Association between respiratory distress time and invasive mechanical ventilation in COVID-19 patients: A multicentre regional cohort study

AIM

To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.

MATERIALS AND METHODS

An observational multicentre cohort study of patients hospitalised in five COVID-19-designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.

MEASUREMENTS AND MAIN RESULTS

We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48-12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89-39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.

DISCUSSION

Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients' need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.

Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis

Background

Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS).

Methods

We analyzed data from the multicenter observational ‘PRactice of VENTilation in COVID-19 patients’ study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed.

Results

Among 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27–7.72 L), 0.78 L (0.26–1.27 L), and − 0.35 L (− 6.52–0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77–0.95, P = 0.0047). Sensitivity analyses showed similar results.

Conclusions

In a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial.

Trial registration Clinicaltrials.gov (NCT04346342); Date of registration: April 15, 2020.

Graphical abstract

Utility of Microhemorrhage as a Diagnostic Tool in Distinguishing Vestibular Schwannomas from other Cerebellopontine Angle (CPA) Tumors

Although a majority of tumors in the Cerebellopontine Angle (CPA) are vestibular schwannomas (VS), other masses can also be seen in the region and differentiation of various CPA tumors, particularly meningiomas can be difficult on imaging alone. Treatment options may vary based on specific pathology of the CPA tumor. In this study, the presence of microhemorrhage (MH) and other imaging features such as size of lesion, cystic features and pattern of IAC extension, were evaluated as a tool in distinguishing VS from other CPA masses. A review of CPA masses in the last 11 years at our institution was performed. All the pathology proven tumors with at least 1 pre-operative MRI were considered for analysis. A T2* GRE or SWI sequence was used to assess presence of MH within the lesion. Pattern of IAC extension ('centric' versus 'eccentric') of tumor was also evaluated. A total of 147 patients were reviewed out of which 102 patients (with T2* GRE or SWI) were included for analysis of MH. 57 patients (56%) had VS as the final histopathological diagnosis and 45 patients (44%) had other types of tumor. A sensitivity of 82% and a specificity of 98% was noted for the presence of MH favoring the diagnosis of VS from other tumors (p < 0.001). All meningiomas with IAC extension (25/31) showed an 'eccentric' pattern of extension into the canal. Visualization of MH and pattern of IAC extension is useful in the differentiation of schwannomas from other CPA masses, particularly meningiomas.

Sleep's role in memory consolidation: What can we learn from atypical development?

Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.

Nasal high flow oxygen in acute respiratory failure

Thermo-humidified nasal high flow (NHF) oxygen therapy is increasingly used in the management of respiratory failure. This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios, including acute and chronic settings. NHF enhances the patient's comfort and tolerance when compared with standard oxygen by supplying a heated and humidified mixture of air and oxygen at flows up to 60L/min. It can be delivered through different devices. Although few studies have compared the clinical effects of different NHF systems, the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice. We have also included a brief description of the most frequently used NHF systems.

Central-to-axial chirality induction in biphenyl chiroptical probes for the stereochemical characterization of chiral primary amines

Flexible biphenyls have been applied as efficient and practical chiroptical probes for absolute configuration assignment to chiral primary amines. The mechanism of the central-to-axial chirality transfer from the amine moiety to the conformationally flexible biphenyl system has been determined by NMR and computational studies. This allowed proposing a general non-empirical rule in order to establish, simply by looking at the sign of the 250 nm A band in the ECD spectrum of the biphenyl derivative, the torsion of the biphenyl and thus the absolute configuration of the amine. The method proved to be very reliable and sensitive, allowing treatment of samples on the μmol scale and permitting the simultaneous determination of the amine sample's absolute configuration and enantiopurity.

A Review of Magnetic Particle Imaging and Perspectives on Neuroimaging

Magnetic particle imaging is an emerging tomographic technique with the potential for simultaneous high-resolution, high-sensitivity, and real-time imaging. Magnetic particle imaging is based on the unique behavior of superparamagnetic iron oxide nanoparticles modeled by the Langevin theory, with the ability to track and quantify nanoparticle concentrations without tissue background noise. It is a promising new imaging technique for multiple applications, including vascular and perfusion imaging, oncology imaging, cell tracking, inflammation imaging, and trauma imaging. In particular, many neuroimaging applications may be enabled and enhanced with magnetic particle imaging. In this review, we will provide an overview of magnetic particle imaging principles and implementation, current applications, promising neuroimaging applications, and practical considerations.

Fibula: The Forgotten Bone-May It Provide Some Insight On a Wider Scope for Bone Mechanostat Control?

The human fibula responds to its mechanical environment differently from the tibia accordingly with foot usage. Fibula structure is unaffected by disuse, and is stronger concerning lateral bending in soccer players (who evert and rotate the foot) and weaker in long-distance runners (who jump while running) with respect to untrained controls, along the insertion region of peroneus muscles. These features, strikingly associated to the abilities of the fibulae of predator and prey quadrupeds to manage uneven surfaces and to store elastic energy to jump, respectively, suggest that bone mechanostat would control bone properties with high selective connotations beyond structural strength.

Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study

AIM

To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward.

METHODS

This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge.

RESULTS

Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome.

CONCLUSION

In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.

General cognition predicts post-stroke recovery defined through minimal clinically important difference (MCID): a cohort study in an Italian rehabilitation clinic

BACKGROUND

In the field of rehabilitation it is crucial to define if changes in functional scores correspond to relevant clinical improvements.

AIM

To assess whether cognition affects motor recovery in post-stroke patients using a clinical meaningful criterion: the minimal clinically important difference (MCID).

DESIGN

Retrospective cohort study.

SETTING

Inpatient rehabilitation clinic

POPULATION

Two hundred nine first-ever stroke patients undergoing a post-acute inpatient rehabilitation.

METHODS

Cognitive status was assessed with the cognitive FIM and the Mini-Mental State Examination (MMSE). The response to the rehabilitation was defined as the achievement of the MCID between admission and discharge in the motor FIM (responder) and both in the motor and in the cognitive FIM (best-responder).

RESULTS

Subjects with a baseline higher MMSE>24.9 had a near four-fold higher probability of being responder (OR 3.91; 95% CI 1.72-8.89) and a two-fold higher probability of being best-responder (OR 2.69; 95% CI 1.24-5.84) on motor FIM as compared to those with a MMSE≤24.9. A duration of the rehabilitation of 55-61 days implies a three-fold higher probability (OR 3.17; 95% CI 1.15-8.72) to be responder as compared to shorter period of treatment; a treatment >61 days does not involve a greater probability of response.

CONCLUSIONS

This is the first study that examined post-stroke motor recovery mainly in terms of clinical relevance (MCID). Subjects with a higher cognitive level are more likely to achieve a clinically meaningful recovery.

CLINICAL REHABILITATION IMPACT

MCID can be applied extensively to post-stroke patients undergoing to an inpatient rehabilitation in order to have a clinically useful instrument that assess the recovery.

Relationship between mandibular second molar calcification stages and cervical vertebrae maturity in Italian children and young adults

AIM

The aim of this study was to investigate the relationship between the stages of calcification of the mandibular second molar and the stages of skeletal maturity among Italian children and young adults.

MATERIALS AND METHODS

Cross-sectional descriptive study. The samples were derived from panoramic radiographs and lateral cephalograms of 500 Italian subjects aged from 10 to 20 years. Dental maturity index (DM) was assessed by calcification stages of the mandibular second molars according to the Demirjian method; skeletal maturity was evaluated with cervical vertebrae maturation index (CVM) according to Hassel and Farman. The Pearson r coefficient and Spearman rank correlation coefficient were estimated to determine the relationship between DM and CVM.

RESULTS

Skeletal maturation stages occurred earlier in females (about 6 months). A highly significant correlation between CVM and DM (0.78-0.86 cor according to Pearson test and 0.81-0.85 rho according to Spearman test) was found. DM stage E corresponds to phase CVM 1 and 2 (the phase prior to the growth spurt), DM stage F corresponds to the phase of pubertal growth spurt, stages CVM 2 and CVM 3; DM stage G is indicator of the growth spurt underway (CVM 3-4), but it can still be found during CVM 5 in females.

CONCLUSION

The second mandibular molars can be considered reliable indicators for the evaluation of the growth phases. In case of females the end of the growth spurt it is not clearly associated with a dental maturity stage and needs to be stated with further parameters such as CVM.

Competing electronic states in high temperature phase of NaTiO(2)

First principle density functional theory calculations on the high temperature phase of layered triangular lattice system NaTiO2 have revealed that a collective electronic state exists energetically close to the ground state but with competing transport properties: the latter is metallic with partially occupied doubly degenerate e'g orbitals, whereas the former is insulating with a1g orbital fully occupied. Significant occupation of this excited state is possible at non zero temperature either thermally or thanks to very soft (large amplitude) oxygen vibrations. Possible explanations of the experimental low conductivity based on competing orbital transport and of the specific heat jump at a structural transition based on orbital entropy are discussed.

The complication of oral piercing and the role of dentist in their prevention: a literature review

OBJECTIVES. The work report about the complications of oral piercing and the role of dentist in their prevention. MATERIALS AND METHODS. The authors conducted a systematic review of the literature through the Medline database by entering "oral piercing", "piercing and complications", "piercing and hygiene" as keywords. Articles published between 1988 and 2012 were considered. RESULTS. Oral piercing is linked to several potential complications. Many of them are due to scarce awareness of the risk, bad habits and inadequate oral care. CONCLUSIONS. The dentist should motivate patients with oral piercing to maintain a good oral care, provide instructions and conduct periodic inspections to secure their understanding and implementation in order to prevent complications.

Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency

Noninvasive mechanical ventilation (NIV) has become a standard of care in select patients with both hypercapnic and non-hypercapnic acute respiratory failure (ARF). Consequent to the increasing use of NIV, new interfaces of different designs, shapes, sizes, and materials have been proposed for clinical use in recent years. The aim of this report is to examine the most relevant physiological aspects related to the choice of interface with particular emphasis on the problems related to dead space and air leaks that may affect the synchrony between the patient and the machine, ultimately determining the patient's compliance and therefore NIV success.

Airborne particulate matter (PM) filter analysis and modeling by total reflection X-ray fluorescence (TXRF) and X-ray standing wave (XSW)

This work is presented as an improvement of a recently introduced method for airborne particulate matter (PM) filter analysis [1]. X-ray standing wave (XSW) and total reflection X-ray fluorescence (TXRF) were performed with a new dedicated laboratory instrumentation. The main advantage of performing both XSW and TXRF, is the possibility to distinguish the nature of the sample: if it is a small droplet dry residue, a thin film like or a bulk sample. Another advantage is related to the possibility to select the angle of total reflection to make TXRF measurements. Finally, the possibility to switch the X-ray source allows to measure with more accuracy lighter and heavier elements (with a change in X-ray anode, for example from Mo to Cu). The aim of the present study is to lay the theoretical foundation of the new proposed method for airborne PM filters quantitative analysis improving the accuracy and efficiency of quantification by means of an external standard. The theoretical model presented and discussed demonstrated that airborne PM filters can be considered as thin layers. A set of reference samples is prepared in laboratory and used to obtain a calibration curve. Our results demonstrate that the proposed method for quantitative analysis of air PM filters is affordable and reliable without the necessity to digest filters to obtain quantitative chemical analysis, and that the use of XSW improve the accuracy of TXRF analysis.

BCR-ABL inhibitors in chronic myeloid leukemia: process chemistry and biochemical profile

Chronic myeloid leukemia (CML) is a myeloproliferative disease originating from a constitutively active tyrosine kinase, called BCR-ABL, expressed by an oncogene resulting from a reciprocal translocation between chromosome 9 and chromosome 22, coded as (t[9,22][q34;q11]). Inhibition of BCR-ABL with tyrosine kinase inhibitors (TKI) proved to be an efficient targeted therapy of Philadelphia-positive (Ph+) CML in the chronic phase. This review mainly addresses the synthetic pathways and process chemistry leading to the large scale preparation for pre-clinical demands and clinical supply of the three TKIs approved for Ph+ CML, i.e., imatinib, dasatinib and nilotinib and three more investigational drugs, i.e., bosutinib, ponatinib and bafetinib. Recent progress on the biochemical profiling of the six examined TKIs has been also reported.

BCS-BEC crossover at finite temperature for superfluid trapped Fermi atoms

We consider the BCS-BEC (Bose-Einstein-condensate) crossover for a system of trapped Fermi atoms at finite temperature, both below and above the superfluid critical temperature, by including fluctuations beyond mean field. We determine the superfluid critical temperature and the pair-breaking temperature as functions of the attractive interaction between Fermi atoms, from the weak- to the strong-coupling limit (where bosonic molecules form as bound-fermion pairs). Density profiles in the trap are also obtained for all temperatures and couplings.

Pairing fluctuation effects on the single-particle spectra for the superconducting state

Single-particle spectra are calculated in the superconducting state for a fermionic system with an attractive interaction, as functions of temperature and coupling strength from weak to strong. The fermionic system is described by a single-particle self-energy that includes pairing-fluctuation effects in the superconducting state. The theory reduces to the ordinary BCS approximation in weak coupling and to the Bogoliubov approximation for the composite bosons in strong coupling. Several features of the single-particle spectral function are shown to compare favorably with experimental data for cuprate superconductors.

Infant-mother attachment among the Dogon of Mali

This study of mothers and infants from the Dogon ethnic group of Mali, West Africa examined three attachment hypotheses: (1) that infant attachment security is linked to the quality of mother-infant communication, (2) that mothers of secure infants respond more sensitively to their infants than do mothers of insecure infants, and (3) that infant disorganization is linked to maternal frightened or frightening behaviors. Participants were 27 mother-infant pairs from a rural town and 15 mother-infant pairs from two agrarian villages; infants ranged in age from 10 to 12.5 months at the first assessment. The distribution of the Strange Situation classifications was 67% secure, 0% avoidant, 8% resistant, and 25% disorganized. Infant attachment security was significantly related to the quality of mother-infant communication as observed in a well-infant exam. The correlation between infant attachment security ratings and maternal sensitivity (assessed in the home) was modest and approached significance. Mothers of disorganized infants had significantly higher ratings of frightened or frightening behaviors. Maternal sensitivity predicted little of the variance in infant security; however, the addition of the frightened/frightening variable in the regression equation tripled the explained variance. The findings are discussed in light of Dogon childrearing practices and key tenets of attachment theory.

Setup error in radiotherapy: on-line correction using electronic kilovoltage and megavoltage radiographs

PURPOSE

We hypothesize that the difference in image quality between the traditional kilovoltage (kV) prescription radiographs and megavoltage (MV) treatment radiographs is a major factor hindering our ability to accurately measure, thus correct, setup error in radiation therapy. The objective of this work is to study the accuracy of on-line correction of setup errors achievable using either kV- or MV-localization (i.e., open-field) radiographs.

METHODS AND MATERIALS

Using a gantry mounted kV and MV dual-beam imaging system, the accuracy of on-line measurement and correction of setup error using electronic kV- and MV-localization images was examined based on anthropomorphic phantom and patient imaging studies. For the phantom study, the user's ability to accurately detect known translational shifts was analyzed. The clinical study included 14 patients with disease in the head and neck, thoracic, and pelvic regions. For each patient, 4 orthogonal kV radiographs acquired during treatment simulation from the right lateral, anterior-to-posterior, left lateral, and posterior-to-anterior directions were employed as reference prescription images. Two-dimensional (2D) anatomic templates were defined on each of the 4 reference images. On each treatment day, after positioning the patient for treatment, 4 orthogonal electronic localization images were acquired with both kV and 6-MV photon beams. On alternate weeks, setup errors were determined from either the kV- or MV-localization images but not both. Setup error was determined by aligning each 2D template with the anatomic information on the corresponding localization image, ignoring rotational and nonrigid variations. For each set of 4 orthogonal images, the results from template alignments were averaged. Based on the results from the phantom study and a parallel study of the inter- and intraobserver template alignment variability, a threshold for minimum correction was set at 2 mm in any direction. Setup correction was applied by translating the treatment couch in the lateral, superior-to-inferior and vertical directions only. During treatment, kV open-field images were acquired for off-line treatment verification and analysis. Each patient study spanned 2-6 weeks. The 14 patient studies were completed with 8248 electronic images acquired and analyzed.

RESULTS

Results from the phantom studies showed that the users were able to detect the applied translational shift to better than 2 mm, and mostly to within 1 mm. The intraobserver variability of template alignment was on the order of 1 mm using a sample of either MV or kV patient images. The difference between using MV or kV images was significant for only a few cases. However in most cases, interobserver alignment variability was larger when using MV images than kV. For on-line setup correction, the study procedure added 10 min. to conventional treatment time. Setup variation measured with either kV- or MV-localization images was similar. The initial magnitude of setup error was appreciable, with a mean displacement of about 6.6 +/- 2.4 mm for the 14 patients. On-line correction using either kV- or MV-localization images improved setup accuracy. Over all study patients, setup errors occurred with standard deviations greater than 2 mm in any direction with a frequency of 48% before correction, and were reduced to 16% after correction. On average, kV image-based correction reduced radial setup variation to 2.6 +/- 1.6 mm compared to the 3.3 +/- 1.8 mm attained using MV images. The difference detected between the kV and MV data was not statistically significant when averaged over all patients. However, for on-line corrections in the neck and thoracic regions, using kV-localization images reduced setup error significantly more than using MV images.

CONCLUSIONS

In our anatomic template alignment study, interobserver variability was smaller using kV images than MV images. Intraobserver variability was smaller for alignments on kV images

Perceived morbidity and health behaviour in a Dogon community

The episodes of morbidity over a 6 month period were recorded at 179 households comprising 1715 people living in the district of Bandiagara (Mali). This population was subdivided into groups according to their distances from the nearest district health centre and educational services, their scholarization, socio-economic and hygiene levels. The subjects interviewed were asked to report illnesses using their vernacular names, the type of therapy selected, the decision process, the time-lapse between onset and remedial action, the treatment undergone and its effect. Subsequent analysis of the data recorded indicates that the frequency of morbidity episodes is inversely proportionate to the household's level of hygiene. It also appears that factors such as the household's hygienic, socio-economic and educational levels along with the type of illness and its duration, are more decisive when resorting (or not resorting) to treatment than is the proximity factor. This seems particularly true in the case of traditional medicine, chosen even where cosmopolitan resources are available and by people with a relatively high socio-economic, hygienic and educational level. In the specific situation under study this paper indicates those areas for further study with a view to improving public health education.

[Evaluation of the recovery of muscular trophicity in aged patients with femoral fractures treated with creatine phosphate and physiokinesitherapy]

Thirty patients over 60 years of age suffering from muscle hypotrophy of the lower limbs due to fracture of the thigh were submitted to rehabilitation training, physiokinesitherapy with and without administration of creatine phosphate (500 mg daily i.m. for 20 days). In order to assess the efficacy of therapy, manual measurement of the circumference of thigh and leg and echotomography were performed in order to measure the thickness of the muscle layer. Manual measurement did not prove to reliable method for evaluation due to the frequent presence of edematous swelling. After 20 days of physiokinesitherapy, echotomography revealed marked recovery of the muscle mass in the 15 patients treated with creatine phosphate who had an increase in muscle mass of 4.4 mm against only 1.5 mm in the group treated with physiokinesitherapy only. This difference is statistically significant (p less than 0.01).

[Frequency of isolation and drug resistance of bacterial strains from urine samples tested in the Bacteriology and Virology Laboratory of the U.S.L. 10/D in Florence]

Two thousand five hundred and sixty-eight positive monomicrobic urine samples (from general practice and hospital wards) were examined and isolated strains were tested against various antimicrobial drugs. Our findings showed that urinary-tract infections caused by Escherichia coli were the most common in females, whereas those by Pseudomonas aeruginosa, Proteus rettgeri, Enterobacter species, other difficult Gram-negative rods and Streptococcus faecalis were in total the most common in males. If we compare the strains isolated from general practice with those from the hospital, no significant differences were observed. E. coli strains were the most susceptible to the tested drugs; cefotaxime, amikacin, cefuroxime and ceftazidime were the most effective drugs against Enterobacter species, Ps. aeruginosa, P. rettgeri and Proteus mirabilis. P. mirabilis and Str. faecalis strains isolated in the hospital were more chemo-resistant than those isolated in general practice. Ampicillin and trimethoprim/sulphamethoxazole were less active against E. coli strains isolated from children's departments in comparison with the others.