Olle Nilsson

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting one of the two main types of splitter.

The gangliosides in six colorectal and two pancreatic carcinomas were examined. Their concentration in the primary tumour and the metastases was 5-10 fold higher than in normal colon mucosa. This increase involved the simple gangliosides, GM3 and GD3, as well as complex mono- and disialogangliosides. Some complex monosialogangliosides were detected in all the colorectal and pancreatic carcinomas but neither in normal colon mucosa and pancreas nor in kidney and lung carcinomas.

A method was developed for the determination of cerebrosides in 1 ml of plasma or 1 ml of packed erythrocytes. At least 90% of the cerebroside fraction consisted of glucosylceramide. In the erythrocytes, nothing but glucosylceramide was identified. The method was applied to plasma samples from 25 controls, 34 Gaucher Type III obligate carriers, 16 Gaucher Type III patients, 7 Gaucher Type I patients and 7 patients with myelogenous or lymphatic leukemia, as well as to erythrocyte samples from 20 controls, 6 Gaucher Type III obligate carriers, 16 Gaucher Type III patients and 6 Gaucher Type I patients. The concentration of plasma cerebroside was 11.4 +/- 4.2 (S.D.) in controls, 11.8 +/- 2.6 in Gaucher Type III carriers, 30.4 +/- 7.7 in Gaucher Type III patients and 21.8 +/- 6.7 mumol/l in Gaucher Type I patients. The Gaucher patients had significantly increased (p less than 0.001) plasma cerebroside values, while the plasma cerebroside concentration of the leukemic patients was only s...

Monoclonal antibodies were raised against prostate-specific antigen (PSA) by immunization with purified free PSA, i.e. not in complex with any protease inhibitor (F-PSA) and PSA in complex with alpha1-anti-chymotrypsin (PSA-ACT). Epitope mapping of PSA using the established monoclonal antibody revealed a complex pattern of independent and partly overlapping antigenic domains in the PSA molecule. Four independent antigenic domains and at least three partly overlapping domains were exposed both in F-PSA and in the PSA-ACT complex, while one antigenic domain was specific for F-PSA. The different domains contained both continuous and discontinuous epitopes. The combination of antibodies recognizing antigenic domains exposed both in F-PSA and PSA-ACT made it possible to develop several highly sensitive sandwich immunoassays for determination of total PSA, i.e. F-PSA + PSA-ACT, with the same molar response for F-PSA and PSA-ACT. Assays specific for F-PSA (cross-reactivity between F-PSA an...

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting ...

A scolex antigen of the horse tapeworm Anoplocephala perfoliata containing at least 14 different proteins was employed in an enzyme-linked immunosorbent assay (ELISA) for detection of antibodies to A. perfoliata in equine sera. The assay was applied to sera from 426 slaughtered horses with different numbers of worms and with varying degrees of intestinal lesions. As measured by the ELISA, there was a very strong effect on the antibody levels both from the number of tapeworms present and from the intestinal lesion score. However, considerable individual variation was observed between horses with similar worm counts. The ELISA values of horses that were either negative for strongyles and tapeworms or positive only for strongyles were similar, whereas both of these groups differed significantly from animals that harboured only A. perfoliata. Thus it seemed that cross-reactivity with concurrent nematode infections did not occur. Furthermore, a significant seasonal pattern in antibody le...

Glycolipid changes in spleen autopsy specimens were determined in four cases of Gaucher's disease type I, three cases of type II, and twelve cases of type III. These changes were also determined in liver autopsy specimens from three cases of type II and in nine cases of type III. The concentration of glucosylceramide in spleen was of the same magnitude in all three types, 36.3 +/- 11.7 mmol/kg in type I, 32.7 +/- 8.5 mmol/kg in type II, and 32.6 +/- 6.9 mmol/kg in type III. In liver there were large differences in the glucosylceramide concentration between splenectomized and non-splenectomized cases. Thus, in the non-splenectomized type III cases it was 9.9 +/- 3.0 mmol/kg, while in the splenectomized type III cases it was 24.1 +/- 6.1 mmol/kg. The accelerated deposition of glucosylceramide in liver after splenectomy was also demonstrated by analyses of liver biopsy specimens. A 2-6-fold increase of gangliosides was found in liver and spleen from the three types, with no signifi...

Using a radioimmunoassay we have determined serum levels of the carcinoma-associated antigen CA-50 in 266 patients with colorectal cancer. Elevated CA-50 levels were found in Dukes' A (15%), Dukes' B (43%), Dukes' C (31%) and Dukes' D (65%). Patients who had developed a recurrence had 66% elevated levels. 25% of resected patients with no evidence of disease also had elevated CA-50 levels. From 139 patients operated on for a Dukes' A-C, a rise in CA-50 levels from the pre- to the 6-9 month post-operative sample was demonstrated in 12 cases in the absence of any clinical evidence for a recurrence. On follow-up, a recurrence later developed in all these cases with lead times of CA-50 titre rises ranging from 5 to 40 months. A rise in CA-50 levels after resection of a Dukes' A-C is indicative of a recurrence and may precede any clinical evidence of disease by several months or years. Data is also presented from 552 cases with colorectal cancer analysed with a imm...

A serological assay for the quantitative determination of the novel tumour-associated epitope CA242 was developed and used for determination of sensitivity and specificity of CA242 in gastrointestinal cancer. The CA242 assay showed a better tumour specificity than CA50 (and CA 19-9). This was most noticeable in benign hepatobiliary disease. The sensitivity at 90% specificity cut-off level was approximately three times higher for CA242 compared to CA50 in colo-rectal cancer Dukes A, B and C, while in pancreatic cancer the sensitivity of CA242 and CA50 was similar. CA242 was expressed independently of CEA, and the combination of CEA and CA242 gave in colo-rectal cancer considerably higher sensitivity than the use of only one of the markers. This was most pronounced in Dukes A and Dukes B patients. CA242 is a novel tumour marker of potential clinical use, particularly in colo-rectal cancer.

Immunologic measurements of the serum concentration of prostate-specific antigen (PSA), an abundant prostatic-secreted serine proteinase, are frequently used to monitor patients with prostate cancer, though it has not been ascertained whether this immunoreactivity represents a PSA zymogen, the active proteinase, or PSA complexed to extracellular proteinase inhibitors. To characterize the PSA immunoreactivity in serum, we used monoclonal antibodies produced against PSA and a polyclonal rabbit IgG against alpha 1-antichymotrypsin in the design of three noncompetitive PSA assays: assay T, which detected PSA both when present as the active proteinase and when complexed to alpha 1-antichymotrypsin; assay F, which recognized the active proteinase but most poorly detected PSA complexed to alpha 1-antichymotrypsin; and assay C, which was specific for PSA complexed to alpha 1-antichymotrypsin. We used the three assays to measure PSA immunoreactivity in 64 patients' sera and in the efflue...

Squamous cell carcinoma antigen (SCCA) is a serological marker of squamous cell carcinomas (SCC). To study whether any of the SCCA isoforms would provide additional and more specific/sensitive clinical information than total SCCA, immunoassays specific for the different forms of SCCA (free SCCA2, total SCCA2, total SCCA1 and total SCCA) were developed. SCCA isoforms were determined before therapy and in follow-up samples from patients with cervical cancer and in serum samples from healthy females. Serum samples from patients with benign skin diseases (psoriasis and eczema) were also selected based on elevated SCCA levels. Rising levels of SCCA1 and SCCA2 were seen in patients with recurrence or progressive disease at the end of the study. The rise in SCCA2 was usually more prominent than that in SCCA1. The dominating serological form of SCCA was free SCCA2 both in healthy controls and in patients with cervical cancer. Both SCCA1 and SCCA2 were elevated in serum from cervical cancer patients and followed the clinical course of the disease during therapy monitoring. SCCA2 did not show improved tumor specificity as compared to SCCA1. A larger study is however necessary to make firm conclusions.

Squamous cell carcinoma antigen (SCCA), a member of the serine protease inhibitor (serpin) family, is a tumor-associated antigen and a serological marker for squamous cell carcinomas (SCC). Elevated serum levels are correlated with the clinical stage of the disease. Gene cloning has previously revealed two tandemly arrayed genes, SCCA1 and SCCA2. Using RT-PCR, an SCCA1/A2 transcript was identified in 6 out of 8 cell lines and the reciprocal SCCA2/A1 transcript was identified in 6 out of 8 analysed cell lines. Southern blot analysis showed an aberrant band pattern in 3 out of 5 cell lines. The cell lines demonstrating a normal band pattern corresponded to the cell lines where no fusion transcript was detected using PCR. Complex binding studies show that SCCA1/A2 binds to cathepsin G but not to cathepsin L, indicating that the SCCA1/A2 fusion protein has the specificity of SCCA2, but the transcription may be regulated as that of SCCA1. SCCA2/A1 reacts in the opposite way. The clinical relevance of these fusion transcripts is not yet known. Studies using primary tumours are underway to elucidate if these fusion transcripts are tumour specific and if they might be used as a diagnostic and prognostic marker for SCC.

Antibodies submitted to the ISOBM TD-3 PSA Workshop were tested for reactivity with free prostate-specific antigen (PSA) and the PSA alpha1-antichymotrypsin (ACT) complex, inhibition of proteolytic activity, recognition of continuous epitopes, and epitope specificity based on complete cross-inhibition studies. The antibodies could be separated into two categories: those recognizing hidden epitopes specific for free PSA, and those recognizing epitopes in both free PSA and the PSA-ACT complex. A large number of distinct antigenic domains were identified both in free PSA and the PSA-ACT complex.

Novel tumour-associated epitopes showing elevated levels in sera from patients with colon carcinoma were studied by means of monoclonal antibodies with respect to co-expression with the tumour-associated epitope CA50 on the cancer antigen (CanAg) glyco-conjugate complex. Co-expression of the different epitopes and CA50 was found on CanAg both from COLO 205 spent medium and sera from patients with colorectal cancer. In a few sera from patients with non-mucinous ovarian tumours, the CanAg complex was also found to express the CA125 epitope. The chemical characterisation showed that all of the novel epitopes on CanAg were of carbohydrate nature, and the results may suggest a structural relationship between several of them.

The objectives of the present study were to use phage display to rescue the specificity of an IgM antibody and by the use of DNA shuffling to construct a sublibrary from which mutants with higher affinity could be selected. As a test system, a hybridoma cell line producing low-affinity IgM against recombinant pro-gastrin-releasing peptide (ProGRP) was chosen as starting material for construction of a single-chain Fv (scFv) phage library. One clone, pGRP5, demonstrating affinity for the antigen, was selected for the study. Random mutations were introduced into the scFv sequence by DNA shuffling, and mutants with raised affinity were selected by biopanning against recombinant ProGRP. Clones with affinities improved by approximately two orders of magnitude were selected after the first round of DNA shuffling. An additional 8- to 9-fold rise in affinity was demonstrated in mutants after the second round of mutagenesis. Sequence analysis demonstrated changes primarily in the complementarity-determining region (CDR) H1, CDR L1 and CDR H3 as compared to the original clone. Thus, by the use of phage display in combination with DNA shuffling, the specificity of an IgM antibody was rescued and the affinity was raised almost three orders of magnitude.

Studies of patients with head trauma have demonstrated a correlation between a serum marker of brain tissue damage, namely S100B, and neuroradiological findings. It was recently demonstrated that the increases in serum S100B levels after heart surgery have extracerebral origins, probably surgically traumatized fat, muscle, and bone marrow. The current study examined multitrauma patients without head trauma, to determine whether soft-tissue and bone damage might confound the interpretation of elevated serum S100B concentrations for patients after head trauma. A commercial assay was used to determine serum S100B concentrations for a normal population (n = 459) and multitrauma patients without head injury (n = 17). Concentrations of the two subtypes of S100B (S100A1B and S100BB) were determined using separate noncommercial assays. The mean serum S100B concentration for a normal healthy population was 0.032 microg/L (median, 0.010 microg/L; standard deviation, 0.040 microg/L). The upper 97.5% and 95% reference limits were 0.13 and 0.10 microg/L, respectively. No major age or sex differences were observed. Among trauma patients, serum S100B levels were highest after bone fractures (range, 2-10 microg/L) and thoracic contusions without fractures (range, 0.5-4 microg/L). Burns (range, 0.8-5 microg/L) and minor bruises also produced increased S100B levels. S100A1B and S100BB were detected in all samples. Trauma, even in the absence of head trauma, results in high serum concentrations of S100B. Interpretation of elevated S100B concentrations immediately after multitrauma may be difficult because of extracerebral contributions. S100B may have a negative predictive value to exclude brain tissue damage after trauma. Similarly, nonacute S100B measurements may be of greater prognostic value than acute measurements.

The aim of the present study was to study the in vivo role of IL-4 and IL-13 on bone metabolism. The skeletal phenotypes of male and female IL-13(-/-) (n = 7+7), IL-4(-/-)IL-13(-/-) (n = 7+7), and WT (n = 7+7) mice were compared. Analysis was made at 6 weeks of age (juvenile) by pQCT, and at 20 weeks of age (adult) by pQCT, biomechanical testing, and by S-IGF-1 and S-Osteocalcin measurements. The skeletal phenotype was affected only in adult male IL-4(-/-)IL-13(-/-) mice. These animals displayed a reduction in cortical bone mineral content (BMC) of both the tibia and the femur, as measured by mid-diaphyseal pQCT scans, compared with WT mice (tibia -8.2%; femur -8.5%; p < 0.01). This reduction in cortical BMC was due to a decreased cross-sectional area as a result of a reduced cortical thickness. The mechanical strength of the cortical bone, tested by three-point-bending at the mid-diaphyseal region of the femurs, demonstrated a significant reduction of displacement at failure (-11.4%), maximal load at failure (-10.6%), and total energy until failure (-29.4%). S-IGF-1 and S-Osteocalcin levels as well as trabecular bone mineral density (tvBMD) were unaffected in adult male IL-4(-/-)IL-13(-/-) mice. IL-4(-/-)IL-13(-/-) male mice show adult onset reduction of cortical bone mass and strength, indicating that the two anti-inflammatory Th(2) cytokines IL-4 and IL-13 are involved in the regulation of bone remodeling.

Forty-two patients (younger than 65 years) with osteoarthritis were operated on with an uncemented CLS stem and randomized to early unrestricted weight bearing combined with intensive physiotherapy or to partial weight bearing combined with self-training. Radiostereometric analysis showed 1.2 (+0.11 to -6.76) mm subsidence of the stem at 24 months in both groups. There was no significant difference in the migration pattern between the unrestricted and partial weight bearing groups. Actual loading on the operated leg, measured with the F-scan system, did not influence the migration of the stem. There was a strong correlation between the average subsidence at 3 and 24 months (r = 0.96). Early full weight bearing and active rehabilitation can be used for the uncemented CLS stem without increased risk of early loosening.

Monoclonal antibodies were produced after immunization of mice with a colorectal adenocarcinoma cell line or liver metastasis membranes from a patient with colon adenocarcinoma. Many monoclonal antibodies were found to react with colorectal adenocarcinoma cells but not with normal colon mucosa, blood lymphocytes, myeloma cells or lung epithelial carcinoma cells. Three of these 'colorectal tumour-specific' antibodies appear to define different antigens that were found in the complex monosialoganglioside fraction from 60 to 90% of the colorectal and pancreatic adenocarcinoma tumours or metastases examined but essentially lacking in normal colon mucosa and other normal or tumour tissues tested.

The effect of cholera toxin on the content of 5-hydroxytryptamine (5-HT) in the enterochromaffin cells of the cat small intestine was estimated by cytofluorimetry of individual enterochromaffin cells at varying times after exposing the intestinal mucosa to the toxin. The observed changes in 5-HT levels in the enterochromaffin cells were correlated with the simultaneously measured rate of net fluid transport across the intestinal epithelium. Intestinal segments exposed to cholera toxin showed a statistically significant decrease in 5-HT levels of enterochromaffin cells compared with segments exposed to heat-inactivated cholera toxin. A good correlation (r = 0.73) was found between relative 5-HT fluorescence in enterochromaffin cells and net fluid transport across the intestinal epithelium. Thus, a diminished 5-HT content was associated with a decreased rate of fluid absorption or an increased rate of secretion. A hypothesis is presented for explaining the possible role of the enterochromaffin cells in the pathophysiology of cholera secretion.

We performed this investigation to determine the possible migration starting immediately after surgery and the effect of different weightbearing regimens on the migration pattern of an uncemented hip stem (CLS). Stem migration was determined with radiostereometry analysis with baseline when the patients still were anesthetized. Subsequent examinations were done up to 1 year. Twenty-nine patients (mean age, 55 years; range, 26-63 years) were randomized to either unrestricted weightbearing combined with intensive physiotherapy from the first day after surgery or to partial weightbearing and a conservative training regimen for the first 3 months after surgery. At 1 week, subsidence was -0.03 mm in the unrestricted weightbearing group and 0.01 mm in the partial weightbearing group. At 1 year, subsidence was 1.01 mm in the unrestricted weightbearing group and 0.51 mm in the partial weightbearing group. One patient in the unrestricted weightbearing group had revision surgery because of aseptic loosening at 1.5 years after surgery. The CLS stem did not have any migration from the end the surgery until 1 week, but there was small migration from 1 week to 3 months after which the stem remained stable. The degree of early weightbearing did not affect the migration pattern.

Interleukin-13 (IL-13) inhibits cell proliferation and stimulates interleukin-6 (IL-6) formation in isolated human osteoblasts (hOBs). Because the related cytokine, interleukin-4 (IL-4), is known to exert effects similar to IL-13 in other tissues, and because IL-4 has been implicated as a regulator of bone metabolism, we compared the effects of IL-13 and IL-4 on cell proliferation, IL-6 synthesis, the expression of osteoblastic phenotypic markers in hOB cultures. Also, the receptor proteins mediating these effects in hOBs have been partly characterized. IL-4 and IL-13 dose-dependently inhibited [(3)H]-thymidine incorporation into the DNA of human osteoblasts and stimulated secretion of IL-6 into culture supernatants. IL-13 and IL-4 also increased the mRNA levels of IL-6, as measured by RNAse protection assay. Furthermore, IL-13 and IL-4 dose-dependently enhanced alkaline phosphatase (ALP) activity, but did not affect osteocalcin or collagen type I synthesis. IL-4 was tenfold more potent than IL-13 in inducing both ALP activity and IL-6 secretion, whereas the cytokines were equipotent as inhibitors of cell proliferation. The expression of mRNA for receptor subunits previously implicated in IL-4 and IL-13 signaling was investigated by reverse transcriptase-polymerase chain reaction. IL-13R, IL-13Ralpha, and IL-4Ralpha mRNA were repeatedly detected in hOBs, whereas mRNA for IL-2Rgamma(C) was not detected. Receptor-blocking antibodies to IL-4Ralpha inhibited the induction of IL-6 formation by both IL-4 and IL-13, indicating that both cytokines utilize this receptor subunit in signaling. However, the antibodies did not affect the IL-4/-13-induced inhibition of [(3)H]-thymidine incorporation or the stimulation of alkaline phosphatase (ALP), suggesting that IL-4Ralpha does not mediate these effects of IL-4/-13 in hOBs. We conclude that the cytokines IL-13 and IL-4, through sharing of receptor components, induce similar effects on hOBs, causing inhibition of cell proliferation, stimulation of IL-6, and enhanced ALP activity.

Glycogen synthase kinase 3β (GSK-3β) actions are central in the canonical Wnt pathway, important in many biological processes and a potential drug target for treating several diseases. It is appreciated that a balanced Wnt canonical signaling is crucial for the maintenance of normal bone mass. In this study we investigated the effects of a potent orally active GSK-3 inhibitor, AZD2858, on bone mass in rats. Treatment (1 μM) of human osteoblast cells with AZD2858 in vitro increased β-catenin levels after a short period of time. In rats, oral AZD2858 treatment caused a dose-dependent increase in trabecular bone mass compared to control after a two-week treatment with a maximum effect at a dose of 20 mg/kg once daily (total BMC: 172% of control; p<0.001). A small but significant effect was also seen at cortical sites (total BMC: 111% of control; p<0.001). Biomechanical testing demonstrated an increase in both vertebral compression strength at a dose of 20 mg/kg once daily (Load at failure: 370% of control, p<0.001) and diaphyseal strength of femora subjected to a three point bending test (Load at failure: 115% of control; p<0.01). Furthermore, histomorphometry showed a dramatic increase in bone formation indices, and serum markers of both bone formation (Osteocalcin, 146% of control; p<0.001) and resorption (CTX, 189% of control; p<0.001) were elevated. Our conclusion is that a GSK-3 inhibitor drug may prove effective as an anabolic strategy in the treatment of diseases characterized by low bone mass, since AZD2858 has extensive bone building effects at predominantly trabecular sites.

A solid phase radioimmunoassay was devised for measuring the value of the carcinoma associated carbohydrate antigen CA 50 in serum based on the use of a specific monoclonal antibody (C 50). Samples of serum from 259 patients with carcinoma, 114 patients with other malignancies or inflammatory diseases, and 150 healthy controls were examined. Serum values of CA 50 exceeding the mean plus three standard deviations for control samples from blood donors were found in a high proportion of patients with colorectal adenocarcinomas (50% of those with early, localised tumours and 75% of advanced cases), other gastrointestinal carcinomas (69%), uterine cancer (75% of those with corporeal and 88% of those with cervical cancer), prostatic cancer (90%), lung cancer (52%), and breast, ovarian, kidney, and urinary bladder carcinoma (26-67%). The CA 50 values in samples from patients with inflammatory diseases, including ulcerative colitis, with rare exceptions (0-7%) were within the normal range, as were those in patients with various sarcomas and malignant melanoma. Measuring serum values of CA 50, which is evidently a generalised carcinoma associated antigen, may be useful in clinical research studies of the diagnosis, management, and prognosis of patients with different types of carcinoma.