Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design.

OBJECTIVE: Meropenem is a ß-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. DESIGN: Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). SETTING: Tertiary and University hospitals. INTERVENTIONS: 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). MEASUREMENTS: The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. CONCLUSIONS: The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections.

Fast beam monitor diamond-based devices for VUV and X-ray synchrotron radiation applications.

The improved performance of third-generation light sources and the advent of next-generation synchrotron radiation facilities require the use of extremely precise monitoring of the main photon-beam parameters, such as position, absolute and relative intensity, and temporal structure. These parameters, and associated real-time feedbacks, are fundamental at the beamline control level and at the machine control level, to improve the stability of the photon beams and to provide bunch-to-bunch quantitative information. Fast response time, high radiation hardness and visible-blind response are main features of photon-beam monitors for VUV and X-ray synchrotron radiation beamlines; hence diamond-based detectors are outstanding candidates. Here, results are presented of an extensive measurement campaign aiming at optimizing the capabilities of diamond detectors to discern time structures below the 100 ps timescale. A custom-built device has been fabricated and tested at the Italian Synchrotron Radiation Laboratory Elettra in Trieste. The results obtained show that diamond is an excellent material for ultra-fast photon pulses with picosecond time resolution; finally the possibilities for application at free-electron laser sources are discussed.

Graphitic Patterns on CVD Diamond Plate as Microheating/Thermometer Devices.

A simple compact temperature sensor and microheater in a wide temperature range has been developed, realizing a laser-patterned resistive structure on the surface of a synthetic polycrystalline diamond plate. Imaging and spectroscopy techniques used to investigate morphology, structure, and composition of the pattern showed that it incorporates different nondiamond carbon phases. Transport experiments revealed the semiconducting behavior of this microresistor. Thermal power measurements versus temperature are presented. A possible application of this device that may easily match compact experimental layouts avoiding both thermal anchoring offset and mechanical stress between sample and sensor is discussed. The patterned structure undergoes testing as a microthermometer, providing fast response and excellent stability versus time. It exhibits a good sensitivity that coupled to an easy calibration procedure minimizes errors and guarantees high accuracy. Plot of temperature versus input power of the resistive patterned line used as microheater shows a linear behavior in an extended temperature range.

Photochemical synthesis of citric acid cycle intermediates based on titanium dioxide.

The emergence of the citric acid cycle is one of the most remarkable occurrences with regard to understanding the origin and evolution of metabolic pathways. Although the chemical steps of the cycle are preserved intact throughout nature, diverse organisms make wide use of its chemistry, and in some cases organisms use only a selected portion of the cycle. However, the origins of this cycle would have arisen in the more primitive anaerobic organism or even back in the proto-metabolism, which likely arose spontaneously under favorable prebiotic chemical conditions. In this context, we report that UV irradiation of formamide in the presence of titanium dioxide afforded 6 of the 11 carboxylic acid intermediates of the reductive version of the citric acid cycle. Since this cycle is the central metabolic pathway of contemporary biology, this report highlights the role of photochemical processes in the origin of the metabolic apparatus.