[Study of cancer risks associated with Lynch syndrome in the Liège region]. / Etude des risques oncologiques associés au syndrome de Lynch en région liégeoise.

Lynch syndrome is a hereditary predisposition to several cancers. The goals of our study were to know the different mutations in our Lynch population, to evaluate the prevalence of cancers in this population and to determine the mean age of onset of those cancers. This retrospective study includes proven carriers of a MMR mutation diagnosed either by the CHU of Liège or either by the CHC Saint-Joseph in Liège, Belgium. We noted a clear majority of MSH2 mutations (50 %) in the Lynch families recorded in Liège, which is different from the main literature. In our study population (106 subjects), 65 % of subjects were affected by at least one cancer. Prevalences for colorectal and endometrial cancers are, respectively, 50 % and 27.5 %. We found no difference in the mean age of onset of cancers compared to literature. We discuss the follow-up of Lynch patients and the interest of additional exams such as hysteroscopy and cystoscopy.

Le syndrome de Lynch est un syndrome de prédisposition héréditaire à un certain nombre de cancers. Les objectifs de notre étude sont de connaître la répartition des différentes mutations dans la population Lynch prise en charge dans nos centres, d'évaluer la prévalence des cancers présentés par les patients Lynch de cette population et de déterminer l'âge moyen d'apparition de ces cancers. Cette étude rétrospective inclut les porteurs confirmés d'une mutation MMR ayant été diagnostiqués, soit par le CHU de Liège, soit par le CHC Saint-Joseph à Liège. Nous avons constaté une nette majorité de mutations MSH2 (50 %) parmi les familles Lynch répertoriées à Liège, ce qui est différent de ce qui est décrit dans la littérature. Dans notre population d'étude (106 sujets), 65 % des sujets ont présenté au moins un cancer. Les prévalences du cancer colorectal et de l'endomètre sont, respectivement, de 50 % et 27.5 %. Nous n'avons pas trouvé de différence dans les âges moyens de présentation des cancers par rapport à la littérature existante. Nous discutons du suivi des patients porteurs d'un syndrome de Lynch et de la place d'examens supplémentaires comme l'hystéroscopie et la cystoscopie.

Regression of Sweet's syndrome associated with Crohn's disease after anti-Tumour Necrosis Factor therapy.

The association of inflammatory bowel disease and acute febrile neutrophilic dermatitis (Sweet's syndrome) has infrequently been reported in the literature. We describe the case of a 41-year-old Caucasian woman with ileo- anal Crohn's disease who presented simultaneously an erythema nodosum and a Sweet's syndrome. A dramatic regression of the cutaneous lesions was observed after infliximab treatment, indicating that this therapy might be useful for both Crohn's disease and Sweet's syndrome.

An aufwuchs chamber slide for high-resolution confocal laser scanning microscopy and stereo imaging of microbial communities in natural biofilms.

Aufwuchs chamber slides were constructed by attaching a silicone rubber gasket to a glass slide with epoxy cement. For biofilm growth, the slides were suspended in Cayuga Lake near Ithaca, NY, for 27 days. Biofilms in the chamber were stained with 0.05% acridine orange. After rinsing, the chamber was filled with molten 1% agarose to stabilize filaments and delicate polymer structures at the biofilm surface. Areas of biofilm approximately 0.5 mm thick on the inner face of the wall of the chamber were selected for side-on optical sectioning in a confocal laser scanning microscope (CLSM). Stacks of high-resolution optical images captured by the CLSM z-sectioning software, were used to create left-right stereo image pairs. At low magnification the stereo pairs showed 3-D details of the microbial landscape in the mature biofilms. Channels, pores, and other structural features of the biofilm matrix were observed in peripheral regions. Higher magnification images revealed the 3-D distribution of specific biofilm components such as filaments of sheathed bacteria projecting outward into the liquid milieu, and organic coatings, including bacterial cells on the surfaces of mineral particles.

Characterization of a Sinorhizobium isolate and its extracellular polymer implicated in pollutant transport in soil.

A bacterium isolated from soil (designated 9702-M4) synthesizes an extracellular polymer that facilitates the transport of such hydrophobic pollutants as polynuclear aromatic hydrocarbons, as well as the toxic metals lead and cadmium in soil. Biolog analysis, growth rate determinations, and percent G+C content identify 9702-M4 as a strain of Sinorhizobium meliloti. Sequence analysis of a 16S rDNA fragment gives 9702-M4 a phylogenetic designation most closely related to Sinorhizobium fredii. The extracellular polymer of isolate 9702-M4 is composed of both an extracellular polysaccharide (EPS) and a rough lipopolysaccharide. The EPS component is composed mainly of 4-glucose linkages with monomers of galactose, mannose, and glucuronic acid and has pyruval and acetyl constituents. The lipid fraction and the negative charge associated with carbonyl groups of the exopolymer are thought to account for the binding of polynuclear aromatic hydrocarbons and cationic metals.

The effects of pH and surface composition on Pb adsorption to natural freshwater biofilms.

Two dominant variables that control the adsorption of toxic trace metals to suspended particulate materials and aquatic surface coatings are surface composition and solution pH. A model for the pH-dependent adsorption of Pbto heterogeneous particulate surface mixtures was derived from experimental evaluation of Pb adsorption to laboratory-derived surrogates. The surrogate materials were selected to represent natural reactive surface components. Pb adsorption to both the laboratory surrogates and natural biofilms was determined in chemically defined solutions under controlled laboratory conditions. Pb adsorption was measured over a pH range of 5-8, with an initial Pb concentration in solution of 2.0 microM. The surface components considered include amorphous Fe oxide, biogenic Mn oxide produced by a Mn(II) oxidizing bacterium (Leptothrix discophora SS-1), Al oxide, the common green alga Chlorella vulgaris, and Leptothrix discophora SS-1 cells. A linearization of Pb adsorption data for each adsorbent was used to quantify the relationship between Pb adsorption and pH. The parameters for individual adsorbents were incorporated into an additive model to predict the total Pb adsorption in multiple-adsorbent natural surface coatings that were collected from Cayuga Lake, NY. Pb adsorption experiments on the natural surface coatings at variable pH were utilized to verify the additive model predictions based on the pH dependent behavior of the experimental laboratory surrogates. Observed Pb adsorption is consistent with the model predictions (within 1-24%) over the range of solution pH values considered. The experimental results indicate that the combination of Fe and biogenic Mn oxides can contribute as much as 90% of Pb adsorbed on Cayuga Lake biofilms, with the dominant adsorbent switching from Mn to Fe oxide with increasing pH.

Phenanthrene desorption from soil in the presence of bacterial extracellular polymer: observations and model predictions of dynamic behavior.

The extracellular polymer produced by a bacterium isolated from soil was employed in laboratory studies of desorption of a model polynuelear aromatic hydrocarbon (PAH), phenanthrene. The experimental results show that the selected extracellular polymer enhances the extent of release of soil-bound phenanthrene. A kinetic model was developed as an aid in interpreting the alterations in phenanthrene desorption resulting from polymer addition. The model employs a statistical gamma (gamma) distribution to describe spectrum of rate constants for transfer of phenanthrene from soil to water, and assumes instantaneous binding of phenanthrene to polymer and of polymer to the test soil. The relevant distribution coefficients and statistical parameters of the gamma distribution needed for the model were evaluated in independent experiments. Using these measured parameters, the model provides a satisfactory independent prediction of phenanthrene release from soil to aqueous phase at two test polymer concentrations, 50 mg TOC/L and 100 mg TOC/L. The success of the independent model predictions suggests a mechanism for the influence of extracellular polymer on phenanthrene desorption. The intrinsic, soil-specific, rate constants for solid to solution transfer of phenanthrene do not appear to be changed by bacterial polymer. Instead, polymer binding of phenanthrene in solution results in an increase in driving force for desorption by decreasing the solution concentration of the free, unbound, PAH molecule.

Structure and carbohydrate analysis of the exopolysaccharide capsule of Pseudomonas putida G7.

The aromatic hydrocarbon-degrading bacterium, Pseudomonas putida G7, produces exopolymers of potential interest in biotechnological applications. These exopolymers have been shown to have significant metal-binding ability. To initiate the study of the metal-polymer interactions, we explored the physical and chemical nature of the P. putida G7 exopolysaccharide, a major component of the exopolymer. A capsular structure was observed by light microscopy surrounding both planktonic and attached cells in biofilms after immunofluorescence staining with polyclonal antiserum raised against planktonic cells. Further work with planktonic cells showed that the immunostained capsule remained associated with young (log phase) cells, whereas older (stationary phase) cells lost their capsular material to the external milieu. Visualization of frozen, hydrated stationary phase cells by cryo-field emission scanning electron microscopy (cryoFESEM) revealed highly preserved extracellular material. In contrast, conventional scanning electron microscopy (SEM) of stationary phase cells showed rope-like material that most probably results from dehydrated and collapsed exopolymer. Both capsular and released exopolymers were separated from cells, and the released extracellular polysaccharide (EPS) was purified. Deoxycholate-polyacrylamide gel electrophoresis (PAGE) and silver/alcian blue staining of the partially purified material showed that it contained both EPS and lipopolysaccharide (LPS). Further purification of the EPS using a differential solubilization technique to remove LPS yielded highly purified EPS. Gas chromatography-mass spectrometry revealed that the purified EPS contained the monosaccharides, glucose, rhamnose, ribose, N-acetylgalactosamine and glucuronic acid. The structural and chemical properties of the P. putida EPS described here increase our understanding of the mechanisms of toxic metal binding by this well-known Proteobacterium.

[Digestive hemorrhage originated elsewhere]. / Une hémorragie digestive venue d'ailleurs.

We report the case of splenic subcapsular haematoma, that happens to a woman after three months. Breaking and fistulation of the splenic haematoma into the gastric cavity and its subsequent evacuation made it first identify as digestive haemorrhage.

Independent prediction of naphthalene transport and biodegradation in soil with a mathematical model.

Experiments were performed to test the ability of a mathematical model to predict naphthalene transport and biodegradation. Pseudomonas putida G7, a model bacterial strain capable of degrading naphthalene, was added to a column packed with the soil that had been pre-equilibrated with naphthalene. Model prediction for transport and degradation were based on predetermined parameters that described naphthalene desorption kinetics and the utilization of naphthalene by the test bacterium. However, initial prediction for naphthalene biodegradation was high, and the formation of cell aggregates is advanced as a plausible explanation. Access of substrate to cells in the interior of an aggregate would be restricted. When the numerical simulation was conducted with a factor to account for cell aggregation, it successfully described the experimental data. Thus, with a single adjustable parameter (an average effectiveness factor), the model predicted macroscopic responses of naphthalene in soil-columns where naphthalene was subject to transport and biodegradation.

Active site topology of artificial peroxidase-like hemoproteins based on antibodies constructed from a specifically designed ortho-carboxy-substituted tetraarylporphyrin.

The topology of the binding site has been studied for two monoclonal antibodies 13G10 and 14H7, elicited against iron(III)-alpha,alpha,alpha,beta-meso-tetrakis(ortho-carboxyphenyl)porph yrin [alpha,alpha,alpha, beta-Fe[(o-COOHPh)4-porphyrin]], and which exhibit in the presence of this alpha,alpha,alpha, beta-Fe[(o-COOHPh)4-porphyrin] cofactor a peroxidase activity. A comparison of the dissociation constants of the complexes of 13G10 and 14H7 with various tetra-aryl-substituted porphyrin has shown that: (a) the central iron(III) atom of alpha,alpha,alpha,beta-Fe[(o-COOHPh)4-porphyrin] is not recognized by either of the two antibodies; and (b) the ortho-carboxylate substituents of the meso-phenyl rings of alpha,alpha,alpha, beta-Fe[(o-COOHPh)4-porphyrin] are essential for the recognition of the porphyrin by 13G10 and 14H7. Measurement of the dissociation constants for the complexes of 13G10 and 14H7 with the four atropoisomers of (o-COOHPh)4-porphyrinH2 as well as mono- and di-ortho-carboxyphenyl-substituted porphyrins suggests that the three carboxylates in the alpha, alpha, beta position are recognized by both 13G10 and 14H7 with the two in the alpha, beta positions more strongly bound to the antibody protein. Accordingly, the topology of the active site of 13G10 and 14H7 has roughly two-thirds of the alpha,alpha,alpha,beta-Fe[(o-COOHPh)4-porphyrin] cofactor inserted into the binding site of the antibodies, with one of the aryl ring remaining outside. Three of the carboxylates are bound to the protein but no amino acid residue acts as an axial ligand to the iron atom. Chemical modification of lysine, histidine, tryptophan and arginine residues has shown that only modification of arginine residues causes a decrease in both the binding of alpha,alpha,alpha, beta-Fe[(o-COOHPh)4-porphyrin] and the peroxidase activity of both antibodies. Consequently, at least one of the carboxylates of the hapten is bound to an arginine residue and no amino acids such as lysine, histidine or tryptophan participate in the catalysis of the heterolytic cleavage of the O-O bond of H2O2. In addition, the amino acid sequence of both antibodies not only reveals the presence of arginine residues, which could be those involved in the binding of the carboxylates of the hapten, but also the presence of several amino acids in the complementary determining regions which could bind other carboxylates through a network of H bonds.

Hemoabzymes. Different strategies for obtaining artificial hemoproteins based on antibodies.

Besides existing models of chemical or biotechnological origin for hemoproteins like peroxidases and cytochromes P450, catalytic antibodies (Abs) with a metalloporphyrin cofactor represent a promising alternative route to catalysts tailored for selective oxidation reactions. A brief overview of the literature shows that, until now, the first strategy for obtaining such artificial hemoproteins has been to produce antiporphyrin Abs, raised against various free-base, N-substituted, Sn-, Pd-, or Fe-porphyrins. Four of them exhibited, in the presence of the corresponding Fe-porphyrin cofactor, a significant peroxidase activity, with kcat/K(m) values of 10(2) to 5 x 10(3)/M/s. This value remained low when compared to that of peroxidases, probably because neither a proximal ligand of the Fe, nor amino acid residues participating in the catalysis of the heterolytic cleavage of the O-O bond of H2O2, have been induced in those Abs. This strategy has been shown to be insufficient for the elaboration of effective models of cytochromes P450, because only one set of Abs, raised against meso-tetrakis(para-carboxyvinylphenyl)porphyrin, was reported to catalyze the nonstereoselective oxidation of styrene by iodosyl benzene using a Mn-porphyrin cofactor, and attempts to generate Abs having binding sites for both the substrate and the metalloporphyrin cofactor, using as a hapten a porphyrin covalently linked to the substrate, were not successful. A second strategy is then proposed, which involves the chemical labeling of antisubstrate Abs with a metalloporphyrin. As an example, preliminary results are presented on the covalent linkage of an Fe-porphyrin to an antiestradiol Ab, in order to obtain semisynthetic catalytic Abs able to catalyze the selective oxidation of steroids.

Growth kinetics of Pseudomonas putida G7 on naphthalene and occurrence of naphthalene toxicity during nutrient deprivation.

The objectives of this work were (1) to demonstrate how the chemostat approach could be modified to allow determination of kinetic parameters for a sparingly soluble, volatile substrate such as naphthalene and (2) to examine the influence of the interactions of various nutrients on possible growth-inhibitory effects of naphthalene. Pseudomonas putida G7 was used as a model naphthalene-degrading microorganism. Naphthalene was found to be toxic to P. putida G7 in the absence of a nitrogen source or oxygen. The death rate of cells grown on minimal medium plus naphthalene and then exposed to naphthalene under anoxic conditions was higher than that observed under oxic conditions in the absence of a nitrogen source. The presence of necessary nutrients for the biodegradation of PAH compounds is indicated to be important for the survival of microorganisms that are capable of PAH degradation. The amounts of ammonia and oxygen necessary for naphthalene biodegradation and for suppression of naphthalene toxicity were calculated from growth yield coefficients. A chemostat culture of P. putida G7 using naphthalene as a carbon and energy source was accomplished by using a feed augmented with a methanol solution of naphthalene so as to provide sufficient growth to allow accurate evaluation of kinetic parameters. When naphthalene was the growth-limiting substrate, the degradation of naphthalene followed Monod kinetics. Maximum specific growth rate (micrometer) and Monod constant (Ks) were 0.627 +/- 0.007 h-1 and 0.234 +/- 0.0185 mg/L, respectively. The evaluation of biodegradation parameters will allow a mathematical model to be applied to predict the long-term behavior of PAH compounds in soil when combined with PAH transport parameters.

The Eurevie Study: contrasting effect of piretanide and thiazides in mild to moderate hypertension.

UNLABELLED: This study compares the loop diuretic piretanide 6 mg in a slow-release formulation (PIR) with hydrochlorothiazide 25 mg (HCT) and the fixed combination altizide 15 mg-spironolactone 25 mg (ALT-SP) in hypertension. 1105 mild to moderate hypertensive patients entered a three-week placebo wash-out period; 899 were randomized in a 6-month, double-blind, parallel group treatment phase; 800 completed the study. Primary end-points; serum potassium concentration and quality of life at one month; secondary end-points: ionic, renal and metabolic variables; blood pressure (BP) measurements. HCT and ALT-SP were compared only to PIR using Dunnett's or chi 2 tests. RESULTS: No difference was found for the overall quality of life. No change of serum potassium concentration at one month was found in PIR while small decreases were detected with ALT-SP (-0.1 mM) and HCT (-0.26 mM). Serum creatinine concentration increased significantly in ALT-SP when compared to PIR. All the drugs were effective in reducing BP: HCT had a higher rate of responders than PIR with similar mean BP falls and ALT-SP induced greater falls in blood pressure. CONCLUSION: PIR proves to be a potent antihypertensive drug without significant effect on serum electrolytes, plasma glucose and lipids. HCT was slightly more potent but induced a fall in serum potassium concentration with a significant risk of hypokalaemia. The addition of SP to ALT led to a more potent diuretic with a higher level of serum potassium and plasma creatinine disturbances.

[Painful ophthalmoplegia disclosing dural fistula of the anterior cranial fossa]. / Ophtalmoplégie douloureuse révélatrice d'une fistule durale de l'étage antérieur.

We report the case of a 54-year-old man without previous medical history who presented with sudden vertical diplopia and frontal headache. Clinical examination and Lancaster's test were consistent with superior rectus muscle palsy. Brain CT scan, MRI and CSF examination were normal. Cerebral angiography revealed a dural arteriovenous fistula at the base of the anterior cranial fossa with bilateral arterial supply from small branches of the ophthalmic artery. The causal relationship, the pathophysiology and the therapeutic approaches are discussed.

[Evaluation of a cardiac rehabilitation program. Analysis after ten years of follow-up]. / Avaliação de programa de reabilitação cardíaca. Análise após 10 anos de acompanhamento.

PURPOSE: To study the benefits of the cardiac rehabilitation program (CRP) in patients with coronary artery disease (CAD). METHODS: Between 1986 and 1995 we studied 49 patients with CAD, participants of the CRP, 45 (91.83%) of them men. They were compared with a control group of 37 sedentary patients, 33 (89.18%) men. The main parameters analyzed were the duration of exercise, the maximal oxygen consumption (VO2 max), the metabolic equivalent (MET), the functional aerobic impairment (FAI) and the change in the classification of the cardiorespiratory capacity between two graded exercise tests (GTX). RESULTS: There were improvements in all parameters of the GTX analyzed in the two groups. The patients of the CRP presented a better functional capacity than the sedentary patients and, in relation to the duration of exercise, to the VO2 max and to the MET, the differences in the two groups achieved statistical significance (p < 0.05). We did not observe benefits, in relation to the physical conditioning, with a more prolonged permanence of the patients in the program (more than 24 months). There were no cardiovascular complications with the practice of the exercise in the period analyzed. CONCLUSION: The improvement in the duration of exercise, in the VO2 max and in the MET, the more negative variation in the FAI and the improvement in the classification of the cardiorespiratory capacity between the two GTX of the patients of the CRP demonstrate improvement in functional capacity significantly better than sedentary patients. The CRP analyzed was considered a therapeutic method safe and efficient after a coronary event.

Microscale-based modeling of polynuclear aromatic hydrocarbon transport and biodegradation in soil.

A mathematical model to describe polynuclear aromatic hydrocarbon (PAH) desorption, transport, and biodegradation in saturated soil was constructed by describing kinetics at a microscopic level and incorporating this description into macroscale transport equations. This approach is novel in that the macroscale predictions are made independently from a knowledge of microscale kinetics and macroscopic fluid dynamics and no adjustable parameters are used to fit the macroscopic response. It was assumed that soil organic matter, the principal site of PAH sorption, was composed of a continuum of compartments with a gamma distribution of desorption rate coefficients. The mass transport of substrates and microorganisms in a mesopore was described by diffusion and that in a macropore by one-dimensional advection and dispersion. Naphthalene was considered as a test PAH compound for initial model simulations. Three mechanisms of naphthalene biodegradation were considered: growth-associated degradation as a carbon and energy source for microbial growth; degradation for maintenance energy; and growth-independent degradation. The Haldane modification of the Monod equation was used to describe microbial growth rates and to account for possible growth inhibition by naphthalene. Multisubstrate interactions were considered and described with a noninteractive model for specific growth rates. The sensitivity of selected model parameters was analyzed under conditions when naphthalene was the sole growth-rate-limiting substrate. The time necessary to achieve a specific degree of naphthalene biodegradation was found to be proportional to the initial concentration of naphthalene in soil organic matter. The biodegradation rate of naphthalene increased when the sorption equilibrium constant of naphthalene was reduced. The presence of an alternative carbon source inhibited naphthalene biodegradation in spite of the calculated increase in biomass. (c) 1996 John Wiley & Sons, Inc.

A dose-effect study of beraprost sodium in intermittent claudication.

We compared the efficacy and safety of three doses of beraprost sodium, an epoprostenol analogue, with placebo in the treatment of intermittent claudication (Fontaine's stage II). One hundred sixty-four patients were randomized to receive either placebo, 20 micrograms beraprost sodium (BPS60 group), 40 micrograms beraprost sodium (BPS120 group), or 60 micrograms beraprost sodium (BPS180 group) three times daily administered orally in a double-blind manner for 12 weeks. Treadmill exercise tests were performed twice during an initial selection phase (D-28 and D0) at week 10 (at trough beraprost concentration) and week 12 (at peak beraprost concentration) of the treatment phase. At week 10, all groups showed an increase in pain-free walking distance, and this distance was greatest in the BPS60 and BPS120 groups (p = 0.055). At week 12, a similar pattern was observed, and the difference was significant between the groups (p = 0.023). The most frequent adverse events reported were gastrointestinal disorders, headaches, skin disorders, and flushes. Patients who received either 60 or 120 micrograms of beraprost sodium daily had an increased pain-free walking distance. Further studies are required to investigate why the highest dose used (180 micrograms daily) showed lower efficacy. Having both vasodilating and antiplatelet properties and being able to increase pain-free walking distance in the short term, beraprost sodium is a promising drug for the treatment of intermittent claudication.

Ventricular fibrillation following administration of thrombolytic treatment. The EMIP experience. European Myocardial Infarction Project.

Reperfusion-induced ventricular fibrillation has been demonstrated in animal models of myocardial ischaemia, but no evidence exists for this in humans. The European Myocardial Infarction Project compared the efficacy and safety of pre-hospital thrombolytic therapy with that of hospital therapy. The objective of this study was to investigate the occurrence of reperfusion-induced ventricular fibrillation in acute myocardial infarction patients following thrombolytic therapy. In a double-blind multicentre trial, eligible patients were randomized to receive anistreplase at home followed by placebo in the hospital (A/P group), or placebo followed by anistreplase (P/A group). The occurrence of ventricular fibrillation, and other adverse events were recorded on specific study forms and could be attributed to defined time intervals. The incidence of ventricular fibrillation in the A/P group was significantly higher following the pre-hospital injection than in the P/A group (2.5% vs 1.6%; P = 0.021); the situation was reversed following the hospital injection (3.6% vs 5.3%; P = 0.002). No relationship was found between this excess of ventricular fibrillation and the patients' condition, with the exception of the site of the infarct. These results suggest the existence of reperfusion-induced ventricular fibrillation in patients developing myocardial infarction who receive thrombolytic treatment.

A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. The OCAPI Study Group. Optimiser le Choix d'un Anti-hypertenseur de Première Intention.

OBJECTIVE: To assess the equivalence of four antihypertensive treatments in patients with mild-to- moderate hypertension, and to compare the effects of those drugs on the subjective quality of life and clinical safety. DESIGN, SETTING AND PATIENTS: 653 patients aged > or = 18 years with untreated hypertension were randomly allocated to receive a combination of two diuretics (altizide and spironolactone), a beta-blocker (bisoprolol), a calcium antagonist (verapamil), or an angiotensin converting enzyme (ACE) inhibitor (enalapril). Follow-up lasted for 1 year. MAIN OUTCOME MEASURES: A composite outcome of the following measures was used to define success: attendance at the 12-month visit; at least nine supine DBP measurements during the study; and median supine DBP < 90 mmHg and a reduction of at least 10 mmHg compared with the baseline value. Failure was defined as one or more of those criteria not being fulfilled. Equivalence was concluded if the 95% confidence interval for the success rates differed between two groups by less than +/- 10%. Clinical safety and subjective quality of life were also assessed. RESULTS: No statistically significant differences in the change in DBP or systolic blood pressure were observed between the groups. The success rates were 43.9, 42.0, 32.5 and 43.9% in diuretic, beta-blocker, calcium antagonist and ACE inhibitor groups, respectively. Equivalence between the treatments could not be concluded, although analysis with a larger equivalence interval showed that some comparisons indicated equivalence. Significant improvement in satisfaction was observed for certain items for subjective quality of life at 1 month in the calcium antagonist treatment group, and significant differences in the responses to the clinical safety questionnaire were observed after 1-month follow-up in calcium antagonist and beta-blocker groups. Differences were no longer significant after 9 months. CONCLUSIONS: These results do not provide evidence on the basis of efficacy of blood pressure lowering or ability to increase short-term (1-year) safety and quality of life favouring any particular treatment among the studied drugs for newly diagnosed patients with mild-to-moderate hypertension.

Trace metal mobilization in soil by bacterial polymers.

Enhanced transport of trace metal in porous media can occur in the presence of a ligand or "carrier" that has a high affinity for binding the pollutant, is dispersed and mobile in the soil environment, is recalcitrant with respect to microbial degradation, and is acceptable to the public. These aspects of the facilitated transport to trace metals are discussed with respect to a naturally occurring carrier: extracellular polymers of bacterial origin. The literature is reviewed regarding the production and composition of bacterial extracellular polymers, the processes relevant to the facilitated transport of trace metals in soil by bacterial polymers, and potential for transformation of polymers in soils by microbial degradation. Model calculations of contaminant retardation are presented for the case of polymer-mediated transport of cadmium in a sandy aquifer material. The available information suggests that extracellular polymers can bind metal ions and are mobile in the soil environment. Extracellular polymers also appear to be relatively slowly degraded by soil microorganisms. These properties and the supporting model calculations indicate that extracellular polymers of bacterial origin merit consideration as agents that may be applied to contaminated soils to enhance trace metal mobility.