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We describe a field investigation in New England that identified the emergence and epidemiology of new strains of multidrug-resistant Salmonella, Newport-MDRAmpC, and summarize the Center for Disease Control and Prevention's surveillance data for these infections. In Massachusetts, the prevalence of Newport-MDRAmpC among Salmonella serotype Newport isolates obtained from humans increased from 0% (0/14) in 1998 to 53% (32/60) in 2001 (P<.001). In a retrospective case-control study, infection with Newport-MDRAmpC was domestically acquired and was associated with exposure to a dairy farm. Isolates from both humans and cattle had indistinguishable or closely related antibiograms and pulsed-field gel electrophoresis patterns. Nationally, the prevalence of ceftriaxone-resistant Salmonella increased from 0.5% in 1998 to 2.4% in 2001; 85% of the isolates in 2001 were Newport-MDRAmpC, and at least 27 states have isolated these strains from humans, cattle, or ground beef. These data document the widespread emergence of Newport-MDRAmpC strains in the United States and show that the 5-fold increase in the prevalence of Salmonella resistant to expanded-spectrum cephalosporins, between 1998 and 2001, is primarily due to the emergence of Newport-MDRAmpC strains. Copyright © 2003 The University of Chicago [ABSTRACT FROM AUTHOR]

Objective: To study the influence of a regional collaboration in epithelial ovarian cancer care on staging procedures, debulking results, and survival., Methods: In an effort to optimize epithelial ovarian cancer treatment, a regional collaboration was introduced in the Netherlands in 2000. Gynecologic oncologists from the university center conducted surgery in community hospitals when ovarian cancer was considered based on the risk of malignancy index or clinical suspicion. The National Cancer Registry registered 1,554 patients with epithelial ovarian cancer diagnosed in 11 participating Dutch hospitals between 1996 and 2010. Surgical procedures were compared during three periods (1996-1999, 2000-2004, and 2005-2009). Log-rank tests compared Kaplan-Meier survival curves of progression-free and overall survival before (1996-2000) and during the start of the collaboration (2001-2005)., Results: Staging was adequate for 139 patients (23.0%) before collaboration, and this proportion increased during the study periods to 32.1% and 62.1% (P<.01), when gynecologic oncologists more often staged cancer in patients (36.7% compared with 54.7% and 80.6%; P<.01). For 1,197 patients with advanced stage disease (stage IIb or greater), the proportion of debulking procedures with an optimal (residual volume less than1 cm) as well as a complete result (no residuals) increased during the 14-year study period from 57.4% to 76.5% (P<.01) and from 24.1% to 43.4% (P<.01), respectively. Survival rates were similar before and during the start of the collaboration. In multivariable analysis, the treatment variables completeness of debulking, chemotherapy, and gynecologic oncologist attendance were independent prognostic factors for overall survival, as were age, stage, and tumor grade., Conclusions: After regional collaboration, gynecologic oncologists attended more surgeries and surgical outcomes improved, but progress in survival could not be demonstrated. Regional collaboration improved care for ovarian cancer patients., Level of Evidence: II.

To elucidate the physiology of active sodium transport (expressed as erythrocytic ouabian-sensitive sodium efflux rate constant = ERCos) in pregnancy and the influence of dietary sodium intake on that transport, active sodium transport was measured in 52 healthy pregnant women in week 16, 20, 24, 28, 32, 36 or week 38 of gestation. ERCos was not influenced by parity, dietary sodium intake or the development of pregnancy-induced hypertension. A statistical significant shift in ERCos was detected between week 24 and week 28 of gestation accompanied by a shift in intracellular sodium content. The meaning of this change in pregnancy remains unsolved, but an influence of ANP through A-II is suggested.

To clarify the effects on angiotensin II and blood pressure on plasma atrial natriuretic peptide in pregnancy, angiotensin II was infused in 37 healthy, normotensive pregnant women in week 32 of gestation. Levels of atrial natriuretic peptide were determined with the women in a sitting position 3 days before the test and in the left lateral recumbent position immediately before and after the test. Levels of atrial natriuretic peptide were not influenced by parity or salt intake. They were found to be significantly higher in the left lateral recumbent position than in the sitting position. There was also a significant increase in atrial natriuretic peptide levels during angiotensin II infusion. A dose of angiotensin II less than 1.5 ng/kg/min did not affect atrial natriuretic peptide levels. Rise in atrial natriuretic peptide levels was minimally correlated with rise in mean arterial pressure, as caused by acute vasoconstriction from angiotensin II infusion. Therefore it is suggested that, in pregnancy, the response of atrial natriuretic peptide to angiotensin II is mediated not only by changes in blood pressure but also by angiotensinergic receptor activity in the atria.