Evaluation of the capability of the VITEK 2 system to detect extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates, in particular with the coproduction of AmpC enzymes.

A total of 317 Klebsiella pneumoniae and 291 Escherichia coli nonduplicate isolates were tested by the VITEK 2 system to evaluate its capability to detect extended-spectrum beta-lactamases (ESBLs) among putative ESBL-producing isolates, in particular those with the coproduction of AmpC enzymes. beta-lactamases produced by the test isolates had been characterised. The sensitivity and specificity for ESBLs were 98.9% and 98.5%, respectively. Ninety of the isolates were AmpC (CMY-2, CMY-8 or DHA-1) and ESBL (SHV and/or CTX-M) coproducers, and 74 isolates (82.2%) of them were flagged as ESBL producers. Our study indicates that the VITEK 2 system is an acceptable tool for ESBL detection among K. pneumoniae and E. coli isolates for laboratories where both imported AmpC and ESBLs are prevalent.

Study of male sterility in Taiwania cryptomerioides Hayata (Taxodiaceae).

A study of male sterility over a period of three consecutive years on a conifer species endemic to Taiwan, Taiwania cryptomerioides Hayata (Taxodiaceae), was done for this article. With the aids of fluorescence and electron microscopic observations, the ontogenic processes in the fertile and sterile microsporangia are compared, using samples collected from Chitou Experimental Forest and Yeou-Shoei-Keng Clonal Orchard of the National Taiwan University, Nantou, Taiwan. The development of male strobili occurred from August to the end of March. Microsporogenesis starts with the formation of the archesporium and ends with the maturation of 2-celled pollen grains within the dehiscing microsporangium. Before meiosis, there was no significant difference in ultrastructure between the fertile and sterile microsporangia. Asynchronous pollen development with various tetrad forms may occur in the same microsporangium of either fertile or sterile strobili. However, a callose wall was observable in the fertile dyad and tetrad, but not in the sterile one. After dissolution of the callose wall, the fertile microspores were released into the locule, while some sterile microspores still retained as tetrads or dyads with intertwining of exine walls in the proximal faces. As a result, there was no well developed lamellated endexine and no granulate ectexine or intine in the sterile microspores. Eventually, the intracellular structures in sterile microspores were dramatically collapsed before anthesis. The present study shows that the abortion in pollen development is possibly attributed to the absence of the callose wall. The importance of this structure to the male sterility of T. cryptomerioides is discussed.

Negative association of Enterobius infestation with asthma and rhinitis in primary school children in Taipei.

BACKGROUND: The relationship between allergy and parasites has been controversial, especially in non-tropical countries. Enterobius vermicularis (human pinworm) is the most prevalent intestinal parasite in industrialized countries. OBJECTIVE: To examine the association between pinworm infestation and allergy in primary school children. METHOD: Peri-anal tape test for pinworm is routinely performed in Taipei primary schools. We collected data from school records and questionnaires distributed to all children in four primary schools grades 1 through 6 (n = 3107). RESULTS: The prevalence of physician-diagnosed asthma (9.3% vs. 14.1%, P = 0.007) and allergic rhinitis (27.4% vs. 38.3%, P = 0.001) was lower in pinworm-positive compared to uninfested children. Pinworm was not correlated with atopic dermatitis or parent allergy. With logistic regression controlling for sex, parent allergy and lower respiratory infection, current asthma (OR = 0.25, 95% CI 0.10-0.63) and rhinitis (OR = 0.61, 95% CI 0.45-0.84) were negatively associated with pinworm. Among children in grades 3-6 who had no asthma or rhinitis before age 7, those with early infestation (pinworm diagnosis at or before grade 1) had a lower risk of having diagnosis of rhinitis during school years, compared to the uninfected group (5.4% vs. 12.3%, P = 0.03; adjusted OR = 0.47, 95% CI 0.21-1.02). CONCLUSIONS: We identified a negative association between pinworm infestation and allergic airway diseases, which could in part be attributed to protective effect of pinworm infestation on development of allergic symptoms. Other mechanisms of association could not be ruled out.

Effect of various surface protections on the margin microleakage of resin-modified glass ionomer cements.

STATEMENT OF PROBLEM: Because conventional glass ionomer cements are moisture sensitive, a surface coating is recommended during the initial setting stage. It is unknown whether resin-modified glass ionomer cements also need surface protection. PURPOSE: This study investigated the effect of various surface protections on microleakage with Class V resin-modified glass ionomer restorations. MATERIAL AND METHODS: Forty extracted molars with buccal and lingual Class V cavity preparations were restored with a resin-modified glass ionomer (Fuji II LC). The occlusal margin of each restoration was on enamel and the cervical margin on dentin. After immediate finishing and polishing, the teeth were divided into 4 groups according to the following surface protection treatments: group I, unprotected; group II, Fuji varnish; group III, resin adhesive; and group IV, acid etching and resin adhesive. After these procedures, all teeth were stored in isotonic saline for 24 hours, thermocycled 1500 times at 5 degrees C to 60 degrees C, and soaked in dye solution for 24 hours. The teeth then were longitudinally sectioned and observed under a stereomicroscope. The degree of dye penetration was recorded and analyzed with the Kruskal-Wallis and Mann-Whitney tests (P<.05) RESULTS: None of the 4 groups demonstrated complete margin sealing at either the occlusal or cervical margins. Groups II and III displayed the least microleakage at cervical margins; a significant difference existed between groups I and III (P=.034). Compared with the other 3 groups, group IV showed significantly greater microleakage at the cervical margins. CONCLUSION: Although resin-modified glass ionomers can be finished immediately, they remain moisture sensitive. Within the limitations of this study, the results suggest that resin adhesive should be used as a surface protection to reduce margin microleakage of resin-modified glass ionomer restorations.

Multiplane transesophageal echocardiography for assessing cardiac abnormalities: comparison to biplane imaging.

BACKGROUND: Transesophageal echocardiography (TEE) is useful for visualizing the spatial relationships of the cardiac anatomy. The purpose of this study was to compare the diagnostic yield of multiplane TEE with that of biplane TEE in assessing cardiac abnormalities. METHODS: A total of 102 consecutive patients underwent an initial comprehensive diagnostic assessment using transverse (0 degree) and longitudinal (90 degrees +/- 2 degrees) planes in the biplane imaging technique. "Off-axis" tomographic sections through the full 0 degree to 180 degrees angle were obtained later by means of the gradual electrical rotation of the transducer. The echoscope can be manipulated to improve the quality of images. All data were recorded on high fidelity videotapes. Subsequently, one observer reviewed only biplane TEE images, while another reviewed only multiplane TEE images; both were blinded to the other's TEE data. The echocardiographic results obtained by these two observers were compared to determine whether multiplane TEE provides any additional information. RESULTS: Multiplane TEE detected more cardiac lesions (275) compared to biplane TEE (235). Significantly more (70 cases) information affecting patient management was obtained using multiplane TEE. Among these patients, biplane TEE detected cardiac lesions in 48 (68.6%) patients. Additional diagnoses provided by multiplane TEE were found in 22 (31.4%) patients. These findings included ventricular septal defect in two patients, prosthetic valve dysfunction in three, cardiac tumor or clot in four, endocarditis in two, aortic dissection in one, valvular abnormality in nine and coronary arteriovenous fistula in one. CONCLUSIONS: Multiplane TEE provides precise visualization of cardiac structures without undue probe manipulation, resulting in greater diagnostic assurance than does biplane TEE.

Analgesic drug prescription and use in cognitively impaired nursing home residents.

BACKGROUND: Prior research has documented the high prevalence of pain in elderly adults and the difficulties associated with properly assessing and treating pain in elders with cognitive impairment. OBJECTIVES: To investigate the prescription and administration of analgesic medications to treat pain in cognitively impaired nursing home residents. METHOD: The current sample consisted of 339 nursing home residents (295 women and 44 men) with a mean age of 87 years (range 66-104). Forty-six percent of the sample had diagnosed cognitive impairment, and 55% had at least one diagnosed painful condition. Data for this correlational study were drawn from four nursing homes in Western Pennsylvania. The Multidimensional Observation Scale for Elderly Subjects was used to assess behavioral indicators of cognitive impairment, and chart review was used to obtain demographic, medication, and diagnostic data. RESULTS: The results indicated that cognitively impaired nursing home residents are prescribed and administered significantly less analgesic medication, both in number and in dosage of pain drugs than their more cognitively intact peers. In multiple regression analyses holding the presence of painful conditions constant, more disoriented and withdrawn residents were prescribed significantly less analgesia by physicians; more disoriented, withdrawn, and functionally impaired residents were administered significantly less analgesia by nursing staff. CONCLUSIONS: The findings highlight the difficulties of assessing pain in cognitively impaired elders and the lack of knowledge among health care providers about effective pain management.

Oligodontia--a case report.

Oligodontia is defined as the congenital absence of six or more teeth, excluding the third molars. Genetic factors play an important role in oligodontia, which can occur as an isolated finding or as part of a syndrome. Characteristic dental symptoms are a reduced number of teeth, a reduction in tooth size, anomalies of tooth form, and delayed eruption. This article describes treatment of a 6-year-old girl with congenital absence of 16 permanent teeth. Her malocclusion was corrected by orthodontic therapy, and removable partial dentures were made to improve esthetics and chewing function.

Morbidity and comorbidity among Great Lakes American Indians: predictors of functional ability.

This article explores patterns of morbidity and comorbidity and their ability to predict functional disability among American Indian elders, using data from a sample of urban, rural off-reservation, and reservation Great Lakes American Indians age 55 and older. Higher rates are reported of a number of chronic illnesses than found in overall samples of U.S. elders. Results of multiple regression analyses predicting Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs) show age to be a consistent predictor of functional disabilities: The CMI (Index of Comorbidity) was found to be a more useful predictor of functional disability than was the simple summation of the number of chronic illnesses.

Analysis of factors related to treatment and prognosis of leprosy patients in southern Taiwan.

This study was undertaken to investigate certain factors of leprosy, using bacterial indices, disability and regular treatment as outcome variables. One hundred and fifty seven leprosy patients were interviewed, face to face personally, using a standard questionnaire, and examined in order to grade these disabilities. Their clinic charts were reviewed and summarized. Percentage, Chi-square test, Fisher's exact test and logistic regression were used to analyze the data. Most patients (88%) were of low educational level; 57% were regularly treated in 1985. About half of the patients were diagnosed within one year. Dapsone was used at first diagnosis, while multiple drug therapy was in present use. The mean correct answer rate of the knowledge of leprosy was 0.49. Interaction with family members was not unusual. The major reason for neglecting treatment of the disease was that "the time is not available". Many patients did not appreciate the severity of the disease. Univariate analysis found that both "drug usage at first diagnosis" and "current drug usage" were related to "bacterial index". Only one factor "time-to-diagnosis" was related to "disability". The factors related to "regular treatment" were the "the time is not available", and "religion". Multiple logistic regression analysis found that the results were the same as those in univariate analysis, except that two more significant continuous variables were also related to regularity of treatment: duration of disease and a score of "beliefs about leprosy", neither analyzed in univariate analysis.

Gender-based differences in the cardiovascular response to standing.

Reduced tolerance to orthostatic stress is a recognized consequence of spaceflight. Both men and women serve as astronauts and are staying longer in space. While there are recognized cardiovascular differences in baseline function based on gender, little is known about any gender-based differences in cardiovascular responses to orthostatic stress. The purpose of this study was to compare the cardiovascular responses of men and women to the stand test. The subjects were 10 men and 10 women, 20-30 years of age. Heart rate, blood pressure, stroke volume, cardiac output, and total peripheral resistance were monitored during 5 min supine and 5 min standing. Men responded similarly in heart rate (39 vs. 35%); but had significantly greater decreases in stroke volume (-53 vs. -40%), cardiac output (-36 vs. -21%), and pulse pressure (-19 vs. -12%); and greater increases in blood pressure (11 vs. 6%) and total peripheral resistance (77 vs. 34%) than did the women. Men and women demonstrated fundamental differences in cardiovascular responses during standing. Differences in the height of the subjects did not account for these differing cardiovascular responses. The mechanisms for these differences are not yet clear. Men and women should be studied as separate groups until these differences are understood.