Genotoxic effects of nanosized and fine TiO2.

The in-vitro genotoxicity of nanosized TiO(2) rutile and anatase was assessed in comparison with fine TiO(2) rutile in human bronchial epithelial BEAS 2B cells using the single-cell gel electrophoresis (comet) assay and the cytokinesis-block micronucleus test. BEAS 2B cells were exposed to eight doses (1-100 microg/cm(2)) of titanium(IV) oxide nanosized rutile (>95%, <5% amorphous SiO(2) coating; 10 x 40 nm), nanosized anatase (99.7%; <25 nm), or fine rutile (99.9%; <5 microm) for 24, 48, and 72 h. Fine rutile reduced cell viability at lower doses than nanosized anatase, which was more cytotoxic than nanosized rutile. In the comet assay, nanosized anatase and fine rutile induced DNA damage at several doses with all treatment times. Dose-dependent effects were seen after the 48- and 72-h treatments with nanosized anatase and after the 24-, 48- (in one out of two experiments), and 72-h treatments (one experiment) with fine rutile. The lowest doses inducing DNA damage were 1 microg/cm(2) for fine rutile and 10 microg/cm( 2) for nanosized anatase. Nanosized rutile showed a significant induction in DNA damage only at 80 microg/cm(2) in the 24-h treatment and at 80 and 100 microg/ cm(2) in the 72-h treatment (with a dose-dependent effect). Only nanosized anatase could elevate the frequency of micronucleated BEAS 2B cells, producing a significant increase at 10 and 60 microg/cm( 2) after the 72-h treatment (no dose-dependency). At increasing doses of all the particles, MN analysis became difficult due to the presence of TiO(2) on the microscopic slides. In conclusion, our studies in human bronchial epithelial BEAS 2B cells showed that uncoated nanosized anatase TiO(2) and fine rutile TiO(2) are more efficient than SiO( 2)-coated nanosized rutile TiO(2) in inducing DNA damage, whereas only nanosized anatase is able to slightly induce micronuclei.

Preparation of nanoparticle dispersions for in-vitro toxicity testing.

Studies on potential toxicity of engineered nanoparticle (ENP) in biological systems require a proper and accurate particle characterization to ensure the reproducibility of the results and to understand biological effects of ENP. A full characterization of ENP should include various measurements such as particle size and size distribution, shape and morphology, crystallinity, composition, surface chemistry, and surface area of ENP. It is also important to characterize the state of ENP dispersions. In this study, four different ENPs, rutile and anatase titanium dioxides and short single- and multi-walled carbon nanotubes, were characterized in two dispersion media: bronchial epithelial growth medium, used for bronchial epithelial BEAS cells, and RPMI-1640 culture media with 10% of fetal calf serum (FCS) for human mesothelial (MeT-5A) cells. The purpose of this study was to determine the characteristics of ENPs and their dispersions as well as to compare dispersion additives suitable for toxicity tests and thus establish an appropriate way to prepare dispersions that performs well with the selected ENP. Dispersion additives studied in the media were bovine serum albumin (BSA) as a protein resource, dipalmitoyl phosphatidylcholine (DPPC) as a model lung surfactant, and combination of BSA and DPPC. Dispersions were characterized using optical microscopy and transmission electron microscopy. Our results showed that protein addition, BSA or FCS, in cell culture media generated small agglomerates of primary particles with narrow size variations and improved the stability of the dispersions and thus also the relevance of the in-vitro genotoxicity tests to be done.

Identification and regulation of the gastric H+/K+-ATPase in the rat heart.

UNLABELLED: Previous reports indicate that H+/K+-adenosine triphosphatase (ATPase) might be expressed in the heart. AIMS: The objectives of the present study were to explore the presence of H+/K+-ATPase protein and gene expression in the rat heart and to investigate whether the enzyme could contribute to potassium transport across the sarcolemma. METHODS AND RESULTS: We performed reverse transcription-polymerase chain reaction (RT-PCR) on mRNA from myocardium and isolated cardiomyocytes using primers specific for the gastric H+/K+-ATPase alpha-subunit. The PCR products were sequenced and the predicted gastric H+/K+-ATPase sequence was verified. Western blots from myocardium detected a 34-kDa band and a 94-kDa band, indicating the beta-subunit and alpha-subunit of the gastric H+/K+-ATPase, respectively. Immunocytochemistry detected significant immunoreactivity of the beta-subunit in cardiomyocytes. H+/K+-ATPase-dependent potassium transport was assessed by 86Rb+-uptake in isolated cardiomyocytes. Both ouabain and the selective H+/K+-ATPase inhibitor Schering 28080 reduced 86Rb+-uptake at maximum specific inhibition, by 70 and 25%, respectively; the effects were additive. Competitive RT-PCR analysis indicated a significant upregulation of the myocardial H+/K+-ATPase in heart failure after myocardial infarction. CONCLUSION: The gastric isoform of H+/K+-ATPase is expressed in rat cardiac myocytes, both at transcript and protein levels. Functional studies indicate that the enzyme could contribute to potassium and pHi regulation in cardiomyocytes.

Cardiomyocyte contractility and calcium handling partially recover after early deterioration during post-infarction failure in rat.

The aim of the study was to determine whether progression of heart failure is associated with deterioration of cardiomyocyte function. Cell dimensions, contractility and calcium transients were measured in cardiomyocytes isolated from the left ventricle of female Wistar rats 1, 4, and 13 weeks after coronary artery ligation or sham-operation. Relative cardiomyocyte shortening decreased from 26% in controls to 11% 1 week after myocardial infarction and recovered to 18 and 20% after 4 and 13 weeks, respectively. Diastolic and systolic calcium concentrations increased markedly 1 week after myocardial infarction with subsequent reduction after 4 and 13 weeks. Time to 50% relaxation was prolonged by 31% after 1 week and 20% after 4 and 13 weeks with corresponding changes in diastolic calcium clearance. Cardiomyocyte length increased by 6, 24, and 26% after 1, 4 and 13 weeks, respectively, whereas myocyte width increased by 4, 11 and 27%. Cardiomyocytes adjacent to the infarct hypertrophied more and initially had more markedly impaired function than in the remote area. Left ventricular diastolic diameter assessed by echocardiography increased by 47, 66 and 84% after 1, 4 and 13 weeks, respectively, and systolic diameter increased by 120, 162 and 194%. Left ventricular end-diastolic pressure increased from 6 mmHg to 24, 25 and 36 mmHg. Whereas initial deterioration of cardiac function is associated with reduced cardiomyocyte contractile function, chronic heart failure progression is not accompanied by further impairment of intrinsic cardiomyocyte contractility in this model. Cardiomyocyte hypertrophy and dysfunction are more marked adjacent to the infarction.

Increased contractility and calcium sensitivity in cardiac myocytes isolated from endurance trained rats.

OBJECTIVE: Regular exercise enhances cardiac function and modulates myocyte growth in healthy individuals. The purpose of the present study was to assess contractile function and expression of selected genes associated with intracellular Ca2+ regulation after intensity controlled aerobic endurance training in the rat. METHODS: Female Sprague-Dawley rats were randomly assigned to sedentary control (SED) or treadmill running (TR) 2 h per day, 5 days per week for 2, 4 or 13 weeks. Rats ran 8-min intervals at 85-90% of VO2max separated by 2 min at 50-60%. Myocyte length, intracellular Ca2+ (Fura-2), and intracellular pH (BCECF) were measured in dissociated cells in response to electrical stimulation at a range of stimulation rates. RESULTS: The increase in VO2max plateaued after 6-8 weeks, 60% above SED. After 13 weeks, left and right ventricular weights were 39 and 36% higher than in SED. Left ventricular myocytes were 13% longer, whereas width remained unchanged. After 4 weeks training, myocyte contractility was approximately 20% higher in TR. Peak systolic intracellular Ca2+ and time for the decay from systole were 20-35 and 12-17% lower, respectively. These results suggest that increased myofilament Ca2+ sensitivity is the dominant effect responsible for enhanced myocyte contractility in TR. Intracellular pH progressively decreased as stimulation frequency was increased in the SED group. This decrease was markedly attenuated in TR and the intracellular pH was significantly higher in the TR group at a stimulation rate of 5-10 Hz. This effect may contribute to the increased contractility observed at the higher stimulation frequencies in TR. A higher intrinsic myofilament Ca2+ sensitivity was observed in permeabilised myocytes from the TR group under conditions of constant pH and [Ca2+]. Western blot analysis indicated 21 and 46% higher myocardial SERCA-2 and phospholamban, but unaltered Na+/Ca(2+)-exchanger levels. Competitive RT-PCR revealed that TR significantly increased Na+/H(+)-exchanger mRNA. CONCLUSION: Intensity controlled interval training increases cardiomyocyte contractility. Higher myofilament Ca(2+)-sensitivity, and enhanced Ca(2+)-handling and pH-regulation are putative mechanisms. Our results suggest that physical exercise induces adaptive hypertrophy in cardiac myocytes with improved contractile function.

Demonstration of Chlamydia pneumoniae in the adenoid from children with and without secretory otitis media using immunohistochemistry and PCR.

Chlamydia pneumoniae has been found in patients with middle ear inflammation. The adenoid, which has a central role in the development of secretory otitis media (SOM), may act as a reservoir for bacteria causing ear infection. Adenoid tissue was examined for the presence of C. pneumoniae. Twenty children undergoing adenoidectomy because of hyperplastic adenoids, 10 with SOM and 10 without SOM, were examined with nasopharyngeal swabs for routine bacteriological culture, serology for C. pneumoniae and throat swabs for C. pneumoniae PCR. The removed tissues were analyzed for C. pneumoniae using immunohistochemical (IHC) analysis and PCR. In the group of children with SOM samples were also taken from the middle ear fluid for routine bacteriological culture and PCR for C. pneumoniae. C. pneumoniae was found in the adenoid by PCR in 3 cases from each group and from all 20 children by IHC. Four children in each group had increased levels of specific antibodies to C. pneumoniae. Two children with SOM had high antibody titers and a positive PCR from a throat swab. Two children were PCR-positive for C. pneumoniae in fluid from the middle ear. The significance of these findings is not yet clear.

[Clinical skills among interns]. / Turnuslegers ferdigheter i praktiske prosedyrer.

BACKGROUND: Previous reports have demonstrated variable and partly insufficient skills levels in common practical procedures among interns after internship in hospital. The aim of the present study was to examine the development in interns' skills levels in practical procedures in relation to their gender, medical school, hospital and supervision. MATERIAL AND METHODS: Between July 1996 and July 1999 all interns in Norway were asked to indicate their skills level in 88 practical clinical procedures before and after hospital internship. Of the 599 interns included, 472 replied (79%). RESULTS: Males reported significant higher skills levels than females. After internship, no differences between interns graduated from the four universities were observed. Our study shows that the hospital internship is an important part of the medical education. An overall improvement was found in all interns. Interns whose skills levels were low before internship, had the best improvement. INTERPRETATION: The finding of a variable skills level before and a variable development during internship indicates that teaching in practical procedures is unstructured and inadequate. A consensus on the skills to be acquired and on what level is needed. Improvements are also needed in the quality of supervision.

Segregation of sex chromosomes in human lymphocytes.

Centromeric FISH was used to investigate the segregation of sex chromosomes in human lymphocytes. The aim of the study was to evaluate the effects of cell culture, cytokinesis block, age and sex on segregation and to compare the behaviour of the X and Y chromosomes. In uncultured T lymphocytes of five elderly women, the mean frequencies of nuclei hyperdiploid and hypodiploid for the X chromosome were not significantly affected by culturing the cells or by cytokinesis block. In cultured binucleate lymphocytes of two age groups of men, the X chromosome showed significantly higher mean frequencies of hyperdiploidy, hypodiploidy and reciprocal gain and loss than the Y chromosome. Reciprocal gain and loss of the Y chromosome was statistically significantly higher in the older than the younger men. In four women, studied in the same series, the rates of X chromosome aneuploidy did not significantly differ from those obtained in men. In conclusion, malsegregation of the X chromosome is common in lymphocytes of both men and women and more frequent than Y chromosome malsegregation. However, there is no clear sex difference for X chromosome reciprocal gain and loss. This would suggest that the high loss of the X chromosome in women, documented in metaphase studies, is due to micronucleation.

Hyperosmotic perfusion of the beating rat heart and the role of the Na+/K+/2Cl- co-transporter and the Na+/H+ exchanger.

The aim of the present study was to investigate the role of the Na+/K+/2Cl- co-transporter and the Na+/H+ exchanger on contractile function and electrolyte regulation during hyperosmotic perfusion of the heart. Langendorff perfused rat hearts were subjected to hyperosmolal perfusion in 10-min intervals. Perfusates were made hyperosmotic by adding mannitol to the buffer (370, 450 and 600 mOsmol/kg H2O). Cardiac contractile function was monitored with a balloon in the left ventricle (LV) coupled to a pressure transducer. Cardiac effluent was sampled repeatedly throughout and after hyperosmotic perfusion and analysed for content of Na+, K+, and Cl-. All three hyperosmotic perfusates initially reduced LV developed pressure (LVDP), but for 370 and 450 mOsmol/kg H2O, LVDP recovered to baseline within 4 min of perfusion. With 600 mOsmol/kg H2O, LVDP recovered slowly and was 50% below baseline after 10 min of hyperosmotic perfusion. Inhibition of the Na+/H+ exchanger with 5-(N-ethyl-N-isopropyl) amiloride (EIPA) and 3-methylsulfonyl-4-piperidinobenzoyl-guanidine methanesulfonate (HOE 694) abolished the recovery of LVDP to the 600 mOsmol/kg H2O perfusate, whereas inhibition of the Na+/K+/2Cl- co-transporter had no impact on LVDP. Potassium was taken up by the heart during hyperosmotic perfusion and this uptake was significantly reduced with inhibition of the Na+/H+ exchanger. Intracellular pH was assessed with 31p magnetic resonance spectroscopy and hyperosmolality induced a significant alkalosis that was dependent upon the Na+/H+ exchanger. The rat heart responds to moderate elevations in osmolality with a transient reduction in contractile function, whereas an elevation of 300 mOsmol/kg H2O persistently reduces contractile function. The Na+/H+ exchanger, but not the Na+/K+/2Cl- co-transporter, is of importance in contractile recovery and electrolyte regulation during hyperosmotic perfusion in the rat heart.

The X chromosome frequently lags behind in female lymphocyte anaphase.

Pancentromeric FISH and X-chromosome painting were used to characterize anaphase aberrations in 2,048 cultured lymphocytes from a healthy 62-year-old woman. Of 163 aberrant anaphases, 66.9% contained either chromosomes or their fragments that lagged behind. Characterization of 200 laggards showed that 49% were autosomes, 33. 5% were autosomal fragments, and 17.5% were X chromosomes. The X chromosome represented one-fourth of all lagging chromosomes and was involved much more often than would be expected by chance (1/23). Labeling of the late-replicating inactive X chromosome with 5-bromo-2'-deoxyuridine revealed that both X homologues contributed equally to the laggards. Among 200 micronuclei examined from interphase cells, the proportion of the X chromosome (31%) and autosomal fragments (50%) was higher than among anaphase laggards, whereas autosomes were involved less often (19%). These findings may reflect either selection or the fact that lagging autosomes, which were more proximal to the poles than were lagging X chromosomes, were more frequently included within the main nucleus. Our results suggest that the well-known high micronucleation and loss of the X chromosome in women's lymphocytes is the result of frequent distal lagging behind in anaphase and effective micronucleation of this chromosome. This lagging appears to affect the inactive and active X chromosomes equally.

Protective effects of repetitive injections of radiographic contrast media on the subsequent tolerance to ischemia in the isolated rat heart.

PURPOSE: Despite detailed knowledge of the effects of X-ray contrast media on cardiac function, no studies have examined the effect of contrast media injections on the subsequent tolerance to ischemia in the heart. METHODS: Isolated perfused rat hearts were exposed to repetitive injections of iohexol, iodixanol, or ioxaglate before 30 min of global ischemia and 120 min of reperfusion. These groups were compared with control (no pretreatment) and ischemic preconditioning known to reduce infarct size. Physiologic variables and infarct size were measured RESULTS: Pretreatment with iodixanol reduced infarct size significantly compared with control and thus afforded protection against ischemia. Injections with iohexol and ioxaglate reduced infarct size, although not significantly, compared with control. CONCLUSION: Pretreatment of the isolated rat heart with commonly used contrast media enhances the cardiac tolerance to subsequent ischemia. The mechanism behind this protective effect could not be determined, but could involve stretching of the heart and/or generation of nitric oxide.

Effect of magnesium infusion on bleeding time in healthy male volunteers.

Intravenous magnesium has proved to be valuable in the treatment of cardiac arrhythmias and eclampsia, but the specific mode of action is not established. In this study the effect of magnesium sulphate (MgSO4) infusion on bleeding time and endogenous prostacyclin (PGI2) production in healthy male volunteers was investigated. Thirty-five males (age 18-30 years) randomized in a double-blind, placebo-controlled, cross-over study were investigated. MgSO4 was given as a bolus (8 mmol, 12 min) followed by continuous infusion (8 mmol in 108 ml saline, 120 min). Control was equal volumes of physiological saline. Heart rate, blood pressure and bleeding time (according to Ivy) were recorded as well as blood concentrations of magnesium and creatinine. Urine PGI2 was analysed as the stable metabolite 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha). Treatment with MgSO4 did not affect bleeding time (MgSO4; 8.4+/-3.5 vs. control 8.0+/-2.7 min) nor the production of PGI2 (MgSO4; 1.2 microg 6-keto-PGF1alpha/g creatinine vs. control; 1.1 microg 6-keto-PGF1alpha/g creatinine). Intravenous infusion of MgSO4 does not affect the PGI2/platelet axis in healthy male volunteers. Studies in patients with endothelium dysfunction and/or concomitant drug therapy are required before the anti-thrombogenic effect of MgSO4 in vivo is discarded.

[Self-assessment of clinical skills among medical trainees when entering internship during the spring seasons 1998]. / Laegers vurdering af deres kliniske faerdighedsniveau ved påbegyndelse af turnus i foråret 1998.

The aim of this study is to identify medical trainees' level of self-reported clinical skills when entering internship. A questionnaire was sent to 124 trainees, who were about to enter their internship. The questionnaire included 88 questions on clinical skills, asking the trainees to rate their level of mastership on a Visual Analogue Scale from zero to ten, 0 = not mastering and 10 = mastering. In total one hundred (81%) returned the questionnaire. There is considerable variation in the self reported acquisition of clinical skills in many of the procedures. In some basic procedures most trainees showed a rather high level of mastership, above 7.5, but in other basic procedures about half of the candidates report a level of mastership below 5.0. A more thorough specification of objectives for practical skills would make it easier to plan an effective and efficient training during internship.

[Self-reported skills in practical procedures among young physicians]. / Unge legers selvrapporterte praktiske ferdigheter.

There is at present no consensus as to which clinical procedures a student should be able to perform after graduation. The present study was undertaken to evaluate the self-reported skills level in practical procedures among graduates from the medical schools in Norway. A questionnaire was mailed to all students who entered internship between July 1996 and January 1998. They were asked to indicate on a visual-analogue scale the level of skill he or she had acquired in 88 practical clinical procedures. 519 of 621 (84%) graduates replied; 89% started internship immediately after graduation. Graduates from Tromsø reported significantly better skills than graduates from Oslo and Bergen. There was considerable variation within and between the universities with respect to several procedures. Overall, men reported a significantly better skills level than their female colleges. The present study demonstrates that the skills level in several procedures vary considerably between candidates graduating from different Norwegian universities after undergraduate medical education. For some procedures the skills level is, in our opinion, disquietingly low. The results of this survey indicate that teaching of clinical procedures in medical school is often random and of inferior quality. There is a need for a systematic approach and a national consensus on the clinical procedures to be acquired and the levels of skills to be attained.

Cardiac contractile function and electrolyte regulation during hyperosmolal stress: an experimental study in the isolated rabbit heart.

Perturbations of the extracellular osmotic environment leads to cell volume changes. The aim of the present study was to evaluate the effects of hyperosmolality on cardiac contractile function and in particular the role of ionic mechanisms anticipated to be operative during hyperosmolal exposure. Paced rabbit hearts were perfused in the Langendorff mode and were exposed to 330, 370, 410, 450 and 600 mOsm kg-1 in 10 min. intervals intervened by 15 min. isosmolal buffer perfusion (by adding mannitol). Thereafter, 370 and 600 mOsm kg-1 perfusates were chosen for investigation of the effects of inhibition of the Na-K-2Cl co-transporter (bumetanide 1 microM and 10 microM), the Na+/H+ exchanger (5-(N-ethyl-N-isopropyl amiloride (EIPA) 100 nM) and the Na+/K(+)-ATPase (ouabain 50 nM). After a rapid and transient decrease in left ventricular developed pressure, all perfusates up to 450 mOsm kg-1 increased LVDP. The 600 mOsm kg-1 perfusate initially reduced LVDP by 50%, but LVDP increased to 85% of initial value at the end of the 10 min. perfusion. EIPA attenuated the recovery of LVDP during perfusion with 600 mOsm kg-1, whereas bumetanide did not affect cardiac contractile function. A net uptake of potassium was observed during hyperosmolal perfusion. Inhibition of the Na+/H+ exchanger resulted in a continued release of cardiac water throughout hyperosmolal perfusion. Isolated perfused rabbit hearts tolerate considerable elevations in perfusate osmolality. Our results suggest that the Na+/H+ antiporter is activated on hyperosmolal exposure with a secondary activation of the Na+/K(+)-ATPase. Since inhibition with bumetanide did not affect contractility or electrolyte movements, the Na-K-2Cl co-transporter does not seem to play an important role in cardiac response to hyperosmolality in rabbits.

Micronuclei in blood lymphocytes and genetic polymorphism for GSTM1, GSTT1 and NAT2 in pesticide-exposed greenhouse workers.

The frequency of micronuclei (MN) in cultured peripheral lymphocytes was used as a biomarker of genotoxic effects in 34 Italian pesticide-exposed greenhouse workers and 33 unexposed referents matched with the exposed workers for age and smoking habits. The possible influence of the genetic polymorphisms of xenobiotic metabolizing enzymes glutathione S-transferase M1 (GSTM1), T1 (GSTT1), and N-acetyltransferase 2 (NAT2) was also evaluated. To restrict the analysis primarily to cells that have divided once in vitro, MN were scored only in cells showing label after a 42-h incubation with bromodeoxyuridine (BrdU), as detected by immunofluorescence (anti-BrdU technique). Two different concentrations of BrdU (0.5 and 1 microg/ml) were compared. Individual frequencies of micronucleated cells (MNCs) obtained with the two concentrations of BrdU significantly correlated with each other (r=0.55, P<0.001). Higher mean MNCs frequencies (per 1000 cells) were detected among exposed smokers (9.0 at 0.5 microg/ml BrdU and 7.8 at 1 microg/ml BrdU) than in smoking referents (6.3 and 5.9, respectively). In multiple regression analysis controlling for age, sex, smoking and genotypes, a significant elevation of MNC frequency (P=0.004 at 1 microg/ml BrdU; P=0.052 at 0.5 microg/ml BrdU) was observed in greenhouse workers with a work history of extensive pesticide spraying (n=17). Increased MNC frequencies were also associated with ageing at 0.5 microg/ml BrdU, with the GSTM1-positive genotype at both 1 (P=0.028) and 0.5 (P=0.056) microg/ml BrdU in all subjects, and with the NAT2 fast acetylator genotype in smokers at 0.5 microg/ml BrdU (P=0.043). The results indicate that MN rates are increased in greenhouse workers, especially in those involved in pesticide spraying. The GSTM1 positive and NAT2 fast genotypes appear to be associated with elevated MNC frequencies, which contradicts with earlier results on elevated chromosomal aberration rates in GSTM1 null smokers and NAT2 slow subjects.

Hyperosmotic pretreatment reduces infarct size in the rat heart.

Preconditioning of the heart can be achieved by an ischemia/reperfusion stimulus, but also by stretching of the heart by an acute volume overload. Since manipulations of the extracellular osmolality affects cell size, we hypothesized that hyperosmotic pretreatment of the isolated perfused rat heart could reduce infarct size following regional ischemia (RI). Langendorff perfused rat hearts were subjected to 30 min RI by ligature of the main branch of the left coronary artery followed by 120 min reperfusion (control group). Ischemic preconditioning (IP-5') was achieved by 5 min total global ischemia and 5 min reperfusion prior to RI. Hyperosmotic pretreatment was accomplished by perfusion with a hyperosmotic buffer (600 mOsm/kg H2O by adding mannitol) for 1 min, 2 min or 5 min. At the end of the experiments, the hearts were cut into 2 mm slices, incubated with triphenyltetrazoliumchloride before scanning and computerized for estimation of infarct size. The average infarct size (as percentage of area at risk) in the control group was 42% and was significantly reduced to 16% by ischemic preconditioning and to 17% by 2 min hyperosmotic pretreatment. Neither 1 min nor 5 min hyperosmotic pretreatment reduced infarct size as compared to the controls. The infarct reducing effect of 2 min hyperosmotic pretreatment was not blunted by inhibition of protein kinase C (chelerytrine chloride), the Na+/H+-exchanger (HOE 694) or stretch-activated anion channels (gadolinium chloride). The results indicate that short-lasting hyperosmotic perturbations of the extracellular environment may precondition the heart to a subsequent ischemic insult.

Tolerance and efficacy of interfering alpha-streptococci in recurrence of streptococcal pharyngotonsillitis: a placebo-controlled study.

A total of 342 patients with clinical signs of tonsillitis and suspected group A beta-haemolytic streptococci (GAS) aetiology, verified with rapid test and GAS culture, were enrolled in a randomized, placebo-controlled, double-blind, multicentre study. They received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococcal or placebo spray treatment in the ratio of 2 : 1. Pharyngeal status, throat culture and adverse events were investigated up to 75 days after treatment. The frequency of bacteriologically verified clinical recurrence was 13% in the alpha-streptococcal group and 15% in the placebo group at the follow-up on day 22. The corresponding figures at the last valid visit after 45-75 days were 19% and 30%, respectively, a statistically significant difference (p = 0.037). Furthermore, at the last valid visit 5% of subjects in the alpha-streptococcal and 12% in the placebo group were healthy carriers, bacteriological treatment failures, of GAS (p = 0.029). Treatment with alpha-streptococci and placebo spray were equally well tolerated. Thus, re-colonization with alpha-streptococci seem to hinder late recurrences of GAS pharyngotonsillitis.

Association of Chlamydia pneumoniae with otitis media in children.

Chlamydia pneumoniae is a common cause of acute and persistent respiratory tract infections. The prevalence of C. pneumoniae was studied using the polymerase chain reaction (PCR) in throat swabs from 85 consecutive children with respiratory tract infections and 86 healthy children. In retrospect, it became evident that this study was conducted in the midst of a local C. pneumoniae epidemic. 38 (45%) of the sick children and 5 (5.7%) of the healthy children were positive for C. pneumoniae by PCR. 26 of the sick children (mean age 6.4 years) were found to have otitis media either at the time of examination or shortly thereafter. Six of 9 children with acute otitis media were PCR positive for C. pneumoniae and 7 of the 9 had specific antibody responses indicating active infection. 10 of 17 children diagnosed as having otitis media with effusion were found to be positive for C. pneumoniae by PCR. Seven children had or developed persistent otitis media with effusion. Chlamydia pneumoniae was demonstrated by PCR from the middle ear fluid in 1 of the children. The results obtained from this study indicate that C. pneumoniae may be involved in the aetiology of otitis media.

Recurrence rate of streptococcal pharyngitis related to hygienic measures.

OBJECTIVE: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes. DESIGN: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families. Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month. At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home. Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys. SETTING: Six health care centres. SUBJECTS: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members. MEASUREMENTS AND MAIN RESULTS: 54 patients/families received hygiene instructions. The total number of recurrences was 40 (35%). There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures. CONCLUSIONS: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis.