Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting

The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1–3) OR presence of a central venous catheter (days 1–3) AND at least TWO of the following—total parenteral nutrition (days 1–3), any dialysis (days 1–3), any major surgery (days −7–0), pancreatitis (days −7–0), any use of steroids (days −7–3), or use of other immunosuppressive agents (days −7–0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis. Results of this project were partially presented at Focus on Fungal Infections 14, New Orleans, LA, USA, 2004. Abstract no. 51.     

Cyto- and histomorphologic changes in the Jensen sarcoma exposed to cisplatin, radiotherapy and combination treatment

Puncture-cytological and histomorphological investigation results are presented in transplanted tumor Jensen sarcoma. The tested tumors did not respond to therapy in growth reaction and reached a quarter of the body mass of the experimental animals on day 18 post transplantation. Within the five groups (untreated, cisplatin daily 0.6 mg/kg b.w., irradiated with 2 Gy S. D., 20 Gy T. D. only, and 2 groups combined therapy cisplatin and irradiation) cytological differences were shown between the several therapeutic groups already at therapy day 7 in spite of similar growth reaction, but not between centre and periphery of tumors, that were marked more distinctly and confirmed in histomorphological picture at the end of therapy at day 18 p.t. The increased occurrence of giant cells with many nuclei and leukocytic inflammation reaction seem to be a typical picture for combined therapy.     

Outcome treatment of pseudoarthrosis of long bones with decortication method depends on osteosynthesis]

Purpose of work was estimation of the results of treatment of pseudoarthrosis of the long bone with the method of decortication, with use of autogenic bone depends on kind of pseudoarthrosis and kind of osteosynthesis. In the years 1995-2005 56 patients were treated because of pseudoarthrosis of long bone in our Clinic. Pseudoarthrosis is classified according to Weber-Cech classification. In the methodology of clinical estimation and subjective estimation of the patient Stewart and Hundley and Anderson classification were used. Union was achieved in 51 cases. Time of bone union achievement was 5 months. The results of treatment are depends on morfology of pseudoartrosis and are independs of kind of osteosynthesis.     

Cellular and Molecular Foundation for Fracture Healing in Children

Abstract Dealing with pediatric fracture patients requires a funded knowledge of complications and remodeling capability of the youth skeleton to find the accurate therapy decision and to avoid unnecessary invasive procedures. Due to the different mechanical environment, fractures in children occur at specific fracture-vulnerable areas. One of those is the growth plate, which on one hand gives rise to the unique ability of correcting angular deformities by specifically increasing the growth rate in definite regions, and on the other hand leads to complications like growth arrest or angular deformity. The pediatric diaphysis presents the exclusive greenstick fracture, only seen in the growing skeleton, which occurs because of the different composition of the pediatric bone. To understand these very specific features of the youth skeleton, the molecular and cellular basis should be taken into consideration. Therefore, this review will present the common characteristics of skeletal development and fracture healing. An insight into the mechanotransduction as part of the remodeling and self-correcting ability of pediatric bone is given to span the bridge between clinical treatment options and scientific background.     

Which way for housing and human settlements?

In order to clarify the housing and settlements component of the European health-for-all programme and to identify perceived priorities with a view to the preparation of training materials, members of WHO's Rural and Urban Development and Housing Network were invited to complete a questionnaire. The results are reported below. The questionnaire can be used in identifying local development priorities, comparing attitudes, and studying perceived needs. Intended as a tool for policy-makers, course organizers and public health professionals, it is available from the authors of the present article.     

Functional and metabolic effects of ribose in combination with prazosin, verapamil and metoprolol in rats in vivo

Ribose improves the function of the rat heart in various pathological conditions through its effects on cardiac energy metabolism, while having no direct haemodynamic actions. We therefore studied its functional and metabolic effects in closed chest rats when given in combination with prazosin, verapamil or metoprolol, all of which have direct effects on the circulation. Ribose administration for 24 h at 200 mg.kg-1.h-1 did not affect heart function but increased the available pool of 5-phosphoribosyl-1-pyrophosphate in heart (four fold) and skeletal muscle (1.7-fold), as assessed by the incorporation of 14C-adenine into the adenine nucleotides. The utilisation of adenine for adenine nucleotide synthesis, expressed as the ratio of adenine nucleotide radioactivity to tissue extract radioactivity, was 70% in heart and 20% in skeletal muscle under control conditions, and 97% and 88% after 24 h of ribose administration. Ribose decreased the 14C-adenine incorporation into the adenine nucleotides in kidney, lungs and liver. After 24 h infusion of prazosin (100 micrograms.kg-1.h-1), heart rate and LVdP/dtmax were not changed, but LVSP (-20%), mean aortic pressure (-16%) and peripheral resistance (-40%) were decreased. Cardiac output was enhanced (+40%). Verapamil (2mg.kg-1.h-1) and metoprolol (2mg.kg-1.h-1) infused for 24 h decreased the pressure-rate and pressure-volume product of the left ventricle to the same extent (-40%). Verapamil had no influence on cardiac output, while metoprolol depressed it (-30%). Simultaneous administration of prazosin, verapamil or metoprolol with ribose did not affect the ribose induced increase in the myocardial 5-phosphoribosyl-1-pyrophosphate pool.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fibrinolysis and coagulation in patients with infectious disease and sepsis

Sepsis is often associated with hemostatic dysfunction. This study aimed to relate changes in fibrinolysis and coagulation parameters to sepsis and sepsis outcome. Urokinase-type plasminogen activator (u-PA) antigen, tissue-type plasminogen activator (t-PA) antigen and activity, plasminogen activator inhibitor (PAI) type 1 antigen, PAI activity, antithrombin (AT) III activity, and protein C activity were measured in 24 patients suffering from sepsis or septic shock and the results were compared with those observed in 30 non-sepsis patients with severe infectious disease. The u-PA level was markedly increased in plasma of sepsis patients as compared to non-sepsis patients (11.5 +/- 9.4 versus 1.6 +/- 1.5 ng/ml, p less than 0.0001). PAI-1 antigen and t-PA activity showed a significant increase in sepsis patients (320 +/- 390 ng/ml versus 120 +/- 200 ng/ml, and 3.0 +/- 3.6 IU/ml versus 1.0 +/- 0.7 IU/ml, respectively, p less than 0.01). AT III was decreased in sepsis patients (58 +/- 28% in sepsis versus 79 +/- 26% in severe infectious disease, p less than 0.01) as was protein C (30 +/- 18% versus 58 +/- 27%, p less than 0.001). No significant difference was found for t-PA antigen nor for PAI activity. Nonsurvivors of sepsis were distinguished mainly by a high u-PA antigen level and increased t-PA activity. It is concluded that plasma u-PA antigen showed the strongest significant difference, among the parameters evaluated, between sepsis and severe infection. u-PA antigen may be of prognostic value in patients admitted to the medical intensive care unit for severe infectious disease.     

Transplantation of central nervous tissue

Studies of post-lesional reorganization of central nervous connections have shown that central nerve fibers respond to nearby denervation by sprouting and formation of new terminals. The connections in the central nervous system (CNS) are accordingly much more plastic than was thought for a long time. This has revived the interest in transplantation of central nervous tissue. In this study we present some historical data on CNS transplantation supplemented by recent results obtained in our laboratory. Pieces of hippocampal tissue from embryonic or early postnatal rats were transplanted to different parts of the brain of littermates or adult rats. About two-thirds of the transplants were recovered after survival times ranging from 4 d to 2 years, and their cytological organization and intrinsic connections were monitored by cell and fiber stains and histochemical methods (AChE staining and Timm sulphide silver method). Comparison with both a normal and a lesioned control material revealed that in most transplants the tissue had developed as it does when left in situ in the donor brain, but deprived of its major afferent connections. In several instances we found evidence of a major exchange of connections between the transplants and host brains. The conditions needed for this to occur appeared to involve growth stimulation of host brain fibers by transection (host to transplant) and denervation of host neuropil (transplant to host). In cases where these conditions are met, the use of transplants may have future implications in attempts to repair lesions in the central nervous systems.