CLINICAL CHARACTERISTICS AND PREDICTORS OF MORTALITY DIFFER BETWEEN PULMONARY AND ABDOMINAL SEPSIS.

ABSTRACT: Background: Pulmonary sepsis and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. Methods: In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin was measured, and the scores of Acute Physiology and Chronic Health Evaluation (APACHE) II, Mortality in Emergency Department Sepsis (MEDS), and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. Data on 28-day mortality were collected for all patients. Results: Compared with patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury, and hospitalization costs. Lactate level and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included Pa o2 /F io2 ratio (hazard ratio [HR], 0.998; P < 0.001) and acute kidney injury (HR, 1.312; P = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; P = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate, and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II score, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; P < 0.001) but not among patients with shock (63.7 vs. 48.4%; P = 0.118). Conclusions: Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.

Rh(II)-catalyzed [3+2] cycloaddition of 2 H-azirines with N-sulfonyl-1,2,3-triazoles.

Rh(II)-catalyzed intermolecular [3+2] cycloaddition of 2 H-azirines with N-sulfonyl-1,2,3-triazoles is disclosed, in which a series of fully functionalized pyrroles is produced via rhodium azavinyl carbene intermediates. A distinct feature of this reaction is that the azavinyl carbene serves as a [2 C] equivalent, instead of as [1 C] or aza-[3 C] synthons, which have been reported previously in cyclopropanations and [3+n] cycloadditions. Moreover, this methodology has also been successfully applied in the total synthesis of URB447 as well as the formal synthesis of Atorvastatin (Lipitor).

Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department.

INTRODUCTION: CD14 is one of the leukocyte differentiation antigens, and is present in macrophages, monocytes, granulocytes and their cell membranes. Presepsin, namely soluble CD14-subtype (sCD14-ST) is produced by circulating plasma proteases activating cleavage of soluble CD14 (sCD14). The aim of this study is to investigate the role of Presepsin and the CURB65 scoring system in the evaluation of severity and outcome of CAP in an ED. METHOD: A prospective, observational study was performed in an ED of an university teaching hospital from November 2011 to October 2012. A total of 359 patients with CAP and 214 patients with severe CAP (SCAP) were consecutively enrolled. Plasma Presepsin, lactate, serum PCT levels and leukocyte counts were measured and CURB65 score were calculated at admission enrollment. RESULT: Plasma Presepsin levels were significantly higher in SCAP patients than in CAP patients (P < 0.0001), increasing correspondingly with the enhancement of CURB65 score. Patients with ARDS or DIC had obviously higher plasma Presepsin levels than those without ARDS or DIC (all P < 0.0001), and plasma Presepsin levels were significantly higher in non-survivors than in survivors at 28-day follow-up. In logistic regression analysis, CURB65 score was the independent predictor of ARDS, and Presepsin was the independent predictor of DIC, and Presepsin and CURB65 score were both the independent predictors of 28-day mortality. The AUCs showed Presepsin in combination with CURB65 score in predicting ARDS, SCAP and 28-day mortality was superior to Presepsin or CURB65 score alone ( all P < 0.01), Presepsin was better than CURB65 score and leukocyte in predicting DIC ( P < 0.01). CONCLUSION: Presepsin is a valuable biomarker in predicting severity and outcome in CAP patients in the ED and Presepsin in combination with CURB65 score significantly enhanced the predictive accuracy.

(DHQ)2AQN-catalyzed asymmetric substitution of isatin-derived hydrazones with O-Boc-protected Morita-Baylis-Hillman adducts: A strategy for synthesizing enantioenriched azo compounds incorporating an oxindole scaffold.

The first example for the preparation of enantioenriched azo compounds from hydrazones and Morita-Baylis-Hillman adducts has been developed, affording azo compounds incorporating an oxindole scaffold in up to 91% yield along with a 93% ee value under the catalysis of (DHQ)2AQN.

Soluble thrombomodulin to evaluate the severity and outcome of community-acquired pneumonia.

This study aims to investigate the role of soluble thrombomodulin (sTM) in the evaluation of the severity and outcome of community-acquired pneumonia (CAP) in the emergency department (ED) and compare sTM with two biomarkers-procalcitonin (PCT) and C-reactive protein (CRP)-and two scoring systems-the Pneumonia Severity Index (PSI) and CURB65 score. Patients with CAP were consecutively enrolled in the ED of an urban university hospital. sTM, PCT, and CRP levels were measured on enrollment. In addition, the PSI and CURB65 scores were calculated. For all patients, a 30-day follow-up was performed. A total of 573 patients with CAP were enrolled in this study. sTM, PCT, and CRP levels increased with the aggravation of the disease severity as assessed by the PSI and CURB65 score (all P <0.01). The multivariate logistic regression analysis showed that sTM and the PSI were independent predictors of 30-day mortality, and the receiver operating characteristic curve analysis showed that the accuracy of sTM in the prediction of 30-day mortality was comparable with the PSI (P >0.05) and better than PCT, CRP, and the CURB65 score (P all <0.05). Furthermore, a combination of sTM and scoring systems can enhance the predictive accuracy of 30-day mortality. sTM is useful in the evaluation of the severity and outcome of CAP in the ED. A well-designed, multi-center study will be needed to further investigate the value of sTM in CAP.

A highly sensitive ratiometric fluorescent probe with a large emission shift for imaging endogenous cysteine in living cells.

A new design strategy for the construction of ratiometric fluorescent probe with a large emission shift was developed. Based on this strategy, a highly selective and sensitive colorimetric and ratiometic fluorescent probe for cysteine (Cys) with a 117 nm red-shifted emission was synthesized and applied to the ratiometric imaging of endogenous Cys in living cells.

Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department.

INTRODUCTION: Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis. METHODS: This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days' follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group. CONCLUSION: Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.

The role of soluble thrombomodulin in the risk stratification and prognosis evaluation of septic patients in the emergency department.

INTRODUCTION: Soluble thrombomodulin (sTM) is a sensitive marker of endothelial damage. In this study we investigated the role of sTM in the evaluation of the severity and prognosis of septic patients in the emergency department (ED). MATERIALS AND METHODS: A prospective, observational cohort study was performed in the ED of an urban, university hospital. Patients who had suspected infection with two or more criteria of systemic inflammatory response syndrome were consecutively enrolled. sTM, D-Dimer and procalcitonin levels were measured on enrollment, and the Mortality in Emergency Department Sepsis (MEDS) score was calculated. A 30-day follow-up was performed for all patients. RESULTS: A total of 372 patients with sepsis, 210 patients with severe sepsis and 98 patients with septic shock were enrolled in this study. According to the disease severity, patients were divided into sepsis subgroup and severe sepsis subgroup (including septic shock). In addition, patients were divided into survivors subgroup and non-survivors subgroup according to the 30-day mortality. Plasma sTM levels in patients with severe sepsis were higher than those with sepsis (P<0.001). Compared with survivors, non-survivors has higher plasma sTM levels (P<0.001). Multivariate logistic regression analysis showed that sTM was an independent predictor of severe sepsis (odds ratio 1.11) and 30-day mortality (odds ratio 1.059). Receiver operating characteristic curve analysis showed that sTM was a useful parameter in prediction of severe sepsis (0.859) and 30-day mortality (0.78). Compared with the MEDS score alone, combination of sTM and the MEDS score can improve the accuracy in prediction of severe sepsis and 30-day mortality. CONCLUSIONS: sTM is a valuable biomarker in the risk stratification and prognosis evaluation of ED sepsis. Furthermore, sTM can enhance the ability of the MEDS score in prediction of severe sepsis and 30-day mortality.

A highly selective colorimetric chemodosimeter for fast and quantitative detection of hydrogen sulfide.

Based on the fact that hydrogen sulfide (H(2)S) possesses the smallest steric hindrance among thiols and the SH(-) group adds faster to an electron-poor C=C double bond, we designed and synthesized a tricyanoethylene-derived colorimetric chemodosimeter 1 for the fast and highly selective assay of H(2)S. Chemodosimeter 1 exhibited excellent water-solubility due to the introduction of two hydrophilic hydroxyl groups. Upon the addition of Na(2)S, chemodosimeter 1 showed a fast (complete within 400 s) and robust decrease of the absorption intensity (>97%), accompanied by a color change from red to colorless. Additionally, a linear relationship between absorption intensity and the added Na(2)S concentrations (0-130 µM) was observed in aqueous buffer solution (pH 7.4, 20 mM PBS). Importantly, the proposed paradigm in this paper, adoption of the tricyanoethylene derivative as a recognition receptor to distinguish H(2)S from other thiols and analytes, provides a promising methodology for the design of colorimetric and fluorescent chemodosimeters for fast determination of H(2)S.

A 4-hydroxynaphthalimide-derived ratiometric fluorescent chemodosimeter for imaging palladium in living cells.

A highly selective ratiometric fluorescent chemodosimeter derived from 4-hydroxynaphthalimide was designed and synthesized to image palladium species in living cells by virtue of a palladium-catalyzed depropargylation reaction, and it could monitor three typical palladium species (0, + 2 and + 4) without additional reagents.