Sepsis Management with a Blood Purification Membrane: European Experience.

BACKGROUND: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. METHOD: A modified Delphi-based method was used to collate -European experts' views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. RESULTS: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. CONCLUSION: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required.

Expression and significance of Ki-67 in lung cancer.

Ki-67 parameter is a proliferation marker in malignant tumors. The increased proliferation activity and the decreased prognosis in lung cancer determined us to investigate different parameters connected to the tumor's aggression, such as cellularity, Ki-67 positivity rate, and proliferating cell nuclear antigen (PCNA). We evaluated the proliferative activity in 62 primary lung tumors by determining the cell's percentage of Ki-67 and immunoreactive PCNA (using MIB-1 and PCNA monoclonal antibodies), classifying Ki-67 and PCNA immunoreactivity into three score groups. The results obtained emphasized a linkage between Ki-67 score with the histological tumor subtype, tumor cellularity and degree of differentiation and with other proliferation immunohistochemistry (IHC) markers, such as p53 cellular tumor antigen. The tumor's cellularity, the Ki-67 positivity rate and PCNA, together with the clinical stage and the histological differentiation bring extra pieces of useful information in order to anticipate the evolution and the prognosis of lung cancer.

Expression of E-cadherin in lung carcinoma, other than those with small cells (NSCLC).

It was suggested that the decrease and/or loss of E-cadherin expression in non-small cell lung cancer (NSCLC) is responsible for the development of the malignant phenotype. Moreover, clinical studies showed that the reduced expression of E-cadherin is associated with tumoral differentiation, with the presence of lymph node metastasis and with unfavorable diagnosis of patients with NSCLC. In order to evaluate if E-cadherin expression is involved in the NSCLC pathogenesis and significantly associated with clinicopathological parameters, we investigated the immunohistochemical (IHC) expression of E-cadherin in 47 lung carcinomas with tumoral resection pieces in the control peritumoral lung tissue, looking for possible correlations between the expression of this molecule and the clinicomorphological features and the evolutive prognosis of the patients. E-cadherin expression was preserved in 10 (21.28%) of the 47 NSCLCs immunostained with anti-E-cadherin antibody and reduced÷absent in 37 of the 47 (78.72%) NSCLCs studied. E-cadherin plays a major role in the intercellular adhesion. The reduced expression of E-cadherin indicates an unfavorable prognosis and can be a useful prognosis factor in NSCLC - for patients with reduced expression of the E-cadherin÷α-catenin complex, needing chemotherapy or radiotherapy.