Intra-abdominal Sepsis – epidemiology and clinical presentation

Dublin, Ireland, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Severe Sepsis (acute organ dysfunction secondary to infection) and septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation) are major healthcare problems, affecting millions of individuals around the world each year, killing one in four (and often more), and increasing in incidence [1]. Incidence increased from 82 to 240/100,000 population Men > women 1.28 CI Reduced mortality rate 27 to 18% Highest mortality black men Decreased length of hospital stay Increased discharge to chronic care Predominance gram positive organism after 1987 Fungal organism increase 207 % Similar to major trauma, acute myocardial infarction or stroke, the speed and appropriateness of therapy administered in the initial hours after severe sepsis develops are likely to influence outcome. In 2004, an international group of experts in the diagnosis and management of infection and sepsis, representing 11 organizations, published the first internationally accepted guidelines that the bedside clinician could use to improve outcomes in severe sepsis and septic shock [2]. These guidelines represented phase II of the Surviving Sepsis Campaign (SSC) an international effort to increase awareness and improve outcomes in severe sepsis. Joined by additional organizations the group met again in 2006 and 2007 to update the guidelines document using a new evidence-based methodology system for assessing quality of evidence and strength of recommendations [3]

End of life decisions – practical applications of the ethical principles of consent and patient autonomy

Dublin, Ireland, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Prior to the mid 1840’s, before the advent of anaesthesia, surgical procedures were limited and confined mainly to amputations for traumatic lower limb injuries and drainage of abscesses. With the advance of ether/chloroform anaesthesia, the scope and extent of elective surgery increased dramatically. The landmark US Schloendorff v Society of New York Hospitals case in 1914 stated the patient requirements to give consent and the consequences for the surgeon who operates without the patient’s consent . Judge J Cardozo ruled that “ every human being of adult years and sound mind has the right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent commits an assault for which he is liable in damages” In the middle of the 20th century society changes had a major impact on the culture and practice of consent. The Nuremberg trials exposed the barbaric nature of Nazi experiments done in the name of medical science when inmates of concentration camps were immersed in iced water to determine how long they would live. This led to the Nuremberg Code adopted in 1947 and the subsequent World Medical Association’s Geneva Declaration on consent. Subsequent Declarations included Helsinki (Research), Sydney (Organ Donation) and Tokyo (Torture). Patient consent is one of the most complex and evolving considerations in clinical practice. Consent can come in different guises. It may be expressed or positively affirmed in writing or may be implied by the conduct or silence of the person whose consent is required. There may be times when obtaining consent is impossible in emergency or extreme situations or when consent, although given by the patient, is based on incomplete or inaccurate information

The detection of flaws in austenitic welds using the decomposition of the time reversal operator

The non-destructive testing of austenitic welds using ultrasound plays an important role in the assessment of the structural integrity of safety critical structures. The internal microstructure of these welds is highly scattering and can lead to the obscuration of defects when investigated by traditional imaging algorithms. This paper proposes an alternative objective method for the detection of flaws embedded in austenitic welds based on the singular value decomposition of the time-frequency domain response matrices. The distribution of the singular values is examined in the cases where a flaw exists and where there is no flaw present. A lower threshold on the singular values, specific to austenitic welds, is derived which, when exceeded, indicates the presence of a flaw. The detection criterion is successfully implemented on both synthetic and experimental data. The datasets arising from welds containing a flaw, are further interrogated using the decomposition of the time reversal operator (DORT) method and the total focussing method (TFM) and it is shown that images constructed via the DORT algorithm typically exhibit a higher signal to noise ratio than those constructed by the TFM algorithm

A Maximum Eigenvalue Approximation for Crack-Sizing Using Ultrasonic Arrays

Ultrasonic phased array systems are becoming increasingly popular as tools for the inspection of safety-critical structures with in the non-destructive testing industry. The datasets captured by these arrays can be used to image the internal microstructure of individual components, all owing the location and nature of any defects to be deduced. Unfortunately, many of the current imaging algorithms require an arbitrary threshold at which the defect measurements can be taken and this aspect of subjectivity can lead to varying characterisations of a flaw between different operators. This paper puts forward an objective approach based on the Kirchoff scattering model and the approximation of the resulting scattering matrices by Toeplitz matrices. A mathematical expression relating the crack size to the maximum eigenvalue of the associated scattering matrix is thus derived. The formula is analysed numerically to assess its sensitivity to the system parameters and it is shown that the method is most effective for sizing defects that are commensurate with the wavelength of the ultrasonic wave (or just smaller than. The method is applied to simulated FMC data arising from finite element calculations where the crack length to wavelength ratios range between 0.6 and 1.8. The recovered objective crack size exhibits an error of 12%

Identification of structural protein–protein interactions of herpes simplex virus type 1

AbstractIn this study we have defined protein–protein interactions between the structural proteins of herpes simplex virus type 1 (HSV-1) using a LexA yeast two-hybrid system. The majority of the capsid, tegument and envelope proteins of HSV-1 were screened in a matrix approach. A total of 40 binary interactions were detected including 9 out of 10 previously identified tegument–tegument interactions (Vittone, V., Diefenbach, E., Triffett, D., Douglas, M.W., Cunningham, A.L., and Diefenbach, R.J., 2005. Determination of interactions between tegument proteins of herpes simplex virus type 1. J. Virol. 79, 9566–9571). A total of 12 interactions involving the capsid protein pUL35 (VP26) and 11 interactions involving the tegument protein pUL46 (VP11/12) were identified. The most significant novel interactions detected in this study, which are likely to play a role in viral assembly, include pUL35–pUL37 (capsid–tegument), pUL46–pUL37 (tegument–tegument) and pUL49 (VP22)–pUS9 (tegument–envelope). This information will provide further insights into the pathways of HSV-1 assembly and the identified interactions are potential targets for new antiviral drugs

Mechanisms of Immune Control of Mucosal HSV Infection: A Guide to Rational Vaccine Design

Herpes Simplex Virus (HSV) is a highly prevalent sexually transmitted infection that aside from causing cold sores and genital lesions, causes complications in the immunocompromised and has facilitated a large proportion of HIV acquisition globally. Despite decades of research, there is no prophylactic HSV vaccine ready for use in humans, leaving many questioning whether a prophylactic vaccine is an achievable goal. A previous HSV vaccine trial did have partial success in decreasing acquisition of HSV2–promising evidence that vaccines can prevent acquisition. However, there is still an incomplete understanding of the immune response pathways elicited by HSV after initial mucosal infection and how best to replicate these responses with a vaccine, such that acquisition and colonization of the dorsal root ganglia could be prevented. Another factor to consider in the rational design of an HSV vaccine is adjuvant choice. Understanding the immune responses elicited by different adjuvants and whether lasting humoral and cell-mediated responses are induced is important, especially when studies of past trial vaccines found that a sufficiently protective cell-mediated response was lacking. In this review, we discuss what is known of the immune control involved in initial herpes lesions and reactivation, including the importance of CD4 and CD8 T cells, and the interplay between innate and adaptive immunity in response to primary infection, specifically focusing on the viral relay involved. Additionally, a summary of previous and current vaccine trials, including the components used, immune responses elicited and the feasibility of prophylactic vaccines looking forward, will also be discussed