Occurrence of multidrug-resistant Enterococcus faecium isolated from environmental samples.

Enterococcus species are present in the microbiota of humans and animals and have also been described in the environment. Among the species, Enterococcus faecium is one of the main pathogens associated with nosocomial infections worldwide. Enterococcus faecium isolates resistant to different classes of antimicrobials have been increasingly reported, including multidrug-resistant (MDR) isolates in environmental sources, which is worrying. Therefore, this study aimed to characterize E. faecium isolates obtained from soil and water samples regarding antimicrobial resistance and virulence determinants. A total 40 E. faecium isolates were recovered from 171 environmental samples. All isolates were classified as MDR, highlighting the resistance to the fluoroquinolones class, linezolid and vancomycin. Furthermore, high-level aminoglycoside resistance and high-level ciprofloxacin resistance were detected in some isolates. Several clinically relevant antimicrobial resistance genes were found, including vanC1, ermB, ermC, mefAE, tetM, tetL, ant(6')-Ia, ant(4')-Ia, aph(3')-IIIa and aac(6')-Ie-aph(2″)-Ia. Three virulence genes were detected among the MDR E. faecium isolates, such as esp, gelE and ace. The results of this study contribute to a better understanding of MDR E. faecium isolates carrying antimicrobial resistance and virulence genes in environmental sources and report for the first time in the world the presence of vanC1-producing E. faecium isolated from soil.

Lung cancer screening with low dose CT: experience at Campus Bio-Medico of Rome on 1500 patients.

AIM: The main purpose of our project was to evaluate the prevalence of lung cancer in high risk, asymptomatic individuals in addition to quantifying the rate of surgically resectable tumors, and evaluating the role of lung cancer with low dose computed tomography (LDCT) as a tool for lung cancer screening. METHODS: Between June 2011 and March 2014, 1500 volunteers at high risk for lung cancer were enrolled in our study and underwent LDCT in our institution. The subsequent diagnostic and therapeutic steps were planned in relation to the results emerging from LDCT. To evaluate speed and type of growth, solid nodules ≤4 mm were reassessed with annual LDCT, those >4-6 mm or >6-8 mm were reassessed with LDCT in 6 or 3 months while nodules suspicious for malignancy were investigated with PET-CT or biopsy according to NCCN guidelines. RESULTS: Non-calcified nodules were detected in 525 subjects (35% of population): among these 42% had a diameter ≤4 mm, 43% had a diameter >5 mm but <10 mm, 3% appeared as "ground glass" lesions, and 63 (12% of detected nodules) had malignant characteristics (irregular margins, retraction of the surrounding parenchyma, diameter >10 mm). Among the 63 patients who underwent PET-CT or biopsy, 25 cases resulted positive for lung cancer (1.7% of population). These patients underwent surgical treatment with histological detection of tumors in stages IA, IB or IIB. CONCLUSION: Our study confirmed the emerging data on the use of LDCT as a screening tool for lung neoplasm in individuals at risk. Due to the LDCT low rate of specificity complementary biomarkers are required to properly define patients at risk and to reduce the number of further radiological examinations.

Efficient 1535 nm light emission from an all-Si-based optical micro-cavity containing Er³âº and Yb³âº ions.

This work reports on the construction and spectroscopic analyses of optical micro-cavities (OMCs) that efficiently emit at ~1535 nm. The emission wavelength matches the third transmission window of commercial optical fibers and the OMCs were entirely based on silicon. The sputtering deposition method was adopted in the preparation of the OMCs, which comprised two Bragg reflectors and one spacer layer made of either Er- or ErYb-doped amorphous silicon nitride. The luminescence signal extracted from the OMCs originated from the 4I(13/2)→<4I(15/2) transition (due to Er3 ions) and its intensity showed to be highly dependent on the presence of Yb3+ ions. According to the results, the Er3+-related light emission was improved by a factor of 48 when combined with Yb3+ ions and inserted in the spacer layer of the OMC. The results also showed the effectiveness of the present experimental approach in producing Si-based light-emitting structures in which the main characteristics are: (a) compatibility with the actual micro-electronics industry, (b) the deposition of optical quality layers with accurate composition control, and (c) no need of uncommon elements-compounds nor extensive thermal treatments. Along with the fundamental characteristics of the OMCs, this work also discusses the impact of the Er3+-Yb3+ ion interaction on the emission intensity as well as the potential of the present findings.

Modificaciones del perfil hormonal sexual como resultado de la administración conjunta de dos sustancias que inhiben el metabolismo de la testosterona / Sexual hormonal profile modifications as a result of the join administration of two substances inhibitors of the testosterone metabolism

Con este trabajo se pretendió ver el efecto sobre el perfil hormonal sexual y en especial sobre la concentración de testosterona después de administrar dos sustancias que bloquean por diferentes mecanismos la degradación de ésta. Además comprobar, utilizando la técnica gases-combustión-espectrometría de isótopos estables (gc-cirms), si la testosterona que se acumula en el organismo por estas inhibiciones se debe simplemente al bloqueo de los mecanismos de degradación o a que alguno de los compuestos administrados entra en la ruta metabólica como precursor para aumentar su producción. Con tal propósito, se estudiaron los efectos que tenía el inhibidor de la aromatasa 3, 6, 17 androstenetriona (6-Oxo) sobre el perfil hormonal sexual de dos voluntarios sanos y confirmamos mediante el análisis isotópico la participación de esta sustancia en la ruta de producción de testosterona mediante el estudio de sus metabolitos mayoritarios de excreción: androsterona y etiocolanolona. Luego se estudió el efecto que tenía la administración de este inhibidor en combinación con un inhibidor del citocromo p-450 (6’, 7’, dihidroxibergamotin-dhb) en otros dos voluntarios. En los dos experimentos se observó un aumento del perfil hormonal, especialmente de la concentración de dehidroepiandrosterona (dhea) y testosterona, explicando por qué se promocionan en el comercio este tipo de mezclas para aumentar la masa muscular y, en consecuencia, la apariencia física.

This work aimed to see the effect on the sexual hormonal profile and in particular on the concentration of testosterone after administration of two different substances that block the mechanisms of its degradation. In addition check, using the technique of stable isotopes (gc-c-irms), if the testosterone that accumulates in the body by these inhibitions is due simply to the blocking of the mechanisms of degradation or any of the compounds administered go into the route as a metabolic precursor to increase its production. To accomplish this we studied the effects that initially had the aromatase inhibitor 3, 6, 17 androstenetriona (6-Oxo) on the sexual hormonal profile of two healthy volunteers and confirmed, by the isotopic analysis, that this substance participate in the road testosterone production by studying its major metabolites of excretion: Androsterone and Ethiocholanolone. Subsequently we studied the effect of the administration of this inhibitor in combination with an inhibitor of cytochrome p-450 (6 ‘, 7’, dihidroxibergamotin-dhb) in two other volunteers. In both experiments showed an increase in the hormonal profile especially in the concentration of dehydroepiandrosterone (dhea) and testosterone, explaining the reason of why such mixtures are promoted to increase muscle mass and thus the physical appearance.

[Screening for diabetes in France: data from the 2000-2001 cohort of the national medical insurance system]. / Dépistage du diabète: les données de l'Echantillon Permanent des Assurés Sociaux, 2000-2001.

BACKGROUND: Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test. METHODS: We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (2000-2001). We used the administrative EPAS cohort from the employee National Health Insurance System which covers 70% of the total population in France. The data are based on reimbursements of glucose testing and hospitalization among people who did not received reimbursements of treatment for diabetes but used medical services during the 2 Years. RESULTS: The opportunistic screening rate within 2 Years was 48.6% overall and increased with age. Among those 45 Years old or older, it was 71.2%. The screening rate was higher among women than men. CONCLUSION: Opportunistic screening for diabetes is commonly practised in France, despite the lack of official guidelines. Several hypotheses may explain the discrepancy between common opportunist screening and high prevalence of undiagnosed diabetes: 1). undiagnosed diabetes is mostly present in people who do not use medical services; 2). opportunistic screening is not performed among the most at-risk population; 3). testing is not performed on fasting samples or results are neglected; 4). results of testing are overlooked by doctors/patients; 5). epidemiological studies based on self-report of diagnosis and only one testing overestimate undiagnosed diabetes.

Failure of stavudine-lamivudine combination therapy in antiretroviral-naive patients with AZT-like HIV-1 resistance mutations.

To analyze the clinical relevance of AZT resistance mutations in AZT-naive patients, 56 HIV-1 seropositive patients treated for 18 months with stavudine/lamivudine (27 patients) or AZT/lamivudine (29 patients) were studied. AZT-like resistance mutations were found in 13 out of 29 (44%) patients treated with AZT/lamivudine and in 11 out of 27 (40%) patients treated with stavudine/lamivudine. No stavudine or multi-drug resistance mutations were detected. After 26 months of treatment more than 60% of patients showed a virological failure. Among 10 patients failing treatment with stavudine/lamivudine, 9 had AZT-like resistance mutations. The phenotypic test, performed on HIV-1 strains isolated from six of these nine patients, showed a resistance to AZT in five isolates and to stavudine in two isolates. The genotypic pattern of the latter two isolates showed the combined mutations M184V plus R211K and L214F. AZT-like resistance mutations in AZT-naive patients seem to correlate with a virological failure during long-term stavudine therapy.

[Coronary revascularization surgery with arterial grafts]. / Cirugía de revascularización coronaria con injertos arteriales.

Coronary artery revascularization surgery is well established procedure throughout the world. The benefits are based on the blood perfusion through the implanted grafts distal to the coronary occlusions and continue as long as the grafts remains patent. The immediate success of this procedure is related to the surgical technique and the anatomical characteristics of the grafted coronary arteries. However, the long term results are mainly dependent on the type of grafts used. The modern era of myocardial revascularization started in the sixties with the use of saphenous vein grafts by Johnson and Favaloro. Alternative vascular conduits to the saphenous vein have been tried, and the internal mammary artery has become the first choice. In recent years, various publications have demonstrated the supremacy of the internal mammary artery over the saphenous vein when used as a single, bilateral, sequential of free graft. In order to obtain full myocardial revascularization, the use of alternatives to the internal mammary artery is required. The gastroepiploic artery, the inferior epigastric artery and the radial artery have been used as alternatives to the saphenous vein with the hope of obtaining long term results similar to the internal mammary artery.

[The antecedents and creation of the Alfonso XIII Institute of Serotherapy, Inoculation and Bacteriology]. / Antecedentes y creación del Instituto de Sueroterapia, Vacunación y Bacteriología de Alfonso XIII.

This article studies the establishment of the Alfonso XIII Institute of Serotherapy, Inoculation and Bacteriology in 1899, using the general press and the professional-scientific, medical and pharmaceutical press as its prime source, It aims to highlight the principal factors which led to its gestation and later development, as well as the circumstances which led to its creation, by analyzing the antecedents and orgins of the aforementioned institution.

Heparin-coated circuit in coronary surgery. A clinical study.

We performed a randomized study in 101 patients who underwent routine isolated coronary bypass graft surgery. In 50 cases an entire coated Carmeda circuit was used (coated group), and an uncoated circuit in the remaining 51 (uncoated group). A Medtronic Maxima oxygenator and a Biomedicus Biohead were used in all cases. Patients with coated circuits received low systemic heparinization with a heparin loading dose of 200 IU/kg, and 300 IU/kg for the control. Activated coagulation time was maintained at more than 275 s for the coated group versus more than 400 s for the uncoated one. The mean age of patients was 64.1 +/- 9.6 for coated and 63.5 +/- 9.7 for the uncoated group. The number of coronary grafts was 3.1 +/- 0.7 for the coated group and 3.1 +/- 0.1 for the uncoated one. Cross-clamp and bypass times were 53 +/- 14 and 98 +/- 24 min for the coated, versus 57 +/- 15 and 104 +/- 24 for the uncoated, group. Chest drainage was 989.4 +/- 509.5 ml for the coated group versus 1435 +/- 1027 for the uncoated one (P < 0.02). The amount of transfused homologous blood was 723 +/- 597 ml for the coated group versus 1071 +/- 831 ml for the uncoated one (P < 0.03). Postoperative endotracheal intubation time was 12.1 +/- 3.6 h for the coated and 14.6 +/- 4.5 h for the uncoated group (P < 0.05). Bleeding required rethoracotomy in 1/50 of the coated group, and in 4/51 of the uncoated one. Hospital mortality was 1/50 in the coated, and 4/51 in the uncoated, group. In our preliminary experience, heparin coating of an extracorporeal circuit reduces post-operative blood loss and blood transfusions in routine coronary bypass operations.

Early primary tissue failure of a Labcor bioprosthesis.

A 78-year-old woman underwent re-replacement of a 19mm Labcor bioprosthesis implanted in aortic position eighteen months earlier. The rupture of the free margin of one leaflet was found at reoperation. There was no apparent cause of this rupture.

[The fight against "avoidable" diseases and the 1918-1919 influenza epidemic in Spain]. / La lucha contra las enfermedades "evitables" en España y la pandemia de gripe de 1918-19.

This study tries to examine a series of proposals for the prevention of "avoidable" diseases, which were presented in Parliament between 1914 and 1922. These proposals illustrate how Spanish physicians approached public prophylaxis against infectious diseases. The article also attempts to highlight how the 1918-1919 influenza pandemic may have affected the number and content of such proposals.

[The idea of well-being in the course of spanish medicine prior to the Welfare State]. / La idea de Bienestar en el discurso médico español anterior al nacimiento del Estado de Bienestar.

By primarily using treatises on medical policy and texts on public hygiene and social medicine as sources, we shall analyse the idea of well-being in the course of Spanish medicine prior to the birth of the Welfare State. We shall look at the economic connotation that this idea acquired during the Enlightenment, and how, towards the end of this period, this idea was incorporated into the development of medicine, and which from that time onwards varied in content during every age depending on the social circumstances of the moment and the corporativist interests of the doctors. This can be clearly seen in the case of good health, which although it was always one of the elements of this view of "well-being" did however become more prominent on three occasions: at the end of the Enlightenment, in the middle of the 19th century (Méndez Alvaro), and during the second decade of this century (Martín Salazar, Codina and Amalio Jimeno).

[Percutaneous mitral valvuloplasty. Immediate results with the 30 mm diameter dilatation balloon]. / Valvuloplastia mitral percutánea. Resultados inmediatos con balón de dilatación de 30 mm de diámetro.

Percutaneous balloon dilatation of the mitral valve is a promising alternative to surgical treatment for patients with mitral stenosis. We analysed echocardiographic and haemodynamic results in 62 consecutive patients who underwent mitral dilatation with a big and one chamber balloon (30 mm diameter). The relationship between the dilatation balloon area and body surface was 4.2 (in 98% of patients it was bigger than 3.5). In the whole series we get significant improvements in the haemodynamic parameters and mitral areas (0.91 cm2 versus 1.78 cm2)(p < 0.005). According to the echocardiographic score, patients were divided in two groups. Good results (mitral area > 1.5 cm2, and final, valve area 50% greater than the initial area), were obtained in 93% of patients with a score of 8 or less, and in 45% of patients with a score bigger than 8. Seventy-five percent of patients with bad results (mitral area < 1.5 cm2) were in atrial fibrillation versus 37% of patients where we get a good results. Mortality of procedure was nulle, and two patients required surgery because of procedure failure for mitral insufficiency. We can conclude: percutaneous mitral valvuloplasty with single balloon is valid alternative, and good results can be expected if there is a good relationship between the area of balloon and patient's body-surface. The echocardiographic score and presence of atrial fibrillation can predict immediate results of this technique.

[Ultrasonic decalcification of the aortic valve. Initial experience]. / Decalcificación ultrasónica de la válvula aórtica. Experiencia inicial.

We report our initial experience in 2 patients with degenerative calcific aortic stenosis who underwent ultrasonic debridement of the aortic valve. Compared with preoperative studies, doppler echocardiographic and hemodynamic evaluation before hospital discharge revealed a reduction in the mean aortic valve pressure gradient (80 and 65 mmHg to less than 10 mmHg). There was no change in aortic regurgitation grade. Follow-up doppler echocardiographic evaluation at four and six months showed no changes in gradient or regurgitation in the comparison to the postoperative data. Long-term results will show the convenience to attempt or not ultrasonic salvage of the native aortic valve in severe calcific stenosis.

[Percutaneous cardiopulmonary bypass in angioplasty and valvuloplasty. The technical considerations]. / Bypass cardiopulmonar percutáneo en la angioplastia y la valvuloplastia. Consideraciones técnicas.

To reduce problems during percutaneous transluminal angioplasties and valvuloplasties in the catheterization laboratory, percutaneous cardiopulmonary bypass was used in 6 patients (three aortic, two mitral and one coronary). Percutaneous 21 F (venous) and 17 F (arterial) cannulas were placed through the femoral vessels. Mean flows of 3 l/min were achieved with a roller pump, with a mean blood pressure of 60 mmHg. Bypass time ranged between 22 and 55 minutes (mean 39). Light intravenous sedations and spontaneous breathing was maintained in all cases. Maximum inflation time of balloons were 4 minutes for the aortic valvuloplasty patients and 50 seconds for the mitral. Two patients developed groin hematomas, and one of them required surgical exploration. Percutaneous bypass is a simple and easily achieved technique to ensure safety in the high-risk patient.

In situ right gastroepiploic artery. A conduit for coronary revascularization.

The internal mammary artery is widely recognized as the graft of choice for coronary artery bypass grafting at present. Alternative conduits have been investigated in order to find other adequate long-term grafts. The right gastroepiploic artery has been recently used as a graft to bypass distal coronary vessels. From November 1989 to June 1990, we have implanted this artery in 46 cases. Pedicled grafts were implanted in 20 patients to the main right coronary artery, in 21 patients we grafted the right distal branches, in 3 patients the left anterior descending, and in 2 the circumflex branches. Mean grafts per patient were 3 in this series, with a mean of 2.2 arterial grafts per patient. One patient died in the early postoperative period. The remaining patients had an uncomplicated postoperative evolution. Thirteen patients underwent graft and coronary angiography. Direct or indirect graft patency was confirmed in all cases. The final important issue concerning the long-term patency of this graft will be solved in the future, but short-term patency rates of the right gastroepiploic artery can be anticipated when proper techniques are used.

[Myocardial revascularization with the gastroepiploic artery. The initial experience]. / Revascularización miocárdica con arteria gastroepiploica. Experiencia inicial.

The internal mammary artery is widely recognized as the graft of choice for coronary artery bypass grafting at present. Alternative conduits have been investigated in order to find other adequate long-term grafts. The right gastroepiploic artery has been recently used as a graft to bypass distal coronary vessels. From November 1989 to April 1990 we have implanted this artery in 33 cases (32 in situ and one free grafts). The pedicled grafts were implanted in 17 patients in the main right coronary artery, in 13 we grafted the right distal branches, in one the left anterior descending, and the circumflex branch in one. The free graft was implanted in the first diagonal. Mean grafts per patient was of three in this series, with a mean of 2 arterial grafts per patient. One patient died in the early postoperative period. The remaining patients had an uncomplicated postoperative period. Thirteen patients underwent graft and coronary angiography. Direct or indirect graft patency was confirmed in all cases. The final important issue concerning the long-term patency of this graft will be solved in the future, but short-term patency rates of the right gastroepiploic artery can be anticipated when proper techniques are used.