Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients.

BACKGROUND: The purpose of this study is to characterize the risk factors of bloodstream infection (BSI) associated with the use of permanent implantable venous ports (Port-A) in solid cancer patients. METHODS: Solid cancer patients implanted with a Port-A were prospectively observed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. A PABSI risk score was developed using the Cox proportional hazards model. RESULTS: A total of 415 patients were registered; 88 PABSI episodes occurred in 58 patients (incidence1.05 per 1000 catheter-days). All but one patient had stage IV cancer. Independent predictors of PABSI occurrence included neutropenia, total parenteral nutrition (TPN), chronic steroid use, invasive procedures, postoperative antibiotics, and preoperative antibiotics. A PABSI risk score with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%) was defined for stage IV cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, -0.970; postoperative antibiotics, +0.959; and invasive procedures, +1.098. The median PABSI-free survival was 4.47 months for patients with scores ≥ 0 but not reached for patients with scores <0 (P < 0.0001). CONCLUSION: The PABSI risk score can assist in identifying high-risk solid cancer patients and may assist in designing future preventive strategies.

Purification and properties of two forms of human alpha-L-fucosidase.

High (100 000) and low (50 000) molecular weight forms of alpha-L-fucosidase (alpha-fucosidase I and II) were purified to apparent homogeneity from human spleen, liver brain and kidney on the basis of differential affinity for epsilon-amino-caproyl fucosamine-agarose bead columns. Alpha-fucosidase I (the "bound" form) consisted of two 50 000 dalton monomers; however, both forms can aggregate to tetramer and hexamer forms. Most previous studies on alpha-fucosidase have been carried out on this form of human alpha-fucosidase although the bound and unbound forms of the enzyme were present in equal amounts in human spleen. The bound (100 000) form is a sialoglycoprotein whereas the unbound (50 000) form, is a neutral mannose-rich glycoprotein. Other differences with respect to amino acid composition, pH optimum, electrophoretic mobility, KM, thermal stability, and natural substrate specificities were observed. All preparations hydrolysed 4-methylumbelliferyl-alpha-L-fucoside, flucosyllactose, and lacto-N-fucopentaose I, but the unbound fraction (alpha-fucosidase II) preferentially hydrolyused lacto-N-fucopentaose II. The unbound (mannose-rich) alpha-fucosidase II was taken up by human skin fibroblasts with higher affinity (5% per 2 h per 2 times 10(5) cells) than the bound (sialo-) alpha-fucosidase I (<1% per 2 times 10(5) cells). Uptake was inhibited by other lysosomal hydrolases, fetal calf serum, mannose 6-phosphate and phosphomannans and to a lesser extent by heparins. Our studies suggest that alpha-fucosidase I is not a simple dimer of alpha-fucosidase II and represents a less-biologically active form of the enzyme.

A simple technique for producing supravalvular aortic stenosis in animals.

A safe and reproducible technique to create supravalvular aortic stenosis was developed, which avoids many of the difficulties encountered in the production of aortic stenosis. Dogs were anaesthetised and artificially ventilated. The chest was opened and the venae cavae were encircled with umbilical tapes. The ascending aorta was then encircled by a 1.5-2 cm wide, 6-7 cm long dacron patch, venous return was stopped by tightening the tapes, and a J-shaped clamp applied to the ascending aorta at the dacron patch. Two layers of continuous mattress suture were placed adjacent to the clamp, plicating the aortic diameter by about 50%. After releasing the clamp and restoring normal venous return, left ventricular (LV) and aortic (AO) pressures were measured. Subsequently, one or two deep mattress sutures were placed below the running mattress sutures to increase the stenosis and to obtain the desired gradient. The LV-AO systolic pressure gradients obtained immediately after the operation ranged from 40 to 75 mm Hg. Two to 6 months after the operation the pressure gradients ranged from 50 to 200 mm Hg. Left ventricular to body weight ratios were 6.41 (SEM 0.26) v 4.24(0.20) for the controls. Heart weight to body weight ratios were 8.37(0.35) v 5.65(0.33). LV end diastolic pressures were normal. This technique can be used either in puppies or adult animals. The problem of aortic rupture is eliminated. The pressure gradient can be easily controlled during the operation and reproducible LV hypertrophy can be obtained in a shorter time than with aortic banding of puppies.

Functional studies of the heart during a 24-hour preservation using a new autoperfusion preparation.

Serial cardiac function studies were carried out during a 24-hour preservation in a new autoperfusion multiorgan preparation using adult Yorkshire swine (n = 8). The heart was removed with the lungs, liver, pancreas, duodenum, and both kidneys while they were still perfused by the heart and oxygenated by the lungs. The organs were placed in a 32 degrees C bath solution containing lactated Ringer's, heparin, and neomycin. Fresh blood and a solution containing glucose (10%) with potassium chloride (2 gm/L), calcium chloride (1 gm/L), heparin sodium (100 mg/L), mannitol (12.5 gm/L), insulin (100 U/L), metronidazole hydrochloride (500 mg/L), penicillin (1,000,000 U/L), and methylprednisolone (250 mg/L) were given slowly through the portal vein. A fat emulsion 2 ml, methylprednisolone 30 mg, and heparin sodium 20 mg were given through the portal vein every 2 hours. No inotropic drugs were used. Aortic systolic pressures ranged from 79 to 97 mm Hg; the aortic diastolic pressures ranged from 44 to 61 mm Hg. Central venous pressures ranged from 0.4 to 2.0 mm Hg, and the heart rate was 69 to 81 beats/min. Left ventricular maximum dp/dt ranged from 1405 to 1836 mm Hg/sec, and maximum dp/dt/p ranged from 17.0 to 26.2 (sec-1). Aortic blood flow ranged from 1.2 to 1.6 L/min, and systemic resistance ranged from 33 to 53 U. Lactic acid decreased from 8.15 to 2.80 mmol/L. Myocardium wet/dry weight ratio after preservation averaged 5.13 (vs 5.09 for control). These results suggest that the heart may be preserved up to 24 hours with minimal change in function with this new autoperfusion preparation.(ABSTRACT TRUNCATED AT 250 WORDS)

Control of vancomycin-resistant enterococci in a hospital: a five-year experience in a Taiwanese teaching hospital.

In order to prevent transmission of hospital-acquired vancomycin-resistant enterococci (VRE), the infection control team (ICT) of the National Taiwan University Hospital (NTUH) introduced practical guidelines from January 1997 to June 2000. All patients at NTUH found to be infected or colonized with VRE were placed in strict contact and cohort isolation. Surveillance cultures were obtained from other patients in close proximity in order to determine any spread of VRE. If identified, these patients were also placed in contact and cohort isolation, and their isolates were subjected to antimicrobial susceptibility testing and molecular typing by pulsed-field gel electrophoresis. During this period, 20 patients were found to have VRE. Based on typing results, there were three occasions where the same VRE strain had spread between index patients and roommates or patients staying in neighbouring rooms. No further spread occurred after applying strict contact isolation for these patients. The hospital-acquired VRE infection rate was around 0.03 to 0.09 per 1000 discharges during the intervention period. After July 2000, however, members of the ICT did not actively monitor or implement any interventions to control VRE. The rate then increased to 0.20 per 1000 discharges in 2001. This study suggests that interventions for the control of VRE, based on the guidelines from the Hospital Infection Control Practice Advisory Committee, are effective for control of VRE spread. Failure to adhere to these guidelines may result in an increase in hospital-acquired VRE.

The conversion of group B red blood cells into group O by an alpha-D-galactosidase from taro (Colocasia esculenta).

An alpha-D-galactosidase (EC 3.2.1.21), capable of converting group B into group O red cells, was isolated from the stem portion of taro. It was purified about 3000 fold by gel filtration and ion-exchange chromatography. The blood group-converting activity was demonstrated by hemolysis and hemagglutination studies. This activity is comparable to that of alpha-D-galactosidase isolated from coffee beans. Taro alpha-D-galactosidase also hydrolyzes (1----4)- and (1----6)-linked alpha-D-galactopyranosyl groups from D-galactose-containing glycoconjugates. Taro alpha-D-galactosidase has a low Km value (0.28mM), a low molecular weight (40,000), and a neutral optimal pH (6.0). At a final enzyme concentration of 30 units/mL in the incubation mixture, the conversion of group B into group O activity was completed within two hours, without apparent changes in the shape of the red cells.

Preparation of activated carbons from corn cob catalyzed by potassium salts and subsequent gasification with CO2.

In the present study, granular activated carbons were prepared from agricultural waste corn cob by chemical activation with potassium salts and/or physical activation with CO2. Under the experimental conditions investigated, potassium hydroxide (KOH) and potassium carbonate (K2CO3) were effective activating agents for chemical activation during a ramping period of 10 degrees C/min and subsequent gasification (i.e., physical activation) at a soaking period of 800 degrees C. Large BET surface areas (>1,600 m2/g) of activated carbons were thus obtained by the combined activation. In addition, this study clearly showed that the porosity created in the acid-unwashed carbon products is substantially lower than that of acid-washed carbon products due to potassium salts left in the pore structure.

Adsorption of acid dye onto activated carbons prepared from agricultural waste bagasse by ZnCl2 activation.

A series of activated carbons were prepared from agricultural waste sugarcane bagasse by chemical activation with zinc chloride (ZnCl2) as an activating agent at 500 degrees C and 0.5 h soaking time. The Langmuir surface area and total pore volume were used to estimate the average pore diameter of the carbon products. The values of the surface area and pore volume increased linearly with increase in the impregnation ratio (IR) up to 100 wt%. The adsorption capacities of the derived adsorbents for Acid Orange 10 were measured at 20 degrees C and 40 degrees C to gain further insights into the acidic surface oxides of the adsorbent from the results of Fourier transform infrared (FTIR) spectroscopy analysis and pH measurement. Adsorption isotherms of the acid dye on adsorbents prepared were determined and correlated with common isotherm equations. It was found that the Langmuir model appears to fit the isotherm data better than the Freundlich model. The physical properties of these adsorbents were consistent with the parameters obtained from the isotherm equations.

Superoxide dismutase in hepatocellular carcinoma affects patient prognosis.

BACKGROUND/AIMS: The free radicals play an important role in the pathogenesis of neoplastic transformation of the tissues. Superoxide dismutase is a metalloenzyme, protecting the cells from oxygen radical insult. The superoxide dismutase activity may therefore alter the cellular signaling pathways against the insults derived from oxidative stress especially in the tumor tissues. Therefore, it is considered that superoxide dismutase activity is crucial in affecting the survival of the cancer bearing patients. This study aims to investigate the level of superoxide dismutase activity in hepatocellular carcinoma tissues and correlate this with patients' survival after surgery for hepatocellular carcinoma. METHODOLOGY: Thirty-six patients who had hepatectomy for hepatocellular carcinoma at the National Taiwan University Hospital from 1992 to 1993 were included in this study. Superoxide dismutase activity of the tumor tissues was determined. The results were correlated with the patients' survival. The patients were grouped based on their postoperative survival time. Those patients who were deceased less then one year after surgery were in group I. Group II included patients who survived more than one year but less than 3 years after operation. Group III patients survived more than 3 years but less than 5 years. Ten patients who survived longer than 5 years after surgical intervention were in group IV. Data were expressed as mean and analyzed with ANOVA. RESULTS: The demographic and clinical information of patients, such as age, gender, plasma albumin, globulin, alpha-fetoprotein levels, and hepatitis markers were comparable among these groups. The superoxide dismutase levels in the hepatocellular carcinoma were significantly higher in group IV than the other three groups (P < 0.05). Similarly, the superoxide dismutase levels of the hepatocellular carcinoma tissues from group III patients were significantly greater than those tissues from patients of either group I or group II. Tumor superoxide dismutase levels tended to be higher in group II than in group I, although it did not reach a statistical significance. CONCLUSIONS: Patients with higher superoxide dismutase levels in the hepatocellular carcinoma survived longer after hepatectomy. The superoxide dismutase levels of the tumor tissue may influence the malignancy and the outcome of the patients. It serves as prognostic factor for patients after hepatocellular carcinoma operation.

Isolation and characterization of jack bean beta-galactosidase.

A simple procedure has been devised to isolate beta-galactosidase from jack bean meal. The final preparation gives one major protein banc in disc gel electrophoresis. The substrate specificity of this enzyme toward some natural oligosaccharides, glycoproteins, and sphingoglycolipids has been examined in detail. Among three isomers of N-acetyllactosamine, Galbeta1leads to4GlcNAc; while Galbeta1leads to3GlcNAc was hydrolyzed very slowly. This property can be used to distinguish the galactose linkage in asialo-GM1 (Galbeta1leads to3GalNAcbeta1leads to4Galbeta1leads to4Glcleads toCer) and that in lacto-N-neotetraosylceramide (Galbeta1leads to4GlcNAcbeta1leads to 3Galbeta1leads to4Glcleads toCer). For hydrolyzing glycolipids, the effect of sodium taurodeoxycholate and sodium taurochenodeoxycholate on the rate of hydrolysis was carefully examined. This enzyme hydrolyzes lactosylceramide and asialo-GM1 faster than GM1. These results suggest that in addition to the type and linkage of the penultimate sugar unit, the sugar unit at the distal position of the saccharide chain also affects the hydrolysis rate. It also readily liberates 80% D-galactosyl units from asialo alpha1-acid glycoprotein. Escherichia coli beta-galactosidase on the other hand cannot hydrolyze asialo-alpha1-acid glycoprotein, lactosylceramide, GM1, asialo-GM1, and lacto-N-neotetraosylceramide. The molecular weight of this enzyme is about 75,000 and the isoelectric point is pH 8.0. With p-nitrophenyl beta-D-galactopyranoside as substrate, optimal activity occurs at pH 2.8 with glycine-HCl buffer and at pH 3.5 with citrate-phosphate buffer. With lactose as substrate, the pH optimum in these two buffers are 2.8 and 4.0, respectively. Km values for p-nitrophenyl beta-D-galactopyranoside, o-nitrophenyl beta-D-galactopyranoside and lactose are 0.51 mM, 0.63 mM, and 12.23 mM, respectively. Many inhibitors for this enzyme including inorganic ions, monosaccharides, and glycosides are investigated. In contrast to E. coli beta-galactosidase, jack bean beta-galactosidase is not inhibited by p-aminophenyl thio-beta-D-galactopyranoside.

Utilization of agricultural waste corn cob for the preparation of carbon adsorbent.

In the present study, a series of activated carbons were prepared from agricultural waste corn cob by chemical and physical activations with potassium hydroxide (KOH)/potassium carbonate (K2CO3) and carbon dioxide (CO2). The effect of process variables such as impregnation ratio, impregnation time, activation temperature and soaking time of CO2 was studied in order to relate these preparation parameters with the physical properties of final carbon products. The resulting activated carbons were characterized by nitrogen adsorption-desorption isotherms at 77 K. The surface areas and pore volumes of carbons were estimated by the BET equation, the Langmuir equation and the t-plot method. Under the experimental conditions investigated, the main parameters in the activation of corn cob were found to be the impregnation ratio and activation temperature. The soaking time of CO2 is another important variable, which had a strong effect on the pore volume development. The BET surface area and total pore volume were as large as about 2000 m2/g and about 1.0 cm3/g, respectively. This study showed that the activation of agricultural waste corn cob with KOH/K2CO3 and CO2 was suitable for the preparation of large-surface-area activated carbons.

Characterization of activated carbons prepared from sugarcane bagasse by ZnCl2 activation.

Activated carbons were prepared from the agricultural waste of sugarcane bagasse by the chemical activation with zinc chloride (ZnCl2) at the activation temperature of 500 degrees C with soaking time of 0.5 hour. The influence of activation parameters on the final carbon products was examined by varying the impregnation ratio (i.e., mass ratio of added ZnCl2 to bagasse) and bagasse size. The physical properties of carbon products were characterized by nitrogen adsorption/desorption isotherms (at 77 K) and helium displacement method. The surface area and pore volume of carbons were thus obtained by the BET equation and t-plot method. Also, the particle density and porosity of carbons were estimated by the total pore volume and true density. The increases of the values of surface area and pore volume are approximately proportional to the impregnation ratio. The microporous carbon product with the BET surface area of 905 m2/g and total pore volume of 0.44 cm3/g was obtained in the present study. Further, the adsorption isotherms of two acid dyes from aqueous solutions onto the carbon products were performed at 30 degrees C. The results show that the adsorption isotherms of acid dyes with high molecular weight or large molecular size on the microporous adsorbents of activated carbons are plateau forms, indicating multilayer adsorptions, which may be attributed to the steric hindrance of the adsorbate molecules.