Coronary vessel involvement by chronic graft-versus-host disease presenting as sudden cardiac death.
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Biomedical subjects
Publications and source records attributed to D Prevost.
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Penicillin-binding proteins (PBPs) are membrane proteins involved in the final stages of peptidoglycan synthesis and represent the targets of beta-lactam antibiotics. Enterococci are naturally resistant to these antibiotics because they produce a PBP, named PBP5fm in Enterococcus faecium, with low-level affinity for beta-lactams. We report here the crystal structure of the acyl-enzyme complex of PBP5fm with benzylpenicillin at a resolution of 2.4 A. A characteristic of the active site, which distinguishes PBP5fm from other PBPs of known structure, is the topology of the loop 451-465 defining the left edge of the cavity. The residue Arg464, involved in a salt bridge with the residue Asp481, confers a greater rigidity to the PBP5fm active site. In addition, the presence of the Val465 residue, which points into the active site, reducing its accessibility, could account for the low affinity of PBP5fm for beta-lactam. This loop is common to PBPs of low affinity, such as PBP2a from Staphylococcus aureus and PBP3 from Bacillus subtilis. Moreover, the insertion of a serine after residue 466 in the most resistant strains underlines even more the determining role of this loop in the recognition of the substrates.
The utilization of wastewater sludge as a raw material for the production of legume inoculant is considered as a new viable alternative for recycling. The effect of addition of nutrient sources (yeast extract and glycerol) and the pH control on S. meliloti was investigated in a shake flask and at controlled pH in a 15 l fermentor. Different concentrations of yeast extract (0.5, 1, 2 and 4 g l(-1)) and glycerol (2.5, 5, 7.5 and 10 g l(-1)) were added to the secondary sludge. The cell yield as well as the generation time were affected by the addition of these nutrient sources. The maximum cell yield (8.85x10(9) cfu ml(-1)) was achieved in 32 hours of incubation with the addition of 4 g l(-1) of yeast extract. This value was 3.2 times higher than from the non-supplemented sludge. Moreover, at this yeast extract concentration, the cell concentration in the stationary phase did not decrease. The addition of glycerol to sludge samples containing 4 g l(-1) of yeast extract further improved the rhizobial growth but not significantly compared with the control. The highest yield (16.5x10(9) cfu ml(-1)) was obtained with 7.5 g l(-1) of glycerol and 4 g l(-1) of yeast extract. In fermentor experiments, pH did not seem to be a limiting factor and the increase of pH up to 8.85 in uncontrolled fermentor seems to have no effect on rhizobial growth and cell yield.
Experimental measurements of acoustic transmission through a solid-solid two-dimensional binary-composite medium constituted of a triangular array of parallel circular steel cylinders in an epoxy matrix are reported. Attention is restricted to propagation of elastic waves perpendicular to the cylinders. Measured transmitted spectra demonstrate the existence of absolute stop bands, i.e., band gaps independent of the direction of propagation in the plane perpendicular to the cylinders. Theoretical calculations of the band structure and transmission spectra using the plane wave expansion and the finite difference time domain methods support unambiguously the absolute nature of the observed band gaps.
X-ray powder diffraction experiments are performed to prove the possible crystallization of nitric acid dihydrate (HNO(3).2H(2)O, further denoted NAD) and to determine the best thermal conditions for growing a single crystal. It is shown that the kinetic behaviour of NAD strongly depends on the preliminary thermal treatment. One good single crystal obtained by an in situ adapted Bridgman method procedure enabled determination of the crystal structure. The intensities of diffracted lines with h odd are all very weak. The H atom of nitric acid is delocalized to one water molecule leading to an association of equimolar nitrate (NO(3)(-)) and an H(5)O(2)(+) ionic group. The asymmetric unit contains two such molecules. These two molecules are related by a pseudo a/2 translation (with a 0.3 A mean atomic distance difference), except for one H atom of the water molecules (0.86 A) because of their different orientations in the two molecules. The two molecules, linked by very strong hydrogen bonds, are arranged in layers. Two layers which are linked by weaker hydrogen bonds are approximately oriented along the c axis. The structure may be described by translations of this set of two layers along the c axis without hydrogen bonds leading to a two-dimensional hydrogen-bond network. The structures of the monohydrate (NAM) and trihydrate (NAT) are re-determined for comparisons. These structures may be described by one- and three-dimensional hydrogen-bond networks, respectively.
The detection and identification of minor peaks in a complex peptide map of recombinant human interferon-gamma was realized by on-line analysis of the eluted peptides using thermospray mass spectrometry and UV absorbance spectrometry. By this procedure the time-consuming process of collection, purification and chemical sequence analysis is avoided. Owing to the formation of multiple charged ions, the domain of the covered masses is extended. Fragmentation of the peptides in the thermospray source was observed resulting from, amongst others, cleavage by acid hydrolysis of peptide bonds involving an aspartic acid. This was of great use for the identification of peptides in a digest of recombinant human interferon-gamma by Staphylococcus aureus strain V8 endoprotease.
OBJECTIVE: To determine the relationship between gastric intramucosal pH and several other indices of splanchnic perfusion in patients undergoing cardiopulmonary bypass. DESIGN: Prospective, single-arm study. SETTING: University Hospital. METHODS: Elective cardiac surgery patients (n = 8), free of hepatic disease, were studied. Before anesthetic induction, a triple-lumen, heparin-bonded fiberoptic catheter was inserted into the hepatic vein under fluoroscopic guidance. An identical catheter was inserted into the pulmonary artery. After endotracheal intubation, a nasogastric tube modified to permit measurement of gastric intramucosal pH was inserted into the stomach. Systemic oxygen delivery (DO2), and arterial, mixed venous, hepatic venous, and femoral venous blood gases and lactate concentrations were recorded at the following times: immediately before induction of anesthesia (time 1); during atrial cannulation (time 2); after 30 mins of hypothermic cardiopulmonary bypass (time 3); 15 mins after termination of cardiopulmonary bypass (time 4); and 1 hr after arrival in the ICU (time 5). Hepatic venous hemoglobin saturation (SO2) and mixed venous hemoglobin saturation (SvO2) were monitored continuously from times 1 to 5. Gastric intramucosal pH was recorded at times 2, 3, 4, and 5. The hepatic catheter was removed as soon as the last samples were collected in the ICU. RESULTS: The square of the weighted mean correlation coefficients (rw)2 for gastric intramucosal pH vs. hepatic venous lactate concentrations, gastric intramucosal pH vs. hepatic venous PO2, and gastric intramucosal pH vs. hepatic venous pH were (rw)2 = .50, (rw)2 = .58, and (rw)2 = .32, respectively. Systemic DO2, hepatic venous lactate concentrations, hepatic venous PO2, and hepatic venous pH were significant determinants in the multiple regression model for gastric intramucosal pH (r2 = .89). There were significant differences between SvO2 and hepatic venous SO2 at times 4 and 5. CONCLUSION: Gastric intramucosal pH may provide a minimally invasive way to monitor the adequacy of splanchnic DO2 in patients undergoing cardiopulmonary bypass. Additional data are necessary to determine whether low gastric intramucosal pH is truly a marker of supply-dependent oxygen uptake across the hepatosplanchnic vascular bed under these conditions.
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A better selection of patients referred for cardiac transplantation should lead to better surgical results. The presence of severe and irreversible pulmonary hypertension is an important factor and its pretransplantation assessment requires pharmacodynamic testing with vasodilators and dobutamine. The aim of this study of 10 patients in congestive cardiac failure referred for cardiac transplantation was to evaluate enoximone in this indication by comparing it with sodium nitroprussiate (3 micrograms/kg/mn). Intravenous enoximone (total dose of 1.5 mg/kg) increased the cardiac index (+49%; p less than 0.01), slightly reduced the mean systemic blood pressure (-8%; p less than 0.05) whilst inducing a greater reduction in systemic arterial resistances (-36%; p less than 0.01); the fall in mean blood pressure was less than with sodium nitroprussiate (-23%; p less than 0.01). Myocardial oxygen consumption (rate-pressure product) did not increase in contrast to the effect of dobutamine (+21%; p less than 0.01). There was a significant reduction in pulmonary arteriolar resistances (p less than 0.01) with all three drugs but the interpretation of this response and its prognostic significance in patients with a low cardiac output and persistent pulmonary hypertension are discutable even when pulmonary arteriolar resistances are less than 6 Wood units. The value of using an inotropic agent such as Dobutamine or Enoximone is to unmask fixed pulmonary hypertension which may be missed in patients with low cardiac output even with vasodilator drugs, and also to mimic the haemodynamic result of transplantation. In this indication Enoximone may be used like Dobutamine but with the advantage of not increasing myocardial oxygen consumption and being probably less arrhythmogenic.
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Peritonitis remains the main complication of CAPD. This study demonstrates that most cases can be successfully treated with cefotiam. In 17 patients under CAPD, 33 cases of bacterial peritonitis were observed, with clinical manifestations in 28. The mean cell count in peritoneal dialysis fluid was 2 820/mm3, with 2 200/mm3 polymorphonuclear leukocytes. Causative pathogens were Staphylococcus in 18 cases, Streptococcus in 4, Stomatococcus mucilaginous in 1, Corynebacterium J.K. in 1, Enterobacter in 3, Acinetobacter in 3 and Pseudomonas in 2. Two cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g cefotiam. 68.80% of patients recovered within 6 days. Failures were due to a methicillin-resistant Staphylococcus epidermidis in 3 cases, a relapsing Stomatococcus mucilaginous infection in 1, a Streptococcus faecalis in 1, an Acinetobacter in 3 and a Pseudomonas in 2. Mean cefotiam concentrations 24 hours after the intraperitoneal injection were 9.4 +/- 7.0 micrograms/ml (range 1.3-26.4 micrograms/ml) in serum and 3.4 +/- 3.3 micrograms/ml (range 0.4-12.2 micrograms/ml) in dialysate. These concentrations are greater than most of cefotiam's MICs for susceptible bacteria, a finding that confirms the value of treatment with a single daily intraperitoneal injection of cefotiam.
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