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Hall S, Xia Y, Ahmed H, Iskhakov D, Alviar C, Berger J, Keller N, Bangalore S. Is there an inter-manufacturer difference in generic clopidogrel response? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Differences in platelet aggregation response to generic clopidogrel by manufacturer has not been investigated.
Purpose
Compare rates of clopidogrel response among patients receiving medication produced by two different manufacturers after acute coronary syndrome and/or percutaneous coronary intervention.
Methods
This quality improvement project included 515 adult patients receiving clopidogrel for acute coronary syndrome or ischemic heart disease and referred for coronary angiography/percutaneous coronary intervention at a large, public hospital. The project was divided into two phases: 1. retrospective collection of baseline data; 2. two 12-week, prospective phases in which all clopidogrel in the hospital was restricted to a single manufacturer at a time. The primary outcome was clopidogrel response measured by platelet function testing defined as ADP response <40% on light transmission aggregometry between two manufacturer groups. Aspirin response defined as arachidonic acid response <20% was also measured.
Results
Of 515 total patients included in both phases (mean [SD] age, 64.5 [11.4] years; 351 [68.2%] men; 450 [87.4%] ACS), 52% were found to be clopidogrel responders based on results of platelet function testing (Table 1 – select variables). Among 135 patients in the prospective phase, there was a significantly lower proportion of patients who were clopidogrel responders in the Manufacturer 1 group compared to the Manufacturer 2 group (34.8% vs. 55.1%, p=0.03) (Table 2 – select variables). After adjustment for age, sex, BMI, aspirin response, therapeutic hypothermia, LHC indication, clopidogrel loading dose, time between loading dose and lab measurement, and manufacturer, aspirin response (OR [95% CI]: 0.96 [0.95–0.97], p<0.001) and manufacturer (OR [95% CI]: 2.45 [1.18–5.22], p=0.02) were associated with clopidogrel response.
Conclusions
In a large public hospital, we observed that pharmacodynamic response to clopidogrel varied by drug manufacturer. Further investigation and/or regulation is needed to minimize inter-manufacturer variability.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Hall
- Bellevue Hospital Center , New York , United States of America
| | - Y Xia
- New York University Grossman School of Medicine , New York , United States of America
| | - H Ahmed
- New York University Grossman School of Medicine , New York , United States of America
| | - D Iskhakov
- New York University Grossman School of Medicine , New York , United States of America
| | - C Alviar
- New York University Grossman School of Medicine , New York , United States of America
| | - J Berger
- New York University Grossman School of Medicine , New York , United States of America
| | - N Keller
- New York University Grossman School of Medicine , New York , United States of America
| | - S Bangalore
- New York University Grossman School of Medicine , New York , United States of America
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Immelman LM, Goodman IH, Keller N. Transient chemotherapy-induced alopecia after successful reversal of 5-fluorouracil myelosuppression and neurotoxicosis in a 9-month-old dog. Aust Vet J 2022; 100:236-242. [PMID: 35243627 DOI: 10.1111/avj.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) cream is a common human topical chemotherapy agent with potentially fatal neurotoxic effects on dogs if accidentally ingested. There are seldom reports in veterinary literature describing the successful outcome of intervention after accidental ingestion of 5-FU cream. CASE SUMMARY A 9-month-old spayed female labradoodle presented 14 h after ingesting an unknown amount of 40 g tube of Efudex cream (5% 5-FU). The dog presented in status epilepticus, which was managed with benzodiazepines and levetiracetam in conjunction with induced coma and mechanical ventilation. No further seizure activity occurred throughout the ensuing 5 days of hospitalisation; however, myelosuppression was featured. The dog was discharged home after 5 days of hospitalisation. Three days post discharge, the dog was noted to develop focal alopecia around the eyes and temporal region. 14 days after discharge, the alopecia progressed to a majority of the head and body. CONCLUSION To the authors' knowledge, this is the first report that documents the enduring adverse effects of 5-FU cream after survival of the initial episode, including an earlier onset of myelosuppression and diffuse alopecia. Successful treatment of accidental 5-FU ingestion is possible several hours after the initial event with minimal long-term consequences.
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Affiliation(s)
- L M Immelman
- Veterinary Specialist Services, Carrara, Queensland, Australia
| | - I H Goodman
- Veterinary Specialist Services, Carrara, Queensland, Australia
| | - N Keller
- Veterinary Specialist Services, Carrara, Queensland, Australia
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3
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Petry-Schmelzer J, Keller N, Karakaya M, Wirth B, Fink G, Wunderlich G. P 27. VPS13D: One family, one mutation, two phenotypes. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Paketci C, Karakaya M, Edem P, Bayram E, Keller N, Daimagüler HS, Cirak S, Jordanova A, Hiz S, Wirth B, Yiş U. Clinical, electrophysiological and genetic characteristics of childhood hereditary polyneuropathies. Rev Neurol (Paris) 2020; 176:846-855. [DOI: 10.1016/j.neurol.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022]
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Lui A, Garber L, Vincent M, Celi L, Masip J, Sionis A, Serpa Neto A, Keller N, Morrow D, Miller P, Van Diepen S, Smilowitz N, Alviar Restrepo C. Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU).
Methods
Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 >120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP.
Results
Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002).
Conclusions
In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.Y Lui
- New York University School of Medicine, New York, United States of America
| | - L Garber
- New York University Langone Medical Center, New York, United States of America
| | - M Vincent
- New York University Langone Medical Center, New York, United States of America
| | - L Celi
- Beth Israel Deaconess Medical Center & Harvard Medical School, Critical Care Medicine, Boston, United States of America
| | - J Masip
- Hospital Sanitas CIMA, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Serpa Neto
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - N Keller
- New York University Langone Medical Center, New York, United States of America
| | - D.A Morrow
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - P.E Miller
- Yale University, New Haven, United States of America
| | | | - N.R Smilowitz
- New York University Langone Medical Center, New York, United States of America
| | - C Alviar Restrepo
- New York University Langone Medical Center, New York, United States of America
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Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, Gautier-Vargas G, Keller N, Kremer S, Fafi-Kremer S, Moulin B, Benotmane I, Caillard S. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol 2020; 28:248-258. [PMID: 32853434 PMCID: PMC7461405 DOI: 10.1111/ene.14491] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
Background and purpose Neurological manifestations in coronavirus disease (COVID)‐2019 may adversely affect clinical outcomes. Severe COVID‐19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID‐19 and to gain pathophysiological insights with respect to CRS. Methods In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. Results Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood−brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS‐CoV2 was undetectable in 88 of the 90 patients with COVID‐19 who underwent Reverse Transcription‐PCR testing of CSF. Conclusions Patients with COVID‐19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T‐cell‐related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune‐mediated mechanisms.
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Affiliation(s)
- P Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - N Collongues
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,Department of Neurology, University Hospital, Strasbourg, France.,Clinical Center for Investigation, INSERM U1434, Strasbourg, France
| | - S Baloglu
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - D Bedo
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - X Bassand
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - T Lavaux
- Department of Biochemistry and Molecular Biology, University Hospital, Strasbourg, France
| | - G Gautier-Vargas
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - N Keller
- Department of Nephrology and Dialysis, University Hospital, Strasbourg, France
| | - S Kremer
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - S Fafi-Kremer
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - B Moulin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - I Benotmane
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - S Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
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7
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Ciatto G, Aubert N, Lecroard M, Engblom C, Fontaine P, Dubuisson JM, Abiven YM, Janolin PE, Kiat JM, Dumont Y, Berini B, Fouchet A, Keller N. FORTE - a multipurpose high-vacuum diffractometer for tender X-ray diffraction and spectroscopy at the SIRIUS beamline of Synchrotron SOLEIL. J Synchrotron Radiat 2019; 26:1374-1387. [PMID: 31274467 DOI: 10.1107/s1600577519003722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Abstract
A new high-vacuum multipurpose diffractometer (called FORTE from the French acronyms of the project) has recently been installed at the tender/hard X-ray SIRIUS beamline of Synchrotron SOLEIL, France. The geometry chosen allows one to work either in the classical Eulerian four-circle geometry for bulk X-ray diffraction (XRD) or in the z-axis geometry for surface XRD. The diffractometer nicely fits the characteristics of the SIRIUS beamline, optimized to work in the 1.1-4.5 keV range, and allows one to perform unprecedented diffraction anomalous fine structure (DAFS) experiments in the tender X-ray region, also around non-specular reflections, covering a large reciprocal-space volume. Installation of an X-ray fluorescence detector on a dedicated flange allows simultaneous DAFS and X-ray absorption (XAS) measurements. The access to the tender X-ray region paves the way to resonant investigations around the L-edges of second-row transition elements which are constituents of functional oxide materials. It also enables access to several edges of interest for semiconductors. Finally, the control architecture based on synchronized Delta Tau units opens up exciting perspectives for improvement of the mechanical sphere of confusion.
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Affiliation(s)
- G Ciatto
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - N Aubert
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - M Lecroard
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - C Engblom
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - P Fontaine
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - J M Dubuisson
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - Y M Abiven
- Synchrotron SOLEIL, L'Orme des Merisiers, Saint-Aubin, BP 48 F-91192 Gif sur Yvette CEDEX, France
| | - P E Janolin
- Laboratoire SPMS, UMR CNRS-CentraleSupélec, Bâtiment Gustave Eiffel - MB.105, 8-10 rue Joliot-Curie, 91190 Gif-Sur-Yvette CEDEX, France
| | - J M Kiat
- Laboratoire SPMS, UMR CNRS-CentraleSupélec, Bâtiment Gustave Eiffel - MB.105, 8-10 rue Joliot-Curie, 91190 Gif-Sur-Yvette CEDEX, France
| | - Y Dumont
- Groupe d'Etudes de la Matière Condensée (GEMaC), Université Versailles Saint-Quentin en Yvelines - CNRS, Université Paris-Saclay, Versailles, France
| | - B Berini
- Groupe d'Etudes de la Matière Condensée (GEMaC), Université Versailles Saint-Quentin en Yvelines - CNRS, Université Paris-Saclay, Versailles, France
| | - A Fouchet
- Groupe d'Etudes de la Matière Condensée (GEMaC), Université Versailles Saint-Quentin en Yvelines - CNRS, Université Paris-Saclay, Versailles, France
| | - N Keller
- Groupe d'Etudes de la Matière Condensée (GEMaC), Université Versailles Saint-Quentin en Yvelines - CNRS, Université Paris-Saclay, Versailles, France
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8
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Brosh-Nissimov T, Hindiyeh M, Azar R, Smollan G, Belausov N, Mandelboim M, Rahav G, Keller N, Gefen-Halevi S. A false-positive Trichomonas vaginalis result due to Trichomonas tenax presence in clinical specimens may reveal a possible T. tenax urogenital infection. Clin Microbiol Infect 2018; 25:123-124. [PMID: 30267929 DOI: 10.1016/j.cmi.2018.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/01/2022]
Affiliation(s)
- T Brosh-Nissimov
- Assuta Ashdod University Hospital, Ashdod, Israel; Israel Defense Force Medical Corps, Tel Hashomer, Israel; School of Medical Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel.
| | - M Hindiyeh
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - R Azar
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - G Smollan
- Clinical Microbiology Laboratory, Sheba Medical Centre, Tel Hashomer, Israel
| | - N Belausov
- Clinical Microbiology Laboratory, Sheba Medical Centre, Tel Hashomer, Israel
| | - M Mandelboim
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G Rahav
- Infectious Disease Unit, Sheba Medical Centre, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Keller
- Clinical Microbiology Laboratory, Sheba Medical Centre, Tel Hashomer, Israel; Ariel University, Ariel, Israel
| | - S Gefen-Halevi
- Clinical Microbiology Laboratory, Sheba Medical Centre, Tel Hashomer, Israel
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9
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Schulman S, Jensen MB, Varon D, Keller N, Gitel N, Horoszowski H, Heim M, Martinowitz U. Feasibility of Using Recombinant Factor VIIa in Continuous Infusion. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650292] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryRecombinant factor Vila (rFVIIa; NovoSeven®) is a recent addition to the hemostatic alternatives for the treatment of hemophiliacs with inhibitors. A drawback in the use of rFVIIa has been its half-life of only about 2 h, which necessitates very frequent and punctual injections. We evaluated the stability of reconstituted, but not further diluted, rFVIIa in 3 infusion systems (WalkMedTM 350 and CADD®-Plus minipumps and Meddex 2001 syringe pump). The factor VII (F VII) activity was maintained for at least 3 days at room temperature with only a minor and clinically insignificant increase in oxidized forms of rFVIIa and minimal leaching of the plastic softeners di-butylphthalate and di-octylphthalate after 24–48 h. Addition of heparin, 5–10 U/ml, to reconstituted rFVIIa caused a loss of about 50% of the activity within 4 h of storage in the infusion system, whereas low molecular weight heparin had no such effect. Repeated samples showed that the infusion systems maintained sterility. Reconstituted rFVIIa did not support bacterial growth when inoculated with Staphylococcus aureus or Escherichia coli to any greater extent than did reconstituted factor VIII, lidocaine in saline or heparin in saline. Two patients were treated with continuous infusion of rFVIIa on 4 occasions (total knee arthroplasty, wound revision, and twice straightening of a 90° contracture of the knee under general anaesthesia). A preoperative pharmacokinetic evaluation was performed, and the clearance was used to calculate the maintenance dose, aiming at a FVII level of 10 U/ml, which proved to be a hemostatic level. The first patient had no change in the clearance during the two treatment episodes. He suffered from repeated thrombophlebitis at the infusion site. The second patient had a progressive decrease of the clearance from 86.4 to 24.7 ml/h/kg. He received during the first treatment a parallel infusion with heparin (≈250 U/24 h) to the same venous access and did not develop thrombophlebitis during 3.5 days of therapy. For the second episode low molecular weight heparin was added directly to the infusion bag, and no adverse effects were observed. Continuous infusion with rFVIIa is thus feasible with the minipumps used by us, eliminates the need for 2 h injections and reduces the total dose of rFVIIa by 50–75%, depending on the behaviour of the clearance.
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Affiliation(s)
- S Schulman
- The National Hemophilia Center, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - D Varon
- The National Hemophilia Center, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Keller
- Department of Clinical Microbiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Gitel
- The National Hemophilia Center, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - H Horoszowski
- The Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - M Heim
- The National Hemophilia Center, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - U Martinowitz
- The National Hemophilia Center, Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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10
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Schulman S, Varon D, Keller N, Gitel S, Martinowitz U. Monoclonal Purified F VIII for Continuous Infusion: Stability, Microbiological Safety and Clinical Experience. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648879] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryReplacement therapy for patients with hemophilia A postoperatively or for major hemorrhage, administered as a continuous infusion, is efficient and reduces the requirement for factor VIII (F VIII). The convenience of the method is increased by using a minipump and not diluting the concentrate further after reconstitution. A monoclonally purified F VIII concentrate (Monoclate-P®), was evaluated for its stability after reconstitution in different infusion systems, for its microbiological safety as well as clinical safety and efficacy in continuous infusion. The F VIII activity was unaffected by 2 of the 3 infusion systems at room temperature during 15 days, whereas in the third (CADD®-1) it decreased below 80% of initial value after 3-7 days. Addition of heparin (1 U/ml) or low molecular weight heparin (1 anti-Xa U/ml), which are used to prevent thrombophlebitis at the site of infusion, did not affect the stability. Nine out of 9 samples taken from the infusion systems after 3 days and again after 7 days were sterile. After inoculation with Staphylococcus aureus or Escherichia coli the bacterial growth in samples of the reconstitued concentrate was not different from that in lidocain in saline or heparin in saline. F VIII was given in continuous infusion with a minipump (Infu-Med™) to 12 patients undergoing major surgery and 8 patients with major hemorrhage for a total of 157 days. A progressive decrease of the clearance was seen during the first 5 days of infusion from 3.0 to 1.7 ml/kg/h. Hemostasis was effectively achieved, and no infectious complications were registered. The administration of monoclonally purified F VIII with a minipump is safe, efficient and convenient and reduces the consumption of F VIII when high doses are needed. Some patients can be discharged earlier and admission to the hospital may even be unnecessary, since high and steady F VIII levels can be maintained.
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Affiliation(s)
- S Schulman
- The National Hemophilia Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - D Varon
- The National Hemophilia Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Keller
- Department of Clinical Microbiology, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - S Gitel
- The National Hemophilia Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - U Martinowitz
- The National Hemophilia Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
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11
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Keller N. Significance of adrenoceptor-mediated atrial natriuretic factor release in normal humans. Scandinavian Journal of Clinical and Laboratory Investigation 2018. [DOI: 10.1080/00365513.1991.11978692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- N. Keller
- Department of Medicine, Division of Cardiology, Hvidovre Hospital, Hvidovre, and Departments of Medicine and Clinical Chemistry, Sundby Hospital, Copenhagen, Denmark
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12
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Helmer D, Voigt A, Wagner S, Keller N, Sachsenheimer K, Kotz F, Nargang TM, Rapp BE. Suspended Liquid Subtractive Lithography: One-step generation of 3D channel geometries in viscous curable polymer matrices. Sci Rep 2017; 7:7387. [PMID: 28785064 PMCID: PMC5547044 DOI: 10.1038/s41598-017-07630-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
The miniaturization of synthesis, analysis and screening experiments is an important step towards more environmentally friendly chemistry, statistically significant biology and fast and cost-effective medicinal assays. The facile generation of arbitrary 3D channel structures in polymers is pivotal to these techniques. Here we present a method for printing microchannels directly into viscous curable polymer matrices by injecting a surfactant into the uncured material via a steel capillary attached to a 3D printer. We demonstrate this technique using polydimethylsiloxane (PDMS) one of the most widely used polymers for the fabrication of, e. g. microfluidic chips. We show that this technique which we term Suspended Liquid Subtractive Lithography (SLSL) is well suited for printing actuators, T-junctions and complex three dimensional structures. The formation of truly arbitrary channels in 3D could revolutionize the fabrication of miniaturized chips and will find broad application in biology, chemistry and medicine.
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Affiliation(s)
- D Helmer
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - A Voigt
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - S Wagner
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - N Keller
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - K Sachsenheimer
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - F Kotz
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - T M Nargang
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
| | - B E Rapp
- Karlsruhe Institute of Technology, Institute of Microstructure Technology IMT, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany.
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Iluz N, Maor Y, Keller N, Malik Z. The synergistic antimicrobial activity of tetrapyrroles and PDT on antibiotic resistant clinical isolates of Staph. aureus. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Richter C, Kotz F, Keller N, Nargang TM, Sachsenheimer K, Helmer D, Rapp BE. An Analytical Solution to Neumann-Type Mixed Boundary Poiseuille Microfluidic Flow in Rectangular Channel Cross-Sections (Slip/No-Slip) including a Numerical Technique to Derive It. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jbise.2017.105016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Martin M, Keller N, Martin A, Twizeyimana E, Argemi X, Hansmann Y, Martin T. A non-fatal pneumonia due to Legionella longbeachae in a patient with systemic lupus erythematosus. Lupus 2016; 25:1503-1504. [DOI: 10.1177/0961203316643599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Martin
- Department of Clinical Immunology, Strasbourg University Hospital, Strasbourg, France
| | - N Keller
- Department of Clinical Immunology, Strasbourg University Hospital, Strasbourg, France
| | - A Martin
- Department of Bacteriology, Strasbourg University Hospital, Strasbourg, France
| | - E Twizeyimana
- Department of Bacteriology, Strasbourg University Hospital, Strasbourg, France
| | - X Argemi
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Y Hansmann
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - T Martin
- Department of Clinical Immunology, Strasbourg University Hospital, Strasbourg, France
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16
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Gonzalez-Valls I, Mirloup A, Le Bahers T, Keller N, Cottineau T, Sautet P, Keller V. Characterization and charge transfer properties of organic BODIPY dyes integrated in TiO2 nanotube based dye-sensitized solar cells. RSC Adv 2016. [DOI: 10.1039/c6ra14152h] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A BODIPY dye grafted on TiO2 NTs is fully characterized and applied in dye-sensitized solar cells showing a good performance.
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Affiliation(s)
- I. Gonzalez-Valls
- ICPEES, Institut de Chimie et Procédés pour l'Énergie, l'Environnement et la Santé
- CNRS/Université de Strasbourg
- 67087 Strasbourg
- France
| | - A. Mirloup
- ICPEES, Institut de Chimie et Procédés pour l'Énergie, l'Environnement et la Santé
- CNRS/Université de Strasbourg
- 67087 Strasbourg
- France
| | - T. Le Bahers
- Laboratoire de Chimie
- Ecole Normale Supérieure de Lyon
- 69346 Lyon
- France
| | - N. Keller
- ICPEES, Institut de Chimie et Procédés pour l'Énergie, l'Environnement et la Santé
- CNRS/Université de Strasbourg
- 67087 Strasbourg
- France
| | - T. Cottineau
- ICPEES, Institut de Chimie et Procédés pour l'Énergie, l'Environnement et la Santé
- CNRS/Université de Strasbourg
- 67087 Strasbourg
- France
| | - P. Sautet
- Laboratoire de Chimie
- Ecole Normale Supérieure de Lyon
- 69346 Lyon
- France
| | - V. Keller
- ICPEES, Institut de Chimie et Procédés pour l'Énergie, l'Environnement et la Santé
- CNRS/Université de Strasbourg
- 67087 Strasbourg
- France
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17
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Ruppert AM, Grams J, Jędrzejczyk M, Matras-Michalska J, Keller N, Ostojska K, Sautet P. Titania-Supported Catalysts for Levulinic Acid Hydrogenation: Influence of Support and its Impact on γ-Valerolactone Yield. ChemSusChem 2015; 8:1538-1547. [PMID: 25641864 DOI: 10.1002/cssc.201403332] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 06/04/2023]
Abstract
A series of titania-supported ruthenium and platinum catalysts was investigated in the levulinic acid hydrogenation towards γ-valerolactone, a key reaction for the catalytic transformation of biomass. It was shown that various morphologies and phases of titania strongly influence the physicochemical and catalytic properties of supported Ru and Pt catalysts in different ways. In the case of the catalyst supported on mixed TiO2 phases, Ru particles are exclusively located on the minority rutile crystallites, whereas such an effect was not observed for platinum. The platinum catalyst activity could be increased when the metal was dispersed on the large surface-area anatase, which was not the case for ruthenium as a result of its agglomeration on this support. The activity of ruthenium on anatase could be increased in two ways: a) when RuO2 formation during catalyst preparation was avoided; b) when pure anatase support material was modified so that it exhibited no microporosity. The obtained results allow a better understanding of the role of the support for Ru and Pt catalysts.
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Affiliation(s)
- A M Ruppert
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Łódź University of Technology ul. Żeromskiego 116, 90-924 Łódź (Poland).
| | - J Grams
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Łódź University of Technology ul. Żeromskiego 116, 90-924 Łódź (Poland)
| | - M Jędrzejczyk
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Łódź University of Technology ul. Żeromskiego 116, 90-924 Łódź (Poland)
| | - J Matras-Michalska
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Łódź University of Technology ul. Żeromskiego 116, 90-924 Łódź (Poland)
| | - N Keller
- Institut de Chimie et Procédés pour l'Energie l'Environnement et la Santé (ICPEES), CNRS, University of Strasbourg, 25 rue Becquerel, 67087, Strasbourg (France)
| | - K Ostojska
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Łódź University of Technology ul. Żeromskiego 116, 90-924 Łódź (Poland)
| | - P Sautet
- Université de Lyon, CNRS, Ecole normale superieure de Lyon, Institut de Chimie de Lyon, Laboratoire de Chimie, 46 allée d'Italie, 69364 Lyon Cedex 07 (France)
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Maor Y, Belausov N, Ben-David D, Smollan G, Keller N, Rahav G. hVISA and MRSA endocarditis: an 8-year experience in a tertiary care centre. Clin Microbiol Infect 2014; 20:O730-6. [DOI: 10.1111/1469-0691.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 12/25/2022]
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19
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Jenni L, Keller N, Almasi B, Duplain J, Homberger B, Lanz M, Korner-Nievergelt F, Schaub M, Jenni-Eiermann S. Transport and release procedures in reintroduction programs: stress and survival in grey partridges. Anim Conserv 2014. [DOI: 10.1111/acv.12136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Jenni
- Swiss Ornithological Institute; Sempach Switzerland
| | - N. Keller
- Swiss Ornithological Institute; Sempach Switzerland
| | - B. Almasi
- Swiss Ornithological Institute; Sempach Switzerland
| | - J. Duplain
- Swiss Ornithological Institute; Sempach Switzerland
| | - B. Homberger
- Swiss Ornithological Institute; Sempach Switzerland
| | - M. Lanz
- Swiss Ornithological Institute; Sempach Switzerland
| | | | - M. Schaub
- Swiss Ornithological Institute; Sempach Switzerland
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20
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Keller N, Czienskowski U, Feufel MA. Tying up loose ends: a method for constructing and evaluating decision aids that meet blunt and sharp-end goals. Ergonomics 2014; 57:1127-1139. [PMID: 24852324 DOI: 10.1080/00140139.2014.917204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present a methodological framework for constructing and evaluating decision aids--fast and frugal trees (FFTs)--ideally suited to the front line of an organisation. Their performance can be analysed in signal detection theory, allowing for transparent selection of FFTs given managerial-level trade-offs among type I and II errors. We extend FFTs from binary classification to selection from multiple actions (FFT multiple) as well as performance analysis to organisational goal states beyond type I and II error reduction. Concepts and framework are introduced and a tutorial-style example application (threat assessment at military checkpoints) is provided. Throughout, we discuss ways to deal with missing or incomplete data and show that the performance of decision aids may be overestimated if the effectiveness of actions is not heeded. The methodology can be used to construct and evaluate decision aids in any area characterised by dichotomised cues and a one-to-many mapping between categorisation outcomes and actions.
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Affiliation(s)
- N Keller
- a Max Planck Institute for Human Development, Center for Adaptive Behavior and Cognition , Berlin , Germany
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21
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Abstract
The caspases are a family of ubiquitously expressed cysteine proteases best known for their roles in programmed cell death. However, caspases play a number of other roles in vertebrates. In the case of caspase-8, loss of expression is an embryonic lethal phenotype, and caspase-8 plays roles in suppressing cellular necrosis, promoting differentiation and immune signaling, regulating autophagy, and promoting cellular migration. Apoptosis and migration require localization of caspase-8 in the periphery of the cells, where caspase-8 acts as part of distinct biosensory complexes that either promote migration in appropriate cellular microenvironments, or cell death in inappropriate settings. In the cellular periphery, caspase-8 interacts with components of the focal adhesion complex in a tyrosine-kinase dependent manner, promoting both cell migration in vitro and metastasis in vivo. Mechanistically, caspase-8 interacts with components of both focal adhesions and early endosomes, enhancing focal adhesion turnover and promoting rapid integrin recycling to the cell surface. Clinically, this suggests that the expression of caspase-8 may not always be a positive prognostic sign, and that the role of caspase-8 in cancer progression is likely context-dependent.
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Affiliation(s)
| | | | | | - D Stupack
- University of California San Diego, Moores Cancer Center, Department of Reproductive Medicine, 0803, 3855 Health Sciences Dr., La Jolla, CA 92093, USA.
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Bocher L, Popova E, Nolan M, Gloter A, Chikoidze E, March K, Warot-Fonrose B, Berini B, Stéphan O, Keller N, Dumont Y. Direct evidence of Fe(2+)-Fe3+ charge ordering in the ferrimagnetic hematite-ilmenite Fe(1.35)Ti(0.65)O(3-δ) thin films. Phys Rev Lett 2013; 111:167202. [PMID: 24182295 DOI: 10.1103/physrevlett.111.167202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Indexed: 06/02/2023]
Abstract
In this Letter we highlight direct experimental evidence of Fe(2+)-Fe3+ charge ordering at room temperature in hematite-ilmenite Fe(1.35)Ti(0.65)O(3-δ) epitaxial thin films grown by pulsed laser deposition, using aberration-corrected scanning transmission electron microscopy coupled to high-resolution energy electron-loss spectroscopy. These advanced spectromicroscopy techniques demonstrate a strong modulation of the Fe2+ valence state along the c axis. Density functional theory calculations provide crucial information on the key role of oxygen vacancies in the observed charge distributions. Their presence at significant levels leads to the localization of extra electrons onto reduced Fe2+ sites, while Ti remains solely +4. The magnetic and transport properties of these films are reviewed in the light of the present results regarding their ferrimagnetic character correlated with the Fe2+ modulation and their semiconducting behavior interpreted by an Efros-Shklovskii variable-range hopping conduction regime via Fe2+ and Fe3+ centers. The experimental evidence of only one type of mixed valence state, i.e., Fe2+ and Fe3+, in the Fe(2-x)Ti(x)O(3-δ) system will thus help to interpret further the origin of its geomagnetic properties and to illuminate fundamental issues regarding its spintronic potential.
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Affiliation(s)
- L Bocher
- Laboratoire de Physique des Solides, Bâtiment 510, UMR 8502, Université Paris Sud XI and CNRS, 91405 Orsay, France
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Ben-Ami R, Rahav G, Elinav H, Kassis I, Shalit I, Gottesman T, Megged O, Weinberger M, Ciobotaro P, Shitrit P, Weber G, Paz A, Miron D, Oren I, Bishara J, Block C, Keller N, Kontoyiannis D, Giladi M. Distribution of fluconazole-resistant Candida bloodstream isolates among hospitals and inpatient services in Israel. Clin Microbiol Infect 2013; 19:752-6. [DOI: 10.1111/1469-0691.12004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Ben-Shimol S, Dagan R, Schonmann Y, Givon-Lavi N, Keller N, Block C, Kassis I, Ephros M, Greenberg D. Dynamics of childhood invasive meningococcal disease in Israel during a 22-year period (1989-2010). Infection 2013; 41:791-8. [PMID: 23475472 DOI: 10.1007/s15010-013-0439-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/19/2013] [Indexed: 01/24/2023]
Abstract
AIM To describe the dynamics in the incidence of childhood invasive meningococcal disease (IMD) in Israel during a 22-year period (1989-2010). METHODS A longitudinal prospective surveillance in all 27 medical centers with pediatric services in Israel. All cases of children <15 years old with positive blood/cerebrospinal fluid (CSF) culture for Neisseria meningitidis were reported. Demographic, clinical, and bacteriological data were recorded. Meningococcal vaccine was not routinely given to Israeli children during the study period. RESULTS The mean age ± standard deviation (SD) among the 743 cases was 40.7 ± 40.2 months. The mean yearly incidence/100,000 was 2.0 ± 0.8. Age-specific incidences were 8.7 ± 2.8, 2.9 ± 1.5, and 0.8 ± 0.5 for children <1, 1-4, and >4 years old, respectively. The overall incidence decreased significantly from 3.7 in 1989 to 1.5 in 2010. Meningitis constituted 69.2 % of all cases. The most common serogroups were: B (76.9 %), C (10.9 %), Y (8.0 %), and W(135) (2.9 %). 78.6 % of all serogroup B isolates were from children <5 years old (p < 0.01). Serogroup C was found mainly in children ≥5 years old (63.4 %). The case fatality rates (CFRs) for children <1, 1-4, >4 years old, and the total study population were 9.2, 12.3, 7.7, and 9.9 %, respectively. CFRs were higher for children without meningitis (14.9 %) compared to children with meningitis (7.9 %) (p < 0.01). CONCLUSIONS Overall, and for serogroups B and W135, childhood IMD rates decreased significantly in Israel during the study period, without routine vaccine usage. The most common serogroup in all age groups was B, which was most prevalent in children <5 years old. No change in the trend of the overall CFR was noted during the study period.
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Affiliation(s)
- S Ben-Shimol
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gross P, Pronkin S, Cottineau T, Keller N, Keller V, Savinova E. Effect of deposition of Ag nanoparticles on photoelectrocatalytic activity of vertically aligned TiO2 nanotubes. Catal Today 2012. [DOI: 10.1016/j.cattod.2012.03.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Ben-David D, Kordevani R, Keller N, Tal I, Marzel A, Gal-Mor O, Maor Y, Rahav G. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2011; 18:54-60. [PMID: 21722257 DOI: 10.1111/j.1469-0691.2011.03478.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the impact of carbapenem-resistant K. pneumoniae bloodstream infections on mortality. During the study period 42, 68 and 120 patients were identified with carbapenem-resistant, extended-spectrum β-lactamase producers (ESBL) and susceptible K. pneumoniae bloodstream infections, respectively. Patients with carbapenem-resistant K. pneumoniae had higher rates of prior antimicrobial exposure, other nosocomial infections, and use of invasive devices. Infection-related mortality was 48% for carbapenem-resistant, 22% for ESBL producers and 17% for susceptible K. pneumoniae. Independent risk factors for infection-related mortality were Pitt bacteraemia score, Charlson score and carbapenem resistance.
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Affiliation(s)
- D Ben-David
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel.
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27
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Keller N. Significance of adrenoceptor-mediated atrial natriuretic factor release in normal humans: Erratum. Scandinavian Journal of Clinical and Laboratory Investigation 2011. [DOI: 10.1080/00365519109091632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Kouamé N, Robert D, Keller V, Keller N, Pham C, Nguyen P. Preliminary study of the use of β-SiC foam as a photocatalytic support for water treatment. Catal Today 2011. [DOI: 10.1016/j.cattod.2010.10.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yeshurun M, Gafter-Gvili A, Thaler M, Keller N, Nagler A, Shimoni A. Clinical characteristics of Stenotrophomonas maltophilia infection in hematopoietic stem cell transplantation recipients: a single center experience. Infection 2010; 38:211-5. [PMID: 20425134 PMCID: PMC7102005 DOI: 10.1007/s15010-010-0023-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 03/17/2010] [Indexed: 12/19/2022]
Abstract
Background Recipients of hematopoietic stem-cell transplantation (HSCT) are at high risk for infections caused by Stenotrophomonas maltophilia. Methods We conducted a retrospective analysis of all infections caused by S. maltophilia in HSCT recipients in a single center in Israel during a 4 year period. Results Of 570 patients undergoing HSCT, 19 patients with an invasive S. maltophilia infection were identified. Sixteen had allogeneic HSCT and 3 had autologous HSCT. Seventeen patients (90%) had an indwelling central venous catheter (CVC) at the time of infection. S. maltophilia infections were detected in three clinical settings: as a complication of prolonged neutropenia (n = 9), as a CVC-related non-neutropenic infection occurring after CVC manipulation (n = 8) and as a respiratory tract infection (n = 2). Eleven patients (58%) had a polymicrobial infection. Ten patients (52.6%) received carbapenems during the previous month. The treatment for all patients included broad spectrum antibiotics, which were switched according to susceptibilities upon identification of the isolates. All isolates were susceptible in vitro to TMP-SMX. CVCs were removed in 12 patients (70%). Six patients, all after allogeneic HSCT, died. The CVC was removed in only two of the five patients with CVCs who died. Conclusions Stenotrophomonas maltophilia is an emerging nosocomial pathogen in HSCT recipients, both in the early neutropenic phase and in the non-neutropenic phase. It is commonly associated with the presence and manipulation of an indwelling CVC. Removal of the CVC in addition to appropriate antibiotic therapy (TMP-SMX) is crucial for infection control.
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Affiliation(s)
- M Yeshurun
- Department of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Beilinson Campus, 49100, Petah-Tiqva, Israel.
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Mikoteit T, Keller N, Brand S, Sievers E, Riecher-Rössler A, Holsboer-Trachsler E, Hatzinger M. PW01-21 - Poor sleep is related to parenting stress and impaired postpartum bonding in depressed mothers. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71423-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Caspases are the key players of apoptosis and inflammation. They are present in the cells as latent precursors, procaspases, and are activated upon an apoptotic or inflammatory stimulus. The activation mechanism of caspases has been studied extensively by biochemical and biophysical methods. Additional structural information on active caspases with a variety of different inhibitors bound at the active site is available. In this study, we investigated the cleavage mechanism of caspase-8 from its zymogen to active caspase-8 by solution NMR and by biochemical methods. The intermolecular cleavage reaction using the catalytically inactive C285A procaspase-8 mutant is triggered by adding caspase-8 and followed by (15)N,(1)H-NMR spectroscopy. The spectrum that initially resembles the one of procaspase-8 gradually over time changes to that of caspase-8, and disappearing peaks display exponential decaying intensities. Removal of either one of the cleavage recognition motifs in the linker, or phosphorylation at Tyr380, is shown to reduce the rate of the cleavage reaction. The data suggest that dimerization repositions the linker to become suitable for intermolecular processing by the associated protomer. Furthermore, analysis of inhibitor binding to the active caspase-8 reveals an induced-fit mechanism for substrate binding.
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Affiliation(s)
- N Keller
- Department of Biochemistry, University of Zurich, Switzerland
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32
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Keller N, Sykulski R, Thamsborg G, Storm T, Larsen J. Atrial natriuretic peptide during exercise in patients with coronary heart disease before and after single dose atenolol and acebutolol. Acta Med Scand 2009; 223:305-11. [PMID: 2967028 DOI: 10.1111/j.0954-6820.1988.tb15878.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Plasma atrial natriuretic peptide (ANP) was measured during dynamic exercise in 10 patients with coronary heart disease before and after single dose atenolol 50 mg and acebutolol 200 mg, respectively. Systolic blood pressure, heart rate and the rate-pressure product increased during exercise before and after beta-blockade, but levels were lower after beta-blockade. Plasma ANP levels at rest were unchanged after atenolol, but rose after acebutolol (p less than 0.01). During exercise plasma ANP increased significantly both before and after beta-blockade, but plasma ANP levels were higher after acebutolol at all workloads (p less than 0.05), whereas plasma ANP levels after atenolol were higher at 125 W exclusively (p less than 0.05). The augmented ANP levels during exercise after beta-blockade probably reflect catecholamine-stimulated ANP release, whereas the elevated plasma ANP levels after acebutolol at rest might be a beta-adrenoceptor-mediated ANP release due to the intrinsic sympathomimetic effect of acebutolol.
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Affiliation(s)
- N Keller
- Department of Internal Medicine, Sundby Hospital, Copenhagen, Denmark
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Abstract
A 25-year-old man was admitted with severe chest pain and an electrocardiogram suggestive of anterior myocardial infarction. Echocardiogram was normal, but chest X-ray showed left-sided pneumothorax. The electrocardiogram showed increasing R-wave amplitude in the days after correction of pneumothorax. Taken in the supine position the electrocardiogram can be misleading in case of pneumothorax or mediastinal emphysema, but the electrocardiogram should be normal if taken in the erect position.
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Thamsborg G, Storm T, Keller N, Sykulski R, Larsen J. Changes in plasma atrial natriuretic peptide during exercise in healthy volunteers. Acta Med Scand 2009; 221:441-4. [PMID: 2955673 DOI: 10.1111/j.0954-6820.1987.tb01278.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Graded exercise was performed in three healthy volunteers. Plasma levels of immunoreactive atrial natriuretic peptide (iANP) were determined at different workloads. Unchanged or slightly decreased plasma levels of iANP were observed during light exercise, whereas at medium to high workloads a considerable increase in plasma levels of iANP was found. Factors responsible for the increase in plasma levels of iANP might include elevated right atrial pressure and increased plasma levels of epinephrine and norepinephrine.
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Feumi C, Raoul W, Keller N, Lavallette S, Houssier M, Behar Cohen F, Combadiere C, Sennlaub F. 677 La microglie sous rétinienne est à l’origine des drusen observés chez les souris invalidées pour le récepteur aux chimiokines CX3CR1. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Raoul W, Feumi C, Keller N, Lavalette S, Houssier M, Behar-Cohen F, Combadière C, Sennlaub F. Lipid-bloated subretinal microglial cells are at the origin of drusen appearance in CX3CR1-deficient mice. Ophthalmic Res 2008; 40:115-9. [PMID: 18421223 DOI: 10.1159/000119860] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Drusen, the white yellowish deposits that can be seen in funduscopy, are a hallmark of age-related macular degeneration. Histologically, drusen are believed to be dome-shaped or more confluent lipid accumulations between the retinal pigment epithelium and the choriocapillaries. Recent advances in mouse funduscopy have revealed the presence of drusen-like structures in chemokine knockout animals in the absence of sizeable dome-shaped material below the retinal pigment epithelium. We show that aged CX3CR1-/- mice present with drusen-like appearance in funduscopy that is associated with a progressive age-related microglial cell accumulation in the subretinal space. We demonstrate that the anatomical equivalent of the drusen-like appearance in these mice are lipid-bloated subretinal microglial cells rather than subretinal pigment epithelium deposits [Combadière C, et al: J Clin Invest 2007;117:2920-2928].
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Affiliation(s)
- W Raoul
- Inserm, UMR S 872, Centre de Recherche des Cordeliers, Paris, France
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37
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Kissler S, Schmidt M, Keller N, Wiegratz I, Kohl J, Baumann R, Kunz G, Kaufmann M, Leyendecker G. Real-Time PCR-Analyse für Östrogen-Rezeptor beta, Progesteronrezeptor und P-450-Aromatase im Menstrualblut – eine Pilotstudie über die Bedeutung des basalen Endometriums in der Pathogenese der Endometriose. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Spirocerca lupi is a nematode mainly affecting dogs but has been found in other animals, particularly carnivores. Anatomical areas of typical and aberrant migration vary. This report describes four cases of Spirocerca lupi causing neurological symptoms, similar to thoracolumbar disc syndrome, as a result of aberrant migration of the nematode into the spinal canal. In two of the cases, the nematode could be demonstrated intraoperatively. The third was discovered on post-mortem examination, while the fourth case displayed compelling evidence of Spirocerca lupi involvement. Surgical removal of the Spirocerca lupi nematode would be the treatment of choice in cases of spinal migration, with therapeutic and preventive treatment with doramectin instituted to treat remote sites and prevent re-infection. In areas endemic for spirocercosis, Spirocerca lupi should be considered as an important differential diagnosis in cases that are presented with clinical signs suggestive of a spinal cord lesion.
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Affiliation(s)
- C J Du Plessis
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
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Sikiric P, Seiwerth S, Brcic L, Blagaic AB, Zoricic I, Sever M, Klicek R, Radic B, Keller N, Sipos K, Jakir A, Udovicic M, Tonkic A, Kokic N, Turkovic B, Mise S, Anic T. Stable gastric pentadecapeptide BPC 157 in trials for inflammatory bowel disease (PL-10, PLD-116, PL 14736, Pliva, Croatia). Full and distended stomach, and vascular response. Inflammopharmacology 2007; 14:214-21. [PMID: 17186181 DOI: 10.1007/s10787-006-1531-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419, safe in clinical trials for inflammatory bowel disease (PL 10, PLD 116, PLD 14736, Pliva, Croatia)) has a particular cytoprotective/adaptive cytoprotective activity. The cytoprotective/adaptive cytoprotection researches largely neglect that stomach distension could per se jeopardize the mucosal integrity, with constantly stretched mucosa and blood vessels, and sphincters more prone for reflux induction. After absolute alcohol instillation in fully distended rat stomach, gastric, esophageal and duodenal lesions occur. Throughout next 3 min, left gastric artery blood vessels clearly disappear at the serosal site, indicative for loss of vessels both integrity and function. Contrary, constant vessels presentation could predict the beneficial effect of applied agent. After pentadecapeptide BPC 157 instillation into the stomach the vessels presentation remains constant, and lesions of stomach, esophagus, and duodenum are inhibited. Standards (atropine, ranitidine, omeprazole) could only slightly improve the vessels presentation compared to control values, and they have only a partial effect on the lesions. In this review we emphasize BPC 157 unusual stability, and some of its important effects: effectiveness against various lesions in gastrointestinal tract, on nitric oxide (NO)-system, and NO-agents effects, on somatosensory neurons, salivary glands function, recovery of AMP-ADP-ATP system, endothelium protection, effect on endothelin, and on angiogenesis promotion. It also antagonizes other alcohol effects, including acute and chronic intoxication. Given peripherally, it counteracts the consequence of central dopamine system disturbances (receptor blockade), and induces serotonin release in substantia nigra. Therapeutic potential of BPC 157 as a cytoprotective agent is also seen in its capability to heal various wounds. Given directly into the stomach, BPC 157 instantly recovers disturbed lower esophageal and pyloric sphincter pressure in rats after 12-20 months of untreated esophagitis. All these could be suggestive for its role as a natural protectant in gastric juice with particular function throughout stomach distension.
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Affiliation(s)
- P Sikiric
- Department of Pharmacology, Medical Faculty University of Zagreb, Zagreb, Croatia.
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Rahav G, Pitlik S, Amitai Z, Lavy A, Blech M, Keller N, Smollan G, Lewis M, Zlotkin A. An outbreak of Mycobacterium jacuzzii infection following insertion of breast implants. Clin Infect Dis 2006; 43:823-30. [PMID: 16941361 DOI: 10.1086/507535] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 06/16/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Surgical wound infections caused by rapidly growing mycobacteria developed in 15 women after insertion of breast implants from August to November 2003 at a single medical center. METHODS A case-control study was conducted that included the identified patients, as well as women who underwent breast operations at the same center who did not develop infections. The study was accompanied by an extensive environmental investigation. Isolates were identified by standard bacteriological methods and by comparison of their 16S rRNA, HSP65, RPOB, SODA, and RECA gene sequences. Isolates were compared by random amplified polymorphic DNA analysis and by pulsed-field gel electrophoresis. RESULTS The risk factors for infection included surgery performed by 1 specific surgeon (odds ratio, 21.3; 95% confidence interval, 3.64-125.6). Identical strains of mycobacteria were isolated from the infected wounds of the patients; from the eyebrows, hair, face, nose, ears, and groin of this particular surgeon; and from this surgeon's outdoor whirlpool. The isolates exhibited a biochemical profile overlapping that of Mycobacterium wolinskyi, but their sequences of 16S rRNA and HSP65, RPOB, SODA, and RECA genes differed. We propose the name "Mycobacterium jacuzzii" for this new species. DNA fingerprints of cultured isolates from the surgical wounds, areas of the surgeon's body that grow hair, and the surgeon's whirlpool were identical. When the surgeon discontinued his use of the whirlpool and began cleaning the hairy areas of his body with a shampoo containing triclosan, the outbreak ended. CONCLUSIONS This outbreak brings to light the possibility of the colonization of human skin and human-to-human transmission of environmental mycobacteria during surgery that involves implant insertion.
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Affiliation(s)
- G Rahav
- Sheba Medical Center, Tel Hashomer, Israel.
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Abstract
Double aortic arch denotes the persistence of both fourth aortic arches and has been reported as 'very rare' in the dog. Most reported cases have been seen in German shepherd dogs. An eight-week-old, male, 1.5-kg beagle presented with a three-week history of regurgitation and dyspnoea. A barium oesophagram showed severe oesophageal constriction cranial to the base of the heart, and a provisional diagnosis of a persistent right aortic arch was made. A left-sided fourth intercostal thoracotomy was performed. The ligamentum arteriosum was ligated and divided. The oesophagus was seen lying on the right-hand side of the aorta. Postoperatively, the puppy deteriorated and was euthanized. Postmortem revealed a double aortic arch entrapping both the oesophagus and trachea. The inexperienced surgeon could consider computed tomography or angiography to determine the exact vascular ring, and other possible concurrent vascular anomalies present, before surgery.
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Affiliation(s)
- C J Du Plessis
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag XO4, Onderstepoort 0110, South Africa
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Weinberger M, Mahrshak I, Keller N, Goldscmied-Reuven A, Amariglio N, Kramer M, Tobar A, Samra Z, Pitlik SD, Rinaldi MG, Thompson E, Sutton D. Isolated endogenous endophthalmitis due to a sporodochial-formingPhialemonium curvatumacquired through intracavernous autoinjections. Med Mycol 2006; 44:253-9. [PMID: 16702105 DOI: 10.1080/13693780500411097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We report a case of endogenous endophthalmitis due to a sporodochial-forming species of Phialemonium curvatum. The infection led to the enucleation of the affected eye, but there was no evidence of systemic dissemination. The isolated P. curvatum produced aggregates of phialides, many occurring on coils or in verticils, which eventually develop into sporodochia. The initial and post-enucleation isolates revealed they were identical to strains of P. curvatum from Israel causing disseminated disease in patients practicing intracavernous autoinjections for the treatment of erectile dysfunction. The reported case had unusual clinical and microbiological features. Despite the route of acquisition and the lack of systemic antifungal therapy, the infection did not spread beyond the eye. The morphology of the phialides aggregates was also unique, and the distinction between Volutella and Acremonium is discussed. This case expands the spectrum of infections due to Phialemonium species, and reveals a novel way of developing fungal endophthalmitis.
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Affiliation(s)
- M Weinberger
- Internal Medicine C & Infectious Diseases, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
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Weinberger M, Leibovici L, Perez S, Samra Z, Ostfeld I, Levi I, Bash E, Turner D, Goldschmied-Reouven A, Regev-Yochay G, Pitlik SD, Keller N. Characteristics of candidaemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality. J Hosp Infect 2005; 61:146-54. [PMID: 16009456 DOI: 10.1016/j.jhin.2005.02.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 02/09/2005] [Indexed: 11/24/2022]
Abstract
Candidaemia due to non-albicans Candida species is increasing in frequency. We describe 272 episodes of candidaemia, define parameters associated with Candida albicans and other Candida species, and analyse predictors associated with mortality. Patients with C. albicans (55%) had the highest fatality rate and frequently received immunosuppressive therapy, while patients with Candida parapsilosis (16%) had the lowest fatality and complication rates. Candida tropicalis (16%) was associated with youth, severe neutropenia, acute leukaemia or bone marrow transplantation, Candida glabrata (10%) was associated with old age and chronic disease, and Candida krusei (2%) was associated with prior fluconazole therapy. The overall fatality rate was 36%, and predictors of death by multi-variate analysis were shock, impaired performance status, low serum albumin and congestive heart failure. Isolation of non-albicans Candida species, prior surgery and catheter removal were protective factors. When shock was excluded from analysis, antifungal therapy was shown to be protective. Unlike previous concerns, infection with Candida species other than C. albicans has not been shown to result in an increased fatality rate.
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Affiliation(s)
- M Weinberger
- Internal Medicine C and Infectious Diseases, Rabin Medical Centre, Beilinson Campus, Petach Tikva, Israel.
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Abstract
Ethylene glycol (anti-freeze) toxicity is a serious emergency in both veterinary and human medicine. Ethylene glycol (E/G) is the active anti-freeze principle in radiator water additives. It is odourless, colourless and has a sweet taste. As little as 5 ml or 20 ml is sufficient to kill a cat or a dog, respectively. Ethylene glycol is rapidly absorbed and metabolised in the liver to oxalate, which is deposited as calcium oxalate in the kidneys causing irreversible damage. This report describes 2 dogs that were suspected to have ingested ethylene glycol. The report contains a description of the 3 stages of ethylene glycol toxicity as well as a short discussion of the treatment. Public awareness about the dangers of anti-freeze will help in limiting exposure of pets and humans to this potentially fatal toxin. Veterinarians need to be aware of anti-freeze toxicity as delayed recognition and treatment will lead to the death of the patient.
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Affiliation(s)
- N Keller
- Small Animal Medicine, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa.
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Ben-Abraham R, Keller N, Teodorovitch N, Barzilai A, Harel R, Barzilay Z, Paret G. Predictors of adverse outcome from candidal infection in a tertiary care hospital. J Infect 2004; 49:317-23. [PMID: 15474630 DOI: 10.1016/j.jinf.2004.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To retrospectively delineate predictors of adverse outcome by looking at the demographic features, therapy and outcome of systemic candida infection in a large tertiary care university-affiliated medical center. METHODS We reviewed the clinical data on 186 inpatients with candidemia over a 6-year period. The major reason for their hospital admission was an underlying malignancy or an infection other than candidemia. RESULTS Candida albicans, tropicalis, parapsilosis, glabrata and krusei caused 54, 22, 13, 8 and 3% of the candidemia episodes, respectively. The overall mortality was 42% and it was highest in patients suffering from candidemia of the glabrata species (73%). Forty-eight (63%) of the 76 patients who received no anti-fungal treatment died compared to 38 (34%) of 110 patients who were treated (P < 0.05). Predictors of adverse outcome were intensive care unit stay, renal failure, thrombocytopenia and the need for mechanical ventilation or inotropic support. CONCLUSIONS We identified four predictors of mortality from candidemia infection. Their validity should be further assessed and the specific candida strains and their susceptibility need to be methodically identified. Our data support immediate initiation of therapy at first identification of infection.
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Affiliation(s)
- R Ben-Abraham
- Department of Anesthesiology and Critical Care, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Joubert KE, Keller N, Du Plessis CJ. A retrospective case series of computer-controlled total intravenous anaesthesia in dogs presented for neurosurgery. J S Afr Vet Assoc 2004; 75:85-9. [PMID: 15456164 DOI: 10.4102/jsava.v75i2.458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
This article describes the anaesthetic management and use of total intravenous anaesthesia (TIVA) for neurosurgery in 4 dogs. Propofol in conjunction with morphine was used for the maintenance of anaesthesia. Anaesthesia was induced with either thiopentone or propofol. The program Stelpump (a target-controlled infusion program) was run on a laptop and connected to a syringe driver via an RS 232 cable. The program was found to be reliable and safe for the administration of TIVA in dogs. Invasive monitoring was required in order to monitor cardiovascular changes during surgery. Ventilation was controlled to maintain the end-tidal carbon dioxide below 40 mm Hg. The anaesthesia was characterised by haemodynamic stability. The haemodynamic stability was probably the result of the choice of TIVA and balanced anaesthesia. Intracranial pressure and oedema was controlled with dexamethasone, mannitol and ventilatory management either in combination or alone. Three dogs survived to hospital discharge and 1 dog was euthanased 2 weeks later due to tumour metastasis. The development and characterisation of the anaesthetic effects of TIVA needs to be elucidated in order to provide clinicians with rational guidelines for the appropriate use of TIVA in veterinary medicine.
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Affiliation(s)
- K E Joubert
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa.
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Linder N, Prince S, Barzilai A, Keller N, Klinger G, Shalit I, Prince T, Sirota L. Disinfection with 10% povidone-iodine versus 0.5% chlorhexidine gluconate in 70% isopropanol in the neonatal intensive care unit. Acta Paediatr 2004. [PMID: 15046275 DOI: 10.1111/j.1651-2227.2004.tb00707.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM The finding that 10% povidone-iodine skin disinfectant may compromise thyroid function in premature infants prompted its replacement with 0.5% chlorhexidine gluconate solution in 70% isopropanol. The objective of this study was to compare the incidence rates of true infection and contamination associated with the use of these two disinfectants in the neonatal intensive care unit. METHODS The study population comprised two cohorts of infants admitted to our neonatal intensive care unit: 1) in 1992-1993 when only 10% povidone-iodine was used as a skin disinfectant, and 2) in 1995-1996 when only 0.5% chlorhexidine gluconate solution in 70% isopropanol was used. A retrospective chart review was conducted to determine whether all documented positive blood, CSF and suprapubic aspirate cultures indicated true infection or contamination. True infection was defined as clinical symptoms and/or laboratory abnormalities suggestive of sepsis, with positive blood, CSF or suprapubic aspirate cultures. RESULTS 1146 infants were admitted during the study periods, 507 during the first period and 639 during the second. In the early group, 17.6% of infants had major malformations, 72.0% were premature and 25.2% had weights of < 1500 g. Corresponding percentages for the latter group were 16.0%, 80.6% and 32.9%, respectively. No statistically significant differences were found between the two research periods in rate of infants with positive blood cultures, true infections, or contamination. CONCLUSION The use of 0.5% chlorhexidine gluconate solution in 70% isopropanol as a skin disinfectant is justified in neonatal intensive care units because it is not associated with an increased incidence of infections as opposed to 10% povidone-iodine and is devoid of detrimental effects.
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Affiliation(s)
- N Linder
- Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tiqwa 49202, Israel.
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Linder N, Prince S, Barzilai A, Keller N, Klinger G, Shalit I, Prince T, Sirota L. Disinfection with 10% povidone-iodine versus 0.5% chlorhexidine gluconate in 70% isopropanol in the neonatal intensive care unit. Acta Paediatr 2004; 93:205-10. [PMID: 15046275 DOI: 10.1080/08035250310008159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
AIM The finding that 10% povidone-iodine skin disinfectant may compromise thyroid function in premature infants prompted its replacement with 0.5% chlorhexidine gluconate solution in 70% isopropanol. The objective of this study was to compare the incidence rates of true infection and contamination associated with the use of these two disinfectants in the neonatal intensive care unit. METHODS The study population comprised two cohorts of infants admitted to our neonatal intensive care unit: 1) in 1992-1993 when only 10% povidone-iodine was used as a skin disinfectant, and 2) in 1995-1996 when only 0.5% chlorhexidine gluconate solution in 70% isopropanol was used. A retrospective chart review was conducted to determine whether all documented positive blood, CSF and suprapubic aspirate cultures indicated true infection or contamination. True infection was defined as clinical symptoms and/or laboratory abnormalities suggestive of sepsis, with positive blood, CSF or suprapubic aspirate cultures. RESULTS 1146 infants were admitted during the study periods, 507 during the first period and 639 during the second. In the early group, 17.6% of infants had major malformations, 72.0% were premature and 25.2% had weights of < 1500 g. Corresponding percentages for the latter group were 16.0%, 80.6% and 32.9%, respectively. No statistically significant differences were found between the two research periods in rate of infants with positive blood cultures, true infections, or contamination. CONCLUSION The use of 0.5% chlorhexidine gluconate solution in 70% isopropanol as a skin disinfectant is justified in neonatal intensive care units because it is not associated with an increased incidence of infections as opposed to 10% povidone-iodine and is devoid of detrimental effects.
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Affiliation(s)
- N Linder
- Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tiqwa 49202, Israel.
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Marouni MJ, Barzilai A, Keller N, Rubinstein E, Sela S. Intracellular survival of persistent Group A streptococci in cultured epithelial cells. Int J Med Microbiol 2004; 294:27-33. [PMID: 15293451 DOI: 10.1016/j.ijmm.2004.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Group A streptococcus (GAS) is the principle etiologic agent of bacterial pharyngotonsillitis and a wide range of other diseases. Failure to eradicate GAS from patients has been documented in 5-30% of patients with pharyngotonsillitis, in spite of the continued sensitivity of GAS to penicillin and other beta-lactams. It was recently proposed that eradication failure might be attributed to the ability of GAS to maintain an intracellular reservoir during antibiotic treatment. We have previously shown that strains derived from patients with bacterial eradication failure, despite antibiotic treatment (persistent strains), adhered to and were internalized by cultured epithelial cells more efficiently than strains that were successfully eradicated. Since, penicillin and other beta-lactams do not penetrate well into mammalian cells, intracellular survival of GAS is crucial in order to persist during prolonged antibiotic treatment. In this study, we compared the survival of GAS strains from cases of eradication failure and eradication success, using an epithelial cell culture model. We found that persistent strains show significantly increased intracellular survival, compared to the 'eradication success' strains. This finding supports the idea that an intracellular reservoir of GAS plays a role in the etiology of antibiotic eradication failure.
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Affiliation(s)
- Mehran J Marouni
- Department of Human Microbiology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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