Current approach to skin and soft tissue infections. Thinking about continuity of care.

Skin and soft tissue infections are a common reason for patients seeking inpatient and outpatient medical care. Surgery is an essential part of managing in many episodes. Careful evaluation of antibiotic therapy could help clinicians in early identification to patients with treatment failure and to consider an alternative approach or a new surgical revision in "focus control". With the arrival of new drugs, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life (long-acting lipoglycopeptides such as dalbavancin or oritavancin), which allows weekly administration (or even greater), can reduce hospital admission and length of stay with fewer healthcare resources through outpatient management (home hospitalization or day hospitals). New anionic fluoroquinolones (e.g. delafloxacin), highly active in an acidic medium and with the possibility of switch from the intravenous to the oral route, will also make it possible to achieve these new healthcare goals and promote continuity of care. Therefore, management should rely on a collaborative multidisciplinary group with experience in this infectious syndrome.

Effect of polystyrene nanoplastics on the activated sludge process performance and biomass characteristics. A laboratory study with a sequencing batch reactor.

The fate and presence of nanoplastics in wastewater treatment systems is a topic of increasing interest. Furthermore, challenges related to their quantification and identification have made it difficult to set up experimental conditions and compare results between studies. In this study, the effect of 100 nm polystyrene nanoplastics on activated sludge was evaluated. A concentration of 2 µg/L was used to continuously feed a sequencing batch reactor (SBR-NPs). Under the experimental conditions used in this study, no changes were observed in the process performance of the SBR-NPs compared to the reactor used as a control. Neither nitrification nor organic matter removal efficiency, which was 96% for both SBRs, were affected by the presence of 100 nm polystyrene nanoplastics, which suggests that the tested nanoplastics were not sufficiently toxic to the biomass. Although no significant differences in the relative abundances of predominant phyla between SBR-Control and SBR-NPs were observed, a slight shift in the relative abundance of Patescibacteria (1.5 ± 0.6% and 3.7 ± 0.8% in SBR-Control and SBR-NPs, respectively, at the end of the test) occurred. The higher abundance of this phylum in SBR-NPs compared to SBR-Control may suggest that these bacteria have some sensitivity to the presence of 100 nm polystyrene nanoplastics. Furthermore, even with the absence of nitrification inhibition, it was observed stagnation of the growth of Nitrotoga bacteria in SBR-NPs, which also suggests that the polystyrene nanoplastics could have an inhibitory effect on these cells and an impact on nitrification in the long term.

Influence of bisphenol A occurrence in wastewaters on biomass characteristics and activated sludge process performance.

In this work, the influence of bisphenol A (BPA) on biological wastewater treatment was studied. For it, two sequencing batch reactors (SBRs) were operated for three months. Both SBRs were fed with synthetic wastewater (SW), adding 1 mg·L-1 of BPA into the feed of reactor SBR-BPA, while the other one operated without BPA as a control reactor (SBR-B). In addition, batch experiments were performed with adapted and non-adapted activated sludge, simulating the reaction step of SBR-BPA, to determine the pathways for BPA removal. Results of batch experiments showed that adsorption and biodegradation were the only significant BPA removal routes. BPA removal by biodegradation was more efficient when adapted biomass was used in the tests (32.2% and 8.2% with adapted and non-adapted biomass, respectively), while BPA adsorption removal route was similar in both types of activated sludge (around 40%). Regarding the SBRs experiments, after 16 days no BPA concentration was detected in SBR-BPA effluent. In the adaptation process, SBR-BPA biomass was more sensitive to low temperatures resulting in higher effluent turbidity, COD and soluble microbial products concentrations than in SBR-B. However, once temperature increased, adapted biomass from SBR-BPA presented higher activity than SBR-B biomass, showing higher values of sludge production, microbial hydrolytic enzymatic activities and specific dynamic respiration rate. The bacterial community study revealed the increase of abundance of Proteobacteria (especially Thiothrix species) and Actinobacteria (especially Nocardioides species) phyla at the expense of Bacteroidetes and Chloroflexi phyla in SBR-BPA during its operation.

The role of salinity on the changes of the biomass characteristics and on the performance of an OMBR treating tannery wastewater.

Tannery wastewaters are difficult to treat biologically due to the high salinity and organic matter concentration. Conventional treatments, like sequential batch reactors (SBR) and membrane bioreactors (MBR), have showed settling problems, in the case of SBR, and ultrafiltration (UF) membrane fouling in the case of MBR, slowing their industrial application. In this work, the treatment of tannery wastewater with an osmotic membrane bioreactor (OMBR) is assessed. Forward osmosis (FO) membranes are characterized by a much lower fouling degree than UF membranes. The permeate passes through the membrane pores (practically only water by the high membrane rejection) from the feed solution to the draw solution, which is also an industrial wastewater (ammonia absorption effluent) in this work. Experiments were carried out at laboratory scale with a FO CTA-NW membrane from Hydration Technology Innovations (HTI). Tannery wastewater was treated by means of an OMBR using as DS an actual industrial wastewater mainly consisting of ammonium sulphate. The monitoring of the biological process was carried out with biological indicators like microbial hydrolytic enzymatic activities, dissolved and total adenosine triphosphate (ATP) in the mixed liquor and microbial population. Results indicated a limiting conductivity in the reactor of 35 mS cm-1 (on the 43th operation day), from which process was deteriorated. This process performance diminution was associated by a high decrease of the dehydrogenase activity and a sudden increase of the protease and lipase activities. The increase of the bacterial stress index also described appropriately the process performance. Regarding the relative abundance of bacterial phylotypes, 37 phyla were identified in the biomass. Proteobacteria were the most abundant (varying the relative abundance between 50.29% and 34.78%) during the first 34 days of operation. From this day on, Bacteroidetes were detected in a greater extent varying the relative abundance of this phylum between 27.20% and 40.45%.

Changes in the process performance, sludge production and microbial activity in an activated sludge reactor with addition of a metabolic uncoupler under different operating conditions.

Sludge production in wastewater treatment plants is nowadays a big concern due to the high produced amounts and their characteristics. Consequently, the study of techniques that reduce the sludge generation in wastewater treatment plants is becoming of great importance. In this work, four laboratory sequencing batch reactors (SBRs), which treated municipal wastewater, were operated to study the effect of adding the metabolic uncoupler 3,3',4',5-tetrachlorosalicylanilide (TCS) on the sludge reduction, the SBRs performance and the microbial hydrolytic enzymatic activities (MHEA). In addition, different operating conditions of the SBRs were tested to study the effect of the TCS on the process: two dissolved oxygen (DO) concentrations (2 and 9 mg L-1) and two F/M ratio (0.18 and 0.35 g COD·g MLVSS-1·d-1). The sludge production decreased under high DO concentrations. At the same time, the DNA and EPS production increased in the four SBRs. After these stress conditions, the performance of the reactors were recovered when DO was around 2 mg L-1. From that moment on, results showed that TCS addition implied a reduction of the adenosine triphosphate (ATP) production, which implied a decrease in the sludge production. In spite of this reduction, the SBRs performances did not decay due to the increase in the global MHEA. Additionally, the sludge reduction was enhanced by the increase of the F/M ratio, achieving 28% and 60% of reduction for the low and the high F/M ratio, respectively.

La Unidad de Oncología Pediátrica del Hospital La Fe en 2013 / The Pediatric Oncology Unit of the Hospital la Fe in 2013

Tras un breve recorrido histórico y tras señalar la misión, visión y valores de la Unidad de Oncología Pediátrica, se describe la estructura de la unidad, recursos estructurales y humanos y su actividad asistencial, docente y de investigación. En referencia a la labor asistencial cabe destacar su atención universal en régimen ambulatorio (consulta externa y hospitalización a domicilio), de hospitalización y de urgencia, incluyendo todos los tratamientos disponibles en Oncología Pediátrica en todas las fases de la enfermedad (desde el diagnóstico hasta la terminal en su caso o en la prevención o rehabilitación de efectos adversos a largo plazo. Su labor en docencia e investigación es también destacable (AU)

After a short history and to point out objectives and care level of Pediatric Oncology Unit, we describe structural and human resources of the Unit and its clinical, investigational and teaching activity. Concerning clinical, activity, we would like to highline the global dedication in outpatient and impatient regimen including home care assistance. We also remark out disposition to offer all types of treatments with known efficacy in children with cancer, including every phase of the disease and late effects (AU)

1-Hexyl-3-methyl imidazolium tetrafluoroborate: an efficient column enhancer for the separation of basic drugs by reversed-phase liquid chromatography.

Ionic liquids are dual modifiers composed by a large anion and a large cation, which interact with both the hydrophobic alkyl-bonded phase and the anionic residual silanols in C18 columns. The deactivation of the silanol groups has important implications on the chromatographic analysis of basic drugs, being the improvement of peak profiles and shorter retention times the most noticeable features. However, other characteristics as selectivity or resolution are not usually considered, or are only examined for selected chromatographic conditions. In this work, the effect of the addition of the ionic liquid 1-hexyl-3-methyl imidazolium tetrafluoroborate to acetonitrile-water mixtures in a wide range of concentrations, using three C18 columns (Zorbax SB-C18, Nucleosil and Spherisorb) was studied for the separation of a group of ß-adrenolytic drugs. The extremely poor chromatographic performance was highly improved in the presence of the ionic liquid, giving rise to shorter analysis times, smaller consumption of acetonitrile, significantly narrower and more symmetric peaks, and high resolution. The improvement was especially noteworthy for the Spherisorb column, which yielded the poorest results in the absence of additive.

Measurement of the elution strength and peak shape enhancement at increasing modifier concentration and temperature in RPLC.

Two approaches are proposed to measure the effect of different experimental factors (such as the modifier concentration and temperature) on the elution strength and peak shape in reversed-phase liquid chromatography, which quantify the percentage change in the retention factor and peak width (referred to the weakest conditions) per unit change in the experimental factor. The approaches were applied to the separation of a set of flavonoids with aqueous micellar mobile phases of the surfactant Brij-35 (polyoxyethylene(23)dodecanol), in comparison with acetonitrile-water mixtures, using an Eclipse XDB-C18 column. The particular interaction of each flavonoid with the oxyethylene chains of Brij-35 molecules (adsorbed on the stationary phase or forming micelles) changed the elution window, distribution of chromatographic peaks and partitioning kinetics, depending on the hydroxyl substitution in the aromatic rings of flavonoids. At 25 °C, peak shape with Brij-35 mobile phases was significantly poorer with regard to acetonitrile-water mixtures. At increasing temperature, the efficiency of Brij-35 increased, approaching at 80 °C the values obtained at equilibrium conditions, already reached with acetonitrile at 25 °C.

Reacción de fototoxicidad por metotrexato / Photoxicity reaction due to methotrexate

No disponible

Silanol suppressing potency of alkyl-imidazolium ionic liquids on C18 stationary phases.

Residual silanols on C18 columns yield undesirable slow-kinetics ion-exchange interactions with positively charged basic compounds that result in asymmetrical peaks, low efficiencies and long retention times. The purity of the silica employed as supporting material, and the technique used to form the bonded phase, which varies with the brand and manufacturer, give rise to different amounts of residual silanols in the packings, and consequently, different chromatographic performance. One of the most efficient and widespread strategies to reduce or even eliminate the different performance among columns is the addition of a reagent to the mobile phase to block the silanol sites. However, the intrinsic nature of both stationary phase and additive leads to particular results. In this work, a group of basic compounds were analysed using six C18 stationary phases (Zorbax SB-C18, X-Terra MS C18, Kromasil, Lichrospher, Nucleosil, and Spherisorb) and acetonitrile-water mixtures. Two ionic liquids (ILs), 1-butyl- and 1-hexyl-3-methyl-imidazolium tetrafluoroborates, were added to the mobile phases to evaluate their silanol suppressing potency, based on the decreased retention of the basic compounds when the silanols are blocked (described by the Horváth equation), and the improvement in peak profile (described by the plots of the peak half-widths at diverse retention times). The suppressing potency based on the retention can be misleading when the adsorption of the IL anion is not negligible, since the anion attracts the cationic basic compounds increasing the retention. However, the accessibility of basic compounds to the silanols is prevented by both IL cation and anion, improving the peak profiles for all stationary phases. This was especially remarkable for Spherisorb, which in the absence of additive yielded by far the worst performance. 1-Hexyl-3-methyl-imidazolium tetrafluoroborate was the best additive in terms of retention and peak profile (width and asymmetry).

Observational prospective study of viral infections in children undergoing allogeneic hematopoietic cell transplantation: a 3-year GETMON experience.

We studied surveillance, incidence and outcome of viral infections in children undergoing allogeneic hematopoietic cell transplantation (HCT) in the main pediatric transplant units in Spain. We prospectively collected data from first year post-HCT in every consecutive allogeneic HCT performed during 3 years (N = 215): first HCT = 188 and second HCT = 27; median age = 6.6 years (0.1-20.7). Most patients had acute leukemia (N = 137) and 135 recipients (63%) were CMV seropositive. A total of 46 patients underwent cord blood transplant, 133 patients underwent HCT from alternative donors (62%) and 101 patients received anti-thymocyte globulin. Observational time was completed in 137 patients, whereas the remaining 78 died after a median survival time of 99 days (3-352). CMV was monitored in all patients; adenovirus (ADV) and human herpesvirus 6 (HHV-6) were monitored in 101 and 33 patients, respectively. We found 145 viral infections in 103 patients: CMV (n = 42), ADV (n = 32), HHV-6 (n = 7), polyomavirus (n = 20), EBV (n = 6), VZV (n=17) and others (n = 8). CMV infection was significantly higher in seropositive patients (25 vs 7%) (P = 0.02). Extensive chronic GVHD (cGVHD) was significantly associated with an increased rate of viral infections (12 of 16 patients with cGVHD had infections vs 91 of 199 without GVHD) (P = 0.035). In total, 10 patients (4.6%) died of viral infections (CMV = 5, ADV = 3, respiratory = 2). We found a high incidence of viral infection, but mortality was low.

Evaluation of chimerism by quantitative PCR analysis of DNA polymorphism after allogeneic hematopoietic stem cell transplantation in a pediatric population with malignancies.

Relapse remains the major pitfall to success for Allo-HSCT in children with malignancies. Ninety-one patients undergoing Allo-HSCT were retrospectively reviewed. Chimerism status was evaluated at days +30, +60, and +100 in PB. VNTR-PCR and STR-PCR were used for this purpose. Thirty-one patients recurred (34%) and none survived. Thirty-two remain alive in CR (35%). Patients who achieved a CC at those days had a significant higher RFS and OS than patients who did not. Twelve patients showing PMC had an increased risk of recurrence (p=0.02. OR 7.7). In the univariate analysis, the probability of death was higher in patients who were not in first CR before transplant (p=0.008.OR 2.09) and in those receiving cells not from PB (p=0.002.OR 2.03). In the multivariate analysis, the absence of CC at day +100 was associated with a higher probability of relapse (p=0.004. OR 10.8) and death (p=0.016. OR 9.3). Serial chimerism PCR-based analyses of polymorphic DNA markers can predict relapse. Patients with PMC are at the highest risk of recurrence. Patients receiving an Allo-HSCT in first CR from PB who achieve a CC at day +100 have a better outcome.

The role of the dual nature of ionic liquids in the reversed-phase liquid chromatographic separation of basic drugs.

The cationic nature of basic drugs gives rise to broad asymmetrical chromatographic peaks with conventional C18 columns and hydro-organic mixtures, due to the ionic interaction of the positively charged solutes with the free silanol groups on the alkyl-bonded reversed-phase packing. Ionic liquids (ILs) have recently attracted some attention to reduce this undesirable silanol activity. ILs are dual modifiers (with a cationic and anionic character), which means that both cation and anion can be adsorbed on the stationary phase, giving rise to interesting interactions with the anionic free silanols and the cationic basic drugs. A comparative study of the performance of four imidazolium-based ILs as modifiers of the chromatographic behaviour of a group of ß-blockers is shown. The ILs differed in the adsorption capability of the cation and anion on C18 columns. Mobile phases without additive and containing a cationic (triethylamine, TEA) or anionic (sodium dodecyl sulphate, SDS) additive were used as references for the interpretation of the behaviours. The changes in the nature of the chromatographic system, at increasing concentration of the additives, were followed based on the changes in retention and peak shape of the ß-blockers. The silanol suppressing potency of the additives, and the association constants between the solutes and modified stationary phase or additive in the mobile phase, were estimated. The study revealed that SDS and the ionic liquid 1-hexyl-3-methylimidazolium tetrafluoroborate are the best enhancers of chromatographic peak shape among those studied.

Study of broadband near-infrared emission in Tm3+-Er3+ codoped TeO2-WO3-PbO glasses.

In this work, we report the near-infrared emission properties of Tm(3+)-Er(3+) codoped tellurite TeO(2)-WO(3)-PbO glasses under 794 nm excitation. A broad emission from 1350 to 1750 nm corresponding to the Tm(3+) and Er(3+) emissions is observed. The full width at half-maximum of this broadband increases with increasing [Tm]/[Er] concentration ratio up to a value of ~ 160 nm. The energy transfer between Tm(3+) and Er(3+) ions is evidenced by both the temporal behavior of the near-infrared luminescence and the effect of Tm3+ codoping on the visible upconversion of Er(3+) ions.

Diagnosis of paediatric anaplastic large-cell lymphoma: a historical perspective from a single institution.

INTRODUCTION: Anaplastic large-cell lymphoma (ALCL) is an infrequent childhood malignancy whose diagnosis and treatment have largely evolved since its initial description in 1985. PATIENTS AND METHODS: We retrospectively reviewed our experience in the field, and report here a single institution experience focusing on diagnostic and therapeutic milestones achieved as novel tools have been developed. This is a series of 9 children diagnosed from 1987 to 2007. RESULTS: Our first patient was diagnosed shortly alter this entity was described based on morphology and Ki-1 positivity, while the diagnostic work-up for the last two children included accurate molecular diagnosis for ALK-NPM rearrangement. Despite a wide variety of multimodal therapies used over time, only one patient died of toxicity during progression and another child relapsed and survived alter an autograft. After 156 months of median follow-up (range 4-245), 8 out of 9 children are alive, free of disease. CONCLUSIONS: Our series exemplifies the long journey travelled from the definition of a new entity only 20 years ago to the molecular characterization not only with diagnostic but also therapeutic purposes. Besides this, significant efforts are being made to recruit all European patients into a multinational collaborative trial in order to start drawing major evidence-based conclusions.

Diagnosis of paediatric anaplastic large-cell lymphoma: a historical perspective from a single institution

INTRODUCTION: Anaplastic large-cell lymphoma (ALCL) is an infrequent childhood malignancy whose diagnosis and treatment have largely evolved since its initial description in 1985. PATIENTS AND METHODS: We retrospectively reviewed our experience in the field, and report here a single institution experience focusing on diagnostic and therapeutic milestones achieved as novel tools have been developed. This is a series of 9 children diagnosed from 1987 to 2007. RESULTS: Our first patient was diagnosed shortly alter this entity was described based on morphology and Ki-1 positivity, while the diagnostic work-up for the last two children included accurate molecular diagnosis for ALK-NPM rearrangement. Despite a wide variety of multimodal therapies used over time, only one patient died of toxicity during progression and another child relapsed and survived alter an autograft. After 156 months of median follow-up (range 4-245), 8 out of 9 children are alive, free of disease. CONCLUSIONS: Our series exemplifies the long journey travelled from the definition of a new entity only 20 years ago to the molecular characterization not only with diagnostic but also therapeutic purposes. Besides this, significant efforts are being made to recruit all European patients into a multinational collaborative trial in order to start drawing major evidence-based conclusions (AU)

Spectroscopic properties of the 1.4 microm emission of Tm3+ ions in TeO2-WO3-PbO glasses.

In this work, we report the spectroscopic properties of the infrared 3H4-->3F4 emission of Tm3+ ions in two different compositions of glasses based on TeO2, WO3, and PbO for three Tm2O3 concentrations (0.1,0.5, and 1 wt%). Judd-Ofelt intensity parameters have been determined and used to calculate the radiative transition probabilities and radiative lifetimes. The infrared emission at around 1490 nm corresponding to the 3H4-->F4 transition has two noticeable features if compared to fluoride glasses used for S-band amplifiers. On one hand, it is broader by nearly 30 nm, and on the other, the stimulated emission cross section is twice the value for fluoride glasses. Both the relative intensity ratio of the 1490 nm emission to 1820 nm and the measured lifetime of the 3H4 level decrease as concentration increases, due to the existence of energy transfer via cross-relaxation among Tm3+ ions. The analysis of the decays from the 3H4 level with increasing concentration indicates the presence of a dipole-dipole quenching process assisted by energy migration.

[Renal tumors in infants aged less than 1 year]. / Tumores renales en niños menores de un año.

OBJECTIVE: To determine the frequency and distribution of primary renal tumors diagnosed in a pediatric oncology unit in children younger than 1 year and identify their clinical and histopathological characteristics, the treatment used, and outcomes. MATERIAL AND METHODS: We retrospectively reviewed the medical records of infants with primary tumors of the kidney diagnosed between January 1972 and February 2003. RESULTS: A total of 137 tumors were diagnosed in our unit during the period studied. Of these, 25 (18.2 %) occurred in infants aged less than 1 year. There were 17 boys and 8 girls. The most prevalent tumor in this age group was Wilms' tumor (WT) in 15 patients, followed by mesoblastic nephroma (MN) in 9 patients and rhabdoid tumor in 1 patient. The mean age at diagnosis of WT was 4.8 months (range: 1 day-11 months), with a median of 5.03 months. The median age at diagnosis of MN was 1 day (range: 1 day-3 months). Presenting symptoms consisted of abdominal mass in 20 patients, hematuria in 4 patients and intestinal pseudo-occlusion (MN) in 1 patient. High blood pressure was found in 12 of the 25 patients. Among the 15 WT, 9 were stage I, 1 was stage II, one was stage III, 2 were stage IV, and 1 was stage V. One patient died before surgery. Overall survival at 5 years was 0.67 (SE 0.12) for WT and 0.89 (SE 0.1) for MN, respectively, with a mean follow-up of 290 months. CONCLUSIONS: MN was more frequent than WT in infants aged less than 6 months. The first-line therapy in these patients is surgery since this type of tumor shows little chemosensitivity and chemotherapy is poorly tolerated in infants.