The Inflammatory and Hemostatic Response in Sepsis and Meningococcemia

Meningococcemia is notorious for evasion of the host immune system and its rapid progression to fulminant disease, and serves as a unique model for pediatric sepsis. Illness severity is determined by complex interplays among host, pathogen, and environment. The inflammatory host response, including proinflammatory and anti-inflammatory responses in innate and adaptive immunity, skews toward a proinflammatory state. This leads to endothelial dysfunction and activation of the hemostatic response, which may lead to disseminated intravascular coagulation. This article reviews the pathogenesis of sepsis, in particular the inflammatory and hemostatic response in meningococcal sepsis

Demonstration of a novel technique to measure two-photon exchange effects in elastic e±pe^\pm p scattering

The discrepancy between proton electromagnetic form factors extracted using unpolarized and polarized scattering data is believed to be a consequence of two-photon exchange (TPE) effects. However, the calculations of TPE corrections have significant model dependence, and there is limited direct experimental evidence for such corrections. We present the results of a new experimental technique for making direct $e^\pm p$ comparisons, which has the potential to make precise measurements over a broad range in $Q^2$ and scattering angles. We use the Jefferson Lab electron beam and the Hall B photon tagger to generate a clean but untagged photon beam. The photon beam impinges on a converter foil to generate a mixed beam of electrons, positrons, and photons. A chicane is used to separate and recombine the electron and positron beams while the photon beam is stopped by a photon blocker. This provides a combined electron and positron beam, with energies from 0.5 to 3.2 GeV, which impinges on a liquid hydrogen target. The large acceptance CLAS detector is used to identify and reconstruct elastic scattering events, determining both the initial lepton energy and the sign of the scattered lepton. The data were collected in two days with a primary electron beam energy of only 3.3 GeV, limiting the data from this run to smaller values of $Q^2$ and scattering angle. Nonetheless, this measurement yields a data sample for $e^\pm p$ with statistics comparable to those of the best previous measurements. We have shown that we can cleanly identify elastic scattering events and correct for the difference in acceptance for electron and positron scattering. The final ratio of positron to electron scattering: $R=1.027\pm0.005\pm0.05$ for $=0.206$ GeV$^2$ and $0.830\leq \epsilon\leq 0.943$

Muscle fatigue resistance during stimulated contractions is reduced in young male smokers.

Aim: To determine whether muscle function is compromised in healthy smokers in comparison with activity-matched non-smokers. Methods: Nine male smokers (aged 22.2 ± 2.5 years: mean ± SD) with a smoking history of 2.5 ± 3.1 pack years, and ten male control participants (25.4 ± 2.9 years) matched for physical activity level participated in this study. Knee extensor strength was measured using isometric maximal voluntary contractions. Voluntary activation of the quadriceps and co-activation of the biceps femoris were determined using interpolated twitches and surface electromyography respectively. The frequency-torque relationship and fatigue resistance were assessed with electrically evoked contractions. A fatigue index was determined as the ratio of final torque to initial torque during a series of isometric contractions (2 min; 30 Hz; 1 s contraction/1 s rest). Quadriceps anatomical cross sectional area was measured with MRI at 50% of femur length. Results: Maximal voluntary contraction torque, quadriceps anatomical cross sectional area, knee extensor torque/quadriceps cross sectional area, activation, co-activation and force-frequency relationship were similar, whereas the fatigue index was 17% lower in smokers than non-smokers. Conclusion: In young men smoking does not significantly affect quadriceps muscle mass and contractile properties, but does reduce fatigue resistance of the quadriceps muscle, which was not attributable to differences in physical activity. © 2007 The Authors

A new scoring system derived from base excess and platelet count at presentation predicts mortality in paediatric meningococcal sepsis

Introduction: The aim of this study was to derive a novel prognostic score for mortality in paediatric meningococcal sepsis (MS) based on readily available laboratory markers.Methods: A multicentre retrospective cohort study for the consortium set and a single centre retrospective study for replication set. The consortium set were 1,073 children (age 1 week to 17.9 years) referred over a 15-year period (1996 to 2011), who had an admission diagnosis of MS, referred to paediatric intensive care units (PICUs) in six different European centres. The consortium set was split into a development set and validation set to derive the score. The replication set were 134 children with MS (age 2 weeks to 16 years) referred over a 4-year period (2007 to 2011) to PICUs via the Children's Acute Transport Service (CATS), London.Results: A total of 85/1,073 (7.9%) children in the consortium set died. A total of 16/134 (11.9%) children in the replication set died. Children dying in the consortium set had significantly lower base excess, C-reactive protein (CRP), platelet and white cell count, more deranged coagulation and higher lactate than survivors. Paediatric risk of mortality (PRISM) score, Glasgow meningococcal septicaemia prognosis score (GMSPS) and Rotterdam score were also higher. Using the consortium set, a new scoring system using base excess and platelet count at presentation, termed the BEP score, was mathematically developed and validated. BEP predicted mortality with high sensitivity and specificity scores (area under the curve (AUC) in the validation set = 0.8

Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units

Background: Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. Methods: Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital de

Measurement of nuclear transparency ratios for protons and neutrons

This paper presents, for the first time, measurements of neutron transparency ratios for nuclei relative to C measured using the (e,e′n) reaction, spanning measured neutron momenta of 1.4 to 2.4 GeV/c. The transparency ratios were extracted in two kinematical regions, corresponding to knockout of mean-field nucleons and to the breakup of Short-Range Correlated nucleon pairs. The extracted neutron transparency ratios are consistent with each other for the two measured kinematical regions and agree with the proton transparencies extracted from new and previous (e,e′p) measurements, including those from neutron-rich nuclei such as lead. The data also agree with and confirm the Glauber approximation that is commonly used to interpret experimental data. The nuclear-mass-dependence of the extracted transparencies scales as Aα with α=−0.289±0.007, which is consistent with nuclear-surface dominance of the reactions

Measurements of the γvp→p′π+π- cross section with the CLAS detector for 0.4 GeV2<Q2<1.0 GeV2 and 1.3 GeV<W<1.825 GeV

New results on the single-differential and fully integrated cross sections for the process γvp→p′π+π- are presented. The experimental data were collected with the CLAS detector at Jefferson Laboratory. Measurements were carried out in the kinematic region of the reaction invariant mass W from 1.3 to 1.825 GeV and the photon virtuality Q2 from 0.4 to 1.0 GeV2. The cross sections were obtained in narrow Q2 bins (0.05 GeV2) with the smallest statistical uncertainties achieved in double-pion electroproduction experiments to date. The results were found to be in agreement with previously available data where they overlap. A preliminary interpretation of the extracted cross sections, which was based on a phenomenological meson-baryon reaction model, revealed substantial relative contributions from nucleon resonances. The data offer promising prospects to improve knowledge on the Q2 evolution of the electrocouplings of most resonances with masses up to ∼1.8 GeV

Differential cross section for γd → ωd using CLAS at Jefferson Lab

The cross section for coherent $\omega$-meson photoproduction off the deuteron has been measured for the first time as a function of the momentum transfer $t = (P_{\gamma}-P_{\omega})^2$ and photon energy $E_{\gamma}$ using the CLAS detector at the Thomas Jefferson National Accelerator Facility. The cross sections are measured in the energy range $1.4 < E_{\gamma} < 3.4$ GeV. A model based on $\omega-N$ rescattering is consistent with the data at low and intermediate momentum transfer, $|t|$. For $2.8 < E_{\gamma} < 3.4$ GeV, the total cross-section of $\omega-N$ scattering, based on fits within the framework of the Vector Meson Dominance model, is in the range of 30-40 mb.Comment: 8 pages, 5 figure

Strangeness Suppression of q(q)over-bar Creation Observed in Exclusive Reactions

We measured the ratios of electroproduction cross-sections from a proton target for three exclusive meson-baryon final states: $\Lambda K^+$, $p\pi^0$, and $n\pi^+$, with the CLAS detector at Jefferson Lab. Using a simple model of quark hadronization we extract q-qbar creation probabilities for the first time in exclusive two-body production, in which only a single q-qbar pair is created. We observe a sizable suppression of strange quark-antiquark pairs compared to non-strange pairs, similar to that seen in high-energy production.Comment: 5pages, 2figure