Improved Time to Notification of Impending Brain Death and Increased Organ Donation Using an Electronic Clinical Decision Support System.

Early referral of patients to an organ procurement organization (OPO) may positively affect donation outcomes. We implemented an electronic clinic decision support (CDS) system to automatically notify our OPO of children meeting clinical triggers indicating impending brain death. Medical records of all patients who died in a pediatric critical care unit or were referred for imminent death for 3 years prior to installation of the initial CDS (pre-CDS) and for 1 year after implementation of the final CDS (post-CDS) were reviewed. Mean time to OPO notification decreased from 30.2 h pre-CDS to 1.7 h post-CDS (p = 0.015). Notification within 1 h of meeting criteria increased from 36% pre-CDS to 70% post-CDS (p = 0.003). Although an increase in donor conversion from 50% pre-CDS to 90% post-CDS did not reach statistical significance (p = 0.0743), there were more organ donors post-CDS (11 of 24 deaths) than pre-CDS (seven of 57 deaths; p = 0.002). Positive outcomes were achieved with the use of a fully automated CDS system while simultaneously realizing few false-positive notifications, low costs, and minimal workflow interruption. Use of an electronic CDS system in a pediatric hospital setting improved timely OPO notification and was associated with increased organ donation.

Endoftalmitis tras inyecciones intravítreas. Incidencia, manejo y pronóstico / Endophthalmitis after intravitreal injections. Incidence, management and prognosis

OBJETIVO: Averiguar la incidencia de la endoftalmitis tras inyecciones intravítreas (IVT) en «sala limpia» de un centro terciario, siguiendo los protocolos de la Sociedad Española de Retina y Vítreo (SERV). Identificar agentes causales, observar la respuesta al tratamiento y el resultado funcional final. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional, en una serie de casos clínicos, de las endoftalmitis tras IVT realizadas en nuestro centro entre 2010 y 2015. En estos casos, se efectuó tratamiento intravítreo y sistémico, siguiendo las pautas de la SERV, así como una vitrectomía diagnóstico-terapéutica, con seguimiento hasta la resolución definitiva del caso. RESULTADOS: Se produjeron 5 casos de endoftalmitis en 9.467 IVT (incidencia 0,053%). Se obtuvieron muestras de acuoso o vítreo, con cultivo positivo en todos los casos: Staphylococcus epidermidis fue el principal agente causal en 4 de los 5 casos. En 2 casos la agudeza visual fue de no percepción luminosa por desprendimiento de retina irreductible tras la resolución del proceso infeccioso. CONCLUSIONES: Las IVT realizadas en «sala limpia» tiene una baja incidencia de endoftalmitis: la especie Staphylococcus es la responsable más frecuente. Dos de los casos acabaron con un mal pronóstico funcional

OBJECTIVE: To assess the rate of endophthalmitis after intravitreal injection (IVI) in a «clean room» of a single health centre, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). MATERIAL AND METHODS: A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health centre between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. RESULTS: There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. CONCLUSIONS: IVI performed in a «clean room» have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor

Endophthalmitis after intravitreal injections. Incidence, management and prognosis. / Endoftalmitis tras inyecciones intravítreas. Incidencia, manejo y pronóstico.

OBJECTIVE: To assess the rate of endophthalmitis after intravitreal injection (IVI) in a «clean room¼ of a single health centre, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). MATERIAL AND METHODS: A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health centre between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. RESULTS: There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. CONCLUSIONS: IVI performed in a «clean room¼ have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor.

[Inhibition and resource capacity during normal aging: a confrontation of the dorsal-ventral and frontal models in a modified version of negative priming]. / Existe-t-il un déficit d'inhibition lors du vieillissement? Confrontation de l'hypothèse dorso-ventrale et de l'hypothèse frontale dans l'effet d'amorçage négatif.

BACKGROUND: Over the past decades, cognitive psychology contribution to our understanding of aging relies on two major perspectives, focusing on the selective impact of age on either cognitive multiple-systems or global factors of cognition: slowing, working memory and inhibition. In the latter, reduction in inhibitory control during aging (in its access, deletion or restraint functions) is associated with poorer performance on a variety of tasks referring to memory, comprehension or language [Hasher, Zacks and May (16)]. The attractiveness of inhibition as an explanatory factor results in part in the absence of negative priming during aging. Negative priming refers to the slow down of latencies when individuals have to respond to recently ignored informations, compared to unrelated informations. The dissociation, between a preserved location negative priming and an absence of identity negative priming during aging, supports the dorsal-ventral model of inhibition which suggests that spatial and identity inhibition are supported by different and independent visual pathways. An alternative model, directly at odds, is that inhibitory mechanisms are supported by the frontal lobe. In this perspective, inhibition is not a central process responsible for the control of working memory contents, but an automatic and local mechanism whose triggering depends on controlled attention. Therefore, working memory drives efficient inhibition by sustaining task instructions and appropriate responses throughout task execution. This hypothesis is consistent with Houghton and Tipper's (17) architecture of selective attention. According to the authors, the presence or absence of automatic inhibition is very closely linked to a Match/Mismatch field whose function is to compare the present stimulus to an internal self-generated internal template. When an information fails to match the subject's current goals, the match/mismatch field causes an automatic inhibitory imbalance which reduces the to-be-ignored properties' responsiveness. In contrast, information matching subjects' goal is enhanced through an automatic excitatory imbalance. The accurate functioning of the Match/Mismatch field requires efficient executive functioning responsible for the uphold of goals and correct responses. In the case of negative priming, manipulating the efficiency of working memory is of interest as it should affect the triggering of slowing, ie, an indirect inhibitory deficit, when the task is resource demanding [Conwayet al. (6)]. Moreover, if inhibition, as reflected by negative priming, is mediated by individual resource capacity, then NP should disappear during aging only when individuals are engaged in a resource-demanding task. OBJECTIVES: To address this issue, we examine whether cognitive control load in a gender decision task contributed to the presence or absence of NP during aging. According to the dorsal-ventral model, task complexity should not have any impact on performance, since gender decision task relies on a conceptual analysis of information. In turn, the frontal model predicts that age differences in performance profile will only differ when individual resource capacity is overloaded. DESIGN OF THE STUDY: Sixty-four participants (32 young and 32 older adults) performed a gender categorisation task through two experiments. Trials involved two stimuli presented successively at the same location. A word served as a prime and a word as a target. Both prime and target could be male or female. When prime and target matched on gender, we talked about VALID pairs (or compatible). When prime and target mismatched on the manipulated features, we talked about INVALID pairs (or incompatible). Participants' task was to identify the gender of the target. They were explicitly instructed not to respond to primes but to read them silently. Our interest was in response latencies for valid versus invalid pairs. We manipulated task complexity by the absence (experiment 1) or presence (experiment 2) of a distractor during probe trials. RESULTS: For younger adults, primes presented before targets gave rise to behavioural costs when pairs were mapped to the same response compared to pairs that were mapped to opposite ones. This slowing, called Negative Compatibility Effect (NCE), was independent of the presence or absence of a distractor. NCE was reliable for the elderly patients only under condition of no interfering information during the probe trial: pattern of performance of older participants was identical to that of young adults (experiment 1). This effect disappeared as task complexity increased (experiment 2). DISCUSSION: This result suggests that NCE triggering is dependant on the amount of cognitive control engaged by the task, and therefore that the ability to inhibit irrelevant information is secondary to a general capacity of the working memory. CONCLUSION: The implications of our data are consistent with the level of processing account, as well as the recent neuroimaging contributions which suggest, for example, the involvement of the dorso-lateral prefrontal cortex (sensitive to aging) when task demands are high, and a ventro-lateral prefrontal implication when demands are low [see Eenshuistra et al. for a review (10)].

Expression of the Pasteurella multocida ompH gene is negatively regulated by the Fur protein.

The fur gene of Pasteurella multocida has been cloned by complementation of an Escherichia coli fur mutant. The P. multocida fur gene, which encodes a predicted protein of 147 amino acids, displaying the highest identity (89%) with the same protein of Haemophilus influenzae, is negatively regulated by its own product. By construction of a P. multocida fur mutant, it has been demonstrated that the ompH gene, encoding a major structural protein of the outer membrane, presenting high antigenicity power, is negatively regulated by iron and glucose. Furthermore, wild-type and fur-defective cells of P. multocida show the same level of virulence.

Cloning and sequence of the gene encoding a novel cefotaxime-hydrolyzing beta-lactamase (CTX-M-9) from Escherichia coli in Spain.

A new CTX-M-type beta-lactamase (CTX-M-9) has been cloned from a clinical cefotaxime-resistant Escherichia coli strain. Despite the close identity that exists between the CTX-M-9 and Toho-2 beta-lactamases (88%), the 35 amino acids located between residues Ala-185 and Ala-219 are totally different in both enzymes. Outside of this region there are only six amino acids substitutions between both proteins.

Cloning and characterization of the recA of Paracoccus denitrificans and construction of a recA-deficient mutant.

The recA gene of Paracoccus denitrificans has been isolated from a genomic library by hybridization with the Rhodobacter sphaeroides recA gene. Its complete nucleotide sequence consists of 1071 bp encoding a polypeptide of 356 amino acids. Nucleotide sequence analysis of the P. denitrificans recA gene revealed the closest identities with the R. sphaeroides and the Rhodobacter capsulatus recA genes. Nevertheless, and surprisingly, recA genes of these two phototrophic bacteria are not DNA damage-inducible when introduced into P. denitrificans cells, whereas recA genes of both P. denitrificans and Rhizobium etli are. These results suggest that the promoters of P. denitrificans and R. etli recA genes have a similar regulatory sequence. A recA-defective mutant of P. denitrificans has also been constructed by replacement of the active recA gene by an in vitro inactivated gene copy.

[Thrombosis of the basilar trunk caused by syphilis]. / Trombose do tronco basilar pela sífilis.

The authors describe a case of cerebrovascular accident by syphilis in a 37 years-old man. The clinical features were headache, right hemiparesis and ptosis of the left eyelid. Blood and spinal fluid tests for syphilis were positive. The angiography showed a basilar trunk occlusion with revascularization of the cerebellar culmen. The autopsy disclosed a sub-total occlusion of the basilar artery and a fresh left cerebellar infarct.

[Meningo-encephalic tuberculosis in childhood. Anatomo pathological study of 10 cases].

The anatomo-pathological study of ten cases of tuberculosis of the central nervous system (CNS) in children under 10 years old is reported. The emphasis is given to the macroscopic and microscopic changes produced by the tuberculosis in the meninges, in the nervous parenchyma and in the vessels. The clinical and pathological findings are discussed and correlated with the literature. The authors concluded that: 1) the lesion in children with tuberculosis of the CNS is generally a proliferative meningoencephalitis; 2) the nervous parenchyma may be affected by the contiguous propagation of the tuberculous process or by the circulatory changes secondary to the arterial lesions; 3) because of the localization of the endocranial vessels in the sub-arachnoidal space they are generally injured by the inflammatory process, which can determine an obliterating endarteritis, which can be observed by a carotid angiography.