Clinical trials and clinical practice: do doctors use the same criteria to judge outcome?

Aims: The results of clinical trials often seem to have little influence on the practice of individual doctors. This could be because trial information is presented in the style of a scientific experiment which cannot often be clearly related to the context of everyday patient care. We tested the hypothesis that such framing effects would cause doctors to assess the clinical significance of treatment outcomes differently when presented as clinical trial results rather than as individual patient data.

Experimental investigation of the distribution of residual strains in the artery wall.

Arterial wall stresses are thought to be a major determinant of vascular remodeling both during normal growth and throughout the development of occlusive vascular disease. A completely physiologic mechanical model of the arterial wall should account not only for its residual strains but also for its structural nonhomogeneity. It is known that each layer of the artery wall possesses different mechanical properties, but the distribution of residual strain among the different mechanical components, and thus the true zero stress state, remain unknown.

The relationship between colonization and haemagglutination inhibiting and B cell epitopes of Porphyromonas gingivalis.

Passive immunization with the monoclonal antibody 61BG1.3 selectively prevents colonization by Porphyromonas gingivalis in humans (Booth V, Ashley FP, Lehner T. Infect Immun 1996; 64:422-7).

HIV type 1 envelope glycoprotein 120 carboxy-terminal peptide-induced human T cell lines selectively suppress heterogeneous proliferative T cell responses to soluble antigens.

It has been proposed that the highly conserved human immunodeficiency virus type 1 (HIV-1) envelope gp120 carboxy-terminal sequence, TKAKRRVVEREKR (CT120), may represent a functional mimic of the human leukocyte antigen (HLA) class II DR beta-chain third hypervariable region (HVR3) sequence motif located at position 69-81. Presentation of this potentially pathogenic fragment by HLA class I and/or II molecules, in a manner analogous to the indirect pathway of allorecognition, may induce both widespread cellular activation and also break self-tolerance, resulting in the selective and progressive anti-self HLA class II-directed immune suppression, which is a central feature of HIV-1 infection and the associated acquired immune deficiency syndrome (AIDS). To investigate the functional role of the HIV-1 gp120 C-terminal fragment T cell lines (TCLs) were raised from three healthy HIV-1-seronegative subjects at low risk of HIV-1 exposure, by repeated stimulation with a short synthetic 13-mer CT120 peptide in vitro.

Effect of viscous fiber (guar) on postprandial motor activity in human small bowel.

Both caloric value and chemical composition of a meal have been shown to regulate postprandial small bowel motility in dog. In the same species, duration of and contractile activity within the postprandial period also depends on mean viscosity. It is unknown, however, whether meal viscosity and fiber content also regulate small bowel motor activity in man.

In vivo assessment of metabolic perturbations following alanine and glucagon administration using 31P-MRS in the rat.

This study set out to validate the use of 31P-NMR spectroscopy together with alanine +/- glucagon infusions to assess hepatic gluconeogenic flux in vivo. Bolus infusions of alanine (2.8 or 5.

Reversible sensorineural hearing loss in Lyme disease.

We report a case of bilateral sensorineural hearing loss of two years duration which appears to have been due to late Borrelia burgdorferi infection. The 39-year-old woman presented with bilateral deafness and multiple other neurological complaints some six months after developing a 'target' lesion on the lower leg after walking in the New Forest. 'Serology' for Borrelia burgdorferi became positive and the patient made a complete recovery from both her deafness and her other neurological problems after a five-week course of oral antibiotic therapy.

Daytime and night time motor activity of the small bowel after solid meals of different caloric value in humans.

Background: Meals disrupt the interdigestive pattern of small bowel motor activity and convert it into the postprandial pattern. Previous studies have shown that duration of postprandial motor activity depends on the caloric value of a meal, but results from two recent human studies suggested that there is a caloric ceiling, above which an additional increase in the caloric load fails to prolong the postprandial period further.

Aim: To investigate the hypothesis of a caloric ceiling by studying daytime motor activity of the human small bowel in response to five solid meals, covering a wide range of calories.

HIV type 2 pathogenicity is not related to subtype in rural Guinea Bissau.

Data from an MRC case-control study in rural Guinea Bissau suggest older HIV-2 carriers (aged 55 to 80 years) appear, over a period of 2 years, to have a mortality similar to that of uninfected controls, whereas in HIV-2 carriers under the age of 55 there is a significantly higher mortality, compared with uninfected controls. Genotyping of viruses from both groups revealed only subtype a to be circulating. Thus, although putative nonpathogenic HIV-2 subtypes have been described in patients from West Africa, these do not appear to be contributing significantly to the nonpathogenic clinical phenotype in this population.

Haemopoietic growth factors.

Haemopoietic growth factors are involved in the production of the various blood cells from progenitors in the bone marrow, making them useful in a range of clinical situations. The genes for several of them have been cloned and their production engineered by recombinant technology, making them widely available. Myeloid growth factors are used to support patients in the aftermath of chemotherapy and bone marrow transplantation and have potential application in the treatment of infectious diseases.

Sequential development of angiotensin receptors and angiotensin I converting enzyme during angiogenesis in the rat subcutaneous sponge granuloma.

1. The vasoconstrictor peptide antiotensin II (AII) can stimulate angiogenesis, an important process in wound healing, tumour growth and chronic inflammation. To elucidate mechanisms underlying AII-enhanced angiogenesis, we have studied a subcutaneous sponge granuloma model in the rat by use of 133Xe clearance, morphometry and quantitative in vitro autoradiography.

What endoscopic accessories do we really need?

This article is a speculative essay that reviews the current limitations of existing flexible endoscopic accessories. Suggestions are offered on future developments that may change endoscopic practice as it adopts an increasingly therapeutic role. There may be a potential for development in flexible endoscopic surgical techniques that will be comparable to those seen in rigid laparoscopic surgery.

Stomatitis glandularis--two confirmed cases of a rare condition.

Stomatitis glandularis is an unusual chronic inflammatory condition of the minor salivary glands, mainly affecting the lower lip. Two cases are reported, one of which was progressive and affected the glands of both the cheeks as well as the lips. After confirmation of the clinical diagnosis by histopathological appearances, treatment was by excision of the suppurating areas as staged procedures.

Malakoplakia and colorectal adenocarcinoma.

We report a case of malakoplakia in association with colonic adenocarcinoma. Tumour-associated malakoplakia in the gastrointestinal tract is a rare finding, generally confined to the colon. It may be locally aggressive, with invasion of pericolic tissues, but is always located adjacent to the tumour.

beta-Lactamase inhibition and in vitro activity of sulbactam and sulbactam/cefoperazone.

beta-Lactamase inhibitors such as sulbactam are beta-lactam compounds that have low antimicrobial activity but are able to inhibit enzymes (beta-lactamases) that destroy beta-lactam antibiotics like penicillins and cephalosporins. The main activity of beta-lactamase inhibitors is directed against plasmid-mediated transferable enzymes and various extended-spectrum enzymes. Sulbactam is also active against some of the fixed chromosomally mediated enzymes produced by gram-negative bacteria and is active against Bacteroides and Acinetobacter species.

High resolution 1H NMR investigations of the reactivities of alpha-keto acid anions with hydrogen peroxide.

The chemical reactivity of various alpha-keto acid anions (beta-hydroxypyruvate, beta-phenylpyruvate, 2-ketobutyrate and 2-ketoglutarate) with hydrogen peroxide (H2O2) was investigated at physiological pH (7.4) and a temperature of 25 degrees C. The initial concentration of the alpha-keto acid anions was kept constant at 1.

A review of the use of the neodymium YAG laser in oral and maxillofacial surgery.

A review of the use of neodymium:YAG laser in oral and maxillofacial surgery is presented. The Nd:YAG laser wavelength exhibits minimal tissue absorption and maximal penetration by comparison with the CO2 laser's maximal absorption and minimal penetration. These properties allow a variety of uses in maxillofacial surgery particularly coagulation of angiomatous lesions, haemostasis in bleeding diatheses, arthroscopic surgery of the temporomandibular joint, combination with CO2 wavelength for resections in vascular tissues (e.

Oesophageal acid and salivary secretion: is chewing gum a treatment option for gastro-oesophageal reflux?

The presence of acid in the oesophagus has been shown to stimulate salivary secretion, but the relevance of this oesophago-salivary reflex for acid clearance in physiological and pathological gastro-oesophageal reflux (GOR) is unknown. This study was designed to investigate the interrelation between oesophageal acid and both resting and stimulated salivary secretion. In 10 healthy volunteers, the acid clearance times after bolus infusion of 20 ml of 0.

Increased titre and avidity of IgG antibodies to Porphyromonas gingivalis whole cells and a cell surface protein in subjects with adult periodontitis.

The titre and avidity of IgG antibodies to Porphyromonas gingivalis whole cells and a 47 kDa cell surface protein were determined in serum samples taken from 20 subjects with adult periodontitis and 20 controls, matched for age, gender, ethnic origin and oral hygiene status. Antibody titres were measured by ELISA and antibody avidity was determined by a chaotrope-dissociation ELISA. Avidity was defined as the molarity of chaotrope required to reduce absorbance by 50% (ID50).

Analysis of the protease and adhesin domains of the PrpRI of Porphyromonas gingivalis.

The production of extracellular proteolytic enzymes is a widely used strategy by human parasites including bacteria, protozoa and helminths in order to ensure survival in the colonized host. The potential benefits to the organism arise through modifications to the external environment of the cell and include the release of essential nutrients, the disablement/deregulation of the host defences and the exposure of previously shielded substrata as new sites for colonization. Damage to the host may arise through direct proteolysis of structural proteins, deregulation of the inflammatory response or the compromising of the local host defences below the threshold necessary for effective defence.

Raised levels of circulating VCAM-1 and circulating E-selectin in patients with recurrent oral ulceration.

Endothelial cell (EC) adhesion molecules VCAM-1 (vascular cell adhesion molecule-1), E-selectin and ICAM-1 (intercellular adhesion molecule-1) are essential for the binding of inflammatory cells to ECs. Recently, circulating forms of these molecules have been detected in a number of vasculitic disease processes. Recurrent oral ulceration (ROU) has some features of a vasculitic disease process.