[Susceptibility of Enterococcus genus to new antimicrobial agents]

The aim of this study was to determine the prevalence of resistance to different antibiotics in 109 clinical strains of Enterococcus isolated consecutively in hospital over a four-month period in 2002. The strains were identified by species using the semiautomatic system Microscan walk away 40 (Dade Behring) and the API20 STREP system (Biomerieux). Three different methods for the susceptibility study were used: Sensititre, E-test and disc diffusion. The percentage of Enterococcus faecalis and Enterococcus faecium isolated was 92% and 8%, respectively. The following resistance to Enterococcus faecalis was detected: erythromycin (53%), telithromycin (36%), penicillin (2%), ampicillin (1%), vancomycin, teicoplanin and linezolid (0%), high level resistance to streptomycin (51%) and gentamicin (32%). A high percentage of strains resistant to penicillin and ampicillin was detected in E. faecium (six of nine strains). For two species, high susceptibility to linezolid and glycopeptides was found.

Functional liver recovery parallels autologous gut salvage in short bowel syndrome

BACKGROUND/PURPOSE

Parenteral nutrition (PN) is life saving in short bowel syndrome. However, long-term parenteral nutrition is frequently complicated by a syndrome of progressive cholestatic liver disease that is considered to be irreversible beyond the early stages of cholestasis, particularly in the presence of any degree of fibrosis in the liver. The purpose of this study was to examine apparent improvement in PN-associated liver dysfunction in a cohort of children with short bowel syndrome.

METHODS

A retrospective case-record review of all patients managed within a dedicated Intestinal Rehabilitation Program (IRP) identified 13 patients with short bowel who had PN-associated liver dysfunction, defined for this purpose as hyperbilirubinemia or an abnormal liver biopsy.

RESULTS

At referral, 12 of the 13 patients were exclusively on PN, and one was on 50% PN. At current follow-up, 3 patients have achieved complete enteral autonomy from PN, and 7 patients have had smaller decrements in PN requirements. Specific operative procedures to improve intestinal function were undertaken in 11 patients; 4 patients also underwent cholecystectomies with biliary irrigation at the time of intestinal reconstruction. The median highest bilirubin level in these 13 patients was 10.7 mg% (range, 3.2 to 24.5 mg%). Liver biopsy results indicated that 5 patients were cirrhotic, 3 had bridging fibrosis, and 4 had severe cholestasis or lesser degrees of fibrosis. Of 10 survivors in this series, 9 patients currently have a serum bilirubin less than 1 mg% with a median bilirubin in the group of 0.6 mg% (range, 0.3 to 6.4 mg%). Twelve of the 13 patients in this series were initially referred for liver-small bowel transplantation.

CONCLUSIONS

This preliminary experience suggests that PN-dependent patients with advanced liver dysfunction in the setting of the short bowel syndrome may, in some instances, experience functional and biochemical liver recovery. The latter appears to parallel autologous gut salvage in most cases. As a corollary, the authors believe that even advanced degrees of liver dysfunction should not preclude attempts at autologous gut salvage in very carefully selected patients. Such a policy of "aggressive conservatism" may help avoid the need for liver/intestinal transplantation in some patients who appear to be not responding to PN.

Antimicrobial resistance in recent fecal enterococci from healthy volunteers and food handlers in Spain: genes and phenotypes

Susceptibility patterns to 15 different antibiotics and the presence of resistance genes were evaluated in recent fecal Enterococcus isolates recovered from 42 healthy volunteers (HV) and 43 food-handlers (FH). A total of 142 Enterococcus faecalis, 74 Enterococcus faecium, and 23 Enterococcus spp. with different antibiotic susceptibility patterns were studied. A higher percentage of resistance for moxifloxacin, erythromycin, glycopeptides and high-level resistance (HLR) to gentamicin were observed in the FH group. Ampicillin- or linezolid-resistant isolates were not recovered in any of the groups. The tet(M) gene was found in 96% and in 85% of tetracycline-resistant isolates from HV and FH, respectively. HLR-kanamycin was mediated by aph(3')-IIIa, or aac(6')-aph(2"), or both genes in all isolates from HV group and in 86% from FH group. The aac(6')-aph(2") gene was found in all HLR-gentamicin isolates. Ninety-one percent of HV and 71% of FH erythromycin-resistant isolates harbored the erm(B) gene (erythromycin MIC range of 8-128 microg/ml), whereas erm(A), erm(C), or mef(A) genes were not detected. Coexistence of erm(B), aph(3')-IIIa, and tet(M) genes was observed in 17% of the isolates of both groups. The HLR-gentamicin isolates presented unrelated PFGE patterns while 2 out of 3 vanA E. faecium isolates showed an indistinguishable SmaI-pulsed-field gel electrophoresis (PFGE) pattern. This study shows that despite 4 years of official banning of antibiotic growth promoters in animals, enterococci isolated from FH are more resistant than those from HV. This suggests the permanence of resistant clones or transferable resistance elements in farms and a possible exchange between food products and humans, or eventually the long-term permanence of certain clones in the FH intestinal tract.

Clonal diversity among erythromycin-resistant beta-haemolytic Streptococcus isolates in La Rioja, Spain

OBJECTIVE

To analyse clonal diversity in 72 erythromycin-resistant beta-haemolytic streptococci.

METHODS

Clonal relationships were studied for streptococci of groups A (GAS, n = 30), B (GBS, n = 34), C (GCS, n = 4) and G (GGS, n = 4) by means of PFGE. Streptococcal isolates were obtained from a 450-bed hospital in Spain during the following periods: GAS (1996-2001), GBS (1999-2001), GCS and GGS (1997-2000).

RESULTS

Twenty-two of the 30 GAS isolates showed the M resistance phenotype and harboured the mef(A) gene. Five unrelated PFGE patterns were identified among these 22 GAS isolates. Sixteen of them, obtained during four different years of the study, showed one of the two predominant PFGE patterns. The remaining eight GAS isolates showed the MLSB resistance phenotype, and four unrelated PFGE patterns were detected. All but one erythromycin-resistant GBS showed the MLSB resistance phenotype, and an erm gene was identified in all cases [erm(B) or erm(A)]. Twenty-two unrelated PFGE patterns were demonstrated among 25 GBS with the MLSB resistance phenotype; the remaining eight MLSB GBS isolates could not be typed by PFGE. The eight erythromycin-resistant GGS and GCS isolates of this study presented seven unrelated PFGE patterns. GGS and GCS strains showed an MLSB resistance phenotype and had the erm(A) gene.

CONCLUSIONS

High clonal diversity was detected in this series of erythromycin-resistant GBS, whereas lower diversity was seen in the GAS isolates.

The phenomenon of one-trial tolerance to the anxiolytic effect of chlordiazepoxide in the elevated plus-maze test is abolished by previous administration of chlordiazepoxide or buspirone

It has been repeatedly reported that the anxiolytic action of benzodiazepines in the elevated plus-maze test is abolished in rats that have received a single prior experience of the test apparatus (one-trial tolerance effect). To analyze whether the one-trial tolerance effect of chlordiazepoxide can be influenced by administration of chlordiazepoxide or buspirone on trial 1, male Wistar rats received an IP injection of vehicle, chlordiazepoxide (8 mg/kg) or buspirone (2.5 mg/kg) 30 min. before testing for 5 min. in the plus-maze (trial 1). Seventy-two hours later, the rats received vehicle or chlordiazepoxide 30 min. before the re-exposure to the plus-maze for 5 min. (trial 2). Groups injected with chlordiazepoxide or buspirone on trial 1 and with chlordiazepoxide on trial 2 showed an anxiolytic effect of chlordiazepoxide on trial 2, as opposed to rats injected with vehicle on trial 1 and with chlordiazepoxide on trial 2. As opposed to previous studies, the present results suggest that the influence of prior experience with the plus-maze on the anxiolytic action of chlordiazepoxide during re-exposure seems to depend critically on the drug state in which trial 1 is experienced. These results are discussed with respect to the hypothesis proposed to explain the phenomenon of one-trial tolerance.

New intravascular contrast agent applied to dynamic contrast enhanced MR imaging of human breast cancer

PURPOSE

To evaluate the feasibility of using dynamic contrast-enhanced MR imaging with a new intravascular contrast agent in grading human breast cancer.

MATERIAL AND METHODS

23 patients with 27 breast tumors (21 carcinomas and 6 fibroadenomas) were examined with dynamic MR imaging after administration of Clariscan, an iron oxide nanoparticle with large T1 relaxivity and a long plasma half life. A 3D T1-weighted gradient echo sequence with an acquisition time of 60 s was repeated at regular intervals of 3-5 min before and up to 1 h after injection of 2 mg/kg b.w. of Clariscan. The endothelial transfer constant, Kps, which reflects overall vascular permeability, and the fractional plasma volume, fPV, were estimated from time-intensity curves acquired from three separate regions of interest (ROIs): whole tumor, a permeability hot spot, and a blood volume hot spot. Kps and fPV were compared to the results of histologic tumor grading (Scarff-Bloom-Richardson, SBR) and microvascular density, MVD.

RESULTS

A statistically significant correlation between the MR-derived Kps parameters and the SBR score was obtained for the whole tumor ROI (R = 0.70), and for the permeability hot spot ROIs (R = 0.67). A correlation between fPV and SBR was detected for the blood volume hot spot ROIs (R = 0.48). There was no statistically significant correlation between Kps or fPV with MVD.

CONCLUSION

The results support the hypothesis that dynamic MR with the intravascular contrast agent Clariscan may be used for non-invasive tumor grading.

Clinical approach to urinary incontinence: a comparison between internists and geriatricians

To compare the initial approach and pattern of practice between internists and geriatricians in treating urinary incontinence. A retrospective chart review of 300 consecutive charts of elderly patients over the age of 65, seen by either internists (IM) or Geriatricians (GERI) for urinary incontinence at the Cleveland Clinic Florida was performed. The clinical approaches to the management of urinary incontinence were compared between IM and GERI groups by using a Student's t test. The mean age for these patients was 77 y for the IM group and 79 y for the GERI group. Majority of patients suffered from two chronic illnesses. We found that geriatricians performed more initial work up such as urodynamic testing before referring, while internists obtained more referrals to gynecologist with special interest in urologic disorders (currently called urogynecologist) without initial workup. IM and GERI groups equally prescribed medications for incontinence. However, the GERI group recommended Kegel exercises more frequently. This study showed that geriatricians manage urinary incontinence more extensively by performing more initial work up including urodynamics and providing initial behavioral therapy (Kegel exercise and toilet schedule) before referring to specialists. Perhaps geriatricians feel more comfortable treating urinary incontinence as shown by their lower frequency of referrals and are therefore more comfortable than internists at addressing this medical issue. On the contrary, the internist did the initial evaluation but preferred to get a referral perhaps due to less familiarity with urinary incontinence.

Genomic and antigenomic chains of hepatitis C virus and hepatitis G virus in serum, liver and peripheral blood mononuclear cells

OBJECTIVE

To determine HCV and HGV replication sites in patients with chronic hepatitis C and to study interaction between these two viruses.

PATIENTS

HGV RNA was studied in 272 patients with chronic hepatitis C. Of these, 35 were positive (group I). Twenty-three patients with chronic hepatitis C not co-infected with HGV were selected (group II).

RESULTS

Genomic and antigenomic chains of HCV were studied in both groups and those of HGV in group I in serum samples, peripheral blood mononuclear cells and liver tissue. In group I genomic chains of HCV and HGV were observed in 86 and 100%, respectively (ns), in serum samples (n = 35), and antigenomic chains in 17 and 23%, respectively (ns). In mononuclear cell samples (n = 15) 100% presented the genomic chain of HCV and 60% presented that of HGV (p < 0.05). Antigenomic chains were detected in 13 and 33%, respectively (ns). In liver tissue (n = 25) genomic chains were observed in 100 and 12%, respectively (p < 0.001); the antigenomic chain of HCV was detected in 76% while that of HGV was not present (p < 0.001). In group II genomic chains of HCV were found to be present in a very high percentage in all samples, while antigenomic chains appeared in 13% of serum and mononuclear cell samples and 89% of liver samples.

CONCLUSIONS

HCV and HGV have different sites of replication: whereas HCV replicates mainly in the liver, HGV is not hepatotropic. Mononuclear cells could represent a replication site for HGV but they are less important for HCV. Lastly, HGV does not modify the viral replication of HCV.

Extended exposure to a discriminated, limited-hold temporal schedule does not produce stimulus control

Four rats were exposed to two different stimuli (either lights or tones), each stimulus being correlated with independent probabilities of water delivery in a temporally defined schedule. The schedule consisted of a 60 s T cycle with 30 s t(D) and t(-) successive subcycles; t(D) was correlated with a probability of water delivery of 1.0 and t(-) was correlated with a probability of water delivery of 0.0. The schedule was maintained during 180 sessions and extended for 25 extra sessions omitting the stimulus in t(-). The four rats showed low frequencies of responding, response frequency being slightly higher in t(-) than in t(D). The percentage of lost reinforcers was independent of response frequency. The rats which lost less reinforcers were those which obtained more water deliveries during the first 15 cycles of each session. These results show that stimulus control does not develop in limited-hold temporal schedules, and that response-reinforcer effectiveness may depend on the initial contact with reinforcers in the first cycles of the session.

Validation of a behavioral recording automated system in the elevated plus-maze test

The elevated plus-maze test has been widely used for screening of anxiolytic drugs and for exploring neurobiological bases of anxiety. In this study, we validated a new automated system that enables to record exploratory behavior in the elevated plus-maze test. This system, called cyberplus, consisted of ten pairs of photoelectric cells strategically located in several parts of the apparatus, and seemed to be sensitive to the position of the animal's forepaws, so it would yield scores in anxiety measurements and locomotor activity similar to those obtained by following the traditional procedure, that is, by analyzing videotapes by experienced observers. In order to assess this hypothesis, we exposed rats to the elevated plus-maze test and compared the scores obtained by cyberplus with the values recorded by two independent observers, conducting a correlational study with both kinds of recording procedures. The results obtained suggest the utility of cyberplus as a behavioral recording automated system in the elevated plus-maze test, making data collection and data analysis easier in exploring pharmacological and neurobiological bases of anxiety.

Plasma prolactin/oestradiol ratio at 38 weeks gestation predicts the duration of lactational amenorrhoea

BACKGROUND

Fully breastfeeding women experience an amenorrhoea of variable duration. Our aim was to identify in pregnancy, endocrine markers that could predict the duration of subsequent lactational amenorrhoea.

METHODS

We studied 17 healthy women at 34 and 38 weeks gestation, and 1 and 3 months post-partum. The women fully breastfed until 6 months post-partum. During pregnancy, prolactin (PRL), oestrogens (total oestradiol, unconjugated oestrone, unconjugated oestriol), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEA-S), progesterone and placental lactogen, and during post-partum PRL, oestrogens and SHBG, were measured. Free oestradiol in pregnancy and post-partum was calculated.

RESULTS

Ten women experienced long (>6 months) and seven experienced short (<6 months) lactational amenorrhoea. At 38 weeks gestation, the women who experienced a long lactational amenorrhoea had twice as much PRL, about half the total oestradiol, lower SHBG concentration (P < 0.05, Student's t-test, Bonferroni modification) and similar free oestradiol concentration, compared with those who experienced short lactational amenorrhoea. The difference in PRL concentration persisted in post-partum postsuckling samples.

CONCLUSION

At 38 weeks gestation, the ratio PRL/oestradiol identified all individual women according to the subsequent duration of their lactational amenorrhoea, suggesting that duration of lactational amenorrhoea is conditioned during pregnancy.

Prenatal exposure to cocaine disrupts D1A dopamine receptor function via selective inhibition of protein phosphatase 1 pathway in rabbit frontal cortex

Previous work has demonstrated that in utero cocaine exposure induces an uncoupling of brain D(1A) dopamine receptors (D(1A)DARs) from G(s)-protein. The present work is an attempt to define the mechanism underlying the uncoupling. We detected a significant elevation of phosphoserine in frontal cortical D(1A)DARs of rabbits that were exposed prenatally to cocaine compared with saline controls. This increase in phosphorylation is observed at gestational day 22 and persists to postnatal day 20. The hyperphosphorylation of the D(1A)DAR is accompanied by a 45% inhibition in frontal cortex (FCX) protein phsphatase-1 (PP1) activity that appears to be mediated via DARPP-32 (dopamine and cAMP-regulated phosphoprotein) as indicated by elevated FCX phospho-DARPP-32 (Thr(34)). Furthermore, we demonstrated in both FCX and in PC2 cells that express D(1A)DARs that PP1 is physically associated with D(1A)DARs. We also observed a dramatic decrease in D(1A)DAR-associated PP1 activity in FCX of prenatal cocaine-exposed rabbits, indicating that the reduction in PP1 activity may be responsible for the hyperphosphorylation of the receptor. Furthermore, pretreatment of cortical membranes obtained from cocaine-exposed animals with exogenous PP1 dephosphorylated the phosphorylated D(1A)DAR and significantly reversed the impaired receptor-G(alphas) coupling. This work indicates (1) that D(1A)DAR dephosphorylation via PP1 is essential for receptor resensitization or reactivation and (2) an alteration in the DARPP-32/PP1 cascade appears to be a primary event responsible for D(1A)DAR dysfunction in in utero cocaine-exposed rabbit progeny. The present finding of an altered DARPP-32/PP1 cascade in association with a dysfunction in D(1A)DAR signal transmission in the prenatal cocaine-exposed rabbit brain may implicate novel strategies for the prevention and treatment for in utero cocaine-induced developmental and behavioral abnormalities.

Hyperbaric oxygen therapy for severe ulcerative colitis

Hyperbaric oxygen therapy has been used to successfully treat perineal Crohn's disease. We describe the first successful use of hyperbaric oxygen therapy in the treatment of ulcerative colitis, refractory to conventional therapies. Therapy consisted of 30 courses of 100% oxygen at a pressure of 2.0 atm absolute. Clinical remission was achieved on the basis of the Truelove-Witts and disease activity index scores. Corticosteroids were successfully tapered off once remission was achieved.

T-kininogen inhibits fibroblast proliferation in the G(1) phase of the cell cycle

By using synthetic protease inhibitors, several investigators have demonstrated that cysteine proteinases are required for cell proliferation. Kininogens are potent and specific physiological inhibitors of cysteine proteinases. We have used several mouse fibroblast-derived cell lines that express biologically active T-kininogen under the control of the mouse metallothionein promoter to test its effect on cell proliferation. Our results indicate that expression of T-kininogen results in diminished proliferative capacity, as measured by reduced cell numbers, both in logarithmically growing cultures and in G(0) cells induced to proliferate in response to serum. Furthermore, both fluorescence-activated cell sorting (FACS) analysis and incorporation of radioactive precursors into DNA suggest that the cells are unable to progress from G(0) through the S phase of the cell cycle in response to serum stimulation. However, we find that T-kininogen-expressing cell lines are still capable of responding to growth factors present in the serum, both by activating the ERK pathway and by expressing early genes, such as c-Fos and c-Jun. Thus, our results suggest that inhibition of cysteine proteinases by T-kininogen leads to inhibition of cell proliferation between the G(1) and S phases of the cell cycle.

Antibiotic resistance in Escherichia coli isolates obtained from animals, foods and humans in Spain

Antibiotic resistance was investigated in 474 Escherichia coli isolates recovered from animal faeces (broilers, pigs, pets, bulls and horses), human faeces (patients and healthy volunteers) and food products of animal origin. E. coli isolates (3260) recovered from human significant infectious samples were also included. There was a high frequency of nalidixic acid, ciprofloxacin and gentamicin resistance in E. coli isolates from broilers (88, 38 and 40%, respectively), and from foods (53, 13 and 17%). High levels of resistance to trimethoprim-sulphamethoxazole and tetracycline have been found in E. coli isolates from broilers, pigs and foods. These data raise important questions about the potential impact of antibiotic use in animals and the possible entry of resistant pathogens into the food chain.

ABC transporters in the protozoan parasite Leishmania

ATP-binding cassette (ABC) transporters constitute one of the biggest and most conserved protein families in the evolutionary scale. Many of them are of enormous clinical relevance, due to their relationship with genetic diseases and drug resistance during the treatment of cancer and infectious diseases. Leishmaniasis is a major and globally widespread group of parasitic diseases, whose treatment has been complicated by the expansion of resistance to conventional drugs. Here, we review the current knowledge about ABC transporters in Leishmania spp, with special attention to their relationship with the drug-resistance phenotype.