Two-year follow-up of directly-observed intermittent regimens for smear-positive pulmonary tuberculosis in China

SETTING: The tuberculosis component of the Infectious and Endemic Disease Control Project in the People's Republic of China is the largest single tuberculosis control project in the world using directly-observed therapy and standardized intermittent regimens. OBJECTIVE: To determine the two-year relapse and mortality rates following completion of treatment. DESIGN: A prospective cohort study of 649 cases cured in this project. The 306 new and 343 retreatment cases were treated under field conditions with 2H3R3Z3S3/4H3R3 and 2H3R3Z3E3S3/6H3R3E3, respectively. Following treatment completion, two sputum samples were collected every six months for two years and examined for acid-fast bacilli. Causes of death were identified. RESULTS: The two-year relapse rates for new and retreatment cases were 3.3% and 5.6%, respectively. Retreatment cases with delayed sputum conversion had a greater risk for subsequent relapse. The two-year mortality rate for new and retreatment cases was 3.3% and 8.5%, respectively. The higher mortality rate in retreatment cases was not attributable to relapse of disease, but rather to non-infectious sequelae of tuberculosis. CONCLUSION: The use of directly-observed intermittent regimens is effective in permanently removing infectious tuberculosis cases from the community.     

Lipoprotein lipase gene variation is associated with a paternal history of premature coronary artery disease and fasting and postprandial plasma triglycerides: the European Atherosclerosis Research Study (EARS)

The H-allele of the intron 8 HindIII polymorphism in the lipoprotein lipase (LPL) gene has been associated with a lower risk of myocardial infarction (MI) and plasma levels of triglycerides (TG). To test whether the HindIII site was in linkage disequilibrium with the functional variant LPL Serine447Stop (S447X), subjects from the European Atherosclerosis Research Study (EARS I) were genotyped for both polymorphic sites. This study included 515 offspring of fathers with a premature (<55 years old) MI, who were designated cases, and 930 age- and sex-matched control subjects from five different regions of Europe. Linkage disequilibrium between the two sites was very strong (>.99), with only three of the four possible haplotypes identified: H+S447, H-S447, and H-X447. The frequency of the H-X447 but not of the H-S447 haplotype was significantly lower in cases than in control subjects (.090 versus .117, P<.01) suggesting a protective effect for MI, with this difference being consistent in all five regions of Europe. Compared with individuals homozygous for the H+S447 haplotype, the odds ratio of having a paternal history of premature MI for H-X447 heterozygotes (approximately 20% of the population) was 0.71 (95% confidence interval, 0.55 to 0.92). In addition, there was an increase of the H-X447 haplotype frequency from north to south in control subjects (0.119 in Finland to 0.143 in the Mediterranean region, P<.01). Compared with the H+S447 haplotype, the H-X447 haplotype was associated with significantly lower concentrations of plasma TGs (5.4% lower, P=.01), with this effect being consistent over the regions of Europe. There was no significant evidence for a heterogeneity of effect between males and females or between cases and control subjects, although the effect on TG levels appeared to be the greatest in male cases (11% lower, P=.05). In a second study (EARS II), of 332 cases and 342 control subjects, postprandial clearance of TGs after a standard fat meal was examined. The H-X447 haplotype was associated with significantly lower postprandial triglyceride levels than was the H+S447 haplotype (9.4% smaller area under the curve, P<.05). Thus, the effects on MI risk and plasma lipids associated with the H allele appeared to be mainly mediated by the X447 mutation, and although the lowering effects associated with the H-X447 haplotype on fasting and postprandial TGs are not large, they are consistent with the lowering effect observed on MI risk throughout Europe.     

Replication and tropism of human immunodeficiency virus type 1 as predictors of disease outcome in infants with vertically acquired infection

In a series of 97 infants born to mothers who were seropositive for human immunodeficiency virus type 1 (HIV-1), 18 were identified as infected within the first 60 days of life on the basis of viral culture and polymerase chain reaction findings. We studied viral burden in vivo by quantitative polymerase chain reaction and the in vitro replication pattern of the HIV-1 infecting strain by culturing patient cells with normal phytohemagglutinin-stimulated peripheral blood mononuclear cells. According to the lag phase before p24 antigen detection and the level of p24 production on peripheral blood mononuclear cells, HIV-1 isolates from these patients were classified as rapid/high (R/H), slow/high (S/H), and slow/low (S/L). The pattern of HIV-1 replication in vitro was significantly associated with the viral burden in vivo; the range of HIV-1 copies per 10(5) peripheral blood mononuclear cells was 10 to 38, 44 to 314, and 360 to 947 in children with isolates of the S/L, S/H, and R/H types, respectively. Viral tropism was assessed by culturing patient cells under end-point dilution conditions with either CD4+ T-lymphocytes or monocyte-derived macrophages. We found that children with S/L isolates harbored mainly monocytotropic variants; all infants with S/H or R/H isolates had T-lymphotropic variants and, in 7 of 11 cases, monocytotropic or amphitropic variants. All children with R/H isolates had HIV-related symptoms by the age of 4 months, and five had acquired immunodeficiency syndrome by the age of 1 year. At 1 year of age, four and no infants with S/H or S/L isolates, respectively, had HIV-1-related symptoms (p < 0.001), and none had acquired immunodeficiency syndrome (p = 0.006).     

Field Measurements and Modeling of Two-Stage Biofilter that Treats Odorous Sulfur Air Emissions

Because the presence of hydrogen sulfide (H2S) and methyl mercaptan (MeSH) inhibits the removal of some organic reduced sulfur compounds (e.g., dimethyl sulfide, Me2S) in biofilters, a two-stage biofilter may be an appropriate method to treat a mixture of reduced sulfur compounds. This work studied the treatment of odorous air emissions [a mixture of H2S, MeSH, Me2S, and dimethyl disulfide (Me2S2)] using a two-stage biofilter. H2S had the highest overall removal efficiency (96%) followed by MeSH and Me2S (90 and 91% removal, respectively) and Me2S2 (81%). Most of the removal of H2S, MeSH, and Me2S2 occurred in the primary biofilter (72% H2S, 66% MeSH, and 52% Me2S2), while most of the Me2S removal occurred in the secondary biofilter (64% Me2S). A dynamic model that describes biofiltration was calibrated and validated to H2S and MeSH field data. This is the first time a model was evaluated with organic odor-causing sulfur compound data obtained from a biofilter packed with compost and wood chips. Model simulations showed that H2S removal in a lava rock packed biofilter would be better than in a similar biofilter packed with compost and wood chips.     

A clinical study of chronic lower respiratory infection with Haemophilus influenza by transtracheal aspiration

We have performed a clinical study on chronic lower respiratory tract infection (CLRTI) with Haemophilus influenzae (H. influenzae) by transtracheal aspiration (TTA) and analyzed clinical factors of the acute exacerbation. In 40 episodes (38 cases) of H. influenzae isolated from CLRTI, monobacterial infection with H. influenzae were 21 episodes and polymicrobial infection were 19 episodes. We classified the disease into acute exacerbated (27 episodes) and stable (13 episodes) phase and the former episodes were divided into bronchitis type (7 episodes) and pneumonia type (20 episodes). Polymicrobial infections were seen more in the pneumonia type (13 episodes) than in the bronchitis type (2 episodes). The principal organism detected with H. influenzae were alpha-Streptococcus and Neisseria sp. in the bronchitis type and S. pneumoniae in the pneumonia type. The acute exacerbated cases were divided into the following 4 patterns; 1. polymicrobial infection with continuous infection of P. aeruginosa, 2. monomicrobial infection after acute upper respiratory tract infection, 3. polymicrobial infection with S. pneumoniae after continuous infection of H. influenzae, 4. bacterial replacement by P. aeruginosa after acute exacerbation. The results of the study suggests that polymicrobial infection is an important chronic lower respiratory tract infection when caused H. influenzae.     

Sulfur reduction by human erythrocytes

Washed human erythrocytes incubated with glucose and S8 and purged with N2 produced H2S at a nearly constant rate of 170 mumol (L cells)-1 min-1, which continued for several hours. In sealed vials up to 25 mM HS- accumulated. Glucose caused the fastest H2S production, although either lactate or glycerol could support slower rates. When glucose was added without S8, anoxic H2S production nonetheless occurred at about 1.5% of the maximum rate, after 24 hr totaling 0.5 mmol H2S (L cells)-1, suggesting the presence of endogenous reducible sulfur. Anaerobic conditions were not required, since oxygenated cells produced H2S from S8 at 80% of the anoxic rate. Using cell lysates, production of H2S occurred after addition of either glutathione, NADH, or NADPH. The observations suggest possible physiological roles for H2S as an electron carrier, and are consistent with an evolutionary relationship between eukaryotic cytoplasm and sulfur-reducing Archaea.     

Clinical and bacteriological studies on panipenem/betamipron in pediatrics. Kanagawa Research Group for Infectious Diseases of Children

Following its introduction into the market, PAPM/BP (panipenem/betamipron) was clinically studied in 188 evaluable cases out of 207 cases primarily of respiratory infectious diseases treated at the pediatric departments of 15 hospitals. In the clinical evaluation, the drug proved effective in three of three cases of sepsis; three of three cases of suppurative meningitis; nine of ten cases of laryngopharyngitis, six of seven cases of tonsillitis, 56 of 63 cases of acute bronchitis, 90 of 98 cases of pneumonia, and one of one case of phyothorax, all of which are respiratory infectious diseases; one of one case of secondary infection of a chronic respiratory disease; and two of two cases of lymphadenitis, which is a disease of the soft dermal structure. The overall efficacy rate was 91.0% (171/188 cases). In the bacteriological study, Gram-positive bacteria were eliminated in five of five strains of S. aureus, 30 of 31 strains of S. pneumoniae (96.8%), and three of three strains of S. pyogenes. Gramnegative bacteria were eliminated in 15 of 17 strains of H. influenzae (88.2%), three of four strains of M. catarrhalis, and two of two strains of K. pneumoniae. The overall elimination rate was 92.1% (70/76 strains). In the 23 strains of S. pneumoniae that were examined, penicillin-resistant strains accounted for 56.5%, showing an elimination rate of 100%. No serious adverse effects were observed, and the incidence of adverse effects was 1.45%. As for abnormalities in laboratory tests, levels of GOT and GPT increased in eight cases (3.88%), LDH increased in one case (0.48%), and neutropenia occurred in one case (0.51%). These results suggest that PAMP/BP could be considered the first choice in the treatment of infectious diseases in pediatrics, due to its effectiveness and high level of safety.     

Resistance of Mycobacterium tuberculosis to antituberculosis drugs in the Central Region of Thailand, 1996

OBJECTIVE: To determine the proportion and profile of antituberculosis drug resistance among Mycobacterium tuberculosis isolates in Thailand. SETTING: A 500-bed cardiothoracic centre. DESIGN: From January to December 1996, isolates of M. tuberculosis from consecutive patients with pulmonary tuberculosis underwent susceptibility testing to isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), kanamycin (K), and ofloxacin (O). RESULTS: In all, 1861 strains were tested, 1738 from new cases and 123 from previously treated cases. Overall initial and acquired resistance were 20.9% and 53.6%, respectively. The percentages of initial resistance to R, H, S, O, K and E were 12.6, 8.3, 6.6, 1.8, 1.1 and 0.8, respectively, whereas those of acquired resistance were 43.0, 29.2, 21.1, 9.7, 8.1 and 4.8, respectively. Multidrug resistance was observed in 4.2% of new patients and 25.2% of previously treated patients. CONCLUSION: The overall drug resistance of M. tuberculosis in the central region of Thailand is high, and acquired multidrug resistance has reached an ominous level. The results have serious implications for tuberculosis control in Thailand. Urgent measures are needed to control the spread of drug resistance, and supervised treatment of standard protocol should be adhered to more strictly.     

Color doppler ultrasonography in peripheral artery occlusive disease: continuous application of a signal enhancer

OBJECTIVE: The purpose of this study was to evaluate the clinical and epidemiological characteristics of meningitis in our environment. PATIENTS AND METHODS: A retrospective study of 166 cases of meningitis diagnosed in our hospital during a 10 year period (1986-1995) was performed. The patients were between 1 month and 14 years of age. RESULTS: Sixty-six percent of the patients were male and 34% female. Eleven cases were younger than 2 months (6.6%), 122 cases (73.5%) were between 3 months and 5 years of age and 33 cases (19.9%) were older than 5 years. The most frequent symptoms and signs were fever (96%), vomiting (60%), impairment of consciousness (24%) and meningeal signs (49%). CSF cultures were positive in 52% and blood cultures in 32%. The pathogen isolated was N. meningitidis in 53 cases (32%), H. influenzae in 38 (23%), S. pneumoniae in 9 patients (5%) and others in 3 children (2%). Meningitis due to H. influenzae increased each year. No microorganism was isolated in blood and CSF in 63 cases (38%). Meningitis in children between 3 months and 5 years of age was due to N. meningitidis in 40 children (33%) and H. influenzae in 36 (29%). The mortality rate was 3%. The most frequent complications were sepsis (36%) and seizures (16%). CONCLUSIONS: The most frequently isolated agent in our study was N. meningitis. Meningitis due to H. influenzae is increasing such that H. influenzae and N. meningitis currently show similar frequency in children between 3 months and 5 years of age.     

Preweaning growth traits for Senepol, Hereford, and reciprocal crossbred calves and feedlot performance and carcass characteristics of steers

We conducted a multiyear study in two phases to determine preweaning performance traits of Senepol (S x S), Hereford (H x H), and reciprocal (S x H and H x S) F1 crossbred calves and feedlot performance and carcass characteristics of steers. In Phase I, from 1985 to 1989, data from S x S (n = 194), H x H (n = 383), and S x H (n = 120) calves were used. Numbers of S x S cows were increased during Phase I so that data from H x S (n = 74) calves could be included in Phase II (1990 to 1992) in addition to S x S (n = 118), H x H (n = 130), and S x H (n = 56) calves. Also during Phase II, feedlot performance and carcass characteristics were determined for S x S (n = 30), H x H (n = 26), H x S (n = 36), and S x H (n = 26) steers. In Phase I, S x S calves had heavier (P < .01) birth weights and heavier (P < .01) 205-d adjusted weaning weights than H x H calves. Birth weights of S x H calves were heavier (P < .01) than the mean of the purebred calves, but 205-d adjusted weaning weights did not differ (P > .10). In phase II, direct heterosis was 3.5% for birth weight (P < .05) and 5.1% for 205-d adjusted weaning weight (P < .01). Senepol maternal breed effects were 1.9 kg for birth weight (P < .10) and 37.9 kg for 205-d adjusted weaning weight (P < .01). Levels of direct heterosis, Senepol maternal breed effects, and Hereford direct breed effects were significant for most feedlot performance traits of steer calves that were fed to a common end point. Breeds did not differ (P > .10) for USDA yield and quality grades, and direct heterosis was not significant for Warner-Bratzler shear force. These results demonstrate significant levels of heterosis in preweaning performance between S x S and H x H calves and in feedlot performance of steers. Levels of heterosis were smaller and nonsignificant for most carcass traits including meat tenderness, which did not differ between S x S and H x H steers in this study.     

Investigation of Mechanical Property of Oil Tube Steel P110S in High Temperature and High Pressure Environment Containing H2S/CO2

With the exploitation of high sour and deep oil well in china,the corrosion medium containing CO 2,H 2 S,Cl-and organic acid threaten the safety of oil equipment and tube steel severely.In this article,many experiments,including corrosion tests,tensile tests,hydrogen concentration measurement tests and SEM examinations,were performed to investigate the effect of H 2 S partial pressure and loading stress on the mechanical property of oil tube steel P110S in high temperature and high pressure environment containing H 2 S/CO 2.The tensile strength and yield strength during fracture process of P110S steel were obtained experimentally and the fracture morphology was analyzed by SEM.The results indicate that both tensile strength and yield strength decreased after corrosion.The damage of tensile strength and yield strength became serious with an increase in H 2 S partial pressure and loading stress.According to the fracture analysis,the fracture mode exhibited quasi-cleavage and dimple mixed fracture,and the area of quasi-cleavage pattern increased with H 2 S partial pressure and loading stress increasing.According to the results of tensile test and hydrogen concentration measurement test,the tensile property degradation is closely associated with diffusible hydrogen concentration of P110S steel in the H 2 S/CO 2 environment.     

Bacterial meningitis in a rural Kenyan hospital

In a prospective study to investigate mortality and antibiotic resistance in meningitis patients, thirty two meningitis cases were seen over a three month period. Mean age was 11.3 years (range one month-60 years). Cerebrospinal fluid cultures were positive in 26 patients (81.3%). S.pneumoniae was responsible for 15 cases (46.9%), followed by H.influenzae in seven (21.9%). Salmonella infection was seen in two patients, and E.coli and N.meningitidis in one each. Twelve patients (37.5%) died during hospitalisation with most of the deaths occurring within 48 hours after admission. No patients presented with atypical signs of meningitis. No significant differences were found between delay and outcome. Malaria parasites were found in blood of thirteen patients (41%), but did not contribute to higher mortality. Three of H.influenzae isolates (42.9%) were resistant to ampicillin and penicillin. Reduced sensitivity to penicillin was found in two (13.3%) of S.pneumoniae isolates.     

Differential effects of learning and recall of a spatial task on phosphoinositide hydrolysis induced by the metabotropic glutamate receptor agonist 1S,3R-ACPD (1S,3R-1-amino-cyclopentane-1,3-discarboxylic acid) in the hippocampus and the prefrontal cortex of rats

Phosphoinositide (PI) hydrolysis, stimulated by 1S,3R-1-amino-cyclopentane-1,3-dicarboxylic acid (1S,3R-ACPD), an agonist of metabotropic glutamate receptors (mGluRs), was measured in hippocampal and prefrontal cortical slices obtained from rats which had been trained for 8 days in a Morris water maze and had learned an allocentric spatial task. Brain slices were pre-labeled with myo-3H-inositol and 1S,3R-ACPD (100 microM) stimulation was assessed by measuring the accumulation of [3H]inositol phosphates ([3H]IPs) in the presence of Li+. Measurements conducted 24 h following the last training session revealed no differences in 1S,3R-ACPD-stimulated formation of [3H]IPs, either in the hippocampus or in the prefrontal cortex. However, a diminished response to mGluRs stimulation was detected in the hippocampus of animals re-trained after an 11-day interval. The decrease was not evident in the prefrontal cortex. These data indicate a differential involvement of the hippocampus and the prefrontal cortex in the processing of spatial information and correspond to the functional differences attributed to these areas.     

Fractors affecting the rate of gluconeogenesis from L-cysteine in the perfused rat liver

It has been shown that the net rate of gluconeogenesis from cysteine was only 10% the rate observed from pyruvate. This suggested that the rate limiting step in gluconeogenesis from cysteine was between cysteine and pyruvate. Evidence is presented showing that the cysteine-sulfinate pathway does not play a regulating role in the conversion of cysteine to glucose. Thus, liver cysteine desulfhydrase (CDS) activity and hydrogen sulfide production were evaluated for their potential effects. Liver CDS activity was increased by a 3 day starvation, by feeding a 90% casein diet or a 4% cysteine + 86% casein diet. In all cases the activity of the enzyme was in excess of that required to account for the rate of conversion of cysteine to glucose observed, thus the potential activity of this enzyme was not a rate limiting factor. The possible effect of H2S, an end product of the CDS reaction, on gluconeogenesis from cysteine was evaluated. The addition of NaHS abolished the glucogenic response observed from cysteine, but had very little effect on glucoeogenesis from lactate, suggesting that accumulated H2S may inhibit CDS, marking CDS rate limiting in the conversion of cysteine to pyruvate.     

Characterization of pathogenetic determinants of Candida albicans strains

In order to get information as to whether direct interaction of H. pylori and yeasts may modulate the course of H. pylori infections, the adhesion of H. pylori to C. albicans, C. glabrata, C. guilliermondii, C. krusei, C. parapsilosis, C. tropicalis and S. cereviseae was investigated. H. pylori adhered significantly more frequently to C. tropicalis (adhesion ratio > 10%) than to the other yeasts (adhesion ratios < 5%). On an average, no significant difference to the adhesion ratios of E. coli and S. aureus was found. Electron microscopic examinations showed that H. pylori cells contacted the cells of C. tropicalis either by knob-like structures or by close surface-to-surface adhesion. Cholesterol-depleted H. pylori cells adhered to the yeast no more than cholesterol-carrying cells. There was no indication that a direct cooperation with yeasts plays a role in H. pylori infections.     

硫化氢发生紫外光度法测定钢铁中硫

钢铁样品在HCl—H_3PO_4混合酸的作用下,硫以硫化氢逸出,经酸洗后用碱液吸收,直接于紫外区进行测定.实验发现:负二价硫离子的吸收峰波长为229nm,ε=5×10~4,若适当加大取样量,可测定钢铁中0.001%的硫.本实验没有发现干扰,选择性高,操作简单.     

Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome]

Two groups of 3 120-160-kg Holstein steers were fed a diet high in carbohydrate and low in long fiber and either with or without added sodium sulfate. Prior to and during the course of feeding the experimental diet, the concentrations of rumen hydrogen sulfide gas and rumen fluid sulfide were determined by a simple sulfide detector tube method and by sulfide-selective electrode, respectively. Other measurements included rumen fluid pH, blood creatine kinase, and blood sulfhemoglobin. Two of the 3 steers fed the high-sulfate diet developed signs and lesions of polioencephalomalacia. Clinical signs included episodic ataxia and blunted or absent menace reaction. Increased ruminal H2S gas concentrations occurred in all 3 steers consuming the diet with added sulfate. The onset of clinical signs coincided with the onset of elevated H2S concentrations. These increases were 40-60 times the values measured in the steers consuming the diet without added sulfate. In contrast, increases in rumen fluid sulfide concentrations usually rose to 4 times that of control steers. The steers fed an identical diet but without added sulfate exhibited no signs or lesions of polioencephalomalacia and no elevations of sulfide in rumen gas or fluid. All steers had a modest decrease in rumen fluid pH associated with the transition to the concentrate diet. No significant changes were observed in any of the blood measurements of any of the steers. An additional pair of steers was fed the experimental diet with or without added sulfate to compare the ruminal H2S gas concentrations estimated by H2S detector tubes with those estimated by a different method of analysis utilizing charcoal trapping of H2S, conversion to sulfate, and measurement of the sulfate. Both methods yielded comparable estimates of H2S concentration. Overall, these data indicate that changes in rumen gas cap H2S concentrations are larger than changes in rumen fluid sulfide concentration and the estimation of rumen gas cap H2S concentration may be a practical approach to detecting pathologic increases in ruminal H2S gas. This simple, rapid, minimally invasive method should be useful for estimating the H2S content of ruminal gas under field conditions.     

Intra-arterial preventive chemotherapy for residual liver after resection of hepatic metastasis from colorectal cancer

We treated 18 cases with intra-hepatic arterial infusion chemotherapy after resection of hepatic metastasis from colorectal cancer (June 1991-September 1997). Eight cases were H1, 7 were H2, and 3 were H3. Hepatic lobectomy was done in 3 cases, lobectomy + partial resection in 2 cases, and partial resection in 13 cases. All cases received high-dose intermittent 5-FU infusion (WHF = 5-FU 1,000 mg/m2/5 hrs/w) on an outpatient basis. The total frequency of WHF was 4-54 times (average 29), and total 5-FU doses ranged from 6.0 to 81.0 g (average 40 g). The 1- and 5-year cumulative survival rates were 100% and 77.5% in all patients 100% and 87.5% in H1 group and 100% and 64.3% in H2 + H3 group, respectively. There was no significant difference of survival between the H1 and H1 + H3 groups. The 1- and 5-year recurrence rates in residual liver were 5.9% and 14.4%, respectively. One of 2 cases with residual liver recurrence was resected for metastasis again, and the patient is now in a disease-free state. WHF after resection of hepatic metastasis from colorectal cancer has a preventive effect for their survival, not only in H1 group but also in H2 + H3 group.