Patients' Perceptions of Physical Therapists Addressing Opioid Misuse.

INTRODUCTION: In the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients' perceptions of PTs addressing opioid misuse. METHODS: We surveyed patients, newly encountering outpatient physical therapy services in a large University-based healthcare setting, via anonymous, web-based survey. Within the survey, questions were rated on a Likert scale (1 = completely disagree to 7 = completely agree) and we evaluated responses of patients who were prescribed opioids versus those who were not. RESULTS: Among 839 respondents, the highest mean score was 6.2 (SD = 1.5) for "It is OK for physical therapists to refer their patients with prescription opioid misuse to a specialist to address the opioid misuse." The lowest mean score was 5.6 (SD = 1.9) for "It is OK for physical therapists to ask their patient why they are misusing prescription opioids." Compared to those with no prescription opioid exposure while attending physical therapy, patients with prescription opioid exposure had lower agreement that it was OK for the physical therapist to refer their patients with opioid misuse to a specialist (ß = -.33, 95% CI = -0.63 to -0.03). CONCLUSIONS: Patients attending outpatient physical therapy seem to support PTs addressing opioid misuse and there are differences in support based on whether the patients had exposure to opioids.

Phase â /â ¡, Double-Masked, Randomized, Vehicle-Controlled Study of H-1337 Ophthalmic Solution for Glaucoma and Ocular Hypertension.

PURPOSE: To perform a phase Ⅰ/Ⅱ evaluation of an H-1337 ophthalmic solution in subjects with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). DESIGN: This was a phase I/II, randomized, double-masked, vehicle-controlled, dose-response study conducted at 6 private practice sites in the United States. The study was registered with clinicaltrials.gov as NCT03452033. PARTICIPANTS: Eighty-seven subjects with bilateral POAG or OHT were enrolled. METHODS: After washout of ocular hypotensive medications as required, the subjects were randomized to receive either the H-1337 ophthalmic solution at 0.06%, 0.2%, and 0.6% or its vehicle twice daily unilaterally in the study eye for the first 3 days and then twice daily in both eyes from day 4 to 28. MAIN OUTCOME MEASURES: The primary efficacy end point was the mean change in intraocular pressure from baseline (day 0) for each group on day 28 at hour 4 compared with the vehicle. RESULTS: In the primary efficacy end point, i.e., mean change from the baseline on day 28 at hour 4, the mean change from the baseline was - 4.45 ± 3.801, - 5.16 ± 3.114, - 4.93 ± 3.110, and - 0.39 ± 2.355 in the 0.06%, 0.2%, and 0.6% H-1337 and vehicle groups, respectively. The difference between each active group and the vehicle group was statistically significant (P < 0.0001). Treatment-emergent adverse events (TEAEs) occurred in 49% of subjects who received H-1337 (range, 41% [0.2% arm]-64% [0.6% arm] across the H-1337 arms) and 18% of subjects who received the vehicle. The majority of TEAEs were mild in severity; 3 subjects who received H-1337 had a TEAE of moderate intensity (instillation site erythema, blurred vision, and muscle strain). CONCLUSIONS: The H-1337 ophthalmic solution showed clinically and statistically significant ocular hypotensive activity and was well tolerated, with a relatively low incidence of hyperemia. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial.

PURPOSE: Phentolamine mesylate ophthalmic solution (PMOS), applied to the eye topically, was shown previously to have beneficial effects in patients with dim light vision disturbances (DLD), including decreased pupil diameter (PD), improved best-corrected distance visual acuity (BCDVA), as well as lower intraocular pressure (IOP). The ORION-1 trial evaluated the long-term safety and efficacy of PMOS in a glaucomatous, presbyopic population. PATIENTS AND METHODS: In this randomized, double-masked, multi-center, placebo-controlled, multiple-dose Phase 2b trial, 39 patients with elevated IOP were randomized to receive one evening dose of study medication or placebo for 14 days. The primary outcome measure was mean change in diurnal IOP, and the key secondary outcome measures included changes in PD, distance-corrected near visual acuity (DCNVA), and conjunctival hyperemia. RESULTS: Use of 1% PMOS did not lead to a statistically significant decrease in diurnal IOP compared to placebo (P = 0.89) but trended toward a greater decrease in patients with lower IOP baselines. PMOS produced a statistically significant mean 20% PD reduction under both photopic and mesopic conditions that was sustained for 36 hours post-dosing. A statistically significant number of patients with PMOS compared to placebo demonstrated ≥1 line of improvement in photopic DCNVA at day 8 (P = 0.0018), day 15 (P = 0.0072), and day 16 (P = 0.0163), with a trend for 2- and 3-line improvements at all time points. There was no statistical difference in conjunctival hyperemia compared to placebo. CONCLUSION: Although mean IOP was not lowered significantly, daily evening dosing of 1% PMOS was found to be well tolerated with no daytime conjunctival redness and demonstrated improvement in DCNVA with sustained PD reduction in a glaucomatous and presbyopic population. Smaller pupil size can have beneficial effects in improving symptoms of presbyopia and DLD, which will be the focus of further studies.

A vasculature-targeting regimen of preoperative docetaxel with or without bevacizumab for locally advanced breast cancer: impact on angiogenic biomarkers.

PURPOSE: Taxanes have effects on angiogenesis causing difficulties in separating biological effects of chemotherapy from those due to angiogenesis inhibitors. This randomized phase II trial was designed to evaluate the additional biomarker effect on angiogenesis when bevacizumab is added to docetaxel. EXPERIMENTAL DESIGN: Patients with inoperable breast cancer were randomized to either 2 cycles of preoperative docetaxel (D) 35 mg/m(2) i.v. weekly for 6 weeks, followed by a 2-week break; or docetaxel with bevacizumab 10 mg/kg i.v. every other week for a total of 16 weeks (DB). Plasma and serum markers of endothelial damage, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and tumor microvessel density were assessed before treatment and at the end of each preoperative cycle. RESULTS: Forty-nine patients were randomized (DB, 24; D, 25). There was no difference in overall clinical response, progression-free survival, or overall survival. Vascular endothelial growth factor increased during treatment; more so with DB (P < 0.0001). Vascular cell adhesion molecule-1 (VCAM-1) also increased (P < 0.0001); more so with DB (P = 0.069). Intercellular adhesion molecule increased (P = 0.018) and E-selectin decreased (P = 0.006) overall. Baseline levels of VCAM-1 and E-selectin correlated with clinical response by univariate analysis. DCE-MRI showed a greater decrease in tumor perfusion calculated by initial area under the curve for the first 90 seconds in DB (P = 0.024). DCE-MRI also showed an overall decrease in tumor volume (P = 0.012). CONCLUSION: Bevacizumab plus docetaxel caused a greater increase in vascular endothelial growth factor and VCAM-1, and a greater reduction in tumor perfusion by DCE-MRI compared with docetaxel. Clinical outcomes of inoperable breast cancer were predicted by changes in VCAM-1 and E-selectin.

Inflammatory breast cancer as a model disease to study tumor angiogenesis: results of a phase IB trial of combination SU5416 and doxorubicin.

PURPOSE: We used inflammatory breast cancer (IBC) as a model disease to investigate biological changes associated with an antiangiogenesis agent, SU5416, combined with doxorubicin. EXPERIMENTAL DESIGN: Patients with stage IIIB or IV IBC were treated neoadjuvantly with the combination of SU5416 and doxorubicin for induction therapy. The dose of SU5416 (administered on days 1 and 4, every 3 weeks) and doxorubicin (administered on day 1 every 3 weeks) were escalated in cohorts of three patients starting at 110 and 60 mg/m2, respectively, for a total of five cycles leading up to mastectomy. Patients underwent serial assessment (pharmacokinetic sampling, biopsy of breast, tumor blood flow dynamic contrast-enhanced magnetic resonance imaging, plasma angiogenesis, and endothelial cell damage markers) prior to treatment, at the end of cycles no. 2 and no. 5, and after mastectomy. RESULTS: Eighteen patients were enrolled; neutropenia was dose-limiting, and overall median survival was not reached (50 months of study follow-up). Four patients (22%) experienced congestive heart failure, which resolved and were likely attributable to a smaller volume of distribution and higher Cmax of doxorubicin in combination with SU5416. We did observe a significant decline in tumor blood flow using Kep calculated by Brix (pretreatment versus post-cycle no. 5; P = 0.033), trend for a decline in tumor microvessel density after treatment, and low baseline levels of soluble intracellular adhesion molecule were associated with improved event-free survival. CONCLUSIONS: This study showed evidence of an unfavorable cardiac interaction between SU5416 and doxorubicin, which prohibits further investigation of this combination. However, this study supports the importance of using IBC as a model for investigating angiogenesis inhibitors.

Antiangiogenic activity of thalidomide in combination with fludarabine, carboplatin, and topotecan for high-risk acute myelogenous leukemia.

Forty-two patients with poor prognosis AML were enrolled in a phase II study combining fludarabine, carboplatin, and topotecan (FCT) with thalidomide. Laboratory correlates included serum vascular endothelial growth factor levels (VEGF) and bone marrow microvascular density (MVD). Ten of 42 (24%) patients achieved a complete remission (CR or CRp). Serious thrombotic adverse events were observed in 5 patients suggesting that the combination of cytotoxic chemotherapy and thalidomide may be thrombogenic despite significant thrombocytopenia. VEGF did not correlate with response to therapy, while a trend towards decreased MVD was noted in patients who achieved CR. The addition of thalidomide did not significantly influence angiogenic markers. It is not clear that thalidomide adds any efficacy to the FCT regimen.

Novel Phase I dose de-escalation design trial to determine the biological modulatory dose of the antiangiogenic agent SU5416.

PURPOSE: To determine the biological modulatory dose of SU5416, we employed a novel trial design, where "dose de-escalation" was based on demonstrable biological changes observed at the maximum tolerated dose. If such an effect was shown, dose de-escalation to a predefined dose level would occur to determine if the lower dose exhibited the same amount of pharmacodynamic effect as the higher dose. EXPERIMENTAL DESIGN: Ten patients with advanced solid tumors were enrolled at each dose level. One of the following pharmacodynamic effects was considered significant: (a) a 35% decrease in microvessel density in sequential tumor biopsies and (b) a 35% decrease in blood flow within tumor as assessed by dynamic contrast-enhanced magnetic resonance imaging. In addition, soluble E-selectin, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule, and plasma vascular endothelial growth factor were measured sequentially. RESULTS: Nineteen patients were enrolled. Sequential tumor biopsies in all evaluable patients showed an increase in microvessel density. Only one patient met the intended pharmacodynamic end point of >35% reduction in blood flow. There was a significant increase in both soluble E-selectin and soluble intercellular adhesion molecule levels pretreatment versus levels at the time of removal of patients from study (P = 0.04 and P = 0.0007, respectively). Levels of serum fibrinogen rose with therapy. There was a trend toward increase in plasma vascular endothelial growth factor levels. CONCLUSION: SU5416 does not result in decreased blood flow in tumors or a decrease in microvessel density. This corresponds to the lack of clinical activity seen with this agent. Our clinical trial design termed dose de-escalation is a novel approach to determine the in vivo biological effects of targeted therapies in cancer patients.

Phase I and correlative study of combination bryostatin 1 and vincristine in relapsed B-cell malignancies.

PURPOSE: Bryostatin 1 activates protein kinase C (PKC) with short-term exposure and results in depletion of PKC with prolonged exposure. Preclinical in vitro and in vivo studies demonstrate synergistic activity and increased tumor apoptosis in B-cell malignancies when a prolonged infusion of bryostatin 1 is followed by vincristine. EXPERIMENTAL DESIGN: We embarked on a Phase I trial of bryostatin 1 as a 24-h continuous infusion followed by bolus vincristine in patients with refractory B-cell malignancies other than acute leukemias. Twenty-four evaluable patients were enrolled. RESULTS: The dose-limiting toxicity was myalgia. The MTD and recommended Phase II dose of bryostatin 1 was 50 microg/m2/24 h followed by vincristine 1.4 mg/m2 (maximum total dose of 2 mg) repeated every 2 weeks. Significant antitumor activity was observed in this relapsed population, including patients who had failed high-dose chemotherapy. This included 5 durable complete and partial responses and 5 patients with stable disease lasting > or =6 months (range, 6-48+ months). Median time to response was 8 months. Correlative studies demonstrated a progressive increase in serum interleukin-6 with bryostatin 1 infusion followed by an additional increase after vincristine. Flow cytometry for detection of apoptosis in B and T cells showed an initial decrease in apoptotic frequency in CD5+ cells within 6 h of bryostatin 1 infusion compatible with its known increase in PKC activity in the majority of patients followed by a return to baseline or overall increase in apoptotic frequency after completion of infusion. All (5 of 5) patients who had an overall increase in apoptotic frequency in CD5+ cells achieved either a clinical response or prolonged stable disease. Four of these 5 patients did not have the initial decrement in apoptosis at 6 h. CONCLUSIONS: Given the lack of myelosuppression and early evidence of clinical efficacy, additional exploration of this regimen in non-Hodgkin's lymphoma and multiple myeloma is warranted.

Job adjustments, job satisfaction and health experience in upper and lower limb amputees.

OBJECTIVES: To explore job adjustments, job satisfaction, and health experience among employees with an upper limb amputation and to compare the results with those of lower limb amputees and control subjects. METHODS: Amputees were recruited from data files of a large European University Medical Centre and orthopaedic workshops. Controls were matched colleagues of the lower limb amputees. All participants filled out the VAG questionnaire (Vragenlijst Arbeid en Gezondheid), assessing job satisfaction and job adjustments, and the RAND-36. RESULTS: 28 upper limb amputees were compared to 144 lower limb amputees and 144 controls. Job adjustments were necessary in 38% and 28% of upper and lower limb amputees, respectively. All three groups were equally satisfied with their jobs (p = 0.90). Vocational rehabilitation was applied to 26% and 8% of upper and lower limb amputees, respectively. Upper limb amputees rated their general health worse (18 points, 95% CI: 12-25) compared to lower limb amputees, corrected for effects of confounders (age and co-morbidity). CONCLUSIONS: Upper and lower limb amputees have high job satisfaction and a minority need job adjustments. In upper limb amputees, the causes of the worrisome general health experience need further investigation. In upper and lower limb amputees, vocational rehabilitation deserves additional attention.

A phase II trial of fosbretabulin in advanced anaplastic thyroid carcinoma and correlation of baseline serum-soluble intracellular adhesion molecule-1 with outcome.

BACKGROUND: Fosbretabulin is a novel vascular-disrupting agent that has antitumor activity against anaplastic thyroid cancer (ATC) cell lines, xenografts, and demonstrable efficacy in a phase I trial. This phase II study determined the efficacy and safety of fosbretabulin in patients with advanced ATC and whether fosbretabulin altered the natural history of ATC by virtue of doubling the median survival. A secondary aim evaluated the prognostic value of serum soluble intracellular adhesion molecule-1 (sICAM). METHODS: Twenty-six patients received fosbretabulin 45 mg/m(2) as a 10-minute intravenous infusion on days 1, 8, and 15 of a 28-day cycle. sICAM levels were obtained at baseline, over the first two cycles, and end of therapy. Treatment was continued until disease progression. RESULTS: Fosbretabulin was well tolerated; grade 3 toxicity was observed in nine patients (35%), and grade 4 toxicity in one (4%). QTc prolongation delayed treatment in four causing one to stop treatment. Median survival was 4.7 months with 34% and 23% alive at 6 and 12 months, respectively. Median duration of stable disease in seven patients was 12.3 months (range, 4.4-37.9 months). Baseline serum sICAM levels were measured in 24 patients with a median 253.5 ng/mL. There was a significant difference in event-free survival among tertiles of baseline sICAM levels (p < 0.009). CONCLUSIONS: There were no objective responses seen with single-agent fosbretabulin as administered in this trial, and we did not observe a doubling of survival as our primary endpoint. This is among the largest prospective trials ever conducted for ATC. Fosbretabulin has an acceptable safety profile in patients with advanced ATC, and one-third survived more than 6 months. Despite a small sample size, low baseline sICAM levels were predictive of event-free survival. Further prospective validation of sICAM as a therapeutic biomarker and exploring combination regimens with fosbretabulin are warranted.

Modification of Conventional Methods for Recovery of Injured Coliforms and Salmonellae 1.

This is a review that concentrates primarily on recent developments in the modification of conventional methods for recovery of injured coliforms and salmonellae; 43 of the 58 references were published in 1975 or later. The review encompasses four areas of activity: (a) most probable numbers procedures, (b) membrane filter procedures, (c) direct plating methods, and (d) the influence of other variables.

Enterococci in Pork Processing.

The purpose of this study was to determine the numbers and species of enterococci encountered on pork carcasses during different stages in the slaughter process as well as on pork products. Three hog slaughtering plants were surveyed, each 3 times at four processing points. Each hog was swabbed at two sites on the carcass. Specimens were plated on two different enterococcal media, KF streptococcal agar and fluorescent gentamycin-thallous-carbonate agar. Retail and spoiled pork sausage products also were examined. Isolates were speciated by using the API Rapid Strep and Baxter MicroScan Pos ID panels. Contamination levels varied between plants as the carcasses progressed down the processing line; the highest counts were obtained directly before packaging in plants A and C. The highest count for plant B occurred at the first stage of sampling. More Enterococcus faecalis than Enterococcus faecium were isolated from the pork carcasses. Pork sausage results also are presented. Enterococci are useful as an indicator of pork sanitation and to detect critical control points during processing. In some instances, high levels of enterococci are associated with spoilage of pork sausage.

Antibiotic Resistance Among Enterococcal Isolates from Environmental and Clinical Sources.

Antibiotic resistance among enterococci and fecal streptococci was examined by testing 149 isolates from pork, water, and clinical material, as well as 50 strains of 13 known species, for resistance to 27 different antimicrobial agents. Tests were performed by using the MicroScan Pos MIC type 6 panels. Pork isolates exhibited less resistance than either water or clinical isolates to most antibiotics, although a larger proportion of pork isolates than others was resistant to tetracycline. Comparisons of antimicrobial-resistance patterns between enterococcal species revealed that Enterococcus faecium was most resistant to ß-lactam antimicrobials, especially ampicillin, whereas Enterococcus faecalis seemed to be the most resistant to the synergistic effects of antimicrobial combinations. Vancomycin resistance was observed in one Enterococcus hirae isolate from water. Enterococcal isolates from any of the sources tested did not show multiple resistance to antibiotics (such as gentamicin, ampicillin, streptomycin, and vancomycin) used to treat serious infections caused by gram-positive cocci.

Aerobic Plate Counts of 100-ml Samples in Plastic Bags 1.

Counts from samples that contained low numbers of bacteria were determined by mixing the samples with double-strength agar media in 42-oz (1.2-L) Whirl-Pak bags. The bag-plate method was compared with other direct-plating methods and the most-probable-number and membrane-filtration procedures. Results obtained by using the bag method were as reliable as methods commonly used for analysis of samples that contain low numbers of viable bacteria.

Automation for Rapid Identification of Salmonellae in Foods 1.

Salmonella isolation and identification follow an inseparable continuum of steps from beginning to end. This paper, therefore, encompasses both aspects of the problem. The importance of recovering injured cells is mentioned, and problems in automating the isolation process are described. Rapid serological tests for identification of salmonellae directly in enrichment media are discussed. Suggestions are made for improvements in antiserum preparation and for automating certain serological tests. Various kits, procedures and automated equipment on sale or under development for the rapid and convenient physiological characterization of salmonellae and other Enterobacteriaceae are described. Examples are given of comparative efficiencies and potential problems that might be encountered. Finally, a prediction is made about the possible nature of future generations of highly efficient and inexpensive automated systems for Salmonella identification.

Optimal Pyruvate Concentration for the Recovery of Conforms from Food and Water.

Recoveries of coliforms in water and food samples were increased by adding sodium pyruvate to the Tryptic Soy Agar (TSA) base layer, and Violet Red Bile (VRBA) overlay, of the Modified VRBA procedure described in Standard Methods for the Examination of Dairy Products. Six pyruvate levels (0, 0.005, 0.01, 0.05, 0.1, and 1.0%) were tested. Counts were significantly lower (P≤0.05) on media containing 0% and 1.0% pyruvate than on the other media. Although 0.05% yielded the highest counts overall, there were no significant differences (P≤0.05) among 0.005, 0.01, 0.05, and 0.1% pyruvate. Analysis by using a general linear model procedure revealed that 0.02% pyruvate was the statistically predicted optimal level to use in the Modified VRBA procedure.

Inexpensive, Disposable Presence-Absence Test for Coliforms and Escherichia coli in Water.

Six-ounce (151-g) Whirl-Pak® bags containing 3.05 g of dehydrated Presence-Absence (P-A) Broth and 5 mg of 4-methylumbelliferyl-ß-D-glucuronide (MUG) were pasteurized with 10 kGy of gamma irradiation. To conduct a "bag" P-A test, 100 ml of water sample were added to a bag. The bag was closed, the medium was dissolved by massaging the bag for about 15 sec, and the bag was then placed in a rack for incubation. The bag method was compared with P-A tests conducted in 160-ml glass bottles and 200-ml polysulfone bottles, as well as with a 5-tube Laury] Tryptose Broth (LTB) most-probable-number (MPN) method. Twenty-nine surface-water samples (11 streams, 7 rivers, and 11 lakes), 9 well-water samples, and 2 sewage effluents were examined. Chi-square analyses of the results revealed that no significant difference (P≤0.1) existed among the different P-A tests. The hydrolysis of MUG provided excellent Escherichia coli detection and was easiest to determine in the bags.

Highly Sensitive Paper-Disc Assays for Detecting Penicillin in Milk.

A modified Bacillus subtilis disc-plate assay could detect 0.015 I.U. of penicillin G per ml of milk, whereas the lower detection limit of the standard assay was 0.050 I.U. per ml. Likewise, a modified Bacillus stearothermophilus disc-plate assay could detect 0.003 I.U. of penicillin G per ml of milk, whereas the lower detection limit of the standard assay was 0.005 I.U. per ml. Increased sensitivities were accomplished by preloading assay discs with "critical" concentrations so that minute quantities of antibiotic above the "critical" concentrations would produce zones of inhibition. Only a few alterations in routine laboratory procedure were required to perform the assays. Use of these assays should assure a milk supply that would not cause allergic reactions in humans or significantly inhibit dairy starter cultures. The general principal of "critical" concentration might have applications other than those that we have described, to increase the sensitivity of radial-diffusion analyses for biologically active compounds.

Metal Ions Reverse the Inhibitory Effects of Selected Food-Grade Phosphates in Staphylococcus aureus.

Previous studies showed that levels as low as 0.1% sodium ultraphosphate (UP), 0.1% sodium polyphosphate glassy (SPG) and 0.5% tetrasodium pyrophosphate (TSPP) were bactericidal and bacteriolytic to early-exponential phase cells of Staphylococcus aureus ISP40 8325. In the present study, Ca2+ (0.01 M) or Mg2+ (0.01 M) reversed the bacteriolytic effects of UP (0.1%) and SPG (0.1%) to S. aureus . In addition, Ca2+ (0.01 M) or Mg2+ (0.01 M), when added to the culture medium before inoculation, protected cells from growth inhibition by UP and SPG. Moreover, the bactericidal effects of UP or SPG were reversed by Ca2+ or Mg2+ in metal-rescue experiments in which the metals were added to polyphosphate-containing medium after 1 h of incubation. No additive effect existed between Mg2+ and Ca2+. Growth inhibition of TSPP was not reversed by Mg2+ or Ca2+, but it was reversed by Fe3+ when Fe3+ was added to protect cells 1 h before the addition of TSPP. These studies show that the antibacterial effects of phosphates can be altered substantially by the metal-ion content of the environment.

Bactericidal and Bacteriolytic Effects of Selected Food-Grade Phosphates, Using Staphylococcus aureus as a Model System.

Phosphates have been approved for use in meat products primarily to protect flavor and increase yields. It also is known that phosphates have antimicrobial properties. The objective of this study was to compare the effects of different phosphates in a model system. Minimum inhibitory concentrations (MICs) of selected food-grade phosphates added to early-exponential-phase cells of Staphylococcus aureus ISP40 8325 in a synthetic medium were determined to be 0.1% for sodium ultraphosphate and sodium polyphosphate glassy and 0.5% for sodium acid pyrophosphate, sodium tripolyphosphate and tetrasodium pyrophosphate. Thus, the MIC values for the very long chain-length phosphates were lower than the MIC values for shorter chain-length phosphates. Leakage of intracellular nucleotides was observed both spectrophotometrically (release of A260-absorbing material) and microscopically (appearance of gelatinous cellular aggregates). Treatment of the gelatinous cellular aggregates with DNase, RNase and proteinase indicated that the aggregates contained DNA, RNA and protein, thus indicating cellular lysis in the presence of phosphates.