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    A scoping review on bio-aerosols in healthcare and the dental environment.
    PLoS One 2017 22;12(5):e0178007. Epub 2017 May 22.
    Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Background: Bio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available.

    Objectives: This study aimed to review evidence on bio-aerosols in healthcare and the dental setting. Read More

    Weekly high-dose liposomal amphotericin B (L-AmB) in critically ill septic patients with multiple Candida colonization: The AmBiDex study.
    PLoS One 2017 22;12(5):e0177093. Epub 2017 May 22.
    Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France.
    Background: To demonstrate the feasibility and safety of weekly high-dose liposomal amphotericin B (L-AmB) (as a pre-emptive antifungal treatment) for 2 weeks in patients with septic shock and Candida colonization.

    Methods: Pilot, multicentre, open-label, prospective study conducted in seven French ICUs. Non-immunocompromised patients, receiving mechanical ventilation were eligible if they presented ICU-acquired severe sepsis requiring newly administered antibacterial agents and Candida colonization in at least two sites. Read More

    Macrophage migration inhibitory factor levels correlate with an infection in trauma patients.
    Ulus Travma Acil Cerrahi Derg 2017 May;23(3):193-198
    Department of Emergency Medicine, Korea University Guro Hdspital, Seoul-South Korea.
    Background: The role of migration inhibitory factor (MIF) is best understood in septic shock and septic disease; however, the role of MIF in a secondary infection after trauma has not yet been completely studied. This study aimed to evaluate the role of MIF in trauma patients.

    Methods: The patients in the study population were divided into two groups according to the results of their MIF levels. Read More

    Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.
    N Engl J Med 2017 May 21. Epub 2017 May 21.
    From the Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, and the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center - both in Pittsburgh (C.W.S.); the New York State Department of Health, Albany (F.G., M.E.F.), and IPRO, Lake Success (G.S.P., K.M.T.) - both in New York; the University of Michigan and the Veterans Affairs Center for Clinical Management Research - both in Ann Arbor (H.C.P., T.J.I.); the Division of Biostatistics, Ohio State University College of Public Health, Columbus (S.L.); Washington University, St. Louis (T.O.); and the Warren Alpert Medical School at Brown University, Providence, RI (M.M.L.).
    Background In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. Methods We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Read More

    Comparison of fluid balance and hemodynamic and metabolic effects of sodium lactate versus sodium bicarbonate versus 0.9% NaCl in porcine endotoxic shock: a randomized, open-label, controlled study.
    Crit Care 2017 May 19;21(1):113. Epub 2017 May 19.
    CHU Lille, Centre de Réanimation, F-59000, Lille, France.
    Background: Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage of lactate is related to a negative chloride balance, its particular metabolism, or simply its energy load.

    Methods: This was an interventional, randomized, open-label, controlled experimental study. Read More

    Prevalence and clinical significance of early high Endotoxin Activity in septic shock: An observational study.
    J Crit Care 2017 Apr 26;41:124-129. Epub 2017 Apr 26.
    Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda. P.zza Ospedale Maggiore 3, 20162 Milan, Italy; University of Milan-Bicocca School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
    Purpose: To measure the prevalence of elevated Endotoxin Activity (EA) in a large cohort of patients with Septic Shock (SS), and to assess its value as an early indicator of Gram-Negative (GN) infection, disease severity, and patient risk.

    Materials And Methods: Adult patients were enrolled in this observational study if an EA determination was obtained within 24-h from SS onset. Demographic, clinical, and microbiological data were collected. Read More

    Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series.
    Int J Artif Organs 2017 May 19. Epub 2017 May 19.
    Department of Cardiac Anesthesiology, University Hospital Ulm, Ulm - Germany.
    Introduction: Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function. Read More

    [Effect of esmolol on hemodynamics and clinical outcomes in patients with septic shock].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 May;29(5):390-395
    Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China. Corresponding author: Li Gang, Email:
    Objective: To evaluate the effect of heart rate control with esmolol on hemodynamics, inflammatory cytokines and clinical outcomes in patients with septic shock.

    Methods: A prospective randomized controlled trial was conducted. The patients with septic shock admitted to Department of Critical Care Medicine of China-Japan Friendship Hospital from August 2014 to October 2016 were enrolled. Read More

    Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia.
    Front Cell Infect Microbiol 2017 4;7:156. Epub 2017 May 4.
    Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon.
    Infections caused by Acinetobacter baumannii (AB), an increasingly prevalent nosocomial pathogen, have been associated with high morbidity and mortality. We conducted this study to analyze the clinical features, outcomes, and factors influencing the survival of patients with AB bacteremia. We retrospectively examined the medical records of all patients developing AB bacteremia during their hospital stay at a tertiary care hospital in Beirut between 2010 and 2015. Read More

    Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient.
    Case Rep Crit Care 2017 24;2017:1092537. Epub 2017 Apr 24.
    Department of Internal Medicine, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, Portugal.
    Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-year-old immunocompetent woman with no previous neurological impairment presented with septic shock and drowsiness that responded well to therapy with clinical improvement and a full neurological recovery. Read More

    Venous-to-arterial carbon dioxide difference in the resuscitation of patients with severe sepsis and septic shock: A systematic review.
    Med Intensiva 2017 May 15. Epub 2017 May 15.
    Fundación Universitaria de Ciencias de la Salud, Facultad de Medicina, Bogotá, Colombia; Servicio de Medicina Interna, Hospital de San José de Bogotá, Bogotá, Colombia.
    Introduction: The way to assess tissue perfusion during the resuscitation of patients with severe sepsis and septic shock is a current subject of research and debate. Venous oxygen saturation and lactate concentration have been the most frequently used criteria, though they involve known limitations. The venous-to-arterial difference of carbon dioxide (pCO2 delta) is a parameter than can be used to indicate tissue perfusion, and its determination therefore may be useful in these patients. Read More

    Role of mitral valve repair in active infective endocarditis: long term results.
    J Cardiothorac Surg 2017 May 18;12(1):29. Epub 2017 May 18.
    Cardiochirurgia, AOU Careggi Firenze, Florence, Italy.
    Background: Although mitral valve repair is at present the technique of choice in mitral regurgitation (MR) due to degenerative valve disease, long term results in patients with active mitral infective endocarditis (IE) are still under evaluation.

    Methods: In the study were included 34 consecutive patients (22 males; mean age, 60 years; range 32-84 years) referred to our institution between January 1, 2005 to December 31, 2011 who were treated with valve repair for mitral valve (MV) active infective endocarditis. Eighteen patients underwent isolated MV repair. Read More

    Protein Carbonyl, But Not Malondialdehyde, Is Associated With ICU Mortality in Patients With Septic Shock.
    J Intensive Care Med 2017 Jan 1:885066617710218. Epub 2017 Jan 1.
    1 Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
    Background: The objective of our study was to evaluate the association of serum malondialdehyde (MDA) and protein carbonyl concentration with intensive care unit (ICU) mortality in patients with septic shock.

    Methods: We prospectively evaluated 175 patients aged over 18 years with septic shock upon ICU admission. However, 16 patients were excluded. Read More

    Metabolic Inflammatory Complex in Sepsis: Septic Cachexia as a Novel Potential Therapeutic Target.
    Shock 2017 May 17. Epub 2017 May 17.
    Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129.
    Despite several decades of focused investigation, sepsis remains a major cause of mortality in critically ill patients. Advancements in intensive care have enabled more patients to survive the acute phase of sepsis than previously, but a growing number of them progress to chronic critical illness. The failure of previous randomized clinical trials of anti-inflammatory agents to show any pro-survival benefit in septic patients underscores current thought that simple anti-inflammatory strategies are ineffective because the inhibitory effect of anti-inflammatory agents undermines the immune response to pathogens. Read More

    Experimental identification and computational characterization of a novel extracellular metalloproteinase produced by Clostridium sordellii.
    RSC Adv 2017 Mar;7(23):13928-13938
    Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID 83642, USA. Email: ; Tel: +1-208-373-1832.
    Clostridium sordellii is a lethal pathogen for both animals and humans. Severe capillary leakage, toxic shock syndrome, and an extreme leukemoid reaction (LR), are hallmark features of C. sordellii infections and contribute to its high mortality rate. Read More

    Gender-based Assessment of Survival in Trauma-hemorrhagic Shock: A Retrospective Analysis of Indian Population.
    Indian J Crit Care Med 2017 Apr;21(4):218-223
    Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
    Introduction: Trauma-hemorrhagic shock (THS) is a leading cause of death. Female rats and women experience better outcomes in terms of survival after major trauma as compared to males. There are limited data in Indian population. Read More

    Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.
    Anesth Analg 2017 May 12. Epub 2017 May 12.
    From the *Division of General Internal Medicine, School of Medicine, University of California, San Francisco, California; †Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California; ‡Department of Quality, Sepsis Program, University of California, San Francisco, California; and §Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, California.
    Background: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. Read More

    Predictors of fifty days in-hospital mortality in patients with culture negative neutrocytic ascites.
    BMC Gastroenterol 2017 May 16;17(1):64. Epub 2017 May 16.
    Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
    Background: Culture negative neutrocytic ascites is a variant of spontaneous bacterial peritonitis. But there are conflicting reports regarding the mortality associated with culture negativeneutrocytic ascites. Therefore we aim to determine the predictors of mortality associated with culture negativeneutrocytic ascites in a larger sample population. Read More

    American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.
    Crit Care Med 2017 Jun;45(6):1061-1093
    1No institution affiliation. 2Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3Department of Pediatric Critical Care, Riley Hospital for Children, Indiana University, IN. 4Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 5Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. 6Pediatric Critical Care Medicine, Covenant Women and Children's Hospital, Texas Tech University, Lubbock, TX. 7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 8Division of Pediatric Critical Care, University of British Columbia, Vancouver, BC, Canada. 9Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. 10Department of Pediatrics, Baylor College of Medicine, Houston, TX. 11Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ. 12Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 13Intensive Care & Bioethics, Great Ormond St Hospital for Sick Children, London, United Kingdom. 14Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada. 15Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's, Durham, NC. 16Departments of Pediatrics and Critical Care, Clinical Epidemiology and Biostatistics, McMaster University, Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada. 17Beth Israel Medical Center, Hartsdale, NY. 18Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 19Departments of Pediatrics and Biochemistry, Washington University in Saint Louis School of Medicine, Saint Louis, MO. 20Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Québec City, QC, Canada. 21Department of Inpatient Pediatrics, Kaiser Santa Clara Medical Center, Santa Clara, CA. 22Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 23Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Mott C.S. Children's Hospital, Ann Arbor, MI. 24Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 25Department of Pediatrics-Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 26Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY. 27Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. 28Department of Critical Care Medicine, Children's Mercy Hospital, Kansas City, MO. 29Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX. 30Division of Pediatric Critical Care, University of Florida, Jacksonville, FL. 31Bon Secours St. Mary's Hospital, Glen Allen, VA. 32Division of Pediatric Critical Care, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY. 33Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 34Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 35Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY. 36Department of Pediatrics, University of British Columbia, UBC & BC Children's Hospital Professor in Critical Care-Global Child Health, Vancouver, BC, Canada. 37Department of Pediatrics, Naval Medical Center San Diego and University of California San Diego School of Medicine, San Diego, CA. 38Department of Pediatrics and Pediatric Critical Care Medicine, The Valley Hospital, Ridgewood, NJ. 39Cardiothoracic ICU, National University Hospital, Singapore. 40Paediatric ICU, The Royal Children's Hospital, Melbourne, Australia. 41Department of Paediatrics, University of Melbourne, Melbourne, Australia. 42Children's Hospital of Pittsburgh, Pittsburgh, PA. 43Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA. 44Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI. 45Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA. 46Division of Emergency Medicine, Ann and Robert Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, IL. 47UCL Great Ormond Street Institute of Child Health and Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom. 48Pediatric Intensive Care and Emergency Services, Apollo Children's Hospital, Chennai, India. 49Division of Pediatric Critical Care, Department of Pediatrics, Duke University School of Nursing and School of Medicine, Durham, NC. 50Pediatrics School of Medicine, Austral University, Pcia de Buenos Aires, Argentina. 51Departments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. 52Critical Care and Transport, Nemours Children's Hospital, Orlando, FL. 53Department of Pediatrics, Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY. 54Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 55Departments of Pediatrics & Anesthesiology, Sinai Hospital/NAPA, Baltimore, MD. 56Department of Pediatrics, University of Maryland Medical School, Baltimore, MD.
    Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."

    Design: Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014). Read More

    Norepinephrine in septic shock: when and how much?
    Curr Opin Crit Care 2017 May 13. Epub 2017 May 13.
    aHôpitaux universitaires Paris-Sud, Hôpital Antoine Béclère, service de réanimation polyvalente, Clamart, France bDepartment of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands cHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale dINSERM UMR S_999, Univ Paris-Sud, Le Kremlin-Bicêtre, France.
    Purpose Of Review: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension because of depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension of when high doses of norepinephrine are required to reach the target.

    Recent Findings: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoid fluid overload. Read More

    Lethal Necrotizing Fasciitis Triggered by Plaster: Case Report and Review of Literature.
    J Orthop Case Rep 2016 Nov-Dec;6(5):73-75
    Department of Orthopaedics, V. S. Hospital, and N. H. L. Medical College, Ahmedabad, India.
    Introduction: Plasters have been frequently associated with known complications such as infection, and compartment syndrome or deep vein thrombosis. However, life-threatening complication of necrotizing fasciitis (NF) has not been frequently attributed to plaster.

    Case Report: We had a case of a 62-year male developing a lethal NF triggered by a below knee plaster for undisplaced fracture medial malleolus after twisting injury. Read More

    Elevation of Serum PARK7 and IL-8 Levels Is Associated With Acute Lung Injury in Patients With Severe Sepsis/Septic Shock.
    J Intensive Care Med 2017 Jan 1:885066617709689. Epub 2017 Jan 1.
    1 Department of Emergency, The First Affiliated Hospital of China Medical University, Liaoning, Shenyang, China.
    Objective: Methods containing only clinical information fail to meet the needs of prediction of acute lung injury (ALI) because of the relatively low positive predictive value. This study aimed to investigate the feasibility of using biomarkers as predictors of ALI in populations with severe sepsis/septic shock and to explore difference among biomarkers after adjustment for potential confounders.

    Methods: Serum specimens were collected from patients with severe sepsis/septic shock (n = 172) presented to the emergency department. Read More

    Red Blood Cell Transfusion and Surgical Site Infection After Colon Resection Surgery: A Cohort Study.
    Anesth Analg 2017 May 11. Epub 2017 May 11.
    From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
    Background: Surgical site infections (SSIs) after colon surgery remain a critical safety issue. Patients with an SSI have an increased risk of death, prolonged hospitalization, and increased costs of care. Red blood cell (RBC) transfusion is given during the perioperative period to increase blood oxygen delivery, but it is associated with complications, including infection. Read More

    Sirtuin 2 Regulates Microvascular Inflammation during Sepsis.
    J Immunol Res 2017 19;2017:2648946. Epub 2017 Apr 19.
    Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
    Objective. Sepsis and septic shock, the leading causes of death in noncoronary intensive care units, kill more than 200,000/year in the US alone. Circulating cell-endothelial cell interactions are the rate determining factor in sepsis inflammation. Read More

    Presepsin a Diagnostic Marker for Sepsis in Intensive Care Unit Patients.
    Egypt J Immunol 2016 Jun;23(2):109-118
    Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
    The aim of the study was to evaluate the usefulness of presepsin as a diagnostic marker of sepsis in intensive care unit (ICU) patients. Presepsin was measured by a rapid method based on a chemiluminescent enzyme immunoassay (PATHFAST). The clinical usefulness of presepsin to diagnose sepsis and septic shock was studied and compared with procalcitonin, C-reactive protein and total leucocytic count. Read More

    Kinetics of circulating fetuin-A may predict mortality independently from adiponectin, high molecular weight adiponectin and prognostic factors in critically ill patients with sepsis: A prospective study.
    J Crit Care 2017 May 6;41:78-85. Epub 2017 May 6.
    Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Laboratory of Clinical Biochemistry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Haidari, Greece. Electronic address:
    Purpose: Fetuin-A and adiponectin, major hepatokine and adipokine respectively, have been implicated in systematic inflammation. Our aim was to jointly investigate whether kinetics of circulating fetuin-A, adiponectin and its isoform HMWA predict 28-day mortality in sepsis.

    Materials And Methods: In a prospective study, serum fetuin-A, adiponectin and HMWA were determined in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS-3, at enrollment and one week after, and in 102 healthy controls matched on age and gender. Read More

    Impact of severe hematological abnormalities in the outcome of hospitalized patients with influenza virus infection.
    Eur J Clin Microbiol Infect Dis 2017 May 13. Epub 2017 May 13.
    Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain.
    Although hematological abnormalities have been described among patients with influenza virus infection, little is known about their impact on the outcome of the patients. The aim of this study was to assess the frequency and clinical impact of severe hematological abnormalities in patients with confirmed influenza virus infection. This was an observational retrospective study including all adult patients with diagnosis of influenza virus infection hospitalized from January to May 2016 in our institution. Read More

    The intensive care medicine research agenda on septic shock.
    Intensive Care Med 2017 May 12. Epub 2017 May 12.
    Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom.
    Septic shock remains a global health challenge with millions of cases every year, high rates of mortality and morbidity, impaired quality of life among survivors and relatives, and high resource use both in developed and developing nations. Care and outcomes are improving through organisational initiatives and updated clinical practice guidelines based on clinical research mainly carried out by large collaborative networks. This progress is likely to continue through the collaborative work of the established and merging trials groups in many parts of the world and through refined trial methodology and translational work. Read More

    Analysis and modeling of septic shock microarray data using Singular Value Decomposition.
    J Biomed Inform 2017 May 9. Epub 2017 May 9.
    Department of Aerospace Engineering, Indian Institute of Technology Madras, Chennai 600 036, India.
    Being a high throughput technique, enormous amounts of microarray data has been generated and there arises a need for more efficient techniques of analysis, in terms of speed and accuracy. Finding the differentially expressed genes based on just fold change and p-value might not extract all the vital biological signals that occur at a lower gene expression level. Besides this, numerous mathematical models have been generated to predict the clinical outcome from microarray data, while very few, if not none, aim at predicting the vital genes that are important in a disease progression. Read More

    Dispatch and prehospital transport for acute septic patients: an observational study.
    Scand J Trauma Resusc Emerg Med 2017 May 12;25(1):51. Epub 2017 May 12.
    Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark & Odense University Hospital, Odense, C DK-5000, Denmark.
    Background: In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system. Read More

    Time course of blood lactate levels, inflammation, and mitochondrial function in experimental sepsis.
    Crit Care 2017 May 12;21(1):105. Epub 2017 May 12.
    Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
    Background: A decrease in blood lactate levels (Lac) >10% during the first hours of resuscitation in sepsis is associated with better outcomes, but the mechanisms are unclear. Our objective was to investigate the relationship between the time course of Lac, inflammatory response, and mitochondrial respiration during experimental sepsis.

    Methods: Original data from two previously published studies were reanalyzed. Read More

    High Frequency of Neuroimaging Abnormalities Among Pediatric Patients With Sepsis Who Undergo Neuroimaging.
    Pediatr Crit Care Med 2017 May 11. Epub 2017 May 11.
    1Division of Pediatric Critical Care, University of Louisville, Norton Children's Hospital, Louisville, KY. 2Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH. 4Division of Neuroradiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 6Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
    Objectives: This study was intended to describe and correlate the neuroimaging findings in pediatric patients after sepsis.

    Design: Retrospective chart review.

    Setting: Single tertiary care PICU. Read More

    [New Sepsis-3 definition : Do we have to treat sepsis before we can diagnose it from now on?]
    Anaesthesist 2017 May 11. Epub 2017 May 11.
    Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
    The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) have been available since the beginning of 2016. SEPSIS-3 completely replaces the old SIRS criteria in the definition of sepsis and defines sepsis from now on as "life-threatening organ dysfunction caused by a dysregulated host response to infection". However, it seems questionable whether in clinical practice the new definition is really superior to the old one. Read More

    Levosimendan does not provide mortality benefit over dobutamine in adult patients with septic shock: A meta-analysis of randomized controlled trials.
    J Clin Anesth 2017 Jun 30;39:67-72. Epub 2017 Mar 30.
    Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.
    Objectives: Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock. Read More

    Platelet desialylation is a novel mechanism and a therapeutic target in thrombocytopenia during sepsis: an open-label, multicenter, randomized controlled trial.
    J Hematol Oncol 2017 May 11;10(1):104. Epub 2017 May 11.
    Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China.
    Background: Studies in murine models suggested that platelet desialylation was an important mechanism of thrombocytopenia during sepsis.

    Methods: First, we performed a prospective, multicenter, observational study that enrolled septic patients with or without thrombocytopenia to determine the association between platelet desialylation and thrombocytopenia in patients with sepsis, severe sepsis, and septic shock. Gender- and age-matched healthy adults were selected as normal controls in analysis of the platelet desialylation levels (study I). Read More

    Candidemia in the elderly: What does it change?
    PLoS One 2017 11;12(5):e0176576. Epub 2017 May 11.
    Laboratorio di Microbiologia, Azienda Ospedaliero Universitaria, Ospedali Riuniti Umberto I°-G.M. Lancisi-G. Salesi, Ancona, Italy.
    Background: Candidemia is a life-threatening fungal infection and it can affect patients of all ages. Characterization of candidemia in the elderly is lacking.

    Methods: We performed a retrospective study of adults (≥ 18 years) with candidemia diagnosed in our center in 2010-2015. Read More

    Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review.
    PLoS Negl Trop Dis 2017 May 11;11(5):e0005603. Epub 2017 May 11.
    Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
    Background: Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. Read More

    The Prognostic Value of Central Venous-to-Arterial CO2 Difference/Arterial-Central Venous O2 Difference Ratio in Septic Shock Patients with Central Venous O2 Saturation ≥80.
    Shock 2017 May 10. Epub 2017 May 10.
    Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
    Background: It is a great challenge for physician to assess the relationship between O2 delivery and O2 consumption in septic shock patients with high ScvO2. Recently, the venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio (P(v-a)CO2/C(a-v)O2) has shown potential for reflecting anaerobic metabolism. Therefore, we evaluated the value of using the P(v-a)CO2/C(a-v)O2 ratio to predict mortality and assess anaerobic metabolism in septic shock patients with high ScvO2 (≥ 80%). Read More

    Elderly versus non-elderly patients with intra-abdominal candidiasis in the ICU.
    Minerva Anestesiol 2017 May 11. Epub 2017 May 11.
    Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy.
    Background: Intra-abdominal candidiasis (IAC) has a considerable cost in terms of mortality and morbidity. We sought to study the epidemiology, characteristics and outcome of elderly (>75 years old) versus non-elderly patients with IAC and risk factors for mortality in elderly patients.

    Methods: Post-hoc analysis of a retrospective multinational cohort study over a 3- year period (2011-2013). Read More

    Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study.
    S Afr Med J 2017 Apr 25;107(5):411-419. Epub 2017 Apr 25.
    Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
    Background: Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries.

    Objective: To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). Read More

    Toxic shock syndrome due to community-acquired methicillin-resistant Staphylococcus aureus infection: Two case reports and a literature review in Japan.
    IDCases 2017 25;8:77-80. Epub 2017 Apr 25.
    Department of General Internal Medicine, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
    Community-acquired methicillin-resistant Staphylococcus aureus has been spreading worldwide, including in Japan. However, few cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus have been reported in Japan. We report 2 cases, in middle-aged women, of toxic shock syndrome due to Community-acquired methicillin-resistant Staphylococcus aureus via a vaginal portal of entry. Read More

    Complement C5a Functions as a Master Switch for the pH Balance in Neutrophils Exerting Fundamental Immunometabolic Effects.
    J Immunol 2017 May 10. Epub 2017 May 10.
    Institute of Clinical and Experimental Trauma-Immunology, University Hospital Ulm, 89081 Ulm, Germany;
    During sepsis, excessive activation of the complement system with generation of the anaphylatoxin C5a results in profound disturbances in crucial neutrophil functions. Moreover, because neutrophil activity is highly dependent on intracellular pH (pHi), we propose a direct mechanistic link between complement activation and neutrophil pHi In this article, we demonstrate that in vitro exposure of human neutrophils to C5a significantly increased pHi by selective activation of the sodium/hydrogen exchanger. Upstream signaling of C5a-mediated intracellular alkalinization was dependent on C5aR1, intracellular calcium, protein kinase C, and calmodulin, and downstream signaling regulated the release of antibacterial myeloperoxidase and lactoferrin. Read More

    ALK-positive anaplastic large cell lymphoma undiagnosed in a patient with tuberculosis: a case report and review of the literature.
    J Med Case Rep 2017 May 11;11(1):132. Epub 2017 May 11.
    Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Background: Due to a similarity between the features of lymphoma and the features of tuberculosis, lymphoma may go unrecognized and undiagnosed in patients with tuberculosis.

    Case Presentation: A 33-year-old Thai man presented to our center with typical clinical manifestations of tuberculous lymphadenitis, with negative tests for both acid-fast bacilli and fungi, and negative polymerase chain reaction for Mycobacterial tuberculosis complex. The disease was not responding to anti-tuberculosis treatment and he developed both pericardial effusion and progressive lymphadenopathy. Read More

    [The 2016 Surviving Sepsis Campaign sepsis guideline].
    Med Klin Intensivmed Notfmed 2017 May 9. Epub 2017 May 9.
    Medizinische Klinik 4, Intensivmedizin, Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland.
    Sepsis is still associated with very high morbidity and mortality. Continuous improvements in the early recognition and management of this syndrome are thus necessary. The 2016 Surviving Sepsis Campaign sepsis guideline presents current evidence and consequences in the management of sepsis. Read More

    Deriving literature-based benchmarks for surgical complications in high-income countries: a protocol for a systematic review and meta-analysis.
    BMJ Open 2017 May 9;7(5):e013780. Epub 2017 May 9.
    Ariadne Labs, Boston, Massachusetts, USA.
    Introduction: To improve surgical safety, health systems must identify preventable adverse outcomes and measure changes in these outcomes in response to quality improvement initiatives. This requires understanding of the scope and limitations of available population-level data. To derive literature-based summary estimates of benchmarks of care, we will systematically review and meta-analyse rates of postoperative complications associated with several common and/or high-risk operations performed in five high-income countries (HICs). Read More

    Prognostic factors of infective endocarditis in patients on hemodialysis: A case series from a National Multicenter Registry.
    Int J Cardiol 2017 Apr 29. Epub 2017 Apr 29.
    Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; Francisco de Vitoria University, Madrid, Spain. Electronic address:
    Background: Infective endocarditis (IE) is a severe complication associated with high mortality.

    Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD.

    Methods: From January 2008 to April 2015, 2488 consecutive patients with definite IE were included. Read More

    A Novel Porcine Model of Septic Shock Induced by Acute Respiratory Distress Syndrome due to Methicillin-resistant Staphylococcus aureus.
    Chin Med J (Engl) 2017 May;130(10):1226-1235
    Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China.
    Background: Sepsis is one of the main causes of mortality in critically ill patients following progression to septic shock. To investigate the pathophysiologic changes of sepsis, we developed a novel porcine model of septic shock induced by acute respiratory distress syndrome (ARDS) due to methicillin-resistant Staphylococcus aureus(MRSA) pneumonia.

    Methods: Twenty-six male Landraces (Lvyuanweiye, Beijing, China) weighing 30 ± 2 kg were divided into four groups: sham group (SH; n = 5); cotton smoke inhalation group (SM; n = 6); MRSA pneumonia group (MR; n = 6); and septic shock group with cotton smoke inhalation + MRSA pneumonia (SS; n = 9). Read More

    Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock.
    Chin Med J (Engl) 2017 May;130(10):1189-1195
    Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China.
    Background: The normal range of red cell distribution width (RDW) level is <15%. Several studies have indicated that a high RDW level was associated with mortality in critically ill patients, and the patients with a high RDW level need increased focus in clinical practice. In view of the difficulty in defining the specific value of high RDW level, the key is to focus on the patient with the level beyond the normal upper limit. Read More

    Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction: A Case-control Study.
    Chin Med J (Engl) 2017 May;130(10):1169-1174
    Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
    Background: Septic cardiomyopathy is a common finding in septic shock patients. The accepted definition of septic cardiomyopathy is often based on the left ventricular ejection fraction (LVEF). The aim of this study was to determine whether the left ventricular longitudinal systolic function was more sensitive than the LVEF in heart function appraisal of septic shock patients. Read More

    Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments: A Multicenter Prospective Cohort Study.
    Chin Med J (Engl) 2017 May;130(10):1146-1154
    Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China.
    Background: Shock is a life-threatening condition in emergency departments (EDs) and is associated with a high mortality; however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs.

    Methods: This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Read More

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