Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population-based cohort study.

AIMS: To examine the incidence, risk factors and clinical outcomes of hyperkalaemia in people with diabetes in a real-world setting. METHODS: Using Danish health registries, we identified a population-based cohort of people with first-time drug-treated diabetes, in the period 2000-2012. First, the cumulative incidence of hyperkalaemia, defined as first blood test with potassium level >5.0 mmol/l after diabetes treatment initiation, was ascertained. Second, in a case-control analysis, risk factors were compared in people with vs without hyperkalaemia. Third, clinical outcomes were assessed among individuals with hyperkalaemia in a before-after analysis, and among people with and without hyperkalaemia in a matched cohort analysis. RESULTS: Of 68 601 individuals with diabetes (median age 62 years, 47% women), 16% experienced hyperkalaemia (incidence rate 40 per 1000 person-years) during a mean follow-up of 4.1 years. People who developed hyperkalaemia had a higher prevalence of chronic kidney disease [prevalence ratio 1.74 (95% CI 1.68-1.81)], heart failure [prevalence ratio 2.35 (95% CI 2.18-2.54)], use of angiotensin-converting enzyme inhibitors [prevalence ratio 1.24 (95% CI 1.20-1.28)], use of spironolactone [prevalence ratio 2.68 (95% CI 2.48-2.88)] and potassium supplements [prevalence ratio 1.59 (95% CI 1.52-1.67)]. In people with diabetes who developed hyperkalaemia, 31% were acutely hospitalized within 6 months before hyperkalaemia, increasing to 50% 6 months after hyperkalaemia [before-after risk ratio 1.67 (95% CI 1.61-1.72)]. The 6-month mortality rate after hyperkalaemia was 20%. Compared with matched individuals without hyperkalaemia, the hazard ratio for death was 6.47 (95% CI 5.81-7.21). CONCLUSIONS: One in six newly diagnosed people with diabetes experienced a hyperkalaemic event, which was associated with severe clinical outcomes and death.

Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture-limitations and scope for fracture liaison services in prevention of hip fracture.

Fracture liaison services prevent hip fractures by identifying other osteoporotic fractures that generally debut at a younger age. However, this study showed that a minority of hip fracture patients are already known to the health services through having had prior osteoporotic fractures. Identification of vertebral fractures in particular is lacking. INTRODUCTION: The purpose of this study was to examine the prevalence of prior major osteoporotic fractures (MOF) in the prior 10 years preceding hip fracture in order to provide information about the potential for prevention of hip fractures by fracture liaison services (FLS). METHODS: We included all patients aged 50+ with surgically treated hip fracture in one calendar year (N = 8158) in the Danish Hospital Discharge Register. Prior fractures were identified using the same data source. A prior hip fracture was only included as a prior fracture if occurring more than 6 months before the present fracture. RESULTS: A total of 28% of hip fracture patients (32% of women and 19% of men) had at least one recognized MOF in the preceding 10 years. Forearm and humerus fractures constituted > 70% of prior MOF. In both genders, vertebral fractures only represented a small percentage (2.6%) of previously recognized MOF. Men were less likely than women to have experienced a prior MOF, chiefly due to fewer forearm and humerus fractures. CONCLUSION: The majority of hip fractures-and in particular hip fractures in men-occur without a previously treated MOF that could have resulted in early detection and treatment of osteoporosis. With current treatment modalities, a maximum of one in six hip fractures in Denmark can be prevented through FLS initiatives. Identification of patients with vertebral fractures for assessment and treatment is therefore critical for successful prevention of hip fractures using this strategy.

Interactions of the Calcite {10.4} Surface with Organic Compounds: Structure and Behaviour at Mineral - Organic Interfaces.

The structure and the strength of organic compound adsorption on mineral surfaces are of interest for a number of industrial and environmental applications, oil recovery, CO2 storage and contamination remediation. Biomineralised calcite plays an essential role in the function of many organisms that control crystal growth with organic macromolecules. Carbonate rocks, composed almost exclusively of calcite, host drinking water aquifers and oil reservoirs. In this study, we examined the ordering behaviour of several organic compounds and the thickness of the adsorbed layers formed on calcite {10.4} surfaces. We used X-ray reflectivity (XRR) to study calcite {10.4} surfaces that were prepared in three alcohols: methanol, isopropanol and pentanol and one carboxylic acid: octanoic acid. All molecules adsorbed in self-assembled layers, where thickness depended on the density and the length of the molecule. For methanol and isopropanol, molecular dynamic simulations (MD) provided complementary information, which allowed us to develop a surface model. Branching in isopropanol induced slightly less ordering because of the additional degree of freedom. Pentanol and octanoic acid adsorbed as single monolayers. The results of this work indicate that adhered organic compounds from the surrounding environment can affect the surface behaviour, depending on properties of the organic compound.

Folic acid supplementation and fecundability: a Danish prospective cohort study.

BACKGROUND/OBJECTIVES: Periconceptional folic acid (FA) supplementation reduces the risk of neural tube defects and has been associated with ovulatory function. However, only two studies have associated supplementation with multivitamins (MVs) that contained FA with increased pregnancy rates. We aimed to examine the association between FA supplementation (obtained either through single FA tablets or through MVs) and fecundability. SUBJECTS/METHODS: A prospective cohort study of 3895 Danish women who were planning a pregnancy between 2007 and 2011. We estimated fecundability ratios (FRs) and 95% confidence intervals (CIs) in relation to FA supplementation (either through single FA tablets or MV) using a proportional probabilities regression model, with adjustment for potential socio-demographic, reproductive and lifestyle confounders. In stratified analyses, we also estimated FR with 95% CI in relation to FA supplementation for women with regular and irregular cycles, respectively, and for women with short (<27 days), medium (27-29 days) and long cycles (⩾30 days), respectively. RESULTS: FA supplementation was associated with increased fecundability (FR=1.15, 95% CI=1.06-1.25), compared with non-use. The adjusted FRs for FA supplement use relative to non-use were 1.35 (95% CI=1.12-1.65) and 1.11 (95% CI=1.01-1.22) for women with irregular and regular cycles, respectively, and 1.36 (95% CI=0.95-1.95), 1.10 (95% CI=0.98-1.22) and 1.24 (95% CI=1.10-1.41) for women with short (<27 days), medium (27-29 days) and long cycles (⩾30 days), respectively. CONCLUSIONS: FA supplementation was associated with increased fecundability, and this association appeared to be stronger among women with irregular cycles and among women with either short or long cycle length.

Rose hip herbal remedy in patients with rheumatoid arthritis - a randomised controlled trial.

OBJECTIVE: To investigate if standardised powder made from rose-hip (Rosa canina) can reduce the symptom score in patients with rheumatoid arthritis. METHODS: In a double-blind placebo-controlled trial, patients with rheumatoid arthritis (RA) according to ARA/ACR criteria were randomised to treatment with capsulated rose-hip powder 5g daily or matching placebo for 6 months at two outpatient clinics in Berlin and Copenhagen. Primary outcome variable was Health Assessment Questionnaire (HAQ) at 6 months, secondary outcome included DAS-28, physician's global evaluation of disease activity, RAQoL, SF-12 and concomitant pain medication. RESULTS: In a total of 89 patients (90% female, mean age 56.6+11.3 years, mean disease duration 12.8+9.6 years) HAQ-DI in the rose-hip group improved by 0.105+/-0.346, whereas in the placebo group it worsened by 0.039+/-0.253 (p adjusted=0.032). In the HAQ Patient Pain Scale no significant differences were observed between both groups. In the HAQ Patient Global Scale a trend was seen favouring rose-hip (p=0.078). The DAS-28 score yielded improvement in the rose-hip group of 0.89+/-1.32 and in the placebo group of 0.34+/-1.27 (p=0.056) indicating moderate clinical relevance. The Physicians Global Scale demonstrated more improvement in the rose-hip compared to the placebo group (p=0.012). RAQoL and SF-12 physical score improved significantly in the rose-hip group compared to placebo, whereas SF-12 mental score remained unchanged. Intake of pain medication was not different between the groups. Per-protocol analysis confirmed these results. CONCLUSION: The results indicate that patients with RA may benefit from additional treatment with rose hip powder.

Antiepileptic drug use, folic acid supplementation, and congenital abnormalities: a population-based case-control study.

OBJECTIVE: To investigate whether folic acid supplementation in early pregnancy modifies the association between the prevalence of congenital abnormalities in the offspring and maternal use of carbamazepine (CBZ), phenobarbital (PB), phenytoin (PHT), and primidone (PRI). DESIGN: A population-based case-control study. SETTING: The Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) (1980-1996) and its information on children from the Hungarian Congenital Abnormality Registry and the Hungarian National Birth Registry. POPULATION: Children with congenital abnormalities (cases; n= 20 792, of whom 148 had been exposed to antiepileptic drugs [AEDs]) and unaffected children (controls; n= 38 151, of whom 184 had been exposed to AEDs). METHODS: Information on drug exposure and background variables for the mothers were collected from antenatal logbooks, discharge summaries, and structured questionnaires completed by the mothers at the time of HCCSCA registration. MAIN OUTCOME MEASURES: Congenital abnormalities detected at termination of pregnancy, at birth or until 3 months of age according to CBZ, PB, PHT, or PRI exposure at 5-12 weeks from first day of the last menstrual period (LMP), stratified by folic acid supplementation. RESULTS: Compared with children unexposed to AEDs and folic acid, the odds ratio of congenital abnormalities was 1.47 (95% CI 1.13-1.90) in children exposed to AEDs without folic acid supplementation and 1.27 (95% CI 0.85-1.89) for children exposed to AEDs with folic acid supplementation. CONCLUSION: The results indicate that the risk of congenital abnormalities in children exposed in utero to CBZ, PB, PHT, and PRI is reduced but not eliminated by folic acid supplementation at 5-12 weeks from LMP. The statistical precision in our study is limited due to rarity of the exposures, and further studies are needed.

Effects of intact glucosinolates and products produced from glucosinolates in myrosinase-catalyzed hydrolysis on the potato cyst nematode (Globodera rostochiensis Cv. Woll).

The potato cyst nematode (Globodera rostochiensis cv. Woll) is responsible for large yield losses in the potato crop, and opportunities for reducing the attack of these plant nematode species are, therefore, important. This study has been devoted to the testing of the in vitro effects on the potato cyst nematode of eight glucosinolates [prop-2-enyl-, but-3-enyl-, (R)-4-methylsulfinylbut-3-enyl-, benzyl-, phenethyl-, 4-hydroxybenzyl-, (2S)-2-hydroxybut-3-enyl-, and (2R)-2-hydroxy-2-phenylethylglucosinolate] as well as the effects of the products of this myrosinase-catalyzed hydrolysis. The glucosinolates were used at three concentrations, 0.05, 0.3, and 1.0 mg/mL, in the presence or absence of the enzyme myrosinase. The effects of the compounds on the mortality were monitored every 8 h for a 72 h period. No effects were found for any of the intact glucosinolates. However, when active myrosinase was included with 1 mg/mL phenethylglucosinolate at pH 6.5, 100% mortality was observed within just 16 h. A similar effect was achieved at the same concentration of benzyl- and prop-2-enylglucosinolates in the myrosinase-containing solutions, although longer exposures were required (24 and 40 h, respectively). The main aglucone products released from the glucosinolates with pronounced effects on the nematodes were shown to be the corresponding isothiocyanates. The results suggest that mixtures of these specific glucosinolates and active myrosinase or autolysis of plant materials containing these enzymes and glucosinolates might be used to control the potato cyst nematode in the soil.

Postoperative mortality in patients with liver cirrhosis undergoing transurethral resection of the prostate: a Danish nationwide cohort study.

OBJECTIVE: To examine the risk of 30-day postoperative mortality from transurethral resection of the prostate (TURP) in patients with liver cirrhosis, who are reportedly at considerably increased perioperative risk. PATIENTS AND METHODS: For the period 1 January 1977 to 31 December 1993, a population-based cohort was identified comprising Danish patients diagnosed with liver cirrhosis and a random sample of Danes also undergoing TURP. Logistic regression models were used to estimate the association between liver cirrhosis, age, type of admission, comorbidity and 30-day mortality. RESULTS: In a cohort of 23 133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure. Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 (95% confidence interval 0.4-22.9) for the 30-day postoperative mortality in patients with liver cirrhosis compared with patients without (mortality 2%). Advanced age, comorbidity and acute admission seemed to be associated with an increased postoperative mortality. CONCLUSION: This study indicates that TURP in patients with liver cirrhosis was associated with increased mortality.

Supercritical fluid chromatography as a method of analysis for the determination of 4-hydroxybenzylglucosinolate degradation products.

In the present study analytical and preparative supercritical fluid chromatography (SFC) were used for investigation of myrosinase catalysed degradation of 4-hydroxybenzylglucosinolate (sinalbin). Sinalbin occurs as a major glucosinolate in seeds of Sinapis alba L., in various mustards and other food products. The degradation products were identified and quantified by analysis based on a developed SFC method using a bare silica column. Determinations comprised transformation products of sinalbin, produced both during degradation of isolated sinalbin, and during autolysis of meal from S. alba seeds. The conditions in the developed SFC method were used as basis for the preparative SFC procedure applied for isolation of the components prior to their identification by nuclear magnetic resonance (NMR) spectroscopy. Myrosinase catalysed sinalbin hydrolysis resulted in the reactive 4-hydroxybenzyl isothiocyanate as an initial product at pH values from 3.5 to 7.5 whereas 4-hydroxybenzyl cyanide was one of the major products at low pH values. 4-Hydroxybenzyl isothiocyanate was found to disappear from the aqueous reaction mixtures in a few hours, as it reacted easily with available nucleophilic reagents. 4-Hydroxybenzyl alcohol was found as the product from reaction with water, and with ascorbic acid, 4-hydroxybenzylascorbigen was produced.

Supercritical fluid chromatography as basis for identification and quantitative determination of indol-3-ylmethyl oligomers and ascorbigens.

Indol-3-ylmethylglucosinolate (glucobrassicin) occurs in most plants of the Brassicaceae family together with hydroxy and methoxy derivatives of glucobrassicin. These compounds and products produced therefrom have been the subject of considerable research interest due to their potential anticarcinogenic effects, and thereby a need for techniques to work with the individual compounds. A method using normal-phase supercritical fluid chromatography (SFC) with methanol as modifier has been developed for determination and quantification of the various indol-3-ylmethyl derivatives including ascorbigens formed from the glucobrassicin degradation product, indol-3-ylmethanol, under acidic conditions (pH 2-6) with and without the presence of ascorbic acid. The SFC method had detection limits in the 10-100-pmol range. In the absence of ascorbic acid a range of oligomers were formed, whereas the presence of ascorbic acid favoured the formation of ascorbigen and products thereof. Quantitatively important indol-3-ylmethyl oligomers consisting of up to five indol rings have been purified with preparative SFC and identified from MS and 1D and 2D NMR experiments with complete assignment of chemical shifts to all of the atoms. Investigation of the autolysis products of white cabbage showed that ascorbigens were the quantitatively dominating degradation products of indol-3-ylmethylglucosinolates.

The prevalence of gentamicin resistance among clinical isolates of enterobacteria in a Danish region.

The susceptibility of enterobacteria to gentamicin was studied in the County of North Jutland during 1993-1998. A total of 378 patients had a first-time gentamicin-resistant isolate. The annual number rose from 34 patients in 1993 to 89 in 1998. The prevalence of resistance per 1000 patients with isolates examined was 13.5 for Escherichia coli, 15.8 for Klebsiella pneumoniae, 26.1 for Klebsiella oxytoca, and 150.4 for Citrobacter freundii. E. coli accounted for 67% of gentamicin-resistant isolates. K. oxytoca was probably associated with a nosocomial epidemic, whereas a source for C. freundii remained unresolved. An analysis confined to E. coli identified specimens other than urine as risk factors for gentamicin resistance. Likewise, resistance to sulfonamides and to fluoroquinolones were strong risk factors for gentamicin resistance among urinary isolates of E. coli. Thus, it is likely that aminoglycoside resistance may be promoted by other antibiotic groups due to co-resistance. The therapeutic and prophylactic uses of aminoglycosides have as yet not been undermined, but continuous population-based surveillance and vigilance are recommended.

No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study.

OBJECTIVE: To investigate the effect of long-term antibiotic treatment in patients with reactive arthritis (ReA) and undifferentiated oligoarthritis. METHODS: One hundred twenty-six patients were treated with ciprofloxacin (500 mg twice a day) or placebo for 3 months, in a double-blind, randomized study. Of these patients, 104 (48 treated with ciprofloxacin and 56 treated with placebo) were valid for clinical evaluation: 55 were diagnosed as having ReA with a preceding symptomatic urogenic or enteric infection and 49 as having undifferentiated oligoarthritis. These 2 groups were randomized separately. The triggering bacterium was sought by serology and/or culture. The percentage of patients in remission after 3 months of treatment was chosen as the primary efficacy parameter. RESULTS: A triggering bacterium could be identified in 52 patients (50%): Chlamydia trachomatis in 13, Yersinia in 14, and Salmonella in 25. No patient was positive for Campylobacter jejuni or for Shigella. No difference in outcome was found between treatment with ciprofloxacin or placebo in the whole group or in subgroups of patients with ReA or undifferentiated oligoarthritis. No difference was seen in patients with a disease duration <3 months. Ciprofloxacin was not effective in Yersinia- or Salmonella-induced arthritis but seemed to be better than placebo in Chlamydia-induced arthritis. This difference was not significant, however, which might be due to the small sample size. CONCLUSION: Long-term treatment of ReA with ciprofloxacin is not effective; however, it might be useful in the subgroup of patients who have Chlamydia-induced arthritis. This has to be proven in a bigger study focusing on patients with Chlamydia-induced arthritis.

Dynamics of the martial arts high front kick.

Fast unloaded movements (i.e. striking, throwing and kicking) are typically performed in a proximo-distal sequence, where initially high proximal segments accelerate while distal segments lag behind, after which proximal segments decelerate while distal segments accelerate. The aims of this study were to examine whether proximal segment deceleration is performed actively by antagonist muscles or is a passive consequence of distal segment movement, and whether distal segment acceleration is enhanced by proximal segment deceleration. Seventeen skilled taekwon-do practitioners were filmed using a high-speed camera while performing a high front kick. During kicking, EMG recordings were obtained from five major lower extremity muscles. Based on the kinematic data, inverse dynamics computations were performed yielding muscle moments and motion-dependent moments. The results indicated that thigh deceleration was caused by motion-dependent moments arising from lower leg motion and not by active deceleration. This was supported by the EMG recordings. Lower leg acceleration was caused partly by a knee extensor muscle moment and partly by a motion-dependent moment arising from thigh angular velocity. Thus, lower leg acceleration was not enhanced by thigh deceleration. On the contrary, thigh deceleration, although not desirable, is unavoidable because of lower leg acceleration.

Influence of triacylglycerol structure and fatty acid profile of dietary fats on milk triacylglycerols in the rat. A two-generation study.

We investigated the influence of dietary fatty acid profile and triacylglycerol structure on the fatty acid profile and triacylglycerol structure of milk lipids in two generations of rats. Three groups of rats received diets containing 20% fat of which approximately 20% was n-3 fatty acids located in different positions of the triacylglycerol: a fish oil-based diet [docosahexaenoic acid (22:6n-3) predominantly in the sn-2 position], a seal oil-based diet (22:6n-3) predominantly in the sn-1/sn-3 position, or a plant oil-based diet [alpha-linolenic acid (18:3n-3) distributed evenly between the three positions]. This design allowed us to investigate (i) the effect of the triacylglycerol structure of the dietary fat; (ii) the effect of receiving the n-3 fatty acids as long-chain derivatives or as the precursor, 18:3n-3; and (ii) the long-term effects over two generations. The fatty acid profiles of the milk lipids largely reflected the diets, but in the second generation, the level of medium-chain fatty acids was higher (P < 0.05) in the milk from rats fed the fish oil diet (24%) compared with the other dietary groups (15 and 18%). This suggests an increased endogenous synthesis of fatty acids in the mammary glands of the fish oil-fed rats. The levels of long-chain n-3 fatty acids in milk were higher (P < 0.05) in rats fed marine oils (8-12%) compared with rats fed vegetable oil (1%) in both generations. The level of long-chain n-3 fatty acids was significantly higher in the milk from the fish oil-fed rats (12.3%) compared to the seal- oil fed rats (8.0%) in the first generation, but not in the second generation (8.9 vs. 9.1%). The general structure of milk triacylglycerols was maintained in the three experimental groups with 16:0 acylated in the sn-2 position and 18:1 in the sn-1/sn-3 positions. The triacylglycerol structure of mammalian milk appears to be conserved even during extreme dietary manipulation over two generations and an extensive enrichment with long-chain n-3 polyunsaturated fatty acids requires their presence in the diet.

Improved method for the analysis of alpha-galactosides in pea seeds by capillary zone electrophoresis. Comparison with high-performance liquid chromatography-triple-pulsed amperometric detection.

A capillary zone electrophoretic (CZE) method is described for the analysis of the raffinose family of oligosaccharides (RFO) in pea seeds. Extraction of RFO was carried out in 80% ethanol and the extract was passed through a Sep-Pak C18 cartridge. This proved to be an improvement on the currently accepted purification technique. High-quality electrophoregrams were obtained which allowed the separation and quantitation of sucrose, raffinose, stachyose and verbascose The CZE results were compared with those obtained by anion-exchange high-performance liquid chromatography coupled to a triple-pulsed amperometric detection (HPAC-PAD). The samples were obtained from four pea strains which were near-isogenic except for genes at the r and rb loci. A high degree of precision and reproducibility was obtained for the RFO compositions of all the pea strains. No statistically significant differences (p < or equal to 0.05) were found between the two analytical techniques using paired Student-t tests.

Coffee consumption and risk of ischaemic heart disease--a settled issue?

OBJECTIVE: Based on a meta-analysis, it was recently stated that there is no association between coffee consumption and the risk of coronary heart disease. Why then, have studies on the issue shown quite variable results? DESIGN SETTING AND SUBJECTS: A prospective study was performed in the Copenhagen Male Study on 2975 men (53-74 years) without cardiovascular disease at baseline in 1985/1986. They were classified according to self-reported consumption of filter coffee. Some 147 men (5%) were coffee abstainers. Potential confounders were alcohol use, physical activity, smoking, serum cotinine, serum lipids, serum selenium, body mass index, blood pressure, Lewis blood group, hypertension, non-insulin-dependent diabetes mellitus and social class. MAIN OUTCOME MEASURES: The incidence of ischaemic heart disease (IHD) 1985/86-1991. RESULTS: Some 184 men had a first IHD event. There was no significant difference between those consuming 1-4, 5-8 or > or = 9 cups per day after controlling for confounders (P-value of trend test: 0.14). The crude incidence rates were 6.8, 6.7 and 4.6%, respectively; the adjusted rates were 6.8, 6.7 and 4.0%, respectively. Coffee consumption was significantly (P < 0.05) inversely correlated with serum selenium concentration (never previously described) and, positively or negatively, with a number of other potential risk factors: smoking, alcohol use, serum triglycerides, serum cholesterol, blood pressure, social class, body mass index, and serum selenium. In nonsmokers and smokers of only a small amount of tobacco, coffee consumption was associated with a lower risk of IHD (P < 0.05). CONCLUSION: We conclude that the association between coffee consumption and risk of IHD is conditioned by known risk factors correlated with use of coffee, which may partly explain the inconsistencies in the results of previous studies.

Oral calcium effectively reduces parathyroid hormone levels in hemodialysis patients: a randomized double-blind placebo-controlled study.

The objective of this study was to elucidate the effect of oral calcium supplement upon the severity of secondary hyperparathyroidism and hyperphosphatemia in patients undergoing hemodialysis. Twenty-three accepted to participate and were randomly allocated to receive in a double-blind manner either 2 g elemental calcium per day (n = 12) or placebo (n = 11) for 6 months. Three patients dropped out leaving 10 patients in each group. In the calcium group serum ionized calcium increased significantly during the 1st month from 1.15 +/- 0.02 to 1.29 +/- 0.04 mmol/l (mean +/- SE) and was then stabilized at an average of 1.26 +/- 0.02 mmol/l for the remaining 5 months. Serum intact parathyroid hormone (PTH) decreased in average by 54% within the 1st month and remained at that level for the following months. Hyperphosphatemia remained stable throughout. On the contrary, in the placebo group, serum concentrations of ionized calcium and intact PTH remained unchanged, while serum phosphate increased significantly. The present study demonstrates that oral calcium reduces secondary hyperparathyroidism and prevents the progression of hyperphosphatemia in patients undergoing hemodialysis.

Pathogenetic role of Chlamydia, Yersinia and Borrelia in undifferentiated oligoarthritis.

We studied the cellular and humoral immune response to Chlamydia trachomatis, Yersinia enterocolitica and Borrelia burgdorferi in paired samples of peripheral blood and synovial fluid (SF) in undifferentiated oligoarthritis, reactive arthritis (ReA) and rheumatoid arthritis. Antigen specific lymphocyte proliferation was found in SF of 43% of patients with ReA and 34% of patients with undifferentiated oligoarthritis. C. trachomatis was the most frequent single agent. HLA-B27 was positive in 83% of patients with ReA and in 62% of patients with undifferentiated oligoarthritis with antigen specific lymphocyte proliferation. Antigen specific lymphocyte proliferation correlated poorly with the specific antibody response. Only chlamydial antigen was detected in SF cells using monoclonal antibodies. We conclude that some patients with undifferentiated oligoarthritis may have a forme fruste of ReA. This finding is important in view of recent evidence supporting the efficacy of antibiotic therapy in ReA.