Brazilian Sepsis Epidemiological Study (BASES study)

INTRODUCTION: Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome METHODS: This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used. RESULTS: For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract. CONCLUSION: Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate

Heating and low-frequency modulation of electrons observed during electron beam operations on TSS 1

We have studied electron responses measured by two electrostatic analyzers (ESA A and B) that comprise the Shuttle Potential and Return Electron Experiment (SPREE) to 60 prolonged beam emissions by the fast pulsed electron generator (FPEG) during the first flight of the Tethered Satellite System (TSS 1). When the beam cleanly escaped into space, responses depended on whether the pitch angle of the beam, α B , was less than or greater than 90°. Beam-like structures were detected by SPREE when α B 90°. Secondary electron fluxes measured by SPREE peaked at pitch angles a between 65° and 75° when α B 90°. At other pitch angles the distributions of electrons returning to the shuttle had repeatable thermal and power law shapes. The distinctive distribution functions are attributed qualitatively to the different regions in and near the beam traversed by electrons reaching SPREE under the two α B conditions. A large fraction of the trajectories of electrons reaching SPREE ESA A with α B )90° lie inside (outside) beam flux tubes. Measurements by a particle correlator in the SPREE data processor show that in 25 cases some of the returning-electron distributions fe were modulated at frequencies in the low kilohertz range. The modulations appeared in portions of the distributions where ∂ƒ e /∂υ < 0 and at frequencies that correspond to none of the plasma's normal modes. In light of previously reported wave measurements taken near the shuttle during electron beam emissions, we suggest that the modulated electrons were bunched by large-amplitude, ion acoustic waves propagating nearly perpendicular to the Earth's magnetic field. The waves were generated as plasma responses to negative space charges in the electron-beam flux tubes moving at orbital speed across the ionosphere

Association of a nsSNP in ADAMTS14 to some osteoarthritis phenotypes

Objective: To investigate the effect in OA (Osteoarthritis) susceptibility of putative damaging changes in ADAM (A Disintegrin And Metalloprotease) and ADAMTS (ADAM with ThromboSpondin motif proteases. Methods: Non-synonymous single nucleotide polymorphisms (nsSNP) in 18 ADAMTS and 31 ADAM genes were analyzed with two software applications for prediction of functional damage. Four putative damaging nsSNP were found in ADAMTS2, ADAMTS14, ADAMTS16 and ADAM12, respectively. These nsSNPs were analyzed in case-control sample collections with a variety of phenotypes totalling 3217 OA patients and 2214 healthy controls, all of them Caucasians. Results: No statistically significant differences were found in ADAMTS2, ADAMTS16 and ADAM12 nsSNPs. Conversely, the rare allele of the rs4747096 nsSNP in ADAMTS14 was overrepresented in women requiring joint replacement because of knee OA (O.R-M-H (odds ratio. Mantel-Haenszel) 1.41, 95% C.I. 1.1-1.8; P 0.002) and in patients with symptomatic hand OA (O.R. 1.37, 95% C.I. 1.0-1.9; P 0.047). A non significant increase in the frequency of the same allele was also found in patients with hip OA requiring prosthesis (O.R.m-pi 1.14, 95% C.I. 1.0--1.3; P -0.08). No association was found with otherOA phenotypes. Conclusion: Our findings implicate ADAMTS14 in OA, specifically in knee OA requiring joint replacement in wornen and, possibly, in hand OA. Independent association of ADAMTS14 genetic variation to knee OA in women has been communicated. ADAMTS14 involvement, if confirmed, will open a now area of interest in OA pathogenesis because of its role in the maturation of collagen fibers. - 2008 Osteoarthntis Research Society International. Published by Elsevier Ltd. All rights reserved