In vitro susceptibility of Clostridium difficile to SMT19969 and comparators, as well as the killing kinetics and post-antibiotic effects of SMT19969 and comparators against C. difficile.

OBJECTIVES: SMT19969 is a novel antimicrobial under clinical development for the treatment of Clostridium difficile infection (CDI). The objective was to determine the comparative susceptibility of 82 C. difficile clinical isolates (which included ribotype 027 isolates and isolates with reduced metronidazole susceptibility) to SMT19969, fidaxomicin, vancomycin and metronidazole and to determine the killing kinetics and post-antibiotic effects of SMT19969, fidaxomicin and vancomycin against C. difficile. METHODS: MICs were determined by agar incorporation. Killing kinetics and post-antibiotic effects were determined against C. difficile BI1, 630 and 5325 (ribotypes 027, 012 and 078, respectively). RESULTS: SMT19969 showed potent inhibition of C. difficile (MIC90=0.125 mg/L) and was markedly more active than either metronidazole (MIC90 = 8 mg/L) or vancomycin (MIC90 = 2 mg/L). There were no differences in susceptibility to SMT19969 between different ribotypes. Fidaxomicin was typically one doubling dilution more active than SMT19969 and both agents maintained activity against isolates with reduced susceptibility to metronidazole. In addition, SMT19969 was bactericidal against the C. difficile strains tested, with reductions in viable counts to below the limit of detection by 24 h post-inoculation. Vancomycin was bacteriostatic against all three strains. Fidaxomicin was bactericidal although reduced killing was observed at concentrations <20 × MIC against C. difficile BI1 (ribotype 027) compared with other strains tested. CONCLUSIONS: These data demonstrate that SMT19969 is associated with potent and bactericidal activity against the strains tested and support further investigation of SMT19969 as potential therapy for CDI.

SMT19969 as a treatment for Clostridium difficile infection: an assessment of antimicrobial activity using conventional susceptibility testing and an in vitro gut model.

OBJECTIVES: We investigated the efficacy of the novel antimicrobial agent SMT19969 in treating simulated Clostridium difficile infection using an in vitro human gut model. METHODS: Concentrations of the predominant cultivable members of the indigenous gut microfloras and C. difficile (total and spore counts) were determined by viable counting. Cytotoxin titres were determined using cell cytotoxicity and expressed as log10 relative units (RU). Clindamycin was used to induce simulated C. difficile PCR ribotype 027 infection. Once high-level cytotoxin titres (≥ 4 RU) were observed, SMT19969 was instilled for 7 days. Two SMT19969 dosing regimens (31.25 and 62.5 mg/L four times daily) were evaluated simultaneously in separate experiments. MICs of SMT19969 were determined against 30 genotypically distinct C. difficile ribotypes. RESULTS: SMT19969 was 7- and 17-fold more active against C. difficile than metronidazole and vancomycin, respectively, against a panel of genotypically distinct isolates (P < 0.05). Both SMT19969 dosing regimens demonstrated little antimicrobial activity against indigenous gut microflora groups except clostridia. SMT19969 inhibited C. difficile growth and repressed C. difficile cytotoxin titres in the gut model. CONCLUSIONS: These data suggest that SMT19969 is a narrow-spectrum and potent antimicrobial agent against C. difficile. Additional studies evaluating SMT19969 in other models of C. difficile infection are warranted, with human studies to place these gut model observations in context.

Spherical, cylindrical and tetrahedral symmetries; hydrogenic states at high magnetic field in Si:P.

Phosphorous donors in silicon have an electronic structure that mimics the hydrogen atom, albeit on a larger length, smaller energy and smaller magnetic field scale. While the hydrogen atom is spherically symmetric, an applied magnetic field imposes cylindrical symmetry, and the solid-state analogue involves, in addition, the symmetry of the Si crystal. For one magnetic field direction, all six conduction-band valleys of Si:P become equivalent. New experimental data to high laboratory fields (30 T), supported by new calculations, demonstrate that this high symmetry field orientation allows the most direct comparison with free hydrogen.

Smoking increases failure rate of operation for established non-union of the scaphoid bone.

The aim of the study was to investigate the effect of smoking on the operative treatment of established non-union of the carpal scaphoid. Case notes and radiographs of patients undergoing bone grafting and screw fixation of scaphoid non-unions were reviewed. There were 34 patients that had undergone 37 operations for established non-union of the carpal scaphoid bone. There were two female patients, and the average age was 26.8 years (range 13.4 years to 52.9 years). The median delay to operation was 11.9 months. The overall success rate of the operation (internal fixation and autologous bone grafting) was 59.5% (22/37), but there was a significant association between non-union and smoking (P=0.02 for Fisher's exact test). In non-smokers (n=17) the success rate was 82.4%, but this dropped to 40.0% among smokers (P<0.01). We concluded that smoking was significantly associated with failure of operative treatment of established non-union of the scaphoid bone.

Comparison of fermentation of selected fructooligosaccharides and other fiber substrates by canine colonic microflora.

OBJECTIVE: To compare fermentation characteristics of fructooligosaccharides (FOS) and other fiber substrates that are commonly found in canine diets. SAMPLE POPULATION: Fecal samples from 3 adult dogs. PROCEDURE: The ability of fiber substrates to be used in microbial fermentation reactions was assessed by use of an in vitro fermentation system. Dogs were fed a commercially available food, and feces were collected for use as the microbial inoculum. Substrates used were beet pulp, cellulose, soy fiber, mannanoligosaccharides (MOS), FOS, and 4 inulin products (inulin 1, 2, 3, and 4). Each substrate was incubated anaerobically with fecal inoculum and growth media for 6, 12, and 24 hours, and production of short-chain fatty acids (SCFA) was measured. RESULTS: Total production of SCFA was higher for fermentation of the 4 inulin products and FOS, whereas fermentation of beet pulp, MOS, and soy fiber resulted in moderate concentrations of SCFA. Fermentation of cellulose produced the lowest concentrations of total SCFA without detection of butyrate or lactate. Butyrate production was greatest for fermentation of the 4 inulin products and FOS. Total lactate production was greatest for FOS and inulin 4. As expected, production of SCFA increased for all substrates as fermentation time increased. CONCLUSIONS AND CLINICAL RELEVANCE: Canine fecal microflora ferment FOS-containing substrates in a similar manner, with little fermentation of cellulose-based carbohydrates. Furthermore, results of an in vitro fermentation system indicate that fiber type affects the metabolic activity of microorganisms, thus influencing the amount and nature of the end products of fermentation.

The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction.

OBJECTIVES/HYPOTHESIS: Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high-risk patients. STUDY DESIGN: We performed a randomized, prospective clinical trial. METHODS: Patients received either 1) parenteral piperacillin/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively, with piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria. RESULTS: Sixty-two patients met inclusion criteria and were enrolled in the study. The overall wound infection rate was 8.1% (95% confidence interval [CI], 2.7%-17.8%). Two of 31 patients (6.4%) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients (9.7%) randomly assigned to receive topical plus parenteral antibiotics. This difference was not statistically significant (P = >.05). Infection rate was not associated with flap type (rotational vs. free tissue transfer), mandibular reconstruction, age, gender, tumor site, stage, surgical duration, or blood loss. CONCLUSIONS: These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery. However, the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone.

Effect of unilateral condylectomy on the sheep temporomandibular joint.

Unilateral condylectomy was performed on five young adult sheep. The animals were killed at three months and both joints and the excised condyles were examined macroscopically and histologically. All five showed pronounced regeneration of the condylar head on the operated side. The articular surface was fibrous and fused to the disc. Four of the five opposite joints showed medial remodelling. Young sheep have a higher regenerative capability than human adults of equivalent age, and similar reactions to those of children.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Characterization of verruciform xanthoma by in situ hybridization and immunohistochemistry.

Verruciform xanthoma (VX) is a rare, benign lesion, mainly found in the oral mucosa. Histologically and ultrastructurally, the lesion is characteristic and well defined. However, the etiology of the lesion remains unclear. The purpose of the present study was to elaborate upon the pathogenesis of VX by evaluation of an additional series of oral examples for human papillomaviruses (HPV), using immunohistochemistry and in situ hybridization, and to further characterize the cellular components of VX immunohistochemically. Twelve specimens diagnosed as VX were retrospectively collected. One of the twelve specimens was positive for HPV types 6/11 by in situ hybridization. None of the twelve specimens demonstrated the presence of HPV antigen by immunohistochemistry. By immunohistochemical studies, the predominant cells in the inflammatory infiltrate were T cells. The foam cells were of monocyte/macrophage lineage. S-100-positive (Langerhans) cells were occasionally found in the suprabasal layer of the epithelium. HLA-DR-positive keratinocytes were noted at the intense inflammatory sites. Taken together, these findings suggest that an immune response may play a role, at least in part, in VX pathogenesis.

Nocturnal hypoxaemia in late pregnancy.

We have measured arterial oxygen saturation (SpO2) continuously overnight in 13 non-pregnant (NP), 13 pregnant normotensive (NPIH) and 15 pregnant patients with a diagnosis of pregnancy-induced hypertension (PIH). The two pregnant groups did not differ in duration of pregnancy (> 35 weeks) and none was in labour. There was no significant difference in age between these three groups. Mean SpO2 in group NP was 98.5% (range 97-99%). This was significantly higher than that in group NPIH (95.2 (91-98) %) and group PIH (94.9 (89-99) %). In seven pregnant patients, more than 20% of the recording was spent with an SpO2 < 90%. We conclude that a significant number of pregnant women (> 35 weeks' gestation) suffer from prolonged nocturnal hypoxaemia.

Identification of an attractant for the caneborerSesamia grisescens walker (Lepidoptera: Noctuidae).

The composition of the sex pheromone ofSesamia grisescens was investigated using gas chromatography, electroantennograms, and field trapping. (Z)-11-Hexadecenyl acetate and (Z)-11-hexadecenol were identified in field tests as the major attractants. Trapping trials identified a 3:2 blend of these compounds as the most effective bait. Gas chromatography indicated the presence of hexadecyl acetate. (Z)-9-hexadecenyl acetate, (Z)-9-hexadecenol, and (E)-11-hexadecenyl acetate in the pheromone gland, but these compounds had no significant effect on trap catches when added to the major components. Traps baited with the major components in a 1:1 ratio caught more male moths than traps baited with virgin females.

Management of chronic orofacial pain.

The diagnosis and management of chronic orofacial pain can be difficult due to the multifactorial nature of the problem involving organic, psychological and social and cultural variables. The establishment of multidisciplinary pain clinics can assist the medical practitioner in both diagnosis and treatment. A review of 185 patients complaining of chronic orofacial pain is presented to show the main conditions diagnosed at a pain clinic.