Validation of an antimicrobial susceptibility testing protocol for Brachyspira hyodysenteriae and Brachyspira pilosicoli in an international ring trial.

Brachyspira hyodysenteriae and Brachyspira pilosicoli cause economically important enteric disease in pigs. Treatment of these infections often includes antimicrobial administration, which can be most effective when therapeutic options are informed by antimicrobial susceptibility testing data. Here we describe a method for broth dilution antimicrobial susceptibility testing of these bacteria, both of which are difficult to culture in vitro. The protocol was evaluated for its fitness for use in an inter-laboratory ring trial involving eight laboratories from seven countries, and employing eleven test strains (5 Brachyspira hyodysenteriae including the type strain B78T and 6 Brachyspira pilosicoli) and six antibiotics. Overall intra- and inter-laboratory reproducibility of this method was very good (>90 % MICs at mode +/- 1 log2). Whole genome sequencing revealed good correspondence between reduced susceptibility and the presence of previously defined antimicrobial resistance determinants. Interestingly, lnu(C) was identified in B. pilosicoli isolates with elevated MICs of lincomycin, whilst tva(B) was associated with elevated MICs of pleuromutilins in this species. We designated two new control strains with MICs lying within currently tested ranges, including for the pleuromutilins, in contrast to the control strain B. hyodysenteriae B78T. These were deposited at the DSMZ-German Collection of Microorganisms and Cell Cultures GmbH. The validation of a standard protocol and identification of new control strains facilitates comparisons between studies, establishment of robust interpretative criteria, and ultimately contributes to rational antimicrobial use when treating infected livestock.

Image assessment of cervical dimensions after LLETZ: a prospective observational study.

OBJECTIVE: To assess the impact of large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia (CIN) on cervical morphology as assessed by three-dimensional ultrasound. DESIGN: Prospective observational study. SETTING: University Hospital in Dublin. POPULATION: Women with CIN who underwent an LLETZ procedure. METHODS: All 106 participants had a three-dimensional transvaginal ultrasound scan (3DTVS) performed immediately before and 6 months after LLETZ. The excised LLETZ specimen dimensions were also recorded. Blind analysis of the images was performed. The volume of the uterus and cervix was documented. MAIN OUTCOME MEASURES: The relationship between the extirpated LLETZ dimensions and subsequent cervical and uterine biometry, as assessed by 3DTVS. RESULTS: LLETZ induced a statistically significant reduction in both the length (mean, -0.46 cm; P < 0.001) and the volume (-6.12 cm(3) ; P < 0.001) of the uterus, and in the volume of the cervix (-1.60 cm(3) ; P < 0.001). The volume of the excised specimen had a significant impact on the reduction of the length of the uterus (ß, -0.038; P = 0.012), the volume of the uterus (ß, -0.791; P = 0.036) and the volume of the cervix (ß, -0.121; P = 0.046). The circumference of the excised specimen appeared to have a significant impact on the length (ß, -0.016; 95% CI, -0.028 to -0.003; P = 0.013) and volume (ß, -0.413; 95% CI, -0.719 to -0.107; P = 0.009) of the uterus 6 months after LLETZ. CONCLUSIONS: The volume of tissue removed at LLETZ is related to the subsequent cervical volume, as well as the uterine length and volume, 6 months after the procedure.

Characterization of a porcine amelogenin preparation, EMDOGAIN, a biological treatment for periodontal disease.

EMDOGAIN is derived from porcine developing enamel matrix and has been shown to facilitate regeneration of the periodontium, although its mechanism of action is unknown. The aim of the present study was to identify enamel matrix proteins and proteolytic enzymes present in EMDOGAIN and compare them with those extracted from developing porcine enamel itself. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), Western blotting, and zymography were used to identify the proteins present and to determine their enzyme activity. The results showed that developing enamel contained amelogenins, albumin, amelin, and enamelin. EMDOGAIN, however, contained only amelogenins. Both metalloendoproteases and serine protease activity were revealed in both EMDOGAIN and developing enamel. The roles of the amelogenin and enzyme components, if any, in periodontal regeneration are unknown.

Juvenile chronic arthritis.

Juvenile chronic arthritis affects one in a thousand children in Great Britain. This article will outline the acute systemic forms and describe the impact that this condition has on child and family so that nurses may better manage their care.

Cautionary tale.

I read with interest Saraswathi Vaidyanathan's article Rheumatoid arthritis: educating the patient in India' (Nursing Standard December 13-19), when she illustrated some very sound principles in establishing health education and teaching programme for sufferers of this disease.

Piezoelectricity in secondary explosives.

A theory for the formation of "hot spots" necessary for the initiation of an explosion is discussed in light of experimental evidence that most solid explosives are highly piezoelectric.