Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): study protocol for a randomized controlled trial

In patients with septic shock, the presence of an elevated heart rate (HR) after fluid resuscitation marks a subgroup of patients with a particularly poor prognosis. Several studies have shown that HR control in this population is safe and can potentially improve outcomes. However, all were conducted in a single-center setting. The aim of this multicenter study is to demonstrate that administration of the highly beta1-selective and ultrashort-acting beta blocker landiolol in patients with septic shock and persistent tachycardia (HR ae 95 beats per minute [bpm]) is effective in reducing and maintaining HR without increasing vasopressor requirements. A phase IV, multicenter, prospective, randomized, open-label, controlled study is being conducted. The study will enroll a total of 200 patients with septic shock as defined by The Third International Consensus Definitions for Sepsis and Septic Shock criteria and tachycardia (HR ae 95 bpm) despite a hemodynamic optimization period of 24-36 h. Patients are randomized (1:1) to receive either standard treatment (according to the Surviving Sepsis Campaign Guidelines 2016) and continuous landiolol infusion to reach a target HR of 80-94 bpm or standard treatment alone. The primary endpoint is HR response (HR 80-94 bpm), the maintenance thereof, and the absence of increased vasopressor requirements during the first 24 h after initiating treatment. Despite recent studies, the role of beta blockers in the treatment of patients with septic shock remains unclear. This study will investigate whether HR control using landiolol is safe, feasible, and effective, and further enhance the understanding of beta blockade in patients with septic shock

Chinese Economic Diplomacy in SADC: "Resources for Infrastructure" Agreements

V roce 2004 uzavřela Angola s Čínskou lidovou republikou smlouvu, podle níž Čína vybuduje v Angole rozsáhlou infrastrukturu a výměnou za to jí Angola poskytne přístup ke svému nerostnému bohatství. Tento typ smlouvy známý pod označením "přírodní zdroje za infrastrukturu" spadá v kontextu mezinárodních vztahů do trendu nazývaného transregionalismus a položil základ nové formy ekonomické diplomacie Číny v Africe založené na nejvyšší komplementaritě zájmů. Použití tohoto modelu financování infrastruktury však skýtá mimo velkých příležitostí i rizika.In 2004, China and Angola have sealed a deal according to which China would build an extensive infrastructure network in Angola while Angola would, in exchange, provide China with access to its natural resource wealth. This kind of agreement known as a "resources for infrastructure" deal is in the context of international relations part of a trend called trans-regionalism and has laid a foundation for a new form of Chinese economic diplomacy in Africa built around the ultimate complementarity of interests. The implementation of this model, however, holds great opportunities as well as threats

Alveolarni recruitment ve strategii ventilacni podpory u nemocnych s plicni dysfunkci.

Atelectatic regions predispose to gas exchange deterioration and may lead to an increased tissue stress in ventilated patients. The use of lung protective ventilatory strategy with tidal volume limitation could be associated with massive derecruitment (alveolar and airway collapse), which is potentially reversible by the use of recruitment manoeuvres (RM), at least in some groups of patients. We have shown in a series of studies on patients with acute lung failure and in the perioperative period that application of alveolar recruitment strategy (ARS) improves compliance of respiratory system and prevents its deterioration during surgery, that repeated use of lung RM improves oxygenation in subacute phase of adult respiratory distress syndrome and that combined assessment of quasistatic compliance of respiratory system and the estimate of the extent of recruitment/ derecruitment -estimated lung recruitment may be used for predicting changes in lung shunt due to positive end-expiratory pressure changes in ARDS patients. The use of ARS may improve lung function in patients with acute lung failure and in the perioperative period. Despite the limited number of available clinical data the use of ARS may be currently considered as an optimal approach to ventilatory support in selected groups of mechanically ventilated patients.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

Udržitelná diplomacie: Rozšiřování potenciálu diplomatických vztahů (Lekce z Nizozemí)

Within its scope, the thesis theoretically underpins the concept of sustainable diplomacy, using an evolutionary approach to diplomacy, and introduces criteria that allow its application on exemplary Dutch foreign policy projects. Three Dutch sustainable diplomacy projects are analyzed using a unified framework to allow their comparison and evaluation based on the criteria from the theoretical part. In light of the findings of the analysis, the thesis also acknowledges limitations of sustainable diplomacy encountered during the research to provide foundations for future development of the concept

Practical Aspects of Esophageal Pressure Monitoring in Patients with Acute Respiratory Distress Syndrome

Esophageal pressure (Pes) monitoring is a minimally invasive advanced respiratory monitoring method with the potential to guide ventilation support management. Pes monitoring enables the separation of lung and chest wall mechanics and estimation of transpulmonary pressure, which is recognized as an important risk factor for lung injury during both spontaneous breathing and mechanical ventilation. Appropriate balloon positioning, calibration, and measurement techniques are important to avoid inaccurate results. Both the approach of using absolute expiratory Pes values and the approach based on tidal Pes difference have shown promising results for ventilation adjustments, with the potential to decrease the risk of ventilator-induced lung injury

Citují se informatické články kladoucí otázky častěji?

V tomto článku testujeme hypotézu, že informatické články kladoucí otázky (tj. s otazníkem na konci názvu) se citují častěji než ty, které tuto vlastnost nemají. Za tímto účelem analyzujeme datovou sadu s téměř dvěma miliony záznamů o odborných článcích v počítačových oborech, jež jsou indexovány v databázi Web of Science, a zaměřujeme svou pozornost na průměrnou citovanost příspěvků v jejích specifických podmnožinách. Hlavním poznatkem je, že průměrná citovanost tzv. „dotazujících se článků“ je o téměř 20 % vyšší než u jiných příspěvků a že tento rozdíl je statisticky významný.In this article, we test the hypothesis that computer science papers asking questions (i.e., those with a question mark at the end of their title) are cited more frequently than those that do not have this property. To this end, we analyze a data set of almost two million records on computer science papers indexed in the Web of Science database and focus our investigation on the mean number of citations per paper of its specific subsets. The main finding is that the average number of citations per paper of the so-called “asking papers” is greater by almost 20% than that of other papers, and that this difference is statistically significant