Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure

This study examined the cultivable microflora before and after stepwise excavation procedures in deep carious lesions in 9 permanent teeth, categorized according to degrees of proximal surface destruction. The final excavation was performed 4-6 months after the initial treatment, which included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. Dentine colour and consistency were assessed by means of standardized scales before the application of a Ca(OH)(2) compound and temporary sealing. Reassessments were performed before and after the final excavation. Microbiological samples of the central demineralized dentine were obtained with a sterile bur before and after the first excavation, as well as before and after the final excavation. After anaerobic cultivation on enriched non-selective tryptic soy agar, 30 colonies from a representative area were identified by standardized biochemical and physiological tests. Before temporary restoration, a yellowish and light brown demineralized soft dentine was typically observed, and gram-positive rods accounted for 70% and lactobacilli for 50% of the total colony-forming units. Lactobacillus casei subsp. rhamnosus and Actinomyces naeslundii dominated the lactobacilli and the other gram-positive rods, respectively. Gram-negative rods were the next most frequent isolates, followed by streptococci, each group accounting for about 20% of the colony-forming units in positive samples. Before the final excavation, which did not cause exposure of the pulp in any of the cases, the retained demineralized dentine had changed into a darker and harder tissue, and the total colony-forming units, as well as the frequency and proportions of lactobacilli were substantially reduced. Gram-negative rods also declined, and the flora was dominated by A. naeslundii and various streptococci. In conclusion, the cultivable flora detected following the treatment interval had declined substantially, and the distribution of bacterial species did not represent a typical cariogenic microbiota of deep lesions, confirming the clinical findings of arrested caries progression.

Short communication: associations between blood calcium status at calving and milk yield in dairy cows

The purpose of the present study was to estimate the effect of total blood plasma calcium (TBPCC) concentration at calving on milk yield in dairy cows. Data originated from 153 dairy cows in 27 herds from a single veterinary practice. For each cow, data included calcium concentration in a blood sample taken within 12 h postpartum, monthly test-day milk yield until 300 d in milk, calving date, parity, breed, and herd. The TBPCC ranged from 0.69 to 2.73 mmol/L, with a mean value of 1.80 mmol/L. The statistical analysis adjusted for the fixed effects of parity and lactation stage, random effects of herd and cow, and the correlation between repeated measures of test-day milk yield. The results showed that TBPCC at calving was not significantly related to fat- and protein-corrected milk yield at any lactation period. The present study indicates that hypocalcemia (low TBPCC) at calving is not an important risk factor for decreased milk yield.

A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse pregnancy outcome

OBJECTIVE

To determine if the discrepancy between gestational age estimated by last menstrual period and by biparietal diameter (GALMP - GABPD) is associated with adverse pregnancy outcome.

DESIGN

Population-based follow up study.

POPULATION

Singleton pregnancies were studied when a reliable date of last menstrual period and biparietal diameter measured between 12 and 22 weeks of gestation was available (n = 16,469).

METHODS

Logistic regression analysis and Kaplan-Meier survival analysis were used to analyse the association between GALMP - GABPD and adverse pregnancy outcome.

MAIN OUTCOME MEASURES

Adverse outcome was defined as abortion after 12 weeks of gestation, still-birth or postnatal death within one year of birth, delivery < 37 weeks of gestation, a birthweight < 2,500 g or a sex-specific birthweight lower than 22% below the expected.

RESULTS

The risk of death was more than doubled if GALMP - GABPD of > or = 8 days was compared with GALMP - GABPD of < 8 days (OR 2.2; 95% CI 1.6-3.1). The risk of death was a factor of 6.1 higher if GALMP - GABPD of > or = 8 days was combined with increased (> 2 x multiple of median) maternal alpha-fetoprotein measured in the 2nd trimester.

CONCLUSIONS

A discrepancy between GALMP and GABPD generally reflects the precision of the two methods used to predict term pregnancy. However, a positive discrepancy of more than seven days, particularly with high maternal alpha-fetoprotein, might indicate intrauterine growth retardation and an increased risk of adverse perinatal outcome.

Increased adverse pregnancy outcomes with unreliable last menstruation

OBJECTIVE

To estimate the risk of adverse outcomes in women whose first day of the last menstrual period (LMP) was unreliable.

METHODS

Among 20,244 singleton pregnancies with measurements of biparietal diameter between 12 and 22 weeks' gestation, LMP was registered as unreliable in 3775 (18.6%) and reliable in 16,469 (81.4%). Adverse outcomes were defined as spontaneous or missed abortions after 12 weeks' gestation, stillbirth or postnatal death within 1 year, preterm birth, birth weight less than 2500 g, and low birth weight (LBW) for gestation (lower than 22% below sex-specific expected weight). Logistic regression analysis and Kaplan-Meier survival analysis were used to analyze the risk of adverse outcomes.

RESULTS

The risk of death was doubled in pregnant women with unreliable LMPs compared with those with reliable LMPs (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6). This risk was highest with respect to stillbirth (OR 2.7; 95% CI 1.7, 4.3). The risks of preterm birth, LBW, and LBW for gestation were also significantly increased (ORs 1.5, 1.4, and 1.2; 95% CIs 1.3, 1.7; 1.2, 1.6; and 1. 0, 1.4, respectively).

CONCLUSION

An unreliable LMP is associated with increased risk of adverse outcomes, especially fetal death.

Disinfection of dental impressions and occlusal records by ultraviolet radiation

As chemical disinfection of dental impressions may cause adverse effects on materials and the dental personnel this study examined disinfection by ultraviolet radiation. Alginate, addition silicone rubber and red wax contaminated by Streptococcus salivarius, Fusobacterium nucleatum and five other bacteria in different suspension media were radiated for up to 18 min, and the number of colony forming units was compared to non-radiated controls. The effect of ultraviolet radiation differed among bacterial species and depended on the organic content in the suspension. Generally, the bacterial reduction after ultraviolet radiation was below 4 log steps and thus insufficient for disinfection of dental impressions.

Ultrasound screening in the 2nd trimester. The pregnant woman's background knowledge, expectations, experiences and acceptances

OBJECTIVE

Ultrasound screening in the second trimester is widely used in maternal health care. To secure the pregnant woman's autonomy, it is essential to obtain information relating to her understanding and wishes as a starting point for the provision of information. The aim of the study was to explore the pregnant woman's background knowledge, expectations, experiences, and acceptances of second trimester ultrasound screening.

DESIGN

Five-hundred consecutive, unselected pregnant woman, of gestational age between 16 and 20 weeks were asked to fill in a questionnaire containing defined and open ended questions.

RESULTS

Approximately 70% of the women recruited had undergone a pregnancy-related ultrasound examination previously. Ninety percent answered that they had received information, either from the family doctor or as written material from the hospital (or both), concerning the purpose of the examination. Literature/newspaper/TV, family and friends played an important role as sources for general information. The pregnant women wished to undertake the ultrasound examination to ensure that the fetus was alive, healthy and without any malformation. Few answers were clinically irrelevant. The womens' expectations were fulfilled in 96% of cases, 86% felt 'more secure' after the examination while 2% did not have their expectations fulfilled. Only 0.8% felt more insecure after the examination. The vast majority of both pregnant women and their partners reported a positive experience from the event.

CONCLUSION

Pregnant women have a good knowledge of ultrasound examination although the quality of information could be improved. Expectations are fulfilled and are clinically relevant. The acceptability and experiences of the examination are very high.

Pathology of fatal West Nile virus infections in native and exotic birds during the 1999 outbreak in New York City, New York

West Nile fever caused fatal disease in humans, horses, and birds in the northeastern United States during 1999. We studied birds from two wildlife facilities in New York City, New York, that died or were euthanatized and were suspected to have West Nile virus infections. Using standard histologic and ultrastructural methods, virus isolation, immunohistochemistry, in situ hybridization and reverse-transcriptase polymerase chain reaction, we identified West Nile virus as the cause of clinical disease, severe pathologic changes, and death in 27 birds representing eight orders and 14 species. Virus was detected in 23/26 brains (88%), 24/ 25 hearts (96%), 15/18 spleens (83%), 14/20 livers (70%), 20/20 kidneys (100%), 10/13 adrenals (77%), 13/ 14 intestines (93%), 10/12 pancreata (83%), 5/12 lungs (42%), and 4/8 ovaries (50%) by one or more methods. Cellular targets included neurons and glial cells in the brain, spinal cord, and peripheral ganglia; myocardial fibers; macrophages and blood monocytes; renal tubular epithelium; adrenal cortical cells; pancreatic acinar cells and islet cells; intestinal crypt epithelium; oocytes; and fibroblasts and smooth muscle cells. Purkinje cells were especially targeted, except in crows and magpies. Gross hemorrhage of the brain, splenomegaly, meningoencephalitis, and myocarditis were the most prominent lesions. Immunohistochemistry was an efficient and reliable method for identifying infected cases, but the polyclonal antibody cross-reacted with St. Louis encephalitis virus and other flaviviruses. In contrast, the in situ hybridization probe pWNV-E (WN-USAMRIID99) reacted only with West Nile virus. These methods should aid diagnosticians faced with the emergence of West Nile virus in the United States.

Does a discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine growth retardation?

OBJECTIVE

To assess the association between gestational age estimated from the last menstrual period (GA(LMP)) or from the biparietal diameter (GA(BPD)), and the subsequent birthweight for gestational age.

DESIGN

Population-based follow up study.

SETTING

Of 21,936 pregnancies contained in the ultrasound database, 16,387 singleton pregnancies with a reliable last menstrual period date and an ultrasound examination between 12 and 22 weeks of gestation were included.

MAIN OUTCOME MEASURES

Correlation between: 1) birthweight deviation (birthweight-expected weight for gestation); 2) birthweight; and 3) pregnancy length and (GA(LMP)-GA(BPD)). Relative risk of birthweight < 2,500 g and low birthweight for gestation (> 22% below normal weight) related to five levels of discrepancy between (GA(LMP)-GA(BPD)).

RESULTS

(GA(LMP)-GA(BPD)) was not associated with deviation of birthweight related to GA(BPD). However the risk of low birthweight (< 2,500 g) and low birthweight for gestational age was significantly increased when (GA(LMP)-GA(BPD)) was > 7 days.

CONCLUSION

A biparietal diameter smaller than expected from the last menstrual period date is mainly a problem of an error related to estimated time of ovulation. At the same time the relative risk of a low birthweight infant is slightly increased.

Whole small fish as a rich calcium source

The present rat balance study investigated Ca availability from the whole indigenous small fish species, mola (Amblypharyngodon mola) from Bangladesh and from skimmed milk. Four groups of six young male rats each were fed ad libitum with diets containing either small fish or milk, at 100 or 160 g crude protein/kg diet dry matter. The study was conducted for 28 d and faeces and urine samples were collected in two balance periods: day 8-14 and 22-28. The Ca and N contents of the diets, faeces and urine were analysed. Ca intake, fractional Ca absorption and Ca retention in relation to N retention were measured. Digestibility and protein utilization of the experimental diets, weight gain of the rats, femur bone weight and mineral composition as well as bone alkaline phosphatase activity were also determined. It was concluded from the values of these variables that Ca from small fish with bones was available and appeared to be a useful Ca source in rats, though perhaps not as available as Ca from milk. This study suggests that small fish with bones may be an important source of Ca in human diets. Promotion of the production and consumption of small fish in population groups with low intakes of milk and milk products should therefore be encouraged.

Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma-detecting probe

Sentinel node staging for breast cancer is increasingly used in place of axillary lymph node dissection but is not yet universally accepted. The problems of non-standardized methodologies and lack of consensus on the optimum techniques to identify sentinel nodes are being addressed. Complementary use of radionuclide imaging before surgery, intraoperative probe detection, and blue dye have yielded the best reported sensitivities for finding a sentinel node (94%). The importance of imaging is summarized as identifying sentinel node(s), distinguishing sentinel from secondary nodes, guiding surgical incision planning, and facilitating lower doses. The learning curve phenomenon, which applies to the surgeon and the nuclear medicine physician, has been recognized; measures to minimize it are being implemented. Radiation exposure to operating room and pathology personnel is very low; estimates of exposure to the surgeon's hands are 0.2% of the annual whole body dose received by every human being from natural background and cosmic sources.

Evaluation of ultrasound-estimated date of delivery in 17,450 spontaneous singleton births: do we need to modify Naegele's rule?

OBJECTIVE

To compare the size of error in the predicted date of delivery by biparietal diameter (BPD) and last menstrual period (LMP) in different clinical models.

MATERIALS AND METHODS

Predicted dates of delivery were calculated in 14,805 spontaneous deliveries with a reliable date of LMP using two assumptions: average length of pregnancy of 280 and of 282 days. Errors in these calculated dates were tested when used alone or combined, i.e. the LMP-predicted date of delivery was used as first choice unless the discrepancy between gestational age calculated by BPD and LMP exceeded 7, 10 or 14 days.

RESULTS

The average discrepancy (error) between predicted date of delivery from BPD and LMP and date of spontaneous delivery was 7.96 and 8.63 days, respectively (p < 0.0001). Adding 282 instead of 280 days to the first day of the LMP reduced the error of the LMP method from 8.63 to 8.41 days, reduced the percentage of classified post-term deliveries from 7.9 to 5.2% and increased the preterm births from 3.96 to 4.48%. No models of combined use of LMP and BPD were superior to the use of BPD alone.

CONCLUSION

If both BPD and LMP are available, BPD should be used to predict term. If only LMP is available, term should be calculated as the first date of the LMP plus 282.

Effect of steam sterilization inside the turbine chambers of dental turbines

OBJECTIVE

It has been demonstrated that contamination of the insides of high-speed dental turbines occurs and that bacteria as well as viruses may remain infectious when expelled from such turbines during subsequent use. Consequently, it has been widely recommended that a high-speed turbine be sterilized after each patient. The purpose of this study was to evaluate the effect of steam autoclaving on a high-speed dental turbine with a contaminated turbine chamber.

STUDY DESIGN

Streptococcus salivarius and endospores of Bacillus stearothermophilus were used as test organisms to determine the effectiveness of 4 different small non-vacuum autoclaves and one vacuum autoclave.

RESULTS

The study demonstrated different efficiencies among the small non-vacuum autoclaves, the best showing close to a 6 log reduction of the test organisms inside the turbine chamber. When cleaning and lubrication of the high-speed dental turbine was carried out before autoclaving, this level of reduction was observed for all the examined non-vacuum autoclaves.

CONCLUSIONS

It is concluded that cleaning before sterilization is essential for safe use of high-speed dental turbines and that small non-vacuum autoclaves should be carefully evaluated before being used for the reprocessing of hollow instruments such as high-speed turbines.

Toxicity of gamma irradiated liposomes. 1. In vitro interactions with blood components

Gamma irradiation is a potential technique for sterilisation of liposome suspensions. Unfortunately, gamma irradiation may result in chemical degradation of the phospholipids and the toxicological aspects have to be considered. The effects of liposome composition and gamma irradiation on the interactions of the liposomes with the hemostatic mechanisms (hemolysis, aggregation and coagulation) were studied. Non-irradiated liposome suspensions showed no hemolysis of erythrocytes. After irradiation, up to 3.1% hemolysis was measured. Least hemolysis was observed with irradiated liposomes composed of unsaturated or charged phospholipids. The negatively charged DSPG-liposomes (both non-irradiated and irradiated) induced aggregation of platelets as observed by the spectrophotometric method. However, no aggregates were seen in the microscope or measured by the aggregometer. Negatively charged liposomes also affected the coagulation cascade where prolonged coagulation times were measured. Irradiation of the liposome suspensions resulted in even longer coagulation times. The prolonged coagulation times correlated to some extent with the measured binding and depletion of calcium from plasma by the negatively charged liposomes.

Immunogenicity of intranasally administered meningococcal native outer membrane vesicles in mice

Colonization of the human nasopharyngeal region by Neisseria meningitidis is believed to lead to natural immunity. Although the presence of bactericidal antibody in serum has been correlated with immunity to meningococcal disease, mucosal immunity at the portal of entry may also play an important role. This study was undertaken to examine in mice the possibility of safely using native outer membrane vesicles (NOMV) not exposed to detergent as an intranasal (i.n.) vaccine. The mucosal and systemic responses of mice to intranasal and intraperitoneal (i.p.) vaccination with NOMV were compared over a range of doses from 0.1 to 20 microgram. Intranasal vaccination of mice with NOMV induced a strong systemic bactericidal antibody response, as well as a strong local immunoglobulin A immune response in the lung as determined by assay of lung lavage fluid by enzyme-linked immunosorbent assay and lung antibody secreting cells by enzyme-linked immunospot assay. However, 8- to 10-fold-higher doses of NOMV were required i.n. compared to i.p. to elicit an equivalent bactericidal antibody response in serum. Some NOMV vaccine was aspirated into the lungs of mice during i.n. immunization and resulted in an acute inflammatory response that peaked at 1 to 2 days postimmunization and was cleared by day 7. These results indicate that i.n. delivery of meningococcal NOMV in mice is highly effective in eliciting the production of both a mucosal immune response and a systemic bactericidal antibody response.

Recurrent fetal polycystic kidneys associated with glutaric aciduria type II

A woman had two pregnancies terminated in the 20th and 21st weeks of gestation after ultrasonographic detection of enlarged hyperechoic kidneys in both fetuses. The combination of polycystic kidneys and steatotic liver found at autopsy suggested glutaric aciduria type II (GA II), which was confirmed by biochemical investigation. GA II or multiple acyl-CoA dehydrogenase deficiency is an autosomal recessively inherited defect of mitochondrial energy metabolism, which usually results in neonatal death. When pregnancy is terminated because of enlarged hyperechoic kidneys in the fetus, autopsy is crucial for establishing the correct diagnosis. The combination of polycystic kidneys and steatotic liver should bring GA II to mind, and prompt appropriate biochemical investigations so that genetic counselling and first trimester diagnosis can be offered in future pregnancies.

Calcium absorption from small soft-boned fish

The prevalence of osteoporosis in developing countries is low compared to most industrialised countries despite an apparent low Ca intake. It is possible, however, that food surveys have overlooked important Ca sources in developing countries. Small fish eaten with the bones can be a rich source of Ca, even though Ca from bone may be considered unavailable for absorption. In the present study, absorption of Ca from indigenous Bengali small fish was compared with the Ca absorption from milk. Ca absorption from single meals was determined in 19 healthy men and women (21-28 y). Each subject received two meal types on two separate occasions. Both meals consisted of white wheat bread, butter and ultra pure water with the main Ca source being either small Bengali fish (397 mg Ca in total) or skimmed milk (377 mg Ca in total). The meals were extrinsically labelled with 47Ca, and whole-body retention was measured on day 8, 12, 15 and 19 after intake of each meal. The labelling procedure was evaluated by an in vitro method. The calculated absorption of Ca as measured with 47Ca whole-body retention was 23.8 +/- 5.6% from the fish meal and 21.8 +/- 6.1% from the milk meal (mean +/- SD), which was not significantly different (p = 0.52). Even after correction for an incomplete isotope exchange, as indicated by the in vitro study, Ca absorption was similar from the two meal types. It was concluded that Ca absorption from small Bengali fish was comparable that from skimmed milk, and that these fish may represent a good source of Ca.

Pancreatic secretion of zinc and carboxypeptidase A and B in growing pigs

The secretion of zinc and the level of carboxypeptidase A and B activity in pancreatic juice were studied in three pigs fitted with a pancreatic pouch re-entrant cannula (PM pigs) and three different pigs with a catheter surgically implanted in their pancreatic duct (CM pigs). The zinc in the pancreatic juice appeared to be primarily associated with carboxypeptidase A and B. Both the concentration of zinc in pancreatic juice and the daily secretion of zinc in PM pigs were greater than in CM pigs. However, compared to the daily intake of zinc, its secretion in pancreatic juice was low. The specific activity levels of carboxypeptidase A and B in pancreatic juice collected from PM pigs were higher than in CM pigs. The total activity of carboxypeptidase A in pancreatic juice did not differ between collection methods. The total activity of carboxypeptidase B was higher in pancreatic juice collected from PM than from CM pigs. The differences in zinc and carboxypeptidase secretion between PM and CM pigs were probably due to physiological changes induced following the different surgical preparations of the animals.

A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals

Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation. There are reasons, therefore, to initiate systematic studies on the alternative procedure known as stepwise excavation. Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation. This study examines the clinical and microbiological alterations during the final excavation performed during long intervals (6-12 months) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. The dentine colour and consistency were assessed by means of standardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6-12 months. Reassessments were performed before the after final excavation. Microbiological dentine samples were obtained in 19 randomly selected lesions by a sterile bur, transferred to and diluted in reduced transport fluid, and plated on tryptic soy agar. After anaerobic incubation at 37 degrees C for 7 days, total colony-forming units per millilitre were counted from (1) peripheral excavated and hard dentine (control), (2) central demineralized dentine before and final excavation, and (3) central dentine after the final excavation. Six samples of central demineralized dentine were without any cultivable flora increasing to 9 samples after the final excavation. The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation. Despite the presence of bacteria in the excavated dentine none of the carious lesions resulted in pulp perforation, suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression. Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinically excavated lesions.

Evaluation of a new device for sterilizing dental high-speed handpieces

Dental high-speed turbines and handpieces can take up and expel microorganisms during operation and thus need regular sterilization. This study established a method for validating devices used to sterilize high-speed turbines and handpieces. The air and water channels and turbine chambers were contaminated with suspensions of Streptococcus salivarius or endospores of Bacillus stearothermophilus. The effect of flushing and/or autoclaving performed by a new device combining both procedures was evaluated by counting the number of viable bacteria recovered from these devices. Further, the effect on clinically used handpieces was evaluated. In an initial experiment, the device partially reduced S. salivarius, and the endospores survived. In a second experiment, a 5 to 6 log reduction of S. salivarius in air and water channels was obtained. No growth was observed in clinically used high-speed handpieces, and both S. salivarius and endospores were eliminated from the turbine chambers. Thus, the method of validation proved capable of discriminating between different levels of bacterial reduction.

Structure, function, and regulation of human cAMP-dependent protein kinases

A large number of hormones, neurotransmitters, and other signaling substances that bind to G-protein-coupled cell-surface receptors have their signals converge at one sole second messenger, cAMP. The question of how specificity can be maintained in a signal-transduction system in which many extracellular signals leading to a vast array of intracellular responses are all mediated through one second-messenger system has been the subject of thorough investigation and a great deal of speculation. An increasing number of cAK isozymes, consisting of homo- or heterodimers of R subunits (RIalpha, RIbeta, RIIalpha, RIIbeta) with associated catalytic subunits (C alpha, Cbeta, Cgamma), may, at least in part, explain this specificity. The various cAK isozymes display distinct biochemical properties, and the heterogeneous subunits of cAK reveal cell-specific expression and differential regulation at the level of gene transcription, mRNA stability, and protein stability in response to a wide range of hormones and other signaling substances. The existence of a number of anchoring proteins specific to either RIIalpha or RIIbeta, and which localize cAKII isozymes toward distinct substrates at defined subcellular loci, strongly supports the idea that specific functions can be assigned to the various cAK isozymes. The demonstration that selective activation of cAKI is necessary and sufficient for cAMP-mediated inhibition of T-cell proliferation, and the observation that T-cell activation is associated with redistribution and colocalization of cAKI to the TCR, is also compatible with the notion of isozyme-specific effects.

Health services, coordination and the Internet

The on-going specialization of medical services requires socioeconomic coordination of different health services. The GP is the key to improve this primary coordination. To qualify referral decisions by the GP an Internet-like information system (VisInfo) has been implemented in Denmark. This VisInfo contains information on (1) alternative periods of waiting, (2) medical guidelines for specific treatments (3) clinical home pages, and (4) links to non-medical providers of health services (NGOs). VisInfo was originally implemented in the Counties of Funen, Northern Jutland and Vejle in 1993-1995. A number of other counties are implementing similar information systems whereof the County of Frederiksborg, recently has implemented the first real Internet-system. Provisional experiences with the VisInfo strategy is presented on (1) the general user interest, (2) elaborations of the strategy, and (3) organization. Based on the BlackSeaDiab Action Plan and the BlackSea TeleDiab project, the potential for dissemination of medical informatics in the Black Sea Region through an adaption of the VisInfo strategy is discussed.

The energy value of short-chain fatty acids infused into the caecum of pigs

The present work was undertaken to study the energy value of a mixture of acetic, propionic and butyric acids (0.682:0.226:0.092) infused intracaecally in growing pigs. A basal diet low in fibre (42 g NSP/kg DM) was given at below the requirement for maximum weight gain. In six 2-week periods, N and energy balance measurements in eight growing pigs were carried out with and without infusion of short-chain fatty acids (SCFA). Heat production was measured using open-circuit chambers and the concentration of SCFA in faeces was determined. Less than 1% of the infused SCFA was excreted in faeces illustrating the capacity of the hind-gut to absorb and metabolize SCFA. Infusion of SCFA did not affect the digestibility of nutrients and energy. However, N retention increased demonstrating that SCFA are an energy source for protein gain when pigs are fed at below the requirement of energy. Increased CH4 production together with an increased excretion of branched-chain fatty acids in faeces suggested that there was a higher microbial activity in the hind-gut during infusion. The partial utilization of the infused energy in SCFA was 0.821. A small proportion of the infused energy in SCFA was retained in protein (0.099) and a considerable amount was retained as fat (0.722).

Development of resistance to metronidazole and minocycline in vitro

By local delivery of antibiotics to periodontal pockets, very high initial concentrations are often quickly succeeded by subinhibitory concentrations, which may facilitate development of bacterial resistance. The purpose of the present study was to investigate possible development of resistance in suspected periodontal pathogens after exposure to subinhibitory concentrations of metronidazole and minocycline. The minimal inhibitory concentration (MIC) of 18 reference strains and 12 clinical isolates was determined by a broth dilution method. Subsequently, all strains with MIC < 8 micrograms/ml were exposed to serial passage on plates containing subinhibitory and gradually increasing concentrations of antibiotics, until growth was inhibited. Initially, most strains were inhibited at < or = 0.250 microgram/ml of minocycline and < or = 0.5 microgram/ml of metronidazole, though A. actinomycetemcomitans was resistant to metronidazole. After growth at subinhibitory concentrations, 8 strains survived 1-2 x and 11 stains survived 8-32 x their initial MIC of metronidazole, growing at up to 8 micrograms/ml. All A. actinomycetemcomitans survived 8-64 x their initial MIC of minocycline, growing at > or = 2 micrograms/ml, while all other strains were inhibited at < or = 0.250 microgram/ml, corresponding to a 1-8 x increase in their initial MIC. Thus, development of resistance was observed for periodontal bacteria growing at up to 64 x their initial MIC, but the final level of resistance was moderate.