Cranberry juice and bacterial colonization in children--a placebo-controlled randomized trial

BACKGROUND: The cranberry produces antimicrobial compounds such as proanthocyanidines in response to microbial invasion. In vitro it is able to prevent growth, adhesion or biofilm formation of a large number of bacteria, while clinically, cranberry juice has been shown to prevent urinary tract infections (UTI) in women. However, the effect of cranberry on bacterial colonization more widely has not been evaluated. We were interested in studying cranberry juice in children since many children with recurrent UTI need long-term antimicrobial prophylaxis and would benefit from an alternative. OBJECTIVE: To evaluate the effect of cranberry juice on nasopharyngeal and colonic bacterial flora, to evaluate how well cranberry juice is accepted by children and to evaluate its effect on infectious diseases and related symptoms. DESIGN: Children (mean age 4.3 years) in day care centers were randomized to receive either cranberry juice (n=171) or a placebo (n=170) for 3 months. Bacterial samples were collected before and after the intervention and analyzed for both respiratory bacterial pathogens and enteric fatty acid composition, reflecting changes in the colonic bacterial flora. Infectious diseases and their symptoms were monitored using symptom diaries. Compliance was evaluated as the number of drop-outs during the trial and by counting the numbers of doses taken. RESULTS: The carriage of respiratory bacteria did not change significantly during the intervention, while fecal fatty acid composition changed significantly with time (P<0.001) but did not differ between the groups (P>0.05). Cranberry juice had no effect on common infectious diseases or their symptoms. The cranberry juice was well accepted: the number of drop-outs in 3 months was 18 (11%) in the cranberry group and 11 (7%) in the placebo group, and most of the doses were taken as instructed, 145 (88%) and 129 (77%) children, respectively, taking at least 90% of the doses. CONCLUSIONS: Cranberry juice was well accepted by the children, but led to no change in either the bacterial flora in the nasopharynx or the bacterial fatty acid composition of stools. Thus cranberries seem to have beneficial effect on urinary health only and this is not compromised by other unexpected antimicrobial effects.     

Another CT sign of sinonasal polyposis: truncation of the bony middle turbinate

In order to study the features of sinonasal polyposis (SNP) on CT, 100 consecutive coronasal sinus CT examinations done for chronic inflamamtory sinonasal disease were reviewed. The CT findings of the 27 fully documented SNPs were analyzed. All our SNPs were bilateral. There was a strong tendency for extensive involvement. Nasal polyps were seen in 22 of 27 (81%); bony trabecular deossification in 23 of 27 (85%); widening of infundibulum in 26 of 27(96%). We discovered a new sign truncation of the bony middle turbinate, where the bulbous part of bony middle turbinate was missing, in 51 of 26 (58 %) of SNP patients without a previous history of middle turbinectomy, 12 of 15(80%) were bilateral. The one SNP patient (1 of 27) with previous middle turbinectomy was not regarded to be real truncation. Truncation of the bony middle turbinate is a characteristic and easily recognizable ancillary sign, and is not seen in other patterns of sinusitis. Together with other features on coronal sinus CT, this adds diagnostic confidence in diagnosing sinonasal polyposis. Correspondence to: E. Y. Liang     

大肠癌高发区居民结肠癌危险因素研究

目的 研究我国结直肠癌最高发达地区浙江嘉善县结肠癌危险因素,为监测和预防结肠癌提供科学依据。方法 采用以全人群为基础的病例对照研究,用统一的调查表调查了109对结肠癌病例和对照（病例对照之比为1：7）,应用Logistic回归对结肠癌相关变量进行了单因素和多因素分析。结果 10年前猪肉月均消耗量高（OR＝1.723)、下消化系统疾病（OR＝4．163）和一级亲属结直肠癌史（OR＝3．421）是嘉善县结肠癌主要危险因素;10年前蔬菜月均消耗量高则为发生结肠癌的保护因素（OR＝0．422）。结论 嘉善县结肠癌与饮食因素有关。研究结果支持结肠癌发生的脂肪胆汁酸假说及纤维缺乏假说。精神压抑、遗传和下消化系统疾病也与结肠癌发病密切相关。     

肠道脱落细胞的C-myc 癌基因检测在大肠癌诊断中的意义

 目的　探讨肠道脱落细胞中 C- myc癌基因检测在大肠癌诊断中的意义。方法　运用DNA点杂交法检测 39例大肠癌患者肠道脱落细胞及癌组织中 C- myc状态 ,以正常人为健康对照。结果　 58.9% ( 2 3/ 39)的癌症患者脱落细胞中存在 C- myc基因扩增 ,64.1 % ( 2 5/ 39)的癌组织中存在 C- myc基因扩增。两者比较无明显差异 ( P>0 .0 5)。 1 0 % ( 2 / 2 0 )正常人脱落细胞中存在 C- myc扩增 ,与病例组差异明显 ( P<0 .0 5)。大肠癌患者其脱落细胞 DNA C- myc扩增阳性率与发病部位和Dukes分期无明显相关 ( P>0 .0 5)。本法对大肠癌诊断的敏感性为 58.79% ,特异性为 90 %。结论　用 DNA点杂交法检测肠道脱落细胞中 C- myc癌基因是一种快速方便、经济可靠且非侵入性的诊断大肠癌方法 ,可作为一种筛选试验.     

Familial adenomatous polyposis at the Tel Aviv Medical Center: demographic and clinical features

Familial adenomatous polyposis (FAP) is an uncommon, but widespread genetic disorder that develops multiple colonic adenomatous polyps and, if untreated, can lead to large bowel cancer. Little is known about its occurrence and characteristics in the Israeli population. Aims: To evaluate FAP prevalence, phenotypic manifestations and compliance for diagnosis and follow-up in our registry. Methods: Since 1993 approximately one-half of FAP patients in Israel have been seen and followed-up by us before and/or after colectomy. They and their families were encouraged to have mutation analysis, genetic and/or endoscopic screening. Results: 37 pedigrees were identified, including 2 non-Jewish. The Jewish ethnic distribution was similar to that of the general population and the point prevalence rate estimated as 28.4/one million Jewish inhabitants. There were 461 first-degree relatives at-risk for FAP. Genetic screening was completed and successful in 28 pedigrees (87.5%), and 73 FAP patients entered the registry. Marked intra-familial phenotypic variations with minimal disease manifestation were noted in 11 patients belonging to 4 pedigrees. Cancer occurred in 15.1% (11 patients), in 10 before FAP diagnosis or during follow-up elsewhere, but one non-compliant patient developed duodenal cancer. One other patient died from a massive, neglected, intra-abdominal desmoid. Compliance for evaluation and follow-up of pedigree members and individual FAP patients was inadequate in 29% and 27%, respectively. Conclusions: FAP occurs in the Israeli Jewish population at the expected rate, but is inadequately recognized in non-Jews. The inadequate compliance for screening and post-surgical follow-up needs to be addressed by educating the public, health care workers and Health Insurers.     

大肠息肉内镜表现与病理特征及恶变关系研究

目的：探讨大肠息肉的内镜下表现与病理特征及其恶变的关系。方法：对门诊患者大肠镜普查发现的361例大肠息肉的内镜及病理特征作回顾性分析。结果：息肉恶变42例42枚（10.5%)。息肉≤5mm者无恶变,6-9mm者恶变率0.9%,10-19mm者恶变率11.8%,≥20mm者恶变率38.5%;腺癌性息肉恶变率9.7%,增生性息肉恶率4.5%,80例炎性息肉有1例恶变。绒毛状腺瘤性息肉是息肉恶变的高危因素,恶变率（19/80）23.8%;恶变的息肉内镜下均表现为宽蒂或无蒂,表达充血或糜烂。结论：息肉恶变与其大小、形态和组织病理类型相关,腺瘤性息肉体积越大,绒毛状结构越多,癌变机会越高;增生性息肉、炎性息肉亦有恶变;大肠息肉不论大小、性质应尽可能予以切除。     

鼻息肉中嗜酸性粒细胞与上皮细胞增殖的相关性研究

目的：探讨嗜酸性粒细胞在鼻息肉发病机理中的意义。方法：用增殖细胞核抗原（PCNA）免疫组化方法对鼻息肉组织76例和正常鼻腔粘膜组织32例进行定量测定,同时对鼻息肉组织中嗜酸性粒细胞定量计数。结果：（1）鼻息肉上皮组织中PCNA阳性细胞表达数明显高于正常鼻腔粘膜（P＜0．001）,（2）嗜酸性粒细胞浸润程度与鼻息肉上皮细胞增殖相关（P＜0．05）。结论：上皮细胞增殖活跃在鼻息肉发病机理中占重要地位,而嗜酸性粒细胞的多少与其上皮细胞增殖相关,说明嗜酸性粒细胞与鼻息肉发病过程有直接相关性。     

人大肠癌中基质金属蛋白酶-7 mRNA的表达

目的:探讨基质金属蛋白酶-7(matrix metalloproteinase 7,MMP-7)与大肠癌浸润和转移的关系.方法:用逆转录聚合酶链式反应(RT-PCR)检测大肠癌和正常黏膜、炎性息肉、腺瘤及淋巴结中MMP-7 mRNA的表达.结果:97.4%(37/38)的大肠癌和1例肝转移中MMP-7 mRNA表达阳性,而相应正常黏膜几乎不表达;大肠癌中MMP-7 mRNA的表达水平随Dukes分期的进展而逐渐升高(P＜0.01),A期(0.28±0.08),B期(0.54±0.17),C期(0.55±0.09),D期(0.73±0.06).5例腺瘤MMP-7均为阳性,但表达水平低于癌组织(P＜0.01);3例炎性息肉均未见MMP-7表达.传统组织学检查有癌转移的13个淋巴结MMP-7表达均为阳性;组织学检查未见转移的12个淋巴结MMP-7表达6个阴性、6个阳性,再次行组织学检查于6个MMP-7阳性者中发现3个有微转移.结论:MMP-7的高表达可能在大肠癌的浸润和转移过程中具有重要作用;用RT-PCR方法检测淋巴结中MMP-7mRNA的表达是诊断大肠癌淋巴结微转移的敏感方法.     

炎症细胞与淋巴细胞在鼻息肉发病机理中的相关性研究

目的：探讨炎症细胞、淋巴细胞及浆细胞在鼻息肉发病中的作用;方法：采用免疫组化SP法及HE、甲苯胺兰染色对34例鼻息肉和30例正常中鼻甲粘膜进行研究;结果：鼻息肉中嗜酸性粒细胞阳性率显著高于对照组织（P＜0.01）;鼻息肉中肥大细胞数量显著多于对照组织（P＜0.01）,肥大细胞数量在吸入性变应原皮肤试验阳性组与阴性组间无显著性差异;鼻息肉中T淋巴细胞阳性细胞（CD43）和B淋巴细胞阳性细胞（CD20）、浆细胞数量显著多于对照组织（P＜0.01）,鼻息肉中T淋巴细胞与B淋巴细胞之间无显著性差异;结论：鼻息肉中存在活跃的细胞免疫和体液免疫,与嗜酸性粒细胞、肥大细胞及中性粒细胞共同参与鼻息肉的发病。