Clinical importance of increased sensitivity of BacT/Alert FAN aerobic and anaerobic blood culture bottles.

Two recent multicenter blood culture studies found that BacT/Alert FAN (FAN) bottles (Organon Teknika, Durham, N.C.) had increased yields in detecting bacteremia and fungemia compared with standard BacT/Alert (STD) bottles. Because the clinical importance of this increase in microbial recovery is unknown, we performed a retrospective analysis to determine the frequency with which FAN bottles were the sole means of detecting an episode of bacteremia. There were 1,047 positive blood cultures in which both study bottles were adequately filled and the organism isolated was judged to be the cause of sepsis: 240 (23%) were positive only in FAN bottles and 73 (7%) were positive only in STD bottles. Of a total of 664 episodes of bacteremia, 126 (19%) were identified only by FAN bottles and 43 (7%) were identified only by STD bottles (P < 0.0001). Episodes detected only by FAN bottles more often were recurrent events (23 of 126, or 18%) than episodes detected only by STD bottles (2 of 43, or 5%) (P < 0.05) and more commonly occurred in patients receiving theoretically effective antibiotic therapy (33 of 126 [26%] versus 4 of 43 [9%]) (P < 0.05). The medical records for patients with 127 of these episodes (92 FAN bottles only; 35 STD bottles only) were available for review. More than half of both FAN bottle-only (60 of 92, or 65%) and STD bottle-only (20 of 35, or 57%) episodes were judged to be clinically important. We conclude that FAN bottles improve the detection of bacteremia and that the majority of the additional episodes detected are clinically important. The benefits of the greater yield in specific patient populations must be balanced against the higher costs of FAN bottles.     

Taking engineered anti-CEA antibodies to the clinic

There is a need to improve on existing targeting technologies in order to develop effective cancer therapy. We have investigated this for colorectal cancer using antibodies directed against carcinoembryonic antigen (CEA). Chemical and molecular protein engineering has been used to produce antibody molecules which differ in molecular weight, affinity, valency and specificity. These have been characterised and tested in animal tumour models and clinical trials to test the parameters important for optimising tumour penetration, increasing residence time in viable areas of the tumour, accelerating clearance from normal tissues and improving therapeutic efficacy.     

Feline leukaemia virus: protective immunity is mediated by virus-specific cytotoxic T lymphocytes

Feline leukaemia virus (FeLV) nucleic acid vaccination of domestic cats affords protection against viraemia and the development of latency without inducing antiviral antibodies.1 To determine the contribution of cell-mediated immunity to the control of virus replication and clearance from the host, FeLV-specific cytotoxic T lymphocyte (CTL) responses were compared in vaccine-protected, transiently viraemic, and persistently viraemic cats. Vaccinal immunity was associated with the detection of higher levels of virus-specific effector CTL in the peripheral blood and lymphoid organs to FeLV Gag/Pro and Env antigens than those observed in unvaccinated control, persistently viraemic cats (P<0.001). Likewise, higher levels of virus-specific CTLs were also observed in transiently viraemic cats which recovered following exposure to FeLV. In cats that controlled their infection, recognition of Gag/Pro antigens was significantly higher than the recognition of Env antigens. This is the first report highlighting the very significant role that virus-specific CTL have in determining the outcome of FeLV infection in either vaccinated cats or cats recovering naturally from FeLV exposure.     

Salt intake by normotensive and spontaneously hypertensive rats: two-bottle and lick rate analyses

Spontaneously hypertensive rats (SHR) overconsume NaCl compared to the normotensive Wistar Kyoto rat (WKY) rat. In the present experiment, two-bottle preference for NaCl (0.01, 0.03, 0.1, 0.3, 0.5, 1.0, 3.0 M) and lick rate analyses were used to identify the possible mechanisms that underlie the intake of NaCl by male SHR. Two-bottle preference and absolute NaCl intake by SHR were greater than that of WKY rats. When NaCl intake was calculated on the basis of body weight, SHR consumed more NaCl per 100 g body weight than did WKY. Also, during the one-bottle test, SHR consumed more 0.1 and 0.3 M NaCl per 100 g body weight than did WKY. The increased intake of NaCl by SHR was most evident for 0.3 M NaCl. Intake is determined by the initial rate of licking and the decline in lick rate over time. Nonlinear regression analysis of lick rate showed that the initial lick rates (licks/min) were similar for male WKY and SHR. Lick rate declined more rapidly when WKY rats drank 0.3 M than when they drank 0.1 M NaCl, a result consistent with the role of negative feedback in controlling the decay in lick rate. This concentration-dependent change in lick rate was not seen in SHR. Also, SHR lick rate for 0.1 and 0.3 M NaCl decelerated more slowly than that of WKY rats. The increased intake of hypertonic NaCl by SHR was due to a decrease in the decline in lick rate, suggesting that SHR are less responsive to ingestion-contingent negative feedback.     

Clinical television microscopy

The technique of television microscopy is the only available technique for the direct quantitative measurement of skin capillary blood flow. Television microscopy has applications in both research and clinical practice, and has attracted considerable interest from clinical groups attempting to study capillary blood flow. The critical requirements for a functioning system are difficult to ascertain from the published literature. The aim of this article is therefore to describe the individual components of a television microscope system, outline the current methods of analysis and briefly describe some of the clinical applications of television microscopy.     

An experimental comparison of detector performance for direct and indirect digital radiography systems

Current flat-panel detectors either directly convert x-ray energy to electronic charge or use indirect conversion with an intermediate optical process. The purpose of this work was to compare direct and indirect detectors in terms of their modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Measurements were made on three flat-panel detectors, Hologic Direct-Ray DR-1000 (DRC), GE Revolution XQ/i (XQ/i), and Philips Digital Diagnost (DiDi) using the IEC-defined RQA5 (approximately 74 kVp, 21 mm Al) and RQA9 (approximately 120 kVp, 40 mm Al) radiographic techniques. The presampled MTFs of the systems were measured using an edge method [Samei et al., Med. Phys. 25, 102 (1998)]. The NPS of the systems were determined for a range of exposure levels by two-dimensional (2D) Fourier analysis of uniformly exposed radiographs [Flynn and Samei, Med. Phys. 26, 1612 (1999)]. The DQEs were assessed from the measured MTF, NPS, exposure, and estimated ideal signal-to-noise ratios. For the direct system, the MTF was found to be significantly higher than that for the indirect systems and very close to an ideal function associated with the detector pixel size. The NPS for the direct system was found to be constant in relation to frequency. For the XQ/i and DRC systems, the DQE results reflected expected differences based on the absorption efficiency of the different detector materials. Using RQA5, the measured DQE values in the diagonal (and axial) direction(s) at spatial frequencies of 0.15 mm(-1) and 2.5 mm(-1) were 64% (64%) and 20% (15%) for the XQ/i system, and 38% (38%) and 20% (20%) for the DRC, respectively. The DQE results of the DiDi system were difficult to interpret due to additional preprocessing steps in that system.     

Comparison of primary and secondary treatment in squamous oral cancer

A popular rule of thumb has often prevailed in treating oral cancer: Try one modality first; if it fails, try the other--the chance for cure will still be good. To study this dogma, a group of 160 consecutive patients with oral cavity squamous carcinoma were reviewed. A hypothesis was formed: secondary treatment for recurrent cancer, whether surgery after radiation failure or vice versa, would salvage essentially as many patients as primary treatment, say within 15%. Results show a large difference in success rates between first and second treatments when all stages are considered together, a difference well over 15 percentage points. Regarding each stage separately, the largest difference occurs in stage II (28 percentage points); other stages exceed 15 point differences. No significant differences in successful salvage occur between "home" failures and "elsewhere" failures. Local recurrence was a major cause of failure in both groups (55%). We conclude that recurrence of oral squamous cancer after first treatment markedly reduces patients' chance for cure.     

p-Dimethoxy-substituted trans-octahydrobenzo[f]- and -[g]quinolines: synthesis and assessment of dopaminergic agonist effects

The N-n-propyl homologues of the title compounds were prepared for further assessment of the ability of the "p-dimethoxy" moiety to confer dopaminergic agonism upon a variety of ring systems. Both the angularly and the linearly annulated trans-benzoquinoline ring derivatives displayed prominent DA2 dopaminergic effects on the peripheral sympathetic nerve terminal and displayed postjunctional dopamine receptor agonist properties in the striatum. It is speculated that the angular octahydrobenzo[f]quinoline derivative (but not the linear octahydrobenzo[g]quinoline derivative) may owe its dopamine-like effects to metabolic activation phenomena. In contrast, the cis-fused isomer of the angularly annulated benzoquinoline was inactive, as was the simple benzene derivative N,N-di-n-propyl-beta-(2,6-dimethoxyphenyl)ethylamine.