Simple color tests based on an alanyl peptidase reaction which differentiate Listeria monocytogenes from other Listeria species.

The hydrolysis of DL-alanine-beta-naphthylamide and D-alanine-p-nitroanilide for identification of Listeria spp. has been studied with 227 cultures. All species of Listeria, except L. monocytogenes, hydrolyzed these substrates. The reactions were detected by simple chromogenic reactions and could substitute for the CAMP test.     

中药蝶脉灵注射液在心肺复苏中脑保护作用的实验研究

目的 探讨中药蝶脉灵注射在心脏骤停时对脑复苏的作用。方法 用电刺激导致室颤制备家兔心脏骤停模型，在光镜和电镜下观察大剂量肾上腺素治疗时，蝶脉灵注射液对脑组织的影响。结果 蝶脉灵注射液对脑细胞有明显的保护作用。结论 蝶脉灵注射液能明显改善心脏骤停时脑缺血性损害，因而有利于脑复苏。     

踝部开放性骨折的急症手术治疗

目的探讨踝部开放性骨折的损伤特点及相关的急症手术技术特点。方法2001年8月至2006年4月，急症手术治疗踝部开放性骨折51例，男39例，女12例；年龄18-72岁，平均36岁。伤口Gustilo分度，Ⅰ度3例，Ⅱ度37例，ⅢA度7例，ⅢB度3例，ⅢC度1例。急诊给予有效抗生素治疗，尽早开始手术。冲洗及彻底清创后，根据骨折类型、粉碎程度及伤口情况制定骨折处理的顺序，依次完成骨折复位、固定。结果48例患者获得随访，随访时间8-48个月，平均26个月。无一例发生深部感染。12例伤口发生浅表皮缘坏死，2例伤口延迟愈合，2例伤口发生浅表感染。踝部骨折在10-18周（平均13周）愈合。采用AOFAS踝后足功能评分标准，48例评分在76-100分，平均90分。结论踝部开放性骨折在急症手术时应彻底清创，注意保护皮肤活力。在处理后踝骨折时，可采用胫骨远端脱出法。多数手术应先精确复位、固定外踝骨折，对旋后内收型、外踝严重粉碎的踝部骨折应先进行内踝骨折的复位、固定。对严重的下胫腓联合分离，应直视下复位且常规使用下胫腓螺钉固定。     

National Alliance for Oral Health Consensus Conference on Medically Necessary Oral Health Care: Legal issues

This paper examines medical malpractice law as it applies to medically necessary oral health care. The basic legal concepts and reported cases involving medically necessary oral health care are reviewed. It is concluded that dental professionals and consumer advocates must advance their educational and legislative advocacy efforts so that health professional colleagues and the public will become aware of the importance of these services and insurers will routinely include coverage of medically necessary oral health care in their medical and dental policies. While failure to provide medically necessary oral health care can be violative of patient rights and legally actionable, medical malpractice litigation should always be the behavior modifier of last resort.     

In vitro activity of ceftriaxone and other cephalosporins against 602 clinical isolates of staphylococci from geographically diverse medical centers

The in vitro activity of ceftriaxone and six additional antimicrobial agents (ceftizoxime, cefoperazone, cefuroxime, fleroxacin, ciprofloxacin, and trimethoprim/sulfamethoxazole) was assessed or 602 recent clinical isolates of staphylococci from six geographically distinct medical centers in North America. All seven antimicrobial agents were active (90–100% of strains susceptible) against oxacillin-susceptible (OS) strains of Staphylococcus aureus (OSSA) and coagulase-negative staphylococci (OSCNS) but had limited activity against oxacillin resistant (OR) staphylococci. Our assessment of the in vitro antistaphylococcal activity of ceftriaxone against contemporary isolates of Staphylococcus aureus and coagulase-negative staphylococci indicates that the activity versus OS staphylococci has not changed over the past decade despite widespread use of the drug. It appears that these agents will continue to be useful for empiric therapy in those centers in which OR strains are uncommon.Corresponding author.     

Laser instrumentation for intra-abdominal microlaser gynecologic surgery

With proper laser instrumentation, the gynecologic microlaser surgeon enhances his ability to accomplish intra-abdominal fertility-promoting procedures in a safe and efficient manner.     

Redistribution of Na-K-ATPase in the dystrophic rat retinal pigment epithelium

Summary Our previous studies have shown that a breakdown in tight junctions in the dystrophic retinal pigment epithelium (RPE) of Royal College of Surgeons' rats is accompanied by changes in intramembrane structure which suggest a redistribution of intramembrane particles. We have now investigated, using thep-nitrophenyl phosphate technique, the possibility that a specific membrane protein, Na-K-ATPase, is redistributed as tight junctions break down in the dystrophic RPE. In the normal RPE, Na-K-ATPase activity is restricted to the apical membrane. Junctional membranes and membranes around phagosomes are free of enzyme activity, suggesting a segregation of the transport enzyme from the Junctional and phagocytic membrane. In the dystrophic RPE, prior to changes in tight junctions, enzyme activity is restricted to the apical membrane. During the initial stages of Junctional breakdown, Junctional membranes and membranes around cytoplasmic inclusions are also labelled. As the breakdown progresses, Na-K-ATPase activity is often present laterally and basolaterally and is sometimes absent apically. Enzyme activity is seen basally only where RPE cells have detached from Bruch's membrane and are superimposed over each other. These changes suggest that Na-K-ATPase redistributes during junctional breakdown, but that attachments between the RPE and Bruch's membrane may restrict the redistribution. The apparent reduction of enzyme activity apically suggests that active transport across the dystrophic RPE may be reduced as the tight junctions break down.     

Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes

BACKGROUND. Many state Medicaid programs limit the number of reimbursable medications that a patient can receive. We hypothesized that such limitations may lead to exacerbations of illness or to admissions to institutions where there are no caps on drug reimbursements. METHODS. We analyzed 36 months of Medicaid claims data from New Hampshire, which had a three-drug limit per patient for 11 of those months, and from New Jersey, which did not. The study patients in New Hampshire (n = 411) and a matched comparison cohort in New Jersey (n = 1375) were Medicaid recipients 60 years of age or older who in a base-line year had been taking three or more medications per month, including at least one maintenance drug for certain chronic diseases. Survival (defined as remaining in the community) and time-series analyses were conducted to determine the effect of the reimbursement cap on admissions to hospitals and nursing homes. RESULTS. The base-line demographic characteristics of the cohorts were nearly identical. In New Hampshire, the 35 percent decline in the use of study drugs after the cap was applied was associated with an increase in rates of admission to nursing homes; no changes were observed in the comparison cohort (RR = 1.8; 95 percent confidence interval, 1.2 to 2.6). There was no significantly increased risk of hospitalization. Among the patients in New Hampshire who regularly took three or more study medications at base line, the relative risk of admission to a nursing home during the period of the cap was 2.2 (95 percent confidence interval, 1.2 to 4.1), and the risk of hospitalization was 1.2 (95 percent confidence interval, 0.8 to 1.6). When the cap was discontinued after 11 months, the use of medications returned nearly to base-line levels, and the excess risk of admission to a nursing home ceased. In general, the patients who were admitted to nursing homes did not return to the community. CONCLUSIONS. Limiting reimbursement for effective drugs puts frail, low-income, elderly patients at increased risk of institutionalization in nursing homes and may increase Medicaid costs.