Enhanced Intimal Proliferation upon Injury to Pre-Existing Neointima and Resistance of Neointimal Cells to Cell Death

Recent evidence supports a role for cell death and inflammation as etiologic factors in neointimal formation and restenosis after angioplasty. This study was undertaken to examine the pattern and intensity of the proliferative response, cell death, and activation of inflammatory, endothelial and smooth muscle cells (SMC) in a model of intimal reinjury. Two ballooning injuries were performed to rat aorta, the second one 14 days after the first injury. Our results demonstrate that ballooning injury to pre-existing neointima differs clearly from an injury to a normal aorta. First, ballooning injury to pre-existing neointima doubled the proliferative response of SMC and intimal thickening, but proliferation of SMC occurred only in the intima, and did not extend into the media. Second, within four hours after the first injury, the number of TUNEL-positive SMC in the media increased from 3% to 23%, but no such increase was found in the pre-existing neointima after the second injury. Third, the prompt proliferative response of intimal SMC after the second injury was linked with a significant increase in endothelial P-selectin and neointimal VCAM-1 immunoreactivity, compared to the first injury at corresponding time points, followed by high numbers of activated ED3+ macrophages and CD4+ T cells in the developing neointima. A balance in injury-induced cell death and proliferation obviously maintains stable cell numbers observed in the media, whereas in the neointima, the resistance of SMC to injury-induced cell death may contribute to a rapid lesion formation in restenosis.     

Immune responses to borrelial VlsE IR6 peptide variants

Laboratory confirmation of Lyme borreliosis (LB) relies mainly on the demonstration of anti-borrelial antibodies. In recent studies, a novel VlsE protein IR₆ peptide-based assay has been introduced. Our aim was to evaluate the IR₆ peptides from three Borrelia burgdorferi sensu lato genospecies in the serodiagnosis of European and North American patients. Five VlsE protein IR₆ peptide variants representing sequences from B. burgdorferi sensu stricto, B. garinii, and B. afzelii were used as antigens in both IgG and IgM enzyme-linked immunosorbent assays (ELISA). Serum antibodies of 187 patients at different stages of LB from Europe and the United States were evaluated for serodiagnosis. For comparison samples were tested with one of the commercial IR₆ ELISAs. Three B. afzelii IR₆ variant peptides revealed antibodies that were concordant with each other. B. burgdorferi sensu stricto peptide antibodies mostly paralleled B. afzelii peptide antibodies, and positive values were also obtained in the majority of European sera. For several sera, B. garinii IR₆ peptide antibodies were discordant to B. afzelii peptide antibodies. The commercial IR₆ peptide antibody assay (C6 ELISA) results correlated better with B. burgdorferi sensu stricto IR₆ than with B. garinii IR₆ peptide IgG results, especially in sera from patients with facial palsy. Thus, antibody specificity to IR₆ peptides may vary according to the infecting Borrelia species. In some manifestations of the disease, C6 ELISA may not cover all LB cases. Evidently, the methodological aspects in ELISA design for peptide antibody measurements are important as well as the amino acids sequence of the antigen.     

Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea–hypopnea index

Sleep apnea–hypopnea syndrome (SAHS) causes impairment of daytime functions and increases risk of cardiovascular diseases. Apnea–hypopnea index (AHI), currently used for the estimation of the severity of SAHS, does not contain information on the morphology or duration aspects of the breathing cessations and related oxygen desaturations. Longer breathing cessations and deeper desaturations may have more severe consequences than shorter and shallower ones. To address these issues, novel parameters containing information on the duration and morphology of breathing cessations and oxygen desaturations were calculated and evaluated on 160 male patients (40 patients in normal, mild, moderate and severe AHI severity categories). Obstruction and desaturation duration parameters consist of sum of event durations normalized with the total analysed time. Desaturation severity is a sum of desaturation event areas normalized with total analysed time and obstruction severity parameter is a sum of the products of apnea and hypopnea durations and related desaturation areas normalized with total analysed time. The median follow-up time of the patients was 183 months (range 154–215 months). The 40 patients in each category were further divided into subgroups A and B with lowest and highest novel parameter values, respectively. AHI showed no differences between the subgroups. Mortality was increased in subgroups B compared to subgroups A. The correlation of the novel parameters with AHI was only moderate and the parameter values were partially overlapping between the AHI severity categories. This suggests that patients with similar AHI may in fact suffer from SAHS of very different severity. Thus, the present results suggest that the novel parameters could bring new insight to the individual estimation of the severity of SAHS.     

Synthesis and characterization of new dimethacrylate monomer and its application in dental resin

In this study, a dimethacrylate monomer, 1,4-Bis[2-(4-(2′-hydroxy-3′-methacryloyloxy-propoxy)phenyl)-2propyl]benzene (BMPPB) was synthesized to replace 2,2-bis[4-(2′-hydroxyl-3′-methacryloyloxy-propoxy)phenyl]propane (Bis-GMA) as one component of dental restorative materials. The structure of BMPPB and its intermediate product 1,4-bis[2-(4-(oxiranylmethoxy)phenyl)-2propyl]benzene (BOPPB) were confirmed by Fourier transform infrared (FTIR) spectroscopy, proton nuclear magnetic resonance spectroscopy (¹H-NMR), and elemental analysis. In order to evaluate the possibility of replacing Bis-GMA with BMPPB in dental resin, double bond conversion (DC), polymerization shrinkage, contact angle, water sorption (WS) and solubility (SL), and flexural strength (FS) and modulus of BMPPB/tri(ethylene glycol)dimethacrylate (TEGDMA) (50/50?wt) resin system and Bis-GMA/BMPPB/TEGDMA (25/25/50?wt) resin system were studied. Commercially used Bis-GMA/TEGDMA (50/50?wt) dental resin system was used as reference. The results showed that BMPPB-contained copolymer had higher DC, higher WS and SL than the copolymer that only contained Bis-GMA (p?<?0.05). All of the copolymers had nearly the same contact angle (p?>?0.05). BMPPB/TEGDMA resin system had lower polymerization shrinkage, higher FS and modulus (p?<?0.05) than Bis-GMA/TEGDMA resin system. There was no significant difference on polymerization shrinkage, FS and modulus (p?>?0.05) between Bis-GMA/BMPPB/TEGDMA resin system and Bis-GMA/TEGDMA resin system. Before and after water immersion, both FS and modulus of every copolymer did not change significantly (p?>?0.05). Therefore, BMPPB had potential to be used to replace Bis-GMA as base resin in dental restorative materials, but many studies should be undertaken further.     

Neuropeptide Y polymorphism and alcohol consumption in middle‐aged men

Neuropeptide Y (NPY) plays an important role in the hypothalamic regulation of food intake and energy balance. According to recent findings in animals, NPY also seems to be a potent regulator of alcohol consumption. We used the recently identified Leu(7) to Pro(7) polymorphism in the signal peptide part of NPY to investigate whether the NPY system is associated with alcohol consumption in humans. The subjects (N = 889) were an ethnically homogenous, nonselected population sample of middle‐aged men from Eastern Finland. The gene variant producing Pro(7) substitution was associated with a 34% higher average alcohol consumption, even after adjustment for a number of covariates (P = 0.03). The proportion of heavy drinkers (over 230 g of ethanol/week) was also somewhat higher in this group (13.1% vs. 8.2%, P = 0.10). Our study provides the first evidence that alcohol preference in humans is likely to be regulated by the NPY system. Am. J. Med. Genet. 93:117–121, 2000. © 2000 Wiley‐Liss, Inc.     

A population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage

Background and Purpose

The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study.

Methods

We identified all subjects with primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland. Hematoma evacuation was carried out by using standard craniotomy or through a burr hole. We compared mortality rates and functional outcomes of patients with hematoma evacuation with those treated conservatively.

Results

Of 982 patients with verified ICH during the study period, 127 (13%) underwent hematoma evacuation. Surgically treated patients were significantly younger (mean ± SD, 63 ± 11 vs. 70 ± 12 years; p < 0.001), had larger hematomas (66 ± 36 vs. 28 ± 40 ml; p < 0.001), lower Glasgow Coma Scale scores (median, 11 vs. 14; p < 0.001) and more frequently subcortical hematomas (68% vs. 24%; p < 0.001) than those treated conservatively. In multivariable analysis, hematoma evacuation independently lowered 3-month mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43–0.88; p < 0.03), particularly among patients aged ≤70 years with ≥30 ml supratentorial hematomas (adjusted HR, 0.26; 95% CI, 0.14–0.49; p < 0.001). However, poor outcome was not improved by surgery (adjusted odds ratio 0.71; 95% CI 0.29–1.70).

Conclusions

Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged ≤70 years with ≥30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.     

Occurrence of chronic disease in former top-level athletes. Predominance of benefits,risks or selection effects?

Former elite athletes from most sports disciplines have lower overall morbidity risk and enjoy better self-rated health in later years compared with the general population and matched controls who were healthy at young age. This is seen particularly among former endurance athletes who have a lower incidence of coronary heart disease and type 2 diabetes mellitus. Most often data are available only for men. Based on the available data, participation in elite sports cannot be regarded as an overall health hazard. However, aside from a high risk of acute injury in specific sports, possible negative effects of long-standing athletic activity on the development of osteoarthritis should not be neglected. It should also be remembered that elite athletes are a biologically and genetically select group who are not representative of the population at large. Given the nature of the available data, the possible health consequences of recent changes in different characteristics of sports, such as training practices, professionalism and use of doping, cannot be properly predicted.     

The incidence of pelvic fractures and related surgery in the Finnish adult population: a nationwide study of 33,469 patients between 1997 and 2014

Background and purpose — Information on the epidemiological trends of pelvic fractures and fracture surgery in the general population is limited. We therefore determined the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and assessed the incidence and trends of fracture surgery.Patients and methods — We used data from the Finnish National Discharge Register (NHDR) to calculate the incidence of pelvic fractures and fracture surgery. All patients 18 years of age or older were included in the study. The NHDR covers the whole Finnish population and gives information on health care services and the surgical procedures performed.Results and interpretation — We found that in Finnish adults the overall incidence of hospitalization for a pelvic fracture increased from 34 to 56/100,000 person-years between 1997 and 2014. This increase was most apparent for the low-energy fragility fractures of the elderly female population. The ageing of the population is likely therefore to partly explain this increase. The annual number and incidence of pelvic fracture surgery also rose between 1997 and 2014, from 118 (number) and 3.0 (incidence) in 1997 to 187 and 4.3 in 2014, respectively. The increasing number and incidence of pelvic fractures in the elderly population will increase the need for social and healthcare services. The main focus should be on fracture prevention.

Pelvic fractures range from minor to major trauma and constitute about 3% to 8% of all fractures treated in hospitals (Court-Brown and Caesar 2006). The incidence of pelvic fractures has varied from 17 to 364/100,000 person-years (Melton et al. 1981, Ragnarsson and Jacobsson 1992, Lüthje et al. 1995, Kannus et al. 2000, Balogh et al. 2007, Andrich et al. 2015, Kannus et al. 2015, Verbeek et al. 2017). This wide range in incidence rates can be explained by different study populations with varying age, and by variations in study designs and follow-up periods. In previous studies, the incidence (n/100,000 person-years) of pelvic fractures was in the United States 37 between 1968 and 1977 (Melton et al. 1981), in Sweden 20 between 1976 and 1985 (Ragnarsson and Jacobsson 1992), in Finland 24 in 1988 (Lüthje et al. 1995), in the Finnish population aged 60 years or older 20 in 1970 and 92 in 1997 (Kannus et al. 2000), in Australia 23 between 2005 and 2006 (Balogh et al. 2007), in the German population aged 60 years or older 22 between 2008 and 2011 (Andrich et al. 2015), in the Finnish population aged 80 years or older 73 in 1971 and 364 in 2013 (Kannus et al. 2015) and in the Netherlands 14 between 2008 and 2012 (Verbeek et al. 2017).In the 80 years and older population, the incidence of low-energy pelvic fractures seems to be increasing (Kannus et al. 2015). Indeed, between 1997 and 2014, the incidence of acetabular fractures, especially low-energy acetabular fractures, rose in Finland (Rinne et al. 2017), whereas the incidence of high-energy acetabular fractures remained at the same level. Notably, since 1997, the incidence of many other fall-related low-energy fractures, such as hip fractures, has decreased in Finland (Korhonen et al. 2013, Kannus et al. 2018).Most pelvic fracture studies concentrate on surgical treatment, even though the majority of these fractures can be treated nonoperatively (Osterhoff et al. 2019, Tornetta et al. 2019). Unstable and dislocated pelvic fractures often need surgery, while stable, non-displaced, or minimally displaced fractures, mostly occurring in elderly people after a simple fall, can usually be treated nonsurgically. At present, however, there is only limited information available regarding the incidence and trends of pelvic fracture surgery in the general population.We assessed the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and the incidence and trends of pelvic fracture surgery.     

Pulmonary artery blood temperature at admission to the intensive care unit is predictive of outcome after on-pump coronary artery bypass surgery

OBJECTIVE: To evaluate whether pulmonary artery blood (PA) temperature on admission to the intensive care unit (ICU) is predictive of postoperative outcome after isolated on-pump coronary artery bypass grafting (CABG). DESIGN: A retrospective study on 1639 patients who underwent isolated on-pump CABG in whom PA temperature at admission to the ICU was available for review. RESULTS: Thirty-three patients (2.0%) died during the in-hospital stay and 87 patients (5.3%) developed low cardiac output syndrome. PA temperature at admission to the ICU was significantly associated with an increased risk of overall postoperative death (p = 0.002), cardiac death (p = 0.03), and low cardiac output syndrome (p < 0.0001), and was significantly correlated with prolonged length of ICU stay (p < 0.0001) and postoperative bleeding (p = 0.001). Patients with high PA temperature had significantly more severe comorbidities, and longer aortic cross-clamping and cardiopulmonary bypass time. The receiver operating characteristic curve showed that PA temperature at admission to the ICU in predicting postoperative death had an area under the curve of 0.660 (p = 0.002) and its best cut-off value was 36.4 degrees C (sensitivity: 63.6%, specificity: 65.2%). When the PA temperature at admission to the ICU was > or = 36.4 degrees C, the postoperative mortality and low cardiac output syndrome rates were 3.6 and 8.3%, whereas they were 1.1 and 3.7% when the PA temperature at admission to the ICU was < 36.4 degrees C (p = 0.001, p < 0.0001), respectively. CONCLUSION: Patients having a PA temperature > or =36.4 degrees C at admission to the ICU after CABG seem to be at higher risk of poor postoperative outcome.