Application of the PredictAD decision support tool to a Danish cohort of patients with Alzheimer's disease and other dementias.

BACKGROUND: The diagnosis of Alzheimer's disease (AD) is based on an ever-increasing body of data and knowledge making it a complex task. The PredictAD tool integrates heterogeneous patient data using an interactive user interface to provide decision support. The aim of this project was to investigate the performance of the tool in distinguishing AD from non-AD dementia using a realistic clinical dataset. METHODS: We retrieved clinical data from a group of patients diagnosed with AD (n = 72), vascular dementia (VaD, n = 30), frontotemporal dementia (FTD, n = 25) or dementia with Lewy bodies (DLB, n = 14) at the Copenhagen Memory Clinic at Rigshospitalet. Three classification methods were applied to the data in order to differentiate between AD and a group of non-AD dementias. The methods were the PredictAD tool's Disease State Index (DSI), the naïve Bayesian classifier and the random forest. RESULTS: The DSI performed best for this realistic dataset with an accuracy of 76.6% compared to the accuracies for the naïve Bayesian classifier and random forest of 67.4 and 66.7%, respectively. Furthermore, the DSI differentiated between the four diagnostic groups with a p value of <0.0001. CONCLUSION: In this dataset, the DSI method used by the PredictAD tool showed a superior performance for the differentiation between patients with AD and those with other dementias. However, the methods need to be refined further in order to optimize the differential diagnosis between AD, FTD, VaD and DLB.

Distribution and epidemiology of genotypes of the crayfish plague agent Aphanomyces astaci from noble crayfish Astacus astacus in Finland.

The crayfish plague agent Aphanomyces astaci was isolated from 69 noble crayfish Astacus astacus samples in Finland between 1996 and 2006. All isolates were genotyped using randomly amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). Altogether, 43 isolates belonged to the genotype group of Astacus strains (As), which is assumed to represent the genotype originally introduced into Europe around 1860 and into Finland in 1893. There were 26 crayfish plague isolates belonging to the group of Pacifastacus strain I (Ps1), which appeared in Europe after the stocking of the North American species signal crayfish Pacifastacus leniusculus. The geographical distribution of the 2 genotypes in Finland corresponded with the stocking strategies of signal crayfish. The majority of Ps1-strains (83%) were associated with a classical crayfish plague episode involving acute mortality, compared with only 33% of the As-strains. As-strains were found more often by searching for reasons for population declines or permanently weak populations, or through cage experiments in connection with reintroduction programmes. In some water bodies, isolations of the As-strains were made in successive years. This study shows that persistent crayfish plague infection is not uncommon in noble crayfish populations. The described epidemiological features suggest a difference in virulence between these 2 genotypes.

Proliferative and anti-apoptotic activity of esophageal mucosa in gastroesophageal reflux disease is not affected by fundoplication: a 4-year follow-up study.

BACKGROUND: The role of fundoplication in the prevention of esophageal adenocarcinoma is controversial. Development of cancer is associated with proliferation and anti-apoptosis, for which little data exist regarding their response to fundoplication. METHODS: Ki-67 and Bcl-2 expression was assessed in the esophagogastric junction (EGJ) and the distal and proximal esophagus of 20 patients with gastroesophageal reflux disease (GERD) treated by fundoplication and in 7 controls. Endoscopy was performed preoperatively and 6 (20 patients) and 48 months (16 patients) postoperatively. RESULTS: There were positive correlations between Ki-67 and Bcl-2 levels in the EGJ (p > 0.001) and in the distal (p = 0.001) and proximal esophagus (p = 0.013). Compared to the preoperative level, Ki-67 expression was elevated in the distal (p = 0.012) and proximal (p = 0.007) esophagus at 48 months. In addition, compared to control values, Ki-67 expression was lower at the 6-month follow-up in the EGJ (p = 0.037) and the proximal esophagus (p = 0.003), and higher at the 48-month follow-up in the distal esophagus (p = 0.002). Compared to control values, Bcl-2 was lower at 6 months in the EGJ (p = 0.038). CONCLUSIONS: Proliferative activity after fundoplication increased in the long term in the distal esophagus despite a normal fundic wrap and healing of GERD.

Comparison of Finnish meat inspection records and average daily gain for cattle herds differing in Mycoplasma bovis test-status.

Detecting Mycoplasma bovis on cattle farms represents a challenge in the absence of an outbreak or cases of M. bovis mastitis, yet identification of an infection is essential to control the spread of the disease successfully. The objectives of this study were: (1) to determine whether meat inspection records can aid identification of cattle farms supporting M. bovis infection, and (2) to compare the average daily weight gain estimated from carcass weight for cattle originating from farms differing in M. bovis test-status. Meat inspection records were collected from two abattoirs in 2015; 80 677 animals in total. All the dairy and mixed breed cows and bulls used for meat production were categorized according to known M. bovis infection status of the farms from which the cattle were derived; positive, contact or control farms. The associations between animals from different M. bovis categories and lung lesions of bulls and cows (pneumonia and pleuritis), identified during meat inspection, and estimated average daily gain (ADG) of bulls, were investigated. The odds ratios for lung lesions, especially pleuritis, were higher in M. bovis test-positive or contact farms compared with control farms. Additionally, odds ratios for pleuritis were higher among animals from M. bovis test-positive farms and animals from contact slaughtering farms originating from M. bovis-free rearing farms. Bulls originating from M. bovis test-positive farms had higher estimated average daily gain than cattle from control farms. Meat inspection records can be used alongside other methods to detect M. bovis-positive farms where M. bovis causes lung lesions.

Overview of HOMEChem: House Observations of Microbial and Environmental Chemistry.

The House Observations of Microbial and Environmental Chemistry (HOMEChem) study is a collaborative field investigation designed to probe how everyday activities influence the emissions, chemical transformations and removal of trace gases and particles in indoor air. Sequential and layered experiments in a research house included cooking, cleaning, variable occupancy, and window-opening. This paper describes the overall design of HOMEChem and presents preliminary case studies investigating the concentrations of reactive trace gases, aerosol particles, and surface films. Cooking was a large source of VOCs, CO2, NOx, and particles. By number, cooking particles were predominantly in the ultrafine mode. Organic aerosol dominated the submicron mass, and, while variable between meals and throughout the cooking process, was dominated by components of hydrocarbon character and low oxygen content, similar to cooking oil. Air exchange in the house ensured that cooking particles were present for only short periods. During unoccupied background intervals, particle concentrations were lower indoors than outdoors. The cooling coils of the house ventilation system induced cyclic changes in water soluble gases. Even during unoccupied periods, concentrations of many organic trace gases were higher indoors than outdoors, consistent with housing materials being potential sources of these compounds to the outdoor environment. Organic material accumulated on indoor surfaces, and exhibited chemical signatures similar to indoor organic aerosol.

[The distribution of mitoses in the imaginal disks of third-instar Drosophila melanogaster larvae].

Development of Drosophila imaginal discs is accompanied by a high-ordered cell proliferation. However, the distinctions in the topographic distribution of mitoses at different developmental stages are insufficiently studied. In this work, we have analyzed the distribution of mitoses in the wing disc of third-instar larvae and determined the regions where mitotic clustering. The results obtained demonstrate that the proliferation rate is region-specific, which is determined by the location of cell cycle regulators and/or the location of growth factors. A comparison of the topography of mitoses with the activity patterns of the regulatory regions of gene string (stg), a known regulator of the mitotic M phase, has demonstrated a similarity between the topography and the activity pattern of one of these regions. The similarity between mitotic distributions in the left and right discs of the same larva (compared with the similarity of gene neuralized expression patterns is considered, and the degree of histone H3 phosphorylation at various mitotic stages is analyzed.

Hot spots, indicator taxa, complementarity and optimal networks of taiga.

If hot spots for different taxa coincide, priority-setting surveys in a region could be carried out more cheaply by focusing on indicator taxa. Several previous studies show that hot spots of different taxa rarely coincide. However, in tropical areas indicator taxa may be used in selecting complementary networks to represent biodiversity as a whole. We studied beetles (Coleoptera), Heteroptera, polypores or bracket fungi (Polyporaceae) and vascular plants of old growth boreal taiga forests. Optimal networks for Heteroptera maximized the high overall species richness of beetles and vascular plants, but these networks were least favourable options for polypores. Polypores are an important group indicating the conservation value of old growth taiga forests. Random selection provided a better option. Thus, certain groups may function as good indicators for maximizing the overall species richness of some taxonomic groups, but all taxa should be examined separately.

Bronchiolitis in rheumatoid arthritis.

Bronchiolitis in association with rheumatoid arthritis has been reported, to our knowledge, in 18 patients to date. In some cases use of penicillamine has been strongly associated with the development of bronchiolitis. Most of the reported cases are described as having marked irreversible airways obstruction and hyperinflation. We describe a patient with rheumatoid arthritis whose respiratory tract symptoms began during gold therapy. Physiologic studies showed marked lung hyperinflation without pathologic findings in forced dry spirometric study. On open lung biopsy a mild degree of granulomatous bronchiolitis was found. Immunofluorescent microscopy showed IgM- and IgG-containing plasma cells in the bronchiolar walls.

Enhanced isolation of MOTT on egg media of low pH.

The influence of alternative carbon sources, i.e. glycerol and pyruvate, and medium pH on the growth of 33 mycobacterial strains, including MOTT (n = 18), M. tuberculosis (TBC) (n = 14) and BCG, was experimentally studied. This was followed by culturing of clinical specimens (n = 4706) on three medium versions for primary isolation of mycobacteria. The decrease of medium pH below 6.5 enhanced the growth of isolated strains of M. avium complex (MAI) and M. malmoense. Pyruvate had a further beneficial effect on half of them; it was, however, inhibitory to some strains of M. malmoense, MAI and TBC as well as to BCG. In primary isolation, 74 specimens were positive for TBC and 37 for MOTT. The number of MOTT isolates of potential clinical significance was 11 on unacidified and 23 on acidified media (pH 6.2) (p less than 0.05). M. malmoense and five of 11 MAI isolates were exclusively detected on acidified media. TBC was isolated in equal frequency on all media, but it was detected on the acidified versions one to four weeks earlier in 20 of 55 (36%) specimens positive on all three media versions. The results indicated that acidified media of pH 6.2 offer enhanced growth conditions for MOTT, especially MAI and M. malmoense, without interfering with the growth of TBC. The growth enhancement obtained with pyruvate for some strains and with glycerol for some others makes it necessary to use both media versions in parallel.

Thyroid antibodies in association with thyroid malignancy. I. Simultaneous occurrence of thyroiditis and thyroid malignancy.

Occurrence of thyroid antibodies and thyroiditis in association with thyroid malignancy, suspected malignancy or other thyroid diseases was studied in 177 patients. Retrospective clinical analysis revealed that 137 patients had thyroid carcinoma (108 papillary carcinomas, 10 occult papillary carcinomas, 14 follicular carcinomas, and 5 other carcinomas) and 40 had other thyroid diseases. Thyroid microsomal (AMC) and thyroglobulin antibodies (ATG) were measured by the particle agglutination method. Clinically significant thyroid antibody titers and histological or clinical features of thyroiditis were seen in nine patients with thyroid carcinoma, being equally prevalent in follicular and papillary carcinomas. Taking into account the prevalence of positive AMC antibodies and thyroid carcinoma in Finland, the highest predicted prevalence of simultaneously occurring thyroid carcinoma and thyroiditis in the under 40 age group should be 0.002% and in the over 40 age group 0.006%. In the present material the observed occurrences in corresponding age groups were unexpectedly high (4.7% and 5.2%). The results may partly be due to patient selection, but they also suggest that there might be a link between thyroiditis and thyroid carcinoma.

Antibodies to pyruvate dehydrogenase in primary biliary cirrhosis: correlation with histology.

Antimitochondrial antibodies to pyruvate dehydrogenase are the hallmark of primary biliary cirrhosis. Their pathogenic role has not been proven, although antibodies to pyruvate dehydrogenase are bound to biliary epithelium. The aim of this study was to characterize serum IgA antibodies to pyruvate dehydrogenase and to evaluate their response to different treatment regimens. We also compared the level of antibodies with severity of histological lesions and the data of biochemical liver tests. Serum samples were collected at baseline and after 24 months from 61 primary biliary cirrhosis patients, whereas 23 patients were treated with ursodeoxycholic acid, 20 with colchicine, and 18 with placebo. ELISA was used to detect antibodies to pyruvate dehydrogenase. IgA and IgG were separated with jacalin and protein-A, respectively. Capacity of immunoglobulins to inhibit enzymatic activity was detected by spectrophotometric observation of the rate of enzyme reaction. 49 (80.3%) of the 61 patients possessed IgA antibodies to pyruvate dehydrogenase. Significant decrease in IgA antibodies was observed only in the ursodeoxycholic acid group (p<0.05). 15 of 18 IgA preparations and all 24 IgG preparations of patients' sera were inhibitory towards pyruvate dehydrogenase (mean inhibitory percent +/-SD: 42+/-33.4% and 79+/-22.4%, respectively, at a protein concentration of 100 microg/ml). The level of serum antibodies to pyruvate dehydrogenase correlated with several histological parameters (fibrosis, inflammatory infiltrate), but not with biochemical parameters. Our data reveal that IgA antibodies to pyruvate dehydrogenase inhibit enzyme function. The correlation between antibodies to pyruvate dehydrogenase and histological parameters might suggest the pathogenic role of these antibodies.

DNA ploidy, cell proliferation and steroid hormone receptors in endometrial hyperplasia and early adenocarcinoma.

We determined DNA content, S-phase fraction, and estrogen (ER) und progesterone receptor (PR) levels in 36 stage I endometrial adenocarcinomas and in 22 hyperplastic lesions to obtain information on the genesis and progression of endometrial malignancy. DNA aneuploidy was detected in 12/36 (33%) carcinomas and in none of the hyperplastic lesions. DNA aneuploidy was significantly more common in poorly and moderately differentiated carcinomas than in the well-differentiated ones. Similarly, the highest number of cells in S-phase were found in poorly and moderately differentiated carcinomas, whereas well-differentiated carcinomas and all hyperplasias had an equally small S-phase fraction. Mean ER and PR levels were highest in hyperplastic lesions, especially those with atypical features, whereas carcinomas of all grades had significantly lower values. Thus, it is likely that the loss or decreased expression of steroid receptors is an early event during carcinogenesis in human endometrium, whereas an increase in the cell proliferation rate and the formation of DNA aneuploidy occur later during tumor progression.

Liver lesions found at colectomy in ulcerative colitis: correlation between histological findings and biochemical parameters.

AIMS: To classify lesions discovered at colectomy in patients with ulcerative colitis; to assess the importance of histological findings by correlating them with biochemical parameters. METHODS: Liver tissue specimens taken at colectomy from 59 patients with chronic ulcerative colitis were studied using light microscopy. The findings were compared with results of biochemical liver function tests. RESULTS: Abnormal laboratory findings were found in 12 patients with liver histology consistent with primary sclerosing cholangitis. Non-specific reactive hepatitis was observed in six patients, eight had fatty liver, and three minor non-specific parenchymal changes. Twenty nine patients had normal liver histology. The highest cholestatic serum enzyme activities were seen in two patients with sclerosing cholangitis. Cholangiography in these patients also revealed changes in the extrahepatic bile ducts. However, identical histological changes were also present in patients with only slightly abnormal or even normal liver enzyme activities. CONCLUSION: Biochemical tests of liver function do not reliably indicate the extent or severity of bile duct damage in ulcerative colitis, the assessment of which requires liver biopsy.

Clinical assessment compared with cyst fluid analysis in the differential diagnosis of cystic lesions in the pancreas.

BACKGROUND: In adults 80% to 90% of cystic lesions in the pancreas are pseudocysts and the remainder are mostly neoplastic cysts. To choose optimal treatment for an individual patient, exact nonoperative diagnosis would be preferable. This study was done to assess the value of cyst fluid analysis, compared with clinical and radiologic findings, in the differential diagnosis of pancreatic cystic lesions. METHODS: Twenty-two patients with a cystic lesion in the pancreas underwent operation, cyst wall biopsy, and aspiration of cyst fluid. Carcinoembryonic antigen (CEA), CA 19-9, pancreatitis-associated protein (PAP), and total protein concentration, amylase activity, and cytologic findings were studied. Final diagnosis was pseudocyst in 14 patients, serous cystadenoma in two, mucinous cystadenoma in two, and mucinous cystadenocarcinoma in four patients. RESULTS: Clinical and radiologic judgment correctly differentiated pseudocysts and neoplastic cysts. Cyst fluid aspiration did not succeed in two patients with mucinous cystadenocarcinomas because of the high fluid viscosity. Cyst fluid amylase activity was high (greater than 16,000 IU/ml) in all but one pseudocyst and low (less than 83 IU/ml) in all but one neoplastic cyst. CEA level was lower in pseudocysts than in neoplastic cysts, but with an overlapping value between the groups. Mean CA 19-9 concentration was higher in pseudocysts than in neoplastic cysts, but with wide overlap between the groups. Pancreatitis-associated protein and total protein concentration and cystic fluid cytologic findings did not differ between various types of cysts. CONCLUSIONS: Clinical judgment including careful history and radiologic studies seems to be the most reliable method of differentiating neoplastic pancreatic cysts from pseudocysts. Amylase and CEA levels give suggestive information, but cyst fluid analysis may be misleading in an individual patient.

Bile flow to the duodenum is reduced in hypothyreosis and enhanced in hyperthyreosis.

Disturbances in sphincter of Oddi (SO) function may prevent normal bile flow and thus enhance probability of common bile duct stone (CBDS) formation. We have previously shown increased prevalence of diagnosed hypothyroidism in CBDS patients, which may be explained by thyroxine-induced inhibition of SO contractility, in addition to previously suggested changes in bile composition and hepatocytic excretion. The aim of this study was to investigate biliary dynamics in relation to altered thyroid gland function in rat, a rodent without a gallbladder. Euthyroid, hypothyroid or hyperthyroid Spraque-Dawley rats were anaesthetized with i.p. urethane, and exsanguinated at 15, 45, or 60 min after intravenous 99mTc HIDA injection. At these timepoints, the bile flow to intestine was determined by measuring the relative intestine vs. liver radioactivity. At 45 min this was 44% lower in hypothyroid rats and at 60 min 73% higher in hyperthyroid rats compared to euthyroid rats, while hepatic radioactivity at 15 min and blood pressure at injection were similar in the groups. We conclude that the bile flow to duodenum is reduced in hypothyreosis and enhanced in hyperthyreosis.

Studies on the site and mechanism of the inhibitory action of intracerebral histamine on the cold-stimulated thyrotropin secretion in male rats.

The locus of the inhibitory action of histamine on cold-stimulated TSH secretion was studied in male rats. Various histaminergic drugs were given either into the median eminence (ME), the third ventricle, the rostral and caudal part of anterior hypothalamus (rAH and cAH) or the posterior hypothalamus (PH) of conscious rats. When infused into ME, histamine (5 and 10 micrograms/rat) decreased and mepyramine (2.5 micrograms) increased the cold-stimulated TSH secretion while a larger dose of mepyramine (10 micrograms/rat), impromidine (0.05 and 0.1 microgram/rat), 2-pyridylethylamine (2-PEA; 5 and 10 micrograms/rat) and cimetidine (2.5 and 7.5 micrograms/rat) had no effect. The inhibitory action of histamine (5 micrograms/rat) was most marked 30 min after the infusion into ME and it remained significant for at least 50 min. Neither cimetidine (50 and 100 mg/kg i.p.) nor mepyramine (10 and 20 mg/kg i.p.) antagonized the inhibitory action of histamine (5 micrograms/rat) in ME. Histamine (10 micrograms/side) inhibited the cold-stimulated TSH secretion likewise when infused bilaterally either into rAH, cAH or PH. TSH secretion induced by exogenous TRH (100 ng i.p.) was also inhibited by histamine (1 microgram/rat) given into the third ventricle. In conclusion, histamine seems to have an inhibitory action on the cold-stimulated TSH secretion. This action is apparently mediated through areas close to the third ventricle. The mechanism of this action seems to be fairly non-specific, i.e. it is mediated through neither H1- nor H2-receptors.

Possible involvement of nigrostriatal dopamine system in the inhibition of thyrotropin secretion in the rat.

The dopaminergic inhibition of cold-stimulated thyrotropin (TSH) secretion was studied in male rats. Serum TSH levels were decreased by apomorphine (1 mg/kg i.p.) but not by dopamine (DA, 0.2--5 mg/kg s.c.). This effect of apomorphine was abolished by haloperidol (1 mg/kg i.p.), metoclopramide and sulpiride (10 mg/kg i.p.) but not by domperidone (0.1--5 mg/kg i.p.). Domperidone does not cross the blood-brain barrier while the other DA receptor antagonists do so. High doses of domperidone itself inhibited the cold-induced TSH secretion whereas the other DA antagonists did not. DA (1--10 micrograms/rat) into the medial basal hypothalamus (MBH) had no effect but 10--50 micrograms/rat into the 3rd ventricle inhibited the cold-stimulated TSH secretion. 6-Hydroxydopamine infusion after desipramine pretreatment (25 mg/kg i.p.) did not affect TSH secretion when given into the MBH (2 micrograms/rat), the 3rd ventricle (100 micrograms/rat) or unilaterally into the substantia nigra (SN, 6 micrograms/nucleus), but bilateral nigral infusions abolished the TSH cold response. The inhibitory effect of apomorphine (0.1 and 0.5 mg/kg i.p.) was amplified only in the rats whose SN was unilaterally destroyed. These results show that tuberoinfundibular DA neurons do not affect TSH secretion. Instead, the inhibition is mediated through the hypothalamic projections of the nigrostriatal DA system.

Dual action of morphine on cold-stimulated thyrotropin secretion in male rats.

The effect of morphine infused into 4 hypothalamic locations and the periaqueductal gray (PAG) on cold-stimulated thyrotropin (TSH) secretion was studied in male rats. Morphine decreased TSH cold-response when infused into the 3rd ventricle (1-20 micrograms/rat) or the median eminence (5 and 10 micrograms/rat). Infusions bilaterally into the anterior hypothalamus (1-10 micrograms/side) or PAG (1 and 10 micrograms/rat) were ineffective, while those given into the posterior hypothalamus (1 and 5 micrograms/side, but not 10 micrograms/side) significantly enhanced TSH cold-response. Naloxone pretreatment (2 or 5 mg/kg, s.c.) reversed the decreasing effect of morphine in the 3rd ventricle (1 microgram/rat) and the increasing effect of morphine in the posterior hypothalamus (1 microgram/side). We conclude that morphine has a dual hypothalamic action on cold-stimulated TSH secretion: an inhibition periventricularly, and a stimulation in the posterior hypothalamus.

Development of progressive pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG) associated with therapy-resistant chronic systemic juvenile arthritis (CJA).

A girl aged 5 years with therapy-resistant chronic systemic juvenile arthritis (CJA) developed progressive fibrosing lung disease. Histology of an open lung biopsy revealed pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG). Since treatment with steroids and immunosuppressive drugs did not prevent progression of lung fibrosis, an experimental treatment with a tumor necrosis factor alpha (TNF alpha) antagonist etanercept was started. Although development of chronic changes in the lung parenchyma could not be prevented, this treatment brought considerable relief and markedly improved the child's physical capacity. By ruling out other causes for development of PICG, we concluded that the primary disease had caused the development of cholesterol granulomata by macrophage activation. We suggest, therefore, that a trial with etanercept in children with otherwise therapy-resistant CJA should be considered, especially if pulmonary complications have developed.

Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy.

This prospective study consisted of 32 patients. In each patient, bile was collected during two separate endoscopic retrograde cholangiopancreatographies (ERCP) to study changes in biliary bacteriology and cytology. The mean interval between ERCPs was 20 months (15-29 months). Twenty-three patients had gallstones in the gallbladder, bile ducts, or both. Nineteen of them had bactibilia compared to none of the 9 patients with normal ERCP (P less than 0.001). Fifteen patients had normal bile ducts in ERCP (Group 1). Four of these patients (27%) had bactibilia initially and 9 (60%) at follow-up (P = 0.069). Seventeen patients had bile duct stones and underwent endoscopic sphincterotomy (Group II). Fifteen of these patients (88%) had bactibilia initially, and 15 (88%) also had bactibilia at follow-up. Initially, anaerobic bacteria were detected in 37 per cent of Group I patients with bactibilia and in 50 per cent of Group II patients with bactibilia. At follow-up, the bile in Group I patients infrequently (11%) contained anaerobes, whereas in Group II patients anaerobes predominated (67%; P less than 0.011). Clear correlation between the biliary cytology and bacteriology could not be observed. The authors conclude that ERCP may result in increased incidence of long-term bactibilia and suggest that contamination occurred during ERCP. The bactibilia associated with bile duct stones does not subside after endoscopic treatment of the common duct stones.