IgA endomysium antibodies--an early predictor for celiac disease in children without villous atrophy.

AIM: To evaluate possible differences between children with anti-endomysium antibodies (EMA) positivity and normal small bowel mucosa and children with positive EMA and an enteropathy diagnosed as celiac disease (CD). METHODS: Children with suspected CD and positive EMA (>or=1/10) undergoing small bowel biopsy during 1996 to 2002, were investigated (n=133). Data registered were: year and month of birth, timing of the first biopsy, sex, heredity for CD, dermatitis herpetiformis and diabetes mellitus and outcome of the anti-gliadin antibody test (AGA). The case group, with EMA positivity and normal histology (n=39; 59% female, mean age at the first biopsy 7.3 years, range 1.4-16), was compared with the disease control group, with positive EMA and a biopsy suggestive and further on diagnosed as CD (n=94; 56% female; mean age 7.6 years at the first biopsy, range 0.70-17). RESULTS: AGA positivity and heredity for CD were found to predict the outcome of a pathological jejunal mucosa. Nineteen of the 39 children in the case group were rebiopsied of whom 11 had developed an enteropathy during a follow-up period of 2-7 years (median 4.5 years). CONCLUSIONS: EMA positivity in the absence of small bowel enteropathy could be a very early predictor for later overt CD, and necessitates further follow-up, especially if the child is AGA positive and there is a family history of CD.

Oats to children with newly diagnosed coeliac disease: a randomised double blind study.

BACKGROUND: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed. AIM: To determine if children with CD tolerate oats in their GFD. PATIENTS AND METHODS: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months. RESULTS: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5-40) g at the six month control and 15 (0-43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew. CONCLUSIONS: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.

Glutamate decarboxylase (GAD65) and tyrosine phosphatase-like protein (IA-2) autoantibodies index in a regional population is related to glucose intolerance and body mass index.

AIMS/HYPOTHESIS: Our aims were to investigate the concentrations and prevalence of autoantibodies against the Mr 65.000 isoform of glutamate decarboxylase (GAD65) and the tyrosine phosphatase-like protein (IA-2) in adults and to test the hypothesis that GAD65 and IA-2 autoantibodies in a regional population are related to abnormal oral glucose tolerance. METHODS: We analysed serum from 2157 Swedish subjects aged either 30, 40, 50 or 60 years old who, in 1988-1992, participated in the Västerbotten County Health Project and were subjected to the World Health Organisation (WHO) standard oral glucose tolerance test at entry into the study. RESULTS: We found 23 of 2157 (1.1%) and 17 of 2152 (0.8%) subjects exceeded the 99th centile of GAD65 autoantibody index and IA-2 autoantibody index, respectively. In 18 subjects with diabetic oral glucose tolerance test, GAD65 autoantibody concentrations were higher than in those with normal oral glucose tolerance test (p = 0.02). Subjects with IGT (n = 185) [corrected] and diabetes (n = 18), i.e. abnormal OGTT (n = 203) [corrected], had higher GAD65Ab [corrected] index compared with those with normal OGTT (p = 0.026) [corrected]. A stepwise multiple logistic regression test showed that the odds ratios for subjects in the highest BMI group to exceed the 95th or 99th GAD65 autoantibody centile were 3.6 (CI 1.4-8.9) and 17.6 (CI 2.6-121.6), respectively. CONCLUSION/INTERPRETATION: GAD65 and IA-2 autoantibodies, are associated with impaired or diabetic glucose tolerance in an adult regional population. This observation together with the association between GAD65 autoantibody concentrations and body mass index indicate a possible relation between islet autoimmunity and beta-cell function abnormalities with obesity and insulin resistance.

Ochratoxin A in rice cultivars after inoculation of Penicillium verrucosum.

The natural occurrence of ochratoxin A in grain samples of 23 rice cultivars was in the range 0.01-1.0 ng g(-1) rice. Samples from the same cultivars were surface sterilized with NaClO, dried to 19% water content and equilibrated at water activity (a(w)) 0.75 and 20 degrees C for 8 days. Varietal differences in equilibrium w/w water content (p < 0.0001) were found, reflected by differences in amylose and protein contents. Samples were then inoculated with an isolate of Penicillium verrucosum with 1 ml spore suspension to each 50 g rice sample; and incubated at a(w) 0.75 and 20 degrees C for 23 weeks. During incubation, ochratoxin A was accumulated in all cultivars. Significant varietal differences in ochratoxin A accumulation were observed (p < 0.0001). Grain samples with less than 19.5% equilibrium water content accumulated less ochratoxin A (p < 0.005). In a multiple regression analysis accumulated ochratoxin A content was expressed as a function of natural occurrence of ochratoxin A (p < 0.05), equilibrium water content at time of inoculation (p < 0.005), 1000-grain weight (p < 0.1), and chalkiness of endosperm (p < 0.05), with p < 0.0001 for the full function. Naturally occurring ochratoxin A was the strongest independent variable with p < 0.0005 for the slope coefficient in single regression. Rice cultivars IR8, IR24, IR620030-18-2-2 and R91-1081-1 had exceptionally low accumulation of ochratoxin A.

Haptic perception of texture gradients.

To pick up 3-D aspects of pictures is arguably the most difficult problem concerning tactile pictorial perception by the blind. The aim of the experiments reported was to examine the potential utility of texture gradients in this context. Since there is no theoretical basis for predicting absolute values of 3-D properties from 2-D patterns read by the finger pads, the abilities of participants to perceive gradients lying between known maxima and minima were assessed. Experiment 1 involved blindfolded sighted participants making verbal magnitude estimations of texture-gradient magnitudes corresponding to plane surfaces at different slants. In experiment 2 the participants' task was to orient a surface at a slant corresponding to the texture gradients depicted tactually, and experiment 3 required early-blind participants to attempt the same task. The results revealed that participants can scale the magnitudes of texture gradients with high precision and that they can also accurately produce surface slants from depictions, providing the extreme conditions are clearly defined and there are opportunities for learning. Texture gradients appear as informative to the blind as they do to the sighted. To what extent these data can be generalised to other gradients and textures or to other projections of 3-D scenes remains to be investigated.

Women with noise-induced hearing-loss: an invisible group?

The aim of this qualitative study was to describe, from the perspective of women with noise-induced hearing loss (NIHL), their experiences of noise as a threat to health and their having to live with a hearing disability, i.e. behaviours, thoughts and emotions in auditory demanding situations. Ten women, patients with NIHL at the Department of Audiology, Borás' Hospital in Sweden, were selected to form a heterogeneous sample. A taped in-depth interview, lasting from 45 minutes to 1 hour, was conducted with each woman. The verbatim transcribed interviews were consecutively analysed using a method influenced by the tradition of grounded theory. Four categories emerged in the process of analysis. These categories were labelled: lack of awareness, ambivalence, controlling and avoiding coping strategies and stigmatization. The category 'lack of awareness' concerned the women's perceptions of the risks of noise on hearing, the lack of efforts on the part of the women to apply for financial compensation for their NIHL, the lack of an awareness of individual's right to have healthy work-place and to receive professional help for hearing impairment. Also lacking was the concept that hearing impaired individuals have the right to participate in the community on similar conditions as non-hearing impaired people. This lack of awareness was identified as a core category relating to the other categories: ambivalence, controlling and avoiding coping strategies and stigmatization. The women's expressions indicated ambivalence concerning the cause of the hearing disability and, also, how to manage the consequences of it: the women in the study seemed to alternate between feelings of hopelessness/resignation and a state of acceptance of the hearing disability. Furthermore, the women alternated between blaming themselves and blaming others for the cause of the hearing loss, indicating a change between internal and external locus of control. Also, the women alternated between controlling and avoiding strategies in coping with demanding auditory situations. The coping strategy chosen by the women in a specific situation intended to prevent or minimize stigmatization, i.e. 'to pass as normal' and thereby to maintain a positive self-image of normality. Despite this, the women often perceived negative and stigmatizing attitudes from others, which reinforced their feelings of ambivalence in how to manage the situation. The hypothesis based on the present pilot study, that women with NIHL are more likely to pass themselves off as normal hearing and therefore might be less likely to be reported in studies of NIHL than men, needs to be further tested in a larger sample.

Infant feeding history shows distinct differences between Swedish celiac and reference children.

Infant feeding history was investigated in 72 celiac and 288 age-matched reference children in a retrospective questionnaire study. The reply rate was 100% in celiac and 91.6% in reference children. The celiac children were breast-fed for a significantly shorter time than reference children, and they were less often breast-fed at the introduction of gluten. The age of the children at gluten introduction was similar, but the celiac children were significantly more often introduced by a gluten-containing follow-up formula, while the reference children more often started on a gluten-containing porridge. The results can be interpreted in two ways. First, it could be argued that breast milk per se protects against symptoms of celiac disease in childhood. It could, however, also be claimed that breast-feeding merely modulates the gluten introduction, causing a less abrupt introduction of gluten in the baby diet and thereby fewer overt symptoms of the disease.

The subjective meaning of illness in severe otosclerosis: a descriptive study in three steps based on focus group interviews and written questionnaire.

The aim of this study of otosclerosis patients was to highlight the circumstances specific to an operable middle ear disease and to describe the psychologically unique aspects accompanying this disorder. In a first step five subjects participated in four focus group interviews, from which emanated a questionnaire answered in a second step by 28 randomly chosen subjects. Finally a second series of supplementary focus interviews were conducted with another group of subjects, after which the interview material was subjected to code-mapping, agreement and validation. The study results indicate that ear surgery was a very important occurrence in the lives of the patients and a unique aspect was that they were burdened by a sense of responsibility for deciding in favour of or against the ear surgery and in choosing the time for operation. An event as tangible as an operation impacts on the individual's psychological processing of the fact that one of his or her senses is damaged. The message to the person's surroundings is very clear: the operation makes others understand how serious the situation is, gives rise to a sense of sympathy. These factors together may promote adaptation to the handicap, or alternately, at least for some persons, may impede adaptation to the necessary hearing aids. To some individuals hearing aids were strongly associated with periods of deteriorating hearing and therefore had negative connotations. Thus the hearing aid was used while waiting for surgery or instead of surgery. The constant hope of regaining one's hearing through ear surgery, although not totally realistic in these cases of severe otosclerosis, always makes the hearing aid the second best solution. The overall conclusion from this study is that there are specific circumstances of an operable ear disease which have great impact upon quality of life, well-being and adaptation. The psychological situation is one of instability, feelings of responsibility and at times of anxiety. Patients with otosclerosis are sometimes told that they are better off than others with impaired hearing, because surgery can improve their hearing and because good amplification through hearing aids can be achieved in persons with conductive hearing losses. It is our hope that this study has helped to provide a fuller picture of the facts of life for persons with severe otosclerosis.

Effects of supplemental mass pollination (SMP) in a young and a mature seed orchard of Pinus sylvestris.

The effects of supplemental mass pollination (SMP) were studied in two Pinus sylvestris seed orchards differing in pollen production. Pollen was dusted over the whole tree during the period of peak female receptivity using a pressurized backpack sprayer. The success of SMP was assessed by means of allozyme markers. In the orchard with high pollen production, detectable differences in SMP success rate were found between clones, but the success rate was not influenced by the number of pollinations per day. The average estimated success rate of SMP was 19%. In the orchard with low pollen production, no significant differences in SMP success rate were found between years (22 versus 34%) or between clones. The SMP success rate in the low pollen production orchard varied between 14 and 69%.

Anti-endomysium and anti-gliadin antibodies as serological markers for coeliac disease in childhood: a clinical study to develop a practical routine.

Anti-gliadin and anti-endomysium antibodies were analyzed in 174 children with suspected or verified coeliac disease with the aim of developing a practical routine. The biopsy was performed without knowledge of the antibody levels. To screen for coeliac disease is children younger than 2 years, we suggest the use of IgA anti-gliadin antibodies, giving a sensitivity of 100% and a specificity of 86%. In older children both tests should be used in parallel, i.e. a biopsy should be performed if at least one of the tests is positive, giving a sensitivity of 98% and a specificity of 81%. To avoid unnecessary biopsy before mucosal relapse can be demonstrated during gluten challenge in a child without clinical symptoms, we suggest that the tests are used as serial testing, i.e. a biopsy should be performed if both tests are positive.

The effect of matrix on the occurrence of hazel grouse (Bonasa bonasia) in isolated habitat fragments.

The aim of this study was to determine the effect of matrix on the occurrence of hazel grouse (Bonasa bonasia) in habitat fragments. The study was conducted in two kinds of landscape: (1) an agricultural landscape, where the censused forest habitat fragments were surrounded by farmland, and (2) in an intensively managed forested landscape, where the censused habitat fragments were surrounded by nonhabitat coniferous forest. Occupied and unoccupied habitat fragments in the agricultural landscape differed significantly in distance to the nearest suitable continuous habitat, with hazel grouse occurring only in habitat fragments closer than 100 m from continuous forest. In the intensively managed forest landscape, the effect of isolation was less evident, but there might be a threshold around 2 km. Effects of isolation occurred over much shorter distances when the surrounding habitats consisted of farmland than when it was forested habitats. The size of the habitat fragments was important in both landscapes, with larger habitat fragments more often containing hazel grouse.

Serum food antibodies analyzed by enzyme-linked immunosorbent assay (ELISA) and diffusion-in-gel (DIG)-ELISA methods in children with and without celiac disease.

Serum antibodies IgA, IgG, and IgM against gliadin, ovalbumin, and beta-lactoglobulin were analyzed at the time of 228 small bowel biopsies in 116 celiac children. These were compared to the antibody levels at the time of biopsies performed in 199 children, where the biopsy discarded a clinical suspicion of celiac disease. For antibodies against gliadin, the enzyme-linked immunosorbent assay (ELISA) and diffusion-in-gel (DIG)-ELISA methods were compared. It was found that the combined information from IgA and IgG antigliadin antibodies gave the highest specificity (94%) and sensitivity (89%). The antibody responses to food antigens decreased with age in both celiac and reference children. The ELISA and DIG-ELISA methods gave comparable results and were equally efficient.

Stimulating effects of mercuric- and silver ions on the superoxide anion production in human polymorphonuclear leukocytes.

In a survey of a number of heavy metal ions for effects on the oxidative metabolism (respiratory burst) of human polymorphonuclear leukocytes (neutrophils) we have found that mercury(II) and silver ions in micromolar concentration significantly increase the production of superoxide anions in cells, initiated by formyl-methionyl-leucylphenylalanine (fMLP). The stimulation of radical formation induced by a certain ion concentration varied considerably in cells isolated from different blood donors, from a moderate increase to a very large (up to 400% of control values). When the soluble stimulator phorbol myristate acetate (PMA) or the particulate stimulator Zymosan were used to initiate the cell respiratory burst, no additional stimulating effects by the metal ions on superoxide anion formation were observed. This fact might indicate that the effect of the metal ions on the fMLP-dependent initiation of cell activity is a mechanism coupled to the interaction between the chemotactic peptide and its corresponding receptor molecules on the cell surface. By increasing the concentration of silver ions during pre-incubation of resting neutrophils, a spontaneous activation of the cells could be recorded at a concentration exceeding 5 microM. However, the silver ion concentration at which such spontaneous initiation of the respiratory burst occurred varied significantly between blood samples from different donors with a concentration range of 5 to 15 microM. This effect could not be shown for mercuric ions due to the toxicity of the metal above 5 microM. Blood samples from some donors contained neutrophils that could be activated by either mercuric- or silver ions at concentration as low at 1 microM. The spontaneous activation of neutrophils with elevated concentrations of silver ions is kinetically similar to the PMA-induced. The onset of superoxide anion formation is preceded by a lag period whose length varies in time with the concentration of agent applied to the cells. It is a known fact that once the neutrophils have been activated with fMLP it is not possible to reactivate the cells by a second supplementation of fMLP. However, after cessation of the fMLP-induced activation, addition of PMA or silver ions gives rise to renewed production of superoxide anions. We propose two different mechanisms of action of silver ions on oxidative metabolism of neutrophils.(ABSTRACT TRUNCATED AT 400 WORDS)

Needs and benefits of empirical power transformations for production and quality traits in forest tree breeding.

Non-normality in the distribution of individual observations of production and quality traits in forest tree breeding may cause inaccurate selection and overestimation of predicted selection gain. The distribution of individual observations of traits such as height, diameter, branch diameter, branch angle and number of branches per whorl is not always normal. We investigated how the observations were distributed and to what degree it is possible to improve normality, homogeneity of error variance and additivity by using empirical power transformations. Computer simulations showed that a seriously skewed distribution impairs selection efficiency and exaggerates selection gain expectations. If the distribution is heavily skewed, transformation might be worthwhile. It does not seem possible to offer any general advice about which varities should be transformed, but in most cases there seems to be no need of any transformation.

Oestrogen-induced enhancement of myeloperoxidase activity in human polymorphonuclear leukocytes--a possible cause of oxidative stress in inflammatory cells.

Micromolar concentrations of beta-estradiol, estrone, 16-alpha-hydroxyestrone and estriol enhance the oxidative metabolism of activated human PMNL's. The corresponding 2-hydroxylated estrogens 2-OH-estradiol, 2-OH-estrone and 2-OH-estriol act on the contrary as powerful inhibitors of cell activity. Equilenine, a naturally occurring steroid hormone structurally closely related to estrone, removes the estrogen-induced increase in oxidative metabolism of activated PMNL's without diminishing cell activity determined in the absence of enhancing hormone. A number of other female and male sexual hormones were without potentiating effect. The cell response to hormone treatment was assayed as increase (or decrease) in LU-dependent CL of activated PMNL's. When assaying LUC-dependent CL of the cells no stimulatory effects of the estrogens could be detected. This fact may imply that the myeloperoxidase enzyme system of the cells is the target for the hormonal action. Various inhibition experiments using activated PMNL's or purified MPO confirmed this conclusion. The efficicious hormones induced approximately a doubling of CL of activated cells and a tenfold increase of the activity of purified MPO. If cell activity was initiated by the additions of low concentrations of hydrogen peroxide, the presence of estrogens caused a remarkable enhancement of the luminol-dependent chemiluminescence. PMNL's activated with fMLP release MPO activity into the surrounding cell medium. It has been found here that the presence of estrogens in micromolar concentrations greatly increases such enzyme release. Release of MPO activity from the cells could be achieved by the mere addition of estrogenic hormones. Estrogen-induced release of enzyme activity was abrogated by the simultaneous presence of equilenine in the cell suspension. Released enzyme responded vigorously to estrogens in the presence of chloride ions and its substrate, hydrogen peroxide. About a tenfold increase in enzyme activity could be measured in the presence of 5 microM beta-estradiol or esteriol. The activity of the released enzyme (as well of purified MPO) was effectively inhibited by small amounts of anti-MPO antibodies. This observation together with other inhibition experiments was taken as evidence for the view that the released enzyme was identical with myeloperoxidase.

Intestinal permeability to inert sugars and different-sized polyethyleneglycols in children with celiac disease.

Intestinal permeability was measured in a total of 42 children, 29 of whom had celiac disease. The celiac children were studied at presentation, during gluten-free diet, and/or at gluten challenge. The permeability was assessed by oral lactulose/L-rhamnose in all 42 children and also by different-sized polyethylene glycols (PEG) in 36 children. Results were compared with the findings of small intestinal biopsy. The mean of the permeability tests in children with enteropathy was significantly abnormal compared with the result in children with a normal mucosal morphology. The lactulose/L-rhamnose test and the PEG test gave equivalent results in the same child. In the celiac children abnormal permeability properties at presentation normalized during gluten-free diet and reappeared during gluten challenge. It is concluded that measurement of intestinal permeability may be a valuable tool in monitoring children with celiac disease, preferably when serial measurements are available in the same child.

Intestinal permeability assessed with different-sized polyethylene glycols in children undergoing small-intestinal biopsy for suspected celiac disease.

The gastrointestinal permeability was assessed by means of an oral load of a mixture of different-sized polyethylene glycols (PEG 400 and PEG 1000) in 76 children undergoing small-intestinal biopsy because of suspected celiac disease. Children with a mucosal abnormality suggestive of celiac disease had a lower urinary recovery of larger PEG molecules. They also displayed an altered permeability barrier, as evidenced by a lower ratio of recovery between large (1074 Da) and small (370 Da) PEG molecules. Gluten elimination and gluten challenge caused a significant change in PEG recoveries in children undergoing repeated PEG tests. Repeated assessments of intestinal permeability by means of different-sized PEGs after gluten withdrawal and challenge could complement or indicate suitable time for performing small-intestinal biopsy in children with gluten intolerance.

[Enterococcal endocarditis following legal abortion]. / Enterokochendokardit efter legal abort.

PIP: Uterine infections after early legal abortion are not very frequent and are most often connected with remaining embryonic material. In the case described, a 42-year old woman with 2 normal deliveries, 1 spontaneous abortion, and 2 legal abortions, who earlier had salpingitis, sought legal abortion in the 1st trimester. A vacuum aspiration was carried out in week 9-10 with no complications. Fever appeared on the 1st postoperative day and reached 40 degrees Celsius. Treatment was begun with doxycycline and metronidazole for 7 days and methyl ergometrine for 3 days. The patient improved but returned with fever again 2 months after the operation. Culture showed enterococci and pelvic examination showed regressively altered placental tissue. 5 months after the primary event the patient was again admitted with high fever, exhaustion and cardiac arrhythmia with aortal and mitral insufficiency. Computer tomography showed a soft swelling containing gas bubbles along the west wall of the vagina. The patient was operated on for hysterectomy and bilateral salpingo-oophorectomy. A year after the abortion the patient received an implanted aorta and mitral valve. A year after the valve operation the patient showed no signs of further infection. Pregnancy over age 40 implies increased risk for septic complications; retained abortion material with chronic endometritis and subsequent parametritis imply that antibiotic treatment will be unsuccessful until the focus of infection is removed surgically.^ieng

The incidence of childhood celiac disease in Sweden.

Within a defined population in southeast Sweden, celiac disease was diagnosed in 167 children born between 1970 and 1982. The diagnosis was based on the criteria of the European Society for Paediatric Gastroenterology and Nutrition. Another six children had an initial flat small intestinal mucosa but do not yet fulfill the criteria for the diagnosis of celiac disease. The incidence of celiac disease was 1.27/1,000 live births for the years 1970-1976 and 1.43/1,000 for 1977-1982. In contrast to our findings, a decline in the disorder during the late 1970s was reported from other countries. We discuss the observation that the incidences of celiac disease in children are moving discrepantly in different populations.