Mixed-effect models for predicting microbial interactions in the vaginal ecosystem.

Three statistical models that predict microbial interactions within the vaginal environment are presented. A large data set was assembled from in vivo studies describing the healthy vaginal environment, and the data set was analyzed to determine whether statistical models which would accurately predict the interactions of the microflora in this environment could be formulated. During assembly of the data set, two new variables were defined and were added to the data set, that is, cycle (sequence of menstrual cycle) and flow stage (subdivision of cycle determined by day of menstrual cycle). Concentrations of total aerobic (includes facultative) bacteria, total anaerobic bacteria, and a Corynebacterium sp. were identified by correlation analysis as variables with significant predictors. By using a regression method with a backward elimination procedure, significant predictors of these outcome variables were identified as the concentrations of Lactobacillus spp., anaerobic Streptococcus spp., and Staphylococcus spp., respectively. For all three outcome variables, pH and flow stage were also identified as significant independent variables. Because some of the data in the data set are repeated measurements for a subject, a mixed-effect model that accounts for the random effects of repeated-measurement data fit best the data set for predicting interactions between various members of the vaginal microflora. The predictive accuracies of the three models were tested by a comparison of model-predicted outcome-variable values with actual mean in vivo outcome-variable values. From these results, we concluded that it is possible to accurately predict vaginal microflora interactions by using a mixed-effect modeling system. The application of this type of modeling strategy and its future use are discussed.     

Microbiology of subgingival plaque from children with localized prepubertal periodontitis

Localized prepubertal periodontitis has been described as a host-defect mediated form of bacterially induced periodontitis, with an early onset and rapid progression around a few teeth in children prior to puberty. To further our understanding of the etiology of this disease, we have examined the microbiological components of subgingival dental plaque in 9 children with localized prepubertal periodontitis to determine if patterns of putative pathogens existed, and have compared these results with those obtained from 4 children with no periodontitis. Subgingival plaque samples were plated onto a selective medium for Actinobacillus actinomycetemcomitans and onto a non-selective medium for anaerobes, and the predominant cultivable microbiota of 2 sites per child was determined. The subgingival microbiota of children with localized prepubertal periodontitis clearly differs from non-diseased children in the detection of high levels of several suspected pathogens, including A. actinomycetemcomitans, Bacteroides intermedius, Eikenella corrodens, and Capnocytophaga sputigena. These putative pathogens were found in various combinations. These findings suggest that localized prepubertal periodontitis is associated with specific subgingival bacteria which are generally not found in children without periodontitis.     

Report from Capetown: GNP+ and ICW hold annual meetings

Capetown, South Africa, has recently hosted the Third Annual Gathering of the International Community of Women Living with HIV/AIDS (ICW) and the Seventh Annual International Conference of the Global Network of People Living with HIV/AIDS (GNP+). The National Council for International Health's AIDS Program sent two participants to the conferences: ICW's key contact in the Caribbean, who is from Trinidad and Tobago, and a US activist from the AIDS Project, Los Angeles. About 200 women from 70 countries attended the ICW conference. Topics included overcoming isolation, caring for others and themselves, sexual abuse, harassment and violence against women, loss/bereavement, situation of women in Africa and the impact of HIV, sexual health, treatments, access to medical care, pregnancy and motherhood, and the impact of HIV on children. More than 400 persons attended the GNP+ conference. The major program tracks were the dichotomy between the importance of holistic health strategies in many parts of the developing world and treatment of opportunistic infections and antiviral treatment in the developed world, travel restrictions, skills building, and communication. Priorities identified during the business sessions were expansion of the network's communication capabilities and enhancement of the autonomy of each of the regions. The GNP+ conference was a significant opportunity for South African PWAs (persons with AIDS) to meet people from around the world. The South African Ministry of Health is committed to a national PWA conference and an affirmative action plan to include more HIV-seropositive staff members in the National AIDS Control Program and the Ministry. Ongoing activities of ICW and GNP+ are preparation of proposals for support from major donors and planning a global survey of the living conditions of persons living with HIV/AIDS and another survey focusing on human rights.     

The working alliance and consumer case management

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.     

Lung cancer in patients aged 50 years and younger: clinical characteristics, treatment details and outcome

Younger patients (< or = 50 years of age) develop lung cancer. Many series report 5-10% of all cases occurring in younger patients. Outcome, inspite of treatment, is universally poor. Females and adenocarcinomas are over-represented and the aetiology for such an early-age presentation is unclear. The aims of this retrospective study were to review the clinical characteristics, treatment details and outcome of patients aged 50 years or younger diagnosed with lung cancer (small cell and non-small cell). Over a period of 34 months, 497 lung cancer patients were treated at the Liverpool Hospital Cancer Therapy Centre. Thirty-seven (7.4%) patients aged less than or equal to 50 years were identified. The median age at diagnosis was 44 years (range 32-49 years) in 20 females and 17 males. Adenocarcinoma was the predominant histological subtype (32%). No referred patient had stage I/II disease. Almost 90% of patients were smokers. Median survival following diagnosis was 12 months (range, 9 days-68 months) with 70% having died by the close of study. The clinical characteristics and outcome of young patients in our study were comparable to other similar series.     

Bladder calcifications after photodynamic therapy: Analysis of a rare complication

Objectives

We analyzed bladder calcifications occurring after photodynamic therapy administered for the treatment of superficial bladder cancer, a finding not previously reported after this treatment.

Methods

Bladder biopsies from 20 patients undergoing photodynamic therapy were evaluated. Bladder calcifications were identified in 2 patients and analyzed for composition.

Results

One patient had diffuse microcrystalline deposition in two biopsies composed of calcium oxalate monohydrate A. A second patient had a focal stone at a healing biopsy site composed of monoclinic calcium hydrogen phosphate dihydrate (brushite) (66%), calcium oxalate (25%), hydroxyapatite (6%), and protein (3%).

Conclusions

Rare calcium oxalate and brushite calcifications were identified after photodynamic therapy and presumed to occur because of tissue injury associated with treatment.     

Interleukin-1β effects on cyclic GMP and cyclic AMP in cultured rat islets of Langerhans — arginine — dependence and relationship to insulin secretion

Summary When islets were cultured with interleukin-1 (1 or 100 pmol/l) for 12 h in arginine-containing medium, cyclic GMP levels were increased 1.6- and 4.5-fold respectively. The arginine analogue, N--nitro-l-arginine methyl ester, which blocks nitric oxide formation and partially reverses inhibition of insulin secretion by 100 pmol/l interleukin-1, largely, but not completely, blocked generation of cyclic GMP. Treatment of islets with 100 pmol/l interleukin-1 for 12 h significantly decreased islet cyclic AMP generation in the absence of isobutylmethylxanthine (from 13.1±0.7 to 9.3±0.8 fmol/g islet protein), this fall was arginine-dependent and may have resulted from an effect on a cyclic AMP phosphodiesterase, since it was masked if isobutylmethylxanthine was present. Isobutylmethylxanthine (0.4 mmol/l) reduced the inhibitory potency of interleukin-1 in 15 h slightly but significantly from 80.5 to 59.0%. The morpholinosydnonimine SIN-1, which is a nitric oxide donor, inhibited insulin secretion, raised islet cyclic GMP and lowered cyclic AMP; its effects were similar to those of interleukin-1. However, 6-anilinoquinoline-5,8-quinone, [LY83583 (1–10 mol/l)], inhibited insulin secretion, and significantly decreased cyclic GMP while 8-bromocyclic GMP stimulated insulin secretion. Both low- and high-dose interleukin-1 treatment give a large arginine-dependent and a small, yet significant, arginine-independent increase in cyclic GMP. The inhibitory effect of SIN-1 or interleukin-1 on insulin secretion seems to depend to a small extent on decreased islet cyclic AMP, though sustained increases in nitric oxide or depleted islet GTP may directly affect the secretory process.     

Infantile hypertrophic pyloric stenosis in a regional centre

Background  

It has been suggested that only specialist paediatric surgeons should manage infantile hypertrophic pyloric stenosis (IMPS).     

Ileostomy construction in complex reoperative surgery with associated abdominal wall defects

Patients who have undergone recent abdominal surgery and have generalized obliterative adhesions provide a major management problem if they require urgent ileostomy for sepsis or fistulization, particularly when there is an associated abdominal wall defect. This report describes a technique for creating an ileostomy through the skin and subcutaneous tissue only, medial to the fascial edge. This minimizes the intraoperative difficulties of stoma creation and reduces the dangers associated with mobilizing enough bowel to bring out through the fascia.     

Chordoma: Radiological–pathological correlation

This review correlates the imaging findings and histological appearances seen in chordomas in a series of patients presenting at our institution, together with a published literature review. A parallel presentation of photographs of imaging findings and microscopic histological findings is made, with the aim being to enhance recognition of this uncommon but clinically significant entity.