Evaluation of Lactobacillus Preparation on Enterotoxigenic E. Coli-induced Rabbit Ileal Loop Reactions

A commercially available lactobacillus-containing preparation has been used extensively in the treatment of diarrhea but few laboratory tests have been performed to determine the efficacy of this product. The rabbit ileal loop reaction was used here to determine the effect of the lactobacillus preparation and its ingredients on E. coli enterotoxin-induced loop fluid response. Enterotoxigenic E. coli cells grown overnight in shake cultures were washed and resuspended in saline to the original volume. They were then diluted in TSB suspensions of the lactobacillus preparation or its ingredients and injected into ileal loops. E. coli diluted in TSB served as positive controls. Fluid response was measured after 18 hours and the loop fluid ratio (LFR) (ml./cm.) of the lactobacillus preparations was compared to the positive controls. The positive controls always showed a high loop fluid ratio (> 1.1 ml./cm.) and negative saline controls showed no fluid response. The lactobacillus granules and tablets had low LFR's (0.08 and 0.05, respectively). Ingredients (whey, talc, sugar, evaporated milk, mineral oil) had variable LFR's (0.65, 0.78, 1.39, 1.46 and 1.54, respectively). Individual ingredients used to make this preparation show little antifluid response when used separately but the final product exhibits a significant antienterotoxin response.     

A Prospective, Controlled Analysis of Endoscopic Cytotechniques for Diagnosis of Malignant Biliary Strictures

We prospectively collected brushings and bile for cytology in 30 consecutive patients with bile duct strictures (17 malignant, 13 benign) who were assessed by endoscopic retrograde cholangiography. When appropriate, the cellular debris on stents that were removed from individuals who were managed with these devices was evaluated for malignant cells as well. Our aim was to assess the value of these endoscopic cytotechniques for making a diagnosis of obstructing cancer of the biliary tract. A cumulative total of 78 specimens were obtained. Overall, sensitivity was highest for stent (36%) and brush (33%) cytology, compared with results obtained from bile (6%). If the results for all methods are combined, 47% of patients with cancer (eight of 17) could be diagnosed by one or more cytological technique. There were no false-positive results (specificity, 100%). Our results show that brush and stent cytology are nearly equivalent for detecting cancer, but because a diagnosis is delayed until the endoprosthesis is removed (mean 3.4 months), the brush technique is preferred. Results for bile cytology are marginal. Specificity for these cytotechniques is high; therefore, a positive result by any method is sufficient evidence for cancer, and other invasive diagnostic procedures are unnecessary.     

Safer injection facility use and syringe sharing in injection drug users

Safer injection facilities provide medical supervision for illicit drug injections. We aimed to examine factors associated with syringe sharing in a community-recruited cohort of illicit injection drug users in a setting where such a facility had recently opened. Between Dec 1, 2003, and June 1, 2004, of 431 active injection drug users 49 (11.4%, 95% CI 8.5-14.3) reported syringe sharing in the past 6 months. In logistic regression analyses, use of the facility was independently associated with reduced syringe sharing (adjusted odds ratio 0.30, 0.11-0.82, p=0.02) after adjustment for relevant sociodemographic and drug-use characteristics. These findings could help inform discussions about the merits of such facilities.     

Diffuse large cell lymphoma in a patient with hairy cell leukemia: immunoglobulin gene analysis reveals separate clonal origins

A 75-year-old man with hairy cell leukemia (HCL) was found to have an immunoblastic lymphoma of the small bowel. Immunologic and genotypic characterization of these neoplasms revealed both the HCL and the immunoblastic lymphoma to be of the B cell lineage. The HCL expressed the HCL-associated antigens detected by the monoclonal antibodies HC-1 and HC-2, whereas the immunoblastic lymphoma failed to react with these antibodies. In addition, surface immunoglobulin light chains could not be accurately determined for the hairy cells, whereas the immunoblastic lymphoma was shown to express only kappa immunoglobulin light chains. These immunophenotype differences were compatible with either the clonal evolution of the HCL into the immunoblastic lymphoma or a separate clonal origin for these two neoplasms. An analysis of tumor DNA by Southern blot hybridization revealed different heavy-chain and kappa light-chain gene rearrangements in these two malignancies. Thus the occurrence of the large cell lymphoma most likely represents the emergence of a second clonally unrelated B cell malignancy.     

Alpha 4 beta 1-integrin expression on sickle reticulocytes: vascular cell adhesion molecule-1-dependent binding to endothelium

Important complications in sickle cell anemia occur secondary to vascular occlusion, which is postulated to be initiated by interactions of erythrocytes with vascular endothelial cells. In patients with sickle cell anemia, up to 25% of reticulocytes express the alpha 4 beta 1-integrin complex. Furthermore, erythrocytes from patients with sickle cell anemia bind to endothelial cells activated by tumor necrosis factor alpha via (TNF alpha) via interactions between erythrocyte alpha 4 beta 1 and endothelial cell vascular cell adhesion molecule-1 (VCAM- 1). Thus, binding of alpha 4 beta 1-expressing reticulocytes to cytokine-activated endothelial cells may initiate vascular complications in sickle cell anemia and perhaps other hemolytic anemias during episodes of infection and inflammation.     

诊室外血压控制疗效分析

本文旨在就接受治疗的高血压患者经用动态血压监测(ABPM)所评测的诊室外血压控制疗效进行大样本调查分析。对象与方法受试对象为12867例接受治疗的高血压患者,均适应接受ABPM监控,年龄皆≥18岁,平均年龄61.9岁,男性52.4%。其高血压均属原发性高血压,并皆已接受了降压药治疗。尔