Welchen Einfluss hat eine mikrobiologische Schnelldiagnostik auf die antiinfektive Therapieänderung bei Patienten mit einer schweren Sepsis oder einem septischen Schock?

Die Sepsis ist die Ursache für einen Todesfall aus zwei bis drei Todesfällen im klinischen Bereich [50]. In dieser Dissertation werden Patienten mit einer schweren Sepsis, welche nach der verwendeten Definition aus dem Jahr 1992 mindestens zwei SIRS-Kriterien erfüllen sowie zusätzlich eine Organdysfunktion oder eine Hypotension oder eine Hypoperfusion aufweisen, und Patienten mit einem septischen Schock, welche eine Sepsis induzierte Hypotension aufweisen, die trotz adäquater Volumentherapie vasopressorenpflichtig ist [3], mit zwei unterschiedlichen Blutkultur - Diagnostikverfahren untersucht. Der Goldstandard für die Diagnostik der Sepsis ist die Blutkulturdiagnostik [9]. Um eine schnellere Diagnostik und damit eine schnellere adäquate Therapie zu erzielen, wird vermehrt der molekulargenetische Ansatz eingesetzt und speziell im Rahmen meiner Dissertation das Prinzip der Fluoreszenz–in–situ–Hybridisierung untersucht [17, 18]. Ziel ist es gewesen, die vermeintliche Schnelligkeit des verwendeten Accelerate PhenoTM Systems bei der Identifizierung der sepsisinduzierenden Mikroben statistisch zu belegen, sowie einen möglichen Vorteil in der Adäquatheit der antiinfektiven Therapie für die Patienten nachzuweisen. Nach unserer Kenntnis sind in der vorliegenden BEMIDIA Studie erstmals die Blutkultur- Schnelldiagnostik in einem 24 / 7 Dienstsystem unter den Bedingungen der klinischen Routine auf einer Intensivstation untersucht worden. Somit konnten erstmals die tatsächlichen klinischen Vorteile einer Schnelldiagnostik für Blutkulturen analysiert werden. Die Ergebnisse meiner Dissertation zeigen, dass die Patienten, welche eine Blutkulturdiagnostik durch die mikrobiologische Schnelldiagnostik mittels des Accelerate PhenoTM Systems erhalten haben, neben einer früheren ID time und AST time, tendenziell auch eine frühere Therapieänderung erhalten haben, im Gegensatz zu den Patienten, deren Blutkulturen nur mit dem Standardverfahren in der medizinischen Mikrobiologie untersucht worden sind, und jene Patienten, bei denen die Blutkultur negativ geblieben ist. Außerdem erhalten insgesamt ein größerer prozentualer Anteil an Patienten, welche eine Blutkulturdiagnostik mittels des Accelerate PhenoTM Systems erhalten haben, eine Änderung in eine adäquate Therapie als die Patienten, deren Blutkulturen nicht im Accelerate PhenoTM System untersucht worden sind.Gerade die hier sichtbar werdenden Vorteile für Patienten aufgrund einer Blutkulturschnelldiagnostik, die 24 Stunden am Tag durchgeführt werden kann, erfordern weitere Forschungen. Außerdem sind jedoch weitere Studien mit größeren Patientenzahlen und zusätzlicher Analyse von geschlechts-, alters- und vorerkrankungsspezifischen Untergruppen nötig, um die statische Aussagekraft der Daten dieser Dissertation zu untermauern und die Vorteile des Accelerate PhenoTM Systems stärker zu verdeutlichen

PACS: 33.20.Fb, 33.20.Kf, 32.50.+d, 61.46.Df, 73.20.Mf, 78.67.Bf, 87

The enhancing properties of silver nanoparticles in surface-enhanced Raman scattering (SERS) and metalenhanced uorescence (MEF) are studied in this work. The obtained results conrm that the partial aggregation of nanoparticles leads to a great increase of Raman scattering cross-section but there are signicant dierences in SERS-activity of colloidal silver treated with various aggregating compounds. The dierences are interpreted through the analysis of both experimental and computational results. The same silver colloid covered with silica shell preventing the uorescence quenching makes possible a several-fold increase in uorescence emission. The eect strongly depends on thickness of the outer layer of nanoparticles. Geometrical parameters of nanoparticles (radius or radius and thickness of the adsorption layer in core-shell systems) are determined on the basis of the dynamic light scattering (DLS) data and extinction spectra analysis

Fluorescence lifetime of collagen degradation products in plasma of patients with left ventricular remodeling

Background. The concentration of collagen degradation products in plasma may reflect the process of left ventricular remodeling in patients after acute myocardial infarction. The aim of this study was to confirm that mean fluorescence lifetime of plasma is decreased in patients with left ventricular systolic dysfunction. Patients, materials and methods. The study group consisted of patients treated with primary percutaneous coronary intervention for acute myocardial infarction admitted to the Department of Cardiology and Internal Medicine at the University Hospital in Bydgoszcz. The overall group comprised of 65 patients. From each patient 8 mL of blood was taken to obtain plasma that was used for further examination. The time-resolved spectrometer Life Spec II with the sub-nanosecond pulsed 360 nm EPLED® diode was used in order to measure fluorescence lifetime of samples. Results. Significant differences were observed in mean fluorescence lifetime of plasma between groups of patients divided according to brain natriuretic peptide levels. Statistical analysis showed that the increase in brain natriuretic peptide level is an independent factor resulting in the decrease in mean fluorescence lifetime. Conclusions. It seems that plasma concentration of collagen degradation products is closely related to brain natriuretic peptide level. However, this experiment confirmed that plasma of patients with potential high probability of developing left ventricular remodeling is characterized by the decrease in mean fluorescence lifetime

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

SERS and DFT study of 5F‐PB‐22

In this work, a joint experimental and theoretical study on the synthetic cannabinoid, 5F‐PB‐22 (1‐(5‐fluoropentyl)‐8‐quinolinyl ester‐1H‐indole‐3‐carboxylic acid) is reported. The molecular vibrations of 5F‐PB‐22 were investigated by Raman and surface‐enhanced Raman spectroscopy (SERS) spectroscopies. In parallel, quantum chemical calculations based on density functional theory (DFT) with the hybrid B3LYP exchange‐correlation functional coupled with the standard 3‐21G basis set were used to determine the geometrical and vibrational characteristics of 5F‐PB‐22 and to predict the adsorption geometry of the molecule on the silver colloidal surface. The SERS spectrum of 5F‐PB‐22 was recorded using a 532‐nm laser line and a hydroxylamine phosphate reduced silver colloid as the SERS substrate. SERS and Raman spectral bands have been assigned by comparison with the DFT calculated spectrum. A self‐aggregation spectrum was obtained, but in order to obtain a spectrum with NaCl as the aggregating agent, a two‐step procedure was developed. It was found that 10‐mM NaCl can be used as a trigger for aggregation before adding 5F‐PB‐22 followed by the addition of 20‐ to 100‐mM NaCl to complete aggregation. Using this procedure, 5F‐PB‐22 was easily detected at 2.12 × 10−8 M. Based on a predicted molecular adsorption geometry from the calculated molecular electrostatic potential and the SERS spectrum, it is proposed that the quinoline moiety of the molecule lies in a preponderant parallel orientation to the silver surface with the plane of the indole ring being perpendicular to the surface. The molecular orientation is affected by the surface coverage by 5F‐PB‐22 and the presence of Cl−

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Effects of connecting corridors on detection of self-overlapping spaces in virtual reality

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