTS

64 492 women entered the study. First year of follow-up was excluded, leaving 3349 cases of cancer. There was no increased overall risk of cancer [SIR 1.04, 95% CI 1.00-1.07]. Elevated risks were found for ovarian cancer (SIR 1.43, 95% CI 1.19-1.71), endocrine tumours (SIR 1.36, 95% CI 1.15-1.61), non-Hodgkin's lymphoma (SIR 1.24, 95% CI 1.02-1.49) and brain tumours (SIR 1.22, 95% CI 1.04-1.41). Women with early diagnosed and long-standing endometriosis had a higher risk of ovarian cancer, with SIR of 2.01 and 2.23, respectively. The average age at endometriosis diagnosis was 39.4, indicating that there are the moderate/severe cases that are included in this study. Women who had a hysterectomy before or at the time of the endometriosis diagnosis did not show an increased risk of ovarian cancer.

CONCLUSION

Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer, and the risk increases with early diagnosed or long-standing disease. Hysterectomy may have a preventive effect against ovarian cancer.

Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county

All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Lipids and antioxidative effects of estradiol and sequential norethisterone acetate treatment in a 3-month randomized controlled trial

OBJECTIVE

To determine the influence of hormone replacement therapy on serum lipids and antioxidative factors associated with the risk of coronary heart disease.

METHODS

The effect of a sequential estradiol-norethisterone acetate regimen or placebo on lipid metabolism, antioxidative variables and fatty acid composition in serum was measured during the peak-estrogen phase in a randomized, double-blind, placebo-controlled study of 42 healthy postmenopausal women for 3 months.

RESULTS

Active treatment significantly reduced lipoprotein(a) by 15% (p = 0.005, compared with placebo), low-density lipoprotein (LDL) cholesterol by 10% (p = 0.005) and the LDL cholesterol/high-density lipoprotein (HDL) cholesterol ratio by 11% (p = 0.016). Serum triglycerides increased by 21% (p = 0.045). No effect was observed on HDL cholesterol, on apolipoproteins apo A(1) or apo B, or on non-esterified fatty acids in serum. No treatment effect was seen in the proportions of monounsaturated and polyunsaturated fatty acids. The concentration of malondialdehyde in serum did not change with the estrogen-progestin treatment.

CONCLUSIONS

This sequential estrogen-progestin therapy has a beneficial effect on apolipoprotein(a) and LDL cholesterol, but no effect on non-esterified fatty acids or the level of lipid peroxidation products in serum.

Crystal and solution structures of N,N-dimethylthioformamide-solvated copper(I), silver(I), and gold(I) ions studied by X-ray diffraction, X-ray absorption, and vibrational spectroscopy

Crystal structures of the solvated copper(I) and silver(I) perchlorate salts crystallizing from N,N-dimethylthioformamide solution have been determined by single-crystal X-ray diffraction at 295 K. Tetrakis(N,N-dimethylthioformamide)copper(I) perchlorate, [Cu(SCHN(CH(3))(2))(4)]ClO(4), crystallizes in the monoclinic space group P2/n (No. 13) with a = 8.428(2), b = 9.605(2), and c = 15.096(3) A, beta = 104.35(2) degrees, and Z = 2. The copper(I) ion in a site of C(2) symmetry coordinates four N,N-dimethylthioformamide ligands in a slightly distorted tetrahedral coordination with Cu-S bond distances of 2.3249(8) and 2.3494(8) A. The triclinic (P1, No. 2) tris(N,N-dimethylthioformamide)silver(I) perchlorate, Ag(SCHN(CH(3))(2))(3)ClO(4), with a = 7.4149(5), b = 7.7953(5), and c = 17.1482(1) A, alpha = 98.341(5), beta = 93.910(5), and gamma = 107.084(5) degrees, and Z = 2, contains centrosymmetric Ag(2)(SCHN(CH(3))(2))(6)(2+) dimers in which two almost planar AgS(3) units are held together by an asymmetric double sulfur bridge with one short and one long Ag-S bond, 2.529(1) and 2.930(1) A, respectively. The Ag-S bond distances to the two terminal N,N-dimethylthioformamide ligands are 2.469(1) and 2.543(1) A. The solvated copper(I) and silver(I) ions in solution were found by means of large-angle X-ray scattering (LAXS) to coordinate four N,N-dimethylthioformamide molecules with the mean Cu-S and Ag-S bond distances 2.36(1) and 2.58(1) A, respectively, probably with distorted tetrahedral coordination geometry, while an EXAFS study gave the Cu-S bond distance 2.34(1) A. EXAFS studies showed a linear S-Au-S entity with an Au-S bond distance of 2.290(5) A in the structure of the solid bis(N,N-dimethylthioformamide)gold(I) tetrafluoroborate, Au(SCHN(CH(3))(2))(2)BF(4). The structure in solution is similar with a mean Au-S bond distance of 2.283(4) A. Raman and infrared vibrational spectra of the solvated copper(I), silver(I), and gold(I) ions in the solid state and N,N-dimethylthioformamide solution have been recorded and assigned.

Structure of the dimethyl sulfoxide solvated thallium(III) ion in solution and in the solid state

The structure and vibrational spectra of the dimethyl sulfoxide solvated thallium(III) ion have been studied in a dimethyl sulfoxide solution and in the solid state. X-ray crystallography shows a trigonal unit cell, space group R(-)3 (No. 148), for the [Tl(dmso)(6)](ClO(4))(3) compound with Z = 3, a = b = 11.9764(13) [11.8995(9)] A, c = 20.802(2) [20.467(2)] A, and V = 2584.0(5) [2509.9(4)] A(3) at 295 [150] K. The crystal structure comprises a highly symmetric hexakis(dimethyl sulfoxide)thallium(III) ion, with thallium in a (-)3 symmetry site and a Tl-O bond distance of 2.224(3) A at 295 K. The octahedral TlO(6) kernel is compressed along the threefold axis with an O-Tl-O bond angle of 96.20(11) degrees. The Tl-O-S bond angle of 120.7(2) degrees corresponds to a Tl.S distance of 3.292(2) A. One perchlorate ion centered on the (-)3 axis was described by a statistically disordered model. A low-temperature EXAFS study (10 K) resulted in the Tl-O and Tl.S distances of 2.221(4) and 3.282(6) A, respectively, consistent with a Tl-O-S bond angle of 120(1) degrees. The low Debye-Waller factors confirm a regular coordination without the disorder of the dimethyl sulfoxide ligands, which would have resulted from the alternative choice of space group R3 for the crystal structure. Raman and infrared spectra have been recorded and assigned, with the bands at 435 and 447 cm(-)(1) corresponding to the vibrational frequency of the symmetric and asymmetric Tl-O stretching modes, respectively. EXAFS data of a 0.5 mol dm(-3)thallium(III) trifluoromethanesulfonate in a dimethyl sulfoxide solution were consistent with that of a hexasolvated ion with mean Tl-O and Tl.S distances of 2.22(1) and 3.33(2) A, respectively, which correspond to a mean Tl-O-S bond angle of 124(2) degrees. The anomalously large disorder parameter for the Tl-O distances is consistent with a weak pseudo-Jahn-Teller effect. The (205)Tl, (13)C, and (1)H NMR spectra of the complex in solution show single signals at 1886, 39.5, and 2.3 ppm, respectively.

Metabolic gene polymorphism frequencies in control populations

Using the International Project on Genetic Susceptibility to Environmental Carcinogens (GSEC) database containing information on over 15,000 control (noncancer) subjects, the allele and genotype frequencies for many of the more commonly studied metabolic genes (CYP1A1, CYP2E1, CYP2D6, GSTM1, GSTT1, NAT2, GSTP, and EPHX) in the human population were determined. Major and significant differences in these frequencies were observed between Caucasians (n = 12,525), Asians (n = 2,136), and Africans and African Americans (n = 996), and some, but much less, heterogeneity was observed within Caucasian populations from different countries. No differences in allele frequencies were seen by age, sex, or type of controls (hospital patients versus population controls). No examples of linkage disequilibrium between the different loci were detected based on comparison of observed and expected frequencies for combinations of specific alleles.

New class of oligonuclear platinum-thallium compounds with a direct metal-metal bond. 5. Structure determination of heterodimetallic cyano complexes in aqueous solution by EXAFS and vibrational spectroscopy

The structures of three closely related heterodimetallic cyano complexes, [(NC)(5)Pt-Tl(CN)(n)()](n)()(-) (n = 1-3), formed in reactions between [Pt(II)(CN)(4)](2)(-) and Tl(III) cyano complexes, have been studied in aqueous solution. Multinuclear NMR data ((205)Tl, (195)Pt, and (13)C) were used for identification and quantitative analysis. X-ray absorption spectra were recorded at the Pt and Tl L(III) edges. The EXAFS data show, after developing a model describing the extensive multiple scattering within the linearly coordinated cyano ligands, short Pt-Tl bond distances in the [(NC)(5)Pt-Tl(CN)(n)()](n)()(-) complexes: 2.60(1), 2.62(1), and 2.64(1) A for n = 1-3, respectively. Thus, the Pt-Tl bond distance increases with increasing number of cyano ligands on the thallium atom. In all three complexes the thallium atom and five cyano ligands, with a mean Pt-C distance of 2.00-2.01 A, octahedrally coordinate the platinum atom. In the hydrated [(NC)(5)Pt-Tl(CN)(H(2)O)(4)](-) species the thallium atom coordinates one cyano ligand, probably as a linear Pt-Tl-CN entity with a Tl-C bond distance of 2.13(1) A, and possibly four loosely bound water molecules with a mean Tl-O bond distance of about 2.51 A. In the [(NC)(5)Pt-Tl(CN)(2)](2)(-) species, the thallium atom probably coordinates the cyano ligands trigonally with two Tl-C bond distances at 2.20(2) A, and in [(NC)(5)Pt-Tl(CN)(3)](3)(-) Tl coordinates tetrahedrally with three Tl-C distances at 2.22(2) A. EXAFS data were reevaluated for previously studied mononuclear thallium(III)-cyano complexes in aqueous solution, [Tl(CN)(2)(H(2)O)(4)](+), [Tl(CN)(3)(H(2)O)], and [Tl(CN)(4)](-), and also for the solid K[Tl(CN)(4)] compound. A comparison shows that the Tl-C bond distances are longer in the dinuclear complexes [(NC)(5)Pt-Tl(CN)(n)()](n)()(-) (n = 1-3) for the same coordination number. Relative oxidation states of the metal atoms were estimated from their (195)Pt and (205)Tl chemical shifts, confirming that the [(NC)(5)Pt-Tl(CN)(n)()](n)()(-) complexes can be considered as metastable intermediates in a two-electron-transfer redox reaction from platinum(II) to thallium(III). Vibrational spectra were recorded and force constants from normal-coordinate analyses are used for discussing the delocalized bonding in these species.

Cigarette smoking, alcohol consumption, and risk of hip fracture in women

BACKGROUND

Previous studies regarding the impact of cigarette smoking on the risk of hip fracture in postmenopausal women have been inconsistent, suggesting different effects in different groups. The effect of alcohol intake on fracture risk is puzzling: moderate alcohol intake appears to increase bone density, and its association with hip fracture is not clear.

METHODS

To assess the associations of cigarette smoking and alcohol consumption with hip fracture risk among postmenopausal women, we conducted an analysis of a population-based case-control study from Sweden. Cases were postmenopausal women, aged 50 to 81 years, who sustained a hip fracture after minor trauma between October 1, 1993, and February 28, 1995; controls were randomly selected from a population-based register during the same period. A mailed questionnaire requesting information on lifestyle habits and medical history was used 3 months after the hip fracture for cases and simultaneously for controls. Age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed by means of logistic regression.

RESULTS

Of those eligible, 1328 cases (82.5%) and 3312 controls (81.6%) responded. Compared with never smokers, current smokers had an increased risk of hip fracture (age-adjusted OR, 1.66; 95% CI, 1.41-1.95). Duration of smoking-particularly postmenopausal smoking-was more important than the amount smoked. Former smokers had a small increase in risk (age-adjusted OR, 1.15; 95% CI, 0.97-1.37) that decreased with the duration of cessation. The age-adjusted OR for women consuming alcohol was 0.80 (95% CI, 0.69-0.93).

CONCLUSIONS

Cigarette smoking is a risk factor for hip fracture among postmenopausal women; risk decreases after cessation. Alcohol consumption has a weak inverse association with risk.

Hydration of some large and highly charged metal ions

EXAFS studies of metal ions with hydration numbers higher than six in aqueous solution, often show asymmetric distribution of the metal-oxygen bond distances. The hydration number can be determined from a correlation with the bond distance. The mean Ca-O distance 2.46(1) A shows the calcium(II) ion to be eight-hydrated in a wide asymmetric distribution. Theoretically calculated EXAFS oscillations for individual snapshots from an MD simulation show large variations. The scandium(III) ion is surrounded by two groups of about eight water molecules, with the mean Sc-O distance 2.185(6) A. The yttrium(III) ion coordinates eight waters in an asymmetric distribution at 2.368(5) A, and the lanthanum(III) ion 6 + 3 water molecules at 2.52(2) and 2.65(3) A, respectively. For the the uranium(IV) and thorium(IV) ions, the M-O distances 2.42(1) and 2.45(1) A, respectively, indicate hydration numbers close to 10.

Multicomponent polyanions. 57. Large-angle X-ray scattering study of aqueous molybdophenylphosphonate solutions

The radial distribution functions are calculated from large-angle X-ray scattering (LAXS) measurements for one concentrated aqueous molybdate/heptamolybdate solution and five aqueous molybdophenylphosphonate solutions (lithium chloride medium). Besides water and hydrated lithium, chloride, and molybdate ions, five species in all, having different nuclearities, are postulated to exist in the solutions, according to equilibrium studies using potentiometry and 31P NMR spectroscopy. The structures of the three polymolybdate species Mo7O24(6-), Mo8O26(4-), and (C6H5P)2Mo5O21(4-), for which the structures are determined crystallographically, are confirmed to exist also in aqueous solution. The principal structures of the remaining two complexes, (C6H5P)Mo6O21(OH2)5(2-) and (C6H5P)Mo7O25(OH2)4-, are elucidated with the use of structures of related species. Both anions have one group of four edge-sharing MoO6 octahedra and another group of two MoO6 octahedra connected by sharing corners, forming a bent unsymmetric six-membered ring, with the C6H5PO3 group placed on the crowded side of the ring. In the former, the group of two MoO6 octahedra is edge-shared, while in the latter, the group is face-shared, resulting in a ring small enough to tetrahedrally coordinate to the seventh molybdenum opposite the phenyl group.

Breast cancer risk in relation to amount of tissue removed during breast reduction operations in Sweden

BACKGROUND

Women who undergo breast reduction operations have substantially lowered risks of breast cancer, and the reasons remain unclear. The current investigation attempted to assess whether the reduction in breast cancer risk was related directly to the amount of breast tissue removed.

METHODS

Medical record retrieval was attempted for 161 breast cancer patients in a Swedish cohort of 31,910 women who had had breast reduction surgery and for 483 women who had not developed breast cancer. Information on amount of breast tissue removed was abstracted along with other factors that influence breast cancer risk. Odds ratios of developing breast cancer were calculated based on amount of breast tissue removed.

RESULTS

The amount of tissue removed was a significant predictor of risk, as subjects in the highest quartile of tissue removal had a significantly lower risk than those in the lowest quartile. Considering the total amount of tissue removed (both breasts), subjects with > or = 1600 versus < 800 grams removed had an odds ratio (OR) of 0.24 [95% confidence interval (CI) 0.1-0.5]. This relation persisted after adjustment for other breast cancer risk factors and was apparent within every subgroup examined.

CONCLUSIONS

The finding that breast cancer risk was reduced in proportion to the amount of tissue removed should be reassuring to women who are considering breast reduction procedures and to women who are electing to have bilateral total prophylactic mastectomies because of a strong genetic predisposition.

Hydration of the calcium ion. An EXAFS, large-angle x-ray scattering, and molecular dynamics simulation study

The structure of the hydrated calcium(II) ion in aqueous solution has been studied by means of extended X-ray absorption fine structure spectroscopy (EXAFS), large-angle X-ray scattering (LAXS), and molecular dynamics (MD) methods. The EXAFS data displayed a broad and asymmetric distribution of the Ca-O bond distances with the centroid at 2.46(2) A. LAXS studies on four aqueous calcium halide solutions (1.5-2 mol dm(-)(3)) gave a mean Ca-O bond distance of 2.46(1) A. This is consistent with a hydration number of 8 determined from correlations between mean distances and coordination numbers from crystal structures. The LAXS studies showed a second coordination sphere with a mean Ca.O(II) distance of 4.58(5) A, and for the hydrated halide ions the distances Cl.O 3.25(1) A, Br.O 3.36(1) A, and I.O 3.61(1) A were obtained. Molecular dynamics simulations of CaCl(2)(aq) were performed using three different Ca(2+)-OH(2) pair potentials. The potential from the GROMOS program gave results in agreement with experiments, i.e., a coordination number of 8 and an average Ca-O distance of 2.46 A, and was used for further comparisons. Theoretical EXAFS oscillations were computed for individual MD snapshots and showed very large variations, though the simulated average spectrum from 2000 snapshots gave satisfactory agreement with the experimental EXAFS spectra. The effect of thermal motions of the coordinated atoms is inherent in the MD simulation method. Thermal disorder parameters evaluated from simulated spatial atom distribution functions of the oxygen atoms coordinated to the calcium ion were in close agreement with those from the current LAXS and EXAFS analyses. The combined results are consistent with a root-mean-square displacement from the mean Ca-O distance of 0.09(2) A in aqueous solution at 300 K.

Estrogens in the causation of breast, endometrial and ovarian cancers - evidence and hypotheses from epidemiological findings

Estrogens along with progesterone/progestins, and other hormones, are important determinants of cancer in the breast, endometrium and ovary. Estrogens may increase the risk of breast cancer through various mechanisms and at various phases of life, with a possible synergistic effect of progesterone/progestins. Exposure to high doses of placental hormones, such as estrogens and/or progesterone, during pregnancy may play a pivotal role in reducing subsequent breast cancer susceptibility. Estrogens cause endometrial cancer, an effect that can be reduced, prevented or reversed by progesterone/progestin - if allowed to act for a sufficiently long period of each cycle. The role of sex hormones seems important for ovarian carcinogenesis. Intake of combined oral contraceptives has a substantial and well-documented protective effect on endometrial and ovarian cancer risks. Epidemiological observations and experimental data from an animal model indicate that estrogens may have an adverse effect, while progesterone/progestins have a risk reducing effect directly on the ovarian epithelium. Thus, estrogens and other sex hormones have potential effects on the three most important female cancers. Research has yet to define how some of the risk factors can be modified or treatment regimens can be improved to reduce these cancer risks.

Physical activity and postmenopausal endometrial cancer risk (Sweden)

OBJECTIVES

To examine the hypothesis that sedentary women have an increased risk of endometrial cancer compared to physically active women.

METHODS

This is a population-based case-control study in the entire Swedish female population aged 50-74 years in 1994-1995. We obtained self-reported information on leisure-time physical activity during childhood, at ages 18-30, and recently from 709 incident case women with endometrial cancer and 3368 population controls. Occupational physical activity was estimated through record linkage to the Swedish census data from 1960, 1970, 1980, and 1990. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for different activity levels by multivariate logistic regression, taking into account potential confounders.

RESULTS

Comparing lowest to highest (reference) levels of physical exercise, we observed statistically significant associations with risk of endometrial cancer for leisure-time activity at age 18-30 years (multivariate OR = 1.4; 95% CI = 1.0-1.8; p for trend 0.01) and in recent years (multivariate OR = 1.3; 95% CI = 1.0-1.7; p for trend 0.01). We found similar associations comparing lowest to highest (reference) levels of occupational activity assessed at the censuses in 1980 (multivariate OR = 1.4; 95% CI = 1.0-1.9; p for trend 0.03) and 1990 (multivariate OR = 1.3; 95% CI = 0.9-1.9, p for trend 0.05), but a less consistent association with censuses in 1960 and 1970. The increased risk associated with low level of occupational physical activity was confined to women who were not obese and to women who were smokers.

CONCLUSION

Our data, in conjunction with past epidemiological studies, indicate that both occupational and leisure-time physical activity may reduce the risk for postmenopausal endometrial cancer.

Steric effects control the structure of the solvated lanthanum(III) ion in aqueous, dimethyl sulfoxide, and N,N'-dimethylpropyleneurea solution. An EXAFS and large-angle X-ray scattering study

The structure of the solvated lanthanum(III) ion has been determined in aqueous, dimethyl sulfoxide, and N,N'-dimethylpropyleneurea solution by means of the EXAFS and large-angle X-ray scattering (LAXS) techniques. The close agreement between the EXAFS spectra of solid nonaaqualanthanum(III) trifluoromethanesulfonate and of an aqueous lanthanum(III) perchlorate solution shows that the hydrated lanthanum(III) ion in aqueous solution most probably has the same structure as in the solid, i.e., nine water molecules coordinated in a tricapped trigonal prismatic configuration. The data analysis from EXAFS and LAXS measurements of the aqueous solution resulted in the La-O bond distances 2.52(2) and 2.65(3) A to the water molecules in the prism and the capping positions, respectively. The LAXS study shows a second hydration sphere consistent with approximately 18 water molecules at 4.63(2) A. The EXAFS spectra of solid octakis(dimethyl sulfoxide)lanthanum(III) trifluoromethanesulfonate and a dimethyl sulfoxide solution of this salt are also similar. The data analysis of EXAFS and LAXS measurements assuming eight-coordination around lanthanum yielded an La-O bond distance of 2.50(2) A, and an La...S distance of 3.70(3) A, giving an La-O-S angle of 133(2) degrees. The EXAFS data of an N,N'-dimethylpropyleneurea solution of lanthanum(III) trifluoromethanesulfonate gave the La-O bond distance 2.438(4) A and the La...C distance 3.41(2) A, which correspond to an La-O-C angle of 131(2) degrees. The La-O bond distance is consistent with seven-coordination around lanthanum, on the basis of the variation of the ionic radii of the lanthanum(III) ion with different coordination numbers.

Solvation of the bismuth(III) ion by water, dimethyl sulfoxide, N,N'-dimethylpropyleneurea, and N,N-dimethylthioformamide. An EXAFS, large-angle X-ray scattering, and crystallographic structural study

The structure of the solvated bismuth(III) ion in aqueous, dimethyl sulfoxide, N,N'-dimethylpropyleneurea, and N,N-dimethylthioformamide solution has been studied by means of EXAFS and large-angle X-ray scattering (LAXS). The crystal structures of the solid compounds octakis(dimethyl sulfoxide)bismuth(III) perchlorate, [Bi(OS(CH3)2)8](ClO4)3, hexakis(N,N'-dimethylpropyleneurea)bismuth(III) perchlorate, [Bi(OCN2(CH2)3(CH3)2)6](ClO4)3, and nonaaquabismuth(III) trifluoromethanesulfonate, [Bi(H2O)9](CF3SO3)3 (redetermination), have been determined. The aqueous solutions must be strongly acidic, since the hydrated bismuth(III) ion starts to hydrolyze into Bi6O4(OH)4(6+) complexes already at an excess of strong acid at 1.0 mol.dm-3. For very acidic aqueous perchlorate solutions, the LAXS and EXAFS data gave a satisfactory fit for eight-coordination of the bismuth(III) ion, with a mean Bi-O bond distance of 2.41(1) A. The crystal structure of octakis(dimethyl sulfoxide)bismuth(III) perchlorate shows that the bismuth(III) ion coordinates eight dimethyl sulfoxide molecules via the oxygen atoms in a distorted square antiprismatic configuration. The mean Bi-O bond distance is 2.43 A and the mean Bi...S distance 3.56 A. For the dimethyl sulfoxide solution, the corresponding mean distances were found to be 2.411(6) and 3.535(12) A. The N,N'-dimethylpropyleneurea-solvated bismuth(III) ion is octahedrally coordinated in both solid state and solution with the Bi-O bond distances of 2.324(5) and 2.322(3) A, respectively. The bismuth(III) ion is six-coordinated in the sulfur donor solvent N,N-dimethylthioformamide with a mean Bi-S bond distance of 2.794(8) A. A comparison with the structure of the solvated lanthanum(III) ion shows that the bismuth(III) ion is smaller for all coordination numbers. New effective ionic radii for the bismuth(III) ion in different coordination numbers are proposed, based on results in this study and in the literature.

Breast cancer following breast reduction surgery in Sweden

Women undergoing breast reduction surgery have been reported to be at low subsequent risk of breast cancer, especially when the surgery is performed after age 40. To evaluate the age and time-related patterns of cancer risk following surgical removal of breast tissue, we identified 31,910 women who underwent breast reduction surgery from 1965 to 1993 in Sweden using hospital discharge register data. There were 19,975 women (63 percent) under age 40 at surgery. Linkages with Swedish registries for cancer, death, and emigration were based on unique national registration numbers assigned to each Swedish resident. Cancer incidence was contrasted with that expected in the general population based on age- and calendar year-specific data from the nationwide cancer registry. Overall, 161 incident breast cancers were identified during 238,765 person-years of observation (mean, 7.5 years) compared with 223.9 expected (standardized incidence ratio = 0.72; 95 percent confidence interval = 0.61 to 0.84). The reduction in risk of breast cancer was most pronounced for women whose operations were performed after age 50 (SIR = 0.57) and for those followed for more than 5 years (SIR = 0.68). Among women operated on before age 40, risk was nonsignificantly elevated within the first 5 years after surgery (SIR = 1.47; 95 percent CI = 0.89 to 2.30) but tended to be reduced thereafter (SIR = 0.80; 95 percent CI = 0.55 to 1.13). The magnitude of the reduction in risk thus appears directly related to age at surgery. Women followed for an average of 7.5 years after bilateral breast reduction surgery, were at a statistically significant 28 percent decreased risk of breast cancer. The current study is thus consistent with a protective effect following partial removal of breast glandular tissue.

Ultrasonographic blood flow measurement in the carotid arteries in postmenopausal women

OBJECTIVES

The aim of the present study was to evaluate blood flow in postmenopausal women on hormone replacement therapy (HRT) compared to controls. Blood flow was ultrasonographically measured in the great arteries of the neck instead of in the vessels of the internal genital organs.

METHODS

Fifty healthy women with climacteric complaints, at least 6 months postmenopausal, participated in the study. They were randomly divided into two groups. One group received 2 mg estradiol (E2) for 12 days, continued with 2 mg E2 and 1 mg norethisterone acetate for 10 days, followed by 1 mg E2 for 6 days, cyclically during 6 months. The other group received placebo tablets the first 3 months and the same HRT as the first group for the last 3 months. Blood flow was measured ultrasonographically by color flow pulsed Doppler in the common (CCA), internal (ICA) and external (ECA) carotid arteries, before the start of the study, after 3 and 6 months of therapy.

RESULTS

CCA and ICA, both low resistance vessels, and ECA, a high resistance vessel, and their waveforms were identified. Pulsatility index did not decrease statistically significant (p > 0.05) in any of the great vessels during 6 months of HRT in this study. There were no differences in blood flow between the HRT-treated group compared to control group during 3 months of therapy, except for the right ECA (p = 0.04).

CONCLUSION

The difference in blood flow and wave-forms of the major arteries of the neck were clearly shown, but HRT did not have any important impact on the blood flow in this study. No difference was shown concerning blood flow between the two groups of postmenopausal women, on active therapy or placebo.

Astrocyte beta1-adrenergic receptor immunoreactivity and agonist induced increases in [Ca2+]i: differential results indicative of a modified membrane receptor

Antibodies against the C-terminus of the beta1-adrenergic receptor were used for staining cultured astrocytes from the rat cerebral cortex. Immunoreactivity was found to be localized exclusively to an intracellular organelle structure similar to the Golgi complex, with no staining of the plasma membrane. The astrocytes stained positive with BODIPY CGP 12177, a FITC-conjugated beta-adrenergic receptor agonist, and this staining was blocked by the beta1-adrenergic antagonist atenolol, indicating that these receptors are expressed on the surface of the astrocytes. The presence of functional plasma membrane beta1-adrenergic receptors was further verified using microspectrofluorometry for measurements of intracellular calcium changes upon beta-adrenergic agonist stimulation. Intracellular immunoreactivity confined to the organelles was also found in astrocytes from mixed astroglial-neuronal cultures. In contrast, the neurons in these cultures showed a strong labeling of the cell bodies by the beta1-adrenergic receptor antibodies. Thus, the beta1-adrenergic receptor antibody, which stains the cell bodies of the neurons, recognizes the astroglial receptors only intracellularly, although functional beta1-adrenergic receptors are present on the astroglial surface. Taken together, these data suggest that the beta1-adrenergic receptors observed intracellularly might be processed on their passage to the surface to a modified form of the final plasma membrane receptor, which is not recognized by the antibodies.

Risk of myocardial infarction after oophorectomy and hysterectomy

To determine the risk of developing a first myocardial infarction after a hysterectomy and/or oophorectomy. Case-cohort analysis performed among 17,126 women in the Uppsala Health Care Region of Sweden, who had undergone a hysterectomy and/or oophorectomy in 1965 to 1983. Record linkage was used for follow-up and medical records to ascertain the actual history of oophorectomy. Risk estimates were calculated by relating the observed number of cases in the cohort to that expected on the basis of incidence rates in the population. Overall, 214 cases of myocardial infarction were observed. In premenopausal women a bilateral oophorectomy alone tended to increase the relative risk 1.6; 95% CI 0.8-3.1, but this operation combined with hysterectomy increased the risk only among those aged 50 and over at surgery. Hysterectomy at premenopausal age or unilateral oophorectomy did not alter the risk of myocardial infarction. In naturally menopausal women, hysterectomy-mainly for uterine myoma-was associated with a four-fold increase in relative risk (3.8; 95% CI 1.9-7.8). Hysterectomy for treatment of myoma performed after a natural menopause is linked to an excess risk for myocardial infarction. Bilateral oophorectomy before menopause may increase the risk of myocardial infarction.