Prevalence of Sleep Apnea and Electrocardiographic Disturbances in Morbidly Obese Patients

Objective: To determine the prevalence of sleep apnea in morbidly obese patients and its relationship with cardiac arrhythmias. Research Methods and Procedures: Fifty‐two consecutive morbidly obese (body mass index ≥ 40 kg/m²) outpatients from the Obesity Clinic of the National Institute of Nutrition Salvador Zubirán underwent two nights of polysomnography with standard laboratory techniques. Electrocardiographic polysomnography signals (Lead II) were evaluated by two experienced cardiologists, and sleep complaints were measured with a standard sleep questionnaire (Sleep Disorders Questionnaire). In order to make comparisons between groups with different severities of sleep‐disordered breathing, we classified the patients in four groups using the apnea‐hypopnea index (AHI): Group 1, AHI 5 < 15 (n = 10); Group 2, AHI 15 < 30 (n = 10); Group 3, AHI 30 < 65 (n = 14); Group 4, AHI ≥ 65 (n = 17). Results: A wide range of sleep‐disordered breathing, ranging from AHI of 2.5 to 128.9 was found. Ninety‐eight percent of the sample (n = 51) had an AHI ≥ 5 (mean = 51 ± 37), and 33% had severe sleep apnea with AHI ≥ 65 with a mean nocturnal desaturation time of <65% over 135 minutes. Electrocardiographic abnormalities were present in 31% of the patients. Cardiac rhythm alterations showed an association with the level of sleep‐disordered breathing and oxygen desaturation. Discussion: We conclude that there is a high prevalence of sleep apnea in morbidly obese patients and that the risk for cardiac arrhythmias increases in this population in the presence of a severe sleep apnea (AHI ≥ 65) with severe oxygen desaturation (Sao ₂ ≤ 65%).     

Changes in resting motor threshold of the tongue with normal aging and stroke

Aim of study: To examine the resting motor threshold of the tongue in healthy adults and stroke survivors.

Methods: Thirty-five healthy adults were classified into three groups: Group 1 (19–38?years; n?=?11), Group 2 (50–64?years; n?=?12) and Group 3 (66–78?years; n?=?12). Six chronic stroke survivors (mean age =59?years, SD?=?9.1?years) were recruited (Group 4). The resting motor thresholds (RMTs) of the tongue were measured and compared (i) among the four groups and (ii) between stroke survivors and age-matched healthy adults.

Results: Group 3 showed significantly higher RMTs than Group 1 (p?=?.001) and 2 (p =?0.007). Group 4 showed significantly higher RMTs than Group 1 (p =?.003) and 2 (p?=?.001). The RMTs of Group 3 and 4 were not significantly different (p =?.385). The RMT was positively correlated with age (r?=?0.534; p =?.001). Group 4 showed significantly higher RMTs than the age-matched controls (U?= 2.5, p?=?.009, r?=?0.77).

Conclusions: The resting motor threshold of the tongue is significantly increased in adults aged above 65 and in stroke survivors when compared with healthy adults. The findings suggested that the cortical excitability of the tongue deteriorates in the elderly and the stroke population.     

Trypanosoma evansi: Activities of adenine nucleotide degradation enzymes in cerebral cortex of infected rats

This study aimed to evaluate the activities of the ectoenzymes NTPDase and 5′-nucleotidase in synaptosomes from cerebral cortex of rats experimentally infected with Trypanosoma evansi. The animals were divided in four groups (n = 10) according to the time and degree of parasitemia (groups A, B, C and D). The animals from group A were euthanized on day 3 (low parasitemia), group B on day 5 (high parasitemia) and group C on day 15 (low parasitemia). Group D consisted of healthy rats (not-infected, n = 15) and were divided in three periods (n = 5) in order to compare with the infected groups. After euthanasia, cerebral cortex was removed for the preparation of synaptosomes and enzymatic assays. Group A showed no changes in enzymatic activities compared with control. The hydrolysis of ATP, ADP and AMP by the enzymes NTPDase and 5′-nucleotidase were increased (P < 0.05) in group B (38%, 140% and 61%, respectively) when compared with control. In the group C it was observed a decreased (22%) hydrolysis of ATP when compared with control group. The activities of NTPDase and 5′-nucleotidase in synaptosomes alters the acute phase of the disease when the number of circulating parasites is high, thus the change observed is probably due to the parasitemia.     

A multimedia tool for the informed consent of patients prior to gastric banding

Objective: Severe obesity is a clear indication for appropriate, effective weight loss therapy. One option is operative intervention, e.g., gastric banding. Risks of the operation and therapeutic alternatives need to be comprehensibly presented to the patient. The literature has shown that better informed consent is obtained using information presented in a multimedia/video‐based format. The current study developed and evaluated a multimedia program aimed at obtaining informed consent from obese patients before gastric banding. Research Methods and Procedure: An interactive multimedia program was developed with information about preoperative examinations, the operation itself, hospital stay, operative risks, alternative therapies, and the pathophysiology and health risks of obesity. Two groups (Group 1, n = 20, mean age 38 years, informed consent attained with conventional document information; Group 2, n = 20, mean age 37 years, informed consent attained with additional multimedia information) were interviewed regarding comprehensibility of the information presented, personal satisfaction, and anxiety levels during the informed consent process. Results: Group 2 showed significantly better (p < 0.05) understanding of the presented information and higher levels of satisfaction with the informed consent process. Anxiety levels did not significantly differ between the two groups. Discussion: Because patient satisfaction with the informed consent process and understanding of the presented information significantly improved, the multimedia program clearly benefits both surgeons and patients. Personal contact from the surgeon remains essential. High volumes of information presented in multimedia format do not alleviate patient anxiety, and personal contact may be beneficial.     

PRESENCE OF CIRCADIAN RHYTHMS IN THE LOCOMOTOR ACTIVITY OF A CAVE-DWELLING MILLIPEDE GLYPHIULUS CAVERNICOLUS SULU (CAMBALIDAE,SPIROSTREPTIDA)

The locomotor activity of the millipede Glyphiulus cavernicolus (Spirostreptida), which occupies the deeper recesses of a cave, was monitored in light-dark (LD) cycles (12h light and 12h darkness), constant darkness (DD), and constant light (LL) conditions. These millipedes live inside the cave and are apparently never exposed to any periodic factors of the environment such as light-dark, temperature, and humidity cycles. The activity of a considerable fraction of these millipedes was found to show circadian rhythm, which entrained to a 12:12 LD cycle with maximum activity during the dark phase of the LD cycle. Under constant darkness (DD), 56.5% of the millipedes (n = 23) showed circadian rhythms, with average free-running period of 25.7h ± 3.3h (mean ± SD, range 22.3h to 35.0h). The remaining 43.5% of the millipedes, however, did not show any clear-cut rhythm. Under DD conditions following an exposure to LD cycles, 66.7% (n = 9) showed faint circadian rhythm, with average free-running period of 24.0h ± 0.8h (mean ± SD, range 22.9h to 25.2h). Under constant light (LL) conditions, only 2 millipedes of 11 showed free-running rhythms, with average period length of 33.3h ± 1.3h. The results suggest that these cave-dwelling millipedes still possess the capacity to measure time and respond to light and dark situations. (Chronobiology International, 17(6), 757–765, 2000)     

In vivo monitoring of serum protein cross linking in patients with diabetes mellitus. Evidence for pharmacological modification of immunoglobulin G cross links

Summary It is well known that increased cross linking of proteins due to nonenzymatic glycosylation occurs in diabetic animals and humans leading to accumulation of proteins (e.g. collagen). This in turn is strongly associated with diabetic long term complications.We developed a noninvasive method for studying in vivo cross linking and its pharmacological inhibition by L-arginine in a blind placebo controlled study with crossing over of two treatment periods of three months each.Glycemic control was assessed by determining blood glucose, HbA1c, fructosamine, and total glycosylated hemoglobin. The patients were randomly assigned to two treatment groups A (n = 14) and B (n = 16). 20 healthy volunteers served as controls. Treatment consisted of two daily dosages of 1 g L-arginine free base. Cross linking of a human serum protein (IgG) was assessed by SDS polyacrylamide gel electrophoresis and subsequent Western blotting.Diabetic patients showed a statistically increased number of cross links compared to normal controls (Group A: 3.6 vs 2.0 bands, group B: 3.8 vs 2.0 bands). L-arginine led to a significant reduction of cross links in both treatment groups (Group A: 3.6 to 2.1 bands, group B: 3.8 to 2.5 bands).The described noninvasive method for assessing in vivo cross linking requires onlyµl amounts of serum and could serve to monitor protein cross linking in patients with diabetes mellitus.     

p53 serum antibodies as prognostic indicator in head and neck cancer

p53 antibodies are a new serological parameter of unknown potential in patients with malignancies. Their occurrence has been described in various types of cancer patients. The mechanism underlying the immunization process is still unclear. We investigated the incidence of p53 serum antibodies in 143 head and neck cancer patients with an enzyme-linked immunosorbent assay. The post-therapy course of two matched study groups (n = 38 each), one p53-antibody-seropositive and one p53-antibody-seronegative, was followed up for 24 months. Thirty-nine head and neck cancer patients (27.3%) were seropositive for p53 antibodies. During the follow-up, the p53-antibody-seropositive patients accounted for more local tumor recurrences (n = 12 versus n = 8) and more tumor-related deaths (n = 11 versus n = 5) than did seronegative patients, and second primary tumors (n = 9 versus n = 0) occurred exclusively in seropositive patients. In total, therapy failures (recurrences, tumor-related deaths, second primaries) were observed in 17/38 cases (44.7%) in the p53-antibody-seropositive group and in 8/38 cases (21.1%) in the p53-antibody-seronegative group. These results, after a follow-up of 2 years, seem to indicate a prognostic value of p53 serum antibodies for therapy failure in patients with head and neck cancer. Received: 5 December 1996 / Accepted: 4 January 1997     

Changes of collagen metabolism predict the left ventricular remodeling after myocardial infarction

Objectives: To analyze the predictive value of cardiac collagen metabolism “in vivo" in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI). Design: Forty-five patients (age 66 ± 8.27) underwent biochemical analysis for cardiac collagen metabolism (groups A, B and C); 30 patients with their first MI were treated with successful PCI (group A; n = 30), group B (n = 5) were MI patients with unsuccessful PCI. Group C were patients without MI (n = 10), they underwent elective diagnostic coronary angiography only. The collagen metabolism was analyzed in acute and subacute MI phases by using serum blood markers: the carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP) and carboxy-terminal telopeptide of type I collagen (ICTP). Furthermore, the ejection fraction (EF) and left ventricular end-diastolic volume maximal changes in the course of 6 months were measured by echocardiography. Results: A significant increase of both PICP and PIIINP on day 4 following MI was detected. Furthermore, PICP and PIIINP level assessed on the 30th day was significantly higher in the PCI unsuccessful group versus successful group. PICP level on day 4 above 110 ug/l and PIIINP level above 4 ug/l was significantly often found in the subgroup of patients with the EF improvement less than 10% or worsening and with significant left ventricular dilatation during 6 months follow-up. Cardiac catheterization itself does not affect collagen metabolism. Conclusion: We concluded that collagen metabolism markers enable to study in vivo the MI healing and to predict left ventricular functional and volume changes.     

Triglyceride‐to‐HDL‐cholesterol Ratio and Metabolic Syndrome as Contributors to Cardiovascular Risk in Overweight Patients

Insulin resistance increases cardiovascular risk of obese patients. Triglyceride to high‐density lipoprotein cholesterol ratio (TG/HDL) ≥3.0 (in mg/dl) is a marker of insulin resistance in overweight persons. We aimed at assessing cardiovascular risk profile in 301 overweight elderly Neapolitan outpatients, according to TG/HDL ratio and metabolic syndrome (MS), diagnosed by National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. TG/HDL ratio was ≥3.0 in 97 patients (group A) and <3.0 in 204 (group B). Overall, 93–97% of group A patients and 38–51% of group B patients had MS, depending on the diagnostic criterion. Group A patients with MS had significantly higher waist‐to‐hip ratio, total and non‐HDL cholesterol than group B patients with MS. In group B, MS and non‐MS patients had similar waist‐to‐hip ratio, blood pressure, total and non‐HDL cholesterol. Ten year coronary risk, calculated by the Framingham equations (n = 243), was 10.3 ± 5% in group B, non‐MS patients; 13.1 ± 6% in group B, MS patients; 19.9 ± 8% in group A (F = 32.8; P < 0.001). At the multiple regression analysis, TG/HDL ratio was associated with coronary risk (r² = 0.227) more closely than gender, blood pressure, waist‐to‐hip ratio, non HDL cholesterol, and MS considered as a whole. A separate regression analysis showed that the logarithmically transformed TG/HDL ratio, an index of the HDL cholesterol esterification rate, is also associated with coronary risk (r² = 0.252). Thus, TG/HDL ratio could help to characterize high‐risk overweight patients deserving a special therapeutic effort. Cardiovascular risk profile of insulin‐sensitive patients, identified by lower values of this parameter, is only moderately affected by MS.     

Utilisation of dental services in a university hospital palliative and long-term care unit in Geneva

Objectives: Dental care plays an important role in the multidisciplinary approach, which is used in palliative and long‐term care to address the complex needs of terminally ill patients. The aim of this study was to assess the utilisation of dental services in a University Hospital Palliative and Long‐term Care Unit. Material and method: Over an observation period of 13 months, structured questionnaires were filled in after each dental appointment. The survey covered three main topics: the initiation and incentive from the dental consultation, particular difficulties because of the patient’s health or the hospital’s organisation as well as the accomplished treatment. Results: Two hundred and seventy‐five questionnaires from a total of 102 patients were available for analysis. The patients’ median age was 83 years (SD 10.3, range 49–101 years), 63 were female, 39 male. A majority of first appointments were initiated by a physician (n = 49 of 102), mainly because of pain (n = 62 of 275). 10.5% of the appointments were cancelled on the same day. Only one‐fifth of the patients were able to reach the practice on foot. Six used a walking stick and 54 relied on a wheelchair. Eighteen patients needed to be seen in their bed. The most frequently performed procedures were extractions and removal of denture sore spots (n = 67 of 275) followed by the manufacturing of new dentures (n = 38 of 275). In more than 17% of the appointments, no particular treatment was performed. Conclusion: The utilisation of dental services in terminally ill and severely compromised elderly patients shown justifies a dental service in a palliative care or geriatric hospital setting. The particular dental work profile requires a practitioner with empathy and professional experience.     

PLOIDAL CHANGES IN CLONAL CULTURES OF SPIROGYRA COMMUNIS AND IMPLICATIONS FOR SPECIES DEFINITION

A clonal culture of Spirogyra filaments of initially uniform width produced filaments of three additional significantly different widths. Group I filaments of the original clone were 30.9 ± 0.7 μm wide (mean ± SD, N = 50). Group I filaments produced Group II filaments (22.0 ± 1.1 μm) through vegetative growth and sexual reproduction. Zygospores from homothallic Group I filaments produced germlings representative of Groups I and II; zygospores from homothallic Group II filaments produced germlings representative of Group II only. Germlings of Groups III (27.7 ± 1.0 μm) and IV (44.9 ± 0.8 μm) were produced in the cross of I × II. Viable zygospores from homothallic Group III filaments were obtained. Cells of Group IV filaments were initially binucleate and did not conjugate. Of the six intergroup crosses possible, four resulted in conjugation-tube formation only; two crosses yielded zygospores (I × II and III × IV). Germlings from the successful cross of Groups III and IV produced filaments of all four groups. Chromosome counts were: Group I (24), Group II (12), Group III (18), and Group IV (24, one nucleus). Relative nuclear fluorescence values of mithramycin-stained DNA were (mean ± SD, N ≥ 30): Group I (11.1 ± 1.4), Group II (5.7 ± 0.7), Group III (8.8 ± 1.3), and Group IV (10.0 ± 0.9, one nucleus). Cytologically, Group II appears to be a diploid (2x), Group I a tetraploid (4x), and Group III a triploid (3x). Systematically, Groups I, II, and III key out to Spirogyra singularis, S. communis, and S. fragilis, respectively, using Transeau's mongraph of the family Zygnemataceae. These species are interpreted to represent a species complex of S. communis (whose name has priority) with the ancestral haploid (x = 6) missing.     

Evaluation of urinary oxalate levels in patients receiving gastrointestinal lipase inhibitor

Objective: The purpose of this study was to examine the possible effects of a gastrointestinal lipase inhibitor “Orlistat (Xenical)” on the intestinal absorption of oxalate and thereby on the urinary levels of oxalate excretion in overweight patients. Methods and Procedures: Long‐term follow‐up data of 95 cases (57 men, 38 women; M/W= 1.5) were documented. Patients were randomly assigned into two groups. While the patients in group I (n = 55) were treated with orlistat (Xenical) for 6 months, patients in group II (n = 40) received no specific medication. Calcium, oxalate, and citrate levels were determined in a 24‐h urine collection from each patient. To evaluate the significance in the groups as well as the differences between the two groups, ANOVA test was performed and the results were given as mean ± s.d. Results: Comparative evaluation of urinary oxalate levels during 3‐month follow‐up clearly showed that urinary oxalate excretion significantly increased in 34/55 patients (61.8%) in the first group (P < 0.05). Of these 34 patients, 30 (88.2%) continued to have increased urinary oxalate excretion during 6‐month follow‐up (P = 0.001). However, our data did not show any significant effect of this medication on urinary citrate and calcium levels during 3‐ and 6‐month follow‐up evaluation (P = 0.05). Discussion: Our results suggest that increased intestinal absorption of dietary oxalate due to this type of medication in obese patients could make a substantial contribution to urinary oxalate excretion and may increase the risk of stone formation.     

Effect of blue-blocking glasses in major depressive disorder with sleep onset insomnia: A randomized,double-blind,placebo-controlled study

Blue wavelengths form the portion of the visible electromagnetic spectrum that most potently regulates circadian rhythm. We hypothesized that wearing blue-blocking (BB) glasses in the evening may influence circadian rhythm disturbances in patients with major depressive disorder (MDD), resulting in improved sleep and mood. We used a randomized placebo-controlled double-blinded design. Patients with MDD with sleep onset insomnia were randomly assigned to wearing either BB glasses or clear glasses (placebo). Patients were instructed to wear the glasses from 20:00 hours until bedtime for 2 weeks. We assessed sleep state (sleep quality on a visual analog scale, the Morningness–Eveningness Questionnaire [MEQ], and a sleep diary) and depressive symptoms at baseline and after 2 weeks. Data were analyzed with a full analysis set. In total, 20 patients were randomly assigned to the BB and placebo groups (BB group, n = 10; placebo group, n = 10). There were three dropouts (BB group, n = 1; placebo group, n = 2). At baseline, sleep quality, sleep latency (assessed via a sleep diary), and antipsychotics use differed between the groups. To take account of these differences, the baseline sleep state or depressive symptoms and antipsychotics use were used as covariates in the later analysis. The change scores for sleep quality did not show a significant improvement in the BB group compared with the placebo group (mean [standard deviation, SD] scores for BB versus placebo: 36.1 [31.7] versus 16.2 [15.1], p = 0.43), although half of the BB group showed a clear improvement in sleep quality. The change in MEQ scores did not significantly differ between the groups (p = 0.14), although there was a trend of a shift to morning type in the BB group (3.10 [4.95] points) and to evening type in the placebo group (0.50 [3.89] points). There were no statistically significant changes in depressive symptoms in either group. Across both groups, 40% of the participants reported pain or discomfort from wearing the glasses, which were available in only one size. Thus, the failure to find significant differences may have resulted from the glasses used in this study. Glasses fitted to individual patients may improve efficacy and safety. Replication of the study with a larger sample size and size-adjustable glasses is needed.     

Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

Objective: Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy. Research Methods and Procedures: We performed a prospective cohort study of 71 patients with chronic kidney disease stage 5 in an outpatient hemodialysis center. Subjects were recruited in June 1998 and followed for 83 months. Survival was compared by the Kaplan‐Meier method. Results: After 83 months of follow‐up, 48 patients (68%) had died. Serum leptin concentrations at study entry were lower among all deceased patients compared with those patients who survived (5.2 ± 9.0 μg/L; n = 48; vs. 7.7 ± 7.8 μg/L; n = 23; p = 0.005). Baseline serum leptin concentrations were significantly lower in patients who died from cardiovascular diseases (4.7 ± 9.4 μg/L, n = 32) or infections (4.0 ± 2.7 μg/L; n = 10; each p < 0.05), but not cancer (9.4 ± 7.9 μg/L; n = 6), than in survivors (7.7 ± 7.8 μg/L; n = 23; p = 0.003). The relative risk for mortality in patients with serum leptin concentrations below the median (<2.6 μg/L) compared with patients above the median was 1.96 (95% confidence interval, 1.01 to 3.79; p = 0.04). Survival was shorter in patients with leptin concentrations below the median compared with those whose leptin concentrations were above the median (all‐cause mortality, χ² = 5.05; p = 0.02). Discussion: Low serum leptin concentration is an independent predictor of mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy.     

Reliability and validity of a Japanese version of the Oral Health Impact Profile for edentulous subjects

doi: 10.1111/j.1741‐2358.2011.00606.x Reliability and validity of a Japanese version of the Oral Health Impact Profile for edentulous subjects Objective: To evaluate the reliability and validity of the Japanese version of the Oral Health Impact Profile for edentulous (OHIP‐EDENT‐J) patients. Background: Oral Health Impact Profile for edentulous is an appropriate instrument for assessing the Quality of life (QOL) in edentulous patients. However, the reliability and validity of the Japanese version had not been evaluated. Methods: The study was conducted on 116 edentulous patients (Group A, requiring new dentures, n = 61; Group B, already having dentures, n = 55). Cronbach’s alpha (α) was used to measure internal consistency of the summary scores for OHIP‐EDENT‐J and various subscales in Groups A and B. The interclass correlation coefficient (ICC) and 95% confidence interval of the summary scores for OHIP‐EDENT‐J and subscales were calculated. The summary scores for OHIP‐EDENT‐J in Groups A and B were compared with evaluate content validity. The Spearman’s correlation coefficient between the summary scores for OHIP‐EDENT‐J and the satisfaction with dentures (100 mm VAS) was calculated for Groups A and B to evaluate concurrent validity. Results: The reliability of the summary scores for OHIP‐EDENT‐J was good (α = 0.93). The ICC of the summary scores for OHIP‐EDENT‐J was 0.85. Summary scores for OHIP‐EDENT‐J were significantly different (p = 0.027) between Group A and Group B, with Group A having the higher value. The Spearman’s correlation coefficient for the degree of satisfaction with dentures and the summary scores for OHIP‐EDENT‐J, calculated for Groups A and B (n = 107), was ?0.609. Conclusion: The OHIP‐EDENT‐J, a questionnaire on oral health–related QOL comprising 19 items, showed good reliability and validity for edentulous patients.     

Vertical distribution of Microcystis population in the regulated Nakdong River, Korea

The vertical distribution of a bloom-forming Microcystis population was studied based on the relevant limnological parameters obtained from the lower Nakdong River (Mulgum) during the summer of 1994. Over three months (late June to late September), a high abundance of Microcystis population (mean ± SD, 2.9 ± 8.4 × 10⁵ cells ml⁻¹, n = 40) and algal biomass (mean ± SD, chlorophyll a, 131 ± 346 μg l⁻¹, n = 31) was persistent throughout the entire water column (0–5 m, n = 11). The vertical distribution of carbon content was uneven, with a high concentration near the surface zone (mean ± SD, total, 7.9 ± 7.8; Microcystis, 5.2 ± 8.3 μg C ml⁻¹, n = 15). Incorporating limnological and meteorological factors, a diel study of the vertical distribution of Microcystis showed that the chlorophyll a concentration was highest near the surface zone on a calm night (wind velocity, <2 m s⁻¹, 2300–700) but was evenly distributed on a windy day (>4 m s⁻¹, 1100–1900). Among many possible factors, wind velocity may have played an important role in controlling the vertical distribution of Microcystis in the lower Nakdong River. Received: July 12, 1999 / Accepted: November 15, 1999     

Characterization of Methicillin-resistant Staphylococcus aureus isolated from public surfaces on a university campus, student homes and local community

Aim: Isolation and characterization of methicillin‐resistant Staphylococcus aureus (MRSA) from frequently touched nonhospital environmental surfaces at a large university, student homes and community sites. Methods and Results: Twenty‐four isolates from 21 (4·1%, n = 509) surfaces were MRSA positive and included 14 (58%, n = 24) SCCmec type IV, two (8%, n = 24) type I, and eight (33%, n = 24) were not type I‐IV (NT). Six different multilocus sequencing types were identified by PCR and sequencing. PCR assays identified one (4·2%, n = 24) Panton‐Valentine leukocidin (PVL) positive, 22 (92%, n = 24) arginine catabolic mobile element (ACME) positive and 23 (96%, n = 24) multidrug‐resistant (kanamycin, macrolide, tetracycline) MRSA isolates. Eleven (46%, n = 24) USA300 isolates were determined by pulsed‐field gel electrophoresis. Conclusion: The MRSA‐positive environmental surfaces were identified in student homes (11·8%, n = 85), the community (2·3%, n = 130) and the university (2·7%, n = 294). USA300 strains were isolated from the university, student homes and community samples. This is the first report of the animal clone ST97 on urban environmental surfaces. Significance and Impact of the Study: The study highlights the distribution of USA300 on frequently touched surfaces. Whether contact with these MRSA contaminated environmental surfaces are associated with increased risk of transmission of MRSA to people needs further research.     

Quadruple therapy with medications containing either rufloxacin or furazolidone as a rescue regimen in the treatment of Helicobacter pylori-infected dyspepsia patients: a randomized pilot study

Background: The eradication rates of first‐line treatment for Helicobacter pylori infection are not satisfactory. Various regimens including quadruple therapies have been recommended as rescue therapies after the first H. pylori eradication attempt failed. Aims: To compare the efficacy and safety between quadruple therapies with medications containing either rufloxacin or levofloxacin in the Chinese nonulcer dyspepsia patients infected with H. pylori. Methods: One hundred and thirty‐eight patients after an unsuccessful 10‐day standard triple therapy were enrolled in this study. They were randomized to receive a 14‐day quadruple therapy with pantoprazole, bismuth citrate, and furazolidone in combination with either rufloxacin (Group Ruf, n = 70) or levofloxacin (Group Lev, n = 68). The H. pylori eradication was evaluated by ¹³C‐urea breath test 4 and 12 weeks after therapy was completed. Results: One hundred and twenty‐seven patients (65 in Group Ruf and 62 in Group Lev) completed the study. The H. pylori eradication rates in Group Ruf were 81.4% for intention‐to‐treat (ITT) analysis and 87.7% for per‐protocol (PP) analysis. The rates were statistically significantly higher than those in Group Lev (66.2% and 72.6%) (p < 0.05). There were no severe adverse effects found in these two groups. Conclusions: Fourteen‐day quadruple therapy with a combination of proton‐pump inhibitor, bismuth citrate, furazolidone, and rufloxacin is considered an effective and safe rescue therapy for H. pylori eradication after failure of standard triple treatment.     

Up-regulation of blood arachidonate (20:4) levels in patients with chronic obstructive pulmonary disease

Context and objective: Plasma arachidonate (20:4) levels in patients with chronic obstructive pulmonary disease (COPD) were investigated.

Methods: Plasma was extracted and free fatty acids (FFAs) were separated using column chromatography and measured by fluorescence. Plasma 20:4 levels and its percentage relative to total FFA levels (%20:4) were measured in COPD (n = 18) and control (n = 20) subjects.

Results and conclusions: FFA levels were lower in COPD compared with normals. However, there was a significant increase in %20:4 levels in COPD patients (GOLD stage I/II 0.9 ± 0.4%; GOLD stage III/IV 1.1 ± 0.1%) compared with control subjects (0.6 ± 0.1, p < 0.05). %20:4 is a potential biomarker for COPD.     

The effect of exogenous progesterone on plasma LH and milk progesterone concentrations in multiple-suckling post-partum cows

Fourteen Friesian cows each suckling four calves were treated for a 7-day period (a) between days 20–40 post partum with progesterone-releasing intravaginal devices (PRID) containing 2% progesterone (Group 1; n = 5), (b) between days 51–264 post partum with PRIDS containing 2% progesterone (Group 2; n = 6) and (c) between days 29–214 days post partum with PRIDS containing 0% progesterone (Group 3; n = 3). Mean plasma LH concentrations decreased during PRID treatment in Group 2 cows only and pre-ovulatory LH surges were observed in $\text{5}\text{6}$ of these cows between 38 and 84 h after coil removal. All Group 2 cows underwent at least one ovarian cycle following PRID removal. No pre-ovulatory LH surges were observed in either Group 1 or Group 3 cows and only one cow (Group 3) underwent an ovarian cycle after treatment. It is suggested that there is an increase in pituitary responsiveness to the feedback effects of progesterone during the post-partum period.