Evaluación de moxifloxacino como tratamiento alternativo en las infecciones por "Stenotrophomonas maltophilia": optimización de dosis empleando sistemas farmacodinámicos

Stenotrophomonas maltophilia es un patógeno nosocomial, emergente, cuya incidencia en procesos severos esta aumentado de manera análoga al incremento de las poblaciones de pacientes con factores predisponentes. S. maltophilia es un microorganismo ubicuo y adaptado a múltiples ambientes, lo que explica la elevada diversidad genética y el resistoma característico de esta especie que le confiere resistencia a la mayoría de clases de antimicrobianos. Se sugiere que el paciente porta al microorganismo en el momento del ingreso y que la combinación entre la presión antibiótica, especialmente aminoglucósidos y carbapenemas, y el profundo y prolongado estado de inmunosupresión favorecen el desarrollo de la infección. El tratamiento de las infecciones severas, bacteriemias y neumonías, es empírico, y relacionado con una elevada mortalidad, 36-67%, que es atribuida a que la mayoría de pacientes recibe una terapia inapropiada. La carencia de antimicrobianos con suficiente actividad, la rápida aparición de resistencias en los pacientes bajo tratamiento y la ausencia de ensayos clínicos que discriminen tratamientos efectivos, condicionan el complicado manejo de los pacientes infectados por S. maltophilia . En la actualidad solo seis antimicrobianos, cotrimoxazol, ticarcilina-ácido clavulánico, de elección y ceftazidima, levofloxacino, minociclina y cloranfenicol, son considerados tratamientos apropiados para este microorganismo por el CLSI o el EUCAST. La probabilidad de supervivencia aumenta con la rápida administración de agentes sensibles in vitro , pero la mortalidad continúa siendo extraordinariamente alta, 14 y el 45%, lo que demuestra la urgente necesidad de alternativas terapéuticas y de la revaloración de los actuales puntos de corte microbiológicos empleados en el pronóstico de eficacia clínica para esta especie..

Infectious complications in digital surgery

The authors expose the infectious complications after the accomplishment of surgical techniques in the foot as well as the antimicrobial treatment of election.The authors expose the infectious complications after the accomplishment of surgical techniques in the foot as well as the antimicrobial treatment of election

Time-expanded FOTDR based on Orthogonal Polarization Frequency Comb generation

Phase-sensitive Optical Time-Domain Reflectometry (ΦOTDR) has emerged as an effective and high-performance solution within the realm of Distributed Optical Fiber Sensing (DOFS) technologies, which has promoted its use in an ever-growing number of fields. The challenges arisen by new operation fields demand surpassing the historical trade-offs in this technology, specially aiming for higher resolution without jeopardizing the system simplicity and cost-effectiveness. In this context, time-expanded (TE-)ΦOTDR has been recently proposed as a DOFS solution delivering cm-range resolution with sub-MHz detection and acquisition bandwidths. It is based on the use of an interferometric scheme that employs a dual frequency comb (DFC), consisting of two mutually coherent optical frequency combs with dissimilar repetition rates. In this paper, we present a novel DFC generation scheme for TE-ΦOTDR that exploits the polarization orthogonality. In particular, our approach considerably increases the common path followed by the two frequency combs, thus reducing instability and noise as compared to the conventional generation scheme. Additionally, we employ an IQ modulation scheme with two PRBS generators that increases the scalability of the interrogator while severely reducing its cost and complexity. Results show a reduction in the noise amplitude spectral density especially at low frequency values, which corroborates the stability enhancement of this proposed architecture as compared to the conventional scheme

Age-Based Inter-Subject Variability in Platelet and Whiteblood Cell Concentrations of Platelet-Rich Plasma Preparedusing a New Application to Blood Separation System

[Abstract] The benefit of autologous platelet-rich plasma (PRP) treatment is still underdiscussion. Variations in PRP products, consequence of the lack of astandardised protocol for the multitude of commercially available blood sepa-ration systems and the lack of knowledge of the optimal composition of PRPor its suitability for the proposed indication are some of the reasons behindclinical inconsistencies. The impact of inter-subject variability in PRP hasreceived less attention in comparison. The purpose of this study was to deter-mine the inter-subject variability, based on age, in the concentrates preparedby a new blood concentration system. Twenty-six healthy volunteers of bothgenders (29-93 years) were enrolled. Whole blood (WB) was collected fromeach participant to prepare PRP using the Easy PRP kit. Platelets and whiteblood cells (WBC) from WB and PRP were analysed after split population byage; patients younger than 65 years (n=13) and patients≥65 years old(n=13). Among the demographic characteristics tested, only age was signifi-cantly different between the groups. Cell capture efficiency of the system wasspecific for each type of blood cell and identical for both age groups. Plateletsand WBC in PRP were higher than in WB (P< .001). In WB, platelets andWBC concentrations were significantly lower in older group (P≤.035). Thesedifferences persisted in the prepared PRP (P≤.004). The ageing of populationhas a strong influence on the haematocrit and therefore on the composition ofPRP. Because the efficiency of blood separator system seems to be constantacross individuals, the inter-subject haematocrit variability based on age couldbe used as a predictor of resulting PRP. The clinical application of PRP shouldbe restricted to the specific cell capture capacity of the different commercialdevice

Recombinant PrPSc shares structural features with brain-derived PrPSc: Insights from limited proteolysis

Very solid evidence suggests that the core of full length PrPSc is a 4-rung β-solenoid, and that individual PrPSc subunits stack to form amyloid fibers. We recently used limited proteolysis to map the β-strands and connecting loops that make up the PrPSc solenoid. Using high resolution SDS-PAGE followed by epitope analysis, and mass spectrometry, we identified positions ~116/118, 133–134, 141, 152–153, 162, 169 and 179 (murine numbering) as Proteinase K (PK) cleavage sites in PrPSc. Such sites likely define loops and/or borders of β-strands, helping us to predict the threading of the β-solenoid. We have now extended this approach to recombinant PrPSc (recPrPSc). The term recPrPSc refers to bona fide recombinant prions prepared by PMCA, exhibiting infectivity with attack rates of ~100%. Limited proteolysis of mouse and bank vole recPrPSc species yielded N-terminally truncated PK-resistant fragments similar to those seen in brain-derived PrPSc, albeit with varying relative yields. Along with these fragments, doubly N- and C-terminally truncated fragments, in particular ~89/97-152, were detected in some recPrPSc preparations; similar fragments are characteristic of atypical strains of brain-derived PrPSc. Our results suggest a shared architecture of recPrPSc and brain PrPSc prions. The observed differences, in particular the distinct yields of specific PK-resistant fragments, are likely due to differences in threading which result in the specific biochemical characteristics of recPrPSc. Furthermore, recombinant PrPSc offers exciting opportunities for structural studies unachievable with brain-derived PrPSc.info:eu-repo/semantics/publishedVersio

Memoria del IV Certamen Universitario de Microrrelatos sobre Asia

Este documento contiene los objetivos, metodología, resultados y evaluación del proyecto IV Certamen Universitario de Microrrelatos sobre Asia. Un proyecto colaborativo entre investigadores y alumnos que busca el intercambio, la formación de los jóvenes, y la generación de material didáctico sobre Asia abierto a la comunidad

Governmental Context Determines Institutional Value: Independently Certified Performance and Failure in the Spanish Newspaper Industry

Many societies demand that independent professionals (e.g. auditors) certify the performance of firms. The value placed on such certification (i.e. the public perception of reliability/unreliability that may impact on an organization's success/failure) is not uniform, however, but contingent upon changing political contexts. This study presents and analyses data on the entire population of newspapers in Spain from 1966 to 1993, a time of peaceful transition from military dictatorship to capitalist democracy. Our results highlight the contingent nature of institutional life, demonstrating how changes in political contexts are associated with varying understandings of institutions. In particular, our findings support the prediction that, under a dictatorship, independently certified performance is not instrumental in organizational success or failure whereas, in a modern democracy, the certification process has a positive effect on the survival chances of firms.Publicad

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden