Tumor-specific, cytotoxic T-lymphocyte response after idiotype vaccination for B-cell, non-Hodgkin's lymphoma

Patients with non-Hodgkin's B-cell lymphoma who received an antitumor vaccine of idiotypic ig protein showed humoral and proliferative immune responses. Because immunity to some antigens, including tumor antigens and human pathogenic viruses, may be better correlated with the cytolytic cellular immune response, we evaluated 16 non-Hodgkin's lymphoma patients immunized with autologous idiotypic ig molecules for changes in tumor-specific cytotoxic T-lymphocyte precursor (CTLp) frequency using limiting dilution analysis. Eleven patients had a significant increase in tumor-specific CTLp. Eight of these 11 patients remain without evidence of disease or with stable minimal disease. In contrast, all five patients who did not have a significant change in tumor-specific CTLp have developed progressive disease. Patient vaccination with tumor associated protein antigens can increase tumor- specific CTLp frequencies. The correlation of increased tumor specific CTLp with freedom from progression is significant at P = .002. This study indicates that measurement of CTLp frequencies are relevant to the clinical evaluation of human tumor vaccines and suggests that cell- mediated cytolytic immune responses may be an important determinant of vaccine efficacy.     

Association between Escherichia coli bacteriuria and renal function in women: long-term follow-up

BACKGROUND: We sought to investigate whether Escherichia coli bacteriuria is associated with a decline in renal function or with the development of end-stage renal failure after long-term follow-up. METHODS: We performed a full cohort analysis for women who participated in 2 population-based studies. The baseline cohort consisted of women who collected morning midstream urine samples that were stored. In the cohort study, the presence of E coli bacteriuria was subsequently determined by real-time polymerase chain reaction. After a mean +/- SD follow-up of 11.5 +/- 1.7 years, blood samples were drawn from 490 women. In the nested case-control study, cases comprised all women who underwent kidney therapy (hemodialysis or renal transplantation) between participation in the baseline cohort study and a mean +/- SD of 13.8 +/- 7.4 years later. RESULTS: The mean +/- SD age at baseline was 45.0 +/- 3.2 years, and 48 women (10%) had E coli bacteriuria. After 11.5 years, the mean +/- SD creatinine clearance (Cockroft-Gault formula) was similar between the 2 groups (87 +/- 21 mL/min [1.5 +/- 0.4 mL/s] and 85 +/- 18 mL/min [1.4 +/- 0.3 mL/s] for women who had and those who did not have bacteriuria, respectively). In the nested case-control study, the prevalence of E coli bacteriuria was 14% among cases and control subjects. The odds ratio corrected for age for the development of end-stage renal failure in the presence of E coli bacteriuria at baseline was 1.1 (95% confidence interval, 0.4-2.8; P = .86). CONCLUSION: Escherichia coli bacteriuria is not associated with a decline in renal function or with the development of end-stage renal failure in a population of generally healthy women during 12 to 14 years of follow-up.     

Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005

Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Åman J, Aanstoot H‐J, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE for the Hvidoere Study Group on Childhood Diabetes. Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005. Objective: To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on metabolic control. Methods: Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally. Results: A total of 2062 adolescents completed questionnaires (age 14.4 ± 2.3 yr; diabetes duration 6.1 ± 3.5 yr). Mean HbA 1c = 8.2 ± 1.4% with significant differences between centres (F = 12.3; p < 0.001) range from 7.4 to 9.1%. There was a significant correlation between parent (r = 0.20) and adolescent (r = 0.21) reports of their perceived ideal HbA1c and their actual HbA1c result (p < 0.001), and a stronger association between parents' (r = 0.39) and adolescents' (r = 0.4) reports of the HbA1c they would be happy with and their actual HbA1c result. There were significant differences between centres on parent and adolescent reports of ideal and happy with HbA1c (8.1 < F > 17.4;p < 0.001). A lower target HbA1c and greater consistency between members of teams within centres were associated with lower centre HbA1c (F = 16.0; df = 15; p < 0.001). Conclusions: Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in metabolic outcomes between centres.     

甘草素与异甘草素的合成

甘草素与异甘草素的合成杨立，沈凤嘉（兰州大学化学系，兰州７３００００）甘草（Ｇｌｙｃｙｒｒｈｉｚａｕｒａｌｅｎｓｉｓｆｉｓｃｈ．）为我国一项宝贵的中药资源，历来受到人们重视。甘草素（ｌｉｑｕｉｒｉｔｉｇｅｎｉｎ）和异甘草素（ｉｓｏｌｉｑｕｉｒｉｔｉｇ...     

Ultrasound appearance of pseudomembranous colitis

A case illustrating that ultrasound can be useful in the diagnosis of pseudomembranous colitis is reported. Diagnosis of pseudomembranous colitis is usually made from microbiological or histopathological investigations. The ultrasound appearance of grossly thickened bowel wall with luminal narrowing is non-specific, but in the correct clinical context should suggest the diagnosis of pseudomembranous colitis.     

Concentration of electrolytes in the sweat of malnourished children

The sweat test was performed by the method of Gibson and Cooke on 36 children with second and third degree malnutrition, aged from 2 months to 4 years. The results were compared with those from 32 healthy, well nourished controls in the same age range. Determinations were made of sodium and chloride concentrations, chloride/sodium ratio, and the sum of the concentrations of the two electrolytes in each sample. The malnourished children were found to have higher sodium and chloride concentrations than the well nourished ones. None of the normal or malnourished children had a sweat chloride value greater than 60 mmol/l; chloride values within a suspicious range (between 40 and 60 mmol/l) were found in two malnourished children. Two well nourished controls and six malnourished children showed suspicious sweat sodium concentrations; in one child with third degree malnutrition the sodium content was greater than 60 mmol/l. In all results in the suspicious range, or greater than 60 mmol/l, the chloride/sodium ratio was less than 1, and the sum of the two electrolytes was below 140 mmol/l. Based on these results, we conclude that malnourished children have raised sweat sodium and chloride concentrations when compared with well nourished children. The electrolyte values for most of them are not in a suspicious range or consistent with a diagnosis of cystic fibrosis. Unlike that found in cystic fibrosis, the sodium/chloride ratio in our subjects was less than 1 and the sum of both electrolytes never exceeded 140 mmol/l.     

Impaired prenatal and postnatal growth in Dutch patients with phenylketonuria. The National PKU Steering Committee

OBJECTIVE: To assess whether physical growth is affected in early treated Dutch patients with phenylketonuria (PKU). METHODS: The birth weights of all 137 early detected patients with PKU born in the period from 1974 to 1988 in the Netherlands were compared with reference values. Height, head circumference, and weight were measured at the age at which treatment started (commonly about 2-3 weeks), at 6 months of age, and yearly from the child's first birthday up to the age of 10 years. These measurements were compared with reference values. RESULTS: The adjusted birth weight in patients with PKU was 141 g (95% confidence interval (CI) 66 to 216 g) less than Dutch reference values by Kloosterman and 103 g (95% CI 9 to 196 g) less compared with the birth weight of another reference group. At the age at which treatment started, z scores of patients for height by age were -0.23 (95% CI -0.44 to -0.02) and z scores for head circumference by the age were -0.25 (95% CI -0.44 to -0.06). From the age at which treatment started up to the age of 3 years z scores for height by age further decreased to -0.74 (95% confidence interval -0.93 to -0.56), after which no additional decrease occurred. In contrast, z scores for head circumference increased from -0.25 at the first visit to 0.08 (95% CI -0.14 to 0.30) at the age of 1 year, after which they remained close to zero. Weight by height was close to the expected centiles for all ages. CONCLUSION: Patients with PKU are growth retarded at birth and have smaller head circumferences than the normal population. In Dutch patients further growth retardation occurs in the first three years of life.     

Management of bacterial urinary tract infections in adult patients with diabetes mellitus

Urinary tract infections (UTIs) are more common and tend to have a more complicated course in patients with diabetes mellitus than in the general population. The mechanisms that potentially contribute to the increased prevalence of both asymptomatic and symptomatic bacteriuria in these patients are defects in the local urinary cytokine secretions and an increased adherence of the microorganisms to the uroepithelial cells. The need for treatment of asymptomatic bacteriuria remains controversial. No evidence is available on the optimal treatment of acute cystitis and pyelonephritis in patients with diabetes. Because of the frequent (asymptomatic) upper tract involvement and the possible serious complications, many experts recommend a 7- to 14-day oral antibacterial regimen for bacterial cystitis in these patients, with an antibacterial agent that achieves high concentrations both in the urine and in urinary tract tissues. The recommended treatment of acute pyelonephritis does not differ from that in patients without diabetes. Clinical trials specifically dealing with the treatment of UTIs in patients with diabetes, comparing the optimal duration and choice of antibacterial agent, are needed. In addition, new approaches to preventive strategies must prove their value in this specific patient group.