Lipemia, a significant source of analytical errors in clinical laboratory settings, should be removed prior to measuring biochemical parameters. We investigated whether lipemia in serum/plasma ...samples can be removed using a method that is easier and more practicable than ultracentrifugation, the current reference method.
Seven hospital laboratories in Spain participated in this study. We first compared the effectiveness of ultracentrifugation (108,200×g) and high-speed centrifugation (10,000×g for 15 minutes) in removing lipemia. Second, we compared high-speed centrifugation with two liquid-liquid extraction methods-LipoClear (StatSpin, Norwood, USA), and 1,1,2-trichlorotrifluoroethane (Merck, Darmstadt, Germany). We assessed 14 biochemical parameters: serum/plasma concentrations of sodium ion, potassium ion, chloride ion, glucose, total protein, albumin, creatinine, urea, alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate-aminotransferase, calcium, and bilirubin. We analyzed whether the differences between lipemia removal methods exceeded the limit for clinically significant interference (LCSI).
When ultracentrifugation and high-speed centrifugation were compared, no parameter had a difference that exceeded the LCSI. When high-speed centrifugation was compared with the two liquid-liquid extraction methods, we found differences exceeding the LCSI in protein, calcium, and aspartate aminotransferase in the comparison with 1,1,2-trichlorotrifluoroethane, and in protein, albumin, and calcium in the comparison with LipoClear. Differences in other parameters did not exceed the LCSI.
High-speed centrifugation (10,000×g for 15 minutes) can be used instead of ultracentrifugation to remove lipemia in serum/plasma samples. LipoClear and 1,1,2-trichlorotrifluoroethane are unsuitable as they interfere with the measurement of certain parameters.
Purpose
In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are ...available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario.
Methods
We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires.
For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers.
Results
The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138.
Conclusions
We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from ...being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
This work studies the combination of direct femtosecond laser structuring of metal surfaces and Spatial Atomic Layer Deposition (SALD) of metal oxides as a novel approach to generate colours on ...different types of day-to-day metallic objects. In particular, a stainless-steel knife and an outdated 25 ct Dutch florin coin have been selected for the study. Our results show that it is possible both, to preserve the iridescence properties produced by laser processing and to tune the final metal surface colour by controlling the thickness of the ZnO coating. At the same time, this oxide coating could act as a protecting layer for the original material. We thus explore two different strategies to generate colour, namely, iridescence and interference, which can be even developed selectively. This novel methodology to colour metallic surfaces is a promising route to achieve cheap, scalable, and high-throughput processing methods and opens up a new avenue of possibilities and applications related to colour.
2055
Background: The ESMO ESCAT scale rank molecular alterations (MA) based on the published evidence supporting their clinical use. Building on our proposal for the first ESCAT classification for ...primary brain tumors (pBT) Mirallas et al. ESMO 2022, we aim to describe the clinical actionability of NGS in a multicentric glioma cohort and gather clinical factors that enrich patients with MA to justify performing NGS. Methods: A multicentric retrospective study included pts with molecular profiling using NGS methods (Foundation Medicine, local NGS, Caris, Oncomine,
and fusion panels). Clinical actionability was classified using the ESCAT scale; Tier 1 (ready for clinical implementation), Tier 2 (alteration-drug match with antitumor activity), Tier 3 (supported in other tumor types), and Tier 4 (preclinical evidence). Clinical factors considered for enrichment were diagnosis of glioblastoma (GBM), sex, and age ≤40 years, differences between groups were determined using Chi-squared test. The overall survival (OS) was calculated through Kaplan-Meier method and cox hazard ratio were fitted. Results: A total of 361 pts with NGS performed between Feb 2018 and Dec 2022 at 4 hospitals in Spain. Median age was 51.5 (range, 3.3-83.8), 77% had ECOG ≥1, 39.2% were women, 23.4% were 40 or younger, 20.8% had IDH1mut, and 73.5% had a diagnosis of GBM. The distribution of MA according to ESCAT was: 10 pts ESCAT 1 (5 BRAFV600E mut, 5 NTRK 1-3 fusions); 75 pts ESCAT 2 (67 IDH1 mut, 6 FGFR-TACC rearrangement, 4 FGFR 1-3 mut, 3 IDH2 mut); 105 pts ESCAT 3 (98 PIK3CA/PTEN mut, 12 PTEN loss, 11 H3K27M mut, 6 BRAF fusion, 2 MET mut, 1 FGFR3 amplification); 93 pts ESCAT 4 (119 TERT mut, 77 EGFR gain, 67 CDKN2A loss, 58 CDKN2B loss, 48 EGFRvIII rearrangement, 46 ATRX mut, 40 EGFR mut, 8 ATM mut). Prevalence of Tier 1-2 MA was 23.6%. In relation to enrichment factors: 12% >40y pts had ESCAT1-2 vs 61% in ≤40y (p<0.001), pts with GBM had a 11% prevalence vs 61% non-GBM (p<0.001), and non-gender differences were seen. The median OS for Tier 1-2 was 135 months (95% CI 166-99) vs Tier 3-4 of 24 months (95% CI 21.5-29.6). Significantly worse OS was observed for Tier 3-4 gliomas (HR: 4.11; 2.84-5.95, p<0.001), and remained significant after adjusting for histology and hospital center (p<0.01). Conclusions: The prevalence of ESCAT Tier 1-2 alterations is high in gliomas suggesting that molecular profiling should be offered, at least, in tertiary centers where these techniques are available. Potential enrichment factors to offer NGS were age and non-GBM pBT, but not gender.
Internal ribosome entry site (IRES) elements are organized in domains that guide internal initiation of translation. Here, we have combined proteomic and imaging analysis to study novel ...foot-and-mouth disease virus IRES interactors recognizing specific RNA structural subdomains. Besides known picornavirus IRES-binding proteins, we identified novel factors belonging to networks involved in RNA and protein transport. Among those, Rab1b and ARF5, two components of the ER-Golgi, revealed direct binding to IRES transcripts. However, whereas Rab1b stimulated IRES function, ARF5 diminished IRES activity. RNA-FISH studies revealed novel features of the IRES element. First, IRES-RNA formed clusters within the cell cytoplasm, whereas cap-RNA displayed disperse punctate distribution. Second, the IRES-driven RNA localized in close proximity with ARF5 and Rab1b, but not with the dominant-negative of Rab1b that disorganizes the Golgi. Thus, our data suggest a role for domain 3 of the IRES in RNA localization around ER-Golgi, a ribosome-rich cellular compartment.
Antifungal stewardship in a tertiary hospital Ramos, Antonio; Pérez-Velilla, Claudia; Asensio, Angel ...
Revista iberoamericana de micologia,
10/2015, Letnik:
32, Številka:
4
Journal Article
Recenzirano
Abstract Background The inappropriate use of antifungals is an important health problem related to increasing adverse effects, unnecessary cost and promotion of resistant and emerging fungal ...infections. Despite its relevance, many health institutions assign few resources to improve prescribing practices. Aims To evaluate the efficiency of an antifungal stewardship programme (ASP) centered on restricted antifungal agents. Methods The main activity during the eight-month study was to perform a programmed review of restricted antifungals (lipid formulations of amphotericin B, echinocandins and voriconazole) prescribed in hospitalized patients. In the case of amendable antifungal treatment, a recommendation was included in the electronic medical record. Results A total of 280 antifungal prescriptions for 262 patients were revised during the study period. The indications were prophylactic in 85 cases (30.4%), pre-emptive in 10 cases (3.5%), empiric in 122 cases (43.6%), and directed in 63 cases (22.5%). A total of 70 prescriptions (25%) in 61 patients were considered to be amendable. In most of these cases, treatment could have been reduced considering the patient's clinical improvement and microbiological results. The most common advice was antifungals change (70%), antifungal withdrawal (21%), removal of one antifungal drug in cases of combined therapy (7%), and switching to oral route (1%). Proposed recommendations were addressed in 28 cases (40%). There was no significant difference in adherence with respect to the type of recommendation ( p = 0.554). There was a 42% lower use of antifungals during the period of the study compared to that observed during a similar previous period. Mortality among patients who were treated according to the recommendations of the ASP was 17% and in whom treatment was not modified it was 30% ( p = 0.393). Conclusions ASPs centered on hospitalized patients may be an efficient strategy to ameliorate antifungal use in hospitals.
PDF
