Targeted mupirocin-based decolonization for Staphylococcus aureus carriers and the subsequent risk of mupirocin resistance in haemodialysis patients - a longitudinal study over 20 years

Mupirocin-based decolonization of Staphylococcus aureus carriers undergoing haemodialysis is not widely implemented due to concerns of mupirocin resistance. In our haemodialysis unit, a strategy combining universal S. aureus screening with targeted mupirocin-based decolonization has been introduced two decades ago. In this study of haemodialysis patients, mupirocin resistance was assessed in blood and colonizing S. aureus isolates during two periods. Mupirocin resistance in S. aureus was infrequent in both blood and colonizing isolates. Furthermore, in the years 2003-2021, a decreasing trend of the annual rate of S. aureus bloodstream infections was observed. Targeted mupirocin-based decolonization of S. aureus carriers undergoing haemodialysis is a sustainable measure for preventing healthcare-associated infections.

Modelling of allocation and balance of carbon in walnut (Juglans regia L.) seedlings during heterotrophy-autotrophy transition

A deterministic and dynamic model of carbon allocation in walnut seedlings is described. Two experimental data sets were used to calibrate and validate the model. These data included: time course of the carbon content, chemical and isotope composition (12C and 13C) of the kernel and growing organs (roots, stem, leaves), and gas exchange rates during the first 55 days of the life of the plant with continuous 13CO2 feeding. The plant is modelled as a network with nodal organs acting as sources or sinks for carbohydrates. In a sink organ the demand for carbon is the sum of four elementary demands: maintenance respiration, structural growth, growth-associated respiration and carbon storage. The organs of the plant are assumed to be in exponential growth phase. The supply of carbon readily accessible for the organs is the store of soluble sugars present in a local reservoir. Carbon flow in the network is determined by the source/sink activities of the organs and local levels of demand and supply. Two carbon sources are considered: soluble sugars from the kernel, and gross photosynthesis. The rate of synthesis of soluble sugars in the kernel, and measured photosynthesis in the leaves are inputs for the plant model. The outputs are the predicted fluxes of carbon within the seedling; 13C composition,carbohydrate allocation to the growing organs, starch and soluble sugars accumulation, and respiration. The mathematical equations were translated into PSPICE software instructions. After optimisation of the parameter values, the model provided an accurate description of experimental observations in the seed-plant system during the critical transition from heterotrophy to autotrophy, especially C allocation to organs and C partitioning between storage, structural growth and respiration in each organ. The growth of the young plant is supply-limited, except at the earliest stages. A sensitivity analysis suggests that intense competition for carbohydrates dominates the relations among and within organs. Copyright 1998 Academic Press Limited

Neuromuscular effects of vecuronium and neostigmine in Montreal and Paris

The potency of vecuronium was reported to be greater in Montréal than in Paris. This study was designed to determine whether there were differences in onset, duration, and reversibility with neostigmine between both centres. Twenty ASA I or II adults (ten men, ten women), aged 18-65 yr were studied in each of the two cities, during a standard thiopentone-fentanyl-nitrous oxide (60-70%) - isoflurane 0.5% end-tidal anaesthetic. Train-of-four stimulation was applied every 20 sec to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis muscle was measured. Vecuronium, 0.1 mg.kg-1, was given as a bolus, and neostigmine, 0.04 mg.kg-1, was administered, with atropine 0.02 mg.kg-1, at 25% first twitch height recovery. Onset time to maximum blockade was (mean +/- SD) 3.9 +/- 1.3 min in Paris vs 4.5 +/- 1.3 min in Montréal (NS). Duration from injection to 25% first twitch recovery was shorter (28.5 +/- 6.8 min) in Paris than in Montréal (39.1 +/- 7.3 min) (P < 0.0001). Time from injection of neostigmine to a train-of-four ratio of 70% was not different in Paris (6.3 +/- 2.2 min) from Montréal (5.6 +/- 1.9 min). It is concluded that the duration of an "intubating" dose of vecuronium is longer in Montréal, but, when given at 25% first twitch recovery, neostigmine has the same efficacy in Montréal as in Paris.

The orbicularis oculi and the adductor pollicis muscles as monitors of atracurium block of laryngeal muscles

The aim of this study was to determine whether atracurium-induced neuromuscular block at the laryngeal adductor muscles could be predicted by visual inspection of either adductor pollicis or orbicularis oculi responses. Twenty-one ASA Class I or II patients were anesthetized with propofol (2-2.5 mg/kg) and fentanyl (2-5 micrograms/kg). Tracheal intubation was performed without neuromuscular blocking drugs. Patients were assigned randomly to receive atracurium 0.3 or 0.5 mg/kg intravenously. Train-of-four stimulation was applied to the ulnar, facial, and recurrent laryngeal nerves. Laryngeal response was measured as the pressure change in the tracheal tube cuff positioned between the vocal cords. The response at the adductor pollicis and orbicularis oculi was evaluated visually by two observers who detected if and when block was complete. Twelve patients, including all those receiving 0.5 mg/kg, had complete orbicularis oculi block. The same patients, except one, also had 100% laryngeal block. Adductor pollicis response was abolished in the same 12 patients plus an additional 4 patients. In patients receiving atracurium 0.5 mg/kg, laryngeal and orbicularis oculi responses were abolished faster (mean +/- SD: 132 +/- 80 and 146 +/- 58 s, respectively) than the adductor pollicis muscle (243 +/- 55 s; P < 0.05). There was a significant correlation (r = 0.94; P < 0.001) between neuromuscular block onset time at the laryngeal adductor and orbicularis oculi muscles but not between laryngeal and thumb muscles. The authors conclude that, after injection of atracurium, laryngeal adductor and orbicularis oculi blocks have similar intensities and time courses.(ABSTRACT TRUNCATED AT 250 WORDS)