Multi-temporal scale analysis of complementarity between hydro and solar power along an alpine transect

Variable renewable energy sources display different space-time variability driving the availability of energy generated from these sources. Complementarity among variable renewable energies in time and space allows reducing the variability of power supply and helps matching the electricity demand curve. This work investigates the temporal structure of complementarity along an alpine transect in North-East Italy, considering a 100% renewable energy mix scenario composed by photovoltaic and run-of-the-river energy. We analyze the dominant scales of variability of variable renewable energy sources and electricity demand. In addition, we introduce a new metric, the wavelet-based complementarity index, to quantify the potential complementarity between two different energy sources. We show that this index varies at different temporal scales and it helps explaining the discrepancy between demand and supply in the study area. Continuous and discrete wavelet analyses are applied to assess the energy balance variability at multiple temporal scales and to identify the optimal mix of renewable energies, respectively. This work describes therefore an effective approach to investigate the temporal-scale dependency of the variance in the energy balance and can be further extended to different and more complex situations.

Validation du score qSOFA au Service d’Accueil des Urgences : étude prospective monocentrique

Introduction : Le sepsis est défini comme une défaillance d’organes secondaire à une infection pouvant entraîner le décès du patient. Le score quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) a récemment été proposé pour dépister la présence d’une défaillance d’organes chez les patients suspects d’infection. L’objectif de cette étude est de valider l’utilisation du score qSOFA au service d’accueil des urgences (SAU) pour prédire la mortalité et le recours à l’hospitalisation en réanimation.

Méthodes : Étude prospective monocentrique au SAU sur 6 mois. Les données démographiques, la source infectieuse, le score qSOFA, le score SOFA et les valeurs biologiques étaient collectés. Les dossiers étaient relus par un comité d’adjudication indépendant pour valider le diagnostic de sepsis en utilisant la définition Sepsis-3. La mortalité à 28 jours était colligée.

Résultats : Parmi les 476 patients suspects d’infection, 374 avaient leur diagnostic confirmé (204 hommes, âge moyen : 65 ± 20 ans). Le score qSOFA était positif chez 77 patients (21%). La mortalité était supérieure pour les patients avec un score qSOFA ≥ 2 (47% vs 4% : p < 0,01). Pour prédire la mortalité à 28 jours, le score qSOFA avait une sensibilité de 74% (IC 95% : 59 - 85%) et une spécificité de 87% (IC 95% : 83 - 91%). L’aire sous la courbe ROC du score qSOFA pour prédire la mortalité à 28 jours était de 0,80 (IC 95% : 0,76 - 0,84).

Conclusion : Cette étude confirme que le score qSOFA recueilli au SAU semble être fiable pour prédire la mortalité à 28 jours.

Staphylococcus Aureus Carriage in French Athletes at Risk of CA-MRSA Infection: a Prospective, Cross-sectional Study

Background

Staphylococcus aureus (SA) is a leading cause of infectious diseases in sports teams. In recent decades, community-associated SA (CA-SA) strains have emerged worldwide and have been responsible for outbreaks in sports teams. There are very few data on the prevalence of these strains in France, and none on the carriage among athletes.

Methods

We conducted a cross-sectional study to determine the SA carriage proportion among athletes practicing sports at risk for CA-SA infection in a French county, and determined the methicillin-resistant and/or CA-SA proportion. We also analyzed SA carriage according to risks factors and studied the SA clonality in a sample of our population.

Results

We included 300 athletes; SA carriage proportion was 61% (n = 183) and one was MRSA carrier (0.33%). The MRSA strain belonged to the clonal complex ST5. None of the strain produced Panton Valentine Leucocidin, and we did not find clonal distribution within the teams. Interestingly, we found a high throat-only carriage (n = 57), 31.1% of the SA carriers.

Conclusion

We found a high SA carriage with a local epidemiology quite different than that reported in a similar population in the USA. Further studies on SA carriage should include throat sampling.

Trial registration

The approved protocol was registered on ClinicalTrial.gov, NCT01148485.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

The Innovative Medicines Initiative's New Drugs for Bad Bugs programme: European public-private partnerships for the development of new strategies to tackle antibiotic resistance

Antibiotic resistance (ABR) is a global public health threat. Despite the emergence of highly resistant organisms and the huge medical need for new drugs, the development of antibacterials has slowed to an unacceptable level worldwide. Numerous government and non-government agencies have called for public-private partnerships and innovative funding mechanisms to address this problem. To respond to this public health crisis, the Innovative Medicines Initiative Joint Undertaking programme has invested more than €660 million, with a goal of matched contributions from the European Commission and the European Federation of Pharmaceutical Industries and Associations, in the development of new antibacterial strategies. The New Drugs for Bad Bugs (ND4BB) programme, an Innovative Medicines Initiative, has the ultimate goal to boost the fight against ABR at every level from basic science and drug discovery, through clinical development to new business models and responsible use of antibiotics. Seven projects have been launched within the ND4BB programme to achieve this goal. Four of them will include clinical trials of new anti-infective compounds, as well as epidemiological studies on an unprecedented scale, which will increase our knowledge of ABR and specific pathogens, and improve the designs of the clinical trials with new investigational drugs. The need for rapid concerted action has driven the funding of seven topics, each of which should add significantly to progress in the fight against ABR. ND4BB unites expertise and provides a platform where the commitment and resources required by all parties are streamlined into a joint public-private partnership initiative of unprecedented scale.

Simple-design ultra-low phase noise microwave frequency synthesizers for high-performing Cs and Rb vapor-cell atomic clocks

We report on the development and characterization of novel 4.596 GHz and 6.834 GHz microwave frequency synthesizers devoted to be used as local oscillators in high-performance Cs and Rb vapor-cell atomic clocks. The key element of the synthesizers is a custom module that integrates a high spectral purity 100 MHz oven controlled quartz crystal oscillator frequency-multiplied to 1.6 GHz with minor excess noise. Frequency multiplication, division, and mixing stages are then implemented to generate the exact output atomic resonance frequencies. Absolute phase noise performances of the output 4.596 GHz signal are measured to be -109 and -141 dB rad(2)/Hz at 100 Hz and 10 kHz Fourier frequencies, respectively. The phase noise of the 6.834 GHz signal is -105 and -138 dB rad(2)/Hz at 100 Hz and 10 kHz offset frequencies, respectively. The performances of the synthesis chains contribute to the atomic clock short term fractional frequency stability at a level of 3.1 × 10(-14) for the Cs cell clock and 2 × 10(-14) for the Rb clock at 1 s averaging time. This value is comparable with the clock shot noise limit. We describe the residual phase noise measurements of key components and stages to identify the main limitations of the synthesis chains. The residual frequency stability of synthesis chains is measured to be at the 10(-15) level for 1 s integration time. Relevant advantages of the synthesis design, using only commercially available components, are to combine excellent phase noise performances, simple-architecture, low-cost, and to be easily customized for signal output generation at 4.596 GHz or 6.834 GHz for applications to Cs or Rb vapor-cell frequency standards.

Strengths and limitations of industry vs. academic randomized controlled trials

Clinical research has evolved substantially over the last two decades, but industry-sponsored research is still substantially superior to academic research in preparing, organizing and monitoring studies. Academics have to realize that conducting clinical research has become a real job with professionalism requirements. The primary objectives of research and development clearly differ between industry and academics. In the first case, new drug development is expected to generate profit, whereas in the latter case, research is aimed at understanding mechanisms of disease, promoting evidence-based medicine, and improving public health and care. However, a large number of clinical studies do not achieve their goals, and the reasons for failure may also differ between sponsored and academic studies. Industry and academics should develop better constructive partnerships and learn from each other. Academics should guide industry in study design and in investigator site selection, and academics should benefit from industry's expertise in improving monitoring and reporting processes. Finally, the existing database from former studies should be opened and shared with academics, to enable the exploration of additional scientific questions and the generation of new hypotheses. The two types of research should not be opposed, but should take the form of a constructive collaboration, increasing the chances of reaching each individual goal.

Adherence to online monitoring of patient-reported outcomes by patients with chronic inflammatory diseases: a feasibility study

Objectives

The objective of this report is to investigate the feasibility of collecting patient-reported outcomes (PROs) via e-questionnaires delivered to patients with chronic inflammatory diseases (CIDs).

Methods

Consecutive outpatients with a confirmed diagnosis of systemic lupus erythematosus, primary Sjögren’s syndrome or inflammatory bowel disease were followed at two medical departments. Patients received monthly e-mails containing the SF36, Hospital Anxiety and Depression scale and an analogue symptom scale over a six-month period. Participation rate, socio-demographic characteristics and patients’ satisfaction were analysed.

Results

A total of 128 patients were included (79% female; mean age: 42 ± 12 years). Eighty-two per cent of questionnaires were returned. The monthly participation rate ranged from 89% to 77%, with a six-month attrition rate of 13%. The mean completion rate of questionnaires was 98%. Factors significantly associated with increased answer rate were: married/couple status, greater number of children at home and previous participation in online surveys. The main reasons for non-response were: ‘too busy to participate’ (35%) and ‘away from home Internet access’ (31%). Overall, 68% of the participants found the study convenient and 96% agreed to continue at a monthly or bimonthly frequency.

Conclusion

Online home self-assessment of PROs was feasible in the setting of CIDs. Patients were satisfied and willing to continue the survey. The Internet allows immediate and sophisticated presentation of PROs to clinicians. Future studies are warranted to determine how PRO monitoring may contribute to routine care in CIDs and other diseases.

A low phase noise microwave frequency synthesis for a high-performance cesium vapor cell atomic clock

We report the development, absolute phase noise, and residual phase noise characterization of a 9.192 GHz microwave frequency synthesis chain devoted to be used as a local oscillator in a high-performance cesium vapor cell atomic clock based on coherent population trapping (CPT). It is based on frequency multiplication of an ultra-low phase noise 100 MHz oven-controlled quartz crystal oscillator using a nonlinear transmission line-based chain. Absolute phase noise performances of the 9.192 GHz output signal are measured to be -42, -100, -117 dB rad(2)/Hz and -129 dB rad(2)/Hz at 1 Hz, 100 Hz, 1 kHz, and 10 kHz offset frequencies, respectively. Compared to current results obtained in a state-of-the-art CPT-based frequency standard developed at LNE-SYRTE, this represents an improvement of 8 dB and 10 dB at f = 166 Hz and f = 10 kHz, respectively. With such performances, the expected Dick effect contribution to the atomic clock short term frequency stability is reported at a level of 6.2 × 10(-14) at 1 s integration time, that is a factor 3 higher than the atomic clock shot noise limit. Main limitations are pointed out.

Structure-based design, synthesis and A-site rRNA co-crystal complexes of novel amphiphilic aminoglycoside antibiotics with new binding modes: a synergistic hydrophobic effect against resistant bacteria

Incorporation of an hydrophobic (phenethylamino)ethyl ether at C2″ of N1-(HABA)-3',4'-dideoxyparomomycin led to a novel analog with an excellent antibacterial profile against a host of resistant bacteria.

[Barotrauma by Venturi effect during apnea testing for the determination of brain death. Should it change the terms of application of this test?]

The clinical diagnosis of brain death is based on three clinical criteria, one of them being the abolition of the spontaneous breathing shown by an apnoea testing [1,2]. During this manoeuvre, oxygen is administered by intratracheal way through oxygen supply tubing inserted into the endotracheal tube. Few cases of barotrauma with tension pneumothorax during this test have been described in the literature bringing to the loss of potential donor or grafts for transplantation. The authors report a new case of tension pneumothorax occurred during an apnoea testing despite the precautionary measures necessary to prevent such a catastrophic complication. In addition to the possible pathophysiologic explanation of the event advanced by the authors, it seems lawful to redefine the practical modalities of implementation of this test to avoid the loss of potential grafts.

[Fulminant myocarditis: clinical value of extracorporeal life support]

Fulminant myocarditis is a rare cause of cardiogenic shock which usually occurs in young adults without known cardiac disease. Initial course may be complicated by a cardiogenic shock refractory to optimal medical treatment. Temporary circulatory assistance using an extracorporeal life support is of great clinical value in this setting, since myocardial systolic function usually fully recovers after a short time delay.

Crystal Structure of the Bacterial Ribosomal Decoding Site Complexed with a Synthetic Doubly Functionalized Paromomycin Derivative: a New Specific Binding Mode to an A-Minor Motif Enhances in vitro Antibacterial Activity

The crystal structure of the complex between oligonucleotide containing the bacterial ribosomal decoding site (A site) and the synthetic paromomycin analogue 1, which contains the gamma-amino-alpha-hydroxybutyryl (L-haba) group at position N1 of ring II (2-DOS ring), and an ether chain with an O-phenethylaminoethyl group at position C2'' of ring III, is reported. Interestingly, next to the paromomycin analogue 1 specifically bound to the A site, a second molecule of 1 with a different conformation is observed at the crystal packing interface which mimics the A-minor interaction between two bulged-out adenines from the A site and the codon-anticodon stem of the mRNA-tRNA complex. Improved antibacterial activity supports the conclusion that analogue 1 might affect protein synthesis on the ribosome in two different ways: 1) specific binding to the A site forces maintenance of the "on" state with two bulged out adenines, and 2) a new binding mode of 1 to an A-minor motif which stabilizes complex formation between the ribosome and the mRNA-tRNA complex regardless of whether the codon-anticodon stem is of the cognate or near-cognate type.

Crystallographic studies of Homo sapiens ribosomal decoding A site complexed with aminoglycosides

Aminoglycosides are highly effective antibacterial drugs that decrease translation accuracy by binding to the aminoacyl-tRNA decoding site (A site) of 16S ribosomal RNA. On the other hand, they are highly toxic to mammals through kidney and ear-associated illnesses by binding to ribosomal A sites. To understand the mechanism of toxicity of aminoglycosides to mammals at atomic level, crystallographic studies have been carried out with a number of Homo sapiens mitochondrial and cytoplasmic A sites complexed with aminoglycosides. Several X-ray diffraction data sets were successfully collected. Initial phases of mitochondrial A site with tobramycin and cytoplasmic A site with paromomycin were derived by the molecular replacement method. Refinements of atomic parameters are now under progress.

Structure-based design, synthesis, and A-site rRNA cocrystal complexes of functionally novel aminoglycoside antibiotics: C2" ether analogues of paromomycin

A series of 2"-O-substituted ether analogues of paromomycin were prepared based on new site-selective functionalizations. X-ray cocrystal complexes of several such analogues revealed a new mode of binding in the A-site rRNA, whereby rings I and II adopted the familiar orientation and position previously observed with paromomycin, but rings III and IV were oriented differently. With few exceptions, all of the new analogues showed potent inhibitory activity equal or better than paromomycin against a sensitive strain of S. aureus. Single digit microM MIC values were obtained against E. coli, with some of the ether appendages containing polar or basic end groups. Two analogues showed excellent survival rate in a mouse septicemia protection assay. Preliminary histopathological analysis of the kidney showed no overt signs of toxicity, while controls with neomycin and kanamycin were toxic at lower doses.

Structure-based design, synthesis, and A-site rRNA cocrystal complexes of functionally novel aminoglycoside antibiotics: C2" ether analogues of paromomycin

A series of 2"-O-substituted ether analogues of paromomycin were prepared based on new site-selective functionalizations. X-ray cocrystal complexes of several such analogues revealed a new mode of binding in the A-site rRNA, whereby rings I and II adopted the familiar orientation and position previously observed with paromomycin, but rings III and IV were oriented differently. With few exceptions, all of the new analogues showed potent inhibitory activity equal or better than paromomycin against a sensitive strain of S. aureus. Single digit microM MIC values were obtained against E. coli, with some of the ether appendages containing polar or basic end groups. Two analogues showed excellent survival rate in a mouse septicemia protection assay. Preliminary histopathological analysis of the kidney showed no overt signs of toxicity, while controls with neomycin and kanamycin were toxic at lower doses.

Crystal structure of the bacterial ribosomal decoding site complexed with amikacin containing the gamma-amino-alpha-hydroxybutyryl (haba) group

Amikacin is the 4,6-linked aminoglycoside modified at position N1 of the 2-deoxystreptamine ring (ring II) by the L-haba group. In the present study, the crystal structure of a complex between oligonucleotide containing the bacterial ribosomal A site and amikacin has been solved at 2.7 A resolution. Amikacin specifically binds to the A site in practically the same way as its parent compound kanamycin. In addition, the L-haba group interacts with the upper side of the A site through two direct contacts, O2*...H-N4(C1496) and N4*-H...O6(G1497). The present crystal structure shows how the introduction of the L-haba group on ring II of aminoglycoside is an effective mutation for obtaining a higher affinity to the bacterial A site.

Binding of neomycin-class aminoglycoside antibiotics to mutant ribosomes with alterations in the A site of 16S rRNA

Aminoglycoside antibiotics that bind to the aminoacyl-tRNA site (A site) of the ribosome are composed of a common neamine core in which a glycopyranosyl ring is attached to position 4 of a 2-deoxystreptamine moiety. The core is further substituted by one (ribostamycin), two (neomycin and paromomycin), or three (lividomycin A) additional sugars attached to position 5 of the 2-deoxystreptamine. To study the role of rings III, IV, and V in aminoglycoside binding, we used isogenic Mycobacterium smegmatis DeltarrnB mutants carrying homogeneous populations of mutant ribosomes with alterations in the 16S rRNA A site. MICs were determined to investigate drug-ribosome interactions, and the results were compared with that of the previously published crystal structure of paromomycin bound to the ribosomal A site. Our analysis demonstrates that the stacking interaction between ring I and G1491 is largely sequence independent, that rings III and IV each increase the strength of drug binding to the ribosome, that ring IV of the 6'-NH3+ aminoglycosides compensates for loss of interactions between ring II and U1495 and between ring III and G1491, that the aminoglycosides rely on pseudo-base pairing between ring I and A1408 for binding independently of the number of sugar rings attached to the neamine core, that addition of ring V to the 6'-OH 4,5-aminoglycoside paromomycin does not alter the mode of binding, and that alteration of the U1406.U1495 wobble base pair to the Watson-Crick interaction pair 1406C-1495G yields ribosomal drug susceptibilities to 4,5-aminoglycosides comparable to those seen with the wild-type A site.

Crystal structures of complexes between aminoglycosides and decoding A site oligonucleotides: role of the number of rings and positive charges in the specific binding leading to miscoding

The crystal structures of six complexes between aminoglycoside antibiotics (neamine, gentamicin C1A, kanamycin A, ribostamycin, lividomycin A and neomycin B) and oligonucleotides containing the decoding A site of bacterial ribosomes are reported at resolutions between 2.2 and 3.0 A. Although the number of contacts between the RNA and the aminoglycosides varies between 20 and 31, up to eight direct hydrogen bonds between rings I and II of the neamine moiety are conserved in the observed complexes. The puckered sugar ring I is inserted into the A site helix by stacking against G1491 and forms a pseudo base pair with two H-bonds to the Watson-Crick sites of the universally conserved A1408. This central interaction helps to maintain A1492 and A1493 in a bulged-out conformation. All these structures of the minimal A site RNA complexed to various aminoglycosides display crystal packings with intermolecular contacts between the bulging A1492 and A1493 and the shallow/minor groove of Watson-Crick pairs in a neighbouring helix. In one crystal, one empty A site is observed. In two crystals, two aminoglycosides are bound to the same A site with one bound specifically and the other bound in various ways in the deep/major groove at the edge of the A sites.

Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma

Cardiac tamponade is an uncommon complication of blunt chest trauma, resulting typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma associated with a sternal fracture. The patient was involved in a violent deceleration accident. Initially, he only complained of an anterior thoracic pain, but subsequently became restless, pale, and dyspneic. A severe hypotension associated with sinus bradycardia (45 bpm) rapidly occurred. Both jugular veins became markedly turgescent, but no significant pulsus paradoxus was noted. Echocardiography disclosed a large hematoma, compressing anteriorly both the right ventricular cavity and outflow tract. Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by instantaneous hemodynamic improvement. Regional extrapericardial tamponade secondary to the acute formation of compressive retrosternal hematoma is an unusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology may be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.

[Hemophagocytosis during multiple organ failure: M-CSF overproduction or viral reactivation?]

OBJECTIVE

This study was aimed to assess the potential role of M-CSF and viral reactivation in the genesis of haemophagocytosis during the multiple organ failure (MOF) syndrome.

METHODS

Twenty-five patients (mean age: 60 +/- 16 years; Apache II: 23 +/- 5) sustaining MOF with an unexplained thrombocytopenia were studied. In each patient, a bone marrow aspirate, serum M-CSF concentration, and a virological examination (Herpes viruses) were obtained on admission. In addition, 20 patients (mean age: 57 +/- 15 years; Apache II: 24 +/- 7) with at least two organ failures but no thrombocytopenia constituted the control group. Circulating M-CSF levels and the frequency of virus reactivation were compared between groups.

RESULTS

Haemophagocytosis was diagnosed in 11/25 patients (44%). No viral reactivation was found. Serum M-CSF concentrations were higher in the presence of haemophagocytosis (699 +/- 242 vs 438 +/- 157 IU.mL-1; p < 0.05). Ferritin levels were also increased in the presence of a macrophage activation (3,258 +/- 2,807 vs. 520 +/- 280 mg.L-1; p < 0.0001). In contrast, both circulating M-CSF and ferritin levels were similar between thrombocytopenic patients with no hemophagocytosis and controls.

CONCLUSIONS

This study confirmed the high incidence of haemophagocytosis in critically ill patients sustaining MOF. In this setting, circulating M-CSF levels were markedly elevated, whereas no Herpes viruses reactivation was found.

Comparison of multiplane transesophageal echocardiography and contrast-enhanced helical CT in the diagnosis of blunt traumatic cardiovascular injuries

BACKGROUND

Multiplane transesophageal echocardiography (TEE) and helical computed tomography (CT) of the chest have been validated separately against aortography for the diagnosis of acute traumatic aortic injuries (ATAI). However, their respective diagnostic accuracy in identifying blunt traumatic cardiovascular lesions has not been compared.

METHODS

During a 3-yr period, 110 consecutive patients with severe blunt chest trauma (age: 41 +/- 17 yr; injury severity score: 34 +/- 14) prospectively underwent TEE and chest CT as part of their initial evaluation. Results of both imaging methods were interpreted independently by experienced investigators and subsequently compared. All cases of subadventitial acute traumatic aortic injury were surgically confirmed.

RESULTS

Seventeen patients had vascular injury and 11 had cardiac lesions. TEE and CT identified all subadventitial disruptions involving the aortic isthmus (n = 10) or the ascending aorta (n = 1) that necessitated surgical repair. In contrast, CT only depicted one disruption of the innominate artery. TEE detected injuries involving the intimal or medial layer, or both, of the aortic isthmus in four patients with apparently normal CT results who underwent successful conservative treatment. All cardiac injuries but two were identified only by TEE.

CONCLUSIONS

In patients with severe blunt chest trauma, TEE and CT have similar diagnostic accuracy for the identification of surgical acute traumatic aortic injuy. TEE also allows the diagnosis of associated cardiac injuries and is more sensitive than CT for the identification of intimal or medial lesions of the thoracic aorta.

A new simple technique for the insertion of cuffed central venous catheters: an initial experience

BACKGROUND

Although tunneled polyurethane catheters with polyester cuffs are useful when prolonged central venous access is necessary but their insertion still remains challenging at times. We report the first study of a new cuffed polyurethane catheter (Seldicuff) that can be easily inserted using the Seldinger technique without the need of a vein dilator and that incorporates a tunneling needle onto the catheter. A Seldicuff catheter was placed in 15 patients (mean age: 53 +/- 11 years) who required prolonged parenteral nutrition. All catheters were inserted into the right subclavian vein. The procedure lasted 6.4 +/- 0.8 minutes and no complication directly related to catheter placement was noted. Catheters remained in position for a mean duration of 103 days (range, 58 to 220 days). During this period, no infectious or mechanical complications were observed.

CONCLUSION

These results demonstrate that placement of this novel cuffed catheter is as simple as inserting a conventional central venous catheter.

Reactivation of human herpesvirus type 6 in multiple organ failure syndrome

Human herpesvirus type 6 (HHV-6) and cytomegalovirus (CMV) are known to interact with the production of cytokines. In this study, we sought to determine the incidence of HHV-6 and CMV reactivation during multiple organ failure syndrome (MOFS) and to evaluate the potential effects of viral replication on both the morbidity and mortality associated with MOFS. Viral reactivation was assessed by use of specific polymerase chain reaction (PCR) analysis of the serum samples obtained from 48 consecutive patients with MOFS (the MOFS group) and from 48 sex- and age-matched patients with <2 organ failures (the control group). In addition, HHV-6 replication was assessed in 106 blood donors (the normal group). The incidence of HHV-6 replication was higher in the MOFS group than in the control and normal groups (26 [54%] of 48 vs. 7 [15%] of 48 and 5 [5%] of 106, respectively; P<.0001), with apparently no influence on morbidity and mortality rates. In contrast, reactivation of CMV was found in a single patient. Further studies are needed to evaluate the pathogenesis of HHV-6 replication in critically ill patients.

Intrathecal baclofen after traumatic brain injury: early treatment using a new technique to prevent spasticity

BACKGROUND

In the early course of severe head trauma, the clinical value of intrathecal administration of baclofen to reduce autonomic disorders and spasticity has not been established.

METHODS

We studied four patients (Glasgow Coma Scale score 3 or 4) with autonomic disorders and spasticity who failed to respond to conventional treatment during the early course of head injury. Baclofen (25 microg/mL) was infused continuously through an intrathecal catheter inserted at patient bedside and subcutaneously tunneled. When this treatment was successful, the spinal catheter was removed and surgically replaced by another catheter connected to a subcutaneous pump. Clinical follow-up was obtained at 6 months after the head injury.

RESULTS

Mean delay for the initiation of intrathecal baclofen was 25 days (range, 21 to 31 days), and optimal dose was 385 +/- 185 microg/day. In all patients, the Ashworth score was consistently reduced (3.5 +/- 0.5 vs. 4.5 +/- 0.5 for upper limbs and 2 +/- 0.5 vs. 4.5 +/- 0.5 for lower limbs), as were both the frequency and intensity of autonomic disorders. The spinal catheters were used during a mean period of 9.5 +/- 1.7 days without complications. All three survivors were equipped with a programmable pump and had a lower Ashworth score at 6 months. Autonomic disorders had disappeared in two patients and remained modest in the remaining patient.

CONCLUSION

Continuous administration of baclofen via the intrathecal route using this new technique seems to reduce autonomic disorders and spasticity during the early course of severe traumatic head injury.