Spurious Ampicillin Resistance by Testing Haemophilus influenzae with Agar Containing Supplement C

Ampicillin resistance (minimal inhibitory concentration >/=10 mug/ml) in the absence of beta-lactamase activity by Haemophilus influenzae was noted in tests performed with Mueller-Hinton agar containing one lot of supplement C. All strains, except five with known resistance due to beta-lactamase activity, were inhibited by 0.6 mug or less of ampicillin per ml of chocolatized blood agar.     

Reflux injury of esophageal mucosa: experimental studies in animal models of esophagitis, Barrett''s esophagus and esophageal adenocarcinoma

Barrett's esophagus (BE), a gastroesophageal reflux associated complication, is defined as the replacement of normal esophageal squamous mucosa by specialized intestinal columnar mucosa with the appearance of goblet cells. The presence of BE is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Although the exposure of gastroduodenal contents to the esophageal mucosa is considered to be an important risk factor for the development of esophagitis, BE and EAC, the mechanisms of reflux esophageal injury are not fully understood. Animal models are now being used extensively to identify the mechanisms of damage and to devise protective and mitigating strategies. Experimental studies on animal models by mimicking the processing of gastroesophageal reflux injury have bloomed during the past decades, however, there is controversy regarding which experimental model for reflux esophagitis, experimental BE and experimental EAC is best. In this review article we aim to clarify the basic understanding of gastroesophageal reflux injury and its complications of BE and EAC, as well as to present current understanding of the reflux experimental models. The animal models of experimental esophageal injury are summarized with focus on the surgical procedures to guide the investigator in choosing or developing a correct animal model in future studies. In addition, our own experimental studies of the animal models are also briefly discussed.     

Impact of Detergent on Biophysical Properties and Immune Response of the IpaDB Fusion Protein,a Candidate Subunit Vaccine against Shigella Species

Shigella spp. are causative agents of bacillary dysentery, a human illness with high global morbidity levels, particularly among elderly and infant populations. Shigella infects via the fecal-oral route, and its virulence is dependent upon a type III secretion system (T3SS). Two components of the exposed needle tip complex of the Shigella T3SS, invasion plasmid antigen D (IpaD) and IpaB, have been identified as broadly protective antigens in the mouse lethal pneumonia model. A recombinant fusion protein (DB fusion) was created by joining the coding sequences of IpaD and IpaB. The DB fusion is coexpressed with IpaB''s cognate chaperone, IpgC, for proper recombinant expression. The chaperone can then be removed by using the mild detergents octyl oligooxyethelene (OPOE) or N,N-dimethyldodecylamine N-oxide (LDAO). The DB fusion in OPOE or LDAO was used for biophysical characterization and subsequent construction of an empirical phase diagram (EPD). The EPD showed that the DB fusion in OPOE is most stable at neutral pH below 55°C. In contrast, the DB fusion in LDAO exhibited remarkable thermal plasticity, since this detergent prevents the loss of secondary and tertiary structures after thermal unfolding at 90°C, as well as preventing thermally induced aggregation. Moreover, the DB fusion in LDAO induced higher interleukin-17 secretion and provided a higher protective efficacy in a mouse challenge model than did the DB fusion in OPOE. These data indicate that LDAO might introduce plasticity to the protein, promoting thermal resilience and enhanced protective efficacy, which may be important in its use as a subunit vaccine.     

Incidence of Sciatic Nerve Palsy After Revision Hip Arthroplasty Through a Posterior Approach

Sciatic nerve palsy after revision hip arthroplasty is rare, but can have substantial impacts. The purpose of this study is to report the safety and reliability of limited sciatic nerve exposure during revision surgery. A retrospective case series of 350 revision hip surgeries performed by a single surgeon underwent sciatic nerve identification. In each case, the sciatic nerve was identified and tagged loosely with a Penrose drain. Three hundred forty-eight of 350 patients (99.4%) underwent successful revision hip arthroplasty. One patient developed a transient sensory palsy; and another patient, a delayed palsy. Both nerve palsies recovered by the 1-year visit. We advocate visual nerve identification and tagging in revision hip surgery as 1 possible method to potentially reduce the risks of sciatic nerve injury.     

Identifying Barriers to Care for Older Adults with Substance Use Disorders and Cognitive Impairments

Some substance use disorders in older adults may be better conceptualized as hazardous use that is sometimes unintentional and affected by other mental health conditions, including dementia. This study identified (1) the types of substances older adults are abusing, (2) how the disorders are linked to dementia and other mental health issues, and (3) barriers to screening and treatment. Focus groups with inpatient and outpatient treatment teams and a review of medical records were completed. Screenings for substance use disorders and other geriatric syndromes (e.g., depression, dementia) are not widely done and is an area in which improvements can be made.     

Software review

SoftPC®. Insignia Solutions, 526 Clyde Avenue, Mountain View, CA 94043 (USA), $399 plus $199 for EGA/AT option module. SoftPC may be used on a Macintosh LC; Macintosh II, Hx, Hcx, Hsi, Ilci, IIfx; Macintosh SE/30; or Macintosh SE with a 68020 or 68030 accelerator card installed. The Macintosh needs a minimum of 2 megabytes RAM, a hard disk with a minimum of 2100K of available space, and system software 6.0 or higher. The EGA/AT option can be run on all of the above except the LC—with a minimum of 3 megabytes RAM, a hard disk with a minimum of 650K of available space, system software 6.0 or higher, and SoftPC Version 1.1 or later. SoftPC and the AT option are both compatible with AU/X® 2.0.     

Improving recognition of psychiatric disorders in a primary care practice

A high percentage of patients who seek care from primary care physicians have a psychiatric disorder, either as the primary illness or secondary to a medical illness or drug use. Drs Thompson and Petersen discuss a number of approaches that physicians can take to better recognize psychiatric disorders, so that they may treat or consult on the less complicated conditions and refer complex or resistant conditions to a psychiatrist.