RESUMEN
The reaction of Appel salt 1 with 1H-pyrazol-5-amines 2 gives main products N-(4-chloro-5H-1,2,3-dithiazol-5-ylidene)-1H-pyrazol-5-amines 3, and 6H-pyrazolo[3,4-c]isothiazole-3-carbonitriles 5, together with several minor side products. When the pyrazoles are N-1 methylated, the product ratio 3:5 can be modified by adjusting the pH of the reaction medium: acidic conditions favor formation of the dithiazolylidenes 3, while basic conditions favor formation of pyrazolo[3,4-c]isothiazoles 5. Furthermore, thermolysis of N-(4-chloro-5H-1,2,3-dithiazol-5-ylidene)-1H-pyrazol-5-amines 3 gives 1H-pyrazolo[3,4-d]thiazole-5-carbonitriles 4. Single crystal X-ray crystallography supports the structure of 4,6-dimethyl-6H-pyrazolo[3,4-c]isothiazole-3-carbonitrile (5a) and helps resolve a previous incorrect structural assignment of 1H-pyrazolo[3,4-d]thiazole-5-carbonitriles 4.
Asunto(s)
Pirazoles/síntesis química , Tiazoles/síntesis química , Estructura Molecular , Pirazoles/química , Tiazoles/químicaRESUMEN
Pseudomonas aeruginosa is the leading cause of morbidity and mortality in cystic fibrosis (CF). This study examines the role of organism-specific factors in the pathogenesis of very early P. aeruginosa infection in the CF airway. A total of 168 longitudinally collected P. aeruginosa isolates from children diagnosed with CF following newborn screening were genotyped by pulsed-field gel electrophoresis (PFGE) and phenotyped for 13 virulence factors. Ninety-two strains were identified. Associations between virulence factors and gender, exacerbation, persistence, timing of infection and infection site were assessed using multivariate regression analysis. Persistent strains showed significantly lower pyoverdine, rhamnolipid, haemolysin, total protease, and swimming and twitching motility than strains eradicated by aggressive antibiotic treatments. Initial strains had higher levels of virulence factors, and significantly higher phospholipase C, than subsequent genotypically different strains at initial isolation. Strains from males had significantly lower pyoverdine and swimming motility than females. Colony size was significantly smaller in strains isolated during exacerbation than those isolated during non-exacerbation periods. All virulence factors were higher and swimming motility significantly higher in strains from bronchoalveolar lavage (BAL) and oropharyngeal sites than BAL alone. Using unadjusted regression modelling, age at initial infection and age at isolation of a strain showed U-shaped profiles for most virulence factors. Among subsequent strains, longer time since initial infection meant lower levels of most virulence factors. This study provides new insight into virulence factors underpinning impaired airway clearance seen in CF infants, despite aggressive antibiotic therapy. This information will be important in the development of new strategies to reduce the impact of P. aeruginosa in CF.
Asunto(s)
Proteínas Bacterianas/biosíntesis , Fibrosis Quística/microbiología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/metabolismo , Factores de Virulencia/biosíntesis , Proteínas Bacterianas/genética , Preescolar , Femenino , Genotipo , Humanos , Lactante , Masculino , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/aislamiento & purificación , Pseudomonas aeruginosa/patogenicidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Virulencia/genéticaRESUMEN
Studies of the type 3 secretion system (T3SS) in Pseudomonas aeruginosa isolates from chronically infected older children and adults with cystic fibrosis (CF) show a predominantly exoS+/exoU- (exoS+) genotype and loss of T3SS effector secretion over time. Relatively little is known about the role of the T3SS in the pathogenesis of early P. aeruginosa infection in the CF airway. In this longitudinal study, 168 P. aeruginosa isolates from 58 children diagnosed with CF following newborn screening and 47 isolates from homes of families with or without children with CF were genotyped by pulsed-field gel electrophoresis (PFGE) and T3SS genotype and phenotype determined using multiplex PCR and western blotting. Associations were sought between T3SS data and clinical variables and comparisons made between T3SS data of clinical and environmental PFGE genotypes. Seventy-seven of the 92 clinical strains were exoS+ (71% secretors (ExoS+)) and 15 were exoU+ (93% secretors (ExoU+)). Initial exoS+ strains were five times more likely to secrete ExoS than subsequent exoS+ strains at first isolation. The proportion of ExoS+ strains declined with increasing age at acquisition. No associations were found between T3SS characteristics and gender, site of isolation, exacerbation, a persistent strain or pulmonary outcomes. Fourteen of the 23 environmental strains were exoS+ (79% ExoS+) and nine were exoU+ (33% ExoU+). The exoU+ environmental strains were significantly less likely to secrete ExoU than clinical strains. This study provides new insight into the T3SS characteristics of P. aeruginosa isolated from the CF airway early in life.
Asunto(s)
Sistemas de Secreción Bacterianos/genética , Bronconeumonía/microbiología , Fibrosis Quística/complicaciones , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/metabolismo , Factores de Virulencia/genética , Factores de Virulencia/metabolismo , ADP Ribosa Transferasas/genética , ADP Ribosa Transferasas/metabolismo , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Toxinas Bacterianas/genética , Toxinas Bacterianas/metabolismo , Western Blotting , Niño , Preescolar , Electroforesis en Gel de Campo Pulsado , Femenino , Genotipo , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Tipificación Molecular , Reacción en Cadena de la Polimerasa Multiplex , Fenotipo , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
Three new antimony(III) halide complexes (SbX(3), X=Cl, Br and I) with the heterocyclic thione ω-thiocaprolactam (1-azacycloheptane-2-thione, (Hthcl)) of formulae {[SbCl(2)(µ(2)-Cl)(Hthcl)(2)](n)} (1), {[(SbBr(2)(µ(2)-Br)(Hthcl)(2))(2)]} (2) and {[(SbI(2)(µ(2)-I)(Hthcl)(2))(2)]} (3) were synthesized from the reaction of antimony(III) halides with ω-thiocaprolactam in 1:2 stoichiometry. The complexes were characterized by elemental analysis, FT-IR spectroscopy, (1)H, (13)C NMR spectroscopy and Thermal Gravimetry-Differential Thermal Analysis (TG-DTA). Crystal structures of the ligand ω-thiocaprolactam and its complexes 1-3 were determined with single crystal X-ray diffraction analysis. Complexes 1-3 and ω-thiocaprolactam were evaluated for their in vitro cytotoxic activity against leiomyosarcoma (LMS) and human breast adenocarcinoma (MCF-7) tumor cell lines. Antimony complexes 1-3 exhibit strong antiproliferative activity against both cell lines tested. The higher such activity was found for 3 with IC(50) values of 0.12±0.04 µM (LMS) and 0.76±0.16 µM (MCF-7) which are 60 and 10 times respectively, stronger than that of cisplatin. The influence of these complexes 1-3 and ω-thiocaprolactam upon the catalytic peroxidation of linoleic acid to hyperoxolinoleic acid by the enzyme lipoxygenase (LOX) was kinetically and theoretically studied. The results were shown negligible inhibitory activity of 1-3 against LOX.
Asunto(s)
Antimonio/farmacología , Antineoplásicos/síntesis química , Caprolactama/análogos & derivados , Complejos de Coordinación/síntesis química , Tionas/síntesis química , Antimonio/química , Antineoplásicos/química , Antineoplásicos/farmacología , Caprolactama/síntesis química , Caprolactama/farmacología , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Complejos de Coordinación/química , Complejos de Coordinación/farmacología , Cristalografía por Rayos X , Humanos , Concentración 50 Inhibidora , Lipooxigenasa/metabolismo , Espectroscopía de Resonancia Magnética , Modelos Moleculares , Espectroscopía Infrarroja por Transformada de Fourier , Tionas/química , Tionas/farmacologíaRESUMEN
The locking compression plate (LCP) supports biological osteosynthesis by functioning as an internal fixator, rather than as a full or limited contact bone plate which must be adequately contoured and affixed directly to the bone for stable internal fixation of the fracture. In order to help justify the use of the LCP in our veterinary patients, in vitro biomechanical testing was performed comparing the LCP to the conventional limited contact dynamic compression plate (LC-DCP) in canine femurs. We hypothesized that the LCP construct would be at least as stiff under bending and torsional loads as the LC-DCP. The LCP and LC-DCP were applied over a 20-mm osteotomy gap to contralateroal bones within each pair of 14 femora. Non-destructive four-point bending and torsion, and cyclical testing in torsion were performed. The constructs were then loaded to failure in torsion. In medial-lateral and lateral-medial structural bending, significant differences were not found between the LCP and LC-DCP, however, at the gap, the LCP construct was stiffer than the LC-DCP in lateral-medial bending. Significant differences in behaviour over time were not noted between the plate designs during cyclical testing. When loading the constructs to failure in internal rotation, the LC-DCP failed at a significantly lower twist angle (P = .0024) than the LCP. Based on the similar performance with loading, the locking compression plate is a good alternative implant for unstable diaphyseal femoral fracture repair in dogs.
Asunto(s)
Fenómenos Biomecánicos , Placas Óseas/veterinaria , Tornillos Óseos/veterinaria , Fracturas del Cuello Femoral/veterinaria , Equipo Ortopédico/veterinaria , Animales , Cadáver , Fuerza Compresiva , Perros , Análisis de Falla de Equipo , Fracturas del Cuello Femoral/cirugía , Estrés MecánicoRESUMEN
DNA microarrays and two-dimensional (2-D) gel electrophoresis were utilized to analyze the global effect of bile on transcription and protein synthesis in Salmonella enterica serovar Typhimurium. Two bile-regulated proteins, YciF and PagC, were identified by 2-D gel electrophoresis and mass spectrometry fingerprinting. The operon yciGFE-katN demonstrated increased transcriptional activity in the presence of bile. While this operon has previously been shown to be RpoS-regulated, data from this study suggested that yciGFE-katN is regulated by bile independent of RpoS. The PhoP-PhoQ-regulated PagC is decreased in the presence of bile. Characterization of the untranslated leader of pagC demonstrated that a 97-bp region is necessary for the bile-mediated repression of this promoter. Analysis of data from the DNA microarray revealed an effect of bile on important global mechanistic pathways in S. enterica serovar Typhimurium. Genes involved in type III secretion-mediated invasion of epithelial cells demonstrated an overall repression of transcription in the presence of bile, corroborating previously reported data from this laboratory [Infect. Immun. 68 (2000) 6763]. In addition, bile-mediated transcriptional repression of genes involved in flagellar biosynthesis and motility was observed. These data further demonstrate that bile is an important environmental signal sensed by Salmonella spp. and that bile plays a role in regulating bacterial gene expression in multiple virulence-associated pathways.
Asunto(s)
Bilis/fisiología , Regulación Bacteriana de la Expresión Génica/efectos de los fármacos , Infecciones por Salmonella/metabolismo , Salmonella typhimurium/genética , Salmonella typhimurium/metabolismo , Transcripción Genética/fisiología , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Movimiento Celular , ADN Bacteriano/química , ADN Bacteriano/genética , Electroforesis en Gel Bidimensional , Flagelos/genética , Flagelos/metabolismo , Humanos , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Análisis de Secuencia por Matrices de Oligonucleótidos , ARN Bacteriano/química , ARN Bacteriano/genética , Recombinación Genética/fisiologíaRESUMEN
GOAL, SCOPE AND BACKGROUND: Over the last decade Greece has become a leading country in the EU as concerns the cage farming of seabream and seabass. A strong debate has risen, however, about the environmental impacts of aquacultures in the coastal areas. The present paper deals with this problem and it is based on measurements of physico-chemical parameters in the water column, particulate matter and sediments in the area of Astakos Gulf, a coastal embayment in western Greece where three big fish farms are currently operating. METHODS: Water samples were collected by using Hydro-Bios sampling bottles, whereas a prototype sediment trap was installed under a fish cage for the collection of particulate matter. Temperature, dissolved oxygen, pH and salinity were measured in situ using portable equipment. Nutrients were determined by standard spectrophotometric methods. Trace metals were determined by Atomic Absorption Spectrometry. Dissolved organic carbon was determined by a Shimadzu 5000A carbon analyzer, whereas organic carbon in sediments was determined titrimetrically. RESULTS AND DISCUSSION: No clear eutrophication incidents have been identified, although the water column near the fish farms was enriched in nutrients and organic carbon. A sludge 'blanket' covers considerable parts of the seabed and is enriched in colloidal organic carbon and trace metals (Cd, Cu, Fe and Zn) that come from unused fish food. The biodegradation of this sludge leads to the development of anoxic conditions followed by the formation of undesirable gases, precipitation or remobilization of metals and the extinction of benthic fauna. CONCLUSION: The operation of fish farms at the coastal area of Astakos Gulf, and probably in similar Mediterranean gulfs, affects the marine environment, particularly in the vicinity of the cages. The most significant influence concerns the near-bottom water layer. The environmental impacts depend on the amount of food given to fishes, the mode of feeding, the fish density in cages, the annual production and the years of unit operation. The hydrology and the geomorphology of the area are also critical factors for its environmental quality. RECOMMENDATION AND OUTLOOK: The success of the fish-farming sector in the Mediterranean is accompanied by environmental and, in some extents, by social and marketing problems. These problems, derived from the rapid development of fish farming, can be solved only through an integrated management, using methods such as environmental impact assessment, risk assessment, economic evaluation, vulnerability assessments, resource accounting, cost-benefit analysis and outcome-based monitoring.
Asunto(s)
Acuicultura , Monitoreo del Ambiente , Eutrofización , Sedimentos Geológicos/química , Contaminantes del Agua/análisis , Animales , Grecia , Metales Pesados/análisis , Oligoelementos/análisis , Agua/químicaRESUMEN
An automated short path thermal desorption system gas chromatograph (GC) accessory was constructed to facilitate the unattended analysis of up to twelve individual samples. The system is personal computer controlled, operates directly on the GC with little or no modification, and was tested in both direct thermal and purge and trap thermal desorption mode. The apparatus was evaluated for overall performance, ruggedness, baseline blanks, efficiency, and precision. Mechanical performance was flawless and a clean baseline was obtained under high sensitivity GC-FID conditions. Linearity and precision was evaluated by quantifying butylated hydroxy toluene standards, safranal in saffron spice, and cinnamic aldehyde in cookies.
Asunto(s)
Cromatografía de Gases/instrumentación , Cromatografía de Gases/métodos , Análisis de los Alimentos/métodos , Odorantes/análisis , Adsorción , Calibración , Calor , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , VolatilizaciónRESUMEN
BACKGROUND: The discovery of a highly active catalase in Helicobacter pylori that in some strains may lose its activity has generated strong scientific interest. We have characterized a spontaneous catalase-negative isolate of H. pylori (UNSW-RU1) and sequenced katA in the parent strain and the promoters of both phenotypes as a prelude to understanding the genetic processes leading to the failure to express catalase. MATERIALS AND METHODS: Protein extracts from both phenotypes were examined for catalase on 2D-PAGE and analyzed by Western blot-based immuno-analysis. Presence of catalase mRNA was detected by Northern blot. Hi-Fidelity PCR was used to sequence the katA promoter while katA was sequenced using cycle-sequencing. The transcription start site was located by primer extension. RESULTS: Catalase protein was absent in UNSW-RU1 (KatA-) by 2D-PAGE and Western blot, as was catalase mRNA by Northern blot, indicating that the cause of the KatA- phenotype was at the level of transcription. No mutations were found in the promoter region of the KatA- isolate. The transcription start site was identified 55 bp upstream of the ATG site and putative RNA polymerase binding sites were mapped at "-10" and "-35". A Fur box was identified 181 bp upstream of the transcription start site. The sequences of an 876 bp ORF and a 366 bp Escherichia coli phnA homologue were identified. CONCLUSIONS: The UNSW-RU1 (KatA-) phenotype does not express KatA or transcribe katA. The absence of defects in its promoter and a large part of its ORF indicates that loss of activity may be due to a mutation in an accessory gene essential for catalase expression, or to the binding of a repressor preventing katA transcription.
Asunto(s)
Proteínas Bacterianas/análisis , Catalasa/análisis , Genes Bacterianos/genética , Helicobacter pylori/enzimología , Helicobacter pylori/genética , Secuencia de Aminoácidos , Proteínas Bacterianas/genética , Secuencia de Bases , Northern Blotting , Catalasa/genética , Humanos , Immunoblotting , Datos de Secuencia Molecular , Fenotipo , Técnica del ADN Polimorfo Amplificado Aleatorio , Análisis de Secuencia , Transcripción Genética/fisiologíaRESUMEN
The effects of metronidazole on catalase-positive and spontaneous catalase-negative mutants of Helicobacter pylori were studied to investigate whether the action of metronidazole on this microaerophilic organism occurs by reactive oxygen species generated by futile cycling or by the reduction of metronidazole to its active form. Increased sensitivity would be expected to occur in catalase-negative mutants if the mode of action of metronidazole was mediated through reactive oxygen species that may result from futile cycling of metronidazole. Two strains, RU1 and N6, were found to mutate spontaneously to a catalase-negative phenotype. The catalase-positive strain RU1(KatA+) and its catalase-negative counterpart RU1(KatA-) were sensitive to metronidazole, with MICs of 0.5 mg/L. The metronidazole-sensitive strain RU1(KatA-) lost viability at a rate similar to the parent RU1(KatA+) strain in the presence of 10 mg/L of metronidazole. Stable resistance to metronidazole was induced in RU1(KatA+) and RU1(KatA-) by passaging these strains in the presence of metronidazole. The catalase-positive and catalase-negative strains, N6(KatA+) and N6(KatA-), were resistant to metronidazole, with MICs of 96 mg/L. These observations indicated that the presence or absence of catalase activity did not affect the susceptibility of strains to metronidazole. The metabolism of metronidazole by H. pylori was investigated by 14N-NMR spectroscopy. Metronidazole was reduced in sensitive, catalase-positive and catalase-negative strains. Metronidazole-resistant cells reduced the 5-nitroimidazole more slowly, suggesting that resistance is achieved through the prevention or inhibition of metronidazole reduction.
Asunto(s)
Antibacterianos/farmacología , Helicobacter pylori/efectos de los fármacos , Metronidazol/farmacología , Antibacterianos/metabolismo , Catalasa/efectos de los fármacos , Catalasa/metabolismo , Farmacorresistencia Microbiana , Helicobacter pylori/enzimología , Helicobacter pylori/metabolismo , Metronidazol/metabolismo , Oxidación-Reducción , FenotipoRESUMEN
OBJECTIVE: To investigate the usefulness of dialysate IgG and C3 concentrations in predicting likelihood of developing peritonitis. DESIGN: Prospective, longitudinal, and comparative study. SETTING: Single university teaching hospital dialysis unit and outpatient clinic. PATIENTS: Thirty-four uremic patients were studied (20 males, 14 females: mean age 47.2, range 20-73 years). Monthly serum and overnight dialysate (eight- to eleven-hour dwell) samples were obtained for IgG and C3 estimations over the first six months of the study, and trimonthly samples were obtained thereafter. All patients performed exchanges using standard transfer sets (Baxter system II, Baxter Healthcare Ltd., Thetford, Norfolk, U.K.), used no hypertonic fluid (3.86%) for overnight exchanges, and were followed up for a minimum of 18 months. OUTCOME MEASURES: Dialysate and serum levels of IgG and C3; peritonitis episodes. RESULTS: Forty-five episodes of peritonitis occurred in 24 patients during the study period. We examined opsonin levels in the group as a whole, and then in two subgroups of patients: those who remained peritonitis-free throughout the study, and those who did not. There were no significant differences between IgG and C3 levels in the two groups at any time point, and large interpatient and intrapatient variation in levels were seen. CONCLUSION: Dialysate levels of IgG and C3 from the overnight dwell are not helpful in predicting the risk of developing continuous ambulatory peritoneal dialysis peritonitis in individual patients. No correlation was found between opsonin levels and onset of clinical peritonitis.
Asunto(s)
Complemento C3/análisis , Soluciones para Diálisis/química , Inmunoglobulina G/análisis , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/inmunología , Adulto , Anciano , Susceptibilidad a Enfermedades , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Estudios Prospectivos , Uremia/inmunología , Uremia/terapiaRESUMEN
Thromboembolism and infection remain potential threats for long-term circulatory assist and replacement devices. The alteration of the hemostatic system and of blood cell functions caused by device implantation may predispose the recipient to these complications. Many sensitive coagulation assays and the technology of flow cytometry would be powerful tools for this investigation. The availability of such immunologic technologies for animal species other than humans has yet to be established. In a series of in vitro tests we found that the following assays, among others, are usable in calves: TAT, TxB2, platelet surface glycoprotein IIbIIIa, and membrane aminophospholipid. F1.2, D-dimer, beta TG, PF-4, and platelet surface expression of GMP-140 and receptors for fibronectin, thrombospondin, and vWF were not measurable. A sustained mild decrease in hematocrit levels in six calves with the Cleveland Clinic-Nimbus total artificial heart for 11-120 days was attributed to an increase in circulating blood volume, but not to red blood cell damage. Whole blood platelet aggregation was suppressed only for the first 3 post operative days, with decreased GPIIbIIIa expression. Polymorphonuclear phagocytosis, chemotaxis, and superoxide anion production were not altered. Device infection and thromboembolism occurred in one of 13 cases overall.
Asunto(s)
Fenómenos Fisiológicos Sanguíneos , Corazón Artificial/efectos adversos , Animales , Recuento de Células Sanguíneas , Coagulación Sanguínea , Bovinos , Estudios de Evaluación como Asunto , Citometría de Flujo , Corazón Auxiliar/efectos adversos , Humanos , Técnicas In Vitro , Infecciones/sangre , Infecciones/etiología , Agregación Plaquetaria , Tromboembolia/sangre , Tromboembolia/etiologíaRESUMEN
Measurement of the circulating blood volume (CBV) is essential to a proper understanding of the hemodynamic performance of total artificial hearts (TAHs). Recently, the authors employed CBV measurements using indocyanine green dye in calves with a TAH. The advantages of this method over previous methods using radionuclides include simplicity, low cost, and the capability of repeated and frequent measurements. Reproducibility of the measurements was demonstrated in three normal calves with a relative standard deviation of 3.9 +/- 2.4%. CBV was measured in eight calves with the Cleveland Clinic-Nimbus TAH and compared with that of seven calves that underwent mitral valve replacement. Small standard deviations in pre operative values in both TAH and mitral valve replacement groups demonstrated the precision of CBV measurements. Although there was no change in CBV in the mitral valve replacement group, CBV in the TAH group increased to more than twice the pre operative value after 2 weeks. Although the right atrial pressure increased similarly after TAH implantation, there was no correlation (r = 0.08) between the right atrial pressure and CBV, which suggested a possible inaccuracy in estimating CBV from the right atrial pressure. A negative correlation between the hematocrit value and CBV suggested that hemodilution might be one of the causes of anemia observed in our TAH animals.
Asunto(s)
Volumen Sanguíneo , Corazón Artificial , Animales , Bioprótesis , Presión Sanguínea , Bovinos , Colorantes , Estudios de Evaluación como Asunto , Atrios Cardíacos , Prótesis Valvulares Cardíacas , Hematócrito , Verde de Indocianina , Masculino , Válvula Mitral/cirugía , Reproducibilidad de los ResultadosRESUMEN
Many cataract surgeons perform sutureless surgery to decrease operating time, postoperative astigmatism, and healing time. Anecdotal case reports of postoperative endophthalmitis after sutureless surgery prompted our investigation of this type of wound closure and its possible relationship to an increased incidence of infection. This in vitro study addressed the question: Is sutureless more likely than sutured cataract surgery to provide a route for inoculation of microbial organisms into the eye? Twenty-eight human eyes obtained postmortem were randomly divided into 14 pairs and successively incubated for 90, 150, 210, and 270 minutes each in a suspension of Staphylococcus epidermidis in physiologic media. Cultured aqueous aspirates yielded no significant differences between sutured and unsutured eyes in colony counts at any time interval. This suggests that both sutured and unsutured wounds resist bacterial ingrowth equally and that a properly constructed unsutured wound is not a significant valve for bacterial inoculation in an eye pressurized to physiological conditions.
Asunto(s)
Extracción de Catarata , Infecciones Bacterianas del Ojo/etiología , Infecciones Estafilocócicas/etiología , Staphylococcus epidermidis/fisiología , Técnicas de Sutura , Adulto , Anciano , Anciano de 80 o más Años , Humor Acuoso/microbiología , Cadáver , Extracción de Catarata/efectos adversos , Niño , Recuento de Colonia Microbiana , Endoftalmitis/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Técnicas de Sutura/efectos adversos , Cicatrización de HeridasRESUMEN
Cesarean section instrument tables are often not prepared in advance because of concern of contamination risk. The Association of Operating Room Nurses Standards decries the use of pre-preparation of surgical instrument tables because of this risk, although there are no scientific data to support this claim. We evaluated the contamination risk of pre-preparation of surgical instrument tables, prolonged table coverage and table uncovering using a specific technique referred to as the "sardine can roll." Colony counts were positive in only seven of 180 cultures (< or = 15 colonies per plate in each instance) from six tables evaluated after prolonged coverage or uncovering, or both. These data suggest that contamination risk is slight for the uncovering technique described herein and advance table preparation (24 hours or less, never recovered) is a reasonable clinical option in units in which table preparation reduces response time in emergent clinical situations, such as cesarean section for acute fetal distress.
Asunto(s)
Cesárea/instrumentación , Contaminación de Equipos/prevención & control , Enfermería de Quirófano/normas , Esterilización/métodos , Corynebacterium/aislamiento & purificación , Urgencias Médicas , Enterococcus/aislamiento & purificación , Femenino , Humanos , Staphylococcus/aislamiento & purificaciónRESUMEN
OBJECTIVE: To assess whether a renal graft outcome is dependent on the modality of dialysis prior to transplantation and to assess risk of peritonitis and catheter-related problems posttransplantation. DESIGN: Retrospect analysis of the outcome of a first cadaveric renal transplantation from hemodialysis (HD) and CAPD patients over a ten-year period. PATIENTS: Out of a total of 905 renal transplants over a ten-year period, 699 were first grafts; 500 of these (241 on CAPD, 259 on hemodialysis) were analyzed while the remaining (incomplete data, predialysis, pediatric) were assessed for graft and patient survival only. MAIN OUTCOME: Graft and patient survival cases were identical in the two groups (five-year graft survival: CAPD 67%, hemodialysis 66%; five-year patient survival: CAPD 88%, hemodialysis 87%). CAPD posttransplant was necessary in 37 patients, while 10 developed peritonitis mostly related to CAPD use and responded to appropriate therapy. Routine catheter removal posttransplant was undertaken between 8 and 12 weeks. CONCLUSION: Excellent graft and patient survival is achieved independent of the modality of dialysis prior to transplantation. Peritoneal dialysis can be used postgrafting, but there is a risk of peritonitis, which can be successfully managed with antibiotics and catheter removal. Great care is needed in executing the dialysis and catheter care after transplantation.
Asunto(s)
Trasplante de Riñón/mortalidad , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Adulto , Cadáver , Catéteres de Permanencia , Inglaterra/epidemiología , Femenino , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión , Masculino , Peritonitis/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
This study assessed the long-term (54 weeks) antihypertensive efficacy and safety of doxazosin in the treatment of mild or moderate essential hypertension, defined as sitting and standing diastolic blood pressure of 95 to 114 mm Hg. Of the 153 patients who successfully completed an initial 14-week trial, 61 continued uninterrupted into a 40-week extension study. Optimal antihypertensive efficacy was achieved by week 12 and maintained in all patients for the duration of 1 year. The final mean sitting blood pressure was 148/84 mm Hg and was reduced from a mean baseline level of 173/102 mm Hg. Occasional decreases in heart rate were observed, but these were not considered to be clinically relevant (1 to 3 beats/min). The mean final dose of doxazosin for patients evaluable for efficacy was 2.4 mg/day; 91.7% of patients were taking less than or equal to 4 mg/day. No increase in daily maintenance dose was observed from the initial phase to the long-term extension study. After 1 year of treatment, 93.3% of patients were considered a therapeutic success (sitting diastolic blood pressure greater than or equal to 10 mm Hg reduction from baseline or less than or equal to 90 mm Hg with greater than or equal to 5 mm Hg reduction). In no patients was there a worsening in the severity category of the hypertension. Total serum cholesterol concentrations were reduced significantly (6.6% p = 0.03) at the end of week 14. Reductions in total serum cholesterol levels persisted throughout the extension study, with a final reduction of 5.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Prazosina/análogos & derivados , Antihipertensivos/administración & dosificación , Colesterol/sangre , Doxazosina , Quimioterapia Combinada , Medicina Familiar y Comunitaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prazosina/administración & dosificación , Prazosina/uso terapéutico , Factores de TiempoRESUMEN
In the 20-year period from March 1968 to March 1988, 860 patients received 1001 renal transplants in the Northwestern Regional Renal Transplant Unit at Manchester Royal Infirmary. Through a continuing policy of avoiding mismatches for HLA antigens and lymphocytotoxic antibody crossmatching, transplant survival rates were found to correlate with the degree of HLA-A and B antigen mismatching from 1968 to 1978 and with HLA-B and DR antigen mismatching from 1979 to 1988. Mismatching for HLA-B and DR antigens was also found to correlate with transplant survival in highly sensitized patients and in patients transplanted since 1981, the "cyclosporine era." Recipients who were HLA-DR1 positive were found to have the highest graft survival compared to recipients negative for this antigen. In contrast, HLA-DR3 positive recipients had the poorest outcome. Transplants from HLA-DRw6 positive donors showed higher transplant survival rates than donor kidneys positive for any other HLA-DR antigen. A correlation of transplant survival with HLA-B and DR mismatching was seen whether kidneys were collected within our region or received through the UK Transplant Service. We conclude that avoidance of mismatching for HLA-B and DR antigens confers high transplant survival rates (91.1% at 5 years for 0 HLA-B and DR mismatches), and in order to achieve this rate for most recipients exchange of donor kidneys between transplant centers will be essential.
Asunto(s)
Antígenos HLA/análisis , Prueba de Histocompatibilidad , Trasplante de Riñón , Adolescente , Adulto , Cadáver , Niño , Preescolar , Inglaterra , Supervivencia de Injerto , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-DR/genética , Humanos , Lactante , Persona de Mediana Edad , Fenotipo , Donantes de TejidosRESUMEN
We report a case of invasive cryptococcosis complicating continuous ambulatory peritoneal dialysis and its successful treatment. This form of infection has not been previously described.
Asunto(s)
Criptococosis/etiología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Anfotericina B/uso terapéutico , Anticuerpos Antifúngicos/análisis , Antígenos Fúngicos/líquido cefalorraquídeo , Criptococosis/tratamiento farmacológico , Cryptococcus neoformans/inmunología , Cryptococcus neoformans/aislamiento & purificación , Flucitosina/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An in situ biotinylated DNA probe assay was evaluated as an adjunct to anti-cytomegalovirus early nuclear antigen indirect immunofluorescence and cytopathic effect on cytomegalovirus-infected monolayers in shell vial cultures. Viral infection was detected by early nuclear antigen indirect immunofluorescence at 24 h and by DNA probe assay and shell vial cytopathic effect at 5 days.