We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to ...septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay EAA 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin®, Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA <0.4). However, after 48 h, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 from admission. Continuous cytokine hemoadsorption (Cytosorb®, Cytosorbent Corporation, Monmouth Junction, NJ, USA) was incorporated into a VA-ECMO circuit for 48 h without a considerable improvement. For this reason, a 72-h continuous veno-venous hemodialysis session was started in which a high cutoff filter was used. Tachycardia and myocardial dysfunction improved by day 6, and VA-ECMO was withdrawn on the tenth day. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to the department of respiratory medicine on day 80, he was discharged from our hospital on day 113. Sequential extracorporeal therapy may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic shock using catecholamines and blockers.
Este artículo aborda un corpus de cuatro cortos de animación provenientes de Centroamérica, puntualmente de El Salvador y Honduras, a fin de analizar cómo representan la violencia armada a partir de ...la apelación a elementos residuales de la guerra. La propuesta pretende, por un lado, demostrar que el trabajo con la animación amplía la reflexión acerca de la representación del conflicto armado en términos estéticos e históricos; y por el otro, se inscribe en una tradición regional del audiovisual emergido desde los “escombros” de las guerras que al reelaborarlos los dota de nuevas significaciones. Tales sentidos revelan claramente un discurso antibelicista, a la vez que propician en el espectador una conexión íntima —es decir, significativa pero también sensible, afectiva y personal— con los hechos y los relatos de violencia que impregnan la historia reciente de América Central.
The new polyurethane/cellulose acetate/magnetic iron oxide nanoparticles composites synthesised presented potential for use as sorbents of mineral oil. The composite synthesised in homogeneous medium ...in the presence of magnetite nanoparticles presented higher oil sorption capacity than composite synthesised in heterogeneous medium for all analysed conditions, and the values obtained, 9.6 ± 0.1 and 12.2 ± 0.5 grams of oil per gram of sorbent, wet and dry dynamic media, respectively, were comparable to those exhibited by commercial products. In addition, the magnetite facilitates the separation of the composite after the sorption process by external magnetic field.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Hemoperfusion (HP) is an extracorporeal blood purification therapy that is used to remove poisons or drugs from the body. This chapter provides a brief overview of the technical aspects and the ...potential indications and limitations of HP, with the focus being on the use of HP for acute poisoning cases reported from January 1, 2000, to April 30, 2022.
Sepsis is a life-threatening syndrome initiated by a dysregulated host response to infection. Maladaptive inflammatory burst damages host tissues and causes organ dysfunction, the burden of which has ...been demonstrated as the paramount predictor of worse clinical outcomes. In this setting, septic shock represents the most lethal complication of sepsis and implies profound alterations of both the cardiovascular system and cellular metabolism with consequent high mortality rate. Although an increasing amount of evidence attempts to characterize this clinical condition, the complexity of multiple interconnections between underlying pathophysiological pathways requires further investigations. Accordingly, most therapeutic interventions remain purely supportive and should be integrated in light of the continuous organ cross-talk, in order to match a patient's specific needs. In this context, different organ supports may be combined to replace multiple organ dysfunctions through the application of sequential extracorporeal therapy in sepsis (SETS). In this chapter, we provide an overview of sepsis-induced organ dysfunction, focusing on the pathophysiological pathways that are triggered by endotoxin. Based on the need to apply specific blood purification techniques in specific time windows with different targets, we suggest a sequence of extracorporeal therapies. Accordingly, we reported the hypothesis that sepsis-induced organ dysfunction may benefit the most from SETS. Finally, we point out basic principles of this innovative approach and describe a multifunctional platform that allows SETS, in order to make clinicians aware of this new therapeutic frontier for critically ill patients.
Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. ...Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum.
The degree to which a fault will impede fluid flow is only as great as its most permeable point. Processes that determine areas of the fault surface containing transmissible fault rocks must be ...utilized to produce reliable predictions of cross-fault fluid flow. We use a study site in Miri, Malaysia, to investigate in detail the fault-core thickness variations along-strike and down dip, and to quantify the risk of discontinuities in the clay-rich fault core.
Four fault-core types have been identified: foliated clay-rich fault core, chaotic clay-rich fault core, anastomosing sandy shear zones and sandy breccia. We performed a geostatistical analysis, showing a correlation over 3 m scale, suggesting the presence of ‘patches’ of thin and thick fault core generally less than 3 m in length in profile.
We interpret this geometry as superimposition of two or more different deformation processes at a smaller and a larger scale. We speculate about the processes that could produce the observed distribution of thickness and composition, and in particular, processes that could have disrupted the through-going clay-rich core.
•We present a rare example of a well exposed 100 m strike-section of a normal fault.•The fault core shows strong variations in fault core thickness and composition.•There are two sand-dominated, high-permeability ‘holes’ in the clay-rich fault core.•Spatial statistics of along-strike core thickness shows a correlation length of 3 m.•This fault must have undergone processes that disrupted the clay-rich fault core.
Background
The baseline endotoxin activity (EAT0) may predict the outcome of critically ill septic patients who receive Polymyxin‐B hemadsorption (PMX‐HA), however, the clinical implications of ...specific EA trends remain unknown.
Methods
Subgroup analysis of the prospective, multicenter, observational study EUPHAS2. We included 50 critically ill patients with septic shock and EAT0 ≥ 0.6, who received PMX‐HA. The primary outcome of the study was the EA and SOFA score progression from T0 to 120 h afterwards (T120). Secondary outcomes included the EA and SOFA score progression in whom had EA at 48 h (EAT48) < 0.6 (EA responders, EA‐R) versus who had not (EA non‐responders, EA‐NR).
Results
Septic shock was mainly caused by 27 abdominal (54%) and 17 pulmonary (34%) infections, predominantly due to Gram negative bacteria (39 patients, 78%). The SAPS II score was 67.5 52.8–82.3 and predicted a mortality rate of 75%. Between T0 and T120, the EA decreased (p < 0.001), while the SOFA score and the Inotropic Score (IS) improved (p < 0.001). In comparison with EA‐NR (18 patients, 47%), the EA‐R group (23 patients, 53%) showed faster IS improvement and lower requirement of continuous renal replacement therapy (CRRT) during the ICU stay. Overall hospital mortality occurred in 18 patients (36%).
Conclusions
In critically ill patients with septic shock and EAT0 ≥ 0.6 who received PMX‐HA, EA decreased and SOFA score improved over 120 h. In whom high EA resolved within 48 h, IS improvement was faster and CRRT requirement was lower compared with patients with EAT48 ≥ 0.6.
In critically ill patients with septic shock and high endotoxin activity (EA) at baseline who received Polymyxin‐B hemadsorption (PMX‐HA), this biomarker decreased while SOFA, RIFLE, and Inotropic Score (IS) improved over 120 h. Patients with EA below 0.6 at 48 h (EA responders, EA‐R) had faster IS decrease and required less CRRT over the ICU stay compared with whom EA was still high at this timepoint (EA non‐responders, EA‐NR).
Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes, including an increased risk of chronic kidney disease, ...cardiovascular events and death. The pathophysiology of SA-AKI remains elusive, although microcirculatory dysfunction, cellular metabolic reprogramming and dysregulated inflammatory responses have been implicated in preclinical studies. SA-AKI is best defined as the occurrence of AKI within 7 days of sepsis onset (diagnosed according to Kidney Disease Improving Global Outcome criteria and Sepsis 3 criteria, respectively). Improving outcomes in SA-AKI is challenging, as patients can present with either clinical or subclinical AKI. Early identification of patients at risk of AKI, or at risk of progressing to severe and/or persistent AKI, is crucial to the timely initiation of adequate supportive measures, including limiting further insults to the kidney. Accordingly, the discovery of biomarkers associated with AKI that can aid in early diagnosis is an area of intensive investigation. Additionally, high-quality evidence on best-practice care of patients with AKI, sepsis and SA-AKI has continued to accrue. Although specific therapeutic options are limited, several clinical trials have evaluated the use of care bundles and extracorporeal techniques as potential therapeutic approaches. Here we provide graded recommendations for managing SA-AKI and highlight priorities for future research.
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