Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix : Study protocol for a two-by-two factorial randomised clinical trial

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Kinetics of cardiovascular and inflammatory biomarkers in paediatric dengue shock syndrome

Glycocalyx disruption and hyperinflammatory responses are implicated in the pathogenesis of dengue-associated vascular leak, however little is known about their association with clinical outcomes of patients with dengue shock syndrome (DSS). We investigated the association of vascular and inflammatory biomarkers with clinical outcomes and their correlations with clinical markers of vascular leakage. We performed a prospective cohort study in Viet Nam. Children ≥5 years of age with a clinical diagnosis of DSS were enrolled into this study. Blood samples were taken daily during ICU stay and 7–10 days after hospital discharge for measurements of plasma levels of Syndecan-1, Hyaluronan, Suppression of tumourigenicity 2 (ST-2), Ferritin, N-terminal pro Brain Natriuretic Peptide (NT-proBNP), and Atrial Natriuretic Peptide (ANP). The primary outcome was recurrent shock. Ninety DSS patients were enrolled. Recurrent shock occurred in 16 patients. All biomarkers, except NT-proBNP, were elevated at presentation with shock. There were no differences between compensated and decompensated DSS patients. Glycocalyx markers were positively correlated with inflammatory biomarkers, haematocrit, percentage haemoconcentration, and negatively correlated with stroke volume index. While Syndecan-1, Hyaluronan, Ferritin, and ST-2 improved with time, ANP continued to be raised at follow-up. Enrolment Syndecan-1 levels were observed to be associated with developing recurrent shock although the association did not reach the statistical significance at the P < 0.01 (OR = 1.82, 95% CI 1.07–3.35, P = 0.038). Cardiovascular and inflammatory biomarkers are elevated in DSS, correlate with clinical vascular leakage parameters and follow different kinetics over time. Syndecan-1 may have potential utility in risk stratifying DSS patients in ICU

Rifampicin tolerance and growth fitness among isoniazid-resistant clinical Mycobacterium tuberculosis isolates: an in-vitro longitudinal study.

Antibiotic tolerance in Mycobacterium tuberculosis leads to less effective bacterial killing, poor treatment responses and resistant emergence. There is limited understanding of antibiotic tolerance in clinical isolates of M. tuberculosis . Therefore, we investigated the rifampicin tolerance of M. tuberculosis isolates, with or without pre-existing isoniazid-resistance. In-vitro rifampicin survival fractions determined by minimum duration of killing assay in isoniazid susceptible (n=119) and resistant (n=84) M. tuberculosis isolates. Rifampicin tolerance was correlated with bacterial growth, rifampicin minimum inhibitory concentrations (MICs) and isoniazid-resistant mutations. The longitudinal isoniazid-resistant isolates were analyzed for rifampicin tolerance based on collection time from patients and associated emergence of genetic variants. The median duration of rifampicin exposure reducing the M. tuberculosis surviving fraction by 90% (minimum duration of killing-MDK90) increased from 1.23 (95%CI 1.11; 1.37) and 1.31 (95%CI 1.14; 1.48) to 2.55 (95%CI 2.04; 2.97) and 1.98 (95%CI 1.69; 2.56) days, for IS and IR respectively, during 15 to 60 days of incubation respectively. Increase in MDK90 time indicated the presence of fast and slow growing tolerant sub-populations. A range of 6 log 10 -fold survival fraction enabled classification of tolerance as low, medium or high and revealed isoniazid-resistance association with increased tolerance with faster growth (OR=2.68 for low vs. medium, OR=4.42 for low vs. high, P -trend=0.0003). The high tolerance in longitudinal isoniazid-resistant isolates was specific to those collected during rifampicin treatment in patients and associated with bacterial genetic microvariants. Our study identifies a range of rifampicin tolerance and reveals that isoniazid resistance is associated with higher tolerance with growth fitness. Furthermore, rifampicin treatment may select isoniazid-resistant isolate microvariants with higher rifampicin tolerance, with survival potential similar to multi-drug resistant isolates. These findings suggest that isoniazid-resistant tuberculosis needs to be evaluated for rifampicin tolerance or needs further improvement in treatment regimen

Assessing the efficacy and safety of magnesium sulfate for management of autonomic nervous system dysregulation in Vietnamese children with severe hand foot and mouth disease.

BACKGROUND: Brainstem encephalitis is a serious complication of hand foot and mouth disease (HFMD) in children. Autonomic nervous system (ANS) dysregulation and hypertension may occur, sometimes progressing to cardiopulmonary failure and death. Vietnamese national guidelines recommend use of milrinone if ANS dysregulation with Stage 2 hypertension develops. We wished to investigate whether magnesium sulfate (MgSO4) improved outcomes in children with HFMD if used earlier in the evolution of the ANS dysregulation (Stage 1 hypertension). METHODS: During a regional epidemic we conducted a randomized, double-blind, placebo-controlled trial of MgSO4 in children with HFMD, ANS dysregulation and Stage 1 hypertension, at the Hospital for Tropical Diseases in Ho Chi Minh city. Study participants received an infusion of MgSO4 or matched placebo for 72 h. We also reviewed data from non-trial HFMD patients in whom milrinone failed to control hypertension, some of whom received MgSO4 as second line therapy. The primary outcome for both analyses was a composite of disease progression within 72 h - addition of milrinone (trial participants only), need for ventilation, shock, or death. RESULTS: Between June 2014 and September 2016, 14 and 12 participants received MgSO4 or placebo respectively, before the trial was stopped due to futility. Among 45 non-trial cases with poorly controlled hypertension despite high-dose milrinone, 33 received MgSO4 while 12 did not. There were no statistically significant differences in the composite outcome between the MgSO4 and the placebo/control groups in either study (adjusted relative risk (95%CI) of [6/14 (43%) vs. 6/12 (50%)], 0.84 (0.37, 1.92), p = 0.682 in the trial and [1/33 (3%) vs. 2/12 (17%)], 0.16 (0.01, 1.79), p = 0.132 in the observational cohort). The incidence of adverse events was similar between the groups. Potentially toxic magnesium levels occurred very rarely with the infusion regime used. CONCLUSION: Although we could not demonstrate efficacy in these studies, there were no safety signals associated with use of 30-50 mg/kg/hr. MgSO4 in severe HFMD. Intermittent outbreaks of HFMD are likely to continue across the region, and an adequately powered trial is still needed to evaluate use of MgSO4 in controlling hypertension in severe HFMD, potentially involving a higher dose regimen. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01940250 (Registered 22 AUG 2013). Trial sponsor: University of Oxford

A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials

Background Dengue is a neglected tropical disease, for which no therapeutic agents have shown clinical efficacy to date. Clinical trials have used strikingly variable clinical endpoints, which hampers reproducibility and comparability of findings. We investigated a delta modified Sequential Organ Failure Assessment (delta mSOFA) score as a uniform composite clinical endpoint for use in clinical trials investigating therapeutics for moderate and severe dengue. Methods We developed a modified SOFA score for dengue, measured and evaluated its performance at baseline and 48 h after enrolment in a prospective observational cohort of 124 adults admitted to a tertiary referral hospital in Vietnam with dengue shock. The modified SOFA score included pulse pressure in the cardiovascular component. Binary logistic regression, cox proportional hazard and linear regression models were used to estimate association between mSOFA, delta mSOFA and clinical outcomes. Results The analysis included 124 adults with dengue shock. 29 (23.4%) patients required ICU admission for organ support or due to persistent haemodynamic instability: 9/124 (7.3%) required mechanical ventilation, 8/124 (6.5%) required vasopressors, 6/124 (4.8%) required haemofiltration and 5/124 (4.0%) patients died. In univariate analyses, higher baseline and delta (48 h) mSOFA score for dengue were associated with admission to ICU, requirement for organ support and mortality, duration of ICU and hospital admission and IV fluid use. Conclusions The baseline and delta mSOFA scores for dengue performed well to discriminate patients with dengue shock by clinical outcomes, including duration of ICU and hospital admission, requirement for organ support and death. We plan to use delta mSOFA as the primary endpoint in an upcoming host-directed therapeutic trial and investigate the performance of this score in other phenotypes of severe dengue in adults and children

Development of a Wide-Range Non-Dispersive Infrared Analyzer for the Continuous Measurement of CO2 in Indoor Environments

Carbon dioxide (CO2) is an indicator of indoor air quality. Ventilation based on the use of a CO2 indicator helps to prevent people from acquiring many diseases, especially respiratory viral infections. Therefore, the monitoring of CO2 is a pivotal issue in the control of indoor air quality. A nondispersive infrared (NDIR) analyzer with a wide range of measurements (i.e., ppmv to percentage levels) was developed for measuring carbon dioxide (CO2) in an indoor environment. The effects of optical pathlength and interfering gases were investigated. The pathlengths of the analyzer were varied at 4.8, 8, 10.4 and 16 m, and the interference gases were CO; NO2; SO2; H2O; BTEX (i.e., benzene, toluene, ethylbenzene and m-/p-xylene) and formaldehyde. The lower detection limit, selectivity and sensitivity were determined to evaluate the performance of the analyzer. It was found that different pathlengths should be used to produce linear calibration curves for CO2 from ppmv to percentage levels. As a result, a wide-range NDIR analyzer, coupled with flexible pathlengths from 4.8 to 10.4 m, was developed. In terms of interference, only H2O should be taken into account due to its high concentration in indoor air. CO should be considered in some special locations at the ppmv level. The measurement errors for ppmv and the percentage levels were 0.4 and 0.9%, respectively

Moisture Removal Techniques for a Continuous Emission Monitoring System: A Review

A continuous emission monitoring system (CEMS) is a well-known tool used to analyze the concentrations of air pollutants from stationary sources. In a CEMS, the presence of a high moisture level in a sample causes a loss of analytes due to artifact formation or absorption. This issue brings about a bias in the measurement data. Thus, moisture removal is an important pretreatment step. Condensation and permeation methods have been widely employed to remove moisture from the CEMS for gaseous compounds. In terms of particulate matter, dilution methods have been applied to reduce the moisture level in the gas stream. Therefore, condensation, permeation, and dilution methods are critically reviewed in this work. The removal efficiencies and recovery rates of analytes are discussed, as well as the advantages and disadvantages of each technique. Furthermore, the suitable applications of each technique are determined. Condensation methods have not been well documented so far, while permeation and dilution methods have been continuously studied. Many types of permeation materials have been developed. The limitations of each method have been overcome over the years. However, the most reliable technique has not yet been discovered

The diaconate in the church : an ecclesial reality in St. Wenceslas parish

En el presente documento se desarrolla el tema: “el diaconado en la iglesia, una realidad eclesial en la parroquia san Wenceslao” que se realizó como una oportunidad para recordar la misión, el papel y el ministerio de los diáconos tanto temporal como permanente. La Iglesia reconoce que la vocación para servir a los fieles de Dios es una vocación de consagración y servicio diario. Los diáconos permanentes se convierten en una alternativa viable que permita la atención del pueblo de Dios al haber carencia de servidores al dentro de la Iglesia En el primer capítulo “el diaconado en la parroquia san Wenceslao”, se quiere presentar desde una mirada histórica, social y cultural de qué manera los diaconados están ayudando o están realizando sus ministerios a través de sus servicios. También, la misión, el papel, la vida espiritual y la realidad del ministerio diaconal muestran la responsabilidad e importancia de esta vocación. Esta mirada a la realidad nos permitirá entender las características de cada uno de los diaconados en sus similitudes y sus notables diferencias. En el segundo capítulo se quiere mencionar el sentido original de la diaconía, de este modo, identificar los servicios de los diáconos en la comunidad cristiana. De ahí que, en primer lugar, se proporcionan datos analíticos sobre el diaconado en la primera Iglesia, muestra sus motivaciones y la figura del diaconado permanente y el diaconado transitorio. A la vez, en un segundo lugar, se identificarán las dificultades que experimentan los diáconos en el ejercicio de su ministerio y la relación con su vida cotidiana. Y en el tercer capítulo resaltamos, de manera particular, el diaconado permanente como participación de la comunidad en el sacerdocio ministerial; en otras palabras, destacamos la ministerialidad propia del diácono permanente y su función legítima dentro de la Iglesia, y al servicio de ella. La palabra “diácono” viene de la palabra griega “diakonía”, que significa servicio. Los diáconos tienen su origen en la misión de Cristo. Una misión que los diáconos deben fundamentar en Cristo Servidor, desde ahí, deben servir a toda la humanidad. Y también, reconoce una mirada a la realidad que se permitirá entender las características de cada uno de los diaconados en sus similitudes y sus notables diferencias. Y la mirada histórica, social y cultural muestra cómo los diaconados están ayudando o están realizando sus ministerios a través de sus servicios (a través del servicio de la parroquia San Wenceslao). Además, los diáconos que sirven en la Parroquia San Wenceslao son un símbolo del amor y testigos de un servidor, de un apóstol siempre entregado desde el amor, el servicio y el Reino de Dios para su Pueblo. También, los diáconos que sirven en la Parroquia San Wenceslao expresan los valores y desempeñan una tarea pastoral en la iglesia local y son apoyo, tanto de los presbíteros y del obispo, en la misión que la misma Iglesia les ha confiado. Los diáconos están realizando y tomando sus experiencias, como responsables del servicio, del sacramento y de la misión. Por eso, los diáconos son el signo de una Iglesia servidora a imagen de Cristo, un signo de ser apóstol del servicio entre Dios con el pueblo: ellos son ministros constituidos para el servicio del pueblo de Dios.Comunidad salesianaParroquia San Wenceslao de BogotáThis document develops the theme: "the diaconate in the church, an ecclesial reality in St. Wenceslas parish" that was realized as an opportunity to remember the mission, role and ministry of deacons both temporary and permanent. The Church recognizes that the vocation to serve the faithful of God is a vocation of consecration and daily service. Permanent deacons become a viable alternative that allows the attention of the people of God as there is a lack of servants within the Church In the first chapter "the diaconate in St. Wenceslas Parish", we want to present from a historical, social and cultural perspective how the deacons are helping or performing their ministries through their services. Also, the mission, the role, the spiritual life and the reality of the diaconal ministry show the responsibility and importance of this vocation. This look at reality will allow us to understand the characteristics of each of the diaconate in their similarities and their notable differences. In the second chapter we want to mention the original meaning of diakonia, in this way, identify the services of deacons in the Christian community. Hence, in the first place, analytical data are provided on the diaconate in the first Church, it shows its motivations and the figure of the permanent diaconate and the transitory diaconate. At the same time, in a second place, the difficulties experienced by deacons in the exercise of their ministry and the relationship with their daily lives will be identified. And in the third chapter we highlight, in a particular way, the permanent diaconate as community participation in the ministerial priesthood; In other words, we highlight the ministeriality of the permanent deacon and his legitimate function within the Church, and at the service of it. The word "deacon" comes from the Greek word "diakonia," which means service. Deacons have their origin in the mission of Christ. A mission that deacons must base on Christ Servant, from there, they must serve all mankind. And also, it recognizes a look at reality that will allow us to understand the characteristics of each of the diaconate in their similarities and their notable differences. And the historical, social and cultural view shows how deacons are helping or performing their ministries through their services (through the service of the St. Wenceslas parish). In addition, the deacons who serve in St. Wenceslas Parish are a symbol of love and witnesses of a servant, of an apostle always delivered from love, service and the Kingdom of God for his People. Also, the deacons who serve in St. Wenceslas Parish express values and perform a pastoral task in the local church and are support, both of the presbyters and the bishop, in the mission entrusted to them by the Church itself. The deacons are realizing and taking their experiences, as responsible for the service, the sacrament and the mission. Therefore, deacons are the sign of a Church serving in the image of Christ, a sign of being an apostle of service between God and the people: they are ministers constituted for the service of God's people.Teólogo (a)Pregrad

SPARC Expression Correlates with Tumor Response to Albumin-Bound Paclitaxel in Head and Neck Cancer Patients

SPARC up-regulation is a poor prognostic factor in head and neck cancer. It was hypothesized that because of a SPARC-albumin interaction, tumoral SPARC facilitates the accumulation of albumin in the tumor and increases the effectiveness of albumin-bound paclitaxel (nab-paclitaxel). This hypothesis was tested by correlating the response to nab-paclitaxel and SPARC tumor expression in a retrospective analysis of a 60-patient clinical study of nab-paclitaxel as monotherapy against head and neck cancer. Sixteen tumor specimens were available for analysis. There were 11 responders (CR/PR) and 5 nonresponders (SD/PD) among the 16 nab-paclitaxel-treated patients (12/16 SPARC-positive, 75%). Response to nab-paclitaxel was higher for SPARC-positive patients (10/12, 83%) than SPARC-negative patients (1/4, 25%). The SPARC-negative patients exhibited significantly lower response than the overall response rate among all 60 patients (1/4, 25% vs 45/60, 75%). Although preliminary, data are supportive of the hypothesis that SPARC overexpression may correlate with response to nab-paclitaxel. If confirmed in larger studies, treatment with nab-paclitaxel may convert a poor prognosis SPARC-positive patient population into a group with better clinical outcomes