Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy.

BACKGROUND: Women with breast cancer undergoing chemotherapy suffer from a range of detrimental disease and treatment related side-effects. Exercise has shown to be able to counter some of these side-effects and improve physical function as well as quality of life. The primary aim of the study is to investigate and compare the effects of two different exercise regimens on the primary outcome cancer-related fatigue and the secondary outcomes muscle strength, function and structure, cardiovascular fitness, systemic inflammation, skeletal muscle gene activity, health related quality of life, pain, disease and treatment-related symptoms in women with breast cancer receiving chemotherapy. The second aim is to examine if any effects are sustained 1, 2, and 5 years following the completion of the intervention and to monitor return to work, recurrence and survival. The third aim of the study is to examine the effect of attendance and adherence rates on the effects of the exercise programme. METHODS: This study is a randomised controlled trial including 240 women with breast cancer receiving chemotherapy in Stockholm, Sweden. The participants are randomly allocated to either: group 1: Aerobic training, group 2: Combined resistance and aerobic training, or group 3: usual care (control group). During the 5-year follow-up period, participants in the exercise groups will receive a physical activity prescription. Measurements for endpoints will take place at baseline, after 16 weeks (end of intervention) as well as after 1, 2 and 5 years. DISCUSSION: This randomised controlled trial will generate substantial information regarding the effects of different types of exercise on the health of patients with breast cancer undergoing chemotherapy. We expect that dissemination of the knowledge gained from this study will contribute to developing effective long term strategies to improve the physical and psychosocial health of breast cancer survivors. TRIAL REGISTRATION: OptiTrain - Optimal Training Women with Breast Cancer (OptiTrain), NCT02522260 ; Registration: June 9, 2015, Last updated version Feb 29, 2016. Retrospectively registered.

Identification of lignans by liquid chromatography-electrospray ionization ion-trap mass spectrometry.

The fragmentation pattern of 30 compounds belonging to different classes of the lignan family was studied by liquid chromatography-electrospray ionization ion-trap mass spectrometry. On the basis of the observed fragmentation patterns, identification of different types of lignans was achieved. For example, dibenzylbutyrolactone lignans showed a characteristic fragmentation pathway by the loss of 44 Da (CO(2)) from the lactone moiety, whereas dibenzylbutanediols showed a loss of 48 Da by a combined loss of formaldehyde and water from the 1,4-butanediol moiety. Lignan glycosides readily lost the sugar residue to give the parent lignan as their primary product ion. In addition, several compound-specific fragmentations were observed and used for identification of individual compounds.A versatile method for analyses of lignans was developed using LC separation on a C8 column followed by fragmentation and detection of ions produced in the ion trap.

A longitudinal study on women's experiences of life with breast cancer in anthroposophical (complementary) and conventional care.

Earlier findings in different care settings have revealed that women with breast cancer admitted to anthroposophical clinics (complementary care) initially had lower quality of life scores compared with those in conventional care, but that the scores after 1 year increased significantly. The anthroposophical hospital in this study offers integrated conventional and anthroposophical healthcare therapies. The present study examines experiences of life among women with breast cancer during the 1-year follow-up of the original study. A second aim was to seek profiles of differences between 37 matched pairs of women with breast cancer. The mean age of the women was 48 years, and 17 of the 37 pairs had a local limited disease, whereas 20 pairs had an advanced disease. The findings highlight seven themes of described meaning. Important changes noticed after 1 year were an appreciation of the beauty of life, experiences of threat, introspection into self and meaning of life, and changes in the body. The experience of being stronger constitutes being existentially demanded, including weakness, vulnerability and strength. Some differences in profiles were noticed after 1 year, in that the group that received anthroposophical care seemed to be more orientated towards personal growth and meaning of life, whereas the matching group was more orientated towards external activities and bodily changes.

Effect of a novel non-thiazolidinedione peroxisome proliferator-activated receptor alpha/gamma agonist on glucose uptake.

AIMS/HYPOTHESIS: The effect of the benzopyran derivative T33, a novel non-thiazolidinedione agent, was studied on peroxisome proliferator-activated receptors (PPARs), insulin signalling and glucose uptake in adipocytes and skeletal muscle. We hypothesised that T33 could activate PPARgamma and exert a beneficial effect on insulin action on glucose uptake and lipid metabolism. MATERIALS AND METHODS: Using a cell-based reporter gene assay, T33 was identified as a PPARalpha/gamma dual agonist, which activated human PPARgamma and PPARalpha with EC50 values of 19 and 148 nmol/l, respectively. The effect of T33 on glucose metabolism was studied in cultured 3T3-L1 adipocytes and L6 myotubes. In vivo effects of T33 on skeletal muscle were determined in ob/ob mice treated with 8 mg/kg T33. The effect of T33 on metabolic abnormalities was observed in diet-induced obese mice. RESULTS: Exposure of 3T3-L1 adipocytes to T33 for 4 days increased basal and insulin-stimulated glucose uptake, with no effect noted in L6 myotubes. Treatment of ob/ob mice for 20 days with T33 normalised basal and insulin-stimulated glucose uptake and increased phosphorylation of Akt and p38 mitogen-activated protein kinase in skeletal muscle. In contrast, phosphorylation of AMP-activated protein kinase was unaltered. Moreover, T33 improved insulin sensitivity and lipid metabolism in diet-induced obese mice. CONCLUSIONS/INTERPRETATION: T33 is non-thiazolidinedione PPARalpha/gamma dual agonist which directly increases basal and insulin-stimulated glucose uptake in adipocytes and secondarily improves insulin action on insulin signalling and glucose metabolism in skeletal muscle from diabetic ob/ob mice.

Psychiatric symptoms of children and adolescents with juvenile neuronal ceroid lipofuscinosis.

BACKGROUND: Juvenile neuronal ceroid lipofuscinosis (JNCL) is one of the most common neurodegenerative disorders in childhood and adolescence. The clinical picture includes diverse and complex psychiatric symptoms that are difficult to treat. Only symptomatic treatment is available. To improve symptomatic therapy, it is important to recognize the symptoms. The purpose of this study was to identify predominant psychiatric symptoms in patients with JNCL. METHODS: The study included 27 patients with JNCL with and without psychotropic treatment. The mean age was 15.2 (range 9-21) years. Characteristic psychiatric symptoms in this patient group were clarified by using the following standardized questionnaires filled in by parents, teachers and the patients themselves: Child Behavior Checklist (CBCL), Teacher Report Form (TRF) and Children's Depression Inventory (CDI). The symptoms were recorded for the entire study group and compared between patients with and without psychotropic treatment and between genders. RESULTS: The patients had a large number of psychiatric symptoms according to the CBCL and TRF. The most commonly reported symptoms were social, thought, attention problems, somatic complaints and aggressive behaviour. Patients receiving psychotropic medication had more psychiatric symptoms according to the CBCL and TRF. Moreover, female patients had more problems than male patients according to the CBCL. The total psychiatric symptom score was at clinical or borderline range for psychiatric disturbance in 74% of patients. The number of depressive symptoms reported by the patients themselves was low. CONCLUSIONS: JNCL patients suffer from a multitude of psychiatric symptoms. To improve drug choice and dosage, a thorough evaluation of these symptoms by standardized methods is needed before initiating treatment. Progress and possible adverse effects of treatment should be monitored on a regular basis.

Long-term effects of eradication of Helicobacter pylori on relapse and histology in gastric ulcer patients: a two-year follow-up study.

BACKGROUND: The main purpose of this study was to compare omeprazole (ome) plus two antibiotics (OMC) with omeprazole plus placebo (OP) with regard to gastric ulcer relapse for a period of 2 years in patients who were Helicobacter pylori-positive at inclusion. METHODS: Using double-blind randomization 125 patients with gastric ulcer were treated with either OMC (ome 20 mg b.i.d., metronidazole 400 mg b.i.d., clarithromycin 250 mg b.i.d.) (n = 64) or OP (ome 20 mg and placebo) (n = 61) for 1 week, followed by ome 20-40 mg o.d. until healing was confirmed endoscopically after 4, 8 or 12 weeks. Endoscopy and H. pylori diagnostics using culture, histology and serology were performed 6, 12 and 24 months after treatment or at symptomatic relapse. At inclusion, 35% of the OMC group and 38% of the OP group were taking non-steroidal anti-inflammatory drugs (NSAIDs). Nine percent (11/125) of the ulcers were malignant. RESULTS: The prevalence of H. pylori was 82% and the eradication rate 88% in the OMC group and 3% in the OP group. More than 90% of the ulcers were healed after 12 weeks. After 2 years, 76% of patients in the OMC group were in remission compared with 28% in the OP group (ITT) (P < 0.001). Sixty percent of patients in the OMC group that continued to take NSAIDs were in remission after 2 years compared with none in the OP group. Atrophy but not intestinal metaplasia decreased after treatment. CONCLUSIONS: Gastric ulcers are mainly caused by H. pylori, and relapse is effectively prevented by H. pylori eradication, even in patients on NSAIDs.

Role of beta-catenin in the developing cortical and hippocampal neuroepithelium.

beta-Catenin plays a pivotal role in Wnt signaling during embryogenesis and is a component of adherens junctions. Since targeted disruption of the beta-catenin gene is lethal at gastrulation we have used a D6-Cre mouse line for conditional inactivation of beta-catenin in the mouse cerebral cortex and hippocampus after embryonic day (E) 10.5. In D6-Cre floxed beta-catenin mice, hippocampal CA1-CA2 fields are disrupted in similar manner as in Wnt-3a and LEF-1 mutants. The cortex of D6-Cre floxed beta-catenin mutants is strongly affected which contrasts with the normal cortex observed in Wnt-3a and LEF-1 mutants. Severe abnormalities in the organization of the neuroepithelium are observed that include disrupted interkinetic nuclear migration, loss of adherens junctions, impaired radial migration of neurons toward superficial layers and decreased cell proliferation after E15.5. At newborn stage, a premature disassembly of the radial glial scaffold and increased numbers of astrocytes are found in the cortex.

Forebrain-specific promoter/enhancer D6 derived from the mouse Dach1 gene controls expression in neural stem cells.

Drosophila dachshund is involved in development of eye and limbs and in the development of mushroom bodies, a brain structure required for learning and memory in flies. Its mouse homologue mDach1 is expressed in various embryonic tissues, including limbs, the eye, the dorsal spinal cord and the forebrain. We have isolated a forebrain-specific 2.5-kb enhancer element termed D6 from the mouse mDach1 gene and created D6-LacZ and D6-green fluorescent protein (GFP) reporter gene mouse lines. In embryonic stages, the D6 enhancer activity is first detected at embryonic day 10.5 in scattered cells of the outbuldging cortical vesicles. By embryonic day 12.5, D6 activity expands throughout the developing neocortex and the hippocampus. In the adult mouse brain, D6 enhancer is active in neurons of the cortical plate, in the CA1 layer of the hippocampus and in cells of the subventricular zone and the ventricular ependymal zone. Adult mice also show D6 activity in the olfactory bulb and in the mamillary nucleus. Cultured D6-positive cells, which were derived from embryonic and postnatal brains, show characteristics of neural stem cells. They form primary and secondary neurospheres that differentiate into neurons and astrocytes as examined by cell-specific markers.Our results show that D6 enhancer exerts highly tissue-specific activity in the neurons of the neocortex and hippocampus and in neural stem cells. Moreover, the fluorescence cell sorting of D6-GFP cells from embryonic and postnatal stages allows specific selection of primary neural progenitors and their analysis.

Development of level A, B and C in vitro-in vivo correlations for modified-release levosimendan capsules.

The aim of this study was to investigate the possibility of developing different levels of correlation between in vitro release and in vivo absorption rate for four modified-release levosimendan capsule formulations. Differences and similarities in the in vitro dissolution curves were compared with pharmacokinetic parameters describing absorption rate. Formulations F, G, H and I differed in the amounts of the delaying excipients alginic acid and HPMC. In vitro release rate was studied by the USP basket method using the following conditions: pH 5.8 or 7.4 and a rotation speed of 50 or 100 rpm. In vivo bioavailability was tested in nine healthy male volunteers and the fractions absorbed were calculated by the Wagner-Nelson method. Dissolution conditions pH 5.8 and a rotation speed of 100 rpm predicted best the similarities and differences in absorption rates among different formulations, and levels C and B correlation coefficients were 0.85 and 0.97, respectively. For formulation H level A correlation (r=0.997) was found when in vitro lag time was 0.2 h and time scale factor 1.9. This study indicated that dissolution tests developed can be used as a surrogate for human bioequivalence studies, for development processes of final commercial products, to ensure batch to batch bioequivalence and in the future in possible scale-up and post approval change cases for modified-release levosimendan formulation H.

Perceived quality of life and coping for Swedish women with breast cancer who choose complementary medicine.

The aim of the present study, which is part of a major clinical controlled study of the life situation of women with breast cancer, was to compare two groups of women concerning perceived quality of life and coping. The women were treated in two different cancer treatment programs: complementary treatment, which included anthroposophic therapy, and conventional cancer treatment. A total of 120 women were included, 60 women treated with anthroposophic medicine, and 60 individually matched women treated with conventional medicine only. Quality of life was measured by the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Core 30, and the Life Satisfaction Questionnaire. Coping was measured by the Mental Adjustment to Cancer scale. The results showed that the women who chose anthroposophic therapy perceived their quality of life to be lower on admission to the hospital and showed more anxious preoccupation than the women in conventional medicine. It can be concluded that, due to the careful matching procedure, the women in the two groups are comparable in a medical sense but not from the perspective of quality of life and coping.

New antidepressive and antipsychotic drugs in juvenile neuronal ceroid lipofuscinoses--a pilot study.

Patients with juvenile neuronal ceroid lipofuscinosis (JNCL) often have severe psychiatric symptoms. These are common in their mid-teens and include such symptoms as anxiety and affective and psychotic disorders. The older antidepressants and antipsychotics do not seem to be effective and often cause many adverse effects. Therefore, we wanted to try the new psychotropic drugs in Finnish patients with JNCL. We also wanted to determine the profile of these drugs in this patient group. Fourteen Finnish patients with JNCL receiving psychotropic drug treatment with citalopram, risperidone, olanzapine or quetiapine, were included. The mean age at initiation of the new psychotropic drugs was 13.8 years. Indications for treatment were psychotic symptoms, affective symptoms, anxiety and an inadequate response to other psychotropic drugs, or even adverse reactions. Information on psychiatric symptoms and current treatment was gathered from interviews and from the medical records. Indications and the clinical outcome of the treatment were determined by a consensus of the assessments by parents and physicians. The psychotropic drugs most commonly used in Finnish patients with JNCL are citalopram and risperidone. The clinical outcome was good or satisfactory in 70%. The adverse effects most commonly reported were fatigue, weight gain and aggravation of extrapyramidal symptoms. Little research has been done in this area and there are no good guidelines for treatment of psychiatric symptoms in patients with JNCL. Therefore, every patient should be treated with the safest and most commonly used drugs in the lowest possible doses.

Immunogenicity and reactogenicity of a new measles, mumps and rubella vaccine when administered as a second dose at 12 y of age.

An open randomized trial involving 301 subjects was conducted in order to compare the reactogenicity and immunogenicity of a new measles, mumps and rubella (MMR) vaccine, SB MMR, with those of a commercial MMR vaccine, Merck MMR, when given as a second dose to children at 11-12 y of age. All subjects had previously received Merck MMR in the first year of life. In initially seronegative subjects, all subjects receiving the Merck MMR vaccine had seroconverted with respect to measles (10/10 subjects), mumps (38/38) and rubella (4/4). Of the subjects receiving SB MMR, 6/7 seroconverted with respect to measles, 29/31 with respect to mumps and 3/3 with respect to rubella. No difference was seen in seroconversion rates or geometric mean values (GMVs) between groups. In initially seropositive subjects, a higher anti-mumps immune response rate was observed in the SB MMR group (59.3%) compared with the Merck MMR group (24.1%). Higher post-vaccination anti-mumps and anti-rubella GMVs were observed in the group receiving SB MMR (p < 0.007), whereas higher anti-measles GMVs were observed in the Merck MMR group (p = 0.0013). There was a lower (p = 0.013) incidence of pain at the injection site in subjects receiving SB MMR (20.1%) compared with Merck MMR (33.3%). Incidences of systemic reactions were similar between groups.

Epilepsy and antiepileptic drug therapy in juvenile neuronal ceroid lipofuscinosis.

PURPOSE: To survey the characteristics of epilepsy in patients with juvenile neuronal ceroid lipofuscinosis (JNCL) and determine the antiepileptic drug (AED) treatment most suitable for these patients. METHODS: The study included 60 patients with JNCL; their mean age was 16.5 years (range 5-33). The age at onset of epilepsy, type of seizures, effect of the first AED on seizures, and the current seizure frequency and AED therapy were studied. The side effects of the AEDs were also clarified. RESULTS: Fifty of the 60 patients had epilepsy. Patients' first epileptic seizure occurred at a mean age of 10.0 years (range 5-16), the most common type being generalized seizures. As the first AED tried, valproate (VPA) and lamotrigine (LTG) appeared equally effective, with 80% of the patients responding to these AEDs. During the study year, the median seizure frequency was four seizures a year (range 0-120), and 72% of the patients had good or satisfactory seizure control (0-6 seizures a year). In the different AED therapy groups, the proportion of patients with good or satisfactory seizure control ranged from 25% to 100%. LTG in monotherapy or in combination with clonazepam (CZP) was superior to other AEDs or combinations, but VPA also seemed effective. Adverse effects leading to the discontinuation of an AED were observed in 25% of the patients, most frequently in patients receiving phenobarbital (PB). No patient receiving LTG had to discontinue the drug due to adverse effects. CONCLUSION: Epilepsy in JNCL can usually be successfully treated with the current AEDs. In Finnish patients with JNCL, treatment is based on LTG, or, secondarily, VPA. In combination therapy, CZP seems a valuable add-on AED.

Yeast two-hybrid system identifies the ubiquitin-conjugating enzyme mUbc9 as a potential partner of mouse Dac.

Using a yeast two hybrid system and pull-down assays we demonstrate that mouse Dac (mDac) specifically binds to mouse ubiquitin-conjugating enzyme mUbc9. In contrast to a direct interaction between Drosophila dachshund (dac) and eyes absent (eya)gene products, we cannot detect by the same methods that mDac binds to mEya2, a functional mouse homologue of the Drosophila Eya. Immunostaining of various cell lines that were transfected with mDac reveals that mDac protein is found predominantly in the nucleus but translocates to the cytoplasm and condensates along the nuclear membrane in a cell-cycle dependent manner. Deletion analysis of mDac show the intracellular localization and protein stability correlates with the binding to mUbc9. The C-terminal half of mDac, which associates with mUbc9, remains cytoplasmic and is degraded in proteasome whereas the non-interacting N-terminus is exclusively nuclear and more stable than the full-length mDac or its C-terminal portion. In situ hybridization on whole-mount embryos or tissue sections detects mUbc9 transcripts in complementary and overlapping areas with mDac expression, particularly in the proliferation zone of the limb buds, the spinal cord and forebrain. Mouse embryos stained with an anti-mDac antibody document that mDac is localized both in the nucleus and the cytoplasm with a cytoplasmic predominance in migrating neural crest cells. In the proliferation zone, visible nuclear envelopes are not formed and mDac is detected throughout the cells.

Identification of a human nuclear receptor defines a new signaling pathway for CYP3A induction.

Nuclear receptors regulate metabolic pathways in response to changes in the environment by appropriate alterations in gene expression of key metabolic enzymes. Here, a computational search approach based on iteratively built hidden Markov models of nuclear receptors was used to identify a human nuclear receptor, termed hPAR, that is expressed in liver and intestines. hPAR was found to be efficiently activated by pregnanes and by clinically used drugs including rifampicin, an antibiotic known to selectively induce human but not murine CYP3A expression. The CYP3A drug-metabolizing enzymes are expressed in gut and liver in response to environmental chemicals and clinically used drugs. Interestingly, hPAR is not activated by pregnenolone 16alpha-carbonitrile, which is a potent inducer of murine CYP3A genes and an activator of the mouse receptor PXR.1. Furthermore, hPAR was found to bind to and trans-activate through a conserved regulatory sequence present in human but not murine CYP3A genes. These results provide evidence that hPAR and PXR.1 may represent orthologous genes from different species that have evolved to regulate overlapping target genes in response to pharmacologically distinct CYP3A activators, and have potential implications for the in vitro identification of drug interactions important to humans.

Long-term exposure to enhanced ultraviolet-B radiation in the sub-arctic does not cause oxidative stress in Vaccinium myrtillus.

The aim of this work was to assess whether or not oxidative stress had developed in a dwarf shrub bilberry (Vaccinium myrtillus L.) under long-term exposure to enhanced levels of ultraviolet-B (u.v.-B) radiation. The bilberry plants were exposed to increased u.v.-B representing a 15% stratospheric ozone depletion for seven full growing seasons (1991-1997) at Abisko, Swedish Lapland (68°N). The oxidative stress was assessed on leaves and stems by analysing ascorbate and glutathione concentrations, and activities of the closely related enzymes ascorbate peroxidase (EC 1.11.1.11) and glutathione reductase (EC 1.6.4.2). The affects of autumnal leaf senescence and stem cold hardening on these variables were also considered. The results showed that the treatment caused scarcely any response in the studied variables, indicating that u.v.-B flux representing a 15% ozone depletion under clear sky conditions is not sufficient to cause oxidative stress in the bilberry. It is suggested that no strain was evoked since adaptation was possible under such u.v.-B increases. The studied variables did, however, respond significantly to leaf senescence and especially to stem cold hardening.

[Patients' perception of surgical care. A study at HUCH, Surgical Hospital in 1994 and a comparison of study results from 1990]. / Potilaiden näkemys kirurgisesta sairaanhoidosta. Tutkimus HYKS:n Kirurgisessa sairaalassa vuonna 1994 ja vertailu tutkimustuloksiin vuodelta 1990.

The purpose of this study was to assess patient satisfaction with care in HUCH, Surgical Hospital 1994 and to compare the results to the results of a-study done with the same questionnaire in 1990. The data were collected using SPRI:s (Sjukvårdens och socialvårdens planerings- och rationaliseringsinsitut) questionnaire from patients (N = 215) at seven wards. The response rate was 72. The structured questions were analysed by using the SOLO calculating program and the open-ended questions by using content analyses method. The results are presented in percentages and cross tabulations in the article. According to the results the patients were elder, suffered from more serious diseases and stayed for a longer time in the hospital than 1990. Patients' satisfaction was improved with information and nursing. However, even if the information was improved, most patients wanted more written information. On the whole, patients were satisfied with nursing care but some criticism was expressed concerning environment.

Novel forms of B-domain-deleted recombinant factor VIII molecules. Construction and biochemical characterization.

Recombinant molecules similar to the smallest active plasma-derived factor VIII molecule, a complex of an 80-kDa and a 90-kDa polypeptide chain lacking the B domain, have been produced using various factor VIII cDNA constructs in order to obtain primary translation products which were efficiently processed into the 80 + 90-kDa complex. Three types of single-chain cDNAs encoding B-domain-deleted derivatives factor VIII were designed, taking account of sites at Arg740 and Glu1649, assumed to be important for processing factor VIII. In the type 1 constructs, either Arg747, Arg752, or Arg776 in the N-terminal region of factor VIII B domain was fused to the N-terminus (Glu1649) of the 80-kDa subunit. In the type 2 construct r-VIII SQ, Ser743 was fused to Gln1638, creating a link of 14 amino acids between the C-terminus (Arg740) of the 90-kDa chain and N-terminus of the 80-kDa chain, whereas in type 2 r-VIII RH, Arg747 was fused to His1646. In the type 3 constructs, the B-domain was completely removed or replaced with 1-4 Arg residues. After expression in Chinese hamster ovary cells, the type 1 derivatives and the type 3 derivatives with 0-2 Arg residues inserted were found to be only partially processed and contained a large amount of the 170-kDa primary translation product. In contrast, most of the type 2 derivatives r-VIII SQ and r-VIII RH and the type 3 derivatives r-VIII R4 and r-VIII R5 containing three or four extra Arg residues preceding the N-terminus of the 80-kDa chain were processed into the desired 80 + 90-kDa chain complexes. The feature common to the most efficiently processed factor VIII deletion derivatives was that they contained the recognition motif for proteolytic cleavage by the membrane-bound subtilisin-like protease furin, which is expressed in most types of cells; that is, basic amino acid residues at positions -1 and -4 relative to the cleavage site at Glu1649. Biochemical studies of r-VIII SQ and r-VIII R5, two of the most effectively processed factor VIII derivatives, showed that both proteins had a normal factor VIII cofactor function, and had N- and C-termini of the 80-kDa and 90-kDa chains corresponding to those found in plasma-derived factor VIII.

The virgin population of Neisseria gonorrhoeae in Stockholm has decreased and antimicrobial resistance is increasing.

AIMS: To investigate the evolution of chromosomal and plasmid mediated resistance for ampicillin and tetracycline of N gonorrhoeae strains in Stockholm during 1982-1993. METHODS: A total of 404 gonococcal strains isolated in 1982, 1987, 1990, 1992, 1993 were analysed for minimal inhibitory concentrations (MIC) of ampicillin and tetracycline and for plasmid content. MIC values were determined by the agar dilution method and plasmid preparations were performed using alkaline lysis. To detect additional gonococcal strains with tet(M) plasmids all strains isolated in 1988-1989 and 1991, in all 234 isolates, were analysed retrospectively for MIC values of tetracycline. If an MIC value of > or = 4.0 mg/l was recorded plasmid analysis was performed. RESULTS: Increased proportions of chromosomally mediated resistance to tetracycline (p < 0.001) as well as plasmid mediated resistance to both ampicillin (p < 0.02) and tetracycline were found in the later part of the study. In 1991 the first gonococcus with tet(M) plasmid was isolated in Sweden. The proportion of strains with chromosomally mediated resistance for ampicillin did not change during the study period. The proportion of gonococcal strains with the 39 kb conjugative plasmid was increased in the later part of the study. CONCLUSIONS: The increased proportion of N gonorrhoeae strains with resistance to ampicillin and tetracycline is most likely due to importation of strains from areas with high prevalence of antibiotic resistant gonococci. The proportion of N gonorrhoeae strains with tet(M) plasmids is low in Sweden, but might increase in the same way as the proportion of PPNG strains has increased during 1982-1993.

Correlation of motor-evoked potentials, somatosensory-evoked potentials, and the wake-up test in a case of kyphoscoliosis.

The ability to monitor the descending motor pathways of the spinal cord during surgery is an important goal in neurophysiologic monitoring of spinal deformities. This report describes a case of a severe spinal deformity for which instrumentation and reduction carried a significant risk of neurologic complications. During the procedure, changes in neurologic status were monitored simultaneously using both SSEPs and tcMMEPs. The reliability of these two complimentary modalities was then verified by concurrent wake-up tests. This case provides documentation of the reliability of tcMMEP responses when an accurate assessment of motor function was necessary.