A scoping review of guidelines for the use of race, ethnicity, and ancestry reveals widespread consensus but also points of ongoing disagreement

The use of population descriptors such as race, ethnicity, and ancestry in science, medicine, and public health has a long, complicated, and at times dark history, particularly for genetics, given the field's perceived importance for understanding between-group differences. The historical and potential harms that come with irresponsible use of these categories suggests a clear need for definitive guidance about when and how they can be used appropriately. However, while many prior authors have provided such guidance, no established consensus exists, and the extant literature has not been examined for implied consensus and sources of disagreement. Here, we present the results of a scoping review of published normative recommendations regarding the use of population categories, particularly in genetics research. Following PRISMA guidelines, we extracted recommendations from n = 121 articles matching inclusion criteria. Articles were published consistently throughout the time period examined and in a broad range of journals, demonstrating an ongoing and interdisciplinary perceived need for guidance. Examined recommendations fall under one of eight themes identified during analysis. Seven are characterized by broad agreement across articles; one, "appropriate definitions of population categories and contexts for use," revealed substantial fundamental disagreement among articles. Additionally, while many articles focus on the inappropriate use of race, none fundamentally problematize ancestry. This work can be a resource to researchers looking for normative guidance on the use of population descriptors and can orient authors of future guidelines to this complex field, thereby contributing to the development of more effective future guidelines for genetics research.

Impact of surface ozone interactions on indoor air chemistry: A modeling study

An INdoor air Detailed Chemical Model was developed to investigate the impact of ozone reactions with indoor surfaces (including occupants), on indoor air chemistry in simulated apartments subject to ambient air pollution. The results are consistent with experimental studies showing that approximately 80% of ozone indoors is lost through deposition to surfaces. The human body removes ozone most effectively from indoor air per square meter of surface, but the most significant surfaces for C₆ -C₁₀ aldehyde formation are soft furniture and painted walls owing to their large internal surfaces. Mixing ratios of between 8 and 11 ppb of C₆ -C₁₀ aldehydes are predicted to form in apartments in various locations in summer, the highest values are when ozone concentrations are enhanced outdoors. The most important aldehyde formed indoors is predicted to be nonanal (5-7 ppb), driven by oxidation-derived emissions from painted walls. In addition, ozone-derived emissions from human skin were estimated for a small bedroom at nighttime with concentrations of nonanal, decanal, and 4-oxopentanal predicted to be 0.5, 0.7, and 0.7 ppb, respectively. A detailed chemical analysis shows that ozone-derived surface aldehyde emissions from materials and people change chemical processing indoors, through enhanced formation of nitrated organic compounds and decreased levels of oxidants.

Multiannual observations of acetone, methanol, and acetaldehyde in remote tropical atlantic air: implications for atmospheric OVOC budgets and oxidative capacity

Oxygenated volatile organic compounds (OVOCs) in the atmosphere are precursors to peroxy acetyl nitrate (PAN), affect the tropospheric ozone budget, and in the remote marine environment represent a significant sink of the hydroxyl radical (OH). The sparse observational database for these compounds, particularly in the tropics, contributes to a high uncertainty in their emissions and atmospheric significance. Here, we show measurements of acetone, methanol, and acetaldehyde in the tropical remote marine boundary layer made between October 2006 and September 2011 at the Cape Verde Atmospheric Observatory (CVAO) (16.85° N, 24.87° W). Mean mixing ratios of acetone, methanol, and acetaldehyde were 546 ± 295 pptv, 742 ± 419 pptv, and 428 ± 190 pptv, respectively, averaged from approximately hourly values over this five-year period. The CAM-Chem global chemical transport model reproduced annual average acetone concentrations well (21% overestimation) but underestimated levels by a factor of 2 in autumn and overestimated concentrations in winter. Annual average concentrations of acetaldehyde were underestimated by a factor of 10, rising to a factor of 40 in summer, and methanol was underestimated on average by a factor of 2, peaking to over a factor of 4 in spring. The model predicted summer minima in acetaldehyde and acetone, which were not apparent in the observations. CAM-Chem was adapted to include a two-way sea-air flux parametrization based on seawater measurements made in the Atlantic Ocean, and the resultant fluxes suggest that the tropical Atlantic region is a net sink for acetone but a net source for methanol and acetaldehyde. Inclusion of the ocean fluxes resulted in good model simulations of monthly averaged methanol levels although still with a 3-fold underestimation in acetaldehyde. Wintertime acetone levels were better simulated, but the observed autumn levels were more severely underestimated than in the standard model. We suggest that the latter may be caused by underestimated terrestrial biogenic African primary and/or secondary OVOC sources by the model. The model underestimation of acetaldehyde concentrations all year round implies a consistent significant missing source, potentially from secondary chemistry of higher alkanes produced biogenically from plants or from the ocean. We estimate that low model bias in OVOC abundances in the remote tropical marine atmosphere may result in up to 8% underestimation of the global methane lifetime due to missing model OH reactivity. Underestimation of acetaldehyde concentrations is responsible for the bulk (∼70%) of this missing reactivity.

The atmospheric chemistry of trace gases and particulate matter emitted by different land uses in Borneo

We report measurements of atmospheric composition over a tropical rainforest and over a nearby oil palm plantation in Sabah, Borneo. The primary vegetation in each of the two landscapes emits very different amounts and kinds of volatile organic compounds (VOCs), resulting in distinctive VOC fingerprints in the atmospheric boundary layer for both landscapes. VOCs over the Borneo rainforest are dominated by isoprene and its oxidation products, with a significant additional contribution from monoterpenes. Rather than consuming the main atmospheric oxidant, OH, these high concentrations of VOCs appear to maintain OH, as has been observed previously over Amazonia. The boundary-layer characteristics and mixing ratios of VOCs observed over the Borneo rainforest are different to those measured previously over Amazonia. Compared with the Bornean rainforest, air over the oil palm plantation contains much more isoprene, monoterpenes are relatively less important, and the flower scent, estragole, is prominent. Concentrations of nitrogen oxides are greater above the agro-industrial oil palm landscape than over the rainforest, and this leads to changes in some secondary pollutant mixing ratios (but not, currently, differences in ozone). Secondary organic aerosol over both landscapes shows a significant contribution from isoprene. Primary biological aerosol dominates the super-micrometre aerosol over the rainforest and is likely to be sensitive to land-use change, since the fungal source of the bioaerosol is closely linked to above-ground biodiversity.

Analysis of roasted and unroasted Pistacia terebinthus volatiles using direct thermal desorption-GCxGC-TOF/MS

The objective of this study was to determine the effects of roasting time on volatile components of Pistacia terebinthus L., a fruit growing wild in Turkey. The whole fruit samples were pan roasted for 0, 5, 10, 15, 20 and 25min at 200°C. Volatile compounds were isolated and identified using the direct thermal desorption (DTD) method coupled with comprehensive gas chromatography - time of flight mass spectrometry (GCxGC-TOF/MS). The major components of the fresh hull of P. terebinthus were α-pinene (10.37%), limonene (8.93%), β-pinene (5.53%), 2-carene (4.47%) and γ-muurolene (4.29%). Eighty-three constituents were characterised from the volatiles of fresh whole P. terebinthus fruits obtained by direct thermal desorption with α-pinene (9.62%), limonene (5.54%), γ-cadinane (5.48%), β-pinene (5.46%), β-caryophyllene (5.24%) being the major constituents. The type and the number of constituents characterised were observed to change with differing roasting times. Limonene (5.56%), α-pinene (4.84%), 5-methylfurfural (4.78%), 5-hydroxymethylfurfural (5-HMF, 3.89%), dimethylmetoxyfuranone (3.67%) and 3-methyl-2(5H)furanone (3.12%) were identified as the major components among the 104 compounds characterised in the volatiles of P. terebinthus, roasted for 25min. In addition, volatiles of fully roasted P. terebinthus fruits contained furans and furanones (15.42%), pyridines (4.45%) and benzene derivatives (3.81%) as the major groups.

Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery

INTRODUCTION

We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective day-case hand and wrist surgery using either absorbable or non-absorbable sutures.

PATIENTS AND METHODS

A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH).

RESULTS

From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH.

CONCLUSIONS

For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients.

Memory Constraints and Flower Choice in Pieris rapae

Darwin hypothesized that flower constancy in insects that feed on nectar results from the need to learn how to extract nectar from a flower of a given species. In laboratory tests, Pieris rapae, the cabbage butterfly, showed flower constancy by continuing to visit flower species with which it had experience. The time required by individuals to find the source of nectar in flowers decreased with successive attempts, the performance following a learning curve. Learning to extract nectar from a second species interfered with the ability to extract nectar from the first. Insects that switch species thus experience a cost in time to learn. These results support recent suggestions on the importance of learning in animal foraging.

The role of the surface chemistry of CoCr alloy particles in the phagocytosis and DNA damage of fibroblast cells

Surface chemistry of CoCr particles is demonstrated to be fundamental to the process of phagocytosis by fibroblast cells in vitro. Particles preincubated in serum for 5 days and washed in water before addition to cell cultures were phagocytosed less readily than were particles preincubated in minimal essential medium (MEM) for 1 h and washed in water. This was explained by the coating of calcium phosphate and protein on the serum-immersed particles investigated by time-of-flight secondary ion mass spectroscopy. The cells incubated with the serum-immersed particles had a reduced mitotic index when compared with the MEM-immersed particles, indicating that the phagocytosed particles were causing cell cycle arrest. The release of soluble ions measured by electrothermal atomic absorption spectroscopy within the first hour of particle immersion in MEM was identified as the most likely cause for the DNA damage measured by single cell gel electrophoresis ("Comet" assay). Cryofocused ion beam SEM with a spatial resolution of 8 nm was used to cross section cells, to investigate the location of the phagocytosed particles, some of which were found within the nuclear membrane. This paper demonstrated that consideration of the surface chemistry is essential to understand the processes of the effects of orthopedic wear debris.

Structural analysis of oligomeric molecules formed from the reaction products of oleic acid ozonolysis

The products arising from the ozonolysis of oleic acid (cis-9-octadecenoic acid) in solution have been studied using negative ion mode electrospray ionization ion trap mass spectrometry. Oleic acid is an important component of atmospheric organic aerosol and is a key model species in predicting aerosol physical and chemical characteristics. The four predicted reaction products, 1-nonanal, nonanoic acid, 9-oxononanoic acid, and azelaic acid, were all observed in roughly equal yields. In addition to these products a large number of higher molecular weight compounds were detected with m/z ratios of up to 1000 Daltons. Tandem mass spectrometry of these larger ions revealed thatthey represented a complex mixture of linear alpha-acyloxyalkyl hydroperoxides, secondary ozonides, and cyclic diperoxides, formed by reactions between ozonolysis products and Criegee intermediates. These comprise the first directly elucidated structures of large oligomeric species from oleic acid ozonolysis. The degree of oligomerization and hence molecular weight distribution was observed to increase with reaction time in solution.

The entrapment of corrosion products from CoCr implant alloys in the deposits of calcium phosphate: a comparison of serum, synovial fluid, albumin, EDTA, and water

Physical wear of orthopedic implants is inevitable. CoCr alloy samples, typically used in joint reconstruction, corrode rapidly after removal of the protective oxide layer. The behavior of CoCr pellets immersed in human serum, foetal bovine serum (FBS), synovial fluid, albumin in phosphate-buffered saline (PBS), EDTA in PBS, and water were studied using X-ray Photoelectron Spectroscopy (XPS) and Time-of-Flight Secondary Ion Mass Spectroscopy (ToF-SIMS). The difference in the corrosive nature of human serum, water, albumin in PBS and synovial fluid after 5 days of immersion was highlighted by the oxide layer, which was respectively 15, 3.5, 1.5, and 1.5 nm thick. The thickness of an additional calcium phosphate deposit from human serum and synovial fluid was 40 and 2 nm, respectively. Co and Cr ions migrated from the bulk metal surface and were trapped in this deposit by the phosphate anion. This may account for the composition of wear debris from CoCr orthopedic implants, which is known to consist predominantly of hydroxy-phosphate compounds. Known components of synovial fluid including proteoglycans, pyrophosphates, phospholipids, lubricin, and superficial zone protein (SZP), have been identified as possible causes for the lack of significant calcium phosphate deposition in this environment. Circulation of these compounds around the whole implant may inhibit calcium phosphate deposition.

Measurement and modelling of air pollution and atmospheric chemistry in the U.K. West Midlands conurbation: overview of the PUMA Consortium project

The PUMA (Pollution of the Urban Midlands Atmosphere) Consortium project involved intensive measurement campaigns in the Summer of 1999 and Winter of 1999/2000, respectively, in which a wide variety of air pollutants were measured in the UK West Midlands conurbation including detailed speciation of VOCs and major component analysis of aerosol. Measurements of the OH and HO2 free radicals by the FAGE technique demonstrated that winter concentrations of OH were approximately half of those measured during the summer despite a factor of 15 reduction in production through the photolysis of ozone. Detailed box modelling of the fast reaction chemistry revealed the decomposition of Criegee intermediates formed from ozone-alkene reactions to be responsible for the majority of the formation of hydroxyl in both the summer and winter campaigns, in contrast to earlier rural measurements in which ozone photolysis was predominant. The main sinks for hydroxyl are reactions with NO2, alkenes and oxygenates. Concentrations of the more stable hydrocarbons were found to be relatively invariant across the conurbation, but the impacts of photochemistry were evident through analyses of formaldehyde which showed the majority to be photochemical in origin as opposed to emitted from road traffic. Measurements on the upwind and downwind boundaries of the conurbation revealed substantial enhancements in NOx as a result of emissions within the conurbation, especially during westerly winds which carried relatively clean air. Using calcium as a tracer for crustal particles, it proved possible to reconstruct aerosol mass from the major chemical components with a fairly high degree of success. The organic to elemental carbon ratios showed a far greater influence of photochemistry in summer than winter, presumably resulting mainly from the greater availability of biogenic precursors during the summer campaign. Two urban airshed models were developed and applied to the conurbation, one Eulerian, the other Lagrangian. Both were able to give a good simulation of concentrations of both primary and secondary pollutants at urban background locations.

An observational case study of ozone and precursors inflow to South East England during an anticyclone

Summertime photochemical air pollution episodes within the United Kingdom have been proposed via modelling studies to be strongly influenced by regional scale inflow of air from the continental European boundary layer. We present a vertically resolved case study using measurements made from the NERC/Met Office BAe 146 research aircraft on 18th August 2005 over the South East of England and the North Sea during a weak anticyclone centred over Northern Europe. The vertical distribution of ozone, CO, NO(x), peroxyacetyl nitrate (PAN) and a wide range of both nonmethane hydrocarbons (NMHC) and oxygenated volatile organic compounds (OVOCs) were determined between 500 ft (approximately 152 m) and 7000 ft (approximately 2134 m) over the East Anglia coastline and 50 km inland. In excess of 80 ppbV ozone was observed within inflowing boundary layer air over the North Sea coast in a broad N-S sloping feature around 60 km wide. The inflowing feature of European origin was also observed further inland within the boundary layer albeit with lower, more variable, ozone mixing ratios. The increased variability in ozone over land was a product of titration by fresh surface emissions of NO via rapid upward transport in thermals, a hypothesis supported by the observed vertical wind speed component. Fast boundary layer mixing over land was further illustrated by a uniform distribution in reactive alkenes. A comparison between aircraft and surface O(3) UK AUN (Automatic Urban Network) measurements showed good agreement with the inland site, Sibton, but marked differences with the coastal monitoring site at Weybourne, potentially due to gradients established by ocean deposition in stably stratified marine air.

Metal-specific differences in levels of DNA damage caused by synovial fluid recovered at revision arthroplasty

Previous research has shown an increase in chromosomal aberrations in patients with worn implants. The type of aberration depended on the type of metal alloy in the prosthesis. We have investigated the metal-specific difference in the level of DNA damage (DNA stand breaks and alkali labile sites) induced by culturing human fibroblasts in synovial fluid retrieved at revision arthroplasty.

All six samples from revision cobalt-chromium metal-on-metal and four of six samples from cobalt-chromium metal-on-polyethylene prostheses caused DNA damage. By contrast, none of six samples from revision stainless-steel metal-on-polyethylene prostheses caused significant damage. Samples of cobalt-chromium alloy left to corrode in phosphate-buffered saline also caused DNA damage and this depended on a synergistic effect between the cobalt and chromium ions.

Our results further emphasise that epidemiological studies of orthopaedic implants should take account of the type of metal alloy used.

Effect of synovial fluid, phosphate-buffered saline solution, and water on the dissolution and corrosion properties of CoCrMo alloys as used in orthopedic implants

The corrosion and dissolution of high- and low-carbon CoCrMo alloys, as used in orthopedic joint replacements, were studied by immersing samples in phosphate-buffered saline (PBS), water, and synovial fluid at 37 degrees C for up to 35 days. Bulk properties were analyzed with a fine ion beam microscope. Surface analyses by X-ray photoelectron spectroscopy and Auger electron spectroscopy showed surprisingly that synovial fluid produced a thin oxide/hydroxide layer. Release of ions into solution from the alloy also followed an unexpected pattern where synovial fluid, of all the samples, had the highest Cr concentration but the lowest Co concentration. The presence of carbide inclusions in the alloy did not affect the corrosion or the dissolution mechanisms, although the carbides were a significant feature on the metal surface. Only one mechanism was recognized as controlling the thickness of the oxide/hydroxide interface. The analysis of the dissolved metal showed two mechanisms at work: (1) a protein film caused ligand-induced dissolution, increasing the Cr concentration in synovial fluid, and was explained by the equilibrium constants; (2) corrosion at the interface increased the Co in PBS. The effect of prepassivating the samples (ASTM F-86-01) did not always have the desired effect of reducing dissolution. The release of Cr into PBS increased after prepassivation. The metal-synovial fluid interface did not contain calcium phosphate as a deposit, typically found where samples are exposed to calcium rich bodily fluids.

The effects of calcium phosphate deposition upon corrosion of CoCr alloys and the potential for implant failure

Physical wear of orthopedic implants is inevitable. CoCr metal samples, typically used in joint reconstruction, corrode rapidly after removal of the protective oxide layer. The behavior of CoCr pellets immersed in human serum, fetal bovine serum (FBS), synovial fluid, and water were studied using time-of-flight secondary ion mass spectroscopy (ToF-SIMS). The differences in the corrosive nature of human serum, FBS, synovial fluid, and water after 5 days immersion were highlighted by the oxide/hydroxide layer, which was, respectively, 25, 10, 1.5, and 3-3.5 nm thick. The thickness of calcium phosphate deposit from human serum, FBS, and synovial fluid was, respectively, 30, 20, and 2 nm. Co and Cr ions migrated from the bulk metal surface and were trapped in the serum deposits, where chromium existed as oxides, hydroxides, and phosphates, whereas the cobalt chemistry was dominated only by phosphates and hydroxides. This may account for the composition of wear debris from CoCr orthopedic implants, which are predominantly hydroxyphosphate compounds. From the literature, proteoglycans, pyrophosphates, phospholipids, lubricin, and superficial zone protein (SZP) have been identified as possible causes for the insignificant deposit of calcium phosphate from synovial fluid. Circulation of these compounds around the whole implant may inhibit calcium phosphate deposition and therefore contribute to osteolysis.

Two high-speed, portable GC systems designed for the measurement of non-methane hydrocarbons and PAN: Results from the Jungfraujoch High Altitude Observatory

Near real-time measurements of light non-methane hydrocarbons (NMHCs) and peroxyacetyl nitrate (PAN) have been performed in the free troposphere using two fast gas chromatography (GC) instruments designed for use on aircraft. A GC-helium ionisation detector (HID) system measured 15 C(2)-C(5) hydrocarbons with 5 min time resolution and a dual channel GC-Electron Capture Detector (ECD) measured PAN with 90 s resolution. Both instruments had low parts per trillion by volume (pptV) detection limits and ran continuously at the remote Jungfraujoch (JFJ) research station in the Swiss Alps (46.55[degree]N, 7.98[degree]E), 3580 m above mean sea level (AMSL), during February/March 2003. Carbon monoxide, ozone, nitrogen oxide and nitrogen dioxide and all odd nitrogen species (NO(y)) were also measured continuously. Hydrocarbons and CO were strongly correlated in all air-masses whilst PAN exhibited both positive and negative correlations with respect to O(3), dependent on age and origin of the air-mass sampled. PAN was found to contribute [similar]20% to the NO(y) sampled on average. The experiment, as well as providing interesting datasets from this remote location, also demonstrated that when optimised, GC techniques have the potential to measure at a time resolution significantly greater than is traditionally considered, with high sensitivity and low uncertainty.

Measurements of C6-C8 hydrocarbons at a UK rural site during January 1999. Site evaluation and correlations between species

Ambient concentrations of C6-C8 aromatic hydrocarbons and n-heptane, determined by gas chromatography with flame ionisation detection, are presented from a winter campaign during January 1999 at a rural site near Leeds. Absolute concentrations are significantly lower than those obtained from the only designated UK rural site (Harwell) in the automated UK hydrocarbon network. Both absolute and relative concentrations of hydrocarbons measured at the site have been interpreted in terms of the arriving back-trajectories. The site is subject to two main airflows during the winter months; relatively polluted air from the southwest and much cleaner air from the northwest. Ratios of hydrocarbon concentrations show evidence of significant chemical processing consistent with chemical removal by OH. Uncertainties in the ages of the trajectories prevent a reliable estimation of the average OH concentration over the trajectory. The dependence of the variance of the hydrocarbon concentrations with their lifetime with respect to removal by OH does not show the expected behaviour.

A note on the emission of nitrogen oxides from silage in opened bunker silos

The evolution of NOx from grass and maize silages was measured using chemiluminescence in samples kept in airtight containers, in the silos and in a 750 kg mass removed to a mixer waggon. Measurements were made on the grass and maize silos in two consecutive years. The results show that there is continuous evolution of NOx after silos have been opened and that high concentrations persist in the mass which are rapidly released on agitation at the feed-out. The maximum recorded concentrations of NO and NO2 were 1985 and 152 ppbv respectively. These values are orders of magnitude greater than for rural background levels and exceed the maximum hourly exposure of 50 ppbv for NO2 recommended by the UK expert panel for quality standards.

Simultaneous monitoring of atmospheric methane and speciated non-methane hydrocarbon concentrations using Peltier effect sub-ambient pre-concentration and gas chromatography

Sub-ambient trapping, used to pre-concentrate atmospheric samples for non-methane hydrocarbon (NMHC) analysis by gas chromatography, can also be used to measure ambient methane concentrations. Above a sample volume of 40 ml, a dynamic equilibrium is established between ambient and trapped methane allowing for simultaneous quantitative determinations of methane and NMHC. The temperature stability of the trap is critical for quantitative methane analysis and this can be achieved by Peltier effect cooling. Simultaneous measurements of methane and NMHC reduce the equipment required for field trips and can ease the interpretation and modelling of atmospheric data. The feasibility for deployment of the system in remote locations was demonstrated by running the apparatus virtually unattended for a 5-day period. The correlations between the concentrations of methane, ethane and ethene measured during this period are discussed.

Susceptibility of anaerobic bacteria to beta-lactam antibiotics and beta-lactamase production

We examined the susceptibility of various anaerobes to four beta-lactamase susceptible (ampicillin, amoxycillin, cyclacillin, and penicillin G) and two beta-lactamase resistant (moxalactam, and N-F-thienamycin) beta-lactam antibiotics and measured beta-lactamase production. Members of the Bacteroides groups were most resistant to the six antibiotics. N-F-thienamycin was the most effective antimicrobial agent against all the test strains, moxalactam the next most effective, and penicillin G the least. Beta-lactamase production was mainly confined to Bacteroides species. Cephalosporinase was the most common beta-lactamase produced; penicillinase was detected less often. About two thirds of the penicillin-resistant isolates produced cephalosporinase. N-F-thienamycin and moxalactam were the most active agents against those anaerobes that were resistant to many beta-lactam antibiotics.

Single-dose cefaclor therapy of urinary tract infection. Evaluation of antibody-coated bacteria test and C-reactive protein assay as predictors of cure

The efficacy of single-dose (cefaclor, 2 g orally) and multidose (cefaclor, 250 mg orally three times a day for 10 days) antibiotic regimens in the therapy of acute uncomplicated urinary tract infections (UTI) in nonpregnant women were compared. The patient's clinical status and results of urine cultures were compared in retrospect with the results of the antibody-coated bacteria (ACB) test and C-reactive protein (CRP) test in order to determine if either test would predict the patient's response. Overall, 10 of 30 patients (33 percent) and 18 of 22 patients (81 percent) given single doses and multidoses, respectively, had negative urine cultures four weeks after completion of therapy. A negative urine culture at four weeks correlated with a negative ACB test utilizing the less inclusive criteria for negativity (less than 5 bacteria with fluorescence in 5 minutes of search) but not with a negative ACB test utilizing the more inclusive criteria (less than 10 percent bacteria with fluorescence) or with a negative CRP test. The cure rate in the ACB-negative single-dose group (7 of 9 patients) utilizing the less inclusive criteria for negativity was similar to the cure rate in the ACB-negative multidose group (8 of 10 patients). This study suggests that the ACB test, if properly standardized, might permit identification of a population of patients with UTI who would respond to single-dose cefaclor therapy.

Metronidazole in the treatment of anaerobic infections

Using metronidazole in oral dosages of 1.5 to 2 g daily, we treated 13 adults who had anaerobic pleuropulmonary infections, including 11 with lung abscess, one with necrotizing pneumonia, and one with thoracic empyema. Five patients (four with lung abscess and one with necrotizing pneumonia) were cured. The lung abscesses of 5 patients did not respond. For 3 patients (one with epigastric distress who refused metronidazole, one with undrained empyema, and one who died while receiving metronidazole), therapy could not be evaluated. Side effects included leukopenia (2 patients), leukopenia and neutropenia (one), neutropenia (one), dark urine (two), bitter taste (two), and epigastric distress (one). In light of our findings, metronidazole is not uniformly effective in the treatment of anaerobic pleuropulmonary infections.

Cefamandole therapy in anaerobic infections

Thirty-one adult patients with infections due to anaerobic bacteria were treated with cefamandole. Bacteroides fragilis group (17) and Bacteroides melaninogenicus (13) were the most frequent anaerobes isolated. Duration of therapy varied from 2 to 49 days. Results were judged satisfactory in 26 cases, and unsatisfactory in 1 case. Four cases could not be evaluated. Adverse reactions occurred in 16 patients and included positive direct Coombs' test without hemolysis, transient liver function abnormalities, phlebitis, reversible neutropenia, fever, eosinophilia, and toxic epidermal necrolysis. The more significant reactions were associated with prolonged therapy. None was lethal. These data suggest that cefamandole is effective in treatment of most anaerobic infections.

Analysis of increasing antibiotic resistance of Klebsiella pneumoniae relative to changes in chemotherapy

Three antibiotic-resistant strains of Klebsiella pneumoniae responsible for outbreaks of systemic infection in a hospital nursery were analyzed. Each organism emerged after prolonged use of a drug to which it was resistant. The first strain (RO16) produced neomycin phosphotransferase and contained three plasmids with molecular weights of 24, 25, and 30 X 10(6) daltons, respectively. Resistance to ampicillin, carbenicillin, neomycin, and kanamycin was transferred by conjugation at a frequency of 10(-6). The second strain of K. pneumoniae (RO106) produced gentamicin adenyltransferase and maintained aminoglycoside resistance only when propagated in antibiotic-containing medium. DNA analyses revealed eight species of plasmid DNA: one species with a molecular weight of 70 X 10(6) daltons apparently accounted for conjugal transfer of resistance to ampicillin, carbenicillin, chloramphenicol, and streptomycin. The third strain (RO180) was resistant primarily to colistin and lacked plasmids. Control of the outbreak due to this strain was achieved by aminoglycoside therapy.

Biochemistry of Vibrio cholerae virulence: purification of cholera enterotoxin by preparative disc electrophoresis

Procedures for cholera enterotoxin purification previously developed in this labarotory were not applicable to large-scale purification, and these methods resulted in low yields of pure toxin. An efficient scheme has been developed whereby pure cholera enterotoxin can be obtained from 6 to 8 liters of culture supernatant fluid. This method consists of concentration by membrane ultrafiltration followed by gel filtration and cation-exchange chromatography. Pure cholera enterotoxin of high biological potency was obtained after a final step of preparative acrylamide gel electrophoresis. The degree of purity of the toxin-antigen as well as its biological activity were determined at various setps of purification. This alternate technique for purification is offered because of the widespread interest in cholera enterotoxin as a specific stimulator of adenyl cyclase.

Separation of type 2 toxins of Vibrio cholerae

Choleragenic toxin was separated from vascular permeability factor by ion-exchange chromatography of supernatants of dialyzed peptone cultures of Vibrio cholerae. The choleragenic toxin eluted from columns of QAE-Sephadex with low-ionicity systems is free of permeability factor activity. Further elution of these columns with 0.5M NaCl removes both the permeability factor and residual choleragenic toxin. When this latter material is chromatographed on columns of carboxymethyl-Sephadex, the permeability factor toxin is eluted by 0.02M phosphate buffer and is free of choleragenic activity. Therefore, choleragenic and permeability factor activities of the type 2 cholera toxins are different and can be separated by these procedures.