Cartilage-hair hypoplasia with normal height in childhood-4 patients with a unique genotype.

The manifestations of cartilage-hair hypoplasia (CHH), a metaphyseal chondrodysplasia caused by RMRP mutations, include short stature, hypoplastic hair, immunodeficiency and increased risk of malignancies. Clinical features show significant variability. We report a patient with normal height until age 12.5 years (-1.6 SDS at 11 years) who was diagnosed with CHH at 14 years. RMRP sequencing revealed compound heterozygosity for g.70A>G mutation and a 10-nucleotide duplication at position -13 (TACTCTGTGA). Through the Finnish Skeletal Dysplasia Register, we identified 3 additional patients with identical genotype. Two of them also showed unusually mild growth failure (height SDS -1.6 at 14 years and -3.0 at 12 years, respectively). Three of the 4 patients suffered from recurrent infections; 1 developed progressive bronchiectasis and another died from aggressive lymphoma. Our findings expand the phenotypic variability in CHH to include normal childhood height. The milder growth retardation related to this particular genotype was not associated with less severe extra-skeletal manifestations, emphasizing the need for careful follow-up also in CHH patients with mild-skeletal manifestations.

Comparing methods for determining motor-hand lateralization based on fTCD signals.

The lateralization index (LI) as determined from functional transcranial Doppler sonography (fTCD) can be used to determine the hemispheric organization of neural activation during a behavioral task. Previous studies have proposed different methods to determine this index, but to our knowledge no studies have compared the performance of these methods. In this study, we compare two established methods with a simpler method proposed here. The aim was to see whether similar results could be achieved with a simpler method and to give an indication of the analysis steps required to determine the LI. A simple unimanual motor task was performed while fTCD was acquired, and the LI determined by each of these methods was compared. In addition, LI determined by each method was related to behavioural output in the form of degree of handedness. The results suggest that although the methods differed in complexity, they yielded similar results when determining the lateralization of motor functions, and its correlation with behavior. Further investigation is needed to expand the conclusions of this preliminary study, however the new method proposed in the paper has great potential as it is much simpler than the more established methods yet yields similar results.

A practice-based study of the variation of diagnostics of dental caries in new and old patients of different ages.

Data mining of digital dental records provides possibilities for analysing the variation between dentists when diagnosing caries. A total of 71,317 male and 82,302 female subjects visited the health centres in Vantaa and Kemi during the 'digital era' (1994-2005). As subjects were classified as 'new patients' at the first examination, all re-examinations of the same subjects thereafter by the same dentist produced 'old patients'. A mean number of decayed surfaces (DS) was counted as a function of the age of the subject during the follow-up. The significance of the difference between old and new patients was determined by the Mann-Whitney test for each age cohort at the cross sections, and for the whole follow-up. Caries was seen to affect new patients more than the old ones in both health centres after the age of 20 years. The mean DS values were the same, reaching about 1 for new and old patients at the age of 15 years. The mean DS had a peak for new patients in both health centres at the age of 25 years and another peak around 45-50 years in Kemi. With a few exceptions there was a significant difference between the DS values of new and old patients at most cross sections and for the whole follow-up time. Evidently dentists examine new patients more carefully than their old patients. After the age of 18 years patients may have changed their dentists because they have finished the free-of-charge treatment period.

Effect of clinical audits of radiation use in one hospital district in Finland.

BACKGROUND: A clinical audit is a systematic, independent, and documented process to improve the quality of radiological processes and radiation safety for patients. PURPOSE: To evaluate the effect of an audit process by comparing the results of two consecutive audits at the same units. MATERIAL AND METHODS: Audits were carried out twice at each imaging unit in the southwest hospital district of Finland: first, at the end of 2003, and again in November 2007. Both evaluations were carried out in a similar way: by interviewing personnel and examining documents, independent experts from other hospital districts ensured that diagnostic medical imaging processes at each unit were carried out according to generally accepted standards for good medical radiological procedures. The results of the consecutive audits were compared in order to analyze the effects of the clinical audits. RESULTS: The use of radiation was in accordance with the requirements and standards of good medical procedures at every audited unit during both evaluations. The list of audit criteria was fulfilled satisfactorily on both occasions at all of the audited units, and clearly better during the second run. In the first audit, the auditors made 80 recommendations for improving diagnostic procedures and, in the second audit, 53 recommendations. During the first audit, most of the recommendations (22/80) concerned instructions in the fundamental practice of examining a patient. During the second audit, most recommendations were in the category of radiation doses. CONCLUSION: The clinical audit had a positive impact on the practice of work procedures in radiological departments. Most of the recommendations made after the first audit had been taken into consideration by the time of the second audit.

The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers.

AIM: This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. BACKGROUND: Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. METHODS: The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). FINDINGS: The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

Data transmission in dental identification of mass disaster victims.

UNLABELLED: Dental evidence, especially from radiographs, has been found to be an effective method in personal identification. Previously, it has been shown that wireless personal digital assistants (PDA) can be used to transfer digitized radiographs. The purpose of this study was to set up a secure and reliable mobile connection for transferring dental digital images for disaster victim identification, and to test this new way of working in Phuket, Thailand, following the December 2004 Asian Tsunami disaster. MATERIAL AND METHODS: Digital dental radiographs and clinical images were transferred in two separate sets using secured data transmission from a server in Finland to PDA terminals in Thailand. The mean size of the images in test 1 and test 2 were 90.7 kB and 88.1 kB, respectively. RESULTS: The mean speed of the transmission was 3.7 kB/s with the Nokia 9500 and 3.4 kB/ s with the Qtek 2020i. The quality of all the pictures was found to be good enough for dental identification purposes. CONCLUSIONS: Wireless personal digital assistants (PDA) together with data secure transmission of digital clinical information could be used in order to assist in disaster victim identification in areas where GSM cellular networks are available.

Skeletal outcome in long-term survivors of childhood high-risk neuroblastoma treated with high-dose therapy and autologous stem cell rescue.

High-dose therapy and hematopoietic stem cell transplantation (HSCT) have been shown to improve survival rates in high-risk neuroblastoma (HR-NBL), but may cause adverse effects on the growing skeleton. We studied skeletal health in a national cohort of long-term survivors of HR-NBL (n=21; age 16-30 years, median 22 years) and in 20 healthy age- and sex-matched controls. In addition to clinical evaluation and measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry, we performed spinal magnetic resonance imaging. Skeletal complications were categorized according to Common Terminology Criteria for Adverse Events (CTCAE). Altogether, 18/21 survivors presented with at least one skeletal adverse event according to CTCAE, the most common skeletal complications being short stature (n=14) and osteopenia (n=13). Altogether, 38% of the subjects had a severe complication (CTCAE score ⩾3) including bilateral slipped capital femoral epiphyseolysis in 3/21. Fracture rate was not increased. In spinal MRI, no vertebral fractures were found and degenerative intervertebral disc changes were equally prevalent in survivors and controls. BMD was lower in survivors than controls, but differences became non-significant when adjusted for bone size. In conclusion, skeletal late complications are common and can significantly impair the quality of life in young adult survivors of HR-NBL treated with high-dose protocols and HSCT.

Sox5 regulates beta-cell phenotype and is reduced in type 2 diabetes.

Type 2 diabetes (T2D) is characterized by insulin resistance and impaired insulin secretion, but the mechanisms underlying insulin secretion failure are not completely understood. Here, we show that a set of co-expressed genes, which is enriched for genes with islet-selective open chromatin, is associated with T2D. These genes are perturbed in T2D and have a similar expression pattern to that of dedifferentiated islets. We identify Sox5 as a regulator of the module. Sox5 knockdown induces gene expression changes similar to those observed in T2D and diabetic animals and has profound effects on insulin secretion, including reduced depolarization-evoked Ca2+-influx and ß-cell exocytosis. SOX5 overexpression reverses the expression perturbations observed in a mouse model of T2D, increases the expression of key ß-cell genes and improves glucose-stimulated insulin secretion in human islets from donors with T2D. We suggest that human islets in T2D display changes reminiscent of dedifferentiation and highlight SOX5 as a regulator of ß-cell phenotype and function.

Laminin-5 as a marker of invasiveness in cervical lesions.

BACKGROUND: Treatment decisions for cervical cancer, a common disease worldwide, depend on demonstrating whether or not tumor invasion of the surrounding tissue has occurred. Invasion can be difficult to assess by standard histopathologic methods, especially when limited amounts of tissue are available. Several studies of a variety of cancers have reported increased expression of laminin-5-an important attachment protein for epithelial cells-in invasive carcinomas. This study was designed to investigate whether the presence of laminin-5 is related to the invasive capacity of cervical lesions. METHODS: We used immunohistochemical methods to stain archival, paraffin-embedded sections of cervical lesions with a polyclonal antibody specifically targeting the gamma2 chain of human laminin-5 protein. The study sample included 23 lesions of mild and moderate dysplasia (cervical intraepithelial neoplasia [CIN] 1 and 2, respectively), 32 lesions of severe dysplasia or carcinoma in situ (CIN 3), 15 lesions of microinvasive cancer, and 20 lesions of frankly invasive cancer. Cellular proliferative activity was also investigated by the use of monoclonal MIB-1 (directed against the antigen Ki-67) and anticyclin A antibodies. RESULTS: Invasiveness of cervical lesions was positively associated with immunohistochemical staining of the gamma2 chain of laminin-5 (two-sided P =.001). All CIN 1 and CIN 2 lesions-except one CIN 2 lesion later shown to be invasive cancer-and 21 CIN 3 lesions tested negative for the gamma2 chain of laminin-5. Eleven CIN 3 lesions and all invasive cancers tested positive for this protein. One lymph node metastasis and a pleural metastasis from one of the patients with invasive cancer showed strong immunohistochemical positivity. Proliferative activity increased with advancement of the lesion but was not confined to cells positive for the gamma2 chain of laminin-5. CONCLUSIONS: These data suggest that antibodies directed against the gamma2 chain of laminin-5 can identify cervical lesions with invasive capacity and thus may be useful as a sensitive marker of early invasion.

Laminin-5 is a marker of invading cancer cells in some human carcinomas and is coexpressed with the receptor for urokinase plasminogen activator in budding cancer cells in colon adenocarcinomas.

Recombinant human gamma 2 chain of laminin-5 was expressed in Escherichia coli, and used to generate specific polyclonal antibodies which were used to study the distribution of the protein in human cancers. A total of 72 biopsies of human cancers were stained, including 23 cases of colon adenocarcinomas, 16 ductal breast carcinomas, 9 malignant melanomas, 14 squamous cell carcinomas of the skin and cervix, and 10 sarcomas. As a control for the specificity of the antibodies, we performed in situ hybridization on adjacent sections of a number of the cases, and in all of these cases the localization of the gamma 2 chain protein and mRNA was identical. We found gamma 2 chain immunoreactivity in cancer cells in all cases of colon adenocarcinomas and squamous cell carcinomas but not in any of the sarcomas, supporting the view that the laminin-5 protein is specific for cells of epithelial origin. Notably, in all of the cases of colon adenocarcinomas, the positive staining was invariably associated with budding cancer cells located at the tip of invading malignant epithelium, whereas the cancer cells deeper in the tumors were most often negative. The staining was cytoplasmic in all cases and only in one case did we see additional extracellular immunoreactivity, indicating that this laminin isoform in cancer tissue is not laid down in the extracellular matrix but probably exerts its function at the cell surface or in its immediate vicinity. Using in situ hybridization to analyze the coexpression of laminin-5 and components of the plasminogen activation system, we found that the histological distribution of laminin-5-positive budding cancer cells at the invasion front in colon adenocarcinomas was identical to that of the receptor for urokinase-type plasminogen activator. These findings suggest that laminin-5 is a marker of invading cancer cells in at least some human malignancies, and that it therefore might represent a valuable marker for the invasive potential of these cancers. The colocalization of laminin-5 and urokinase-type plasminogen activator receptor in a subset of cancer cells in colon cancer also suggests that a controlled up-regulation of a number of gene products is a characteristic of budding colon cancer cells, and that these gene products serve functions crucial for the invasive phenotype of these cancer cells.

Urokinase plasminogen activator is expressed by basal keratinocytes before interstitial collagenase, stromelysin-1, and laminin-5 in experimentally induced dermatitis herpetiformis lesions.

We studied the temporal expression of interstitial collagenase, stromelysin-1 and -2, and urokinase plasminogen activator (uPA) mRNAs by in situ hybridization in eight patients with dermatitis herpetiformis. To induce blisters, 50% potassium iodide patch tests were performed, and serial biopsy specimens were taken at 4, 12, and 24 h. Additional samples were taken from occasional spontaneous blisters. Components of the basement membrane, laminin-5, laminin-1, and type VII collagen, were examined immunohistochemically in relation to matrix metalloproteinase expression. At 12 h, when no blisters were seen, uPA mRNA was present in basal keratinocytes in five of eight samples, whereas interstitial collagenase and stromelysin-1 mRNA were not detected. At this time, immunohistochemistry failed to show changes in the basement membrane. At 24 h, uPA, collagenase, and stromelysin-1 mRNAs were present in basal keratinocytes, suggesting an activation of latent forms of the two latter enzymes by the uPA-plasmin pathway. Signal for stromelysin-2 was not detected. Furthermore, disruptions of laminin-1 and type VII collagen were evident. The data suggest that stromelysin-1 and interstitial collagenase may contribute to the degradation of basement membrane in dermatitis herpetiformis. Intracellular staining for laminin-5 co-localized with collagenase mRNA in basal keratinocytes. Because laminin-5 is essential for adhesion of keratinocytes to basement membrane and for establishment of focal adhesions on migrating cells, its production may reflect a regenerative response after the destruction of basement membrane components.

Effect of obesity on the response to insulin therapy in noninsulin-dependent diabetes mellitus.

An initial improvement in glycemic control is often followed by gradual deterioration of glycemia during insulin treatment of patients with noninsulin-dependent diabetes mellitus (NIDDM). We examined the causes of such worsening in a 12-month follow-up analysis of 100 insulin-treated NIDDM patients in the Finnish Multicenter Insulin Therapy Study who were treated with either combination therapy with insulin or insulin alone. In the entire study group, glycemic control averaged 9.7 +/- 0.2% at 0 months and 8.0 +/- 0.1%, 8.0 +/- 0.1%, 8.2 +/- 0.1%, and 8.5 +/- 0.2% at 3, 6, 9, and 12 months (P < 0.001 for each time point vs. 0 months). Glycemic control at 12 months was significantly worse than that at 3 (P < 0.001), 6 (P < 0.001), and 9 months (P < 0.02). Baseline body mass index was the most significant predictor of deterioration in glycemic control. During 1 yr, hemoglobin A1c decreased almost 3-fold more (by 1.7 +/- 0.2%; P < 0.001 vs. 0 months) in patients whose baseline weight was below the mean baseline body mass index of 28.1 kg/m2 (nonobese patients) than in those whose weight exceeded 28.1 kg/m2 (obese patients; 0.5 +/- 0.2%; P = NS vs. 0 months; P < 0.01 vs. obese patients). Glycemic control improved similarly over 1 yr in the nonobese subjects and deteriorated similarly in the obese patients regardless of their treatment regimen. Insulin doses, per body weight, were similar in the nonobese and obese patients. The nonobese patients consistently gained less weight during 12 months of combination therapy with insulin (3.5 +/- 0.6 kg at 12 months) than during insulin therapy alone (5.1 +/- 0.6 kg; P < 0.05). The treatment regimen did not influence weight gain in the obese group, who gained 4.4 +/- 1.0 kg during combination therapy with insulin and 4.5 +/- 1.1 kg during insulin therapy alone. We reached the following conclusions: 1) after an initial good response, glycemic control deteriorates more in obese than in nonobese patients with NIDDM; 2) in obese patients, weight gain per se cannot explain the poor glycemic response to combination or insulin therapy, but it may induce a disproportionately large increase in insulin requirements because of greater insulin resistance in the obese than in the nonobese; 3) in nonobese patients, glycemic control improves equally during 1 yr with combination therapy with insulin and insulin alone, but combination therapy with insulin is associated with less weight gain than treatment with insulin alone; 4) weight gain appears harmful, as it is associated with increases in blood pressure and low density lipoprotein cholesterol.

Chain specificity assignment of monoclonal antibodies to human laminins by using recombinant laminin beta1 and gamma1 chains.

In the present study, the chain specificity of 16 commonly used monoclonal antibodies to human laminin(s) was analysed by using recombinant laminin beta1 and gamma1 chains. By ELISA, all antibodies reacted with purified placenta laminin, and most antibodies recognised either recombinant beta1 or gamma1 chains. Reactivity and chain specificity was confirmed against the recombinant chains in Western blotting under non-reducing conditions, and only a few antibodies were reactive under reducing conditions. Most antibodies were able to immunoprecipitate associated laminin beta1/gamma1 chains from platelet lysates. Based on these results and data from the literature, a tentative epitope map is presented.

Laminin-5 promotes adhesion and migration of epithelial cells: identification of a migration-related element in the gamma2 chain gene (LAMC2) with activity in transgenic mice.

The effects of laminin-5 and its subunit gamma2 chain on cell adhesion and migration were studied, and a migration-related cis-acting element was identified in the gamma2 chain gene (LAMC2) using promoter-reporter gene constructs in transgenic mice. Intact laminin-5 molecules, but not recombinant gamma2 chain promoted cell adhesion of human keratinocytes and mouse squamous carcinoma cells, indicating that the gamma2 chain does not contain a cellular binding site. However, the gamma2 chain as such is probably involved in the process of cell locomotion, as antibodies against the short arm of the chain inhibited migration of carcinoma cells in an in vitro assay. Further evidence for the involvement of the gamma2 chain in cell migration was obtained by the identification of a cis-acting element in a promoter-lacZ reporter gene construct that was active in migratory epithelial cells of healing wounds in mice made transgenic by microinjection of the construct into fertilized oozytes. The migration active element was located in the sequence between -613 and +55. The same construct, and another one containing 5900 base pairs of the 5' flanking region, yielded very limited expression in cells of normal tissues. The limited expression was, however, only observed in epithelial cells of different tissues, i.e. cell types that normally express laminin-5 in vivo. The results show that the sequence between -613 and +55 contains elements that can drive expression during epithelial cell migration and that also partially confers more general epithelium expression. However, elements outside -5900 and +55 are needed for normal epithelium expression of the LAMC2 gene.

Effect of fasting and food intake on magnetization transfer of human liver tissue.

Magnetization transfer (MT) technique is a promising method in differential diagnosis of diseases in parenchymal tissues. Basic knowledge about circumstances and elementary factors that influence MT and its parameters is still insufficient, however. Having a meal before the magnetic resonance (MR) examination could change liver MT parameters compared to fasting state through alteration in liver perfusion, blood flow, and content of portal blood (proteins and other derivates from a meal). If MT parameters can be altered by a meal, then MR liver studies should always be performed after fasting. Before MRI examinations we examined three healthy volunteers after a high-fat meal with Doppler ultrasound technique to find out duration and magnitude of changes in portal blood flow. Duration of > or = 50% increased peak-flow value compared to fasting state in portal vein was > 90 min, which is enough for our MR examination. With a low-field 0.1-T MR imager we examined 10 healthy volunteers after a short (range from 3 h 45 min to 17 h 30 min) fast and also immediately after a high-fat meal. Magnetization transfer parameters, magnetization transfer ratio (MTR) and magnetization transfer rate Rwm of liver tissue were determined. MTR changed significantly (Student paired two-tailed t-test, p = .0044) after a meal, but Rwm did not (p = .0952). We recommend a 4 h fast before MR examination that aims to determine the MTR of liver tissue.

Cancer of the vagina: Laminin-5gamma2 chain expression and prognosis.

The purpose of this experiment was to investigate the expression and the prognostic impact of the gamma2 subchain of laminin-5 in vaginal malignancies. The outcome of the rare disease primary carcinoma of the vagina is poor and little is known about prognostic markers. The gamma2 chain of laminin-5, an epithelial basement membrane protein, is thought to play a crucial role in tumor cell adhesion, migration, and proliferation, and may thus be an additive potential marker. Archival, paraffin-embedded sections were stained immunohistochemically with an antibody against the gamma2 chain of human laminin-5 protein. The material consisted of 59 cases of primary vaginal malignancies, subdivided into short- and long-time survivors. All invasive malignancies of epithelial origin were positively stained with the antibody against the gamma2 chain. High expression of the gamma2 chain correlated significantly in an univariate analysis with short-time survival (P = 0.041), but in the multivariate analysis only age and tumor size were independent prognostic factors. A significant intercorrelation between large tumors and high gamma2 chain immunoreactivity was found (P = 0.003). These results indicate that laminin-5gamma2 subchain expression in primary vaginal carcinomas is of prognostic impact. However, in a multivariate analysis only patient age and tumor size had independent prognostic value.

The effect of haemosiderosis and blood transfusions on the T2 relaxation time and 1/T2 relaxation rate of liver tissue.

Patients with chronic anaemia need repeated blood transfusions, which eventually lead to iron overload. The excess iron from blood transfusions is deposited in the reticuloendothelial system and in the parenchymal cells of the liver, spleen and other organs. Cellular damage is likely to occur when iron overload in the liver is pronounced. Liver biopsy is still necessary to evaluate the degree of haemosiderosis or haemochromatosis. To avoid this invasive procedure, methods have been sought to determine the concentration of iron in liver tissue and to estimate the effect of the treatment of haemosiderosis or haemochromatosis. In this MRI study, the T2 relaxation time and the 1/T2 relaxation rate of liver were determined in 23 patients who had undergone repeated blood transfusions for chronic anaemia. The first 60 transfusions had the greatest influence on the measured T2 relaxation time, with T2 relaxation time decreasing as haemosiderosis progresses. The 1/T2 relaxation rate increases significantly in a linear fashion when the number of blood transfusions increases up to 60. After 60 transfusions the influence of additional blood transfusions on the T2 value was minimal; the same response, although in reverse, was seen in the 1/T2 relaxation rate curve. One possible explanation for this may be that the MR system could detect the effect of only a limited amount of iron excess and any concentration over this limit gives a very short T2 relaxation time and a very weak signal from the liver, which is overwhelmed by background noise. However, in mild and moderate haemosiderosis caused by blood transfusions, T2 relaxation time and 1/T2 relaxation rate reflect iron accumulation in liver tissue.

Evaluation of surface contamination and the presence of Listeria monocytogenes in fish processing factories.

The main objective of this study was to determine the level of surface contamination in fish processing factories and the presence of Listeria in the factory environment and products. Another objective was evaluation of the different hygiene-monitoring methods. Total aerobic heterotrophic and enterobacteria, yeast and mold samples were collected and ATP levels measured in 28 factories. The number of well or adequately washed and disinfected factories was small (2 of 28), in terms of total aerobic heterotrophic bacterial counts on the surfaces. Most surfaces contaminated with bacteria were heavily contaminated. Results of the ATP and the total bacteria contact agar slide methods were poorly correlated (r = 0.21) although 68% of the samples were categorized as good to moderate or unacceptable with both methods. The Listeria-positive surface samples usually contained increased numbers of total bacteria (70.9%). The contamination of products and raw fish together with Listeria spp. was 45% and with Listeria monocytogenes 12%. Cold smoked fish was the most contaminated, with 75% Listeria spp. and cold salted fish with 20% L. monocytogenes. Listeria innocua was found in the samples more than twice as often as L. monocytogenes.

The efficacy of adhesives in the application of wound dressings.

The use of adhesive preparations to reinforce surgical tapes and to secure dressings to the skin is standard practice. BioBrane is a biosynthetic membrane for use in dressing clean, well-debrided wounds, particularly partial-thickness burns and skin graft donor sites. The close and undisturbed contact of this material with the wound surface is important during the first 2 days after its application to achieve adherence. This has prompted a study to test the relative anchoring strength of four methods of securing the dressing to the normal skin around the wound: 1/2-inch (1.27-cm) Steri-Strips only; Mastisol, a mastic compound, with and without 1/2-inch Steri-Strips; and compound tincture of benzoin, USP, in combination with 1/2-inch Steri-Strips. The results obtained with a tension of 1.1 pounds/square inch (0.5 kg/6.5 cm2) were not conclusive as to the superiority of any one method. However, with a tension of 2.2 pounds/square inch (1 kg/6.5 cm2), the combination of mastic compound and 1/2-inch Steri-Strips provided the strongest adhesion. This type of application should also prove useful when other types of surgical dressings must be anchored in place.

Validation of the microbiological methods hygicult dipslide, contact plate, and swabbing in surface hygiene control: a Nordic collaborative study.

A collaborative study on total aerobic bacterial count was conducted to validate the Hygicult TPC dipslide against contact plates and swabbing, using stainless-steel surfaces artificially contaminated with different microbes at various levels. Twelve laboratories took part in the validation procedure. The total number of collaborative samples was 108. The microbial level in each sample was assessed in triplicate using the 3 above-mentioned methods under 3 different incubation conditions (at 25 +/- 1 degrees C for 48 and 72 h and at 30 +/- 1 degrees C for 48 h). Surface sampling methods detached 25-30% at the lowest (theoretical yield, 1.4 cfu/cm2), 18-20% at the middle (theoretical yield, 10.7 cfu/cm2), and 16-21% at the highest (theoretical yield, 43.6 cfu/cm2) levels of microbes from the test surfaces. The percentage of acceptable results after removing outliers was 89%. Repeatability standard deviations ranged from 27.2 to 74.6% and reproducibility standard deviations ranged from 42.1 to 97.5%. There were no significant differences between results obtained at different incubation temperatures (25 and 30 degrees C) or incubation times (48 and 72 h) for all 3 methods. The Hygicult TPC dipslide, contact plate, and swabbing methods gave similar results at all 3 microbial levels tested: 0.35-0.43 cfu/cm2 at the lowest level, 1.9-2.2 cfu/cm2 at the middle level, and 7.1-9.1 cfu/cm2 at the highest level.