IMP Group Research Articles

PSX-18 Long term implanting of finished Angus Hereford steers: examining the relationship between feed and water efficiency

Abstract Herein, we investigate the effects of a long-term release trenbolone acetate and estradiol implant (200 mg and 40 mg respectively, Revalor-XS; Merck Animal Health; Summit, NJ) on implanted [IMP; n = 9, body weight (BW) = 473.13 kg ± 25.22] and non-implanted (NIMP; n = 9, BW = 481.13 kg ± 21.78) finished Angus Hereford steers fed a single diet three times daily (0600, 1100, 1600 h). The objectives were to identify water and feed efficiency parameters and mechanisms of IMP and NIMP steers. Parameters evaluated included daily dry matter intake (DMI), freshwater intake (FWI), average daily gain (ADG), animal water units (AWU), drinking behavior, feed conversion (FC), feed conversion ratio (FCR), water conversion (WC), water conversion ratio (WCR), residual growth rate (RGR), and Kleiber index (KI). Linear mixed models were fitted to analyze the data under assumption of a completely randomized design, and variable relationships examined through partial correlation networks and principal component analysis. Implanted animals were more feed efficient than NIMP for FC (P < 0.001; SEM = 0.00), FCR (P < 0.001; SEM = 0.29), RGR (P < 0.001; SEM = 0.0.02), and KI (P < 0.001; SEM = 0.00). When evaluating water efficiency, IMP animals had less WCR (P < 0.001; SEM = 1.54) and greater WC (P < 0.001; SEM = 0.001). No differences were observed on marbling and carcass grades, but carcass weight, final BW, and rib eye area were greater for IMP groups (P < 0.001, P < 0.001, P = 0.004, respectively). For IMP, multivariate variable contribution (values > 10) appeared to associate FWI on the first and second eigenvectors with DMI, FC, and FCR. For NIMP, FWI was associated with WC, WCR, and AWU. The FWI of Implanted animals was associated with AWU, WCR, while NIMP was associated with AWU. Feed conversion ratio and DMI had the greatest node strength for the IMP animals, whereas for NIMP, KI was the only node with strength greater than 2. Our results indicate that feed and water efficiencies may share mechanistic pathways. We present a simple metric that accurately remains relevant in evaluating water requirements for both IMP and NIMP steers as AWU. We show how relationship strength is related to gain and efficiency for IMP animals, whereas metabolic activity, potentially in relation to body composition changes, drives the variation and relationships for NIMP animals.

Add-on homeopathic treatment to institutional management protocol in children suffering from acute encephalitis syndrome: A retrospective comparative cohort study

Background and objectives: Acute encephalitis syndrome is a health burden to a populous country like India. It is characterized by a sudden onset of fever, altered sensorium with or without seizures, irritability, abnormal behaviour, or unconsciousness. This study aims to augment further evidence on the effects of add-on homeopathic treatment in reducing mortality and morbidity in children. Methods: This comparative retrospective study included children hospitalized with acute encephalitis syndrome between July 2016 to December 2016. We compared the parameters of children for whom decisions on Glasgow Outcome scale and Liverpool outcome score aided by add-on homeopathy against those of children from the same year when the add-on homeopathy was not used. All the children were on conventional supportive care and treatment tailored to each child. We also counted the days until the resumption of oral feeding and the length of hospital stay. Results: Ordinal regression analysis on analyses on 622 children (IH +CSC=329; IMP only=293) was done. Odds of a shift towards increased recovery were superior in the homeopathy-added group than in the IMP group without adjustment (crude OR 2·30, 95% CI 1·66 to 3·20; p=0·0001) and with adjustment (adjusted OR 3.38, 95% CI 2·38 to 4.81; p=0·0001). There was 14.8% less mortality and 17.4% more recovery in the add-on homeopathy group compared to CSC alone. Individualized homeopathic remedies commonly used were: Belladonna (n =238), Stramonium (n =17), Opium (n = 14), Sulphur (n=11) and Hyoscyamus niger (n = 7). Conclusion : This retrospective cohort study advocates for add-on homoeopathy in children suffering acute encephalitis which can produce notable improvements in terms of mortality and morbidity. Further studies in different settings are warranted.

Impella Versus Non-Impella for Nonemergent High-Risk Percutaneous Coronary Intervention

The benefit of mechanical circulatory support (MCS) with Impella (Abiomed, Inc., Danvers, MA) for high-risk percutaneous coronary intervention (HR-PCI) is uncertain. PROTECT III registry data showed improved outcomes with Impella compared to historical data (PROTECT II) but lacks a direct comparison to the HR-PCI cohort without Impella support. We retrospectively identified patients meeting PROTECT III inclusion criteria for HR-PCI and compared this group (NonIMP) to the outcomes data from the PROTECT III registry (IMP). Baseline differences were balanced using inverse propensity weighting (IPW). The co-primary outcome was major adverse cardiac events (MACE) in-hospital and at 90 days. A total of 283 high-risk patients who did not receive Impella support; 200 patients had at 90-day event ascertainment and were included in the IPW analysis and compared with 504 patients in the IMP group. After calibration, few residual differences remained between groups. The primary outcome was not different in-hospital (3.0% vs. 4.8%, p=0.403) but lower in NonIMP at 90 days (7.5% vs. 13.8%, p=0.033). Periprocedural vascular complications, bleeding, and transfusion rate were not different between groups; however, acute kidney injury occurred more frequently in the NonIMP group (10.5% vs. 5.4%, p=0.023). In conclusion, under identical HR-PCI inclusion criteria for Impella use in PROTECT III, an institutional non-Impella-supported HR-PCI cohort demonstrated similar MACE in-hospital but lower MACE at 90 days, while there was no signal for periprocedural harm with Impella use. These results do not support routine usage of Impella for HR-PCI patients.

The Prevalence of Genetic Determinants of Antibiotic Resistance, which are of Particular Epidemiological Consequences, in the Microbiota of the Oropharyngeal Swabs in Patients with Cystic Fibrosis

Relevance. Antibiotic resistance of microorganisms can contribute to the chronicity of the inflammatory process, lead to an increase in the cost of treating patients and make it difficult to eradicate the pathogen. Patients with cystic fibrosis constantly require medical supervision, regular visits to medical institutions, and therefore there is a high risk of infection with nosocomial antibiotic- resistant strains. In addition, the necessary intake of antibacterial drugs provides an advantage for the reproduction of resistant microorganisms.Aim. Comparison of the frequency of detection of antibiotic resistance determinants in oropharyngeal swabs in children with cystic fibrosis and conditionally healthy children using molecular biological methods.Materials and methods. A PCR study of oropharyngeal discharge from 100 children with cystic fibrosis and 100 children from the control (healthy comparison subject) group was performed. Genetic antibiotic resistance locus: metallo-b-lactamases of the VIM, IMP and NDM groups; carbapenemase genes of the KPC and OXA-48 groups; extended-spectrum beta-lactamase genes of the CTX-M group and the mecA gene were detected by polymerase chain reaction (PCR) with hybridization-fluorescence detection.Results and discussion. As a result of the analysis, a statistically significant increase in the frequency of detection of genetic determinants of antibiotic resistance in the microbiota of the oropharyngeal discharge in children with cystic fibrosis was found compared with healthy children (p<0.001). The chances of detecting antibiotic resistance loci in the discharge of the oropharynx among children with cystic fibrosis are 38.5 times higher than among healthy children (95% CI: 5.1-289.5). In 28% of children with cystic fibrosis, DNA of the genetic determinants of antibiotic resistance was detected in the microbiome of the discharge of the oropharynx. A high percentage of the presence of genetic determinants of antibiotic resistance may be the reason for the ineffectiveness of antibiotic therapy.Conclusion. Due to the high occurrence in the microbiome of the oropharyngeal discharge of patients with cystic fibrosis of genetic antibiotic resistance locus that are of particular clinical and/or epidemiological significance, and the high risk of the spread of antibiotic-resistant strains outside medical institutions, it is necessary to include this group of patients in regular epidemiological monitoring.

The precision of two alternative indirect workflows for digital model production: an illusion or a possibility?

ObjectiveDespite the clear drive from both research and clinical dentistry toward digital transformation, there are limitations to implementing intra-oral scanning (IOS) into daily dental practice. This study aimed to compare the precision of digital models obtained from two alternative indirect workflows to direct IOS.Material and methodsTwo indirect digital workflows were evaluated in this study. In the IOS group (direct), IOS directly obtained digital impressions of participants’ upper and lower dental arches, while in the Scan Impression (Scan Imp) group (indirect), a desktop scanner scanned silicone-based impressions of upper and lower whole arches that were taken with plastic trays. In the cone-beam computed tomography impression (CBCT Imp) group (indirect), a CBCT machine scanned the silicone-based impressions. Then, the precision of the entire arch and individual teeth for all digital impressions was virtually quantified. Following superimposition, differences between standard tessellation language (STL) files obtained from both—direct and indirect—methods were evaluated by color-mapping and measuring the surface distance between superimposed STL files. Furthermore, 18 linear measurements were taken from each digital model. ANOVA with repeated measures, Pearson coefficient, and intraclass correlation coefficient were used for intergroup comparisons.ResultsThe digital models obtained from the two indirect workflows differed from the IOS in some dental and intra-arch measurements but were considered clinically acceptable. Ranked against IOS, CBCT Imp models had greater precision, followed by Scan Imp.ConclusionDigital models obtained from two indirect, alternative workflows, desktop, and CBCT scanning of impression, have clinically acceptable accuracy and reliability of tooth size and intra-arch measurements, providing the use of proper methodologies.Clinical relevanceThere are some limitations to implementing IOS in daily clinical practice. However, several alternative digital model production techniques might provide an affordable solution. Although they may insignificantly differ in accuracy, all can be applied clinically.

MP70-01 MANAGEMENT OF THE REFRACTORY NOCTURNAL ENURESIS PATIENT TO DESMOPRESSIN IN A PEDIATRIC POPULATION: DESMOPRESSIN + OXYBUTYNIN VS. DESMOPRESSIN + IMIPRAMINE

You have accessJournal of UrologyCME1 Apr 2023MP70-01 MANAGEMENT OF THE REFRACTORY NOCTURNAL ENURESIS PATIENT TO DESMOPRESSIN IN A PEDIATRIC POPULATION: DESMOPRESSIN + OXYBUTYNIN VS. DESMOPRESSIN + IMIPRAMINE Spencer Shain, Jordan Gitlin, Amelia Pantazis, Ronnie Fine, Mark Horowitz, Steven Friedman, Paul Zelkovic, Lori Dyer, Richard Schlussel, Jamie Freyle, Alexander Fang, Jessica Sommer, and Israel Franco Spencer ShainSpencer Shain More articles by this author , Jordan GitlinJordan Gitlin More articles by this author , Amelia PantazisAmelia Pantazis More articles by this author , Ronnie FineRonnie Fine More articles by this author , Mark HorowitzMark Horowitz More articles by this author , Steven FriedmanSteven Friedman More articles by this author , Paul ZelkovicPaul Zelkovic More articles by this author , Lori DyerLori Dyer More articles by this author , Richard SchlusselRichard Schlussel More articles by this author , Jamie FreyleJamie Freyle More articles by this author , Alexander FangAlexander Fang More articles by this author , Jessica SommerJessica Sommer More articles by this author , and Israel FrancoIsrael Franco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Desmopressin (DDAVP) is well accepted as first-line medical therapy for nocturnal enuresis (NE). If DDAVP is ineffective, combination therapy of DDAVP+oxybutynin (Oxy) or DDAVP+imipramine (Imp) has been used. This study assessed the efficacy of adjunct therapy with either Imp or Oxy in the management of NE patients who failed DDAVP treatment. METHODS: A retrospective chart review of our database for patients with NE was performed. All patients who were prescribed DDAVP, Oxy, and Imp over 14 years for NE were included. Two cohorts of patients were examined; group A was treated with DDAVP and Oxy, and group B was treated with DDAVP and Imp. Pretreatment measurement of Vancouver Symptom Score (VSS) was used to compare groups as well as the VSS question “I wet my bed at night” with 4: I wet my bed every night, 3: 4-5 nights per week, 2: 1-2 nights per week, 1: 3-4 nights per month, and 0: never. ICCS criteria for continence success was utilized to determine outcomes. Statistical analysis was performed with SPSS. RESULTS: 2521 patients were identified who were prescribed one of the 3 medications. 72 patients with a mean age of 9.8±2.8 years were identified, of which 48 were male and 24 female. Of these patients, 58 were prescribed both DDAVP and Imp (group B), 23 DDAVP and Oxy (group A), and 9 transitioned from group A to group B. Mean pretreatment VSS showed no difference between the groups. Both groups had minimal drops in wet nights with DDAVP alone. When comparing groups, it was found that group B reduced wet nights significantly more than group A (VSS wet night score 0.7 vs 2.3 respectively). Complete response rate was 68% vs 5% (OR=42.5, p<0.001) (Imp vs Oxy respectively). CONCLUSIONS: A combination of DDAVP and Imp was more effective in reducing wet nights and had a complete response rate that was 42.5 times greater than DDAVP and oxybutynin. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer Shain More articles by this author Jordan Gitlin More articles by this author Amelia Pantazis More articles by this author Ronnie Fine More articles by this author Mark Horowitz More articles by this author Steven Friedman More articles by this author Paul Zelkovic More articles by this author Lori Dyer More articles by this author Richard Schlussel More articles by this author Jamie Freyle More articles by this author Alexander Fang More articles by this author Jessica Sommer More articles by this author Israel Franco More articles by this author Expand All Advertisement PDF downloadLoading ...

Multi-joint isometric measurement for the evidence-based assessment of upper limb strength impairment in wheelchair athletes with different health conditions: a preliminary study.

The present study presents a novel specific multi-joint isometric test to assess upper limb strength impairment for evidence-based classification in wheelchair sports. Sixteen wheelchair athletes participated in this study and were classified according to their type of physical impairment and health condition as follows: athletes with neurological impairment (ANI, n = 5) and athletes with impaired muscle power (IMP, n = 11). In addition, six non-disabled participants formed a control group (CG, n = 6). All the participants performed the isometric propulsion strength test (IPST), evaluating pushing and pulling actions, and two wheelchair performance tests. Excellent relative intra-session reliability scores were obtained for strength values for the ANI, IMP and CG groups (0.90 < ICC < 0.99) and absolute reproducibility showed acceptable scores of SEM (< 9.52%) for IPST pushing action. The ANI had significantly lower scores in strength and wheelchair performance than the IMP and the CG, while no differences were found between the IMP and the non-disabled participants. In addition, no correlations were found for wheelchair athletes between the isometric upper limb strength measure and wheelchair performance. Our findings suggest that the IPST is a valid test for strength measurement in upper limb impairment wheelchair athletes with different health conditions, which must be used in combination with a performance test to obtain a holistic assessment of this population.

Structural-functional aberrations of erythrocytes in the northern red-backed vole (Clethrionomys rutilus Pallas, 1779) that inhabits the zone of influence of the copper smelter (the Middle Ural).

Red blood cell parameters were assessed in a natural population of the northern red-backed vole (Clethrionomys rutilus Pallas, 1779) in the zone of influence of the Kirovgrad Copper Smelter along a gradient of pollution by heavy metals (Cu, Zn, Cd, and Pb) at three catching sites (polluted [Imp] and controls [Bg-1, and Bg-2]). The difference of the smelter area (Imp group of voles) from both background groups (Bg-1 and Bg-2) was proven by means of a set of 13 parameters in univariate and multivariate analyses. Among the detected erythrocyte disturbances, we noted the following: a decrease in activities of Na+,K+-ATPase and antioxidant enzymes (SOD, GSH-Px, and CAT); an increase in the concentration of lipid peroxidation products, in osmotic fragility, and in intravascular hemolysis; interruption of carbohydrate metabolism; and lowered oxygen-carrying capacity. A higher load of Cd (p = 0.0009) and possibly Pb (p = 0.054) in the Imp animals was confirmed by quantitation of heavy metals in the liver. Most erythrocyte parameters (11 out of 13) covaried with individual Cd load by obeying a semilogarithmic dependence; such a relation was not found for Cu, Zn, and Pb. A decrease in the growth rate of structural and functional erythrocyte aberrations ("resistance improvement") with increasing cadmium load is probably due to compensatory enhancement of the synthesis of metallothioneins in the liver and kidneys and hence a greater proportion of Cd bound to metallothioneins. Problems of differences/similarities in Cd-associated reactivity among the animals are discussed too, taking into account the catching sites (polluted [Imp] and controls [Bg-1, and Bg-2]) and reproductive-age (i.e., immature underyearlings, mature underyearlings, and individuals that overwintered). The persistence of differences in erythrocyte status observed by us between the Imp and background groups after normalization to Cd load may be due to the action of other (unexamined) adverse factors and calls for further ecotoxicological studies.

Evaluation of an immunological assay for the identification of multiple carbapenemase-producing Gram-negative bacteria

Carbapenemase-producing Gram-negative organisms (CPOs) frequently gain multidrug-resistant phenotypes and thereby limit the therapeutic options available. Colonisation and infection with CPOs are critical risks for mortality in clinical settings, especially in critical care medicine. Carbapenemase genes on plasmids have transferred to many Gram-negative species, and these species have spread, leading to global concern regarding antimicrobial resistance. A molecular rapid diagnostic test (mRDT) for CPOs is urgently required in critical care medicine. Here, we evaluated a rapid lateral flow immunoassay (LFIA) for CPOs isolated from patients at university hospitals, including intensive care units, and compared the results with those obtained using the multiplex polymerase chain reaction (PCR) method. NG-test CARBA 5 detected multiple carbapenemases, KPC, OXA-48, NDM, VIM, and IMP variants expressed in clinical isolates. Quick Chaser IMP detected IMP variants. The LFIAs exhibited 100% sensitivity and specificity relative to clinical isolates on agar plates. By contrast, the multiplex PCR method exhibited a limited ability to detect IMP-7-producing isolates not belonging to the IMP1 group, which resulted in 97% sensitivity and 100% specificity for IMP-producing isolates. Our results demonstrate that the LFIA is a useful mRDT to identify CPOs and has an advantage over the PCR method for both detection time and sensitivity to the IMP groups. LFIA could complement the nucleic acid amplification test used to identify CPOs. In conclusion, we evaluated sensitive and specific LFIAs capable of detecting carbapenemase production in Gram-negative bacteria. We anticipate that LFIAs will become a point-of-care test enabling rapid detection of carbapenemases in hospital settings, particularly in intensive care units.

Integrating the business networks and internet of things perspectives: A system of systems (SoS) approach for industrial markets

In industrial business-to-business (B2B) markets, physical entities (such as products, machines, materials, or other objects) are increasingly connected among each other. This Industrial Internet of Things (IIoT) is quickly developing thanks to advances in fields such as information systems, factory digitalization, data sciences, robotics. Thus, industrial markets appear both as business networks - encompassing connections between individual or organizational actors – and networks of connected things. The purpose of this research is to provide an integrative perspective that encompasses both types of networks. It seeks to contribute to the literature on industrial B2B markets in two ways. First, it proposes the system of systems (SoS) theory - which emphasizes diversity and autonomy of systems - as an integrative perspective. Second, it argues that this integrated perspective contributes to a new view on how resources are produced, combined, and used, and, therefore, on business network models. We discuss the implications for one of the most established models, the IMP Group's A-R-A model.

Comparison of sCIM and Other Phenotypic Detection Methods for Carbapenemase-Producing Enterobacterales.

ABSTRACTRapid detection and reporting of carbapenemase-producing Enterobacterales (CPE) is one of the top priorities of clinical microbiology laboratories. The Clinical and Laboratory Standards Institute recommends the modified carbapenem inactivation method (mCIM) as the preferred method for this purpose, but it requires a broth incubation process which can be cumbersome. Here, we compared the performance of mCIM with three alternative rapid CPE detection methods against a collection of genetically defined CPE, with most carrying blaIMP, and non-CPE clinical isolates. The sensitivities of mCIM, simplified carbapenem inactivation method (sCIM), Rapidec Carba NP, and NG-Test Carba 5 were 98.0%, 54.9%, 90.2%, and 72.5%, whereas the specificities were 89.5%, 84.2%, 89.5%, and 100%, respectively. Modification of the interpretive criteria of sCIM increased its sensitivity to 88.2% and specificity to 89.5%. The results suggest that mCIM is currently the optimal method for CPE detection in an epidemiological setting where CPE-producing IMP group carbapenemase is predominant. While sCIM is easier to perform, it requires further validation before it can be widely adopted as an alternative to mCIM in the clinical laboratory.IMPORTANCE Simple identification methods for carbapenemase-producing Enterobacterales are required for the clinical laboratory. The simplified carbapenem inactivation method (sCIM) is a carbapenemase detection method that can be performed with less hands-on time than mCIM, but its sensitivity and specificity were suboptimal compared with other phenotypic detection methods when tested against a collection of IMP-producing CPE. Insufficient inactivation of imipenem from inadequate inoculation was suspected as the cause. While sCIM is easier to perform, it requires optimization before it can be widely adopted as an alternative to mCIM in the clinical laboratory.

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1-4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)-22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1-4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

Carbapenemases: Transforming Acinetobacter baumannii into a Yet More Dangerous Menace.

Acinetobacter baumannii is a common cause of serious nosocomial infections. Although community-acquired infections are observed, the vast majority occur in people with preexisting comorbidities. A. baumannii emerged as a problematic pathogen in the 1980s when an increase in virulence, difficulty in treatment due to drug resistance, and opportunities for infection turned it into one of the most important threats to human health. Some of the clinical manifestations of A. baumannii nosocomial infection are pneumonia; bloodstream infections; lower respiratory tract, urinary tract, and wound infections; burn infections; skin and soft tissue infections (including necrotizing fasciitis); meningitis; osteomyelitis; and endocarditis. A. baumannii has an extraordinary genetic plasticity that results in a high capacity to acquire antimicrobial resistance traits. In particular, acquisition of resistance to carbapenems, which are among the antimicrobials of last resort for treatment of multidrug infections, is increasing among A. baumannii strains compounding the problem of nosocomial infections caused by this pathogen. It is not uncommon to find multidrug-resistant (MDR, resistance to at least three classes of antimicrobials), extensively drug-resistant (XDR, MDR plus resistance to carbapenems), and pan-drug-resistant (PDR, XDR plus resistance to polymyxins) nosocomial isolates that are hard to treat with the currently available drugs. In this article we review the acquired resistance to carbapenems by A. baumannii. We describe the enzymes within the OXA, NDM, VIM, IMP, and KPC groups of carbapenemases and the coding genes found in A. baumannii clinical isolates.

A Real-Life Study: Intravitreal Aflibercept, Ranibizumab and Dexamethasone for Macular Edema Secondary to Branch Retinal Vein Occlusion.

Objectives:This study aims to compare the efficacy of intravitreal injection of aflibercept (IVA), ranibizumab (IVR) and dexamethasone implant (DEX IMP) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods:In this retrospective and comparative study, 57 eyes of 57 patients with ME after BRVO were studied. Patients were diveded into three groups according to treatment regimen as follows: 2 mg IVA (group 1, n=18), 0,5 mg IVR (group 2, n=20) and 0,7 mg Dex imp (group 3, n=19). Group 1 and group 2 were treated with three monthly anti-VEGF treatment followed by pro re nata (PRN) regimen, and group 3 was treated with 0,7 mg dexamethasone dose followed by another injection based on patients’ data. Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) measurements were noted at baseline, 1, 2, 3 and 6 months.Results:All groups were similar concerning age, gender, duration of symptoms, initial CMT and BCVA (p>0.05). Mean number of injections were 3,85±0.74 in group 1, 3,85±0,87 in group 2 and 1,75±0,44 in group 3. All the groups decreased CMT and increased BCVA for six months. There was not a statistically significant difference between groups. Concerning side effects, one person in group 1 and 2, four people in group 3 increased IOP, but all of them controlled IOP with anti-glaucomatous drugs. One patient in group 1, two in group 2, four in group three patients had cataract progression.Conclusion:All three drugs have similar results in patients with ME secondary to BRVO at a six-month follow-up. Compared to anti-VEGF drugs, dex imp has side effects as increased IOP and cataract progression, but it has higher BCVA at all months in the treatment of ME after BRVO.

A Randomized, Parallel Group, Open Label, Multicenter Study to Assess the Potential for Adrenal Suppression and Systemic Drug Absorption Following Multiple Dosing with Clobetasol Propionate Cream (Impoyz™), 0.025% versus Clobetasol Propionate (Temovate®)

Importance: Topical corticosteroids continue to play an important role in therapy for individuals with moderate-to-severe psoriasis, particularly in cases where systemic therapy is contraindicated or in which combination topical-systemic therapy is needed to achieve desired results. Although super-high-potency corticosteroids such as clobetasol propionate have the potential to produce desired results, side effects related to systemic absorption may limit their clinical utility. Objectives: To evaluate the potential of a new, lower-concentration clobetasol propionate cream 0. 025% (Impoyz Cream, [IMP]) to suppress the hypothalamic-pituitary-adrenal (HPA) axis as compared to clobetasol propionate, 0.05% cream (Temovate Cream, [TMV]) under maximal use conditions in patients with moderate-to-severe plaque psoriasis. To compare the plasma concentrations of clobetasol propionate before and after 2 weeks of topical treatment with either IMP Cream or TMV Cream under maximal use conditions.Design, Setting, and Participants: Randomized, multi-center, open-label study conducted across 15 clinical sites in the United States. Eligible subjects were males or females, at least 18 years old, with a clinical diagnosis of stable (at least 3 months) plaque-type psoriasis that involved 20% to 50% of the body surface area (BSA). 50 patients with an Investigator Global Assessment (IGA) grade of at least 3 (moderate) at Baseline were randomized (1:1) to twice daily treatment with either IMP Cream or TMV Cream for 15 consecutive days.Main Outcomes and Measures: Primary safety assessments included hypothalamic-pituitary-adrenal axis suppression (as measured by ACTH stimulation test) and systemic drug absorption (as measured by plasma clobetasol propionate levels drawn at baseline and on Day 15 of treatment at 0, 1, 3, and 6 hours after final study product application). Secondary safety assessments included serum DHEAS at Days 8 and 15 and local cutaneous adverse events. The primary efficacy assessment was Investigator Global Assessment (IGA) score, measured at Days 8 and 15 of treatment.Results: Upon conclusion of the treatment period, the mean serum concentration of clobetasol propionate was significantly lower in the IMP Cream group vs the TMV group (56.3 vs 152.5 pg/mL, p=0.014). A lower proportion of subjects in the IMP group experienced HPA-axis suppression compared to the TMV group, although this did not reach statistical significance (12.5% vs 36.4%, p=0.086). In terms of efficacy, the two treatment groups displayed similar marked improvement in psoriasis severity after 15 days of treatment, with 50% of the subjects in each group having an IGA score of 2 (mild) and 16.7% in the IMP group and 18.1% in the TMV group having a score of 0 or 1 (none or minimal). Conclusions and Relevance: Subjects with moderate-to-severe plaque psoriasis treated with a 15 day course of IMP Cream demonstrate lower levels of plasma clobetasol propionate than those treated with TMV, suggesting lower levels of systemic corticosteroid exposure with IMP versus those with TMV. Additionally, in this sample, topical therapy with IMP was associated with a trend towards a lower incidence of HPA axis suppression than TMV without comprising efficacy. Trial Registration: Registered 6 May, 2014.

Evaluation of the fit of zirconia copings fabricated by direct and indirect digital scanning procedures

Statement of problemIntraoral scanners are effective for direct digital scans when dental restorations are fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM); however, if the abutment tooth cannot be dried completely or the prepared margin is placed subgingivally, accurate digital images cannot always be guaranteed. PurposeThe purpose of this in vitro study was to compare the internal and marginal discrepancies of zirconia copings fabricated directly using an intraoral scanner with those fabricated indirectly with impression scanning. Material and methodsForty-five resin dies fabricated with a 3-dimensional (3D) printer were divided into 3 groups: direct scanning (DS), impression scanning (IMP), and lost-wax casting (LW). For the DS group, a resin die was scanned with an intraoral scanner (Trios; 3Shape), whereas for the IMP group, impressions made with polyether were scanned with a cast scanner (D700; 3Shape). The zirconia copings were fabricated in the same way in the DS and IMP groups. For the LW group, impressions were made in the same way as in the IMP group, and Ni-Cr alloy copings were fabricated using LW. The marginal and internal discrepancies of the copings were measured by cementing them onto resin dies, embedding them in acrylic resin, and sectioning them in a buccolingual direction. The cement layer was measured, and the Kruskal-Wallis test was used to detect significant differences (α=.05). A nonparametric Friedman test was also performed to compare the measurements of each group by location (α=.05). ResultsThe mean marginal discrepancies in the DS, IMP, and LW groups were 18.1 ±9.8, 23.2 ±17.2, and 32.3 ±18.6 μm (mean ±standard deviation), respectively. The mean internal discrepancies of the DS, IMP, and LW groups in the axial area were 38.0 ±9.1, 47.0 ±16.3, and 36.5 ±15.8 μm, and those in the occlusal area were 36.7 ±16.9, 33.4 ±21.6, and 44.5 ±31.9 μm, respectively. No statistically significant differences were found in marginal or internal discrepancies among groups (P>.05). ConclusionsWithin the limitations of this study, the zirconia copings fabricated with CAD-CAM using different digitization methods and Ni-Cr copings fabricated using the lost-wax technique and casting produced clinically acceptable marginal and internal discrepancies. No significant differences were found among the DS, IMP, and LW groups.

Inpatient psychiatric treatment is not always effective in adolescent sample

Objective: Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients.Methods: Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n = 67) were compared to the rest (N-IMP, n = 15). For statistical analysis STATISTICA package was used.Results: The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups.Conclusions: The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.

Combined analysis of the safety of intra-coronary drug delivery during primary percutaneous coronary intervention for acute myocardial infarction: A study of three clinical trials.

BackgroundThe local injection of novel cardioprotective study drugs prior to percutaneous coronary intervention could cause embolisation of thrombus, resulting in increased reperfusion injury and subsequent infarct size. The aim of this study was to assess the safety of the delivery of an intracoronary therapy delivered during primary percutaneous coronary intervention for acute myocardial infarction prior to the re-establishment of thrombolysis in myocardial infarction III flow.MethodsOne hundred sixty-seven patients with acute myocardial infarction successfully reperfused through primary percutaneous coronary intervention and undergoing Cardiac MRI within the first week after reperfusion were studied. Patients either underwent the delivery of an intracoronary agent (IMP or placebo) prior to balloon dilatation (n = 80) or standard primary percutaneous coronary intervention procedure (n = 117).ResultsBaseline characteristics were similar between the two groups. There were a similar number of successful procedures (IC IMP 75 (93.8%) vs. No IMP 114, (97.4%), p = 0.374), rates of no-reflow (IC IMP 1 (1.3%) vs. No IMP 2 (1.7%), p = 0.99) and levels of ST segment resolution (88.5% IC IMP vs. No IC IMP 87.0%, p = 0.669) between the two groups. Similar levels of microvascular obstruction were seen between the two groups with a trend to reduced infarct size, and improved ejection fractions in the IMP group. Lower MACE rates were seen in the IMP group.ConclusionThe local intracoronary infusion of potential cardioprotective agents prior to the restoration of TIMI flow in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction appears to be safe and does not increase microvascular damage. This route should be considered when testing novel cardioprotective agents.

The Influences of B2B Service Quality on the Relationship Satisfaction, Brand Performance and Relationship Performance - An Application of the IMP Interaction Model

Objectives: This study purpose to identify of B2B (Business to Business) Service Quality on Relationship Satisfaction, Brand Performance and Relationship Performance in B2B environment. Theoretical framework is based on the Interaction Model from IMP Group (1982)1. Methods/Statistical Analysis: Purchasing decision Maker and Influencers, such as IT Staffs and Operators who were provided Hardware devices and Software Solutions for Business Office, were selected as objects of this study. Sample was conducted for 3 months from Oct. 2015, 110 copies from Decision Makers and 225 copies from the IT staffs and Influencers. Exploratory factors analysis, reliability analysis and structural equating model analysis were preceded by SPSS 19.0 and AMOS 19.0. Findings: As result of this study, B2B Service Quality was found positive effect on Brand Performance and Relationship Satisfaction, but not found positive effect on Relationship Performance. On the other hand, Brand Performance was found to have positive effect on Relationship Satisfaction and Relationship Performance. And found positive effect between Relationship Satisfaction and Relationship Performance. In addition, Brand Performance had mediation effect significantly between B2B Service Quality and Relationship-Satisfaction. And also had mediation effect significantly between B2B Service Quality and Relationship-Performance. Finally, Relationship- Satisfaction had significant mediation effect between Brand Performance and Relationship Performance. According to this study results, we found 4 factors of relational exchange are applied in various industry area in B2B and it matches with previous studies by2,3. Improvements/Applications: The limitation of this study were followings, it may be able to utilize future research direction. First, there were no prior concerns about internal decision process in Customer Organization, Second, could not capture for information exchange and adaptation as variables of IMP interaction model. Third, need to study what is process indicator and mediation effect in between B2B Service Quality and Relationship Performance.

The managerial challenge of business interaction: behind the market façade

Purpose– The purpose of this paper is to address three aspects of the managerial challenge that arises from the process of business interaction: the diversity of interaction; the dynamic effects of interaction; and the integration of interaction into company operations and strategy. The paper develops a typology which characterizes different types of interaction in order to identify the managerial issues they represent.Design/methodology/approach– The paper is based on the empirical research programme of the IMP Group (impgroup.org) and on a recent large scale research project within that programme.Findings– The paper seeks to identify the dynamic effects of each type of interaction on the resources and activities involved in it and address the implications that these effects have for management. Finally, the paper discusses how the challenges and opportunities presented by business interaction can be integrated into the general management of a company.Research limitations/implications– The paper is mainly based on detailed empirical observations focusing some special features. Focusing other aspects would give another result.Practical implications– Important for all companies having important business relationships.Originality/value– Gives a new view of managerial challenges related to the variety in business relationships.