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Strojnik K, Mahkovic-Hergouth K, Novakovic BJ, Seruga B. Outcome of severe infections in afebrile neutropenic cancer patients. Radiol Oncol 2016; 50:442-448. [PMID: 27904453 PMCID: PMC5120576 DOI: 10.1515/raon-2016-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/05/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. PATIENTS AND METHODS We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher's exact test. RESULTS We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). CONCLUSIONS Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy.
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Affiliation(s)
- Ksenija Strojnik
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
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12102
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Iba T. Bleeding complications of anticoagulant therapy in sepsis-induced disseminated intravascular coagulation. Crit Care 2016; 20:307. [PMID: 27677585 PMCID: PMC5039791 DOI: 10.1186/s13054-016-1464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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12103
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Laine O, Joutsi-Korhonen L, Lassila R, Huhtala H, Vaheri A, Mäkelä S, Mustonen J. Elevated thrombopoietin and platelet indices confirm active thrombopoiesis but fail to predict clinical severity of puumala hantavirus infection. Medicine (Baltimore) 2016; 95:e5689. [PMID: 28033261 PMCID: PMC5207557 DOI: 10.1097/md.0000000000005689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We evaluated the mechanisms of thrombocytopenia and procoagulant changes in relation with clinical variables in a cohort of patients with acute hantavirus disease.Blood samples of 33 prospectively recruited, consecutive, hospitalized patients with acute Puumala virus-induced hemorrhagic fever with renal syndrome (HFRS) were collected acutely and at the recovery visit (control). Serum thrombopoietin (TPO) and activity of plasma microparticles (MPs) from various cell sources were measured with enzyme-linked immunosorbent assay-based methods. The results were related to data on platelet indices and functions, coagulation variables, and clinical disease.Serum TPO was nearly 4-fold higher acutely compared with the control (median 207 pg/mL, range 56-1258 pg/mL vs. median 58 pg/mL, range 11-241 pg/mL, P < 0.001) and coincided with high mean platelet volume (MPV) and immature platelet fraction (IPF%). Prothrombin fragments and D-dimer were high acutely compared with the control (F1 + 2 median 704 pmol/L, range 284-1875 pmol/L vs. median 249 pmol/L, range 118-556 pmol/L, P < 0.001; D-dimer median 2.8 mg/L, range 0.6-34.0 mg/L vs. median 0.4 mg/L, range 0.2-1.1 mg/L, P < 0.001), and associated with low platelet count and severe acute kidney injury (AKI). MPs' procoagulant activity was high acutely only among patients with mild AKI (plasma creatinine below the median at the time of the measurement).Upregulated TPO together with high MPV and IPF% confirm active thrombopoiesis, but do not predict severity of HFRS. Simultaneously, elevated prothrombin fragments and D-dimer suggest increased consumption of platelets in patients with severe AKI. Activity of platelet-derived MPs in HFRS should be studied with flow cytometry in a larger cohort of patients.
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Affiliation(s)
- Outi Laine
- Department of Internal Medicine, Tampere University Hospital
- School of Medicine, University of Tampere, Tampere
| | - Lotta Joutsi-Korhonen
- Coagulation Disorders Unit, Clinical Chemistry, HUSLAB Laboratory Services, Helsinki University Hospital
| | - Riitta Lassila
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Helsinki University, and Helsinki University Hospital, Helsinki
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere
| | - Antti Vaheri
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital
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12104
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Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation. Shock 2016; 46:623-631. [DOI: 10.1097/shk.0000000000000727] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12105
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Ghanekar S, Corey S, Lippert T, Borlongan CV. Pathological links between stroke and cardiac arrest. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0056-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12106
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Templin T, Sharma P, Guida P, Grabham P. Short-Term Effects of Low-LET Radiation on the Endothelial Barrier: Uncoupling of PECAM-1 and the Production of Endothelial Microparticles. Radiat Res 2016; 186:602-613. [PMID: 27905868 DOI: 10.1667/rr14510.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A significant target for radiation-induced effects is the microvascular system, which is critical to healthy tissue function and its pathology is linked to disrupted endothelial barrier function. Low-linear energy transfer (LET) ionizing radiation is a source of noncancer pathologies in humans and little is known about the early events that could initiate subsequent diseases. However, it is well known that gamma radiation causes a very early disruption of the endothelial barrier at doses below those required for cytotoxic effects. After irradiation of human umbilical vein endothelial cells (HUVECs) to doses as low as 2 Gy, transendothelial electrical resistance (TEER) is transiently reduced at 3 h, and the platelet-derived endothothelial cell adhesion molecule (PECAM-1 or CD31) is uncoupled from the cells along with the release of endothelial microparticles (EMPs). In this study, we measured TEER reduction as an indicator of barrier function loss, and specifically examined the shedding of EMPs from human endothelial barrier models after a variety of low-LET irradiations, including photons and charged particles. Our findings showed two TEER responses, dependent on radiation type and environmental conditions. The first response was diminishing oscillations of TEER, which occurred during the first 10 h postirradiation. This response occurred after a 5 Gy proton or helium-ion (1 GeV/n) dose in addition to a 5 Gy gamma or X radiation dose. This occurred only in the presence of multiple growth factors and did not show a dose response, nor was it associated with EMP release. The second response was a single acute drop in TEER at 3 h after photon irradiation. Dose response was observed and was associated with the shedding of EMPs in 2D barrier cultures and in 3D vessel models. In this case, helium-ion and proton irradiations did not induce a drop in TEER or shedding of EMPs. The photon radiation effects was observed both in serum-free media and in the presence of multiple growth factors, indicating that it occurs under a range of environmental conditions. These results show an acute response of the human endothelial barrier that is relevant to photon irradiation. Significantly, it involves the release of EMPs, which have recently attracted attention due to their emerging clinical importance.
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Affiliation(s)
- Thomas Templin
- a Center for Radiological Research, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Preety Sharma
- a Center for Radiological Research, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Peter Guida
- b Brookhaven National Laboratory, Biosciences Department, Upton, New York
| | - Peter Grabham
- a Center for Radiological Research, College of Physicians and Surgeons, Columbia University, New York, New York
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12107
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12108
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Baboi L, Subtil F, Guérin C. A bench evaluation of fraction of oxygen in air delivery and tidal volume accuracy in home care ventilators available for hospital use. J Thorac Dis 2016; 8:3639-3647. [PMID: 28149559 DOI: 10.21037/jtd.2016.12.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Turbine-powered ventilators are not only designed for long-term ventilation at home but also for hospital use. It is important to verify their capabilities in delivering fraction of oxygen in air (FIO2) and tidal volume (VT). METHODS We assessed the FIO2 accuracy and the VT delivery in four home care ventilators (HCV) on the bench. The four HCV were Astral 150, Elisée 150, Monnal T50 and Trilogy 200 HCV, which were connected to a lung model (ASL 5000). For assessing FIO2 accuracy, lung model was set to mimic an obstructive lung and HCV were set in volume controlled mode (VC). They supplied with air, 3 or 15 L/min oxygen and FIO2 was measured by using a ventilator tester (Citrex H4TM). For the VT accuracy, the lung model was set in a way to mimic three adult configurations (normal, obstructive, or restrictive respiratory disorder) and one pediatric configuration. Each HCV was set in VC. Two VT (300 and 500 mL) in adult lung configuration and one 50 mL VT in pediatric lung configuration, at two positive end expiratory pressures 5 and 10 cmH2O, were tested. VT accuracy was measured as volume error (the relative difference between set and measured VT). Statistical analysis was performed by suing one-factor ANOVA with a Bonferroni correction for multiple tests. RESULTS For Astral 150, Elisée 150, Monnal T50 and Trilogy 200, FIO2 averaged 99.2%, 93.7%, 86.3%, and 62.1%, respectively, at 15 L/min oxygen supplementation rate (P<0.001). Volume error was 0.5%±0%, -38%±0%, -9%±0%, -29%±0% and -36%±0% for pediatric lung condition (P<0.001). In adult lung configurations, Monnal T50 systematically over delivered VT and Trilogy 150 was sensitive to lung configuration when VT was set to 300 mL at either positive end-expiratory pressure (PEEP). CONCLUSIONS HCV are different in terms of FIO2 efficiency and VT delivery.
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Affiliation(s)
| | - Fabien Subtil
- Biostatistic Department, Lyon University Hospital, Lyon, France;; University of Lyon, Lyon, France;; Biometry and Evolutionary Biology Laboratory, CNRS 5558, Villeurbanne, France
| | - Claude Guérin
- Medical ICU, Lyon University Hospital, Lyon, France;; University of Lyon, Lyon, France;; INSERM 955, 94010 Créteil cedex, France
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12109
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Marton-Popovici M, Glogar D. New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2016. [DOI: 10.1515/jce-2016-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Out-of-hospital cardiac arrest (OHCA) occurring as the first manifestation of an acute myocardial infarction is associated with very high mortality rates. As in comatose patients the etiology of cardiac arrest may be unclear, especially in cases without ST-segment elevation on the surface electrocardiogram, the decision to perform or not to perform urgent coronary angiography can have a significant impact on the prognosis of these patients. This review summarises the current knowledge and recommendations for treating patients with acute myocardial infarction presenting with OHCA. New therapeutic measures for the post-resuscitation phase are presented, such as hypothermia or extracardiac life support, together with strategies aiming to restore the coronary flow in the resuscitation phase using intra-arrest percutaneous revascularization performed during resuscitation. The role of regional networks in providing rapid access to the hospital facilities and to a catheterization laboratory for these critical cardiovascular emergencies is described.
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Affiliation(s)
- Monica Marton-Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington, United States of America
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12110
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Silvetti S, Crivellari M, Castiglioni A, Landoni G, Zangrillo A, Alfieri O, Koster A, Faraoni D, Bolliger D, Tanaka KA. CASE 12—2016 Ascending Aorta Dissection in a Jehovah’s Witness Patient on Warfarin. J Cardiothorac Vasc Anesth 2016; 30:1709-1715. [DOI: 10.1053/j.jvca.2016.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Indexed: 01/01/2023]
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12111
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Speckle tracking echocardiography: another step towards early detection of septic myocardial dysfunction? Crit Care 2016; 20:236. [PMID: 27535825 PMCID: PMC4989354 DOI: 10.1186/s13054-016-1411-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12112
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Banfi C, Pozzi M, Siegenthaler N, Brunner ME, Tassaux D, Obadia JF, Bendjelid K, Giraud R. Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis 2016; 8:3762-3773. [PMID: 28149575 DOI: 10.21037/jtd.2016.12.88] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection. While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, 'triple' cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO.
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Affiliation(s)
- Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Nils Siegenthaler
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Geneva, Switzerland;; Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Eve Brunner
- Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Tassaux
- Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Karim Bendjelid
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Geneva, Switzerland;; Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Raphaël Giraud
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Geneva, Switzerland;; Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland
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12113
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Abstract
OBJECTIVES To provide a review of the definition, pathophysiology, differential diagnosis, and treatment of disseminated intravascular coagulation (DIC). METHODS A case scenario and a review of the literature related to the pertinent facts concerning DIC are provided. RESULTS DIC is a systemic pathophysiologic process and not a single disease entity, resulting from an overwhelming activation of coagulation that consumes platelets and coagulation factors and causes microvascular fibrin thrombi, which can result in multiorgan dysfunction syndrome from tissue ischemia. Some conditions associated with acute DIC include septic shock, exsanguinating trauma, burns, or acute promyelocytic leukemia. CONCLUSIONS The massive tissue factor stimulus results in excess intravascular thrombin, which overcomes the anticoagulant systems and leads to thrombosis. Because of consumption of coagulation factors and platelets, DIC also has a hemorrhagic phase. Treatment of the bleeding patient with DIC is supportive with the use of blood components.
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Affiliation(s)
| | - Dennis J Williams
- Pathology and Laboratory MedicineUniversity of Kentucky Medical Center, Lexington
| | - Leonard I Boral
- Pathology and Laboratory MedicineUniversity of Kentucky Medical Center, Lexington
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12114
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Hospital characteristics and favourable neurological outcome among patients with out-of-hospital cardiac arrest in Osaka, Japan. Resuscitation 2016; 110:146-153. [PMID: 27893969 DOI: 10.1016/j.resuscitation.2016.11.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/27/2016] [Accepted: 11/13/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA). METHODS This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012. We divided acute care hospitals into CCMCs or non-CCMCs, the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases: low-volume (≤10 cases), middle-volume (11-39 cases), and high-volume (≥40 cases) groups. Random effects logistic regression models, with hospital treated as a random effect, were used to assess factors potentially associated with a favourable neurological outcome. RESULTS A total of 44,474 patients were eligible. The proportions of favourable neurological outcome from OHCA were 0.9% (31/3559) in the low-volume group, 1.2% (106/9171) in the middle-volume group, 1.6% (222/14,007) in the high-volume group, and 4.3% (766/17,737) in the CCMC group (P<0.001). In the multivariable analysis, transport to CCMCs was significantly associated with favourable neurological outcome, compared with transport to non-CCMCs (adjusted odds ratio 1.63; 95% confidence interval, 1.60-1.66). Among the non-CCMC group, there was no significant relationship between hospital volume and favourable neurological outcome. CONCLUSIONS In this population, transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA, whereas no significant association was noted among the hospitals with different volumes.
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12115
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Yang X, Wan M, Liang T, Peng M, Chen F. Synthetic polyphosphate inhibits endogenous coagulation and platelet aggregation in vitro. Biomed Rep 2016; 6:57-62. [PMID: 28123708 DOI: 10.3892/br.2016.816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
Platelet-derived polyphosphate has previously been indicated to induce coagulation. However, industrially synthesized polyphosphate has been found to have different effects from those of the platelet-derived form. The present study investigated whether synthetic sodium polyphosphate inhibits coagulation using routine coagulation tests and thromboelastography. Synthetic polyphosphate was found to inhibit adenosine diphosphate-, epinephrine-, arachidonic acid-, ristocetin-, thrombin-, oxytocin- and pituitrin-induced platelet aggregation. The effects of synthetic polyphosphate in clotting inhibition were revealed by the analysis of clotting factor activity and platelet aggregation tests. Synthetic polyphosphate may inhibit platelet aggregation by reducing platelet calcium levels, as indicated by the results of flow cytometric analysis and high-throughput fluorescent screening. Furthermore, analysis of thromboxane (TX)B2 by ELISA indicated that synthetic polyphosphate reduces platelet aggregation by inhibiting the TXA2 signaling pathway. In conclusion, synthetic polyphosphate inhibits clotting factor activity and endogenous coagulation by reducing the levels of calcium ions and TXA2 to curb platelet aggregation.
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Affiliation(s)
- Xiaoyang Yang
- Department of Hematology, Haikou Municipal Hospital, Affiliated Haikou Hospital of Central South University, Haikou, Hainan 570208, P.R. China; Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Mengjie Wan
- Department of Hematology, Haikou Municipal Hospital, Affiliated Haikou Hospital of Central South University, Haikou, Hainan 570208, P.R. China
| | - Ting Liang
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Minyuan Peng
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Fangping Chen
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China; Department of Hematology, The Third Hospital of Xiangya Central South University, Changsha, Hunan 410013, P.R. China
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12116
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Yuanbo Z, Jin W, Fei S, Liangong L, Xunfa L, Shihai X, Aijun S. ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome. Ann Intensive Care 2016; 6:113. [PMID: 27873292 PMCID: PMC5118373 DOI: 10.1186/s13613-016-0217-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess whether a management algorithm using data obtained with a PiCCO system can improve clinical outcomes in critically ill patients with acute respiratory distress syndrome (ARDS). RESULTS The PaO2/FiO2 ratio increased over time in both groups, with a sharper increase in the PiCCO group. There was no difference in 28-day mortality (3.2 vs. 3.6%, P = 0.841). Days on mechanical ventilation (3 vs. 5 days, P = 0.002) and ICU length of stay (6 vs. 11 days, P = 0.004) were significantly lower in the PiCCO group than in the CVP group. Treatment costs were lower in the PiCCO group than in the CVP group. Multivariate logistic regression model showed that the monitoring method (PiCCO vs. CVP) was independently associated with the length of ICU stay [odds ratio (OR) 3.16, 95% confidence interval (95% CI) 1.55-6.63, P = 0.001], as well as shock (OR 3.41, 95% CI 1.74-6.44, P = 0.002), shock and ARDS (OR 3.46, 95% CI 1.79-6.87, P = 0.002), and APACHE II score (OR 1.17, 95% CI 1.02-1.86, P = 0.014). CONCLUSIONS This study investigated the usefulness of the PiCCO system in improving outcomes for patient with severe thoracic trauma and ARDS and provided new evidence for fluid management in critical care settings.
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Affiliation(s)
- Zhong Yuanbo
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Wang Jin
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Shi Fei
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Long Liangong
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Liu Xunfa
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Xu Shihai
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Shan Aijun
- Emergency Center, Shenzhen People's Hospital, Shenzhen, 518020, China.
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12117
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Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, Blumenthal R, Danesh J, Smith GD, DeMets D, Evans S, Law M, MacMahon S, Martin S, Neal B, Poulter N, Preiss D, Ridker P, Roberts I, Rodgers A, Sandercock P, Schulz K, Sever P, Simes J, Smeeth L, Wald N, Yusuf S, Peto R. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016; 388:2532-2561. [PMID: 27616593 DOI: 10.1016/s0140-6736(16)31357-5] [Citation(s) in RCA: 1182] [Impact Index Per Article: 147.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023]
Abstract
This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment. Large-scale evidence from randomised trials shows that statin therapy reduces the risk of major vascular events (ie, coronary deaths or myocardial infarctions, strokes, and coronary revascularisation procedures) by about one-quarter for each mmol/L reduction in LDL cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg, atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10 000 patients would typically prevent major vascular events from occurring in about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive vascular disease (secondary prevention) and in 500 patients (ie, 5% absolute benefit) who are at increased risk but have not yet had a vascular event (primary prevention). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long term. The only serious adverse events that have been shown to be caused by long-term statin therapy-ie, adverse effects of the statin-are myopathy (defined as muscle pain or weakness combined with large increases in blood concentrations of creatine kinase), new-onset diabetes mellitus, and, probably, haemorrhagic stroke. Typically, treatment of 10 000 patients for 5 years with an effective regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of myopathy (one of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute benefits. Statin therapy may cause symptomatic adverse events (eg, muscle pain or weakness) in up to about 50-100 patients (ie, 0·5-1·0% absolute harm) per 10 000 treated for 5 years. However, placebo-controlled randomised trials have shown definitively that almost all of the symptomatic adverse events that are attributed to statin therapy in routine practice are not actually caused by it (ie, they represent misattribution). The large-scale evidence available from randomised trials also indicates that it is unlikely that large absolute excesses in other serious adverse events still await discovery. Consequently, any further findings that emerge about the effects of statin therapy would not be expected to alter materially the balance of benefits and harms. It is, therefore, of concern that exaggerated claims about side-effect rates with statin therapy may be responsible for its under-use among individuals at increased risk of cardiovascular events. For, whereas the rare cases of myopathy and any muscle-related symptoms that are attributed to statin therapy generally resolve rapidly when treatment is stopped, the heart attacks or strokes that may occur if statin therapy is stopped unnecessarily can be devastating.
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Affiliation(s)
- Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christina Reith
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Armitage
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colin Baigent
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Blackwell
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - David DeMets
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Stephen Evans
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Malcolm Law
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen MacMahon
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Seth Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Neil Poulter
- International Centre for Circulatory Health & Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - David Preiss
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Anthony Rodgers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Schulz
- FHI 360, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Peter Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - John Simes
- National Health and Medical Research Council Clinical Trial Centre, University of Sydney, Sydney, Australia
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Nicholas Wald
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit and MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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12118
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Fu H, Du H, Hu Z, Ying X, Zhou R. Gelsolin expression in liver, spleen and blood plasma provides insights into its function in mice following acute insults. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x16678005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Gelsolin (GSN) is an actin-binding plasma protein with a pivotal role in the systemic response to acute tissue damage. The present study investigated GSN expression in the liver, spleen and blood serum in mice after burn. Method: A murine model of thermal injury was selected, and the animals were sacrificed at 8, 24, 48 and 72 h after injury. Real-time quantitative polymerase chain reaction (RT-PCR) was performed to determine the messenger RNA (mRNA) expression of GSN, and GSN protein expression was determined by enzyme-linked immunosorbent assay (ELISA). Results: We found that GSN mRNA and protein were expressed in the liver, spleen and blood serum of the mice. GSN expression in these tissues was the lowest among the tested time points at 8 h after burn injury. The mortality within 72 h among the mice subjected to burn injury was significantly lower in those treated with GSN than in those not treated with GSN. Treatment with GSN markedly increased the GSN levels in the liver, spleen and blood serum after injury. Conclusion: These results indicated that GSN treatment may affect the outcome of thermal injury via changes in the GSN content of multiple tissues.
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Affiliation(s)
- Haiyan Fu
- PLA General Hospital, Beijing, PR China
- Intensive Care Unit, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Hongyang Du
- Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, Beijing, PR China
| | - Zhansheng Hu
- Intensive Care Unit, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Xiudong Ying
- Intensive Care Unit, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
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12119
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Vascular access and extracorporeal circuit patency in continuous renal replacement therapy. Med Intensiva 2016; 40:572-585. [PMID: 27839725 DOI: 10.1016/j.medin.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/21/2022]
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12120
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Rhouma M, Beaudry F, Thériault W, Letellier A. Colistin in Pig Production: Chemistry, Mechanism of Antibacterial Action, Microbial Resistance Emergence, and One Health Perspectives. Front Microbiol 2016; 7:1789. [PMID: 27891118 PMCID: PMC5104958 DOI: 10.3389/fmicb.2016.01789] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023] Open
Abstract
Colistin (Polymyxin E) is one of the few cationic antimicrobial peptides commercialized in both human and veterinary medicine. For several years now, colistin has been considered the last line of defense against infections caused by multidrug-resistant Gram-negative such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Colistin has been extensively used orally since the 1960s in food animals and particularly in swine for the control of Enterobacteriaceae infections. However, with the recent discovery of plasmid-mediated colistin resistance encoded by the mcr-1 gene and the higher prevalence of samples harboring this gene in animal isolates compared to other origins, livestock has been singled out as the principal reservoir for colistin resistance amplification and spread. Co-localization of the mcr-1 gene and Extended-Spectrum-β-Lactamase genes on a unique plasmid has been also identified in many isolates from animal origin. The use of colistin in pigs as a growth promoter and for prophylaxis purposes should be banned, and the implantation of sustainable measures in pig farms for microbial infection prevention should be actively encouraged and financed. The scientific research should be encouraged in swine medicine to generate data helping to reduce the exacerbation of colistin resistance in pigs and in manure. The establishment of guidelines ensuring a judicious therapeutic use of colistin in pigs, in countries where this drug is approved, is of crucial importance. The implementation of a microbiological withdrawal period that could reduce the potential contamination of consumers with colistin resistant bacteria of porcine origin should be encouraged. Moreover, the management of colistin resistance at the human-pig-environment interface requires the urgent use of the One Health approach for effective control and prevention. This approach needs the collaborative effort of multiple disciplines and close cooperation between physicians, veterinarians, and other scientific health and environmental professionals. This review is an update on the chemistry of colistin, its applications and antibacterial mechanism of action, and on Enterobacteriaceae resistance to colistin in pigs. We also detail and discuss the One Health approach and propose guidelines for colistin resistance management.
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Affiliation(s)
- Mohamed Rhouma
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - Francis Beaudry
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche en Pharmacologie Animale du Québec, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - William Thériault
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - Ann Letellier
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche en Pharmacologie Animale du Québec, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
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12121
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Öz P, Saybaşılı H. In vitro detection of oxygen and glucose deprivation-induced neurodegeneration and pharmacological neuroprotection based on hippocampal stratum pyramidale width. Neurosci Lett 2016; 636:196-204. [PMID: 27845243 DOI: 10.1016/j.neulet.2016.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/23/2016] [Accepted: 11/10/2016] [Indexed: 12/30/2022]
Abstract
Ischemia is one of the most prominent risk factors of neurodegenerative diseases such as Alzheimer's disease. The effects of oxygen and glucose depletion in hippocampal tissue due to ischemia can be mimicked in vitro using the oxygen and glucose deprivation (OGD) model. In this study, we applied OGD on acute rat hippocampal slices in order to design an elementary yet quantitative histological technique that compares the neuroprotective effects of (l)-carnitine to known neuroprotectors, such as the N-methyl-d-aspartate (NMDA) receptor antagonist memantine and the gamma-aminobutyric acid (GABA)-B receptor agonist baclofen. The level of neurodegeneration and the efficiency of pharmacological applications were estimated via stratum pyramidale width measurements in CA1 and CA3 regions of Nissl-stained 200-μm thick hippocampal slices. We demonstrated that (l)-carnitine is an effective pharmacological target against the neurodegeneration induced by in vitro ischemia in a narrow range of concentrations. Even though the effect of chemical neuroprotection was significant, full recovery was not achieved in the dose interval of 5-100μM. In addition to chemical applications, hypothermia was used as a physical neuroprotection against ischemia-related neurodegeneration. Our results showed that incubation of slices for 60min at 4°C provided the same level of neuroprotection as the most effective doses of memantine, baclofen, and (l)-carnitine.
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Affiliation(s)
- Pınar Öz
- Neuropsychopharmacology Application and Research Center, Üsküdar University Central Campus, Altunizade Mah. Haluk Türksoy Sk. No:14 34662, Istanbul, Turkey; Institute of Biomedical Engineering, Boğaziçi Üniversity Kandilli Campus, Kandilli Mah., 34684 Istanbul, Turkey
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi Üniversity Kandilli Campus, Kandilli Mah., 34684 Istanbul, Turkey.
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12122
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Yasumoto H, Katoh H, Kinoshita M, Shimizu M, Hamaoka S, Akiyama K, Naito Y, Sawa T. Epidemiological analysis of serum anti-Pseudomonas aeruginosa PcrV titers in adults. Microbiol Immunol 2016; 60:114-20. [PMID: 26696420 DOI: 10.1111/1348-0421.12353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
Of the various virulence mechanisms of the opportunistic pathogen Pseudomonas aeruginosa, the type III secretion system (TTSS) has been characterized as a major factor associated with acute lung injury, bacteremia and mortality. In addition, PcrV, a component protein of the TTSS, has been characterized as a protective antigen against infection with P. aeruginosa. This study comprised an epidemiological analysis of serum anti-PcrV titers in a cohort of Japanese adults. From April 2012 to March 2013, serum anti-PcrV titers of 198 volunteer participants undergoing anesthesia for scheduled surgeries were measured. The median, minimum and maximum serum anti-PcrV titers among the 198 participants were 4.09 nM, 1.01 nM and 113.81 nM, respectively. The maximum peaks in the histogram were within the anti-PcrV 2.00-4.99 nM titer range; values for 115 participants (58.1%) were within this range. Anti-PcrV titers were more than approximately three-fold greater (>12 nM) than the median value in 21 participants (10.6%). Ten-year interval age increases, history of treatment for traffic trauma, and a history of past surgery each showed statistically significant associations with higher anti-PcrV titers (i.e., >10 nM) than did the other factors assessed by binomial analysis. This study revealed a considerable variation in anti-PcrV titers in adult subjects without any obvious histories of infection with P. aeruginosa.
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Affiliation(s)
- Hiroaki Yasumoto
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hideya Katoh
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masaru Shimizu
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Saeko Hamaoka
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Koichi Akiyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yoshifumi Naito
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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12123
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Berezin AE, Kremzer A, Berezina T, Martovitskaya Y. The signature of circulating microparticles in heart failure patients with metabolic syndrome. J Circ Biomark 2016; 5:1849454416663659. [PMID: 28936261 PMCID: PMC5548327 DOI: 10.1177/1849454416663659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 07/15/2016] [Indexed: 11/15/2022] Open
Abstract
The role of pattern of circulating endothelial cell-derived microparticles, platelet-derived microparticles (PMPs), and monocyte-derived microparticles (MMPs) in metabolic syndrome (MetS) patients with chronic heart failure (CHF) is not still understood. The aim of the study was to investigate a pattern of circulating microparticles (MPs) in MetS patients with CHF in relation to neurohumoral and inflammatory activation. The study retrospectively involved 101 patients with MetS and 35 healthy volunteers. Biomarkers were measured at baseline of the study. The results of the study have shown that numerous circulating PMPs- and MMPs in subjects with MetS (with or without CHF) insufficiently distinguished from level obtained in healthy volunteers. We found elevated level of CD31+/annexin V+ MPs in association with lower level of CD62E+ MPs. Therefore, we found that biomarkers of biomechanical stress serum N-terminal brain natriuretic peptide and inflammation (high-sensitive C-reactive protein ,osteoprotegerin) remain statistically significant predictors for decreased CD62E+ to CD31+/annexin V+ ratio in MetS patients with CHF. In conclusion, decreased CD62E+ to CD31+/annexin V+ ratio reflected that impaired immune phenotype of MPs may be discussed as a surrogate marker of CHF development in MetS population.
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Affiliation(s)
- Alexander E Berezin
- Consultant of the Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine
| | - Alexander Kremzer
- Consultant of the Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine
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12124
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Ramakrishnan A, Vijayakumar N, Renuka M. Naringin regulates glutamate-nitric oxide cGMP pathway in ammonium chloride induced neurotoxicity. Biomed Pharmacother 2016; 84:1717-1726. [PMID: 27836465 DOI: 10.1016/j.biopha.2016.10.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022] Open
Abstract
Naringin, plant bioflavonoid extracted mainly from grapefruit and other related citrus species. This study was designed to assess the neuroprotective effect of naringin on ammonium chloride (NH4Cl) induced hyperammonemic rats. Experimental hyperammonemia was induced by intraperitonial injection (i.p) of NH4Cl (100mg/kg body weight (b.w.)) thrice a week for 8 consecutive weeks. Hyperammonemic rats were treated with naringin (80mg/kg b.w.) via oral gavage. Naringin administration drastically restored the levels of blood ammonia, plasma urea, nitric oxide (NO), glutamate, glutamine, lipid peroxidation, lipid profile, activities of liver marker enzymes, antioxidant status and sodium/potassium-ATPase (Na+/K+-ATPase). In addition, naringin supplementation reverted back the pathological changes of liver, brain and kidney tissues, the expressions of Glutamine synthetase (GS), Na+/K+-ATPase, neuronal nitric oxide (nNOS) and soluble guanylate cyclase (sGC) in hyperammonemic rats. Hence, this study suggested that nargingin exhibited their protective effect against NH4Cl induced toxicity via enhancing the activities of antioxidant enzymes and inhibiting the lipid peroxidation process. Take together, this study provides data that naingin effectively reduced neurotoxicity by attenuating hyperammonemia, suggesting that naringin act as a potential therapeutic agent to treat hyperammonemic rats.
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Affiliation(s)
- Arumugam Ramakrishnan
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, India
| | - Natesan Vijayakumar
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, India.
| | - Mani Renuka
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, India
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12125
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Chuma M, Makishima M, Imai T, Tochikura N, Sakaue T, Kikuchi N, Kinoshita K, Kaburaki M, Yoshida Y. Duration of Systemic Inflammatory Response Syndrome Influences Serum Vancomycin Concentration in Patients With Sepsis. Clin Ther 2016; 38:2598-2609. [PMID: 27836495 DOI: 10.1016/j.clinthera.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Vancomycin (VCM) is used in the treatment of methicillin-resistant Staphylococcus aureus infection. The dosage of VCM must be adjusted by using therapeutic drug monitoring because of the drug's narrow therapeutic concentration window. Although optimal administration based on population pharmacokinetic (PPK) analysis and/or a Bayesian method has improved prediction accuracy, serum concentrations of VCM in patients with sepsis often deviate significantly from predicted values. We investigated factors influencing prediction errors with PPK analysis in VCM dosing. METHODS This retrospective cohort study included patients treated with VCM. Their clinical data were recorded, and there were 27 nonseptic patients and 68 septic patients. VCM concentrations were predicted by using PPK analysis and data compared with observed concentrations. FINDINGS Patients with sepsis had a higher mean absolute error than nonseptic patients, indicating a deviation of VCM concentrations from predicted values in the septic patients. To determine factors influencing prediction errors, we classified patients with sepsis into 3 subgroups according to the mean absolute error value (2.17) for the nonseptic patients: "lower" group (prediction errors, below -2.17), "upper" group (>2.17), and "no change" group (-2.17 to 2.17). In a comparison of clinical characteristics of the 3 groups, significant differences were found in the duration of systemic inflammatory response syndrome (SIRS), SIRS score, disseminated intravascular coagulation score, and levels of creatinine clearance (CrCl), hemoglobin, and diastolic blood pressure. Multiple logistic regression analysis identified SIRS duration and CrCl as factors associated with VCM concentrations in the lower and/or upper groups of septic patients. Shorter and longer SIRS duration were associated with VCM concentrations in the lower group and the upper group, respectively, compared with predicted values in patients with sepsis. According to receiver-operating characteristic curve analysis, the optimal cutoff value of SIRS duration for the lower group was 2 days; for the upper group, it was 6 days. VCM clearance in patients with an SIRS duration <2 days was higher than that for patients with an SIRS duration ≥6 days. IMPLICATIONS SIRS duration was identified as influencing VCM concentration in patients with sepsis. This study has 2 limitations. First, we performed blood sampling only for trough concentrations. Repeated blood sampling for both peak and trough concentrations should be performed for more accurate pharmacokinetic evaluation in critically ill patients. Second, we determined CrCl by using the Cockcroft-Gault formula, which may not be accurate in critically ill patients. Modifying VCM dosing according to SIRS duration will improve prediction accuracy of VCM concentration based on therapeutic drug monitoring.
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Affiliation(s)
- Masayuki Chuma
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Makoto Makishima
- Division of Biochemistry, Department of Biomedical Sciences, Nihon University School of Medicine, Tokyo, Japan.
| | - Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Naohiro Tochikura
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takako Sakaue
- Department of Pharmacy, Kanagawa Prefectural Keiyukai Keiyu Hospital, Yokohama, Japan
| | | | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Morio Kaburaki
- Department of Pharmacy, Nihon University Hospital, Tokyo, Japan
| | - Yoshikazu Yoshida
- Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan
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12126
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Kitagawa RS, Storm C, Nonogi H. Clinical Applications of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2016; 6:160-163. [PMID: 27824528 DOI: 10.1089/ther.2016.29019.rsk] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ryan S Kitagawa
- 1 The Vivian L. Smith Department of Neurosurgery, University of Texas , Houston, Texas
| | - Christian Storm
- 2 Klinik fur Nephrologie und Internistische Intensivmedizin Charité Universitätsmedizin , Berlin, Germany
| | - Hiroshi Nonogi
- 3 Department of Cardiology Shizuoka General Hospital , Shizuoka, Japan
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12127
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Benedek T, Popovici MM, Glogar D. Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition. ACTA ACUST UNITED AC 2016; 2:164-174. [PMID: 29967856 DOI: 10.1515/jccm-2016-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/20/2016] [Indexed: 12/14/2022]
Abstract
This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.
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Affiliation(s)
- Theodora Benedek
- University of Medicine and Pharmacy Tirgu Mures, Clinic of Cardiology, Tirgu Mures, Romania
| | - Monica Marton Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington, USA
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12128
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Scarlatescu E, Tomescu D, Arama SS. Sepsis-Associated Coagulopathy. ACTA ACUST UNITED AC 2016; 2:156-163. [PMID: 29967855 DOI: 10.1515/jccm-2016-0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
Systemic inflammatory activation in sepsis often leads to coagulation activation, but the relationship is bilateral, as coagulation also modulates the inflammatory response. This close associate has significant consequences for the pathogenesis of microvascular thrombosis and organ dysfunction in sepsis. While coagulation activation can be beneficial for immune defense, it can also be detrimental once it becomes widespread and uncontrolled. The knowledge of the pathophysiologic mechanisms involved in the interaction between infection and coagulation may lead to the better timing for the administration of targeted antithrombotic therapies in septic patients. This brief review highlights the pathophysiologic pathways leading to the prothrombotic state in sepsis and the mechanisms that play a role in the interaction between infection and coagulation.
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Affiliation(s)
- Ecaterina Scarlatescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Dana Tomescu
- Department of Anesthesiology and Intensive Care III, Fundeni Clinical Institute, Bucharest, Romania
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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12129
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Miyazawa H, Ookawara S, Ito K, Yanai K, Ishii H, Kitano T, Shindo M, Ueda Y, Kaku Y, Hirai K, Hoshino T, Tabei K, Morishita Y. Factors associating with oxygenation of lower-limb muscle tissue in hemodialysis patients. World J Nephrol 2016; 5:524-530. [PMID: 27872834 PMCID: PMC5099598 DOI: 10.5527/wjn.v5.i6.524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/18/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the lower-limb muscle oxygenation in hemodialysis (HD) patients and identify the factors associating with muscle oxygenation.
METHODS Sixty-seven HD patients (53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals (nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen (rSO2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C (Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rSO2 and clinical parameters.
RESULTS The rSO2 values were significantly lower in patients undergoing HD than in healthy individuals (50.0% ± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle rSO2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle rSO2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lower-limb muscle rSO2 was independently associated with serum inorganic phosphate (standardized coefficient: 0.27) and serum albumin concentrations (standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle rSO2 between diabetic and non-diabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lower-limb muscle rSO2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.
CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.
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12130
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Development of an intensive care unit resource assessment survey for the care of critically ill patients in resource-limited settings. J Crit Care 2016; 38:172-176. [PMID: 27918902 DOI: 10.1016/j.jcrc.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 09/28/2016] [Accepted: 11/01/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Capacity to provide critical care in resource-limited settings is poorly understood because of lack of data about resources available to manage critically ill patients. Our objective was to develop a survey to address this issue. METHODS We developed and piloted a cross-sectional self-administered survey in 9 resource-limited countries. The survey consisted of 8 domains; specific items within domains were modified from previously developed survey tools. We distributed the survey by e-mail to a convenience sample of health care providers responsible for providing care to critically ill patients. We assessed clinical sensibility and test-retest reliability. RESULTS Nine of 15 health care providers responded to the survey on 2 separate occasions, separated by 2 to 4 weeks. Clinical sensibility was high (3.9-4.9/5 on assessment tool). Test-retest reliability for questions related to resource availability was acceptable (intraclass correlation coefficient, 0.94; 95% confidence interval, 0.75-0.99; mean (SD) of weighted κ values = 0.67 [0.19]). The mean (SD) time for survey completion survey was 21 (16) minutes. CONCLUSIONS A reliable cross-sectional survey of available resources to manage critically ill patients can be feasibly administered to health care providers in resource-limited settings. The survey will inform future research focusing on access to critical care where it is poorly described but urgently needed.
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12131
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Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate. Cardiovasc Intervent Radiol 2016; 40:236-244. [DOI: 10.1007/s00270-016-1496-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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12132
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Al-Omari A, Aljamaan F, Alhazzani W, Salih S, Arabi Y. Cytomegalovirus infection in immunocompetent critically ill adults: literature review. Ann Intensive Care 2016; 6:110. [PMID: 27813024 PMCID: PMC5095093 DOI: 10.1186/s13613-016-0207-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/17/2016] [Indexed: 12/21/2022] Open
Abstract
Cytomegalovirus (CMV) infection is increasingly recognized in critically ill immunocompetent patients. Some studies have demonstrated an association between CMV disease and increased mortality rates, prolonged intensive care unit and hospital length of stay, prolonged mechanical ventilation, and nosocomial infections. However, there is a considerable controversy whether such association represents a causal relationship between CMV disease and unfavorable outcomes or just a marker of the severity of the critical illness. Detection of CMV using polymerase chain reaction and CMV antigenemia is the standard diagnostic approach. CMV may have variety of clinical manifestations reflecting the involvement of different organ systems. Treatment of CMV in critical care is challenging due to diagnostic challenge and drug toxicity, and building predictive model for CMV disease in critical care setting would be promising to identify patients at risk and starting prophylactic therapy. Our objective was to broadly review the current literature on the prevalence and incidence, clinical manifestations, potential limitations of different diagnostic modalities, prognosis, and therapeutic options of CMV disease in critically ill patients.
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Affiliation(s)
- Awad Al-Omari
- Critical Care and Infection Control Department, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia. .,AlFaisal University, Riyadh, Saudi Arabia.
| | - Fadi Aljamaan
- Intensive Care Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | - Samer Salih
- Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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12133
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Pérez SB, Rodríguez-Fanjul J, García IJ, Hernando JM, Iriondo Sanz M. Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study. Biomark Insights 2016; 11:123-129. [PMID: 27840575 PMCID: PMC5096765 DOI: 10.4137/bmi.s40658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS. PATIENTS AND METHODS This is a prospective study of newborns admitted to the neonatal intensive care unit after CS. INTERVENTIONS PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery. RESULTS A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively. CONCLUSION This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.
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Affiliation(s)
- Sara Bobillo Pérez
- Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan García
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Paediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
| | - Julio Moreno Hernando
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Martín Iriondo Sanz
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
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12134
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Moore JX, Zakai NA, Mahalingam M, Griffin RL, Irvin MR, Safford MM, Baddley JW, Wang HE. Hemostasis biomarkers and risk of sepsis: the REGARDS cohort. J Thromb Haemost 2016; 14:2169-2176. [PMID: 27512924 PMCID: PMC5503746 DOI: 10.1111/jth.13446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022]
Abstract
Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention. SUMMARY Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.
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Affiliation(s)
- J X Moore
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Zakai
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M Mahalingam
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R L Griffin
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M R Irvin
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M M Safford
- Department of Medicine, Weill-Cornell Medical Center, New York, NY, USA
| | - J W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H E Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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rBaltMIP, a recombinant alpha-type myotoxin inhibitor from Bothrops alternatus (Rhinocerophis alternatus) snake, as a potential candidate to complement the antivenom therapy. Toxicon 2016; 124:53-62. [PMID: 28327300 DOI: 10.1016/j.toxicon.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 02/04/2023]
Abstract
Phospholipase A2 inhibitors (PLIs) are important targets in the search and development of new drugs. This study aimed at evaluating the potential of an alpha-type phospholipase A2 inhibitor from Bothrops alternatus (Rhinocerophis alternatus) snake in its recombinant form (rBaltMIP) to complement the conventional antivenom therapy. Biochemical experiments showed that rBaltMIP presented pI 5.8 and molecular masses of ∼21 kDa by SDS-PAGE and 19.57 kDa by MALDI/TOF MS. After tryptic peptides sequencing, the results were compared with other PLIs available in databases, showing 100% identity between rBaltMIP and its native inhibitor BaltMIP and from 92% to 96% identity with other inhibitors. Myotoxic activities of BthTX-I and BthTX-II toxins were measured via plasma CK levels, showing myotoxic effective concentrations (EC50) of 0.1256 μg/μL and 0.6183 μg/μL, respectively. rBaltMIP neutralized the myotoxicity caused by these two toxins up to 65%, without promoting primary antibody response against itself. Nevertheless, this recombinant PLI was immunogenic when standard immunization protocol with Freud's adjuvant was used. In paw edema assays, EC50 of 0.02581 μg/μL and 0.02810 μg/μL, respectively, were observed with edema reductions of up to 40% by rBaltMIP, suggesting its use as an additional antivenom. In addition, myotoxicity neutralization experiments with the myotoxin BthTX-I showed that rBaltMIP was more effective in inhibiting muscle damage than the conventional antivenom. Thus, considering the severity of envenomations due to Bothrops alternatus (Rhinocerophis alternatus) and the low neutralization of their local effects (such as myotoxicity) by the current antivenoms, rBaltMIP is a promising molecule for the development of novel therapeutic strategies for clinical applications.
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12136
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Gmyr V, Bonner C, Moerman E, Tournoys A, Delalleau N, Quenon A, Thevenet J, Chetboun M, Kerr-Conte J, Pattou F, Hubert T, Jourdain M. Human Recombinant Antithrombin (ATryn ®) Administration Improves Survival and Prevents Intravascular Coagulation After Intraportal Islet Transplantation in a Piglet Model. Cell Transplant 2016; 26:309-317. [PMID: 27938471 DOI: 10.3727/096368916x693554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Human islet transplantation is a viable treatment option for type 1 diabetes mellitus (T1DM). However, pancreatic islet inflammation after transplantation induced by innate immune responses is likely to hinder graft function. This is mediated by incompatibility between islets and the blood interface, known as instant blood-mediated inflammatory reaction (IBMIR). Herein we hypothesized that portal venous administration of islet cells with human recombinant antithrombin (ATryn®), a serine protease inhibitor (serpin), which plays a central role in the physiological regulation of coagulation and exerts indirect anti-inflammatory activities, may offset coagulation abnormalities such as disseminated intravascular coagulation (DIC) and IBMIR. The current prospective, randomized experiment was conducted using an established preclinical pig model. Three groups were constituted for digested pancreatic tissue transplantation (0.15 ml/kg): control, NaCl 0.9% (n = 7); gold standard, heparin (25 UI/kg) (n = 7); and human recombinant ATryn® (500 UI/kg) (n = 7). Blood samples were collected over time (T0 to 24 h), and biochemical, coagulation, and inflammatory parameters were evaluated. In both the control and heparin groups, one animal died after a portal thrombosis, while no deaths occurred in the ATryn®-treated group. As expected, islet transplantation was associated with an increase in plasma IL-6 or TNF-α levels in all three groups. However, DIC was only observed in the control group, an effect that was suppressed after ATryn® administration. ATryn® administration increased antithrombin activity by 800%, which remained at 200% for the remaining period of the study, without any hemorrhagic complications. These studies suggest that coadministration of ATryn® and pancreatic islets via intraportal transplantation may be a valuable therapeutic approach for DIC without risk for islets and subjects.
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12137
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Sawa T, Hamaoka S, Kinoshita M, Kainuma A, Naito Y, Akiyama K, Kato H. Pseudomonas aeruginosa Type III Secretory Toxin ExoU and Its Predicted Homologs. Toxins (Basel) 2016; 8:toxins8110307. [PMID: 27792159 PMCID: PMC5127104 DOI: 10.3390/toxins8110307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022] Open
Abstract
Pseudomonas aeruginosa ExoU, a type III secretory toxin and major virulence factor with patatin-like phospholipase activity, is responsible for acute lung injury and sepsis in immunocompromised patients. Through use of a recently updated bacterial genome database, protein sequences predicted to be homologous to Ps. aeruginosa ExoU were identified in 17 other Pseudomonas species (Ps. fluorescens, Ps. lundensis, Ps. weihenstephanensis, Ps. marginalis, Ps. rhodesiae, Ps. synxantha, Ps. libanensis, Ps. extremaustralis, Ps. veronii, Ps. simiae, Ps. trivialis, Ps. tolaasii, Ps. orientalis, Ps. taetrolens, Ps. syringae, Ps. viridiflava, and Ps. cannabina) and 8 Gram-negative bacteria from three other genera (Photorhabdus, Aeromonas, and Paludibacterium). In the alignment of the predicted primary amino acid sequences used for the phylogenetic analyses, both highly conserved and nonconserved parts of the toxin were discovered among the various species. Further comparative studies of the predicted ExoU homologs should provide us with more detailed information about the unique characteristics of the Ps. aeruginosa ExoU toxin.
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Affiliation(s)
- Teiji Sawa
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Saeko Hamaoka
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Mao Kinoshita
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Atsushi Kainuma
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Yoshifumi Naito
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Koichi Akiyama
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
| | - Hideya Kato
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
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12138
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Blanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians. Crit Ultrasound J 2016; 8:15. [PMID: 27783380 PMCID: PMC5081982 DOI: 10.1186/s13089-016-0052-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Point-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside. OBJECTIVES This article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them. DISCUSSION The following aspects were selected and reviewed: pericardial effusion vs. pleural vs. ascites vs. epicardial fat; right ventricle dilation in acute pulmonary embolism and inferior vena cava for volume status assessment in cardiac ultrasound; lung point and lung pulse misinterpretations and mirror artifacts vs. lung consolidations in lung ultrasound; peritoneal fluid vs. the stomach and a critical appraisal of gallbladder signs of acute cholecystitis in abdominal ultrasound; the rouleaux phenomenon vs. deep vein thrombosis or acute right strain in vascular ultrasound. CONCLUSIONS Following some rules in technique and interpretation, and always integrating POCUS findings into the broader clinical context, most POCUS misdiagnosis can be avoided, and thus patients' safety can be enhanced. Being aware of a list of common pitfalls may help to avoid misdiagnoses.
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Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Hospital Dr. Emilio Ferreyra, 4801, 59 St., 7630, Necochea, Argentina. .,Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., 7630, Necochea, Argentina.
| | - Giovanni Volpicelli
- Emergency Medicine, San Luigi Gonzaga University Hospital, 10043, Turin, Italy
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Meersch M, Schmidt C, Schmidt J, Zarbock A. Timing of renal replacement therapy in critically ill patients with acute kidney injury. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:360. [PMID: 27775733 DOI: 10.21037/atm.2016.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Melanie Meersch
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Christoph Schmidt
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Joachim Schmidt
- Department of Cardiac Surgery, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
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12140
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Sun DS, Ho PH, Chang HH. Soluble P-selectin rescues viper venom-induced mortality through anti-inflammatory properties and PSGL-1 pathway-mediated correction of hemostasis. Sci Rep 2016; 6:35868. [PMID: 27779216 PMCID: PMC5078805 DOI: 10.1038/srep35868] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/03/2016] [Indexed: 01/24/2023] Open
Abstract
Venomous snakebites are lethal and occur frequently worldwide each year, and receiving the antivenom antibody is currently the most effective treatment. However, the specific antivenom might be unavailable in remote areas. Snakebites by Viperidae usually lead to hemorrhage and mortality if untreated. In the present study, challenges of rattlesnake (Crotalus atrox) venom markedly increased the circulating soluble P-selectin (sP-sel) level, but not P-selectin (P-sel, Selp−/−) mutants, in wild-type mice. Because sP-sel enhances coagulation through the P-selectin ligand 1 (PSGL-1, Selplg) pathway to produce tissue factor–positive microparticles, we hypothesized that increasing the plasma sP-sel level can be a self-rescue response in hosts against snake venom–mediated suppression of the coagulation system. Confirming our hypothesis, our results indicated that compared with wild-type mice, Selp−/− and Selplg−/− mice were more sensitive to rattlesnake venom. Additionally, administration of recombinant sP-sel could effectively reduce the mortality rate of mice challenged with venoms from three other Viperidae snakes. The antivenom property of sP-sel is associated with improved coagulation activity in vivo. Our data suggest that the elevation of endogenous sP-sel level is a self-protective response against venom-suppressed coagulation. The administration of recombinant sP-sel may be developed as a new strategy to treat Viperidae snakebites.
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Affiliation(s)
- Der-Shan Sun
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien 970, Taiwan.,Center for Vascular Medicine, Tzu-Chi University, Hualien 970, Taiwan
| | - Pei-Hsun Ho
- Center for Vascular Medicine, Tzu-Chi University, Hualien 970, Taiwan
| | - Hsin-Hou Chang
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien 970, Taiwan.,Center for Vascular Medicine, Tzu-Chi University, Hualien 970, Taiwan
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12141
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Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, Wang S. Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget 2016; 7:71052-71061. [PMID: 27626493 PMCID: PMC5342608 DOI: 10.18632/oncotarget.11958] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022] Open
Abstract
Hyperglycemia after severe traumatic brain injury (TBI) occurs frequently and is associated with poor clinical outcome and increased mortality. In this review, we highlight the mechanisms that lead to hyperglycemia and discuss how they may contribute to poor outcomes in patients with severe TBI. Moreover, we systematically review the proper management of hyperglycemia after TBI, covering topics such as nutritional support, glucose control, moderated hypothermia, naloxone, and mannitol treatment. However, to date, an optimal and safe glycemic target range has not been determined, and may not be safe to implement among TBI patients. Therefore, there is a mandate to explore a reasonable glycemic target range that can facilitate recovery after severe TBI.
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Affiliation(s)
- Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bo Dong
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yumin Mao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Guan
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiachao Cao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Rongxing Zhu
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Suinuan Wang
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
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12142
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In Vitro Bactericidal Activity of Trimethoprim-Sulfamethoxazole Alone and in Combination with Colistin against Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates. Antimicrob Agents Chemother 2016; 60:6903-6906. [PMID: 27550356 DOI: 10.1128/aac.01082-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023] Open
Abstract
Trimethoprim-sulfamethoxazole alone and combined with colistin was tested in vitro against six carbapenem-resistant Acinetobacter baumannii (CRAB) clinical strains. After 24 h, at achievable serum concentrations, trimethoprim-sulfamethoxazole effectively killed all strains, while colistin killed only one strain. Trimethoprim-sulfamethoxazole plus colistin rapidly killed all strains after 6 h and for up to 24 h. Trimethoprim-sulfamethoxazole, one of the few remaining antimicrobials that still has a degree of activity, particularly combined with colistin, might represent an effective therapy for severe CRAB infections.
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12143
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A Novel Large Animal Model of Acute Respiratory Distress Syndrome Induced by Mitochondrial Products. Ann Surg 2016; 266:1091-1096. [PMID: 27735823 DOI: 10.1097/sla.0000000000002011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to create a reproducible lung injury model utilizing injection of mitochondrial damage-associated molecular products. Our goal was to characterize the pathophysiologic response to damage-associated molecular pattern mediated organ injury. SUMMARY BACKGROUND DATA There remain significant gaps in our understanding of acute respiratory distress syndrome, in part due to the lack of clinically applicable animal models of this disease. Animal models of noninfectious, tissue damage-induced lung injury are needed to understand the signals and responses associated with this injury. METHODS Ten pigs (35-45 kg) received an intravenous dose of disrupted mitochondrial products and were followed for 6 hours under general anesthesia. These animals were compared to a control group (n = 5) and a model of lung injury induced by bacterial products (lipopolysaccharide n = 5). RESULTS Heart rate and temperature were significantly elevated in the mitochondrial product (204 ± 12 and 41 ± 1) and lipopolysaccharide groups (178 ± 18 and 42 ± 0.5) compared with controls (100 ± 13 and 38 ± 0.5) (P <0.05). Lung oxygenation (PaO2/FiO2) was significantly lower 6 hours after injection in the mitochondrial products and lipopolysaccharide groups compared with controls (170 ± 39, 196 ± 27, and 564 ± 75 mm Hg respectively, P = 0.001). Lung injury scoring of histological sections was significantly worse in mitochondrial and lipopolysaccharide groups compared with controls (mitochondrial-64 ± 6, lipopolysaccharide-54 ± 8, control-14 ± 1.5, P= 0.002). CONCLUSIONS Our data demonstrated that the presence of mitochondrial products in the circulation leads to systemic inflammatory response and lung injury. In its acute phase lung injury induced by tissue or bacterial products is clinically indistinguishable.
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12144
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Anwar E, Hamdy G, Taher E, Fawzy E, Abdulattif S, Attia MH. Burden and Outcome of Vitamin D Deficiency Among Critically Ill Patients: A Prospective Study. Nutr Clin Pract 2016; 32:378-384. [PMID: 28537519 DOI: 10.1177/0884533616671741] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is a prevalent condition among critically ill patients. Information about the relationship between vitamin D levels and outcomes in the intensive care unit (ICU) is sparse. PURPOSE To evaluate vitamin D status among critically ill patients and its relevance to severity of illness, ICU stay period, and mortality. METHODS This prospective multicenter study was conducted in the ICUs of Fayoum, Cairo, Alazhar, and Ain Shams university hospitals. All patients were subjected to interview questionnaire, laboratory investigation, vitamin D level assessment, and severity of illness evaluation using the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score. RESULTS In total, 250 patients were included in the study. The median age was 62 (40-73) years, and most patients were male (52%). The median serum level of vitamin D was 19 (7-40.6). Vitamin D was deficient in 197 patients (78.8%) on admission. While we grouped the ICU patients as vitamin D deficient, insufficient, and sufficient, vitamin D-deficient patients had more severe diseases (mean APACHE II score, 44 ± 15; P = .014). Prolonged ICU stay was observed among the deficient group but with no significant association. The overall mortality rate was 6.8%; of these, 70.5% were vitamin D-deficient patients. However, logistic regression analysis demonstrated that vitamin D deficiency was not an independent risk factor for mortality. CONCLUSION Vitamin D insufficiency is common in critically ill patients (69%); it is associated with more severity of illness, but it is not an independent risk factor for longer ICU stay or mortality.
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Affiliation(s)
- Enas Anwar
- 1 Internal Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Gehan Hamdy
- 2 Internal Medicine Departments, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Taher
- 3 Community Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esmat Fawzy
- 4 Clinical and Chemical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif Abdulattif
- 5 Anesthesia & ICU Department, Faculty of Medicine, Alazhar University, Cairo, Egypt
| | - Mohamed H Attia
- 6 Internal Medicine Departments, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12145
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Effects of intravitreally injected Fc fragment on rat eyes. Graefes Arch Clin Exp Ophthalmol 2016; 254:2401-2409. [PMID: 27752777 DOI: 10.1007/s00417-016-3511-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/14/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Anti-vascular endothelial growth factor (VEGF) drugs are used to treat neovascular eye diseases. Some of these drugs contain Fc fragments (Fc), but it is unknown how their mode of action is influenced by Fc. Therefore, this study investigated the effects of Fc on rat eyes after intravitreal injection. METHODS Eighteen Long-Evans rats were intravitreally injected with sterile, biotin-labeled rat Fc (9.1 μg in 5 μl PBS). For control, 5 μl PBS was injected in another nine rats. Animals were sacrificed between 1 and 3 days (group 1), 7 days (group 2), and 14 days (group 3) after injection. The right eyes were examined by electron microscopy (EM). The left eyes were stained by immunohistochemistry to investigate the distribution of Fc and the presence of macrophages. RESULTS After 1 day, Fc had penetrated into the anterior chamber and the retina up to the inner nuclear layer, and was located especially in retinal vessels. High numbers of infiltrating cells were present within the vitreous, around the ciliary body, anterior chamber and inside the retina 1-3 days after Fc injection (p < 0.02 group 1 vs. control). Immunohistochemistry and EM showed that they were macrophages or granulocytes in close association with Fc. Ultrastructurally, there were effects on the blood vessels such as thrombocyte activation and fibrin formation. CONCLUSIONS Biotin labeling is ideal for investigating the distribution of intravitreally injected proteins in ocular tissue. Fc fragments at a dose corresponding to their concentration in standard AMD treatments induced inflammation, and particularly the attraction of immune-competent cells. This may be associated with the risk of inflammation or endophthalmitis after anti-VEGF treatment, and needs further investigation.
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12146
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Schock RB, Janata A, Peacock WF, Deal NS, Kalra S, Sterz F. Time to Cooling Is Associated with Resuscitation Outcomes. Ther Hypothermia Temp Manag 2016; 6:208-217. [PMID: 27906641 PMCID: PMC5144870 DOI: 10.1089/ther.2016.0026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Our purpose was to analyze evidence related to timing of cooling from studies of targeted temperature management (TTM) after return of spontaneous circulation (ROSC) after cardiac arrest and to recommend directions for future therapy optimization. We conducted a preliminary review of studies of both animals and patients treated with post-ROSC TTM and hypothesized that a more rapid cooling strategy in the absence of volume-adding cold infusions would provide improved outcomes in comparison with slower cooling. We defined rapid cooling as the achievement of 34°C within 3.5 hours of ROSC without the use of volume-adding cold infusions, with a ≥3.0°C/hour rate of cooling. Using the PubMed database and a previously published systematic review, we identified clinical studies published from 2002 through 2014 related to TTM. Analysis included studies with time from collapse to ROSC of 20–30 minutes, reporting of time from ROSC to target temperature and rate of patients in ventricular tachycardia or ventricular fibrillation, and hypothermia maintained for 20–24 hours. The use of cardiopulmonary bypass as a cooling method was an exclusion criterion for this analysis. We compared all rapid cooling studies with all slower cooling studies of ≥100 patients. Eleven studies were initially identified for analysis, comprising 4091 patients. Two additional studies totaling 609 patients were added based on availability of unpublished data, bringing the total to 13 studies of 4700 patients. Outcomes for patients, dichotomized into faster and slower cooling approaches, were determined using weighted linear regression using IBM SPSS Statistics software. Rapid cooling without volume-adding cold infusions yielded a higher rate of good neurological recovery than slower cooling methods. Attainment of a temperature below 34°C within 3.5 hours of ROSC and using a cooling rate of more than 3°C/hour appear to be beneficial.
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Affiliation(s)
- Robert B Schock
- 1 Sid Wolvek Research Center , Life Recovery Systems HD, LLC, Kinnelon, New Jersey
| | - Andreas Janata
- 2 Universitätsklinik für Notfallmedizin, Medizinische Universität Wien , Wien, Austria
| | - W Frank Peacock
- 3 Emergency Medicine, Ben Taub General Hospital , Houston, Texas
| | - Nathan S Deal
- 3 Emergency Medicine, Ben Taub General Hospital , Houston, Texas
| | | | - Fritz Sterz
- 2 Universitätsklinik für Notfallmedizin, Medizinische Universität Wien , Wien, Austria
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12147
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Ho KM, Lan NSH. Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection. J Crit Care 2016; 38:1-5. [PMID: 27829179 DOI: 10.1016/j.jcrc.2016.10.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/04/2016] [Accepted: 10/10/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to determine whether quick Sequential Organ Failure Assessment (qSOFA) score can be used to predict mortality of patients without suspected infection. MATERIALS AND METHODS Using prospectively collected data within the first hour of intensive care unit admission, the predictive ability of qSOFA was compared with the Simplified Acute Physiology Score III, Admission Mortality Prediction Model III, Acute Physiology and Chronic Health Evaluation II model, and standard (full-version) SOFA score using area under the receiver operating characteristic (AUROC) curve and Brier score. RESULTS Of the 2322 patients included, 279 (12.0%) died after intensive care unit admission. The qSOFA score had a modest ability to predict mortality of all critically ill patients (AUROC, 0.672; 95% confidence interval [CI], 0.638-0.707; Brier score 0.099) including the noninfected patients (AUROC, 0.685; 95% CI, 0.637-0.732; Brier score 0.081). The overall predictive ability and calibration of the qSOFA was comparable to other prognostic scores. Combining qSOFA score with lactate concentrations further enhanced its predictive ability (AUROC, 0.730; 95% CI, 0.694-0.765; Brier score 0.097), comparable to the standard SOFA score. CONCLUSIONS The qSOFA score had a modest ability to predict mortality of both septic and nonseptic patients; combining qSOFA with plasma lactate had a predictive ability comparable to the standard SOFA score.
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Affiliation(s)
- Kwok M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, Australia; School of Population Health, University of Western Australia, Perth, Australia; School of Veterinary & Life Sciences, Murdoch University, Perth, Australia.
| | - Norris S H Lan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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12148
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Zimmermann L, Das I, Désiré J, Sautrey G, Barros R. S. V, El Khoury M, Mingeot-Leclercq MP, Décout JL. New Broad-Spectrum Antibacterial Amphiphilic Aminoglycosides Active against Resistant Bacteria: From Neamine Derivatives to Smaller Neosamine Analogues. J Med Chem 2016; 59:9350-9369. [DOI: 10.1021/acs.jmedchem.6b00818] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Louis Zimmermann
- Département
de Pharmacochimie Moléculaire, ICMG FR 2607, University Grenoble Alpes/CNRS, UMR 5063, 470 Rue de la Chimie, BP 53, F-38041 Grenoble, France
| | - Indrajit Das
- Département
de Pharmacochimie Moléculaire, ICMG FR 2607, University Grenoble Alpes/CNRS, UMR 5063, 470 Rue de la Chimie, BP 53, F-38041 Grenoble, France
| | - Jérôme Désiré
- Département
de Pharmacochimie Moléculaire, ICMG FR 2607, University Grenoble Alpes/CNRS, UMR 5063, 470 Rue de la Chimie, BP 53, F-38041 Grenoble, France
| | - Guillaume Sautrey
- Unité
de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research
Institute, Université Catholique de Louvain, Avenue E.
Mounier 73, B1.73.05, B-1200 Brussels, Belgium
| | - Vinicius Barros R. S.
- Département
de Pharmacochimie Moléculaire, ICMG FR 2607, University Grenoble Alpes/CNRS, UMR 5063, 470 Rue de la Chimie, BP 53, F-38041 Grenoble, France
| | - Micheline El Khoury
- Unité
de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research
Institute, Université Catholique de Louvain, Avenue E.
Mounier 73, B1.73.05, B-1200 Brussels, Belgium
| | - Marie-Paule Mingeot-Leclercq
- Unité
de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research
Institute, Université Catholique de Louvain, Avenue E.
Mounier 73, B1.73.05, B-1200 Brussels, Belgium
| | - Jean-Luc Décout
- Département
de Pharmacochimie Moléculaire, ICMG FR 2607, University Grenoble Alpes/CNRS, UMR 5063, 470 Rue de la Chimie, BP 53, F-38041 Grenoble, France
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12149
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Hopkins P, Patel S. Beware the Trojan Horse - a timely reality check about re-using single-use devices. Anaesthesia 2016; 72:8-12. [PMID: 27748514 DOI: 10.1111/anae.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- P Hopkins
- King's Critical Care, King's College Hospital, London, UK
| | - S Patel
- King's Critical Care, King's College Hospital, London, UK
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12150
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Vaught AJ. Critical Care for the Obstetrician and Gynecologist: Obstetric Hemorrhage and Disseminated Intravascular Coagulopathy. Obstet Gynecol Clin North Am 2016; 43:611-622. [PMID: 27816150 DOI: 10.1016/j.ogc.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obstetric hemorrhage accounts for 5% all deliveries in the United States and accounts for high maternal morbidity and mortality. Many hemorrhages are secondary to uterine atony and are quickly ameliorated with appropriate uterotonic use. However, for a subset of cases, severe hemorrhage may require advanced resuscitative techniques, and innovative procedural and surgical techniques. This article guides a provider through such a resuscitation.
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Affiliation(s)
- Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 228, Baltimore, MD 21287, USA.
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