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Background: Whether hospital bed number and rapid response system (RRS) call rate is associated with the clinical outcomes of patients who have RRS activations is unknown. We test a hypothesis that hospital volume and RRS call rates are associated with the clinical outcomes of patients with RRSs.Methods: This is a retrospective chart analysis of an existing dataset associated with In-Hospital Emergency Registry in Japan. In the present study, 4818 patients in 24 hospitals from April 2014 to March 2018 were analyzed. Primary outcome variable was an unplanned intensive care unit (ICU) admission after RRS activation.Results: In the primary analysis of the study using a multivariate analysis adjusting potential confounding factors, higher RRS call rate was significantly associated with decreased unplanned ICU admissions (P < 0.0001, Odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92-0.98), but there was no significant association of hospital volume with unplanned ICU admissions (P = 0.44). In the secondary analysis of the study, there was a non-significant trend of increased cardiac arrest on arrival at the location of the RRS provider at large-volume hospitals (P = 0.084, OR 1.16, 95% CI 0.98-1.38). Large-volume hospitals had a significantly higher 1-month mortality rate (P = 0.0040, OR 1.10, 95% CI 1.03-1.18).Conclusion: Hospitals with increased RRS call rates had significantly decreased unplanned ICU admission in patients who had RRS activations. Patients who had RRS activations at large-volume hospitals had an increased 1-month mortality rate. [ABSTRACT FROM AUTHOR]

Background: The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients.Methods: We systematically searched the PubMed, MEDLINE, Cochrane Resister of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Igaku Chuo Zasshi databases for studies published from 1986 to August 2016 that evaluated the accuracy of IL-6 levels for the diagnosis of infection. We constructed 2 × 2 tables and calculated summary estimates of sensitivity and specificity using a bivariate random-effects model.Results: The literature search identified 775 articles, six of which with a total of 527 patients were included according to the predefined criteria. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.73 (95% confidence interval [CI], 0.61-0.82), 0.76 (95% CI, 0.61-0.87), and 2.31 (95% CI, 1.20-3.48), respectively. The area under the curve (AUC) of the summary receiver operator characteristic (SROC) curve was 0.81 (95% CI, 0.78-0.85). In the secondary analysis of two studies with a total of 263 adult critically ill patients with organ dysfunction, the pooled sensitivity, specificity, and diagnostic odds ratio were 0.81 (95% CI, 0.75-0.86), 0.77 (95% CI, 0.67-0.84), and 2.87 (95% CI 2.15-3.60), respectively.Conclusions: Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection. [ABSTRACT FROM AUTHOR]

Short-term pulsed exposure tests have been increasingly used to evaluate the ecotoxicity of pollutants of which concentrations vary over time in the field. In pulsed exposure, time-weighted average (TWA) concentration is often used as an index of exposure. However, there have been few studies to demonstrate whether TWA concentration can be used to evaluate the effect of endocrine-disrupting chemicals on the daphnids. Pyriproxyfen is one of the juvenile hormone analogs that induces daphnids to produce male offspring. To evaluate whether peak or TWA concentration can explain the effects of pyriproxyfen on daphnid reproduction, we measured the number of offspring and the proportion of male offspring produced by Daphnia magna during 21-day under different exposure treatments, constant, single-pulse, and multi-pulse exposure, at an equivalent TWA concentration. Constant exposure of 50 ng/L pyriproxyfen did not affect either the fecundity or the proportion of male offspring, while a single-pulse exposure of 525 ng/L pyriproxyfen over 2 day at four different age did not reduce fecundity, but the proportion of male offspring increased age dependently. Multi-pulses exposure of 131 ng/L pyriproxyfen over two days four times (total eight days) resulted in a decrease in fecundity and the highest proportion of male offspring. Daily observation demonstrated that male offspring was only produced several days after the exposure to a certain concentration of pyriproxyfen. Therefore, neither TWA nor peak concentration accurately evaluated the effects of pulsed exposure of pyriproxyfen on the reproduction of D. magna , particularly its effect on the proportion of male offspring. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: No reliable predictor for the prognosis of out-of-hospital cardiac arrest (OHCA) on arrival at hospital has been identified so far. We speculate that ammonia and lactate may predict patient outcome. Methods: This is a prospective observational study. Non-traumatic OHCA patients who gained sustained return of spontaneous circulation and were admitted to acute care unit were included. Blood ammonia and lactate levels were measured on arrival at hospital. The patients were classified into two groups: ‘favourable outcome’ group (Cerebral Performance Category CPC1–2 at 6-months’ follow-up) and ‘poor outcome’ group (CPC3–5). Basal characteristics obtained from the Utstein template and biomarker levels were compared between these two outcome groups. Independent predictors were selected from all candidates using logistic regression analysis. Results: A total of 98 patients were included. Ammonia and lactate levels in the favourable outcome group (n =10) were significantly lower than those in poor outcome group (n =88) (p <0.05, respectively). On receiver operating characteristic analysis, the optimal cut-off value for predicting favourable outcome was determined as 170μgdl−1 of ammonia and 12.0mmoll−1 of lactate (area under the curve; 0.714 and 0.735, respectively). Logistic regression analysis identified ammonia (≤170μgdl−1), therapeutic hypothermia and witnessed by emergency medical service personnel as independent predictors of favourable outcome. When both these biomarker levels were over threshold, positive predictive value (PPV) for poor outcome was calculated as 100%. Conclusions: Blood ammonia and lactate levels on arrival are independent prognostic factors for OHCA. PPV with the combination of these biomarkers predicting poor outcome is high enough to be useful in clinical settings. [Copyright &y& Elsevier]

Abstract: Objectives: To investigate the usefulness of analysis of single nucleotide polymorphism (SNP) using a newly developed DNA chip assay involving single base extension(SBE) and subsequent hybridization in cytokine-related genes in critical care patients. Design and methods: Genotyping was performed in 76 ICU patients admitted to the ICU. First, the DNA samples from 58 patients were subjected to PCR and SBE conditioning for DNA. Second, another 18 patients were subjected to genotyping for SNPs in IL-6 −596G/A, −572C/G, −174G/C, TNF-α −308G/A, −238G/A, IL-1β −511C/T and −31T/C by both TaqMan and DNA chip method, and by DNA direct sequencing prospectively. Results: First, PCR and SBE condition were established with initial sample sets, which were consistent with results by TaqMan method. Second, no difference was observed between two assay methods in prospective validation set. Conclusions: The genotyping assay using the new chip was developed and its usefulness was confirmed. [Copyright &y& Elsevier]

Abstract: Introduction: Most patients with cardiac arrest (CA) admitted to hospitals after successful cardiopulmonary resuscitation (CPR) are discharged with various degree of neurological deficits. To determine predictor of neurological outcome early and accurately, and to determine cutoff values, serum levels of protein S-100B and neuron-specific enolase (NSE) within 24h after CA were assessed. Methods and results: A multicenter prospective observational study was conducted between May 2007 and April 2008 at three medical institutions in Japan on 107 consecutive non-traumatic CA patients with return of spontaneous circulation after CPR. Based on “best-ever achieved” Glasgow-Pittsburgh cerebral performance categories (CPC) score within 6 months after CA, patients were classified into a “poor neurological outcome” group (CPC3 to CPC5) (n =67) and “favorable neurological outcome” group (CPC1 and CPC2) (n =13). Blood was sampled on admission, at 6 and 24h after CA. Serum S-100B and NSE in “poor outcome” group were higher than those in “favorable outcome” group (P <0.01). On ROC analysis, area under the curve of S-100B was 0.85, 0.94 and 1.0, respectively. These were greater than those of NSE at all sampling points. The “100%-specific” cutoff values of S-100B predictive of poor neurological outcome were 1.41, 0.21, and 0.05ng/mL, respectively. These values corresponded to sensitivities of 20.9%, 62.8%, and 100%, respectively, each of which was higher than those of NSE. Conclusions: S-100B is more reliable as an early predictor of poor neurological outcome within 24h after CA than NSE and can be applied clinically. [Copyright &y& Elsevier]

Abstract: We compared the clinical efficacy of high-flow dialysate continuous hemodiafiltration (HFCHDF) performed as artificial liver support (ALS) in fulminant hepatic failure (FHF) with those of conventional ALS techniques. Ninety patients were divided into non-HFCHDF and HFCHDF groups. Rate of recovery from coma was significantly higher in the HFCHDF group (70.2%) than in the non-HFCHDF group (44.2%) (p <0.01). The excellent recovery rate from coma achieved in patients with FHF by HFCHDF may be due to its enhanced capacity for liver support enabling efficient removal of substances causing hepatic coma from blood. HFCHDF should thus be useful for ALS. [Copyright &y& Elsevier]

Abstract: Objective: To examine the role of hypercytokinemia in the pathophysiology of tumor lysis syndrome (TLS) and the efficacy of continuous hemodiafiltration in the treatment of TLS. Design and setting: Retrospective observational study in a general intensive care unit of a university hospital. Patients: Four patients with hematological disorder developing TLS after the treatment of anti-tumor chemotherapy. Interventions: Continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) was performed at the onset of TLS. Blood samples were collected daily after ICU admission, and clinical parameters and blood levels of cytokines were evaluated. Measurements and results: All four patients underwent induction anti-tumor chemotherapy, during which they developed hyperuricemia, hyperkalemia, and acute renal failure. Two of them also developed multiple organ failure. Serum levels of tumor necrosis factor (TNF) -alpha, interleukin-6 (IL-6), and IL-10 prior to the initiation of PMMA-CHDF were 102±85pg/mL, 1097±546pg/mL, and 98±83pg/mL, respectively (mean ± SD). After three days of PMMA-CHDF treatment, corresponding blood levels were 37±55pg/mL, 326±511pg/mL, and 9±8pg/mL, respectively. Thus, all cytokine levels were significantly decreased by three days of PMMA-CHDF treatment (p <0.05, paired t-test). Following three days of PMMA-CHDF treatment, blood urea nitrogen (BUN) and serum creatinine (Cre.) were significantly decreased (pre/post BUN 42.3±15.4/16.5±8.4mg/dL, p <0.05, pre/post Cre. 2.7±1.2/1.2±0.6mg/dL, mean ± SD, p <0.05). Furthermore, the clinical condition of each patient was improved after the treatment of PMMA-CHDF, and all of four patients were survived. Conclusion: Hypercytokinemia plays a pivotal role in the pathophysiology of TLS and PMMA-CHDF may be an effective therapeutic modality for TLS patients not only as renal replacement therapy but also as a cytokine modulator. [Copyright &y& Elsevier]

Abstract: Reactive (or secondary) hemophagocytic syndrome (RHS) is a potentially lethal condition and characterized by hypercytokinemia. Immune modulating drugs sometimes fail to achieve satisfactory control. Therefore we investigate the efficacy of continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter (PMMA-CHDF) for cytokine removal in patients with RHS. Eight consecutive patients who admitted to our ICU with RHS complicating organ failures and refractory to medical therapy were initiated intensive care including PMMA-CHDF. Although remission was achieved in six patients, remaining two patients died of exacerbation of underlying diseases. Changes in blood levels of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) as indices of cytokine network activation, and serum ferritin level as an index of severity of RHS were investigated during PMMA-CHDF. PMMA-CHDF performed for 3days significantly reduced blood TNF-α level (183±159pg/ml to 84±98pg/ml, p <0.05) and also blood IL-6 level (1113±903pg/ml to 402±411pg/ml, p <0.01). Furthermore, serum ferritin level was significantly decreased 3days after initiation of PMMA-CHDF (52390±65168ng/ml to 4136±2932ng/ml, p <0.05) although it tended to increase before initiation of PMMA-CHDF. No PMMA-CHDF-related adverse events were observed in any of the patients. PMMA-CHDF was effective to remove cytokine and improved disease severity. Thus, PMMA-CHDF may be an adjunctive treatment in RHS refractory to medical therapy. [Copyright &y& Elsevier]

Abstract: We studied the susceptibility of three genetically different strains of the cyclical parthenogen Daphnia magna (Cladocera, Crustacea) in producing male neonates following exposure to juvenile hormone analogs. In experiment 1, NIES, Clone A, and Belgium A strains were exposed to the insect growth regulators (IGRs) fenoxycarb or epofenonane in a 21-day reproduction experiment. Fenoxycarb exposure decreased the total number of neonates and increased production of male neonates in a concentration-dependent manner in the NIES strain. The decrease in the total number of neonates was so great in Clone A following fenoxycarb exposure that male neonates were not observed, even at the highest concentration, where the total number of neonates was only 2% of the control. In the Belgium A strain, male neonates were observed at a rate of about 20% following exposure to the highest fenoxycarb concentration, but the total number observed was small. Epofenonane did not decrease reproduction in the NIES and Belgium A strains as dramatically as did fenoxycarb, but the neonatal sex ratio changed in a concentration-dependent manner. Although the ratio of males was as low as about 10%, induction of male neonates was also observed in Clone A following epofenonane exposure. In experiment 2, gravid females were exposed to high concentrations (5 or 10μg/l) of fenoxycarb or pyriproxyfen for 12h. These treatments induced the production of male neonates in all strains, with a small decrease in the total number of neonates. Although induction of male neonates by juvenile hormones and their analogs was universal among genetically different strains, care is needed in interpreting the results of the 21-day reproduction tests, because decreased numbers of neonates at higher concentrations could obscure the presence of male neonates. [Copyright &y& Elsevier]

Abstract: We exposed the water flea Daphnia magna (Cladocera, Crustacea) to either juvenile hormone I (JH I), juvenile hormone II (JH II), or the juvenile hormone-mimicking insecticides kinoprene, hydroprene, epofenonane, or fenoxycarb. By 21-day reproduction tests, we investigated the effects on the number of neonates born per female and the offspring sex ratio. All six chemicals induced D. magna to produce male neonates; the male sex ratio of the offspring increased as the chemical concentration increased. EC50 values for production of male neonates were estimated as 400 (JH I), 410 (JH II), 190 (kinoprene), 2.9 (hydroprene), 64 (epofenonane), and 0.92 (fenoxycarb)μg/l. The number of neonates produced was reduced with all chemicals at the concentrations investigated. At the EC50 for male production, five of the six chemicals reduced the reproductive rate to less than 50%; the exception was epofenonane, which caused only a slight reduction in reproductive rate. These results were similar to those obtained for five juvenoids studied previously, one of which was studied here again. There are now 10 chemical substances—all juvenile hormones or their analogs—that are known to induce D. magna to produce male neonates. This suggests that juvenile hormone is involved in initiating male production followed by sexual reproduction in D. magna, and probably in most cladocerans that exhibit cyclic parthenogenesis. [Copyright &y& Elsevier]

Abstract: Previous studies have found that exposure of a cyclic parthenogen, the water flea Daphnia magna (Cladocera, Crustacea), to juvenile hormones and their analogs results in the production of neonates of male sex at concentration-dependent rates. We conducted reproduction experiments in four different species (Moina macrocopa, M. micrura, Ceriodaphnia dubia and C. reticulata) of cladoceran to test for the first time whether the occurrence of this phenomenon after exposure of the parent to such hormones is a generalized phenomenon. In the presence of a juvenile hormone analog, fenoxycarb, all four species produced male neonates and showed reduced rates of reproduction. The estimated median effective concentration (EC50) for the production of male neonates varied with species, ranging from 0.60×103 to 9.3×103 ng/l. Although there was a wide range of sensitivity to fenoxycarb, the production of male neonates in all four species demonstrates that this phenomenon is a common response to juvenile hormone analogs and further suggests that these hormones are capable of initiating sexual reproduction in cladocerans, most of which exhibit cyclic parthenogenesis. [Copyright &y& Elsevier]

The water flea Daphnia magna reproduces primarily by cyclic parthenogenesis. Environmental stimuli that signal a change to adverse conditions induce the organisms to switch from parthenogenesis to gamogenetic reproduction. During the gamogenetic period, they produce male daphnids and dormant resting eggs, which can survive prolonged periods of environmental adversity. However, little is known about the mechanisms associated with the switch from parthenogenesis to gamogenetic reproduction. We investigated the effects of several juvenoids on sex determination in Daphnia. Females less than 24 h old were exposed to various concentrations of the test substance and were observed for 21 days. It was found that they can trigger the appearance of male daphnids: the percentage of males in the population increases to a level greater than what occurs under ordinary environmental conditions. We found that methylfarnesoate, juvenile hormone III, methoprene, and the phenoxyphenoxy derivatives pyriproxyfen and fenoxycarb (both insecticides) reduced the production of offspring and produced sex ratios dominated by male daphnids. Pyriproxyfen and fenoxycarb showed striking effects at low concentrations. Exposure to either of these chemicals at a concentration of 330 ng l−1 caused adult females to produce almost all male neonates. Methylfarnesoate, juvenile hormone III, and methoprene showed an effect in inducing male production at higher concentrations (3.7 × 103, 3.3 × 105, and 1.3 × 105 ng l−1, respectively). Our findings suggest that juvenile hormone agonists, including some insecticides, affect the chemical signaling responsible for inducing the production of male offspring. [Copyright &y& Elsevier]

Abstract: Blood purification has been steadily improved in the field of critical care, supported by advances in related biomedical technologies as well as efforts to develop better operating procedures. As it has become clear that hypercytokinemia plays a key role in the pathophysiology of critical pathological conditions, use of various blood purification techniques to control hypercytokinemia has been investigated. Answers to questions concerning the optimal cytokine-removing device (dialyzer/hemofilter/adsorber) as well as operating procedures and conditions of such devices in particular clinical conditions have been obtained in the course of such investigations. The recent success in real-time monitoring of cytokine levels in clinical practice to assess the extent of cytokine network activation may improve the precision and efficacy of blood purification in the treatment of hypercytokinemia. In addition, the recently documented effects of genetic factors on hypercytokinemia suggest that the introduction of tailor-made medicine considering the differences in genetic background among individual patients may improve the efficacy of blood purification as a countermeasure to hypercytokinemia. [Copyright &y& Elsevier]

Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Multimodal therapy including continuous renal replacement therapy (CRRT) and mechanical ventilation was initiated, and oral VCM administration (0.5 g every 6 h) was begun for suspected severe pseudomembranous colitis with large amounts of watery stool. Despite continued CRRT, the serum VCM concentration increased to 30.6 μg/mL after 4 days. Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to be over 54.5%. Colonoscopy showed that the mucosa was severely damaged throughout the large intestine, resulting in considerable exudation of plasma and blood. This case indicates the need for careful and early monitoring during high-dose oral VCM administration to patients with severe mucosal injury and renal insufficiency. [ABSTRACT FROM AUTHOR]

Introduction We sought to investigate the energy requirements for patients under therapeutic hypothermia, and the relationship of energy fulfillment to patient outcome. Patients and methods Adult patients admitted to our ICU after successful resuscitation from cardiac arrest for post resuscitation therapeutic hypothermia from April, 2012 to March, 2014 were enrolled. Body temperature was managed using the surface cooling device (Arctic Sun ® , IMI). Calorimeter module on the ventilator (Engström carestation ® , GE) was used for indirect calorimetry. Energy expenditure (EE) and respiratory quotient (RQ) were recorded continuously, as the average of the recent 2 h. Measurements were started at the hypothermic phase and continued until the rewarming was completed. Cumulative energy deficit was calculated as the sum of difference between EE and daily energy provision for the 4 days during hypothermia therapy. Results Seven patients were eligible for analysis. Median EE for the hypothermic phase (day 1) was 1557.0 kcal d −1 . EE was elevated according with the rise in body temperature, reaching 2375 kcal d −1 at normothermic phase. There was significant association between cumulative energy deficit and the length of ICU stay, among patients with good neurologic recovery (cerebral performance category (CPC): 1–3). Conclusion The EE for patients under therapeutic hypothermia was higher than expected. Meeting the energy demand may improve patient outcome, as observed in the length of ICU stay for the present study. A larger, prospective study is awaited to validate the results of our study. [ABSTRACT FROM AUTHOR]

Aim Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. Methods Witnessed non-traumatic cardiac arrest patients ( n = 108) were randomized to receive standard care with ( n = 53) or without pharyngeal cooling ( n = 55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5 °C) into a pharyngeal cuff for 120 min. Results There was a significant decrease in tympanic temperature at 40 min after arrival ( P = 0.02) with a maximum difference between the groups at 120 min (32.9 ± 1.2 °C, pharyngeal cooling group vs. 34.1 ± 1.3 °C, control group; P < 0.001). The return of spontaneous circulation (70% vs. 65%, P = 0.63) and rearrest (38% vs. 47%, P = 0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group ( P = 0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups. Conclusions Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium. [ABSTRACT FROM AUTHOR]

Abstract: Background: A 5-HT3 receptor antagonist, tropisetron, has been reported to exhibit an anti-inflammatory effect in chronic inflammatory diseases by antagonizing a particular subtype of serotonin receptors. We investigated whether overproduction of cytokines could be controlled by intervention with tropisetron in an animal model of sepsis and also examined the effects of tropisetron on autonomic nervous activity. Methods: Sixty-eight adult male Sprague–Dawley rats were used (28 for examination of cytokine production and autonomic nervous activity; 40 for survival analysis). Each part of the study involved 4 animal groups, including two control groups without drug administration. Sepsis was induced by cecal ligation and puncture (CLP). Tropisetron hydrochloride (1mg/kg) was administered immediately after surgery. Continuous electrocardiograms were recorded for 5min before and 1, 2, 4, and 6h after surgery in CLP and sham-operated animals for heart rate variability (HRV) analysis. Blood samples were collected 6h after surgery for serum cytokine and catecholamine assay. Results: HRV analysis demonstrated a significant increase in LF/(LF+HF) in the CLP animals compared with the sham-operated animals, regardless of tropisetron administration, indicating induction of sympathetic overstimulation. Tropisetron significantly inhibited IL-6 induction in the CLP animals (p <0.01). Although it did not significantly change HRV parameters, tropisetron significantly inhibited increase in serum level of noradrenaline (p <0.05). Tropisetron did not significantly improve CLP animal survival rate. Conclusions: Intervention with a 5-HT3 receptor antagonist can control excess cytokine production involved in the pathogenesis of severe sepsis/septic shock. [Copyright &y& Elsevier]

Abstract: In response to a central nervous system (CNS) injury, microglia and astrocytes release tumor necrosis factor-α (TNF-α). This proinflammatory cytokine has been implicated in both neuronal cell death and survival. Here, we show that TNF-α is involved in the recovery of neuromotor function following traumatic brain injury. Composite neuroscore and accel rotarod were employed to measure neuromotor function. TNF-α-deficient (TNF-α−/−) mice showed no improvement in their locomotor function up to 28 days following controlled cortical impact brain injury. Although collateral sprouting of the unlesioned corticospinal tract, as assessed by retrograde biotin dextran amine labeling, at the cervical spinal cord was observed following injury in the wild-type mice, such changes were not induced in the TNF-α−/− mice at 4 weeks after injury. These results provide evidence that TNF-α is involved in neuroanatomical plasticity and functional recovery following CNS injury. [Copyright &y& Elsevier]

Purpose: Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury that frequently shows fatal outcomes. As radiographic predictive factors, some reports have focused on the region of ill-aerated lung, but none have focused on well-aerated lung. Our objective was to evaluate the relationship between computed tomography (CT) volume of the well-aerated lung region and prognosis in patients with ARDS.Method: This retrospective observational study of a single intensive care unit (ICU) included patients with ARDS treated between April 2011 and May 2013. We identified 42 patients with ARDS for whom adequate helical CT scans were available. CT images were analyzed for 3-dimensional reconstruction, and lung region volumes were measured using automated volumetry methods. Lung regions were identified by CT attenuation in Hounsfield units (HU).Results: Of the 42 patients, 35 (83.3 %) survived 28 days and 32 (76.2 %) survived to ICU discharge. CT lung volumetry was performed within 144.5 ± 76.6 s, and inter-rater reliability of CT lung volumetry for lung regions below -500 HU (well-aerated lung region) were near-perfect. Well-aerated lung region showed a positive correlation with 28-day survival (P = 0.020), and lung volumes below -900 HU correlated positively with 28-day survival and ICU survival, respectively (P = 0.028, 0.017). Survival outcome was better for percentage of well-aerated lung region/predicted total lung capacity ≥40 % than for <40 % (P = 0.039).Conclusions: CT lung volumetry of the well-aerated lung region using an automated method allows fast, reliable quantitative CT analysis and potentially prediction of the clinical course in patients with ARDS. [ABSTRACT FROM AUTHOR]