Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Nanocrystalline diamond films grown at very low substrate temperature using a distributed antenna array microwave process: Towards polymeric substrate coating

International audienc

Growth processes of nanocrystalline diamond films in microwave cavity and distributed antenna array systems: A comparative study

International audienc

Synthesis of graphene by cobalt-catalyzed decomposition of methane in plasma-enhanced CVD: Optimization of experimental parameters with Taguchi method

This article describes the significant roles of process parameters in the deposition of graphene films via cobalt-catalyzed decomposition of methane diluted in hydrogen using plasma-enhanced chemical vapor deposition (PECVD). The influence of growth temperature (700–850 °C), molar concentration of methane (2%–20%), growth time (30–90 s), and microwave power (300–400 W) on graphene thickness and defect density is investigated using Taguchi method which enables reaching the optimal parameter settings by performing reduced number of experiments. Growth temperature is found to be the most influential parameter in minimizing the number of graphene layers, whereas microwave power has the second largest effect on crystalline quality and minor role on thickness of graphene films. The structural properties of PECVD graphene obtained with optimized synthesis conditions are investigated with Raman spectroscopy and corroborated with atomic-scale characterization performed by high-resolution transmission electron microscopy and scanning tunneling microscopy, which reveals formation of continuous film consisting of 2–7 high quality graphene layers

Millers and millwrights in antiquity and the early middle ages

The study of early watermills has, from its very beginning, concentrated on two issues: their diffusion (in time and space) and their technical construction. Very little interest has been devoted to the persons who built and managed them—the millwrights and the millers. This tendency has been even more manifest from the 1980s onward, when interest has focused more and more on the increasing number of archaeological finds. The written evidence, our almost sole source for people connected with the mills, plays a quite insignificant part in modern scholarship. This short article does not aim at far-reaching conclusions concerning the socioeconomic conditions of the two professions involved. Its main purpose is to show the extent of the evidence actually at hand. The varied nature of this evidence, as well as the uncertain authenticity of parts of it, complicates the study. After a short presentation of the terminology, I start my investigation by presenting the millers according to the three basic socioeconomic areas within which they were working, and end up with a discussion of the millwrights, in order to show how the two occupations were at least partly related