Clinical review: Balancing the therapeutic, safety, and economic issues underlying effective antipseudomonal carbapenem use

Antipseudomonal carbapenems have played a useful role in our antimicrobial armamentarium for 20 years. However, a review of their use during that period creates concern that their clinical effectiveness is critically dependent on attainment of an appropriate dosing range. Unfortunately, adequate carbapenem dosing is missed for many reasons, including benefit/risk misconceptions, a narrow therapeutic window for imipenem and meropenem (due to an increased rate of seizures at higher doses), increasingly resistant pathogens requiring higher doses than are typically given, and cost containment issues that may limit their use. To improve the use of carbapenems, several initiatives should be considered: increase awareness about appropriate treatment with carbapenems across hospital departments; determine optimal dosing regimens for settings where multidrug resistant organisms are more likely encountered; use of, or combination with, an alternative antimicrobial agent having more favorable pharmacokinetic, pharmacodynamic, or adverse event profile; and administer a newer carbapenem with lower propensity for resistance development (for example, reduced expression of efflux pumps or greater stability against carbapenemases)

Possible role of the phagocytic proteinases, cathepsin B and elastas, in orthotopic liver transplantation

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Mediators of leukocyte yctivation play a role in disseminated intravascular coagulation during orthotopic liver transplantation

Leukocytes play an important role in the development of disseminated intravascular coagulation (DIC). In the reperfusion phase of OLT a DIC-like situation has been described and has been held responsible for the high blood loss during this phase. We investigated the role of leukocytes in the pathogenesis of DIC in OLT by measuring the leukocytic mediators released upon activation (cathepsin B, elastase, TNF, neopterin) and the levels of thrombin-antithrombin III (TAT) complexes, seen as markers of prothrombin activation. Arterial blood samples were taken at 10 different time points during and after OLT. Samples were also taken of the perfusate released from the liver graft vein during the flushing procedure before the reperfusion phase. Aprotinin was given as a continuous infusion (0.2-0.4 Mill. KlU/hr) and its plasma levels were determined. Significantly elevated levels of neopterin (15-fold; P<0.01), cathepsin B (440-fold; P<0.01) in the perfusate, as compared with the systemic circulation, as well as their significant increases in the early reperfusion phase suggested that they were released by the graft liver. This was paralleled by elevated levels of elastase (1.3-fold, P<0.05), TNF (1.5-fold, P=NS), and TAT complexes (1.4-fold; P<0.1) in the perfusate. Significant correlations could be identified between the parameters of leukocyte activation and TAT complexes, whereas no correlation was observed between any of the parameters investigated and the aprotinin levels. Our results strongly indicate a release of leukocytic mediators from the graft liver during its reperfusion which seems to be related to the parallely increased prothrombin activation. No correlation could be seen between levels of aprotinin and levels of leukocytic mediators

On the inclusion of collisional correlations in quantum dynamics

AbstractWe present a formalism to describe collisional correlations responsible for thermalization effects in finite quantum systems. The approach consists in a stochastic extension of time dependent mean field theory. Correlations are treated in time dependent perturbation theory and loss of coherence is assumed at some time intervals allowing a stochastic reduction of the correlated dynamics in terms of a stochastic ensemble of time dependent mean-fields. This theory was formulated long ago in terms of density matrices but never applied in practical cases because of its complexity. We propose here a reformulation of the theory in terms of wave functions and use a simplified 1D model of cluster and molecules allowing to test the theory in a schematic but realistic manner. We illustrate the performance in terms of several observables, in particular global moments of the density matrix and single particle entropy built on occupation numbers. The occupation numbers remain fixed in time dependent mean-field propagation and change when evaluating the correlations, then taking fractional values. They converge asymptotically towards Fermi distributions which is a clear indication of thermalization

Different aprotinin applications influencing hemostatic chances in orthotopic liver transplantation

The effect of different aprotinin applications on hemmtatic changes and blood product requirements in orthotopic liver transplantation was investigated in a prospective, open, and randomized study. From November 1989 to June 1990, 13 patients received aprotinin as a bolus of 0.5 Mill, kallikrein inac-tivator units (KIU) on three occasions in the course of an OLT, whereas 10 other patients were treated with continuous aprotinin infusion of 0.1-0.4 Mill. KIU/hr. Before and after reperfusion of the graft liver, signs of hyperfibrinolysis, measured by thrombelastography, were significantly lower in the infusion group. Tissue-type plasminogen activator (t-PA) activity increased during the anhepatic phase but to a significantly lesser extent in the infusion group. Blood product requirements during OLT were tendentiously higher in the bolus group but not significantly so. However, the use of packed red blood cells was significantly lower in the postoperative period, whereas there was no significant difference in fresh frozen plasma requirements between the two groups. All 23 patients have survived, and only one woman of each group required retransplantation due to severe host-versus-graft reactions. Furthermore, we investigated the perfusate of the graft liver in both groups and detected signs of a decreased t-PA release in the infusion group. Our results demonstrate an advantage of aprotinin given as continuous infusion over bolus application in OLT

Ultra-cold atoms in an optical cavity: two-mode laser locking to the cavity avoiding radiation pressure

The combination of ultra-cold atomic clouds with the light fields of optical cavities provides a powerful model system for the development of new types of laser cooling and for studying cooperative phenomena. These experiments critically depend on the precise tuning of an incident pump laser with respect to a cavity resonance. Here, we present a simple and reliable experimental tuning scheme based on a two-mode laser spectrometer. The scheme uses a first laser for probing higher-order transversal modes of the cavity having an intensity minimum near the cavity's optical axis, where the atoms are confined by a magnetic trap. In this way the cavity resonance is observed without exposing the atoms to unwanted radiation pressure. A second laser, which is phase-locked to the first one and tuned close to a fundamental cavity mode drives the coherent atom-field dynamics.Comment: 7 pages, 7 figure

Compliant, Aggressive and Detached Types Differ in Generalized Purchasing Involvement

Cohen\u27s (1967) method of determining compliant, aggressive and detached personality types is modified and employed in exploring the relationship between personality types and generalized purchasing involvement. The hypothesis that the detached personality type will be less involved in purchasing than compliant or aggressive personality types is tested and supported. Theoretical implications are discussed

Self-synchronization and dissipation-induced threshold in collective atomic recoil lasing

Networks of globally coupled oscillators exhibit phase transitions from incoherent to coherent states. Atoms interacting with the counterpropagating modes of a unidirectionally pumped high-finesse ring cavity form such a globally coupled network. The coupling mechanism is provided by collective atomic recoil lasing, i.e., cooperative Bragg scattering of laser light at an atomic density grating, which is self-induced by the laser light. Under the rule of an additional friction force, the atomic ensemble is expected to undergo a phase transition to a state of synchronized atomic motion. We present the experimental investigation of this phase transition by studying the threshold behavior of this lasing process