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The optimisation of the use of β-lactam antibiotics (BLA) via prolonged infusions in life-threatening complications such as febrile neutropenia (FN) is still controversial. This systematic review and meta-analysis aim to evaluate the efficacy of this strategy in onco-haematological patients with FN. A systematic search was performed of PubMed, Web of Science, Cochrane, EMBASE, World Health Organization, and ClinicalTrials.gov, from database inception until December 2022. The search included randomised controlled trials (RCTs) and observational studies that compared prolonged vs short-term infusions of the same BLA. The primary outcome was all-cause mortality. Secondary outcomes were defervescence, requirement of vasoactive drugs, length of hospital stay and adverse events. Pooled risk ratios were calculated using random effects models. Five studies were included, comprising 691 episodes of FN, mainly in haematological patients. Prolonged infusion was not associated with a reduction in all-cause mortality (pRR 0.83; 95% confidence interval 0.47–1.48). Nor differences were found in secondary outcomes. The limited data available did not show significant differences in terms of all-cause mortality or significant secondary outcomes in patients with FN receiving BLA in prolonged vs. short-term infusion. High-quality RCTs are needed to determine whether there are subgroups of FN patients who would benefit from prolonged BLA infusion. [ABSTRACT FROM AUTHOR]

To compare the frequency of health-care worker (HCW) hand contamination by Escherichia coli versus Klebsiella species after patient care and to determine activities associated with contamination. We conducted a prospective observational study at two tertiary-care centres. We observed HCWs caring for patients colonized/infected with E. coli or Klebsiella. HCW hands were cultured before room entry and after patient care. Contamination was defined as detecting E. coli or Klebsiella on HCW hands. Risk factors for contamination were analysed using logistic regression. Patient-to-HCW transmission was confirmed by pulsed-field gel electrophoresis (PFGE). We performed 466 HCW observations: 290 from patients with E. coli , 149 with Klebsiella , and 27 with both species. Eighty-seven per cent of observations (404/464) occurred in patients who had received chlorhexidine bathing within 2 days. HCW hand contamination rates were similar between E. coli (6.2%; 18/290) and Klebsiella (7.4%; 11/149) (p 0.6). High-risk activities independently associated with contamination were toilet assistance (OR 9.34; 95% CI 3.10–28.16), contact with moist secretions (OR 6.93; 95% CI 2.82–17.00), and hygiene/bed-bathing (OR 3.80; 95% CI 1.48–9.80). PFGE identified identical/closely related isolates in the patient and HCW hands in 100% (18/18) of E. coli and 54.5% (6/11) of Klebsiella observations. We did not find a difference in HCW hand contamination rates between E. coli and Klebsiella after patient care. Hand hygiene should be reinforced after high-risk activities. Discrepancies in matching patient and HCW hand isolates occurred more frequently for Klebsiella than for E. coli ; differences in species-level transmission dynamics might exist. [ABSTRACT FROM AUTHOR]

This study aimed to assess the association between exposure to chromium and neuropsychological development among children. A cross-sectional study was conducted with 393 children aged 6–11 years old randomly selected from State-funded schools in two provinces in Southern Spain (Almeria and Huelva), in 2010 and 2012. Chromium levels in urine and hair samples were analyzed by inductively coupled plasma mass spectrometry with an octopole reaction system. Neuropsychological development was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and three computerized tests from the Behavioural Assessment and Research System (BARS): Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT). Multivariable linear regression models adjusted for potential confounders, including heavy metals, were applied to examine the association between chromium levels and neuropsychological outcomes. A 10-fold increase in urine chromium levels was associated with a decrease of 5.99 points on the WISC-IV Full-Scale IQ (95% CI: 11.98 to −0.02). Likewise, a 10-fold increase in urine chromium levels in boys was associated with a decrease of 0.03 points in the percentage of omissions (95% CI: 0.0 to 0.05) in the SAT, with an increase of 68.35 points in latency (95% CI: 6.60 to 130.12) in the RTT, and with an increase in the number of trials with latencies > 1000 ms (β = 37.92; 95% CI: 2.73 to 73.12) in the RTT. An inverse significant association was detected between chromium levels in hair and latency in the SAT in boys (β = −50.53; 95% CI: 86.86 to −14.22) and girls (β = −55.95; 95% CI: 78.93 to −32.97). Excluding trials with latencies >1000 ms in the RTT increased latency scores by 29.36 points in boys (95% CI: 0.17 to 58.57), and 39.91 points in girls (95% CI: 21.25 to 58.59). This study is the first to show the detrimental effects of postnatal chromium exposure on neuropsychological development in school-aged children. • Chromium environmental exposure is associated with a detrimental neuropsychological development in children. • Hair and urine chromium levels declines neurobehavioral performance both in boys and girls. • Urine chromium levels appears to affect the intellectual function only in boys. Childhood chromium exposure is associated with detrimental consequences on neuropsychological development among children aged 6–11 years old. [ABSTRACT FROM AUTHOR]

Pediatric donation is underutilized because of presumed increased risk of vascular thrombosis (VT) and graft loss. Using young pediatric donors (YPDs) for young pediatric recipients (YPRs) is suggested to be even at greater risk and therefore precluded in many centers. The aim of this study was to analyze the outcome of kidney transplantation (KT) from YPD to age-matched YPR. A retrospective study of 118 pediatric KT performed between January 2007–July 2017. The authors identified KT with YPD (considered as those aged <6 years) and age-matched YPR. Organ allocation was performed based on the best paired size (YPR for YPR). Data were collected regarding donor and recipient characteristics, surgical and urological complications, graft loss, and outcomes. Forty cases of YPD to age-matched YPR were identified (33.89% of the cohort). Mean recipient and donor age were 2.9 years (SD 1.68) and 2.24 years (SD 1.5), respectively. Mean recipient and donor weight were 12.7 kg (SD 4.1) and 13.7 kg (SD 4.15), respectively. Thirty of those young recipients (75%) weighed <15 kg. The most frequent primary renal disease was the congenital nephrotic syndrome. Nine out of 40 patients (22.5%) had received a previous KT before. Three received a combined liver-KT. Eight (20%) were classified as high immunological risk and 19 (47.5%) as high thrombotic risk. All allografts were implanted extraperitoneally and anastomosed to the iliac vessels. Major complications requiring reintervention occurred in seven patients (17.5%): three VT, three bleeding episodes, and one ureteral necrosis. Remarkably, only one surgical complication (VT) resulted in graft loss. Regarding long-term urological complications, four patients (10%) all with obstructive uropathy-developed vesicoureteral reflux to the graft. Actuarial graft survival at 1,5, and 10 years in the YPD to age-matched YPR cohort was 83% −78% −78%, respectively. Mean follow-up was 3.6 years (SD 3.2) (r = 7–10). Over time, eight patients lost their graft, not related to surgical factors in seven out of eight cases. The authors suggest that KT using YPD for age-match YPR yields good results in expert centers, even in high-risk patients and is associated with good graft survival. In this series, surgical complications were rarely related to graft loss. [ABSTRACT FROM AUTHOR]

Marine debris accumulation was analyzed from three exposed beaches of the Canary Islands (Lambra, Famara and Las Canteras). Large microplastics (1–5 mm), mesoplastics (5–25 mm) and tar pollution were assessed twice a month for a year. There was great spatial and temporal variability in the Canary Island coastal pollution. Seasonal patterns differed at each location, marine debris concentration depended mainly of local-scale wind and wave conditions. The most polluted beach was Lambra, a remote beach infrequently visited. The types of debris found were mainly preproduction resin pellets, plastic fragments and tar, evidencing that pollution was not of local origin, but it cames from the open sea. The levels of pollution were similar to those of highly industrialized and contaminated regions. This study corroborates that the Canary Islands are an area of accumulation of microplastics and tar rafted from the North Atlantic Ocean by the southward flowing Canary Current. [ABSTRACT FROM AUTHOR]

A novel two-sense support for flexural tests has been designed and manufactured in Ikerlan. The aim of this support is to do two-sense bending fatigue tests. In order to reduce the displacement corresponding to a given stress, a novel test configuration, designated as five-point bending, is modelled analytically. Basically, it is a three-point configuration with two supports at the ends that exert forces in the same sense as the applied load. In this way, a partial clamping is obtained that can be modelled by concentrated loads. The model has been checked carrying out quasi-static three-point and five-point bending tests at different spans in unidirectional carbon/epoxy composite specimens. Flexural modulus and the out-of-plane shear modulus have been obtained by linear regression in both cases, after having obtained experimentally the stiffness of the system. [ABSTRACT FROM AUTHOR]

A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment ( OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal ( OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source ( OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock ( OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. [ABSTRACT FROM AUTHOR]

Packaging sector generates 40% of the plastics consumption in Europe. Among the most consumed plastics, polyethylene terephthalate (PET) is still the material that undoubtedly continues to grow in the packaging sector. Hence, there is a concern related to the recycling process, which today is only around 56%. Therefore, the objective of this work focuses on the use of this recycled material as a source of raw material for pultrusion processes. This work studies and compares the processability of final composite pultruded parts by using three different pre-impregnated recycled materials different in their viscosity and stream. Those composites were characterized by mechanical testing and microscopy analysis. The obtained results were compared with those of another pultruded thermoplastic (polypropylene) composite. From this study, it was possible to transform a waste into a product with high added value, reducing the carbon footprint. [ABSTRACT FROM AUTHOR]

The use of recycled PET (rPET) in long-term applications, such as composites, may provide an environmentally friendly solution for PET wastes. Main problem to overcome to use rPET in composites is its high viscosity which compromises the impregnation with the fibers during the consolidation process. As it is well known, PET undergoes thermo-mechanical and hydrolytic degradation during its mechanical recycling decreasing its viscosity and causing a loss of mechanical properties. For this reason, this paper takes into consideration a rheological modification during mechanical recycling to achieve the necessary fluidity for composites while maintaining the mechanical properties. Rheological modification was carried out by physical and chemical methods. Physical method was realized through blending with virgin PET (vPET) of low melt viscosity. Chemical method was performed on rPET, vPET and its blends by reactive extrusion. The effect of rheological modifications on the final thermal and mechanical properties was studied. Main results showed that both methods are able to decrease the viscosity without compromising mechanical properties. In addition, the chemical method during the reactive extrusion provided higher Elastic Modulus values. • Recycling of poly(ethylene terephthalate). • Rheological modification by physical and chemical methods. • Decreasing the viscosity while maintaining mechanical properties. [ABSTRACT FROM AUTHOR]

Our aim is to present our experience with split liver transplantation. From 1992–2002, 14 livers were split to obtain 28 grafts that were transplanted to 12 adults and 16 children. Ex situ splitting was performed in all cases. The left graft consisted of the left lateral segment (segments II–III) in 11 cases and the left lobe in three, depending on the size of the pediatric recipient. Pediatric recipients were of mean age 3, 4 years; mean weight 13 kg; six emergency cases for fulminant hepatic failure or urgent retransplantation and seven of 10 elective cases for biliary atresia. Postoperative mortality rate was 31% (five cases), including four of six emergency cases and one elective case (10%). The main cause was multiorgan failure. Technical complications were: one arterial thrombosis, one portal vein thrombosis, and four biliary complications. Eleven patients are alive and well. Adult recipients were of mean age 53 years. The indications were hepatocellular carcinoma in six cases, liver cirrhosis of various etiologies in five, and one recurrence of hepatitis C in a graft. Two patients died during the postoperative period from sepsis after retransplantation for primary nonfunction of the split graft and multiorgan failure with sepsis. One-year actuarial survival was 84%.: ConclusionsThe results of split liver transplantation in elective cases are similar to whole liver transplantation, whereas patient survival among emergency cases is low due to the critical condition of the patients. [Copyright &y& Elsevier]

Summary Introduction Despite the widespread organ shortage dilemma, there is hesitancy regarding utilization of young donors (aged ≤6 years) because previous reports have suggested that this is associated with an increased risk of surgical complications and graft loss. Objective The aim of this study was to determine if donor age ≤6 years is related to increased risk of surgical complications or allograft loss in pediatric kidney transplantation (KT). Study design A retrospective study of pediatric kidney transplants (KT) undertaken between January 2000 and July 2015. The incidence of surgical and urological complications, and allograft loss were analyzed and compared between donors aged ≤6 years (Group 1) and donors aged >6 years (Group 2). Results A total of 171 pediatric KTs were performed at the current center during the study period. Twenty-eight patients were excluded; as a result, the study comprised 143 patients: 60 (Group 1) and 83 (Group 2). Mean recipient weight was 17 kg (SD 9.7; range 3.2–47) in Group 1 and 38.2 kg (SD 15.3; range 7.8–73) in Group 2. Despite a significantly higher proportion of risk factors in Group 1, no significant between-group differences were observed in terms of: surgical complications (OR 0.4; range 0.1–1.2), early urological complications (OR 2.2; range 0.4–11), late urological complications (OR 0.3; range 0.8–1.4), lymphoceles (OR 6.2; range 0.7–51.7) and allograft loss (OR 1.5; range 0.7–3.1, summary Table). Graft survival at 1 and 5 years was: 81% and 70% (Group 1) and 92% and 79% (Group 2), respectively (P = 0.093). Mean follow-up was 90.13 ± 49.7 months. Discussion The main finding of this retrospective study was that pediatric donor kidneys from donors aged ≤6 years could safely be used in pediatric recipients without an increased risk of surgical and urological complications or graft loss. Nevertheless, KT with small donor kidneys is challenging and should be performed at experienced pediatric centers. Conclusion In line with these results, the outcomes of KT using donors aged ≤6 years were encouraging and similar to those obtained with older donors. Thus, this study supported using kidney grafts from young donors, given the organ shortage and potential high mortality risk while awaiting KT. Summary Table Surgical and urological complications, and allograft loss. Group 1: donor age ≤6 years (n = 60) n (%) Group 2: donor age >6 years (n = 83) n (%) P -value OR (95% CI) Surgical complications 12 (20) 10 (12.1) 0.193* 2.0 (0.8–5.2) Early urological complications 2 (3.3) 6 (7.2) 0.468° 0.4 (0.08–2.2) Late urological complications 6 (10) 3 (3.6) 0.116° 0.3 (0.8–1.4) Lymphocele 1 (1.7) 8 (9.6) 0.079° 6.2 (0.7–51.7) Reintervention 13 (22) 14 (17.1) 0.778* 0.7 (0.3–1.6) Graft loss due to surgical complications 5 (8.3) 2 (2.4) 0.240° 3.1 (0.5–18.2) Graft survival 1 year 81% 92% 0.093+ 5 years 70% 79% [ABSTRACT FROM AUTHOR]

Objective Paradoxical growth (PG) and trailing effect (TE) are frequently observed during antifungal susceptibility testing (AFST). These two phenomena interfere with the determination of the minimal inhibitory concentration (MIC). The aim of this study was to assess the clinical impact of TE and PG. Methods We analysed the frequency of TE and PG of 690 Candida isolates collected from a population-based study performed in Spain (CANDIPOP) and correlated the results with clinical outcome of the patients. Results Around 70% (484/690) of the isolates exhibited TE to azoles. Candida tropicalis showed the highest presence of TE (39/53 isolates exhibited residual growth >25% of control). No TE was seen in most of the isolates from the psilosis complex. PG was mainly associated with echinocandins. In patients treated with fluconazole within the first 48 hours after blood sampling ( n = 221), the presence of TE to azoles tended to be associated with lower 30-day mortality (odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25–1.00) but not with clinical failure (OR 0.85, 95% CI 0.45–1.54). In the subgroup of 117 patients treated with echinocandins, the presence of PG was not associated with patient's response to antifungal treatment (OR for 30-day mortality 1.63, 95% CI 0.76–4.03; OR for clinical failure 1.17, 95% CI 0.53–2.70). Conclusions TE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome. [ABSTRACT FROM AUTHOR]

Candins are commonly used as initial therapy in patients with candidemia and are known to diffuse poorly into ocular tissue. The aim of our multicenter study was to assess whether eye involvement was more common in patients initially treated with echinocandins. We performed a post hoc analysis of a prospective, multicenter, population-based candidemic surveillance program implemented in Spain during 2010–2011 (CANDIPOP project). Eye involvement was detected in 13 of 168 patients with candidemia (7.7%) who underwent ophthalmoscopy. Two patients had endophthalmitis, while the remaining patients had chorioretinitis. The frequency of ocular candidiasis was similar in patients receiving initial therapy with candins (3/56; 5.4%) or with other regimens (10/112; 8.9%). At multivariate analysis, risk conditions for eye involvement were dialysis after candidemia (OR, 19.4; 95% CI, 1.7–218.4) and involvement of organs other than the eye (OR, 5.4; 95% CI, 1.1–25.7). In conclusion, eye involvement was not found to be more frequent in patients receiving initial therapy with echinocandins than in patients receiving other drugs. [ABSTRACT FROM AUTHOR]

Among the different graphene synthesis methods, chemical vapor deposition of graphene on low cost copper foil shows great promise for large scale applications. Here, we present growth experiments to obtain high quality graphene and its clean transfer onto any substrates. Bilayer-free monolayer graphene was obtained by a careful pre-annealing step and by optimizing the H 2 flow during growth. The as-grown graphene was transferred using an improved wet chemical graphene transfer process. Some major flaws in the conventional wet chemical, polymethyl methacrylate (PMMA) assisted, graphene transfer process are addressed. The transferred graphene on arbitrary substrates was found to be free of metallic contaminants, defects (cracks, holes or folds caused by water trapped beneath graphene) and PMMA residues. The high quality of the transferred graphene was further evidenced by angle resolved photoelectron spectroscopy studies, for which the linear dependency of the electronic band structure characteristic of graphene was measured at the Dirac point. This is the first Dirac cone observation on the CVD grown graphene transferred on some 3D bulk substrate. [ABSTRACT FROM AUTHOR]

To evaluate the top causes of unplanned admissions and readmissions by number of encounters and average total payments (ATP) using a novel Major Diagnostic Categories (MDC) framework that categorizes hospitalizations according to pathophysiology. Conclusions Governmental agencies and health services researchers use Medicare's Major Diagnostic Categories (MDCs), which combine disease conditions in 26 groups, including Pre-MDC, to measure burden of disease and rank healthcare expenditures. [Extracted from the article]

Objectives The clinical correlation of fluconazole antifungal susceptibility testing (AST) for Candida isolates and its integration with pharmacokinetics/pharmacodynamics (PK/PD) parameters is unclear. We analysed the impact of fluconazole minimum inhibitory concentration (MIC) values, 24-hour area under the concentration–time curve (AUC 24 ) and AUC 24 /MIC ratio on the outcome of candidemic patients. Methods We included 257 episodes of candidaemia treated with fluconazole monotherapy for ≥72 hours from a population-based surveillance conducted in 29 hospitals (CANDIPOP Project). AST was centrally performed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) microdilution methods. Primary outcome was clinical failure (30-day mortality and/or persistent candidaemia for ≥72 hours from initiation of therapy). Secondary outcomes included early (3–7 days) and late (3–30 days) mortality. Results Rates of clinical failure, early and late mortality among evaluable episodes were 32.3% (80/248), 3.1% (8/257) and 23.4% (59/248). There was no relationship between fluconazole MIC values or PK/PD parameters and clinical failure. Although MIC values ≥2 mg/L by EUCAST (positive predictive value 32.1%, negative predictive value 68.7%) and ≥0.5 mg/L by CLSI (positive predictive value 34.8%, negative predictive value 74.4%) appeared to be optimal for predicting clinical failure, no significant associations remained after multivariate adjustment (odds ratio 1.67; 95% confidence interval 0.48–5.79; p 0.423). Lack of association was consistent for alternative thresholds (including proposed clinical breakpoints). The only association found for secondary outcomes was between an AUC 24 /MIC ratio >400 h by CLSI and early mortality (odds ratio 0.18; 95% confidence interval 0.04–0.98; p 0.026). Conclusions High fluconazole MIC values did not negatively impact outcome of patients with candidaemia treated with fluconazole. No effect of PK/PD targets on the risk of clinical failure was found. [ABSTRACT FROM AUTHOR]

We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17–0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41–1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia. [ABSTRACT FROM AUTHOR]