Trends in Australian dental prescribing of antibiotics: 2005-2016

BACKGROUND

Prescribing of antibiotics by dentists for surgical prophylaxis or as an adjunct to managing dental infections is a substantial part of the overall landscape for prescribed antibiotics in health care settings.

METHODS

We explored trends in the antibiotic prescribing patterns of Australian dentists over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered dentists subsidized on the Pharmaceutical Benefits Scheme.

RESULTS

Australian dentists were responsible for almost 7 million dispensed prescriptions of antibiotics over 12 years; an average of 24 prescriptions per year per dentist. The most commonly prescribed antibiotic was amoxicillin, followed by amoxicillin + clavulanic acid and metronidazole. These top three antibiotics constituted more than 80% of all antibiotics prescribed and their use increased dramatically over time. There was a large increase in the prescribing of broad-spectrum antibiotics over time, most of which occurred from 2011 to 2016.

CONCLUSIONS

Excessive prescribing of broad-spectrum antibiotics runs contrary to national antimicrobial stewardship (AMS) initiatives and guidelines. Multifaceted educational strategies are essential to align prescribing with current best practice. High-level evidence to inform clear guidelines on antibiotic prescribing in dental infections, with audit and feedback, should reduce the inappropriate use of antibiotics in dentistry.

Challenges and Recent Advances in Medulloblastoma Therapy

Medulloblastoma (MB) is the most common childhood brain tumor, which occurs in the posterior fossa. MB tumors are highly heterogeneous and have diverse genetic make-ups, with differential microRNA (miRNA) expression profiles and variable prognoses. MB can be classified into four subgroups, each with different origins, pathogenesis, and potential therapeutic targets. miRNA and small-molecule targeted therapies have emerged as a potential new therapeutic paradigm in MB treatment. However, the development of chemoresistance due to surviving cancer stem cells and dysregulation of miRNAs remains a challenge. Combination therapies using multiple drugs and miRNAs could be effective approaches. In this review we discuss various MB subtypes, barriers, and novel therapeutic options which may be less toxic than current standard treatments.

Abstract C8: Putative tumor-initiating cell populations in mantle cell lymphoma exhibit microenvironmentally influenced differences in stem cell-like and tumorigenic properties

The presence of subpopulations of cells possessing enhanced tumor formation capabilities has been described in several tissues. These cells have been termed tumor-initiating cells (TICs) or cancer stem cells and have been isolated using various techniques, including the side population (SP), the use of cell surface markers including CD133 and CD44 and aldehyde dehydrogenase activity. We have elected to evaluate the stem cell-like and tumor forming capabilities of SP and CD133+/CD44+ cells in Mantle Cell Lymphoma (MCL), an aggressive and relatively therapy unresponsive form of Non-Hodgkin's Lymphoma. All analyses were conducted in the presence of micro-environmental niche cells (murine stromal 5 cells) or extracellular matrix components (Matrigel) as these factors are known to play an integral role in processes associated with stem cell self-renewal and differentiation. SP cells and CD133+/CD44+ cells were present in Granta 519, an aggressive MCL cell line. The in-vitro technique of the Cobblestone Area Forming Cell (CAFC) assay was utilized to assess the self-renewal capabilities of SP and CD133+/CD44+ cells when the two cell types were cultured in the presence and absence of Matrigel, a mixture of extracellular matrix proteins derived from the Englebreth-Holm murine sarcoma. CAFC assays revealed enhanced self-renewal capabilities for Granta SP cells over non-SP cells, with the addition of Matrigel increasing the self-renewal frequency of SP and non-SP cells by 5.8 and 8.6 fold respectively. Conversely, Granta CD133+/CD44+ and CD133−/CD44− cells possessed similar self-renewal capabilities, with the addition of Matrigel having a negligible effect. When evaluated for chemotherapy resistance, the murine stromal 5 (MS5)-adherent CD133+/CD44+ cells and the non-adherent SP cells were more resistant to hydroxyurea while all MS5-adherent Granta cells were resistant to this agent. In-vivo analyses demonstrated tumor formation of Matrigel mixed SP and non-SP populations but not for Matrigel mixed CD133+/CD44+ or CD133−/CD44− cells. Although micro-metastatic tumors were not detected for SP and non-SP injected mice, flow cytometric analyses identified Granta cells, characterized by CD20 expression, in all murine tissues examined. IL-8, a proangiogenic cytokine implicated in tumor metastasis, may be involved in the metastatic spread of Granta cells as it was significantly present in the supernatants of Granta SP MS5 co-cultures, but was negligible or undetected when non-SP, CD133+/CD44+ and CD133−/CD44− cells were co-cultured with MS5 cells. These studies suggest that the SP phenotype may be a better marker for the isolation of stem-like cells in MCL. Moreover, the micro-environmental components found in Matrigel, rather than cell phenotype differences, appear to play a vital role in the initiation of tumor development by SP and non-SP cells. The tumor micro-environmental niche may therefore be an important target for development of novel therapeutic agents.

Citation Information: Cancer Res 2009;69(23 Suppl):C8.

The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico

This paper estimates the impact of managed care on use of mental health services by residents of low-income areas in Puerto Rico. A quasi-experimental design evaluates the impact of a low capitation rate on a minority population using three waves of data from a random community sample. Results indicate that two years after introducing managed care, privatization of mental health services had minimal impact on use. Advocates had hoped health care reform would increase access in comparison to access seen within the public system, while opponents feared profit motives would lead to decreased access. Neither forecast turned out to be correct. The question remains as to how to improve access for the poor with low capitation rates.

Does managed mental health care reallocate resources to those with greater need for services?

Evidence points to the existence of two coexisting inefficiencies in mental health care resource allocation: those with need receive too limited or no care while those with no apparent need receive services. In addition to reducing costs, managed mental health care is expected to reallocate treatment resources to those with greater need for services. However, there are no empirical findings regarding this issue. This study tests whether managed mental health care has had a differential impact by level of need. Data consist of three waves of a community sample with a control group. The study finds that managed care has not succeeded in reallocating resources from the unlikely to the definite "needers."

Changes in access to mental health care among the poor and nonpoor: results from the health care reform in Puerto Rico

OBJECTIVES

Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care.

METHODS

Data from 3 waves of a random community sample were collected on approximately 3,000 adults. Changes in use of mental health services were assessed in a pretest-posttest, quasi-experimental design.

RESULTS

Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector.

CONCLUSIONS

Reallocation of mental health services may be a result of expanding Medicaid eligibility.

Massive ibuprofen ingestion with survival

OBJECTIVE

To report a massive, 100 g ibuprofen ingestion in an adolescent, with survival.

CASE REPORT

The patient developed coma, metabolic acidosis, and mild thrombocytopenia, but improved rapidly with supportive care. Renal function remained normal and no gastrointestinal bleeding occurred.

CONCLUSIONS

Massive ingestion of ibuprofen may result in a variable picture with some elements of significant toxicity, but supportive care usually results in survival without sequelae.

Calcium blockade reduces renal apoptosis during ischemia reperfusion

Apoptosis is well described in invertebrates and recently documented in mammals. The prevalence and pathophysiology of mammalian apoptosis is unknown and may have clinical ramifications. The aim of this study is to investigate the apoptotic response during kidney ischemia-reperfusion (I/R) injury. Kidney I/R was initiated in anesthetized rats by occlusion of the renal pedicle for 45 min with or without pretreatment with .2 mg/kg verapamil: control animals received sham exposure. Flow was re-established after ischemia and the animals were allowed to recover for 24 h. Bilateral kidneys were harvested for DNA electrophoresis, Western analysis for p53, Northern analysis for c-myc expression, and light and electron microscopic analysis. Kidney I/R caused characteristic DNA laddering in the clamped kidney, and less extensive laddering was seen in the contralateral kidney. Light and electron microscopic analysis confirmed apoptotic morphology in the reperfused tissues. Verapamil pretreatment completely abolished DNA laddering and attenuated the microscopic evidence of apoptosis. p53 levels were increased by I/R in the ischemic kidney and moderately increased in the contralateral organ. c-myc mRNA levels were increased by the I/R insult. Kidney I/R injury may induce global apoptosis, which seems to be associated with an alteration in calcium homeostasis. The increase in p53 and c-myc mRNA levels seen with I/R may facilitate apoptosis. Calcium modulation seems to reduce apoptosis during I/R and may have therapeutic implications.

Localized sequence heterogeneity in the long terminal repeats of in vivo isolates of equine infectious anemia virus

The role of in vivo long terminal repeat (LTR) sequence variation of the lentivirus equine infectious anemia virus (EIAV) has not been explored. In this study, we investigated the heterogeneity found in the LTR sequences from seven EIAV-seropositive horses: three horses with clinical disease and four horses without any detectable signs of disease. LTR sequences were targeted in this study because the LTR U3 enhancer region of tissue culture-derived isolates has been identified as one of the few hypervariable regions of the EIAV genome. Furthermore, LTR variation may regulate EIAV expression in vivo. Both intra- and interanimal sequence variations were investigated. The intra-animal variation was low in seropositive, healthy horses (on average 0.44%). Intra-animal variation was consistently higher in clinically ill horses (0.99%), suggesting that greater numbers of quasispecies of EIAV are present when active virus replication is ongoing. Interanimal comparisons of consensus sequences generated from each horse demonstrated that the enhancer region is a hotspot of sequence variation in vivo. Thirty-seven of the 83 nucleotides that compose the U3 enhancer region were variable between the different in vivo-derived LTRs. The remainder of the LTR that was analyzed was more conserved, 8 of 195 nucleotide positions being variable. Results of electrophoretic mobility shift assays demonstrated that some nucleotide substitutions that occurred in the enhancer region eliminated or altered transcription factor binding motifs that are known to be important for EIAV LTR expression. These data suggested that the selective pressures exerted on the EIAV LTR enhancer sequences are different from those exerted on the remainder of the LTR. Our findings are consistent with the possibility that enhancer sequence hypervariability can alter expression of the virus in tissue macrophages and therefore contribute to clinical disease in infected horses.

Managers' attitudes towards mechanical aids

This article reports a study of the attitudes of NHS management and financial personnel to issues of moving and handling, in particular the use of mechanical aids. The study highlights some confusions about the responsibilities and roles of different personnel, and the authors make some recommendations to clarify these.

Epstein-Barr virus (herpesvirus 4) types A, B and herpesvirus-6 variants A and B in patients presenting with recurrent upper respiratory inflammation, persistent paravertebral thoraco-lumbar muscle spasm and fatigue by polymerase chain reaction (PCR)

DNA from Epstein-Barr virus (EBV) Types A, B and Herpesvirus-6 (HHV-6) Variants A and B was detected by the Polymerase chain reaction (PCR) in the saliva of 51 non-immunocompromised donor patients and in the blood of seventy non-immunocompromised donor patients with specific signs and symptoms. The minimum selection criteria for each patient included acute or recurrent upper respiratory infection, unilateral thoracolumbar muscle spasm and fatigue. PCR DNA detection in the saliva of selected donors revealed 80% of the donors had either Type A or B EBV (41 of 51), 34.1% Type B EBV only (14 of 41), 9% Type A only (4 of 41), and 56.1% Type A and B EBV (23 of 41). HHV-6 DNA was detected in 45.0% (23 of 51). PCR for EBV in blood of selected donors revealed 68.5% Type A or B EBV (48 of 70), 0% type B EBV alone, 64.8% Type A EBV only (31 of 48) and 35.4% both Type A and B EBV (17 of 48). HHV-6 was detected in 96.4% (64 of 70). The association of Type B EBV in the pathogenesis of these patients is explored based on the PCR quantitation of B type EBV DNA present in the samples.

An evaluation of mechanical aids used within the NHS

This paper describes Phase III of the study of mechanical aids used within the NHS, the aim of which was to evaluate the acceptability and effectiveness of mechanical aids within the service. Phases I and II of the study consisted of interviewing nurses and clients concerning their attitudes towards mechanical aids and observing nurses in the clinical area using mechanical aids. Phase III consisted of an experiment being undertaken to compare the usability of a number of mechanical aids for controlled task in a laboratory environment. The aim of this was to compare a number of different mechanical aids currently available, for perceived safety, comfort, ease of use and manoeuvrability in ward simulated conditions.

A study into clients' attitudes towards mechanical aids

In the second article of three (the first appeared in last week's issue), the authors describe Phase II of the study "An Evaluation of Mechanical Aids used within the NHS', the aim of which was to evaluate the acceptability and effectiveness of mechanical aids. In this article clients' attitudes toward mechanical aid use is considered. This is supplemented by data obtained through observing nurses and clients using mechanical aids in the clinical area. It was found that, although mechanical aids were considered desirable and safe by most patients and their operation involved only moderate postural discomfort to the nurses operating them, the nurses still offered client discomfort or fear as a reason for not using the aids. The authors offer some recommendations to encourage increased use of mechanical aids in appropriate client care situations. The final article, describing Phase III of the study, will appear in next week's issue.

A study of nurses' attitudes towards mechanical aids

Publication of the Manual Handling Operations Regulations (HSE 1992) focused attention on the use of mechanical aids for the purposes of moving and handling. However, nurses' reluctance to use this equipment has been widely documented. The reasons for this are complex and the aim of this study was to examine in depth the effectiveness and acceptability of mechanical aids to nurses and clients. This article reports on the part of the study which surveyed nurses' attitudes towards this equipment. The data were obtained by means of a semi-structured interview schedule. One hundred and eighty five nurses from a selection of specialties were interviewed. Common problems identified by the researchers were lack of proper training in mechanical aid use, mechanical aids and slings being unavailable or inaccessible, arbitrary use of mechanical aids and spatial constraints to mechanical aid use. Recommendations are made which aim to address the issues raised. Phases II and III of the study will appear in the next two issues.

Antibody against an Anaplasma marginale MSP5 epitope common to tick and erythrocyte stages identifies persistently infected cattle

A protein epitope of major surface protein 5 (MSP5), defined by monoclonal antibody (MAb) ANAF16C1, is conserved among Anaplasma species (E. S. Visser, T. C. McGuire, G. H. Palmer, W. C. Davis, V. Shkap, E. Pipano, and D. P. Knowles, Jr., Infect. Immun. 60:5139-5144, 1992) and is expressed in the salivary glands of infected ticks. A competitive inhibition ELISA (cELISA) for the detection of bovine anti-MSP5 antibodies was developed by using purified recombinant MSP5 fusion protein and MAb ANAF16C1. The specificity of the recombinant-MSP5 cELISA within North America was established by using 261 serum samples from cattle in the regions of Hawaii and Northern Ontario where anaplasmosis is not endemic and from cattle proven by splenectomy or subinoculation of whole blood into susceptible splenectomized recipients to be uninfected. The maximum percent inhibition by these sera was 18%. Sera known to be positive were obtained from 35 cattle either experimentally inoculated with infected erythrocytes or exposed to infected Dermacentor andersoni ticks. Thirty-four of the 35 serum samples inhibited MAb ANAF16C1 binding by > or = 25%. During acute infection, the MSP5 cELISA detected antibodies prior to or concomitantly with the appearance of rickettsiae in erythrocytes. Antibodies were detectable in sera from persistently infected cattle inoculated as long as 6 years previously.

An assessment of moving and handling practices among Scottish nurses

The aim of this study was to examine current practices within the Lothian Health Board area in relation to reporting of occupationally induced musculoskeletal injuries, training in moving and handling, and use of mechanical aids. A sample of 5,184 nurses working throughout the health board was given a questionnaire containing both open and closed questions. The results showed a significant proportion of nurses had time off work due to musculoskeletal injury and that this was related to grade and specialty. There was also a significant proportion of the respondents who did not report injuries and/or who experienced pain/discomfort, but did not take time off work. Present moving and handling training appears to be inadequate and too infrequent for the needs of staff. These findings emphasise the need for a review of both accident reporting systems and training, in particular in the use of mechanical aids.

Protective immunity to Haemonchus contortus induced by immunoaffinity isolated antigens that share a phylogenetically conserved carbohydrate gut surface epitope

Whole gut homogenates of the blood-sucking nematode Haemonchus contortus induce protective immunity in goats, and some of these gut Ag are conserved among related parasitic nematode species. To identify gut Ag that induce protective immunity and have phylogenetically conserved epitopes, mAb were made to gut-surface Ag of H. contortus. Forty-nine mAb reacted with microvilli of the parasite gut. Two of these mAb (42/10.6.1 and 42/53.3.5) were analyzed here. Both of the mAb bound to the microvillar surface of freshly isolated gut, and each mAb recognized carbohydrate epitopes, based on sensitivity to periodate oxidation. The 42/10.6.1 epitope occurred on at least 18 proteins in Western blots and in several H. contortus tissues. Proteins recognized by this mAb localized to membrane and excretory/secretory fractions of the worm. This epitope was also identified on the gut and other tissues and multiple proteins of related adult and larval nematodes, including larval Ancylostoma caninum and a mixed population of the free-living nematode Caenorhabditis elegans. In contrast, the 42/53.3.5 mAb bound to the gut surface and recognized proteins of 100 and 46 kDa from adult H. contortus gut. Four proteins of 100, 52, 46, and 30 kDa were isolated from the 42/53.3.5 immunoaffinity columns, and except for the 30-kDa protein, each was recognized by both the 42/10.6.1 and 42/53.3.5 mAb. Epitopes recognized by each mAb were distinct from one another and phosphorylcholine. When used to immunize goats, Ag isolated by both mAb induced protection that significantly (p < 0.05) reduced total worm counts after challenge infections compared with the control groups.

Protective immunity to Haemonchus contortus induced by immunoaffinity isolated antigens that share a phylogenetically conserved carbohydrate gut surface epitope

Whole gut homogenates of the blood-sucking nematode Haemonchus contortus induce protective immunity in goats, and some of these gut Ag are conserved among related parasitic nematode species. To identify gut Ag that induce protective immunity and have phylogenetically conserved epitopes, mAb were made to gut-surface Ag of H. contortus. Forty-nine mAb reacted with microvilli of the parasite gut. Two of these mAb (42/10.6.1 and 42/53.3.5) were analyzed here. Both of the mAb bound to the microvillar surface of freshly isolated gut, and each mAb recognized carbohydrate epitopes, based on sensitivity to periodate oxidation. The 42/10.6.1 epitope occurred on at least 18 proteins in Western blots and in several H. contortus tissues. Proteins recognized by this mAb localized to membrane and excretory/secretory fractions of the worm. This epitope was also identified on the gut and other tissues and multiple proteins of related adult and larval nematodes, including larval Ancylostoma caninum and a mixed population of the free-living nematode Caenorhabditis elegans. In contrast, the 42/53.3.5 mAb bound to the gut surface and recognized proteins of 100 and 46 kDa from adult H. contortus gut. Four proteins of 100, 52, 46, and 30 kDa were isolated from the 42/53.3.5 immunoaffinity columns, and except for the 30-kDa protein, each was recognized by both the 42/10.6.1 and 42/53.3.5 mAb. Epitopes recognized by each mAb were distinct from one another and phosphorylcholine. When used to immunize goats, Ag isolated by both mAb induced protection that significantly (p &lt; 0.05) reduced total worm counts after challenge infections compared with the control groups.

Chronic active Epstein-Barr virus infection, an AIDS-Co-Factor or predominant infection?

Chronic Active Epstein-Barr Virus is associated with Epstein-Barr Virus 2B (EBNA2B) and AIDS and possibly a widespread clinical syndrome. Provocative conclusions regarding their association are noted.

DRGs: labels, information and uncertainty

This paper presents a new perspective on why Diagnosis Related Groups (DRGs) are successful. It begins with a characterisation of labels we use to describe their attributes and a brief overview of the Commonwealth Australian National Diagnosis Related Group (AN-DRG) localisation project. Information required and produced by AN-DRGs computer programs is then outlined to establish their domain of application. Uncertainty in such information limits the utility of DRGs as a planning and managing tool. Examples are presented to clarify their statistical properties and to motivate discussion regarding technology for improving their performance.

Psychosomatic musculoskeletal pain in childhood: clinical and psychological analyses of 100 children

The clinical and psychological findings on 100 children with psychosomatic musculoskeletal pain seen at a major pediatric rheumatology referral center are reported. Most (76%) were female, median age was 13 years, and median duration of symptoms was 1 year. Multiple painful sites were common (66%). The pain was constant (63%) or intermittent (37%); 45% had hyperesthesia, and almost all maintained a cheerful affect when complaining of severe pain. Two predominant abnormal family milieu were seen. One was cohesive, stable, and organized, but intolerant of separation and individuation. The other was chaotic, emotionally unsupportive, with high levels of conflict. Members of the cohesive family type reported significantly less distress than members of chaotic families. Enmeshment between mother and child was common in both family types. Although frequently viewed as bright, most of these children had normal intelligence, and some had unrecognized academic difficulty. These children, compared with those with arthritis, had a significantly lower global well-being score. Clinical depression was unusual (11%). Most (97%) responded favorably to intensive physical and occupational therapy along with individual or family psychotherapy; 78% become symptom free or fully functional. Children with these signs and symptoms should have full psychological evaluations and respond well to treatment directed toward decreasing pain and restoring function.

Severity of arthritis is predicted by antibody response to gp135 in chronic infection with caprine arthritis-encephalitis virus

Antibody titers to caprine arthritis-encephalitis virus surface glycoprotein gp135 and core protein p28 in synovial fluid and serum from 35 goats infected for 3 years were compared with the histologic severity of arthritis in these animals. Anti-gp135 antibody titers in synovial fluid and serum directly reflect the severity of carpal arthritis in chronically infected goats.

Genetic Variability among Strains of the Entomopathogenic Nematode Steinernema feltiae

A systematic program of genetic improvement was initiated by assessing the phenotypic variation of Steinernema feltiae strains for two traits assumed to limit efficacy: ultraviolet tolerance and host-finding ability. All of the strains assayed showed both low ultraviolet tolerance and poor host-finding ability, indicating that the likelihood of improving these traits through more extensive population sampling is remote. Limited genetic variation was detected among the strains for tolerance to ultraviolet, suggesting that selective breeding for increased tolerance would be inefficient. By contrast, highly significant phenotypic differences were found with regard to host-finding ability, suggesting that this trait would be responsive to selection. A genetically heterogeneous population was constructed by round-robin mating of 10 strains; it will serve as the foundation population for selective breeding.

Detection of Anaplasma-marginale-infected tick vectors by using a cloned DNA probe

Anaplasmosis is the most widely distributed of several important tick-borne diseases that constrain cattle production throughout much of the world. Evaluation of the effectiveness of disease control strategies that integrate vaccination with tick control requires the ability to monitor tick and cattle infection rates. To detect Anaplasma marginale in ticks and bovine erythrocytes, a 2-kilobase DNA fragment from a cloned A. marginale gene coding for a surface protein having a Mr of 105,000 was prepared and evaluated as a probe. The probe was species specific and detected A. marginale DNA derived from infected bovine erythrocytes and adult Dermacentor ticks infected either as nymphs or adults. Tick infection was confirmed by microscopy and test feeding on a susceptible calf. The sensitivity of the probe is suitable for detecting infected ticks in experimental and field epizootiology studies.

Survey of the utilization of psychiatrists and psychologists for hospitalized children

Although interest by psychiatrists and psychologists in consultation to pediatric settings has increased in the past few years, little is known about how frequently they have been involved in providing psychosocial services to hospitalized children. The authors distributed a 20-item questionnaire to 136 pediatricians and 12 head nurses, representing 22 hospitals throughout Washington State. The questionnaire was designed to assess the disciplines involved in providing psychosocial care, the availability of various personnel, teaching functions, funding of services, and perceived need for further services. The results showed that psychiatrists and psychologists were utilized least often in all settings. Respondents from 68% of the hospitals represented specifically requested more services from psychiatrists and psychologists trained in pediatric issues. The authors discuss possible reasons behind the underutilization of psychiatrists and psychologists.

Qualitative and quantitative analysis of uroliths in dogs: definitive determination of chemical type

Effective treatment and prevention of urolithiasis depends on accurate determination of the chemical nature of the uroliths. A widely used qualitative chemical procedure was compared with quantitative crystallographic analysis of 272 canine uroliths. Agreement between the 2 methods was 78%. Qualitative analysis failed to detect 62% of calcium-containing uroliths and 83% of carbonate apatite uroliths. Qualitative analysis gave false-positive results for urates in 55% of cystine uroliths. Mixed uroliths comprising 6% of the total could not be classified without quantitative analysis. Silicate, cystine, and urate uroliths generally were of pure composition. Crystallographic analysis indicated the following distribution of major types: struvite, 69%; calcium oxalate, 10%; urate, 7%; silicate, 3.5%; cystine, 3.2%; calcium phosphate, 1%; and mixed, 6%. Among dogs with struvite uroliths, 66% had positive results of bacterial culturing from the urinary bladder. Six breeds (Miniature Schnauzer, Welsh Corgi, Lhasa Apso, Yorkshire Terrier, Pekingese, and Pug) had a significantly higher risk for urolithiasis, compared with other breeds. The German Shepherd Dog had a significantly lowered risk, compared with other breeds. Two breeds had significant relationship to a specific type of urolith: Miniature Schnauzer for oxalate, and Dalmatian for urate (P less than 0.001). It was concluded that quantitative analysis, using crystallography, was superior for the detection of calcium oxalate, carbonate apatite, cystine, urate, and mixed uroliths.

Profound shock following intervention for chronic untreated stool retention. A case report

Chronic stool retention with soiling is a common and distressing condition in children. Diagnosis and treatment generally involve both medical and psychological aspects. This case addresses a potentially life-threatening complication of shock occurring during treatment of chronic stool retention with castor oil, and also explores the psychosocial factors felt to be contributory.

Development of a somatic mutation screening system using Hb mutants. IV. Successful detection of red cells containing the human frameshift mutants Hb Wayne and Hb Cranston using monospecific fluorescent antibodies

The production and purification of antibodies detecting Hb Wayne, an alpha-globin frameshift mutant, and Hb Cranston, a beta-globin frameshift mutant, are described. The antibodies are of a nonprecipitating nature, and they permit strong fluorescent labeling of erythrocytes containing Hb Wayne or Hb Cranston. Studies using artificial mixtures containing cells with either of the two mutants in frequencies ranging from 1 in 10(2) to 1 in 10(5) showed that fluorescent antibodies can detect rare mutant red cells in the presence of vast excesses of normal erythrocytes. On the basis of the structures and the molecular lesions underlying production of the two abnormal hemoglobins, we predict that the anti-Hb Wayne antibody will detect several frameshift mutants resulting from deletion of 3n + 1 nucleotides or insertion of 3n + 2 nucleotides at the 5' side of the codon normally specifying residue 139 of the alpha chain. The anti-Hb Cranston antibody should be capable of detecting beta chains, the corresponding genes of which have sustained insertions of 3n + 2 nucleotides or deletions of 3n + 1 nucleotides on the 5' side of the codon normally specifying residue 144. The two antibodies may, therefore, prove to be valuable in the development of a system aimed at detecting rare erythrocytes that express mutations which arise in the hemopoietic stem cells of normal individuals and subjects exposed to mutagens.