SODIUM/IODIDE SYMPORTER-NIS Abundant and Important in Gastric Mucosa

ABSTRACT Background: Iodine is essential for development and growth as a constituent in thyroid hormones. Biological mechanisms for iodide uptake and concentration are very important, espe-cially as iodine is a relatively scarce element. Active iodide transport into thyroid fol-licular cells is mediated by the sodium/iodide symporter (NIS), powered by Na+/K+-ATPase. NIS is expressed also in extra thyroidal tissues, most abundantly in gastric mucosa - the focus of this thesis. Cellular localisation of NIS: NIS expression was found basolaterally in gastric mucosal surface cells of several mammals including man, basolaterally in salivary gland ducts and apicolaterally in rat bile ducts. Weak NIS immunoreactivity was found basolaterally also in duodenal mucosal surface cells. Findings in gastric mucosa and salivary glands were confirmed by in situ hybridisation. Gastric iodide transport Considerable secretion of iodide from the bloodstream into the stomach, but negligi-ble uptake from the stomach, was shown in vivo and in vitro in rat using 125I as marker. In the Ussing-chamber in vitro system both the competitive NIS-inhibitor sodium perchlorate (NaClO4) and the Na+/K+-ATPase-inhibitor ouabain attenuated gastric iodide transport from serosal to mucosal side, proving that gastric iodide se-cretion is, to a large extent, mediated by NIS. NIS in MNNG-induced tumours: Gastric cancer was chemically induced in rats by the administration of N-methyl-N’-nitro-N-nitrosoguanidine (MNNG) in the drinking water. Multiple microadenomas as well as large adenomas were found in the stomachs of all MNNG-treated rats. The surface epithelium of gastric adenomas was NIS immunoreactive, but staining was less intense than in normal mucosa. In addition, almost all of the MNNG-treated animals displayed either large papillary cystadenomas in the liver, found to express NIS with varying staining intensity, and/or infiltrating carcinomas of Brunner’s glands, which did not express NIS. Conclusions: • NIS is abundantly expressed in gastric mucosa and also expressed in salivary gland and bile duct epithelium. • Iodide secretion into the gastric lumen is mediated by NIS. There are several theo-ries as to the function of this transport including mediating recirculation of io-dide, as well as securing presence of iodide in the stomach for antimicrobial or an-tioxidative purposes. • MNNG-induced tumours in gastric mucosa and bile ducts all express NIS, which might make radioiodine an aid in treatment and diagnosis of these cancer types

Exploring the role of sexual attitude reassessment and restructuring (SAR) in current sexology education: for whom, how and why?

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.As concerns about sexual and reproductive health and rights become integrated into public health policies, the demand for higher education in sexology rises. There is a need therefore to evaluate established pedagogical methods to ensure that they are relevant, efficient and lead to valuable competencies. This study explored the current evidence and pedagogical relevance for Sexual Attitude Reassessment and restructuring (SAR) as part of professional higher education in sexology. A systematic review was conducted with eleven included publications. Data were synthesised across studies and presented narratively. The publications were generally old and derive from a small pool of researchers geographically centred to the USA. Several studies were based on small numbers of participants, display a great variety in types of participants, use different evaluation instruments (mostly unvalidated), and a variety of methods to measure the results of SAR. Furthermore, long-term follow-up has been rare. Extensive, highquality, and up-to-date research for SAR as an effective pedagogical method for use in sexology higher education for professionals today is lacking. Digital solutions focusing on broadening students sexological self-awareness appear more feasible than SAR, and suitable pedagogical and digital solutions need to be developed and evaluated to ensure high-quality teaching of sexology in higher education.publishedVersio

Different groups of colic and their correlation to parasites

Parasitrelaterad kolik hos häst är ett alltmer aktuellt ämne. Sedan en mer restriktiv avmaskningsregim antogs 2007 i Sverige har djursjukhus och djurhälsopersonal rapporterar om en ökande förekomst av inälvsparasiter i samband med bukoperation. Den restriktiva avmaskningen syftar till att minska resistensutvecklingen hos parasiterna genom att endast avmaska de hästar där träckprov visar att behov finns. På senare år har det kommit studier som försöker studera ett eventuellt samband mellan den restriktiva avmaskningen och sjukdomsfall. En dansk studie har påvisat ett samband mellan en ökad förekomst av S. vulgaris på gårdar som använder sig av den restriktiva avmaskningsregimen. En annan dansk studie har visat på ett samband mellan förekomst av Strongylus vulgaris (stor blodmask) och icke strangulerande kolik. Den här studien är en fortsättning på den fall-kontroll studie Mörby (2017) gjorde med 72 kolikfall och 72 tillhörande kontroller som inkom till ett svenskt hästsjukhus under februari 2016 till och med november 2016. Denna studie innefattar endast fallhästarna, alltså de med koliksymtom, och innehåller ytterligare 13 hästar då studien fortsatte till och med januari 2017, totalt ingår 85 hästar i studien. De parametrar som undersöktes var EPG (eggs per gram faeces), typ av parasitinfektion, tid till avmaskning, avmaskningsrutin och -preparat samt om individen varit infekterad av stora blodmasken de senaste 24 månaderna. I Mörbys studie var samtliga kolikhästar klassificerade med diagnosen ospecificerad kolik. Med endast fallhästarna kvar har journalerna studerats och kolikdiagnoserna har delats upp i ospecificerad, strangulerande, icke strangulerande och en grupp för övriga koliker, baserat på vilken diagnos kod veterinären har noterat i journalen. Syftet är att se om det finns ett samband mellan parasitförekomst och kolikdiagnoserna enligt uppdelningen ovan. Det fanns en signifikant skillnad vad gäller förekomsten av cyathostominer för ospecificerad kolik (95 %) jämfört med icke strangulerande kolik (56 %), vilket skulle kunna vara en antydan till att cyathostominer framförallt ger symtom i form av mildare och övergående kolik. Mer studier behövs för att vidare utreda signifikansen i teorin. Ett annat intressant resultat, som dock inte var signifikant, var att bandmask (Anaplocephala perfoliata) förekom i högre grad hos hästar som var avmaskade inom 3 månader jämfört med de hästar som var avmaskade för över tre månader sedan. Även om resultatet saknade signifikans så väcker det frågan om de hästar som var avmaskade inom 3 månader var avmaskade med ett preparat mot bandmask eller ej. Användandet av träckprov som indikator för parasitförekomst har vissa begränsningar som ett kliniskt verktyg vid kolik. Framförallt är tidpunkt för när provet tas väldigt avgörande och det ställer krav på veterinärer och djurägares kunskaper om parasitens livscykel för att möjliggöra en korrekt bedömning av resultatet. Träckprov fungerar bra som förebyggande parasitkontroll men ej som diagnostisk metod på klinik då det tar tid innan svar erhålles och tidpunkten för provtagningen går inte att påverka. När parasitäggen detekteras i faeces så är livscykeln redan fullbordad och för blodmaskarna är det de migrerande larverna som är patogena. Diagnostiken för koliker utan buköppning är idag relativt ospecifik och i kombination med en provtagningsform för parasitförekomst som främst visar på vuxna larver försvåras tolkningen av resultaten i denna och flera andra studier inom området.The interest for parasite related colic is a growing isue. Due to resistance to anthelmintic drugs among parasites was a more restrictive approach towards the usage of anthelmintic drugs was introduced in Sweden 2007. During the last years have animal hospitals and animal health personnel have reported an increase in intestinal parasites related to abdominal surgery. The restrictive usage (selective treatment) of anthelmintic drugs aims to decrease the resistance of intestinal parasites by analyzing parasitic burden in fecal sample and only deworm the horses that are infected with endoparasites. A Danish study observed a correlation with high prevalence Strongylus vulgaris on study farms that applied selective treatment. Another study showed an association of S. vulgaris infection and non-strangling colic. This student project is a proceeding of the case-control research by Mörby (2017) which studied 72 horses with colic and 72 without colic who visited a Swedish horse hospital between February 2016 and November 2016. This study includes only the horses with colic from Mörby’s study and another 13 horses that was added because the study continued until January 2017, with a total number of 85 horses. The parameters that were studied was EPG, parasite species, time for deworming, deworming routines and anthelmintic drugs used and if the horse have been infected with S. vulgaris during the last 24 months. In Mörby’s study all of the colic diseased horses were labeled as unspecified colic. By evaluating the journals of the case-horses, the colic diseased horses were divided into unspecified, strangulated, non-strangulated and other colics. The purpose is to investigate if there is a correlation that can be observed when the colic has been divided into groups, which didn’t show when all cases of colic were unspecified. One significant difference that this report demonstrates is the presence of cyathostominae for unspecified colic (95%) and non-strangulated colic (56%), which could imply that cyathostominae particularly give more lenient symptoms and passing colic. To further investigate the theory more studies must be conducted. Another interesting result in this study was the higher prevalence of Anoplocephala perfoliata (tapeworm) in the horses that were dewormed within three months compared to the horses that were dewormed for more than three months. There was, however, no significant difference, but the result is enough to raise the question if the horses that had been dewormed within three months were treated with a drug effective against tapeworms or not. The usage of fecal samples on the clinic as an indicator of parasite infection has its limits as only the adult worms that produce eggs can be detected and it is the migrating larvae that cause the colic. The time of fecal sample is of great significance and require knowledge among veterinarians and owners about the parasites life-cycle to enable a correct assessment. Fecal samples are a good tool for preventing parasite management of bloodworms on a farm but not as a diagnostic method in clinics due to the time difference between the result and the time of the sampling, which cannot be influenced

Tramadol - veterinärmedicinsk placebo?

Tramadol är en centralt verkande opioid vars smärtlindrande effekt främst anses bero av två mekanismer. Dels en svag affinitet för μ-receptorn men även en inhiberande effekt på återupptaget av och en stimulerande effekt på den cellulära frisättningen av serotonin och noradrenalin. Till strukturen liknar tramadol kodein och morfin men affiniteten för μ-receptorn är 10 gånger lägre jämfört med kodein och 6000 gånger lägre jämfört med morfin. Vid metabolisering i levern bildas en aktiv metabolit, mono-o-demethyltramadol (M1), som har en 200 gånger högre affinitet för μ-receptorn jämfört med tramadol. Hos människa anses M1 ha en stor del i den analgetiska effekten. Tramadol är ett mycket använt läkemedel inom humanmedicin vid lindrig till måttlig, akut och kronisk smärta, mycket på grund av lindrig påverkan på respirationen jämfört med andra opioider samt en god biotillgänglighet som möjliggör oral administrering. Detta har också lett till att tramadol har blivit allt vanligare som smärtlindring inom veterinärmedicinen trots att det inte finns några veterinärmedicinska läkemedel innehållande tramadol. Doseringen blir därför en extrapolering av doserna uträknade från studier gjorda på människor. Den här studiens syfte är att utreda om det finns någon vetenskaplig grund för användandet av tramadol inom veterinärmedicinen genom att jämföra studier av metabolism, biverkningar och analgesi. En annan enzymaktivitet jämfört med människa gör att hos häst är M2 den dominerande metaboliten medan hos hund är det både M2 och M5. För bägge djurslagen detekteras M1 bara i låga plasmakoncentrationer. Varken M2 eller M5 har påvisats farmakologiskt aktiva vilket gör att den analgesin som påvisats i studier verkar komma från modersubstansen tramadol. I ett fåtal studier har forskargruppen direkt utvärderat den analgetiska effekten medan andra har använt den för människa uträknade minsta plasmakoncentrationen av M1 associerad med analgesi för att bedöma effektiviteten. Tramadol har oönskade effekter på hund men framförallt på häst vilket indikerar att tramadol är farmakologiskt aktivt på djurslagen. Det finns även indikationer på att tramadol har en smärtlindrande effekt hos hund och häst som inte beror av den aktiva metaboliten M1 men det råder ännu oklarheter i graden av analgesi samt den bakomliggande verkningsmekanismen. Det krävs framtida studier som utreder eventuell aktivitet även hos konjugerat tramadol samt jämförelser med andra analgetiska läkemedel för att få en tydligare uppskattning om graden av smärtlindring. Slutsatsen är att utifrån det forskningsunderlag som finns idag inte går att avgöra om tramadol ger adekvat analgesi på hund och häst vilket gör användandet tveksamt som veterinärmedicinskt analgetikum i de doser som undersökts.Tramadol is a centrally acting opioid which analgesic effect primarily seems to depend on two mechanisms. Partly a weak affinity for the μ-receptor, but also an inhibitory effect on the reuptake of and stimulatory effect on the cellular release of serotonin and noradrenaline. The structure of tramadol is similar to that of codeine and morphine but the affinity for μ-receptor is ten times lower compared to codeine and 6000 times lower than morphine. Metabolism of tramadol takes place in the liver and form a pharmacologically active metabolite, mono-O-desmethyltramadol (M1), which has 200 times higher affinity for μ-receptor than tramadol. The analgesic effect is considered to be mainly M1 dependent in humans. Tramadol is a common analgesic in human medicine as to treat moderate, acute and chronic pain. Its popularity is much due to limited impact on respiration compared to other opioids and a satisfactory uptake from the gastrointestinal tract which enables per oral administration. Consequently, tramadol has become frequently used for treatment of pain also in veterinary medicine despite the absence of drugs registered for use in animals. The doses have therefore been extrapolated from doses used in humans. The purpose of this literature review is to evaluate if there are any scientific evidence for the use of tramadol in veterinary medicine by comparing the results from studies of metabolism, side effects and analgesia. Due to different enzyme activity in dogs and horses compared to humans, M2 is the main metabolite in horses while M2 and M5 are main metabolites in dogs. M1 is detected only in low plasma concentrations in both dogs and horses. Neither M2 nor M5 have proved to be pharmacologically active so the analgesia reported in some studies appears to be due to tramadol. Analgesia has been evaluated both in experimental studies and by comparison of plasma concentrations of M1 in dogs and horses to plasma concentrations of M1 associated with analgesia in humans. In horses, and in smaller extent in dogs, Tramadol shows side effects which indicate pharmacological activity. There are also indications that tramadol has a pain relieving effect in dogs and horses unrelated to M1. However, there are still ambiguity in the efficacy of analgesia and the mechanism of action. Future studies which investigate possible activity among the tramadol-conjugates as well as comparisons with other analgesic drugs will help to better estimate the extent of pain relief tramadol and to better answer the question if tramadol has a place in veterinary analgesia

Vulnerability analysis in sexual and reproductive health and rights (SRHR) — Indications of intersecting vulnerable positions in a nnational survey among young people in Sweden

Introduction: Sexual and reproductive health and rights (SRHR) policies use gender as the foremost social determinant to explain vulnerability in relation to SRHR among young people. Therefore, our aim was to explore intersecting vulnerable positions within the three SRHR-related outcome areas: unsafe sex, sex against one’s will, and transactional sex, among young people aged 16–29. Methods: The data set is from a randomised, cross-sectional, and population-based SRHR survey conducted in Sweden in 2015, and the 7755 respondents imply a response rate (26%) in line with the power estimations. How gender intersects with fve other social positions, i.e. social determinants (sexual identity, transgender experience, perceived economy, being foreign-born, and social welfare recipiency), was explored through a stepwise descriptive intersecting vulnerability analysis exemplifed through three outcome variables: unsafe sex, sex against one’s will, and transactional sex. Results: Gender intersects with other social determinants and creates vulnerable positions in SRHR-related outcomes. The most vulnerable positions within each of the three outcome variables were the following: (1) for unsafe sex: being a man and homosexual; (2) for sex against one’s will: being a woman and bisexual; and (3) for transactional sex: being a man and having transgender experience. Conclusions: Despite limitations, the descriptive intersecting vulnerability analysis indicates how gender intersects with other social determinants and generates multiple vulnerable positions in relation to SRHR. Policy Implications: The results can be of interest in future studies on vulnerability and inform policies that intend to fulfl the intention of leaving no one behind, as stated in the Agenda 2030.publishedVersio

Quality indicators of nutritional care practice in elderly care

Objectives: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Measurements: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Results: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Conclusion: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished

En avreglerad monopolmarknad – Vilka utmaningar möter nyetablerade aktörer på en marknad med homogena tjänster?

Studiens syfte är att undersöka vilka utmaningar som finns för nyetablerade aktörer att skapa konkurrensfördelar på en tidigare monopolistisk marknad. Den svenska marknaden för fordonsbesiktning avreglerades år 2010 och karaktäriseras av en homogen kärntjänst med begränsningar till horisontell och vertikal differentiering. Verksamheten är starkt regelstyrd med en oelastisk efterfråga, vilket skapar utmaningar för nya aktörer att inträda marknaden då även etableringsvillkoren är höga. En kvalitativ flerfallsstudie har gjorts utifrån en induktiv ansats med deduktiva inslag. Den teoretiska utgångspunkten tar avstamp i Porters generiska konkurrensstrategier. Branschanalysen beskrivs utifrån Porters Five Forces, vilket har kompletterats med Deans, Kroeger & Zeisels Consolidation Curve om en avreglerad marknads livscykel. Då marknaden befinner sig i en tidig fas av avreglering är det betydande för företagen att ta marknadsandelar och mycket tyder på att endast få aktörer förväntas överleva den hårda konkurrensen. Studiens resultat visar att statlig reglering är en avgörande faktor för marknadskonsolideringen. En yttre faktor som varken Five Forces eller Consolidation Curve tar hänsyn till

Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19 : a cohort study

Objective Determine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19. Design Nationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals who tested positive for SARS-CoV-2); Statistics Sweden (socioeconomical variables) and the National Board of Health and Welfare (causes of death). Participants Postmenopausal women between 50 and 80 years of age with verified COVID-19. Interventions Pharmaceutical modulation of oestrogen as defined by (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic oestrogen levels); (2) women receiving hormone replacement therapy (increased systemic oestrogen levels) and (3) a control group not fulfilling requirements for group 1 or 2 (postmenopausal oestrogen levels). Adjustments were made for potential confounders such as age, annual disposable income (richest group as the reference category), highest level of education (primary, secondary and tertiary (reference)) and the weighted Charlson Comorbidity Index (wCCI). Primary outcome measure Death following COVID-19. Results From a nationwide cohort consisting of 49 853 women diagnosed with COVID-19 between 4 February and 14 September 2020 in Sweden, 16 693 were between 50 and 80 years of age. We included 14 685 women in the study with 11 923 (81%) in the control group, 227 (2%) women in group 1 and 2535 (17%) women in group 2. The unadjusted ORs for death following COVID-19 were 2.35 (95% CI 1.51 to 3.65) for group 1 and 0.45 (0.34 to 0.6) for group 2. Only the adjusted OR for death remained significant for group 2 with OR 0.47 (0.34 to 0.63). Absolute risk of death was 4.6% for the control group vs 10.1% and 2.1%, for the decreased and increased oestrogen groups, respectively. The risk of death due to COVID-19 was significantly associated with: age, OR 1.15 (1.14 to 1.17); annual income, poorest 2.79 (1.96 to 3.97), poor 2.43 (91.71 to 3.46) and middle 1.64 (1.11 to 2.41); and education (primary 1.4 (1.07 to 1.81)) and wCCI 1.13 (1.1 to 1.16). Conclusions Oestrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in this nationwide cohort study. These findings are limited by the retrospective and non-randomised design. Further randomised intervention trials are warranted.Peer reviewe