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[PMID]: 26246141
[Au] Autor:Nacionales DC; Szpila B; Ungaro R; Lopez MC; Zhang J; Gentile LF; Cuenca AL; Vanzant E; Mathias B; Jyot J; Westerveld D; Bihorac A; Joseph A; Mohr A; Duckworth LV; Moore FA; Baker HV; Leeuwenburgh C; Moldawer LL; Brakenridge S; Efron PA
[Ad] Address:Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610;...
[Ti] Title:A Detailed Characterization of the Dysfunctional Immunity and Abnormal Myelopoiesis Induced by Severe Shock and Trauma in the Aged.
[So] Source:J Immunol;195(5):2396-407, 2015 Sep 1.
[Is] ISSN:1550-6606
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The elderly are particularly susceptible to trauma, and their outcomes are frequently dismal. Such patients often have complicated clinical courses and ultimately die of infection and sepsis. Recent research has revealed that although elderly subjects have increased baseline inflammation as compared with their younger counterparts, the elderly do not respond to severe infection or injury with an exaggerated inflammatory response. Initial retrospective analysis of clinical data from the Glue Grant trauma database demonstrated that despite a similar frequency, elderly trauma patients have worse outcomes to pneumonia than younger subjects do. Subsequent analysis with a murine trauma model also demonstrated that elderly mice had increased mortality after posttrauma Pseudomonas pneumonia. Blood, bone marrow, and bronchoalveolar lavage sample analyses from juvenile and 20-24-mo-old mice showed that increased mortality to trauma combined with secondary infection in the aged are not due to an exaggerated inflammatory response. Rather, they are due to a failure of bone marrow progenitors, blood neutrophils, and bronchoalveolar lavage cells to initiate and complete an emergency myelopoietic response, engendering myeloid cells that fail to clear secondary infection. In addition, elderly people appeared unable to resolve their inflammatory response to severe injury effectively.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.4049/jimmunol.1500984

  2 / 92699 MEDLINE  
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[PMID]: 26254472
[Au] Autor:Verbakel JY; Lemiengre MB; De Burghgraeve T; De Sutter A; Aertgeerts B; Bullens DM; Shinkins B; Van den Bruel A; Buntinx F
[Ad] Address:Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK....
[Ti] Title:Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.
[So] Source:BMJ Open;5(8):e008657, 2015.
[Is] ISSN:2044-6055
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population. DESIGN: Diagnostic accuracy study validating a clinical prediction rule. SETTING AND PARTICIPANTS: Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department. INTERVENTION: Physicians were asked to score the decision tree in every child. PRIMARY OUTCOME MEASURES: The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values. RESULTS: In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%. CONCLUSIONS: In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. TRIAL REGISTRATION NUMBER: NCT02024282.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1136/bmjopen-2015-008657

  3 / 92699 MEDLINE  
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[PMID]: 26250834
[Au] Autor:Yang Y; Sun L; Liu N; Hou X; Wang H; Jia M
[Ad] Address:Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China (mainland)....
[Ti] Title:Effects of Noninvasive Positive-Pressure Ventilation with Different Interfaces in Patients with Hypoxemia after Surgery for Stanford Type A Aortic Dissection.
[So] Source:Med Sci Monit;21:2294-304, 2015.
[Is] ISSN:1643-3750
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND Hypoxemia is a severe perioperative complication that can substantially increase intensive care unit and hospital stay and mortality. The aim of this study was to determine the effects of non-invasive positive-pressure ventilation (NIPPV) in patients with hypoxemia after surgery for Stanford type A aortic dissection, and to compare the effects of helmet and mask NIPPV. MATERIAL AND METHODS We recruited 40 patients who developed hypoxemia within 24 h after extubation after surgery for Stanford type A aortic dissection in the Beijing Anzhen Hospital. The patients were randomly divided into the helmet and mask NIPPV groups. The primary endpoints were blood oxygenation levels at 1 and 6 h after initiation and at the end of the treatment. The secondary endpoint was patient outcome, including mortality; incidence of pulmonary atelectasis, pneumonia, re-intubation, and sepsis; and length of ICU and hospital stays. RESULTS NIPPV improved oxygenation in both groups. Compared with pretreatment levels, the oxygenation index (PaO2/FiO2), PaO2, PaCO2, and respiratory rate (RR) improved in the initial (0-1 h), maintenance (1-6 h), and end stages of the treatment (P<0.05). Compared with mask ventilation, helmet ventilation better improved pH, PaO2, SpO2, PaO2/FiO2, and decreased PaCO2 in the 3 stages (P<0.05). The incidence of major complications, including flatulence, intolerance, and facial pressure sores, was significantly lower with helmet ventilation. CONCLUSIONS NIPPV effectively improved oxygenation and reduced PaCO2 in patients who developed hypoxemia soon after extubation following surgery for Stanford type A aortic dissection. Compared with mask NIPPV, helmet NIPPV more rapidly increased PaO2 and reduced PaCO2, increased patient tolerance and comfort, and reduced complications.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.12659/MSM.893956

  4 / 92699 MEDLINE  
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[PMID]: 25678072
[Au] Autor:Santos CA; Brennan DC; Chapman WC; Fraser VJ; Olsen MA
[Ad] Address:Division of Infectious Diseases, Department of Medicine.
[Ti] Title:Delayed-onset cytomegalovirus disease coded during hospital readmission in a multicenter, retrospective cohort of liver transplant recipients.
[So] Source:Liver Transpl;21(5):581-90, 2015 May.
[Is] ISSN:1527-6473
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Delayed-onset cytomegalovirus (CMV) disease can occur among liver transplant recipients after CMV prophylaxis is stopped. We hypothesized that delayed-onset CMV disease (>100 days after transplant) occurs more commonly than early-onset CMV disease and is associated with clinical sepsis and death. Using 2004-2010 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 4 Healthcare Cost and Utilization Project state inpatient databases, we assembled a large and more representative cohort of 7229 adult liver transplant recipients from 26 transplant centers, and we identified demographics, comorbidities, CMV disease, and clinical sepsis coded during readmission and inpatient death. Multivariate analysis was performed with Cox proportional hazards models. Delayed-onset CMV disease occurred in 4.3% (n = 309), whereas early-onset CMV disease occurred in 2% (n = 142). Delayed-onset CMV disease was associated with previous transplant failure or rejection [adjusted hazard ratio (aHR), 1.4; 95% confidence interval (CI), 1.1-1.7]. Clinical sepsis > 100 days after transplant was associated with previous CMV disease (aHR, 1.3; 95% CI; 1.0-1.7), previous transplant failure or rejection (aHR, 2.1; 95% CI; 1.8-2.4), female sex (aHR, 1.3; 95% CI; 1.1-1.5), and several comorbidities. Death > 100 days after transplant was associated with delayed-onset CMV disease (aHR, 2.0; 95% CI; 1.6-2.6), transplant failure or rejection (aHR, 4.3; 95% CI; 3.4-5.5), increasing age by decade (aHR, 1.1; 95% CI; 1.0-1.2), and some comorbidities. In conclusion, delayed-onset CMV disease is more common than early-onset CMV disease among liver transplant recipients. Previous CMV disease may be a risk factor for clinical sepsis > 100 days after transplant, and delayed-onset CMV disease may be a risk factor for death > 100 days after transplant.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Entry month:1504
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1002/lt.24089

  5 / 92699 MEDLINE  
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[PMID]: 26202987
[Au] Autor:Hecker A; Küllmar M; Wilker S; Richter K; Zakrzewicz A; Atanasova S; Mathes V; Timm T; Lerner S; Klein J; Kaufmann A; Bauer S; Padberg W; Kummer W; Janciauskiene S; Fronius M; Schweda EK; Lochnit G; Grau V
[Ad] Address:Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, D-35385 Giessen, Germany;...
[Ti] Title:Phosphocholine-Modified Macromolecules and Canonical Nicotinic Agonists Inhibit ATP-Induced IL-1ß Release.
[So] Source:J Immunol;195(5):2325-34, 2015 Sep 1.
[Is] ISSN:1550-6606
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:IL-1ß is a potent proinflammatory cytokine of the innate immune system that is involved in host defense against infection. However, increased production of IL-1ß plays a pathogenic role in various inflammatory diseases, such as rheumatoid arthritis, gout, sepsis, stroke, and transplant rejection. To prevent detrimental collateral damage, IL-1ß release is tightly controlled and typically requires two consecutive danger signals. LPS from Gram-negative bacteria is a prototypical first signal inducing pro-IL-1ß synthesis, whereas extracellular ATP is a typical second signal sensed by the ATP receptor P2X7 that triggers activation of the NLRP3-containing inflammasome, proteolytic cleavage of pro-IL-1ß by caspase-1, and release of mature IL-1ß. Mechanisms controlling IL-1ß release, even in the presence of both danger signals, are needed to protect from collateral damage and are of therapeutic interest. In this article, we show that acetylcholine, choline, phosphocholine, phosphocholine-modified LPS from Haemophilus influenzae, and phosphocholine-modified protein efficiently inhibit ATP-mediated IL-1ß release in human and rat monocytes via nicotinic acetylcholine receptors containing subunits α7, α9, and/or α10. Of note, we identify receptors for phosphocholine-modified macromolecules that are synthesized by microbes and eukaryotic parasites and are well-known modulators of the immune system. Our data suggest that an endogenous anti-inflammatory cholinergic control mechanism effectively controls ATP-mediated release of IL-1ß and that the same mechanism is used by symbionts and misused by parasites to evade innate immune responses of the host.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.4049/jimmunol.1400974

  6 / 92699 MEDLINE  
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[PMID]: 26212184
[Au] Autor:Larson KE; Carrillo-Marquez M
[Ad] Address:Pediatric Residency Program, Sanford School of Medicine, University of South Dakota, Sioux Falls. Electronic address: kelarson2@gmail.com.
[Ti] Title:Endogenous methicillin-resistant Staphylococcus aureus endophthalmitis after leg trauma.
[So] Source:J AAPOS;19(4):387-9, 2015 Aug.
[Is] ISSN:1528-3933
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:We present a case of endogenous endophthalmitis in a 13-year-old boy with methicillin-resistant Staphylococcus aureus sepsis. The patient underwent magnetic resonance imaging of the brain after intermittent anisocoria was noted on examination, leading to a diagnosis of endophthalmitis with a chorodial abscess.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:IM
[St] Status:In-Data-Review

  7 / 92699 MEDLINE  
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[PMID]: 26295920
[Au] Autor:Graham CA
[Ad] Address:Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.
[Ti] Title:Outbreaks, Middle East respiratory syndrome and sepsis in emergency care.
[So] Source:Eur J Emerg Med;22(5):297, 2015 Oct.
[Is] ISSN:1473-5695
[Cp] Country of publication:England
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1097/MEJ.0000000000000329

  8 / 92699 MEDLINE  
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[PMID]: 25485968
[Au] Autor:Cowan SL; Holland JA; Kane AD; Frost I; Boyle AA
[Ad] Address:aWest Suffolk Hospital, Bury St Edmunds bAddenbrooke's Hospital, Cambridge, UK.
[Ti] Title:The burden of sepsis in the Emergency Department: an observational snapshot.
[So] Source:Eur J Emerg Med;22(5):363-5, 2015 Oct.
[Is] ISSN:1473-5695
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:The primary aim of our study was to establish what proportion of patients in the Emergency Department (ED) fulfill the criteria for sepsis. All adult patients presenting to ED in two 1-week periods, 6 months apart, were included. Notes were reviewed retrospectively to identify which patients fulfilled the criteria for sepsis and severe sepsis. The proportion of patients with sepsis was 4.3% (95% confidence interval 3.3-5.2%) and the proportion with severe sepsis was 2.2% (95% confidence interval 1.5-2.8%). In conclusion our results suggest that sepsis is more common than previously reported and this represents a significant burden on ED.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1097/MEJ.0000000000000234

  9 / 92699 MEDLINE  
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[PMID]: 25144398
[Au] Autor:Hilderink MJ; Roest AA; Hermans M; Keulemans YC; Stehouwer CD; Stassen PM
[Ad] Address:Departments of aInternal Medicine bGastro-enterology, School of CAPHRI, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.
[Ti] Title:Predictive accuracy and feasibility of risk stratification scores for 28-day mortality of patients with sepsis in an emergency department.
[So] Source:Eur J Emerg Med;22(5):331-7, 2015 Oct.
[Is] ISSN:1473-5695
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Sepsis is associated with high mortality. Because early therapy has proven to decrease mortality, a risk stratification tool that quickly and easily quantifies mortality risk of patients will be helpful to guide appropriate treatment. We investigated five scores in terms of (a) predicting 28-day mortality and (b) their feasibility for use in the emergency department (ED). MATERIALS AND METHODS: We carried out a historical cohort study in the ED of Maastricht University Medical Centre (MUMC). Patients who fulfilled the criteria for sepsis were included if they had been admitted to the hospital by an internist between August 2009 and August 2010. The Mortality in Emergency Department Sepsis (MEDS), Confusion, Urea, Respiratory rate, Blood pressure, age>65 (CURB-65), Acute Physiology And Chronic Health Evaluation II (APACHE II), Rapid Acute Physiology Score (RAPS), and Rapid Emergency Medicine Score (REMS) scores were calculated using ED charts. The primary outcome was total 28-day mortality. Receiver operating characteristic curves and calibration plots were constructed to evaluate predictive accuracy. Feasibility was defined as the proportion of patients for whom all data were available. RESULTS: We included 600 patients, of whom 90 (15%) died within 28 days. Discriminating ability for total 28-day mortality of the MEDS [area under the curve (AUC): 0.82, 95% confidence interval (CI) 0.78-0.87], CURB-65 (AUC: 0.78, 95% CI 0.73-0.83), and APACHE II (AUC: 0.71, 95% CI 0.64-0.79) was the highest, but only the difference between the MEDS and REMS (P=0.007) and the RAPS score (P<0.001) was significant. Both the MEDS and the CURB-65 had higher AUCs for predicting 28-day in-hospital mortality than the other three scores, but this was only significant for the MEDS score compared with the RAPS (P=0.003). Both the MEDS and the CURB-65 underestimated mortality, especially for the higher scores. The MEDS, CURB-65, REMS, and RAPS were most feasible as they could be calculated in more than 96% of patients. CONCLUSION: The MEDS and CURB-65 scores are the most adequate and feasible tools for the prediction of total 28-day mortality in septic patients presenting at the ED, but they need local recalibration before use in the ED.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1097/MEJ.0000000000000185

  10 / 92699 MEDLINE  
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[PMID]: 25010926
[Au] Autor:Sivayoham N; Holmes P; Cecconi M; Rhodes A
[Ad] Address:Departments of aEmergency Medicine bIntensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, London, UK.
[Ti] Title:Internal emergency department validation of the simplified MISSED score.
[So] Source:Eur J Emerg Med;22(5):321-6, 2015 Oct.
[Is] ISSN:1473-5695
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The MISSED score was derived and validated in emergency department (ED) patients with sepsis who were admitted to the ICU. This score has now been refined and simplified. The independent variables associated with mortality are age at least 65 years, serum albumin 27 g/l or less, and an international normalized ratio at least 1.3. The simplified MISSED score ranges from 0 to 3 depending on the number of variables present. OBJECTIVE: The primary objective is to validate the simplified MISSED score for predicting all-cause mortality in the ED population admitted with sepsis. The secondary end-point is to validate the risk stratification for ICU admission. METHODS: This is a pragmatic retrospective study of prospectively collected data. ED patients admitted with a diagnosis of sepsis in the year 2012 were studied. Those on warfarin were excluded. The simplified MISSED score was calculated for each patient. The test characteristics for mortality of the simplified MISSED score and the odds ratios of the high-risk groups for the secondary end-point were calculated. RESULTS: In total, 674 patients, including 65 deaths, were studied. The area under the curve for the simplified MISSED score was 0.74 [95% confidence interval (CI) 0.70-0.77; P<0.0001]. The test characteristics for mortality were as follows: sensitivity 93.9% (95% CI 85-98.3), specificity 37.9% (95% CI 34.1-41.9), positive predictive value 13.9% (95% CI 10.8-17.5), and negative predictive value 98.3% (95% CI 95.7-99.5). The odds ratio for mortality for a score 2 or more was 5.01 (95% CI 2.93-8.57; P<0.0001), and that for ICU admission was 3.00 (95% CI 1.70-5.28; P=0.0001). CONCLUSION: The simplified MISSED score could be used to risk stratify septic patients in the ED.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1097/MEJ.0000000000000176


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