Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients

INTRODUCTION: The prognostic value of continuous monitoring of tissue oxygen saturation (StO2) during early goal-directed therapy of critically ill patients has not been investigated. We conducted this prospective study to test the hypothesis that the persistence of low StO2 levels following intensive care admission is related to adverse outcome. METHODS: We followed 22 critically ill patients admitted with increased lactate levels (>3 mmol/l). Near-infrared spectroscopy (NIRS) was used to measure the thenar eminence StO2 and the rate of StO2 increase (RincStO2) after a vascular occlusion test. NIRS dynamic measurements were recorded at intensive care admission and each 2-hour interval during 8 hours of resuscitation. All repeated StO2 measurements were further compared with Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II and hemodynamic physiological variables: heart rate (HR), mean arterial pressure (MAP), central venous oxygen saturation (ScvO2) and parameters of peripheral circulation (physical examination and peripheral flow index (PFI)). RESULTS: Twelve patients were admitted with low StO2 levels (StO2 <70%). The mean scores for SOFA and APACHE II scores were significantly higher in patients who persisted with low StO2 levels (n = 10) than in those who exhibited normal StO2 levels (n = 12) at 8 hours after the resuscitation period (P < 0.05; median (interquartile range): SOFA, 8 (7 to 11) vs. 5 (3 to 8); APACHE II, 32(24 to 33) vs. 19 (15 to 25)). There was no significant relationship between StO2 and mean global hemodynamic variables (HR, P = 0.26; MAP, P = 0.51; ScvO2, P = 0.11). However, there was a strong association between StO2 with clinical abnormalities of peripheral perfusion (P = 0.004), PFI (P = 0.005) and RincStO2 (P = 0.002). The persistence of low StO2 values was associated with a low percentage of lactate decrease (P < 0.05; median (interquartile range): 33% (12 to 43%) vs. 43% (30 to 54%)). CONCLUSIONS: We found that patients who consistently exhibited low StO2 levels following an initial resuscitation had significantly worse organ failure than did patients with normal StO2 values, and found that StO2 changes had no relationship with global hemodynamic variable

Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition:a meta-analysis

Women with familial or genetic aggregation of breast cancer are offered screening outside the population screening programme. However, the possible benefit of mammography screening could be reduced due to the risk of radiation-induced tumours. A systematic search was conducted addressing the question of how low-dose radiation exposure affects breast cancer risk among high-risk women. A systematic search was conducted for articles addressing breast cancer, mammography screening, radiation and high-risk women. Effects of low-dose radiation on breast cancer risk were presented in terms of pooled odds ratios (OR). Of 127 articles found, 7 were selected for the meta-analysis. Pooled OR revealed an increased risk of breast cancer among high-risk women due to low-dose radiation exposure (OR = 1.3, 95% CI: 0.9- 1.8). Exposure before age 20 (OR = 2.0, 95% CI: 1.3-3.1) or a mean of a parts per thousand yen5 exposures (OR = 1.8, 95% CI: 1.1-3.0) was significantly associated with a higher radiation-induced breast cancer risk. Low-dose radiation increases breast cancer risk among high-risk women. When using low-dose radiation among high-risk women, a careful approach is needed, by means of reducing repeated exposure, avoidance of exposure at a younger age and using non-ionising screening techniques

SIMAGE: SImulation of DNA-MicroArray Gene Expression data

Background: Simulation of DNA-microarray data serves at least three purposes: (i) optimizing the design of an intended DNA microarray experiment, (ii) comparing existing pre-processing and processing methods for best analysis of a given DNA microarray experiment, (iii) educating students, lab-workers and other researchers by making them aware of the many factors influencing DNA microarray experiments. Results: Our model has multiple layers of factors influencing the experiment. The relative influence of such factors can differ significantly between labs, experiments within labs, etc. Therefore, we have added a module to roughly estimate their parameters from a given data set. This guarantees that our simulated data mimics real data as closely as possible. Conclusions: We introduce a model for the simulation of dual-dye cDNA-microarray data closely resembling real data and coin the model and its software implementation SIMAGE which stands for simulation of microarray gene expression data. The software is freely accessible at: http://bioinformatics.biol.rug.nl/websoftware/simag

Opportunities for CO2 capture through oxygen conducting membranes at medium-scale oxyfuel coal boilers

AbstractEcofys and ECN conducted a study commissioned by the IEA Greenhouse Gas R&D Programme to identify the most suitable combinations of medium-scale CO2 sources (1–100 MWth) and capture technologies, with respect to potential and costs (see parallel paper by Hendriks et al.). An industrial coal-fired Circulating Fluidized Bed (CFB) boiler with oxyfuel combustion and Oxygen Conducting Membranes (OCM) appeared to be an economically attractive combination to capture CO2. This paper describes the principle and economic evaluation of this combination in comparison with a reference coal boiler without CO2 capture, as well as a coal boiler with CO2 capture based on amine scrubbing

Staggered fermions for chiral gauge theories: Test on a two-dimensional axial-vector model

As a first step towards constructing chiral models on the lattice with staggered fermions, we study a U(1) model with axial-vector coupling to an external gauge field in two dimensions. In our approach gauge invariance is broken, but it is restored in the classical continuum limit. We find that the continuum divergence relations for the vector and axial-vector currents are reproduced, up to contact terms, which we determine analytically. The current divergence relations are also studied numerically for smooth external gauge fields with topological charge zero. We furthermore investigate the effect of fluctuating gauge transformations and of gauge configurations with non-trivial topological charge.Comment: 17 pages, 5 postscript figures (appended), ITFA 93-13, UCSD/PTH 93-1