Comparison of Microbial Respiratory Cultures versus MRSA Nasal Screen to Guide Vancomycin De-escalation in Patients Hospitalized for Bacterial Pneumonia

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal screen identifies the presence of MRSA nasal colonization, which can be used as a valuable antimicrobial stewardship tool to de-escalate empiric vancomycin therapy in patients with pneumonia. Current practices at a Florida hospital include using respiratory culture and MRSA nasal screening results to assist in treating MRSA pneumonia infections. This study aimed to evaluate the total duration of vancomycin therapy in patients with suspected MRSA respiratory tract infections. Methods: This was a single-center, retrospective chart review conducted at a tertiary medical center. Adult patients were assigned to either the respiratory culture-directed group or the MRSA nasal screening-directed group. The primary outcome was the duration of vancomycin therapy, in hours, in patients who were started on vancomycin for suspected pneumonia. Secondary outcomes included new onset acute kidney injury, length of stay, 30-day in-hospital mortality, number of vancomycin levels obtained, cost-avoidance analysis, and duration of mupirocin therapy before MRSA nasal screening. Results: Thirty-four patients were evaluated in the culture-directed group and 56 in the MRSA nasal screen-directed group (N = 90). The MRSA nasal screen-directed cohort had a statistically significant reduction in the duration of vancomycin therapy compared to the culture-directed group (24 vs. 94 hours; p \u3c .00001). Discussion: The empiric vancomycin therapy duration was significantly lower in the MRSA nasal screen cohort compared to the respiratory culture cohort. Hospitals could have a beneficial, cost-saving impact by utilizing MRSA nasal screening for patients with a lower respiratory tract infection

Non-invasive computer-assisted measurement of knee alignment

The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1° larger than for the rigid model with statistically similar variance (p=0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost ±1°, with up to ±0.5° loss of repeatability for coronal alignment measured before and after stress maneuvers, and a ±0.2° loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were ±1.6° and ±2.3°, respectively. Varus and valgus stress measurements agreed to within ±1.3° and ±1.1°, respectively. Agreement limits for standing MFT angles were ±2.9° (coronal) and ±5.0° (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs

ESR, ENDOR and TRIPLE resonance studies of the primary donor radical cation P960+ in the photosynthetic bacterium Rhodopseudomonas viridis

The light-induced radical cation of the primary electron donor P960+• in photosynthetic reaction centers from Rhodopseudomonas viridis has been investigated by ESR, ENDOR and TRIPLE techniques. Both the comparison with the cation radical of monomeric bacteriochlorophyll b (BChl b) and with molecular-orbital calculations performed on P960+• using the results of an X-ray structure analysis, consistently show an asymmetric distribution of the unpaired electron over the two BChl b molecules which constitute P960+•. The possible relevance of this result for the primary electron transfer step in the reaction center is briefly discussed

Modified reaction centers from Rhodobacter sphaeroides R26

Incubation of photosynthetic reaction centers from Rhodobacter sphaeroides R26 with exogenous 132-OH-bacteriochlorophyll ap or aGG according to Scheer et al. (1987) results in the exchange of endogenous bacteriochlorophyll ap. The exchange amounts to less-than-or-equals, slant 50% according to HPLC analysis, corresponding to a complete replacement of the ‘monomeric’ bacteriochlorophylls, bm and bl, by exogenous pigment. The absorption spectra show small, but distinct changes in the Qx-region of the bacteriochlorophylls, and bleaching of the modified reaction centers is retained. The corresponding binding sites must be accessible from the exterior, and allow for the introduction of a polar residue at C-132. This is supported by the observation of side reactions of the endogenous ‘monomeric’ bacteriochlorophylls within the reaction center pigments, e.g. epimerization and hydroxylation at C-132

STRUCTURE OF METHYLPHEOPHORBIDE-RCI

he methanolic extract of the cyanobacterium (blue-green alga) Spirulina geitleri has been treated with methanolic acid to convert all chlorophyllous pigments to their methylpheophorbides. Fractionation of the latter from methylpheophorbide a by thin layer chromatography and high pressure liquid chromatography yielded methylpheophorbide-RCI. Its structure has been determined as 132S-hydroxy-20-chloro-methylpheophorbide a by 1H-nuclear magnetic resonance, absorption and circular dichroism spectroscopy, mass spectrometry and by partial synthesis from chlorophyll a. The pigment is isolated from Spirulina geitleri irrespective of the use or omission of chlorinated substances during the isolation procedure

Optical switching of radical pair conformation enhances magnetic sensitivity

The yield of chemical reactions involving intermediate radical pairs is influenced by magnetic fields well beyond the levels expected from energy considerations. This dependence can be traced back to the microscopic dynamics of electron spins and constitutes the basis of the chemical compass. Here we propose a new experimental approach based on molecular photoswitches to achieve additional control on the chemical reaction and to allow short-time resolution of the spin dynamics. Our proposal enables experiments to test some of the standard assumptions of the radical pair model and improves the sensitivity of chemical magnetometers by two orders of magnitude

Differential Regulation of the Period Genes in Striatal Regions following Cocaine Exposure

Several studies have suggested that disruptions in circadian rhythms contribute to the pathophysiology of multiple psychiatric diseases, including drug addiction. In fact, a number of the genes involved in the regulation of circadian rhythms are also involved in modulating the reward value for drugs of abuse, like cocaine. Thus, we wanted to determine the effects of chronic cocaine on the expression of several circadian genes in the Nucleus Accumbens (NAc) and Caudate Putamen (CP), regions of the brain known to be involved in the behavioral responses to drugs of abuse. Moreover, we wanted to explore the mechanism by which these genes are regulated following cocaine exposure. Here we find that after repeated cocaine exposure, expression of the Period (Per) genes and Neuronal PAS Domain Protein 2 (Npas2) are elevated, in a somewhat regionally selective fashion. Moreover, NPAS2 (but not CLOCK (Circadian Locomotor Output Cycles Kaput)) protein binding at Per gene promoters was enhanced following cocaine treatment. Mice lacking a functional Npas2 gene failed to exhibit any induction of Per gene expression after cocaine, suggesting that NPAS2 is necessary for this cocaine-induced regulation. Examination of Per gene and Npas2 expression over twenty-four hours identified changes in diurnal rhythmicity of these genes following chronic cocaine, which were regionally specific. Taken together, these studies point to selective disruptions in Per gene rhythmicity in striatial regions following chronic cocaine treatment, which are mediated primarily by NPAS2. © 2013 Falcon et al

Radically enhanced molecular recognition

The tendency for viologen radical cations to dimerize has been harnessed to establish a recognition motif based on their ability to form extremely strong inclusion complexes with cyclobis(paraquat-p-phenylene) in its diradical dicationic redox state. This previously unreported complex involving three bipyridinium cation radicals increases the versatility of host–guest chemistry, extending its practice beyond the traditional reliance on neutral and charged guests and hosts. In particular, transporting the concept of radical dimerization into the field of mechanically interlocked molecules introduces a higher level of control within molecular switches and machines. Herein, we report that bistable and tristable [2]rotaxanes can be switched by altering electrochemical potentials. In a tristable [2]rotaxane composed of a cyclobis(paraquat-p-phenylene) ring and a dumbbell with tetrathiafulvalene, dioxynaphthalene and bipyridinium recognition sites, the position of the ring can be switched. On oxidation, it moves from the tetrathiafulvalene to the dioxynaphthalene, and on reduction, to the bipyridinium radical cation, provided the ring is also reduced simultaneously to the diradical dication