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51.
We studied the impact of brief caspofungin exposures on postantifungal effects (PAFEs) and paradoxical effects for five Candida albicans isolates. In time-kill studies, caspofungin at 4× and 16× the MIC resulted in significant killing of all isolates. Caspofungin at 8 μg/ml resulted in lower levels of killing, and paradoxical effects were evident with 4 isolates. Caspofungin exposures of 5 to 60 min caused prolonged, concentration-dependent killing that approached or exceeded the results seen with time-kill experiments and eliminated paradoxical growth.  相似文献   
52.
Health care employees are more likely than other workers to be victims of violence or aggression. Results from one Australian study suggest that 30% of respondents experienced aggression on a daily or near daily basis. In an Irish context, a total of 22% of all reported injuries in the health and social sector related to injuries inflicted by another person. However, both in Ireland and internationally, there has been an inadequate categorization of the types of incident to which staff are exposed. This contributes to definitional difficulties as well as problems in comparing research findings and using such findings to make work environments safe. The current study aimed to identify the types of violent or aggressive incidents that staff in Irish Accident and Emergency departments were exposed to within a month long period. A cross-sectional study was undertaken with all nurses (N = 80) working in Accident and Emergency departments in two sites nationally as part of a larger study of aggression and violence in health services looking at both Mental Health Services and Accident and Emergency departments. Data were collected using the Scale of Aggressive and Violent Experiences - questionnaire adapted from the Perception of Prevalence of Aggression Scale. The questionnaire captured data on personal and professional demographics as well as experiences of aggressive or violent incidents respondents may have encountered 'in their work situation'. There was a response rate of 46% (n = 37). Data were analysed utilizing spss-11. The relevant data were subjected to a series of one-way anovas and chi-square analysis. The findings suggest that nursing staff in Accident and Emergency departments experienced high levels of verbal aggression. Additionally, they encountered violence or aggression that is vicariously experienced more than forms that were overtly directed towards staff. It is a matter of concern that less than one-third of staff in this study reported that they had training in the management of aggression and violence. The implications will be discussed in relation to both policy and practice.  相似文献   
53.
The covalent attachment of palmitate to specific proteins by the action of palmitoyl acyltransferases (PAT) plays critical roles in the biological activities of several oncoproteins. Two PAT activities are expressed by human cells: type 1 PATs that modify the farnesyl-dependent palmitoylation motif found in H- and N-Ras, and type 2 PATs that modify the myristoyl-dependent palmitoylation motif found in the Src family of tyrosine kinases. We have previously shown that the type 1 PAT HIP14 causes cellular transformation. In the current study, we show that mRNA encoding HIP14 is up-regulated in a number of types of human tumors. To assess the potential of HIP14 and other PATs as targets for new anticancer drugs, we developed three cell-based assays suitable for high-throughput screening to identify inhibitors of these enzymes. Using these screens, five chemotypes, with activity toward either type 1 or type 2 PAT activity, were identified. The activity of the hits were confirmed using assays that quantify the in vitro inhibition of PAT activity, as well as a cell-based assay that determines the abilities of the compounds to prevent the localization of palmitoylated green fluorescent proteins to the plasma membrane. Representative compounds from each chemotype showed broad antiproliferative activity toward a panel of human tumor cell lines and inhibited the growth of tumors in vivo. Together, these data show that PATs, and HIP14 in particular, are interesting new targets for anticancer compounds, and that small molecules with such activity can be identified by high-throughput screening.  相似文献   
54.

Background

Neurologic complications are common, and amongst the most devastating complications in pediatric patients undergoing extracorporeal life support (ECLS). Carotid artery cannulation (CAN) has been associated with an increase in these complications, thereby shaping practices to avoid this approach in most pediatric patients in which other cannulation approaches are viable.

Methods

A retrospective review of children (0–18 years) in the ELSO database was undertaken from 1989 through 2013. Multivariate logistic regression analysis of rates of stroke and other neurologic complications based on cannulation technique was undertaken, adjusting for patient factors including age, underlying disease process, and severity of illness.

Results

A total of 30,282 ECLS runs were found in the database. CAN was associated with higher rates of stroke (5.15% vs 3.74%) and overall neurologic complications. However, when correcting for patient factors, including age, underlying disease process, and support type, CAN was not associated with an increased rate of neurologic complications or stroke (p > 0.05 for both).

Conclusion

When correcting for patient related factors CAN is not associated with an increase in stroke or neurologic compilcations. CAN should be re-examined as a cannulation technique for older pediatric patients.

Level of evidence

III.  相似文献   
55.
56.
57.

Background

We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork.

Methods

Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores.

Results

TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = ?0.556, p = 0.025) and with the TEAM task management component scores (r = ?0.513, p = 0.042).

Conclusions

Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM.  相似文献   
58.
59.

Context

Salvage radiotherapy (SRT) is a standard of care for men who recur postprostatectomy, and recent randomized trials have assessed the benefit and toxicity of adding hormone therapy (HT) to SRT with differing results.

Objective

To perform a systematic review of randomized phase III trials of the use of SRT ± HT and generate a framework for the use of HT with SRT.

Evidence acquisition

Systematic literature searches were conducted on February 15, 2017 in three databases (MEDLINE [via PubMed], EMBASE, and ClinicalTrials.gov) for human-only randomized clinical trials from January 30, 1990, through January 30, 2017. Only two randomized trials met all inclusion criteria.

Evidence synthesis

Overall survival benefits from HT were found in one trial, which was limited to when follow-up extended to ≥10 yr, pre-SRT prostate-specific antigen (PSA) ≥0.7 ng/ml, or when higher Gleason grade or positive margins were present. Both trials demonstrated a benefit from HT in men with higher pre-SRT PSAs. Three prognostic factors appeared to discriminate improvements in meaningful clinical endpoints (eg, distant metastasis or survival): pre-SRT PSA, Gleason score, and margin status. Two years of bicalutamide monotherapy resulted in higher rates of gynecomastia with a trend for worse survival when given in favorable risk patients, and 6 mo of luteinizing hormone–releasing hormone agonist therapy resulted in higher rates of hot flashes and long-term hypertension.

Conclusions

Similar to the selective use of HT with radiotherapy in localized prostate cancer, not all patients appear to derive a meaningful benefit from HT with SRT. Patient, tumor, and treatment factors must be considered when recommending the use of HT with SRT. Knowledge gaps exist in the level 1 data regarding the optimal duration and type of HT, as well as the ability to use predictive biomarkers to personalize the use of HT with SRT. Important clinical trials (RADICALS and NRG GU-006) are aimed to answer these questions.

Patient summary

In this report, we performed a systematic review of the literature to determine the benefit and harm of adding hormone therapy to salvage radiotherapy (SRT) for recurrent prostate cancer. We found that the benefit of hormone therapy varied by important prognostic factors, including pre-SRT prostate-specific antigen, Gleason grade, and surgical margin status. Our group then developed a framework on how best to utilize hormone therapy with SRT.  相似文献   
60.
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