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    Streptococcus pyogenes nuclease A (SpnA) mediated virulence does not exclusively depend on nuclease activity.
    J Microbiol Immunol Infect 2017 Nov 13. Epub 2017 Nov 13.
    Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand. Electronic address:
    Background: Streptococcus pyogenes, or Group A Streptococcus (GAS), is a human pathogen that causes a wide range of diseases, including pharyngitis, necrotizing fasciitis and toxic shock syndrome. The bacterium produces a large arsenal of virulence factors, including the cell wall-anchored Streptococcus pyogenes nuclease A (SpnA), which facilitates immune evasion by degrading the DNA backbone of neutrophil extracellular traps. SpnA consists of a C-terminal endo/exonuclease domain and a N-terminal domain of unknown function. Read More

    Purpura Fulminans: Mechanism and Management of Dysregulated Hemostasis.
    Transfus Med Rev 2017 Oct 16. Epub 2017 Oct 16.
    Harvard Medical School, Boston, MA; Division of Hematology, Massachusetts General Hospital, Boston, MA; Blood Transfusion Service, Massachusetts General Hospital, Boston, MA. Electronic address:
    Purpura fulminans (PF) is a highly thrombotic subtype of disseminated intravascular coagulation that can accompany severe bacterial, and more rarely, viral infections. PF is associated with an extremely high mortality rate, and patients often die of overwhelming multisystemic thrombosis rather than septic shock. Survivors typically experience amputation of involved extremities and significant scarring in affected areas. Read More

    Disseminated methicillin-susceptible Staphylococcus aureus infection.
    J Med Microbiol 2017 Nov 20. Epub 2017 Nov 20.
    3​Texas A&M Health Science Center College of Medicine, Temple, TX, USA.
    Introduction: When clinicians think about Staphylococcus aureus bacteria, what comes to the mind of most is the dreaded methicillin-resistant form. However, clinicians should not forget the methicillin-susceptible type, which is just as virulent.

    Case Presentation: The authors present the case of a 20-year-old woman who was admitted with septic shock and multi-organ failure and was found to have disseminated methicillin-susceptible Staphylococcus aureus (MSSA) infection. Read More

    Pyruvate enhancement of cardiac performance: Cellular mechanisms and clinical application.
    Exp Biol Med (Maywood) 2017 Jan 1:1535370217743919. Epub 2017 Jan 1.
    3 Emeritus Member of the American Physiological Society, McLean, VA 22101, USA.
    Cardiac contractile function is adenosine-5'-triphosphate (ATP)-intensive, and the myocardium's high demand for oxygen and energy substrates leaves it acutely vulnerable to interruptions in its blood supply. The myriad cardioprotective properties of the natural intermediary metabolite pyruvate make it a potentially powerful intervention against the complex injury cascade ignited by myocardial ischemia-reperfusion. A readily oxidized metabolic substrate, pyruvate augments myocardial free energy of ATP hydrolysis to a greater extent than the physiological fuels glucose, lactate and fatty acids, particularly when it is provided at supra-physiological plasma concentrations. Read More

    Management of arrhythmia in sepsis and septic shock.
    Anaesthesiol Intensive Ther 2017 Nov 18. Epub 2017 Nov 18.
    Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republik.
    The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of a sinus rhythm and diastolic ventricular filling. Read More

    Management of Sepsis-Induced Immunosuppression.
    Crit Care Clin 2018 Jan 6;34(1):97-106. Epub 2017 Oct 6.
    Laboratoire d'Immunologie, Cellular Immunology Laboratory, Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon E - 5 place d'Arsonval, Lyon Cedex 03 69437, France; EA 7426 PI3 "Pathophysiology of Injury-induced Immunosuppression", Université Claude Bernard Lyon I, Hospices Civils de Lyon, bioMérieux, Hôpital Edouard Herriot, Place d'Arsonval, Lyon Cedex 03 69437, France; TRIGGERSEP (TRIal Group for Global Evaluation and Research in SEPsis), F-CRIN Network, France. Electronic address:
    It is now well established that profound immunosuppression develops within a few days after sepsis onset in patients. This should be considered additional organ failure because it is associated with increased rate of nosocomial infections, mortality, and long-term complications, thus constituting the rationale for immunomodulation in patients. Nevertheless, the demonstration of the efficacy of such therapeutic strategy in improving deleterious outcomes in sepsis remains to be made. Read More

    Pathophysiology of Septic Shock.
    Crit Care Clin 2018 Jan;34(1):43-61
    Department of Medicine, Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
    Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Read More

    Novel Interventions: What's New and the Future.
    Crit Care Clin 2018 Jan 14;34(1):161-173. Epub 2017 Oct 14.
    Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, Brussels 1070, Belgium.
    Despite decades of sepsis research, no specific therapies for sepsis have emerged and current management still relies on source control, antibiotics, and organ support. With improved understanding of sepsis pathophysiology and the development of new techniques to enable better characterization of patients with sepsis, clinical trials are beginning to better target new interventions at those patients most likely to respond. This article discusses advances in sepsis therapeutics designed to improve endothelial cell function, purify the blood to help restore immune homeostasis, and provide immunostimulation for patients with immune exhaustion. Read More

    Expression Profiling of Long Noncoding RNA Splice Variants in Human Microvascular Endothelial Cells: Lipopolysaccharide Effects In Vitro.
    Mediators Inflamm 2017 25;2017:3427461. Epub 2017 Sep 25.
    Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
    Endothelial cell interactions with lipopolysaccharide (LPS) involve both activating and repressing signals resulting in pronounced alterations in their transcriptome and proteome. Noncoding RNAs are now appreciated as posttranscriptional and translational regulators of cellular signaling and responses, but their expression status and roles during endothelial interactions with LPS are not well understood. We report on the expression profile of long noncoding (lnc) RNAs of human microvascular endothelial cells in response to LPS. Read More

    Clostridium difficile and Clostridium sordellii toxins, proinflammatory versus anti-inflammatory response.
    Toxicon 2017 Nov 14. Epub 2017 Nov 14.
    Institut Pasteur, Bactéries anaérobies et Toxines, 25 rue du Dr Roux, 75724, Paris cedex 15, France. Electronic address:
    Clostridium difficile and Clostridium sordellii produce related potent toxins (C. difficile toxin A (TcdA) and toxin B (TcdB), C. sordellii lethal toxin (TcsL) and hemorrhagic toxin (TcsH)) which belong to the large clostridial glucosylating toxin (LCGT) family. Read More

    Rapid screening of pyogenic Staphylococcus aureus for confirmation of genus and species, methicillin resistance and virulence factors by using two novel multiplex PCR.
    Pak J Med Sci 2017 Sep-Oct;33(5):1095-1100
    Zohaib Nisar, M.Sc. Department of Bioinformatics and Biotechnology, GC University, Faisalabad, Pakistan.
    Objectives: Emergence of methicillin resistant Staphylococcus aureus (MRSA) is a major medical problem of current era. These bacteria are resistant to most drugs and rapid diagnosis can provide a clear guideline to clinicians. They possess specific virulence factors and relevant information can be very useful. Read More

    The Effects of Atorvastatin on Inflammatory Responses and Mortality in Septic Shock: A Single-center, Randomized Controlled Trial.
    Indian J Crit Care Med 2017 Oct;21(10):646-654
    Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
    Aim Of The Study: Pleiotropic effect of statins can modulate inflammation in septic shock. We tested the hypothesis whether statins can reduce mortality in septic shock.

    Patients And Methods: We conducted a randomized double-blinded trial with treatment (40 mg dose of atorvastatin for 7 days) and control (placebo) arm in adult septic shock patients admitted to the Intensive Care Unit. Read More

    Host resistance to endotoxic shock requires the neuroendocrine regulation of group 1 innate lymphoid cells.
    J Exp Med 2017 Nov 15. Epub 2017 Nov 15.
    Aix-Marseille Université, CNRS, INSERM, CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
    Upon infection, the immune system produces inflammatory mediators important for pathogen clearance. However, inflammation can also have deleterious effect on the host and is tightly regulated. Immune system-derived cytokines stimulate the hypothalamic-pituitary-adrenal (HPA) axis, triggering endogenous glucocorticoid production. Read More

    Development of a Simple Sequential Organ Failure Assessment Score for Risk Assessment of Emergency Department Patients With Sepsis.
    J Intensive Care Med 2017 Jan 1:885066617741284. Epub 2017 Jan 1.
    2 Department of Emergency Medicine, University of Mississippi, Jackson, MS, USA.
    Objectives: Sepsis-3 recommends using the quick Sequential Organ Failure Assessment (qSOFA) score followed by SOFA score for sepsis evaluation. The SOFA is complex and unfamiliar to most emergency physicians, while qSOFA is insensitive for sepsis screening and may result in missed cases of sepsis. The objective of this study was to devise an easy-to-use simple SOFA score for use in the emergency department (ED). Read More

    Antifungal treatment with echinocandins: a 10-year clinical experience.
    Rev Esp Quimioter 2017 Nov 10. Epub 2017 Nov 10.
    Rodrigo Poves Álvarez, Anesthesiology and Surgical Critical Care Department Clinic Universitary Hospital of Valladolid, Avenida Ramón y Cajal 3. 47003. Valladolid, Spain.
    Objective: The number of studies evaluating the use of echinocandins, whether or not its indication meets international guidelines, in clinical practice is limited. The objective of the present study was to determine the use of echinocandins in a tertiary Spanish hospital in 10 years of clinical practice, and to evaluate its impact on prognosis.

    Methods: This retrospective study involved adult nonneutropenic ill patients with suspicion of fungal invasion who started treatment with echinocandins between 2006 and 2015. Read More

    Use of Postmortem Computed Tomography to Detect Bowel Obstruction and its Relationship to the Cause of Death.
    Am J Forensic Med Pathol 2017 Nov 15. Epub 2017 Nov 15.
    From the *Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland; †Department of Forensic Pathology APHM, CHU Timone; ‡Aix-Marseille Université, CNRS, EFS, ADES UMR; and §Department of Pediatric Imaging, APHM, CHU Timone, Marseille, France.
    Bowel distension frequently indicates bowel obstruction, which is a common diagnosis in clinical radiology. Typically, symptoms and complaints lead to radiological examinations and the detection of the etiology. Untreated intestinal obstructions can lead to a fatal outcome through cardiac failure due to septic shock. Read More

    Elevated serum levels of lipoprotein‑associated phospholipase A2 predict mortality rates in patients with sepsis.
    Mol Med Rep 2017 Nov 13. Epub 2017 Nov 13.
    Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China.
    Sepsis remains one of the leading contributors to mortality rates in the intensive care unit (ICU) and emergency intensive care unit (EICU). Therefore, any treatments against the agents which produce sepsis in a medical emergency, are welcome. Elevated serum levels of lipoprotein‑associated phospholipase A2 (Lp‑PLA2) have been reported in a small cohort of patients with inflammation. Read More

    Trauma: a major cause of death among surgical inpatients of a Nigerian tertiary hospital.
    Pan Afr Med J 2017 5;28. Epub 2017 Sep 5.
    Department of Surgery, University of Port Harcourt Teaching Hospital, Alakahia, Port Harcourt, Nigeria.
    Introduction: Trauma presents a significant global health burden. Death resulting from trauma remains high in low income countries despite a steady decrease in developed countries. Analysis of the pattern of death will enable intervention to reduce these deaths from trauma in developing countries. Read More

    Association of positive fluid balance and mortality in sepsis and septic shock in an Australian cohort.
    Anaesth Intensive Care 2017 Nov;45(6):737-743
    Associate Professor and Principal Research Fellow Intensive Care Medicine, Intensive Care, Nepean Hospital, Sydney, New South Wales.
    In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. Read More

    Necroptosis regulated proteins expression is an early prognostic biomarker in patient with sepsis: a prospective observational study.
    Oncotarget 2017 Oct 20;8(48):84066-84073. Epub 2017 Sep 20.
    Department of Intensive Care Unit and Key Laboratory for Critical Care Medicine of the Ministry of Health, Emergency Medicine Research Institute, Tianjin First Center Hospital, Tianjin 300192, China.
    Background And Aim: Increasing researchers indicate that necroptosis is playing an important role in the regulation of systemic inflammatory response syndrome. The current study was to investigate the prognostic biomarker of the regulated proteins of necroptosis in sepsis patients.

    Results: One hundred and twenty-four patients were divided into three groups: 43 patients (34. Read More

    Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis: Is it safe and effective without preoperative drainage?
    Medicine (Baltimore) 2017 Nov;96(45):e8657
    Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
    To evaluate the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of proximal ureteral stones accompanied with obstructive pyelonephritis without preoperative drainage.We retrospectively reviewed 21 cases of proximal ureteral stones with infected kidney undergoing RLU between July 2013 and September 2016. Stone-induced obstructive infected hydronephrosis was diagnosed using blood and urine tests and imaging modalities. Read More

    Risk of Subsequent Sepsis within 90 Days of a Previous Hospital Stay by Type of Antibiotic Exposure.
    Clin Infect Dis 2017 Nov 9. Epub 2017 Nov 9.
    Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
    Background: We examined the risk of sepsis within 90 days after discharge from a previous hospital stay by type of antibiotic received during the previous stay.

    Methods: We retrospectively identified a cohort of hospitalized patients from the Truven Health MarketScan Hospital Drug Database. We examined the association between the use of certain antibiotics, determined a priori, during the initial hospital stay and risk of post-discharge sepsis controlling for potential confounding factors in a multivariable logistic regression model. Read More

    Outcomes of vancomycin plus a β-lactam versus vancomycin only for the treatment of methicillin-resistant Staphylococcus aureus bacteremia.
    Antimicrob Agents Chemother 2017 Nov 13. Epub 2017 Nov 13.
    Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA.
    The objective of this retrospective study was to compare the rates of treatment failure, which was a composite of clinical and microbiologic failure, of patients receiving vancomycin and a β-lactam to those receiving vancomycin only for MRSA bacteremia. Patients 16 to 89 years of age with MRSA bacteremia admitted to a university-affiliated hospital from January 1(st), 2014 to December 31(st), 2016 were screened for study inclusion. Patients were eligible if they received >48 hours of vancomycin and a β-lactam (combination group) or vancomycin only (standard group) within 48 hours following bacteremia onset. Read More

    Human resistin protects against endotoxic shock by blocking LPS-TLR4 interaction.
    Proc Natl Acad Sci U S A 2017 Nov 13. Epub 2017 Nov 13.
    Division of Biomedical Sciences, University of California, Riverside, CA 92521;
    Helminths trigger multiple immunomodulatory pathways that can protect from sepsis. Human resistin (hRetn) is an immune cell-derived protein that is highly elevated in helminth infection and sepsis. However, the function of hRetn in sepsis, or whether hRetn influences helminth protection against sepsis, is unknown. Read More

    Red blood cell distribution width is associated with mortality in elderly patients with sepsis.
    Am J Emerg Med 2017 Nov 10. Epub 2017 Nov 10.
    Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, New-Taipei City, Taiwan. Electronic address:
    Introduction: RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. Read More

    Perivalvular Mitral Abscess Fistulised to the Pericardial Cavity Revealing Staphylococcal Endocarditis.
    Heart Lung Circ 2017 Oct 31. Epub 2017 Oct 31.
    Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France. Electronic address:
    Background: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism.

    Methods: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity.

    Results: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis. Read More

    Sepsis and Septic Shock Strategies.
    Surg Clin North Am 2017 Dec 5;97(6):1339-1379. Epub 2017 Oct 5.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA.
    Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Read More

    A critical role of Pentraxin 3 in severe sepsis and septic shock.
    Eur J Clin Invest 2017 Nov 13. Epub 2017 Nov 13.
    Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
    As already done in the past three years, the Council of the European Society of Clinical Investigation (ESCI) will award at the next Scientific Meeting in Barcelona (May 30(th) -Juin 1(st) 2018) the best clinical research article published in the European Journal of Clinical Investigation (EJCI) from November 2016 to October 2017. In the final selection round, five clinical articles were selected based on their outstanding scientific value [1-5]. Among those finalists, the article by Caironi and co-workers obtained the highest consideration and was selected as the winner of the 2018 ESCI Award for the Best EJCI Basic Research Article [3]. Read More

    Combined use of high doses of vasopressin and corticosteroids in a patient with Crohn's disease with refractory septic shock after intestinal perforation: a case report.
    J Med Case Rep 2017 Nov 13;11(1):320. Epub 2017 Nov 13.
    Intensive Care Unit, AORN dei colli Vincenzo Monaldi Hospital, Naples, Italy.
    Background: In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery. The use of such high doses of vasopressin for this type of shock is not described in the literature.

    Case Presentation: A 49-year-old white woman with grade III obesity, Crohn's disease, and an intestinal perforation presented with refractory septic shock. Read More

    A sense oligonucleotide to inducible nitric oxide synthase mRNA increases the survival rate of rats in septic shock.
    Nitric Oxide 2017 Nov 8. Epub 2017 Nov 8.
    Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan. Electronic address:
    Natural antisense transcripts (asRNAs) that do not encode proteins are transcribed from rat, mouse, and human genes, encoding inducible nitric oxide synthase (iNOS), which catalyzes the production of the inflammatory mediator nitric oxide (NO). In septic shock, NO is excessively produced in hepatocytes and macrophages. The iNOS asRNA interacts with and stabilizes iNOS mRNA. Read More

    Right Ventricle Dysfunction and Pre Implantation Vasopressors in Refractory ARDS Supported by VV-ECMO.
    Heart Lung Circ 2017 Oct 31. Epub 2017 Oct 31.
    Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
    Background: Acute respiratory distress syndrome (ARDS) has been shown to be frequently associated with haemodynamic instability requiring the use of vasopressors. To date, there is still some uncertainty in the use of veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) in haemodynamically unstable ARDS patients.

    Methods: We therefore assessed whether patients receiving pre ECMO vasopressors had a worse prognosis and, furthermore, we reviewed the factors associated with the use of pre ECMO vasopressors in 92 consecutive patients with refractory ARDS treated with VV-ECMO. Read More

    Diabetic ketoacidosis, hyperuricemia, and encephalopathy intractable to regular-dose insulin.
    J Pediatr Endocrinol Metab 2017 Nov 11. Epub 2017 Nov 11.
    Background: Diabetic ketoacidosis (DKA) in children less than 1 year of age is a rare occurrence. Typical presentation includes a prodrome of weight loss and polyuria with subsequent presentation to medical care when acidosis becomes symptomatic.

    Case Presentation: We describe an unusual case of a previously healthy infant with a 3 days' history of constipation, presenting acutely with abdominal pain, lethargy, and dehydration. Read More

    Adjunctive use of physostigmine salicylate (Anticholium®) in perioperative sepsis and septic shock: study protocol for a randomized, double-blind, placebo-controlled, monocentric trial (Anticholium® per Se).
    Trials 2017 Nov 10;18(1):530. Epub 2017 Nov 10.
    Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
    Background: Severe sepsis and septic shock remain a major challenge, even in modern intensive care. In Germany, about 68,000 patients die annually because of septic diseases, characterized by a complex systemic inflammatory response. Causal treatment of the underlying infection is essential for successful management of sepsis, but the course can be positively influenced by supportive and adjuvant measures. Read More

    Acute Kidney Injury in Critically Ill Surgical Patients: Epidemiology, Risk Factors and Outcomes.
    Nephrology (Carlton) 2017 Nov 10. Epub 2017 Nov 10.
    Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
    Aim: Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear.

    Methods: A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. Read More

    Successful peritoneal dialysis using a percutaneous tube for peritoneal drainage in an extremely low birth weight infant: a case report.
    Surg Case Rep 2017 Nov 9;3(1):115. Epub 2017 Nov 9.
    Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, Wakayama, 640-8558, Japan.
    Background: Peritoneal dialysis (PD) for acute kidney injury (AKI) of newborns has been performed safely. AKI occurs in 8 to 24% of extremely low birth weight (ELBW) infants. Although PD has only been used occasionally in ELBW infants, prognosis is poor for ELBW infants with AKI. Read More

    Pitfalls of cannulation for extracorporeal life support: review of the literature and illustrative case presentation.
    J Artif Organs 2017 Nov 9. Epub 2017 Nov 9.
    Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
    Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are an increasingly established advanced therapy for emerging severe lung and/or cardiocirculatory dysfunction or failure. Several reports have provided evidence for a potential benefit in prognosis by ECLS in cases of cardiogenic shock including cardiopulmonary resuscitation. Routine use in specialized centers reduces the incidence of negative side effects (e. Read More

    Patients' comorbidities reduce the clinical value of emergency colonoscopy: results of a retrospective cohort study.
    Endosc Int Open 2017 Nov 8;5(11):E1119-E1127. Epub 2017 Nov 8.
    EC2M3: Department of Academic Research (EA7375) Université Paris Est Créteil (UPEC) - Val de Marne, France.
    Background And Study Aims:  Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controversial.

    Patients And Methods:  We studied the role of emergency colonoscopy in diagnosis and treatment of all consecutive patients presenting with acute lower gastrointestinal symptoms referred to our hospital on an emergency basis. Read More

    Two cases with intra-aortic balloon pumping use for severe septic cardiomyopathy.
    Acute Med Surg 2017 Oct 13;4(4):446-450. Epub 2017 Jul 13.
    Department of Emergency MedicineYokohama City University Graduate School of MedicineMinami-kuYokohamaJapan.
    Cases: Septic cardiomyopathy is defined as a reversible left ventricular systolic dysfunction. Patients with severe septic cardiomyopathy have a high mortality rate, even if they receive conventional therapy. For those patients, previous reports showed intra-aortic balloon pump (IABP) efficacy. Read More

    Early evaluation of severity in patients with severe sepsis: a comparison with "septic shock" - subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR).
    Acute Med Surg 2017 Oct 27;4(4):426-431. Epub 2017 Jul 27.
    Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR) Study GroupTokyoJapan.
    Aim: The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM-SR-Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than "septic shock."

    Methods: Among 624 patients with severe sepsis registered in JAAM-SR-Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in-hospital mortality. Read More

    Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study.
    Acute Med Surg 2017 Oct 17;4(4):408-417. Epub 2017 Jul 17.
    Department of Emergency Medicine and Critical CareSapporo City General HospitalSapporoJapan.
    Aim: This multicenter retrospective observational study aimed to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) support for septic patients with severe respiratory failure using propensity score analyses.

    Methods: The data of severe sepsis patients from 42 intensive care units between January 2011 and December 2013 were retrospectively collected. Propensity score matching analyses were undertaken for severe respiratory failure patients with/without veno-venous ECMO support. Read More

    Superior mesenteric artery syndrome leading to reversible mucosal gangrene.
    Acute Med Surg 2017 Jul 8;4(3):375-376. Epub 2017 May 8.
    The Emergency and Critical Care CenterMie University HospitalTsuMieJapan.
    We describe a case in which gastrointestinal distention due to superior mesenteric artery syndrome (SMAS) developed into membranous gangrene, which in turn led to septic shock in a 60-year-old woman with cerebral palsy and cachexia. The association with SMAS and septic shock is considered extremely rare, it is important to consider this combination especially in cachectic patients with gastric distension accompanying refractory shock unknown etiology. Read More

    Persistent bacteraemia caused by Staphylococcus aureus in the gall bladder.
    BMJ Case Rep 2017 Nov 8;2017. Epub 2017 Nov 8.
    Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
    Staphylococcus aureusbacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult S. Read More

    Early administration of appropriate antimicrobial agent to improve the outcome of carbapenem resistant acinetobacter baumannii complex bacteremic pneumonia.
    Int J Antimicrob Agents 2017 11 6. Epub 2017 Nov 6.
    Division of Infectious Diseases, Department of Internal Medicine3, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. Electronic address:
    Background: Carbapenem resistant Acinetobacter baumannii complex (CRABC) is an emerging pathogen that causes bloodstream infections and nosocomial pneumonia. This study aimed to describe the severe infection associated with CRABC bacteremic pneumonia and to investigate risk factors for 28-day mortality.

    Methods: All patients ≥18 years of age with a CRABC bacteremic pneumonia were enrolled retrospectively at five teaching hospitals in South Korea. Read More

    Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis.
    Br J Anaesth 2017 Oct;119(4):583-594
    Department of Anaesthesia and Critical Care, St Georges University Hospitals NHS Trust, Blackshaw Road, SW17?0QT London, UK.
    Background: Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e' and E/e' are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures. Read More

    Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database.
    Br J Anaesth 2017 Oct;119(4):626-636
    Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London WC1V 6AZ, UK.
    Background: New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions.

    Methods: We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Read More

    Continuing chronic beta-blockade in the acute phase of severe sepsis and septic shock is associated with decreased mortality rates up to 90 days.
    Br J Anaesth 2017 Oct;119(4):616-625
    Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany.
    Background: There is growing evidence that beta-blockade may reduce mortality in selected patients with sepsis. However, it is unclear if a pre-existing, chronic oral beta-blocker therapy should be continued or discontinued during the acute phase of severe sepsis and septic shock.

    Methods: The present secondary analysis of a prospective observational single centre trial compared patient and treatment characteristics, length of stay and mortality rates between adult patients with severe sepsis or septic shock, in whom chronic beta-blocker therapy was continued or discontinued, respectively. Read More

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