Rapid dissemination of beta-lactamase-producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward.
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Anti-Bacterial Agents↗
Biomedical subjects
N E Smith
Publications and source records attributed to N E Smith.
Primary structure of the major pepsin inhibitor from the intestinal parasitic nematode Ascaris suum.
The major pepsin inhibitor from Ascaris suum was isolated by affinity chromatography and chromatofocusing. Its amino acid sequence was determined by automated Edman degradation of peptide fragments. Peptides were produced by chemical and enzymatic cleavage of pyridylethylated protein and were purified by reverse-phase high-performance liquid chromatography. The inhibitor consists of 149 residues with the following sequence: QFLFSMSTGP10FICTVKDNQV20FVANLPWTML30EGDDIQVGKE40 FAARVEDCTN50VKHDMAPTCT60KPPPFCGPQD70MKMFNFVGCS80VLGNKLFIDQ90KYVRDLTAK D100 HAEVQTFREK110IAAFEEQQEN120QPPSSGMPHG130AVPAGGLSPP140PPPSFCTVQ149. It has a molecular weight of 16,396. All cysteines are engaged as disulfide bonds: Cys(13)-Cys(59), Cys(48)-Cys(66), and Cys(79)-Cys(146). The protein is probably composed of two domains connected by a short hydrophobic region. This is the first aspartyl protease inhibitor of animal origin that has been sequenced. The sequence has no significant homology with any other known protein.
Amino Acid Sequence↗
Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units.
BACKGROUND AND METHODS: Coagulase-negative staphylococci are now the chief cause of bacteremia in neonatal intensive care units. To investigate potential risk factors for this nosocomial infection, we conducted a case--control study among 882 infants treated in two neonatal intensive care units during 1982. RESULTS: The 38 case patients and 76 controls were similar with respect to 27 indicators of the severity of the underlying illness. In addition, of the 20 potential risk factors for bacteremia that we investigated, only 2 met conventional criteria for causality. Infants with coagulase-negative staphylococcal bacteremia were 5.8 times as likely as controls (95 percent confidence interval, 4.1 to 8.3) to have received intravenous lipid emulsion before the onset of bacteremia. Because the use of lipids was common, 56.6 percent of all of the cases of nosocomial bacteremia could be attributed to lipid administration. Infants with bacteremia were also 3.5 times as likely as controls (95 percent confidence interval, 1.4 to 8.3) to have had a percutaneously inserted central venous catheter (attributable risk, 14.9 percent). The induction time for bacteremia after lipid administration, usually through peripheral catheters, was often less than one day. In contrast, the average induction period for nosocomial bacteremia associated with the use of central catheters, which were rarely used for lipid administration, was at least 5.5 days. Similar analyses of data on an additional 31 neonates treated in 1988 confirmed the strong and apparently independent association of coagulase-negative staphylococcal bacteremia with the intravenous administration of lipids (adjusted odds ratio, 5.3; 95 percent confidence interval, 3.5 to 6.7). CONCLUSIONS: The risk of coagulase-negative staphylococcal bacteremia in infants in neonatal intensive care units can be attributed primarily to the intravenous administration of lipid emulsions. Since lipids are critical for the nutritional support of premature infants, further studies are needed to examine the pathogenesis and prevention of lipid-associated bacteremia.
Catheterization, Central Venous↗
Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations.
Coagulase-negative staphylococci were the leading cause of nosocomial bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and Children's Hospital, Boston, Mass, in 1982. To determine the consequences of these nosocomial bacteremias, a cohort study was conducted in which two comparison subjects were matched with each of 38 bacteremic infants by hospital, birth weight within 100 g, and nearest date of discharge. To adjust for duration of stay in the hospital, it was also required that both comparison subjects have survived and remained in the hospital for as long as the time until bacteremia occurred in the bacteremic infant. The average day of onset of bacteremia was the 20th hospital day. Despite having similar birth weights and comparable severity of underlying illness, bacteremic infants remained in the hospital for an average of 19.8 days longer than the nonbacteremic comparison subjects (77.3 vs 57.5 days). The bacteremic patients received antibiotics for an average of 11.2 more days than the nonbacteremic infants. Vancomycin hydrochloride was given to 20 (52.6%) of the bacteremic patients but only 4 (5.3%) of the comparison patients. All of the comparison subjects and 37 of the 38 infants with bacteremia survived. Thus, nosocomial bacteremia with coagulase-negative staphylococci is a late complication of hospitalization that occurs in infants who are already relatively long-term survivors. This bacteremia appears to be associated with substantially longer hospital stay and antibiotic therapy but little, if any, excess mortality.
Cross Infection↗
Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding.
Coagulase-negative staphylococci are the most common cause of bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and the Children's Hospital, Boston, Massachusetts. In 1982, nosocomial bacteremia with coagulase-negative staphylococci occurred in 45 of 882 (5.1%) infants admitted to these units who survived and remained in intensive care for more than 48 hours and were therefore at risk. The overall cumulative incidence (attack rate) of nosocomial bacteremia rose dramatically with decreasing birth weight. The smallest infants, those with birth weights of less than 750 g, experienced an overall risk of nosocomial bacteremia 44.5 times that of infants with birth weights of greater than 2,000 g. A large part of the excess risk for small babies was attributable to their longer hospitalizations. However, after adjustment for length of stay, the smallest infants still suffered a daily rate of bacteremia (incidence density) 5.3 times that of the largest, indicating a considerable residual effect of birth weight on the daily risk of nosocomial coagulase-negative staphylococcal bacteremia. The results were similar in the two nurseries. Thus, there is still a substantially increased intrinsic risk of nosocomial coagulase-negative staphylococcal bacteremia among infants with very low birth weights, even after adjustment for duration of hospitalization, and differences in birth weight can confound comparative studies.
Birth Weight↗
Effects of age, milk replacer composition, and rumen function on lipogenesis in adipose tissue of young calves.
Rates of utilization of glucose, acetate, and lactate and activities of selected enzymes were determined in vitro to evaluate the effects of age and diet on lipogenesis in perirenal adipose tissue of calves. Three-day-old Holstein bull calves were fed up to 12 wk of age on one of three dietary treatments: a high carbohydrate milk replacer; a high fat milk replacer; and weaning at 6 wk of age from high fat replacer to calf starter. Adipose tissue biopsies were obtained from calves at 2, 5, 8, and 12 wk of age. Rates of fatty acid synthesis and activities of enzymes of the pentose phosphate and citrate cleavage pathways were increased in calves fed high carbohydrate milk replacer. These parameters were decreased in calves fed high fat replacer and were further depressed after weaning. Substrate preference for fatty acid synthesis in all calves was acetate, then lactate, then glucose. With increase in age from 2 to 12 wk, adipose tissue of calves fed milk replacer partitioned more acetate and lactate toward fatty acid synthesis and less toward oxidation. The pentose phosphate cycle was characterized by high rate of recycling and contributed at least 50% of reducing equivalents required for fatty acid synthesis. It appeared that several features of lipogenesis characteristic of functional ruminants are also shared by preruminant calves.
Adipose Tissue↗
The effects of location, orientation, and cumulation of boxes in the Baldwin illusion.
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Female↗
Cardiac disability. The impact of coronary heart disease on patients' daily activities.
We studied 100 men with clinically stable coronary heart disease. Their capacity for exertion as defined by treadmill test was compared with the physical and social avocational activities they carried out in their daily routine, as reported by them. Exercise capacity (treadmill time) was strongly correlated with a physician's independent assessment of symptomatic status (anginal history). Although participation in some relatively strenuous elective activities was related slightly to exercise capacity, participation in many household duties and social undertakings bore no relationship to exercise capacity or to other measures of the severity of the underlying heart disease. The patients' own perceptions of their cardiac limitation varied for different activities and for some activities it was determined as much by their own concern and outside advice as by cardiac symptoms. Decreased capacity for exertion seems to exert surprisingly little influence on a cardiac patient's daily routine and interventions aimed at altering one of these measures of performance will not necessarily affect the other.
Activities of Daily Living↗
Three or two times daily milking of older cows and first lactation cows for entire lactations.
Thirty-eight older (second and greater lactation) and 15 Holstein cows in first lactation were in a full lactation (44 wk) study to evaluate the effect of either twice or three times daily milking on yield of milk and milk components, milk composition, feed intake, and body weight change. All cows were managed alike and were fed diets of high, medium, and low energy concentration as lactation progressed from calving to 44 wk. First lactation cows were switched from diets of high energy to lower energy at the same milk production as lactation advanced. Dietary changes for older cows milked twice and three times (A) were at similar production, whereas three times (B) cows were switched to lower energy at higher milk production. Older cows milked three times daily (A and B) produced 17 and 13% more milk over the entire lactation than cows milked twice daily. Dry matter and energy intakes were not affected by three times milking, but gain of body weight was reduced. Cows milked three times daily during their first lactation produced 6% more milk than their twice counterparts, although this increase was not significant. Dry matter and energy intakes were not affected by three times daily milking, but three times milking of first lactation cows reduced weight gain over the lactation. Reproductive performance of cows milked three times daily was not significantly different from cows milked twice daily. Herds milking three times will require high management of nutrition and reproduction.
Animals↗
Roles of glucose and its interactions with acetate in maintenance and biosynthesis in bovine mammary tissue.
Mammary gland tissues from three lactating Holstein cows were sampled and slices incubated with various concentrations of glucose and in combinations with other substrates in Krebs-Ringer bicarbonate-based media. Conversions of 1-and 2-carbon-14 glucose to carbon dioxide, lactose, glyceride-glycerol, citrate, and fatty acids were determined. Glucose utilization increased asymptotically with glucose availability. Carbon dioxide, lactose, and glyceride glycerol production accounted for nearly 90% of glucose recovered. Only trace quantities of glucose were recovered as fatty acids. Estimates of apparent affinities for glucose use were in a physiological concentration range of glucose. Oxidation of glucose was positively correlated with availability of acetate. Acetate availability increased the ratio of 1-carbon-14 glucose to 2-carbon-14 glucose oxidation and decreased glucose conversion to fatty acids. Glucose conversion to glyceride-glycerol was not affected by acetate availability. Primary uses of glucose are in lactose and glyceride glycerol synthesis and formation of reduced nicotinamide adenine dinucleotide phosphate for lipogenesis. Extensive use of glucose for these purposes may limit amounts available for fatty acid synthesis.
Acetates↗
Roles of lactate and its interactions with acetate in maintenance and biosynthesis in bovine mammary tissue.
Mammary gland tissue slices from three lactating Holstein cows were incubated in Krebs-Ringer bicarbonate-based media with varying concentrations of lactate and other substrates. Conversions of 1- and 2-carbon-14 of lactate to carbon dioxide, fatty acids, citrate, glyceride glycerol, and lactose were determined. Effects of acetate, glucose, beta-hydroxybutyrate, stearate, and pyruvate on lactate metabolism were evaluated. Oxidation of lactate increased asymptotically with lactate concentration. Low acetate concentration stimulated oxidation of carbon 2 of lactate slightly while higher acetate availability inhibited lactate oxidation. Conversion of lactate to fatty acids increased linearly with lactate concentration. This conversion of lactate was inhibited strongly by acetate. Significant conversion of carbon 2 of lactate to glyceride-glycerol but not lactose was detected. Bovine mammary glands have the capacity of utilize sizeable quantities of lactate for oxidation and lipogenesis. Both phenomena are highly dependent on availability of acetate. Pyruvate dehydrogenase and citrate lyase could represent important regulatory sites in vivo for determination of tissue preference for acetate over lactate. Results indicate factors other than an inactive malate transhydrogenation cycle likely limit glucose conversion to fatty acids.
Acetates↗
A new angle on the freemish crate.
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Depth Perception↗
Exercise stress testing.
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Electrocardiography↗
Roles of acetate and its interactions with glucose and lactate in cow mammary tissue.
Slices from mammary glands from six lactating Holstein cows were incubated in Krebs-Ringer bicarbonate-based media in the presence of varying concentrations of acetate, glucose, and lactate. Conversions of acetate to carbon dioxide, fatty acids, citrate, glyceride-glycerol, and lactose were determined. Specific effects of beta-hydroxybutyrate and stearate availability also were evaluated. Utilization of acetate for all functions usually followed Michaelis-Menten kinetics with apparent affinities in the physiological concentration range of acetate. Availability of glucose had a large "permissive" effect on acetate to conversion to fatty acids. However, acetate metabolism was independent of the availability of lactate. Conversion of acetate to glyceride-glycerol was significant. This indicates the possibility of bidirectional glycolytic flux, which could limit glucose conversion to fatty acids. Addition of stearate caused general increases of acetate metabolism. Conversion of acetate to fatty acids, carbon dioxide, and citrate was elevated in the absence of beta-hydroxybutyrate. The latter observation indicates beta-hydroxybutyrate may not be a required initiator of fatty acid synthesis in mammary tissue.
Acetates↗
Effect of sodium bicarbonate addition to alfalfa hay-based diets on digestibility of dietary fractions and rumen characteristics.
Three trials were to evaluate effects of sodium bicarbonate in alfalfa hay-based diets. In Experiment 1, four Jersey cows were fed diets of 40:60 chopped alfalfa hay:grain with either 0, .25, .5, and .75% sodium bicarbonate in a 4 X 4 Latin square digestion trial. Dry matter and fiber digestion were unaffected. Volatile fatty acids of ruminal fluid and milk fatty acids were not different. In Experiment 2, two rumen fistulated cattle were fed diets of Experiment 1 for changes of ruminal fluid characteristics at -1, 2, 4, and 8 h postfeeding. Volatile fatty acids of ruminal fluid and hydrogen ion concentration were not different across time with sodium bicarbonate. In Experiment 3, four Holstein cows with rumen cannulae were fed diets of 30:70 chopped alfalfa hay:grain with 0, .4, .8, and 1.2% sodium bicarbonate in a 4 X 4 Latin square. Dry matter and fiber digestion were unaffected. Ruminal fluid samples were collected at -1, 3, 6, and 9 h postfeeding. Volatile fatty acids were different only at 6 h with 0 and 1.2% sodium bicarbonate diets displaying lower concentrations. Rate of increase of hydrogen ion concentration was greater for diets containing 0 and .4% compared with .8 and 1.2% sodium bicarbonate between -1 and 6 h. Milk fatty acid composition, ruminal liquid dilution rate, and dry matter disappearance from nylon bags suspended in the rumen were not affected by sodium bicarbonate.
Ammonia↗
Growth, health, and blood glucose concentrations of calves fed high-glucose or high-fat milk replacers.
The influence of age, carbohydrate-fat ratios of milk replacers, and development of ruminal function on growth, health, and blood glucose concentrations were evaluated in calves. Colostrum-fed, 3-day-old Holstein bull calves were fed to 12 wk on one of three dietary treatments: 1) a high carbohydrate, low fat (60.5% glucose, 9.5% lactose, and 3% lard) milk replacer; 2) a low carbohydrate, high fat (23% glucose, 12.5% lactose, and 30% lard) milk replacer; and 3) weaning at 6 wk of age from high-fat replacer to a standard calf starter. The high fat milk replacer was superior to low fat milk replacer for total weight gains and efficiency of feed conversion. Rates of weight gain of starter calves were similar to those of calves fed low fat. Calves fed the diet with low fat had a high incidence of diarrhea, an occasional outbreak of a yeast-related ethanol intoxication syndrome, and high concentrations of glucose in urine. Irrespective of milk replacer composition or development of ruminal function, plasma and whole blood glucose concentrations declined rapidly in the first 6 wk. Corpuscular glucose declined steadily with age in all calves. This age-related decrease of blood glucose concentration of calves seems to be a constitutive phenomenon.
Animals↗
The synthesis of models to describe metabolism and its integration.
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Adipose Tissue↗
Digestibility and effects of whole cottonseed fed to lactating cows.
Four lactating Holstein cows producing about 21 kg milk/day were fed complete rations containing 0, 5, 15, and 25% whole cottonseed in a 4 X 4 Latin square design. Diets were fed ad libitum. Periods were 21 days in length with total collections of feces and urine during the last 7 days of each period. Digestibilities o nitrogen, lipid, and energy increased with increasing cottonseed in the diet. There were no significant effects of cottonseed on digestibility or availability of fiber components, calcium, phosphorous, and magnesium. Cottonseed feeding did not affect dry matter intake or milk yield but did increase yields of milk fat and fat-corrected milk and decrease milk protein and solids-not-fat percentages. Synthesis of fatty acid in the mammary gland was depressed by about 50% on the 25% cottonseed diet, but transfer of dietary fat resulted in twofold increases in yields of stearic and oleic acids. Hydrogenation of cottonseed fatty acid in the rumen resulted in a fourfold increase in yield of trans oleic acid in milk fat. Samples from bulk milk tank and data collected from 55 commercial dairies showed similar changes in fatty acid composition of milk from cows fed whole cottonseed. There was no apparent effect of feeding up to 2.9 kg cottonseed dry matter per cow per day on calving interval or on incidence of displaced abomasum, ketosis, milk, fever, or retained placenta.
Animal Feed↗