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Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients : a randomized clinical trial
Bastiaan H. Wittekamp, Nienke L. Plantinga, Ben S. Cooper, Joaquin Lopez-Contreras, Pere Coll, Jordi Mancebo, Matt P. Wise, Matt P. G. Morgan, Pieter Depuydt, Jerina Boelens, Viktorija Tomič, Franc Šifrer, 2018

Povzetek: Importance: The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown. Objective: To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance. Design, setting, and participants: Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum [beta]-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017. Interventions: Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily. Main outcomes and measures: The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period. Results: A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline. Conclusions and relevance: Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.
Ključne besede: anti-infective agents -- therapeutic use, bacteremia -- prevention and control, chlorhexidine -- therapeutic use, cross infection -- prevention and control, disinfection -- methods, bacterial drug resistance, gastrointestinal tract -- microbiology, Gram-negative bacterial infections -- prevention and control, hospital mortality, intensive care units, mouthwashes -- therapeutic use, oropharynx -- microbiology, artificial respiration, multicenter study, randomized controlled trial
DiRROS - Objavljeno: 09.11.2020; Ogledov: 184; Prenosov: 58

Detection of EGFR variants in plasma : a multilaboratory comparison of a real-time PCR EGFR mutation test in Europe
Cleo Keppens, John Palma, Partha Das, Sidney Scudder, Wei Wen, Nicola Normanno, Han J. J. M. van Krieken, Alessandra Sacco, Francesca Fenizia, David Gonzalez de Castro, Selma Hönigschnabl, Izidor Kern, Fernando Lopez-Rios, Maria D. Lozano, Antonio Marchetti, Philippe Halfon, Ed Schuuring, Ulrike Setinek, Boe Sorensen, Phillipe Taniere, Markus Tiemann, Hana Vosmikova, Elisabeth Dequeker, 2018

Povzetek: Molecular testing of EGFR is required to predict the response likelihood to targeted therapy in non-small cell lung cancer. Analysis of circulating tumor DNA in plasma may complement limitations of tumor tissue. This study evaluated the interlaboratory performance and reproducibility of a real-time PCR EGFR mutation test (cobas EGFR Mutation Test v2) to detect EGFR variants in plasma. Fourteen laboratories received two identical panels of 27 single-blinded plasma samples. Samples were wild type or spiked with plasmid DNA to contain seven common EGFR variants at six predefined concentrations from 50 to 5000 copies per milliliter. The circulating tumor DNA was extracted by a cell-free circulating DNA sample preparation kit (cobas cfDNA Sample Preparation Kit), followed by duplicate analysis with the real-time PCR EGFR mutation test (Roche Molecular Systems, Pleasanton, CA). Lowest sensitivities were obtained for the c.2156G>C p.(Gly719Ala) and c.2573T>G p.(Leu858Arg) variants for the lowest target copies. For all other variants, sensitivities varied between 96.3% and 100.0%. All specificities were 98.8% to 100.0%. Coefficients of variation indicated good intralaboratory and interlaboratory repeatability and reproducibility but increased for decreasing concentrations. Prediction models revealed a significant correlation for all variants between the predefined copy number and the observed semiquantitative index values, which reflect the samples' plasma mutation load. This study demonstrates an overall robust performance of the real-time PCR EGFR mutation test kit in plasma. Prediction models may be applied to estimate the plasma mutation load for diagnostic or research purposes.
Ključne besede: non-small cell lung cancer, plasma, EGFR, molecular testing
DiRROS - Objavljeno: 23.11.2020; Ogledov: 182; Prenosov: 27

Emerging organic compounds in European groundwater
B. Lopez, A. Togola, M. E. van Vliet, L. Rosenqvist, Nina Mali, A. Kuczyńska, Anja Koroša, J. Grima-Olmedo, E. J. Crane, D. J. Lapworth, S. Y. Bunting

Povzetek: In Europe, emerging organic compounds (EOCs) in groundwater is a growing research area. Prioritisationfor monitoring EOCs in Europe was formalised in 2019 through the development of thefirst voluntarygroundwater watch list (GWWL). Despite this, groundwater occurrence data in the peer reviewedliterature for Europe has not been reviewed to date. Questions surrounding the effect, toxicity, move-ment in the subsurface and unsaturated zone make the process of regulating EOC use difficult. The aim inEurope is to develop a unified strategy for the classification, and prioritisation of EOCs to be monitored ingroundwater. This paper compiles evidence from the recent published studies from across Europe, since2012, when the last major literature global review of EOCs in groundwater took place. A total of 39studies were identified for review based on specific selection criteria (geography, publication date,sample size>10, inclusion of EOCs data). Data on specific compounds, and associated meta-data, arecompiled and reviewed. The two most frequently detected EOCs, carbamazepine and caffeine, occurredin groundwater at concentrations of up to 2.3 and 14.8mg/L, respectively.
Ključne besede: emerging organic chemicals, environmental exposure, groundwater contaminants, compounds of concern, groundwater hazards
DiRROS - Objavljeno: 13.01.2021; Ogledov: 148; Prenosov: 73
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