Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia.

INTRODUCTION: Sepsis is the leading cause of infectious morbidity and mortality among hospitalized neonates. In high-resource pediatric and adult intensive care units, use of aqueous chlorhexidine (CHG) solution has been associated with reduced risk of bloodstream infections (BSI). OBJECTIVES: To assess the impact of bathing of neonates with 2% CHG on BSI, suspected sepsis, and mortality in a low-income country neonatal care unit. METHODS: We conducted a secondary analysis of data from the Sepsis Prevention in Neonates in Zambia (SPINZ) study, a prospective observational cohort study performed at a large public referral hospital in Lusaka, Zambia. The SPINZ study assessed the impact of an infection control bundle (consisting of alcohol hand rub, SMS hygiene reminders, enhanced environmental cleaning, and CHG baths for babies ≥1.5 kg) on sepsis, BSI, and all-cause mortality. Episodic shortages in study staffing resulted in some enrolled babies not receiving a CHG bath. Using Longitudinal Targeted Maximum Likelihood Estimation and Cox proportional hazards regression to adjust for observed confounding, we estimated the causal effect of receiving a CHG bath within the first 3 days of life on suspected sepsis, BSI, and death among inborn babies enrolled during the study implementation and intervention phases. RESULTS: The majority of inborn, enrolled babies ≥1.5 kg received a CHG bath within 3 days of NICU admission (864 of 1233, 70%). We found that CHG bathing reduced the hazard rate of BSI among inborn babies ≥1.5 kg by a factor of 0.58 (p = 0.10, 95% CI: 0.31, 1.11), corresponding to an absolute risk reduction of 9.6 percentage points within a week of admission (p = 0.002, 95% CI: 3.4-15.7 percentage points). We did not find a statistically significant effect of CHG bathing on culture-negative sepsis (p = 0.54) or death (p = 0.85). CONCLUSION: In our single center study, CHG bathing at admission was associated with a reduced risk of BSI due to a pathogenic organism after adjusting for potential confounding. Our results suggest that CHG may be an effective intervention for preventing neonatal sepsis in high-risk, low-income country settings.

An alternative method of anthropometry of anterior cruciate ligament through 3-D digital image reconstruction.

Accurate and flexible measurements of length, area, and volume are important in evaluation of the mechanical properties of soft tissue. Although a number of contact-based and non-contact techniques have been reported in the literature, due to a variety of reasons such as cost, complexity, and low accuracy, the research community has not adopted a standardized technique. In this paper, an alternative method of measuring the geometric parameters of cadaver anterior cruciate ligament (ACL) is presented. In this method, a 3-D scan of the ACL is constructed using a simple, commercially available, scanning system. The 3-D scan is then analyzed using the 3-D Doctor Software to extract important information regarding the length, cross-sectional area, and volume of the ACL. The accuracy and repeatability of measurements obtained by this method are acceptable and comparable to existing non-contact methods. The limitation of the method is that surface concavities cannot be detected. However, the non-contact optical method, described here, has inherent advantages over the existing methods: (1) it is inexpensive; (2) it allows the determination of area at any distance along the length of the tissue of interest; (3) all relevant information including minimum area is extracted from one single application of the method; (4) the volume can be calculated with a simple additional step of length measurement although, for accurate results, condylar blockage must be minimized by coring the ACL out. The entire process of scanning takes less than 30 min. This technique has the potential to become a standard method in anthropometry of soft tissue.

A double ring closing metathesis reaction in the rapid, enantioselective synthesis of NK-1 receptor antagonists.

[structure: see text]. The NK-1 receptor antagonist 1 has been prepared in seven steps from phenylglycine methyl ester. The key steps are a double ring closing metathesis reaction of tetraene 7 to prepare spirocycle 6 and a reductive Heck reaction to introduce the aryl moiety. This latter reaction discriminates the olefins of compound 6 and proceeds in a highly regio- and stereoselective manner.

Heterogeneity of cholecystokinin/gastrin-like immunoreactivity in the nervous system of the nematode Ascaris suum.

A wholemount immunocytochemical method was used for the localization of cholecystokinin (CCK8)-like and gastrin-like immunoreactivity in Ascaris. The patterns of specific neuronal staining given by two antisera and four monoclonal antibodies made against CCK8, and one antiserum made against gastrin were investigated. Preabsorption of these antibodies with CCK8 or gastrin 17 resulted in complete loss of immunoreactivity in almost all of the neurons (two antisera also contained nonspecific antibodies), suggesting that all of the antibodies recognize epitopes, in Ascaris neurons, that include some or all of the C-terminal five amino acids that are identical in CCK8 and gastrin 17. However, the seven different antibodies showed immunoreactivity in different subpopulations of neurons, implying that there are at least seven different species of CCK-like molecules in Ascaris. Fractionation of Ascaris peptide extracts by high performance liquid chromatography (HPLC), monitoring fractions with a CCK8 radioimmunoassay (RIA), also shows heterogeneity of molecules immunologically related to CCK8.

Eight novel FMRFamide-like neuropeptides isolated from the nematode Ascaris suum.

Eight FMRFamide-like neuropeptides were isolated from an extract of heads and tails from the nematode Ascaris suum using seven steps of HPLC. The peptides ranged in size from 8 to 14 amino acid residues: AF3 (Ala-Val-Pro-Gly-Val-Leu-Arg-Phe-amide), AF4 (Gly-Asp-Val-Pro-Gly-Val-Leu-Arg-Phe-amide), AF5 (Ser-Gly-Lys-Pro-Thr-Phe-Ile-Arg-Phe-amide), AF7 (Ala-Gly-Pro-Arg-Phe-Ile-Arg-Phe-amide), AF9 (Gly-Leu-Gly-Pro-Arg-Pro-Leu-Arg-Phe-amide), AF10 (Gly-Phe-Gly-Asp-Glu-Met-Ser-Met-Pro-Gly-Val-Leu-Arg-Phe-amide), AF11 (Ser-Asp-Ile-Gly-Ile-Ser-Glu-Pro-Asn-Phe-Leu-Arg-Phe-amide), and AF12 (Phe-Gly-Asp-Glu-Met-Ser-Met-Pro-Gly-Val-Leu-Arg-Phe-amide). The effect of synthetic AF4 on muscle tension in a dorsal muscle strip preparation was a strong, long-lasting contraction. PF1, a peptide present in Panagrellus redivivus and Caenorhabditis elegans, relaxed the AF4-induced contraction.

Localization and differential expression of FMRFamide-like immunoreactivity in the nematode Ascaris suum.

By immunocytochemical and immunohistochemical methods, FMRFamide-like immunoreactivity (FLI) was localized to many neurons and processes in the Ascaris nervous system, including the head, tail, and lateral lines. Some of these cells were identified; they included sensory neurons, interneurons, and motor neurons. FLI was also present in the pharyngeal neurons and in their varicosities near the surface of the pharynx. By HPLC analysis of extracts, only a subset of the FMRFamide-like peptides (FLPs) expressed in Ascaris heads, and heads from which the pharynx had been removed, were expressed in the pharynx. Furthermore, FLPs appeared to be differentially expressed in female heads and tails and male heads and tails. Acetone and acid methanol differentially extracted subforms of FLI from Ascaris heads and from C. elegans.

AF2, an Ascaris neuropeptide: isolation, sequence, and bioactivity.

A FMRFamide-like neuropeptide, KHEYLRFamide (Lys-His-Glu-Tyr-Leu-Arg-Phe-amide; AF2) was isolated from a head extract of the nematode Ascaris suum by using a three-step HPLC separation. In a dorsal muscle strip preparation, synthetic AF2 produced multiple effects on muscle tension: a slow relaxation was followed by contraction and rhythmic activity. Sulfated AF2 was no more potent than AF2. The effects on muscle tension were correlated with electrical activity recorded intracellularly from muscle cells. AF2 markedly increased the tension change associated with change in muscle membrane potential.

Motor behavior and motor nervous system function in the nematode Ascaris suum.

Ascaris suum has a nervous system that is very simple both numerically and morphologically. It comprises only 298 neurons almost all of which are extremely simple in shape. Extensive anatomical descriptions of the morphology of neurons and of their synaptic connections, together with the study, by using intracellular recording techniques, of their physiological properties, have led to a prediction of how the motor nervous system controls behavior. Subsequent discovery of endogenous neuropeptides that have potent activity on subsets of the motor neurons suggests that the description of the motor circuitry is more complex than is apparent from its anatomy.

A versatile dot-ELISA method with femtomole sensitivity for detecting small peptides.

Several protocols for conjugating peptides in situ to a protein carrier on paper, nitrocellulose, or nylon membranes were explored for their usefulness in dot-ELISA detection of the peptides. The most sensitive method in which peptide diluted in bovine serum albumin is applied to nitrocellulose, then fixed with glutaraldehyde, can detect several peptides, ranging from 4 to 38 amino acids in length, at the level of 2-10 fmol. Both immunohistochemical grade antisera and monoclonal antibodies have been used successfully. The method may be a useful alternative to radioimmunoassay since there is no requirement for radiolabelled peptide, or (for quantitation) for known quantities of unlabelled peptide. The method has been used to monitor, semiquantitatively, the fractionation of FMRFamide-like or CCK-like peptides from the nematode Ascaris, and to detect peptide-like immunoreactivities in tissue extracts.

Neuropeptide diversity in Ascaris: an immunocytochemical study.

An immunocytochemical method was used for localization of various peptide-like substances in the Ascaris nervous system. Out of 45 antipeptide antisera, 12 demonstrated immunoreactivity in different subsets of neurons; these 12 antisera were raised against luteinizing hormone-releasing hormone (LHRH), Aplysia peptide L11 (L11), Aplysia peptide 12B (12B), small cardioactive peptide B (SCPB), neuropeptide Y (NPY), FMRFamide, gastrin-17, cholecystokinin octapeptide (CCK-8), alpha-melanocyte stimulating hormone (alpha MSH), calcitonin gene related peptide (CGRP), corticotropin releasing factor (CRF), and vasoactive intestinal peptide (VIP). Several peptide-like substances were colocalized to the same neuron. Our results suggest that Ascaris, like other organisms, contains multiple peptidergic systems.

Generation of monoclonal antibodies against a nematode peptide extract: another approach for identifying unknown neuropeptides.

Monoclonal antibodies that cross-react with Ascaris neural antigens were generated in mice immunized with a conjugate made with keyhole limpet hemocyanin (KLH) linked to a crude peptide extract from Caenorhabditis elegans. The response to KLH was suppressed by injection of cyclophosphamide 3 days after immunization with a gamma-aminobutyric acid (GABA)-KLH conjugate. Screening of hybridomas was carried out by enzyme-linked immunosorbent assay and whole mount immunocytochemistry. Two similar clones produced antibodies that recognized a small subset of Ascaris neurons. This result suggests that the monoclonal antibody technique might be useful for identifying new neuropeptides since the antibodies can be used for localization of the neuropeptidelike substances and, potentially, for immunoaffinity chromatography. As a by-product of this experiment, monoclonal antibodies that recognize GABA-like immunoreactivity in whole mounts and plastic sections were also obtained.

AF1, a sequenced bioactive neuropeptide isolated from the nematode Ascaris suum.

An FMRFamide-like neuropeptide, named AF1, was isolated from head extracts of the nematode Ascaris suum using five steps of HPLC. AF1 is a heptapeptide with the amino acid sequence Lys-Asn-Glu-Phe-Ile-Arg-Phe-NH2. Synthetic AF1 (10(-9) to 10(-7) M) rapidly and reversibly abolished slow membrane potential oscillations of identified ventral and dorsal inhibitory motoneurons and selectively reduced their input resistances. Synaptic transmission was not blocked. In intact Ascaris, AF1 inhibited locomotory movements. This study indicates a potential physiological role for an endogenous neuropeptide in nematodes.