Integrated analysis of CANVAS 1 and 2: phase 3, multicenter, randomized, double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skin-structure infection.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of complicated skin and skin-structure infection (cSSSI). Increasing antimicrobial resistance in cSSSI has led to a need for new safe and effective therapies. Ceftaroline was evaluated as treatment for cSSSI in 2 identical phase 3 clinical trials, the pooled analysis of which is presented here. The primary objective of each trial was to determine the noninferiority of the clinical cure rate achieved with ceftaroline monotherapy, compared with that achieved with vancomycin plus aztreonam combination therapy, in the clinically evaluable (CE) and modified intent-to-treat (MITT) patient populations. METHODS: Adult patients with cSSSI requiring intravenous therapy received ceftaroline (600 mg every 12 h) or vancomycin plus aztreonam (1 g each every 12 h) for 5-14 days. RESULTS: Of 1378 patients enrolled in both trials, 693 received ceftaroline and 685 received vancomycin plus aztreonam. Baseline characteristics of the treatment groups were comparable. Clinical cure rates were similar for ceftaroline and vancomycin plus aztreonam in the CE (91.6% vs 92.7%) and MITT (85.9% vs 85.5%) populations, respectively, as well as in patients infected with MRSA (93.4% vs 94.3%). The rates of adverse events, discontinuations because of an adverse event, serious adverse events, and death also were similar between treatment groups. CONCLUSIONS: Ceftaroline achieved high clinical cure rates, was efficacious against cSSSI caused by MRSA and other common cSSSI pathogens, and was well tolerated, with a safety profile consistent with the cephalosporin class. Ceftaroline has the potential to provide a monotherapy alternative for the treatment of cSSSI. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00424190 for CANVAS 1 and NCT00423657 for CANVAS 2.

Variability in phenotype induced by the podocin variant R229Q plus a single pathogenic mutation.

BACKGROUND: Mutations in podocin (NPHS2) are the most common cause of childhood onset autosomal recessive steroid-resistant nephrotic syndrome (SRNS). The disease is characterized by early-onset proteinuria, resistance to immunosuppressive therapy and rapid progression to end-stage renal disease. Compound heterozygous changes involving the podocin variant R229Q combined with another pathogenic mutation have been associated with a mild phenotype with disease onset often in adulthood. METHODS: We screened 19 families with early-onset SRNS for mutations in NPHS2 and WT1 and identified four disease-causing mutations (three in NPHS2 and one in WT1) prior to planned whole-exome sequencing. RESULTS: We describe two families with three individuals presenting in childhood who are compound heterozygous for R229Q and one other pathogenic NPHS2 mutation, either L327F or A297V. One child presented at age 4 years (A297V plus R229Q) and the other two at age 13 (L327F plus R229Q), one with steadily deteriorating renal function. CONCLUSIONS: These cases highlight the phenotypic variability associated with the NPHS2 R229Q variant plus pathogenic mutation. Individuals may present with early aggressive disease.

Dolutegravir plus Abacavir-Lamivudine for the treatment of HIV-1 infection

BACKGROUND: Dolutegravir (S/GSK1349572), a once-daily, unboosted integrase inhibitor, was recently approved in the United States for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents. Dolutegravir, in combination with abacavir-lamivudine, may provide a simplified regimen. METHODS: We conducted a randomized, double-blind, phase 3 study involving adult participants who had not received previous therapy for HIV-1 infection and who had an HIV-1 RNA level of 1000 copies per milliliter or more. Participants were randomly assigned to dolutegravir at a dose of 50 mg plus abacavir-lamivudine once daily (DTG-ABC-3TC group) or combination therapy with efavirenz-tenofovir disoproxil fumarate (DF)-emtricitabine once daily (EFV-TDF-FTC group). The primary end point was the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter at week 48. Secondary end points included the time to viral suppression, the change from baseline in CD4+ T-cell count, safety, and viral resistance. RESULTS: A total of 833 participants received at least one dose of study drug. At week 48, the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter was significantly higher in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (88% vs. 81%, P = 0.003), thus meeting the criterion for superiority. The DTG-ABC-3TC group had a shorter median time to viral suppression than did the EFV-TDF-FTC group (28 vs. 84 days, P<0.001), as well as greater increases in CD4+ T-cell count (267 vs. 208 per cubic millimeter, P<0.001). The proportion of participants who discontinued therapy owing to adverse events was lower in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (2% vs. 10%); rash and neuropsychiatric events (including abnormal dreams, anxiety, dizziness, and somnolence) were significantly more common in the EFV-TDF-FTC group, whereas insomnia was reported more frequently in the DTG-ABC-3TC group. No participants in the DTG-ABC-3TC group had detectable antiviral resistance; one tenofovir DF-associated mutation and four efavirenz-associated mutations were detected in participants with virologic failure in the EFV-TDF-FTC group. CONCLUSIONS: Dolutegravir plus abacavir-lamivudine had a better safety profile and was more effective through 48 weeks than the regimen with efavirenz-tenofovir DF-emtricitabine. Copyright © 2013 Massachusetts Medical Society.

La calculadora TI 92 plus y el CBR en la modelación del movimiento pendular

La introducción a la clase de matemáticas de la calculadora TI 92 Plus y otros dispositivos, tales como el CBR, están generando una nueva cultura matemática, caracterizar algunos rasgos de éste fenómeno educativo en la modelación del movimiento pendular es el propósito central de la presente investigación. El trabajo de los estudiantes permitió observar en la práctica los constitutivos del marco teórico del proyecto de incorporación de nuevas tecnologías al currículo de matemáticas de Colombia, como son: mediación instrumental, representaciones ejecutables, cognición situada, solución de problemas, fluidez algorítmica y fluidez conceptual.

Enseñanza de la trigonometría partiendo de la proporcionalidad, mediante la implementación de la calculadora TI-92 plus: una experiencia en el aula

En el trabajo que hemos venido realizando en las pasantías de extensión, pretendemos desarrollar parte de la trigonometría desde la época griega hasta la actualidad; tomando como eje central la proporcionalidad, basados en una metodología de resolución de problemas e implementado la calculadora T.I.- 92 Plus en el aula. Para llevar a cabo este proyecto, diseñamos una serie de actividades enfocadas a desarrollar el concepto de proporcionalidad, trabajando desde la semejanza de triángulos. Este enfoque permite al estudiante, por medio de sus experiencias, construir un conjunto de herramientas que le contribuya no sólo enfrentarse a una situación problema, sino que también le ayude a desarrollar su comprensión y habilidad matemáticas.

Cabri II Plus como herramienta para la enseñanza de las isometrías

La incorporación en la vida cotidiana de las nuevas tecnologías de la información y la comunicación ha significado un cambio radical en la forma de desarrollar el proceso de enseñanza y aprendizaje en las diferentes disciplinas y niveles escolares. En este sentido, el software de geometría dinámica “Cabri Géomètre II Plus” es un programa computacional de fácil manipulación, amigable y de rápido aprendizaje, que permite a los estudiantes visualizar, descubrir, conjeturar y/o comprobar propiedades que se deseen trabajar. El presente artículo tiene como finalidad mostrar actividades en el tema de transformaciones isométricas y que se pueden desarrollar con el uso de Cabri II Plus, y que permiten el desarrollo del pensamiento geométrico.

Actividades elementales en la calculadora graficadora (Ti - 89, Ti – 92 Plus, Voyage 200)

Actualmente la influencia que tiene la tecnología en la Educación Matemática como medio facilitador tanto en el proceso de aprendizaje como en el de enseñanza de algunas temáticas de las matemáticas escolares, ha generado su inclusión en las instituciones educativas como es el caso, de las calculadoras graficadoras. No obstante, en general son varios los profesores de matemáticas que aunque cuentan con este tipo de recursos para desarrollar sus clases, se abstienen de utilizarlos porque no saben cómo ni en qué momento hacerlo. Por tanto, se presenta algunas actividades sobre ciertas temáticas de la matemática escolar en donde sea factible el uso de herramientas básicas de la calculadora.

[Performance review] Philip Glass, Galileo Galilei

Review of the European premiere of the opera Galileo Galilei by Philip Glass performed at The Goodman Theatre, Barbican Centre, London in November 2002.

Role of bonding time and temperature on the physical properties of coupled anisotropic conductive–nonconductive adhesive film for flip chip on glass technology

Using thermosetting epoxy based conductive adhesive films for the flip chip interconnect possess a great deal of attractions to the electronics manufacturing industries due to the ever increasing demands for miniaturized electronic products. Adhesive manufacturers have taken many attempts over the last decade to produce a number of types of adhesives and the coupled anisotropic conductive-nonconductive adhesive film is one of them. The successful formation of the flip chip interconnection using this particular type of adhesive depends on, among factors, how the physical properties of the adhesive changes during the bonding process. Experimental measurements of the temperature in the adhesive have revealed that the temperature becomes very close to the required maximum bonding temperature within the first 1s of the bonding time. The higher the bonding temperature the faster the ramp up of temperature is. A dynamic mechanical analysis (DMA) has been carried out to investigate the nature of the changes of the physical properties of the coupled anisotropic conductive-nonconductive adhesive film for a range of bonding parameters. Adhesive samples that are pre-cured at 170, 190 and 210°C for 3, 5 and 10s have been analyzed using a DMA instrument. The results have revealed that the glass transition temperature of this type of adhesive increases with the increase in the bonding time for the bonding temperatures that have been used in this work. For the curing time of 3 and 5s, the maximum glass transition temperature increases with the increase in the bonding temperature, but for the curing time of 10s the maximum glass transition temperature has been observed in the sample which is cured at 190°C. Based on these results it has been concluded that the optimal bonding temperature and time for this kind of adhesive are 190°C and 10s, respectively.

The influence of alkali metal chlorides on the loss of water from glass-ionomer dental cements

The water loss behaviour of a clinical glass-ionomer dental cement has been studied with and without the addition of alkali metal chlorides. Dehydrating conditions were provided by placing specimens in a desiccator over concentrated sulphuric acid. Cements were prepared using either pure water or an aqueous solution of metal chloride (LiCl, NaCl, KCl) at 1.0 mol/dm(3). In addition, NaCl at 0.5 mol/dm(3) was also used to fabricate cements. Disc-shaped specimens of size 6 mm diameter x 2 mm thickness were made, six performulation, and cured at 37 degrees C for 1 hour They were then exposed to desiccating conditions, and the mass measured at regular intervals. All formulations were found to lose water in a diffusion process that equilibrated after approximately 3 weeks. Diffusion coefficients ranged from 2.27 (0.13) x 10(9) with no additive to 1.85 (0.07) x 10(9) m(2)/s with 1.0 mol/dm(3) KCl. For the salts, diffusion coefficients decreased in the order LiCl > NaCl > KCl. There was no statistically significant difference between the diffusion coefficients for 1.0 and 0.5 mol/dm(3) NaCl. For all salts at 1.0 mol/dm(3) and also additive-free cements, equilibrium losses were, with statistical limits, the same, ranging from 6.23 to 6.34%. On the other hand, 0.5 mol/dm(3) NaCl lost significantly more water 7.05%.

Review paper: role of aluminum in glass-ionomer dental cements and its biological effects

The role of aluminum in glass-ionomers and resin-modified glass-ionomers for dentistry is reviewed. Aluminum is included in the glass component of these materials in the form of Al(2)O(3) to confer basicity on the glass and enable the glass to take part in the acid-base setting reactions. Results of studies of these reactions by FTIR and magic-angle spinning (MAS)-NMR spectroscopy are reported and the role of aluminum is discussed in detail. Aluminum has been shown to be present in the glasses in predominantly 4-coordination, as well as 5- and 6-coordination, and during setting a proportion of this is converted to 6-coordinate species within the matrix of the cement. Despite this, mature cements may contain detectable amounts of both 4- and 5-coordinate aluminum. Aluminum has been found to be leached from glass-ionomer cements, with greater amounts being released under acidic conditions. It may be associated with fluoride, with which it is known to complex strongly. Aluminum that enters the body via the gastro-intestinal tract is mainly excreted, and only about 1% ingested aluminum crosses the gut wall. Calculation shows that, if a glass-ionomer filling dissolved completely over 5 years, it would add only an extra 0.5% of the recommended maximum intake of aluminum to an adult patient. This leads to the conclusion that the release of aluminum from either type of glass-ionomer cement in the mouth poses a negligible health hazard.

The biocompatibility of resin-modified glass-ionomer cements for dentistry

OBJECTIVES: The biological effects of resin-modified glass-ionomer cements as used in clinical dentistry are described, and the literature reviewed on this topic. METHODS: Information on resin-modified glass-ionomers and on 2-hydroxyethyl methacrylate (HEMA), the most damaging substance released by these materials, has been collected from over 50 published papers. These were mainly identified through Scopus. RESULTS: HEMA is known to be released from these materials and has a variety of damaging biological properties, ranging from pulpal inflammation to allergic contact dermatitis. These are therefore potential hazards from resin-modified glass-ionomers. However, clinical results with these materials that have been reported to date are generally positive. CONCLUSIONS/SIGNIFICANCE: Resin-modified glass-ionomers cannot be considered biocompatible to nearly the same extent as conventional glass-ionomers. Care needs to be taken with regard to their use in dentistry and, in particular, dental personnel may be at risk from adverse effects such as contact dermatitis and other immunological responses.

Kinetic studies of water uptake and loss in glass-ionomer cements

The water sorption and desorption behaviour of three commercial glass-ionomer cements used in clinical dentistry have been studied in detail. Cured specimens of each material were found to show slight but variable water uptake in high humidity conditions, but steady loss in desiccating ones. This water loss was found to follow Fick's law for the first 4-5 h. Diffusion coefficients at 22 degrees C were: Chemflex 1.34 x 10(-6) cm(2) s(-1), Fuji IX 5.87 x 10(-7) cm(2) s(-1), Aquacem 3.08 x 10(-6) cm(2) s(-1). At 7 degrees C they were: Chemflex 8.90 x 10(-7) cm(2) s(-1), Fuji IX 5.04 x 10(-7) cm(2) s(-1), Aquacem 2.88 x 10(-6) cm(2) s(-1). Activation energies for water loss were determined from the Arrhenius equation and were found to be Chemflex 161.8 J mol(-1), Fuji IX 101.3 J mol(-1), Aquacem 47.1 J mol(-1). Such low values show that water transport requires less energy in these cements than in resin-modified glass-ionomers. Fick's law plots were found not to pass through the origin. This implies that, in each case, there is a small water loss that does not involve diffusion. This was concluded to be water at the surface of the specimens, and was termed "superficial water". As such, it represents a fraction of the previously identified unbound (loose) water. Superficial water levels were: Chemflex 0.56%, Fuji IX 0.23%, Aquacem 0.87%. Equilibrium mass loss values were shown to be unaffected by temperature, and allowed ratios of bound:unbound water to be determined for all three cements. These showed wide variation, ranging from 1:5.26 for Chemflex to 1:1.25 for Fuji IX.

Water transport in resin-modified glass-ionomer dental cement

Water uptake and water loss have been studied in a commercial resin-modified glass-ionomer cement, Fuji II LC, under a variety of conditions. Uptake was generally non-Fickian, but affected by temperature. At room temperature, the equilibrium water uptake values varied from 2.47 to 2.78% whereas at low temperature (12 degrees C), it varied from 0.85 to 1.18%. Cure time affected uptake values significantly. Water uptake was much lower than in conventional glass-ionomer restorative cements exposed to water vapor. Loss of water under desiccating conditions was found to be Fickian for the first 5 h loss at both 22 and 12 degrees C. Diffusion coefficients were between 0.45 and 0.76 x 10( -7) cm(2)/s, with low temperature diffusion coefficients slightly greater than those at room temperature. Plotting water loss as percentage versus s(-(1/2)) allowed activation energies to be determined from the Arrhenius equation and these were found to be 65.6, 79.8, and 7.7 kJ/mol respectively for 30, 20, and 10 s cure times. The overall conclusion is that the main advantage of incorporating HEMA into resin-modified-glass-ionomers is to alter water loss behavior. Rate of water loss and total amount lost are both reduced. Hence, resin-modified glass-ionomers are less sensitive to water loss than conventional glass-ionomers.