Daptomycin plus fosfomycin versus daptomycin monotherapy in treating MRSA: protocol of a multicentre, randomised, phase III trial.

INTRODUCTION: Despite the availability of new antibiotics such as daptomycin, methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia continues to be associated with high clinical failure rates. Combination therapy has been proposed as an alternative to improve outcomes but there is a lack of clinical studies. The study aims to demonstrate that combination of daptomycin plus fosfomycin achieves higher clinical success rates in the treatment of MRSA bacteraemia than daptomycin alone. METHODS AND ANALYSIS: A multicentre open-label, randomised phase III study. Adult patients hospitalised with MRSA bacteraemia will be randomly assigned (1:1) to group 1: daptomycin 10 mg/kg/24 h intravenous; or group 2: daptomycin 10 mg/kg/24 h intravenous plus fosfomycin 2 gr/6 g intravenous. The main outcome will be treatment response at week 6 after stopping therapy (test-of-cure (TOC) visit). This is a composite variable with two values: Treatment success: resolution of clinical signs and symptoms (clinical success) and negative blood cultures (microbiological success) at the TOC visit. Treatment failure: if any of the following conditions apply: (1) lack of clinical improvement at 72 h or more after starting therapy; (2) persistent bacteraemia (positive blood cultures on day 7); (3) therapy is discontinued early due to adverse effects or for some other reason based on clinical judgement; (4) relapse of MRSA bacteraemia before the TOC visit; (5) death for any reason before the TOC visit. Assuming a 60% cure rate with daptomycin and a 20% difference in cure rates between the two groups, 103 patients will be needed for each group (α:0.05, ß: 0.2). Statistical analysis will be based on intention to treat, as well as per protocol and safety analysis. ETHICS AND DISSEMINATION: The protocol was approved by the Spanish Medicines and Healthcare Products Regulatory Agency (AEMPS). The sponsor commits itself to publishing the data in first quartile peer-review journals within 12 months of the completion of the study

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

CAD of a direct drive rotary motor based on giant magnetostrictive alloys

Highly magnetostrictive materials such as Tb-3Dy7Fe2, commercially known as Terfenol-D, have been used to date in a variety of devices such as high power actuators and linear motors. The authors are investigating a finite element model devoted to Computer Aided Design (CAD) of a direct micro-stepping rotary motor. Such a motor would be a high torque micro-radian stepper, capable of precision movements and self-braking in the power off state. The thrust of this paper is to test the validity of the so-called "weak coupling" approach on a motor based on the proven inch worm technique. Comparison between numerical outputs from the model and test results on prototype hardware will be presented

Modélisation des phénomènes électromagnétiques et mécaniques couples : application à l'analyse vibratoire des machines électriques

La réduction des bruits et vibrations dans l'appareillage et les machines électriques préoccupe un grand nombre de constructeurs ; la demande dans ce domaine se fait de plus en plus pressante. A travers nos travaux qui portent essentiellement sur les machines tournantes à courant continu, nous présentons une analyse qualitative, puis quantitative, des vibrations d'origine électromagnétique. Cette dernière nous a conduit au développement d'un logiciel de calcul de magnéto-mécanique basé sur la méthode des éléments finis, afin de permettre la prédiction des différents niveaux vibratoires en régime de fonctionnement permanent. Quelques exemples permettent d'illustrer la faisabilité du logiciel et montrent que les résultats obtenus sont très prometteurs

Modélisation des phénomènes électromagnétiques et mécaniques couples : application à l'analyse vibratoire des machines électriques

Manufacturers in electrical machinery are becoming highly interested in the reduction of noise and vibrations ; this is due to the increasing awareness of the problem. In this paper, a qualitative and quantitative analysis of electromagnetic vibrations in D.C. machines is proposed. Then, the software which has been developed for the calculation of vibration levels in the case of steady state is presented and examples show that results are very promising.La réduction des bruits et vibrations dans l'appareillage et les machines électriques préoccupe un grand nombre de constructeurs ; la demande dans ce domaine se fait de plus en plus pressante. A travers nos travaux qui portent essentiellement sur les machines tournantes à courant continu, nous présentons une analyse qualitative, puis quantitative, des vibrations d'origine électromagnétique. Cette dernière nous a conduit au développement d'un logiciel de calcul de magnéto-mécanique basé sur la méthode des éléments finis, afin de permettre la prédiction des différents niveaux vibratoires en régime de fonctionnement permanent. Quelques exemples permettent d'illustrer la faisabilité du logiciel et montrent que les résultats obtenus sont très prometteurs

An induction micromotor on a permanent magnet bearing

A first operational prototype of induction electromagnetic micromotor (OE18*2 mm) mounted on a magnetic bearing was built and tested. The maximum speed reached is 4500 rpm, and the corresponding measured torque 1.2 mu Nm. Induction devices therefore seem viable to be miniaturised

Magnetophoretic and Dielectrophoretic Actuations Coupled with Diamagnetic Trapping in Air and Liquids

International audienc

Magnetophoretic and Dielectrophoretic Actuations Coupled with Diamagnetic Trapping in Air and Liquids

International audienc