Impact of a sustained, collaborative antimicrobial stewardship programme in spinal cord injury patients.

Background: In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission. Objectives: This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3 years. Methods: A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6 month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3 years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included. Results: The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3 years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51-0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3 years post-implementation (IRR 0.78; 95% CI 0.61-1.00; P = 0.052). A shorter antimicrobial order duration in the 3 year post-implementation period was observed (-28%; 95% CI -39% to -15%; P ≤ 0.001). This was most noticeable in IV orders at 3 years (-36%; 95% CI -51% to -16%; P = 0.001), and was also observed for oral orders at 3 years (-25%; 95% CI -38% to -10%; P = 0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (-43%; 95% CI -67% to -1%; P = 0.045), pulmonary infections (-45%; 95% CI -67% to -9%; P = 0.022) and urinary infections (-31%; 95% CI -47% to -9%; P = 0.009). Ninety-day mortality rates were not impacted. Conclusions: This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90 day mortality.

15N isotopic labelling for in-cell protein studies by NMR spectroscopy and single-cell IR synchrotron radiation FTIR microscopy: a correlative study.

The ultimate goal of modern structural biology is to probe protein structures and dynamics in their physiological microenvironment. In-cell NMR spectroscopy is an ideal technique for achieving this goal, being able to investigate proteins at atomic-resolution in living cells. The reliability of the results provided by in-cell NMR relies on the selectivity of the labelling methodology coupled with the filtering capabilities offered by heteronuclear NMR experiments. However, solution NMR is not well-suited either for measuring to what extent the non-specific labelling occurs, or to evaluate how it is affected by cell-to-cell variability and, eventually, whether the labelling procedure affects the cellular macromolecular content in general. To answer these questions, we correlated in-cell 1D 1H and 2D 1H-15N NMR experiments on HEK293T cells overexpressing superoxide dismutase 1 (SOD1) with single-cell Synchrotron Radiation FTIR Microscopy (FTIRM) experiments on the same samples. We verified that SOD1 overexpression in 15N-enriched media does not induce modifications in the overall cellular profile, and that the cell-to-cell labelling variability is independent of SOD1 overexpression and is likely cell cycle-related. We concluded that the non-specific incorporation of 15N into cellular components other than the protein of interest is one of the main factors that hinder the possibility of in-cell conformational studies by FTIRM at the single-cell level. Improving labelling selectivity by employing protein insertion approaches, and increasing FTIRM sensitivity by plasmonic enhancement, would open new perspectives for in-cell ultra-sensitive single-protein conformational studies complementing NMR and vibrational analyses.

Treatment of intermittent claudication with antiplatelet agents.

In a double-blind study, 296 patients with intermittent claudication (Fontaine stage II) were treated with 250 mg ticlopidine twice daily, 500 mg aspirin every third day plus 75 mg dipyridamole three times daily, or 300 mg xanthinol nicotinate three times daily for 6 months. Ticlopidine and aspirin/dipyridamole, but not xanthinol nicotinate, improved platelet aggregation, reduced beta-thromboglobulin, platelet factor IV and fibrinopeptide A concentrations, and increased antithrombin III concentrations and red blood cell filterability. No changes in lipid profiles, platelet count or fibrinogen were recorded following any treatment. The doppler systolic blood pressure ratio was improved in patients treated with ticlopidine or aspirin/dipyridamole, but not with xanthinol nicotinate. It is concluded that antiplatelet treatment is useful for the treatment of limb arteriopathy.

Hemostasis and mechanism of action of selective antimetastatic drugs in mice bearing Lewis lung carcinoma.

The selective antimetastatic agents p-(3,3-dimethyl-1-triazeno)benzoic acid potassium salt (DM-COOK), 5-(3,3-dimethyl-1-triazeno)imidazole-4-carboxamide (DTIC) and (+/-)1,2-di(3,5-dioxopiperazin-1-yl)propane (ICRF-159) have been shown to markedly depress the formation of spontaneous hematogenous metastases in mice bearing s.c. Lewis lung carcinoma, with a mechanism unrelated to cytotoxicity for tumor cells. The effects on hemostasis of DM-COOK, DTIC and ICRF-159 have thus been examined in comparison with those of a purely cytotoxic agent, cyclophosphamide, in mice bearing i.m. Lewis lung carcinoma. The parameters considered are the number of platelets and their aggregability, prothrombin and partial thromboplastin times, plasma fibrinogen concentration and tumor cell procoagulant activity. Slight variations are caused by drug treatment in tumor-bearing mice as compared with untreated tumor-bearing controls; the pattern of effects of the selective antimetastatic agents does not differ from that of the reference cytotoxic compound used, cyclophosphamide. These data thus indicate that the effects on hemostasis of the drugs examined can contribute only marginally to their antimetastatic action, since more pronounced effects on hemostasis have been shown to be required to significantly affect metastasis formation.

[Evaluation of platelet function and coagulation in deafness and sudden vestibular disorders]. / Valutazione della funzionalità piastrinica e della coagulazione nella sordità e nelle turbe vestibolari improvvise.

Thirty-five patients affected by acute vestibular dysfunction (A.V.D.) and/or sudden deafness (S.D.) were studied. Twenty-seven of them presented, as major component of the clinical disorder, a vestibular dysfunction, eight a sudden deafness. The control group was matched for sex, age, smoking habit and family history of diabetes and myocardial infarction. In all the subjects the following tests were carried out: platelet aggregation (Born's method), PF3 (Spaet and Cintron), PF4 and BTg (RIA), aPTT, AT III, cholesterol and triglycerides. The results indicate in the patients group increase of P.A.: SAV = 27 vs 43% (p = 0.03) at 1.2 X 10(-6) M ADP, a larger availability of PF3 in PPP and PRP, increase of PF4: 7.2 vs 17.2 (p = 0.01) and BTg: 32.4 vs 49.1 (p = 0.009). The data indicate in A.V.D. and S.D. a platelet hyperactivity; if so, an antiplatelet therapy may be reasonable.

[Detection of paraproteinemia in blood donors. Results of systematic analysis of 3800 donors in Trieste]. / La ricerca della paraproteinemia nei donatori di sangue. Risultati dell'analisi sistematica di 3800 donatori della provincia di Trieste.

A systematic analysis of plasma protein pattern performed by agarose gel electrophoresis has detected paraproteinemia in 13 out of 3800 blood donors in the district of Trieste. The variations in the incidence of monoclonal gammopathies in surveys of blood donors could be related not only with geographical origin and the age and sex distribution of the population studied but also with the sensitivity of the screening technique employed. The physiopathological and clinical implications of the detection of paraproteins favour the inclusion of the screening plasma electrophoretic analysis among the laboratory investigations for blood donors.

[HBsAg and HBsAb in carriers and their families]. / HBsAg ed HBsAb in portatori e loro familiari

Relatives of 98 Au antigen carriers were examined (positivity by AUSRIA II-125), already donors at the Immunotransfusion Centre of Trieste General Hospitals, totalling 106 cases: 98 out of same were represented by their wives and children, older than 7 years. 8 of the wives were HB,sAg (8.2%) positive and 90 negative: children were all antigen negative. In wives and children the presence of eventual anti-HBsAg antibodies by means of AUSAb technique (Abbott) was investigated obtaining 29 positive (29.3%) and 69 negative sera. With Dr. Lacy's (Abbott Diagnostic Division) collaboration the typing of HBsAg and HBsAb found was performed in order to obtaine epidemiological informations.