Plasmid profile analysis and antibiotic resistance of Salmonella strains from clinical isolates in Cluj-Napoca

Resistance patterns, plasmid profiles and the genetic resistance determinants were investigated in 38 isolates of Salmonella enterica serotype Typhimurium and 19 isolates of Salmonella enterica serovar Enteritidis derived from children hospitalized in two clinics in Cluj-Napoca, during the period of 1995-1997. Incidence of plasmid and antibiotic resistance was very high in Salmonella typhimurium isolates. All strains were resistant to almost all antibiotics tested but susceptible to the third generation cephalosporines and fluoroquinolones. We identified three resistance patterns and six plasmid profiles. Each plasmid profile was characterized by the presence of two large plasmids of 150-180 Kbp. Approximately 60% of strains harbored three or four small plasmids of 1.3 to 9.5 Kbp. The plasmids of 8.5 Kbp encoded resistance to beta-lactam antibiotics and were non-conjugative. The other small plasmids were cryptic and also non-conjugative. Salmonella enteritidis isolates were susceptible to many antibiotics, except Tetracycline and Trimethoprim-Sulfamethoxazole. We identified three different resistance patterns but nine plasmid profiles. All plasmid profiles were characterized by the presence of a large plasmid (> 100 Kbp). The number and the diversity of small plasmids were higher than in S. typhimurium strains. There was no parallelism between resistance and plasmid profile: for the same resistance pattern a number of two or three plasmid profiles were found. Our conclusions are that Salmonella typhimurium strains were multiresistant to antibiotics and that many genetically different strains of Salmonella typhimurium and Salmonella enteritidis were responsible for gastroenteritis in children from Cluj County. The increasing antibiotic resistance highlights the need for more refined methods in genetic and epidemiological characterization of bacteria involved in gastrointestinal infections.

Serum content of the C-propeptide of the cartilage molecule type II collagen in children

OBJECTIVE

The C-propeptide of cartilage type II procollagen, together with the N-propeptide, are removed from newly synthesized procollagen during collagen fibril assembly in cartilage matrix. The presence and content of the C-propeptide reflect the synthesis of this molecule. Recently, we showed that serum levels of the C-propeptide are increased in adults with rheumatoid arthritis, pointing to increased synthesis of this molecule. In this study we examined its content in the sera of children to determine whether it changes during development.

METHODS

Sera were obtained from 44 premature infants (cord blood), 75 children (0-18 years), 14 young adults (18-22 years) and 47 adults (35-60 years). The concentration of serum C-propeptide of type II procollagen was determined by a solution phase competitive inhibition radioimmunoassay which uses a polyclonal antiserum specific for the bovine and human C-propeptide.

RESULTS

Compared with adults, concentrations of the C-propeptide of type II procollagen were significantly elevated in children of ages 0-14 years. Concentrations were constant until 10 years of age (premature infants: 14.5 +/- 1.4 ng/ml, mean +/- SE; 0-10 years: 13.6 +/- 1 ng/ml). In children of ages 10-14 years, during which the pubertal growth spurt is ordinarily observed, the mean concentration increased (10-14 years: 21.6 +/- 0.7 ng/ml) although not significantly due to the variation between individuals. Concentrations at all ages younger than 14 were significantly greater than those in older adolescents ages 14-18 (6.3 +/- 0.7 ng/ml), young adults (8.4 +/- 2.0 ng/ml) and adults (5.7 +/- 0.4 ng/ml). Serum concentrations did not show significant differences with respect to sex, but varied from child to child at any given age.

CONCLUSIONS

The measurement of this circulating C-propeptide may be of use in studying the biochemical and physiological bases of changes in cartilage turnover in children, and abnormalities thereof.

Enhanced cleavage of type II collagen by collagenases in osteoarthritic articular cartilage

We demonstrate the direct involvement of increased collagenase activity in the cleavage of type II collagen in osteoarthritic human femoral condylar cartilage by developing and using antibodies reactive to carboxy-terminal (COL2-3/4C(short)) and amino-terminal (COL2-1/4N1) neoepitopes generated by cleavage of native human type II collagen by collagenase matrix metalloproteinase (MMP)-1 (collagenase-1), MMP-8 (collagenase-2), and MMP-13 (collagenase-3). A secondary cleavage followed the initial cleavage produced by these recombinant collagenases. This generated neoepitope COL2-1/4N2. There was significantly more COL2-3/4C(short) neoepitope in osteoarthritis (OA) compared to adult nonarthritic cartilages as determined by immunoassay of cartilage extracts. A synthetic preferential inhibitor of MMP-13 significantly reduced the unstimulated release in culture of neoepitope COL2-3/4C(short) from human osteoarthritic cartilage explants. These data suggest that collagenase(s) produced by chondrocytes is (are) involved in the cleavage and denaturation of type II collagen in articular cartilage, that this is increased in OA, and that MMP-13 may play a significant role in this process.

Interactions between Borrelia burgdorferi and eukaryote cells: comparative ultrastructural aspects

In the present study, mammalian VERO cells, human polymorphonuclear leukocytes (PMN) and mouse peritoneal macrophages (MPM) were coincubated with B31 Borrelia burgdorferi strain (Bb) and examined by transmission electron microscopy. The results indicate that the spirochete adheres to the mammalian cells mainly by the apical pole and less frequently by the lateral wall. In VERO cells and MPM cell penetration is accomplished especially by cytoplasmic membrane destruction, the spirochete appearing free in the cytoplasm, but also by phagocytosis. In this latter case the pathogen is seen in phagosome. In PMN the internalization takes place exclusively by phagocytosis, the spirochete undergoing destruction in phagosomes. Sometimes an alteration of the phagosomal membrane is observable, probably produced by the pathogen as a mechanism to avoid fusion with the lysosome. Other aspects indicate the contribution of the parasitized cell cytoskeleton to the spreading of Borrelia to adjacent cells. MPM does not represent a very efficient barrier against Bb, as can be seen from the cellular behaviour of the spirochetes in this study, PMN seems to a more efficient barrier, by its unique capacity to destroy the microorganism after phagocytosis.

Plasmid profile analysis and restriction enzyme analysis in characterizing Shigella flexneri isolates from an outbreak

Shigella flexneri strains which are multiply resistant to antimicrobial agents were isolated from 11 children from an orphanage in Cluj-Napoca during an epidemiological investigation initiated by the Department of Epidemiology. Plasmid profile analysis and restriction endonuclease analysis were used in conjunction with biotyping, serotyping and antimicrobial susceptibility testing for identifying epidemiological related isolates. All strains were serotype 2a and with one exception all of them showed the same resistotype. Plasmid profile analysis differentiated S. flexneri isolate into four patterns, with two common plasmids of 3.5 and 1.9 kb. This study indicates that this outbreak was caused by at least two different strains of S. flexneri which were not differentiated by the classical technique-biotyping, serotyping and antimicrobial susceptibility pattern.

[Total proctocolectomy with an ileoanal anastomosis and reservoir]

The following report documents the initial experience (13 cases) and the one year functional and quality of life results after restorative proctocolectomy procedures in the Surgery Clinic of Fundeni Hospital. The histologic preoperative diagnosis was ulcerative colitis in 7 patients (53.84%) and familial polyposis in 6 patients (46.16%). 80% of patients experienced at least one postoperative complication after pouch construction or ileostomy closure. There was a single death in our patient group. This occurred in a patient with malignized polyposis, who died in the first 24 hours after operation from bilateral pulmonary emboli. The necropsy exam has shown also a metastatic nodule of the liver. The most frequent complication in our series was the small bowel obstruction and the pouch-anal anastomosis leak (30.76%). Patients' follow-up was achieved by means of a questionnaire which assessed pouch function at follow-up visit at 1 month, 3 month, 6 month and one year after the ileostomy closure. Quality of life was also assessed by that questionnaire and included injury into aspects of occupational, social and sexual function. The functional and quality of life results in this series was very similar to that reported by other authors who have performed restorative proctocolectomy for ulcerative colitis and familial polyposis.

Contents and distributions of the proteoglycans decorin and biglycan in normal and osteoarthritic human articular cartilage

The study was designed to determine the contents and distributions of the proteoglycans decorin and biglycan in adult human femoral condylar cartilage and whether these may change in osteoarthritis. New radioimmunoassays were established using peptides representing the amino-terminal 21 amino acid sequence of each proteoglycan (to which a tyrosine was added for radioiodination) and antibodies in a rabbit antiserum raised to both these molecules. Cartilage was extracted with 4 M guanidine HCl to determine total content, and extracts were analyzed by chromatography to determine molecular sizes. Frozen sections were cut parallel to the articular surface and were extracted to determine distribution within the tissue. Gel chromatography on Sepharose CL-2B under dissociative conditions revealed molecules with a partition coefficient of 0.7-0.75 in both normal and osteoarthritic cartilage. In normal adult cartilage, the mean contents of the core proteins of biglycan and decorin were calculated to be approximately 0.34 and 0.48 mg per gram wet weight, respectively. These represented molar contents similar to that of aggrecan. In osteoarthritic cartilage, there were no overall significant changes in the content and distribution of these molecules. There was, however, considerable individual variation in both distribution and content. Analyses indicated that there was a trend in osteoarthritic cartilage toward a loss of biglycan and decorin from the more superficial layers of intact cartilage, where both these molecules are normally more concentrated. This was accompanied by maintenance of proteoglycan content deeper in the cartilage, regardless of the degree of degeneration.

Changes in cartilage proteoglycan aggrecan after intra-articular injection of interleukin-1 in rabbits: studies of synovial fluid and articular cartilage

OBJECTIVE

To determine how acute but transient inflammation affects the cartilage proteoglycan aggrecan and the value of analyses of synovial fluid to study this.

METHODS

For 96 hours after a single intra-articular injection of rabbit knees with human interleukin-1 alpha (IL-1 alpha) or vehicle, articular cartilage and synovial fluid were examined using a putative indicator of aggrecan synthesis (aggrecan chondroitin sulphate epitope 846), immunoreactive keratan sulphate, and total glycosaminoglycan (GAG) content. Aggrecan extractability (with 0.5 M NaCl) followed by 4 M guanidine hydrochloride extraction permitted analyses of cartilage damage, total content and aggrecan heterogeneity. Aggrecan epitopes as well as GAG were assayed in synovial fluid. Changes were related to total joint leucocyte content in synovial fluid.

RESULTS

At 10 ng, IL-1 alpha produced a transient increase in synovial fluid leucocytes at six hours and 24 hours. This accompanied a reduction in content and increased extractability of GAG, which was greatest in the tibial medial compartment of the knee. Further studies of this compartment showed no change in keratan sulphate epitope content, but a transient increase in extractability in 0.5 M NaCl. Epitope 846 content and extractability were unchanged. Total contents and extractability for GAG were inversely correlated in both controls and joints injected with IL-1 alpha. These changes were accompanied by transient increases in GAG, keratan sulphate epitope, and 846 content in synovial fluid.

CONCLUSION

According to the aggrecan component measured, damage to the matrix of articular cartilage was sometimes reflected by a transient increased extractability and a net loss of aggrecan. There was always an increased release of GAG, and keratan sulphate, and 846 epitopes into synovial fluid. These studies show that changes in aggrecan epitopes and GAG in synovial fluid reflect changes in cartilage metabolism induced by acute transient inflammation.

No relationship between insulin antibodies and transient remission in type 1 diabetic patients

It has been speculated that the insulin antibodies may contribute to the prevention of the onset of the transient remission in insulin-treated diabetic patients. To address this hypothesis, we analysed the titre of insulin antibodies (determined by RIA method, using polyethylenglycol separation technique and expressed as percentage of binding of insulin) in two groups of patients: group A: 46 type 1 diabetics, 25 males and 21 females aged 24 +/- 11.2 years, mean +/- SD, who did not manifest during the first period of the disease any clinical sign of remission; group B: 21 type I diabetics, 13 males and 8 females, aged 25.3 +/- 8.0 years, who manifested in the first year either a partial (18 cases) or a total (3 cases) transient remission. Thirty-eight of cases with disease onset before 1984 were treated with conventional insulins (27 of 46 cases in A group and 11 of 21 cases in B group); the remaining cases were treated with monocomponent (MC) insulins. The binding of the insulin was significantly higher in the patients treated with conventional insulins vs those treated with MC insulins, i.e., 18 +/- 7.1% vs 10.2 +/- 5.2% (p < 0.001). However, no difference was found in the binding of insulin in A group (14.5 +/- 1.3%) compared with B group (13.7 +/- 11.1%). Moreover, in 3 cases from B group the onset of the remission was coincident with the increase of insulin antibodies.

Cartilage and bone metabolism in rheumatoid arthritis. Differences between rapid and slow progression of disease identified by serum markers of cartilage metabolism

Serum concentrations of specific cartilage and bone molecules reflecting tissue turnover were measured in two well-defined patient groups with early rheumatoid arthritis with distinctly different disease outcome to see if early differences in their levels are prognostic of the rate of joint destruction. Compared with a matched normal population, increased concentrations of cartilage oligomeric matrix protein (COMP) were found in all patients who developed rapid hip joint destruction. In contrast, levels of a putative marker of cartilage aggrecan synthesis, the chondroitin sulfate epitope 846, were increased only in patients with slow joint destruction. Levels of bone sialoprotein (BSP) were increased in both groups, as were levels of the C-propeptide of type II procollagen (CPII), a marker of collagen II synthesis. The increased concentrations of the 846 epitope in patients with slow joint destruction suggest increased aggrecan synthesis. The low levels of the 846 epitope in patients with rapid joint destruction, concomitant with elevated levels of CPII, suggest a selective increase in collagen synthesis. The elevated BSP levels indicate an increased bone turnover in both groups. Thus elevated serum levels of COMP may indicate an unfavorable prognosis for rapid joint destruction, whereas elevated 846 epitope indicates a more favorable prognosis.

Changes in cartilage metabolism in arthritis are reflected by altered serum and synovial fluid levels of the cartilage proteoglycan aggrecan. Implications for pathogenesis

The metabolism of the cartilage proteoglycan aggrecan was studied in patients with osteoarthritis (OA, n = 83), rheumatoid arthritis (RA, n = 127), and in controls (n = 117) using monoclonal antibody-based radioimmunoassays for glycosaminoglycans in the serum and synovial fluid (SF) to detect epitope 846 on chondroitin sulfate (probably only on recently synthesized molecules) and a keratan sulfate (KS) epitope AN9PI, present on intact and degraded molecules. Epitope 846 levels were always elevated in SF over serum (mean 38-fold in OA and 8.6-fold in RA) being highest in OA patients with the longest disease duration and greatest loss of cartilage, and lowest in RA joints with high leucocyte counts. Serum levels were more often elevated in RA (56%) than in OA (19%) and probably reflect increased aggrecan synthesis in diseased joints. KS levels were higher in SF than in serum in 69% of patients (up to 2.3-fold); levels were inversely (OA) and directly (RA) related to SF leucocyte counts. Serum KS was reduced in both diseases and in RA was inversely related to both systemic and joint inflammation markers. SF 846 levels were inversely related to SF KS in both diseases. These epitopes may provide a measure of the balance between cartilage synthesis and degradation in these diseases.

Pharmacokinetic based adjustment of lidocaine antiarrhythmic schedule

Administration of lidocaine, 200 mg/day i.m. or 275 mg orally, decreased sudden death after myocardial infarct (from 20.7% to 10.3%) although such schedules are not considered adequate to guarantee efficient plasma levels. Inclusion of lidocaine in a polyethylene matrix assured a slow release and complete disappearance of known side effects. Lidocaine was administered 200 mg intramuscularly to hospitalized patients every 6 h or 275 mg oral tablets to healthy volunteers every 8 h and plasma levels evaluated. Plasma levels after oral administration to healthy volunteers showed a great variability, so that it was not possible to draw a statistically significant conclusion about the accumulation of lidocaine in a period of 1 week. In coronary artery disease patients, plasma levels slowly increased with time, but clinical signs indicated, in some cases, a much more rapid accumulation. The therapeutic efficiency at low repeated doses was explained as a consequence of a slow accumulation on the one hand and of the addition of the action of MEGX, the major metabolite of lidocaine, on the other hand.

Enhanced prothrombin and intrinsic factor X activation on blood platelets from diabetic patients

The present work was conducted to bring information about the enhanced procoagulant activity of blood platelets in diabetes mellitus, as compared to normal control platelets. The inquiry was performed on platelets from either human patients or hamsters with streptozotocin-induced diabetes. The experiments comprised functional assays of factor Xa and thrombin generation in the presence of normal or diabetic platelets, using saturating amounts of coagulation factors. The prothrombinasic and tenasic complexes activation was measured by using discontinuous amidolytic tests with chromogenic substrates (S-2238 for FXa and S-2222 for thrombin). The results showed that, in contrast to the low prothrombin and factor X converting activity of normal platelets, the thrombin and FXa generation on diabetic platelets was increased by 3-7 times for either humans or hamsters. These findings may be relevant for the pathogenesis of thrombotic complications known to occur in diabetes mellitus.

Bacillus subtilis genome project: cloning and sequencing of the 97 kb region from 325 degrees to 333 degrees

In the framework of the European project aimed at the sequencing of the Bacillus subtilis genome the DNA region located between gerB (314 degrees) and sacXY (333 degrees) was assigned to the Institut Pasteur. In this paper we describe the cloning and sequencing of a segment of 97 kb of contiguous DNA. Ninety-two open reading frames were predicted to encode putative proteins among which only forty-two were found to display significant similarities to known proteins present in databanks, e.g. amino acid permeases, proteins involved in cell wall or antibiotic biosynthesis, various regulatory proteins, proteins of several dehydrogenase families and enzymes II of the phosphotransferase system involved in sugar transport. Additional experiments led to the identification of the products of new B. subtilis genes, e.g. galactokinase and an operon involved in thiamine biosynthesis.

Osteoarthritis in the human knee: a dynamic process of cartilage matrix degradation, synthesis and reorganization

The matrix of articular cartilage undergoes degenerative changes in osteoarthritis which involve a number of matrix molecules. The structural and mechanical integrity is organized around the composite collagen II, IX, XI fibrillar organization. The small proteoglycan decorin that binds to these fibrils may influence their structure and mechanical properties. Aggrecan interacts indirectly via hyaluronic acid and possibly directly through unknown mechanisms. When collagen is cleaved at the articular surface in early osteoarthritis, decorin and aggrecan are lost. Increases in decorin and aggrecan content occur deeper in the cartilage. This is accompanied by evidence for increased formation of collagen fibrils and increased degradation and synthesis of aggrecan and type II collagen. The net contents of these proteoglycan per tissue do not, however, change until advanced degeneration occurs. These degradative processes are likely catalyzed by metalloproteinases and cysteine proteases. Cartilage exhibits significant capacity for remodelling which may be enhanced by therapeutic management of this process.

Antityphoid and antitetanic intradermal vaccination of chronic neuropsychic patients in a typhoid fever outbreak

Intradermal immunization of 229 chronic neuropsychic patients in Gura Ocnitzei Sanatorium, Dîmbovitza County, where a typhoid fever outbreak burst, was performed with a freeze-dried typhoid vaccine, suspended in purified and concentrated tetanic anatoxin. Adverse reactions were minimal and immunologic response, evaluated by laboratory tests, was good, reaching the level of that obtained as a result of classic vaccination methods (subcutaneous antityphoid and intramuscular anti-tetanic). Both after vaccination and also booster O and H agglutinating titers increased 4-7 times and anti-S. typhi. seroprotecting effect reached and maintained a high level. Moreover, antityphoid vaccination permitted epidemic focus limiting and its complete extinguishing after booster. Antitetanic vaccination resulted in protecting titers settlement (greater than or equal to 0.01 IU/ml) in all previously non-protected persons (1/3 of all subjects) and in the increase of protecting titers, existing before vaccination in the other persons.

Study of specific immune response to unadsorbed concentrated tetanus vaccine administered by intradermal route to non-immunized persons in the last ten years

Investigations of anti-tetanus response, in 404 subjects, most of them aged 60, being non-immunized for at least 10 years, stressed out the fact that 28.7% were not protected and 6.18% presented a protecting titer of 0.01 IU/ml, evaluated by "in vivo" protection test in mice. Some subjects were immunized with unadsorbed Tetanus vaccine (10 Lf/0.1 ml/dose) by i.d. route, using Jet-injector, and the others with adsorbed Tetanus vaccine (0.5 ml/dose), by i.m. route, using the needle and syringe. The vaccines were well tolerated and adverse reactions were not recorded. After 30 days, a single vaccine dose produced a protecting effect in 97.45% of non-protected subjects, belonging to i.d. immunized group, and also in 93.33% belonging to i.m. immunized group. 30 days after the administration of a second dose, protection set up in all subjects, no matter of vaccine type and administration route used. For a continuous reduction of tetanus morbidity, the authors suggest a specific periodical immunization of non-protected persons, selected by serological screening, using unadsorbed Tetanus vaccine, administered by i.d. route by means of the Jet-injector.

[Juxtapapillary ulcer]

The paper analysed the technical possibilities for the treatment of juxtapapillary ulcer exemplified by the clinical experience of 62 cases of recognized juxtapapillary ulcer. The authors insist on the technique of the duodenum dissection, on the way of passing the suture threads at the level of the papilla and on the importance of a correct drainage.

[Fatal postoperative pulmonary embolism]

A total of 76 cases were investigated in which fatal postoperative pulmonary embolisms were identified at the necroptic study. The following aspects are considered: the high incidence of fatal postoperative pulmonary embolisms in patients without favouring factors in antecedents (38%), and of patients operated for benign affections (50.6%); the rare occurrence of clinical signs of venous thrombosis in patients with fatal postoperative pulmonary embolisms (11.8%); the high incidence of early fatal postoperative pulmonary embolisms (46%)--in the first three days after surgery, of which 26.3% in the first 24 hours and the importance of their identification so as to exclude an erroneous interpretation of the cause of death, and finally the indications and the limitations of the prophylactic treatment with low amounts of heparin.

[Indications for pancreatectomy in chronic pancreatitis]

The authors have considered the experience acquired in connection with 15 cases of chronic pancreatitis in whom surgery was performed, and define the parameters which make mandatory surgical interventions in this affection.