TGF-beta 1 stimulates cultured human fibroblasts to proliferate and produce tissue-like fibroplasia: a fibronectin matrix-dependent event

During wound repair, fibroblasts accumulate in the injured area until any defect is filled with stratified layers of cells and matrix. Such fibroplasia also occurs in many fibrotic disorders. Transforming growth factor-beta (TGF-beta), a promotor of granulation tissue in vivo and extracellular matrix production in vitro, is expressed during the active fibroplasia of wound healing and fibroproliferative diseases. Under usual tissue culture conditions, normal fibroblasts grow to confluence and then cease proliferation. In this study, culture conditions with TGF-beta 1 have been delineated that promote human fibroblasts to grow in stratified layers mimicking in vivo fibroplasia. When medium supplemented with serum, ascorbate, proline, and TGF-beta was added thrice weekly to normal human dermal fibroblasts, the cells proliferated and stratified up to 16 cell layers thick within the culture dish, producing a tissue-like fibroplasia. TGF-beta stimulated both DNA synthesis as measured by 3H-thymidine uptake and cell proliferation as measured by a Hoechst dye DNA assay in these postconfluent cultures. The stratification was dependent on fibronectin assembly, as demonstrated by anti-fibronectin antibodies which inhibited both basal and TGF-beta-stimulated cell proliferation and stratification. Suppression of collagen matrix assembly in cell layers with beta-amino-proprionitrile (BAPN) did not inhibit basal or TGF-beta stimulated in vitro fibroplasia. BAPN did not interfere with fibronectin matrix assembly as judged by immunofluorescence microscopy. Thus, in concert with serum factors, TGF-beta stimulates postconfluent, fibronectin matrix-dependent, fibroblast growth creating a fibroplasia-like tissue in vitro.

Accuracy of assessment of the extent of examination by experienced colonoscopists

One hundred colonoscopies were done. The colonoscopist noted whether the cecum had been intubated as well as the markers used to make this determination. With the colonoscope in position at maximum penetration, a radiologist independently determined its position using fluoroscopy, with a contrast agent delivered through the colonoscope. The cecum was entered in 86 of 100 cases. The tip of the colonoscope was at the level of the ileocecal valve in nine additional cases; the colonoscopist judged that the cecum was well seen in five of these nine. In one case, the colonoscopist overestimated the extent of the examination when transillumination in the right lower quadrant was the only confirming marker. When the more reliable markers (ileocecal valve, appendiceal orifice, converging indentations of the taenia coli in the cecal pole) were seen, no errors were made. Experienced colonoscopists are accurate in assessing the extent of colonoscopy and fluoroscopic confirmation is not routinely needed. When reliable markers are not seen during the examination, a barium enema, preferably with air contrast, should be done.

Salmonella newport infections transmitted by fiberoptic colonoscopy

During a 2-week period following the colonoscopy and biopsy of a patient with acute Salmonella newport gastroenteritis, S. newport was recovered from colonic aspirates or fecal specimens of eight of 28 patients from whom specimens were cultured during or after colonoscopy. Two of the eight persons from whom S. newport was isolated developed acute gastroenteritis, two had asymptomatic infections, and four had positive aspirates collected through a colonoscope but did not become infected. Although S. newport was never recovered from the four colonoscopes used during the outbreak, cultures of one of the colonic biopsy forceps grew S. newport. Contamination of the equipment most likely occurred during colonoscopy of the index patient. Inadequate disinfection of the equipment allowed the organism to survive and possibly to cross-contaminate other colonoscopes, and the organism was then transmitted to other patients by use of the contaminated colonoscopes or the contaminated biopsy forceps. Implemented control measures terminated the outbreak.