The Swedish National Cataract Register: A 9-year review

The Swedish National Cataract Register (NCR) has been collecting data on cataract extractions in Sweden since 1992. This unique national database now contains data pertaining to more than 400 000 operations, representing 93.4% of all operations performed nationwide during 1992-2000. Clinic participation in the NCR is voluntary. Tests have shown NCR data to be extremely reliable, while the participation of nearly all providers of cataract surgery in Sweden makes the data highly representative of cataract surgery throughout the country. The NCR collects pre- and per-operative data for every cataract extraction performed at participating clinics. Surgical outcome data and data about patients' self-assessed visual function is collected in approximately 10% of cases. Since 1998, all cases of suspected postoperative endophthalmitis have also been reported to the NCR. The rate of surgery has increased from 4.47 to 7.26 per 1000 inhabitants during the period. Female subjects have constituted about 66% of all operated subjects each year and the mean age of patients has slowly increased from 75.2 to 76.1 years. Average pre-operative visual acuity has improved each year. Second eye surgery has increased from 28.5% to 36.8% of all surgeries. Phacoemulsification has reached 98% as type of surgery (in 2000) and 92.7% of all intraocular lenses are foldable. Surgical outcome has improved by achieving a final refraction closer to the target refraction and less surgically induced astigmatism. The positive impact of cataract surgery in very elderly people has been demonstrated, as has the positive effect of second eye surgery, especially in young subjects. The NCR has served to enhance knowledge about trends and results of cataract surgery in Sweden. This review article describes some of the activities carried out and their results.     

A remote auscultation tool for advanced home health-care

We have developed an Internet-based tool for remote realtime auscultation. The device was based on a commercially available electronic stethoscope and a PC which digitized and transmitted the signals. A voice and video channel were also available. The remote auscultation tool was evaluated between two sites in Sweden separated by a distance of 500 km. A doctor at one of the sites performed cardiac and pulmonary auscultations on patients located at the other site. Four test patients were assisted by a nurse operating the electronic stethoscope. The auscultation sessions were performed with and without video support to assess the importance of visual contact between doctor and patient. Twenty sessions were conducted (excluding technical testing to solve problems with the equipment). Audio quality was sufficient, as judged subjectively by the doctors concerned. Video support improved the doctor s confidence that the stethoscope was being operated properly and greatly simplified the interaction. Moreover, it improved all participants subjective impression of the virtual meeting. Our work demonstrates the feasibility of performing remote auscultation sessions over the Internet.     

A new index approach to measure lost benefits from progression to blindness

OBJECTIVES: An index approach for measuring the reduction in daily activities of patients suffering from an eye disease associated with progressive visual loss is proposed. The approach is illustrated using data collected from patients with cataract. METHOD: The approach uses recently developed methods based on index theory together with measurements of daily activities. In a simulation based on observations of visual acuity and daily activities in patients with cataract, indexes of changes in benefits were estimated for varying levels of visual acuity. RESULTS: Results show the development of loss in benefits resulting from a progressive deterioration in visual acuity. The results indicate a 40% loss in benefits at low levels of visual acuity, equivalent to a potential increase in benefits of 75% for these individuals following successful treatment. CONCLUSIONS: The proposed index approach may prove useful for measuring reductions in daily activities resulting from the progressive loss of vision in eye disease. The approach has successfully measured the reduction in daily activities in patients with cataract and may be applicable in patients with other eye diseases, including age-related macular degeneration and open-angle glaucoma.     

No Prognostic Importance of Resistance to Activated Protein C in Unstable Coronary Artery Disease Despite Signs of Thrombin Activation

Resistance to activated protein C (APC resistance) is the single most important hemostatic defect associated with venous thromboembolic disease. However, little is known about this defect in arterial disease. The aim of this study was thus to investigate the frequency and prognostic importance of APC resistance and its influence on the coagulation system in one type of arterial thrombosis. In this study, 323 patients admitted to hospital because of unstable coronary artery disease, that is, unstable angina pectoris or non-Q-wave myocardial infarction, were investigated and compared with a reference group of apparently healthy individuals. The patients participated in a prospective, multicenter, randomized, and placebo-controlled investigation evaluating the protective value of low molecular weight heparin (dalteparin) in unstable coronary artery disease. The APC ratio was assayed using a modified activated partial thromboplastin time reaction method to measure the response to activated protein C. APC resistance was defined as an APC ratio 2.2. Signs of thrombin activation were measured by prothrombin fragment 1+2 levels. The 7.2% (23/318) occurrence of APC resistance found in patients did not differ from the 5.8% (4/69) level in the reference population (P = 0.16). A significant elevation of the prothrombin fragment 1+2 median level of 2.5 nM (interquartile range, 1.9-3.2 nM) was found in the patients with APC resistance compared with 1.7 nM (interquartile range, 1.2-2.4 nM) in the group with a normal APC ratio (P < 0.01). During the 150-day follow-up period, there was no increased risk of cardiac events in patients with APC resistance. Although accompanied by signs of increased thrombin formation, APC resistance does not seem to be an important risk factor for the development of instability in coronary artery disease.     

Characterization of two genome types of adenovirus type 31 isolated in Stockholm during 1987

The authors isolated during 1987 seven adenovirus type 31 (Ad31) within a 9-month period. The isolates were obtained from urine, throat, and feces, implying a systemic spread of the infection. Most patients displayed gastrointestinal symptoms, but some had respiratory symptoms and fever. All of the strains differed by restriction endonuclease analysis from the prototype strain (1315) by an additional Bgl II restriction site. Ad31 isolates 1-6 could be divided into two groups by the enzymes Bam HI, Msp I, and Xho I. Each enzyme gave rise to the same group distribution: isolates 1-3 and 4-6, respectively. Digestion with Bst EII, Hind III, Kpn I, and Sma I resulted in identical patterns for isolates 1-6. Isolate 7, however, demonstrated a DNA deletion of approximately 0.8 kbp, but it was otherwise identical to isolates 4-6. In conclusion, two separate genome types of Ad31 were isolated, one of which included a DNA deletion mutant. The increased isolation rate may reflect an epidemiological situation, as the same isolation procedure had been used both before and after this period.     

Increased Synthesis of Prostaglandins in the Guinea Pig Following Scalding Injury

The urinary excretion in guinea pigs of the major urinary metabolite of prostaglandins E₁ and E₂, viz 5β,7α-dihydroxy-11-ketotetranor-prostanoic acid, was increased 5–9 fold following scalding injury. Lipid extracts of homogenates of scalded guinea pig skin contained 20–40 times more smooth muscle stimulating activity than did extracts of non-scalded skin. Prostaglandins (mainly PGE₂ and PGF_2α) were responsible for about 80% of this activity.     

Habituation and Dishabituation of the Orienting Reaction to Between and Within Trial Changes in Pitch and Loudness

We investigated the effect of between and within trial changes in pitch and loudness on the electrodermal orienting reaction (OR), perceptions of movement, and their interaction. First, following 20 habituation trials (6-s, 80dB, 1000 Hz), four groups of 10 subjects experienced either an increase or a between-trial decrease in pitch (2000 or 500 Hz) or loudness (90 or 70 dB) on the 21st trial. Second, four additional groups of 20 subjects heard 20 tones that, within each 6-s trial, either increased or decreased in pitch (500 to 2000 or 2000 to 500 Hz) or loudness (70 to 90 or 90 to 70 dB). During a dishabituation phase each group was split into halves having a nonchanging tone either increasing or decreasing relative to mean pitch or loudness. After each session subjects rated whether they perceived tones as approaching, retreating, or motionless. Compared with groups experiencing constant stimuli, groups presented tones changing within trials had greater skin conductance responses that habituated slower irrespective of direction of change or its perception. During dishabituation a similar number of subjects dishabituated to a stimulus increase as compared to a decrease irrespective of whether the change was in pitch or loudness. Perceptions of movement treated as an independent variable did not predict habituation or dishabituation of the OR. The results generally support Sokolov, and are discussed in relation to hypotheses presented by Sokolov, O'Gorman, and Bernstein.     

Identification of a novel HLA DRB1 exon 2 sequence,DRB1*1345

Five different haplotypes in the human HLA D region are recognized based on their gene composition. The HLA DR52 associated DRB1 alleles include DRB1*03/08/11/12/13/14 and are characterized by the YST sequence motif in the codons 10-12 but vary in other polymorphic regions. The mechanisms generating the extensive variability are not entirely clear. Some alleles have probably arisen from point mutations, but most polymorphism has probably been caused by intralocus gene conversion, and the distinction between the ancient serologically defined groups is more and more difficult. This report describes the identification of a novel DRB1* allele - DRB1*1345 - found in a kidney transplant recipient from East Africa. The new allele shows the closest resemblance to DRB1*1114 and DRB1*1323. It differs from both those alleles at codons 57, 58 and 60, where the new allele carries the 'A-H' sequence motif common to DRB1*14 alleles such as 1401/04/07/10/16/25. This motif is only found in one other DRB1*13 allele namely DRB1*1343.     

Overexpression of semicarbazide-sensitive amine oxidase in smooth muscle cells leads to an abnormal structure of the aortic elastic laminas

Elevated semicarbazide-sensitive amine oxidase (SSAO) activity has been observed in several human conditions, eg, diabetes, and it has been speculated that SSAO contributes to the development of vasculopathies associated with this disease. To investigate in vivo consequences of elevated expression of SSAO in vascular tissues, we have developed a transgenic model for overexpression of human SSAO in mice. A smooth muscle-specific promoter, smooth muscle alpha-actin promoter 8 (SMP8) was used. Transgenic expression of human SSAO in tissues with a high content of smooth muscle cells was confirmed by Northern blot analysis. Enzymatic analysis of homogenates from transgenic tissues showed elevated levels of SSAO activity compared to non-transgenic littermates. Furthermore, when plasma SSAO activity was analyzed, much higher activity was detected compared to plasma from control mice, indicating that plasma SSAO may originate from smooth muscle cells. Histopathological evaluation of aorta and renal artery from transgenic mice revealed an abnormal structure of the elastin tissue. Instead of the regularly folded elastic laminae normally found in tunica media of sacrificed mice, the elastic laminae were straight and unfolded with irregularly arranged elastic fibers, forming tangled webs, between the intercalating elastic laminae. These alterations of the elastin structures suggest that overexpression of SSAO has led to a reduced elasticity of the arteries. Moreover, the mean femoral arterial pressure of the SMP8 SSAO transgenic mice was significantly lower in comparison to non-transgenic littermates. This suggests that the transgenic mice have a defect in their ability to regulate blood pressure.     

Conserved structure and function in the granulysin and NK-lysin peptide family

Granulysin and NK-lysin are homologous bactericidal proteins with a moderate residue identity (35%), both of which have antimycobacterial activity. Short loop peptides derived from the antimycobacterial domains of granulysin, NK-lysin, and a putative chicken NK-lysin were examined and shown to have comparable antimycobacterial but variable Escherichia coli activities. The known structure of the NK-lysin loop peptide was used to predict the structure of the equivalent peptides of granulysin and chicken NK-lysin by homology modeling. The last two adopted a secondary structure almost identical to that of NK-lysin. All three peptides form very similar three-dimensional (3-D) architectures in which the important basic residues assume the same positions in space. The basic residues in granulysin are arginine, while those in NK-lysin and chicken NK-lysin are a mixture of arginine and lysine. We altered the ratio of arginine to lysine in the granulysin fragment to examine the importance of basic residues for antimycobacterial activity. The alteration of the amino acids reduced the activity against E. coli to a larger extent than that against Mycobacterium smegmatis. In granulysin, the arginines in the loop structure are not crucial for antimycobacterial activity but are important for cytotoxicity. We suggest that the antibacterial domains of the related proteins granulysin, NK-lysin, and chicken NK-lysin have conserved their 3-D structure and their function against mycobacteria.