In vivo activity of amphotericin B lipid complex in immunocompromised mice against fluconazole-resistant or fluconazole-susceptible Candida tropicalis

We compared four doses of amphotericin B lipid complex (ABLC) with three doses of fluconazole in temporarily neutropenic mice in a murine model of disseminated candidiasis due to four different isolates of Candida tropicalis. The mice were infected with a 90% lethal dose of four strains of C. tropicalis for which the fluconazole MICs ranged from 1 to >125 mg/liter 3 days after receiving 200 mg of cyclophosphamide/kg of body weight. Treatment was started 18 h after infection and lasted for 7 days. ABLC (1, 2, 5, and 10 mg/kg) was administered once a day intravenously, fluconazole was administered by oral gavage once daily (25 and 50 mg/kg/day) or twice daily (125 mg/kg). MICs determined in five different ways with 24- and 48-h endpoints were also compared. The overall survival rates were controls, 14%; fluconazole, 64%; and ABLC, 82%. Treatment with ABLC at 2 to 10 mg/kg increased survival compared to controls (P = <0.0001) and was also superior to fluconazole at 25 and 50 mg/kg (P = 0.006). In the fluconazole-resistant C. tropicalis model (MIC, 128 microg/ml), ABLC at 2 to 10 mg/kg was superior to fluconazole at 250 mg/kg and ABLC at 10 mg/kg was superior to all fluconazole doses (P = <0.05). Fluconazole at 250 mg/kg daily was superior to both 25 and 50 mg/kg at reducing mortality with most isolates. ABLC was superior to fluconazole (P = <0.01), and fluconazole at 250 mg/kg was superior to fluconazole at both 25 and 50 mg/kg (P = 0.02) in all models at reducing C. tropicalis counts in the kidneys. Neither drug consistently sterilized the brain or kidneys. A 48-h endpoint reading with the NCCLS susceptibility testing microtiter variation overestimates resistance to fluconazole. ABLC is an effective treatment for fluconazole-resistant C. tropicalis at all doses tested.

Maximizing unused power. Hospitals save millions by extracting more out of information systems already in place

Forced to cut costs, healthcare organizations are taking a pass on the whiz-bang features and elaborate functions of new technology in favor of what's already there. With a new focus on getting more value out of existing technology, providers have discovered unused power in their information systems and are saving millions along the way.

Osteogenic protein-1 prevents renal fibrogenesis associated with ureteral obstruction

Unilateral ureteral obstruction (UUO) is a model of renal injury characterized by progressive tubulointerstitial fibrosis and renal damage, while relatively sparing the glomerulus and not producing hypertension or abnormalities in lipid metabolism. Tubulointerstitial fibrosis is a major component of several kidney diseases associated with the progression to end-stage renal failure. Here we report that when a critical renal developmental morphogen, osteogenic protein-1 (OP-1; 100 or 300 microg/kg body wt), is administered at the time of UUO and every other day thereafter, interstitial inflammation and fibrogenesis are prevented, leading to preservation of renal function during the first 5 days after obstruction. Compared with angiotensin-converting enzyme inhibition with enalapril treatment, OP-1 was more effective in preventing tubulointerstitial fibrosis and in preserving renal function. The mechanism of OP-1- induced renal protection was associated with prevention of tubular atrophy, an effect not shared with enalapril, and was related to preservation of tubular epithelial integrity. OP-1 blocked the stimulation of epithelial cell apoptosis produced by UUO, which promoted maintenance of tubular epithelial integrity. OP-1 preserved renal blood flow (RBF) during UUO, but enalapril also stimulated RBF. Thus OP-1 treatment inhibited tubular epithelial disruption stimulated by the renal injury of UUO, preventing tubular atrophy and diminishing the activation of tubulointerstitial inflammation and fibrosis and preserving renal function.

Dosimetry in mice exposed to 1.6 GHz microwaves in a carrousel irradiator

We have developed a carrousel irradiator for mice which delivers a head-first and near-field radiofrequency exposure that more closely simulates cellular telephone and radio use than conventional whole body exposure systems. Mouse cadavers were placed on the carrousel irradiator and exposed with their noses 5 mm from the feedpoint of a 1.6 GHz antenna. Local measured specific absorption rates (SAR) in brain regions corresponding to the frontal cortex, medial caudate putamen, and midhippocampal areas were 2.9, 2.4, and 2.2 W/kg per watt of irradiated power, respectively. In addition, average SAR was estimated to be 3.4 W/kg per watt along the sagittal plane of the brain, 2.0 W/kg per watt along the sagittal plane of the body, and between 6.8 and 8.1 W/kg per watt at peak locations along the sagittal plane at the body surface. This detailed SAR information in mice is critical to the interpretation of biological studies of IRIDIUM exposure, and similar analysis should be included for all studies of in vivo exposure of small animals to microwaves.

The staphylococcal transferrin receptor: a glycolytic enzyme with novel functions

To obtain iron from the host for growth, staphylococci have evolved sophisticated iron-scavenging systems including siderophores and a cell surface receptor for transferrin, the mammalian iron-transporting glycoprotein. The staphylococcal transferrin receptor has been identified as a member of a newly emerging family of multifunctional, cell-surface-associated glyceraldehyde-3-phosphate dehydrogenases, which not only retain their glycolytic enzyme activities but also bind diverse human serum proteins and possess NAD-ribosylating activity. These multiple functions suggest a potential contribution to virulence far beyond iron acquisition.

Top 100 hospitals

What sets high-performing hospitals apart from the rest of the pack? Despite dwindling Medicare revenues, they manage to get by on whatever they can get. The facilities that performed best clinically and operationally are also far more profitable than the industry at large, and they're doing it despite a sicker patient census than the national norm. Those are among the findings in our report on the top 100 hospitals.