The third nationwide surveillance of antimicrobial susceptibility against Neisseria gonorrhoeae from male urethritis in Japan, 2016-2017.

Neisseria gonorrhoeae is one of the important pathogens of sexually transmitted infections. N. gonorrhoeae is rapidly becoming antimicrobial resistant, and there are few drugs that are effective in the initial treatment of gonorrhea. To understand the trends of antimicrobial susceptibility of N. gonorrhoeae, the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology conducted the third nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis. The specimens were collected from male patients with urethritis at 30 facilities from May 2016 to July 2017. From the 159 specimens collected, 87 N. gonorrhoeae strains were isolated, and 85 were tested for susceptibility to 21 antimicrobial agents. All strains were non-susceptible to penicillin G. Seven strains (8.2%) were ß-lactamase-producing strains. The rates of susceptibility to cefixime and cefpodoxime were 96.5% and 52.9%, respectively. Three strains were non-susceptible with a minimum inhibitory concentration (MIC) of 0.5 mg/L for cefixime. None of the strains were resistant to ceftriaxone or spectinomycin. The susceptibility rate for ciprofloxacin was 23.5% (20 strains), and no strains showed intermediate susceptibility. The susceptibility rate against azithromycin was 81.2%, with one strain isolated with a MIC of 8 mg/L against azithromycin. The results of this surveillance indicate that ceftriaxone and spectinomycin, which are currently recommended for gonococcal infections in Japan, appear to be effective. It will be necessary to further expand the scale of the next surveillance to understand the current status of drug-resistant N. gonorrhoeae in Japan.

Color and translucency of enamel in vital maxillary central incisors.

STATEMENT OF PROBLEM: Limited data, especially in vivo data, exist regarding translucency parameter (TP) values for vital anterior nonrestored dentition. Additionally, published information on the CIELab values of vital enamel at a theoretical infinite thickness is lacking. Obtaining TP and CIELab values in a population that varies in terms of ethnicity, age, and sex would be useful to inform the development and placement of esthetic dental restorations that more accurately capture the complex optical qualities of enamel. PURPOSE: The purpose of this clinical study was to investigate in vivo the TP and CIELab values of vital anterior incisor enamel at a theoretical infinite thickness in a diverse pool of participants who varied in age, ethnicity, and sex. MATERIAL AND METHODS: Spectral reflectance measurements (380 to 780 nm at 2-nm intervals) of the mid-incisal region of vital, unrestored maxillary anterior teeth were made in 120 participants, equally divided into 2 sexes, 4 racial or ethnic groups, and 5 age ranges. Instruments were oriented to achieve 0-degree observation and 45-degree illumination, and spectral measurements were made with white and black silicone backgrounds. Reflectance spectra of the incisal enamel from both the black and white silicone backing were used to fit to the Kubelka-Munk (K-M) reflectance theory. The CIEDE2000 color difference formula was used to determine TP, and data were compared among participant demographics. CIELab color coordinate values for enamel at an infinite thickness were calculated by using a D65 illumination and CIE standard human (2-degree) observer. To determine value ranges and significant differences among participant groups, CIELab values were analyzed with a 4-way ANOVA, and TP values were analyzed with a generalized linear mixed model. Pairwise comparisons of interest were evaluated with Bonferroni-corrected Student t tests. RESULTS: For maxillary central incisor enamel, the average TP was 10.1 ±3.6, and the average CIELab color coordinates were L∗=73.5 ±7.6, a∗=2.2 ±1.8, b∗=11.9 ±8.4. TP values of incisal enamel significantly differed among specific age and ethnic groups, with general significant interactions of age and sex (P=.009), as well as ethnicity and age (P=.042). CIE color coordinates of enamel at an infinite thickness were found in the L∗ coordinate among different age groups with the same sex and ethnicity, specifically when comparing CIELab direction with the population characteristics of age (P=.011) and the interaction between age, sex, and ethnicity (P=.035). CONCLUSIONS: In vivo L∗ values and TP values of incisal enamel differed significantly among groups determined by ethnicity, age, and sex.

Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan: Comparison with the first surveillance report.

The Urogenital Sub-committee and the Surveillance Committee of the Japanese Society of Chemotherapy, The Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology conducted the second nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis. In this second surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 26 hospitals and clinics from May 2016 to July 2017. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 41 isolates; the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, azithromycin and solithromycin were 2 µg/ml (2 µg/ml), 1 µg/ml (0.5 µg/ml), 0.25 µg/ml (0.25 µg/ml), 0.125 µg/ml (0.063 µg/ml), 0.125 µg/ml (0.125 µg/ml), 0.25 µg/ml (0.25 µg/ml), 0.031 µg/ml (0.031 µg/ml), 0.25 µg/ml (0.125 µg/ml), and 0.016 µg/ml (0.008 µg/ml), respectively. In summary, this surveillance project did not identify any strains resistant to fluoroquinolone, tetracycline, or macrolide agents in Japan. In addition, the MIC of solithromycin was favorable and lower than that of other antimicrobial agents. However, the MIC of azithromycin had a slightly higher value than that reported in the first surveillance report, though this might be within the acceptable margin of error. Therefore, the susceptibility of azithromycin, especially, should be monitored henceforth.

Validity of a visual scoring method using gummy jelly for evaluating chewing efficiency in a large-scale epidemiological survey.

BACKGROUND: Several methods exist for objectively evaluating chewing efficiency by using gummy jelly. However, the validity of the subjective visual evaluation of chewing efficiency has not been assessed. OBJECTIVE: To verify with an epidemiological study, the validity of a visual scoring method using gummy jelly by testing the relationship between masticatory performance (MP) using a fully automatic measuring system and visual score (VS) using a visual scoring method. METHODS: Community-dwelling elderly individuals (n = 1234) ≥70 years old participated. One evaluator measured VS consecutively after participants chewed the gummy jelly (ie, actual-VS). The chewed jelly was photographed. Two evaluators used the photograph to measure the gummy jelly (ie, photo-VS). To test the validity of both methods, the correlation between actual-VS and MP and between photo-VS and MP were analysed. Inter-rater reliability between the evaluators of photo-VS was analysed. RESULTS: Significant correlations existed between actual-VS and MP and between photo-VS and MP (r = 0.86-0.87; P < 0.001). The intra-class correlation coefficient of the inter-rater reliability for photo-VS was very high (0.93; P < 0.001; 95% confidence interval: 0.877-0.953); however, the distribution of photo-VS deviated slightly from the actual-VS. A large coefficient of variation in the MP for low VSs suggested the influence of incomplete comminution, which was not reflected by the VS, and the accidental swallowing of small pieces during chewing. CONCLUSION: The VS deviated slightly from the MP calculated using a fully automated method; however, the VS can be utilised for epidemiological surveys with numerous participants.

Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan.

Genital chlamydial infection is a principal sexually transmitted infection worldwide. Chlamydia trachomatis can cause male urethritis, acute epididymitis, cervicitis, and pelvic inflammatory disease as sexually transmitted infections. Fortunately, homotypic resistant C. trachomatis strains have not been isolated to date; however, several studies have reported the isolation of heterotypic resistant strains from patients. In this surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 51 hospitals and clinics in 2009 and 38 in 2012. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 19 isolates in 2009 and 39 in 2012. In 2009 and 2012, the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, and azithromycin were 2 µg/ml and 1 µg/ml, 0.5 µg/ml and 0.5 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.063 µg/ml and 0.063 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.016 µg/ml and 0.016 µg/ml, and 0.063 µg/ml and 0.063 µg/ml, respectively. In summary, this surveillance project did not identify any resistant strain against fluoroquinolone, tetracycline, or macrolide agents in Japan.

The second nationwide surveillance of the antimicrobial susceptibility of Neisseria gonorrhoeae from male urethritis in Japan, 2012-2013.

Worldwide, the most important concern in the treatment of sexually transmitted infections is the increase in antimicrobial resistant Neisseria gonorrhoeae strains including resistance to cephalosporins, penicillins, fluoroquinolones or macrolides. To investigate the trends of antimicrobial susceptibility among N. gonorrhoeae strains isolated from male patients with urethritis, a Japanese surveillance committee conducted the second nationwide surveillance study. Urethral discharge was collected from male patients with urethritis at 26 medical facilities from March 2012 to January 2013. Of the 151 specimens, 103 N. gonorrhoeae strains were tested for susceptibility to 20 antimicrobial agents. None of the strains was resistant to ceftriaxone, but the minimum inhibitory concentration (MIC) 90% of ceftriaxone increased to 0.125 µg/ml, and 11 (10.7%) strains were considered less susceptible with an MIC of 0.125 µg/ml. There were 11 strains resistant to cefixime, and the MICs of these strains were 0.5 µg/ml. The distributions of the MICs of fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin, were bimodal. Sitafloxacin, a fluoroquinolone, showed strong activity against all strains, including strains resistant to other three fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin. The azithromycin MICs in 2 strains were 1 µg/ml.

Proposed shade guide for attached gingiva--a pilot study.

PURPOSE: The purpose of this study was to evaluate the effect of race, age, and gender on Commision Internationale de l'Eclairage Lab color space (CIELAB) values of attached gingival colors. The color coordinates of an optimal proposed attached gingival shade guide were also determined. MATERIAL AND METHODS: Participants (n = 120) were recruited to fulfill the following stratification of five age groups: 18-29, 30-39, 40-49, 50-59, and 60-85, with four racial categories (white, black, Asian, and others) and balanced for gender. Reflectance measurements of participants' attached gingiva were made using a spectroradiometer and Xenon arc lamp with a 45/0 optical configuration. A stepwise discriminant analysis was carried out to identify gingival color contribution from race, age, and gender. A hierarchical clustering analysis was used to identify color groups that clustered together. The coverage error of the proposed shade guide was calculated to the original gingival color. RESULTS: The stepwise discriminant analysis showed a statistically significant difference in gingival color contribution from the factors evaluated. Significant influence was found for the race/gender factors (p < 0.05), but not for age. The cluster analysis results revealed three cluster centroids with mean L*a*b* as follows: (1 = 51.0 ± 4.2, 27.7 ± 4.7, 18.3 ± 3.2), (2 = 61.4 ± 4.5, 24.3 ± 4.3, 17.6 ± 2.3), and (3 = 36.1 ± 4.1, 21 ± 4.9, 16 ± 5.2). The coverage errors to the following racial categories were: Asian (ΔE = 6.0 ± 4.8), black (ΔE = 6.7 ± 3.9), others (ΔE = 5.8 ± 2.9), and white (ΔE = 4.6 ± 2.7). CONCLUSIONS: The study showed that L*a*b* was significantly affected by race and gender. Clustering analysis was able to identify clusters in 120 participants for three gingival tones.

Increased risk of falls in older adults with hearing loss and slow gait: results from the Otassha Study.

Age-related hearing loss (ARHL) and impaired gait both independently heighten the risk of accidental falls among older adults. However, the combined impact of these factors remains unclear. We analyzed the data of 786 community-dwelling Japanese older adults. Hearing was evaluated at frequencies of 1.0 and 4.0 kHz, with participants categorized into ARHL (> 25 dB) and non-ARHL groups. Gait was also assessed, defining slow gait (SG) as speeds one standard deviation below the age- and sex-specific mean. Participants were divided into four groups based on their ARHL and SG statuses and were monitored annually for 8 years to track falls and related injuries. Throughout the follow-up, incidents included 328 single falls (9.6/100 person-years), 117 multiple falls (2.8/100 person-years), 249 minor injuries from falls (6.7/100 person-years), and 55 fractures due to falls (1.3/100 person-years). Cox proportional hazard regression models showed that participants without ARHL but with SG faced a significantly increased risk of frequent falls. Furthermore, ARHL combined with SG significantly raised the risk of both single and frequent falls, and increased the incidence of both minor and severe fall-related injuries, including fractures. In contrast, no significant association was found between ARHL alone and fall-related incidents. These findings suggest that the previously reported risk associated with hearing loss in fall incidents predominantly relates to gait impairment. The co-occurrence of ARHL and SG significantly escalates the risk of falls and related injuries, highlighting the critical need for routine gait monitoring.

Nationwide surveillance of the antimicrobial susceptibility of Neisseria gonorrhoeae from male urethritis in Japan.

Neisseria gonorrhoeae is one of the most important pathogens causing sexually transmitted infection, and strains that are resistant to several antimicrobials are increasing. To investigate the trends of antimicrobial susceptibility among N. gonorrhoeae strains isolated from male patients with urethritis, a Japanese surveillance committee conducted the first nationwide surveillance. The urethral discharge was collected from male patients with urethritis at 51 medical facilities from April 2009 to October 2010. Of the 156 specimens, 83 N. gonorrhoeae strains were tested for susceptibility to 18 antimicrobial agents. The prevalence of ß-lactamase-producing strains and chromosomally mediated resistant strains were 7.2 % and 16.5 %, respectively. None of the strains was resistant to ceftriaxone, but the minimum inhibitory concentration (MIC) of ceftriaxone for 7 strains (8.4 %) was 0.125 µg/ml. One strain was resistant to cefixime (MIC 0.5 µg/ml). The MICs of fluoroquinolones, such as ciprofloxacin, levofloxacin, and tosufloxacin, showed a bimodal distribution. The MIC of sitafloxacin was lower than those of the three fluoroquinolones listed here, and it was found that the antimicrobial activity of sitafloxacin was stronger than that of the fluoroquinolones. The MIC of azithromycin in 2 strains was 2 µg/ml, but no high-level resistance to macrolides was detected.

The combination of a nylon and traditional partial removable dental prosthesis for improved esthetics: a clinical report.

A benefit of a nylon partial removable dental prosthesis (PRDP) is the absence of a metal framework, providing improved esthetics. Unfortunately, the lack of a traditional framework reduces rigidity and the support of occlusal rests. This clinical report describes a combination of a nylon PRDP (polyamide denture base resin) and a traditional PRDP (framework/resin) for a Kennedy Class II, Modification 1, partially edentulous mandible.

Cognitive, physical, and mental profiles of older adults with misplaced self-evaluation of hearing loss.

BACKGROUND: Although inconsistency between objective and subjective hearing loss among older adults has been suggested, a systematic examination of the cognitive and physical functioning among such older adults is lacking. Our objective was to assess the cognitive, physical, and mental profiles associated with the discrepancy. METHODS: The auditory acuity of 696 community-dwelling older adults was evaluated using a pure-tone average of hearing thresholds at 1.0 and 4.0 kHz in the better-hearing ear. Participants were then stratified as follows: normal hearing ≤ 25 dB, mild loss >25 dB and ≤40 dB, and moderate loss >40 dB and ≤70 dB. Global cognition, gait speed, and depressive symptoms were also assessed. RESULTS: Among older adults, 63.5% of those with mild hearing loss and 22.2% of those with moderate hearing loss did not recognize hearing difficulties. Significantly lower cognition and gait performance were observed in those with moderate hearing loss without subjective hearing loss (i.e., overestimation of hearing acuity) than in those with subjective hearing loss. Furthermore, older adults with subjective hearing loss showed a higher tendency toward depression than those without subjective hearing loss, irrespective of objective hearing loss. CONCLUSIONS: Our results suggest that failure to recognize a high level of age-related hearing loss may be related to impaired cognition and gait performance among older adults. Subjective hearing loss may indicate a tendency toward depression.

Denture wearing is associated with nutritional status among older adults requiring long-term care: A cross-sectional study.

BACKGROUND/PURPOSE: Dentures are important for the reconstruction of occlusal support and masticatory performance for older adults with poor dentition. We aimed to elucidate the oral health factors associated with malnutrition in older adults requiring long-term care, including denture use. MATERIALS AND METHODS: This cross-sectional study included 322 older adults (63 men, 259 women; mean age, 86.6 ± 6.9 years) who required long-term care in rural Japan. The participant's nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA®-SF). Oral health was assessed using participant's dentition and oral function. Barthel Index (BI) and medical history were measured for assessing general health status. Multiple logistic regression analyses were performed to determine the oral health factors associated with malnutrition. RESULTS: The proportion of participants with malnutrition was 17.2%. The BI score (odds ratio [OR], 0.95; 95% confidence interval [CI] 0.93-0.98, p<0.001), having <20 teeth and dentures (OR 0.42; 95%CI 0.18-0.99; p = 0.047), and poor lip-closure ability (OR 2.86; 95%CI 1.32-6.20; p = 0.008) were significantly associated with malnutrition. CONCLUSION: Denture use, lip-closure ability, and activities of daily living were significantly associated with malnutrition in older adults requiring long-term care, suggesting that wearing dentures for tooth loss and maintaining oral function contributes to nutritional status.

Factors Associated with Denture Non-use in Older Adults Requiring Long-Term Care.

BACKGROUND: Evidence suggests that denture non-use is significantly associated with activities of daily living, oral function, and cognitive decline. Few studies have focused on the possibility that the indications for denture use may differ depending on the cognitive and physical functions in older adults requiring long-term care. OBJECTIVES: The aim of this study was to elucidate the factors associated with denture non-use in older adults requiring long-term care. METHODS: This cross-sectional study comprised 201 older adults (45 men and 156 women; average age = 86.2 ± 7.1 years) requiring long-term care in Japan. Those who did not require denture treatment were classified by dentists into denture-use and denture non-use groups. The severity of dementia was assessed using the Clinical Dementia Rating scale. Multiple logistic regression analyses were conducted to detect the factors significantly associated with denture non-use. RESULTS: The proportion of participants without dentures was 58.2%. Multiple logistic regression analyses revealed that a moderate dementia (odds ratio [OR], 4.44; 95% confidence interval [CI] 1.18-16.71, p=0.027) and rinsing ability (OR 3.00; 95% CI 1.12-8.06; p=0.030) were significant factors related to the non-use of dentures. CONCLUSION: Severity of dementia and rinsing ability were significantly associated with non-use of dentures. These findings indicate the necessity of evaluating oral and cognitive functions while planning denture treatment in older adults requiring long-term care.

Relation between knee extension torque and occlusal force in community-dwelling elderly adults.

The relation between occlusal force and general motor ability induced by lower-limb musculature is unclear. To identify indicators of oral and lower-limb muscle weakness, this study examined the relation between masticatory muscle strength and lower limb muscle force in 742 community-dwelling elderly adults (315 men and 427 women, mean age 73.3 ± 5.5 years) living in Itabashi ward, Tokyo. Multiple regression analysis of the relation between occlusal force and knee extension torque, in relation to age and sex, showed a significant correlation between the two variables (r = 0.348, P < 0.001), which indicates that occlusal force is a determinant of knee extension torque. Occlusal force remained significantly correlated with knee extension torque after adjustment for factors known to be related to the latter. In conclusion, chewing function and lower-limb motor function were significantly correlated and thus might be indicators of muscle weakness in elderly adults.

[Case report: long-term follow-up of a transitional denture].

PATIENT: A 70-year-old woman visited our clinic with a chief complaint of chewing difficulty due to serious periodontitis and an improper RPD. A poor prognosis of the maxillary anterior residual teeth was predicted. However, the patient' s consent for tooth extraction could not be obtained. Consequently, the RPD was designed for the future additional tooth. DISCUSSION: The maxillary RPD has been functioning for 9 years through repeated additional teeth and repairs. Designing of the metal plate for the predicted prognosis allowed for additional teeth and repairs after losing of the residual teeth. CONCLUSION: Designing of the denture for the predicted prognosis allowed long-term continuous use of the denture.

Utility of the luminance standard deviation to quantify magnetic resonance imaging motion artifact induced by tongue movement.

Clear magnetic resonance imaging (MRI) is required to diagnose tongue cancer. However, the absence of occlusal support may cause tongue movements which are known to introduce artifacts on the MR image. This pilot study compared the manifest of artifacts from the tongue at rest and during motion using luminance standard deviation (LSD) to quantify the artifacts, in dentulous subjects. Participants were ten dentulous participants (5 males, 5 females; age 31.50 ± 8.38 years) with occlusal support. MRI was conducted with the tongue at rest and during lateral movement. The LSD was measured in the regions of interest (ROI) in the axial and sagittal planes. Tongue movement evoked unclear MR images, compared with the images taken at rest. Statistical analysis revealed that the LSD significantly differed between the tongue at rest and in motion in the axial (P = 0.004) and sagittal planes (ROI-A: P = 0.002, ROI-P: P = 0.006). These findings suggest that tongue movement introduces motion artifact and the LSD responds quantitatively to the magnitude of artifacts. Future studies will evaluate whether a prosthetic device used to provide occlusive support can decrease these artifacts when analyzed using LSD.

Dentures wearing reduce motion artifacts related to tongue movement in magnetic resonance imaging.

PURPOSE: Tongue movement with unstable swallowing cause artifacts on magnetic resonance imaging (MRI). This may be associated with loss of occlusal support. This study aimed to clarify whether motion artifacts can be mitigated by denture wearing during MRI examination in patients without occlusal support, and whether denture wearing affect tongue stability, form, and position were also evaluated. METHODS: Ten subjects without occlusal support (6 male, 4 female; mean age 73.20±10.12 years) participated in the study. MRI was performed with dentures worn (DW), followed with removal of dentures (NDW). Luminance standard deviation (LSD) was measured in regions of interest in the axial and sagittal planes. The position of the base of the tongue (TB), tip of the tongue apex (TA), and tongue's long diameter (TLD) were compared between DW and NDW. RESULTS: NDW evoked ambiguous MR images in the axial and sagittal planes compared with DW. There were significant differences in LSD between DW and NDW in both the axial (p=0.047) and sagittal planes (p=0.02). No significant difference in the position of TB were observed (p=0.78). The position of TA was significantly more protruded with DW (p=0.007). Also, TLD was significantly longer with DW (p=0.001). CONCLUSIONS: Results of this study suggest that wearing the dentures during MRI examination reduces motion artifacts in edentulous patients without occlusal support, and maintained the normal form of the tongue during imaging.

The relationship between masseter muscle thickness and appendicular skeletal muscle mass in Japanese community-dwelling elders: A cross-sectional study.

PURPOSE OF THE STUDY: Sarcopenia has been identified as a health hazard in elderly people. Although the association between sarcopenia and a decrease in masticatory function has been reported, the mechanism underlying this association has not been widely reported. Therefore, in order to elucidate the relationship between sarcopenia and masticatory function, we examined whether the masseter muscle thickness (MMT), which is a factor influencing masticatory function, in community-dwelling elders is associated with the appendicular skeletal muscle index (SMI), a diagnostic criterion for sarcopenia. MATERIALS AND METHODS: MMT was measured in 774 community-dwelling elders aged 65 years or older at resting state via ultrasonography, and SMI was measured with the bioelectrical impedance method. The relationships were investigated by calculating Pearson's correlation coefficients. Multiple regression analyses adjusted for age and sex, SMI, and oral-related items were performed to determine the association between these factors. RESULTS: There was a significant correlation between the MMT and the SMI. The multiple regression analysis indicated that SMI was significantly associated with a decrease in MMT. CONCLUSIONS: The reduction in whole-body skeletal muscle mass in sarcopenia may be involved in the reduction in MMT. Prevention of sarcopenia may be an important factor for maintaining masticatory function in the elderly.

Quantitative evaluation of diagnostic information around the contours in ultrasound images.

PURPOSE: To develop a new contour extraction method for identifying abnormal tissue. METHODS: We combined two techniques: logarithmic K distribution of a scattering model (method 1) and regional discrimination using the characteristics of local ultrasound images (method 2) into an integrated method (method 3) that provides accurate contours, which are essential for quantitizing border information. RESULTS: The diagnostic tissue information around the border of an image can be characterized by its shape and texture statistics. The degrees of circularity and irregularity and the depth-width ratio were calculated for the extracted contours of breast tumors. In addition, gradients, separability, and variance between the two regions along the contour and the area and variance of the internal echoes, were calculated as indices of diagnostic criteria of breast tumors. The quantitized indices were able to discriminate among cysts, fibroadenomas, and cancer. CONCLUSION: In many ultrasound images of breast tumors, the combined techniques, the variance ratio of the logarithmic K distribution to the logarithmic Rayleigh distribution and the multilevel technique with local image information can effectively extract abnormal tissue contours.

Antimicrobial activity of imipenem against isolates from complicated urinary tract infections.

Antimicrobial activity of imipenem was measured using 4725 strains isolated from patients with complicated urinary tract infections (CUTIs) between 1988 and 2000. Imipenem was inactive against methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis, Enterococcus faecium and some non-fermenting Gram-negative rods. Resistant strains (MIC>16 mg/l) were observed in Staphylococcus haemolyticus (22%), Enterococcus faecalis (4%), Enterococcus avium (8%), Serratia marcescens (5%) and Pseudomonas aeruginosa (7%). Although the prevalence of imipenem-resistant strains of S. aureus, S. epidermidis and P. aeruginosa was sporadically high in some years, no steady increase was seen over the period. Resistant strains were rare in other major uropathogenic species. These results suggest that imipenem is still one of the most reliable antimicrobial drugs.