A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk

In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi. Eighty-six percent of cases had enteritis characterized by fever, abdominal pain, and diarrhea. In three separate case-control studies, drinking milk pasteurized by plant A was statistically associated with illness. In a survey of randomly chosen households, 8.3% of persons who recalled having drunk milk from plant A during the suspect period experienced a yersiniosislike illness. Inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique. Although outbreaks of enteric disease caused by pasteurized milk are rare in the United States, the ability of Y enterocolitica to grow in milk at refrigeration temperatures makes pasteurized milk a possible vehicle for virulent Y enterocolitica. The extent to which milk is responsible for sporadic cases of yersiniosis is unknown.     

The influence of multiple treatment with doxorubicin or 4'-deoxy-doxorubicin on the DNA synthesis and morphology of mouse heart

To correlate animal experiments with clinical experience, CD-1 mice were treated weekly for eight weeks with 4 mg/kg doxorubicin or 2.7 mg/kg 4'-deoxy-doxorubicin i.v. Periodically the incorporation of 3H-thymidine (3H-dThd) into DNA was measured in the heart, liver, spleen and bone marrow, 24 or 72 hours after the last treatment. The morphology of the hearts was examined by light microscopy. In animals sacrificed 24 hours after the last treatment, the incorporation of 3H-dThd was reduced considerably and to a similar extent by both molecules in the first weeks, while at the 8th week the values for the heart were higher than in the controls. In the other organs, inhibition percentages of incorporation of 3H-dThd into DNA persisted for both molecules, with higher values in the spleen. In animals killed 72 hours after the last treatment, no change in incorporation capacity was found. These results point to the role of cardiac DNA repair in understanding the pharmacodynamics of these two molecules. The data are discussed in relation to morphology.     

The in vivo effects of recombinant human erythropoietin on cisdiamminodichloroplatinum-induced anemia in golden Syrian hamsters.

Recombinant human erythropoietin given subcutaneously is able to accelerate hematopoietic recovery in hamsters affected by cisplatin-induced anemia, increasing hemoglobin and hematocrit levels. The increase in hemoglobin and hematocrit levels. The increase in hemoglobin and hematocrit levels is not accompanied by an increase of platelet or granulocyte counts in the peripheral blood. However, an increase in the marrow concentration of burst and colony forming units--erythroid (BFU-E, CFU-E) is observed after recombinant human erythropoietin treatment. This increase in the concentration of marrow erythroid progenitors was accompanied by an increase in the percentage of these stem cells in DNA synthesis as assessed by exposure to ARA-Cyt. Recombinant human erythropoietin seems highly effective in ameliorating and/or preventing cisplatin-induced anemia in experimental animals.     

Cisplatinum in Combination with 5-Fluorouracil and Citrovorum Factor in the Treatment of Advanced Colorectal Carcinoma

A phase 11 trial of citrovorum factor, 500 mg/m²/week, plus 5-fluorouracil, 400 mg/m²/week on day 1, and cisplatin, 20 mglm²lweek on day 2, was carried out in a group of 40 patients with metastatic colorectal carcinoma. A partial response with a mean duration of 8.4+ months was achieved in 24% of patients, a minimal response with a mean duration of 5.4 months was obtained in 6% of patients, and a stabilization of 6.2 months was achieved in 41%. Ten patients (29%) progressed. A 38% partial response rate was seen in patients with advanced rectal carcinoma, whereas no response was obtained in patients with colon cancer. Interestingly, 5 partial responses were seen in 12 patients pretreated with 5-fluorouracil. The overall survival was 9.8+ months. The mean survival of patients who achieved a partial response was 12.0+ months, whereas patients who progressed survived a mean of 6.6+ months. Patients with colon cancer had a mean survival of 8.1 + months, and those with rectal cancer survived a mean of 11A + months. This difference was not statistically significant. The treatment was generally very well tolerated, with patients showing mostly grade 1-2 gastrointestinal and Ior hematological toxicity.     

Repair kinetics of DNA, RNA and proteins in the tissues of mice treated with doxorubicin

Experiments in mice treated with a single 10 mg/kg dose of doxorubicin (adriamycin) i.p. revealed considerable reduction in the incorporation of 3H-thymidine in DNA and of 3H-uridine in RNA, in the spleen and liver, and at mitochondrial and non-mitochondrial level in the heart. Although protein syntheses in the heart and spleen were not reduced by the drug to any great degree, they took 10 days to return to normal; conversely, liver protein syntheses were not inhibited at all and indeed presented signs of stimulation.     

Comparative performance of human papillomavirus DNA testing using novel sample collection methods

To explore alternative cervical cancer screening approaches in an underserved population, we compared the performance of human papillomavirus (HPV) DNA assays in combination with different sample collection methods for primary cervical screening in the Mississippi Delta region. Three specimens were collected from women aged 26 to 65 years who were either routinely undergoing screening (n = 252) or not (n = 191): clinician-collected cervical specimens, clinician-collected cervicovaginal specimens, and self-collected cervicovaginal specimens taken at home. A novel collection device and medium were used for cervicovaginal sampling. Specimens were tested by three HPV DNA assays: hybrid capture 2 (HC2; Qiagen Corp., Gaithersburg, MD), Linear Array (LA; Roche Molecular Systems, Pleasanton, CA), and Amplicor (Roche Molecular Systems, Pleasanton, CA). Liquid-based cytology was performed on cervical specimens. We compared the overall positivity (a proxy for clinical specificity) for any carcinogenic HPV genotype and calculated the agreement across assay and specimen type using McNemar's test for differences in test positivity. Across all three assays there were no significant differences between clinician-collected and self-collected cervicovaginal specimens (P > 0.01 for all comparisons). For both cervicovaginal specimens (clinician collected and self-collected), fewer women tested positive by HC2 than by LA or Amplicor (P < 0.01 for all comparisons). HC2 had the best agreement between specimens for all assays. HC2 is likely more clinically specific, although possibly less sensitive, than either PCR test. Thus, use of HC2 on cervicovaginal specimens for screening could result in fewer referrals compared to LA and Amplicor.     

Prevalence of plasmid-mediated quinolone resistance genes in uropathogenic Escherichia coli isolated in a teaching hospital of northern Italy

A retrospective study was conducted to determine the prevalence of plasmid-mediated quinolone resistance (PMQR) determinants in uropathogenic Escherichia coli isolated from inpatients and outpatients in a teaching hospital of northern Italy. The presence of qnrA, qnrB, qnrS, aac(6')-Ib-cr, and qepA was evaluated in 76 and 72 nalidixic acid-resistant E. coli, isolated in 2004 and 2006, respectively. Positivity for the aac(6')-Ib-cr gene was demonstrated in 3 of 76 (3.9%) and 8 of 72 (11%) isolates, respectively; no other PMQR determinant was found. All aac(6')-Ib-cr-positive strains also showed two point mutations in the gyrA and parC genes. Most aac(6')-Ib-cr-positive isolates demonstrated the contemporary presence of bla(CTX-M-15), bla(OXA-1/30), and bla(TEM-1) genes and 4/11 harbored a class 1 integron with a dfrA17-aadA5 gene cassette arrangement. Interestingly, all aac(6')-Ib-cr-positive isolates belonged to B2 phylogenetic group, O25b antigen type, multi locus sequence type 131, and to a cluster of approximately 70% similarity level by pulsed-field gel electrophoresis (PFGE). These findings suggest the circulation of the previously described intercontinentally spreading E. coli O25:H4-ST131 clone in our geographical area since 2004. Hybridization studies of the PFGE profiles showed the aac(6')-Ib-cr gene to be associated with different molecular weight bands (40-350 kb) and interestingly aac(6')-Ib-cr chromosomal integration was demonstrated in one strain by I-Ceu I method. This represents the first report to investigate the presence and diffusion of PMQR determinants in northern Italy and to describe aac(6')-Ib-cr chromosomal integration in E. coli.     

Why do patients change their general practitioner? Suggestions on corrective actions

Aims  

The aim of this study was to determine what made people want to change their choice of general practitioners (GP). Furthermore, the study aimed to correlate the perceived quality of patient-GP communication with the motives inducing individuals to change their doctors.     

The in vitro effect of recombinant erythropoietin on cisdiamminodichloroplatinum-induced inhibition of murine erythroid stem cells

An in vitro study was carried out to evaluate the possible protective effect of recombinant human erythropoietin (rhEpo) on cisplatin (CDDP)-induced inhibition of erythroid colony growth. CDDP at the dose of 0.4 mg/ml caused a 72-75% inhibition of erythroid stem cell growth in plasma clots. In the short-term assay rhEpo was not able to protect normal murine erythroid stem cells from the inhibitory effect of CDDP at any of the tested concentrations. In long-term bone marrow cultures, although the kinetics of cellular populations in suspensions and of erythroid stem cells were similar in both controls and CDDP-treated cultures, both cellularity and erythroid stem cells levels were much lower in CDDP-treated flasks than in control ones regardless of the addition of rhEpo. These results indicate that rhEpo is not able to prevent of ameliorate erythroid stem cell inhibition due to a possible toxic effect of CDDP, at least in vitro.     

5-Fluorouracil and recombinant alpha interferon-2a in the treatment of advanced colorectal carcinoma: a dose optimization study

A dose optimization study was carried out with the aim of identifying the maximally tolerated dose of recombinant alpha interferon-2a (raIFN-2a) in combination with 5-fluorouracil (5FU). 5FU was given at the dose of 750 mg/m2 over a 4-hour infusion on day 1- - greater than 5 followed by 750 mg/m2 weekly i.v. bolus. Recombinant aIFN-2a was started at 3 x 10(6) IU subcutaneously three times/week. 12 patients with advanced colorectal carcinoma were included in the study. 10 patients had previously received chemotherapy for advanced disease. Severe fatigue, most likely attributable to rIFN, was the dose-limiting toxicity. The dosage of raIFN-2a could not be further escalated above 12 x 10(6) IU. At this dose level all patients required dose reduction due to fatigue, fever, myalgia and severe reduction of performance status.