Soluble receptor for advanced glycation end products as an indicator of pulmonary vascular injury after cardiac surgery

Background: Cardiac surgery is frequently complicated by an acute vascular lung injury and this may be mediated, at least in part, by the (soluble) receptor for advanced glycation end products (sRAGE).Methods: In two university hospital intensive care units, circulating sRAGE was measured together with the 68Gallium-transferrin pulmonary leak index (PLI), a measure of pulmonary vascular permeabiliy, in 60 consecutive cardiac surgery patients stratified by the amount of blood transfusion, within 3 hours of admission to the intensive care.Results: Cardiac surgery resulted in elevated plasma sRAGE levels compared to baseline (315 ± 181 vs 110 ± 55 pg/ml, P = 0.001). In 37 patients the PLI was elevated 50% above normal. The PLI correlated with sRAGE (r2 = 0.11, P = 0.018). Plasma sRAGE discriminated well between those with an elevated PLI and those with a normal PLI (area under the operator curve 0.75; P = 0.035; 95% CI 0.55-0.95), with 91% sensitivity but low specificity of 36% at a cutoff value of 200 pg/mL

Dijet photoproduction of massless charm jets at next-to-leading order of QCD

We compute the charm dijet photoproduction cross section at next-to-leading order of QCD in the zero-mass variable flavour number scheme, i.e. with active charm quarks in the proton and photon. The results are compared to recent measurements from the ZEUS experiment at HERA. The predictions for various distributions agree well with the data, in particular for large momentum fractions of the the partons in the photon, where direct photon processes dominate. At low momentum fractions, the predictions are quite sensitive to the charm content in the photon. The experimental data are shown to favour parameterizations with a substantial charm quark density such as the one proposed by Cornet et al.Comment: 18 pages, 11 figure

Recombinant human activated protein C in the treatment of acute respiratory distress syndrome

Rationale: Pulmonary coagulopathy may play a pathogenetic role in acute respiratory distress syndrome (ARDS), by contributing to alveolocapillary inflammation and increased permeability. Recombinant human activated protein C (rh-APC) may inhibit this process and thereby improve patient outcome. Methods: A prospective randomized, saline-controlled, single-blinded clinical trial was performed in the intensive care units of two university hospitals, and patients with ARDS were included within 24 h after meeting inclusion criteria. Intervention: A 4-day course of intravenous rh-APC (24 mcg/kg/h) (n = 33) versus saline (n = 38). Outcomes: The primary outcome parameter was the pulmonary leak index (PLI) of 67Gallium-transferrin as a measure of alveolocapillary permeability and secondary outcomes were disease severity scores and ventilator-free days, among others. Results: Baseline characteristics were similar; in 87% of patients the PLI was above normal and in 90% mechanical or noninvasive ventilation was instituted at a median lung injury score of 2.5. There was no evidence that Rh-APC treatment affected the PLI or attenuated lung injury and sequential organ failure assessment scores. Mean ventilator-free days amounted to 14 (rh-APC) and 12 days (saline, P = 0.35). 28-day mortality was 6% in rh-APC- and 18% in saline-treated patients (P = 0.12). There was no difference in bleeding events. The study was prematurely discontinued because rh-APC was withdrawn from the market. Conclusion: There is no evidence that treatment with intravenous rh-APC during 4 days for infectious or inflammatory ARDS ameliorates increased alveolocapillary permeability or the clinical course of ARDS patients. We cannot exclude underpowering. Trial Registration: Nederlands Trial Registe

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

Background: The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives. Aim: To determine the prevalence of Do No

Total photoproduction cross-section at very high energy

In this paper we apply to photoproduction total cross-section a model we have proposed for purely hadronic processes and which is based on QCD mini-jets and soft gluon re-summation. We compare the predictions of our model with the HERA data as well as with other models. For cosmic rays, our model predicts substantially higher cross-sections at TeV energies than models based on factorization but lower than models based on mini-jets alone, without soft gluons. We discuss the origin of this difference.Comment: 13 pages, 9 figures. Accepted for publication in EPJC. Changes concern added references, clarifications of the Soft Gluon Resummation method used in the paper, and other changes requested by the Journal referee which do not change the results of the original versio