Effect of Transport Time of up to 12 Hours on Welfare of Cows and Bulls

The aim of the study was to investigate the effects of transport time up to 12 h on welfare of bulls and cows. Cattle transport vehicle was used for the experiment. Sensors to measure temperature, relative humidity and video camera to monitor behaviour were mounted in observation pen. Eighteen measurements were performed during summer and winter for 4, 8, and 12 h transport time with three replications. To determine cortisol, glucose, lactate, and creatine kinase concentrations, blood samples were collected before and after transport from 80 bulls, 82 cows and 20 control animals. Cortisol concentration was generally inversely proportional to transport time (P < 0.001). Glucose concentration for cows was the highest at 12 h and the lowest at 8 h and for bulls it increased with transport time (P < 0.002). Lactate level generally correlated with transport time (P < 0.001), but for bulls the highest and the lowest were at 8 and 4 h in winter. Creatine kinase concentration positively correlated with transport time for bulls and cows but at different rates. Loss of balance and swaying strongly correlated with transport time (P < 0.002). Based on behaviour, stress hormones and pH values, an increase from 4 to 8 h had a higher effect than from 8 to 12 h transport time on welfare and subsequent meat quality

Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial

Introduction: To evaluate whether alkaline phosphatase (AP) treatment improves renal function in sepsis-induced acute kidney injury (AKI), a prospective, double-blind, randomized, placebo-controlled study in critically ill patients with severe sepsis or septic shock with evidence of AKI was performed.Methods: Thirty-six adult patients with severe sepsis or septic shock according to Systemic Inflammatory Response Syndrome criteria and renal injury defined according to the AKI Network criteria were included. Dialysis intervention was standardized according to Acute Dialysis Quality Initiative consensus. Intravenous infusion of alkaline phosphatase (bolus injection of 67.5 U/kg body weight followed by continuous infusion of 132.5 U/kg/24 h for 48 hours, or placebo) starting within 48 hours of AKI onset and followed up to 28 days post-treatment. The primary outcome variable was progress in renal function variables (endogenous creatinine clearance, requirement and duration of renal replacement therapy, RRT) after 28 days. The secondary outcome variables included changes in circulating inflammatory mediators, urinary excretion of biomarkers of tubular injury, and safety.Results: There was a significant (P = 0.02) difference in favor of AP treatment relative to controls for the primary outcome variable. Individual renal parameters showed that endogenous creatinine clearance (baseline to Day 28) was significantly higher in the treated group relative to placebo (from 50 ± 27 to 108 ± 73 mL/minute (mean ± SEM) for the AP group; and from 40 ± 37 to 65 ± 30 mL/minute for placebo; P = 0.01). Reductions in RRT requirement and duration did not reach significance. The results in renal parameters were supported by significantly more pronounced reductions in the systemic markers C-reactive protein, Interleukin-6, LPS-binding protein and in the urinary excretion of Kidney Injury Molecule-1 and Interleukin-18 in AP-treated patients relative to placebo. The Drug Safety Monitoring Board did not raise any issues throughout the trial.Conclusions: The improvements in renal function suggest alkaline phosphatase is a promising new treatment for patients with severe sepsis or septic shock with AKI.Trial Registration: www.clinicaltrials.gov: NCTNCT00511186. © 2012 Pickkers et al.; licensee BioMed Central Ltd

Population pharmacokinetics at two dose levels and pharmacodynamic profiling of flucloxacillin

Flucloxacillin is often used for the treatment of serious infections due to sensitive staphylococci. The pharmacokinetic (PK)-pharmacodynamic (PD) breakpoint of flucloxacillin has not been determined by the use of population PK. Targets based on the duration of non-protein-bound concentrations above the MIC (fT(> MIC)) best correlate with clinical cure rates for beta-lactams. We compared the breakpoints for flucloxacillin between several dosage regimens. In a randomized, two-way crossover study, 10 healthy volunteers received 500 mg and 1,000 mg flucloxacillin as 5-min intravenous infusions. Drug concentrations were determined by high-pressure liquid chromatography. We used the programs WinNonlin for noncompartmental analysis and statistics and NONMEM for population PK and Monte Carlo simulation. We compared the probability of target attainment (PTA) for intermittent- and continuous-dosage regimens based on the targets of fT(> MIS)s of >= 50% and >= 30% of the dosing interval. The clearance and the volume of distribution were very similar after the administration of 500 mg and 1,000 mg flucloxacillin. We estimated renal and nonrenal clearances of 5.37 liters/h (coefficient of variation, 19%) and 2.73 liters/h (33%). For near maximal killing (target, fT(> MIC) of >= 50%) flucloxacillin showed a robust (>= 90%) PTA up to MICs of 0.75 to 1 mg/liter (PTA of 860/v at 1 mg/liter) for a continuous or a prolonged infusion of 6 g/day. Short-term infusions of 6 g/day had a lower breakpoint of 0.25 to 0.375 mg/liter. The flucloxacillin PK was linear for doses of 500 mg and 1,000 mg. Prolonged and continuous infusion at a 66% lower daily dose achieved the same PK-PD breakpoints as short-term infusions. Prolonged infusion and continuous infusion are appealing options for the treatment of serious infections caused by sensitive staphylococci

Clinical population pharmacokinetics and toxicodynamics of linezolid

Thrombocytopenia is a common side effect of linezolid, an oxazolidinone antibiotic often used to treat multidrug-resistant Gram-positive bacterial infections. Various risk factors have been suggested, including linezolid dose and duration of therapy, baseline platelet counts, and renal dysfunction; still, the mechanisms behind this potentially treatment-limiting toxicity are largely unknown. A clinical study was conducted to investigate the relationship between linezolid pharmacokinetics and toxico-dynamics and inform strategies to prevent and manage linezolid-associated toxicity. Forty-one patients received 42 separate treatment courses of linezolid (600 mg every 12 h). A new mechanism-based, population pharmacokinetic/toxicodynamic model was developed to describe the time course of plasma linezolid concentrations and platelets. A linezolid concentration of 8.06 mg/ liter (101% between-patient variability) inhibited the synthesis of platelet precursor cells by 50%. Simulations predicted treatment durations of 5 and 7 days to carry a substantially lower risk than 10- to 28-day therapy for platelet nadirs o

Performance assessment and clinical validation of OR ventilation systems

Microbiological burden of room-air in operating theatres is a known risk factor for surgical site infections. However, it is unclear how to best evaluate efficacy and efficiency under routine clinical conditions. Moreover, there still is a lack of data to assess the impact on infection rates. To date there still is substantial discussion in the scientific community which ventilation system provides the most effective and economical respectively efficient control of microbial risk factors during surgery. This is especially important as most standards do not require a performance assessment of the operating room ventilation, but rather rely on tests “at rest” in empty rooms. This might be an explanation for the conflicting results regarding infection preventive effects of different OR ventilation systems as well as the ambiguous data for infection rates. Since the release of the latest version of DIN 1946-4 in 2018 in Germany [DIN, 2018] a positioning analysis (worst-case scenario with the largest space requirement) for determining the required protected area in class 1a (highest standard) operating rooms is also mandatory. Therefore, another key point of this investigation was to use typical workflow scenarios to assess existing installations regarding the match of the required and the built size of the protected area. Positioning analyses were done together with the onsite staff for various clinical procedures in different hospitals. In all cases, the positioning analysis revealed that required protected areas need to be significantly larger than provided by the existing setup. The size of the protected area that is actually required can only be determined by individual positioning analysis. Most existing installations of unidirectional flow systems (UDF) are likely to be too small. The larger protected areas actually require significantly larger rooms in order to maintain proper thermodynamics. Furthermore, significantly higher volumetric flow rates are required. Finally, the current mismatch between actual and necessary protected area would be a possible explanation for the controversial data situation regarding the infection preventive effects of UDF systems. Thus, we aimed to evaluate how different widely used qualification techniques as well as several operational parameters impact OR ventilation performance assessment. We specifically studied the desired effect of reducing microbiological air burden and infection rates under routine clinical conditions. Therefore, we evaluated the performance of a temperature controlled ventilation system (TcAF) during surgery and its impact on surgical site infections. This was done under routine clinical conditions in 10 clinical installations of the TcAF system Opragon (Avidicare AB, Sweden) during live surgeries according to the Swedish SIS TS 39: 2015 standard. Furthermore, a retrospective analysis of 1,000 consecutive cases of primary total joint arthroplasty (hip, knee) before and 1000 after installation of the TcAF system was performed. Endpoints for clinical outcome were length of stay and infection rates. Our results show that performance testing is essential for a proper assessment of OR ventilation systems. Moreover, we demonstrated that TcAF systems are able to reliably and robustly ensure "ultra-clean" air (<10 CFU/m3) in the entire operating room demonstrating its capability to reduce the risk of airborne microbial transmission during surgery. The retrospective analysis of clinical patient data shows positive impact of TcAF on key clinical outcome parameters in line with previous research by Charnley and Lidwell.publishedVersio

The combination of colistin and doripenem is synergistic against Klebsiella pneumoniae at multiple inocula and suppresses colistin resistance in an in vitro pharmacokinetic/pharmacodynamic model

There has been a resurgence of interest in aerosolization of antibiotics for treatment of patients with severe pneumonia caused by multidrug-resistant pathogens. A combination formulation of amikacin-fosfomycin is currently undergoing clinical testing although the exposure-response relationships of these drugs have not been fully characterized. The aim of this study was to describe the individual and combined antibacterial effects of simulated epithelial lining fluid exposures of aerosolized amikacin and fosfomycin against resistant clinical isolates of Pseudomonas aeruginosa (MICs of 16 mg/liter and 64 mg/liter) and Klebsiella pneumoniae (MICs of 2 mg/liter and 64 mg/liter) using a dynamic hollow-fiber infection model over 7 days. Targeted peak concentrations of 300 mg/liter amikacin and/or 1,200 mg/liter fosfomycin as a 12-hourly dosing regimens were used. Quantitative cultures were performed to describe changes in concentrations of the total and resistant bacterial populations. The targeted starting inoculum was 10(8) CFU/ml for both strains. We observed that neither amikacin nor fosfomycin monotherapy was bactericidal against P. aeruginosa while both were associated with rapid amplification of resistant P. aeruginosa strains (about 10(8) to 10(9) CFU/ml within 24 to 48 h). For K. pneumoniae, amikacin but not fosfomycin was bactericidal. When both drugs were combined, a rapid killing was observed for P. aeruginosa and K. pneumoniae (6-log kill within 24 h). Furthermore, the combination of amikacin and fosfomycin effectively suppressed growth of resistant strains of P. aeruginosa and K. pneumoniae In conclusion, the combination of amikacin and fosfomycin was effective at maximizing bacterial killing and suppressing emergence of resistance against these clinical isolates