Trends in Medicare use of post-hospital care

The introduction of Medicare's hospital prospective payment system has raised concerns about availability of and access to needed health care services after beneficiaries are discharged from the hospital. In this article, Medicare coverage of skilled nursing facility, home health agency, and inpatient hospital rehabilitation services is discussed and recent trends in the use of these services are explored. In addition, an overview is provided of two major studies currently sponsored by the Federal Government to examine availability and other issues related to post-hospital care.

Cyclohexane triones, novel membrane-active antibacterial agents

The cyclohexane triones are a novel group of synthetic antibacterial agents that are active against gram-positive bacteria, Haemophilus influenzae, and Mycobacterium smegmatis. In general, these compounds behaved in a manner similar to that of hexachlorophene, inhibiting the transport of low-molecular-weight hydrophilic substances into bacteria. Unlike cationic detergents, such as chlorhexidine, they did not cause disruption of the bacterial cytoplasmic membrane over a short time period. The most potent antibacterial cyclohexane trione studied had a reduced ability to inhibit solute transport in comparison with certain less active analogs. Cyclohexane triones may express more than a single type of antibacterial effect.

Is embryonic mortality increased in normal female rats mated to subfertile males?

Normal female rats were mated to control males or males which were subjected to unilateral testicular heating (43 degrees C for 30 min), irradiation (500 R), efferent duct ligation, arterial ligation or castration; in all males, the contralateral ductus deferens was ligated. All treatments caused reduced fertility and eventually infertility, as judged by the percentage of females becoming pregnant; the infertility was temporary after heating and irradiation. During the periods of reduced fertility, the numbers of fetuses per pregnant female and the fetus/corpus luteum ratios were reduced. In subsequent experiments, after heating of the testis, there was not only failure of fertilization despite the presence of normal numbers of spermatozoa in the uterus, but also an increased rate of embryonic degeneration in normal females. These results provide evidence that the male, while still fertile, can affect the fecundity of the female and the rate of embryo mortality.

Barium enemas are a headache

The frequency of headache after Picolax (sodium picosulphate, Nordic Ltd) preparation for barium enema was investigated and its association with dehydration, as assessed by haemoconcentration, was determined. Eleven out of 41 patients (26.8%) complained specifically of headaches. Although patients with and without headaches developed significant increases in haemoglobin concentration after Picolax preparation, the rise in haemoglobin in those with headaches was significantly greater than in those without (P less than 0.05). In both groups the haemoglobin concentration returned to normal after a bowel washout. These results suggest an association between dehydration and headache developing after a Picolax regimen. It may be possible to prevent this symptom by advising on the intake of specific volumes of fluid during preparation for barium enema.

Pancytopenia and folate deficiency in alcoholics

Three alcoholic patients are reported who presented with pancytopenia and macrocytosis due to acute folate deficiency. While folate deficiency is a common finding in alcohol abusers due to abnormalities in diet, intestinal absorption, internal metabolism and excretion, this life-threatening complication has not been well documented.

Medicaid recipients in intermediate care facilities for the mentally retarded

In this study, we examined Medicaid utilization and expenditure patterns of Medicaid recipients in intermediate care facilities for the mentally retarded (ICF's/MR) in three States: California, Georgia, and Michigan. Data were obtained from uniform Medicaid data files (Tape-to-Tape project). Most recipients in ICF's/MR were nonelderly adults with severe or profound mental retardation who were in an ICF/MR for the entire year. The average annual cost of care ranged from $26,617 per recipient in Georgia to $36,128 per recipient in Michigan. The vast majority of recipients were low utilizers of other Medicaid services. Approximately one-third of the recipients were also covered by Medicare.

Antiviral activity of 5'-PAA and 5'-PFA phosphate esters of 2'-deoxyuridines

The 5'-PAA and 5'-PFA phosphate esters of 5-bromo-2'-deoxyuridine (BUdR) were synthesized and their antiherpes virus activity was evaluated in vitro. Both compounds showed activity of the same order as the parent nucleoside, BUdR, against HSV-2 but were 4 to 12 times less potent against HSV-1. The 5'-PAA phosphate ester of BUdR (Ro 21-9875) was also active against varicella-zoster virus (VZV) and human cytomegalovirus (HCMV). The 5'-PAA phosphate ester of 5-bromovinyl-2'-deoxyuridine (BVdU) was also synthesized and showed good antiviral activity against HSV-1 only (ID50 = 1.3 mg/l). Further evaluation against selected mutants (TK- or PAAr) indicated a requirement for the expression of the virus-coded thymidine kinase (TK) for the antiviral activity of Ro 21-9875. Kinetic studies revealed non-competitive mixed inhibition of the viral enzyme by this compound. This suggests that it may have some intrinsic TK mediated activity though breakdown to its component parts is undoubtedly a significant contributing factor.

Anti-herpes virus combinations in relation to drug resistance

Two broad categories of combinations have been subject to experimental investigation against HSV-1 and HSV-2; those consisting of an active antiviral drug and an inhibitor of its catabolism and those which contain two active antiviral agents. The latter seek to exploit biochemical mechanisms likely to lead to a synergistic or complementary interaction. Examples of both types of combination for the suppression of resistance development and for the treatment of infection caused by resistant strains are discussed. Their possible relevance to the latent state is considered.

The quest for a herpes simplex virus vaccine: background and recent developments

Herpes simplex virus infections in humans range from localized skin infections of the oral, ocular and genital regions, to severe and often fatal disseminated infections of immunocompromised hosts. Following primary infection, the virus often becomes established in a latent form in the neurons of sensory ganglia and can reactivate to excrete virus asymptomatically or produce recrudescent lesions. This review describes some of the mechanisms involved in the immune response against HSV infections and examines the different strategies adopted to develop a vaccine against this seemingly intractable disease.

1H-NMR assignment and secondary structure of a herpes simplex virus glycoprotein D-1 antigenic domain

The peptide alpha Ahx-Met-Ala-Asp-Pro-Asn-Arg-Phe-Arg-Gly-Lys-Asp-Leu-Pro-Val-Leu- Asp-Gln-Leu-Thr-Asp-Pro-Pro-alpha Ahx (epsilon Ahx = 6-aminohexanoyl), the antigenic sequence 11-32 from Herpes simplex virus glycoprotein D-1, has been synthesised. Its 1H-NMR spectrum has been assigned by a combination of two-dimensional techniques in H2O and 2H2O. Its secondary structure has been defined by nuclear Overhauser effects and amide proton exchange rates, and also to some extent chemical shifts, coupling constants and amide proton temperature coefficients. These latter parameters are shown to be less reliable as guides to secondary structure. The peptide has a helical (type I/III) turn at residues Pro-14-Asn-15 and helical structure at residues Lys-20-Val-24, in rapid equilibrium with random-coil structure. A beta-turn at residues Arg-18-Gly-19 may be present as a minor component. These locations of secondary structure correspond with previously determined regions of antigenic activity.

Secondary structure of a herpes simplex virus glycoprotein D antigenic domain

The peptide 6-amino caproyl-Pro-Ser-Leu-Lys-Met-Ala-Asp-Pro-Asn-Arg-Phe-Arg-Gly-Lys-Asp-Leu- Pro-6- amino caproate has been synthesized and its secondary structure has been investigated by 1H n.m.r. at 400 MHz. Resonances were assigned from 2D NOESY and COSY spectra, and the secondary structure was determined using NOEs, three-bond coupling constants, and exchange rates of amide protons. The peptide has two tight turns centered on the Pro-Asn and Arg-Gly pairs. The relationship between the secondary structure found here and the antigenic nature of the peptide is discussed.

9-alkyl anthracyclines. Absence of cross-resistance to adriamycin in human and murine cell cultures

Four cell lines of human (CCRF CEM and U266BL) or murine (L1210 and P388D1) origin, resistant to the anthracycline antibiotic Adriamycin (doxorubicin) were selected in vitro from cultured cells by serial passage in the presence of Adriamycin. The resistant sublines were also cross-resistant to Mitoxantrone, 4'-epi Adriamycin and a number of novel anthracyclines including 4'-deoxy and 4'-methoxy analogues. However, a series of 9-alkyl substituted 4-demethoxyanthracyclines retained full activity against all the resistant sublines as did Aclacinomycin A. These results suggest that 9-alkyl substitution of 4-demethoxy-anthracyclines is an important determinant of activity against Adriamycin-resistant cell lines in vitro.

The in vitro antibacterial activity of ceftriaxone in comparison with nine other antibiotics

The results of a large three centre co-ordinated study into the in vitro susceptibility of bacterial clinical pathogens showed no significant evidence of regional variation within the U.K. towards the 10 antibiotics examined. The newer cephalosporins were highly potent and superior to other antibiotics against the Enterobacteriaceae, with ceftriaxone and cefotaxime the most potent. Against Pseudomonas aeruginosa, gentamicin was the most active, followed by ceftazidime, piperacillin and ceftriaxone; cefotetan was the least active. Staphylococcus aureus and Staphylococcus albus were most susceptible to cefuroxime and gentamicin, though most were also susceptible to ceftriaxone, cefotaxime and cefoxitin. Streptococcus (Groups A and B), Streptococcus pneumoniae and Neisseria spp. were susceptible to most agents other than gentamicin, but ceftriaxone and cefotaxime were overall the most potent. Ceftriaxone was the most active agent against Haemophilus influenzae. The newer agents were variable and relatively poor against anaerobes and only amoxycillin and piperacillin were significantly active against Streptococcus faecalis. The overall resistance level to the third generation cephalosporins was low.

Gastrocnemius myositis in a patient with inflammatory bowel disease

A young woman with long-standing inflammatory bowel disease presented with a tender left gastrocnemius myositis in association with an exacerbation of her disease. Muscle biopsy showed a chronic inflammatory cell infiltrate and atrophic muscle fibres, but no granulomata or vasculitis, and her symptoms responded to high-dose steroids. Twelve months later she underwent subtotal colectomy for troublesome symptoms and incidentally was discovered to have an adenocarcinoma of the sigmoid colon. Myositis without granulomata has not been reported previously in either Crohn's disease or ulcerative colitis.

Effect of wheat bran on zinc absorption

The effect of wheat bran on zinc absorption was studied in normal volunteers using a zinc tolerance test (ZTT) and whole-body monitor to measure the 7-day percentage retention of 65zinc (65Zn). Twenty-three subjects (age 21-26 years) were randomized into three groups. All were given 5 microCi of 65Zn orally in a 10 ml solution of zinc sulphate which contained 15 mg of elemental zinc. In addition, Group A were given 20 g wheat bran, Group B 20 g Rice Krispies (a low-fibre food) and Group C had zinc alone. The differences between the retention of 65Zn in the three groups were all statistically significant (A vs B P less than 0.005; B vs C and A vs C P less than 0.001). Similarly the differences in the areas under the ZTT curves in the three groups were all statistically significant (A vs B P less than 0.005; B vs C and A vs C P less than 0.001). We conclude that wheat bran leads to a significant reduction in zinc absorption which could eventually induce a state of zinc deficiency.

Tsetse and trypanosomiasis survey of Southern Darfur province, Sudan. II. Entomological aspects

Atsetse survey of Southern Darfur province, Sudan showed that the distribution of the only species present, Glossina morsitans submorsitans, had not appreciably altered over 10 years. Fly populations are most dense south of the Wadi Umbelasha but light infestations are found in the woodlands north of this riverine system to a latitude of about 10 degrees 15' N. Data are given on host availability which is thought to be the major factor determining tsetse distribution. The relative importance of tsetse and of tabanids as transmitters of bovine trypanosomiasis in the province is discussed. The evidence indicates that tsetse are very much more important and that cattle are most at risk of contracting infections during their dry season southerly migrations to the tsetse belts especially during their "Rushash" migration at first rains. Possibilities of tsetse control are discussed but in the short term trypanosomiasis control is most likely best achieved by chemical prophylaxis/therapy of cattle at risk.

Synergistic antibacterial activity between L-norvalyl-L-1-aminoethylphosphonic acid and nocardicin A

The phosphonopeptide L- norvalyl -L-1- aminoethylphosphonic acid [ Nva -Ala(P)] has been studied in combination with 12 beta-lactam antibiotics for activity against Pseudomonas aeruginosa. Nocardicin A was found to give the most potent synergistic combination with Nva -Ala(P). This interaction was widely observed in clinical isolates of P. aeruginosa in vitro and in a mouse septicemia model. Synergy was also observed in vitro and in vivo in several other species, including Proteus mirabilis, indole-positive Proteus spp., and Serratia marcescens. The interaction between Nva -Ala(P) and nocardicin A involved a strongly bacteriolytic mechanism. In addition, the individual components were complementary to one another in their action against organisms not showing synergy. These properties resulted in a broad spectrum of activity of the combination Nva -Ala(P) plus nocardicin A when used to treat experimental gram-negative bacterial infections.

Tsetse and trypanosomiasis survey of Southern Darfur Province, Sudan. I. Bovine trypanosomiasis

During a survey of Southern Darfur Province, Sudan blood samples from over 4,000 migratory cattle were analysed to determine levels of anaemia and trypanosome parasitaemia by buffy coat examination of microhaematocrit centrifuged samples. Levels of trypanosomal infections in the herds correlated well with their risk of exposure to tsetse being significantly lower at increasing distance from tsetse foci. Trypansoma vivax infections predominated in all herds, increasingly so with increasing distance from tsetse foci. Packed cell volume values could not be used to assist in trypanosome diagnosis at either individual or herd levels and the lack of correlation between anaemia and parasitaemia is suggested as evidence of a degree of trypanosomal tolerance in the Western Baggara cattle. Drug use and problems of drug resistance are discussed. Bovine trypanosomiasis is largely under control at present but requires continued surveillance (particularly of drug use) to prevent future problems as tsetse/cattle interactions increase.

Phosphonopeptides as substrates for peptide transport systems and peptidases of Escherichia coli

Peptide transport and peptidase susceptibility of the antibacterial agent alafosfalin and other phosphonopeptides have been characterized in Escherichia coli. Phosphonodipeptides were accumulated by a process which appeared to involve multiple permeases; saturation was not achieved even at concentrations of 128 microM. Competition studies showed that these compounds had only a low affinity for the system transporting phosphonooligopeptides and were rapidly taken up by and were inhibitory to E. coli mutants unable to transport the toxic peptide triornithine. Phosphonodipeptides containing D-residues were not appreciably transported. By contrast, phosphonooligopeptides were generally transported by a distinct saturable permease system for which they had a high affinity. This system was identical to that utilized by triornithine. Phosphonooligopeptides with simple monoalkyl substituents at the amino terminus were also transported except in the case of a t-butyl substituent. The oligopeptide permease was also able to transport certain derivatives which contained some residues having D rather than L stereochemistry. Intracellular metabolism of phosphonooligopeptides was initiated almost exclusively by hydrolysis from the N terminus by an L-specific peptidase. This initial hydrolytic activity was unaffected by the aminopeptidase inhibitor bestatin, unlike the final hydrolysis step which yields L-1-aminoethylphosphonic acid from the phosphonodipeptide intermediate.

The fractional inhibitory concentration (FIC) index as a measure of synergy

The value of the FIC index as a predictor of synergy has been investigated using the antibacterial agents alafosfalin and cephalexin combined together with themselves in fully blind experiments. Under the conditions used, even weak interaction (FIC index 0.5-0.99) proved to be statistically highly significant. The use of such fully controlled blind studies would greatly enhance the credibility of many of the claims of synergy published in the literature. The representation of results as average isobolograms is only of value with combinations which show moderate to strong interaction.

Clinical experience of zinc supplementation during intravenous nutrition in Crohn's disease: value of serum and urine zinc measurements

Serum zinc concentrations and urine zinc excretion have been studied in 10 patients with severe Crohn's disease before and during 59 patient-weeks of intravenous nutrition. Before serum zinc concentrations (9.9 +/- 1.0 mumol/l: mean +/- SEM) and urine zinc excretion (3-3 +/- 0.6 mumol/24h) were less than controls (p less than 0.01). No patients had clinical signs of zinc deficiency before intravenous nutrition and none developed signs during it. There was no overall change in serum zinc concentrations, despite improvements in body weight, skinfold thickness, and mid-arm circumference in all patients, and increased serum albumin and serum transferrin concentrations during all but two periods of intravenous nutrition. Nor was there any relationship between serum zinc concentrations and zinc uptake (up to 220 mumol/day), serum zinc concentrations remaining significantly lower than control levels. Urine zinc excretion during the first week of intravenous nutrition showed a 1.2 to 53-fold increase (mean 11-fold) over pre-intravenous nutrition levels, and a positive relationship was demonstrated between zinc intake and urine zinc excretion. It is suggested that zinc supplied by the intravenous route is inefficiently transported to the tissues, and that some is excreted in the form of small molecular weight chelates into urine. Recommendations are made for the supply of intravenous zinc, based on monitoring urine zinc excretion in individual patients.

Antibacterial activity and mechanism of action of phosphonopeptides based on aminomethylphosphonic acid

Phosphonopeptides based on aminomethylphosphonic acid as the C-terminal residue linked to L-amino acids possessed antibacterial activity in vitro and in vivo. Analogs in this series were generally less potent than corresponding compounds based on L-1-aminoethylphosphonic acid such as alafosfalin (L-alanyl-L-1-aminoethylphosphonic acid). Significant differences in antibacterial spectra were observed. The mechanism of action involved active transport of the peptide mimetics into the bacterial cells, followed by intracellular release of high concentrations of aminomethylphosphonic acid which inhibited bacterial cell wall biosynthesis. Aminomethylphosphonic acid behaved as a mimetic of both D- and L-alanine and inhibited D-Ala-D-Ala synthetase (EC 6.3.2.4.), alanine racemase (EC 5.1.1.1.), and UDP-N-acetylmuramyl-L-alanine synthetase (EC 6.3.2.8.). The minimal inhibitory concentration of L-norvalyl-aminomethylphosphonic acid was essentially unaffected by the presence of D-alanine, whereas the activity of the corresponding L-norvalyl derivative of L-1-aminoethylphosphonic acid was markedly decreased. Substantial differences in the inhibitory and lytic activity of the L-norvalyl derivatives of aminomethylphosphonic and L-1-aminoethylphosphonic acids were also observed when these agents were combined with other inhibitors of bacterial cell wall biosynthesis.

Antibacterial properties of alafosfalin combined with cephalexin

The phosphonopeptide alafosfalin (L-alanyl-L-1-aminoethylphosphonic acid) exhibited synergy in vitro and in animal studies against a range of bacterial genera when combined with cephalexin. Alafosfalin also showed synergy with mecillinam and, to a much lesser extent, with ampicillin. Synergy with cephalexin was more pronounced when the bacteria were relatively insensitive to the beta-lactam component. The action of this combination involved both an inhibitory and a bacteriolytic mechanism which was abolished by concurrent treatment with the aminopeptidase inhibitor, bestatin. Regrowth of subpopulation resistant to either component was markedly reduced by the combination. The potential of alafosfalin combined with cephalexin for use in therapy is discussed.

Gemfibrozil--the effect of biliary cholesterol saturation of a new lipid-lowering agent and its comparison with clofibrate

Clofibrate is known to increase cholesterol saturation of bile and the prevalence of gallstones. We studied 10 healthy volunteer subjects to determine the effect of gemfibrozil (a new lipid-lowering agent) on biliary cholesterol saturation and to compare it with that of clofibrate. Biliary cholesterol saturation indices were calculated on fasting duodenal bile samples collected before and after administration of each drug for 4 weeks using a 4-week "washout" period between each preparation. There was a statistically significant rise in the cholesterol saturation index from a control value, taken as the mean of 2 samples, of 1.226 (0.785--1.526), median (range), to 1.547 (0.807--1.781) after clofibrate, P less than 0.05, but the rise to 1.352 (0.840--2.686) after gemfibrozil was not significant. However, direct comparison of the cholesterol saturation indices on clofibrate and gemfibrozil revealed no statistically significant difference. Only prospective clinical trials will establish definitively the risk of cholelithiasis on gemfibrozil but these results suggest that this drug is unlikely to have an advantage over clofibrate in this respect.

Isolation of haemagglutinating adeno-like virus related to virus 127 from an Australian poultry flock with an egg drop syndrome

An egg drop syndrome within Australian broiler poultry is described. The syndrome was characterised by delayed onset of laying, a lower peak in egg production and a drop in egg production shortly after reaching peak production. Antibody to virus 127 was detected in 102 of 106 fowl serums tested. Two haemagglutinating viruses were isolated from one affected flock and one was subjected to further study. It was adenovirus-like on electron-microscopic examination and haemagglutination was not inhibited by a specific antiserum to Newcastle disease virus. An antiserum was raised in White Leghorn fowl against the isolate and this antiserum was found to cross-react with virus 127, a prototype virus of Egg Drop Syndrome 76.

Mg deficiency in chronic inflammatory bowel disease and requirements during intravenous nutrition

Assessment of magnesium (Mg) status by serum and 24-hr urine estimations has been used to study a group of 17 patients with severe Crohn's disease, 10 of whom have required intravenous (IV) nutrition. Mg depletion was present in 15 (88%) and severe enough to cause symptoms in two. Urine levels were low in most patients and would appear to be a more sensitive indication of Mg depletion than serum levels alone. Serum Mg levels were significantly lower in the Crohn's group than in a group of hospital controls; 5-10 mmol of IV Mg were required daily to prevent Mg depletion during IV nutrition and some patients required higher intakes. Three patients with particularly severe malabsorption required oral Mg supplements in the long-term. The rationale for using our method of assessing Mg status, and the importance of recognizing and treating chronic Mg deficiency are presented.

Phosphonopeptide antibacterial agents related to alafosfalin: design, synthesis, and structure-activity relationships

Dipeptide variants of alafosfalin (L-alanyl-L-1-aminoethylphosphonic acid) with substantial differences in potency and antibacterial spectrum in vitro and in vivo have been synthesized. Certain dipeptides with alternatives to the L-alanyl residue had broader antibacterial spectra; activity against Pseudomonas aeruginosa was included. Some compounds had better in vivo activity than alafosfalin when introduced into infected rodents orally, but for the majority of the more active phosphonodipeptides, parenteral administration was more effective. Certain oligopeptides derived from the more active phosphonodipeptides possessed good in vitro activity against an extended range of organisms; they included Haemophilus influenzae, Streptococcus faecalis, and Streptococcus pneumoniae. The in vivo activity of some of these phosphono-oligopeptides was significantly greater than that of the parent dipeptide and correlated well with the in vitro results. This indicates that phosphono-oligopeptides exert part of their in vivo action directly, in addition to that arising from smaller peptides produced by peptidase cleavage.

The interaction of phenobarbital and other anticonvulsants with oral contraceptive steroid therapy

In a group of 5 women on long-term anticonvulsant and oral contraceptive therapy, the plasma ethynylestradiol (EE) concentration on 50 microgram EE daily was 11.1 +/- 4.5 pg/ml. These values were at the lower end of the range found in normal women in this laboratory taking 30 microgram EE daily (6-190 pg/ml). Four women have been studied prospectively for 3 months, over 1 cycle before and 2 cycles during phenobarbital 30 mg b.i.d. therapy. Significant falls in the plasma EE concentration were seen in two women (from 104.8 +/- 13.4 to 37.7 +/- 2.0 pg/ml and from 125.6 +/- 23.8 to 34.8 +/- 6.7 pg/ml p less than 0.01) and breakthrough bleeding was seen in both women. No changes in plasma concentrations of follicle stimulating hormone, progesterone, norethindrone or norgestrel were seen. There was a significant increase in the sex hormone binding globulin capacity from 100.7 +/- 5.8 to 133.3 +/- 1.2 nmoles/1 (p less than 0.05). These changes are consistent with the known microsomal enzyme inducing effect of phenobarbital.

Home enteral tube feeding with a liquid diet in the long term management of inflammatory bowel disease and intestinal failure

A 35-year-old man, who had spent 10 1/2 out of 18 months in hospital, has required repeated courses of intravenous nutrition (IVN) because of nutritional failure due to severe inflammatory bowel disease. He has been maintained on a nocturnal pump-fed liquid diet supplementing his day-time oral diet for five months, four of which have been at home. The cost of such therapy is less than with an elemental diet and there are other advantages. This regime has been shown to be nutritionally adequate. The need to assess other cheaper liquid diets in patients with intestinal failure is recognised.

Elemental diet therapy in the management of complicated Crohn's disease

The purpose of this report was to study the types of complications of Crohn's disease which may benefit from the use of elemental diets. The elemental diet Vivonex was used in the management of patients with Crohn's disease with local complications but without nutritional deficiency. Sole treatment of this kind was found to be of value in promoting healing of perianal or anal ulceration and anal fissures; it was also of value in allowing subacute ileal obstruction to settle, thus postponing surgery and allowing better bowel and nutritional preparation for surgery. Patients with bile acid-induced diarrhoea associated with severe ileal Crohn's disease noted improvement in the diarrhoea on the elemental diet, and the treatment was also useful in reducing ileostomy output and helping ileostomy skin lesions to heal in a patient with severe skin excoriation related to leakage of excessive ileostomy fluid output.

Phosphonopeptides as antibacterial agents: rationale, chemistry, and structure-activity relationships

Peptide mimetics with C-terminal residues simulating natural amino acids have been designed as inhibitors of bacterial cell wall biosynthesis. The phosphonopeptide series consisting of various l and d residues of natural amino acids combined with 1-aminoalkyl (and aryl-alkyl-) phosphonic acid residues had the most interesting antibacterial properties when the C-terminal residue was l-1-aminoethylphosphonic acid. The in vitro antibacterial activities of representative phosphonodi- to phosphonohexapeptides were investigated. The antibacterial action of the active compounds has been explained in terms of transport into the bacterial cell and intracellular release of the alanine mimetic, which interferes with the biosynthesis of the peptidoglycan of the bacterial cell wall.

Phosphonopeptides as antibacterial agents: alaphosphin and related phosphonopeptides

Alaphosphin, l-alanyl-l-1-aminoethylphosphonic acid, was selected from a range of phosphonopeptides for evaluation in humans on the basis of its antibacterial activity, pharmacokinetics, and stability to intestinal and kidney peptidases. In vitro, the antibacterial action was antagonized by small peptides, resulting in low activity on peptone media. On an antagonist-free medium alaphosphin was bactericidal and rapidly lysed most susceptible gram-negative bacteria, but it was largely bacteriostatic and essentially nonlytic against gram-positive organisms. Its spectrum included most strains normally isolated from urinary tract infections, but potency was greatly reduced by very high inoculum levels and by alkaline pH. Although strains of Proteus and Pseudomonas were less susceptible to alaphosphin than were other common gram-negative bacteria, like other species they formed spheroplasts when exposed under appropriate conditions. Alaphosphin was equally effective against penicillin-susceptible and -resistant strains and showed no cross-resistance with known antibiotics. Good synergy and increased bactericidal activity were demonstrated with combinations of alaphosphin and d-cycloserine or beta-lactam antibiotics.

Phosphonopeptides as antibacterial agents: mechanism of action of alaphosphin

The novel antibacterial peptide mimetic alaphosphin (l-alanyl-l-1-aminoethylphosphonic acid) selectively inhibited peptidoglycan biosynthesis in both gram-negative and gram-positive bacteria. It induced accumulation of uridine diphosphate-N-acetyl-muramyl-tripeptide in gram-positive organisms and significantly reduced the intracellular pool levels of d-alanine. Alaphosphin was actively transported into bacterial cells by stereospecific peptide permeases and was subsequently hydrolyzed by intracellular aminopeptidases to yield l-1-aminoethylphosphonic acid. This alanine mimetic rapidly accumulated inside susceptible cells to yield a concentration which was 100- to 1,000-fold in excess of that of the precursor peptide in the surrounding medium. In the case of susceptible gram-negative organisms, it was shown that 1-aminoethylphosphonic acid was incorporated into a metabolite which was tentatively identified as uridine diphosphate-N-acetylmuramyl-aminoethylphosphonate. The primary intracellular target site of 1-aminoethylphosphonic acid was alanine racemase (EC 5.1.1.1), which was reversibly and competitively inhibited in the gram-negative organisms Escherichia coli and Pseudomonas aeruginosa and irreversibly inhibited in a time-dependent manner in the gram-positive organisms Staphylococcus aureus and Streptococcus faecalis. A secondary target site could be uridine diphosphate-N-acetylmuramyl-l-alanine synthetase [EC 6.3.2.8(b)]. The mechanism of action of alaphosphin may be regarded as involving at least three stages: (i) active transport by peptide permeases; (ii) intracellular peptidase cleavage; and (iii) action of l-1-aminoethylphosphonate on alanine racemase.

Oxygen demand by lipid-accumulating yeasts in continuous culture

Specific oxygen uptake rates [Q(02)] were highest when Candida 107 and Rhodotorula gracilis grew at their maximum dilution rates. In nitrogen-limited medium, which encourages lipid accumulation, Q(02) values of both yeasts decreased as the dilution rate was lowered.

Lipid Accumulation in an Oleaginous Yeast ( Candida 107) Growing on Glucose Under Various Conditions in a One- and Two-Stage Continuous Culture

Lipid accumulation and fatty acid composition in Candida 107 have been studied using a two-stage continuous culture system in which the first vessel was run under carbon-limited conditions and then the entire output was passed into a second vessel, where lipid accumulation was stimulated by adding only glucose. Maximum lipid accumulation (28% of yeast [dry weight]) occurred for a volume ratio of vessel 1 to vessel 2 of 3:5, with 30 g of glucose per liter being added to vessel 2 operated at 25°C with an aeration rate of between 0.1 and 1.0 volume of air/volume of medium per min. Although the maximum specific rate of lipid formation (0.05 g of lipid/g of yeast per h) was higher than in a nitrogen-limited, single-stage system, the efficiency of lipid formation was much less and never exceeded 14 g of lipid produced per 100 g of glucose consumed. The fatty acid composition was not significantly altered in either the two-stage or single-stage culture (nitrogen-limited) systems by changes in growth temperature (from 19 to 33°C) or aeration rates (0.05 to 1.0 volume of air/volume of medium per min); or, in the two-stage system, by changes in the residence time of the yeast in the second vessel (from 3.2 to 24.4 h), or, in the single-stage system, by changes in pH (from 3.5 to 7.5). Only when the concentration of glucose entering vessel 2 of the two-stage system was less than 30 g/liter did significant changes in the fatty acids occur. Thus, although a two-stage continuous culture system allows lipid accumulation to be separated from the growth phase, it offers no practical advantages over a single-stage system as a means of producing microbial oils and fats.