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Homophone (HP) priming occurs when phonologically ambiguous words persistently coactivate their contextually irrelevant meanings. If suppressing those meanings fails, they subliminally bias preferences. Yet, it is unclear if prior findings generalize beyond individual words and to bilingual contexts. This has implications for consumer behavior and the debate on differences between first (L1) and second language (L2) lexical processing. We present four multi-item experiments with German-English bilinguals. An initial eye-tracked primed choice task established that homophones affect decision making. Three visual preference experiments with written and/or auditory primes and high- or low-proficiency L2 users found that homophones bias preferences more in L1 than L2. The L1-L2 gap widened if listening or low proficiency made suppression more difficult. We argue that the interplay between reduced suppression in L2 as predicted by activation-suppression models and lower subjective frequency of L2 homophones assumed by the frequency lag hypothesis explain the size of the L1-L2 priming gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This study examined the impact of sport-specific cognitive training (CT) on executive functions (EFs) in youth soccer players. Thirty-one athletes (13-15 years) participated, 13 in the intervention group (IG) and 18 in the control group (CG). The IG underwent an 8-week soccer-focused CT program, while the CG maintained regular training. The assessments included working memory, inhibition, and cognitive flexibility tasks. The results revealed no significant improvements in EFs in the IG compared to those in the CG. Both groups showed enhanced cognitive flexibility, possibly due to general cognitive development or learning effects. The study suggested that an 8-week sport-specific CT may not enhance EFs in young soccer players, potentially due to a ceiling effect in highly skilled athletes. These findings should be considered when designing cognitive training programs for athletes, and future research could explore the optimal duration of such programs., (© 2024. The Author(s).)

While researchers and practitioners attribute an essential role to executive functions (EFs) for soccer performance, the usefulness of respective diagnostics and the predictive value remain unclear. One limitation restricting the translation and relevance of study results to improve actual game performance is the insufficient consideration of competitive conditions. Thus, this study aimed to conduct soccer-specific cognitive diagnostics under a soccer-specific psychophysiological stress condition, mimicing the demands of a competitive game. A total of 92 (M age  = 15.17, SD age  = 1.45) youth elite players performed tests for inhibition (flanker task) or cognitive flexibility (number-letter task) with a soccer-specific motor response (i.e., pass into goals). After a pre-test in a neutral condition, players were randomly assigned to a neutral (moderate soccer-specific exercise) or a stress condition (physical stress and competitive instructions and filming for psychological stress). Objective (i.e., cortisol, heart rate variability) and subjective stress-related measures (i.e., SAM, VAS) were assessed six times throughout experimental procedure. Analyses revealed significant interaction effects between time and condition for all objective and subjective variables indicating a successful experimental stress induction. For cognitive performance, results revealed significant main effects of time, but no significant interaction effects between time and condition. However, descriptive statistics suggested improved performance under stress, with decreased flanker effect and switch costs. Additionally, response time variability in the flanker task significantly decreased in the stress condition. These findings offer insights into individual stress perception and processing under game-related psychophysiological demands, expanding previous research on situational EF alterations that also hold relevance for applied practitioners., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The study investigates relative age effects (RAE) in German youth soccer (Youth Bundesliga A: January 2004 to December 2005 and B: January 2006 to December 2007; highest league in German youth soccer) and its persistence in third-division players. Data from the 2022-2023 season (120 teams, 3,174 players) were analyzed using chi-square tests. Significant RAE was found in the A-series ( p  < .001), B-series ( p  < .001), and third-division professionals ( p  < .001). Notably, RAE was prominent among younger players but less evident in older third-division players ( p  = .116), indicating a diminishing selection effect with age and professional tenure. Coaches and talent managers are advised to consider RAE and additional factors like player maturity in talent selection for more efficient talent management strategies, especially in youth academies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Heilmann, Kuhlig and Stoll.)

Introduction: Executive functions (EFs) are relevant for game performance in soccer and have been investigated in previous research. However, emotions are a well-known performance factor in sport competitions, which may affect performance by means of EFs. The diagnostic of EFs has mainly been performed disregarding the potential impact of emotional states. Thus, we aimed to initially analyze interaction between emotional states and EFs in two studies with male youth elite soccer players., Methods: In the first study, 105 players ( M age = 14.97) completed computerized tasks assessing inhibition, cognitive flexibility and working memory. In the second study, 92 players ( M age = 15.17) performed adapted and validated tests of inhibition ( n  = 45) or cognitive flexibility ( n  = 47) in a soccer-specific setting (SoccerBot360). Emotional and affective states were assessed using the German Sport Emotion Questionnaire and self-assessment manikins., Results: For the computerized tasks, results showed a significant negative correlation between switch costs accuracy and tension, r  = 0.28, indicating lower error rates with higher levels of tension. In contrast, in the SoccerBot360 we found significant positive correlations for response time and tension (no-switch: r  = 0.38; switch: r  = 0.39) representing prolonged response times related to tension. Further, for soccer-specific inhibition, positive emotions were significantly positively correlated with response time (congruent: r  = 0.32; incongruent: r  = 0.32). Subsequent regression analyses also demonstrate that valence and arousal effectively explain variance in cognitive performance parameters under neutral conditions., Discussion: Accordingly, the ambiguity of the results suggests high variability in EF performance, affective and emotional states as well as a potentially moderating influence of other variables such as context and task difficulty. Thus, future cognitive diagnostic research should integrate assessments of emotional and affective states as these may contribute to situational fluctuations in EF performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Knöbel, Weinberg, Heilmann and Lautenbach.)

Cognitive training primarily aims to improve executive functions (EFs). It has become a popular research topic, as previous studies have provided preliminary evidence that EFs relate to sports performance. However, whether a domain-generic cognitive training intervention can improve EFs in high-performance athletes is still unclear. The present randomized controlled study aimed to examine the effects of an eight-week (5 min/day, 5 days/week) smartphone-based domain-generic cognitive training intervention (i.e., the smartphone game "Fruit Ninja") on EFs in youth soccer athletes ( N  = 33; intervention: n  = 15, passive control: n  = 18; German youth soccer academy). We assessed working memory (3-back task), inhibition (Flanker & Go/NoGo task), and cognitive flexibility (number-letter task) in a pre-post design with computerized tasks. The results showed no significant time x group differences attributable to the cognitive training between the intervention group and the control group, except for a response time variable of the Go/NoGo task. These preliminary results do not suggest an application of CT as a smartphone-based game to improve EFs performance in soccer players. However, more research is needed to establish the efficacy of domain-specific interventions in high-level team sport athletes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Heilmann, Formenti, Trecroci and Lautenbach.)

Cognitive diagnostics, especially the measurement of executive functions (EFs) in the context of sports and talent diagnostics, is a popular research topic. However, research is lacking on how self-reports are sufficient to examine the EFs of youth athletes for performance diagnostics. Thus, the current study aims to evaluate the relationships between neuropsychological tasks (3-back task, cued Go/NoGo task, flanker task, and number-letter task) and a self-report for examining EFs (BRIEF-SB). Furthermore, it should be investigated whether it is possible to predict the outcome of EF tasks using a self-report inventory. Therefore, 68 young professional soccer players (Mage = 14.26 ± 1.35 years) from a national youth academy were included in the study. The weak-to-moderate correlations (r = 0.000, p = 0.999 to r = −0.442, p < 0.01) and the results of sensitivity analysis (0.125 to 0.538) do not support using a self-report of EFs for cognitive performance diagnostics. The inventory is only suitable for identifying executive dysfunctions in athletes recovering from head injuries or concussions.

Exercise modes can be categorized based on the skills required (open vs. closed skills), which implicates various demands on cognitive skills, especially executive functions (EFs). Thus, their practice may have varying effects on EFs. There is a lack of detailed analysis of cognitive requirements and suitable classification of sports. It is hypothesized that the amount and type of cognitive requirements of sports lead to small effect sizes when comparing open-skill exercising (OSE) and closed-skill exercising (CSE) athletes. The current meta-analysis evaluates the variances in EFs skills caused by particular sport modes. Four research databases (Web of Science, PubMed, ScienceDirect, PsychINFO) were searched for cross-sectional studies in which the authors compare the performance in EF tasks of OSE and CSE athletes. Risk of bias assessment was conducted using funnel plots and two reviewer selection process (overall and subgroup analysis; low risk of publication and selection bias). A total of 19 studies were included, revealing an overall effect size of Hedge’s g = 0.174 (p = 0.157), favoring OSE for the development of EFs. The subgroup analysis revealed the effects for the subdomains of EFs (cognitive flexibility: Hedge’s g = 0.210 > inhibitory control: Hedge’s g = 0.191 > working memory: Hedge’s g = 0.138; p > 0.05), which could be characterized as low to moderate. The hypothesis that studies with the smallest effect sizes compare sport modes with similar cognitive demands was rejected. The paper discusses the differentiation of sports into OSE and CSE and presents new approaches for their categorization.

The assessment of core executive functions (EFs; i.e., inhibition, working memory, cognitive flexibility) has often been presented as a diagnostic tool for evaluating cognitive functions in recent publications. For example, EFs are essential in soccer because players must quickly adapt, change strategies, and inhibit responses in rapidly changing game situations. Previous research has shown relations between (subjectively rated) game performance and the EFs of soccer players. Nevertheless, the previous studies' samples were heterogeneous in their performance level (experts vs. amateurs), and the ratings were rather unsystematic (no validated rating protocol). Therefore, the current study aimed to predict soccer players' game performance (i.e., systematically rated by coaches) with the help of EF performance. Therefore, we assessed the game performance (small-sided game, Game Performance Assessment Instrument [GPAI]) and EFs (inhibition: flanker task; working memory: 3-back task; cognitive flexibility: number-letter task) of 94 male soccer players (12-19 years old) from Germany's highest competitive level. Multiple regression model results indicate that inhibition (i.e., flanker effect) and calendar age explain ~18% of players' game performance variance. Results have to be interpreted with regard to the age-dependency of game performance and EFs. In conclusion, even though the results are based on a cross-sectional study, it appears that calendar age needs to be considered when assessing EFs.

Athletes in a particular sport have specific cognitive skills acquired due to regular confrontation with sport-specific requirements. Studies show that the particular type of sport carried out and fostered by general physical activity impacts executive functions (EFs) such as inhibition, working memory, and cognitive flexibility. There are inconsistent results on the connections between domain-specific cognitive skills and executive functions. This study aimed to evaluate the relations between EFs and domain-specific cognitive skills in climbing. Due to that, we examined the executive functions (neuropsychological tests) and domain-specific cognitive skills (climbing-specific test: a preview of the route vs. climbed moves; climbed moves vs. recognition of moves) of 19 climbers (10 novices, 9 experts, grades 5 to 6a vs. 6c+ to 7b). The inter-subject effects analysis shows that novices and experts in sport climbing do not differ in executive functions in this particular case. Concerning domain-specific cognitive skills, there are differences between experts and novices. Experts show a significantly higher level in planning performance or route idea ( p < 0.001) as well as in memorizing of climbed moves ( p = 0.004). There are no relations between executive functions and domain-specific cognitive skills in climbers.

The Interactive Balance System (IBS), a posturography device for assessing posture control, is widely used in clinical and rehabilitation settings. However, data on the validity of the device are unavailable. Fluctuations of the center of pressure (COP) were measured in 24 healthy participants (age: 29 ± 5 (mean ± SD) years, 12 females) synchronously using the IBS, which was rigidly mounted on a Kistler platform. Four different bipedal conditions were examined: eyes open or closed on stable or soft surfaces. Time series were compared using congruity (CON, proportion of the measurement time during which values of both devices changed similarly in direction), whereas IBS-specific postural outcomes were correlated with traditional postural control outcomes of the Kistler force platform. The time-displacement curves showed similar shapes for CON (>0.9) for each of the four standing conditions without differences between male and female participants (P > 0.39). The path length results of both devices showed very high linear associations, explaining on average 92% (medio-lateral) or 96% (anterior-posterior) of the common variance. The Kistler path length of the anterior-posterior direction revealed nearly perfect linear associations with the stability index of the IBS (r 2  > 0.99). The results of this study indicate that the IBS provides valid posturographic results. Since the medial-lateral and anterior-posterior trajectories of the IBS can be used to calculate COP fluctuations, comparisons between different measurement systems are possible., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Detection of Shiga toxin-producing Escherichia coli (STEC) in The Netherlands is traditionally limited to serogroup O157. To assess the relative importance of STEC, including non-O157 serogroups, stool samples submitted nationwide for investigation of enteric pathogens or diarrhoea were screened with real-time PCR for the presence of the Shiga toxin genes. Patients were selected if their stool contained blood upon macroscopic examination, if they had a history of bloody diarrhoea, were diagnosed with haemolytic uraemic syndrome, or were aged <6 years (irrespective of the bloody aspect of the stool). PCR-positive stools were forwarded to a central laboratory for STEC isolation and typing. In total, 4069 stools were examined, with 68 (1.7%) positive PCR results. The highest prevalence was for stools containing macroscopic blood (3.5%), followed by stools from patients with a history of bloody diarrhoea (2.4%). Among young children, the prevalence (1.0%) was not significantly higher than among random, non-bloody, stool samples from diarrhoeal patients (1.4%). STEC strains were isolated from 25 (38%) PCR-positive stools. Eleven O-serogroups were detected, including five STEC O157 strains. As serogroup O157 represented only 20% of the STEC isolates, laboratories should be encouraged to use techniques enabling them to detect non-O157 serogroups, in parallel with culture, for isolation and subsequent characterisation of STEC strains for public health surveillance and detection of outbreaks.

Ceramic composites composed of constituents with different bone cell reactions present an interesting consideration for a new bone replacement material. The first component of the composite used in this study, hydroxyapatite, is known to be replaced by natural tissue significantly slower than the second, calcium carbonate, which has limited structural stability. A graded hydroxyapatite/calcium carbonate composite with bimodal component distribution was developed using a combined slip infiltration and dip-coating technique from a porous polyurethane sponge replica. A graded hydroxyapatite scaffold with porosities from 5 to 90% was produced and then infiltrated with a calcium carbonate slip and sintered. The resultant composite had improved mechanical properties compared with the monolith as measured by crushing and moduli tests.

Background and Objectives: Sample mix-ups are a threat to the validity of clinical laboratory test results. To detect serum sample mix-ups we developed a single nucleotide polymorphism (SNP) profiling test. SNPs are frequent sequence variations in the human genome. Each individual has a unique combination of these nucleotide variations., Materials and Methods: Predeveloped SNP amplification assays are commercially available. We recently discovered that these SNP assays could be applied to serological samples, which is not self-evident because a key step in serum preparation is removal of white blood cells, the major source of DNA, from blood. DNA was extracted from serum samples. Real-time polymerase chain reaction (PCR) analysis of the purified DNA using a selection of 10 SNP assays provided SNP profiles., Results: The applicability of the SNP profiling test was demonstrated by means of a case where hepatitis E virus serological determinations of four serum samples of one patient seemed inconsistent. SNP profiling of the samples demonstrated that this was due to the enzyme-linked immunosorbent assay test instead of sample mix-up., Conclusion: We have developed an SNP profiling assay that provides a way to link human serum samples to a source, without post-PCR processing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18 000. Solving potential serum sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.

We treat the problem of selecting the next degree of freedom for update in an extremal optimization algorithm designed to find the ground state of a system with a complex energy landscape. We show that there exists a best distribution for selecting the next degree of freedom in order to optimize any linear function of the state probabilities, e.g., the expected number of visits to the ground state. We dub the class of algorithms using this best distribution in conjunction with extremal optimization fitness threshold accepting. In addition, we construct an extended random walk and use it to show that fitness threshold accepting is optimal also for several other measures of algorithm performance, such as maximizing the expected probability of seeing the ground state and minimizing the expected value of the lowest energy seen.

A 48-year-old Dutch patient presented with general malaise, recurrent fever and weight loss. Routine cultures identified a Campylobacter in two blood cultures. When initial treatment with clarithromycin failed, the patient developed endocarditis. DNA sequencing identified Campylobacter fetus subspecies fetus (C. fetus). The patient recovered after treatment of the infection with imipenem and gentamycin, based on the minimal inhibiting concentration. C. fetus is a rare cause of infection in humans and is mostly transmitted by handling infected animal material. The patient contracted the infection as a result of a puncture accident with a butcher's knife about a year previously whilst working in a slaughterhouse.

Background: Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4)., Aims: The aim of this clinical study was to evaluate the effects of topical application of n-6 or n-6 polyunsaturated fatty acids in patients with experimental gingivitis., Methods: In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography., Results: After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n-6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range))., Conclusion: The topical application of n-6 or n-6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n-6 fatty acids could reduce the level of GCF in established experimental gingivitis.

Background: Tuberculosis was diagnosed in a student nurse. The source of infection was unknown and no positive culture was available., Methods: The diagnosis of tuberculous bronchitis was established on the grounds of a positive Mantoux test, the pathology of a bronchial biopsy and the results of a CT scan of the thorax. Spoligotyping of, for example, formalin-fixed tissue makes it possible to establish the diagnosis in a later phase after all., Results: Cultures for Mycobacterium tuberculosis were not performed for the student nurse and Ziehl-Neelsen staining of the formalin-fixed bronchial biopsy was negative. The final tuberculosis diagnosis was confirmed by a PCR fingerprint technique, i.e., spoligotyping of a formalin-fixed biopsy specimen. By means of contact investigation and identification of the strain via spoligotyping, comparison of the spoligo patterns made it possible to treat both the patient and those infected by this person correctly., Conclusions: When there is a pronounced suspicion of tuberculosis and a microbiological culture is not available, it is recommended that supplementary spoligotyping of clinical specimens be carried out. The purpose is to confirm the diagnosis, trace the presumed source case and indirectly to provide information on the drug susceptibility of the relevant M. tuberculosis strain.

A married couple affected by necrotizing enterocolitis is described. Both had the same toxin-producing Staphylococcus aureus which was considered to be responsible for the necrotizing enterocolitis.

We investigate by numerical simulations the dynamics of spiral pairs which are found in oscillatory and excitable media as described by the complex Ginzburg-Landau equation. Our simulations include two spiral pairs which approach each other and interact. The spirals typically exchange partners and form new pairs. This type of interaction gives rise to some patterns: a right-angle scattering pattern, a rotating state coming out of two traveling pairs, and a symmetric spiral lattice. The scenarios are compared to other conservative and dissipative systems where scattering at right angles is also observed.

Aims: To detect and differentiate Mycobacterium tuberculosis simultaneously by polymerase chain reaction (PCR) in clinical samples prepared for histopathological analysis and for microscopic detection of acid fast bacteria., Methods: Paraffin wax embedded tissue samples and Ziehl-Neelsen (ZN) and auramine stained microscopic preparations from culture positive tuberculosis patients were subjected to DNA extraction and amplification by PCR. PCR was performed with primers specific for direct repeats and the product was detected by hybridisation to a set of 43 different oligonucleotides, a procedure designated as "spoligotyping"., Results: Mycobacterium tuberculosis complex DNA was detected in all of the 23 paraffin wax embedded tissues analysed. Strain differentiation was possible in 20 of the 23 paraffin wax embedded tissues. Mycobacterium tuberculosis complex DNA was also detected and typed in eight of 10 ZN stained microscopic preparations. The hybridisation patterns obtained from virtually all of these samples were identical to those obtained from DNA extracted from cultures., Conclusion: Simultaneous detection and strain differentiation of M. tuberculosis complex bacteria is possible in clinical samples prepared by current methods for microscopic and histopathological analysis, without the need to culture. The methodology described opens the way to rapid disclosure of outbreaks in high risk settings, such as hospitals and prisons, where dissemination of tuberculosis might be very fast as a result of a high prevalence of human immunodeficiency virus infected patients.

The antimicrobial susceptibility of 196 recent clinical isolates of anaerobic bacteria to ampicillin alone, ampicillin plus 1 mug/ml sulbactam, ampicillin plus 5 mug/ml sulbactam, and cefoxitin was studied by means of agar dilution tests. The ampicillin/sulbactam combination was most effective against species of the Bacteroides fragilis group, the minimum inhibitory concentration (MIC)(90) of ampicillin plus 5 mug/ml sulbactam for B. fragilis being 1 mug/ml, compared with 256 mug/ml of amoicillin, 4 mug/ml of ampicillin plus 1 mug/ml sulbactam, and 8 mug/ml of cefoxitin. No significant difference between ampicillin alone and in combination with sulbactam was observed against Gram-positive anaerobic rods or cocci.

Bacterial interactions in mixed infections may compromise antimicrobial therapy. The in vitro bactericidal activity of ampicillin and ampicillin-sulbactam against aerobic/anaerobic mixed cultures of Bacteroides fragilis, Escherichia coli and Enterococcus spp. was studied by means of broth dilution tests. The MBC of ampicillin for Enterococcus faecalis 6 was 0.25 mg/l when tested singly; in association with B. fragilis 1, however, the MBC for E. faecalis 6 was 16 mg/l. When tested singly E. coli 9 and B. fragilis 1 were both killed by ampicillin at a concentration of 4 mg/l in combination with 1 mg/l sulbactam. When both strains were associated, the MBC for B. fragilis 1 rose to > 256 mg/l. Results obtained indicate that the behaviour of bacteria as determined in pure cultures is not necessarily identical with the antibiotic susceptibility present in mixed cultures. It was shown that, besides beta-lactamase production by involved bacteria, other factors contribute to the alteration of bacterial susceptibility in mixed cultures. Synergistic and antagonistic effects between associated organisms were observed. For example, it was found that two moderately sensitive bacterial strains were resistant in mixed culture.

Bacterial interactions in mixed infections may interfere with antimicrobial therapy. The in-vitro efficacy of ampicillin alone, combination sulbactam/ampicillin, and metronidazole was studied. Strains of Bacteroides fragilis, Escherichia coli, and Enterococcus faecalis, alone and in association, were tested by means of a broth dilution method. Minimal bactericidal concentrations (MBC) of ampicillin for B. fragilis 74 in association with E. coli 68 were up to 16-fold higher than for B. fragilis 74 alone (256 compared to 16 mg/l), but only 2-fold higher for sulbactam (5 mg/l)/ampicillin (0.5 and 0.25 g/l). Association of B. fragilis 45 and E. faecalis 186 increased ampicillin MBC of E. faecalis 186 from 2 to 16 mg/l, but the combination sulbactam/ampicillin restored activity of ampicillin. In association with E. faecalis, metronidazole MBCs of B. fragilis increased up to 64-fold. Strains of E. faecalis and E. coli were able to destroy 10 mg/l metronidazole within 8 to 20 h. The present experiments demonstrated effectiveness of sulbactam/ampicillin to inhibit beta-lactamases of associated pathogens. Destruction of metronidazole by E. faecalis lends additional support to the use of the combination in aerobic/anaerobic infections including E. faecalis.

The antimicrobial susceptibility of 195 recent clinical isolates of anaerobic bacteria was studied to ampicillin alone, ampicillin + 1 mg/l sulbactam, ampicillin + 5 mg/l sulbactam, and cefoxitin by means of agar dilution tests. The ampicillin-sulbactam combinations were the most effective drugs against species of the Bacteroides fragilis group, the MIC90 of ampicillin + 5 mg/l sulbactam for B. fragilis being less than 1 mg/l, compared to 256 mg/l of ampicillin, 4 mg/l of ampicillin + 1 mg/l sulbactam, and 8 mg/l of cefoxitin. No significant difference between ampicillin alone and in combination with sulbactam was observed against gram-positive anaerobic rods, Peptococcus spp. and Peptostreptococcus spp. with MIC's less than 2 mg/l.

Effect of a Combination of Ampicillin and Sulbactam on Clinical Isolates of Anaerobic Bacteria. The antimicrobial susceptibility of 182 recent clinical isolates of anaerobic bacteria to ampicillin alone, ampicillin plus 1 mg/l sulbactam, ampicillin plus 5 mg/l sulbactam, and cefoxitin was studied by means of agar dilution tests. The ampicillin-sulbactam combination (Unacid) was most effective against species of the Bacteroides fragilis group, the MIC90 of ampicillin plus 5 mg/l sulbactam for B. fragilis being less than or equal to 1 mg/l, compared to 256 mg/l of ampicillin, 4 mg/l of ampicillin plus 1 mg/l sulbactam, and 8 mg/l of cefoxitin. No significant difference between ampicillin alone and in combination with sulbactam was observed against gram-positive anaerobic rods or cocci.

In infections of polymicrobial etiology, it seems mandatory to combine an antibiotic with marginal activity against anaerobes with an anti-anaerobic drug, e.g. metronidazole or clindamycin. We investigated the effect of associations of anaerobic and facultatively anaerobic pathogens on MBCs of enoxacin, clindamycin, metronidazole, and combinations of enoxacin plus clindamycin or metronidazole. Single testing, and associations of Bacteroides fragilis with Escherichia coli or Enterococcus faecalis revealed MBCs of 64 mg/l for enoxacin. However, investigating metronidazole, MBCs for B. fragilis increased from 0.5-1 mg/l to 2-4 mg/l in association with E. coli. The combination of enoxacin with metronidazole restored MBCs of 0.5 and 1 mg/l for the B. fragilis strains. B. fragilis associated with E. faecalis showed MBCs of 2 to 64 mg/l for metronidazole, an increase of up to 64-fold. The enoxacin MBCs for E. coli in association with B. fragilis were up to eight-fold higher than for E. coli alone (2 mg/l compared to 0.25 mg/l). Association of E. coli with E. faecalis and B. fragilis showed a low to moderate increase for MBCs of E. coli when enoxacin was tested alone or in combination with metronidazole or clindamycin. In contrast, MBCs for E. faecalis did not change significantly with any of the associations or combinations tested. It is evident that in vitro antimicrobial susceptibility of associations of pathogens can be modified by interactions between strains, and/or antimicrobials.

Revascularisation after arterial block in the lower leg is a low-risk procedure which is definitely superior to lumbar sympathectomy in stage III and IV. In 110 patients 115 femorocrural reconstructions were performed in almost 9 years. Four weeks after the operation the revascularisation was open and showed free flow in 93.3%. In 64.4% an open revascularisation with largely painless walking ability was found 2-9 years post-operatively.

Clavulanic acid is known to potentiate the activity of amoxycillin and ticarcillin against beta-lactamase-producing Bacteroides species. In order to assess the usefulness of the clavulanate antibiotics in mixed infections with aerobes and anaerobes, artificially associated cultures of clinically significant Bacteroides species and facultative anaerobes (Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, Enterococcus faecalis, Staphylococcus spp. and Streptococcus spp.) were tested. The minimal bactericidal concentrations (MBC) of amoxycillin and ticarcillin, singly and in combination with clavulanate, were determined for the individual species in the associated culture and for the associated culture as a whole. In the absence of clavulanate, association experiments showed that the MBCs of susceptible strains increased in the presence of beta-lactamase-producing species, whereas the addition of clavulanate to the test systems led to MBCs which were mostly comparable to values as determined in single strain testing.

The aim of automated susceptibility testing systems like the Cobas Bact is to provide the clinicians with rapid and reliable results for the care of patients and to decrease the work load in microbiological laboratories. Because data about accuracy on mezlocillin, azlocillin and ciprofloxacin were lacking, we investigated 184 bacterial strains and compared the results of the Cobas Bact susceptibility testing to standardized agar dilution and agar diffusion methods. Essential correlations for all methods compared exceeded 90% for the three chemotherapeutics and all species investigated, with the exception of Pseudomonas aeruginosa. On an average only 1.5% very major errors were observed with the several species of Enterobacteriaceae, whereas P. aeruginosa and Enterococcus faecalis were characterized by the complete absence of very major errors when Cobas Bact was correlated to NCCLS agar diffusion.

Susceptibility of anaerobic clinical isolates from the United States, Canada, and Germany to sulbactam/ampicillin (1 + 2) (SBT/AMP), ampicillin alone (AMP), and cefoxitin (CFX) was determined with a standard agar dilution test. The isolates included 192 strains of Bacteroides fragilis, 132 strains of other Bacteroides spp., and 19 strains of Clostridium spp. Against all species tested, SBT/AMP was more active than AMP or CFX. Results obtained by a new model of associative susceptibility testing indicated that susceptibility testing of single pathogens from polymicrobial infections is not necessarily reflective of the susceptibility of the pathogens at the site of infection. The results suggest that sulbactam is effective in associations of pathogens producing beta-lactamases of Richmond-Sykes types II-V and beta-lactamases of anaerobic bacteria.