Isolation and characterisation of a family of small plasmids encoding resistance to nucleic acid-binding compounds in Staphylococcus aureus

A family of small plasmids encoding resistance to nucleic acid-binding (NAB) compounds has recently been identified in strains of Staphylococcus aureus isolated in Italy, Texas and Western Australia. The mol. wts of the NAB-resistance plasmids are in the range (1.5-1.9) X 10(6) and all but one encode resistance to acridine yellow, ethidium bromide and quaternary ammonium compounds. The largest of the plasmids, pWG1773, differed in that it did not confer resistance to ethidium bromide. Restriction enzyme analysis of these plasmids revealed four distinct patterns corresponding to plasmids of four different mol. wts and physical maps were constructed based on the restriction patterns. Two plasmid types of molecular sizes approximately 2440 and 2240 base pairs had a 610-base pair region in common. Physical maps of the other two plasmid types were not related. The presence of a family of small NAB-resistance plasmids which carry no other known phenotypic markers provides further evidence for the strong selective advantage associated with maintenance of this determinant in clinical isolates of S. aureus.     

Understanding vascular ultrasonography.

The technology of imaging has progressed rapidly; thus, physicians must stay abreast of the principles of utilization and the interpretation of these new tests. Most of the information about this technology is presented in subspecialty literature that is not readily accessible or easily interpretable by nonspecialists. Herein we review the current literature on vascular ultrasonography and present the information in a simple, practical manner. The safety, utility, and accuracy of the ultrasound devices are delineated for the study of various vascular conditions.     

Alloimmunization to human immunoglobulin genetic markers is frequent in early rheumatoid arthritis.

HLA and Gm allotypes of 99 consecutive Swedish patients with rheumatoid arthritis were determined. Ninety-two of the 198 haplotypes contained DR4, a significant increase. The patients' sera from 3 different occasions were studied for anti-immunoglobulin profile as judged by 6 selected anti-Rh coats, 4 of them being monoclonal anti-Ds restricted as to allotype. Ninety-two of the patients were reactive with a polyclonal anti-Rh Ri as against 10 with the monoclonal carrying the G1m(f) allotype. Antibodies to Ig coats carrying defined allotypes were more frequently observed in patients not carrying the allotype in question than in those individuals possessing it. The difference was significant or highly significant as regards presence/absence of G1m(a), G3m(b) and G3m(g), respectively. Anti-G1m(a) and anti-G3m(g) cooccurred in 17 of the patients. Results consistent with presence/absence of particular anti-immunoglobulins at the 3 examinations were observed in 74 of the patients. Gm allotypes or antiallotypes were not statistically related with DR4 status. In conclusion, alloimmunization to Gm markers frequently occurs in early rheumatoid arthritis.     

Ocular chrysiasis: accumulation of gold in the rabbit eye

Gold entered the eye and was accumulated in the aqueous humor, iris-ciliary body, and cornea (measured by flameless atomic absorption spectroscopy) of rabbits given gold sodium thiomalate by subcutaneous infusion for 4 weeks. It was not detected following such exposure in the vitreous humor, lens or retina. The concentration of gold in the cornea was quite high, about 25% of that in the liver. The concentration in the aqueous humor was only about 2.5% of that in the plasma, which is similar to the fraction of gold (5%) that is not bound to plasma proteins.     

An evaluation of self-certified compliance with minimum standards in regulated family day care homes

The regulation of family day care homes in Texas has relied for many years on registration with self-certification of compliance with minimum standards. A recent random inspection of 20% of regulated family day care homes revealed seriously high noncompliance rates on a number of behaviorally clear and unambiguous standards putting in doubt the efficacy of self-certification in assuring compliance. The use of orientation followed by an inspection visits as a regulatory approach to increase compliance is suggested. Contrary to the idea that inspection programs are intrusive, caregivers in our sample were overwhelmingly positive about the program.     

Relationships among serum cystatin C, serum creatinine, lean tissue mass and glomerular filtration rate in healthy adults

In an effort to increase our knowledge of the optimal use of serum cystatin C and creatinine as glomerular filtration rate (GFR) markers, these variables, as well as lean tissue mass and GFR, were determined in a population of 42 healthy young adults (men and women with normal GFR). Dual-energy X-ray absorptiometry and measurement of the plasma clearance of iohexol were used to measure lean tissue mass and GFR, respectively. Serum creatinine was significantly correlated to lean tissue mass (r=0.65; p < 0.0001) but not to GFR (1/creatinine vs. GFR: r=0.11; p=0.106). In contrast, serum cystatin C correlated with GFR (1/cystatin C vs. GFR: r=0.32; p=0.0387), especially in men (1/cystatin C vs. GFR: r=0.64; p=0.0055), but not to lean tissue mass. These results might explain previous observations that serum cystatin C seems to be a better marker for GFR than serum creatinine, particularly for individuals with small to moderate decreases in GFR. However, the results also show that the serum concentrations of both creatinine and cystatin C are determined not only by GFR, but also by other factors. Since these additional factors differ for cystatin C and creatinine, it seems justified to use serum creatinine and cystatin C in conjunction to estimate GFR, at least until it is known in what situations serum creatinine or cystatin C is the preferable marker.     

Chronicity of memory impairment in long-term out-of-hospital cardiac arrest survivors

As a result of out-of-hospital defibrillation initiatives, many cities have an increasing population of out-of-hospital cardiac arrest survivors. We previously identified that one third of these patients suffer memory problems in the months after resuscitation. The pattern of memory impairment (impaired recall memory and intact recognition memory) is suggestive of hippocampal damage. In this study we followed up ten subjects who had previously been found to have memory impairment after their cardiac arrest. To assess the chronicity of this memory impairment, we re-tested memory function approximately 3 years after the index events. These subjects were compared with age and sex matched control subjects with previous myocardial infarction and no cardiac arrest. Memory was assessed using the Rivermead Behavioural Memory test (RBMT). To further assess recall and recognition memory we used the Doors and People test (DPT), which is specifically designed to identify deficits in these functions. RBMT scores declined significantly in both groups compared with the original assessment 8 months after cardiac arrest, possibly an effect of ageing-control group: mean (S.D.) 22.2 (1. 4)-18.4 (2.9); cardiac arrest group: 16.1 (2.7)-14.6 (4.4). The inter-group difference in RBMT score remained significant (P=0.001). DPT scores were poor in the cardiac arrest group (mean (S.D.) total 5.8 (2.8)), compared with the control group (10.8 (3.4)) who scored normally. Both recall and recognition memory were poor in the cardiac arrest group. We conclude that the memory deficits that we previously observed in cardiac arrest victims are persistent. Both recall and recognition memory are affected, implying that non-selective brain injury may be the mechanism.     

Non-steroidal anti-inflammatory drug use and the risk of benign prostatic hyperplasia-related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Study Type – Therapy (cohort) Level of Evidence 4 What's known on the subject? and What does the study add? Accumulating evidence suggests that inflammation may contribute to the development of BPH and LUTS. Therefore, it is plausible that anti‐inflammatory agents, such as aspirin and other NSAIDs, may reduce the risk of BPH/LUTS, as was observed in a recent analysis of daily aspirin use and BPH/LUTS risk in the Olmsted County Study of Urinary Symptoms and Health Status in Men. The present study, conducted in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, found no association for recent aspirin or ibuprofen use with the risk of BPH/LUTS.

OBJECTIVE

• ? To investigate the relationship between non‐steroidal anti‐inflammatory drug (NSAID) use and the incidence of benign prostatic hyperplasia (BPH)‐related outcomes and nocturia, a lower urinary tract symptom (LUTS) of BPH, in light of accumulating evidence suggesting a role for inflammation in BPH/LUTS development.

PATIENTS AND METHODS

• ? At baseline, participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial completed questions on recent, regular aspirin and ibuprofen use, BPH surgery, diagnosis of an enlarged prostate/BPH, and nocturia. Participants in the intervention arm also underwent a digital rectal examination (DRE), from which prostate dimensions were estimated, as well as a prostate‐specific antigen (PSA) test. Only participants in the intervention arm without BPH/LUTS at baseline were included in the analysis (n= 4771).
• ? During follow‐up, participants underwent annual DREs and PSA tests, provided annual information on finasteride use, and completed a supplemental questionnaire in 2006–2008 that included additional questions on diagnosis of an enlarged prostate/BPH and nocturia.
• ? Information collected was used to investigate regular aspirin or ibuprofen use in relation to the incidence of six BPH/LUTS definitions: diagnosis of an enlarged prostate/BPH, nocturia (waking two or more times per night to urinate), finasteride use, any self‐reported BPH/LUTS, prostate enlargement (estimated prostate volume ≥30 mL on any follow‐up DRE) and elevation in PSA level (>1.4 ng/mL on any follow‐up PSA test).

RESULTS

• ? Generally, null results were observed for any recent, regular aspirin or ibuprofen use (risk ratio = 0.92–1.21, P= 0.043–0.91) and frequency of use (risk ratios for one category increase in NSAID use = 0.98–1.11, P‐trends = 0.10–0.99) with incident BPH/LUTS.

CONCLUSION

• ? The findings obtained in the present study do not support a protective role for recent NSAID use in BPH/LUTS development.