Evolution of Helicobacter pylori susceptibility to antibiotics during a 10‐year period in Lithuania

The study evaluated the changes in the prevalence of Helicobacter pylori strains with primary resistance to antibiotics during the last 10 years in Lithuania. H. pylori susceptibilities to antibiotics were tested in 89 patients in 1998, in 81 patients in 2001 and in 90 patients in 2007/2008. Susceptibility to metronidazole, clarithromycin, amoxicillin and tetracycline was tested using E‐test or agar dilution method. Susceptibility to ciprofloxacin was only tested in 2007/2008. Data about utilization of all authorized and available on market macrolides and clindamycin in Lithuania during 2003–2007 were evaluated using WHO ATC/DDD methodology. A total of 260 H. pylori strains cultured from untreated adult patients were investigated. Primary resistance rates (1998, 2001 and 2007/2008) for metronidazole were 24.7%, 33.3%, and 35.6%, for clarithromycin 1.1%, 3.7%, and 3.3% and for tetracycline 0%, 2.5% and 0% respectively. No cases of amoxicillin resistance have been detected. The resistance rate for ciprofloxacin was 5.6% in 2007/2008. Data of total macrolides and clarithromycin utilization in Lithuania revealed that despite an increase of consumption of these drugs in Lithuania during 2003–2007 in 1.5 times, the total macrolide consumption remains one of the lowest in Europe. We have not observed any significant changes in the susceptibility of H. pylori to the most widely used antibiotics during the recent 10‐year period. The low resistance rate to clarithromycin might be related to the policy to avoid use of macrolides as first‐line treatment for pulmonary and other infections.     

Agentive and communitarian play in early childhood

Play has long been recognised as a vehicle by which significant developmental advances occur during early childhood. Children use play to explore their relationships, their psychosocial skills, and their environment, and through their experiences, they begin to adopt specific capacities and values that have an impact on future socio-emotional and academic outcomes. To understand more fully the factors that contribute to well-being in early childhood, we explored footage of a full ‘day in the life’ of a 5-year-old boy in transition to kindergarten, and we conducted interviews with him, his parents, and teacher. We identified agentive and communitarian strivings to be significant sources of his thriving and primary elements of many episodes of play during his filmed day. Previous research indicates that the development of strong agentive and communitarian skills and values is related to positive psychosocial outcomes. The current case study explores our participant's agentive and communitarian behaviours as exemplified through episodes of play, and the ways in which these skills and values are encouraged and supported by his caregivers. Implications regarding the role of parents and educators in the facilitation of agentive and communitarian skills are discussed.     

Morphological pattern of intrinsic nerve plexus distributed on the rabbit heart and interatrial septum

Although the rabbit is routinely used as the animal model of choice to investigate cardiac electrophysiology, the neuroanatomy of the rabbit heart is not well documented. The aim of this study was to examine the topography of the intrinsic nerve plexus located on the rabbit heart surface and interatrial septum stained histochemically for acetylcholinesterase using pressure‐distended whole hearts and whole‐mount preparations from 33 Californian rabbits. Mediastinal cardiac nerves entered the venous part of the heart along the root of the right cranial vein (superior caval vein) and at the bifurcation of the pulmonary trunk. The accessing nerves of the venous part of the heart passed into the nerve plexus of heart hilum at the heart base. Nerves approaching the heart extended epicardially and innervated the atria, interatrial septum and ventricles by five nerve subplexuses, i.e. left and middle dorsal, dorsal right atrial, ventral right and left atrial subplexuses. Numerous nerves accessed the arterial part of the arterial part of the heart hilum between the aorta and pulmonary trunk, and distributed onto ventricles by the left and right coronary subplexuses. Clusters of intrinsic cardiac neurons were concentrated at the heart base at the roots of pulmonary veins with some positioned on the infundibulum. The mean number of intrinsic neurons in the rabbit heart is not significantly affected by aging: 2200 ± 262 (range 1517–2788; aged) vs. 2118 ± 108 (range 1513–2822; juvenile). In conclusion, despite anatomic differences in the distribution of intrinsic cardiac neurons and the presence of well‐developed nerve plexus within the heart hilum, the topography of all seven subplexuses of the intrinsic nerve plexus in rabbit heart corresponds rather well to other mammalian species, including humans.     

Efficacy of 750-mg, 5-day levofloxacin in the treatment of community-acquired pneumonia caused by atypical pathogens

BACKGROUND: Current recommended durations for treatment of atypical community-acquired pneumonia (CAP) range from 10 to 21 days. However, antibiotics such as the fluoroquinolones may allow for effective, short-course regimens. OBJECTIVE: This study evaluated the efficacy of 750 mg levofloxacin for 5 days compared to a 500-mg, 10-day levofloxacin regimen for the treatment of atypical CAP. METHODS: A randomized, active-controlled, double-blind, multicenter study was conducted within the United States. Of the 528 patients enrolled in the study, 149 were diagnosed with CAP due to Legionella pneumophila, Chlamydia pneumoniae, or Mycoplasma pneumoniae. Patients' baseline symptoms were re-evaluated on Day 3 of therapy. Clinical efficacy and resolution of CAP symptoms were evaluated at the posttherapy visit (7-14 days after the last dose of active drug). RESULTS: This report represents a subgroup analysis of a previous clinical study. Among the 123 clinically evaluable patients diagnosed with atypical CAP (26 patients were unevaluable), the clinical success rates were 95.5% (63 of 66 patients) for the 750-mg group and 96.5% (55 of 57 patients) for the 500-mg group (95% CI for success rate of the 500-mg group minus that of the 750-mg group, -6.8 to 8.8). At the poststudy evaluation (31-38 days after treatment began), relapse occurred in 相似文献   

Innervation of pulmonary veins: Morphologic pattern and pathways of nerves in the human fetus

The aim of the study was to determine the anatomy of intrinsic nerves supplying human pulmonary veins (PVs). Twenty-two hearts of human fetuses with full sets of PVs were examined using a histochemical method for acetylcholinesterase in order to stain transmurally intrinsic neural structures on non-sectioned PVs for subsequent stereomicroscopic examination. Findings of the study demonstrate that epicardiac nerve extensions from both the dorsal right atrial and the middle dorsal subplexuses reached the right superior as well as the right inferior PVs, whereas the left superior PV was supplied by nerve extensions from the left dorsal subplexus. The left and middle dorsal subplexuses contributed nerves to the left inferior PV. The ganglia related topographically to PVs were patchy in distribution. On the left and right superior PVs, 38±6 and 31±3 ganglia were found, respectively, whereas 46±7 and 38±7 ganglia were identified on the left and right inferior PVs. The size of ganglia was similar for all four veins, ranging in area from 0.004±0.0003 to 0.007±0.0004 mm². The total area of ganglia distributed on a given PV was similar, ranging from 0.15±0.0003 to 0.25±0.0004 mm². The present findings demonstrate that the richest ganglion sites supplying intrinsic nerves to the human PVs are located on the posterior sides of both inferior and the left superior PVs and, therefore, these sites may be considered primary targets for focal pulmonary vein ablation in catheter-based therapy of atrial fibrillation.     

Levofloxacin efficacy in the treatment of community-acquired legionellosis

BACKGROUND: Although fluoroquinolones possess excellent in vitro activity against Legionella, few large-scale clinical trials have examined their efficacy in the treatment of Legionnaires disease. Even fewer studies have applied rigorous criteria for diagnosis of community-acquired Legionnaires disease, including culture of respiratory secretions on selective media. METHODS: Data from six clinical trials encompassing 1,997 total patients have been analyzed to determine the efficacy of levofloxacin (500 mg qd or 750 mg qd) in treating patients with community-acquired pneumonia (CAP) due to Legionella. RESULTS: Of the 1,997 total patients with CAP from the clinical trials, 75 patients had infection with a Legionella species. Demographics showed a large portion of these patients were < 55 years of age and nonsmokers. More than 90% of mild-to-moderate and severe cases of Legionella infection resolved clinically at the posttherapy visit, 2 to 14 days after treatment termination. No deaths were reported for any patient with Legionnaires disease treated with levofloxacin during the studies. CONCLUSIONS: Levofloxacin was efficacious at both 500 mg for 7 to 14 days and 750 mg for 5 days. Legionnaires disease is not associated only with smokers, the elderly, and the immunosuppressed, but also has the potential to affect a broader demographic range of the general population than previously thought.     

Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

Introduction

The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP).

Architecture and age-related analysis of the neuronal number of the guinea pig intrinsic cardiac nerve plexus.

The aims of the present study have been to determine the architecture of the guinea pig intrinsic cardiac nerve plexus (ICNP) and to test whether or not the heart of this species undergoes decrease in neuronal number with aging. Nine young (3-4 weeks of age) and nine adult (18-24 months of age) animals were examined employing histochemistry for acetylcholinesterase to reveal the ICNP in total hearts. The number of intracardiac neurons in seven animals was assessed via counting of the nerve cells both on total hearts and in serial sections of the atrial walls. The intracardiac neurons from adult guinea pigs were amassed within 329 +/- 15 ganglia. The hearts of young animals contained significantly fewer ganglia, only 211 +/- 27. In adult guinea pigs approximately 60% of the intracardiac neurons were distributed within ganglia of not more than 20 neurons, but the ganglia of such size accumulated only 45% of the neurons in young animals. The total number of the intracardiac neurons estimated per guinea pig heart was 2321 +/- 215, and this number did not differ significantly between young and adult animals. The nerves entering the guinea pig heart were found both in the arterial and venous part of the heart hilum. The nerves from the arterial part of the heart hilum proceeded into the ventricles, but the nerves from the venous part of the hilum formed a nerve plexus of the cardiac hilum located on the heart base. Within the guinea pig epicardium, intrinsic nerves divided into six routes and proceeded to separate atrial, ventricular and septal regions. In conclusion, findings of this study contradict the age-related decrease of the neuronal number in the guinea pig heart and illustrate the remarkable similarity in the architecture of the intracardiac nerve plexuses between guinea pig and rat.