The levels of cytokines in rats following the use of prophylactic agents in vascular graft infection.

OBJECTIVES: The aim of this study was to investigate the circulating levels of IL-1, IL-6, IL-10 and TNF-? in serum following the use of topical and intra-peritoneal vancomycin and teicoplanin, as well as topical fusidic acid to prevent MRSA vascular graft infection in a rat model. METHODS: Graft infections were established in the subcutaneous tissue of rats by implantation of Dacron prostheses. Circulating levels of IL-1, IL-6, IL-10 and TNF-alpha were measured in serum samples of all rats obtained by ELISA at sacrifice. RESULTS: The mean serum levels of IL-1, IL-6 and IL-10 were found indifferent in all groups. The mean serum levels of TNF-alpha were as follows: 32.9 +/- 9.9 pg/ml in uncontaminated control group, 59.9 +/- 7.1 pg/ml in untreated contaminated group, 41.4 +/- 11.5 pg/ml in intraperitoneal vancomycin group, 39.6 +/- 10.1 pg/ml in intraperitoneal teicoplanin group, 35.6 +/- 8.2 pg/ml in topical vancomycin group, 37.3 +/- 19.5 pg/ml in topical teicoplanin group, 35.5 +/- 16.7 pg/ml in topical 10% fusidic acid group, 36.4 +/- 6.9 pg/ml in topical 40% fusidic acid group. The level of TNF-alpha in untreated contaminated group was significantly higher than in all of the other groups (p < 0.01, p < 0.05, p < 0.02, p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively). CONCLUSION: TNF-alpha was determined to be a more accurate cytokine than IL-1, IL-6 and IL-10 in a rat model in which intra-peritoneal and topical glycopeptides as well as fusidic acid were administered for the prevention of vascular graft infection (Tab. 3, Fig. 2, Ref. 20).

Serum concentration of procoagulant, endothelial and oxidative stress markers in early primary varicose veins.

OBJECTIVE: Endothelial disorders of the veins are considered to play a role in the pathogenesis of primary varicose veins and oxidative stress is implicated in these disorders. With this aim, we investigated vascular endothelial marker levels and the effect of endothelial damage on coagulation parameters and vasodilator substances to determine metabolic markers of oxidative stress in patients with varicose veins and vascular endothelial damage caused by oxidative stress. METHODS: We investigated the levels of malondialdehyde (MDA), protein C, protein S, fibrinogen, von Willebrand factor (vWf), tissue plasminogen activator (tPA), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), interleukin-12 (IL-12) and nitric oxide (NO) in the blood taken from the brachial vein of 25 patients with primary varicose veins (study group) and compared the results with 25 healthy volunteers (control group). We also investigated the urinary levels of prostaglandin I2 (PGI2) in the study group and compared the results with the control group. RESULTS: There was no statistically significant difference between the study group and the control group with respect to the plasma levels of MDA, protein C, fibrinogen, tPA, IL-6, NO and urinary levels of PGI2. But plasma levels of protein S, vWf, VEGF and IL-12 were found to be statistically significantly higher in the study group than in the control group. CONCLUSIONS: Although the systemically measured levels of protein S, vWf, VEGF and IL-12 were found to be higher in patients of primary varicose veins, levels of protein C, fibrinogen, homocysteine and PGI2 were not found to be statistically significant. No systemic increased oxidative stress seems to be related to the early stages of chronic venous insufficiency. Further studies are warranted for understanding the role of molecules such as NO, oxidative stress parameters and cytokines.

Protective effects of N-acetylcysteine and beta-glucan pretreatment on oxidative stress in cecal ligation and puncture model of sepsis.

This study was designed to compare the effect of pretreatment with N-acetylcysteine (NAC) and beta -glucan (beta GLU) on inflammatory response in a rat model of sepsis. The study was performed in the animal laboratory of the Kahramanmaras Sutcu Imam University, School of Medicine. Forty rats were randomized into four groups (control, sham, NAC, and beta GLU). Control and Sham groups received saline or NAC (200 mg/kg, po) in the NAC group and beta GLU (50 mg/kg, po) in the betaGLU group via intragastric gavage once a day for 10 days and 30 min prior to surgery. Sepsis was induced by cecal ligation and puncture (CLP) in rats. In the NAC, beta GLU, and control groups, a laparotomy was performed with the CLP procedure. In the sham group, laparotomy was performed and cecum was manipulated but not ligated or perforated. TNF-alpha and IL-6 levels were significantly elevated in the control group and decreased in the NAC and beta GLU groups. IL-10 levels were significantly increased in the beta GLU group (p < .05). Superoxide dismutase and catalase levels in the liver tissue were significantly increased in the NAC and beta GLU groups, whereas superoxide dismutase levels were higher in the beta GLU pretreatment group than the NAC pretreatment group (p < 0.05). Malondialdehyde levels in the liver tissue were significantly elevated in the control group and decreased in the NAC and beta GLU groups (p < .05). Prophylactic administration of NAC or beta GLU similarly ameliorated sepsis syndrome by reduction of the proinflammatory cytokines and increase of the anti-inflammatory cytokine levels and accession of cellular antioxidants, which protect cells from oxidative stress, thereby recruiting inflammatory cells into tissue.

Evaluation of a new chromogenic medium for isolation and identification of common urinary tract pathogens.

In the study presented here, a new chromogenic medium (CPS ID 3; bioMérieux, Marcy l'Etoile, France) was compared to routine media for the isolation, identification and antimicrobial susceptibility testing of bacteria recovered from urine specimens, and a cost analysis was performed. Escherichia coli, Proteeae tribe, Pseudomonas aeruginosa, Enterococcus spp. and Streptococcus agalactiae grew on the chromogenic medium as typical differentiated colonies and were accurately identified even in mixed cultures. Although the similarity of colors produced by isolates belonging to the Klebsiella, Enterobacter, Serratia and Citrobacter (KESC) group prevents differentiation among them, members of KESC were easily identified as coliforms. No substantial difference was observed when comparing the results of antimicrobial susceptibility testing performed on colonies selected from reference media versus CPS ID 3. Use of the new medium was associated with a savings of 75% over the conventional methods and the API system. Furthermore, this medium facilitated a remarkable reduction in the laboratory workload and consequently resulted in additional time and cost savings.

Efficacy of vancomycin, teicoplanin and fusidic acid as prophylactic agents in prevention of vascular graft infection: an experimental study in rat.

OBJECTIVES: To compare the efficacy of a single prophylactic dose of intra-peritoneal vancomycin and teicoplanin with anti-biotic treated Dacron grafts (vancomycin, teicoplanin, 10 or 40% fusidic acid-soaked grafts) in preventing vascular graft infections in a rat model. DESIGN: Prospective, randomized, controlled animal study. MATERIALS AND METHODS: The graft infections were established in the subcutaneous tissues of 80 female Sprague-Dawley rats by the implantation of Dacron prostheses followed by the topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1) uncontaminated control group, (2) untreated contaminated group, (3) contaminated group with intra-peritoneal vancomycin, (4) contaminated group with intra-peritoneal teicoplanin, (5) contaminated group received vancomycin-soaked Dacron graft, (6) contaminated group received teicoplanin-soaked Dacron graft, (7) contaminated group received 40% fusidic acid-soaked Dacron graft, and (8) contaminated group received 10% fusidic acid-soaked Dacron graft prophylaxis. The grafts were removed after 7 days and evaluated by a quantitative culture analysis. RESULTS: No infection was detected in controls. The untreated contaminated group had a high bacteria count (6.0 x 10(4) CFU/cm2 Dacron graft). Groups that received intra-peritoneal vancomycin or teicoplanin had less bacterial growth (4.8 x 10(3) and 3.9 x 10(3)CFU/cm2 Dacron graft, respectively). Similarly, the group that received 10% fusidic acid-soaked graft showed less bacterial growth (3.6 x 10(3) CFU/cm2 Dacron graft). The groups with vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts showed no evidence of infection. Statistical analyses demonstrated that intra-peritoneal prophylactic antibiotic treatment was less effective in inhibiting bacterial growth than high concentration antimicrobial-soaking of grafts. CONCLUSION: The use of vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts was effective in preventing primary prosthetic vascular graft infection.

Optimal reconstruction of historical water supply to a distribution system: A. Methodology.

The New Jersey Department of Health and Senior Services (NJDHSS), with support from the Agency for Toxic Substances and Disease Registry (ATSDR) conducted an epidemiological study of childhood leukaemia and nervous system cancers that occurred in the period 1979 through 1996 in Dover Township, Ocean County, New Jersey. The epidemiological study explored a wide variety of possible risk factors, including environmental exposures. ATSDR and NJDHSS determined that completed human exposure pathways to groundwater contaminants occurred in the past through private and community water supplies (i.e. the water distribution system serving the area). To investigate this exposure, a model of the water distribution system was developed and calibrated through an extensive field investigation. The components of this water distribution system, such as number of pipes, number of tanks, and number of supply wells in the network, changed significantly over a 35-year period (1962--1996), the time frame established for the epidemiological study. Data on the historical management of this system was limited. Thus, it was necessary to investigate alternative ways to reconstruct the operation of the system and test the sensitivity of the system to various alternative operations. Manual reconstruction of the historical water supply to the system in order to provide this sensitivity analysis was time-consuming and labour intensive, given the complexity of the system and the time constraints imposed on the study. To address these issues, the problem was formulated as an optimization problem, where it was assumed that the water distribution system was operated in an optimum manner at all times to satisfy the constraints in the system. The solution to the optimization problem provided the historical water supply strategy in a consistent manner for each month of the study period. The non-uniqueness of the selected historical water supply strategy was addressed by the formulation of a second model, which was based on the first solution. Numerous other sensitivity analyses were also conducted using these two models. Both models are solved using a two-stage progressive optimality algorithm along with genetic algorithms (GAs) and the EPANET2 water distribution network solver. This process reduced the required solution time and generated a historically consistent water supply strategy for the water distribution system.

Optimal reconstruction of historical water supply to a distribution system: B. Applications.

In a recently completed case-control epidemiological study, the New Jersey Department of Health and Senior Services (NJDHSS) with support from the Agency for Toxic Substances and Disease Registry (ATSDR) documented an association between prenatal exposure to a specific contaminated community water source and leukaemia in female children. An important and necessary step in the epidemiological study was the reconstruction of the historical water supply strategy of the water distribution system serving the Dover Township area, New Jersey. The sensitivity of solutions to: (1) pressure and pattern factor constraints, (2) allowable operational extremes of water levels in the storage tanks, and (3) the non-uniqueness of the water supply solution are analysed in detail. The computational results show that the proposed approach yields satisfactory results for the complete set of monthly simulations and sensitivity analyses, providing a consistent approach for identifying the historical water supply strategy of the water distribution system. Sensitivity analyses indicated that the alternative strategy obtained from the revised objective function and the variation of constraints did not yield significantly different water supply characteristics. The overall analysis demonstrates that the progressive optimality genetic algorithm (POGA) developed to solve the optimization problem is an effective and efficient algorithm for the reconstruction of water supply strategies in water distribution systems.

Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome.

To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings.

Correlation of anxiety and depression symptoms in patients with restless legs syndrome: a population based survey.

BACKGROUND AND OBJECTIVES: Restless legs syndrome (RLS) is an important and common cause of insomnia, and previous studies indicate that psychiatric wellbeing may be impaired among RLS patients. We aimed to investigate the interaction between anxiety/depression and RLS in a population based survey. METHODS: Data were drawn from the Mersin University Neuro-Epidemiology Project, a representative community sample of adults aged over 17 years residing in Mersin (n = 3234). Subjects found to be positive for RLS (n = 103) were evaluated for symptoms of anxiety and depression using the Hamilton Anxiety and Depression Scales and compared with the same number of contemporaneous control subjects. RESULTS: Significantly greater anxiety and depression symptoms were observed among patients with RLS than in the control subjects. Our data also seem to provide initial evidence of a correlation between the severity of RLS and of anxiety and depression symptoms (r = 0.21, p = 0.03 and r = 0.201, p = 0.04 respectively). CONCLUSIONS: Assessment of psychiatric status of RLS patients can be helpful and sometimes necessary to determine additional features and treatment strategies of this bothering condition. Further studies are needed to replicate our findings using longitudinal data.

Prevalence of essential tremor: door-to-door neurologic exams in Mersin Province, Turkey.

Estimates of the prevalence of essential tremor (ET) are probably low because screening questionnaires have been used. The authors estimated the prevalence of ET in Mersin Province, Turkey, in 2,253 individuals aged >or=40 years, all of whom were examined by study neurologists. There were 89 ET cases (prevalence = 4.0%, 95% CI = 3.2 to 4.8%). The prevalence of ET may be higher than previously estimated. This is important when defining the extent of the health care problem.

Unexpectedly low prevalence and unusual characteristics of RLS in Mersin, Turkey.

OBJECTIVE: To determine the prevalence, risk factors, and clinical presentation of restless legs syndrome (RLS) in a Turkish population. METHODS: A face-to-face, population-based epidemiologic survey was conducted. Multistep, stratified, cluster, and systematic samplings were used. A total of 3,234 adults were interviewed. RESULTS: Of the 3,234 participants, 103 (3.19%) experienced RLS. This prevalence rate is lower than those of other epidemiologic studies conducted among European and North American populations. RLS was found to be more common among women, cigarette smokers, and individuals residing in high altitudes. The self-reported mental and general health status of patients was worse than in the control subjects. The prevalence of RLS did not differ by age or body mass index. CONCLUSION: The discrepancy in RLS prevalence studies (including the authors') suggests that prevalence varies among different races, thus supporting a genetic predisposition.

Estimating exposure to volatile organic compounds from municipal water-supply systems: use of a better computational model.

The Southington, Connecticut, water-supply system is characterized by a distribution network that contains more than 1 700 pipeline segments of varying diameters and construction materials, more than 186 mi (299 km) of pipe, 9 groundwater extraction wells capable of pumping more than 4 700 gal/min (0.2965 m3/s), and 3 municipal reservoirs. Volatile organic compounds, which contaminated the underlying groundwater reservoir during the 1970s, contaminated the water-supply system and exposed the town's residents to volatile organic chemicals. We applied a computational model to the water-supply system to characterize and quantify the distribution of volatile organic compounds in the pipelines, from which we estimated the demographic distribution of potential exposure to the town's residents. Based on results from modeling analyses, we concluded the following: (a) exposure to volatile organic compound contamination may vary significantly from one census block to another, even when these census blocks are adjacent to each other within a specified radius; (b) maximum spatial spread of contamination in a water-distribution system may not occur under peak demand conditions, and, therefore, maximum spatial distribution of the exposed population also may not correspond to peak demand conditions, and (c) use of the proposed computational model allows for a more refined and rigorous methodology with which to estimate census-block-level contamination for exposure assessment and epidemiologic investigations.

Use of computational models to reconstruct and predict trichloroethylene exposure.

In this study, a type frequently encountered by ATSDR, groundwater and surface-water contamination have occurred near the Gratuity Road site in the town of Groton, Massachusetts. A petitioned public health assessment for the Gratuity Road site identified the primary contaminants as trichloro-ethylene (TCE), 1,1,1-trichloroethane (TCA), hexavalent chromium (Cr+6), chromium (Cr), and lead (Pb) (ATSDR 1992). The health assessment also indicated that off-site residential groundwater wells had been contaminated with TCE and TCA. Because direct measures of historical exposure to TCE are unavailable for the Gratuity Road site, computational models were used to reconstruct and predict exposure to TCE. These computational models included environmental transport and exposure models. For the environmental transport models, numerical methods were used to approximate the equations of groundwater flow and contaminant transport. Results of using environmental transport models provided us with the spatial and temporal database necessary to conduct an exposure analysis. This database indicated that groundwater concentrations of TCE typically exceeded EPA's MCL of 5 ppb for TCE. The study demonstrated that although a hazardous waste site can be remediated, nearby populations may experience significant exposure because of historical contamination, which will not be captured by remediation activities. The exposure analysis used simulated concentrations of TCE predicted by environmental transport models. These concentrations were used to compare exposure to TCE from inhalation in a one-compartment model shower with exposure from ingestion of domestic water contaminated by TCE. The exposure model indicated that exposure to TCE by the inhalation route during showering is nearly identical to exposure by ingestion of domestic water supplies contaminated with TCE. As a result, entry by inhalation route is as important as entry by ingestion route when conducting exposure analyses of contamination from volatile organic compounds such as TCE.