Characterization of the DNA of a Nonoccluded Baculovirus, Hz-1V

The DNA of the nonoccluded baculovirus (Hz-1V) obtained from the IMC-Hz-1 cell line was characterized by physicochemical and restriction endonuclease techniques. Hz-1V DNA isolated from purified virus had buoyant densities of 1.58 and 1.54 g/ml in CsCl-ethidium bromide density gradients, which corresponded to supercoiled and to relaxed circular and linear DNA, respectively. Neutral CsCl equilibrium centrifugation indicated that the Hz-1V DNA had a buoyant density of 1.7024 g/ml, which corresponded to a guanine-plus-cytosine (G+C) content of 43%. Thermal denaturation indicated a high G+C domain(s) in the Hz-1V genomic DNA. The domain(s), which included about 11% of the total genomic DNA, exhibited a T(m) of 97 degrees C. The remaining portion (89%) of the DNA had a T(m) of 86.5 degrees C. The T(m)s corresponded to G+C contents of 42 and 67%, respectively. The mean genetic complexity of Hz-1V DNA determined by DNA reassociation kinetic analysis was found to be 152 x 10(6). A possible rapidly reassociating component comprising approximately 13% of the genome was observed. The mean molecular weights from restriction endonuclease digests were 159 x 10(6) for both HindIII and EcoRI. Genomic heterogeneity was found in both the wild-type Hz-1V stock and in two plaque isolates. Of 12 single-plaque isolates, 3 basic restriction endonuclease DNA fragment patterns were observed. The molecular size estimates from electron microscopic contour lengths of uncloned viral DNA ranged from 70 to 158 megadaltons, and the mode was the 130- to 140-megadalton class.

Muscle function and morphology in myotonic dystrophy

Patients with myotonic dystrophy classified clinically into function groups were studied. Muscle strength for knee extension and flexion was, with few exceptions, moderately or markedly reduced with successively more severe clinical disability. The reduction in maximal walking speed showed a similar tendency. There was a large percentage of both type I and in relation to normal findings of type II C fibers in biopsies from most patients. The fiber area varied greatly even in the patients in the best function groups, some of whom had large type II fibers. The most common-histopathological changes, found in all function groups, were fiber atrophy with small angular fibers, internal nuclei, splitting, fibrosis and moth-eaten fibers. A high percentage of type I fibers can already be seen in patients with practically no other morphological changes and without significant functional deterioration.

Characterization of beta-lactam-resistant Bacteroides fragilis isolates by use of PCR fingerprinting

PCR fingerprinting was used for characterization of 35 beta-lactam-resistant Bacteroides fragilis strains isolated in Sweden and Hungary. Ten B. fragilis strains showed unique PCR fingerprints by use of the M13 core primer. Their main product was a DNA fragment with a length of 2000-bp which was absent in the other 25 strains and the reference strain B. fragilis ATCC 25285. The 2000-bp fragment from four imipenem-resistant strains gave rise to positive reactions in a specific PCR for detection of ccrA. Printed by the T3B primer, five B. fragilis strains, including the imipenem-resistant strains showed unique PCR fingerprints. The investigated imipenem-resistant strains produced carbapenem-hydrolysing metallo-beta-lactamases. The study indicates that the unique PCR fingerprinting profiles shown in highly beta-lactam resistant B. fragilis strains are correlated to antimicrobial resistance. The PCR fingerprinting technique is a useful tool for differentiation of Bacteroides fragilis strains with high-level beta-lactam resistance.

Examination of cfiA-mediated carbapenem resistance in Bacteroides fragilis strains from a European antibiotic susceptibility survey

Of 1284 Bacteroides strains collected in Europe in 2000 for antibiotic susceptibility surveillance, 65 isolates displayed imipenem minimum inhibitory concentrations (MICs) > or =1 mg/L and were chosen for a thorough analysis of their resistance mechanism. Twenty-five of the isolates were positive for the cfiA carbapenem resistance gene. The resistance rates were 0.8% and 1.3% for imipenem and meropenem, respectively. In six of the strains, insertion sequence (IS) elements (IS613, IS614B, IS1186 and IS1187) activated the cfiA gene. However, other strains displayed at least elevated carbapenem MICs or were carbapenem resistant and produced measurable carbapenemase activities but did not harbour IS elements in the region upstream of the cfiA gene. The major determinant of carbapenem resistance in Bacteroides fragilis is production of CfiA metallo-beta-lactamase via activation of the cfiA gene by IS elements (higher level resistance) or by activation of its putative own promoter.

Cerebrovascular accidents after cardiac surgery: an analysis of CT scans in relation to clinical symptoms

There is a link between aortic manipulation, particle embolization, and cerebrovascular accidents (CVA) in cardiac surgery. The present aim was to study hemispheric side differences of CVA. Cardiac-surgery patients with CVA and with computer tomography (CT) performed (n = 77) were analyzed within a total group of 2641 consecutive cases. CT data were reviewed for hemispheric and vascular distribution, and compared with CVA-symptom data of immediate and delayed type. Of the included patients, 66% had positive CT. In the group of 'cardiac-type' operations (e.g., routine clamping and cannulation) and having immediate CVA, right-hemispheric lesions were more frequent than of the contra-lateral side (p = 0.005). Patients with aortic dissections had strong dominance of bilateral findings, which was different from the unilateral pattern of 'cardiac-type' operations (p = 0.001). The middle-cerebral artery territory dominated, and when involved showed a significant (p = 0.022) right-sided distribution. Both CT and clinical symptoms confirmed that CVA after cardiac surgery has a right-hemispheric predominance. These observations may imply that aortic manipulation directs embolic material towards the brachiocephalic trunk.

31P MRS evaluation of fatigue in anterior tibial muscle in postpoliomyelitis patients and healthy volunteers

Changes in concentration of high energy phosphates and pH were studied during rest, exercise and subsequent recovery in the anterior tibial muscle of 10 patients with late effects of poliomyelitis and 10 age- and sex-matched healthy volunteers using 31P MRS. The exercise was dynamic and isometric, and the force levels were individually adapted to each subject and stepwise increased. In general, there were no differences in metabolite changes between the groups, except for lower Pi and Pi/PCr for the volunteers during the recovery phase, also reflected by shorter recovery half-time for Pi. The interindividual variation was much higher for the patient group. Some of the patients showed deviating results probably because of differences in muscle fibre type.

Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe

OBJECTIVE

To evaluate the activity of old and newer antianaerobic drugs against clinical isolates of Bacteroides fragilis group strains from different parts of Europe.

METHODS

Bacteroides fragilis group isolates from 37 laboratories in 19 countries were biochemically characterized. The MICs of seven antimicrobial agents were determined by the agar dilution method as recommended by the NCCLS. Production of beta-lactamase was detected by nitrocefin.

RESULTS

There were 1284 B. fragilis group isolates included in the study. Abdominal infections and wounds were the most common sources of isolation and B. fragilis was the dominating species. Ninety-nine percent of the strains were resistant to ampicillin (breakpoint 2 mg/L), 6% to cefoxitin (64 mg/L), 15% to clindamycin (8 mg/L) and 9% to moxifloxacin (8 mg/L). Less than 1% were resistant to imipenem (16 mg/L), piperacillin-tazobactam (128 mg/L) and metronidazole (32 mg/L). Ninety-six percent of the isolates were beta-lactamase producers.

CONCLUSIONS

Antimicrobial resistance among the B. fragilis group is increasing.

Depleted uranium particles in selected Kosovo samples

Selected soil samples, collected in Kosovo locations where DU ammunition was expended during the 1999 Balkan conflict, have been investigated by secondary ion mass spectrometry (SIMS), X-ray fluorescence imaging using a micro-beam (micro-XRF) and scanning electron microscopy equipped with an energy dispersive X-ray fluorescence detector (SEM-EDXRF), with the objective to test the suitability of these techniques to identify the presence of small DU particles and measure their size distribution and the 235U/238U isotopic ratio (SIMS). Although the results do not permit any legitimate extrapolation to all the sites hit by the DU rounds used during the conflict, they indicated that there can be "spots ' where hundreds of thousands of particles may be present in a few milligrams of DU contaminated soil. The particle size distribution showed that most of the DU particles were <5 microm in diameter and more than 50% of the particles had a diameter <1.5 microm. Knowledge on DU particles is needed as a basis for the assessment of the potential environmental and health impacts of military use of DU, since it provides information on possible re-suspension and inhalation.

Distress in everyday life in people with poliomyelitis sequelae

The prevalence of distress in aspects of perceived health and its relation to involvement of poliomyelitis sequelae were studied with the Nottingham Health Profile (NHP) in 113 outpatients (mean age 57 years). The leisure and employment situation was also recorded. Most distress was found in the NHP dimensions physical mobility, pain and energy, and least distress in social isolation. Most health-related problems were reported in housework, employment and leisure. Three-quarters of the persons were satisfied with their leisure, although many of them had problems. Fifty-nine per cent of the subjects of working age were in gainful employment, and no difference in employment rate due to the distribution of polio involvement was found. In comparison with norm values for the respective age groups, the subjects with poliomyelitis sequelae aged below 45 and 45-65 years had more distress in a larger number of NHP dimensions than older subjects.

Physical activity, muscle performance and quality of life in patients treated with chronic peritoneal dialysis

OBJECTIVE

Today's medical treatment of patients with end-stage renal failure has increased their opportunities for an active lifestyle. The aim of this study was to describe the muscle performance, level of physical activity, independence in activities of daily living and quality of life in patients treated with chronic peritoneal dialysis.

MATERIAL AND METHODS

The study investigated 33 patients (30-81 years old) treated with chronic peritoneal dialysis. The results were compared with an age-matched healthy reference group. Muscle mass was determined by measuring total body potassium, while maximal grip strength was measured with an electric force transducer. The ability to perform heel-lifts, walking speed and level of physical activity were also assessed, along with the extent to which patients were independent in activities of daily living (ADL) and satisfied with their health.

RESULTS

Total body potassium was 97 +/- 11.6% of normal and correlated positively with the maximal grip strength (r = 0.658, p < 0.0002) and the maximal walking speed (r = 0.558, p < 0.0027). Maximal grip strength was 70% of the reference, the ability to perform heel-lifts was 49% of the reference, the walking speed was 85% the reference and the level of physical activity was 56% of expected. The patients were independent in ADL to a great extent and 52% of the patients were satisfied with their health.

CONCLUSION

The peritoneal dialysis patients had a relatively good quality of life and were largely independent in ADL Further studies are needed to investigate whether it is possible to improve muscle performance and the level of physical activity with exercise and muscle training in these patients.

Muscle performance in an urban population sample of 40- to 79-year-old men and women

An urban population sample of 40 to 79-year-old men and women was investigated to evaluate the influence of age and activity level on muscle strength and endurance and to establish a reference material. During the investigation 144 persons were tested bilaterally, except for ankle strength, when only the right side was examined. Isometric muscle strength was determined in the knee extensors and flexors. Isokinetic (at 60 degrees/s and at 180 degrees/s) muscle strength was determined concentrically and eccentrically in the knee extensors and flexors. The dynamic and static endurance of the extensors was measured. Isometric strength was determined in the ankle plantar and dorsiflexor muscles. Isokinetic ankle plantar flexion strength was determined concentrically at 60 degrees/s with and without prior eccentric muscle contraction. Hand-grip strength was evaluated with a dynamometer. Walking velocity and the number of heel-rises were recorded. Physical activity level was assessed by questionnaire. Muscle biopsies were taken from the vastus lateralis muscle for histochemical and enzymatic analyses. Walking and the different muscle tests declined with age, and with a slight gender difference. Muscle biopsies showed a trend toward smaller muscle fibers with age. The results of our study can be used as reference material for clinical studies in different age groups.

Ecological disturbances in intestinal microflora caused by clinafloxacin, an extended-spectrum quinolone

BACKGROUND

The quinolones developed over the past few years have enhanced in vitro activity and a broader spectrum of antimicrobial activity compared to many other antimicrobial agents including the older quinolones. The present study focuses on the effect of clinafloxacin, a member of the new broad-spectrum quinolone class of antibiotics, on the normal intestinal microflora.

SUBJECTS AND METHODS

A total of 12 healthy volunteers received clinafloxacin orally, 200 mg twice daily for 7 days. Fecal specimens were collected at defined intervals before, during and after the administration in order to study the effect of clinafloxacin on the intestinal microflora and to correlate this effect with fecal clinafloxacin concentrations. Intestinal microorganisms isolated before, during and 2 weeks after clinafloxacin administration were tested for their suseptibility to clinafloxacin.

RESULTS

Oral administration of clinafloxacin resulted in high drug levels in feces (mean value 176.2 mg/kg on day 7) and pronounced ecological disturbances. The aerobic microflora was eradicated in 11 of the 12 subjects and the anaerobic microflora was strongly suppressed during administration. There was a significant emergence of clinafloxacin-resistant Bacteroides spp. strains (MIC > or = 4 mg/ml) during administration. The elevated MIC values still remained 2 weeks after discontinuation of the antibiotic (p < 0.001).

CONCLUSION

The emergence of clinafloxacin-resistant Bacteroides spp. demonstrates the necessity of restricting prescription for particular indications in order to preserve the efficacy of the highly active broad-spectrum quinolones.

Electrophysiologic evaluation of muscle fatigue development and recovery in late polio

OBJECTIVES

To study aspects of fatigue in late-polio patients and healthy controls. We hypothesized that late-polio subjects would develop more peripheral fatigue, assessed with surface electromyography (EMG), and that no major differences would exist between the two groups in neuromuscular junction transmission.

DESIGN

Case-control study.

SETTING

University hospital laboratory.

SUBJECTS

Ten patients with a history of polio (mean age, 54 yrs, SD = 5; mean time since polio onset, 49 yrs, SD = 7) and a matched control group (mean age, 52 yrs, SD = 8).

METHODS

A protocol with a stepwise force increase up to 80% of maximal voluntary contraction ending with an 8-minute recovery period was performed twice, first with surface EMG and then with electrical stimulation and surface-recorded evoked M-response.

MAIN OUTCOME MEASURES

Surface EMG analysis of voluntary activity and evoked M-response.

RESULTS

No significant differences existed between groups in the relative decrease during the fatigue protocol. The recovery of force was slower in the late-polio subjects. A reduction in the root mean square (RMS) value during recovery was seen in the polio group, although a normalization of the mean power frequency (MPF) was seen in both groups.

CONCLUSION

The weakness during the fatigue procedure was not caused by neuromuscular blockade, because electrical nerve stimulation evoked a normal response. The weakness after exercise was the result of a slow recovery that may reflect both central and peripheral fatigue.

Activities of synthetic hybrid peptides against anaerobic bacteria: aspects of methodology and stability

The increasing problem of antibiotic resistance among pathogenic bacteria requires development of new antimicrobial agents. One line of investigation is the synthesis of antimicrobial hybrid peptides. The aim of the present investigation was to determine the in vitro activities of 16 cecropin-melittin hybrid peptides (CAMEL analogues) against 60 anaerobic bacterial strains, to compare their activities with those of seven clinically used antimicrobial agents, and to compare different methods for anaerobic susceptibility testing of these peptides. The stability of one of the peptides, temporin B, with different stereoisomeric configurations was investigated in a fecal milieu. The CAMEL analogues showed antimicrobial activity against the anaerobic bacteria, with MICs ranging from 0.125 to 32 microg/ml. The overall activities (the MICs at which 90% of isolates are inhibited) of the CAMEL analogues against anaerobic bacteria were mainly inferior to those of imipenem, clindamycin, and piperacillin but were equal to or superior to those of metronidazole, cefoxitin, ciprofloxacin, and chloramphenicol. The agarose dilution method was found to be an accurate method for the testing of large numbers of bacterial strains. The D isomer of temporin B was inactivated more slowly in feces than the L isomer. This study shows that the CAMEL analogues are potential agents for the treatment of anaerobic infections.

Long-term effects on the regulation of pancreatic secretion after gastric surgery

BACKGROUND

Apart from smoking, known risk factors for the development of pancreatic carcinoma are few, gastric resection being proposed as one. The trophic effect of cholecystokinin (CCK) on the pancreatic gland is well known from animal experience and increased concentrations of CCK in plasma have been shown to induce pancreatic neoplasia experimentally. In several studies the release of CCK in response to food ingestion has been shown to be increased following gastric surgery. However, in those studies, the time between surgery and investigation of the CCK response was short, and methods of CCK analysis have since improved.

PATIENTS AND METHODS

In patients, partially gastrectomized 8 years (median) earlier, we studied the plasma concentrations of CCK, insulin and gastrin, as well as some specific pancreatic enzymes. The findings were compared to an age-matched control group of individuals not subjected to gastric surgery.

RESULTS

Basal CCK concentrations in the operated group were found to be lower, but increased postprandially to the same level as in controls. Serum levels of specific pancreatic enzymes were equal in the 2 groups.

CONCLUSION

It is possible that a disturbed regulation of pancreatic secretion, or a secretory dysfunction within the gland, following partial gastrectomy, could contribute to the development of pancreatic carcinoma. However, our findings do not favor the idea of plasma CCK as a promotor of pancreatic carcinoma.

Survival following pancreatic carcinoma: a follow-up study of all cases recorded in Malmö, Sweden, 1977-1991

BACKGROUND

The aim of this follow-up study was to assess whether there has been any increase in the percentage of patients offered attempted curative surgery for pancreatic carcinoma and whether the overall survival rate has improved, during the time period 1977-1991.

METHODS

Details of new cases of pancreatic carcinoma arising in the population of Malmö during the study period were retrieved from the Local Tumour Register in Lund, Sweden. In all, 740 patients were found; 575 of these were diagnosed before death. Kaplan-Meier analysis was used to calculate overall survival rates, and Cox regression analysis was used to assess survival in relation to year of diagnosis after adjustment for sex, age at diagnosis and stage of disease.

RESULTS

Cytological or histopathological evidence of the disease was given in 95 per cent of cases. The overall 5-year survival rate was 0.5 per cent (three of 575). Curative surgery was attempted in 24 patients (4.2 per cent); the proportion undergoing curative surgery increased in the last part of the study. Two of the 24 patients in this group survived for 5 years.

CONCLUSION

The prognosis in pancreatic carcinoma remains dismal. Attempted curative surgery still is the only hope for cure, but the group of patients that can be offered this possibility is very limited. In this study, an increase was found in the proportion of patients who were offered attempted curative surgery, but there was no statistically significant increase in the 5-year survival rate following surgery.

[Choose preparations that affect the intestinal ecosystem as little as possible!]

The administration of antimicrobials often causes ecological disturbances in the normal microflora, such as decreased colonisation resistance which may result in overgrowth of potentially pathogenic micro-organisms such as yeasts and Clostridium difficile. Another possible consequence is the establishment of resistant strains which may spread within the host, or from person to person, causing infection. Resistant bacteria can also transfer resistance genes to their own or other species. The article consists in a review of studies performed by various investigators during the past 20 years, and illustrating the impact of different antimicrobial agents on the human gastrointestinal microflora.

Impact of endogenous thrombopoietin levels on the differential diagnosis of essential thrombocythaemia and reactive thrombocytosis

By using the newly commercialized Quantikine human TPO immunoassay, plasma thrombopoietin (TPO) concentrations were measured in 12 patients with essential thrombocythaemia (ET), 13 patients with reactive thrombocytosis (RT) and 11 healthy volunteers. For the healthy volunteers the mean plasma TPO concentration was 21.1+/-11.0 pg/ml. The mean plasma TPO concentration in the group of RT was slightly lower (16.4+/-8.6 pg/ml) but did not differ significantly from the control group. The mean plasma TPO concentration in ET patients (44.1+/-45.2 pg/ml) was significantly (p<0.05) higher than the mean for RT patients, but did not differ statistically from the mean of healthy volunteers. These data suggest a defective clearance of plasma TPO in patients with ET.

Muscular performance in heart failure

BACKGROUND

Some of the major symptoms in patients with chronic heart failure are muscle weakness and fatigue. However, not much is known about muscle performance in these patients compared to healthy controls.

METHODS AND RESULTS

Activity level, gait speed, hand grip strength, muscle performance of the knee extensors and flexors along with the plantar and dorsal flexors of the foot were evaluated. Muscle biopsies from the lateral vastus lateralis were taken. Sixteen patients in New York Heart Association class II or III were tested and compared to 112 reference subjects. Compared to the reference subjects, there was a reduction in activity level, gait speed, isometric and isokinetic peak torque for knee extension at different velocities, hand grip strength, peak torque for plantar and dorsal flexion of the ankle and isometric and isokinetic endurance for the knee extension. Recovery was faster. There were small differences in fiber composition. 3-Hydroxy-acylCoA-dehydrogenase and citrate synthase were lower, and lactate dehydrogenase was increased.

CONCLUSIONS

Muscle performance is affected in terms of both strength and endurance, which might affect performance in everyday activities. The more pronounced reduction in hand grip compared to the other muscles tested could be an indication of intrinsic abnormalities in the skeletal muscle.

Pancreatic carcinoma following gastric resection. A case-control study based on 21,660 consecutive clinical necropsies at Malmö University Hospital

CONCLUSION

In this necropsy-based case-control study, there was no relationship between pancreatic carcinoma and previous gastric resection. Based on the association between lung cancer and gastric resection, it is suggested that the relationship between pancreatic carcinoma and gastric resection shown in other studies may have been confounded by smoking.

BACKGROUND

This case-control study was designed to assess whether in patients dying from pancreatic carcinoma, there is a relationship to previous gastric resection for peptic ulcer disease.

METHODS

By linking the autopsy data base in Malmö with the national Cause of Death Register, we identified 439 autopsied individuals who had died of pancreatic carcinoma between 1970 and 1982. The 21,660 individuals in the data base represent 64% of all deaths during that time period. For each of these individuals who died of pancreatic carcinoma, we randomly chose three controls who were matched for age at death, gender, and year of death. In order to assess the specificity of the assumed relationship, we also used as a control group the 1337 autopsied individuals who had died of lung cancer.

RESULTS

The prevalence of previous gastric resections was 3.4% in patients dying from pancreatic carcinoma, 7.6% in patients dying from lung cancer, and 4.4% in the age- and sex-matched control group. The odds for previous gastric resection in patients dying from pancreatic carcinoma was 0.9 [95% confidence interval (CI) 0.5-1.7] in comparison with this age- and sex-matched control group. The lower odds for previous gastric resection in patients dying of pancreatic carcinoma than in patients dying of lung cancer remained in the logistic regression analysis after controlling for age at death, gender, and year of death (odds ratio [OR] 0.5; 95% CI 0.3-0.9).