Light propagation from fluorescent probes in biological tissues by coupled time-dependent parabolic simplified spherical harmonics equations

We introduce a system of coupled time-dependent parabolic simplified spherical harmonic equations to model the propagation of both excitation and fluorescence light in biological tissues. We resort to a finite element approach to obtain the time-dependent profile of the excitation and the fluorescence light fields in the medium. We present results for cases involving two geometries in three-dimensions: a homogeneous cylinder with an embedded fluorescent inclusion and a realistically-shaped rodent with an embedded inclusion alike an organ filled with a fluorescent probe. For the cylindrical geometry, we show the differences in the time-dependent fluorescence response for a point-like, a spherical, and a spherically Gaussian distributed fluorescent inclusion. From our results, we conclude that the model is able to describe the time-dependent excitation and fluorescent light transfer in small geometries with high absorption coefficients and in nondiffusive domains, as may be found in small animal diffuse optical tomography (DOT) and fluorescence DOT imaging.     

Cultures of sternal wound and mediastinum taken at the end of heart surgery do not predict postsurgical mediastinitis

The aim of the study was to assess of the role of intraoperative cultures taken at the end of major heart surgery (MHS) in the prediction of postoperative mediastinitis (PM) in patients undergoing MHS over a 6-month period in a tertiary university hospital. Just before wound closure, a sample of the sternal border was taken, swabbing back and forth the sternal border and the subcutaneous tissues. A second sample was taken after irrigation of the deep mediastinal structures with 10 mL of Ringer lactate. Swabs were processed semiquantitatively and the mediastinal fluid with a quantitative technique. The observation of one or more colonies per plate was considered a positive culture. Cultures obtained at the end of 229 surgical interventions (227 patients) were positive with the semiquantitative or with the quantitative procedures in 31.0% (95% confidence interval [CI], 25.1-37.4%) and 34.5% (95% CI, 28.4-41.0%) of the times, respectively (P = NS). The number of microorganisms isolated in the wound swab or mediastinal fluid was 91 and 110, respectively. Of the 227 patients, 7 developed an episode of PM (3.1%; 95% CI, 1.2-6.2%) after a median time of 11 days (range, 5-19 days). The microorganisms causing the 7 cases of mediastinitis were not isolated in the intraoperative cultures in any of the cases. The value of intraoperative cultures as a test for prediction of PM depending on the breakpoint chosen were as follows: sensitivity (0%), specificity (66.2-97.3%), and positive (0%) and negative predictive values (96.8-98.0%). We recommend against surveillance cultures taken intraoperatively in patients undergoing MHS.     

Genotypic diversity of coagulase-negative staphylococci causing endocarditis: a global perspective

Coagulase-negative staphylococci (CNS) are important causes of infective endocarditis (IE), but their microbiological profiles are poorly described. We performed DNA target sequencing and susceptibility testing for 91 patients with definite CNS IE who were identified from the International Collaboration on Endocarditis-Microbiology, a large, multicenter, multinational consortium. A hierarchy of gene sequences demonstrated great genetic diversity within CNS from patients with definite endocarditis that represented diverse geographic regions. In particular, rpoB sequence data demonstrated unique genetic signatures with the potential to serve as an important tool for global surveillance.     

BK virus infection in human immunodeficiency virus-infected patients

The aim of this study is to evaluate the prevalence of BK virus (BKV) infection in HIV-positive patients receiving highly active antiretroviral therapy (HAART) in our hospital. The presence of BKV was analysed in urine and plasma samples from 78 non-selected HIV-infected patients. Clinical data were recorded using a pre-established protocol. We used a nested PCR to amplify a specific region of the BKV T-large antigen. Positive samples were quantified using real-time PCR. Mean CD4 count in HIV-infected patients was 472 cells/mm3 and median HIV viral load was <50 copies/mL. BKV viraemia was detected in only 1 HIV-positive patient, but 57.7% (45 out of 78) had BKV viruria, which was more common in patients with CD4 counts>500 cells/mm3 (74.3% vs 25.7%; p=0.007). Viruria was present in 21.7% of healthy controls (5 out of 23 samples, p=0.02). All viral loads were low (<100 copies/mL), and we could not find any association between BKV infection and renal or neurological manifestations. We provide an update on the prevalence of BKV in HIV-infected patients treated with HAART. BKV viruria was more common in HIV-infected patients; however, no role for BKV has been demonstrated in this population.     

An integrative in vitro approach to analyse digestion of wheat polysaccharides and the effect of enzyme supplementation

The digestion of polysaccharides from the wheat cultivars Caphorn and Isengrain was investigated, and the efficiency of an enzyme preparation was tested using the TNO gastrointestinal model (TIM-1). The apparent digestibility (AD) of carbohydrates was determined based on the measurement of organic matter (OM), total monosaccharides, reducing ends (RE) and end products (EP: glucose, maltose and xylobiose). The AD of the OM from Caphorn and Isengrain measured using caecectomised cockerels did not differ from that measured using TIM-1: 72.0 (SD 2.6) v. 70.6 (SD 0.6) % for Caphorn (P = 0.580) and 73.0 (SD 2.3) v. 71.1 (SD 1.9) % for Isengrain (P = 0.252). After the 6 h TIM-1 digestion, 41.4-58.9 % of the OM, RE and EP were recovered from the jejunal compartment and 18.3-27.1 % from the ileal compartment, while ileal deliveries and digestive residues constituted the remainder. A commercial enzyme cocktail tested at 0.2 μl/g of wheat improved TIM-1 digestibility of Caphorn and Isengrain polysaccharides: 3.9 % (P = 0.0203) and 3.4 % (P = 0.0058) based on the OM; 9.7 % (P < 0.0001) and 3.1 % (P = 0.031) based on the total glucose; 47.2 % (P < 0.0001) and 14.2 % (P = 0.0004) based on the RE, respectively. The enzyme cocktail improved the release of the EP for Caphorn (3.8 %, P = 0.008) but not for Isengrain ( ? 0.8 %, P = 0.561). The higher efficiency of the enzyme supplementation on the digestion of Caphorn polysaccharides compared with Isengrain seems to be linked to the higher soluble carbohydrate contents and/or less ramified arabinoxylan of Caphorn.     

Stereotaxic thalamotomy and pallidotomy with computerized planning in Parkinson's disease: short-term evaluation of motor function in 50 patients

We evaluated the motor function of 50 patients with Parkinson's disease, who underwent stereotaxic surgery with computerized planning, without ventriculography (ventrolateral thalamotomy- VLT- and/or posteroventral pallidotomy- PVP) before and one month after surgery. 27 unilateral TVL, 10 unilateral PVP, 6 bilateral PVP, and 7 TVL with PVP were performed. The motor evaluation was performed with the Unified Parkinson's Disease Rating Scale, motor score, during on and off periods. We observed a global motor improvement in all groups. The improvement of dyskinesias was obtained in the contralateral side of the body, in the PVP groups. From the 50 patients, 16 (32%) presented post-operative complications, 9 of these (56.25%) improved completely, 6 (37.25%) improved partially, and 1 (6.25%) did not improve during the first month. These results were considered satisfactory, and a long term analysis will show whether these benefits are long lasting or not.     

Retrospective analysis of two hundred and twelve cases of bacteremia due to anaerobic microorganisms

Cases of bacteremia caused by anaerobic microorganisms and occurring during a four year period in a non-selected patient group in a Spanish general hospital were analysed retrospectively. Microbiological data was collected on 212 patients and clinical data on 103 patients. Cases of anaerobic bacteremia represented 8.6 % of the total number of cases of bacteremia. Of the 232 anaerobic microorganism causing bacteremia, gram-negative bacilli were responsible in 113 cases (48.7 %), gram-positive bacilli in 92 cases (39.6 %), grampositive cocci in 25 cases (10.7 %), andVeillonella spp. in two cases (0.8 %). The most important clinical features were fever (64 %), anemia (56 %), septic shock (22 %) and metastatic abscesses (21 %). Patients with anaerobic bacteremia were hospitalized for an average of 51.7 days. The overall mortality was 32 % and factors associated with poor prognosis were severe underlying disease, nosocomial acquisition, presence of shock, presence of metastatic foci of infection, and absence of adequate surgical drainage. The mortality rate of patients who received adequate antimicrobial therapy was 30 % and that of patients who received inadequate treatment or none was 29 %. It is concluded that anaerobic bacteremia has a significant rate of morbidity and mortality and that underlying disease and surgical debridement and/or drainage have greater prognostic significance than the use of antimicrobial agents.     

Correlation between the elastase activity index and invasiveness of clinical isolates of Aspergillus fumigatus

We calculated an elastase activity index (EAI) by dividing the diameter of the elastin lysis halo by the fungal growth diameter. After 10 days' incubation at 37 degrees C, all strains but one obtained from invasive aspergillosis showed an EAI > or = 1. Of the 18 strains obtained from colonized patients, only 4 (22.2%) had an EAI > or = 1, whereas neither of the strains isolated from patients with fungus ball reached this value. Overall, 44 out of the 142 strains obtained from the environment had an EAI > or = 1 (30.9%).