Tea crude extracts effectively inactivate severe acute respiratory syndrome coronavirus 2

It is well known that black and green tea extracts, particularly polyphenols, have antimicrobial activity against various pathogenic microbes including viruses. However, there is limited data on the antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which emerged rapidly in China in late 2019 and which has been responsible for coronavirus disease 2019 (COVID‐19) pandemic globally. In this study, 20 compounds and three extracts were obtained from black and green tea and found that three tea extracts showed significant antiviral activity against SARS‐CoV‐2, whereby the viral titre decreased about 5 logs TCID₅₀ per ml by 1·375 mg ml⁻¹ black tea extract and two‐fold diluted tea bag infusion obtained from black tea when incubated at 25°C for 10 s. However, when concentrations of black and green tea extracts were equally adjusted to 344 µg ml⁻¹, green tea extracts showed more antiviral activity against SARS‐CoV‐2. This simple and highly respected beverage may be a cheap and widely acceptable means to reduce SARS‐CoV‐2 viral burden in the mouth and upper gastrointestinal and respiratory tracts in developed as well as developing countries.

In vitro antitumor activity of TAS-103 against freshly-isolated human colorectal cancer

DNA topoisomerases (Topo) are enzymes that relieve the secondary twist on the DNA strand in the process of DNA synthesis and transcription; therefore they are unique targeting molecules for the chemotherapy of colorectal cancer. TAS-103 (6-[[2-(dimethylamino)ethyl]amino]-3-hydroxy-7H-in-deno [2,1-c]quinolin-7-one dihydrochloride, MW; 406.31), a novel quinoline derivative, has recently been established as a Topo I and Topo II inhibitor. The aim of the present study was to investigate the antitumor activity of TAS-103 by the MTT assay in human highly-purified and freshly-isolated colorectal cancer cells. To our knowledge, this is the first data concerning the antitumor activity of TAS-103 in highly-purified and isolated human colorectal cancer cells. TAS-103 showed the strongest antitumor activity among the conventional anticancer agents for colorectal cancer (p<0.05). The combination with CDDP augmented the antitumor activity of TAS-103 (p<0.05), indicating that CDDP is one of the most potent candidates to be used in combination with TAS-103. To predict the clinical effect of TAS-103, the expressions of Topo I and Topo II were measured by quantitative PCR. However, a correlation between the expression of Topo and the antitumor activity of TAS-103 was not established. In conclusion, according to this data, TAS-103 may be useful in the chemotherapy of colorectal cancer.

[A checking system for contraindications using a prescription, injection and disease name ordering system and its evaluation]

It is important to administer appropriate agents to inpatients and outpatients with various conditions. In addition to the preparation and guidance for taking drugs, we should always consider the patient's basic information including age, history of allergy, name of disease, and history of examination. In particular, information on contraindications may have serious effects on patients, and must be checked most strictly. However, it is impossible to do routine work after obtaining all information such as the patient's basic information that are serially changing, drug history frequently revised, and a large volume of information on medication. In this study, we developed a prescription surveillance system. This system facilitates real-time checking of the names of diseases that correspond to contraindications as a rule, drug interactions, and administration to elderly patients and pregnant women on attached documents for medicines, utilizing prescription orders, injection orders, and disease name orders. This system facilitates efficient and accurate checking even in the following cases: when a prescription involves another department; when several prescriptions on different prescription dates occur; when a combination of an oral agent and an injection is contraindicated; or when an agent that can not be administered due to the patient's disease is prescribed. Therefore, all pharmacists can detect prescriptions involving agents that are contraindicated regardless of job skill. Pharmacists may contribute to higher quality medical practice.

Dehalogenation of aromatic halides using metallic calcium in ethanol

The scope and limitations of the dehalogenation of aromatic halides 1 and 4a-p using metallic calcium in ethanol at room temperature were revealed. The cleavage of the carbon-chlorine bond on the aromatic ring bearing electron-donating group was difficult compared to the one bearing electron-withdrawing group. Moreover, we applied this method to the dechlorination of polychlorinated biphenyls (PCBs) in transformer oil. It was also found that the dechlorination took place easily under mild conditions. The existence of PCBs residue in the reaction at room temperature was less than 0.04% according to the GC-MS analysis. The chlorine was identified as calcium chloride.

[Efficiency improvement of dispensing of drugs for injection by a total automatic injection dispenser system including infusion fluids and its evaluation]

For the appropriate use of drugs for injection, injection dispensing by pharmacists has been initiated at various institutions. With this movement, automatic injection dispensers have actively been developed. In our hospital, an injection order system was connected with an automatic injection dispenser in November, 1997, and this integrated system has been operating in all wards. However, the efficiency of dispensing work was not satisfactory because there were limitations in the types and volume of drugs placed in the automatic injection dispenser. Therefore, we constructed an automatic injection dispenser system that allows us to use more than 100 ml infusion fluids and also to use drugs stored in a cool place, which could not be used in the conventional system. In the new system, two trays coming from an ampoulevial line and an infusion fluid line are automatically coordinated using a discharge lifter for each patient and transported into an injection cart. After the introduction of this system, the automatic dispenser utilization rate in terms of the number of used injections increased from 52.6% to 73.3%. In addition, since the dispensing time for infusion fluids and drugs stored in a cool place, which had been collected by man power, was reduced, it became possible to pay more attention to checking for prescription.

Delay of the diagnostic lumbar puncture and intrathecal chemotherapy in children with acute lymphoblastic leukemia who undergo routine corticosteroid testing: Tokyo Children's Cancer Study Group study L89-12

PURPOSE

To determine the effects of eliminating initial lumbar punctures in 418 consecutively treated children with acute lymphoblastic leukemia (ALL).

PATIENTS AND METHODS

Patients were enrolled onto a trial conducted in central Japan between 1989 and 1992. Treatment consisted of standard four-drug induction therapy followed by a risk-based intensification phase, reinduction therapy, late intensification, and remission maintenance therapy (total of 104 weeks). The initial lumbar puncture, with an intrathecal injection of chemotherapy, was performed after 1 week of prednisolone sensitivity testing (day 8). End points included response to prednisolone, CNS status at the time of the day 8 lumbar puncture, subsequent adverse events in CNS and bone marrow, and event-free survival (EFS).

RESULTS

The remission induction rate was 93.1% with a 6-year EFS rate (+/- SE) of 68.7% +/- 2.4%, which is similar to historical results for patients who received their diagnostic lumbar puncture and first instillation of intrathecal chemotherapy on day 0. Overall, 84.5% of the patients had good responses to prednisolone, whereas 15.5% had poor responses. Clinical outcome was strikingly better for the good responders (6-year EFS, 74.1% +/- 2.5% compared with 40.1% +/- 6.4% for patients with poor responses), suggesting that omission of intrathecal chemotherapy did not alter the predictive value of drug sensitivity testing. Eighteen patients experienced CNS relapse as their first adverse event (cumulative risk, 5.1%; 95% confidence interval, 2.7% to 7.4%), coincident with reports from groups using conventional strategies of CNS clinical management. Bleeding into the CSF at the time of the day 8 lumbar puncture was apparent in 29 cases (8.1%), but leukemic blasts were identified in only two.

CONCLUSION

Delay of the initial lumbar puncture and intrathecal injection of chemotherapy seems to be feasible in children with ALL. Further controlled evaluations are needed to establish the validity of this conclusion.

Upregulated expression of angiogenesis genes and down regulation of cell cycle genes in human colorectal cancer tissue determined by cDNA macroarray

The differential expression of hundreds of tightly, transcriptionally controlled genes in isolated human colorectal cancer and respective normal mucosa from two patients was analyzed by the cDNA macroarray technique. mRNA prepared from the colorectal cancer tumors was compared with 588 genes spotted onto the filter. Case A showed down-regulation of the expression of cell-cycle-related genes including cyclins, cyclin-dependent kinase (CDK) 2, and CDK-activating kinase, as compared with normal mucosa from the same patient. The tumors showed up-regulation of expression of angiogenesis-related genes such as type II cytoskeletal 8 keratin, metalloproteinase subtypes, VEGF, and bFGF, to over 5-fold the levels in normal mucosa. Thus, colorectal carcinoma tissues are characterized by the upregulation of molecules related with angiogenesis. These results suggest that angiogenesis-related molecules are suitable candidates for target-based therapies for colorectal cancer patients. In case B, the largest difference in expression between the tumor and mucosal tissues was observed in the MMP-1 gene. In contrast to the first case, there was no increase in expression of angiogenesis-related molecules or decrease in expression of cell-cycle-regulatory molecules. The expression profile was quite different between these two patients. This approach may eventually provide a mean of selecting target-based drugs in individual colon cancer patients.

Long-term follow-up of childhood acute lymphoblastic leukemia in Tokyo Children's Cancer Study Group 1981-1995

The objectives were as follows: Firstly, to estimate the overall probability of event-free survival (EFS) and isolated CNS relapse in the studies for children with acute lymphoblastic leukemia (ALL) during the 1980s and 1990s. Secondly, to report the EFS according to presenting features and lineage. Thirdly, to evaluate the treatment results re-classified by the risks of NCI criteria. Four consecutive protocol studies were performed in the Tokyo Children's Cancer Study Group: L81-10 protocol (1981-1984, 189 patients), L84-11 (1984-1989, 484 patents), L89-12 (1989-1992, 418 patients) and L92-13 (1992-1995, 347 patients). Overall EFS at 5 years in each protocol was 56.5 +/- 3.8(1 s.e.)%, 71.0 +/- 2.1%, 67.8 +/- 2.3%, and 63.4 +/- 2.7%, respectively. The cumulative isolated CNS relapse rate at 5 years was 8.1 +/- 2.1%, 3.5 +/- 0.9%, 3.6 +/- 1.0%, 1.0 +/- 0.6. The EFS in SR/HR (standard risk/high risk) according to the NCI criteria in B-precursor ALL at 5 years was 61.9 +/- 4.3%/41.4 +/- 7.4% (lineage was not confirmed.), 72.5 +/- 2.6%/63.4 +/- 5.0%, 77.4 +/- 2.7%/56.3 +/- 4.7%, and 67.8 +/- 3.4%/56.7 +/- 5.4% in each protocol. Also EFSs according to NCI SR/HR at 5 years of T-ALL in protocols L84-11, L89-12 and L92-13 were 55.6 +/- 16.6%/60.9 +/- 10.1%, 72.7 +/- 13.4%/51.6 +/- 9.1%, and 77.1 +/- 14.4%/53.6/10.1%, respectively. The truncation of maintenance therapy to 6 months resulted in a decreased EFS in L92-13, particularly due to an increase of bone marrow relapse after cessation of therapy in SR and HR. The NCI risk criteria work properly even in the patients treated by different intensities, so that it makes the comparison possible among the patients in various groups. The overall EFSs in childhood ALL improved in 1980s, but it seemed stable or decreased in 1990s. The short maintenance therapy resulted in poor outcome in SR on the L92-13 protocol. Many of these late relapsers were effectively rescued and overall survival remained at a high level. The proportion of patients who received cranial irradiation reduced without any increase of the CNS events.

Outcome of clonal hemophagocytic lymphohistiocytosis: analysis of 32 cases

We studied the impact of clonality, determined by analysis of Epstein-Barr virus genome termini, T-cell receptor genes and clonal chromosomal abnormality, on the clinical outcome in 32 patients with hemophagocytic lymphohistiocytosis (HLH). Of the cases studied, 23 cases were EBV-clonal, 15 cases were TCR-clonal and 7 cases were cytogenetically clonal. Thirty patients were treated with immuno-chemotherapy and/or multiagents' chemotherapy and 4 received bone marrow transplantation. All 7 cases, in which cytogenetically abnormal clones were identified, were fatal (3-year survival by Kaplan-Meier analysis; 14%, 95%CI: 0-40%). None of these 7 cases received bone marrow transplantation. On the other hand, the 3-year survival of 23 clonal EBV-positive HLH cases including 4 cytogenetically abnormal cases was 64 % (95%CI: 42-84%), while that of 15 TCR-clonal cases was 53% (95%CI: 26-78%). Our observations suggest that cytogenetically abnormal cases are at extremely high risk, requiring intensive immuno-chemotherapy followed by prompt and timely allogeneic bone marrow transplantation.

Six months of maintenance chemotherapy after intensified treatment for acute lymphoblastic leukemia of childhood

PURPOSE

We postulated that intensification of chemotherapy immediately after remission induction might reduce the leukemic cell burden sufficiently to allow an abbreviated period of antimetabolite therapy.

PATIENTS AND METHODS

Three hundred forty-seven children (ages 1 to 15 years) with previously untreated acute lymphoblastic leukemia (ALL) were enrolled onto the Tokyo L92-13 study, which excluded patients with mature B-cell ALL and patients less than 1 year old. One hundred twenty-four patients were classified as standard risk, 122 as high risk, and 101 as extremely high risk, according to age, peripheral-blood leukocyte count, selected genetic abnormalities, and immunophenotype. All subjects received four drugs for remission induction, followed by a risk-directed multidrug intensification phase and therapy for presymptomatic leukemia in the CNS. Maintenance chemotherapy with oral mercaptopurine and methotrexate was administered for 6 months, with all treatment stopped by 1 year after diagnosis.

RESULTS

The mean (+/- SD) event-free survival (EFS) and overall survival rates for all patients were 59.5% +/- 3.4% and 81.5% +/- 2.2%, respectively, at 5. 5 years after diagnosis. EFS rates by risk category were similar (60. 2% +/- 6.0% for standard risk, 57.7% +/- 5.6% for high risk, and 62. 5% +/- 5.7% for extremely high risk), whereas overall survival rates differed significantly (91.2% +/- 2.7%, 80.0% +/- 4.1%, and 72.1% +/- 4.5%, respectively, P <.0001 by the log-rank test). There were 107 relapses. Eighty-five (79.4%) of these 107 patients achieved second complete remissions, with subsequent EFS rates of 61.5% +/- 7. 9% (standard risk), 42.6% +/- 8.1% (high risk), and 9.6% +/- 6.4% (extremely high risk). Of the five risk factors analyzed, only the response to prednisolone monotherapy among extremely high-risk patients proved important.

CONCLUSION

Early treatment intensification did not compensate for a truncated phase of maintenance chemotherapy in children with standard- or high-risk ALL. However, 6 months of antimetabolite treatment seemed adequate for extremely high-risk patients who were good responders to prednisolone and received intensified chemotherapy that included high-dose cytarabine early in the clinical course.

New ocular movement detector system as a communication tool in ventilator-assisted Werdnig-Hoffmann disease

A non-contact communication system was developed for a ventilator-assisted patient with Werdnig-Hoffmann disease who had lost all voluntary movements except for those of the eye. The system detects the extraocular movements and converts them to either a 'yes' signal (produced by one lateral eyeball movement) or a 'no' signal (produced by two successive lateral eyeball movements) using a video camera placed outside the patient's visual field. The patient is thus able to concentrate on performing a task without any intrusion from the detection system. Once the setting conditions of the device have been selected, there is no need for any resetting, as the patient is unable to move his body. In addition to playing television games, the child can use the device to select television channels, compose music, and learn written Japanese and Chinese characters. This seems to broaden the patient's daily world and promote mental development.

In vitro augmentation of antitumor effect in combination with CPT-11 and CDDP for human colorectal cancer

BACKGROUND AND OBJECTIVES

Irinotecan hydrochloride (CPT-11) is one of the camptothecin analogues that has shown a broad spectrum of strong antitumor effectiveness against various cancers, including colorectal cancer. In order to promote the clinical response of chemotherapy for colorectal cancer using CPT-11, one of the most effective strategies is to use it in combination with other anticancer agents. In the present study, anticancer effects after combining CPT-11 and other antitumor agents were determined by a 3-(4,5-di-methylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay of colorectal cancer cells, especially freshly isolated cancer cells.

METHODS

Freshly isolated cancer cells from 20 patients with colorectal cancer and the established colon cancer cell lines were used in this study. The augmentation of the antitumor effectiveness of 7-ethyl-10-hydroxy-CPT (SN-38) was analyzed in combination with other anticancer agents. Furthermore, the antitumor effectiveness using lower concentrations of anticancer agents was measured to understand the mechanism of the augmentation.

RESULTS

The percent inhibition of SN-38 in combination with cisplatin (CDDP) and mitomycin revealed a high anticancer effect compared with each anticancer agent alone for freshly isolated rectal cancer. CDDP also had a synergistic effect in combination with SN-38 according to the fractional product concept. At lower than plasma peak concentrations of SN-38, the anticancer effects were augmented in combination with lower concentrations of CDDP for freshly isolated colorectal cancer. This augmentation showed a strong synergistic effect.

CONCLUSIONS

These results may be supportive to ongoing clinical studies of chemotherapy by using CPT-11 and CDDP for advanced colorectal cancer.

DNA damage-associated cell cycle and cell death control is differentially modulated by caffeine in clones with p53 mutations

Caffeine is known to potentiate the cytotoxic effects of DNA damaging agents and increases the sensitivity of p53-deficient cells to X-irradiation (X-IR). We have analyzed the cell cycle and cell death control after X-IR in the absence or presence of caffeine in hematological cell lines with various configurations of the p53 gene; EBV-immortalized lymphoblastoid cells with heterozygous p53 mutation (wt/mt), human leukemia cell lines HL60 and KOPM28 with no and mutant p53 expression, respectively. These cell lines display an impaired G0/G1 checkpoint and G2 delay following X-IR, and resistance to apoptosis, which are in accordance with findings previously reported. When irradiated in combination with caffeine, all these cell lines overrode the G2 delay and accumulated at G0/G1. The cell cycle modifications in these cell lines correlated with the increase in radiation-induced p34Cdc2 kinase activity by caffeine. These cell cycle control modifications by caffeine, however, were not associated with enhancement of radiation-induced apoptosis or reduction of clonogenic growth activity in these cell lines. These results suggest that the cytocidal effect of caffeine may need to be verified independently of its cell cycle regulatory activities at least in some cases with p53 mutation.

Increased serum trypsin and elastase-1 levels in patients undergoing L-asparaginase therapy

Although there is abundant literature on the association of L-asparaginase and acute pancreatitis in patients undergoing chemotherapy, few studies have investigated the usefulness of pancreatic enzyme measurement in the early diagnosis of L-asparaginase-induced acute pancreatitis. We measured levels of serum pancreatic enzymes before, during, and after L-asparaginase therapy in nine children with acute lymphocytic leukaemia or non-Hodgkin lymphoma. Serum levels of amylase, pancreatic isoamylase, and lipase did not change between the 1st and 30th day of L-asparaginase administration. However, the serum trypsin and elastase- levels, 10 and 20 days after beginning L-asparaginase therapy, were significantly higher than those prior to therapy.

CONCLUSION

L-asparaginase may induce subclinical pancreatitis and the estimation of serum trypsin and elastase-1 may be useful in the early diagnosis of L-asparaginase-induced acute pancreatitis.

Characterization of leukemic cells in CD2/CD19 double positive acute lymphoblastic leukemia

In the diagnosis of leukemia, CD2 which is a T-cell associated marker and CD19 which is a B-cell associated marker are widely used to determine the lineage of leukemic cells. It is known that the cells of acute lymphoblastic leukemia (ALL) express both CD2 and CD19 in some cases. The origins of these cells are generally thought to be a common precursor for T- and B-lymphocytes. However, cytoplasmic staining of CD3 which is a more specific marker for T-lineage and cytoplasmic staining of mb-1 (CD79a) which is more specific for B-lineage were not performed in previous reports and the determination of the cell lineages of these cells was unclear. We had two cases of ALL whose blasts were CD2/CD19 double positive. The first case was assessed as B-lineage because the cells expressed cytoplasmic CD79a and lacked cytoplasmic CD3. The immunoglobulin (Ig) heavy chain gene was rearranged. The other cell surface markers including CD22 and HLA-DR also suggested that these cells were B-lineage. The CD2 expression may be a coincidence and should not be taken as a T-cell marker in this case. It was difficult to determine the lineage in the second case because both cytoplasmic CD79a and cytoplasmic CD3 were expressed and neither TCR beta chain nor Ig heavy chain genes were rearranged. The other surface markers were not useful to determine the lineage. We concluded that this case was really an unclassified ALL. Accordingly, cytoplasmic staining of CD3 and CD79a should be carried out in the diagnosis of leukemia when it is difficult to determine the cell lineage.

[Severe surgical infection with no information in terms of bacteria]

The incidence of bacteria caused postoperative infections was performed at the timing when bacteria or fungi is not yet detected. This period is important for management of postoperative infections. MRSA, E. faecalis, P. aeruginosa and fungi were detected with high frequency irrespective of the surgical area. After the operation of esophageal cancer, the most frequent infection was postoperative pneumonia, and the isolated bacteria was P. aeruginosa frequently. In the cases of gastric cancer, hepato-biliary-pancreas cancer and colorectal cancer, intraabdominal sepsis was the highest incidence, and the isolated bacteria was E. faecalis. In terms of intravenous catheter infection, fungus was common. Thus, it may suggest that we can identify the bacteria caused, and the management for postoperative infections was performed appropriately by using the antibiotics which have the sensitive against the expected pathogen.

Nodular lymphoid hyperplasia of the terminal ileum: report of a case and the findings of an immunological analysis

The immunological and immunohistochemical characteristics of a patient with nodular lymphoid hyperplasia (NLH) of the terminal ileum were investigated pre- and post-operatively. The patient presented with diarrhea, lower abdominal pain, and weight loss, and an abdominal X-ray following barium enema revealed multiple small nodules in the terminal ileum which were subsequently confirmed to be NLH by histological examination. Preoperatively, although the serum immunoglobulin levels were normal, the T-cell responses in the peripheral blood, including the phytohemagglutinin (PHA)-blastogenesis and the T4/T8 ratio, were impaired. However, following an ileocecal resection, the PHA-blastogenesis became augmented and the T4/T8 ratio recovered to within the normal range. The immunohistochemical findings revealed a more marked accumulation of T cells in the interstitium around the hyperplastic follicles than in the interstitium of the normal intestine.

Clinical evaluation of chemosensitivity testing for patients with colorectal cancer using MTT assay

PURPOSE

Colorectal cancer is one of the tumors most refractory to treatment by chemotherapy. The chemosensitivity test should be performed to individualize the chemotherapy for patients with colorectal cancer, which is less sensitive for anticancer drugs. The present study was designed to determine the chemosensitivity in fresh human colorectal cancer, using highly purified tumor cells, and the correlation of this sensitivity with clinical response.

METHODS

We determined the chemosensitivity for cisplatin, mitomycin C, adriamycin, and 5-fluorouracil in vitro in 93 fresh human colorectal cancers using the MTT assay and performed chemotherapy according to results of the MTT assay.

RESULTS

Inhibition rate of tumor cells for cisplatin was higher than those for other drugs. Fifteen patients who have evaluable lesions received chemotherapy according to results of the MTT assay. Clinical responses were obtained in 5 of 15 patients, and the inhibition rate for cisplatin was higher in responders than in nonresponders.

CONCLUSIONS

It is suggested that the chemotherapy according to results of the MTT assay is effective in patients with colorectal cancer.

Reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision for perianal extramammary Paget's disease. Report of two cases

PURPOSE

Extramammary Paget's disease is a rare dermatosis. Wide local excision is recommended in patients with perianal extramammary Paget's disease. After wide local excision, it is necessary to do reconstruction, with preservation of bowel function. We present here two cases of perianal Paget's disease, in which the patients were treated by reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision.

PATIENTS AND METHODS

A 55-year-old woman and 58-year-old man were admitted with anal pain and bleeding. Histologic examination of the perianal lesion revealed the presence of typical Paget's cells, and no underlying carcinoma and no distant metastasis was detected in either patient. Wide local excision, including the rectal mucosa, was performed, with reference to intraoperative frozen sections. Surgical defect was overlapped with bilateral gluteus maximus myocutaneous rotation flap, and the anus was reconstructed.

RESULTS

Postoperative bowel function and quality of life were well preserved, and flaps healed satisfactorily. Patients have had no recurrence and have been able to return to work.

CONCLUSION

Bilateral gluteus maximus rotation flap may be useful after wide local excision of perianal extramammary Paget's disease without underlying invasive carcinoma.

[Current occurrence and infection control of MRSA enteritis for surgical patients in Japan (first report)]

We investigated the current occurrence and the infection control of MRSA enteritis in the surgical facilities in Japan from July 1990 to June 1992. In this two years, MRSA enteritis was encountered in 831 cases in 144 of 279 facilities (51.6%) which had replied to our survey. Frequency of onset of MRSA enteritis in the surgical specialty was 95% in abdominal surgery and general surgery. Nosocomial infection controls for MRSA infection were done in 92.1% of 261 facilities who replied to our questionnaire. Preventive control in the preoperative and postoperative periods were performed in 23.8%. Various controls for MRSA enteritis were recognized and enforced in 56.7% with restriction of postoperative antibiotics, 65.5% with environmental controls, 70.5% with preventive control for the medical staff and 42.9% with the control for the expansion of nosocomial MRSA infections.

One hundred neuroblastomas detected through a mass screening system in Japan

BACKGROUND

In Japan, a nationwide mass screening (MS) program for preclinical detection of neuroblastoma in infants was done by measuring urinary vanillylmandelic acid and homovanillic acid at the age of 6 months. In this study, clinical, histopathologic, and biologic features of 100 neuroblastomas detected through the Japanese MS are presented.

METHODS

Clinical data of the MS cases were collected and histologic and biologic studies performed on the surgically resected neuroblastomas. Histopathologic evaluation was done including the Shimada classification (all tumors), N-myc oncogene status (58 tumors), and ploidy analysis (31 tumors). The serum ferritin level was measured before surgical intervention in 27 cases.

RESULTS

The primary tumor sites of these cases were adrenal (69), retroperitoneum (21), and mediastinum (10). The tumors were clinical Stage I (31), II (31), III (19), IV (8), and IV-S (9); two children had bilateral primary adrenal tumors. Ninety-three percent (93/100) had favorable histology; 100% (58/58) had nonamplified N-myc oncogene expression; 81% (25/31) showed a favorable ploidy pattern, and 96% (26/27) had normal serum ferritin levels. To date, all children in this series are alive and well, although a total of 13 tumors were associated with one or two poor risk factors; 6 had unfavorable histology (UH), 5 had an unfavorable ploidy (UP) pattern, one had UH and UP, and one had an elevated ferritin level.

CONCLUSIONS

The majority of neuroblastomas detected through the MS showed favorable biologic factors (biologically favorable group). However, there was a small group with histopathologic and/or biologic unfavorable factors. Patients with unfavorable factors apparently benefit most from early surgical intervention.

Extracorporeal shock wave lithotripsy (ESWL) for biliary stones: a nationwide survey in Japan

To assess the current status of extracorporeal shock wave lithotripsy (ESWL) for the treatment of gall-stones in Japan, we conducted a nationwide survey by sending a questionnaire to 251 institutions using this therapy. Replies were obtained from 50 institutions. The use of ESWL was investigated over the period from its introduction up to October 1992. ESWL was performed on 2,760 of 10,058 patients with gallstones (27.4%). The stones were completely pulverized in 1,021 of these 2,760 patients (37.0%). Complete disappearance was limited to single gallstones less than 20 mm in maximum diameter. A comparison in the number of ESWL sessions revealed no significant difference between the patients with and without a good response. Choledocholithiasis was resolved completely in 44.0% of 157 patients who underwent ESWL for this condition and intrahepatic stones were cured in 18.7% of 32 patients. Therefore, ESWL may be a useful form of conservative therapy for biliary calculi.

[c-erbB-2 oncogene product expression in lacrimal gland tumors]

Using a polyclonal antibody to the c-erbB-2 oncogene product (ErbB-2 protein), an immunohistochemical study on the expression of ErbB-2 protein in lacrimal gland tumors was performed. The expression of ErbB-2 protein was observed in 4 (33.3%) of 12 cases of pleomorphic adenoma, but was not in two cases of adenoid cystic carcinoma and one case of normal lacrimal gland. The immunohistochemical reaction was localized in the cell membrane and cytoplasm, and was more intense in the former. There were strongly stained cells in the epithelium of ductal cell lineage and in the solid area, and some of the cells in the myxoid/chondroid areas were weakly stained. The relation ErbB-2 protein with the malignant lacrimal gland tumors in general is not clear, but pleomorphic adenomas of lacrimal gland could have some relation with this protein.

Nucleotide sequence of the rpoN gene and characterization of two downstream open reading frames in Pseudomonas aeruginosa

The rpoN gene of Pseudomonas aeruginosa is required for the expression of a number of diverse genes, ranging from several classes of bacterial adhesins to enzymes for amino acid biosynthesis. The nucleotide sequence of the rpoN gene and its flanking region has been determined. The deduced amino acid sequence of the rpoN product is highly homologous to sequences of RpoN proteins of other microorganisms. Moreover, two open reading frames (ORF1 and ORF2) encoding peptides of 103 and 154 amino acids long, respectively, were found downstream of the rpoN gene. These two ORF products have a high degree of amino acid sequence homology with products of similar ORFs located adjacent to the rpoN genes in other microorganisms. Mutations in either ORF lead to a significant increase in P. aeruginosa generation time when propagated on minimal medium. These mutations had no effect on the expression of pilin or flagellin genes, whose expression depends on RpoN. Complementation analysis showed that the two ORFs are in the same transcriptional unit and the growth defects of the two ORF mutants on minimal medium are due to mutational effects on ORF2. The adverse effect of the ORF mutations on the growth of P. aeruginosa in minimal media can be suppressed by the addition of glutamine but not arginine, glutamate, histidine, or proline. Since rpoN mutants of P. aeruginosa display this same amino acid requirement for growth, the ORF2 product very likely functions as a coinducer of some but not all of the RpoN-controlled genes.

[A study of E2A gene in childhood acute lymphoblastic leukemia]

E2A gene rearrangements and E2A-PBX1 chimeric mRNA produced by t(1;19) were examined in 50 cases with acute lymphoblastic leukemia (ALL). Nine of 10 ALL cases with t(1;19) showed the rearrangement by Southern blotting using the E2A gene probe when digested with Xba I, Bgl II, and Eco RI, and the remaining one having hyperdiploidy which was considered to be a sign of good prognosis, lacked E2A rearrangement. Six of 7 ALL cases with t(1;19) that were tested showed the predicted 164 bps band of E2A-PBX1 chimeric mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR), while a case having t(1;19) without E2A rearrangement and 10 cases lacking t(1;19) did not. Three ALL cases tested did not have E2A-PBX1 mRNA at the time complete remission 4 months after diagnosis. Forty ALL cases lacking t(1;19), including 4 cases with t(11;19), did not reveal rearrangement of E2A. We conclude that t(1;19)-ALL can be molecularly diagnosed, and minimal residual disease could be detected by the RT-PCR method.

[Malignant lymphoma with various neuropsychological symptoms]

A case of malignant lymphoma presented with various neuropsychological symptoms which made it difficult to achieve the diagnosis and therapy. A 9-year-old boy was referred to our hospital with complaints of psychological symptoms, impairment of consciousness and generalized convulsive seizures. A lumbar puncture revealed infiltration of numerous blasts which were positive for immature B cell markers. CT scan showed a mass in the right ethmoidal sinus, but no space occupying lesion in the brain. The tumor cells in the right ethmoidal sinus had the same phenotypes as those in the CSF. Thus a diagnosis of non-Hodgkin's lymphoma, developing in the right ethmoidal sinus and infiltrating into the central nervous system, was established. The blast cells in the liquor and the tumor of the right ethmoidal sinus disappeared after induction of systemic chemotherapy, irradiation and intrathecal chemotherapy. However, intracranial bleeding occurred during the chemotherapy. He died of respiratory failure 10 months after the start of treatment.

Electromagnetic wave emitting products and "Kikoh" potentiate human leukocyte functions

Tourmaline (electric stone, a type of granite stone), common granite stone, ceramic disks, hot spring water and human palmar energy (called "Kikoh" in Japan and China), all which emit electromagnetic radiation in the far infrared region (wavelength 4-14 microns). These materials were thus examined for effects on human leukocyte activity and on lipid peroxidation of unsaturated fatty acids. It was revealed that these materials significantly increased intracellular calcium ion concentration, phagocytosis, and generation of reactive oxygen species in neutrophils, and the blastogenetic response of lymphocytes to mitogens. Chemotactic activity by neutrophils was also enhanced by exposure to tourmaline and the palm of "Kikohshi" i.e., a person who heals professionally by the laying on of hands. Despite the increase in reactive oxygen species generated by neutrophils, lipid peroxidation from unsaturated fatty acid was markedly inhibited by these four materials. The results suggest that materials emitting electromagnetic radiation in the far infrared range, which are widely used in Japan for cosmetic, therapeutic, and preservative purposes, appear capable of potentiating leukocyte functions without promoting oxidative injury.

Carbamazepine-induced thrombocytopenia and leucopenia complicated by Henoch-Schönlein purpura symptoms

A rare case of carbamazepine-induced leucopenia and thrombocytopenia complicated by Henoch-Schönlein purpura (HSP) symptoms is presented. Laboratory findings suggested that leucopenia and thrombocytopenia could be due to bone marrow suppression and HSP symptoms to an allergic reaction to carbamazepine. To the best of our knowledge this is the first report that carbamazepine may cause haematological disorders associated with symptoms of HSP by different mechanisms at the same time in the same patient.

Granulocyte colony-stimulating factor down-regulates the surface expression of the human leucocyte adhesion molecule-1 on human neutrophils in vitro and in vivo

The leucocyte adhesion molecule-1 (LAM-1) is the human homologue of the murine peripheral lymph node homing receptor, MEL-14, and might play a crucial role in neutrophil localization at inflammatory sites. We have reported previously that recombinant human granulocyte colony-stimulating factor (rhG-CSF) stimulates or enhances several neutrophil functions in vivo, as well as in vitro. To further explore the possible role of G-CSF in inflammation we studied the effect of rhG-CSF on the surface expression of LAM-1 on human neutrophils, both in vitro and in vivo. The expression of LAM-1 by human neutrophils was investigated by indirect immunofluorescence using flow cytometry and monoclonal antibodies anti-Leu-8 and TQ1. A whole blood analysis was performed to minimize in vitro manipulation. Most circulating human neutrophils expressed LAM-1 on the cell surface. Brief exposure of neutrophils to rhG-CSF in vitro decreased the surface expression of LAM-1. rhG-CSF down-regulated neutrophil LAM-1 expression in a time- and dose-dependent manner. Neutrophils from healthy volunteers and from patients who were receiving rhG-CSF exhibited a decreased expression of LAM-1 after rhG-CSF administration, and the expression thereafter returned or overshot the pretreatment level after stopping rhG-CSF administration. These findings indicate that rhG-CSF down-regulates the surface expression of LAM-1 on human neutrophils in vivo, as well as in vitro, and G-CSF might participate in neutrophil-endothelial cell interaction in inflamed tissue.

Age-dependent basal level and induction capacity of copper-zinc and manganese superoxide dismutase and other scavenging enzyme activities in leukocytes from young and elderly adults

Several enzymes, including superoxide dismutase (SOD), catalase, glutathione peroxidase, and D-glucose-6-phosphate dehydrogenase are capable of scavenging reactive oxygen species in in vivo. We assessed both basal levels and the capacity of these enzyme activities to be induced in human leukocytes in response to a variety of agents. Basal activity of copper-zinc SOD, and manganese SOD showed little variation with age. In contrast, the basal activity of the three H2O2 scavenging enzymes, catalase, glutathione peroxidase, and D-glucose-6-phosphate dehydrogenase, was significantly higher in younger adults than in elderly individuals. Both manganese SOD and copper, zinc SOD activities were significantly induced by paraquat, interleukin-1, tumor necrosis factor, adriamycin, and bleomycin in lymphocytes and neutrophils from asymptomatic non-aged adults, whereas neither activity was induced in aged individuals. In contrast, glutathione peroxidase activity was significantly induced in both groups of subjects, whereas catalase and D-glucose-6-phosphate dehydrogenase were only slightly induced in either. Enzyme induction with paraquat, adriamycin, or bleomycin was inhibitable by neutralizing antibody to interleukin-1 and tumor necrosis factor, suggesting that the inductions observed with these three drugs are due to the distal mediators, interleukin-1 or tumor necrosis factor released from the cells. Finally, as observed in the regulation of genes in eukaryotes (Storz et al: Bacterial defenses against oxidative stress. Trends Genetics 1990, 6:363-368, ref. 1) O2- and H2O2 seem to differ in the rate of change with age in both basal levels and inducibility under oxygen stress.

Genetic and functional characterization of the gene cluster specifying expression of Pseudomonas aeruginosa pili

The genetic organization of the gene cluster containing pilA, the structural gene for type IV pilin of Pseudomonas aeruginosa, as well as the accessory genes pilB, pilC, and pilD, has been studied. DNA sequences capable of initiating transcription when fused to a promoterless lacZ gene have been identified in the pilA-pilB and pilB-pilC intergenic regions. Unlike pilA, which requires rpoN (encoding the sigma 54 subunit of RNA polymerase) and products of two regulatory genes, pilS and pilR, expression of pilB, pilC, or pilD did not depend on any of these transcriptional regulators. Moreover, transcription of pilA from the tac promoter in an rpoN mutant background resulted in piliated bacteria, suggesting that the RpoN-based regulatory network is specific for pilA and does not control expression of any other genes necessary for formation of pili. Insertion of the omega fragment containing strong transcriptional terminators into pilB, pilC, and pilD failed to have a polar effect on expression of downstream genes, as determined by the ability of each cloned gene to complement, in trans, the corresponding insertionally inactivated chromosomal copy. Insertions into pilC, however, resulted in decreased synthesis of PilD as determined by quantitation of PilD enzymatic activity in processing prepilin in vitro and by immunoassay. This finding suggests that PilD may require PilC for its optimal stability or correct membrane localization.

[Human parvovirus B19 infection in patients with hematologic disorders on chemotherapy]

We described two cases having erythroid hypoplasia and pancytopenia, respectively, caused by human parvovirus B19 (PVB19) infection on chemotherapy. The first patient was a seven-year-old boy with Non-Hodgkin's lymphoma. He has obtained complete remission with LSA2L2 protocol, but, immediately after this remission, he suddenly developed high fever, erythema on cheeks and severe anemia without reticulocytes. We concluded that the cause of anemia and other symptoms were due to PVB19 infection because PVB19 DNA in his serum was detected by dot blot hybridization and polymerase chain reaction, although specific antibodies to PVB19 remained absent. He received gamma-globulin intravenously (200mg/kg/day for 5 days). The fever and erythema were improved promptly, but viremia and anemia lasted a few weeks and the specific antibodies to PVB19 were negative for about two months thereafter. The second patient was a nine-year-old boy with common ALL in remission. Pancytopenia suddenly occurred under maintenance therapy. Because IgM to PVB19 was detected in his serum, the patient was diagnosed to have temporary pancytopenia due to PVB19 infection. In conclusion, it is important to confirm specific antibodies and PVB19 DNA in serum when anemia or pancytopenia of unknown cause occurs in immunocompromised patients receiving chemotherapy.

Skull base reconstruction in cases of intracranial teratoma extending into the extracranial structures

Recently experienced were two cases of postnatally diagnosed intracranial teratoma, one a mature teratoma and the other an immature teratoma, both extending into the extracranial structures. In each case, tumor resection was performed in which a barrier was created between the intracranial and extracranial spaces with a temporalis muscle flap. The technical aspect of skull base reconstruction is described, and previously reported cases of intracranial teratoma involving the skull base are reviewed.

[A case of neuro-Behçet's disease with hemorrhagic brain stem lesion detected by MRI]

A 45-year-old woman complained of fever, arthralgia and left hemiparesis. She had suffered from recurrent oral aphthous ulcers, genital ulcers, uveitis and erythema nodosum. Laboratory examination demonstrated pleocytosis in the cerebrospinal fluid. MRI showed foci of high signal intensity on the T2-weighted images in the right pontine base, surrounded by a rim of low signal intensity suggestive of small hemorrhages. Following steroid therapy, these symptoms diminished and abnormal findings in brain MRI improved. This MRI findings may be due to hemosiderin deposition at recent stage resulting hemorrhages in foci of acute inflammation stage. We would like to emphasize that MRI are useful to evaluate the lesion of neuro-Behçet's disease and some lesions may behave like hemorrhages.

Characteristics and management of patients with fetal neuroblastoma

At 35 weeks 6 days of gestational age, ultrasound evaluation of the fetal abdomen showed a mixed cystic mass in the superior pole of the left kidney. The mass was suspected to be an adrenal hemorrhage or neuroblastoma. The diagnosis was fetal neuroblastoma. Differential diagnosis enabled the fetal neuroblastoma to be distinguished from adrenal hemorrhage. The parameters of diagnosis of fetal neuroblastoma include no specific ultrasonographic pattern, lack of palpability, and no tumor markers. However, certain features do characterize fetal neuroblastoma, such as little metastases, complete resection at operation, and excellent prognosis. In cases of suspected neuroblastoma, a laparotomy performed as soon as possible is generally regarded as the best course of treatment. Nonetheless, biological analyses of the tumor may prove in the future to be necessary for determining whether or not laparotomy is the best treatment.

Recombinant human granulocyte-colony-stimulating factor in the treatment of patients with chronic benign granulocytopenia and congenital agranulocytosis (Kostmann's syndrome)

Seven patients with chronic benign granulocytopenia and nine patients with congenital agranulocytosis, received consecutive seven-day courses of recombinant human granulocyte-colony stimulating factor at a starting dose of 50 micrograms/m2/day, subcutaneously. If there was no response the doses were increased to 300 micrograms/m2. All patients with chronic benign granulocytopenia responded rapidly at the minimum dose within 1-3 days after administration. By contrast, only three of the nine patients with congenital agranulocytosis responded within 1-7 days at this dose. Four patients with congenital agranulocytosis showed a response between days 7-19 at a dose of granulocyte-colony-stimulating factor 100-200 micrograms/m2 but in the remaining two cases no response was obtained. The administration of granulocyte-colony-stimulating factor was shown to be safe and effective also in reducing infectious episodes in these patients. Previously it was reported that granulocyte-colony-stimulating factor 10-30 micrograms/kg/day was effective for patients with congenital agranulocytosis. These results indicate that patients with congenital agranulocytosis may require much higher doses of recombinant human granulocyte-colony-stimulating factor than patients with chronic benign granulocytopenia and that the response to ordinary doses of recombinant human granulocyte-colony-stimulating factor may be useful in differentiating between chronic benign granulocytopenia and congenital agranulocytosis.

[Successful treatment of metastatic and refractory osteosarcoma by ifosfamide, carboplatin and vindesine: case report]

A 13-year-old boy with unresectable pulmonary metastatic osteosarcoma, which was refractory to high dose methotrexate, adriamycin, cisplatin and combination of bleomycin, cyclophosphamide and actinomycin D, was treated by aggressive chemotherapy including the combination of ifosfamide (1 g/m2 x day 1-4), Carboplatin (100 mg/m2 x day 1-4) and Vindesine (4 mg/m2 x day 1). After 5 courses of the treatment, pulmonary metastasis regressed, respiratory symptoms resolved completely, and in this regimen no severe toxicity was observed. Thoracotomy for pulmonary metastatic osteosarcoma is an accepted treatment, but treatment for patients with unresectable disease has not been established. It is suggested that this regimen is relatively safe and very effective for refractory and unresectable osteosarcoma.

[Factors relating to postoperative infections in cancer patients]

Some factors relating to the increasing prevalence of postoperative infections after gastroenterological surgery were investigated from the standpoint of both patients profile and isolated bacteria. Data were collected from 542 cancer patients comprising 39 with esophagus cancer, 229 with gastric cancer, 149 with hepato-biliary tract and pancreatic cancer and 125 with colon cancer. Respiratory infections after operations were most frequently caused by aging, disturbance of glucose tolerance and respiratory dysfunction, whereas with intraabdominal abscess the major factors were disturbance of glucose tolerance, hepatic dysfunction and respiratory dysfunction in this order. Two factors in the management of patients during operation were singled out as mainly contributing to infection: these were prolonged operative time as in the case of esophagus cancer or hepato-biliary tract and pancreatic cancer, and massive intraoperative bleeding as in hepato-biliary tract, pancreatic and gastric cancer. As isolated bacteria, the most frequent clinical isolates were MRSA, Enterococcus, P. aeruginosa and Enterobacter, and it is noteworthy that all of these were strongly resistant to all antimicrobial agents. The greater emphasis on prevention control of postoperative infections, therefore, should be focussed on aging, preoperative risk factors, surgical stress and the kinds of antimicrobial agents administered.

Computer simulation of optimum personnel assignment in hospital pharmacy using a work-sampling method

A computer simulation of the dispensing work performed in a hospital pharmacy was undertaken, based on analysis data from a work-sampling method and utilizing a personal computer. As a result it was found to be possible to estimate the complete work volume of a day based on the number of prescriptions in the day, and hence to predict fairly precisely the number of pharmacists required to complete that work. The method also enables the users to assign the optimum number of staff for dispensing duties according to the estimated number of prescriptions and the optimum waiting time of patients. A correlation has been noted between the total residence time of prescriptions and the mean waiting time of patients. Using this simple and effective technique to efficiently assign personnel makes it possible to cope with an increasing workload and limited number of staff.

Induction of superoxide dismutase in leukocytes by paraquat: correlation with age and possible predictor of longevity

Reactive oxygen species (ROS) are thought to play a role in the aging process as well as in a number of human diseases states. Superoxide dismutase (SOD), an enzyme that scavenges the superoxide anion (O2-) is constitutively expressed in leukocytes and other tissues. When assayed in peripheral blood leukocytes (PBL), constitutive SOD activity shows little variation among individuals of different ages. We have found that significant induction of SOD activity occurs in PBL incubated in vitro with paraquat, an agent known to cause intracellular O2- production. This induction was found to be highly age dependent; lymphocytes from 36 healthy subjects aged 20 to 40 years showed an increase of 85% +/- 10%, versus an increase of only 8% +/- 1% for lymphocytes from 30 healthy subjects aged 65 to 79 years (P less than 10(-4)). Forty subjects, aged 67 to 73 years, who were healthy at the time of assay of leukocyte SOD induction were followed up 5 years later. Nineteen of these subjects had died; all 19 had shown SOD induction of less than 10% (range, 0% to 7%; mean, 2.4%). In contrast, of the 21 survivors (range, 2.5% to 50%; mean, 21%), 12 had shown SOD induction greater than 10%, and 7 had shown SOD induction greater than or equal to 35% (P less than 10(-3)). Thirteen of the 19 deaths were attributable to malignancy or cerebrocardiovascular disease. Preservation of leukocyte SOD inducibility appears to correlate with longevity in elderly individuals and may be of value in predicting resistance to malignancy or fetal cardiovascular events.

Problems of mass screening for neuroblastoma: analysis of false-negative cases

The Japanese mass screening (MS) system for neuroblastoma at 6 months of age has resulted in the earlier diagnosis of the tumor with excellent therapeutic results. However, some problems are involved in the present MS system. We present six false-negative cases, ages ranging from 1 year 11 months to 3 years 11 months. Neuroblastoma cell taken from four of these patients were studied biologically. These patients had advanced disease (one was stage III; five were stage IV). Three of the patients have died and one is terminally ill despite undergoing surgery combined with intensive chemotherapy. Cytogenetic analysis performed in three cases showed that all the cases had diploid chromosome mode associated with 1P-, double minutes (DMs), or marker chromosomes. N-myc oncogene analysis, performed in four cases, showed amplification in two; one patient had diploid chromosomes, but the other was not examined cytogenetically. These findings were strikingly different biologically from those of cases found by MS. The majority of neuroblastomas detected by MS were found to be triploid tumors without N-myc amplification. These findings suggest that the main reason for the false-negative results in the patients we examined is that they were tumor-free or the tumors were so small in size that they were unable to produce urinary vanillylmandelic acid and or homovanillic acid levels high enough to be detected at the time of MS. Therefore, we conclude that MS at 6 months of age is too early to detect neuroblastoma with a diploid chromosome mode and/or amplified N-myc oncogene. We propose that MS at the age of 1 year 6 months would be more effective to pick up these cases, because treatment strategies depend on the different biological characteristics of tumor cells.

The effect of piliation and exoproduct expression on the adherence of Pseudomonas aeruginosa to respiratory epithelial monolayers

The adherence properties of Pseudomonas aeruginosa strains with known pilin DNA sequences were studied. A polar pilus clearly contributed to adherence, as 35S-labeled pilus-positive (Pil+) strains bound significantly more to bovine trachea epithelial monolayers than did pilus-negative (Pil-) mutants (P less than .05) and minimally more than hyperpiliated strains. A pil- mutant PAK/NP, constructed by gene replacement, demonstrated low levels of attachment (3.8% of the inoculum adherent compared with 7% for the wild-type strain PAK), suggesting that other adhesins are functional. The Pil-, flagellum-negative strain PAO1150.1 bound the least (0.3% of the inoculum adherent), confirming the importance of motility in the binding process. The pilin sequences of strains P1 and PA1244 were virtually identical, although P1 bound threefold more than did PA1244. P1 produced 10-fold more proteinase than did PA1244, and a proteinase-negative mutant of P1, isolated by transposon mutagenesis, had binding equivalent to that of PA1244. The adherence of PAO1 was increased 60% in the presence of bacterial supernatants from phosphate-limited cultures and correlated with phospholipase C activity in the supernatant. Thus, the expression of several Pseudomonas genes may be required to promote efficient binding to epithelial surfaces.