Diagnosis of Clostridium difficile-associated disease: examination of multiple algorithms using toxin EIA, glutamate dehydrogenase EIA and loop-mediated isothermal amplification.

The laboratory diagnosis of Clostridium difficile infection (CDI) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. Three methods are evaluated using 810 consecutive stool samples against toxigenic culture: CDT TOX A/B Premier enzyme immunoassay (EIA) kit (Meridian Bioscience, Europe), Premier EIA for C. difficile glutamate dehydrogenase (GDH) (Meridian Bioscience, Europe) and the Illumigene kit (Meridian Bioscience, Europe), both individually and within combined testing algorithms. The study revealed that the CDT TOX A/B Premier EIA gave rise to false-positive and false-negative results and demonstrated poor sensitivity (56.47%), compared to Premier EIA for C. difficile GDH (97.65%), suggesting this GDH EIA can be a useful negative screening method. Results for the Illumigene assay alone showed sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of 91.57%, 98.07%, 99.03% and 84.44%, respectively. A two-stage algorithm using Premier EIA for C. difficile GDH/Illumigene assay yielded superior results compared with other testing algorithms (91.57%, 98.07%, 99.03% and 84.44%, respectively), mirroring the Illumigene performance. However, Illumigene is approximately half the cost of current polymerase chain reaction (PCR) methods, has a rapid turnaround time and requires no specialised skill base, making it an attractive alternative to assays such as the Xpert C. difficile assay (Cepheid, Sunnyvale, CA). A three-stage algorithm offered no improvement and would hamper workflow.

Infective endocarditis: changing aetiology of disease.

Infective endocarditis (IE) is an evolving disease resulting in high morbidity and mortality. Despite medical and diagnostic advances, the incidence of the disease has remained unchanged, reflecting the changing epidemiological and microbiological profile of IE. Classical risk factors such as rheumatic heart disease have now been overtaken by new risk factors including an ageing population, degenerative valve disease and intravenous drug use. The routine use of invasive procedures, implantable cardiac devices and prosthetic heart valves has served to increase the number of at-risk patients. The microbiology of IE mirrors the changing risk factors, with staphylococcal infections predominating over viridans streptococci. An overview of this rare disease is given describing current understanding, investigation and changing epidemiology and microbiology of IE.

Alveolar macrophage activation and an emphysema-like phenotype in adiponectin-deficient mice.

Adiponectin is an adipocyte-derived collectin that acts on a wide range of tissues including liver, brain, heart, and vascular endothelium. To date, little is known about the actions of adiponectin in the lung. Herein, we demonstrate that adiponectin is present in lung lining fluid and that adiponectin deficiency leads to increases in proinflammatory mediators and an emphysema-like phenotype in the mouse lung. Alveolar macrophages from adiponectin-deficient mice spontaneously display increased production of tumor necrosis factor-alpha (TNF-alpha) and matrix metalloproteinase (MMP-12) activity. Consistent with these observations, we found that pretreatment of alveolar macrophages with adiponectin leads to TNF-alpha and MMP-12 suppression. Together, our findings show that adiponectin leads to macrophage suppression in the lung and suggest that adiponectin-deficient states may contribute to the pathogenesis of inflammatory lung conditions such as emphysema.

Identification of high affinity binding sites for inhibin on ovine pituitary cells in culture.

The aim of this study was to identify and characterize binding sites for inhibin in primary cultures of ovine anterior pituitary cells. Recombinant human 31-kDa inhibin A was iodinated by an optimized lactoperoxidase procedure. Fractionation of the labeled protein by gel filtration chromatography on Sephadex G-100 in 0.1 M HCl yielded two immunoactive peak regions, the second of which was bioactive as assessed by in vitro bioassay, with a ratio of bioactivity/immunoactivity of 0.62-0.77 and an iodine incorporation ratio of 1.7-2.0 mol 125I/mol inhibin. The specific binding of purified [125I]inhibin to cultured ovine pituitary cells varied with time, temperature, and cell number. Displacement of the tracer by unlabeled inhibin, as assessed by Scatchard analysis, revealed two binding sites with average Kd values of 0.28 and 3.9 nM and with approximately 250 and 3100 binding sites/anterior pituitary cell, respectively. There was little cross-reaction between inhibin and activin A (<2%), transforming growth factor-beta (<0.2%), or follistatin (<<0.1%). Examination of cell lines that were not expected to have inhibin receptors showed that there was no specific binding of inhibin to human leukemia (Jurkat) cells, whereas the binding to human embryonic kidney (293) cells was displaced by both inhibin and activin with a similar degree of cross-reaction, which suggests binding to an activin receptor. It is concluded that inhibin-binding sites with high affinity and specificity have been identified on ovine pituitary cells, consistent with both inhibin action on the pituitary and the presence of the putative inhibin receptor.

Activation of Host Defense Mechanisms by Elevated Production of H2O2 in Transgenic Plants.

Active oxygen species have been postulated to perform multiple functions in plant defense, but their exact role in plant resistance to diseases is not fully understood. We have recently demonstrated H2O2-mediated disease resistance in transgenic potato (Solanum tuberosum) plants expressing a foreign gene encoding glucose oxidase. In this study we provide further evidence that the H2O2-mediated disease resistance in potato is effective against a broad range of plant pathogens. We have investigated mechanisms underlying the H2O2-mediated disease resistance in transgenic potato plants. The constitutively elevated levels of H2O2 induced the accumulation of total salicylic acid severalfold in the leaf tissue of transgenic plants, although no significant change was detected in the level of free salicylic acid. The mRNAs of two defense-related genes encoding the anionic peroxidase and acidic chitinase were also induced. In addition, an increased accumulation of several isoforms of extracellular peroxidase, including a newly induced one, was observed. This was accompanied by a significant increase in the lignin content of stem and root tissues of the transgenic plants. The results suggest that constitutively elevated sublethal levels of H2O2 are sufficient to activate an array of host defense mechanisms, and these defense mechanisms may be a major contributing factor to the H2O2-mediated disease resistance in transgenic plants.

Disease resistance conferred by expression of a gene encoding H2O2-generating glucose oxidase in transgenic potato plants.

Plant defense responses to pathogen infection involve the production of active oxygen species, including hydrogen peroxide (H2O2). We obtained transgenic potato plants expressing a fungal gene encoding glucose oxidase, which generates H2O2 when glucose is oxidized. H2O2 levels were elevated in both leaf and tuber tissues of these plants. Transgenic potato tubers exhibited strong resistance to a bacterial soft rot disease caused by Erwinia carotovora subsp carotovora, and disease resistance was sustained under both aerobic and anaerobic conditions of bacterial infection. This resistance to soft rot was apparently mediated by elevated levels of H2O2, because the resistance could be counteracted by exogenously added H2O2-degrading catalase. The transgenic plants with increased levels of H2O2 also exhibited enhanced resistance to potato late blight caused by Phytophthora infestans. The development of lesions resulting from infection by P. infestans was significantly delayed in leaves of these plants. Thus, the expression of an active oxygen species-generating enzyme in transgenic plants represents a novel approach for engineering broad-spectrum disease resistance in plants.

Pathology and probability. Likelihood ratios and receiver operating characteristic curves in the interpretation of bronchial brush specimens.

Diagnoses in pathology often are qualitative, such as atypical or suspicious, and consequently are thought to have limited clinical value. To investigate the utility of a qualitative diagnostic system, seven pathologists retrospectively evaluated 100 bronchial brush specimens using the following categories: definitely benign, probably benign, possibly malignant, probably malignant, and definitely malignant. The likelihood ratio (LR) and receiver operating characteristic (ROC) curve, two statistical probabilistic measurements, were used to calculate diagnostic accuracy among individuals and groups. The results show: (1) the LR for individual diagnostic categories varied among observers, resulting in different clinically malignant probabilities; (2) observer experience did not appear to play a role in overall diagnostic accuracy, except in the diagnosis of small cell carcinoma; (3) observers operate at higher levels of diagnostic accuracy with, rather than without, clinical history. The authors conclude that qualitative diagnoses contain important information and can be interpreted effectively with LR and ROC.

Production of the cytokines interleukin 1 and 6 by murine brain microvessel endothelium and smooth muscle pericytes.

Murine brain microvessel endothelial cells and smooth muscle/pericytes (SM/P) cells were cultured from newborn BALB/c (normal strain) and SJL/j (autoimmune-prone strain) mice. These cells were evaluated for their ability to produce interleukin (IL)-1 and IL-6 cytokines. The expression of mRNA for IL-1 and IL-6 was shown in highly purified BALB/c endothelial cells and SM/P cells using polymerase chain reaction with specific primers for IL-1 alpha, IL-1 beta and IL-6. IL-6 but not IL-1 mRNA was detected in unstimulated SJL/j brain microvessel cells. The presence of IL-1 and IL-6 mRNA in the BALB/c brain microvessel endothelial cells and SM/P was confirmed by in situ hybridization. By D10.G4.1 assay, unstimulated BALB/c endothelial cells were shown to produce active IL-1 to a higher degree than SM/P. By B9 bioassay, a low amount of active IL-6 was detected in the supernatant of endothelial cells and SM/P. The production of IL-1 and IL-6 in the bioassays was upregulated by lipopolysaccharide (LPS) activation of the cells in a time- and dose-dependent way. IL-6 production was also shown to be upregulated by IL-1 beta activation of the cells. Brain microvessel endothelial cells of SJL/j origin released equivalent amounts of IL-6 compared to endothelial cells of BALB/c origin. However, the production of IL-6 was markedly higher in SM/P of SJL/j origin than in those of BALB/c origin. These observations, together with our previous data showing that brain microvessel SM/P cells produce GM-CSF, emphasize the possibility for active participation of brain microvasculature SM/P as well as endothelium in inflammatory reactions of the central nervous system.

Effects of carbohydrate loading and weight-lifting on muscle girth.

Bodybuilders have used different carbohydrate loading regimens in conjunction with resistance exercise prior to competition in the belief that this would result in increased muscle size. To investigate this possibility, muscle girth measurements were obtained from nine weight-trained males before and after a control (standard isocaloric diet) and an experimental trial (carbohydrate loading). The latter regimen consisted of 3 days of intense weight-lifting while the subjects ingested a diet of 10% carbohydrate (CHO), 57% fat (F), and 33% protein (P), followed by 3 days of light weight-lifting and a day of rest while ingesting a diet of 80% CHO, 5% F, and 15% P. The control trial consisted of an identical weight-lifting regimen while subjects ingested an isocaloric (45 kcal/kg BW/day) diet. Body weight and girths (forearm, upper arm, chest, thigh, waist, and calf) were obtained before and after each trial in a relaxed and flexed state. The results indicate that an exercise/carbohydrate loading regimen had no significant effect on muscle girth as compared to the control trial. It is concluded that CHO loading has no additional advantage to enhancing muscle girth in bodybuilders over weight-lifting alone.

Disposable jet nebulizers. How reliable are they?

We studied the frequency of malfunction, variability in rate of nebulization, and effect of this variability on aerosol particle size of eight disposable jet nebulizer models produced by six manufacturers. Four of eight models showed visual signs of malfunction, including spraying of large, individually visible droplets, leaking of nebulizer solution, and air leaks that completely prevented nebulization. Variability of nebulization rate within specific models ranged from 57 to 129 percent. The model with the largest variability of nebulization rate was also associated with an unacceptably large variability in particle size. In contrast, two models with smaller variability in nebulization rate had greater consistency of particle size. These results indicate poor quality control by some manufacturers in the disposable nebulizer industry. The data suggest that purchasing agents should consider reliability as well as cost before selecting a specific nebulizer model and that their evaluation should include physical testing of multiple units of each model under consideration.

Carbohydrate Catabolism in Populations of Bursaphelenchus xylophilus and in B. mucronatus.

Genotypically different host specific pathotypes of Bursaphelenchus xylophilus have been identified. These pathotypes elicit different responses in pines depending on susceptibility, tolerance, or resistance. Continued passage of some of these pathotypes on fungal cultures leads to conversion to nonparasitic populations. These populations metabolize carbon substrates to ethanol by an anaerobic pathway, while operating some level of a phosphoenolpyruvate (PEP)-succinate pathway to excrete succinate-lactate and malate. On the other hand, parasitic populations metabolize glucose to lactate-succinate, mainly by a PEP-succinate pathway, and maintain redox balance through glycerol production. Ethanol and malate are not excreted by parasitic populations.

Effect of Simulated Acid Rain on Bursaphelenchus xylophilus Infection of Pine Seedlings.

White, Scots, and Austrian 3-year-old pine seedlings were treated with conditions simulating acid rain and inoculated with the white pine specific pathotype of Bursaphelenchus xylophilus, VPSt-1. Oleoresin concentration increased slightly and carbohydrate concentration decreased in all seedlings treated with simulated acid rain (SAR). The changes were significantly increased after inoculation of SAR-treated white and Scots pine seedlings with VPSt-1. Wilting was delayed and nematode reproduction decreased in SAR-treated white pine seedlings inoculated with VPSt-1. SAR-treated Austrian pine seedlings were resistant to VPSt-1, but SAR-treated Scots pine seedlings lost tolerance to VPSt-1 and wilted 50-60 days after inoculation.

Carbohydrate Concentration in Pine as Affected by Inoculation with Bursaphelenchus xylophilus.

Pines responded to inoculation with Bursaphelenchus xylophilus by changes in reducing and nonreducing carbohydrate concentrations dependent on the pine species and the pathotype of B. xylophilus with which the trees were inoculated. Carbohydrate concentrations, in compatible pine-nematode pathotype combinations, decreased initially after inoculation and then increased slightly before decreasing to approximately 10% of the control levels as the seedlings wilted. In compatible nematode pathotype-pine species combinations, carbohydrate concentrations decreased and then increased as the nematode population densities declined.

Characterization of a Nonparasitic Isolate of Bursaphelenchus xylophilus.

Bursaphelenchus xylophilus isolate MPSy-1av was subcultured from pathotype MPSy-1. MPSy-1av is nonparasitic and does not establish in Pinus sylvestris, P. strobus, P. nigra, or P. taeda. This isolate produces ethanol as an end product of carbohydrate metabolism, whereas its parent pathotype, MPSy-1, does not. Alcohol dehydrogenase activity was easily detectable in homogenates of MPSy-1av but barely detectable in some homogenates of MPSy-1. Genomic differences were seen between MPSy-1 and M PSy-1av by restriction endonuclease analysis of total nematode DNA, and hybridization of DNA fragments to the alcohol dehydrogenase gene from Drosophila.

Pathotypes of the Pinewood Nematode Bursaphelenchus xylophilus.

An isolate of Bursaphelenchus xylophilus from Pinus sylvestris in Missouri infected and reproduced in 2-3-year-old seedlings of P. sylvestris and to some extent in seedlings of P. nigra. Wilting, however, occurred only in P. sylvestris. B. xylophilus isolated from P. strobus in Vermont infected and reproduced only in P. strobus seedlings. P. taeda seedlings were resistant to both of these isolates. Phytotoxin production was seen only in susceptible seedling species-nematode combinations. Significant water loss occurred only in those seedlings that were wilted because of infection by a compatible nematode isolate. Our results suggest that these isolates are pathotypes of B. xylophilus.

Measurements by filter elution of DNA single- and double-strand breaks in rat hepatocytes: effects of nitrosamines and gamma-irradiation.

This work presents a filter elution method for measuring DNA single- and double-strand breaks in primary rat hepatocytes without radioactive labeling of DNA. We have studied the effects of a series of nitrosamines and of gamma-irradiation on DNA single- and double-strand break induction. The repair of DNA single-strand breaks in the hepatocytes was measured after treatment with 60Co, 1-methyl-1-nitrosourea, and N-nitrosodimethylamine. The hepatocytes were isolated by ethylene glycol-bis(beta-aminoethyl ether)-N,N'-tetra acetic acid-collagenase perfusion and had a mean viability of 91 +/- 4% (S.D.). The isolated cells were treated for varying lengths of time with nitrosamines in suspension culture in L-15 medium containing 10% fetal bovine serum. After treatment, the cells were chilled, loaded onto 2 micrometers polycarbonate filters, and lysed in a 2% sodium dodecyl sulfate-proteinase K solution, pH 9.6. The DNA was eluted from the filter at either native or denaturing pH with fractions collected every 3 hr. The quantity of DNA in each fraction was determined by measuring the fluorescent product formed between it and diaminobenzoic acid after ethanol-sodium acetate precipitation and trapping of the DNA on 0.2-micrometer polycarbonate filters. The results show that the carcinogens, N-nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosodipropylamine, N-nitrosodibutylamine, and 1-nitrosopiperidine all made dose- and time-related increases in the number of single-strand breaks in rat hepatocytes. N-Nitrosodiphenylamine produced small numbers of single-strand breaks. No double-strand breaks were formed by any of the nitrosamines. Single-strand breaks induced by N-nitrosodimethylamine were repaired very slowly relative to repair of either gamma-ray of 1-methyl-1-nitrosourea-induced single-strand breaks. This system has many advantages for studying carcinogen metabolism and DNA damage in hepatocytes, one of the major target cells for many carcinogens.-