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Sample records for alley revisited sepsis

  1. Sepsis

    OpenAIRE

    Valeria Tombini; Sonja Lamberti; Maurizio Bottiroli; Daniele Coen

    2006-01-01

    Sepsis is a complex syndrome difficult to define, to diagnose and to treat. The term defines a group of clinical conditions caused by the systemic answer of the organism to an infection that can cause the dysfunction of one or more organs (severe sepsis) and death. Much more often than one can imagine, ED physicians must diagnose and manage patients with more or less severe sepsis. During the last few years, as it happened for myocardial infarction and stroke, it has been acknowledged the imp...

  2. Sepsis

    OpenAIRE

    TAŞDELEN FIŞGIN, Dr. Nuriye

    2009-01-01

    Mikroorganizmaların ve yapıtaşlarının, immun sistem ile karşılaşmaları sonucu, inflamatuar mediatörlenn aşırı salınımı sepsis ile sonuçlanır. Sepsisin etyolojisinde tüm mikroorganizmalar rol oynayabilmekle birlikte, son yıllarda gram pozitif mikroorganizmalar ile oluşan sepsis insidansında artış bildirilmektedir. Sepsisin mortalite ve morbiditesi halen yüksektir. Inflamasyon ve koagulasyon sistemlerinin ilişkisini moleküler düzeyde ortaya koyan bilgiler, sepsisin tedavisinde yeni gelişmelere ...

  3. 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.

  4. In Fond Memory of Rewi Alley

    Institute of Scientific and Technical Information of China (English)

    ZhengWanzhen

    2004-01-01

    Rewi Alley passed away on December 27, 1987 at the age of ninety. News of his demise came as a great shock to me, then on a diplomatic assignment in Washington, D.C. where I was serving as press counsellor of the Chinese Embassy.Even to this day I still deeply regret for not being able to attend his funeral service to bid final farewell to this great New Zealander who was not only an unflinching peace fighter but also a true internationalist who dedicated almost his entire life and who cherished boundless sympathy and love for China and the Chinese people.

  5. Neonatal sepsis

    OpenAIRE

    Mihatov Stefanovic, Iva

    2011-01-01

    Neonatal sepsis is the most common cause of neonatal deaths with high mortality despite treatment. Neonatal sepsis can be classified into two subtypes depending upon onset of symptoms. There are many factors that make neonates more susceptable to infection. Signs of sepsis in neonates are often non-specific and high degree of suspicion is needed for early diagnosis. Some laboratory parameters can be helpful for screening of neonates with neonatal sepsis, but none of it is specific and sensiti...

  6. 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.

  7. 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.

  8. Neonatal sepsis

    OpenAIRE

    Angelica Dessì; Chiara Pravettoni; Giovanni Ottonello; Francesca Birocchi; Francesca Cioglia; Vassilios Fanos

    2014-01-01

    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, 2...

  9. 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...

  10. 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

  11. 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.

  12. 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 ...

  13. 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

  14. 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

  15. The successive alleys test of anxiety in mice and rats.

    Science.gov (United States)

    Deacon, Robert M J

    2013-06-17

    The plus-maze was derived from the early work of Montgomery. He observed that rats tended to avoid the open arms of a maze, preferring the enclosed ones. Handley, Mithani and File et al. performed the first studies on the plus-maze design we use today, and in 1987 Lister published a design for use with mice. Time spent on, and entries into, the open arms are an index of anxiety; the lower these indices, the more anxious the mouse is. Alternatively, a mouse that spends most of its time in the closed arms is classed as anxious. One of the problems of the plus-maze is that, while time spent on, and entries into, the open arms is a fairly unambiguous measure of anxiety, time in the central area is more difficult to interpret, although time spent here has been classified as "decision making". In many tests central area time is a considerable part of the total test time. Shepherd et al. produced an ingenious design to eliminate the central area, which they called the "zero maze". However, although used by several groups, it has never been as widely adopted as the plus-maze. In the present article I describe a modification of the plus-maze design that not only eliminates the central area but also incorporates elements from other anxiety tests, such as the light-dark box and emergence tests. It is a linear series of four alleys, each having increasing anxiogenic properties. It has given similar results to the plus-maze in general. Although it may not be more sensitive than the plus-maze (more data is needed before a firm conclusion can be reached on this point), it provides a useful confirmation of plus-maze results which would be useful when, for example, only a single example of a mutant mouse was available, as, for example, in ENU-based mutagenesis programs.

  16. [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

  17. Steroid Use in Sepsis

    Directory of Open Access Journals (Sweden)

    Şerife Mehlika Kuşkonmaz

    2013-12-01

    Full Text Available Sepsis is defined as “systemic signs and symptoms of infection in the presence of infection”. Nearly one fourth of sepsis cases eventually die. Therefore, rapid and correct management of sepsis is important. There is no reliable test to evaluate adrenal insufficiency in sepsis due to the changes in the hypothalamic-pituitary-adrenal axis and intracellular effects of cortisol during the critical illness. Clinical studies reported conflicting results regarding the effects of steroid therapy on mortality and morbidity in sepsis. Contemporary sepsis management guidelines - although not based on strong evidence - suggest consideration of steroid use in septic patients who do not respond to intravenous fluids and vasopressors. Stronger evidence obtained from randomized controlled trials is needed for this suggestion to be certain. Turk Jem 2013; 17: 121-4

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

    NARCIS (Netherlands)

    Mungai, D.N.; Coulson, C.L.; Stigter, C.J.; Ng'ang'a, J.K.; Mugendi, D.N.

    2001-01-01

    Alley cropping of Cassia siamea and maize was studied in semi-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 (C

  19. 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 ...

  20. 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, ...

  1. 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...

  2. 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.

  3. 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.

  4. Nutrient cycling in an agroforestry alley cropping system receiving poultry litter or nitrogen fertilizer

    Science.gov (United States)

    Optimal utilization of animal manures as a plant nutrient source should also prevent adverse impacts on water quality. The objective of this study was to evaluate long-term poultry litter and N fertilizer application on nutrient cycling following establishment of an alley cropping system with easter...

  5. Soil quality indicators of a mature alley-cropping agroforestry system in temperate North America

    Science.gov (United States)

    Although agroforestry practices are believed to improve soil quality, reports on long-term effects of alley cropping on soils within agroforestry in the temperate zone are limited. The objective of this study was to examine effects of management, landscape, and soil depth of an established agrofores...

  6. Pharmacological management of sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Fletcher, J.R.

    1985-01-01

    Systemic sepsis continues to be the most-difficult management problem in caring for the combat casualty. The complications of sepsis pervade all areas of injury to soldiers in the field, whether it is mechanical (missiles), thermal (burns), chemical, biological, or radiation injury. With the advent of tactical nuclear weapons, the problem of sepsis will be much higher in future wars than has previously been experienced through the world. The purpose of this chapter is a) to review the data suggesting pharmacological agents that may benefit the septic patient, and b) to emphasize the adjunctive therapies that should be explored in clinical trials. The pharmacological management of sepsis remains controversial. Most of the drugs utilized clinically treat the symptoms of the disease and are not necessarily directed at fundamental mechanisms that are known to be present in sepsis. A broad data base is emerging, indicating that NSAID should be used in human clinical trials. Prostaglandins are sensitive indicators of cellular injury and may be mediators for a number of vasoactive chemicals. Opiate antagonists and calcium channel blockers require more in-depth data; however, recent studies generate excitement for their potential use in the critically ill patient. Pharmacological effects of antibiotics, in concert with other drugs, suggest an entirely new approach to pharmacological treatment in sepsis. There is no doubt that new treatment modalities or adjunctive therapies must be utilized to alter the poor prognosis of severe sepsis that we have observed in the past 4 decades.

  7. New sepsis biomarkers

    Institute of Scientific and Technical Information of China (English)

    Dolores Limongi; Cartesio DAgostini; Marco Ciotti

    2016-01-01

    Sepsis remains a leading cause of death in the intensive care units and in all age groups worldwide. Early recognition and diagnosis are key to achieving improved outcomes. Therefore, novel biomarkers that might better inform clinicians treating such patients are surely needed. The main attributes of successful biomarkers would be high sensitivity, specificity, possibility of bedside monitoring and financial accessibility. A panel of sepsis biomarkers along with currently used laboratory tests will facilitate earlier diagnosis, timely treatment and improved outcome may be more effective than single biomarkers. In this review, we summarize the most recent advances on sepsis biomarkers evaluated in clinical and experimental studies.

  8. 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.

  9. 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.

  10. Relative impacts of key drivers on the response of the water table to a major alley farming experiment

    Science.gov (United States)

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

    2009-11-01

    Widespread clearing of native vegetation in Southwest Western Australia has led to land degradation associated with rising groundwater, secondary salinisation and waterlogging. Re-establishing deep-rooted perennial vegetation across parts of the landscape is one technique for managing land degradation. Alley farming is an agroforestry practice where multiple perennial tree belts are planted in alternation with traditional agricultural crops. To identify the best configuration (belt width versus alley width) for controlling rising groundwater levels and providing viable economic returns, a large scale experiment was established in 1995. The experiment contains seven different alley farming designs, each with transects of piezometers running across tree belts into adjacent alleys to monitor changes in the groundwater level. Two control piezometers were also installed in an adjacent paddock. Groundwater at the site is shallow (agroforestry system. It is concluded that declining annual rainfall is the principal control on hydrograph response at the site, whilst perennial biomass development has a lesser impact on water table depth.

  11. 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.

  12. Framework for studying the hydrological impact of climate change in an alley cropping system

    Science.gov (United States)

    Hallema, Dennis W.; Rousseau, Alain N.; Gumiere, Silvio J.; Périard, Yann; Hiemstra, Paul H.; Bouttier, Léa; Fossey, Maxime; Paquette, Alain; Cogliastro, Alain; Olivier, Alain

    2014-09-01

    Alley cropping is an agroforestry practice whereby crops are grown between hedgerows of trees planted at wide spacings. The local climate and the physiological adaptation mechanisms of the trees are key factors in the growth and survival of the trees and intercrops, because they directly affect the soil moisture distribution. In order to evaluate the long-term hydrological impact of climate change in an alley cropping system in eastern Canada, we developed a framework that combines local soil moisture data with local projections of climate change and a model of soil water movement, root uptake and evapotranspiration. Forty-five frequency domain reflectometers (FDR) along a transect perpendicular to the tree rows generated a two-year dataset that we used for the parameterization and evaluation of the model. An impact study with simulations based on local projections of three global and one regional climate simulation suggest that the soil becomes drier overall in the period between 2041 and 2070, while the number of critically wet periods with a length of one day increases slightly with respect to the reference period between 1967 and 1996. Hydrological simulations based on a fourth climate scenario however point toward wetter conditions. In all cases the changes are minor. Although our simulations indicate that the experimental alley cropping system will possibly suffer drier conditions in response to higher temperatures and increased evaporative demand, these conditions are not necessarily critical for vegetation during the snow-free season.

  13. Sepsis in critical care.

    Science.gov (United States)

    King, Joan E

    2007-03-01

    Sepsis is a syndrome produced by the accelerated activity of the inflammatory immune response, the clotting cascade, and endothelial damage. It is a systematic process that can progress easily into septic shock and MODS. The chemical mediators or cytokines produce a complex self-perpetuating process that impacts all body systems. It is critical for the nurse first to identify patients at risk for developing sepsis and to assess patients who have SIRS and sepsis continually for signs and symptoms of organ involvement and organ dysfunction. Once sepsis has been diagnosed, evidence-based practice indicates initiation of fluid resuscitation. Vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy should be started within the first hour. Within a 6-hour timeframe the goal is stabilization of the CVP, MAP, and UOP to prevent further organ damage. The challenge for nurses caring for septic patients is to support the treatment goals, to prevent added complications including stress ulcers, DVTs, aspiration pneumonia, and the progression to MODS, and to address the patient's and the family's psychosocial needs. As complex as the pathophysiology of sepsis is, the nursing care is equally complex but also rewarding. Patients who previously might have died now recover as vigilant nursing care combines forces with new drug therapies and evidence-based practice guidelines.

  14. 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 ...

  15. Glucocorticosteroids for sepsis

    DEFF Research Database (Denmark)

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

    2015-01-01

    outcomes were mortality at longest follow-up and serious adverse events. RESULTS: A total of 35 trials randomising 4682 patients were assessed and reviewed in full text. All trials but two had high risk of bias. No statistically significant effect was found for any dose of steroids versus placebo......-adjusted CI 0.7-1.48). The effects did not vary according to the degree of sepsis. TSA showed that many more randomised patients are needed before definitive conclusions may be drawn. CONCLUSION: Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking. The results...

  16. 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

  17. 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

  18. The encephalopathy of sepsis.

    Science.gov (United States)

    Jackson, A C; Gilbert, J J; Young, G B; Bolton, C F

    1985-11-01

    Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

  19. 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...

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. Simply obtained global radiation, soil temperature and soil moisture in an alley cropping system in semi-arid Kenya

    NARCIS (Netherlands)

    Mungai, D.N.; Stigter, C.J.; Coulson, C.L.; Ng'ang'a, J.K.

    2000-01-01

    Global radiation, soil temperature and soil moisture data were obtained from a 4-6 year old Cassia siamea/maize (CM) alley cropping (or hedgerow intercropping) system, at a semi-arid site at Machakos, Kenya, in the late eighties. With the growing need to explore and manage variations in agro-ecosyst

  5. 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

  6. 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...

  7. 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.

  8. Muscle regeneration after sepsis.

    Science.gov (United States)

    Bouglé, Adrien; Rocheteau, Pierre; Sharshar, Tarek; Chrétien, Fabrice

    2016-01-01

    Severe critical illness is often complicated by intensive care unit-acquired weakness (ICU-AW), which is associated with increased ICU and post-ICU mortality, delayed weaning from mechanical ventilation and long-term functional disability. Several mechanisms have been implicated in the pathophysiology of ICU-AW, but muscle regeneration has not been investigated to any extent in this context, even though its involvement is suggested by the protracted functional consequences of ICU-AW. Recent data suggest that muscle regeneration could be impaired after sepsis, and that mesenchymal stem cell treatment could improve the post-injury muscle recovery. PMID:27193340

  9. 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)...

  10. The effect of changes in rainfall on the response of the water table to a major alley farming experiment

    Directory of Open Access Journals (Sweden)

    S. L. Noorduijn

    2009-06-01

    Full Text Available Widespread clearing of native vegetation in Southwest Western Australia has led to land degradation associated with rising groundwater, secondary salinisation and waterlogging. Land degradation can be controlled by re-establishing native deep rooted perennial vegetation across parts of the landscape. Alley farming is an agroforestry practice where multiple perennial tree belts are planted in alternation with traditional agricultural crops. To identify the best configuration (belt width verses alley width for controlling rising groundwater levels and providing viable economic returns, a large scale experiment was established in 1995. The experiment contains seven different alley farming designs, each with transects of piezometers running across tree belts into adjacent alleys to monitor changes in the groundwater level. Two control piezometers were also installed in an adjacent paddock. At the site groundwater is shallow (<3 m and of poor quality (pH 3–5, Ec 2.1–45.9 mS cm−1 and so root water uptake from the saturated zone is limited.

    Simple hydrograph analysis did not identify any treatment effects on the water table response. Subsequent statistical analysis revealed that 20–30% of the variability in the water table data over the 12 year period was attributable to the alley farming experiment. It was hypothesized that a climate trend (reducing annual rainfall over time may be obscuring the effect of the experiment. To further investigate the effect of the experiment on groundwater response, further hydrograph analysis was conducted to compare the trends in the control piezometers in relation to those located within the belts. A difference of 0.9 m was observed between the mean groundwater levels in the control piezometers and the mean levels in the perennial belt piezometers. For a mean specific yield of 0.03 m3 m−3 this equates to a small additional water use of 27 mm yr−1 by the

  11. BACTEROIDES FRAGILIS IN SEPSIS

    Directory of Open Access Journals (Sweden)

    Sugumari Chandrasegaran

    2016-07-01

    Full Text Available PURPOSE 1. To find out the prevalence of Bacteroides fragilis in patients with Sepsis and to perform Antimicrobial susceptibility testing. 2. To identify the Metronidazole resistant Bacteroides fragilis and to confirm the resistant pattern genomically by gene sequencing. MATERIALS AND METHODS This prospective study was conducted for 6 months in 175 patients with varied infections. The presumptive identification of Bacteroides fragilis was confirmed and Antimicrobial susceptibility testing was performed by Broth disc method described by Kurynski & Co-workers. Resistant strains confirmed by short sequencing by NCBI Blast. RESULTS Bacteroides fragilis was isolated from 32 of 175 samples with a prevalence of 18.3%. Out of this 32 samples, only one organism revealed resistance to Metronidazole. CONCLUSION The prevalence of Bacteroides fragilis resistant to metronidazole was isolated in post-operative wound infections giving a warning signal to the clinicians on emerging Metronidazole resistance on nosocomial infections in this hospital.

  12. Cardiorenal Syndromes and Sepsis

    Directory of Open Access Journals (Sweden)

    C. Chelazzi

    2011-01-01

    Full Text Available The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ “crosstalk” and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function.

  13. 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.

  14. Sepsis por shigella flexneri

    Directory of Open Access Journals (Sweden)

    César Cabrera C

    2005-04-01

    Full Text Available Se presenta un caso raro de sepsis por Shigella flexneri en una paciente de 45 años de edad quien estando hospitalizada para el estudio de un tumor cerebral, requirió el uso de manitol y dosis altas de corticoides; luego de ello presenta deposiciones líquidas con moco y sangre, desarrolla síndrome de respuesta inflamatoria sistémica, luego se aísla Shigella flexneri en el hemocultivo; recibió tratamiento antibiótico con ciprofloxacina. Se describen las características del caso y se comenta de acuerdo con la revisión de literatura.

  15. 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

  16. 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.

  17. 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.

  18. Surviving sepsis in the critical care environment.

    Science.gov (United States)

    Benedict, Lara

    2015-01-01

    The management of sepsis and septic shock in the intensive care environment is a complex task requiring the cooperation of a multidisciplinary team. The Surviving Sepsis Campaign provides systematic guidelines for the recognition, early intervention, and supportive management of sepsis. Critical care nurses are instrumental in ensuring that these guidelines and other sources of evidence-based practice are used for patients with severe sepsis or septic shock. This article discusses the pathophysiologic processes in severe sepsis and septic shock and discusses the appropriate interventions as recommended by the Surviving Sepsis Campaign. Recommended early treatments are reviewed along with interventions related to hemodynamics, perfusion, and supportive care in the critical care environment.

  19. Antimicrobial peptides in human sepsis

    Directory of Open Access Journals (Sweden)

    Lukas eMartin

    2015-08-01

    Full Text Available Nearly 100 years ago, antimicrobial peptides (AMPs were identified as an important part of innate immunity. They exist in species from bacteria to mammals and can be isolated in body fluids and on surfaces constitutively or induced by inflammation. Defensins have anti-bacterial effects against Gram-positive and Gram-negative bacteria as well as anti-viral and anti-yeast effects. Human neutrophil peptides (HNP 1-3 and human beta-defensins (HBDs 1-3 are some of the most important defensins in humans. Recent studies have demonstrated higher levels of HNP -1-3 and HBD-2 in sepsis. The bactericidal/permeability increasing protein (BPI attenuates local inflammatory response and decreases systemic toxicity of endotoxins. Moreover, BPI might reflect the severity of organ dysfunction in sepsis. Elevated plasma lactoferrin is detected in patients with organ failure. HNP-1-3, lactoferrin, BPI and heparin-binding protein (HBP are increased in sepsis. Human lactoferrin peptide 1-11 (hLF 1-11 possesses antimicrobial activity and modulates inflammation. The recombinant form of lactoferrin (talactoferrin alpha, TLF has been shown to decrease mortality in critically ill patients. A phase II/III study with TLF in sepsis did not confirm this result. The growing number of multiresistant bacteria is an ongoing problem in sepsis therapy. Furthermore, antibiotics are known to promote the liberation of pro-inflammatory cell components and thus augment the severity of sepsis. Compared to antibiotics, AMPs kill bacteria but also neutralize pathogenic factors such as lipopolysaccharide (LPS. The obstacle to applying naturally occurring AMPs is their high nephro- and neurotoxicity. Therefore, the challenge is to develop peptides to treat septic patients effectively without causing harm. This overview focuses on natural and synthetic AMPs in human and experimental sepsis and their potential to provide significant improvements in the treatment of critically ill with severe

  20. Relative impacts of key drivers on the response of the water table to a major alley farming experiment

    Directory of Open Access Journals (Sweden)

    A. Ghadouani

    2009-11-01

    Full Text Available Widespread clearing of native vegetation in Southwest Western Australia has led to land degradation associated with rising groundwater, secondary salinisation and waterlogging. Re-establishing deep-rooted perennial vegetation across parts of the landscape is one technique for managing land degradation. Alley farming is an agroforestry practice where multiple perennial tree belts are planted in alternation with traditional agricultural crops. To identify the best configuration (belt width versus alley width for controlling rising groundwater levels and providing viable economic returns, a large scale experiment was established in 1995. The experiment contains seven different alley farming designs, each with transects of piezometers running across tree belts into adjacent alleys to monitor changes in the groundwater level. Two control piezometers were also installed in an adjacent paddock. Groundwater at the site is shallow (<3 m and of poor quality (pH 3–5, Ec 2.1–45.9 mS cm−1 so root water uptake from the saturated zone is limited.

    Simple hydrograph analysis could not separate treatment effects on the water table response. Subsequent statistical analysis revealed that 20–30% of the variability in the water table data over the 12 year study period was attributable to the alley farming experiment. To futher investigate the effect of the experiment on groundwater response, additional hydrograph analysis was conducted to compare the trends in the control piezometers in relation to those located within the belts. A difference of 0.9 m was observed between the mean groundwater levels in the control piezometers and the mean levels in the perennial belt piezometers. For a mean specific yield of 0.03 m3 m−3 (standard deviation of 0.03 m3 m−3 this equates to an additional average annual water use of 27 mm yr−1 (standard deviation of 33 mm yr−1 by the

  1. Current epidemiology of sepsis in mainland China

    Science.gov (United States)

    Liao, Xuelian; Du, Bin; Lu, Meizhu; Wu, Minming

    2016-01-01

    The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China.

  2. 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 ...

  3. 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 ...

  4. 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 ...

  5. 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

  6. 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

  7. Scintigraphic evaluation in musculoskeletal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Merkel, K.D.; Fitzgerald, R.H. Jr.; Brown, M.L.

    1984-07-01

    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.

  8. 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

  9. 冷巷的被动降温原理及其启示%The Principles of Passive-cooling Alley and Its Inspiration

    Institute of Scientific and Technical Information of China (English)

    陈晓扬; 仲德崑

    2011-01-01

    A field study of thermal environment is carried out on narrow alleys of three residential buildings to analyze the principles of passive-cooling alley. The main technical strategies can be concluded as: narrow alley with sunshade and ventilation, the ground and wall as heat sink, and night ventilation. Its inspiration on architectural design is also discussed.%通过对三处民居的窄巷进行热环境实测.剖析冷巷的被动降温原理,总结其主要技术策略为:遮阳通风的窄通道、蓄冷墙及地面、夜间通风.同时论述了这些技术策略对建筑设计的启示.

  10. 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

  11. 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.

  12. 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...

  13. 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...

  14. 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.

  15. 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.

  16. 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...

  17. 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 ...

  18. 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

  19. 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.

  20. Autophagy in sepsis: Degradation into exhaustion?

    Science.gov (United States)

    Ho, Jeffery; Yu, Jun; Wong, Sunny H; Zhang, Lin; Liu, Xiaodong; Wong, Wai T; Leung, Czarina C H; Choi, Gordon; Wang, Maggie H T; Gin, Tony; Chan, Matthew T V; Wu, William K K

    2016-07-01

    Autophagy is one of the innate immune defense mechanisms against microbial challenges. Previous in vitro and in vivo models of sepsis demonstrated that autophagy was activated initially in sepsis, followed by a subsequent phase of impairment. Autophagy modulation appears to be protective against multiple organ injuries in these murine sepsis models. This is achieved in part by preventing apoptosis, maintaining a balance between the productions of pro- and anti-inflammatory cytokines, and preserving mitochondrial functions. This article aims to discuss the role of autophagy in sepsis and the therapeutic potential of autophagy enhancers.

  1. 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.

  2. 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...

  3. 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...

  4. 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

  5. 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....

  6. 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.

  7. I costi della sepsi in Italia

    Directory of Open Access Journals (Sweden)

    C. Lucioni

    2001-09-01

    Full Text Available The aim of this study is to evaluate additional hospitalisation costs and intangible costs (mortality in patients with sepsis (intended as severe sepsis or sepsis shock in Italy. The evaluation is based on clinical data from the Italian Sepsis Study, a prospective, multicentre study conducted in 99 Intensive Care Units (ICUslocated across Italy. Each ICU enrolled the first two (or three patients admitted each month, during the year April 1993 to March 1994. In particular, data collected included the Average Length Of Stay (ALOS in ICU and later in the regular ward, and the mortality within four weeks and in hospital. Out of the 2,946 patients enrolled, 2,641 never developed sepsis and were considered as the control group (comparability was confirmed based on gender, age, and comorbidity. The additional (respective to the control group ALOSs of the patients with sepsis were valued in monetary terms using per diem full costs, inflated to 2000: 1,033.43 Euro for l day in ICU (published data and 299.54 Euro for l day in the regular ward (estimated data based on published materials. Statistical significance was tested with Student t test. The hospitalisation cost of a patient with sepsis (21,571.88 Euro is significantly higher (+86% than that patient without sepsis (11,590.84 Euro, due to a longer (+ 163% stay in the expensive ICU, not balanced by shorter stay in the regular ward. Also intangible costs are significantly higher: the risk for an ICU patient with sepsis to die in hospital is 3 times higher than that of an ICU patient without sepsis. In particular, those patients developing sepsis after admission are more costly and with a higher mortality risk.

  8. 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.

  9. 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

  10. 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.

  11. Pseudomonas sepsis with Noma: an association?

    Science.gov (United States)

    Vaidyanathan, S; Tullu, M S; Lahiri, K R; Deshmukh, C T

    2005-08-01

    We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.

  12. 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...

  13. Apolipoprotein M - a new biomarker in sepsis

    DEFF Research Database (Denmark)

    Christoffersen, Christina; Nielsen, Lars Bo

    2012-01-01

    ABSTRACT: Sepsis is one of the leading causes of mortality in non-cardiac intensive care units, and the need for markers of progression and severity are high. Also, treatment of sepsis is highly debated and potential new targets of treatment are of great interest. In the previous issue of Critical...... 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 severity of disease. This identifies apoM as a potential new biomarker in sepsis. It also underscores the possibility that altered high-density lipoprotein in sepsis patients can affect the course of disease. Thus, since apoM is the carrier of Sphingosine-1-P (S1P), a molecule with great influence...

  14. 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

  15. 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...

  16. The Surviving Sepsis Campaign: past, present and future.

    Science.gov (United States)

    Schorr, Christa A; Dellinger, R Phillip

    2014-04-01

    The Surviving Sepsis Campaign (SSC) was created in 2002 and consists of severe sepsis management guidelines and a sepsis performance improvement program. The second revision of the guidelines, published in 2013, are sponsored by 30 international scientific organizations and contain changes in recommendations for fluids and vasopressor administration. The new 3- and 6-hour sepsis 'bundles' (sets of care elements) include a software program that can be downloaded free from the Surviving Sepsis Campaign website (www.survivingsepsis.org). The traditional intensive care unit and emergency department champion-driven sepsis performance improvement program continues internationally with the kick off of a new grant-funded hospital floor sepsis performance improvement initiative.

  17. Morganella morganii sepsis with massive hemolysis.

    Science.gov (United States)

    Kim, Jong Hoon; Cho, Chong Rae; Um, Tae Hyun; Rhu, Ji Yoon; Kim, Eu Suk; Jeong, Jae Won; Lee, Hye Ran

    2007-12-01

    Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.

  18. 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...

  19. 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

  20. 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...

  1. 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

  2. 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

  3. 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 (...

  4. 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...

  5. 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.

  6. 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.

  7. 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...... 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....

  8. Anticoagulant modulation of inflammation in severe sepsis

    OpenAIRE

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-01-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by ...

  9. 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.

  10. 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

  11. 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....

  12. 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.

  13. 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

  14. Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

    Science.gov (United States)

    Çankayalı, İlkin; Boyacılar, Özden; Demirağ, Kubilay; Uyar, Mehmet; Moral, Ali Reşat

    2016-01-01

    Background: Electrophysiological studies show that critical illness polyneuromyopathy appears in the early stage of sepsis before the manifestation of clinical findings. The metabolic response observed during sepsis causes glutamine to become a relative essential amino acid. Aims: We aimed to assess the changes in neuromuscular transmission in the early stage of sepsis after glutamine supplementation. Study Design: Animal experimentation. Methods: Twenty male Sprague-Dawley rats were randomized into two groups. Rats in both groups were given normal feeding for one week. In the study group, 1 g/kg/day glutamine was added to normal feeding by feeding tube for one week. Cecal ligation and perforation (CLP) surgery was performed at the end of one week. Before and 24 hours after CLP, compound muscle action potentials were recorded from the gastrocnemius muscle. Results: Latency measurements before and 24 hours after CLP were 0.68±0.05 ms and 0.80±0.09 ms in the control group and 0.69±0.07 ms and 0.73±0.07 ms in the study group (p<0.05). Conclusion: Since enteral glutamine prevented compound muscle action potentials (CMAP) latency prolongation in the early phase of sepsis, it was concluded that enteral glutamine replacement might be promising in the prevention of neuromuscular dysfunction in sepsis; however, further studies are required. PMID:27308070

  15. Neonatal sepsis in Dubai, United Arab Emirates.

    Science.gov (United States)

    Koutouby, A; Habibullah, J

    1995-06-01

    The case records of all neonates admitted to the neonatal unit of Al Wasl Hospital (Dubai) in a period of 60 months (May 1987-April 1992) were analysed. One-hundred-and-six neonates had confirmed sepsis. The most common causative organisms were Group B Streptococci (23 per cent), E. coli (17 per cent), Staph. epidermidis (17 per cent), and Klebsiella pneumoniae (16 per cent). Group B Streptococcus presented as the most common organism in very early (< or = 24 hours) and early onset (2-6 days) of sepsis (34 per cent, 21/61), Klebsiella pneumoniae (24 per cent), Staphylococcal epidermidis (18 per cent) and Candida (13 per cent) were most common organisms causing late onset of sepsis (7-30 days). Pseudomonas aeruginosa and Klebsiella pneumoniae had highest mortality (71 per cent, 5/7; and 59 per cent, 10/17, respectively). Lowest mortality (4 per cent, 1/25) was observed in Group B Streptococcus sepsis. Prematurity, low birth weight, and nosocomial sepsis were high risk factors associated with fatal outcome.

  16. 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....

  17. 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...

  18. A Hydrostatic Paradox Revisited

    Science.gov (United States)

    Ganci, Salvatore

    2012-01-01

    This paper revisits a well-known hydrostatic paradox, observed when turning upside down a glass partially filled with water and covered with a sheet of light material. The phenomenon is studied in its most general form by including the mass of the cover. A historical survey of this experiment shows that a common misunderstanding of the phenomenon…

  19. 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.

  20. 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...

  1. 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.

  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. 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

  4. Anticoagulant modulation of inflammation in severe sepsis.

    Science.gov (United States)

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-05-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis. PMID:25938026

  5. 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

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

    NARCIS (Netherlands)

    S. Yende; T. van der 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 m

  7. 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

  8. An Evidence Based Approach to Sepsis: Educational Program

    Science.gov (United States)

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  9. 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.)

  10. 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

  11. 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

  12. 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 to one...... molecule 1, and plasminogen activator inhibitor 1 (PAI-1). Outcomes were organ dysfunction and in-hospital mortality. RESULTS: We enrolled a total of 166 patients: 63 with sepsis (38%), 61 with severe sepsis (37%), and 42 with septic shock (25%). All endothelial biomarkers were significantly associated...... with sepsis severity, P

  13. [International guidelines of the Surviving Sepsis Campaign : update 2012].

    Science.gov (United States)

    Briegel, J; Möhnle, P

    2013-04-01

    An update of the international guidelines for therapy of sepsis was published in February 2012 by the Surviving Sepsis Campaign (SSC). The update includes a further development of the guidelines from 2004 and 2008. The guidelines are divided into three sections, sepsis-specific therapeutic measures, recommendations on general intensive care measures for sepsis and finally special features of sepsis in pediatric intensive care medicine are presented in detail. This article discusses the most important amendments in the first two sections and delving deeper into the guidelines.

  14. 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.

  15. 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...

  16. Current treatment of sepsis and endotoxaemia.

    Science.gov (United States)

    Periti, P

    2000-09-01

    This article reviews the new criteria for selecting the proper antimicrobial agent and dosage regimen for standard treatment of severe sepsis, with the intention of preventing septic shock. After introducing new concepts on the pathogenesis of sepsis and septic shock, the authors analyse the parameters of beta-lactam antibacterial activity, the antibiotic-induced release of bacterial endotoxin and the interrelationships between pharmacokinetics and pharmacodynamics of antibiotics in the search for an optimum dosage regimen of antimicrobial mono- or polytherapy for severely ill septic patients admitted to the intensive care unit. The mortality rate resulting from severe bacterial sepsis, particularly that associated with shock, still approaches 50% in spite of appropriate antimicrobial therapy and optimum supportive care. Bacterial endotoxins that are part of the cell wall are one of the cofactors in the pathogenesis of sepsis and septic shock and are often induced by antimicrobial chemotherapy, even if administered rationally. Not all antimicrobial agents are equally capable of inducing septic shock; this is dependent on their mechanism of action rather than on the causative pathogen species. The quantity of endotoxin released depends on the drug dose and whether filaments or spheroplast formation predominate. Some antibiotics, such as carbapenems, ceftriaxone, cefepime, glycopeptides, aminoglycosides and quinolones, do not have the propensity to provoke septic shock because their rapid bacterial activity induces mainly spheroplast or fragile spheroplast-like bacterial forms.

  17. 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 ...

  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. 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

  20. Remembered Experiences and Revisit Intentions

    DEFF Research Database (Denmark)

    Barnes, Stuart; Mattsson, Jan; Sørensen, Flemming

    2016-01-01

    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...

  1. Deterministic Graphical Games Revisited

    DEFF Research Database (Denmark)

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

    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...... games and obtain an almost-linear time comparison-based algorithm for computing an equilibrium of such a game. The existence of a linear time comparison-based algorithm remains an open problem.......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...

  2. 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...

  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. 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...

  5. 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...... are proton‐dicarboxylic acid anion cotransporters and not simply electrogenic proton translocators. These results necessitate revision of previous theories of biological energy transduction, coupling, and ATP synthesis. The novel molecular mechanism is extended to cover ATP synthesis in prokaryotes...

  6. Sirtuin-2 Regulates Sepsis Inflammation in ob/ob Mice

    Science.gov (United States)

    Wang, Xianfeng; Buechler, Nancy L.; Martin, Ayana; Wells, Jonathan; Yoza, Barbara; McCall, Charles E.; Vachharajani, Vidula

    2016-01-01

    Objective Obesity increases morbidity and resource utilization in sepsis patients. Sepsis transitions from early/hyper-inflammatory to late/hypo-inflammatory phase. Majority of sepsis-mortality occurs during the late sepsis; no therapies exist to treat late sepsis. In lean mice, we have shown that sirtuins (SIRTs) modulate this transition. Here, we investigated the role of sirtuins, especially the adipose-tissue abundant SIRT-2 on transition from early to late sepsis in obese with sepsis. Methods Sepsis was induced using cecal ligation and puncture (CLP) in ob/ob mice. We measured microvascular inflammation in response to lipopolysaccharide/normal saline re-stimulation as a “second-hit” (marker of immune function) at different time points to track phases of sepsis in ob/ob mice. We determined SIRT-2 expression during different phases of sepsis. We studied the effect of SIRT-2 inhibition during the hypo-inflammatory phase on immune function and 7-day survival. We used a RAW264.7 (RAW) cell model of sepsis for mechanistic studies. We confirmed key findings in diet induced obese (DIO) mice with sepsis. Results We observed that the ob/ob-septic mice showed an enhanced early inflammation and a persistent and prolonged hypo-inflammatory phase when compared to WT mice. Unlike WT mice that showed increased SIRT1 expression, we found that SIRT2 levels were increased in ob/ob mice during hypo-inflammation. SIRT-2 inhibition in ob/ob mice during the hypo-inflammatory phase of sepsis reversed the repressed microvascular inflammation in vivo via activation of endothelial cells and circulating leukocytes and significantly improved survival. We confirmed the key finding of the role of SIRT2 during hypo-inflammatory phase of sepsis in this project in DIO-sepsis mice. Mechanistically, in the sepsis cell model, SIRT-2 expression modulated inflammatory response by deacetylation of NFκBp65. Conclusion SIRT-2 regulates microvascular inflammation in obese mice with sepsis and may

  7. 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.

  8. 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

  9. Apoptosis: Therapeutic target in neurodegeneration and sepsis

    Directory of Open Access Journals (Sweden)

    Gonzalo Arboleda

    2005-12-01

    Full Text Available Cellular apoptosis has been considered as themain physiological mechanism underlyingneuronal demise associated to neurodegenerativediseases. Apoptosis has also been described inparenquimal and microvascular endotheliumin the acute phase of sepsis during multi-organicdysfunction. Therefore, strategies aimed toMuerte celular: blanco terapéutico enneurodegeneración y sepsisGonzalo Arboleda*, Luisa M. Matheus†prevent apoptosis (anti-apoptotic represent avaluable tool for prevention and/or retardationof the appearance of clinical symptoms in thesedisorders, which generate a large morbilitymortality,social and economic burden worldwide.The present review is aim to show that antiapoptoticstrategies hold a great therapeuticpotential. In this sense, we will review some ofthese potential therapies such as caspaseinhibitors, activated protein C, Bcl-2 family andthe PI3K/Akt signalling pathway.

  10. Neuro-oxidative-nitrosative stress in sepsis

    DEFF Research Database (Denmark)

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

    2011-01-01

    mitochondrial dysfunction by inhibiting the mitochondrial electron transport chain and uncoupling oxidative phosphorylation, which ultimately leads to neuronal bioenergetic failure. Furthermore, in certain 'at risk' areas of the brain, free radicals may induce neuronal apoptosis. In the present review, we......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...... brain parenchyma, due to failure of the local antioxidant systems. ROS/RNS cause structural membrane damage, induce inflammation, and scavenge nitric oxide (NO) to yield peroxynitrite (ONOO(-)). This activates the inducible NO synthase, which further compounds ONOO(-) formation. ROS/RNS cause...

  11. 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

  12. 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.

  13. 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...

  14. 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...

  15. 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...

  16. MicroRNA's are novel biomarkers in sepsis

    DEFF Research Database (Denmark)

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

    2015-01-01

    Purpose: Sepsis is one of the leading causes of death after admission to the intensive care unit (ICU). The discovery of small non-coding microRNAs (miRs) and their correlation to sepsis has gained increasing interest. Our aim was to systematically review the literature examining the association...... 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...... original studies were included into the systematic review. The included studies consisted of 12 case-control studies and one randomized controlled trial. 28 different miRs were associated with sepsis. However, we were unable to link the identified miRs with any predictive genes specific for sepsis, when...

  17. 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)

  18. Coagulation in patients with severe sepsis.

    Science.gov (United States)

    Levi, Marcel; Poll, Tom van der

    2015-02-01

    In the majority of patients with severe sepsis, systemic activation of coagulation is present. Increasing evidence points to an extensive cross-talk between coagulation and inflammation that may play an important role in the pathogenesis of sepsis. Inflammation not only leads to activation of coagulation, but coagulation also considerably affects inflammatory activity. Molecular pathways that contribute to inflammation-induced activation of coagulation have been precisely identified. Proinflammatory cytokines and other mediators are capable of activating the coagulation system and downregulating important physiological anticoagulant pathways. Activation of the coagulation system and ensuing thrombin generation is dependent on expression of tissue factor on activated mononuclear cells and endothelial cells, and is insufficiently counteracted by TFPI. Simultaneously, endothelial-bound anticoagulant mechanism, in particular the protein C system, is shutoff by proinflammatory cytokines. In addition, fibrin removal is severely inhibited, because of inactivation of the fibrinolytic system, caused by an upregulation of its main inhibitor, plasminogen activator inhibitor type 1 (PAI-1). Increased fibrin formation and impaired removal lead to (micro)vascular thrombosis, which may result in tissue ischemia and subsequent organ damage. The cornerstone of the management of coagulation in sepsis is the specific and vigorous treatment of the underlying disorder. Strategies aimed at the inhibition of coagulation activation may theoretically be justified and have been found beneficial in experimental and initial clinical studies. Heparin may be an effective anticoagulant approach and alternative strategies comprise restoration of physiological anticoagulant pathways. PMID:25590524

  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. 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

  2. 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...

  3. 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...

  4. [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

  5. 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

  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. 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

  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. 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.

  10. DMPD: Role of Toll-like receptor responses for sepsis pathogenesis. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 18086373 Role of Toll-like receptor responses for sepsis pathogenesis. Weighardt H,... of Toll-like receptor responses for sepsis pathogenesis. PubmedID 18086373 Title Role of Toll-like receptor responses for sepsis pat

  11. 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...

  12. 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.

  13. 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

  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. 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.

  16. 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.

  17. 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 ...

  18. 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

  19. 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 .

  20. 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...

  1. 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...

  2. 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

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. Seven Issues Revisited

    DEFF Research Database (Denmark)

    Grønbæk, Kaj; Whitehead, Jim; De Bra, Paul;

    2002-01-01

    It has been 15 years since the original presentation by Frank Halasz at Hypertext'87 on seven issues for the next generation of hypertext systems. These issues are: Search and Query Composites Virtual Structures Computation in/over hypertext network Versioning Collaborative Work Extensibility...... and Tailorability Since that time, these issues have formed the nucleus of multiple research agendas within the Hypertext community. Befitting this direction-setting role, the issues have been revisited several times, by Halasz in his 1991 Hypertext keynote talk, and by Randy Trigg in his 1996 Hypertext keynote...... five years later. Additionally, over the intervening 15 years, many research systems have addressed the original seven issues, and new research avenues have opened up. The goal of this panel is to begin the process of developing a new set of seven issues for the next generation of hypertext system...

  9. Deterministic Graphical Games Revisited

    DEFF Research Database (Denmark)

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

    2012-01-01

    , such 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-based algorithm...... for finding optimal strategies in such games. The existence of a linear time comparison-based algorithm remains an open problem.......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...

  10. 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.

  11. 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...... at birth should not vary between countries. Finally the distributional assumptions are relaxed as compared to the assumptions made in an earlier work by the author. These assumptions concern the calculation of the life expectancy change due to the removal of an accident source. Moreover a simple public...... consistency problems with the standard power function expression of the LQI are pointed out. It is emphasized that the combination coefficient in the convex differential combination between the relative differential of the gross domestic product per capita and the relative differential of the expected life...

  12. 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).

  13. 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...

  14. Logistics Innovation Process Revisited

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...... on internal stakeholders as on external relationships; and logistics innovation process may start out as a dialectic, conflict ridden process and end up in a well-ordered goal-oriented teleological process. Research limitations/implications – In general, the study contributes to the knowledge base...... on an existing model by methodological triangulation in order to learn more about the qualities of actual processes and their implications for theory and practice....

  15. Revisiting the Lambert's Problem

    CERN Document Server

    Izzo, Dario

    2014-01-01

    The orbital boundary value problem, also known as Lambert Problem, is revisited. Building upon Lancaster and Blanchard approach, new relations are revealed and a new variable representing all problem classes, under L-similarity, is used to express the time of flight equation. In the new variable, the time of flight curves have two oblique asymptotes and they mostly appear to be conveniently approximated by piecewise continuous lines. We use and invert such a simple approximation to provide an efficient initial guess to an Householder iterative method that is then able to converge, for the single revoltuion case, in only two iterations. The resulting algorithm is compared to Gooding's procedure revealing to be numerically as accurate, while having a smaller computational complexity.

  16. Klein's double discontinuity revisited

    DEFF Research Database (Denmark)

    Winsløw, Carl; Grønbæk, Niels

    2014-01-01

    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 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...... 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...

  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 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].

  19. 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

  20. Intestinal radiation syndrome: sepsis and endotoxin

    Energy Technology Data Exchange (ETDEWEB)

    Geraci, J.P.; Jackson, K.L.; Mariano, M.S.

    1985-03-01

    Rats were whole-body irradiated with 8-MeV cyclotron-produced neutrons and /sup 137/Cs ..gamma.. 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 ..gamma..-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.

  1. 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.

  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. 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)

  4. 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.

  5. The role of arginine in infection and sepsis.

    Science.gov (United States)

    Luiking, Yvette C; Poeze, Martijn; Ramsay, Graham; Deutz, Nicolaas E P

    2005-01-01

    Sepsis is a systemic response to an infection, with high morbidity and mortality rates. Metabolic changes during infection and sepsis could be related to changes in metabolism of the amino acid L-arginine. In sepsis, protein breakdown is increased, which is a key process to maintain arginine delivery because both endogenous de novo arginine production from citrulline and food intake are reduced. Arginine catabolism, on the other hand, is markedly increased by enhanced use of arginine via the arginase and nitric oxide pathways. As a result, lowered plasma arginine levels are usually found. Arginine may therefore be considered as an essential amino acid in sepsis, and supplementation could be beneficial in sepsis by improving microcirculation and protein anabolism. L-Arginine supplementation in a hyperdynamic pig model of sepsis prohibits the increase in pulmonary arterial blood pressure, improves muscle and liver protein metabolism, and restores the intestinal motility pattern. Arguments raised against arginine supplementation are mainly pointed at stimulating nitric oxide (NO) production, with concerns about toxicity of increased NO and hemodynamic instability with refractory hypotension. NO synthase inhibition, however, increased mortality. Arginine supplementation in septic patients has transient effects on hemodynamics when supplied as a bolus but seems without hemodynamic side effects when supplied continuously. In conclusion, arginine could have an essential role in infection and sepsis.

  6. 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?

  7. Injuria renal aguda en la sepsis grave Acute kidney injury in severe sepsis

    Directory of Open Access Journals (Sweden)

    Hernán Trimarchi

    2009-06-01

    Full Text Available La sepsis afecta al 40% de los pacientes críticos, siendo su mortalidad de aproximadamente un 30% en el caso de la sepsis grave, y de 75% con injuria renal aguda, la cual sucede en el 20-51% de los casos. Se realizó un estudio prospectivo, observacional, longitudinal, en 80 pacientes sépticos graves en el lapso de 1 año para determinar el desarrollo de injuria renal aguda y su relación con la mortalidad; correlacionar antecedentes clínicos y variaciones del laboratorio con la mortalidad; determinar la tasa de mortalidad de la sepsis grave; relacionar óbito y foco séptico primario; evaluar la predictibilidad de mortalidad según niveles de creatinina de ingreso y sus variaciones finales. Se definieron dos grupos: Obito (n = 25 y No-óbito (n = 55. Analizados según la creatinina de ingreso, 39 tenían valores normales de creatinina (10 óbitos y 41 la presentaban elevada (15 óbitos; según la creatinina de egreso, 48 presentaron creatinina normal y fallecieron 7, mientras que 32 tenían daño renal agudo, de los cuales 18 fallecieron. De los 25 pacientes fallecidos, el 72% presentaron daño renal. De éstos, 7 pacientes vivos y 2 fallecidos requirieron hemodiálisis. El foco primario más frecuente fue el respiratorio (26.4%. El desarrollo de daño renal es un alto predictor de mortalidad en la sepsis, independientemente de los valores iniciales de creatinina. Edad más avanzada, hipertensión arterial, score APACHE más elevado, anemia más grave, hipoalbuminemia, hiperfosfatemia e hiperkalemia se asociaron a mayor mortalidad. La mortalidad global fue 31.3%. La imposibilidad de identificar el foco séptico primario se asoció a mayor mortalidad. El foco respiratorio se relacionó a mayor riesgo de requerir hemodiálisis.Sepsis affects 40% of critically ill patients, with a reported mortality of approximately 30% in severe sepsis, raising to 75% when acute kidney injury ensues, which occurs in about 20-51% of cases. The present study

  8. 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.

  9. 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...

  10. 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...

  11. Brain infection following experimental Staphylococcus aureus sepsis in pigs

    DEFF Research Database (Denmark)

    Astrup, Lærke Boye; Iburg, Tine Moesgaard; Nielsen, Ole Lerberg;

    2010-01-01

    Introduction: Sepsis is a major problem in humans and both the incidence and mortality is increasing. Multiple microabcesses can be found in the brain of septic patients. Staphylococcus aureus is one of the most common causes of sepsis and brain abscesses. S. aureus is also a frequent cause...... pigs were kept as controls. The pigs were euthanized in groups of four at either 6, 12, 24 or 48 h post infection. The brain was collected from all the animals and examined histologically. Results: All the inoculated pigs developed sepsis and 7 out of 12 animals had microabscesses in the prosencephalon...

  12. 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.

  13. 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.

  14. 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...

  15. 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,...

  16. Nosography of systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome in internal medicine patients

    Directory of Open Access Journals (Sweden)

    Silvia Spoto

    2015-09-01

    Full Text Available Sepsis is defined by the presence of at least two systemic inflammatory response syndrome criteria associated with an infection microbiologically or clinically evidenced. In Italy sepsis is responsible for 80,000 hospital admissions per year and, in the last decades, severe sepsis and septic shock cases are increasing, in correlation with the increased prevalence of multi-drugresistant microbial strains. The predominant etiologic agents are Gram-positive and Gram-negative bacteria, but sepsis caused by fungi is increasing. The host response with both inflammatory and anti-inflammatory processes is responsible for organic failures, which complicate the syndrome, and for the susceptibility to secondary infections. The impairment of one or more organs or systems may be the onset clinical presentation. The organ dysfunctions complicating sepsis involve mainly cardiorespiratory system, kidneys, hemostatis and central nervous system. Fever or hypothermia, tachycardia, tachypnea, leukocytosis or leukopenia, elevated blood levels of lactate and procalcitonin, hypotension are diagnostically sensitive findings for sepsis. Definitive diagnosis requires isolation of the pathogen from blood sample or from the focus of infection. Therapeutic success against sepsis depends on the appropriate use of antibiotics, on the treatment of hemodynamic and respiratory disorder and on general supportive care. In some cases the use of activated protein C is to take in consideration.

  17. 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.

  18. 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

  19. Rahnella aquatilis Sepsis in a Premature Newborn

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    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.

  20. Sepsis from dropped clips at laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, Sarwat E-mail: sarwathussain@hotmail.com

    2001-12-01

    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.

  1. 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

  2. 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

  3. In-111 WBC imaging in musculoskeletal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, L.; Ouzounian, T.J.; Webber, M.M.; Amstutz, H.C.

    1984-01-01

    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 ..mu..Ci. 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.

  4. 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.

  5. Cats protecting birds revisited.

    Science.gov (United States)

    Fan, Meng; Kuang, Yang; Feng, Zhilan

    2005-09-01

    In this paper, we revisit the dynamical interaction among prey (bird), mesopredator (rat), and superpredator (cat) discussed in [Courchamp, F., Langlais, M., Sugihara, G., 1999. Cats protecting birds: modelling the mesopredator release effect. Journal of Animal Ecology 68, 282-292]. First, we develop a prey-mesopredator-superpredator (i.e., bird-rat-cat, briefly, BRC) model, where the predator's functional responses are derived based on the classical Holling's time budget arguments. Our BRC model overcomes several model construction problems in Courchamp et al. (1999), and admits richer, reasonable and realistic dynamics. We explore the possible control strategies to save or restore the bird by controlling or eliminating the rat or the cat when the bird is endangered. We establish the existence of two types of mesopredator release phenomena: severe mesopredator release, where once superpredators are suppressed, a burst of mesopredators follows which leads their shared prey to extinction; and mild mesopredator release, where the mesopredator release could assert more negative impact on the endemic prey but does not lead the endemic prey to extinction. A sharp sufficient criterion is established for the occurrence of severe mesopredator release. We also show that, in a prey-mesopredator-superpredator trophic food web, eradication of introduced superpredators such as feral domestic cats in the BRC model, is not always the best solution to protect endemic insular prey. The presence of a superpredator may have a beneficial effect in such systems. PMID:15998496

  6. Lorentz violation naturalness revisited

    Science.gov (United States)

    Belenchia, Alessio; Gambassi, Andrea; Liberati, Stefano

    2016-06-01

    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-energy percolation also in this case.

  7. 南京太平巷幼儿园设计中色彩的运用%On color application of Taiping Alley Kindergarten design in Nanjing

    Institute of Scientific and Technical Information of China (English)

    谢岚

    2015-01-01

    According to the analysis of the color design of kindergartens, the paper explores the meaning and methods for the indoor colors design of kindergartens, illustrates the features and methods for the color design in kindergartens with the case of Taiping Alley Kindergarten in Nanjing, introduces color application in the spatial design of kindergarten, and explores the optimal methods for the spatial color composition.%通过对幼儿园色彩设计的分析,探讨了幼儿园室内色彩设计的意义和方法,并以太平巷幼儿园为具体案例,阐述了幼儿园色彩设计的特点和手法,介绍了幼儿园空间设计中色彩的搭配及运用,以探索出幼儿园空间色彩组合的最佳方法。

  8. Counter-Orientalism: Retranslating the ‘Invisible Arab’1 in Leila Aboulela’s The Translator and Lyrics Alley2

    Directory of Open Access Journals (Sweden)

    Ahmed Gamal El Din

    2015-02-01

    Full Text Available Retranslation is a foundational postcolonial metaphor that might highlight the new horizons of transcultural and transnational relations and their political backdrop. By the same token, Arab British migrant narratives are of special relevancy to both translation and cultural studies, since migrant identity and writing are closely associated with the politics of translation, rewriting, relocation and cross-cultural pollination. This contribution explores the role of counter-discourses in general and counter-Orientalism in particular in the contemporary fiction of Arab British writers. In particular the paper focuses on the textual representations of invisible Arab men and women and the East-West cultural exchange in the writing of the Sudanese feminist and Scottish immigrant Leila Aboulela (1964-. Drawing on the counter-traditional concept of translation as engagement rather than transfer, this article attempts to spotlight the aesthetic and political parameters of cultural translation in Arab British literature represented by Leila Aboulela’s The Translator (1999 and Lyrics Alley (2010. Many studies have examined the mis/representation of Arabs in Western Orientalist narratives, but very few have probed how Arab émigrés have deftly attempted to engage with Orientalist narratives by restructuring new identities and critically hybridizing unexampled cultural models. In other words, counter-Orientalism implies appropriating Orientalist stereotypes of space, history, identity and gender in counter-narratives that seek to retranslate, demythologize and therefore de-Orientalize Arab subjects.

  9. 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.)

  10. Soluble ST2 plasma concentrations predict mortality in severe sepsis

    NARCIS (Netherlands)

    J.J. Hoogerwerf; M.W.T. Tanck; M.A.D. van Zoelen; X. Wittebole; P.F. Laterre; T. van der Poll

    2010-01-01

    Patients with sepsis-after surviving the initial hyperinflammatory phase-display features consistent with immunosuppression, including hyporesponsiveness of immunocompetent cells to bacterial agents. Immunosuppression is thought to be facilitated by negative regulators of toll-like receptors, includ

  11. 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 on the 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...

  12. Thrombomodulin: A Bifunctional Modulator of Inflammation and Coagulation in Sepsis

    Directory of Open Access Journals (Sweden)

    Takayuki Okamoto

    2012-01-01

    Full Text Available Deregulated interplay between inflammation and coagulation plays a pivotal role in the pathogenesis of sepsis. Therapeutic approaches that simultaneously target both inflammation and coagulation hold great promise for the treatment of sepsis. Thrombomodulin is an endogenous anticoagulant protein that, in cooperation with protein C and thrombin-activatable fibrinolysis inhibitor, serves to maintain the endothelial microenvironment in an anti-inflammatory and anticoagulant state. A recombinant soluble form of thrombomodulin has been approved to treat patients suffering from disseminated intravascular coagulation (DIC and has thus far shown greater therapeutic potential than heparin. A phase II clinical trial is currently underway in the USA to study the efficacy of thrombomodulin for the treatment of sepsis with DIC complications. This paper focuses on the critical roles that thrombomodulin plays at the intersection of inflammation and coagulation and proposes the possible existence of interactions with integrins via protein C. Finally, we provide a rationale for the clinical application of thrombomodulin for alleviating sepsis.

  13. 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....

  14. Development of an e-learning package for sepsis care.

    Science.gov (United States)

    Davis, Anna; Henderson, James; Langmack, Gill

    Severe sepsis is a major cause of morbidity and mortality in the UK. This article describes the collaborative development and implementation of an interactive online learning package to understand the key role nurses have in recognising and then starting to apply the Sepsis Six care bundle in clinical practice. The e-learning package, developed in a UK teaching hospital, uses a case study approach to address the knowledge that is required to be able to recognise sepsis, to understand the processes that occur and the ongoing care and treatment required. The package is relevant to final-year student nurses, newly registered nurses in preceptorship and other health professionals involved in assessing and treating patients who may be developing sepsis.

  15. Paradoxical Roles of the Neutrophil in Sepsis: Protective and Deleterious

    Science.gov (United States)

    Sônego, Fabiane; Castanheira, Fernanda Vargas e Silva; Ferreira, Raphael Gomes; Kanashiro, Alexandre; Leite, Caio Abner Vitorino Gonçalves; Nascimento, Daniele Carvalho; Colón, David Fernando; Borges, Vanessa de Fátima; Alves-Filho, José Carlos; Cunha, Fernando Queiróz

    2016-01-01

    Sepsis, an overwhelming inflammatory response syndrome secondary to infection, is one of the costliest and deadliest medical conditions worldwide. Neutrophils are classically considered to be essential players in the host defense against invading pathogens. However, several investigations have shown that impairment of neutrophil migration to the site of infection, also referred to as neutrophil paralysis, occurs during severe sepsis, resulting in an inability of the host to contain and eliminate the infection. On the other hand, the neutrophil antibacterial arsenal contributes to tissue damage and the development of organ dysfunction during sepsis. In this review, we provide an overview of the main events in which neutrophils play a beneficial or deleterious role in the outcome of sepsis. PMID:27199981

  16. 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

  17. 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.

  18. HDL in sepsis - risk factor and therapeutic approach

    Directory of Open Access Journals (Sweden)

    Emily E Morin

    2015-10-01

    Full Text Available High-density lipoprotein (HDL is a key component of circulating blood and plays essential roles in regulation of vascular endothelial function and immunity. Clinical data demonstrate that HDL levels drop by 40-70% in septic patients, which is associated with a poor prognosis. Experimental studies using Apolipoprotein A-I (ApoAI null mice as an HDL deficient model showed that mice lacking HDL are susceptible to septic death, and overexpressing ApoAI in mice to increase HDL levels protects against septic death. These clinical and animal studies support our hypothesis that a decrease in HDL level is a risk factor for sepsis, and raising circulating HDL levels may provide an efficient therapy for sepsis. In this review, we discuss the roles of HDL in sepsis and summarize the efforts of using synthetic HDL as a potential therapy for sepsis.

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

    Energy Technology Data Exchange (ETDEWEB)

    Barkhausen, J.; Stoeblen, F.; Mueller, R.D. [University Hospital Essen (Germany). Dept. of Radiology; Dominguez-Fernandez, E. [University Hospital Essen (Germany). Dept. of General Surgery; Henseke, P. [Nycomed-Amersham Arzneimittel GmbH, Muenchen (Germany)

    1999-09-01

    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.)

  20. Benjamin Franklin and Mesmerism, revisited.

    Science.gov (United States)

    McConkey, Kevin M; Perry, Campbell

    2002-10-01

    The authors revisit and update their previous historiographical note (McConkey & Perry, 1985) on Benjamin Franklin's involvement with and investigation of animal magnetism or mesmerism. They incorporate more recent literature and offer additional comment about Franklin's role in and views about mesmerism. Franklin had a higher degree of personal involvement with and a more detailed opinion of mesmerism than has been previously appreciated.

  1. 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…

  2. 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 ...

  3. 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. ...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  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. 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 ...

  11. 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.

  12. 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...

  13. 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

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. Role of C5 Activation Products in Sepsis

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    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.

  18. 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.

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

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    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.

  20. 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.

  1. Role of Circulating Lymphocytes in Patients with Sepsis

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    Raul de Pablo

    2014-01-01

    Full Text Available Sepsis is a systemic inflammatory response syndrome due to infection. The incidence rate is estimated to be up to 19 million cases worldwide per year and the number of cases is rising. Infection triggers a complex and prolonged host response, in which both the innate and adaptive immune response are involved. The disturbance of immune system cells plays a key role in the induction of abnormal levels of immunoregulatory molecules. Furthermore, the involvement of effector immune system cells also impairs the host response to the infective agents and tissue damage. Recently, postmortem studies of patients who died of sepsis have provided important insights into why septic patients die and showed an extensive depletion of CD4 and CD8 lymphocytes and they found that circulating blood cells showed similar findings. Thus, the knowledge of the characterization of circulating lymphocyte abnormalities is relevant for the understanding of the sepsis pathophysiology. In addition, monitoring the immune response in sepsis, including circulating lymphocyte subsets count, appears to be potential biomarker for predicting the clinical outcome of the patient. This paper analyzes the lymphocyte involvement and dysfunction found in patients with sepsis and new opportunities to prevent sepsis and guide therapeutic intervention have been revealed.

  2. 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

  3. Identification of adults with sepsis in the prehospital environment: a systematic review

    Science.gov (United States)

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Objective Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting Prehospital/emergency medical services (EMS). Study selection All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures Recognition of sepsis by EMS clinicians. Results Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. PMID:27496231

  4. 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.

  5. 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.

  6. Absolute counts of peripheral blood leukocyte subpopulations in intraabdominal sepsis and pneumonia-derived sepsis: a pilot study Absolute counts of peripheral blood leukocyte subpopulations in intraabdominal sepsis and pneumonia-derived sepsis: a pilot study

    Directory of Open Access Journals (Sweden)

    Grazyna Anna Hoser

    2012-10-01

    Full Text Available The leading pathophysiological changes during sepsis include systemic abnormalities in the immune
    response. Due to the general character of these disturbances, sepsis is usually studied as a homogenous clinical
    condition. We aimed to compare the immune response in intraabdominal sepsis (IAS and pneumonia-derived
    sepsis (PDS. The following cell populations were examined: white blood cell count (WBC, monocytes, lymphocytes:
    CD3+, CD4+ and CD8+ T cells, B cells, and NK cells. In both studied groups (i.e. IAS and PDS, the
    WBC was elevated. However, it was significantly higher in the IAS group than in the PDS group. The difference
    was due to a lower granulocyte count, as well as a lower monocyte count in PDS. We found no significant
    correlation between the total lymphocyte number and CD3+CD8+ T cells in either form of sepsis. Similarly, we
    observed no correlation between the total lymphocyte number and the NK cells subset in IAS. However, the
    numbers of CD3+CD8+ and NK cells correlated similarly in both types of sepsis. Both studied types of sepsis
    induced profound lymphocytopenia, with marked loss of CD8+ T cells and the NK cells. However, the similar
    relation between them, which was independent of the infection type, suggests that the NK and CD3+CD8+ cells
    have shared mechanisms of regulation. The primary site of infection has an impact on the global immune reaction.
    These alternations include especially myeloid cells: granulocytes and monocytes which disappear from peripheral
    blood during PDS, but increase in IAS.
    The leading pathophysiological changes during sepsis include systemic abnormalities in the immune
    response. Due to the general character of these disturbances, sepsis is usually studied as a homogenous clinical
    condition. We aimed to compare the immune response in intraabdominal sepsis (IAS and pneumonia-derived
    sepsis (PDS. The following cell

  7. Absceso de Muslo, Sepsis y Embarazo

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    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.

  8. 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...

  9. 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

  10. Enceladus' tidal dissipation revisited

    Science.gov (United States)

    Tobie, Gabriel; Behounkova, Marie; Choblet, Gael; Cadek, Ondrej; Soucek, Ondrej

    2016-10-01

    A series of chemical and physical evidence indicates that the intense activity at Enceladus' South Pole is related to a subsurface salty water reservoir underneath the tectonically active ice shell. The detection of a significant libration implies that this water reservoir is global and that the average ice shell thickness is about 20-25km (Thomas et al. 2016). The interpretation of gravity and topography data further predicts large variations in ice shell thickness, resulting in a shell potentially thinner than 5 km in the South Polar Terrain (SPT) (Cadek et al. 2016). Such an ice shell structure requires a very strong heat source in the interior, with a focusing mechanism at the SPT. Thermal diffusion through the ice shell implies that at least 25-30 GW is lost into space by passive diffusion, implying a very efficient dissipation mechanism in Enceladus' interior to maintain such an ocean/ice configuration thermally stable.In order to determine in which conditions such a large dissipation power may be generated, we model the tidal response of Enceladus including variable ice shell thickness. For the rock core, we consider a wide range of rheological parameters representative of water-saturated porous rock materials. We demonstrate that the thinning toward the South Pole leads to a strong increase in heat production in the ice shell, with a optimal thickness obtained between 1.5 and 3 km, depending on the assumed ice viscosity. Our results imply that the heat production in the ice shell within the SPT may be sufficient to counterbalance the heat loss by diffusion and to power eruption activity. However, outside the SPT, a strong dissipation in the porous core is required to counterbalance the diffusive heat loss. We show that about 20 GW can be generated in the core, for an effective viscosity of 1012 Pa.s, which is comparable to the effective viscosity estimated in water-saturated glacial tills on Earth. We will discuss the implications of this revisited tidal

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

    Directory of Open Access Journals (Sweden)

    Sartaj Bhat

    2015-07-01

    Full Text Available 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. Among 560 neonates, 80/560 (14.28% had Culture positive sepsis. Out of 80 blood culture positive neonates 73 were term neonates and 7 were near term. Gram positive sepsis occurred in 21/80 (26.25%, gram negative sepsis in 54/80 (67.5%, and fungal sepsis in 5/80 (6.25%. Incidence of thrombocytopenia in Gram negative sepsis was (35/54 64.81%, in gram positive sepsis (15/21 71.41% and in fungal sepsis was (3/5 60%. Mean platelet count at the onset of sepsis in all the patients was 123287.5±49428.68. The mean duration of thrombocytopenia in gram positive sepsis was 4.66 ±2.6 days, in gram negative sepsis 4.39 ± 2.22 days and in fungal sepsis 5.2±1.3 days. MPV at the time of onset of sepsis (MPV was high in gram positive sepsis than in gram negative sepsis (11.57±0.88 Vs 11.29 ± 0.76. The MPV of thrombocytopenic neonates was significantly higher than that of non-thrombocytopenic neonates (p < 0.01.

  12. Global fibrinolytic capacity in pediatric patients with sepsis and disseminated intravascular coagulation.

    Science.gov (United States)

    Bay, Ali; Oner, Ahmet Faik; Kose, Dogan; Dogan, Murat

    2006-10-01

    There are many complex pathophysiologic changes of the coagulation system in sepsis. The fibrinolytic system was evaluated in septic children using the global fibrinolytic capacity (GFC), a new technique reflecting the overall fibrinolytic activity. The study consisted of 24 children with sepsis, 36 children with sepsis plus disseminated intravascular coagulation (DIC), and 20 healthy age-matched control individuals. Compared with controls, 86% of sepsis patients and 87% of sepsis plus DIC patients had decreased GFC levels. Between the sepsis plus DIC and sepsis groups there was no significant difference in terms of GFC levels. While 19 patients (52.7%) died in the sepsis plus DIC group, only three patients (12.5%) died in the sepsis group. When survivors and nonsurvivors were compared in terms of coagulation tests, there were significant differences for protein C, antithrombin, platelet, fibrinogen, aspartate aminotransferase, alanine aminotransferase, prothrombin time, and white blood cell values. In conclusion, the level of GFC reduced in most of the pediatric sepsis patients but no difference was observed between patients with sepsis and patients with sepsis plus DIC. While inhibition of fibrinolysis is an important finding in sepsis, the mortality is mainly associated with the presence of end-organ damage and the status of coagulation parameters.

  13. Revisiting SU(N) integrals

    CERN Document Server

    Zuber, Jean-Bernard

    2016-01-01

    In this note, I revisit integrals over $\\SU(N)$ of the form $ \\int DU\\, U_{i_1j_1}\\cdots U_{i_pj_p}\\Ud_{k_1l_1}\\cdots \\Ud_{k_nl_n}$. While the case $p=n$ is well known, it seems that explicit expressions for $p=n+N$ had not appeared in the literature. Similarities and differences, in particular in the large $N$ limit, between the two cases are discussed

  14. The Damped String Problem Revisited

    CERN Document Server

    Gesztesy, Fritz

    2010-01-01

    We revisit the damped string equation on a compact interval with a variety of boundary conditions and derive an infinite sequence of trace formulas associated with it, employing methods familiar from supersymmetric quantum mechanics. We also derive completeness and Riesz basis results (with parentheses) for the associated root functions under less smoothness assumptions on the coefficients than usual, using operator theoretic methods (rather than detailed eigenvalue and root function asymptotics) only.

  15. 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...

  16. 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...

  17. Role of Pore-Forming Toxins in Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    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.

  18. Translocation of gut flora and its role in sepsis

    Directory of Open Access Journals (Sweden)

    C Vaishnavi

    2013-01-01

    Full Text Available 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 intestinal obstruction and in immunocompromised patients and is the cause of subsequent sepsis. Factors that can trigger bacterial translocation from the gut are host immune deficiencies and immunosuppression, disturbances in normal ecological balance of gut, mucosal barrier permeability, obstructive jaundice, stress, etc. Bacterial translocation occurs through the transcellular and the paracellular pathways and can be measured both directly by culture of mesenteric lymph nodes and indirectly by using labeled bacteria, peripheral blood culture, detection of microbial DNA or endotoxin and urinary excretion of non-metabolisable sugars. Bacterial translocation may be a normal phenomenon occurring on frequent basis in healthy individuals without any deleterious consequences. But when the immune system is challenged extensively, it breaks down and results in septic complications at different sites away from the main focus. The factors released from the gut and carried in the mesenteric lymphatics but not in the portal blood are enough to cause multi-organ failure. Thus, bacterial translocation may be a promoter of sepsis but not the initiator. This paper reviews literature on the translocation of gut flora and its role in causing sepsis.

  19. 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.

  20. Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation.

    Science.gov (United States)

    Sivula, Mirka; Pettilä, Ville; Niemi, Tomi T; Varpula, Marjut; Kuitunen, Anne H

    2009-09-01

    Severe sepsis induces coagulopathy, which may lead to disseminated intravascular coagulation (DIC). Thromboelastometry is a point-of-care whole blood coagulation monitor, which has been validated in human endotoxemia model. We assessed thromboelastometry in severe sepsis and overt DIC and investigated its applicability in differentiating sepsis-related coagulation disturbances. Thromboelastometry (EXTEM and FIBTEM tests) and traditional coagulation assays were analyzed in 28 patients with severe sepsis, 12 of who fulfilled the criteria of overt DIC on admission. Ten healthy persons served as controls. Coagulation parameters, clotting time, clot formation time (CFT), alpha angle, maximal clot firmness (MCF) and lysis index at 60 min, were registered. In patients with overt DIC, EXTEM MCF, CFT and alpha angle differed from that in both healthy controls and patients without DIC, indicating hypocoagulation (MCF 52, 63 and 68 mm; CFT 184, 88 and 73 s; and alpha angle 58, 72 and 76 degrees , respectively, P coagulation assays showed progressively worsening coagulopathy from controls to septic patients without DIC and further to those with overt DIC. We conclude that thromboelastometry may be a valuable tool in assessing whole blood coagulation capacity in patients with severe sepsis with and without overt DIC.

  1. 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.

  2. Use of miRNAs as Biomarkers in Sepsis

    Directory of Open Access Journals (Sweden)

    Raluca Dumache

    2015-01-01

    Full Text Available Sepsis is one of the most common causes of death in critical patients. Severe generalized inflammation, infections, and severe physiological imbalances significantly decrease the survival rate with more than 50%. Moreover, monitoring, evaluation, and therapy management often become extremely difficult for the clinician in this type of patients. Current methods of diagnosing sepsis vary based especially on the determination of biochemical-humoral markers, such as cytokines, components of the complement, and proinflammatory and anti-inflammatory compounds. Recent studies highlight the use of new biomarkers for sepsis, namely, miRNAs. miRNAs belong to a class of small, noncoding RNAs with an approximate content of 19–23 nucleotides. Following biochemical and physiological imbalances, the expression of miRNAs in blood or other body fluids changes significantly. Moreover, its stability, specificity, and selectivity make miRNAs ideal candidates for sepsis biomarkers. In conclusion, we can affirm that stable species of circulating miRNAs represent potential biomarkers for monitoring the evolution of sepsis.

  3. 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.

  4. 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

  5. Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Anant Mohan

    2015-01-01

    Full Text Available Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. Materials and Methods: Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II, Simplified Acute Physiology Score II and III (SAPS II and SAPS III, and Sequential Organ Function Assessment (SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Results: One hundred patients were enrolled over two years (54% males. The overall mortality was 53%, (69.5% in females, 38.8% in males (P < 0.01. Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively, P < 0.01. Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively. There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission. Conclusion: Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score based on SAPS II

  6. 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 ...

  7. 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....

  8. Host response biomarkers in sepsis: the role of procalcitonin.

    Science.gov (United States)

    Vincent, Jean-Louis; Van Nuffelen, Marc; Lelubre, Christophe

    2015-01-01

    Procalcitonin is the prohormone of calcitonin and present in minute quantities in health. However, during infection, its levels rise considerably and are correlated with the severity of the infection. Several assays have been developed for measurement of procalcitonin levels; in this article, we will briefly present the PCT-sensitive Kryptor(®) test (Brahms, Hennigsdorf, Germany), one of the most widely used assays for procalcitonin in recent studies. Many studies have demonstrated the value of procalcitonin levels for diagnosing sepsis and assessing disease severity. Procalcitonin levels have also been successfully used to guide antibiotic administration. However, procalcitonin is not specific for sepsis, and values need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. Neonatal sepsis of vertical transmission: an epidemiological study from the "Grupo de Hospitales Castrillo".

    Science.gov (United States)

    López Sastre, J B; Coto Cotallo, G D; Fernández Colomer, B

    2000-01-01

    A prospective multicenter study was designed to assess the epidemiology of neonatal sepsis of vertical transmission in Spain. The study was carried out by the "Grupo de Hospitales Castrillo" that included the neonatal services of 19 tertiary care (reference) hospitals and 9 secondary care hospitals. Prospective data from infants with culture-proved neonatal sepsis, clinical sepsis and bacteremia were recorded for 1995 to 1997. In a total of 203,288 neonates, proven sepsis was diagnosed in 515 (rate of 2.5 per 1000 live births), clinical sepsis in 724 (rate of 3.6 per 1000 live births), and bacteremia of vertical transmission in 155 (rate of 0.76 per 1000 live births). Very low birth weight (VLBW) infants ( 1500 g. Streptococcus agalactiae was the most frequent causative pathogen in cases of proven sepsis (51%) and bacteremia (33%), but Escherichia coli was the most frequently recovered organism in the VLBW group. The mortality rate of proven sepsis was significantly higher than that of clinical sepsis (8.7% versus 4.3%) (P < 0.01). In the VLBW cohort, there were no significant differences in the mortality rate between proven sepsis and clinical sepsis. In conclusion, clinical sepsis was the most frequent diagnosis, probably related to intrapartum chemoprophylaxis. Streptococcus agalactiae was the most frequent causative pathogen of culture-positive sepsis and bacteremia, whereas E. coli was the most significant in VLBW infants.

  14. Sepsis in the intensive care unit: epidemiology, outcome and host response

    NARCIS (Netherlands)

    L.A. van Vught

    2016-01-01

    Sepsis is a life-threatening syndrome that arises when a dysbalanced patient response to an infection causes damage to the body’s own organs and tissues. Sepsis is, to date, still a major cause of morbidity and mortality worldwide. A detailed understanding of the pathogenesis of sepsis is likely to

  15. 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

  16. 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

  17. 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.

  18. 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

  19. Diagnostic and prognostic biomarkers of sepsis in critical care.

    Science.gov (United States)

    Kibe, Savitri; Adams, Kate; Barlow, Gavin

    2011-04-01

    Sepsis is a leading cause of mortality in critically ill patients. Delay in diagnosis and initiation of antibiotics have been shown to increase mortality in this cohort. However, differentiating sepsis from non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult, especially in critically ill patients who may have SIRS for other reasons. It is this conundrum that predominantly drives broad-spectrum antimicrobial use and the associated evolution of antibiotic resistance in critical care environments. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis, but is not accurate enough for clinicians to dispense with clinical judgement. There is stronger evidence, however, that measurement of PCT has a role in reducing the antibiotic exposure of critical care patients. For units intending to incorporate PCT assays into routine clinical practice, the cost-effectiveness of this is likely to depend on the pre-implementation length of an average antibiotic course and the subsequent impact of implementation on emerging antibiotic resistance. In most of the trials to date, the average baseline duration of the antibiotic course was longer than is currently standard practice in many UK critical care units. Many other biomarkers are currently being investigated. To be highly useful in clinical practice, it may be necessary to combine these with other novel biomarkers and/or traditional markers of sepsis.

  20. 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.

  1. 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.

  2. 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

  3. 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...

  4. Cold agglutinin disease in sepsis: A rare entity

    Science.gov (United States)

    Garg, Ravinder; Kukar, Neetu; Bajwa, Sukhminder Jit Singh; Kaur, Shaminder

    2015-01-01

    Cold agglutinin disease (CAgD) is a type of autoimmune hemolytic anemia which generally occurs in adults and is characterized by the presence of IgM antibodies directed against polysaccharide antigens on red blood cell surface. A 16-year-old male, having clinical picture of sepsis and anemia, presented to the Emergency Department of our Institute in an Hemodynamically unstable condition. Investigation profile revealed hemolysis due to CAgD, which responded to corticosteroids, antibiotics and supportive treatment. This case highlights the importance of recognizing this entity in such type of cases presenting with sepsis and anemia. PMID:26229347

  5. 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.

  6. 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

  7. 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

  8. Locomotion and claw disorders in Norwegian dairy cows housed in freestalls with slatted concrete, solid concrete, or solid rubber flooring in the alleys.

    Science.gov (United States)

    Fjeldaas, T; Sogstad, A M; Osterås, O

    2011-03-01

    This study was part of a cross-sectional project on freestall housing, and the aim was to compare locomotion and claw disorders in freestall dairy cattle herds with slatted concrete, solid concrete, or solid rubber flooring in the alleys. The final population for studying claw disorders consisted of 66 dairy herds with 2,709 dry or lactating cows, whereas the population for studying locomotion consisted of 54 herds with 2,216 cows. All herds used Norwegian Red as the main breed. The herds were visited by 15 trained claw trimmers one time during the period from the beginning of February to summer let-out onto pasture in 2008. The trimmers assessed locomotion scores (LocS) of all cows before trimming. At trimming, claw disorders were diagnosed and recorded in the Norwegian Claw Health Card. Estimates describing locomotion and claw disorders in the hind feet were identified by use of multivariable models fit with LocS and each claw disorder as dependent variables, respectively. Herd nested within claw trimmer was included in the model as random effects. The odds ratio (OR) of having LocS >2 and LocS >3 was 1.9 and 2.1, respectively, on slatted concrete compared with solid concrete. Fewer cases of dermatitis were found on slatted than solid concrete (OR=0.70) and a tendency was observed for fewer heel horn erosions on slatted concrete than solid rubber (OR=0.47). Hemorrhages of the white line and sole were more prevalent in herds housed on slatted and solid concrete than in those housed on solid rubber (OR=2.6 and OR=2.1, respectively). White line fissures were also more prevalent in herds housed on slatted and solid concrete than in those housed on solid rubber (OR=2.1 and OR=2.0, respectively). Double soles were more prevalent on solid concrete than solid rubber (OR=4.4). However, sole ulcers were less prevalent in herds with slatted and solid concrete than solid rubber (OR=0.39 and OR=0.53, respectively). Fewer corkscrewed claws were found on slatted concrete than

  9. 语言景观个案研究--以昆明文化巷为例%Research on Linguistic Landscape - A Case Study of Wenhua Alley in Kunming

    Institute of Scientific and Technical Information of China (English)

    夏娜; 夏百川

    2016-01-01

    Taking Yunnan Kunming foreigners’ distributing center—Wenhua Alley as the research object,the paper inquired the impact of English as the world language upon Kunming by means of the research method of linguistic landscape. The survey results re-veal that English has a great influence on the southwestern region of Kunming,and there have appeared a number of bilingual,trilin-gual and mixed language phenomena. The globalization trend of the linguistic landscape in Wenhua Alley is distinct.%以云南昆明外国人集散地———文化巷为研究对象,借助语言景观学的研究方法,探究作为世界语言的英语对昆明的影响力。调查结果表明,英语对地处西南地区的昆明有较大影响,并出现了多种双语、三语以及混合语现象,昆明文化巷语言景观的全球化趋向明显。

  10. 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;

    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....

  11. 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;

    2006-01-01

    BACKGROUND: 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 ...

  12. Development and validation of a multiplex add-on assay of biomarkers related to sepsis using xMAP technology

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Vest Schneider, Uffe; Scheel, Troels;

    2006-01-01

    BACKGROUND: 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 ...

  13. The power reinforcement framework revisited

    DEFF Research Database (Denmark)

    Nielsen, Jeppe; Andersen, Kim Normann; Danziger, James N.

    2016-01-01

    public organizations. This article revisits the 30-yearold power reinforcement framework by means of an empirical analysis on the use of mobile technology in a large-scale programme in Danish public sector home care. It explores whether and to what extent administrative management has controlled decision......-dominated and centrally controlled technologies that were the main focus of the 1970s and 1980s studies. Yet this study concludes that there is general support for the reinforcement framework in the contemporary application of mobile technology in public sector home care....

  14. 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...... 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 between hard, soft, and general practices....

  15. Jesus and the law revisited

    Directory of Open Access Journals (Sweden)

    William R.G. Loader

    2011-06-01

    Full Text Available This article revisited the issue of Jesus’ attitude towards the Torah on the basis of a critical discussion of the most recent extensive treatment of the theme by Meier in his A marginal Jew: Rethinking the historical Jesus: Volume four: Law and love (2009. It engaged Meier’s contribution in the light of contemporary research, concluding that, whilst Meier provided an erudite analysis, his thesis that Jesus’ teaching on divorce and oaths revoked Mosaic law did not convince, for it did not adequately consider the extent to which the contemporary interpretation of the Torah could encompass such radicalisation.

  16. 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.

  17. 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...

  18. 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

  19. 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)

  20. Experimental Cannabinoid 2 Receptor-Mediated Immune Modulation in Sepsis

    Directory of Open Access Journals (Sweden)

    J. Sardinha

    2014-01-01

    Full Text Available Sepsis is a complex condition that results from a dysregulated immune system in response to a systemic infection. Current treatments lack effectiveness in reducing the incidence and mortality associated with this disease. The endocannabinoid system offers great promise in managing sepsis pathogenesis due to its unique characteristics. The present study explored the effect of modulating the CB2 receptor pathway in an acute sepsis mouse model. Endotoxemia was induced by intravenous injection of lipopolysaccharide (LPS in mice and intestinal microcirculation was assessed through intravital microscopy. We found that HU308 (CB2 receptor agonist reduced the number of adherent leukocytes in submucosal venules but did not restore muscular and mucosal villi FCD in endotoxemic mice. AM630 (CB2 receptor antagonist maintained the level of adherent leukocytes induced by LPS but further reduced muscular and mucosal villi FCD. URB597 (FAAH inhibitor and JZL184 (MAGL inhibitor both reduced the number of adherent leukocytes in submucosal venules but did not restore the mucosal villi FCD. Using various compounds we have shown different mechanisms of activating CB2 receptors to reduce leukocyte endothelial interactions in order to prevent further inflammatory damage during sepsis.

  1. 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...

  2. 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 .

  3. 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.

  4. 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

  5. Platelets: versatile effector cells in pneumonia and sepsis

    NARCIS (Netherlands)

    S.F. de Stoppelaar

    2015-01-01

    The role of platelets in infection and immunity is an exciting new theme, which is rapidly evolving. In this thesis we studied the involvement of platelets in the host response to pneumonia and sepsis. We made use of well established mouse models in which mice were infected with a bacterial inoculum

  6. Early onset neonatal sepsis due to Morganella morganii.

    Science.gov (United States)

    Dutta, Sourabh; Narang, Anil

    2004-11-01

    Two neonates, both 32-weekers, developed Morganella morganii sepsis on the first day of life. They presented within a day of each other, primarily with respiratory signs. In both cases there was a history of spontaneous premature rupture of membranes, exposure to a single dose of ampicillin ante-partum, and similar antibiograms. No common source could be identified.

  7. [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

  8. 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.

  9. 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

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

    Science.gov (United States)

    Segura-Cervantes, Enrique; Mancilla-Ramírez, Javier; González-Canudas, Jorge; Alba, Erika; Santillán-Ballesteros, René; Morales-Barquet, Deneb; Sandoval-Plata, Gabriela

    2016-01-01

    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. PMID:27293317

  11. Recombinant Anticoagulant Factors for Adjunctive Treatment of Sepsis

    NARCIS (Netherlands)

    M. Levi; E. Lowenberg; J.C. Meijers

    2010-01-01

    Inflammation and coagulation play a pivotal role in the pathogenesis of sepsis. Increasing evidence points to an extensive cross-talk between these two systems, whereby inflammation not only leads to activation of coagulation, but coagulation also considerably affects inflammatory activity. The intr

  12. 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

  13. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Bowton, D.L.; Bertels, N.H.; Prough, D.S.; Stump, D.A.

    1989-05-01

    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 CO/sub 2/ in nine patients with sepsis syndrome using the /sup 133/Xe 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 CO/sub 2/ 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.

  15. 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

  16. 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.

  17. 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.

  18. 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

  19. IL-35 is elevated in clinical and experimental sepsis and mediates inflammation.

    Science.gov (United States)

    Cao, Ju; Xu, Fang; Lin, Shihui; Tao, Xintong; Xiang, Yu; Lai, Xiaofei; Zhang, Liping

    2015-12-01

    Sepsis carries considerable morbidity and mortality. IL-35 is a newly described cytokine, which plays a regulatory role in infection and immunity. In this study, we found that IL-35 concentration in serum samples from adult or child patients with sepsis was significantly higher compared with that from healthy controls. IL-35 gradually increased according to sepsis severity. Increased serum IL-35 was associated with LOD (Logistic Organ Dysfunction) or SAPS II (Simplified Acute Physiology Score) scores, and correlated with markers of inflammation. In murine abdominal sepsis, administration of anti-IL-35 p35 antibodies significantly diminished dissemination of the bacteria in septic animals, which was accompanied by enhanced local neutrophil recruitment and early increased release of inflammatory cytokines and chemokines. Therefore, sepsis is associated with enhanced release of IL-35. In abdominal sepsis, IL-35 likely facilitates bacterial dissemination. IL-35 plays a major role in the immunopathogenesis of sepsis.

  20. 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

  1. 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.

  2. Sinomenine hydrochloride protects against polymicrobial sepsis via autophagy.

    Science.gov (United States)

    Jiang, Yu; Gao, Min; Wang, Wenmei; Lang, Yuejiao; Tong, Zhongyi; Wang, Kangkai; Zhang, Huali; Chen, Guangwen; Liu, Meidong; Yao, Yongming; Xiao, Xianzhong

    2015-01-23

    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. 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. 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?

    NARCIS (Netherlands)

    Flier, M. van der; Sharma, D.B.; Estevao, S.; Emonts, M.; Rook, D.; Hazelzet, J.A.; Goudoever, J.B. van; Hartwig, N.G.

    2013-01-01

    The 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 per

  7. 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...

  8. 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...

  9. Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

    Science.gov (United States)

    Mann-Salinas, Elizabeth A; Baun, Mara M; Meininger, Janet C; Murray, Clinton K; Aden, James K; Wolf, Steven E; Wade, Charles E

    2013-01-01

    The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P burn patient.

  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. 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

  12. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

    Science.gov (United States)

    Kaur, Gurpreet; Vinayak, Nikhil; Mittal, Kundan; Kaushik, Jaya Shankar; Aamir, Mohammad

    2014-01-01

    Background: Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries. Methods: A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated. Results: A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI

  13. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Gurpreet Kaur

    2014-01-01

    Full Text Available Background: Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries. Methods: A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated. Results: A total of 50 patients (30 [60%] males were enrolled in the study, of whom 21 (42% were discharged (survivors and rest 29 (58% expired (nonsurvivor. Median (interquartile range age of enrolled patients were 18 (6, 60 months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI

  14. 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.......006-0.010). The absence of LF' oscillations was associated with a higher 30-day mortality [50 vs. 18%, hazard ratio, 3.6 (95% confidence interval: 1.4-9.8), P=0.01]. CONCLUSION: Spontaneous blood pressure oscillations in mechanically ventilated septic patients may be suppressed to lower frequencies than previously...... 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...

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

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    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.

  16. Clinicomicrobiological profile of the Indian elderly with sepsis

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    Arvind Kumar Anand

    2016-01-01

    Full Text Available The study included 400 elderly patients (≥60 years of age with clinically suspected sepsis. The maximum number of patients was in the age group of 60-69. Diabetes was the most prevalent comorbid condition. The most common site of infection was the urinary tract followed by the lungs atypical manifestations were quite prevalent with delirium being present in majority of patients. The most common organism isolated was Staphylococcus aureus followed by Escherichia coli. Introduction: Sepsis is one of the leading causes of morbidity and mortality in the elderly; despite great progress in antimicrobial treatment and intensive care medicine, the incidence of sepsis remains high while severe sepsis still has high mortality. Materials and Methods: The study included 400 consecutive elderly patients (≥60 years of age with clinically suspected sepsis. Sepsis definition was based on the presence of infection and two or more of the systemic inflammatory response syndrome (SIRS criteria. Blood and other site cultures were obtained on admission and during hospitalization when needed. Result: The total number of elderly patients with suspected septicemia who were enrolled in the study was 400. The maximum number of patients (68% were in the age group of 60-69 years, whereas 32 patients (8% were in the age group of >80 years. The age of the study population ranges from 60 years to a maximum of 95 years. The mean age of our study population was 67.52 ± 6.65 years with a male: female ratio of 1.68. The prevalence of SIRS criterion in the study population shows that tachycardia (89% was the most common criteria followed by fever (84% and leukocytosis (82.5%. All the four SIRS criteria were present in 42% of the patients, three in 37.5% of the patients and only two in 20.5% of the patients. The most common site of infection was the urinary tract (30.5% followed by the lungs (21.25% and skin infection (14%. Atypical manifestations were quite prevalent in the

  17. 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 ...

  18. 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

  19. Surviving sepsis--a 3D integrative educational simulator.

    Science.gov (United States)

    Ježek, Filip; Tribula, Martin; Kulhánek, Tomáš; Mateják, Marek; Privitzer, Pavol; Šilar, Jan; Kofránek, Jiří; Lhotská, Lenka

    2015-08-01

    Computer technology offers greater educational possibilities, notably simulation and virtual reality. This paper presents a technology which serves to integrate multiple modalities, namely 3D virtual reality, node-based simulator, Physiomodel explorer and explanatory physiological simulators employing Modelica language and Unity3D platform. This emerging tool chain should allow the authors to concentrate more on educational content instead of application development. The technology is demonstrated through Surviving sepsis educational scenario, targeted on Microsoft Windows Store platform. PMID:26737091

  20. 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.

  1. 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,...

  2. 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

  3. 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

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

    Science.gov (United States)

    de Lima, Lúcio Flávio Peixoto

    2016-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    Holman, J.M. Jr.; Saba, T.M.

    1988-08-01

    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 (/sup 14/C)alanine to (/sup 14/C)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.

  6. Update in sepsis and acute kidney injury 2014.

    Science.gov (United States)

    Schortgen, Frédérique; Asfar, Pierre

    2015-06-01

    Sepsis and acute kidney injury (AKI) represent an important burden in intensive care unit clinical practices. The Journal published important contributions in sepsis for novel therapeutic approaches suggesting that combined molecular targets (e.g., dual inhibition of IL-1β and IL-18, and coadministration of endothelial progenitor cells and stromal cell-derived factor-1α analog) could perform better. The clinical effectiveness of 1,25-dihydroxyvitamin D was reported in a double-blind, randomized, placebo-controlled trial. Although its experimental properties appeared favorable in the pro- and antiinflammatory cytokine balance, 1,25-dihydroxyvitamin D failed to improve survival. Strategies for decreasing antimicrobial resistances are of particular importance. Effective (aerosolized antibiotics for ventilator-associated pneumonia) and ineffective (procalcitonin algorithm for antibiotic deescalation) approaches were published. In 2014, several publications raised an important point shared by survivors from sepsis and/or AKI. The increased number of survivors over time brought out long-term sequelae, leading to a poor outcome after hospital discharge. Among them, cardiovascular events and chronic kidney disease may explain the significant increase in the risk of death, which can persist up to 10 years and significantly increases the use of health care. Postdischarge survival represents a new target for future research in sepsis and AKI to find how we can prevent and manage long-term sequelae. A milestone of the year was the Ebola outbreak. The Journal contributed to our better understanding of Ebola virus disease with a paper underlying the crucial role of a large implementation of pragmatic supportive care, including fluid infusion and correction of metabolic abnormalities, to save more lives. PMID:26029837

  7. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients.

    Science.gov (United States)

    Claushuis, Theodora A M; van Vught, Lonneke A; Scicluna, Brendon P; Wiewel, Maryse A; Klein Klouwenberg, Peter M C; Hoogendijk, Arie J; Ong, David S Y; Cremer, Olaf L; Horn, Janneke; Franitza, Marek; Toliat, Mohammad R; Nürnberg, Peter; Zwinderman, Aeilko H; Bonten, Marc J; Schultz, Marcus J; van der Poll, Tom

    2016-06-16

    Preclinical studies have suggested that platelets influence the host response during sepsis. We sought to assess the association of admission thrombocytopenia with the presentation, outcome, and host response in patients with sepsis. Nine hundred thirty-one consecutive sepsis patients were stratified according to platelet counts (very low pathways implicated in sepsis pathogenesis and by whole genome blood leukocyte expression profiling. In the propensity matched cohort, platelet counts coagulation activation was similar between groups. Blood microarray analysis revealed a distinct gene expression pattern in sepsis patients with <50 × 10(9)/L platelets, showing reduced signaling in leukocyte adhesion and diapedesis and increased complement signaling. These data show that admission thrombocytopenia is associated with enhanced mortality and a more disturbed host response during sepsis independent of disease severity, thereby providing clinical validity to animal studies on the role of platelets in severe infection. PMID:26956172

  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. Sepsis-induced acute kidney injury in patients with cirrhosis.

    Science.gov (United States)

    Angeli, Paolo; Tonon, Marta; Pilutti, Chiara; Morando, Filippo; Piano, Salvatore

    2016-01-01

    Acute kidney injury (AKI) is a common and life-threatening complication in patients with cirrhosis. Recently, new criteria for the diagnosis of AKI have been proposed in patients with cirrhosis by the International Club of Ascites. Almost all types of bacterial infections can induce AKI in patients with cirrhosis representing its most common precipitating event. The bacterial infection-induced AKI usually meets the diagnostic criteria of hepatorenal syndrome (HRS). Well in keeping with the "splanchnic arterial vasodilation hypothesis", it has been stated that HRS develops as a consequence of a severe reduction of effective circulating volume related to splanchnic arterial vasodilation and to an inadequate cardiac output. Nevertheless, the role of bacterial infections in precipitating organ failures, including renal failure, is enhanced when their course is characterized by the development of a systemic inflammatory response syndrome (SIRS), thus, when sepsis occurs. Sepsis has been shown to be capable to induce "per se" AKI in animals as well as in patients conditioning also the features of renal damage. This observation suggests that when precipitated by sepsis, the pathogenesis and the clinical course of AKI also in patients with cirrhosis may differentiate to a certain extent from AKI with another or no precipitating factor. The purpose of this review is to describe the features of AKI precipitated by bacterial infections and to highlight whether infection and/or the development of SIRS may influence its clinical course, and, in particular, the response to treatment.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  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. 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.)

  16. 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

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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).

  4. 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.

  5. 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

  6. 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 ...

  7. [Experience in the treatment of severe forms of sepsis by extracorporeal therapy and hyperbaric oxygenation].

    Science.gov (United States)

    Zhidkov, K P; Klechikov, V Z; Bogatyr', M N

    1997-01-01

    The results of multiple modality treatment of 81 patients with sepsis complicated by multiple organ failure are assessed. In 40 patients the traditional therapy of sepsis was supplemented with extracorporeal methods (hemoperfusion, autotransfusion of UV-exposed blood, and perfusion of xenospleen slices) and hyperbaric oxygenation (HBO) sessions. In the patients treated traditionally the mortality was 94%, whereas addition of extracorporeal treatment and HBO decreased this value to 40%. Hence, extracorporeal treatment and HBO are recommended for the treatment of sepsis.

  8. 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...

  9. 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...

  10. 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...

  11. The Surviving Sepsis Campaign: Where have we been and where are we going?

    Science.gov (United States)

    Dellinger, R Phillip

    2015-04-01

    The Surviving Sepsis Campaign develops and promotes evidence-based guidelines and performance-improvement practices aimed at reducing deaths from sepsis worldwide. The most recent guidelines, published in 2013, provide detailed management strategies for acute care, fluid resuscitation, and vasopressor use. In addition, the campaign has developed simple, short protocols for what to do within 3 and 6 hours of recognition of sepsis. These protocols are associated with reduced mortality rates.

  12. 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...

  13. 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...

  14. 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...

  15. 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 ...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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

  1. 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.

  2. Neonatal sepsis of nosocomial origin: an epidemiological study from the "Grupo de Hospitales Castrillo".

    Science.gov (United States)

    López Sastre, J B; Coto Cotallo, D; Fernández Colomer, B

    2002-01-01

    A prospective multicenter study was designed to assess the frequency, etiology, and mortality of nosocomial neonatal sepsis diagnosed between 1996 and 1997 in the neonatology services of 27 acute-care hospitals in Spain ("Grupo de Hospitales Castrillo"). Nosocomial sepsis is defined in the literature using chronological criteria (> 3-7 days of life at the onset of symptoms); accordingly, there is the possibility of including late-onset maternally acquired sepsis or of excluding early-onset nosocomial sepsis ( or = 1500 g (1.16%) (P 1500 g (17.3% vs. 6.5%, P < 0.001).

  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. 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. PMID:27516993

  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. Revisiting tourist behavior via destination brand worldness

    Directory of Open Access Journals (Sweden)

    Murat Kayak

    2016-11-01

    Full Text Available Taking tourists’ perspective rather than destination offerings as its core concept, this study introduces “perceived destination brand worldness” as a variable. Perceived destination brand worldness is defined as the positive perception that a tourist has of a country that is visited by tourists from all over the world. Then, the relationship between perceived destination brand worldness and intention to revisit is analyzed using partial least squares regression. This empirical study selects Taiwanese tourists as its sample, and the results show that perceived destination brand worldness is a direct predictor of intention to revisit. In light of these empirical findings and observations, practical and theoretical implications are discussed.

  7. 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

  8. 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

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

    Science.gov (United States)

    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 on the genomic host response to sepsis. We compared whole blood leukocyte gene expression profiles among sepsis patients with or without HIV co-infection in the intensive care unit (ICU) and validated our findings in a cohort of patients admitted to the same ICUs in a different time frame. To examine the influence of HIV infection per se, we also determined the expression of genes of interest in a cohort of asymptomatic HIV patients. We identified a predominantly common host response in sepsis patients with or without HIV co-infection. HIV positive sepsis patients in both ICU cohorts showed overexpression of genes involved in granzyme signaling (GZMA, GZMB), cytotoxic T-cell signaling (CD8A, CD8B) and T-cell inhibitory signaling (LAG3), compared to HIV negative patients. Enhanced expression of CD8A, CD8B and LAG3 was also unmasked in asymptomatic HIV patients. Plasma levels of granzymes in sepsis patients were largely below detection limit, without differences according to HIV status. These results demonstrate that sepsis is characterized by a massive common response with few differences between HIV positive and HIV negative sepsis patients. Observed differences in granzyme signaling, cytotoxic T-cell signaling and T-cell inhibitory signaling appear to be changes commonly observed in asymptomatic HIV patients which persist during sepsis.

  10. Role of nicotine on cognitive and behavioral deficits in sepsis-surviving rats.

    Science.gov (United States)

    Leite, Franco B; Prediger, Rui D; Silva, Mônica V; de Sousa, João Batista; Carneiro, Fabiana P; Gasbarri, Antonella; Tomaz, Carlos; Queiroz, Amadeu J; Martins, Natália T; Ferreira, Vania M

    2013-04-24

    Sepsis and its complications are important causes of mortality in intensive care units and sepsis survivors may present long-term cognitive and emotional impairments, including memory deficits and anxiety symptoms. In the present study, we investigated whether repeated nicotine administration can affect the behavioral changes in sepsis-surviving rats. Male Wistar rats were divided in two groups: sham-operated and experimental sepsis induced by cecal ligation and puncture (CLP). The animals were injected subcutaneously with nicotine (0.1 mg/kg) or vehicle once a day during 1 week before and/or 1 week after sepsis induction. Thirty minutes after the last administration (i.e., 7 days after surgery), the animals were tested in the open field, elevated plus-maze and step-down inhibitory avoidance tasks. The repeated nicotine treatment did not affect the survival rate in the sepsis group (50%). Moreover, no significant changes on locomotor activity were observed in the sepsis group while the treatment with nicotine during 1 week after surgery reduced the locomotion of sepsis-surviving rats in the open field. It is important to note that both schedules of nicotine treatment (prior and/or after CLP) improved the sepsis-induced anxiogenic-like responses. Interestingly, nicotine was able to improve short- and long-term inhibitory avoidance memory impairments, observed in sepsis survivors, only when administered during 2 consecutive weeks (i.e., prior and after CLP). Taken together, these results indicate that repeated nicotine administration does not alter the survival rate in rats submitted to CLP and provide new evidence that nicotine can improve long-lasting memory impairments and anxiogenic-like responses in sepsis-surviving animals.

  11. SEPSIS-ASSOCIATED DISSEMINATED INTRAVASCULAR COAGULATION AND THROMBOEMBOLIC DISEASE

    Directory of Open Access Journals (Sweden)

    Nicola Semeraro

    2010-08-01

    Full Text Available Sepsis is almost invariably associated with haemostatic abnormalities ranging from subclinical activation of blood coagulation (hypercoagulability, which may contribute to localized venous thromboembolism, to acute disseminated intravascular coagulation (DIC, characterized by massive thrombin formation and widespread microvascular thrombosis, partly responsible of the multiple organ dysfunction syndrome (MODS, and subsequent consumption of platelets and coagulation proteins causing, in most severe cases, bleeding manifestations. There is general agreement that the key event underlying this life-threatening sepsis complication is the overwhelming inflammatory host response to the infectious agent leading to the overexpression of inflammatory mediators. Mechanistically, the latter, together with the micro-organism and its derivatives, causes DIC by 1 up-regulation of procoagulant molecules, primarily tissue factor (TF, which is produced mainly by stimulated monocytes-macrophages and by specific cells in target tissues; 2 impairment of physiological anticoagulant pathways (antithrombin, protein C pathway, tissue factor pathway inhibitor, which is orchestrated mainly by dysfunctional endothelial cells (ECs; and 3 suppression of fibrinolysis due to increased plasminogen activator inhibitor-1 (PAI-1 by ECs and likely also to thrombin-mediated  activation of thrombin-activatable fibrinolysis inhibitor (TAFI. Notably, clotting enzymes non only lead to microvascular thrombosis but can also elicit cellular responses that amplify the inflammatory reactions. Inflammatory mediators can also cause, directly or indirectly, cell apoptosis or necrosis and recent evidence indicates that products released from dead cells, such as nuclear proteins (particularly extracellular histones, are able to propagate further inflammation, coagulation, cell death and MODS. These insights into the pathogenetic mechanisms of DIC and MODS may have important implications for the

  12. Predictive model for SEPSIS in the intensive care unit.

    Directory of Open Access Journals (Sweden)

    Lavoisier Morais de Medeiros

    2016-07-01

    Full Text Available This study aimed to provide a probabilistic decision model for sepsis, early diagnosis. The data contained in the medical records of 100 individuals admitted to a general ICU in a public hospital in the inland of the State of Paraiba were analyzed, in the period from March to September, 2011. The studied variables were: age, gender, initial diagnosis, minimum and maximum axillary temperature, heart and breathing rate, oxygen and carbon dioxide partial pressure, lactate serum levels, potassium, sodium, total count of leukocytes, bands and segs., among others. The binary logistic regression were used to determine the prediction model, and data were analyzed by SPSS software, version 19.0. 63% of the subjects were male, with a 62.5 year average age. as explanatory variables the following were considered: minimum axillary temperature, maximum axillary temperature, carbon dioxide partial pressure, lactate, white blood cell count and number of bands. Through ROC curve we identified the ideal cut-off point for classifying the subjects with regard to the presence or absence of disease, which has contributed to formulating the decision-making rule for sepsis early diagnosis. The concordance degree were compared between blood culture result regarded as gold standard for infection diagnosis and the model submitted in the study using Kappa coefficient, obtaining a 0.93 concordance percentage, regarded as outstanding. It was demonstrated being possible to carry out sepsis early detection adopting statistical models as the submitted one, however, new studies with populations from different ICUs must be performed in order to provide a better casuistry, making the found results reproducible in different clinical situations.

  13. 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

  14. 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 ...

  15. 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 ...

  16. 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...

  17. 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....

  18. 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;

    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....

  19. Long-Term Trends in the Epidemiology of Neonatal Sepsis and Antibiotic Susceptibility of Causative Agents

    NARCIS (Netherlands)

    van den Hoogen, Agnes; Gerards, Leo J.; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2010-01-01

    Background: In an era with increased maternal antibiotic use, patterns in early- and late-onset sepsis and antibiotic susceptibility may have changed. Objectives: To identify longitudinal trends in causative microorganisms for neonatal sepsis and analyze antibiotic susceptibility of all blood isolat

  20. 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.

  1. 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 ...

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

    DEFF Research Database (Denmark)

    Toft, P; Schmidt, R; Broechner, A C;

    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....

  3. 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

  4. 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...

  5. 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.

  6. 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

  7. 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.

  8. 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...

  9. Hyperferritinemic Sepsis: An Opportunity for Earlier Diagnosis and Intervention?

    Science.gov (United States)

    Halstead, E. Scott; Rajasekaran, Surender; Fitzgerald, Julie C.; Weiss, Scott L.

    2016-01-01

    We describe a case of an infant with HSV meningitis and septic shock who demonstrated a remarkably high serum ferritin level. Aggressive pediatric intensive care and the administration of high-dose glucocorticoids were not able to reverse the multiple organ dysfunctions. Subsequent autopsy identified the presence of hemophagocytosis, thus the patient fulfilled hemophagocytic lymphohistiocytosis (HLH) criteria post-mortem. This case highlights that serum ferritin may be an important early indicator of mortality in sepsis due to a cytokine storm similar to macrophage activation syndrome and HLH. PMID:27532033

  10. 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.

  11. A multicenter, prospective evaluation of quality of care and mortality in Japan based on the Surviving Sepsis Campaign guidelines.

    Science.gov (United States)

    Fujishima, Seitaro; Gando, Satoshi; Saitoh, Daizoh; Mayumi, Toshihiko; Kushimoto, Shigeki; Shiraishi, Shin-Ichiro; Ogura, Hiroshi; Takuma, Kiyotsugu; Kotani, Joji; Ikeda, Hiroto; Yamashita, Norio; Suzuki, Koichiro; Tsuruta, Ryosuke; Takeyama, Naoshi; Araki, Tsunetoshi; Suzuki, Yasushi; Miki, Yasuo; Yamaguchi, Yoshihiro; Aikawa, Naoki

    2014-02-01

    To elucidate the standard Surviving Sepsis Campaign (SSC) guidelines-based quality of care and mortality related to severe sepsis in Japan, we conducted a multicenter, prospective, observational study using a new web-based database between June 1, 2010, and December 31, 2011. A total of 1104 patients with severe sepsis were enrolled from 39 Japanese emergency and critical care centers. All-cause hospital mortality was 29.3% in patients with severe sepsis and 40.7% in patients with septic shock. Pulmonary, renal, hepatic, and hematological dysfunctions were associated with significantly higher mortality, and hematological dysfunction, especially coagulopathy, was associated with the highest odds ratio for mortality. Compliance with severe sepsis bundles in our study was generally low compared with that in a previous international sepsis registry study, and glycemic control was associated with lowest odds ratio for mortality. Despite higher complication rates of multiple organ dysfunction syndrome and low compliance with severe sepsis bundles on the whole, mortality in our study was similar to that in the international sepsis registry study. From these results, we concluded that our prospective multicenter study was successful in evaluating SSC guidelines-based standard quality of care and mortality related to severe sepsis in Japan. Although mortality in Japan was equivalent to that reported worldwide in the above-mentioned international sepsis registry study, compliance with severe sepsis bundles was low. Thus, there is scope for improvement in the initial treatment of severe sepsis and septic shock in Japanese emergency and critical care centers.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. [Serum lactate as a biomarker of severe sepsis in children with cancer, neutropenia and fever].

    Science.gov (United States)

    Pacheco-Rosas, Daniel Octavio; Huelgas-Plaza, Ana Celia; Miranda-Novales, María Guadalupe

    2014-01-01

    INTRODUCCIÓN: la neutropenia es una complicación frecuente secundaria a la quimioterapia en los pacientes con cáncer, en quienes la prevalencia de sepsis es de 12.9 a 17.4 % y la letalidad es de 16 %. El objetivo de este estudio fue determinar la utilidad del lactato como biomarcador de sepsis grave en niños con cáncer, fiebre y neutropenia. MÉTODOS: se realizó un estudio de prueba diagnóstica fase II. Se midieron los niveles del lactato al ingreso. Los episodios de neutropenia se clasificaron en tres grupos: I, con sepsis II, sin sepsis; III, pacientes neutropénicos sin fiebre (controles). Se calculó sensibilidad, especificidad, valores predictivos positivo y negativo e índices de verosimilitud. El estándar de oro fue el diagnóstico clínico de sepsis grave.

  17. Antioxidant protection of statins in acute kidney injury induced by sepsis

    Directory of Open Access Journals (Sweden)

    Franciele do Nascimento Santos

    2014-10-01

    Full Text Available Objective Evaluating the effect of preconditioning with simvastatin in acute kidney injury induced by sepsis. Method Male adult Wistar rats were divided into the following groups: SHAM (control; SHAM+Statin (0.5 mg/kg simvastatin, orally; Sepsis (cecal puncture ligation – CPL; Sepsis+Statin. Physiological parameters, peritoneal fluid culture, renal function, oxidative metabolites, severity of acute kidney injury and animal survival were evaluated. Results The treatment with simvastatin in induced sepsis showed elevation of creatinine clearance with attenuation of generation of oxidative metabolites, lower severity of acute kidney injury and reduced mortality. Conclusion This investigation confirmed the renoprotection with antioxidant principle of the simvastatin in acute kidney injury induced by sepsis in an experimental model.

  18. Short-term Gains with Long-term Consequences: The Evolving Story of Sepsis Survivorship.

    Science.gov (United States)

    Maley, Jason H; Mikkelsen, Mark E

    2016-06-01

    Sepsis is an acute, life-threatening condition that afflicts millions of patients annually. Advances in care and heightened awareness have led to substantial declines in short-term mortality. An expanding body of literature describes the long-term impact of sepsis, revealing long-term cognitive and functional impairments, sustained inflammation and immune dysfunction, increased healthcare resource use, reduced health-related quality of life, and increased mortality. The evidence challenges the notion that sepsis is an acute, transient illness, revealing rather that sepsis is an acute illness with lingering consequences. This article provides a state-of-the-art review of the emerging literature of the long-term consequences of sepsis. PMID:27229651

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

    Energy Technology Data Exchange (ETDEWEB)

    Ouzounian, T.J.; Thompson, L.; Grogan, T.J.; Webber, M.M.; Amstutz, H.C.

    1987-08-01

    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.

  20. 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

  1. Management of the patient with sepsis in emergency department: a new alternative protocol

    Directory of Open Access Journals (Sweden)

    Manuel Monti

    2014-10-01

    Full Text Available Sepsis is a clinical syndrome induced from the host response to an infection. Severe sepsis is the leading cause of death in critically ill patients. The introduction of the early goaldirected therapy (EGDT has been able to reduce mortality in patients with severe sepsis/ septic shock. However, sepsis mortality rates remain high compared to other critical illnesses. Many studies have pointed out that the use of arterial line placement and the execution of central venous pressure and central venous oxygen saturation measurements are the most difficult EGDT elements to carry out in community hospitals. For these reasons, the present independent review examines recent pathogenic, diagnostic, and therapeutic development in sepsis with particular relevance to the emergency practice, following the latest guidelines published in February 2013 and several recent studies. We propose a non-invasive alternative protocol which can replace the standard treatment with non-substantial changes in the patient outcome though overcoming the obstacles of a invasive method.

  2. 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...

  3. 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.

  4. Revisiting the Regenerative Possibilities of Ortiz

    Science.gov (United States)

    Duques, Matthew

    2004-01-01

    The author of this article revisits Simon Ortiz's poem, "From Sand Creek," in which the latter can in so few words convey both the horrific tragedy of conquest and colonization, while at the same time find a space for possibility, a means for recovery that is never about forgetting but always occurs as a kind of recuperative remembering. Ortiz…

  5. Topological string theory revisited I: The stage

    Science.gov (United States)

    Jia, Bei

    2016-08-01

    In this paper, we reformulate topological string theory using supermanifolds and supermoduli spaces, following the approach worked out by Witten (Superstring perturbation theory revisited, arXiv:1209.5461). We intend to make the construction geometrical in nature, by using supergeometry techniques extensively. The goal is to establish the foundation of studying topological string amplitudes in terms of integration over appropriate supermoduli spaces.

  6. Coccolithophorids in polar waters: Calciarcus spp. revisited

    DEFF Research Database (Denmark)

    Thomsen, Helge Abildhauge; Østergaard, Jette B.

    2014-01-01

    The genus Calciarcus is revisited here with the purpose of providing, based on additional sampling from both polar regions, an update on species diversity and morphology that can serve as a reference for future work. The geographic realm of the genus is significantly widened and a case is built...

  7. 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.

  8. 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…

  9. Revisiting Basic Counseling Skills with Children

    Science.gov (United States)

    Van Velsor, Patricia

    2004-01-01

    Counseling with children can be challenging for counselors whose training focused on adult clients. The purpose of this article is to offer information to counselors seeking to improve their skills with children, revisiting a topic discussed in an earlier Journal of Counseling & Development article by P. Erdman and R. Lampe (1996). Examples of…

  10. 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.

  11. 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

  12. Neutrophil Extracellular Traps Induce Organ Damage during Experimental and Clinical Sepsis.

    Science.gov (United States)

    Czaikoski, Paula Giselle; Mota, José Maurício Segundo Correia; Nascimento, Daniele Carvalho; Sônego, Fabiane; Castanheira, Fernanda Vargas e Silva; Melo, Paulo Henrique; Scortegagna, Gabriela Trentin; Silva, Rangel Leal; Barroso-Sousa, Romualdo; Souto, Fabrício Oliveira; Pazin-Filho, Antonio; Figueiredo, Florencio; Alves-Filho, José Carlos; Cunha, Fernando Queiróz

    2016-01-01

    Organ dysfunction is a major concern in sepsis pathophysiology and contributes to its high mortality rate. Neutrophil extracellular traps (NETs) have been implicated in endothelial damage and take part in the pathogenesis of organ dysfunction in several conditions. NETs also have an important role in counteracting invading microorganisms during infection. The aim of this study was to evaluate systemic NETs formation, their participation in host bacterial clearance and their contribution to organ dysfunction in sepsis. C57Bl/6 mice were subjected to endotoxic shock or a polymicrobial sepsis model induced by cecal ligation and puncture (CLP). The involvement of cf-DNA/NETs in the physiopathology of sepsis was evaluated through NETs degradation by rhDNase. This treatment was also associated with a broad-spectrum antibiotic treatment (ertapenem) in mice after CLP. CLP or endotoxin administration induced a significant increase in the serum concentrations of NETs. The increase in CLP-induced NETs was sustained over a period of 3 to 24 h after surgery in mice and was not inhibited by the antibiotic treatment. Systemic rhDNase treatment reduced serum NETs and increased the bacterial load in non-antibiotic-treated septic mice. rhDNase plus antibiotics attenuated sepsis-induced organ damage and improved the survival rate. The correlation between the presence of NETs in peripheral blood and organ dysfunction was evaluated in 31 septic patients. Higher cf-DNA concentrations were detected in septic patients in comparison with healthy controls, and levels were correlated with sepsis severity and organ dysfunction. In conclusion, cf-DNA/NETs are formed during sepsis and are associated with sepsis severity. In the experimental setting, the degradation of NETs by rhDNase attenuates organ damage only when combined with antibiotics, confirming that NETs take part in sepsis pathogenesis. Altogether, our results suggest that NETs are important for host bacterial control and are

  13. Neutrophil Extracellular Traps Induce Organ Damage during Experimental and Clinical Sepsis.

    Directory of Open Access Journals (Sweden)

    Paula Giselle Czaikoski

    Full Text Available Organ dysfunction is a major concern in sepsis pathophysiology and contributes to its high mortality rate. Neutrophil extracellular traps (NETs have been implicated in endothelial damage and take part in the pathogenesis of organ dysfunction in several conditions. NETs also have an important role in counteracting invading microorganisms during infection. The aim of this study was to evaluate systemic NETs formation, their participation in host bacterial clearance and their contribution to organ dysfunction in sepsis. C57Bl/6 mice were subjected to endotoxic shock or a polymicrobial sepsis model induced by cecal ligation and puncture (CLP. The involvement of cf-DNA/NETs in the physiopathology of sepsis was evaluated through NETs degradation by rhDNase. This treatment was also associated with a broad-spectrum antibiotic treatment (ertapenem in mice after CLP. CLP or endotoxin administration induced a significant increase in the serum concentrations of NETs. The increase in CLP-induced NETs was sustained over a period of 3 to 24 h after surgery in mice and was not inhibited by the antibiotic treatment. Systemic rhDNase treatment reduced serum NETs and increased the bacterial load in non-antibiotic-treated septic mice. rhDNase plus antibiotics attenuated sepsis-induced organ damage and improved the survival rate. The correlation between the presence of NETs in peripheral blood and organ dysfunction was evaluated in 31 septic patients. Higher cf-DNA concentrations were detected in septic patients in comparison with healthy controls, and levels were correlated with sepsis severity and organ dysfunction. In conclusion, cf-DNA/NETs are formed during sepsis and are associated with sepsis severity. In the experimental setting, the degradation of NETs by rhDNase attenuates organ damage only when combined with antibiotics, confirming that NETs take part in sepsis pathogenesis. Altogether, our results suggest that NETs are important for host bacterial

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

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    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.

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

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    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.

  16. 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

  17. 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

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

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    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

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

    Directory of Open Access Journals (Sweden)

    Deepak 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. DiscussionNeonatal 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

  20. 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.

  1. 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

  2. Modulation of myocardial mitochondrial mechanisms during severe polymicrobial sepsis in the rat.

    Directory of Open Access Journals (Sweden)

    Mani Chopra

    Full Text Available BACKGROUND: We tested the hypothesis that 5-Hydroxydecanoic acid (5HD, a putative mitoK(ATP channel blocker, will reverse sepsis-induced cardiodynamic and adult rat ventricular myocyte (ARVM contractile dysfunction, restore mitochondrial membrane permeability alterations and improve survival. METHODOLOGY/PRINCIPAL FINDINGS: Male Sprague-Dawley rats (350-400 g were made septic using 400 mg/kg cecal inoculum, ip. Sham animals received 5% dextrose water, ip. The Voltage Dependent Anion Channels (VDAC1, Bax and cytochrome C levels were determined in isolated single ARVMs obtained from sham and septic rat heart. Mitochondria and cytosolic fractions were isolated from ARVMs treated with norepinephrine (NE, 10 µmoles in the presence/absence of 5HD (100 µmoles. A continuous infusion of 5HD using an Alzet pump reversed sepsis-induced mortality when administered at the time of induction of sepsis (-40% and at 6 hr post-sepsis (-20%. Electrocardiography revealed that 5HD reversed sepsis-induced decrease in the average ejection fraction, Simpsons+m Mode (53.5±2.5 in sepsis and 69.2±1.2 at 24 hr in sepsis+5HD vs. 79.9±1.5 basal group and cardiac output (63.3±1.2 mL/min sepsis and 79.3±3.9 mL/min at 24 hr in sepsis+5HD vs. 85.8±1.5 mL/min basal group. The treatment of ARVMs with 5HD also reversed sepsis-induced depressed contractility in both the vehicle and NE-treated groups. Sepsis produced a significant downregulation of VDAC1, and upregulation of Bax levels, along with mitochondrial membrane potential collapse in ARVMs. Pretreatment of septic ARVMs with 5HD blocked a NE-induced decrease in the VDAC1 and release of cytochrome C. CONCLUSION: The data suggest that Bax activation is an upstream event that may precede the opening of the mitoK(ATP channels in sepsis. We concluded that mitoK(ATP channel inhibition via decreased mitochondrial membrane potential and reduced release of cytochrome C provided protection against sepsis-induced ARVM and

  3. 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.

  4. 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.

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

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    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.

  6. Data showing phenotypic profile of uropathogenic Escherichia coli isolates from sepsis patients

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    Vivek Verma

    2016-06-01

    Full Text Available Bacterial virulence factors (VFs influence the site and severity of urinary tract infections (UTI and further leading to sepsis infection. Phenotypic characterisation of VFs specific to sepsis Escherichia coli strains has not been characterized in Indian population till date. In this data article, we have described important VFs of uropathogenic E. coli (UPEC that is P fim, Type-1 fim, cell surface hydrophobicity, mannose resistant haemagglutination/mannose sensitive haemagglutination (MRHA/MSHA expression and α-haemolysin production. The data includes a profile of the five VFs investigated in E. coli isolates from sepsis patients (N=78 and control group (N=50 from non-sepsis subjects. We found that P fim phenotype was expressed in 25.3% of E. coli isolates from sepsis patients, whereas Type-1 fimbriae was detected in 30.5%. Cell surface hydrophobicity phenotype was present in 30.5%, α-haemolysin in 26.3% and MRHA/MSHA in 22.1% of sepsis E. coli isolates. None of the control E. coli isolates showed presence of these phenotypes. The combined phenotypic profile of all the five VFs was significantly higher in sepsis patients as compared to the control group.

  7. Early PREdiction of Severe Sepsis (ExPRES-Sepsis) study: protocol for an observational derivation study to discover potential leucocyte cell surface biomarkers

    Science.gov (United States)

    Antonelli, Jean; Warner, Noel; Brown, Kenneth Alun; Wright, John; Simpson, A John; Rennie, Jillian; Hulme, Gillian; Lewis, Sion Marc; Mare, Tracey Anne; Cookson, Sharon; Weir, Christopher John; Dimmick, Ian; Keenan, Jim; Rossi, Adriano Giorgio; Shankar-Hari, Manu; Walsh, Timothy S

    2016-01-01

    Introduction Sepsis is an acute illness resulting from infection and the host immune response. Early identification of individuals at risk of developing life-threatening severe sepsis could enable early triage and treatment, and improve outcomes. Currently available biomarkers have poor predictive value for predicting subsequent clinical course in patients with suspected infection. Circulating leucocytes provide readily accessible tissues that reflect many aspects of the complex immune responses described in sepsis. We hypothesise that measuring cellular markers of immune responses by flow cytometry will enable early identification of infected patients at risk of adverse outcomes. We aim to characterise leucocyte surface markers (biomarkers) and their abnormalities in a population of patients presenting to the hospital emergency department with suspected sepsis, and explore their ability to predict subsequent clinical course. Methods and analysis We will conduct a prospective, multicentre, clinical, exploratory, cohort observational study. To answer our study question, 3 patient populations will be studied. First, patients with suspected sepsis from the emergency department (n=300). To assess performance characteristics of potential tests, critically ill patients with established sepsis, and age and gender matched patients without suspicion of infection requiring hospital admission (both n=100) will be recruited as comparator populations. In all 3 groups, we plan to assess circulating biomarker profiles using flow cytometry. We will select candidate biomarkers by cross-cohort comparison, and then explore their predictive value for clinical outcomes within the cohort with suspected sepsis. Ethics and dissemination The study will be carried out based on the principles in the Declaration of Helsinki and the International Conference on Harmonisation Good Clinical Practice. Ethics approval has been granted from the Scotland A Research Ethics Committee (REC) and Oxford C

  8. 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

  9. Making the journey safe: recognising and responding to severe sepsis in accident and emergency

    Science.gov (United States)

    Pinnington, Sarah; Atterton, Brigid; Ingleby, Sarah

    2016-01-01

    Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions.

  10. 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

  11. 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

  12. Development and Innovation of Leisure-themed Cultural Business Streets---Taking Jinli Alley of Chengdu%文化休闲商业街的开发与创新--以成都锦里为例

    Institute of Scientific and Technical Information of China (English)

    徐明波; 晋超

    2014-01-01

    文化休闲商业街区是城市文化品牌、休闲生活、商业聚集的最好方式。文化休闲商业街的开发与创新是发展文化产业、都市旅游的重点。文章以成都锦里为例,提出高水平的文化创意是文化休闲商业街开发成功的核心,文化空间的营造是文化真实性体验得以实现的途径。%Leisure-themed cultural business streets are a trademark for a city ,integrating leisure activities and businesses .Their development and innovation are crucial for the growth of cultural industry and urban tourism . This paper ,taking Jinli Alley in Chengdu as an example , points out that high-level cultural innovation is the core for the success of such streets ,and that creation of cultural space is an effective approach to authentic cul-tural experience .

  13. 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...

  14. 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.

  15. 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...

  16. Chromogranin A levels and mortality in patients with severe sepsis

    Science.gov (United States)

    Hsu, Chih-Hsin; Reyes, Luis F.; Orihuela, Carlos J.; Buitrago, Ricardo; Anzueto, Antonio; Soni, Nilam J.; Levine, Stephanie; Peters, Jay; Hinojosa, Cecilia A.; Aliberti, Stefano; Sibila, Oriol; Rodriguez, Alejandro; Chalmers, James D.; Martin-Loeches, Ignacio; Bordon, Jose; Blanquer, Jose; Sanz, Francisco; Marcos, Pedro J.; Rello, Jordi; Solé-Violán, Jordi; Restrepo, Marcos I.

    2016-01-01

    Context Chromogranin A (CgA) is a novel biomarker with potential to assess mortality risk of patients with severe sepsis. Objective Assess association of CgA levels and mortality risk of severely septic patients. Methods Serum CgA levels were measured in 50 hospitalized, severely septic patients with organ failure <48 hours. Results Higher CgA levels trended towards higher ICU and hospital mortality. Patients without cardiovascular disease who died in the ICU had higher median (IQR) CgA levels 602.3 (343.3, 1134.3) ng/ml vs. 205.5 (130.7, 325.9) ng/ml, p=0.01. Conclusions High CgA levels predict ICU mortality in severely septic patients without prior cardiovascular disease. PMID:26154393

  17. Potential diagnostic markers for disseminated intravascular coagulation of sepsis.

    Science.gov (United States)

    Iba, Toshiaki; Ito, Takashi; Maruyama, Ikuro; Jilma, Bernd; Brenner, Thorsten; Müller, Marcella C A; Juffermans, Nicole P; Thachil, Jecko

    2016-03-01

    Disseminated intravascular coagulation (DIC) is an acquired thrombo-haemorrhagic disorder which arises in clinical scenarios like sepsis, trauma and malignancies. The clinic-laboratory diagnosis of DIC is made in a patient who develops the combination of laboratory abnormalities in the appropriate clinical scenario. The most common laboratory parameters in this setting have been the clotting profile, platelet count, serum fibrinogen and fibrin degradation markers. These tests had the advantage that they could be performed easily and in most laboratories. However, with the better understanding of the pathophysiology of DIC, in recent years, more specific tests have been suggested to be useful in this setting. The newer tests can also prove to be useful in prognostication in DIC. In addition, they may provide assistance in the selection and monitoring of patients diagnosed with DIC.

  18. 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...

  19. [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.

  20. Marine Compounds with Therapeutic Potential in Gram-Negative Sepsis

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

  2. 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

  3. Revisiting the Diffusion Problem in a Capillary Tube Geometry

    CERN Document Server

    Sullivan, Eric

    2012-01-01

    The present work revisits the problem of modeling diffusion above a stagnant liquid interface in a capillary tube geometry. In this revisitation we elucidate a misconception found in the classical model proposed by Bird et. al. Furthermore, we propose alternative explanations for thermally forced diffusion and provide a description of natural convection in the absence of forcing terms.

  4. Coccolithophorids in polar waters: Wigwamma spp. revisited

    DEFF Research Database (Denmark)

    Thomsen, Helge Abildhauge; Østergaard, Jette B.; Heldal, Mikal

    2013-01-01

    A contingent of weakly calcified coccolithophorid genera and species were described from polar regions almost 40 years ago. In the interim period a few additional findings have been reported enlarging the realm of some of the species. The genus Wigwamma is revisited here with the purpose of provi......A contingent of weakly calcified coccolithophorid genera and species were described from polar regions almost 40 years ago. In the interim period a few additional findings have been reported enlarging the realm of some of the species. The genus Wigwamma is revisited here with the purpose...... of providing, based on additional sampling from both polar regions, an update on species morphology, life history events and biogeography that can serve as a reference for the future. A new genus, Pseudowigwamma gen. nov. is described to accommodate Wigwamma scenozonion, a species which critically deviates...

  5. 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...

  6. 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.)

  7. 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.)

  8. Coagulation and sepsis%凝血和脓毒症

    Institute of Scientific and Technical Information of China (English)

    张樱; 陈昊; 陈亚岗

    2008-01-01

    从单一血小板计数的下降到DIC,凝血系统异常在危重病患者中屡见不鲜,病死率随之升高.在脓毒症中,组织因子活化外源性凝血途径增强凝血,同时诱导抗凝和阻碍纤维蛋白溶解,从而造成机体高凝血状态,形成微血管血栓,干扰器官微循环,导致器官功能衰竭.许多炎症介质涉及到凝血系统的活化;反之,许多凝血蛋白与炎症也密切相关.此文综述了炎症和凝血的复杂关系,对这一关系的全新理解有助于形成新的治疗脓毒症的措施.%Coagulation abnormalities,ranging from a simple fall in platelet count to full-blown disseminated intravascular coagulation,are common occurrences in severe diseases patients and have been associated with increased mortality.In.sepsis,activation of the extrinsic coagulation pathway by tissue factor induces increased coagulation,simultaneous depression of the inhibitory mechanisms of coagulation,and suppression of the fibrinolytic system results in a procoagulant state that may lead to the formation of microvascular thrombi disturbing organ microcirculation and promoting the development of organ dysfunction.Many inflammatory mediators are involved in the activation of coagulation,but many coagulation proteins are themselves actively involved in the inflammatory process.In this article,we explore the complex relation between inflammation and coagulation and how improved understanding of this interaction has led to the development of new therapeutic agents for patients with severe sepsis.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. ConocoPhillips’ share price model revisited

    OpenAIRE

    Kitov, Ivan

    2012-01-01

    Three years ago we found a statistically reliable link between ConocoPhillips’ (NYSE: COP) stock price and the difference between the core and headline CPI in the United States. In this article, the original relationship is revisited with new data available since 2009. The agreement between the observed monthly closing price (adjusted for dividends and splits) and that predicted from the CPI difference is confirmed. The original quantitative link is validated. In order to improve the accurac...

  14. Spine revisited: Principles and parlance redefined

    Directory of Open Access Journals (Sweden)

    Kothari M

    2005-01-01

    Full Text Available A revised appreciation of the evolution and the nature of bone in general and of vertebrae in particular, allows revisiting the human spine to usher in some new principles and more rational parlance, that embody spine′s phylogeny, ontogeny, anatomy and physiology. Such an approach accords primacy to spine′s soft-tissues, and relegates to its bones a secondary place.

  15. The Actinide Transition Revisited by Gutzwiller Approximation

    Science.gov (United States)

    Xu, Wenhu; Lanata, Nicola; Yao, Yongxin; Kotliar, Gabriel

    2015-03-01

    We revisit the problem of the actinide transition using the Gutzwiller approximation (GA) in combination with the local density approximation (LDA). In particular, we compute the equilibrium volumes of the actinide series and reproduce the abrupt change of density found experimentally near plutonium as a function of the atomic number. We discuss how this behavior relates with the electron correlations in the 5 f states, the lattice structure, and the spin-orbit interaction. Our results are in good agreement with the experiments.

  16. 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

  17. 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)

  18. 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 ...

  19. Dynamic cerebral autoregulation to induced blood pressure changes in human experimental and clinical sepsis

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Plovsing, Ronni R; Bailey, Damian M;

    2016-01-01

    Previous studies have demonstrated that dynamic cerebral autoregulation to spontaneous fluctuations in blood pressure is enhanced following lipopolysaccharide (LPS) infusion, a human experimental model of early sepsis, whereas by contrast it is impaired in patients with severe sepsis or septic......R). This was performed before and after LPS infusion in healthy volunteers, and within 72 h following clinical diagnosis of sepsis in patients. In healthy volunteers, thigh-cuff deflation caused a MAP reduction of 16 (13-20) % at baseline and 18 (16-20) % after LPS, while the MAP reduction was 12 (11-13) % in patients......(-1) ; P = 0·91 versus baseline; P = 0·14 versus LPS]. While our findings support the concept that dynamic cerebral autoregulation is enhanced during the very early stages of sepsis, they remain inconclusive with regard to more advanced stages of disease, because thigh-cuff deflation failed to induce...

  20. 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.