Is there a risk for bacterial transmission from surgical marker pens?

Markers for preoperative skin marking are used several times and bear a risk of transmitting bacteria. Bacterial contamination was assessed by sonication and culture. Antimicrobial susceptibility testing (AST) was performed for facultative pathogens to assess multi-drug resistance (MDR). An accelerated failure time model was applied to assess the statistical relationship between the bacterial contamination and the filling status of markers. Of 45 markers, 13 had a colony count <10 cfu/mL and 32 had counts from 10 to 12,500 cfu/mL. Three markers were colonized by Staphylococcus aureus. No MDR bacteria were found. We recommend single use of markers to reduce transmission risk.

European core curriculum in neurorehabilitation.

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

Subjective body vertical: a promising diagnostic tool in idiopathic normal pressure hydrocephalus?

Postural instability is a frequent symptom of patients with idiopathic normal pressure hydrocephalus (iNPH), and might be due to the misperception of body verticality. The objective of this study was to assess the usefulness of the subjective body vertical (SBV) as a potential tool for diagnosing iNPH. Twenty patients with iNPH underwent tests of SBV in the pitch and roll planes before and after cerebrospinal fluid (CSF) drainage. Ten patients with other central gait disorders served as controls and also underwent tests for SBV. Before CSF drainage, patients with iNPH showed an impaired verticality perception in the pitch plane with a significant backward deviation of the SBV as compared to the control group (iNPH: mean ± SD -3.7 ± 3.6°; control group: -0.8 ± 2.2°; t value = -2.30, p t-test = 0.03). After CSF drainage, the SBV of the iNPH patients normalized for the pitch plane (-0.9 ± 1.9°). There was a correlation between the backward deviation of the SBV and the ventricular enlargement of the frontal horns (Evan's index; r = -0.52; p Pearson = 0.02). An even stronger correlation was found with the enlargement of the third ventricle (Thalamus index; r = -0.64; p Pearson = 0.002). The new and clinically relevant finding of this study is that verticality perception of patients with iNPH is primarily impaired the pitch plane, and it improves after CSF drainage. This disturbance in pitch might be due to a bilateral central vestibular dysfunction of the thalamus. Determination of the SBV in pitch promises to increase diagnostic accuracy in the cases of suspected iNPH.

Lifetime of vibrational levels from Fourier grid calculations: RbCs example.

We present systematic calculations of the lifetimes of vibrational levels of excited Rb(5s)Cs(6p(1/2)) 0(+) electronic states. We show that a precise description of the variation with the internuclear distance of the transition dipole moment between electronic states is essential. It is also crucial to account precisely for the spin-orbit coupling between the Rb(5s)Cs(6p) A (1)Σ(+) and b (3)Π states. We describe the general trends of the probability of formation of stable molecules in the Rb(5s)Cs(6s) X (1)Σ(+) and a (3)Σ(+) electronic states, through radiative decay from the 0(+)v' levels, together with the branching ratios for the obtention of singlet or triplet molecules, stable with respect to dissociation. Furthermore, this analysis allows us to demonstrate the efficiency of the Mapped Fourier Grid Hamiltonian Representation method (MFGHR) to determine rigorously the energy variation, throughout the continuous part of the spectrum, of the density of an observable connecting bound vibrational levels and continuum states. The resolution in energy can be adapted to the studied problem through a judicious choice of the grid parameters.

Comparison of methods to detect recent HIV type 1 infection in cross-sectionally collected specimens from a cohort of female sex workers in the Dominican Republic.

Interest in estimating HIV-1 incidence using specimens obtained as part of cross-sectional surveys has led to the development of new methods to detect recent HIV-1 infection through the testing of a single anti-HIV-positive specimen. These assays are based on quantitative and qualitative differences in anti-HIV-1 antibodies between recent and long-standing infections. An ongoing vaccine preparedness study enrolled female sex workers in the Dominican Republic. Specimens from women found to be HIV positive at baseline were tested for recent HIV-1 infection using the detuned assay, avidity index, and BED-CEIA assay. An unweighted kappa statistic in pairwise comparisons was used to estimate the correlation of recent HIV-1 infection detection by the three methods. Nineteen (3.9%) of 482 women were positive for HIV-1 infection. The incidence of HIV infection was 1.4% [95% confidence interval (CI): 0.2, 5.3], 0.9%(95% CI: 0.1, 4.4), and 1.0%(95% CI: 0.1, 4.4) using detuned assay, avidity index, and BED-CEIA techniques, respectively. The overall agreement between both detuned assay and avidity index and detuned assay and BED-CEIA was 94%(kappa = 0.8, 95% CI; 0.3, 1.0). The correlation was highest between BED-CEIA and avidity index methods (100%; kappa = 1.0). All three methods performed similarly in detecting recent HIV-1 infection in this region dominated by clade B HIV-1 infection. Although incidence estimates were slightly higher using the detuned assay method, they were not significantly different. These assays may be of value in both clinical research and practice. The utility of individual assays for recent infection detection will depend upon operating characteristics, HIV-1 subtype limitations, and selection of appropriate assay cutoff values.

[Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital"]. / Frührehabilitation im Krankenhaus--Definition und Indikation. Ein Ergebnisbericht der Methodengruppe "Frührehabilitation im Krankenhaus".

As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.

[Nightmares in patients with Alzheimer's disease caused by donepezil. Therapeutic effect depends on the time of intake]. / Albträume bei Patienten mit Alzheimer-Demenz durch Donepezil. Therapeutischer Effekt ist abhängig vom Einnahmezeitpunkt.

Dementia of the Alzheimer type (DAT) has been linked to losses of cholinergic function in the brain. The acetylcholinesterase inhibitors donepezil, rivastigmine and galantamine improve cognitive performance in manifest dementia. These substances, however, also influence the quality of sleep, and particularly the quality and amount of dreams. We therefore investigated the influence of the time point of donepezil intake on the occurrence of nightmares. We observed a clear-cut relationship between the occurrence of nightmares and an evening dose of donepezil in eight patients with DAT. None of these patients reported nightmares when donepezil was taken in the morning. We suggest that the activation of the visual association cortex during REM sleep is enhanced by donepezil, a mechanism most likely facilitating the development of nightmares in patients with DAT.

Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study.

BACKGROUND: Functional disability is generally caused by hemiplegia after stroke. Physiotherapy used to be the only way of improving motor function in such patients. However, administration of amphetamines in addition to exercise improves motor recovery in animals, probably by increasing the concentration of norepinephrine in the central nervous system. Our aim was to ascertain whether levodopa could enhance the efficacy of physiotherapy after hemiplegia. METHODS: We did a prospective, randomised, placebo-controlled, double-blind study in which we enrolled 53 primary stroke patients. For the first 3 weeks patients received single doses of levodopa 100 mg or placebo daily in combination with physiotherapy. For the second 3 weeks patients had only physiotherapy. We quantitatively assessed motor function every week with Rivermead motor assessment (RMA). FINDINGS: Six patients were excluded from analyses because of non-neurological complications. Motor recovery was significantly improved after 3 weeks of drug intervention in those on levodopa (RMA improved by 6.4 points) compared with placebo (4.1), and the result was independent of initial degree of impairment (p<0.004). The advantage of the levodopa group was maintained at study endpoint 3 weeks after levodopa was stopped. At the end of the study the total RMA score gain for the levodopa group was 8.2 points compared with 5.7 in the placebo group (p=0.020). INTERPRETATION: A single dose of levodopa is well tolerated and, when given in combination with physiotherapy, enhances motor recovery in patients with hemiplegia. In view of its minimal side-effects, levodopa will be a possible add- on during stroke rehabilitation.

Cryptic peripheral ribosomal domains distributed intermittently along mammalian myelinated axons.

A growing body of metabolic and molecular evidence of an endogenous protein-synthesizing machinery in the mature axon is a challenge to the prevailing dogma that the latter is dependent exclusively on slow axoplasmic transport to maintain protein mass in a steady state. However, evidence for a systematic occurrence of ribosomes in mature vertebrate axons has been lacking until recently, when restricted ribosomal domains, called "periaxoplasmic plaques," were described in goldfish CNS myelinated axons. Comparable restricted RNA/ribosomal "plaque" domains now have been identified in myelinated axons of lumbar spinal nerve roots in rabbit and rat on the basis of RNase sensitivity of YOYO-1-binding fluorescence, immunofluorescence of ribosome-specific antibodies, and ribosome phosphorus mapping by electron spectroscopic imaging (ESI). The findings were derived from examination of the axoplasm isolated from myelinated fibers as axoplasmic whole mounts and delipidated spinal nerve roots. Ribosomal periaxoplasmic plaque domains in rabbit axons were typically narrow ( approximately 2 microm), elongated ( approximately 10 microm) sites that frequently were marked by a protruding structure. The domain complexity included an apparent ribosome-binding matrix. The small size, random distribution, and variable intermittent axial spacing of plaques around the periphery of axoplasm near the axon-myelin border are likely reasons why their systematic occurrence has remained undetected in ensheathed axons. The periodic but regular incidence of ribosomal domains provides a structural basis for previous metabolic evidence of protein synthesis in myelinated axons.

[Familial myoclonus-dystonia syndrome associated with panic attacks]. / Familiäres Myoklonus-Dystonie-Syndrom assoziiert mit Panikattacken.

We report a case of autosomal dominantly inherited dystonia and panic attacks to discuss successful treatment of a common serotonergic pathology with medication. The objective analysis of the movement disorder was done by Optotrak. First we demonstrate a reduction of the myoclonus by L-5-hydroxytryptophan, which inhibits after 11 months. After changing the medication to Nefadozone, the myoclonus and the frequency of panic attacks were reduced.

Protein synthesis in axons and terminals: significance for maintenance, plasticity and regulation of phenotype. With a critique of slow transport theory.

This article focuses on local protein synthesis as a basis for maintaining axoplasmic mass, and expression of plasticity in axons and terminals. Recent evidence of discrete ribosomal domains, subjacent to the axolemma, which are distributed at intermittent intervals along axons, are described. Studies of locally synthesized proteins, and proteins encoded by RNA transcripts in axons indicate that the latter comprise constituents of the so-called slow transport rate groups. A comprehensive review and analysis of published data on synaptosomes and identified presynaptic terminals warrants the conclusion that a cytoribosomal machinery is present, and that protein synthesis could play a role in long-term changes of modifiable synapses. The concept that all axonal proteins are supplied by slow transport after synthesis in the perikaryon is challenged because the underlying assumptions of the model are discordant with known metabolic principles. The flawed slow transport model is supplanted by a metabolic model that is supported by evidence of local synthesis and turnover of proteins in axons. A comparison of the relative strengths of the two models shows that, unlike the local synthesis model, the slow transport model fails as a credible theoretical construct to account for axons and terminals as we know them. Evidence for a dynamic anatomy of axons is presented. It is proposed that a distributed "sprouting program," which governs local plasticity of axons, is regulated by environmental cues, and ultimately depends on local synthesis. In this respect, nerve regeneration is treated as a special case of the sprouting program. The term merotrophism is proposed to denote a class of phenomena, in which regional phenotype changes are regulated locally without specific involvement of the neuronal nucleus.

Field evaluation of the Determine rapid human immunodeficiency virus diagnostic test in Honduras and the Dominican Republic.

Rapid detection of human immunodeficiency virus (HIV) infection can result in improved patient care and/or faster implementation of public health preventive measures. A new rapid test, Determine (Abbott, Abbott Park, Ill.), detects HIV type 1 (HIV-1) and HIV-2 antibodies within 15 min by using 50 microl of serum or plasma. No specialized equipment or ancillary supplies are required, and results are read visually. A positive result is noted by the appearance of a red line. An operational control (red line) indicates proper test performance. We evaluated the Determine rapid HIV detection test with a group of well-characterized serum samples (CD4 counts and viral loads were known) and serum samples from HIV-positive individuals at field sites in Honduras and the Dominican Republic. In the field evaluations, the results obtained by the Determine assay were compared to those obtained by local in-country HIV screening procedures. We evaluated serum from 100 HIV-positive patients and 66 HIV-negative patients. All samples gave the expected results. In a companion study, 42 HIV-positive samples from a Miami, Fla., serum bank were tested by the Determine assay. The samples had been characterized in terms of CD4 counts and viral loads. Fifteen patients had CD4 counts <200 cells/mm(3), while 27 patients had CD4 counts >200 cells/mm(3). Viral loads ranged from 630 to 873,746 log(10) copies/ml. All samples from the Miami serum bank were positive by the Determine test. Combined results from the multicenter studies indicated that the correct results were obtained by the Determine assay for 100% (142 of 142) of the HIV-positive serum samples and 100% (66 of 66) of the HIV-negative serum samples. The Determine test was simple to perform and the results were easy to interpret. The Determine test provides a valuable new method for the rapid identification of HIV-positive individuals, especially in developing countries with limited laboratory infrastructures.

Protein-synthesizing machinery in the axon compartment.

Contrary to the prevailing view that the axon lacks the capacity to synthesize proteins, a substantial body of evidence points to the existence of a metabolically active endogenous translational machinery. The machinery appears to be largely localized in the cortical zone of the axon, where, in vertebrate axons, it is distributed longitudinally as intermittent, discrete domains, called periaxoplasmic plaques. Studies, based on translation assays and probes of RNA transcripts in axon models such as the squid giant axon and selected vertebrate axons, provide evidence of locally synthesized proteins, most of which appear to be constituents of the slow axoplasmic transport rate groups. Metabolic and molecular biological findings are consistent with the view that the synthesis of proteins undergoing local turnover in the axonal compartment of macroneurons depends on the activity of an endogenous translational machinery. The documented presence of a metabolically active machinery in presynaptic terminals of squid photoreceptor neurons is also described. Finally, potential sources of axoplasmic RNAs comprising the machinery, which may include the ensheathing cell of the axon, as well as the cognate cell body, are also discussed.

Cortical plaque-like structures identify ribosome-containing domains in the Mauthner cell axon.

The hypothesis that ribosomes are present, but may have a restricted distribution, in the Mauthner (M) axon was evaluated in isolated M-cell axoplasm after (1) staining with YOYO-1 and (2) inspection by electron spectroscopic imaging (ESI) of ribosomal RNA (rRNA) phosphorus (P). Discrete periaxoplasmic plaques, identified by their ribonuclease-sensitive fluorescence, were located circumferentially at the surface boundary of isolated axoplasm and distributed longitudinally at random intervals. Conditions that destabilized plaques, and surface blotting of plaques onto a coverslip, revealed that fluorescent puncta were probably a significant source of plaque fluorescence. Fluorescent puncta were also distributed in a delimited volume of axoplasm, subjacent to the plaque. The notably higher density of F-actin in the latter region suggested that the actin cytoskeleton may govern the spatial distribution of puncta in subcortical axoplasm. Some fluorescent plaques were superficial to the cortical F-actin layer, whereas others formed inclusions within the F-actin layer; however, plaques did not appear to contain F-actin. Periaxoplasmic plaques were also identified in ordinary myelinated axons. ESI, in which rRNA emits bright signals in the phosphorus (P) spectral line against a low-contrast background, showed that isolated axoplasm contained characteristic 25 nm P signals, which were associated or in direct contact with a pleiomorphic structural matrix, located at the surface boundary. Polyribosomal P signals were also distributed in peripheral axoplasm below the matrix. The concept of a distinct polyribosome-populated domain, distributed intermittently in the cortical zone of the axon is described. This domain is spatially defined by a plaque-like periaxoplasmic structural matrix, and a confluent volume of subcortical axoplasm integrated through an actin cytoskeleton.

Direct calorimetry for the measurement of heat release in preterm infants: methods and applications.

Direct calorimetry is a sensitive and accurate method for the measurement of biologic heat release in humans. At the Children's Medical Center of Brooklyn, State University of New York, we have established direct calorimetry for the measurement of heat release by low birth weight premature infants. We have tested the method and find it to be simple, safe, and accurate. We studied heat release in 10 low birth weight infants on 22 occasions. The smallest infant in the study group weighed 1.43 kg. All the infant underwent direct calorimetry between 1 week and 18 weeks of age. Heat release in the infants ranged from 1.31 kcal/kg/hr. This method of direct calorimetry offers a tool for measuring total metabolic heat release from the first weeks of life in very low birth weight infants to estimate the insensible water losses and to examine the effect of various feeding regimens and disease states on total heat release.