ETIOLOGY OF YELLOW FEVER : VIII. PRESENCE OF A LEPTOSPIRA IN WILD ANIMALS IN GUAYAQUIL AND ITS RELATION TO LEPTOSPIRA ICTEROH?MORRHAGI? AND LEPTOSPIRA ICTEROIDES.

By the inoculation of guinea pigs intraperitoneally with the emulsions of kidneys from wild rats and mice captured in Guayaquil, it was found that 67 per cent of the wild rats tested harbored in their kidneys a leptospira which produced in guinea pigs symptoms and lesions identical with those produced by Leptospira icterohamorrhagia derived either from patients suffering from infectious jaundice in Japan or Europe, or from wild rats caught in New York. Immune sera were prepared in rabbits by injecting different strains of the Guayaquil leptospira. These sera had a marked agglutinating and disintegrating influence upon the homologous strains, and also, but often to a less pronounced degree, upon the strains of Leptospira icterohœmorrhagiœ from other sources. Pfeiffer''s phenomenon was also found to be positive, and protection was demonstrated against infection with virulent cultures of strains of Leptospira icterohœmorrhagiœ. The same sera had no effect, or at most a very slight one, upon Leptospira icteroides. Guinea pigs inoculated with icteroides strains were not noticeably protected by the use of the immune sera prepared with the Guayaquil rat strains. Guinea pigs inoculated with killed cultures of the Guayaquil strains of leptospira proved to be resistant to a subsequent infection with heterologous as well as homologous strains of Leptospira icterohœmorrhagiœ. It is concluded, therefore, that the leptospira isolated from the kidneys of wild rats and mice in Guayaquil belongs to the group of Leptospira icterohœmorrhagiœ, and differs from Leptospira icteroides in its immunity reactions. No positive transmission was obtained with kidney material from bats and an opossum.     

CHANGES IN THE SHAPE AND SIZE OF BACTERIUM COLI AND BACILLUS MEGATHERIUM UNDER THE INFLUENCE OF BACTERIOPHAGE—A MOTION PHOTOMICROGRAPHIC ANALYSIS OF THE MECHANISM OF LYSIS

This paper contains the records of a motion photomicrographic investigation of the lysis of Bact. coli and B. megatherium by bacteriophage. The bacteria mixed with bacteriophage were grown on moist nutrient agar in small culture chambers on the stage of a microscope in an incubator maintained at 37°C. The apparatus used permitted continuous inspection of the preparations. Photographs were made at the rates of 2 and 30 per minute and at the rate of 8 per second during the terminal stage of lysis of Bact. coli. The accurately timed films were studied by rapid projection and by the projection of single frames. Measurements of dimensions of cells, calculations of volumes, information on generations, generation times and duration spans are presented in the tables. Similar information on normal cultures grown and photographed in the same way is furnished for comparison. Groups of serial photographs are reproduced in the plates to illustrate the special features observed. These observations seem to us to warrant the following conclusions: 1. Enlargement or swelling of the cells of Bact. coli usually, but not always, precedes lysis. Some of the enlargement is an expression of increase of cell substance and is not altogether due to imbibition of water. Cells of early generations of Bact. coli enlarge to greater absolute and relative proportions than cells of later generations. Enlargement does not occur before lysis in B. megatherium. 2. The terminal stage of lysis of Bact. coli is explosive, occupying ½ to ⅞ second. The terminal stage of lysis of B. megatherium is a slow disintegrative process, extending over 2–10 minutes. 3. Bacteriophage inhibits fission of some cells, but does not stop the reproduction of other cells in contact with it. The genealogical records of six generations of cells of Bact. coli and of two generations of cells of B. megatherium indicate that bacteriophage may be transmitted through parents to the offspring which ultimately undergo lysis. 4. Bacteriophage spreads by contact through a group of cells and also along paths determined by genetical relationships. 5. A large amount of cellular debris remains after the lysis of the cells in both of these species of bacteria. This residue of material is in the form of irregularly shaped masses and granules. This material is not in solution at the time of lysis and appears not to be digested or hydrolized. 6. Theories of the mechanism of lysis are discussed. It is suggested that reduction of surface tension of the cells may be an important factor in the mechanism of lysis.     

THE EFFECT OF EXERCISE AND TIME ON THE HEIGHT AND WIDTH OF THE MEDIAL LONGITUDINAL ARCH FOLLOWING THE MODIFIED REVERSE‐6 AND THE MODIFIED AUGMENTED LOW‐DYE TAPING PROCEDURES

Purpose/Background:

No evidence exits regarding the magnitude of the change in foot posture following the “modified reverse‐6” (MR6) taping procedure, either alone or in combination with the “low‐dye” (LD) taping technique. The purpose of this study was to investigate the change in the height and width of the midfoot after application of the MR6 and the MR6 plus the LD (MR6+LD) taping technique and determine how long those changes last.

Methods:

Eleven individuals (2 female and 9 male) were recruited for this study and were tested under each of two experimental conditions, the MR6 and the MR6+LD taping technique. The order of testing for the two conditions was randomly determined. For each condition, the height and width of the midfoot at 50% of each subject''s foot length was initially measured and then again immediately following the application of the tape. These measurements were repeated four hours later immediately prior to running two miles on a treadmill, again immediately after running, and finally after another four hours.

Results:

The dorsal arch height increased significantly with both the MR6 and MR6+LD taping, but only the MR6+LD remained statistically greater after four hours, a bout of exercise and again at the end of the day. The mean width of the midfoot significantly decreased with both taping procedures. The change in the width of the midfoot remained significantly decreased in both taping conditions after exercise and throughout the day.

Conclusions:

Both taping procedures are able to significantly change the height and width of the medial longitudinal arch of the foot, but the change lasted longer when the two taping procedures were combined.

Levels of Evidence:

Level 3, Prospective Cohort Study     

STUDIES ON THE MECHANISM OF IMMUNITY IN TUBERCULOSIS : THE R?LE OF EXTRACELLULAR FACTORS AND LOCAL IMMUNITY IN THE FIXATION AND INHIBITION OF GROWTH OF TUBERCLE BACILLI

1. The fate of bacilli of reinfection at the portal of entry and in metastatic foci, and also the associated host responses, are essentially similar in rabbits and guinea pigs. 2. However, in the guinea pig tubercle bacilli of reinfection are more effectively fixed at the portal of entry than in the rabbit. 3. The guinea pig fixes at the site of reinfection unrelated substances, such as trypan blue and agar particles, more effectively than the rabbit. 4. At the site of a local non-specific inflammation precipitins from the circulating blood accumulate in higher concentration in tuberculous guinea pigs than in tuberculous rabbits. 5. These differing fixing capacities of the two species are associated with differences of extracellular character in the inflammation resulting from reinfection. (a) In the guinea pig, whose tissues are highly sensitized and greatly injured by the tubercle bacillus, the lymphatics adjoining the site of reinfection become thrombosed. In the rabbit whose tissues are moderately sensitized and less injured by the tubercle bacillus the corresponding lymphatics remain open. (b) In the guinea pig the fibrinous network at the site of inflammation forms a fine sieve-like structure. In the rabbit this network forms a coarse sieve-like barrier. 6. In rabbits and guinea pigs primarily infected, the destruction of tubercle bacilli takes place first and most extensively at the portal of entry. At this time they are less effectively destroyed in the nearest metastatic foci. Simultaneously they are still growing without hinderance in such foci in remote internal organs. 7. The cell-free body fluids of normal animals support the growth of tubercle bacilli in vivo. The body fluids of tuberculous animals under the same conditions are bacteriostatic for this microorganism. 8. Tubercle bacilli often multiply by preliminary subdivision into non-acid-fast granules, from which the acid-fast rods sprout. This confirms the work of Kahn.     

THE SURVIVAL OF LEPTOSPIRA (SPIROCH?TA) ICTEROH?MORRHAGI? IN NATURE; OBSERVATIONS CONCERNING MICROCHEMICAL REACTIONS AND INTERMEDIARY HOSTS

1. Leptospira icterohæmorrhagiæ is unable to grow in the urine, either with or without the addition of suitable culture ingredients, the acidity of the urine being detrimental to the growth. It survives less than 24 hours, unless the urine is neutralized or slightly alkalized, when the period of survival is somewhat longer. If suitable nutrient ingredients are added to the neutralized or slightly alkalized urine, the organism is able to grow for about 10 days, after which multiplication ceases. 2. Feces from normal or jaundiced persons destroy Leptospira icterohæmorrhagiæ within 24 hours when a rich culture is added and the mixture allowed to stand at 26°C. The addition of blood serum and corpuscles does not prevent the destruction of the organism. Autoclaved specimens and filtrates of unheated feces do not constitute a suitable medium in which to keep the organism alive for any length of time, but the addition of blood corpuscles and serum in adequate quantities renders them fairly satisfactory as media. Under natural conditions Leptospira icterohæmorrhagiæ cast off in the feces cannot survive more than 24 hours. 3. Polluted water, sewage, and soil will not serve to keep Leptospira icterohæmorrhagiæ alive for more than 3 days at the most. When deprived by filtration or autoclaving of their bacteria they become indifferent diluents and may be used to make up a culture medium when mixed with serum and citrate plasma of a suitable animal. Sterilized soil with a neutral reaction, when added to a culture, has an unfavorable effect upon the growth of the organism. 4. Most of the aerobic bacteria found in feces, sewage, soil, and tap water inhibit the growth of Leptospira icterohæmorrhagiæ when inoculated into the same medium. Bacillus fæcalis alkaligenes and many strains of non-hemolytic streptococci caused the least interference, although growth was never so vigorous or lasting in the media in which they were present as in the control media. Certain pathogenic bacteria (Bacillus typhosus, Bacillus paratyphosus, Bacillus dysenteriæ, pneumococcus) are antagonistic to the growth of the spirochete. 5. Leptospira icterohæmorrhagiæ is highly sensitive to the destructive action of bile, bile salts, and sodium oleate, but resists the action of saponin. In this last respect it differs from many so called spirochetes. The destructive action of these agents is counteracted by blood serum. 6. The larvae and adults of the Culex mosquito, the larvæ of the house-fly and bluebottle fly, wood ticks (Dermacentor andersoni), and leeches failed to become carriers of the spirochetes when fed on infected guinea pigs or their organs; that is, they cannot play the part of an intermediary host of Leptospira icterohæmorrhagiæ.     

THE GERMICIDAL AND HEMOLYTIC ACTION OF α-BROM SOAPS

1. The soaps of the α-brom fatty acids are usually more germicidal than the unsubstituted soaps. Only when B. typhosus was the test organism was there no increase in germicidal action. 2. For any test organism, germicidal action of the brominated soaps increases rapidly with increasing molecular weight up to a certain point, then diminishes. This is likewise true of the hemolytic titer. The point of maximal germicidal action varies with the different species of tests organisms. In the series studied, brominated soaps of 12 and 14 carbon atoms were most germicidal for the Gram-negative organisms, while soaps of 16 and 18 carbon atoms were most germicidal for Gram-positive organisms. 3. The brominated soaps are, in general, more active in acid that in neutral or alkaline reactions. The reasons for this have been discussed in a previous paper, in which a similar phenomenon with unsubstituted soaps was observed. 4. For certain organisms, the brominated soaps are among the most rapid and potent germicides known.     

THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN IMMUNITY : VI. THE EFFECT OF ENDOTHELIAL BLOCKADE ON THE STORAGE AND DISTRIBUTION OF NEOARSPHENAMINE

1. Blockade of the reticulo-endothelial system by means of a single injection of India ink caused a marked retention of neoarsphenamine in the blood of guinea pigs during the first twenty minutes of observation after intravenous injection, as contrasted with the rapid disappearance of the drug from the blood of normal controls. 2. Rabbits blocked by a single dose of India ink showed a slower elimination of the drug from the circulation following the first few hours after intravenous injection than corresponding controls. 3. The arsenic content of the liver of mice, which received neoarsphenamine intravenously after a preceding blocking injection with India ink, was appreciably lower than the arsenic content of the normal organ under similar experimental conditions.     

CROSS‐CULTURAL ADAPTATION AND VALIDATION OF THE KOREAN VERSION OF THE CUMBERLAND ANKLE INSTABILITY TOOL

Background

The Cumberland Ankle Instability Tool (CAIT) is a valid and reliable patient reported outcome used to assess the presence and severity of chronic ankle instability (CAI). The CAIT has been cross‐culturally adapted into other languages for use in non‐English speaking populations. However, there are no valid questionnaires to assess CAI in individuals who speak Korean.

Purpose

The purpose of this study was to translate, cross‐culturally adapt, and validate the CAIT, for use in a Korean‐speaking population with CAI.

Study Design

Cross‐cultural reliability study.

Methods

The CAIT was cross‐culturally adapted into Korean according to accepted guidelines and renamed the Cumberland Ankle Instability Tool‐Korean (CAIT‐K). Twenty‐three participants (12 males, 11 females) who were bilingual in English and Korean were recruited and completed the original and adapted versions to assess agreement between versions. An additional 168 national level Korean athletes (106 male, 62 females; age = 20.3 ± 1.1 yrs), who participated in ≥ 90 minutes of physical activity per week, completed the final version of the CAIT‐K twice within 14 days. Their completed questionnaires were assessed for internal consistency, test‐retest reliability, criterion validity, and construct validity.

Results

For bilingual participants, intra‐class correlation coefficients (ICC_2,1) between the CAIT and the CAIT‐K for test‐retest reliability were 0.95 (SEM=1.83) and 0.96 (SEM=1.50) in right and left limbs, respectively. The Cronbach''s alpha coefficients were 0.92 and 0.90 for the CAIT‐K in right and left limbs, respectively. For native Korean speakers, the CAIT‐K had high internal consistency (Cronbach''s α=0.89) and intra‐class correlation coefficient (ICC_2,1 = 0.94, SEM=1.72), correlation with the physical component score (rho=0.70, p = 0.001) of the Short‐Form Health Survey (SF‐36), and the Kaiser‐Meyer‐Olkin score was 0.87.

Conclusions

The original CAIT was translated, cross‐culturally adapted, and validated from English to Korean. The CAIT‐K appears to be valid and reliable and could be useful in assessing the Korean speaking population with CAI.     

FURTHER STUDY ON THE CULTURAL CONDITIONS OF LEPTOSPIRA (SPIROCH?TA) ICTEROH?MORRHAGI?

1. The presence of suitable animal or human serum is essential for the cultivation of Leptospira icterohæmorrhagiæ. 2. The nutrient value of serum is considerably reduced by heating to 60°C. for 30 minutes and is destroyed by boiling (100°C). Filtration through a Berkefeld filter does not diminish the nutrient value of the serum. 3. The cultural value of different animal sera varies considerably. It is entirely absent from the sera of the rat and the pig. The sera of the rabbit, horse, and goat are better suited for the growth of the organism than those of the guinea pig, sheep, donkey, or calf. Human serum is suitable, but not ascitic fluid. 4. Fresh or heated emulsions of the liver, kidney, heart muscle, or testicle of the normal guinea pig or rabbit have no cultural value for the organism. The same may be said of both the white and yolk of the hen''s egg. 5. A luxuriant growth takes place in a medium of Ringer''s solution to which more than 10 per cent of normal rabbit serum is added. There is only moderate growth with 5 per cent of serum, and none when less than 2 per cent is present. The use of an undiluted serum offers no advantage over a diluted one, provided the latter contains at least 10 per cent of serum. In the case of certain animal sera dilution seems to make them more suitable for cultivation purposes, owing perhaps to its reduction of their inherent alkalinity. 6. The tonicity of the culture medium has but little influence upon the growth and morphology of the organism. A medium containing distilled water as diluent or one containing 8 per cent sodium chloride seems to give identical results. The viability of the organism was greatest in a medium in which Ringer''s solution or isotonic salt solution was used as diluent. 7. The reaction of the medium is an important factor in the cultivation of the organism, which thrives most vigorously in a medium of which the reaction is slightly alkaline, not exceeding that of the serum. If the reaction is neutral, the growth is meager, and the culture is short lived. When the reaction of a medium becomes alkaline by the addition of a small amount of sodium hydroxide, or faintly acid by the addition of a little hydrochloric acid, no growth can take place. 8. Leptospira icterohæmorrhagiæ is an obligatory aerobe. Any hindrance to the access of oxygen constitutes an unfavorable factor in obtaining a culture. 9. The addition of carbohydrates to media has no perceptible effect upon the growth or morphology of the organism. The reaction of the media is not modified by their presence. 10. Leptospira icterohæmorrhagiæ grows at any temperature between 37° and 10°C., the optimum zone being 30–37°C. Growth proceeds more rapidly at 37°C. than at 30° or at 25°, but the cultures remain viable much longer at the latter temperatures. No growth takes place at 42°C. 11. Three different media are described for the cultivation of freshly isolated strains. After prolonged cultivation on these media a strain may be readily cultivated in a serum diluted with Ringer''s or isotonic salt solution.     

THE INFLUENCE OF CHOLINE,CYSTINE, AND OF α-TOCOPHEROL UPON THE OCCURRENCE OF CEROID PIGMENT IN DIETARY CIRRHOSIS OF RATS

1. Five per cent l-cystine in a stock or low protein diet produces ceroid deposits in rat liver. This effect of l-cystine is much greater in low protein than in stock diets. 2. One per cent choline has an inhibiting effect on deposition of liver ceroid resulting from a low protein diet containing excess cystine. 3. The occurrence of ceroid pigment in the livers of rats on a low protein diet, with or without the addition of excess l-cystine, is transiently inhibited by the administration of α-tocopherol. Five per cent cod liver oil in the diet did not prevent this effect of α-tocopherol. 4. On low protein, vitamin E-deficient diets, there occurs after 4 months, a rapid and progressive weight loss. This does not happen when α-tocopherol is added to the diet.     

THE USE OF THE FINAL HYDROGEN ION CONCENTRATION IN DIFFERENTIATION OF STREPTOCOCCUS H?MOLYTICUS OF HUMAN AND BOVINE TYPES

1. Under the conditions of these experiments, there appears to be a distinct and constant difference in the final hydrogen ion concentration of Streptococcus hæmolyticus from human and bovine sources. 2. Of 124 strains of Streptococcus hæmolyticus from known human origin, 116 reached a final hydrogen ion concentration of from pH 5.0 to 5.3. Only 8 reached a pH more acid than 5.0 and none more acid than pH 4.8. 3. Of 45 strains of Streptococcus hæmolyticus from bovine sources, including 26 strains isolated from milk and the udder of cows, and 19 from cream cheese, 40 reached a final hydrogen ion concentration of pH 4.3 to 4.5. Of the remaining 5 which reached a pH of 5.0 to 5.2, two were of known human type and three of uncertain diagnosis. 4. A rapid and practical application of this method is proposed as a presumptive test in the differentiation of human and bovine types of Streptococcus hæmolyticus.     

THE IMMEDIATE AND LONG-TERM EFFECTS OF KINESIOTAPE? ON BALANCE AND FUNCTIONAL PERFORMANCE

Background

The application of Kinesio Tex® tape (KT) results, in theory, in the improvement of muscle contractibility by supporting weakened muscles. The effect of KT on muscle strength has been investigated by numerous researchers who have theorized that KT facilitates an immediate increase in muscle strength by generating a concentric pull on the fascia. The effect of KT on balance and functional performance has been controversial because of the inconsistencies of tension and direction of pull required during application of KT and whether its use on healthy individuals provides therapeutic benefits.

Hypotheses/Purpose

The purpose of the present study was to investigate the immediate and long-term effects of the prescribed application (for facilitation) of KT when applied to the dominant lower extremity of healthy individuals. The hypothesis was that balance and functional performance would improve with the prescribed application of KT versus the sham application.

Study Design

Pretest-posttest repeated measures control group design.

Methods

Seventeen healthy subjects (9 males; 8 females) ranging from 18-35 years of age (mean age 23.3 ± 0.72), volunteered to participate in this study. KT was applied to the gastrocnemius of the participant''s dominant leg using a prescribed application to facilitate muscle performance for the experimental group versus a sham application for the control group. The Biodex Balance System and four hop tests were utilized to assess balance, proprioception, and functional performance beginning on the first day including pre- and immediately post-KT application measurements. Subsequent measurements were performed 24, 72, and 120 hours after tape application. Repeated measures ANOVA''s were performed for each individual dependent variable.

Results

There were no significant differences for main and interaction effects between KT and sham groups for the balance and four hop tests.

Conclusion

The results of the present study did not indicate any significant differences in balance and functional performance when KT was applied to the gastrocnemius muscle of the lower extremity.

Level of evidence

Level 1- Randomized Clinical Trial     

THE GERMICIDAL ACTION OF α-MERCAPTO AND α-DISULFO SOAPS

1. Certain of the α-mercapto soaps and α-disulfo soaps are powerful germicides. 2. In the α-mercapto series, those soaps with 12 and 14 carbon atoms are most germicidal. In the disulfo series, the dicaprate, dilaurate, and dimyristate are most germicidal. The optimum number of carbon atoms varies with the test organism used. 3. These soaps, like others previously studied, show a markedly selective germicidal action.     

STUDIES ON THE BIOLOGY OF STREPTOCOCCUS : IV. THE OCCURRENCE OF STREPTOCOCCUS SCARLATIN? IN CONVALESCENCE AND IN THE COMPLICATIONS OF SCARLET FEVER.

1. A group of streptococci which agglutinate with scarlatinal immune sera has been isolated from the throats of 65 per cent of cases of scarlet fever during the 1st week of the disease. 2. Strains of hemolytic streptococci belonging to this group have been isolated from the throats of patients at the termination of quarantine (30 days). 3. Hemolytic streptococci are found most frequently in the throat in convalescent patients in whom the tonsillar inflammation has not entirely subsided. 4. The complications occurring in scarlet fever may be due to the original scarlatinal strain or may be the result of a secondary infection with pyogenic strains of streptococci.     

THE R?LE OF THE THYROID IN THE REGULATION OF THE BLOOD CHOLESTEROL OF RABBITS

1. The blood cholesterol of rabbits on a normal diet without added cholesterol is increased only slightly (19 per cent) by thyroidectomy. 2. In rabbits with a hypercholesterolemia due to long continued cholesterol feeding, thyroidectomy causes a marked rise (137 per cent) in the blood cholesterol. This rise is usually maintained. 3. When long continued cholesterol feeding has failed to cause a rise in the blood cholesterol of rabbits, thyroidectomy abolishes this resistance and a hypercholesterolemia is promptly produced. 4. A single injection of thyroxin causes a significant drop in the blood cholesterol of rabbits with hypercholesterolemia. This reaction is not influenced by thyroidectomy. 5. Potassium iodide causes an increase in the blood cholesterol of rabbits with hypercholesterolemia. This reaction is not influenced by thyroidectomy in contrast to the effect of KI in preventing a rise in blood cholesterol when given concurrently from the beginning of cholesterol feeding, an effect which is abolished by thyroidectomy. It is suggested that two different mechanisms are involved. 6. A single injection of insulin produces a fall in the blood cholesterol of rabbits with hypercholesterolemia. If anything, thyroidectomy increases the magnitude of this effect.     

THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN IMMUNITY : III. THE PRODUCTION OF ACTIVE AND PASSIVE ANAPHYLAXIS IN THE BLOCKED ANIMAL.

1. Guinea pigs injected intravenously with massive doses of India ink before active sensitization exhibited occasionally a more or less marked, decreased sensitiveness to the reinjection of the antigen. 2. The serum of rabbits which had received massive doses of India ink before the sensitizing injections, showed approximately the same titer of anaphylactic antibodies as that of sensitized normal control animals, as demonstrated by the degree of passive sensitization induced in guinea pigs. 3. The precipitin titer of sensitized rabbits blocked with massive doses of India ink was somewhat lower than that of sensitized normal controls. In one instance, the intravenous injection of smaller doses of India ink was followed by a higher precipitin titer. No uniform relation was found between the height of the precipitin titer and the anaphylactic power of the antiserums. 4. One blocking injection of India ink given to guinea pigs before passive sensitization did not interfere with the occurrence of anaphylactic shock nor alter its nature.     

THE FREQUENCY OF BACILLUS INFLUENZ? IN THE NOSE AND THROAT IN ACUTE LOBAR PNEUMONIA

1. Bacillus influenza is frequently found in association with lobar pneumonia. 2. In lobar pneumonia both Bacillus influenza and pneumococcus are frequently found in the nose. 3. The influenza bacilli found in the upper respiratory tract of cases of lobar pneumonia are of various types. 4. The exact significance of these findings is at the present time not clear.