Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients

BACKGROUND: Elevated lactate and interleukin-6 (IL-6) levels were shown to correlate with mortality and multiple organ dysfunction in severely traumatized patients. The purpose of this study was to test whether an association exists between 24-hour lactate clearance, IL-6 and procalcitonin (PCT) levels, and the development of infectious complications in trauma patients. METHODS: A total of 1757 consecutive trauma patients with an Injury Severity Score (ISS) > 16 admitted over a 10-year period were retrospectively analyzed over a 21-day period. Exclusion criteria included death within 72 h of admission (24.5%), late admission > 12 h after injury (16%), and age < 16 years (0.5%). Data are stated as the median (range). RESULTS: Altogether, 1032 trauma patients (76.2% male) with an average age of 38 years, a median ISS of 29 (16-75), and an Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II score of 14 (0-40) were evaluated. The in-hospital mortality (>3 days) was 10%. Patients with insufficient 24-hour lactate clearance had a high rate of overall mortality and infections. Elevated early serum procalcitonin on days 1 to 5 after trauma was strongly associated with the subsequent development of sepsis (p < 0.01) but not with nonseptic infections. The kinetics of IL-6 were similar to those of PCT but did differentiate between infected and noninfected patients after day 5. CONCLUSIONS: This study demonstrates that elevated early procalcitonin and IL-6 levels and inadequate 24-hour lactate clearance help identify trauma patients who develop septic and nonseptic infectious complications. Definition of specific cutoff values and early monitoring of these parameters may help direct early surgical and antibiotic therapy and reduce infectious mortality.

A Combinatorial Approach to the Variable Selection in Multiple Linear Regression: Analysis of Selwood et al Data set -A Case Study.

A combinatorial protocol (CP) is introduced here to interface it with the multiple linear regression (MLR) for variable selection. The efficiency of CP-MLR is primarily based on the restriction of entry of correlated variables to the model development stage. It has been used for the analysis of Selwood et al data set [16], and the obtained models are compared with those reported from GFA [8] and MUSEUM [9] approaches. For this data set CP-MLR could identify three highly independent models (27, 28 and 31) with Q2 value in the range of 0.632-0.518. Also, these models are divergent and unique. Even though, the present study does not share any models with GFA [8], and MUSEUM [9] results, there are several descriptors common to all these studies, including the present one. Also a simulation is carried out on the same data set to explain the model formation in CP-MLR. The results demonstrate that the proposed method should be able to offer solutions to data sets with 50 to 60 descriptors in reasonable time frame. By carefully selecting the inter-parameter correlation cutoff values in CP-MLR one can identify divergent models and handle data sets larger than the present one without involving excessive computer time.

Relationship of individual scapular anatomy and degenerative rotator cuff tears.

BACKGROUND The etiology of rotator cuff disease is age related, as documented by prevalence data. Despite conflicting results, growing evidence suggests that distinct scapular morphologies may accelerate the underlying degenerative process. The purpose of the present study was to evaluate the predictive power of 5 commonly used radiologic parameters of scapular morphology to discriminate between patients with intact rotator cuff tendons and those with torn rotator cuff tendons. METHODS A pre hoc power analysis was performed to determine the sample size. Two independent readers measured the acromion index, lateral acromion angle, and critical shoulder angle on standardized anteroposterior radiographs. In addition, the acromial morphology according to Bigliani and the acromial slope were determined on true outlet views. Measurements were performed in 51 consecutive patients with documented degenerative rotator cuff tears and in an age- and sex-matched control group of 51 patients with intact rotator cuff tendons. Receiver operating characteristic analyses were performed to determine cutoff values and to assess the sensitivity and specificity of each parameter. RESULTS Patients with degenerative rotator cuff tears demonstrated significantly higher acromion indices, smaller lateral acromion angles, and larger critical shoulder angles than patients with intact rotator cuffs. However, no difference was found between the acromial morphology according to Bigliani and the acromial slope. With an area under the receiver operating characteristic curve of 0.855 and an odds ratio of 10.8, the critical shoulder angle represented the strongest predictor for the presence of a rotator cuff tear. CONCLUSION The acromion index, lateral acromion angle, and critical shoulder angle accurately predict the presence of degenerative rotator cuff tears.

Ethanol Metabolites: Their Role in the Assessment of Alcohol Intake

BACKGROUND Alcohol-related disorders are common, expensive in their course, and often underdiagnosed. To facilitate early diagnosis and therapy of alcohol-related disorders and to prevent later complications, questionnaires and biomarkers are useful. METHODS Indirect state markers like gamma-glutamyl-transpeptidase, mean corpuscular volume, and carbohydrate deficient transferrin are influenced by age, gender, various substances, and nonalcohol-related illnesses, and do not cover the entire timeline for alcohol consumption. Ethanol (EtOH) metabolites, such as ethyl glucuronide, ethyl sulfate, phosphatidylethanol, and fatty acid ethyl esters have gained enormous interest in the last decades as they are detectable after EtOH intake. RESULTS For each biomarker, pharmacological characteristics, detection methods in different body tissues, sensitivity/specificity values, cutoff values, time frames of detection, and general limitations are presented. Another focus of the review is the use of the markers in special clinical and forensic samples. CONCLUSIONS Depending on the biological material used for analysis, ethanol metabolites can be applied in different settings such as assessment of alcohol intake, screening, prevention, diagnosis, and therapy of alcohol use disorders.

Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.

BACKGROUND & AIMS It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. METHODS Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. RESULTS Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. CONCLUSIONS In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.

Analysis of Mycobacterium tuberculosis in the state of Texas for rifampin resistance using molecular beacons

Mycobacterium tuberculosis, a bacillus known to cause disease in humans since ancient times, is the etiological agent of tuberculosis (TB). The infection is primarily pulmonary, although other organs may also be affected. The prevalence of pulmonary TB disease in the US is highest along the US-Mexico border, and of the four US states bordering Mexico, Texas had the second highest percentage of cases of TB disease among Mexico-born individuals in 1999 (CDC, 2001). Between the years of 1993 and 1998, the prevalence of drug-resistant (DR) TB was 9.1% among Mexican-born individuals and 4.4% among US-born individuals (CDC, 2001). In the same time period, the prevalence of multi-drug resistant (MDR) TB was 1.4% among Mexican-born individuals and 0.6% among US-born individuals (CDC, 2001). There is a renewed urgency in the quest for faster and more effective screening, diagnosis, and treatment methods for TB due to the resurgence of tuberculosis in the US during the mid-1980s and early 1990s (CDC, 2007a), and the emergence of drug-resistant, multidrug-resistant, and extremely drug-resistant tuberculosis worldwide. Failure to identify DR and MDR-TB quickly leads to poorer treatment outcomes (CDC, 2007b). The recent rise in TB/HIV comorbidity further complicates TB control efforts. The gold standard for identification of DR-TB requires mycobacterial growth in culture, a technique taking up to three weeks, during which time DR/MDR-TB individuals harboring resistant organisms may be receiving inappropriate treatment. The goal of this study was to determine the sensitivity and specificity of real-time quantitative polymerase chain reaction (qPCR) using molecular beacons in the Texas population. qPCR using molecular beacons is a novel approach to detect mycobacterial mutations conferring drug resistance. This technique is time-efficient and has been shown to have high sensitivity and specificity in several populations worldwide. Rifampin (RIF) susceptibility was chosen as the test parameter because strains of M. tuberculosis which are resistant to RIF are likely to also be MDR. Due to its status as a point of entry for many immigrants into the US, control efforts against TB and drug-resistant TB in Texas is a vital component of prevention efforts in the US as a whole. We show that qPCR using molecular beacons has high sensitivity and specificity when compared with culture (94% and 87%, respectively) and DNA sequencing (90% and 96%, respectively). We also used receiver operator curve analysis to calculate cutoff values for the objective determination of results obtained by qPCR using molecular beacons. ^

40Ar-39Ar geochronological studies on rocks at DSDP Leg 58 Holes

The technique of 40Ar-39Ar step-heating dating was applied to three rock samples from core of DSDP Site 443, one sample from Site 445, and four samples at Site 446. All sites were drilled during DSDP Leg 58. At Site 443 (Shikoku Basin), about 116 meters of basalt basement was drilled. Three samples were chosen for dating from different levels in the basalt; two samples are aphyric basalt, and the other is subophitic dolerite. At Site 445 (Daito Ridge), no basement rock was drilled; however, conglomeratic sandstone was cored in the lower part of the hole. 40Ar-39Ar dating was applied to a basalt pebble in the conglomerate. At Site 446 (Daito Basin), the lower cored sequence is clay stone interlayered with 16 basalt sills. Four samples were chosen from sills at different levels.

40Ar-39Ar dating of rocks drilled at sites 60-458 and 60-459

40Ar-39Ar dating of a high-MgO bronzite andesite from near the top of basement drilled at Site 458 shows the characteristic symptoms of artificially disturbed samples - i.e., an inverse staircase-type age spectrum, approximate linearity on an isochron plot, and concordance between total fusion age and isochron age. From conclusions based on other artificially disturbed samples (Ozima et al., 1979), we suggest that the reference isochron age (33.6 Ma) approximates the age of the sample. A basalt from deeper in Hole 458 gives an isochron age of 19.1 ± 0.2 Ma, which is slightly younger than the plateau age of 21.4 ± 1.0 Ma. Both ages are, however, considerably younger than the age of fossils in the overlying sediments (30 - 34 Ma). The age discrepancy may be explained if the 40Ar-39Ar age represents the age of secondary minerals, which formed later. No useful age data were obtained from a basalt sample recovered from Hole 459B.

A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms

OBJECTIVES We sought to develop and validate a risk score combining both clinical and dobutamine echocardiographic (DbE) features in 4,890 patients who underwent DbE at three expert laboratories and were followed for death or myocardial infarction for up to five years. BACKGROUND In contrast to exercise scores, no score exists to combine clinical, stress, and echocardiographic findings with DbE. METHODS Dobutamine echocardiography was performed for evaluation of known or suspected coronary artery disease in 3,156 patients at two sites in the U.S. After exclusion of patients with incomplete follow-up, 1,456 DbEs were randomly selected to develop a multivariate model for prediction of events. After simplification of each model for clinical use, the models were internally validated in the remaining DbE patients in the same series and externally validated in 1,733 patients in an independent series. RESULTS The following score was derived from regression models in the modeling group (160 events): DbE risk = (age (.) 0.02) + (heart failure + rate-pressure product <15,000) (.) 0.4 + (ischemia + scar) (.) 0.6. The presence of each variable was scored as 1 and its absence scored as 0, except for age (continuous variable). Using cutoff values of 1.2 and 2.6, patients were classified into groups with five-year event-free survivals >95%, 75% to 95%, and <75%. Application of the score in the internal validation group (265 events) gave equivalent results, as did its application in the external validation group (494 events, C index = 0.72). CONCLUSIONS A risk score based on clinical and echocardiographic data may be used to quantify the risk of events in patients undergoing DbE. (C) 2004 by the American College of Cardiology Foundation.

Comunicação, Valores Comunitários e Sustentabilidade: os portais da UMESP, FEI e FSA.

Este trabalho analisou a relação entre comunicação e sustentabilidade em universidades comunitárias no Estado de São Paulo associadas à ABRUC (Associação Brasileira das Universidades Comunitárias). O objetivo foi examinar a imagem das universidades, a partir das estratégias de comunicação utilizadas nos portais institucionais. Procurou entender se e como utilizam o diferencial de caráter comunitário no marketing institucional. A pesquisa é de natureza qualitativa, tendo como metodologia central o estudo de caso múltiplos de Yin (2005). Foram também utilizados alguns dos aspectos da Análise de Conteúdo de Bardin (2006) para a categorização dos termos que identificam os valores comunitários. Os portais das universidades comunitárias localizadas na região do ABC paulista (Universidade Metodista do Estado de São Paulo UMESP, Centro Universitário Engenharia Industrial FEI e Centro Universitário Fundação Santo André FSA), se constituem no corpus principal desta pesquisa. A técnica para a análise dos portais foi estruturada a partir do trabalho de Vilella (2003). Foram avaliados aspectos voltados para a facilidade da navegação no uso das informações, tais como: usabilidade, funcionalidade e conteúdo. O período para a coleta de dados foi de um mês, assim distribuído: uma semana durante o período de inscrições para o vestibular e três semanas no início do período letivo do ano de 2008. Como parte da análise da construção da imagem institucional foi também verificado, a partir dos resultados econômicos e financeiros, se existe correlação entre a política de comunicação das instituições comunitárias e a sustentabilidade financeira. Os principais resultados foram: a) não existe uma visibilidade clara dos valores comunitários nos portais institucionais; b) os portais seguem os padrões tradicionais, sem incorporar as inovações tecnológicas, que garantam visibilidade e transparência nas ações das instituições; c) existe correlação entre os resultados econômico-financeiros e o diferencial comunitário como estratégia de comunicação e sustentabilidade das instituições.(AU)

Mineralogical and geochemical influences on sediment color of Amazon wetlands analyzed by visible spectrophotometry

Based on sedimentological and geochemical data, this work relates spectrophotometric measurements with sediment composition and its application in palaeoecological studies of Amazon wetlands. The CIELAB values are directly related to mineralogical and chemical composition, mostly involving quartz, iron oxyhydroxides and sulfides (e.g. pyrite), and total organic carbon. Total organic carbon contents between 0.4-1%, 1-2%, 3-5% and 15-40% were related to L* (lightness) data of 27, 26-15, 7-10 and 7 or less, respectively. The CIELAB values of a deposit in Marabá, Pará, were proportional to variations in quartz and total organic carbon contents, but changes in zones of similar color, mainly in the +a* (red) and +b* (yellow) values of deposits in Calçoene, Amapá and Soure, Pará, indicate a close relationship between total organic carbon content and iron oxyhydroxides and sulfides. Furthermore, the Q7/4 diagram (ratio between the % re?ectance value at 700 nm to that at 400 nm, coupled with L*) indicated iron-rich sediments in the bioturbated mud facies of the Amapá deposit, bioturbated mud and bioturbated sand facies of Soure deposit, and cross-laminated sand and massive sand facies of the Marabá core. Also, organic-rich sediments were found in the bioturbated mud facies of the Amapá deposit, lenticular heterolithic and bioturbated mud facies of the Soure deposit, and laminated mud and peat facies of the Marabá deposit. At the Marabá site, the data suggest an autochthonous influence with peat formation. The coastal wetland sites at Marajó and Amapá represent the development of a typical tidal flat setting with sulfide and iron oxyhydroxides formation during alternated flooding and drying.

Is there an age cutoff to apply adult formulas for GFR estimation in children?

BACKGROUND: Estimation of glomerular filtration rate (eGFR) using a common formula for both adult and pediatric populations is challenging. Using inulin clearances (iGFRs), this study aims to investigate the existence of a precise age cutoff beyond which the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), or the Cockroft-Gault (CG) formulas, can be applied with acceptable precision. Performance of the new Schwartz formula according to age is also evaluated. METHOD: We compared 503 iGFRs for 503 children aged between 33 months and 18 years to eGFRs. To define the most precise age cutoff value for each formula, a circular binary segmentation method analyzing the formulas' bias values according to the children's ages was performed. Bias was defined by the difference between iGFRs and eGFRs. To validate the identified cutoff, 30% accuracy was calculated. RESULTS: For MDRD, CKD-EPI and CG, the best age cutoff was ≥14.3, ≥14.2 and ≤10.8 years, respectively. The lowest mean bias and highest accuracy were -17.11 and 64.7% for MDRD, 27.4 and 51% for CKD-EPI, and 8.31 and 77.2% for CG. The Schwartz formula showed the best performance below the age of 10.9 years. CONCLUSION: For the MDRD and CKD-EPI formulas, the mean bias values decreased with increasing child age and these formulas were more accurate beyond an age cutoff of 14.3 and 14.2 years, respectively. For the CG and Schwartz formulas, the lowest mean bias values and the best accuracies were below an age cutoff of 10.8 and 10.9 years, respectively. Nevertheless, the accuracies of the formulas were still below the National Kidney Foundation Kidney Disease Outcomes Quality Initiative target to be validated in these age groups and, therefore, none of these formulas can be used to estimate GFR in children and adolescent populations.

Quantitation of genistein and genistin in soy dry extracts by UV-Visible spectrophotometric method

This paper describes the development and validation of an UV-Visible spectrophotometric method for quantitation of genistein and genistin in soy dry extracts, after reaction with aluminum chloride. The method showed to be linear (r²= 0.9999), precise (R.S.D. < 2%), accurate (recovery of 101.56%) and robust. Seven samples of soy dry extracts were analyzed by the spectrophotometric validated method and by RP-HPLC. Genistein concentrations determined by spectrophotometry (0.63% - 16.05%) were slightly higher than values obtained by HPLC analysis (0.40% - 12.79%); however, the results of both methods showed a strong correlation.

Identification of sarcopenic obesity in postmenopausal women: a cutoff proposal

Sarcopenic obesity is the combination of reduced fat-free mass (FFM) and increased fat mass (FM) with advancing age but there is lack of clear criteria for its identification. The purposes of the present investigation were: 1) to determine the prevalence of postmenopausal women with reduced FFM relative to their FM and height, and 2) to examine whether there are associations between the proposed classification and health-related variables. A total of 607 women were included in this cross-sectional study and were separated into two subsets: 258 older women with a mean age of 66.8 ± 5.6 years and 349 young women aged 18-40 years (mean age, 29.0 ± 7.5 years). All volunteers underwent body composition assessment by dual-energy X-ray absorptiometry. The FFM index relative to FM and height was calculated and the cutoff value corresponded to two standard deviations below the mean of the young reference group. To examine the clinical significance of the classification, all older participants underwent measurements of quadriceps strength and cardiorespiratory fitness. Values were compared between those who were classified as low FFM or not, using an independent samples t-test and correlations were examined. The cutoff corresponded to a residual of -3.4 and generated a sarcopenic obesity prevalence of 19.8% that was associated with reduced muscle strength and aerobic fitness among the older participants. Also, the index correlated significantly with the health-related fitness variables. The results demonstrated reduced functional capacity for those below the proposed cutoff and suggested applicability of the approach as a definition for sarcopenic obesity.

Variation des biomarqueurs dans le spectre visible non résolu de la Terre

L’évolution rapide des technologies de détection et de caractérisation des exoplanètes depuis le début des années 1990 permet de croire que de nouveaux instruments du type Terrestrial Planet Finder (TPF) pourront prendre les premiers spectres d’exoplanètes semblables à la Terre d’ici une ou deux décennies. Dans ce contexte, l’étude du spectre de la seule planète habitée connue, la Terre, est essentielle pour concevoir ces instruments et analyser leurs résultats. Cette recherche présente les spectres de la Terre dans le visible (390-900 nm), acquis lors de 8 nuits d’observation étalées sur plus d’un an. Ces spectres ont été obtenus en observant la lumière cendrée de la Lune avec le télescope de 1.6 m de l’Observatoire du Mont-Mégantic (OMM). La surface de la Lune réfléchissant de manière diffuse la lumière provenant d’une portion de la Terre, ces spectres sont non résolus spatialement. L’évolution de ces spectres en fonction de la lumière réfléchie à différentes phases de Terre est analogue à celle du spectre d’une exoplanète, dont la phase change selon sa position autour de l’étoile. L'eau, l'oxygène et l'ozone de l’atmosphère, détectés dans tous nos spectres, sont des biomarqueurs dont la présence suggère l’habitabilité de la planète et/ou la présence d’une activité biologique. Le Vegetation Red Edge (VRE), une autre biosignature spectrale, dû aux organismes photosynthétiques à la surface, est caractérisé par l’augmentation de la réflectivité autour de 700 nm. Pour les spectres de 5 nuits, cette augmentation a été évaluée entre -5 et 15% ±~5%, après que les contributions de la diffusion de Rayleigh, des aérosols et d’une large bande moléculaire de l’ozone aient été enlevées. Les valeurs mesurées sont cohérentes avec la présence de végétation dans la phase de la Terre contribuant au spectre, mais s’étendent sur une plage de variations plus large que celles trouvées dans la littérature (0-10%). Cela pourrait s’expliquer par des choix faits lors de la réduction des données et du calcul du VRE, ou encore par la présence d’autres éléments de surface ou de l’atmosphère dont la contribution spectrale autour de 700 nm serait variable.