Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery.

Between March and May 2012, three neonates born at a regional maternity hospital developed Elizabethkingia meningoseptica (previously Chryseobacterium meningosepticum) sepsis with meningitis aged <10 days, and were treated successfully with intravenous ciprofloxacin plus vancomycin or piperacillin-tazobactam for three to six weeks. Four (16.6%) of 24 environmental specimens obtained from the nursery and delivery room were positive for this organism. All of the clinical isolates and two isolates from storage boxes for pacifiers and pacifier covers were genetically identical. After changing the storage boxes to stainless steel boxes that underwent regular autoclave sterilization, there were no further cases of infection with E. meningoseptica.

The relationship between acid-suppressing drugs and phytobezoar formation: a retrospective analysis and discussion of phytobezoar formation.

OBJECTIVES: Although phytobezoars are a rare cause of gastrointestinal obstruction, they are most commonly found in patients with previous gastric surgery. It is well known that predisposing factors of phytobezoar formation are ingestion of fruits containing soluble tannin, presence of dilute hydrochloric acid in the stomach, and gastric stasis or delayed emptying. We investigated whether intake of acid-suppressing drugs that neutralize gastric acidity or inhibit gastric acid secretion to constitute a hypo-acidic condition, increases the risk of phytobezoar formation. MATERIALS AND METHODS: Between September 1992 and October 2008, 32 patients (24 male and 8 female) with gastrointestinal phytobezoars were diagnosed either surgically or endoscopically at the Tri-Service General Hospital, Taipei, Republic of China. The data were collected from hospital records and analyzed retrospectively. RESULTS: Eighteen (56.25%) of all patients had previous gastric surgery and 6 (42.9%) of the 14 patients who had not undergone surgery had diabetes mellitus. The majority of admissions were during winter and spring (between October and March) (P < 0.01) and none of the patients had taken acid-suppressing drugs during the 6 months before detection of gastrointestinal phytobezoars. CONCLUSIONS: In our study, intake of acid-suppressing drugs did not increase the risk of phytobezoar formation in patients with normal gastric motility. Moreover, we believe that the major factor in phytobezoar formation is gastric stasis or delayed emptying, which sufficiently prolongs the retention period of materials in the stomach, while dilute hydrochloric acid is a minor factor.

Improvement of insulin resistance by panax ginseng in fructose-rich chow-fed rats.

In an attempt to probe a new target for handling insulin resistance, we used Panax ginseng root to screen the effect on insulin resistance induced by fructose-rich chow in rats. Insulin action on glucose disposal rate was measured using the glucose-insulin index, which is the product of the areas under the curve of glucose and insulin during the intraperitoneal glucose tolerance test. Oral administration of Panax ginseng root (125.0 mg/kg) into rats three times daily for three days after receiving fructose-rich chow for four weeks reversed the increased glucose-insulin index, indicating that Panax ginseng root has the ability to improve insulin sensitivity. In addition, the plasma glucose concentrations in rats repeatedly treated with Panax ginseng root were not elevated as markedly as those of the vehicle-treated group during the fructose-rich chow-feeding period. Also, the time in which the plasma glucose-lowering response to tolbutamide (10.0 mg/kg, i. p.) receded in fructose-rich chow fed rats was markedly delayed by repeated Panax ginseng root treatment compared to the vehicle-treated group. The plasma glucose-lowering activity of tolbutamide is believed to depend on the secretion of endogenous insulin, which is widely used as an indicator of insulin resistance development. Thus, it provided supportive data that oral administration of Panax ginseng root could delay the development of insulin resistance in rats. In conclusion, our results suggest that oral administration of Panax ginseng root improves insulin sensitivity and may be used as an adjuvant therapy for treating diabetic patients with insulin resistance.

Stimulatory effect of paeoniflorin on the release of noradrenaline from ileal synaptosomes of guinea-pig in-vitro.

The effect of paeoniflorin (an active principle of Paeoniae Radix, commonly used in traditional Chinese medicine) on the release of noradrenaline (norepineprhine) from nerve terminals was investigated using guinea-pig isolated ileal synaptosomes. Release was determined as the amount of noradrenaline, quantified by high-performance liquid chromatography-electrochemical detection, from samples incubated with paeoniflorin or vehicle. Paeoniflorin stimulated the release of noradrenaline in a concentration-dependent manner without an effect on the level of lactate dehydrogenase in the bathing medium. Tetrodotoxin abolished the action of paeoniflorin at concentrations sufficient to block sodium channels. The depolarizing effect of paeoniflorin on the membrane potential was also illustrated by a concentration-dependent increase in the fluorescence of bisoxonol. Moreover, the effect of paeoniflorin on bisoxonol fluorescence in ileal synaptosomes seems more potent than that of 4-aminopyridine. That paeoniflorin causes influx of calcium ions via the depolarization of nerve terminals could be considered. The noradrenaline-releasing action of paeoniflorin was abolished by removal of calcium chloride from the bathing medium. This action of paeoniflorin was also attenuated by Rp-cAMP atconcentrations sufficientto inhibitthe action of cyclicAMP. Therefore, paeoniflorin could induce a calcium-dependent and cyclic-AMP-related release of noradrenaline from sympathetic nerve terminals of guinea-pig ileum. Guanethidine inhibited the noradrenaline-releasing action of paeoniflorin in a concentration-dependent manner. The effect of paeoniflorin on the increase of bisoxonol fluorescence was not modified by atropine. Release of noradrenaline by paeoniflorin from noradrenergic nerve terminals was characterized. These findings suggest that paeoniflorin can stimulate tetrodotoxin-sensitive depolarization of membranes to result in a calcium-dependent and cyclic-AMP-related release of noradrenaline from noradrenergic nerve terminals.

Stimulatory effect of D-ephedrine on beta3-adrenoceptors in adipose tissue of rats.

The effect of ephedrine on beta3-adrenoceptos (beta3-AR) was studied in the isolated adipose tissue of Wistar rat. Incubation with D-ephedrine (0.1-10 microM) induced a concentration-dependent decrease of uptake of [14C]-deoxy-D-glucose into white adipose tissues (WAT). The inhibitory effect of D-ephedrine was potentiated by BRL 37344, the agonist of beta3-AR and concentration-dependently inhibited by SR 59230A, the selective antagonist of beta3-AR. The action of D-ephedrine on beta3-AR was further blocked by the antibodies for beta3-AR, but not the immunoglobulin. in a concentration-dependent manner. Moreover, D-ephedrine increased glycerol release from the isolated brown adipose tissues (BAT) and this action was also abolished by SR 59230A at concentration sufficient to block beta3-AR. Thus, these results suggest that D-ephedrine has the ability to activate beta3-AR both in WAT and BAT of Wistar rats in vitro.

Large drug resistance virulence plasmids of clinical isolates of Salmonella enterica serovar Choleraesuis.

Salmonella enterica serovar Choleraesuis generally causes systemic human salmonellosis without diarrhea, and therefore, antimicrobial treatment is essential for such patients. The drug resistance information on this organism is thus of high value. Serovar Choleraesuis usually harbors a virulence plasmid (pSCV) of 50 kb in size. Of the 16 clinical isolates identified to be serovar Choleraesuis, all except one harbored a pSCV and seven of them carried a pSCV of more than 125 kb in size. A pSCV was defined as a plasmid carrying spvC and characteristic deletions detected by PCR and by DNA-DNA hybridization (for the former criterion). The results of PCR, restriction fragment profiles, and Southern DNA-DNA hybridizations of the profiles all indicated that such larger pSCVs were derived from the 50-kb plasmid recombined with non-pSCVs found in some clinical isolates. Fifteen of the 17 strains, including a laboratory strain, were then tested for drug resistance against 16 antibiotics with E-test and the dilution method. The laboratory strain, which harbored a 50-kb pSCV and a 6-kb non-pSCV, was resistant only to sulfonamides (SUL), and its resistance gene, sulII, checked with PCR and DNA-DNA hybridization, was located on the 6-kb non-pSCV. All 14 clinical strains were resistant to multiple drugs. Of the 14, 7 were resistant to SUL, and the resistance gene was located on a plasmid. The sulII gene, but not bla(TEM-1), was carried only on the 6-kb non-pSCV. Of the remaining six large plasmids, three of 90 kb, two of 136 kb, and one of 140 kb, the last three were pSCVs and carried the other SUL gene (sulI) and the bla(TEM-1) gene. The six strains were also resistant to trimethoprim-sulfamethoxazole. None of the 50-kb pSCVs carried resistance genes. These drug resistance genes on the large pSCVs were apparently also acquired through recombination.

Comparative physical and genetic maps of the virulence plasmids of Salmonella enterica serovars typhimurium, enteritidis, choleraesuis, and dublin.

Using fragment profiling, PCR, and Southern hybridization, we found that Salmonella enterica serovar Choleraesuis harbored virulence plasmids of various sizes, whereas serovars Typhimurium, Enteritidis, and Dublin carried a plasmid of a unique size. Also, the virulence plasmid of Typhimurium contained genes in the same order detected in the other three plasmids, all of which contained deletions.

Primary carcinoma of the gallbladder: results of surgery--a retrospective study.

BACKGROUND: The development of hepatobiliary imaging modalities has resulted in earlier detection of gallbladder cancer. This is a retrospective evaluation of surgical resection of gallbladder cancer. METHODS: Records of 58 patients with gallbladder carcinoma who underwent surgical resection in the past 14 years were examined. Patients were staged according to the Nevin system: six had Nevin stage I disease; 10, stage II; 9, stage III; four, stage IV; and 24 had stage V cancer. Forty-three patients were thought to have resectable lesions. Of these, 14 had extended cholecystectomy, 21 simple cholecystectomy, seven simple cholecystectomy with biliary drainage and one patient had radical cholecystectomy with pancreaticoduodenectomy. Prognoses were analyzed in relation to pathologic staging and surgical procedures. RESULTS: The overall one-year and five-year survival rates were 50% and 19.2%, respectively. The five-year survival rate for Nevin stage I was 100%; for stage II, 60%; stage III, 33%; stage IV, 25% and for stage V, 0%. Radical surgery led to a better cumulative survival rate for Nevin stages III and IV (p < 0.01) than did simple cholecystectomy. Five Stage II cases were treated with simple cholecystectomy but two patients had early metastasis. Four stage III patients underwent simple cholecystectomy and three had metastasis within one year. CONCLUSIONS: Based on these results, stage III and IV tumors require extended procedures for better survival. A high index of suspicion for the disease, careful intraoperative examination of the gallbladder specimen and earlier, more aggressive treatment may improve patient survival.

Effects of allitridi on intracellular Ca2+ concentration in isolated rat brain cells.

AIM: To study actions of allitridi extracted from garlic on intracellular calcium in isolated rat brain cells. METHODS: Brain cells were isolated from newborn rat brain with Fura 2-AM measurements of intracellular Ca2+ concentration ([Ca2+]i). RESULTS: Allitridi 1-100 mumol.L-1 concentration-dependently blocked increases of [Ca2+]i caused by potassium chloride and sodium glutamate (Glu) with IC50 of 59.7 and 69.9 mumol.L-1 respectively. Allitridi 100 mumol.L-1 blocked norepinephrine (Nor)-induced [Ca2+]i elevation. CONCLUSION: Allitridi is an effective agent for blocking the [Ca2+]i increase caused by potassium chloride, Nor and Glu.

8-(N,N-diethylamino)-n-octyl-3,4,5-trimethoxybenzoate reduced [Ca2+]i elevation induced by histamine, serotonin, and glutamate in cultured calf basilar artery smooth muscle cells.

AIM: To study the effects of 8-(N,N-diethylamino)-n-octyl-3,4,5- trimethoxybenzoate (TMB-8) on intracellular free calcium ([Ca2+]i) in cultured calf basilar artery smooth muscle cells. METHODS: [Ca2+]i was examined by a system of measurement of AR-CM-MIC, using Fura 2-AM as a fluorescent indicator. RESULTS: In the presence of extracellular Ca2+ 1.3 mmol.L-1, histamine (His), serotonin (5-HT), and sodium glutamate (Glu) markedly increased the [Ca2+]i which was attenuated by TMB-8. In Ca2+ free Hanks' solution containing egtazic acid 0.1 mmol.L-1, TMB-8 not only reduced the resting [Ca2+]i, but also inhibited the elevation of [Ca2+]i evoked by His and 5-HT. CONCLUSION: TMB-8 reduced the resting [Ca2+]i and attenuated His-, 5-HT-, and Glu-induced increases of [Ca2+]i in basilar artery smooth muscle cells.

Huge splenic epidermoid cyst: a case report.

A case is reported of splenic epidermoid cyst discovered in a 21-year-old female. The lesion was shown by abdominal ultrasonography and computed tomography to be 14 x 12 x 8 cm in size and to contain serous fluid in the lumen. The spleen was easily removed by surgery. Histopathologically, the epidermoid cyst was composed of a loosely fibrous wall and a single layer interior lining of flattened or low-cuboidal epithelium, without skin appendages. The remaining splenic tissue showed mild congestive change with thickened sinusoidal stroma. Most splenic cysts have presented with symptoms related to both the size of the mass and compression of an adjacent organ. Potential complications include hemorrhage, infection, and rupture of the splenic cyst. Splenectomy is recommend to eradicate symptoms produced by the cyst and to prevent potential complications.

[High performance liquid chromatographic method for the determination of ipriflavone in serum and its pharmacokinetic study in healthy volunteers].

A sensitive and rapid high performance liquid chromatographic method has been developed for the determination of ipriflavone in human serum. The average recovery of ipriflavone was 85% with relative standard deviation of 3.8%-5.4%. The calibration curve was linear in the range from 8 ng.ml-1 to 400 ng.ml-1 with gamma = 0.9981. The detection limit of the method was 3 ng.ml-1 (S/N > or = 3). The serum drug concentration-time curve exhibited a 2-compartment model and the mean T1/2 beta was 12.00 +/- 1.89 h (for ipriflavone made in Japan) and 9.05 +/- 0.80 h (for ipriflavone made in China). The AUC0-->infinity of the two kinds of ipriflavone were 804.99 ng.h.ml-1 and 807.40 ng.h.ml-1, respectively. The relative bioavailability of ipriflavone made in China vs that made in Japan was 1.003.

[Pathogenic strains of Escherichia coli in Taiwan].

From July 1994 through June 1996, 28 strains of Escherichia coli were isolated from 1,260 patients with acute diarrhea. These strains were further differentiated with serotypes and virulence factors. Enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC) were accounted for 53.6 (15 of 28 strains), 28.6 (8 of 28), 10.7 (3 of 28) and 7.1% (2 of 28), respectively. Therefore, ETEC and EPEC are playing an important role in food-borne illness in Taiwan. Escherichia coli O157:H7, a new emerging pathogen of food-borne disease, has not been isolated in this study.

[Effect of berberine on intracellular free CA2+ concentration in cultured brain cells].

Intracellular free calcium concentration ([Ca2+]i) was measured with Ca(2+)-sensitive fluorescent indicator, Fura-2/AM, in cultured brain cells using AR-CM-MIC cation measurement system, and the effects of berberine (Ber) on the changes in [Ca2+]i induced by CaCl2, norepinephrine, KCl and H2O2 were studied. The results indicate that the resting [Ca2+]i was 35 +/- 8 nmol.L-1 in Ca(2+)-free Hank's solution. Ber showed no effect on the resting [Ca2+]i when the extracellular Ca2+ were 0.01-10 mmol.L-1. Ber 1-100 mumol.L-1 dose-dependently inhibited norepinephrine and H2O2 induced [Ca2+]i elevation. Ber at high concentration (10-100 mumol.L-1) inhibited K(+)-induced [Ca2+]i elevation. This suggests that the inhibitory effects of Ber on norepinephrine, K(+)-, and H2O2-induced [Ca2+]i elevation may be one of the mechanisms against cerebral ischemia.

Influences of ginsenosides Rb1 and Rg1 on reversible focal brain ischemia in rats.

AIM: To study the influences of ginsenosides Rb1 and Rg1 (active components of the total saponins of Panax ginseng) on the brains against ischemia-reperfusion injury. METHODS: Rat focal cerebral ischemia was induced by reversible middle cerebral artery occlusion (MCAO) without craniectomy. The influences of ginsenoside Rb1 and Rg1 on infarct size (IS), neurologic deficit (ND) and the contents of calcium and potassium in the infarct were observed. RESULTS: In a 2-h ischemia, Rb1 10-40 mg.kg-1 i.v. 30 min before MCAO decreased IS by 20%-49% and ND score from 5.1 to 4.1-2.3, and inhibited Ca accumulation and K loss by 22%-50% and 18-37%, respectively; Rb1 10-40 mg.kg-1 i.v. immediately after MCA was recanalized decreased IS by 12%-35% and ND score from 5.2 to 4.3-3.3, and inhibited Ca accumulation and K loss by 10%-40% and 17%-30%, respectively. In permanent ischemia, Rb1 40 mg.kg-1 i.v. reduced IS, ND, Ca accumulation and K loss. However, Rg1 40 mg.kg-1 i.v. did not show effect on both permanent and 2-h MCAO. CONCLUSIONS: Rb1 protected brain from ischemic and reperfusion injuries.

Tetrandrine vs nicardipine in cerebral ischemia-reperfusion damages in gerbils.

AIM: To study the effects of tetrandrine (Tet) vs nicardipine (Nic) on cerebral ischemia-reperfusion damages. METHODS: Cerebral ischemia was produced by 10-min occlusion of bilateral carotid arteries followed by 5-min reperfusion in gerbils. The changes in electroencephalogram (EEG), calcium and water contents, lipid peroxide (LPO) content and ultrastructure in gerbil brains were compared. RESULTS: Pretreatment with Tet (15 mg.kg-1, i.v.) and Nic (0.25 mg.kg-1, i.v.) enhanced the recovery of EEG amplitude, reduced the calcium (151.2 +/- 1.1 and 155.3 +/- 2.4 mg/kg dry wt in Tet and Nic groups vs 193 +/- 8 mg/kg dry wt in ischemia-reperfusion group, P < 0.05) and water contents, attenuated the increase in LPO content (293 +/- 29 and 276 +/- 23 mumol.kg-1 wet wt in Tet and Nic groups vs 427 +/- 24 mumol.kg-1 wet wt in ischemia-reperfusion group, P < 0.01), and diminished the ultrastructural abnormalities of cortex and hippocampus in gerbil brain during ischemia and reperfusion. CONCLUSION: Tet and Nic had protective effects against ischemia-reperfusion brain damages in gerbils. The effects of Tet were similar to, but less potent than those of Nic.

[Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion].

Berberine (Ber) 20 mg.kg-1.d-1 for 1, 3, or 5 d inhibited platelet aggregation induced by ADP, arachidonic acid (AA) and collagen (Coll) in rats with 24 h reversible middle cerebral artery occlusion (MCAO), and the platelet adhesiveness was inhibited as well. Using radioimmunoassay method, the thromboxane B2(TXB2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) contents in rat plasma were measured 24 h after MCAO. The results indicate that the TXB2 levels after drug treatment were lower than those in ischemia control rats, but the 6-keto-PGF1 alpha levels showed no obvious difference between the two groups. The same dose of Ber was also shown to inhibit thrombosis formation. This suggests that the decline of platelet aggregation and decrease of TXB2 content may be one of the important factors involved in the anti-cerebral ischemia effect of Ber.

Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis.

OBJECTIVE: To investigate the clinical characteristics of a coexisting sharp ductal angulation (< 90 degrees) with biliary stricture and to evaluate the difficulties it imposes in the management of retained or recurrent hepatolithiasis. DESIGN: Case-controlled study. SETTING: A referral center. PATIENTS: Eighteen consecutive patients having right-sided hepatolithiasis and a coexisting sharp ductal angulation associated with biliary stricture (group 1) were compared with 84 patients matched with sex, age, and conditions of hepatolithiasis and intrahepatic biliary stricture(s) but no sharp angulated duct (group 2). INTERVENTION: Postoperative cholangioscopic management (electrohydraulic lithotripsy or other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube tract or percutaneous transhepatic route). MAIN OUTCOME MEASURES: Sessions of manipulations, incidence of complications associated with interventions or disease, and mortality were compared. RESULTS: Patients of group 1 needed more sessions of postoperative manipulation of stones and strictures (13.7 +/- 4.2 vs 8.0 +/- 2.3; P < .001). During management, there was a significantly increased vulnerability of severe and/or recurrent cholangitis (66.7% vs 9.5%; P < .001), septic shock (77.8% vs 11.9%; P < .001), liver abscess (55.6% vs 7.1%; P < .001), or massive hemobilia (33.3% vs 7.4%) in group 1 than in group 2. Their risks of coexisting secondary biliary cirrhosis (55.6% vs 9.5%; P < .001) and/or cholangiocarcinoma (16.6% vs 2.4%; P < .04) and mortality (27.8% vs 4.8%; P < .01) were also significantly higher in group 1. CONCLUSION: Our results suggest that the coexisting sharp ductal angulation with biliary strictures in right-sided hepatolithiasis is a distinct difficult clinical entity in the field of biliary tract calculi.

[Uterus, fallopian tube and ovary within a sliding hernia: a case report].

Sliding hernias of the tube, ovaries and uterus occur occasionally in newborn female infants, but are rare in older women. This report entails a case of a sliding inguinal hernia which contains the organs of the female genital tract in a 56-year-old multipara woman. Under diagnosis of incarcerated inguinal hernia preoperatively, the operative intervention was performed, but it appeared the organs of uterus, ovary and fallopian tube there instead of the intestine. After operation, wound recovery was good. At follow-up six months later, there was no recurrence nor lower abdominal discomfort.

Intussusception of mucocele of the appendix: a case report.

A 63-year-old man had had repeated episodes of ileo-caecal intussusception, and a pre-operative barium enema revealed appendiceal mucocele as a leading cause. Resection of appendix and part of the caecum were undertaken through exploration. The post-operative course was smooth. This unusual etiology is reported and discussed.