Controlled clinical comparison of Isolator and BACTEC 9240 Aerobic/F resin bottle for detection of bloodstream infections

A controlled clinical comparison was carried out with the BACTEC 9240 Aerobic/F resin bottle and the Isolator system with adult patients suspected of having bloodstream infections. A total of 10,500 paired specimens were collected, of which 1,122 from 520 patients were positive. There were 68 false-positive BACTEC bottles; 259 positive cultures that were excluded from analysis because the bottle, the Isolator, or both failed to meet the minimum volume criterion of 8 ml of blood; and 207 positive cultures that were excluded because the isolates were found to be clinically insignificant or of indeterminate clinical significance on the basis of patient assessment. A total of 656 positive cultures from 258 patients formed the basis of the analysis. Significantly more Staphylococcus aureus isolates (P = 0.03), Staphylococcus epidermidis isolates (P = 0.03), members of the family Enterobacteriaceae (P = 0.03), and Pseudomonas aeruginosa isolates (P = 0.04) were recovered from the resin bottle, and there was no category of organism that was recovered significantly more frequently from the Isolator system. With patients receiving antibiotics at the time of blood culture, S. aureus, S. epidermidis, and gram-negative bacilli were recovered significantly more frequently from the resin bottle. No significant differences between systems were found with cultures from patients not receiving antibiotics at the time of blood culture. Only 12 clinically significant organisms were recovered from the bottle on terminal subcultures, and only 1 of these had not been previously isolated from another blood culture set (10 of the 12) or from the companion Isolator (1 of 12). The Aerobic/F resin bottle continuously monitored in the BACTEC 9240 instrument proved to be superior to the Isolator in overall yield of organisms causing bloodstream infection in adults and required less technician time for specimen processing and examination than the Isolator system.     

Multicenter clinical comparison of resin-containing bottles with standard aerobic and anaerobic bottles for culture of microorganisms from blood

In a study comparing the Bactec 9240 (Plus Aerobic/F and Anaerobic/F bottles, containing resins; Becton Dickinson, USA) and the Vital (standard aerobic and anaerobic bottles, with no additives; bioMérieux, France) blood culture systems, 6456 sets of four bottles of 9660 blood cultures submitted were evaluated. There were 531 clinically significant isolates from 795 positive blood cultures. Of the 531 positive blood cultures, 355 were positive in both systems, 141 with the Bactec 9240 alone, and 30 with the Vital alone (p < 0.001); five were not detected by either system. The average time to detection of positive cultures for the matched sets was 10.65 h and 18.41 h by the Bactec 9240 system and the Vital system, respectively. The false-positive rate per bottle was 0.65% in the Bactec 9240 and 0.71% in the Vital. The rate of false-negative pairs (i.e., major errors) was very low (0.12% for the Bactec 9240, 0.19% for the Vital) and not significantly different between the two systems. The striking differences in recovery of microorganisms may be due to the presence of resins in the Bactec medium. However, the observed superiority of the Bactec 9240, even for patients not receiving antibiotics, suggests that resins adsorb other inhibitors present in patients' blood.     

Multicenter comparison of ESP Culture System II with BACTEC 460TB and with Lowenstein-Jensen medium for recovery of mycobacteria from different clinical specimens, including blood

The recently developed ESP Culture System II (AccuMed, Chicago, Ill.) was compared with radiometric BACTEC 460TB (Becton Dickinson, Towson, Md.) and with Lowenstein-Jensen medium for recovery of mycobacteria from over 2,500 clinical specimens both of respiratory and nonrespiratory origin, including blood. The majority of the 219 mycobacterial isolates (129) belonged to the Mycobacterium tuberculosis complex, followed by 37 isolates of the Mycobacterium avium complex (MAC) and 53 isolates of eight other mycobacterial species. Rates of recovery obtained with BACTEC, ESP, and Lowenstein-Jensen medium were 89, 79, and 64%, respectively, with such differences being statistically significant. Different media and systems appeared to behave differently when the more frequently detected organisms were considered: M. tuberculosis complex isolates grew better with BACTEC, and MAC isolates grew better with ESP. An analysis of the combinations of Lowenstein-Jensen medium with BACTEC and with ESP did not reveal significant differences in recovery rates. With regard to the times needed for the detection of positive cultures, they were significantly longer on Lowenstein-Jensen medium (average, 28 days) than with the remaining two systems, between which there was no difference (average, 18 days). We conclude, therefore, that the ESP system, when used in combination with a solid medium, performs as well as the thoroughly validated radiometric BACTEC system and offers the advantages of full automation and absence of radioisotopes.     

Mycobacterial growth and bacterial contamination in the mycobacteria growth indicator tube and BACTEC 460 culture systems

The BACTEC 460 system currently provides the most rapid detection of mycobacterial growth, but the system is radiometric and requires needles to inoculate specimens through the bottle's septum. The Mycobacteria Growth Indicator Tube (MGIT) system has a liquid medium, like the BACTEC system, and does not require needles when inoculating specimens. We compared mycobacterial growth from 510 specimens in the two systems. Average time to acid-fast bacillus (AFB) detection and identification to the species level was less with the BACTEC system, but this result was statistically significant only for AFB detection in specimens containing Mycobacterium avium-M. intracellulare complex. The contamination rate with MGIT was 29%; the BACTEC rate was 5%. To investigate MGIT contamination, we initiated a second study with changes in specimen processing. The MGIT contamination rate was reduced to 12%; the BACTEC rate was not significantly affected (5.5%). The most likely explanation for the contamination in MGIT is the richness of its medium compared to the BACTEC medium. Cost analysis for the two systems in a laboratory that processes 4,500 specimens a year is presented. The data suggest that the BACTEC 460 and the MGIT systems are approximately equivalent in cost and ability to support the growth of AFB. The MGIT system appears safer and easier to use and was preferred by laboratory personnel, but it cannot currently be used for blood specimens or antituberculosis susceptibility testing.     

Manual blood culture systems and the antimicrobial removal device

In the midst of technologic advances within blood culture microbiology, several manual blood culture systems, which have an important role in the detection of bacteremia, mycobacteremia, and fungemia, are often overlooked. These include traditional broth-based systems, agar-broth biphasic blood culture techniques, a commercial broth-based manual system in which growth is detected by a broth displacement method, and lysis-centrifugation. This article reviews the operational features, advantages, and disadvantages of each.     

Controlled clinical evaluation of Isolator and ESP aerobic blood culture systems for detection of bloodstream infections

A controlled clinical evaluation comparing the Isolator system (Wampole Laboratories, Cranbury, N.J.) and the ESP 80A blood culture bottle in the automated ESP system (Difco Laboratories, Detroit, Mich.) was performed with 10,535 blood culture sets from patients with suspected septicemia. Of 1,150 positive cultures, 844 positive cultures from 285 patients with 394 septic episodes fulfilled the study criteria for minimum blood sample requirements in each system and clinical significance of isolates. The Isolator system detected statistically significantly more positive cultures of Staphylococcus aureus (P < 0.001), Enterococcus spp. (P = 0.007), Escherichia coli (P = 0.001), Alcaligenes xylosoxidans (P = 0.02), Xanthomonas maltophilia (P = 0.01), Candida albicans (P < 0.001), and Candida glabrata (P = 0.05). The Isolator system detected significantly more septic episodes due to S. aureus (P < 0.001), X. maltophilia (P = 0.02), and C. albicans (P = 0.004) than did the ESP 80A bottle; however, the two systems did not otherwise significantly differ in their abilities to detect septic episodes due to other organisms.     

The use of continuous monitoring blood culture systems in the diagnosis of catheter related sepsis

AIM: To assess whether the information provided by automated continuous monitoring blood culture systems could aid in the diagnosis of catheter related sepsis. METHODS: Serial dilutions of a strain of coagulase negative staphylococcus were inoculated into the BacT/Alert blood culture system. Blood culture results for seven patients with possible catheter related sepsis from coagulase negative staphylococci were reviewed. RESULTS: Time to positivity and length of lag period were strongly related to the concentration of bacteria inoculated (average decrease of 1.5 hours to positivity for each 10-fold increase in concentration). Time to positivity and length of lag period were significantly shorter for central line blood cultures than for those taken from peripheral sites. CONCLUSIONS: Using data already measured by continuous monitoring blood culture systems may provide a simple alternative to quantitative blood cultures for the diagnosis of catheter related sepsis.     

Multicenter evaluation of a patient-administered test for blood cholesterol measurement

BACKGROUND: In order to assess accuracy of a newly developed, noninstrumented, self-administered fingerstick test that measures cholesterol levels in whole blood, the AccuMeter Cholesterol Self-Test was evaluated for home-use by untrained consumers in a multicenter study. METHODS: A total of 486 untrained adult volunteers of varying age, occupation, and educational background were recruited at four sites. Participants received written instructions provided in the kit, access to a telephone "800" number for additional help, and, if necessary, a short instructional video available to consumers on request. Fingerstick cholesterol results obtained by untrained volunteers were compared with paired venous serum results obtained by the Abell-Kendall cholesterol reference method. After application of exclusion criteria, 79.0% (384/486) of subjects had AccuMeter fingerstick results available for comparison with the reference method. RESULTS: Results obtained with the AccuMeter test correlated well with the Abell-Kendall results (r = 0.91). There was a mean overall bias for the AccuMeter of -0.116 +/- 0.528 mmol/liter (-2.2%), with a mean absolute bias of 0.398 +/- 0.367 mmol/liter (7.6%). Biases at the National Cholesterol Education Program cutpoints of 5.20 and 6.20 mmol/liter were -2.2 and -2.5%, respectively. Subjects with high-risk total cholesterol values (> or = 6.20 mmol/liter) were correctly classified 80.0% of the time, with an additional 18.8% placed in the borderline category (5.20-6.20 mmol/liter); 1.2% were inappropriately placed in the desirable category. No subjects were placed in the high-risk category by the AccuMeter test if they had a desirable cholesterol value by the reference method, while 9.8% were placed in this category if they were in fact borderline. CONCLUSIONS: This test appears to be a useful addition to available options in the effort to increase awareness of cholesterol as a heart disease risk factor. A large portion of untrained consumers were able to perform the AccuMeter Cholesterol Self-Test and obtain comparable results to the reference method. This test for the first time allows consumers to determine their own cholesterol values, with a reasonably good degree of accuracy.     

Isolation of blood-borne Mycobacterium avium by using the nonradioactive BACTEC 9000 MB system and comparison with a solid-culture system

We conducted a 12-month prospective study comparing two approaches to the detection of Mycobacterium avium in the blood of human immunodeficiency virus type 1-infected patients, namely, a lytic centrifugation system combined with Middlebrook solid culture medium (the conventional procedure) and the nonradiometric BACTEC 9000 MB system. Species identification relied on 16S rRNA probe hybridization and cell wall fatty acids chromatography. M. avium was isolated in 17 of 345 (5%) blood specimens by the BACTEC 9000 MB automated system and in 14 of 345 (4%) blood specimens by the conventional procedure (nonsignificant, chi2 test). Detection time was 16 +/- 6 days by the BACTEC 9000 MB automated system and 27 +/- 3 days by the conventional procedure (P < 0.001, Student t test). Non-M. avium mycobacteria were not recovered during the study period. Contamination rate was 8% (30 specimens) by the BACTEC 9000 MB system and 0% by the conventional procedure, indicating the necessity of using an antibiotic mixture (PANTA, consisting of polymyxin B, amphotericin B, nalidixic acid, trimethoprim, and azlocillin). Working time was 1 min 30 s by the BACTEC 9000 MB system and 8 min by the conventional procedure, which was 1.8 times more expensive than the BACTEC system. Use of the BACTEC 9000 MB system increased the sensitivity of M. avium detection and reduced detection time in blood culture.     

Multicenter comparison of first- and second-generation IMx tacrolimus microparticle enzyme immunoassays in liver and kidney transplantation

Foetuses born to mothers with gestational diabetes are at increased risk of developing respiratory distress, foetal macrosomia, foetal anomalies and platelet hyperaggregability. High blood glucose level induces oxidative stress and decreases antioxidant defences. The present study discusses the possibility of lipid peroxidation and protein oxidation in both maternal and foetal erythrocytes as an indicator of oxygen radical activity. The level of lipid peroxidation and protein oxidation in erythrocytes was estimated in 20 mothers with gestational diabetes and their newborns. The maternal age varied between 19 and 42 y and foetal age ranged between 34 and 39 weeks. The proteolytic activities in the erythrocyte lysates obtained from mothers with gestational diabetes and their newborns were significantly greater [(mean +/- SD) 24.41 +/- 9.05 and 16.70 +/- 3.36 microM of amino groups/g haemoglobin, n = 20, respectively] than those from control group (10.18 +/- 4.84 and 14.64 +/- 6.21 microM amino groups/g haemoglobin, n = 15, respectively; p < 0.05 in both cases). Similarly erythrocyte malondialdehyde levels were significantly elevated in babies born to mothers with gestational diabetes (10.11 +/- 2.21 nM/g haemoglobin) when compared to controls (6.8 +/- 3.75 nM/g haemoglobin) (p < 0.05). In the erythrocytes of mothers with gestational diabetes, malondialdehyde levels correlated significantly with glycated haemoglobin levels (p < 0.01). The results of this study indicate that the oxidative stress induced by gestational diabetes manifests as increased lipid peroxidation and protein oxidative damage in the erythrocytes of both mothers with gestational diabetes and their newborn infants.     

几种液压AGC方式的图形化仿真比较

为提高计算机进行轧制仿真时的结构灵活性和扩展方便性,以控制系统常用的软件MATLAB/Simulink为平台,将主要轧制设备建立传递函数模型,用有相应输入输出端口的简单框图表示,类似实际设备可以自由调度组合,搭建出不同控制系统,从而开发出既便于独立建模研究又易于构建不同控制方案的轧制形象化仿真方法.通过输入同种原始条件,对几种液压AGC系统进行了仿真比较,结果表明动态设定AGC响应更好.     

Use of the BacT/Alert blood culture system for culture of sterile body fluids other than blood

Studies have demonstrated that large-volume culture methods for sterile body fluids other than blood increase recovery compared to traditional plated-medium methods. BacT/Alert is a fully automated blood culture system for detecting bacteremia and fungemia. In this study, we compared culture in BacT/Alert standard aerobic and anaerobic bottles, BacT/Alert FAN aerobic and FAN anaerobic bottles, and culture on routine media for six specimen types, i.e., continuous ambulatory peritoneal dialysate (CAPD), peritoneal, amniotic, pericardial, synovial, and pleural fluids. Specimen volumes were divided equally among the three arms of the study. A total of 1,157 specimens were tested, with 227 significant isolates recovered from 193 specimens. Recovery by method was as follows: standard bottles, 186 of 227 (82%); FAN bottles, 217 of 227 (96%); and routine culture, 184 of 227 (81%). The FAN bottles recovered significantly more gram-positive cocci (P < 0.001), Staphylococcus aureus (P = 0.003), coagulase-negative staphylococci (P = 0.008), gram-negative bacilli (P < 0.001), Enterobacteriaceae (P = 0.005), and total organisms (P < 0.001) than the routine culture. There were no significant differences in recovery between the standard bottles and the routine culture. The FAN aerobic bottle recovered significantly more gram-positive cocci (P < 0.001), S. aureus isolates (P < 0.001), coagulase-negative staphyococci (P = 0.003), and total organisms (P < 0.001) than the standard aerobic bottle, while the FAN anaerobic bottle recovered significantly more gram-positive cocci (P < 0.001), S. aureus isolates (P < 0.001), Enterobacteriaceae (P = 0.03), and total organisms (P < 0.001) than the standard anaerobic bottle. For specific specimen types, significantly more isolates were recovered from the FAN bottles compared to the routine culture for synovial (P < 0.001) and CAPD (P = 0.004) fluids. Overall, the FAN bottles were superior in performance to both the standard bottles and the routine culture for detection of microorganisms from the types of sterile body fluids included in this study.     

Evaluation of the MB/BacT system and comparison to the BACTEC 460 system and solid media for isolation of mycobacteria from clinical specimens

The MB/BacT automated system is designed for the isolation of mycobacteria from clinical specimens. It utilizes a colorimetric sensor and reflected light to continuously monitor the CO2 concentration in the culture medium. We compared its performance to that of the BACTEC 12B media for the radiometric BACTEC 460 instrument and that of solid culture media. Respiratory specimens and urine samples were decontaminated with 4% NaOH. The vials of the two instruments were inoculated with 500 microl of sample and two solid egg-based media at 200 microl each. All vials were incubated at 37 degrees C for 6 weeks. A total of 1,078 specimens (633 respiratory specimens, 78 cerebrospinal fluid specimens, 177 other body fluid specimens, 87 urine specimens, and 103 other types of specimens) were cultured in parallel. Mycobacteria could be identified from 73 (6.8%) specimens: 67 M. tuberculosis, 3 M. kansasii, 1 M. xenopi, 1 M. terrae, and 1 mixed M. avium with M. scrofulaceum. Of these, 63 (86.3%) specimens were positive with the MB/BacT system, 67 (91.8%) were positive with the BACTEC 460 instrument, and 58 (79.5%) were positive with the two egg-based media. MB/BacT cultures were positive on average after 17.5 (+/-6.4) days, BACTEC cultures with a growth index of >20 (mean, 200) were positive after 14.3 (+/-8.2) days, and egg-based media were positive after 24.2 (+/-7.5) days. Microorganisms other than mycobacteria contaminated 46 (4.3%) MB/BacT cultures and 31 (2.9%) BACTEC cultures, which had to be discarded. The MB/BacT system is a well-automated system for the detection of M. tuberculosis in clinical specimens without using radioactive reagents. Further trials are required to determine whether it is suitable for the culture of nontuberculous mycobacteria.     

Plateletapheresis: comparison of processing times, platelet yields, and white blood cell content with several commonly used systems

In this study we compare processing times and platelet yields of eight systems: five double-needle (DN)--Fenwal CS3000 Plus with interface offset (IO) of 6 (Fen 6) and IO of 10 (Fen 10), a prototype Fenwal Amicus (AM-DN), Spectra version 4 (Spec 4-DN) and version 5 with leukoreduction system (Spec 5-LRS); and three single-needle (SN) systems--Haemonetics MCS Plus (MCS+), prototype Amicus (AM-SN), and Spectra version 4 (Spec 4-SN). Twenty-five procedures from each of the systems (except AM-SN, N = 13) were compared; each system had comparable preprocedure platelet counts and similar endpoints. Five systems--MCS+, Fen 6, Fen 10 with leukoreduction filter (MCS + LRF), (Fen 6 LRF), (Fen 10 LRF), as well as AM-DN, and Spec 5-LRS--were compared for WBC content. P-selectin expression was compared in the MCS+; Fen-10 with A-35 (Fen 10-A35) and PLT-30 (Fen 10-PLT30) collection chambers; Spec 4-DN; and platelet-rich plasma. We found AM-DN (63 +/- 16 min) had a significantly lower average processing time than all other systems except AM-SN. Spectra 4-DN (5.6 +/- 1.7 x 10(11) Plt) produced significantly more platelets and had a significantly higher incidence of products > or = 6.0 x 10(11) (56%) and higher incidence of products > or = 6.6 x 10(11) Plt (32%) than all other systems. AM-DN (0.073 +/- 0.017 x 10(11) Plt/min) had a significantly higher collection rate than all other systems except AM-SN. The WBC content comparison indicated MCS+ with a filter; and AM-DN and Spectra 5-LRS without filters were capable of consistently (99.32-100%) producing products with < 5 x 10(6) WBC, but were less consistent (86.36-99.26%) at < 1 x 10(6) WBC. MCS+ and Fen 10-PLT30 had significantly (p < .05) less p-selectin expression than all other systems but not between each other. From the data in this study, if leukoreduced platelets were needed in the shortest processing time, the first and second choices would be Amicus-DN and Spectra 5-LRS, respectively.     

医师管理制度的国际比较

创造适当的制度氛围,对医生进行合理的激励和约束,让医生为患者提供合理的服务,可能是解决目前中国诸多医疗管理问题的突破口,在这样的背景下,本研究关注医生的管理问题,集中分析医生的准入过程、执业方式、经济关系和行为监管4个具体的医生管理范畴,这4个问题本身是相互关联的,共同组成一个比较完整的"管理模式",在特定的管理模式下,政府、社会和医生相互作用,影响医疗服务产出和医疗系统的绩效.     

Physician-patient interactions: a comparison of analysis systems

OBJECTIVE: The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them. OBJECTIVE: 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes. METHOD: Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature. RESULTS: Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more on the medical interview and on specific topics, such as cancer or hospital medical consultations. CONCLUSIONS: When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a "patient-centred approach", since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.     

Selective expansion and continuous culture of macrophages from adult pig blood

Macrophages were selectively expanded and continuously cultured from adult pig blood. One-half ml of heparinized adult pig blood was inoculated directly into the medium overlaying a feeder layer of STO mouse fibroblasts. After attachment to the feeder cells for 24 h, the culture was washed several times with the medium to remove most of any unattached blood cells and re-fed. Approximately 7 x 10(4) blood monocytes were initially detected and enumerated by specific binding of DiI-labeled acetylated low density lipoprotein (DiI-Ac-LDL). Macrophage outgrowths appeared in the primary culture after 6-7 days. The macrophages grew to relatively high density in 2-3 weeks (2-3 x 10(6) cells/T25 flask), and the culture was passaged on to fresh STO feeder layers to begin secondary culture. Over 2-3 months of culture the macrophage replication produced as many as 1.4 x 10(9) DiI-Ac-LDL-positive cells. The macrophages grew on top of the feeder cells in two forms: either a semi-attached, round morphology, or a closely adherent, flat ameboid morphology with several extended pseudopods. Electron microscopic examination revealed the cells to be uniformly of macrophage character and that 4-5% were giant cells. The macrophages were phagocytic and expressed CD14 on their surfaces. They also reacted positively with pig macrophage-specific monoclonal antibody (mAb), and were negative for reactivity with pig T- and B-cell-specific mAb. This simple method for isolating and propagating macrophages may indicate the replicative capacity of either adult pig blood monocytes or circulating blood stem cells, and it may be useful in providing macrophages for general research, virological assay, adoptive-immunotherapy models, and somatic gene therapy models.     

Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients

Responses in dry matter intake (DMI) and acidbase balance to three sources of anionic salts (dietary cation-anion difference = -63 to -40 meq/kg of dry matter), an acidified fermentation by-product, MgSO4.7H2O + NH4Cl, and MgSO4.7H2O + CaCl2.2H2O + CaSO4, were evaluated relative to the responses of cows fed a control diet (dietary cationanion difference = 203 meq/kg of dry matter) that did not contain anionic salts. Diets were fed for 1-wk periods to eight nonlactating Holsteins assigned to two replicated 4 x 4 Latin squares. Daily DMI increased as time of access to the diet increased up to d 5; mean DMI over d 5 to 7 was reduced by dietary anionic salts. Diets containing anionic salts induced a mild metabolic acidosis that was completely compensated by nonrespiratory mechanisms (decreased blood bicarbonate and base excess; pCO2 and pH values were unaffected). Urinary pH values and bicarbonate excretion were reduced, and urinary NH4+ and titratable acidity excretion were increased, for cows fed diets containing anionic salts. Strong ion difference in urine was decreased by dietary anionic salts because of the relatively greater excretions of Cl- and S2- versus Na+ and K+ by cows fed these diets. Dietary anionic salts decreased mean ruminal pH by 0.12 units, possibly because of the reduced strong ion difference of ruminal fluid. Dietary anionic salts increased mean ruminal NH3 concentration by 2.2 mM, probably because of the higher nonprotein N content of these diets. The strong negative relationship (r2 = 0.95) between urinary pH and net acid excretion by cows fed the diets containing anionic salts suggested that urinary pH measurement might be a useful tool to assess the degree of metabolic acidosis that was imposed by dietary anionic salts.