Purpose
The EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA ≥ 0.60. No difference was found in 28-day ...all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA ≥ 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0.6–0.89.
Methods
Post-hoc analysis of the EUPHRATES trial for the 194 patients with EAA ≥ 0.6–0.89 who completed two treatments (PMX or sham). The primary end point was mortality at 28 days adjusted for APACHE II score and baseline mean arterial pressure (MAP). Additional end points included changes in MAP, cumulative vasopressor index (CVI), median EAA reduction, ventilator-free days (VFD), dialysis-free days (DFD) and hospital length of stay. Subpopulations analyzed were site and type of infection and those with norepinephrine dose > 0.1 mcg/kg/min at baseline.
Results
At 28 days, 23 patients of 88 (26.1%) in the PMX group died versus 39 of 106 (36.8%) in the sham group risk difference 10.7%, OR 0.52, 95% CI (0.27, 0.99),
P
= 0.047. When unadjusted for baseline variables,
P
= 0.11. The 28-day survival time in the PMX group was longer than for the sham group HR 0.56 (95% CI 0.33, 0.95)
P
= 0.03. PMX treatment compared with sham showed greater change in MAP median (IQR) 8 mmHg (− 0.5, 19.5) vs. 4 mmHg (− 4.0, 11)
P
= 0.04 and VFD median (IQR) 20 days (0.5, 23.5) vs. 6 days (0, 20),
P
= 0.004. There were no significant differences in other end points. There was a significant difference in mortality in PMX-treated patients with no bacterial growth on culture PMX, 6/30 (20%) vs. sham, 13/31 (41.9%),
P
= 0.005. The median EAA change in the population was − 12.9% (range: increase 49.2%–reduction 86.3%). The mortality in the above median EAA change group was PMX: 6/38 (15.7%) vs. sham 15/49 (30.6%),
P
= 0.08.
Conclusions
These hypothesis-generating results, based on an exploratory post hoc analysis of the EUPHRATES trial, suggest measurable responses in patients with septic shock and an EAA ≥ 0.6 to 0.89 on changes in mean arterial pressure, ventilator-free days and mortality.
Trial registration
Clinicaltrials.gov Identifier: NCT01046669. Funding Spectral Medical Incorporated.
The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI ...syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
Antimicrobial Resistance in ESKAPE Pathogens De Oliveira, David M P; Forde, Brian M; Kidd, Timothy J ...
Clinical microbiology reviews,
06/2020, Letnik:
33, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Antimicrobial-resistant ESKAPE (
,
,
,
,
, and
species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the ...treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
Imaging intact human organs from the organ to the cellular scale in three dimensions is a goal of biomedical imaging. To meet this challenge, we developed hierarchical phase-contrast tomography ...(HiP-CT), an X-ray phase propagation technique using the European Synchrotron Radiation Facility (ESRF)'s Extremely Brilliant Source (EBS). The spatial coherence of the ESRF-EBS combined with our beamline equipment, sample preparation and scanning developments enabled us to perform non-destructive, three-dimensional (3D) scans with hierarchically increasing resolution at any location in whole human organs. We applied HiP-CT to image five intact human organ types: brain, lung, heart, kidney and spleen. HiP-CT provided a structural overview of each whole organ followed by multiple higher-resolution volumes of interest, capturing organotypic functional units and certain individual specialized cells within intact human organs. We demonstrate the potential applications of HiP-CT through quantification and morphometry of glomeruli in an intact human kidney and identification of regional changes in the tissue architecture in a lung from a deceased donor with coronavirus disease 2019 (COVID-19).
Integration of quasi-two-dimensional (2D) films of metal–chalcogenides in optical microcavities permits new photonic applications of these materials. Here we present tunable microcavities with ...monolayer MoS2 or few monolayer GaSe films. We observe significant modification of spectral and temporal properties of photoluminescence (PL): PL is emitted in spectrally narrow and wavelength-tunable cavity modes with quality factors up to 7400; a 10-fold PL lifetime shortening is achieved, a consequence of Purcell enhancement of the spontaneous emission rate.
Highly nonlinear optical materials with strong effective photon-photon interactions are required for ultrafast and quantum optical signal processing circuitry. Here we report strong Kerr-like ...nonlinearities by employing efficient optical transitions of charged excitons (trions) observed in semiconducting transition metal dichalcogenides (TMDCs). By hybridising trions in monolayer MoSe
at low electron densities with a microcavity mode, we realise trion-polaritons exhibiting significant energy shifts at small photon fluxes due to phase space filling. We find the ratio of trion- to neutral exciton-polariton interaction strength is in the range from 10 to 100 in TMDC materials and that trion-polariton nonlinearity is comparable to that in other polariton systems. The results are in good agreement with a theory accounting for the composite nature of excitons and trions and deviation of their statistics from that of ideal bosons and fermions. Our findings open a way to scalable quantum optics applications with TMDCs.
We study exciton-polariton nonlinear optical fluids in the high momentum waveguide regime for the first time. We demonstrate the formation of dark solitons with the expected dependence of width on ...fluid density for both main classes of soliton-forming fluid defects. The results are well described by numerical modeling of the fluid propagation. We deduce a continuous wave nonlinearity more than ten times that on picosecond time scales, arising due to interaction with the exciton reservoir.
Resonant inelastic x-ray scattering is used to investigate the electronic origin of orbital polarization in nickelate heterostructures taking LaTiO_{3}-LaNiO_{3}-3×(LaAlO_{3}), a system with ...exceptionally large polarization, as a model system. We find that heterostructuring generates only minor changes in the Ni 3d orbital energy levels, contradicting the often-invoked picture in which changes in orbital energy levels generate orbital polarization. Instead, O K-edge x-ray absorption spectroscopy demonstrates that orbital polarization is caused by an anisotropic reconstruction of the oxygen ligand hole states. This provides an explanation for the limited success of theoretical predictions based on tuning orbital energy levels and implies that future theories should focus on anisotropic hybridization as the most effective means to drive large changes in electronic structure and realize novel emergent phenomena.
Two-Photon Three-Dimensional Optical Storage Memory Dvornikov, A. S; Walker, E. P; Rentzepis, P. M
The journal of physical chemistry. A, Molecules, spectroscopy, kinetics, environment, & general theory,
12/2009, Letnik:
113, Številka:
49
Journal Article
Recenzirano
We describe the design and construction of ultrahigh capacity three-dimensional, 3D, optical storage devices that operate by two-photon absorption. The molecular systems and their properties that are ...used as two photon media for writing and one photon for accessing the stored information within the volume of the device are presented in some detail and the nonlinear two-photon absorption mechanism is briefly visited. The optical system and its components, which facilitated writing and reading, are also described and the bit density, bit error rate, store and access speeds, cycle times, and stability of the materials under various experimental conditions are also topics addressed in this review. The first ever storage of terabyte data in a removable storage disk is described in detail.
We study exciton polaritons in a two-dimensional Lieb lattice of micropillars. The energy spectrum of the system features two flat bands formed from S and P_{x,y} photonic orbitals, into which we ...trigger bosonic condensation under high power excitation. The symmetry of the orbital wave functions combined with photonic spin-orbit coupling gives rise to emission patterns with pseudospin texture in the flat band condensates. Our Letter shows the potential of polariton lattices for emulating flat band Hamiltonians with spin-orbit coupling, orbital degrees of freedom, and interactions.
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