Levels of Inflammatory Cytokines and Chemokines in Hospitalized Children with Sepsis and Pneumonia

Introduction. Pneumonia is a common childhood lower respiratory tract infection, which accounts for large number of hospitalization and death among children; its diagnosis is based mainly on clinical signs.Aim of the study was to measure inflammatory cytokine panels in children with pneumonia, and their correlation with clinically used inflammatory markers. Materials and methods. We included 20 patients, hospitalized in Children’s Clinical University hospital, with systemic inflammatory response syndrome (SIRS) and radiologically confirmed pneumonia from October 2011 to January 2013. In all patients cytokine and chemokine panels and clinical inflammatory markers were measured at the time of admission, after 24 hours and on the time of discharge.Results. 12 different inflammatory cytokines were measured. sFAS, sVCAM1, IL-8, IL-10, TNF alpha, Eotaxin, G-CSF, IL1ra, IP10 and MCP1 showed statistically significant changes between levels of inclusion in the study and levels after 24 hours. G-CSF, IL-8, IFN gamma, TNF alpha and IL-10 showed also medium strong correlation with clinically used inflammatory markers (PCT, CRO, and IL-6).Conclusions. Inflammatory cytokines show statistically significant changes during course of treatment, thus they could be used in diagnostics in septic patients with pneumonia, and also could show patients response to therapy.publishersversionPeer reviewe

Biomarker combinations in predicting sepsis in hospitalized children with fever

Funding Information: This study was conducted as a part of the Republic of Latvia “State Research Program VPP BIOMEDICINE” Project No 8.2 „Clinical, molecular-biological and morpho-functional research of diagnostics and treatment of inherited and acquired diseases of childhood”. Funding Information: This study was also partially funded by “The Latvian National Research Program BIOMEDICINE FOR PUBLIC HEALTH”, project No 6. Publisher Copyright: © 2022, The Author(s).Sepsis is among the leading causes of critical illness worldwide. It includes physiologic, pathologic, and biochemical abnormalities, induced by infection. Novel methods for recognizing a dysregulated inflammatory response and predicting associated mortality must be developed. Our aim was to investigate biomarkers that characterize a pro-inflammatory and anti-inflammatory response in patients with fever by comparing predictive validity for sepsis. 165 patients with fever were enrolled in this study, 55 of them had sepsis according to pSOFA criteria. All patients had blood samples drawn at the time of inclusion and after 24 h. CRP, PCT and also IL-6, IL-8 and sFAS levels were significantly higher in patients with sepsis. The AUC of CRP to predict sepsis was 0.799, all the other biomarkers had AUC’s lower than that. Cytokines, when used as a single marker, did not show a significant diagnostic performance We analyzed various models of biomarker combinations. CRP combined with sFAS showed increase in sensitivity in predicting sepsis (88% vs. 83%). The highest AUC was achieved, when CRP, IL-6, sFAS and sVCAM-1 markers were combined 0.830 (95% CI 0.762–0.884) with a sensitivity of 70% and specificity of 84%. vs. 0.799 for CRP alone.publishersversionPeer reviewe

Assessment of ADAMTS-13 Level in Hospitalized Children with Serious Bacterial Infections as a Possible Prognostic Marker

Background and objectives: In children, acute infection is the most common cause of visits in the primary care or emergency department. In 2002, criteria for diagnostics of pediatric sepsis were published, and then revised in 2016 as life-threatening organ dysfunction due to a dysregulated host response to infection. In the pathophysiology of sepsis endothelial dysfunction plays a very important role. Deficient proteolysis of von Willebrand factor, due to reduced ADAMTS-13 activity, results in disseminated platelet-rich thrombi in the microcirculation. ADAMTS-13 deficiency has been detected in systemic inflammation. The clinical relevance of ADAMTS-13 during sepsis is still unclear. We aimed to investigate the possible use of ADAMTS-13 as a prognostic marker in children with serious bacterial infection (SBI). Materials and Methods: Inclusion criteria were hospitalized children with SBI, aged from 1 month to 17 years. SBI was defined based on available clinical, imaging, and later also on microbiological data. Sepsis was diagnosed using criteria by The International Consensus Conference. In all the patients, the levels of ADAMTS-13 were measured at the time of inclusion. Results: Data from 71 patients were analyzed. A total of 47.9% (34) had sepsis, 21.1% (15) were admitted to the ICU, 8.5% (6) had mechanical ventilator support, and 4.2% (3) patients had a positive blood culture. The median level of ADAMTS-13 in this study population was 689.43 ng/mL. Patients with sepsis, patients admitted to the Intensive Care Unit, and patients in need of mechanical ventilator support had significantly lower levels of ADAMTS-13. None of the patients had ADAMTS-13 deficiency. In patients with SBI, the area under the curve (AUC) to predict sepsis was 0.67. A cut-off ADAMTS-13 level of <= 730.49 had 82% sensitivity and 60% specificity for sepsis in patients with SBI. Conclusions: ADATMS-13 levels were lower in patients with SBI and sepsis, but AUC and sensitivity were too low to accept it as a prognostic markerPeer reviewe

Double Bars, Inner Disks, and Nuclear Rings in Early-Type Disk Galaxies

We present results from an imaging survey of an unbiased sample of thirty-eight early-type (S0--Sa), low-inclination, optically barred galaxies in the field. Our goal was to find and characterize central stellar and gaseous structures: secondary bars, inner disks, and nuclear rings. Bars inside bars are surprisingly common: at least one quarter of the sample galaxies (possibly as many as 40%) are double-barred, with no preference for Hubble type or the strength of the primary bar. A typical secondary bar is ~12% of the size of its primary bar and 240--750 pc in radius. We see no significant effect of secondary bars on nuclear activity. We also find kiloparsec-scale inner disks in at least 20% of our sample, almost exclusively in S0 galaxies. These disks are on average 20% the size of their host bar, and show a wider range of relative sizes than do secondary bars. Nuclear rings are present in about a third of our sample. Most are dusty, sites of current or recent star formation, or both; such rings are preferentially found in Sa galaxies. Three S0 galaxies (15% of the S0's) appear to have purely stellar nuclear rings, with no evidence for dust or recent star formation. The fact that these central stellar structures are so common indicates that the inner regions of early-type barred galaxies typically contain dynamically cool and disklike structures. This is especially true for S0 galaxies, where secondary bars, inner disks, and/or stellar nuclear rings are present at least two thirds of the time. (abridged)Comment: LaTeX, 15 pages, 7 EPS figures; to appear in The Astronomical Journal (July 2002

Mitä on älykäs sopeutuminen?

Alueiden ja kuntien epätasaisen kehityksen seurauksena yli kaksi kolmasosaa Manner-Suomen kunnista on menettänyt väestöään kahden viime vuosikymmenen aikana. Tässä raportissa kuntien sopeutumista väestön vähenemiseen tarkastellaan älykkään sopeutumisen viitekehyksessä. Älykkään sopeutumisen käsite on vielä vakiintumaton ja hakee muotoaan aluepolitiikassa sekä aluekehityksen ja kuntien tutkimuksessa Suomessa. Raportissa selvitetään älykkään sopeutumisen käsitettä tutkimuskirjallisuuden avulla, kuvataan älykkään sopeutumisen lähestymistapaa kolmessa EU-maassa ja tuotetaan tilannekuva siitä, miten kunnat Suomessa ovat pyrkineet ja kyenneet sopeutumaan väestön vähenemiseen ja ikääntymiseen. Lisäksi esitellään älykkään sopeutumisen juurruttamisen keinoja. Suomessa tarvitaan hallinnolliset ja alueelliset tasot läpäisevä politiikka- ja toimenpideohjelma, jonka lähtökohtana on väestöltään vähenevien alueiden paikkaperustaisuus ja siitä juontuvat tarpeet. Älykästä sopeutumista voidaan pitää välivaiheena uudistumiselle. Lähtökohtana on koko kuntayhteisön eikä ainoastaan kuntaorganisaation uudistumiskyvyn vahvistaminen. Väestön vähenemiseen sopeutumisessa painopiste tulisi olla älykkäässä sopeutumisessa ja uudistamisessa, mutta myös elinkeinojen ja elinvoiman kehittämisessä.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa.(tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

The fourth phase of the radiative transfer model intercomparison (RAMI) exercise : Actual canopy scenarios and conformity testing

The RAdiative transfer Model Intercomparison (RAMI) activity focuses on the benchmarking of canopy radiative transfer (RT) models. For the current fourth phase of RAMI, six highly realistic virtual plant environments were constructed on the basis of intensive field data collected from (both deciduous and coniferous) forest stands as well as test sites in Europe and South Africa. Twelve RT modelling groups provided simulations of canopy scale (directional and hemispherically integrated) radiative quantities, as well as a series of binary hemispherical photographs acquired from different locations within the virtual canopies. The simulation results showed much greater variance than those recently analysed for the abstract canopy scenarios of RAMI-IV. Canopy complexity is among the most likely drivers behind operator induced errors that gave rise to the discrepancies. Conformity testing was introduced to separate the simulation results into acceptable and non-acceptable contributions. More specifically, a shared risk approach is used to evaluate the compliance of RI model simulations on the basis of reference data generated with the weighted ensemble averaging technique from ISO-13528. However, using concepts from legal metrology, the uncertainty of this reference solution will be shown to prevent a confident assessment of model performance with respect to the selected tolerance intervals. As an alternative, guarded risk decision rules will be presented to account explicitly for the uncertainty associated with the reference and candidate methods. Both guarded acceptance and guarded rejection approaches are used to make confident statements about the acceptance and/or rejection of RT model simulations with respect to the predefined tolerance intervals. (C) 2015 The Authors. Published by Elsevier Inc.Peer reviewe

Kotihoidon kehittäminen vastuuhoitajan näkökulmasta

Ikääntyneiden suomalaisten määrä on kasvussa, mikä tarkoittaa sitä, että sosiaali- ja terveyspalveluiden tarve on lisääntymässä. Kuntien tulee laatia suunnitelma ikääntyvän väestön hyvinvoinnin ja terveyden sekä toimintakyvyn edistämiseksi, jossa keskiössä ovat itsenäisen suoriutumisen sekä kotona asumisen tukeminen ja kuntouttavien toimintatapojen edistäminen. Tämän opinnäytetyön tavoitteena oli saada konkreettisia ideoita kotihoidon kehittämiseen vastuuhoitajan näkökulmasta. Tarkoituksena oli saada hoitajilta käytännön kokemuksista nousevat ideat vastuuhoitajuuden työnkuvan tueksi. Opinnäytetyössä käytettiin laadullista tutkimusmenetelmää vastuuhoitajien kehitysideoiden saamiseksi. Kysely toteutettiin yhdessä Helsingin kaupungin kotihoidon yksikössä Metropolian sähköisen e-lomakkeen avulla, mihin vastatattiin anonyymisti. Tutkimuskysymyksemme oli, miten vastuuhoitajat kehittäisivät kotihoitoa. Kyselyyn vastasi 16 henkilöä. Tuloksista tuli esille, että vastuuhoitajat kokevat ajan puutetta sekä resurssien vähyyttä. Lisäksi työyhteisön ja organisaation tukea pidettiin tärkeänä. Työnjärjestelyä ja koulutuksia kehittämällä voidaan tukea vastuuhoitajien työnkuvaa kotihoidossa. Kirjallisten töiden lisääntyminen koettiin kuormittavan välitöntä asiakastyötä ja virtuaalipalveluiden hyödyntäminen tukevan työn tekemistä. Opinnäytetyön tuloksien perusteella voimme päätellä, että työnhallinnan tukeminen ja työntekijän itseohjautuvuuden lisääminen edistävät kotihoidon vastuuhoitajien työmotivaatiota sekä työssä jaksamista. Kotihoidon jatkuva kehittäminen sekä tulevaisuuden haasteisiin valmistautuminen tarvitsevat niin työntekijöiden kuin organisaatioiden panostusta uusien toimintamallien kehittämiseen. Kotihoitoa tulisi kehittää asiakaslähtöisesti organisaation näkökulman sijaan. Vastuuhoitajat ovat keskeisiä asiantuntijoita asiakasnäkökulman hyödyntämisessä kotihoidon kehittämisessä. Tuloksissa nousi esille myös riittävän perehdytyksen sekä työtä tukevan työyhteisön merkitys

Inflammatory Cytokine and Chemokine Patterns in Paediatric Patients with Suspected Serious Bacterial Infection

Background and objectives: In children, acute infection is the most common cause of visits to the emergency department. Although most of them are self-limiting, mortality due to severe bacterial infections (SBI) in developed countries is still high. When the risk of serious bacterial infection is too high to ignore, yet too low to justify admission and hospital observation, clinicians try to improve diagnostic accuracy by performing various laboratory tests. The aim of the study was to investigate whether an early inflammatory cytokine and chemokine panel can add information in diagnostics of SBI and assessment of efficacy of early therapies in hospitalized children with fever. Methods: This study included 51 children with febrile infections that were admitted to the emergency department (ED). Clinical examination and microbiological and radiological tests were used as reference standards for the definition of SBI. Study population was categorized into two groups: (1) patients with SBI (n = 21); (2) patients without SBI (n = 30). Inflammatory cytokine and chemokine panels were analyzed from the first routine blood samples at hospital admission and after 24 h. Results: Out of 12 cytokines and chemokines, only Eotaxin and granulocyte colony-stimulating factor (G-CSF) had statistically significant differences between groups at the time of inclusion. Receiver operator characteristic analysis to predict SBI showed an area under the curve (AUC) of 0.679 for G-CSF. Conclusions: Analysis of inflammatory cytokine profiles may provide additional information in early diagnostics of SBI