Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A retrospective observational study

BACKGROUND: Shock index (SI) (heart rate/systolic blood pressure) has been used to predict outcome in both adult and pediatric sepsis within the intensive care unit (ICU). We aimed to evaluate the utility of SI prior to pediatric ICU (PICU) admission. METHODS: We conducted a retrospective observational study of children referred to a pediatric intensive care transport service (PICTS) between 2005 and 2011. The predictive value of SI, heart rate and blood pressure at three pre-specified time points (at referral to PICTS, at PICTS arrival at the referring hospital, and at PICU admission), and changes in SI between the time points, were evaluated. Death within the first 48 hours of ICU admission (early death) was the primary outcome variable. RESULTS: Over the seven-year period, 572 children with sepsis were referred to the PICTS. Thirty-nine children died prior to transport to a PICU, while 474 were transported alive. Adjusting for age, time-points and time duration in a multi-level regression analysis, SI was significantly higher in those who died early. There was a significant improvement in SI with the transport team in survivors but not in non-survivors. However, the predictive value of a change in SI for mortality was no better than either a change in heart rate or blood pressure. CONCLUSIONS: The absolute or change in SI does not predict early death any more than heart rate and systolic blood pressure individually in children with sepsis

Managing the winter surge in demand for resources

This article evaluates whether providing extra clinical resource during the winter of 2014/15 improved the availability of paediatric intensive care retrieval teams in a North London retrieval service. We explored the potential impact of different staffing patterns in future years to inform service planning. We used retrospective routine data to compare the proportion of referrals refused due to lack of capacity between the winter of 2014/15 and the previous five winters. In the winter of 2014/15, an additional team were on shift for 12% of the time. We compared shifts where the additional team were available in the winter of 2014/15 to similar shifts in previous years. We used mathematical modelling to predict the potential impact of staffing levels in future winters. From 1 November 2014 to 3 January 2015, the service performed 380 emergency retrievals and refused 25 due to no available team (6.2%). The proportion of refusals during shifts with the additional team available in 2014/15 was 4.2% vs 12.4% in similar shifts from 2009/10 to 2013/14 (p = 0.026). Mathematical modelling showed that staffing an additional full-time team could result in 2% of referrals refused compared to 8% without and that much benefit could be obtained by a third team working a 12-hour shift from 10am until 10pm (refusal rate 2.8%)

Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review

Pancreatic resections are surgical procedures associated with high incidence of complications, with relevant morbidity and mortality even at high volume centres. A multidisciplinary approach is essential in the management of these events and interventional radiology plays a crucial role in the treatment of patients developing post-surgical complications. This paper offers an overview on the interventional radiological procedures that can be performed to treat different type of complications after pancreatic resection. Procedures such as percutaneous drainage of fluid collections, percutaneous transhepatic biliary procedures, arterial embolisation, venous interventions and fistula embolisation are viable treatment options, with fewer complications compared with re-look surgery, shorter hospital stay and faster recovery. A selection of cases of complications following pancreatic surgery managed with interventional radiological procedure are presented and discussed. Teaching Points \u2022 Interventional radiology is crucial to treat complications after pancreatic surgery \u2022 Percutaneous drainage of collections can be performed under ultrasound or computed tomography guidance \u2022 Percutaneous biliary procedures can be used to treat biliary complications \u2022 Venous procedures can be performed effectively through transhepatic or transjugular access \u2022 Fistulas can be treated effectively by percutaneous embolisation

Evolutionary relationships between Rhynchosporium lolii sp. nov. and other Rhynchosporium species on grass.

Copyright: 2013 King et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedThe fungal genus Rhynchosporium (causative agent of leaf blotch) contains several host-specialised species, including R. commune (colonising barley and brome-grass), R. agropyri (couch-grass), R. secalis (rye and triticale) and the more distantly related R. orthosporum (cocksfoot). This study used molecular fingerprinting, multilocus DNA sequence data, conidial morphology, host range tests and scanning electron microscopy to investigate the relationship between Rhynchosporium species on ryegrasses, both economically important forage grasses and common wild grasses in many cereal growing areas, and other plant species. Two different types of Rhynchosporium were found on ryegrasses in the UK. Firstly, there were isolates of R. commune that were pathogenic to both barley and Italian ryegrass. Secondly, there were isolates of a new species, here named R. lolii, that were pathogenic only to ryegrass species. R. lolii was most closely related to R. orthosporum, but exhibited clear molecular, morphological and host range differences. The species was estimated to have diverged from R. orthosporum ca. 5735 years before the present. The colonisation strategy of all of the different Rhynchosporium species involved extensive hyphal growth in the sub-cuticular regions of the leaves. Finally, new species-specific PCR diagnostic tests were developed that could distinguish between these five closely related Rhynchosporium species.Peer reviewedFinal Published versio

Ultrafast x-ray-induced nuclear dynamics in diatomic molecules using femtosecond x-ray-pump-x-ray-probe spectroscopy

Citation: Lehmann, C. S., Picon, A., Bostedt, C., Rudenko, A., Marinelli, A., Moonshiram, D., . . . Southworth, S. H. (2016). Ultrafast x-ray-induced nuclear dynamics in diatomic molecules using femtosecond x-ray-pump-x-ray-probe spectroscopy. Physical Review A, 94(1), 7. doi:10.1103/PhysRevA.94.013426The capability of generating two intense, femtosecond x-ray pulses with a controlled time delay opens the possibility of performing time-resolved experiments for x-ray-induced phenomena. We have applied this capability to study the photoinduced dynamics in diatomic molecules. In molecules composed of low-Z elements, K-shell ionization creates a core-hole state in which the main decay mode is an Auger process involving two electrons in the valence shell. After Auger decay, the nuclear wave packets of the transient two-valence-hole states continue evolving on the femtosecond time scale, leading either to separated atomic ions or long-lived quasibound states. By using an x-ray pump and an x-ray probe pulse tuned above the K-shell ionization threshold of the nitrogen molecule, we are able to observe ion dissociation in progress by measuring the time-dependent kinetic energy releases of different breakup channels. We simulated the measurements on N-2 with a molecular dynamics model that accounts for K-shell ionization, Auger decay, and the time evolution of the nuclear wave packets. In addition to explaining the time-dependent feature in the measured kinetic energy release distributions from the dissociative states, the simulation also reveals the contributions of quasibound states

Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics

Citation: Picon, A., Lehmann, C. S., Bostedt, C., Rudenko, A., Marinelli, A., Osipov, T., . . . Southworth, S. H. (2016). Hetero-site-specific X-ray pump-probe spectroscopy for femtosecond intramolecular dynamics. Nature Communications, 7, 6. doi:10.1038/ncomms11652New capabilities at X-ray free-electron laser facilities allow the generation of two-colour femtosecond X-ray pulses, opening the possibility of performing ultrafast studies of X-ray-induced phenomena. Particularly, the experimental realization of hetero-site-specific X-ray-pump/X-ray-probe spectroscopy is of special interest, in which an X-ray pump pulse is absorbed at one site within a molecule and an X-ray probe pulse follows the X-ray-induced dynamics at another site within the same molecule. Here we show experimental evidence of a hetero-site pump-probe signal. By using two-colour 10-fs X-ray pulses, we are able to observe the femtosecond time dependence for the formation of F ions during the fragmentation of XeF2 molecules following X-ray absorption at the Xe site