Clinical features of infections due to Escherichia coli producing heat-stable toxin during an outbreak in Wisconsin: a rarely suspected cause of diarrhea in the United States

In September 1994, a foodborne outbreak of enterotoxigenic Escherichia coli (ETEC) infection occurred in attendees of a banquet in Milwaukee. E. coli was isolated from stool specimens from 13 patients that were comprehensively tested; isolates from five patients were positive for E. coli producing heat-stable toxin, were biochemically identified and serotyped as E. coli O153:H45, and were all resistant to tetracycline, ampicillin, sulfisoxazole, and streptomycin. Diarrhea (100%) and abdominal cramps (83%) were the most prevalent symptoms in 205 cases; vomiting (13%) and fever (19%) were less common. The median duration of diarrhea and abdominal cramps was 6 days and 5 days, respectively. In the United States, health care providers rarely consider ETEC as a possible cause of diarrhea in their patients, and few laboratories offer testing to identify ETEC. Hence, outbreaks of ETEC infection may be underdiagnosed and underreported. As in this outbreak, the relatively high prevalence of diarrhea and cramps lasting > or = 4 days and the low prevalence of vomiting and fever can help distinguish ETEC infection from Norwalk-like virus infection and gastroenteritis due to other causes with incubation times of > or = 15 hours and can provide direction for confirmatory laboratory testing.     

Extracorporeal circulation in pregnancy: report of a case. Update and review of the literature

OBJECTIVE: To investigate the role of platelet activating factor (PAF) in the hypoxic pulmonary hypertension. MATERIAL AND METHODS: Fifteen of 30 male Wistar rats were exposed to hypoxia for 3 weeks, and another 15 rats served as controls. The pulmonary arterial pressure was examined by catheterization. The sections of rat lung were treated by the avidin-biotin-peroxidase complex method to expose the location of PAF. RESULTS: The rats developed pulmonary hypertension and right ventricular hypertrophy after hypoxic exposure. Under the light microscope, PAF is distributed on the vascular and alveolar walls of normal lung, and the content of PAF in the lung of rats with hypoxic pulmonary hypertension are remarkably higher than those of normoxic controls. CONCLUSIONS: PAF plays not only a physiological role in the rat lung, but also a pathophysiologic role in hypoxic pulmonary hypertension.     

The murine anti-human common gamma chain monoclonal antibody CP.B8 blocks the second step in the formation of the intermediate affinity IL-2 receptor

A murine monoclonal antibody, CP.B8, specific for the extracellular portion of the human common gamma (gammac) chain, and its Fab fragment are shown to block the binding of IL-2 to COS-7 cells transfected with the cDNA for the full-length IL-2 receptor beta (IL-2Rbeta) and gammac chains, components which together comprise the intermediate affinity IL-2 receptor (IL-2R) expressed on the surface of resting T cells, NK cells, and on certain intestinal epithelial cells. To investigate the mechanism of this inhibition, the extracellular portions of the IL-2Rbeta and gammac chains were expressed and purified, and their interactions with each other and with IL-2 were studied by gel filtration and by surface plasmon resonance (SPR). By gel filtration, a stable ternary complex was formed by association of the three proteins, while no stable binary complexes were detected between any two of the three proteins. By SPR analysis, IL-2 was shown to associate rapidly with IL-2Rbeta, forming a binary complex with an equilibrium dissociation constant (Kd) of 800 nM, which permitted subsequent association of the gammac chain. Dissociation of the IL-2/IL-2Rbeta/gammac chain complex was significantly slower than dissociation of the IL-2/IL-2Rbeta complex. Using these model systems, we tested the ability of mAb CP.B8 to inhibit the association of the gammac chain with IL-2 and IL-2Rbeta. By gel filtration, mAb CP.B8 formed a stable complex with the gammac chain, preventing its association with IL-2 and IL-2Rbeta. MAb CP.B8 was also capable of dissociating the gammac chain already complexed with IL-2 and IL-2Rbeta. SPR analysis confirmed these findings and showed, in addition, that the Fab fragment of CP.B8 was also capable of inhibiting the association of the gammac chain with the IL-2/IL-2Rbeta complex. We conclude that mAb CP.B8 blocks the second step in the formation of the intermediate affinity IL-2R on the surface of transfected COS-7 cells by binding at or close to a region on the gammac chain that is involved in contact with IL-2 and/or IL-2Rbeta.     

Cytokine regulation of human microglial cell IL-8 production

IL-8 involvement in neutrophil activation and chemotaxis may be important in inflammatory responses within the central nervous system, secondary to meningitis, encephalitis, and traumatic injury. The source of IL-8 within the brain during these inflammatory processes, however, is unknown. To explore the role of microglia in the production of IL-8, human fetal microglia, which are the resident macrophages of the brain, were treated with LPS and pro- and anti-inflammatory cytokines to determine their effects on IL-8 production. We found that IL-8 protein levels increased in response to LPS or IL-1 beta, or to TNF-alpha, which also corresponded to elevated IL-8 mRNA levels by RT-PCR. Pretreatment with IL-4, IL-10, or TGF-beta 1 potently inhibited the stimulatory effects of these proinflammatory agents. These findings indicate that human microglia synthesize IL-8 in response to proinflammatory stimuli, and that anti-inflammatory cytokines down-regulate the production of this chemokine. These results may have important therapeutic implications for certain central nervous system insults involving inflammation.     

Functionally oriented and clinically feasible quantitative gait analysis method

Zygotes of fucoid algae acquire polarity de novo. The initial polarity establishes the apical-basal polarity of the multicellular embryo and the adult plant. Acquisition of polarity involves the translation of external vectorial signals into spatial information within the cell via spatial photoreceptor activation at the level of the plasma membrane. Fixation of the polar axis involves interactions between the cytoskeleton, plasma membrane and the cell wall. Recently a central role for targeted secretion in polar axis fixation has been identified. In the multicellular embryo, evidence is accumulating for roles of cell wall and intercellular communication via diffusible signals in pattern formation and control of cell fate.     

Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results

OBJECTIVE: This study sought to compare two strategies of revascularization in patients obtaining a good immediate angiographic result after percutaneous transluminal coronary angioplasty (PTCA): elective stenting versus optimal PTCA. A good immediate angiographic result with provisional stenting was considered to occur only if early loss in minimal luminal diameter (MLD) was documented at 30 min post-PTCA angiography. BACKGROUND: Coronary stenting reduces restenosis in lesions exhibiting early deterioration (>0.3 mm) in MLD within the first 24 hours (early loss) after successful PTCA. Lesions with no early loss after PTCA have a low restenosis rate. METHODS: To compare angiographic restenosis and target vessel revascularization (TVR) of lesions treated with coronary stenting versus those treated with optimal PTCA, 116 patients were randomized to stent (n=57) or to optimal PTCA (n=59). After randomization in the PTCA group, 13.5% of the patients crossed over to stent due to early loss (provisional stenting). RESULTS: Baseline demographic and angiographic characteristics were similar in both groups of patients. At 7.6 months, 96.6% of the entire population had a follow-up angiographic study: 98.2% in the stent and 94.9% in the PTCA group. Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group (1.95 vs. 1.5 mm; p < 0.03). However, late loss was significantly higher in the stent than the PTCA group (0.63+/-0.59 vs. 0.26+/-0.44, respectively; p=0.01). Hence, net gain with both techniques was similar (1.32< or =0.3 vs. 1.24+/-0.29 mm for the stent and the PTCA groups, respectively; p=NS). Angiographic restenosis rate at follow-up (19.2% in stent vs. 16.4% in PTCA; p=NS) and TVR (17.5% in stent vs. 13.5% in PTCA; p=NS) were similar. Furthermore, event-free survival was 80.8% in the stent versus 83.1% in the PTCA group (p=NS). Overall costs (hospital and follow-up) were US $591,740 in the stent versus US $398,480 in the PTCA group (p < 0.02). CONCLUSIONS: The strategy of PTCA with delay angiogram and provisional stent if early loss occurs had similar restenosis rate and TVR, but lower cost than primary stenting after PTCA.     

Protein kinase C isoforms during the development of deciduomata in pseudopregnant rats

In this study, we determined the expression of protein kinase C (PKC) isoforms during trauma-induced decidualization. The findings revealed that at least five PKC isoforms (alpha, delta, zeta, iota and lambda) were present in both control and decidualized tissues. After trauma-stimulation, PKC alpha was down-modulated in the deciduomata but not in the myometrium. Down-modulation was compatible with the increase in cell mitosis which reached a maximum at 2-3 days. On the other hand, PKC zeta was not down-modulated. It was increased both in the deciduomata and myometrium, and paralleled the frequency of decidual cell mitosis. The PKC isoforms of delta, iota and lambda were also increased, but they were associated with the depression of cell mitosis. Therefore, these findings suggested that the variable expression of PKC isoforms in trauma-induced decidualizing tissue in pseudopregnant rats may be involved in the modulation of decidual cell growth.     

Reducing the risk of accidental death due to vehicle-related carbon monoxide poisoning

Emissions of carbon monoxide (CO) from motor vehicles cause several hundred accidental fatal poisonings annually in the United States. The circumstances that could lead to fatal poisonings in residential settings with motor vehicles as the source of CO were explored. The risk of death in a garage (volume = 90 m3) and a single-family dwelling (400 m3) was evaluated using a Monte Carlo simulation with varying CO emission rates and ventilation rates. Information on emission rates was obtained from a survey of motor vehicle exhaust gas composition under warm idle conditions in California, and information on ventilation rates was obtained from a summary of published measurements in the U.S. housing stock. The risk of death ranged from 16 to 21% for a 3-hr exposure in a garage to 0% for a 1-hr exposure in a house. Older vehicles were associated with a disproportionately high risk of death. Removing all pre-1975 vehicles from the fleet would reduce the risk of death by one-fourth to two-thirds, depending on the exposure scenario. Significant efforts have been made to control CO emissions from motor vehicles with the goal of reducing CO concentrations in outdoor air. Substantial public health benefit could also be obtained if vehicle control measures were designed to take account of acute CO poisonings explicitly.     

Fellowship training in infectious diseases: a report from the regional and national meetings of infectious diseases division chiefs and program directors

During the 2-year period April 1995 to April 1997, six regional meetings and one national meeting of division chiefs and program directors of adult infectious diseases programs in the United States were held to review fellowship training. Herein, we report data on job availability and job selection for recently graduated fellows. We summarize discussions on decreasing the number of fellows in training, and we outline suggested components of a core clinical curriculum and of three training tracks--clinician track, clinical investigator track, and basic investigator track.     

Neuroendocrine differentiated carcinoma of the uterine cervix

Cervical neuroendocrine carcinomas (CNC) are rare tumors. The term includes the cervical carcinoid, the small cell (oat-cell) carcinoma and the primitive neuroectodermal tumor (PNET). Between 1979 and 1993 eight CNC out of 788 cervical carcinomas were identified by conventional light microscopy and immunohistochemistry. Three tumors were small cell carcinomas with positive staining for NSE (6/8 tumors) and chromogranin A (2/8). In one case a PNET was diagnosed by identifying rosette like structures and negative immunohistochemistry for neuroendocrine markers. Two patients (including PNET) died of disease 3.1 (1.3 to 4.8) years after diagnosis. The others showed no evidence of disease after a mean follow up to 4.4 years. Three of them got pelvic radiation postoperatively. Four tumors showed foci of squamous cell carcinoma [3] and adenocarcinoma [2]. There is no evidence, that these foci influence the prognosis on CNC. Therefore, it is important to recognize the neuroendocrine component, as this type of carcinoma requires special therapeutic considerations. The authors favour the metaplastic origin of CNC from a multipotent (endocervical) stem cell.