Efficacy and safety of azithromycin 1 g once daily for 3 days in the treatment of community-acquired pneumonia: an open-label randomised comparison with amoxicillin-clavulanate 875/125 mg twice daily for 7 days

This randomised, open-label, non-inferiority study was designed to demonstrate that a 3-day course of oral azithromycin 1 g once daily was at least as effective as a standard 7-day course of oral amoxicillin-clavulanate 875/125 mg twice daily in the treatment of outpatients with community-acquired pneumonia (Fine class I and II). In total, 267 patients with clinically and radiologically confirmed community-acquired pneumonia were randomly assigned to receive either the azithromycin (n=136) or the amoxicillin-clavulanate (n=131) regimen. At screening, 60/136 (58.8%) and 61/131 (62.9%) respectively had at least one pathogen identified by sputum culture, PCR, or serology. The primary endpoint was the clinical response in the intent-to-treat population at the end of therapy (day 8 to 12). Clinical success rates were 126/136 (92.6%) for azithromycin and 122/131 (93.1%) for amoxicillin-clavulanate (treatment difference: - 0.48%; 95% confidence interval: - 5.66%; 4.69%). Clinical and radiological success rates at follow-up (day 22-26) were consistent with the end of therapy results, no patient reporting clinical relapse. Bacteriological success rates at the end of therapy were 32/35 (91.4%) for azithromycin and 30/33 (90.9%) for amoxicillin-clavulanate (treatment difference: 0.52%; 95% confidence interval - 10.81%; 11.85%). Both treatment regimens were well tolerated: the overall incidence of adverse events was 34/136 (25.0%) for azithromycin and 22/132 (16.7%) for amoxicillin-clavulanate. In both treatment groups, the most commonly reported events were gastrointestinal symptoms. Azithromycin 1g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia.

In neuroblastic tumours, Schwann cells do not harbour the genetic alterations of neuroblasts but may nevertheless share the same clonal origin

Neuroblastic tumours are composed of variable proportions of neuroblasts and Schwann cells. Whether both components share a common neoplastic origin is highly debated and discrepant results have been reported about the presence of tumour-related genetic alterations in Schwann cells. We have used X-methylation analysis and array-CGH to investigate contiguous Schwannian and neuroblastic areas in tumours with a nodular pattern. A skewed X inactivation was observed in four out of five stromal components. Interestingly, in these four cases, the X-inactivation profiles of the neuroblastic components were identical to the matched stromal areas. However, whereas all neuroblastic areas displayed chromosomal imbalances, no alteration was found in any Schwann cell components. Similarly, no alteration was observed in a series of 19 tumours with a single stroma-rich component, which occasionally exhibited a skewed X-inactivation pattern (3/17 informative tumours). Altogether, this indicates that most stroma-rich tumours display a polyclonal proliferation and that Schwann cells do not derive from neuroblasts. However, in tumours with both stroma-rich and -poor components, our results suggest that cells from both areas share a common progenitor.

Identification of functional apple scab resistance gene promoters

Apple scab (Venturia inaequalis) is one of the most damaging diseases affecting commercial apple production. Some wild Malus species possess resistance against apple scab. One gene, HcrVf2, from a cluster of three genes derived from the wild apple Malus floribunda clone 821, has recently been shown to confer resistance to apple scab when transferred into a scab-susceptible apple variety. For this proof-of-function experiment, the use of the 35S promoter from Cauliflower mosaic virus was reliable and appropriate. However, in order to reduce the amount of non-plant DNA in genetically modified apple to a minimum, with the aim of increasing genetically modified organism acceptability, these genes would ideally be regulated by their own promoters. In this study, sequences from the promoter region of the three members of the HcrVf gene family were compared. Promoter constructs containing progressive 5' deletions were prepared and used for functional analyses. Qualitative assessment confirmed promoter activity in apple. Quantitative promoter comparison was carried out in tobacco (Nicotiana glutinosa) and led to the identification of several promoter regions with different strengths from a basal level to half the strength of the 35S promoter from Cauliflower mosaic virus.

HLA class I serotypes and cytotoxic T-lymphocyte responses among human immunodeficiency virus-1-uninfected Thai volunteers immunized with ALVAC-HIV in combination with monomeric gp120 or oligomeric gp160 protein boosting

Antigen-induced cellular immunogenicity may vary between populations due to differences in human leukocyte antigen (HLA) diversity and, hence, may play a critical role in the protection afforded by vaccines. In the setting of two, phase I/II human immunodeficiency virus-1 vaccine trials of a recombinant canarypox prime, and boosting with either recombinant monomeric gp120 or oligomeric gp160, we assessed the association between specific human leukocyte antigen (HLA) class I serotypes and the presence of cytotoxic T-lymphocyte response measured by 51Cr-release assay. HLA class I serotypes A11, A24, A33, B46, and B75 were the most common, present in 10% or more of 245 individuals studied. Forty of 187 (21.4%) Thai adults who received either ALVAC-HIV with gp120 or oligomeric gp160 or ALVAC alone had a precursor cytolytic CD8 T-cell response (pCTL). HLA-B44 was positively and significantly associated with a pCTL response (odds ratio 7.6, 95% CI: 2.7-21.2), whereas B46 was negatively associated but not robust when adjusted for multiple comparisons. Responses to Env proteins accounted for the majority (nine of 11) of pCTL activity among those persons with B44. This HLA class I serotype occurred in 9.4% of participants overall (including the placebo group), less commonly than what is reported from populations of European ancestry. These results strengthen the importance of assessing HLA class I distributions in conjunction with studies of vaccines designed to elicit cellular immunity in different populations.

Cytokines, chemokine receptors, and homing molecule distribution in the rectum and stomach of pediatric patients with ulcerative colitis

BACKGROUND

Cytokines appear to play a significant role in the pathogenesis of inflammatory bowel disease (IBD) with a predominant Th2 pattern in colonic mucosa of patients with ulcerative colitis (UC). Chemokines and their receptors also regulate the migration of Th1 or Th2 lymphocytes to inflammatory tissues during the immune response. Although adult UC is usually confined to the colon, pediatric UC not uncommonly affects the stomach.

AIMS

The aim of this study was to compare expression of cytokines, chemokine receptors, and homing molecules in the rectal and the histologically characterized gastric mucosa of pediatric patients with UC. SUBJECTS Sixteen patients (11 girls and 5 boys; median age, 9 years) having all the features of UC were included in the study.

METHODS

Rectal and gastric mucosa obtained from UC cases were immunostained with antibodies against L-selectin, beta 7 integrin, CXCR3, CCR3, and CCR5. IL-4 and IL-12 p40 transcript expression was studied by in situ hybridization.

RESULTS

Chronic gastritis was found in 93.7% of cases and Helicobacter pylori (Hp) was found in 2 (13.3%) cases. In the rectal and gastric mucosa, CXCR3 was found in perivascular lymphocytes and CCR5 in a subset of CXCR3+ cells in the lamina propria. CCR3+ lymphocytes and IL-4-positive cells were always found, but there was no evidence of IL-12 production. Most of the lymphocytes infiltrating the gastric mucosa expressed beta 7 but not CD62L. In contrast, beta 7-positive cells were randomly dispersed in the rectal lamina propria, and the fraction of CD3+beta 7+ was low.

CONCLUSIONS

The authors conclude that gastritis is common in pediatric UC. The presence of CCR3+ lymphocytes, IL-4 transcript expression, without IL-12 p40 production in the stomach and in the rectum suggests a Th2 immune response. The presence of CCR3+, CD62L- activated Th2 cells may suggest that these gastric cells are recruited from colorectal primary lesions.

The challenge of adversity: three narratives of alcohol dependence, recovery, and adult development

Turning points have been known to reverse the downward spiral of alcoholism and its concomitant associations with divorce, depression, and work-related difficulties. In this study, the authors present the stories of 3 women from the Mills Longitudinal Study who were alcoholic. Using a narrative approach, the authors tracked the women's developmental gains during recovery using Erik Erikson's theory of psychosocial development, specifically focusing on the tasks of identity, intimacy, and generativity. Results show that despite similar personal problems and turning points that moved them to stop drinking, each woman followed a different path to self-reconstruction and psychological growth. These accounts offer important information about individual differences in recovery from alcoholism, which are often lost in larger aggregate accounts of personal change.

Atrial septal aneurysm in a patient with pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE) is a rare heritable disorder of the connective tissue characterized by marked clinical heterogeneity. Common cardiovascular complications of PXE include renovascular hypertension, premature coronary artery disease and calcification of peripheral arteries frequently leading to claudicatio intermittens; fibrous thickening of the endocardium and atrioventricular valves, leading to restrictive cardiomyopathy and/or mitral valve prolapse have been also described. We herein report on a PXE patient who developed an atrial septal aneurysm as a previously undescribed cardiologic manifestation of her disease.

Interleukin-12 expression is focally enhanced in the gastric mucosa of pediatric patients with Crohn's disease

The stomach is frequently involved in children suffering from Crohn's disease (CD). Diagnosis of specific gastritis may be difficult when granulomas are absent. We have used in situ hybridization to examine the expression of interleukin (IL)-12, a key cytokine in the Th1 response. IL-12 p35 and p40 antisense probes were used to examine ileal specimens from 9 children with CD and gastric biopsies from 24 children (13 with CD, 6 with Helicobacter pylori chronic gastritis, and 5 with a normal gastric mucosa). In all patients with CD, many clusters of IL-12-positive cells were present in the lamina propria. This was the case in the ileal specimens as well as in gastric mucosa showing granulomatous gastritis or nongranulomatous gastritis. The same distribution patterns were found for the IL-12 p35 and p40. In three patients with Helicobacter pylori gastritis, few scattered IL-12-positive cells were found. No positive cells were found in the normal gastric mucosa. The focally enhanced IL-12 expression in the gastric mucosa of pediatric patients with CD, with or without specific lesions, suggests that both are indeed linked to the disease and supports the major part of IL-12 in initiating and maintaining of the cascade resulting in the Th1 responses.

In situ Rantes and interferon-gamma gene expression in pediatric small bowel Crohn's disease

BACKGROUND

Rantes (regulated upon activation, normal T cell expressed and secreted) is a chemotactic cytokine for memory T lymphocytes, monocytes, and eosinophils. The cytokine interferon-gamma (IFN-gamma) plays a key in the immune response. Their distributions and possible roles in the selective accumulation of inflammatory cells in Crohn's disease (CD) were examined by determining the expression of Rantes and IFN-gamma genes in patients with CD using in situ hybridization (ISH) on frozen and paraffin-embedded tissue sections.

METHODS

Intestinal and mesenteric lymph node samples from 9 children who had undergone ileal resection for CD were examined for the presence of epithelioid-giant cell granulomas (EGCG) and Rantes and IFN-gamma messenger RNA (mRNA). Normal pediatric intestine (n = 5) and lymph nodes (n = 2) served as controls.

RESULTS

Many cells in all CD specimens in the epithelial compartment, lamina propria, and the EGCG gave positive signal with the Rantes antisense probe. Labelled cells were identified on paraffin sections as lymphocytes, macrophages, and epithelioid cells. There were Rantes-positive cells in the control intestinal tissues, but many Rantes-positive cells in control lymph nodes that showed follicular hyperplasia. IFN-gamma-positive cells were present in all CD ileal and lymph node specimens, predominantly in close contact with EGCC. No positive signal was obtained with the Rantes and IFN-gamma sense control probes.

CONCLUSIONS

These findings suggest that Rantes and IFN-gamma contribute to the selective accumulation of macrophages and memory T helper lymphocytes inside the granulomas and inflammatory infiltrates that are characteristic of CD.

The closed tracheal suction system: implications for critical care nursing

The Closed Tracheal Suction System (CTSS) is a multiple-use suction catheter available for suctioning the ventilator dependent patient. While research has been reported on its impact on oxygen desaturation, ventilator function, and nosocomial pneumonia, the practical issues of the technical design of the catheter and its advantage in decreasing exposure of staff to infected respiratory secretions have not been investigated. This study reports the critical care nurses' perceptions in the use of the SteriCath (Concord/Portex) CTSS focusing on hemodynamic stability, effectiveness of suctioning, patient safety and staff personnel exposure.

Liver phospholipidosis induced by parenteral nutrition: histologic, histochemical, and ultrastructural investigations

Histochemical and electron microscopic examinations of the liver were performed in 5 adults receiving parenteral nutrition for greater than 18 mo and in 4 adults receiving parenteral nutrition for less than 5 mo. Phospholipidosis, reflected by the presence of cytoplasmic phospholipid deposits at histochemical examination and the presence of multilamellar lysosomes at electron microscopy, was marked and present in hepatocytes, Kupffer cells, and portal macrophages in all 5 patients receiving parenteral nutrition for greater than 18 mo. Mild phospholipidosis, affecting only hepatocytes, was demonstrated in 3 of the 4 patients receiving parenteral nutrition for less than 5 mo. These findings indicate that liver phospholipidosis is relatively common in patients receiving parenteral nutrition and that the degree of liver phospholipidosis depends on the duration of parenteral nutrition. Liver phospholipidosis might be due to intrahepatic accumulation of intravenous phospholipids provided by fat-emulsion sources.

Effects of dietary saturated and polyunsaturated fat on lipoprotein lipase and hepatic triglyceride lipase activity

The effects of saturated and polyunsaturated dietary fat on the lipolytic activity of post-heparin plasma, lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) were studied in the rat. The lipolytic activity was studied from 0 to 60 min using labelled chylomicrons as the substrate. Triacylglycerol hydrolysis rate was higher for the plasma of rats fed high fat diets (14% fat by weight). Chylomicrons of rats fed saturated or unsaturated fats were hydrolyzed at the same rate within the first 15 min but afterwards hydrolysis of chylomicrons of rats fed saturated fat was slower. The activities of LPL and HTGL were increased by high fat diets. Unsaturated fat increased more LPL activity than saturated fat conversely, HTGL activity was enhanced more by saturated fat than by unsaturated fat.

Plasma and sweat electrolyte concentrations in the horse during long distance exercise

Blood samples were taken from 20 horses competing in a 100 km endurance ride and plasma concentrations of sodium, potassium, chloride, bicarbonate and protein measured. Measurements were performed on samples taken before the ride (pre-ride), at the mid point and end of the ride and after a 30 min recovery period (post-ride). Sweat samples were collected from 6 horses competing in the endurance ride and 14 horses competing in a 3-day event competition and sweat concentrations of sodium, potassium and chloride measured. There were substantial decreases in plasma electrolyte concentrations, which were greater than previously reported. Decreases from pre to post ride samples of 5 mmol/1 of sodium, 1.2 mmol/1 of potassium and 16 mmol/1 of chloride were found. These losses appeared to be related directly to sweat electrolyte concentrations, where potassium and chloride had relatively greater concentrations than in plasma.

Double-blind paired comparison clinical trial of halcinonide and hydrocortisone

Fifty patients with a diagnosis of psoriasis, eczematous dermatitis, atopic dermatitis, or neurodermatitis and with bilateral symmetric lesions of equal severity participated in this study. A double-blind paired comparison technique was used in which halcinonide-neomycin-amphotericin ointment was applied to the lesions on one side of the body and hydrocortisone ointment to similar lesions on the other side according to a randomized schedule. The halcinonide-containing combination was statistically superior (p less than 0.05) to hydrocortisone ointment in the treatment of psoriasis patients. No statistically significant difference between the two drugs was obtained for the three other indications studied. No side effects with either ointment were observed. Halcinonide as formulated in this combination is an effective and safe corticosteroid.

The effect of various dietary factors on the size distribution of lymph fat particles in rat

By means of cellulose acetate electrophoresis and measurement of radio-activity, lipoproteins (d less than or equal to 1,006) of lymph collected from rats fed a diet containing fats added to labeled fatty acids for 20-24 hr, have been separated into two kinds differing in their size. Fats with different saturated and unsaturated fatty acid content were tested: corn oil, lard, mutton tallow, tripalmitin, corn oil-lard mixture, and randomized palmitic-linoleic triglycerides. Factors studied were: (a) increased amounts of these fats given alone or included in a test meal; (b) added amounts of nutrients (other than fats) in the test meal; (c) adaptation to a diet containing 20% fat for 10 days. The major part of the labeled lymph lipid was always transported by the smaller particles. Size distribution of lymph fat particles was influenced by some of the factors studied. Generally, unsaturated fats produced higher amounts of larger particles.