Infect Control Hosp Epidemiol, 2001 Jul, 22(7), 433 - 6 Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea; Yoo S et al.; OBJECTIVE: To determine whether surveillance and infection control interventions decrease the incidence of catheter-related (CR) bloodstream infections (BSIs) in Korea . SETTING: A medical-surgical intensive care unit (ICU) of a university hospital in Korea . DESIGN: The CR infection rate of the intervention period was compared to that of historical controls for a 4-month period . PATIENTS: All patients with a central venous catheter in the intensive care unit (ICU) from October 1998 to January 1999 . METHODS: Active infection control programs were initiated during the intervention period . Data collected included patient characteristics, risk factors of CR infection, and the microbiology laboratory results . Laboratory-proven CR infection rates were compared between the intervention group and control group . RESULTS: 304 catheters were inserted into 248 patients . The intervention group and the control group showed similar characteristics, but more patients in the intervention group received steroid therapy, and subclavian insertion was more common in the intervention group . CR BSI occurred in 1.3 per 1,000 catheter-days in the intervention group and 4.2 in the control group (binomial test, P=.14) . CR infections were associated with the duration of ICU admission by multivariate logistic regression . CONCLUSIONS: The data suggested that an active infection surveillance and control program could reduce the rate of CR Br J Biomed Sci, 2001, 58(3), 154 - 8 Improved detection of Mycobacterium spp . using the Bactec MGIT 960 system; Jayakumar KV et al.; Until 1987, the notification rate for mycobacterial infection was on the decline; however, it now appears to be increasing once more . The reason for this may be multifactoral and include improved reporting of diagnosed cases, increased infection of an ageing population, homelessness, immunosuppression (e.g . due to human immunodeficiency virus infection), and immigration of people from countries where tuberculosis is endemic . This rising incidence and the increasing importance of resistant organisms mean that rapid identification by the clinical microbiology laboratory is required, and this is where an automated detection system can be an advantage . Over a two-year period, 2743 clinical specimen were examined for Mycobacterium spp . using the Bactec MGIT 960, and 286 were positive . Time to detection ranged from three to 14 days (mean: 9.3 days), and M . tuberculosis was recovered from 214 (75.5%) . Contamination rate was higher (8.6%) than with manual methods, however . On balance, the Bactec MGIT 960 system proved a valuable tool in the routine microbiology laboratory. J Clin Microbiol, 2001 Oct, 39(10), 3705 - 8 Rapid differentiation of "Mycobacterium canettii" from other Mycobacterium tuberculosis complex organisms by PCR-restriction analysis of the hsp65 gene; Goh KS et al.; A total of 102 isolates of the Mycobacterium tuberculosis complex, including available "M . canettii" isolates, were studied by PCR-restriction analysis of a 441-bp fragment of the hsp65 gene . PRA upon HhaI enzyme digestion (GCGC) allowed easy differentiation of "M . canettii" from other members of the M . tuberculosis complex (three bands of 260, 105, and 60 bp for "M . canetti," compared to four bands of 185, 105, 75, and 60 bp for other members of the M . tuberculosis complex) . Sequencing of the 441-bp hsp65 fragment of "M . canettii" isolates showed the disappearance of an HhaI site at position 235 due to a C-to-T transition that corresponded to position 631 of the homologous hsp65 gene of M . tuberculosis H37Rv . Considering that "M . canettii" may also exist as a stable rough morphotype, we suggest that the true number of "M . canettii" isolates may be underestimated in clinical microbiology laboratories. J Clin Microbiol, 2001 Oct, 39(10), 3563 - 71 Automated high-throughput genotyping for study of global epidemiology of Mycobacterium tuberculosis based on mycobacterial interspersed repetitive units; Supply P et al.; Large-scale genotyping of Mycobacterium tuberculosis is especially challenging, as the current typing methods are labor-intensive and the results are difficult to compare among laboratories . Here, automated typing based on variable-number tandem repeats (VNTRs) of genetic elements named mycobacterial interspersed repetitive units (MIRUs) in 12 mammalian minisatellite-like loci of M . tuberculosis is presented . This system combines analysis of multiplex PCRs on a fluorescence-based DNA analyzer with computerized automation of the genotyping . Analysis of a blinded reference set of 90 strains from 38 countries (K . Kremer et al., J . Clin . Microbiol . 37:2607-2618, 1999) demonstrated that it is 100% reproducible, sensitive, and specific for M . tuberculosis complex isolates, a performance that has not been achieved by any other typing method tested in the same conditions . MIRU-VNTRs can be used for analysis of the global genetic diversity of M . tuberculosis complex strains at different levels of evolutionary divergence . To fully exploit the portability of this typing system, a website was set up for the analysis of M . tuberculosis MIRU-VNTR genotypes via the Internet . This opens the way for global epidemiological surveillance of tuberculosis and should lead to novel insights into the evolutionary and population genetics of this major pathogen. Am J Surg, 2001 Aug, 182(2), 151 - 4 Sclerosing encapsulating peritonitis after orthotopic liver transplantation; Maguire D et al.; BACKGROUND: The etiology of abdominal cocoon (a rare cause of intestinal obstruction) is unknown . It has occurred in adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients undergoing peritoneal dialysis . We report our experience with patients after orthotopic liver transplantation (OLT) . METHODS: Five patients (4 male, 1 female, aged 16 to 57 years) underwent OLT (3 whole liver, 2 right lobe grafts) and subsequently developed abdominal cocoon . RESULTS: All developed pyrexia by 66 +/- 21 hours posttransplant . Additional symptoms (epigastric discomfort and intermittent vomiting) occurred 12 +/- 10 days later . Bacterial peritonitis was confirmed by microbiology in 2 cases and diagnosed by exclusion in the others . C-reactive protein levels were persistently elevated in all patients (35 to 82 mg/L) . While abdominal CT consistently demonstrated marked ascites with the small intestine confined to a particular area of the abdomen, intestinal contrast studies and ultrasound were not diagnostic . All patients underwent surgical removal of the cocoon membrane by 58 +/- 22 days after transplant . CONCLUSIONS: Sclerosing peritonitis may complicate liver transplantation and occurs because of low-grade intra-abdominal sepsis. Rinsho Byori, 2001 Aug, 49(8), 801 - 3 {Hospital infection control in the 21st century--importance of network for hospital infection control and role of clinical laboratory}; Kusano N; The clinical laboratory is important as a department which provides diagnostic and advisory services to clinicians and support surveillance for hospital infection control . Though the link between clinical laboratory and other departments including infection control team is paramount for infection control, there are the communication delays by the documented reports . The use of the hospital information system can streamline the work of infection control, because laboratory(including microbiology) data can be obtained quickly . In order to implement efficient infection control, it is necessary to construct the information network by utilizing the local area network in the hospital . Since the community-acquired infections due to resistant micro-organisms are increasing in 1990s, we should expand the information network in community and nation-wide in the 21st century. Clin Lab Med, 2001 Sep, 21(3), 549 - 91 Agroterrorism, biological crimes, and biowarfare targeting animal agriculture . The clinical, pathologic, diagnostic, and epidemiologic features of some important animal diseases; Wilson TM et al.; In the past 100 years, to our knowledge there have been approximately 12 events involving the intentional introduction of microbiologic agents into livestock and animal populations worldwide, of which three were World War I events in the United States . To the best of the authors' knowledge, there has been no recent intentional introduction of microbiologic agents (viruses or bacteria) into livestock and animal populations in the United States . The criminal or terrorist use of chemicals against animals and agriculture products have been more common . With the political, economic, and military new world order, however, the United States must maintain a vigilant posture . The framework for this vigilance must be an intelligence system sensitive to the needs of agriculture and a first-class animal disease diagnostic surveillance and response system. Appl Environ Microbiol, 2001 Oct, 67(10), 4880 - 90 Axial differences in community structure of Crenarchaeota and Euryarchaeota in the highly compartmentalized gut of the soil-feeding termite Cubitermes orthognathus; Friedrich MW et al.; Methanogenesis represents an important electron sink reaction in the hindgut of soil-feeding termites . This is the first comprehensive analysis of the archaeal community structure within the highly compartmentalized intestinal tract of a humivorous insect, combining clonal analysis and terminal restriction fragment (T-RF) length polymorphism (T-RFLP) fingerprinting of the archaeal communities in the different gut compartments of Cubitermes orthognathus . We found that the morphological and physicochemical heterogeneity of the gut is reflected in a large phylogenetic diversity and pronounced axial differences in the composition of the archaeal gut microbiota, notably among those clones or ribotypes that could be assigned to methanogenic taxa . Comparative analysis of the relative frequencies of different archaeal lineages among the small-subunit rRNA gene (SSU rDNA) clones and their corresponding T-RF indicated that the archaeal community in the anterior, extremely alkaline hindgut compartment (P1) consists mainly of members of the Methanosarcinaceae, whereas Methanobacteriaceae and Methanomicrobiales predominate in the subsequent, more posterior compartments (P3/4a and P4b) . The relative abundance of Thermoplasmales increased towards the rectum (P5) . SSU rDNA sequences representing Crenarchaeota, which have not yet been reported to occur in the intestinal tracts of arthropods, were detected in all gut sections . We discuss how the spatial distribution of methanogenic populations may be linked to axial heterogeneity in the physicochemical gut conditions and to functional adaptations to their respective ecological niches. Appl Environ Microbiol, 2001 Oct, 67(10), 4495 - 503 Simultaneous recovery of RNA and DNA from soils and sediments; Hurt RA et al.; Recovery of mRNA from environmental samples for measurement of in situ metabolic activities is a significant challenge . A robust, simple, rapid, and effective method was developed for simultaneous recovery of both RNA and DNA from soils of diverse composition by adapting our previous grinding-based cell lysis method (Zhou et al., Appl . Environ . Microbiol . 62:316-322, 1996) for DNA extraction . One of the key differences is that the samples are ground in a denaturing solution at a temperature below 0 degrees C to inactivate nuclease activity . Two different methods were evaluated for separating RNA from DNA . Among the methods examined for RNA purification, anion exchange resin gave the best results in terms of RNA integrity, yield, and purity . With the optimized protocol, intact RNA and high-molecular-weight DNA were simultaneously recovered from 19 soil and stream sediment samples of diverse composition . The RNA yield from these samples ranged from 1.4 to 56 microg g of soil(-1) dry weight), whereas the DNA yield ranged from 23 to 435 microg g(-1) . In addition, studies with the same soil sample showed that the DNA yield was, on average, 40% higher than that in our previous procedure and 68% higher than that in a commercial bead milling method . For the majority of the samples, the DNA and RNA recovered were of sufficient purity for nuclease digestion, microarray hybridization, and PCR or reverse transcription-PCR amplification. Acta Odontol Scand, 2001 Aug, 59(4), 235 - 43 Inflammatory bowel disease: clinics and pathology . Do inflammatory bowel disease and periodontal disease have similar immunopathogeneses? Brandtzaeg P. Inflammatory bowel disease (IBD) comprises two chronic, tissue-destructive, clinical entities Crohn disease (CD) and ulcerative colitis (UC) both apparently caused by immunological overreaction (hypersensitivity) to commensal gut bacteria . Under normal conditions the intestinal immune system shows a down-regulating tone ('oral tolerance') against dietary antigens and the indigenous microbiota . This local homeostasis is disturbed in IBD, leading to hyperactivation of T helper 1 (Th1) cells with abundant secretion of interferon-gamma and tumor necrosis factor (TNF) and production of IgG antibodies against commensal bacteria . In addition, UC includes genetically determined autoimmunity, particularly IgG1-mediated cytotoxic epithelial attack . Breaching of the epithelium is the best-defined event underlying abrogation of oral tolerance, but immune deviation caused by cytokines fiom irritated epithelial cells or subepithelial elements (for example, mast cells, natural killer cells, macrophages) may also be involved . Endogenous infection with local hypersensitivity likewise causes periodontal disease, reflecting 'frustrated' immune elimination mechanisms entertained by antigens from dental plaque . Altogether, perturbation of a tightly controlled cytokine network, with abnormal crosstalk between several cell types, apparently explains the progressive immunopathology of chronic inflammatory mucosal diseases in general . This adverse development will be influenced by numerous immunity genes, the dosage and potential pathogeniciy of commensal bacteria, general health, nutritional status, and psychological factors . Several targets for new therapy have tentatively been identified to block immunopathological mechanisms in IBD, and inhibition of TNF has a striking beneficial effect in CD, supporting a central role of this cytokine. Zh Mikrobiol Epidemiol Immunobiol, 2001 Jul-Aug, (4), 10 - 2 {The first isolation of Borrelia burgdorferi sensu stricto in Russia}; Gorelova NB et al.; 18 Borrelia isolates obtained from adult ticks of the Ixodes ricinus species, collected from different plants in April 2000 in the Khostinsk region of the Krasnodar Territory in the vicinity of the health resort of Matsesta not far from Sochi, were identified by means of PCR and the analysis of polymorphism of the restriction fragments of ribosomal rrf-rrl spacer amplicon . Among them, in addition to Borrelia species, found in Russia earlier (B . garinii, B . afzelii, B . valaisiana and B . lusitaniae), the classical causative agent of Lyme borreliosis (B . burgdorferi sensu stricto) was detected for the first time . The isolated strain (lr-4721) is now kept in the collection of the Borreliosis Center of the Ministry of Health of Russia (the Laboratory of Infections Vectors at the Gamaleya Research Institute of Epidemiology and Microbiology) . The probable role of this infective agent in infectious pathology in Russia is discussed. Unfallchirurg, 2001 Aug, 104(8), 682 - 6 {Diagnosis and stage-related therapy of joint infections}; Stutz G et al.; BACKGROUND: Our management of septic arthritis is a combination of a stage-related arthroscopic irrigation, debridement and antibiotic therapy . At the start of therapy x-rays of the infected joint, leukocyte rate with differentiation and C-reactive protein level are necessary and aspiration of the joint should be performed for gram strain and crystal analysis . Additional imaging and laboratory tests can be needed for special indications . An arthroscopic staging of the initial joint infection has been shown to have prognostic and therapeutic consequences . Antibiotic therapy should start after aspirates and biopsy specimen have been taken intraoperatively and has to be adapted to the final results of the microbiology . Overall, antibiotic therapy is necessary for a period of 4-6 weeks, unless clinical findings and laboratory tests have returned to normal . A transition to oral administration of antibiotics is possible prior to patient release . INTRAOPERATIVE TREATMENT: Intraoperatively, the synovial membrane should be left intact . There is no indication for the intra-articular use of antibiotics and antiseptics . Wound drains are not necessary . If symptoms of infection persist under antibiotic therapy, arthroscopic irrigation can be repeated with good results. Toxicology, 2001 Oct 15, 167(2), 101 - 34 Toxicity, metabolism, and impact of mycotoxins on humans and animals; Hussein HS et al.; The worldwide contamination of foods and feeds with mycotoxins is a significant problem . Mycotoxins are secondary metabolites of molds that have adverse effects on humans, animals, and crops that result in illnesses and economic losses . Aflatoxins, ochratoxins, trichothecenes, zearelenone, fumonisins, tremorgenic toxins, and ergot alkaloids are the mycotoxins of greatest agro-economic importance . Some molds are capable of producing more than one mycotoxin and some mycotoxins are produced by more than one fungal species . Often more than one mycotoxin is found on a contaminated substrate . Factors influencing the presence of mycotoxins in foods or feeds include environmental conditions related to storage that can be controlled . Other extrinsic factors such as climate or intrinsic factors such as fungal strain specificity, strain variation, and instability of toxigenic properties are more difficult to control . Mycotoxins have various acute and chronic effects on humans and animals (especially monogastrics) depending on species and susceptibility of an animal within a species . Ruminants have, however, generally been more resistant to the adverse effects of mycotoxins . This is because the rumen microbiota is capable of degrading mycotoxins . The economic impact of mycotoxins include loss of human and animal life, increased health care and veterinary care costs, reduced livestock production, disposal of contaminated foods and feeds, and investment in research and applications to reduce severity of the mycotoxin problem . Although efforts have continued internationally to set guidelines to control mycotoxins, practical measures have not been adequately implemented. J Microbiol Methods, 2001 Oct, 47(1), 65 - 71 Multicenter evaluation of the novel enzyme immunoassay based on P1-enriched protein for the detection of Mycoplasma pneumoniae infection; Suni J et al.; The aim of the study was to evaluate new Mycoplasma pneumoniae IgG, IgA and IgM EIA methods based on the enrichment of P1-protein (ThermoLabsystems, Helsinki, Finland) (L) for the detection of acute infection . This evaluation was performed in two independent routine clinical microbiology laboratories . The first laboratory used samples preselected by IgG and IgM Platelia enzyme immunoassay (P) and the second used samples preseleced by Serion ELISA Classic M . pneumoniae IgG, IgM (V) . The L method was also compared to the FDA approved method of ImmunoWell M . pneumoniae IgG and IgM (G) . When the agreement of two methods was applied as a serologic criteria for an acute infection, the following ratios of acute to nonacute infection were calculated 32/86 (totally 118) in the first and 20/72 (totally 92) in the second laboratory . In the first laboratory, the corresponding ratios by methods were 35/83 (sensitivity 100%, specificity 96.5%), 31/87 (sensitivity 97%, specificity 100%), and 55/63 (sensitivity 100%, specificity 79%) for the L, P and G methods, respectively . In the second laboratory, the ratios were 21/71 (sensitivity 100%, specificity 99%), 16/76 (sensitivity 83%, specificity 100%), and 53/39 (sensitivity 100, specificity 69%) for the L, V and G methods, respectively . Taking into account that the tested sample material was preselected by the P and V methods, which may have introduced some bias in their favor, the newly developed L method utilizing P1-enriched protein was found reliable for serodiagnosis of acute M . pneumoniae infection . The method G was the least specific in detection of acute infection. Dtsch Med Wochenschr, 2001 Sep 21, 126(38), 1043 - 6 {Epstein-Barr virus-associated pericarditis}; Lentini S et al.; HISTORY AND ADMISSION FINDINGS: A 73 year old woman presented with increasing dyspnoea caused by a large pericardial effusion . INVESTIGATIONS: Transthoracic echocardiography revealed a diastolically 35 mm broad pericardial effusion . Subxiphoidal drainage controlled by ultrasound delivered 350 ml of a haemorrhagic fluid that was submitted to pathology and microbiology examination . This was completed by serological and immunological tests and a specific extensive search for malignant diseases, i . e . computer tomograms of chest and abdomen, mammography, bronchoscopy, gastroscopy and coloscopy . All examinations were negative . However, nested PCR analysis of blood leucocytes and of pericardial effusion revealed the pericardial presence of Epstein-Barr virus (EBV), consistent with a localized pericardial EBV persistence or reactivation . TREATMENT AND COURSE: Follow-up showed a complete resolution of the pericardial effusion without the necessity of further specific treatment . CONCLUSIONS: Although EBV infection is common in the general population, cardiac involvement, in particular in the adult, is infrequent and usually takes an uncomplicated course . The present case report demonstrates a beginning pericardial tamponade due to localized pericardial EBV persistence or reactivation without detectable systemic EBV infection . In addition, the importance of molecular tests for diagnostic accuracy is highlighted. Zh Mikrobiol Epidemiol Immunobiol, 2001 May-Jun, (3), 87 - 9 {Ecovariant differences of Escherichia coli strains with respect to colicinogenicity and colicin resistance}; Gritsenko VA et al.; The analysis of 173 Escherichia coli strains, isolated from different sources, for colicinogenicity and colicin resistance revealed that frequency of these signs increased in the following order: water in open reservoirs, intestine, extraintestinal localizations . In most cases resistance to 5 or more bacterial colicins was due to the absence of the corresponding receptors to colicins . Colicin resistance and colicinogenicity render E . coli selective advantages under the conditions of intestinal microbiocenosis. Dig Dis, 2001, 19(2), 99 - 103 Impact of Helicobacter pylori virulence on the outcome of gastroduodenal diseases: lessons from the microbiologist; Megraud F; Two main pathogenic factors have been described in Helicobacter pylori strains: the cag pathogenicity island (cag PAI) and the vacuolating cytotoxin VacA . The cag PAI is comprised of approximately 40 open reading frames probably originating from another species . It encodes a type IV secretion system, i.e., an apparatus derived from pili which may contribute to the transfer of bacterial molecules to epithelial cells . One of the most well known is the CagA protein which is involved in cell actin rearrangement . Another important property is the induction of interleukin 8, a proinflammatory mediator, which is the consequence of other cag PAI genes . VacA has also been the subject of numerous studies . In vitro, it leads to vacuoles in epithelial cells from the late endosome compartment . However, its main impact could be to induce apoptosis by acting on mitochondria, as was shown in a recent study . The presence of cag PAI as well as VacA has been associated with a higher pathogenic potential of H . pylori strains . Indeed, both are often found simultaneously, but it may well be that the combination of the two, with specific adherence properties, increases even more the pathogenicity of the strains . J Infect, 2001 May, 42(4), 281 - 3 Endophlebitis of the leg caused by brucella infection; Memish ZA et al.; Brucellosis is hyperendemic in Saudi Arabia where, despite rapid urbanisation, a large segment of the population has a nomadic background and clings to cultural traditions such as the drinking of raw milk . We report here an unusual complication of brucellosis in a microbiology technologist . A 41-year-old male presented with an 8-day history of right ankle pain which, over a 3-day period, extended up to his calf where swelling and tightness developed . The leg symptomatology occurred on a background of fever, seats and rigors . X-ray of the limb was normal but a venogram revealed thrombosis of the deep veins of the right calf . Although his blood culture was negative, he developed high brucella antibody titres . Treatment with anticoagulants combined with a course of doxycycline and rifampin produced a full recovery . Acta Astronaut, 1999 Apr-Jun, 44(7-12), 693 - 9 Space analogue studies in Antarctica; Lugg D et al.; Medical research has been carried out on the Australian National Antarctic Research Expeditions (ANARE) for 50 years . As an extension of this program collaborative Australian/United States research on immunology, microbiology, psychology and remote medicine has produced important data and insight on how humans adapt to the stress of extreme isolation, confinement and the harsh environment of Antarctica . An outstanding analogue for the isolation and confinement of space missions (especially planetary outposts), ANARE has been used as an international research platform by Australia and the United States since 1993 . Collaborative research has demonstrated a lowered responsiveness of the immune system under the isolation and confinement of Antarctic winter-over; a reduction of almost 50% in T cell proliferation to mitogen phytohaemogglutinin, as well as changes in latent herpesvirus states and the expansion of the polyclonal latent Epstein-Barr virus infected B cell populations . Although no clinically significant disease has been found to result from these immune changes, research is currently assessing the effects of psychological factors on the immune system . This and associated research performed to date and its relevance to both organisations is discussed, and comment made on possible extensions to the program in both medical and other fields. Adv Space Res, 1996, 18(1-2), 211 - 21 Johnson Space Center's Regenerative Life Support Systems Test Bed; Barta DJ et al.; The Regenerative Life Support Systems (RLSS) Test Bed at NASA's Johnson Space Center is an atmospherically closed, controlled environment facility for human testing of regenerative life support systems using higher plants in conjunction with physicochemical life support systems . The facility supports NASA's Advanced Life Support (ALS) Program . The facility is comprised of two large scale plant growth chambers, each with approximately 11 m2 growing area . The root zone in each chamber is configurable for hydroponic or solid media plant culture systems . One of the two chambers, the Variable Pressure Growth Chamber (VPGC), is capable of operating at lower atmospheric pressures to evaluate a range of environments that may be used in a planetary surface habitat; the other chamber, the Ambient Pressure Growth Chamber (APGC) operates at ambient atmospheric pressure . The air lock of the VPGC is currently being outfitted for short duration (1 to 15 day) human habitation at ambient pressures . Testing with and without human subjects will focus on 1) integration of biological and physicochemical air and water revitalization systems; 2) effect of atmospheric pressure on system performance; 3) planetary resource utilization for ALS systems, in which solid substrates (simulated planetary soils or manufactured soils) are used in selected crop growth studies; 4) environmental microbiology and toxicology; 5) monitoring and control strategies; and 6) plant growth systems design . Included are descriptions of the overall design of the test facility, including discussions of the atmospheric conditioning, thermal control, lighting, and nutrient delivery systems. Proc Natl Acad Sci U S A, 1991 Nov, 88, 10014 - 7 Two-dimensional life? de Duve C, Miller SL. A model {Wachtershauser, G . (1988) Microbiol . Rev . 52, 452-484}, according to which life started in the form of a monomolecular layer of interacting anionic metabolites electrostatically bound to a positively charged surface, is examined critically . The model raises a number of thermodynamic and kinetic difficulties. Planet Space Sci, 1995 Jan-Feb, 43(1-2), 179 - 88 A morphological view on potential niches for exobiology on Mars; Cabrol NA et al.; The discovery of microbiota in the Dry Valleys of Antarctica has encouraged the construction of new models of Martian ecosystems in order to determine if life could have once existed on Mars . The Antarctic cyanobacteria reside just below the surface of sandstone rocks where they are protected from the extreme cold and dry environment . Analogy with the Antarctic Dry Valleys supports speculation that hypothetical micro-organisms existed on Mars in the early history of the planet and could have migrated into suitable rocks as the availability of liquid water decreased . Although evidence for sandstone layers on Mars has not been substantiated, the palaeohydrology of Martian fluvial valleys (MFVs) reveals the evidence of lake bed sediment depositions which have formed consolidated sediments . As the MFVs formation may result from underground drainage processes, the sediment material would be expected to contain debris such as pumice washload, and pumilith of volcanic and meteoritic origin . These materials may have formed consolidated porous terrains similar to the Antarctic sandstone . Therefore, the endolithic model is consistent with the Martian liquid water habitat model of perenially ice-covered lakes. Planet Space Sci, 1995 Jan-Feb, 43(1-2), 115 - 22 Hyperthermophilic life at deep-sea hydrothermal vents; Prieur D et al.; The discovery of deep-sea hydrothermal vents in 1977 considerably modified the views on deep-sea biology . For the first time, an ecosystem totally based on primary production achieved by chemosynthetic bacteria was discovered . Besides the warm vents where dense invertebrate communities and their symbiotic bacteria are located, the "black smokers" venting fluids at temperatures up to 350 degrees C were also investigated by microbiologists . Several strains of hyperthermophilic Archaea (methanogens, sulfate-reducers, sulfur-reducers) were isolated from smokers and surrounding materials . Deep-sea isolates that have been totally described, have been assigned to new species, within genera previously found in coastal geothermally heated environments . However, some species appear to exist in both deep and shallow ecosystems . Some deep-sea hyperthermophiles appear to be adapted to hydrostatic pressure and showed a barophilic response . The distribution of hyperthermophiles in the hot ecosystems of the planet, and their adaptation to pressure are presented and discussed. Polarforschung, 1988, 58(2-3), 193 - 8 Primary production of the cryptoendolithic microbiota from the Antarctic Desert; Vestal JR; Primary production in the Antarctic cryptoendolithic microbiota can be determined from biomass and photosynthetic 14CO2 incorporation measurements . Even though good nanoclimate data are available, it is difficult to determine the amount of time when abiotic conditions permit metabolism . Making appropriate assumptions concerning the metabolism of the cryptoendolithic microbiota during periods of warmth, light and moisture, the primary production of the biota was calculated to be on the order of 0.108 to 4.41 mgC/m2/yr, with a carbon turnover time from 576 to 23,520 years . These production values are the lowest found on planet Earth. Eur J Oral Sci, 2001 Aug, 109(4), 249 - 59 Ultrastructural analysis of structural framework in dental plaque developing on synthetic carbonate apatite applied to human tooth surfaces; Takeuchi H et al.; This study focused on determining the structural framework by oral microbiota in supragingival plaque on a carbonate apatite film applied to human tooth surfaces . The sequential phases of plaque formation over a 3-wk period were found to be equivalent to those previously reported for natural tooth surfaces . Scanning electron microscopy of specimens prepared by vertical sectioning demonstrated the organization of two types of framework between certain genera of initial and secondary colonizers in the pre- and post-organization phases, respectively . The initial colonizers in the pre-organization phase were of a coccoid type, while colonizers in the post-organization phase were of a bacillary type . Secondary colonizers, filamentous cells, were common to both frameworks . Transmission electron microscopy using freeze-substitution and immunohistochemistry demonstrated two types of coaggregation, fibril- and saliva-mediated modes, among the plaque microbiota . Coaggregation between microbiota, which organized the framework, showed a tendency to occur in the fibril-mediated mode, and the filamentous secondary colonizers were characterized by inducing multigeneric coaggregation . The present findings indicate that a structural framework and specific cells to form this framework are essential for plaque formation. J Clin Microbiol, 2001 Sep, 39(9), 3321 - 5 Six-year study of the incidence of herpes in genital and nongenital cultures in a central Kentucky medical center patient population; Ribes JA et al.; Herpes infections are among the most common sexually transmitted diseases and are the most common cause of genital ulcer disease in the United States . This study addresses the changing distribution of herpes simplex virus type 1 (HSV-1) and HSV-2 in patients presenting for evaluation of herpetic infections . Viral culture results from the University of Kentucky Clinical Microbiology Laboratory were reviewed for a 6-year period (1994 through 1999) . Data were collected on patient sex, site of culture, and culture result . These data were analyzed statistically to identify yearly trends . Of the 4,498 cultures analyzed, nearly equal proportions of HSV-1 (13.3%) and HSV-2 (12.0%) were detected for an overall culture positivity rate of 25.3% . Approximately two-thirds of all positive cultures were from women . Although HSV-2 remained the predominant type of genital herpes, over the 6-year span of this study, there was a trend toward increasing proportions of HSV-1 genitalis, with 31.8% of male patients and 44.8% of female patients demonstrating HSV-1 genitalis by 1999 . The majority of patients with HSV in nongenital sites grew HSV-1 . Although there was significant yearly variation, HSV-2 was isolated from only 9.4% of patients with nongenital HSV for the entire 6-year period . This study therefore concludes that HSV-2 remains primarily a genital pathogen, while HSV-1 is taking on an increasingly important role in causing genital ulcer disease in addition to being the primary nongenital HSV. Appl Environ Microbiol, 2001 Sep, 67(9), 4166 - 76 Role of an essential acyl coenzyme A carboxylase in the primary and secondary metabolism of Streptomyces coelicolor A3(2); Rodriguez E et al.; Two genes, accB and accE, that form part of the same operon, were cloned from Streptomyces coelicolor A3(2) . AccB is homologous to the carboxyl transferase domain of several propionyl coezyme A (CoA) carboxylases and acyl-CoA carboxylases (ACCases) of actinomycete origin, while AccE shows no significant homology to any known protein . Expression of accB and accE in Escherichia coli and subsequent in vitro reconstitution of enzyme activity in the presence of the biotinylated protein AccA1 or AccA2 confirmed that AccB was the carboxyl transferase subunit of an ACCase . The additional presence of AccE considerably enhanced the activity of the enzyme complex, suggesting that this small polypeptide is a functional component of the ACCase . The impossibility of obtaining an accB null mutant and the thiostrepton growth dependency of a tipAp accB conditional mutant confirmed that AccB is essential for S . coelicolor viability . Normal growth phenotype in the absence of the inducer was restored in the conditional mutant by the addition of exogenous long-chain fatty acids in the medium, indicating that the inducer-dependent phenotype was specifically related to a conditional block in fatty acid biosynthesis . Thus, AccB, together with AccA2, which is also an essential protein (E . Rodriguez and H . Gramajo, Microbiology 143:3109-3119, 1999), are the most likely components of an ACCase whose main physiological role is the synthesis of malonyl-CoA, the first committed step of fatty acid synthesis . Although normal growth of the conditional mutant was restored by fatty acids, the cultures did not produce actinorhodin or undecylprodigiosin, suggesting a direct participation of this enzyme complex in the supply of malonyl-CoA for the synthesis of these secondary metabolites. Appl Environ Microbiol, 2001 Sep, 67(9), 4077 - 83 Growth patterns of two marine isolates: adaptations to substrate patchiness? Pernthaler A, Pernthaler J, Eilers H, Amann R. During bottle incubations of heterotrophic marine picoplankton, some bacterial groups are conspicuously favored . In an earlier investigation bacteria of the genus Pseudoalteromonas rapidly multiplied in substrate-amended North Sea water, whereas the densities of Oceanospirillum changed little (H . Eilers, J . Pernthaler, and R . Amann, Appl . Environ . Microbiol . 66:4634-4640, 2000) . We therefore studied the growth patterns of two isolates affiliating with Pseudoalteromonas and Oceanospirillum in batch culture . Upon substrate resupply, Oceanospirillum lagged threefold longer than Pseudoalteromonas but reached more than fivefold-higher final cell density and biomass . A second, mobile morphotype was present in the starved Oceanospirillum populations with distinctly greater cell size, DNA and protein content, and 16S rRNA concentration . Contrasting cellular ribosome concentrations during stationary phase suggested basic differences in the growth responses of the two strains to a patchy environment . Therefore, we exposed the strains to different modes of substrate addition . During cocultivation on a single batch of substrates, the final cell densities of Oceanospirillum were reduced three times as much as those Pseudoalteromonas, compared to growth yields in pure cultures . In contrast, the gradual addition of substrates to stationary-phase cocultures was clearly disadvantageous for the Pseudoalteromonas population . Different growth responses to substrate gradients could thus be another facet affecting the competition between marine bacteria and may help to explain community shifts observed during enrichments. Am J Med Sci, 2001 Aug, 322(2), 61 - 7 Multiple antibiotic changes during the first 72 hours of hospitalization; Lawrence C et al.; BACKGROUND: Increasing concern about inappropriate antibiotic use prompted us to examine whether our patients were receiving frequent and perhaps unwarranted changes of antibiotic therapy . METHODS: We evaluated antibiotic prescribing by the physicians in the Emergency Department and by those on the inpatient medical service during the first 72 hours of hospitalization in 119 patients admitted with suspected serious infections to an acute care, university-affiliated, municipal teaching hospital . The appropriateness of antibiotic prescriptions was assessed independently and retrospectively by 2 infectious disease specialists (each based at a different hospital) using a 4-grade scale (from 1 = wrong choice to 4 = appropriate) . Of their evaluations of the 427 antibiotic regimens given to the 119 patients during 4 defined intervals during their first 72 hours of hospitalization, 90% agreed with each other within 1 grade . Their evaluations were then compared with the selections that had been made at each interval by the prescribing physicians . RESULTS: Successive prescribing physicians changed the antibiotic regimens in 77% of cases during the first 24 hours and in 56% during the next 48, often without apparent clinical or microbiologic indications . By 72 hours, the 119 patients had received a mean of 3.1 +/- 1.3 (+/-SD) different antibiotics, and 40 received between 4 and 7 . Only 7% of the patients had no change in the regimen prescribed originally . CONCLUSIONS: Many patients had multiple changes of antibiotics, often unnecessarily, resulting in exposure to too many agents. Clin Infect Dis, 2001 Sep 15, 33 Suppl 3, S230 - 2 Reevaluation of antibiotic breakpoints; Phillips I; Differences in antibiotic breakpoints have resulted from differences in clinical practice and in interpretation of the parameters that are considered when breakpoints are set . Differences in the first of these are less common for newer agents, whereas differences in the latter could be resolved by consensus discussions . Greater difficulty arises when common pathogens acquire resistance, especially when this occurs by degrees, as has happened with penicillin for gonococci and the pneumococci, and for the fluoroquinolones in relation to a wide variety of bacterial species . Changes to breakpoints under such circumstances should be introduced only after the most careful consideration and the education of diagnostic microbiologists and clinicians. Clin Lab Sci, 2001 Summer, 14(3), 141 - 4 Carcinomatous meningitis in a patient with metastatic breast cancer; Lauby G; Metastases are defined as the appearance of neoplasms in parts of the body remote from the site of the primary tumor . Metastasis can occur through one of three processes: direct seeding of body cavities or surfaces, lymphatic spread, and hematogenous spread . The importance of laboratory utilization in the diagnosis of metastasis is explored using a case study of a 39-year-old female with metastatic breast carcinoma to the brain . This case study was carried out using clinical records, laboratory results, pathology reports, and physician interviews . Cerebrospinal fluid was obtained and examined in hematology, chemistry, and microbiology . Tissue from the breast was examined both before and after chemotherapy . Morphologic comparisons of both primary and metastatic tumor cells were carried out . The breast tissue showed infiltrating mammary carcinoma, ductal type, with 8/11 auxiliary lymph nodes showing metastasis . Evaluations of cerebrospinal fluid cell count results revealed the presence of malignant cells in remarkable numbers . Based on cytological and hematological results, a diagnosis of meningeal carcinomatosis was determined and treatment was started . Following the intrathecal chemotherapy, serial cerebrospinal fluid examinations showed the percentage of malignant cells decreased and no cells were detected 11 days after treatment . Metastasis, including meningeal carcinomatosis is a common occurrence with breast carcinoma . An effective chemotherapeutic treatment is evaluated for this disease when an accurate diagnosis is made . As demonstrated by this case study, proper use of the laboratory can help establish the diagnosis of metastasis. Angle Orthod, 2001 Aug, 71(4), 299 - 306 Evaluation of aerosol contamination during debonding procedures; Toroglu MS et al.; The aim of this study was to show how the aerosol generated by the use of an air turbine handpiece during debonding procedures increases the potential risk factor for the distribution of infectious agents . A second aim of the study was to evaluate the effectiveness of a preprocedural chlorhexidine mouth rinse in reducing the number of colony forming units (CFU) found in aerosol samples . Blood agar plates were attached to the face shields and the dental chair table and were used for collecting the aerosol samples . In the first part of the study, 260 samples were collected for the baseline group in an empty room, 36 samples were collected for the control group (C), in which the orthodontist, dental assistant, and the patient were in the operatory room, and 42 samples were collected for the debonding group (DB) . The microbiologic analysis showed significant differences between the baseline group and the control group (P < .05) . Furthermore, aerosol contamination increased significantly during the debonding procedure when compared with the control group (P < .01) . In the second part of the study, an air turbine handpiece was used to remove excess adhesive from the tooth surface on one side of the mouth and air samples were collected . The patients then were instructed to rinse their mouths with 0.2% chlorhexidine gluconate for 1 minute, and the orthodontist worked on the other side of the mouth and the air sampling was repeated . An insignificant reduction was found in the number of colony forming units following the chlorhexidine mouth rinse . Results of this study indicated that orthodontists are exposed to high levels of aerosol generation and contamination during the debonding procedure, and preprocedural chlorhexidine gluconate mouth rinse appears to be ineffective in decreasing the exposure to infectious agents . Therefore, barrier equipment should be used to prevent aerosol contamination. APMIS, 2001 Jun, 109(6), 441 - 6 RANTES in otitis media with effusion: presence, role and correlation with cytokines and microbiology; Schousboe LP et al.; Various inflammatory cells and cytokines have been identified in otitis media with effusion (OME) . The presence of neutrophils has been linked to interleukin-8, but no chemotactic factor has as yet been identified for monocytes . The chemokine RANTES (Regulated upon Activation, Normal T Expressed and Secreted) attracts and activates primarily monocytes and may contribute to the pathogenesis of middle ear inflammation . We investigated the presence of RANTES by: 1) ELISA measurement in 114 middle ear effusions from children suffering from OME, 2) immunohistochemical localisation in experimental OME rabbit middle ear mucosa, and 3) expression in cultured rabbit middle ear epithelium in response to proinflammatory stimuli . RANTES was detectable in 94 (82%) of 114 effusions with a median concentration of 79.7 pg/mg total protein content . The concentration of RANTES was positively correlated with the endotoxin content . Immunohistochemically, RANTES was localized to the epithelial layer in experimental OME . In vitro, RANTES was expressed in middle ear epithelium in response to proinflammatory stimuli (TNF-alpha) in a dose-dependent manner . The expression of RANTES may explain the recruitment of monocytes in OME, possibly as a result of TNF-alpha-mediated endotoxin stimulation. Chest, 2001 Aug, 120(2), 674 - 8 TB or not TB: cavitary bronchiolitis obliterans organizing pneumonia mimicking pulmonary tuberculosis; Heller I et al.; Two patients with subacute symptoms and signs compatible with pulmonary tuberculosis (TB) had right upper lobe cavitary infiltrates shown on chest radiography . In both patients, purified protein derivative and microbiologic testing excluded TB, and tissue examination yielded typical histologic changes of bronchiolitis obliterans organizing pneumonia (BOOP) . Glucocorticoid therapy led to clinical and radiologic resolution . Though probably rare in this situation, BOOP should be considered in the differential diagnosis of patients presenting with clinical and radiologic features of pulmonary TB. Folia Microbiol (Praha), 2000, 45(6), 567 - 71 Influence of intoxication with organophosphates on rumen bacteria and rumen protozoa and protective effect of clinoptilolite-rich zeolite on bacterial and protozoan concentration in rumen; Nistiar F et al.; The effect of O-ethyl-S-(2-diisopropylaminoethyl) methylthiophosphonate on rumen bacteria and rumen protozoa was investigated in sheep (after premedication with clinoptilolite-rich zeolite and without that premedication) . In control animals a decrease in the total concentration of rumen protozoa was observed 3-7 d after intoxication (particularly in small and large ones) . In clinoptilolite-rich-zeolite-treated animals only a slight decrease in protozoan numbers occurred during the first hours after the intoxication . Similarly, in every category of rumen bacteria marked differences between the groups were recorded, particularly in concentration of lipolytic bacteria . The results suggest some protective effect of clinoptilolite-rich zeolite for rumen microbiota against the organophosphate poison. Microb Pathog, 2001 Sep, 31(3), 131 - 44 Binding of fibronectin by Trichomonas vaginalis is influenced by iron and calcium; Crouch ML et al.; We have reported that Trichomonas vaginalis, the causative agent of the most common, non-viral sexually transmitted disease, bound to cover slips coated with fibronectin (FN) (Crouch & Alderete, Microbiol 1999 145: 2835-43) . In this study, we extend that observation by showing that FN binding is specific, and we present data on the requirements of FN binding by T . vaginalis . Immunofluorescence and immuno-gold labelling readily detected FN throughout the trichomonal surface . Parasites bound to(125)I-labelled FN in a time- and concentration-dependent fashion . In the absence of protease inhibitor, iodinated FN was released from the trichomonad surface . Unlabelled FN specifically competed for binding in a concentration-dependent fashion with the(125)I-labelled FN . Interestingly, the amount of FN bound by T . vaginalis organisms was dependent on iron . High-iron-grown trichomonads acquired lower numbers of molecules but with 10-fold higher affinity than low-iron-grown organisms . Further, we show that for iron-replete organisms, calcium (Ca(2+)) at physiological levels increased amounts of bound FN . The increase in binding was rapid, occurring within 5 min of Ca(2+)addition, and required de novo protein synthesis . Co-incubation of live parasites with Ca(2+)in the presence of FN was necessary to increase the amount of FN bound . Treatment of trichomonads with okadaic acid, but not other phosphatase inhibitors, resulted in a 50% decrease in binding of FN, regardless of the presence of Ca(2+), suggesting a role for phosphatase in FN association . These results indicate that depending on the iron status of T . vaginalis organisms in vivo, Ca(2+)may influence trichomonad recognition and binding to FN during host parasitism . Microbiol Immunol, 2001, 45(6), 413 - 6 Prevention of bacterial diarrhea by pasteurization of drinking water in Kenya; Iijima Y et al.; Diarrheal disease is one of the major causes of morbidity and mortality in developing countries . Drinking water is a primary transmission route of infectious diarrheagenic bacteria in a rural area of Kenya (Microbiol . Immunol . 41: 773-778, 1997) . We tried to prevent diarrhea at villages with approximately 1,500 households in Kenya by pasteurizing drinking water . A durable simple thermoindicator which changes color at 70 C was used as an indicator of pasteurization . The number of households in which drinking water was coliform bacteria-free increased from 10.7% to 43.1% after adoption of a pasteurization practice . Consequently, the incidence of severe diarrhea among people drinking pasteurized water was significantly lower than in people taking raw water (odds ratio=0.55, P=0.0016) . The reduction ratio of the incidence after pasteurization was nearly equivalent with that after the adoption of a boiling method . Employment of women leaders as fieldworkers and demonstration of bacterial colony disappearance on agar plates by pasteurization also affected reduction of the diarrheal incidence. Infect Dis Obstet Gynecol, 2001, 9(2), 105 - 11 The classic approach to diagnosis of vulvovaginitis: a critical analysis; Bornstein J et al.; OBJECTIVE: To correlate the symptoms, signs and clinical diagnosis in women with vaginal discharge, based on the combined weight of the character of the vaginal discharge and bedside tests, with the laboratory diagnosis . METHODS: Women presenting consecutively to the women's health center with vaginal discharge were interviewed and examined for assessment of the quantity and color of the discharge . One drop of the material was then examined for pH and the whiff test was done; a wet mount in saline and in 10% KOH was examined microscopically . The clinical diagnosis was based on the results of these assessments . Gram stain and cultures of the discharge were sent to the microbiology laboratory . RESULTS: One hundred and fifty-three women with vaginal discharge with a clinical diagnosis of vulvovaginitis participated in the study . Fifty-five (35.9%) had normal flora and the other 98 (64.1%) had true infectious vulvovaginitis (kappa agreement = 18%) . According to the laboratory, the principal infectious micro-organism causing the vulvovaginitis was Candida species . Candida infection was associated with pH levels of less than 4.5 (p < 0.0001, odds ratio = 4.74, 95% confidence interval: 2.35-9.5, positive predictive value 68.4%) . The whiff test was positive in only a small percentage of bacterial vaginosis (BV) (p = not significant (NS)) . Clue cells were documented in 53.3% of patients with a laboratory diagnosis of BV (p < 0.02, positive predictive value 26.7%) . CONCLUSIONS: The current approach to the diagnosis of vulvovaginitis should be further studied . The classical and time-consuming assessments were shown not to be reliable diagnostic measures. Refuat Hapeh Vehashinayim, 2001 Apr, 18(2), 6 - 8, 60 Periodontal medicine in the next millennium; Cohen DW; Dentistry and medicine have, to a great extent, been somewhat separated during the last 160 years, despite the fact that they have the same patients in common . We have now reached a period in our history when research is bringing medicine and dentistry closer together with data that are cogent to physicians and dentists and, most importantly, to the patient . A new paradigm is emerging with regard to susceptibility to periodontal disease, its etiology, and pathogenesis . Definite relationships between the oral disease and systemic conditions show that some risk factors are a concern for periodontal disease and certain systemic diseased such as cardiovascular disease . Periodontal diseases and systemic diseases--this is a two-way street . It is becoming clear that the dentist needs to know more about systemic diseases, and the physician needs to increase his or her knowledge of oral diseases . We may see an increase in oral microbiology testing for patients with periodontal disease . We also will see more dentists doing glucose testing as well as other tests in their practices . Physicians and dentists working more closely together, more patients with systemic diseases will be managed more successfully, and patients will benefit from predictable treatment regimens to save their dentition. Eur Respir J, 2001 Jun, 17(6), 1195 - 200 Intron-8 polythymidine sequence in Australasian individuals with CF mutations R117H and R117C; Massie RJ et al.; Compound heterozygotes for a severe cystic fibrosis transmembrane conductance regulator (CFTR) mutation and the R117H or R117C mutation (R117H/C) have clinical presentations that vary from classic cystic fibrosis (CF) to an incidental genetic finding . The aim of this study was to assess the influence of the intron-8 polythvmidine sequence (IVS8) on the relationship between genotype and phenotype of individuals with R117H/C . All individuals with R117H/C known to CF clinics in Australia and New Zealand were retrospectively studied by collecting information on genotype, age, pancreatic status, sweat electrolytes, sputum microbiology and pulmonary function . Forty-one individuals (39 with R117H and two with R117C), 16 on an IVS8-5T background and 25 on an IVS8-7T background were identified . Twelve individuals presented clinically, four were siblings of known R117H/C compound heterozygotes and 25 were detected by newborn screening . Eleven of 14 of the IVS8-5T group (78%) with sweat chloride results available had sweat CI > 60 mmol x L(-1) compared to 5 (20%) of the R117H/7T group (Chi-squared=10.4, p=0.001) . Two were pancreatic insufficient, both IVS8-5T . Two IVS8-5T individuals have recently died (aged 43 and 19) and of the 14 surviving IVS8-5T group, 11 (79%) are symptomatic compared to eight (32%) of the IVS8-7T individuals (Chi-squared=6.1, p=0.01) . In conclusion, most individuals with R117H/C on a IVS8-5T background have an elevated sweat chloride and clinical cystic fibrosis, which in some cases is severe . Most individuals with R117H/C on an IVS8-7T background do not have clinical cystic fibrosis but should be followed for the development of clinical disease. Int J Periodontics Restorative Dent, 2001 Jun, 21(3), 232 - 9 The clinical relevance of microbiologic testing: a comparative analysis of microbiologic samples secured from the same sites and cultured in two independent laboratories; Mellado JR et al.; A field study using five different private periodontal practices was conducted; it compared two microbiologic culture samples simultaneously secured from the same sites within 23 individual patients and submitted for bacterial identification and antibiotic sensitivity testing to two separate laboratories . The results from the two laboratories were often different . In no instance did both laboratories agree on the presence of identical bacterial species . When only bacteria above threshold levels were compared, agreement was found in only nine of 23 cases . When examining antibiotic sensitivity, using 100% kill of all tested pathogens as the ideal, agreement between the two laboratories was poor . The laboratories agreed on the use of amoxicillin 17% of the time, tetracycline 26% of the time, and metronidazole 48% of the time . The use of amoxicillin and metronidazole in combination yielded a 78% agreement when the results of both laboratories were combined . It would appear from the data that the empirical use of amoxicillin-metronidazole combination therapy may be more clinically sound and cost effective than culturing and antibiotic selection based on the results of culture from any single microbiologic testing laboratory. Pediatr Neurosurg, 2001 Jul, 35(1), 13 - 7 The Influence of hair shave on the infection rate in neurosurgery . A prospective study; Tang K et al.; OBJECTIVE: To investigate whether not shaving hair in neurosurgical operations carries an increased infection rate . METHODS: Taking advantage of different practices among neurosurgeons in a single institution, we embarked upon a prospective non-randomised study of 100 consecutive neurosurgical procedures involving 90 paediatric patients aged 7 days to 16.8 years . The patients were split into two groups ('hair shave' and 'no hair shave') . The differences with respect to wound complications, positive microbiology on wound culture swabs and wound infection rates were analysed . Other factors considered were the cleansing solution, prophylactic antibiotic regime, duration of the operation, the surgeon's experience and the patient's age . RESULTS: The only complications observed were 4 incidences of wound dehiscence (2 in the hair shave and 2 in the no hair shave group) and 3 shunt infections (2 in the hair shave and 1 in the no hair shave group) . We did not find any significant difference between the two arms for any of the factors assessed . Age was a significant factor in shunt infection, as all shunt infections were seen in patients aged less than 6 months, regardless of whether the hair was shaved or not (p = 0.024, Fisher's exact test) . CONCLUSION: This study confirms our clinical experience that no hair shave is a good alternative to the traditional hair shaving approach, allowing patients to enjoy the psychological benefits of undisturbed body image while recovering from major surgery . J Bacteriol, 2001 Sep, 183(17), 5050 - 7 Extracellular synthesis, specific recognition, and intracellular degradation of cyclomaltodextrins by the hyperthermophilic archaeon Thermococcus sp . strain B1001; Hashimoto Y et al.; A unique extracellular and thermostable cyclomaltodextrin glucanotransferase (CGTase) from the hyperthermophilic archaeon Thermococcus sp . strain B1001 produces predominantly (>85%) alpha-cyclomaltodextrin (alpha-CD) from starch (Y . Tachibana, et al., Appl . Environ . Microbiol . 65:1991--1997, 1999) . Nucleotide sequencing of the CGTase gene (cgtA) and its flanking region was performed, and a cluster of five genes was found, including a gene homolog encoding a cyclomaltodextrinase (CDase) involved in the degradation of CDs (cgtB), the gene encoding CGTase (cgtA), a gene homolog for a CD-binding protein (CBP) (cgtC), and a putative CBP-dependent ABC transporter involved in uptake of CDs (cgtDE) . The CDase was expressed in Escherichia coli and purified . The optimum pH and temperature for CD hydrolysis were 5.5 and 95 degrees C, respectively . The molecular weight of the recombinant enzyme was estimated to be 79,000 . The CDase hydrolyzed beta-CD most efficiently among other CDs . Maltose and pullulan were not utilized as substrates . Linear maltodextrins with a small glucose unit were very slowly hydrolyzed, and starch was hydrolyzed more slowly . Analysis by thin-layer chromatography revealed that glucose and maltose were produced as end products . The purified recombinant CBP bound to maltose as well as to alpha-CD . However, the CBP exhibited higher thermostability in the presence of alpha-CD . These results suggested that strain B1001 possesses a unique metabolic pathway that includes extracellular synthesis, transmembrane uptake, and intracellular degradation of CDs in starch utilization . Potential advantages of this starch metabolic pathway via CDs are discussed. J Emerg Med, 2001 Aug, 21(2), 171 - 8 Cerebrospinal fluid; Jerrard DA et al.; A quick and accurate diagnosis of maladies affecting the central nervous system (CNS) is imperative . Procurement and analysis of cerebrospinal fluid (CSF) are paramount in helping the clinician determine a patient's clinical condition . Various staining methods, measurement of white blood cell counts, glucose and protein levels, recognition of xanthochromia, and microbiologic studies are CSF parameters that are collectively important in the ultimate determination by a clinician of the presence or absence of a catastrophic CNS condition . Many of these CNS parameters have significant limitations that should be recognized to minimize under treating patients with catastrophic illness. Nat Rev Genet, 2001 Aug, 2(8), 634 - 9 Do bacteria have sex? Redfield RJ. Do bacteria have genes for genetic exchange? The idea that the bacterial processes that cause genetic exchange exist because of natural selection for this process is shared by almost all microbiologists and population geneticists . However, this assumption has been perpetuated by generations of biology, microbiology and genetics textbooks without ever being critically examined. Am Heart J, 2001 Aug, 142(2), 280 - 5 Cardiac conduction abnormalities in endocarditis defined by the Duke criteria; Meine TJ et al.; BACKGROUND: Cardiac conduction abnormalities occur in endocarditis and have been associated with infection extension and increased mortality . There have been no prospective studies of electrocardiographic (ECG) conduction changes in endocarditis . We examined the incidence of ECG changes in a large prospective cohort with suspected endocarditis and correlated changes with echocardiographic evidence of invasive infection and mortality . METHODS: One hundred thirty-seven of 1396 (10%) suspected cases of endocarditis were classified as "definite" or "possible" by the Duke criteria and had an interpretable ECG . ECG conduction changes were classified as old (pre-existing hospitalization), new (evident on admission or developed during hospitalization), or indeterminate . New or indeterminate abnormalities were considered "ECG conduction changes." Echocardiogram results were reviewed to identify infected valves and invasive infection . RESULTS: ECG conduction changes were present in 36 of 137 (26%) patients . Patients with ECG conduction changes were more often male (69% vs 46%, P =.005) and had prosthetic valves (47% vs 23%, P <.001) . There were no significant differences in microbiology results or treatment with cardiac surgery . In 76 (55%) patients, at least one infected valve was identified by echocardiography; 15 of 76 (20%) patients were determined to have evidence of invasive infection . Eight of 15 (53%) invasive infections exhibited ECG conduction changes compared with 16 of 61 (26%) isolated valve infections (P =.046) . Eleven of 36 (31%) patients with ECG conduction changes died during hospitalization compared with 15 of 101 (15%) patients without changes (P =.039) . CONCLUSIONS: ECG conduction changes commonly occur in endocarditis despite more sensitive diagnostic criteria and are associated with increased mortality and invasive infection. Analyst, 2001 Jul, 126(7), 1068 - 72 Enzyme modified microband electrodes: cross-talk effects and their elimination; Quinto M et al.; One microband of an array of four microband electrodes (1 mm long and 25 microm wide with a 25 microm gap) was modified with glucose oxidase by direct electrochemically assisted immobilisation, giving a stable microbiosensor with an apparent Michaelis-Menten constant of 12 mM and an i(max) of 80 nA . Cross-talk effects on the adjacent microbands were studied and three different methods for their elimination were tested: the most efficient one involved catalase deposition on the adjacent microband . Under these conditions, the maximum response at the unmodified microbands was in the worst case about 3% compared with the response of the modified microband . This approach has the potential to fabricate a multianalyte microbiosensor. FEMS Immunol Med Microbiol, 2001 Jul, 31(1), 1 - 14 Association of immunological disorders in lethal side effect of NSAIDs on beta-glucan-administered mice; Takahashi H et al.; (1-->3)-beta-D-Glucan (beta-glucan) is a biological response modifier that regulates host immune response . We have found that the combination of a beta-glucan and a non-steroidal anti-inflammatory drug (NSAID), indomethacin (IND), induced lethal toxicity in mice {Yoshioka et al . (1998) FEMS Immunol . Med . Microbiol., 21, 171-179} . This study was undertaken to analyze the mechanism of the lethal side effect . Combination of a beta-glucan and IND increased the number of leukocytes, especially macrophages and neutrophils, in various organs and these cells were activated . The activated state of these cells was supported by the enhanced production of interferon-gamma in the presence of IND in vitro culture of the peritoneal exudate cells . Intestinal bacterial flora was translocated into the peritoneal cavity in these mice to cause peritonitis . Comparing the toxicity of various NSAIDs, nabumetone, a partially cyclooxygenase-2-selective NSAID with weaker toxicity to the gastrointestinal tract, did not exhibit a lethal side effect . These facts strongly suggested that gastrointestinal damage by NSAIDs was more severe in beta-glucan-administered mice, resulting in peritonitis by enteric bacteria and leading to death. Biotech Histochem, 2001 May, 76(3), 119 - 25 Application of stains in clinical microbiology; Madison BM; Stains have been used for diagnosing infectious diseases since the late 1800s . The Gram stain remains the most commonly used stain because it detects and differentiates a wide range of pathogens . The next most commonly used diagnostic technique is acid-fast staining that is used primarily to detect Mycobacterium tuberculosis and other severe infections . Many infectious agents grow slowly on culture media or may not grow at all; stains may be the only method to detect these organisms in clinical specimens . In the hands of experienced clinical microscopists, stains provide rapid and cost-effective information for preliminary diagnosis of infectious diseases . A review of the most common staining methods used in the clinical microbiology laboratory is presented here. Acta Gastroenterol Belg, 2001 Apr-Jun, 64(2), 165 - 9 Biologicals: principles, techniques and mechanisms of action; Sands BE; Biological agents for the treatment of IBD are the result of both the explosion of knowledge precipitated by the techniques of molecular biology, and by the ability to use these same techniques to produce agents . Thus, there has been a greatly facilitated translation of basic knowledge into clinical therapy . An astounding number of biologic agents are currently in development for the treatment of IBD and other immune-mediated conditions . These include native microbiologic preparations isolated for beneficial properties, recombinant cytokines and anticytokines, monoclonal antibodies, antisense oligonucleotides, and in the future, somatic gene therapy . This work seeks to describe the principles and techniques of biologic agent development, as well as prime sites of action targeted by these agents . Recent advances in the techniques of molecular biology have made possible unprecedented progress in the treatment of many conditions . The techniques of molecular biology have provided new methods of drug discovery and at the same time have elucidated new therapeutic targets . Most notable has been the progress made in the treatment of chronic inflammatory and immune mediated conditions, including inflammatory bowel disease . This paper is intended to highlight the methodological principles behind biologic agents, methods of discovery and production, and to highlight potential therapeutic targets for these new agents. Ned Tijdschr Geneeskd, 2001 Jul 7, 145(27), 1285 - 9 {Virus quantification in peripheral blood as a reflection of the clinical course}; Kroes AC; Quantitative determination of viral nucleic acid in peripheral blood appears to be important for nearly all viral infections with a chronic and reactivating course, as this provides relevant information on the clinical consequences, the level of infectivity and the response to antiviral treatment or other interventions . The practical application of this principle in clinical virology has benefited from the availability of new techniques, particularly those in which amplification of viral nucleic acid can be followed in real time . In addition, the potential value of quantitative virology was clearly demonstrated by the experience gained from viral load monitoring in HIV-infected patients . This approach will probably be widely applicable in clinical microbiology in general. BMC Infect Dis . 2001;1(1):6 . Epub 2001 Jul 04. Clinical features of culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia; Madani TA et al.; OBJECTIVE: This retrospective chart review describes the epidemiology and clinical features of 40 patients with culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia . METHODS: Patients with positive M . pneumoniae cultures from respiratory specimens from January 1997 through December 1998 were identified through the Microbiology records . Charts of patients were reviewed . RESULTS: 40 patients were identified, 33 (82.5%) of whom required admission . Most infections (92.5%) were community-acquired . The infection affected all age groups but was most common in infants (32.5%) and pre-school children (22.5%) . It occurred year-round but was most common in the fall (35%) and spring (30%) . More than three-quarters of patients (77.5%) had comorbidities . Twenty-four isolates (60%) were associated with pneumonia, 14 (35%) with upper respiratory tract infections, and 2 (5%) with bronchiolitis . Cough (82.5%), fever (75%), and malaise (58.8%) were the most common symptoms, and crepitations (60%), and wheezes (40%) were the most common signs . Most patients with pneumonia had crepitations (79.2%) but only 25% had bronchial breathing . Immunocompromised patients were more likely than non-immunocompromised patients to present with pneumonia (8/9 versus 16/31, P = 0.05) . Of the 24 patients with pneumonia, 14 (58.3%) had uneventful recovery, 4 (16.7%) recovered following some complications, 3 (12.5%) died because of M pneumoniae infection, and 3 (12.5%) died due to underlying comorbidities . The 3 patients who died of M pneumoniae pneumonia had other comorbidities . CONCLUSION: our results were similar to published data except for the finding that infections were more common in infants and preschool children and that the mortality rate of pneumonia in patients with comorbidities was high. Aliment Pharmacol Ther, 2001 Aug, 15(8), 1199 - 204 Ranitidine bismuth citrate with clarithromycin alone or with metronidazole for the eradication of Helicobacter pylori; Bardhan KD et al.; BACKGROUND: Both triple therapy with ranitidine bismuth citrate (RBC) plus two antibiotics for 7 days and dual therapy of RBC with clarithromycin for 14 days have been extensively studied; both regimens effectively eradicate Helicobacter pylori . However, few studies have assessed the efficacy of dual therapy given for 7 days . AIM: To compare the efficacy and safety of RBC 400 mg with clarithromycin 500 mg, alone or with metronidazole 400 mg, given twice daily for 7 days for the eradication of H . pylori . METHODS: This single centre, randomized, double-blind study involved 118 patients with dyspepsia or a history of peptic ulcer disease . H . pylori infection was detected initially by CLO test, and confirmed in 109 patients by urea breath test and/or microbiology culture . H . pylori eradication was assessed 4 and 12 weeks after the end of treatment by urea breath test . H . pylori antibiotic susceptibility was assessed pre-study in all patients, and post-treatment in patients with a positive post-treatment urea breath test . Adverse events were recorded throughout the study . RESULTS: H . pylori was eradicated in 93% of patients who received RBC with clarithromycin and metronidazole and in 84% of patients who received RBC with clarithromycin (intention-to-treat rates) . Per protocol eradication rates were 98% and 90% for triple therapy and dual therapy, respectively . The eradication of metronidazole-resistant H . pylori was achieved in 100% and 88% of patients following dual therapy and triple therapy, respectively, and acquired resistance to clarithromycin occurred in only one patient following treatment failure . Both treatments were well-tolerated; only one patient (2%) was withdrawn from each treatment group due to adverse events . CONCLUSIONS: RBC with clarithromycin and metronidazole is a highly effective and well-tolerated triple therapy regimen for the eradication of H . pylori . RBC with clarithromycin dual therapy has a similar efficacy, and offers an alternative to triple therapy when there are concerns about treatment with metronidazole or the use of multiple antibiotics . Both regimens are effective against antibiotic-resistant strains of H . pylori. FEMS Microbiol Lett, 2001 Jul 24, 201(2), 139 - 43 First evidence for a restriction-modification system in Leptospira sp; Brenot A et al.; The LE1 leptophage exhibited a host range restricted to the saprophytic Leptospira biflexa {Saint Girons et al., Res . Microbiol . 141 (1990) 1131-1133} and mainly to the Patoc 1 strain (hereafter called PFRA) kept in the Paris, France collection . Results of titration of LE1 lysates indicated the presence of a host-controlled modification and restriction system within PUSA (Patoc 1 strain maintained in the Morgantown, WV, USA collection) that was absent in PFRA . Because genomic DNA of PITAL (Patoc 1 strain maintained in Trieste, Italy) appeared smeared in pulsed field gel electrophoresis (PFGE), this strain is likely to contain nucleases that are activated upon DNA isolation . Moreover, comparative NotI digestions of PUSA and PFRA DNAs, as visualized by PFGE, indicated that PUSA belonged to a different serovar than PFRA . Finally, 16S ribosomal sequence analysis indicated that PUSA belonged to the saprophytic Leptospira meyeri species, while PITAL and PFRA appertained to L . biflexa . The evolutionary significance and the importance of the restriction and modification enzymes or non-specific nucleases within strains for genetic experiments are discussed. Curr Gastroenterol Rep, 2001 Aug, 3(4), 304 - 14 Diarrhea in the returned traveler; Sanders JW et al.; Diarrhea in the returned traveler is a common problem that can be caused by a number of different pathogens . A history of the patient's travel and exposures, the duration of illness, the response to prior treatment, and the clinical syndrome can help to establish a good etiologic differential diagnosis on which further therapy can be based . Many of these patients can be treated empirically with antibiotics, either a fluoroquinolone or azithromycin, without further microbiologic evaluation . Those patients with severe or persistent disease or comorbid illnesses, or those who have failed empiric therapy, should undergo further microbiologic evaluation with directed stool cultures and ova and parasite screening . For those patients with negative evaluations, further empiric therapy may be warranted if syndromes are suggestive of specific agents of infection, such as by Giardia or Cyclospora species . Other patients may require endoscopic evaluation to exclude diagnoses such as tropical sprue or inflammatory bowel disease. Mil Med, 2001 Jul, 166(7), 637 - 40 Diagnostic medical auxiliary equipment in a field hospital: experience from the Israeli delegation to the site of the Turkish earthquake at Adapazari; Finestone AS et al.; An earthquake striking a highly populated area is likely to cause a mass casualty situation for even the most advanced trauma center . If the local medical teams are injured and the hospitals are damaged beyond immediate repair, external intervention is needed . In the Turkish earthquake crisis, Israel was one of many states to deploy a field hospital to the crisis site . This was set up in Adapazari, the second most severely hit city in terms of the amount of damage . The hospital provided advanced surgical and medical facilities, including laparotomy, cesarean section, and intensive care surveillance . These facilities require sophisticated laboratory and radiology services, including hematology, chemistry, microbiology, and blood bank . The speed with which the hospital must be assembled and transported to be efficient and the basic conditions of a field hospital dictate specific considerations regarding diagnostic auxiliary equipment . Considerations in choosing this equipment, problems encountered during installation, and recommendations for the future are presented. Tuberculosis (Edinb), 2001, 81(3), 243 - 8 The use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis; Burgess LJ et al.; SETTING: Tygerberg Hospital, an academic hospital in the Western Cape, South Africa.Objective: To determine the diagnostic utility of ascitic fluid adenosine deaminase (ADA) in the diagnosis of tuberculous peritonitis . DESIGN: A prospective study, carried out from February 1995 to February 1998, resulted in 178 paired ascites and serum specimens being collected from adult patients . Specimens were evaluated for biochemistry, ADA, microbiology and cytology; further investigations were done at the treating clinician's discretion . Diagnoses were made according the pre-determined criteria . RESULTS: The median (range) ADA activity in the tuberculous group was 61.6 (17.5--115.0) U/L and was significantly higher than in any other diagnostic group (p<0.05) . Using ROC curves, a cut-off level of 30 U/L for the diagnosis of tuberculous peritonitis was found to yield the best results; corresponding sensitivity and specificity was 94% and 92%, respectively . No statistically significant difference in ADA activity was observed when tuberculous ascites occurred in the absence or presence of cirrhosis . CONCLUSIONS: Ascitic fluid ADA activity is useful in identifying those patients in whom the diagnosis of tuberculous peritonitis should be actively pursued to justify its routine use, at least in areas such as South Africa where TB is endemic . The presence or absence of underlying cirrhosis does not appear to distract from its diagnostic utility . Ann Thorac Surg, 2001 Jul, 72(1), 39 - 43 Recurrent infective endocarditis: a multivariate analysis of 21 years of experience . arenzul@tin.it; Renzulli A et al.; BACKGROUND: To evaluate which variables predict recurrence of endocarditis after surgical treatment, we reviewed our 21-year experience . METHODS: Between January 1979 and May 2000, 308 consecutive valve replacement procedures for infective endocarditis were performed in 271 patients . Univariate and multivariate time-related analyses were performed to retrospectively evaluate the role of the following variables in the development of recurrent postoperative endocarditis: gender, site of endocarditis, previous valve disease, drug abuse, diabetes, positive valve/blood cultures, sepsis, perivalvular involvement, previous embolic events, type of replacement device, and persistent postoperative fever . RESULTS: Clinical and echocardiographic follow-up was 97.36% complete, mean follow-up time was 53.2+/-3.4 months . Recurrent endocarditis developed in 58 cases (22.5%) . Variables predicting recurrence were prosthetic endocarditis (p = 0.00001), positive valve culture (p = 0.0039), and persistence of fever at the seventh postoperative day (p = 0.000001) . CONCLUSIONS: Correct protocols of antibiotic therapy guided by microbiology may reduce the incidence of recurrent endocarditis to allow for surgery on sterile tissues and to prevent prosthetic infection . Recurrence rate is not affected by the choice of valve substitute, but can be prevented by complete surgical debridement. Ann Endocrinol (Paris), 2001 Jun, 62(3), 230 - 4 {Thyroid nodules: histological approach using microbiopsies obtained with a biopsy gun: preliminary study}; Sarafian V et al.; Surgery remains the safest treatment of thyroid nodules, even though the frequency of the cancer is low . Modern diagnostic techniques are aimed at reducing the number of useless surgical interventions . These techniques rely on diagnostic patterns; cytology plays a predominant role . Nevertheless, it is difficult do obtain a sample with enough cellular material for the cytology study . The pathologist must also have skilled experience to provide a reliable reading . Surgical biopsies are no longer performed due to the risk of severe complications . Microbiopsy techniques have been greatly improved and are now widely used for many organs . In this preliminary study, we performed 18 microbiopsies of thyroid nodules measuring less than 1 cm in 18 patients using a 20-gauge biopsy gun . We had one complication: a cervical hematoma after the third biopsy in the series that resolved rapidly . The pathology examination identified follicular adenoma in 14 cases, and Hashimoto thyroiditis in 1 . Three small samples contained subnormal thyroid vesicles with suspicion of adenoma for one . All samples were diagnostic, more cellular and easier to read than cytology specimens . This study points to the usefulness of these microbiopsy techniques for histological analysis, particularly applicable to thyroid nodules, and the obvious benefit in biopsy and reading efficiency. Eur J Ophthalmol, 2001 Apr-Jun, 11(2), 180 - 2 Necrotising fasciitis of the orbit: early recognition and treatment a key to success; Puri P et al.; PURPOSE: To report a case of necrotising fasciitis which was managed successfully with timely intervention . CASE REPORT: A 77-year-old lady diagnosed as having narcotizing fasciitis of the orbit based on the clinical picture and microbiology report is presented . Early recognition of the condition followed by timely surgical intervention in the form of surgical debridement and subsequent exenteration led to a favorable prognosis . DISCUSSION: Necrotising fasciitis is a fulminant synergistic infection . It spreads along facial planes causing necrosis of the overlying skin . Management of this condition includes both medical treatment and surgical debridement . Early intervention is of vital importance to save the patient's life as septicemia often leads to death within 24-96 hours . CONCLUSIONS: Early recognition and treatment are the key to successful management of cases with necrotising fasciitis of the orbit. S Afr Med J, 2001 Jun, 91(6), 514 - 6 Does tutor subject-matter expertise influence student achievement in the problem-based learning curriculum at UNITRA Medical School? Kwizera EN, Dambisya YM, Aguirre JH. OBJECTIVE: To establish whether or not tutor subject-matter expertise influences student achievement in content-based examinations in the problem-based learning (PBL) curriculum at the University of Transkei (UNITRA) Medical School . DESIGN: A retrospective study of MB ChB III student achievement in end-of-block modified essay questions (MEQ) examinations in microbiology, pathology and pharmacology for the years 1994-1999, inclusive . Pooled scores from the expert-tutored groups were compared with those from the groups tutored by non-experts using analysis of variance (ANOVA) or t-test . Subject expert tutors were those with postgraduate specialisation in the given discipline . SETTING: The Medical School, Faculty of Health Sciences, UNITRA, Umtata . OUTCOME MEASURES: Whether pooled mean MEQ scores in end-of-block examinations for microbiology, pathology or pharmacology differ according to the subject-matter expertise of the tutor . RESULTS: There were no significant differences in mean scores obtained for pharmacology (51.1 +/- 0.6 versus 52.6 +/- 0.7, P = 0.109) and pathology (49.8 +/- 0.6 versus 49.9 +/- 0.8, P = 0.919) . The difference between the scores in microbiology was small (3 percentage points) but statistically significant, with the groups tutored by microbiologists scoring higher than those tutored by pathologists or pharmacologists (54.1 +/- 1.0 versus 51.2 +/- 0.8, P = 0.032) . CONCLUSIONS: These data demonstrating that in the UNITRA Medical School PBL curriculum tutor subject-matter expertise has little or no influence on student achievement in the discrete areas of tutor expertise. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi, 2001 Jun, 18(2), 272 - 5 {Recent developments of magnetic microspheres for use in the fields of biomedicine}; Li Y et al.; This paper presents a review of the recent developments of magnetic microspheres (MMS), a new kind of multi-function reagent for uses in the fields of cytology, immunology, microbiology, molecular biology, clinical diagnosis and treatment, etc. J Heart Lung Transplant, 2001 Jul, 20(7), 789 - 91 Nocardia asteroides abscess after heart transplantation; Stamenkovic SA et al.; We describe a patient who developed a primary, thigh adductor-muscle abscess caused by Nocardia asteroides 3 years after orthotopic cardiac transplantation . Nocardia was diagnosed by microbiologic culture and responded fully to a prolonged course of cotrimoxazole . The patient remains free of local or systemic disease at 2 years follow-up. Infect Dis Clin North Am, 2001 Jun, 15(2), 671 - 702, xi Dermatologic infections in the immunocompromised (non-HIV) host; Lopez FA et al.; The immunocompromised host's susceptibility to infections often present a difficult diagnostic challenge to the physician . A working knowledge of the host immune defenses and microbiologic complications that can occur when these functions are compromised provides a more focused framework for further evaluation and management . Infections in these patients are often morbid and life-threatening, creating an urgent need for prompt diagnosis . The skin may manifest the first clue(s) of a serious underlying infection . Appropriate workup and diagnosis of cutaneous lesions provide an expeditious, noninvasive, and potentially life-saving approach to the immunocompromised host with a dermatologic infection. Infect Dis Clin North Am, 2001 Jun, 15(2), 483 - 520 Infections following hematopoietic stem cell transplantation; Leather HL et al.; Numerous advances have been made in the management of infection in HSCT recipients . With increasing knowledge the authors are able to prevent several serious infections from occurring, and reduce the severity of infections once they occur . Despite these advances, several previously unrecognized pathogens have emerged and pose risks to this population . Ongoing surveillance and reporting of atypical infections are warranted . Transplant and infectious disease clinicians alike must be vigilant to the shifts in infectious syndromes as a consequence of various prophylaxis and preemptive strategies, and be ready to modify empiric strategies to meet the changing microbiologic milieu . As we increase our understanding of the HSCT process, and use the immune system rather than relying on high-dose chemotherapy, the authors are likely to reduce toxicities and improve patient outcomes. Indian J Dent Res, 2001 Jan-Mar, 12(1), 7 - 20 Visceral organ involvement is infrequent in oral submucous fibrosis (OSF); Rajendra R et al.; Associated visceral organ involvement evidence by systemic fibrosis has not been explored in oral submucous fibrosis (OSF) . The investigations in this aspect were limited to loco-regional sites of naso/oropharynx and oesophagus . The study of whether the oral fibrosis is part of a systemic spectrum of disease involving multiple organs is an interesting pursuit . With this intention the patients diagnosed on clinical and histological grounds for OSF were concurrently tested by biophysical means for the presence of endomyocardial fibrosis (EMF), pancreatic (PF) and retroperitoneal fibrosis (RPF), which are endemic to the area studied . Twenty-five (n = 25) cases of OSF who visited the Department of Oral pathology & Microbiology . Govt . Dental College, Trivandrum, India for symptomatic relief of their illness comprised the study group . Ten (n = 10) age and sex matched healthy volunteers comprised the control . All the subjects have had undergone cardiologic and gastrointestinal investigations to rule out the possibility of concurrent EMF and PF . The patients were all of Indian ethnic extraction and mostly (> 90%) were from low socio economic classes . The mean age of the patients was 54.16 +/- 14.6 years, including 18 females and 7 males (F:M = 2.57:1) . The severity of fibrosis was unrelated to the age of patients (P > 0.05) . All the patients were chewers of areca quid (12%)/tobacco (88%) . In addition to quid chewing 3/25 (12%) patients smoked 'bidi' and 6/25 (24%) consumed home brewed liquor (arrack/toddy) which contain about 40-50% ethanol . Statistically no relationship was observed between the clinical stages of OSF and severity of epithelial dysplasia in this study (P > 0.05) . Out of the 25 patients, 5 (20%) showed sclerotic aortic value which may be an age related finding . Also 7 (28%) patients were found to be hypertensive and interstitial lung disease was present in 2 (8%) . The possibility of EMF in one female patient who showed thickened RV apical endocardium was ruled out by cardiac catheterisation . Thus none of the patients showed evidence of endomyocardial fibrosis . The pancreas was found to be hyperchoic in 8(32 1/4) by ultra sonography . Liver was found to be hyperchoic in 6 (24%) . Fat stain in stool samples was found to be positive in 13(58%) . The hyperchogenecity of pancreas may be due to alcoholism or an underlying endocrine pancreatic insufficiency like diabetes and not due to pancreatic fibrosis . The positivity of fat stain could be due to fatty liver/alcoholism . Thus the study fails to reveal any evidence of pancreatic fibrosis in the group . The lack of any evidence of an associated visceral organ fibrosis in OSF made it prudent to believe that this is a loco-regional disease, initiated by local factors and propagated under their influence without systemic involvement. Radiol Med (Torino), 2001 May, 101(5), 341 - 7 {Digital stereotactic breast microbiopsy with the mammotome: study of 122 cases}; Ancona A et al.; PURPOSE: To evaluate the diagnostic value of vacuum-assisted biopsy (VB) with digital stereotactic Mammotome on dubious mammary lesions clinically and sonographically negative as an alternative to surgical biopsy diagnosis . MATERIAL AND METHODS: From November 1999 to November 2000, 122 biopsies were performed using a vacuum suction aspiration device with digital stereotactic-guided Mammotome (Fischer prone table) on 116 patients between the age of 34 and 74 years (median 51 yrs) . Sampling was performed with an 11 gauge probe . All patients were previously subjected to mammography in which dubious lesions were evidenced without clinical and sonogram confirmation . All lesions that were obviously benign or malignant were excluded . Mammography demonstrated isolated microcalcifications, small opacities and parenchymal distortions . Microcalcifications were then subdivided into lobular, rad-shaped, granular, mixed and pulverulent, according to Tabar's classification . The median diameter of lesions was 13 mm (range 3-50) . The median number of Mammotome biopsy samples was 10.8 (range 3-19) . All samples were radiographed and magnified . In 76 patients, the Mammotome biopies were incisional (only a part of the lesion was removed) and in 46 the biopsy was excisional (the entire lesion was removed) . The biopsy site was marked with a non-magnetic metallic clip in 83 patients . Slight bleeding was noted during the procedure in two cases . Ultrasound visualization evidenced a hematoma at the biopsy site in one patient which was successfully resolved in one month with local therapy . No noticeable pain or patient intolerance to the procedure was observed . RESULTS: Histological probe sample examination was negative in 91 patients (74.6%) and positive in 31 patients (25.4%) . The benign histologies included adenosis and epitheliosis (47 pts), sclerosing adenosis (7 pts), fibroadenoma (7 pts), fibrosis and fibrocystic mastopathy (30 pts) . Of the 31 positive patients, 14 were infiltrating carcinomas (45%) and 17 ductal carcinomas in situ (DCIS) (55%) . All positive cases underwent surgery . The post-surgical histological examination confirmed all diagnoses of infiltrating carcinoma while the diagnosis of DCIS was confirmed in 15 cases; infiltrating microfoci associated with DCIS were evidenced in two cases . CONCLUSIONS: VB with digital stereotactic Mammotome was shown to be a valid method for dubious mamographic lesions in which cytology often supplies an inadequate or false-negative responses . This method distinguishes between benign and malignant lesions rapidly without discomfort to the patient, thus reducing the number of diagnostic surgical biopsies . Moreover, in positive cases, it offers the advantage of avoiding extemporaneous intraoperative procedures and the possibility to perform biological tests on the tumor before surgery (estrogen and progesterone receptors, HER-2 neu, grading, Ki 67, p53 ), thus providing patient benefits and a distinct reduction of costs . However, this method is purely diagnostic and is not sufficient for therapeutical purposes. Clin Chim Acta, 2001 Jul 20, 309(2), 179 - 81 Accreditation of external quality assessment schemes in the United Kingdom; Goldie DJ; There are some 130 pathology external quality assessment schemes available in the United Kingdom . Most are provided from within the National Health Service, but a few from the private sector . At the invitation of the Department of Health, Clinical Pathology Accreditation (UK) Ltd . has developed an accreditation system for these schemes . Accreditation is based on scheme organisers declaring compliance with 62 standards and an on-site inspection . As of the end of 2000, 105 schemes have been accredited . Most of the schemes in the disciplines of Clinical Biochemistry, Haematology, Immunology and Microbiology have now been accredited, but progress has been slower in non-numerical schemes in the disciplines of Cellular Pathology and Genetics. J Nutr, 2001 Jul, 131(7), 2040 - 8 Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in U.S . women; Weinstein SJ et al.; Previous observational epidemiologic studies of folate and cervical cancer, as well as folate supplementation trials for cervical dysplasia, have produced mixed results . We examined the relationship between serum and RBC folate and incident invasive cervical cancer in a large, multicenter, community-based case-control study . Detailed in-person interviews were conducted, and blood was drawn at least 6 mo after completion of cancer treatment from 51% of cases and 68% of controls who were interviewed . Blood folate was measured with both microbiologic and radiobinding assays . Included in the final analyses were 183 cases and 540 controls . Logistic regression was used to control for all accepted risk factors, including age, sexual behavior, smoking, oral contraceptive use, Papanicolaou smear history and human papillomavirus (HPV)-16 serology . For all four folate measures, the geometric mean in cases was lower than in controls (e.g., 11.6 vs . 13.0 nmol/L, P < 0.01 for the serum radiobinding assay) . Folate measures using microbiologic and radiobinding assays were correlated (serum: r = 0.90; RBC: r = 0.77) . For serum folate, multivariate-adjusted odds ratios (OR) in the lowest vs . highest quartile were 1.3 {95% confidence interval (CI) = 0.8--2.9} and 1.6 (0.9--2.9), using the microbiologic and radiobinding assays, respectively . For RBC folate, comparable OR were 1.2 (0.6--2.2) and 1.5 (0.8--2.7) . Similar risks were obtained when restricting analyses to subjects with a history of HPV infection . Thus, low serum and RBC folate were each moderately, but nonsignificantly, associated with increased invasive cervical cancer risk . These findings support a role for one-carbon metabolism in the etiology of cervical cancer. J Chemother, 2001 Apr, 13 Suppl 1, 7 - 10 Infectious diseases on the 21st century doorstep; Ronald A; Accelerating change can be expected to occur in the fields of Clinical Microbiology and Infectious Diseases . New pathogens, new diseases, new technologies, new vaccines and new treatment modalities will descend on us with increasing frequency in the decade ahead . In order to cope with and even appreciate change, we need to increase our commitment to training, recruiting and retaining health professionals in these disciplines, enhance our research programs, and remain enthusiastic about the benefits offered by skilled, knowledgeable practitioners to our patients . Infectious disease deaths have been increasing during the '90's in most societies . We must reverse this! Nihon Kokyuki Gakkai Zasshi, 2001 Mar, 39(3), 166 - 71 {Opportunistic pneumonia after kidney transplantation}; Uchida K et al.; This study was conducted to evaluate clinical features at the onset of pneumonia and the usefulness of methods for diagnosing pneumonia in patients who have undergone kidney transplantation . From January 1990 to December 1998 . 174 kidney transplantations were performed, and were followed by 22 cases of pneumonia . Of the 22 pneumonia patients, 16 were male and 6 were female . The median age of the 22 patients was 37.2 +/- 13.3 years . All the patients received cyclosporin A and corticosteroids . In 11 cases, the organisms were identified in the microbiology or pathology laboratory, either during life or at autopsy . Six cases were due to Pneumocystis carinii (PC), three to PC and Cytomegalovirus (CMV), one to Aspergillus, and one resulted from miliary tuberculosis . Pneumonia occurred within 4 months after kidney transplantation in most cases . The mean interval between the transplantation and the appearance of pneumonia was 77.3 +/- 34.3 days, except in the cases of Aspergillosis and miliary tuberculosis, where the intervals were 46 and 50 months, respectively . The mean interval from the appearance of symptoms to the detection of pulmonary infiltration was 3.3 +/- 4.3 days . The clinical features present when pulmonary infiltration was detected by CT were fever (91%), cough (32%), and crackles (27%) . However, at this time, 55% of the cases had no symptoms other than fever . Chest radiographs were positive for pulmonary infiltration in 64% of the cases at the same time that the pulmonary infiltrates were detected by CT . Eighty percent of the cases exhibited diffuse interstitial infiltrates . Organisms were detected in 7 of 9 cases examined with bronchofiberscopy (BF) . But in only one of 13 cases that did not undergo BF . Increased values of serum beta-D-glucan were detected in the early phase of three PC pneumonia cases, suggesting that beta-D-glucan is useful as a marker of PC pneumonia . The use of bronchofiberscopy was more frequent in survivors of PC pneumonia than in non-survivors, whereas the mean age was higher and coexisting CMV infections were identified more frequently in the non-survivors . We concluded that fever is important as an initial symptom of pulmonary infection . In addition, we find that CT is very useful for the detection of interstitial infiltrates, and BF is an excellent method for detecting organisms in the pneumonia patient after kidney transplantation. Cad Saude Publica, 2001, 17 Suppl, 141 - 6 Public health challenges and emerging diseases: the case of São Paulo; da Silva LJ; The author discusses the challenges posed by emerging infectious diseases in 100 years of public health in the state of Sao Paulo, Brazil . With an advanced and organized public health system, Sao Paulo responded to the emergence of infectious diseases by creating research institutions and control programs . The late 19th century witnessed the first modern research institution in microbiology, in response to the bubonic plague . A changing economy led to constant changes in ecosystems . The late 20th century presents a wide array of both emerging and rapidly changing infectious diseases . The present situation calls for creative solutions . Ecosystem analysis and more agile epidemiological surveillance are seen as the best alternatives. Int J Dermatol, 2001 Mar, 40(3), 179 - 84 Post-kala-azar dermal leishmaniasis in Nepal; Garg VK et al.; BACKGROUND: Post-kala-azar dermal leishmaniasis (PKDL) manifests as a skin eruption after healing of visceral leishmaniasis (VL), either spontaneously or as a result of treatment . This study was undertaken to describe the demographic, clinical, and histopathologic features of PKDL in Nepal . METHODS: Demographic, clinical, microbiologic, and histopathologic features and response to treatment were studied in 22 patients with PKDL from April 1998 to March 2000 . RESULTS: PKDL accounted for 0.13% of all new dermatologic cases . There were 13 (59.1%) males and nine (40.9%) females . A past history of kala-azar was present in all but one patient . A family history of kala-azar was noted in eight (36.4%) patients . All patients presented with multiple types of lesion, except for two in whom only macular lesions were seen . Oral lesions in the form of nodules and plaques were seen in four patients . Generalized lymphadenopathy was present in five patients . Slit skin smears revealed Leishman-Donovan bodies (LDBs) in nine (40.9%) patients . In macular lesions, there was a sparse infiltrate of plasma cells, lymphocytes, or histiocytes in the upper dermis . There was a dense chronic inflammatory infiltrate comprising plasma cells, lymphocytes, histiocytes, and epithelioid cells in the entire dermis from papules, plaques, or nodules . Giemsa staining of biopsy specimens revealed LDBs in seven (38.9%) patients only . Fine needle aspiration from epitrochlear lymph nodes in two patients demonstrated LDBs . All patients responded well to treatment with minimal side-effects . CONCLUSIONS: This study emphasizes the need to be aware of the possibility of cases of PKDL in endemic regions of leprosy, as the conditions may be difficult to distinguish clinically and histopathologically. Helicobacter, 2001 Jun, 6(2), 136 - 45 Interactions among gastric somatostatin, interleukin-8 and mucosal inflammation in Helicobacter pylori-positive peptic ulcer patients; Yamamoto S et al.; BACKGROUND: To investigate whether Helicobacter pylori infection, but not drugs, affects gastric somatostatin, interleukin-8 (IL-8), histological inflammation through eradication therapy, and interactions among these parameters . METHODS: Twenty-eight H . pylori-positive patients (21 males; mean age 47.0 years) with either gastric ulcer (GU: n = 11) or duodenal ulcer (n = 17) diagnosed endoscopically were treated with dual therapy . Eradication was defined as negative microbiologic tests and 13C-urea breath test . Levels of antral and gastric juice somatostatin and mucosal IL-8 were measured by radioimmunoassay and enzyme-linked immunosorbent assay, respectively . Histology was assessed by the Sydney system . RESULTS: H . pylori was eradicated in 15 patients (10 males, 6 GU) out of 28 (54%) . The patients' backgrounds did not affect the eradication of H . pylori . Successes in eradication significantly increased antral and juice somatostatin contents, and dramatically decreased IL-8 levels and histological gastritis . In contrast, persistent H . pylori infection did not affect somatostatin and histological gastritis . An inverse correlation was present between changes in somatostatin levels and histological activity . No relationship was observed in changed values between antral somatostatin and IL-8 . CONCLUSIONS: These results indicate that eradication of H . pylori, but not the drugs used, induced an increase in somatostatin levels in the antrum and gastric juice, suggesting a close relationship between H . pylori and gastric somatostatin regulation . A close correlation between an increase in gastric somatostatin levels and the normalization of histological activity was present, suggesting that certain peptide-immune interactions in the gastric mucosa exist in H . pylori infection. Pharmacoepidemiol Drug Saf, 2001 Jan-Feb, 10(1), 49 - 54 The evolution of screening; Gray JA; Botany is usually considered to be the gentlest of sciences with botanists being regarded as people who study relatively safe specimens, compared with, for example, anthropologists or microbiologists . However, botanists have their moments, particularly when collecting new species . The great botanists of the eighteenth and nineteenth centuries risked their lives in collecting and bringing back species, which we now take for granted, and Robert Brown was one of these adventurers, a young Scot who accompanied Sir Joseph Banks to New Holland . It was not, however, for his adventurous lifestyle that Brown is remembered but for his startling observation of the movements of pollen grains on a microscope slide . He noted that the pollen grains were in perpetual agitated motion, without purpose or direction but full of energy . This motion, called Brownian motion, arises from the movement of molecules, and Brownian motion is the term that has been applied to much of healthcare, including many screening programmes, which have in the past been marked more by the amount of energy and activity than by a clear sense of direction or positive achievement. J Microbiol Methods, 2001 Aug, 46(2), 119 - 29 Measurements of net fluxes and extracellular changes of H+, Ca2+, K+, and NH4+ in Escherichia coli using ion-selective microelectrodes; Shabala L et al.; This study introduced the use of a non-invasive ion-selective microelectrode (MIFE) technique to study membrane-transport processes in bacteria . Net ion fluxes and changes in the extracellular concentrations of H+, Ca2+, K+ and NH4+ in adherent bacteria, isolated from cultures at different growth stages (exponential, late exponential, and stationary phases), were monitored . With the exception of Ca2+, a significant (P=0.05) difference was found in the magnitude of net fluxes of the ions measured from bacterial cells at different stages of the population growth curve . The magnitude of the H+ response was glucose-dependent with maximum changes occurring at the highest concentration . There was a progressive increase in H+ extrusion followed by a gradual return to zero at late stationary phase . Measurements of net ion fluxes crossing the bacterial cytoplasmic membrane, demonstrated here for the first time, may offer insight into underlying mechanisms of ion transport kinetics . Applications of the non-invasive ion-selective microelectrode technique in microbiology are discussed. Arch Bronconeumol, 2001 Jun, 37(6), 281 - 6 {Environmental mycobacterial diseases in patients with and without HIV infection: epidemiology and clinical course}; Martinez-Moragon E et al.; The objective of the present study was to ascertain the clinical features, risk factors, microbiologic spectrum and course of disease after treatment of infections by environmental mycobacteria (EM) in patients with and without HIV infection in our community . Eighty-eight patients with diseases caused by EM diagnosed between 1989 and 1997 were studied; 46 (52.7%) were HIV-positive . Mycobacterium kansasii was the most prevalent pathogen (54%) overall, followed by M . avium complex (40%) . However, M . avium complex was most prevalent among HIV-positive patients (61%) and M . kansasii was most prevalent among HIV-negative patients (76%) . Localized lung infections were most common among HIV-negative patients, whereas 74% of HIV-positive patients had disseminated disease . Among HIV-negative patients, chronic obstructive pulmonary disease and corticosteroid use were common associations . Pulmonary disease was subacute and non-specific in both patient groups, whereas abdominal pain was the first symptom of most patients with disseminated disease . On the chest films of 76% of the HIV-negative patients, we observed cavitation and infiltrates; 60% of HIV-negative patients had normal x-rays . No differences in antibiotic sensitivity were observed between strains from HIV-positive and HIV-negative patients . The prognosis was good in the HIV-negative group with combined therapy with 2 to 4 first-line antituberculous drugs, whereas response was poor in HIV-positive patients in spite of prolonged treatment with 3 to 5 drugs . Nevertheless, thanks to the highly effective anti-retroviral treatment of recent years, we seem to be observing improved response to therapy with less aggressive forms of EM disease. Clin Cancer Res, 2001 Jun, 7(6), 1577 - 81 Chemotherapy response of breast cancer depends on HER-2 status and anthracycline dose intensity in the neoadjuvant setting; Petit T et al.; We evaluated the predictive value of a tumor's HER-2 status for chemotherapy response in the neoadjuvant setting and the effect of anthracycline dose intensity on this predictive value . HER-2 status was evaluated by immunochemistry on microbiopsy before neoadjuvant chemotherapy (monoclonal antibody CB-11; Novocastra) in 39 patients (group A) treated with FEC50 (500 mg/m(2) 5-fluorouracil, 50 mg/m(2) epirubicin, and 500 mg/m(2) cyclophosphamide) and 40 patients (group B) treated with FEC100 (500 mg/m(2) 5-fluorouracil, 100 mg/m(2) epirubicin, and 500 mg/m(2) cyclophosphamide) . All tumors were stage II or noninflammatory stage III adenocarcinoma . Overall response rate (OR) was evaluated through ultrasound and mammographic measurements . Pathological complete response was evaluated by tumor excision and axillary node resection after six cycles of chemotherapy . Patient and tumor characteristics (age, tumor size, clinical nodal status, SBR grade, hormonal receptor status, and HER-2 expression) were similar in the two groups . In univariate analyses, anthracycline dose was the only factor predictive of response (OR = 61.5% with FEC50; OR = 82.5% with FEC100; P = 0.038) . When anthracycline dose was correlated with HER-2 status, an OR of 73.9% was demonstrated in HER-2- tumors (tumors without HER-2 overexpression), and an OR of 12.5% was demonstrated in HER-2+ tumors (tumors with HER-2 with overexpression) in group A . In group B, an OR of 69.5% was demonstrated in HER-2- tumors, and an OR of 100% was demonstrated in HER-2+ tumors . There was no difference in OR for HER-2- tumors treated with FEC50 or FEC100 (P = 0.74) . On the other hand, erbB-2+ tumors treated with FEC100 had a significantly better OR than HER-2+ tumors treated with FEC50 (P = 0.0003) . In a multivariate analysis, the most powerful predictive factor of OR was a conditional variable associating anthracycline dose with HER-2 status . Low-dose anthracycline and HER-2+ predicted a poor OR, low- or high-dose anthracycline and HER-2- predicted an intermediate OR, and high-dose anthracycline and HER-2+ predicted a high OR . Our results merit additional studies, given the possibility for choosing anthracycline dose according to a tumor's HER-2 status. Diagn Microbiol Infect Dis, 2001 Apr, 39(4), 211 - 4 Effect of sputum induction by hypertonic saline on specimen quality; Chuard C et al.; Microbiologic work-up of expectorated material is routinely used to search for the etiology of pulmonary infections, but sputum is often contaminated by saliva . Inhalation of hypertonic saline induces bronchial secretions and theoretically may improve specimen quality . We compared in a laboratory-blinded, randomized study the quality of sputum obtained either with induction by saline or without induction in patients with respiratory tract infection and a history of productive cough . The quality of sputum was considered good if the polymorphonuclear neutrophils (PMNs)/squamous epithelial cells (SECs) ratio was > or = 2 or the Q (quality) score was > or = +1 on Gram stain . Forty-nine and 50 patients were able to expectorate in the induced and spontaneous sputum groups, respectively . PMNs/SECs ratio was > or = 2 in 65% and 74% of the patients in the induced and spontaneous sputum groups (p = 0.47); for the Q score, a value > or = +1 was found in 55% and 66% of the patients of each group (p = 0.37) . In conclusion, sputum induction by hypertonic saline inhalation does not improve specimen quality as judged by the PMNs/SECs ratio on Gram stain. J Biotechnol, 2001 Jun 15, 88(2), 141 - 9 Long and accurate PCR with a mixture of KOD DNA polymerase and its exonuclease deficient mutant enzyme; Nishioka M et al.; DNA polymerase from Thermococcus kodakaraensis KOD1 (previously Pyrococcus sp . KOD1) is one of the most efficient thermostable PCR enzymes exhibiting higher accuracy and elongation velocity than any other commercially available DN