Morbidity,mortality, and management of methicillin-resistant S. aureus bacteremia in the USA: update on antibacterial choices and understanding

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with significant healthcare costs, morbidity, and mortality in the United States. Complications of MRSA bacteremia include infective endocarditis, osteomyelitis, and sepsis, all of which are difficult to treat. Time to effective therapy and antibacterial choice greatly affect patient outcomes. Vancomycin and daptomycin remain first-line therapies; however, reports of vancomycin-associated treatment failure and reduced daptomycin susceptibility highlight the need to define alternative strategies for MRSA bacteremia treatment. In addition, several patient- and pathogen-specific factors influence the outcomes of MRSA bacteremia. It is, therefore, critical to explore the interaction between host- and pathogen-specific factors and its effect on MRSA bacteremia pathogenesis and mortality. This review discusses the factors that drive the development of MRSA bacteremia and examines alternative treatment strategies.     

Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups

Objective : The use of protein S100B as a marker of brain cell injury in conjunction with cardiopulmonary bypass (CPB) has recently been questioned. The present study investigates functional brain injury based on the relation between S100B and memory disturbances. Methods : Four hundred and fifteen low-risk coronary artery bypass patients exposed to CPB were examined. The protein S100B was sampled during and after surgery. Explicit and implicit memory function was assessed preoperatively and at discharge from hospital. Possible associations between the release of the protein S100B and memory function were studied. Results : Serum concentration of S100B peaked at termination of CPB (0.895 &#45 0.84 µ g/l) and decreased gradually; 7 h post CPB (0.436 &#45 0.59 µ g/l), day 1 (0.149 &#45 0.27 µ g/l) and day 2 (0.043 &#45 0.15 µ g/l). High levels of S100B (>1.5 µ g/l) 7 h post CPB were associated with a significant (-1 SD) decline of explicit memory function ( p = 0.006); this was not seen at termination of CPB ( p = 0.834). Predictors of memory decline were S100B 7 h post CPB, length of stay in hospital and concomitant neurological disorders. Postoperative S100B concentration was higher among patients with atrial fibrillation ( p = 0.022). Conclusion : Only high levels of protein S100B found 7 h post CPB were associated with decline of explicit memory function, not the release seen during CPB. Thus, when using protein S100B, only values several hours remote from surgery should be used as a brain cell injury marker.     

影响科技查新工作质量因素分析

本文对科技查新过程中科技查新点的提炼与归纳,查新检索用词及查新结论撰写几个方面进行探讨,分析影响查新工作质量因素的主要原因,分析其不足之处,并提出建议,力争在提高查新工作质量方面做出努力,确保查新工作质量的准确性。     

Association of Prehospital Step 1 Vital Sign Criteria and Vital Sign Decline with Increased Emergency Department and Hospital Death

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On the development of the European S3 guidelines on the systemic treatment of psoriasis vulgaris: structure and challenges

Background The development of evidence based guidelines is a demanding and time consuming process. Therefore it is important to share the knowledge and discuss the structure of these guidelines in detail. Objectives To present a method report on the development process of the European evidence based guidelines on the systemic treatment of psoriasis vulgaris with the aim to offer guidance to other guidelines groups with lesser experience and to critically appraise the methodology of the guidelines development process. Methods The guidelines are based on the previously evaluated literature from three European national evidence based guidelines and an additional systematic search and evaluation of new literature. Further steps included a structured consensus conference and a DELPHI procedure to develop the recommendations, as well as several internal and external reviews. All steps were coordinated by the Division of evidence based medicine in cooperation with a group of methodologists. Results A total of 114 studies were included, serving as base for the efficacy chapters of the intervention. The recommendations, based on the efficacy and the level of evidence of the included studies were discussed and finally consented by the guidelines group. After subsequent reviews the guidelines were presented to the European Dermatology Forum, European Academy of Dermatology and Venereology and Union Européenne des Médicins Spécialistes for approval and published in October 2009. Conclusion The development of European evidence based guidelines requires a coordinated structure which can be achieved by the integration of an experienced group of methodologists. Nevertheless further improvements are imaginable and might be considered for an update or other European evidence based guidelines.     

Molecular and structural basis of steroid hormone binding and release from corticosteroid-binding globulin

Corticosteroid-binding globulin (CBG), a non-inhibitory member of the serine proteinase inhibitor (serpin) super-family, is the high-affinity transport protein for glucocorticoids in vertebrate blood. Plasma CBG is a glycoprotein with 30% of its mass represented by N-linked oligosaccharide chains. Its well-characterized steroid-binding properties represent a “bench-mark data set” used extensively for in silico studies of protein–ligand interactions and drug design. Recent crystal structure analyses of intact rat CBG and cleaved human CBG have revealed the precise topography of the steroid-binding site, and shown that cortisol-bound CBG displays a typical stressed (S) serpin conformation with the reactive center loop (RCL) fully exposed from the central β-sheet A, while proteolytic cleavage of the RCL results in CBG adopting a relaxed (R) conformation with the cleaved RCL fully inserted within the protein core. These crystal structures have set the stage for mechanistic studies of CBG function which have so far shown that helix D plays a key role in coupling RCL movement and steroid-binding site integrity, and provided evidence for an allosteric mechanism that modulates steroid binding and release from CBG. These studies have also revealed how the irreversible release of steroids occurs after proteolysis and re-orientation of the RCL within the R conformation. This recent insight into the structure and function of CBG reveals how naturally occurring genetic CBG mutations affect steroid binding, and helps understand how proteolysis of CBG enhances the targeted delivery of biologically active steroids to their sites of action.     

Ontogeny of the Shell Bones of Embryos of Podocnemis unifilis (Troschel, 1848) (Testudines,Podocnemididae)

The aim of the present study was to investigate the sequence of shell bone formation in the embryos of the Pleurodira, Podocnemis unifilis. Their bones and cartilage were collected and cleared before staining. The shell was also examined by obtaining a series of histological slices. All the bony elements of the plastron have independent ossification centers, which subsequently join together and retain two fontanelles until the period of hatching. This turtle has a mesoplastra, which is characteristic of the Podocnemididae. The carapace begins to form concurrently with the ossification of the ribs at the beginning of stage 20. All the plates, except the suprapygal, initiate ossification during the embryonic period. The main purpose of the histological investigation was to highlight the relationship between the formation of the carapace and ribs with that of the neural plates. The costal and neural plates were found not to independent ossification centers, but to be closely related to components of the endoskeleton, originating as expansions of the perichondral collar of the ribs and the neural arches, respectively. Considering the ribs as an endoskeletal element of the carapace, the carapace and plastron begin ossification at the same stage in P. unifilis. This pattern reveals similarities with other Pleurodira, as well as evident variations, such as the presence of the seven neural bones and the presence of only one ossification center in the nuchal plate. Anat Rec, 2011. © 2011 Wiley‐Liss, Inc.     

Lateral Medullary Infarct Presenting as Acute Dysphagia

Lateral medullary infarct (LMI) usually presents with a variety of neurological features. We describe a case of LMI in which acute dysphagia was the only initial symptom. This typical neurological syndrome is very unlikely to be found during ENT practice; however, it needs to be considered among the differential diagnoses when encountering dysphagia of uncertain origin.     

Benzocaine-induced methemoglobinemia in an acute-exposure rat model

Tricaine methanesulfonate, a sedative for temporarily immobilizing fish, has a 21-day withdrawal time. Benzocaine has been proposed as an alternative sedative because a withdrawal period may not be required. Since benzocaine is known to induce methemoglobinemia, the potential for orally administered benzocaine to induce methemoglobin was assessed in rats. Sprague-Dawley rats were given a single gavage administration of 64 mg benzocaine hydrochloride per kg bw and then euthanized at intervals up to 120 min. Plasma levels of benzocaine were relatively low at all times, whereas methemoglobin peaked at 24 min. Additional rats were orally gavaged with 0-1024 mg benzocaine hydrochloride per kg bw and euthanized after 24 min. Plasma levels of benzocaine increased from 0.01 μM at 2 mg per kg bw to 2.9 μM at 1024 mg per kg bw. Methemoglobin levels did not differ from controls at doses up to 32 mg per kg bw in females and 64 mg per kg bw in males, whereupon the value increased to ∼80% at 1024 mg per kg bw. These data were used to estimate the potential impact of benzocaine residues in fish and suggest that the consumption of fish treated with benzocaine hydrochloride will not cause methemoglobinemia in humans.