Leaf physiological and water soluble carbohydrate content responses to trinexapac-ethyl application of sports turf grasses exposed to water stress

Water stress causes alterations in physiological and metabolic processes in plants and is considered the primary environmental factor affecting the management of sports turf grass species.This glasshouse experiment was conducted to investigate the effect of trinexapac-ethyl (TE) on canopy net photosynthesis (Pn), cell membrane stability (CMS), turf quality (TQ) and water soluble carbohydrate (WSC) accumulation responses of sports turf cultivars [Cv] (100% fescue, Rootzone and Arena sports) subjected to water stress. Commercially obtained sods of turf plants were treated with 2 L/ ha TE and then exposed 7 days after to water stress. The treatments were: (i) water untreated, (ii) water TE-treated, (iii) water stress untreated; and (iv) water stress TE-treated and the experiment was a randomized complete block design with four replicates. Results showed that specifically in Cv. Rootzone, Pn was 50% higher for well water TE treated plants compared to the other treatments during the second and third week of the study. Similarly, at 14 days after application, the effect TE resulted to 35% and 50% reduction in cell membrane leakages respectively in well water and water stressed TE-treated Cv. Rootzone plants and this was statistically significant (P=0.05) different from the untreated plants. On a scale of 1-9, all turf types recorded TQ rating of ≥8 at the start of the experiment. By the fourth week of the study, it was observed that all water stress untreated plants had mean TQ (5.75) ratings lower than the minimum acceptable TQ (6). WSC content of well-watered TE-untreated plants was maintained below 60 mg/g DW throughout the study regardless of turf type. After 28 day of water stress duration, the WSC contents obtained in water stress TE-treated plants were 41%, 43% and 50% higher for Cv. Rootzone, 100% fescue and Cv. Arena sports, respectively , than in well water untreated plants. Summer preconditioning of plants with TE can be a possible management tool in alleviating the detrimental impacts of water stress in sport turf species

Early sedation with dexmedetomidine in ventilated critically ill patients and heterogeneity of treatment effect in the SPICE III randomised controlled trial

Purpose To quantify potential heterogeneity of treatment effect (HTE), of early sedation with dexmedetomidine (DEX) compared with usual care, and identify patients who have a high probability of lower or higher 90-day mortality according to age, and other identified clusters. Methods Bayesian analysis of 3904 critically ill adult patients expected to receive invasive ventilation > 24 h and enrolled in a multinational randomized controlled trial comparing early DEX with usual care sedation. Results HTE was assessed according to age and clusters (based on 12 baseline characteristics) using a Bayesian hierarchical models. DEX was associated with lower 90-day mortality compared to usual care in patients > 65 years (odds ratio [OR], 0.83 [95% credible interval [CrI] 0.68–1.00], with 97.7% probability of reduced mortality across broad categories of illness severity. Conversely, the probability of increased mortality in patients ≤ 65 years was 98.5% (OR 1.26 [95% CrI 1.02–1.56]. Two clusters were identified: cluster 1 (976 patients) mostly operative, and cluster 2 (2346 patients), predominantly non-operative. There was a greater probability of benefit with DEX in cluster 1 (OR 0.86 [95% CrI 0.65–1.14]) across broad categories of age, with 86.4% probability that DEX is more beneficial in cluster 1 than cluster 2. Conclusion In critically ill mechanically ventilated patients, early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status. Conversely, a high probability of increased 90-day mortality was observed in younger patients of non-operative status. Further studies are needed to confirm these findings.Yahya Shehabi, Ary Serpa Neto, Belinda D. Howe, Rinaldo Bellomo, Yaseen M. Arabi, Michael Bailey ... et al

A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators

Purpose: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results: From 2395 initially eligible abstracts, five randomised clinical trials (n\ua0=\ua04735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2\ua0% [495/2134] versus control: 22.4\ua0% [582/2601]; pooled OR 1.01 [95\ua0% CI 0.88–1.16], P\ua0=\ua00.9, with heterogeneity [I\ua0=\ua057\ua0%; P\ua0=\ua00.055]). The pooled estimate of 90-day mortality from the three recent multicentre studies (n\ua0=\ua04063) also showed no difference [pooled OR 0.99 (95\ua0% CI 0.86–1.15), P\ua0=\ua00.93] with no heterogeneity (I\ua0=\ua00.0\ua0%; P\ua0=\ua00.97). EGDT increased vasopressor use (OR 1.25 [95\ua0% CI 1.10–1.41]; P\ua