Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review

HSS Journal ® - Unanticipated severe injury to part of the musculoskeletal system, referred to as orthopedic trauma, can be debilitating. It can also be accompanied by equally debilitating...     

Ampicillin resistance in Haemophilus influenzae as determined by a rapid test for beta-lactamase production

A rapid capillary tube method was used to demonstrate beta-lactamase production by ampicillin-resistant strains of Haemophilus influenzae.     

Use of an anti-low density lipoprotein receptor antibody to quantify the role of the LDL receptor in the removal of chylomicron remnants in the mouse in vivo

Lipoproteins are removed from the plasma by LDL receptor-dependent and -independent pathways. The relative contribution of these has been established for LDL by using modified lipoproteins, but this has not been possible for apoE-rich lipoproteins, such as chylomicron remnants. To do this, we used a monospecific antibody to the rat LDL receptor. The antibody was injected intravenously into mice followed by 125I-lipoproteins. Blood samples were obtained sequentially and radioactivity measured to determine the plasma clearance of the lipoproteins. The animals were then sacrificed and the tissues removed, dried, and the radioactivity measured to determine tissue uptake. An albumin space was also measured to correct for blood trapping. With 125I-human LDL, approximately 50% of the injected dose was cleared in 180 min. This was reduced to 30% by the antibody and this was identical to the disappearance of reductively methylated LDL. This is a lower estimate of LDL-mediated uptake (40%) than in other species. LDL uptake per gram tissue was similar for the liver and the adrenal gland and was approximately 50% LDL receptor-dependent in both tissues. With 125I-chylomicron remnants, clearance was much more rapid with approximately 50% cleared in 5 min. By agarose gel electrophoresis, radioactivity was not transferred from chylomicron remnants to other lipoprotein classes. Chylomicron remnants with label on only apoB or in 3H-cholesterol esters showed a similar pattern. Combining the estimates of the three labeling procedures, approximately 35% of the 30 s and 25% of the 5 min chylomicron remnant disappearance was LDL receptor dependent. The liver, per gram tissue, took up five times as much radioactivity as the adrenal gland. At 5 min, at least 50% of this was LDL receptor-dependent in liver and 65% in adrenal gland. We conclude that the LDL receptor plays a major, and somewhat similar quantitative role in the clearance of both LDL and chylomicron remnants in the mouse. However, at least in the mouse, non-LDL receptor-mediated lipoprotein clearance is quantitatively important and is also very rapid for chylomicron remnants. Thus, for chylomicron remnants, it can easily compensate for LDL receptors if they are blocked or absent. Further, the tissue distribution of lipoprotein uptake may be directed by factors other than LDL receptor density.     

In Vitro Susceptibility of Haemophilus influenzae to Trimethoprim-Sulfamethoxazole

Thirty-four strains of Haemophilus influenzae (20 ampicillin sensitive and 14 ampicillin resistant), mostly type b isolates from cerebrospinal fluid or blood, were tested for susceptibility to a combination of trimethoprim-sulfamethoxazole (TMP-SMZ) in a ratio of 1 part TMP to 19 parts SMZ. All strains were very susceptible to the TMP-SMZ combination, with minimal inhibitory concentrations ranging from 0.007-0.14 to 0.06-1.18 mug of TMP-SMZ per ml. There was little difference in the susceptibility of the ampicillin-sensitive and ampicillin-resistant strains to TMP-SMZ.     

Risk of Readmission After Uncomplicated Hospitalization After Radical Cystectomy

Background

Enhanced recovery pathways after radical cystectomy attempt to decrease length of hospitalization, but might increase risk of readmission after discharge. We evaluated the relationship between length of stay and readmission after uncomplicated hospitalization for bladder cancer patients treated with radical cystectomy.

Minimum Bactericidal Concentration of Sulfamethoxazole-Trimethoprim for Haemophilus influenzae: Correlation with Prophylaxis

The inability of sulfamethoxazole-trimethoprim (SXT) to eradicate Haemophilus influenzae nasopharyngeal carriage in all asymptomatic patients in closed populations was examined in vitro. A broth medium was adapted for susceptibility testing of H. influenzae which permitted us to determine minimum inhibitory concentrations and minimum bactericidal concentrations (MBCs). The minimum inhibitory concentrations were all low, but the MBCs were bimodally distributed. Trimethoprim alone or the combination SXT either was bactericidal for H. influenzae isolates at low concentrations (i.e., low MBCs) similar to minimum inhibitory concentrations or showed no bactericidal activity (i.e., high MBCs). If trimethoprim was bactericidal when tested alone against H. influenzae, then the combination SXT was also bactericidal. H. influenzae carriage could not be eradicated from asymptomatic patients with SXT therapy when that combination was not bactericidal for these isolates in vitro. H. influenzae carriage was eradicated from patients when the activity of SXT was bactericidal in vitro. H. influenzae strains that are not killed by trimethoprim or SXT seem to occur at random.     

The staff psychiatrist and the Joint Commission survey

The psychiatrist on a hospital's medical staff has a major role in maintaining the quality standards established by the Joint Commission on Accreditation of Healthcare Organizations and in preparing for its accreditation survey. The authors review the medical staff's role in quality assurance activities, including development of clinical indicators, monitoring of clinical data, peer review of problems, and planning for improved care. Other areas of hospital operation requiring the attention of the medical staff are the functioning of the medical executive committee, hospital bylaws, and procedures for granting, denying, and amending clinical privileges.     

EBV-induced human B cell lymphomas in hu-PBL-SCID mice.

Epstein-Barr virus (EBV) infection is associated with Burkitt's lymphoma (BL) in normal individuals and immunoblastic B cell lymphomas in immunosuppressed or HIV-infected individuals. SCID mice reconstituted with human peripheral blood leukocytes (hu-PBL-SCID) from EBV-seropositive donors also may develop spontaneous B cell lymphomas which histologically and phenotypically resemble post-transplant tumors, and are distinct from BL. These tumors always contain EBV DNA. We have noted three different reproducible outcomes depending upon the EBV-seropositive donor used for generation of hu-PBL-SCID mice: (i) no tumors appear; (ii) tumors appear in a fraction of hu-PBL-SCID mice with a 10-20 wk. latent period; or (iii) tumors appear in all hu-PBL-SCID mice within 6-10 wk. Southern blot analysis of late versus early tumors using a probe specific for the EBV terminal repeat sequences (BamNJ), which allows distinction between circular latent and linear replicating genomes, shows that late tumors do not involve active EBV replication but that early tumors do show replicating genomes. In addition, EBV genomes were monoclonal in late tumors but polyclonal in early tumors. These data suggest two mechanisms for EBV lymphomagenesis, slow outgrowth of rare latently-infected B cells, and more rapid transformation of uninfected bystander B cells by replicating virus. The latter process may be highly amenable to therapy in patients at risk for EBV-related lymphomas. In addition, prospective screening of EBV-seropositive transplant recipients in the hu-PBL-SCID model may predict the risk of post-transplant lymphoma development.     

Multiple HPV infection: microanatomy by in situ hybridization and immunohistochemistry.

Specific human papillomavirus (HPV) types have been shown to be associated with proliferative epithelial lesions with variable biological consequences in infected patients. Simultaneous infection by more than one HPV type has been infrequently reported, and its clinical significance is unknown. We have examined four biopsies of cervical and vulvar tissue, each with evidence of infection by two different HPVs. Using both in situ hybridization and immunohistochemical techniques, we determined the cellular distribution of the viral infections. Using biotinylated type-specific probes and stringent conditions we were able to demonstrate that in each case the two HPVs occupied distinct, non-overlapping foci within the lesions. The condylomatous tissues contained DNA from HPV types that are associated with high-grade neoplasia and invasive cancer (16 and 18), as well as types commonly associated with benign proliferative lesions. Immunohistochemical analysis of the lesions with antibody to bovine papillomavirus capsid antigen failed to detect HPV in regions shown by in situ hybridization to contain HPV 16 and 18 DNA, whereas type 6 and 11 infected areas were readily identified. These results provide indirect evidence of viral interference between HPV types and indicate that interference may limit the number of HPV types that produce active infections within a single cell.