Antimicrobial Drug Penetration Is Enhanced by Lung Tissue Inflammation and Injury.

Rationale: Pneumonia is a frequent and feared complication in intubated critically ill patients. Tissue concentrations of antimicrobial drugs need to be sufficiently high to treat the infection and also prevent development of bacterial resistance. It is uncertain whether pulmonary inflammation and injury affect antimicrobial drug penetration into lung tissue.Objectives: To determine and compare tissue and BAL fluid concentrations of ceftaroline fosamil and linezolid in a model of unilateral acute lung injury in pigs and to evaluate whether dose adjustment is necessary to reach sufficient antimicrobial concentrations in injured lung tissue.Methods: After induction of unilateral acute lung injury, ceftaroline fosamil and linezolid were administered intravenously. Drug concentrations were measured in lung tissue through microdialysis and in blood and BAL fluid samples during the following 8 hours. The primary endpoint was the tissue concentration area under the concentration curve in the first 8 hours (AUC0-8 h) of the two antimicrobial drugs.Measurements and Main Results: In 10 pigs, antimicrobial drug concentrations were higher in inflamed and injured lung tissue compared with those in uninflamed and uninjured lung tissue (median ceftaroline fosamil AUC0-8 h [and interquartile range] = 26.7 mg ⋅ h ⋅ L-1 [19.7-39.0] vs. 16.0 mg ⋅ h ⋅ L-1 [13.6-19.9], P = 0.02; median linezolid AUC0-8 h 76.0 mg ⋅ h ⋅ L-1 [68.1-96.0] vs. 54.6 mg ⋅ h ⋅ L-1 [42.7-60.9], P = 0.01), resulting in a longer time above the minimal inhibitory concentration and in higher peak concentrations and dialysate/plasma ratios. Penetration into BAL fluid was excellent for both antimicrobials, but without left-to-right differences (ceftaroline fosamil, P = 0.78; linezolid, P = 1.00).Conclusions: Tissue penetration of two commonly used antimicrobial drugs for pneumonia is enhanced by early lung tissue inflammation and injury, resulting in longer times above the minimal inhibitory concentration. Thus, lung tissue inflammation ameliorates antimicrobial drug penetration during the acute phase.

Effect of Regular Electrotherapy on Spinal Flexibility and Pain Sensitivity in Patients with Chronic Non-Specific Neck Pain and Low Back Pain: A Randomized Controlled Double-Blinded Pilot Trial.

Background and Objectives: Chronic neck pain and low back pain are common conditions in high-income countries leading to social and medical problems such as invalidity and decreased quality of life. The aim of this study was to investigate the effect of supra-threshold electrotherapy on pain level, subjective feeling of disability, and spinal mobility in patients with chronic pain in the spinal cord. Materials and Methods: 11 men and 24 women with a mean age of 49 years were randomly divided into three groups: group 1, "therapy": supra-threshold electrotherapy was applied on the whole back after electrical calibration; group 2, "control": electrical calibration without successive electrotherapy; group 3, "control of control": no stimulation. Sessions were performed once a week and six times in total, each lasting 30 min. The numeric pain rating scale (NRS), cervical and lumbar range of motion (ROM), as well as disability in daily live were investigated before and after the sessions using questionnaires (Neck Disability Index, Roland Morris Questionnaire, Short-form Mc Gill Pain Questionnaire (SF-MPQ)). Results: Spinal mobility improved significantly in the lumbar anteflexion (baseline mean, 20.34 ± SD 1.46; post session mean, 21.43 ± SD 1.95; p = 0.003) and retroflexion (baseline mean, 13.68 ± SD 1.46; post session mean, 12.05 ± SD 1.37; p = 0.006) in the group receiving electrotherapy. Pain levels measured by the NRS and disability-questionnaire scores did not differ significantly before and after treatment in any of the groups. Conclusions: Our data indicate that regular supra-threshold electrotherapy for six times has a positive effect on lumbar flexibility in chronic neck pain and low back pain patients, whereas pain sensation or subjective feeling of disability remained unchanged.

A novel device for the clinical assessment of intranasal trigeminal sensitivity.

OBJECTIVE: Despite the significance of trigeminal pathology, practical clinical tests that accurately evaluate intranasal trigeminal function are scarce. The aim of the present study is to introduce a practical procedure for the assessment of intranasal trigeminal sensitivity. METHODS: We developed a device to stimulate the nasal mucosa using carbon dioxide, which is self-administered intranasally by holding down a timed button until the required sensory response has been triggered. The trigeminal sensitivity is derived from the measured administration time in conjunction with the concentration of carbon dioxide administered. Sixty-three healthy participants were used to validate the device, after which the new device was compared with a standard lateralization task in an additional 16 participants. In 20 participants, the experiment was repeated to verify test-retest reliability. RESULTS: Statistical analysis showed significant consistency in administration-duration in healthy individuals, including those in the test-retest group. Those participants with higher scores in the lateralization task were found to show higher intranasal sensitivity measured by the new device. CONCLUSION: Herein, we present the design and validation of a novel device for the practical assessment of intranasal trigeminal sensitivity. In this study, we demonstrate the efficacy and reliability of this device.

Clinical significance of smell and taste disorders in patients with diabetes mellitus.

Chemosensory dysfunction has been reported in patients with diabetes mellitus (DM). However, the clinical significance in relation to the disease stage remains unclear. The aim of this investigation was to assess olfactory and gustatory function with valid clinical tests in patients with DM types 1 and 2 with and without accompanying diseases. Seventy-six patients with DM were divided into three groups according to disease stage. Taste function was tested by means of impregnated paper strips and smell function was screened using a five-item smell identification test. The results of the patients with uncomplicated DM were compared with the results from 29 healthy subjects. The results showed no significant differences in smell and taste function between patients with uncomplicated DM and healthy subjects. However, patients with additional diseases exhibited decreased smell acuity. Moreover, patients with DM type 2 showed impaired smell function compared with patients with DM type 1.

Clinical assessment of gustatory function before and after middle ear surgery: a prospective study with a two-year follow-up period.

OBJECTIVES: Middle ear surgery can affect gustatory function because of the course of the chorda tympani nerve (CTN) close to the tympanic membrane. The aim of the study was to evaluate the sense of taste before and after middle ear surgery with a test suitable for clinical routine. Moreover, subjective complaints were assessed over a relatively long period of time. METHODS: Forty-seven patients (26 female, 21 male; mean age, 42 years) were investigated before and 4 days after surgery on both sides of the anterior part of the tongue. Self-assessment of taste function was performed by visual analog scales. RESULTS: The mean (+/- SD) taste scores significantly decreased on the side ipsilateral to the operated ear in patients with major manipulation of the CTN (12.0 +/- 4.5 before surgery and 6.9 +/- 4.5 after surgery; p < 0.001), whereas no significant changes were measured in patients with minor manipulation of the CTN (12.5 +/- 3.1 before surgery and 11.2 +/- 3.9 after surgery; p = 0.14). Self-assessed ratings of taste function significantly decreased after surgery in all patients (p < 0.001). Reassessment of subjective taste function after 2 years indicated no persisting complaints. CONCLUSIONS: Depending on the amount of manipulation of the CTN, taste function is decreased after surgery. However, long-lasting changes of gustatory function seem to be rare.

Non-Hebbian plasticity at C-fiber synapses in rat spinal cord lamina I neurons.

Current concepts of memory storage are largely based on Hebbian-type synaptic long-term potentiation induced by concurrent activity of pre- and postsynaptic neurons. Little is known about non-Hebbian synaptic plasticity, which, if present in nociceptive pathways, could resolve a number of unexplained findings. We performed whole-cell patch-clamp recordings in rat spinal cord slices and found that a rise in postsynaptic [Ca(2+)]i due to postsynaptic depolarization was sufficient to induce synaptic long-term potentiation (LTP) in the absence of any presynaptic conditioning stimulation. LTP induction could be prevented by postsynaptic application of the Ca(2+) chelator BAPTA (1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid), the L-type voltage-gated calcium channel (VGCC) antagonist nifedipine, and by postsynaptic application of the NMDA receptor antagonist MK801. This indicates that synaptic potentiation was induced postsynaptically by Ca(2+) entry likely via L-type voltage-gated Ca(2+) channels (VGCC) and via NMDA receptor channels. The paired pulse ratio and the coefficient of variation remained unchanged in neurons expressing LTP, suggesting that this form of synaptic potentiation was not only induced, but also expressed postsynaptically. Postsynaptic depolarization had no influence on firing patterns, action potential shape, or neuronal excitability. An increase in [Ca(2+)]i in spinal lamina I neurons induces a non-Hebbian form of synaptic plasticity in spinal nociceptive pathways without affecting neuronal active and passive membrane properties.

A self-administered odor identification test procedure using the "Sniffin' Sticks".

Assessment of smell function in clinical routine is often limited due to a lack of time and/or costs of the personnel administering the test. The aim of the present study was to validate a procedure allowing for self-administered olfactory testing in a clinical setting. Seventy-four healthy subjects (13 male, 61 female) from 18 to 30 years of age (mean 20.3 years) were tested on 2 days (interval 7-21 days, mean 8.7 days) with 16 odors of the "Sniffin' Sticks" identification test kit. On one occasion, the test was administered by an examiner. On another occasion, subjects administered the test to themselves, with the odors being identified after they had been "painted" on a sheet of paper. No significant differences were obtained between the results from both test procedures. With a maximum score of 16, assisted testing yielded a mean score of 13.7 [standard deviation (SD) 1.3] while the self-administered procedure yielded an average score of 13.8 (SD = 1.5) (P = 0.72). The mean difference between the assisted and the self-administered smell test procedures was 0.05 (SD = 1.28). The 95% confidence interval of differences ranged from -2.51 to 2.61. These results suggest that odor identification with the Sniffin' Sticks can also be administered by the subjects themselves.