CT evidence of a diverticular abscess has a prognostic impact as it correlates with a high risk of failure from nonoperative management regardless of the patient's age. After treatment of diverticulitis with CT evidence of an abscess, physicians should strongly consider elective surgery in order to prevent recurrent diverticulitis.

No abstract

BackgroundPreterm birth is an enormous public health problem, affecting over 12% of live births and costing over $26 billion in the United States alone. The causes are complex, but twin studies support the role of genetics in determining gestation length. Despite widespread use of the mouse in studies of the genetics of preterm birth, there have been few studies that actually address the precise natural gestation length of the mouse, and to what degree the timing of labor and birth is genetically determined.Methodology/Principal FindingsTo further develop the mouse as a genetic model of preterm birth, we developed a high-throughput monitoring system and measured the gestation length in 15 inbred strains. Our results show an unexpectedly wide variation in overall gestation length between strains that approaches two full days, while intra-strain variation is quite low. Although litter size shows a strong inverse correlation with gestation length, genetic difference alone accounts for a significant portion of the variation. In addition, ovarian transplant experiments support a primary role of maternal genetics in the determination of gestation length. Preliminary analysis of gestation length in the C57BL/6J-Chr#A/J/NaJ chromosome substitution strain (B.A CSS) panel suggests complex genetic control of gestation length.Conclusions/SignificanceTogether, these data support the role of genetics in regulating gestation length and present the mouse as an important tool for the discovery of genes governing preterm birth.

This is the largest single institution series of retained colorectal foreign bodies. Although foreign objects located in the sigmoid colon can be retrieved at the bedside, these cases are more likely to require operative intervention.

The need for cellular markers that permit a quick and accurate evaluation of a protein's subcellular localization has increased with the surge of new data generated by the Drosophila genome project. In this report, we present three ubiquitously expressed Drosophila transgenes that expressed a green fluorescent protein variant (enhanced yellow fluorescent protein) that has been targeted to different intracellular membrane targets: the Golgi apparatus, mitochondria, and endoplasmic reticulum. These markers serve as an internal standard for characterizing a protein's subcellular localization or as a means of tracking the dynamics of intracellular organelles during normal or abnormal cellular or developmental processes. We have also examined fixation artifacts using these constructs to illustrate the effects that fixation and permeabilization have on intracellular membrane organization.

Fifty-two patients with severe Crohn's disease were enrolled in this study. Six (11.5%) were intolerant of the medication and had to be excluded. The remaining 46 patients were treated with rifabutin in combination with a macrolide antibiotic (clarithromycin or azithromycin). Patients were treated for a mean of 18.7 (range 6-35) months and followed up for 25.1 (range 7-41) months. Of the 19 patients who were steroid dependent at the start of this study, only two continued to require steroids when treatment was established. A reduction in the Harvey-Bradshaw Crohn's disease activity index occurred after 6 months' treatment (P = 0.004, paired Wilcoxon test) and was maintained at 24 months (P < 0.001). An improvement in inflammatory parameters was observed as measured by a reduction in erythrocyte sedimentation rate (P = 0.009) and C-reactive protein (P = 0.03) at 18 months compared with pretreatment levels, and an increase in serum albumin at 12 months (P = 0.04). When subsets of the study population were analysed, patients with pan-intestinal disease achieved better remission at 2 years than did those with less extensive involvement (P = 0.04, Mann-Whitney U-test). No difference in treatment response by age, disease duration, the presence of granulomas on histology, or the occurrence of drug-induced side-effects, was observed. These data suggest that treatment with rifabutin and clarithromycin or azithromycin may result in a substantial clinical improvement in Crohn's disease and justify the conduct of a randomized controlled trial.

SUMMARYOral administration of antigen induces a state of tolerance that is associated with activation of CD8 T cells that can transfer unresponsiveness to naõ Ève syngeneic hosts. These T cells are not lytic, but they inhibit development of antibody, CD4T helper cell, and CD8 cytotoxic T lymphocyte (CTL) responses upon adoptive transfer into naõ Ève, syngeneic mice. In addition, we have shown that depletion of gd T cells by injection of the anti-d chain antibody (GL3) down modulates the expression of gd T-cell receptor (TCR) and inhibits the induction of oral tolerance to ovalbumin. Oral administration of antigen also fails to induce tolerance in TCR d-chain knockout mice suggesting that gd T cells play a critical, active role in tolerance induced by orally administered antigen. To further study the contribution of gd T cells to tolerance, murine gd T cells were isolated from intraepithelial lymphocytes (IEL) of the small intestine by stimulation with splenic ®ller cells, concanavalin A and growth factors. gd IEL lines demonstrated lytic activity in a redirected lysis assay. gd T-cell clones express different gd TCR genes and secrete large amounts of interleukin (IL)-10, but little or no IL-2, IL-4, or interferong. gd IEL clones expressed transforming growth factor-b1 and macrophage migration inhibitory factor, as well as IL-10, mRNA. Moreover, gd T-cell clones potently inhibited the generation of CTL responses by secreted molecules rather than by direct cell-to-cell contact.

No abstract