Comparison of three methods for identification ofEnterobacteriaceae

This study compares the ability of three commercial overnight methods, API 20E, Minitek and Enteric-Tek, to accurately and completely identify 368 clinically isolatedEnterobacteriaceae without supplemental tests. Organisms includedEscherichia coli (54 strains),Shigella spp. (7),Edwardsiella tarda (1),Salmonella enteritidis (10),Citrobacter spp. (30),Klebsiella spp. (55),Enterobacter spp. (68),Hafnia alvei (2),Serratia spp. (33),Proteus spp. (64),Morganella morganii (24),Providencia spp. (18), andYersinia enterocolitica (2). Methods were those of the manufactures without supplemental tests. API 20E correctly identified 93.2 % of strains to species and 3.3 % to genus level only, with 3.0 % as part of a spectrum of identifications, and 0.5 % incorrect identifications. Minitek yielded 96.0 % correct identifications to species and 0.5 % to genus level only, with 2.5 % spectrum identifications, and 1.0 % incorrect identifications. Enteric-Tek correctly identified 97.0 % of strains to species level with 3.0 % spectrum identifications. API 20E identification of someSerratia andCitrobacter strains was to genus level only. Problem organisms for Minitek includedEnterobacter agglomerans andSerratia marcescens. A comparison of these three commercial methods shows that all three have the ability to identify most clinically isolatedEnterobacteriaceae without supplemental tests.     

Comparison of four methods for identification of gram-negative non-fermenters: Organisms less commonly encountered in clinical specimens

Four commercial kits - Oxi/Ferm (OF), API 20E (AP), Minitek (MT), Flow N/F (NF) were evaluated, without additional tests, for identification of 105 opportunistic Gram-negative non-fermentative rods. OF correctly identified 42% of strains, with 35% as part (but not first) of a spectrum of identifications (SI) and 23% incorrect identification. MT yielded 75% correct identification, with 12% SI and 13% incorrect. AP correctly identified 64% of strains, with 26% SI, 10% incorrect. NF correctly speciated 70% of strains, with 24% SI, 6% incorrect. All 4 methods show deficiencies in identification of these rare but increasingly clinically encountered organisms. Addition of new tests/modification of existing ones would render these systems more capable of identifying this organisms group.     

Oblique screws at the plate ends increase the fixation strength in synthetic bone test medium

OBJECTIVE: To test the hypothesis that oblique screws at the ends of a plate provide increased strength of fixation as compared to standard screw insertion. DESIGN: Biomechanical laboratory study in synthetic bone test medium. METHODS: Narrow 4.5-mm stainless steel low-contoured dynamic compression plates were anchored with cortical screws to blocks of polyurethane foam. The fixation strength in cantilever bending (gap closing mode) and torsion was quantified using a material testing system. Different constructs were tested to investigate the effect of the screw orientation at the end of the plate (straight versus oblique at 30 degrees), the plate, and bridging length as well as the number of screws. RESULTS: An oblique screw at the plate end produced an increased strength of fixation in all tests; however, the difference was more significant in shorter plates and in constructs with no screw omission adjacent to the fracture site. Both longer plates and increased bridging length produced a significantly stronger construct able to withstand higher compression loads. Under torsional loading, the fixation strength was mainly dependent on the number of screws. CONCLUSIONS: The current data suggest that when using a conventional plating technique, plate length is the most important factor in withstanding forces in cantilever bending. With regard to resisting torsional load, the number of screws is the most important factor. Furthermore, oblique screws at the ends of a plate increase fixation strength.     

Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age

Background:

Management of femoral diaphyseal fractures in the age group of 6-16 years is controversial. There has been a resurgence worldwide for operative fixation.

Materials and Methods:

Twenty-two children (18 boys, 4 girls) aged 6-16 years with recent (> 3 days) femoral diaphyseal fractures (20 closed, 2 open) were stabilized with Titanium Elastic Nail (TEN). These fractures were in proximal third (n=3), middle third (n=15) and in the distal third (n=4) 17 patients underwent surgery within seven days of their injury. The results were evaluated using Flynn''s scoring criteria. Statistical analysis was done using Fischer''s exact test.

Results:

All 22 patients were available for evaluation after a mean of 26 months (14-36 months) of followup. Radiological union in all cases were achieved in a mean time of 8.7 weeks. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The results were excellent in 13 patients (59.0%), successful in six (27.2%) and poor in three patients (13.6%). All patients had early return to school.

Conclusion:

Intramedullary fixation titanium elastic nailing is an effective treatment of diaphyseal fractures of the femur in properly selected patients of the 6-16 years age group.     

Correlation of P-glycoprotein expression and function in childhood acute leukemia: a children's cancer group study

Clinical drug resistance may be attributed to the simultaneous selection and expression of genes modulating the uptake and metabolism of chemotherapeutic agents. P-glycoprotein (P-gp) functions as a membrane-associated drug efflux pump whose increased expression results in resistance to anthracyclines, epipodophyllotoxins, vinca alkaloids, and some alkylating agents. This type of resistance occurs as both de novo and acquired resistance to therapy for leukemia. We have studied P- gp expression and function in childhood acute leukemias by developing a series of doxorubicin- and vincristine-selected CEM, T-cell lymphoblastoid cell lines that recapitulate the low levels of expression and resistance seen clinically. These cell lines have been used to develop flow cytometric assays for the semiquantitative measurements of P-gp expression with the MRK16 monoclonal antibody and P-gp function using the enhanced retention of rhodamine 123 in the presence of verapamil, a resistance modulator. Kolmogorov-Smirnov statistics, represented by the D measurement, are used to determine the difference in level of P-gp expression by comparing MRK16 staining to an IgG2a isotype control. When D is > 0.09, there is an excellent correlation (R = 0.82) between P-gp expression and function. The evaluation of 107 bone marrow specimens from 84 children with lymphoblastic or myelogenous leukemia showed a statistically significant (P = .004) increase in P-gp function at relapse. P-gp expression at relapse, however, approached but did not reach a significant level (P = .097). Using this methodology, we can identify patients with levels of P-gp expression and function that we can define clinically, as well as children with discordant multidrug resistance phenotypes. This study supports the role of P-gp-mediated drug resistance in childhood leukemia and confirms that P-gp expression and function are measurable in their leukemic blasts. These assays provide the means for the in vitro testing of resistance modulators and the monitoring of in vivo response to treatment with these agents.