Characterization of an antibiotic resistant Clostridium hathewayi strain from a continuous-flow exclusion chemostat culture derived from the cecal contents of a feral pig

The chemostat model has been an important tool in studying intestinal microflora. To date, several competitive exclusion products have been developed from such studies as prophylactic treatment against pathogenic bacteria. A continuous-flow chemostat model of a feral pig was developed using inocula from the cecal contents of a wild boar caught in East Texas. Several strains of antibiotic-sensitive bacteria were isolated including Bacteroides, Lactobacillus, Enterococcus and Clostridium sp. This study reports on the characterization of a multidrug-resistant Clostridium hathewayi strain that was isolated from this feral pig's cecal contents maintained in a continuous-flow chemostat system showing high resistance to carbapenems and macrolides (including the growth promoter tylosin). Clostridium hathewayi has been documented to be pathogenic to both humans and animals. Feral pigs may be an important source of pathogenic and antibiotic resistant bacteria and may pose potential risk to domestic species. Further work is needed to elucidate the prevalence of these reservoirs and assess the contribution these may play in the spread of disease and resistance.

Effect of B vitamins and genetics on success of in-vitro fertilisation: prospective cohort study

BACKGROUND

There is a need to understand what affects the success of in-vitro fertilisation (IVF) and the rate of resulting twin births so that pregnancy rates can be improved and multiple gestations avoided. Our aim was to assess the role of B vitamins and genetics.

METHODS

We did a prospective cohort study of 602 women undergoing fertility treatment. We assessed intake of folate and vitamin B12 with a questionnaire and measured their plasma and red-blood-cell concentrations by radioimmunoassay. We measured five B-vitamin-related gene variants in women who received treatment and in 932 women who conceived naturally.

FINDINGS

The likelihood of a twin birth after IVF rose with increased concentrations of plasma folate (1.52, 1.01-2.28; p=0.032) and red-cell folate (1.28, 1.00-1.65; p=0.039). There was no association between folate and vitamin B12 levels and likelihood of a successful pregnancy. Women homozygous for the 1298 CC variant of methylenetetrahydro-folate reductase (MTHFR), rather than the AA variant, were less likely to produce a livebirth after IVF (0.24, 0.08-0.71; p=0.003) or to have had a previous pregnancy (0.42, 0.21-0.81; p=0.008).

INTERPRETATION

Our findings suggest that MTHFR genotype is linked to a woman's potential to produce healthy embryos (possibly through interaction with genes related to DNA methylation). In women likely to have a successful IVF pregnancy, high folate status increases the likelihood of twin birth after multiple embryo transfer. Proposals to fortify the UK diet with folic acid could lead to an increase in the number of twins born after IVF.

Rehabilitation practice following profound brain damage

The rehabilitation of the person with profound brain damage is a complex process requiring the skills of a true interdisciplinary team. The process is as much about the ability to: assess and diagnose; provide the optimal environment for recovery; prevent and treat secondary complications; support the family; and modify the environment as it is about a formal rehabilitation programme. Ideally these should be seamless but each contains many challenges, including the experience and skills of the observer, the ability to communicate with members of the family, and the ability to work within an interdisciplinary team.

Behavioral evaluation of consciousness in severe brain damage

This paper reviews the current state of bedside behavioral assessment in brain-damaged patients with impaired consciousness (coma, vegetative state, minimally conscious state). As misdiagnosis in this field is unfortunately very frequent, we first discuss a number of fundamental principles of clinical evaluation that should guide the assessment of consciousness in brain-damaged patients in order to avoid confusion between vegetative state and minimally conscious state. The role of standardized behavioral assessment tools is particularly stressed. The second part of this paper reviews existing behavioral assessment techniques of consciousness, showing that there are actually a large number of these scales. After a discussion of the most widely used scale, the Glasgow Coma Scale, we present several new promising tools that show higher sensitivity and reliability for detecting subtle signs of recovery of consciousness in the post-acute setting.

Medical decision making in the vegetative state: withdrawal of nutrition and hydration

Withdrawal of nutrition and hydration, is a difficult and sensitive issue for all those working with people in the vegetative state. There are arguments against the decision to withdraw any treatment that might result in the patient deteriorating or dying. These arguments include the view that all life is worth having, that we can never be certain that the patient is not aware, and concerns that there may be new scientific developments in the future from which the patient would benefit. Others argue that the patient has no interests in life; that it is undignified, if not an assault, to insert tubes into a permanently unconscious person; that very few people would want to survive in this condition; and that it prevents loves ones from grieving. These strongly held opposing views can make clinical decision making very difficult for the clinician. Once the decision has been made to withdraw treatment then the clinician has to be certain that the patient is in the vegetative state, that there are no factors preventing the patient demonstrating awareness, that he has received expert assessment and treatment, and that the prognosis for lack of recovery is as clear as it can be. It is important to support family and staff throughout this process. The concept of withdrawal of nutrition and hydration is a sensitive issue and clinicians can expect to be considered as not acting in the patient's best interest whatever decision is taken.

Patterns of smoking, quit attempts and services for a cohort of 15- to 19-year-olds

OBJECTIVES

To establish patterns of smoking among 15-to 19-year-olds within mixed urban and suburban area and explore preference for the nature of services to assist quitting.

DESIGN

Postal survey and depth interviews with focus group validation.

SETTING

People registered with health services in the Borough of Solihull, UK. The borough has a diverse population with areas of high deprivation to the north and a range of prosperity elsewhere.

PARTICIPANTS

Questionnaires were sent to 50% of those registered and 20 people interviewed aged from 15 to 19 years.

MAIN OUTCOME MEASURES

The survey contained demographic questions relating to educational attainment and family, smoking status, history and quit attempts, use of facilities for quit attempts. Qualitative themes explored attitudes and experience of quitting, utilization of cessation services, barriers to access and nicotine replacement therapy.

RESULTS

Total survey response rate was 32.6%. Three in five reported smoking a cigarette sometime, 17.2% current regular smokers, 7.2% current occasional smokers. Median age of starting smoking was significantly lower (P = 0.004) for current regular smokers, distinguishable in two groups; weekend smokers and all week smokers. More quit attempts had been made or planned by current regular smokers but were often short lived. Weekend smokers had a slightly longer duration of quitting (P = 0.03). Eight-two per cent were optimistic about quitting in the future although the majority (80%) had already made one quit attempt. Knowledge and use of existing services was poor, with concerns about privacy and confidentiality. Models based on autonomy were identified as potentially useful.

CONCLUSION

Teenage smoking is characterized by optimism about quitting despite the failure of many quit attempts, lack of regard for existing services and barriers to uptake.

Clinical approaches to the withdrawal of nutrition and hydration

The request for withdrawal of nutrition and hydration from the vegetative patient is rare, but when it occurs it causes considerable anxiety for the clinical team. This anxiety is exacerbated by the need to seek a declaration from court that withdrawal of treatment would be legal. This paper discusses the process from the time of the request to the withdrawal of the tube feeding, and the actions the clinical team needs to take.

Voluntary arrangements to cope with diffuse pollution from agriculture and their role in European water policy

A limited number of Member States in the EU have gained experience with establishing co-operative agreements between agriculture and the water sector. Their main aim is to reduce or prevent water pollution caused by intensive farming practices. The research has shown that significant changes in farming practices have been achieved as a result of negotiation between farmers and water suppliers. Consequently, in many catchment areas improvements in water quality can be observed. Co-operative agreements have the important advantage that the measures taken can be tailored to the different local conditions in catchment areas. Reducing diffuse pollution resulting from intensive agriculture is one of the main issues of the EU Water Framework Directive. The current paper builds on the results of a EU-wide research project which examines the role co-operative agreements can play in water policy and the Common Agricultural Policy.

The effects of hyperglycemia on skin graft survival in the burn patient

The authors elected to determine the relative effects of hyperglycemia and/or elevated wound Gram-positive bacterial counts on success of skin graft survival in 74 burn patients. Results of serum glucose and quantitative wound biopsies on the day of admission and on postoperative day 4 were charted. Cases were separated into the following groups for analysis: normoglycemia plus normal bacterial counts, elevated bacterial counts only, hyperglycemia only, and hyperglycemia plus elevated bacterial counts. Successful graft "take" was defined as survival of 80% to 100% of the grafted area as assessed on postoperative day 4. Significant results included decreased incidence of graft take for groups with hyperglycemia only (62.5%), elevated bacterial counts only (63.3%), as well as hyperglycemia plus elevated bacterial counts (54.5%) when compared with the group with normoglycemia plus normal bacterial counts (92.8%; p = 0.020, p = 0.042, p = 0.012 respectively) for physiological parameters measured on postoperative day 4 only. Additionally, incidence of graft take was reassessed and found to be decreased significantly in groups with hyperglycemia (60.0%) vs. groups with normoglycemia (84.6%), regardless of Gram-positive bacterial counts (p = 0.034).

Screening for specific chromosome involvement in hematological malignancies using a set of seven chromosome painting probes. An alternative approach for chromosome analysis using standard FISH instrumentation

We report the application of multi-color fluorescence in situ hydribidization (FISH) for bone marrow metaphase cell analysis of hematological malignancies using a sub-set of the human karyotype for chromosome painting. A combination of chromosome probes labeled with three haptens enabled the construction of a "painting probe" which detects seven different chromosomes. The probe was used to screen three chronic myeloid leukemia (CML) derived cell lines and ten CML patient bone marrow samples for aberrations, additional to the Ph rearrangement, that are associated with the onset of blast crisis of CML. This approach was shown to identify karyotype changes commonly seen by conventional karyotyping, and in addition revealed chromosome changes unresolved or undetected by conventional cytogenetic analysis. The seven-color painting probe provides a useful, fast, and reliable complementary tool for chromosome analysis, especially in cases with poor chromosome morphology. This is a simple approach, since the probes can be displayed in a standard red/green/blue format accessible to standard fluorescence microscopes and image-processing software. The proposed approach using panels of locus-specific probes as well as chromosome paints will be useful in all diagnostic routine environments where analysis is directed towards screening for genetic rearrangements and/or specific patterns of chromosome involvement with diagnostic/prognostic value.

Prenatal cocaine exposure and prematurity: neurodevelopmental growth

The consequences of prematurity and prenatal cocaine exposure on early neurobehavior and physical growth were examined longitudinally in a sample of 20 cocaine-exposed and 20 non-exposed preterm neonates. The magnitude of the difference in physical growth acceleration related to prenatal cocaine exposure increased with increasing birth gestational age, whereas growth rate differences in irritability decreased. In contrast, prenatal cocaine exposure, independent of prematurity, was related to reduced attention skills at 36 weeks conceptional age and increased rates of neurobehavioral change. The effects of prenatal cocaine exposure differed with respect to the degree of prematurity, depending on the nature of the outcome examined, suggesting differing windows of vulnerability for different outcome domains. The usefulness of a developmental growth perspective was demonstrated.

The management of cubital tunnel syndrome: a meta-analysis of clinical studies

Despite extensive clinical experience in treating cubital tunnel syndrome, optimal surgical management remains controversial. A meta-analysis of 30 studies with accurate preoperative and postoperative staging was undertaken. Patients were staged preoperatively into minimum, moderate, and severe groups on the basis of clinical presentation. Treatment modalities included nonoperative management, surgical decompression, medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition. Statistical analysis using a standard SAS database with analysis of variance and chi-square tests was used to assess the efficacy of each therapeutic modality. For minimum-staged patients, all modalities produced similar degrees of satisfaction. However, total relief occurred most after medial epicondylectomy and least after anterior subcutaneous transposition. Patients treated nonoperatively had the highest rate of recurrence. For moderate-staged patients, submuscular transposition was most efficacious, whereas patients with nonoperative management fared the worst. Finally, for severe-staged patients, current therapeutic modalities were not consistently effective, with medial epicondylectomy producing the poorest operative result. This article reveals statistically significant differences in outcomes among therapeutic modalities, which may assist in treatment planning; it introduces standardized methods to aid in determining, analyzing, and communicating treatment outcomes.

Alterations in the peptidyltransferase and decoding domains of ribosomal RNA suppress mutations in the elongation factor G gene

The translocation stage of protein synthesis is a highly conserved process in all cells. Although the components necessary for translocation have been delineated, the mechanism of this activity has not been well defined. Ribosome movement on template mRNA must allow for displacement of tRNA-mRNA complexes from the ribosomal A to P sites and P to E sites, while ensuring rigid maintenance of the correct reading frame. In Escherichia coli, translocation of the ribosome is promoted by elongation factor G (EF-G). To examine the role of EF-G and rRNA in translocation we have characterized mutations in rRNA genes that can suppress a temperature-sensitive (ts) allele of fusA, the gene in E. coli that encodes EF-G. This analysis was performed using the ts E. coli strain PEM100, which contains a point mutation within fusA. The ts phenotype of PEM100 can be suppressed by either of two mutations in the decoding region of the 16S rRNA when present in combination with a mutation at position 2058 in the peptidyltransferase domain of the 23S rRNA. Communication between these ribosomal domains is essential for coordinating the events of the elongation cycle. We propose a model in which EF-G promotes translocation by modulating this communication, thereby increasing the efficiency of this fundamental process.

Fluorescence in situ hybridization detection of two telomeres on the short arm of a derived chromosome 16 in an infant with thrombocytopenia

We report a case of severe thrombocytopenia with an abnormal bone marrow karyotype described by G-banding analysis as t(16;21)(p?13;q11). Using fluorescence in situ hybridization (FISH) analysis with whole chromosome paints, the chromosome rearrangement was shown to be more complex, with the additional cryptic involvement of the long arm of chromosome 3. The chromosome rearrangement involved the breakpoints 3q26, 16p13.3, and 21q11; this rearrangement has not been previously described. The size of genomic material translocated from the chromosome 16 homologue was too small to be detected by chromosome paint. A 16p-specific telomeric probe was hybridized to locate the translocated 16p material. The 16p telomeric unique sequence DNA was retained on the der(16) chromosome, indicating a more distal breakpoint. This study demonstrates that telomeric translocations can occur that would be undetected by telomeric-specific FISH probes.

The youthful forehead: placement of skin incisions in hidden furrows

BACKGROUND

Attaining good aesthetic results remains a primary goal in removal of benign cutaneous facial lesions.

OBJECTIVE

Strategic planning of the incision is perhaps the most critical step in excision of such a lesion.

METHODS

A study of one case of epidermoid cyst excision from a youthful forehead was undertaken.

RESULTS

Poor surgical planning of a simple cyst excision from the forehead resulted in placement of the incision inferior to a natural furrow and within the basin defect, producing a noticeable scar. Facial animation accentuates the aesthetically poor placement of the surgical incision.

CONCLUSION

The detection of hidden furrows through facial animation during preoperative planning, especially in the youthful forehead, is imperative for achievement of an optimal aesthetic result. When possible, incisions should be concealed within natural furrows.

Helping Wisconsin women quit smoking: a successful collaboration

The cost of treatments for tobacco dependence frequently presents a financial barrier to their use. To overcome such barriers, the Wisconsin Women's Health Foundation, the Wisconsin Bureau of Public Health, the McNeil Consumer Healthcare, and the University of Wisconsin Center for Tobacco Research and Intervention collaborated in an initiative to distribute nicotine patches to Wisconsin women at no cost. As a result of this collaborative effort, approximately 19,000 women received a 6-week course of Nicotrol Patches. To evaluate the effectiveness of this initiative, a sample of 500 recipients were contacted and surveyed by telephone 6 months after receiving their patches. Approximately 22% of these women reported total abstinence at 6 months, and another 77% reported they had reduced their smoking. At follow-up, women who had successfully quit rated their health status significantly better than women who were still smoking. More than 99% of respondents recommended that the program be repeated. Extrapolating the observed abstinence rate to the 19,000 patch recipients, an estimated 4000 Wisconsin women successfully quit smoking as a result of this program.

Efficacy of vaccines containing rhoptry-associated proteins RAP1 and RAP2 of Plasmodium falciparum in Saimiri boliviensis monkeys

A vaccine trial was conducted with rhoptry-associated proteins 1 and 2 (RAP1 and RAP2) of Plasmodium falciparum in Saimiri boliviensis monkeys to compare the ability of parasite-derived (PfRAP1 and 2) and recombinant proteins (rRAP1 and 2) to induce protective immune responses and to find adjuvants suitable for use in humans. Eight groups of 6 monkeys each were immunized with parasite-derived or recombinant RAP1 and 2 with Freund's complete adjuvant (FCA) followed by Freund's incomplete adjuvant (FIA), Montanide ISA720 adjuvant, or CRL1005 adjuvant. Recombinant RAP1 and RAP2 were also administered separately, with Montanide ISA720. After 3 immunizations, monkeys were challenged by iv inoculation of 50,000 parasites of the Uganda Palo Alto strain of P. falciparum. Of the animals vaccinated using FCA/FIA, 1 of 6 control monkeys, 3 of 6 immunized with PfRAP1 and 2, and 2 of 6 with rRAP1 and 2 did not require drug treatment. Of the monkeys vaccinated with Montanide ISA720 adjuvant, 0 of the 6 control monkeys, 2 of 6 immunized with RAP1 and 2, 1 of 6 immunized with rRAP1, and 4 of 6 immunized with RAP2 did not require drug treatment. Two of 6 monkeys immunized with PfRAP1 and 2 with CRL1005 did not require treatment. All groups receiving RAP1, RAP2, or both had a significant decrease in initial parasite multiplication rates and there was a significant negative correlation between anti-RAP2 antibody and multiplication rates. Animals were rechallenged with the homologous parasite 126 days after the first challenge. Of the monkeys that did not require drug treatment after the first challenge, none developed detectable parasitemia following rechallenge.