Levosimendan for the prevention of acute organ dysfunction in sepsis

BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODS We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTS The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). CONCLUSIONS The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.

The solid modeling of the fillet on the intersection line of two cylinders

2005-2006 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Grouted jetted precast concrete sheet piles: Method, experiments, and applications

This paper introduces an innovative technology - grouted jetted precast concrete piling - that increases the efficiency of piling operations in coastal regions. The technology includes the following steps: (i) casting concrete piles factory-designed especially for jetting and grouting; (ii) jetting to drive the concrete piles with a crane on a floating ship or platform into soil; and (iii) grouting to enhance the sheet pile connections and to increase the pile bearing capacity. This technology was applied to a number of piling construction projects at the mouth of the Yellow River Delta in China, and this experience demonstrated that it is a robust, fast track, cost-effective, and environmentally friendly piling method. © 2006 NRC Canada.published_or_final_versio

The forming theory and nc machining of the rotary burs with special cutting edges

2005-2006 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Experimental demonstration of quantum memory for light

The information carrier of today's communications, a weak pulse of light, is an intrinsically quantum object. As a consequence, complete information about the pulse cannot, even in principle, be perfectly recorded in a classical memory. In the field of quantum information this has led to a long standing challenge: how to achieve a high-fidelity transfer of an independently prepared quantum state of light onto the atomic quantum state? Here we propose and experimentally demonstrate a protocol for such quantum memory based on atomic ensembles. We demonstrate for the first time a recording of an externally provided quantum state of light onto the atomic quantum memory with a fidelity up to 70%, significantly higher than that for the classical recording. Quantum storage of light is achieved in three steps: an interaction of light with atoms, the subsequent measurement on the transmitted light, and the feedback onto the atoms conditioned on the measurement result. Density of recorded states 33% higher than that for the best classical recording of light on atoms is achieved. A quantum memory lifetime of up to 4 msec is demonstrated.Comment: 22 pages (double line spacing) incl. supplementary information, 4 figures, accepted for publication in Natur

Quantum catastrophe of slow light

Catastrophes are at the heart of many fascinating optical phenomena. The rainbow, for example, is a ray catastrophe where light rays become infinitely intense. The wave nature of light resolves the infinities of ray catastrophes while drawing delicate interference patterns such as the supernumerary arcs of the rainbow. Black holes cause wave singularities. Waves oscillate with infinitely small wave lengths at the event horizon where time stands still. The quantum nature of light avoids this higher level of catastrophic behaviour while producing a quantum phenomenon known as Hawking radiation. As this letter describes, light brought to a standstill in laboratory experiments can suffer a similar wave singularity caused by a parabolic profile of the group velocity. In turn, the quantum vacuum is forced to create photon pairs with a characteristic spectrum. The idea may initiate a theory of quantum catastrophes, in addition to classical catastrophe theory, and the proposed experiment may lead to the first direct observation of a phenomenon related to Hawking radiation.Comment: Published as "A laboratory analogue of the event horizon using slow light in an atomic medium

Moving frame aand its application in the error analysis of point contact gearing

2005-2006 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Therapy and Long-Term Prophylaxis of Vaccinia Virus Respiratory Infections in Mice with an Adenovirus-Vectored Interferon Alpha (mDEF201)

An adenovirus 5 vector encoding for mouse interferon alpha, subtype 5 (mDEF201) was evaluated for efficacy against lethal vaccinia virus (WR strain) respiratory infections in mice. mDEF201 was administered as a single intranasal treatment either prophylactically or therapeutically at doses of 106 to 108 plaque forming units/mouse. When the prophylactic treatment was given at 56 days prior to infection, it protected 90% of animals from death (100% protection for treatments given between 1–49 days pre-infection), with minimal weight loss occurring during infection. Surviving animals re-challenged with virus 22 days after the primary infection were protected from death, indicating that mDEF201 did not compromise the immune response against the initial infection. Post-exposure therapy was given between 6–24 h after vaccinia virus exposure and protection was afforded by a 108 dose of mDEF201 given at 24 h, whereas a 107 dose was effective up to 12 h. Comparisons were made of the ability of mDEF201, given either 28 or 1 day prior to infection, to inhibit tissue virus titers and lung infection parameters. Lung, liver, and spleen virus titers were inhibited to nearly the same extent by either treatment, as were lung weights and lung hemorrhage scores (indicators of pneumonitis). Lung virus titers were significantly (>100-fold) lower than in the placebo group, and the other infection parameters in mDEF201 treated mice were nearly at baseline. In contrast, viral titers and lung infection parameters were high in the placebo group on day 5 of the infection. These results demonstrate the long-acting prophylactic and treatment capacity of mDEF201 to combat vaccinia virus infections