Exhaled nitric oxide (NO) remains a promising noninvasive index for monitoring inflammatory lung diseases; however, the plateau concentration (C NO,plat ) is nonspecific and requires a constant exhalation flow rate. We utilized a new technique that employs a variable flow rate to estimate key flow-independent parameters characteristic of NO exchange in a group (n ϭ 9) of 10 to 14 yr-old healthy children and children with cystic fibrosis (CF): maximum flux of NO from the airways (J NO,max , pl s

Currently accepted techniques utilize the plateau concentration of nitric oxide (NO) at a constant exhalation flow rate to characterize NO exchange, which cannot sufficiently distinguish airway and alveolar sources. Using nonlinear least squares regression and a two-compartment model, we recently described a new technique (Tsoukias et al. J Appl Physiol 91: 477–487, 2001), which utilizes a preexpiratory breath hold followed by a decreasing flow rate maneuver, to estimate three flow-independent NO parameters: maximum flux of NO from the airways ( J NO,max, pl/s), diffusing capacity of NO in the airways ( D NO,air, pl · s−1 · ppb−1), and steady-state alveolar concentration (Calv,ss, ppb). In healthy adults ( n = 10), the optimal breath-hold time was 20 s, and the mean (95% intramaneuver, intrasubject, and intrapopulation confidence interval) J NO,max, D NO,air, and Calv,ss are 640 (26, 20, and 15%) pl/s, 4.2 (168, 87, and 37%) pl · s−1 · ppb−1, and 2.5 (81, 59, and 21%) ppb, respectively. J NO,maxcan be estimated with the greatest certainty, and the variability of all the parameters within the population of healthy adults is significant. There is no correlation between the flow-independent NO parameters and forced vital capacity or the ratio of forced expiratory volume in 1 s to forced vital capacity. With the use of these parameters, the two-compartment model can accurately predict experimentally measured plateau NO concentrations at a constant flow rate. We conclude that this new technique is simple to perform and can simultaneously characterize airway and alveolar NO exchange in healthy adults with the use of a single breathing maneuver.

The outer membrane protein (OMP) OprD is the major channel through which carbapenems permeate the outer membrane of Pseudomonas aeruginosa. In this study, we analyzed the OMP profiles of several P. aeruginosa clinical isolates showing diminished susceptibility to imipenem while remaining susceptible to meropenem. All these isolates lacked OprD or showed a reduced expression of this porin. Susceptibility to meropenem was thus independent of the level of OprD expression, indicating that the antimicrobial could be taken up via an alternative route. The level of expression of OprC (70 kD) was also unrelated to meropenem susceptibility. Nevertheless, OMPs OprF and OprE were expressed by all isolates, suggesting that in the absence of OprD, these porins might be involved in the permeation of meropenem.

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RESUMEN Se describe el caso de un paciente que consultó por hipoestesia mentoniana que en el curso evolutivo resultó ser secundario a un carcinoma de pulmón. Los procesos linfoproliferativos, el cáncer de mama y el de pulmón son los procesos neoplásicos que más frecuentemente se asocian con neuropatía mentoniana. La presencia de una neuropatía mentoniana, lejos de ser considerada un síntoma "banal", debe alertar al clínico de la presencia de cáncer e iniciar su búsqueda de forma inmediata. PALABRAS CLAVE: Neuropatía mentoniana. Cáncer. Caso clínico. Revisión.

Previously, it has been postulated that the porin OprC facilitates the diffusion of ceftazidime through the outer membrane of Pseudomonas aeruginosa. To further investigate this claim, the outer membrane protein (OMP) profiles of 22 ceftazidime-susceptible clinical isolates were analyzed. No correlation was found between MIC values and the level of expression of OprC. Further, OprC was either undetectable or expressed in reduced amounts in 12 isolates. In contrast, OprF and OprE were present in all isolates studied. This study suggests that OprC is dispensable for the permeation of ceftazidime through the outer membrane of P. aeruginosa.

Conclusion. To our knowledge, these are the first systematic data showing bacteremia by Enterobacter spp. with discordant ertapenem and imipenem/meropenem susceptibilities is not infrequent; interestingly, ertapenem susceptible/imipenem non-susceptible was more common than ertapenem non-susceptible/imipenem susceptible isolates. Bacteremia by Enterobacter isolates with discordant carbapenem results were rapidly cleared and no difference in mortality was detected.Disclosures. All authors: No reported disclosures. Trends in the Incidence of Bacteremia with Carbapenem Non-susceptibleAcinetobacter spp. in

RESUMENLos autores desarrollan en este artículo los factores que a su juicio explican actualmente la complejidad de la asistencia urgente y emergente en España. Desde el inicio del siglo XXI, y a pesar de que la medicina de urgencias y emergencias en el mundo está viviendo un considerable progreso científico-técnico, la asistencia urgente en España está inmersa en una vorágine asistencial que actúa sobre un terreno poco abonado para que arraiguen y se desarrollen los avances tecnológi-cos que sucesivamente van emergiendo. Este problema es debido a la persistencia de múltiples obstáculos que impiden el progreso incidiendo, principalmente y de manera directa, la ausencia de especialidad y el corporativismo de las juntas directivas de algunas sociedades científicas. Por todo ello, los avances son propiciados frecuentemente más por la propia inercia o por el rebosamiento de información desde otras disciplinas, que por el propio empuje de los profesionales de la medicina de urgencias y emergencias en España. Asimismo, estos profesionales presentan una progresiva incidencia de transfuguismo hacia otras disciplinas o ámbitos de la asistencia que ofrecen mejores condiciones laborales o simplemente mayores expectativas profesionales.Palabras clave. Urgencias. Gestión. Complejidad asistencial. Atención sanitaria. Emergencias. ABSTRACTIn this article, the authors explore the factors that, in their opinion, currently explain the complexity of emergency care in Spain. Since the start of the XXI century, and in spite of the fact that accident and emergency medicine in the world is undergoing considerable scientific-technical progress, accident and emergency care in Spain is immersed in a care maelstrom acting on a terrain that is ill-prepared for the successive emergent technological advances to take root and develop. This problem is due to the persistence of numerous obstacles preventing progress, with the lack of specialisation and the corporative spirit of the management boards of some scientific societies playing a principal and direct role in this. Due to all of this, advances are frequently achieved more through inertia, or through the overflow of information from other disciplines, than due to the initiative of the professionals of emergency medicine in Spain. Similarly, there is a growing tendency amongst these professionals to move to other disciplines or fields of care that offer better working conditions or simply better professional expectations.