Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.
We determined whether: (1) an acute lipid infusion impairs skeletal muscle AMP-activated protein kinase (AMPK)α2 activity, increases inducible nitric oxide synthase (iNOS) and causes peripheral insulin resistance in conscious, unstressed, lean mice; and (2) restoration of AMPKα2 activity during the lipid infusion attenuates the increase in iNOS and reverses the defect in insulin sensitivity in vivo.
Chow-fed, 18-week-old C57BL/6J male mice were surgically catheterised. After 5 days they received: (1) a 5 h infusion of 5 ml kg−1 h−1 Intralipid + 6U/h heparin (Lipid treatment) or saline (Control); (2) Lipid treatment or Control, followed by a 2 h hyperinsulinaemic–euglycaemic clamp (insulin clamp; 4 mU kg−1 min−1); and (3) infusion of the AMPK activator, 5-aminoimidazole-4-carboxamide 1-β-d-ribofuranoside (AICAR) (1 mg kg−1 min−1), or saline during Lipid treatment, followed by a 2 h insulin clamp. In a separate protocol, mice producing a muscle-specific kinase-dead AMPKα2 subunit (α2-KD) underwent an insulin clamp to determine the role of AMPKα2 in insulin-mediated muscle glucose metabolism.
Lipid treatment decreased AMPKα2 activity, increased iNOS abundance/activation and reduced whole-body insulin sensitivity in vivo. AICAR increased AMPKα2 activity twofold; this did not suppress iNOS or improve whole-body or tissue-specific rates of glucose uptake during Lipid treatment. AICAR caused a marked increase in insulin-mediated glycogen synthesis in skeletal muscle. Consistent with this latter result, lean α2-KD mice exhibited impaired insulinstimulated glycogen synthesis even though muscle glucose uptake was not affected.
Acute induction of insulin resistance via lipid infusion in healthy mice impairs AMPKα2, increases iNOS and causes insulin resistance in vivo. However, these changes do not appear to be interrelated. Rather, a functionally active AMPKα2 subunit is required for insulin-stimulated muscle glycogen synthesis.
AICAR; Glucose metabolism; Glycogen synthesis; Skeletal muscle
The discovery of topological insulators (TIs) has led to numerous exciting opportunities for studying topological states of quantum physics and for exploring spintronic applications due to the new physics arising from their robust metallic surface states. Here, we report the high-quality topological insulator (BixSb1−x)2Te3 thin films using a single van der Waals GaSe buffer layer. As a result, ultra-low surface carrier density of 1.3 × 1012 cm−2 and a high Hall mobility of 3100 cm2/Vs have been achieved for (Bi0.53Sb0.47)2Te3. The high-quality films enable us to observe quantum oscillations associated with the top and bottom surface states and to manipulate the Dirac electrons and bulk holes' conduction properties. The observation of the two surface states may lead to a path towards the implementation of TIs in spintronics.
Heteroleptic copper compounds have been designed and synthesized on solid supports. Chemical redox agents were used to change the oxidation state of the SiO2-immobilized heteroleptic copper compounds from Cu(I) to Cu(II) and then back to Cu(I). Optical spectroscopy of a dimethyl sulfoxide (DMSO) suspension demonstrated the reversibility of the Cu(I)/Cu(II) SiO2-immobilized compounds by monitoring the metal-to-ligand charge transfer (MLCT) peak at about 450 nm. EPR spectroscopy was used to monitor the isomerization of Cu(I) tetrahedral to Cu(II) square planar. This conformational change corresponds to a 90° rotation of one ligand with respect to the other. Conductive AFM (cAFM) and macroscopic gold electrodes were used to study the electrical properties of a p+ Si-immobilized heteroleptic copper compound where switching between the Cu(I)/Cu(II) states occurred at −0.8 and +2.3 V.
The spin-transfer nano-oscillator (STNO) offers the possibility of using the transfer of spin angular momentum via spin-polarized currents to generate microwave signals. However, at present STNO microwave emission mainly relies on both large drive currents and external magnetic fields. These issues hinder the implementation of STNOs for practical applications in terms of power dissipation and size. Here, we report microwave measurements on STNOs built with MgO-based magnetic tunnel junctions having a planar polarizer and a perpendicular free layer, where microwave emission with large output power, excited at ultralow current densities, and in the absence of any bias magnetic fields is observed. The measured critical current density is over one order of magnitude smaller than previously reported. These results suggest the possibility of improved integration of STNOs with complementary metal-oxide-semiconductor technology, and could represent a new route for the development of the next-generation of on-chip oscillators.
Traditionally laparoscopic cholecystectomy is done under general anesthesia. But recently there is a growing interest to get it conducted under central neuraxial blockade. We conducted a clinical study comprising bupivacaine alone or a combination of bupivacaine and clonidine (2 μg/kg) in thoracic epidural anesthesia for laparoscopic cholecystectomy (LC). The aim was to attenuate the undesirable hemodynamic changes due to pneumoperitoneum (PNO) and achieve a better qualitative blockade.
Patients and Methods:
After taking approval from Institutional Ethical Committee, 50 adult patients of ASA grade I and II were divided into two groups; group A where bupivacaine was given with 2 μg/kg of clonidine (Cloneon, Neon) and in group B bupivacaine (Anawin, Neon) was given with 1 ml of saline as placebo. Thoracic epidural was given at the T9-T10 or T10-T11 interspace to obtain a block of T4-L2 dermatome. Hemodynamic parameters like heart rate (HR), noninvasive blood pressure (NIBP), respiratory rate (RR), electrocardiogram (ECG), oxygen saturation (SpO2) and arterial pressure of carbon dioxide (PaCO2) were monitored and readings were recorded before and 10 minutes (min.) after the blockade and then at 5 min, 15 min and 30 min after PNO and 15 min after exsufflation.
All the parameters of the patients in group A remained stable but the patients of group B showed an increase in mean arterial pressure (MAP) and HR at 5, 15 and 30 min after PNO and 15 min after exsufflation as compared to Group A. PaCO2, SpO2 and RR values in both the groups were comparable. In group A, two patients complained of shoulder pain while in group B12 patients complained of shoulder pain.
Thoracic epidural anesthesia for LC is a satisfactory alternative technique in selected cases. Addition of clonidine (2 μg/kg) to bupivacaine produces better qualitative anesthetic conditions. It prevents hemodynamic perturbations produced by pneumoperitoneum and also decreases the incidence of shoulder pain. Thus we strongly advocate the incorporation of clonidine as an adjuvant in thoracic epidural anesthesia for LC.
α2-adrenergic receptor agonists; cholecystectomy; clonidine; epidural anesthesia
Topological insulators, a new quantum state of matter, create exciting opportunities for studying topological quantum physics and for exploring spintronic applications due to their gapless helical metallic surface states. Here, we report the observation of weak anti-localization and quantum oscillations originated from surface states in Bi2Se2Te crystals. Angle-resolved photoemission spectroscopy measurements on cleaved Bi2Se2Te crystals show a well-defined linear dispersion without intersection of the conduction band. The measured weak anti-localization effect agrees well with the Hikami-Larkin-Nagaoka model and the extracted phase coherent length shows a power-law dependence with temperature (∼T−0.44), indicating the presence of the surface states. More importantly, the analysis of a Landau-level fan diagram of Shubnikov-de Hass oscillations yields a finite Berry phase of ∼0.42π, suggesting the Dirac nature of the surface states. Our results demonstrate that Bi2Se2Te can serve as a suitable topological insulator candidate for achieving intrinsic quantum transport of surface Dirac fermions.
Topological insulators show unique properties resulting from massless, Dirac-like surface states that are protected by time-reversal symmetry. Theory predicts that the surface states exhibit a quantum spin Hall effect with counter-propagating electrons carrying opposite spins in the absence of an external magnetic field. However, to date, the revelation of these states through conventional transport measurements remains a significant challenge owing to the predominance of bulk carriers. Here, we report on an experimental observation of Shubnikov-de Haas oscillations in quantum capacitance measurements, which originate from topological helical states. Unlike the traditional transport approach, the quantum capacitance measurements are remarkably alleviated from bulk interference at high excitation frequencies, thus enabling a distinction between the surface and bulk. We also demonstrate easy access to the surface states at relatively high temperatures up to 60 K. Our approach may eventually facilitate an exciting exploration of exotic topological properties at room temperature.
The use of a functional molecular unit acting as a state variable provides an attractive alternative for the next generations of nanoscale electronics. It may help overcome the limits of conventional MOSFETd due to their potential scalability, low-cost, low variability, and highly integratable characteristics as well as the capability to exploit bottom-up self-assembly processes. This bottom-up construction and the operation of nanoscale machines/devices, in which the molecular motion can be controlled to perform functions, have been studied for their functionalities. Being triggered by external stimuli such as light, electricity or chemical reagents, these devices have shown various functions including those of diodes, rectifiers, memories, resonant tunnel junctions and single settable molecular switches that can be electronically configured for logic gates. Molecule-specific electronic switching has also been reported for several of these device structures, including nanopores containing oligo(phenylene ethynylene) monolayers, and planar junctions incorporating rotaxane and catenane monolayers for the construction and operation of complex molecular machines. A specific electrically driven surface mounted molecular rotor is described in detail in this review. The rotor is comprised of a monolayer of redox-active ligated copper compounds sandwiched between a gold electrode and a highly-doped P+ Si. This electrically driven sandwich-type monolayer molecular rotor device showed an on/off ratio of approximately 104, a read window of about 2.5 V, and a retention time of greater than 104 s. The rotation speed of this type of molecular rotor has been reported to be in the picosecond timescale, which provides a potential of high switching speed applications. Current-voltage spectroscopy (I-V) revealed a temperature-dependent negative differential resistance (NDR) associated with the device. The analysis of the device I–V characteristics suggests the source of the observed switching effects to be the result of the redox-induced ligand rotation around the copper metal center and this attribution of switching is consistent with the observed temperature dependence of the switching behavior as well as the proposed energy diagram of the device. The observed resistance switching shows the potential for future non-volatile memories and logic devices applications. This review will discuss the progress and provide a perspective of molecular motion for nanoelectronics and other applications.
molecular rotor; molecular devices; switching; memory; crossbar architecture
GeMn/Ge epitaxial 'superlattices' grown by molecular beam epitaxy with different growth conditions have been systematically investigated by transmission electron microscopy. It is revealed that periodic arrays of GeMn nanodots can be formed on Ge and GaAs substrates at low temperature (approximately 70°C) due to the matched lattice constants of Ge (5.656 Å) and GaAs (5.653 Å), while a periodic Ge/GeMn superlattice grown on Si showed disordered GeMn nanodots with a large amount of stacking faults, which can be explained by the fact that Ge and Si have a large lattice mismatch. Moreover, by varying growth conditions, the GeMn/Ge superlattices can be manipulated from having disordered GeMn nanodots to ordered coherent nanodots and then to ordered nanocolumns.
PACS: 75.50.Pp; 61.72.-y; 66.30.Pa; 68.37.L.
ferromagnetic semiconductor; transmission electron microscopy; magnetic precipitation; molecular beam epitaxy
Graphene has attracted considerable interest as a potential new electronic material1–11. With the highest carrier mobility exceeding 200,000 cm2/V·s, graphene is of particular interest for ultra-high speed radio frequency (RF) electronics12–18. However, the conventional dielectric integration and device fabrication processes cannot be readily applied to fabricate high speed graphene transistors because they can often introduce significant defects into the monolayer of carbon lattices and severely degrade the device performance19–21. Here we report a new approach to fabricate high-speed graphene transistors with a self-aligned nanowire gate to enable unprecedented performance. The graphene transistors are fabricated using a Co2Si/Al2O3 core/shell nanowire as the gate, with the source and drain electrodes defined through a self-alignment process and the channel length defined by the nanowire diameter. The physical assembly of nanowire gate preserves the high carrier mobility in graphene, and the self-aligned process ensures that the edges of the source, drain, and gate electrodes are automatically and precisely positioned so that no overlapping or significant gaps exist between these electrodes and thus minimizes access resistance. It therefore enables transistor performance not previously possible. Graphene transistors with channel length down to 140 nm have been fabricated with the highest scaled on-current (3.32 mA μm−1) and transconductance (1.27 mS μm−1) reported to date. Significantly, on-chip microwave measurements demonstrate that the self-aligned devices exhibit a record high intrinsic cutoff frequency (fT) in the range of 100–300 GHz, with the extrinsic fT in the range of a few gigahertz largely limited by parasitic pad capacitance. The reported intrinsic cutoff frequency of the graphene transistors is comparable to that of the very best high electron mobility transistors with similar gate lengths10. It therefore marks an important milestone in graphene RF devices and can enable exciting opportunities in high-speed electronics.
Electric-field control of ferromagnetism in magnetic semiconductors at room temperature has been actively pursued as one of the important approaches to realize practical spintronics and non-volatile logic devices. While Mn-doped III-V semiconductors were considered as potential candidates for achieving this controllability, the search for an ideal material with high Curie temperature (Tc>300 K) and controllable ferromagnetism at room temperature has continued for nearly a decade. Among various dilute magnetic semiconductors (DMSs), materials derived from group IV elements such as Si and Ge are the ideal candidates for such materials due to their excellent compatibility with the conventional complementary metal-oxide-semiconductor (CMOS) technology. Here, we review recent reports on the development of high-Curie temperature Mn0.05Ge0.95 quantum dots (QDs) and successfully demonstrate electric-field control of ferromagnetism in the Mn0.05Ge0.95 quantum dots up to 300 K. Upon the application of gate-bias to a metal-oxide-semiconductor (MOS) capacitor, the ferromagnetism of the channel layer (i.e. the Mn0.05Ge0.95 quantum dots) was modulated as a function of the hole concentration. Finally, a theoretical model based upon the formation of magnetic polarons has been proposed to explain the observed field controlled ferromagnetism.
diluted magnetic semiconductors; spintronics; non-volatile; Mn0.05Ge0.95; quantum dots; electric-field controlled ferromagnetism; magnetic polarons
Graphene has unique electronic properties1,2 and graphene nanoribbons are of particular interest because they exhibit a conduction band gap, which arises due to size confinement and edge effects3-11. Theoretical studies have suggested that graphene nanoribbons could have interesting magneto-electronic properties with very large magnetoresistance predicted4,12-20. Here we report the experimental observation of a significant enhancement in the conductance of a graphene nanoribbon field-effect transistor in a perpendicular magnetic field. A negative magnetoresistance of nearly 100% was observed at low temperatures, with over 50% remaining at room temperature. This magnetoresistance can be tuned by varying the gate or source-drain bias. We also find that the charge transport in the nanoribbons is not significantly modified by an in-plane magnetic field. The large values of the magnetoresistance we observe may be attributed to the reduction of quantum confinement by the formation of cyclotron orbits and the delocalization effect under the perpendicular magnetic field15-20.
In searching appropriate candidates of magnetic semiconductors compatible with mainstream Si technology for future spintronic devices, extensive attention has been focused on Mn-doped Ge magnetic semiconductors. Up to now, lack of reliable methods to obtain high-quality MnGe nanostructures with a desired shape and a good controllability has been a barrier to make these materials practically applicable for spintronic devices. Here, we report, for the first time, an innovative growth approach to produce self-assembled and coherent magnetic MnGe nanodot arrays with an excellent reproducibility. Magnetotransport experiments reveal that the nanodot arrays possess giant magneto-resistance associated with geometrical effects. The discovery of the MnGe nanodot arrays paves the way towards next-generation high-density magnetic memories and spintronic devices with low-power dissipation.
Maxillofacial fractures present unique airway problems to the anaesthesiologist. Nasotracheal intubation is contraindicated due to associated Lefort I, II or III fractures. The requirement for intraoperative maxillomandibular fixation (MMF) to re-establish dental occlusion in such cases precludes orotracheal intubation. Tracheostomy has a high complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. Hernandez1 in 1986 first described “The submental route for endotracheal intubation”. Later some workers faced difficult tube passage, bleeding, and sublingual gland involvement with this approach. They modified this to strict midline submental intubation and there were no operative or postoperative complications in their cases.67&8. Therefore we used mid line approach for submental orotracheal intubation in this study to demonstrate its feasibility and reliability and that it can be used as an excellent substitute to short term tracheostomy.
Patients & Methods:
We used midline submental intubation in 25 cases selected out of 310 consecutively treated patients with maxillofacial trauma over a 3 year period. After induction orotracheal intubation was done with spiral re-inforced tube. A 1.5-2.0 cm skin incision was made in the submental region in the midline 2.0 cm behind the symphysis and endotracheal tube was taken out through this incision in all the cases. At the end of the surgery the procedure was reversed, the submental wound was stitched; all the patients could be extubated & none of them required post-operative mechanical ventilation.
There were no significant operative or postoperative complications. Postoperative submental scarring was acceptable. We conclude that midline submental intubation is a simple and useful technique with low morbidity. It can be chosen in selected cases of maxillofacial trauma and is an excellent substitute to tracheostomy where postoperative mechanical ventilation is not required.
Submental orotracheal intubation; Maxillofacial injury; Tracheostomy
Background: Stress fractures do not often occur in the shaft of the femur. They are more common in the femoral neck, the tibial shaft, the metatarsals, and other bones of the foot. In female athletes, stress fractures classically afflict the distance runner, the ballerina, the gymnast, and the figure skater.
Objectives: To describe the clinical presentation, diagnosis, treatment, and outcome of seven college female lacrosse players with femoral shaft stress fractures, and review the literature.
Results: The unusual results of this study support the principle that clinical suspicion should be high when treating any female athlete regardless of the sport. In this case series, an abrupt change in the quality of the running surface during the competitive training season was the only underlying common thread among the athletes.
Conclusion: The findings suggest that risk factors for the female athlete are variable and are no longer limited to the undernourished or overtrained.
Drug resistance is a major problem affecting the clinical efficacy of antiretroviral agents, including protease inhibitors, in the treatment of infection with human immunodeficiency virus type 1 (HIV-1)/AIDS. Consequently, the elucidation of the mechanisms by which HIV-1 protease inhibitors maintain antiviral activity in the presence of mutations is critical to the development of superior inhibitors. Tipranavir, a nonpeptidic HIV-1 protease inhibitor, has been recently approved for the treatment of HIV infection. Tipranavir inhibits wild-type protease with high potency (Ki = 19 pM) and demonstrates durable efficacy in the treatment of patients infected with HIV-1 strains containing multiple common mutations associated with resistance. The high potency of tipranavir results from a very large favorable entropy change (−TΔS = −14.6 kcal/mol) combined with a favorable, albeit small, enthalpy change (ΔH = −0.7 kcal/mol, 25°C). Characterization of tipranavir binding to wild-type protease, active site mutants I50V and V82F/I84V, the multidrug-resistant mutant L10I/L33I/M46I/I54V/L63I/V82A/I84V/L90M, and the tipranavir in vitro-selected mutant I13V/V32L/L33F/K45I/V82L/I84V was performed by isothermal titration calorimetry and crystallography. Thermodynamically, the good response of tipranavir arises from a unique behavior: it compensates for entropic losses by actual enthalpic gains or by sustaining minimal enthalpic losses when facing the mutants. The net result is a small loss in binding affinity. Structurally, tipranavir establishes a very strong hydrogen bond network with invariant regions of the protease, which is maintained with the mutants, including catalytic Asp25 and the backbone of Asp29, Asp30, Gly48 and Ile50. Moreover, tipranavir forms hydrogen bonds directly to Ile50, while all other inhibitors do so by being mediated by a water molecule.
Bactericidal activities of LY191145, an investigational glycopeptide, and vancomycin against Staphylococcus aureus were evaluated. Only LY191145 at a concentration 16-fold greater than the MIC was able to achieve 99.9% killing against methicillin-susceptible S. aureus (ATCC 25923; 8.0 h). Both agents demonstrated 99.9% killing against methicillin-resistant clinical isolate S. aureus MRSA67 over 24 h at concentrations 4-, 8-, and 16-fold greater than the MIC, but bacteria were killed at a more rapid rate by LY191145 (1.63 versus 5.02 h; P < 0.001). Against strain ATCC 25923- and MRSA67-infected fibrin clots, total reductions by LY191145 and vancomycin over 72 h were not statistically significantly different at a concentration 16 times the MIC (1.12 +/- 0.31 and 1.23 +/- 0.13 and 1.40 +/- 0.17 and 1.36 +/- 0.37 CFU/g; respectively). Increasing the drug concentration to 50 times the MIC did not alter the values significantly, and there was no statistically significant difference between the two agents. Overall, LY191145 exhibited more rapid bactericidal activity than vancomycin against S. aureus, and a concentration 16-fold greater than the MIC appears to be optimal.
Cefepime (CP) is a new injectable cephalosporin with a broad spectrum of activity and stability against common chromosomally and plasmid-mediated beta-lactamases. The bactericidal activities of CP, ceftazidime (CZ), cefotaxime (CTX), and ceftriaxone (CAX) against reference and clinical strains of Staphylococcus aureus, an isogenic pair of Enterobacter aerogenes strains (wild type and a CZ-resistant derepressed mutant), and a Klebsiella pneumoniae isolate possessing a TEM-10 beta-lactamase were investigated in a two-compartment pharmacodynamic in vitro infection model which simulates human pharmacokinetics. An inoculum of approximately 10(6) CFU/ml was used in all model experiments. Antibiotics were administered to simulate the following regimens: CP at 2 g every 12 h (q12h), CZ at 2 g q8h, CTX at 2 g q8h, and CAX at 2 g q24h. Human albumin was added during experiments with CAX and staphylococci to simulate protein binding. Samples were removed at multiple time points over a 48-h period to determine the inoculum size for time-kill curves. Development of resistance was detected by inoculating samples obtained at 0, 24, and 48 h onto antibiotic-containing agar plates. The time to 99.9% killing was used to compare drug regimens. Against staphylococci, the time to bacterial eradication was significantly delayed with CAX-albumin. All regimens had similar activities against the wild-type Enterobacter strain; however, regrowth was noted with CZ, CTX, and CAX against the CZ-resistant strain. There were no differences between the CP, CTX, and CAX regimens against K. pneumoniae. Of interest, no regrowth of any organism was noted with CP. These data indicate that CP has activity against S.aureus and CZ-resistant gram-negative bacilli.
We compared the pharmacodynamics and killing activity of ceftazidime, administered by continuous infusion and intermittent bolus, against Pseudomonas aeruginosa ATCC 27853 and ceftazidime-resistant P. aeruginosa 27853CR with and without a single daily dose of amikacin in an in vitro infection model over a 48-h period. Resistance to ceftazidime was selected for by serial passage of P. aeruginosa onto agar containing increasing concentrations of ceftazidime. Human pharmacokinetics and dosages were simulated as follows: half-life, 2 h; intermittent-bolus ceftazidime, 2 g every 8 h (q8h) and q12h; continuous infusion, 2-g loading dose and maintenance infusions of 5, 10, and 20 micrograms/ml; amikacin, 15 mg/kg q24h. There was no significant difference in time to 99.9% killing between any of the monotherapy regimens or between any combination regimen against ceftazidime-susceptible P. aeruginosa. Continuous infusions of 10 and 20 micrograms/ml killed as effectively as an intermittent bolus of 2 g q12h and q8h, respectively. Continuous infusion of 20 micrograms/ml and an intermittent bolus of 2 g q8h were the only regimens which prevented organism regrowth at 48 h, while a continuous infusion of 5 micrograms/ml resulted in the most regrowth. All of the combination regimens exhibited a synergistic response, with rapid killing of ceftazidime-susceptible P. aeruginosa and no regrowth. Against ceftazidime-resistant P. aeruginosa, none of the ceftazidime monotherapy regimens achieved 99.9% killing. The combination regimens exhibited the same rapid killing of the resistant strain as occurred with the susceptible strain; however, regrowth occurred with all regimens. The combination regimens of continuous infusion of 20 micrograms/ml plus amikacin and intermittent bolus q8h or q12h plus amikacin continued to be synergistic. Overall, continuous infusion monotherapy with ceftazidime at concentrations 4 to 5 and 10 to 15 times the MIC was as effective as an intermittent bolus of 2 g q12h (10 to 15 times the MIC) and q8h (25 to 35 times the MIC), respectively, against ceftazidime-susceptible P. aeruginosa. Combination therapy with amikacin plus ceftazidime, either intermittently q8h or by continuous infusion of 20 micrograms/ml, appeared to be effective and exhibited synergism against ceftazidime-resistant P. aeruginosa.
The bactericidal activity and emergence of resistance to RP 59500 (quinupristin/dalfopristin) when it was administered alone and in combination with vancomycin against fibrin clots that have been infected with methicillin-susceptible Staphylococcus aureus ATCC 25923 or methicillin-resistant S. aureus (MRSA) 67 were evaluated in an in vitro pharmacodynamic infected fibrin clot model. Fibrin clots were infected with S. aureus to achieve an inoculum of approximately 10(9) CFU/g. Antibiotics were administered to simulate pharmacokinetics in humans: RP 59500 (7.5 mg/kg of body weight) every 8 h and vancomycin (15 mg/kg) every 12 h over 72 h. Preliminary test tube time-kill experiments with an inoculum of approximately 10(5) CFU/ml suggested that RP 59500 was more rapid in achieving a 99.9% reduction in the number of CFU per milliliter than vancomycin against ATCC 25923 (6.94 versus 24 h; P = 0.0003) and MRSA 67 (6.77 versus 17.03 h; P = 0.004). At a higher inoculum (approximately 10(8) CFU/ml), 99.9% kill was achieved only with the combination regimen against ATCC 25923 and MRSA 67 (10.9 and 10.5 h, respectively), with total reductions of 6.35 and 6.33 log10 CFU/ml over 24 h, respectively. In the fibrin clot model, RP 59500 was more effective than vancomycin in reducing organism titers over 72 h. In the fibrin clot model, the most optimal therapy was the combination regimen.
The human transcription factor USF, purified from HeLa cells, and its recombinant 43-kDa component bind to the long terminal repeat (LTR) of human immunodeficiency virus type 1. The proteins footprint over nucleotides from position -173 to -157 upstream of the transcription start site, generating strong DNAse I hypersensitivity sites at the 3' sides on both strands. As detected by methylation protection studies, the factor forms symmetric contacts with the guanines of the palindromic CACGTG core of the recognized sequence. Its binding ability is abolished by the mutation of this core sequence and is strongly reduced by the cytosine methylation of the central CpG dinucleotide. Upon binding, both recombinant and purified USFs bend the LTR DNA template. The role of USF in the control of transcription initiation from the LTR was tested by in vitro transcription assays. Upon addition of the protein, transcription from constructs containing an intact binding site is increased, while the responsiveness in constructs with a mutated sequence is abolished. Furthermore, the addition of a decoy plasmid which contains multiple repeats of the target sequence results in downregulation of transcription from the LTR. These results suggest that USF is a positive regulator of LTR-mediated transcriptional activation.
The pharmacodynamic properties of levofloxacin (an optically active isomer of ofloxacin), ofloxacin, and ciprofloxacin, alone and in combination with rifampin, were evaluated over 24 to 48 h against clinical isolates of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA 1199 and MRSA 494, respectively) in an in vitro infection model. The incidence of the emergence of resistance among the test strains was also determined. The fluoroquinolones were administered to simulate dosage regimens of 200 mg, 400 mg given intravenously (i.v.) every 12 h (q12h), and 400 and 800 mg given i.v. q24h. Rifampin was dosed at 600 mg i.v. q24h. Although the MICs and MBCs of the quinolones were similar (< or = 0.49 microgram/ml), levofloxacin was the most potent agent in time-kill studies on the basis of the time required to achieve a 99.9% reduction in the number of log10 CFU per milliliter (e.g., with the regimen of levofloxacin [400 mg q24h, 6.5 h] versus ofloxacin [12.5 h], P < 0.024, and levofloxacin versus ciprofloxacin [6.5 versus 9.0 h], P < 0.0017) against MSSA 1199. The killing activity of levofloxacin was similar to that of ofloxacin against MRSA 494 (time to achieve a 99.9% reduction in the number of log10 CFU per milliliter, 11.1 versus 13.8 h, respectively). Levofloxacin and ofloxacin dosed once daily demonstrated greater bactericidal activity than when they were dosed twice daily against MSSA 1199. Resistance to levofloxacin or ofloxacin was not observed with any dosage regimen. Furthermore, resistance to ofloxacin was not detected when the half-life was reduced from 6 to 3 h. Regrowth and stable resistance (65-fold increase in the MIC for MSSA 1199; 16-fold increase in the MIC for MRSA 494) were noted within 24 h of exposure to ciprofloxacin at 200 mg q12h. Combination therapy with rifampin prevented the emergence of resistance to ciprofloxacin. Neither DNA gyrase alteration nor an energy-dependent efflux process mediated by the norA gene appeared to be responsible for the resistance observed. Our data suggest that with levofloxacin there is a more rapid onset of bactericidal activity than with ofloxacin or ciprofloxacin against MSSA 1199 and that the activity of levofloxacin is similar to that of ofloxacin but better than that of ciprofloxacin against MRSA 494. Resistance was noted only after exposure to the low dose of ciprofloxacin. Resistance to ofloxacin did not develop even when the pharmacokinetics of the drug were set to equal those of ciprofloxacin, suggesting that ofloxacin differs from ciprofloxacin irrespective of time of exposure. The resistance to ciprofloxacin that developed in our vitro model may be mediated by the cfx-ofx locus, which has been shown to be associated with low-level fluoroquinolone resistance. Overall, levofloxacin demonstrated potent bactericidal activity against S. aureus, without the emergence of resistance in our infection model. Quinolones dosed once daily were more effective than equivalent dosages administered twice daily. The addition of rifampin was not synergistic but prevented the emergence of ciprofloxacin resistance.
We adapted an in vitro pharmacodynamic model of infection to incorporate simulated endocardial vegetations. The bactericidal activities of teicoplanin, vancomycin, gentamicin, and various combinations of these drugs were studied against a strain of methicillin-susceptible Staphylococcus aureus obtained from a patient being treated for endocarditis at Detroit Receiving Hospital. Bacteria were grown overnight, concentrated, and added to a mixture of cryoprecipitate (80%) and thrombin (10%) to achieve approximately 5 x 10(9) CFU/g. Fibrin clots (8 to 10) were suspended into the model, removed at 24, 48, and 72 h in duplicate, weighed, and homogenized in 1.25% trypsin. Control experiments were conducted to characterize the growth kinetics. The following antibiotics were administered to simulate the pharmacokinetics of the drugs in humans: teicoplanin at 3 and 15 mg/kg of body weight, vancomycin at 15 mg/kg, and gentamicin at 1 mg/kg. Fibrin clot samples used to detect resistance were plated on antibiotic-containing tryptic soy agar plates. For the teicoplanin and vancomycin regimens, protein binding to cryoprecipitate, thrombin, and fibrin clot was determined to be 32, 43, and 50% and 26, 28, and 29%, respectively. In comparison with no treatment, vancomycin or teicoplanin at 15 mg/kg or either of these regimens combined with gentamicin significantly reduced bacterial counts (P < 0.0001). Monotherapy with teicoplanin at 3 mg/kg or gentamicin resulted in no killing activity. Combination treatment with teicoplanin at 3 mg/kg and gentamicin resulted in the killing of approximately 2 log10 CFU/g by 72 h and the development of resistance to gentamicin. The results obtained with the in vitro model of endocarditis are similar to the results reported by several investigators with the rabbit model of infective endocarditis. This unique infection model is useful for designing initial drug dosage regimens and may be predictive of drug efficacy against infective endocarditis.
To further characterize the gene structure of the proto-oncogene c-src and the mechanism for the genesis of the v-src sequence in Rous sarcoma virus, we have analyzed genomic and cDNA copies of the chicken c-src gene. From a cDNA library of chicken embryo fibroblasts, we isolated and sequenced several overlapping cDNA clones covering the full length of the 4-kb c-src mRNA. The cDNA sequence contains a 1.84-kb sequence downstream from the 1.6-kb pp60c-src coding region. An open reading frame of 217 amino acids, called sdr (src downstream region), was found 105 nucleotides from the termination codon for pp60c-src. Within the 3' noncoding region, a 39-bp sequence corresponding to the 3' end of the RSV v-src was detected 660 bases downstream of the pp60c-src termination codon. The presence of this sequence in the c-src mRNA exon supports a model involving an RNA intermediate during transduction of the c-src sequence. The 5' region of the c-src cDNA was determined by analyzing several cDNA clones generated by conventional cloning methods and by polymerase chain reaction. Sequences of these chicken embryo fibroblast clones plus two c-src cDNA clones isolated from a brain cDNA library show that there is considerable heterogeneity in sequences upstream from the c-src coding sequence. Within this region, which contains at least 300 nucleotides upstream of the translational initiation site in exon 2, there exist at least two exons in each cDNA which fall into five cDNA classes. Four unique 5' exon sequences, designated exons UE1, UE2, UEX, and UEY, were observed. All of them are spliced to the previously characterized c-src exons 1 and 2 with the exception of type 2 cDNA. In type 2, the exon 1 is spliced to a novel downstream exon, designated exon 1a, which maps in the region of the c-src DNA defined previously as intron 1. Exon UE1 is rich in G+C content and is mapped at 7.8 kb upstream from exon 1. This exon is also present in the two cDNA clones from the brain cDNA library. Exon UE2 is located at 8.5 kb upstream from exon 1. The precise locations of exons UEX and UEY have not been determined, but both are more than 12 kb upstream from exon 1. The existence and exon arrangements of these 5' cDNAs were further confirmed by RNase protection assays and polymerase chain reactions using specific primers. Our findings indicate that the heterogeneity in the 5' sequences of the c-src mRNAs results from differential splicing and perhaps use of distinct initiation sites. All of these RNAs have the potential of coding for pp60c-src, since their 5' exons are all eventually joined to exon 2.