Infecciones causadas por bacterias gramnegativas multirresistentes: enterobacterias, Pseudomonas aeruginosa, Acinetobacter baumannii y otros bacilos gramnegativos no fermentadores

Multiresistant Gram-negative bacteria represent a major health problem worldwide. This is related to the severity of the infections they cause, the difficulties for empiric (even directed) treatment, the ease of multiresistance spread, and the absence of new antimicrobial agents active against this group of pathogens. Accordingly, antimicrobial therapy should be based on the results of susceptibility testing, and may require using antimicrobial combinations. The production of extended-spectrum beta-lactamases represents the most important current problem of resistance among enterobacteria; these organisms cause nosocomial infections, but can also be cultured from non-hospitalised patients. In our country, enterobacteria producing plasmid-mediated AmpC enzymes or most carbapenemases are still uncommon, at the moment. Enterobacteria expressing these types of beta-lactamases present high rates of resistance to aminoglycosides and quinolones, because plasmids coding for beta-lactamases also contain other genes involved in additional resistances and/or the selection of additional chromosomal mutations. Among multiresistant Gram-negative non-fermenting bacteria, the most clinically relevant organism is Pseudomonas aeruginosa, an organism with intrinsic resistance to multiple agents and with ability to capture acquired resistance mechanisms. Other organisms in the latter group include Acinetobacter baumannii, with increasing rates of resistance to antimicrobial agents, and to a lesser extent Stenotrophomonas maltophilia.     

Manual aspiration prior to stenting does not reduce the incidence of filter no reflow in saphenous vein graft lesions protected by FilterWire EX/EZ

Abstract

Background: The beneficial role of manual thrombus aspiration in thrombus-containing lesions has been proven in acute myocardial infarction but data is lacking in saphenous vein graft lesions. Methods: From January 2004 to December 2008, 74 consecutive post-bypass patients underwent percutaneous coronary interventions to 76 saphenous vein graft lesions under the protection of FilterWire EX/EZ. Among them, the latest 25 consecutive patients with 25 lesions were treated with manual aspiration before stenting. The incidence of filter no reflow was compared between patients with and without manual aspiration pretreatment. Results: No major difference in demography, clinical, lesion, and procedure characteristics, and in-hospital outcome has been observed between the two patient groups. Most importantly, the incidence of filter no reflow has not been reduced (32.0% versus 19.6%, P = 0.26) by manual aspiration, even among thrombus-containing lesions (63.2% versus 64.7%, P = 1.00). The absence of diabetes mellitus is found to be the independent predictor for the occurrence of filter no reflow. Conclusions: Adjunctive manual thrombus aspiration fails to reduce the filter no reflow, and probably has no additional benefit in saphenous vein graft lesions already protected by FilterWire EX/EZ.     

Predictive power to assist phase 3 go/no go decision based on phase 2 data on a different endpoint

One of the most critical decision points during drug development is to make a phase 3 go/no go decision after a phase 2 proof of concept trial is conducted. It is particularly challenging in oncology drug development where oftentimes the primary endpoint for phase 3 trial is overall survival (OS), but the phase 2 proof of concept trial is powered only for an early endpoint, typically progression-free survival (PFS), whose relationship to OS is often unclear. We propose the use of predictive power to assist the phase 3 go/no go decision by evaluating the strength of actual observed phase 2 efficacy effects in terms of how likely it will predict the chance of OS success in the subsequent phase 3 trial. The formula is provided for calculation of predictive power based on either observed PFS effect only, or observed OS effect only, or both. An example is provided to compare these three predictive powers, which shows that when there is little prior information about PFS and OS, the predictability based on the observed phase 2 PFS effect is low and not sensitive to the size of the trial and extent of the observed PFS effect, and it also has limited added value to the predictability based on the observed phase 2 OS effect. Therefore, one should be cautious of inherently high risk of making a phase 3 go/no go decision based on phase 2 PFS outcome alone and should take the phase 2 OS data into consideration whenever possible.     

Efectos de la terapia no farmacológica en el envejecimiento normal y el deterioro cognitivo: consideraciones sobre los objetivos terapéuticos

Introduction

Non-pharmacological therapies for normal ageing and dementia are a set of treatment programmes intended to improve the performance of cognitive processes, improve emotional well-being, promote independence in daily life activities, and ultimately increase patients’ quality of life.

Methods

We applied a battery of tests assessing four major domains (general mental state, emotional well-being, quality of life, and daily life activities) to a sample of 317 adults older than 64 (240 with normal ageing and 77 with cognitive impairment). They were then assigned either to non-pharmacological therapy groups according to their abilities or to other non-specific activities. Progress was assessed 9 months later using the same test battery.

Results

The results show a general improvement in mental state in the group with normal ageing and absence of disease progression in the group with pathological ageing. In both groups, emotional well-being (anxiety and depression) and self-identified quality of life both benefited from non-pharmacological therapy. However, other aspects commonly included among the therapeutic targets did not seem to improve, including independence in daily life activities.

Conclusions

This study provides evidence that non-pharmacological therapy in ageing patients can produce positive results. It must be stressed that benefits are greater in individuals with cognitive impairment, although generalising use of this therapy could prove to be an excellent primary programme for preventing cognitive and emotional disorders.     

饮食及运动干预对2型糖尿病治疗效果的影响

目的：观察饮食及运动干预对糖尿病患者治疗效果的影响,帮助患者认识合理饮食及运动的重要性。方法将40例糖尿病患者（维持原治疗方案,空腹血糖范围7.0~9.0 mmol/ L）分为糖尿病饮食组、糖尿病饮食加运动组、糖尿痛饮食加晚餐无主食组、糖尿病饮食晚餐无主食加运动组,其中对参与患者依据《糖尿病防治指南2010年版》进行糖尿病饮食教育,运动为有氧运动0.5～1 h/ d,晚餐无主食指在糖尿病饮食的基础上,晚餐无米、面等主食,主要构成为蔬菜、鱼肉。4组 l 临床观察3个月后,4组均改为糖尿病饮食晚餐无主食加运动干预,继续观察3个月。比较4组患者血糖控制情况及组内前后对比。结果糖尿病饮食晚餐无主食组优于单纯糖尿病饮食组（P ﹤0.05）;饮食加运动组优于单纯饮食组（P ﹤0.05）。结论饮食及运动可以有效改善患者血糖控制情况,晚餐无主食对于患者血糖控制改善尤为明显。     

一种无参考监控视频图像清晰度评价方法

监控视频调焦时容易出现镜头离焦,导致输出图像模糊。为了降低人工检测成本,提出了一种基于结构相似度的无参考图像清晰度评价算法,用于评价监控安防设备视频图像的清晰度。在无参考的情况下,首先利用Sobel算子和高斯滤波器对待评价图像构造参考图,在此基础上计算分块后的图像结构相似度SSIM,为了更好地与人眼习惯吻合,利用权值加成各子块SSIM值,最后根据计算值评价图像的清晰度。实验结果表明：本文方法对图像模糊敏感度高,检测准确性优于传统检测方法,可以应用于实时的监控视频图像诊断。     

基于fluent的西林瓶升温曲线模拟

为了深入研究西林瓶在热风循环型烘箱中的受热情况,利用fluent系列软件对不同风温及风速时西林瓶升温曲线进行模拟,并与已有的实验数据进行对比,以期得到合理的热风风温及风速。为工业生产提供借鉴意义。