Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 exhibit strong antifungal effects against vulvovaginal candidiasis-causing Candida glabrata isolates.

AIMS: This study investigates the antagonistic effects of the probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 against vulvovaginal candidiasis (VVC)-causing Candida glabrata. METHODS AND RESULTS: Growth inhibitory activities of Lact. rhamnosus GR-1 and Lact. reuteri RC-14 strains against C. glabrata were demonstrated using a spot overlay assay and a plate-based microtitre assay. In addition, these probiotic lactobacilli strains also exhibited potent candidacidal activity against C. glabrata, as demonstrated by a LIVE/DEAD yeast viability assay performed using confocal laser scanning microscopy. The metabolic activities of all C. glabrata strains were completely shut down in response to the challenges by the probiotic lactobacilli strains. In addition, both probiotic lactobacilli strains exhibited strong autoaggregation and coaggregation phenotypes in the presence of C. glabrata, which indicate that these lactobacilli strains may exert their probiotic effects through the formation of aggregates and, thus the consequent prevention of colonization by C. glabrata. CONCLUSIONS: Probiotic Lact. rhamnosus GR-1 and Lact. reuteri RC-14 strains exhibited potent antagonistic activities against all of the tested C. glabrata strains. These lactobacilli exhibited antifungal effects, including those attributed to their aggregation abilities, and their presence caused the cessation of growth and eventual cell death of C. glabrata. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study to report on the antagonistic effects of these probiotic lactobacilli strains against the non-Candida albicans Candida (NCAC) species C. glabrata.

Msps/XMAP215 interacts with the centrosomal protein D-TACC to regulate microtubule behaviour.

The XMAP215/ch-TOG/Msps family of microtubule-associated proteins (MAPs) promote microtubule growth in vitro and are concentrated at centrosomes in vivo. We show here that Msps (mini-spindles protein) interacts with the centrosomal protein D-TACC, and that this interaction strongly influences microtubule behaviour in Drosophila embryos. If D-TACC levels are reduced, Msps does not concentrate at the centrosomes efficiently and the centrosomal microtubules appear to be destabilized. If D-TACC levels are increased, both D-TACC and Msps accumulate around the centrosomes/spindle poles, and the centrosomal microtubules appear to be stabilized. We show that the interaction between D-TACC and Msps is evolutionarily conserved. We propose that D-TACC and Msps normally cooperate to stabilize centrosomal microtubules by binding to their minus ends and binding to their plus ends as they grow out from the centrosome.

Facilitators and barriers to the training and maintenance of young persons' advisory groups (YPAGs).

INTRODUCTION: Increasing demands from public and private healthcare coupled with national initiatives in patient-oriented research has led to an increase in avenues to allow patients to be directly involved in research. In particular, the push towards participation of children and youth has resulted in the formation of pediatric patient advisory groups with broad partnerships and consultation requests across the globe. However, there is a lack of evidence to examine the challenges in formation and training of young persons' advisory groups (YPAGs) and management processes required thereafter. PURPOSE AND OBJECTIVES: This study's purpose is to document YPAG formation and training protocols around the world, highlight common strengths, and evaluate pitfalls and challenges. The results from this study will subsequently inform the development of standardized training protocols for children and youth to be piloted globally. METHODS: In this study, 17 select YPAG team leaders from 7 countries were surveyed to determine current training techniques used within existing groups. 17 youth representatives and 16 team leaders were then interviewed to gather further qualitative data on facilitators and barriers that aid or prevent successful initiation and maintenance of these groups. Qualitative interview data was coded and analyzed using NVivo by two independent reviewers (SYC, VWLT). Any inconsistencies in thematic analysis was confirmed by a third reviewer (JB). RESULTS: The most common training topics include consent and assent (64.71%), clinical trials (64.71%), and patient safety (70.59%). There are significant discrepancies to the amount of training received by each team. Most YPAGs out of the 17 groups receive no formal training (58.82%) while training sessions in the remaining 7 groups vary in both duration and frequency. Collectively, meetings ranged from 15  minutes to 6  hours long, with the majority of team meetings being 2-3  hours long (58.82%). The most common training facilitators are a positive relationship with a local hospital (82.35%) and access to a dedicated team coordinator (64.71%). 70.59% of team leaders identified a lack of access to appropriate educational materials available as a drawback to the impact of their YPAG, making this the greatest common barrier. CONCLUSION: Bringing children and youth to the forefront of paediatric trials and clinical research facilitates appropriate patient representation in subsequent research decision-making. There is an urgency to create and implement standardized protocols for the training of children and youth, especially in preparation for national and international research consultations. This low barrier framework may be of special interest to lower-middle-income countries who wish to encourage community participation in healthcare.

Acardiac anomaly.

Two cases of acardius, one in a twin and the other in a triplet pregnancy are presented. The obstetrical significance and current management options are discussed.

A 6 year review of ectopic pregnancy.

PIP: During the period 1972-77, there were 106 cases of ectopic pregnancy, confirmed by laparotomy, at Kandang Kerbau Hospital, Singapore. This makes an incidence rate of 1/340 deliveries. This rate is actually much lower than the actuality because many other cases were admitted to other surgical units and not recognized. This rate is an increase over an earlier rate at the same hospital. Since only 3 of the women in this series had a history of pregnancy termination, the increase cannot be attributed to liberalization of legal abortion since 1972. The majority of these cases occurred among women over 30. 16 of the cases had a history of infertility, corresponding to the general knowledge that the ectopic pregnancy rate among those who attend infertility clinics is 7 times higher than normal. Management of the cases is discussed. Salpingectomy was performed in almost 3/4 of the cases and salpingo-oopherectomy in 18.8%. The conception rate after ectopic pregnancy was approximately 50%; after a salpingectomy, the conception was 74%. Therefore, salpingectomy is the recommended management for such cases. In this series under study, there was an 8.5% repeat ectopic pregnancy rate. There was no mortality and morbidity was minimal. Early diagnosis and treatment with conservative management is recommended.^ieng

Investigation and treatment of female urinary incontinence.

There are four main types of urinary incontinence in the female namely stress incontinence, urge incontinence, overflow incontinence due to retention of urine and total incontinence. It is important to differentiate them to institute proper treatment. It is the aim of this paper to present a simple clinical evaluation of an incontinent woman. The different methods of surgical correction of stress incontinence are discussed. The latest trend is the paraurethral suspension of the bladder neck. 39 cases of Grade II stress incontinence were treated by paraurethral suspension of the bladder neck at "A" Unit, Kandang Kerbau Hospital and Dept. of Urology, SGH. 33 cases were cured. 4 improved with occasional stress incontinence, frequency and urgency. Of these, 3 were cured with imipramine. One failed because of a fixed, "lead pipe" rigid urethra from previous multiple operations to the bladder neck.

Clinical experience with the Silc Cup Vacuum Extractor.

The relative merits of vacuum extraction have been extensively studied and its advantages analysed. These include its ease of application, encouragement of "autorotation" of the malpositioned foetal head and its safety for both foetus and especially the mother. One hundred and eighty-six vacuum extraction assisted deliveries were performed at the Department of Gynaecological Oncology & Urology, Kandang Kerbau Hospital, from 1988 to 1990 using the 50 mm Silicone Silc Cup Vacuum Extractor (Menox AB). Anaesthetic requirements were minimal with 97% of cases accomplished with local perineal anaesthesia. Maternal complications were very few and only 1.6% of cases had third degree lacerations. There was no maternal or foetal mortality. The most frequent foetal morbidity was neonatal jaundice (28%) with only 7% requiring phototherapy. Cephalohaematoma was found in 8% and 2% had minor scalp abrasions. There were 3 infants with subaponeurotic haematoma who subsequently recovered uneventfully. Vacuum deliveries that were attempted but completed by forceps deliveries ("failed" vacuum extraction) accounted for 10% of total cases. The Silc cup vacuum extractor although not a replacement for all forceps manoeuvres offers a safe and efficient method of assisted delivery under the appropriate clinical circumstances.

The role of urodynamics in evaluating incontinent females.

A total of 84 patients had urodynamic evaluations. Twenty-two patients complained of stress incontinence, 41 patients complained of stress incontinence with other urinary symptoms and 21 complained of other urinary symptoms but not stress incontinence. Of those complaining of stress incontinence alone, 4 (18.2%) had detrussor instability, 11 (50%) had genuine stress incontinence and 7 (31%) had neither condition. Of those complaining of stress incontinence with other symptoms, 16 (39%) had detrussor instability, 19 (46.3%) had stress incontinence and 6 (14.6%) had neither condition. Of those complaining of other urinary symptoms except stress incontinence, 5 (23.8%) had detrussor instability, 3 (14.3%) had stress incontinence and 13 (61.9%) had neither condition. Urinary symptoms were found to have little correlation with the final diagnosis except for enuresis which was associated with detrussor instability.

Management of breech presentation at term.

The management of 159 consecutive women with singleton breech presentation occurring at 37 or more weeks of gestational age was reviewed. They were stratified into three groups: (a) caesarean section without trial of labour (87), (b) trial of labour resulting in caesarean section (21), and (c) trial of labour culminating in successful vaginal delivery (51). The criteria for allowing a trial of labour were described. Careful review of material and foetal variables indicated that a trial of labour in carefully selected patients resulted in vaginal delivery in 70.8% and that this was achieved without an increase in foetal or maternal mortality or morbidity.