Subglottic secretion volume and viscosity: effect of systemic volume and oral hydration.

Removal of secretions from the subglottic space, which is the larynx cavity below the glottis that contains the vocal cords, reduces the risk for ventilator associated pneumonia. Relationships between factors associated with subglottic secretion volume and viscosity have not been investigated. Subglottic secretions may have a possible link with systemic volume status and oral cavity hydration. The purpose of this study was to examine the relationships among systemic volume, oral cavity hydration, and subglottic secretion (SS) volume and viscosity in mechanically ventilated adults. Seventy daily oral and SS samples were obtained over a 24-hour collection period from 15 mechanically ventilated adults. Markers of systemic volume and oral cavity hydration and measurements of SS volume and viscosity were collected and analyzed. The daily volume of oral secretions ranged from 0 to 1.0 mL (SD 0.180 mL), and SS ranged from 0 to 15 mL (SD 22.9 mL). BUN/creatinine ratio (marker of systemic volume status) was moderately correlated with oral secretion volume (r = -0.43). Weak correlations were identified between SS volume and oral volume (r = 0.29) and SS viscosity and oral viscosity (r = 0.22). No other linear relationships were identified among the variables. This study confirmed that SS accumulation occurs, the amount varies widely, and the secretions are highly viscous. SS volume and viscosity were not found to have a very strong relationship with the variables measured. Nevertheless, clinical implications for practice are present. Further research is needed to understand secretion dynamics in ventilated adults to prevent complications and promote positive patient outcomes

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee

Many clinical trials have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of clinical thrombotic events. Aspirin and ticlopidine have been shown to be effective, but both have potentially serious adverse effects. Clopidogrel, a new thienopyridine derivative similar to ticlopidine, is an inhibitor of platelet aggregation induced by adenosine diphosphate. METHODS: CAPRIE was a randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed. The population studied comprised subgroups of patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease. Patients were followed for 1 to 3 years. FINDINGS: 19,185 patients, with more than 6300 in each of the clinical subgroups, were recruited over 3 years, with a mean follow-up of 1.91 years. There were 1960 first events included in the outcome cluster on which an intention-to-treat analysis showed that patients treated with clopidogrel had an annual 5.32% risk of ischaemic stroke, myocardial infarction, or vascular death compared with 5.83% with aspirin. These rates reflect a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group. INTERPRETATION: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin

Swift-BAT GUANO follow-up of gravitational-wave triggers in the third LIGO-Virgo-KAGRA observing run

International audienceWe present results from a search for X-ray/gamma-ray counterparts of gravitational-wave (GW) candidates from the third observing run (O3) of the LIGO-Virgo-KAGRA (LVK) network using the Swift Burst Alert Telescope (Swift-BAT). The search includes 636 GW candidates received in low latency, 86 of which have been confirmed by the offline analysis and included in the third cumulative Gravitational-Wave Transient Catalogs (GWTC-3). Targeted searches were carried out on the entire GW sample using the maximum--likelihood NITRATES pipeline on the BAT data made available via the GUANO infrastructure. We do not detect any significant electromagnetic emission that is temporally and spatially coincident with any of the GW candidates. We report flux upper limits in the 15-350 keV band as a function of sky position for all the catalog candidates. For GW candidates where the Swift-BAT false alarm rate is less than 10$^{-3}$ Hz, we compute the GW--BAT joint false alarm rate. Finally, the derived Swift-BAT upper limits are used to infer constraints on the putative electromagnetic emission associated with binary black hole mergers

Swift-BAT GUANO follow-up of gravitational-wave triggers in the third LIGO-Virgo-KAGRA observing run

International audienceWe present results from a search for X-ray/gamma-ray counterparts of gravitational-wave (GW) candidates from the third observing run (O3) of the LIGO-Virgo-KAGRA (LVK) network using the Swift Burst Alert Telescope (Swift-BAT). The search includes 636 GW candidates received in low latency, 86 of which have been confirmed by the offline analysis and included in the third cumulative Gravitational-Wave Transient Catalogs (GWTC-3). Targeted searches were carried out on the entire GW sample using the maximum--likelihood NITRATES pipeline on the BAT data made available via the GUANO infrastructure. We do not detect any significant electromagnetic emission that is temporally and spatially coincident with any of the GW candidates. We report flux upper limits in the 15-350 keV band as a function of sky position for all the catalog candidates. For GW candidates where the Swift-BAT false alarm rate is less than 10$^{-3}$ Hz, we compute the GW--BAT joint false alarm rate. Finally, the derived Swift-BAT upper limits are used to infer constraints on the putative electromagnetic emission associated with binary black hole mergers