Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project

OBJECTIVES

Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry-based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency.

METHODS

By using the natural variation in health providers' preference for compulsory care as a source of quasi-randomisation we will estimate causal effects of compulsory care on short- and long-term trajectories.

CONCLUSIONS

This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.

The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway

BACKGROUND

Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects.

AIM

To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others.

METHODS

Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014-2017 predicted an increase in the standardized suicide ratios in 2014-2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287).

RESULTS

We found no adverse effects on patients' health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care.

CONCLUSIONS

Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

Geographical variation in compulsory hospitalisation - ethical challenges

BACKGROUND

Compulsory hospitalisation in mental health care restricts patients' liberty and is experienced as harmful by many. Such hospitalisations continue to be used due to their assumed benefit, despite limited scientific evidence. Observed geographical variation in compulsory hospitalisation raises concern that rates are higher and lower than necessary in some areas.

METHODS/DISCUSSION

We present a specific normative ethical analysis of how geographical variation in compulsory hospitalisation challenges four core principles of health care ethics. We then consider the theoretical possibility of a "right", or appropriate, level of compulsory hospitalisation, as a general norm for assessing the moral divergence, i.e., too little, or too much. Finally, we discuss implications of our analysis and how they can inform the future direction of mental health services.

Service Characteristics and Geographical Variation in Compulsory Hospitalisation: An Exploratory Random Effects Within-Between Analysis of Norwegian Municipalities, 2015-2018

Background: Compulsory hospitalisation in mental healthcare is contested. For ethical and legal reasons, it should only be used as a last resort. Geographical variation could indicate that some areas employ compulsory hospitalisation more frequently than is strictly necessary. Explaining variation in compulsory hospitalisation might contribute to reducing overuse, but research on associations with service characteristics remains patchy. Objectives: We aimed to investigate the associations between the levels of compulsory hospitalisation and the characteristics of primary mental health services in Norway between 2015 and 2018 and the amount of variance explained by groups of explanatory variables. Methods: We applied random-effects within-between Poisson regression of 461 municipalities/city districts, nested within 72 community mental health centre catchment areas (N = 1,828 municipality-years). Results: More general practitioners, mental health nurses, and the total labour-years in municipal mental health and addiction services per population are associated with lower levels of compulsory hospitalisations within the same areas, as measured by both persons (inpatients) and events (hospitalisations). Areas that, on average, have more general practitioners and public housing per population have lower levels of compulsory hospitalisation, while higher levels of compulsory hospitalisation are seen in areas with a longer history of supported employment and the systematic gathering of service users' experiences. In combination, all the variables, including the control variables, could account for 39-40% of the variation, with 5-6% related to municipal health services. Conclusion: Strengthening primary mental healthcare by increasing the number of general practitioners and mental health workers can reduce the use of compulsory hospitalisation and improve the quality of health services.

Measuring the level of compulsory hospitalisation in mental health care: The performance of different measures across areas and over time

OBJECTIVE

A variety of measures are used for reporting levels of compulsory psychiatric hospitalisation. This complicates comparisons between studies and makes it hard to establish the extent of geographic variation. We aimed to investigate how measures based on events, individuals and duration portray geographical variation differently and perform over time, how they correlate and how well they predict future ranked levels of compulsory hospitalisation.

METHODS

Small-area analysis, correlation analysis and linear regressions of data from a Norwegian health registry containing whole population data from 2014 to 2018.

RESULTS

The average compulsory hospitalisation rate per 100,000 inhabitant was 5.6 times higher in the highest area, compared to the lowest, while the difference for the compulsory inpatient rate was 3.2. Population rates based on inpatients correlate strongly with rates of compulsory hospitalisations (r = 0.88) and duration (r = 0.78). 68%-81% of ranked compulsory hospitalisation rates could be explained by each area's rank the previous year.

CONCLUSION

There are stable differences in service delivery between catchment areas in Norway. In future research, multiple measures of the level of compulsory hospitalisation should ideally be included when investigating geographical variation. It is important that researchers describe accurately the measure upon which their results are based.

What Makes Some Diseases More Typical than Others? A Survey on the Impact of Disease Characteristics and Professional Background on Disease Typicality

Health professionals tend to perceive some diseases as more typical than others. If disease typicalities have implications for health professionals or health policy makers' handling of different diseases, then it is of great social, epistemic, and ethical interest. Accordingly, it is important to find out what makes health professionals rank diseases as more or less typical. This study investigates the impact of various factors on how typical various diseases are perceived to be by health professionals. In particular, we study the influence of broad disease categories, such as somatic versus psychological/behavioral conditions, and a wide range of more specific disease characteristics, as well as the health professional's own background. We find that professional background strongly impacted disease typicality. All professionals (MD, RN, physiotherapists and psychologists) considered somatic conditions to be more typical than psychological/behavioral. As expected, psychologists also found psychological/behavioral conditions to be more typical than did other groups. Professions of respondents could be well predicted from their individual typicality judgments, with the exception of physiotherapists and nurses who had very similar judgment profiles. We also demonstrate how various disease characteristics impact typicality for the different professionals. Typicality showed moderate to strong positive correlations with condition severity and mortality, and only non-severe conditions were rated as atypical. Hence, studying how different disease characteristics and occupational background influences health professionals' perception of disease typicality is the first and important step toward a more general study of how typicality influences disease handling.

Dysgonomonas gen. nov. to accommodate Dysgonomonas gadei sp. nov., an organism isolated from a human gall bladder, and Dysgonomonas capnocytophagoides (formerly CDC group DF-3)

Results of a polyphasic taxonomic study on an unknown Gram-negative, facultatively anaerobic, coccobacillus-shaped organism isolated from an infected human gall bladder are presented. Phenotypic and molecular taxonomic studies revealed the organism to be close to, but distinct from, organisms designated CDC (Centers for Disease Control and Prevention) group DF-3. The unknown bacterium was readily distinguished from reference strains of Bacteroides, Prevotella, Porphyromonas and related taxa by 16S rRNA gene sequencing, biochemical tests, analysis of cellular long-chain fatty acids and electrophoretic analysis of whole-cell proteins. Based on the results of the present study, it is proposed that the unknown bacterium be classified in a new genus, Dysgonomonas, as Dysgonomonas gadei sp. nov. (type strain CCUG 42882T = CIP 106420T). In addition, a new species, Dysgonomonas capnocytophagoides sp. nov., is proposed to accommodate strains previously belonging to CDC group DF-3. The type species of the genus Dysgonomonas is Dysgonomonas gadei.

Molecular characterization and allelic distribution of the phage-mediated hyaluronidase genes hylP and hylP2 among group A streptococci from western Norway

Forty-two isolates of group A streptococcus from patients with invasive and non-invasive diseases in western Norway, belonging to the emm sequence types emml, emm3, emm6, emm22, emm28, emm75 and emm78 were screened by PCR for the phage-mediated hyaluronidase genes hylP and hylP2. The amplified genes were characterized by nucleotide sequencing and/or by PCR-RFLP, with the objective of looking for possible associations between alleles of these two genes and invasiveness. The hylP was amplified from all isolates and two main alleles were found hylP-emm3 in all emm3 isolates and hylP-emm6A in all emm6 isolates, the latter possibly generated by an intergenic recombination between hylP and hylP2. The isolates of the other sequence types had either of these two alleles, or both. Only 27 isolates gave amplicons of the appropriate size with the primers targeting hylP2. Sequencing of these amplicons showed two main types: one was similar to the published hylP2 and the other (hylP-emm6B) was probably a variant of hylP. PCR-RFLP revealed the presence of both hylP-emm6B and hylP2 in at least six of the emm6 isolates. The alleles of both hylP and hylP2 seemed to have emm sequence type preferences. No association between invasiveness and specific phage-mediated hyaluronidase genes/alleles or the production of extracellular hyaluronidase was observed.

Emm gene polymorphism among temporally clustered group A streptococcal isolates in western Norway

Nineteen group A streptococcal isolates obtained in western Norway from patients with invasive disease during a period of high morbidity and mortality were examined for clonality and emm gene polymorphism. These isolates belonged to the prevalent serotypes during the outbreak, namely T1, T3 or T6. Restriction fragment length polymorphism and sequencing of the emm genes were used to compare these isolates with 14 isolates of the same serotype but from non-invasive infections. The restriction analysis did not identify specific invasive clones. The emm genes in three of the four T3 isolates from invasive disease had nucleotide substitutions inducing a charge difference in the N-terminal part of the M protein. The 4 T6 isolates had a longer emm amplicon when compared to 15 isolates from superficial infections and also showed nucleotide substitutions that could induce conformational changes in the hypervariable end of the M protein. Restriction analysis of the emm amplicon of the T6 isolates in order to estimate the number of A- and C-repeats is described. The emm gene sequence served as an epidemiological marker within the serotypes T3 and T6, but the significance of the emm polymorphism displayed by the isolates from invasive disease is uncertain at this stage.

[Tuberculosis in Bergen 1996]

In 1996, 30 patients with tuberculosis were reported from Haukeland University Hospital to the Norwegian Tuberculosis Registry. Culturing proved 63% with mycobacterium tuberculosis (M. tuberculosis). 13 of the patients, eight adults and five children, all natives, were identified as close relatives or friends (cluster). M. tuberculosis with identical restriction fragment length polymorphism pattern (RFLP) were found in all the adults, indicating that they carried the same bacteria strain. We have compared the clinical findings, bacteriology and treatment among the adults in the cluster with other patients with pulmonary tuberculosis identified the same year at the Department of Thoracic Medicine at Haukeland University Hospital. The patients in the cluster were young adults without any previous chest X-ray changes. The other natives with tuberculosis were older, two showing chest X-ray changes indicating former tuberculosis. No difference was seen in sex, BCG status, tuberculin sensitivity, symptoms, physical findings or chest X-ray between the two groups. In the cluster, four patients proved sputum smear positive, as compared to four in the other group. Spread of infection and new cases of M. tuberculosis with identical RFLP were found only in the cluster. Since RFLP analyses of M. tuberculosis started in Norway in 1993, this cluster in Bergen is the largest cluster observed with identical RFLP pattern.

Septicaemia with Neisseria elongata ssp. nitroreducens in a patient with hypertrophic obstructive cardiomyopathia

Neisseria elongata ssp. nitroreducens, a commensal of the human upper respiratory tract, is a newly recognized cause of endocarditis. We report the isolation of the organism from blood cultures of a 30-y-old man with hypertrophic obstructive cardiomyopathy. The patient was successfully treated with benzylpenicillin and netilmicin in combination, followed by ceftriaxone and amoxicillin.

A mouse model for latent tuberculosis

The aim of the study was to establish a reproducible murine model for latent tuberculosis. We propose an operational definition of latent murine tuberculosis as a stable Mycobacterium-tuberculosis count in lungs and spleens without clinical signs or obvious histopathological changes in the lungs over a long period of time and without spontaneous reactivation of disease. B6D2F1Bom mice were inoculated with a wide range of Mycobacterium tuberculosis doses intraperitoneally or intravenously and followed for a long period to determine suitable conditions to produce latent infection. No anti-tuberculosis drug treatment was used. Microbiological and histopathological studies were carried out. Corticosterone challenge was used to reactivate the latent infection. Mice infected with 4 x 10(4) and 4 x 10(5) bacilli i.p. were followed up to 107 weeks without spontaneous reactivation. The present model is discussed in comparison with previous latent tuberculosis mouse models as well as the possible mechanisms of shift to stationary phase from multiplying bacilli.

Antibiotic susceptibility of group A streptococci in a national consultant hospital in Dar es Salaam: a four year follow-up

Seventy one Group A streptococcal strains isolated between 1992 and 1995 at Muhimbili Medical Centre in Dar es Salaam were found to be susceptible to penicillin G and cotrimoxazole. All except two strains, which showed intermediate susceptibility, were susceptible to erythromycin. Sixty five strains (91.5%) were resistant to doxycycline. The findings confirm continuing efficacy of penicillin G, erythromycin and contrimoxazole in treating Group A streptococci (GAS). The low prevalence of GAS with intermediate susceptibility to erythromycin and resistance to doxycycline by a majority of the GAS emphasise the need for regular monitoring of antibiotic susceptibility of GAS.

Chromosomal restriction endonuclease analysis and ribotyping of Bacteroides fragilis

We have analysed the restriction fragment length patterns of chromosomal DNA and of ribosomal RNA (rRNA) genes in order to investigate the clonal distribution within Bacteroides fragilis isolates. Eighteen blood culture isolates from 18 patients and 4 faecal isolates from 4 subjects were examined. Chromosomal restriction endonuclease analysis (REA) was performed by separating BamHI-generated DNA fragments using polyacrylamide gel electrophoresis (PAGE). Ribotyping was accomplished by hybridizing EcoRI-treated genomic DNA subjected to conventional REA on agarose to a radiolabelled probe obtained from 16+23S rRNA of E. coli. All 22 isolates could be differentiated by their REA patterns with a varying percentage of similar fragments. Analysis of the rRNA gene patterns displayed heterogeneity, and revealed 14 ribotypes among the 18 blood culture isolates and 3 among the 4 faecal isolates. The predominant ribotype among the clinical isolates was also shared by one faecal isolate. The results suggest that no particular clones are predominantly responsible for systemic infection.

Utility of newer techniques for classification and identification of pathogenic anaerobic bacteria

Results of genetic and biochemical analyses have broadened our understanding of taxonomic relationships among groups of anaerobic bacteria and have led to a better understanding of the pathogenesis of infection. Conventional bacteriologic methods are still of prime importance for the detection and identification of anaerobic pathogens. The use of nucleic acid probes has so far been restricted to research laboratories. A polymerase chain reaction-generated probe would be most useful for the rapid detection of toxigenic Clostridium difficile in feces. Probes are needed for detection of periodontopathogenic bacteria in dental plaque. Use of nucleic acid probes may become a useful adjunct to classic methodology in reference and teaching laboratories.

Small-fragment restriction endonuclease analysis in epidemiological mapping of group A streptococci

The usefulness of small-fragment restriction endonuclease digest analysis (SF-REA) of group A streptococcal DNA with EcoRI, as a supplement to the more conventional T serotyping, was assessed for epidemiological characterisation. One hundred and thirty-five clinical isolates from 1988-1990 were examined. SF-REA provided characteristic fingerprints of all isolates, whereas eight isolates were non-typable by T serotyping. Generally, there was a striking correlation between the results obtained with the two techniques. Furthermore, SF-REA reliably classified the eight T-non-typable isolates and occasionally revealed subgroups within the T serotypes. In addition, SF-REA was useful for the clarification of discrepancies between serotyping results from two different reference laboratories. No obvious correlation was observed between the DNA fingerprints and the clinical manifestations of infection or the geographical origin of the group A streptococcal isolates. SF-REA is a valuable supplement to T typing in epidemiological studies and frequently appears to be a more efficient tool for strain differentiation.

Stimulation of B lymphocytes by lipopolysaccharides from anaerobic bacteria

Lipopolysaccharides (LPSs) from anaerobic gram-negative bacteria, including those of low endotoxic activity that are isolated from Bacteroides, Prevotella, and Porphyromonas are potent inducers of DNA replication and polyclonal immunoglobulin production in murine B lymphocytes. The activation is dose-dependent and T cell-independent. Replication of DNA and production of immunoglobulins were also stimulated by lipid A and by the LPS heteropolysaccharide that were isolated by mild acid hydrolysis of the LPSs of Bacteroides fragilis and Fusobacterium nucleatum. Combinations of LPS, lipid A, and acid-degraded polysaccharide amplified the blastogenic response. Antibodies that react with the polysaccharide part of LPSs isolated from members of the Bacteroidaceae are present in healthy human serum.

Virulence factors in anaerobic bacteri

Various surface structures can be expressed in Bacteroides fragilis, but little is known about capsular structures in other non-spore-forming anaerobes. Fimbriae have been isolated from Bacteroides fragilis and Porphyromonas gingivalis. The importance of iron-repressible outer membrane proteins as virulence factors in Bacteroides fragilis is under study. The low endotoxic activity of Bacteroides fragilis lipopolysaccharide can be attributed to the chemical composition of this organism's lipid A. A tissue culture system for the demonstration of Bacteroides fragilis enterotoxin has recently been described. The toxins A and B of Clostridium difficile are immunologically distinct. The importance of IgA proteases and other enzymes as virulence factors in anaerobic bacteria remains unclear.

DNA base composition, aerotolerance and enzyme patterns of Leptotrichia buccalis

The guanine plus cytosine content of the DNA of Leptotrichia buccalis varied from 28.4 to 29.5 mol% (three strains). Eleven strains examined grew well under anaerobic and microaerobic conditions, but slowly in air in the presence of CO2. When examined for preformed enzymes in the APIZYM Complete Research Kit, positive reactions were obtained for several glucosidases and carboxylic ester hydrolases, and for a few peptidases.

DNA fingerprinting of isolates of Staphylococcus aureus from newborns and their contacts

During a study on the epidemiology of Staphylococcus aureus colonization in newborns, mothers, and hospital staff, S. aureus was isolated from 536 of 1,945 specimens. Ninety-three isolates of S. aureus from the three groups of individuals were included in a study to evaluate the potential of DNA fingerprinting for strain differentiation. The 93 isolates were also phage typed and their plasmid profiles were analyzed. Cleavage of DNA with BamHI resulted in 13 different DNA restriction endonuclease band patterns (DNA REBPs), one of which consisted of eight isolates whose DNA was not cleaved with BamHI. The DNAs from these eight isolates were easily cleaved with HindIII. The different DNA REBPs were stable both during in vitro and in vivo growth and allowed strain differentiation within phage groups or types. We could not show any strong association between DNA REBP classes, phage types or groups, and plasmid profiles. Of the 93 isolates, 27 (29.0%) could not be phage typed and 12 (12.9%) lacked plasmids. We therefore conclude that DNA fingerprinting is a powerful tool, in addition to phage typing and plasmid profile analysis, for strain differentiation of S. aureus.

Neonatal tetanus despite protective serum antitoxin concentration

Using the ELISA technique to estimate serum antibodies against tetanus toxin, seven neonates with clinical tetanus were found to have antibody levels 4-13 times higher than the presumed minimum protective level of 0.01 IU/ml. All but one of their mothers had been vaccinated with tetanus toxoid in pregnancy. In two other neonates, whose mothers had received multiple booster doses of toxoid during pregnancy, the anti-toxin concentrations were 100- and 400-times the presumed protective level. Therefore the toxin dose may overwhelm the pre-existing anti-toxin level and produce disease. Furthermore, multiple booster injections of tetanus toxoid may not only enhance serum anti-toxin titres, but could also lead to an ineffective immune response.

Synergistic effect on blastogenesis in murine spleen cells of lipopolysaccharide, lipid A, and acid-degraded polysaccharide from Fusobacterium nucleatum

Interchangeable combinations of Fusobacterium nucleatum Fev1 lipopolysaccharide (LPS) with its split products by acetic acid hydrolysis, i.e. lipid A (LA) and degraded polysaccharide (PS), amplified the blastogenic response in murine spleen cell cultures as measured by [3H]thymidine uptake. Athymic murine spleen cells precultured with LPS-Fev1 for 48 h (stage 1), washed twice and cultured together with fresh cells and either LA or PS for 72 h (stage 2) gave a synergistic response over that found in spleen cell cultures of thymic mice. Spleen cells pre-cultured with LA or PS and with fresh cells and LPS-Fev1 added to stage 2 cultures gave less significant amplification compared with precultures of LPS and either LA or PS together with fresh cells added to stage 2. Precultures with LA, PS or LPS-Fev1 and with pokeweed mitogen (PWM) and fresh cells added produced an additional increment of synergy which was most pronounced in spleen cell cultures of normal mice.

Blastogenesis and polyclonal immunoglobulin synthesis in murine spleen cells stimulated with lipopolysaccharide, lipid A and acid-degraded polysaccharide from Fusobacterium nucleatum

Lipopolysaccharide of Fusobacterium nucleatum strain Fevl was split by acid hydrolysis. The split products, i.e. lipid A and degraded polysaccharide were mitogenic for murine spleen cells as measured by uptake of [3H]thymidine. The uptake of [3H]thymidine was dose-dependent. Incubation of spleen cells with stimulants for 3 days resulted in a polyclonal activation of immunoglobulin synthesis. Higher mitogenic response and immunoglobulin production were found in spleen cells of athymic mice compared to those of thymic mice. The activity of lipid A in stimulating immunoglobulin synthesis was comparable with the parent lipopolysaccharide-Fevl, the degraded polysaccharide being the less potent stimulator.

Current taxonomy of medically important nonsporing anaerobes

This review deals mainly with the taxonomy of the genera and species in the family Bacteroidaceae. It has been proposed that the genus Bacteroides should be restricted to include the "Bacteroides fragilis group" and that the asaccharolytic black-pigmented Bacteroides species be transferred to a new genus, Porphyromonas. New Bacteroides, Fusobacterium, and Selenomonas species have been described. A high degree of heterogeneity is apparently present among Peptostreptococcus species. Mobiluncus is a novel genus including gram-variable curved rods isolated from the human vagina. Brachyspira has been proposed as the generic name for spirochetes isolated from patients with intestinal spirochetosis.

Serogroup A Neisseria meningitidis of clone III-1 present in western Norway as early as 1969-73

A clone of serogroup A Neisseria meningitidis recognized by multilocus enzyme electrophoresis and designated as clone III-1, has caused major epidemics of meningococcal disease in various parts of the world since the 1970s. In Norway, serogroup B meningococci have been responsible for an epidemic since the mid-1970s. We have studied a sample of 53 meningococci isolated from patients in western Norway prior to the serogroup B epidemic. 22/35 meningococcal isolates collected 1969-73 represented clone III-1, whereas this clone was not found in the 18 isolates from 1962-68. It has been speculated that the epidemic of meningococcal disease in Finland caused by clone III-1 in 1973-75 had spread from an epidemic in USSR that began in 1969. Our findings demonstrate, however, that the clone III-1 was present in Scandinavia in 1969.

Outer membrane proteins as major antigens of Fusobacterium nucleatum

The immunochemical reactions of rabbit polyclonal antibodies directed to different preparations of Fusobacterium nucleatum i.e, whole cells, peptidoglycan associated proteins, a peptidoglycan-protein complex and a purified 40 kiloDalton (kDa) protein, were investigated on outer membrane preparations of Fusobacterium species and a restricted number of Leptotrichia buccalis after their separation on sodium dodecyl sulphate polyacrylamide gels and electrotransfer to nitrocellulose. All F. nucleatum strains had identical reaction patterns with the immune sera tested. Surface exposed parts of a restricted number of proteins with apparent molecular weights at 70 kDa (a doublet band), 60 kDa, 55 kDa and 40 kDa seemed to be major immunogens. Antigenic related proteins either of identical or slightly deviating electrophoretic mobilities to the 40-kDa protein were observed with the other members of Bacteroidaceae tested. The characteristic 70-kDa protein doublet seemed to be restricted to F. nucleatum although single protein bands of near identical molecular weights belonging to the other species tested also reacted. The data also indicate that the 60-kDa and 55-kDa polypeptides might be present in other species of Fusobacterium.

Adherence of Campylobacter jejuni and Campylobacter coli to porcine intestinal brush border membranes

The adhesion of Campylobacter jejuni and C. coli to isolated porcine intestinal brush border membranes was studied by phase-contrast and electron microscopy. Approximately 45% of the cell population adhered to the brush borders, possibly in a specific manner. Pretreatment of the brush borders with trypsin or pronase, and competitive inhibition with L-rhamnose caused a slight reduction of the adhesion. Different forms of pretreatment of the bacterial cells reduced their ability to adhere, but also their motility.

Outer membrane protein pattern of Eubacterium plautii

The outer membrane SDS-PAGE pattern of Eubacterium plautii was characterized by a large number of surface exposed low- and high-molecular-mass proteins. Silver stainable carbohydrate was not present. The pattern was clearly distinct from those of outer membrane preparations of Eubacterium saburreum and Fusobacterium nucleatum. The results are compatible with a Gram-positive cell wall structure in E. plautii.

Another polysaccharide antigen of Eubacterium saburreum with heptose as the main constituent

The polysaccharide antigen of Eubacterium saburreum strains L76, reacting by precipitation and complement-fixation, has D-glycero-D-galacto-heptose as the main component, and, in addition, O-acyl groups.

Microflora of cervical and vaginal secretion in women using copper- and norgestrel-releasing IUCDs

In 90 women with a norgestrel-releasing IUCD inserted and 50 women having a copper releasing IUCD, culturing of cervical and vaginal secretion was performed prior to, and 3 and 12 months after insertion of the IUCD. There were no significant changes in the cervical or vaginal microflora, and no significant differences between the groups. According to these findings, locally released progestogens from an IUCD do not affect the microflora of the vagina or of the cervix.

Biological activity of lipopolysaccharides from oral Selenomonas

Lipopolysaccharides (LPSs) were extracted by phenol-water from three oral strains of Selenomonas. The preparations were tested for the ability to induce a blastogenic response in cultures of spleen cells from normal and nude BALB/c mice, to activate guinea pig complement and the clotting enzyme system of Limulus polyphemus amoebocytes, and to kill Actinomycin-D treated mice. The capacity of the three LPSs was comparable to that of enterobacterial LPS.

A possible effect on the Shwartzman reaction in the rabbit caused by fentanyl-fluanisone tranquillization

Shwartzman's reaction was elicited in four Chinchilla rabbits. Two of the animals were tranquillized with fentanyl-fluanisone (Hypnorm: Janssen Pharmaceuticals). There was a reduced response in the tranquillized rabbits while the untranquillized animals developed the typical dose-responsive skin reaction. Fentanyl-fluanisone tranquillization may interfere with the development of the Shwartzman reaction in Chinchilla rabbits.