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2. Bacterial sepsis: Diagnostics and calculated antibiotic therapy

Author

Richter, D. C., Heininger, A., Brenner, T., Hochreiter, M., Bernhard, M., Briegel, J., Dubler, S., Grabein, B., Hecker, A., Kruger, W. A., Mayer, K., Pletz, M. W., Storzinger, D., Pinder, N., Hoppe-Tichy, T., Weiterer, S., Zimmermann, S., Brinkmann, A., Weigand, M. A., and Lichtenstern, C.

Published
2019
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6. Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Author

König, R. Kolte, A. Ahlers, O. Oswald, M. Krauss, V. Roell, D. Sommerfeld, O. Dimopoulos, G. Tsangaris, I. Antoniadou, E. Jaishankar, N. Bogatsch, H. Löffler, M. Rödel, M. Garcia-Moreno, M. Tuchscherr, L. Sprung, C.L. Singer, M. Brunkhorst, F. Oppert, M. Gerlach, H. Claus, R.A. Coldewey, S.M. Briegel, J. Giamarellos-Bourboulis, E.J. Keh, D. Bauer, M.

Abstract

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need. © Copyright © 2021 König, Kolte, Ahlers, Oswald, Krauss, Roell, Sommerfeld, Dimopoulos, Tsangaris, Antoniadou, Jaishankar, Bogatsch, Löffler, Rödel, Garcia-Moreno, Tuchscherr, Sprung, Singer, Brunkhorst, Oppert, Gerlach, Claus, Coldewey, Briegel, Giamarellos-Bourboulis, Keh and Bauer.

Published
2021

13. From Space to the Patient: A New Cytokine Release Assay to Monitor the Immune Status of HIV Infected Patients and Sepsis Patients

Author

Kaufmann, I, Draenert, R, Gruber, M, Feuerecker, M, Crucian, B. E, Mehta, S. L, Roider, J, Pierson, D. L, Briegel, J. M, Schelling, G, Sams, C. F, and Chouker, A

Subjects
Aerospace Medicine
Abstract

Monitoring of humans either in the healthy men under extreme environmental stress like space flight, in human immunodeficiency virus (HIV) infected patients or in sepsis is of critical importance with regard to the timing of adequate therapeutic (counter-)measures. The in vivo skin delayed-type hypersensitivity test (DTH) served for many years as a tool to evaluate cell mediated immunity. However, this standardised in vivo test was removed from the market in 2002 due to the risk of antigen stabilization. To the best of our knowledge an alternative test as monitoring tool to determine cell mediated immunity is not available so far. For this purpose we tested a new alternative assay using elements of the skin DTH which is based on an ex vivo cytokine release from whole blood and asked if it is suitable and applicable to monitor immune changes in HIV infected patients and in patients with septic shock.

Published
2013

21. Significance of CSF markers for detection of ventriculitis in patients with EVD after traumatic brain injury

Author

Lenski, M, Biczok, A, Schichor, C, Briegel, J, Tonn, JC, and Thon, N

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Objective: The aim of this study was to investigate in patients with traumatic brain injury and external ventricular drain the diagnostic potential of inflammatory markers in cerebro-spinal fluid (CSF) and serum (S) (CSF_IL-6, CSF_total leucocyte count, CSF_protein, S_CRP, S_white[for full text, please go to the a.m. URL], 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Published
2019
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22. Posters

Author

Ryan, D. W., Belyaev S., Rudnov V., Mironov A., Bhagwanjee, S., Muckart, D. J. J., Hodgson, R. E., Afessa, B., Meyers, B., Koch, K., Delke, I., Schelline, G., Meier, M., Haller, M., Briegel, J., Schüffel, W., Peter, K., Jones, C., Griffiths, R. D., Macmillan, R. R., Harris, C., Colardyn, F. A., Dheene, P., Danneels, C., Verstraete, A., Burn, L., Dawsen, B., Baudouin, S. V., Stoll, C., Schelling, G., Bullinger, M., Stott, S. A., Noble, D. W., Weir, J., Vesely, H., Gregor, Th., Defouillov, C., Defouilloy, I., Dimov, G., Tinturier, F., Slama, M., Ossart, M., Rosengaard, L. Bredahl, Eriksen, K., Nielsen, P. Rotbøll, Heslet, L., Moreno, R., Miranda, D. Reis, Fidler, V., Apolone, G., Sicignano, A., Carozzi, C., Giudici, D., Merli, G., Pulici, M., Gaillard, M., Emmanuelli, J., Hervé, C., Davous, H., Beck, D. H., Taylor, B. L., Smith, G. B., Paionk, F. G., Waydhas, C., Fischer, A., Duswald, K. H., Jiménez, M. J., del Nogal, F., Martín, A., Díaz, R., López, J., Suárez, J., Algora, A., Singer, M., Groeneveld, A. B. J., Bossink, A. W. K., Hack, C. E., Thijs, L. G., Mata, G. Vazquez, Fernandez, R. Rivera, Paeec, Proyecto, Schulze, K., Verner, Lj., Logemann, F., Kirchner, E., Garnacho-Montero, J., García-Garmendia, J. L., Ortiz-Leyba, C., Rincón-Ferrari, M. D., Villar, J. Monterrubio, Jiménez-Jiménez, F. J., Jiménez-Jiménez, L. M., Armaganidis, A., Dimitriadou, E., Kaltsas, P., Charisis, A., Pontikis, X., Roussos, Ch., Platsouka, E., Routsi, Ch., Markaki, V., Paniara, O., Young, J. D., Newton, B., Rowan, K., Jara, F., Naya, J. M., Cherta, I., Quíntana, S., Vázquez, P., Alvarez, M., Perez, J. Martinez, Garcia-Bach, M., Aparicio, A., Vila, F., Rué, M., Valero, C., Quintana, S., Artigas, A., Linde-Zwirble, W. T., Clermont, G., Coleman, M. B., Brodak, S., Angus, D. C., Dougnac, A., Hernandez, G., Ojeda, M., Castro, J., Labarca, E., Castillo, L., Andresen, M., Bugedo, G., Diaz, O., Arriagada, D., Dagnino, J., Pinsky, M. R., Newbold, R. C., Tampubolon, O. E., Iskandar, S., Siahaan, M., Suntoro, A., Albert, A., Fongaro, A., Carlot, A., Sattin, A., ARCHIDIA, and ICNARC Working Group on coding conditions in intensive care

Published
1996
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24. Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation

Author

Kemming, G. I., Merkel, M. J., Schallerer, A., Habler, O. P., Kleen, M. S., Haller, M., Briegel, J., Vogelmeier, C., Furst, H., Reichart, B., and Zwissler, B.

Subjects
Health care industry
Abstract

Byline: G. I. Kemming (1), M. J. Merkel (1), A. Schallerer (1), O. P. Habler (1), M. S. Kleen (1), M. Haller (1), J. Briegel (1), C. Vogelmeier (3), H. Furst (4), B. Reichart (5), B. Zwissler (1) Keywords: Key words Lung transplantation; Inhaled vasodilators; Nitric oxide; Pulmonary hypertension; Selective pulmonary vasodilation; Reperfusion injury Abstract: Objective: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantion. Design: Prospective clinical dose- response study. Setting: Anesthesiological intensive care unit of a university hospital. Patients and participants: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO.sub.2/FIO.sub.2) of less than 13.3 kPa (100 mmHg). Interventions: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. Measurements and results: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p &lt 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO.sub.2 increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO.sub.2), all were subject to long-term inhalation (1--19 days). All were successfully weaned from NO and were discharged from the intensive care unit. Conclusion: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation. Author Affiliation: (1) Department of Anesthesiology, Ludwig-Maximilians-Universitat Munchen, Klinikum Grosshadern, Marchioninistrasse 15, D-81 377 Munchen, Germany e-mail: bernhard.zwissler@ana.med.uni-muenchen.de Tel. + 49 (89) 7095-3417 Fax + 49 (89) 7095--8886, DE (2) Department of Surgical Research, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (3) Department of Internal Medicine, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (4) Department of Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (5) Department of Cardiac Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE Article note: Received: 23 February 1998 Accepted: 20 August 1998

Published
1998

29. Kidney

Author

Tormo, C., Calvo, R., Ferrandis, S., Parra, V., Maravall, J. L., Lacuevo, V., Dreyfuss, D., Mier, L., Leviel, F., Lanore, J. J., Djedaïni, K., Costa, F., Paillard, M., Del Rio F., Cardenal C., De Castro J., Blesa A., Martín-Benitez J., Hermo B., Suarez R., Martín Santos F., Le Cacheux, P., de Ligny, B. Hurault, Cardineau, E., Ryckelvnck, J. P., Marggraf, G., Schumann, V., Doetsch, N., Wagner, K., Philipp, Th., Reidemeister, J. Ch., Aykaç B., Öz H., Sun S., Bozkurt P., Cotonel, B., Mercatello, A., HadjAïssa, A., Chery, C., Pozet, N., Clermont, N., Bégou, C., Tissot, E., Fisher, L. P., Moskovtchenko, J. F., Laurent, V., Coronel, B., Bret, M., Colon, S., Colpart, J. J., Woittiez, A. J. J., Drenth, I. M., Jamali, M., Bollaert, P. E., Cao, T., Bauer, P., Kessler, M., Lambert, H., Larcan, A., Rogiere, P. E., Leeman, M., Kahn, R. J., Vincent, J. L., Nagler, J., Neels, H., Singer, M., Screaton, G., McNally, T., Mackie, I., Machin, S., Cohen, S., Haller, M., Schönfelder, R., Briegel, J., Jauch, K. W., Zwiebel, F., Forst, H., Sicignano, A., Vesconi, S., Bellato, V., De Pietri, P., Minuto, A., Foroni, C., Comité, C., Caprioli, R., Gemignani, R., Stefani, M., Russo, V., Mazzei, A., Rusehi, R., Pardelli, M., Matamis, D., Tsagourias, M., Melekos, Th., Bitzani, M., Rodini, I., Rigos, D., Inglis, T. J. J., Kuteifan, K., Martin-Barbaz, F., Man, N. K., Descamps, J. M., Bosch, F. H., van Genderen, W., van Leusen, R., de Boer, J. P., Creasey, A. A., Chang, A., Roem, D., Eerenberg, A. J. M., Brouwer, M. C., Hack, C. E., and Taylor, F. B.

Published
1992
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33. MicroRNAs 143 and 150 in whole blood enable detection of T-cell immunoparalysis in sepsis

Author

Möhnle, P. Hirschberger, S. Hinske, L.C. Briegel, J. Hübner, M. Weis, S. Dimopoulos, G. Bauer, M. Giamarellos-Bourboulis, E.J. Kreth, S.

Abstract

Background: Currently, no suitable clinical marker for detection of septic immunosuppression is available. We aimed at identifying microRNAs that could serve as biomarkers of T-cell mediated immunoparalysis in sepsis. Methods: RNA was isolated from purified T-cells or from whole blood cells obtained from septic patients and healthy volunteers. Differentially regulated miRNAs were identified by miRNA Microarray (n = 7). Validation was performed via qPCR (n = 31). Results: T-cells of septic patients revealed characteristics of immunosuppression: Pro-inflammatory miR-150 and miR-342 were downregulated, whereas anti-inflammatory miR-15a, miR-16, miR-93, miR-143, miR-223 and miR-424 were upregulated. Assessment of T-cell effector status showed significantly reduced mRNA-levels of IL2, IL7R and ICOS, and increased levels of IL4, IL10 and TGF-β. The individual extent of immunosuppression differed markedly. MicroRNA-143, - 150 and - 223 independently indicated T-cell immunoparalysis and significantly correlated with patient's IL7R-/ICOS-expression and SOFA-scores. In whole blood, composed of innate and adaptive immune cells, both traits of immunosuppression and hyperinflammation were detected. Importantly, miR-143 and miR-150 - both predominantly expressed in T-cells - retained strong power of discrimination also in whole blood samples. Conclusions: These findings suggest miR-143 and miR-150 as promising markers for detection of T-cell immunosuppression in whole blood and may help to develop new approaches for miRNA-based diagnostic in sepsis. © 2018 The Author(s).

Published
2018

36. Seeking Worldwide Professional Consensus on the Principles of End-of-life Care for the Critically Ill: The Welpicus Study

Author

Sprung CL, Truog RD, Curtis JR, Joynt GM, Baras M, Michalsen A, Briegel J, Kesecioglu J, Efferen L, Bulpa P, Metnitz P, Patil N, Hawryluck L, Manthous C, Moreno R, Leonard S, Hill NS, Wennberg E, McDermid RC, Mikstacki A, Mularski RA, Hartog CS, Avidan A., DE ROBERTIS, EDOARDO, Sprung, Cl, Truog, Rd, Curtis, Jr, Joynt, Gm, Baras, M, Michalsen, A, Briegel, J, Kesecioglu, J, Efferen, L, DE ROBERTIS, Edoardo, Bulpa, P, Metnitz, P, Patil, N, Hawryluck, L, Manthous, C, Moreno, R, Leonard, S, Hill, N, Wennberg, E, Mcdermid, Rc, Mikstacki, A, Mularski, Ra, Hartog, C, and Avidan, A.

Published
2014

38. Treatment of sepsis

Author

Matamis, D., Koletsos, K., Grammenos, A., Kioumis, I., Sobolos, K., Rigos, D., Lanoret, J. J., Dhainaut, J. F., Fisher, C. J., Opal, S. M., Zimmerman, J., Nightingale, P., Stephens, S., Schein, R. L., Panacek, E. A., Vincent, J. L., Foulke, G. E., Warren, E. L., Garrard, C., Park, G., Bodmer, M. W., Cohen, J., van der Linden, G., Sadoff, J. C., Pochard, F., Boulot, A., Capellier, G., Racadot, E., Tissot, H., Balvay, P., Cordier, A., Wijdenes, J., Herve, P., Barale, F., Lanore, J. J., Briegel, J., Forst, H., Kellermann, W., Haller, M., Bittl, M., Lenhart, F. -P., Peler, K., Fourrier, F., Chopin, C., Huart, J. J., Runge, I., Caron, C., Mehdaoui, H., Goudemand, J., Rime, A., Socolovski, C., CB0006 Study Group, and CB0006 Study Group

Published
1992
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39. Bakterielle Sepsis : Diagnostik und kalkulierte Antibiotikatherapie.

Author

Richter, D. C., Heininger, A., Brenner, T., Hochreiter, M., Bernhard, M., Briegel, J., Dubler, S., Grabein, B., Hecker, A., Kruger, W. A., Mayer, K., Pletz, M. W., Storzinger, D., Pinder, N., Hoppe-Tichy, T., Weiterer, S., Zimmermann, S., Brinkmann, A., Weigand, M. A., and Lichtenstern, C.

Subjects
SEPTICEMIA treatment, SEPSIS, ANTIBIOTICS, PHARMACOKINETICS, BACTERIAL diseases, ANTI-infective agents
Abstract

The mortality of patients with sepsis and septic shock is still unacceptably high. An effective calculated antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed infection and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account during the selection of anti-infective treatment. Many pathophysiologic alterations influence the pharmacokinetics (PK) of antibiotics during sepsis. The principle of standard dosing should be abandoned and replaced by an individual treatment approach with stronger weighting of the pharmacokinetics/pharmacodynamics (PK/PD) index of the substance groups. Although this is not yet the clinical standard, prolonged (or continuous) infusion of β‑lactam antibiotics and therapeutic drug monitoring (TDM) can help to achieve defined PK targets. Prolonged infusion is sufficient without TDM, but for continuous infusion, TDM is generally necessary. A further argument for individual PK/PD-oriented antibiotic approaches is the increasing number of infections due to multidrug-resistant (MDR) pathogens in the intensive care unit. For effective treatment, antibiotic stewardship teams (ABS teams) are becoming more established. Interdisciplinary cooperation of the ABS team with infectious disease (ID) specialists, microbiologists, and clinical pharmacists leads not only to rational administration of antibiotics, but also has a positive influence on treatment outcome. The gold standards for pathogen identification are still culture-based detection and microbiologic resistance testing for the various antibiotic groups. Despite the rapid investigation time, novel polymerase chain reaction(PCR)-based procedures for pathogen identification and resistance determination are currently only an adjunct to routine sepsis diagnostics, due to the limited number of studies, high costs, and limited availability. In complicated septic courses with multiple anti-infective therapies or recurrent sepsis, PCR-based procedures can be used in addition to treatment monitoring and diagnostics. Novel antibiotics represent potent alternatives in the treatment of MDR infections. Due to the often defined spectrum of pathogens and the practically (still) absent resistance, they are suitable for targeted treatment of severe MDR infections (therapy escalation). (Contribution available free of charge by "Free Access" [ https://link.springer.com/article/10.1007/s00101-017-0396-z ].). [ABSTRACT FROM AUTHOR]

Published
2019
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42. Milk production and composition, and progeny performance in young ewes with high merit for rapid growth and muscle and fat accumulation.

Author

Rosales Nieto, C. A., Ferguson, M. B., Macleay, C. A., Briegel, J. R., Wood, D. A., Martin, G. B., Bencini, R., and Thompson, A. N.

Abstract

In ewe lambs, acceleration of growth and accumulation of both muscle and fat leads to earlier sexual maturity and better reproductive performance. The next stage in the development of this theme is to test whether these aspects of growth in young ewes affect milk production in their first lactation and the growth of their first progeny. We studied 75 young Merino ewes that had known phenotypic values for depth of eye muscle (EMD) and fat (FAT), and known Australian Sheep Breeding Values for post-weaning weight (PWT) and depths of eye muscle (PEMD) and fat (PFAT). They lambed for the first time at 1 year of age. Their lambs were weighed weekly from birth to weaning at 10 weeks to determine live weight gain and weaning weight. Progeny birth weight was positively associated with live weight gain and weaning weight (P <0.001). The PWT of the mothers was positively associated with birth weight (P <0.01), live weight gain and weaning weight of the progeny (P <0.05); however, these progeny traits were not influenced by EMD, FAT, PEMD, PFAT of the mothers (P >0.05). The PWT of the sire was positively associated with live weight gain (P <0.05) and weaning weight of the progeny (P <0.01). At around day 20 postpartum , we measured milk production and milk composition (fat, protein, lactose, total solids). Milk production was influenced positively by birth type (single or twin; P <0.05) and negatively by birth weight (P <0.05), but not by mother phenotype or genotype, sire genotype of the mother or the sex of the progeny (P >0.05). The concentrations of fat, protein, lactose and total solids in the milk were not affected by the phenotype or genotype of the mothers or of the sires of the mothers, or by the sex of the progeny (P >0.05). We conclude that selection of young Merino ewes for better growth, and more rapid accumulation of muscle and fat, will lead to progeny that are heavier at birth, grow faster and are heavier at weaning. Moreover, milk production and composition do not seem to be affected by the genetic merit of the mother for post-weaning live weight or PEMD or PFAT. Therefore, Merino ewes can lamb at 1 year of age without affecting the production objectives of the Merino sheep industry. [ABSTRACT FROM AUTHOR]

Published
2018
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43. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Author

Keth, Th, Azoulay, E, Echeverria, Pm, Vincent, Jl, Collaboratorsmargarit, A, Valentini, R, Alan Javier, Z, Bevilacqua, C, Curone, M, Rabuffetti, R, Comignani, P, Torres Boden, M, Chertcoff, F, Cardonatti, G, Adén, F, Marcos, L, Dónofrio, M, Fernández, R, Lamberghini, R, Balasini, S, Teves, J, Las Heras, M, Sinner, J, Ceraso, D, Curcio, D, Aguilar, L, Weller, C, Cardonnet, L, Santa Cruz, R, Manrique, E, Bernardez, D, Iolster, T, Chiappero, G, Ramos, P, Vergara, J, Moine, I, Ilutovich, S, Jannello, G, Waschbusch, M, Rios Picaza, G, Raimondi, A, Miriam, M, Lovesio, C, Caridi, M, Leong, T, Orford, N, Reece, G, Ernest, D, Hawker, F, Tan, J, Giannellis, C, Ihle, B, Bersten, A, Mcinnes, J, Tallott, M, Mcfadyen, B, Vibert, J, Parr, M, Tran, K, Sutton, J, Webb, S, Groves, N, Cole, L, Long, D, Bass, F, Erickson, S, Lipman, J, Delzoppo, C, Thomas, J, Dobb, G, Daley, M, Roberts, B, Santamaria, J, Young, J, Festa, M, Holland, R, Mullany, D, Williams, P, Corkeron, M, Gales, M, Banerjee, A, Yung, M, Mutz, N, Hiesmayr, M, Faybik, P, Fitzgerald, R, Firlinger, F, Zasmeta, G, Zink, M, Sieber, W, Hildegard, J, Bakondy, R, Schlieber, J, Filzwieser, G, Beer, R, Joannidis, M, Schuster, R, Scherzer, W, Smolle, K, Fitzal, S, Manzoor, R, Brunain, J, D'Hondt, A, Huylenbroeck, G, Van der Schueren, M, 't Kindt, H, Slock, E, Rijckaert, D, Raemaekers, J, Bourgeois, M, Van Cotthem, I, Nackaerts, G, Gusu, D, Gadisseux, P, Vancollie, O, Lignian, H, Michel, P, Fraipont, V, Vander Stappen, M, Forêt, F, De Bels, D, Devriendt, J, Massaut, J, Biston, P, Roman, A, Lambermont, B, De Meulder, A, Frederic, V, Sottiaux, T, Ruyffelaere, P, Collin, V, Anane, S, Kleiren, P, Simon, M, Machayekhi, S, Frans, E, Leroy, G, Berghmans, T, Joseph, R, Eerens, J, Laterre, P, Lagrou, B, Rutsaert, R, Pisarek, W, Dive, A, De Waele, J, Spapen, H, Damas, P, Malbrain, M, Hidalgo, J, Baptista, M, Salgado, D, Braga, M, Avila, C, Westphal, G, Caser, E, Alves, A, Friedman, G, Luz, M, Assuncao, M, Reis, H, Gomes, A, Silva, U, Nogueira Fh, W, El Dash, S, Valiatti, J, Barbosa, A, Coelho, C, Knibel, M, Minelli, C, Caovilla, J, Teixeira, G, Hovnanian, A, Rea Neto, A, Lobo, S, Lugarinho, M, Souza, P, Ferreira, D, Duarte, P, Oliveira, M, Marques, J, Machado, R, Rehder, P, Mataloun, S, Grilo, M, Quesado, P, Moock, M, Ferreira, F, Teles, J, Silva, E, Morais, A, Bruzzi de Carvalho, F, Wanderley, M, Velasco, M, Brandão da Silva, N, Feijó, J, Souza Dantas, V, Costa Filho, R, Japiassú, A, Villela, D, Santos, C, Passos, R, Alheira Rocha, R, Silva, R, Houly, J, Aldrighi, J, Hatum, R, Suparregui Dias, F, Ferreira, L, Ferro, L, Gomez, J, Fleury, R, David, C, Resener, T, Mendes, C, Germano, A, De Marco, F, Lage, S, Salluh, J, Torelly, A, Sad, R, Oliveira, G, Lima, R, Paranhos, J, Rocha, M, Bitencourt, W, Grion, C, Forte, D, Guimarães, H, Piras, C, Stephanova, L, Lyubenov, L, Tsarianski, G, Dimov, G, Green, R, Levasseur, J, Ward, R, Lesur, O, Poirier, G, Wax, R, Wood, G, Cook, D, Marshall, J, Herridge, M, Ferguson, N, 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Nguyen Huu, C.

Published
2011

44. Long-Term Isoflurane Therapy for Refractory Bronchospasm Associated with Herpes Simplex Pneumonia in a Heart Transplant Patient

Author

Hornuss, C., Firsching, M., Dolch, M., Martignoni, A., Peraud, A., and Briegel, J.

Subjects
Article Subject
Abstract

A 47-year-old man with a history of heart transplant was admitted after severe traumatic brain injury and seizures. During mechanical ventilation, the patient developed bronchospasm that severely compromised respiratory function that led to cardiac arrest. After resuscitation, application of isoflurane through the Anaesthetic Conserving Device (AnaConDa) in the ICU successfully treated bronchospasm, provided adequate sedation, and enabled appropriate ventilation and diagnostic bronchoscopy. A subsequent bronchoalveolar lavage revealed a high amount of Herpes simplex DNA. Herpes simplex pneumonia was diagnosed and treated with acyclovir. Isoflurane treatment was applied for twelve days total without side effects on renal and cerebral function. The patient recovered quickly after the termination of sedation. At discharge, he was fully awake without focal neurological deficiency and his long-term outcome was excellent. This case demonstrates that isoflurane is a treatment option in life-threatening cases of bronchospasm and a safe option for long-term sedation.

Published
2010
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45. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine

Author

Marik, P.E. Pastores, S.M. Annane, D. Meduri, G.U. Sprung, C.L. Arlt, W. Keh, D. Briegel, J. Beishuizen, A. Dimopoulou, I. Tsagarakis, S. Singer, M. Chrousos, G.P. Zaloga, G. Bokhari, F. Vogeser, M.

Abstract

OBJECTIVE:: To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients. PARTICIPANTS:: A multidisciplinary, multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. In addition, international experts in endocrinology were invited to participate. DESIGN/METHODS:: The task force members reviewed published literature and provided expert opinion from which the consensus was derived. The consensus statements were developed using a modified Delphi methodology. The strength of each recommendation was quantified using the Modified GRADE system, which classifies recommendations as strong (grade 1) or weak (grade 2) and the quality of evidence as high (grade A), moderate (grade B), or low (grade C) based on factors that include the study design, the consistency of the results, and the directness of the evidence. RESULTS:: The task force coined the term critical illness-related corticosteroid insufficiency to describe the dysfunction of the hypothalamic-pituitary-adrenal axis that occurs during critical illness. Critical illness-related corticosteroid insufficiency is caused by adrenal insufficiency together with tissue corticosteroid resistance and is characterized by an exaggerated and protracted proinflammatory response. Critical illness-related corticosteroid insufficiency should be suspected in hypotensive patients who have responded poorly to fluids and vasopressor agents, particularly in the setting of sepsis. At this time, the diagnosis of tissue corticosteroid resistance remains problematic. Adrenal insufficiency in critically ill patients is best made by a delta total serum cortisol of

Published
2008

47. Capizzi-Style Methotrexate with Pegasparagase (C-MTX) Is Superior to High-Dose Methotrexate (HDMTX) in T-Lineage Acute Lymphoblastic Leukemia (T-ALL): Results from Children's Oncology Group (COG) AALL0434

Author

Winter, Stuart S., Devidas, Meenakshi, Chen, Si, Asselin, Barbara, Carroll, William L., Wood, Brent L, Esiashvili, Natia, Nikki, Briegel J, Hayashi, Robert J., Loh, Mignon L., Carroll, Andrew J., Heerema, Nyla A., Raetz, Elizabeth, Winick, Naomi J., Hunger, Stephen P., and Dunsmore, Kimberly P.

Published
2015
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50. Selection for superior growth advances the onset of puberty and increases reproductive performance in ewe lambs.

Author

Rosales Nieto, C. A., Ferguson, M. B., Macleay, C. A., Briegel, J. R., Martin, G. B., and Thompson, A. N.

Subjects
MAMMAL reproduction, SHEEP, PUBERTY, EWES, BODY mass index, SHEEP breeding, STATISTICAL models, PHENOTYPES, TESTOSTERONE
Abstract

The reproductive efficiency of the entire sheep flock could be improved if ewe lambs go through puberty early and produce their first lamb at 1 year of age. The onset of puberty is linked to the attainment of critical body mass, and therefore we tested whether it would be influenced by genetic selection for growth rate or for rate of accumulation of muscle or fat. We studied 136 Merino ewe lambs with phenotypic values for depth of eye muscle (EMD) and fat (FAT) and Australian Sheep Breeding Values at post-weaning age (200 days) for live weight (PWT), eye muscle depth (PEMD) and fat depth (PFAT). First oestrus was detected with testosterone-treated wethers and then entire rams as the ewes progressed from 6 to 10 months of age. Blood concentrations of leptin and IGF-I were measured to test whether they were related to production traits and reproductive performance (puberty, fertility and reproductive rate). In total, 97% of the lambs reached first oestrus at average weight 39.4 ± 0.4 kg (mean ± s.e.m.) and age 219 days (range 163 to 301). Age at first oestrus decreased with increases in values for PWT (P < 0.001), and concentrations of IGF-I (P < 0.05) and leptin (P < 0.01). The proportion of ewe lambs that achieved puberty was positively related with increases in values for EMD (P < 0.01), FAT (P < 0.05) or PWT (P < 0.01), and 75% of the ewe lambs were pregnant at average weight 44.7 ± 0.5 kg and age 263 days (range 219 to 307). Ewe lambs that were heavier at the start of mating were more fertile (P < 0.001) and had a higher reproductive rate (P < 0.001). Fertility and reproductive rate were positively correlated with increases in values for EMD (P < 0.01), FAT (P < 0.05), PWT (P < 0.01) and leptin concentration (P < 0.01). Fertility, but not reproductive rate, increased as values for PFAT increased (P < 0.05). Leptin concentration increased with increases in values for EMD (P < 0.001), FAT (P < 0.001), PWT (P < 0.001), PEMD (P < 0.05) and PFAT (P < 0.05). Many of these relationships became non-significant when PWT or live weight was added to the statistical model. We conclude that selection for genetic potential for growth can accelerate the onset of puberty and increase fertility and reproductive rate of Merino ewe lambs. The metabolic hormones, IGF-I and leptin, might act as a physiological link between the growing tissues and the reproductive axis. [ABSTRACT FROM AUTHOR]

Published
2013
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