Interleukin-8 gene expression and apoptosis induced by Salmonella Typhimurium in the presence of Bacillus probiotics in the epithelial cell.

AIMS: This study aimed to evaluate the effects of three Bacillus probiotics on Salmonella Typhimurium, and interleukin-8 (IL-8) gene expression in the co-culture of the Bacillus and the pathogen in vitro. METHODS AND RESULTS: Bacillus subtilis, Bacillus indicus and Bacillus coagulans were initially turned to spore and heat-inactivated forms. The cellular damages of the probiotics on the HT-29 cells were investigated individually and in combination with S. Typhimurium using 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and fluorescence assays. To extract cell free supernatants (CFS) of the probiotics, they were cultured in selective media. The inhibitory activity of CFSs were then assayed against the pathogen. The gene expression of IL-8 of the HT-29 cells was evaluated by real-time PCR in all the groups. The results showed that the CFSs of three probiotics could inhibit the growth of S. Typhimurium by more than 50%. Inhibitory effects of B. indicus and B. subtilis CFSs were related to the production of pepsin-sensitive compounds, except B. coagulans in which the high inhibitory effect was due to organic acids. The spores of the three probiotics and the heat-inactivated forms of B. subtilis and B. coagulans could reduce the cytotoxicity of S. Typhimurium. The cell viability also increased applying both forms probiotics against the pathogen. In all co-culture groups, the IL-8 gene expression induced by S. Typhimurium was reduced. CONCLUSIONS: The three Bacillus probiotics can be considered as proper candidates for the prevention and treatment of S. Typhimurium food poisoning. SIGNIFICANCE AND IMPACT OF THE STUDY: Applying probiotics as live bacteria is universally noted in foods. This study tried to discover the effects of Bacillus probiotics in the form of spore or even heat-killed bacteria against S. Typhimurium and evaluate ratio of IL-8 gene expression in cell culture. The most effective Bacillus probiotic will be recommended. This approach will help to use probiotics as nonvegetative cells in foods to fight gastrointestinal pathogens.

Medullary thyroid cancer is associated with high serum vitamin D level and polymorphism of vitamin D receptors.

BACKGROUND: Thyroid cancer is the most common endocrine malignancy. Studies have observed an anti-cancer effect for vitamin D and found that polymorphisms of vitamin D receptors can influence the prevalence of various cancers. The present study investigated the serum level of vitamin D and FokI, BsmI and Tru9I polymorphisms of vitamin D receptors. METHODS: Forty patients with medullary thyroid cancer and 40 healthy controls were investigated. The genomic DNA of the subjects was extracted using saturated salt/proteinase K and investigated by PCR sequencing. Serum levels of vitamin D were evaluated by ELISA. The results were analyzed in SPSS and GraphPad Prism 5 software. RESULTS: The genotypic and allelic frequencies of FokI and BsmI polymorphisms showed no significant differences between test and control groups. For Tru9I polymorphism, Tt genotype and t allelic frequency in the test group were significantly different from those of the control group. Also, we found Tt genotype and t allelic frequency to be significantly associated with medullary thyroid cancer (MTC) type and the agressiveness of the disease. The average serum vitamin D level was 23.32 ng/mL and 18.95 ng/mL for patients and controls, respectively, and the difference between the two groups was statistically significant. Moreover, we found high serum vitamin D level to be associated with t allelic frequency. CONCLUSIONS: Unexpectedly, the mean serum vitamin D level of the test group was significantly higher than that of the control group. Tru9I polymorphism was found to be significantly correlated with the prevalence of medullary thyroid carcinoma.

CO2 utilization: Turning greenhouse gas into fuels and valuable products.

This study critically reviews the recent developments and future opportunities pertinent to the conversion of CO2 as a potent greenhouse gas (GHG) to fuels and valuable products. CO2 emissions have reached an alarming level of around 410 ppm and have become the primary driver of global warming and climate change leading to devastating events such as droughts, hurricanes, torrential rains, floods, tornados and wildfires across the world. These events are responsible for thousands of deaths and have adversely affected the economic development of many countries, loss of billions of dollars, across the globe. One of the promising choices to tackle this issue is carbon sequestration by pre- and post-combustion processes and oxyfuel combustion. The captured CO2 can be converted into fuels and valuable products, including methanol, dimethyl ether (DME), and methane (CH4). The efficient use of the sequestered CO2 for the desalinization might be critical in overcoming water scarcity and energy issues in developing countries. Using the sequestered CO2 to produce algae in combination with wastewater, and producing biofuels is among the promising strategies. Many methods, like direct combustion, fermentation, transesterification, pyrolysis, anaerobic digestion (AD), and gasification, can be used for the conversion of algae into biofuel. Direct air capturing (DAC) is another productive technique for absorbing CO2 from the atmosphere and converting it into various useful energy resources like CH4. These methods can effectively tackle the issues of climate change, water security, and energy crises. However, future research is required to make these conversion methods cost-effective and commercially applicable.

Profiling of how nociceptor neurons detect danger - new and old foes.

The host evolves redundant mechanisms to preserve physiological processing and homeostasis. These functions range from sensing internal and external threats, creating a memory of the insult and generating reflexes, which aim to resolve inflammation. Impairment in such functioning leads to chronic inflammatory diseases. By interacting through a common language of ligands and receptors, the immune and sensory nervous systems work in concert to accomplish such protective functions. Whilst this bidirectional communication helps to protect from danger, it can contribute to disease pathophysiology. Thus, the somatosensory nervous system is anatomically positioned within primary and secondary lymphoid tissues and mucosa to modulate immunity directly. Upstream of this interplay, neurons detect danger, which prompts the release of neuropeptides initiating (i) defensive reflexes (ranging from withdrawal response to coughing) and (ii) chemotaxis, adhesion and local infiltration of immune cells. The resulting outcome of such neuro-immune interplay is still ill-defined, but consensual findings start to emerge and support neuropeptides not only as blockers of TH 1-mediated immunity but also as drivers of TH 2 immune responses. However, the modalities detected by nociceptors revealed broader than mechanical pressure and temperature sensing and include signals as various as cytokines and pathogens to immunoglobulins and even microRNAs. Along these lines, we aggregated various dorsal root ganglion sensory neuron expression profiling datasets supporting such wide-ranging sensing capabilities to help identifying new danger detection modalities of these cells. Thus, revealing unexpected aspects of nociceptor neuron biology might prompt the identification of novel drivers of immunity, means to resolve inflammation and strategies to safeguard homeostasis.

Dietary intake and lifestyle behaviour in different phenotypes of polycystic ovarian syndrome: a case-control study.

BACKGROUND: The present study aimed to compare dietary intake and lifestyle behaviour in women with polycystic ovarian syndrome (PCOS) and healthy women. METHODS: One hundred and sixty healthy women (partner with male infertility) were recruited to a control group; 168 women with PCOS (diagnosed on ultrasound) were recruited to a case study group for this cross-sectional comparative study. The case group was classified into three phenotypes based on the presence or absence of menstrual disorder (M), hyperandrogenism (HA) and polycystic ovary according to sonography (PCO): HA+PCO (n = 53), PCO+M (n = 57) and M+HA+PCO (n = 66). Dietary intake and lifestyle behaviour were measured using a food frequency questionnaire and a lifestyle questionnaire. RESULTS: The mean energy (P < 0.001) and fat (P < 0.001) intakes were greater in PCOS groups compared to the control group. The average energy and fat intakes were greater in HA+M+PCO group after age and body mass index (BMI) adjustment compared to the other phenotypes (P < 0.001). In comparison with the control group, lifestyle scores were lower in the PCOS group in the fields of physical activity, weight and nutrition control after age and BMI adjustment (P < 0.001). The average score of lifestyle in the fields of physical activity, weight and nutrition control, and psychological health was lower in the phenotype HA+M+PCO compared to the other phenotypes (P < 0.001). CONCLUSIONS: A limited energy and fat intake is strongly recommended in Iranian women with PCOS, especially for phenotype HA+M+PCO. Consultation with respect to improvement of psychological health and the importance of weight and nutrition control, as well as appropriate physical activity, is advocated, especially in patients with phenotype HA+M+PCO.

Production of MPT-64 recombinant protein from virulent strain of Mycobacterium bovis.

Tuberculosis (TB) is a zoonotic infectious disease common to humans and animals which has been caused by a rod shaped, acid fast bacterium, called Mycobacterium bovis. The rapid and sensitive detection is a great challenge for TB diagnosis. The virulent strains of Mycobacterium tuberculosis complex (MTBC) have 16 different regions of difference (RD) in their genome which encode some important antigens. The major protein of M. bovis 64 (MPT-64) is one of the main immune-stimulating antigens which are encode by RD-2 region. The aim of the present study was cloning, expression and purification of MPT-64 as a protein antigen of M. bovis in a prokaryotic system for the usage in the future diagnostic studies. In this experimental study, the mpt-64 gene with 687 bp has been proliferated from M. bovis whole genome by polymerase chain reaction (PCR) method. The PCR product has been digested by BamHI and HindIII restriction enzymes and cloned into pQE-30 plasmid. The recombinant protein has been expressed in the Escherichia coli M15 with induction by isopropyl-ß-D-thiogalactopyranoside (IPTG). The expressed protein was analyzed on SDS-PAGE, and purified with Nitrilotriacetic acid (Ni-NTA) column. Finally, its biological properties were confirmed in Western blotting method using specific antibodies. Data showed the successful cloning of mpt-64 gene (as a 687 bp segment) in expression vector. The MPT-64 recombinant protein was ideally expressed and purified as a 24 kDa protein. The result of this study indicated that MPT-64 recombinant protein (24 kDa) has been successfully expressed and purified in a prokaryotic system, so this protein could be used for differential diagnosis of pathogenic and non-pathogenic Mycobacterium, in suspected BTB cases.

Vaccination with human amniotic epithelial cells confer effective protection in a murine model of Colon adenocarcinoma.

As a prophylactic cancer vaccine, human amniotic membrane epithelial cells (hAECs) conferred effective protection in a murine model of colon cancer. The immunized mice mounted strong cross-protective CTL and antibody responses. Tumor burden was significantly reduced in tumor-bearing mice after immunization with hAECs. Placental cancer immunotherapy could be a promising approach for primary prevention of cancer. In spite of being the star of therapeutic strategies for cancer treatment, the results of immunotherapeutic approaches are still far from expectations. In this regard, primary prevention of cancer using prophylactic cancer vaccines has gained considerable attention. The immunologic similarities between cancer development and placentation have helped researchers to unravel molecular mechanisms responsible for carcinogenesis and to take advantage of stem cells from reproductive organs to elicit robust anti-cancer immune responses. Here, we showed that vaccination of mice with human amniotic membrane epithelial cells (hAECs) conferred effective protection against colon cancer and led to expansion of systemic and splenic cytotoxic T cell population and induction of cross-protective cytotoxic responses against tumor cells. Vaccinated mice mounted tumor-specific Th1 responses and produced cross-reactive antibodies against cell surface markers of cancer cells. Tumor burden was also significantly reduced in tumor-bearing mice immunized with hAECs. Our findings pave the way for potential future application of hAECs as an effective prophylactic cancer vaccine.

Mycobacterium avium subsp. paratuberculosis induces differential cytosine methylation at miR-21 transcription start site region.

Mycobacterium avium subspecies paratuberculosis (MAP), as an obligate intracellular bacterium, causes paratuberculosis (Johne's disease) in ruminants. Plus, MAP has consistently been isolated from Crohn's disease (CD) lesions in humans; a notion implying possible direct causative effect for MAP in CD development. Infections caused by MAP are refractory to treatment and in many cases the treatment does not easily resolve the infection. Studying the molecular mechanisms of host-pathogen interaction is helpful in identifying possible drug targets. In this line, it has already been shown that in macrophages infected with various bacteria, including mycobacteria, micro RNA 21 (miR-21) is upregulated, a change that results in diminished macrophages clearance ability and favours pathogens survival within the cells. However, the molecular mechanism(s) by which the intracellular bacteria induce miR-21 expression is not known. In order to verify possible effects from epigenetic changes induced by intracellular bacteria, we studied the cytosine methylation changes at the transcription start regions of miR-21 in THP-1 macrophages infected with MAP. For this purpose, genomic DNA was extracted from infected cells and the methylation status at the region of interest was evaluated by bisulfite conversion method. Our work showed that MAP directs de-methylation of the cystosines at CpG di-nucleotides in this region, while non-CpG cytosines of this region did not show significant changes. Interestingly, the CpG cytosines that were differentially methylated in the infected macrophages occur at the binding sites of the transcription factors already known to regulate miR-21 expression.

Occurrence of Arcobacter in Iranian poultry and slaughterhouse samples implicates contamination by processing equipment and procedures.

1. The occurrence of Arcobacter spp. and three pathogenic species of Arcobacter from Iranian poultry carcasses was investigated at different steps of broiler processing to determine critical control points for reducing carcass contamination. 2. Samples were collected from (a) cloaca immediately before processing, (b) different points during processing and (c) at different stations in a processing plant of a slaughterhouse in southern Iran. 3. After enrichment steps in Arcobacter selective broth, DNA of the samples was extracted and three significant pathogen species of Arcobacter were identified based on polymerase chain reaction (PCR) detection of 16S rRNA and specific species PCR. 4. Out of a total of 540 samples, 244 (45%) were positive for Arcobacter spp. Arcobacter butzleri was more frequently detected (73% ± 13.9%) than A. cryaeophilus (9% ± 13.9%) and A. skirrowii (4.1%). In addition, co-colonisation (A. butzleri and A. cryaerophilus) occurred in 13.9% of the positive samples. 5. The results indicate a high prevalence of Arcobacter in the investigated slaughterhouse and broiler carcasses and that Arcobacter is not a normal flora of the broilers. Evidence for the presence of Arcobacter in the environment and water of processing plants suggests that these are sources of contamination of poultry carcasses. In addition, contamination of the poultry carcasses can spread between poultry meats in different parts and processes of the slaughterhouse (pre-scalding to after evisceration).

Characterization of hemolysins of Staphylococcus strains isolated from human and bovine, southern Iran.

The staphylococci are important pathogenic bacteria causing various infections in animals and human. Hemolysin is one of the virulence factors of coagulase-positive (CPS) and coagulase-negative staphylococci (CNS). The aims of the study were to characterize hemolysins of Staphylococcus spp. isolated from human and bovine origin, phenotypic- and genotypically. Characterization of hemolysin phenotypically based on hemolysis pattern of Staphylococcus spp. was done on the sheep, horse and rabbit blood agar plates. Genes encoding hemolysin were amplified with specific primers by using polymerase chain reaction (PCR) technique. Hemolytic activities phenotypically were determined in 60 and 90% of the total bovine and human isolates, respectively. All non hemolytic isolates were CNS (P≤0.05). In all isolates, hla and hld genes were determined by PCR amplification. None of the bovine and human isolates showed phenotypically and genotypically gamma hemolysin. The results from this study suggest that, in accordance with what is generally believed, some differences are apparent in hemolysin types among Staphylococcus strains of bovine and human origin. Furthermore, this study showed that CNS can be important as new pathogens.

Low-temperature self-assembled vertically aligned carbon nanofibers as counter-electrode material for dye-sensitized solar cells.

Low-temperature AC-DC PECVD is employed for direct growth of vertically aligned carbon nanofibers (VACNFs) on ordinary transparent conductive glass as counter-electrode material for dye-sensitized solar cells (DSSCs). To the best of our knowledge, this is the first report on utilization of VACNFs grown directly on ordinary FTO-coated glass as a cost-effective catalyst material in DSSCs. According to the FESEM images, the as-grown arrays are well aligned and dense, and offer uniform coverage on the surface of the substrate. In-plane and out-of-plane conductivity measurements reveal their good electrical conductivity, and Raman spectroscopy suggests a high number of electrocatalytic active sites, favoring charge transport at the electrolyte/electrode interface. Hybrid VACNF/Pt electrodes are also fabricated for performance comparison with Pt and VACNF electrodes. X-ray diffraction results verify the crystallization of Pt in hybrid electrodes and further confirm the vertical alignment of carbon nanofibers. Electrochemical characterization indicates that VACNFs provide both high catalytic and good charge transfer capability, which can be attributed to their high surface area, defect-rich and one-dimensional structure, vertical alignment and low contact resistance. As a result, VACNF cells can achieve a comparable performance (~5.6%) to that of the reference Pt cells (~6.5%). Moreover, by combination of the excellent charge transport and catalytic ability of VACNFs and the high conductivity of Pt nanoparticles, hybrid VACNF/Pt cells can deliver a performance superior to that of the Pt cells (~7.2%), despite having a much smaller amount of Pt loading, which raises hopes for low-cost large-scale production of DSSCs in the future.

Effects of leached components from silorane and methacrylate-based dental composites on the male mice reproductive system.

BACKGROUND: This study aimed to investigate the potential toxic effects of leached components from either a methacrylate-based composite (Filtek Z250) or a silorane-based composite (Filtek P90) on the male mice reproductive system. METHODS: Sixty adult Syrian male mice were divided into six groups. In test groups, leached components from composite specimens in artificial saliva or 75% aqueous ethanol solution were administered intragastrically daily for 28 days. The mice were then euthanized and the following reproductive parameters recorded: body weight changes; weight of paired testes; testis volume; Gonadosomatic Index (GSI); sperm motility; sperm viability; daily sperm production and epididymal sperm count. RESULTS: There were no significant differences in body weight changes, weight of paired testes, GSI, testis volume, epididymal sperm count, and daily sperm production between groups. Sperm motility and sperm viability were significantly lower in all the test groups in comparison to the control groups. In addition, they were significantly lower in the test groups in which composite samples were immersed in aqueous ethanol solution. CONCLUSIONS: Within the limitations of this study, the present data indicate that leached components from dental composites could affect sperm quality and therefore could potentially cause adverse effects on the male mice reproductive system.

Effect of Dietary Cation-Anion Difference during Prepartum and Postpartum Periods on Performance, Blood and Urine Minerals Status of Holstein Dairy Cow.

Twenty four periparturient cows were used to determine the effects of DCAD on acid-base balance, plasma and urine mineral concentrations, health status, and subsequent lactation performance. Each group of 12 cows received either a diet containing -100 DCAD or +100 DCAD for 21 d prepartum. Both anionic and cationic groups were divided into two groups, one received a +200 DCAD and the other +400 DCAD diet for 60 d postpartum. Prepartum reduction of DCAD decreased DMI, urinary and blood pH, urinary concentrations of Na or K and increased plasma and urinary Ca, Mg, Cl and S. Also cows fed -100 DCAD diet consumed the most dry matter in the first 60 d after calving. Postpartum +400 DCAD increased milk fat and total solid percentages, urinary and blood pH and urinary Na and K concentrations, but urinary Ca, P, Cl and S contents decreased. Greater DMI, FCM yields were observed in cows fed a diet of +400 DCAD than +200 DCAD. No case of milk fever occurred for any diets but feeding with a negative DCAD diet reduced placenta expulsion time. In conclusion, feeding negative DCAD in late gestation period and high DCAD in early lactation improves performance and productivity of dairy cows.

Evaluation of Bis-GMA/TEGDMA monomers leaching from a hybrid dental composite resin.

AIM: Postcuring elution of unreacted monomers has harmful effects on mechanical characteristics and biocompatibility of resin composite restorations. The purpose of this study was to evaluate the amount of eluted Bis-GMA and TEGDMA monomers from a hybrid dental composite cured with LED or halogen curing unit after immersing in saliva or water. METHODS: Thirty-six composite disc specimens (Hybrid Filtek Z250,3M-ESPE, USA) were made and divided in four groups. After polymerization with LED or halogen curing units, samples were immersed in water or saliva for 24 hours. The amounts of each monomer (Bis-GMA and TEGDMA) released in different mediums were detected by high-performance liquid chromatography (HPLC). Data were analyzed with two-way ANOVA and one-way ANOVA tests. RESULTS: The samples were immersed in water, in both curing methods, released significantly more Bis-GMA than TEGDMA (P<0.05). The total monomers eluted was higher in samples cured with halogen curing unit than LED (P=0.001); in addition, saliva caused elution of more monomer than water (P=0.007). CONCLUSION: In conclusion, chemical property of monomers, power of curing light unit and the type of immersion media play key roles in the quantity of eluted monomers from composite resins. Saliva and halogen curing unit can cause greater monomer leaching from hybrid resins composite.

An evaluation of beta-hydroxybutyrate in milk and blood for prediction of subclinical ketosis in dairy cows.

The first objective of this study was to investigate the relationship between concentrations of beta-hydroxybutyrate (BHBA) in milk and blood to assess the reliability of the BHBA concentrations in milk measured by a semi quantitative keto-test paper to detect subclinical ketosis (SCK) in 50 fresh high-producing Iranian Holstein cows in Golestan Province, Iran. The second objective was the effects of SCK on milk yield and components. Concentrations of nonesterified fatty acids (NEFA) and BHBA were analyzed quantitatively in blood plasma and commercial keto-test paper was used for semi quantitative determination of BHBA concentration in milk. Milk yield was measured until 60 d after calving but milk compositions were measured until 30 d after calving. The mean plasma BHBA, milk BHBA, plasma NEFA, milk yield, milk fat percentage and milk fat: protein ratio were 1,234 micromol/L, 145 micromol/L, 0.482 mEq/L, 29.5 kg, 3.9% and 1.4, respectively. Fifty eight percent of the cows had SCK during the first month of lactation. High correlation coefficients were observed between blood BHBA and blood NEFA, and between blood and milk BHBA. The milk yield of cattle with SCK decreased (P < 0.01) but the fat percentage and milk fat: protein ratio increased (P < 0.01). The commercial keto-test paper used had a low false positive result at a cut-off point of 200 fmol of BHBA/L of milk. The results showed that the best time to assess SCK using the commercial keto-test paper was d 10, 14 and 17 after calving.

Nitrification of ammonium-rich sanitary landfill leachate.

The nitrification of ammonium-rich wastewater is considered challenging due to the substrate inhibition particularly in the form of free ammonia (FA) and free nitrous acid (FNA) in ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB). The feasibility of the nitrifying activated sludge system to completely nitrify synthetic stabilized landfill leachate with N-NH(4)(+) concentration of 1452mg/L was tested in this study. The process started with 0.4kg N-NH(4)(+)/m(3)/day of nitrogen loading rate (NLR) in a fed-batch mode to avoid any accumulation of the FA and FNA in the system followed by increasing the nitrogen loading rate (NLR) gradually. Complete nitrification was achieved with a very high ammonium removal percentage (approximately 100%). The maximum specific and volumetric nitrification rate obtained were 0.49g N-NH(4)(+)/g VSS/day and 3.0kg N-NH(4)(+)/m(3)/day, respectively which were higher than those reported previously for ammonium-rich removal using activated sludge system. The nitrifying sludge exhibited good settling characteristics of up to 36mL/g VSS and a long SRT of more than 53 days which contributed to the success of the nitrification process. The coexistence and syntrophic association of the AOB and NOB was observed by using Fluorescence in situ hybridization (FISH) technique which supported the results on complete nitrification obtained in the system. These findings would be of prominent importance for further treatment of actual sanitary landfill leachate.

Land use change and nutrients simulation for the Siah Darvishan Basin of the Anzali wetland region, Iran.

The Anzali Ramsar Convention wetland is located in an ecologically and economically important region in Iran. The wetland is largely surrounded by agriculture, natural forests and rangelands (approximately 36% and 63%, respectively). Urban areas consist of less than 1% of the total area. Urban land use produces the highest rates of nutrient transfer into the lake as TN, TP and BOD5 equal to 24, 2.4 and 79 Kg/ha/year, respectively, whilst, natural land use produces the lowest rate as 10, 1.3 and 27 kg/ha/year. These results will inform the future sustainable management of this important wetland in this ever increasingly water stressed region in Iran.

Performance and egg quality of laying hens affected by different sources of phytase.

Ninety hens were divided into six groups as a 2 x 3 factorial design and fed diets containing Wheat Bran (WB) at two levels of 0 and 5% and the enzyme phytase at three levels of 0, 150 and 300 FTU kg(-1). Egg weight, egg production, feed intake and Feed Conversion Ratio (FCR) were determined. Eggs were collected on two consecutive days at fortnightly intervals to measure egg size and egg component weights. Shell thickness was measured. Egg production, egg weight, FCR and feed intake were not affected by WB. Egg production, egg weight and feed intake were significantly higher in phytase-supplemented groups than unsupplemented groups. FCR differed significantly between dietary treatments as phytase supplementation significantly decreased FCR. Inclusion of WB to the diets had no effect on egg size and albumen weight. Phytase supplementation did not affect yolk weight, although albumen and shell weight were significantly affected.

Pain tracker diagnostic instrument: effect on patients' satisfaction with their interactions with the primary care physician.

In a randomized trial, the pain tracker instrument was evaluated as a diagnostic screening tool and for its effect on patients' satisfaction with their interactions with the primary care physician. The instrument form was filled in by the physician after asking the study patients about symptoms. Control (n = 53) and study patients (n = 49) were interviewed and the instrument's effect was analysed from responses to 15 statements. The pain tracker group were significantly more satisfied with the physician relationship than were controls (mean satisfaction score 85 +/- 8 versus 61 +/- 9). A direct linear correlation was found between patients' assessment of the visit and overall satisfaction (r = 0.86). The pain tracker can be an important component in history taking and a useful diagnostic screening tool in pain presentations.