Arch Pediatr, 2005 Jan, 12(1), 34 - 41 Laugel V, Escande B, Entz-Werle N, Mazingue F, Ferster A, Bertrand Y, Missud F, Lutz P. Asparaginase is frequently used in the treatment of lymphoblastic malignancies in children and is a major cause of drug-induced acute pancreatitis . Severe cases of iatrogenic pancreatitis are uncommon but potentially lethal, and represent a diagnostic and therapeutic challenge . Patients and method . - We have retrospectively collected pediatric cases of severe acute pancreatitis induced by asparaginase, having occurred since January 1996 in participating centers from France and Belgium . Results . - Eleven patients, between four and 15 years old, have been included . Pancreatitis has been observed in all treatment phases, after 6 to 21 doses of asparaginase, 2 to 16 days after the last injection . Circulatory collapse (5/11), insulin-dependent diabetes (6/11) and pancreatic pseudokysts (7/11) were the major complications . Non-surgical treatment mainly included digestive rest, broad-spectrum antibiotic therapy and prolonged use of morphine . Asparaginase has been eventually reintroduced in three cases, and has caused a recurrence of pancreatitis in two of them . Conclusion . - Intensive supportive management should enable a favourable outcome in most cases of acute pancreatitis induced by asparaginase in children . There is no way to predict the occurrence of this adverse event . Re-use of asparaginase should probably be ruled out. Arch Pediatr, 2005 Jan, 12(1), 10 - 15 Assathiany R, Kemeny J, Sznajder M, Hummel M, Van Egroo LD, Chevallier B; l'Arepege. Objectives . - To assess the presence and impact of health education messages in pediatricians' waiting rooms . Methods.- In September 2001, 81 pediatricians completed a questionnaire about the furnishings and equipment in their waiting rooms . They also distributed a questionnaire about waiting room health education messages to parents, to be completed at home . Results . - The analysis considered 1830 questionnaires . Health education messages were posted in 91% of the waiting rooms and most frequently concerned children's accidents, vaccines, hygiene and nutrition . The best topics that the parents remembered involved child neglect, antibiotic therapy, AIDS and other sexually transmitted diseases, and nutrition . Although memorization of the messages was not influenced by duration of the wait, it was higher among parents who had previously visited the pediatrician . These messages led 14% of the parents to discuss them spontaneously with their pediatrician . Conclusion . - Health education messages are posted in nearly all the waiting rooms studied; parents remember them in a variable and rather inexplicable order . Posting these messages demonstrates the pediatricians' willingness to be involved - beyond the simple consultation - in the health education of children and families . Identifying the real impact of these messages would require further study. J Int Med Res, 2005 Jan-Feb, 33(1), 1 - 20 Cell wall-deficient bacteria as a cause of infections: a review of the clinical significance; Onwuamaegbu ME et al.; Cell wall-deficient bacteria (CWDB) are pleomorphic bacterial forms . These atypical organisms may occur naturally or they can be induced in the laboratory . Their presence has been known about for over a century, but a definite link to clinical disease outcomes has not been demonstrated . A number of case reports and laboratory studies suggest some disease associations, however . Considerable controversy surrounds the true relevance of CWDB to disease; there is a widespread belief that they may represent a response by the walled organism to adverse extracellular conditions like antibiotic pressure . This review looks at studies published between 1934 and 2003, which were identified by Dialog DataStar using the key words 'cell wall deficient bacteria and clinical significance and infections' and by further scanning the reference list at the end of the papers retrieved . We conclude that the evidence for the clinical significance of CWDB in disease is not compelling. Z Gastroenterol, 2005 Jan, 43(1), 35 - 46 {Gastrointestinal bleeding in portal hypertensive patients.}; Biecker E et al.; There are three major goals in the prophylaxis and treatment of upper gastrointestinal bleeding in portal hypertensive patients: prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding . Several therapeutic options are available: non-selective beta-blockers are the treatment of choice in the primary prophylaxis of the first bleeding episode in patients with large esophageal varices . Alternatively, endoscopic band ligation therapy is an option . Acute bleeding varices should be treated by ligation pharmacological and antibiotic therapy . Prophylaxis of recurrent bleeding is patient-dependent: shunt surgery is an option in young patients in a good medical condition (Child-Pugh class A) . In patients with refractory ascites and a bilirubin below 3 mg/dl, TIPS is a good option together with recurrent bleeding . At the moment, there are no trials showing that endoscopic ligation therapy is superior to prevent pharmacological therapy . Nevertheless, the first-line treatment in most patients in Germany is endoscopic band ligation . Bleeding from ectopic varices and bleeding from hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy. Curr Opin Ophthalmol, 2005 Feb, 16(1), 65 - 70 Endophthalmitis: incidence and prevention; Soriano ES et al.; PURPOSE OF REVIEW: To present current peer-reviewed articles related to the incidence and prevention of postoperative endophthalmitis . RECENT FINDINGS: Recent literature indicates that the incidence of postoperative endophthalmitis may be on the rise . Although the preoperative use of antibiotics as prophylaxis is still controversial, it is becoming more common . SUMMARY: The reports of endophthalmitis analyzed from peer-reviewed ophthalmic journals suggest that the incidence of endophthalmitis has increased, ranging from 0.1 to 0.18% in different countries . This may be related to factors associated with the incision . Although some resistance has been detected, fourth-generation fluoroquinolones seem to be a proper antibiotic for endophthalmitis prophylaxis because of their spectrum, mode of action, and penetration. Protist, 2004 Dec, 155(4), 381 - 93 The bacterial paromomycin resistance gene, aphH, as a dominant selectable marker in Volvox carteri; Jakobiak T et al.; The aminoglycoside antibiotic paromomycin that is highly toxic to the green alga Volvox carteri is efficiently inactivated by aminoglycoside 3'-phosphotransferase from Streptomyces rimosus . Therefore, we made constructs in which the bacterial aphH gene encoding this enzyme was combined with Volvox cis-regulatory elements in an attempt to develop a new dominant selectable marker--paromomycin resistance (PmR)--for use in Volvox nuclear transformation . The construct that provided the most efficient transformation was one in which aphH was placed between a chimeric promoter that was generated by fusing the Volvox hsp70 and rbcS3 promoters and the 3' UTR of the Volvox rbcS3 gene . When this plasmid was used in combination with a high-impact biolistic device, the frequency of stable PmR transformants ranged about 15 per 106 target cells . Due to rapid and sharp selection, PmR transformants were readily isolated after six days, which is half the time required for previously used markers . Co-transformation of an unselected marker ranged about 30% . The chimeric aphH gene was stably integrated into the Volvox genome, frequently as tandem multiple copies, and was expressed at a level that made selection of PmR transformants simple and unambiguous . This makes the engineered bacterial aphH gene an efficient dominant selection marker for the transformation and co-transformation of a broad range of V . carteri strains without the recurring need for using auxotrophic recipient strains. Mund Kiefer Gesichtschir . 2005 Jan 13; {Epub ahead of print} {Castleman's disease Seltene Differenzialdiagnose einer submandibularen Schwellung.}; Holzle F et al.; CASE REPORT: A 25-year-old patient with fever, dysphagia, and reduced general condition was referred to our department by his dentist after 1 week of antibiotic therapy . He presented with a painful palpable mass in the right lower jaw that had developed 2 weeks before . The orthopantomogram showed a caries and periapical lesion at the right lower wisdom tooth . During extraction of the tooth and putative intra- and extraoral abscess incision, no pus could be drained and the mass persisted . CT scans then revealed lobulated soft tissue masses on both sides of the neck with the main focus on the right side . In an additional operation with excision of the mass, Castleman's disease of the hyaline vascular type was diagnosed.HISTOPATHOLOGIC FINDINGS: Staging could not detect further pathological findings and the patient's postoperative general condition improved continuously . The histological features of the hayline vascular type of Castleman's disease were characterized by multiple germinal centers surrounded by circumferentially arranged layers of small lymphocytes interconnected by a prominent vascular stroma with occasional plasma cells ("onion skin").CONCLUSION: Castleman's disease is a rare and yet poorly understood disease, characterized by inhomogeneous growth of lymphoid tissue . Mostly benign it remains a diagnostic challenge before histological investigation . In unclear submandibular swellings and neck lumps assumed to be an abscess, this rare differential diagnosis must be considered . Facing recurrence and potential for malignancy, follow-up of the patients over several years is necessary. Health Aff (Millwood), 2005 Jan-Feb, 24(1), 102 - 13 Making policy when the evidence is in dispute; Atkins D et al.; Policymakers often struggle with medical issues that are the subject of fierce scientific debate . On closer examination, many of these debates are manifestations of conflicting perspectives and values as much as disagreements over the evidence . We summarize common factors underlying recent debates and outline a series of questions that can help disentangle questions of evidence from those of values . These questions focus on identifying the most important outcomes, evaluating the quality of evidence, and assessing the trade-offs involved . We then use four recent policy debates-involving prostate-specific antigen (PSA) screening, high-dose chemotherapy for breast cancer, antibiotic therapy for otitis media, and newborn hearing screening-to illustrate how this approach can help clarify areas of agreement and disagreement of the opposing sides. Breast J, 2005 Jan-Feb, 11(1), 57 - 9 A Rare Case of Primary Actinomycosis of the Breast Caused by Actinomyces viscosus: Diagnosis by Fine-needle Aspiration Cytology under Ultrasound Guidance; Capobianco G et al.; We report the case of a 27-year-old woman with primary actinomycosis of the breast . Diagnosis was established by culture examination of specimen recovered by fine-needle aspiration cytology (FNAC) under ultrasound guidance . To our knowledge, this is the first description in the literature of a case of primary actinomycosis of the breast caused by Actinomyces viscosus . Twenty-nine previous cases of primary actinomycosis of the breast have been published, but these were caused by the more common species Actinomyces israelii . Targeted antibiotic therapy did not ameliorate the condition, thus drainage and excision of the mass were carried out . No other medical therapy was administered . Six years after surgery, no recurrence has been observed on both ultrasonographic and mammographic examinations. ILAR J, 2005, 46(1), 8 - 14 Administrative issues related to infectious disease research in the age of bioterrorism; Jaax J; The recent unprecedented growth in infectious disease research funding and infrastructure has resulted in part from an outgrowth of concern about newly emerging and re-emerging diseases and the progressive development of antibiotic-resistant pathogens . However, the most compelling impetus is the suspected and demonstrated capability and will of unknown individuals, groups, or states to use biological agents and/or toxins as weapons . Although the actual number of known victims and fatalities from bioterrorism in the United States has been miniscule compared with many other daily hazards, biological agents have the potential to cause human mass casualties, severely damage segments of our economy or agricultural infrastructure, poison or compromise our food or water supply, and, perhaps most damaging, disrupt our society physically and psychologically . The significant institutional commitment necessary to participate in infectious disease research is described, with a focus on programs that involve research with pathogens thought to have potential for use by bioterrorists . Administrative considerations are described, and include obtaining necessary research funding to offset high operating costs; complying with "select agent" regulations, security screening of employees; building or renovating a biocontainment facility; finding skilled professional and technical manpower; providing adequate physical security in a threat environment; conducting targeted training; overcoming potential internal and external dissent; developing and/or providing sufficient occupational health and safety programs; achieving and maintaining compliance standards in a fluid regulatory environment; mitigating potentially hazardous working conditions; understanding personal and institutional liability; and reassuring and dealing with a concerned, skeptical, or even hostile public. Aliment Pharmacol Ther, 2005 Jan 1, 21(1), 91 - 6 Rifabutin- and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first- and second-line eradication attempts in dyspepsia patients; Qasim A et al.; Summary Background : Optimal management approach is not well defined for subjects who fail initial first- and second-line Helicobacter pylori eradication attempts and are dealt on a case-by-case basis by the specialists . Aim: To evaluate the efficacy and safety of standard and 'rescue' eradication therapies at primary and secondary care levels . Methods : H . pylori infected dyspepsia patients referred to our C13 urea breath testing laboratory between January 1999 to February 2002 were included . Eradication failure at secondary care level was treated using strategies including antibiotic sensitivity testing and the use of rifabutin- and furazolidone-based therapies . Results : 3280 patients received standard first-line eradication therapy, which was successful in 2530 (77%) patients . Second-line therapy (bismuth-based 'quadruple') or triple therapy (altering constituent antibiotics) was successful in 56% of 270 treated patients . Subsequent eradication attempts using rifabutin-based (n = 34) and furazolidone-based (n = 10) regimens were successful in 38% and 60% patients respectively . H . pylori eradication rates were significantly different for guidelines compliant (94.8%) and non-compliant (82%) groups (P = 0.0001) . H . pylori eradication rates for non-ulcer dyspepsia (40%) and peptic ulcer disease (36%) were not significantly different . Conclusions : Available H . pylori eradication therapies remain very effective and compliance to guidelines achieves high success rates . Furazolidone-based 'rescue' regimen achieved high eradication rates after failure of the standard first-line, second-line and rifabutin-based therapies. Int J STD AIDS, 2004 Dec, 15(12), 831 - 2 Treatment of Chlamydia trachomatis in North Thames region 2003; Sethi G et al.; Following on from the survey of techniques used for testing chlamydia, a multi-centre re-audit of the treatment of C . trachomatis in genitourinary clinic attendees in the North Thames region from February to March 2003 was performed . This showed an improvement since our previous audit with a significant increase in the number of centres following national guidelines in antibiotic prescribing and offering test of cure in clinically indicated cases. Nat Struct Mol Biol . 2005 Jan 09; {Epub ahead of print} Surface charge and hydrophobicity determine ErbB2 binding to the Hsp90 chaperone complex; Xu W et al.; The molecular chaperone Hsp90 modulates the function of specific cell signaling proteins . Although targeting Hsp90 with the antibiotic inhibitor geldanamycin (GA) may be a promising approach for cancer treatment, little is known about the determinants of Hsp90 interaction with its client proteins . Here we identify a loop within the N lobe of the kinase domain of ErbB2 that determines Hsp90 binding . The amino acid sequence of the loop determines the electrostatic and hydrophobic character of the protein's surface, which in turn govern interaction with Hsp90 . A point mutation within the loop that alters ErbB2 surface properties disrupts Hsp90 association and confers GA resistance . Notably, the immature ErbB2 point mutant remains sensitive to GA, suggesting that mature and nascent client kinases may use distinct motifs to interact with the Hsp90 chaperone complex. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi, 2004 Sep, 18(3), 287 - 8 {Clinical analysis of 77 liver failure patients with nosocomially infected septicemia.}; He WP et al.; BACKGROUND: To study the clinical characteristics and preventive measures of liver failure with nosocomial septicemia . METHODS: Retrospective analysis of nosocomial septicemia seen between 2001 and 2002 was carried out in our hospital . RESULTS: Incidence of nosocomial septicemia was 0.61%, mortality was 14.29%, the main pathogen was Escherichia coli, the drug resistance occurred in most pathogens to the commonly used antibiotics . CONCLUSION: In order to reduce nosocomial septicemia, antibiotics should be used rationally, should be paid attention to bacterial culture and antibiotic sensitivity, and preventive measures should be taken. Bone Marrow Transplant . 2005 Jan 10; {Epub ahead of print} A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients; Jordanides NE et al.; Summary:A blinded prospective study was performed to determine whether screening of whole blood using a real-time, panfungal polymerase chain reaction (PCR) technique could predict the development of invasive fungal infection (IFI) in immunocompromised haemato-oncology patients . In all, 78 patients (125 treatment episodes) were screened twice weekly by real-time panfungal PCR using LightCyclertrade mark technology . IFI was documented in 19 treatment episodes (five proven, three probable and 11 possible), and in 12, PCR was sequentially positive . PCR positivity occurred in: 4/5 proven; 2/3 probable; 6/11 possible; and 29/106 with no IFI . In 8/12 with IFI and sequentially positive PCR results, PCR positivity occurred before (median 19.5 days) and in 4/12 (median 10.5 days) after the initiation of empirical antifungal therapy . Based on sequential positive results for proven/probable IFI sensitivity, specificity, positive predictive value and negative predictive value were 75, 70, 15 and 98%, respectively . Real-time panfungal PCR is a sensitive tool for the early diagnosis of IFI in immunocompromised haemato-oncology patients . It may be most useful as a screening method in high-risk patients, either to direct early pre-emptive antifungal therapy or to determine when empirical antifungal therapy can be withheld in patients with antibiotic--resistant neutropenic fever . However, these strategies require further assessment in comparative clinical trials.Bone Marrow Transplantation advance online publication, 10 January 2005; doi:10.1038/sj.bmt.1704768. Yi Chuan, 2003 Jul, 25(4), 466 - 70 {Using of selective marker gene in transgenic plants and its removal.}; Hou AJ et al.; Selective marker gene is usually used to select transformed cells or tissue during gene transfer.However,the use of selective marker gene,especially antibiotic-resistant gene,is harmful to environment,plant development and affects multi-transformation.A new strategy that offers a approach for the elimination of those disadvantages caused by the selectable marker gene is developed.We summarized correlative marker genes used in transgenic plants and some methods of its removal. Yi Chuan, 2003 Jan, 25(1), 119 - 22 {The new safe strategy on the marker genes in transgenic plant.}; Zhao Y et al.; The presence in transgenic plants of antibiotic and herbicide resistant selective marker genes might be an unpredictable hazard to the ecosystem as well as to human health.There are two applicable strategies can be used to resolve this problem.One is to remove the resistant marker genes before the transgenic plants are released to field.The other is to develop and use safe marker genes to produce transgenic plants.The present paper reviewed three technique systems employed to remove resistant marker genes in transgenic plants and several safe marker genes used in plant transformation. Arch Biochem Biophys, 2005 Feb 15, 434(2), 232 - 40 Amplification of C1027-induced DNA cleavage and apoptosis by a quinacrine-netropsin hybrid molecule in tumor cell lines; Iwamoto T et al.; We examined the effect of a newly synthesized DNA-binding ligand, quinacrine-netropsin hybrid molecule (QN), on cytotoxicity, apoptosis, and DNA strand breaks induced by an enediyne antitumor antibiotic, C1027 . QN significantly enhanced C1027-induced cellular DNA strand breaks, caspase-3 activation, and DNA ladder formation, characteristic of apoptosis, in human HL-60 cells . Flow cytometry revealed that C1027-induced intracellular H(2)O(2) generation was enhanced by QN, suggesting that QN enhances C1027-induced cytotoxic effect through H(2)O(2)-mediated apoptosis . QN also significantly enhanced C1027-induced apoptosis in BJAB cells, and the inhibition of apoptosis was observed in BJAB cells transfected with Bcl-2 gene . The experiment using (32)P-labeled DNA fragments showed that the addition of QN enhanced C1027-induced double-stranded DNA cleavage at the 5'-AGG-3'/3'-TCC-5' sequence (cutting sites are underlined) . These results suggest that QN enhances C1027-induced antitumor effect via DNA cleavage and apoptosis . The present study shows a novel approach to the potentially effective anticancer therapy. Curr Protein Pept Sci, 2005 Jan, 6(1), 103 - 14 Membrane Interactions of Host-defense Peptides Studied in Model Systems; Jelinek R et al.; Host-defense, antibiotic peptides are believed to generate their cytolytic effects by interacting with the membranes of bacterial cells . Direct analyses of peptide interactions with real cellular membranes are difficult, however, due to the high complexity of physiological membranes . This review summarizes experimental work aiming to understand peptide-membrane interactions and their relationships with the peptides' biological actions using specific model systems . Varied model assemblies have been constructed that generally aim to mimic the fundamental lipid bilayer organization of the membrane . The model systems we will describe include multilamellar and unilamellar vesicles, planar lipid bilayers, lipid monolayers and micelles, and colorimetric biomimetic membranes . The different artificial models have facilitated examination of specific biological or chemical parameters affecting peptide action, for example the effect of membrane lipid composition on peptide affinities and membrane penetration, the relationship between membrane fluidity and peptide interactions, the conformations of active peptides, and other factors . We evaluate the strengths and limitations of the various approaches, and point to future directions in the field. Neurosurg Focus . 2004 Dec 15;17(6):E2. Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine; Acosta FL Jr et al.; Establishing the diagnosis of cervical osteomyelitis in a timely fashion is critical to prevent catastrophic neurological injury . In the modern imaging era, magnetic resonance imaging in particular has facilitated the diagnosis of cervical osteomyelitis, even before the onset of neurological signs or symptoms . Nevertheless, despite advancements in diagnosis, disagreement remains regarding appropriate surgical treatment . The role of instrumentation and type of graft material after cervical decompression remain controversial . The authors describe the epidemiological features, pathogenesis, and diagnostic evaluation, and the surgical and nonsurgical interventions that can be used to treat osteomyelitis of the cervical spine . They also review the current debate about the role of instrumentation in preventing spinal deformity after surgical decompression for cervical osteomyelitis . Based on this review, the authors conclude that nonsurgical therapy is appropriate if neurological signs or symptoms, instability, deformity, or spinal cord compression are absent . Surgical decompression, debridement, stabilization, and deformity correction are the goals once the decision to perform surgery has been made . The roles of autogenous graft, instrumentation, and allograft have not been clearly delineated with Class I data, but the authors believe that spinal stability and decompression override creating an environment that can be completely sterilized by antibiotic drugs. Neurosurg Focus . 2004 Dec 15;17(6):E11. Cervical osteomyelitis: a brief review; Barnes B et al.; OBJECT: The authors conducted a literature-based review of the etiology, diagnosis, and treatment of cervical vertebral osteomyelitis (CVO) . METHODS: A Medline (PubMed) search using the key words "cervical vertebral osteomyelitis" yielded 256 articles . These were further screened for relevance, yielding 15 articles . Each publication was reviewed, and several others not identified in the PubMed search were screened and included in the review according to relevance . Each article was identified as involving either the epidemiology/etiology, diagnosis, or treatment of CVO . Separate categories were created for case reports and general reviews . CONCLUSIONS: Cervical vertebral osteomyelitis has a spectrum of origins, which include spontaneous, postoperative, traumatic, and hematogenously spread causes . The majority of patients have medical risk factors and comorbidities that include diabetes, trauma, drug abuse, and infectious processes in extraspinal areas . The diagnosis of CVO can be accomplished in most cases by using plain x-ray films and computerized tomography scans . Nevertheless, preferential use of magnetic resonance imaging in cases in which there is a neurological deficit is helpful in identifying epidural compressive processes . Treatment for CVO can be successfully initiated with intravenous antibiotic therapy . Nevertheless, in cases in which there is a neurological deficit, spinal deformity and/or progressive lysis, or intractable pain, the earliest feasible surgical intervention with debridement and fusion is warranted. Am J Otolaryngol, 2005 Jan-Feb, 26(1), 35 - 8 Subacute infratemporal fossa cellulitis with subsequent abscess formation in an immunocompromised patient; Akst LM et al.; Abstract Objectives To present a case of subacute infratemporal fossa cellulitis with subsequent abscess formation to show important anatomic relationships as they effect presentation and treatment of infections in this area . Study design Case report and brief literature review . Methods The case of an immunocompromised patient who developed subacute infratemporal fossa cellulitis with subsequent abscess formation is presented . A literature review discusses etiology, diagnosis, and treatment of these infections . Results Careful history and physical examination revealed unilateral facial pain, swelling, and trismus to be caused by an infratemporal fossa abscess . Intraoral drainage and intravenous antibiotic therapy led to resolution of the infection . Conclusion Infratemporal fossa abscesses are potentially dangerous complications of odontogenic infections . Although clinical diagnosis may be difficult, knowledge of relevant anatomy and pathways of spread allow more effective diagnosis and treatment of these infections. Am J Otolaryngol, 2005 Jan-Feb, 26(1), 1 - 6 A comprehensive study on lesions of the pinna; Prasad KC et al.; Abstract Purpose Pinna contributes enormously to the facial aesthesis . Lesions affecting the pinna can lead to overt disfigurement and change the entire appeal of the face . Gross deformity can occur because of a delay in diagnosis and mismanagement . The aim of our study was to determine the clinical presentation, relevant investigations, appropriate treatment, timing of surgical intervention, and complications encountered . Factors that predispose and aggravate the condition and their appropriate management are also discussed . The point to be emphasized is that a good clinical history and examination alone is sufficient to diagnose the conditions without the aid of any special investigation . Materials and Methods Our clinical study comprised of 307 cases of men and women patients presenting with swelling of the pinna, who attended the Ear, Nose, and Throat Department, Kasturba Medical College, Mangalore, India, during the period of February 1992 to June 2002 . Wide bore needle aspiration was done for the majority of cases of seroma and hematoma . Patients who had recurrence were managed by window procedure . Incision and drainage with or without curettage of diseased cartilage was performed for perichondritis . Other lesions like keloid, hemangioma, dermoid cyst, sebaceous cyst, and malignancy were managed by complete excision . A firm pressure dressing was applied in all cases after surgery . Majority of the cases were done under local anesthesia . Results Prompt surgical intervention under good antibiotic cover gave excellent results with minimal complications . Conclusions Surgical intervention at the earliest followed by a firm pressure dressing under antibiotic cover decreases the morbidity . Diabetes mellitus plays a significant role in few of the conditions and has to be simultaneously controlled. J Oral Maxillofac Surg, 2005 Jan, 63(1), 36 - 41 Ultrasound-guided drainage of submasseteric space abscesses; Al-Belasy FA; Purpose The oral approach for incision and drainage (I&D) in patients presenting with submasseteric space (SMS) abscesses and marked trismus is more difficult and requires a general anesthetic, necessitating an anesthetist experienced in fiberoptic-guided nasal intubation . In such patients, ultrasound-guided drainage (USGD) has been attempted to obviate this need . The purpose of this trial was to report our experience with the surgical management of 11 SMS abscesses, with special reference to their USGD . Materials and methods Seven men and 4 women ranging in age from 18 to 41 years (average age, 25 years) participated in this trial . They were initially examined with US, and their abscesses were subsequently drained under US guidance using a 16-gauge intravenous catheter . An antibiotic regimen was prescribed, and arrangements were made to see the patients daily for 5 days . USGD was repeated after 24 hours, and 24 hours later the infection course was monitored in each patient . Patients with nonresolving infection had their abscesses formally incised and drained extraorally . The source of infection was removed as soon as the acute phase of infection passed and the interincisal opening (IIO) allowed . The catheter or corrugated drain was removed when the discharge ceased or became minimal . Patients were then instructed to continue a 3-day course of an antibiotic and to return after 1 week and then after 1 month . Results Resolution of infection was successfully achieved by USGD with no need for I&D in 8 of the 11 patients (73%) . In those patients, the average total amount of pus removed was 8.5 mL, and the average IIO was 17.4 mm immediately after an average initial aspirate of 4.5 mL of pus . I&D was required in the remaining 3 patients (27%) . In those patients the average total amount of pus removed was 17.5 mL, and the average IIO was 7.7 mm immediately after an average initial aspirate of 9.3 mL of pus . Conclusions Resolution of infection with USGD is more probable if there was an immediate improvement of the IIO to about 1.5 cm or more after an initial aspiration of 5 mL of pus. J Bone Joint Surg Am, 2005 Jan, 87-A(1), 8 - 12 The effect of surgical delay on acute infection following 554 open fractures in children; Skaggs DL et al.; BACKGROUND: Traditional recommendations hold that open fractures in both children and adults require urgent surgical debridement for a number of reasons, including the preservation of soft-tissue viability and vascular status as well as the prevention of infection . Following the widespread use of early administration of antibiotics, a number of single-institution studies challenged the belief that urgent surgical debridement decreases the risk of acute infection . METHODS: We performed a retrospective, multicenter study of open fractures that had been treated at six tertiary pediatric medical centers between 1989 and 2000 . The standard protocol at each medical center was for all children to be given intravenous antibiotics upon arrival in the emergency department . The medical records of all children with open fractures were reviewed to identify the location of the fracture, the interval between the injury and the time of surgery, the Gustilo and Anderson classification, and the occurrence of acute infection . RESULTS: The analysis included 554 open fractures in 536 consecutive patients who were eighteen years of age or younger . The overall infection rate was 3% (sixteen of 554) . The infection rate was 3% (twelve of 344) for fractures that had been treated within six hours after the injury, compared with 2% (four of 210) for those that had been treated at least seven hours after the injury; this difference was not significant (p = 0.43) . When the fractures were separated according to the Gustilo and Anderson classification system, there were no significant differences in the infection rate between those that had been treated within six hours after the injury and those that had been treated at least seven hours after the injury . Specifically, these infection rates were 2% (three of 173) and 2% (two of 129), respectively, for type-I fractures, 3% (three of 110) and 0% (zero of forty-four), respectively, for type-II fractures, and 10% (six of sixty-one) and 2% (two of thirty-seven), respectively, for type-III fractures (p > 0.05 for all three comparisons) . CONCLUSIONS: In the present retrospective, multicenter study of children with Gustilo and Anderson type-I, II, and III open fractures, the rates of acute infection were similar regardless of whether surgery was performed within six hours after the injury or at least seven hours after the injury . The findings of the present study suggest that, in children who receive early antibiotic therapy following an open fracture, surgical debridement within six hours after the injury offers little benefit over debridement within twenty-four hours after the injury with regard to the prevention of acute infection . LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions to Authors for a complete description of levels of evidence. J Biol Chem . 2005 Jan 4; {Epub ahead of print} Cyclin D1 and c-Myc internal ribosome entry site (IRES)-dependent translation is regulated by AKT activity and enhanced by rapamycin through a p38 MAPK and ERK-dependent pathway; Shi Y et al.; The macrolide antibiotic rapamycin inhibits the mammalian target of rapamycin protein (mTOR) kinase resulting in the global inhibition of cap-dependent protein synthesis, a blockade in ribosome component biosynthesis and G(1) cell cycle arrest . G(1) arrest may occur by inhibiting the protein synthesis of critical factors required for cell cycle progression . Hypersensitivity to mTOR inhibitors has been demonstrated in cells having elevated levels of AKT kinase activity, whereas cells containing quiescent AKT activity are relatively resistant . Our previous data suggest that low AKT activity induces resistance by allowing continued cap-independent protein synthesis of cyclin D1 and c-myc proteins . In support of this notion, the current study demonstrates that the human cyclin D1 mRNA 5' untranslated region contains an internal ribosome entry site (IRES) and that both this IRES and the c-myc IRES are negatively regulated by AKT activity . Furthermore, we show that cyclin D1 and c-myc IRES function is enhanced following exposure to rapamycin and requires both p38 MAPK and RAF/MEK/ERK signaling, as specific inhibitors of these pathways reduce IRES-mediated translation and protein levels under conditions of quiescent AKT activity . Thus, continued IRES-mediated translation initiation may permit cell cycle progression upon mTOR inactivation in cells whose AKT kinase activity is relatively low. Orthopedics, 2004 Dec, 27(12), 1289 - 91 Addition of hand-blended generic tobramycin in bone cement: effect on mechanical strength; DeLuise M et al.; This study compared the mechanical strength of commercially prepared antibiotic bone cement (Simplex With Tobramycin; Stryker, Mahwah, NJ), cement with generic tobramycin (Pharma-Tek, Huntington, NY) blended in by the orthopedic nursing staff, and standard nonantibiotic bone cement . The results showed an approximate 36% decrease in the strength of the cement with hand-mixed generic tobramycin, while the commercial antibiotic cement remained unchanged relative to the nonantibiotic control . These results indicate the mechanical properties of bone cement can be severely compromised by hand-mixing antibiotics into bone cement at the time of surgery. Pediatr Pulmonol, 2005 Feb, 39(2), 156 - 61 Prevalence of thrombophilia and catheter-related thrombosis in cystic fibrosis; Barker M et al.; Venous thrombosis in children and young adults is frequently associated with predisposing conditions and with an indwelling catheter or totally implantable venous access device (TIVAD) . These systems are commonly used for the delivery of antibiotic therapy in patients with cystic fibrosis (CF) . We reviewed our CF center's history of catheter-related events over 13 years and prospectively investigated the presence of risk factors for thrombosis in 66 children and adults with CF (age, 3-38 years; 32 females) . Five thrombotic events had occurred in 4 patients, 2 of whom carried the factor V Leiden mutation . Five asymptomatic patients were diagnosed with heterozygous mutations of the factor V or prothrombin gene . Functional activity of protein C was decreased in 13 subjects, with a correlation to impaired liver function . Protein S activity was abnormal in 20 patients and was related to CF genotype . Anti-phospholipid antibodies (APA) were present in 6 asymptomatic patients . A reinvestigation after 3 years confirmed protein S deficiency in 12 of 14 patients, while most abnormalities for protein C or APA were inconsistent . In conclusion, a thrombophilic state was detected in 53% of patients, and 2 out of 4 subjects with TIVAD-related thrombosis carried a genetic defect . It may thus be helpful to include a hemostatic evaluation in the clinical decision process for or against TIVAD insertion in eligible CF patients . Pediatr Pulmonol . 2005;39:156-161 . (c) 2005 Wiley-Liss, Inc. Neurocirugia (Astur), 2004 Dec, 15(6), 543 - 51; discussion 551-2 {Spinal epidural empyema . Analysis of 14 cases}; Gelabert-Gonzalez M et al.; OBJECTIVE: The goal of this study was to review our series of spinal epidural empyema diagnosed in the last 20 years and review the literature regarding the pathogenesis, diagnosis and treatment of these lesions . PATIENTS AND METHODS: This is a retrospective study over 14 patients diagnosed of spinal epidural empyema . We review the epidemiological data, clinical symptoms, laboratory and imaging data, the treatment regimen and the results . RESULTS: Fourteen patients, 7 males and 7 females, with an age range from 8 to 76 years (mean 48.9) were identified . The first symptom was localized back/ neck pain in 12 patients and the mean duration of symptoms was 9.3 days . Erythrocyte sedimentation rate (ESR) was elevated in all patients; peripheral leukocyte count was elevated in 13 cases (92.9%) . Site of spinal epidural empyemas was distributed along the axis but in 11 cases the location was thoracic . Thirteen patients had surgery for debridement and spinal decompression and one patient was treated successfully with antibiotics alone . CONCLUSIONS: Patients with localized back pain and fever who are at risk for developing such empyemas with elevation of white blood cells and increased ESR, should have an immediate magnetic resonance imaging sean . Urgent surgical drainage and antibiotic use are the treatment of choice in order to prevent irreversible neurological deficits . Nonsurgical treatment should be reserved for poor surgical candidates and patients without neurological deficits. Acta Med Port, 2003 Nov-Dec, 16(6), 389 - 394 Epub 2003 Dec 1. {Monitoring serum levels of gentamicin in neonates.}; Rocha MJ et al.; Newborn infants in intensive care units demonstrated a higher incidence of gestational age below 31 week . Obstetrical and neonatal diseases procedures required for the management of critically ill neonates are associated with an increased risk of infections . Gentamicin is an aminoglycoside antibiotic often used to treat gramnegative bacillary infections and suspected sepsis in neonates . The risk of toxicity or poor efficacy is further increased due to the recognised wide intra and interpatient variability of the newborn . The present work involved 49 infants of 31.3 +/- 4.1 (mean +/- SD) weeks of gestational age, weighing 1.7 +/- 0.8 kg and were treated with standard doses of gentamicin (3.8 +/- 0.9 mg/kg/day) . Routine clinical care data were retrospectively collected from the medical records in the neonatal intensivecare unit at Coimbra University Hospital . Data analysis demonstrated that potentially toxic serum levels were observed in 49% of newborn infants (trough > 2 mg/L) . Additionally, the obtained results also showed that 7.5% of peak concentrations were found to be higher than 10 mg/L . Potentially sub-therapeutic concentrations were observed in 15% of the patients (peak > 6 mg/L). J Bacteriol, 2005 Jan, 187(2), 687 - 96 Biochemical Activities of the absA Two-Component System of Streptomyces coelicolor; Sheeler NL et al.; The AbsA1 sensor kinase and its cognate response regulator AbsA2 are important regulators of antibiotic synthesis in Streptomyces coelicolor . While certain point mutations in absA1 reduce or eliminate the synthesis of several antibiotics, null mutations in these genes bring about enhanced antibiotic synthesis . We show here that AbsA1, which is unusual in sequence and structure, is both an AbsA2 kinase and an AbsA2 approximately P phosphatase . The half-life of AbsA2 approximately P in solution is 68.6 min, consistent with a role in maintaining a relatively stable state of transcriptional repression or activation . We find that mutations in the absA locus that enhance antibiotic synthesis impair AbsA2 kinase activity and that mutations that repress antibiotic synthesis impair AbsA2 approximately P phosphatase activity . These results support a model in which the phosphorylation state of AbsA2 is determined by the balance of the kinase and phosphatase activities of AbsA1 and where AbsA2 approximately P represses antibiotic biosynthetic genes either directly or indirectly. Farm Hosp, 2004, 28(6), 410 - 418 {A study of antibiotc use at a county hospital . Years 1998-2002.}; Aparici Bolufer J et al.; Introduction: Adequate antibiotic use clearly influences the development of bacterial resistance, adverse events and healthcare costs . Studies of drug usage allow us to detect deviations in antibiotic use . Material and methods: Antibiotic use during the period 1998-2002 was analyzed using data provided by management software applications . The prescription of restricted-use antibiotics during years 2001 and 2002 was analyzed by selecting patients according to the information available in the unit-dose drug distribution area database at the pharmacy department . Results: Antibiotic use increased from 78 to 100 DDD during the period of time studied . The use of new quinolones has displaced macrolides . Two thirds of piperacillin -tazobactam prescriptions are for surgical patients . Conclusions: 1.Changes in the pattern of antibiotic use have been detected . 2.The relative weight of restricted-use antibiotics has increased . 3.This study allows a prioritization of intervention areas. Biochemistry, 2005 Jan 11, 44(1), 268 - 277 Fungal Metabolite Sulfamisterin Suppresses Sphingolipid Synthesis through Inhibition of Serine Palmitoyltransferase; Yamaji-Hasegawa A et al.; Sphingolipids and their metabolites are known to modulate various cellular events including proliferation, differentiation, and apoptosis . Serine palmitoyltransferase (SPT) is the enzyme that catalyzes the first step of the biosynthesis of all sphingolipids . Here, we report that a newly identified antibiotic, sulfamisterin, derived from the fungus Pycnidiella sp., is a specific inhibitor of SPT . The chemical structure of sulfamisterin resembles both that of sphingosine as well as a potent inhibitor of SPT, ISP-1 (myriocin) . Sulfamisterin inhibited SPT activity with IC(50) = 3 nM in a cell-free lysate prepared from Chinese hamster ovary (CHO) fibroblasts . Sulfamisterin markedly inhibited the biosynthesis of sphingolipids in living CHO cells and in yeast Saccharomyces cerevisiae as monitored by radioactive precursors . Unlike the cell-free experiments, 10 muM sulfamisterin was required for complete inhibition of sphingolipid biosynthesis in intact cells . We also synthesized a series of structural analogues of sulfamisterin and examined their activities both in cell-free and in living cell systems. Antibiot Khimioter, 2004, 49(6), 15 - 9 {Pharmacokinetic substantiation of ceftriaxone prophylaxis of hereditary syphilis}; Frontal ataxia in childhood; Department of Paediatric Neurology, University Medical Centre St . Radboud, Nijmegen, The Netherlands . c.erasmus@cukz.umcn.nl Frontal ataxia may be the result of a unilateral frontal lesion . In this report three cases are presented with ataxia due to right frontal lesions . One case concerns a boy presenting with an unsteady gait and titubation of the trunk, mimicking developmental disequilibrium and with complex partial seizures . It proved to be caused by a small right-sided cavernoma in the middle frontal gyrus . After surgical intervention the symptoms and the seizures disappeared . Two subsequent cases concern teenage patients presenting with headache after an ENT infection and on physical examination mild dysmetric function of the upper limbs and slight disequilibrium, due to right-sided frontal lobe abscesses . After neurosurgical and antibiotic therapy the symptoms were relieved . The frontal origin of ataxia should be considered in children presenting with a "cerebellar syndrome" . Frontal gait disorders consist of a clinical pattern of different gait disorders . The syndrome has been mentioned in the literature under different names . Our patients show signs compatible with the term frontal disequilibrium, a clinical pattern of frontal gait disorder . This assumes walking problems characterized by loss of control of motor planning, leading to imbalance . Remarkably, frontal ataxia may mimic developmental delay as demonstrated in the first case and may be the leading mild symptom in extensive frontal lobe damage as demonstrated by the two other cases . We suppose that frontal ataxia is the result of a disturbance in the cerebellar-frontal circuitries and an impairment of executive and planning functions of the basal ganglia-frontal lobe circuitry. Pediatr Pulmonol . 2004 Dec 30;39(2):156-161 {Epub ahead of print} Prevalence of thrombophilia and catheter-related thrombosis in cystic fibrosis; Barker M et al.; Venous thrombosis in children and young adults is frequently associated with predisposing conditions and with an indwelling catheter or totally implantable venous access device (TIVAD) . These systems are commonly used for the delivery of antibiotic therapy in patients with cystic fibrosis (CF) . We reviewed our CF center's history of catheter-related events over 13 years and prospectively investigated the presence of risk factors for thrombosis in 66 children and adults with CF (age, 3-38 years; 32 females) . Five thrombotic events had occurred in 4 patients, 2 of whom carried the factor V Leiden mutation . Five asymptomatic patients were diagnosed with heterozygous mutations of the factor V or prothrombin gene . Functional activity of protein C was decreased in 13 subjects, with a correlation to impaired liver function . Protein S activity was abnormal in 20 patients and was related to CF genotype . Anti-phospholipid antibodies (APA) were present in 6 asymptomatic patients . A reinvestigation after 3 years confirmed protein S deficiency in 12 of 14 patients, while most abnormalities for protein C or APA were inconsistent . In conclusion, a thrombophilic state was detected in 53% of patients, and 2 out of 4 subjects with TIVAD-related thrombosis carried a genetic defect . It may thus be helpful to include a hemostatic evaluation in the clinical decision process for or against TIVAD insertion in eligible CF patients . Pediatr Pulmonol . 2005;39:156-161 . (c) 2005 Wiley-Liss, Inc. Eur Radiol . 2004 Dec 31; {Epub ahead of print} Cerebral infections; Karampekios S et al.; Despite the development of many effective antibiotic therapies and the general improvement in hygiene and health care systems all over the world, the incidence of central nervous system (CNS) infection has increased significantly in the past 15 years . This can be attributed primarily to the acquired immunodeficiency syndrome (AIDS) epidemic and its devastating effect on the immune system and secondarily to various immunosuppressive agents that are being used in aggressive cancer treatment and in organ transplantations . The brain particularly is protected from infection by the calvarium, meninges and blood brain barrier . However, different types of pathogens, including bacteria, viruses, fungi and parasites, can reach the brain hematogenously or, less likely, by direct extension from an adjacent infected focus . The early detection and specific diagnosis of infection are of great importance, since brain infections are potentially treatable diseases . Imaging studies play a crucial role in the diagnostic process, along with the history (exposure to infectious agents), host factors (open head trauma, CSF leak, sinusitis, otitis, immune status), physical examination and laboratory analysis of CSF. Curr Opin Urol, 2004 Nov, 14(6), 375 - 80 Current role of penile implants for erectile dysfunction; Moncada I et al.; PURPOSE OF REVIEW: The purpose of this review is to appraise new developments and publications in the field of penile prosthetic surgery . Urologists dealing with erectile dysfunction need to recognize the value of penile prosthetic surgery as a very efficacious treatment for this common condition . This type of surgery is needed in a considerable proportion of patients with erectile dysfunction so this review is timely and relevant . RECENT FINDINGS: The main themes in the literature covered include risk factors for infection of penile prostheses, its prevention with the use of hydrophilic and antibiotic-coated prostheses, particularly in re-operations, and its management with the new rescue procedures . Surgical tips for prosthetic surgery are also reviewed as well as clinical outcomes and factors influencing them . SUMMARY: Of all the invasive treatments currently available, placement of a penile prosthesis is one of the most successful, giving high levels of satisfaction . With the aid of new technical advances, the risk of infection--the most feared complication--can be minimized so prosthetic surgery may play a major role in the treatment of erectile dysfunction. Pediatr Hematol Oncol, 2004 Oct-Nov, 21(7), 585 - 92 Intracranial hemorrhage due to vitamin K deficiency after the newborn period; Demiroren K et al.; This study presents clinical and laboratory findings and outcome of infants with intracranial hemorrhage (ICH) due to vitamin K deficiency after the newborn period, and evaluates vitamin K prophylaxis . The hospital records of 19 infants with a diagnosis of ICH due to vitamin K deficiency after the newborn period, seen in our clinic in less than 4 years, were retrospectively evaluated . The mean age at onset of the symptoms was 49 +/- 18 days . The most frequent presenting complaints were convulsion (58%), vomiting (47%), and irritability (47%) . The most frequent examination findings were coma (74%), fontanel bulging (68%), and absence of pupil reaction (42%) . The localizations of the ICHs were as follows: parenchymal (47%), subarachnoid (47%), subdural (42%), and intraventricular (26%) . Four patients had used antibiotics and 1 patient had suffered diarrhea before the onset of the symptoms . One patient had a mild hepatic dysfunction that resolved spontaneously in a few weeks and its cause was not found . Mortality was observed in 6 (32%) patients . Ten patients were followed up for a mean period of 26.9 +/- 22.6 months . The follow-up findings were developmental delay (40%), microcephaly (30%), epilepsy (30%), blindness (20%), strabismus (20%), spastic tetraparesis (10%), spastic hemiparesis (10%), growth retardation (10%), and hydrocephaly (10%) . Three (30%) patients remained neurologically normal . Vitamin K deficiency leads to death and neurological defects . Vitamin K prophylaxis at birth is therefore a priority . In this series, hepatic dysfunction had been detected in only 1 patient . The authors speculate that additional vitamin K to breast-fed infants with liver problem, antibiotic use, diarrhea, etc., should be considered. Am J Physiol Renal Physiol . 2004 Dec 29; {Epub ahead of print} Acute Renal Failure in Zebrafish - A Novel System to Study a Complex Disease; Hentschel DM et al.; Acute renal failure (ARF) is characterized by a very high mortality essentially unchanged over the past 40 years . Simple vertebrate models are needed to improve our understanding of ARF and facilitate the development of novel therapies for this clinical syndrome . Here we demonstrate that gentamicin, a commonly used nephrotoxic antibiotic, causes larval zebrafish to develop ARF characterized by histological and functional changes that mirror aminoglycoside toxicity in higher vertebrates and inability of zebrafish to maintain fluid homeostasis . We developed a novel method to quantitate renal function in larval zebrafish, and demonstrate a decline in glomerular filtration rate after gentamicin exposure . The anti-neoplastic drug cisplatin, whose use in humans is limited by kidney toxicity, also causes typical histological changes and a decline in renal function in larval zebrafish . A specific inhibitor of Omi/HtrA2, a serine protease implicated in cisplatin-induced apoptosis, prevented renal failure and increased survival . This protective effect was confirmed in a mouse model of cisplatin-induced nephrotoxicity . Therefore zebrafish provides a unique model system, amenable to genetic manipulation and drug screening, to explore the pathophysiology of ARF and establish novel therapies with potential use in mammals. J R Army Med Corps, 2004 Sep, 150(3), 182 - 6 Hospitalisation due to Lyme disease: case series in British Forces Germany; Baker BC et al.; Lyme disease is a tick-transmitted infection with disabling sequelae and important occupational health implications for a military workforce . It is likely that some military patients with typical clinical signs remain undiagnosed and untreated . Prompt treatment with an antibiotic is essential, besides targeted education on preventing infection through avoiding exposure to tick bites . We describe four British Forces Germany personnel (two serving military personnel, one adult civilian, one child) who during 2002--2003 required hospital inpatient treatment for Lyme disease . The epidemiology, pathogenesis, clinical features, diagnosis and treatment of the disease are discussed. Electrophoresis, 2005 Jan, 26(1), 196 - 201 Direct determination of gentamicin components by capillary electrophoresis with potential gradient detection; Yuan L et al.; A simple and fast method was developed to determine non-UV active compounds directly without derivatization . The usefulness of the method was demonstrated by detecting the major components in aminoglycoside antibiotic mixtures using capillary zone electrophoresis with potential gradient detection . Under optimized separation conditions (0.2 mM cetyltrimethylammonium bromide (CTAB), 1 mM ammonium citrate, pH 3.5), gentamicin was separated into three major peaks (C1, C1a, and C2+C2a) within 15 min . This method showed better sensitivity than other capillary electrophoresis (CE) methods for determining underivatized gentamicin . The linear range was from 10 to 500 ppm . Because of its good repeatability and simplicity, this new method could be a good alternative for the current assays given by US Pharmacopoeia and European Pharmacopoeia. Indian Pediatr, 2004 Dec, 41(12), 1205 - 10 Prevalence and Risk Factors of Asthma and Wheeze in School-going children in Lucknow, North India; Awasthi S et al.; OBJECTIVE: To assess the prevalence of asthma and wheeze and factors associated with it in children aged 6-7 and 13-14 years . METHOD: School based, prospective survey using self/parental reporting of occurence of asthma or wheeze on pre-designed questionnaire . RESULTS: Out of 112 schools, 17 and 15 schools were randomly selected for recruitment of subjects in age group 6-7 and 13-14 years, respectively . Prevalence of asthma and wheeze reported were 2.3 PERCNT and 6.2 PERCNT, respectively, in age group 6-7 years and 3.3 PERCNT and 7.8 PERCNT, respectively, in age group 13-14 years . On the basis of adjusted odds ratio, risk factors for wheeze or asthma were tertiary education of mother, antibiotic use in the first year of life, eating pasta or fast-food or meat once or more per week and exercise once or more/week while the protective factors were intake of vegetables once or more and fruits thrice or more per week . In univariate analysis, breastfeeding was also found to be protective . CONCLUSION: Promotion of rational use of antibiotic in first year of life, avoidance of fast food and promotion of breastfeeding and intake of fruits and vegetables may reduce the risk of asthma/wheeze and should be encouraged. J Vasc Surg, 2004 Dec, 40(6), 1234 - 7 Combined endovascular stent grafting and endoscopic injection of fibrin sealant for aortoenteric fistula complicating esophagectomy; Mok VW et al.; A 67-year-old man with previous total gastrectomy and roux-en-Y esophagojejunostomy had hematemesis 4 weeks after esophagectomy performed because of carcinoma of the esophagus . Investigation showed an aortojejunal fistula with a thoracic aortic pseudoaneurysm . Endovascular stent grafting of the pseudoaneurysm, followed by endoscopic injection of fibrin sealant for the fistula, was performed, and the infection was controlled with broad-spectrum antibiotic agents together with drainage and daily irrigation of the pseudoaneurysm sac . The fistula subsequently healed . The patient remained well 14 months after the procedure; follow-up computed tomograms at 12 months did not show any pseudoaneurysm, and there was no evidence of reopening of the fistula. Plast Reconstr Surg, 2005 Jan, 115(1), 142 - 7 The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity; Hong JP et al.; From April of 2000 to May of 2003, 28 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (six cases were combined with vastus lateralis muscle flaps) . All wounds were open for a minimum period of 6 weeks (average, 24.7 months; range, 6 weeks to 52 months) . The average patient age was 42.8 years (range, 18 to 71 years), there were 21 male and seven female patients, and the average follow-up period was 18.2 months (range, 5 to 41 months) . The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in eight cases, and diabetic foot in 10 cases . The surface defects ranged from 50 to 153 cm . The wounds were debrided an average of 2.5 times and then reconstructed with flap and treated with antibiotics for 6 weeks . Antibiotic beads were used in six cases and secondary bone graft procedures were performed in seven cases 3 months after the flap coverage . All 28 flaps were successful without any signs of recurrences or persistent osteomyelitis, but partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes . These wounds healed spontaneously . All patients achieved acceptable gait function after rehabilitation . No debulking procedure was necessary in any case . Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, provided that total debridement and obliteration of dead spaces are achieved . A well-vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis. Autoimmunity, 2004 Sep, 37(5), 387 - 92 Molecular Mimicry toBorrelia burgdorferi: Pathway to Autoimmunity? Bolz DD, Weis JJ. Lyme borreliosis is due to infection with the tick-borne spirochete Borrelia burgdorferi, and is associated with persistent infection unless treated with antibiotics . The persistent nature of infection by B . burgdorferi can lead to development of chronic disease, as found in patients infected before recognition of the effectiveness of antibiotic therapy . Much speculation has surrounded the possibility that autoimmune mechanisms are involved in chronic symptoms . In most cases, involvement of autoimmunity in Lyme disease has not received experimental support . The exception is in a small group of patients with chronic arthritis whose abnormal joint symptoms persist after apparent elimination of the bacteria . In this review, the evidence supporting autoimmune mechanisms in Lyme disease will be discussed. Med Mal Infect, 2004 Nov, 34(11), 538 - 45 {Acute exacerbation of chronic bronchitis: patients, antibiotherapy, and guidelines}; Gaillat J et al.; OBJECTIVE: The aim of this study was to compare antibiotic prescriptions made by general practitioners to French recommendations for the management of Acute Exacerbation of Chronic Bronchitis (AECB) referring to the patient's socio-demographic data, history of Chronic Bronchitis (CB), current episode management, and quality of life . METHODS: This cross-sectional study was made on 101 general practitioners . RESULTS: Four hundred eighteen patients were included: mean age: 66 +/- 12 years; male patients 71%; mean history of CB: 13 years; cardiac comorbidity: 45%; depression: 34%; obstructive ventilatory syndrome: 64%; respiratory functional test performed: 44%; FEV1 <35%: 10% . An antibiotic was prescribed in 95% of cases . 94% of treated patients were classified as type 1 or 2, according to Anthonisen's criteria: 85% of these presented with purulent expectoration . The classification used in French recommendations was applied in 364/418 patients, 79 had simple CB, 231 had moderate obstructive CB, 43 had severe obstructive CB . The antibiotic (AB) prescriptions concerned mostly group 2 . Group 2 AB were over-prescribed in 70% of patients suffering from obstructive CB or simple CB . But group 2 AB were under-prescribed in 25% of patients suffering from severe obstructive CB . CONCLUSION: Group 1 AB prescriptions were compliant with Anthonisen's criteria in most cases but the choice of AB did not follow French recommendations, with an over-prescription of group 2 AB and a bad assessment of simple CB. J Ethnopharmacol, 2005 Jan 15, 96(3), 597 - 601 Epub 2004 Nov 30. Interesting biological activities from plants traditionally used by Native Australians; Pennacchio M et al.; Four plants routinely used for medicinal purposes by Native Australians were screened for various biological activities . Methanol extracts of Eremophila maculata, Acacia auriculoformis and Acacia bivenosa exhibited antibiotic effects, while Eremophila alternifolia yielded an extract that induced significant changes to the heart activity of spontaneously hypertensive rats . We report on these biological activities. Am J Surg, 2004 Dec, 188(6), 628 - 32 Could medical intervention work for aortic aneurysms? Baxter BT. BACKGROUND: Aortic aneurysms represent a serious and common condition . Current therapies are based on mechanical treatment . With increased knowledge of the biochemical mechanisms responsible for aneurysm expansion, it may be possible to prevent the growth of small aneurysms . METHODS: A series of experiments performed in the investigator's laboratory during the past decade is outlined to show the evolution of our concepts of the processes underlying aneurysm formation and progression . RESULTS: Our understanding of aortic aneurysms has changed dramatically . Once thought to represent a simple degenerative process, aneurysm tissue is highly active metabolically with ongoing synthesis and degradation of matrix proteins . Several members of a family of matrix-degrading enzymes play an important role in this process . These enzymes can be inhibited by the antibiotic doxycycline . CONCLUSIONS: With a better understanding of aneurysm pathology, it may be possible in the future to inhibit the growth of small aortic aneurysms before they reach a size at which the risk of rupture is significant. Mol Phylogenet Evol, 2005 Feb, 34(2), 371 - 81 Epub 2004 Dec 15. Reconstructing evolutionary relationships from functional data: a consistent classification of organisms based on translation inhibition response; Briones C et al.; The last two decades have witnessed an unsurpassed effort aimed at reconstructing the history of life from the genetic information contained in extant organisms . The availability of many sequenced genomes has allowed the reconstruction of phylogenies from gene families and its comparison with traditional single-gene trees . However, the appearance of major discrepancies between both approaches questions whether horizontal gene transfer (HGT) has played a prominent role in shaping the topology of the Tree of Life . Recent attempts at solving this controversy and reaching a consensus tree combine molecular data with additional phylogenetic markers . Translation is a universal cellular function that involves a meaningful, highly conserved set of genes: both rRNA and r-protein operons have an undisputed phylogenetic value and rarely undergo HGT . Ribosomal function reflects the concerted expression of that genetic network and consequently yields information about the evolutionary paths followed by the organisms . Here we report on tree reconstruction using a measure of the performance of the ribosome: antibiotic sensitivity of protein synthesis . A large database has been used where 33 ribosomal systems belonging to the three major cellular lineages were probed against 38 protein synthesis inhibitors . Different definitions of distance between pairs of organisms have been explored, and the classical algorithm of bootstrap evaluation has been adapted to quantify the reliability of the reconstructions obtained . Our analysis returns a consistent phylogeny, where archaea are systematically affiliated to eukarya, in agreement with recent reconstructions which used information-processing systems . The integration of the information derived from relevant functional markers into current phylogenetic reconstructions might facilitate achieving a consensus Tree of Life. Eur J Gastroenterol Hepatol, 2004 Nov, 16(12), 1309 - 14 Recurrence of Helicobacter pylori infection 1 year after successful treatment: prospective cohort study in the Republic of Yemen; Gunaid AA et al.; OBJECTIVES: To investigate the prevalence of Helicobacter pylori infection in dyspeptic patients in the Republic of Yemen and the recurrence rate 1 year after apparently successful eradication . METHODS: A total of 275 patients with chronic dyspepsia seen in one clinic were enrolled . Gastric biopsies were obtained at endoscopy and H . pylori infection was diagnosed using the rapid urease test . Patients with H . pylori infection were given either clarithromycin or metronidazole-based triple therapy . Six weeks later H . pylori status was assessed using the C-urea breath test (C-UBT) . Those who were negative for H . pylori had a further C-UBT after 1 year to establish the recurrence rate . RESULTS: The prevalence of H . pylori infection at entry to the study was 82.2% {95% confidence interval (CI) 78-87%} . The overall eradication rate 6 weeks after treatment was 49.1% (95% CI 42.6-55.6%) by intention-to-treat analysis, and 60% (95% CI 53-67%) by per-protocol analysis . Recurrence rate of H . pylori infection at 1 year was 34% (95% CI 14-45%) and the only predictor of recurrence was an excess delta C-UBT value less than 3.5 per million but equal to or greater than 2.5 per million at 6 weeks after treatment (odds ratio 2.28; 95% CI 1.17-4.44; P = 0.028) . CONCLUSION: The prevalence of H . pylori infection in dyspeptic patients in Yemen is very high, the eradication rate with standard triple therapy was unsatisfactory probably because of widespread bacterial resistance due to unrestricted antibiotic use . The recurrence rate of infection at 1 year was high, as a result of recrudescence of incompletely eradicated organisms rather than reinfection. Drug News Perspect, 1998 Nov, 11(9), 523 - 79 Glutamate in CNS disorders as a target for drug development: an update; Parsons CG et al.; The authors provide an extensive review of new data related to the role of glutamate in CNS disorders, describing new aspects in glutamate and glutamatergic receptors-NMDA receptors, NR2B-selective antagonists, non-NMDA ionotropic glutamate receptors, N-acetylaspartylglutamate, and glutamate and glycine transporters . New findings in animal models and in human diseases-stroke, traumatic brain injury, Alzheimer's, Parkinson's and Huntington's diseases, tardive dyskinesia, ALS, olivopontcerebellar degeneration, AIDS, allergic encephalomyelitis, epilepsy, anxiety, depression, schizophrenia, liver disease, aminoglycoside antibiotic-induced hearing loss, hemiplegia, chronic pain and drug tolerance and abuse-are presented . Finally, the authors cite the progress achieved in the development of agents that interact with the glutamatergic system: NMDA channel blockers, competitive NMDA receptor antagonists, NR2B-selective antagonists, glutamate release inhibitors, glycineB antagonists, AMPA and kainate receptor antagonists, AMPA receptor-positive modulators and agents that act by modifying endogenous kynurenic acid metabolism . (c) 1998 Prous Science . All rights reserved. Minn Med, 2004 Nov, 87(11), 42 - 4 Advanced medical care for soldiers injured in Iraq and Afghanistan; Polly DW Jr et al.; War inevitably advances medical knowledge, particularly in the area of orthopedic surgery . This article presents an overview of the types of injuries emerging from the current conflicts in Iraq and Afghanistan, the majority of which are extremity injuries, and the care soldiers are receiving on the battlefield, while being evacuated, and at Walter Reed Army Medical Center . It highlights the Army's use of new therapeutic approaches such as use of methyl methacrylate antibiotic beads, vacuum-assisted closure devices, and new prosthetic technologies. J Math Biol . 2004 Dec 20; {Epub ahead of print} Modeling the impact of periodic bottlenecks, unidirectional mutation, and observational error in experimental evolution; Joyce P et al.; Antibiotic resistant bacteria are a constant threat in the battle against infectious diseases . One strategy for reducing their effect is to temporarily discontinue the use of certain antibiotics in the hope that in the absence of the antibiotic the resistant strains will be replaced by the sensitive strains . An experiment where this strategy is employed in vitro {5} produces data which showed a slow accumulation of sensitive mutants . Here we propose a mathematical model and statistical analysis to explain this data.The stochastic model elucidates the trend and error structure of the data . It provides a guide for developing future sampling strategies, and provides a framework for long term predictions of the effects of discontinuing specific antibiotics on the dynamics of resistant bacterial populations. Rev Gastroenterol Peru, 2004 Oct-Dec, 24(4), 314 - 22 {Percutaneous endoscopic gastrostomy: prospective experience at a national private center}; Yriberry Urena S et al.; Percutaneous endoscopic gastrostomy tube feeding is a safe and effective method of providing long-term enteral nutrition in patients who are unable to swallow and offers important advantages over nasogastric tub feeding . The indications of this procedure have been received and over 7 years of practice on 103 patients and 128 procedures have been experienced with Ponsky pull techniques . All patients were given vitamin K and a prophylactic antibiotic (chephalotine) prior to testing . 1.56% of major deadly complications have been reports both for reflux and aspiration at 48 and 72 hours post treatment . The most common minor complication was wound infection in 8.9% of patients . There was no further mortality during testing or while undergoing treatment in the following 30 days . All patients were suffering from post heart attack dementia and stroke (CVA) at a rate of 23.3% and 21.4%, respectively . Percutaneous endoscopic gastrostomy has become the method of choice to sustain long-term enteral nutrition. Med Mal Infect, 2004 Jun, 34(6), 246 - 56 {Treatment and prophylaxis of opportunistic infections in the course of HIV disease: a state of the art in 2004 . Part 2: Viral, fungal and bacterial infections}; Lacombe K et al.; Remarkable progress has been made in antiretroviral therapeutics, as well as in the prophylaxis and treatment of opportunistic infections, since the beginning of the AIDS epidemic . The patient's life expectancy and quality of life have consequently improved, thanks to better management of opportunistic diseases . The introduction of protease inhibitors-containing regimen (i.e . highly active antiretroviral therapy or HAART), since 1996, has drastically reduced the incidence of opportunistic infections by restoring immunity . The large panel of antiretroviral drugs responsible for frequent sustained viral and immune responses has thus allowed a new definition of guidelines for the prophylaxis and treatment of opportunistic infections . A better use of prophylactic drugs should help to reduce the risk of drug-related toxicity and pharmaceutical interactions . It should also decrease the cost of HIV management and eventually increase compliance to treatment and quality of life. Can Respir J, 2004 Nov-Dec, 11(8), 559 - 64 Rates and patterns of chronic obstructive pulmonary disease exacerbations; de Melo MN et al.; BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are believed to be a common occurrence in patients with COPD and are known to be associated with considerable morbidity . OBJECTIVE: To describe the frequency of treated COPD exacerbations in a large population-based cohort . SUBJECTS AND METHODS: A cohort of newly treated patients with COPD was formed from the administrative databases of Saskatchewan Health . The outcome was the occurrence of all moderate or severe exacerbations from 1990 to 1999 . Exacerbations were defined in three ways: dispensing of a prescription for a systemic antibiotic; dispensing of both a prescription for an antibiotic and a prescription for an oral corticosteroid on the same day; and requiring a hospitalization with a primary discharge diagnosis of COPD . RESULTS: There were 5645 patients who entered the COPD cohort between 1990 and 1997, of whom 4453 experienced at least one exacerbation requiring treatment during follow-up . The overall rate of acute exacerbations was 1.12/person-year . It was constant across all age groups, and was similar in both men and women (1.13/person-year versus 1.11/person-year, respectively) . The rate of exacerbations was highest in the first trimester of therapy for the disease (1.39/person-year) and stabilized thereafter at 1.04 exacerbations/person-year . CONCLUSIONS: The results indicate that in a population-based cohort of patients with COPD, the average rate of exacerbations was 1.12/person-year . Men and women had similar rates of exacerbations. RNA, 2005 Jan, 11(1), 1 - 6 Binding of manganese(II) to a tertiary stabilized hammerhead ribozyme as studied by electron paramagnetic resonance spectroscopy; Kisseleva N et al.; Electron paramagnetic resonance (EPR) spectroscopy is used to study the binding of MnII ions to a tertiary stabilized hammer-head ribozyme (tsHHRz) and to compare it with the binding to the minimal hammerhead ribozyme (mHHRz) . Continuous wave EPR measurements show that the tsHHRz possesses a single high-affinity MnII binding site with a KD of < or =10 nM at an NaCl concentration of 0.1 M . This dissociation constant is at least two orders of magnitude smaller than the KD determined previously for the single high-affinity MnII site in the mHHRz . In addition, whereas the high-affinity MnII is displaced from the mHHRz upon binding of the aminoglycoside antibiotic neomycin B, it is not from the tsHHRz . Despite these pronounced differences in binding, a comparison between the electron spin echo envelope modulation and hyperfine sublevel correlation spectra of the minimal and tertiary stabilized HHRz demonstrates that the structure of both binding sites is very similar . This suggests that the MnII is located in both ribozymes between the bases A9 and G10.1 of the sheared G . A tandem base pair, as shown previously and in detail for the mHHRz . Thus, the much stronger MnII binding in the tsHHRz is attributed to the interaction between the two external loops, which locks in the RNA fold, trapping the MnII in the tightly bound conformation, whereas the absence of long-range loop-loop interactions in the mHHRz leads to more dynamical and open conformations, decreasing MnII binding. Vet Res, 2005 January-February, 36(1), 101 - 116 High milk neutrophil chemiluminescence limits the severity of bovine coliform mastitis; Mehrzad J et al.; Polymorphonuclear neutrophil (PMN) function changes during mastitis . To investigate the contribution of milk PMN to the severity of Escherichia coli (E . coli) mastitis, chemiluminescence (CL) of blood and milk PMN and their efficiency to destroy coliform bacteria in the mammary gland were examined following the induction of E . coli mastitis in early lactating cows . To better assess and define the degree of mastitis severity, cows were classified as moderate and severe responders according to milk production loss in the non-infected quarters at post-infection hour (PIH) 48 . There was an inverse relationship between pre-infection milk PMN CL and colony-forming units at PIH 6 . In moderate cows, the pre-infection blood and milk PMN CL was ~ 2-fold higher than that of severe cows . The probability of severe response increased with decreasing pre-infection PMN CL . At the beginning of the infection blood and milk PMN CL was consistently higher, and milk PMN CL increased faster after infection in moderate cows . At PIH > 48 milk PMN CL in severe cows exceeded that of moderate cows . The somatic cell count (SCC) in moderate cows increased faster than colony-forming units, whereas in severe cows the results were reversed . The kinetics of CL activity for blood and milk PMN before and during the early phase of infection confirmed an impairment in PMN CL activity for severe responding cows . High pre-infection blood and milk PMN CL and the immediate increase of milk PMN CL and SCC after infection limited bacterial growth thereby facilitating the recovery of E . coli mastitis in moderate cows . Our study strengthens the idea that pre-existing milk PMN (a static part of the udder's immune defense) functions as a "cellular antibiotic" before and during infection, and low milk PMN CL is a risk factor for bovine coliform mastitis. Int Braz J Urol, 2004 Sep-Oct, 30(5), 403 - 5 Vesical metastasis of gastric adenocarcinoma; Antunes AA et al.; Metastatic vesical tumors are rare, and constitute approximately 1% of all neoplasias affecting this organ . The authors report the case of a 63-year old woman with vesical metastasis of gastric adenocarcinoma . Patient presented signs of cachexia and complained of left lumbar pain and dysuria unresponsive to antibiotic therapy for approximately 5 months . She reported a previous partial gastrectomy due to ulcerative undifferentiated gastric adenocarcinoma 1 year and 9 months before . Cystoscopy revealed an extensive vegetative lesion in bladder, occupying its entire mucosal surface . The biopsy revealed metastatic signet-ring cell adenocarcinoma. J Neurol Sci, 2005 Jan 15, 228(1), 41 - 8 Epub 2004 Nov 05. Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries; Akpede GO et al.; There is a paucity of data on the referral of children with meningitis in developing countries, and on the relationship of presentation and outcome to previous care . Referral and previous care were investigated in 281 post-neonatal children treated in two tertiary centres . Data were obtained through the review of referral notes from orthodox health facilities, interview of parents/guardians and review of admission notes . Forty-four (16%) children were facility-referred and 81 (29%) self-referred from orthodox facilities while 156 (55%) were self-referred without previous care in these facilities . The facility-referrals (n=44) included 19 (43%) with meningitis on treatment, 13 (30%) with suspected meningitis and 12 (27%) with unsuspected meningitis . Twenty-two (50%) were referred because of deterioration, partial response or non-response to treatment, 5 (11%) on request by the parents, 9 (21%) on the suspicion of meningitis or other neurological disorder and 7 (16%) for mixed reasons . No reason was given in 1 case of meningitis on treatment . Among the 19 children referred with meningitis on treatment, only 1 was referred within 24 h of diagnosis, a confirmatory lumbar puncture was done only in 7, and only 10 of 18 (no data in 1 case) were on reasonably appropriate antibiotic regimens . Previous care in orthodox facilities was significantly associated with delayed presentation (>3 days of illness, p<0.001), partial treatment (p<0.001), lack of typical signs (p<0.05), severe illness (p<0.01), and adverse outcome (death or recovery with neurological sequelae, p<0.05) . Limited recognition of the possibility of meningitis in acutely ill children and an inadequate referral practice may account for these effects . A clear delineation of referral needs might reduce the magnitude of these problems. No Shinkei Geka, 2004 Dec, 32(12), 1263 - 8 {Four cases of the infectious cerebral aneurysms}; Oshita J et al.; The authors evaluated various clinical courses of ruptured infectious cerebral aneurysms associated with infective endocarditis in 4 patients . The first case: A 60-year-old male, who had a large hematoma resulting from rupture of a distal anterior cerebral artery aneurysm at the left frontal lobe co-existing with cerebral infarction at the right temporo-occipital lobe, with complications of renal and liver embolisms and pyogenic spondylitis, was treated with antibiotic therapy . However, he died of rupture of another newly formed aneurysm 29 days after onset . The second case: A 71-year-old female presented cerebral infarction in the right occipital lobe at onset . Two days later, abrupt occurrence of a large hematoma at the left parietal lobe led to deterioration of her consciousness . She underwent emergent evacuation of a large hematoma containing the infectious cerebral aneurysm proven histologically afterwards . The third patient: A 49-year-old female was suffered from a large hematoma and subdural hematoma accompanied distal posterior cerebral artery aneurysm at the right occipital lobe . She was operated by removal of the hematoma and the aneurysm proven as a bacterial infectious aneurysm . The fourth patient: A 71-year-old female had hemiplegia caused by a brain abscess and cerebral hemorrhage in the right temporal lobe and a distal middle cerebral artery aneurysm adjacent to the same region . Trapping of the aneurysm was undertaken and clinical course was uneventful . Attention needs to be paid to the various cerebrovascular condition arising from the bacterial embolus of infective endocarditis. Ann Ital Chir, 2004 May-Jun, 75(3), 353 - 6 {Bleeding gastric lymphoma: report of two cases}; Benfatto G et al.; We report two cases of bleeding gastric lymphoma . The stomach is the most common site of primary extranodal Non-Hodgkins Lymphomas . The best treatment for primary gastric lymphoma has not yet been defined . For many years the treatment of choice has been the gastric resection . Helicobacter pylori (H . pylori) has been associated with many gastric pathologies, including gastric lymphoma . Eradication of H . pylori is now considered essential for the treatment of this pathology, and usually consists of antibiotic therapy, combined with acid suppression by a proton pump inhibitor . This simple treatment in patients with low grade histology and tumor confined to the stomach can often obviate the need for surgical intervention . Surgery is a necessary treatment, independently of the grading and the staging of lymphoma, in the bleeding complication as the cases we showed. Cornea, 2005 Jan, 24(1), 66 - 71 Comparison of corneal surface effects of gatifloxacin and moxifloxacin using intensive and prolonged dosing protocols; Herrygers LA et al.; PURPOSE: To compare the effects of the commercial formulations of moxifloxacin and gatifloxacin on rabbit corneal epithelium using two dosing protocols: high-frequency dosing for bacterial keratitis and cataract surgery prophylaxis . METHODS: Forty eyes of 20 New Zealand white rabbits were randomized to receive topical gatifloxacin, topical moxifloxacin, or no drops as controls . Eighteen eyes received 1 drop of antibiotic every 5 minutes for 15 minutes followed by 1 drop every 15 minutes for 4 hours . Twelve eyes received topical gatifloxacin or topical moxifloxacin 4 times a day for 10 days . Rabbits were euthanized, eyes enucleated, and the corneas separated, washed, and fixed; scanning electron microscopy was performed . Photomicrographs of three separate areas from the corneal apex were taken at x1200 and x3000 for each cornea . Two masked, experienced examiners then graded the corneal epithelial damage . RESULTS: In the high-frequency dosing group, mean corneal damage score for eyes treated with gatifloxacin was 1.593, that for moxifloxacin was 1.407, and control was 1.000 . No statistically significant difference was found between gatifloxacin and moxifloxacin (P = 0.41), gatifloxacin and control (P = 0.14), or moxifloxacin and control (P = 0.23) . In the cataract surgery prophylaxis group, mean corneal damage scores for eyes treated with gatifloxacin was 1.167, that for moxifloxacin was 1.368, and control was 1.000 . No statistically significant difference was found between gatifloxacin and moxifloxacin (P = 0.23), gatifloxacin and control (P = 0.08), or moxifloxacin and control (P = 0.23) . CONCLUSION: Despite differences in formulations, with short-term dosing neither gatifloxacin nor moxifloxacin appears to be toxic to the corneal epithelium in this rabbit model. Plant Mol Biol, 2004 Sep, 56(2), 203 - 16 Stable transformation of the cotton plastid genome and maternal inheritance of transgenes; Kumar S et al.; Chloroplast genetic engineering overcomes concerns of gene containment, low levels of transgene expression, gene silencing, positional and pleiotropic effects or presence of vector sequences in transformed genomes . Several therapeutic proteins and agronomic traits have been highly expressed via the tobacco chloroplast genome but extending this concept to important crops has been a major challenge; lack of 100 homologous species-specific chloroplast transformation vectors containing suitable selectable markers, ability to regulate transgene expression in developing plastids and inadequate tissue culture systems via somatic embryogenesis are major challenges . We employed a 'Double Gene/Single Selection (DGSS)' plastid transformation vector that harbors two selectable marker genes (aph A-6 and npt II) to detoxify the same antibiotic by two enzymes, irrespective of the type of tissues or plastids; by combining this with an efficient regeneration system via somatic embryogenesis, cotton plastid transformation was achieved for the first time . The DGSS transformation vector is at least 8-fold (1 event/2.4 bombarded plates) more efficient than 'Single Gene/Single Selection (SGSS)' vector (aph A-6; 1 event per 20 bombarded plates) . Chloroplast transgenic lines were fertile, flowered and set seeds similar to untransformed plants . Transgenes stably integrated into the cotton chloroplast genome were maternally inherited and were not transmitted via pollen when out-crossed with untransformed female plants . Cotton is one of the most important genetically modified crops (120 billion US dollars US annual economy) . Successful transformation of the chloroplast genome should address concerns about transgene escape, insects developing resistance, inadequate insect control and promote public acceptance of genetically modified cotton. Ann N Y Acad Sci, 2004 Nov, 1026, 118 - 24 Comparative study of three surgical treatments for two forms of the clinical presentation of bovine pododermatitis; Silva LA et al.; In this study, 1013 animals showing signs of clinical pododermatitis were examined and divided into five unevenly numbered groups . Affected animals in Groups I and II showed only signs of vegetative interdigital pododermatitis . The lesions were surgically removed and either protected with bandages (in Group I) or cauterized with incandescent iron (Group II) . The animals in Groups III, IV, and V, showed signs of necrotic pododermatitis . These were treated with different protocols after the necrotic tissue was surgically removed: in Group III, the lesion was cauterized; in Group IV, the wound was protected with bandages; and in Group V, both the second and the third phalanges were amputated . There was a statistically significant relapse difference between Group III and Group V, as well as a difference among Group IV and Group V animals, and there were fewer relapses among the latter . The treatment used in Groups II and III proved to be efficient and inexpensive . Amputation of the phalanges was the treatment that resulted in fewer relapses among all protocols, despite its mutilating effect . The association of a local and parenteral treatment with an antibiotic agent, as well as the use of foot baths, contributed greatly to a fast recovery. East Mediterr Health J, 2002 Jul-Sep, 8(4-5), 550 - 5 General practitioner prescribing patterns in Babol city, Islamic Republic of Iran; Moghadamnia AA et al.; To determine patterns of prescribing in Iranian primary care, we analysed 4000 randomly selected prescriptions from 52 general practitioners (GPs) in Babol city during 1999-2000 . The mean number of drugs prescribed per encounter was 4.4 +/- 1.7, with 98% prescribed by generic name . The most commonly prescribed items were non-steroidal anti-inflammatory drugs (62.9% of encounters) and antibiotics (61.9%), followed by central nervous system drugs, gastrointestinal tract drugs, corticosteroids, vitamins and cardiovascular system drugs respectively . Injections were prescribed in 58.0% of encounters . Female and male doctors had significantly different antibiotic prescribing patterns . Our study confirms the tendency of GPs to overprescribe. Org Biomol Chem, 2005 Jan 7, 3(1), 39 - 47 Epub 2004 Nov 15. Conformational analysis of oleandomycin and its 8-methylene-9-oxime derivative by NMR and molecular modelling; Novak P et al.; Conformations of the 14-membered macrolide antibiotic oleandomycin and its 8-methylene-9-oxime derivative were determined in various solvents . The experimental NMR data-coupling constants and NOE contacts-were compared with the results of molecular modelling-molecular mechanics calculations and molecular dynamics simulations . The conformational changes, on the right-hand side of the 14-membered ring, affected mostly the (3)J(H2,H3) values and NOE crosspeaks H3 or H4 to H11 . Oleandomycin was found to be present predominantly in the C3-C5 folded-in conformations in DMSO-d(6) solution, whereas in buffered D(2)O, acetone-d(6) and CDCl(3), there was a mixture of folded-in and folded-out conformational families . The predominant conformation of the 8-methylene-oleandomycin-9-oxime derivative in solution was a folded-out one although different amounts of folded-in conformation were also present depending on the solvent . Oleandrose and desosamine sugar moieties adopted the usual and expected chair conformation . The conformation around the glycosidic bonds, governing the relative orientation of sugars vs . the lactone ring, showed a certain flexibility within two conformationally close families . We believe that by combining the experimental NMR data and the molecular modelling techniques, as reported in this paper, we have made significant progress in understanding the conformational behaviour and properties of macrolides . Our belief is based on our own current studies on oleandomycins as well as on the previously reported results and best practices concerning other macrolides . A rational for macrolide conformational studies and advances in methodology has been suggested accordingly. Vestn Otorinolaringol, 2004, (5), 17 - 20 {Effects of extrastimulation on morphofunctional state of cochlear stria vascularis} {Postradiation dental extractions} Chaux-Bodard AG, Gourmet R, Montbarbon X, Bodard S, Breton P. Centre Leon Berard, 28, rue Laennec, 69373 Lyon 08 . anneetsteph.bod@freesbee.fr INTRODUCTION: Healing may fail after postradiation dental extractions, with a risk of followed osteoradionecrosis, and its dramatic prognosis . We propose a protocol for postradiation extractions . MATERIAL AND METHODS: From January 2000 to December 2001, 107 patients underwent 287 dental extractions after radiation therapy: 80.5% in mandibular jaw, average radiation dose 61.6 Gy, average time between radiation and extraction 6 years . Extractions were performed under general anesthesia, diazanalgesia or local anesthesia, and extraction wounds were sutured after insertion of a collagenic sealant impregnated with gentamicin . General antibiotic prophylaxy was given . RESULTS: Healing failed in only two cases . The first case involved early-stage osteoradionecrosis and the second a tumoral localization . The rate of post-extraction osteoradionecrosis was thus 0.35% . DISCUSSION: A strict protocol associating non-traumatic surgery and an alveolar sealant can considerably decrease the risk of osteoradionecrosis after dental extraction in radiated bone. Int J STD AIDS, 2004 Dec, 15(12), 815 - 21 Chlamydial infection in women along the US-Mexico border; Baldwin SB et al.; Few studies have reported on sexually transmitted infections at the US-Mexico border, so the prevalence of Chlamydia trachomatis in this population remains uncertain . This binational project investigated the prevalence of, and risk factors for, C . trachomatis among women along the Arizona, US-Sonora, Mexico border . Women who self-referred for routine gynaecological care were invited to complete an interviewer-administered questionnaire and to undergo a Pap smear, C . trachomatis test, and HPV test . In 2270 women, C . trachomatis prevalence overall was 8.2% as measured by hybrid capture and 2.6% by enzyme immunoassay . Infection was associated with young age, a history of new sexual partner(s) in the previous three months, HPV infection, and proximity of clinic to the international border . Antibiotic use in the previous 30 days was associated with decreased odds of infection . Women in Arizona-Sonora border communities are at increased risk for C . trachomatis infection compared to women attending clinics in non-border locations. Phys Rev E Stat Nonlin Soft Matter Phys . 2004 Oct;70(4 Pt 1):041912 . Epub 2004 Oct 29. Interaction of a polar molecule with an ion channel; Levadny V et al.; The binding of a polar macromolecule to a large ion channel is studied theoretically, paying special attention to the influence of external conditions (applied voltage and ion strength of solution) . The molecule behavior in bound state is considered as random thermal fluctuations within a limited fraction of its phase space . The mean duration of molecule binding (residence time tau r) is represented as the mean first passage time to reach the boundary of that restricted domain . By invoking the adiabatic approximation we reduce the problem to one dimension with the angle between macromolecule dipole and channel axes being the key variable of the problem . The model accounts for experimental measurements of tau r for the antibiotic Ampicillin within the bacterial porin OmpF of Escherichia coli . By assuming that the electrical interaction between Ampicillin dipole and OmpF ionizable groups affects the fluctuations, we find that the biased residence time-voltage dependence observed in experiments is the result of the strong transversal electric field in OmpF constriction with a tilt approximately 30 degrees aside the cis side. Herz, 2004 Dec, 29(8), 802 - 805 Effectiveness of Intrapericardial Administration of Streptokinase in Purulent Pericarditis; Zbyszek Tomkowski W et al.; BACKGROUND AND PURPOSE: : Purulent pericarditis is very rare . However, among patients suffering from this disease the mortality rate is very high . The aim of this study was to evaluate the effectiveness and side effects of intrapericardial streptokinase administration in patients with confirmed purulent pericarditis . PATIENTS AND METHODS: : Three patients, one 50-year-old man and two women aged 64 and 40 years, who were admitted to the intensive care unit (ICU) due to purulent pericarditis, entered the study . In all three cases a subxiphoid pericardiotomy followed by insertion of a drainage line into the pericardial space was performed . Antibiotic therapy was started immediately on admission to the hospital . Despite continued antibiotic therapy in all three patients, daily drainage from the pericardium-during several days after surgery-staggered between 50-200 ml/day . Due to considerable purulent pericardial drainage loculations and/or fibrin deposits confirmed by echocardiography, streptokinase (500,000 IU dissolved in 50 ml of normal saline) was administered into the pericardial space over 10 min, using the previously inserted drainage catheter . This regimen was repeated after 12 and 24 h . The total dose of streptokinase was 1,500,000 IU . RESULTS: : The clinical effect of intrapericardial streptokinase administration was excellent . Several days after intrapericardial administration of streptokinase, drainage of purulent pericardial fluid stopped . No complications associated with intrapericardial streptokinase administration were observed . In the follow-up echocardiography (in two patients repeated 6 and 9 months after delivery of streptokinase), pericardial fluid and echocardiographic signs of pericardial constriction were not observed . CONCLUSION: : Intrapericardial administration of streptokinase in purulent pericarditis is effective and safe. Mund Kiefer Gesichtschir . 2004 Dec 14; {Epub ahead of print} {Incorporation of multiple foreign bodies due to borderline personality disorder Literaturubersicht und Fallbeschreibung.}; Hermes D et al.; BACKGROUND: Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder . Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies . In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations . Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature.CASE REPORT: A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region . After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies . Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms . A total of 76 metallic foreign bodies was removed surgically . During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies.DISCUSSION: The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder . Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists . Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration. J Clin Gastroenterol, 2005 Jan, 39(1), 64 - 7 Hepatitis in a United States tertiary referral center; Galan MV et al.; BACKGROUND/GOALS: There are limited data regarding the frequency and proportionality of drug-induced hepatotoxicity in the United States . We sought to determine the scope of nonfulminant drug-induced hepatitis as seen in a community-based hepatology referral service . STUDY: From a population of 4,039 outpatients referred for evaluation of acute (n = 96) and chronic (n = 3,943) liver disease over a 10-year period, we reviewed the records of those patients diagnosed with acute bona fide drug-induced hepatitis . RESULTS: Thirty-two patients presented with self-limited acute drug-induced hepatitis, representing 0.8% of all hepatology patients and 33% of those patients presenting with acute liver injury . Antibiotics (amoxicillin/clavulanic acid, minocycline, nitrofurantoin, an investigational ketolide antibiotic, trimethoprim-sulfamethoxazole, and trovafloxacin) were the class of drugs most frequently implicated (14 of 32; 44%), while amiodarone was the single agent most commonly associated with liver injury (7 of 32; 22%) . The mean age of affected patients was 52.2 years, and we found a male predominance (18 of 32; 56%) . The mean time to biochemical resolution after discontinuation of the offending agent was 14.1 weeks . CONCLUSIONS: Drug-induced hepatitis is an uncommon entity in clinical hepatology but does represent a significant proportion of acute self-limited liver disease in the United States . Antibiotics and amiodarone were the most common drug culprits in our population . Time to resolution following the discontinuation of the offending agent may be protracted . Prospective studies are needed to further assess the burden of drug-induced liver injury. Zhi Wu Sheng Li Yu Fen Zi Sheng Wu Xue Xue Bao, 2004 Apr, 30(2), 121 - 6 {Excision of selectable marker gene from transgenic plant}; Lu HJ et al.; Currently used plant transformation systems require selectable marker genes encoding antibiotic or herbicide resistance, along with the gene of interest, to select transformed cells from a large population of mostly untransformed cells . The continued presence of these selectable markers, especially in food crop, is of increasing public concern . The generation of selectable marker-free transgenic plant is one of the new projects in plant biotechnology research . Two techniques, segregation excision and recombination excision, for removal of selectable marker genes are described in this article . The advances in producing selectable marker-free transgenic plants are reviewed too. Ann Pharmacother . 2004 Dec 14; {Epub ahead of print} Verapamil Toxicity Resulting from a Probable Interaction with Telithromycin (February); Reed M et al.; OBJECTIVE: To report a case of hypotension and bradyarrhythmia caused by verapamil toxicity in a patient prescribed telithromycin . CASE SUMMARY: A 76-year-old white woman receiving verapamil 180 mg/day for hypertension experienced a sudden onset of shortness of breath and weakness and was found to be profoundly hypotensive and bradycardic, with a systolic blood pressure of 50-60 mm Hg and a heart rate of 30 beats/min . She had been taking telithromycin 800 mg/day for 2 days previously for acute sinusitis . The patient was treated with crystalloids, vasopressors, and transvenous pacing . Approximately 72 hours after admission, her blood pressure and heart rate rapidly returned to normal, and she was discharged several days later . DISCUSSION: Telithromycin is a known substrate of the CYP3A4 system, and several pharmacokinetic interactions can occur by displacement of other drugs from this system . Verapamil is metabolized through several cytochrome P450 isoenzyme systems . Although there are no previous reports of an interaction between these drugs, other possible causes for the patient's symptoms were excluded and the diagnosis of a probable interaction between verapamil and telithromycin leading to verapamil toxicity was made . CONCLUSIONS: Telithromycin is a ketolide antibiotic approved for treatment of respiratory tract infections and acute sinusitis . The potential for clinically significant drug interactions should be considered before using this agent, especially in patients taking other drugs that are metabolized through the CYP3A system . Caution should be exercised when considering the use of this antibiotic in patients receiving verapamil. J Heart Valve Dis, 2004 Nov, 13(6), 997 - 1004 Impact of echocardiography in the short- and long-term prognosis of patients with infective endocarditis and negative blood cultures; Zamorano J et al.; BACKGROUND AND AIM OF THE STUDY: Higher morbidity and mortality have been attributed to patients suffering endocarditis but with negative blood cultures . The study aim was to determine whether, in the present era of routine echocardiography, patients with negative-culture endocarditis had a worse short- and long-term outcome, and whether outcomes in patients with true negative and aborted positive blood cultures were different . METHODS: When endocarditis was clinically suspected, an early (<24 h) echocardiographic examination was performed in all patients, regardless of blood culture results . In total, 151 patients diagnosed with infective endocarditis (IE) comprised the study group . Among these patients, 40 (26%) had negative blood cultures, and 28 of this subgroup (70%) had received previous antibiotic therapy . Short- and long-term features and prognosis were compared between both groups . The combined main end-point was death or need for surgical repair . RESULTS: Similar anatomic and clinical characteristics were present among those patients with positive and negative cultures . In addition, mortality and need for surgery with regard to short- and long-term follow up of both groups was similar . There were no significant differences between patients with true- or aborted-negative cultures in terms of short- and long-term prognosis . CONCLUSION: No differences in short- and long-term prognosis were seen among patients with IE and positive versus negative blood cultures . The prognosis was also similar between those with true negative culture versus aborted negative cultures . Early echocardiography in patients with clinically suspected IE may have changed the outcome in patients with negative cultures. Infection, 2004 Dec, 32(6), 350 - 5 Concentrations of macrophage inflammatory proteins MIP-1alpha and MIP-1beta and interleukin 8 (il-8) in lyme borreliosis; Grygorczuk S et al.; BACKGROUND: Components of the spirochete Borrelia burgdorferi sensu lato ( B . burgdorferi s.l.) do not have chemotactic activity . However, B . burgdorferi s.l . causes a chemotactic response, probably by stimulating synthesis of cytokines of the chemokine family by host cells . Our aim was to confirm that the synthesis of chemokines is increased in Lyme borreliosis and that they may account for leukocyte migration, thus being involved in inflammatory response . MATERIALS AND METHODS: We measured concentrations of chemokines: interleukin 8 (Il-8) and macrophage inflammatory protein 1alpha and 1beta (MIP-1alpha, -1beta) in serum of 20 patients with erythema migrans (early localized infection, group I), of 19 patients with Lyme arthritis (chronic infection, group II), and in serum and cerebrospinal fluid (CSF) of 20 patients with neuroborreliosis (early disseminated infection, group III), before and after 2 weeks of antibiotic therapy (examinations 1 and 2), as well as in the sera of 12 healthy blood donors and CSF of ten patients in whom Lyme borreliosis and meningitis were excluded (control group) . Interleukin 1beta (Il-1beta) level in serum and CSF and pleocytosis of CSF were assessed simultaneously . RESULTS: The mean concentrations of all studied chemokines in serum were significantly elevated in all study groups in examination 1 and decreased in examination 2 . The concentration of Il-8 in serum was higher in group I and the concentration of MIP-1alpha in group III was higher in comparison with group II . Serum concentrations of all chemokines in group I and III correlated with the concentration of Il-1beta, while in group II this correlation appeared only for Il-8 in examination 2 . Concentrations of all chemokines in CSF were significantly increased, but as for MIP-1alpha and 1beta they remained lower than in serum . The concentration of Il-8 in CSF was variable and reached values several fold higher than in the serum in some patients . There was no correlation between chemokine concentrations and CSF pleocytosis . CONCLUSION: The synthesis of chemokines (Il-8, MIP-1alpha and 1beta) is increased in Lyme borreliosis and, at least in the early stages of the disease, is related to the synthesis of Il-1beta . Chemokine concentrations depend on the clinical form of Lyme borreliosis, with a tendency for higher values in early infection (erythema migrans and neuroborreliosis) . Of the chemokines studied, Il-8 created a chemotactic gradient towards the inflammation site, and thus might be responsible for leukocyte migration. Protein Expr Purif, 2005 Jan, 39(1), 8 - 17 Tetracycline-regulated highly inducible expression of the human prion protein in murine 3T3 cells; Stuke AW et al.; To provide an in vitro system that allows inducible or conditional overexpression of human prion protein (PrP), we have established a tetracycline (Tc)-regulated system in murine 3T3 L1 fibroblast cells . A replacement-type gene targeting vector cassette was constructed to express the human fatal familial insomnia (FFI) prion protein gene (PRNP) under control of a Tc-responsive element . Following stable integration of the vector into 3T3 Tet-Off cells, we have isolated and characterised six 3T3 L1 pTet-Off FFI clones