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Find video protocols related to scientific articles indexed in Pubmed.
Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intravascular coagulation: A prospective, multicentre, observational study.
Eur J Anaesthesiol
PUBLISHED: 11-12-2014
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Few prospective studies have described the prognostic accuracy of presepsin for 28-day mortality during days 0 to 7, or its role in the diagnosis of disseminated intravascular coagulation (DIC) in patients with infection.
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Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis: a multicenter prospective study.
J. Infect. Chemother.
PUBLISHED: 01-28-2014
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Presepsin is a protein whose levels increase specifically in the blood of patients with sepsis. It is proposed as a diagnostic and prognostic marker for assessing the degree of sepsis severity. The present multicenter prospective study compared the clinical utility of presepsin with other conventional sepsis biomarkers including procalcitonin, interleukin-6, and C-reactive protein for evaluating the severity of sepsis during follow-up. Patients with sepsis (n = 103) admitted to the emergency room or intensive care unit were enrolled in this study and classified into 3 diagnostic groups: sepsis, severe sepsis, and septic shock. Blood samples were obtained from each patient on admission and after 1, 3, 5, and 7 days. The patients were further divided into the favorable and unfavorable prognosis groups on the basis of several indicators of sepsis severity (i.e., Sequential Organ Failure Assessment score, and Acute Physiology and Chronic Health Evaluation II score). The patients in the favorable prognosis group exhibited significant decreases in all biomarker levels on days 3 and 7 after admission. In the unfavorable prognosis group, only presepsin levels did not decrease significantly during follow-up. The period of antibiotics treatment in the unfavorable prognosis group was significantly longer than those in the favorable prognosis group (P < 0.05). The unfavorable prognosis group had significantly higher 28-day mortality than the favorable prognosis group (P < 0.05). Therefore, the results suggest that presepsin levels correlated with the severity of sepsis during follow-up in comparison with other conventional sepsis biomarkers.
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A randomized, controlled, multicenter trial of the effects of antithrombin on disseminated intravascular coagulation in patients with sepsis.
Crit Care
PUBLISHED: 07-18-2013
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To test the hypothesis that the administration of antithrombin concentrate improves disseminated intravascular coagulation (DIC), resulting in recovery from DIC and better outcomes in patients with sepsis, we conducted a prospective, randomized controlled multicenter trial at 13 critical care centers in tertiary care hospitals.
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Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a tsunami in Japan.
Respir Investig
PUBLISHED: 06-26-2013
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Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patients head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.
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[Hypokalemic myopathy with severe constipation in a patient routinely administered sodium polystyrene sulfonate and the spherical carbon adsorbent].
Chudoku Kenkyu
PUBLISHED: 04-23-2013
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66-year-old man was hospitalized because of severe abdominal pain. He had been treated for chronic renal failure. Sodium polystyrene sulfonate (SPS) and the spherical carbon adsorbent AST-120 were routinely administered to him. However, after several treatments, his pain did not resolve and his serum creatine kinase concentration was markedly elevated, so he was transferred to our hospital. Before admission to the previous hospital, muscular weakness was noted in his extremities and those symptoms persisted. His serum potassium concentration was 1.6 mEq/L, and he was administered potassium. A lower gastrointestinal endoscopy revealed normal mucosa and SPS powder-like brownish-yellow stool containing AST-120 granules in the colorectum. After massive stool discharge, the patients pain improved and his serum potassium concentration gradually increased. The patient was diagnosed with hypokalemic myopathy thought to be mainly caused by accumulation of SPS in the colorectum.
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A case of secondary aortoesophageal fistula inserted a covered self-expanding esophageal stent to control gastrointestinal bleeding.
Case Rep Gastrointest Med
PUBLISHED: 04-17-2013
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A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients.
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Interleukin-8 induces an elevation in the endotoxin activity assay (EAA) level: does the EAA truly measure the endotoxin level?
J. Infect. Chemother.
PUBLISHED: 01-29-2013
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The endotoxin activity assay (EAA) is a FDA-approved blood endotoxin assay that is reported as a useful tool for the diagnosis of gram-negative bacterial infection. However, discrepancies between the results of the EAA and those of the limulus amebocyte lysate (LAL) assay have been reported. Thus, we verified these methods. Blood was incubated with anti-endotoxin antibody, the resultant polymorphonuclear activation to produce oxidants was measured and the EAA level calculated. As a reference endotoxin assay, we used an endotoxin-specific LAL assay. Significant increases in plasma LAL assay levels were observed only in patients with sepsis caused by gram-negative bacterial infections, whereas higher EAA levels were observed in almost all the sepsis cases and the SIRS cases, especially those with acute pancreatitis. Graded amounts of LPS (1-10,000 pg/ml) were spiked into normal blood to obtain dose-response curves: a good dose-response curve, from 1 to 1,000 pg/ml, was obtained for the LAL assay. A good dose-response curve was barely obtained for the EAA; the lowest detection limit seemed to be 1,000 pg/ml. Addition of methylprednisolone decreased the EAA levels. Interleukin-8 (IL-8) induced elevation in EAA levels when IL-8 was added to volunteers blood samples. Overall, the EAA kit could not measure clinically relevant doses of endotoxin. Because IL-8 induced an increase in EAA level, it is suggested that the EAA level reflects the primed state of polymorphonuclear leukocytes.
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Evaluation of an endotoxin-specific limulus amebocyte lysate assay using leukocyte-rich plasma for the diagnosis of gram-negative bacterial infection.
J. Infect. Chemother.
PUBLISHED: 01-07-2013
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We focused our attention on the endotoxin present within and on the surface of white blood cells and attempted to establish a new sample preparation method for endotoxin assays in leukocyte-rich plasma (LRP), taking advantage of the erythrocyte-aggregating property of hydroxyethyl starch. We used an endotoxin-specific turbidimetric kinetic assay, which is the conventional method used to assay endotoxin levels in platelet-rich plasma (PRP). Then, we comparatively assessed the assay results obtained with the endotoxin assay using PRP and LRP. It was found that the sensitivity of endotoxin assay in LRP was 88.5 %, which was superior to 73.1 % of the sensitivity in PRP in the diagnosis of infections caused by gram-negative bacteria. These results suggest that our newly developed LRP endotoxin assay may contribute to an improvement in the rate of sepsis diagnosis.
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Tsunami lung.
J Anesth
PUBLISHED: 09-24-2011
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We encountered three cases of lung disorders caused by drowning in the recent large tsunami that struck following the Great East Japan Earthquake. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. All three died within 3 weeks. In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Sputum culture for bacteria yielded isolation of Stenotrophomonas maltophilia, Legionella pneumophila, Burkholderia cepacia, and Pseudomonas aeruginosa. The cause of tsunami lung may be a combination of chemical induced pneumonia and bacterial pneumonia.
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Green Urine Discoloration due to Propofol Infusion: A Case Report.
Case Rep Emerg Med
PUBLISHED: 08-25-2011
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We present a 19-year-old man who excreted green urine after propofol infusion. The patient was admitted to our hospital for injuries sustained in a traffic accident and underwent surgery. After starting continuous infusion of propofol for postoperative sedation, his urine became dark green. Serum total bilirubin and urine bilirubin were both elevated. We believe that the green discoloration of the urine was caused by propofol infusion and was related to impaired enterohepatic circulation and extrahepatic glucuronidation in the kidneys.
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[Detection of glimepiride and rosiglitazone from Chinese dietary supplements].
Chudoku Kenkyu
PUBLISHED: 04-13-2011
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A 79-year-old man with diabetes mellitus developed prolonged hypoglycemia. The patient had ingested two Chinese dietary supplements in addition to his prescribed nateglinide (Fastic). Using liquid chromatography tandem mass spectrometry, glimepiride from sulfonylurea, as well as rosiglitazone from a thiazolidine derivative, were detected in the Chinese dietary supplements, which were then quantitatively analyzed using liquid chromatography with UV detector. Mean values (n=3) of glimepiride contents of the Chinese dietary supplements were 0.75 and 0.86 mg/capsule. Predicted intake of glimepiride in the patient was estimated to be 4.8-8.2 mg/day according to the glimepiride contents and directions of the Chinese dietary supplements. The daily intake of glimepiride in this patient was greater than daily maintenance doses (1-4 mg) of glimepiride for diabetic patients. Therefore, overdose of glimepiride by ingestion of the Chinese dietary supplements appears to be associated with the development of prolonged hypoglycemia.
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Concentrations of trace element in human dentin by sex and age.
Forensic Sci. Int.
PUBLISHED: 04-05-2011
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Teeth are recently drawing attention for their potential as biological modeling investigation samples due to their ability to be collected and their slow substance metabolism. There is no active metabolism of elements after the completion of dentin. Dentin is surrounded by enamel and cementum, and is not affected by the oral environment. Therefore, the amount of trace elements in dentin may change with age, and this is considered to be a reliable biological load index. The objectives in this study are to demonstrate concentrations of elements in the dentin of healthy Japanese subjects by sex and age, and to reveal the relationship between element levels and age. 121 healthy teeth samples were extracted due to periodontal disease or orthodontic treatment. Each tooth was sliced from the crown to the root apex into 0.5-1mm thickness, then enamel, cementum, and the pulp were removed; the dentins were used as samples. The concentration of 10 trace elements (B, Mn, Co, Cu, Zn, Rb, Sr, Mo, Cd, and Pb) in the dentin was measured using inductively coupled plasma mass spectrometer (ICP-MS). The differences Co and Pb in the dentin between men and women were significant (p<0.01). Significant positive correlation was observed between B, Co, Cu, Zn, Sr and Pb concentrations in the dentin and age (p<0.001). The results of the present study suggest that human dentin is an appropriate substance for relativity with sex and age at further future research.
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Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome.
J. Infect. Chemother.
PUBLISHED: 04-01-2011
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CD14 is present in macrophage, monocyte, and granulocyte cells and their cell membranes, and it is said to be responsible for intracellular transduction of endotoxin signals. Its soluble fraction is present in blood and is thought to be produced in association with infections. It is called the soluble CD14-subtype (sCD14-ST), and in the following text it is referred to by its generic name, presepsin. We have previously reported that presepsin is produced in association with infection and that it is specifically expressed in sepsis. In the present study we developed a new rapid diagnostic method by using a chemiluminescent enzyme immunoassay that allowed making automated measurements in a shorter time. The results of using this method to measure presepsin values in different pathological conditions were normal, 294.2 ± 121.4 pg/ml; local infection, 721.0 ± 611.3 pg/ml; systemic inflammatory response syndrome, 333.5 ± 130.6 pg/ml; sepsis, 817.9 ± 572.7 pg/ml; and severe sepsis, 1,992.9 ± 1509.2 pg/ml; the presepsin values were significantly higher in patients with local infection, sepsis, and severe sepsis than in patients who did not have infection as a complication. In a comparative study with other diagnostic markers of sepsis based on ROC curves, the area under the curve (AUC) of presepsin was 0.845, and greater than the AUC of procalcitonin (PCT, 0.652), C-reactive protein (CRP, 0.815), or interleukin 6 (IL-6, 0.672). In addition, a significant correlation was found between the APACHE II scores, an index of disease severity, and the presepsin values, suggesting that presepsin values can serve as a parameter that closely reflects the pathology.
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A fatal case of acute hydrogen sulfide poisoning caused by hydrogen sulfide: hydroxocobalamin therapy for acute hydrogen sulfide poisoning.
J Anal Toxicol
PUBLISHED: 03-15-2011
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A patient committed suicide with hydrogen sulfide (H(2)S) by combining two commercial products. The patient was given hydroxocobalamin as an antidote in addition to treatment with cardiopulmonary resuscitation, but died approximately 42 min after his arrival at the hospital. The patients cause of death was attributed to acute hydrogen sulfide poisoning. Serum concentrations of sulfide before and after administration of hydroxocobalamin were 0.22 and 0.11 ?g/mL, respectively; serum concentrations of thiosulfate before and after hydroxocobalamin administration were 0.34 and 0.04 ?mol/mL, respectively. Hydroxocobalamin is believed to form a complex with H(2)S in detoxification pathways of H(2)S. Although H(2)S is rapidly metabolized and excreted, the decreased sulfide concentration may be also associated with this complex formation. The decreased sulfide concentration suggests that hydroxocobalamin therapy may be effective for acute H(2)S poisoning. The decreased thiosulfate concentration seems to be associated with formation of a thiosulfate/hydroxocobalamin complex, because hydroxocobalamin can form a complex with thiosulfate. The thiosulfate concentration decreased to a greater extent than did sulfide, suggesting that hydroxocobalamin has a higher affinity for thiosulfate than for H(2)S. Therefore, prompt administration of hydroxocobalamin after H(2)S exposure may be effective for H(2)S poisoning.
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Serum selenium levels are inversely associated with death risk among hemodialysis patients.
Nephrol. Dial. Transplant.
PUBLISHED: 03-03-2011
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Previous studies have indicated that serum selenium levels are decreased in hemodialysis patients. Selenium deficiency may contribute to an increased risk for death among hemodialysis patients.
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Retrospective study on the effect of tight glucose control in postoperative sepsis patients using an artificial pancreas.
J. Infect. Chemother.
PUBLISHED: 02-23-2011
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Tight glucose control (TGC) using a sliding scale based on intermittent blood glucose measurements occasionally can have a fatal outcome as a result of insulin-induced hypoglycemia. The present study was undertaken to examine whether the use of an artificial pancreas to achieve TGC would be possible in postoperative patients with sepsis. The retrospective study was carried out as an exploratory study, focusing on the possibility of precise evaluation of the significance of TGC as a beneficial intervention by serological monitoring of various mediators. TGC was accomplished using an artificial pancreas (STG-22; (Nikkiso, Tokyo, Japan). The patients were divided into two groups: the TGC group (6 patients with sepsis in whom the target blood glucose level set at <150 mg/dl was attempted using the artificial pancreas), and the glucose control (GC) group (6 patients with sepsis in whom glucose control was attempted using a sliding scale; target blood glucose level was set at 200 mg/dl or lower). The mean blood glucose level was 129.7 ± 9.7 mg/dl in the TGC group and 200.9 ± 14.7 mg/dl in the GC group (P < 0.01, ANOVA). No hypoglycemia associated with the artificial pancreas was seen in any of the patients. The serum levels of S100A12 and HMGB-1 tended to decrease, and those of sRAGE tended to increase, in the TGC group. Further data collection from a larger number of cases would be expected to allow a precise assessment of TGC as a potentially beneficial intervention in sepsis patients.
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Reevaluation of the efficacy and safety of the neutrophil elastase inhibitor, Sivelestat, for the treatment of acute lung injury associated with systemic inflammatory response syndrome; a phase IV study.
Pulm Pharmacol Ther
PUBLISHED: 02-17-2011
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Sivelestat, a neutrophil elastase inhibitor, has been approved in Japan for the treatment of patients with acute lung injury (ALI) associated with systemic inflammatory response syndrome (SIRS). The Pharmaceuticals and Medical Devices Agency (PMDA) has ordered to conduct a postmarket clinical study in order to reevaluate the efficacy and safety of Sivelestat in actual clinical settings in Japan.
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Serum selenium levels in hemodialysis patients are significantly lower than those in healthy controls.
Blood Purif.
PUBLISHED: 02-11-2011
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Serum selenium levels have been thought to be decreased in hemodialysis patients; however, results of previous studies have been inconsistent. Population-based hemodialysis patients (n = 1,041) and randomly recruited healthy controls (n = 384) were enrolled. Serum selenium levels were determined by inductively coupled plasma mass spectrometry and compared in hemodialysis patients and controls using analysis of covariance after adjustment for confounding factors with p < 0.1 as the result of the multiple regression analysis. Age, serum albumin levels, hsCRP levels, LDLC levels, HDLC levels, regular drinking habit and hemodialysis treatment were significantly associated with serum selenium levels in multiple regression analysis. Multivariate-adjusted means (95% CIs) of serum selenium levels were 103 ?g/l (101-105) in hemodialysis patients and 117 ?g/l (114-121) in controls. Selenium levels in hemodialysis patients were decreased. Whether decreased serum selenium levels contribute to increased risks for morbidity and mortality in hemodialysis patients should be examined.
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[Case followed by delayed loss of consciousness after exposure to hydrogen sulfide that was treated with intermittent administration of sodium nitrite].
Chudoku Kenkyu
PUBLISHED: 11-24-2010
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A 49-year-old man lost consciousness after being accidentally exposed to what was probably hydrogen sulfide gas while performing maintenance on a machine producing feather meal. He was immediately taken to the hospital. Upon admission, his consciousness level was 14 (E4V4M6) on the Glasgow Coma Scale (GCS), but it subsequently decreased, and the patient was intubated when his respirations became depressed as well. About 5 hours after the initial incident, he was transferred to our department. His consciousness level was GCS 9 (E2V2M5), his blood pressure was 95/78 mmHg, and his heart rate was 90 beats per min. There was no metabolic acidosis. Mechanical ventilation was begun and 10% sodium nitrite was intermittently administered intravenously, with the goal of lowering arterial blood methemoglobin saturation to 20%. Two days following admission, the patient regained full consciousness and sodium nitrite administration was stopped. The following day mechanical ventilation was also discontinued. This patient exhibited severe recurring neurologic symptoms without metabolic acidosis; thus, the manifestations of toxicity in this case might have been due to the direct neurologic toxicity of hydrogen sulfide, hypoxia, or delayed post-ischemic cerebral hypoperfusion syndrome. The patient made a full recovery without any sequelae; therefore we would like to hypothesize that repetitive intravenous administration of sodium nitrite is effective in cases of hydrogen sulfide exposure.
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Suppressive effects of sivelestat on interleukin 8 and TNF-? production from LPS-stimulated granulocytes in whole blood culture.
J Anesth
PUBLISHED: 09-20-2010
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The goal of the study was to examine the effects of sivelestat sodium hydrate (sivelestat), a neutrophil elastase inhibitor, on production of cytokines in granulocytes and monocytes, using flow cytometry after cytokine staining in whole blood culture.
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Significance of measuring S100A12 and sRAGE in the serum of sepsis patients with postoperative acute lung injury.
Dig Surg
PUBLISHED: 04-05-2010
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There is a report that S100A12 is useful as an early marker of acute lung injury (ALI). The purpose of this study was to determine whether S100A12 or sRAGE is useful as a marker during the development of ALI in postoperative sepsis patients.
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A prospective cohort study of ALI/ARDS in the Tohoku district of Japan (second report).
J Anesth
PUBLISHED: 03-27-2010
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We previously reported a study of systemic inflammatory response syndrome (SIRS) cases in the Tohoku district of Japan in which the patients showed a 30-day mortality from acute lung injury/acute respiratory distress syndrome (ALI/ARDS) of about 20%. Cases in which chest X-ray findings did not meet ALI/ARDS criteria were diagnosed as acute hypoxemic respiratory failure (AHRF), but about 50% of these patients progressed to ALI/ARDS. The objective of this study was to verify the findings obtained in the earlier study and to gain further insights into the pathognomonic symptoms of AHRF associated with SIRS.
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Effect of linezolid on cytokine production capacity and plasma endotoxin levels in response to lipopolysaccharide stimulation of whole blood.
J. Infect. Chemother.
PUBLISHED: 01-22-2010
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The purpose of this study was to assess lipopolysaccharide (LPS)-stimulated cytokine production in the presence of linezolid (LZD) in comparison with the drug effect on the plasma endotoxin level. Peripheral venous whole-blood samples collected from five healthy subjects were stimulated with 10 microg/ml of LPS. LZD was then added to the LPS-stimulated blood samples at concentrations of 0, 2, 4, and 15 microg/ml , followed by incubation for 24 h at 37 degrees C in a 5% CO(2)-95% air atmosphere. Supernatants of the resultant cultures were assayed to determine the levels of tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-10, monocyte chemoattractant protein (MCP)-1, and endotoxin. Significant decreases in the levels of TNF-alpha and IFN-gamma were observed in the LZD 2, 4, and 15 microg/ml groups as compared with that in the 0 microg/ml group (Dunnetts procedure; P < 0.05). The level of IL-10 tended to increase irrespective of the LZD concentration; however, no significant intergroup differences were observed [analysis of variance (ANOVA); P = 0.68]. No significant decrease of the endotoxin level was observed in the LZD 2, 4, or 15 microg/ml groups as compared with that in the 0 microg/ml group, with no significant intergroup differences (ANOVA; P = 0.83). No change in the MCP-1 levels was observed irrespective of the LZD concentration (ANOVA; P = 0.82). To conclude: (1) it appears possible that LZD inhibits the production of INF-gamma and TNF-alpha to a limited extent; (2) LZD did not exert any inhibitory effect on endotoxin production by bacteria, while suppressing cytokine production. The results indicate that LZD may have a significant role in saving the lives of patients with sepsis.
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Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group.
BMC Psychiatry
PUBLISHED: 01-12-2010
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The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group.
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Disseminated intravascular coagulation (DIC) diagnosed based on the Japanese Association for Acute Medicine criteria is a dependent continuum to overt DIC in patients with sepsis.
Thromb. Res.
PUBLISHED: 06-16-2009
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Sepsis is the most common disease associated with disseminated intravascular coagulation (DIC). To test the hypothesis that DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC scoring system (JAAM DIC) constitutes a dependent continuum to overt DIC diagnosed by the International Society on Thrombosis and Haemostasis (ISTH) overt DIC scoring system (ISTH overt DIC) in patients with sepsis, we conducted a retrospective study.
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[Study on the leukocyte-rich plasma as the specimen for the measurement of endotoxin].
Rinsho Byori
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In the diagnosis of sepsis, the sensitivity of the endotoxin assay using platelet-rich plasma (PRP) is not as high as expected. In the endotoxin assay using PRP, endotoxin occurring within and on the surface of white blood cells cannot be measured. Thus, we devised a method of preparing leukocyte-rich plasma (LRP) using hydroxyethyl starch (HES) in order to improve the endotoxin assay.
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Characteristics of suicide attempts in patients diagnosed with schizophrenia in comparison with depression: a study of emergency room visit cases in Japan.
Schizophr. Res.
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We worked on characterizing suicide attempts in patients with schizophrenia in comparison with mood disorders. This study population comprised 260 patients with F2 disorders (ICD-10), i.e., "schizophrenic group" and 705 patients with F3 disorders, i.e., "depressive group" who presented at the psychiatric emergency department of our hospital for 8 years. They were compared in three age groups: young (?24 years), middle-aged (25-44 years), and elderly (?45 years). Multivariate logistic regression analysis identified factors associated with the seriousness of the suicide attempt method. The schizophrenic group (?25 years) had a younger mean age and higher prevalences of "within-1-year suicide attempts" and "past suicide attempts" than the depressive group. The Schizophrenic group tended to use serious methods, such as "jumping from high places," "throwing oneself in front of an oncoming train," and "burning oneself," in their suicide attempts, with "hallucination-delusion" accounting for an overwhelmingly large percentage of suicide attempt motives, irrespective of the age group. In the elderly group, the ratio of "no-housemate" patients was high. In all age groups, jobless individuals were prevalent, and the schizophrenic group had lower LCU (Life Change Unit) scores than did the depressive group. The middle-aged cases of schizophrenic group had higher BPRS (Brief Psychiatric Rating Scale) scores and lower GAS (Global Assessment Scale) scores. Regarding factors influencing the seriousness of the methods, a history of within-1-year suicide attempts increased the method seriousness in the schizophrenic group. Years of education correlated with the method seriousness in the schizophrenic group. Low scores of overall health on the GAS increased the method seriousness in both groups.
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Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report.
BMC Emerg Med
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Septic arthritis of the sternoclavicular joint (SCJ) is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes.
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Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study.
J. Infect. Chemother.
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The clinical usefulness of presepsin for discriminating between bacterial and nonbacterial infections (including systemic inflammatory response syndrome) was studied and compared with procalcitonin (PCT) and interleukin-6 (IL-6) in a multicenter prospective study. Suspected sepsis patients (n = 207) were enrolled into the study. Presepsin levels in patients with systemic bacterial infection and localized bacterial infection were significantly higher than in those with nonbacterial infections. In addition, presepsin, PCT, and IL-6 levels in patients with bacterial infectious disease were significantly higher than in those with nonbacterial infectious disease (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The area under the receiver operating characteristic curve was 0.908 for presepsin, 0.905 for PCT, and 0.825 for IL-6 in patients with bacterial infectious disease and those with nonbacterial infectious disease. The cutoff value of presepsin for discrimination of bacterial and nonbacterial infectious diseases was determined to be 600 pg/ml, of which the clinical sensitivity and specificity were 87.8 % and 81.4 %, respectively. Presepsin levels did not differ significantly between patients with gram-positive and gram-negative bacterial infections. The sensitivity of blood culture was 35.4 %; that for presepsin was 91.9 %. Also there were no significant differences in presepsin levels between the blood culture-positive and -negative groups. Consequently, presepsin is useful for the diagnosis of sepsis, and it is superior to conventional markers and blood culture.
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Interleukin-18 levels reflect the long-term prognosis of acute lung injury and acute respiratory distress syndrome.
J Anesth
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The purpose of this study was to investigate the relationship between the blood levels of interleukin (IL)-18 measured in the early stage of acute respiratory failure and the prognosis for patient survival.
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Experimental application of a synthetic luminescent substrate assay using endotoxin-specific limulus amebocyte lysate to human blood.
J. Infect. Chemother.
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A synthetic luminescent substrate method, using a mutant-type luciferase whose luminescence intensity is more than ten times as intense as the wild type, was developed recently. We conducted the first basic studies on clinical application of the novel endotoxin measurement method. We assessed and established measurement conditions, including reagent concentrations and reaction time, so that it would be possible to apply the luminescent synthetic substrate method proposed by Noda et al. to measurements in human blood. When we added lipopolysaccharide (LPS) to water, it was possible to measure LPS at a concentration of 0.1 pg/ml, whereas it was possible to measure LPS in tenfold diluted and heated plasma at a concentration of 1 pg/ml. When plasma was further diluted, inhibiting activity decreased considerably. Thus, it will be necessary to completely eliminate the inhibitor present in plasma. However, the shortest time after collecting the specimen in which it was possible to make measurements was 30-40 min, suggesting that if an assay is established, it will be possible to use the method as a novel blood endotoxin assay.
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Direct effects of esmolol and landiolol on cardiac function, coronary vasoactivity, and ventricular electrophysiology in guinea-pig hearts.
J. Pharmacol. Sci.
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The ultra-short acting, selective ?(1)-adrenergic antagonists landiolol and esmolol are widely used perioperatively; however, little is known about their acute direct actions on the heart. The current study utilized the Langendorff perfused heart system to measure changes in cardiac function and hemodynamics in response to each drug. Furthermore, electrophysiological analysis was performed on isolated ventricular myocytes. Direct application of esmolol significantly decreased systolic left ventricular pressure and heart rate at concentrations > 10 µM, while it dose-dependently increased coronary perfusion pressure. Esmolol also shortened the action potential duration (APD) in a concentration-dependent manner, an action maintained even when the delayed rectifier K(+) current or ATP sensitive K(+) current was blocked. Moreover, esmolol inhibited both the inward rectifier K(+) current (I(K1)) and the L-type Ca(2+) current (I(CaL)) and increased the outward current dose-dependently. In contrast, landiolol had minimal cardiac effects. In the Kyoto Model computer simulation, inhibition of either I(K1) or I(CaL) alone failed to shorten the APD; however, an additional increase in the time-independent outward current caused shortening of the APD, equal to that induced by esmolol. In conclusion, esmolol directly inhibits cardiac performance significantly more so than landiolol, an effect revealed to be at least in part mediated by esmolol-induced APD shortening.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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