WorldWideScience

Sample records for alley revisited sepsis

  1. The diagnosis of sepsis revisited - a challenge for young medical scientists in the 21st century

    OpenAIRE

    Lynn, Lawrence A

    2014-01-01

    In 1991, a well-meaning consensus group of thought leaders derived a simple definition for sepsis which required the breach of only a few static thresholds. More than 20 years later, this simple definition has calcified to become the gold standard for sepsis protocols and research. Yet sepsis clearly comprises a complex, dynamic, and relational distortion of human life. Given the profound scope of the loss of life worldwide, there is a need to disengage from the simple concepts of the past. T...

  2. Blind Alley Aware ACO Routing Algorithm

    Science.gov (United States)

    Yoshikawa, Masaya; Otani, Kazuo

    2010-10-01

    The routing problem is applied to various engineering fields. Many researchers study this problem. In this paper, we propose a new routing algorithm which is based on Ant Colony Optimization. The proposed algorithm introduces the tabu search mechanism to escape the blind alley. Thus, the proposed algorithm enables to find the shortest route, even if the map data contains the blind alley. Experiments using map data prove the effectiveness in comparison with Dijkstra algorithm which is the most popular conventional routing algorithm.

  3. Eliminating Major Tornadoes in Tornado Alley

    Science.gov (United States)

    Tao, R.

    2015-03-01

    In my recent paper, I propose that major tornadoes in Tornado Alley can be eliminated by building east-west ranged walls, 300 meter high and 50 meter wide. The work has received much attention, but some meteorologists are against the idea, claiming that the major tornadoes in Tornado Alley are not related to the collisions between northbound warm air flow and southbound cold air flow because supercells are not at the collision front. In this talk, we will show that wind tunnel experiments and airplane wing tip vortices clearly demonstrate that vortices produced by air mass collisions are usually not at the collision front because of the extremely volatile condition over there; they are either near the ends or at side of the collision fronts. When the warm and moist wind collides with the cold wind violently in Tornado Alley, similarly, the supercell storms cannot be right at the collision fronts, but are near the ends or at sides of the collision fronts. While only a small portion of vortices in the warm air side may have a chance to develop into tornadoes, the major tornadoes in Tornado Alley indeed start from the air mass clashes. If we can weaken such violent air mass collisions, we will eliminate the major tornadoes in Tornado Alley. The work is supported in part by Naval Research Lab.

  4. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis - a prospective, observational study

    Directory of Open Access Journals (Sweden)

    Nierhaus Axel

    2013-02-01

    Full Text Available Abstract Background Sepsis is a serious disease condition and a major cause of intensive care unit (ICU admission. Its diagnosis in critically ill patients is complicated. To diagnose an infection rapidly, and to accurately differentiate systemic inflammatory response syndrome (SIRS from sepsis, is challenging yet early diagnosis is vital for early induction of an appropriate therapy. The aim of this study was to evaluate whether the immature granulocyte (IG count is a useful early diagnostic marker of sepsis compared to other markers. Therefore, a total of 70 consecutive surgical intensive care patients were assessed. IGs were measured from whole blood samples using an automated analyzer. C-reactive protein (CRP, lipopolysaccharide binding protein (LBP and interleukin-6 (IL-6 concentrations were also determined. The observation period was a maximum of 21 days and ended with the patients’ discharge from ICU or death. Receiver operating characteristic (ROC analyses were conducted and area under the curve (AUC was calculated to determine sensitivities and specificities for the parameters. Results We found that the IG count significantly discriminates between infected and non-infected patients (P  Conclusions The total number of IG in peripheral blood from ICU patients is a good marker to discriminate infected and non-infected patients very early during SIRS. However, the IG count is not suitable as a prognostic marker for mortality. Routine and serial measurement of IGs may provide new possibilities for rapid screening of SIRS patients on ICU with suspected infections.

  5. Cassini/CIRS Observations of Saturn's "Storm Alley"

    Science.gov (United States)

    Hesman, Brigette E.

    2010-01-01

    In the Voyager era storms on Saturn were observed predominantly in the northern hemisphere, however, in recent years storm activity has been confined to a narrow range of latitudes referred to as "storm alley" (approx.40degS planetographic latitude). Throughout Cassini's prime mission storms have been detected by two independent instruments: ISS through dayside images and RPWS using radio emissions from Saturn Electrostatic Discharges (SED's) (Dyudina et al. 2007). Analysis of these storms indicates that the cloud tops are in the 200 - 500rnbar altitude range. During Saturn's Equinox, in August 2009, lSS imaged lightning on the night side in storm alley when ring-shine was at a minimum (Dyudina et al. 2010). This study indicates that lightning may have originated as deep as the water cloud. Decently, Cassini/CIRS was targeted at storm alley while a storm, originally detected by amateurs, was ongoing (March 2010). Phosphine can be used as a tracer of vertical transport because it is a disequilibrium species that falls off with altitude in the upper troposphere. CIRS can measure temperature and phosphine abundance independently in the altitude range where these cloud tops occur. Early analysis of these data shows stronger phosphine absorption at storm longitudes. This is an indication that powerful updrafts were dredging material upward into the upper troposphere. The results of the analysis of the March 2010 CIRS observations of storm alley will be presented.

  6. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or...

  7. Neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Angelica Dessì

    2014-06-01

    Full Text Available In this paper on neonatal sepsis, after a short presentation of etiopathogenesis and physiopathology, we will briefly present the clinical picture, the diagnosis and the therapy. Concerning diagnosis, we will focus our attention on procalcitonin (PCT, serum amyloid A (SAA, presepsin (sCD14 and metabolomics. Three practical tables complete the review. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

  8. Chemical Characteristics of Six Woody Species for Alley Cropping

    Directory of Open Access Journals (Sweden)

    Mosango, M.

    1999-01-01

    Full Text Available Leaves of six woody species (Leguminosae for alley cropping have been chemically analysed in order to evaluate their potentiality in the restoration of soil fertility. These species are : Acacia mangium, Cajanus cajan, Flemingia grahamiana, F. macrophylla, Leucaena leucocephala and Sesbania sesban. Nitrogen, carbon, cellulose, hemicellulose, lignin, active fraction and ash contents were determined as well as C/N and L/N ratios. AH these species appear to be rich in N and C. Fiber contents (cellulose, hemicellulose and lignin are globally low but variable from one species to another. C/N and L/N ratios are globally low. Among these species, Leucaena leucocephala and Senna spectabilis show the lowest C/N and LIN ratios. Such low values of C/N and L/N are normally found in species with rapid decomposition of organic matter.

  9. Land Tenure and the Potential for the Adoption of Alley Farming in West Africa

    OpenAIRE

    Lawry, S; Steinberger, D; Jabbar, Mohammad A.

    1994-01-01

    Alley farming was developed as a means of maintaining soil fertility in fields under permanent cultivation in Africa, as population pressure makes the traditional practice of slash-and-burn combined with fallowing unsustainable. It is an agroforestry system under which food crops are grown in alleys formed by hedgerows of leguminous trees and shrubs. Studies have shown that it works, but farmers are only taking it up very slowly. Recent work suggests that land tenure might be a factor in the ...

  10. Assessment of Carbon Sequestration in German Alley Cropping Systems

    Science.gov (United States)

    Tsonkova, P. B.; Quinkenstein, A.; Böhm, C.; Freese, D.

    2012-04-01

    Alley cropping systems (ACS) are agroforestry practices in which perennial trees or shrubs are grown in wide rows and arable crops are cultivated in the alleys between the tree rows. Recently, ACS which integrate stripes of short rotation coppices into conventional agricultural sites have gained interest in Germany. These systems can be used for simultaneous production of crops and woody biomass which enables farmers to diversify the provision of market goods. Adding trees into the agricultural landscape creates additional benefits for the farmer and society also known as ecosystem services. An ecosystem service provided by land use systems is carbon sequestration. The literature indicates that ACS are able to store more carbon compared to agriculture and their implementation may lead to greater benefits for the environment and society. Moreover, carbon sequestration in ACS could be included in carbon trading schemes and farmers rewarded additionally for the provision of this ecosystem service. However, methods are required which are easy to use and provide reliable information regarding change in carbon sequestration with change of the land use practice. In this context, our aim was to develop a methodology to assess carbon sequestration benefit provided by ACS in Germany. Therefore, the change of carbon in both soil and biomass had to be considered. To predict the change in soil carbon our methodology combined the 2006 IPCC Guidelines for National Greenhouse Gas Inventories and the soil organic carbon balance recommended by the Association of German Agricultural Investigation and Research Centers (VDLUFA). To reflect the change in biomass carbon average annual yields were adopted. The results showed that ACS established on agricultural sites can increase the carbon stored because in the new soil-plant system carbon content is higher compared to agriculture. ACS have been recommended as suitable land use systems for marginal sites, such as post-mining areas. In

  11. Multifactorial biogeochemical monitoring of linden alley in Moscow

    Science.gov (United States)

    Ermakov, Vadim; Khushvakhtova, Sabsbakhor; Tyutikov, Sergey; Danilova, Valentina; Roca, Núria; Bech, Jaume

    2015-04-01

    The ecological and biogeochemical assessment of the linden alley within the Kosygin Street was conducted by means of an integrated comparative study of soils, their chemical composition and morphological parameters of leaf linden. For this purpose 5 points were tested within the linden alley and 5 other points outside the highway. In soils, water extract of soil, leaf linden the content of Cu, Pb, Mn, Fe, Cd, Zn, As, Ni, Co Mo, Cr and Se were determined by AAS and spectrofluorimetric method [1]. Macrocomponents (Ca, Mg, K, Na, P, sulphates, chlorides), pH and total mineralization of water soil extract were measured by generally accepted methods. Thio-containing compounds in the leaves were determined by HPLC-NAM spectrofluorometry [2]. On level content of trace elements the soils of "contaminated" points different from background more high concentrations of lead, manganese, iron, selenium, strontium and low level of zinc. Leaf of linden from contaminated sites characterized by an increase of lead, copper, iron, zinc, arsenic, chromium, and a sharp decrease in the level of manganese and strontium. Analysis of the aqueous extracts of the soil showed a slight decrease in the pH value in the "control" points and lower content of calcium, magnesium, potassium, sodium and total mineralization of the water soil extract. The phytochelatins test in the leaves of linden was weakly effective and the degree of asymmetry of leaf lamina too. The most differences between the variants were marked by the degree of pathology leaves (chlorosis and necrosis) and the content of pigments (chlorophyll and carotene). The data obtained reflect the impact of the application of de-icing salts and automobile emissions. References 1. Ermakov V.V., Danilova V.N., Khyshvakhtova S.D. Application of HPLC-NAM spectrofluorimtry to determination of sulfur-containing compounds in the environmental objects// Science of the biosphere: Innovation. Moscow State University by M.V. Lomonosov, 2014. P. 10

  12. [Sepsis in Emergency Medicine].

    Science.gov (United States)

    Christ, Michael; Geier, Felicitas; Bertsch, Thomas; Singler, Katrin

    2016-07-01

    Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host-response to infection". Presence of organ dysfunction is associated with a mortality of 10% and higher in hospitalized sepsis patients.Introduction of standards in diagnosis and treatment of sepsis in intensive care units has not considerably reduced sepsis mortality. About 80% of patients with sepsis are transferred to intensive care units from usual care wards and emergency departments. Thus, it is tempting to speculate whether opportunities for further improvement of sepsis management exist outside of intensive care units. Performing a "quick sequential organ assessment" (qSOFA; two of following criteria have to be present: respiratory rate >22/min; sytolic blood pressure <100mmHg; altered mental status) supports to identify patients with suspicion of an infection and an increased risk of death within the hospital. Subsequent treatment according to current guidelines on sepsis management will reduce in-hospital mortality of sepsis patients. Indeed, we were able to show a substantial decrease of in-hospital mortality of about 20% in patients presenting with community acquired pneumonia to the emergency department.In summary, decision of further management of sepsis patients has to be done outside intensive care units at the time of initial presentation to professional care givers. Sepsis management in acute care settings should include a structured and standardized protocol to further improve survival in affected patients with even mild organ dysfunction. PMID:27464279

  13. Postoperative Immundepression und Sepsis

    OpenAIRE

    Hinrichs, Carl

    2010-01-01

    With an incidence of about 200/100 000 citizens per year is sepsis one of the most frequent diseases in Germany. Despite of progress in the treatment of sepsis, lethality still remains high. The development of sepsis is characterized by a dysbalance of pro- and antiinflammatory mechanisms due to invading microorganisms. Resulting from this dysregulation of the immune sytem, the host defense against pathogens often is impaired. Similar immunologic changes can be found not only after infection ...

  14. Animal models of sepsis

    OpenAIRE

    Fink, Mitchell P.

    2013-01-01

    Sepsis remains a common, serious, and heterogeneous clinical entity that is difficult to define adequately. Despite its importance as a public health problem, efforts to develop and gain regulatory approval for a specific therapeutic agent for the adjuvant treatment of sepsis have been remarkably unsuccessful. One step in the critical pathway for the development of a new agent for adjuvant treatment of sepsis is evaluation in an appropriate animal model of the human condition. Unfortunately, ...

  15. Hemodynamic Support in Sepsis

    OpenAIRE

    Fatih Yildiz; Emre Karakoc

    2014-01-01

    Sepsis is called systemic inflammatory response syndrome due to infection. When added to organs failure and perfusion abnormality is defined in severe sepsis, Hypotension that do not respond to fluid therapy is as defined septic shock. Fluid resuscitation is a most important parts of the treatment in patients with septic shock. Ongoing hypotension that despite of the adequate fluid therapy, vasopressor support initiation is required. Sepsis and septic shock, hemodynamic support is often under...

  16. Advances in understanding sepsis

    OpenAIRE

    Shimaoka, M.; Park, E J

    2008-01-01

    Sepsis, a systemic inflammatory response to infection, is a leading cause of death in intensive care units. Recent investigations into the pathogenesis of sepsis reveal a biphasic inflammatory process. An early phase is characterized by pro-inflammatory cytokines (e.g. tumour necrosis factor-α), whereas a late phase is mediated by an inflammatory high-mobility group box 1 and an anti-inflammatory interleukin-10. Inflammation aberrantly activates coagulation cascades as sepsis progresses. This...

  17. Revising definitions of sepsis

    OpenAIRE

    Drewry, Anne M; Hotchkiss, Richard S.

    2015-01-01

    The traditional definition of sepsis requires the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in addition to a suspected or proven infection. A recent large retrospective study, however, suggests that the requirement for two SIRS criteria excludes one in eight patients with severe sepsis.

  18. Multimedia networks, globalization and strategies of innovation : the case of the silicon alley

    OpenAIRE

    Heydebrand, Wolf

    1999-01-01

    The report offers a sociological portrait of the structure and dynamics of „Silicon Alley“, an industry cluster of about a thousand new media firms that has emerged since the early 1990s. Situated in the context of New York’s development as a global city, Silicon Alley is part of the rise of advanced producer services and the dramatic growth of information and communications technology in an increasingly transnational economy. In analyzing the nature and importance of inter-firm networks amon...

  19. New biomarkers for sepsis

    Directory of Open Access Journals (Sweden)

    Li-xin XIE

    2013-01-01

    Full Text Available There is a higher sepsis rate in the intensive care unit (ICU patients, which is one of the most important causes for patient death, but the sepsis lacks specific clinical manifestations. Exploring sensitive and specific molecular markers for infection that accurately reflect infection severity and prognosis is very clinically important. In this article, based on our previous study, we introduce some new biomarkers with high sensitivity and specificity for the diagnosis and predicting the prognosis and severity of sepsis. Increase of serum soluble(s triggering receptor expressed on myeloid cells-1 (sTREM-1 suggests a poor prognosis of septic patients, and changes of locus rs2234237 of sTREM-1 may be the one of important mechanisms. Additionally, urine sTREM-1 can provide an early warning of possible secondary acute kidney injury (AKI in sepsis patients. Serum sCD163 level was found to be a more important factor than procalcitonin (PCT and C-reactive protein (CRP in prognosis of sepsis, especially severe sepsis. Moreover, urine sCD163 also shows excellent performance in the diagnosis of sepsis and sepsis-associated AKI. Circulating microRNAs, such as miR-150, miR-297, miR-574-5p, miR -146a , miR-223, miR -15a and miR-16, also play important roles in the evaluation of status of septic patients. In the foreseeable future, newly-emerging technologies, including proteomics, metabonomics and trans-omics, may exert profound effects on the discovery of valuable biomarkers for sepsis.

  20. Speech by CPAFFC Vice President Li Xiaolin at Commemorative Meeting Of Rewi Alley (Excerpts)

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>In Beijing on September 7, we held the commemorative meeting marking Rewi Alley’s 110th anniversary of birth, 80th anniversary of arrival in China and 20th anniversary of passing. Today we are holding this grand meeting here to cherish the memory of this renowned writer, poet, educator and social activist, our old friend Rewi Alley.

  1. "Manana Is Soon Enough for Me": Latin America through Tin Pan Alley's Prism.

    Science.gov (United States)

    Aiex, Nola Kortner

    In order to examine the vision of Latin America transmitted to the American public in Tin Pan Alley's popular songs in the first half of the twentieth century, a study analyzed nearly 50 songs. The songs were grouped into five categories: (1) songs which describe Latin locales; (2) songs which are constructed around a Latin woman's name; (3) songs…

  2. Sepsis and membrane receptors

    Institute of Scientific and Technical Information of China (English)

    段朝霞; 朱佩芳; 蒋建新

    2005-01-01

    @@ Sepsis and septic shock remains to be the major clinical problem for infectious disease specialists although our understanding of the pathophysiology of this syndrome has been improved greatly over the past 5 years.

  3. Hemodynamic Support in Sepsis

    Directory of Open Access Journals (Sweden)

    Fatih Yildiz

    2014-04-01

    Full Text Available Sepsis is called systemic inflammatory response syndrome due to infection. When added to organs failure and perfusion abnormality is defined in severe sepsis, Hypotension that do not respond to fluid therapy is as defined septic shock. Fluid resuscitation is a most important parts of the treatment in patients with septic shock. Ongoing hypotension that despite of the adequate fluid therapy, vasopressor support initiation is required. Sepsis and septic shock, hemodynamic support is often understood as the hemodynamic support. The different approaches to the development of methods to track and objective comes up. Patients with severe sepsis and septic shock should be follow in the intensive care unit and rapid fluid replacement and effectual hemodynamic support should be provided.

  4. All that seems sepsis is not sepsis

    Directory of Open Access Journals (Sweden)

    Vivek S Guleria

    2013-01-01

    Full Text Available Catastrophic antiphospholipid antibody syndrome (CAPS resembles severe sepsis in its acute presentation, with features of systemic inflammatory response syndrome (SIRS leading to multiple organ dysfunction. Infections are the best known triggers of CAPS. This emphasizes the need for early diagnosis and aggressive treatment as the mortality is as high as 50%. We present a 42-year-old woman who developed SIRS postoperatively and was eventually diagnosed as CAPS.

  5. Harmful molecular mechanisms in sepsis

    OpenAIRE

    Rittirsch, Daniel; Flierl, Michael A; Ward, Peter A.

    2008-01-01

    Sepsis and sepsis-associated multi-organ failure are major challenges for scientists and clinicians and are a tremendous burden for health-care systems. Despite extensive basic research and clinical studies, the pathophysiology of sepsis is still poorly understood. We are now beginning to understand that sepsis is a heterogeneous, dynamic syndrome caused by imbalances in the ‘inflammatory network’. In this Review, we highlight recent insights into the molecular interactions that occur during ...

  6. Management of biological processes in alley farming: Need for more research

    International Nuclear Information System (INIS)

    Alley farming involves the integration of trees, managed as hedgerows, within cropping systems. Research has shown that the system is highly stable and sustainable. The trees act within the system both as a nutrient pump and nutrient source, ensuring the constant injection of nutrients and their efficient cycling within the system. Nitrogen-fixing trees have a great capacity for maintaining soil fertility and sustainability in such systems, because of biological nitrogen fixation and its contribution to soil fertility. Some tree species such as Leucaena leucocephala, Gliricidia sepium can fix as much as 200-300 kg N/ha/year while others such as Faidherbia albida may fix only one tenth. Senna siamea and S. spectabilis do not fix N2. Nitrogen input from prunings of nitrogen fixing trees to alley farming systems is high but its use efficiency by an associated crop is low (10-30%). It may be that not enough is known of the basics of the biological processes to improve N use efficiency in alley cropping. This paper calls for increased research into such processes using precise and appropriate methodologies such as isotope aided techniques. (author). 33 refs, 2 tabs

  7. Nutrition and sepsis.

    Science.gov (United States)

    Cohen, Jonathan; Chin, w Dat N

    2013-01-01

    The effect of nutritional support in critically ill patients with sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all critically ill patients, nutritional support, preferably via the enteral route, should be commenced once initial resuscitation and adequate perfusion pressure is achieved. Where enteral feeding is impossible or not tolerated, parenteral nutrition (either as total or complimentary therapy) may safely be administered. Most positive studies relating to nutritional support and sepsis have been in the setting of sepsis prevention. Thus, the administration of standard nutrition formulas to critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of pneumonia. Both arginine-supplemented enteral diets, given in the perioperative period, and glutamine-supplemented parenteral nutrition have been shown to decrease infections in surgical patients. Parenteral fish oil lipid emulsions as well as probiotics given in the perioperative period may also reduce infections in patients undergoing major abdominal operations, such as liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular fish oil, probiotics, or antioxidants, in the setting of established sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients. PMID:23075593

  8. Glucocorticosteroids for sepsis

    DEFF Research Database (Denmark)

    Volbeda, M; Wetterslev, J; Gluud, C;

    2015-01-01

    INTRODUCTION: Glucocorticosteroids (steroids) are widely used for sepsis patients. However, the potential benefits and harms of both high and low dose steroids remain unclear. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis (TSA) might shed light...

  9. Sepsis: pathophysiology and clinical management.

    Science.gov (United States)

    Gotts, Jeffrey E; Matthay, Michael A

    2016-01-01

    Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level. Despite uncertainties in hemodynamic management and several treatments that have failed in clinical trials, investigational therapies increasingly target sepsis induced organ and immune dysfunction. Outcomes in sepsis have greatly improved overall, probably because of an enhanced focus on early diagnosis and fluid resuscitation, the rapid delivery of effective antibiotics, and other improvements in supportive care for critically ill patients. These improvements include lung protective ventilation, more judicious use of blood products, and strategies to reduce nosocomial infections. PMID:27217054

  10. Myocardial protection in sepsis

    OpenAIRE

    Shakar, Simon; Brian D Lowes

    2008-01-01

    Sepsis with myocardial dysfunction is seen commonly. Beta-blockers have been used successfully to treat chronic heart failure based on the premise that chronically elevated adrenergic drive is detrimental to the myocardium. However, recent reports on the acute use of beta-blockers in situations with potential hemodynamic compromise have shown the risks associated with this approach. In critical situations, the main effect of adrenergic activation is to support cardiovascular function. Caution...

  11. Assessment of competition for water between peanut (Arachis hypogaea) and Choerospondias axillaris in an alley cropping system in subtropical China

    International Nuclear Information System (INIS)

    Tree and crop components of an alley cropping system may compete for nutrients and water in the surface soil while the deeper-rooting tree may have better access to resources in the subsoil. The objectives of the present study in an alley cropping system were to monitor runoff and soil loss, spatial variation of soil water, and tree sap flow to determine competitiveness for water between the tree and peanut. Plant and root growth were also recorded to evaluate competition. The tree competed for water in the surface soil at some critical period as indicated by the spatial variation of monitored soil water content. The tree used deep soil water and reduced deep drainage as indicated by modelling of soil water fluxes and direction of water movement. Trees in the alley cropping system used less soil water than peanut, and more water than trees alone, as indicated by water balance modelling. The magnitude of the reduction of deep drainage increased with tree age. The alley cropping system increased system water use efficiency by using deep soil water as indicated by water balance modelling. The alley cropping system promoted Choerospondias axillaris growth by 50 to 100% and reduced peanut biomass and yield by 20 to 50%. Field management should aim to prevent water competition between trees and crops in the surface soil. (author)

  12. ERCP Related Sepsis

    Directory of Open Access Journals (Sweden)

    Iffet Palabıyıkoglu

    2005-01-01

    Full Text Available Endoscopic procedures performed worldwide have increased considerably in recent years. In addition to diagnosis, many cases previously necessitating surgery now often can be carried out by endoscopic techniques. However, endoscopy has introduced its own infection risk. Most reports of gastrointestinal endoscopy-associated infection describe sepsis after endoscopic retrograde cholangiopancreatography (ERCP in patients with biliary tract obstruction. During this study, which was conducted by Infection Control Committee of Ankara University Hospital, 13 out of 1147 (1.1% and 17 out of 922 patients (1.8% had ERCP related sepsis in 2002 and 2003 respectively, at the ERCP Unit of Gastroenterology Department. Sepsis-caused mortality were 23.1 and 29.4% in 2002 and 2003 respectively. The first four causative agents were Escherichia coli, Pseudomonas spp, Klebsiella spp and Enterobacter spp. Type and frequency of the causative agents remind that both endogenous and exogenous mechanisms are together responsible for the infections emerging from ERCP Unit. Besides, increasing isolation of Pseudomonas spp. brings out the strong need for re-evaluation of infection control measures, mainly effective cleansing and disinfection of endoscopes.

  13. Bacterial Culture of Neonatal Sepsis

    OpenAIRE

    AH Movahedian; R Moniri; Z Mosayebi

    2006-01-01

    Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion (BHI) broth accordi...

  14. Maternal Sepsis and Septic Shock.

    Science.gov (United States)

    Chebbo, Ahmad; Tan, Susanna; Kassis, Christelle; Tamura, Leslie; Carlson, Richard W

    2016-01-01

    The year 2015 marked the 200th anniversary of the birth of Ignaz Semmelweis, the Hungarian physician who identified unhygienic practices of physicians as a major cause of childbed fever or puerperal sepsis. Although such practices have largely disappeared as a factor in the development of chorioamnionitis and postpartum or puerperal endometritis, it is appropriate that this article on sepsis in pregnancy acknowledges his contributions to maternal health. This review describes the incidence and mortality of sepsis in pregnancy, methods to identify and define sepsis in this population, including scoring systems, causes, and sites of infection during pregnancy and parturition and management guidelines. PMID:26600449

  15. Unrevealing culture-negative severe sepsis

    OpenAIRE

    de Prost, Nicolas; Razazi, Keyvan; Brun-Buisson, Christian

    2013-01-01

    Sepsis involves a wide array of sources and microorganisms, only a fraction of which are microbiologically documented. Culture-negative sepsis poses special diagnostic challenges to both clinicians and microbiologists and further questions the validity of sepsis definitions.

  16. Endotoxin dosage in sepsis

    Directory of Open Access Journals (Sweden)

    Vincenzo Rondinelli

    2012-03-01

    Full Text Available Introduction. Endotoxin, a component of the cell wall of Gram-negative bacteria is a major contributor to the pathogenesis of septic shock and multiple organ failure (MOF. Its entry into the bloodstream stimulates monocytes/macrophages which once activated produce and release cytokines, nitric oxide and other mediators that induce systemic inflammation, endothelial damage, organ dysfunction, hypotension (shock and MOF.The aim of this study is to evaluate the usefulness of a quantitative test for the dosage of endotoxin to determine the risk of severe Gram-negative sepsis. Materials and methods. In the period January 2009 - June 2011 we performed 897 tests for 765 patients, mostly coming from the emergency room and intensive care, of which 328 (43% women (mean age 53 and 437 (57% male (mean age 49. Fifty-nine patients, no statistically significant difference in sex, were monitored by an average of two determinations of EA.All patients had procalcitonin values significantly altered.The kit used was EAA (Endotoxin Activity Assay Estor Company, Milan, which has three ranges of endotoxin activity (EA: low risk of sepsis if <0.40 units, medium if between 0.40 and 0.59; high if 0.60. Results. 78 out of 765 patients (10% had a low risk, 447 (58% a medium risk and 240 (32% a high risk.The dosage of EA, combined with that of procalcitonin, has allowed a more targeted antibiotic therapy. Six patients in serious clinical conditions were treated by direct hemoperfusion with Toraymyxin, a device comprising a housing containing a fiber polypropylene and polystyrene with surface-bound polymyxin B, an antibiotic that removes bacterial endotoxins from the blood. Conclusions.The test is useful in risk stratification as well as Gram negative sepsis, to set and monitor targeted therapies, also based on the neutralization of endotoxin.

  17. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes

    OpenAIRE

    Martin, Greg S

    2012-01-01

    Sepsis has been around since the dawn of time, having been described for more than 2000 years, although clinical definitions are recent. The consensus sepsis definitions have permitted worldwide epidemiological studies of sepsis to be conducted. We now recognize the common nature of sepsis and the consistency of its disease – particularly severe sepsis and septic shock. The incidence of sepsis, severe sepsis and septic shock continues to increase, and although Gram-positive bacterial pathogen...

  18. Alcoholic leukopenic pneumococcal sepsis.

    Science.gov (United States)

    Alraiyes, Abdul Hamid; Shaheen, Khaldoon; Alraies, M Chadi

    2013-04-01

    Alcohol abuse has been associated with an increased mortality and morbidity due to increased aspiration, delirium tremens, and seizures. The association of pneumococcal lung infections and leukopenia in the setting of alcohol abuse are rarely reported; however, when present, severe lung infections can happen with severe lung injury and poor response to conventional therapy and ultimately, death. We are reporting a case of 55-year-old-man presented with shortness of breath, cough and altered mental status and eventually found with severe pneumococcal lung infection in the setting of leukopenia and long-term alcohol abuse representing alcoholic leukopenic pneumococcal sepsis syndrome. PMID:23930244

  19. Can we eliminate major tornadoes in Tornado Alley? — Response to the Comments

    Science.gov (United States)

    Tao, R.

    2014-11-01

    Dahl and Markowski are wrong and misleading to claim that the major tornadoes in USA Tornado Alley are not related to the collisions between northbound warm air flow and southbound cold air flow. In addition, they use incompressible and inviscid fluid model for atmosphere in their simulations about the interaction between air wind and the wall. Such approach ignores the basic physics and thus cannot reach any meaningful results. As air is compressible, the collision between the wind and wall will compress air, eventually lead the air density to decrease fast with the height and make the air flow stratified. The viscosity will produce wind shear, turbulent eddies and greatly reduce the wind's forwarding speed. Laboratory experiments and the Nature have all shown that hills with height about 300 m will not block winds completely to change the climate, but can effectively reduce the wind speed, weaken the air mass collisions and eliminate the major tornadoes. All these strongly support the theory that building east-west ranged walls of 300 m high and 50 m wide will eliminate major tornado threat in Tornado Alley.

  20. Beijing Alley

    Institute of Scientific and Technical Information of China (English)

    LiXiaoke

    2004-01-01

    There are many distinguished artists with work in residence at Beijing's Creation Gallery, but there is one worthy of particular mention - gallery founder Li Xiaoke. Through his work, Li successfully unites elements of western art with traditional Chinese ideas and art theories. His favorite places of inspiration are old Beijing, Tibet, and southern China.

  1. Vegetation barrier and tillage effects on runoff and sediment in an alley crop system on a Luvisol in Burkina Faso

    NARCIS (Netherlands)

    Spaan, W.P.; Sikking, A.F.S.; Hoogmoed, W.B.

    2005-01-01

    The effects of vegetation barriers and tillage on runoff and soil loss were evaluated in an alley crop system at a research station in central Burkina Faso. On a 2% slope of a sandy loam various local species (grasses, woody species and a succulent) were planted as conservation barriers in order to

  2. Lakatos Revisited.

    Science.gov (United States)

    Court, Deborah

    1999-01-01

    Revisits and reviews Imre Lakatos' ideas on "Falsification and the Methodology of Scientific Research Programmes." Suggests that Lakatos' framework offers an insightful way of looking at the relationship between theory and research that is relevant not only for evaluating research programs in theoretical physics, but in the social sciences as…

  3. Moraxella catarrhalis sepsis

    Directory of Open Access Journals (Sweden)

    Paola Gualdi

    2008-06-01

    Full Text Available Moraxella catarrhalis is a Gram-negative aerobic diplococcus, commensal of the oro-pharingeal cavity, actually playing an emerging role in the upper respiratory tract infections together with Streptococcus pneumoniae and Haemophilus influenzae. This study reports the case of a twoyearold child who was admitted into hospital with fever, headache and vomit. The chest radiograph showed signs of basal lung involvementmaking the clinical suspicion of bacterial infectionlikely. From blood culture a Moraxella catarrhalis strain was isolated. In young children M. catarrhalis is known to cause otitis media and sinusitis, but only rarely bacteremia. In this case the child showed a clinical picture of lung infection and consequent sepsis due to M. catarrhalis.

  4. Epidemiology of sepsis in Norway in 1999

    OpenAIRE

    Flaatten, Hans

    2004-01-01

    Introduction Sepsis and severe sepsis are asociated with high hospital mortality. Little is known about the occurrence of sepsis in general hospital populations. The goal of the present study was to reveal the epidemiology of sepsis in Norwegian hospitals over 1 year. Methods Patients admitted to all Norwegian hospitals during 1999 (n = 700,107) were analyzed by searching the database of the Norwegian Patient Registry for markers of sepsis, using International Classification of Diseases (ICD)...

  5. Radiologic findings of neonatal sepsis

    International Nuclear Information System (INIS)

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment

  6. Radiologic findings of neonatal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo; Han, Dae Hee; Choi, Guk Myeong; Jung, Hye Won [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Yoon, Hye Kyung; Han, Bokyung Kim; Lee, Nam Yong [Sansung Medical Center, Seoul (Korea, Republic of)

    1997-06-01

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.

  7. A prospective treatment for sepsis

    OpenAIRE

    Shahidi Bonjar, Leyla

    2015-01-01

    Mohammad Rashid Shahidi Bonjar,1 Leyla Shahidi Bonjar2 1School of Dentistry, 2College of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran Abstract: The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principa...

  8. A prospective treatment for sepsis

    OpenAIRE

    Shahidi Bonjar MR; Shahidi Bonjar L

    2015-01-01

    Mohammad Rashid Shahidi Bonjar,1 Leyla Shahidi Bonjar2 1School of Dentistry, 2College of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran Abstract: The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principal compon...

  9. Sensemaking Revisited

    DEFF Research Database (Denmark)

    Holt, Robin; Cornelissen, Joep

    2014-01-01

    We critique and extend theory on organizational sensemaking around three themes. First, we investigate sense arising non-productively and so beyond any instrumental relationship with things; second, we consider how sense is experienced through mood as well as our cognitive skills of manipulation ...... research by revisiting Weick’s seminal reading of Norman Maclean’s book surrounding the tragic events of a 1949 forest fire at Mann Gulch, USA....

  10. Phenotypic nutrient up-take differences in an alley cropping system in semi-arid Machakos, Kenya

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Alley cropping of Cassia siamea and maize was studied insemi-arid Kenya for soil fertility improvement. Katumani composite maize was planted except in the short rains of 1988 (SR88) when a hybrid variety was sown. Therefore the grain yield per row increased differently in the alley cropped maize (CM). Sole maize (SM) and CM yields were higher in SR88 than in the long rains of 1988 (LR88) by 62% and 38%, while yields from the same treatments in LR89 were only 21% and 45% of those in SR88. These differences in relative maize yields are attributed to differences between the two maize varieties in competition under nutrient stress conditions.

  11. Improving the Odds of Surviving Sepsis

    Science.gov (United States)

    ... Science Home Page Improving the Odds of Surviving Sepsis By Carolyn Beans Posted August 18, 2014 A ... it quickly and reduce its later effects. Detecting Sepsis Early Researchers aim to develop a tool that ...

  12. Fast Action Can Prevent Sepsis Death: CDC

    Science.gov (United States)

    ... fullstory_160574.html Fast Action Can Prevent Sepsis Death: CDC Know the signs of extreme response to ... treated long before it causes severe illness or death, U.S. health officials report. Sepsis, or septicemia, occurs ...

  13. Procalcitonin as a marker of neonatal sepsis

    OpenAIRE

    Nazeer Ahmad Jeergal; Rizwan-u-zama; Naushad Ali .N. Malagi; Faisal Farooqui; Sadashiva .B. Ukkali; Ravindra Naganoor; A.N. Thobbi

    2016-01-01

    Introduction: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. Objective: To assess the role of procalcitonin (PCT) as a marker in the early diagnosis, treatment and follow-up of neonatal sepsis. Methods: Twenty five neonates with clinical (n=5), suspected (n=13) and proven sepsis (n=7) were evaluated. The PCT levels were measured by immunoluminoassay before and on ...

  14. Histological changes in neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Eleonora Obinu

    2014-06-01

    Full Text Available One of the most significant causes of neonatal morbidity and mortality is represented by neonatal sepsis that often manifests itself as a systemic inflammatory response syndrome (SIRS. The progression of SIRS usually leads to multiple organ dysfunction, occasionally culminating in multiple organ failure (MOF. The loss of endothelial barrier represents the unifying lesion of multiple organs in newborns affected by sepsis and the most important pathological change responsible for the evolution toward MOF in neonates. The aim of this study is to present the most important pathological changes occurring in neonatal sepsis.  Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

  15. "Storm Alley" on Saturn and "Roaring Forties" on Earth: two bright phenomena of the same origin

    Science.gov (United States)

    Kochemasov, G. G.

    2009-04-01

    "Storm Alley" on Saturn and "Roaring Forties' on Earth: two bright phenomena of the same origin. G. Kochemasov IGEM of the Russian Academy of Sciences, Moscow, Russia, kochem.36@mail.ru Persisting swirling storms around 35 parallel of the southern latitude in the Saturnian atmosphere and famous "Roaring Forties" of the terrestrial hydro- and atmosphere are two bright phenomena that should be explained by the same physical law. The saturnian "Storm Alley" (as it is called by the Cassini scientists) is a stable feature observed also by "Voyager". The Earth's "Roaring Forties" are well known to navigators from very remote times. The wave planetology [1-3 & others] explains this similarity by a fact that both atmospheres belong to rotating globular planets. This means that the tropic and extra-tropic belts of these bodies have differing angular momenta. Belonging to one body these belts, naturally, tend to equilibrate their angular momenta mainly by redistribution of masses and densities [4]. But a perfect equilibration is impossible as long as a rotating body (Saturn or Earth or any other) keeps its globular shape due to mighty gravity. So, a contradiction of tropics and extra-tropics will be forever and the zone mainly between 30 to 50 degrees in both hemispheres always will be a zone of friction, turbulence and strong winds. Some echoes of these events will be felt farther poleward up to 70 degrees. On Earth the Roaring Forties (40˚-50˚) have a continuation in Furious Fifties (50˚-60˚) and Shrieking (Screaming) Sixties (below 60˚, close to Antarctica). Below are some examples of excited atmosphere of Saturn imaged by Cassini. PIA09734 - storms within 46˚ south; PIA09778 - monitoring the Maelstrom, 44˚ north; PIA09787 - northern storms, 59˚ north; PIA09796 - cloud details, 44˚ north; PIA10413 - storms of the high north, 70˚ north; PIA10411 - swirling storms, "Storm Alley", 35˚ south; PIA10457 - keep it rolling, "Storm Alley", 35˚ south; PIA10439 - dance

  16. Scintigraphic evaluation in musculoskeletal sepsis

    International Nuclear Information System (INIS)

    In this article, the mechanism of technetium, gallium, and indium-labeled white blood cell localization in septic processes is detailed, and the method of interpretation of these three isotopes with relationship to musculoskeletal infection is outlined. Specific clinical application of technetium, gallium, and indium-labeled white blood cell imaging for musculoskeletal sepsis is reviewed

  17. Diagnosing sepsis - The role of laboratory medicine.

    Science.gov (United States)

    Fan, Shu-Ling; Miller, Nancy S; Lee, John; Remick, Daniel G

    2016-09-01

    Sepsis is the host response to microbial pathogens resulting in significant morbidity and mortality. An accurate and timely diagnosis of sepsis allows prompt and appropriate treatment. This review discusses laboratory testing for sepsis because differentiating systemic inflammation from infection is challenging. Procalcitonin (PCT) is currently an FDA approved test to aid in the diagnosis of sepsis but with questionable efficacy. However, studies support the use of PCT for antibiotic de-escalation. Serial lactate measurements have been recommended for monitoring treatment efficacy as part of sepsis bundles. The 2016 sepsis consensus definitions include lactate concentrations >2mmol/L (>18mg/dL) as part of the definition of septic shock. Also included in the 2016 definitions are measuring bilirubin and creatinine to determine progression of organ failure indicating worse prognosis. Hematologic parameters, including a simple white blood cell count and differential, are frequently part of the initial sepsis diagnostic protocols. Several new biomarkers have been proposed to diagnose sepsis or to predict mortality, but they currently lack sufficient sensitivity and specificity to be considered as stand-alone testing. If sepsis is suspected, new technologies and microbiologic assays allow rapid and specific identification of pathogens. In 2016 there is no single laboratory test that accurately diagnoses sepsis. PMID:27387712

  18. Inactivation of the Dorsal Raphé Nucleus Reduces the Anxiogenic Response of Rats Running an Alley for Intravenous Cocaine

    OpenAIRE

    Ettenberg, Aaron; Ofer, Oren A.; Mueller, Carl L.; Waldroup, Stephanie; Cohen, Ami; Ben-Shahar, Osnat

    2010-01-01

    Rats traversing a straight alley once a day for delivery of a single i.v. injection of cocaine develop over trials an ambivalence about entering the goal box. This ambivalence is characterized by the increasing occurrence of “retreat behaviors” where animals leave the start box and run quickly to the goal box, but then stop at the entry point and “retreat” back toward the start box. This unique pattern of retreat behavior has been shown to reflect a form of “approach-avoidance conflict” that ...

  19. Water table response to an experimental alley farming trial: dissecting the spatial and temporal structure of the data.

    Science.gov (United States)

    Noorduijn, S L; Ghadouani, A; Vogwill, R; Smettem, K R J; Legendre, P

    2010-09-01

    Clearing vegetation for traditional agriculture diminishes native habitat and reduces plant transpiration, leading to increased groundwater recharge and onset of dryland salinization due to rising groundwater and mobilization of salt stores in the soil profile. This change in hydrology and salinity can also negatively affect biodiversity in many semiarid regions. Alternating native perennial tree belts with mono-species agriculture within the tree belt alleys is one possible system that can provide recharge control and recover some of the ecosystem services of degraded agricultural landscapes. To assess the effect of this agroforestry technique on groundwater levels, an alley farming trial was established in 1995, incorporating different combinations of belt width, alley width, and revegetation density. Transects of piezometers within each design have been monitored from October 1995 to January 2008. The data set consisted of 70 piezometers monitored on 39 dates. Two trends were observed within the raw data: An increase in water table depth with time and an increase in the range of depths monitored at the site were clearly discernible. However, simple hydrograph analysis of the data has proved unsuccessful at distinguishing the effect of the tree belts on the water table morphology. The statistical techniques employed in this paper to show the effect of the experiment on the water table were variation partitioning, principal coordinates of neighbor matrices (PCNM), and canonical redundancy analysis (RDA). The environmental variables (alley farming design, distance of piezometer from the tree belt, and percentage vegetation cover including edge effect) explained 20-30% of the variation of the transformed and detrended data for the entire site. The spatial PCNM variables explained a further 20-30% of the variation. Partitioning of the site into a northern and southern block increased the proportion of explained variation for the plots in the northern block. The

  20. Pelvic sepsis after stapled hemorrhoidopexy

    Institute of Scientific and Technical Information of China (English)

    Remco JA van Wensen; Maarten H van Leuken; Koop Bosscha

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade Ⅲ and Ⅳ hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons.

  1. The Inflammatory Response in Sepsis

    OpenAIRE

    Bosmann, Markus; Ward, Peter A.

    2012-01-01

    The pathophysiology of sepsis and its accompanying systemic inflammatory response syndrome (SIRS) and the events that lead to multiorgan failure and death are poorly understood. It is known that, in septic humans and rodents, the development of SIRS is associated with a loss of the redox balance, but SIRS can also develop in non-infectious states. In addition, a hyperinflammatory state develops, together with impaired innate immune functions of phagocytes, immunosuppression, and complement ac...

  2. Serratia sepsis: a case report

    OpenAIRE

    BAYKAN, Dr.Mahmut; Özerol, Dr. İ. Halil; KART, Dr.Hilal; BAYSAL, Dr.Bülent

    1994-01-01

    We refxirt a case of Serratia sepsis who developed in a boy whom 12 years old. Serratia organizms occur in soil, dairy products, water and sewage, as well as in the intestinal and upper respiratory tract of man and animals. The microorganism was long considered a harmless bacteria, but since 1960, it has been isolated with increasing frequency in human mostly in nosocomial infections. Serratia usually infect patients with debilitating disorders, or under treatment with broad-spectrum antimicr...

  3. Bacterial Culture of Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    AH Movahedian

    2006-08-01

    Full Text Available Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion (BHI broth according to standard method. From the 1680 neonates 36% had positive blood culture for Pseudomans aeruginosa, 20.7% for Coagulase negative Staphylococci, and 17% for Klebsiella spp. Gram-negative organisms accounted for 72.1% of all positive cultures. The overall mortality rate was 19.8% (22 /111 of whom 63.6% (14 /22 were preterm. Pseudomona aeruginosa and Klebsiella spp. showed a high degree of resistance to commonly used antibiotics (ampicillin, gentamicin as well as third generation cephalosporins. Continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence.

  4. Biosensor of endotoxin and sepsis

    Science.gov (United States)

    Shao, Yang; Wang, Xiang; Wu, Xi; Gao, Wei; He, Qing-hua; Cai, Shaoxi

    2001-09-01

    To investigate the relation between biosensor of endotoxin and endotoxin of plasma in sepsis. Method: biosensor of endotoxin was designed with technology of quartz crystal microbalance bioaffinity sensor ligand of endotoxin were immobilized by protein A conjugate. When a sample soliton of plasma containing endotoxin 0.01, 0.03, 0.06, 0.1, 0.5, 1.0Eu, treated with perchloric acid and injected into slot of quartz crystal surface respectively, the ligand was released from the surface of quartz crystal to form a more stable complex with endotoxin in solution. The endotoxin concentration corresponded to the weight change on the crystal surface, and caused change of frequency that occurred when desorbed. The result was biosensor of endotoxin might detect endotoxin of plasma in sepsis, measurements range between 0.05Eu and 0.5Eu in the stop flow mode, measurement range between 0.1Eu and 1Eu in the flow mode. The sensor of endotoxin could detect the endotoxin of plasm rapidly, and use for detection sepsis in clinically.

  5. Candida Sepsis Following Transcervical Chorionic Villi Sampling

    OpenAIRE

    Israel Potasman; Roni Gonen; Alona Paz

    2001-01-01

    Background: The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections.Candida sepsis associated with pregnancy is rare. Candida sepsis following chorionic villi sampling (CVS) has never been reported. Case: A 31-year-old pregnant woman presented with signs of sepsis one day after undergoing transcervical CVS. Blood culture and curettage material yielded C. albicans. She was treated with 400 mg of fluconazole daily for 4 weeks and completely ...

  6. Mobilization in Severe Sepsis: An Integrative Review

    OpenAIRE

    Govindan, Sushant; Iwashyna, Theodore J.; Odden, Andrew; Flanders, Scott A; Chopra, Vineet

    2015-01-01

    Severe sepsis is a leading cause of long-term morbidity in the United States. Up to half of severe sepsis is treated in non-intensive care unit (ICU) settings, making it applicable to hospitalist practice. Evidence has demonstrated benefits from physical therapy (PT) in myriad conditions; whether PT may benefit severe sepsis patients either within or outside the ICU is unknown. Therefore, we conduct a review of the literature to understand whether early mobilization improves outcomes in patie...

  7. Procalcitonin as a Marker of Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    Mohmoud Hajiahmadi

    2009-04-01

    Full Text Available Objective:Early diagnosis of neonatal sepsis and appropriate treatment decreases the mortality and morbidity of these infants. The aim of this study was to assess the role of procalcitonin (PCT as a marker in the early diagnosis, treatment and follow-up of neonatal sepsis. Methods:Thirty-eight neonates with clinical (n=8, suspected (n=19 and proven sepsis (n=11 were evaluated. The PCT levels were measured by immunoluminoassay before and on day 5 of treatment. PTC levels of 0.5-2 ng/ml, 2.1-10 ng/ml and >10 ng/ml were considered as weakly positive, positive, and strongly positive, respectively. The sepsis screen tests and cultures of blood or other sterile body fluids in these three groups of infants were recorded. Findings:The levels of PCT in proven sepsis group were higher than that in other groups. Strongly positive PTC level was seen in none of 8 cases of clinical sepsis, 4 of 19 suspected and in 10 of 11 cases with proven sepsis. PCT levels were dramatically decreased in three groups on day 5 of treatment. Conclusion:The results show that the serum procalcitonin levels seem to be significantly increased in proven sepsis and decrease dramatically in all types of sepsis after appropriate treatment.

  8. Differential Paradigms in Animal Models of Sepsis.

    Science.gov (United States)

    Kingsley, S Manoj Kumar; Bhat, B Vishnu

    2016-09-01

    Sepsis is a serious clinical problem involving complex mechanisms which requires better understanding and insight. Animal models of sepsis have played a major role in providing insight into the complex pathophysiology of sepsis. There have been various animal models of sepsis with different paradigms. Endotoxin, bacterial infusion, cecal ligation and puncture, and colon ascendens stent peritonitis models are the commonly practiced methods at present. Each of these models has their own advantages and also confounding factors. We have discussed the underlying mechanisms regulating each of these models along with possible reasons why each model failed to translate into the clinic. In animal models, the timing of development of the hemodynamic phases and the varied cytokine patterns could not accurately resemble the progression of clinical sepsis. More often, the exuberant and transient pro-inflammatory cytokine response is only focused in most models. Immunosuppression and apoptosis in the later phase of sepsis have been found to cause more damage than the initial acute phase of sepsis. Likewise, better understanding of the existing models of sepsis could help us create a more relevant model which could provide solution to the currently failed clinical trials in sepsis. PMID:27432263

  9. Prospective evaluation of cases with neonatal sepsis

    Directory of Open Access Journals (Sweden)

    H Alper Gürsu

    2007-01-01

    Full Text Available Objective: With this prospective study we aimed to evaluate 60 patients with neonatal sepsis. Material and Methods: Between 07 March 2003 and 31 January 2005, the newborns with neonatal sepsis were evaluated for clinical signs and symptoms, complaints, blood culture results, risk factors and mortality. Results: Thirty two (53.4% of 60 patients with sepsis were male and 28(46.6% female. Twenty eight (46.6% had early sepsis, while 32 (53.4% late. The most common complaints were fever, poor sucking reşex and respiratory distress. Depression in newborn reşexes, fever and hypotonia were the most common symptoms. The most common bacteria isolated in blood cultures with early onset sepsis were gram (- bacilli and staphylococci in the group with late onset most common bacteria were staphylococci and gram (- bacilli. The mortality rate was 21.4% and 18.8% in early and late sepsis respectively. Mortality was higher in early onset sepsis whereas meningitis was more frequent in late onset. Mortality in preterms was 24.3%, higher than in terms as 16.1%. Conclusion: Mortality is still high in neonatal sepsis. Prevention of risk factors predisposing to neonatal sepsis, like prematurity and delivery of low birth weight newborns early diagnosis and initiation of treatment, sufficient supportive therapy would help to reduce mortality.

  10. Development and Implementation of Sepsis Alert Systems.

    Science.gov (United States)

    Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

    2016-06-01

    Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit. PMID:27229639

  11. Advances in sepsis-associated liver dysfunction

    Directory of Open Access Journals (Sweden)

    Dawei Wang

    2014-07-01

    Full Text Available Recent studies have revealed liver dysfunction as an early event in sepsis. Sepsis-associated liver dysfunction is mainly resulted from systemic or microcirculatory disturbances, spillovers of bacteria and endotoxin (lipopolysaccharide, LPS, and subsequent activation of inflammatory cytokines as well as mediators. Three main cell types of the liver which contribute to the hepatic response in sepsis are Kupffer cells (KCs, hepatocytes and liver sinusoidal endothelial cells (LSECs. In addition, activated neutrophils, which are also recruited to the liver and produce potentially destructive enzymes and oxygen-free radicals, may further enhance acute liver injury. The clinical manifestations of sepsis-associated liver dysfunction can roughly be divided into two categories: Hypoxic hepatitis and jaundice. The latter is much more frequent in the context of sepsis. Hepatic failure is traditionally considered as a late manifestation of sepsis-induced multiple organ dysfunction syndrome. To date, no specific therapeutics for sepsis-associated liver dysfunction are available. Treatment measure is mainly focused on eradication of the underlying infection and management for severe sepsis. A better understanding of the pathophysiology of liver response in sepsis may lead to further increase in survival rates.

  12. Sepsis induced immunosuppression: Implications for secondary infections and complications

    OpenAIRE

    Krishna M Sundar; Mazen Sires

    2013-01-01

    Sepsis is the commonest cause of admission to medical ICUs across the world. Mortality from sepsis continues to be high. Besides shock and multi-organ dysfunction occurring following the intense inflammatory reaction to sepsis, complications arising from sepsis-related immunoparalysis contribute to the morbidity and mortality from sepsis. This review explores the basis for sepsis related immune dysfunction and discusses its clinical implications for the treating intensivist. Recent trends ind...

  13. Five additions to the list of Sepsidae (Diptera) for Vietnam: Perochaeta cuirassa sp. n., Perochaeta lobo sp. n., Sepsis spura sp. n., Sepsis sepsi Ozerov, 2003 and Sepsis monostigma Thompson, 1869

    OpenAIRE

    Yuchen Ang; Rudolf Meier

    2010-01-01

    Abstract A recent collecting trip to Vietnam yielded three new species and two new records of Sepsidae (Diptera) for the country. Here we describe two new species in the species-poor genus Perochaeta (Perochaeta cuirassa sp. n. andPerochaeta lobo sp. n.) and one to the largest sepsid genus Sepsis (Sepsis spura sp. n.) which is also found in Sumatra and Sulawesi. Two additional Sepsis species are new records for Vietnam (Sepsis sepsi Ozerov, 2003; Sepsis monostigma Thompson, 1869). We conclude...

  14. Procalcitonin as an adjunctive biomarker in sepsis

    Directory of Open Access Journals (Sweden)

    Mahua Sinha

    2011-01-01

    Full Text Available Sepsis can sometimes be difficult to substantiate, and its distinction from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT assay is one of the biomarkers of sepsis. The present study was aimed to assess the usefulness of PCT assay in critically ill patients with suspected sepsis. The study included 40 patients from the intensive care unit with suspected sepsis. Sepsis was confirmed clinically and/or by positive blood culture. Serum PCT was assayed semi-quantitatively by rapid immunochromatographic technique (within 2 hours of sample receipt. Among 40 critically ill patients, 21 had clinically confirmed sepsis. There were 12 patients with serum PCT ≥10 ng/ml (8, blood culture positive; 1, rickettsia; 2, post-antibiotic blood culture sterile; and 1, non-sepsis; 7 patients with PCT 2-10 ng/ml (4, blood culture positive; 1, falciparum malaria; 2, post-antibiotic blood culture sterile; 3 patients with PCT of 0.5 to 2 ng/ml (sepsis in 1 patient; and 18 patients with PCT < 0.5 ng/ml (sepsis in 2 patients. Patients with PCT ≥ 2 ng/ml had statistically significant correlation with the presence of sepsis (P<0.0001. The PCT assay revealed moderate sensitivity (86% and high specificity (95% at a cut-off ≥ 2 ng/ml. The PCT assay was found to be a useful biomarker of sepsis in this study. The assay could be performed and reported rapidly and provided valuable information before availability of culture results. This might assist in avoiding unwarranted antibiotic usage.

  15. Sepsis neonatal por Estreptococos Pyogenes

    Directory of Open Access Journals (Sweden)

    Gilberto Rodríguez-Herrera

    2009-09-01

    Full Text Available Se presenta el caso de un paciente masculino, recién nacido a término adecuado para la edad gestacional, quien nace por parto vaginal, con el antecedente de fiebre en la madre durante el periodo de postparto inmediato. Los padres consultan a los 2 días de vida pues le notan dificultad respiratoria, hipoactividad y rechazo a la leche materna. El paciente se interna y se aborda como una sepsis. Durante su estancia en el servicio de neonatología del Hospital Nacional de Niños asocia fallo respiratorio que amerita ventilación mecánica asistida por varios días en diferentes ocasiones, derrame pleural exudativo, convulsiones de origen hipóxico isquémico. Con reporte de hemocultivos positivos por Estreptococos pyogenes. El Estreptococos pyogenes o estreptococo β-hemolνtico del grupo A, fue un problema en los comienzos del siglo pasado, siendo frecuente en las infecciones puerperales y del reciιn nacido. En la actualidad es un germen sumamente raro en los procesos de sepsis neonatal.2 La gravedad de la enfermedad causada por este microorganismo en el periodo neonatal varνa desde una onfalitis crónica de bajo grado a una septicemia, una meningitis fulminante y la muerte.1 El presente artículo pretende hacer un resumen del paciente, con su evolución clínica, radiológica y además ejemplificar todas las complicaciones que tuvimos con este germen tan poco frecuente en la actualidad en sepsis neonatal.

  16. Sepsis neonatal por Estreptococos Pyogenes

    OpenAIRE

    Gilberto Rodríguez-Herrera; Cinthya Ramírez-Navarro

    2009-01-01

    Se presenta el caso de un paciente masculino, recién nacido a término adecuado para la edad gestacional, quien nace por parto vaginal, con el antecedente de fiebre en la madre durante el periodo de postparto inmediato. Los padres consultan a los 2 días de vida pues le notan dificultad respiratoria, hipoactividad y rechazo a la leche materna. El paciente se interna y se aborda como una sepsis. Durante su estancia en el servicio de neonatología del Hospital Nacional de Niños asocia fallo respir...

  17. Radiodiagnosis of lung syndrome in surgical sepsis

    International Nuclear Information System (INIS)

    The results of treatment of 23 patients with acute surgical sepsis were analysed. It was shown that the X-ray examination must be obligatory in surveillance of patients with purulent foci. Two roentgenological variants are possible in surgical sepsis: central and perepheric. X-ray examinations of chest organs should be conducted every 2-3 day

  18. Neuro-oxidative-nitrosative stress in sepsis

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Møller, Kirsten; Bailey, Damian M

    2011-01-01

    Neuro-oxidative-nitrosative stress may prove the molecular basis underlying brain dysfunction in sepsis. In the current review, we describe how sepsis-induced reactive oxygen and nitrogen species (ROS/RNS) trigger lipid peroxidation chain reactions throughout the cerebrovasculature and surrounding...

  19. Cytokine profile in elderly patients with sepsis

    Directory of Open Access Journals (Sweden)

    Kumar Anil

    2009-01-01

    Full Text Available Context: Sepsis is a serious health problem in the elderly with a high degree of mortality. There is very limited data available in elderly subjects regarding the markers for sepsis. Development of good markers will help in overall management and prediction of sepsis. Objectives: Serial estimation of Interleukin-6 (IL-6 and Tumor Necrosis Factor-Alpha (TNF-α and their correlation with mortality in sepsis in elderly patients and to determine the influence of gender on cytokine production and mortality in elderly patients with sepsis. Settings and Design: The prospective study was conducted at our tertiary care center from April 2007 to September 2008. Elderly Patients satisfying the Systemic Inflammatory Response Syndrome (SIRS criteria were included. Methods and Material: TNF-α and IL-6 were estimated in 30 elderly patients admitted to our intensive care unit with SIRS and sepsis. The estimations were done on day 1, 3 and 7 of admission. Statistical Analysis Used: Student and paired ′t′ tests, and ANOVA, which were further followed up by post-hoc ′t′ tests with Bonferroni correction using SPSS. Results: Reducing levels of IL-6 levels from day 1 to 7 was found in the survivor group. TNF-α level was significantly low on day 1 in the nonsurvivor female group. Conclusions: Serial estimation of cytokines in elderly patients with sepsis will help in prediction of mortality. Female gender was an independent predictor of increased morality in critically ill patients with sepsis.

  20. Think Sepsis. Time Matters. PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2016-08-23

    This 60 second public service announcement is based on the August 2016 CDC Vital Signs report. Sepsis is a medical emergency and can happen quickly. Learn the signs of sepsis and how to prevent it.  Created: 8/23/2016 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 8/23/2016.

  1. Differences in Ambient Polycyclic Aromatic Hydrocarbon Concentrations between Streets and Alleys in New York City: Open Space vs. Semi-Closed Space

    Directory of Open Access Journals (Sweden)

    Stephanie Lovinsky-Desir

    2016-01-01

    Full Text Available Background: Outdoor ambient polycyclic aromatic hydrocarbon (PAH concentrations are variable throughout an urban environment. However, little is known about how variation in semivolatile and nonvolatile PAHs related to the built environment (open space vs. semi-closed space contributes to differences in concentrations. Methods: We simultaneously collected 14, two-week samples of PAHs from the outside of windows facing the front (adjacent to the street open side of a New York City apartment building and the alley, semi-closed side of the same apartment unit between 2007 and 2012. We also analyzed samples of PAHs measured from 35 homes across Northern Manhattan and the Bronx, 17 from street facing windows with a median floor level of 4 (range 2–26 and 18 from alley-facing windows with a median floor level of 4 (range 1–15. Results: Levels of nonvolatile ambient PAHs were significantly higher when measured from a window adjacent to a street (an open space, compared to a window 30 feet away, adjacent to an alley (a semi-closed space (street geometric mean (GM 1.32 ng/m3, arithmetic mean ± standard deviation (AM ± SD 1.61 ± 1.04 ng/m3; alley GM 1.10 ng/m3, AM ± SD 1.37 ± 0.94 ng/m3. In the neighborhood-wide comparison, nonvolatile PAHs were also significantly higher when measured adjacent to streets compared with adjacent to alley sides of apartment buildings (street GM 1.10 ng/m3, AM ± SD 1.46 ± 1.24 ng/m3; alley GM 0.61 ng/m3, AM ± SD 0.81 ± 0.80 ng/m3, but not semivolatile PAHs. Conclusions: Ambient PAHs, nonvolatile PAHs in particular, are significantly higher when measured from a window adjacent to a street compared to a window adjacent to an alley, despite both locations being relatively close to street traffic. This study highlights small-scale spatial variations in ambient PAH concentrations that may be related to the built environment (open space vs. semi-closed space from which the samples are measured, as well as the relative

  2. Revisiting and Renegotiating Wars

    DEFF Research Database (Denmark)

    Gade, Solveig

    2014-01-01

    Alley in order to avoid the bullets of the Bosnian Serbian snipers positioned around the city. Based on a close reading of Sala’s work, this article will scrutinize how subjectivating techniques of power, during times of war, affectively work to create boundaries between those excluded from and those...... included within humanity. Conversely, focusing on how these techniques are being questioned within the work, I will discuss the resistance potential of what I will refer to as practices of subjectivization. Eventually, I will seek to position the “war-critical” strategy of the work within a broader context...... of the late modern war paradigm....

  3. Fertilizer nitrogen recovery from different soil depths in an alley cropping system consisting of peanut (Arachis hypogaea) and Choerospondias axillaris in subtropical China

    International Nuclear Information System (INIS)

    Tree and crop components of an alley cropping system may compete for N in the surface soil while the tree may use leached N in the deep soil not accessed by the crop. The objective of the present study was to evaluate the recovery of nitrogen by placing 15N fertilizer at different soil depths to assess the competitiveness for N between tree and crop in an alley cropping system, consisting of peanut and Choerospondias axillaris. The tree competed with peanut for N in the surface soil as indicated by the lower 15N recovery by peanut and the higher 15N recovery in the tree in the alley cropping system, and by a higher N content in the tree mono treatment. The tree can use leached N in the deep soil as indicated by the high 15N recovery when 15N was placed at 60 cm depth. Usage of N in the deep soil was consistent with the deeper tree root distribution in the alley cropping system as compared to that in the tree alone system. The magnitudes of these changes were larger for the system with larger trees and increased with time. The alley cropping system increased system N use efficiency compared with the peanut mono cropping system. The N use efficiency increased as the tree grew as indicated by the increased 15N recovery. These results suggest that introduction of trees can reduce N loss in cropping systems, but management should aim to prevent N competition with the crop in the surface soil. (author)

  4. Sepsis neonatal por Estreptococos Pyogenes Neonatal Sepsis by Streptococcus pyogenes

    Directory of Open Access Journals (Sweden)

    Gilberto Rodríguez-Herrera

    2009-09-01

    Full Text Available Se presenta el caso de un paciente masculino, recién nacido a término adecuado para la edad gestacional, quien nace por parto vaginal, con el antecedente de fiebre en la madre durante el periodo de postparto inmediato. Los padres consultan a los 2 días de vida pues le notan dificultad respiratoria, hipoactividad y rechazo a la leche materna. El paciente se interna y se aborda como una sepsis. Durante su estancia en el servicio de neonatología del Hospital Nacional de Niños asocia fallo respiratorio que amerita ventilación mecánica asistida por varios días en diferentes ocasiones, derrame pleural exudativo, convulsiones de origen hipóxico isquémico. Con reporte de hemocultivos positivos por Estreptococos pyogenes. El Estreptococos pyogenes o estreptococo β-hemolνtico del grupo A, fue un problema en los comienzos del siglo pasado, siendo frecuente en las infecciones puerperales y del reciιn nacido. En la actualidad es un germen sumamente raro en los procesos de sepsis neonatal.2 La gravedad de la enfermedad causada por este microorganismo en el periodo neonatal varνa desde una onfalitis crónica de bajo grado a una septicemia, una meningitis fulminante y la muerte.1 El presente artículo pretende hacer un resumen del paciente, con su evolución clínica, radiológica y además ejemplificar todas las complicaciones que tuvimos con este germen tan poco frecuente en la actualidad en sepsis neonatal.We present herein the case of a newborn patient of appropriate gestational age weight ( 3700 grams, born by vaginal delivery, from a mother that had had 2 previous pregnancies (2 normal deliveries. During the immediate puerperium she had fever. The parents consulted at the age of 2 days, stating that they had noticed difficult breathing since his birth, hipoactivity and poor appetite. He was admitted to the hospital and underwent several studies searching for the origin and germ causing the sepsis. He developed respiratory failure and needed

  5. Sepsis

    Science.gov (United States)

    ... infants labored or unusual breathing change in skin color (paler than usual or mildly bluish) or a rash listlessness or lethargy change in the sound of the baby's cry or excessive crying change ...

  6. Prediction about severity and outcome of sepsis by proatrial

    OpenAIRE

    Wang, Rui-Lan; KANG Fu-xin

    2010-01-01

    Sepsis is one of the most frequent causes of death in intensive care unit (ICU) patients worldwide. According to recent reports, the incidence of sepsis has been rising at a rate of 1.5%-8% per year.1 About 9% of the sepsis develops to serious sepsis and 3% to septic shock. Although great progress has been made in the treatment of sepsis, themortality of patients with severe sepsis is still as high as 30%- 70%.2-4 Moreover, the high expenditure of sepsis management has resulted in a heavy fin...

  7. Dysglycemia and Glucose Control During Sepsis.

    Science.gov (United States)

    Plummer, Mark P; Deane, Adam M

    2016-06-01

    Sepsis predisposes to disordered metabolism and dysglycemia; the latter is a broad term that includes hyperglycemia, hypoglycemia, and glycemic variability. Dysglycemia is a marker of illness severity. Large randomized controlled trials have provided considerable insight into the optimal blood glucose targets for critically ill patients with sepsis. However, it may be that the pathophysiologic consequences of dysglycemia are dynamic throughout the course of a septic insult and also altered by premorbid glycemia. This review highlights the relevance of hyperglycemia, hypoglycemia, and glycemic variability in patients with sepsis with an emphasis on a rational approach to management. PMID:27229647

  8. Sepsis Resuscitation: Fluid Choice and Dose.

    Science.gov (United States)

    Semler, Matthew W; Rice, Todd W

    2016-06-01

    Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research. PMID:27229641

  9. Suspected sepsis: summary of NICE guidance

    OpenAIRE

    Freitag, A.; Constanti, M.; O'Flynn, N; Faust, S.

    2016-01-01

    The UK Parliamentary and Health Service Ombudsman inquiry “Time to Act” found failures in the recognition, diagnosis, and early management of those who died from sepsis, which triggered this guidance. In sepsis the body’s immune and coagulation systems are switched on by an infection and cause one or more body organs to malfunction with variable severity. The condition is life threatening. Although most people with infection do not have and will not develop sepsis, non-specific signs and symp...

  10. Sepsis, venous return, and teleology.

    Science.gov (United States)

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  11. Hubungan Nilai Mean Platelet Voulme (Mpv) Dengan Derajat Sepsis

    OpenAIRE

    Ginting, Andi Raga

    2016-01-01

    Background:Sepsis is a major disease that affects millions of people worldwide every year. Almost all organs and systems were affected by sepsis. Hemostatic system is also affected. Easily accessible, inexpensive, and widely used laboratory tests that shows sepsis and the severity are important Purpose:To investigate the relationship of the MPV values with the degree of sepsis, correlation MPV with procalcitonin and the diagnostic value of MPV to diagnose sepsis. Method: A cross section...

  12. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6.

    Science.gov (United States)

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. PMID:27239303

  13. Chronic kidney disease-induced HMGB1 elevation worsens sepsis and sepsis-induced acute kidney injury

    OpenAIRE

    Leelahavanichkul, Asada; Huang, Yuning; Hu, Xuzhen; Zhou, Hua; Tsuji, Takayuki; Chen, Richard; Jeffrey B Kopp; Schnermann, Jürgen; Yuen, Peter S.T.; Star, Robert A.

    2011-01-01

    We previously showed that kidney dysfunction/interstitial fibrosis by folate predisposes mice to sepsis mortality (normal/sepsis: 15%; folate/sepsis: 90%); agents that increased survival in normal septic mice were ineffective in the two-stage model. We used a recently characterized 5/6 nephrectomy (Nx) mouse model of progressive chronic kidney disease (CKD) to study how CKD impacts sepsis and acute kidney injury (AKI) induced by cecal ligation-puncture (CLP). CKD intensified sepsis severity (...

  14. Hepatic blood flow in late sepsis patients

    Directory of Open Access Journals (Sweden)

    Amany Abd El Maqsoud

    2013-01-01

    Conclusion Duplex ultrasound assessment was a useful bedside method for predicting mortality in late sepsis patients through estimation of HABF, with a reasonable predictive potential at a definite cutoff level.

  15. Thromboelastography in patients with severe sepsis

    DEFF Research Database (Denmark)

    Haase, Nicolai; Ostrowski, Sisse Rye; Wetterslev, Jørn;

    2015-01-01

    PURPOSE: To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS: Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156......) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox...... subsequent bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS: In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding....

  16. Toll-like receptors in neonatal sepsis.

    LENUS (Irish Health Repository)

    O'Hare, Fiona M

    2013-06-01

    Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host-pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.

  17. Oxidative phosphorylation revisited

    DEFF Research Database (Denmark)

    Nath, Sunil; Villadsen, John

    2015-01-01

    The fundamentals of oxidative phosphorylation and photophosphorylation are revisited. New experimental data on the involvement of succinate and malate anions respectively in oxidative phosphorylation and photophosphorylation are presented. These new data offer a novel molecular mechanistic explan...

  18. Prediction about severity and outcome of sepsis by proatrial

    Directory of Open Access Journals (Sweden)

    WANG Rui-lan

    2010-06-01

    Full Text Available Sepsis is one of the most frequent causes of death in intensive care unit (ICU patients worldwide. According to recent reports, the incidence of sepsis has been rising at a rate of 1.5%-8% per year.1 About 9% of the sepsis develops to serious sepsis and 3% to septic shock. Although great progress has been made in the treatment of sepsis, themortality of patients with severe sepsis is still as high as 30%- 70%.2-4 Moreover, the high expenditure of sepsis management has resulted in a heavy financial burden to the government and patients.1 Therefore, howto estimatethe severity of sepsis early and apply targeted therapies timely is very important in the treatment of sepsis.

  19. A biomarker panel to discriminate between systemic inflammatory response syndrome SIRS and sepsis and sepsis severity

    NARCIS (Netherlands)

    Punyadeera, C.; Schneider, E. M.; Schaffer, D.; Hsu, H-Y.; Joos, T.O.; Kriebel, F; Weiss, M.; Verhaegh, W.F.J.

    2009-01-01

    In this study we report on initial efforts to discover putative biomarkers for differential diagnosis of a systemic inflammatory response syndrome (SIRS) vs. sepsis; and different stages of sepsis. In addition, we also investigated whether there are proteins that can discriminate between patients wh

  20. Svær sepsis og septisk shock

    DEFF Research Database (Denmark)

    Tønnesen, Else; Larsen, Kim

    2014-01-01

    Sepsis, severe sepsis and septic shock are syndromes. The incidence of sepsis is as high as 35% and with mortality rates in the intensive care unit from 27% to 54% in sepsis and septic shock, respectively. Many new treatments have been tested but only few have been implemented in clinical practise....... The treatment of severe sepsis and septic shock is based on the Surviving Sepsis Campaign guidelines developed by an international expert panel. Early diagnosis, optimization of haemodynamics, rapid identification of focus and adequate antibiotic treatment are the most important strategies....

  1. Living on the Edge:The Cost/Benefit Perceptions of TornadoSafe Rooms on the Periphery of Tornado Alley

    OpenAIRE

    Kuntz, Gerard

    2012-01-01

    Abstract There is a lack of correlation between the believed and actual threat of tornadoes on the periphery of Tornado Alley. The purpose of this project is to record the perceptions of homeowners and realtors of the threat posed by tornadoes in a specific geographic location and the need of tornado safe rooms to mitigate that threat and/or provide peace of mind from the potential of that threat. The research included surveying real estate agents and residents within the specified geo...

  2. Understanding yields in alley cropping maize (Zea mays L. ) and Cassia siamea Lam. under semi-arid conditions in Machakos,Eastern Kenya

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Six seasons of experiments in Machakos, Kenya, revealed that above about 150 mm of rainfall, maize yields per row in alley cropped “replacement” agroforestry (AF) plots, of Cassia siamea Lam. and maize (Zea mays, cv. Katumani Composite B), may be expected to exceed those in the control (sole maize) plots. Such yields were insufficient to compensate for the area “lost” to the hedgerows. Below about 150 mm the control plots may be expected to perform better. This result was due to competition for water. Greater association of the fine roots of Cassia and maize was observed in the middle of the alleys than near the hedgerows. Photosynthetic consequences of shading were insignificant relative to other factors. In the alleys, reductions of soil temperature due to shade in the western and eastern maize rows were higher than in the middle row. Soil moisture extraction was higher in the AF than in the control plots. In the AF plots, moisture extraction was greater under the central maize rows than under those nearest the Cassia. Yield patterns followed such soil temperature and soil moisture patterns. Maize transpiration and photosynthetic rates were significantly higher in the control than in the AF plots during a below-average rainy season but not during above-average rainy seasons. It is concluded that alley cropping under semi-arid conditions should be approached differently from the system worked on. It must at least provide strong physical protection of crops and/or soils and have a strong economic incentive to be of interest to the farmers.

  3. Designing a Pediatric Severe Sepsis Screening Tool

    Directory of Open Access Journals (Sweden)

    Robert eSepanski

    2014-06-01

    Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

  4. Mechanisms of Intestinal Barrier Dysfunction in Sepsis.

    Science.gov (United States)

    Yoseph, Benyam P; Klingensmith, Nathan J; Liang, Zhe; Breed, Elise R; Burd, Eileen M; Mittal, Rohit; Dominguez, Jessica A; Petrie, Benjamin; Ford, Mandy L; Coopersmith, Craig M

    2016-07-01

    Intestinal barrier dysfunction is thought to contribute to the development of multiple organ dysfunction syndrome in sepsis. Although there are similarities in clinical course following sepsis, there are significant differences in the host response depending on the initiating organism and time course of the disease, and pathways of gut injury vary widely in different preclinical models of sepsis. The purpose of this study was to determine whether the timecourse and mechanisms of intestinal barrier dysfunction are similar in disparate mouse models of sepsis with similar mortalities. FVB/N mice were randomized to receive cecal ligation and puncture (CLP) or sham laparotomy, and permeability was measured to fluoresceinisothiocyanate conjugated-dextran (FD-4) six to 48 h later. Intestinal permeability was elevated following CLP at all timepoints measured, peaking at 6 to 12 h. Tight junction proteins claudin 1, 2, 3, 4, 5, 7, 8, 13, and 15, Junctional Adhesion Molecule-A (JAM-A), occludin, and ZO-1 were than assayed by Western blot, real-time polymerase chain reaction, and immunohistochemistry 12 h after CLP to determine potential mechanisms underlying increases in intestinal permeability. Claudin 2 and JAM-A were increased by sepsis, whereas claudin-5 and occludin were decreased by sepsis. All other tight junction proteins were unchanged. A further timecourse experiment demonstrated that alterations in claudin-2 and occludin were detectable as early as 1 h after the onset of sepsis. Similar experiments were then performed in a different group of mice subjected to Pseudomonas aeruginosa pneumonia. Mice with pneumonia had an increase in intestinal permeability similar in timecourse and magnitude to that seen in CLP. Similar changes in tight junction proteins were seen in both models of sepsis although mice subjected to pneumonia also had a marked decrease in ZO-1 not seen in CLP. These results indicate that two disparate, clinically relevant models of sepsis

  5. Biomarkers for neonatal sepsis: recent developments

    Directory of Open Access Journals (Sweden)

    Mally P

    2014-09-01

    Full Text Available Pradeep Mally,1 Jie Xu,2 Karen D Hendricks-Muñoz2 1Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY, USA; 2Department of Pediatrics, Division of Neonatal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Abstract: As a leading cause of neonatal morbidity and mortality, neonatal sepsis remains a significant global health challenge. Despite recent advances in the management of neonatal sepsis, including use of more potent antibiotics, timely identification continues to be a frequent and challenging problem in the management of the newborn or high-risk neonate in the neonatal intensive care unit. Lack of specific early objective diagnostic evaluations or specific signs and symptoms, especially in the preterm infant, impedes early identification. However, emerging technologies linked with enhanced understanding of the immature and developing neonatal immune system responses to early infection provide an opportunity to develop critically needed biomarkers to improve early identification in this high-risk population. This review will focus on the field of neonatal sepsis biomarker development, identifying current promising biomarkers that have been investigated and widely utilized, as well as provide insight into recent advances and the rapidly evolving technologies that are being exploited in biomarker development to improve diagnosis, treatment, and prognosis in neonatal sepsis. Keywords: biomarker, cytokines, neonatal sepsis, recent developments, morbidity, mortality, neonates

  6. Soluble L-selectin levels predict survival in sepsis

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Nielsen, Ole H; Strøm, Jens

    2002-01-01

    To evaluate serum soluble L-selectin as a prognostic factor for survival in patients with sepsis.......To evaluate serum soluble L-selectin as a prognostic factor for survival in patients with sepsis....

  7. Diabetes and sepsis outcomes - it is not all bad news

    OpenAIRE

    Yende, S; Poll

    2009-01-01

    Patients with diabetes mellitus have an increased risk of developing infections and sepsis. In this issue of Critical Care Esper and colleagues report on a large survey, involving 12.5 million sepsis cases, that examined the impact of pre-existing diabetes on organ dysfunction during sepsis. Their main conclusion was that diabetes patients, relative to non-diabetics, were less likely to develop respiratory failure and more likely to develop renal failure during the course of sepsis.

  8. Current concept of abdominal sepsis: WSES position paper

    OpenAIRE

    Sartelli, Massimo; Catena, Fausto; Di Saverio, Salomone; Ansaloni, Luca; Malangoni, Mark; Moore, Ernest E; Moore, Frederick A; Ivatury, Rao; Coimbra, Raul; Leppaniemi, Ari; Biffl, Walter; Kluger, Yoram; Fraga, Gustavo P; Ordonez, Carlos A.; Marwah, Sanjay

    2014-01-01

    Although sepsis is a systemic process, the pathophysiological cascade of events may vary from region to region. Abdominal sepsis represents the host’s systemic inflammatory response to bacterial peritonitis. It is associated with significant morbidity and mortality rates, and is the second most common cause of sepsis-related mortality in the intensive care unit. The review focuses on sepsis in the specific setting of severe peritonitis.

  9. Cytokines as diagnostic biomarkers in canine pyometra and sepsis

    OpenAIRE

    Karlsson, Iulia

    2015-01-01

    Sepsis is a syndrome with high morbidity, mortality and astronomical health care costs and it is challenging to diagnose both in humans and animals due to the lack of suitable diagnostic biomarkers. Although several types of proteins have been suggested as diagnostic biomarkers of sepsis, none of them were shown to be reliable for routine use in the clinical practice. Dogs with uterine bacterial infection called pyometra often develop sepsis and have been suggested as a natural model of sepsi...

  10. Performance improvement in the management of sepsis.

    Science.gov (United States)

    Schorr, Christa

    2011-03-01

    Sepsis guidelines, although creating a base to allow change in health care practitioner behavior, do not, in and of themselves, effect change. Change only comes with institution of a PI program, converting a core of key goals of guideline recommendations to quality indicators, and giving feedback on performance. These quality indicators are tracked before or during (recommended approach) initiation of hospital-wide education to evaluate baseline performance. When combining multispecialty and multidisciplinary champions in the ED, hospital wards, ICU, and hospital administrative leadership with timely performance feedback, case failure analysis, and re-education, an opportunity to succeed in decreasing mortality in severe sepsis can be achieved. Sepsis bundle indicators require updating as new evidence emerges and new guidelines are published.(30,31) PMID:21316576

  11. Mitochondrial dysfunction and resuscitation in sepsis.

    Science.gov (United States)

    Ruggieri, Albert J; Levy, Richard J; Deutschman, Clifford S

    2010-07-01

    Sepsis is among the most common causes of death in patients in intensive care units in North America and Europe. In the United States, it accounts for upwards of 250,000 deaths each year. Investigations into the pathobiology of sepsis have most recently focused on common cellular and subcellular processes. One possibility would be a defect in the production of energy, which translates to an abnormality in the production of adenosine triphosphate and therefore in the function of mitochondria. This article presents a clear role for mitochondrial dysfunction in the pathogenesis and pathophysiology of sepsis. What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive. PMID:20643307

  12. Implementatie van de Surviving Sepsis Campaign bundels : Monitoring van ervaringen

    NARCIS (Netherlands)

    Rensen, A.; Willems, A.; Stevens, N.; Zeegers, F.; Vloet, Lilian; Schouten, J.

    2011-01-01

    Sepsis komt vaak voor in ziekenhuizen. Ernstige sepsis is verantwoordelijk voor 10 - 20% van alle Intensive Care (IC) opnames en is de belangrijkste doodsoorzaak op niet-cardiale IC?s. De gemiddelde mortaliteit van volwassenen met ernstige sepsis op de IC is 33% en van volwassenen met septische shoc

  13. Indium 111 leucocyte scintigraphy in abdominal sepsis

    International Nuclear Information System (INIS)

    We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected intra-abdominal sepsis upon which therapeutic decisions can be based. (orig.)

  14. Leberversagen bei Sepsis und Multiorganversagen

    Directory of Open Access Journals (Sweden)

    Kapral C

    2005-01-01

    Full Text Available Eine Störung der Leberfunktion wird bei etwa 20–25% der Patienten mit Organversagen im Rahmen einer schweren Entzündungsreaktion beobachtet. Obwohl der klinische Parameter hierfür – der Anstieg des Bilirubins – in der Regel erst nach Funktionsstörungen anderer Organe auftritt, zeigen sehr sensitive Nachweismethoden einer hepatalen Dysfunktion wie die Indozyangrünclearance, daß die Leberbeteiligung ein sehr frühes Ereignis darstellt. Ursache für die Funktionseinschränkung der Leber sind vor allem Zytokine, die großteils direkt in der Leber selbst auf die verschiedenen Stimuli (Endotoxine, Hypoxie usw. freigesetzt werden. Spezifische Therapiemaßnahmen zur Verbesserung der Leberfunktion stehen dem Kliniker derzeit nicht zur Verfügung. Es gilt auch hier der Grundsatz, daß durch eine frühzeitige Herdsanierung und effektive Kreislauftherapie die Zytokinaktivierung möglichst gering gehalten werden soll, um damit auch Organtoxizitäten zu vermindern. Die zur Verfügung stehenden, kreislaufaktiven Substanzen zeigen eine individuell nur schwer voraussagbare, sehr unterschiedliche Wirkung auf Kreislauf und Funktion der Leber. Einzig Adrenalin dürfte aufgrund der vorliegenden Untersuchungen eine eher ungünstige Wirkung haben und sollte daher nicht zur Anwendung kommen. In der letzten Zeit konnten jedoch durch neue Maßnahmen erste klinische Erfolge nachgewiesen werden, bzw. im Tierexperiment eine Verbesserung der Leberfunktion beobachtet werden. So konnte durch Normalisierung der Blutzuckerkonzentration bei Patienten mit Sepsis eine Verbesserung der Mortalität und auch Verbesserung der mitochondrialen Funktion von Leberzellen beobachtet werden. Durch die Gabe von N-Acetylcystein wurde in Studien an kleinen Fallzahlen eine günstige Wirkung beobachtet, größere Studien werden hier Klarheit schaffen. Ebenfalls in klinischer Erprobung ist die orale Gabe von Gallensäuren, die den Gallensäuregehalt des Darmes erhöhen und damit die

  15. Therapeutic Targets in Sepsis: Past, Present, and Future.

    Science.gov (United States)

    Seeley, Eric J; Bernard, Gordon R

    2016-06-01

    Antibiotics and fluids have been standard treatment for sepsis since World War II. Many molecular mediators of septic shock have since been identified. In models of sepsis, blocking these mediators improved organ injury and decreased mortality. Clinical trials, however, have failed. The absence of new therapies has been vexing to clinicians, clinical researchers, basic scientists, and the pharmaceutical industry. This article examines the evolution of sepsis therapy and theorizes about why so many well-reasoned therapies have not worked in human trials. We review new molecular targets for sepsis and examine trial designs that might lead to successful treatments for sepsis. PMID:27229636

  16. Transanal Endoscopic Drainage of Abdominopelvic Sepsis

    OpenAIRE

    Abbas, Maher A; Falls, Garietta

    2008-01-01

    Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an evolving experimental field exploring the technical feasibility and outcome of therapeutic interventions performed through the natural orifices of the body. The knowledge accumulating in NOTES is the result of animal experimentation and ongoing early clinical experience in humans. In this report we describe a patient treated with transanal endoscopic drainage of postoperative abdominopelvic sepsis.

  17. Perioperative treatment of patients with sepsis

    DEFF Research Database (Denmark)

    Ibsen, Michael; Perner, Anders

    2013-01-01

    Key elements in the initial resuscitation and stabilization of the patient with sepsis are fluid therapy, vasopressor or inotropic support, administration of adequate antibiotics and source control. This review will primarily discuss fluid, vasopressor and antibiotic therapy because these have been...

  18. Risk factors for sepsis-associated encephalopathy

    Institute of Scientific and Technical Information of China (English)

    Jian Li; Ang Li; Yibing Weng; Shuwen Zhang; Meili Duan

    2011-01-01

    Sepsis-associated encephalopathy (SAE) is a diffuse and acute cerebral dysfunction caused by sepsis. Many sepsis patients exhibit acute deterioration in mental status during the early stage of disease, and central nervous system dysfunction has been shown to increase patient mortality. The present study selected 284 sepsis patients who were admitted to the Intensive Care Unit of Beijing Friendship Hospital, Capital Medical University, from January to December 2009. The patients were assigned to SAE and non-SAE patient groups according to SAE occurrence. SAE incidence was 37.68%, and mortality was significantly greater in SAE patients compared with non-SAE patients (41.12% vs. 17.51%, P < 0.01). Univariate analysis and multivariate logistic regression analysis indicated lower arterial partial pressure of oxygen and greater alanine aminotransferase and Acute Physiology and Chronic Health Evaluation II scores in the SAE group compared with the non-SAE group. Arterial partial pressure of oxygen, alanine aminotransferase, and Acute Physiology and Chronic Health Evaluation II scores were determined to be potential risk factors for SAE.

  19. Surviving Sepsis: Taming a Deadly Immune Response

    Science.gov (United States)

    ... 5 affected people. It causes symptoms such as fever, chills, rapid breathing, and confusion. Anyone can get sepsis, ... other conditions. Medical personnel look for these signs: Fever or low body temperature (hypothermia) Chills Rapid heart rate Difficulty breathing Skin rash Confusion ...

  20. Apolipoprotein M - a new biomarker in sepsis

    DEFF Research Database (Denmark)

    Christoffersen, Christina; Nielsen, Lars Bo

    2012-01-01

    Care Kumaraswamy and colleagues have investigated whether plasma apolipoprotein M (apoM) is affected during different grades of sepsis, septic shock and systemic inflammatory response syndrome. Interestingly, plasma apoM was significantly decreased in all groups of patients with a relationship to...

  1. Clinical analysis of cases of neonatal Streptococcus agalactiae sepsis.

    Science.gov (United States)

    Zeng, S J; Tang, X S; Zhao, W L; Qiu, H X; Wang, H; Feng, Z C

    2016-01-01

    With the advent of antibiotic resistance, pathogenic bacteria have become a major threat in cases of neonatal sepsis; however, guidelines for treatment have not yet been standardized. In this study, 15 cases of neonatal Streptococcus agalactiae sepsis from our hospital were retrospectively analyzed. Of these, nine cases showed early-onset and six cases showed late-onset sepsis. Pathogens were characterized by genotyping and antibiotic sensitivity tests on blood cultures. Results demonstrated that in cases with early-onset sepsis, clinical manifestations affected mainly the respiratory tract, while late-onset sepsis was accompanied by intracranial infection. Therefore, we suggest including a cerebrospinal fluid examination when diagnosing neonatal sepsis. Bacterial genotyping indicated the bacteria were mainly type Ib, Ia, and III S. agalactiae. We recommend treatment with penicillin or ampicillin, since bacteria were resistant to clindamycin and tetracycline. In conclusion, our results provide valuable information for the clinical treatment of S. agalactiae sepsis in neonatal infants. PMID:27323190

  2. Growth and yield of maize and cassava cultivars as affected by mycorrhizal inoculation and alley cropping regime

    Directory of Open Access Journals (Sweden)

    Salami Olusola Abiodun

    2006-01-01

    Full Text Available Effect of myeorrhizal inoculation and two pruning regimes in experimental alley cropping treatments on the leaf biomass and nutrient yield of sole and mixed Gliricidica septum (a Modulating plant ami Senna siamea (a non-nodulating plant were investigated both in the greenhouse and in the field. The impact of the mixtures of these legumes as hedgerows on maize and one cultivar of cassava was also studied on the Held. Gliricidia sepiuni prunnings were found to have high nutrient yields, notably 358.4 kg ha-1 of N and 14.7 kg ha-1 of P as well as fast decomposition and nutrient release. In both Giricidia and Senna. there was similar leaf dry matter values in sole and mixed inoculated or non-inoculated trees for either of the pruning regime and for most of the pruning harvests, although significant differences occurred between inoculated and non-inoculated mixed or sole trees. There was no difference between the total leaf dry matter of the two- and three-month pruning regimes in G. sepium. However, in contrast to G. sepium, the total leaf dry matter of the two-month pruning regime of iS'. sianica was lower than its three-month pruning regime, except for sole non-inoculated trees. Generally, inoculation and mixing of trees in the same hedgerows significantly increased the total N and P yield in G. sepium and S. siantea with greater values in the former than the latter. In G. sephium and except for mixed inoculated trees, while total N yield in the leaf was higher in three-monthly primed than two-monthly pruned trees, the converse was the case for P. For S. siamea the total N and P yield were higher in three-monthly than two-monthly pruned trees. Myeorrhizal inoculations consistently increased the yield of the cassava root tuber and maize grain over their non-inoculated counterparts.

  3. The Faraday effect revisited

    DEFF Research Database (Denmark)

    Cornean, Horia; Nenciu, Gheorghe

    2009-01-01

    This paper is the second in a series revisiting the (effect of) Faraday rotation. We formulate and prove the thermodynamic limit for the transverse electric conductivity of Bloch electrons, as well as for the Verdet constant. The main mathematical tool is a regularized magnetic and geometric...

  4. Colloquial Hebrew Imperatives Revisited

    Science.gov (United States)

    Bolozky, Shmuel

    2009-01-01

    In revisiting Bolozky's [Bolozky, Shmuel, 1979. "On the new imperative in colloquial Hebrew." "Hebrew Annual Review" 3, 17-24] and Bat-El's [Bat-El, Outi, 2002. "True truncation in colloquial Hebrew imperatives." "Language" 78(4), 651-683] analyses of colloquial Hebrew imperatives, the article argues for restricting Imperative Truncation to the…

  5. Deterministic Graphical Games Revisited

    DEFF Research Database (Denmark)

    Andersson, Daniel; Hansen, Kristoffer Arnsfelt; Miltersen, Peter Bro; Sørensen, Troels Bjerre

    2008-01-01

    We revisit the deterministic graphical games of Washburn. A deterministic graphical game can be described as a simple stochastic game (a notion due to Anne Condon), except that we allow arbitrary real payoffs but disallow moves of chance. We study the complexity of solving deterministic graphical...

  6. Life quality index revisited

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager

    2004-01-01

    The derivation of the life quality index (LQI) is revisited for a revision. This revision takes into account the unpaid but necessary work time needed to stay alive in clean and healthy conditions to be fit for effective wealth producing work and to enjoyable free time. Dimension analysis...

  7. The Linguistic Repertoire Revisited

    Science.gov (United States)

    Busch, Brigitta

    2012-01-01

    This article argues for the relevance of poststructuralist approaches to the notion of a linguistic repertoire and introduces the notion of language portraits as a basis for empirical study of the way in which speakers conceive and represent their heteroglossic repertoires. The first part of the article revisits Gumperz's notion of a linguistic…

  8. The influence of tagasaste (chamaecytisus proliferus link) trees on the water balance of an alley cropping system on deep sand in south-western Australia)

    International Nuclear Information System (INIS)

    Components of the water balance of an alley cropping system were measured to assess the extent to which tree rows 30 m apart with access to a fresh, perched watertable at 5 m depth were able to capture deep drainage from an inter-cropped cereal-legume rotation. Neutron probe data showed that the 4-year-old trees, cut back to 0.6-m high at the beginning of the experiment, depleted soil water to 2, 4, and 8 m laterally from the tree rows in their first, second, and third years of coppice regrowth, respectively. Combining data from soil water depletion in summer and comparisons of deuterium/hydrogen ratios of groundwater, xylem sap of trees, and herbaceous plants, it was shown that tagasaste trees drew on soil water for 80% of their transpiration in the first winter and 40% in the second, while switching to near total dependence on groundwater each summer and early autumn. Tree water use on a whole plot basis was 170 mm in 1997 (68% from groundwater) v. 167 mm in 1998 (73% from groundwater). Recharge to the perched watertable was estimated to be 193 mm under sole crop in 1998 (52% of rainfall), reducing to 32 mm when uptake of groundwater by trees was included. The degree of complementarity between tagasaste trees and crops in alley cropping used for water management is quantified for 1998 by calculating the ratio of the distance over which trees reduced drainage to zero to the distance over which they reduced crop yield to zero. It is concluded that segregated monocultures of trees and crops would be a more appropriate strategy than a closely integrated system such as alley cropping in this case. Copyright (2001) CSIRO Australia

  9. Epidemiology of sepsis in ICUs of Western China

    Institute of Scientific and Technical Information of China (English)

    Hao Tang; Dong Liu; Hua-Yu Zhang; Shi-Jin Sun; Xiu-Zhu Zhang; Dong-Po Jiang; Lian-Yang Zhang

    2016-01-01

    Objectives: To investigate the relationship between sepsis prevalence and disease types in intensive care units (ICUs), as well as the effect of knowledge of the health care workers about the sepsis guidelines on sepsis morbidity and mortality. Methods: A one-day cross-sectional survey was conducted in five ICUs in the cities of Chongqing and Guizhou, China. The included patients were divided into three groups:the internal medicine group (Group A), surgery group (Group B), and trauma group (Group C). Sepsis was diagnosed by the 2012 Sepsis Guidelines, and the prevalence and 28-day mortality were statistically analyzed. The relationship between the knowledge of health care workers about sepsis and morbidity and mortality was analyzed. Results: Among the enrolled 71 patients, the sepsis prevalence rate was 81.5%, 66.7%, and 87.0% in Groups A, B, and C, respectively. In total, the 28-day mortality rate was 36.4%, 42.9%and 20.0%in Groups A, B, and C, respectively, indicating no significant difference. The sepsis prevalence was 66.7%, 90.0%, 90.9%, 100.0%and 76.9%in the five ICUs. The average cognitive score of each hospital was 68.5 ± 15.4, 65.7 ± 16.7, 69.0 ± 23.3, 25.0 ± 8.4, and 61.4 ± 19.9 points in the five ICUs. Cognitive scores were not associated with prevalence of sepsis, but they were negatively related with sepsis mortality. Conclusions: Sepsis prevalence and mortality are not associated with diseases types within ICUs, but the knowledge of sepsis of health care workers is associated with the prognosis of sepsis patients.

  10. A biomarker panel to discriminate between systemic inflammatory response syndrome and sepsis and sepsis severity

    Directory of Open Access Journals (Sweden)

    Punyadeera Chamindie

    2010-01-01

    Full Text Available Introduction: In this study, we report on initial efforts to discover putative biomarkers for differential diagnosis of a systemic inflammatory response syndrome (SIRS versus sepsis; and different stages of sepsis. In addition, we also investigated whether there are proteins that can discriminate between patients who survived sepsis from those who did not. Materials and Methods: Our study group consisted of 16 patients, of which 6 died and 10 survived. We daily measured 28 plasma proteins, for the whole stay of the patients in the ICU. Results: We observed that metalloproteinases and sE-selectin play a role in the distinction between SIRS and sepsis, and that IL-1α, IP-10, sTNF-R2 and sFas appear to be indicative for the progression from sepsis to septic shock. A combined measurement of MMP-3, -10, IL-1α, IP-10, sIL-2R, sFas, sTNF-R1, sRAGE, GM-CSF, IL-1β and Eotaxin allows for a good separation of patients that survived from those that died (mortality prediction with a sensitivity of 79% and specificity of 86%. Correlation analysis suggests a novel interaction between IL-1a and IP-10. Conclusion: The marker panel is ready to be verified in a validation study with or without therapeutic intervention

  11. Development of Immunopathobiogenesis on SIRS-Sepsis

    Directory of Open Access Journals (Sweden)

    A Guntur Hermawan

    2009-04-01

    Full Text Available Over the past decade, sepsis has been diagnosed according to consensus guidelines established in 1991 as an infection in addition to the symptoms of systemic inflammatory response syndrome (SIRS. In addition to the previous criteria, the 2001 conference added several new diagnostic criteria for sepsis. Of particular interest was the inclusion of the biomarkers procalcitonin (PCT and C-reactive protein (CRP, despite the overall conclusion that it was premature to use biomarkers for sepsis diagnosis. The primary recommendation of the panel was the implementation of the Predisposition, insult Infection, Response, and Organ dysfunction (PIRO.The immune system has traditionally been devided into innate and adaptive components, each of which has a different role and function in defending the host against infectious agents. Stimulation of different TLRs induces distinct patterns of gene expression, which not only leads to the activation of innate immunity but also increasing evidence supports an additional critical role for TLRs in orchestrating the development of adaptive immune responses. The superantigens are able to induce toxic shock syndrome and can sometimes cause multiple organ failure via adaptive immune system. The superantigenic activity of the bacterial exotoxins can be attributed to their ability to cross-link major histocompatibility complex class II molecules on antigen-presenting cells outside the peptide groove with T-cell receptors to form a trimolecular complex. This trimolecular interaction leads to uncontrolled release of a number of proinflammatory cytokines. Proinflammatory cytokines especially IFN-γ and TNF-α, the key cytokines causing toxic shock syndrome. KEYWORDS: sepsis, innate immunity, adaptive.

  12. Metabolic changes in cardiomyocytes during sepsis

    OpenAIRE

    Douglas, James J; Keith R Walley

    2013-01-01

    Different types of shock induce distinct metabolic changes. The myocardium at rest utilizes free fatty acids as its primary energy source, a mechanism that changes to aerobic glycolysis during sepsis and is in contrast to hemorrhagic shock. The immune system also uses this mechanism, changing its substrate utilization to activate innate and adaptive cells. Cardiomyocytes share a number of features similar to antigen-presenting cells and may use this mechanism to augment the immune response at...

  13. Insulin and metabolic substrates during human sepsis

    OpenAIRE

    Finney, Simon J

    2004-01-01

    Rusavy and colleagues recently endeavoured to dissect out the metabolic effects of insulin in patients with severe sepsis, in the setting of normoglycaemia. Twenty stable patients were studied 3–7 days after admission using a euglycaemic clamp at two supraphysiological insulin levels. Increased doses of exogenous insulin caused preferential use of glucose as a metabolic substrate, while total energy expenditure remained constant. Consequently, hyperinsulinaemia reduced tissue oxygen demand an...

  14. Nosocomial Bloodstream Infection and Clinical Sepsis

    OpenAIRE

    Hugonnet, Stéphane; Sax, Hugo; Eggimann, Philippe; Chevrolet, Jean-Claude; Pittet, Didier

    2004-01-01

    Primary bloodstream infection (BSI) is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients’ outcome. Surveillance definitions for primary BSI distinguish those that are microbiologically documented from those that are not. The latter is known as clinical sepsis, but information on its epidemiologic importance is limited. We analyzed prospective on-site surveillance data of nosocomial infections in a medical intensive care unit. Of th...

  15. Shigella flexneri Sepsis in an Infant

    OpenAIRE

    Ju-Bei Yen; Kuei-Wen Chang; Tsu-Lan Wu; An-Jin Kuo; Lin-Hui Su

    2003-01-01

    Shigellosis continues to be an important public health problem in developed countries,since communication in the world village has become more frequent. In addition, this diseaseis difficult to be prevented because only a small number of bacteria are required tocause infection, and it has exhibited steady trends towards multiple drug resistance. Thisreport describes a 7-month-old female infant with Shigella flexneri sepsis presenting initiallywith a high fever, watery diarrhea, and dehydratio...

  16. Clinical Practice Guidelines for Severe Sepsis Treatment.

    OpenAIRE

    Julio Héctor Jova Dueñas; Diosdania Alfonso Falcón; Marcos Diosdado Iraola Ferrer; Inti Santana Carballosa; José Noel Marrero.

    2009-01-01

    Clinical Practice Guidelines for Severe Sepsis Treatment. It is a syndrome of inflammatory systemic response caused by documented infection (clinical and/or microbiological), associated with organic dysfunction (respiratory, renal, hepatic, cardiovascular, haematological and neurological), hypotension or hypoperfusion. This document includes a review and update of the concept, risk factors, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be ...

  17. In vitro diagnosis of sepsis: a review

    Directory of Open Access Journals (Sweden)

    Guido M

    2016-03-01

    Full Text Available Marcello Guido,1 Maria Rosaria Tumolo,2 Antonella De Donno,1 Tiziano Verri,3 Francesca Serio,1 Francesco Bagordo,1 Antonella Zizza2 1Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy; 2National Research Council, Institute of Clinical Physiology, 3Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, ItalyAbstract: Sepsis, severe sepsis and septic shock, systemic inflammatory response, and other related manifestations represent a relevant medical problem with high morbidity and mortality, despite the improvements in diagnosis, treatment, and preventive measures over the last few decades. The limited knowledge of the pathophysiology in association with the lack of in vitro diagnostic methods for the certain and quick determination of the causative microbiological agents and their antibiotic resistance means the condition is still critical and of high impact in health care. The current gold standard method to detect the sepsis-causing pathogens, which is based on blood culture, is still insufficiently sensitive and slow. The new culture-independent molecular biology-based techniques can lead to the identification of a broad range of microorganisms and resistance markers within a few hours and with high sensitivity and specificity; nevertheless, limitations of, for example, the polymerase chain reaction-based methods still hamper their application in the clinical routine. This review summarizes the in vitro diagnostic methods and their approach in the clinical diagnosis of the bloodstream infections, and explores their advantages and disadvantages at the current state of the art. A quick analysis of the future prospective in multiplex technologies for microbiological diagnosis of sepsis is also provided. Keywords: PCR, PCR/ESI-MS, microarray, MALDI-TOF, next

  18. Sepsis due to clostridium septicum: case report

    International Nuclear Information System (INIS)

    Clostridium septicum is an unusual anaerobic, gram-positive, gas-producing bacillus, which has been identified as a cause of fulminant rapidly fatal infection in humans. Infection with C. septicum usually occurs in patients with cancer, patients receiving immunosuppressive chemotherapy, or patients with a nonmalignant hematological disorder such as hemolytic uremic syndrome. C. septicum infection most commonly involves the abdomen, and a recent review article has identified 164 cases in the medical literature describing the abdominal findings in this disease. Intracranial manifestation of C. septicum infection are less common and include meningitis, cerebritis, abscess formation and pneumocephalus. There have been only 12 documented cases in the English literature describing central nervous system lesions associated with C. septicum. We present a case report of a 56-year-old man in whom septicemia due to C. septicum developed as a complication of Crohn's disease. To our knowledge, there has never been a previous report of C. septicum sepsis related to underlying Crohn's disease. Our case is also remarkable in that an intracerebral gas collection developed at the site of a mycotic infarct related to C. septicum bacteremia, Intracranial, intraparenchymal gas formation related to anaerobic infection is extremely rare; to our knowledge, this radiological finding related to C. septicum sepsis has been described in only 1 previous case report in the medical literature. We also describe the intra-abdominal manifestations of C. septicum sepsis that occurred in this patient as well as the associated radiographic and pathologic findings. (author)

  19. THE EPITHELIUM AS A TARGET IN SEPSIS.

    Science.gov (United States)

    Chawla, Lakhmir S; Fink, Mitchell; Goldstein, Stuart L; Opal, Steven; Gómez, Alonso; Murray, Patrick; Gómez, Hernando; Kellum, John A

    2016-03-01

    Organ dysfunction induced by sepsis has been consistently associated with worse outcome and death. Regardless of the organ compromised, epithelial dysfunction is present throughout the body, affecting those organs that contain epithelia like the skin, lungs, liver, gut, and kidneys. Despite their obvious differences, sepsis seems to alter common features of all epithelia, such as barrier function and vectorial ion transport. Such alterations in the lung, the gut, and the kidney have direct implications that may explain the profound organ functional impairments in the absence of overt cell death. Epithelial injury in this context is not only an explanatory real pathophysiologic event, but also represents a source of biomarkers that have been explored to identify organ compromise earlier, predict outcome, and even to test novel therapeutic interventions such as blood purification. However, this remains largely experimental, and despite promising results, work is still required to better understand the response of the epithelial cells to sepsis, to define their role in adaptation to insults, to comprehend the interorgan cross-talk that occurs in these circumstances, and to exploit these aspects in pursuit of targeted therapies like blood purification, which may improve outcome for these patients in the future. PMID:26863125

  20. Sepsis due to clostridium septicum: case report

    Energy Technology Data Exchange (ETDEWEB)

    Foga, M.M.; McGinn, G.J.; Kroeker, M.A. [Univ. of Manitoba Teaching Hospitals, St. Boniface General Hospital, Dept. of Radiology, Winnipeg, Manitoba (Canada); Guzman, R. [Univ. of Manitoba Teaching Hospitals, St. Boniface General Hospital, Dept. of Surgery, Winnipeg, Manitoba (Canada)

    2000-04-15

    Clostridium septicum is an unusual anaerobic, gram-positive, gas-producing bacillus, which has been identified as a cause of fulminant rapidly fatal infection in humans. Infection with C. septicum usually occurs in patients with cancer, patients receiving immunosuppressive chemotherapy, or patients with a nonmalignant hematological disorder such as hemolytic uremic syndrome. C. septicum infection most commonly involves the abdomen, and a recent review article has identified 164 cases in the medical literature describing the abdominal findings in this disease. Intracranial manifestation of C. septicum infection are less common and include meningitis, cerebritis, abscess formation and pneumocephalus. There have been only 12 documented cases in the English literature describing central nervous system lesions associated with C. septicum. We present a case report of a 56-year-old man in whom septicemia due to C. septicum developed as a complication of Crohn's disease. To our knowledge, there has never been a previous report of C. septicum sepsis related to underlying Crohn's disease. Our case is also remarkable in that an intracerebral gas collection developed at the site of a mycotic infarct related to C. septicum bacteremia, Intracranial, intraparenchymal gas formation related to anaerobic infection is extremely rare; to our knowledge, this radiological finding related to C. septicum sepsis has been described in only 1 previous case report in the medical literature. We also describe the intra-abdominal manifestations of C. septicum sepsis that occurred in this patient as well as the associated radiographic and pathologic findings. (author)

  1. Fossil turbulence revisited

    CERN Document Server

    Gibson, C H

    1999-01-01

    A theory of fossil turbulence presented in the 11th Liege Colloquium on Marine turbulence is "revisited" in the 29th Liege Colloquium "Marine Turbulence Revisited". The Gibson (1980) theory applied universal similarity theories of turbulence and turbulent mixing to the vertical evolution of an isolated patch of turbulence in a stratified fluid as it is constrained and fossilized by buoyancy forces. Towed oceanic microstructure measurements of Schedvin (1979) confirmed the predicted universal constants. Universal constants, spectra, hydrodynamic phase diagrams (HPDs) and other predictions of the theory have been reconfirmed by a wide variety of field and laboratory observations. Fossil turbulence theory has many applications; for example, in marine biology, laboratory and field measurements suggest phytoplankton species with different swimming abilities adjust their growth strategies differently by pattern recognition of several days of turbulence-fossil-turbulence dissipation and persistence times above thres...

  2. The bar instability revisited

    OpenAIRE

    Chiodi, Filippo; Andreotti, Bruno; Claudin, Philippe

    2012-01-01

    The river bar instability is revisited, using a hydrodynamical model based on Reynolds averaged Navier-Stokes equations. The results are contrasted with the standard analysis based on shallow water Saint-Venant equations. We first show that the stability of both transverse modes (ripples) and of small wavelength inclined modes (bars) predicted by the Saint-Venant approach are artefacts of this hydrodynamical approximation. When using a more reliable hydrodynamical model, the dispersion relati...

  3. Reverse cholesterol transport revisited

    Institute of Scientific and Technical Information of China (English)

    Astrid; E; van; der; Velde

    2010-01-01

    Reverse cholesterol transport was originally described as the high-density lipoprotein-mediated cholesterol flux from the periphery via the hepatobiliary tract to the intestinal lumen, leading to fecal excretion. Since the introduction of reverse cholesterol transport in the 1970s, this pathway has been intensively investigated. In this topic highlight, the classical reverse cholesterol transport concepts are discussed and the subject reverse cholesterol transport is revisited.

  4. Drotrecogin alfa (aktiviert) bei der Behandlung der schweren Sepsis

    OpenAIRE

    Schumacher, HK; Müller-Nordhorn, J.; Roll, S.; Willich, SN; Greiner, W

    2007-01-01

    Introduction Sepsis is defined as an invasion of microorganisms and/or their toxins into the blood associated the reaction of the organism to this invasion. Severe sepsis is a major cost driver in intensive care medicine. In Germany, prevalence data was assessed in the context of the German Prevalence Study. Severe sepsis has a prevalence of 35% in German intensive care units. Research questions The following questions were analysed: is Drotrecogin alfa (activated) (DAA) eff...

  5. [Prevention and treatment strategy for burn wound sepsis in children].

    Science.gov (United States)

    Niu, Xihua; Li, Xiaoling

    2016-02-01

    Wound sepsis is one of the main causes of death in patients with severe burn and trauma. The high incidence of burn wound sepsis in children is attributed to their imperfect immune system function, poor resistance against infection, and the weakened skin barrier function after burn. The key to reduce the mortality of pediatric patients with burn wound sepsis is to enhance the understanding of its etiology, epidemiology, pathogenesis, and diagnostic criteria, in order to improve its early diagnosis and treatment. PMID:26902271

  6. Recommendations for sepsis management in resource-limited settings

    OpenAIRE

    Dünser, Martin W; Festic, Emir; Dondorp, Arjen; Kissoon, Niranjan; Ganbat, Tsenddorj; Kwizera, Arthur; Haniffa, Rashan; Baker, Tim; Schultz, Marcus J; ,

    2012-01-01

    Purpose To provide clinicians practicing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. Methods The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings. Results Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequ...

  7. Inhibition of Intestinal Thiamin Transport in Rat Model of Sepsis

    Science.gov (United States)

    Sassoon, Catherine S.; Zhu, Ercheng; Fang, Liwei; Subramanian, Veedamali S.; Said, Hamid M.

    2016-01-01

    Objective Thiamin deficiency is highly prevalent in patients with sepsis, but the mechanism by which sepsis induces thiamin deficiency is unknown. This study aimed to determine the influence of various severity of sepsis on carrier-mediated intestinal thiamin uptake, level of expressions of thiamin transporters (thiamin transporter-1 (THTR-1) and thiamin transporter-2 (THTR-2)), and mitochondrial thiamin pyrophosphate transporter (MTPPT). Design Randomized, controlled study Setting Research laboratory at a Veterans Affairs Medical Center Subjects Twenty-four Sprague-Dawley rats were randomized into controls, mild, moderate and severe sepsis with equal number of animals in each group. Measurements and Main Results Sepsis was induced by cecal ligation and puncture with the cecum ligated below the cecal valve at 25 %, 50 % and 75 % of cecal length, defined as severe, moderate and mild sepsis, respectively. Control animals underwent laparotomy only. After 2 days of induced sepsis, carrier-mediated intestinal thiamin uptake was measured using [3H]thiamin. Expressions of THTR-1, THTR-2, and MTPPT proteins and mRNA were measured. Proinflammatory cytokines (IL-1β and IL-6), and adenosine triphosphate (ATP) were also measured. Sepsis inhibited [3H]thiamin uptake and the inhibition was a function of sepsis severity. Both cell membranes thiamin transporters and MTPPT expression levels were suppressed; also levels of ATP in the intestine of animals with moderate and severe sepsis were significantly lower than that of sham operated controls. Conclusions For the first time we demonstrated that sepsis inhibited carrier-mediated intestinal thiamin uptake as a function of sepsis severity, suppressed thiamin transporters and MTPPT, leading to ATP depletion. PMID:27065466

  8. Prognosis of AKI in malignant diseases with and without sepsis

    OpenAIRE

    2013-01-01

    Background AKI significantly worsens prognosis of hospitalized patients. This is particularly the case in patients with sepsis. The risk for aquiring sepsis is significantly increased in malignant diseases. Aim of the present retrospective study was to analyze outcomes of tumor patients with sepsis and AKI. Methods One-thousand and seventeen patients, treated at the ICU of the Department of Nephrology and Rheumatology of the University Hospital Göttingen from 2009 to 2011 were retrospect...

  9. Procalcitonin as a marker for the diagnosis of sepsis

    OpenAIRE

    C. G. Chivate; G. J. Belwalkar; R. P. Limaye; Rahul V. Patil

    2016-01-01

    Background: Quick diagnosis of sepsis in intensive care unit patients is challenging for physicians. Methods: The prospective study was conducted at our hospital. We studied the efficacy of procalcitonin as a marker of sepsis in 87 adults admitted to our intensive care unit with symptoms of systemic infection. The study samples included all patients aged above 18 years with acute sepsis. Statistical analyses were done using SPSS. PCT and various other relevant factors were measured in all...

  10. Serum Procalcitonine Levels as an Early Diagnostic Indicator of Sepsis

    OpenAIRE

    Beqja-Lika, Anila; Bulo-Kasneci, Anyla; Refatllari, Etleva; Heta-Alliu, Nevila; Rucaj-Barbullushi, Alma; Mone, Iris; Mitre, Anila

    2013-01-01

    Introduction: Prompt and accurate diagnosis of sepsis is of high importance for clinicians. Procalcitonine (PCT) and C-reactive protein (CRP) have been proposed as markers for this purpose. Our aim was to evaluate the levels of PCT and CRP in early sepsis and its correlation with severity of sepsis. Methods: Levels of PCT and CRP were taken from 60 patients with sepsis criteria and 39 patients with SIRS symptoms from the University Hospital Center “Mother Teresa” in Tirana, Albania during 201...

  11. Characteristics of bacterial sepsis among patients with visceral leishmaniasis

    Institute of Scientific and Technical Information of China (English)

    Mengistu; Endris; Yegnasew; Takele; Desalegn; Woldeyohannes; Chandrashekhar; Unakal; Feleke; Moges; Moges; Tiruneh; Ermias; Diro

    2014-01-01

    Sepsis is one of the major causes and predictors of death in patients with visceral leishmaniasis(VL).Globally,incidence rate of sepsis ranged from 56-91 cases per 100000 people,with a mortality rate of 30%.Incidence of sepsis has been raised due to aging of the population and the higher incidence of immunosuppressive conditions such as HIV.VL and others.The prevalence of sepsis was reported from 4.2%to 32.3%and 14.1%in VL and VL-HIV coinfectcd patients,respectively.The mortality rate of VL patients with sepsis is greater than50%.Factors associated with sepsis in VL patients are immune suppression,pancytopenia.HIV co-infection,age 40 years old,indwelling of central venous lines and hospitalization.Although antimicrobial susceptibility patterns were not well reported,both Gram-positive and Gram-negative bacteria were isolated from patients with VL.So far.limited information is available on sepsis in VL.especially in VL-HIV coinfected patients.Therefore,further studies about sepsis prevalence,causative agents and their antibiotic patterns,and associated factors among VL and VL-HIV coinfectcd patients arc necessary.This review provides information about bacterial sepsis in patients with VL.

  12. Viewpoint on the current status of researches on sepsis

    Directory of Open Access Journals (Sweden)

    Zheng-guo WANG

    2012-11-01

    Full Text Available Sepsis is a common complication after severe trauma and burn, and also one of the main causes of death. Recently, although some new progresses were seen in antibiotic therapy, the mortality of sepsis is still on the rise, and the death rate as a result of sepsis is higher than a total of that of prostate cancer, breast cancer and AIDS. Therefore, sepsis has obviously become one of the serious ailments threatening human health. The present paper introduced the international definition of sepsis, severe sepsis and septic shock, the current researches on diagnosis and therapy, and proposed that we should not only pay attention to pathogenesis and treatment, but also to sepsis prevention in sepsis researches, and we should try to find out the breakthrough in the interaction and dynamic balance between human being and pathogenic factors. Researches on the strategies to revert strong toxicity of infectious agents to non-toxic or weak pathogenic factors, and to conduct further research concerning biological characteristics of microorganisms and mechanism of drug resistance in order to render them to lose the drug resistance ability, or to increase its sensitivity to the drugs. The above suggested approaches might form the future strategies for preventing and controlling sepsis.

  13. The hemodynamic management of elderly patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Sepsis is among the most common reason for admission to intensive care units throughout the world. In the US and most Western nations sepsis is largely a disease of the elderly. Management of elderly patients with severe sepsis is challenging. Early recognition of this syndrome, together with the early administration of appropriate antibiotics and cautious fluid resuscitation is the cornerstone of therapy. Echocardiography together with non-invasive or invasive hemodynamic monitoring is recommended in patients who have responded poorly to fluids or have significant underlying cardiac disease. This paper reviews the hemodynamic changes that characterize sepsis, particularly as they apply to elderly patients and provides recommendations for the management of these patients.

  14. Characteristics of bacterial sepsis among patients with visceral leishmaniasis

    Institute of Scientific and Technical Information of China (English)

    Mengistu Endris; Yegnasew Takele; Desalegn Woldeyohannes; Chandrashekhar Unakal; Feleke Moges; Moges Tiruneh; Ermias Diro

    2014-01-01

    Sepsis is one of the major causes and predictors of death in patients with visceral leishmaniasis (VL). Globally, incidence rate of sepsis ranged from 56-91 cases per 100000 people, with a mortality rate of 30%. Incidence of sepsis has been raised due to aging of the population and the higher incidence of immunosuppressive conditions such as HIV, VL and others. The prevalence of sepsis was reported from 4.2% to 32.3% and 14.1% in VL and VL-HIV coinfected patients, respectively. The mortality rate of VL patients with sepsis is greater than 50%. Factors associated with sepsis in VL patients are immune suppression, pancytopenia, HIV co-infection, age 40 years old, indwelling of central venous lines and hospitalization. Although antimicrobial susceptibility patterns were not well reported, both Gram-positive and Gram-negative bacteria were isolated from patients with VL. So far, limited information is available on sepsis in VL, especially in VL-HIV coinfected patients. Therefore, further studies about sepsis prevalence, causative agents and their antibiotic patterns, and associated factors among VL and VL-HIV coinfected patients are necessary. This review provides information about bacterial sepsis in patients with VL.

  15. Biology and Metabolism of Sepsis: Innate Immunity, Bioenergetics, and Autophagy.

    Science.gov (United States)

    Lewis, Anthony J; Billiar, Timothy R; Rosengart, Matthew R

    2016-06-01

    Sepsis is a complex, heterogeneous physiologic condition that represents a significant public health concern. While many insights into the pathophysiology of sepsis have been elucidated over the past decades of research, important questions remain. This article serves as a review of several important areas in sepsis research. Understanding the innate immune response has been at the forefront as of late, especially in the context of cytokine-directed therapeutic trials. Cellular bioenergetic changes provide insight into the development of organ dysfunction in sepsis. Autophagy and mitophagy perform crucial cell housekeeping and stress response functions. Finally, age-related changes and their potential impact on the septic response are reviewed. PMID:27093228

  16. Clinical significance of plasma level of AT-Ⅲ determination in sepsis patients

    Institute of Scientific and Technical Information of China (English)

    Wei Chen; Zhi-Hua Hu; Chen-Mian

    2015-01-01

    Objective:Through measure changes of anticoagulant enzyme (AT-Ⅲ) activity in plasma in sepsis patients, this paper discusses the clinical significance of AT-Ⅲ activity changes in predicting sepsis occurrence and prognosis.Methods: The non-sepsis 30 cases, with sepsis 76 cases, including 25 cases of severe sepsis, use method of thrombin gelatum lacuna for determining activity of AT-Ⅲ in plasma, platelet count and APACHEⅢ score simultaneously. Results:Sepsis group, severe sepsis groups contrast with the non-sepsis group respectively, activity of AT-Ⅲ reduced significantly (P<0.01), severe sepsis group lower than sepsis group (P=0.055).Conclusion:AT-Ⅲ activity reduced early in sepsis patients, with patient's condition aggravat, its value further reduced, hints measurement of AT-Ⅲ activity has certainly clinical significance in predicting sepsis occurrence and prognosis.

  17. Diagnosis of post-traumatic sepsis according to "Sepsis guidelines": a cross-sectional survey of sepsis in a trauma intensive care unit

    Directory of Open Access Journals (Sweden)

    Hao TANG

    2016-04-01

    Full Text Available Objective  To investigate the prevalence and risk factors of post-traumatic sepsis, and to evaluate the rationality of the 1992, 2001 and 2012 international sepsis definitions in diagnosing post-traumatic sepsis in a trauma intensive care unit (ICU in China. Methods  A one-day cross-sectional survey of trauma patients who met the inclusion criteria was conducted from 8:00 a.m., June 16, 2014 to 8:00 a.m., June 17, 2014 in the trauma ICU of Daping Hospital. The survey data included demographic information, clinical characteristics, pertinent scores (APACHE Ⅱ, SOFA, GCS, ISS and injury mechanism. According to the definition of sepsis as depicted in the 1992, 2001, and 2012 "International Guideline of Sepsis", the patients were divided into A, B and C groups. The infection site, infection pathogens, and key medical treatment were recorded, the infection identified, and the 28day mortality recorded. A positive pathogen culture of respiratory and urinary tracts, blood, cerebrospinal fluid, and wound secretion was adopted as the diagnostic "gold standard" for septic infection. The diagnostic sensitivity and specificity of the three versions of the guidelines were statistically analyzed and the diagnostic feasibility of each definition was assessed. Results  A total of 30 trauma patients were enrolled, twenty-three patients met the 1992 sepsis criteria, 22 met the 2001 criteria, and 20 met the 2012 criteria. The prevalence rates were 76.7%, 73.3%, and 66.7%, respectively, and there was no significant statistical difference. Four patients died within 28 days, which was in line with the diagnostic criteria of the three versions of the sepsis criteria. The 28-day mortality in the three sepsis guidelines groups was 17.4%, 18.2%, and 25.0%, respectively, indicating no statistical difference. By adopting culture-positive pathogens as the "gold standard" of septic infection, the diagnostic sensitivity and specificity of the group A was 77.8% and 25

  18. Immunomodulatory role of leptin treatment in experimental sepsis caused by gram negative bacteria

    OpenAIRE

    Koca, Cemile; KAVAKLI, Havva ŞAHİN; ALICI, Özlem

    2011-01-01

    To investigate the effect of leptin treatment on circulating inflammatory cytokines and on tissue damage in experimental rat model of gram-negative sepsis. Materials and methods: Adult male Wistar rats, 28 in total, were randomly divided into 4 groups (n = 7): sham, leptin, sepsis, and sepsis group treated with leptin (sepsis+leptin). Sepsis was induced by intraperitoneal (ip) injection of 2 × 1010 CFU of Escherichia coli ATCC 25922. Leptin and sepsis+leptin groups received a single dose ip ...

  19. Improving the care of sepsis: Between system redesign and professional responsibility: A roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia

    OpenAIRE

    Yaseen Arabi; Ahmed Alamry; Levy, Mitchell M; Saadi Taher; Abdellatif M Marini

    2014-01-01

    This paper summarizes the roundtable discussion in September 25, 2013, Riyadh, Saudi Arabia as part of the World Sepsis Day held in King Abdulaziz Medical City, Riyadh. The objectives of the roundtable discussion were to (1) review the chasm between the current management of sepsis and best practice, (2) discuss system redesign and role of the microsystem in sepsis management, (3) emphasize the multidisciplinary nature of the care of sepsis and that improvement of the care of sepsis is the re...

  20. Nutrient cycling, soil properties and physiological and yield responses in a Gliricidia Maize alley cropping system in the mid-country intermediate zone of Sri Lanka

    International Nuclear Information System (INIS)

    The objective of the research was to study the potential of alley-cropping agroforestry systems to improve degraded lands in the Mid-Country Intermediate Zone of Sri Lanka. A field experiment was carried out at the University of Peradeniya experimental station using Gliricidia as the hedgerow tree species. Gliricidia hedgerows having within row spacing of 0.75 m (8 m long rows) and between row spacing of 7 m were established. 15N-enriched ammonium sulphate (60 kg N ha1, 10 atom % 15N excess) was applied to a subplot (2.25 m wide x 3.5 m long) in the alley, which enclosed 3 Gliricidia trees. Labelled plant material was added to microplots as crop residue only (ML), Gliricidia loppings only (GL), crop residue and Gliricidia loppings (GLML), and no residues (NL) in the subsequent seasons. Soil properties, crop yields and nutrient dynamics were recorded regularly for every growing season.Addition of Gliricidia loppings and crop residues over 5 a improved soil chemical properties including soil organic matter, major (especially N) and minor nutrients and physical properties. There was no significant impact of hedgerows on soil fertility compared with the sole crop or at different distances from the hedgerow. Physiological parameters measured in this study illustrated that hedgerows may influence one or two adjacent crop rows negatively, possibly due to competition for light or water resources. Photosynthesis rates of both maize and cowpea crops were reduced near the hedgerow compared to the sole crops, due to partial shading by the hedgerow. However, leaf photosynthesis and yields were significantly greater in rows in the middle of the alleys compared with the sole-crop (control). This would suggest the existence of complementary interactions from Gliricidia hedgerows through increasing the resource availability and/or making the microenvironment more favorable for the crop species. Addition of Gliricidia and crop residues (MLGL) enhanced growth and yield of crops more

  1. Diagnosis of post-traumatic sepsis according to "Sepsis guidelines": a cross-sectional survey of sepsis in a trauma intensive care unit

    OpenAIRE

    Tang, Hao; Liu, Dong; Zhang, Hua-Yu; Li, Yang; Ming-tao CHANG; ZHANG Xiu-zhu; Jiang, Dong-Po; ZHANG Lian-yang

    2016-01-01

    Objective  To investigate the prevalence and risk factors of post-traumatic sepsis, and to evaluate the rationality of the 1992, 2001 and 2012 international sepsis definitions in diagnosing post-traumatic sepsis in a trauma intensive care unit (ICU) in China. Methods  A one-day cross-sectional survey of trauma patients who met the inclusion criteria was conducted from 8:00 a.m., June 16, 2014 to 8:00 a.m., June 17, 2014 in the trauma ICU of Daping Hospital. The survey data included demographi...

  2. MR imaging of spinal epidural sepsis

    International Nuclear Information System (INIS)

    Spinal epidural abscess is uncommonly found in adults and children. Early diagnosis and treatment improves prognosis and prevents serious neurologic sequelae. Four patients with spinal epidural infections were recently evaluated with MR and CT of the spine. In all cases, MR and CT localized the site of infection accurately and showed adjacent bony osteomyelitis. MR proved superior in characterizing infection (abscess vs. inflammatory edema) and demonstrating epidural involvement and spinal cord compression. In all cases, MR obviated the need for myelography. Early recognition by MR of spinal epidural sepsis led to expeditious treatment and better clinical outcome

  3. Administration of bone marrow stromal cells in sepsis attenuates sepsis-related coagulopathy.

    Science.gov (United States)

    Tan, Lifei; Huang, Yueyue; Pan, Xiaojun; Quan, Shichao; Xu, Shunyao; Li, Dequan; Song, Lijun; Zhang, Xiaomin; Chen, Wanzhou; Pan, Jingye

    2016-06-01

    Introduction Coagulopathy plays an important role in sepsis. The aim of this study was to determine whether bone marrow stromal cell (BMSC) administration could attenuate coagulopathy in sepsis. Materials and methods In vitro: endothelial cells were cultured with/without BMSCs for 6 h following LPS stimulation and were collected for thrombomodulin (TM) and endothelial protein C receptor (EPCR) measurements. In vivo: Thirty-six mice were randomized into sham, sepsis, and sepsis + BMSC groups (n = 12 each group). Sepsis was induced through cecal ligation and puncture (CLP). BMSC infusion was started at 6 h after CLP. Lung tissues and plasma samples were collected at 24 h after CLP for enzyme-linked immunosorbent assay (ELISA), quantitative real-time RT-PCR, western blot, and immunohistochemistry analysis. Results In vitro: BMSCs attenuated the decrease in TM and EPCR mRNA and protein expression levels in LPS-stimulated endothelial cells. In vivo: BMSC treatment decreased lung injury and mesenteric perfusion impairment, and ameliorated coagulopathy, as suggested by the reduction in elevated TF, vWF, and TAT circulation levels. BMSC infusion decreased TF mRNA transcription and protein expression levels in lung tissues, and increased TM and EPCR mRNA transcription and expression levels. Discussion BMSC administration attenuated coagulopathy, and decreased lung injury and mesenteric perfusion impairment in sepsis. Key messages BMSCs increased the expression of TM and EPCR from endothelium cells exposed to LPS in vitro. BMSC treatment attenuated lung injury and coagulopathy in the mice cecal ligation and puncture (CLP) model. BMSC administration-attenuated coagulopathy is related to the reduced expression of TF and increased expression of TM and EPCR. PMID:26969493

  4. Puerperal sepsis: predominant organisms and their antibiotic sensitivity pattern

    Directory of Open Access Journals (Sweden)

    Sabiha S. Tamboli

    2016-03-01

    Conclusions: Puerperal sepsis is the common life threatening condition in the postnatal period, particularly following vaginal delivery. Early diagnosis and appropriate treatment of puerperal sepsis can make the difference between life and death. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 762-765

  5. Treatment of neonatal sepsis with intravenous immune globulin

    DEFF Research Database (Denmark)

    Brocklehurst, Peter; Farrell, Barbara; King, Andrew;

    2011-01-01

    Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis...

  6. Biomarkers of Endothelial Cell Activation in Early Sepsis

    DEFF Research Database (Denmark)

    2013-01-01

    and mortality in sepsis and that (ii) soluble fms-like tyrosine kinase 1 (sFlt-1) holds promise as a novel prognostic marker in sepsis. METHODS: This was a prospective, multicenter, observational study of a convenience sample of emergency department (ED) patients with a suspected infection presenting...

  7. Procalcitonin as a marker for the diagnosis of sepsis

    Directory of Open Access Journals (Sweden)

    C. G. Chivate

    2016-04-01

    Results: PCT proved to be an excellent indicator of sepsis. Serum PCT levels predicts mortality in the present study. Conclusions: PCT is among the most promising sepsis markers capable of completing clinical signs and routine lab parameters suggestive of severe infection. [Int J Res Med Sci 2016; 4(4.000: 1216-1218

  8. Analogue Magnetism Revisited

    CERN Document Server

    Osano, Bob

    2016-01-01

    In this article we revisit the significance of the often debated structural similarity between the equations of electromagnetism and fluid dynamics. Although the matching of the two sets of equations has successfully been done for non-dissipative forms of the equations, little has been done for cases where the dissipative terms are non-negligible. We consider the consequence of non-negligible viscosity and diffusivity, and how the fine-tuning of these parameters could allow fluid dynamics to be used to indirectly study certain properties of magnetic fields.

  9. Bottomonium spectrum revisited

    Science.gov (United States)

    Segovia, Jorge; Ortega, Pablo G.; Entem, David R.; Fernández, Francisco

    2016-04-01

    We revisit the bottomonium spectrum motivated by the recently exciting experimental progress in the observation of new bottomonium states, both conventional and unconventional. Our framework is a nonrelativistic constituent quark model which has been applied to a wide range of hadronic observables from the light to the heavy quark sector, and thus the model parameters are completely constrained. Beyond the spectrum, we provide a large number of electromagnetic, strong and hadronic decays in order to discuss the quark content of the bottomonium states and give more insights about a better way to determine their properties experimentally.

  10. T-duality revisited

    OpenAIRE

    Erik Plauschinn

    2014-01-01

    We revisit the transformation rules of the metric and Kalb-Ramond field under T-duality, and express the corresponding relations in terms of the metric G and the field strength H = dB . In the course of the derivation, we find an explanation for potential reductions of the isometry group in the dual background. The formalism employed in this paper is illustrated with examples based on tori and spheres, where for the latter we construct a new non-geometric background.

  11. Deterministic Graphical Games Revisited

    DEFF Research Database (Denmark)

    Andersson, Klas Olof Daniel; Hansen, Kristoffer Arnsfelt; Miltersen, Peter Bro;

    2012-01-01

    as retrograde analysis, have been rediscovered independently. We then revisit Washburn’s deterministic graphical games (DGGs), a natural generalization of chess-like games to arbitrary zero-sum payoffs. We study the complexity of solving DGGs and obtain an almost-linear time comparison......Starting from Zermelo’s classical formal treatment of chess, we trace through history the analysis of two-player win/lose/draw games with perfect information and potentially infinite play. Such chess-like games have appeared in many different research communities, and methods for solving them, such...

  12. Reframing in dentistry: revisited.

    Science.gov (United States)

    Nuvvula, Sivakumar; Kamatham, Rekalakshmi; Challa, Ramasubbareddy; Asokan, Sharath

    2013-01-01

    The successful practice of dentistry involves a good combination of technical skills and soft skills. Soft skills or communication skills are not taught extensively in dental schools and it can be challenging to learn and at times in treating dental patients. Guiding the child's behavior in the dental operatory is one of the preliminary steps to be taken by the pediatric dentist and one who can successfully modify the behavior can definitely pave the way for a life time comprehensive oral care. This article is an attempt to revisit a simple behavior guidance technique, reframing and explain the possible psychological perspectives behind it for better use in the clinical practice. PMID:24021326

  13. Early diagnostics and treatment with acute burn sepsis

    Institute of Scientific and Technical Information of China (English)

    Ahmedov A.A.; Shakirov B.M.; Karabaev H.K

    2015-01-01

    Objective: To determine the value of the procalcitonin test used for early diagnosis of sepsis and to study the course and treatment of burn sepsis in patients with severe burns. Methods: Eighty patients in the Burn Department of Republican Scientific Centre of Emergency Medical Care, aged 17-75 years with burn injuries covering 30%-85% of the body surface, were enrolled in the study. Procalcitonin is marker of sepsis, procalcitonin > 2 ng/mL, sensitivity -89%, specific feature -94%. Results: The result showed that among septic patients with severe burns, rational use of intensive therapy for burn sepsis and septic shock in combination with parentrial ozonotherapy resulted in decreases of syndrome of poly organ insufficiency and lethal outcomes from 70%accordingly. The result allows the conclusion that the treatment examined leads to a significant increase in survival coefficient. Conclusions: This in turn confirms the efficacy of early necrectomy and auto dermoplasty of deep burn wounds in victims with sepsis.

  14. Mesenchymal stem cells as a therapeutic tool to treat sepsis

    Institute of Scientific and Technical Information of China (English)

    Eleuterio Lombardo; Tom van der Poll; Olga DelaRosa; Wilfried Dalemans

    2015-01-01

    Sepsis is a clinical syndrome caused by a deregulatedhost response to an infection. Sepsis is the mostfrequent cause of death in hospitalized patients.Although knowledge of the pathogenesis of sepsishas increased substantially during the last decades,attempts to design effective and specific therapiestargeting components of the derailed host responsehave failed. Therefore, there is a dramatic need fornew and mechanistically alternative therapies to treatthis syndrome. Based on their immunomodulatoryproperties, adult mesenchymal stem or stromal cells(MSCs) can be a novel therapeutic tool to treat sepsis.Indeed, MSCs reduce mortality in experimental modelsof sepsis by modulating the deregulated inflammatoryresponse against bacteria through the regulation ofmultiple inflammatory networks, the reprogrammingof macrophages and neutrophils towards a more antiinflammatoryphenotype and the release of antimicrobialpeptides. This report will review the currentknowledge on the effects of MSC treatment in preclinicalexperimental small animal models of sepsis.

  15. Alley cropping of legumes with grasses as forages : Effect of different grass species and row spacing of gliricidia on the growth and biomass production of forages

    Directory of Open Access Journals (Sweden)

    Siti Yuhaeni

    1998-12-01

    Full Text Available A study to evaluate the effect of different grass species and row spacing of gliricidia (Gliricidia sepium on the growth and biomass production of forages in an alley cropping system was conducted in two different agroclimatical zones i.e. Bogor, located at 500 m a .s .l . with an average annual rainfall of 3,112 nun/year and Sukabumi located at 900 m a .s .l . with an average annual rainfall of 1,402 mm/year . Both locations have low N, P, and K content and the soil is classified as acidic. The experimental design used was a split plot design with 3 replicates . The main plots were different grass species i.e. king grass (Pennisetum purpureum x P. typhoides and elephant grass (P. purpureum. The sub plots were the row spacing of gliricidia at 2, 3, 4, 6 m (1 hedgerows and 4 m (2 hedgerows. The results indicated that the growth and biomass production of grasses were significantly affected (P<0 .05 by the treatments in Bogor. The highest biomass productions was obtained from the 2 m row spacing which gave the highest dry matter production of grasses (1 .65 kg/hill and gliricidia (0 .086 kg/tree . In Sukabumi the growth and biomass production of grasses and gliricidia were also significantly affected by the treatments . The highest dry matter production was obtained with 2 m row spacing (dry matter of grasses and gliricidia were 1 .12 kg/hill and 0 .026 kg/tree, respectively . The result further indicated that biomass production of forages increased with the increase in gliricidia population. The alley cropping system wich is suitable for Bogor was the 2 m row spacing of gliricidia intercropped with either king or elephant grass and for Sukabumi 2 and 4 m (2 rows of gliricidia row spacing intercropped with king or elephant grass .

  16. Sepsis 的新概念

    Institute of Scientific and Technical Information of China (English)

    万献尧

    2000-01-01

    @@ Sepsis概念始于50年代,指各种致病微生物或其毒素存在于血液或组织中[1],是临床上常用的名词术语,但长期以来 infection(感染)、bacteremia(菌血症)、sepsis、sepsis syndromer、sepsis shock等名词术语定义不清,且易混淆,不能确切反映疾病的本质、临床病理过程及预后,给感染和sepsis的基础和临床研究造成一定困难[2].因此,继续沿用传统的概念和定义显然已不相适应.1991年8月美国胸科医师学会和危重病医学会(ACCP/SCCM)联席会议委员会在芝加哥经共同商讨后对sepsis及其相关名词术语做出明确定义,并推荐在今后临床和基础研究中应用新的概念及标准[3].

  17. Intestinal radiation syndrome: sepsis and endotoxin

    International Nuclear Information System (INIS)

    Rats were whole-body irradiated with 8-MeV cyclotron-produced neutrons and 137Cs γ rays to study the role of enteric bacteria and endotoxin in the intestinal radiation syndrome. Decrease in intestinal weight was used as an index of radiation-induced breakdown of the mucosa. Neutron and γ-ray doses that were sublethal for intestinal death resulted in a dose-dependent decrease in intestinal weight, reaching minimal values 2 to 3 days after exposure, followed by recovery within 5 days after irradiation. Neutron and photon doses that caused intestinal death resulted in greater mucosal breakdown with little or no evidence of mucosal recovery. The presence of fluid in the intestine and diarrhea, but not bacteremia or endotoxemia, were related to mucosal breakdown and recovery. Neither sepsis nor endotoxin could be detected in liver samples taken at autopsy from animals which died a short time earlier from intestinal injury. These results suggest that overt sepsis and endotoxemia do not play a significant role in the intestinal radiation syndrome

  18. Sepsis-associated AKI: epithelial cell dysfunction.

    Science.gov (United States)

    Emlet, David R; Shaw, Andrew D; Kellum, John A

    2015-01-01

    Acute kidney injury (AKI) occurs frequently in critically ill patients with sepsis, in whom it doubles the mortality rate and half of the survivors suffer permanent kidney damage or chronic kidney disease. Failure in the development of viable therapies has prompted studies to better elucidate the cellular and molecular etiologies of AKI, which have generated novel theories and paradigms for the mechanisms of this disease. These studies have shown multifaceted origins and elements of AKI that, in addition to/in lieu of ischemia, include the generation of damage-associated molecular patterns and pathogen-associated molecular patterns, the inflammatory response, humoral and cellular immune activation, perturbation of microvascular flow and oxidative stress, bioenergetic alterations, cell-cycle alterations, and cellular de-differentiation/re-differentiation. It is becoming clear that a major etiologic effector of all these inputs is the renal tubule epithelial cell (RTEC). This review discusses these elements and their effects on RTECs, and reviews the current hypotheses of how these effects may determine the fate of RTECs during sepsis-induced AKI. PMID:25795502

  19. Trends in Sepsis and Infection Sources in the United States. A Population-Based Study

    OpenAIRE

    Walkey, Allan J.; Lagu, Tara; Lindenauer, Peter K.

    2015-01-01

    Rationale: Stakeholders seek to monitor processes and outcomes of care among patients with sepsis, but use of administrative data for sepsis surveillance is controversial. Prior studies using only principal diagnoses from claims data have shown a trend of rising sepsis incidence with falling infection incidence, implying that administrative data are inaccurate for sepsis surveillance.

  20. Early onset neonatal sepsis in preterm premature rupture of membranes

    International Nuclear Information System (INIS)

    To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes (PPROM). Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Material and Methods: Neonates of singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Results: Out of 164 babies, 84 (51.2%) were female and 80 (48.8%) were male. Mean maternal age was 23 years (range: 18-36 years). Mean gestational age was 33 weeks (range: 30-36 weeks). Sepsis was suspected in 41(25%) babies on clinical grounds. C-reactive protein was raised in 36 (22%) neonates. There was statistically insignificant difference between clinical versus serological diagnosis (p=0.515). Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane (p < 0.001). Conclusion: Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis. (author)

  1. Experimental models of sepsis and septic shock: an overview

    Directory of Open Access Journals (Sweden)

    Garrido Alejandra G.

    2004-01-01

    Full Text Available Sepsis remains a major cause of morbidity and mortality in surgical patients and trauma victims, mainly due to sepsis-induced multiple organ dysfunction. In contrast to preclinical studies, most clinical trials of promising new treatment strategies for sepsis have fails to demonstrate efficacy. Although many reasons could account for this discrepancy, the misinterpretation of preclinical data obtained from experimental studies, and especially the use of animal models that do not adequately mimic human sepsis may have been contributing factors. In this review, the benefits and limitations of various animal models of sepsis are discussed to clarify the extend to which findings are relevant to human sepsis, particularly with respect to the subsequent design and execution of clinical trials. Such models include intravascular infusion of endotoxin or live bacteria, bacterial peritonitis, cecal ligation and perforation, soft tissue infection, pneumonia or meningitis models, using different animal species including rats, mice, rabbits, dogs, pigs, sheep and nonhuman primates. Despite several limitations, animal models remain essential in the development of all new therapies for sepsis and septic shock, because they provide fundamental information about the pharmacokinetics, toxicity, and mechanism of drug action that cannot be duplicated by other methods. New therapeutic agents should be studies in infection models, even after the initiation of the septic process. Furthermore, debility conditions need to be reproduced to avoid the exclusive use of healthy animals, which often do not represent the human septic patient.

  2. Serum Calprotectin: A Potential Biomarker for Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    Lidia Decembrino

    2015-01-01

    Full Text Available Introduction. The correct diagnosis of neonatal sepsis is a relevant problem because sepsis is one of the most important causes of neonatal morbidity, mortality, and prolonged hospital stay. Calprotectin is an antimicrobial, calcium and zinc binding heterocomplex protein that could be used as a nonspecific marker for activation of granulocytes and mononuclear phagocytes. Calprotectin has been proposed for the diagnosis of inflammatory conditions. Our aim is to study serum calprotectin as a biomarker for neonatal sepsis diagnosis. Methods. 41 (20 females, 21 males infants who underwent blood culture due to suspected sepsis were enrolled in the study. Serum calprotectin was measured by a commercial ELISA assay (Calprest, Eurospital, Trieste, Italy. Statistical analysis was performed using the statistical software package Stata 13.1 (Stata Corporation, College Station, Texas, USA. Results. 8 neonates (19.51% showed sepsis with positive culture and 33 (80.49% showed suspected sepsis. The optimal cut-off for calprotectin is 2.2 μg/mL with a sensitivity of 62.5% and a specificity of 69.7%. Conclusions. Calprotectin may be considered a promising early, sensitive, specific marker of sepsis thanks to the importance of calprotectin in defense mechanisms and physiological functions of the immune system.

  3. PROTEOMIC AND EPIGENOMIC MARKERS OF SEPSIS-INDUCED DELIRIUM (SID

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-10-01

    Full Text Available In elderly population sepsis is one of the leading causes of intensive care unit (ICU admissions in the United States. Sepsis-induced delirium (SID is the most frequent cause of delirium in ICU (1. Together delirium and SID represent under recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143 to 152 billion dollars per year (2. The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (3-4. Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium.This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?

  4. Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis.

    OpenAIRE

    Thomas, Benjamin S.; Jafarzadeh, S. Reza; Warren, David K.; McCormick, Sandra; Fraser, Victoria J.; Marschall, Jonas

    2015-01-01

    BACKGROUND Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. METHODS We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Lou...

  5. Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis

    OpenAIRE

    Thomas, Benjamin S.; Jafarzadeh, S. Reza; Warren, David K.; McCormick, Sandra; Fraser, Victoria J.; Marschall, Jonas

    2015-01-01

    Background Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. Methods We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri...

  6. Knowledge and challenge: inspiration gained from the epidemiological trend of sepsis

    Directory of Open Access Journals (Sweden)

    Peng-lin MA

    2012-11-01

    Full Text Available Associated with high morbility and mortality, sepsis has been seriously threatening human's health. Epidemiological trend of sepsis indicated that the increase of prevalence rate of sepsis was partially related with the current innovations in medical care, especially the rapid increase in invasive techniques for caring patients suffering from critical illness. Because the pathogenesis of sepsis remains unclear, with a low specificity of the ESICM/SCCM consensus diagnostic criteria for sepsis, the diagnosis of 'severe sepsis' has attracted a great deal of attention of medical scientists due to its higher accordance with the septic pathophysiological process of this clinical syndrome. In addition, the lack of knowledge on diagnostic criteria and management guideline seriously impede clinical application of some valid interventions for severe sepsis, thus resulting in consistent high incidence and mortality of sepsis. Moreover, lack of knowledge for sepsis in the society and even among the healthcare providers is the serious barrier to sepsis prevention and management.

  7. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock.

    Science.gov (United States)

    Chang, Ronald; Holcomb, John B

    2016-07-01

    Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis. PMID:26844975

  8. Systematic review of use of β-blockers in sepsis

    Directory of Open Access Journals (Sweden)

    Cyril Jacob Chacko

    2015-01-01

    Conclusion: There is insufficient evidence to justify the routine use of β-blockers in sepsis. A large adequately powered multi-centered randomized controlled clinical trial is required to address the question on the efficacy of β-blocker usage in sepsis. This trial should also consider a number of important questions including the choice of β-blocker used, optimal dosing, timing of intervention, duration of intervention and discontinuation of the drug. Until such time based on the available evidence, there is no place for the use of β-blockers in sepsis in current clinical practice.

  9. Challenges with Diagnosing and Managing Sepsis in Older Adults.

    Science.gov (United States)

    Clifford, Kalin M; Dy-Boarman, Eliza A; Haase, Krystal K; Maxvill, Kristen; Pass, Steven E; Alvarez, Carlos A

    2016-02-01

    Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis and offers recommendations for monitoring and treating sepsis in the older adult population. PMID:26687340

  10. Procalcitonin in sepsis and bacterial infections

    Directory of Open Access Journals (Sweden)

    Abhijit Chaudhury

    2013-10-01

    Full Text Available The differentiation of sepsis and systemic bacterial infections from other causes of systemic inflammatory response is crucial from the therapeutic point of view. The clinical signs and symptoms are non-specific and traditional biomarkers like white cell count, erythrocyte sedimentation rate and C-reactive protein are not sufficiently sensitive or specific to guide therapeutic decisions. Procalcitonin (PCT is considered a reliable marker for the diagnosis and prognosis of moderate to severe bacterial infections, and it has also been evaluated to guide the clinicians in the rational usage of antibiotics. This review describes the diagnostic and prognostic role of PCT as a biomarker in various clinical settings along with the laboratory aspects and its usefulness in risk stratification and antibiotic stewardship.

  11. Interprofessional sepsis education module: a pilot study.

    Science.gov (United States)

    Chung, Han-Oh; Medina, Damien; Fox-Robichaud, Alison

    2016-03-01

    Although there is an increasing emphasis on interprofessional collaboration for safer health care systems, there remains a paucity of opportunities for postgraduate trainees to engage in formal interprofessional education (IPE). Current opportunities for interprofessional learning, such as simulation sessions, typically do not provide true IPE because they often utilize actors or confederates as support staff, making residents the only stakeholders in the education experience. Here, we describe a flexible educational module designed to provide genuine IPE for physicians, nurses, and respiratory therapists. We outline how simulation, feedback, and group discussions can be used to teach interprofessional team communication, collaboration, and crew resource management skills-while, at the same time, also teaching a highly relevant medical topic (sepsis management) and thus resulting in learner engagement and motivation. PMID:26063312

  12. Sepsis from dropped clips at laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis

  13. Rahnella aquatilis Sepsis in a Premature Newborn

    Directory of Open Access Journals (Sweden)

    Canan Kuzdan

    2015-01-01

    Full Text Available Rahnella aquatilis is an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organism’s natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused by Rahnella aquatilis during the treatment for ventilator associated pneumonia due to Stenotrophomonas maltophilia with ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. Although R. aquatilis is one of the saprophyticus organisms, it may cause life-threatening infection in newborn.

  14. Rahnella aquatilis Sepsis in a Premature Newborn.

    Science.gov (United States)

    Kuzdan, Canan; Soysal, Ahmet; Özdemir, Hülya; Coşkun, Şenay; Akman, İpek; Bilgen, Hülya; Özek, Eren; Bakır, Mustafa

    2015-01-01

    Rahnella aquatilis is an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organism's natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused by Rahnella aquatilis during the treatment for ventilator associated pneumonia due to Stenotrophomonas maltophilia with ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. Although R. aquatilis is one of the saprophyticus organisms, it may cause life-threatening infection in newborn. PMID:26090257

  15. Rahnella aquatilis Sepsis in a Premature Newborn

    Science.gov (United States)

    Kuzdan, Canan; Soysal, Ahmet; Özdemir, Hülya; Coşkun, Şenay; Akman, İpek; Bilgen, Hülya; Özek, Eren; Bakır, Mustafa

    2015-01-01

    Rahnella aquatilis is an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organism's natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused by Rahnella aquatilis during the treatment for ventilator associated pneumonia due to Stenotrophomonas maltophilia with ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. Although R. aquatilis is one of the saprophyticus organisms, it may cause life-threatening infection in newborn. PMID:26090257

  16. An Immunological Perspective on Neonatal Sepsis.

    Science.gov (United States)

    Kan, Bernard; Razzaghian, Hamid Reza; Lavoie, Pascal M

    2016-04-01

    Despite concerted international efforts, mortality from neonatal infections remains unacceptably high in some areas of the world, particularly for premature infants. Recent developments in flow cytometry and next-generation sequencing technologies have led to major discoveries over the past few years, providing a more integrated understanding of the developing human immune system in the context of its microbial environment. We review these recent findings, focusing on how in human newborns incomplete maturation of the immune system before a full term of gestation impacts on their vulnerability to infection. We also discuss some of the clinical implications of this research in guiding the design of more-accurate age-adapted diagnostic and preventive strategies for neonatal sepsis. PMID:26993220

  17. Endothelial ROS and Impaired Myocardial Oxygen Consumption in Sepsis-induced Cardiac Dysfunction

    OpenAIRE

    Potz, Brittany A; Sellke, Frank W.; Abid, M. Ruhul

    2016-01-01

    Sepsis is known as the presence of a Systemic Inflammatory Response Syndrome (SIRS) in response to an infection. In the USA alone, 750,000 cases of severe sepsis are diagnosed annually. More than 70% of sepsis-related deaths occur due to organ failure and more than 50% of septic patients demonstrate cardiac dysfunction. Patients with sepsis who develop cardiac dysfunction have significantly higher mortality, and thus cardiac dysfunction serves as a predictor of survival in sepsis.

  18. Knowledge and challenge: inspiration gained from the epidemiological trend of sepsis

    OpenAIRE

    Peng-lin MA

    2012-01-01

    Associated with high morbility and mortality, sepsis has been seriously threatening human's health. Epidemiological trend of sepsis indicated that the increase of prevalence rate of sepsis was partially related with the current innovations in medical care, especially the rapid increase in invasive techniques for caring patients suffering from critical illness. Because the pathogenesis of sepsis remains unclear, with a low specificity of the ESICM/SCCM consensus diagnostic criteria for sepsis,...

  19. Hubungan Antara Neutrophil – Lymphocyte Count Ratio Dengan Kadar Procalcitonin Pada Pasien Sepsis

    OpenAIRE

    Silalahi, Bratasena

    2016-01-01

    Background: Sepsis is a major worldwide problem which is associated with the high incidence of death annually. It takes rapid, and accurate diagnose to prevent death and worst outcomes of sepsis. The neutrophil-lymphocyte count ratio (NLCR) has been shown a simple promising method to predict sepsis. Purpose: To investigate the difference of NLCR value between sepsis patients and in infection non-sepsis patients and its relationship to procalcitonin Method : A cross sectional...

  20. Peritoneal sepsis: re laparotomy characteristic patient

    International Nuclear Information System (INIS)

    Patients suffering from severe sepsis originating in the abdominal peritoneal region frequently require re-interventions, as this condition persist with high morbidity.Management of therapy is difficult and tends to be controversial; existing studies consider a universe which that is far from homogenic.The analysis covers a five year period.Case material involved 55 patients with severe abdominal sepsis requiring at least one re laparotomy.It takes into considerations the incidence, clinical manifestations leading to a positive re laparotomy, death rate and factors involved in prognosis.The absence of multi organic dysfunction (MOD) was considered a valid criteria for exclusion. A total of 121 relapses with corresponding laparotomy were performed, of which 17(14%) showed no relapse.The latter was less frequently associated with the presence of prolonged symptomatology, gastrointestinal anastomosis and /or MOD at the time of re-laparotomizing the patient (p<0,05).Local signs proved to be poor indicators of the advisability to re laparotomize. When comparing programmed re-laparotomy with this procedure undertaken whenever it be required, no differences were established as to the number of interventions performed, mean hospital days of patients and mortality. Crude mortality was 76% and related death-rate was 55%.The oldest patient was 70 years of age, the A:P:A:C:H:E: II points exceeded 17 and the presence of 3 or more sys functions were significantly associated with death rate in the range of 90%.The conclusion of this stud was that, given the high mortality of patients with 3 or more dysfunctions, the strategy for improving death rate is to re operate at an early stage those patients with 1 or 2 dysfunctions,particularity those presenting prolonged symptoms and/or gastrointestinal anastomosis

  1. In-111 WBC imaging in musculoskeletal sepsis

    International Nuclear Information System (INIS)

    This study evaluated the accuracy and utility of the In-111 labeled WBC imaging in a series of patients who were suspected of having musculoskeletal sepsis. The labeling of the WBCs was patterned after a method previously described, in which the WBCs are labeled with In-111 oxine in plasma. The WBCs from 100 ml of blood are separated and incubated with In-111 oxine complex, and then 500 μCi. of the labeled cells were reinjected into the patient. Images of the areas in question were obtained at 24 hrs. In some instances, 48 hour images were also obtained. Images were interpreted using consistent criteria. Forty imaging procedures were done on 39 patients. These included 39 total joint protheses, and 17 other images to evaluate possible osteomyelitis, septic arthritis or deep abscesses. Of these studies, 15 were positive, and 42 negative. The findings were then correlated with operative culture and pathology in 21, aspiration cultures and gram stains in 14, and with clinical findings in the remaining 21. This correlation showed 41 true negatives, 12 true positives, 1 false negative, and 2 false positives. The sensitivity was 92.9% and the specificity was 95.2%l. The false negative occurred in a patient on chronic suppressive antibiotic therapy for an infected total hip replacement. The false positive images occurred in a patient with active rheumatoid arthritis and in a patient imaged one month post operative placement of the prosthesis. These images were very useful in several septic patients who had many possible sites of infection. The authors conclude that In-III imaging is an accurate and useful non-invasive method of evaluating musculoskeletal sepsis

  2. The bar instability revisited

    CERN Document Server

    Chiodi, Filippo; Claudin, Philippe

    2012-01-01

    The river bar instability is revisited, using a hydrodynamical model based on Reynolds averaged Navier-Stokes equations. The results are contrasted with the standard analysis based on shallow water Saint-Venant equations. We first show that the stability of both transverse modes (ripples) and of small wavelength inclined modes (bars) predicted by the Saint-Venant approach are artefacts of this hydrodynamical approximation. When using a more reliable hydrodynamical model, the dispersion relation does not present any maximum of the growth rate when the sediment transport is assumed to be locally saturated. The analysis therefore reveals the fundamental importance of the relaxation of sediment transport towards equilibrium as it it is responsible for the stabilisation of small wavelength modes. This dynamical mechanism is characterised by the saturation number, defined as the ratio of the saturation length to the water depth Lsat/H. This dimensionless number controls the transition from ripples (transverse patte...

  3. Quantum duel revisited

    International Nuclear Information System (INIS)

    We revisit the quantum two-person duel. In this problem, both Alice and Bob each possess a spin-1/2 particle which models dead and alive states for each player. We review the Abbott and Flitney result—now considering non-zero α1 and α2 in order to decide if it is better for Alice to shoot or not the second time—and we also consider a duel where players do not necessarily start alive. This simple assumption allows us to explore several interesting special cases, namely how a dead player can win the duel shooting just once, or how can Bob revive Alice after one shot, and the better strategy for Alice—being either alive or in a superposition of alive and dead states—fighting a dead opponent. (paper)

  4. Firewall Configuration Errors Revisited

    CERN Document Server

    Wool, Avishai

    2009-01-01

    The first quantitative evaluation of the quality of corporate firewall configurations appeared in 2004, based on Check Point FireWall-1 rule-sets. In general that survey indicated that corporate firewalls were often enforcing poorly written rule-sets, containing many mistakes. The goal of this work is to revisit the first survey. The current study is much larger. Moreover, for the first time, the study includes configurations from two major vendors. The study also introduce a novel "Firewall Complexity" (FC) measure, that applies to both types of firewalls. The findings of the current study indeed validate the 2004 study's main observations: firewalls are (still) poorly configured, and a rule-set's complexity is (still) positively correlated with the number of detected risk items. Thus we can conclude that, for well-configured firewalls, ``small is (still) beautiful''. However, unlike the 2004 study, we see no significant indication that later software versions have fewer errors (for both vendors).

  5. Logistics Innovation Process Revisited

    DEFF Research Database (Denmark)

    Gammelgaard, Britta; Su, Shong-Iee Ivan; Yang, Su-Lan

    2011-01-01

    Purpose – The purpose of this paper is to learn more about logistics innovation processes and their implications for the focal organization as well as the supply chain, especially suppliers. Design/methodology/approach – The empirical basis of the study is a longitudinal action research project...... that was triggered by the practical needs of new ways of handling material flows of a hospital. This approach made it possible to revisit theory on logistics innovation process. Findings – Apart from the tangible benefits reported to the case hospital, five findings can be extracted from this study: the logistics...... innovation process model may include not just customers but also suppliers; logistics innovation in buyer-supplier relations may serve as an alternative to outsourcing; logistics innovation processes are dynamic and may improve supplier partnerships; logistics innovations in the supply chain are as dependent...

  6. Reframing in dentistry: Revisited

    Directory of Open Access Journals (Sweden)

    Sivakumar Nuvvula

    2013-01-01

    Full Text Available The successful practice of dentistry involves a good combination of technical skills and soft skills. Soft skills or communication skills are not taught extensively in dental schools and it can be challenging to learn and at times in treating dental patients. Guiding the child′s behavior in the dental operatory is one of the preliminary steps to be taken by the pediatric dentist and one who can successfully modify the behavior can definitely pave the way for a life time comprehensive oral care. This article is an attempt to revisit a simple behavior guidance technique, reframing and explain the possible psychological perspectives behind it for better use in the clinical practice.

  7. Klein's double discontinuity revisited

    DEFF Research Database (Denmark)

    Winsløw, Carl; Grønbæk, Niels

    2014-01-01

    bridging measures, success rates and many other aspects of these “entrance transition” problems. In this paper, we consider the inverse transition, experienced by university students as they revisit core parts of high school mathematics (in particular, calculus) after completing the undergraduate......Much effort and research has been invested into understanding and bridging the ‘gaps’ which many students experience in terms of contents and expectations as they begin university studies with a heavy component of mathematics, typically in the form of calculus courses. We have several studies of...... mathematics courses which are mandatory to become a high school teacher of mathematics. To what extent does the “advanced” experience enable them to approach the high school calculus in a deeper and more autonomous way ? To what extent can “capstone” courses support such an approach ? How could it be hindered...

  8. Quantum duel revisited

    Science.gov (United States)

    Schmidt, Alexandre G. M.; Paiva, Milena M.

    2012-03-01

    We revisit the quantum two-person duel. In this problem, both Alice and Bob each possess a spin-1/2 particle which models dead and alive states for each player. We review the Abbott and Flitney result—now considering non-zero α1 and α2 in order to decide if it is better for Alice to shoot or not the second time—and we also consider a duel where players do not necessarily start alive. This simple assumption allows us to explore several interesting special cases, namely how a dead player can win the duel shooting just once, or how can Bob revive Alice after one shot, and the better strategy for Alice—being either alive or in a superposition of alive and dead states—fighting a dead opponent.

  9. Lorentz violation naturalness revisited

    CERN Document Server

    Belenchia, Alessio; Liberati, Stefano

    2016-01-01

    We revisit here the naturalness problem of Lorentz invariance violations on a simple toy model of a scalar field coupled to a fermion field via a Yukawa interaction. We first review some well-known results concerning the low-energy percolation of Lorentz violation from high energies, presenting some details of the analysis not explicitly discussed in the literature and discussing some previously unnoticed subtleties. We then show how a separation between the scale of validity of the effective field theory and that one of Lorentz invariance violations can hinder this low-energy percolation. While such protection mechanism was previously considered in the literature, we provide here a simple illustration of how it works and of its general features. Finally, we consider a case in which dissipation is present, showing that the dissipative behaviour does not percolate generically to lower mass dimension operators albeit dispersion does. Moreover, we show that a scale separation can protect from unsuppressed low-en...

  10. Measuring and combining multiple diagnostic and prognostic sepsis biomarkers

    DEFF Research Database (Denmark)

    Kofoed, K.

    of sepsis is of great importance for choice of treatment, level of monitoring and prognosis. In this biomarkers could be a significant aid, and thus the search for and application of "new" sepsis biomarkers is of great importance. The thesis reviews the definitions and the epidemiology, and gives an...... overview of the immunology of sepsis with emphasis on the suggested roles of the soluble fractions of triggering receptor expressed on myeloide cells-1 (sTREM-1), urokinase-type plasminogen activator receptor (suPAR), and the cytokine macrophage migration inhibitory factor (MIF). The Luminex technology is...... described, it is explained how a multiplex assay is developed and validated, and based on our experience and onthe literature the advantages and shortcomings of the method are discussed. In the last part the results of the two clinical studies on 161 patients suspected of sepsis are put into the context of...

  11. Impact of CT in patients with sepsis of unknown origin

    International Nuclear Information System (INIS)

    Purpose: To evaluate the diagnostic relevance of CT in patients with sepsis of unknown origin. Material and Methods: Sixty-three consecutive intensive care patients with suspicion of an abscess and negative or inconclusive previous radiological examinations were included. CT was performed using the helical technique. A total of 45 abdominal and 38 chest examinations were evaluated. Results: 5/38 examinations of the chest revealed the source of sepsis (pleural empyema 2, lung abscess 1, mediastinitis 1, retrosternal abscess 1). 7/45 abdominal CT examinations showed the source of sepsis (intraabdominal abscess 2, hepatic abscess 3, intestinal perforation 1, gangrenous colitis 1). Conclusion: CT is useful for the evaluation of patients with fever or sepsis without a known source. Due to the detection of a spetic focus by CT, 19% of the patients in our study could be immediately referred to causal therapy as percutaneous drainage or surgery. (orig.)

  12. Molecular Hydrogen Therapy Ameliorates Organ Damage Induced by Sepsis

    Science.gov (United States)

    Zheng, Yijun; Zhu, Duming

    2016-01-01

    Since it was proposed in 2007, molecular hydrogen therapy has been widely concerned and researched. Many animal experiments were carried out in a variety of disease fields, such as cerebral infarction, ischemia reperfusion injury, Parkinson syndrome, type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, radiation injury, chronic hepatitis, rheumatoid arthritis, stress ulcer, acute sports injuries, mitochondrial and inflammatory disease, and acute erythema skin disease and other pathological processes or diseases. Molecular hydrogen therapy is pointed out as there is protective effect for sepsis patients, too. The impact of molecular hydrogen therapy against sepsis is shown from the aspects of basic vital signs, organ functions (brain, lung, liver, kidney, small intestine, etc.), survival rate, and so forth. Molecular hydrogen therapy is able to significantly reduce the release of inflammatory factors and oxidative stress injury. Thereby it can reduce damage of various organ functions from sepsis and improve survival rate. Molecular hydrogen therapy is a prospective method against sepsis. PMID:27413421

  13. Sepsis-Induced Myocardial Depression and Takotsubo Syndrome

    Directory of Open Access Journals (Sweden)

    Mustafa Kemal Arslantaş

    2015-08-01

    Full Text Available Sepsis induced temporary myocardial dysfunction characterized as impairment of myocardial contraction is an important cause of mortality and morbidity in intensive care units. Takotsubo syndrome (TS is temporary ballooning and dysfunction of the apical part of left ventricle without significant stenosis of coronary arteries. Recently, it was suggested that impairment in regional catecholamine distribution caused by stress factors and excessive cardiac sympathetic activity mechanism play role in sepsis such as other causes of TS. Additionally, vasopressor agents (as noradrenaline which are widely used in sepsis treatment may be triggering factor. Serial case reports of sepsis associated TS are reported, however pathophysiology, diagnosis and treatment strategies of these two different syndromes is not obvious.

  14. PSP/reg: a new stone in sepsis biomarkers?

    OpenAIRE

    Busani, Stefano; Girardis, Massimo

    2012-01-01

    Rapid diagnosis, appropriate management, and time are the key factors for improving survival rate in many emergency clinical scenarios such as acute myocardial infarction, pulmonary embolism, cerebral stroke, and severe sepsis. Clinical signs and electrocardiographic, radiological, and echographic investigations associated with biomarkers usually allow a quick diagnosis in all of the above situations, except severe sepsis, in which the diagnosis in the early phases is often only presumptive. ...

  15. Procalcitonin Sebagai Marker dan Hubungannya dengan Derajat Keparahan Sepsis

    OpenAIRE

    Purba, Donald Boy P.

    2011-01-01

    Background : The mortality on sepsis is still high. It’s because of delayed ofthe treatment resulted from the diagnosis of sepsis estabilished more frequently imprecise. The inflammatory makers as c reactive protein and leucocyte apparently have high sensitivity and specifity where do contemn whereas blood culture examination required so long time and the result of culture often negatively. Research on Procalcitonin (PCT) formering have important of the role for the establishment diagnos...

  16. Comparison of Cox and Gray's survival models in severe sepsis

    DEFF Research Database (Denmark)

    Kasal, Jan; Andersen, Zorana Jovanovic; Clermont, Gilles;

    2004-01-01

    Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate.......Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate....

  17. Kadar Procalcitonin sebagai marker dan hubungannya dengan derajat keparahan sepsis.

    OpenAIRE

    Purba, Donald Boy P.

    2012-01-01

    Background : The mortality on sepsis is still high. It’s because of delayed ofthe treatment resulted from the diagnosis of sepsis estabilished more frequently imprecise. The inflammatory makers as c reactive protein and leucocyte apparently have high sensitivity and specifity where do contemn whereas blood culture examination required so long time and the result of culture often negatively. Research on Procalcitonin (PCT) formering have important of the role for the establishment diagnos...

  18. Leptin Exacerbates Sepsis-Mediated Morbidity and Mortality

    OpenAIRE

    Shapiro, Nathan I; Khankin, Eliyahu V.; van Meurs, Matijs; Shih, Shou-Ching; Lu, Shulin; Yano, Midori; Castro, Pedro R.; Maratos-Flier, Eleftheria; Parikh, Samir M.; Karumanchi, S. Ananth; Yano, Kiichiro

    2010-01-01

    The adipose-derived hormone leptin is well known for its contribution to energy metabolism and satiety signaling in the hypothalamus. Previous studies suggested that obesity is an independent risk factor for sepsis morbidity and mortality, and it is associated with elevated baseline levels of circulating leptin in normal, nonseptic patients. In mouse endotoxemia and cecal ligation puncture models of sepsis, we observed elevated levels of leptin and soluble leptin receptor (sLR). Exogenously a...

  19. PROCALCITONIN AS A MARKER FOR EARLY DIAGNOSIS OF SEPSIS

    OpenAIRE

    Rahim Raoofi; Zahra Salmani; Fatemh Moradi; Abdolrerza Sotoodeh; Saeed Sobhanian

    2014-01-01

    Sepsis is a critical condition often caused by bacterial infection and associated with death and mortality. The prognosis of this disease depends on early diagnosis and proper treatment. Definite diagnosis of sepsis is positive blood culture and this test needs a long time to perform, so other biochemical parameters such as procalcitonin serum level has been introduced. To determine sensitivity, specificity, positive and negative predictive value of procalcitonin serum level at first time and...

  20. Hyperuricemia: An Early Marker for Severity of Illness in Sepsis

    OpenAIRE

    Akbar, Sana R.; Long, Dustin M.; Kashif Hussain; Ahmad Alhajhusain; Ahmed, Umair S; Iqbal, Hafiz I.; Ali, Ailia W.; Rachel Leonard; Cheryl Dalton

    2015-01-01

    Background. Uric acid can acutely activate various inflammatory transcription factors. Since high levels of oxyradicals and lower antioxidant levels in septic patients are believed to result in multiorgan failure, uric acid levels could be used as a marker of oxidative stress and poor prognosis in patients with sepsis. Design. We conducted a prospective cohort study on Medical Intensive Care Unit (MICU) patients and hypothesized that elevated uric acid in patients with sepsis is predictive of...

  1. Home delivery complicated with puerperal sepsis in urban India

    OpenAIRE

    Niranjan N. Chavan; Pradnya R. Changede; Shaista R. Khan

    2016-01-01

    Puerperal sepsis is among the leading and preventable causes of maternal morbidity and mortality worldwide and especially in developing countries. We report an interesting case of home delivery complicated with puerperal sepsis, who required obstetric hysterectomy. Inspite of being a resident of an urban metropolitan city patient had no access to antepartum, intrapartum or even postpartum care. She presented on day eleven postpartum to our institute by which time, her condition had progressed...

  2. The complex interplay between delirium, sepsis and sedation

    OpenAIRE

    Kress, John P

    2010-01-01

    Critically ill patients requiring mechanical ventilation frequently suffer from intensive care unit delirium, a syndrome associated with numerous poor measured outcomes. The relationship between delirium, sepsis, and sedation is complex. A discussion of the recent study ('Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS [maximizing efficacy of targeted sedation and reducing neurological dysfunction] randomized controlled...

  3. Effects of intra-abdominal sepsis on atherosclerosis in mice

    OpenAIRE

    Kaynar, Ata Murat; Yende, Sachin; Zhu, Lin; Frederick, Daniel R; Chambers, Robin; Burton, Christine L; Carter, Melinda; Stolz, Donna Beer; Agostini, Brittani; Gregory, Alyssa D.; Nagarajan, Shanmugam; Shapiro, Steven D; Angus, Derek C.

    2014-01-01

    Introduction Sepsis and other infections are associated with late cardiovascular events. Although persistent inflammation is implicated, a causal relationship has not been established. We tested whether sepsis causes vascular inflammation and accelerates atherosclerosis. Methods We performed prospective, randomized animal studies at a university research laboratory involving adult male ApoE-deficient (ApoE−/−) and young C57B/L6 wild-type (WT) mice. In the primary study conducted to determine ...

  4. Recently published papers: Sepsis – guidelines, treatment and novel approaches

    OpenAIRE

    Kalsi, Navneet; Forni, Lui G

    2008-01-01

    The choice of inotropic agent, particularly in catecholamine-resistant septic shock, remains an area of debate. Here we discuss a recent trial examining the use of vasopressin in a carefully controlled trial setting. Yet more data on the use of drotrecogin alfa (activated) in septic shock are described, as are novel but as yet experimental approaches to the treatment of sepsis. Finally, it is important not to forget to read the latest surviving sepsis guidelines.

  5. Why we need a new definition of sepsis

    OpenAIRE

    Beesley, Sarah J.; Lanspa, Michael J.

    2015-01-01

    On April 23, 2015, Kaukonen and colleagues published an article in the New England Journal of Medicine entitled “Systemic inflammatory response syndrome criteria in defining severe sepsis”, which investigated the sensitivity and validity of using SIRS criteria to define intensive care unit (ICU) patients with severe sepsis. This study used admission data of over 100,000 patients in order to investigate patients with severe sepsis who either met or didn’t meet SIRS criteria. The investigators ...

  6. New Translational Research Provides Insights into Liver Dysfunction in Sepsis

    OpenAIRE

    Recknagel, P; Gonnert, F. A.; Westermann, M.; Lambeck, S.; Lupp, A.; Rudiger, A.; Dyson, A.; Carré, J. E.; Kortgen, A.; Krafft, C; Popp, J.; Sponholz, C.; Fuhrmann, V.; Hilger, I; Claus, R. A.

    2012-01-01

    Editors' Summary Background Sepsis (blood poisoning)—a life-threatening condition caused by an inappropriate immune response to an infection—is a major global cause of death. Normally, when bacteria or other microbes enter the human body, the immune system efficiently destroys the invaders. In sepsis the immune system goes into overdrive, and the chemicals it releases into the blood to combat the infection trigger widespread inflammation (swelling). This leads to the formation of small blood ...

  7. New Approaches to Sepsis: Molecular Diagnostics and Biomarkers

    OpenAIRE

    Reinhart, Konrad; Bauer, Michael; Riedemann, Niels C.; Hartog, Christiane S

    2012-01-01

    Summary: Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and ...

  8. Acute kidney injury in severe sepsis and septic shock

    OpenAIRE

    Poukkanen, Meri

    2015-01-01

    Severe sepsis is the main cause of acute kidney injury (AKI) among critically ill patients. Septic AKI has been shown to associate with lower mean arterial pressure (MAP) levels. The initiation of renal replacement therapy (RRT) is mainly based on clinical judgment. The objectives of this study were to assess the incidence and 90-day mortality of patients with severe sepsis associated AKI treated in the intensive care units (ICUs), to evaluate the impact of MAP on development of AKI, to asses...

  9. Mortality audit of neonatal sepsis secondary to Acinetobacter

    OpenAIRE

    Anuradha S; Madhuri R Rathi; Mathur, Meenakshi M

    2013-01-01

    Background: Multidrug resistant Acinetobacter infection has emerged as an important pathogen in neonatal sepsis in the recent years causing morbidity as well as mortality. Materials and Methods: A retrospective analysis was performed over a one and a half year period of all neonates admitted with sepsis in our neonatal intensive care unit (NICU), who developed Acinetobacter infection and to identify mortality-associated risk factors in these neonates. Results: Incidence of neonatal septicaemi...

  10. Membrane TLR Signaling Mechanisms in the Gastrointestinal Tract during Sepsis

    OpenAIRE

    Buchholz, Bettina M.; Bauer, Anthony J

    2010-01-01

    Our bacterial residents are deadly Janus-faced indwellers which can lead to a septic-induced systemic inflammatory response syndrome and multiple organ failure. Over half of ICU patients suffer from infections and sepsis remains among the top ten causes of death in the United States. Severe ileus frequently accompanies sepsis setting up an insidious cycle of gut-derived microbial translocation and the copious intestinal production of potent systemic inflammatory mediators. Few therapeutic adv...

  11. Translocation of gut flora and its role in sepsis

    OpenAIRE

    Vaishnavi, C

    2013-01-01

    Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and the internal organs. Sometimes instead of bacteria, inflammatory compounds are responsible for clinical symptoms as in systemic inflammatory response syndrome (SIRS). The difference between sepsis and SIRS is that pathogenic bacteria are isolated from patients with sepsis but not with those of SIRS. Bacterial translocation occurs more frequently in patients with int...

  12. The role of endothelium and endogenous vasoactive substances in sepsis

    OpenAIRE

    Kotsovolis, G; Kallaras, K

    2010-01-01

    Sepsis and septic shock are great challenges for the doctors who treat critically ill patients. A big part of the scientific community is performing researches about the pathophysiology and treatment of this clinical problem. The endothelium has a very significant role in the alterations that sepsis causes especially to the circulatory system. The disorders of the normal function of the endothelium include derangement of the vascular tone, increase of endothelium permeability, activation of t...

  13. Brain stem and thalamus antioxidative defense in experimental sepsis

    OpenAIRE

    Ninković Milica; Maličević Ž.; Stojanović Dragica; Vasiljević Ivana; Jovanović Marina; Đukić Mirjana

    2008-01-01

    Although brain complications in sepsis are not rare, early pathophysiologic events had not been made clear yet. We have considered antioxidative components-glutathione peroxidase (GSHPx) activity and reduced glutathione (GSH) concentration in two brain integrative centers, i.e the brain stem (BS) and thalamus. Sepsis was induced in adult male Wistar rats (200-250 g) by cecal ligation and perforation (CLP) with inoculation of Escherichia coli suspension (ATCC 25922) (n=40). The control group w...

  14. Anti-inflammatory effect of Momordica charantia in sepsis mice.

    Science.gov (United States)

    Chao, Che-Yi; Sung, Ping-Jyun; Wang, Wei-Hsien; Kuo, Yueh-Hsiung

    2014-01-01

    Wild bitter gourd (Momordica charantia L. var. abbreviate Seringe), a common vegetable in Asia, is used in traditional medicine to treat various diseases, including inflammation. Extant literature indicates that wild bitter gourds have components that activate PPARα and PPARγ. This research probed the influence of adding wild bitter gourd to diets on inflammation responses in mice with sepsis induced by intraperitoneal injection of LPS. Male BALB/c mice were divided normal, sepsis, positive control, and three experimental groups. The latter ate diets with low (1%), moderate (2%), and high (10%) ratios of wild bitter gourd lyophilized powder. Before mice were sacrificed, with the exception of the normal group, intraperitoneal injection of LPS induced sepsis in each group; positive control group was injected with LPS after PDTC. This experiment revealed starkly lower weights in groups with added wild bitter gourd than those of the remaining groups. Blood lipids (TG, cholesterol, and NEFA) were also lower in comparison to the sepsis group, and blood glucose concentrations recovered and approached normal levels. Blood biochemistry values related to inflammation reactions indicated GOT, GPT, C-RP, and NO concentrations of groups with added wild bitter gourd were all lower than those of the sepsis group. Secretion levels of the spleen pro-inflammatory cytokines IL-1, IL-6, and TNF-α tallied significantly lower in comparison to the sepsis group, whereas secretion levels of IL-10 anti-inflammatory cytokine increased. Expression level of proteins NF-κB, iNOS, and COX-2 were significantly inhibited. Results indicate wild bitter gourd in diets promoted lipid metabolism, reducing fat accumulation, and improving low blood glucose in sepsis. Addition of wild bitter gourd can reduce inflammation biochemical markers or indicators and pro-inflammatory cytokines in the body, hence improving the inflammation responses in mice with sepsis. PMID:25153878

  15. Endothelial progenitors in sepsis: vox clamantis in deserto?

    OpenAIRE

    Goligorsky, Michael S

    2011-01-01

    In this issue of Critical Care, Patschan and colleagues present a study of endothelial progenitor cells (EPCs) in patients with sepsis. The importance of this study is in focusing attention on several frequently ignored aspects of sepsis. Among those are the phenomenon of microvascular dysfunction, which is potentially responsible for profound metabolic perturbations at the tissue level, and the role of endothelial progenitors in repair processes. Other important aspects of the study are the ...

  16. PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis

    Directory of Open Access Journals (Sweden)

    Jufitriani Ismy

    2016-11-01

    Full Text Available Background Sepsis remains a major cause of morbidity andmortality among critically ill children in the pediatric intensivecare unit (PICU. Procalcitonin and lactate have been used asbiomarkers of sepsis, as they have been correlated with diseaseseverity, organ failure and death. The Pediatric Logistic OrganDysfunction (PELOD score is a tool to assess the severity oforgan dysfunction in critically ill children.Objective To investigate the correlation between PELOD scoreand procalcitonin and lactate levels in pediatric sepsis.Methods A cross-sectional study was conducted in childrenwith sepsis who were admitted to the PICU from April to July2012. Sepsis was defined as systemic inflammatory responsesyndrome (SIRS, as a result of suspected or proven infection.Proven infection was defined as positive culture findings (blood, mL. Spearman’s test was used to assess for correlations betweenPELOD scores and procalcitonin as well as lactate levels.Results Thirty-two patients were analyzed, consisting of 18 malesand 14 females with an age range of 1-432 months (median 21months. There was no statistically significant correlation betweenprocalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502to 0.174, P=0.308 nor between lactate level(r=-0.069, 95%CI-0.408 to 0.287, P=0.709 and PELOD score.Conclusion Serum procalcitonin and lactate levels are notcorrelated with PELOD scores in children with sepsis.

  17. Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis

    Directory of Open Access Journals (Sweden)

    Sang Hoon Lee

    2015-01-01

    Full Text Available Background. Despite extensive research and an improved standard of care, sepsis remains a disorder with a high mortality rate. Sepsis is accompanied by severe metabolic alterations. Methods. We evaluated 117 patients with sepsis (severe sepsis [n=19] and septic shock [n=98] who were admitted to the intensive care unit. Serum cholesterol, triglyceride (TG, high-density lipoprotein (HDL, low-density lipoprotein (LDL, free fatty acid (FFA, and apolipoprotein (Apo A-I levels were measured on days 0, 1, 3, and 7. Results. Nonsurvivors had low levels of cholesterol, TG, HDL, LDL, and Apo A-I on days 0, 1, 3, and 7. In a linear mixed model analysis, the variations in TG, LDL, FFA, and Apo A-I levels over time differed significantly between the groups (p=0.043, p=0.020, p=0.005, and p=0.015, resp.. According to multivariate analysis, TG levels and SOFA scores were associated with mortality on days 0 and 1 (p=0.018 and p=0.008, resp.. Conclusions. Our study illustrated that TG levels are associated with mortality in patients with sepsis. This may be attributable to alterations in serum lipid metabolism during sepsis, thus modulating the host response to inflammation in critically ill patients.

  18. Role of C5 Activation Products in Sepsis

    Directory of Open Access Journals (Sweden)

    Peter A. Ward

    2010-01-01

    Full Text Available Complement activation products are known to be generated in the setting of both experimental and human sepsis. C5 activation products (C5a anaphylatoxin and the membrane attack complex [MAC] C5b-9 are generated during sepsis following infusion of endotoxin, or after cecal ligation and puncture (CLP, which produces polymicrobial sepsis. C5a reacts with its receptors C5aR and C5L2 in a manner that creates the “cytokine storm”, and is associated with development of multiorgan failure (MOF. A number of other complications arising from the interaction of C5a with its receptors include apoptosis of lymphoid cells, loss of innate immune functions of neutrophils (PMNs, polymorphonuclear leukocytes, cardiomyopathy, disseminated intravascular coagulation, and complications associated with MOF. Neutralization of C5a in vivo or absence/blockade of C5a receptors greatly reduces the adverse events in the setting of sepsis, markedly attenuates MOF, and greatly improves survival. Regarding the possible role of C5b-9 in sepsis, the literature is conflicting. Some studies suggest that C5b-9 is protective, while other studies suggest the contrary. Clearly, in human sepsis, C5a and its receptors may be logical targets for interception.

  19. Pathogen diagnosis of children sepsis by LAMP technology

    Institute of Scientific and Technical Information of China (English)

    Yu-Cai Zhang

    2013-01-01

    Objective:To explore a rapid diagnostic method in neonatal sepsis and bacterial meningitis. Methods:The primers were designed and synthesized based on16S rRNA gene of Staphylococcus aureus.Four specimens ofStaphylococcus aureus,16 specimens of coagulase-negativeStaphylococci,2 specimens ofEnterococci,3 specimens ofStreptococcus,1 specimen ofMicrococcus,3 specimens ofEscherichia coli,4 specimens ofKlebsiella pneumoniae,3 specimens ofPseudomonas aeruginosa,2 specimens ofEnterobacter cloacae, and5 specimens of Acinetobacterwere tested by loop-mediated isothermal amplification(LAMP) assay.A total of118 clinical specimens of sepsis and non-sepsis were collected and detected with bothLAMP assay and blood culture.Results:By designing primers specific forStaphylococcus aureus, specimens containing different kinds of pathogens were carried out byLAMP assay, and our data showed LAMP technology for the specific detection ofStaphylococcus aureus in samples was successfully established.All clinical specimens of sepsis and non-sepsis were tested by both blood cultures andLAMP, and our data showed that compared wit blood culture method, theLAMP technology showed significantly high detection rate(P <0.01).Conclusions:As a quick and easy detection ofStaphylococcus aureus, theLAMP technology was successfully established, laid the foundation for the diagnosis and treatment of childrenStaphylococcus aureus sepsis, and showed great promotion and application value.

  20. New approaches to sepsis: molecular diagnostics and biomarkers.

    Science.gov (United States)

    Reinhart, Konrad; Bauer, Michael; Riedemann, Niels C; Hartog, Christiane S

    2012-10-01

    Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and add information about screening, diagnosis, risk stratification, and monitoring of the response to therapy. The host response involves hundreds of mediators and single molecules, many of which have been proposed as biomarkers. It is, however, unlikely that one single biomarker is able to satisfy all the needs and expectations for sepsis research and management. Among biomarkers that are measurable by assays approved for clinical use, procalcitonin (PCT) has shown some usefulness as an infection marker and for antibiotic stewardship. Other possible new approaches consist of molecular strategies to improve pathogen detection and molecular diagnostics and prognostics based on transcriptomic, proteomic, or metabolic profiling. Novel approaches to sepsis promise to transform sepsis from a physiologic syndrome into a group of distinct biochemical disorders and help in the development of better diagnostic tools and effective adjunctive sepsis therapies. PMID:23034322

  1. Sepsis otopathy: experimental sepsis leads to significant hearing impairment due to apoptosis and glutamate excitotoxicity in murine cochlea

    Directory of Open Access Journals (Sweden)

    Joachim Schmutzhard

    2013-05-01

    Hearing loss is frequent in intensive care patients and can be due to several causes. However, sepsis has not been examined as a possible cause. The aim of this study is to assess the influence of experimental sepsis on hearing thresholds and to evaluate pathological changes in the cochlea. The cecal ligation puncture technique was used to induce sepsis in 18 mice. Results were compared with those from 13 sham-operated and 13 untreated control mice. The hearing thresholds of the animals were evaluated with auditory evoked brainstem responses prior to the induction of sepsis and again at the peak of the disease. Immediately after the second measurement, the mice were sacrificed and the inner ears harvested and prepared for further evaluation. The cochleae were examined with light microscopy, electron microscopy and immunohistochemistry for Bax, cleaved caspase-3 and Bcl-2. The mice with sepsis showed a significant hearing loss but not the control groups. Induction of apoptosis could be shown in the supporting cells of the organ of Corti. Furthermore, excitotoxicity could be shown at the basal pole of the inner hair cells. In this murine model, sepsis leads to significant hearing impairment. The physiological alteration could be linked to apoptosis in the supporting cells of the organ of Corti and to a disturbance of the synapses of the inner hair cells.

  2. A clinical study of sepsis patients with hypophosphatemia infected by different bacteria

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To compare hypophosphatemia between the sepsis patients and the non-sepsis patients,and between the subgroups of sepsis patients.Methods We collected 312 sepsis cases and 300 non-sepsis cases by stratified random sampling method yearly.In the sepsis cases,the number infected by gram-negative bacteria was 170,and by gram-positive bacteria was 142,containing 4 different bacteria infected cases in each one.Serum phosphorus of cases in each group were collected.

  3. Absceso de Muslo, Sepsis y Embarazo

    Directory of Open Access Journals (Sweden)

    Nadir Peggy Ortíz Samur

    2010-06-01

    Full Text Available Las infecciones de piel y tejidos blandos son, junto con las infecciones de las vías respiratorias, las infecciones más frecuentes en clínica humana. Los gérmenes normalmente implicados son el Staphylococcus Aureus, Streptococcus spp, Pseudomona Aeruginosa y Enterococcus. De forma ocasional pueden formarse abscesos como resultado de la celulitis. Algunas complicaciones raras, pero graves incluyen la producción de fascitis necrotizante y bacteriemia. La celulitis causada por microorganismos Gram negativos generalmente ocurre a través de una fuente cutánea en un paciente inmunodeprimido, pero también puede desarrollarse a través de bacteriemia.A continuación presentamos el caso de una mujer de 17 años de edad, primigesta con 19 semanas de gestación, sin antecedente traumático, ni puerta de entrada evidenciable que ingresa por dolor intenso en muslo derecho, edematizado y con imposibilidad de movilización, compatible con celulitis, formación de absceso y sepsis. Se latrato según protocolo para el cuadro séptico, una vez identificado el absceso se realiza drenaje quirúrgico y antibioticoterapiapara Escherichia Coli.

  4. Multinomial pattern matching revisited

    Science.gov (United States)

    Horvath, Matthew S.; Rigling, Brian D.

    2015-05-01

    Multinomial pattern matching (MPM) is an automatic target recognition algorithm developed for specifically radar data at Sandia National Laboratories. The algorithm is in a family of algorithms that first quantizes pixel value into Nq bins based on pixel amplitude before training and classification. This quantization step reduces the sensitivity of algorithm performance to absolute intensity variation in the data, typical of radar data where signatures exhibit high variation for even small changes in aspect angle. Our previous work has focused on performance analysis of peaky template matching, a special case of MPM where binary quantization is used (Nq = 2). Unfortunately references on these algorithms are generally difficult to locate and here we revisit the MPM algorithm and illustrate the underlying statistical model and decision rules for two algorithm interpretations: the 1-of-K vector form and the scalar. MPM can also be used as a detector and specific attention is given to algorithm tuning where "peak pixels" are chosen based on their underlying empirical probabilities according to a reward minimization strategy aimed at reducing false alarms in the detection scenario and false positives in a classification capacity. The algorithms are demonstrated using Monte Carlo simulations on the AFRL civilian vehicle dataset for variety of choices of Nq.

  5. Revisiting energy efficiency fundamentals

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Lombard, L.; Velazquez, D. [Grupo de Termotecnia, Escuela Superior de Ingenieros, Universidad de Sevilla, Camino de los Descubrimientos s/n, 41092 Seville (Spain); Ortiz, J. [Building Research Establishment (BRE), Garston, Watford, WD25 9XX (United Kingdom)

    2013-05-15

    Energy efficiency is a central target for energy policy and a keystone to mitigate climate change and to achieve a sustainable development. Although great efforts have been carried out during the last four decades to investigate the issue, focusing into measuring energy efficiency, understanding its trends and impacts on energy consumption and to design effective energy efficiency policies, many energy efficiency-related concepts, some methodological problems for the construction of energy efficiency indicators (EEI) and even some of the energy efficiency potential gains are often ignored or misunderstood, causing no little confusion and controversy not only for laymen but even for specialists. This paper aims to revisit, analyse and discuss some efficiency fundamental topics that could improve understanding and critical judgement of efficiency stakeholders and that could help in avoiding unfounded judgements and misleading statements. Firstly, we address the problem of measuring energy efficiency both in qualitative and quantitative terms. Secondly, main methodological problems standing in the way of the construction of EEI are discussed, and a sequence of actions is proposed to tackle them in an ordered fashion. Finally, two key topics are discussed in detail: the links between energy efficiency and energy savings, and the border between energy efficiency improvement and renewable sources promotion.

  6. Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease

    OpenAIRE

    Mehta, Ravindra L; Bouchard, Josée; Soroko, Sharon B.; Ikizler, T. Alp; Paganini, Emil P.; Chertow, Glenn M.; Himmelfarb, Jonathan

    2011-01-01

    Sepsis commonly contributes to acute kidney injury (AKI); however, the frequency with which sepsis develops as a complication of AKI and the clinical consequences of this sepsis are unknown. This study examined the incidence of, and outcomes associated with, sepsis developing after AKI. We analyzed data from 618 critically ill patients enrolled in a multicenter observational study of AKI (PICARD). Patients were stratified according to their sepsis status and timing of incident sepsis relat...

  7. Leadership and Management Theories Revisited

    DEFF Research Database (Denmark)

    Madsen, Mona Toft

    2001-01-01

    The goal of the paper is to revisit and analyze key contributions to the understanding of leadership and management. As a part of the discussion a role perspective that allows for additional and/or integrated leader dimensions, including a change-centered, will be outlined. Seemingly, a major...

  8. The "Mushroom Cloud" Demonstration Revisited

    Science.gov (United States)

    Panzarasa, Guido; Sparnacci, Katia

    2013-01-01

    A revisitation of the classical "mushroom cloud" demonstration is described. Instead of aniline and benzoyl peroxide, the proposed reaction involves household chemicals such as alpha-pinene (turpentine oil) and trichloroisocyanuric acid ("Trichlor") giving an impressive demonstration of oxidation and combustion reactions that…

  9. Cultural Warping of Childbirth, Revisited

    OpenAIRE

    Budin, Wendy C.

    2007-01-01

    In this column, the editor of The Journal of Perinatal Education revisits Doris Haire's classic 1972 article, “The Cultural Warping of Childbirth,” and describes the birth culture of today. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.

  10. Multi-analytical Approaches Informing the Risk of Sepsis

    Science.gov (United States)

    Gwadry-Sridhar, Femida; Lewden, Benoit; Mequanint, Selam; Bauer, Michael

    Sepsis is a significant cause of mortality and morbidity and is often associated with increased hospital resource utilization, prolonged intensive care unit (ICU) and hospital stay. The economic burden associated with sepsis is huge. With advances in medicine, there are now aggressive goal oriented treatments that can be used to help these patients. If we were able to predict which patients may be at risk for sepsis we could start treatment early and potentially reduce the risk of mortality and morbidity. Analytic methods currently used in clinical research to determine the risk of a patient developing sepsis may be further enhanced by using multi-modal analytic methods that together could be used to provide greater precision. Researchers commonly use univariate and multivariate regressions to develop predictive models. We hypothesized that such models could be enhanced by using multiple analytic methods that together could be used to provide greater insight. In this paper, we analyze data about patients with and without sepsis using a decision tree approach and a cluster analysis approach. A comparison with a regression approach shows strong similarity among variables identified, though not an exact match. We compare the variables identified by the different approaches and draw conclusions about the respective predictive capabilities,while considering their clinical significance.

  11. PROCALCITONIN AS A MARKER FOR EARLY DIAGNOSIS OF SEPSIS

    Directory of Open Access Journals (Sweden)

    Rahim Raoofi

    2014-01-01

    Full Text Available Sepsis is a critical condition often caused by bacterial infection and associated with death and mortality. The prognosis of this disease depends on early diagnosis and proper treatment. Definite diagnosis of sepsis is positive blood culture and this test needs a long time to perform, so other biochemical parameters such as procalcitonin serum level has been introduced. To determine sensitivity, specificity, positive and negative predictive value of procalcitonin serum level at first time and 72 h after admission and to compare it with blood culture test for diagnosis of sepsis. Blood sample for blood culture, prepheral blood smear at first time and procalcitonin serum level measuring by semi quantitative method at first and 72 h after admission were sampled. Nine patients had positive blood cultures. Peripheral blood smear was positive in 38 patients, (29 patients: gram stain positive, 6 patients: gram stain negative and 3 patients: both gram positive and gram negative. At first time 76.8% had positive procalcitonin (>0.5 ng mL-1 and after 72 h 65% of patients had positive procalcitonin. Sensitivity, specificity, positive and negative predictive value of procalcitonin at the first time were 100, 16,16 and 100% and for procalcitonin after 72 h respectively were 75, 35, 15 and 90%. This study showed that sensitivity of procalcitonin serum level can be used for diagnosis of sepsis. Procalcitonin increased as severity of sepsis and this study suggests high serum level of procalcitonin after 72 h might indicate poor outcome.

  12. A clinical perspective of sepsis-associated delirium.

    Science.gov (United States)

    Tsuruta, Ryosuke; Oda, Yasutaka

    2016-01-01

    The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established. PMID:27011789

  13. Endocrine dysfunction in sepsis: a beneficial or deleterious host response?

    Science.gov (United States)

    Gheorghiţă, Valeriu; Barbu, Alina Elena; Gheorghiu, Monica Livia; Căruntu, Florin Alexandru

    2015-03-01

    Sepsis is a systemic, deleterious inflammatory host response triggered by an infective agent leading to severe sepsis, septic shock and multi-organ failure. The host response to infection involves a complex, organized and coherent interaction between immune, autonomic, neuroendocrine and behavioral systems. Recent data have confirmed that disturbances of the autonomic nervous and neuroendocrine systems could contribute to sepsis-induced organ dysfunction. Through this review, we aimed to summarize the current knowledge about the endocrine dysfunction as response to sepsis, specifically addressed to vasopressin, copeptin, cortisol, insulin and leptin. We searched the following readily accessible, clinically relevant databases: PubMed, UpToDate, BioMed Central. The immune system could be regarded as a "diffuse sensory organ" that signals the presence of pathogens to the brain through different pathways, such as the vagus nerve, endothelial activation/dysfunction, cytokines and neurotoxic mediators and the circumventricular organs, especially the neurohypophysis. The hormonal profile changes substantially as a consequence of inflammatory mediators and microorganism products leading to inappropriately low levels of vasopressin, sick euthyroid syndrome, reduced adrenal responsiveness to ACTH, insulin resistance, hyperglycemia as well as hyperleptinemia. In conclusion, clinical diagnosis of this "pan-endocrine illness" is frequently challenging due to the many limiting factors. The most important benefits of endocrine markers in the management of sepsis may be reflected by their potential to be used as biomarkers in different scoring systems to estimate the severity of the disease and the risk of death. PMID:25763364

  14. "Neonatal Sepsis due to Klebsiella: Frequency, Outcome and Antibiotic Sensitivity"

    Directory of Open Access Journals (Sweden)

    E Malakan Rad

    2004-07-01

    Full Text Available Sepsis is a significant cause of morbidity and mortality in neonates. The most common pathogens of bacterial sepsis and antibiotic sensitivity patterns vary in different parts of the world. The aim of this study was to determine the most common pathogens and outcome of neonatal sepsis and also antibiotic sensitivity patterns of Klebsiella species. A retrospective descriptive study was carried out. The study was performed at a neonatal care unit in Kashan between October 2000 to October 2003.Only those neonates with positive blood culture were included. Patients with Klebsiella septicemia were categorized into two groups of early and late-onset sepsis. Patterns of the antibiotic resistance of the bacterial isolates were studied by disc diffusion technique. Frequencies and Fisher’s Exact test was used to compare the early-onset outcome versus late –onset outcome. One hundred and thirty –six neonates had positive blood cultures out of 453 cases. The most common pathogens were Pseudomonas, Klebsiella and coagulase negative Staphylococci respectively. Overall crude mortality rate was 39% (Pseudomonas was the predominant cause. All Klebsiella species were resistant to ampicillin. Twenty-three percent of Klebsiella species were multiresistant considering our most common etiologic pathogens of bacterial sepsis and the significant number of resistant bacteria to ampicillin and gentamicin; it seems prudent to consider revising the present choice of empirical antibiotic treatment.

  15. Role of Pore-Forming Toxins in Neonatal Sepsis

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    Andreas F.-P. Sonnen

    2013-01-01

    Full Text Available Protein toxins are important virulence factors contributing to neonatal sepsis. The major pathogens of neonatal sepsis, group B Streptococci, Escherichia coli, Listeria monocytogenes, and Staphylococcus aureus, secrete toxins of different molecular nature, which are key for defining the disease. Amongst these toxins are pore-forming exotoxins that are expressed as soluble monomers prior to engagement of the target cell membrane with subsequent formation of an aqueous membrane pore. Membrane pore formation is not only a means for immediate lysis of the targeted cell but also a general mechanism that contributes to penetration of epithelial barriers and evasion of the immune system, thus creating survival niches for the pathogens. Pore-forming toxins, however, can also contribute to the induction of inflammation and hence to the manifestation of sepsis. Clearly, pore-forming toxins are not the sole factors that drive sepsis progression, but they often act in concert with other bacterial effectors, especially in the initial stages of neonatal sepsis manifestation.

  16. Disturbances of the hypothalamic-pituitary-adrenal axis and plasma electrolytes during experimental sepsis

    OpenAIRE

    Flierl, Michael A; Rittirsch, Daniel; Weckbach, Sebastian; Huber-Lang, Markus; Ipaktchi, Kyros; Ward, Peter A.; Stahel, Philip F.

    2011-01-01

    Background Sepsis continues to be a poorly understood syndrome with a high mortality rate. While we are beginning to decipher the intricate interplay of the inflammatory response during sepsis, the precise regulation of the hypothalamic-pituitary-adrenal (HPA) axis and its impact on electrolyte homeostasis during sepsis remains incompletely understood. Methods Sepsis was induced in adult male Sprague-Dawley rats by cecal ligation and puncture (CLP). Plasma samples were obtained as a function ...

  17. Is The Essential Newborn Care Package an Effective Intervention for Reducing Neonatal Sepsis In India?

    OpenAIRE

    Masters, Rebecca

    2008-01-01

    Background: Neonatal sepsis is an important cause of morbidity and mortality in India. Neonatal health programmes such as the Essential Newborn Care Package focus on preventative and curative care for the reduction of neonatal sepsis. However, neonates continue to die as a consequence of sepsis, many of which deaths are preventable. This critical review examines the factors that impact on neonatal sepsis and evaluates the effectiveness of this package aimed at preventing neonatal death....

  18. Severe postpartum sepsis with prolonged myocardial dysfunction: a case report

    Directory of Open Access Journals (Sweden)

    Chen Katherine T

    2010-10-01

    Full Text Available Abstract Introduction Severe sepsis during pregnancy or in the postpartum period is a rare clinical event. In non obstetric surviving patients, the cardiovascular changes seen in sepsis and septic shock are fully reversible five to ten days after their onset. We report a case of septic myocardial dysfunction lasting longer than ten days. To the best of our knowledge, this is the first report of prolonged septic myocardial dysfunction in a parturient. Case presentation A 24 year old Hispanic woman with no previous medical history developed pyelonephritis and severe sepsis with prolonged myocardial dysfunction after a normal spontaneous vaginal delivery. Conclusions Septic myocardial dysfunction may be prolonged in parturients requiring longer term follow up and pharmacologic treatment.

  19. The coagulopathy in sepsis: significance and implications for treatment

    Directory of Open Access Journals (Sweden)

    Berardino Pollio

    2011-09-01

    Full Text Available Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC. There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant system, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis.

  20. Functional and histopathologic changes in the liver during sepsis.

    Science.gov (United States)

    Caruana, J A; Montes, M; Camara, D S; Ummer, A; Potmesil, S H; Gage, A A

    1982-05-01

    Although liver failure from sepsis is a frequent occurrence in serious ill, hospitalized patients, little information is available on the histologic changes of the liver. We examined the histopathology of the liver of 19 patients who died of clinical sepsis and attempted to relate certain features of the illness or treatment to the observed histopathologic changes. The most striking finding was midzonal and peripheral necrosis of a moderate to marked degree in 11 of 19 patients. Other important changes were acute inflammation and cholestasis. The severity of hepatocellular necrosis did not appear to be influenced by the premortem circulating pathogen, by the nutritional support administered or by the arterial blood pressure. It is suggested that hepatocellular necrosis is characteristic of sepsis and may be caused by loss of specific factors which normally maintain liver function and structure. PMID:6803371

  1. Hydrogen Gas Presents a Promising Therapeutic Strategy for Sepsis

    Directory of Open Access Journals (Sweden)

    Keliang Xie

    2014-01-01

    Full Text Available Sepsis is characterized by a severe inflammatory response to infection. It remains a major cause of morbidity and mortality in critically ill patients despite developments in monitoring devices, diagnostic tools, and new therapeutic options. Recently, some studies have found that molecular hydrogen is a new therapeutic gas. Our studies have found that hydrogen gas can improve the survival and organ damage in mice and rats with cecal ligation and puncture, zymosan, and lipopolysaccharide-induced sepsis. The mechanisms are associated with the regulation of oxidative stress, inflammatory response, and apoptosis, which might be through NF-κB and Nrf2/HO-1 signaling pathway. In this paper, we summarized the progress of hydrogen treatment in sepsis.

  2. Distribution characteristics of liquid sequestration in rats with sepsis

    Directory of Open Access Journals (Sweden)

    Bin LI

    2012-03-01

    Full Text Available Objective To investigate the distribution characteristics of organs with liquid sequestration during fluid resuscitation in rats with sepsis. Methods Fifty male Wistar rats were randomly divided into five groups: control group (n=10, sepsis group (n=10, crystalloid group (n=10, albumin group (n=10, and artificial colloid (HAES group (n=10. The sepsis model was reproduced by cecal ligation and puncture. The mean arterial pressure was monitored with carotid artery intubation. Twelve hours after fluid infusion by micro-infusion pump via the femoral vein, tissues from the heart, liver, lungs, kidney (right, and small intestine were harvested to observe the pathological changes and calculate the tissue water content. Results The water content of every visceral tissue was higher in the sepsis group than in the control group (P < 0.05; the water content in the heart, liver, and lung tissues was higher in the albumin group than in the crystalloid group (P < 0.05. The water content in both albumin and crystalloid groups was higher than that in the sepsis group (P < 0.05. Moreover, the water content in the heart, liver, and lungs in the HAES group was lower than that in the crystalloid and albumin groups (P < 0.05. Cellular injuries were more severe in the heart, liver, and lungs than in the intestine and kidney in the crystalloid group and albumin group under electron-microscope. Conclusion Liquid sequestration exists mainly in the lungs, heart, and liver of rats with sepsis during fluid resuscitation. The phenomenon is less evident in the kidney and small intestine. Artificial colloid can reduce capillary leak with a good volume expansion effect.

  3. PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis

    Directory of Open Access Journals (Sweden)

    Jufitriani Ismy

    2015-11-01

    Full Text Available Background Sepsis remains a major cause of morbidity and mortality among critically ill children in the pediatric intensive care unit (PICU. Procalcitonin and lactate have been used as biomarkers of sepsis, as they have been correlated with disease severity, organ failure and death. The Pediatric Logistic Organ Dysfunction (PELOD score is a tool to assess the severity of organ dysfunction in critically ill children. Objective To investigate the correlation between PELOD score and procalcitonin and lactate levels in pediatric sepsis. Methods A cross-sectional study was conducted in children with sepsis who were admitted to the PICU from April to July 2012. Sepsis was defined as systemic inflammatory response syndrome (SIRS, as a result of suspected or proven infection. Proven infection was defined as positive culture findings (blood, urine ot other specimens and/or serum procalcitonin >2 ng/mL. Spearman’s test was used to assess for correlations between PELOD scores and procalcitonin as well as lactate levels. Results Thirty-two patients were analyzed, consisting of 18 males and 14 females with an age range of 1-432 months (median 21 months. There was no statistically significant correlation between procalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502 to 0.174, P=0.308 nor between lactate level(r=-0.069, 95%CI-0.408 to 0.287, P=0.709 and PELOD score. Conclusion Serum procalcitonin and lactate levels are not correlated with PELOD scores in children with sepsis.

  4. Development of an anti-endotoxin vaccine for sepsis.

    Science.gov (United States)

    Cross, Alan S

    2010-01-01

    Gram-negative bacterial lipopolysaccharide (LPS, endotoxin) is an important initiator of sepsis, a clinical syndrome that is a leading cause of death in intensive care units. Vaccines directed against core LPS structures that are widely conserved among Gram-negative bacteria (GNB) have been developed for the treatment and/or prevention of sepsis. Killed whole bacterial vaccines (E. coli O111:B4, J5 [Rc chemotype] mutant and S. minnesota, Re chemotype) protected mice against experimental sepsis. Human J5 immune antisera reduced the mortality from GNB sepsis in a large controlled clinical trial; however, subsequent clinical studies with antiendotoxin antibodies did not demonstrate protective efficacy in sepsis. Multiple clinical studies have since demonstrated a correlation between the level of circulating antibodies to LPS core and morbidity and mortality in different clinical settings. We therefore developed a subunit vaccine by combining detoxified J5 LPS (J5 dLPS) with the outer membrane protein (OMP) from group B N. meningitidis. This vaccine was highly efficacious in experimental models of sepsis and progressed to phase 1 clinical trial. While well-tolerated, this vaccine induced only 3-4-fold increases in anti-J5 dLPS antibody. Addition of the TLR9 agonist, oligodeoxynucleotide with a CpG motif, as adjuvant to the vaccine increased antibody levels in mice and the vaccine/CpG combination will progress to phase 1 human study. Additional vaccines in which the core glycolipid was either conjugated to carrier protein or incorporated into liposomes have been developed, but have not progressed to clinical trial. Should an antiendotoxin vaccine become available, a new immunization strategy directed towards distinct populations at risk will be required. PMID:20593272

  5. Optical detection of sepsis markers using liquid crystal based biosensors

    Science.gov (United States)

    McCamley, Maureen K.; Artenstein, Andrew W.; Opal, Steven M.; Crawford, Gregory P.

    2007-02-01

    A liquid crystal based biosensor for the detection and diagnosis of sepsis is currently in development. Sepsis, a major clinical syndrome with a significant public health burden in the US due to a large elderly population, is the systemic response of the body to a localized infection and is defined as the combination of pathologic infection and physiological changes. Bacterial infections are responsible for 90% of cases of sepsis in the US. Currently there is no bedside diagnostic available to positively identify sepsis. The basic detection scheme employed in a liquid crystal biosensor contains attributes that would find value in a clinical setting, especially for the early detection of sepsis. Utilizing the unique properties of liquid crystals, such as birefringence, a bedside diagnostic is in development which will optically report the presence of biomolecules. In a septic patient, an endotoxin known as lipopolysaccharide (LPS) is released from the outer membrane of Gram-negative bacteria and can be found in the blood stream. It is hypothesized that this long chained molecule will cause local disruptions to the open surface of a sensor containing aligned liquid crystal. The bulk liquid crystal ampli.es these local changes at the surface due to the presence of the sepsis marker, providing an optical readout through polarizing microscopy images. Liquid crystal sensors consisting of both square and circular grids, 100-200 μm in size, have been fabricated and filled with a common liquid crystal material, 5CB. Homeotropic alignment was confirmed using polarizing microscopy. The grids were then contacted with either saline only (control), or saline with varying concentrations of LPS. Changes in the con.guration of the nematic director of the liquid crystal were observed through the range of concentrations tested (5mg/mL - 1pg/mL) which have been confirmed by a consulting physician as clinically relevant levels.

  6. Membrane TLR signaling mechanisms in the gastrointestinal tract during sepsis.

    Science.gov (United States)

    Buchholz, B M; Bauer, A J

    2010-03-01

    Our bacterial residents are deadly Janus-faced indwellers that can lead to a sepsis-induced systemic inflammatory response syndrome and multiple organ failure. Over half of ICU patients suffer from infections and sepsis remains one of the top 10 causes of death worldwide. Severe ileus frequently accompanies sepsis setting up an insidious cycle of gut-derived microbial translocation and the copious intestinal production of potent systemic inflammatory mediators. Few therapeutic advances have occurred to prevent/treat the sequelae of sepsis. Here, we selectively review studies on cellular membrane-bound Toll-like receptor (TLR) mechanisms of ileus. Virtually, no data exist on Gram-positive/TLR2 signaling mechanisms of ileus; however, TLR2 is highly inducible by numerous inflammatory mediators and studies using clinically relevant scenarios of Gram-positive sepsis are needed. Specific Gram-negative/TLR4 signaling pathways are being elucidated using a 'reverse engineering' approach, which has revealed that endotoxin-induced ileus is dually mediated by classical leukocyte signaling and by a MyD88-dependent non-bone marrow-derived mechanism, but the specific roles of individual cell populations are still unknown. Like TLR2, little is also know of the role of flagellin/TLR5 signaling in ileus. But, much can be learned by understanding TLR signaling in other systems. Clearly, the use of polymicrobial models provides important clinical relevancy, but the simultaneous activation of virtually all pattern recognition receptors makes it impossible to discretely study specific pathways. We believe that the dissection of individual TLR pathways within the gastrointestinal tract, which can then be intelligently reassembled in a meaningful manner, will provide insight into treatments for sepsis. PMID:20377787

  7. The Microcirculation is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

    DEFF Research Database (Denmark)

    2014-01-01

    -acuity sepsis patients. The hypothesis was that patients with sepsis, but without hypotension, will demonstrate signs of flow abnormalities compared to noninfected control patients. Methods This was a prospective, observational study in a convenience sample of patients with sepsis and noninfected controls...

  8. The central role of monocytes in the pathogenesis of sepsis : consequences for immunomonitoring and treatment

    NARCIS (Netherlands)

    Haveman, JW; Kobold, ACM; Tervaert, JWC; van den Berg, AP; Tulleken, JE; Kallenberg, CGM; The, TH

    1999-01-01

    Despite important advances in critical care medicine during the last two decades, the mortality rate of sepsis has remained high, probably because the pathogenesis of sepsis is still incompletely understood. Recent studies have shown that sepsis is a bimodal entity. The first phase is characterized

  9. Value of Superficial Cultures: Diagnosing neonatal sepsis in a community hospital

    OpenAIRE

    Paes, Bosco A.; Modi, Anjana

    1992-01-01

    In a study of babies younger than 2 weeks who were admitted to a community neonatal facility with suspected sepsis, pathogenic organisms grown from superficial swab samples were compared with those from deep cultures to meet the gold standard definition of true sepsis. We conclude that superficial cultures have limited value in the diagnosis of neonatal sepsis in a community setting.

  10. The Impact of HIV Co-Infection on the Genomic Response to Sepsis

    NARCIS (Netherlands)

    Huson, Michaëla A M; Scicluna, Brendon P; van Vught, Lonneke A; Wiewel, Maryse A; Hoogendijk, Arie J; Cremer, Olaf L; Bonten, Marc J M; Schultz, Marcus J; Franitza, Marek; Toliat, Mohammad R; Nürnberg, Peter; Grobusch, Martin P; van der Poll, Tom

    2016-01-01

    HIV patients have an increased risk to develop sepsis and HIV infection affects several components of the immune system involved in sepsis pathogenesis. We hypothesized that HIV infection might aggrevate the aberrant immune response during sepsis, so we aimed to determine the impact of HIV infection

  11. Nutrición artificial en la sepsis Nutritional support in sepsis

    Directory of Open Access Journals (Sweden)

    C. Ortiz Leyba

    2005-06-01

    Full Text Available Aunque se considera que el soporte metabólico y nutricional debe formar parte de las medidas de tratamiento de los pacientes sépticos, no se ha demostrado de forma concluyente que el soporte nutricional mejore la supervivencia o las complicaciones de la sepsis. Los datos específicos sobre este tema son escasos dado que no son muchos los trabajos en los que se investigue el soporte nutricional especializado en pacientes sépticos. Por ello, las recomendaciones están basadas, en su mayoría, en los resultados obtenidos en pacientes graves con diferentes patologías. Se asume que el soporte nutricional debe llevarse a cabo por vía enteral, siempre que sea posible, al igual que en otros pacientes críticos. El gasto energético en estos pacientes es muy variable, si bien, en general, la situación hipermetabólica puede ser clasificada como moderada. Se recomienda un factor de 1,25-1,30 para el ajuste de la ecuación de Harris-Benedict en el cálculo del aporte calórico. Los enfermos con sepsis deberían recibir un aporte hiperproteico. La cantidad de glucosa administrada no debería exceder el 70% de las calorías no proteicas en tanto que el aporte de lípidos no debería superar el 40%. Respecto a los micronutrientes, se recomienda un aumento en el aporte de aquellos con propiedades antioxidantes (Vitamina E, carotenos, Vitamina C, selenio. Existen datos para considerar que la utilización de dietas enriquecidas en fármaconutrientes (tanto por vía parenteral como por vía enteral es beneficiosa en los enfermos con sepsis, si bien existe controversia en la interpretación de los resultados.Although it is considered that metabolic and nutritional support must be part of the management of septic patients, it has not been conclusively shown that nutritional support will improve survival or complications from sepsis. Specific data on this issue are scarce since there are few studies that have investigated specialized nutritional support in

  12. Alternative splicing of SMPD1 in human sepsis.

    Directory of Open Access Journals (Sweden)

    Marcel Kramer

    Full Text Available Acid sphingomyelinase (ASM or sphingomyelin phosphodiesterase, SMPD activity engages a critical role for regulation of immune response and development of organ failure in critically ill patients. Beside genetic variation in the human gene encoding ASM (SMPD1, alternative splicing of the mRNA is involved in regulation of enzymatic activity. Here we show that the patterns of alternatively spliced SMPD1 transcripts are significantly different in patients with systemic inflammatory response syndrome and severe sepsis/septic shock compared to control subjects allowing discrimination of respective disease entity. The different splicing patterns might contribute to the better understanding of the pathophysiology of human sepsis.

  13. ALGORITHM FOR POST-BURN BACTERIAL SEPSIS DIAGNOSIS

    OpenAIRE

    Guzenko, B. V.

    2013-01-01

    Introduction. In patients with extensive deep burns the most severe of all infectious and inflammatory complications is sepsis which causes high death rate.The purpose of our work was to develop the algorithm of bacterial sepsis diagnosis in patients with severe burn disease.Materials and methods. The study involved 140 burned patients divided into two groups: Group 1 – 78 patients who underwent necrectomy within 3-7 days after the burn, Group 2  (control) – 62 patients with necrectomy perfor...

  14. Neuroanatomy and Physiology of Brain Dysfunction in Sepsis.

    Science.gov (United States)

    Mazeraud, Aurelien; Pascal, Quentin; Verdonk, Franck; Heming, Nicholas; Chrétien, Fabrice; Sharshar, Tarek

    2016-06-01

    Sepsis-associated encephalopathy (SAE), a complication of sepsis, is often complicated by acute and long-term brain dysfunction. SAE is associated with electroencephalogram pattern changes and abnormal neuroimaging findings. The major processes involved are neuroinflammation, circulatory dysfunction, and excitotoxicity. Neuroinflammation and microcirculatory alterations are diffuse, whereas excitotoxicity might occur in more specific structures involved in the response to stress and the control of vital functions. A dysfunction of the brainstem, amygdala, and hippocampus might account for the increased mortality, psychological disorders, and cognitive impairment. This review summarizes clinical and paraclinical features of SAE and describes its mechanisms at cellular and structural levels. PMID:27229649

  15. MicroRNA's are novel biomarkers in sepsis

    DEFF Research Database (Denmark)

    Søndergaard, Edith Smed; Alamili, Mahdi; Coskun, Mehmet;

    2015-01-01

    inflammatory response syndrome. The miR measures were done during the ICU-stay and the outcome was either death or survival. The identified miRs were combined with predicted human target genes, in order to identify target genes associated with the inflammatory response. Results: We found 245 papers. Eleven...... between differential expression of miRs and sepsis. Methods: We performed a systematic search in the MEDLINE, Embase and Cochrane Library databases according to PRISMA-guidelines. We included all original English-language studies including human subjects admitted to the ICU with sepsis or systemic...

  16. Endothelial progenitors in sepsis: vox clamantis in deserto?

    Science.gov (United States)

    Goligorsky, Michael S

    2011-01-01

    In this issue of Critical Care, Patschan and colleagues present a study of endothelial progenitor cells (EPCs) in patients with sepsis. The importance of this study is in focusing attention on several frequently ignored aspects of sepsis. Among those are the phenomenon of microvascular dysfunction, which is potentially responsible for profound metabolic perturbations at the tissue level, and the role of endothelial progenitors in repair processes. Other important aspects of the study are the regenerative capacity of mobilized EPCs and the dissociation between the numerical value and clonogenic competence. Attempting to restore the competence to EPCs should be a priority in the future. PMID:21489327

  17. Atmospheric predictability revisited

    Directory of Open Access Journals (Sweden)

    Lizzie S. R. Froude

    2013-06-01

    Full Text Available This article examines the potential to improve numerical weather prediction (NWP by estimating upper and lower bounds on predictability by re-visiting the original study of Lorenz (1982 but applied to the most recent version of the European Centre for Medium Range Weather Forecasts (ECMWF forecast system, for both the deterministic and ensemble prediction systems (EPS. These bounds are contrasted with an older version of the same NWP system to see how they have changed with improvements to the NWP system. The computations were performed for the earlier seasons of DJF 1985/1986 and JJA 1986 and the later seasons of DJF 2010/2011 and JJA 2011 using the 500-hPa geopotential height field. Results indicate that for this field, we may be approaching the limit of deterministic forecasting so that further improvements might only be obtained by improving the initial state. The results also show that predictability calculations with earlier versions of the model may overestimate potential forecast skill, which may be due to insufficient internal variability in the model and because recent versions of the model are more realistic in representing the true atmospheric evolution. The same methodology is applied to the EPS to calculate upper and lower bounds of predictability of the ensemble mean forecast in order to explore how ensemble forecasting could extend the limits of the deterministic forecast. The results show that there is a large potential to improve the ensemble predictions, but for the increased predictability of the ensemble mean, there will be a trade-off in information as the forecasts will become increasingly smoothed with time. From around the 10-d forecast time, the ensemble mean begins to converge towards climatology. Until this point, the ensemble mean is able to predict the main features of the large-scale flow accurately and with high consistency from one forecast cycle to the next. By the 15-d forecast time, the ensemble mean has lost

  18. Dynamic Topography Revisited

    Science.gov (United States)

    Moresi, Louis

    2015-04-01

    Dynamic Topography Revisited Dynamic topography is usually considered to be one of the trinity of contributing causes to the Earth's non-hydrostatic topography along with the long-term elastic strength of the lithosphere and isostatic responses to density anomalies within the lithosphere. Dynamic topography, thought of this way, is what is left over when other sources of support have been eliminated. An alternate and explicit definition of dynamic topography is that deflection of the surface which is attributable to creeping viscous flow. The problem with the first definition of dynamic topography is 1) that the lithosphere is almost certainly a visco-elastic / brittle layer with no absolute boundary between flowing and static regions, and 2) the lithosphere is, a thermal / compositional boundary layer in which some buoyancy is attributable to immutable, intrinsic density variations and some is due to thermal anomalies which are coupled to the flow. In each case, it is difficult to draw a sharp line between each contribution to the overall topography. The second definition of dynamic topography does seem cleaner / more precise but it suffers from the problem that it is not measurable in practice. On the other hand, this approach has resulted in a rich literature concerning the analysis of large scale geoid and topography and the relation to buoyancy and mechanical properties of the Earth [e.g. refs 1,2,3] In convection models with viscous, elastic, brittle rheology and compositional buoyancy, however, it is possible to examine how the surface topography (and geoid) are supported and how different ways of interpreting the "observable" fields introduce different biases. This is what we will do. References (a.k.a. homework) [1] Hager, B. H., R. W. Clayton, M. A. Richards, R. P. Comer, and A. M. Dziewonski (1985), Lower mantle heterogeneity, dynamic topography and the geoid, Nature, 313(6003), 541-545, doi:10.1038/313541a0. [2] Parsons, B., and S. Daly (1983), The

  19. Remembered Experiences and Revisit Intentions

    DEFF Research Database (Denmark)

    Barnes, Stuart; Mattsson, Jan; Sørensen, Flemming

    2016-01-01

    Tourism is an experience-intensive sector in which customers seek and pay for experiences above everything else. Remembering past tourism experiences is also crucial for an understanding of the present, including the predicted behaviours of visitors to tourist destinations. We adopt a longitudinal...... approach to memory data collection from psychological science, which has the potential to contribute to our understanding of tourist behaviour. In this study, we examine the impact of remembered tourist experiences in a safari park. In particular, using matched survey data collected longitudinally and PLS...... path modelling, we examine the impact of positive affect tourist experiences on the development of revisit intentions. We find that longer-term remembered experiences have the strongest impact on revisit intentions, more so than predicted or immediate memory after an event. We also find that remembered...

  20. Revisiting Mutual Fund Performance Evaluation

    OpenAIRE

    Angelidis, Timotheos; Giamouridis, Daniel; Tessaromatis, Nikolaos

    2012-01-01

    Mutual fund manager excess performance should be measured relative to their self-reported benchmark rather than the return of a passive portfolio with the same risk characteristics. Ignoring the self-reported benchmark introduces biases in the measurement of stock selection and timing components of excess performance. We revisit baseline empirical evidence in mutual fund performance evaluation utilizing stock selection and timing measures that address these biases. We introduce a ...

  1. Markowitz Revisited: Social Portfolio Engineering

    OpenAIRE

    Gasser, Stephan; Kremser, Thomas; Rammerstorfer, Margarethe; Weinmayer, Karl

    2014-01-01

    In recent years socially responsible investing has become an increasingly more popular subject with both private and institutional investors. At the same time, a number of scientific papers have been published on socially responsible investments (SRIs), covering a broad range of topics, from what actually defines SRIs to the financial performance of SRI funds in contrast to non-SRI funds. In this paper, we revisit Markowitz' Portfolio Selection Theory and propose a modification...

  2. Leadership and Management Theories Revisited

    OpenAIRE

    Madsen, Mona Toft

    2001-01-01

    The goal of the paper is to revisit and analyze key contributions to the understanding of leadership and management. As a part of the discussion a role perspective that allows for additional and/or integrated leader dimensions, including a change-centered, will be outlined. Seemingly, a major challenge on the substantive level is the integration of soft and hard managerial functions, while the concepts used in presenting these should at least in transition be able to contain a distinction bet...

  3. Development and validation of a multiplex add-on assay for sepsis biomarkers using xMAP technology

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Schneider, Uffe Vest; Scheel, Troels; Andersen, Ove; Eugen-Olsen, Jesper

    2006-01-01

    Sepsis is a common and often fatal disease. Because sepsis can be caused by many different organisms, biomarkers that can aid in diagnosing sepsis and monitoring treatment efficacy are highly warranted. New sepsis markers may provide additional information to complement the currently used markers....

  4. Arginine, citrulline and nitric oxide metabolism in sepsis

    Science.gov (United States)

    Arginine has vasodilatory effects, via its conversion by nitric oxide (NO) synthase into NO, and immunomodulatory actions that play important roles in sepsis. Protein breakdown affects arginine availability, and the release of asymmetric dimethylarginine, an inhibitor of NO synthase, may therefore a...

  5. The redistribution of granulocytes following E. coli endotoxin induced sepsis

    DEFF Research Database (Denmark)

    Toft, P; Lillevang, S T; Tønnesen, Else Kirstine;

    1994-01-01

    Infusion of endotoxin elicits granulocytopenia followed by increased numbers of granulocytes in peripheral blood. The purpose of this study was to investigate the redistribution and sequestration of granulocytes in the tissues following E. coli endotoxin induced sepsis. From 16 rabbits granulocytes...

  6. Cerebral blood flow is reduced in patients with sepsis syndrome

    International Nuclear Information System (INIS)

    The relationship between sepsis-induced CNS dysfunction and changes in brain blood flow remains unknown, and animal studies examining the influence of sepsis on cerebral blood flow (CBF) do not satisfactorily address that relationship. We measured CBF and cerebrovascular reactivity to CO2 in nine patients with sepsis syndrome using the 133Xe clearance technique. Mean CBF was 29.6 +/- 15.8 (SD) ml/100 g.min, significantly lower than the normal age-matched value in this laboratory of 44.9 +/- 6.2 ml/100 g.min (p less than .02). This depression did not correlate with changes in mean arterial pressure. Despite the reduction in CBF, the specific reactivity of the cerebral vasculature to changes in CO2 was normal, 1.3 +/- 0.9 ml/100 g.min/mm Hg. Brain blood flow is reduced in septic humans; the contribution of this reduction to the metabolic and functional changes observed in sepsis requires further study

  7. The etiology of neonatal sepsis and patterns of antibiotic resistance

    International Nuclear Information System (INIS)

    Objective: To study the patterns of causative bacteria and antibiotic resistance in neonatal sepsis. Results: Among 228 cases included in the study, the male to female ratio was 2.1 to 1. The gestational age was less than 36 weeks in 68 (30%) cases and low birth weight babies were 143 (62.6%). History of birth asphyxia was present in 103 (45%) cases. There were 142 (62.3%) cases of early onset (7 days). Out of 233 positive blood cultures Escherichia coli was found to be commonest (47.8%, n =111, p<0.05) both in early onset (47.8%, n=68, p <0.05) and late onset sepsis (47.3%,n=43, p<0.05). Staphylococcus aureus was the most common among gram positive organism. Resistance to cefotaxime, ceftazidime and amikacin was 34% to 80% and to ciprofloxacin 13% to 72%. A total of 64 cases (28%) died. Mortality was four times higher in early onset sespis. Conclusion: Gram negative bacteria are the commenst cause of neonatal sepsis. The resistance to the commonly used antibiotics is alarmingly high. Mortality is four times higher in early one set sepsis. (author)

  8. ROLE OF TUMOR NECROSIS FACTOR IN NEONATAL SEPSIS

    Institute of Scientific and Technical Information of China (English)

    史源; 沈际臬; 汪江淮; 李华强; 覃世文; 刘韧

    1994-01-01

    In order to assess the role of tumor necrosis factor (TNF) in neonatal sepsis,plasma TNF levels were deter-mined by a method using L929 cells at the time of septic work-up in 67 neonates.Thirty-three patients with sepsis were found to have significantly higher TNF levels (533.33±468.74U/ml;1U corresponding to 1.67 pg re-combinant TNF)as compared with 34 non-sepsis patients (100.0±188,974U/ml)and 30 healthy newborns (27.33±16.17U/ml,P<0.05,respectively),The upper limit of normal plasma TNF levels was 60U/ml and the best cutoff value for predicting neonatal sepsis was 160U/ml.This had remarkable sensitivity (88%).Plasma TNF levels were significantly associated with the occurrence of shock,organ failure,sclerema and outcome.Thus,anti-TNF anti-bodies might be used in protecting newborns from septic death.

  9. Sepsis Patient Detection and Monitor Based on Auto-BN.

    Science.gov (United States)

    Jiang, Yu; Sha, Lui; Rahmaniheris, Maryam; Wan, Binhua; Hosseini, Mohammad; Tan, Pengliu; Berlin, Richard B

    2016-04-01

    Sepsis is a life-threatening condition caused by an inappropriate immune response to infection, and is a leading cause of elderly death globally. Early recognition of patients and timely antibiotic therapy based on guidelines improve survival rate. Unfortunately, for those patients, it is often detected late because it is too expensive and impractical to perform frequent monitoring for all the elderly. In this paper, we present a risk driven sepsis screening and monitoring framework to shorten the time of onset detection without frequent monitoring of all the elderly. Within this framework, the sepsis ultimate risk of onset probability and mortality is calculated based on a novel temporal probabilistic model named Auto-BN, which consists of time dependent state, state dependent property, and state dependent inference structures. Then, different stages of a patient are encoded into different states, monitoring frequency is encoded into the state dependent property, and screening content is encoded into different state dependent inference structures. In this way, the screening and monitoring frequency and content can be automatically adjusted when encoding the sepsis ultimate risk into the guard of state transition. This allows for flexible manipulation of the tradeoff between screening accuracy and frequency. We evaluate its effectiveness through empirical study, and incorporate it into existing medical guidance system to improve medical healthcare. PMID:26940673

  10. Thymic Stromal Lymphopoietin Improves Survival and Reduces Inflammation in Sepsis.

    Science.gov (United States)

    Piliponsky, Adrian M; Lahiri, Asha; Truong, Phuong; Clauson, Morgan; Shubin, Nicholas J; Han, Hongwei; Ziegler, Steven F

    2016-08-01

    The mechanisms that contribute to homeostasis of the immune system in sepsis are largely unknown. One study suggests a potential detrimental role for thymic stromal lymphopoietin (TSLP) in sepsis; however, the immune-regulatory effects of TSLP on myeloid cells within the intestinal microenvironment suggest the contrary. Our objective was to clarify TSLP's role in sepsis. Cecal ligation and puncture was performed in mice with total or myeloid-specific deficiency in the TSLP receptor (TSLPR). Survival was monitored closely, peritoneal fluids and plasma were analyzed for markers of inflammation, and myeloid cell numbers and their ability to produce inflammatory mediators was determined. The interaction of TSLP with TSLPR in myeloid cells contributed to mouse survival after septic peritonitis. Mice with TSLPR deficiency in myeloid cells displayed excessive local and systemic inflammation levels (e.g., increased inflammatory cell and cytokine levels) relative to control mice. Moreover, hepatic injury was exacerbated in mice with TSLPR deficiency in their myeloid cells. However, the enhanced inflammatory response did not affect the ability of these mice to clear bacteria. Resident neutrophils and macrophages from septic mice with TSLPR deficiency exhibited an increased ability to produce proinflammatory cytokines. Collectively, our findings suggest that the effects of TSLP on myeloid cells are crucial in reducing the multiple organ failure that is associated with systemic inflammation, which highlights the significance of this cytokine in modulating the host response to infection and in reducing the risks of sepsis development. PMID:26934097

  11. Fatal Sepsis by Bacillus Circulans in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    S Jahani Sherafat

    2011-12-01

    Full Text Available An immunosuppressed man was admitted to hospital with diarrhea and a history of urinary tract infection. He was subjected to treatment with antibiotics. The patient died of putative severe sepsis. The etiological agent was a carbapenemase producing isolate of Bacillus circulans with resistance to all prescribed antimicrobial agents.

  12. Dog-bite induced sepsis : a report of four cases

    NARCIS (Netherlands)

    Hovenga, S; Tulleken, JE; Moller, LVM; Jackson, SA; Van der Werf, TS; Zijlstra, JG

    1997-01-01

    Occasionally, a dog-bite is complicated by a systemic overwhelming infection. We report four consecutive patients who were admitted to our intensive care unit because of sepsis syndrome following dog-bites. The history of these patients did not reveal any immunocompromising conditions. Capnocytophag

  13. Vasopressin in cirrhosis and sepsis: physiology and clinical implications.

    Science.gov (United States)

    Wagener, G; Bakker, J

    2015-12-01

    Arginine-vasopressin (AVP) is an important hormone in the regulation of plasma osmolality and blood volume/pressure. In clinical practice it is frequently used in the treatment of septic shock and decompensated cirrhosis. In this review the physiology of AVP and its analogues is presented. In addition the use of AVP in cirrhosis and sepsis is reviewed. PMID:25384691

  14. Systemic inflammatory response syndrome in surgical patients with sepsis

    OpenAIRE

    Milić Dragan J.; Pejić Miljko A.; Živić Saša S.; Karanikolić Aleksandar D.; Jovanović Slobodan; Radojković Milan

    2004-01-01

    Systemic inflammatory response syndrome and sepsis are common in surgically treated patients. Systemic inflammatory response syndrome represents a major factor of morbidity and mortality in these patients. The pathogenesis of these syndromes has been increasingly clarified. The objective of this review is to present an overview of our current understanding of the physiology underlying these conditions.

  15. Leukocyte activation in sepsis; correlations with disease state and mortality

    NARCIS (Netherlands)

    Kobold, ACM; Tulleken, JE; Zijlstra, JG; Sluiter, W; Hermans, J; Kallenberg, CGM; Tervaert, JWC

    2000-01-01

    Objective: The immune response in sepsis shows a bimodal pattern consisting of an early, frequently exaggerated inflammatory response followed by a state of hyporesponsiveness often referred to as the compensatory anti-inflammatory response syndrome (CARS). Insight into the disease state may be help

  16. Mortality audit of neonatal sepsis secondary to Acinetobacter

    Directory of Open Access Journals (Sweden)

    Anuradha S De

    2013-01-01

    Full Text Available Background: Multidrug resistant Acinetobacter infection has emerged as an important pathogen in neonatal sepsis in the recent years causing morbidity as well as mortality. Materials and Methods: A retrospective analysis was performed over a one and a half year period of all neonates admitted with sepsis in our neonatal intensive care unit (NICU, who developed Acinetobacter infection and to identify mortality-associated risk factors in these neonates. Results: Incidence of neonatal septicaemia due to Acinetobacter species was 9.18%. All were cases of early onset sepsis. Predominant species isolated was Acinetobacter baumanii (67.5%. The major symptoms were lethargy and poor feeding. The major signs were tachypnoea, rib retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. Overall, 53.75% were multidrug resistant (MDR Acinetobacter. Resistance to more than two drugs (MDR was statistically significant in A. baumanii as compared with nonbaumanii. Overall mortality due to Acinetobacter neonatal sepsis was 20%. Septicemia due to A. baumanii was associated with higher mortality than those due to nonbaumanii isolates. Lethargy, tachypnoea, rib retraction, tachycardia, respiratory distress, and mechanical ventilation were significant predictors of mortality. Conclusion: Multidrug resistant Acinetobacter infection is fatal, particularly in premature and low birth weight neonates. Therefore, an effective infection control policy and rational antibiotic use are mandatory in neonatal intensive care areas of each hospital in order to control Acinetobacter infection and improve outcome.

  17. Role of intravenous immunoglobulin in suspected or proven neonatal sepsis

    Institute of Scientific and Technical Information of China (English)

    GAUTAM M. K.; JIANG Li

    2013-01-01

    Neonatal sepsis remains the major cause of mortality and morbidity including neurodevelopmental impairment and prolonged hospital stay in newborn infants .Despite of advances in technology and optimal antibiotic tre-atment, incidence of neonatal sepsis and its complications remains unacceptably high especially in developing countries .Premature neonates in particular are at higher risk due to developmentally immature host defence mecha-nisms.Though not approved by Food and Drug Administration ( FDA ) U.S.A, off label use of intravenous immunoglobulin as prophylactic or adjuvant agent in suspected or proven neonatal infections continues in many countries.In a recent large multicenter clinical trial by International Neonatal Immunotherapy Study (INIS) group, the use of polyvalent IgG immune globulin was not associated with significant differences in the risk of major com -plications or other adverse outcomes in neonates with suspected or proven sepsis .Hence, use of intravenous immu-noglobulin in suspected or proven neonatal sepsis is not recommended .The expense of prophylactic use of intrave-nous immunoglobulin administration for both term and preterm newborn population , given the minimal benefit as demonstrated by many individual studies and by meta-analysis is not justified .

  18. [Metabolic therapy and pulmonary disfunction in patients with obstetric sepsis].

    Science.gov (United States)

    Iakovlev, A Iu; Zaĭtsev, P M; Zubeev, P S; Mokrov, K B; Balandina, A V; Gushchina, N N; Kucherenko, V E

    2011-01-01

    The role of reamberin, a succinate-containing infusion preparation in correlation of pulmonary metabolic and respiratory disturbances in patients with obstetric puerperal sepsis was estimated. The prospective randomized study enrolled 43 patients with puerperal obstetric sepsis complicated by polyorganic deficiency (SOFA 8-10). Nineteen patients of the 1st group and 24 patients of the 2nd group were additionally treated with reamberin in a dose of 800 ml/day for 8 days. The venous and arterial difference by glucose, lactate, pyruvate, diene conjugates, malondialdehyde and ceruloplasmin was investigated. The blood gases were determined with the Ciba Corning 45 apparatus. Lower metabolic activity of the lungs with prevalence of the glucose anaerobic metabolism and lower activity of the intrapulmonary antioxidant protection were observed in the patients with obstetric sepsis. The use of reamberin in the complex therapy of obstetric sepsis promoted maintenance of the initial balance and anaeroibic and aerobic pulmonary metabolism, thus providing shorter terms of the decompensation and recovery of the lungs respiratory function. PMID:21913408

  19. Listeria monocytogenes infection in pregnancy and neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Francesca Pascale

    2008-06-01

    Full Text Available Authors report a fatal neonatal sepsis caused by Listeria monocytogenes. While the diagnostic procedure aimed to identify the microrganism is described, it is emphasized the importance to recover Streptococcus agalactiae (GBS and L. monocytogenes by means of vaginal-rectal swab culture. The intrapartum screening for L. monocytogenes, by Polymerase Chain Reaction (PCR providing results in 75 minutes is also evaluated.

  20. Inflammatory Response in Preterm and Very Preterm Newborns with Sepsis

    Directory of Open Access Journals (Sweden)

    Enrique Segura-Cervantes

    2016-01-01

    Full Text Available The response of the adaptive immune system is usually less intense in premature neonates than term neonates. The primary objective of this study was to determine whether immunological parameters vary between preterm (PT neonates (≥32 weeks of gestational age and very preterm (VPT neonates (<32 weeks of gestational age. A cross-sectional study was designed to prospectively follow PT and VPT neonates at risk of developing sepsis. Plasma concentrations of IFN-γ, TNF-α, IL-6, IL-4, and IL-10 were detected using flow cytometry. C-reactive protein (C-RP and the complex SC5b-9 were detected in the plasma using commercial kits. A total of 83 patients were included. The laboratory results and clinical histories showed that 26 patients had sepsis; 14 were VPT, and 12 were PT. The levels of C-RP, SC5b-9 (innate immune response mediators, and IL-10 or IL-4 (anti-inflammatory cytokines were elevated during sepsis in both groups. IFN-γ, TNF-α, and IL-6 (proinflammatory cytokines were differentially elevated only in PT neonates. The VPT neonates with sepsis presented increases in C-RP, SC5b-9, and anti-inflammatory cytokines but not in proinflammatory cytokines, whereas PT neonates showed increases in all studied mediators of inflammation.

  1. Reactivation of multiple viruses in patients with sepsis.

    Directory of Open Access Journals (Sweden)

    Andrew H Walton

    Full Text Available A current controversy is whether patients with sepsis progress to an immunosuppressed state. We hypothesized that reactivation of latent viruses occurred with prolonged sepsis thereby providing evidence of clinically-relevant immunosuppression and potentially providing a means to serially-monitor patients' immune status. Secondly, if viral loads are markedly elevated, they may contribute to morbidity and mortality. This study determined if reactivation of herpesviruses, polyomaviruses, and the anellovirus TTV occurred in sepsis and correlated with severity. Serial whole blood and plasma samples from 560 critically-ill septic, 161 critically-ill non-septic, and 164 healthy age-matched patients were analyzed by quantitative-polymerase-chain-reaction for cytomegalovirus (CMV, Epstein-Barr (EBV, herpes-simplex (HSV, human herpes virus-6 (HHV-6, and TTV. Polyomaviruses BK and JC were quantitated in urine. Detectable virus was analyzed with respect to secondary fungal and opportunistic bacterial infections, ICU duration, severity of illness, and survival. Patients with protracted sepsis had markedly increased frequency of detectable virus. Cumulative viral DNA detection rates in blood were: CMV (24.2%, EBV (53.2%, HSV (14.1%, HHV-6 (10.4%, and TTV (77.5%. 42.7% of septic patients had presence of two or more viruses. The 50% detection rate for herpesviruses was 5-8 days after sepsis onset. A small subgroup of septic patients had markedly elevated viral loads (>104-106 DNA copies/ml blood for CMV, EBV, and HSV. Excluding TTV, DNAemia was uncommon in critically-ill non-septic patients and in age-matched healthy controls. Compared to septic patients without DNAemia, septic patients with viremia had increased fungal and opportunistic bacterial infections. Patients with detectable CMV in plasma had higher 90-day mortality compared to CMV-negative patients; p<0.05. Reactivation of latent viruses is common with prolonged sepsis, with frequencies similar to

  2. Sinomenine Hydrochloride Protects against Polymicrobial Sepsis via Autophagy

    Directory of Open Access Journals (Sweden)

    Yu Jiang

    2015-01-01

    Full Text Available Sepsis, a systemic inflammatory response to infection, is the major cause of death in intensive care units (ICUs. The mortality rate of sepsis remains high even though the treatment and understanding of sepsis both continue to improve. Sinomenine (SIN is a natural alkaloid extracted from Chinese medicinal plant Sinomenium acutum, and its hydrochloride salt (Sinomenine hydrochloride, SIN-HCl is widely used to treat rheumatoid arthritis (RA. However, its role in sepsis remains unclear. In the present study, we investigated the role of SIN-HCl in sepsis induced by cecal ligation and puncture (CLP in BALB/c mice and the corresponding mechanism. SIN-HCl treatment improved the survival of BALB/c mice that were subjected to CLP and reduced multiple organ dysfunction and the release of systemic inflammatory mediators. Autophagy activities were examined using Western blotting. The results showed that CLP-induced autophagy was elevated, and SIN-HCl treatment further strengthened the autophagy activity. Autophagy blocker 3-methyladenine (3-MA was used to investigate the mechanism of SIN-HCl in vitro. Autophagy activities were determined by examining the autophagosome formation, which was shown as microtubule-associated protein light chain 3 (LC3 puncta with green immunofluorescence. SIN-HCl reduced lipopolysaccharide (LPS-induced inflammatory cytokine release and increased autophagy in peritoneal macrophages (PM. 3-MA significantly decreased autophagosome formation induced by LPS and SIN-HCl. The decrease of inflammatory cytokines caused by SIN-HCl was partially aggravated by 3-MA treatment. Taken together, our results indicated that SIN-HCl could improve survival, reduce organ damage, and attenuate the release of inflammatory cytokines induced by CLP, at least in part through regulating autophagy activities.

  3. Therapeutic effects of compound hypertonic saline on rats with sepsis

    Directory of Open Access Journals (Sweden)

    Fang Dong

    2014-09-01

    Full Text Available Sepsis is one of the major causes of death and is the biggest obstacle preventing improvement of the success rate in curing critical illnesses. Currently, isotonic solutions are used in fluid resuscitation technique. Several studies have shown that hypertonic saline applied in hemorrhagic shock can rapidly increase the plasma osmotic pressure, facilitate the rapid return of interstitial fluid into the blood vessels, and restore the effective circulating blood volume. Here, we established a rat model of sepsis by using the cecal ligation and puncture approach. We found that intravenous injection of hypertonic saline dextran (7.5% NaCl/6% dextran after cecal ligation and puncture can improve circulatory failure at the onset of sepsis. We found that the levels of tumor necrosis factor-α, interleukin-1β, interleukin-6 and intracellular adhesion molecule 1 levels in the lung tissue of cecal ligation and puncture rats treated with hypertonic saline dextran were significantly lower than the corresponding levels in the control group. We inferred that hypertonic saline dextran has a positive immunoregulatory effect and inhibits the overexpression of the inflammatory response in the treatment of sepsis. The percentage of neutrophils, lung myeloperoxidase activity, wet to dry weight ratio of lung tissues, histopathological changes in lung tissues, and indicators of arterial blood gas analysis was significantly better in the hypertonic saline dextran-treated group than in the other groups in this study. Hypertonic saline dextran-treated rats had significantly improved survival rates at 9 and 18 h compared to the control group. Our results suggest that hypertonic saline dextran plays a protective role in acute lung injury caused after cecal ligation and puncture. In conclusion, hypertonic/hyperoncotic solutions have beneficial therapeutic effects in the treatment of an animal model of sepsis.

  4. Characterization and modulation of the immunosuppressive phase of sepsis.

    Science.gov (United States)

    Muenzer, Jared T; Davis, Christopher G; Chang, Kathy; Schmidt, Robert E; Dunne, W Michael; Coopersmith, Craig M; Hotchkiss, Richard S

    2010-04-01

    Sepsis continues to cause significant morbidity and mortality in critically ill patients. Studies of patients and animal models have revealed that changes in the immune response during sepsis play a decisive role in the outcome. Using a clinically relevant two-hit model of sepsis, i.e., cecal ligation and puncture (CLP) followed by the induction of Pseudomonas aeruginosa pneumonia, we characterized the host immune response. Second, AS101 [ammonium trichloro(dioxoethylene-o,o')tellurate], a compound that blocks interleukin 10 (IL-10), a key mediator of immunosuppression in sepsis, was tested for its ability to reverse immunoparalysis and improve survival. Mice subjected to pneumonia following CLP had different survival rates depending upon the timing of the secondary injury. Animals challenged with P. aeruginosa at 4 days post-CLP had approximately 40% survival, whereas animals challenged at 7 days had 85% survival. This improvement in survival was associated with decreased lymphocyte apoptosis, restoration of innate cell populations, increased proinflammatory cytokines, and restoration of gamma interferon (IFN-gamma) production by stimulated splenocytes. These animals also showed significantly less P. aeruginosa growth from blood and bronchoalveolar lavage fluid. Importantly, AS101 improved survival after secondary injury 4 days following CLP. This increased survival was associated with many of the same findings observed in the 7-day group, i.e., restoration of IFN-gamma production, increased proinflammatory cytokines, and decreased bacterial growth. Collectively, these studies demonstrate that immunosuppression following initial septic insult increases susceptibility to secondary infection. However, by 7 days post-CLP, the host's immune system has recovered sufficiently to mount an effective immune response. Modulation of the immunosuppressive phase of sepsis may aid in the development of new therapeutic strategies. PMID:20100863

  5. Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease

    OpenAIRE

    Mehta, Ravindra L; Bouchard, Josée; Soroko, Sharon B.; Ikizler, T. Alp; Paganini, Emil P.; Chertow, Glenn M.; Himmelfarb, Jonathan; ,

    2010-01-01

    Purpose Sepsis commonly contributes to acute kidney injury (AKI); however, the frequency with which sepsis develops as a complication of AKI and the clinical consequences of this sepsis are unknown. This study examined the incidence of, and outcomes associated with, sepsis developing after AKI. Methods We analyzed data from 618 critically ill patients enrolled in a multicenter observational study of AKI (PICARD). Patients were stratified according to their sepsis status and timing of incident...

  6. A comprehensive time-course–based multicohort analysis of sepsis and sterile inflammation reveals a robust diagnostic gene set

    OpenAIRE

    Sweeney, Timothy E.; Shidham, Aaditya; Wong, Hector R.; Khatri, Purvesh

    2015-01-01

    Although several dozen studies of gene expression in sepsis have been published, distinguishing sepsis from a sterile systemic inflammatory response syndrome (SIRS) is still largely up to clinical suspicion. We hypothesized that a multicohort analysis of the publicly available sepsis gene expression data sets would yield a robust set of genes for distinguishing patients with sepsis from patients with sterile inflammation. A comprehensive search for gene expression data sets in sepsis identifi...

  7. Diagnostic value of urine sCD163 levels for sepsis and relevant acute kidney injury: a prospective study

    OpenAIRE

    Su Longxiang; Feng Lin; Liu Changting; Jiang Zhaoxu; Li Ming; Xiao Kun; Yan Peng; Jia Yanhong; Feng Dan; Xie Lixin

    2012-01-01

    Abstract Background Sepsis is a common syndrome in critically ill patients and easily leads to the occurrence of acute kidney injury (AKI), with high mortality rates. This study aimed to investigate the diagnostic value of urine soluble CD163 (sCD163) for identification of sepsis, severity of sepsis, and for secondary AKI, and to assess the patients’ prognosis. Methods We enrolled 20 cases with systemic inflammatory response syndrome (SIRS), 40 cases with sepsis (further divided into 17 sepsi...

  8. Evaluation of hedgerow trees in alley cropping for phosphorus use efficiency and N2 fixation in low P soils in moist savanna in Nigeria

    International Nuclear Information System (INIS)

    Soils low in P and N are common in the moist savanna climatic zones and consequently growth of hedgerow trees in alley cropping systems might require addition of N and P fertilizers. This is difficult for small scale farmers who have limited access to fertilizers and therefore depend only on limited input cropping systems. Exploiting genetic differences in P use efficiency and using hedgerow trees selected for high N2 fixation ability can improve tree establishment and growth on N and P-poor soils, restore soil fertility and preserve soil from degradation. Field experiments carried out at Fashola (moist savanna) have shown that large differences in growth and P use efficiency occurred between N2 fixing trees such as Gliricidia sepium, and non N2-fixing trees such as Senna siamea and Senna spectabilis. Provenances or isoline differences in P use efficiency also occurred within species and was also influenced by level of P and period of growth. Differences between species and provenances in P uptake and growth were largely related to differences in physiological P-use efficiency (PPUE), root length and VAM infection rate, especially at low P. In general, nodulation was improved by P application, but varied among provenances. Gliricidia Sepium fixed about 61% of its N from atmospheric N2 in the pot experiment and 40% in the field. The percentage of N fixed was not affected by rate of P application. Differences in P and N accumulation and use efficiency were also influenced by management practices such as pruning. The distribution of total P followed the same trend as that of dry matter yield, while no significant correlations were found between partitioning of dry matter and total N. Uncut and cut G. Sepium derived 35 and 54% respectively of their N from atmospheric N2. About 54% of the fixed N2 was partitioned to shoots and roots and this was not proportional to the size of these organs relative the whole plant. 17 refs, 2 figs,. 2 tabs

  9. Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics

    Directory of Open Access Journals (Sweden)

    João Manoel Silva

    2013-01-01

    Full Text Available Introduction: Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. Methods: A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU. Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP, procalcitonin (PCT, interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality. Results: The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008. The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001. Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4% and Gram-positive cocci (36.4% (p=0.001. CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively, with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005, with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74. In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively. Conclusions: The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and

  10. The diagnosis of sepsis using POCT in the Emergency Department – Medical and legal implications

    Directory of Open Access Journals (Sweden)

    Bogdan C. Teușdea

    2015-04-01

    Full Text Available Sepsis, severe sepsis and septic shock are some of the most serious affections which threaten the lives of the patients who come to the Emergency Department and which require fast treatment because the more severe the sepsis was, the higher the mortality, up to 50% higher in severe sepsis. That is why, at present, the 2013 Guides of Surviving Sepsis Campaign recommend that the potential source of infection should be confirmed as soon as possible, in the first 6 hours since the patient arrived in the Emergency Unit if possible, moreover the large spectrum antibiotics therapy must be administered in one hour after the severe sepsis or the septic shock were identified. That is why the identification of these patients at risk is very important and this identification can only be made using POCT type devices. This type of devices has the capacity to make precise determinations, in a short time (15-17 minutes, using minimum quantities of integral blood, without using test tubes, sepsis biomarkers and other additional material. The possibility to fast diagnose sepsis, offers the doctors from the Emergency Department, the capacity to fast initiate an antibiotic treatment, to hospitalize the patient and at the same time, it gives them the certainty that they did not miss the sepsis diagnosis, thus avoiding the situation of malpractice. A preliminary study, regarding the sepsis biomarkers, which took place in the Emergency Unit of University Central Emergency Military Hospital, is also presented within this article.

  11. Spontaneous blood pressure oscillations in mechanically ventilated patients with sepsis

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Plovsing, Ronni R; Greve, Anders M;

    2016-01-01

    OBJECTIVE: In the present hypothesis-generating study, we investigated whether spontaneous blood pressure oscillations are suppressed to lower frequencies, and whether abolished oscillations are associated with an adverse outcome in mechanically ventilated patients with sepsis. METHODS: We...... retrospectively subjected invasive steady-state blood pressure recordings from 65 mechanically ventilated patients with sepsis to spectral analysis. Modified spectral bands were visually identified by plotting spectral power against frequency. RESULTS: Modified middle-frequency and low-frequency (MF' and LF......') oscillations were absent in 9% and 22% of the patients, respectively. In patients in whom spontaneous blood pressure oscillations were preserved, the MF' oscillations occurred at 0.021 Hz (median, interquartile range 0.013-0.030), whereas the LF' oscillations occurred at 0.009 Hz (median, interquartile range 0...

  12. Renal replacement therapy in sepsis-induced acute renal failure

    Directory of Open Access Journals (Sweden)

    Rajapakse Senaka

    2009-01-01

    Full Text Available Acute renal failure (ARF is a common complication of sepsis and carries a high mortality. Renal replacement therapy (RRT during the acute stage is the mainstay of therapy. Va-rious modalities of RRT are available. Continuous RRT using convective methods are preferred in sepsis-induced ARF, especially in hemodynamically unstable patients, although clear evidence of benefit over intermittent hemodialysis is still not available. Peritoneal dialysis is clearly inferior, and is not recommended. Early initiation of RRT is probably advantageous, although the optimal timing of dialysis is yet unknown. Higher doses of RRT are more likely to be beneficial. Use of bio-compatible membranes and bicarbonate buffer in the dialysate are preferred. Anticoagulation during dialysis must be carefully adjusted and monitored.

  13. Coagulation cascade in sepsis: getting from bench to bedside?

    OpenAIRE

    Brown, Glen

    2002-01-01

    The relationship between blood coagulation factors and the promotion or inhibition of the anti-inflammatory response continues to be defined through basic research. The potential key role of blood coagulation factors in the response during sepsis provides an exciting potential mechanism(s) for modification through the application of new therapies. The complexity of the potential multiple actions of the proteins, such as protein C, should allow for development of new therapies to minimize the ...

  14. Effect of bacterial sepsis on gluconeogenic capacity in the rat

    International Nuclear Information System (INIS)

    Since sepsis places increased demands on the host for energy and on other substrates for tissue repair and host defense, hepatic gluconeogenesis is critical for the host's adaptation to sepsis. Substrate-stimulated gluconeogenesis (i.e., gluconeogenic capacity) was assessed by the alanine load method in mannoheptulose-pretreated rats made septic by cecal ligation after laparotomy, as well as by cecal ligation and puncture after laparotomy. Fasted rats subjected to laparotomy only (sham-ligated) and fasted, nonoperated rats (controls) were investigated simultaneously. Following an overnight (-18 to 0 hr) fast, nonoperated animals converted 17.9 +/- 1.5% of [14C]alanine to [14C]glucose. Continued fasting in nonoperated animals resulted in enhanced (P less than 0.05) gluconeogenic capacity (6 hr = 27.2 +/- 3.0%; 24 hr = 26.2 +/- 1.9%; and 48 hr = 28.5 +/- 2.6%) relative to Time 0. Laparotomy alone (sham ligation) delayed the fasting-induced increase (P less than 0.05) in gluconeogenesis capacity (6 hr = 21.1 +/- 1.2%; 24 hr = 18.5 +/- 1.3%; 48 hr = 27.8 +/- 1.0%) relative to Time 0. In contrast, postoperative sepsis produced a sustained depression (P less than 0.05) of gluconeogenic capacity relative to nonoperated sham-ligated controls at 48 hr (cecal ligation, 18.4 +/- 1.4%; and cecal ligation and puncture, 18.8 +/- 1.2%). Thus, (1) fasting enhances hepatic gluconeogenic capacity; (2) surgical trauma transiently blunts the gluconeogenic response to fasting; and (3) sepsis undermines the gluconeogenic response to fasting

  15. Metabolic resuscitation in sepsis: a necessary step beyond the hemodynamic?

    Science.gov (United States)

    Leite, Heitor Pons; de Lima, Lúcio Flávio Peixoto

    2016-07-01

    Despite the advances made in monitoring and treatment of sepsis and septic shock, many septic patients ultimately develop multiple organ dysfunction (MODS) and die, suggesting that other players are involved in the pathophysiology of this syndrome. Mitochondrial dysfunction occurs early in sepsis and has a central role in MODS development. MODS severity and recovery of mitochondrial function have been associated with survival. In recent clinical and experimental investigations, mitochondrion-target therapy for sepsis and septic shock has been suggested to reduce MODS severity and mortality. This intervention, which might be named "metabolic resuscitation", would lead to improved mitochondrial activity afforded by pharmacological and nutritional agents. Of particular interest in this therapeutic strategy is thiamine, a water-soluble vitamin that plays an essential role in cellular energy metabolism. Critical illness associated with hypermetabolic states may predispose susceptible individuals to the development of thiamine deficiency, which is not usually identified by clinicians as a source of lactic acidosis. The protective effects of thiamine on mitochondrial function may justify supplementation in septic patients at risk of deficiency. Perspectives of supplementation with other micronutrients (ascorbic acid, tocopherol, selenium and zinc) and potential metabolic resuscitators [coenzyme Q10 (CoQ10), cytochrome oxidase (CytOx), L-carnitine, melatonin] to target sepsis-induced mitochondrial dysfunction are also emerging. Metabolic resuscitation may probably be a safe and effective strategy in the treatment of septic shock in the future. However, until then, preliminary investigations should be replicated in further researches for confirmation. Better identification of groups of patients presumed to benefit clinically by a certain intervention directed to "mitochondrial resuscitation" are expected to increase driven by genomics and metabolomics. PMID:27501325

  16. Shedding metabo‘light’ on the search for sepsis biomarkers

    OpenAIRE

    Claudia C. Dos Santos

    2015-01-01

    The clinical presentation of severe infection with generalized inflammation is similar, if not identical, to systemic inflammation induced by sterile tissue injury. Novel models and unbiased technologies are urgently needed for biomarker identification and disease profiling in sepsis. Here we briefly review the article of Kamisoglu and colleagues in this issue of Critical Care on comparing metabolomics data from different studies to assess whether responses elicited by endotoxin recapitulate,...

  17. Scrub Typhus with Sepsis and Acute Respiratory Distress Syndrome

    OpenAIRE

    Kurup, Asok; Issac, Aneesh; Loh, Jin Phang; Lee, Too Bou; Chua, Robert; Bist, Pradeep; Chao, Chien-Chung; Lewis, Michael; Gubler, Duane J.; Ching, Wei Mei; Ooi, Eng Eong; Sukumaran, Bindu

    2013-01-01

    Scrub typhus is a major infectious threat in the Asia-Pacific region. We report an unusual case of scrub typhus in a patient in Singapore who presented with sepsis and acute respiratory distress syndrome but lacked the pathognomonic eschar. The patient recovered after appropriate diagnosis and doxycycline treatment. Rickettsial diseases should be included in the differential diagnosis of febrile illnesses in regions where the diseases are endemic, and absence of eschar should not be the crite...

  18. Exploring distributed leadership in the BC Sepsis Network.

    Science.gov (United States)

    Gorley, Charlotte; Lindstrom, Ronald R; McKeown, Shari; Krause, Christina; Pamplin, Chantale; Sweet, David; Marsden, Julian; Kennedy, Colleen

    2016-03-01

    Commissioned research was undertaken to explore the role of networks in supporting large-scale change and improvement. Participatory action research and social network analysis were used to study the BC Sepsis Network. Findings of this research include insights into distributed leadership, enablers and barriers within a network approach; the importance of relationships and trust; and the need for meaningful and timely data. Recommendations are made for health leaders who are considering utilizing networks for improving patient quality and safety. PMID:26872797

  19. Systemic Inflammatory Response Syndrome und Sepsis beim Hund

    OpenAIRE

    Gebhardt, Constance

    2010-01-01

    SIRS and sepsis are rarely described in the veterinary literature; both diseases have a high incidence and a high mortality rate. An early diagnosis and prognostic assessment is important for optimal therapeutic intervention. Therefore the objectives of this study were to describe the clinical signs, hematological, biochemical, and coagulation parameters and the C-reactive protein and to evaluate if baseline values and changes in these parameters (day 0 to day 2) might predict survival in ...

  20. Iron dysregulation combined with aging prevents sepsis-induced apoptosis

    Science.gov (United States)

    Javadi, Pardis; Buchman, Timothy G.; Stromberg, Paul E.; Turnbull, Isaiah R.; Vyas, Dinesh; Hotchkiss, Richard S.; Karl, Irene E.; Coopersmith, Craig M.

    2005-01-01

    Background Sepsis, iron loading and aging cause independent increases in gut epithelial and splenic apoptosis. It is unknown how their combination will affect apoptosis and systemic cytokine levels. Methods Hfe−/− mice (a murine homolog of hemochromatosis) abnormally accumulate iron in their tissues. Aged (24–26 months) or mature (16–18 months) Hfe−/− mice and wild type (WT) littermates were subjected to cecal ligation and puncture (CLP) or sham laparotomy. Intestine, spleen, and blood were harvested 24 hours later and assessed for apoptosis and cytokine levels. Results Gut epithelial and splenic apoptosis were low in both aged septic and sham Hfe−/− mice, regardless of the amount of iron in their diet. Mature septic WT mice had increased apoptosis compared to age-matched sham WT mice. Mature septic Hfe−/− mice had similar levels of intestinal cell death to age-matched septic WT mice but higher levels of splenic apoptosis. Apoptosis was significantly lower in septic aged Hfe−/− mice than septic mature Hfe−/− animals. Interleukin-6 was elevated in septic aged Hfe−/− mice compared to sham mice. Conclusions Although sepsis, chronic iron dysregulation, and aging each increase gut and splenic apoptosis, their combination yields cell death levels similar to sham animals despite the fact that aged Hfe−/− mice are able to mount an inflammatory response following CLP and mature Hfe−/− mice have elevated sepsis-induced apoptosis. Combining sepsis with two risk factors that ordinarily increase cell death and increase mortality in CLP yields an apoptotic response that could not have been predicted based upon each element in isolation. PMID:15921699

  1. Early acute kidney injury and sepsis: a multicentre evaluation

    OpenAIRE

    Bagshaw, Sean M.; George, Carol; Bellomo, Rinaldo; ,

    2008-01-01

    Introduction We conducted a study to evaluate the incidence, risk factors and outcomes associated with early acute kidney injury (AKI) in sepsis. Methods The study was a retrospective interrogation of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were collected from 57 intensive care units (ICUs) across Australia. In total, 120,123 patients admitted to ICU for more than 24 hours from 1 January 2000 to 31 December 2005 were inc...

  2. A catheter related sepsis case caused by Pantoea agglomerans

    Directory of Open Access Journals (Sweden)

    Fadime Yılmaz

    2015-04-01

    microorganism was sensitive to piperacillin-tazobactam, so, patient's therapy was not changed. After treatment, when the general condition of the patient healed, he was discharged by ending antibiotics on the sixteenth day. This case report, is intended to call attention to the risk of the growth of catheter-associated sepsis and antibioterapi are lated to P. agglomerans which is rarely seen on immunocompromised patients.

  3. Pantoea species causing early onset neonatal sepsis: a case report

    OpenAIRE

    Tiwari, Shreekant; Beriha, Siba Shankar

    2015-01-01

    Introduction Pantoea agglomerans is a plant pathogen which very rarely causes an opportunistic infection. Human beings are usually infected by thorn prick injuries or by contaminated parenteral fluids. Pantoea agglomerans has been reported as a cause of neonatal sepsis very rarely and to the best of our knowledge this is the first reported case from India. Case presentation A 4-day-old Asian baby boy from the rural area of Odisha, India, was admitted to our neonatal intensive care unit when h...

  4. A catheter related sepsis case caused by Pantoea agglomerans

    OpenAIRE

    Fadime Yılmaz; Sercan Savcı; Elvin Pazar - Yıldırım; Nevriye Gönüllü; Işıl Bavunoğlu; Fatma Köksal - Çakırlar; Yavuz Uyar; Hrisi Bahar Tokman; Murat Günaydın; Nuri Kiraz

    2015-01-01

    Pantoea species, members of the Enterobacteriaceae family are facultative anaerobic Gram-negative bacilli that can be isolated from plants and soil. Pantoea agglomerans can lead to localized infections in health people with normal immune systems and to systemic infections in newborns and immunocompromised patients. Nosocomial infections caused by these opportunistic-pathogenbacteria are; septi arthritis, pneumonia, sepsis, peritonitis, urinary system infections, surgical infections, and ca...

  5. Des aliments tu feras medecine: Hippocrate revisite

    OpenAIRE

    Lahlou, Saadi

    1999-01-01

    "Let foods be your medicine Hippocrates revisited". In this article the author discusses the behaviour of consumers, concepts of 'health foods' and helth eating towards food and the rise of businesses built around the health food industry.

  6. A case report of thyroid storm induced by acute sepsis

    Institute of Scientific and Technical Information of China (English)

    Chiu-Yin Yeh; Wen-Liang Yu

    2016-01-01

    Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL;free tetraiodothyronine, 5.67 ng/dL;thyroid-stimulating hormone receptor antibody, 76.9%(normal range, < 14%); and antimicrosomal antibody titer, 1:102 400 (normal range,<1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

  7. Sinusitis and intracranial sepsis: the CT imaging and clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Saxton, V.J. [Dept. of Radiology, Royal Children`s Hospital, Melbourne (Australia); Boldt, D.W. [Dept. of Radiology, Royal Children`s Hospital, Melbourne (Australia); Shield, L.K. [Dept. of Neurology, Royal Children`s Hospital, Melbourne (Australia)

    1995-11-01

    The CT imaging and clinical presentation in 14 children with coexistent intracranial sepsis and sinusitis were reviewed. A routine CT head scan (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was missed in four patients and the abnormal sinuses not shown in six. In half the children the dagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense headache and facial swelling in early adolescent males. In this clinical setting we recommend: (1) The routine scan is extended through the frontal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct coronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but the fronto-ethomoidal sinuses are abnormal and there is a high clinical supicion of intracranial sepsis; and (4) in the presence of intracranial sepsis the vault is viewed at bone window settings to exclude cranial osteomyelitis. (orig.)

  8. Sinusitis and intracranial sepsis: the CT imaging and clinical presentation

    International Nuclear Information System (INIS)

    The CT imaging and clinical presentation in 14 children with coexistent intracranial sepsis and sinusitis were reviewed. A routine CT head scan (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was missed in four patients and the abnormal sinuses not shown in six. In half the children the dagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense headache and facial swelling in early adolescent males. In this clinical setting we recommend: (1) The routine scan is extended through the frontal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct coronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but the fronto-ethomoidal sinuses are abnormal and there is a high clinical supicion of intracranial sepsis; and (4) in the presence of intracranial sepsis the vault is viewed at bone window settings to exclude cranial osteomyelitis. (orig.)

  9. Early neonatal sepsis at tertiary care teaching hospital

    Institute of Scientific and Technical Information of China (English)

    Muhammad Javed; Abdul Majid Memon

    2009-01-01

    Objective:To study organisms in cases of early neonatal sepsis, and sensitivity patterns of these isolates. Methods: All pregnant mothers admitted from Jan 2006-Dec 2006 were registered. Neonates delivered at the hospital were examined upto 72 hours of birth, with special emphasis on the signs and symp-toms of suspected sepsis. Neonates with no maternal or neonatal risk factor were included in the study, blood examination and appropriate cultures were taken. Antibiotics as cephatexime and amikacin were started on em-pirical bases until final cultures report was received. In cases of negative cultures, antibiotics were stopped. Other wise it continued according to culture and sensitivity for 10 to 14 days. Results: Among these 257 ca-ses, 113 neonates full filled our criteria. Staph aureus being the commonest organism in our study (59.29%) followed by KlebsieUa pneumoniae (19.47%) and Entrococci (19.47%). These findings are not consistent with other studies in the country. Conclusion: Neonatal sepsis is a major cause of mortality and morbidity. Choice of antibiotic should depend on the local studies from time to time.

  10. Asymmetric dimethylarginine, endothelial nitric oxide bioavailability and mortality in sepsis.

    Directory of Open Access Journals (Sweden)

    Joshua S Davis

    Full Text Available BACKGROUND: Plasma concentrations of asymmetric dimethylarginine (ADMA, an endogenous inhibitor of nitric oxide synthase, are raised in patients with chronic vascular disease, causing increased cardiovascular risk and endothelial dysfunction, but the role of ADMA in acute inflammatory states is less well defined. METHODS AND RESULTS: In a prospective longitudinal study in 67 patients with acute sepsis and 31 controls, digital microvascular reactivity was measured by peripheral arterial tonometry and blood was collected at baseline and 2-4 days later. Plasma ADMA and L-arginine concentrations were determined by high performance liquid chromatography. Baseline plasma L-arginine: ADMA ratio was significantly lower in sepsis patients (median [IQR] 63 [45-103] than in hospital controls (143 [123-166], p<0.0001 and correlated with microvascular reactivity (r = 0.34, R(2 = 0.12, p = 0.02. Baseline plasma ADMA was independently associated with 28-day mortality (Odds ratio [95% CI] for death in those in the highest quartile (≥ 0.66 µmol/L = 20.8 [2.2-195.0], p = 0.008, and was independently correlated with severity of organ failure. Increase in ADMA over time correlated with increase in organ failure and decrease in microvascular reactivity. CONCLUSIONS: Impaired endothelial and microvascular function due to decreased endothelial NO bioavailability is a potential mechanism linking increased plasma ADMA with organ failure and death in sepsis.

  11. Zwitterionic chitosan for the systemic treatment of sepsis

    Science.gov (United States)

    Cho, Eun Jung; Doh, Kyung-Oh; Park, Jinho; Hyun, Hyesun; Wilson, Erin M.; Snyder, Paul W.; Tsifansky, Michael D.; Yeo, Yoon

    2016-01-01

    Severe sepsis and septic shock are life-threatening conditions, with Gram-negative organisms responsible for most sepsis mortality. Systemic administration of compounds that block the action of lipopolysaccharide (LPS), a constituent of the Gram-negative outer cell membrane, is hampered by their hydrophobicity and cationic charge, the very properties responsible for their interactions with LPS. We hypothesize that a chitosan derivative zwitterionic chitosan (ZWC), previously shown to suppress the production of pro-inflammatory cellular mediators in LPS-challenged macrophages, will have protective effects in an animal model of sepsis induced by systemic injection of LPS. In this study, we evaluate whether ZWC attenuates the fatal effect of LPS in C57BL/6 mice and investigate the mechanism by which ZWC counteracts the LPS effect using a PMJ2-PC peritoneal macrophage cell line. Unlike its parent compound with low water solubility, intraperitoneally administered ZWC is readily absorbed with no local residue or adverse tissue reaction at the injection site. Whether administered at or prior to the LPS challenge, ZWC more than doubles the animals’ median survival time. ZWC appears to protect the LPS-challenged organisms by forming a complex with LPS and thus attenuating pro-inflammatory signaling pathways. These findings suggest that ZWC have utility as a systemic anti-LPS agent. PMID:27412050

  12. Hyperuricemia: An Early Marker for Severity of Illness in Sepsis

    Directory of Open Access Journals (Sweden)

    Sana R. Akbar

    2015-01-01

    Full Text Available Background. Uric acid can acutely activate various inflammatory transcription factors. Since high levels of oxyradicals and lower antioxidant levels in septic patients are believed to result in multiorgan failure, uric acid levels could be used as a marker of oxidative stress and poor prognosis in patients with sepsis. Design. We conducted a prospective cohort study on Medical Intensive Care Unit (MICU patients and hypothesized that elevated uric acid in patients with sepsis is predictive of greater morbidity. The primary end point was the correlation between hyperuricemia and the morbidity rate. Secondary end points were Acute Kidney Injury (AKI, mortality, Acute Respiratory Distress Syndrome (ARDS, and duration of stay. Results. We enrolled 144 patients. 54 (37.5% had the primary end point of hyperuricemia. The overall morbidity rate was 85.2%. The probability of having hyperuricemia along with AKI was 68.5% and without AKI was 31.5%. Meanwhile the probability of having a uric acid value <7 mg/dL along with AKI was 18.9% and without AKI was 81.1% (p value < 0.0001. Conclusion. We report that elevated uric acid levels on arrival to the MICU in patients with sepsis are associated with poor prognosis. These patients are at an increased risk for AKI and ARDS.

  13. Hyperuricemia: An Early Marker for Severity of Illness in Sepsis

    Science.gov (United States)

    Akbar, Sana R.; Long, Dustin M.; Hussain, Kashif; Alhajhusain, Ahmad; Ahmed, Umair S.; Iqbal, Hafiz I.; Ali, Ailia W.; Leonard, Rachel; Dalton, Cheryl

    2015-01-01

    Background. Uric acid can acutely activate various inflammatory transcription factors. Since high levels of oxyradicals and lower antioxidant levels in septic patients are believed to result in multiorgan failure, uric acid levels could be used as a marker of oxidative stress and poor prognosis in patients with sepsis. Design. We conducted a prospective cohort study on Medical Intensive Care Unit (MICU) patients and hypothesized that elevated uric acid in patients with sepsis is predictive of greater morbidity. The primary end point was the correlation between hyperuricemia and the morbidity rate. Secondary end points were Acute Kidney Injury (AKI), mortality, Acute Respiratory Distress Syndrome (ARDS), and duration of stay. Results. We enrolled 144 patients. 54 (37.5%) had the primary end point of hyperuricemia. The overall morbidity rate was 85.2%. The probability of having hyperuricemia along with AKI was 68.5% and without AKI was 31.5%. Meanwhile the probability of having a uric acid value <7 mg/dL along with AKI was 18.9% and without AKI was 81.1% (p value < 0.0001). Conclusion. We report that elevated uric acid levels on arrival to the MICU in patients with sepsis are associated with poor prognosis. These patients are at an increased risk for AKI and ARDS. PMID:26294973

  14. Protective effect of Aloe vera on polymicrobial sepsis in mice.

    Science.gov (United States)

    Yun, Nari; Lee, Chan-Ho; Lee, Sun-Mee

    2009-06-01

    Sepsis is an acute life-threatening clinical condition and remains the major cause of death in intensive care units. The primary pathophysiologic event central to the septic response is an overwhelming activation of the inflammatory system and countervailing response from the anti-inflammatory system. However, the cause of this perturbation has yet to be elucidated. In this study, we report that Aloe vera therapeutically reverses the lethality induced by cecal ligation and puncture (CLP), a clinically relevant model of sepsis. The administration of Aloe vera ameliorated the multiple organ dysfunction syndrome, as evidenced by the serum levels of biochemical parameters and histological changes. In order to investigate the pharmacological mechanism of Aloe vera, the levels of the cytokines, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 were determined by ELISA at various time points. The increases in the levels of TNF-alpha, IL-1beta, and IL-6 were attenuated by Aloe vera.In vivo administration of Aloe vera also markedly enhanced bacterial clearance. Our findings suggest that Aloe vera could be a potential therapeutic agent for the clinical treatment of sepsis. PMID:19298839

  15. Leptospirosis mimicking sepsis after orthopedic surgery: a case report

    Directory of Open Access Journals (Sweden)

    C. S. Abboud

    2001-10-01

    Full Text Available We report a case of leptospirosis that occurred after elective surgery involving tendon transfer and shoulder arthroscopy. The disease mimicked hospital infection after orthopedic surgery and was at first misdiagnosed as post-operative sepsis. The patient was 60 year old female that developed sepsis with hypotension, shock, bleeding, jaundice and renal insufficiency 4 hours after surgery. Shock treatment procedures were performed and broad spectrum antibiotic therapy was used with coverage for bacteria acquired in hospitals. A careful investigation was carried out by the Hospital Infection Control Service in search of the possible source of the infection. After clinical evaluation by a specialist in infectious diseases, the hypothesis of leptospirosis was put forward based on clinical and epidemiological data. The hypothesis was later confirmed by the positive result of serological tests with the microagglutination method that yielded 1:800 and then 1:12,600 7 days later. This is the first reported case of leptospirosis manifest directly following surgery, mimicking postoperative sepsis.

  16. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn;

    2016-01-01

    PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient...... characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume...... sepsis. The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis....

  17. Passive solar in tornado alley

    Energy Technology Data Exchange (ETDEWEB)

    Kriescher, P.

    2000-02-01

    The renewable energy and energy efficiency industries have long relied on entrepreneurial individuals with a passion for integrating clean energy alternatives into residential and commercial construction. Most of these individuals were drawn into sustainable energy design during time of inflationary energy prices (e.g., the 1973 oil crisis), when government and industry were investing in clean energy technologies. Some of the best and brightest maintained their enthusiasm for high quality, low energy building design--even as government and industry support slowed--and worked tirelessly toward making sustainable design viable in the marketplace.

  18. Nephrilin peptide modulates a neuroimmune stress response in rodent models of burn trauma and sepsis

    OpenAIRE

    Mascarenhas, Desmond D.; ElAyadi, Amina; Singh, Baljit K.; Prasai, Anesh; Hegde, Sachin D; Herndon, David N; Finnerty, Celeste C.

    2013-01-01

    Sepsis occurs three times more often in burns than in other types of trauma, suggesting an overlap or synergy between underlying immune mechanisms in burn trauma and sepsis. Nephrilin peptide, a designed inhibitor of mTORC2, has previously been shown to modulate a neuroimmune stress response in rodent models of xenobiotic and metabolic stress. Here we investigate the effect of nephrilin peptide administration in different rodent models of burn trauma and sepsis. In a rat scald burn model, dai...

  19. Sepsis-induced long-term immune paralysis – results of a descriptive, explorative study

    OpenAIRE

    Arens, Christoph; Bajwa, S. A; Koch, C; Siegler, Benedikt H; Schneck, E; A. Hecker; Weiterer, Sebastian; Lichtenstern, Christoph; Weigand, Markus A.; Uhle, Florian

    2016-01-01

    Background: Long-lasting impairment of the immune system is believed to be the underlying reason for delayed deaths after surviving sepsis. We tested the hypothesis of persisting changes to the immune system in survivors of sepsis for the first time. Methods: In our prospective, cross-sectional pilot study, eight former patients who survived catecholamine-dependent sepsis and eight control individuals matched for age, sex, diabetes and renal insufficiency were enrolled. Each participant com...

  20. Incidence of thrombocytopenia and changes in various platelet parameters, in blood culture positive neonatal sepsis

    OpenAIRE

    Sartaj Bhat; Suhail Naik; Wasim Rafiq; Syed Tariq A

    2015-01-01

    Abstract Objective: To assess the incidence of thrombocytopenia and changes in various platelet parameters, in culture positive neonatal sepsis. Methods: This was prospective study conducted over a period of one year from December 2009 to November 2010 in neonatal intensive care unit of DDUH Hospital, a tertiary care hospital in Delhi, North India. All babies who were admitted during this period were evaluated prospectively for evidence of sepsis. Results: sepsis was diagnosed in 560 neonates...

  1. Discharge diagnoses versus medical record review in the identification of community-acquired sepsis

    OpenAIRE

    Henry E. Wang; Addis, Dylan R; Donnelly, John P.; Shapiro, Nathan I.; Griffin, Russell L.; Safford, Monika M.; Baddley, John W.

    2015-01-01

    Introduction We evaluated the accuracy of hospital discharge diagnoses in the identification of community-acquired sepsis and severe sepsis. Methods We reviewed 379 serious infection hospitalizations from 2003 to 2012 from the national population-based reasons for geographic and racial differences in stroke (REGARDS) cohort. Through manual review of medical records, we defined criterion-standard community-acquired sepsis events as the presence of a serious infection on hospital presentation w...

  2. Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis

    OpenAIRE

    Orati, Juliane Agustini; Almeida, Patricia; Santos, Vanessa; Ciorla, Gustavo; Lobo, Suzana Margareth

    2013-01-01

    Objectives To evaluate the C-reactive protein serum levels in patients with pulmonary and abdominal sepsis during the first five days of sepsis progression. Methods The present investigation was a retrospective cohort study conducted at the university hospital with 345 patients who were admitted to the intensive care unit and diagnosed with sepsis of pulmonary or abdominal origin. Serum C-reactive protein concentrations were measured by the turbidimetric immunoassay. For analysis of C-reactiv...

  3. Efficacy and effectiveness of recombinant human activated protein C in severe sepsis of adults

    OpenAIRE

    Greiner, Wolfgang; Willich, Stefan N.; Roll, Stefanie; Müller-Nordhorn, Jaqueline; Schumacher, Helge Knut

    2007-01-01

    Introduction: Sepsis is defined as an invasion of microorganisms and/or their toxins into the blood associated the reaction of the organism to this invasion. Severe sepsis is a major cost driver in intensive care medicine. In Germany, prevalence data was assessed in the context of the German Prevalence Study. Severe sepsis has a prevalence of 35% in German intensive care units. Research questions: The following questions were analysed: is Drotrecogin alfa (activated) (DAA) effective in the tr...

  4. Rasio Neutrofil Imatur Dengan Neutrofil Total Dalam Menegakkan Diagnosis Dini Sepsis Bakterialis Pada Neonatus

    OpenAIRE

    Darnifayanti

    2013-01-01

    Background. Bacterial sepsis is the main cause morbidity and mortality in neonates. Early diagnostic and appropriate treatment can reduce the mortality rate. Gold standard to diagnose bacterial sepsis is blood culture, but it needed 3-5 day for the results, but the disease may progress rapidly in neonates. Examination of ratio immature to total neutrophil in peripheral blood smear is a quick and cheaper method to diagnose sepsis bacterial in neonates. Some studies found that sensitivity of ra...

  5. Hematological scoring system as an early diagnostic tool for neonatal sepsis

    OpenAIRE

    Fathia Meirina; Bidasari Lubis; Tiangsa Sembiring; Nelly Rosdiana; Olga R. Siregar

    2015-01-01

    Background Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis is still a difficult problem because of clinical features are not specific. Blood culture is the gold standard, but it takes several days and is expensive. The hematological scoring system (HSS) consists of hematologic parameters (leucocyte count, polymorphonuclear (PMN) cells, degenerative changes, and platelet count) for early diagnosis of neonatal sepsis. Ob...

  6. Hematological scoring system(HSS)sebagai alat uji diagnostik dini sepsis pada neonatus

    OpenAIRE

    Meirina, Fathia

    2015-01-01

    Background. Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis was still a difficult problem because of clinical features were not specific. Blood culture was the gold standard, but it took several days and expensive. The hematological scoring system (HSS) consist of hematologic parameters (leucocyte, polymorphonuclear (PMN), degenerative changes, and platelet count) for early diagnosis of neonatal sepsis. Objective. To de...

  7. NK cells promote neutrophil recruitment in the brain during sepsis-induced neuroinflammation

    OpenAIRE

    Hao He; Tingting Geng; Piyun Chen; Meixiang Wang; Jingxia Hu; Li Kang; Wengang Song; Hua Tang

    2016-01-01

    Sepsis could affect the central nervous system and thus induces neuroinflammation, which subsequently leads to brain damage or dysfunction. However, the mechanisms of generation of neuroinflammation during sepsis remain poorly understood. By administration of lipopolysaccharides (LPS) in mice to mimic sepsis, we found that shortly after opening the blood–brain barrier, conventional CD11b+CD27+ NK subset migrated into the brain followed by subsequent neutrophil infiltration. Interestingly, dep...

  8. Bench-to-bedside review: Sepsis - from the redox point of view

    OpenAIRE

    Andrades, Michael Éverton; Morina, Arian; Spasić, Snežana; Spasojević, Ivan

    2011-01-01

    The pathogenesis of sepsis and its progression to multiple organ dysfunction syndrome and septic shock have been the subject of investigations for nearly half a century. Controversies still exist with regard to understanding the molecular pathophysiology of sepsis in relation to the complex roles played by reactive oxygen species, nitric oxide, complements and cytokines. In the present review we categorise the key turning points in sepsis development and outline the most probable sequence of ...

  9. Heart Rate Characteristics: Physiomarkers for Detection of Late-Onset Neonatal Sepsis

    OpenAIRE

    Fairchild, Karen D.; O'Shea, T. Michael

    2010-01-01

    Early detection of late onset neonatal sepsis, prior to obvious and potentially catastrophic clinical signs, is an important goal in neonatal medicine. Sepsis causes a well-known series of physiologic changes including abnormalities of blood pressure, respiration, temperature, and heart rate, and less well-known changes in heart rate variability. While vital signs are frequently or continuously monitored in NICU patients, changes in these parameters are subtle in the early phase of sepsis and...

  10. Predictors of Acute Hemodynamic Decompensation in Early Sepsis: An Observational Study

    OpenAIRE

    Lee, Young Im; Smith, Robert L; Gartshteyn, Yevgeniya; Kwon, Sophia; Caraher, Erin J.; Nolan, Anna

    2016-01-01

    Background The study of sepsis is hindered by its heterogeneous time course and evolution. A subgroup of patients with severe sepsis develops shock soon after the initiation of treatment while others present hypotensive. We sought to determine the incidence of hypotension after the initiation of treatment for sepsis, and characterize their clinical features and course. Methods A retrospective review of electronic medical record of all septic patients (n = 542) that met the definition of septi...

  11. Based on the Four Segments and Treatment by Syndrome Differentiation to Lower the Mortality of Sepsis

    Institute of Scientific and Technical Information of China (English)

    LIU Qing-quan

    2009-01-01

    @@ Lowering the mortality of sepsis has become an important issue in the international critical care medicine because of its unacceptably high incidence. In 2004 and 2008, there were no essential breakthroughs in international guidelines for the management of severe sepsis and shock. The treatments did not meet the objective of lowering the clinical mortality of severe sepsis, which still remains at 30%-50%(1,2).

  12. Maternal sepsis: a Scottish population-based case–control study

    OpenAIRE

    Acosta, CD; Bhattacharya, S; Tuffnell, D; Kurinczuk, JJ; Knight, M.

    2012-01-01

    Objective To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery. Design Population-based, case–control study. Setting North NHS region of Scotland. Population All cases of pregnant, intrapartum and postpartum women with International Classification of Disease-9 codes for sepsis or severe sepsis recorded in the Aberdeen Maternal and Neonatal Databank (AMND) from 1986 to 2009. Four controls per case selected from t...

  13. The top cited clinical research articles on sepsis: a bibliometric analysis

    OpenAIRE

    Tao, Tianzhu; Xiaohong ZHAO; Lou, Jingsheng; Bo, Lulong; Wang, Fei; Li, Jinbao; Deng, Xiaoming

    2012-01-01

    Introduction The objective of this study was to identify and characterize the most highly cited clinical research articles published on sepsis. Methods A comprehensive list of citation classics in sepsis was generated by searching the database of Web of Science-Expanded (1970 to present) using keywords 'sepsis' or 'septic shock'. The top 50 cited clinical research papers were retrieved by reading the abstract or full text if needed. Each eligible article was reviewed for basic information, in...

  14. Severe Maternal Sepsis in the UK, 2011–2012: A National Case-Control Study

    OpenAIRE

    Acosta, Colleen D.; Kurinczuk, Jennifer J.; D Nuala Lucas; Derek J Tuffnell; Susan Sellers; Marian Knight

    2014-01-01

    Editors' Summary Background Every year, nearly 300,000 women worldwide die during pregnancy or labour, or shortly after. According to a recent World Health Organization estimate, sepsis (blood poisoning) is responsible for 10.7% of these maternal deaths. Sepsis is caused by an inappropriate immune response to an infection. Normally, when bacteria or other microbes enter the human body, the immune system efficiently destroys the invaders. In sepsis, the immune system goes into overdrive, and t...

  15. Sepsis and AKI in ICU Patients: The Role of Plasma Biomarkers

    OpenAIRE

    Paolo Lentini; Massimo de Cal; Anna Clementi; Angela D'Angelo; Claudio Ronco

    2012-01-01

    Given the higher mortality rate of ICU patients with sepsis and AKI, we decided to investigate the possible correlation between serum biomarkers of organ damage, and endotoxin activity in ICU septic patients. Ninety-eight consecutive adult patients were enrolled in this study. Patients were divided in two groups depending on the presence of sepsis. Fifty-six patients had sepsis, while forty-two patients were nonseptic. Among septic patients, twenty-four subjects developed AKI, while thirty-tw...

  16. Heat Shock Protein 90 Inhibitors Prolong Survival, Attenuate Inflammation, and Reduce Lung Injury in Murine Sepsis

    OpenAIRE

    Chatterjee, Anuran; Dimitropoulou, Christiana; Drakopanayiotakis, Fotios; ANTONOVA, Galina; Snead, Connie; Cannon, Joseph; Venema, Richard C.; Catravas, John D.

    2007-01-01

    Rationale: Severe sepsis is the leading cause of death for patients in intensive care units. Patients with severe sepsis develop multiple organ failure, including acute lung injury (ALI), resulting from a deregulated inflammatory response. Inhibitors of the ubiquitous chaperone, heat shock protein 90 (Hsp90), block the activity of certain proinflammatory mediators in vitro. We hypothesized that Hsp90 inhibitors may ameliorate the inflammation and ALI associated with severe sepsis.

  17. Thyrotoxic storm during sepsis: study of a rare complication, clinical and biological observations

    OpenAIRE

    Ferdinando Dodi; Monica Centanaro; Elisa Porcile; Elisabetta Riccò; Anna Di Noto; Angelo Gratarola

    2016-01-01

    We describe an uncommon severe clinical complication of sepsis – thyrotoxic storm (TS). Common biologic, pathogenic, clinical conditions that can determine sepsis can cause a TS. High circulating values of vascular cellular adhesive molecules-1 and various pro-inflammatory citochines are related with thyroid damage. During sepsis, moderate dysfunctions are not expression of actual disease, but severe damage in pituitary-thyroid hormonal axis. Thyroid stimulated hormon release, and consequent ...

  18. New paradigms in sepsis: from prevention to protection of failing microcirculation.

    Science.gov (United States)

    Hawiger, J; Veach, R A; Zienkiewicz, J

    2015-10-01

    Sepsis, also known as septicemia, is one of the 10 leading causes of death worldwide. The rising tide of sepsis due to bacterial, fungal and viral infections cannot be stemmed by current antimicrobial therapies and supportive measures. New paradigms for the mechanism and resolution of sepsis and consequences for sepsis survivors are emerging. Consistent with Benjamin Franklin's dictum 'an ounce of prevention is worth a pound of cure', sepsis can be prevented by vaccinations against pneumococci and meningococci. Recently, the NIH NHLBI Panel redefined sepsis as 'severe endothelial dysfunction syndrome in response to intravascular and extravascular infections causing reversible or irreversible injury to the microcirculation responsible for multiple organ failure'. Microvascular endothelial injury underlies sepsis-associated hypotension, edema, disseminated intravascular coagulation, acute respiratory distress syndrome and acute kidney injury. Microbial genome products trigger 'genome wars' in sepsis that reprogram the human genome and culminate in a 'genomic storm' in blood and vascular cells. Sepsis can be averted experimentally by endothelial cytoprotection through targeting nuclear signaling that mediates inflammation and deranged metabolism. Endothelial 'rheostats' (e.g. inhibitors of NF-κB, A20 protein, CRADD/RAIDD protein and microRNAs) regulate endothelial signaling. Physiologic 'extinguishers' (e.g. suppressor of cytokine signaling 3) can be replenished through intracellular protein therapy. Lipid mediators (e.g. resolvin D1) hasten sepsis resolution. As sepsis cases rose from 387 330 in 1996 to 1.1 million in 2011, and are estimated to reach 2 million by 2020 in the US, mortality due to sepsis approaches that of heart attacks and exceeds deaths from stroke. More preventive vaccines and therapeutic measures are urgently needed. PMID:26190521

  19. Characterization of an animal model of severe sepsis associated with respiratory dysfunction

    OpenAIRE

    Luciano Cesar Pontes de Azevedo; Marcelo Park; Danilo Teixeira Noritomi; Alexandre Toledo Maciel; Milena Karina Brunialti; Reinaldo Salomão

    2007-01-01

    PURPOSE: Pathophysiological studies in humans regarding sepsis are difficult to perform due to ethical and methodological concerns. In this context, animal models of sepsis can be useful to better understand this condition and to test therapeutic strategies. The purpose of this study was to characterize a feasible and clinically relevant model of sepsis in pigs that could be useful for testing different therapeutic interventions. METHODS: 5 White Large pigs were anesthetized, arterial and pul...

  20. Blockade of Thrombopoietin Reduces Organ Damage in Experimental Endotoxemia and Polymicrobial Sepsis

    OpenAIRE

    Cuccurullo, Alessandra; Greco, Elisabetta; Lupia, Enrico; De Giuli, Paolo; Bosco, Ornella; Martin-Conte, Erica; Spatola, Tiziana; Turco, Emilia; Montrucchio, Giuseppe

    2016-01-01

    Background and Purpose Thrombopoietin (TPO), a growth factor primarily involved in thrombopoiesis may also have a role in the pathophysiology of sepsis. In patients with sepsis, indeed, TPO levels are markedly increased, with disease severity being the major independent determinant of TPO concentrations. Moreover, TPO increases and correlates with ex vivo indices of platelet activation in patients with burn injury upon sepsis development, and may contribute to depress cardiac contractility in...

  1. Polymicrobial sepsis alters Ag-dependent and -independent memory CD8 T cell functions1

    OpenAIRE

    Duong, Sean; Condotta, Stephanie A.; Rai, Deepa; Martin, Matthew D.; Griffith, Thomas S.; Vladimir P. Badovinac

    2014-01-01

    Mortality from sepsis frequently results from secondary infections, and the extent to which sepsis affects pathogen-specific memory CD8 T cell responses remains unknown. Using the cecal-ligation and puncture (CLP) model of polymicrobial sepsis, we observed rapid apoptosis of pre-existing memory CD8 T cells after sepsis induction that led to a loss in CD8 T cell-mediated protection. Ag-sensitivity (functional avidity) and Ag-driven secondary expansion of memory CD8 T cells were decreased after...

  2. Development and Validation of a Disease Severity Scoring Model for Pediatric Sepsis

    Science.gov (United States)

    HU, Li; ZHU, Yimin; CHEN, Mengshi; LI, Xun; LU, Xiulan; LIANG, Ying; TAN, Hongzhuan

    2016-01-01

    Background: Multiple severity scoring systems have been devised and evaluated in adult sepsis, but a simplified scoring model for pediatric sepsis has not yet been developed. This study aimed to develop and validate a new scoring model to stratify the severity of pediatric sepsis, thus assisting the treatment of sepsis in children. Methods: Data from 634 consecutive patients who presented with sepsis at Children’s hospital of Hunan province in China in 2011–2013 were analyzed, with 476 patients placed in training group and 158 patients in validation group. Stepwise discriminant analysis was used to develop the accurate discriminate model. A simplified scoring model was generated using weightings defined by the discriminate coefficients. The discriminant ability of the model was tested by receiver operating characteristic curves (ROC). Results: The discriminant analysis showed that prothrombin time, D-dimer, total bilirubin, serum total protein, uric acid, PaO2/FiO2 ratio, myoglobin were associated with severity of sepsis. These seven variables were assigned with values of 4, 3, 3, 4, 3, 3, 3 respectively based on the standardized discriminant coefficients. Patients with higher scores had higher risk of severe sepsis. The areas under ROC (AROC) were 0.836 for accurate discriminate model, and 0.825 for simplified scoring model in validation group. Conclusions: The proposed disease severity scoring model for pediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which has important clinical significance in evaluating the severity of pediatric sepsis and predicting its progress.

  3. Impact of HIV infection on the haemostatic response during sepsis and malaria.

    Science.gov (United States)

    Huson, Michaëla A M; Kalkman, Rachel; Hoogendijk, Arie J; Alabi, Abraham S; van 't Veer, Cornelis; Grobusch, Martin P; Meijers, Joost C M; van der Poll, Tom

    2016-06-01

    Patients positive for the human immunodeficiency virus (HIV) are more susceptible to sepsis and malaria, two conditions known to activate the coagulation system. As chronic HIV infection also influences haemostatic mechanisms, we determined the influence of HIV co-infection on coagulation, anticoagulation and the endothelium during sepsis or malaria. We performed a prospective observational study in 325 subjects with or without HIV infection (103 with sepsis, 127 with malaria and 95 asymptomatic controls) in an HIV endemic area in Central Africa. We measured plasma biomarkers indicative of activation of distinct haemostatic mechanisms. Sepsis and malaria had similar effects with elevated markers of coagulation, reduced anticoagulation markers and activation of endothelium. In particular, asymptomatic HIV infection reduced the plasma levels of the anticoagulant co-factor free protein S, and increased activation of the vascular endothelium, which were not normalized by combination antiretroviral therapy. HIV co-infection during sepsis and malaria caused more profound changes in free protein S and von Willebrand factor in sepsis and malaria, and ADAMTS13 in sepsis, while not influencing sepsis- or malaria-induced coagulation activation. These results show for the first time that HIV infection augments selective haemostatic changes during sepsis and malaria, which may contribute to the enhanced morbidity of these conditions in HIV patients. PMID:26970408

  4. EXTERNALIZATION AND INTERNALIZATION OF CARDIAC ENDOTHELIN RECEPTORS DURING DIFFERENT PHASES OF SEPSIS IN RAT

    Institute of Scientific and Technical Information of China (English)

    王晓红; 杨军; 董林旺; 庞永政; 苏静怡; 唐朝枢; 刘乃奎

    2001-01-01

    Objective. To study the redistribution of endothelin-1 (ET-1) receptors in two subcellular organelles , the sarcolemmal membrane and the light vesicle, of rat heart during the progression of sepsis. Methods. Sepsis was induced by cecal ligation and puncture (CLP). ET1 receptor was assayed by using [125I]-ET1 binding. Marker enzyme activities, protein yield, and dry-to-wet weight ratio of cardiac membranes were measured. Results. Septic rat heart exhibited two distinct phases: an initial hyperdynamic phase( 9h after CLP; early stage of sepsis) followed by a hypodynamic (18h after CLP, late stage of sepsis) phase. [125I]-ET1 binding study showed that during early stage of sepsis, the Bmax of ET1 receptors was increased by 30% in sarcolemma but decreased by 19% in light vesicles, while during late stage of sepsis, the Bmax was decreased by 24% in sarcolemma but increased by 38% in light vesicles.The total binding of sarcolemma and light vesicles was increased by 25% during early stage of sepsis but decreased by 17% during late stage of sepsis. Conclusions. These data indicated that ET1 receptors in the rat heart were externalized from light vesicles to sarcolemmal membranes during early hyperdynamic phase while internalized from surface membranes to intracellular compartment during late hypodynamic phase of sepsis.

  5. Epstein-Barr virus-associated hemophagocytic syndrome mimicking severe sepsis

    Directory of Open Access Journals (Sweden)

    Spivack Talya

    2008-01-01

    Full Text Available Severe sepsis is amongst the most common reasons for admission to the intensive care unit (ICU throughout the world and is a common cause of death. The diagnosis of sepsis is usually straightforward, being based on a constellation of clinical and laboratory features. Noninfectious disorders, including pancreatitis, drug reactions, and autoimmune disorders, may cause a systemic inflammatory response that mimics sepsis. We present the case of a 32-year-old male with Epstein-Barr virus-associated hemophagocytic syndrome who presented to the ICU with features of severe sepsis which progressed to multisystem organ failure and death despite aggressive supportive measures.

  6. Decreased ADAMTS 13 Activity is Associated With Disease Severity and Outcome in Pediatric Severe Sepsis

    Science.gov (United States)

    Lin, Jainn-Jim; Chan, Oi-Wa; Hsiao, Hsiang-Ju; Wang, Yu; Hsia, Shao-Hsuan; Chiu, Cheng-Hsun

    2016-01-01

    Abstract Decreased ADAMTS 13 activity has been reported in severe sepsis and in sepsis-induced disseminated intravascular coagulation. This study aimed to investigate the role of ADAMTS 13 in different pediatric sepsis syndromes and evaluate its relationship with disease severity and outcome. We prospectively collected cases of sepsis treated in a pediatric intensive care unit, between July 2012 and June 2014 in Chang Gung Children's Hospital in Taoyuan, Taiwan. Clinical characteristics and ADAMTS-13 activity were analyzed. All sepsis syndromes had decreased ADAMTS 13 activity on days 1 and 3 of admission compared to healthy controls. Patients with septic shock had significantly decreased ADAMTS 13 activity on days 1 and 3 compared to those with sepsis and severe sepsis. There was a significant negative correlation between ADAMTS 13 activity on day 1 and day 1 PRISM-II, PELOD, P-MOD, and DIC scores. Patients with mortality had significantly decreased ADAMTS 13 activity on day 1 than survivors, but not on day 3. Different pediatric sepsis syndromes have varying degrees of decreased ADAMTS 13 activity. ADAMTS 13 activity is strongly negatively correlated with disease severity of pediatric sepsis syndrome, whereas decreased ADAMTS 13 activity on day 1 is associated with increased risk of mortality. PMID:27100422

  7. Temporal increase of platelet mitochondrial respiration is negatively associated with clinical outcome in patients with sepsis

    DEFF Research Database (Denmark)

    Sjövall, Fredrik; Morota, Saori; Hansson, Magnus J;

    2010-01-01

    Mitochondrial dysfunction has been suggested as a contributing factor to the pathogenesis of sepsis-induced multiple organ failure. Also, restoration of mitochondrial function, known as mitochondrial biogenesis, has been implicated as a key factor for the recovery of organ function in patients wi...... sepsis. Here we investigated temporal changes in platelet mitochondrial respiratory function in patients with sepsis during the first week after disease onset.......Mitochondrial dysfunction has been suggested as a contributing factor to the pathogenesis of sepsis-induced multiple organ failure. Also, restoration of mitochondrial function, known as mitochondrial biogenesis, has been implicated as a key factor for the recovery of organ function in patients with...

  8. Bacterial Etiology and Antibiotic Sensitivity Patterns of Early-Late Onset Neonatal Sepsis among Newborns in Shiraz, Iran 2004-2007

    OpenAIRE

    Mozhgan Shahian; Narjes Pishva; Mehdi Kalani

    2010-01-01

    Background: Neonatal sepsis is a major cause of mortalityand morbidity, especially in developing countries. The goal ofthe present study was to determine the bacterial etiology andantibiotic sensitivity patterns of neonatal sepsis.Methods: This cross sectional study was conducted on 208neonates admitted with clinically suspected sepsis over a periodof 30 months. Sepsis was divided into early onset sepsis(EOS, ≤5 days of age) and late onset sepsis (LOS, >5 days ofage). The two groups were furt...

  9. Protein kinase a activity is increased in rat heart during late hypodynamic phase of sepsis.

    Science.gov (United States)

    Yang, S L; Hsu, C; Lue, S I; Hsu, H K; Liu, M S

    1997-07-01

    Changes in the activities of protein kinase A (PKA, or cAMP-dependent protein kinase) in rat heart during different cardiodynamic phases of sepsis were investigated. Sepsis was induced by cecal ligation and puncture. Experiments were divided into three groups: control, early sepsis, and late sepsis. Early and late sepsis refers to those animals killed at 9 and 18 h, respectively, after cecal ligation and puncture. Cardiac PKA was extracted and partially purified by acid precipitation, ammonium sulfate fractionation, and DEAE-cellulose chromatography. PKA was eluted from DEAE-cellulose column with a linear NaCl gradient. Two peaks of PKA, type I (eluted at low ionic strength) and type II (eluted at high ionic strength), were collected and their activities were determined based on the rate of incorporation of [gamma-32P]ATP into histone. Results obtained show that during early sepsis, both type I and type II PKA activities were unaffected. During late sepsis, type I PKA activities were stimulated by 66.7-97.7%, while type II PKA activities remained constant. Kinetic analysis of the data on type I PKA during late sepsis reveals that the Vmax values for ATP, cAMP, and histone were increased by 84.7, 66.7, and 97.7%, respectively; while the Km values for ATP, cAMP, and histone were unaltered. These data indicate that type I PKA is activated in rat heart during late hypodynamic phase of sepsis. Since kinase-mediated phosphorylation plays an important role in regulating myocardial function and metabolism, an activation of type I PKA during late sepsis may contribute to the development of altered myocardial function during hypodynamic phase of sepsis. PMID:9249915

  10. Differential activation of protein kinase A in various regions of myocardium during sepsis.

    Science.gov (United States)

    Hsu, C; Yang, S L; Hsu, S P; Hsu, H K; Liu, M S

    1997-08-01

    Changes in the activities of protein kinase A (PKA) (cAMP-dependent protein kinase) in various regions of rat myocardium during different cardiodynamic phases of sepsis were studied in an attempt to understand the pathophysiology of cardiac dysfunction during sepsis. Sepsis was induced by cecal ligation and puncture (CLP). Experiments were divided into three groups: control, early sepsis, and late sepsis. Early and late sepsis refers to those animals sacrificed at 9 and 18 hr, respectively, after CLP. Cardiac PKA was extracted and partially purified by acid precipitation, ammonium sulfate fractionation, and DEAE-cellulose chromatography. PKA was eluted from DEAE-cellulose column with a linear NaCl gradient. Two types of PKA, Type I (eluted at low ionic strength) and Type II (eluted at high ionic strength), were collected, and their activities were determined based on the rate of incorporation of [gamma-32P]ATP into histone. Under physiological conditions, Type I PKA activities were unevenly distributed (left atrium > right atrium > pacemaker region > left ventricle > right ventricle > ventricular septum) while Type II PKA activities were evenly distributed among different regions of myocardium. During early sepsis, Type I PKA activities remained unchanged while Type II PKA activities were activated by 32 and 70% in right atrium and pacemaker regions, respectively. During late sepsis, Type I PKA activities were stimulated by 228% in ventricular septum while Type II PKA activities were not affected. These data demonstrate that different PKA activities exist in various regions of the myocardium and that PKA activities were preferentially activated in certain areas during the progression of sepsis. Since PKA plays an important role in the regulation of myocardial function and metabolism, the activation of PKA in different regions of myocardial during different stages of sepsis may contribute to the altered cardiac function during the progression of sepsis. PMID:9299285

  11. A remote coal deposit revisited

    DEFF Research Database (Denmark)

    Bojesen-Kofoed, Jørgen A.; Kalkreuth, Wolfgang; Petersen, Henrik I.;

    2012-01-01

    In 1908, members of the “Danmark Expedition” discovered a coal deposit in a very remote area in western Germania Land, close to the margin of the inland ice in northeast Greenland. The deposit was, however, neither sampled nor described, and was revisited in 2009 for the first time since its...... discovery. The outcrops found in 2009 amount to approximately 8 m of sediment including a coal seam of 2 m thickness. More outcrops and additional coal deposits most certainly are to be found, pending further fieldwork. The deposits are Middle Jurassic, Callovian, in age and were deposited in a floodplain...... environment related to meandering river channels. Spores and pollen in the lower fluvial deposits reflect abundant vegetation of ferns along the river banks. In contrast, a sparse spore and pollen flora in the coals show a mixed vegetation of ferns and gymnosperms. Based on proximate and petrographic analyses...

  12. 中国四川旱坡地植物篱农作系统能流特征%ENERGY FLOW CHARACTERISTICS OF ALLEY CROPPING ON HILLSIDES IN SICHUAN, CHINA

    Institute of Scientific and Technical Information of China (English)

    陈一兵; 林超文; 黄晶晶; 涂仕华

    2007-01-01

    关于农业生态系统能流特征的研究很多,但关于植物篱农作系统能流特征的研究很少.在四川盆地雨养丘陵农区,2/3的耕地土壤侵蚀严重,为了控制土壤侵蚀和提高耕地生产力,该区域大量栽种了植物篱.该研究通过了解作物与植物篱之间的能流交付作用,通过系统能量投入水平提高与结构优化,建立环境友好的农作系统,最终实现坡地农业的可持续.通过两年田间小区试验,详细记录所有劳力投入、化肥投入、农药投入、农事管理活动以及落叶的数量并折算为标准能量单位.作物收获后所有生物产量的能量根据其各部分的转换值折算为标准能量.系统能流特征及效率通过统计分析完成.通过研究主要获得了以下3个结论:1)"作物-植物篱"系统产出能和输入能的数量和结构变化主要受植物篱子系统类型的影响.与大面积旱坡地传统农作物生产系统比较,植物篱农作系统能有效提高系统光能利用率、人工输入能效率,耕地单位面积总产出能也会增加,坡度越大,相对增幅亦越大;由于能极显著减少无机能施入量,这有利于降低化肥农药使用量,减少对环境的污染和破坏.2)"作物-果树类植物篱"系统输入能总量和有机能输入量大幅度增加,因此有利于优化输入能结构,促进坡地生态系统良性循环和集约高效农业发展.3)"作物-草本植物篱"系统人工辅助能的输入量大幅度下降,由于它所需投入能少,有机能耗和无机能耗均低,人工输入能效率很高而生物产量也较高,并且它们提高了与其间作的其它作物的能量产投比,因此提升了整个系统能量产投比率;由于保水固土的生态功能显著,使它能在四川广大山地、丘陵区退耕还林还草工程中发挥重要作用.%Aims Energy flow characteristics of alley cropping have been rarely studied, although alley cropping is common in Sichuan in order

  13. The impact of severe sepsis on health-related quality of life: A long-term follow-up study

    OpenAIRE

    Hofhuis, Jose; Spronk, Peter; Stel, Henk; Schrijvers, Augustinus; Rommes, Johannes Hans; Bakker, Jan

    2008-01-01

    textabstractBACKGROUND:: Severe sepsis is frequently complicated by organ failure and accompanied by high mortality. Patients surviving severe sepsis can have impaired health-related quality of life (HRQOL). The time course of changes in HRQOL in severe sepsis survivors after discharge from the intensive care unit (ICU) and during a general ward stay have not been studied. METHODS:: We performed a long-term prospective study in a medical-surgical ICU. Patients with severe sepsis (n = 170) adm...

  14. Pyomyoma as a Rare Source of Postpartum Sepsis

    Directory of Open Access Journals (Sweden)

    A. DeMaio

    2015-01-01

    Full Text Available Pyomyoma, also known as suppurative leiomyoma, is a rare clinical complication that occurs when a leiomyoma undergoes infarction and subsequent infection. A high index of suspicion is required to make the diagnosis and can be guided by a classic triad of symptoms that includes abdominal pain, sepsis without an obvious source, and a history of leiomyoma. In the vast majority of these cases, total abdominal hysterectomy is required to avoid severe morbidity and potential mortality. We present an unusual case of a postpartum pyomyoma that was successfully treated without the need for hysterectomy. With strong clinical suspicion, early diagnosis, and appropriate management, some affected patients may preserve fertility.

  15. 凝血/纤溶系统与SIRS、Sepsis

    Institute of Scientific and Technical Information of China (English)

    詹芝娅

    2008-01-01

    凝血/纤溶系统功能紊乱在全身性感染(Sepsis)的发生发展中有着重要作用,本文综述凝血/纤溶系统功能紊乱与Sepsis的关系、三种重要抗凝因子(抗凝血酶Ⅲ、活化蛋白C,组织因子途径抑制剂)的作用及其在Sepsis中的应用.

  16. Hypolipidemia and Sepsis: It is The Hypolipidemia Not The Statins

    Directory of Open Access Journals (Sweden)

    Elmehdawi RR

    2008-01-01

    Full Text Available To The Editor: I read with great interest the correspondence written by Mathew and Daniel [1], who have the same concerns regarding the potential risks of hypolipidemia [2]. However, Mathew and Daniel referred to the recently published systemic review by Falagas and his colleagues [3], who analyzed twenty studies that examined the use of statins in patients with septicemia and other different bacterial and viral infections. They concluded that statins may have a positive role in treatment of patients with sepsis and infection.

  17. Vascular Dysfunction following Polymicrobial Sepsis: Role of Pattern Recognition Receptors

    OpenAIRE

    Ehrentraut, Stefan Felix; Dörr, Anne; EHRENTRAUT Heidi; Lohner, Ralph; Lee, Sun-Hee; Hoeft, Andreas; Baumgarten, Georg; Knuefermann, Pascal; Boehm, Olaf; Meyer, Rainer

    2012-01-01

    Aims Aim was to elucidate the specific role of pattern recognition receptors in vascular dysfunction during polymicrobial sepsis (colon ascendens stent peritonitis, CASP). Methods and Results Vascular contractility of C57BL/6 (wildtype) mice and mice deficient for Toll-like receptor 2/4/9 (TLR2-D, TLR4-D, TLR9-D) or CD14 (CD14-D) was measured 18 h following CASP. mRNA expression of pro- (Tumor Necrosis Factor-α (TNFα), Interleukin (IL)-1β, IL-6) and anti-inflammatory cytokines (IL-10) and of ...

  18. Ursodeoxycholic acid in neonatal sepsis-associated cholestasis

    Directory of Open Access Journals (Sweden)

    Rita Mey Rina

    2014-07-01

    Full Text Available Background Sepsis-associated cholestasis (SAC is an intrahe-intrahepatic cholestasis caused by inflammatory cytokines. Patients with this condition have poor prognoses. Antibiotics are the mainstay of therapy, however, other adjuvant therapies, such as ursodeoxycholic acid (UDCA, have not been well established. Objective To assess the effect of UDCA for treatment of neonatal sepsis-associated cholestasis. Methods We performed a randomized, double-blind, controlled trial in 37 neonates who were diagnosed with sepsis-associated cholestasis in the Neonatal Care Unit of Cipto Mangunkusumo Hospital. Subjects were divided into two groups, with 19 neonates randomly allocated to the intervention group (received UDCA at 30 mg/kg/day divided into 3 doses for 7 days and 18 neonates to the control group (received placebo. After 7 days of treatment, we evaluated the subjects’ liver function parameters and performed a survival analysis. Results Liver function parameter improvements at day 7 were not significantly different between the UDCA group and the control group, including for mean decrease of total bilirubin (TB levels [2.2 (SD 2.9 mg/dL vs 1.7 (SD 4.6 mg/dL; P=0.080, mean decrease of direct bilirubin (DB levels [1.1 (SD 2.3 mg/dL vs 0.6 (SD 3.6 mg/dL; P=0.080, median indirect bilirubin (IB levels [0.4 (range 0.1- 5.6 mg/dL vs 0.9 (range 0.1-4.1 mg/dL; P=0.358, mean decrease of alanine aminotransferase (ALT levels [0.5 (-80.0 - 21.0 U/L vs -2.0 (ranged -167.0 - 85.0 U/L; P= 0.730, median aspartate aminotransferase (AST levels [43.0 (range 14.0-297.0 U/L vs 150.0 (range 24.0-840.0 U/L; P=0.081, and median gamma-glutamyl transpeptidase (GGT levels [125.0 (48.0-481.0 U/L vs 235.0 (56.0-456.0 U/L; P=0.108]. Five neonates in control group died compared to two in the UDCA group (P=0.232. In addition, UDCA did not significantly lengthen the survival time (hazard ratio/HR 3.62; 95%CI 0.69 to 18.77. Conclusion Ursodeoxycholic acid tends to improve total

  19. Sepsis no doente com cirrose hepática

    OpenAIRE

    Branco, J

    2013-01-01

    Trabalho realizado no contexto do estágio de Cuidados Intensivos do Internato Médico Complementar, sob orientação de Luís Revés O presente  trabalho  aborda  a  sepsis  no  doente  com  cirrose  hepática  com  enfoque  primordial   na  abordagem  deste  doente  em  contexto  de  cuidados  intensivos.       A   escolha   deste   tema  prende...

  20. Maturity aggravates sepsis-associated skeletal muscle catabolism in growing pigs

    Science.gov (United States)

    Synthesis and accretion of muscle protein is elevated in neonates and decreases with development. During sepsis, muscle protein synthesis is reduced, but the effect of development on the metabolic response to sepsis in skeletal muscle is not well understood. Fasted 7- and 26-d-old pigs were infused ...

  1. Mechanical ventilation and sepsis induce skeletal muscle catabolism in neonatal pigs

    Science.gov (United States)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  2. Sepsis and development impede muscle protein synthesis in neonatal pigs by different ribosomal mechanisms

    Science.gov (United States)

    In muscle, sepsis reduces protein synthesis (MPS) by restraining translation in neonates and adults. Even though protein accretion decreases with development as neonatal MPS rapidly declines by maturation, the changes imposed by development on the sepsis-associated decrease in MPS have not been desc...

  3. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis

    DEFF Research Database (Denmark)

    Perner, Anders; Haase, Nicolai; Guttormsen, Anne B;

    2012-01-01

    Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis.......Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis....

  4. In vivo arginine production and intravascular nitric oxide synthesis in hypotensive sepsis

    Science.gov (United States)

    Arginine is important in the response to infections and is a precursor for the synthesis of the vasodilator nitric oxide (NO). Low plasma arginine is correlated with a worse prognosis in patients with sepsis, and increased NO has been implicated in the hypotension of sepsis. Data on in vivo arginine...

  5. Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients

    DEFF Research Database (Denmark)

    Martí-Carvajal, Arturo J; Solà, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona, Andrés Felipe

    2012-01-01

    Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been introduced to reduce the high risk of death associated with severe sepsis or septic shock. This systematic review is an update of a Cochrane review originally published in 2007....

  6. Functional impairments at school age of preterm born children with late-onset sepsis

    NARCIS (Netherlands)

    van der Ree, Meike; Tanis, Jozien C.; Van Braeckel, Koenraad N. J. A.; Bos, Arend F.; Roze, Elise

    2011-01-01

    Background: Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants. Aim: We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis com

  7. The effect of hospital volume on mortality in patients admitted with severe sepsis.

    Directory of Open Access Journals (Sweden)

    Sajid Shahul

    Full Text Available IMPORTANCE: The association between hospital volume and inpatient mortality for severe sepsis is unclear. OBJECTIVE: To assess the effect of severe sepsis case volume and inpatient mortality. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011. EXPOSURES: The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles. MAIN OUTCOMES AND MEASURES: Inpatient mortality. RESULTS: Compared with the highest tertile of severe sepsis volume (>60 cases per year, the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year was 1.188 (95% CI: 1.074-1.315, while the odds ratio was 1.090 (95% CI: 1.031-1.152 for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03 for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64 for hospitals with the highest volume. CONCLUSIONS AND RELEVANCE: We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.

  8. Mechanical ventilation alone, and in the presence sepsis, induces peripheral skeletal muscle catabolism in neonatal pigs

    Science.gov (United States)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  9. Effect of plasmapheresis on the immune system in endotoxin-induced sepsis

    DEFF Research Database (Denmark)

    Toft, P; Schmidt, R; Broechner, A C; Nielsen, B U; Bollen, P; Olsen, K E

    2008-01-01

    BACKGROUND: It has been proposed that plasmapheresis is most effective when applied early in Gram-negative sepsis. We therefore studied the effect of early plasmapheresis on immunity in experimental Escherichia coli endotoxin-induced sepsis. METHODS: 20 pigs received 30 microg/kg of E. coli...... infusion, it only temporarily attenuated a part of the activated cell-mediated immunity....

  10. Severe Sepsis and Septic Shock Associated with Chikungunya Virus Infection, Guadeloupe, 2014.

    Science.gov (United States)

    Rollé, Amélie; Schepers, Kinda; Cassadou, Sylvie; Curlier, Elodie; Madeux, Benjamin; Hermann-Storck, Cécile; Fabre, Isabelle; Lamaury, Isabelle; Tressières, Benoit; Thiery, Guillaume; Hoen, Bruno

    2016-05-01

    During a 2014 outbreak, 450 patients with confirmed chikungunya virus infection were admitted to the University Hospital of Pointe-à-Pitre, Guadeloupe. Of these, 110 were nonpregnant adults; 42 had severe disease, and of those, 25 had severe sepsis or septic shock and 12 died. Severe sepsis may be a rare complication of chikungunya virus infection. PMID:27088710

  11. CDC Vital Signs–Think Sepsis. Time Matters.

    Centers for Disease Control (CDC) Podcasts

    2016-08-23

    This podcast is based on the August 2016 CDC Vital Signs report. Sepsis is a medical emergency and can happen quickly. Learn the signs of sepsis and how to prevent it.  Created: 8/23/2016 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 8/23/2016.

  12. Male sex predisposes the newborn surgical patient to parenteral nutrition-associated cholestasis and to sepsis

    NARCIS (Netherlands)

    Albers, MJIJ; de Gast-Bakker, DAH; van Dam, NAM; Madern, GC; Tibboel, D

    2002-01-01

    Hypothesis: Sepsis is an epiphenomenon of parenteral nutrition-associated cholestasis (PNAC) and not a causative factor, and the incidence of sepsis is not affected by the presence or absence of PNAC. Design: Observational cohort study. Setting: Pediatric surgery department in a tertiary referral ch

  13. Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients

    OpenAIRE

    Yi YANG; Xie, Jianfeng; Guo, Fengmei; Longhini, Federico; Gao, Zhiwei; Huang, Yingzi; Qiu, Haibo

    2016-01-01

    Objective To measure the ability of a new bioscore to diagnose sepsis in a general critical care population. Methods The study was done at an intensive care unit (ICU) from April to December 2012. Demographic and clinical patient information were recorded on admission to the ICU with blood samples taken for C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, white blood cell count, as well as body temperature, age and the sepsis-related organ failure (SOFA) score. These parameters w...

  14. The impact of nationwide education program on clinical practice in sepsis care and mortality of severe sepsis: a population-based study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Yu-Chun Chen

    Full Text Available OBJECTIVES: We investigated the effect of a nationwide educational program following surviving sepsis campaign (SSC guidelines. Physicians' clinical practice in sepsis care and patient mortality rate for severe sepsis were analyzed using a nationally representative cohort. METHODS: Hospitalizations for severe sepsis with organ failure from 1997 to 2008 were extracted from Taiwan's National Health Insurance Research Database (NHIRD, and trends in sepsis incidence and mortality rates were analyzed. A before-and-after study design was used to evaluate changes in the utilization rates of SSC items and changes in severe sepsis mortality rates occurred after a national education program conducted by the Joint Taiwan Critical Care Medicine Committee since 2004. A total of 39,706 hospitalizations were analyzed, which consisted of a pre-intervention cohort of 14,848 individuals (2000-2003 and a post-intervention cohort of 24,858 individuals (2005-2008. RESULTS: The incidence rate of severe sepsis increased from 1.88 per 1,000 individuals in 1997 to 5.07 per 1,000 individuals in 2008. The cumulative mortality rate decreased slightly from 48.2% for the pre-intervention cohort to 45.9% for the post-intervention cohort. The utilization rates of almost all SSC items changed significantly between the pre-intervention and post-intervention cohorts. These changes of utilization rates were found to be associated with mild reduction in mortality rate. CONCLUSION: The nationwide education program through a national professional society has a significant impact on physicians' clinical practice and resulted in a slight but significant reduction of severe sepsis mortality rate.

  15. Epidemiology and microbiology of sepsis in mainland China in the first decade of the 21st century

    Directory of Open Access Journals (Sweden)

    Xin-Chuan Chen

    2015-02-01

    Conclusions: The difference in sepsis mortality between urban and rural areas decreased over time. Males, the elderly, and neonates were found to be high-risk subpopulations. Gram (+ bacteria were predominant among neonates with sepsis, but the proportion of patients with Gram (+ or Gram (– bacteria was similar among adults with sepsis.

  16. Diabetes does not influence activation of coagulation, fibrinolysis or anticoagulant pathways in Gram-negative sepsis (melioidosis)

    NARCIS (Netherlands)

    G.C.K.W. Koh; J.C.M. Meijers; R.R. Maude; D. Limmathurotsakul; N.P.J. Day; S.J. Peacock; T. van der Poll; W.J. Wiersinga

    2011-01-01

    Diabetes is associated with a disturbance of the haemostatic balance and is an important risk factor for sepsis, but the influence of diabetes on the pathogenesis of sepsis remains unclear. Melioidosis (Burkholderia pseudomallei infection) is a common cause of community-acquired sepsis in Southeast

  17. Predicting treatment failure in severe sepsis and septic shock: looking for the Holy Grail

    Science.gov (United States)

    2013-01-01

    Procalcitonin has been proposed as a specific biomarker of bacterial infections and has been related to the severity of sepsis. The prognostic ability of the initial concentrations of procalcitonin in sepsis is controversial. Some studies find higher initial concentrations in non-survivors but others find no differences. Prognostic assessment based on follow-up of procalcitonin levels may be better than evaluation of the initial levels of procalcitonin. The persistence of elevated procalcitonin levels is indicative of poor prognosis and is associated with mortality. Procalcitonin kinetics could be a tool for assessing the evolution of severe sepsis and sepsis shock. Procalcitonin should find its place as a biomarker for predicting treatment failure of severe sepsis and septic shock. PMID:24004571

  18. Evaluation of musculoskeletal sepsis with indium-111 white blood cell imaging

    International Nuclear Information System (INIS)

    The detection of musculoskeletal sepsis, especially following joint replacement, continues to be a challenging problem. Often, even with invasive diagnostic evaluation, the diagnosis of infection remains uncertain. This is a report on the first 55 Indium-111 white blood cell (WBC) images performed in 39 patients for the evaluation of musculoskeletal sepsis. There were 40 negative and 15 positive Indium-111 WBC images. These were correlated with operative culture and tissue pathology, aspiration culture, and clinical findings. Thirty-eight images were performed for the evaluation of possible total joint sepsis (8 positive and 30 negative images); 17 for the evaluation of nonarthroplasty-related musculoskeletal sepsis (7 positive and 10 negative images). Overall, there were 13 true-positive, 39 true-negative, two false-positive, and one false-negative images. Indium-111 WBC imaging is a sensitive and specific means of evaluating musculoskeletal sepsis, especially following total joint replacement

  19. Improving the Recognition of, and Response to In-Hospital Sepsis.

    Science.gov (United States)

    Chan, Peter; Peake, Sandra; Bellomo, Rinaldo; Jones, Daryl

    2016-07-01

    Sepsis is an important cause of patient morbidity and mortality worldwide. Although the associated mortality seems to be decreasing, approximately 20 % of patients with organ dysfunction die in hospital. Since 1991 diagnostic criteria for sepsis focused on the systemic inflammatory response syndrome (SIRS). However, the utility of such criteria has been questioned, and alternative criteria have recently been proposed. It is likely that administration of early appropriate antibiotics and resolution of shock reduce sepsis-associated mortality. Accordingly, strategies need to be developed to improve the early recognition of, and response to patients with sepsis. Such system approaches may include improved acquisition and documentation of vital signs, enhanced recognition of shock, and integration of laboratory and microbiological results using clinical informatics. Hospitals should have guidelines for escalating care of septic patients, antibiotics stewardship programs, and systems to audit morbidity and mortality associated with sepsis. PMID:27193917

  20. Research progress of measures for renal perfusion adjustment in sepsis patients

    Directory of Open Access Journals (Sweden)

    Xiao-dan WANG

    2015-10-01

    Full Text Available Sepsis is the result of systemic inflammatory reaction induced by bacteria, virus or fungus infection, and it can lead to shock, multiple organ dysfunction syndrome, and even death. It has become the main cause for death of the patients in intensive care unit (ICU. Acute kidney injury (AKI is one of the most common, and the most serious complications in the course of sepsis, and it is characterized by acute renal failure (ARF. The incidence of AKI would climb with the severity of sepsis, and it is significantly more eminent than the other factors. Along with the advancement in the research on sepsis, a new understanding in the treatment of renal injury caused by sepsis is gradually obtained, and attention is given to the improvement of renal perfusion. In this review, we review the measures for adjusting the renal perfusion.. DOI: 10.11855/j.issn.0577-7402.2015.08.15

  1. Liver protein kinase A activity is decreased during the late hypoglycemic phase of sepsis.

    Science.gov (United States)

    Hsu, C; Hsu, H K; Yang, S L; Jao, H C; Liu, M S

    1999-10-01

    Changes in protein kinase A (PKA, or cAMP-dependent protein kinase) activity in the rat liver during different metabolic phases of sepsis were investigated. Sepsis was induced by cecal ligation and puncture (CLP). Experiments were divided into 3 groups: control, early sepsis, and late sepsis. Early and late sepsis refer to those animals killed at 9 and 18 h, respectively, after CLP. Hepatic PKA was extracted and partially purified by acid precipitation, ammonium sulfate fractionation, and diethylaminoethyl (DEAE)-cellulose chromatography. PKA was eluted from DEAE-cellulose column with a linear NaCl gradient. Two peaks of PKA, type I (eluted at low ionic strength) and type II (eluted at high ionic strength), were collected and their activities were determined on the basis of the rate of incorporation of [gamma-32-P]ATP into histone. The results show that during early sepsis, both type I and type II PKA activities remained unchanged. During late sepsis, type I PKA activity was decreased by 40.7-53.6%, whereas type II PKA activity was unaffected. Kinetic analysis of the data on type I PKA during the late phase of sepsis reveals that the Vmax (maximal velocity) values for ATP, cAMP, and histone were decreased by 40.7, 53.6, and 47.3%, respectively whereas the Km (substrate concentration required for half-maximal enzymatic activity) values for ATP, cAMP, and histone were unaltered. These data indicate that type I PKA was inactivated during the late hypoglycemic phase of sepsis in the rat liver. Because PKA-mediated phosphorylation plays an important role in the regulation of hepatic glucose metabolism, an inactivation of PKA may contribute to the development of hypoglycemia during the late phase of sepsis. PMID:10509629

  2. Functional polymorphisms of interferon-gamma affect pneumonia-induced sepsis.

    Directory of Open Access Journals (Sweden)

    Ding Wang

    Full Text Available OBJECTIVE: Sepsis is an inflammatory syndrome caused by infection, and both its incidence and mortality are high. Because interferon-gamma (IFN-γ plays an important role in inflammation, this work assessed IFN-γ single nucleotide polymorphism (SNPs that may be associated with sepsis. METHODS: A total of 196 patients with pneumonia-induced sepsis and 213 age- and sex-matched healthy volunteers participated in our study from July 2012 to July 2013 in Guangzhou, China. Patient clinical information was collected. Clinical pathology was assessed in subgroups defined based on clinical criteria, APACHE II (acute physiology and chronic health evaluation and SOFA (sepsis-related organ failure assessment scores and discharge rate. Four functional SNPs, -1616T/C (rs2069705, -764G/C (rs2069707, +874A/T (rs2430561 and +3234C/T (rs2069718, were genotyped by Snapshot in both sepsis patients and healthy controls. Pearson's chi-square test or Fisher's exact test were used to analyze the distribution of the SNPs, and the probability values (P values, odds ratios (OR and 95% confidence intervals (CIs were calculated. RESULTS: No mutations in the IFN-γ -764G/C SNP were detected among the participants in our study. The +874A/T and +3234C/T SNPs were in strong linkage disequilibrium (LD (r(2 = 0.894. The -1616 TC+TT, +874 AT+AA genotype and the TAC haplotype were significantly associated with sepsis susceptibility, while the CTT haplotype was associated with protection against sepsis incidence. Genotype of -1616 TT wasn't only protective against severity of sepsis, but also against higher APACHE II and SOFA scores as +874 AA and +3234 CC. The TAC haplotype was was protective against progression to severe sepsis either. CONCLUSION: Our results suggest that functional IFN-γ SNPs and their haplotypes are associated with pneumonia-induced sepsis.

  3. CB2 cannabinoid receptors contribute to bacterial invasion and mortality in polymicrobial sepsis.

    Directory of Open Access Journals (Sweden)

    Balázs Csóka

    Full Text Available BACKGROUND: Sepsis is a major healthcare problem and current estimates suggest that the incidence of sepsis is approximately 750,000 annually. Sepsis is caused by an inability of the immune system to eliminate invading pathogens. It was recently proposed that endogenous mediators produced during sepsis can contribute to the immune dysfunction that is observed in sepsis. Endocannabinoids that are produced excessively in sepsis are potential factors leading to immune dysfunction, because they suppress immune cell function by binding to G-protein-coupled CB(2 receptors on immune cells. Here we examined the role of CB(2 receptors in regulating the host's response to sepsis. METHODS AND FINDINGS: The role of CB(2 receptors was studied by subjecting CB(2 receptor wild-type and knockout mice to bacterial sepsis induced by cecal ligation and puncture. We report that CB(2 receptor inactivation by knockout decreases sepsis-induced mortality, and bacterial translocation into the bloodstream of septic animals. Furthermore, CB(2 receptor inactivation decreases kidney and muscle injury, suppresses splenic nuclear factor (NF-kappaB activation, and diminishes the production of IL-10, IL-6 and MIP-2. Finally, CB(2 receptor deficiency prevents apoptosis in lymphoid organs and augments the number of CD11b(+ and CD19(+ cells during CLP. CONCLUSIONS: Taken together, our results establish for the first time that CB(2 receptors are important contributors to septic immune dysfunction and mortality, indicating that CB(2 receptors may be therapeutically targeted for the benefit of patients suffering from sepsis.

  4. Epidemiology of systemic inflammatory response syndrome and sepsis in cats hospitalized in a veterinary teaching hospital.

    Science.gov (United States)

    Babyak, Jonathan M; Sharp, Claire R

    2016-07-01

    OBJECTIVE To describe the epidemiology of the systemic inflammatory response syndrome (SIRS) and sepsis in cats hospitalized in a veterinary teaching hospital. DESIGN Observational study. ANIMALS 246 client-owned cats. PROCEDURES During a 3-month period, daily treatment records were evaluated for all hospitalized cats. Information extracted included signalment, temperature, heart rate, respiratory rate, diagnostic test results, diagnosis, duration of hospitalization, and outcome (survival or death). Cats were classified into 1 of 4 disease categories (sepsis [confirmed infection and SIRS], infection [confirmed infection without SIRS], noninfectious SIRS [SIRS without a confirmed infection], and no SIRS [no SIRS or infection]). RESULTS Of the 246 cats, 26 and 3 were hospitalized 2 and 3 times, respectively; thus, 275 hospitalizations were evaluated. When SIRS was defined as the presence of ≥ 2 of 4 SIRS criteria, 17 cats had sepsis, 16 had infections, 81 had noninfectious SIRS, and 161 were classified in the no SIRS category at hospital admission. The prevalence of sepsis at hospital admission was 6.2 cases/100 admissions. Four cats developed sepsis while hospitalized, resulting in a sepsis incidence rate of 1.5 cases/100 hospital admissions. Four of 17 cats with sepsis at hospital admission and 3 of 4 cats that developed sepsis while hospitalized died or were euthanized, resulting in a mortality rate of 33.3% for septic cats; 239 hospitalizations resulted in survival, 28 resulted in euthanasia, and 8 resulted in death. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that many hospitalized cats have evidence of SIRS and some have sepsis. In cats, sepsis is an important clinical entity with a high mortality rate. PMID:27308883

  5. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50 with those without severe sepsis (controls = 354. Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001. In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons.We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

  6. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    International Nuclear Information System (INIS)

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment

  7. Heparin defends against the toxicity of circulating histones in sepsis.

    Science.gov (United States)

    Wang, Feifei; Zhang, Naipu; Li, Biru; Liu, Lanbo; Ding, Lei; Wang, Ying; Zhu, Yimin; Mo, Xi; Cao, Qing

    2015-01-01

    Although circulating histones were demonstrated as major mediators of death in septic mice models, their roles in septic patients are not clarified. The present study sought to evaluate the clinical relevance of the circulating histone levels in septic children, and the antagonizing effects of heparin on circulating histones. Histone levels in the plasma of septic children were significantly higher than healthy controls, and positively correlated with disease severity. Histone treatment could activate NF-κB pathway of the endothelial cells and induce the secretion of large amount of cytokines that further amplify inflammation, subsequently leading to organ damage. Co-injection of low dose heparin with lethal dose histones could protect mouse from organ damage and death by antagonizing circulating histones, and similar effects were also observed in other septic models. Collectively, these findings indicated that circulating histones might serve as key factors in the pathogenesis of sepsis and their levels in plasma might be a marker for disease progression and prognosis. Furthermore, low dose heparin might be an effective therapy to hamper sepsis progression and reduce the mortality. PMID:25961556

  8. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Lyul; Cho, June Sik; Kwon, Soon Tae; Lee, Sang Jin; Rhee, Byung Chull [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1993-11-15

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment.

  9. Petechial Hemorrhage: A clinical diagnosis of neonatal Thrombocytopenia and sepsis

    Directory of Open Access Journals (Sweden)

    Deepak Kumar sharma

    2015-02-01

    Full Text Available A preterm female baby with birth weight of 1.5kg was referred to our hospital on day 6 for difficulty in breathing. Baby was admitted at birth for respiratory distress and feed intolerance to other hospital and in view of clinical deterioration baby was referred. Baby had thrombocytopenia with platelets counts of 11000/ mm3 and high CRP titer. Baby had petechial haemorrhagic spots all over the body with hepatosplenomegaly and sclerema (figure 1,2,3. Baby further platelets counts were 3000, 43000, 67000 and then normal. Baby was managed with antibiotics and platelets transfusion. Gradually baby counts improved and petechial spots disappeared. Discussion Neonatal Sepsis is a common complication in the neonatal intensive care unit. It is most common in the smallest and most premature infants in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is the common manifestation of neonatal sepsis in sick babies(1. The manifestation can be seen in newborn as petechial spots over the body with predominance over chest and abdomen(2.Thrombocytopenia is seen in 18% to 35% of NICU patients, and in 73% of extremely low birth weight (ELBW infants(3. Bacterial,fungal and viral infection causes thrombocytopenia. Infection causes damage to vascular endothelium which increases the destruction of platelets and there removal by reticuloendothelial system(4

  10. Características de la mortalidad por sepsis en la provincia de Matanzas Characteristics of mortality by sepsis at the province of Matanzas

    Directory of Open Access Journals (Sweden)

    Pablo Rodríguez Jiménez

    2010-02-01

    Full Text Available La sepsis se define como la respuesta inflamatoria sistémica a la infección, implica la estimulación de la respuesta inflamatoria del huésped por un organismo infectante o sus productos, puede progresar a etapas más graves y producir disfunción múltiple de órganos y la muerte. Se realizó un estudio descriptivo transversal retrospectivo de las defunciones por sepsis ocurridos en la provincia de Matanzas del año 2001 al 2006. El PAVV/F en los fallecidos por todas las causas resultó mayor que el mostrado por los fallecidos por sepsis (71,6 vs. 68.6 respectivamente mientras el PAVP/F en los fallecidos por todas las causas fue inferior al registrado por las defunciones por sepsis (17.3 vs. 20.5 respectivamente. Predominó el sexo femenino entre los fallecidos por sepsis y el masculino entre los fallecidos por todas las causas, ambas diferencias estadísticamente significativas. Las defunciones por sepsis describieron una curva semejante a la que siguió la mortalidad por todas las causas, con tendencia al incremento en relación directa con la edad. No hubo diferencias sustanciales entre los grupos de fallecidos comparados según su color de piel. La tasa cruda de mortalidad por todas las causas según municipio fue 33.1 veces superior que la de los fallecidos por sepsis, oscilando desde 44.3 hasta 21.7. Se concluyó que sería recomendable estudiar determinadas características y que no hay explicación para las diferencias de género encontradas ni para hipótesis que surgieron en este trabajo, recomendándose analizar variables poco estudiadas e iniciar investigaciones con nuevos diseños.Sepsis is defined as the systemic inflammatory answer to an infection, implying the stimulation of the host inflammatory answer caused by an infecting organism or their products. It may progress to more serious stages and lead to organic multiple dysfunction and death. We developed a transversal retrospective, descriptive study of the deceases by

  11. Escherichia coli counting using lens-free imaging for sepsis diagnosis

    Science.gov (United States)

    Moon, Sangjun; Manzur, Fahim; Manzur, Tariq; Klapperich, Catherine; Demirci, Utkan

    2009-09-01

    Sepsis causes 9.3% of overall deaths in United States. To diagnose sepsis, cell/bacteria capture and culturing methods have been widely investigated in the medical field. Escherichia Coli (E. Coli) is used as a model organism for sepsis in blood stream since wide variety of antibodies are established and the genetic modification process is well documented for fluorescent tagging. In point-of-care testing applications, the sepsis diagnostics require fast monitoring, inexpensive testing, and reliable results at resource limited settings, i.e. battle field, home care for dialysis. However, the cell/E.coli are hard to directly capture and see at the POCT because of the small size, 2 μm long and 0.5 μm in diameter, and the bacteria are rare in the blood stream in sepsis. Here, we propose a novel POCT platform to image and enumerate cell/E.coli on a microfluidic surface to diagnose sepsis at resource limited conditions. We demonstrate that target cells are captured from 5 μl of whole blood using specific antibodies and E.coli are imaged using a lens-free imaging platform, 2.2 μm pixel CMOS based imaging sensor. This POCT cell/bacteria capture and enumeration approach can further be used for medical diagnostics of sepsis. We also show approaches to rapidly quantify white blood cell counts from blood which can be used to monitor immune response.

  12. Hematological scoring system as an early diagnostic tool for neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Fathia Meirina

    2015-11-01

    Full Text Available Background Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis is still a difficult problem because of clinical features are not specific. Blood culture is the gold standard, but it takes several days and is expensive. The hematological scoring system (HSS consists of hematologic parameters (leucocyte count, polymorphonuclear (PMN cells, degenerative changes, and platelet count for early diagnosis of neonatal sepsis. Objective To measure HSS as an early diagnostic tool for neonatal sepsis. Methods A cross sectional study was conducted in March to June 2013. Samples were collected by consecutive sampling. Fourty neonates suspected sepsis in neonatology unit H. Adam Malik Hospital, Medan, North Sumatera, underwent routine blood count, blood culture, and peripheral blood smear. Each hematologic parameters were analysed using the HSS of Rodwell et al. The hematologic parameters were total leucocyte count, total PMN cells, total PMN immature, I:T PMN ratio, I:M PMN ratio, degenerative changes, and platelet count. The total value revealed HSS score. Diagnostic study parameters were calculated. Results Ten of fourty neonates had sepsis based on blood culture results. The HSS score >4 had sensitivity 80%, specificity 90% with positive predictive value (PPV 73%, negative predictive value (NPV 93%, ROC curve showed cut off point 0.902 (95% CI 0.803 to 1.0. Conclusion Score HSS >4 could be used as an early diagnostic tool for neonatal sepsis.

  13. Procalcitonin Clearance for Early Prediction of Survival in Critically Ill Patients with Severe Sepsis

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    Mohd Basri Mat Nor

    2014-01-01

    Full Text Available Introduction. Serum procalcitonin (PCT diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48 was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT. Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS. 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76 but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84. Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90. Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.

  14. A Neutrophil Phenotype Model for Extracorporeal Treatment of Sepsis.

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    Alexander D Malkin

    2015-10-01

    Full Text Available Neutrophils play a central role in eliminating bacterial pathogens, but may also contribute to end-organ damage in sepsis. Interleukin-8 (IL-8, a key modulator of neutrophil function, signals through neutrophil specific surface receptors CXCR-1 and CXCR-2. In this study a mechanistic computational model was used to evaluate and deploy an extracorporeal sepsis treatment which modulates CXCR-1/2 levels. First, a simplified mechanistic computational model of IL-8 mediated activation of CXCR-1/2 receptors was developed, containing 16 ODEs and 43 parameters. Receptor level dynamics and systemic parameters were coupled with multiple neutrophil phenotypes to generate dynamic populations of activated neutrophils which reduce pathogen load, and/or primed neutrophils which cause adverse tissue damage when misdirected. The mathematical model was calibrated using experimental data from baboons administered a two-hour infusion of E coli and followed for a maximum of 28 days. Ensembles of parameters were generated using a Bayesian parallel tempering approach to produce model fits that could recreate experimental outcomes. Stepwise logistic regression identified seven model parameters as key determinants of mortality. Sensitivity analysis showed that parameters controlling the level of killer cell neutrophils affected the overall systemic damage of individuals. To evaluate rescue strategies and provide probabilistic predictions of their impact on mortality, time of onset, duration, and capture efficacy of an extracorporeal device that modulated neutrophil phenotype were explored. Our findings suggest that interventions aiming to modulate phenotypic composition are time sensitive. When introduced between 3-6 hours of infection for a 72 hour duration, the survivor population increased from 31% to 40-80%. Treatment efficacy quickly diminishes if not introduced within 15 hours of infection. Significant harm is possible with treatment durations ranging from 5

  15. Differentiating sepsis from non-infectious systemic inflammation based on microvesicle-bacteria aggregation

    Science.gov (United States)

    Herrmann, I. K.; Bertazzo, S.; O'Callaghan, D. J. P.; Schlegel, A. A.; Kallepitis, C.; Antcliffe, D. B.; Gordon, A. C.; Stevens, M. M.

    2015-08-01

    Sepsis is a severe medical condition and a leading cause of hospital mortality. Prompt diagnosis and early treatment has a significant, positive impact on patient outcome. However, sepsis is not always easy to diagnose, especially in critically ill patients. Here, we present a conceptionally new approach for the rapid diagnostic differentiation of sepsis from non-septic intensive care unit patients. Using advanced microscopy and spectroscopy techniques, we measure infection-specific changes in the activity of nano-sized cell-derived microvesicles to bind bacteria. We report on the use of a point-of-care-compatible microfluidic chip to measure microvesicle-bacteria aggregation and demonstrate rapid (sepsis diagnosis and introduces microvesicle-bacteria aggregation as a potentially useful parameter for making early clinical management decisions.Sepsis is a severe medical condition and a leading cause of hospital mortality. Prompt diagnosis and early treatment has a significant, positive impact on patient outcome. However, sepsis is not always easy to diagnose, especially in critically ill patients. Here, we present a conceptionally new approach for the rapid diagnostic differentiation of sepsis from non-septic intensive care unit patients. Using advanced microscopy and spectroscopy techniques, we measure infection-specific changes in the activity of nano-sized cell-derived microvesicles to bind bacteria. We report on the use of a point-of-care-compatible microfluidic chip to measure microvesicle-bacteria aggregation and demonstrate rapid (sepsis diagnosis and introduces microvesicle-bacteria aggregation as a potentially useful parameter for making early clinical management decisions. Electronic supplementary information (ESI) available: Fig. S1: Markers of inflammation and microvesicle characteristics in patient plasma samples, Fig. S2: Experimental sepsis model, Table S1: Patient characteristics. Table S2: Inclusion/exclusion criteria. See DOI: 10.1039/c5nr01851j

  16. PREVALENCE AND SUSCEPTIBILITY PATTERN OF E. COLI IN LOW BIRTH WEIGHT NEONATES OF EARLY ONSET SEPSIS

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    R. Singh et al.

    2011-12-01

    Full Text Available Neonatal sepsis is one of the commonest cause of neonatal mortality in the developing world which can be classified into early onset sepsis (EOS which occurs in the first 7 days of life and late onset sepsis (LOS which occurs ≥7 days of life. E. coli has been reported to be one of the significant and most common nosocomial pathogen which may cause septicemia, pneumonia and meningitis in the newborn. Most of the antibiotics which have been used extensively as life saving are rendered useless because of the emergence of resistant strains of bacterias. Therefore for determining the prevalence and antimicrobial susceptibility pattern of E. coli which is responsible for EOS and LOS and to establish the relationship with birth weight, a total of 229 blood samples were obtained from the neonates admitted to neonatal intensive care unit (NICU who showed the clinical signs and symptoms of neonatal sepsis and sent for culture and sensitivity. Out of these 229, 102 showed the positive culture, among which early onset sepsis was found in 80 neonates while late onset sepsis was diagnosed in 22 neonates. The most frequent pathogen isolated from positive blood culture was E. coli (66.66% and it was also the most common pathogen in low birth weight and preterm neonates of both early (59 cases- 57.84% and late-onset (9 cases- 8.82% sepsis and the incidence was found higher in early onset sepsis. The isolate was completely resistant to vancomycin and the resistance was higher for monotherapy of semi-synthetic penicillin group of antibiotics than their combination therapy with sulbactum. Imepenam and gatifloxacin showed the highest sensitivity (100%, followed by Piperacillin - tazobactum and ciprofloxacin, however the frequency of resistance was more common in low birth weight neonates of early onset sepsis.

  17. Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands.

    Science.gov (United States)

    van der Wekken, Lena C W; Alam, Nadia; Holleman, Frits; van Exter, Pieternel; Kramer, Mark H H; Nanayakkara, Prabath W B

    2016-01-01

    Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. We conducted a retrospective cohort study using transport information from EMS Amsterdam and admission diagnoses at the emergency department gathered through discharge data from two academic hospitals in Amsterdam for the year 2012. A total of 253 patients with sepsis were evaluated, of which 131 were transported by ambulance. The in-hospital mortality rate of the total population was 21% and a mean length of hospital stay was of 13.5 days. Sixty-seven patients (26.5%) were admitted to the intensive care unit. Almost half of the patients were assigned to the internal medicine ward (117; 46.2%). The most common site of infection was the urinary tract (30%). E. coli was the most frequent cause of infections. EMS staff recognized 18/131 (13.7%) transported patients with (severe) sepsis or septic shock. In 52 cases (39.7%) sepsis went unrecognized, probably due to an incomplete primary survey. In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness. PMID:26024065

  18. Relationship between sensitization system of endotoxin and severe burn sepsis and its clinical significance

    Directory of Open Access Journals (Sweden)

    Ning DONG

    2011-01-01

    Full Text Available Objective To explore the relationship between the changes of lipopolysaccharide-binding protein(LBP and CD14 as a sensitization system of endotoxin and severe burn sepsis,and investigate the clinical significance of the relationship.Methods Thirty-five severe burn patients( > 30% TBSA were involved in present study and divided into sepsis group(n=19 and non-sepsis group(n=16 based on the definition and diagnosis standard of sepsis.The blood samples were collected on day 1,3,5,7,14,21 and 28 after burn and the plasma levels of LBP,soluble CD14(sCD14 and interleukin-6(IL-6 were measured by enzyme-linked immunosorbent assay(ELISA.Eleven healthy blood donors were chosen as controls.Results Plasma levels of LBP,sCD14 and IL-6 were markedly elevated in severe burn patients compared with those in controls(P < 0.01.LBP levels were significantly higher in sepsis group than in non-sepsis group on day 3,14,21 and 28 after burn(P < 0.05 or 0.01.Plasma levels of sCD14 and IL-6 elevated significantly in sepsis group than in non-sepsis group during later stage,especially on day 14 to 28 after burn(P < 0.05 or 0.01.In addition,there existed a significant positive correlation between sCD14/IL-6 and LBP levels(P < 0.05 or 0.01.Conclusions Endotoxin sensitization system participates in the postburn pathophysiological processes.Dynamically monitoring the levels of LBP and sCD14 may be helpful to understand the development of postburn sepsis.

  19. Bench-to-bedside review: the role of nitric oxide in sepsis.

    Science.gov (United States)

    De Cruz, Sharon J; Kenyon, Nicholas J; Sandrock, Christian E

    2009-10-01

    Sepsis is a state of systemic inflammation directed at microbes or their toxins in blood or tissues. Nitric oxide (NO) is one of many vasoactive molecules released from a variety of cell types during sepsis. Almost two decades ago, NO emerged as a potential therapeutic target in sepsis. NO produced by the constitutive NO synthase (NOS) isoform (endothelial NOS and neuronal NOS) in the vascular endothelium and elsewhere acts as a nonadrenergic, noncholinergic neurotransmitter, an inhibitor of platelet aggregation and a vasodilator. During sepsis, activation of inducible NOS (iNOS) in the lung epithelium and other organs occurs, leading to NO overproduction. The result of excessive circulating NO is enhanced bacterial destruction, but also profound vasodilatation, activation of inflammatory cascades and depression of cardiac function. Trials of nonselective NOS inhibitors have shown increased mean arterial pressure, but also increased pulmonary artery pressure and reduced cardiac output. Small animal studies of iNOS selective inhibition have produced dichotomous results, but larger clinical studies assessing mortality are lacking. Inhaled NO has been touted as a therapeutic option to improve systemic oxygenation in the acute lung injury of sepsis (hypoxic pulmonary vasoconstriction and pulmonary hypertension); however, studies of inhaled NO in acute respiratory distress syndrome have not shown survival efficacy. Further investigation into the role of NO in human sepsis, and the development of methods to assess NO balance in patients with sepsis is essential in this field. In this review, we outline the effects of NO in sepsis, and summarize the therapeutic outcomes of NOS inhibitors, and inhaled NO in sepsis and acute respiratory distress syndrome. PMID:20477340

  20. Fine structure of the butterfly diagram revisited

    Science.gov (United States)

    Major, Balázs

    The latitudinal time distribution of sunspots (butterfly diagram) was studied by Becker (1959) and Antalová & Gnevyshev (1985). Our goal is to revisit these studies. In the first case we check whether there is a poleward migration in sunspot activity. In the second case we confirm the results, and make more quantitative statements concerning their significance and the position of the activity peaks.

  1. The Rotating Morse-Pekeris Oscillator Revisited

    Science.gov (United States)

    Zuniga, Jose; Bastida, Adolfo; Requena, Alberto

    2008-01-01

    The Morse-Pekeris oscillator model for the calculation of the vibration-rotation energy levels of diatomic molecules is revisited. This model is based on the realization of a second-order exponential expansion of the centrifugal term about the minimum of the vibrational Morse oscillator and the subsequent analytical resolution of the resulting…

  2. Toll like receptors and inflammatory factors in sepsis and differential expression related to age

    Institute of Scientific and Technical Information of China (English)

    ZHU Ying-gang; QU Jie-ming

    2007-01-01

    @@ In recent years, the incidence of systematic severe infection in intensive care units (ICUs) has increased significantly. Sepsis is a complex, multifactorial syndrome that can develop into conditions of different severity, described as severe sepsis or septic shock.1 The immunology of severe sepsis and septic shock is poorly defined, despite many studies investigating the pathogenesis of this syndrome. With mortality rates of up to 50%,2, 3 greater understanding of the interactions between host and microbe is necessary to improve patient outcome.

  3. Accuracy of Presepsin in Sepsis Diagnosis: A Systematic Review and Meta-Analysis

    OpenAIRE

    Wu, Jiayuan; Hu, Liren; Zhang, Gaohua; Wu, Fenping; He, Taiping

    2015-01-01

    Objective It’s difficult to differentiate sepsis from non-sepsis, especially non-infectious SIRS, because no good standard exists for proof of infection. Soluble CD14 subtype (sCD14-ST), recently re-named presepsin, was identified as a new marker for the diagnosis of sepsis in several reports. However, the findings were based on the results of individual clinical trials, rather than a comprehensive and overall estimation. Thus, we conducted this systematic review and meta-analysis to estimate...

  4. Targeted delivery of siRNA to cell death proteins in sepsis

    OpenAIRE

    Brahmamdam, Pavan; Watanabe, Eizo; Unsinger, Jacqueline; Chang, Katherine C.; Schierding, William; Hoekzema, Andrew S.; Zhou, Tony T.; McDonough, Jacquelyn S.; Holemon, Heather; Heidel, Jeremy D.; Coopersmith, Craig M.; McDunn, Jonathan E.; Hotchkiss, Richard S.

    2009-01-01

    Immune suppression is a major cause of morbidity and mortality in the septic patient. Apoptotic loss of immune effector cells such as CD4 T and B cells is a key component in the loss immune competence in sepsis. Inhibition of lymphocyte apoptosis has led to improved survival in animal models of sepsis. Using qRT-PCR of isolated splenic CD4 T and B cells, we determined that Bim and PUMA, two key cell death proteins, are markedly up-regulated during sepsis. Lymphocytes have been notoriously dif...

  5. Targeted mass spectrometry analysis of neutrophil-derived proteins released during sepsis progression

    DEFF Research Database (Denmark)

    Malmström, E; Davidova, A; Mörgelin, M; Linder, A; Larsen, Michael; Qvortrup, Klaus; Nordenfelt, P; Shannon, O; Dzupova, O; Holub, M; Malmström, J; Herwald, H

    2014-01-01

    Early diagnosis of severe infectious diseases is essential for timely implementation of lifesaving therapies. In a search for novel biomarkers in sepsis diagnosis we focused on polymorphonuclear neutrophils (PMNs). Notably, PMNs have their protein cargo readily stored in granules and following...... systemic stimulation an immediate increase of neutrophil-borne proteins can be observed into the circulation of sepsis patients. We applied a combination of mass spectrometry (MS) based approaches, LC-MS/MS and selected reaction monitoring (SRM), to characterise and quantify the neutrophil proteome in...... and, thus, a promising technology to study a complex, dynamic and multifactorial disease such as sepsis....

  6. Survey of long-term quality of life in patients with severe sepsis

    OpenAIRE

    Cheng, Bao-Li; Jin, Yue; Liu, Xi-Wang; Zhang, Ying-Chun; Chen, Xiang-Ping; Le-hui CHEN; Zhu, Tao; Fang, Xiang-ming

    2011-01-01

    Objective To evaluate the long-term quality of life of patients with severe sepsis after being discharged from hospital for 2 to 5 years.Methods Prospective cohort study and follow-up was conducted in 3 affiliated hospitals of Zhejiang University.Three hundred and sixty two severe sepsis and non-sepsis critical ill patients discharged from intensive care units of the participating hospitals during Jan.1st,2002 to Mar.1st,2007 were enrolled in present study.Fifty one cases were followed up,to ...

  7. [Sepsis caused by Raoultella ornithinolytica in an immunocompetent patient].

    Science.gov (United States)

    Sueifan, M; Moog, V; Rau, E; Eichenauer, T

    2016-02-01

    Raoultella ornithinolytica is a species of gram-negative encapsulated and aerobic bacteria belonging to the family Enterobacteriaceae and is mainly found in fish. The most distinctive feature of this bacterium is the ability to convert histidine to histamine; therefore, the consumption of decomposing fish infected by R. ornithinolytica causes rashes, diarrhea, flushing, sweating and vomiting. This food poisoning is also called histamine fish poisoning; however, human infections with R. ornithinolytica are extremely rare and have so far only affected patients with diseases suppressing the immune system. The current case report describes for the first time sepsis with evidence of bloodstream infection by R. ornithinolytica in an immunocompetent male patient and the successful antibiotic treatment. PMID:26811948

  8. Clavanin bacterial sepsis control using a novel methacrylate nanocarrier

    Directory of Open Access Journals (Sweden)

    Saúde ACM

    2014-10-01

    Full Text Available Amanda CM Saúde,1 Alicia S Ombredane,1 Osmar N Silva,1 João ARG Barbosa,1,2 Susana E Moreno,3 Ana Claudia Guerra Araujo,4 Rosana Falcão,4 Luciano P Silva,4 Simoni C Dias,1 Octávio L Franco1,3 1Programa de Pós Graduação em Ciências Genômicas e Biotecnologia, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, FD, Brazil; 2Laboratório de Biofísica-Departamento de Biologia Celular-IB, Universidade de Brasília – UNB, DF, Brazil; 3Universidade Católica Dom Bosco – UCDB, Campo Grande, MS, Brazil; 4Empresa Brasileira de Pesquisa Agropecuária – EMBRAPA – Recursos Genéticos e Biotecnologia, Brasília, DF, Brazil Abstract: Controlling human pathogenic bacteria is a worldwide problem due to increasing bacterial resistance. This has prompted a number of studies investigating peptides isolated from marine animals as a possible alternative for control of human pathogen infections. Clavanins are antimicrobial peptides isolated from the marine tunicate Styela clava, showing 23 amino acid residues in length, cationic properties, and also high bactericidal activity. In spite of clear benefits from the use of peptides, currently 95% of peptide properties have limited pharmaceutical applicability, such as low solubility and short half-life in the circulatory system. Here, nanobiotechnology was used to encapsulate clavanin A in order to develop nanoantibiotics against bacterial sepsis. Clavanin was nanostructured using EUDRAGIT® L 100-55 and RS 30 D solution (3:1 w:w. Atomic force, scanning electron microscopy and dynamic light scattering showed nanoparticles ranging from 120 to 372 nm in diameter, with a zeta potential of -7.16 mV and a polydispersity index of 0.123. Encapsulation rate of 98% was assessed by reversed-phase chromatography. In vitro bioassays showed that the nanostructured clavanin was partially able to control development of Staphylococcus aureus, Klebsiella pneumoniae, and

  9. Treatment of sepsis: current status of clinical immunotherapy.

    LENUS (Irish Health Repository)

    O'Callaghan, A

    2012-02-03

    While antibiotics address the root cause of sepsis--that of pathogen infection--they fail to provide an adequate cure for the condition. Currently, 30% to 50% of septic patients die, and this figure is likely to increase in line with the proliferation of multi-drug resistant bacteria. With an increased understanding of the immune response, it has been proposed that modulation of this defence mechanism offers the best hope of cure. Many entry-points in the immune system have been identified and targeted therapies have been developed,but why are these not in routine clinical practice? This review examines the latest evidence for the use of immuno-modulating drugs, obtained from human clinical trials. We discuss cytokine-based therapies, steroids and anti-coagulants. Finally, consideration is given as to why successful therapies in the laboratory, and in vivo models, do not automatically translate into clinical benefit

  10. Marine Compounds with Therapeutic Potential in Gram-Negative Sepsis

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    Irina Yermak

    2013-06-01

    Full Text Available This paper concerns the potential use of compounds, including lipid A, chitosan, and carrageenan, from marine sources as agents for treating endotoxemic complications from Gram-negative infections, such as sepsis and endotoxic shock. Lipid A, which can be isolated from various species of marine bacteria, is a potential antagonist of bacterial endotoxins (lipopolysaccharide (LPSs. Chitosan is a widespread marine polysaccharide that is derived from chitin, the major component of crustacean shells. The potential of chitosan as an LPS-binding and endotoxin-neutralizing agent is also examined in this paper, including a discussion on the generation of hydrophobic chitosan derivatives to increase the binding affinity of chitosan to LPS. In addition, the ability of carrageenan, which is the polysaccharide of red alga, to decrease the toxicity of LPS is discussed. We also review data obtained using animal models that demonstrate the potency of carrageenan and chitosan as antiendotoxin agents.

  11. The redistribution of granulocytes following E. coli endotoxin induced sepsis

    DEFF Research Database (Denmark)

    Toft, P; Lillevang, S T; Tønnesen, Else Kirstine;

    1994-01-01

    Infusion of endotoxin elicits granulocytopenia followed by increased numbers of granulocytes in peripheral blood. The purpose of this study was to investigate the redistribution and sequestration of granulocytes in the tissues following E. coli endotoxin induced sepsis. From 16 rabbits granulocytes...... were isolated, labelled with Indium and reinjected intravenously. Eight rabbits received an infusion of E. coli endotoxin 2 micrograms kg-1 while eight received isotonic saline. The redistribution of granulocytes was imaged with a gamma camera and calculated with a connected computer before and 2 and 6...... hours after infusion of endotoxin or saline. Serum cortisol and interleukin-1 beta were measured. In another seven rabbits, respiratory burst activity and degranulation of granulocytes were measured prior to and from 5 min to 6 hours after infusion of E. coli endotoxin 2 micrograms kg-1 BW. Following...

  12. Non-traumatic abdominal emergencies: imaging and intervention in sepsis

    International Nuclear Information System (INIS)

    Cross-sectional imaging, in particular CT, has become the main method of detecting abdominal collections. Indium-labelled white-cell scintigraphy and gallium scintigraphy are reserved for patients in whom there is a high clinical suspicion of abdominal sepsis but CT has not revealed a source of sepsis. Scintigraphy is also used in patients with suspected vascular graft infections or suspected infected hip prostheses. Percutaneous abscess drainage (PAD) has revolutionised the treatment of abdominal abscesses over the past 20 years, with repeat laparotomy for postoperative abscesses becoming a rare event. Ultrasound or CT can be used to guide PAD. Choosing an access route that does not cross intervening organs is of crucial importance to the safe performance of PAD. The Trocar or Seldinger techniques can be used with equal success. The cavity should be aspirated until dry and irrigated with saline. Repeat imaging after drainage is helpful to detect any undrained locules. PAD endpoints include patient defervescence, reduction in white blood cell count and catheter drainage of less than 10 ml per day. Details regarding PAD in specific abdominal regions are discussed. Success rates for PAD are high (close to 90%) in most abdominal organs. Slightly lower success rates are seen with PAD of pancreatic abscesses and abscesses associated with fistulas (60-85% success rates). Complication rates lie between 0% and 10%. Complications can be minimised by ensuring that the patient has broad spectrum antibiotic coverage before drainage, by carefully planning the access route and by ensuring diligent post-procedure care by radiology staff. (orig.)

  13. Sepsis: a more faster report from blood culture

    Directory of Open Access Journals (Sweden)

    Raffaella Ledonne

    2010-09-01

    Full Text Available Introduction: Sepsis is a leading cause of morbidity and mortality. Several studies demonstrated that the earliness of the intervention therapy, including antimicrobial treatment active on the specific pathogen, is associated with a reduction of mortality. In order to permit the use of a quicker appropriate treatment in respect to using the conventional method,we evaluated both the accuracy of strain identification and in vitro antimicrobial susceptibilities directly from the haemocultural bottles. Methods:We examined 112 samples of positive blood cultures through traditional technique of subculture, identification and susceptibility testing, and a diagnostic alternative method in the following way: 5-6 ml from positive blood cultures (BACTEC 9640 were transferred into a test tube fitted with a sterile gel separator and centrifuged at 3200 rpm for 15 minutes. After the removal of supernatant, the microbial pellet was suspended in a saline buffer to obtain an 0.5 McFarland inoculum; this turbidity was needed to set up the direct identification and the susceptibility testing (VITEK 2. Results: The correlation between the two procedures has demonstrated a correlation of 98% for the strains identification; the correlation was of 100% for MRSA and ESBL recognition. Conclusions: The results showed that the use of the direct test for both Gram positive and Gram negative bacteria can give a complete report regarding the identification and susceptibility testing within 24 hours from when the sample becomes positive instead of 48h required using the conventional method.The procedure has demonstrated a high reliability both in terms of strains identification and of antibioticsusceptibility. We therefore can suggest, in the diagnostic of sepsis, the introduction of direct method in normal laboratory practice.

  14. Non-traumatic abdominal emergencies: imaging and intervention in sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M.J. [Department of Radiology, Beaumont Hospital and the Royal College of Surgeons Medical, Beaumont Road, Dublin 9 (Ireland)

    2002-09-01

    Cross-sectional imaging, in particular CT, has become the main method of detecting abdominal collections. Indium-labelled white-cell scintigraphy and gallium scintigraphy are reserved for patients in whom there is a high clinical suspicion of abdominal sepsis but CT has not revealed a source of sepsis. Scintigraphy is also used in patients with suspected vascular graft infections or suspected infected hip prostheses. Percutaneous abscess drainage (PAD) has revolutionised the treatment of abdominal abscesses over the past 20 years, with repeat laparotomy for postoperative abscesses becoming a rare event. Ultrasound or CT can be used to guide PAD. Choosing an access route that does not cross intervening organs is of crucial importance to the safe performance of PAD. The Trocar or Seldinger techniques can be used with equal success. The cavity should be aspirated until dry and irrigated with saline. Repeat imaging after drainage is helpful to detect any undrained locules. PAD endpoints include patient defervescence, reduction in white blood cell count and catheter drainage of less than 10 ml per day. Details regarding PAD in specific abdominal regions are discussed. Success rates for PAD are high (close to 90%) in most abdominal organs. Slightly lower success rates are seen with PAD of pancreatic abscesses and abscesses associated with fistulas (60-85% success rates). Complication rates lie between 0% and 10%. Complications can be minimised by ensuring that the patient has broad spectrum antibiotic coverage before drainage, by carefully planning the access route and by ensuring diligent post-procedure care by radiology staff. (orig.)

  15. Vascular dysfunction following polymicrobial sepsis: role of pattern recognition receptors.

    Directory of Open Access Journals (Sweden)

    Stefan Felix Ehrentraut

    Full Text Available AIMS: Aim was to elucidate the specific role of pattern recognition receptors in vascular dysfunction during polymicrobial sepsis (colon ascendens stent peritonitis, CASP. METHODS AND RESULTS: Vascular contractility of C57BL/6 (wildtype mice and mice deficient for Toll-like receptor 2/4/9 (TLR2-D, TLR4-D, TLR9-D or CD14 (CD14-D was measured 18 h following CASP. mRNA expression of pro- (Tumor Necrosis Factor-α (TNFα, Interleukin (IL-1β, IL-6 and anti-inflammatory cytokines (IL-10 and of vascular inducible NO-Synthase (iNOS was determined using RT-qPCR. Wildtype mice exhibited a significant loss of vascular contractility after CASP. This was aggravated in TLR2-D mice, blunted in TLR4-D animals and abolished in TLR9-D and CD14-D animals. TNF-α expression was significantly up-regulated after CASP in wildtype and TLR2-D animals, but not in mice deficient for TLR4, -9 or CD14. iNOS was significantly up-regulated in TLR2-D animals only. TLR2-D animals showed significantly higher levels of TLR4, -9 and CD14. Application of H154-ODN, a TLR9 antagonist, attenuated CASP-induced cytokine release and vascular dysfunction in wildtype mice. CONCLUSIONS: Within our model, CD14 and TLR9 play a decisive role for the development of vascular dysfunction and thus can be effectively antagonized using H154-ODN. TLR2-D animals are more prone to polymicrobial sepsis, presumably due to up-regulation of TLR4, 9 and CD14.

  16. Cytokines and signaling molecules predict clinical outcomes in sepsis.

    Directory of Open Access Journals (Sweden)

    Christopher D Fjell

    Full Text Available INTRODUCTION: Inflammatory response during sepsis is incompletely understood due to small sample sizes and variable timing of measurements following the onset of symptoms. The vasopressin in septic shock trial (VASST compared the addition of vasopressin to norepinephrine alone in patients with septic shock. During this study plasma was collected and 39 cytokines measured in a 363 patients at both baseline (before treatment and 24 hours. Clinical features relating to both underlying health and the acute organ dysfunction induced by the severe infection were collected during the first 28 days of admission. HYPOTHESIS: Cluster analysis of cytokines identifies subgroups of patients at differing risk of death and organ failure. METHODS: Circulating cytokines and other signaling molecules were measured using a Luminex multi-bead analyte detection system. Hierarchical clustering was performed on plasma values to create patient subgroups. Enrichment analysis identified clinical outcomes significantly different according to these chemically defined patient subgroups. Logistic regression was performed to assess the importance of cytokines for predicting patient subgroups. RESULTS: Plasma levels at baseline produced three subgroups of patients, while 24 hour levels produced two subgroups. Using baseline cytokine data, one subgroup of 47 patients showed a high level of enrichment for severe septic shock, coagulopathy, renal failure, and risk of death. Using data at 24 hours, a larger subgroup of 81 patients that largely encompassed the 47 baseline subgroup patients had a similar enrichment profile. Measurement of two cytokines, IL2 and CSF2 and their product were sufficient to classify patients into these subgroups that defined clinical risks. CONCLUSIONS: A distinct pattern of cytokine levels measured early in the course of sepsis predicts disease outcome. Subpopulations of patients have differing clinical outcomes that can be predicted accurately from

  17. Sepsis causes neuroinflammation and concomitant decrease of cerebral metabolism

    Directory of Open Access Journals (Sweden)

    Semmler Alexander

    2008-09-01

    Full Text Available Abstract Background Septic encephalopathy is a severe brain dysfunction caused by systemic inflammation in the absence of direct brain infection. Changes in cerebral blood flow, release of inflammatory molecules and metabolic alterations contribute to neuronal dysfunction and cell death. Methods To investigate the relation of electrophysiological, metabolic and morphological changes caused by SE, we simultaneously assessed systemic circulation, regional cerebral blood flow and cortical electroencephalography in rats exposed to bacterial lipopolysaccharide. Additionally, cerebral glucose uptake, astro- and microglial activation as well as changes of inflammatory gene transcription were examined by small animal PET using [18F]FDG, immunohistochemistry, and real time PCR. Results While the systemic hemodynamic did not change significantly, regional cerebral blood flow was decreased in the cortex paralleled by a decrease of alpha activity of the electroencephalography. Cerebral glucose uptake was reduced in all analyzed neocortical areas, but preserved in the caudate nucleus, the hippocampus and the thalamus. Sepsis enhanced the transcription of several pro- and anti-inflammatory cytokines and chemokines including tumor necrosis factor alpha, interleukin-1 beta, transforming growth factor beta, and monocot chemoattractant protein 1 in the cerebrum. Regional analysis of different brain regions revealed an increase in ED1-positive microglia in the cortex, while total and neuronal cell counts decreased in the cortex and the hippocampus. Conclusion Together, the present study highlights the complexity of sepsis induced early impairment of neuronal metabolism and activity. Since our model uses techniques that determine parameters relevant to the clinical setting, it might be a useful tool to develop brain specific therapeutic strategies for human septic encephalopathy.

  18. Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

    Science.gov (United States)

    Richard, Kathleen R.; Lovvorn, Joshua J.; Oliver, Sara E.; Ross, Shannon A.; Benner, Kim W.; Kong, Michele Y.F.

    2015-01-01

    Patient: Male, 11 Final Diagnosis: Chromobacterium violaceum infection Symptoms: Abscess • fever • rash Medication: — Clinical Procedure: ECMO Specialty: Critical Care Medicine Objective: Rare disease Background: Chromobacterium violaceum (C. violaceum) is a facultative anaerobic gram-negative bacterium found in soil and water, especially in tropical and subtropical areas. Although infection in humans is rare, it is associated with significant morbidity. The bacterium is known for its resistance to multiple antimicrobials, and the possibility of relapse and reinfection. Presence of bacteremia, disseminated infection, and ineffective antimicrobial agents are predictors of mortality. Case Report: We report the case of a previously healthy 11-year-old male with C. violaceum sepsis who was exposed to stagnant water. He presented with severe septic shock and developed multi-organ system failure. Initial presumptive diagnosis was staphylococcal infection secondary to presence of skin abscesses resulting in antibiotic coverage with vancomycin, clindamycin, nafcillin and ceftriaxone. He also had multiple lung and liver abscesses. Once C. violaceum was identified, he received meropenem and ciprofloxacin, and was later discharged on ertapenem and trimethoprim-sulfamethoxazole (TMP-SMX) to complete a total of six months of antibiotics. He was diagnosed with chronic granulomatous disease (CGD) and is currently on prophylactic TMP-SMX and itraconazole. He has not had any relapses since his initial presentation. Conclusions: This case highlights the importance of considering C. violaceum as a relevant human pathogen, and considering it early in temperate regions, particularly in cases of fulminant sepsis associated with multi-organ abscesses. Once C. violaceum is identified, appropriate antimicrobial therapy should be started promptly, and sufficient duration of treatment is necessary for successful therapy. PMID:26477750

  19. Increased CD4+ T Cell Co-Inhibitory Immune Receptor CEACAM1 in Neonatal Sepsis and Soluble-CEACAM1 in Meningococcal Sepsis: A Role in Sepsis-Associated Immune Suppression?

    OpenAIRE

    Michiel van der Flier; Sharma, Dyana B.; Silvia Estevão; Marieke Emonts; Denise Rook; Hazelzet, Jan A.; van Goudoever, Johannes B.; Hartwig, Nico G.

    2013-01-01

    textabstractThe co-inhibitory immune receptor carcinoembryonic antigen-related cell-adhesion molecule 1 (CEACAM1) and its self-ligand CEACAM1 can suppress T cell function. Suppression of T cell function in sepsis is well documented. Late-onset neonatal sepsis in VLBW-infants was associated with an increased percentage CEACAM1 positive CD4+ T-cells. Meningococcal septic shock in children was associated with increased serum soluble CEACAM1. In conclusion our data demonstrate increased surface e...

  20. Revisiting the 1761 Transatlantic Tsunami

    Science.gov (United States)

    Baptista, Maria Ana; Wronna, Martin; Miranda, Jorge Miguel

    2016-04-01

    The tsunami catalogs of the Atlantic include two transatlantic tsunamis in the 18th century the well known 1st November 1755 and the 31st March 1761. The 31st March 1761 earthquake struck Portugal, Spain, and Morocco. The earthquake occurred around noontime in Lisbon alarming the inhabitants and throwing down ruins of the past 1st November 1755 earthquake. According to several sources, the earthquake was followed by a tsunami observed as far as Cornwall (United Kingdom), Cork (Ireland) and Barbados (Caribbean). The analysis of macroseismic information and its compatibility with tsunami travel time information led to a source area close to the Ampere Seamount with an estimated epicenter circa 34.5°N 13°W. The estimated magnitude of the earthquake was 8.5. In this study, we revisit the tsunami observations, and we include a report from Cadiz not used before. We use the results of the compilation of the multi-beam bathymetric data, that covers the area between 34°N - 38°N and 12.5°W - 5.5°W and use the recent tectonic map published for the Southwest Iberian Margin to select among possible source scenarios. Finally, we use a non-linear shallow water model that includes the discretization and explicit leap-frog finite difference scheme to solve the shallow water equations in the spherical or Cartesian coordinate to compute tsunami waveforms and tsunami inundation and check the results against the historical descriptions to infer the source of the event. This study received funding from project ASTARTE- Assessment Strategy and Risk Reduction for Tsunamis in Europe a collaborative project Grant 603839, FP7-ENV2013 6.4-3

  1. Avances en el desarrollo de terapias neutralizantes en la sepsis Advances in the development of neutralizing therapies for sepsis

    Directory of Open Access Journals (Sweden)

    Maria Florencia Henning

    2006-06-01

    Full Text Available El lipopolisacárido bacteriano (LPS, también denominado endotoxina, es el constituyente mayoritario de la membrana externa de bacterias Gram negativas. Esta molécula es liberada de la bacteria a la circulación exhibiendo una amplia variedad de efectos tóxicos y pro-inflamatorios, los cuales están asociados al lípido A y a su vez están relacionados a la patogénesis de la sepsis. Muchos de los fenómenos fisiológicos producidos por el LPS resultan de la capacidad de esta molécula de activar las células del sistema inmune del huésped, entre ellas monocitos, macrófagos y leucocitos polimorfonucleares. Este proceso produce una inflamación local, proceso beneficioso para el huésped. Sin embargo, si la cantidad de LPS liberado excede cierta concentración crítica umbral, la exacerbada liberación de citoquinas inflamatorias como Factor de Necrosis Tumoral (TNF-a e interleuquinas (IL resulta en sepsis grave, lo que hace necesario encontrar nuevas opciones terapéuticas capaces de neutralizar la endotoxina circulante. En este artículo se presenta una revisión actualizada de los resultados experimentales obtenidos in vivo e in vitro empleando proteínas y péptidos sintéticos con la finalidad de neutralizar el LPS, y las perspectivas que en este área ofrece el uso de lipoproteínas, en particular la apolipoproteína A-I y formas mutantes o péptidos derivados de esta proteína.Lipopolisaccharide (LPS, also called endotoxin, is the major component of the external membrane in Gram negative bacteria. This molecule is released to circulation by the bacteria, producing a large variety of toxic and pro-inflammatory effects which are associated with lipid A as well as with sepsis pathogenesis. Many physiological phenomena produced by LPS arise from this molecule's capacity to activate cells in the host immune system such as monocytes, macrophages and polymorphonuclear leukocytes. This process leads to a local inflammation, and it is

  2. Changes of serum procalcitonin (PCT) and IL-6 levels in patients with sepsis

    International Nuclear Information System (INIS)

    Objective: To investigate the importance of determination of changes of serum procalcitonin (PCT) and IL-6 levels in patients with sepsis. Methods: Serum PCT (with double-sandwich immunofluorescence assay) and IL-6 (with ELISA) levels were measured repeatedly in 130 patients with sepsis on d1, d3, d5, d7 after admission. Values in 130 healthy individuals were also measured as control. Results: The serum levels of PCT and IL-6 in the patients with sepsis of admission were significantly higher than those in controls. The levels dropped markedly in the survivors by d7. Among the septic patients, the levels in the succumbed patients were significantly higher those in the survivors (P<0.05). Conclusion: Serum PCT and IL-6 values appeared to be of prognostic value in patients with sepsis. (authors)

  3. Mechanical ventilation and sepsis impair protein metabolism in the diaphragm of neonatal pigs

    Science.gov (United States)

    Mechanical ventilation (MV) impairs diaphragmatic function and diminishes the ability to wean from ventilatory support in adult humans. In normal neonatal pigs, animals that are highly anabolic, endotoxin (LPS) infusion induces sepsis, reduces peripheral skeletal muscle protein synthesis rates, but ...

  4. Broad defects in the energy metabolism of leukocytes underlie immunoparalysis in sepsis.

    Science.gov (United States)

    Cheng, Shih-Chin; Scicluna, Brendon P; Arts, Rob J W; Gresnigt, Mark S; Lachmandas, Ekta; Giamarellos-Bourboulis, Evangelos J; Kox, Matthijs; Manjeri, Ganesh R; Wagenaars, Jori A L; Cremer, Olaf L; Leentjens, Jenneke; van der Meer, Anne J; van de Veerdonk, Frank L; Bonten, Marc J; Schultz, Marcus J; Willems, Peter H G M; Pickkers, Peter; Joosten, Leo A B; van der Poll, Tom; Netea, Mihai G

    2016-04-01

    The acute phase of sepsis is characterized by a strong inflammatory reaction. At later stages in some patients, immunoparalysis may be encountered, which is associated with a poor outcome. By transcriptional and metabolic profiling of human patients with sepsis, we found that a shift from oxidative phosphorylation to aerobic glycolysis was an important component of initial activation of host defense. Blocking metabolic pathways with metformin diminished cytokine production and increased mortality in systemic fungal infection in mice. In contrast, in leukocytes rendered tolerant by exposure to lipopolysaccharide or after isolation from patients with sepsis and immunoparalysis, a generalized metabolic defect at the level of both glycolysis and oxidative metabolism was apparent, which was restored after recovery of the patients. Finally, the immunometabolic defects in humans were partially restored by therapy with recombinant interferon-γ, which suggested that metabolic processes might represent a therapeutic target in sepsis. PMID:26950237

  5. Toll-like Receptor 1 Polymorphisms Affect Innate Immune Responses and Outcomes in Sepsis

    OpenAIRE

    Wurfel, Mark M.; Gordon, Anthony C.; Holden, Tarah D.; Radella, Frank; Strout, Jeanna; Kajikawa, Osamu; Ruzinski, John T.; Rona, Gail; Black, R. Anthony; Stratton, Seth; Jarvik, Gail P.; Hajjar, Adeline M.; Nickerson, Deborah A.; Rieder, Mark; Sevransky, Jonathan

    2008-01-01

    Rationale: Polymorphisms affecting Toll-like receptor (TLR)–mediated responses could predispose to excessive inflammation during an infection and contribute to an increased risk for poor outcomes in patients with sepsis.

  6. Low zinc and selenium concentrations in sepsis are associated with oxidative damage and inflammation

    DEFF Research Database (Denmark)

    Mertens, K; Lowes, D A; Webster, N R; Talib, J; Hall, L; Davies, Michael Jonathan; Beattie, J H; Galley, H F

    2015-01-01

    . Zinc, selenium, and a series of biomarkers of oxidative stress and inflammation were measured in plasma from critically ill patients with and without sepsis. RESULTS: Culturing cells with different concentrations of zinc caused altered zinc transporter protein expression and cellular zinc content, and...... oxidative stress and inflammatory biomarkers, particularly in patients with sepsis. Oxidative stress as a result of suboptimal selenium and zinc concentrations might contribute to damage of key proteins. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: registration number NCT01328509.......BACKGROUND: Oxidative stress with dysregulated inflammation are hallmarks of sepsis. Zinc and selenium have important antioxidant functions, such that they could be important in patients with sepsis. We used an in vitro approach to assess the effect of zinc and selenium on oxidative stress...

  7. Association between biomarkers of endothelial injury and hypocoagulability in patients with severe sepsis

    DEFF Research Database (Denmark)

    Ostrowski, Sisse Rye; Haase, Nicolai; Müller, Rasmus Beier; Møller, Morten Hylander; Pott, Frank Christian; Perner, Anders; Johansson, Pär Ingemar

    2015-01-01

    INTRODUCTION: Patients with severe sepsis often present with concurrent coagulopathy, microcirculatory failure and evidence of vascular endothelial activation and damage. Given the critical role of the endothelium in balancing hemostasis, we investigated single-point associations between whole...... blood coagulopathy by thrombelastography (TEG) and plasma/serum markers of endothelial activation and damage in patients with severe sepsis. METHODS: A post-hoc multicenter prospective observational study in a subgroup of 184 patients from the Scandinavian Starch for Severe Sepsis/Septic Shock (6S......) Trial. Study patients were admitted to two Danish intensive care units. Inclusion criteria were severe sepsis, pre-intervention whole blood TEG measurement and a plasma/serum research sample available from baseline (pre-intervention) for analysis of endothelial-derived biomarkers. Endothelial...

  8. Modelling severe Staphylococcus aureus sepsis in conscious pigs: are implications for animal welfare justified?

    DEFF Research Database (Denmark)

    Olsen, Helle G; Kjelgaard-Hansen, Mads; Tveden-Nyborg, Pernille;

    2016-01-01

    , according to humane endpoints. A usable balance between scientific purpose and animal welfare could not be achieved, and we therefore find it hard to justify further use of this conscious porcine sepsis model. In order to make a model of translational relevance for human sepsis, we suggest that future model......A porcine model of haematogenous Staphylococcus aureus sepsis has previously been established in our research group. In these studies, pigs developed severe sepsis including liver dysfunction during a 48 h study period. As pigs were awake during the study, animal welfare was challenged by the...... severity of induced disease, which in some cases necessitated humane euthanasia. A pilot study was therefore performed in order to establish the sufficient inoculum concentration and application protocol needed to produce signs of liver dysfunction within limits of our pre-defined humane endpoints. Four...

  9. Lactoferrin and neonatology - role in neonatal sepsis and necrotizing enterocolitis: present, past and future.

    Science.gov (United States)

    Sharma, Deepak; Shastri, Sweta

    2016-03-01

    Neonatal sepsis and necrotizing enterocolitis (NEC) are two most important neonatal problems in nursery which constitute the bulk of neonatal mortality and morbidity. Inflammatory mediators secondary to sepsis and NEC increases morbidity, by affecting various system of body like lung, brain and eye, thus causing long term implications. Lactoferrin (LF) is a component of breast milk and multiple actions that includes antimicrobial, antiviral, anti-fungal and anti-cancer and various other actions. Few studies have been completed and a number of them are in progress for evaluation of efficacy and safety of LF in the prevention of neonatal sepsis and NEC in field of neonatology. In future, LF prophylaxis and therapy may have a significant impact in improving clinical outcomes of vulnerable preterm neonates. This review analyse the role of lactoferrin in prevention of neonatal sepsis and NEC, with emphasis on mechanism of action, recent studies and current studies going on around the globe. PMID:25758631

  10. Use of Methylene Blue for Treatment of Severe Sepsis in an Immunosuppressed Patient after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Saravanan Ramamoorthy

    2013-01-01

    Full Text Available Sepsis in the immunosuppressed patient is associated with very high mortality and morbidity. Treatment of sepsis in immunocompromised patients is especially challenging due to an unbalanced systemic inflammatory reaction with subsequent development of profound vasoplegia. Methylene blue (MB has been successfully used for the treatment of refractory hypotension, but its use has not previously been reported for treatment of sepsis in immunosuppressed patients. The mechanism of MB's action is thought to be due to its inhibitory effect on cGMP-mediated vasodilatation. This case report describes the successful use of MB for treatment of severe septic shock in an immunosuppressed patient after liver transplantation. Hypotension in this patient was refractory to volume repletion and a combination of vasopressors. After MB administration, hemodynamic stability was rapidly reestablished. In the setting of severe sepsis in an immunosuppressed patient, MB should be considered early as a therapeutic option for treatment of refractory vasoplegia.

  11. Alpha-Lipoic Acid Attenuates Oxidative Damage in Organs After Sepsis.

    Science.gov (United States)

    Petronilho, Fabricia; Florentino, Drielly; Danielski, Lucinéia Gainski; Vieira, Luiz Carlos; Martins, Maryane Modolon; Vieira, Andriele; Bonfante, Sandra; Goldim, Mariana Pereira; Vuolo, Francieli

    2016-02-01

    Sepsis progression is linked with the imbalance between reactive oxygen species and antioxidant enzymes. Thus, the aim of this study was to evaluate the effect of alpha-lipoic acid (ALA), a powerful antioxidant, in organs of rats submitted to sepsis. Male Wistar rats were subjected to sepsis by cecal ligation puncture (CLP) and treated with ALA or vehicle. After CLP (12 and 24 h), the myeloperoxidase (MPO) activity, protein and lipid oxidative damage, and antioxidant enzymes in the liver, kidney, heart, and lung were evaluated. ALA was effective in reducing MPO activity, lipid peroxidation in the liver, and protein carbonylation only in the kidney in 12 h after CLP. In 12 h, SOD activity increased in the kidney and CAT activity in the liver and kidney with ALA treatment. Thus, ALA was able to reduce the inflammation and oxidative stress in the liver and kidney after sepsis in rats. PMID:26431839

  12. Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

    Science.gov (United States)

    López Sastre, José B; Pérez Solís, David; Roqués Serradilla, Vicente; Fernández Colomer, Belén; Coto Cotallo, Gil D; Krauel Vidal, Xavier; Narbona López, Eduardo; García del Río, Manuel; Sánchez Luna, Manuel; Belaustegui Cueto, Antonio; Moro Serrano, Manuel; Urbón Artero, Alfonso; Álvaro Iglesias, Emilio; Cotero Lavín, Ángel; Martínez Vilalta, Eduardo; Jiménez Cobos, Bartolomé

    2006-01-01

    Background It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12–24 h and 36–48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated. Results The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36–48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12–24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36–48 h of birth (sensitivity 86.5%, specificity 72.7%). Conclusion Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be

  13. Genomic landscape of the individual host response and outcomes in sepsis: a prospective cohort study

    Science.gov (United States)

    Davenport, Emma E; Burnham, Katie L; Radhakrishnan, Jayachandran; Humburg, Peter; Hutton, Paula; Mills, Tara C; Rautanen, Anna; Gordon, Anthony C; Garrard, Christopher; Hill, Adrian V S; Hinds, Charles J; Knight, Julian C

    2016-01-01

    Summary Background Effective targeted therapy for sepsis requires an understanding of the heterogeneity in the individual host response to infection. We investigated this heterogeneity by defining interindividual variation in the transcriptome of patients with sepsis and related this to outcome and genetic diversity. Methods We assayed peripheral blood leucocyte global gene expression for a prospective discovery cohort of 265 adult patients admitted to UK intensive care units with sepsis due to community-acquired pneumonia and evidence of organ dysfunction. We then validated our findings in a replication cohort consisting of a further 106 patients. We mapped genomic determinants of variation in gene transcription between patients as expression quantitative trait loci (eQTL). Findings We discovered that following admission to intensive care, transcriptomic analysis of peripheral blood leucocytes defines two distinct sepsis response signatures (SRS1 and SRS2). The presence of SRS1 (detected in 108 [41%] patients in discovery cohort) identifies individuals with an immunosuppressed phenotype that included features of endotoxin tolerance, T-cell exhaustion, and downregulation of human leucocyte antigen (HLA) class II. SRS1 was associated with higher 14 day mortality than was SRS2 (discovery cohort hazard ratio (HR) 2·4, 95% CI 1·3–4·5, p=0·005; validation cohort HR 2·8, 95% CI 1·5–5·1, p=0·0007). We found that a predictive set of seven genes enabled the classification of patients as SRS1 or SRS2. We identified cis-acting and trans-acting eQTL for key immune and metabolic response genes and sepsis response networks. Sepsis eQTL were enriched in endotoxin-induced epigenetic marks and modulated the individual host response to sepsis, including effects specific to SRS group. We identified regulatory genetic variants involving key mediators of gene networks implicated in the hypoxic response and the switch to glycolysis that occurs in sepsis, including HIF1α and

  14. Predictive Value of IL-8 for Sepsis and Severe Infections after Burn Injury - A Clinical Study

    OpenAIRE

    Kraft, Robert; Herndon, David N; Finnerty, Celeste C.; Cox, Robert A.; Song, Juquan; Jeschke, Marc G.

    2015-01-01

    The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring post-burn inflammation is of paramount importance but so far there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As IL-8 is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict post-burn sepsis, infections, and m...

  15. Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

    Science.gov (United States)

    López Sastre, José B; Solís, David Pérez; Serradilla, Vicente Roqués; Colomer, Belén Fernández; Cotallo, Gil D Coto

    2007-01-01

    Background The results of recent studies suggest the usefulness of PCT for early diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to determine the behavior of serum PCT concentrations in both uninfected and infected neonates, and to assess the value of this marker for diagnosis of neonatal sepsis of vertical transmission. Methods PCT was measured in 827 blood samples collected prospectively from 317 neonates admitted to 13 acute-care teaching hospitals in Spain over one year. Serum PCT concentrations were determined by a specific immunoluminometric assay. The diagnostic efficacy of PCT at birth and within 12–24 h and 36–48 h of life was evaluated calculating the sensitivity, specificity, and likelihood ratio of positive and negative results. Results 169 asymptomatic newborns and 148 symptomatic newborns (confirmed vertical sepsis: 31, vertical clinical sepsis: 38, non-infectious diseases: 79) were studied. In asymptomatic neonates, PCT values at 12–24 h were significantly higher than at birth and at 36–48 h of life. Resuscitation at birth and chorioamnionitis were independently associated to PCT values. Neonates with confirmed vertical sepsis showed significantly higher PCT values than those with clinical sepsis. PCT thresholds for the diagnosis of sepsis were 0.55 ng/mL at birth (sensitivity 75.4%, specificity 72.3%); 4.7 ng/mL within 12–24 h of life (sensitivity 73.8%, specificity 80.8%); and 1.7 ng/mL within 36–48 h of life (sensitivity 77.6%, specificity 79.2%). Conclusion Serum PCT was moderately useful for the detection of sepsis of vertical transmission, and its reliability as a maker of bacterial infection requires specific cutoff values for each evaluation point over the first 48 h of life. PMID:17324267

  16. Interleukin 10.G microsatellite in the promoter region of the interleukin-10 gene in severe sepsis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background The highly polymorphic interleukin 10.G (IL10.G) microsatellite located in the promoter region of the interleukin-10 (IL-10) gene exerts a positive transcriptional regulatory effect on IL-10 gene expression and correlates with the in vitro IL-10 secretion. This study was conducted to investigate whether IL10.G microsatellite is associated with the incidence and /or the outcome of severe sepsis.Methods One hundred and fifteen patients with severe sepsis who had been treated at the intensive care unit of the university hospital were studied. One hundred and forty-one healthy individuals served as controls. IL10.G microsatellite genotyping was performed with the following two methods: fluorescent based polymerase chain reaction (PCR) techniques and silver staining of the amplified DNA fragment in polyacrylamide gel. Alleles were defined according to the size of the amplified DNA product.Results Ten alleles and 36 genotypes were detected both in the patients with severe sepsis and in the healthy controls. Allele IL10.G9 and allele IL10.G13 were the commonest alleles with the frequencies of 32.6% and 21.3% respectively in the patients with severe sepsis, and 34% and 27% respectively in the healthy controls. The allele frequencies of IL10.G microsatellite were neither different between the patients with severe sepsis and the healthy controls (P > 0.05), nor between survivors and non-survivors (P > 0.05). However, the frequency of one common allele IL10.G13 was slightly lower in the patients with severe sepsis than in the healthy controls (21.3% vs 27%, P > 0.05), and the frequency of allele IL10.G9 was slightly higher in the non-survivors than in the survivors (37.1% vs 28.1%, P > 0.05).Conclusion IL10.G microsatellite may neither contribute to the susceptibility to severe sepsis nor to the fatal outcome of severe sepsis.

  17. Studies on the possible role of thyroid hormone in altered muscle protein turnover during sepsis

    International Nuclear Information System (INIS)

    Five days after thyroidectomy (Tx) or sham-Tx in young male Sprague-Dawley rats, sepsis was induced by cecal ligation and puncture (CLP). Control animals underwent laparotomy and manipulation of the cecum without ligation or puncture. Sixteen hours after CLP or laparotomy, protein synthesis and degradation were measured in incubated extensor digitorum longus (EDL) and soleus (SOL) muscles by determining rate of 14C-phenylalanine incorporation into protein and tyrosine release into incubation medium, respectively. Triiodothyronine (T3) was measured in serum and muscle tissue. Protein synthesis was reduced by 39% and 22% in EDL and SOL, respectively, 16 hours after CLP in sham-Tx rats. The response to sepsis of protein synthesis was abolished in Tx rats. Protein breakdown was increased by 113% and 68% in EDL and SOL, respectively, 16 hours after CLP in sham-Tx animals. The increase in muscle proteolysis during sepsis was blunted in hypothyroid animals and was 42% and 49% in EDL and SOL, respectively. T3 in serum was reduced by sepsis, both in Tx and sham-Tx rats. T3 in muscle, however, was maintained or increased during sepsis. Abolished or blunted response of muscle protein turnover after CLP in hypothyroid animals may reflect a role of thyroid hormones in altered muscle protein metabolism during sepsis. Reduced serum levels of T3, but maintained or increased muscle concentrations of the hormone, suggests that increased T3 uptake by muscle may be one mechanism of low T3 syndrome in sepsis, further supporting the concept of a role for thyroid hormone in metabolic alterations in muscle during sepsis

  18. Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders; Inkeri Hennings, Louise;

    2013-01-01

    To assess the effects of fluid therapy with hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin on mortality, kidney injury, bleeding, and serious adverse events in patients with sepsis.......To assess the effects of fluid therapy with hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin on mortality, kidney injury, bleeding, and serious adverse events in patients with sepsis....

  19. Effects of hydroxyethyl starch in subgroups of patients with severe sepsis

    DEFF Research Database (Denmark)

    Müller, Rasmus G; Haase, Nicolai; Wetterslev, Jørn;

    2013-01-01

    It has been speculated that certain subgroups of sepsis patients may benefit from treatment with hydroxyethyl starch (HES) 130/0.42, specifically in the earlier resuscitation of patients with more severely impaired circulation.......It has been speculated that certain subgroups of sepsis patients may benefit from treatment with hydroxyethyl starch (HES) 130/0.42, specifically in the earlier resuscitation of patients with more severely impaired circulation....

  20. JAK2 inhibition prevents innate immune responses and rescues animals from sepsis

    OpenAIRE

    Peña, Geber; Cai, Bolin; Deitch, Edwin A.; Ulloa, Luis

    2010-01-01

    Sepsis, a leading cause of death in hospitalized patients, is characterized by lethal systemic inflammatory responses. JAK2 is an essential tyrosine kinase modulating immune responses. However, the implications of JAK2 in infectious disorders remain undetermined. Here, we report that JAK2 inhibitors rescue animals from polymicrobial sepsis in a clinically relevant time frame. JAK2 inhibition with AG490 prevents NF-κB activation, modulates macrophage activation, and restrains the production of...

  1. National estimates of emergency department visits for pediatric severe sepsis in the United States

    Directory of Open Access Journals (Sweden)

    Sara Singhal

    2013-05-01

    Full Text Available Objective. We sought to determine the characteristics of children presenting to United States (US Emergency Departments (ED with severe sepsis. Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS. Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes, we identified children <18 years old presenting with both infection (triage fever or ICD-9 infection and organ dysfunction (triage hypotension or ICD-9 organ dysfunction. Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29–0.39%. Fever and respiratory infection were the most common indicators of an infection. Hypotension and respiratory failure were the most common indicators of organ dysfunction. Most severe sepsis occurred in children ages 31 days–1 year old (32.1%. Most visits for pediatric severe sepsis occurred during winter months (37.4%, and only 11.1% of patients arrived at the ED by ambulance. Over half of severe sepsis cases were self-pay or insured by Medicaid. A large portion (44.1% of pediatric severe sepsis ED visits occurred in the South census region. ED length of stay was over 3 h, and 16.5% were admitted to the hospital. Conclusion. Nearly 100,000 children annually present to US EDs with severe sepsis. The findings of this study highlight the unique characteristics of children treated in the ED for severe sepsis.

  2. An ongoing search for potential targets and therapies for lethal sepsis

    OpenAIRE

    Bao, Guo-Qiang; He, Li; Lee, David; D’Angelo, John; Wang, Hai-Chao

    2015-01-01

    Sepsis, which refers to a systemic inflammatory response syndrome resulting from a microbial infection, represents the leading cause of death in intensive care units. The pathogenesis of sepsis remains poorly understood although it is attributable to dysregulated immune responses orchestrated by innate immune cells that are sequentially released early (e.g., tumor necrosis factor(TNF), interleukin-1(IL-1), and interferon-γ(IFN-γ)) and late (e.g., high mobility group box 1(HMGB1)) pro-inflamma...

  3. Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock

    OpenAIRE

    Parsons, Elizabeth C.; Hough, Catherine L.; Seymour, Christopher W; Cooke, Colin R.; Rubenfeld, Gordon D.; Watkins, Timothy R

    2011-01-01

    Introduction In this study, we sought to determine the association between red blood cell (RBC) transfusion and outcomes in patients with acute lung injury (ALI), sepsis and shock. Methods We performed a secondary analysis of new-onset ALI patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial (2000 to 2005) who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria (mean arterial pressure (MAP) < 60 mmHg or vasopressor ...

  4. Update on the Immunological Pathway of Negative Regulation in Acute Insults and Sepsis

    OpenAIRE

    Luan, Ying-yi; Yong-ming YAO; Sheng, Zhi-Yong

    2012-01-01

    Sepsis with subsequent multiple organ dysfunction is a distinctly systemic inflammatory response to concealed or known infection and is a leading cause of death in intensive care units. In the initial stage of sepsis, a phase of immune activation can be evident, but a marked apoptosis-induced depletion of lymphocytes and a nonspecific anergy of immune function after severe trauma and burns might be responsible for the increased susceptibility of the host to subsequent septic complications. Re...

  5. Severe Cystic Periventricular Leukomalacia in a Premature Infant with Capnocytophaga Sepsis

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    W. Thomas Bass

    2014-11-01

    Full Text Available Capnocytophaga is an opportunistic gram-negative anaerobic bacillus found in the oropharyngeal cavity of mammals and is associated with periodontal disease in humans. Sepsis, osteomyelitis, lung abscess, endocarditis, and meningitis have been reported in humans following animal bites. Perinatal infection with Capnocytophaga is infrequent and is generally considered to have a low risk of morbidity to the mother and fetus. We report a case of neonatal Capnocytophaga sepsis associated with the development of severe cystic periventricular leukomalacia

  6. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction

    OpenAIRE

    Castelli, Gian Paolo; Pognani, Claudio; Meisner, Michael; Stuani, Antonio; Bellomi, Daniela; Sgarbi, Laura

    2004-01-01

    Introduction Both C-reactive protein (CRP) and procalcitonin (PCT) are accepted sepsis markers. However, there is still some debate concerning the correlation between their serum concentrations and sepsis severity. We hypothesised that PCT and CRP concentrations are different in patients with infection or with no infection at a similar severity of organ dysfunction or of systemic inflammatory response. Patients and methods One hundred and fifty adult intensive care unit patients were observed...

  7. High-sensitivity C-reactive protein and risk of sepsis.

    Directory of Open Access Journals (Sweden)

    Henry E Wang

    Full Text Available BACKGROUND: Conventional C-reactive protein assays have been used to detect or guide the treatment of acute sepsis. The objective of this study was to determine the association between elevated baseline high-sensitivity C-reactive protein (hsCRP and the risk of future sepsis events. METHODS: We studied data from 30,239 community dwelling, black and white individuals, age ≥45 years old enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS cohort. Baseline hsCRP and participant characteristics were determined at the start of the study. We identified sepsis events through review of hospital records. Elevated hsCRP was defined as values >3.0 mg/L. Using Cox regression, we determined the association between elevated hsCRP and first sepsis event, adjusting for sociodemographic factors (age, sex, race, region, education, income, health behaviors (tobacco and alcohol use, chronic medical conditions (coronary artery disease, diabetes, dyslipidemia, hypertension, chronic kidney disease, chronic lung disease and statin use. RESULTS: Over the mean observation time of 5.7 years (IQR 4.5-7.1, 974 individuals experienced a sepsis event, and 11,447 (37.9% had elevated baseline hsCRP (>3.0 mg/L. Elevated baseline hsCRP was independently associated with subsequent sepsis (adjusted HR 1.56; 95% CI 1.36-1.79, adjusted for sociodemographics, health behaviors, chronic medical conditions and statin use. CONCLUSION: Elevated baseline hsCRP was associated with increased risk of future sepsis events. hsCRP may help to identify individuals at increased risk for sepsis.

  8. Comparison of the effects of hyperbaric oxygen and normobaric oxygen on sepsis in rats

    Directory of Open Access Journals (Sweden)

    Ahmet Ozturk

    2016-03-01

    Conclusion: HBO or NBO should be used as an agent for the adjuvant treatment of sepsis. It can be concluded that applying HBO therapy as an adjuvant will be more useful for the patients meeting the criteria of sepsis. Advanced studies are required to understand the mechanism of treatment and to investigate the usability and efficiency. [Arch Clin Exp Surg 2016; 5(1.000: 7-12

  9. Aetiology of community-acquired neonatal sepsis in low- and middle-income countries

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    Donald Waters

    2011-12-01

    Full Text Available 99% of the approximate 1 million annual neonatal deaths from life-threatening invasive bacterial infections occur in developing countries, at least 50% of which are from home births or community settings. Data concerning aetiology of sepsis in these settings are necessary to inform targeted therapy and devise management guidelines. This review describes and analyses the bacterial aetiology of community-acquired neonatal sepsis in developing countries.

  10. Elevated Cardiac Troponins in Setting of Systemic Inflammatory Response Syndrome, Sepsis, and Septic Shock

    OpenAIRE

    Nasir Hussain

    2013-01-01

    Elevation of cardiac troponins and creatinine kinase is frequently observed in setting of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock. Underlying pathophysiologic mechanism for such troponin leak, its clinical significance, and what different could be done in such settings remain elusive. In this paper we have briefly overviewed the proposed pathogenic mechanisms for SIRS, sepsis, or septic shock-related troponin elevation (SRTE) and have provided brief overview on...

  11. Xanthine oxidase activity and free radical generation in patients with sepsis syndrome

    DEFF Research Database (Denmark)

    Galley, H F; Davies, Michael Jonathan; Webster, N R

    1996-01-01

    OBJECTIVE: To determine xanthine oxidase activity, free radical concentrations, and lipid peroxidation in patients with sepsis syndrome compared with noninfected critically ill patients. DESIGN: A prospective observational study. SETTING: A nine-bed intensive care unit in a university teaching...... hospital trust. PATIENTS: Fourteen consecutive patients who met the established criteria for sepsis syndrome with multiple organ dysfunction syndrome, and ten noninfected critically ill patients were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Xanthine oxidase activity was increased in...

  12. Sepsis-Induced Inflammation Is Exacerbated in an Animal Model of Type 2 Diabetes

    OpenAIRE

    Jacob, Asha; Steinberg, Marissa L.; Yang, Juntao; Dong, Weifeng; Ji, Youxin; Wang, Ping

    2008-01-01

    Hyperglycemia is common in critically ill patients and pronounced hyperglycemia may lead to complications which include severe infections, polyneuropathy, multiple organ failure and death in such patients. Sustained hyperglycemia is generally observed in patients with Type 2 diabetes. To explore sepsis-induced inflammation in Type 2 diabetes, polymicrobial sepsis was induced by cecal ligation and puncture (CLP) in the Goto-Kakizaki (GK) rat, a spontaneous animal model of Type 2 diabetes. The ...

  13. Hubungan Nilai Red Cell Distribution Width dengan Mortalitas pada Pasien Sepsis di Unit Perawatan Intensif Anak

    OpenAIRE

    Devina, Trina

    2014-01-01

    Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcome in adult with sepsis. However, the role of RDW as a mortality predictor in pediatric population remains doubtful. Objective The aim of the study was to determine the relationship between RDW value and mortality in pediatric sepsis. Method We performed a cross sectional study o...

  14. Diagnostic value of lipopolysaccharide-binding protein and procalcitonin for sepsis diagnosis in forensic pathology

    OpenAIRE

    Augsburger, Marc; Iglesias, Katia; Bardy, Daniel; Mangin, Patrice; Palmiere, Cristian

    2016-01-01

    The aims of this study were twofold. The first was to investigate the diagnostic performance of two biochemical markers, procalcitonin (PCT) and lipopolysaccharide-binding protein (LBP), considering each individually and then combined, for the postmortem diagnosis of sepsis. We also tested the usefulness of pericardial fluid for postmortem LBP determination. Two study groups were formed, a sepsis-related fatalities group of 12 cases and a control group of 30 cases. Postmortem native CT scans,...

  15. Leukotriene B4 enhances innate immune defense against the puerperal sepsis agent Streptococcus pyogenes

    OpenAIRE

    Soares, Elyara M.; Mason, Katie L.; Rogers, Lisa M.; Serezani, Carlos H.; Faccioli, Lucia H.; David M. Aronoff

    2013-01-01

    Puerperal sepsis is a leading cause of maternal mortality worldwide. Streptococcus pyogenes (Group A Streptococcus; GAS) is a major etiologic agent of severe postpartum sepsis yet little is known regarding the pathogenesis of these infections. Tissue macrophages provide innate defense against GAS and their actions are highly regulated. The intracellular second messenger cAMP can negatively regulate macrophage actions against GAS. Because leukotriene (LT) B4 has been shown to suppress intracel...

  16. Serum concentrations of vitamin D and organ dysfunction in patients with severe sepsis and septic shock

    OpenAIRE

    Alves, Fernanda Sampaio; Freitas, Flavio Geraldo Resende; Bafi, Antonio Tonete; Azevedo, Luciano Cesar Pontes; Machado, Flavia Ribeiro

    2015-01-01

    Objectives To evaluate the serum concentrations of vitamin D and their variations in patients with severe sepsis or septic shock and in control subjects upon admission and after 7 days of hospitalization in the intensive care unit and to correlate these concentrations with the severity of organ dysfunction. Methods This case-control, prospective, observational study involved patients aged > 18 years with severe sepsis or septic shock paired with a control group. Serum vitamin D concentrations...

  17. APPROPRIATE USE OF ANTIBIOTICS FOR THE MANAGEMENT OF SEPSIS IN NEONATES

    OpenAIRE

    Samiya Nazeer Khan* and Siby Joseph

    2012-01-01

    Neonatal sepsis is associated with increased mortality and morbidity including neurodevelopmental impairment and prolongation of hospital stay. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for timely diagnosis. Antibiotics are a very important group of drugs for the sick neonate and have undoubtedly played a role in their improved survival. But they come with a set of risks like other drugs used in critical care which must be carefully con...

  18. Risk Factors and Prevention of Late Onset Sepsis in Premature Infants

    OpenAIRE

    Downey, L Corbin; Smith, P. Brian; Benjamin, Daniel K.

    2010-01-01

    Late-onset sepsis in premature infants is a major cause of morbidity, mortality, and increased medical costs. Risk factors include low birth weight, low gestational age, previous antimicrobial exposure, poor hand hygiene, and central venous catheters. Methods studied to prevent late-onset sepsis include early feedings, immune globulin administration, prophylactic antimicrobial administration, and improved hand hygiene. In this review, we will outline the risk factors for development of late-o...

  19. Hypoglycemia Revisited in the Acute Care Setting

    OpenAIRE

    Tsai, Shih-Hung; Lin, Yen-Yue; Hsu, Chin-Wang; Cheng, Chien-Sheng; Chu, Der-Ming

    2011-01-01

    Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic comp...

  20. TLR2-induced IL-10 production impairs neutrophil recruitment to infected tissues during neonatal bacterial sepsis.

    Science.gov (United States)

    Andrade, Elva B; Alves, Joana; Madureira, Pedro; Oliveira, Liliana; Ribeiro, Adília; Cordeiro-da-Silva, Anabela; Correia-Neves, Margarida; Trieu-Cuot, Patrick; Ferreira, Paula

    2013-11-01

    Sepsis is the third most common cause of neonatal death, with Group B Streptococcus (GBS) being the leading bacterial agent. The pathogenesis of neonatal septicemia is still unsolved. We described previously that host susceptibility to GBS infection is due to early IL-10 production. In this study, we investigated whether triggering TLR2 to produce IL-10 is a risk factor for neonatal bacterial sepsis. We observed that, in contrast to wild-type (WT) pups, neonatal TLR2-deficient mice were resistant to GBS-induced sepsis. Moreover, if IL-10 signaling were blocked in WT mice, they also were resistant to sepsis. This increased survival rate was due to an efficient recruitment of neutrophils to infected tissues that leads to bacterial clearance, thus preventing the development of sepsis. To confirm that IL-10 produced through TLR2 activation prevents neutrophil recruitment, WT pups were treated with the TLR2 agonist Pam3CSK4 prior to nebulization with the neutrophil chemotactic agent LTB4. Neutrophil recruitment into the neonatal lungs was inhibited in pups treated with Pam3CSK4. However, the migration was restored in Pam3CSK4-treated pups when IL-10 signaling was blocked (either by anti-IL-10R mAb treatment or by using IL-10-deficient mice). Our findings highlight that TLR2-induced IL-10 production is a key event in neonatal susceptibility to bacterial sepsis. PMID:24078699

  1. Effect of sepsis on VLDL kinetics: responses in basal state and during glucose infusion

    International Nuclear Information System (INIS)

    The effect of gram-negative sepsis on the kinetics and oxidation of very low-density lipoprotein (VLDL) fatty acids was assessed in conscious dogs in the normal state and 24 h after infusion of live Escherichia coli. VLDL, labeled with [2-3H]glycerol and [1-14C]palmitic acid, was used to trace VLDL kinetics and oxidation, and [1-13C]palmitic acid bound to albumin was infused simultaneously to quantify kinetics and oxidation of free fatty acid (FFA) in plasma. Sepsis caused a fivefold increase in the rate of VLDL production (RaVLDL). In the control dogs, the direct oxidation of VLDL-fatty acids was not an important contributor to their overall energy metabolism, but in dogs with sepsis, 17% of the total rate of CO2 production could be accounted for by VLDL-fatty acid oxidation. When glucose was infused into dogs with insulin and glucagon levels clamped at basal levels (by means of infusion of somatostatin and replacement of the hormones), RaVLDL increased significantly in the control dogs, but it did not increase further in dogs with sepsis. The authors conclude that the increase in triglyceride concentration in fasting dogs with gram-negative sepsis is the result of an increase in VLDL production and that the fatty acids in VLDL can serve as an important source of energy in sepsis

  2. Procalcitonin, MR-Proadrenomedullin, and Cytokines Measurement in Sepsis Diagnosis: Advantages from Test Combination

    Directory of Open Access Journals (Sweden)

    Silvia Angeletti

    2015-01-01

    Full Text Available Background. Elevated cytokines levels correlate with sepsis severity and mortality but their role in the diagnosis is controversial, whereas Procalcitonin (PCT has been largely used. Recently, the mid-regional proadrenomedullin (MR-proADM has been combined with PCT for diagnosis optimization. In this study the combined measurement of PCT, MR-proADM, and cytokines in patients with sepsis was evaluated. Methods. One hundred and four septic patients and 101 controls were enrolled. Receiver operating characteristic (ROC analysis and multiple logistic regression were used to evaluate applicant markers for sepsis diagnosis. Markers with best Odds Ratio (OR were combined, and the posttest probability and a composite score were computed. Results. Based upon ROC curves analysis, PCT, MR-proADM, IL-6, IL-10, TNF-α, and MCP-1 were considered applicant for sepsis diagnosis. Among these PCT, MR-proADM , IL-6, and TNF-α showed the best OR. A better posttest probability was found with the combination of PCT with MR-proADM and PCT with IL-6 or TNF-α compared to the single marker. A composite score of PCT, MR-proADM, and TNF-α showed the best ROC curve in the early diagnosis of sepsis. Conclusion. The combination of PCT with other markers should expedite diagnosis and treatment of sepsis optimizing clinical management.

  3. Serum inflammatory markers in the elderly: are they useful in differentiating sepsis from SIRS?

    Directory of Open Access Journals (Sweden)

    Mahshid Talebi-Taher

    2014-06-01

    Full Text Available Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP, Erythrocyte Sedimentation Rate (ESR, procalcitonin (PCT, and Interleukin-6 (IL-6 to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS in an emergency department. Blood samples for measuring CRP, PCT, IL-6, ESR and white blood cells (WBC count were taken at first day of admission. Sensitivity, specificity, positive and negative predictive values were calculated for each inflammatory markers being studied. A total of 150 elderly patients aged 65 and older, 50 with sepsis and 50 with SIRS, and fifty individuals in a normal health status were included. CRP exhibited the greatest sensitivity (98% and negative predictive value (98.6% and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI. On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients.

  4. Postmortem serum protein growth arrest-specific 6 levels in sepsis-related deaths.

    Science.gov (United States)

    Palmiere, Cristian; Augsburger, Marc

    2015-09-01

    Growth arrest-specific 6 (Gas6) is widely expressed in leukocytes, platelets, endothelial cells, and monocytes. It regulates various processes including granulocyte adhesion to the endothelium, cell migration, thrombus stabilization, and cytokine release. In humans, increased plasma Gas6 levels have been described in patients with sepsis and septic shock. In this study, Gas6 concentrations were measured in postmortem serum from femoral blood in a series of sepsis-related fatalities and control cases. The aims were twofold: first, to determine whether Gas6 can be reliably determined in postmortem serum; and second, to assess its diagnostic potential in identifying sepsis-related deaths. Two study groups were prospectively formed, a sepsis-related fatalities group (24 cases) and a control group (24 cases) including cases of deep vein thrombosis and fatal pulmonary embolism, cases of systemic inflammatory response syndrome in severe trauma, cases of end-stage renal failure, and cases of hanging (non-septic, non-SIRS, non-end stage renal failure cases). The preliminary results of this study seem to indicate that Gas6 can be effectively measured in postmortem serum. However, Gas6 levels in sepsis-related fatalities do not appear to be clearly distinguishable from concentrations in pulmonary embolism, severe trauma, and end-stage renal failure cases. These findings tend to support previous reports that indicated that Gas6 behaves as an acute phase reactant and can be considered a general marker of inflammation rather than a specific biomarker of sepsis. PMID:26233610

  5. Sepsis, oxidative stress, and hypoxia: Are there clues to better treatment?

    Science.gov (United States)

    Bar-Or, David; Carrick, Matthew M; Mains, Charles W; Rael, Leonard T; Slone, Denetta; Brody, Edward N

    2015-09-01

    Sepsis is a clinical syndrome characterized by systemic inflammation, usually in response to infection. The signs and symptoms are very similar to Systemic Inflammatory Response Syndrome (SIRS), which typically occur consequent to trauma and auto-immune diseases. Common treatments of sepsis include administration of antibiotics and oxygen. Oxygen is administered due to ischemia in tissues, which results in the production of free radicals. Poor utilization of oxygen by the mitochondrial electron transport chain can increase oxidative stress during ischemia and exacerbate the severity and outcome in septic patients. This course of treatment virtually mimics the conditions seen in ischemia-reperfusion disorders. Therefore, this review proposes that the mechanism of free radical production seen in sepsis and SIRS is identical to the oxidative stress seen in ischemia-reperfusion injury. Specifically, this is due to a biochemical mechanism within the mitochondria where the oxidation of succinate to fumarate by succinate dehydrogenase (complex II) is reversed in sepsis (hypoxia), leading to succinate accumulation. Oxygen administration (equivalent to reperfusion) rapidly oxidizes the accumulated succinate, leading to the generation of large amounts of superoxide radical and other free radical species. Organ damage possibly leading to multi-organ failure could result from this oxidative burst seen in sepsis and SIRS. Accordingly, we postulate that temporal administration with anti-oxidants targeting the mitochondria and/or succinate dehydrogenase inhibitors could be beneficial in sepsis and SIRS patients. PMID:25803628

  6. Probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas

    Directory of Open Access Journals (Sweden)

    Shapkin Yu.G.

    2015-06-01

    Full Text Available Objective: the probable determination of severe sepsis in patients of elderly and senile age with necrotic erysipelas based on a comprehensive assessment (clinical examination using systems — scales and determination of the level markers of SIRS. Material and methods. The analysis of peculiarities of necrotic erysipelas clinical course in 59 patients. The first group consisted of 17 patients with severe sepsis, the second — 18 patients with sepsis without multiple organ failure, in the comparison group —22 patients with local infection. We determined albumin, urea, creatinine, pro-calcitonin of plasma. The scale SAPS III was used to quantify SIRS, scale SOFA —to determine the extent of damage to organs and systems. Results. The most sensitive marker of developing sepsis in patients with necrotic erysipelas was procalcitonin. The second important indicator of SIRS severity in patients with necrotic erysipelas was the blood albumin. Scale SAPS III also allows to select a group of patients with high risk of developing severe sepsis. Use of the SOFA to predict the scale has been found out to be less important. Conclusion. A comprehensive assessment of the severity of the condition by scale SAPS III in combination with determining the levels of procalcitonin and plasma albumin is advisable to apply for prediction the probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas. For the last indicator it is important to assess of absolute values and the decrease of its concentration.

  7. Neonatal sepsis and multiple skin abscess in a newborn with Down’s syndrome: A case report

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    Arunava Kali

    2013-02-01

    Full Text Available Neonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonates. Here we report a case of Down’s syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection. The baby was empirically treated with vancomycin. Subsequently, multidrug resistant Klebsiella pneumoniae was detected from both pus and blood culture. Change to appropriate antibiotic resulted in clinical recovery. Although sepsis is one of the major ailments in neonates, atypical presentations of neonatal sepsis in Down’s syndrome patients are underreported. Here we highlight the atypical presentation of Klebsiella sepsis and the importance of early antibiogram in such cases.

  8. Management of sepsis and septic shock in infants and children.

    Science.gov (United States)

    von Rosenstiel, N; von Rosenstiel, I; Adam, D

    2001-01-01

    Sepsis and septic shock constitute an important cause of morbidity and mortality in critically ill children. Thus, the systemic response to infection and its management remains a major challenge in clinical medicine. Apart from antibiotic administration, the majority of available therapies are limited to supportive strategies, although considerable efforts are being undertaken to devise innovative approaches that modulate host inflammatory responses. In suspected sepsis, 2 or 3 days' empiric antibiotic therapy should begin immediately after cultures have been obtained without awaiting results. Antibiotics should be re-evaluated when the results of the cultures and susceptibility tests are available. The initial antibiotic (combination) is determined by the likely causative agent, susceptibility patterns within a specific institution, CNS penetration, toxicity, and the patient's hepatic and renal function. The likely offending micro-organism in turn depends primarily on the patient's age, coexistence of any premorbid condition leading to impaired immune response, and the presenting signs and symptoms. Close attention to cardiovascular, respiratory, fluid and electrolyte, haematological, renal and metabolic/nutritional support is essential to optimise outcome. Fluid resuscitation is of utmost importance to overcome hypovolaemia on the basis of a diffuse capillary leak. Monitoring and normalisation of the heart rate is essential. In case of nonresponse to fluid resuscitation, inotropic and vasoactive agents are commonly used to increase cardiac output, maintain adequate blood pressure and enhance oxygen delivery to the tissue. Because respiratory distress syndrome is seen in about 40% of critically ill children with septic shock, increased inspired oxygen is essential. To provide optimal relief from respiratory muscle fatigue and facilitate the provision of positive airway pressure, early intubation and mechanical ventilation should be considered. Renal support is

  9. Effects of aging on the immunopathological response to sepsis

    Science.gov (United States)

    Turnbull, Isaiah R.; Clark, Andrew T.; Stromberg, Paul E.; Dixon, David J.; Woolsey, Cheryl A.; Davis, Christopher G.; Hotchkiss, Richard S.; Buchman, Timothy G.; Coopersmith, Craig M.

    2009-01-01

    Objective Aging is associated with increased inflammation following sepsis. The purpose of this study was to determine if this represents a fundamental age-based difference in the host response or is secondary to the increased mortality seen in aged hosts. Design Prospective, randomized controlled study. Setting Animal laboratory in a university medical center. Subjects Young (6–12 week) and aged (20–24 month) FVB/N mice. Interventions Mice were subjected to 2×25 or 1×30 cecal ligation and puncture (CLP). Measurements and Main Results Survival was similar in young mice subjected to 2×25 CLP and aged mice subjected to 1×30 CLP (p=0.15). Young mice subjected to 1×30 CLP had improved survival compared to both other groups (p<0.05). When injury was held constant but mortality was greater, both systemic and peritoneal levels of TNF-α, IL-6, IL-10 and MCP-1 were elevated 24 hours after CLP in aged animals compared to young animals (p<0.05). When mortality was similar but injury severity was different, there were no significant differences in systemic cytokines between aged mice and young mice. In contrast, peritoneal levels of TNF-α, IL-6, and IL-10 were higher in aged mice subjected to 1×30 CLP than young mice subjected to 2×25 CLP despite their similar mortalities (p<0.05). There were no significant differences in either bacteremia or peritoneal cultures when animals of different ages sustained similar injuries or had different injuries with similar mortalities. Conclusions Aged mice are more likely to die from sepsis than young mice when subjected to an equivalent insult, and this is associated with increases in both systemic and local inflammation. There is an exaggerated local but not systemic inflammatory response in aged mice compared to young mice when mortality is similar. This suggests that systemic processes that culminate in death may be age-independent, but the local inflammatory response may be greater with aging. PMID:19237912

  10. Prevalence of Multidrug Resistant Extended-Spectrum Beta-Lactamase Producing Gram-Negative Bacteria in Neonatal Sepsis

    OpenAIRE

    Ali Peirovifar; Mohammad Ahangarzadeh Rezaee; Manizheh Mostafa Gharehbaghi

    2014-01-01

    Objectives: Neonatal sepsis with extended-spectrum beta-lactamase (ESBL) producing microorganisms is recognized increasingly in recent years. ESBL can be produced by various bacterial strains. This study was conducted to determine the prevalence of ESBL producing pathogens in neonatal sepsis and its impact on clinical outcome. Materials and Methods: A study was carried out from Jan 2012 to Jan 2013 in a referral university hospital. All neonates who had diagnosed as sepsis were enrolled in...

  11. Regulation of chemokine receptor by Toll-like receptor 2 is critical to neutrophil migration and resistance to polymicrobial sepsis

    OpenAIRE

    Alves-Filho, Jose C.; Freitas, Andressa; Souto, Fabricio O.; Spiller, Fernando; Paula-Neto, Heitor; Silva, Joao S.; Gazzinelli, Ricardo T.; Teixeira, Mauro M.; Ferreira, Sergio H.; Cunha, Fernando Q.

    2009-01-01

    Patients with sepsis have a marked defect in neutrophil migration. Here we identify a key role of Toll-like receptor 2 (TLR2) in the regulation of neutrophil migration and resistance during polymicrobial sepsis. We found that the expression of the chemokine receptor CXCR2 was dramatically down-regulated in circulating neutrophils from WT mice with severe sepsis, which correlates with reduced chemotaxis to CXCL2 in vitro and impaired migration into an infectious focus in vivo. TLR2 deficiency ...

  12. Intensive care unit—acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock

    OpenAIRE

    Schefold, Joerg C; Bierbrauer, Jeffrey; Weber-Carstens, Steffen

    2010-01-01

    Sepsis presents a major health care problem and remains one of the leading causes of death within the intensive care unit (ICU). Therapeutic approaches against severe sepsis and septic shock focus on early identification. Adequate source control, administration of antibiotics, preload optimization by fluid resuscitation and further hemodynamic stabilisation using vasopressors whenever appropriate are considered pivotal within the early—golden—hours of sepsis. However, organ dysfunction develo...

  13. Protective effects of rosmarinic acid on sepsis-induced DNA damage in the liver of Wistar albino rats

    OpenAIRE

    Hatice Gul Goktas; Gokce Taner; Tolga Sahin; Arif Ahmet Başaran

    2015-01-01

    Sepsis is an imbalance between pro and anti-inflammatory responses. Sepsis induced multiple organ failure that is associated with mortality is characterized by liver, renal, cardiovascular and pulmonary dysfunction and reactive oxygen species (ROS) are believed to be involved in the development of sepsis. Plant polyphenols may act as antioxidants by different mechanisms such as free radical scavenging, metal chelation and protein binding. Data indicates possible beneficial effects of plant de...

  14. Statistical validity of interleukin-6 as a biomarker for the diagnosis of early-onset neonatal sepsis

    OpenAIRE

    Sriparna Basu; Shashikant Dewangan; Shampa Anupurva; Ashok Kumar

    2012-01-01

    Use of empirical antibiotics in neonates with risk factors of early-onset neonatal sepsis (EOS) is a common practice. A laboratory parameter is needed to help in the accurate diagnosis of EOS to avoid unnecessary use of antibiotics. The aim of this prospective observational cohort study was to compare the statistical validity of cord blood interleukin-6 (IL-6) with conventional sepsis screening as an early diagnostic marker for EOS. Eighty-seven neonates with antenatal risk factors for sepsis...

  15. Hubungan Kadar Procalcitonin dengan Jenis Bakteri Penyebab Infeksi pada Sepsis di RSUP H. Adam Malik Tahun 2014

    OpenAIRE

    Paulus

    2016-01-01

    Sepsis is a condition where systemic inflammation response syndrome which is caused by invasion of bacteria, virus, fungi or paracites. In America, the incidence of post operation sepsis increased three times, from 0,3% to 0,9%. Sepsis could be diagnosed with some marker examination, such as procalcitonin, CRP, Erythrocyte Sedimentation Rate (ESR) and white blood count, with microorganism culture as gold standard. The purpose of this research is to know the relationship betw...

  16. Sepsis survivors monitoring and coordination in outpatient health care (SMOOTH): study protocol for a randomized controlled trial

    OpenAIRE

    Schmidt, K.; Thiel, P; Mueller, F.; Schmuecker, K.; Worrack, S.; Mehlhorn, J; Engel, C.; Brenk-Franz, K.; Kausche, S; Jakobi, U.; Bindara-Klippel, A.; Schneider, N; Freytag, A.; Davydow, D.; Wensing, M

    2014-01-01

    BACKGROUND Sepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors. METHODS/DESIGN In a two-armed randomized multicenter interventional study, patients after sepsi...

  17. Revisiting Pattern Structures for Structured Attribute Sets

    OpenAIRE

    Alam, Mehwish; Buzmakov, Aleksey; Napoli, Amedeo; Sailanbayev, Alibek

    2015-01-01

    In this paper, we revisit an original proposition on pattern structures for structured sets of attributes. There are several reasons for carrying out this kind of research work. The original proposition does not give many details on the whole framework, and especially on the possible ways of implementing the similarity operation. There exists an alternative definition without any reference to pattern structures, and we would like to make a parallel between two points of view. Moreover we disc...

  18. Hyperinflation in Brazil, Israel, and Nicaragua revisited

    OpenAIRE

    Szybisz, M. A.; Szybisz, L.

    2016-01-01

    The aim of this work is to address the description of hyperinflation regimes in economy. The spirals of hyperinflation developed in Brazil, Israel, and Nicaragua are revisited. This new analysis of data indicates that the episodes occurred in Brazil and Nicaragua can be understood within the frame of the model available in the literature, which is based on a nonlinear feedback (NLF) characterized by an exponent $\\beta>0$. In the NLF model the accumulated consumer price index carries a finite ...

  19. Directed animals and Gas Models Revisited

    OpenAIRE

    Le Borgne, Yvan; Marckert, Jean-François

    2007-01-01

    In this paper, we revisit the enumeration of directed animals using gas models. We show that there exists a natural construction of random directed animals on any directed graph together with a particle system that explains at the level of objects the formal link known between the density of the gas model and the generating function of directed animals counted according to the area. This provides some new methods to compute the generating function of directed animals counted according to area...

  20. THE MATHEMATICAL FOUNDATIONS OF GENERAL RELATIVITY REVISITED

    OpenAIRE

    Jean-Francois Pommaret

    2013-01-01

    The purpose of this paper is to present for the first time an elementary summary of a few recent results obtained through the application of the formal theory of partial differential equations and Lie pseudogroups in order to revisit the mathematical foundations of general relativity. Other engineering examples (control theory, elasticity theory, electromagnetism) will also be considered in order to illustrate the three fundamental results that we shall provide successively. 1) VESSIOT VERSU...