Quantification of differences in bone texture from plain radiographs in knees with and without osteoarthritis.

OBJECTIVE: To quantify differences in bone texture between subjects with different stages of knee osteoarthritis (OA) and age- and gender-matched controls from plain radiographs using advanced image analysis methods. DESIGN: Altogether 203 knees were imaged using constant X-ray parameters and graded according to Kellgren-Lawrence (KL) grading scale (KL0: n = 110, KL1: n = 28, KL2: n = 27, KL3: n = 31, KL4: n = 7). Bone density-related and structure-related parameters were calculated from medial and lateral tibial subchondral bone plate and trabecular bone and from femur. Density-related parameters were derived from grayscale values and structure-related parameters from Laplacian- and local binary patterns (LBP)-based images. RESULTS: Reproducibilities of structure-related parameters were better than bone density-related parameters. Bone density-related parameters were significantly (P < 0.05) higher in KL2-4 groups than in control group (KL0) in medial tibial subchondral bone plate and trabecular bone. LBP-based structure parameters differed significantly between KL0 and KL2-4 groups in medial subchondral bone plate, between KL0 and KL1-4 groups in medial and lateral trabecular bone, and between KL0 and KL1-4/KL2-4 in medial and lateral femur. Laplacian-based parameters differed significantly between KL0 and KL2-4 groups in medial side regions-of-interest (ROIs). CONCLUSIONS: Our results indicate that the changes in bone texture in knee OA can be quantitatively evaluated from plain radiographs using advanced image analysis. Based on the results, increased bone density can be directly estimated if the X-ray imaging conditions are constant between patients. However, structural analysis of bone was more reproducible than direct evaluation of grayscale values, and is therefore better suited for quantitative analysis when imaging conditions are variable.

BMD T-score discriminates trochanteric fractures from unfractured controls, whereas geometry discriminates cervical fracture cases from unfractured controls of similar BMD.

UNLABELLED: The ability of bone mineral density (BMD) to discriminate cervical and trochanteric hip fractures was studied. Since the majority of fractures occur among people who are not diagnosed as having osteoporosis, we also examined this population to elucidate whether geometrical risk factors can yield additional information on hip fracture risk beside BMD. The study showed that the T-score criterion was able to discriminate fracture patients from controls in the cases of trochanteric fractures, whereas geometrical measures may discriminate cervical fracture cases in patients with T-score >-2.5. INTRODUCTION: Low bone mineral density (BMD) is a well-established risk factor for hip fracture. However, majority of fractures occur among people not diagnosed as having osteoporosis. We studied the ability of BMD to discriminate cervical and trochanteric hip fractures. Furthermore, we examined whether geometrical measures can yield additional information on the assessment of hip fracture risk in the fracture cases in subjects with T-score >-2.5. METHODS: Study group consisted of postmenopausal females with non-pathologic cervical (n = 39) or trochanteric (n = 18) hip fracture (mean age 74.2 years) and 40 age-matched controls. BMD was measured at femoral neck, and femoral neck axis length, femoral neck and shaft cortex thicknesses (FNC and FSC), and femoral neck-shaft angle (NSA) were measured from radiographs. RESULTS: BMD T-score threshold of -2.5 was able to discriminate trochanteric fractures from controls (p < 0.001). Seventeen out of 18 trochanteric fractures occurred in individuals with T-score -2.5. Within these non-osteoporotic cervical fracture patients (N = 19) and non-osteoporotic controls (N = 35), 83.3% were classified correctly based on a model including NSA and FNC (p < 0.001), area under the receiver operating characteristics curve being 0.85 for the model, while it was only 0.56 for BMD alone. CONCLUSIONS: The study suggests that the risk of trochanteric fractures could be discriminated based on a BMD T-score <-2.5 criterion, whereas cervical fracture cases would remain under-diagnosed if solely using this criterion. Instead, geometrical risk factors are able to discriminate cervical fracture cases even among individuals with T-score >-2.5. For cervical and trochanteric fractures combined, BMD and geometric measures independently contributed to hip fracture discrimination. Our data support changing from T-score <-2.5 to a more comprehensive assessment of hip fracture etiology, in which fracture type is also taken into account. The findings need to be confirmed with a larger sample, preferably in a prospective study.

Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings.

All patients with total hip arthroplasty (THA) are exposed to soluble or particulate forms of Co and Cr. Adverse effects of these wear products are not known. Data from Nordic registries is used to estimate adverse effects on a large scale, based mostly on metal-on-polyethylene bearings. Cancer incidence was in line with the general population when the patients were operated on for all indications and significantly decreased when the indication was primary osteoarthritis. Stomach cancer and colorectal cancers were significantly reduced and prostate cancer and skin melanoma significantly increased. There was no significant excess of cancer in target organs, i.e. liver, kidney, or haematopoietic cancers. THA patients had reduced mortality and extended life expectancy compared with standard Nordic populations. All-site cancer incidence of the first-generation metal-on-metal McKee-Farrar patients operated on for primary osteoarthritis was in line with the general population after follow-up for up to 28 years. General mortality of these patients was also reduced and they also had an extended life expectancy. Temporary increases in haematopoietic cancers at different follow-up periods were seen in some cohorts. This malignancy deserves a special record linkage monitoring while large numbers of young patients are provided with the second generation of metal-on-metal prostheses.

Changes in the Metabolome of Picea balfouriana Embryogenic Tissues That Were Linked to Different Levels of 6-BAP by Gas Chromatography-Mass Spectrometry Approach.

Embryogenic cultures of Picea balfouriana, which is an important commercial species for reforestation in Southern China, easily lose their embryogenic ability during long-term culture. Embryogenic tissue that proliferated at lower concentrations (3.6 µM and 2.5 µM) of 6-benzylaminopurine (6-BAP) were more productive, and generated 113 ± 6 and 89 ± 3 mature embryos per 100 mg embryogenic tissue, respectively. A metabolomic approach was used to study the changes in metabolites linked to embryogenic competence related to three different 6-BAP concentrations (2.5 µM, 3.6 µM, and 5 µM). A total of 309 compounds were obtained, among which 123 metabolites mapped to Kyoto Encyclopedia of Genes and genomes (KEGG) pathways. The levels of 35 metabolites were significantly differentially regulated among the three 6-BAP treatments, and 32 metabolites differed between the 2.5 µM and 5 µM treatments. A total of 17 metabolites appeared only once among the three comparisons. The combination of a score plot and a loading plot showed that in the samples with higher embryogenic ability (3.6 µM and 2.5 µM), up-regulated metabolites were mostly amino acids and down-regulated metabolites were mostly primary carbohydrates (especially sugars). These results suggested that 6-BAP may influence embryogenic competence by nitrogen metabolism, which could cause an increase in amino acid levels and higher amounts of aspartate, isoleucine, and leucine in tissues with higher embryogenic ability. Furthermore, we speculated that 6-BAP may affect the amount of tryptophan in tissues, which would change the indole-3-acetic acid levels and influence the embryogenic ability.

Does lactose intolerance predispose to low bone density? A population-based study of perimenopausal Finnish women.

The relationship of lactase malabsorption to osteoporosis is unclear. We examined the relationship of self-reported lactose intolerance (LI) to bone mineral density (BMD) in perimenopausal Finnish women. A random population sample of 2025 women aged 48-59, who underwent spinal and femoral BMD measurement with dual X-ray absorptiometry in Kuopio, Finland during 1989-1991 formed the study population. Out of these women, 162 women reported LI. The mean dairy calcium intake was 558 mg/day in women with LI and 828 mg/day in other women (p < 0.0001). The mean spinal BMDs were 1.097 and 1.129 g/cm2 (-2.8%) (p = 0.016) and the mean femoral BMDs were 0.906 and 0.932 g/cm2 (-2.8%) (p = 0.012) for the LI and other women, respectively. After adjusting for weight, age, years since menopause, and the history of hormone replacement therapy, these differences changed to -2.7% (p = 0.016) for the spinal and -2.4% (p = 0.012) for the femoral BMD, respectively. Dairy calcium intake was an independent determinant of femoral BMD. The addition of calcium intake variables into the multivariate model did not affect the spinal BMD difference, but weakened the femoral BMD difference to -1.9% (p = 0.075). Our results suggest that LI slightly reduces perimenopausal BMD, possibly through reduced calcium intake.

Genotype-environment interactions in pollen competitive ability in an anemophilous tree, Betula pendula Roth.

This study describes genotype-environment interactions in pollen competitive ability expressed as pollen-tube growth rate and seed-siring success in Betula pendula Roth. A factorial crossing design was applied using the same maternal and paternal clones in two different environmental conditions, in a B. pendula seed orchard established in a greenhouse and at an outdoor clone collection. Both single donor and two-donor pollinations were employed. Female inflorescences were collected after a fixed time of germination, pollen-tube lengths were measured for each cross, and paternity of the seeds sired by two-donor pollen mixtures was analyzed using isozyme markers. The pollination site had a significant influence on pollen-tube growth rate and seed-siring success. Significant interactions between pollination site and pollen donor indicated genotype-environment interactions in pollen-tube growth rate and seed-siring success. A highly significant positive correlation between pollen-tube growth rate and seed-siring success was found in the greenhouse but not at the outdoor clone collection. These results suggest that the pollen-tube growth rate can be a predictor of seed-siring success in controlled greenhouse conditions, where differences among maternal plants are mainly of genetic origin, but not in more heterogeneous outdoor conditions. In natural birch stands, environmental maternal effects probably diminish the significance of pollen competition for sexual selection in Betula pendula. At seed orchards, the effects of environmental conditions on pollen competitive ability can have important consequences for the genetic composition of the seed crop.

Structural adaptation rather than water conservation was observed in Scots pine over a range of wet to dry climates.

We investigated the functional and structural responses of Scots pine to climate and estimated the importance of the genotype on the traits studied. We analysed 13C isotope discrimination (Δ13C) of various provenances in a common garden experiment and gas exchange characteristics for provenances growing in their natural environment. No clear climatic trend was found in the foliar Δ13C values of common garden trees. Similar results were obtained from estimation of λ (a largely VPD, temperature and light independent measure of intrinsic water use efficiency) from the gas exchange data. The ratio of needle mass to unit stem area and branch area to stem area increased towards south in both experiments and hence, seemed to be genetic. Trees from drier and warmer conditions seemed not to have either lower needle mass or higher intrinsic water use efficiency compared to northern latitudes.

Specific inhibition of spermatozoal energy metabolism by oxidized spermine.

PIP: Oxidized spermine, an iminoaldehyde, inhibited the energy metabolism of human sperm cells with striking specifity compared with other mammalian cell types. Low concentrations of oxidized spermine virtually abolished the conversion of glucose to CO2 and lactate in human sperm, whereas in Ehrlich ascites-carcinoma cells, in human peripheral lymphocytes, and in human vaginal minces, the iminoaldehyde caused little, if any, inhibition of glucose degradation. Other aliphatic aldehydes with long carbon chain, also inhibitory to human sperm cells, did not show cell specifity, depressing equally in all cell types. Heparin prevented but did not reverse the metabolic inhibition caused by oxidized spermine, but did not even prevent inhibitory action of other aliphatic aldehydes. Though largely unclear, the mechanism of action of this inhibitory phenomenon may involve a compound-cell interaction, since cell-free extracts did not produce the inhibition. That the inhibition caused by oxidized spermine differs from an unspecified detergent-like effect was supported by the ability of Triton-X to depress glucose degradation in all cell types, not just in human sperm cells. Oxidized spermine also inhibited conversion of radioactive pyruvate to CO2 in human sperm cells.^ieng

Computer analysis and plotting of physiologic signals in cardiac muscle research.

A program (Caphys) for IMB-compatible microcomputers is described which facilitates off-line analysis of muscle physiologic signals. Caphys was written as an analysis tool for data acquired through AxoTape program (Axon Instruments). Parameters for time course and amplitude of isometric contractions and intracellularly recorded action potentials are calculated by the program. The features of Caphys include low-pass filtering and derivation of the measured signals. The programs allows also screen display and printer output of the analyzed physiological tracings. Caphys is a suitable extension for the commercially available acquisition software, making the analysis and plotting of primary physiologic data faster and more efficient.

Impact of chronic low back pain on military service.

The performance of 245 male conscripts with chronic low back pain (CLBP) during military service was compared with their pre-conscription performance and with that of 126 age-matched male controls without low back pain (LBP). The frequency of LBP in the conscripts with CLBP increased significantly during their service period compared to risk before service (odds ratio, 10.35; 95% confidence interval, 3.61-29.52). The same factors that induced LBP before entering service, mainly lifting and carrying, also caused LBP during military service. Of the conscripts with CLBP, 120 had experienced an accidental back injury and 125 had injured their backs during lifting or carrying before entering service. During service, back problems were caused by accidents in 88 cases and by lifting or carrying in 157 cases. The frequency of LBP injuries, measured as the need for medical consultation or treatment, increased 2.4-fold (95% confidence interval, 1.41-4.10) during the term of service. Conscripts with CLBP served significantly more frequently as ordinary soldiers than the controls. There was no difference in participation in leisure time or competitive sports activities between the two groups. The future expectations of the CLBP conscripts were pessimistic: only one-fifth believed in complete recovery, and two-fifths thought that they would need substantial outside help in the future.

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three designs from the Finnish Arthroplasty Register.

BACKGROUND AND AIMS: Large headed metal-on-metal total hip arthroplasty may produce more metal ions than hip resurfacing arthroplasty. Increased metal-ion levels may be associated with higher revision rates due to adverse reaction to metal debris. The purpose of our study was to compare the survivorship of three hip resurfacing arthroplasty designs with their analogous cementless large-diameter head metal-on-metal total hip arthroplasties. MATERIAL AND METHODS: Based on data obtained from the Finnish Arthroplasty Register, the revision risks of three metal-on-metal hip resurfacing arthroplasty/total hip arthroplasty design couples performed during 2001-2011 were analyzed using the Cox regression model. RESULTS: In the Cox regression analysis for compared design pairs adjusted for age, gender, operated side, head size, diagnosis, and implant, there was no statistically significant difference in revision risk between ReCap hip resurfacing arthroplasty and Bimetric/ReCap total hip arthroplasty (risk ratio = 1.43, confidence interval = 0.95-2.14, p = 0.09) or between Birmingham hip resurfacing arthroplasty and Synergy/Birmingham hip resurfacing total hip arthroplasty (risk ratio = 1.35, confidence interval = 0.75-2.43, p = 0.31). However, the revision risk of Corail and Summit/articular surface replacement total hip arthroplasty (ASR HRA) was significantly increased compared to ASR HRA. (risk ratio = 0.73, confidence interval = 0.54-0.98, p = 0.04). CONCLUSION: We conclude that the short-term revision risk of large headed metal-on-metal total hip arthroplasties was not increased compared to analogous hip resurfacing arthroplasties in two out of three devices studied at a nationwide level. There may be implant-related factors having an effect on the success of single manufacturer devices. However, more information on the incidence of adverse soft-tissue reactions in these patient cohorts is needed.

Cementless total hip arthroplasty with large diameter metal-on-metal heads: short-term survivorship of 8059 hips from the Finnish Arthroplasty Register.

BACKGROUND AND AIMS: Population-based register data from the National Joint Register of Australia and England and Wales have revealed that the mid-term outcome of cementless large diameter head metal-on-metal total hip arthroplasty is inferior to that of conventional cemented metal-on-polyethylene total hip arthroplasty. The aim of this study was to compare the results of cementless large diameter head metal-on-metal total hip arthroplasty with conventional cemented arthroplasty in Finland. The second aim of this study was to compare the cementless large diameter head metal-on-metal models with each other. MATERIAL AND METHODS: Based on the data extracted from the Finnish Arthroplasty Register, the risk of revision of 8059 cementless large diameter head metal-on-metal total hip arthroplasties performed during 2002-2009 was analyzed using Cox regression model. The revision risk of these hips was compared to that of 16,978 cemented metal-on-polyethylene total hip arthroplasties performed during the same time period. RESULTS: In the Cox regression analysis, there was no difference in revision risks between cementless large diameter head metal-on-metal total hip arthroplasty and cemented metal-on-polyethylene total hip arthroplasty (relative risk = 0.90, confidence interval = 0.74-1.10, p = 0.3). However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip replacements showed a significantly increased risk of revision as compared to cemented total hip replacements (relative risk = 1.33, confidence interval = 1.04-1.70). Compared to the reference implant in this study (cementless Synergy stem combined with Birmingham Hip Resurfacing [BHR] cup), the CementLess Spotorno (CLS) stem combined with Durom cup had a 2.9-fold (95% confidence interval = 1.17-6.90) increased risk of revision. CONCLUSIONS: We found that cementless large diameter head metal-on-metal total hip arthroplasty had short-term survivorship compared with cemented total hip arthroplasty at a nation-wide level. However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip arthroplasty showed inferior results. Furthermore, implant design had an influence on revision rates. Longer follow-up time is needed to assess the success of large diameter head metal-on-metal total hip arthroplasty.

Dual-energy digital radiography in the assessment of bone mechanical properties.

At present, bone fragility and fracture risk are estimated with bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DXA). It is known that DXA-based BMD (BMD(DXA)) has a relationship with mechanical characteristics of bone. Dual-energy digital radiography (DEDR) has also been shown to be a potential method to determine BMD, but the ability of DEDR-based BMD (BMD(DEDR)) to predict bone mechanical properties is not yet known. In this study, we investigated the ability of BMD(DEDR) to predict the mechanical characteristics of bone. Reindeer femora (N = 50) were imaged at two different energies (79 and 100 kV(p)) using a clinical digital radiography system. BMD was determined in four regions from these images using the DXA calculation principle. Femora were mechanically tested using axial loading configuration. Mechanical parameters were correlated with the BMD(DEDR) and BMD(DXA) of the femoral neck (FNBMD(DEDR) and FNBMD(DXA)). FNBMD(DEDR) and FNBMD(DXA) both correlated moderately with mechanical parameters. The highest correlations were found with maximal load (r = 0.53 and r = 0.65, p < 0.01, respectively). No statistically significant differences were found between the correlation coefficients when comparing the FNBMD(DEDR) or FNBMD(DXA) values and mechanical parameters. The correlation coefficient between BMD(DEDR) and BMD(DXA) varied between r = 0.56 and 0.86 (p < 0.01) in different regions of the upper femur. In conclusion, BMD(DEDR) predicts the mechanical parameters of reindeer bone with similar accuracy as BMD(DXA).

Combination of radiograph-based trabecular and geometrical parameters can discriminate cervical hip fractures from controls in individuals with BMD in non-osteoporotic range.

Majority of hip fractures occur in individuals with bone mineral density (BMD) in non-osteoporotic range. This suggests that factors other than BMD are associated with increased fracture risk in these individuals. The aim of this study was to investigate the combined ability of radiograph-based trabecular and geometrical parameters to discriminate cervical hip fractures from controls in individuals with non-osteoporotic BMD. A total of 39 postmenopausal females with non-pathologic cervical hip fracture were recruited to the study. Nineteen of the fracture patients (48.7%) had non-osteoporotic BMD and they constituted the fracture group. The control group consisted of 35 BMD-matched non-osteoporotic females. Several geometrical and trabecular parameters were extracted from plain pelvic radiographs, and their combined ability to discriminate fracture patients from controls was studied using a receiver operating characteristics (ROC) analysis. Significant differences in several radiograph-based geometrical and trabecular parameters were found between the fracture patients and controls, whereas no statistically significant difference in BMD was observed (p=0.92) between the groups. Area under the ROC curve was 0.993 (95% CI 0.977-1.008) for the combined multiple regression model, which included both trabecular and geometrical parameters as explanatory factors. Here, the sensitivity of 100% was achieved with the specificity of 94%. In a cross-validation of the model, 94.4% of the fracture patients, and 94.1% of the controls were classified correctly. The combination of radiograph-based trabecular and geometrical parameters was able to discriminate the cervical hip fracture cases from controls with similar BMD, showing that the method can provide additional information on bone structure and fracture risk beyond BMD.

Cemented total hip replacement for primary osteoarthritis in patients aged 55 years or older: results of the 12 most common cemented implants followed for 25 years in the Finnish Arthroplasty Register.

We have analysed from the Finnish Arthroplasty Register the long-term survivorship of the 12 most commonly-used cemented implants between 1980 and 2005 in patients aged 55 years or older with osteoarthritis. Only two designs of femoral component, the Exeter Universal and the Müller Straight femoral component had a survivorship of over 95% at ten years with revision for aseptic loosening as the endpoint. At 15 years of the femoral and acetabular component combinations, only the Exeter Universal/Exeter All-poly implant had a survival rate of over 90% with revision for aseptic loosening as the endpoint. In the subgroup of patients aged between 55 and 64 years, survivorship overall was less than 90% at ten years. The variation in the long-term rates of survival of different cemented hip implants was considerable in patients aged 55 years or older. In those aged between 55 and 64 years, none of the cemented prostheses studied yielded excellent long-term survival rates (> or = 90% at 15 years).

Experimental hip fracture load can be predicted from plain radiography by combined analysis of trabecular bone structure and bone geometry.

UNLABELLED: Computerized analysis of the trabecular structure was used to test whether femur failure load can be estimated from radiographs. The study showed that combined analysis of trabecular bone structure and geometry predicts in vitro failure load with similar accuracy as DXA. INTRODUCTION: Since conventional radiography is widely available with low imaging cost, it is of considerable interest to discover how well bone mechanical competence can be determined using this technology. We tested the hypothesis that the mechanical strength of the femur can be estimated by the combined analysis of the bone trabecular structure and geometry. METHODS: The sample consisted of 62 cadaver femurs (34 females, 28 males). After radiography and DXA, femora were mechanically tested in side impact configuration. Fracture patterns were classified as being cervical or trochanteric. Computerized image analysis was applied to obtain structure-related trabecular parameters (trabecular bone area, Euler number, homogeneity index, and trabecular main orientation), and set of geometrical variables (neck-shaft angle, medial calcar and femoral shaft cortex thicknesses, and femoral neck axis length). Multiple linear regression analysis was performed to identify the variables that best explain variation in BMD and failure load between subjects. RESULTS: In cervical fracture cases, trabecular bone area and femoral neck axis length explained 64% of the variability in failure loads, while femoral neck BMD also explained 64%. In trochanteric fracture cases, Euler number and femoral cortex thickness explained 66% of the variability in failure load, while trochanteric BMD explained 72%. CONCLUSIONS: Structural parameters of trabecular bone and bone geometry predict in vitro failure loads of the proximal femur with similar accuracy as DXA, when using appropriate image analysis technology.

Smoking and pregnancy: the influence of maternal and gestational factors on the outcome of pregnancy and the newborn.

In this multivariate prospective case controlled study a total of 576 pregnancies were examined. Of the mothers 162 were light, 46 moderate and 80 ex-smokers, and 288 non-smokers. Forty variants of the mother, pregnancy, delivery and the newborn were taken in consideration. The mean gestational age in all study groups varied between 276-280 days, the maternal gestational weight gain between 12.2-14.7 kg. No difference was observed in maternal pre-pregnant weight and height. Light smokers' newborns' mean birth weight was 3396 g, moderate smokers' 3196, ex-smokers' 3516, and non smoking controls' 3577. When maternal size, gestational age and weight gain were standardised, smoking remained the only cause to explain the differences observed between smokers' and non-smokers' newborns' characteristics. No differences were observed between ex-smokers, women who stopped smoking during the first trimester of gestation, and non smoking controls.

Inherited narrow crown form, harvest index and stem biomass production in Norway spruce, Picea abies.

The effect of crown form on stem biomass production was investigated in an 18-19-year-old Norway spruce stand (Picea abies (L.) Karst.). The harvest index was 0.271 in pendula trees, which have a heritable narrow crown form, and 0.235 in normal-crowned trees and the dry weights of stem biomass were 2.57 kg and 3.37 kg, respectively. However, the production of stem biomass per crown projected area was more than twice as much in pendula trees as in normal-crowned trees. Results indicate that the crown form of pendula spruce is less plastic than that of normal-crowned spruce suggesting that such trees might maintain a high stemwood yield per unit ground area with increasing stand density. Because pendula spruce has a higher harvest index and a less flexible crown than normal-crowned spruce, it might be useful for crop tree ideotype breeding.

Metronidazole combined with nystatin (vagitories) in the prevention of bacterial vaginosis after initial treatment with oral metronidazole.

In a double-blind trial comprising 66 patients we assessed the effect of metronidazole-nystatin vagitories on the prevention of bacterial vaginosis (BV) in women using IUD as a contraceptive method after an initial oral single dose of 2.0 g metronidazole and 7 days of intravaginal metronidazole-nystatin or placebo treatment. The prophylactic treatment consisted of metronidazole-nystatin or placebo vagitories applied at bedtime for 3 days after menstruation over 6 consecutive menstrual periods. The patients were randomized in two study groups: a treatment group of 32 patients (group A) and a placebo group of 34 patients (group B). The overall objective cure rate after the initial treatment was 97% in group A and 91% in group B. After 6 months of follow-up, the overall cumulative objective cure rate in group A was 100%, and 76% in group B. The single-dose oral treatment was well tolerated and no notable side effects were recorded.

Viability and seasonal distribution patterns of Scots pine pollen in Finland.

Germination ability and airborne counts of Scots pine (Pinus sylvestris L.) pollen were studied during the spring of 1993 at Turku in southern Finland (60 degrees 32' N, 22 degrees 28' E) and at Utsjoki in northern Finland (69 degrees 45' N, 27 degrees 01' E). Pollen waas trapped from the beginning of May to the end of June in a high-volume air sampler. Germination tests were performed to determine the in vitro pollen viability of the trapped pollen. Airborne pine pollen counts were obtained from a continuously operating Burkard trap located near each high-volume sampler. When male flowering began, phenological observations were carried out on pollen grains collected in rotored samplers located in pine and spruce stands and open fields near Turku and Utsjoki. In southern Finland, the peak period of pine pollen production was short, lasting for only 3 days, but it accounted for about 80% of the total germinating pine pollen yield for the year. The peak count was on May 20, with over 2000 germinating pollen grains per cubic meter of air. Pollen germination rates of up to 70% were obtained during the week preceding the local pollen peak, and rates reached almost 90% on the peak day. Pollen viability remained at 45 to 65% for 1 week after the peak. There was no significant difference between the pollen counts for day and night, indicating that during the main pollen season, the pollen source was close to Turku. Before the local pollen peak, the counts of living pine pollen were low, indicating that pine pollen transported over long distances was of little ecological importance in 1993 in the Turku area. In northern Finland, the first pollen grains were caught on July 4, and the peak day was July 13. However, no viable pollen was observed during this period, indicating that there was little gene drift from southern to northern Finland in 1993.