Impact of patient handover structure on neonatal perioperative safety.

OBJECTIVE: To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. STUDY DESIGN: A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. RESULTS: The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers. CONCLUSIONS: NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.

Auxiliary-field quantum Monte Carlo simulations of neutron matter in chiral effective field theory.

We present variational Monte Carlo calculations of the neutron matter equation of state using chiral nuclear forces. The ground-state wave function of neutron matter, containing nonperturbative many-body correlations, is obtained from auxiliary-field quantum Monte Carlo simulations of up to about 340 neutrons interacting on a 10(3) discretized lattice. The evolution Hamiltonian is chosen to be attractive and spin independent in order to avoid the fermion sign problem and is constructed to best reproduce broad features of the chiral nuclear force. This is facilitated by choosing a lattice spacing of 1.5 fm, corresponding to a momentum-space cutoff of Λ=414 MeV/c, a resolution scale at which strongly repulsive features of nuclear two-body forces are suppressed. Differences between the evolution potential and the full chiral nuclear interaction (Entem and Machleidt Λ=414 MeV [L. Coraggio et al., Phys. Rev. C 87, 014322 (2013).

[Erwinia amylovora--the fire blight pathogen of trees in Ukraine].

Niduses of fire blight of fruit and ornamental trees have been found in the Kyiv and Vinnitsa regions of Ukraine. Pathogen Erwinia amylovora was isolated between April and October. The pathogen was often accompanied by bacteria Pseudomonas syringae pv. syringae. Artificial infection with a mixture of bacteria E. amylovora and P. syringae pv. syringae accelerates and enhances the disease process in the laboratory.

[Polyvalence of bacteriophages isolated from fruit trees, affected by bacterial fire blight].

Phage populations appearing as a result of a pathogenic process caused by Erwinia amylovora have been discovered and described. They accompany bacterial fire blight development in the process of quince, pear and apple trees vegetation in Zakarpattya region of Ukraine. Phage isolates of the affected pear and quince include polyvalent virulent phages able to develop on bacterial strains associated with plants--E. amylovora. E. "horticola" and Pantoea agglomerans. E. amylovora isolated from the plant tissues affected by the fire blight and detected at the same time as phages proved to be resistant to the viral infection. It is hard to explain now this characteristic however it was noticed that resistance to phages can change drastically in case of dissociation, lysogenization and mutagenesis of erwinia in laboratory conditions. Phage population study shows that they are heterogeneous and can obviously include not only polyvalent but also specific viruses. Further studies of biology and molecular genetics of pure lines of isolated phages will help to get closer to understanding the place and role of bacteriophages in the complicated network of relations between bacterial pathogens and plants.

[Electron microscopy and restriction analysis of bacteriophages isolated from quince and pear with symptoms of fire blight].

Phage populations of isolates from quince and pear affected with fire blight disease were studied using electron microscopy, restriction analysis and both agarose gel electrophoresis of particles and host range scoping method. The isolate from quince (pMA1) comprises at least three phage populations and two phage variants that can be detected on different bacterial indicators. After titration of this isolate on Erwinia amylovora the bacteriophage KEY of B1 morphotype with the genome size of 82.4 kb was identified. The isolate pMA1 also includes a unique phage population 4*, which can be identified on the test bacteria Pantoea agglomerans (Pag) g150. Two analogous populations being also present in the isolate pMA1 that appeared to be close phage variants with almost identical Hpal-restriction patterns can be identified using Pag g157 and 9/7-1. The situation is similar in the case of phage isolates from pear, pMG. Three phage populations identified in it using three different indicators represent the same phage of C1 morphotype (TT10-27) with a genome size of 71.4 kb. At least two other phage populations were also detected in the same isolate using P. agglomerans 9/7-2 as an indicator. A model system allowing the most efficient analysis of the isolates for the presence of different phage populations and phage variants in plants infected by fire blight disease has been developed. It provides for using three indicator enterobacterial species closely associated with the plants: E. amylovora, Erwinia "horticola" and Pagglomerans and ignoring of the phage cloning procedure.

[Properties of pectolitic phytopathogenic bacteria isolates obtained in Ukraine].

Bacteria obtained from potato tubers having symptoms of soft rot and grown in different regions of Ukraine are identified as Pectobacterium carotovorum subsp. carotovorum. These bacteria strains are able to produce bacteriocines. Their killer activity in respect of P. carotovorum and Esherichia coli has been studied. The sensitivity to bactericines has been shown. Purified fractions of bacteriocines having high molecular weight (MCTV) have been obtained. The difference in composition of proteins from phage tails as compared to the ones in P. carotovorum J2 has been studied by the method of electrophoresis. It was found that the composition of MCTV major proteins of studied isolates mostly corresponds to P. carotovorum J2. The set of enzyme minor fractions has some different compositions as compared to P. carotovorum J2. It has been hypothesized that this difference is responsible for killer specificity.

[Effect of cultivation conditions on fatty acid content of Clavibacter michiganensis subsp. michiganensis lipids].

The fatty acid content of C. michiganensis subsp. michiganensis cellular lipids in different culture conditions was investigated. It was established, that it lies in a narrow range C14-C18 and belongs to isoanteiso type. The species character is constant, independent of temperature, duration of cultivation and medium content dominance of saturated branched-chain fatty acids, among which the anteiso-acids dominate, generally a-C15. A response to the temperature modification of bacteria cultivation, medium and age of culture is expressed by relations between separate fatty acids. Thus the modifications of fatty acid content, connected with age of culture and temperature of cultivation, depend on a strain. The cultivation of bacteria on a rich medium in comparison with poor one enlarges the content of nonbranched-chain and anteiso-acids in lipids.

[Etiology of mass tomato disease in the farms of Ukraine].

It was established, that the main cause of bacterial tomato wilting in the fields and greenhouses is Clavibacter michiganensis subsp. michiganensis, the agent of tomato bacterial canker. It is especially dangerous in the greenhouse soil, where it causes the mass plant diseases in the fruiting period. In greenhouses, the TBC appears as the vein disease, while in fields--as leaf and fruit disease. In conditions of artificial infection in fields, the ability of Cmm to cause the fruit rotting was found out. The isolates do not differ from those described in the literature by their phenotypical characteristics, by fatty acid content in particular. The sensitivity of isolates to pesticides, recommended for control of other tomato pathogens, was established. Antagonists, isolated from tomato seeds, are promising for the control.

Initial experience of subfascial endoscopic perforator vein surgery in patients with severe chronic venous insufficiency.

Subfascial Endoscopic Perforator Surgery (SEPS) is a foolproof method of treatment of perforating veins reflux without direct surgical manipulation in the area of trophic disturbances. In this paper, we present initial case series, consisted of 5 patients with severe chronic venous insufficiency (CEAP classes C4-C6), SEPS being used in complex treatment. The criteria used for selection of the patients for SEPS was presence of incompetent perforating veins in the area of trophic disturbances, confirmed by duplex scanning of the venous system. Dual-port SEPS technique with using of space-maker was performed in combination with high ligation and below-knee stripping of long saphenous vein. No early postoperative complications related to SEPS were noted. Healing of all active venous ulcers among patients in class C6 and decrease of clinical severity score in all cases were achieved during follow-up period ranged from 2 to 13 months. Results of treatment in the presented case series confirm high effectiveness of SEPS in severe chronic venous insufficiency.

[Study of population dissociation of collection strains of Erwinia carotovora]. / Izuchenie populiatsionnoi dissotsiatsii kollektsionnykh shtammov Erwinia carotovora.

Unusual dissociants of Erwinia carotovora subsp. atroseptica (EAT) population that emerge with high frequency (18-94%) during long-term storage of cultures were found. The dissociants (Poe-phenotype) differ from parental forms by slow growth and long development of the colour of colonies on EMB agar though they are not Lac-mutants. More than 60% of Poe-mutants of strain EAT 39A are characterized by 8- and 150-fold decrease of stability to erythromycin and oleandomicin, correspondingly. They are also sensitive to colicin-like carotovoricin, which is induced by mytomicin C, to carotovoricin of initial strain EAT 39A and to autocin, which they produce themselves during induction. A multiple phenotype of these dissociants (dissociants of the second type) is labeled: PoeOmSErSBnSAu. Its appearance as well as the appearance of pure Poe-variants is not associated with usual mutations and a loss of residential plasmids by cells. Population dissociants of the both types--Poe and PoeApSOmS--were also obtained from E. carotovora subsp. carotovora (J2) during growth at supraoptimal temperature. Poe-variants are more often observed in representatives of subspecies atroseptica than carotovora and can be useful when studying pathogeneity of these practically important erwinias.

Celiac disease in a patient with a congenital deficiency of intestinal enteropeptidase.

We report on a 40-yr-old man with both primary enteropeptidase deficiency and celiac disease. He suffered from severe intestinal malabsorption and growth failure as a child. Enteropeptidase deficiency was found and pancreatic enzyme replacement therapy resulted in a growth spurt. Enteropeptidase levels in his intestinal mucosa and intraluminal fluid remained very low throughout childhood and early adult life. Celiac disease was confirmed by characteristic abnormalities in tests of intestinal function and in mucosal biopsies, which recovered when he instituted a gluten-free diet. He remains clinically intolerant to gluten as an adult. Enteropeptidase levels have remained abnormally low whether or not his intestinal mucosa has been normal in response to gluten restriction. Enteropeptidase levels have previously been shown to be normal in untreated celiac patients. The relationship between the two disorders remains unclear.

[Adsorbed receptors for Erwinia carotovor subsp. carotovora macromolecular bacteriocins]. / Izuchenie adsorbtsionnykh retseptorov makromolekuliarnykh bakteriotsinov Erwinia carotovora subsp. carotovora.

Study of nature of receptors for macromolecular bacteriocins Erwinia carotovora subsp. carotovora has shown that lipopolysaccharide (LPS) of cell membrane is an attaching structure for them. It has been established that enzymic treatment of LPS preparation with its further deproteinization by phenol is necessary for isolation of biologically active lipopolysaccharide. The process of absorption by LPS has been studied quantitatively and it has been shown that it is a low-efficient receptor as compared with LPS included in the native cell membranes. An approach has been proposed for the first time to the estimation of monosaccharide composition of LPS-receptor based on relations between bacteriocin sensitivity and content of monosaccharides. Study of six strains of E. carotovora subsp. carotovora from different sources has shown that the structure of LPS-receptors includes mannose, fucose, xylose, ramnose and two lipophylic monosaccharides of unknown nature. A conclusion has been made that S-LPS (0-chain) is that part which contains the sites of attachment of macromolecular carotovoricins.

[Characteristics of bacterial lipopolysaccharides depending on extraction method]. / Kharakterystyka lipopolisakharydiv bakterii zalezhno vid metodu vydilennia.

Carbohydrate-containing biopolymers have been isolated from Erwinia carotovora subsp. atroseptica 549 by two methods--the aqueous-phenol and with using physiological solution--with addition and without addition of ethylenediaminetetraacetate (EDTA). The biopolymers yield from the cells of bacteria are shown to depend on the extraction method. Lipopolysaccharide-protein complex have been isolated by the sparing method. The purest lipopolysaccharide have been isolated by the aqueousphenol method. The preliminary treatment of cells by EDTA increased the biopolymers output. Carbohydrate containing biopolymers isolated from the cells of bacteria by different methods possess the similar qualitative composition of monosaccharides but they differ in the quantitative content of monosaccharides, spectrum of fatty acids of lipid components as well as in the protein content.

Revealing some oncofetal antigens in peripheral blood mononuclear cells of donors and patients with B-chronic lymphocytic leukemia.

Eidelman et al. showed that the expression of functional carcinoembryonic antigen (CEA) on the surface of cells can block terminal differentiation and maintain their proliferative capabilities. This led us to analyze the expression of CEA, trophoblast-specific beta-1-glycoprotein (TSG) and embryonic prealbumin-1 (EPA) in peripheral blood mononuclear cells (PBMs) isolated from healthy donors and patients with B-chronic lymphocytic leukemia (B-CLL). We demonstrated that the PBMs of patients with B-CLL differed from PBMs of healthy donors by having greater numbers of CEA-, EPA- and TSG-positive cells.

[The effect of trophoblast-specific beta 1-glycoprotein and oncoprecipitin A on the growth and morphology of HeLa-M tumor cells]. / Vliianie trofoblast-spetsificheskogo beta 1-glikoproteina i onkopretsipitina A na rost i morfologiiu opukholevykh kletok linii HeLa-M.

Pregnancy-specific beta 1-glycoprotein (PS-1), one of a large family in oncofetal antigens, and oncoprecipitin A, a specific glycoprotein isolated from ascidians, have been shown to reduce cell proliferative activity in HeLa-M cells but almost not to change RNA synthesis. Using scanning electron microscopy, distinct surface transductions in the studied cells were demonstrated. After the incubation of cells with oncoprecipitin A, cell shape alteration and intensive cell spreading were observed. The treatment of tumor cells with PS-1 changed cell shape and essentially reduced cell contacts, as compared to control cells. The changes in cell surface and shape correlated with essential reorganization of actin microfilaments. The use of substances influencing the growth and adhesive characteristics of tumor cells may help in understanding mechanisms of cell transformation.

Primary sclerosing cholangitis in 32 children: clinical, laboratory, and radiographic features, with survival analysis.

The clinical presentation and outcome of 32 children with primary sclerosing cholangitis (PSC) are reviewed, the largest North American series. The majority of patients were diagnosed in their second decade (median age: 13 years). Four children presented before the age of 2 years, but none in the neonatal period. Seventeen patients had inflammatory bowel disease (IBD), all with colitis, 14 ulcerative colitis, and 3 Crohn's disease. Eight patients presented with chronic liver disease before clinical onset of IBD. Only 8 of 32 patients were jaundiced at presentation. Fifteen of 32 had a normal serum alkaline phosphatase (ALP) level at presentation. Nine children presented with features similar to those of autoimmune hepatitis. Cholangiography was performed in all cases and classified by a scoring system specifically developed for pediatric patients. Intrahepatic disease predominated; in only three cases a common bile duct stricture was identified requiring stenting. Findings on the initial liver biopsy were classified according to Ludwig's criteria for staging PSC: there were 15 biopsies in stages 1 to 2 and 17 biopsies stages 3 to 4. HLA class I and II antigens were determined in 27 patients. An increased incidence of HLA B8 and DR2(15) but not DRw52a (DRB3*0101) was found. Anti-neutrophil cytoplasmic antibody (ANCA) was positive in 10 of 24 patients tested. Survival analysis indicated that a later age at presentation, splenomegaly, and prolonged prothrombin time (PT) at presentation were significant contributors to the prediction of poor outcome (i.e., death or listing for transplantation). Liver transplantation was successfully performed in seven children. Physicians must maintain a high index of suspicion of PSC in any child or young adult presenting with chronic liver disease, especially in the presence of IBD, even with a normal serum alkaline phosphatase level.

[Isolation and general characteristics of lectin from the ascidian Didemnum ternatum]. / Vydelenie i obshchaia kharakteristika lektina iz astsidin Didemnum ternatum.

DTL was isolated from the Didemnum ternatum colonial ascidian and purified by affinity chromatography on cross-linked ovalbumin followed by gel-filtration on Sephadex G-100. SDS-PAGE of the preparation showed a major intense band with a relative mol. wt. of ca. 27 kDa. In the presence of 2-mercaptoethanol, DTL gave rise to a single band of 10 kDa. The lectin isolated was found to agglutinate Ehrlich's carcinoma cells and trypsinized human A, B, O erythrocytes, the hemagglutination being inhibited by GlcNAc, chitobiose, desialylated glycoproteins. Comparison of the sugar moieties of the glycoproteins used as inhibitors led to suggestion that the specific sugar binding site contains, as a dominant sugar, a "bisecting" glucosamine attached through a beta-1,4-linkage to the beta-linked mannose residue of N-glycosidic chains of a complex or hybrid type. An absence of sialic acid residues linked with galactose residues appeared to be necessary for binding DTL with the complex-type sugar chains. DTL inhibits proliferation and reduces DNA biosynthesis ([3H]thymidine incorporation) in tumour cells (HeLa). Principal morphological differences were detected to occur between intact and DTL-treated HeLa cells.