Blood culture-negative prosthetic valve endocarditis and daptomycin-associated eosinophilic pneumonia: A case report.

Acute eosinophilic pneumonia is a rare but severe side effect of daptomycin, which has been recommended as empirical antimicrobial drug therapy for blood culture-negative prosthetic valve endocarditis. Here, we present a case of an 82-year-old man who developed fever, cough, and shortness of breath after 23-day treatment with daptomycin for prosthetic valve endocarditis. Bilateral ground-glass opacities were observed on computed tomography with peripheral eosinophilia of 640/µL (7%). Cessation of daptomycin and commencement of corticosteroid therapy improved his symptoms. This case highlights the importance of prompt diagnosis of acute eosinophilic pneumonia in endocarditis patients treated with daptomycin. .

Clinical impact of newly developed atrial fibrillation complicated with longstanding ventricular fibrillation during left ventricular assist device support: A case report.

BACKGROUND: Continuous-flow left ventricular assist devices (LVADs) improve survival and morbidity in patients with stage D heart failure. Management of LVADs for longer durations is necessary in some clinical settings, and a better understanding of the hemodynamics of patients using LVADs is warranted. Arrhythmia, including atrial (AA) and ventricular (VAs) arrhythmias, is a modifying factor of hemodynamics that is highly prevalent among patients with LVADs. However, the clinical impact of arrhythmias in various clinical settings in patients with LVAD, in which the hemodynamic load is likely to present as worsening of right heart failure, remains to be completely elucidated. CASE PRESENTATION: We describe the case of a patient under sustained ventricular fibrillation for extraordinarily long duration who was stabilized using LVAD support and in whom newly developed atrial fibrillation led to a significant worsening of right heart failure while using an LVAD. CONCLUSION: This case demonstrates the substantial clinical impact of AAs in the management of right heart failure using an LVAD.

An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study.

AIM: Presepsin values could assist early diagnosis and prognosis of sepsis. In sepsis, prognosis is determined according to multiple organ dysfunction, where coagulopathy is common and associated with prognosis. This study aimed to determine the correlation between presepsin value trend and prognosis, and investigate coagulation abnormality in sepsis. METHODS: We retrospectively examined 18 intensive care unit patients diagnosed with sepsis whose presepsin values at admission were ≥500 ng/mL. If presepsin values had decreased ≥50% on hospital day 6, compared to admission values, the patient was allocated into a decreased presepsin group. RESULTS: Presepsin values in non-survivors with sepsis were significantly higher than in survivors on day 6 (P = 0.022). No significant differences in procalcitonin or C-reactive protein were identified between survivors and non-survivors, and platelet counts were significantly lower in non-survivors on days 0, 3, and 6 (P = 0.001, P < 0.001, and P = 0.001, respectively). The 90-day mortality rate in a decreased presepsin group significantly improved, even when presepsin values were high on admission (P = 0.012). Platelet counts were significantly lower on all hospital days in the non-decreased presepsin group. CONCLUSION: Fifty percent decrease in presepsin levels could be a useful prognostic predictor of sepsis. Larger studies are required to confirm our findings.

Phosphatidylinositol 4-phosphate on Rab7-positive autophagosomes revealed by the freeze-fracture replica labeling.

Phosphatidylinositol 4-phophate (PtdIns(4)P) is an essential signaling molecule in the Golgi body, endosomal system, and plasma membrane and functions in the regulation of membrane trafficking, cytoskeletal organization, lipid metabolism and signal transduction pathways, all mediated by direct interaction with PtdIns(4)P-binding proteins. PtdIns(4)P was recently reported to have functional roles in autophagosome biogenesis. LC3 and GABARAP subfamilies and a small GTP-binding protein, Rab7, are localized on autophagosomal membranes and participate at each stage of autophagosome formation and maturation. To better understand autophagosome biogenesis, it is essential to determine the localization of PtdIns(4)P and to examine its relationship with LC3 and GABARAP subfamilies and Rab7. To analyze PtdIns(4)P distribution, we used an electron microscopy technique that labels PtdIns(4)P on the freeze-fracture replica of intracellular biological membranes, which minimizes the possibility of artificial perturbation because molecules in the membrane are physically immobilized in situ. Using this technique, we found that PtdIns(4)P is localized on the cytoplasmic, but not the luminal (exoplasmic), leaflet of the inner and outer membranes of autophagosomes. Double labeling revealed that PtdIns(4)P mostly colocalizes with Rab7, but not with LC3B, GABARAP, GABARAPL1 and GABARAPL2. Rab7 plays essential roles in autophagosome maturation and in autophagosome-lysosome fusion events. We suggest that PtdIns(4)P is localized to the cytoplasmic leaflet of the autophagosome at later stages, which may illuminate the importance of PtdIns(4)P at the later stages of autophagosome formation.

Variation of Risk Factors for Cause-Specific Reintubation: A Preliminary Study.

Unexpected reintubation may occur, even if the risk factors are considered and a spontaneous breathing trial is successful. Reintubation is thought to be caused by various factors. Several studies have investigated the risk factors of reintubation, but most did not classify reintubation by cause. We retrospectively classified patients undergoing reintubation at intensive care unit by cause (respiratory insufficiency vs. nonrespiratory insufficiency) to examine the cause-specific risk factors of reintubation. A total of 262 patients were included; reintubation within 48 hours after extubation was performed in 12 patients (reintubation rate, 4.5%). After classification by cause of reintubation, the pressure of arterial oxygen to fractional inspired oxygen concentration (P/F) ratio exhibited a significant association with reintubation only in the respiratory insufficiency group (odds ratio (OR) 0.989, 95% confidence interval (CI) 0.980 to 0.999, p=0.036, and OR 0.989, 95% CI 0.979 to 0.999, p=0.026, in the univariate and multivariate analyses, respectively). In the propensity score analysis, a P/F ratio ≤ 200 may be a risk factor for reintubation in the respiratory insufficiency group (OR 7.811, 95% CI 1.345 to 45.367, p=0.022). In the nonrespiratory insufficiency group, intubation duration was significantly related to reintubation (OR 1.165, 95% CI 1.012 to 1.342, p=0.033, and OR 1.163, 95% CI 1.004 to 1.348, p=0.044, in the univariate and multivariate analyses, respectively). In conclusion, a low P/F ratio at extubation may be a risk factor for reintubation due to respiratory insufficiency. In the nonrespiratory insufficiency group, intubation duration may be significantly related to reintubation. The risk factors for reintubation may differ by the cause of reintubation. Further large-scale randomized controlled trials are required.

Enantioselective Michael Reaction of Cyclic ß-Ketoesters with Morita-Baylis-Hillman Derivatives Using a Phase-Transfer Catalyst.

This study aims to develop a highly enantioselective Michael reaction of cyclic ß-ketoesters with Morita-Baylis-Hillman (MBH) derivatives using a phase-transfer catalyst. Cyclic ß-ketoesters reacted with MBH derivatives to stereoselectively generate a quaternary carbon center in the presence of cinchona alkaloid-derived bulky ammonium catalyst, and aqueous KOH and Michael adducts bearing an acrylate moiety were obtained in good chemical yields with good enantioselectivity.

Dexmedetomidine attenuates the positive chronotropic effects of intravenous atropine in patients with bradycardia during spinal anaesthesia: a retrospective study.

INTRODUCTION: Dexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives. METHODS: We examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively. RESULTS: A total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p <  0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026). CONCLUSIONS: The positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.