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Purpose: Thenar eminence tissue oxygen saturation (StO) was developed to assess organ perfusion. However, mottling, a strong predictor of mortality in septic shock, develops preferentially around the knee. We aimed to evaluate the prognostic value of StO measured around the knee in septic shock patients and compare it to thenar StO. Methods: This was a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included. Parameters were recorded when vasopressors were started (H0) and every 6 h during 24 h. Their predictive value was assessed on 14-day mortality. Results: Fifty-two patients were included. SOFA score was 11 (9-15) and SAPS II was 56 (40-72). At 6 h after ICU admission (H6), mean arterial pressure, cardiac index, and central venous pressure were not different between non-survivors and survivors; but non-survivors had higher arterial lactate level (8.8 ± 5.0 vs. 2.2 ± 1.5 mmol/l, P < 0.001), lower urinary output (0.22 ± 0.45 vs. 0.70 ± 0.50 ml/kg/h, P < 0.001) and ScvO (62 ± 20 vs. 72 ± 9 %, P = 0.03). At H6, StO was lower in non-survivors; this difference was not significant for thenar StO (70 ± 15 vs. 77 ± 12 %, P = 0.10) but was very pronounced for knee StO (39 ± 23 vs. 71 ± 12 %, P < 0.001). At H6, a low knee StO was associated with a higher mottling score ( P < 0.01), a higher lactate level ( P < 0.002, R = 0.2), and a lower urinary output ( P = 0.02, R = 0.12). Conclusion: After initial septic shock resuscitation, StO measured around the knee is a strong predictive factor of 14-day mortality. [ABSTRACT FROM AUTHOR]

Background: Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock. Methods: We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)]. Results: Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [<1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5); >3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p < 0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred ( p < 0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005). Conclusion: The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock. [ABSTRACT FROM AUTHOR]

In this study YAlO: Ce powder scintillator was evaluated for use in X-ray imaging detectors. This phosphor, also known as YAG: Ce scintillator or P-46 phosphor, is a non-hygroscopic, emitting green light with very short decay time. These properties are very attractive for X-ray imaging. YAlO: Ce powder was used to prepare various test screens (33-166 mg/cm). Absolute luminescence efficiency measurements were performed for various X-ray tube voltages (50-130 kVp). In addition parameters related to image quality such as the modulation transfer function and the detective quantum efficiency were examined. A theoretical model, describing radiation and light transfer, was employed to fit experimental data and to estimate values of optical parameters. Absolute efficiency was found to decrease with X-ray tube voltage. Highest efficiency was obtained for the 107 mg/cm screen. Light attenuation coefficients were close to those of green emitting rare earth scintillators. At low spatial frequencies the detective quantum efficiency was high for the 107-166 mg/cm screens. The light emission efficiency and imaging performance of YAlO: Ce was not better than currently employed scintillators. However due to its very fast response and high spectral compatibility to optical sensors it may be considered for use in digital imaging detectors. [ABSTRACT FROM AUTHOR]