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Metabolism provides the foundation for all cellular functions. During persistent infections, in adapted pathogenic bacteria metabolism functions radically differently compared with more naïve strains. Whether this is simply a necessary accommodation to the persistence phenotype or if metabolism plays a direct role in achieving persistence in the host is still unclear. Here, we characterize a convergent shift in metabolic function(s) linked with the persistence phenotype during Pseudomonas aeruginosa colonization in the airways of people with cystic fibrosis. We show that clinically relevant mutations in the key metabolic enzyme, pyruvate dehydrogenase, lead to a host-specialized metabolism together with a lower virulence and immune response recruitment. These changes in infection phenotype are mediated by impaired type III secretion system activity and by secretion of the antioxidant metabolite, pyruvate, respectively. Our results show how metabolic adaptations directly impinge on persistence and pathogenicity in this organism., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pedersen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Understanding metabolism is fundamental to access and harness bacterial physiology. In most bacteria, nutrient utilization is hierarchically optimized according to their energetic potential and their availability in the environment to maximise growth rates. Low-throughput methods have been largely used to characterize bacterial metabolic profiles. However, in-depth analysis of large collections of strains across several conditions is challenging since high-throughput approaches are still limited - especially for non-traditional hosts. Here, we developed a high-throughput dilution-resolved cultivation method for metabolic footprinting of Pseudomonas putida and Pseudomonas aeruginosa. This method was benchmarked against a conventional low-throughput time-resolved cultivation approach using either a synthetic culture medium (where a single carbon source is present) for P. putida or a complex nutrient mixture for P. aeruginosa. Dynamic metabolic footprinting, either by sugar quantification or by targeted exo-metabolomic analyses, revealed overlaps between the bacterial metabolic profiles irrespective of the cultivation strategy, suggesting a certain level of robustness and flexibility of the high-throughput dilution-resolved method. Cultivation of P. putida in microtiter plates imposed a metabolic constraint, dependent on oxygen availability, which altered the pattern of secreted metabolites at the level of sugar oxidation. Deep-well plates, however, constituted an optimal cultivation set-up yielding consistent and comparable metabolic profiles across conditions and strains. Altogether, the results illustrate the usefulness of this technological advance for high-throughput analyses of bacterial metabolism for both biotechnological applications and automation purposes., (© 2021 The Authors. Microbial Biotechnology published by Society for Applied Microbiology and John Wiley & Sons Ltd.)

Numerous studies have demonstrated that tardigrades in a resting state (tun state) are very resistant to exceptional stress levels in comparison with the resistance observed in multicellular organisms in general. The types of stress include desiccation and radiation, which are also relevant in astrobiological research, and therefore, tardigrades are used as multicellular model organisms. For example, tardigrades have been investigated in the TARSE, TARDIS, RoTaRad, and TARDIKISS projects; their survival has been evaluated according to stressful conditions that prevail in low earth orbit, including the effects of cosmic radiation and microgravity. Despite this interest, the study of tardigrade biology has been severely hampered by the sparsity of appropriate quantitative techniques that inform at the single-organism level. In this study, we present results on mass-specific respiration rates as a function of termination of anhydrobiosis and variations in temperature and salinity, including Mars-analog perchlorate solutions, by using microsensor technology to measure respiration. Based on our results for Richtersius cf coronifer , we estimated the activation energy (50.8 kJ/mole O 2 ) for its metabolism as well as Q10 for selected temperature intervals. Q10 was constant-∼1.5-between 2°C and 33°C, except for the interval 11-16°C, where Q10 was 5.5. The steady-state mass-specific respiration rate of individuals of Richtersius cf coronifer increased with increasing salinity below the lethal limit, likely representing the energy requirements of its osmoregulatory response. We report the first quantitative data of a tardigrade's metabolic dynamics during the termination of anhydrobiosis, revealing significant variation between individuals. However, we observed a general trend, that is, a high initial metabolic rate after exposure to water. Our approach would allow us to carry out quantitative physiological studies of tardigrades on board of the International Space Station, and thus significantly extend the possibility of studying the response of multicellular organisms in space. Summary statement This article reports on first measurements of mass-specific respiration rates of individual tardigrades of the species Richtersius cf coronifer during termination of anhydrobiosis as well as measurements of the impact of temperature and salinity on oxygen uptake rates.

Studies of tardigrade biology have been severely limited by the sparsity of appropriate quantitative techniques, informative on a single-organism level. Therefore, many studies rely on motility-based survival scoring and quantifying reproductive success. Measurements of O 2 respiration rates, as an integrating expression of the metabolic activity of single tardigrades, would provide a more comprehensive insight into how an individual tardigrade is responding to specific environmental factors or changes in life stages. Here, we present and validate a new method for determining the O 2 respiration rate (nmol O 2  mg -1  h -1 ) of single tardigrades under steady state, using O 2 microsensors. As an example, we show that the O 2 respiration rate determined in MilliQ water for individuals of Richtersius coronifer and of Macrobiotus macrocalix at 22°C was 10.8±1.84 and 13.1±2.19 nmol O 2  mg -1  h -1 , respectively., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2020. Published by The Company of Biologists Ltd.)

Aim: Mercury-in-silastic strain gauge pletysmography (SGP) is a well-established technique for blood flow and blood pressure measurements. The aim of this study was to examine (i) the possible influence of clinical clues, e.g. the presence of wounds and color changes during blood pressure measurements, and (ii) intra- and inter-observer variation of curve interpretation for segmental blood pressure measurements., Methods: A total of 204 patients with known or suspected peripheral arterial disease (PAD) were included in a diagnostic accuracy trial. Toe and ankle pressures were measured in both limbs, and primary observers analyzed a total of 804 pressure curve sets. The SGP curves were later reanalyzed separately by two observers blinded to clinical clues. Intra- and inter-observer agreement was quantified using Cohen's kappa and reliability was quantified using intra-class correlation coefficients, coefficients of variance, and Bland-Altman analysis., Results: There was an overall agreement regarding patient diagnostic classification (PAD/not PAD) in 202/204 (99.0%) for intra-observer (κ = 0.969, p < 0.001), and 201/204 (98.5%) for inter-observer readings (κ = 0.953, p < 0.001). Reliability analysis showed excellent correlation between blinded versus non-blinded and inter-observer readings for determination of absolute segmental pressures (all intraclass correlation coefficients ≥ 0.984). The coefficient of variance for determination of absolute segmental blood pressure ranged from 2.9-3.4% for blinded/non-blinded data and from 3.8-5.0% for inter-observer data., Conclusion: This study shows a low inter-observer variation among experienced laboratory technicians for reading strain gauge curves. The low variation between blinded/non-blinded readings indicates that SGP measurements are minimally biased by clinical clues.

Introduction: It has been hypothesised that return to work rates among sick-listed workers increases with enterprise size. The aim of the present study was to estimate the effect of enterprise size on the odds of returning to work among previously employed stroke patients in Denmark, 2000-2006., Methods: We used a prospective design with a 2 year follow-up period. The study population consisted of 13,178 stroke patients divided into four enterprise sizes categories, according to the place of their employment prior to the stroke: micro (1-9 employees), small (10-49 employees), medium (50-249 employees) and large (>250 employees). The analysis was based on nationwide data on enterprise size from Statistics Denmark merged with data from the Danish occupational hospitalisation register., Results: We found a statistically significant association (p = 0.034); each increase in enterprise size category was followed by an increase in the estimated odds of returning to work., Conclusions: The chances of returning to work after stroke increases as the size of enterprise increases. Preventive efforts and research aimed at finding ways of mitigating the effect are warranted.

Background: The proportion of old people in need of care is growing rapidly in most western societies, and there is a rising demand for qualified eldercare workers in the years to come. Hence, solutions to high turnover in the eldercare sector are becoming increasingly important., Aim: To test whether bullying, violence and/or threats of violence (violence) among health care trainees are predictors of subsequent dropout from the eldercare sector 2 years after graduation from college., Methods: A questionnaire was given to all health care trainees in Denmark approximately 2 weeks before their graduation in 2004. Female respondents (N = 5000) were followed in national employment registers to see whether they had dropped out of the eldercare sector by the end of 2006. Logistic regression was used to model the outcome., Results: Among the respondents, 5.5% had been bullied during the training period, 9.1% had been subjected to violence. Hereof, 1% reported exposure to both bullying and violence. At follow-up, 37% had dropped out of the eldercare sector. The odds of dropout were significantly associated with bullying, OR = 1.39 (95% CI: 1.08-1.79), but not with violence, OR = 0.89 (95% CI: 0.72-1.09)., Conclusion: Being bullied while in training as a health care worker is a predictor of subsequent dropout from the eldercare sector., (© 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.)

Thirty four varieties of sour cherries (Prunus cerasus) were investigated for their total antioxidant activity, Caco-2 cancer cell proliferation inhibitory activity and effect on prostaglandin E2 (PGE2) production. Total phenolic content, oxygen radical absorbance capacity (ORAC) and cancer cell proliferation inhibitory activity of sour cherries were closely correlated but not PGE2 production. The cultivars 'Birgitte × Böttermö', 'Fanal' and 'Tiki' were the three cultivars with the highest ORAC values (180, 147 and 133 µmol TE/g, respectively) and inhibition against Caco-2 cancer cell proliferation (74%, 79% and 73%, respectively). 'Stevnsbaer Birgitte' (22%) and 'Stevnsbaer Viki' (22%) inhibited PGE2 production with a similar potency as the positive controls indomethacin and NS-398. Significant differences between cultivars in all bioactivity experiments indicated that selection of cultivars is important to obtain sour cherries with better potential health promoting effects., (Copyright © 2012 John Wiley & Sons, Ltd.)

Juice was manufactured from seven different sour cherry clones/cultivars and evaluated by quantitative descriptive sensory analysis and (1)H NMR spectroscopy. The sensory evaluation showed a large variation in several sensory attributes between the sour cherry clones/cultivars, which could be divided into two groups on the basis of both the sensory data and the NMR spectroscopic data. These groups were closely related to the genetic background of the clones. Kelleris clones were distinctly different from Stevnsberry and Fanal clones. Hence, (1)H NMR spectroscopic data seem to correlate with sensory quality of different sour cherry clones. In addition, malic acid was the most important metabolite for modeling the two highly correlated sensory attributes sweetness and sourness, whereas the glucose content had a slight effect and the fructose content had no impact on sweetness/sourness. Other metabolites (ethyl acetate, asparagine, ethanol) could be correlated with sensory attributes; however, a direct causal connection could not be established.

Background: In most countries throughout the world the construction industry continues to account for a disturbingly high proportion of fatal and nonfatal injuries. Research has shown that large enterprises seem to be most actively working for a safe working environment when compared to small and medium-sized enterprises. Also, statistics from Canada, Italy and South Korea suggest that the risk of injury among construction workers decreases with enterprise size, that is the smaller the enterprise the greater the risk of injury. This trend, however, is neither confirmed by the official statistics from Eurostat valid for EU-15 + Norway nor by a separate Danish study - although these findings might have missed a trend due to severe underreporting. In addition, none of the above mentioned studies controlled for the occupational distribution within the enterprises. A part of the declining injury rates observed in Canada, Italy and South Korea therefore might be explained by an increasing proportion of white-collar employees in large enterprises., Objective: To investigate the relation between enterprise size and injury rates in the Danish construction industry., Methods/design: All male construction workers in Denmark aged 20-59 years will be followed yearly through national registers from 1999 to 2006 for first hospital treated injury (ICD-10: S00-T98) and linked to data about employment status, occupation and enterprise size. Enterprise size-classes are based on the Danish business pattern where micro (less than 5 employees), small (5-9 employees) and medium-sized (10-19 employees) enterprises will be compared to large enterprises (at least 20 employees). The analyses will be controlled for age (five-year age groups), calendar year (as categorical variable) and occupation. A multi-level Poisson regression will be used where the enterprises will be treated as the subjects while observations within the enterprises will be treated as correlated repeated measurements., Discussion: This follow-up study uses register data that include all people in the target population. Sampling bias and response bias are thereby eliminated. A disadvantage of the study is that only injuries requiring hospital treatment are covered.

Background: Successful return to work is regarded as one of the most important outcome factors for working-age post stroke patients. The present study will estimate the effect of various predictors on the odds of returning to work after stroke. Nearly twenty thousand 20-57 year-old stroke patients in Denmark who were gainfully occupied prior to the stroke will be included in the study., Methods/design: Stroke patients will be followed prospectively through national registers. Multi-level logistic regression will be used to model the odds of being gainfully occupied ca. two years after the stroke as a function of the following predictors: Age (20-49 years, 50-57 years) gender, occupational class, self-employment (yes; no), onset calendar year (1996, 1997, ..., 2006), diagnosis (subarachnoid haemorrhage; intracerebral haemorrhage; cerebral infarction; stroke, not specified as haemorrhage or infarction) and 'type of municipality' (the variable is set to 1 if the person lived in a municipality which had a brain injury rehabilitation centre at the time of the stroke. Otherwise it is set to 0). Municipalities will be treated as the subjects while individual observations within municipalities are treated as correlated repeated measurements., Discussion: Since our follow-up is done through registers and all people in the target population are included, the study is free from sampling bias, recall bias and non-response bias. The study is also strengthened by its size. The major weakness of the study is that it does not contain any stroke severity measures. Thus, it cannot accurately predict whether a particular stroke patient will in fact return to work. The study is, however, quite useful from a public health perspective. It can be used to estimate the proportion of patients in a certain group that is expected to return to work, and thereby provide a comparison material, which e.g. municipalities can use to evaluate their success in returning their stroke patients to work.

Background: Owing to high injury rates, safety interventions are needed in the construction industry. Evidence-based interventions tailored to this industry are, however, scarce. Leader-based safety interventions have proven more effective than worker-based interventions in other industries., Objective: To test a leader-based safety intervention for construction sites. The intervention consists of encouraging safety coordinators to provide feedback on work safety to the client and line management. The intention is to increase communication and interactions regarding safety within the line management and between the client and the senior management. It is hypothesised that this, in turn, will lead to increased communication and interaction about safety between management and coworkers as well as an increased on-site safety level., Setting: A group-randomised double-blinded case study of six Danish construction sites (three intervention sites and three control sites). The recruitment of the construction sites is performed continuously from January 2010 to June 2010. The investigation of each site lasts 20 continuous weeks., Methods: Confirmatory statistical analysis is used to test if the safety level increased, and if the probability of safety communications between management and coworkers increases as a consequence of the intervention. The data collection will be blinded. Qualitative methods are used to evaluate if communication and interactions about safety at all managerial levels, including the client, increase., Outcome Measures: (1) The proportion of safety-related communications out of all studied communications between management and coworkers. (2) The safety level index of the construction sites.

Objectives: To estimate proportions of injuries that are attributable to the work environment (excess fractions) among economically active men and to identify industries associated with an elevated injury risk., Methods: A follow-up study was conducted among all economically active men in Denmark aged 20-59 yr 1 January 1999 (N=1,315,772) for first hospital contacts in the period 1999-2003 due to injury in five body regions. Age standardised hospital treatment ratios (SHR) were calculated by industry and excess fractions were estimated., Results: The excess fractions by body region attributable to the work environment were: 22% (95% CI 18-26%) for lower extremities, 29% (95% CI 24-34%) for head and neck, 31% (95% CI 25-37%) for thorax, 36% (95% CI 30-43%) for upper extremities, and 39% (CI: 32-46%) for back injuries. We identified eight industries associated with significantly elevated risks for injuries to each of the five body regions. These were: "road contractors", "bricklayer, joiner, and carpentry work", "finishing (construction work)", "transport of goods", "fire service and salvage corps", "stone-works, pottery, and glass industry", "cleaning, laundries, and dry cleaners", and "slaughterhouse industry"., Conclusions: There are substantial industrial inequalities in injury rates among male workers in Denmark. The size of the inequalities differs between body regions.

Purpose: Intestinal activity at the inferior myocardial wall represents an issue for assessment of myocardial perfusion imaging (MPI) with 99mTc-labelled tracers. The aim of this study was to investigate the effect of time and food on upper abdominal activity in 99mTc-tetrofosmin MPI., Methods: The study population consisted of 152 consecutive patients referred for routine MPI. All patients underwent 2-day stress-rest 99mTc-tetrofosmin single-photon emission computed tomography MPI. Before stress testing, patients were randomized in a factorial design to four different regimens. Group A: early scan (image acquisition initiated within 15 min after injection of the tracer) and no food; group B: early scan and food (two pieces of white bread with butter and a minimum of 450 ml of water); group C: late scan (image acquisition 30-60 min after injection of the tracer) and no food; and group D: late and scan with food. Patients underwent standard bicycle exercise or pharmacological stress test. The degree of upper abdominal activity was evaluated by trained observers blinded to the randomization code. The primary endpoint was the proportion of accepted scans in the intention-to-treat population in stress MPI., Results: The results showed statistical significant impact on both time and food on upper abdominal activity. The primary endpoint showed that the acceptance rate improved from 55% in group A to 100% success rate in group D. An early scan reduced the acceptance rate by 30% versus a late scan [hazard ratio 0.70, 95% confidence interval 0.58-0.84; P<0.0001], whereas the addition of food improved the success rate versus no food by 27% (hazard ratio 1.27, 95% confidence interval 1.07-1.51; P=0.006). No significant interaction between food and time was observed. An analysis of accepted scans according to the actual scan time and food consumption confirmed the findings of the intention-to-treat analysis. In addition, similar findings were seen in 116 of 152 patients with a rest MPI (success rate of 53% in group A vs. 96% in group D)., Conclusion: A combination of solid food and water administered after injection of the tracer and delayed image acquisition led to significant and clinically relevant decrease of interfering upper abdominal activity in 99mTc-tetrofosmin MPI.

Weight loss seems associated with a decrease in bone mineral density (BMD) as measured by absorptiometry, which may be the result of accuracy errors caused by differences in soft tissue between non-bone and bone pixels. The aim was to study the abdominal fat% and thickness in regions corresponding to non-bone, soft tissue-only and bone pixels for spinal BMD measurements by dual energy X-ray absorptiometry (DXA), and to calculate the theoretical errors in measurement of changes in BMD by DXA as a result of changes in soft tissue heterogeneity with weight loss. Abdominal computed tomography (CT) and DXA scans were performed in 34 obese subjects (42.1+/-10.1 years (mean +/- SD), wt: 102.1+/-12.8 kg and BMI: 36.6+/-3.8 kg m(-2)) before and after weight loss (11.3+/-6.9 kg after 1 year). There were some significant differences in fat% and thickness of soft tissue between abdominal regions corresponding to non-bone and bone pixels, respectively, for spinal BMD measurements by DXA, both before and after weight loss. With weight loss there were some changes in the soft tissue heterogeneity, which caused a minor theoretical error (apparent, but false decrease of 1-2%) of borderline significance for the anterior-posterior (AP) spinal BMD by DXA.

Goal orientation theory and competence motivation theory were used to examine the relationships between young athletes' achievement goals and indices of somatic and cognitive trait sport competition anxiety. Included in these analyses were also the potential mediating and moderating role of the athletes' perceived competence in sport. We examined 136 young athletes aged 13 to 18 years involved in organized sport within a community in northern Norway. Whereas no association was found between an ego oriented achievement goal and indices of anxiety, multiple regression analyses revealed that both a high task goal orientation and high perceived sport competence predicted a reduced tendency to report cognitive anxiety when competing in sport. In addition, athletes who perceived their competence in sport as high were found to be less predisposed to experiencing somatic anxiety in the form of elevated physiological arousal when competing than those who doubt their competence. The results further showed that perceived competence did not mediate or moderate the relationships between achievement goal orientations and somatic and cognitive indices of trait sport competition anxiety. The findings suggest that being task oriented in sport as well as having a sense of being competent are important in order to prevent sport competitions giving rise to elevated cognitive anxiety in young athletes.

Study Objective: The study details our preliminary experience with endoscopic ultrasonography (EUS) guided fine-needle aspiration biopsy (FNAB) of mediastinal masses suspected of malignancy., Design: Prospective uncontrolled study., Patients: Nine patients had lesions suspected of malignancy ranging from 1 to 9 cm in diameter in various locations of the mediastinum., Interventions: The EUS examination was performed with a gastroscope (Hitachi/Pentax FG-32 UA) equipped with an adjustable 5- or 7.5-MHz curved array ultrasonic transducer. The scanning plane is in the long axis of the endoscope allowing endosonographically guided biopsy to be performed. A 21-gauge (0.8 mm), full-length steel needle housed in a biopsy handle (type: Hancke/Vilmann; GIP-Medizin Technik; Grassau, Germany) was used for the biopsies., Results: Nine patients had biopsy specimens taken from 13 lesions. The total number of needle passes was 18 (range, 1 to 3; median, 1.4). The cytologic diagnosis was conclusive for cancer in ten lesions and consistent with a benign lesion in three lesions. All ten malignant diagnoses and two benign diagnoses were confirmed either by operation or follow-up. In the last patient with lung cancer, a final diagnosis of the EUS-guided biopsy of an enlarged lymph node could not be obtained. No false-positive or negative biopsy diagnoses were recorded. The biopsy procedure was well tolerated by all patients, and there were no complications., Conclusions: EUS-guided aspiration biopsy is a significant advance in the differentiation between malignant and benign lesions of the mediastinum carrying a high diagnostic potential.

Rates of growth, protein synthesis and oxygen consumption were measured in herring larvae, Clupea harengus, in order to estimate the contribution that protein synthesis makes to oxygen consumption during rapid growth at 8°C. Protein synthesis rates were determined in larvae 9 to 17 d after hatching. Larvae were bathed in (3)H phenylalanine for several hours and the free pool and protein-bound phenylalanine specific radioactivities were determined.Fractional rates of protein synthesis increased 5 to 11 fold with feeding after a period of fasting. Efficiencies of retention of synthesized protein were approximately 50% during rapid growth. Rapid growth in herring larvae thus appears to be characterized by moderate levels of protein turnover similar to those obtained for larger fish. Increases in growth rate occurred without changes in RNA concentration, i.e., the larvae increased the efficiency of RNA rapidly. Oxygen consumption rates were not correlated with growth rates. Protein synthesis was estimated to account for 79% of the oxygen consumption, and energy costs of protein synthesis were high, i.e., about 98 mmole O2 g(-1) protein synthesized.

A method of endoscopic ultrasonography (EUS) with guided needle aspiration biopsy for conclusive diagnosis of a mediastinal mass lesions is described. The technique might prove useful for diagnosis of solid mass lesions in the mediastinum including diagnosis of lymph nodes for preoperative staging of lung cancer.

Until recently, direct imaging of the Achilles tendon has been proved difficult. CT scanning was performed in three patients with Achilles tendon pain. The authors find that CT scanning is of diagnostic value but further experience is required.

To obtain information on possible determinants of weight loss after horizontal gastroplasty, pouch emptying was prospectively investigated in 27 morbidly obese patients. A scintigraphic method was used. Examinations were carried out every 6 months until 2 years after surgery. Pouch emptying was described by means of delay, time until half emptying, mean transit time, and emptying rate. The measures all showed a significant (p less than 0.05) acceleration of pouch emptying during the first 6 months after gastroplasty. Thereafter pouch emptying was unaltered. No significant association could be detected between measures of pouch emptying and weight loss. From calculation of 95% confidence intervals for coefficients of correlation it proved very unlikely that pouch emptying is an important determinant of weight loss.

Pouch volume, stoma diameter, and pouch emptying rate were measured postoperatively and after 6 months in 45 morbidly obese patients who had been assigned to either horizontal gastroplasty (HGP) or vertical banded gastroplasty (VBGP) after pretreatment with diet alone. Pouch volume and stoma diameter were measured by a standardized radiographic method with blinded assessment by two observers. Pouch emptying rate was determined by a standardized scintigraphic method and expressed as the mean transit time (t60). Pouch volume and stoma diameter did not change, whereas t60 decreased by 36% during the first 6 months after HGP (p less than 0.001). Pouch volume was larger after HGP (p less than 0.001). Pouch emptying was faster after VBGP (p less than 0.001), but these patients had the better weight loss (p less than 0.001). Variation in weight loss after either operation was unrelated to pouch volume, stoma diameter, and t60. Stoma diameter was not correlated with t60. The study provides further evidence against the significance of stoma diameter and pouch emptying rate as determinants of weight loss after gastroplasty. The much smaller pouch volume after VBGP may favor weight loss.

This study investigated possible determinants of food intake change after gastroplastry. Preoperatively and 6 and 12 months postoperatively, 27 morbidly obese patients were prospectively examined with 7-day food registration and radiologic measurement of pouch volume and stoma diameter. Pouch emptying was determined as the mean transit time by a scintigraphic method. None of the measured variables was found to influence the change in food intake taking place during the first 6 months, when most of the weight loss was observed. Between 6 and 12 months, the change of stoma diameter was positively associated with the change of solid foods consumed (by weight, p = 0.01; by energy content, p = 0.02). The change of pouch volume was negatively associated with the change of energy from beverages (p = 0.005). In conclusion, it seems impossible to tailor the reduction of food intake through adjustments of the surgical dimensions, at least within the ranges of our observations. Increased food consumption and decreased energy intake with beverages may be caused by late dilations, or vice versa.

In gastroplasty and gastric bypass procedures for obesity much importance has been attached to obtaining a small fundic pouch combined with a narrow outlet, factors considered to determine weight loss. The present study is a prospective investigation of the influence of these stomach dimensions on the clinical outcome. With a standardized radiological procedure 72 examinations were carried out in 27 patients during the first 18 months after gastroplasty by the method of Gomez. Median pouch volume and stoma diameter were unaltered through the observation period. Early pouch volumes ranged from 51 to 244 ml, and stoma size ranged from 6 to 24 mm after 6 months. Within these limits pouch and stoma size were not significantly correlated to the weight loss obtained. Other factors seem to be of major importance for the weight-reducing effect of gastroplasty.

The dietary habits and defecation patterns of 12 patients were examined 8-34 months after total colectomy with mucosal proctectomy and the construction of an ileal reservoir attached to an anal anastomosis. The reservoir was provided with a long efferent leg (12 cm) through the anal canal. The patients were divided into two groups in accordance with the frequency of defecation--one with fewer than six defecations per 24 h and another with more than six defecations per 24 h. The fecal output, however, was not significantly different in the two groups. The fecal content of sodium and potassium was the same as in feces from conventional ileostomies. The dietary intake was insufficient in energy content, vitamins, minerals, and trace elements. Dietary supplement was recommended.

Bile acid metabolism was studied by means of the fractional turnover rate or orally ingested 14C-labeled taurocholic acid and by gas chromatographic determination of fecal excretion of the bile acids cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), and lithocholic acid (LCA). Thirty patients with Crohn's disease (CD) of the small bowel, of whom 19 had been operated on with limited ileal resections, were studied and compared with 11 healthy volunteers. The unoperated group of CD patients did not show significant increase in bile acid excretion in the stools in contrast to the CD patients with ileal resection. The fecal excretion consisted mostly of primary bile acids, and a significant correlation between length of resection and bile acid excretion was found (rs = 0.81, p less than 0.01). The fractional turnover rate of CA + DCA was significantly increased in both unoperated (0.21 l/day) and operated (0.44 l/day) patients compared with normal controls (0.06 l/day). The bile acid pool of CA + DCA, however, was normal in patients with ileal resections, indicating a compensatory increase in bile acid synthesis. In unoperated patients the bile acid pool of CA + DCA was slightly decreased (3.1 mmol) compared with operated patients (6.2 mmol) and normal controls (4.8 mmol). The pool size was not significantly correlated to mean transit time of dietary residue, feces excretion, loss of weight, or amount of fat in feces. The mean transit time of dietary residue was decreased in both operated and unoperated CD patients.

In a prospective, blinded study we investigated 30 patients with Crohn's disease (CD) and 27 normal controls by means of dynamic grey-scale ultrasound scan. Within a few weeks the patients were also examined by radiography of the small bowel. Of the 30 patients, 21 had CD lesion of the small bowel as judged by radiography. A target lesion at the ultrasound scan indicating thickened bowel wall was seen in 15 CD patients, of which 14 showed radiographic signs of CD in the ileum and/or right side of the large bowel, whereas one had normal radiographic findings. Seven patients out of 15 without sonographic changes had radiographic signs of CD. The patients with discrepancy between the two examinations could not be clinically characterized as an entity. None of the 27 normal controls showed signs of intestinal disease at the ultrasound examination. We conclude that dynamic grey-scale ultrasound examination is a new tool in depicting the CD lesion, but it does not seem to be able to replace the radiographic examination. However, it may find a place in the follow-up study of patients with known CD, thereby avoiding repeated radiographic examinations. Furthermore, the possibility of diagnosing abscesses and fistulae by sonography is well known and has relevance in CD.

Biliary metabolism in 11 patients with ileum reservoirs with anal anastomosis and a long efferent leg was studied. Eleven healthy persons served as controls. A significantly higher excretion of bile acids was found in the patients, but they seemed to have a normal cholic acid pool size. The bile acids excreted were cholic acid and chenodeoxycholic acid, the so-called primary bile acids, for more than 90%, whereas the normal controls mainly excreted secondary bile acids (deoxycholic acid and lithocholic acid). Fat excretion was generally not increased in the group but was above normal in two patients. Vitamin B12 absorption was subnormal in two patients and was not correlated to bile acid excretion. Bile acid excretion was not correlated to the weight of feces. The bacterial flora was more feces-like than would have been expected from a normal terminal ileum but was correlated neither to the bile acid excretion nor to the quantity of feces. We conclude that the patients showed dysfunction of the terminal ileum with regard to biliary acid absorption comparable to that found in patients with partial ileal resections.