High mobility group box 1, ATP, lipid mediators, and tissue factor are elevated in COVID-19 patients: HMGB1 as a biomarker of worst prognosis

The severe acute respiratory syndrome coronavirus 2, the agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, has spread worldwide since it was first identified in November 2019 in Wuhan, China. Since then, progress in pathogenesis linked severity of this systemic disease to the hyperactivation of network of cytokine-driven pro-inflammatory cascades. Here, we aimed to identify molecular biomarkers of disease severity by measuring the serum levels of inflammatory mediators in a Brazilian cohort of patients with COVID-19 and healthy controls (HCs). Critically ill patients in the intensive care unit were defined as such by dependence on oxygen supplementation (93% intubated and 7% face mask), and computed tomography profiles showing ground-glass opacity pneumonia associated to and high levels of D-dimer. Our panel of mediators included HMGB1, ATP, tissue factor, PGE₂ , LTB₄ , and cys-LTs. Follow-up studies showed increased serum levels of every inflammatory mediator in patients with COVID-19 as compared to HCs. Originally acting as a transcription factor, HMGB1 acquires pro-inflammatory functions following secretion by activated leukocytes or necrotic tissues. Serum levels of HMGB1 were positively correlated with cys-LTs, D-dimer, aspartate aminotransferase, and alanine aminotransferase. Notably, the levels of the classical alarmin HMGB1 were higher in deceased patients, allowing their discrimination from patients that had been discharged at the early pulmonary and hyperinflammatory phase of COVID-19. In particular, we verified that HMGB1 levels above 125.4 ng/ml is the cutoff that distinguishes patients that are at higher risk of death. In conclusion, we propose the use of serum levels of HMGB1 as a biomarker of severe prognosis of COVID-19.

Effects of an antioxidant protective topical formulation on eye exposed to ultraviolet-irradiation: a study in rabbit animal model

Ultraviolet-radiation exerts a well-known role in the development of various ocular diseases and may contribute to the progress of age-related macular degeneration. Therefore, the use of compounds able to protect the eyes from UV-induced cellular damage is challenging. The aim of this study has been to test the protective effects of an antioxidant topical formulation against UV-induced damage in rabbit eyes. Twelve male rabbits were used. Animals were divided into 4 groups of 3 animals each. Control group (CG) did not receive any irradiation and/or eye drop. The other three experimental groups were treated as follows: the first group received only UVR irradiation for 30 min, without eye drop supplementation (Irradiation group, IG), the second (G30) and the third (G60) groups received UV irradiation for 30' and 60', respectively, and eye drop supplementation (riboflavin, d-alpha-tocopheryl polyethylene glycol, proline, glycine, lysine and leucine solution) every 15 min for three hours. In the IG group a significant increase of oxidized glutathione (GSSG) and hydrogen peroxide (H(2)O(2)) was recorded in the aqueous humor, whereas ascorbic acid levels were significantly lower when compared to control eyes. In the groups exposed to UVR rays for 30 min, and treated with the topical antioxidant formulation, the GSSG, H(2)O(2) and ascorbic acid levels were similar to those recorded in controls, whereas in the G60 group the three markers significantly differ from control group. In the lens, a significant decrease of alpha tocopherol and total antioxidant capacity (TAC) was recorded in IG-animals as compared to control group, whereas malondialdehyde (MDA) levels were significantly higher in UV-induced eye than in control eyes. In the G30 groups the alpha tocopherol, MDA and TAC levels do not significantly differ from those recorded in controls, whereas in the G60 group these three markers significantly differ from control group. Present findings demonstrate that topical treatment with the antioxidant formulation used herein protects ocular structures from oxidative stress induced by UV exposure in in vivo animal model.

Effect of water restriction on milk yield and quality in Lacaune breed ewes

The effect of water restriction on body weight, body condition score, milk yield, and milk composition and rheological characteristics in intensively reared Lacaune ewes was evaluated. After 7 days of adaptation, the trial lasted 28 days. Thirty lactating ewes (48 ± 5 months of age; mean value ± standard deviation) at the beginning of third lactation month were divided into three groups (n = 10), corresponding to the following water restriction treatment: a group control received no drinking water restriction (W100), and two groups received water to the extent of 80% and 60% of W100 daily consumption (W80 and W60 group respectively). The effects of water restriction were assessed at the beginning of experiment (D0), at D14 and D28. The W60 group resulted in a significant decrease in body weight, body condition score, milk yield and feed consumption of hay due to the experimental treatment; whereas a marked increase in both W60 and W80 groups of milk lactose, urea, sodium, sodium chloride content and titratable acidity was observed. Rheological parameters of milk, rennet coagulation time and curd-firming time were positively affected by water restriction treatments, with a decrease in both experimental groups of the time required for the formation of a stable and firm curd. Results highlight the importance of water consumption in dairy sheep. The scarce availability of water, significantly affecting ewes milk production, is worthy of particular attention in arid area where water stress-resistant breeds should be considered. This study underlines that milk yield, being closely linked to the availability of water of the breeding habitat due to its high water content (about 81%), could be reached in area where water is not a limiting factor without reducing the genetic expression of the animals. Less severe water restrictions, such as 20% of daily voluntary water intake, produce no detrimental effect on milk yield.

The effect of Laurus nobilis on the blood and lenses antioxidant activity in rabbit under fat-enriched diet

Fat-enriched diet is strongly associated with cataract development. Laurus nobilis shows antioxidant activity. Herein we evaluated the effect of Laurus nobilis oral administration on the blood and lenses antioxidant activity in rabbits under fat-enriched diet. Sixty rabbits divided into 4 groups were used. One group represented the control (N-CTR). The second group (P-CTR) fed a diet supplemented with 2.5 % of pig fat; the third group (EXP1) received a diet supplemented with 2.5 % of pig fat and 1 g/kg of dried-bay leaves; the fourth group (EXP2) was treated with dried-bay leaves at the rate of 1 g/kg of feed. At baseline and at the end of the study (56 days) the following blood parameters were determined: thiobarbituric acid reactive substances (TBARS), reactive oxygen metabolites (ROMs), total phenols, superoxide dismutase (SOD), oxygen radical absorbance capacity (ORAC(pca)), ferric ion reducing antioxidant power (FRAP), retinol and alfa-tocopherol. At the end of the follow-up, the eyes were enucleated and the antioxidant profile, such as total antioxidant activity (TAC), TBARS, retinol and alfa-tocopherol of lenses was evaluated. Plasma ROMs and TBARS levels were statistically lower in the groups receiving bay leaves integration. A significant increase of plasma retinol, FRAP and ORAC(pca) levels was found in EXP1 and EXP2 groups, whereas plasma alfa-tocopherol resulted statistically higher only in EXP2 group. Bay leaves supplementation enhanced TAC, retinol and alfa-tocopherol in rabbit lens, particularly in EXP2 group; whereas lenses TBARS levels significantly decreased in both treated groups. These findings demonstrate that Laurus nobilis oral administration exerts a protective effect on the risk of cataract development in rabbits under fat-enriched diet.

Effect of dietary Lippia citriodora extract on reproductive and productive performance and plasma biochemical parameters in rabbit does

Two doses of natural extract from Lippia citriodora (titrated in verbascoside) were assessed in New Zealand White rabbit does evaluating selected reproductive, productive and plasma biochemical parameters. After 1 week of adaptation period, the trial on 45 rabbit does for three consecutive reproductive cycles was conducted; does were divided into three groups of 15 animals each, homogenous by age (1 year ± 2 weeks), bodyweight (4.77 ± 0.21 kg) and parity (2 ± 1). A control group (CON) did not receive the dietary supplement in the feed and the other two groups received 1 g of natural extract supplement in the feed (5 mg verbascoside/kg feed; LNE) and 2 g of natural extract (10 mg verbascoside/kg feed; HNE). The use of a dietary NE supplement improved kit bodyweight at weaning (934 vs 1104 g; P < 0.001), and average daily weight gain from birth to weaning (24.7 vs 29.7 g/day; P < 0.001), with no NE dose effect. In the LNE and HNE groups serum triglycerides, total cholesterol, low density lipoprotein cholesterol, bilirubin, and activities of alkaline phosphatase, alanine aminotransferase (P < 0.05) and aspartate aminotransferase (P < 0.01) decreased and high density lipoprotein cholesterol (P < 0.01) increased, according to the cycle effect. The dietary supplement also improved blood oxidative status markers in the experimental groups due to an increase in the concentrations of plasma vitamin A and E (P < 0.01) and a decrease in plasma reactive oxygen metabolites and thiobarbituric acid reactive substances values (P < 0.01). In conclusion, the dietary Lippia NE supplement improved selected productive and reproductive parameters and the animal welfare of does, expressed by a general improvement of blood profile, with no effect of the dose.

Dietary effect of dried bay leaves (Laurus nobilis) meal on some biochemical parameters and on plasma oxidative status in New Zealand white growing rabbit

Effects of dietary supplementation of Laurus nobilis on selected biochemical parameters and plasma oxidative status in growing rabbits, fed with and without enriched-fat diet, integrated with and without dried bay leaves meal, were investigated. In the test, 120 New Zealand white 35-day-old male rabbits were divided into four homogeneous groups of 30 animals each. A negative control group (CON) received a feed that met the animal nutrient requirement; a positive control group (CG) receiving a supplement of 2.5% pig fat in feed; an experimental group (GA) feeding an integration of 2.5% pig fat and 1 g/kg of dried bay leaves (Laurus nobilis) in feed; an experimental group (CA) with dried bay leaves at the rate of 1 g/kg in feed. The dietary integration with dried bay leaves meal have resulted in a significant decrease in the blood lipid profile, glycemic profile and liver enzymes, with reduced levels of ALT and AST, glucose, total cholesterol, LDL cholesterol, triglycerides and increased HDL cholesterol. Plasma oxidative status markers have statistically improved with an increase in blood total phenols, SOD, ORAC, the FRAP and lipo-vitamin concentration, together with a significant reduction in ROMs and the MDA values. The results of present research underline that the dietary treatment with bay leaves meal, in the extend of 1 g/kg feed, confirms the lowering cholesterol activity and the epato-protective and ipo-glycemic effect in enrich-fat diet, controlling the oxidative status of plasma markers.

Dietary <i>Lippia citriodora</i> extract in rabbit feeding: effects on quality of carcass and meat

Abstract. Due to consumer demand, in recent years considerable attention has been focused on the use of natural compounds in animal feed. The aim of this study was to evaluate the effect of dietary natural extract from Lippia citriodora (commonly named "limoncina"), titrated in verbascoside, on quality, measured as oxidative stability, fatty acid composition, alpha-tocopherol and retinol content and sensory traits of rabbit meat. Forty-five New Zealand white rabbits were randomly assigned to three age- and body-weight-balanced feeding groups of 15 animals each in which a conventional pelleted diet (CON) was supplemented with 1 or 2 kg t−1 (low natural-extract (LNE) and high natural-extract (HNE) groups, respectively) of Lippia citriodora extract for 55 days. No influence on carcass characteristics and the chemical composition of meat was observed. A trend for a positive effect on alpha-tocopherol tissue content (P = 0.07) and on thiobarbituric reactive substance (TBARS) values was observed (P = 0.063) in Longissimus Lumborum muscle from the HNE group. The fatty acid profile of the meat was affected by dietary treatment with a significant decrease (P = 0.001) in saturated fatty acids and an increase (P = 0.01) in polyunsaturated fatty acids in both treated groups compared to the CON group. The supplementation with natural extract at the highest dosage improved the tenderness and juiciness of meat, highlighting a better consistency than CON and LNE groups. In conclusion, this study shows that the natural extract used has the potential to improve rabbit meat in order to produce functional food, without altering the chemical and physical characteristics of meat.

FOLFIRI regimen: an effective second-line chemotherapy after failure of etoposide-platinum combination in patients with neuroendocrine carcinomas grade 3

Patients with neuroendocrine carcinomas (NECs) grade 3 have a poor prognosis. Etoposide-platinum combination is the standard chemotherapy but the role of a second-line therapy remains unknown. Irinotecan alone or in combination has shown some efficacy in patients treated for small cell lung cancer which had pathological similarities with neuroendocine tumors. The aim of this study is to determine safety and efficacy of the FOLFIRI regimen in patients with NECs grade 3 after failure of etoposide-platinum combination. This study was retrospective, including patients with NECs grade 3 and treated with the FOLFIRI regimen after progression or toxicity of etoposide-platinum combination in first-line. Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≥3 and/or serum alkaline phosphatase ≥5×upper limit of normal value (ULN) and/or bilirubin ≥1.5×ULN were excluded. Among 39 patients who failed etoposide-platinum combination, 19 (49%; 12 women, median age 53 (29-78) years) received the FOLFIRI regimen with a median number of 6 (1-16) courses. Six patients (31%) had at least one episode of grades 3-4 toxicity (neutropenia, n=3; diarrhea, n=3) without toxic death. Six patients (31%) had objective response, 6 (31%) stable disease, and 7 (38%) tumor progression. Median progression-free survival under FOLFIRI was 4 months. Overall survival was 18 vs 6.8 months in noneligible patients. FOLFIRI regimen is a safe and potentially efficient chemotherapy given as second-line in patients with NECs grade 3 who remain in good condition and with correct liver tests after failure of etoposide-platinum combination. These results should be confirmed in a future prospective study.

Cost-effectiveness analysis of micafungin versus caspofungin for treatment of systemic Candida infections in the UK

OBJECTIVE

To evaluate the cost-effectiveness of micafungin compared to caspofungin in the treatment of systemic Candida infections (SCIs) in the UK, including invasive candidiasis and candidaemia.

RESEARCH DESIGN AND METHODS

Cost-effectiveness of both echinocandin antifungal drugs was estimated using decision analysis. Response to treatment, resource utilisation, and costs in the model were derived from a phase 3, head-to-head comparative trial. The model includes only data directly related to the treatment of the systemic Candida infection over the study duration (a maximum period of 14 weeks). Transition probabilities were calculated based on the efficacy results from the clinical trial.

MAIN OUTCOME MEASURES

The model's effectiveness outcome is surviving patients who are successfully treated, based on the absence of signs and symptoms, radiographic abnormalities, and culture/histologic evidence associated with the fungal infection. In addition, subgroup analyses were performed to identify cost-effectiveness in several specific patient groups.

RESULTS

The total medical treatment costs for the micafungin group were pound 29,095, which is similar to the total costs for the caspofungin group (pound 29,953). In the micafungin arm 60% of the patients and in the caspofungin arm 58% of the patients were successfully treated and alive. Cost-effectiveness ratio of micafungin was pound 48,771, and of caspofungin pound 52,066 per successfully treated patient. Because the costs are lower and the effectiveness is higher for micafungin in comparison with caspofungin, micafungin is more cost-effective than caspofungin. However, probabilistic sensitivity and subgroup analysis show that the differences cannot be considered significant due to a large variance although micafungin remained the most cost-effective option throughout all but one of the sensitivity analyses.

CONCLUSIONS

Costs and effects of micafungin compare to those of caspofungin in the treatment of systemic Candida infections in the UK. The results indicate that micafungin is cost-effective compared to caspofungin, although the difference was not found to be significant.

Toll-like receptor agonists regulate β-defensin 2 release in hair follicle

BACKGROUND

Skin is constantly in contact with different pathogens, which are present in the environment. The hair follicle is particularly susceptible to this microbial invasion as it offers an easy way of access for microorganisms; for this reason it is equipped with defence mechanisms to avoid frequent infections.

OBJECTIVES

To analyse the expression pattern of four different members of the toll-like receptor (TLR) family in murine hair follicles and to evaluate the effects of their activation by their specific microbiota-derived agonists, in terms of production of the antimicrobial peptide beta-defensin 2 (DEFB2).

METHODS

TLR and DEFB2 protein expression was investigated by immunohistochemistry on murine skin samples.

RESULTS

Murine hair follicle expresses TLR2, TLR4 and TLR5; agonists of TLR2, TLR4 and TLR5 but not of TLR9 induced DEFB2 production in this compartment. The strongest DEFB2 expression was observed following TLR4 activation by lipopolysaccharide.

CONCLUSIONS

Our data show that the hair follicle is equipped with TLR2, TLR4 and TLR5, and that these receptors are able to respond to microbial stimuli inducing the production of DEFB2 by epithelial cells. This immune response might be important in preserving the skin from microorganism infections.

Caveolin-1 is expressed on multipotent cells of hair follicles and might be involved in their resistance to chemotherapy

BACKGROUND

Caveolin-1 is the principal protein that composes caveolae, which are vesicular invaginations present on the plasma membrane of different cell types. Caveolae are involved in a variety of cellular functions including regulation of proliferation rate and resistance to chemotherapeutic drugs. Chemotherapy frequently induces alopecia which is reversible most probably due to the low proliferative rate of hair follicle stem cells and due to the expression of proteins which confer resistance.

OBJECTIVES

Using a specific animal model and immunohistochemistry, we analysed the expression of both caveolin-1 and the cell proliferation marker beta-catenin, at different stages of the hair follicle cycle, both before and after doxorubicin (DXR) -induced alopecia.

METHODS

Seven-week-old C57BL/6 mice were depilated in order to synchronize hair follicle cycle in the anagen phase. Chemotherapy with DXR 15 mg kg(-1) was used to induce alopecia. Control and treated mice were then sacrificed at precise time points and caveolin-1 expression in hairs at different stages of the cycle were analysed by immunohistochemistry. By double immunofluorescence, colocalization of caveolin-1 and cytokeratin-15 was confirmed in the bulge region. The state of proliferation of cells composing hair follicle was assessed by beta-catenin immunohistochemistry.

RESULTS

Caveolin-1 was expressed by the cells of the bulge area, the multipotent compartment of the hair follicle, during all phases of growth (anagen), regression (catagen) and resting (telogen). During the anagen phases, nuclear beta-catenin labelling was not observed in bulge cells, but rather in the deeper portion of the follicle. Damaged hair follicles from DXR-treated mice presented bulge cells which still expressed caveolin-1, suggesting that this protein might play a role in their drug resistance. As expected, no beta-catenin nuclear staining was detectable in DXR-treated hair follicles, indicating the complete lack of proliferative processes. The differential localization of caveolin-1 and beta-catenin suggests that the mutually exclusive expression of these proteins is useful for correct hair regrowth, whether during the physiological cycle or after chemotherapy-induced alopecia.

CONCLUSIONS

Expression of caveolin-1 within the multipotent cell compartment of the hair follicle can explain the resistance of bulge cells to many chemotherapeutics, suggested by the reversibility of chemotherapy-induced alopecia.

Effects of two different housing systems on behavior, physiology and milk yield of Comisana ewes

Two groups of 20 early-lactating Comisana ewes were used in this study, and were allocated to either an indoor or outdoor daytime environment. The indoor environment was a 3mx12m straw bedded pen inside a pre-fabricated building. The outdoor environment was a 200m(2) paddock during daytime (09.00-19.00h) with ewes being moved to the shed, as described for the indoor treatment, at night. Behavior of ewes was recorded at 14 days interval from 09.00 to 19.00h. A phytohemagglutinin (PHA) skin test was performed at weeks 6, 11, 15 and 18 of the experiment to induce a non-specific delayed-type hypersensitivity in ewes. Jugular blood samples were taken at the beginning and at weeks 5, 10, 14 and 18 to determine endocrine and metabolic responses of animals to housing system and to changes in climatic conditions and stage of lactation. Ewe milk yield was recorded daily and individual milk samples were analyzed for milk composition, coagulating properties and somatic cell count (SCC) at 14 days interval. No differences were found between groups for endocrine and immune responses. Outdoor ewes had increased locomotor activities (P<0.01) and decreased idling (P<0.05) compared to indoor animals. The outdoor group had higher levels of blood creatinine (P<0.01) and inorganic phosphorus (P<0.05) as well as lower urea (P<0.01) and glucose (P<0.001) concentrations compared to the indoor group. Milk yield and composition were not changed by the housing system, though significant timextreatment interactions were found for milk constituents, with indoor-housed ewes having higher (P<0.05) milk protein, fat and lactose concentrations during the middle of the trial. Outdoor ewes had lower SCC (P<0.003) and pH (P<0.001) in their milk than indoor ewes, whereas renneting parameters were not different across treatments. Results suggest that ewe welfare and productivity were not substantially affected by the housing system. The provision of feeding rations that meet the greater energy demand for maintenance is required to sustain productivity in outdoor reared sheep.

Oxygen transport patterns in patients with sepsis syndrome or septic shock: influence of treatment and relationship to outcome

OBJECTIVE

To investigate the relationship between oxygen transport patterns and outcome in patients with sepsis syndrome or septic shock managed according to two different treatment regimens.

DESIGN

Retrospective study of a subgroup of patients with sepsis syndrome or septic shock taken from a randomized, prospective, controlled trial.

SETTING

General intensive care units in a teaching and a district general hospital.

PATIENTS

Seventy-eight patients classified according to predetermined criteria as having sepsis syndrome or septic shock were drawn retrospectively from a larger study group of 109 consecutive patients considered to be at risk for developing multiple organ failure.

INTERVENTIONS

All patients received volume expansion to an optimal pulmonary artery occlusion pressure. If the therapeutic goals (cardiac index of > 4.5 L/min/m2, oxygen delivery [DO2] of > 600 mL/min/m2, and oxygen consumption [VO2] of > 170 mL/min/m2) were not achieved with fluids alone, patients were randomized to either a control group or a treatment group. In the treatment group, dobutamine (5 to 200 micrograms/kg/min) was administered to increase cardiac index and DO2 until all three goals were simultaneously achieved. In the control group, dobutamine was administered only if the cardiac index was < 2.8 L/min/m2. In both groups, norepinephrine was infused to maintain mean arterial pressure at 80 mm Hg.

MEASUREMENTS AND MAIN RESULTS

Hemodynamic, oxygen transport, and lactate measurements were made at the time of admission to the study, at the time of optimal volume administration, at 1, 2, 4, 8, 12, 16, 20, and 24 hrs, then every 6 hrs for the next 24 hrs, and at least every 8 hrs thereafter. The time at which all therapeutic goals were first achieved simultaneously or the time of maximal DO2 was identified and termed "tmax." Survivors from both the control and treatment groups significantly (p < .001) increased cardiac index and DO2 in response to maximal resuscitation, and despite an associated decrease in oxygen extraction (p < .01), there was a significant (p < .01) increase in VO2. In nonsurvivors from both groups, despite significant increases in cardiac index (p < .05) and DO2 (p < .01) at tmax, oxygen extraction decreased (p < .01) and VO2 remained unchanged. DO2 and VO2 were significantly lower (p < .05) at tmax in nonsurvivors than in survivors from both groups. Persistently high lactate concentrations were characteristic of nonsurvivors.

CONCLUSIONS

Survivors of sepsis syndrome or septic shock are characterized by an ability to increase both DO2 and VO2. In contrast, nonsurvivors typically have reduced cardiac reserve, they fail to increase VO2 following resuscitation, and when delivery is enhanced with aggressive inotropic support, oxygen extraction falls. These patterns of response were similar in both treatment and control groups, although the magnitude of the changes was exaggerated in the treatment group. These observations may help to explain the findings by some investigators that treatment aimed at achieving survivor values of cardiac index, DO2, and VO2 fails to improve outcome when instituted following admission to intensive care.

An impaled neck. Management of difficult airway access

We describe the management of a patient impaled through the lower submandibular area by the top spike of some iron railings which immobilised his jaw and blocked access to the trachea. The Fire Brigade used specialised equipment to cut out a section of the railings so that the patient could be transported to hospital. Awake fibreoptic intubation was used to gain access to the patient's airway before induction of anaesthesia.

Elevation of systemic oxygen delivery in the treatment of critically ill patients

BACKGROUND

Elevation of systemic oxygen delivery and consumption has been associated with an improved outcome in critically ill patients. We conducted a randomized trial to determine whether boosting oxygen delivery by infusing the inotropic agent dobutamine would improve the outcome in a diverse group of such patients.

METHODS

On the basis of previously published recommendations, we established the following goals: a cardiac index above 4.5 liters per minute per square meter of body-surface area, oxygen delivery above 600 ml per minute per square meter, and oxygen consumption above 170 ml per minute per square meter. If these goals were not achieved with volume expansion alone, patients were randomly assigned to a treatment or control group. The treatment group received intravenous dobutamine (5 to 200 micrograms per kilogram of body weight per minute) until all three goals had been achieved. Dobutamine was administered to the control group only if the cardiac index was below 2.8 liters per minute per square meter.

RESULTS

A total of 109 patients were studied. In nine patients the therapeutic goals were achieved with volume expansion alone; all nine patients survived to leave the hospital. Fifty patients were randomly assigned to the treatment group, and 50 to the control group. During treatment, there were no differences between the two groups in mean arterial pressure or oxygen consumption, despite a significantly higher cardiac index and level of oxygen delivery in the treatment group (P < 0.05). Although the predicted risk of death during hospitalization was 34 percent for both groups, the in-hospital mortality was lower in the control group (34 percent) than in the treatment group (54 percent) (P = 0.04; 95 percent confidence interval, 0.9 to 39.1 percent).

CONCLUSIONS

The use of dobutamine to boost the cardiac index and systemic oxygen delivery failed to improve the outcome in this heterogeneous group of critically ill patients. Contrary to what might have been expected, our results suggest that in some cases aggressive efforts to increase oxygen consumption may have been detrimental.

Logistic regression analysis of fixed patient factors for postoperative sickness: a model for risk assessment

One hundred and forty-seven patients undergoing minor orthopaedic surgery were studied prospectively by logistic regression analysis to determine the association of independent fixed patient factors with the incidence of postoperative sickness (nausea, retching or vomiting). Gender, history of previous postoperative sickness, postoperative opioids and interaction between gender and previous history of sickness were significant independent factors for postoperative sickness; history of motion sickness was weakly associated. The probability of postoperative sickness in the first 24 h after surgery may be estimated from the equation: logit postoperative sickness = -5.03+2.24(postoperative opioids) +3.97 (previous sickness history) +2.4 (gender) +0.78 (motion sickness) -3.2 (gender x previous sickness history). (Log likelihood ratio test for 5 degrees of freedom for the coefficients, chi-square = 53.5 (P < 0.001).) It is suggested that the calculated probability for sickness may be a useful addition for balancing patient treatment groups and allowing between-study comparisons.