Pneumococcal antibody protection in patients with autoimmune inflammatory rheumatic diseases with varying vaccination status.

Objectives: The aims of this cross-sectional study were to assess the pneumococcal antibody coverage in patients with autoimmune inflammatory rheumatic disease (AIRD) and to identify predictors associated with inadequate protective antibody levels. Method: Antibodies to 12 serotypes occurring in the commonly applied pneumococcal vaccines in Denmark were measured in AIRD patients with a diagnosis of rheumatoid arthritis, spondyloarthritis, or psoriatic arthritis attending the Department of Rheumatology at the North Denmark Regional Hospital. Immunization against pneumococcal infection was defined as a geometric mean level ≥ 1 µg antibodies/mL. Clinical information about vaccination status and disease/treatment history was retrieved from the medical file system. Results: Results of antibody measurement and vaccination status were available from 346 AIRD patients, of whom 200 (58%) were registered as receiving pneumococcal vaccination, whereas the remaining 146 patients (42%) were not. Of all 346 patients, only 61 (18%) were measured with an adequate level of protective antibodies (30% vs 1%, respectively). Methotrexate treatment at the time of vaccination and increasing age were identified as predictors of poor vaccination outcome in multiple logistic regression analysis. Conclusions: This post-vaccination study showed that less than one-fifth of the AIRD patients are adequately protected against pneumococcal infection, although the immunization programme had been implemented in more than half of the study population. Development of improved vaccination strategies is required to achieve a higher immunization coverage rate and more efficient lasting antibody response.

Polycomb group genes control pattern formation in plant seed.

Transcriptional activators of the Trithorax group (TRX-G) and repressors of the Polycomb group (Pc-G) are involved in multiple aspects of embryogenesis in Drosophila and the mouse [1, 2] and appear to have a conserved role in the zygotic control of the development of the anterior-posterior axis [3, 4, 5]. In the model plant Arabidopsis, three Pc-G genes have been isolated and characterized to date. CURLY LEAF (CLF) represses the expression of a floral homeotic gene in vegetative tissues but does not appear to have a role in plant embryogenesis [6]. Two other Pc-G genes, FIS1/MEDEA [7, 8, 9], and FIS3/FIE [8, 10] have been characterized in studies of mutants that produce seeds in the absence of fertilization. Seeds resulting from autonomous development in fis mutants do not contain an embryo but only endosperm, the second product of double fertilization in flowering plants [11, 12]. Thus, FIS genes are considered to be repressors of endosperm development before fertilization. We report that when fis ovules are fertilized, the endosperm patterning along the major polar axis is perturbed. Posterior structures develop in more anterior domains of the endosperm. This correlates with the ectopic expression of a posterior molecular marker. FIS genes appear to be potent regulators of the establishment of the anterior-posterior polar axis in the endosperm.

Feature domain-specific movement intention detection for stroke rehabilitation with brain-computer interfaces.

Brain-computer interface (BCI) driven electrical stimulation has been proposed for neuromodulation for stroke rehabilitation by pairing intentions to move with somatosensory feedback from electrical stimulation. Movement intentions have been detected in several studies using different techniques, with temporal and spectral features being the most common. A few studies have compared temporal and spectral features, but conflicting results have been reported. In this study, the aim was to investigate if complexity measures can be used for movement intention detection and to compare the detection performance based on features extracted from three different domains (time, frequency and complexity) from single-trial EEG. Two data sets were used where four different isometric palmar grasps or dorsiflexions were performed while continuous EEG was recorded. 39 healthy subjects performed or imagined these movements and 11 stroke patients attempted to perform the movements. The EEG was pre-processed and divided into two epoch classes: Background EEG (2 s) and movement intention (2 s). To obtain an estimated detection performance, temporal, spectral and complexity features were extracted and classified (linear discriminant analysis) after the feature vector was reduced using sequential forward selection. The results show that accuracies between 82-87% and 74-80% are obtained for foot and hand movements, respectively. The temporal feature domain was the most dominant for foot movement intention detection, while the spectral features contributed more to the hand movement detection. The complexity features could be used to detect movement intentions, but the performance was much lower compared to temporal and spectral features.

The effect of Lactobacillus paracasei subsp. paracasei L. casei W8® on blood levels of triacylglycerol is independent of colonisation.

Gut microbiota (GM) dysbiosis has been linked to obesity and its metabolic complications such as cardiovascular disease (CVD). The risk of developing CVD increases with elevated concentration of serum triacylglycerol (TAG). In a blinded, randomised two-arm parallel human intervention study we have previously found that four weeks of supplementation with Lactobacillus paracasei subsp. paracasei L. casei W8® (L. casei W8) compared to placebo reduced the concentration of TAG in 64 young healthy adults, an effect, likely mediated by a decreased stearoyl- CoA desaturase-1 (SCD1) activity. In the present study we analysed faecal samples obtained during the intervention study to investigate whether this effect was related to the ability of L. casei W8 to colonise the human gut after supplementation of L. casei W8 (1010 cfu daily) as determined by qPCR specific for L. paracasei and L. casei (L. casei group); whether L. casei W8 consumption affected GM composition as determined by 16S rRNA gene targeted 454/FLX amplicon sequencing; and whether these changes were associated with changes in TAG concentration and SCD1 activity. Faecal samples were collected at baseline, after four weeks supplementation and two weeks after the supplementation was ended, and fasting blood samples were collected at baseline and after 4 weeks. Four weeks supplementation with L. casei W8 did not affect the overall composition of the GM; however, an increase in the relative abundance of the L. casei group from 8.48×10-6% of the total GM compared to 2.83×10-3% at baseline (P<0.001) was observed. Two weeks after supplementation ended, the relative abundance of the L. casei group was still increased 14 times compared to before the intervention (P<0.01). However, neither the increase in the abundance of the L. casei group nor overall GM composition correlated with changes in blood lipids or SCD1 activity.

Temporal changes in clinic and ambulatory blood pressure during cyclic post-menopausal hormone replacement therapy.

OBJECTIVE: Post-menopausal hormone replacement (HRT) might protect against cardiovascular disease, possibly by arterial vasodilation and reduced blood pressure. Progestogens are needed to avoid endometrial disease but vascular effects are controversial. The objective was to assess temporal changes in blood pressure (BP) by two measurement techniques during a cyclic hormone replacement regimen. DESIGN AND METHODS: Sixteen healthy and normotensive post-menopausal women (age 55 +/- 3 years) were studied in a placebo-controlled, randomized crossover study, and were randomized to 17beta-oestradiol plus cyclic norethisterone acetate (NETA) or placebo in two 12-week periods separated by a 3-month washout Clinic blood pressure was measured sitting by the same observer with a mercury manometer at four visits in each period. Twenty-four hour ambulatory blood pressure was measured at baseline and in the ninth weeks of treatment in both periods. RESULTS: Clinic systolic and diastolic BP were reduced after 10 days of oestradiol (-5.1 and -3.2 mmHg respectively, P < or = 0.05). After 9 weeks of cyclic HRT, prior to progestogen addition, clinic BP returned to baseline. During addition of NETA, diastolic blood pressure was again reduced (-3.6 mmHg, P= 0.037). Mean 24 h ambulatory systolic and diastolic blood pressures were significantly lower than clinic measurements (-15.7 and -5.9 mmHg, P < 0.001) but were unaffected by HRT. CONCLUSIONS: Clinic blood pressure is reduced during a cyclic HRT regimen but the reduction varies with the HRT regimen, which might explain the diversity in previous BP findings during HRT. Norethisterone acetate might possess additive blood pressure-lowering effects in postmenopausal women.

Differences between users and non-users of emergency contraception after a recognized unprotected intercourse.

Knowledge of emergency contraception is crucial but might not transform into use. Factors influencing decision-making related to use of emergency contraception after an unprotected intercourse and the characteristics of users of emergency contraception (EC) were assessed. In an abortion clinic setting, 217 women referred for termination of pregnancy were asked to fill in a questionnaire. Of the 217 women, 139 (64%) were aware of pregnancy risk but only 9 (4%) had used EC after the unprotected intercourse. 42% were estimated to have sufficient knowledge to use hormonal emergency contraception. In a larger background population, a calculated 29% used EC after a recognized unprotected intercourse. EC users were older, better educated, more often in stable relationships, had experienced more abortions, and gestation age was less. However, younger women were in general better informed of EC. Knowledge of EC does not necessarily transform into action. Neglect of risk after an unprotected intercourse is frequent in younger well-informed women and information has to be better targeted.

Prognostic implications of ventricular ectopy one week, one month, and sixteen months after an acute myocardial infarction. Danish Study Group on Verapamil in Myocardial Infarction.

BACKGROUND: Ventricular ectopy early after an acute myocardial infarction (AMI) has previously been demonstrated to predict mortality. Less information is available about the prognostic implications of ventricular ectopy occurring late after an AMI, and no information is available about the prognostic implication of the development of ventricular ectopy during the first year after an AMI. HYPOTHESIS: The purpose of the present prospectively conducted trial, a part of the Danish Verapamil Infarction Trial II (DAVIT II), was to evaluate the prognostic implication of (1) ventricular premature complexes (VPCs) recorded by 24-h Holter monitoring 1 week, 1 month, and 16 months after an AMI; and (2) development of > 10 VPCs/h or of any complex ventricular ectopy, that is, pairs, more than two types of VPCs, ventricular tachycardia, or > 10 VPCs/h during follow-up after an AMI. METHODS: Patients were monitored 1 week (n = 250), 1 month (n = 210), and 16 months (n = 201) after AMI. RESULTS: Multivariate analyses based on history, clinical findings, and ventricular ectopy showed the following results: After 1 week, > 10 VPCs/h (p = 0.0006) and heart failure (p < 0.007); after 1 month, > 10 VPCs/h (p = 0.003) and resting heart rate (p < 0.02); and after 16 months, ventricular tachycardia (p = 0.002) independently predicted long-term mortality. Mortality was significantly predicted by the development of > 10 VPCs/h from 1 week to 1 month (p = 0.003) and 16 months (p = 0.03), and from 1 to 16 months (p = 0.007) after AMI, as well as by the development of any complex ventricular ectopy from 1 week to 1 month (p = 0.02) and 16 months (p = 0.01), and from 1 to 16 months (p = 0.04) after AMI. CONCLUSION: The present study demonstrated that 1 week and 1 month after an AMI the quantity of VPCs, that is, > 10 VPCs/h, predicted mortality, whereas 16 months after an AMI the quality of VPCs, that is, ventricular tachycardia, predicted mortality.

Women at cardiac risk: is HRT the route to maintaining cardiovascular health?

Cardiovascular disease is the leading cause of death in women of postmenopausal age. Data from observational studies suggest that the risk of coronary heart disease in postmenopausal women can be reduced by 30-50% by estrogen replacement therapy. The protective effect of estrogen is multifactorial, affecting lipids, carbohydrate metabolism, hemostasis, body-fat distribution and blood pressure. Although the unopposed use of estrogen is associated with an increased risk of endometrial cancer, this risk can be reduced or even neutralized by the addition of progestogen. The protection against cardiovascular disease provided by combined estrogen/progestogen treatment has been the subject of much debate. However, results from epidemiological studies, intervention trials and animal experiments now suggest that the addition of progestogen does not attenuate the beneficial effects of estrogen. While secondary prevention studies are needed to evaluate the various hormone regimens, the use of combined estrogen/progestogen therapy can be supported.

Prehospital treatment of patients with i.v. heroin overdose: what are we treating?

OBJECTIVE: To measure blood levels of morphine and additional drugs in patients suspected of intravenous (i.v.) heroin abuse and to evaluate the effects of antidote treatment. DESIGN: Prehospital blood sampling in 52 patients. RESULTS: Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses. CONCLUSION: This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.

[Use of pneumatic anti-shock equipment (MAST = military anti-shock trousers) in prehospital emergency treatment. A review]. / Brug af pneumatisk antishockudstyr (MAST = military anti-shock trousers) i akut praehospitalsbehandling. En oversigt.

Employment of pneumatic anti-shock (MAST) equipment is a therapeutic possibility in some countries for hypovolaemic and shocked patients. This treatment may be associated with particularly serious side effects and no documentation is available to prove that MAST is beneficial for the patients. The only meticulous clinically controlled investigation concludes that MAST is without effect in city regions with well-trained paramedical or medical staff and employment of MAST can thus not be recommended. The effect of MAST outside urban regions is unknown and should be assessed by means of a clinically controlled investigation.

[Azoospermia in 2 body-builders after taking anabolic steroids]. / Azoospermi hos to bodybuildere efter anaboliske steroider.

During investigations for infertility azoospermia was diagnosed in two men who were concomitantly using anabolic steroids for body-building. Following cessation of anabolic steroid use the semen quality was normalized. Suppression of spermatogenesis during treatment with testosterone and derivatives hereof is wellknown. Usage of anabolic steroids should be remembered as a cause of oligo- and azoospermia and asked about in cases of sperm counts approaching or at zero.

[Sudden unexpected respiratory arrest outside hospital among young patients with asthma]. / Pludseligt, uventet respirationsstop hos unge asthmapatienter uden for hospital.

In a prospective investigation lasting for one year, the medically staffed ambulance in Copenhagen registered patients under the age of 60 years with asthma who developed respiratory arrest outside hospital. The circumstances involved in the acute serious cases were illustrated as far as possible by review of the case records and interviews with the surviving patients. Five patients participated in the investigation. All of these were young with a median age of 24 years (19-28). Two patients had cardiac arrest, four patients survived after tracheal intubation at the site of the onset of illness and subsequent mechanical ventilation. One patient died in hospital on account of anoxic encephalopathy. The common denominators of all of the patients were that the condition had been recognized for many years, that before the attack involved they had been well and without asthmatic symptoms, the attack commenced hyper-acutely and the patients had not taken medicine regularly during a prolonged period. On the basis of these observations, the present authors recommend that young patients with asthma should receive optimal medication and that the necessity of taking the prescribed medicine despite possible good health should be emphasized.

[Emergency prehospital treatment of severe hypoglycemia in the Copenhagen Municipality. A retrospective analysis of 180 episodes]. / Akut praehospitalsbehandling af svaer hypoglykaemi i Københavns Kommune. En retrospektiv analyse af 180 episoder.

A retrospective study concerning prehospital treatment of 180 consecutive patients with severe hypoglycaemia, treated by the Mobile intensive care unit (MICU) in Copenhagen was performed. A total of 113 (63%) were male. Of these 104 patients had blood-glucose concentrations less than 2 mmol/l. Eleven patients had blood-glucose concentrations between 2 and 4 mmol/l. After treatment with 50% glucose solution: (25-50 ml I.V.), 131 patients could remain at home. During the 24 hour period after the initial event, two patients needed a second treatment by the mobile intensive care unit on account of secondary hypoglycaemia. Four further patients were admitted to hospital; none of these suffered secondary hypoglycaemic events. One case was registered as "life-saving" on account of treatment of severe airway obstruction. It seems that prehospital treatment of severe hypoglycaemia is beneficial mainly because transportation of delirious, abusive patients can be avoided and the workload of emergency-rooms can be reduced. 69% of patients suffering a severe hypoglycaemic event, were treated prehospitally without subsequent transportation to hospital.

[Monitoring of anesthesia during magnetic resonance imaging]. / Anaestesimonitorering ved magnetisk resonans undersøgelser.

Clinical employment of magnetic resonance scanning presents great diagnostic possibilities, partly in the form of the quality of the imaging and also on account of the possibilities for carrying out spectroscopic measurements by mens of which in vivo non-invasive chemical analysis of drug concentrations in the tissues may be performed. In anticipation of the possibility of employing MR-scanning as an important diagnostic aid for assessing the causes of unconsciousness in patients in intensive care, attempts have been made to establish reliable and justifiable equipment for monitoring which can render possible investigation of unconscious or anaesthetized patients in scanners with magnetic fields of over 1.5 Tesla. The medical technical difficulties involved are mentioned and the solutions which are employed in the Danish scientific Centre for Magnetic Resonance in Hvidovre Hospital in Copenhagen are described. This monitoring includes continuous ECG recording, measurements of pulse and blood-pressure once per minute and continual monitoring of respiration including concentrations of carbon dioxide in the inspired and expired air and the concentration of oxygen in the inspired air. In addition, model solutions have be outlined for establishing mechanical ventilation with the servorespirator and the possibility of producing an employable pulse oxymeter is described. It is stated that, provided all of the elements in the above mentioned model solution for monitoring during anaesthesia in the MR laboratory have been carried out, it is considered justifiable to place all patients, including children, in the MR-scanner.

[Acute asthma outside hospital. The predictive value of pulse oximetry in manifestation of respiratory insufficiency]. / Akut astma uden for hospital. Vaerdien af pulsoximetri som prognostikum for manifest respirationsinsufficiens.

The objective of the study was to evaluate the predictive value of pulse oximetry before treatment of acute asthma in the prehospital setting. Unfavorable outcome was defined as need for mechanical ventilation during the acute attack. The study was carried out prospectively. The patients were divided into two groups: SpO2 < 80% and SpO2 > or = 80%. The study group consisted of 44 patients with 47 asthmatic attacks. Eleven patients had SpO2 < 80%, of whom two required mechanical ventilation. Thirty-three patients with 36 attacks had SpO2 > or = 80%, none required mechanical ventilation. Oximetry before treatment with a cut off point of < 80% had a specificity of 18% and a sensitivity of 100% for prediction of unfavourable outcome. We conclude at SpO2 < 80% in the acute asthmatic attack is a serious prognostic sign which should warn the physician that the patient's condition is lifethreatening.

[Prognosis and costs of patients with prehospital cardiac arrest treated with respirators]. / Prognose og omkostninger hos respiratorbehandlede patienter efter praehospitalt opstået hjertestop.

A retrospective study was undertaken of prehospital cardiac arrest and revealed that mechanical ventilation was employed in 132 consecutive patients after resuscitation. A total of 24 of these survived for more than three months; 14 were discharged to their homes while ten were discharged to nursing homes on account of cerebral sequelae. No patients in whom the cardiac arrest had lasted more than 25 minutes survived for more than three months and patients with cerebral sequelae were more frequently mechanically ventilated for longer than 48 hours. The total cost of treatment for the 132 patients was estimated to be 10,500,000 Danish crowns (approximately 954,000 pounds). A total of 7% of the patients survived with cerebral sequelae but these were responsible for more than 60% of the expenses.

[Emergency prehospitalization treatment of cardiac arrest in the municipality of Copenhagen]. / Akut praehospitalsbehandling af hjertestop i Københavns Kommune.

A retrospective study was performed concerning prehospital cardiac arrest. This revealed that 177 consecutive patients received advanced medical resuscitation by an anaesthesiologist at the site of the accident during the period 01.01.1988-31.12.1988. A total of 61 (35%) were admitted to hospital and 24 of these (14%) survived for more than 30 days. All 24 were discharged to their homes without major cerebral sequelae. After one year, 21 were still alive. Compared with the results of previous studies in Copenhagen, this study reveals that the overall survival rate may have improved and that cerebral function after cardiac arrest seems to have been improved by the introduction of prehospital medically staffed ambulances.

[Resectability of papillary and pancreatic cancer assessed by ultrasonography and computer tomography]. / Resektabilitet af papil- og pancreascancer vurderet ved ultralydskanning og computertomografi.

A retrospective study of 65 patients with postoperatively verified pancreatic or peripancreatic cancer was conducted. Before surgery all patients had ultrasonography (US) performed, and 46 patients had computed tomography (CT) performed as well. After operation description of pre-operative radiological findings has been compared to description of operative and pathological findings. Three of the 65 patients were excluded either because of lacking radiological descriptions (two patients) or uncertain operative findings (one patient). When both investigations were performed, they were carried out independently by two skilled radiologists without knowledge of the result of the other investigations. The following criteria were used for non-resectability encasement of splanchnic vessels, liver metastases, peritoneal thickening with ascites, and glandular enlargement. As assessed by US, 15 of 16 (94%) were truly predicted to be non-resectable, whereas only 21 of 38 (55%) were truly predicted resectable. CT was performed in 46 patients of which 19 of 21 (90%) were truly predicted non-resectable, and 17 of 21 (81%) were truly predicted resectable. It was not possible to perform a conclusive radiological investigation in eight of 62 (13%) cases by US, and four of 46 (9%) cases by CT. One patient was falsely predicted non-resectable by US and an additional one by CT. Both were falsely predicted non-resectable on suspicion of vessel involvement. Overall, invasion of vessels was the most common cause for non-resectability, at the same time this was the index of non-resectability that was most often not detected pre-operatively. US is reliable when predicting non-resectability. When resectable tumour is detected by US, supplementary investigations such as CT should be applied, and when necessary endoscopic procedures or laparoscopy as well. Hereby unnecessary laparotomies may be avoided. Care should be taken when suspecting papillary tumour; only 66% of these were detected by either of the two methods.

[Prehospital pain relief with nitrous oxide (Entonox)]. / Praehospital smertebehandling med kvaelstofforilte (Entonox).

Many patients suffering from trauma or acute illness are in need of pain treatment in the prehospital phase, a treatment they seldom receive. In Denmark, it has been considered whether ambulance personnel should be allowed to administer pain treatment. Inhalation of 50% nitrous oxide and 50% oxygen has been administered for many years by non-physicians around the world. Therefore considerations concerning implementation of this treatment in Denmark are relevant. The aim of this paper was to evaluate the available knowledge about and experiences in using nitrous oxide outside the hospital for patients suffering from acute pain. The papers so far published are positive, but give no definite background for uncritical recommendation of prehospital pain treatment with nitrous oxide. There are no controlled studies concerning the effect of pain treatment in the prehospital phase. The few available controlled studies conducted inside the hospital have not shown significant pain-relieving effects of nitrous oxide for patients suffering from pain of acute medical of surgical origin when compared to other methods of pain treatment. Controlled studies of the effects of prehospital treatment with nitrous oxide need to be done. Technical problems and problems concerning indications, side effects, complications, pollution and possible addiction remain to be fully elucidated before prehospital treatment with nitrous oxide can be recommended for routine use in the Danish ambulances.

[Pre-hospital care]. / Praehospital behandling.

Organisatory and therapeutic characteristics for selected pre-hospital medical treatment systems are described. It is emphasized that all of the links in the therapeutic chain must function optimally to achieve effective treatment of acute disease and injuries. The importance of rapid decision-making by highly qualified medical staff is emphasized. On the basis of experience from Denmark and from abroad, a model for up-to-date pre-hospital treatment in Denmark is outlined.