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Objectives: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia., Methods: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months., Results: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002)., Conclusions: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms., (Copyright © 2015 John Wiley & Sons, Ltd.)

Purpose: To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair., Methods: Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014., Results: Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7 %). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair., Conclusions: Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.

The effects of short-term high-intensity exercise on single fiber contractile function in humans are unknown. Therefore, the purposes of this study were: (a) to access the acute effects of repeated high-intensity exercise on human single muscle fiber contractile function; and (b) to examine whether contractile function was affected by alterations in the redox balance. Eleven elite cross-country skiers performed four maximal bouts of 1300 m treadmill skiing with 45 min recovery. Contractile function of chemically skinned single fibers from triceps brachii was examined before the first and following the fourth sprint with respect to Ca(2+) sensitivity and maximal Ca(2+) -activated force. To investigate the oxidative effects of exercise on single fiber contractile function, a subset of fibers was incubated with dithiothreitol (DTT) before analysis. Ca(2+) sensitivity was enhanced by exercise in both MHC I (17%, P < 0.05) and MHC II (15%, P < 0.05) fibers. This potentiation was not present after incubation of fibers with DTT. Specific force of both MHC I and MHC II fibers was unaffected by exercise. In conclusion, repeated high-intensity exercise increased Ca(2+) sensitivity in both MHC I and MHC II fibers. This effect was not observed in a reducing environment indicative of an exercise-induced oxidation of the human contractile apparatus., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Summary: Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development., Introduction: The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people., Methods: In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression., Results: Participants had a mean age of 89.3 ± 4.7 years; 65.8% were women, 36.8% lived in residential care facilities, 33.6% had dementia, and 20.4% had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1%) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95% confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95% CI, 1.82-14.44), currently smoking (HR = 4.38; 95% CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95% CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95% CI, 1.09-2.77), and age (HR = 1.09; 95% CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95% CI, 0.15-0.91), but only for those with bilateral hip prostheses., Conclusions: Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

Background: Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001., Methods: Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0., Results: The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%-9.5%) in 2008-2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones., Conclusions: Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected., (© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America.)

Purpose: The purpose of the present study was to explore the risk for complications and reoperations following open repairs for sliding groin hernias., Method: All primary indirect inguinal hernia repairs registered in the Swedish Hernia Register 1998-2011 were identified. Repeated and bilateral procedures were excluded. The epidemiology, the incidence of per- and postoperative complications, and the reoperation rate due to recurrences were analyzed., Results: 100 240 non-repeated unilateral repairs were registered with sliding hernias in 13 132 (13.1 %) (male 14 %, female 5 %) procedures. The methods of repair for sliding and non-sliding hernias were Lichtenstein and other open anterior mesh repairs (N = 10865, 82.7 % and N = 60790, 69.8 %), endoscopic techniques (N = 136, 1.0 % and N = 4352, 5.0 %), and other techniques (N = 2131, 16.2 % and N = 21966, 25.2 %). In multivariate analyses with adjustment for gender, acute/planned surgery, reducibility, method of repair and age, sliding hernias were associated with a low but slightly increased risk for perioperative complications (hazard ratio 1.30, 95 % confidence interval 1.04-1.62, p = 0.023) and postoperative hematoma (hazard ratio 1.13, confidence interval 1.02-1.26, p = 0.019). There was no increased risk of reoperation due to recurrences., Conclusion: Compared to older reports, the incidence of repairs due to primary indirect sliding inguinal hernias has increased over time and it is not just a male disease. The overall results are good with low and comparable complication rates, and no increased risk of reoperations due to recurrences.

Objectives: To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types., Design: Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study., Setting: Residential care facilities, Umeå, Sweden., Participants: Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N=186)., Intervention: Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity., Measurements: Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months., Results: Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=-1.6-4.3; BI=0.6, 95% CI=-0.2-1.4) or 7 (FIM=0.8, 95% CI=-2.2-3.8; BI=0.6, 95% CI=-0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months., Conclusion: In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia., (© 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.)

Introduction: Tuberculosis can affect any organ of the body, including the heart., Presentation of Case: An 18-year old woman presented with a multifocal tuberculosis infection involving abdominal lymph nodes, a sternotomy wound, an abscess of the abdominal wall and most notably a myocardial tuberculoma. Establishing the diagnosis of the myocardial tuberculoma was challenging mainly due to the location within the heart. Initially a diagnostic percutaneous femoral vascular catheter guided biopsy of the right atrial mass was performed, but later open surgery involving median sternotomy was needed. The patient recovered fully after surgery and nine months treatment with anti-tuberculosis drugs., Discussion: The optimal length of treatment for myocardial tuberculoma is unknown. Medical treatment for six months might be enough regardless whether surgery is performed or not., Conclusion: Myocardial tuberculoma requires culture from the infected tissue for confirmed diagnosis and might be successfully treated with anti-tuberculosis drugs only. Indications for surgery include uncertain diagnosis, poor response to medical treatment or cardiac complications., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Successful cross-country skiing, one of the most demanding of endurance sports, involves considerable physiological challenges posed by the combined upper- and lower-body effort of varying intensity and duration, on hilly terrain, often at moderate altitude and in a cold environment. Over the years, this unique sport has helped physiologists gain novel insights into the limits of human performance and regulatory capacity. There is a long-standing tradition of researchers in this field working together with coaches and athletes to improve training routines, monitor progress, and refine skiing techniques. This review summarizes research on elite cross-country skiers, with special emphasis on the studies initiated by Professor Bengt Saltin. He often employed exercise as a means to learn more about the human body, successfully engaging elite endurance athletes to improve our understanding of the demands, characteristics, and specific effects associated with different types of exercise., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Aim of the present study was to investigate performance and kinematics of cross-country skiers during sprint running and bounding on different inclines, in relationship to maximal strength, power and skiing performance., Methods: On day one, the maximal strength of 14 elite skiers was tested using a mid-thigh isometric pull and maximal relative leg power determined using squat and countermovement jumps. Day two involved 15-m maximal sprints and 5-step bounding at 0º, 7.5° and 15º inclines. From video recordings sprint, step, contact and flight times; step length and frequency; total number of sprint steps and average bounding velocity were determined. Skiing performance was assessed using International Ski Federation (FIS) points from the preceding season and compared to strength, power, bounding and sprint performance, and kinematics., Results: On steeper inclines sprint time was higher and bounding distance shorter (both P<0.001), and step frequency during sprinting and bounding, reduced and increased respectively (P<0.001). Isometric maximal strength correlated strongly with bounding distance on the two steeper inclines (r=0.76 and 0.83). Squat and countermovement jump heights correlated moderately with sprint performance at both 7° and 15°, and bounding performance on all three inclines (r=0.55-0.65). The distance bounded uphill correlated moderately with FIS points (r=-0.55 and -0.67)., Conclusion: Incline influenced sprinting and bounding performance and kinematics. Maximal leg power is important for both sprinting and bounding uphill, while maximal strength is important for the latter. The skiers with better FIS rankings bounded farther on steeper inclines, suggesting that this capacity is beneficial for cross-country skiing performance.

To determine whether a fast reduction in fat mass can be achieved in 4 days by combining caloric restriction (CR: 3.2 kcal/kg body weight per day) with exercise (8-h walking + 45-min arm cranking per day) to induce an energy deficit of ∼5000 kcal/day, 15 overweight men underwent five experimental phases: pretest, exercise + CR for 4 days (WCR), control diet + reduced exercise for 3 days (DIET), and follow-up 4 weeks (POST1) and 1 year later (POST2). During WCR, the diet consisted solely of whey protein (n = 8) or sucrose (n = 7) (0.8 g/kg body weight per day). After WCR, DIET, POST1, and POST2, fat mass was reduced by a mean of 2.1, 2.8, 3.8, and 1.9 kg (P < 0.05), with two thirds of this loss from the trunk; and lean mass by 2.8, 1.0, 0.5, and 0.4 kg, respectively. After WCR, serum glucose, insulin, homeostatic model assessment, total and low-density lipoprotein cholesterol and triglycerides were reduced, and free fatty acid and cortisol increased. Serum leptin was reduced by 64%, 50%, and 33% following WCR, DIET, and POST1, respectively (P < 0.05). The effects were similar in both groups. In conclusion, a clinically relevant reduction in fat mass can be achieved in overweight men in just 4 days by combining prolonged exercise with CR., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We compared the reduction in running velocities from road to off-road terrain in eight elite and eight amateur male orienteer athletes to investigate whether this factor differentiates elite from amateur athletes. On two separate days, each subject ran three 2-km time trials and three 20-m sprints "all-out" on a road, on a path, and in a forest. On a third day, the running economy and maximal aerobic power of individuals were assessed on a treadmill. The elite orienteer ran faster than the amateur on all three surfaces and at both distances, in line with their better running economy and aerobic power. In the forest, the elites ran at a slightly higher percentage of their 2-km (∼3%) and 20-m (∼4%) road velocities. Although these differences did not exhibit traditional statistical significance, magnitude-based inferences suggested likely meaningful differences, particularly during 20-m sprinting. Of course, cognitive, mental, and physical attributes other than the ability to run on different surfaces are required for excellence in orienteering (e.g., a high aerobic power). However, we suggest that athlete-specific assessment of running performance on various surfaces and distances might assist in tailoring training and identifying individual strengths and/or weaknesses in an orienteer., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We studied the immunoglobulin (Ig) response to causative serotype-specific capsular polysaccharides in adult pneumococcal pneumonia patients. The serotypes were grouped according to their degree of encapsulation and invasive potential. Seventy patients with pneumococcal pneumonia, 20 of whom were bacteremic, were prospectively studied. All pneumococcal isolates from the patients were serotyped, and the Ig titers to the homologous serotype were determined in acute- and convalescent-phase sera using a serotype-specific enzyme-linked immunosorbent assay. The Ig titers were lower in bacteremic cases than in nonbacteremic cases (P < 0.042). The Ig titer ratio (convalescent/acute titer) was ≥2 in 33 patients, 1 to 1.99 in 20 patients, and <1 in 17 patients. Patients ≥65 years old had a lower median Ig titer ratio than did younger patients (P < 0.031). The patients with serotypes with a thin capsule (1, 4, 7F, 9N, 9V, and 14) and medium/high invasive potential (1, 4, 7F, 9N, 9V, 14, and 18C) had higher Ig titer ratios than did patients with serotypes with a thick capsule (3, 6B, 11A, 18C, 19A, 19F, and 23F) and low invasive potential (3, 6B, 19A, 19F, and 23F) (P < 0.05 for both comparisons after adjustment for age). Ig titer ratios of <1 were predominantly noted in patients with serotypes with a thick capsule. In 8 patients with pneumococcal DNA detected in plasma, the three patients with the highest DNA load had the lowest Ig titer ratios. In conclusion, a high antibody response was associated with serotypes with a thin capsule and medium/high invasive potential, although a low antibody response was associated with serotypes with a thick capsule and a high pneumococcal plasma load., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

Aim: This study aimed to quantify the cardiorespiratory, metabolic and hormonal responses of elite open-wheel indoor kart racers., Methods: Ten male racers (age: 21±3 yrs; height: 1.92±0.06 m, body mass: 76.0±5.9 kg) participated in a racing tournament. Their peak oxygen uptake and heart rate were assessed by a ramp test (100 W, increase 30 W·min-1) in the laboratory. During the racing itself, the cardio-respiratory and accelerometer values were recorded and pre- and post-race levels of blood lactate and salivary cortisol were determined., Results: The average peak values for all of the drivers with respect to oxygen uptake and heart rate were 4.5±0.8 L·min-1 (56.7±7.9 mL·min-1·kg-1) and 193±5 beats·min-1, respectively. Overall, 28.3±3.3 laps were completed during 30-min of racing. Acceleration forces for the entire test averaged 1.20±0.51 G (maximum: 3.30 G), declining from the first 10 min until the end of racing (P<0.03). The oxygen uptake (~20 mL·min-1·kg-1), heart rate (~133 beats·min-1), respiratory exchange ratio (~0.96) and ventilation (~70 L·min-1) observed indicated moderate cardio-respiratory responses. Blood lactate concentration was significantly higher after the race than before but remained at <2 mmol·L-1 (P<0.01; effect size: 1.62)., Conclusion: There were no differences between salivary cortisol levels before and after the race (P<0.06; effect size: 0.49). Directly after the race, the drivers rated their perceived exertion on Borg's scale as 11.1±1.3. The present data revealed that the psycho-physical exertion associated with a 30-min open-wheel indoor kart race is moderate.

Three dominant techniques are used for downhill turning in cross-country skiing. In this study, kinematic, kinetic, and temporal characteristics of these techniques are described and related to skier strength and power. Twelve elite female cross-country skiers performed six consecutive turns of standardized geometry while being monitored by a Global Navigation Satellite System. Overall time was used as an indicator of performance. Skiing and turning parameters were determined from skier trajectories; the proportional use of each technique was determined from video analysis. Leg strength and power were determined by isometric squats and countermovement jumps on a force plate. Snow plowing, parallel skidding, and step turning were utilized for all turns. Faster skiers employed less snow plowing and more step turning, more rapid deceleration and earlier initiation of step turning at higher speed (r = 0.80-0.93; all P < 0.01). Better performance was significantly correlated to higher mean speed and shorter trajectory (r = 0.99/0.65; both P < 0.05) and to countermovement jump characteristics of peak force, time to peak force, and rate of force development (r = -0.71/0.78/-0.83; all P < 0.05). In conclusion, faster skiers used step turning to a greater extent and exhibited higher maximal leg power, which enabled them to combine high speeds with shorter trajectories during turns., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In preclinical hemophilia research, an animal model that reflects both the phenotype and the pathology of the disease is needed., Objectives: Here, we describe the generation and characterization of a novel genetically engineered F8(-/-) rat model., Methods: The rats were produced on a Sprague Dawley background with the zinc finger nuclease technique. A founder with a 13-bp deletion in exon 16 causing a premature translational stop in the C-terminal part of the A3 domain of factor VIII was selected, and a breeding colony was established., Results: Seventy per cent of the homozygous rats had clinically manifest spontaneous hemorrhagic episodes that needed treatment. The F8(-/-) rats had no detectable FVIII activity, and had a significantly prolonged activated partial thromboplastin time (APTT) and clot formation time as compared with wild-type (WT)/WT rats. In vitro spiking of rat plasma with human recombinant FVIII resulted in dose-dependent normalization of the APTT., Conclusion: On the basis of the targeted deletion in F8, and the distinct physical and analytic characteristics of the rat, we conclude that an FVIII-deficient rat strain has been generated that has the potential to contribute greatly to translational research., (© 2014 International Society on Thrombosis and Haemostasis.)

This investigation was designed to analyse the kinematics and kinetics of cross-country skiing at different velocities with the herringbone technique on a steep incline. Eleven elite male cross-country skiers performed this technique at maximal, high, and moderate velocities on a snow-covered 15° incline. They positioned their skis laterally (25 to 30°) with a slight inside tilt and planted their poles laterally (8 to 12°) with most leg thrust force exerted on the inside forefoot. Although 77% of the total propulsive force was generated by the legs, the ratio between propulsive and total force was approximately fourfold higher for the poles. The cycle rate increased with velocity (1.20 to 1.60 Hz), whereas the cycle length increased from moderate up to high velocity, but then remained the same at maximal velocity (2.0 to 2.3 m). In conclusion, with the herringbone technique, the skis were angled laterally without gliding, with the forces distributed mainly on the inside forefoot to enable grip for propulsion. The skiers utilized high cycle rates with major propulsion by the legs, highlighting the importance of high peak and rapid generation of leg forces., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Football is played worldwide and players often have to cope with hot and cold temperatures as well as high altitude conditions. The upcoming and past world championships in Brazil, Qatar and South Africa illustrate the necessity for behavioural strategies and adaptation to extreme environmental conditions. When playing football in the heat or cold, special clothing, hydration and nutritional and acclimatisation strategies are vital for high-level performance. When playing at high altitude, the reduced oxygen partial pressure impairs endurance performance and alters the technical and tactical requirements. Special high-altitude adaptation and preparation strategies are essential for football teams based at sea-level in order to perform well and compete successfully. Therefore, the aim of the underlying review is: 1) to highlight the difficulties and needs of football teams competing in extreme environmental conditions, 2) to summarise the thermoregulatory, physiological, neuronal and psychological mechanism, and 3) to provide recommendations for coping with extreme environmental conditions in order to perform at a high level when playing football in the heat, cold and at high altitude., (© Georg Thieme Verlag KG Stuttgart · New York.)

Greater gender differences have been found in exercise modes where the upper body is involved. Therefore, the present study investigated the influence of poling on gender differences in endurance performance by elite cross-country skiers. Initially, the performance of eight male and eight female sprint skiers was compared during four different types of exercise involving different degrees of poling: double poling (DP), G3 skating, and diagonal stride (DIA) techniques during treadmill roller skiing, and treadmill running (RUN). Thereafter, DP was examined for physiological and kinematic parameters. The relative gender differences associated with the DP, G3, DIA and RUN performances were approximately 20%, 17%, 14%, and 12%, respectively. Thus, the type of exercise exerted an overall effect on the relative gender differences (P < 0.05). In connection with DP, the men achieved 63%, 16%, and 8% higher VO2peak than the women in absolute terms and with normalization for total and fat-free body mass (all P < 0.05). The DP VO2peak in percentage of VO2max in RUN was higher in men (P < 0.05). The gender difference in DP peak cycle length was 23% (P < 0.05). In conclusion, the present investigation demonstrates that the gender difference in performance by elite sprint skiers is enhanced when the contribution from poling increases., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We aimed to compare sputum and nasopharyngeal aspirate (NpA) samples and the PCR gene targets lytA and Spn9802 in quantitative PCR (qPCR) assays for rapid detection of pneumococcal etiology in community-acquired pneumonia (CAP). Seventy-eight adult patients hospitalized for radiologically confirmed CAP had both good-quality sputum and NpA specimens collected at admission. These samples were subjected to lytA qPCR and Spn9802 qPCR assays with analytical times of <3 h. Thirty-two patients had CAP with a pneumococcal etiology, according to conventional diagnostic criteria. The following qPCR positivity rates were noted in CAP cases with and without pneumococcal etiology: 96% and 15% (sputum lytA assay), 96% and 17% (sputum Spn9802 assay), 81% and 11% (NpA lytA assay), and 81% and 20% (NpA Spn9802 assay), respectively. The mean lytA and Spn9802 DNA levels were significantly higher in qPCR-positive sputum samples from cases with pneumococcal etiology than in qPCR-positive sputum samples from CAP cases without pneumococcal etiology or qPCR-positive NpA samples from cases with pneumococcal etiology (P < 0.02 for all comparisons). For detection of pneumococcal etiology, receiver operating characteristic curve analysis showed that sputum specimens were superior to NpA specimens as the sample type (P < 0.02 for both gene targets) and lytA tended to be superior to Spn9802 as the gene target. The best-performing test, the sputum lytA qPCR assay, showed high sensitivity (94%) and specificity (96%) with a cutoff value of 10(5) DNA copies/ml. In CAP patients with good sputum production, this test has great potential to be used for the rapid detection of pneumococcal etiology and to target penicillin therapy.

To determine the relationship of muscle activation, force production, and cycle characteristics to O(2) extraction during high- and lower-intensity double poling (DP), nine well-trained male cross-country skiers performed DP on a treadmill for 3 min at 90% VO(2peak) followed by 6 min at 70%. During the final minute at each workload, arterial, femoral, and subclavian venous blood were collected for determination of partial pressure of O(2), partial pressure of CO(2), pH, and lactate. Electromyography (EMG) was recorded from six upper and lower body muscles, leg and pole forces were measured, and cardiorespiratory variables were monitored continuously. O(2) extraction was associated with time point of peak pole force (PF(peak)), duration of recovery, EMG activity, and lower body use. Arm O(2) extraction was lower than in the legs at both intensities (P < 0.001) and was reduced to a lesser extent upon decreasing the workload (P < 0.05). Arm root-mean-square EMG was higher during the poling phase and entire cycle compared with the legs (P < 0.001). Blood lactate was higher in the subclavian than in femoral vein and artery (P < 0.001) and independent of intensity. O(2) extraction was correlated to low muscle activation, later PF(peak) , prolonged poling time, and extensive dynamic lower body use. Cycle rate and recovery time were associated with O(2) extraction during high-intensity exercise only., (© 2012 John Wiley & Sons A/S.)

We prospectively evaluated the diagnostic contribution of (123)I-FP-Cit (DAT) and (123)I-IBZM (IBZM) SPECT in 29 patients with Parkinson's disease (PD) (74.4 ± 4.2 years) and 28 patients with atypical parkinsonian diseases (APD) (74.3 ± 9.2 years). Twelve had multiple system atrophy (MSA) and 16 progressive supranuclear palsy (PSP). Sixteen age-matched healthy controls (HC) were included. DAT and IBZM SPECTs were made at baseline and after 1 year in all PD patients and in 20 (DAT) and 18 (IBZM) of the APD patients, and after 3 years in 22 (DAT) and 17 (IBZM) of the PD patients and in 10 (DAT) and 10 (IBZM) of the APD patients. The relative DAT uptake decrease was faster in PD and PSP than in HC and MSA. In PSP the DAT uptake was lower than in MSA after 1 year but not after 3 years. Baseline IBZM uptake was not significantly different between patients and HC or between PD and APD. One year after initiated dopaminergic treatment the mean IBZM uptake in the MSA patients remained high compared to PSP and after 3 years compared to PD, PSP, and HC. Thus, the pattern of uptake of these ligands over time may be of value in discriminating between these diagnoses.

This document presents the 2012 evidence based guidelines of the Swedish Society of Infectious Diseases for the in- hospital management of adult immunocompetent patients with community-acquired pneumonia (CAP). The prognostic score 'CRB-65' is recommended for the initial assessment of all CAP patients, and should be regarded as an aid for decision-making concerning the level of care required, microbiological investigation, and antibiotic treatment. Due to the favourable antibiotic resistance situation in Sweden, an initial narrow-spectrum antibiotic treatment primarily directed at Streptococcus pneumoniae is recommended in most situations. The recommended treatment for patients with severe CAP (CRB-65 score 2) is penicillin G in most situations. In critically ill patients (CRB-65 score 3-4), combination therapy with cefotaxime/macrolide or penicillin G/fluoroquinolone is recommended. A thorough microbiological investigation should be undertaken in all patients, including blood cultures, respiratory tract sampling, and urine antigens, with the addition of extensive sampling for more uncommon respiratory pathogens in the case of severe disease. Recommended measures for the prevention of CAP include vaccination for influenza and pneumococci, as well as smoking cessation.

Purpose: To investigate the clinical and electrophysiologic effect of a single intravitreal injection of bevacizumab for neovascular glaucoma (NVG) after ischemic central retinal vein occlusion (iCRVO)., Methods: Nineteen eyes from 19 patients with NVG secondary to iCRVO were randomly allocated to either an intravitreal bevacizumab injection and panretinal photocoagulation (PRP) (10 eyes) or PRP alone (9 eyes). The primary outcome measure was the change in the total retinal function 6 months after treatment, demonstrated by full-field electroretinography (ERG). Secondary outcomes included visual acuity, intraocular pressure (IOP), glaucoma medication, additional IOP-lowering treatment, and the presence of ocular neovascularization before treatment, and 1 week, 2 months, and 6 months after treatment., Results: The regression of ocular neovascularization in the bevacizumab/PRP group was confirmed 1 week after injection. Patients in both study groups had very poor visual acuity at baseline. This remained unchanged. There was no significant difference in the mean IOP between the groups at any point in time. The a-wave amplitudes of combined rod-cone response were significantly decreased after 6 months in the bevacizumab/PRP group (p=0.028), compared with the baseline values. The a- and b-wave amplitudes of combined rod-cone response and the b-wave amplitudes of the 30-Hz flicker response were also markedly reduced compared with the PRP group (-60%, -43%, -47% vs +23%, -36%, -16%, respectively)., Conclusions: This study suggests that intravitreal injection of bevacizumab is valuable in the treatment of NVG by hastening the resolution of neovascularization, while the full-field ERG results indicate that bevacizumab may reduce the photoreceptor function in NVG patients.

This article considers the interfamily clustering of infant mortality (defined as mortality during the first year of life). We developed and evaluated statistical tools to detect clustering and a measure to quantify excess clustering for nineteenth-century data from Skellefteå, Sweden. The detection was performed using the standard methods of generalized linear models and logistic regression. The index of clustering was constructed by comparing the observed numbers of families with specific numbers of deaths to the corresponding observed numbers, after correcting for explanatory variables. To the best of our knowledge, no clustering index of this kind has ever been created.

The aims of the present study were to develop a method for classifying slalom skiing performance and to examine differences in mechanical parameters. Eighteen elite skiers were recorded with three-dimensional kinematical measurements and thereafter divided into a higher (HP) and lower performance group, using the ratio between the difference in mechanical energy divided by the mass of the skier and section entrance velocity (Δe(mech)/v(in)). Moreover, the skiers' velocity (v), acceleration (a), center of mass turn radii (R(CM)) and skis' turn radii (R(AMS)), ground reaction forces (GRF) and differential specific mechanical energy [diff(e(mech))] were calculated. v and diff(e(mech)) were different between the performance groups (P<0.001 and <0.05), while no inter-group differences in R(CM), R(AMS), a and GRF were observed. A relationship between R(AMS) and diff(e(mech)) was demonstrated (r=0.58; P<0.001). The highest GRFs were related to the lowest diff(e(mech)) and a was related to GRF (r=-0.60; P<0.001). The Δe(mech)/v(in) predicted the performance over short course sections. The HP skiers skied with a higher v and a similar range of diff(e(mech)). We suggest that shortest R(AMS) and the highest GRFs should be reduced in elite slalom in order to increase performance., (© 2010 John Wiley & Sons A/S.)

The aim of this study was to analyze double poling using combined kinetic and 3D kinematic analysis at high skiing speeds as regards pole force components, pole angles and pole behavior during the poling and swing phase. The hypothesis was that a horizontal pole force is more predictive for maximal skiing speed (V(max)) than the resultant pole force. Sixteen elite skiers performed a double-poling V(max) test while treadmill roller skiing. Pole forces and 3D kinematics of pole movement at a speed of 30 km/h were analyzed and related to V(max). The duration of the "preparation phase" showed the strongest relationship with V(max) (r=0.87, P<0.001). Faster skiers generated longer cycle lengths with longer swing and poling times, had less inclined pole angles at pole plant and a later peak pole force. Horizontal pole forces were not more highly related to V(max) compared with the resultant pole force. Impact force was not related to V(max). At high skiing speeds, skiers should aim to combine high pole forces with appropriate timing of pole forces and appropriate pole and body positions during the swing and poling phase. The emphasis in training should be on the development of specific strength capacities for pole force production and the utilization of these capacities in double-poling training sessions., (© 2011 John Wiley & Sons A/S.)

Introduction: In competitive sports different types of compression garments (socks, shorts, tights and whole body suits) have become popular. The results of scientific studies regarding their effectiveness, however, are heterogeneous. The aim of this literature review is to (i) survey the scientific data regarding performance enhancing benefits and the support of recovery when applying compression fabrics and (ii) to describe the practical relevance for the application of compression textiles in the competitive sport context., Method: In order to detect relevant publications for the present review an internet search using the medical databases "Medline" and "PubMed" was performed. Altogether, 37 studies were analysed. All publications were from the years 1987 to 2010., Results: The literature review showed no general scientific indications regarding the benefit of compression garments in competitive sports., Conclusion: In particular, the different study designs and different clothing styles as well as different pressure gradients gave rise to contradictory data., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The aim of this paper was to investigate the influence of the new cross country racing suit, designed for the Olympic Winter Games in Vancouver 2010, on cardio-respiratory, thermoregulatory and perceptual responses., Methods: Six elite cross country skiers (29±6 years, peak oxygen uptake 73.2±6.9 mL·min-1·kg-1) performed two exercise bouts wearing either the 2009 or the 2010 racing suit. Bouts consisted of incremental testing on roller skis (12 km·h-1 at 5° inclination; 11 km·h-1 at 6° inclination and 12 km·h-1at 8° inclination for six minutes)., Results: During increasing intensities, significantly lower values were found for oxygen uptake, minute ventilation, RER and heart rate when wearing the new suit compared to the old one (P<0.05; effect sizes: 0.21-4.00). Core temperature was lower with the new suit during steps 2 and 3 (P<0.05, effect size: 1.22-1.27). Also, mean skin temperature was lower during the last increment (P<0.05, effect size: 0.87)., Conclusion: The new 2010 racing suit, developed specifically for the Olympic Winter Games in Vancouver 2010, demonstrated lower values for oxygen uptake, minute ventilation, heart rate, skin and core temperature, ratings of thermal and sweat sensation when compared to the 2009 racing suit.

The present study investigated the physiological characteristics of eight world-class (WC) and eight national-class (NC) Norwegian sprint cross country skiers. To measure the physiological response and treadmill performance, the skiers performed a submaximal test, a peak aerobic capacity (VO2peak) test, and a peak treadmill speed (V(peak)) test in the skating G3 technique. Moreover, the skiers were tested for G3 acceleration outdoors on asphalt and maximal strength in the lab. The standard of sprint skating performance level on snow was determined by International Ski Federation points, and the training distribution was quantified. WC skiers showed 8% higher VO2peak and twice as long a VO(2) plateau time at the VO2peak test, and a higher gross efficiency at the submaximal test (all P<0.05). Furthermore, WC skiers showed 8% higher V(peak) (P<0.05), but did not differ from NC skiers in acceleration and maximal strength. WC skiers performed more low- and moderate-intensity endurance training and speed training (both P<0.05). The current results show that aerobic capacity, efficiency, and high speed capacity differentiate WC and NC sprint skiers and it is suggested that these variables determine sprint skiing performance., (© 2010 John Wiley & Sons A/S.)

Blood collection in mice can be a challenge, in particular for samples used for coagulation analysis as initiation of coagulation during the procedures can influence the results. Blood collection from the retrobulbar venous plexus is commonly used but the method remains controversial. Several alternatives exist but not all are applicable to mice with a compromised coagulation system because of subsequently excessive bleeding. We therefore wanted to explore whether blood collection by puncture of the submandibular vein could replace blood collected from the retrobulbar venous plexus during pharmacokinetic and pharmacodynamic studies in mice lacking coagulation factor VIII (FVIII). The plasma concentrations of recombinant activated factor VII were independent of the blood collection method in a pharmacokinetic study. The same applied to the thromboelastographic profile of mice with normal coagulation in a pharmacodynamic study. However, excessive haemorrhages were observed in all FVIII knockout mice after a single puncture of the submandibular vein and 60% of the mice were euthanized 2-4 h after the blood collection. In contrast, no or only slight haemorrhage was observed in animals subjected to blood collection from the retrobulbar venous plexus. No signs of distress determined by blood glucose level or clinical abnormalities of the eye were observed after puncture of the retrobulbar venous plexus. In conclusion, blood collected by puncture of the submandibular vein and retrobulbar venous plexus has a quality which allows it to be used in coagulation assays. However, because of excessive bleedings, puncture of the submandibular vein is not recommended in mice lacking FVIII.

According to the recommendations of the Swedish Community-Acquired Pneumonia (CAP) guidelines, the selection of empirical antibiotic therapy should be based on the CRB-65 rule. The guidelines recommend empirical therapy directed predominantly against Streptococcus pneumoniae for patients with low CRB-65 scores and broad-spectrum therapy for patients with high CRB-65 scores. In order to study the utility of the recommendations, we analyzed the data from an aetiological study previously performed on 235 hospitalized adult CAP patients at our medical centre. A definite, probable, or possible bacterial aetiology was noted in 194 cases (83%), including 112 cases (48%) with S. pneumoniae aetiology. The following frequencies of definite-probable aetiologies were noted in the patients with CRB-65 score 0-1 (n=155) and CRB-65 score 2-4 (n=80): S. pneumoniae 30% and 35%, Haemophilus influenzae 6.5% and 14% (p=0.063), Mycoplasma pneumoniae 15% and 5.0% (p=0.019), Chlamydophila species 2.6% and 1.2%, Legionella pneumophila 1.9% and 0%, and Staphylococcus aureus 1.3% and 1.2%, respectively. The high frequency of S. pneumoniae in the study supports the recommendations to predominantly cover this bacterium in the empirical therapy of patients with low CRB-65 scores. In the case of treatment failure in these patients, the study indicates that coverage against M. pneumoniae and H. influenzae should be considered.

Background: Recombinant factor VIIa (rFVIIa, Novoseven) is currently used to control bleeding in hemophiliacs with inhibitors. A new rFVIIa variant, NN1731, with increased activity on the surface of activated platelets, has demonstrated a more potent and faster onset of reactivity than rFVIIa in various in vitro models. The present study aimed to investigate whether this translates into greater efficacy and faster promotion of hemostasis in vivo., Method and Results: In a severe tail-bleeding model in hemophilia A mice, NN1731 demonstrated significantly greater efficacy than rFVIIa, plasma-derived activated prothrombin complex concentrate (pd-aPCC, FEIBA or FVIII (Refacto). Assessment of the blood loss over time showed that NN1731 significantly and dose-dependently reduced the blood loss in the first 5-min observation period, whereas the effect of rFVIIa, FVIII and pd-aPCC first became evident 5-10 min after injury., Conclusion: This study shows that NN1731 has a greater efficacy and faster resolution of bleeding in a severe bleeding model in hemophilia A mice compared with any of the other agents tested.

Aims: To compare levels of insulin antibodies in children and adolescents after initiation of insulin therapy using either insulin aspart (IAsp) or human insulin (HI) in combination with Neutral Protamine Hagedorn (NPH) insulin, and to investigate the relationships between insulin antibodies and HbA(1c) and insulin dose., Methods: IAsp-specific antibodies (IAsp-Ab) and antibodies cross-reacting with HI and IAsp (HI-cross-Ab) were analysed by radioimmunoassay at diagnosis of diabetes and every 3-6 months for 30 months. Seventy-two patients (HI = 30, IAsp = 42) with Type 1 diabetes, aged 2-17 years were included. Data on HbA(1c), insulin dose and serious adverse events (SAEs) were collected retrospectively., Results: IAsp-Ab levels remained low throughout the study. After 9 months, the level of HI-cross-Ab increased [mean (SD) HI, 48.8% (21.53); IAsp, 40.2% (17.92)] and remained elevated. Repeated measurement analysis of HI-cross-Ab levels showed no significant difference between treatments (P = 0.16). HI-cross-Ab were significantly associated with total insulin dose (U/kg) (P = 0.001) and time (P < 0.0001), but not with HbA(1c) (P = 0.24). Mean (+/- SD) HbA(1c) was similar at diagnosis (HI 9.5 +/- 1.97%; IAsp 9.6 +/- 1.62%); HbA(1c) then decreased and stabilized to about 6.0% in both groups. Few SAEs were reported, the majority being hypoglycaemic episodes., Conclusions: Treatment with IAsp and with HI was associated with an increase in HI-cross-Ab in insulin-naive children, but this did not influence treatment efficacy or safety. These results support the safe use of IAsp in children and adolescents with Type 1 diabetes.

Pulmonary ventilation and gas exchange were determined during prolonged skiing (approximately 76% of V(O2, max); cardiac output=26-27 L min(-1)) using diagonal technique (DIA) for 40 min followed by 10 min of double poling (DPOL) and 10 min of leg skiing (LEG). Exercise caused approximately 2-5% reduction of arterial oxygen saturation Sa(O2). For a given cardiac output and V(O2), DPOL presented higher V(E), lower Pa(CO2) and a more efficient pulmonary gas exchange, revealed by higher PA(O2) and Pa(O2) and lower A-aD(O2). The A-aD(O2) widened 2 mmHg L(-1) of cardiac output increase. However, for a given cardiac output and V(O2), exercise mode had an important influence on pulmonary ventilation and gas exchange. Highly trained cross-country skiers' present about 2 units reduction in Sa(O2) from resting values during submaximal exercise at 76% of V(O2, max). Half of the reduction in saturation is accounted for by the rightward-shift of the oxygen dissociation curve of the haemoglobin. The exercise duration has almost no repercussion on pulmonary gas exchange in these athletes, with the small effect on Sa(O2) associated to the increase in body core temperature.

Arterial desaturation during exercise is common in endurance-trained athletes, a phenomenon often more pronounced when the muscle mass engaged in the exercise is large. With this background, the present study monitored seven international-level cross country skiers performing on a treadmill while running (RUN), double poling (DP; upper body exercise) and diagonal skiing (DIA; arm and leg exercise). Static and dynamic lung function tests were performed and oxygen uptake was measured during submaximal and maximal exercise. Lung function variables (including the diffusion capacity) were only 5-20% higher than reported in sedentary men. Vital capacity was considerably lower than expected from the skiers' maximal oxygen uptake (VO(2max)), but the maximal ventilation followed a linear relationship with VO(2max). None or only a mild desaturation was observed in DP, RUN and DIA. Blood lactate concentration was slightly higher in DIA than in DP but not different from RUN. In DIA, VO(2max) was 6.23 +/- 0.47 L/min (mean +/- SD), which was 3.8% and 13.9% higher than in RUN and DP, respectively, with similar peak heart rates for the three exercise modes. No relationships were present either between the degree of desaturation and pulmonary functions tests, or with peak oxygen uptakes. The low blood lactate accumulation during the exhaustive efforts contributed to the arterial oxygen saturation being mild in spite of the very high oxygen uptake observed in these skiers.

Aim: To investigate if training during hypoxia (H) improves the adaptation of muscle oxidative function compared with normoxic (N) training performed at the same relative intensity., Method: Eight untrained volunteers performed one-legged cycle training during 4 weeks in a low-pressure chamber. One leg was trained under N conditions and the other leg under hypobaric hypoxia (526 mmHg) at the same relative intensity as during N (65% of maximal power output, W(max)). Muscle biopsies were taken from vastus lateralis before and after the training period. Muscle samples were analysed for the activities of oxidative enzymes [citrate synthase (CS) and cytochrome c oxidase (COX)] and mitochondrial respiratory function., Results: W(max) increased with more than 30% over the training period during both N and H. CS activity increased significantly after training during N conditions (+20.8%, P < 0.05) but remained unchanged after H training (+4.5%, ns) with a significant difference between conditions (P < 0.05 H vs. N). COX activity was not significantly changed by training and was not different between exercise conditions [+14.6 (N) vs. -2.3% (H), ns]. Maximal ADP stimulated respiration (state 3) expressed per weight of muscle tended to increase after N (+31.2%, P < 0.08) but not after H training (+3.2%, ns). No changes were found in state four respiration, respiratory control index, P/O ratio, mitochondrial Ca(2+) resistance and apparent Km for oxygen., Conclusion: The training-induced increase in muscle oxidative function observed during N was abolished during H. Altitude training may thus be disadvantageous for adaptation of muscle oxidative function.

We have developed high-throughput tests for the detection of the insulin gene region SNPs -23HphI and -2221MspI. The potential of these markers to enhance the efficiency of type 1 diabetes risk screening was then evaluated by analyzing them in Finnish and Swedish populations. Blood spots on filter paper were analyzed using PCR followed by sequence-specific hybridization and time-resolved fluorometry reading. Distribution of the genotypes at both positions differed significantly among the affected children compared to the controls. The risk genotypes (CC, AA) were significantly more common in Finland than in Sweden, both among patients and controls. The VNTR genotype homozygous for the protective class III alleles showed a significantly stronger protective effect than the heterozygote (p=0.02). Analyzing both SNPs enabled the detection of VNTR class III subclasses IIIA and IIIB. The observed significance between effects of the protective genotypes was due to the strong protective effect of the IIIA/IIIA genotype. IIIA/IIIA was the only genotype with significant discrepancy between protective effects compared to the other class III genotypes. These observations suggest that heterogeneity between the protective IDDM2 lineages could exist, and analyzing both -23HphI and -2221MspI would thus potentially enhance the sensitivity and specificity of type 1 diabetes risk estimation.

This study aimed at evaluating whether addition of extensive upper body training in well-trained cross country skiers induces an adaptation of the triceps brachii (TB) muscle and whether this affects performance. Muscle biopsies were obtained from TB muscle in six male elite cross country skiers before and after 20 weeks of increased upper body training. The cross-sectional area of type I and IIA fibers increased by 11.3% and 24.0%, respectively, and so did the number of capillaries per fiber (2.3-3.2) (all P<0.05). SDS-polyacrylamide electrophoresis revealed in single fibers that the number of fibers expressing myosin heavy chain (MHC) type I isoform decreased from 68.7% to 60.9% (P<0.05), MHC I/IIA isoform was unaltered, while MHC IIA fibers increased from 21.6% to 35.7% and the 4.8% MHC IIA/IIX disappeared with the training (both P<0.05). Citrate synthase and 3-hydroxyacyl coenzyme A dehydrogenase activities increased by 23.3% and 15.4%, respectively, and double poling 10 km time-trial by 10.4% (all P<0.05). The values for TB are similar to what has been demonstrated for leg muscles after exercise training. The subjects who demonstrated the largest improvement in performance exhibited the largest muscle adaptation, which, in turn, was related to the pre-maximal oxygen uptake.

Enteroviruses, particularly Coxsackie virus B4 (CVB4), are considered to be involved in the pathogenesis of type 1 diabetes. We wanted to compare the characteristics of T-cell immune response to CVB4 in children with type 1 diabetes and healthy children with and without HLA risk-associated haplotypes (HLA-DR3-DQ2 or HLA-DR4-DQ8) for type 1 diabetes. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured with CVB4 and analyzed for cytokine and chemokine receptors by flow cytometry and for expression of transcription factors Tbet and GATA-3 by RT-PCR and Western blot. Culture supernatants were analyzed for secretion of gamma-interferon (IFN-gamma). In children with type 1 diabetes, a decreased percentage of T-cells expressed CCR2, CXCR6, interleukin (IL)-18R, and IL-12Rbeta2-chain after in vitro stimulation with CVB4 in comparison with healthy children with or without HLA risk genotype. Moreover, we found that children with type 1 diabetes had decreased IFN-gamma secretion and expression of Tbet, both on mRNA and protein level, in CVB4-stimulated PBMCs. Accordingly, children with type 1 diabetes show an impaired type 1 immune response against CVB4 compared with healthy children. This may lead to a delayed clearance of the virus and, at least partly, explain why children with type 1 diabetes may be more prone to CVB4 infections and related complications, such as beta-cell damage.

Respiratory culture and multiplex PCR for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydophila pneumoniae were applied to sputum, nasopharyngeal swabs, and nasopharyngeal aspirates from 235 adult patients with community-acquired pneumonia and 113 controls. Both culture and multiplex PCR performed well with the different samples and appear to be useful as diagnostic tools.