Genotype-phenotype correlation in multiresistant Escherichia coli and Klebsiella pneumoniae strains isolated in Western Romania.

OBJECTIVE: Bacterial multidrug-resistance (MDR) to antimicrobials has become an important public health issue all over the world and it involves both hospital and community-acquired strains. MATERIALS AND METHODS: A number of 75 Escherichia coli and 77 Klebsiella pneumoniae (K.) strains identified in biological samples collected from community (CA) and hospital-acquired (HA) infections were found to be resistant to the third generation cephalosporins. Of these, 93 MDR strains were subjected to microarray analysis to detect the expression of 31 antimicrobial resistance genes. RESULTS: We found that all HA extended-spectrum ß-lactamase (ESBL) producing E. coli strains had at least one resistance gene to third generation cephalosporins, while in 54% of all CA strains genetic substrates justifying their antibiotic resistance were identified. Almost 81% of HA-ESBL (Extended-Spectrum ß Lactamase) K. pneumoniae strains had at least one resistance gene to third generation cephalosporins, while in only 6% of the CA strains a similar genotype was identified. In the HA group, the blaCTX-M-15 genotype proved to be most frequent in multidrug-resistant E. coli strains and second most frequent (after ampC) in K. pneumoniae, while in the CA group, this genotype was the fourth most frequent in ESBL E. coli (after ampC, sul1, tet(R)). CONCLUSIONS: Overall, in 67% of all ESBL producing Enterobacteriaceae strains a genetic substrate justifying the resistance to beta-lactam antibiotics was identified; most of the remaining 33.33% strains were CA with a predominance of K. pneumoniae, in which a different antibiotic resistance genetic substrate (outside the detection limit of the kit used in this study) might have been involved.

Estrogen receptor alpha polymorphisms: correlation with clinicopathological parameters in breast cancer.

Polymorphisms in estrogen receptor alpha gene (ESR1) have been previously associated with breast cancer risk; however, the results were not fully consistent. Our purpose was to study interactions between common genotypes in ESR1, breast cancer risk and tumor phenotypes. 6 ESR1 single nucleotide polymorphisms (SNPs) were genotyped in 103 breast cancer patients and 90 controls using hybridization probes; the genotypes were correlated with known prognostic factors for breast cancer and 5 years-follow up data. To assess estrogen and progesterone receptors (ER, PR) and HER2/neu expressions, immunohistochemistry was performed. Our results showed that rs3798577 was significantly associated with the risk of breast cancer, the common allele C conferring susceptibility (p-trend=4 x 10(-5)); rs3798577 was also correlated with PR expression (p=0.01), but not with ER expression; rs2228480 (p=0.047) and rs1801132 (p=0.02) were associated with the age at diagnosis; rs1801132 was correlated with hypercholesterolemia (p=0.003) and increased BMI (body mass index) (p=0.01); rs2234693 showed a low significant association (p=0.042) with the tumor grade; rs3798577 was correlated with disease-free survival (p=0.05), allele C conferring increased risk for relapses, but it reached not statistical significance after adjustments. In conclusions, we identified four genotypes significantly correlated with either the risk or some tumor characteristics, suggesting that the main selection criteria of the investigated SNPs (frequency and the position in modulating domains of the gene) are pertinent instruments for establish correlations between the gene structure and the tumor phenotype.

Prospective clinical study evaluating the long-time adjunctive use of chlorhexidine after one-stage full-mouth SRP.

OBJECTIVES: Scaling and root planing are the causal procedure in the treatment of periodontitis. Many attempts have been made to improve the outcome. The aim of this study was to verify the influence of the extended use of chlorhexidine after one-stage full-mouth (FM) SRP in patients with chronic periodontitis on the clinical outcome after 3 months. METHODS: Eighty-one patients with pockets > or =5 mm were treated by FM. All patients rinsed additionally with 0.2% chlorhexidine (CHX) twice daily over 3 months. Plaque index, bleeding on probing, probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and after 1 and 3 months. RESULTS: In the test group, all variables were significantly improved after 1 and 3 months. Mean reduction of PD and CAL gain was 2.25 +/- 1.08 and 1.67 +/- 1.08 after 1 and 2.99 +/- 1.11 and 2.33 +/- 1.31 after 3 months respectively. CONCLUSIONS: Over 3 months of extended use of CHX mouth rinse after SRP showed slightly but statistically significant better results.

Competition-driven network dynamics: emergence of a scale-free leadership structure and collective efficiency.

Using the minority game as a model for competition dynamics, we investigate the effects of interagent communications across a network on the global evolution of the game. Agent communication across this network leads to the formation of an influence network, which is dynamically coupled to the evolution of the game, and it is responsible for the information flow driving the agents' actions. We show that the influence network spontaneously develops hubs with a broad distribution of in-degrees, defining a scale-free robust leadership structure. Furthermore, in realistic parameter ranges, facilitated by information exchange on the network, agents can generate a high degree of cooperation making the collective almost maximally efficient.

Estimation of entropies and dimensions by nonlinear symbolic time series analysis.

Symbolic nonlinear time series analysis methods have the potential for analyzing nonlinear data efficiently with low sensitivity to noise. In symbolic nonlinear time series analysis a time series for a fixed delay is partitioned into a small number (called the alphabet size) of cells labeled by symbols, creating a symbolic time series. Symbolic methods involve computing the statistics of words made from the symbolic time series. Specifically, the Shannon entropy of the distribution of possible words for a range of word lengths is computed. The rate of increase of the entropy with word length is the metric (Kolmogorov-Sinai) entropy. Methods of computing the metric entropy for flows as well as for maps are shown. A method of computing the information dimension appropriate to symbolic analysis is proposed. In terms of this formulation, the information dimension is determined by the scaling of entropy as alphabet size is modestly increased, using the information obtained from large word length. We discuss the role of sampling time and the issue of using these methods when there may be no generating partition.

Precursory dynamics in threshold systems.

A precursory dynamics, motivated by the analysis of recent experiments on solid-on-solid friction, is introduced in a continuous cellular automaton that mimics the physics of earthquake source processes. The resulting system of equations for the interevent cycle can be decoupled and yields an analytical solution in the mean-field limit, exhibiting a smoothing effect of the dynamics on the stress field. Simulation results show the resulting departure from scaling at the large-event end of the frequency distribution, and support claims that the field leakage may parametrize the superposition of scaling and characteristic regimes observed in real earthquake faults.

Asian Indian women: knowledge, attitudes and behaviors toward breast cancer early detection.

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.

Recruiting older women to research studies: the san diego cooperative mammography project.

BACKGROUND: Despite the growing number of older people in the population, this age group continues to be under represented in clinical trials. As a result, physicians must base treatment decisions for older patients on data from studies involving primarily younger, and presumably healthier, adults. Little experience is available to guide the development of study methodologies that will enhance the recruitment of older patients to clinical studies. METHODS: This pilot study compared two methods of recruiting women 75 years and older to a clinical research study related to their most recent screening mammogram. The effectiveness of a single, "in-person" invitation to participate made during the screening mammogram appointment was compared with the effectiveness of a single invitation to participate sent "by-mail" following a screening mammogram. RESULTS: Both methods succeeded in recruiting a sizable sample (N=2,394). The "in-person" invitation to participate was more labor-intense and less likely to be inclusive of all eligible women, but secured a significantly greater proportion of the women to participate. However, once recruited, women in the "by-mail" method were significantly more likely to comply with the optional elements of the study and to express a willingness to continue with follow-up studies than those recruited by the "in-person" method. CONCLUSIONS: Lack of participation of older women in clinical research may be more a reflection of not being asked, rather than their lack of willingness to participate, thus reinforcing the key role health care providers can play in recruiting older women to clinical studies.

Clusters and fluctuations at mean-field critical points and spinodals

We show that the structure of the fluctuations close to spinodals and mean-field critical points is qualitatively different from the structure close to non-mean-field critical points. This difference has important implications for many areas including the formation of glasses in supercooled liquids. In particular, the divergence of the measured static structure function in near-mean-field systems close to the glass transition is suppressed relative to the mean-field prediction in systems for which a spatial symmetry is broken.

The migratory and phagocytic activity of polymorphonuclear leukocytes in rheumatoid arthritis and osteoarthritis patients.

Polymorphonuclear neutrophils (PMN) play a central role in the elimination of most extracellular pathogenic microorganisms and any impairment of their functions therefore predisposes to defect immune defence. We investigated the migratory and phagocytic functions of the PMNs isolated from peripheral blood and synovial fluid of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). The results suggest that in RA the number and the migratory but not phagocytic capacity of synovial fluid (SF) neutrophils were enhanced, while in OA they were significantly decreased in synovial fluid cells comparatively with peripheral blood (PB). The migratory function of both PB and SF cells from RA patients was increased comparatively with that of the cells from OA patients. We found the different abnormal functions in synovial fluid neutrophils from RA and OA patients. These results may help to elucidate the underlying mechanism which leads to severe joint destruction and different susceptibility to infectious diseases in patients with rheumatic disorders.

Shift toward T lymphocytes with Th1 and Tc1 cytokine-secterion profile in the joints of patients with osteoarthritis.

Osteoarthritis (OA), although a heterogeneous disease, is generally believed by rheumatologists to be primarily a disease generated by biomechanical alterations. In order to determine the role of T cells, the pattern of T lymphocyte cytokines and to characterize the mononuclear cells from both peripheral blood (PB) and synovial fluid (SF) from patients with OA flow cytometry with a panel of monoclonal antibodies recognising CD4, CD8 and intracellular cytokines (IL2, IL4, IL10, gamma-IFN) was employed. The coexpression of CD4 and CD8 markers only on the SF T cells surface after in vitro stimulation by phorbol-miristate acetate and ionomicine, but not on PBL or in vitro unstimulated SFL was noted. The intracellular IFN-gamma was detected in enhanced levels in both CD4+ and CD8+ SF T cells, while the IL2 contents was not different in PB and SF samples. The Th2/Tc2 cytokines (IL4 and IL10) were detected in low amounts in both PBL and SFL. This study shows the role of some T cell populations and cytokines in the generation of joint destruction in osteoarthritis.

[Importance of apical instrumentation limit in the endodontic technique]. / Importanta limitei apicale a instrumentatiei in tehnica endodontica.

An improved knowledge of anatomy and psysiology of the apical radicular region has made mandatory a better classical endodontic technique concerning the apical limit of instrumentation, and has stressed the importance of a precise determination of the cemento-dentinal junction as the apical limit of canal obturation. On the basis of these orientations a clinical and radiographic study was carried out on 120 teeth extracted form humans, in which the frequency was determined of the excentric position of the cement conus with regard to the apex, and the distance between the cemento-dentinal junction and the apex. In 45 teeth in situ, with pulpar inflammation, gangrene and apical parodontitis a clinical and radiological appraisal was done of the cemento-dentinal junction, and evolution was followed after canal obturation.

[Essential trigeminal neuralgia]. / Nevralgia esentiala de trigemen.

Out of a series of 364 patients, 56 cases of essential trigeminal neuralgias operated upon by retrogasserian radicotomy by intradural temporal route are presented. Pointing out that we are in a period of confrontation between the great surgery, classical or micro-neurosurgery of the trigeminal nerve and the drug therapy or percutaneous surgery, the authors conclude that the indication of great surgery is restricted but has not disappeared--taking into account the good permanent results obtained (89%) and the reduced rate of failures and recurrences (11%). In the conditions of a general anesthesia with intracranial hypotension and correct surveillance the surgeon has gaine an extra security when performing these operations.