Anidulafungin concentrations were quantified with high-pressure liquid chromatography (HPLC) and UV detection of the ascites fluid and pleural effusion of 10 adult critically ill patients. Samples ...were collected from ascites fluid and from pleural drains or during paracentesis and thoracentesis, respectively. Anidulafungin levels in ascites fluid (0.12 to 0.99 μg/ml) and in pleural effusion (0.32 to 2.02 μg/ml) were below the simultaneous levels in plasma (1.04 to 7.70 and 2.48 to 13.36 μg/ml, respectively) and below the MIC values for several pathogenic
strains.
Summary
Background
The lymphocyte‐to‐monocyte ratio (LMR) is easily determined from the white blood cell count. Lymphocytes were previously investigated as a part of the neutrophil‐to‐lymphocyte ...ratio (NLR) in patients with atherosclerotic disease and an elevated NLR was negatively associated with cardiovascular endpoints. As monocytes play a leading role in the progression of atherosclerosis, especially in peripheral arterial occlusive disease (PAOD), we investigated LMR and its association with critical limb ischemia and other vascular endpoints in PAOD patients.
Methods and Findings
We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. LMR was calculated and the cohort was divided into tertiles according to the LMR. An optimal cut‐off value for the continuous LMR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non‐CLI.
In our cohort occurrence of CLI decreased significantly with an increase in LMR. An LMR of 3.1 was identified as an optimal cut‐off. Two groups were categorized, one with 1021 patients (LMR < 3.1) and a second one with 1100 patients (LMR ≥ 3.1). CLI was more frequent in LMR < 3.1 patients 426 (41.7%) than in LMR ≥ 3.1 patients 254 (23.1%) (p < 0.001), as was also the case with prior myocardial infarction 60 (9.5%) vs. 35 (3.2%), p = 0.003 and congestive heart failure 136 (13.3%) vs. 66 (6.0%), p < 0.001). As to inflammatory parameters, C‐reactive protein median 9.0 mg/l (4.0–30.0) vs. median 4.0 mg/l (2.0–8.0) and fibrinogen (median 438 mg/dl (350–563) vs. 372 mg/dl (316–459.5) also differed significantly in the two patient groups (both p < 0.001). A LMR < 3.1 was associated with an odds ratio (OR) of 2.0 (95% CI 1.8–2.2, p < 0.001) for CLI, even after adjustment for other vascular risk factors.
Conclusions
A decreased LMR is significantly associated with a high risk for CLI and other vascular endpoints. The LMR is an easily determinable, broadly available and inexpensive marker that could be used to identify patients at high risk for vascular endpoints.
A 56-year-old woman was found unconscious and promptly intubated. The electrocardiogram showed ST elevations in I, aVL, V1-V4. Thus, lysis therapy was performed. After admission to the intensive care ...unit, the patient was reassessed. Laboratory evaluation confirmed elevated troponin T. However, coronary angiography showed no coronary artery disease, whereas cerebral computed tomography revealed massive intracranial hemorrhage without neurosurgical treatment option. Brain death was confirmed after 54 hours. This case highlights electrocardiographic changes in intracranial hemorrhage that may be masquerading as STEMI.
With neutrino astronomy on the rise, calibration aspects of large-volume detectors are becoming one of the key targets to boost detector performance. In the scope of the IceCube Upgrade planned for ...the South Pole season of 2022/23, we developed a novel, isotropic, self-monitoring, precision calibration light source. We present the device characteristics as well as first studies of calibration impacts for different detection environments.
We present a case of a fetus acquiring two different balanced translocations from each parent and subsequent uniparental isodisomy from postzygotic loss of a paternal chromosome. Balanced chromosomal ...translocations occur in 0.14% of the population and increase the risk of other genetic abnormalities, such as uniparental disomy (UPD) and mosaicism. Preimplantation genetic testing (PGT) can identify some genetic abnormalities. Translocations t(6;21) and t(5;15) have been reported individually but never together in a viable fetus. A non-consanguineous couple who were known carriers of two different balanced translocations conceived via classic in vitro fertilization (IVF). They had a normal PGT completed. Chorionic villus sampling (CVS) revealed that the fetus had received t(6;21) from the mother and t(5;15) from the father. The probability of the fetus acquiring both translocations was 2.8%. CVS also revealed UPD of chromosome 14. Amniocentesis was performed, which was consistent with the CVS in detecting the balanced translocations but provided more information about the UPD, determining that it was a mosaic maternal uniparental isodisomy of chromosome 14 (UPD(14)mat). The couple underwent genetic counseling to discuss the above findings and ultimately decided on dilation and evacuation at 17 weeks of gestation. The likelihood of conception of this fetus and survival past the first trimester is extremely rare. These specific chromosomal translocations and (UPD(14)mat) have never been reported before. This case emphasizes the concomitant nature of imprinted genes, resulting in multiple genetically unique alterations. This report also highlights the limitations of PGT, CVS, and amniocentesis in being reproducibly consistent, which is important to discuss prior to IVF conception.
Relatives of intensive care patients have a very high need for information. This is due to the acute and serious, often life-threatening illness of the patients and the very complex and technical ...environment of an intensive care unit (ICU). Unmet needs for information can increase anxiety, sleep disorders, stress, and depressive symptoms in the relatives.
The potential of the ICU families website in terms of usability and functionality during real-time testing were evaluated.
The ICU families project created a dynamic online information platform in the form of a password-protected website. It contains pictures, written explanations, 5 movies, a forum and a diary function. The usability of the website was tested among 10 lay people and 10 experts (7 nurses and 3 physicians) according to the Think Aloud Method.
The outcome is qualitative feedback based on video documentation by laypeople and suggestions by experts. Criticisms mentioned by the test subjects were insufficient image material, small size of the operator contact link and lack of a home button. With a mean of 9.1 (rating scale, 0 = very poor, 10 = very good), the website was almost universally recommended by the experts.
This usability test of a website for relatives of ICU patients conducted among 20 test subjects showed the biggest challenges related to solving individual test scenarios and provided valuable hints for improving website usability. Features of the website highlighted as positive were the clear layout, the symbols, the diary and the consideration of children. This information was used to improve the site for subsequent roll-out in a randomized, controlled and multicentre study.
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