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    Cell-Derived Nanoparticles are Endogenous Modulators of Sepsis with Therapeutic Potential.
    Shock 2017 Feb 22. Epub 2017 Feb 22.
    *Institute of Anatomy, University of Lübeck, Lübeck, Germany †Division of Research, Department of Surgery, University of Cincinnati, Cincinnati, Ohio ‡Institute of Biology, University of Lübeck, Lübeck, Germany §Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Clinical Center Schleswig-Holstein, Kiel, Germany.
    Cell-derived nanoparticles (CDNPs) containing cytosolic proteins and RNAs/DNAs can be isolated from stressed eukaryotic cells. Previously, CDNPs isolated from cultured cells exerted immunomodulatory activities in different infections. Here, we sought to elucidate the role of CDNPs using a murine model of cecal ligation and puncture (CLP). Read More

    Comparison of Automated Methods Versus the American Burn Association Sepsis Definition to Identify Sepsis and Sepsis With Organ Dysfunction/Septic Shock in Burn-Injured Adults.
    J Burn Care Res 2017 Feb 22. Epub 2017 Feb 22.
    From the *Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois; †Department of Surgery, Loyola University Medical Center, Maywood, Illinois; ‡Stritch School of Medicine, Loyola University Chicago, Illinois; §Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland; ‖Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; ¶Division of GI, Tumor and Endocrine Surgery, Department of Surgery and the Mucosal Inflammation Program at the University of Colorado Denver; #Division of Pulmonary and Critical Care Medicine, Loyola University Chicago, Illinois; and **Department of Public Health Sciences, Loyola University Chicago, Illinois.
    To develop an algorithm to identify sepsis and sepsis with organ dysfunction/septic shock in burn-injured patients incorporating criteria from the American Burn Association sepsis definition that possesses good test characteristics compared with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9) codes and an algorithm previously validated in nonburn-injured septic patients (Martin et al method). This was a retrospective cohort study of consecutive patients admitted to the burn intensive care unit between January 2008 and March 2015. Of the 4761 admitted, 8. Read More

    Safety and efficacy of natalizumab in patients with acute ischaemic stroke (ACTION): a randomised, placebo-controlled, double-blind phase 2 trial.
    Lancet Neurol 2017 Mar 15;16(3):217-226. Epub 2017 Feb 15.
    Department of Neurology, Columbia University, New York, NY, USA.
    Background: In animal models of acute ischaemic stroke, blocking of the leukocyte-endothelium adhesion by antagonism of α4 integrin reduces infarct volumes and improves outcomes. We assessed the effect of one dose of natalizumab, an antibody against the leukocyte adhesion molecule α4 integrin, in patients with acute ischaemic stroke.

    Methods: In this double-blind, phase 2 study, patients with acute ischaemic stroke (aged 18-85 years) from 30 US and European clinical sites were randomly assigned (1:1) to 300 mg intravenous natalizumab or placebo with stratification by treatment window and baseline infarct size. Read More

    A Case of Influenza A (H3N2) Complicated by Community-Acquired Pneumonia and Death in a Young Healthy Adult during the 2013-2014 Season.
    Front Public Health 2017 8;5. Epub 2017 Feb 8.
    Division of Infectious Diseases, School of Medicine and Global Health Institute, Duke University , Durham, NC , USA.
    With multiple available vaccines and antivirals, seasonal influenza A is typically a self-limited acutely debilitating illness in young healthy adults. Here, we illustrate unexpected morbidity and mortality in a relatively young and healthy patient seen at a large tertiary care academic medical center for seasonal influenza A (H3N2) complicated by community-acquired pneumonia, hypoxic respiratory failure, septic shock, and death. Read More

    Predicting short-term ICU outcomes using a sequential contrast motif based classification framework.
    Conf Proc IEEE Eng Med Biol Soc 2016 Aug;2016:5612-5615
    Critical ICU events like acute hypotension and septic shock are dangerous complications, leading to multiple organ failures and eventual death. Previously, pattern mining algorithms have been employed for extracting interesting rules in various clinical domains. However, the extracted rules are directly investigated by clinicians for diagnosing a disease. Read More

    Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study.
    Front Surg 2017 7;4. Epub 2017 Feb 7.
    3rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
    Background: Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier's gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease. Read More

    Immunological Defects in Neonatal Sepsis and Potential Therapeutic Approaches.
    Front Pediatr 2017 7;5:14. Epub 2017 Feb 7.
    Department of Surgery, University of Florida College of Medicine , Gainesville, FL , USA.
    Despite advances in critical care medicine, neonatal sepsis remains a major cause of morbidity and mortality worldwide, with the greatest risk affecting very low birth weight, preterm neonates. The presentation of neonatal sepsis varies markedly from its presentation in adults, and there is no clear consensus definition of neonatal sepsis. Previous work has demonstrated that when neonates become septic, death can occur rapidly over a matter of hours or days and is generally associated with inflammation, organ injury, and respiratory failure. Read More

    Timing, method and discontinuation of hydrocortisone administration for septic shock patients.
    World J Crit Care Med 2017 Feb 4;6(1):65-73. Epub 2017 Feb 4.
    Miguel A Ibarra-Estrada, Pável E Aguilera-González, Critical Care Unit, Instituto Jalisciense de Cancerología, Guadalajara Jalisco 44280, Mexico.
    Aim: To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.

    Methods: This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone. It was performed at 2 critical care units in academic hospitals from June 1(st), 2015, to July 31(st), 2016. Read More

    Recurring septic shock in a patient with blunt abdominal and pelvic trauma: how mandatory is source control surgery?: a case report.
    J Med Case Rep 2017 Feb 22;11(1):49. Epub 2017 Feb 22.
    Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Via Fonte Romana 8, Pescara, Italy.
    Background: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control.

    Case Presentation: A 42-year-old white man presented with traumatic hemorrhagic shock. Read More

    Effects of Glycyrrhizin on the Differentiation of Myeloid Cells of the Heart and Lungs in Lipopolysaccharide-Induced Septic Mice.
    Shock 2017 Feb 17. Epub 2017 Feb 17.
    *Department of Cellular and Molecular Medicine, Konkuk University School of Medicine, Seoul, Korea. †Department of Microbiology, Konkuk University School of Medicine, Seoul, Korea. ‡Department of Anesthesiology and Pain medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. §Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Korea.
    Background: This study investigated the effects of glycyrrhizin (GR) on the ratio of myeloid-derived suppressor cells (MDSCs) to cluster of differentiation (CD)11b+Gr1 myeloid cells in the heart and lungs in lipopolysaccharide (LPS)-induced septic mice.

    Methods: Mice were divided into three groups: Control, LPS, and LPS+GR. After intraperitoneal injection of phosphate-buffered saline for the Control group, LPS for the LPS group, and a combination of LPS and GR for the LPS+GR group, fluorescence-activated cell sorting was utilized to evaluate cytokines and immune cells in the blood, heart, and lungs. Read More

    Antipyretic Therapy in Critically Ill Septic Patients: A Systematic Review and Meta-Analysis.
    Crit Care Med 2017 Feb 17. Epub 2017 Feb 17.
    1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. 2Departments of Emergency Medicine and Anesthesiology, Washington University School of Medicine, St. Louis, MO. 3University of Missouri-Columbia School of Medicine, Columbia, MO. 4Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 5Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO.
    Objective: This meta-analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults.

    Data Sources: Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and through February 2016. Read More

    Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting.
    Ann Intensive Care 2017 Dec 20;7(1):19. Epub 2017 Feb 20.
    CIBER Enfermedades Respiratorias, Madrid, Spain.
    Background: Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals.

    Methods: A large retrospective analysis of a 5-year period (2008-2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Read More

    Prediction of pediatric sepsis mortality within 1 h of intensive care admission.
    Intensive Care Med 2017 Feb 20. Epub 2017 Feb 20.
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
    Purpose: The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children.

    Methods: Multicenter cohort study including children <16 years admitted with sepsis or septic shock to ICUs in Australia and New Zealand in the period 2012-2015. We assessed septic shock criteria at ICU admission to define sepsis severity, using 30-day mortality as outcome. Read More

    Rapid and Rigorous IL-17A Production by a Distinct Subpopulation of Effector Memory T Lymphocytes Constitutes a Novel Mechanism of Toxic Shock Syndrome Immunopathology.
    J Immunol 2017 Feb 20. Epub 2017 Feb 20.
    Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada;
    Toxic shock syndrome (TSS) is caused by staphylococcal and streptococcal superantigens (SAgs) that provoke a swift hyperinflammatory response typified by a cytokine storm. The precipitous decline in the host's clinical status and the lack of targeted therapies for TSS emphasize the need to identify key players of the storm's initial wave. Using a humanized mouse model of TSS and human cells, we herein demonstrate that SAgs elicit in vitro and in vivo IL-17A responses within hours. Read More

    Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial.
    Lancet Respir Med 2017 Feb 14. Epub 2017 Feb 14.
    Institut für anesthesiologische Pathophysiologie und Verfahrensentwicklung, Universitätklinikum Ulm, Ulm, Germany.
    Background: There is insufficient research into the use of mechanical ventilation with increased inspiratory oxygen concentration (FiO2) and fluid resuscitation with hypertonic saline solution in patients with septic shock. We tested whether these interventions are associated with reduced mortality.

    Methods: This two-by-two factorial, multicentre, randomised, clinical trial (HYPERS2S) recruited patients aged 18 years and older with septic shock who were on mechanical ventilation from 22 centres in France. Read More

    [Change of prognosis and pathogens in adult patients with severe community-acquired pneumonia during different periods].
    Zhonghua Yi Xue Za Zhi 2017 Feb;97(5):332-337
    Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
    Objective: To compare the change of prognosis and pathogens of adult patients with severe community-acquired pneumonia (CAP) requiring admission to Respiratory Intensive Care Unit (RICU) during different period, and estimate the risk factors of severe CAP. Methods: The clinical data of 186 patients with severe CAP admission to RICU was collected and assessed the trend in outcomes of these patients during three time periods: Period Ⅰ (January 1 2000 to October 31 2006), Period Ⅱ (November 1 2006 to December 31 2010), and Period Ⅲ (January 1 2011 to December 31 2015), analyzed the risk factors by Cox Proportional Hazards regression, and compared the pathogens detection. Results: The total mortality was 34. Read More

    Human scFvs That Counteract Bioactivities of Staphylococcus aureus TSST-1.
    Toxins (Basel) 2017 Feb 17;9(2). Epub 2017 Feb 17.
    Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
    Some Staphylococcus aureus isolates produced toxic shock syndrome toxin-1 (TSST-1) which is a pyrogenic toxin superantigen (PTSAg). The toxin activates a large fraction of peripheral blood T lymphocytes causing the cells to proliferate and release massive amounts of pro-inflammatory cytokines leading to a life-threatening multisystem disorder: toxic shock syndrome (TSS). PTSAg-mediated-T cell stimulation circumvents the conventional antigenic peptide presentation to T cell receptor (TCR) by the antigen-presenting cell (APC). Read More

    Prostatic abscess in a patient with chronic granulomatous disease: a multi-disciplinary intervention.
    Urologia 2017 Feb 8. Epub 2017 Feb 8.
    First University Urology Clinic, Laiko Hospital, Athens - Greece.
    Introduction: Chronic granulomatous disease (CGD) is a rare pathology that increases patients' susceptibility to infections, given the inability to generate oxygen radicals to fight microorganisms.In the context of CGD, primary prostatic involvement has been described only once in the past, in a pediatric patient.

    Case Report: We report the case of a 35-year old patient with CGD presenting with persistent fever. Read More

    Asymmetric dimethylarginine in the assessment of febrile neutropenia in hematological patients.
    Scand J Clin Lab Invest 2017 Apr;77(2):130-134
    b Department of Medicine , Kuopio University Hospital , Kuopio , Finland.
    Asymmetric dimethylarginine (ADMA) has been recognized as an independent prognostic factor for sepsis mortality in intensive care units. No data are available on kinetics or prognostic value of ADMA in hematological patients. We evaluated the ability of ADMA to act as a predictor for complicated course of febrile neutropenia, defined as bacteremia and/or septic shock in adult hematological patients receiving intensive chemotherapy. Read More

    Ultrasound-Guided Resuscitative Endovascular Balloon Occlusion of the Aorta in the Resuscitation Area.
    J Emerg Med 2017 Feb 17. Epub 2017 Feb 17.
    Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
    Background: In trauma resuscitation with resuscitative endovascular balloon occlusion of the aorta (REBOA), urgent and accurate placement of the catheter in the resuscitation area without fluoroscopy can shorten the time from admission to REBOA, allowing rapid, temporary control of bleeding.

    Discussion: The experience-based protocol in our center for ultrasound-guided REBOA in the resuscitation area without fluoroscopy is as follows: the femoral artery is punctured and a guidewire inserted; sonography is used to verify that the guidewire is in the abdominal aorta; the position of the balloon is confirmed with ultrasound after estimating the distance to the clavicle, and the pressure in the radial artery and sheath is used to monitor correct positioning; connect the pressure transducer to the catheter sheath for continuous monitoring of the blood pressure in the sheath, and inflate the balloon until the blood pressure tracing at the sheath has disappeared; check the pulse in the left radial artery, and withdraw the catheter slightly if the pulse in the radial artery is not palpable or is decreased (if this pulse is not palpable or decreased, the balloon is in the aortic arch). In this retrospective review of our REBOA protocol, between April 2012 and March 2016, 34 patients were enrolled. Read More

    Opportunities for repurposing of poly(ADP-ribose) polymerase (PARP) inhibitors for the therapy of non-oncological diseases.
    Br J Pharmacol 2017 Feb 18. Epub 2017 Feb 18.
    Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
    The recent clinical availability of the PARP inhibitor Lynparza (olaparib) opens the door for potential therapeutic repurposing for non-oncological indications. Considering (a) the preclinical efficacy data with PARP inhibitors in non-oncological diseases and (b) the risk-benefit ratio of treating patients with a compound that inhibits an enzyme that has physiological roles in the regulation of DNA repair, indications where (a) the severity of the disease is high, (b) the available therapeutic options are limited, and (c) the duration of PARP inhibitor administration could be short, provide first-line options for therapeutic repurposing. These indications are as follows: acute ischemic stroke; traumatic brain injury; septic shock; acute pancreatitis and severe acute lung injury. Read More

    Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients.
    Ann Intensive Care 2017 Dec 17;7(1):17. Epub 2017 Feb 17.
    Critical Care Echocardiography Service, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, 84157, USA.
    Background: In sepsis, tachycardia may indicate low preload, adrenergic stimulation, or both. Adrenergic overstimulation is associated with septic cardiomyopathy. We sought to determine whether tachycardia was associated with left ventricular longitudinal strain, a measure of cardiac dysfunction. Read More

    Expression profiling of TRIM protein family in THP1-derived macrophages following TLR stimulation.
    Sci Rep 2017 Feb 17;7:42781. Epub 2017 Feb 17.
    Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi, 330031, China.
    Activated macrophages play an important role in many inflammatory diseases including septic shock and atherosclerosis. However, the molecular mechanisms limiting macrophage activation are not completely understood. Members of the tripartite motif (TRIM) family have recently emerged as important players in innate immunity and antivirus. Read More

    Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae.
    Eur J Clin Microbiol Infect Dis 2017 Feb 16. Epub 2017 Feb 16.
    6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123.
    We report our experience using the double-carbapenem combination as salvage therapy for patients with untreatable infections caused by KPC-2- producing Klebsiella pneumoniae. A total of 27 patients in two institutions in Athens, Greece suffering from complicated urinary tract infections (16) with or without secondary bacteraemia (four and 12 respectively), primary (six) or catheter-related bloodstream infections (two), HAP or VAP (two) and external ventricular drainage infection (one) were treated exclusively with ertapenem and high-dose prolonged infusion meropenem because in-vitro active antimicrobials were unavailable (19) or failed (four) or were contraindicated (six). Most patients presented with severe infections with median APACHE II score of 17 and 11 of those patients (40. Read More

    Mass spectrometry for the discovery of biomarkers of sepsis.
    Mol Biosyst 2017 Feb 16. Epub 2017 Feb 16.
    Department of Chemistry and Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA.
    Sepsis is a serious medical condition that occurs in 30% of patients in intensive care units (ICUs). Early detection of sepsis is key to prevent its progression to severe sepsis and septic shock, which can cause organ failure and death. Diagnostic criteria for sepsis are nonspecific and hinder a timely diagnosis in patients. Read More

    Organ dysfunction during continuous veno-venous high cut-off hemodialysis in patients with septic acute kidney injury: A prospective observational study.
    PLoS One 2017 16;12(2):e0172039. Epub 2017 Feb 16.
    Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
    Background: Continuous veno-venous hemodialysis with high cut-off membranes (HCO-CVVHD) removes inflammatory mediators involved in organ dysfunction during sepsis. The aim of the present study was to assess the variations in SOFA score and identify early predictors of short-term mortality in a cohort of patients with septic shock, treated with HCO-CVVHD for acute kidney injury (AKI).

    Methods: An observational prospective multicenter cohort study was conducted in four mixed medical-surgical ICUs. Read More

    The new sepsis definition: limitations and contribution to research and diagnosis of sepsis.
    Curr Opin Anaesthesiol 2017 Feb 15. Epub 2017 Feb 15.
    aDepartment of Anesthesiology and Critical Care, SMUR and Burn Unit, GH Saint-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris bInfection and Epidemiology Department, Human Histopathology and Animal Models Unit, Institut Pasteur cUniversity Paris Diderot, Sorbonne Paris Cité dU 942 INSERM, Paris, France.
    Purpose Of Review: Based on recent clinical, epidemiological, and pathophysiological data, a third international consensus conference was carried out to define new criteria of sepsis in February 2016. This review presents the different items of this new definition, their limitations and their contribution to research and diagnosis of sepsis, in comparison with the previous definitions.

    Recent Findings: Incidence, management, and pathophysiological knowledge of sepsis have improved over the past 20 years. Read More

    Thiamine as a Renal Protective Agent in Septic Shock: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial.
    Ann Am Thorac Soc 2017 Feb 16. Epub 2017 Feb 16.
    Beth Israel Deaconess Medical Center, Emergency Medicine , One Deaconess Road , West Clinical Center 2 , Boston, Massachusetts, United States , 02215 ;
    Rationale: Acute kidney injury (AKI) is common in patients with sepsis and has been associated with high mortality rates. The provision of thiamine to septic patients may reduce the incidence and severity of sepsis-related AKI and thereby prevent renal failure requiring renal replacement therapy (RRT).

    Objectives: To test the hypothesis that thiamine supplementation mitigates kidney injury in septic shock. Read More

    Ann Pharmacother 2017 Feb 1:1060028017694376. Epub 2017 Feb 1.
    1 UC Health - University of Cincinnati Medical Center Department of Pharmacy Services, Cincinnati, Ohio.
    Obesity presents a growing challenge in critically ill patients because of variable medication pharmacokinetics and pharmacodynamics. Vasopressors used in the treatment of septic shock, including norepinephrine, are dosed using weight-based (WB) or non-weight-based (NWB) strategies. Retrospective research has evaluated the effect of total body weight and body mass index on vasopressor requirements, consequently finding that obese patients require less total vasopressor per kilogram to obtain clinical end points such as mean arterial pressure. Read More

    Non-fermentative Gram-negative rods bacteremia in children with cancer: a 14-year single-center experience.
    Infection 2017 Feb 15. Epub 2017 Feb 15.
    Pediatric Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
    Purpose: Data on non-fermentative Gram-negative rods (NFGNR) bacteremia in children with malignancies are limited. The aim of this study was to present clinical picture, antimicrobial susceptibility pattern, risk factors for resistance and outcome in NFGNR bacteremia in children with cancer.

    Methods: All episodes of NFGNR bacteremia occurring during 2001-2014 in children with cancer in a tertiary-care hospital were retrospectively analyzed. Read More

    Impact of preoperative steroid or immunosuppressant use on short-term outcomes following colectomy in Crohn's disease patients.
    Tech Coloproctol 2017 Feb 15. Epub 2017 Feb 15.
    Department of Colorectal Surgery, Columbia University Medical Center, Presbyterian Hospital, New York, NY, 10032, USA.
    Background: Evaluating the impact of steroid or immunosuppressants (SI) therapy prior to colectomy in Crohn's disease (CD) patients on postoperative septic and colectomy-specific outcomes using the American College of Surgeons (ACS)-National Surgical Quality Improvement Program (NSQIP)-targeted colectomy database.

    Methods: All CD patients undergoing colectomy were retrieved from the 2012-2013 NSQIP-targeted database. Thirty-day postoperative outcomes were compared for patients who were on steroids or immunosuppressants (SI) within the 30 days prior to colectomy to the others using univariable and multivariable analyses. Read More

    Left ventricular systolic dysfunction during septic shock: the role of loading conditions.
    Intensive Care Med 2017 Feb 15. Epub 2017 Feb 15.
    AP-HP, Hôpitaux universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.
    Purpose: The clinical significance of septic myocardial dysfunction is controversial, a fact that may be explained by the influence of loading conditions. Many indices may be useful to characterize cardiac function during septic shock, but their feasibility and physiological coherence in the clinical setting are unknown.

    Methods: Hemodynamic and echocardiographic data with tissue Doppler and speckle tracking were prospectively recorded on the first 3 days of human septic shock. Read More

    From amino acids polymers, antimicrobial peptides, and histones, to their possible role in the pathogenesis of septic shock: a historical perspective.
    J Inflamm Res 2017 1;10:7-15. Epub 2017 Feb 1.
    Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem.
    This paper describes the evolution of our understanding of the biological role played by synthetic and natural antimicrobial cationic peptides and by the highly basic nuclear histones as modulators of infection, postinfectious sequelae, trauma, and coagulation phenomena. The authors discuss the effects of the synthetic polymers of basic poly α amino acids, poly l-lysine, and poly l-arginine on blood coagulation, fibrinolysis, bacterial killing, and blood vessels; the properties of natural and synthetic antimicrobial cationic peptides as potential replacements or adjuncts to antibiotics; polycations as opsonizing agents promoting endocytosis/phagocytosis; polycations and muramidases as activators of autolytic wall enzymes in bacteria, causing bacteriolysis and tissue damage; and polycations and nuclear histones as potential virulence factors and as markers of sepsis, septic shock, disseminated intravasclar coagulopathy, acute lung injury, pancreatitis, trauma, and other additional clinical disorders. Read More

    Complication profile, failure to rescue, and mortality following elective endovascular aortic aneurysm repair.
    Am J Surg 2017 Feb 8. Epub 2017 Feb 8.
    Department of Radiology, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA, USA.
    Introduction: Understanding the relationship between patient risk factors, postoperative complications, and morbidity and mortality is important when considering elective endovascular aortic aneurysm repair (E-EVAR) performed to prevent aneurysm rupture mortality. We aimed to stratify complications in E-EVAR and explore their relationship with postoperative death.

    Methods: E-EVAR cases from 2012 NSQIP were identified. Read More

    Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia.
    Crit Care 2017 Feb 16;21(1):33. Epub 2017 Feb 16.
    Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
    Background: Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation.

    Methods: The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared. Read More

    Transcriptomic meta-analysis reveals up-regulation of gene expression functional in osteoclast differentiation in human septic shock.
    PLoS One 2017 15;12(2):e0171689. Epub 2017 Feb 15.
    National Institute of Biomedical Genomics, Kalyani, West Bengal, India.
    Septic shock is a major medical problem with high morbidity and mortality and incompletely understood biology. Integration of multiple data sets into a single analysis framework empowers discovery of new knowledge about the condition that may have been missed by individual analysis of each of these datasets. Electronic search was performed on medical literature and gene expression databases for selection of transcriptomic studies done in circulating leukocytes from human subjects suffering from septic shock. Read More

    Recent Insights into the Molecular Mechanisms Underlying Pyroptosis and Gasdermin Family Functions.
    Trends Immunol 2017 Feb 11. Epub 2017 Feb 11.
    Department of Early Discovery Biochemistry, Genentech, South San Francisco, CA 94080, USA. Electronic address:
    Pyroptosis is an inflammatory form of cell death that not only protects multicellular organisms from invading pathogenic bacteria and microbial infections, but can also lead to sepsis and lethal septic shock if overactivated. Here, we present an overview of recent developments within the pyroptosis field, beginning with the discovery of Gasdermin D (GSDMD) as a substrate of caspase-1 and caspase-11 upon detection of cytosolic lipopolysaccharide (LPS). Cleavage releases the N-terminal domain of GSDMD, causing it to form cytotoxic pores in the plasma membrane of cells. Read More

    Coinfection of Leishmania guyanensis and Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome: Report of a Case of Disseminated Cutaneous Leishmaniasis in Ecuador.
    Am J Trop Med Hyg 2017 Feb 13. Epub 2017 Feb 13.
    The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University of Jerusalem, Jerusalem, Israel.
    Reported herein is the first case of Leishmania-human immunodeficiency virus (HIV) coinfection in Ecuador. In Ecuador, HIV infections overlap endemic areas of leishmaniasis. Immunosuppression is a well-established risk factor for developing severe disease. Read More

    Inadvertent Skipping of Steroids in Septic Shock Leads to a Diagnosis of Adult Onset Still's Disease.
    Cureus 2017 Jan 14;9(1):e978. Epub 2017 Jan 14.
    Department of General Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, India.
    Adult onset Still's disease is uncommon in middle-aged and elderly individuals and can rarely present with shock; shock is usually associated with disseminated intravascular coagulation, multiorgan dysfunction syndrome or acute respiratory distress syndrome. We report a post-menopausal woman with arthritis, fever, pneumonitis and hypotension which was managed as septic shock. Steroids were inadvertently missed during the second day of hospitalization in the intensive care unit. Read More

    Macrophage Migration Inhibitory Factor as an Emerging Drug Target to Regulate Antioxidant Response Element System.
    Oxid Med Cell Longev 2017 16;2017:8584930. Epub 2017 Jan 16.
    Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1 Muraoka-Higashi 2-Chome, Fujisawa, Kanagawa 251-8555, Japan.
    Oxidative stress is involved in pathophysiology and pathological conditions of numerous human diseases. Thus, understanding the mechanisms underlying the redox homeostasis in cells and organs is valuable for discovery of therapeutic drugs for oxidative stress-related diseases. Recently, by applying chemical biology approach with an ARE activator, BTZO-1, we found macrophage migration inhibitory factor (MIF) as a new regulator of antioxidant response element- (ARE-) mediated gene transcription. Read More

    Neurologic complications of sepsis.
    Handb Clin Neurol 2017 ;141:675-683
    Neurocritical Care Unit, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
    Over the past decades, the incidence of sepsis and resultant neurologic sequelae has increased, both in industrialized and low- or middle-income countries, by approximately 5% per year. Up to 300 patients per 100 000 population per year are reported to suffer from sepsis, severe sepsis, and septic shock. Mortality is up to 30%, depending on the precision of diagnostic criteria. Read More

    A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management.
    Int J Surg Case Rep 2017 Jan 23;31:221-224. Epub 2017 Jan 23.
    Blacktown Hospital, NSW, Australia.
    Introduction: Necrotising fasciitis of the breast is a rare entity with very few cases reported in the literature. It is rapidly progressive and can lead to sepsis and multi-organ failure without prompt medical and surgical management.

    Presentation Of Case: We describe a case of a non-diabetic 23-year-old female with primary necrotising fasciitis of the right breast. Read More

    SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity.
    Intern Emerg Med 2017 Feb 10. Epub 2017 Feb 10.
    High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
    Several widely used scoring systems for septic patients have been validated in an ICU setting, and may not be appropriate for other settings like Emergency Departments (ED) or High-Dependency Units (HDU), where a relevant number of these patients are managed. The purpose of this study is to find reliable tools for prognostic assessment of septic patients managed in an ED-HDU. In 742 patients diagnosed with sepsis/severe sepsis/septic shock, not-intubated, admitted in ED between June 2008 and April 2016, SOFA, qSOFA, PIRO, MEWS, Charlson Comorbidity Index, MEDS, and APACHE II were calculated at ED admission (T0); SOFA and MEWS were also calculated after 24 h of ED-High-Dependency Unit stay (T1). Read More

    New Consensus Definitions for Sepsis and Septic Shock: Implications for Treatment Strategies and Drug Development?
    Drugs 2017 Feb 10. Epub 2017 Feb 10.
    Section of Anaesthesia, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK.
    Sepsis continues to escape a precise diagnostic definition. The most recent consensus definition, termed Sepsis-3, highlights the importance of the maladaptive and potentially life-threatening host response to infection. After briefly reviewing the history and epidemiology of sepsis, we go on to describe some of the challenges encountered when classifying such a heterogenous disease state. Read More

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