Specialized dementia programs in residential care settings

The authors conducted a telephone survey in 7 states to determine the prevalence of residential care specialized dementia programs (RC-SDPs) and to identify a sample of homes (n = 56) for more detailed study. The 56 homes were site visited, and data were gathered on facility administration, therapeutic environment, and characteristics of 259 randomly selected residents. Comparison data from 138 nursing home Special Care Units (NH-SCUs) and 1,340 of their residents were obtained from 4 studies conducted in the same 7 states. RC-SDPs were smaller, provided a more homelike environment, and had a higher proportion of residents paying privately, compared with NH-SCUs. Mean levels of cognitive and physical impairment among residents were higher in NH-SCUs; prevalences of psychotropic medication use and problem behaviors were similar. Among RC facilities, small homes were more homelike, provided fewer structured activities, and charged less than larger facilities. RC-SDPs include 5 types: small, independently operated homes; multiple small homes with joint administration; larger, all-dementia facilities; SDPs operated within larger, exclusively RC facilities; and RC-SDPs in multilevel facilities.

Degree of acetylation of heteropolysaccharides

The acetyl groups in polysaccharides and glycoproteins have been determined using 4 N HCl at 120 degrees C for acid hydrolysis. Acetic acid and hexosamine were determined by high-performance cation-exchange chromatography with UV detection and high-performance anion-exchange chromatography with pulsed amperomeric detection, respectively. The method compares well with other procedures and shows an additional advantage of being able to analyze for hexosamine in the same hydrolyzate, thus permitting the degree of acetylation of hexosamine-containing biopolymers to be determined directly without correction for additional components in the material of interest.

Autohydrolysis of phytic acid

The autohydrolysis of phytic acid at 120 degrees C resulted in the formation of most of the phosphate esters of myo-inositol in varying amounts depending upon the reaction time. Eighteen of the 39 chromatographically distinct myo-inositol mono-, bis-, tris-, tetrakis-, pentakis-, and hexakisphosphates have been characterized using two different HPLC systems. These myo-inositol phosphates were partially purified by preparative anion-exchange chromatography under acidic and alkaline elution conditions. The combination of these two methods provides a two-tiered chromatographic approach to the rapid and sensitive identification of inositol phosphates in complex mixtures. Identification of the products was confirmed by 1D and 2D (1)H NMR analysis. The analytical procedure was applied to the autohydrolysis of the mixture of inositol phosphates from corn steep water.

Intravenous ondansetron for the control of opioid-induced nausea and vomiting. International S3AA3013 Study Group

This randomized, double-masked, placebo-controlled, multicenter trial was conducted in 9 countries to assess the safety and efficacy of 2 doses of intravenous ondansetron (8 and 16 mg) for the control of opioid-induced nausea and vomiting. A total of 2574 nonsurgical patients who presented with pain requiring treatment with an opioid analgesic agent participated in this trial. The most common presenting painful condition was back or neck pain, reported by approximately one third of patients. A total of 520 patients (317 females, 203 males) developed nausea or vomiting after opioid administration and were randomly assigned to receive a single dose of 1 of 3 study treatments: placebo (n = 94), ondansetron 8 mg (n = 215), or ondansetron 16 mg (n = 211). Ondansetron 8 and 16 mg led to complete control of emesis in 134 of 215 patients (62.3%) and 145 of 211 patients (68.7%), respectively. Results with both doses were significantly better than those seen with placebo (43 of 94 patients [45.7%]). Complete control of nausea was achieved in 6.8% of placebo patients, 14.8% of ondansetron 8-mg-treated patients, and 19.4% of ondansetron 16-mg treated patients; only ondansetron 16 mg was significantly better than placebo (P = 0.007). Significantly more patients who received ondansetron 8 mg than patients who received placebo were satisfied/very satisfied with their antiemetic treatment, as assessed by 4 patient-satisfaction questions. Significantly more patients who received ondansetron 16 mg compared with placebo were satisfied/very satisfied on 2 of 4 satisfaction questions. In conclusion, based on the observed incidence of opioid-induced nausea and vomiting in this study, it may be more appropriate to treat symptoms on occurrence rather than administering antiemetic agents prophylactically. The results of this study demonstrate that intravenous ondansetron in doses of 8 or 16 mg is an effective antiemetic agent for the control of opioid-induced nausea and vomiting in nonsurgical patients requiring opioid analgesia for pain.

Extracellular polysaccharide of Erwinia chrysanthemi CU643

Erwinia chrysanthemi are gram-negative bacterial phytopathogens causing soft rots in a number of plants. The structure of the extracellular polysaccharide (EPS) produced by E. chrysanthemi strain CU643, pathogenic to Philodendron, has been determined using a combination of chemical and physical techniques including methylation analysis, high- and low-pressure gel-filtration and anion-exchange chromatography, high-pH anion-exchange chromatography, partial acid hydrolysis, mass spectrometry, and 1- and 2-D NMR spectroscopy. In contrast to the structures of the EPS reported for other strains of E. chrysanthemi, the EPS from strain CU643 is a linear polysaccharide containing L-Rhap, D-Galp, and D-GlcAp in the ratio 4:1:1. Evidence is presented for the following hexasaccharide repeat unit: -->3)-beta-D-Galp-(1-->2)-alpha-L-Rhap-(1-->4)-beta-D-GlcAp- (1-->2)-alpha-L- Rhap-(1-->2)-alpha-L-Rhap-(1-->2)-alpha-L-Rhap-(1-->(1 ).

Heterogeneity of glycans at each N-glycosylation site of horseradish peroxidase

The tryptic glycopeptides of horseradish peroxidase isozyme c (HRPc) were studied by methylation linkage analysis, exoglycosidase degradation, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOFMS). Over 90% of the predicted tryptic peptides and glycopeptides of HRPc could be identified in the unfractionated digest. Four glycans, namely (Xyl)Man3(Fuc)GlcNAc2 (major species), (Xyl)Man2(Fuc)GlcNAc2, (Xyl)Man3GlcNAc2, and Man3(Fuc)GlcNAc2 (minor species), were observed at all of the N-glycosylation sites and account for greater than 95% of the carbohydrate. Other members of this glycan family, namely (Xyl)xManm(Fuc)f GlcNAc2 (x = 0 or 1, f = 0 or 1, m = 4, 5, 6, or 7), account for the rest of the glycans. Only traces of high mannose-type glycans were detected in HRPc. Two sites, namely those at Asn-57 and Asn-267, were found to be more heterogeneous than the sites at Asn-13, Asn-158, Asn-186, 198 (doubly glycosylated peptide), Asn-214, and Asn-255. Two of the glycopeptides were observed as part of disulfide-linked species. MALDITOFMS confirmed the N-glycosylation sites previously reported [K.G. Welinder, Eur. J. Biochem., 96 (1979) 483-502] and was used to determine the heterogeneity of the glycan pool at each site.

The N-glycosylation sites of soybean seed coat peroxidase

Tryptic digestion of apo-soybean peroxidase (apo-SBP), with and without acetamidation, chromatographic separation of the tryptic fragments and MALDI-TOF analysis of the major components, both before and after digestion with glycopeptidase A, demonstrated the presence of six carbohydrate groups on five peptides. Five of the glycopeptides can be mapped with confidence to the peptides containing Asn16, Asn90, Asn104, Asn169, and Asn174. The sixth N-glycosylation site is not known and does not appear to be Asn145. It may be present on the N-terminus of SBP, which has not been sequenced.

Predictive assessment of vocal efficiency (PAVE). A method for voice therapy outcome measurement

A prospective study was carried out to examine the degree to which a standard voice assessment could discriminate between the potential benefits of two different voice therapy programmes for individual patients. The study encompassed 200 dysphonia subjects who were referred for voice therapy and had completed treatment within a prescribed two-year period. A standard assessment procedure was carried out on first attendance for each patient and guidelines were used to assign patients to different treatment programmes on the basis of the assessment results. The assessment discriminated well between patients requiring voice therapy to change physiological parameters of voice usage and patients able to self adjust voice usage, and provided an objective means of measuring outcomes.

Laparoscopic assisted live donor nephrectomy--a comparison with the open approach

Live donor renal transplantation provides significant advantages when compared with cadaveric donor renal transplantation in terms of improved patient and graft survival, a lower incidence of delayed function, and a shorter waiting time. Yet despite these advantages, live donors continue to be an under utilized source of kidneys for transplantation. Disincentives to live donation include the length of hospitalization, postoperative pain, cosmetic concerns, and the prolonged convalescence associated with the donor operation. In many instances minimally invasive video-assisted techniques have proven more efficacious than standard open procedures in terms of patient discomfort, length of hospital stay, cost, and length of time until the patient can return to full activity. Laparoscopic live donor nephrectomies are being performed at our institution in an attempt to make live donation more attractive to the potential donor. The purpose of this study was to retrospectively review the results of laparoscopic live donor nephrectomy (LapNx) and to compare them with those obtained using the standard open approach (OpenNx). Ten consecutive LapNx were performed from February 1995 through April 1996. The control group consisted of the 20 consecutive OpenNx performed at the same institution from January 1991 through January 1995 immediately before the initiation of the LapNx program. Live donors were considered candidates for LapNx if they possessed at least one kidney with normal renal anatomy with single renal vessels and a single ureter. LapNx was safely performed in all cases. No patients required open conversion or blood transfusions. The allograft warm ischemic time for the laparoscopic cases was 4.2+/-1.3 min. All kidneys harvested laparoscopically produced urine on the table immediately upon revascularization. Presently nine of the ten recipients have functioning allografts. At three months posttransplant the calculated recipient creatinine clearances were 67.0+/-11.5 ml/min and 64.8+/-21.4 ml/min for the LapNx and OpenNx groups, respectively (P=NS). The LapNx donors had a significantly decreased estimated blood loss, shorter time until resumption of oral intake, decreased postoperative pain (in terms of decreased analgesic requirements), shorter hospitalization, and a shorter interval until the resumption of full activities (P<0.05 for all). In addition, the LapNx group donors returned to work sooner than the OpenNx group (3.9+/-1.6 wk vs. 6.4+/-3.1 wk, respectively) (P=0.024). Four individuals agreed to donate a kidney only after learning of the availability of the laparoscopic approach. We conclude that laparoscopic live donor nephrectomy is technically feasible. In addition, it may offer significant advantages over the standard open approach in terms of patient comfort and convenience. These advantages may make live donor renal transplantation more attractive to prospective donors. The potential decrease in hospitalization and convalescence may also prove to be financially advantageous. We believe that further careful study of this procedure is warranted.

The structure of stewartan, a capsular polysaccharide produced by Erwinia stewartii strain DC283

Stewartan is a capsular polysaccharide produced by Erwinia stewartii, the causative agent of Stewart's wilt of maize. The structure of stewartan is shown, by a combination of methylation analysis, Li/ethylenediamine degradation, 1D and 2D NMR spectroscopy, partial acid hydrolysis and isolation of oligosaccharides, Smith degradation, MALDI-TOFMS analysis and exoglycosidase digestion, to have the following repeating unit: [sequence: see text]

Comparison of extracellular polysaccharides of Erwinia chrysanthemi spp

Two extracellular polysaccharides from strains of Erwinia chrysanhemi Ech 1 and 9, phytopathogens of potatoes, have been isolated and purified. Both have similar compositions and other properties to that produced by strain SR 260, a phytopathogen of corn. These polysaccharides are composed of L-rhamnose, D-mannose, D-glucose, D-glucuronic acid in the ratio 3:1:1:1. Initial structural aspects of these polysaccharides are reflected in the 600 MHz 1H NMR spectra and the products of partial acid hydrolysis, which are presented for comparison.

Do cyanobacteria swim using traveling surface waves?

Bacteria that swim without the benefit of flagella might do so by generating longitudinal or transverse surface waves. For example, swimming speeds of order 25 microns/s are expected for a spherical cell propagating longitudinal waves of 0.2 micron length, 0.02 micron amplitude, and 160 microns/s speed. This problem was solved earlier by mathematicians who were interested in the locomotion of ciliates and who considered the undulations of the envelope swept out by ciliary tips. A new solution is given for spheres propagating sinusoidal waveforms rather than Legendre polynomials. The earlier work is reviewed and possible experimental tests are suggested.

The glycans of horseradish peroxidase

Horseradish peroxidase (E.C. 1.11.1.7) isozyme c (HRPc) is a glycoprotein found to contain 21.8% carbohydrate with the average composition: 2 mol GlcNAc, 2.6 mol Man, and 0.8 mol each of Fuc and Xyl. The oligosaccharides of HRPc were investigated by a combination of High pH Anion-Exchange Chromatography with Pulsed Amperometric Detection, methylation analysis and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. The structure of the major oligosaccharide released by digestion with glycopeptidase A, accounting for between 75 and 80% of the total, was confirmed to be [sequence: see text]. Most of the remaining oligosaccharides were found to belong to the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1; x = 0 or 1) family. Less than 5% of the oligosaccharides were of the ManmGlcNAc2 (m = 4 to 7) type. Methylation analysis of holo- and apo-HRPc and its tryptic glycopeptides support the structures proposed for the oligosaccharides. Furthermore, methylation analysis of the tryptic glycopeptides provides evidence for the heterogeneity of the oligosaccharides occurring at each of the N-linked sites.

Laparoscopic live donor nephrectomy: the initial 3 cases

PURPOSE

Successful laparoscopic live donor nephrectomy in 3 patients is described.

MATERIALS AND METHODS

The procedures were performed completely laparoscopically and the kidneys were extracted via 8 cm. infraumbilical incisions.

RESULTS

In all 3 cases warm ischemic time was less than 5 minutes, and the renal vessels and ureter of the harvested kidneys were of adequate length for routine transplantation. Donors required minimal postoperative parenteral analgesia and were discharged home 1 to 3 days after the procedure. All harvested kidneys were successfully transplanted, and functioned well initially and at hospital discharge.

CONCLUSIONS

Laparoscopic live donor nephrectomy may be an alternative surgical modality to conventional open nephrectomy. Advantages include less postoperative pain, shorter hospital stay and convalescence, and a more desirable cosmetic result. Additionally, these advantages may encourage more individuals to consider live donation, resulting in an increase in organ supply.

The glycans of soybean peroxidase

Soybean hull peroxidase (SBP, E.C. 1.11.1.7), an anionic glycoprotein, was found to contain 18.2% carbohydrate with the average composition: 2 mol GlcNAc, 3.3 mol Man, 0.9 mol Fuc, and 0.7 mol Xyl. The oligosaccharides of SBP, after release with glycopeptidase A, were investigated by a combination of high pH anion exchange chromatography with pulsed amperometric detection, methylation analysis and matrix assisted laser desorption/ionization-time-of-flight mass spectrometry. The structure of the major oligosaccharide, accounting for 60 to 65% of the total, is Man alpha 1-->6(Man beta 1-->3)(Xyl beta 1-->2)Man beta 1-->4GlcNAc beta 1-->4(Fuc alpha 1-->3)GlcNAc. A further 20 to 25% of the released oligosaccharides belong to the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1, x = 0 or 1) family. The rest of the oligosaccharides were of the high-mannose type. Investigation of the six tryptic fractions containing carbohydrate revealed considerable heterogeneity in the N-linked oligosaccharides present in each fraction. The major glycan (4, Table III) was present in each fraction. Two of the fractions contained the major part of the high-mannose type glycans, ManmGlcNAc2 (m = 5-9), the major species being Man7GlcNAc2. The other four fractions contained mainly members of the (Xyl)xManm(Fuc)fGlcNAc2 (m = 2, 4, 5, 6; f = 0 or 1; x = 0 or 1) family. Methylation analysis of the holo- and apo-SBP provide support for the structures proposed for the oligosaccharides as well as for the heterogeneity of the glycopeptide fractions.

Extracellular polysaccharide of Erwinia chrysanthemi Ech6

Many strains of Erwinia chrysanthemi, which are Gram-negative bacterial phytopathogens, produce copious amounts of extracellular polysaccharides. The extracellular polysaccharide from E. chrysanthemi pv. zeae strain SR 260, a phytopathogen of corn, is a branched-chain glucomannorhamnan of proven structure (Gray et al., Carbohydr. Res. 1993, 245, 271-287). The extracellular polysaccharide from E. chrysanthemi Ech6 is different, containing no rhamnose or mannose. It is composed of L-fucose, D-galactose, D-glucose and D-glucuronic acid in the ratio 2:2:1:1. The structure of the polysaccharide is as follows: [sequence: see text]

Separation and analysis of 4'-epimeric UDP-sugars, nucleotides, and sugar phosphates by anion-exchange high-performance liquid chromatography with conductimetric detection

An anion-exchange HPLC method coupled with conductimetric detection was developed for the analysis of UDP-sugars, nucleotides, and sugar phosphates, each in a single chromatographic run. The analysis was applicable to concentrations over 50 pmol. The utility of this technique was demonstrated by the measurement of UDP-sugar 4'-epimerase activity of cell-free extracts from wild-type and mutant Neisseria meningitidis serogroup B strains. Additionally, the method has been applied to the analysis of the intermediates of glycolysis in human erythrocytes.

Merger offers IS managers flexibility & less stressful integrating, downsizing, & outsourcing. Interview by Bill Childs

A merger between two multi-million dollar IS firms in July 1993 created a company with $315 million in sales and a sharp focus on healthcare. National Healthtech Corp., parent firm of MRI, brought the focus to the deal. And Dallas-based Affiliated Computer Services, a data services provider to financial, commercial and healthcare organizations, brought telecommunications and outsourcing expertise. Bill Childs, editor-in-chief, recently spoke with the two firms' principals--Richard A. Montgomery, CEO of National Healthtech Corp., and Steve Carpenter, senior VP of ACS and COO of NHC. Excerpts from their conversation follow.

Structure of an extracellular polysaccharide produced by Erwinia chrysanthemi

Erwinia chrysanthemi pv zeae strain SR260, a phytopathogen of corn, produced from lactose an acidic extracellular polysaccharide which was purified and found to consist of L-rhamnose, D-mannose, D-glucose, and D-glucuronic acid in the ratio of 3:1:1:1. A combination of chemical (carboxyl-group reduction, methylation analysis, periodate oxidation, Smith degradation, and lithium-ethylenediamine degradation) and physical (1 and 2D NMR spectroscopy) methods revealed that the polysaccharide is composed of a hexasaccharide repeating unit 1: [formula: see text]