Environmental Detection of Parasites in the Marginalized Paiute Reservations Compared to a Nearby Area

The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission and give indications of the possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks in Paiute indigenous tribal areas in southwestern Utah and from the higher income city of St. George, Utah, and tested them for 11 parasites that can cause human disease. Molecular tests revealed an elevated odds ratio (OR) of 3.072 (range, 1.114-8.065) for detecting the helminth Trichuris trichiura and an elevated OR of 3.036 (range, 1.101-7.966) for any protozoa (not including Acanthamoeba) in the tribal land playgrounds compared with St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have more parasites in the soil, which may lead to higher disease prevalence rates.

Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area

The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission as well as giving indications of possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks located on Paiute indigenous tribal areas in southwest Utah and from higher income city of St. George, Utah, and tested them for the presence of 11 parasites that can cause human disease. Molecular tests revealed elevated odds ratio of detecting the helminth Trichuris trichiura 3.072 (1.114 to 8.065) and any protozoa (not including Acanthamoeba ) 3.036 (1.101 to 7.966) in the tribal land playgrounds compared to St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have higher presence of parasites in the soil that may lead to higher rates of disease prevalence.

Degeneration alters the biomechanical properties and structural composition of lateral human menisci

OBJECTIVE

Because the literature relating to the influence of degeneration on the viscoelasticity and tissue composition of human lateral menisci remains contradictory or completely lacking, the aim of this study was to fill these gaps by comprehensively characterising the biomechanical properties of menisci with regard to the degree of degeneration.

DESIGN

Meniscal tissue from 24 patients undergoing a total knee replacement was collected and the degeneration of each region classified according to Pauli et al. For biomechanical characterisation, compression and tensile tests were performed. Additionally, the water content was determined and infrared (IR) spectroscopy was applied to detect changes in the structural composition, particularly of the proteoglycan and collagen content.

RESULTS

With an increasing degree of degeneration, a significant decrease of the equilibrium modulus was detected, while simultaneously the water content and the hydraulic permeability significantly increased. However, the tensile modulus displayed a tendency to decrease with increasing degeneration, which might be due to the significantly decreasing amount of collagen content identified by the IR measurements.

CONCLUSION

The findings of the current study may contribute to the understanding of meniscus degeneration, showing that degenerative processes appear to mainly worsen viscoelastic properties of the inner circumference by disrupting the collagen integrity.

Experimentally derived incorporation rates and diet-to-tissue discrimination values for carbon and nitrogen stable isotopes in gray wolves (Canis lupus) fed a marine diet

Recent studies have noted the differential effects of marine versus terrestrial diets on the carbon and nitrogen stable isotope (13C and 15N, respectively) diet-to-tissue discrimination values and incorporation rates for omnivorous and carnivorous mammals. Inaccurate estimates of these parameters may result in misrepresentation of diet composition or in the timing of diet shifts. Here, we present the results of a diet-switch experiment designed to estimate diet-to-tissue discrimination values and incorporation rates for tissues of gray wolves (Canis lupus Linnaeus, 1758) fed a diet of Pacific salmon (genus Oncorhynchus Suckley, 1861). Our results demonstrate substantial differences in both parameters between wolves maintained on a marine (salmon) diet and wolves maintained on terrestrially sourced prey (beef, Bos taurus Linnaeus, 1758). Increased awareness of the significance of marine resources to omnivorous and carnivorous consumers, like wolves, highlights the importance of phenomenological and mechanistic understandings of the effects of fish and other marine prey on dietary investigations based on stable isotopes.

US NCI's Center for Global Health Regional Centers for Research Excellence Program to Support Research Infrastructure on Noncommunicable Diseases, Metal Health, and Injuries

Background and context: To advance our broad, collective understanding of cancer epidemiology, prevention, diagnosis, and treatment. Sophisticated researchers have an inclination that populations in low- and middle-income countries (LMICs) may hold the essential keys needed to advance our understanding carcinogenesis and other disease progression. Aim: To address this need, the US NCI's Center for Global Health selected 11 meritorious, peer-reviewed teams of investigators, throughout the world, to receive Regional Centers of Research Excellence Planning Grants (RCREs). RCRE centers are designed to focus the US NCI's ongoing, international research investments in cancer epidemiology, prevention, diagnosis, and treatment in places where international populations are essential to making progress for humankind. Strategy/Tactics: The RCRE program galvanizes investigators, clinicians, and patients in LMIC communities. It answers their requests (1) by including investigators from both high-, middle-, and lower-income countries; (2) by encouraging multiple chronic conditions to be studied together; and (3) is driven by the research needs to of the people living in the LMIC communities. Program/Policy process: Furthermore, the RCRE program smooths the way for investigators to plan centers that coordinate the cancer and NCD research needs by providing the investigators with protected time. Lastly, each RCRE team is required to complete a small demonstration project in the LMICs. Outcomes: At the end of the two-year planning grant, all 11 RCRE teams will have created a plan for a Regional Center of Research Excellence. Mechanistically, this plan will have several sections, that together will recount the center's scientific impact on the region. The plan will influence researchers, clinicians, patients, policy makers, and members of civil society as they identify the cancer and other NCD research areas pertinent to their community. Six of the 11 centers focused their cancer pilot research project on breast cancer. Five of the centers focused their pilot projects on cervix, esophageal, oral, prostate, or stomach cancer research. Cancer pilot projects ranged from identifying novel risk factors for liver cancer to investigating the association of single nucleotide polymorphisms variants with metabolic syndrome. All RCREs focused on a second NCD including 6 centers focusing on cardiovascular disease and 5 centers focusing on diabetes, injury, or depression research. What was learned: With a modest financial investment, 11 2-year planning grants can be supported. These 11 grants provide finance support for multiple principal investigators, at 23 distinct institutions. These 11 RCRE centers span 16 countries and 10 NCDs. Remarkably, during the first half of their 36-month project period, they have collectively published 10 manuscripts. The NCI Center for Global Health encourages the UICC/WCC community to become involved in this exciting research program.

Hypertrophic intraventricular flow obstruction after very-low-dose dexamethasone (Minidex) in preterm infants: case presentation and review of the literature

The use of dexamethasone in preterm infants developing bronchopulmonary dysplasia has been proven to be effective. Hypertrophic cardiomyopathy is a frequently reported, although transient, side effect of high-dose dexamethasone administration. The recent introduction of very low dexamethasone dose, called 'Minidex', promised equal effectiveness compared to high-dose dexamethasone without relevant side effects. Our study presents two patients developing hypertrophic cardiomyopathy with intraventricular cardiac obstruction after administration of 'Minidex'. Marked cardiac side effects may occur even during very-low-dose dexamethasone treatment in preterm neonates. Betablocker and discontinuation of dexamethasone seem to allow spontaneous reversal of myocardial hypertrophy and obstruction. After all, systematic surveys of the incidence of cardiac complications in a larger population of preterm infants treated with very low doses of dexamethasone are needed.

[Pharmacotherapeutic treatment strategies for smoking cessation]

Regular tobacco smoking occurs in about 35% of the male and 25% of the female German population. Individual attempts to independently quit smoking and to remain abstinent for 1 year have been shown to be successful in less than 5% of cases. This rate can be doubled by means of individual consulting and cognitive-behavioral interventions and additional pharmacological treatment might increase abstinence rates up to 25%. Apart from nicotine substitution (e.g. transdermal, oral and inhalative applications) and bupropion, recent studies have shown beneficial effects of varenicline for smoking cessation and abstinence. Varenicline, a selective partial nicotinergic agonist, has been specifically developed for the purpose of smoking cessation. Currently available data suggest that varenicline is more effective compared to nicotine substitution therapy and bupropion, increasing the abstinence likelihood by a factor of 2.3 compared to a placebo. Recent data regarding anti-nicotine vaccines suggest that this approach might yield a comparable treatment outcome and probably even better relapse-preventing effects than conventional psychopharmacological strategies. The first anti-nicotine vaccines are expected to be approved by national authorities within the forthcoming 1-2 years.

The liver X receptor (LXR) and its target gene ABCA1 are regulated upon low oxygen in human trophoblast cells: a reason for alterations in preeclampsia?

OBJECTIVES

The Liver X receptors (LXR) alpha and beta and their target genes such as the ATP-binding cassette (ABC) transporters have been shown to be crucially involved in the regulation of cellular cholesterol homeostasis. The aim of this study was to characterize the role of LXR alpha/beta in the human placenta under normal physiological circumstances and in preeclampsia.

STUDY DESIGN

We investigated the expression pattern of the LXRs and their target genes in the human placenta during normal pregnancy and in preeclampsia. Placental explants and cell lines were studied under different oxygen levels and pharmacological LXR agonists.

MAIN OUTCOME MEASURES

Gene expressions (Taqman PCR) and protein levels (Western Blot) were combined with immunohistochemistry to analyze the expression of LXR and its target genes.

RESULTS

In the human placenta, LXRA and LXRB expression increased during normal pregnancy. This was paralleled by the expression of their prototypical target genes, e.g., the cholesterol transporter ABCA1. Interestingly, early-onset preeclamptic placentae revealed a significant upregulation of ABCA1. Culture of JAr trophoblast cells and human first trimester placental explants under low oxygen lead to increased expression of LXRA and ABCA1 which was further enhanced by the LXR agonist T0901317.

CONCLUSIONS

LXRA together with ABCA1 are specifically expressed in the human placenta and can be regulated by hypoxia. Deregulation of this system in early preeclampsia might be the result of placental hypoxia and hence might have consequences for maternal-fetal cholesterol transport.

Expanding CEP290 mutational spectrum in ciliopathies

Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.

Psoriasis is associated with pleiotropic susceptibility loci identified in type II diabetes and Crohn disease

BACKGROUND

Psoriasis is an immune-mediated skin disorder that is inherited as a multifactorial trait. Linkage analyses have clearly mapped a primary disease susceptibility locus to the major histocompatibility complex (MHC) region on chromosome 6p21. More recently, whole-genome association studies have identified two non-MHC disease genes (IL12B and IL23R), both of which also confer susceptibility to Crohn disease (CD).

OBJECTIVE AND METHODS

To ascertain the genetic overlap between these two inflammatory conditions further, we investigated 15 CD-associated loci in a psoriasis case-control dataset.

RESULTS

The analysis of 1256 patients and 2938 unrelated controls found significant associations for loci mapping to chromosomes 1q24 (rs12035082, p = 0.009), 6p22 (rs6908425, p = 0.00015) and 21q22 (rs2836754, p = 0.0003). Notably, the marker showing the strongest phenotypic effect (rs6908425) maps to CDKAL1, a gene also associated with type 2 diabetes.

CONCLUSIONS

These results substantiate emerging evidence for a pleiotropic role for s genes that contribute to the pathogenesis of immune-mediated disorders.

Zahnanomalien in der Neuropädiatrie

Zahnanomalien in der Neuropädatrie sind einfach zu diagnostizieren und helfen bei der Diagnose verschiedener Erkrankungen. Sie finden sich bei gut bekannten Krankheitsbildern wie der Incontinentia pigmenti, aber auch bei seltenen wie dem Kohlschütter-Tönz-Syndrom oder dem kürzlich beschriebenen Krankheitsbild der Ataxie, verzögerten Dentition und Hypomyelinisierung. Anomalien von Zahnform, Zahnschmelz und damit Zahnfarbe, Zahnanzahl und Eruption sind möglich. Die Kenntnis dieser Auffälligkeiten ist wichtig für den Genetiker und den Kinderneurologen.

[Prevalence of latent tuberculosis infection in healthcare workers in geriatric care]

INTRODUCTION

The incidence of active tuberculosis rises with age. The present study examined whether this results in an increased prevalence of latent tuberculosis infection (LTBI) in healthcare workers (HCW) in geriatric care, using other HCW as comparison group.

METHODS

Data collection was performed by occupational physicians in three hospitals. The LTBI was diagnosed using the QuantiFERON-TB Gold in Tube (QFT-IT), an Interferon-gamma Release Assay (IGRA). The odds ratios adjusted for age, gender and migration were calculated.

RESULTS

A total of 454 HCW were examined, 58 (12.8 %) of whom worked at geriatric care units. The prevalence of LTBI was 19.0 % in geriatric care and 10.5 % in other HCW. The age, gender, and migration adjusted odds ratio for a positive QFT-IT was 2.4 (5 % CI 1.1 - 5.2) in health care workers working at geriatric care units. A strong positive association between age and LTBI was observed. The prevalence of LTBI increased from 4.6 % in HCW younger than 30 years to 69.2 % in HCW older than 60 years (p < 0.0005).

DISCUSSION

The data suggest an elevated prevalence of LTBI and therefore an elevated infection risk for HCW engaged in geriatric care. The increase of the LTBI prevalence with age might be explained by longer exposure time at work but also by a cohort effect.

[Latent tuberculosis infection in healthcare workers--evaluation of an Interferon-gamma release assay]

INTRODUCTION

The Interferon-gamma release assay (IGRA) is a promising alternative to the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI). But so far only limited experience is available regarding the performance of these IGRAs especially in occupational medicine when used for screening healthcare workers (HCW).

METHOD

In an ongoing study employees of three German hospitals are screened for LTBI using the TST Mendel-Mantoux and the IGRA (QuantiFERON-TB Gold in Tube) simultaneously. Information on earlier tests which had been performed with the multipuncture tests were obtained by interview. Risk factors for a positive test result were calculated using multivariate logistic regression.

RESULTS

The analysis comprises 161 employees for whom information on all the tests - multipuncture test, TST Mendel-Mantoux and IGRA were available. The multipuncture test was positive in 34.8 %, the TST Mendel-Mantoux in 26.7 % and the IGRA in 12.4 % of the participants. When adjusting for the proportion of positive test results caused by cross-reaction with BCG vaccination, the prevalence of LTBI reduces to 18.8 % in the multipuncture test and 19.2 % in the TST Mendel-Mantoux. The Test results of the IGRA were positively correlated with age while the results of the two in-vivo tests were not.

DISCUSSION

The multipuncture test and the TST Mendel-Mantoux overestimate the prevalence of LTBI in HCW. A positive result in the TST should be verified by the IGRA before any further actions are recommended. A larger data base is needed in order to confirm that the IGRA is more sensitive in diagnosing a LTBI than the skin tests.

Efficacy of MitoTracker Green and CMXrosamine to measure changes in mitochondrial membrane potentials in living cells and tissues

BACKGROUND

Chloromethyl-X-rosamine (CMXRos) and MitoTracker Green (MTG) have proved to be useful dyes with which to measure mitochondrial function. CMXRos is a lipophilic cationic fluorescent dye that is concentrated inside mitochondria by their negative mitochondrial membrane potential (MMP). MTG fluorescence has been used as a measure of mitochondrial mass independent of MMP. The fluorescence ratio of the two dyes is a relative measure of the MMP independent of mitochondrial mass. Because MTG was recently reported to be sensitive to MMP, we have reevaluated the effects of loss of MMP on MTG and CMXRos fluorescence, using both flow cytometry and laser scanning confocal microscopy (LSCM).

METHODS

Using flow cytometry, the relative fluorescence of CMXRos, R123, and MTG was determined in human lymphoblastoid cell lines (LCLs) with or without carbonyl cyanide p-trifluoromethoxylphenyl-hydrazone (FCCP), used to collapse the MMP. LSCM analysis was also used to evaluate the effect of FCCP on MTG and CMXRos fluorescence of mouse cells and viable lenses in culture. The cytotoxicity of the dyes was determined using flow analysis of endogenous NADH fluorescence. The sensitivity of MTG fluorescence to H(2)O(2) was also evaluated using flow cytometry.

RESULTS

CMXRos fluorescence was dependent on MMP, whereas MTG fluorescence was not affected by MMP, using either flow or LSCM. Specific staining of mitochondria was seen with both dyes in all cell types tested, without evidence of cytotoxicity, as determined by NADH levels. H(2)O(2) damage slightly increased MTG staining of cells.

CONCLUSIONS

Our results indicate that CMXRos is a nontoxic sensitive indicator of relative changes in MMP, whereas MTG is relatively insensitive to MMP and oxidative stress, using both flow and LSCM analyses, provided optimal staining conditions are used. In addition, these dyes can be useful for the study of mitochondrial morphology and function in whole tissues, using LSCM.

The effect of antibiotic therapy on intrauterine infection-induced preterm parturition in rabbits

OBJECTIVE

The purpose of this study was to determine whether early antibiotic administration to pregnant rabbits with intrauterine infection could prevent preterm delivery and perinatal mortality.

STUDY DESIGN

Under hysteroscopic guidance, pregnant rabbits at 70% gestation (21 days) were allocated to three groups: (1) control group, transcervical inoculation of 0.2 ml phosphate-buffered saline (n = 16); (2) infection group, transcervical inoculation of 0.2 ml of 10(5) colony-forming units (CFU) of Escherichia coli (n = 21); (3) infection and antibiotics group, transcervical inoculations of 0.2 ml of 10(5) CFU of E. coli and ampicillin-sulbactam 150 mg/kg every 8 h intramuscularly (n = 32). To examine the consequences of treatment delay, animals in the latter group were subdivided to receive antibiotics at different time intervals of 0, 6, 11 and 18 h after bacterial inoculation. The intervals from bacterial inoculation to delivery and litter survival were documented. Systemic (rectal) temperatures were recorded at 4 h intervals through the first 36 h and every 12 h until delivery. A p value of < 0.05 was considered significant.

RESULTS

All rabbits inoculated with E. coli without antibiotic treatment delivered prematurely. The median inoculation-to-delivery interval was significantly shorter in the infected group than in the control group (median 32 h, range 14.9-76.5 h vs. median 219 h, range 173-246 h, respectively; p < 0.0001). Antibiotic administration within 12 h of inoculation, but not after 18 h, increased duration of pregnancy (by reducing the rate of preterm delivery) and neonatal survival (0% vs. 71%; p < 0.0001). The mean temperatures at delivery of animals whose treatments began at 6 and 11 h post-inoculation were significantly lower than those untreated with antibiotics or those treated at 18 h post-inoculation (p < 0.0001 for each comparison).

CONCLUSIONS

Antibiotic administration can prolong pregnancy and reduce perinatal mortality if administered early (within 12 h of microbial inoculation) in a rabbit model of ascending intrauterine infection.

Construction of a YAC library from barley cultivar Franka and identification of YAC-derived markers linked to the Rh2 gene conferring resistance to scald (Rhynchosporium secalis)

The Rh2 resistance gene of barley (Hordeum vulgare) confers resistance against the scald pathogen (Rhynchosporium secalis). A high-resolution genetic map of the Rh2 region on chromosome I (7H) was established by the use of molecular markers. Tightly linked markers from this region were used to screen existing and a newly constructed yeast artificial chromosome (YAC) library of barley cv. Franka composed of 45,000 clones representing approximately two genome equivalents. Corresponding YAC clones were identified for most markers, indicating that the combined YAC library has good representation of the barley genome. The contiguous sets of YAC clones with the most tightly linked molecular markers represent entry points for map-based cloning of this resistance gene.

The effects of oral rabeprazole on endocrine and gastric secretory function in healthy volunteers

AIM

To evaluate the short-term effects of rabeprazole 20 mg on endocrine parameters, in particular serum testosterone and cortisol, and on 24 h intragastric pH, H+ activity and nocturnal gastric acid secretion.

METHODS

In this double-blind, two-period crossover study, 12 healthy young male volunteers were randomly given oral rabeprazole 20 mg o.m. or placebo for 14 days. There was a washout period of at least 1 week between the two studies. The effects of rabeprazole and placebo on cortisol and testosterone (primary criteria), and on tri-iodothyronine, thyroxine, 17beta-oestradiol, thyroid-stimulating hormone, thyroxine-binding protein, parathyroid hormone, insulin, glucagon, rennin, aldosterone, follicle-stimulating hormone, luteotrophic hormone, prolactin, somatotrophic hormone, dehydroepiandrosterone, cortisol-binding globulin and urinary 6-beta hydroxycortisol were compared. Intragastric 24 h pH, 24 h H+ activity and nocturnal gastric acid secretion were determined by pH probe and gastric aspiration.

RESULTS

Rabeprazole produced no clinically relevant effects on endocrine function as assessed by measurement of serum testosterone, circadian serum cortisol levels, ACTH-stimulated serum cortisol levels and 17 other endocrine function tests. Rabeprazole significantly increased the 24 h median pH values compared to placebo (on Days 7 and 14 median values ranged from 3.92 to 6.88 with rabeprazole and from 1.48 and 4.22 with placebo, P < 0.001) and significantly decreased the integrated 24 h H+ activity (AUC08--08) from 343 mmol/L/h with placebo to 44 mmol/L/h with rabeprazole (P < 0.001). Following cessation of dosing, intragastric pH levels decreased and H+ activity increased, but acid secretion did not recover completely during the next 72 h. The mean value for nocturnal gastric acid secretion on Days 7 and 8 was 36 mmol/6 h with placebo and 5.6 mmol/6 h with rabeprazole (P < 0.001). Rabeprazole was well tolerated.

CONCLUSION

Rabeprazole did not influence endocrine function in healthy young male volunteers during short-term dosing. Rabeprazole substantially increased intragastric pH over a 24 h period and significantly decreased intragastric acidity and nocturnal gastric acid secretion.

[Evaluation of ambulatory orthopedic-traumatologic rehabilitation by compensation insurance. A comparison with inpatient rehabilitation]

In 1994, "Ambulant Orthopaedic-Traumatologic Rehabilitation" (AOTR) was introduced by the Ersatzkassen health insurance funds. This study investigated structural, process and outcome quality. One of the study questions asked is whether AOTR is as effective for (1) patients with low back pain and clinical signs of disc problems and (2) patients with cruciate ligament injury as the routinely practised inpatient rehabilitation. In a quasi-experimental cohort study patients from five AOTR centers were compared to patients from five orthopedic rehabilitation clinics with regard to their rehabilitation outcome measured on the clinical, disability and handicap level. At the beginning (t0) and the end (t1) of the rehabilitation, data were collected from patients and therapists and 6 months later (t2) only from patients by means of questionnaires. The inclusion criteria for patients with back problems had to be broadened ("patients with low back pain") because of difficulties with patient sampling. Sample sizes were n = 166 (AOTR: 100, inpatient: 66) for t0 and t1 and n = 101 (AOTR: 47, inpatient: 54) for t0, t1 and t2. At baseline, ambulant patients with low back pain were younger (43 vs. 49 years) and better off with regard to disabilities and handicaps than patients from rehabilitation clinics. Clinical signs (e.g., neurological signs, Lasègue sign, flexibility of the spine) showed smaller differences. At t1 clinical, disability and handicaps variables had improved considerably in both groups. At t2 the improvements had stabilized or had become greater. Analyses of variance showed that improvements in the ambulant group were not much greater after accounting for the different baseline status. The sample size of patients with knee ligament injury was n = 66 (AOTR: 50, inpatient: 16). Ambulant patients considerably improved with regard to knee function and handicaps. Despite of small sample sizes this study provides some evidence that (1) AOTR and inpatient rehabilitation both are effective for treating subgroups of patients with low back pain and (2) AOTR is effective for treating patients with cruciate ligament injury.

Enteric coating of aspirin significantly decreases gastroduodenal mucosal lesions

BACKGROUND

Low-dose aspirin (acetylsalicylic acid, ASA) increases the risk of developing peptic ulceration.

AIM

To investigate the gastroduodenal mucosal tolerability of enteric-coated ASA (EC-ASA) 100 mg/day compared to either placebo (study 1) or plain ASA 100 mg/day (study 2) in healthy volunteers.

METHODS

Study 1: In this double-blind study 18 volunteers received randomized dosing with either EC-ASA 100 mg or placebo for 15 days. Study 2: 41 volunteers underwent randomized 7-day dosing of either EC-ASA 100 mg or plain ASA 100 mg in this double-blind, parallel-group, comparison study. In both studies acute gastroduodenal mucosal lesions were assessed endoscopically before treatment, on the morning of day 1 after the first dose (only in study 2), and on the morning after the last dose of the test medication.

RESULTS

Study 1 did not reveal any significant differences between the lesion scores of EC-ASA and placebo. In contrast, in study 2 significantly higher total gastroduodenal mucosal lesion scores were observed on day 1 after the first dose and after 7 days of dosing with plain ASA (mean sum of the lesion scores in the gastric fundus, body, antrum and in the duodenal bulb: day 1: plain ASA 3.95+/-3.38 vs. EC-ASA 1.43+/-1.91, P = 0.03; day 7: plain ASA 6.35+/-4.10 vs. EC-ASA 2.00+/-2.02, P = 0.0004). Tolerance of the test drugs was good, and no other adverse events were observed.

CONCLUSIONS

Enteric-coated aspirin 100 mg/day causes significantly less gastroduodenal damage over 7 days than the same dose of plain aspirin, when given to healthy subjects. There was little gastric injury and no significant differences between EC-ASA and placebo in this respect.

Transforming growth factor-beta, but not ciliary neurotrophic factor, inhibits DNA synthesis of adrenal medullary cells in vitro

Transforming growth factor-betas are members of a superfamily of multifunctional cytokines regulating cell growth and differentiation. Their functions in neural and endocrine cells are not well understood. We show here that transforming growth factor-betas are synthesized, stored and released by the neuroendocrine chromaffin cells, which also express the transforming growth factor-beta receptor type II. In contrast to the developmentally related sympathetic neurons, chromaffin cells continue to proliferate throughout postnatal life. Using 5-bromo-2'-deoxyuridine pulse labeling and tyrosine hydroxylase immunocytochemistry as a marker for young postnatal rat chromaffin cells, we show that treatment with fibroblast growth factor-2 (1 nM) and insulin-like growth factor-II (10 nM) increased the fraction of 5-bromo-2'-deoxyuridine-labeled nuclei from 1% to about 40% of the cells in the absence of serum. In the presence of fibroblast growth factor-2 and insulin-like growth factor-II, transforming growth factor-beta1 (0.08 nM) reduced 5-bromo-2'-deoxyuridine labeling by about 50%, without interfering with chromaffin cell survival or death. Doses lower and higher than 0.08 nM were less effective. Similar effects were seen with transforming growth factor-beta3. In contrast to transforming growth factor-beta, ciliary neurotrophic factor, which inhibits proliferation of sympathetic progenitor cells, was not effective on rat chromaffin cells from postnatal day 6. Glucocorticoids also suppress DNA synthesis in fibroblast growth factor-2/insulin-like growth factor-II-treated chromaffin cells. This effect was not mediated by chromaffin cell-derived transforming growth factor-beta, as shown by addition of neutralizing antibodies. We conclude that one function of adrenal medullary transforming growth factor-beta may be to act as a negative regulator of chromaffin cell division.

Expression of neurotrophin receptors trkB and trkC and their ligands in rat adrenal gland and the intermediolateral column of the spinal cord

Neurotrophins and their trk receptors constitute major classes of signaling molecules with important actions in the developing and adult nervous system. With regard to the sympathoadrenal cell lineage, which gives rise to sympathetic neurons and chromaffin cells, neurotrophin-3 (NT-3) and nerve growth factor (NGF) are thought to influence developing sympathetic neurons. Neurotrophin requirements of chromaffin cells of the adrenal medulla are less well understood than those for NGF. In order to provide the bases for understanding of putative functions of neurotrophins for the development and maintenance of chromaffin cells and their preganglionic innervation, in situ hybridization has been used to study the expression of brain-derived neurotrophic factor (BDNF) and NT-3, together with their cognate receptors trkB and trkC, in the adrenal gland and in the intermediolateral column (IML) of the spinal cord. BDNF is highly expressed in the embryonic adrenal cortex and later in cells of the cortical reticularis zone. Adrenal medullary chromaffin cells fail to express detectable levels of mRNAs for BDNF, NT-3, and their cognate receptors trkB and trkC. Neurons in the IML express BDNF and trkB, and low levels of NT-3 and trkC. Our data make it unlikely that BDNF and NT-3 serve as retrograde trophic factors for IML neurons but suggest roles of BDNF and NT-3 locally within the spinal cord and possibly for sensory nerves of the adrenal cortex.

Slow oxidation of acetoxime and methylethyl ketoxime to the corresponding nitronates and hydroxy nitronates by liver microsomes from rats, mice, and humans

Acetoxime and methylethyl ketoxime (MEKO) are tumorigenic in rodents, inducing liver tumors in male animals. The mechanisms of tumorigenicity for these compounds are not well defined. Oxidation of the oximes to nitronates of secondary-nitroalkanes, which are mutagenic and tumorigenic in rodents, has been postulated to play a role in the bioactivation of ketoximes. In these experiments, we have compared the oxidation of acetoxime and methylethyl ketoxime to corresponding nitronates in liver microsomes from different species. The oximes were incubated with liver microsomes from mice, rats, and several human liver samples. After tautomeric equilibration and extraction with n-hexane, 2-nitropropane and 2-nitrobutane were quantitated by GC/MS-NCI (limit of detection of 250 fmol/injection volume). In liver microsomes, nitronate formation from MEKO and acetoxime was dependent on time, enzymatically active proteins, and the presence of NADPH. Nitronate formation was increased in liver microsomes of rats pretreated with inducers of cytochrome P450 and reduced in the presence of inhibitors (n-octylamine and diethyldithiocarbamate). Rates of oxidation of MEKO (Vmax) were 1.1 nmol/min/mg (mice), 0.5 nmol/min/mg (humans), and 0.1 nmol/min/mg (rats). In addition to nitronates, several minor metabolites were also enzymatically formed (two diastereoisomers of 3-nitro-2-butanol, 2-hydroxy-3-butanone oxime and 2-nitro-1-butanol). Acetoxime was also metabolized to the corresponding nitronate at rates approximately 50% of those observed with MEKO oxidation in the three species examined. 2-Nitro-1-propanol was identified as a minor product formed from acetoxime. No sex differences in the capacity to oxidize acetoxime and MEKO were observed in the species examined. The observed results show that formation of sec-nitronates from ketoximes occurs slowly, but is not the only pathway involved in the oxidative biotransformation of these compounds. Due to the lack of sex-specific oxidative metabolism, other metabolic pathways or mechanisms of tumorigenicity not involving bioactivation may be involved in the sex-specific tumorigenicity of ketoximes in rodents.

Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging

BACKGROUND

Previous studies have shown that gated single photon emission computed tomography (SPECT) technetium 99-labeled sestamibi imaging provides accurate and reproducible measurement of left ventricular (LV) ejection fraction (EF), wall motion, and thickening. This study examined the reliability of gated SPECT sestamibi imaging in measuring LV end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV).

METHODS AND RESULTS

Gated SPECT measurements were compared with an independent nongeometric method based on thermodilution SV and first-pass radionuclide angiographic EF (using a multicrystal gamma camera). Twenty-four patients aged 58+/-11 years underwent cardiac catheterization and coronary angiography for evaluation of chest pain syndromes. None had primary valvular disease, intracardiac shunts, or atrial fibrillation.

RESULTS

The correlation between the two methods were as follows: EDV: r = 0.89, P<.001; ESV: r = .938, P<.001; SV: r = 0.577, P<.001. Bland-Altman plots showed mean differences (+/-standard deviation [SD]) for EDV of -14.3+/-33.3 mL, for ESV of -0.4+/-23.7 mL, and for SV of -13.9+/-15.2 mL. The reproducibility of measuring EDV and ESV by gated SPECT was very high (r = 0.99 each).

CONCLUSION

Gated 99mTc-labeled sestamibi SPECT provides reproducible LV volume measurements. With validation of volume measurement, gated SPECT provides comprehensive assessment of regional and global LV function. This information is important in many patient groups such as those with ischemic cardiomyopathy, concomitant coronary and valve disease, and those who have had myocardial infarction. It will also be useful to assess the incremental value of LV volumes in risk assessment.

TrkB and neurotrophin-4 are important for development and maintenance of sympathetic preganglionic neurons innervating the adrenal medulla

The adrenal medulla receives its major presynaptic input from sympathetic preganglionic neurons that are located in the intermediolateral (IML) column of the thoracic spinal cord. The neurotrophic factor concept would predict that these IML neurons receive trophic support from chromaffin cells in the adrenal medulla. We show here that adrenal chromaffin cells in the adult rat store neurotrophin (NT)-4, but do not synthesize or store detectable levels of BDNF or NT-3, respectively. Preganglionic neurons to the adrenal medulla identified by retrograde tracing with fast blue or Fluoro-Gold (FG) express TrkB mRNA. After unilateral destruction of the adrenal medulla, 24% of IML neurons, i.e., all neurons that are preganglionic to the adrenal medulla in spinal cord segments T7-T10, disappear. Administration of NT-4 in gelfoams (6 microgram) implanted into the medullectomized adrenal gland rescued all preganglionic neurons as evidenced by their presence after 4 weeks. NT-3 and cytochrome C were not effective. The action of NT-4 is accompanied by massive sprouting of axons in the vicinity of the NT-4 source as monitored by staining for acetylcholinesterase and synaptophysin immunoreactivity, suggesting that NT-4 may enlarge the terminal field of preganglionic nerves and enhance their access to trophic factors. Analysis of TrkB-deficient mice revealed degenerative changes in axon terminals on chromaffin cells. Furthermore, numbers of FG-labeled IML neurons in spinal cord segments T7-T10 of NT-4-deficient adult mice were significantly reduced. These data are consistent with the notion that NT-4 from chromaffin cells operates through TrkB receptors to regulate development and maintenance of the preganglionic innervation of the adrenal medulla.

[Recommendation for rehabilitation measures of elderly disabled patients by the medical service of hospital insurance in Berlin and Brandenburg]

According to the German Nursing Care insurance law (Pflegeversicherungsgesetz) experts of the Medical Advisory Board of the statutory sickness funds (Medizinischer Dienst der Krankenversicherung, MDK) must consider recommending rehabilitative measures for persons in need of nursing care. This study measures the proportion of proposed rehabilitative therapies (physiotherapy, ergotherapy, speech therapy) as well as clinical and non-clinical predictors for these recommendations. The study population of the cross-sectional study consisted of all persons aged 60 years and older in Berlin and Brandenburg for whom the MDK experts had diagnosed a need for nursing care (stages I to III) by means of home visits in the second half of 1995. Data on recommendations and potential predictors were taken from the expert records. Recommendation rates were 6.6% (physiotherapy), 0.7% (ergotherapy) and 0.8% (speech therapy) respectively, for Berlin and Brandenburg taken together. While clinical variables (impairments and disabilities) had a considerable impact on the recommendations, also non-clinical variations were noted. Physiotherapy recommendation rates differed 3-fold by region (Brandenburg: 10.3%; Berlin: 3.4%). Variations also existed for age (60-70 years: 10.7%; > 90 years: 2.5%) and the presence of a professional care institution (present: 8.6%; not present: 5.4%). The strongest effect had an already existing prescription of physiotherapy from the patient's physician (current physiotherapy: 23.5%, no current physiotherapy: 4.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and clinical characteristics. Variations of physiotherapy recommendation rates were also found for profession of the MDK experts (physician: 5.9%; nurse: 9.2%; physician and nurse together: 7%), but the effects were only partially independent. The observed low rates of recommended physiotherapy, ergotherapy and speech therapy as well as the non-clinical variations question the appropriateness of current recommendation practices.

Detection of pulmonary emboli and associated right heart dysfunction by combining ventilation perfusion lung scanning and xenon ventriculography

PURPOSE

The authors sought to determine if the right ventricular ejection fraction (RVEF), as measured by xenon ventriculography, is depressed in patients with pulmonary emboli. The authors also sought to correlate any decrement in RVEF with the extent of lung perfusion defects.

MATERIALS AND METHODS

The authors identified all patients who had lung ventilation-perfusion (V/Q) scans between January 1994 and December 1996, that were interpreted as high probability for pulmonary embolism. From these patients, the authors selected those who had undergone concurrent xenon ventriculography (XV) (n = 23), and then reprocessed the initial ventriculography data for confirmation. The authors also reviewed original V/Q scans, chest radiographs, and clinical data. A control group was drawn from patients with normal V/Q scans who had undergone XV.

RESULTS

Fifteen patients (65%) with high probability V/Q scans had an abnormally low RVEF (< .32). Patients with high probability V/Q scans also had a significantly lower mean RVEF (0.28 +/- .08) than patients with normal V/Q scans (.39 +/- .08 SD). The degree of RVEF decline correlated poorly with the number of segmental perfusion defects (r = -.39).

CONCLUSIONS

RVEF is often depressed in patients with high probability V/Q scans. XV can identify these patients, while routine lung V/Q scans cannot.

Lansoprazole versus omeprazole: influence on meal-stimulated gastric acid secretion

AIMS

To investigate, by means of meal-stimulated acid secretion, the extent to which differences in plasma half-life, bioavailability and the recommended therapeutic dose can influence the antisecretory potency of lansoprazole and omeprazole.

METHODS

In this double-blind, placebo-controlled, crossover study, 10 healthy male volunteers received 15 mg or 30 mg lansoprazole, 20 mg or 40 mg omeprazole or placebo for 5 days, in a randomized order. Meal-stimulated acid secretion was determined by means of a homogenized test meal and intragastric titration.

RESULTS

On day 1, meal-stimulated acid secretion was decreased by 35% and 45% after administration of 15 mg or 30 mg lansoprazole, and by 16% and 42% after 20 mg or 40 mg omeprazole. After 3 and 5 days of dosing the decreases were 53% and 48% with 15 mg lansoprazole, 82% and 82% with 30 mg lansoprazole, 43% and 39% with 20 mg omeprazole, and 76% and 83% with 40 mg omeprazole. At all measuring points during the 5-day dosing periods, lansoprazole 15 mg and 30 mg proved superior to 20 mg omeprazole in inhibiting meal-stimulated gastric acid secretion, but the differences were only statistically significant for the lansoprazole 30 mg dose, 30 mg lansoprazole and 40 mg omeprazole proved equipotent. On day 1 only 30 mg lansoprazole was significantly better than placebo.

CONCLUSION

This study demonstrated the following order of antisecretory potency: 30 mg lansoprazole = 40 mg omeprazole > 15 mg lansoprazole approximately 20 mg omeprazole.

Treatment with the interleukin-I receptor antagonist and soluble tumor necrosis factor receptor Fc fusion protein does not prevent endotoxin-induced preterm parturition in mice

OBJECTIVE

To determine whether the administration of anticytokine agents, the interleukin-1 receptor antagonist (IL-1ra) and a soluble tumor necrosis factor receptor Fc fusion protein (sTNFR-Fc), prevents endotoxin-induced preterm delivery in mice.

METHODS

C3H/HeN pregnant mice at 15 days of gestation (70% gestation) were randomized to receive phosphate-buffered saline (PBS) or lipopolysaccharide (LPS) (50 micrograms/mouse) intraperitoneally (i.p.). Randomly selected PBS- or LPS-treated mice were additionally treated intravenously (i.v.), i.p., or subcutaneously (s.c.) every 3 hours with IL-1ra (1-50 mg) or every 12 hours with sTNFR-Fc (200-400 micrograms) beginning 1 hour before LPS injection. Animals were observed for vaginal bleeding and preterm delivery.

RESULTS

Mice treated i.p. with 50 micrograms LPS (n = 13) had a shorter injection-to-delivery interval than mice treated similarly with PBS (n = 19) (median 13.5 hours, range 10-105 versus median 86.8 hours, range 53-120, respectively; P < .001). Saline-treated mice given 10 mg IL-1ra every 3 hours i.p. (n = 3) or 200 micrograms sTNFR-Fc every 12 hours i.v. (n = 4) had similar injection-to-delivery intervals as PBS-treated control mice (median 70 hours, range 70-76 versus median 58 hours, range 50-120, respectively). Similarly, LPS-treated mice given PBS every 3 hours (n = 20) had injection-to-delivery intervals comparable to LPS-treated mice (n = 13) (median 15.5 hours, range 9.8-92 versus median 13.5 hours, range 10-105, respectively). Lipopolysaccharide-treated mice given i.p. injections of 1 (n = 4), 10 (n = 31), or 50 (n = 15) mg of IL-1ra every 3 hours did not have longer injection-to-delivery intervals compared with LPS-treated mice (n = 13) (medians 11.6, 15, 14.5 and 13.5 hours; ranges 10.8-12, 8-95, 11-92, and 10-105, respectively). Lipopolysaccharide-treated mice given i.v. injections of 200 (n = 4) or 400 (n = 9) micrograms sTNFR-Fc every 12 hours did not have longer injection-to-delivery intervals compared with LPS-treated mice (n = 8) (medians 23.3, 22.5, and 21.9 hours; ranges 14.8-33, 15-95.5, and 15.5-44, respectively). The median injection-to-delivery interval of LPS-treated mice given both IL-1ra (10 mg) every 3 hours i.p. and sTNFR-Fc (200 micrograms) every 12 hours i.v. (n = 5) was not different from that of LPS-treated mice (median 26 hours, range 24.5-72 versus median 13.5 hours, range 10-105, respectively; P > .05).

CONCLUSION

The anticytokine agents IL-1ra and sTNFR-Fc did not prevent preterm delivery or prolong pregnancy in endotoxin-induced preterm labor in mice.

Clostripain linker deletion variants yield active enzyme in Escherichia coli: a possible function of the linker peptide as intramolecular inhibitor of clostripain automaturation

The clostripain core protein is composed of the light and heavy chain subunits linked by a nonapeptide into a single polypeptide chain [Mol. Gen. Genet. 240: 140, 1993]. Linker removal is due to autocatalytic processing yielding active heterodimeric enzyme. We have expressed mutationally altered core protein variants in the heterologous host Escherichia coli to gain further insight into the process of clostripain automaturation. In a mutationally created Cys231 --> Ser variant, heterodimer formation was largely impaired, providing molecular evidence that the capacity for automaturation is attributed to the active site cysteine, Cys231, of the native enzyme. Artificially generated deletions of the linker peptide did not prevent the formation of active enzyme. One variant gave rise to a single-chain molecule devoid of the authentic processing sites while retaining enzymatic activity. Experiments performed with linker substitution variants suggested that the efficacy of automaturation depends on a proper configuration of the linker region. According to computerized predictions, the formation of a turn-structured protein loop or hinge with hydrophilic characteristics in the linker region is probably a prerequisite for the interaction of the active site cysteine with the processing sites, Arg181 and Arg190. We propose that the clostripain linker nonapeptide serves as an important transient intramolecular inhibitor in the cellular self-defense program evolved by the natural host Clostridium histolyticum.

Cellular proliferative capacity and life span in small and large dogs

In a study comparing animal life spans and in vitro clonal proliferative capacity of skin fibroblasts in groupings of small, middle, large, and very large breeds of dogs of specific ages, the following results were obtained: (1) their life spans were inversely correlated to the frame sizes of the breeds; (2) the percent of large clones present in clone size distributions from the small dogs was inversely proportional to the age of the subjects (this was not true for the large breeds; however, animals older than 8 years were not available in those breeds); and (3) the group composed of the two largest breeds (Great Dane and Irish Wolfhound) had the shortest life spans and also had significantly smaller percentages of large skin fibroblast clones formed in vitro than either of the two groupings of smaller dogs at any age studied. It appears that within the domestic dogs the large body size is accompanied by shorter life span and, in the two largest breeds, decreased cellular growth potential.

Transgenic barley expressing a protein-engineered, thermostable (1,3-1,4)-beta-glucanase during germination

The codon usage of a hybrid bacterial gene encoding a thermostable (1,3-1,4)-beta-glucanase was modified to match that of the barley (1,3-1,4)-beta-glucanase isoenzyme EII gene. Both the modified and unmodified bacterial genes were fused to a DNA segment encoding the barley high-pI alpha-amylase signal peptide downstream of the barley (1,3-1,4)-beta-glucanase isoenzyme EII gene promoter. When introduced into barley aleurone protoplasts, the bacterial gene with adapted codon usage directed synthesis of heat stable (1,3-1,4)-beta-glucanase, whereas activity of the heterologous enzyme was not detectable when protoplasts were transfected with the unmodified gene. In a different expression plasmid, the codon modified bacterial gene was cloned downstream of the barley high-pI alpha-amylase gene promoter and signal peptide coding region. This expression cassette was introduced into immature barley embryos together with plasmids carrying the bar and the uidA genes. Green, fertile plants were regenerated and approximately 75% of grains harvested from primary transformants synthesized thermostable (1,3-1,4)-beta-glucanase during germination. All three trans genes were detected in 17 progenies from a homozygous T1 plant.

Coordinate developmental control of the meiotic cell cycle and spermatid differentiation in Drosophila males

Wild-type function of four Drosophila genes, spermatocyte arrest, cannonball, always early and meiosis I arrest, is required both for cell-cycle progression through the G2/M transition of meiosis I in males and for onset of spermatid differentiation. In males mutant for any one of these meiotic arrest genes, mature primary spermatocytes with partially condensed chromosomes accumulate and postmeiotic cells are lacking. The arrest in cell-cycle progression occurs prior to degradation of cyclin A protein. The block in spermatogenesis in these mutants is not simply a secondary consequence of meiotic cell-cycle arrest, as spermatid differentiation proceeds in males mutant for the cell cycle activating phosphatase twine. Instead, the arrest of both meiosis and spermiogenesis suggests a control point that may serve to coordinate the male meiotic cell cycle with the spermatid differentiation program. The phenotype of the Drosophila meiotic arrest mutants is strikingly similar to the histopathological features of meiosis I maturation arrest infertility in human males, suggesting that the control point may be conserved from flies to man.

TGF-beta rescues target-deprived preganglionic sympathetic neurons in the spinal cord

Transforming growth factors beta (TGF-beta), a family of pleiotropic cytokines, are widely distributed in the developing and adult nervous system. In order to further determine the neural functions of TGF-beta, we have localized the TGF-beta isoforms 1, 2 and 3 in the adult rat adrenal medulla and studied the neuroprotective capacity of one representative family member, TGF-beta 2, for those spinal cord neurons which innervate adrenal chromaffin cells and which die after destruction of the adrenal medulla. Unilateral electrothermal destruction of the adrenal medulla led to the disappearance of 25% of sympathetic preganglionic neurons, which are located in the intermediolateral (IML) column of thoracic spinal cord segments 7-10 and can be selectively marked by NADPH-diaphorase. The neurons which disappeared following adrenomedullectomy constitute the full set of neurons that innervate the adrenal medulla. Implantation of gelfoam soaked with 0.5 micrograms TGF-beta 2 into the adrenal wound cavity rescued all spinal cord neurons in the IML ipsilaterally to the lesioned side. Cytochrome c was not effective. Injections of [125I]TGF-beta 2 into the adrenal medulla did not result in retrograde transport and subsequent labelling of spinal cord neurons, suggesting that TGF-beta may exert its neuroprotective actions by indirect mechanisms. TGF-beta applied to cultured adrenocortical cells did not overtly increase the amount of mRNA for fibroblast growth factor-2, an established trophic molecule for sympathetic preganglionic spinal cord neurons. The mechanisms by which TGF-beta exerts its neurotrophic effect are therefore unclear. Even so, our data provide the first evidence that TGF-beta may play an important role in vivo in the control of maintenance of a population of spinal cord neurons.

Reduced birthweight and length in the offspring of females exposed to PCDFs, PCP, and lindane

The objective of this study was to investigate a broad range of adverse health outcomes and their potential association to wood preservative used in daycare centers. This article focuses on reproductive effects. A sample of 221 exposed teachers was provided by the employer's liability insurers. A comparison group (n = 189) insured by the same two organizations was recruited from nonexposed daycare centers. In a face-to-face interview, job history and reproductive history of 398 female teachers were ascertained. Data on exposure were provided, including measurements on concentration of pentachlorophenol (PCP) and lindane in wood panels, and of PCP, lindane, polychlorinated dibenzo-p-dioxins and dibenzofurans in indoor air. An exposure matrix based on individual job history, independent exposure information from each center, and reproductive history was set up with regard to the vulnerable time windows for each pregnancy. Using this approach, 49 exposed and 507 nonexposed pregnancies were identified, including 32 exposed and 386 nonexposed live births. For subgroup analyses the observations were restricted to independent pregnancies, excluding multiple and consecutive births. The data were analyzed with linear regression techniques, taking confounders into account. The crude median difference between exposed and nonexposed was 175 g in birthweight and 2 cm in length. Controlling for confounders, the results show a significantly reduced but weight (p = 0.04) and length (p = 0.02) in exposed pregnancies, even after restricting the data to independent pregnancies and pregnancies for which data could be validated from the mother's health cards. These differences were not explained by differences in gestational age indicating that a toxic effect, which could cause small-for date newborns, might have affected the fetus.