Red cell distribution width is a prognostic factor in severe sepsis and septic shock.

OBJECTIVE: This study was performed to investigate the association of red cell distribution width (RDW) with 28-day mortality in patients with severe sepsis and septic shock. METHODS: We performed a retrospective analysis of patients with severe sepsis and septic shock. Patients' demographic data, comorbidities, the blood test results including RDW at admission to the emergency department, and Acute Physiologic and Chronic Health Evaluation II score were compared between 28-day survivors and nonsurvivors. Red cell distribution width was categorized into tertiles as 14% or less, 14.1% to 15.7%, and 15.8% or greater. Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 566 patients were included, and overall mortality was 29%. Red cell distribution width was significantly higher in nonsurvivors than in survivors, and the corresponding mortality of patients with an RDW of 14% or less, 14.1% to 15.7%, and 15.8% or greater was 13.1%, 30.1%, and 44.9%, respectively (P < .001). In Cox proportional hazards analysis, groups with higher RDW are independently associated with 28-day mortality compared with groups with an RDW of 14.0% or less: RDW 14.1% to 15.7% (hazard ratio, 1.66; 95% confidence interval [CI], 1.00-2.76) and RDW of 15.8% or greater (hazard ratio, 2.57; 95% CI, 1.53-4.34). The area under the receiver operating curve of RDW was 0.68 (95% CI, 0.63-0.72). CONCLUSION: Red cell distribution width is associated with 28-day mortality in patients with severe sepsis and septic shock.

Heart-type fatty acid-binding protein as a prognostic factor in patients with severe sepsis and septic shock.

OBJECTIVE: This study was performed to evaluate whether heart-type fatty acid-binding protein (H-FABP) could predict 28-day mortality in patients with severe sepsis and septic shock. METHODS: We performed a prospective observational study and included consecutive patients with severe sepsis and septic shock. Patients' demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the blood test results including H-FABP concentrations were compared between the 28-day survivors and nonsurvivors. The association between the concentration of H-FABP and survival was analyzed with multivariate logistic regression and Cox proportional hazards regression analyses. The prognostic performance of H-FABP was compared with those of the APACHE II score and albumin using the area under the receiver operating characteristic curve. RESULTS: Of the 99 patients, 38 (38%) died. The mortality rate increased with increasing H-FABP concentration. In multivariate logistic regression analyses, H-FABP greater than 40 ng/mL was an independent predictor of mortality compared with H-FABP less than 7 ng/mL (odds ratios, 9.23; 95% confidence interval, 1.29-65.86). By Cox proportional hazards analysis, H-FABP greater than 40 ng/mL was associated with a 5.57-fold increased risk for death during the 28-day follow-up period (hazard ratio, 5.57; 95% confidence interval, 1.20-25.80). The area under the receiver operating characteristic curve of H-FABP was 0.739 (95% confidence interval, 0.640-0.839), which was comparable with those of the APACHE II score and albumin. CONCLUSION: The H-FABP was an independent prognostic factor and could be a useful biomarker for 28-day mortality in patients with severe sepsis and septic shock.

Modulations of AtGSTF10 expression induce stress tolerance and BAK1-mediated cell death.

Glutathione-S-transferases are essential proteins involved in cellular detoxification. The expression of GSTs has been studied extensively under various environmental stressors including xenobiotics. Here, we have isolated AtGST10, one of the phi classes of AtGSTs on the basis of its interaction with BAK1 in a yeast two-hybrid screen. BAK1 is an LRR-RLK, acting in both brassinosteroid signaling and plant defense responses. We found that AtGSTF10 binds to BAK1 through its N-terminal domain. AtGSTF10 is expressed ubiquitously in plant tissues, and the endogenous transcript level of AtGSTF10 was not induced by plant growth regulators or abiotic stressors, except drought, unlike other GSTs. Overexpression of AtGSTF10 conferred higher tolerance to salt and disturbed redox status of transgenic plants. The down-regulation of AtGSTF10 produced by RNA interference caused reduced tolerance to abiotic stress and an accelerated senescence of transformants, indicating that AtGSTF10 is involved in stress tolerance and the BAK1-mediated spontaneous cell death signaling pathway in Arabidopsis.

Dementia mimicking a sudden cognitive and behavioral change induced by left globus pallidus infarction: review of two cases.

Recently there has been increasing interest in the non-motor functions of the globus pallidus, and especially its role in cognitive processing. We experienced two patients with acute cognitive and behavior changes after globus pallidus infarctions. Examination of both revealed inattention, decreased verbal fluency, emotional blunting, and amnesia. There were no other sensory or motor symptoms. Brain magnetic resonance imaging (MRI) showed focal acute cerebral infarction in the left globus pallidus. Neuropsychological assessment revealed decreased frontal executive function, with verbal memory disturbance. These cases suggest that strategic infarction dementia can result from a single globus pallidus lesion.

Highly functionalized and stereocontrolled syntheses of 2-(2-methylenecycloalkyl)-furan derivatives by Pd-catalyzed cycloreduction.

[structure: see text]. We have discovered a new method employing Pd-catalyzed cycloreduction of conjugated enynals 1 bearing an alkyne unit leading to the corresponding 2-(2-methylenecycloalkyl)-furans 2a-j and a related compound 7 in good to excellent yields.

Transcriptome analysis of reproductive-stage Arabidopsis plants exposed gamma-ray irradiation at various doses.

PURPOSE: Gamma rays (GR) induce significant changes in the structure and expression of genes involved in the regulation of diverse biochemical and physiological processes. Arabidopsis plants exhibit different growth and development patterns in response to exposure to GR. The effects on gene expression of different radiation doses of GR (100 and 800 Gy) administered to Arabidopsis plants were examined at the reproductive stage. MATERIALS AND METHODS: We irradiated 26-day-old plants with three replications [developmental stages 5.1-6.0, according to Boyes et al. ( 2001 )] using a GR irradiator (60 Co, ca. 150 TBq capacity, Atomic Energy of Canada Limited, Ontario, Canada) at the Korea Atomic Energy Research Institute. Plants were treated with 100, 200, 300, 400, 800, 1200, 1600, or 2000 Gy, and the doses were made from varying the distance to the source. RESULTS: We conducted a high-throughput screening analysis and detected 883 GR-responsive genes that showed significant changes; these were involved in several putative metabolic pathways related to biotic stress. Additionally, five overrepresented cis-regulatory elements were identified in the 1-kb upstream regions of GR-responsive genes by using motif enrichment analysis. We also detected three GR-responsive genes associated with stamen development and confirmed their co-regulation with functionally interacting genes. CONCLUSIONS: This finding suggests that a network-based analysis is a viable approach to identify significant GR-responsive genes associated with the reproductive stage of Arabidopsis. Our results provide further insights into the complex biological systems involved in the response to different doses of GR in plants.

Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents.

OBJECTIVE: To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents. METHODS: A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis. RESULTS: A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81). CONCLUSIONS: Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.

WITHDRAWN: A novel calmodulin-interacting protein (CUGT1) is rapidly induced by stress signals in Arabidopsis.

The manuscript has been withdrawn on request of the authors and will not be published in that version in the print edition of Planta.

Butylscopolammonium bromide does not provide additional analgesia when combined with morphine and ketorolac for acute renal colic.

OBJECTIVE: To evaluate the effect of adding butylscopolammonium bromide (BB) to morphine and ketorolac in the treatment of acute renal colic in the ED. METHODS: A prospective, double-blind, randomized controlled trial of i.v. triple therapy (morphine, ketorolac and BB) versus double therapy (morphine and ketorolac) in adult ED patients with a clinical diagnosis of acute renal colic and a pain rating greater than five on a 10 cm visual analogue scale (VAS). VAS was recorded at time 0, 20 and 40 min. Patients received rescue morphine at 20 or 40 min according to the protocol if needed. We compared pain reduction and the need for rescue analgesia at 4 min between two groups. RESULTS: Eighty-nine patients were randomized over a 13 month period. A total of 46 (51.7%) patients received BB in addition to morphine and ketorolac. The mean difference in change in pain score in the triple therapy group and double therapy group was 7.1 cm (95% CI 6.4-7.8) and 5.9 cm (95% CI 5.1-6.7), respectively (P= 0.024). Rescue morphine was required by 7/46 (15.2% [95% CI 4.4-20.6]) patients in the triple therapy group and 14/43 (32.6% [95% CI 18.0-47.1]) in the double therapy group (OR 0.37 [95% CI 0.133-1.038]). CONCLUSIONS: Although the addition of BB to morphine and ketorolac appeared to show a statistically significant reduction in pain compared with morphine and ketorolac alone, a reduction of 1.2 cm on VAS is unlikely to be clinically significant.