Post-operative enteral immunonutrition for gynecologic oncology patients undergoing laparotomy decreases wound complications.

OBJECTIVES: The aim of this study is to determine if peri-operative immune modulating dietary supplements decrease wound complications in gynecologic oncology patients undergoing laparotomy. METHODS: In July 2013 we instituted a practice change and recommended pre- and post-operative oral immune modulating diets (IMDs) to patients undergoing laparotomy. We retrospectively compared patients who received IMDs to those who did not for the study period July 2012 to June 2014. Our outcome of interest was the frequency of Centers for Disease Control surgical site infections (CDC SSIs). RESULTS: Of the 338 patients who underwent laparotomy during the study period, 112 (33%) received IMDs post-operatively. There were 89 (26%) wound complications, including 69 (78%) CDC SSI class 1, 7(8%) class 2 and 13(15%) class 3. Patients receiving IMDs had fewer wound complications than those who did not (19.6% vs. 33%, p=0.049). After controlling for variables significantly associated with the development of a wound complication (ASA classification, body mass index (BMI), history of diabetes mellitus or pelvic radiation, length of surgery and blood loss) consumption of IMDs remained protective against wound complications (OR 0.45, CI 0.25-0.84, p=0.013) and was associated with a 78% reduction in the incidence of CDC SSI class 2 and 3 infections (OR=0.22, CI 0.05-0.95, p=0.044). CONCLUSIONS: Post-operative IMDs are associated with fewer wound complications in patients undergoing laparotomy for gynecologic malignancy and may reduce the incidence of CDC SSI class 2 and 3 infections.

Bacteriostatic effect of sequential hydrodynamic and ultrasound-induced stress.

AIMS: To elucidate the mechanism of action of a nonchemical microbial control technology employing coupled hydrodynamic and ultrasound-induced stress. METHODS & RESULTS: The effects of a laboratory model system using a commercial nonchemical device on Pseudomonas putida revealed growth and respiration were inhibited without a loss of viability from the treated population. Damage to cell membranes was evident using fluorescent microscopy and a reporter strain containing lux genes fused with a membrane damage stress-response promoter. Other reporter strains also indicated the possible involvement of DNA and protein repair systems. A consequence of treatment was a reduced ability to form biofilms. CONCLUSIONS: The nonchemical device caused a biostatic effect on treated cells induced by sublethal damage to several cellular systems, including cell membranes. SIGNIFICANCE AND IMPACT OF THE STUDY: The study demonstrates that biostasis can be an effective mechanism for microbial control in some industrial systems and provides insight into understanding and applying this device and other nonchemical microbial control technologies to real-world problems of microbial contamination.

Sensory and nutritional quality of split peas (Pisum sativum) stored up to 34 y in residential storage.

The sensory and nutritional quality of split peas stored up to 34 y was determined. Nine samples of split peas representing 5 retail brands packaged in Nr 10 cans and stored at room temperature were obtained from donors. Duplicate cans of a fresh sample of split peas were purchased as controls. Can head space oxygen ranged from 0.255% to 20.1%. Water activity of the raw split peas ranged from 0.41 to 0.56. The green color of the raw split peas decreased over time as shown by increasing CIE a* values. Flavor, appearance, texture, and overall liking hedonic scores (9-point scale) of split-pea soup made from each sample ranged from 3.7 to 6.7 and decreased over time. Hedonic scores for appearance were correlated with the decrease in raw product green color (r(2)= 0.65). Hedonic scores for soup texture declined over time, which corresponded with increasing hardness of the cooked peas as measured by a TA.XT2 texture analyzer. All samples were judged to be acceptable in an emergency situation by over 75% of sensory panelists. Available thiamin was significantly lower in older samples while riboflavin remained unchanged. The results indicate that split pea quality declines over time, but the product maintains sufficient sensory acceptance to be considered for potential use in emergency storage and other applications where minimal stock rotation is a common practice.

An unhydrolyzable analogue of N-(4-hydroxyphenyl)retinamide. synthesis and preliminary biological studies.

The synthesis of a nonhydrolyzable, carbon-linked analogue (4-HBR) of the retinoid N-(4-hydroxyphenyl)retinamide (4-HPR) using Umpolung methods is described. Preliminary studies of biological activity show 4-HBR is similar to 4-HPR in its actions although a potentially relevant and desirable difference is its reduced suppression of plasma vitamin A levels. These results show that 4-HPR does not have to be hydrolyzed to retinoic acid to produce its chemotherapeutic effects.

Chemotherapeutic evaluation of 4-hydroxybenzylretinone (4-HBR), a nonhydrolyzable C-linked analog of N-(4-hydroxyphenyl) retinamide (4-HPR) against mammary carcinogenesis.

The antitumor effects of N-(4-hydroxyphenyl)retinamide (4-HPR), and its stable C-linked analog, 4-hydroxybenzylretinone (4-HBR) on the regression of established 7,12-dimethylbenz(a)anthracene(DMBA)-induced rat mammary tumors were compared. 4-HBR is a stable and nonhydroyzable derivative which cannot be converted in vivo to retinoic acid (RA). The results indicate that 4-HBR decreased mammary tumor volumes to the same extent as equimolar concentration (2 mmol/kg diet) of 4-HPR (-45% for 4-HBR vs. -42% for 4-HPR, p<0.01). Both 4-HPR and 4-HBR bind very poorly to nuclear retinoid receptors RARs and RXRs. The similarity of physicochemical properties of 4-HPR and 4-HBR as well as their equal antitumor potency suggests that 4-HPR like 4-HBR, is acting directly rather than through hydrolysis to free RA. Treatment with 4-HPR caused an almost 65% decrease in serum retinol levels. These results suggest that 4-HBR may have a significant chemotherapeutic advantage over 4-HPR, as the nonhydrolyzable analog may not cause night blindness which occurs as a significant side effect of 4-HPR usage.

Preservative tolerance and resistance.

Preservative tolerance is defined as a situation in which a formerly effective preservative system no longer controls microbial growth. Tolerance can have several potential causes: destabilization of the preservative, establishment of biofilms in the manufacturing system, and the development of resistance. As part of an effort to understand and control tolerance, a collection of preservative-resistant bacteria was established. Pseudomonas and related genera constitute 92% of the isolates in the collection. The collection includes bacteria isolated from products preserved with dimethoxy dimethyl hydantoin (DMDMH), dibromodicyanobutane (DBCB), glutaraldehyde (GLUT), benzisothiazolone (BIT), and methylchloroisothiazolone/methylisothiazolone (MCI/MI). Several isolates were also obtained from products preserved with combinations of DMDMH/iodopropargyl butylcarbamate (IPBC) and DMDMH/IBPC/MCI/MI. Bacteria were deemed resistant if they were isolated from a matrix in which the preservative was stable, and their minimal inhibitory concentrations (MIC) were significantly elevated as compared to a group of conspecific strains from the American Type Culture Collection. Isolates resistant to DMDMH, DBCB, or GLUT had normal outer membrane protein (OMP) profiles, and were cross-resistant to formaldehyde (FA) and several other FA-releasing preservatives, a pattern typical of strains producing elevated levels of FA dehydrogenase. The BIT-resistant isolates were cross-resistant to a number of structurally dissimilar preservatives but retained susceptibility to MCI. MCI-resistant isolates had altered OMP profiles, displayed reduced uptake of MCI, and were cross-resistant to some other preservatives. Restoration of sensitivity to MCI by treatment with EDTA confirmed the role of the outer membrane in MCI resistance.

Nurses' experience with implementing developmental care in NICUs.

The aim of this study was to gain insight into nurses' (N = 8) experience of working in a neonatal intensive-care unit (NICU) that incorporated the developmental-care approach. Although Als's model is family centered, the basic social process identified by nurses was putting the baby first. The process of putting the baby first was uncovered using grounded-theory methodology. The process included three phases: learning, reacting, and advocating/nonadvocating. In each of the phases, four main concepts--encountering, appraising, supporting, and gaining sensitivity--emerged from the data. Nurses appraised the advantages and disadvantages of this therapeutic approach not only to the infant but also to themselves.

Assessment of reliability and validity of the behavioral observation record for developmental care.

Due to time constraints, clinicians are rarely able to carry out neurobehavioral assessments that use the Naturalistic Observation of Newborn Behavior Instrument. The content validity, interrater reliability, and criterion-related validity for a less time-consuming instrument, the Modified Infant Behavioral Observation Record (MIBOR) for developmental care was evaluated in this study. Eight developmental care specialists evaluated the MIBOR for content validity. Fifteen infants (birth weight < 1,500 g) were observed to determine interrater reliability, and three were observed to evaluate criterion-related validity. The content validity of the MIBOR, as determined by average congruence, was 96.9%. Interrater reliability for each developmental care subsystem ranged from 67% to 98%. Three of the four subsystems on the MIBOR achieved criterion-related validity, achieving an agreement of r = .60.

Holding on: parents' perceptions of premature infants' transfers.

OBJECTIVE: To describe parents' perceptions of their infants' transfers within a regional system of perinatal care. DESIGN: Qualitative; grounded theory methodology. SETTING: Interviews were conducted in an office adjacent to a neonatal intensive care unit (NICU), in an intermediate care unit (IMCU), and in the homes of parents. PARTICIPANTS: Fifteen parents of premature infants were recruited and interviewed during the 3 days before their infants were transferred from a NICU to an IMCU or home. The 15 parents were interviewed again during the 5 days after the initial interview to learn their feelings about the transfer. DATA COLLECTION: After consent was obtained, unstructured interviews were recorded and transcribed. Analyses of the data were ongoing, and the second interviews with parents were more focused. RESULTS: Parents identified four phases that described their transfer experience. Within the four phases, four categories were identified to depict parents experiences further. The core category of holding on reflected the belief that transfer home would become a reality and normal family life eventually would ensue. CONCLUSIONS: Nurses in NICUs and IMCUs have a responsibility to educate the parents of infants at high risk. Nurses sensitive to parental perceptions of neonatal transfer can better facilitate a positive transfer experience.

Methylchloroisothiazolone-induced growth inhibition and lethality in Escherichia coli.

Exposure of log phase Escherichia coli cells to inhibitory levels of 5-chloro-2-methyl-isothiazolin-3-one (MCI) results in rapid bacteriostasis and a delayed onset of bactericidal activity. Inhibition of respiration occurs within the same time frame as bacteriostasis, and is followed by a decline in intracellular ATP levels. In vitro and in vivo experiments suggest that growth inhibition is the result of selective inhibition of particular targets, with succinate dehydrogenase being identified as a possible target. Such selectivity was not anticipated from this highly reactive molecule. MCI-induced lethality is positively correlated with a loss of reduced protein sulphydryls (r2 = 0.79). A greater than equimolar loss of reduced protein sulphydryls, compared with the number of MCI molecules added, and a reduction in killing by MCI after induction of the OxyR regulon suggest that free radical generation may have a role in the antibacterial activity of MCI. We present an examination of the in vivo effects of MCI exposure on bacterial cells, and evidence that the isothiazolones exhibit selectivity in their cellular targets and antimicrobial effects.

Low-level resistance to the cephalosporin 3'-quinolone ester Ro 23-9424 in Escherichia coli.

Four spontaneous, single-step mutants of Escherichia coli K-12 resistant to low levels of the cephalosporin 3'-quinolone ester Ro 23-9424 were isolated at a frequency of 10(-10) to 10(-11) mutants per CFU plated. The mutants were cross-resistant to both cephalosporin (cefotaxime) and quinolone (fleroxacin) components. Accordingly, they had altered porins and replicative DNA biosynthesis resistant to fleroxacin. There was no increase in beta-lactamase activity when tested with nitrocephin, and the penicillin-binding protein profiles were normal.

Supporting: men's experiences with the event of their partners' miscarriage.

The purpose of this study was to investigate men's experiences with the event of their partner's miscarriage. Grounded theory methodology was employed to gather data from eight men whose partners had experienced a total of 10 miscarriages. Data were collected through informal, unstructured interviews. Four sequential phases emerged from the data: (a) recognizing sign(s), (b)confirming the news, (c) working through it, and (d) getting on with life. Supporting was the basic social process that emerged, and four major concepts arose: (a) living the feelings, (b) waiting, (c) seeking help, and (d) accepting. The implications for practice are examined and recommendations for future research are presented.

Hemodynamic responses and activity tolerance to stair climbing during the second week post-myocardial infarction.

The purpose of this study was to evaluate the hemodynamic responses and activity tolerance to stair climbing of second week post-myocardial infarction (MI) patients. Forty MI patients were stratified into beta-blocker medication users and non-users and randomly assigned to the experimental or control conditions. The 21 experimental subjects performed a walk/stair climb, and the 19 control subjects, a walk/stand activity protocol. Changes in heart rate and blood pressure from before, to immediately after both the walk/stair and walk/stand activity protocols were clinically small. No significant differences existed in the distribution of hemodynamic signs among the experimental and control subjects. However, proportionately more experimental than control subjects had symptoms of activity intolerance (7/21 vs 1/19; p less than 0.05). No correlation existed between activity (in) tolerance and either days post-MI or time required for stair climbing. Based upon these preliminary findings, assessment of tolerance to stair climbing activities is warranted during the second week post-MI.

Holding death at bay: the experience of the spouses of patients undergoing cardiovascular surgery.

This study utilized a grounded theory design to investigate the experiences related to being the spouse of a cardiovascular surgical patient during five subject-identified phases: a) finding out the surgery was necessary, b) waiting for surgery, c) waiting during surgery, d) the intensive care unit (ICU) experience, and e) the recovery period before hospital discharge. Data were collected from each of eight subjects via three unstructured, tape-recorded interviews conducted a) on the day of the patients' hospital admission, b) during the first 48 hours of the patients' ICU stay and c) just before the patients' hospital discharge. Holding Death at Bay was identified as the core category. Three main categories: uncertainty, helping commitment and reorganization emerged from the data and were apparent in each of the five subject-identified phases of the spouses' experience. Main categories and subcategories of the core category emerging from the data are described. Implications of this research for nursing practice and further nursing research are discussed.

Mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit.

This study explored mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit. A convenience sample of 15 mothers was selected, and the researchers interviewed each mother once within a week after her neonate's transfer. Three themes emerged from the data: (1) the mothers expressed feelings of relief accompanied by concern, fear of the unknown, and feelings of alienation; (2) the mothers depended on familiar things and people; and (3) the mothers experienced feelings of helplessness. The mothers' perceptions of their preparation for transfer and continuity of care were mainly negative.

Mode of action of the dual-action cephalosporin Ro 23-9424.

Ro 23-9424 is a broad-spectrum antibacterial agent composed of a cephalosporin and a quinolone moiety. Its biological properties were compared with those of its two components and structurally related cephalosporins and quinolones. Like ceftriaxone and cefotaxime but unlike its decomposition product, desacetyl cefotaxime, Ro 23-9424 bound at less than or equal to 2 micrograms/ml to the essential penicillin-binding proteins 1b and 3 of Escherichia coli and 1, 2, and 3 of Staphylococcus aureus. In E. coli, Ro 23-9424 produced filaments exclusively and decreased cell growth; cefotaxime produced both filaments and lysis. Like its decomposition product fleroxacin but unlike quinolone esters, Ro 23-9424 also inhibited replicative DNA biosynthesis in E. coli. In an E. coli strain lacking OmpF, growth continued after addition of Ro 23-9424, decreased after addition of cefotaxime, and stopped immediately after addition of fleroxacin. The results, together with the chemical stability of Ro 23-9424 (half-life, approximately 3 h at pH 7.4 and 37 degrees C), suggest that in E. coli the compound acts initially as a cephalosporin with intrinsic activity comparable to that of cefotaxime but with poorer penetration. Subsequent to the decomposition of Ro 23-9424 to fleroxacin and desacetyl cefotaxime, quinolone activity appears. The in vitro antibacterial activity reflects both mechanisms of action.

Fleroxacin resistance in Escherichia coli.

Spontaneous fleroxacin-resistant mutants of Escherichia coli K-12 were isolated at a frequency of 10(-10) to 10(-11) mutants per CFU plated. All mutants exhibited quinolone-resistant replicative DNA biosynthesis, and 4 of 11 mutants also had decreased amounts of OmpF or OmpC porin. None of the mutants had changes solely in porin proteins.