Optimization of antibiotic therapy is still urgently needed in critically ill patients. The aim of the ONTAI survey (online survey on the use of Therapeutic Drug Monitoring of antibiotics in ...intensive care units) was to evaluate which strategies intensive care physicians in Germany use to improve the quality of antibiotic therapy and what role a Therapeutic Drug Monitoring (TDM) plays.
Among the members of the German Society for Anaesthesiology and the German Society for Medical Intensive Care Medicine and Emergency Medicine, a national cross-sectional survey was conducted using an online questionnaire.
The questionnaire was completely answered by 398 respondents. Without TDM, prolonged infusion was judged to be the most appropriate dosing regimen for beta lactams. A TDM for piperacillin, meropenem and vancomycin was performed in 17, 22 and 75% of respondents, respectively. For all beta lactams, a TDM was requested more often than it was available. There was great uncertainty as to the optimal pharmacokinetic/pharmacodynamic index for beta-lactams. 86% of the respondents who received minimal inhibitory concentrations adapted the therapy accordingly.
German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.
German intensive care physicians demand (red) more often Therapeutic Drug Monitoring for all antibiotics except vancomycin, than they have it available (green). Abbreviations: TZP piperacillin/tazobactam, MEM meropenem, SAM ampicillin/sulbactam, VAN vancomycin, LZD linezolid, CRO ceftriaxone, FLX flucloxacillin, CAZ ceftazidime, CFZ cefazolin, IPM imipenem, TDM Therapeutic Drug Monitoring. Display omitted
•German ICU specialists believe that antibiotic therapy can be improved by TDM.•The availability of TDM measurements for beta lactams is below the expectations.•Many practitioners do not have access to regular MIC determinations.•Target values are not uniformly defined for beta lactams.
We present results from a new ultra-deep 400 ks Chandra observation of the SSA22 protocluster at z = 3.09. We have studied the X-ray properties of 234 z ~ 3 Lyman Break Galaxies (LBGs; protocluster ...and field) and 158 z = 3.09 Ly alpha Emitters (LAEs) in SSA22 to measure the influence of the high-density protocluster environment on the accretion activity of supermassive black holes (SMBHs) in these UV-selected star-forming populations. We detect individually X-ray emission from active galactic nuclei (AGNs) in six LBGs and five LAEs; due to small overlap between the LBG and LAE source population, ten of these sources are unique. At least six and potentially eight of these sources are members of the protocluster. These sources have rest-frame 8-32 keV luminosities in the range of L 8 -32 keV = (3-50) X1043 ergs s -1and an average observed-frame 2-8 keV to 0.5-2 keV band ratio (BR) of 0.8 (mean effective photon index of Gamma eff 1.1), suggesting significant absorption columns of N H 1022-1024 cm -2. We find that the fraction of LBGs and LAEs in the z = 3.09 protocluster harboring an AGN with L 8 -32 keV 3 X 1043 ergs s -1is 9.5+12.7 -6.1% and 5.1+6.8 -3.3%, respectively. These AGN fractions are somewhat larger (by a mean factor of 6.1+10.3 -3.6; significant at the 95% confidence level) than z ~ 3 sources found in lower-density 'field' environments. Theoretical models imply that these results may be due to the presence of more actively growing and/or massive SMBHs in LBGs and LAEs within the protocluster compared to the field. Such a result is expected in a scenario where enhanced merger activity in the protocluster drives accelerated galaxy and SMBH growth at z 2-3. Using Spitzer IRAC imaging we found that the fraction of IRAC-detected LBGs is significantly larger in the protocluster than in the field (by a factor of 3.0+2.0 -1.3). From these data, we constrained the median rest-frame H-band luminosity in the protocluster to be 1.2-1.8 times larger than that for the field. When combined with our X-ray data, this suggests that both galaxies and SMBHs grew more rapidly in protocluster environments.
Radionuclide bone scanning has been used routinely in the evaluation of bone pathology for decades. The greatest strength of the procedure is its extreme sensitivity for bone metabolism, allowing it ...to distinguish between active and inactive bony abnormalities. The downside of this reliance on abnormal bone turnover is the relative lack of anatomical detail compared with ever-improving CT and MRI technology. Fusion imaging using SPECT/CT (SCT), PET/CT, and PET/MRI offers an opportunity to combine the sensitivity of nuclear medicine examinations with the anatomical detail of CT and MRI. This fusion of technologies is especially important in situations where anatomical imaging modalities alone provide insufficient diagnostic information. In this review, we highlight the utility of SPECT/CT bone imaging in the pre- and postoperative evaluation of patients undergoing procedures of the spine, foot, and ankle.
Aims Significant brady- and tachyarrhythmias may occur in active endurance athletes. It is controversial whether these arrhythmias do persist after cessation of competitive endurance training. ...Methods and results Among all 134 former Swiss professional cyclists hereafter, former athletes (FAs) participating at least once in the professional bicycle race Tour de Suisse in 1955–1975, 62 (46%) were recruited for the study. The control group consisted of 62 male golfers matched for age, weight, hypertension, and cardiac medication. All participants were screened with history, clinical and echocardiographic examination, ECG, and 24 h ECG. The time for the last bicycle race of FAs was 38 ± 6 years. The mean age at examination was 66 ± 6 years in controls and 66 ± 7 years in FAs (P = 0.47). The percentage of study participants with >4 h current cardiovascular training per week was identical. QRS duration (102 ± 20 vs. 95 ± 13 ms, P = 0.03) and corrected QTc interval (416 ± 27 vs. 404 ± 18, P = 0.004) were longer in FAs. There was no significant difference in the number of isolated atrial or ventricular premature complexes, or supraventricular tachycardias in the 24 h ECG; however, ventricular tachycardias tended to occur more often in FAs than in controls (15 vs. 3%, P = 0.05). The average heart rate was lower in FAs (66 ± 9 vs. 70 ± 8 b.p.m.) (P = 0.004). Paroxysmal or persistent atrial fibrillation or flutter was reported more often in FAs (P = 0.028). Sinus node disease (SND), defined as bradycardia of <40 b.p.m. (10 vs. 2%), atrial flutter (6 vs. 0%), pacemaker for bradyarrhythmias (3 vs. 0%), and/or maximal RR interval of >2.5 s (6 vs. 0%), was more common in FA (16%) than in controls (2%, P = 0.006). Observed survival of all FAs was not different from the expected. Conclusions Among FAs, SND occurred significantly more often compared with age-matched controls, and there is trend towards more frequent ventricular tachycardias. Further studies have to evaluate prevention of arrhythmias with extreme endurance training, the necessity of regular follow-up of heart rhythm, and management of arrhythmias in former competitive endurance athletes.
Nuclear medical imaging is indicated in most, but not all, patients with suspected paragangliomas of the head and neck. Advances in technology and somatostatin receptor analogs have improved the ...selectivity and sensitivity of this imaging.
Bone SPECT/CT in Skeletal Trauma Scharf, Stephen C., MD
Seminars in nuclear medicine,
2015, January 2015, 2015-Jan, 2015-01-00, 20150101, Letnik:
45, Številka:
1
Journal Article
Recenzirano
The utility of radionuclide bone scanning in skeletal trauma has been greatly enhanced over the last decade by hybrid technology merging multislice CT with SPECT that can take advantage of CT-based ...correction of attenuation and scatter. The resulting images have been particularly helpful in giving us new insights into the evaluation of foot and ankle injuries and vertebral pathology both before and after surgery. The physiological information and anatomical detail allow a better understanding of the causes of patients׳ pain and have proven to be particularly useful in planning surgical intervention.
Abstract
We studied the light yield of a pure polystyrene slide
coated with wavelength-shifter molecules, coupled to a
photomultiplier, using
β
-
particles from a
90
Sr
source, as a possible ...easy-to-build, low-cost plastic scintillator
detector. Comparison measurements were performed with an uncoated
polystyrene slide as well as with uncoated and coated PMMA slides,
the latter which can only produce Cherenkov light when being
traversed by charged particles. The results with the single (double)
coated polystyrene slides show about 4.9 (6.3) times higher detected
photon yield compared to the uncoated slide. For comparison, the
light yield of a polystyrene-based extruded plastic scintillator
material doped with PTP and POPOP was measured as well. The
absolute detected light yield motivates future studies for
developing easy-to-build, low-cost polystyrene-based plastic
scintillator detectors.
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