Distributed abstraction and verification of an installed optical fibre network.

The management of wavelength routed optical mesh networks is complex with many potential light path routes and numerous physical layer impairments to transmission performance. This complexity can be reduced by applying the ideas of abstraction from computer science where different equipment is described in the same basic terms. The noise-to-signal ratio can be used as a metric to describe the quality of transmission performance of a signal propagated through a network element and accumulates additively through a sequence of such elements allowing the estimation of end-to-end performance. This study aims to explore the robustness of the noise-to-signal ratio metric in an installed fibre infrastructure. We show that the abstracted noise-to-signal ratio is independent of the observers and their location. We confirm that the abstracted noise-to-signal ratio can reasonably predict the performance of light-paths subsequently set in our network. Having a robust network element abstraction that can be incorporated into routeing engines allows the network management controller to make decisions on the most effective way to use the network resources in terms of the routeing and data coding format.

Is reduced vancomycin susceptibility a factor associated with poor prognosis in MSSA bacteraemia?

OBJECTIVES: The known data about the influence of vancomycin MIC on Staphylococcus aureus bacteraemia are contradictory. Our objective was to study the possible impact of vancomycin MIC ≥1.5 mg/L on short- and medium-term mortality. METHODS: A prospective cohort study was carried out from March 2008 to January 2011 on adult patients with MSSA bacteraemia admitted to a tertiary hospital located in Seville (Spain). We studied the relationship between vancomycin MIC, accessory gene regulator (agr) type and absence of δ-haemolysin and poor prognosis. All isolates were genotyped by PFGE. Multivariate analysis, including a propensity score for having a vancomycin MIC of ≥1.5 mg/L, was performed by Cox regression. RESULTS: One hundred and thirty-five episodes of bacteraemia due to MSSA were included in the analysis. Twenty-nine (21.5%) isolates had a vancomycin MIC of ≥1.5 mg/L by Etest. There were no differences in agr distribution or absence of δ-haemolysin between isolates with reduced vancomycin susceptibility (RVS) and those without. RVS was not more frequent in specific clones; RVS was not associated with higher 14 or 30 day crude mortality (relative risk = 0.44, 95% CI = 0.14-1.35; and relative risk = 1.01, 95% CI = 0.52-1.96) rates, and it did not show higher rates of complicated bacteraemia (14.2% versus 13.8%, P = 0.61). Cox regression analysis did not significantly modify the results for 14 day mortality (HR = 0.39, 95% CI = 0.11-1.34) or 30 day mortality (HR = 0.89, 95% CI = 0.39-2.04). CONCLUSIONS: Contrary to previously published data, we did not find a relationship between RVS and higher mortality in patients with MSSA bacteraemia and we did not find a link with higher complicated bacteraemia rates.

Clinical and molecular epidemiology of meticillin-resistant Staphylococcus aureus causing bacteraemia in Southern Spain.

BACKGROUND: Some molecular features of meticillin-resistant Staphylococcus aureus (MRSA) isolates causing invasive infections have been shown to have clinical implications. There is a need to monitor the situation using a combination of molecular and clinical data because, although MRSA clones tend to predominate over wide geographical areas, clonal shifts may take place. AIM: To study the epidemiological features and perform molecular characterization of a retrospective cohort of 98 cases of nosocomial and healthcare-associated MRSA bacteraemia in 10 hospitals in Andalusia, Spain. METHODS: Relatedness of isolates was investigated using pulsed-field gel electrophoresis (PFGE), S. aureus protein A (spa) typing and clonal complex (CC) assignment. Staphylococcal chromosomal cassette mec (SCCmec) type and accessory gene regulator (agr) group were studied by polymerase chain reaction. agr function was assessed. RESULTS: Most isolates were CC5, SCCmec type IV and agr group II. The most common spa type was t067. Six major clusters were identified by PFGE. Six small clusters of epidemiologically related cases sharing isolates from the same PFGE subtype were identified. Five percent of isolates had a vancomycin minimum inhibitory concentration (MIC) of 2 µg/mL on broth microdilution, although 44% had an MIC >1 µg/mL on E-test. Variables independently associated with MIC >1 mg/L on E-test were surgery during present admission and Charlson index ≥2. CONCLUSION: A specific CC that has been predominant in Spain over the last decade caused most of the cases in this study. PFGE was more discriminatory than spa typing in showing clusters of epidemiologically related cases. Some patient features were associated with vancomycin MIC >1 mg/L on E-test.

Inflamación granulomatosa por reacción de cuerpo extraño en estudio de PET/TAC con FDG en un paciente con recidiva tumoral de carcinoma colorrectal / Foreign body granulomatous inflammation in PET/CT scan study with FDG in a patient withtumor recurrence of colorectoral carcinoma

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[Role of FDG PET in the staging, recurrence and treatment response to imatinib (Glivec) in patients with gastrointestinal stromal tumors]. / Utilidad de la PET con FDG en el estudio de estadificación inicial, recurrencia y respuesta al tratamiento con imatinib (Glivec) en pacientes diagnosticados de un tumor del estroma gastrointestinal.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) account for almost 4 % of all gastrointestinal neoplasms. Recently, a new type of tyrosine kinase inhibitor (Glivec), has been successfully used in patients with metastasic or unresectable disease. The aim of the study is to show the utility of PET in the staging, recurrence and treatment response to Glivec in GIST tumors. MATERIALS AND METHODS: 48 whole body FDG-PET studies in 27 patients with GIST (19 men/mean age = 56 y) were evaluated for initial staging (n = 13), recurrence (n = 15) or treatment response to Glivec (n = 20). Images were acquired in a whole body 2D mode using attenuation correction on an Advance Nxi G.E.MS camera and were evaluated visually and quantatively using SUV analysis. Results were compared with radiological findings, hystological confirmation or follow-up. RESULTS: In the initial staging evaluation, FDG-PET shows a more extensive disease than suspected in 3/10 patients. In other 3 patients PET ruled out mesenteric or peritoneal disease. In the evaluation of treatment response to Glivec, FDG-PET showed a good response in eleven patients (complete response in seven and partial response in four). In this group a sixty percent decrease of the SUV max was assessed. Two patients showed no response to Glivec at doses of 400 mg or 800 mg, showing a stable SUV value and/or increased in some abdominal lesions. PET detected recurrence in one patient. CONCLUSIONS: This study show how FDG-PET is accurate in the early treatment response to Glivec. PET could be helpful in the staging and recurrence of GIST tumors.

Utilidad de la PET con FDG en el estudio de estadificación inicial, recurrencia y respuesta al tratamiento con imatinib (Glivec) en pacientes diagnosticados de un tumor del estroma gastrointestinal / Role of FDG PET in the staging, recurrence and treatment response to imatinib (Glivec) in patients with gastrointestinal stromal tumors

ntroducción. Los tumores del estroma gastrointestinal (GIST) pueden presentarse como una enfermedad diseminada. Un inhibidor de la tirosina-quinasa (Glivec) ha obtenido respuestas espectaculares en pacientes con enfermedad irresecable. El objetivo de este estudio fue mostrar la utilidad de la tomografía por emisión de positrones-fluorodesoxiglucosa (PET-FDG) en la estadificación inicial, en la recurrencia y en la valoración precoz de la respuesta al Glivec. Material y métodos. Realizamos 48 estudios con PET en 27 pacientes (19 varones/edad media = 56a): estadificación inicial (n = 13), valoración de enfermedad recurrente (n = 15) y respuesta al tratamiento con imatinib (n = 20). La valoración de los estudios se realizó mediante análisis visual y semicuantitativo (SUV [standardized uptake value]). Los resultados se confirmaron mediante seguimiento, pruebas de imagen y/o histología. Resultados. En la estadificación inicial, la PET mostró una mayor extensión de la enfermedad en 3/10 de los pacientes evaluados. En otros 3 pacientes evitamos la administración adyuvante de imatinib. La PET mostró una correcta respuesta terapéutica en once de los trece pacientes evaluados (completa en siete y parcial en cuatro). La disminución media del SUV en los respondedores parciales fue del 60 %. Dos pacientes no mostraron disminución de la captación del trazador con dosis de 400 ni de 800 mg de Glivec, permaneciendo el SUV estable y/o aumentado la intensidad de captación en algunas lesiones. Asimismo, la PET detectó una recurrencia tumoral en un paciente. Conclusiones. Este estudio muestra cómo la PET-FDG es una técnica útil en la valoración precoz de la respuesta terapéutica al imatinib. La PET puede ser también eficaz en la detección y re-estadificación de la enfermedad recurrente

Introduction. Gastrointestinal stromal tumors (GISTs) account for almost 4 % of all gastrointestinal neoplasms. Recently, a new type of tyrosine kinasa inhibitor (Glivec), has been successfully used in patients with metastasic or unresectable disease. The aim of the study is to show the utility of PET in the staging, recurrence and treatment response to Glivec in GIST tumors. Materials and methods. 48 whole body FDG-PET studies in 27 patients with GIST (19 men/mean age = 56 y) were evaluated for initial staging (n = 13), recurrence (n = 15) or treatment response to Glivec (n = 20). Images were acquired in a whole body 2D mode using attenuation correction on an Advance Nxi G.E.MS camera and were evaluated visually and quantatively using SUV analysis. Results were compared with radiological findings, hystological confirmation or follow-up. Results. In the initial staging evaluation, FDG-PET shows a more extensive disease than suspected in 3/10 patients. In other 3 patients PET ruled out mesenteric or peritoneal disease. In the evaluation of treatment response to Glivec, FDG-PET showed a good response in eleven patients (complete response in seven and partial response in four). In this group a sixty percent decrease of the SUV max was assessed. Two patients show not response to Glivec at doses of 400 mg neither 800 mg, showing an stable SUV value and/or increased in some abdominal lesions. PET detected recurrence in one patient. Conclusions. This study show how FDG-PET is accurate in the early treatment response to Glivec. PET could be helpful in the staging and recurrence of GIST tumors

[Rectosigmoid endometriosis with lymph node involvement]. / Endometriosis de rectosigma con afección de los ganglios linfáticos.

Endometriosis mainly affects women of a fertile age and is usually located in the pelvis. Extrapelvic involvement is less frequent. We present the case of a female patient with endometriosis of the rectosigmoid and mesenteric lymph nodes, which is an extremely rare finding. Although the most widely accepted theory of the pathogenesis of this disease postulates retrograde menstruation through the Fallopian tubes with subsequent implantation in the peritoneum, these findings support lymphatic dissemination of endometrial cells as a theory of pathogenesis in cases of extrapelvic involvement.

Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains.

Sulbactam and imipenem were compared in an experimental pneumonia model in immunocompetent mice, using a susceptible strain of Acinetobacter baumannii, and in an experimental endocarditis model in rabbits, using an intermediately susceptible strain. In the former, sulbactam was as efficacious as imipenem in terms of survival, sterility of lungs and in the bacterial clearance from lungs and blood, provided that the t > MIC for sulbactam (1.84 h) was similar to that for imipenem (2.01 h). In the endocarditis model, imipenem (t > MIC, 2.12 h) was more efficacious than sulbactam (t > MIC, 1.17 h) in bacterial clearance from vegetations. These results show the efficacy of sulbactam in infections caused by susceptible strains of A. baumannii, with an MIC up to 4 mg/L, provided that doses reach a t > MIC similar to that of imipenem. The activity of sulbactam was time dependent.

Epidemiología de la dispepsia en una comunidad del sur de España. Prevalencia de la infección por Helicobacter pylori / Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection

OBJETIVO: la verdadera prevalencia de la dispepsia en la comunidad es poco conocida, pues la mayoría de los estudios se han realizado sobre muestras no representativas de la -población general. El objetivo fue estudiar la prevalencia de la dispepsia en una muestra aleatoria de una población general, así como sus características sociodemográficas y epidemiológicas. DISEÑO EXPERIMENTAL Y PARTICIPANTES: se realizó un estudio epidemiológico prospectivo basado en una encuesta directa y personal en una muestra de 264 sujetos, elegida al azar, entre una población del sur de España. RESULTADOS: la prevalencia de dispepsia fue del 24 por ciento, sin apreciarse relación entre ésta y diversos parámetros demográficos, hábitos tóxicos o subgrupos de dispepsia. El 49 por ciento de la población se automedicaba y el 44 por ciento acudió en busca de ayuda médica por su dispepsia. Mostraron un síndrome de intestino irritable 36 sujetos (13,6 por ciento) y 20 de ellos referían también síntomas de dispepsia (55,5 por ciento). Habían sido investigados 40 sujetos con dispepsia (80 por ciento mediante radiología con papilla de bario, 45 por ciento con ecografía y 18 por ciento con gastroscopia), obteniéndose un diagnóstico de enfermedad orgánica en el 45 por ciento de ellos. El subgrupo de dispepsia similar a reflujo gastroesofágico fue el más frecuente (60 por ciento), observándose un amplio solapamiento entre los diversos subgrupos de dispepsia. Los anti-H. Pylorí-IgG fueron positivos en el 52 por ciento, pero no hubo relación entre la infección bacteriana y la presencia de dispepsia. CONCLUSIONES: la dispepsia afecta a una cuarta parte de nuestra población, asociándose a síndrome de intestino irritable en la mitad de los casos, pero sin relación con la presencia de una infección por H. pylori (AU)

Imipenem, doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia.

Acinetobacter baumannii is a common cause of nosocomial pneumonia and other nosocomial infections. Multiresistant A. baumannii has also a high prevalence, which can make effective treatment difficult. We designed a new model of A. baumannii experimental pneumonia using C57BL/6 immunocompetent mice. This model was used to compare the efficacy of imipenem, doxycycline and amikacin in monotherapy, and the combination of imipenem plus amikacin and doxycycline plus amikacin. Doxycycline plus amikacin were synergic in vitro after 24 h incubation, whereas imipenem plus amikacin showed no in vitro synergy. The number of sterile lungs and the lung clearance of A. baumannii were greater in the group treated with imipenem than in those treated with amikacin or doxycycline in monotherapy (P < 0.05). The combination of imipenem plus amikacin and doxycycline plus amikacin was no more effective than imipenem alone in the clearance of organisms from lungs (2.42 +/- 1.46 cfu/g versus 2.7 +/- 1.5 cfu/g versus 1.23 +/- 1.02 cfu/g). These results suggest that the addition of amikacin does not improve the results obtained by imipenem monotherapy. Doxycycline plus amikacin is an alternative to imipenem in the therapy of A. baumannii pneumonia.

Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection.

AIM: The prevalence of dyspepsia in the community is poorly known, because most studies have used samples that were not representative of the general population. This study was intended to determine the prevalence of dyspepsia in a random sample of the general population, and its epidemiologic and sociodemographic characteristics. METHODS: In this descriptive study we used a questionnaire administered during a personal interview to survey a random sample of 264 subjects in a Mediterranean population. RESULTS: The prevalence of dyspepsia was 24%; we found no relation between prevalence and demographic characteristics, smoking and drinking, or type of dyspepsia. Forty subjects with dyspepsia were examined and the specific diagnosis was found in 18 (45%) of them. The subgroup with reflux-like dyspepsia was the largest (60%), although there was considerable overlap between subgroups with reflux-like, ulcer-like and dysmotility-like dyspepsia. Anti-Helicobacter pylori antibodies (IgG) were found in 52% of the subjects, but bacterial infection was not related with dyspepsia. CONCLUSIONS: Up to one-fourth of the general population in the city where the subjects reside may have dyspepsia. This disorder was associated with irritable bowel syndrome in half of the cases, but was not associated with H. pylori infection.

[Congenital aneurysm of the sinus of Valsalva ruptured to right ventricle with a ventricular septal defect and aortic regurgitation]. / Aneurisma congénito del seno de Valsalva roto a ventrículo derecho, comunicación interventricular e insuficiencia aórtica.

We report the case of a patient with a congenital aneurysm of the sinus of Valsalva ruptured in the right ventricle, aortic valvular regurgitation and ventricular septal defect that remained asymptomatic for many years and presented clinically with severe volume overload of the heart and congestive heart failure. We describe the anatomic, echocardiographic and angiographic findings of this unusual entity with a review of the literature.

[A hydatid cyst in the vena cava inferior and right atrium with venous flow obstruction and pulmonary dissemination]. / Quiste hidatídico en vena cava inferior y aurícula derecha con obstrucción del flujo venoso y diseminación pulmonar.

We report the case of a 62-year-old female patient operated for a hepatic hydatid cyst that years later was found to have a hydatid cyst in the inferior vena cava and right atrium that was the source of disseminated pulmonary spread of the disease and occlusion of the inferior vena cava blood flow. Cardiac hydatid disease is very uncommon and is frequently associated with a poor prognosis. The literature for hydatid disease of the heart is reviewed and the clinical and echocardiographic relevant findings of this patient are discussed.

Metabolism of L-phenylalanine and L-tyrosine by the phototrophic bacterium Rhodobacter capsulatus.

The phototrophic bacterium Rhodobacter capsulatus utilizes the aromatic amino acids L-phenylalanine and L-tyrosine as nitrogen source. L-Phenylalanine is hydroxylated to L-tyrosine, which is further converted into p-hydroxyphenyl pyruvate (pHPP) by a transamination reaction. The bacterium is unable to grow at the expense of these amino acids as the sole carbon source, although it is able to degrade them to homogentisate, probably by unspecific hydroxylation reactions. Metabolization of L-phenylalanine or L-tyrosine as nitrogen source requires phototrophic growth conditions and does not produce free ammonium inside the cells. A low aminotransferase activity with 2-oxoglutarate and L-tyrosine as substrates can be detected in crude extracts of R. capsulatus. Uptake of both amino acids by R. capsulatus was completely inhibited by ammonium addition, which also prevents aminotransferase induction.

Irritable bowel syndrome in patients with dyspepsia: a community-based study in southern Europe.

OBJECTIVES: Dyspepsia and irritable bowel syndrome (IBS) share aetiopathogenic factors, and may therefore be part of a single disorder. This study was intended to determine their prevalence in the general population, and the degree of overlap between these two digestive disorders. DESIGN: Descriptive study. METHODS: A sample of 264 subjects chosen randomly from the population census of a city in Spain, and considered representative of the general population in this city, was surveyed by questionnaire. RESULTS: The prevalence of dyspepsia was 23.9%, and that of IBS was 13.6%. Of the subjects with dyspepsia, 31.6% had IBS, and of the subjects with IBS, 55.6% reported symptoms of dyspepsia. The prevalence of IBS was higher among subjects with dyspepsia (31.7%) than among those who reported no symptoms of dyspepsia (7.9%; P < 0.05). Moreover, the prevalence of IBS was similar in three subgroups identified according to the type of dyspepsia described (ulcer-like, reflux-like or dysmotility-like). When we compared subjects with both dyspepsia and IBS and those with dyspepsia alone, we found no significant differences in clinical characteristics except for abdominal pain and fear of cancer, which were more frequent in the former. Of the entire sample, 27.7% of the subjects sought medical attention for IBS and 17% missed work because of IBS. CONCLUSION: Our findings suggest that functional dyspepsia and IBS are two manifestations of a single, more extensive digestive system disorder.

Degradation of p-nitrophenol by the phototrophic bacterium Rhodobacter capsulatus.

The phototrophic bacterium Rhodobacter capsulatus detoxified p-nitrophenol and 4-nitrocatechol. The bacterium tolerated moderate concentrations of p-nitrophenol (up to 0.5 mM) and degraded it under light at an optimal O2 pressure of 20 kPa. The bacterium did not metabolize the xenobiotic in the dark or under strictly anoxic conditions or high O2 pressure. Bacterial growth with acetate in the presence of p-nitrophenol took place with the simultaneous release of nonstoichiometric amounts of 4-nitrocatechol, which can also be degraded by the bacterium. Crude extracts from R. capsulatus produced 4-nitrocatechol from p-nitrophenol upon the addition of NAD(P)H, although at a very low rate. A constitutive catechol 1, 2-dioxygenase activity yielding cis,cis-muconate was also detected in crude extracts of R. capsulatus. Further degradation of 4-nitrocatechol included both nitrite- and CO2-releasing steps since: (1) a strain of R. capsulatus (B10) unable to assimilate nitrate and nitrite released nitrite into the medium when grown with p-nitrophenol or 4-nitrocatechol, and the nitrite concentration was stoichiometric with the 4-nitrocatechol degraded, and (2) cultures of R. capsulatus growing microaerobically produced low amounts of 14CO2 from radiolabeled p-nitrophenol. The radioactivity was also incorporated into cellular compounds from cells grown with uniformly labeled 14C-p-nitrophenol. From these results we concluded that the xenobiotic is used as a carbon source by R. capsulatus, but that only the strain able to assimilate nitrite (E1F1) can use p-nitrophenol as a nitrogen source.