Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

The role of eScience in service crystallography: the National Crystallography Service Grid facility [Poster]

The EPSRC National Crystallography Service (NCS) facility, working with the CombeChem eScience testbed project, has been exploring the use of Web/Grid services in e-Science applications. The Grid is an infrastructure for delivering access to distributed services such as computational and data storage facilities, instruments and wide area networks in a seamless manner. The NCS approach1,2 combines aspects of software and instrument automation to produce a service that increases user interaction and participation with application for use, sample submission, and also data acquisition, processing and analysis procedures, through networked electronic services on the Grid. A prospective user of the NCS is directed to the Grid Facility, where he/she may apply for an allocation by filling in an electronic form and uploading a case for support. At this point the metadata gathering and management process is initiated e.g. the contact details provided are directly incorporated into the security sign up and identification processes. Following successful peer review of their proposal by the NCS Management Panel, the applicant becomes a user and is securely provided with digital keys that enable access to the NCS Grid Facility. The user may now submit samples to the NCS through an electronic interface, which gathers all the chemical metadata concerning the sample, e.g. synthetic pathway, proposed formula and structure (2D information, by means of structure drawing applets), sensitivity, COSHH information, etc. The user may now query a web-based sample status database in order to monitor the progress of their sample(s), and ONLY their samples, in the queuing system. When a sample is scheduled for examination the user is informed by e-mail as to the allotted start time of the experiment, at which point they can initiate a secure, Web services based, interactive experiment from the sample status database. The crystal is mounted on the diffractometer by the sample changing robot in the case of the ‘dark laboratory’ experiment or by a service operator should interaction with an expert be requested / necessary. The user is then involved in a series of decision making stages, either automatically or with the service operator, which control the outcome of the unit cell determination and data collection procedures. At the conclusion of the experiment the data is made available to the user for download

Efficiency of curative and prophylactic treatment with rituximab in ADAMTS13-deficient thrombotic thrombocytopenic purpura: a study of 11 cases

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease that occurs mainly in young adults. Acquired cases are usually a result of antibodies directed against ADAMTS13 (a disintegrin-like and metalloprotease [reprolysin type] with thrombospondin type 1 motif 13), a protease that cleaves the von Willebrand factor multimers. Prognosis has been improved by plasma therapy, but some acute severe forms are refractory to this treatment and achieving a sustained remission is still a challenge in chronic relapsing forms. We therefore conducted a multicentric open-label prospective trial to test the efficacy of rituximab, an anti-B-cell monoclonal antibody, as a curative and prophylactic treatment in patients with TTP as a result of anti-ADAMTS13 antibodies. Six patients were included during an acute refractory TTP episode. Five patients with severe relapsing TTP and persistent anti-ADAMTS13 antibodies were prophylactically treated during remission. All patients received 4 weekly infusions of rituximab. The target of treatment was to restore a significant ADAMTS13 plasma activity (> 10%). Treatment with rituximab led to clinical remission in all cases of acute refractory TTP. In all patients, anti-ADAMTS13 antibodies disappeared, and a significant (18%-75%) plasma ADAMTS13 activity was detected following treatment. Tolerance of rituximab was good. Rituximab is a promising first-line immunosuppressive treatment in patients with acute refractory and severe relapsing TTP related to anti-ADAMTS13 antibodies