Shock treatment in a cohort of Scandinavian intensive care units in 2014.

BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units. METHODS: Seven-day inception cohort study in 43 intensive care units in Scandinavia. Patients ≥ 15 years old receiving more than 4 h of cardiovascular acting drug infusion were included. The use of fluids, vasopressor and inotropic drugs, type of monitoring, and target values were recorded. RESULTS: One hundred and seventy-one patients were included. At inclusion, 136/168 (81%) had received vasopressor and/or inotropic drug therapy for less than 24 h, and 143/171 (84%) had received volume loading before the onset of vasoactive drug treatment. Ringer's solution was given to 129/143 (90%) of patients and starches in 3/143 (2%) patients. Noradrenaline was the most commonly used cardiovascular acting drug, given in 168/171 (98%) of cases while dopamine was rarely used. Mean arterial pressure was considered the most important variable for hemodynamic monitoring. Invasive arterial blood pressure was monitored in 166/171 (97%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%). CONCLUSION: In this survey, Ringer's solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive arterial blood pressure, but comprehensive hemodynamic monitoring was used only in a minority of patients.

Capturing metal-support interactions in situ during the reduction of a Re promoted Co/γ-Al2O3 catalyst.

The reduction of a Re promoted Co/γ-Al2O3 catalyst was monitored in situ by synchrotron X-ray powder diffraction (XRPD) under H2 environment. Whole powder pattern analysis revealed a non-linear expansion of the unit cell of γ-Al2O3 during the reduction process, suggesting the diffusion of Co cations into the structure of the support. The non-linear cell expansion coincided with the formation of a CoO phase. In addition, space resolved diffraction at the inlet and the outlet of the reactor evidenced a negative effect of the partial pressure of indigenous H2O(g) on the reduction process.

On the origin of the cobalt particle size effects in Fischer-Tropsch catalysis.

The effects of metal particle size in catalysis are of prime scientific and industrial importance and call for a better understanding. In this paper the origin of the cobalt particle size effects in Fischer-Tropsch (FT) catalysis was studied. Steady-State Isotopic Transient Kinetic Analysis (SSITKA) was applied to provide surface residence times and coverages of reaction intermediates as a function of Co particle size (2.6-16 nm). For carbon nanofiber supported cobalt catalysts at 210 degrees C and H(2)/CO = 10 v/v, it appeared that the surface residence times of reversibly bonded CH(x) and OH(x) intermediates increased, whereas that of CO decreased for small (<6 nm) Co particles. A higher coverage of irreversibly bonded CO was found for small Co particles that was ascribed to a larger fraction of low-coordinated surface sites. The coverages and residence times obtained from SSITKA were used to describe the surface-specific activity (TOF) quantitatively and the CH(4) selectivity qualitatively as a function of Co particle size for the FT reaction (220 degrees C, H(2)/CO = 2). The lower TOF of Co particles <6 nm is caused by both blocking of edge/corner sites and a lower intrinsic activity at the small terraces. The higher methane selectivity of small Co particles is mainly brought about by their higher hydrogen coverages.

Birthplace and social characteristics as risk factors for acute myocardial infarction in the province of Halland, Sweden.

The aim of the study was to explore the impact of birthplace and socio-economic characteristics on the risk of acute myocardial infarction (AMI) in a rural Swedish province. A case control study was performed and cases were all patients 30-72-y-old treated for the first time for an AMI during 1980-1992 and identified in a computerised hospital register. Three controls for each case were randomly selected from the national population register and were matched for gender, age and municipality. Birthplace ie within or outside the province, and a variety of socio-economic background factors were determined for cases and controls. The study comprised a total of 18 948 individuals including cases and controls. Altogether 4737 cases of AMI were identified whereof 3514 were men. Being born in the province was associated with the lowest risk for AMI in both sexes (RR=0.62, CI 0.57-0.67 for men and RR=0.61, CI 0.53-0.69 for women). A substantially reduced risk for men was found in farmers. In both sexes, high socio-economic status had a favourable effect on the risk to suffer an AMI. Being born in the province carried the lowest risk for AMI in both sexes and was independent of other tested socio-economic factors (income, education, occupation, and civil status). Province characteristics might be associated with this protective factor. Alternatively, migration as such might include unfavourable exposures that increase the risk for AMI among those who had moved to the province.

Thermodynamics of sequence-specific binding of PNA to DNA.

For further characterization of the hybridization properties of peptide nucleic acids (PNAs), the thermodynamics of hybridization of mixed sequence PNA-DNA duplexes have been studied. We have characterized the binding of PNA to DNA in terms of binding affinity (perfectly matched duplexes) and sequence specificity of binding (singly mismatched duplexes) using mainly absorption hypochromicity melting curves and isothermal titration calorimetry. For perfectly sequence-matched duplexes of varying lengths (6-20 bp), the average free energy of binding (DeltaG degrees ) was determined to be -6.5+/-0.3 kJ mol(-1) bp(-1), corresponding to a microscopic binding constant of about 14 M(-1) bp(-1). A variety of single mismatches were introduced in 9- and 12-mer PNA-DNA duplexes. Melting temperatures (T(m)) of 9- and 12-mer PNA-DNA duplexes with a single mismatch dropped typically 15-20 degrees C relative to that of the perfectly matched sequence with a corresponding free energy penalty of about 15 kJ mol(-1) bp(-1). The average cost of a single mismatch is therefore estimated to be on the order of or larger than the gain of two matched base pairs, resulting in an apparent binding constant of only 0.02 M(-1) per mismatch. The impact of a mismatch was found to be dependent on the neighboring base pairs. To a first approximation, increasing the stability of the surrounding region, i.e., the distribution of A.T and G.C base pairs, decreases the effect of the introduced mismatch.

Soft tissue response to clinically contaminated and thereafter cleaned titanium surfaces. An experimental study in the rat.

The aim of the present study was to evaluate the soft tissue response to intra-orally exposed and contaminated titanium surfaces (machined, blasted or polished) after being chemically and/or mechanically cleaned. Eight adult Sprague-Dawley rats were used for histomorphometrical and histological analyses. A total of 44 experimental abutments (26 tests and 18 controls) were inserted into abdominal skinpockets of the rats for 6 weeks. No differences regarding the soft tissue response between the different surface characteristics analysed and between test and control could be observed.

1,8-Naphthalimides as Stereochemical Probes for Chiral Amines: A Study of Electronic Transitions and Exciton Coupling.

The absorption and magnetic circular dichroism (MCD) spectra of 1,8-naphthalimide are analyzed in terms of the number of contributing electronic transitions and their polarization. The experimental results are supported by semiempirical INDO/S calculations. It is demonstrated that the strongly allowed, pi --> pi naphthalene transition of the 1,8-naphthalimide chromophore located at 231 nm is perfectly suited for absolute configuration assignments of amine derivatives on the basis of the bichromophoric exciton coupling. Both degenerate (bis-1,8-naphthalimide) and nondegenerate (1,8-naphthalimide-phthalimide, 1,8-naphthalimide-phenyl, or 1,8-naphthalimide-benzoate) couplings were studied. In the latter case, the sign of the exciton Cotton effect was opposite to the sign of the degenerate exciton Cotton effect for the same absolute configuration. An extension of the application of the exciton coupling to the 264 nm pi --> pi transition of 1,9-anthraimide is also shown.

Micronuclei in lymphocyte subsets in relation to immune proteins and allergic disease.

This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years). The study group contained 12 boys and five girls with asthma and 23 boys and seven girls with allergic rhinitis. Sensitivity to pollen and furred animals were reported by 22 boys and eight girls and by 17 boys and six girls, respectively. The levels of serum immune proteins (IgA, IgE and IgG with subclasses, and IgM) were determined by immunological techniques. As a biomarker of chromosomal damages, the lymphocyte micronuclei was used. We analyzed the frequencies of micronuclei in 3000 B-lymphocytes and in equal numbers of T4- and T8-lymphocytes. The lymphocytes were separated by magnetic attraction in T4 (CD4), T8 (CD8) and B (CD19) fractions using Dynabeads(R). The most interesting finding of this investigation was that the three markers of atopic disease, asthma, hypersensitivity to pollen and IgE levels, associated significantly with increased frequencies of micronuclei in B-lymphocytes. There was also a relation between IgA and the frequency of micronuclei in B-cells. In an epidemiological study of 7000 individuals with allergic diseases, we have found an over-risk for lymphomas in the group with positive skin prick test. Hypothetically, we think that there may be a link between our present finding of an increased mutagenic activity and the lymphoma over-risk among individuals with allergic disease since most lymphomas stem from B-lymphocytes.

Hybridization of peptide nucleic acid.

The thermodynamics of hybridization and the conformations of decameric mixed purine-pyrimidine sequence PNA/PNA, PNA/DNA, and DNA/DNA duplexes have been studied using fluorescence energy transfer (FET), absorption hypochromicity (ABS), isothermal titration calorimetry (ITC), and circular dichroism (CD) techniques. The interchromophoric distances determined in the FET experiments on fluorescein- and rhodamine-labeled duplexes indicate that the solution structures of the duplexes are extended helices in agreement with available NMR (PNA/DNA) and crystal X-ray data (PNA/PNA). The melting thermodynamics of the duplexes was studied with both FET and ABS. The thermodynamic parameters obtained with ABS are in good agreement with the parameters from calorimetric measurements while FET detection of duplex melting gives in most cases more favorable free energies of hybridization. This discrepancy between FET and ABS detection is ascribed to the conjugated dyes which affect the stability of the duplexes substantially. Especially, the dianionic fluorescein attached via a flexible linker either to PNA or to DNA seems to be involved in an attractive interaction with the opposite dicationic lysine when hybridized to a PNA strand. This interaction leads to an increased thermal stability as manifested as a 3-4 degreesC increase of the melting temperature. For the PNA/DNA duplex where fluorescein is attached to the PNA strand, a large destabilization (DeltaTm = -12 degreesC) occurs relative to the unlabeled duplex, probably originating from electrostatic repulsion between the fluorescein and the negatively charged DNA backbone. In the case of the PNA/PNA duplex, the sense of helicity of the duplex is reversed upon conjugation of fluorescein via a flexible linker arm, but not when the fluorescein is attached without a linker to the PNA.

Long-term effects of a change from a mixed diet to a lacto-vegetarian diet on human urinary and faecal mutagenic activity.

This is an investigation of the long-term effects of a shift from a mixed diet to a lacto-vegetarian diet and of a return to a mixed diet on the mutagenic activity in urine and faeces. The participants were 20 normal weight, non-smoking subjects. Dietary surveys and urinary and faecal samples were collected before and 3, 6 and 12 months after the dietary shift as well as 3 years after termination of the lacto-vegetarian diet period. The faecal samples were assayed for direct acting mutagens with the fluctuation test for weak mutagens and the urinary samples were assayed with the same assay but with a metabolic activation system, the so-called S9 fraction. The dietary data showed an increase in consumption of fruits, vegetables and dairy products and a decrease in meat, fish, eggs, sweets and biscuits during the vegetarian diet period. These changes led to an increase in total carbohydrates, fibre, vitamin C and calcium and a decrease in fat and protein intake. Mutagenic activity in both urine and faeces decreased after shift to the vegetarian diet and mutagenic activity in faeces increased when the volunteers returned to a mixed diet (P = 0.025 and 0.035 respectively when comparing the diets). These data indicate that dietary factors may effect mutagenic activity in urine and faeces. However, it is still not clear whether a decrease in animal products, a change in other nutritional factors or a decrease in frying are the main contributors to this change.

Evaluation of an oral health education program for nursing personnel in special housing facilities for the elderly.

The aim of this study was to evaluate the influence of an oral health education program (OHEP) on attitudes among the responsible nursing personnel toward performing oral health procedures for care receivers. A total of 2882 nursing personnel were offered participation in the OHEP, and the effect was evaluated by means of a questionnaire distributed pre-educationally as well as 1-2 months post-educationally. The nursing personnel were allocated, on the basis of nursing education, to either a "high level of health care education" group (HHCE), including registered and enrolled nurses, or a "low level of health care education" group (LHCE), including nursing assistants and home care aides. Statistical analysis was performed by means of descriptive and analytical statistics. After the OHEP, the nursing personnel estimated their ability to perform oral hygiene procedures for care receivers to be significantly increased. Post-educationally, a significant shift in importance was observed from knowledge regarding the diseased oral cavity to knowledge regarding the healthy oral cavity. It was also observed that, in the LHCE group, the OHEP favored practical procedures, while in the HHCE group, theoretical considerations were favored. This indicates that, when oral health education programs are designed, due attention should be paid to the nursing personnel's education level.

Frequency of patients with acute asthma in relation to ozone, nitrogen dioxide, other pollutants of ambient air and meteorological observations.

OBJECTIVE: To study the association of the daily frequency of registration of patients with acute asthma at the emergency department of a central hospital in the south-west of Sweden with levels of air pollution and meteorological observations. METHODS: A retrospective longitudinal study was made of asthma patients taken from a hospital registry. This information was correlated with measurements of ozone, nitrogen dioxide, sulphur dioxide, toluene, temperature and relative humidity. Patients were from the catchment area of the Central Hospital of Halmstad containing around 120,000 inhabitants. A total of 4127 visits of patients with acute asthma to the emergency department at the Central Hospital of Halmstad were registered during a period of 1247 days from January 1990 to May 1993. The differential optical absorption spectroscopy (DOAS) technique was used to monitor levels of air pollutants over a distance of 1000 m in the central part of the town of Halmstad. Data on temperature, relative humidity, precipitation, wind speed and wind direction for the time period were supplied by the Swedish Meteorological and Hydrological Institute (SMHI). RESULTS: There were many statistically significant correlations between the levels of air pollutants and the meteorological measurements and a strong negative correlation between ozone and nitrogen dioxide. There was a statistically significant effect on asthma visits in children of low temperature and high nitrogen dioxide levels, and on asthma visits in adults of high temperature and high levels of ozone. CONCLUSIONS: There was a different reaction pattern in children and adults with asthma regarding temperature and ozone/nitrogen dioxide. The strong correlations between temperature and air pollution and between the levels of ozone and nitrogen dioxide made the true relation between asthma, air pollution and temperature hard to evaluate statistically.

Dietary influence on some proposed risk factors for colon cancer: fecal and urinary mutagenic activity and the activity of some intestinal bacterial enzymes.

This investigation studied the effects of a shift from a well-balanced mixed diet to a lacto-vegetarian diet on the mutagenic activity in urine and feces and on some cancer-associated bacterial enzymes in human feces (beta-glucuronidase, beta-glucosidase, and sulphatase). Three months after the shift to the lacto-vegetarian diet, there was a significant decrease in mutagenic activity in urine and feces, beta-glucuronidase, beta-glucosidase, and sulphatase per gram feces wet weight. In contrast, the fecal mutagenic activity and the enzyme activities remained unchanged if expressed per daily output. However, the urinary mutagenic activity expressed as total daily output decreased. Part of the explanation for the decreased fecal mutagenic activity and the decreased enzyme activities is obviously a dilution effect, because much of the increased fecal weight after the shift in diet was associated with a higher water content.

Acute glomerulonephritis, Henoch-Schönlein purpura and dental amalgam in Swedish children: a case-control study.

The issue of adverse health effects from dental amalgam and the concurrent low-dose exposure to inorganic mercury have been scrutinized by several Swedish expert groups during the past years. Only rarely have amalgam fillings in children been related to health effects. Experimental studies in genetically disposed animals have shown that low doses of inorganic mercury can induce autoimmune glomerulonephritis. The present case-control study included 31 children with acute glomerulonephritis and 33 with Henoch-Schönlein purpura retrieved from an in-patient register for the period 1973-1992 at the county hospital in Halmstad, Sweden. The median age was 10 and 9 years, respectively, for the two diagnostic groups. Dental clinics reported amalgam burden of the patients during the year before the date of diagnosis. Corresponding data were obtained for three randomly selected controls for each case, drawn from the case records of the same dental clinics, with matching for age and sex. Odds ratios (95% confidence interval) were 1.42 (0.49, 4.11) for Henoch-Schönlein purpura, 0.59 (0.25, 1.38) for acute glomerulonephritis and 0.84 (0.40, 1.75) for both diseases combined. The results of this study did not indicate increased disease risk in relation to amalgam burden.

Skin prick tests with standardized extracts of inhalant allergens in 7099 adult patients with asthma or rhinitis: cross-sensitizations and relationships to age, sex, month of birth and year of testing.

The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients with asthma and/or rhinitis were retrospectively analyzed. Standardized Soluprick extracts of Dermatophagoides pteronyssinus, animals and pollen, and unstandardized extracts of Cladosporium++ and chironomids (red mosquito larvae, Chir), were used. The proportion of atopics (patients with positive SPT results) was 44 percent, decreasing from 61 percent in patients 14-20 years old to 18 percent in patients 61-70 years old. The decrease with age was most pronounced with timothy, cat and horse allergens. In the whole patient group, timothy, cat and birch gave the highest number of positive SPTs. Positive SPTs with dog and Chir were more common in asthmatics than in patients with rhinitis, whereas pollen allergy was more common in patients with rhinitis. Sensitization against D. pteronyssinus, timothy and Chir was more common in men than in women. Of the atopic patients, 65 percent were sensitized against several allergens and 35 percent had a mono-allergy, most frequently to D. pteronyssinus (7.4 percent) and timothy (70 percent). The proportion monoallergies/multi-allergies was higher in older patients than in younger ones. The degree of atopy, expressed as the sum of plusses of the test results with eight allergens for each patient, was higher in younger patients than in older ones. The size of the wheals induced by the positive histamine control increased with age, and the histamine-induced wheals were larger in men than in women and larger in non-atopics than in topics. Strong correlations were found between test results with cat, dog and horse. A greater proportion of the patients with an isolated pollen allergy were born in February-May than was to be expected. The proportion of positive SPTs with mugwort (Artemisia), in relation to positive SPTs with other pollen allergens, decreased from 1981 to 1992. It can be concluded that sensitization to various inhalant allergens is influenced by age, and to a lesser extent by sex, and that pollen sensitization is influenced by the month of birth. During a 12-year period, sensitization to mugwort showed a decrease, as compared to other pollen allergens.

A prospective study of cancer incidence in a cohort examined for allergy.

In order to assess the association between atopy and cancer risk, a cohort of 6593 skin-prick-tested patients was established. Among atopic subjects, no overall increased cancer risk was found, but the incidence of both breast cancer (standardized incidence ratio (SIR) 2.50, 95% CI 1.01-5.16) and malignant lymphomas (SIR 4.40, 95% CI 1.20-11.3) was significantly enhanced. Atopic subjects with asthma showed a decreased overall cancer risk (SIR 0.73, 95% CI 0.27-1.60), as compared with the other asthmatic subjects (SIR 1.46, 95% CI 1.03-2.04). The cancer risk for subjects with rhinitis was near unity (SIR 1.11), irrespective of whether the subjects were atopic or not. An almost significant risk increase for cancer was observed among subjects with urticaria (SIR 1.70, 95% CI 0.99-2.80). Our results support neither the original hypothesis of an overall cancer protective effect of atopy, nor that of an opposite effect; rather, they strengthen the view that the association between atopic diseases and cancer is complex.

Increased frequencies of micronuclei in T8 lymphocytes of smokers.

Micronucleus frequencies and mitotic indices were analyzed in B, T4, and T8 lymphocytes from 40 smokers and 42 non-smoking referents. The highest level of micronuclei was found in T4 cells followed by T8 and B cells. These differences were statistically significant. There were statistically significant linear correlations between the micronucleus frequencies of all three subsets. There was a statistically significant effect of smoking only in the T8 cells. Smoking also increased the number of neutrophilic granulocytes and lymphocytes in the peripheral blood. There was a statistically significant effect of age on the micronucleus frequencies in T4 and T8 lymphocytes. The mitotic indices did not have any effect on the micronucleus frequencies and they were not influenced by smoking, age or sex.

Does transurethral resection of a clinically benign prostate gland increase the risk of developing clinical prostate cancer? A 10-year follow-up study.

BACKGROUND: Theoretical considerations have raised the suspicion that transurethral resection of the prostate (TURP) may increase the risk of developing prostate cancer in clinically benign prostate glands. Previous studies have not shown an increased risk among men who had undergone TURP for benign prostatic hyperplasia compared with the risk in age-matched control subjects. However, in all of these studies, all men with stage T1 prostate cancer in the TURP-group were excluded, possibly creating a bias, because no similar exclusion could be made for the controls. METHODS: The incidence and mortality of clinical prostate cancer were studied in 198 patients who had TURP and in 203 age-matched male control subjects. In both groups, all patients with known prostate cancer and patients with suspected cancer by digital rectal examination were excluded from the study. However, patients with stage T1 cancer found by the TURP were included in the comparison between the groups. RESULTS: The mean age in the two groups was 67 +/- 6 years. The patients were followed for an average of 10.2 +/- 1.2 years and 10.4 +/- 1.8 years in the TURP group and the control group, respectively. Clinical prostate cancer developed in six patients who had TURP and subsequently in five control (odds ratio, 0.8 [0.2-3.1]; P < 0.97). Before follow-up, three men in each group died because of prostate cancer (odds ratio, 1.3 (0.24-7.45); P < 0.97). CONCLUSIONS: The results of this study suggest that neither benign prostatic hyperplasia nor TURP increased the risk of developing clinical prostate cancer over the next 10 years in patients with a benign prostate gland determined by rectal examination before TURP.