Tuning Ni-Pyrazolate Frameworks by Post-Synthetic Fe-Incorporation for Oxidase-Mimicking H2 O2 Activation.

The introduction of iron ionic sites by metal exchange of defective homometallic nickel pyrazolate frameworks generates non-precious, Earth-abundant, first-row heterometallic Fe/Ni-pyrazolate frameworks. The Fe incorporation at the Ni nodes of the framework allows to control the hydrogen peroxide activation, minimizing its decomposition and O2 liberation, occurring at the homometallic Ni nodes. The generation of Fe-OH reactive oxygen species at the heterometallic Fe/Ni nodes is demonstrated by the higher activity in the proof-of-concept oxidation of 1-phenylethanol to acetophenone in an aqueous medium.

High Rate of Inappropriate Antibiotics in Patients with Hematologic Malignancies and Pseudomonas aeruginosa Bacteremia following International Guideline Recommendations.

Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the ß-lactam antibiotics recommended in international guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate ß-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed. IMPORTANCE Bloodstream infection (BSI) caused by P. aeruginosa is related with an elevated morbidity and mortality in neutropenic patients. For this reason, optimal antipseudomonal coverage has been the basis of all historical recommendations in the empirical treatment of febrile neutropenia. However, in recent years the emergence of multiple types of antibiotic resistances has posed a challenge in treating infections caused by this microorganism. In our study we postulated that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines. This observation is associated with frequent IEAT and increased mortality. Consequently, there is a need for a new therapeutic strategy.

Ictericia no obstructiva como síndrome paraneoplásico del carcinoma de próstata: revisión sistemática de casos publicados / Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases

El síndrome de Stauffer es un síndrome paraneoplásico (SPN) en el que se produce una afectación hepática; clásicamente se ha relacionado con tumores renales, pero también con otros tumores como el adenocarcinoma de próstata (ACP). Nuestro objetivo es llevar a cabo una revisión sistemática de los casos publicados asociados al cáncer de próstata. El número de artículos cribados en la revisión bibliográfica fue de 357, de los cuales 25 cumplieron los criterios de inclusión. Todos los casos publicados de síndrome de Stauffer en pacientes con ACP estaban en estadio metastásico. El SPN se resolvió en 3 de cada 4 pacientes cuando se instauró el tratamiento dirigido al cáncer de próstata. La aparición del SPN en pacientes ya diagnosticados de ACP, niveles no elevados de bilirrubina total y la no resolución del SPN se presentaron como factores de mal pronóstico. (AU)

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment. (AU)

[Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases]. / Ictericia no obstructiva como síndrome paraneoplásico del carcinoma de próstata: revisión sistemática de casos publicados.

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment.

Resistance to empirical ß-lactams recommended in febrile neutropenia guidelines in Gram-negative bacilli bloodstream infections in Spain: a multicentre study.

OBJECTIVES: To describe current resistance to the ß-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB). METHODS: Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated. RESULTS: Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three ß-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT. CONCLUSIONS: Current resistance to empirical ß-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.

Comparison of the Parasitization of Chelonus inanitus L. (Hymenoptera: Braconidae) in Two Spodoptera Pests and Evaluation of the Procedure for Its Production.

Chelonus inanitus (L.) is an egg-larval parasitoid of noctuids Spodoptera exigua (Hübner) and S. littoralis (Boisduval), whose mass rearing or real potential has not been targeted yet. To improve the rearing in the factitious host Ephestia kuehniella Zeller, we investigated the influence of host age and number of females parasitizing simultaneously on the overall rearing success, the influence of host age on the life cycle, and the influence of host species on the parasitoid body size. The proportion of emerging C. inanitus was higher from young host eggs, but more females emerged from mature eggs. Under high parasitoid competition, we observed a reduction in non-parasitized hosts without reducing parasitoid emergence. The parasitoid life cycle was longer in females, but the mismatch between sexes was smaller in mature eggs. The parasitoid size was smaller in the factitious host than in the natural hosts. Under semi-field conditions, we investigated the competition among parasitoid females on the overall parasitism success. The reproductive parasitism was more successful in S. exigua than in S. littoralis, and the maximum emergence was reached with three and four females, respectively. The control of S. littoralis may be attributed to the high developmental mortality, a non-reproductive parasitism that is often underestimated.

[Compliance with post-cesarean section thromboprophylaxis recommendations. A cross sectional study in 233 women]. / Adherencia a las recomendaciones de tromboprofilaxis post-cesárea: estudio de corte transversal.

BACKGROUND: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. AIM: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. PATIENTS AND METHODS: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. RESULTS: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). CONCLUSIONS: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

Adherencia a las recomendaciones de tromboprofilaxis post-cesárea: estudio de corte transversal / Compliance with post-cesarean section thromboprophylaxis recommendations. A cross sectional study in 233 women

Background: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. Aim: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. Patients and Methods: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. Results: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). Conclusions: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

A Novel Visual Grading for Ureteral Encrusted Stent Classification to Help Decide the Endourologic Treatment.

Objective: The aim of the study is to propose a visual classification for encrusted stents (ESs) to help choose the appropriate endourologic treatment. Materials and Methods: A multicenter, retrospective, and descriptive study was performed. A total of 140 patients with encrusted Double-J stents were enrolled from 5 different institutions. The novel visual grading for ureteral encrusted stent (V-GUES) classification system ranges from A to D, increasing with severity of encrustation. Results: ESs could be removed with a single intervention in 112 patients (86.8%). Type A and B ESs could be removed in all patients (100% success). Type D stents had minor retrieval and stone-free rates (p = 0.006 and p < 0.0001, respectively). Flexible ureteroscopy had a low success rate (77.7%) for type C stents (odds ratio [OR]: 0.21). Combined access had a 100% success rate for retrieval of type C ESs and a 92.9% success rate for type D ESs (OR: 9.18). Type D stents were associated with patients requiring more than one session to retrieve the stent (OR: 0.11) and stones (OR: 0.21). Conclusions: The V-GUES system is associated with treatment success rates of ES retrieval and stone-free status. It is also associated with the complication rate and the number of sessions needed for patients to be stent and stone free. The V-GUES classification could help counsel patients about the best treatment options and their outcomes. Further prospective studies will be needed to provide external validation.

Changes in melon plant phytochemistry impair Aphis gossypii growth and weight under elevated CO2.

Elevated CO2 (eCO2) modifies plant primary and secondary metabolism that subsequently impacts herbivore insect performance due to changes in its nutritional requirements. This laboratory study evaluated interactions between Aphis gossypii Glover (Hemiptera: Aphididae) and melon (Cucumis melo L., Cucurbitaceae), previously acclimated two or six weeks to different CO2 levels, eCO2 (700 ppm) or ambient CO2 (400 ppm). Under eCO2, melon plants decreased nitrogen foliar concentration and increased carbon to nitrogen ratio, independently of acclimation period, significantly reducing the content of some amino acids (alanine, asparagine, glycine, isoleucine, lysine, serine, threonine, and valine) and increasing the carbohydrate (sucrose) content in melon leaves. The dilution in some essential amino acids for aphid nutrition could have aggravated the reduction in A. gossypii population growth reared on melon previously acclimated two weeks to eCO2, as well as the loss of aphid body mass from two successive generations of A. gossypii reared under eCO2 on plants previously acclimated two or six weeks to eCO2. The response to eCO2 of phloem feeders, such as aphids, is actually variable, but this study highlights a negative response of A. gossypii to this climate change driver. Potential implications on control of this pest in a global change scenario are discussed.

Analyzing the capability of PSP, PCT and sCD25 to support the diagnosis of infection in cancer patients with febrile neutropenia.

Background Early diagnosis of infection is essential for the initial management of cancer patients with chemotherapy-associated febrile neutropenia (FN). In this study, we have evaluated two emerging infection biomarkers, pancreatic stone protein (PSP) and soluble receptor of interleukin 2, known as soluble cluster of differentiation 25 (sCD25), for the detection of an infectious cause in FN, in comparison with other commonly used infection biomarkers, such as procalcitonin (PCT). Methods A total of 105 cancer patients presenting to the emergency department were prospectively enrolled. We observed 114 episodes of chemotherapy-associated FN. At presentation, a blood sample was collected for the measurement of PCT, PSP and sCD25. In order to evaluate the discriminatory ability of these markers for the diagnosis of infection, the area under the curve (AUC) of the receiver operating characteristic curves was calculated. Results Infection was documented in 59 FN episodes. PCT, PSP and sCD25 levels were significantly higher in infected patients. PCT was the biomarker with the highest diagnostic accuracy for infection (AUC: 0.901), whereas PSP and sCD25 showed a similar performance, with AUCs of 0.751 and 0.730, respectively. In a multivariable analysis, PCT and sCD25 were shown to be independently associated with infection. Conclusions Two novel biomarkers, PSP and sCD25, correlated with infection in cancer patients with chemotherapy-associated FN, but neither PSP nor sCD25 improved the performance of PCT. Based on the results obtained, the introduction of these novel biomarkers as a tool for the diagnosis of infection in this patient group is not recommended.

Prognostic value of procalcitonin and lipopolysaccharide binding protein in cancer patients with chemotherapy-associated febrile neutropenia presenting to an emergency department.

INTRODUCTION: Cancer patients with chemotherapy-induced febrile neutropenia are a heterogeneous group with a significant risk of serious medical complications. In these patients, the Multinational Association for Supportive Care in Cancer (MASCC) score is the most widely used tool for risk-stratification. The aim of this prospective study was to analyse the value of procalcitonin (PCT) and lipopolysaccharide binding protein (LBP) to predict serious complications and bacteraemia in cancer patients with febrile neutropenia, compared with MASCC score. MATERIALS AND METHODS: Data were collected from 111 episodes of febrile neutropenia admitted consecutively to the emergency department. In all of them, MASCC score was calculated and serum samples were collected for measurement of PCT and LBP by well-established methods. The main and secondary outcomes were the development of serious complications and bacteraemia, respectively. RESULTS: A serious complication occurred in 20 (18%) episodes and in 16 (14%) bacteraemia was detected. Areas under the receiver operating characteristic curve (ROC AUC) of MASCC score, PCT and LBP to select low-risk patients were 0.83 (95% confidence interval (CI): 0.74 - 0.89), 0.85 (95% CI: 0.77 - 0.91) and 0.70 (95% CI: 0.61 - 0.78), respectively. For bacteraemia, MASCC score, PCT and LBP showed ROC AUCs of 0.74 (95% CI: 0.64 - 0.82), 0.86 (95% CI: 0.78 - 0.92) and 0.76 (95% CI: 0.67 - 0.83), respectively. CONCLUSION: A single measurement of PCT performs similarly as MASCC score to predict serious medical complications in cancer patients with febrile neutropenia and can be a useful tool for risk stratification. Besides, low PCT concentrations can be used to rule-out the presence of bacteraemia.

Aumento en los recuentos de leucocitos y neutrófilos durante las primeras 18 semanas de tratamiento con clozapina en pacientes ingresadas en una unidad de cuidados psiquiátricos prolongados / Increase in white cell and neutrophil counts during the first eighteen weeks of treatment with clozapine in patients admitted to a long-term psychiatric care inpatient unit

Material y métodos. Se estudió una muestra de mujeres ingresadas en nuestra UCPP y en tratamiento con clozapina. Se estudió la variación de los recuentos de leucocitos y neutrófilos durante las primeras 18 semanas de tratamiento, la aparición de leucopenia, neutropenia y agranulocitosis, así como la influencia de los fármacos empleados de forma concomitante. Resultados y conclusiones. Se obtuvo una tasa de incidencia de neutropenia de 1,82% (IC 95%: 0,05-10,13) y ningún caso de leucopenia ni agranulocitosis (0%). En el análisis cuantitativo de leucocitos y neutrófilos durante las 18 semanas de tratamiento, se observó un aumento hasta la semana 3-4, tendiendo después a la estabilización de las cifras alcanzadas, pero manteniendo siempre cifras superiores a las de los valores iniciales. Estas diferencias resultaron estadísticamente significativas para los leucocitos en el ANOVA de medidas repetidas con la corrección de Greenhouse-Geisser F (11,47, 37)=2,114 (p=0,011), ŋ2P=0,038. También resultó significativo para los neutrófilos el ANOVA con la corrección de Greenhouse-Geisser F (10,33, 37)=3,312 (p=0,0002), y el MANOVA F (18, 37)=2,693 (p=0,005), ŋ2P=0,567). La influencia de los fármacos estudiados de forma concomitante (litio, valproico y biperideno) no resultó globalmente significativa (MANOVA) sobre el aumento hallado en los leucocitos y neutrófilos

Introduction. Clozapine is an antipsychotic drug that has shown to be more effective than other antipsychotics in the treatment of schizophrenia, but its use is limited due to its side effects, particularly by the risk of causing agranulocytosis. A study was made on the variations in white cell and neutrophil counts in patients treated with clozapine in a Long-term Psychiatric Unit. Methods. A retrospective observational study was conducted with a sample of women of our long-term psychiatric care unit who had been treated with clozapine. A study was made on the variations in white cell and neutrophil counts during the first 18 weeks of treatment, as well as the onset of leukopenia, neutropenia, agranulocytosis, and the influence of concomitant drugs. Results and conclusions. The study included 55 patients on treatment with clozapine. The incidence rate of neutropenia was 1.82% (95% CI; 0.05-10.13). The incidence rate of leukopenia and agranulocytosis was 0%. An increase in white cell and neutrophil counts from baseline to week 3-4 was observed. Only small variations were observed after this time, but the counts remained higher than the initial values. These changes were statistically significant in the white cell count: One-way repeated ANOVA with Greenhouse-Geisser correction F (11.47, 37) = 2.114 (P= .011); and in neutrophils: One-way repeated ANOVA with Greenhouse-Geisser correction F (10.3, 37)=3.312 (P=.0002), and MANOVA F (18, 37)=2.693 (P=.005), ŋ2P=0.567. The influence of concomitant drugs (lithium, valproic and biperiden) was not significant on the overall increase found in white cells or neutrophils (MANOVA)

Strong metal-support interaction improves activity and stability of Pt electrocatalysts on doped metal oxides.

Niobium and antimony doped tin oxide loose-tubes decorated with Pt nanoparticles present outstanding mass activity and stability, exceeding those of a reference carbon-based electrocatalyst. Physico-chemical characterisation and in particular X-ray photoelectron spectroscopy demonstrate that this observation can be ascribed to the strong metal-support interaction promoting electroactivity and Pt anchoring on doped metal oxide supports.

Increase in white cell and neutrophil counts during the first eighteen weeks of treatment with clozapine in patients admitted to a long-term psychiatric care inpatient unit. / Aumento en los recuentos de leucocitos y neutrófilos durante las primeras 18semanas de tratamiento con clozapina en pacientes ingresadas en una unidad de cuidados psiquiátricos prolongados.

INTRODUCTION: Clozapine is an antipsychotic drug that has shown to be more effective than other antipsychotics in the treatment of schizophrenia, but its use is limited due to its side effects, particularly by the risk of causing agranulocytosis. A study was made on the variations in white cell and neutrophil counts in patients treated with clozapine in a Long-term Psychiatric Unit. METHODS: A retrospective observational study was conducted with a sample of women of our long-term psychiatric care unit who had been treated with clozapine. A study was made on the variations in white cell and neutrophil counts during the first 18 weeks of treatment, as well as the onset of leukopenia, neutropenia, agranulocytosis, and the influence of concomitant drugs. RESULTS AND CONCLUSIONS: The study included 55 patients on treatment with clozapine. The incidence rate of neutropenia was 1.82% (95% CI; 0.05-10.13). The incidence rate of leukopenia and agranulocytosis was 0%. An increase in white cell and neutrophil counts from baseline to week 3-4 was observed. Only small variations were observed after this time, but the counts remained higher than the initial values. These changes were statistically significant in the white cell count: One-way repeated ANOVA with Greenhouse-Geisser correction F (11.47, 37) = 2.114 (P= .011); and in neutrophils: One-way repeated ANOVA with Greenhouse-Geisser correction F (10.3, 37)=3.312 (P=.0002), and MANOVA F (18, 37)=2.693 (P=.005), ŋ2P=0.567. The influence of concomitant drugs (lithium, valproic and biperiden) was not significant on the overall increase found in white cells or neutrophils (MANOVA).

Liver histological changes and lipid peroxidation in the amphibian Ambystoma mexicanum induced by sediment elutriates from the Lake Xochimilco.

Lacustrine sediments accumulate pollutants that input from the lake watershed and can be released to the water column by sediment resuspension; thus, pollutants can change their bioavailability and exert adverse effects to aquatic biota. Shallow-urban lakes are particularly susceptible to receive pollutants from urban discharges and sediment resuspension. Lake Xochimilco, in Mexico City, an urban-shallow lake, faces multiple problems: urban sprawl, overexploitation of aquifers, drying of springs, discharge of wastewater from treatment plants, and sediment resuspension. The aquatic biota living in this ecosystem is continuously exposed to the release of pollutants from the sediments. We assessed the risk that pollutants released from sediments from Lake Xochimilco, Touristic (TZ) and Agriculture zone (AZ), can exert on a native amphibian species of the lake (Ambystoma mexicanum) through exposure bioassays to sediment elutriates. We evaluate alterations in the amphibian by three approaches: biochemical (level of lipid peroxidation, LPO), cellular (ultrastructure) and the liver histology of A. mexicanum and we compare them with a batch control. Additionally, we assessed heavy metals (Pb, Cd and Hg) in elutriates. Elutriates from TZ showed the highest concentrations of the metals assessed. Organisms exposed to sediment elutriates from either study sites showed higher LPO values than control organisms (p<0.05). Organisms exposed to elutriates from the TZ showed the most conspicuous damages: hepatic vasodilation of sinusoids, capillaries with erythrocytes, leukocyte infiltration and cytoplasmic vacuolation in hepatocytes. The biological responses assessed reflected the risk that faces A. mexicanum when is exposed for prolonged periods to sediment resuspension in Lake Xochimilco.

Value of lipopolysaccharide binding protein as diagnostic marker of infection in adult cancer patients with febrile neutropenia: comparison with C-reactive protein, procalcitonin, and interleukin 6.

PURPOSE: Early detection of infection is essential for initial management of cancer patients with chemotherapy-associated febrile neutropenia in the emergency department. In this study, we evaluated lipopolysaccharide binding protein (LBP) as predictor for infection in febrile neutropenia and compared with other biomarkers previously studied: C-reactive protein (CRP), procalcitonin (PCT), and interleukin (IL)-6. METHODS: A total of 61 episodes of chemotherapy-associated febrile neutropenia in 58 adult cancer patients were included. Serum samples were collected on admission at emergency department and CRP, LBP, PCT, and IL-6 were measured. Patients were classified into fever of unknown origin and infection, including microbiologically and clinically documented infection, groups. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker for the diagnosis of infection. RESULTS: Thirty-two of the 61 episodes were classified as infection. On admission, CRP, PCT, IL-6, and LBP were significantly increased in patients with infection compared to fever of unknown origin group. Area under the ROC curve (AUC ROC) of CRP, PCT, IL-6, and LBP for discriminating both groups was 0.77, 0.88, 0.82, and 0.82, respectively, without significant difference between them. The combination of IL-6 and PCT or LBP did not lead to a significant improvement of the diagnostic accuracy of PCT or LBP alone. CONCLUSIONS: On admission, LBP has a similar diagnostic accuracy than PCT or IL-6 for the diagnosis of infection and might be used as additional diagnostic tool in adult cancer patients with chemotherapy-associated febrile neutropenia.

Utilidad de la procalcitonina para predecir bacteriemia en pacientes oncológicos con fiebre / Usefulness of procalcitonin for predicting bacteremia in cancer patients with fever

Introducción. La bacteriemia es una de las principales causas de morbimortalidad en el paciente con cáncer. El objetivo de este estudio es evaluar la utilidad de la procalcitonina como marcador predictor de bacteriemia en pacientes oncológicos y oncohematológicos que acudieron al Servicio de Urgencias de nuestro hospital. Material y métodos. Se incluyeron en el estudio 152 episodios de fiebre en 134 pacientes adultos oncológicos. Al ingreso en el Servicio de Urgencias una muestra de sangre fue extraída para la medida de proteína C reactiva (PCR) y procalcitonina (PCT). Los episodios febriles se clasificaron en dos grupos en función de los resultados del hemocultivo: bacteriémicos (n = 22) y no bacteriémicos (n = 130). El rendimiento diagnóstico de los biomarcadores como predictores de bacteriemia fue calculado mediante el análisis del área bajo la curva Receiver Operating Characteristic. Resultados. Las concentraciones de PCT y PCR fueron significativamente más altas en los episodios febriles con bacteriemia que en los no bacteriémicos. La PCT presentó un rendimiento diagnóstico más alto que la PCR como predictor de bacteriemia (área bajo la curva Receiver Operating Characteristic: PCT 0,781 (IC 95%: 0,667 - 0,895) vs. PCR: 0,632 (IC 95%: 0,493 - 0,771); p = 0,02). Un punto de corte de 0,20 ng/mL presentó un valor predictivo negativo de 95,8% para descartar bacteriemia. Conclusión. En el Servicio de Urgencias, la medida de PCT en pacientes oncológicos con fiebre es una herramienta útil para descartar bacteriemia y puede contribuir a la toma inicial de decisiones terapéuticas y a racionalizar la solicitud del hemocultivo (AU)

Aim. Bacteraemia is one of the most important causes of morbidity and mortality in cancer patients. The aim of this study was to evaluate the usefulness of procalcitonin for predicting bacteraemia in febrile oncology and oncohaematology patients admitted to the Emergency Department of our hospital. Material and methods. The study included a total of 152 febrile episodes in 134 adult cancer patients. A blood sample was collected on admission to the Emergency Department to measure C-reactive protein (CRP) and procalcitonin (PCT). Febrile episodes were classified into two groups according to the blood culture results: bacteraemia episodes (n = 22) and non-bacteraemia episodes (n = 130). Receiver Operating Characteristic curve analysis was performed for each biomarker as a predictor of bacteraemia. Results. PCT and CRP levels were significantly higher in the bacteraemia episodes group when compared with non-bacteraemia episodes group. PCT showed a diagnostic accuracy higher than CRP for predicting bacteraemia (AUC Receiver Operating Characteristic: PCT 0,781 (95% CI: 0,667 - 0,895) vs. CRP: 0,632 (95% CI: 0,493 - 0,771); p = 0,02). A cut-off value of 0,20 ng/mL was associated with a negative predictive value of 95,8% to rule-out bacteraemia. Conclusion. PCT measurement in febrile cancer patients in the Emergency Department is a useful tool to rule-out bacteraemia, and may contribute in initial therapeutic decision making and rationalise the request for blood culture (AU)

The development of an economic threshold for Nasonovia ribisnigri (Hemiptera: Aphididae) on lettuce in central Spain.

This study reports economic thresholds for the lettuce aphid Nasonovia ribisnigri (Mosley), based exclusively on cosmetic damage, that is, presence or absence of aphids at harvest time. Field trials were conducted in La Poveda Experimental Farm, Madrid (Spain) during autumn (2004 and 2005) and spring (2005 and 2006). Plants were arranged in plots and just before the formation of lettuce hearts they were infested with different densities of N. ribisnigri. Two days later, half of each plot was treated with tau-fluvalinate (Klartan24AF) and the other half remained as an untreated control. Economic thresholds were obtained from nonlinear regressions calculated between the percentage of commercial plants at the end of the crop cycle for both, treated and untreated semiplots, and the different initial densities of N. ribisnigri per plant. Two criteria were used to consider a commercial lettuce plant: a conservative estimate (0 aphids/plant) and a lax one (< 5 aphids/plant). Thus, an economic threshold was established for each season and criterium. The economic thresholds that were obtained with the most and least conservative criteria were in spring 0.06 and 0.12 aphids per plant, and in autumn 0.07 and 0.13 aphids per plant, respectively. These results show that to avoid cosmetic damage, insecticide sprays are required when a very low aphid density is detected in lettuce seedlings soon after transplant.