Search

Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

Marine biodegradable fibers with high strength and elasticity were successfully fabricated from microbial polyesters using a melt-spinning method. Polymers were melted at temperatures lower than th...

A superior electrical conductivity of 38.5 S/cm and an electromagnetic shielding (EMS) effectiveness of −30 dB (−545 dB/mm) across a wide frequency range of 0–15 GHz, including the X-band, were achieved with thin organic paper of (55 μm) cellulose nanofiber (CNF)/polyaniline (PANI) doped with (±)-10-camphorsulfonic acid nanohybrid. Both electrical conductivity and EMS effectiveness of the PANI-coated CNF were strongly affected by the amount and type of dopant, which could be tunable after fabrication process via simple in situ oxidative polymerization of aniline. Flexible and free-standing film was obtained, since CNF provides good mechanical property without diminishing the electrical property of PANI.

Investigation on the effect of starch interface towards mechanical behaviour of rice grains was reported through mechanical tests (compression and three-point bending) and finite element micromechanics model. The model considered starch kernels within the rice grain (for milled rice) as well as a layer of husk on top (for unmilled rice). The interface between the kernels was modelled using cohesive zone model to simulate interfacial damage. Higher fracture stress was reported at lower moisture content from the three-point bending, and linear elastic behaviour was observed from compression tests of milled rice, which was independent of moisture contents. The force-displacement curves of milled rice are linear, whereas unmilled rice showed initial softening before hardening at approximately 0.1 mm displacement. The representative finite element models showed agreement with compression and bending experiments, suggesting significant influence of starch interface damage towards fracture of milled rice grain.

The biodegradation behaviors of several forms of poly[(R)-3-hydroxybutyrate-co-(R)-3-hydroxyvalerate] (P(3HB-co-3HV)) in seawater and freshwater, namely, powder, cast film, undrawn fiber, and fivefold-drawn fiber, were analyzed via biochemical oxygen demand, weight loss, and scanning electron microscopy measurements. The powder showed the highest degradation rate, attributed to its larger surface area, which allows microorganisms to attach to the surface and form a biofilm that begins to degrade sooner. The fivefold-drawn fibers degraded more slowly than the undrawn fibers owing to the higher crystallinity caused by the orientation of the former. Moreover, the degradation results of the fivefold-drawn fibers in seawater and freshwater showed that the degradation rate depended on the number of microorganisms in both environmental water types. The analysis of the degradation behavior in the freshwater revealed that the crystalline and amorphous phases in the film degraded simultaneously, whereas the degradation of the fibers started from the amorphous phase, followed by the crystalline phase.

The thermal degradation behavior of poly[(R)-3-hydroxybutyrate-co-16 mol%-4-hydroxybutyrate] (P(3HB-co-16 mol%-4HB)) was investigated based on spectroscopic analysis of its pyrolyzates and two kinetic modeling approaches. Pyrolyzate analysis revealed that trans-crotonic acid, cis-crotonic acid, γ-butyrolactone, and their oligomers (dimers and trimers) were produced following thermal degradation of P(3HB-co-16 mol%-4HB). The kinetic analyses confirmed that the thermal degradation behavior of this copolymer changed depending on the time and/or temperature parameters. Specifically, this degradation process proceeded in at least two steps, (i) initial random degradation and (ii) subsequent 0th-order weight loss, which indicated unzipping degradation of the 3HB units. Based on 13C NMR and two-dimensional NMR methods, it was determined that the unzipping degradation of 3HB units starting from the chain end may stop or volatilize an oligomer when the reaction reaches a 4HB unit randomly present in the copolymer.

Background Klebsiella pneumonia is a well-known human pathogen, and recently, a distinct invasive syndrome caused by K. pneumoniae serotypes K1 and K2 has been recognized in Southeast Asia. This syndrome is characterized by primary liver abscess and extrahepatic complications resulting from bacteremic dissemination. We report the first adult case of primary liver abscess caused by the definite K2 serotyped pathogen, with endogenous endophthalmitis in Japan. Case presentation A 64-year-old woman was admitted to a nearby hospital for a high fever and diarrhea. She had visual loss of her right eye, renal dysfunction, and thrombocytopenia within 24 h from admission. She was transferred to our institution. On admission, she had no alteration of mental status and normal vital signs; however, she had almost complete ablepsia of the right eye. Laboratory data showed severe inflammation, liver dysfunction, thrombocytopenia, an increased serum creatinine level, and coagulopathy. Computed tomography showed a low density area in the right lobe of the liver. Invasive liver abscess syndrome probably caused by K. pneumonia was highly suspected and immediately administered broad-spectrum antibiotics for severe sepsis. Concurrently, endogenous endophthalmitis was diagnosed, and we performed vitrectomy on the day of admission. The blood culture showed K. pneumoniae infection. Percutaneous drainage of the liver abscess was also performed. Although she was discharged in a good general condition on day 22, she had complete ablepsia of the right eye. The K2A gene was detected by polymerase chain reaction (PCR), which is consistent with the K2 serotype. PCR was also positive for the virulence-associated gene rmpA. Final diagnosis was invasive liver abscess syndrome caused by K2 serotype K. pneumonia. Conclusions Although the primary liver abscess caused by K. pneumoniae with a hypermucoviscous phenotype is infrequently reported outside Southeast Asia, physicians should recognize this syndrome, and appropriate diagnosis and treatment is essential for saving patients’ lives and preserving organ function, especially for visual acuity.

To describe a case of complete remission of thrombotic microangiopathy after treatment with eculizumab in a patient with non-Shiga toxin-associated bacterial enteritis. Case report: Medical/surgical intensive care unit (ICU) of a university teaching hospital. A 62-year-old man presented to a local hospital with mucous and bloody stool persisting for 1 month and worsening abdominal pain for 2 weeks. He had thrombocytopenia and renal dysfunction and was admitted with a diagnosis of sepsis due to intraabdominal infection. However, he did not respond to antimicrobial therapy, and after 7 days he was transferred to the Chiba University Hospital ICU. Antimicrobial therapy was continued, and continuous hemodiafiltration was initiated on ICU day 3, but the patient's condition deteriorated and he became anuric. Plasma exchange (PE) was initiated on ICU day 11, but anuria and thrombocytopenia persisted. Intravenous eculizumab therapy was initiated on day 26 and resulted in quick recovery of urine output and platelet count and successful discontinuation of renal support. The diagnosis of thrombotic microangiopathy was established by the presence of schistocytes on the peripheral blood smear on ICU day 9. A plasma sample collected prior to initiation of PE showed a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs member 13 (ADAMTS13) activity level of >10% (25.1%). The absence of both Shiga-toxin producing E coli in feces and anti-Shiga-toxin antibody in blood led to suspicion of atypical hemolytic uremic syndrome (aHUS). Genetic test identified a nonsynonymous mutation (p.Ala311Val) in the membrane cofactor protein gene (MCP). Although the pathological significance is currently unknown, this mutation may have been the cause of adult-onset aHUS in our patient. In this case, eculizumab was successfully introduced and discontinued, and the patient remained relapse-free after 1 year of follow-up. The duration of eculizumab therapy for patients with aHUS should be determined on a case-by-case basis and possibly according to the causative genetic mutation, even though discontinuation of eculizumab therapy once initiated is not generally recommended.

The present study investigated the relationship between age [1] and biomarkers of coagulation and fibrinolysis [2] and their impact on outcome in severe sepsis patients.

Background Alarmins, including high-mobility group box 1 (HMGB-1), can be released from damaged tissues and activated cells as inflammatory mediators. We aimed to evaluate HMGB-1 and mitochondrial DNA dynamics and estimate the prognostic value for neurological outcome in patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrest. Methods We evaluated the dynamics of HMGB-1, mitochondrial DNA, and other variables in patients with return of spontaneous circulation after out-of-hospital cardiac arrest. Patients were divided into two groups according to the cerebral performance category at 30 days: the favourable outcome group (cerebral performance categories 1 and 2) and unfavourable group (≥3). Results Twenty-one patients were included, and 11 demonstrated favourable outcomes. HMGB-1 levels and mitochondrial DNA on day 1 were significantly higher than on days 2, 3, 5, and 7. Plasma levels of HMGB-1 on day 1 correlated with prognostic parameters (estimated interval to return of spontaneous circulation, lactate, and NH3), tissue damage, systemic inflammation, and disease severity. HMGB-1 on day 1 in the unfavourable group was significantly higher than in the favourable group (median [interquartile range] 15.5 [6.65–18.7], 39.4 [17–69.5], P = 0.009). These findings were not observed regarding mitochondrial DNA. Regarding HMGB-1 prediction accuracy for a good neurological outcome, the area under the receiver operating characteristic curve was 0.864 (95 % confidence interval 0.702, 1.000). Conclusions HMGB-1 may be involved in acute-phase post-cardiac arrest syndrome pathophysiology, and an increase in plasma levels may be associated with a poor neurological outcome. The study was registered with the University Hospital Medical Information Network Clinical Trials Registry ID: UMIN000006714. Electronic supplementary material The online version of this article (doi:10.1186/s40560-016-0161-4) contains supplementary material, which is available to authorized users.