Purpose
We describe the impact of a multifaceted program for decreasing ventilator-associated pneumonia (VAP) after implementing nine preventive measures, including selective oropharyngeal ...decontamination (SOD).
Methods
We compared VAP rates during an 8-month pre-intervention period, a 12-month intervention period, and an 11-month post-intervention period in a cohort of patients who received mechanical ventilation (MV) for > 48 h. The primary objective was to assess the effect on first VAP occurrence, using a Cox cause-specific proportional hazards model. Secondary objectives included the impact on emergence of antimicrobial resistance, antibiotic consumption, duration of MV, and ICU mortality.
Results
Pre-intervention, intervention and post-intervention VAP rates were 24.0, 11.0 and 3.9 VAP episodes per 1000 ventilation-days, respectively. VAP rates decreased by 56% hazard ratio (HR) 0.44, 95% CI 0.29–0.65;
P
< 0.001 in the intervention and by 85% (HR 0.15, 95% CI 0.08–0.27;
P
< 0.001) in the post-intervention periods. During the intervention period, VAP rates decreased by 42% (HR 0.58, 95% CI 0.38–0.87;
P
< 0.001) after implementation of eight preventive measures without SOD, and by 70% after adding SOD (HR 0.30, 95% CI 0.13–0.72;
P
< 0.001) compared to the pre-intervention period. The incidence density of intrinsically resistant bacteria (to colistin or tobramycin) did not increase. We documented a significant reduction of days of therapy per 1000 patient-days of broad-spectrum antibiotic used to treat lower respiratory tract infection (
P
< 0.028), median duration of MV (from 7.1 to 6.4 days;
P
< 0.003) and ICU mortality (from 16.2 to 13.5%;
P
< 0.049) for patients ventilated > 48 h between the pre- and post-intervention periods.
Conclusions
Our preventive program produced a sustained decrease in VAP incidence. SOD provides an additive value.
This study focuses on the use of Fourier Transform Infrared (FTIR) microspectroscopy to determine chemical changes induced in the nematode Caenorhabditis elegans by supplementation of C. elegans ...maintenance media (CeMM) by Eicosapentaenoic acid (EPA). Wild-type C. elegans (N2) and mutant strains (tub-1 and fat-3) were grown in CeMM alone, and CeMM supplemented with EPA at 25 or 100 μM. Feeding was performed for 72 h. FTIR imaging was performed in transmission mode on individual worms. The FTIR imaging analysis of wild-type animals revealed the presence of vibrations assigned to unsaturated fatty acids, specifically bands at 3008 cm
(double bond, length as m-dashC-H, olefinic stretch) and 1744 cm
(Cdouble bond, length as m-dashO, unsaturated fatty acids). It confirmed previously reported synthesis of unsaturated fatty acids in wild-type C. elegans. For the FTIR spectra of mutant strains, these vibrations were absent or present only as very small shoulder, which indicates that tub-1 and fat-3 synthesize essentially saturated fatty acids as indicated by the presence of -CH
and Cdouble bond, length as m-dashO vibrations. These results are in agreement with previous studies which reported that these mutants have altered lipid compositions. Principal component analysis showed differences in chemical composition between wild-type and mutant strains as well as between mutant strains cultured in normal CeMM and those cultured in CeMM supplemented with EPA. This study demonstrated the usefulness of FTIR microspectroscopy to investigate fat metabolism in C. elegans.
The objective of this work was to develop a process that allows the synthesis of an apatitic material of controlled composition and morphology, which could be used for medical and environmental ...applications. The adsorbent was synthesized, and characterized using scanning electron microscopy, nuclear magnetic resonance, Thermal analysis and other techniques, Atomic Force Microscopy, X-ray photoelectron spectroscopy and Total organic carbon. Different experimental parameters such as the effect of the amount of adsorbent, solution pH and temperatures and contact times were studied. Pseudo-order kinetics models were studied, and our data followed a pseudo second order. Experimental data were analyzed for both Langmuir and Freundlich models and the data fitted well with the Langmuir isotherm model. To understand the mechanism of adsorption, thermodynamic parameters like standard enthalpy, standard Gibbs free energy, and standard entropy were studied. The study indicated that the process is spontaneous, exothermic in nature and follow physisorption mechanisms. The novelty of this study showed surface of composite based of hydroxyapatite has the ability to highlight the surface designed for efficient removal of Cu2+ and Zn2+ ions, from aqueous solutions more than other studies.
Guar gum is a water-soluble, nonionic, nontoxic, biodegradable and biocompatible hetero polysaccharide with unlimited number of industrial applications. In this study, guar gum was evaluated as a ...natural inhibitor of carbon steel (CS) corrosion in 2 M H3PO4 solution. The characteristic effect of guar gum on the steel corrosion was studied at concentration ranges from 0.1 to 1.0 g/L at 298–328 K by weight loss and electrochemical methods. Obtained results showed that, the inhibition efficiency (η%) of guar gum decreased slightly when the temperature increased and increased by increasing the inhibitor concentration reaching the maximum value at 1.0 g/L. The adsorption of guar gum on steel surface was studied by the Temkin adsorption model. EIS measurements indicate that the values of the polarization resistance (Rp) of CS in presence of guar gum are significantly higher than that of the untreated surface. Steel surface coated with guar gum was analyzed by SEM, FTIR and XRD. The quantum calculations using DFT method and Molecular Dynamic (MD) simulations were performed to define the relationship between inhibition performance of investigated compound and their molecular structure.
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•Guar gum inhibited corrosion of carbon steel in phosphoric acid environment.•Guar gum concentration play a key role in the inhibition process.•The Surface analyses support the polarization and EIS data.•Excellent correlation exists between inhibition efficiency and DFT and MD simulations studies.
Post-translational modification of proteins with ubiquitin and ubiquitin-like molecules (UBLs) controls a vast if not every biological process in the cell. It is not surprising that deregulation in ...ubiquitin and UBL signalling has been implicated in the pathogenesis of many diseases and that these pathways are considered as major targets for therapeutic intervention. In this review, we summarise recent advances in our understanding of the role of the UBL neural precursor cell expressed developmentally downregulated-8 (NEDD8) in cancer-related processes and potential strategies for the use of NEDD8 inhibitors as chemotherapeutics.
Traditional surgical approaches to the talus often fail to afford adequate exposure of the talar body, especially in the case of complex talar body fractures. Preservation of the remaining blood ...supply to the talus is a main concern during operative repair and can be difficult to accomplish when multiple approaches and forceful manipulations are required to gain satisfactory exposure. A medial malleolar osteotomy was used to gain access to the talar body in situations in which the traditional approaches did not provide adequate exposure. We describe our technique in a small series of patients.
Gastric electrical stimulation (GES) is effective to improve symptoms of nausea and vomiting in most patients, but very little is known about the effect of varying stimulation parameters. We analysed ...stimulation parameters in a pilot study of 22 patients (12 idiopathic, four diabetic and four postsurgical) with drug‐refractory gastroparesis who did not respond optimally to initial settings. Patients underwent high‐frequency/lowenergy GES using identical initial stimulation parameters: 5 mA of current, 330 μs pulse width, 14 Hz for 0.1 s on and 5.0 s off. Due to lack on optimal response, 22 patients underwent alteration of an algorithm using stimulation parameters. At follow‐up (mean of 4.3 years) a dose–response relationship for charge, power and energy were compared with baseline for the whole group and for each diagnostic subgroup by anovadata are reported as mean ± SE. Based on the mean of individual dose–response curves, differences in data are charge, current per pulse and energy per pulse were noted for the whole group at follow up vs baseline. The subgroup of patients with postsurgical gastroparesis required the most energy using the algorithm. In conclusion, an algorithmic approach to identify optimal stimulation parameters in GES for individual patients is associated with symptom improvement. Also, certain subgroups appear to have different energy parameters. Based on this preliminary data, the use of an algorithm for some patients with GES is feasible and may have potential for clinical application. A randomized‐controlled trial of different stimulation parameters for GES seems warranted.
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