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Objective: To test the hypothesis that successful implementation of a care bundle designed to prevent nosocomial airway infection will be associated with decreased incidence of ventilator-associated tracheobronchitis., Design: Prospective pre- and post interventional., Setting: PICU at an academic medical center, Patients: : All patients admitted to the PICU who received invasive mechanical ventilation for greater than or equal to 48 hours between March 1, 2009, and December 31, 2011., Intervention: Multidisciplinary, unit wide implementation of an evidence-based care bundle to prevent ventilator-associated airway infection., Measurements and Main Results: There were 725 patients included in the analysis (338 patients preintervention and 387 patients postintervention). Baseline ventilator-associated tracheobronchitis rate in the preintervention period was 3.9 cases per 1,000 ventilator days compared with 1.8 cases per 1,000 ventilator days postintervention (p = 0.04, Fisher exact test). Compared with patients without ventilator-associated tracheobronchitis or ventilator-associated pneumonia, patients with ventilator-associated tracheobronchitis had fewer ventilator-free days in 28 days (4.9 vs 22; p < 0.0001, Mann-Whitney U test) and fewer ICU-free days in 28 days (0.5 vs 19; p < 0.0001, Mann-Whitney U test). These relationships remained significant after adjusting for covariates by multivariable linear regression., Conclusions: Successful implementation of a care bundle to prevent ventilator-associated infection was associated with decreased incidence of ventilator-associated tracheobronchitis. Development of ventilator-associated tracheobronchitis was independently associated with adverse outcomes in our cohort of pediatric ICU patients.

Unlabelled: We describe a recently developed chopper, the retrochopper, and a technique for managing black and brunescent cataracts. The technique enables the surgeon to effectively disassemble the nucleus and perform a safe procedure with a short learning curve., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Objective: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients., Methods: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria., Results: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002)., Conclusions: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

Background: The purpose of this paper is to describe clinical characteristics and determine correlations between clinical outcomes and antifungal susceptibility among molecularly characterized ocular Fusarium isolates in Brazil., Methods: Forty-one Fusarium isolates obtained from 41 eyes of 41 patients were retrieved from the ophthalmic microbiology laboratory at São Paulo Federal University and grown in pure culture. These isolates were genotyped and antifungal susceptibilities determined for each isolate using a broth microdilution method. The corresponding medical records were reviewed to determine clinical outcomes., Results: The 41 isolates were genotypically classified as Fusarium solani species complex (36 isolates, 88%), Fusarium oxysporum species complex (two isolates, 5%), Fusarium dimerum species complex (one isolate, 2%) and two isolates that did not group into any of the species complexes. Final best corrected visual acuity varied from 20/20 to light perception and was on average 20/800 (logarithm of the minimum angle of resolution (LogMAR) 1.6). A history of trauma was the most common risk factor, being present in 21 patients (51%). Therapeutic penetrating keratoplasty was necessary in 22 patients (54%). Amphotericin B had the lowest minimum inhibitory concentration for 90% of isolates (MIC90) value (2 μg/mL) and voriconazole had the highest (16 μg/mL). There was an association between a higher natamycin MIC and need for therapeutic penetrating keratoplasty (Mann-Whitney test, P < 0.005)., Conclusion: Trauma was the main risk factor, and therapeutic penetrating keratoplasty was necessary in 54% of patients. Amphotericin B had the lowest MIC90 (2 μg/mL) of the three antifungal agents tested. There was an association between higher natamycin MIC levels and corneal perforation, emphasizing the need for antifungal susceptibility testing and tailoring of antifungal strategies.

Studies on the detection of animal by-products in poultry meat are rare and practically nonexistent in chicken meat. With the development of the technique of stable isotopes for traceability purposes and the certification of broiler diet patterns, it has been necessary to know the behavior of the isotopic signature of different tissues in birds, in case of a potential replacement of a diet containing animal ingredients with a strictly vegetable one and vice versa. Thus, this study, carried out at the São Paulo State University, Botucatu Campus, Brazil, aimed to evaluate meat from the breast, thigh, drumstick, and wings to trace the presence of poultry offal meal (OM) in broiler feed using the analysis of stable isotopes of carbon ((13)C/(12)C) and nitrogen ((15)N/(14)N) by mass spectrometry. In total, 720 one-d-old chicks were distributed into 6 groups: vegetable diet (VD) from 1 to 42 d; 8% poultry offal meal (OM) diet from 1 to 42 d; VD from 1 to 21 d and 8% OM diet from 22 to 42 d; VD from 1 to 35 d and 8% OM diet from 36 to 42 d; 8% OM diet from 1 to 21 d and VD from 22 to 42 d; and 8% OM diet from 1 to 35 d and VD from 36 to 42 d. Through the analysis of C and N, it is possible to trace the use of OM in broiler feeding when this ingredient is part of the feeding throughout the breeding phase or when it substitutes a strictly VD even up to 35 d. When an OM diet is substituted by a VD, the animal ingredient has to be part of the feeding for 21 d or longer to be detected by this method.

The 13C turnover rates of the liver and thoracic pectoral muscle of growing broilers were determined by feeding diets with varying 13C content. Male chicks (1-d-old) were subjected to treatments based on free choice of 5 different mixes of energy and protein sources from plants with C3 and C4 photosynthetic pathways that had differing 13C content. Rice bran (R) and soybean meal (S) were the C3 sources, while maize (C) and maize gluten meal (G) were the C4 sources. Choices were R + S, C + G, R + G, C + S or R + C + G + S. The 6th treatment was a complete feed (CF) that was similar to a commercial broiler feed. The isotopic composition of the birds' tissues was representative of the isotopic composition of the diets. The assimilation was faster for C3, in both liver and muscle, than for C4 diets, and give the delta per mil difference between the diet and tissues. The liver is the most active metabolic tissue and gave more rapid isotope turnover than in muscle.

In this study, 91 primiparous women were selected, with a period of post-delivery variable from 45 to 60 days. These patients were divided according to the type of delivery into three groups: I--consisting of 32 patients who had vaginal delivery; II--comprised 29 patients who were subjected to forceps; III--formed by 30 women who were subjected to cesarean section. Patients with a previous pregnancy were not included, so that the possible previous alterations of the pelvic floor did not interfere with the present evaluation. Patients with a pre-term pregnancy, fetus below 2,500 g or above 4,000 g, anomalous presentations, twin pregnancy, diabetes mellitus, systhemic arterial hypertension, hypertensive disease specific of pregnancy, endocrinopathies and neuropathies were also excluded. After 45 to 60 days from delivery the patients were subjected to anamnesis, gynecological examination, functional evaluation of the pelvic floor (FEAF), Q-Tip test and ultrasound of the bladder neck. As for the functional evaluation of the pelvic floor, it was observed that the patients with cesarean section presented better indexes compared to those who were subjected to forceps. The Q-Tip test showed that in both the patients from group I and group II bladder neck mobility was greater than in those from group III. Concerning bladder neck topography in relation to public symphysis and its mobility, which were evaluated by ultrasound, it was observed that at rest all the groups had the neck in a supra-pubic position, with no differences among them. Yet, during the required strain, the bladder neck stayed in the infra-pubic position with major frequency in group I. Bladder neck mobility was greater in the vaginal delivery group in relation to the other groups. It was also noticed that the group undergoing cesarean section showed less mobility. The obtained results lead us to conclude that despite the fact that vaginal delivery may cause displacement of the urethro-vesical junction during strain, and consequently greater bladder neck mobility, it is the attending physician's role to minimize the damage to the pelvic floor, thus avoiding the emergence of a predisposing factor to future stress urinary incontinence.

The degradation kinetics of cello- and xylooligomers under alkaline conditions has been studied, and kinetic order, kinetic rate constants as well as activation parameters (E(A), DeltaE(#), DeltaS(#)) for the different oligomers have been determined. The results were corroborated by a mathematical model of the degradation kinetics. A reliable and convenient method for the separation and simultaneous quantification of cello- and xylooligomers, based on capillary electrophoresis (CE) with pre-column derivatization, has been established. p-Aminobenzonitrile was used as the UV tag, and 550 mM borate buffer containing hexadimethrine bromide was employed as the running electrolyte.

Objective: To evaluate the number of collagen and muscle fibers in the muscle layer of the urethra and in the bladder wall of castrated and under-hormone replacement female rats., Method: We studied 37 castrated female rats assigned to the following groups: Group C (n=9): received no medication; Group P (n=8) was given 0.1 ml of placebo, subcutaneous (SC) route; Group E (n=10): 17beta-estradiol, 10 microg/kg/day, SC route; Group PR (n=9): medroxyprogesterone acetate. 0.2 mg/kg/day, SC route; Group E+PR (n=9): association of 17beta-estradiol and medroxyprogesterone acetate. Sections were taken from the bladder wall and from the middle third of the urethra, and the specimens were stained with picrosirius for collagen and muscle fiber identification., Results: Groups C and P showed a similar amount of collagen in the bladder and in the urethra, however greater than the other groups. Group E showed the smallest number of collagen fibers in the urethra. Groups E and E+PR presented a larger number of muscle fibers in the bladder. Group PR presented a larger number of muscle fibers than groups C and P, however smaller than groups E and E+PR. In the muscle layer of the urethra, the number of collagen fibers was smaller in Group E than in all the other groups, which were similar among one another. In regard to the urethral muscles, Group E was found to present the largest number of muscle fibers as compared to the other groups analyzed, while Group PR showed a significant decrease in the muscle layer, even in relation to the groups that were given no hormone medication., Conclusion: Estrogens significantly decrease the amount of collagen fibers, increase the amount of muscle fibers and determine a significantly decreased collagen/muscle ratio in both the detrusor muscle and in the urethral muscle layer. It is also noticed that isolated progestogen decreases the amount of collagen fibers and increases the number of muscle fibers in the detrusor muscle, but with less intensity than replacement with estrogens alone. It neither alters the number of collagen fibers nor decreases the muscle fibers in the muscle layer of the urethra, with increased collagen/muscle ratio in that structure. Finally, the estrogen-progestogen combination determines significantly decreased collagen fibers and increased muscle fibers in the detrusor muscle, causing no alteration to the collagen or muscle fibers in the muscle layer of the urethra.

Seven male broiler strains (Arbor Acres, Avian Farms, Cobb-500, Hubbard-Peterson, ISA, Naked Neck, and Ross) were compared for their growth rate, feed efficiency, and mortality due to sudden death and ascites. In addition, weekly plasma levels of thyroid hormones [3,3',5-triiodothyronine (T3) thyroxine (T4), T3: T4 ratio, growth hormone (GH), and insulin-like growth factor-I (IGF-I)] were determined. The highly productive, commercial strains were very similar in their endocrine profiles but differed markedly from the Naked Neck chickens. Naked Neck chickens were characterized by higher plasma T3 and lower T4 levels at similar ages as well as when compared on the same body weight basis. The present findings support the hypothesis that the slightly hypothyroid state of high productive broilers renders them more sensitive to metabolic disorders. Naked Neck chickens also had higher plasma GH levels than those of their age-matched commercial broilers. The coefficient of variation for GH was highest for Naked Neck chickens, which is indicative for an amplified GH burst amplitude. It may be stated that changes in plasma thyroid hormone concentration in indirect response to selection for low feed conversion and fast growth may be causatively linked to susceptibility for metabolic disturbances such as sudden death syndrome and ascites.

Two trials were carried out to test the susceptibility for metabolic disturbances of different strains of male broilers. In Trial 1, 1,890 male chickens were allotted in a randomized block design with seven treatments (Arbor Acres, Avian Farms, Cobb-500, Hubbard-Peterson, ISA, Naked Neck, and Ross) and six blocks of 45 chickens. Trial 2 involved 2,184 male chickens of six strains (Arbor Acres, Avian Farms, Cobb 500, Hubbard-Peterson, ISA Naked Neck, and Ross) allotted in seven complete blocks of 52 birds. The same management system was adopted for all birds, reared up to 42 d in an open house during late winter (Trial 1) or late autumn (Trial 2). The most marked differences observed among the strains tested was the lower BW and higher feed conversion of Naked Neck broilers. Total percentage mortalities were high among the most productive broilers, being more than 50% due to sudden death (SDS) and ascites syndrome (AS). No Naked Neck birds died as a consequence of these disturbances and the total mortalities were significantly lower (P < or = 0.05) than the other strains. The ratio of right ventricle weight to total ventricle weight of the dead birds was over 0.25, except for Naked Neck birds, which presented a nonhypertrophic ratio. The two trials confirmed the relationship between high productivity and high incidence of SDS and AS and indicated that Naked Neck male broilers are resistant to these metabolic disturbances.

Objective: The aim of the study was to investigate clinically and urodynamically the effects of hormonal replacement in the treatment of genuine stress urinary incontinence in postmenopausal females., Methods: Clinical and urodynamic variables of 30 postmenopausal women with genuine stress urinary incontinence were evaluated after 3 months' treatment with conjugated estrogens plus progestogens. Urodynamic evaluations were performed in all patients before and after treatment., Results: Forty-six percent of the patients treated medically were judged to be cured and 43% were judged to be markedly improved. Maximum urethral closure pressure, maximum cystometric capacity and mean flow were significantly increased. Residual urine and diurnal and nocturnal voluntary micturition were markedly decreased (P < 0.05)., Conclusion: We conclude that hormone replacement in the form of conjugated estrogens plus progestogens results in the clinical and urodynamic improvement of genuine stress urinary incontinence in postmenopausal women.

The ability of B-scan ultrasonography to detect soft tissue foreign bodies of various sizes and composition was investigated in a canine model. Foreign bodies consisting of wooden rods 0.7 mm and larger, lead-free glass rods 2.0 mm and larger, plastic rods 3.9 mm and 5.6 mm, and metal needles 0.5 mm and larger were embedded in fleshy soft tissue. All objects examined were discernible. Wood is best visualized followed by glass, plastic, and metal. Ultrasound may be a valuable noninvasive means of detecting soft tissue foreign bodies; further investigation to delineate its clinical role is warranted.