The Pekin duck IL-10R2 common chain: cDNA cloning, genomic structure, molecular characterization and mRNA expression analysis.

The interleukin-10 receptor 2 (IL-10R2, IL-10Rß) is required for the signalling of the class 2 cytokines IL-10, IL-22, IL-26 and IFN-λ1-3 . Here, we describe the identification of the Pekin duck IL-10R2 (duIL-10R2) common chain and its gene structure. The duIL-10R2 cDNA encodes a 343 amino acid protein that has an amino acid identity of 76% and 42% with chicken and human IL-10R2, respectively. Binding residues of human IL-10R2 for IL-10 and IL-22 were mostly conserved in the avian IL-10R2 proteins within loops L3 and L5, but not within loops L2 and L6. Homology modelling of the duIL-10R2 extracellular domain structure using soluble human IL-10R2 (shIL-10R2, PDB ID: 3LQM) as a template revealed a protruding loop L5 and two distinct clefts between loops L2/L3 and L3/L5, similar to shIL-10R2. However, in contrast to the three amino acid ß-hairpin loop L2 of shIL-10R2, loop L2 of duIL-10R2 is five residues longer. Residues within a putative Tyk2 binding site were highly conserved across all vertebrate IL-10R2 proteins examined. The duIL-10R2 gene shares a seven exon-six intron structure with chicken and human IL-10R2 genes, but avian genes are more compact. DuIL-10R2 mRNA was constitutively expressed in all tissues. Mitogen stimulation of duck peripheral blood mononuclear cells (PBMC) did not alter transcript levels. Our observations suggest that genomic organization and structural features implicated in multiple cytokine-binding properties of human IL-10R2 are conserved in duck IL-10R2, but the evolutionary changes that appear to have lead to low-affinity cytokine interaction within loop L2 are distinct to mammalian species.

Factors influencing physicians' assessment of urgency for inpatient surgery.

OBJECTIVES: To assess to what extent patient, disease and referral characteristics influenced physicians' assessment of urgency of inpatient surgery. METHODS: In total, 452 patients, mean age 50 years, were examined in surgical or gynaecological outpatient clinics in one hospital and referred for inpatient surgery. Data were collected by the examining physician, and the patients were either given a maximal waiting time or the waiting time was not specified. A stepwise logistic regression, with urgency for surgery within four weeks or less as the dependent variable, was used. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of 452 patients, 181 (40%) were deemed urgent (four weeks or less). In multivariate logistic regression analysis, suspected or verified malignant disease (OR 3.45, 95% CI 2.11 to 5.64), risk of serious deterioration (OR 4.53, 95% CI 2.17 to 9.46), being on sick leave from work (OR 3.97, 95% CI 1.82 to 8.64) and being assessed by a physician undergoing specialist training (OR 1.99, 95% CI 1.24 to 3.21) were significant predictors of being assessed as needing inpatient surgery urgently. CONCLUSIONS: Physicians' judgements, in an informal way, internalize many of the public's concerns for fairness, such as the severity of a condition, the potential for improvement and aversion to inequalities in health. More research is needed to understand the difference in urgency ratings between junior and more experienced physicians.

[Establishment of the Cancer Registry]. / Opprettelsen av Kreftregisteret.

In 1948, the WHO proposed that five countries, Norway among them, should study the incidence of cancer. Three years later the Norwegian Ministry of Health and Social Affairs issued instructions for the reporting of all cases of cancer to the new Cancer Registry of Norway. Its first director was Dr. Einar Pedersen, who was succeeded by Dr. Frøydis Langmark in 1983. Between 1957-61 and 1992-96, the number of cancer cases increased from 41,648 to 99,601. Most types of cancer were up; stomach cancer was an exception to this trend. The increase was highest for malignant melanoma and lung cancer, for both types higher among women than among men. There are considerable variations in cancer incidence between Norwegian counties, between the municipalities within the counties, and between urban and rural communities.

[Registration of canine cancer]. / Registrering av kreft hos hund.

A Norwegian Canine Cancer Registry, covering four of 19 counties, has been operative since March 1990. Until the end of April 1994 about 6,000 tumours have been registered, more than 50% of these being manifestly or potentially malignant. Among 14 selected breeds the relative risk ratio for all tumours varies with factor 35 from boxer to dunker, the boxer having the highest tumour risk. The percentage distribution of specified tumour types also varies greatly between breeds, mammary cancer constituting 59% of all neoplasms in the dachshund, but only 4% in the Bernese mountain dog. Because of the genetic diversity between breeds the dog is a suitable species for differentiation between genetically determined predisposition and environmental influences in the etiology of cancer. Epidemiological surveillance of cancer morbidity in dogs may be a useful instrument for tracing carcinogens, even in the surroundings of man.

Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding. Five years' experience in a central hospital.

BACKGROUND: Despite improved surgical and endoscopic technics, acute bleeding from peptic ulcer is still a serious condition, and management remains controversial. The aim of the study was to evaluate a management policy of aggressive endoscopic and restrictive surgical treatment for acute peptic ulcer bleeding. METHODS: We retrospectively investigated the course of all 341 hospital admissions during 1986 to 1990 caused by bleeding peptic ulceration from the first bleeding episode until 30 days after discharge. RESULTS: Total mortality, in-hospital 30 days' mortality, and operative mortality were 6.3%, 4.4%, and 23.5%, respectively. Risk factors associated with mortality were age and number of concomitant diseases, malignant disease, rebleeding episodes, and surgical complications. No patients without associated illness died. In 73 cases (21%) patients were treated endoscopically one or more times, and altogether 17 patients (5%) were operated on. Rebleeding occurred in 67 cases (23%), and only 23 of these were treated endoscopically at admission. Twenty-six (51%) of the rebleeding patients were treated endoscopically and 13 rebleeding patients were operated on. Two-thirds of patients presenting with arterial bleeding were managed endoscopically. No complications occurred in endoscopically treated patients, whereas there were complications in 8 of 17 operated patients. Operated patients needed significantly more intensive care unit observation time and had longer hospital stay than patients treated endoscopically. CONCLUSIONS: Endoscopic treatment is a safe procedure with a low mortality, and, if successful, the need for emergency surgery is substantially reduced. In the relatively few patients requiring surgery after unsuccessful endoscopy, the mortality remains high.

A model for car exhaust exposure calculations to investigate health effects of air pollution.

This paper presents a model for car exhaust exposure calculations, which improves the air pollution exposure estimates necessary to study relationships between health and air pollution. The model enables calculation of hour-by-hour air pollution concentrations at receptor points in an area. Combined with a diary method, in which participants in the study give data on their movement in the area, the model enables personal air pollution exposure values to be calculated. The paper shows examples of comparison between measured and calculated exposure.

[Content, function and structure of standardized hospital waiting lists in Norway]. / Innhold, funksjon og oppbygging ved standardiserte sykehusventelister i Norge.

Standardization of hospital waiting lists will improve the quality of information on waiting lists, allowing comparison between different hospitals and different counties, and a nationwide aggregation. Waiting lists must include all elective referrals, and will accordingly allow future planning and surveillance of the complete elective hospital activity. A current indication for evaluation/treatment in hospital is a prerequisite for waiting list registration. The registers must be continuously validated by erasing old referrals. Referrals are categorized in relation to hospital departments, sections and levels of care. Subgroups comprise medical specialties and diagnostic groups.

[Grouping and calculated measurements of standardized waiting lists in Norway. Definitions and interpretations of waiting lists]. / Gruppering og opptellingsmåter ved standardiserte ventelister i Norge. Definisjoner og tolkning av ventetider.

Waiting list parameters calculated for defined dates and time periods allow studies to determine balance between new and completed referrals. The authors discuss various sub-groupings of the waiting lists. The main waiting time parameter is mean waiting time for the various levels of care in the case of the different medical specialties and diagnostic groups. Waiting time is defined as the difference between date of first admission to hospital and the date when the patient was referred. It is possible to calculate total waiting time for patients undergoing out-patient evaluation before in-patient or day-care treatment. Aggregated waiting times should exclude control admissions and admissions postponed at the wish of the patient.

[Reports of waiting list data from hospitals to the central registry--a database for reducing hospital waiting lists. Minimum dataset of waiting list parameters]. / Rapportering av ventelistedata fra sykehus til sentralregisteret--database for reduksjon av sykehuskø. Minste felles datasett med ventelisteparametre.

The governmental regulations concerning registration of waiting lists and priority of patients, laid down in July 1990, introduce a "waiting time guarantee" which ensures a waiting time not exceeding six months for patients suffering from diseases having severe impacts on health. Hospitals that are unable to treat these patients within six months are requested to refer them to other hospitals before the deadline. All hospitals have to make monthly reports of waiting list parameters to a Central Waiting List Register, enabling both a nationwide waiting list survey and comparisons between different hospitals and different counties. An online communication facility to the central register enables searches for and reporting of vacant treatment capacity.

Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds.

The value of thorough examination of the case history as a diagnostic tool on hospitalization of patients with suspected myocardial infarction was investigated in three independent prospective studies. Use of a limited number of pain-related elements (= 'criteria'), that had already been obtained in the emergency room, could improve the decision on whether or not to admit patients to the coronary-care unit. As an example, in one of the studies, use of such criteria would have reduced the number of 'unnecessary' coronary-care-unit admissions from 298 to 162, a 46% reduction (P less than 0.001). In the same patient sample, use of the criteria could have reduced the number of patients with definite acute myocardial infarction, admitted to the general wards, from 47 to 22, a 53% reduction (P less than 0.01). These favourable results were confirmed in the two independent, smaller-scale studies.

Oxalate nephropathy in a Tibetan spaniel litter. A probable case of primary hyperoxaluria.

Severe oxalate nephropathy with end-stage kidney lesions was found in two pups of a litter of three Tibetan Spaniels. This histopathological finding strongly suggests a primary hyperoxaluria since there was no exposure to agents capable of producing secondary hyperoxaluria. Primary hyperoxaluria has not been reported as a spontaneous disease in the dog, although it is a well-known, but rare, inherited metabolic disease of man.

[Testing of a computer program model for the diagnosis of suspected acute coronary disease]. / Uttesting av en EDB-basert modell for diagnostisering av mulig akutt koronarsykdom.

A computerized diagnostic system to be used in patients with acute chest pain was recently developed in our department, and was tested prospectively in 213 consecutive patients with acute chest pain. In our study, the computer system almost invariably improved the decision as to whether or not admission to the coronary care unit was necessary. Thus, compared with decisions made by the emergency room physicians the computer system would have reduced by approximately 75% the number of patients with acute myocardial infarction who are incorrectly referred to the general ward. The system would also have reduced by the same figure the number of cases wrongly placed in the coronary care unit. Thus, in patients admitted with acute chest pain, the use of our computerized system would have improved both diagnostic accuracy and correct referral of patients from the emergency room.

Dose adjusted heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.

Two studies have been done to establish recommendations for dosage and dose adjustment in the treatment of deep vein thrombosis (DVT) with low molecular weight heparin (LMWH). In the first, 56 patients were randomized in a double blind study to be treated either with unfractionated heparin (UFH) or LMWH s.c. every 12 h. Initial doses were given according to age and sex, disregarding bodyweight, and the dose was then adjusted when the peak plasma heparin concentration fell outside the desired range of 0.5-0.8 anti-FXa U/ml. There were fewer dose adjustments in the LMWH group. The correlation between injected dose (U/kg bodyweight) and the heparin concentration was higher in the LMWH group (r = 0.59) than in the UFH group (r = 0.38). The results suggest that, in order to obtain the desired heparin concentration, the initial dose of LMWH should be about 100 U/kg bodyweight every 12 h. In the second, open study, this dosage plan was followed in 15 patients. The peak heparin concentration on Day 2 ranged from 0.40 to 0.75 anti-FXa U/ml and adjustment was only required in 3 patients. Day to day variation in peak heparin activity in the individual patient varied little (CV 11-22%), and there was no accumulation. The results indicate that plasma heparin concentration is more predictable using LMWH than UFH, and they point to definite advantages in the use of LMWH in a bodyweight adjusted dosage.

Plasmacytoma of the uvea in a case of multiple myeloma.

A case of plasmacytoma in the uvea, both clinically and grossly anatomically mimicking a malignant melanoma, is described in a 63-year-old man who died from multiple myeloma. This is an extremely rare condition in the eye. Only one report of a similar tumour has been found in the literature.

Liver cell necrosis and regeneration following injections of carbon tetrachloride. Effects of the thyrotropin-releasing hormone and somatostatin.

Mice were given 10 micrograms somatostatin or 25 micrograms TRH intraperitoneally 10 min before s.c. injection of 2 or 20 mg CCl4. The extent of liver cell necrosis and nuclear size were measured by the electronic Mini Mop method and the extent of necrosis and nuclear pleomorphism were estimated by a visual linear analogue scale of 100 mm, and compared to plasma concentrations of ASAT and ALAT. Pre-treatment with TRH or somatostatin resulted in significant reduction in the extent of necrosis 24 h after CCl4-injections (25%), with a lowering of ASAT from 13209 +/- 2955 U/l to 5144 +/- 924 after TRH and to 6186 +/- 966 after somatostatin, and of ALAT from 14343 +/- 3209 to 7718 +/- 1727 and 6494 +/- 1253 U/l, respectively. After 3 days the necroses were reduced from 16.5 +/- 1.7% by the Minimop method to 1.4 +/- 0.5% (90%) in mice given CCl4 alone, and from 12.3 +/- 1.7% to 3.8 +/- 1.2% in mice pretreated with TRH, and from 12.3 +/- 1.8% to 3.8 +/- 1.7% (70%) in mice pretreated with somatostatin. The plasma concentrations of ASAT and ALAT were reduced correspondingly. After 5 days no necroses were seen, and the plasma ASAT and ALAT were normal. After 6 months of weekly injections of TRH or somatostatin before 20 mg CCl4 the liver cell nuclear size (10.5 and 9.7 0.3 mu 2) was similar to that after CCl4 alone (9.7 0.3 mu 2), and twice that of controls (4.6-5.4 0.1 mu 2). Liver cell necrosis was not seen. The plasma concentrations of ASAT (131 8.6-162 11.3) and ALAT (98 8-104 9 Iu/l) were similarly 2-3 times those in controls. TRH and somatostatin thus reduced liver cell injury and delayed regeneration after single injections of CCl4. After 6 months of weekly injections no effects were observed.

The morphology of human cells from the choroid and retinal pigment epithelium grown in vitro on isolated Bruch's membrane.

Cells from samples of human choroidal tissue were collected and seeded onto isolated Bruch's membrane in vitro, and the morphology of the developing cultures was examined by light-, scanning electron- and transmission electron-microscopy. In early cultures, the cells showed a flattened, spread out appearance with short surface villi and a low degree of cellular overlapping. After 48 h, a shift towards a more elongated cell form was observed, and one week old cultures were composed of predominantly elongated cells with a pronounced degree of overlapping. In contrast, human retinal pigment epithelial cells seeded onto sheets of Bruch's membrane maintained a spread out epithelial morphology with a varying degree of overlapping throughout the culture period. The present system permits comparative studies on the behavior of choroidal and pigment epithelial cells under controlled conditions. It may serve as an in vitro model for disorders characterized by growth of these cells on Bruch's membrane in vivo.

Prostaglandins and CCl4-induced liver cell mortality. The effect of the prostaglandin analogue enprostil.

Prostaglandins have been reported to reduce the carbon tetrachloride (CCl4)-induced liver cell injury in rats. The object of the present experiments was to examine the effect of the prostaglandin E2 analogue enprostil on the survival of isolated liver cells exposed to CCl4. Liver parenchymal cells were isolated from rat livers by collagenase perfusion and released into a 'suspension' buffer. Aliquots of the cell suspension were incubated with 1 micrograms or 0.5 microgram CCl4, and to parallel test suspensions 20 ng enprostil was added 5-10 min before CCl4. Incubation was performed on ice, at room temperature, and at 37 degrees C. The average percentage of dead cells after CCl4 treatment was significantly reduced by pretreatment with enprostil at room temperature (1 microgram CCl4: 69 +/- 21% and 44 +/- 13%, respectively) and after 10 min of incubation at 37 degrees C (1 microgram Cl4: 56 +/- 25% and 37 +/- 27%; 0.5 microgram CCl4: 51 +/- 33% and 29 +/- 18%, respectively). When the liver cell mortality approximated 100% after long-term incubation at 37 degrees C, no protective effect of enprostil was observed.

Human retinal pigment epithelium in long term explant culture.

Explants of human retinal pigment epithelium were maintained in culture in various types of media, and examined by light and transmission electron microscopy. After one month in vitro, the central areas showed a monolayered configuration with distinct polarity and presence of ruthenium red stainable material on the apical surface. On the peripheral areas of Bruch's membrane, multilayered lesions were observed to develop and to extend from the monolayered epithelium and past the cut edge in Bruch's membrane. Cells in these lesions contained little melanin and generally lacked an apico-basal polarity. Ruthenium red staining revealed the presence of electron dense material on the apical surface of the lesions as well as in the extracellular space between cells in the various layers. Development of multilayered lesions with deposition of extracellular material are seen in various chorio-retinal disorders, including senile macular degenerations and also subsequent to laser and cryo-therapy. The findings in the present study point to the explant culture system as a valuable tool in the study of important aspects of chorio-retinal pathology.

Subcutaneous heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.

In a double-blind study, patients with phlebographically proven deep venous thrombosis (DVT) were treated with subcutaneous injections twice a day of either unfractionated heparin (UH; n = 27) or low molecular weight heparin (LH; n = 29) for 7 days, and the dose was adjusted until therapeutic range was reached, according to a chromogenic substrate anti-Xa assay. Forty-eight percent of the LH group did not need dose adjustment as compared to 24% of the UH group. During the course of heparin administration, deviation from initial heparin activity was frequent in both groups, but mean activity did not indicate a cumulative effect in either group. There was 1 incidence of pulmonary embolism (LH) and only 1 minor bleeding episode (UH). Half of the patients in both groups were phlebographically improved. We conclude that subcutaneous heparin treatment with UH or LH appears safe and convenient.