Biofilm in complicated urinary tract infection.

We studied the clinical efficacy of oral treatment with ciprofloxacin (CPFX) alone and combined with clarithromycin (CAM) in patients with complicated urinary tract infection with or without an indwelling catheter. Patients were randomly allocated to 600 mg CPFX (CPFX group) or to 600 mg CPFX plus 600 mg CAM (combination group) for 14 days. Evaluation was done on day 14 according to the criteria advocated by the Japanese Urinary Tract Infection Committee. In patients with a urinary catheter, the combination achieved a higher complete bacterial elimination rate (50.0%) and clinical efficacy rate (83.9%) than CPFX alone (30.0 and 61.5%, respectively). While no significant difference was found in the bacterial elimination rate between the two groups, the clinical efficacy of the combination (40.0%) was superior to that of CPFX alone (23.3%) in patients with an indwelling catheter. The better clinical efficacy of the combination may partly be attributed to the antibiofilm effect of CAM in the clinical setting. The results also indicate that difficulties still remain in the treatment of complicated urinary tract infections in patients with an indwelling catheter.

Reflex responses of bladder motility after stimulation of interspinous tissues in the anesthetized rat.

OBJECTIVES: To determine the effects of somatic stimulation, including noxious chemical stimulation of interspinous tissues, on bladder motility in the anesthetized rat. METHODS: Changes in pressure in the previously quiescent bladder were measured in anesthetized adult female Wistar rats after various forms of noxious and innocuous somatic stimulation, including injection of the thoracic and lumbar interspinous tissues with capsaicin. Measurements were taken in both central nervous system-intact and spinalized animals, as well as in animals in whom the pelvic nerves had been transected bilaterally. Changes in bladder pressure were also measured in response to electrical stimulation of the primary dorsal ramus of lumbar spinal nerves. RESULTS: Noxious and innocuous stimulation of the fore- and hindpaws and the skin overlying the sacrum generally failed to elicit discernible changes in bladder pressure. However, capsaicin injection of thoracic and lumbar interspinous tissues produced profound and long-lasting increases in bladder pressure. There were no significant differences in the responses to thoracic, as opposed to lumbar, stimulation. Spinalization above the level of stimulation abolished the response to capsaicin injection, as did bilateral transection of the pelvic nerves. CONCLUSION: In general, pressure in the quiescent bladder was relatively insensitive to somatic stimulation. However, noxious chemical stimulation of the interspinous tissues produced a nonsegmentally organized, supraspinal, parasympathetically mediated reflex increase in bladder tone.

Hypothalamic corticotropin-releasing hormone (CRH) secretion into hypophysial portal blood is regulated by cutaneous sensory stimulation in anesthetized rats.

The effects of noxious and non-noxious mechanical stimulation of various segmental skin areas (face, forelimb and forepaw, abdomen, hindlimb and hindpaw) on the secretion of immunoreactive corticotropin-releasing hormone (iCRH) from the hypothalamus into hypophysial portal blood was examined in artificially ventilated rats under halothane anesthesia. Secretion of iCRH was calculated from the iCRH concentration in hypophysial portal plasma and the plasma flow rate. Noxious mechanical stimulation of the skin was delivered by pinching using surgical clamps, while non-noxious mechanical stimulation was provided by brushing with tooth brushes. Pinching of the bilateral forepaws or hindpaws and brushing of the bilateral hindlimbs for 20 min increased hypothalamic iCRH secretion. In contrast, pinching of the face or abdomen and brushing of the face, forelimbs, or abdomen for 20 min did not significantly influence it. These results indicate that cutaneous mechanical sensory stimulation contributes to the reflex regulation of CRH secretion from the hypothalamus into hypophysial portal blood, and also that this effect is highly dependent on the site of stimulation.

Age-related changes in rates of basal secretion of immunoreactive vasoactive intestinal polypeptide and dopamine into pituitary stalk blood from the hypothalamus in anesthetized male rats.

Age-related changes in prolactin (PRL) in systemic blood plasma, and in secretions of hypothalamic vasoactive intestinal polypeptide (VIP), an important candidate for PRL-releasing factor, and dopamine, a PRL-inhibiting factor, into the pituitary stalk blood were investigated. The experiments were performed on male urethane-chloralose-anesthetized Wistar rats of three different ages, i.e., (1) adult rats 5-8 months old, (2) middle-aged rats 12-15 months old, and (3) aged rats 24-26 months old. The concentration of immunoreactive PRL (iPRL) in systemic blood plasma of the aged rats was significantly higher than that of the adult rats (p less than 0.01). The secretion rate of hypothalamic immunoreactive VIP (iVIP) into the pituitary stalk blood was unchanged during aging, while that of dopamine was markedly increased in the aged rats in comparison with the value in both adult and middle-aged rats (p less than 0.01). These results indicate that the basal secretion of hypothalamic VIP is well maintained, while that of hypothalamic dopamine is augmented in aged rats with hyperprolactinemia. It can be assumed that the increase in the pituitary PRL secretion is a primary event during aging in rats, and that a high circulating level of PRL may facilitate the hypothalamic dopamine secretion through the activation of a negative feedback system of the hormone.