Simultaneous analysis of cell surface antigens and DNA content by flow cytometry

Cells obtained from the blood or bone marrow of patients with haematological malignancies can both be stained with fluorescent labelled monoclonal antibodies to determine an immunophenotype and permeabilized with 30% ethanol then stained with propidium iodide for simultaneous DNA analysis. In the technique described here, no evidence of selective depletion of the malignant cell population was demonstrated and decreases in the mean fluorescence intensity of the surface markers were insufficient to affect the sensitivity of flow cytometric analysis. The combined method is simple and robust enough to allow incorporation of DNA analysis into routine immunophenotyping of leukaemia and lymphoma cells.

Cross-sectional study of osteopenia with quantitative MR imaging and bone densitometry

PURPOSE

To evaluation the cancellous bone-induced intravoxel spin dephasing rate (R2') and its relationship to bone mineral density and marrow fat and to examine these parameters as predictors of vertebral fracture status.

MATERIALS AND METHODS

R2' and R2, the rate constants for reversible and irreversible spin dephasing, and marrow fat fraction were measured in the lumbar vertebrae and proximal femur. One hundred thirty-nine subjects (mean age, 62.4 years +/- 11.4 [SD]; 33 men, 106 women) had spinal dual-energy x-ray absorptiometric bone mineral density (BMD) T scores ranging from +3 to -5. R2', BMD, and bone marrow composition as determinants of vertebral fracture status were examined.

RESULTS

Strongest single predictors of fracture status for BMD and R2' were the Ward triangle (r(2) = 0.48) and trochanter (r(2) = 0.37), respectively. Combined, the two parameters and sites increased fracture prediction (r(2) = 0. 62), whereas the combination of multiple BMD sites did not. Multivariate regression involving marrow fat fraction further improved fracture status prediction. R2' was correlated with BMD at all sites, although slopes differed by a factor of up to 2.5, which reflected differences in trabecular orientation relative to the static field. R2, the true transverse relaxation rate, was negatively correlated with marrow fat fraction. A non-age-related increase in marrow fat fraction in osteoporosis parallels earlier findings in animal models.

CONCLUSION

Cancellous bone marrow R2' measured in the proximal femur provides information, which, with BMD, improves prediction of vertebral fracture status.

Palatability of wethers fed an 80% barley diet processed at different ages and of yearling wethers grazed on native range

Seasonal availability of lamb in the Western United States contributes to a large fluctuation in lamb supply and value. However, alternatives to fall marketing may not be practical unless palatability traits are acceptable. A 3-yr study was conducted to investigate 1) the effects of slaughter age (7 to 8; 10 to 11; or 14 to 15 mo) on carcass and palatability characteristics of wethers fed an 80% barley diet (Exp. 1); and 2) the effects of finishing on range or on an 80% barley diet on carcass and palatability traits of 14- to 15-mo-old wethers (Exp. 2). In Exp. 1, no differences (P = .27) were detected in flavor intensity or longissimus muscle area among slaughter age groups, but fat depth was greater (P < .05) for 7- to 8-mo-old wethers than for 10- to 11- or 14- to 15-mo-old wethers. Year x slaughter age interactions were detected (P < .10) for hot carcass weight, Warner-Bratzler shear value, body wall thickness, and percentage kidney fat. Hot carcass weight was greater (P < .05) for 14- to 15-mo-old wethers than for both groups of younger wethers in yr 1, did not differ (P = .53) among slaughter ages in yr 2, and was greater (P < .05) for 10- to 11- than for 14- to 15-mo-old wethers in yr 3. Warner-Bratzler shear values did not differ (P > .10) among slaughter ages in yr 1 and 3, but shear values for 14- to 15-mo-old wethers were greater (P < .05) than for both younger slaughter age groups in yr 2. Percentage kidney fat was lower (P < .05) for 14- to 15- than for 7- to 8-mo-old wethers in all years. In Exp. 2, flavor intensity of the meat did not differ (P = .35) between finishing systems, but longissimus muscle area was greater (P = .02) for range-finished wethers than for wethers fed an 80% barley diet. Year x finishing treatment interactions were detected (P < .10) for shear values, body wall thickness, percentage kidney fat, and fat depth. Shear values were greater (P = .10) for range-finished wethers than for wethers fed an 80% barley diet in yr 1, but did not differ (P > .55) in yr 2 and 3. Body wall and fat measurements were greater (P < .10) for wethers fed an 80% barley diet than for range-finished wethers in all years except yr 3, when fat depth did not differ (P = .47). Overall, slaughtering wethers fed an 80% barley diet or range-finished wethers at older ages produced acceptable carcasses with desirable meat palatability traits.

Measurement of R'2 in the presence of multiple spectral components using reference spectrum deconvolution

A method is described for measuring R'2, the RF reversible contribution to the effective transverse relaxation rate in yellow trabecular marrow, as a means to evaluate trabecular bone structure and density. The method exploits the similarity in spectral composition of the marrow and fat in subcutaneous tissue. Under these conditions the gradient echo envelope of the marrow signal can be regarded as a convolution of a function describing the bone marrow intravoxel line broadening (R'2) with a function expressing chemical shift modulation, which is obtained from the echo envelope of the subcutaneous fat signal in a reference region. Simple division of each of a series of echoes by the reference signal is shown to afford a smooth decay which can be fitted to a model to extract R'2. The method has been evaluated in the upper femur of test subjects and a strong correlation of the thus derived R'2 values with those obtained by the GESFIDE technique is demonstrated. The close correspondence in spectral composition of proximal femur marrow and subcutaneous fat is further illustrated by means of localized spectroscopy. The major potential error source is global inhomogeneity in the reference region which can lead to an underestimation of the demodulation-derived R'2.

The effects of amount of whole barley, barley bulk density, and form of roughage on feedlot lamb performance, carcass characteristics, and digesta kinetics

We conducted two feedlot trials and one metabolism trial to evaluate the effect of barley level, barley bulk density, and physical form of roughage on lamb growth performance and digesta kinetics. Level of whole barley (50, 70, 90%) and type of roughage (chopped or pelleted alfalfa) were evaluated in Trial 1 (50 d period). Trial 2 (50 d) evaluated barley bulk density (heavy = 671 and light = 607 kg/m3), form of roughage (pelleted or chopped alfalfa), and level of barley (80 or 40%). The influence of treatments used in Trial 2 on digesta kinetics was evaluated in Trial 3. Gain:feed increased and DMI decreased (P < .10) linearly with increasing level of barley, and ADG and DMI were greater (P < . 10) for lambs fed pelleted vs chopped alfalfa in Trial 1. The 70% barley diet produced the highest yield grade and kidney-pelvic fat and the lowest leg score among barley levels (P < .10). Lambs fed pelleted alfalfa had heavier carcasses and a thicker body wall than lambs fed chopped alfalfa (P < .02). In Trial 2, DMI was less and gain:feed greater (P < .01) for lambs fed the heavy barley than for lambs fed the light barley and for the 80% barley diet compared to the 40% barley diet. Lambs fed pelleted alfalfa had greater dressing percentages than lambs fed chopped alfalfa. Backfat and body wall thickness were greater (P < .10) for lambs fed the 80% barley diet than for those fed the 40% barley diet. In Trial 3, retention time of barley was greater (P < .10) for lambs fed light rather than heavy barley, and retention time of alfalfa was greater (P < .10) for lambs fed chopped compared with pelleted alfalfa. Acetate:propionate ratio was greater (P < .10) for lambs fed light vs heavy barley and lambs fed the 40 vs 80% barley diets. Ruminal pH was lower (P = .05) and in situ barley digestion greater (P = .03) over time in lambs fed the 80% barley diet than in lambs fed the 40% barley diet. Feedlot lamb ADG was not always greatest with high levels of barley; however, gain:feed improved at the higher barley levels. The higher barley levels seemed to result in fatter lambs.

Magnetic susceptibility measurement of insoluble solids by NMR: magnetic susceptibility of bone

Measurements of the volume magnetic susceptibility of solids using the classical Gouy balance approach are hampered by variations in apparent density of the packed powder. In this paper a quantitative NMR measurement of the volume magnetic susceptibility of powdered solids is described and the volume susceptibility of bone is reported. The technique is based on the measurement of changes in incremental linewidth (1/pi T2') induced in a marker fluid whose susceptibility can be predictably modified by changing the composition, such as by addition of a soluble diamagnetic compound. The spectroscopic linewidth of the marker fluid is determined by the susceptibility difference between the fluid and the suspended solid. Changes in the linewidth are accompanied by bulk magnetic susceptibility induced frequency shifts in the fluid resonance. Correlating the two dependencies allows measurement of the absolute volume susceptibility of the solid. The susceptibility of bovine rib bone was found to be -0.9 +/- 0.02 x -10(-6) (CGS) confirming previous estimates which suggested bone to be more diamagnetic than the marrow constituents. Knowledge of the susceptibility of bone is relevant in view of the growing interest in MRI osteodensitometric techniques.

Refractive index of NH(4)Cl-H2O as a function of wavelength: the effect of temperature and concentration

The refractive index of NH(4)Cl-H(2)O solutions has been measured over a wavelength range from 496.5 to 690 nm. The NH(4)Cl concentration was varied from 15 to 30 wt. % over a temperature range from 10 to 35 °C. We obtained mathematical equations relating the refractive index to wavelength, temperature, and concentration using the least-squares method. A knowledge of these properties is important for analyzing and modeling the dendritic growth of this system.

A strategy for the identification of candidate genes for alcohol-related phenotypes and other human disorders using rapid polymerase chain reaction mapping of gene-based sequence-tagged sites

We describe a method for the rapid identification and mapping of human genes, including those possibly contributing to disease and alcohol-related phenotypes. New human genes are identified from cDNA libraries through single-pass sequencing into the 3' untranslated (3'UT) regions of human brain cDNAs. Primers derived from the 3'UT region sequences [representing gene-based, sequence-tagged sites (STSs)] are used for polymerase chain reaction (PCR) analyses of the CEPH megabase insert yeast artificial chromosome (YAC) DNA pools. With this approach, approximately 18,000 megabase YACs can be screened and a single YAC identified using only 52 PCR reactions. The YAC localization in conjunction with other mapping techniques, such as PCR mapping to human chromosomes using somatic cell hybrids, allows identification of chromosomal band locations. In this manner, each gene can be associated with its own STS, which in turn specifies both a corresponding genomic clone and specific location in the genome. These locations can be compared with the purported locations of disease genes. The locations of the STSs can also be compared with those of Quantitative Trait Loci implicated for quantitative traits (e.g., alcohol-related phenotypes) on the basis of synteny between the mouse and human genes. Using this strategy, we found candidates for 78 human disease/syndrome genes among the first 220 genes mapped.

Gene-based sequence-tagged-sites (STSs) as the basis for a human gene map

Using our data set of 3,143 single pass sequences from human brain cDNA libraries, we have developed a strategy in which gene-based sequence-tagged-sites (STSs), derived from 3'untranslated regions of human cDNAs, are rapidly assigned to megabase-insert yeast artificial chromosomes and somatic cell hybrids to generate regional gene mapping data. Employing this approach, we have mapped 318 cDNAs, representing 308 human genes. Ninety-two of these mapped to regions implicated in human genetic diseases, identifying them as candidate genes. Extension of this strategy has the potential to result in virtually every human gene having, at its 3' end, its own associated STS, with each STS in turn specifying both a corresponding genomic clone and a specific regional location in the genome.

Clinical correlates of anaerobic bacteriology in peritonitis

Recent surgical reports indicate that for patients with secondary bacterial peritonitis, surgeons do not routinely use the identification of the bacterial pathogens and determination of their antimicrobial susceptibilities in choosing antimicrobial therapy. Further, some surgeons advocate abandoning the routine practice of obtaining culture specimens from patients with complicated appendicitis, because the data from the clinical laboratory have not been found to have an impact on postoperative care. We review the rationale for continued surveillance of and implementation of bacteriological data in treatment of secondary peritonitis. We also describe in detail the anaerobic flora of secondary peritonitis, the unique susceptibility patterns of these organisms, and the specific virulence factors of anaerobes, particularly Bacteroides fragilis. The fact that clinical investigations sometimes result in treatment failure when gram-negative anaerobes are resistant to the antimicrobials used or when complete antimicrobial susceptibility data are not available emphasizes the need for accurate and early knowledge of the bacteriologic characteristic of the flora of the operative site. We emphasize the relationship of in vitro susceptibility of intraoperative isolates with clinical outcome. We propose a cooperative trial that would demonstrate that successful antimicrobial therapy should be based on the susceptibility of the flora of the operative site, which correlates with clinical outcome.

Adjunctive antimicrobial therapy for complicated appendicitis: bacterial overkill by combination therapy

Although single antimicrobials with broad-spectrum aerobic and anaerobic coverage are effective in patients with appendicitis, many general surgeons continue to use multiple agents. A prospective, double-blind, randomized trial was designed to detect any clinical correlate of in vitro susceptibility advantage of multiple antimicrobials as adjunctive therapy for 114 patients undergoing operation for complicated appendicitis. There was clinical resolution of intraabdominal infections with no occurrence of postoperative infectious complications in 90% (36 of 40) of the cefotetan group and 86% (31 of 36) of the clindamycin/amikacin group (p = 0.11). The number of patients who had changes in antibiotic therapy due to postoperative complications was higher in the clindamycin/amikacin group: five (12.5%), compared to one (2.8%) in the cefotetan group (p = 0.07). Although Bacteroides fragilis group organisms resistant to cefotetan were identified, none was responsible for the postoperative infections. Adverse drug events in 28% of the cefotetan group and 26% of the clindamycin/amikacin group consisted primarily of transient elevations of liver function tests. Monotherapy with a second-generation, broad-spectrum cephalosporin, such as cefotetan, given twice a day is an economical and effective adjunctive regimen in patients with complicated appendicitis for which operation is the definitive treatment. Aminoglycosides and other, more potent antimicrobials should be reserved for resistant organisms or nosocomial infections.

Single pass sequencing and physical and genetic mapping of human brain cDNAs

We have performed single pass sequencing of 1,024 human brain cDNAs, over 900 of which seem to represent new human genes. Library prescreening with total brain cDNA significantly reduced repeated sequencing of highly represented cDNAs. A subset of sequenced cDNAs were physically mapped to their chromosomal locations using gene-specific STS primers derived from 3' untranslated regions. We have also determined that human brain cDNAs represent a rich source of gene-associated polymorphic markers. Microsatellite-containing cDNAs can be physically mapped and converted to highly informative genetic markers, thus facilitating integration of the human physical, expression and genetic maps.

Absence of minimal residual disease detectable by FACS, Southern blot or PCR in patients with chronic lymphocytic leukaemia treated with fludarabine

We report the results of assessment of minimal residual disease in four patients with chronic lymphocytic leukaemia, who achieved clinical and haematological complete response following treatment with fludarabine. Patients were assessed both before and after treatment by immunophenotyping, DNA electrophoresis, Southern blotting and PCR amplification to detect immunoglobulin gene rearrangements. Immediately after treatment, no patient had disease detectable by any method and there was evidence of recovery of normal B-cells. No patient has yet shown evidence of clinical or haematological relapse (follow-up 59-142 weeks). Two patients remain in immunophenotypic and molecular remission at 141 and 59 weeks. These methods have allowed more sensitive definition of elimination of residual disease, with PCR demonstrating the capacity to detect disease recurrence before any other evidence is available.

Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection

Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections. One hundred thirty-six (78%) patients were males. The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5. Overall recovery without infection was 75 per cent (131/175). Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection. Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates. Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures. Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent. A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.

Cefepime for infections of the biliary tract

Antibiotic treatment of biliary tract infections is widely accepted. An open, prospective, randomized, multicenter trial comparing cefepime (2 grams every 12 hours) with gentamicin (1.5 milligrams per kilograms every eight hours) plus mezlocillin (3 grams every four hours) for a minimum of five days was undertaken. Of the 149 patients enrolled, 120 were evaluable; 80 were randomized to receive cefepime and 40 were randomized to receive gentamicin plus mezlocillin (two to one randomization schedule). The diagnosis was acute cholecystitis in 101 patients and acute cholangitis in the remainder. There were no differences between the two treatment groups with regard to gender, age, disease, signs and symptoms, admitting temperature or laboratory values. All patients (100 percent) treated with gentamicin and mezlocillin were cured of the infection, as were 78 (97.5 percent) of the patients treated with cefepime (difference not significant). The incidence and spectrum of adverse events and complications were similar between the two groups (8.8 percent for cefepime versus 10 percent for gentamicin and mezlocillin). Our data show that the efficacy and safety of cefepime administered every 12 hours is equivalent to that of gentamicin and mezlocillin combination for treating patients with acute infections of the biliary tract. In addition, twice-daily administration of cefepime may be more cost-effective than the aminoglycoside-based combination.

Molecular Probe Analysis of Shigella dysenteriae type 1 Isolates from 1940 to 1987

Fourteen strains of Shigella dysenteriae type 1 (Shiga bacillus) isolated from people in diverse locations from 1940 to 1987 were studied. Southern hybridization with three cloned Escherichia coli genes, Shiga-like toxin I (SLTI), frd, and ompF, was used to determine restriction fragment length polymorphism (RFLP) of the genomic DNA of these strains. Digestion with each of four restriction endonucleases generated fragments of identical size to which the frd and ompF hybridized for each of the 14 strains, indicating the conservation of these genes and their flanking sequences. In contrast, after digestion with HindIII, EcoRV, and ClaI and probing with SLTI, there were RFLP among the strains. The results showed three clones of the Shiga bacillus, and suggested that dissemination of a single clone may continue for decades within a wide geographical area.

Adjunctive antimicrobials in surgery of soft tissue infections: evaluation of cephalosporins and carbapenems

The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44. A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria. Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes. Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent. Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites. Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash). Operative drainage and debridement remain the critical elements in therapy. Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents. The extended spectrum carbapenems are most useful for severe infections or resistant organisms.

Use of 3' untranslated sequences of human cDNAs for rapid chromosome assignment and conversion to STSs: implications for an expression map of the genome

A general mapping strategy is described in which the 3'untranslated regions of human cDNAs are used to design PCR primers which will selectively amplify human genomic sequences in a rodent background. When applied to panels of human x hamster somatic cell hybrid DNAs, this approach provides a PCR-based method for rapidly assigning genes to specific chromosomes and chromosomal regions. In addition, it follows from the virtual absence of introns in the 3'untranslated region of vertebrate genes that within this region the cDNA sequences almost always will be identical to those of the genomic DNA and can therefore be used to automatically generate gene-specific sequence-tagged sites (STSs). We have applied this strategy to six human cDNAs and demonstrate that 1) the primers selectively amplify human genomic DNA and 2) the PCR product is of the size predicted from the cDNA. To test this approach further we have utilized it to confirm the known chromosomal location of the retinoblastoma gene. Lastly, we describe how this strategy can readily be applied to unknown human cDNAs, and thereby be integrated into efforts to generate a human STS expression map of the genome. A strategy for production of such a map, using human brain cDNAs as a model, is described.

Efficient double stranded sequencing of cDNA clones containing long poly(A) tails using anchored poly(dT) primers

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Pathogenesis of Campylobacter fetus infections: serum resistance associated with high-molecular-weight surface proteins

Campylobacter fetus subspecies fetus causes both systemic and diarrheal illnesses. We studied 38 strains of C. fetus isolated from 34 patients; underlying illness was present in eight (89%) of nine patients with only systemic isolates compared with three (20%) of 15 patients with only fecal isolates (P = .002). In a standardized assay of susceptibility to normal human serum, 27 (71%) strains were resistant, six (16%) had intermediate susceptibility, and five (13%) were serum sensitive. Major protein bands migrating at 100 kDa or 125 kDa on polyacrylamide gels were present in all of the 25 serum-resistant strains tested but in only four of seven serum-sensitive isolates of C. fetus from humans and animals (P = .007). The presence of these bands was associated with type A lipopolysaccharide. A low-passaged strain, 82-40, was serum resistant and contained the 100-kDa protein; however, a spontaneous mutant of this strain lacked this band and was serum sensitive. The 100-kDa and 125-kDa proteins of three strains of C. fetus were antigenically cross reactive or identical and were exposed on the surface of the C. fetus cell. Serum resistance is inherent to most C. fetus isolates from humans and is associated with the presence of cross-reactive surface proteins.

A comparison of cefotaxime versus cefamandole in prophylaxis for surgical treatment of the biliary tract

Fiscal considerations prompted comparison of cefotaxime (a third generation cephalosporin) with cefamandole (a second generation cephalosporin) for prophylaxis in the surgical treatment of the biliary tract. One hundred and eight patients who underwent an operation upon the biliary tract received three 1 gram doses of cefotaxime (54 patients) or cefamandole (54 patients) at induction of anesthesia and then one and three hours later. The study was prospective, blinded and randomized. The groups (cefotaxime versus cefamandole) were statistically comparable for age, sex, diagnosis, type and duration of operation and positive cultures. The most prevalent bacteria isolated from qualitative aerobic and anaerobic cultures of bile and the wall of the gallbladder were Escherichia coli, Streptococcus and Klebsiella. The incidence of bactibilia in patients with one of these conditions was: 75 per cent for cancer; 69 per cent for patients more than 60 years old; 33 per cent for jaundice; 58 per cent for pancreatitis; 60 per cent for exploration of the common bile duct, and 22 per cent for acute cholecystitis. Microbiologic agar diffusion assays of tissue from the wall of the gallbladder, subcutaneous fat and rectus muscle and samples of bile and serum obtained 30 minutes after the second dose of antibiotic showed a statistically significant greater concentration of cefamandole in the wall of the gallbladder. Otherwise there was no difference between the concentration of cefamandole and cefotaxime. The groups showed no statistical difference for temperature of more than or equal to 38 degrees C. on two consecutive measurements, postoperative wound and urinary infections, postoperative hospital stay and days in the intensive care unit and incidence of readmission within a month. Prophylactic use of cefotaxime in a three dose regimen provided no advantage in prophylaxis compared with cefamandole.

Antigenicity of Campylobacter jejuni flagella

We studied the antigenicity of a wild-type flagellate and motile (F+M+) Campylobacter jejuni strain (81116) and two daughter mutants, one flagellate and immotile (F+M-) and one aflagellate and immotile (F-M-). By sodium dodecyl sulfate-polyacrylamide gel electrophoresis of acid-extracted surface proteins, a 63-kilodalton (kDa) band identified from sheared flagella as the flagellar protein was present in the F+M+ and F+M- strains but not in the F-M- strain. No other differences in protein profile among the three strains were noted. By Western blotting, serum from rabbits immunized with either the F+M+ or F-M- strain detected a 63-kDa protein in the F+M+ and F+M- strains but not in the F-M- strain. That the F-M- antiserum recognized the 63-kDa band suggests that small amounts of this protein or a cross-reacting antigen is present on the F-M- strain. By counterimmunoelectrophoresis of the acid-extracted preparations with immune sera, all three strains were found to share three major antigens, but a fourth antigen with a net positive charge was present only in the F+M+ and F+M- strains. Antisera to five C. jejuni and two Campylobacter fetus strains recognized the 63-kDa protein of purified F+M+ flagella in Western blots, demonstrating a common antigen is present, but enzyme-linked immunosorbent assay results suggest that the sharing of this antigen among Campylobacter strains is variable.

Antigenicity of Campylobacter jejuni flagella

We studied the antigenicity of a wild-type flagellate and motile (F+M+) Campylobacter jejuni strain (81116) and two daughter mutants, one flagellate and immotile (F+M-) and one aflagellate and immotile (F-M-). By sodium dodecyl sulfate-polyacrylamide gel electrophoresis of acid-extracted surface proteins, a 63-kilodalton (kDa) band identified from sheared flagella as the flagellar protein was present in the F+M+ and F+M- strains but not in the F-M- strain. No other differences in protein profile among the three strains were noted. By Western blotting, serum from rabbits immunized with either the F+M+ or F-M- strain detected a 63-kDa protein in the F+M+ and F+M- strains but not in the F-M- strain. That the F-M- antiserum recognized the 63-kDa band suggests that small amounts of this protein or a cross-reacting antigen is present on the F-M- strain. By counterimmunoelectrophoresis of the acid-extracted preparations with immune sera, all three strains were found to share three major antigens, but a fourth antigen with a net positive charge was present only in the F+M+ and F+M- strains. Antisera to five C. jejuni and two Campylobacter fetus strains recognized the 63-kDa protein of purified F+M+ flagella in Western blots, demonstrating a common antigen is present, but enzyme-linked immunosorbent assay results suggest that the sharing of this antigen among Campylobacter strains is variable.

Lipopolysaccharide structures in Enterobacteriaceae, Pseudomonas aeruginosa, and Vibrio cholerae are immunologically related to Campylobacter spp

To determine whether lipopolysaccharide (LPS) structures of Campylobacter species are immunologically related to those of 11 other gram-negative organisms, we immunoblotted from polyacrylamide gels the LPS of these strains with immune rabbit serum raised against six Campylobacter jejuni strains and two Campylobacter fetus strains. The LPS studied were from Salmonella minnesota wild type and Ra to Re mutants, Salmonella typhi, Escherichia coli, Yersinia enterocolitica, Vibrio cholerae, and Pseudomonas aeruginosa. None of the 11 LPS preparations was recognized by the eight antisera, but antisera to each of the Campylobacter strains recognized core determinants of some LPS preparations. Antiserum directed against the most serum-sensitive C. jejuni strain, 79-193, was the only antiserum sample that recognized core regions of the rough Salmonella mutants. In converse experiments, when LPS preparations from five Campylobacter strains were blotted with antiserum to Salmonella lipid A, recognition of core structures of each was shown; data from an enzyme-linked immunosorbent assay confirmed this result. In contrast, antiserum to Salmonella typhimurium Re LPS showed no reactivity. We conclude that LPS of Campylobacter strains share lipid A antigenic determinants with the core region of LPS of several other gram-negative organisms.

Antigenic heterogeneity of lipopolysaccharides from Campylobacter jejuni and Campylobacter fetus

The lipopolysaccharide (LPS) structure of Campylobacter spp. can be visualized with polyacrylamide gel electrophoresis by examining proteinase K-treated whole cell lysates. Polyacrylamide gel electrophoresis LPS profiles of C. jejuni strains are rough type with low concentrations of low-molecular-weight polysaccharide side chains, serum-resistant C. fetus strains have smooth-type LPS, and serum-sensitive C. fetus strains have rough-type LPS. We electroblotted the proteinase K-treated whole cell lysates of 17 C. jejuni and 9 C. fetus strains from polyacrylamide gel electrophoresis to nitrocellulose paper to examine antigenicity to immune rabbit sera. There was virtually no antigenic cross-reactivity of C. jejuni and C. fetus LPS. Among C. jejuni strains, core LPS structures were cross-reactive, but the O-polysaccharide side chains were best recognized by homologous antisera. Antisera to several serum-resistant C. fetus strains recognized only the polysaccharide side-chain regions of serum-resistant strains and no part of the LPS from the sensitive strain. Antiserum raised against a serum-sensitive C. fetus strain but not homologous antisera recognized the core region of the LPS of the serum-resistant C. fetus strains. These findings suggest that core LPS antigens are widely shared within C. fetus subsp. fetus strains but that in the serum-resistant strains this core region is not surface exposed and therefore not immunogenic to rabbits infected with whole cells.

Campylobacter jejuni outer membrane proteins are antigenic for humans

All Campylobacter jejuni strains have a major outer membrane protein (OMP) that migrates between a molecular weight of 41,000 (41K) and 45K and represents more than 50% of protein present, plus several more minor bands. Using 125I-radiolabeled C. jejuni cells in a radioimmunoprecipitation procedure to assess whether the OMPs were antigenic, we studied serum from rabbits immunized with C. jejuni cells, from humans convalescent after C. jejuni infection, and from appropriate controls. In this assay, the major OMP was the major antigen for both homologously and heterologously immunized rabbits and infected humans but not for controls. Minor bands at 29K and 50K were also antigenic. We tested human and animal sera in a Western blot procedure using anti-immunoglobulin A (IgA), anti-IgG, or anti-IgM conjugates. Homologous and heterologous immune rabbit serum, but not control serum, recognized a large number of membrane proteins between 15K and 91K, including the major OMP. Both Campylobacter spp.-infected and healthy humans showed IgA, IgG, and IgM responses to the major OMP, although the response was more pronounced in the former group. Sera from infected humans recognized several minor bands to a significantly greater extent than control sera did. Our data suggest that there is antigenic similarity between the OMPs of different C. jejuni strains and that some of these OMPs recognized by infected animals and humans have vaccinogenic potential.

Identification and characterization of Campylobacter jejuni outer membrane proteins

Outer membrane proteins from isolates of Campylobacter jejuni were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Sarcosinate-insoluble membrane preparations were outer membrane enriched based on increased ketodeoxyoctonate concentrations, the presence of surface-exposed 125I-labeled proteins that were hydrophobic, and similarity to membrane vesicle (bleb) sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles. Most isolates contained a single major band with molecular weight of 41,000 to 45,000. Profiles of C. jejuni and Campylobacter coli isolates were indistinguishable, but either could be easily differentiated from Campylobacter fetus and Campylobacter faecalis. The profiles were stable for strains under a variety of growth, incubation and passage conditions. We classified 110 isolates from patients with sporadic campylobacter enteritis into nine subtypes based on differences in outer membrane sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles. Two categories accounted for 76% of the isolates. Complete concordance was observed in subtypes of strains obtained from epidemiologically related cases. Thus, comparison of the major outer membrane proteins of C. jejuni is a useful technique for investigating the transmission of this organism and may provide a basis for immunological characterization of the outer membrane proteins.

Clinical trial of an emergency resuscitation algorithm

Clinical trials of a resuscitation algorithm for patients entering the Surgical Emergency Department (ED) with acute hypotension were conducted for a 30-month period. The intent was not to compare good management with bad, but rather university-run county hospital services with and without an algorithm. The study group was comprised of 603 hypotensive patients out of 6833 consecutive admissions. The effects of the policy of using a resuscitation algorithm were evaluated by the outcomes of the patients who were treated by residents given the algorithm (protocol group) versus those treated by residents not given the algorithm (control group). The efficacy of the algorithm, per se, was evaluated by outcomes of patients whose management was in satisfactory compliance with the algorithm as compared with those whose management deviated from the algorithm. The patients were also evaluated by the primary cause of their hypotension and the presence of severe associated illnesses. Outcomes of patients treated by residents given the algorithm were as good and in a number of respects better than those of patients treated by residents without the algorithm. The mean resuscitation time of the protocol group was markedly and significantly less than that of the control group indicating that the policy of using the algorithm facilitated resuscitation even though it was not always properly followed. Patients with trauma, hemorrhage, and sepsis, whose care was in satisfactory compliance with the algorithm had shorter resuscitation times, lower MAP-time deficits, and less shock-related complications. The algorithm which is primarily directed toward fluid resuscitation did not appear to be efficacious for patients whose trauma was primarily head injury, where fluid restriction may be the therapy of choice.

Clinical aspects of resuscitation with and without an algorithm: relative importance of various decisions

Clinical description was made of a series of hypotensive patients resuscitated with and without an algorithm. Of 603 hypotensive patients, there were 114 (19%) deaths and 169 (28%) patients with complications; the average low MAP was 53 +/- 25 mm Hg. Of 169 patients with complications, 48 (28%) had shock-related (SR) complications; 25 (52%) of these patients died. There were 265 (44%) patients who had severe associated diseases and these patients comprised the group most vulnerable to complications and death; in this group, there were 41 patients with SR-complications who had significantly higher mortality, longer resuscitation times, lower MAP, more deviations from the algorithm, and more delays in resuscitation than did those with nonshock-related complications. Multiple deviations from the algorithm were associated with longer resuscitation times, and higher incidence of SR complications. Most of the delays in resuscitation of these patients and most of the SR complications could have been prevented. Seventeen percent of hypotensive patients entering the emergency department (ED) normally carried low arterial pressures, which averaged 75 +/- 3 (SD) mm Hg; this was more common, but not confined to young females. Of the 603 patients who actually were hypotensive, 6% were admitted in arrest (phase I), 18% in severe shock (phase II, MAP less than 60 mm Hg), 52% in moderate shock (phase III, MAP less than 80 mm Hg), and 24% were normotensive but subsequently became hypotensive (phase IV). The importance of various decision nodes of the algorithm were evaluated. The present algorithm, designed for these hypotensive emergency patients, provides a framework for fluid management that expedites resuscitation and reduces complications related to shock. We conclude that: (a) delays in resuscitation can be clearly related to an increased incidence of SR complications; (b) when the algorithm was satisfactorily followed, there was faster resuscitation and less SR complications; and (c) when the algorithm was satisfactorily followed in patients with severe associated illnesses, there was also shorter ICU stay, shorter hospitalization and decreased mortality.

Clinical trial of an algorithm for outcome prediction in acute circulatory failure

The authors evaluated prospectively an index for outcome prediction previously developed retrospectively from the cardiorespiratory data of a series of 113 critically ill postoperative general surgical patients. A predictive score generated by nonparametric multivariate analysis of the observed value for each cardiorespiratory variable and the frequency distributions of survivors' and nonsurvivors' values of that variable at each stage of postoperative shock. An overall global predictive index was then generated from the sum of the weighted predictive scores in each variable. This predictive index was tested prospectively in a new series of 156 operations and was found to be 94% accurate for the values of the last available data set, suggesting that the method satisfactorily predicts outcome. This index may be used as an objective measure of the severity of illness; i.e., it may be used to track the clinical course of postoperative general surgical patients during periods of critical illness. It was concluded that the predictive index aids in evaluation of monitored cardiorespiratory variables, improves interpretation of physiologic alternation, and facilitates clinical decision-making of critically ill patients at the bedside.

Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation

Over a 2.5 year period, the fluid management of 600 hypotensive patients entering our surgical emergency department was evaluated during a prospective clinical trial of a resuscitation algorithm. The major clinical determinants (low mean arterial pressure, age, severity of illness, primary illness or injury, amount of blood loss, volume of fluids given, use of a protocol or clinical algorithm and satisfactory compliance with the algorithm) were controlled by grouping the patients into specific strata; the resuscitation times were almost always shorter with a regimen of about one-fourth colloids than with crystalloids only. This is consistent with the observations of greater increases in hemodynamic and oxygen transport variables after albumin than after lactated Ringer's solution when the latter was given in either 2 or 4 times the volume.

Pathogenesis of respiratory failure (ARDS) after hemorrhage and trauma: I. Cardiorespiratory patterns preceding the development of ARDS

To evaluate clinical and physiologic determinants of adult respiratory distress syndrome (ARDS), we studied 152 consecutively monitored patients with trauma and hemorrhage: 60 developed ARDS. The cardiorespiratory patterns of hemorrhage and trauma patients who did not develop ARDS were compared to those who subsequently did develop ARDS, but before the time of their ARDS. Comparisons also were made in the patients with trauma and those with hemorrhage, as well as in those who survived and those who did not. Hemorrhage and trauma patients who developed ARDS had greater reductions in blood volume, red cell mass, PaCO2 and O2 delivery throughout all stages, as well as greater pulmonary vascular resistance index (PVRI) and pH in the early and middle stages. Nonsurvivors of ARDS had greater deficits in blood volume and red cell mass, higher PVRI and pH, as well as lower central venous pressure (CVP), hemoglobin (Hgb), and PaCO2 than did ARDS survivors. Hemorrhage patients had lower blood volume, left ventricular function, O2 delivery and VO2, as well as higher systemic vascular resistance index (SVRI), PVRI, and O2 extraction than either the trauma patients or normal subjects. Description of the temporal cardiorespiratory patterns before the clinical appearance of ARDS showed the progressive appearance of these deficits beginning 36 h before the hypoxemia was observed. The data are consistent with the concept that ARDS after hemorrhage and trauma is preceded by hypovolemia, reduced myocardial performance, inadequate O2 delivery, and inadequate O2 extraction needed to maintain VO2 at the elevated levels demanded by the increased metabolic requirements of the injured patients. Thus, the so-called shock lung is a complication of shock associated with hypovolemia, hypoxemia, and inadequate cardiac compensatory responses to increasesd O2 demands.

Treatment of surgical emergencies with and without an algorithm

A patient care algorithm was developed for resuscitation of patients entering the surgical emergency department with hypotension. The diagnostic workup, monitoring, and therapy were progressively excalated according to admission blood pressure and responses to therapeutic interventions. The branching-chain logic is ideally suited for rapid decision making in emergency conditions where the need is most urgent, the time constraints are most severe, and the potential improvements in terms of patient salvage are greatest. Preliminary results from these ongoing clinical trials indicate that (1) physicians can and will use an algorithm for emergency medical service resuscitation; (2) in a university hospital with a large emergency service and a commitment to emergency care, the physicians using the aigorithm performed as well as and in some instances better than those not using the algorithm; and (3) the use of the algorithm may prevent delays in resuscitation and lead to less morbidity and mortality. Thus, we conclude that the algorithm helps to organize emergency care, establish standards, and improve care.

Comparison of sevral wild-type influenza viruses in the ferret tracheal organ culture system

Several strains of wild-type influenza A virus were studied in the ferret tracheal organ culture system. Ciliary activity and viral replication were measured. Ciliary activity was reduced more rapidly by A/Hong Kong/45/68 (H3N2) (A/HK) and A/Victoria/3/75 (H3N2) (A/Vic) than by A/New Jersey/8/76 (Hsw1N1) (A/NJ), A/Scotland/840/74(3HN2) (A/Scot), or A/USSR/90/77 (H1N1) (A/USSR). A/HK, A/Vic, and A/Scot produced titers of virus higher than A/USSR or A/NJ during the first three days after infection. Differences in effects of the five viruses on cilia were not related to history of egg passage. The two strains that destroyed ciliary activity rapidly had caused excess mortality in the United States, whereas the three that destroyed ciliary activity more slowly had not. A relationship may exist between the properties contributing to virulence in humans and the destruction of ciliary activity in vitro in this culture system.

Behavior of vaccine revertants of temperature-sensitive mutants of influenza virus in ferret tracheal organ culture

A live attenuated influenza vaccine candidate was not genetically stable when administered to some children who lacked antibody to surface proteins of the virus. To obtain additional biological information about these revertants, the vaccine strain, the wild-type parental strain, and isolates recovered from inoculated children during a vaccine trial were evaluated in ferret tracheal organ culture for effects on the ciliated epithelium and replication at both permissive and restrictive temperatures. The studies revealed that the vaccine strain destroyed cilia and replicated to high titer at its permissive temperature (33 degrees ) but caused minimal damage and replicated to very low titer at its restrictive temperature (37 degrees C). The wild-type parent destroyed cilia at both 33 and 37 degrees C. Isolates which were no longer temperature sensitive (ts(+)) destroyed cilia at both restrictive and permissive temperatures and grew to high titer. Isolates which retained the ts phenotype behaved as the vaccine strain in this system. The ts(+) virus recovered from volunteers behaved like the wild-type parent, which suggests that these viruses had not merely lost their ts phenotype, but had undergone reversion to wild type. Important information about the genetic stability of temperature-sensitive influenza vaccine strains recovered from volunteers can be obtained by evaluating them in ferret tracheal organ culture.

Resuscitation algorithm for management of acute emergencies

Assuming that unrecognized or inadequately corrected hypovolemia results in higher mortality and morbidity rates, we developed a systematic approach to resuscitation that would: 1) identify criteria to aid in the recognition of hypovolemia and ensure the expeditious correction of this defect without interfering with diagnostic workup and management; 2) define criteria to prevent fluid overload which may jeopardize the patient's course, and 3) express these criteria in an explicit, systematic, patient care algorithm, ie, protocol, useful to both the resident and the practicing physician. We are now conducting prospective clinical trials with one service using the algorithm and the others acting as the control group. Preliminary results comparing patient outcomes suggest that the algorithm improves patient care by shortening resuscitation time and results in fewer hospital days, intensive care unit days, febrile days, and days on mechanical ventilation as well as reduced mortality. The algorithm provides a systematic plan to organize patient care so that the most urgently needed procedures are not delayed or overlooked.