Early prediction of outcome in score-identified, postcardiac surgical patients at high risk for sepsis, using soluble tumor necrosis factor receptor-p55 concentrations

OBJECTIVE: To investigate the prognostic value of increased serum concentrations of soluble tumor necrosis factor (TNF) receptors in patients at high risk for sepsis. DESIGN: Prospective study. SETTING: Cardiac surgical intensive care unit in a University Hospital. PATIENTS: Those 27 of 870 consecutive postcardiac surgical patients who met a previously validated high-risk criterion for imminent sepsis (Acute Physiology and Chronic Health Evaluation II [APACHE II] score of > or = 24 on the first postoperative day [day 1]). In this population, systemic inflammatory response syndrome was present in 96% of the patients and the in-hospital mortality rate was 30%. In addition, ten postcardiac surgical patients with an uncomplicated course (mortality rate 0%) were studied for comparison. INTERVENTIONS: Blood sampling for measurements of serum concentrations of TNF and soluble TNF receptors 55 kilodalton (TNF receptor-p55) and 75 kilodalton (TNF receptor-p75) on days 1, 2, 3, and 5. MEASUREMENTS AND MAIN RESULTS: Compared with the ten patients with an uncomplicated course (group A), the high-risk patients had significantly higher baseline (day 1) serum concentrations of soluble TNF receptor-p55 (9.2 vs. 4.2 ng/mL) and soluble TNF receptor-p75 (9.2 vs. 5.5 ng/mL). These high-risk patients could be further differentiated into two subgroups: one (B) with a prompt decrease in APACHE II score and a good prognosis (mortality rate 0%) and another (C) with a persisting high risk of sepsis and mortality rate (40%, p < .05). Although baseline APACHE II score was similar in both high-risk subgroups, soluble TNF receptor-p55 concentrations were significantly higher in subgroup C compared with subgroup B already at baseline (10.7 vs. 4.7 ng/mL). The receiver operating characteristic curve for subgroup classification by soluble TNF receptor-p55 was in a discriminating position with an area (0.773 +/- 0.096), confirming soluble TNF receptor-p55 as a predictor of mortality. TNF and soluble TNF receptor-p75 concentrations were less predictive at baseline. CONCLUSIONS: This study suggest that increased soluble TNF receptor-p55 concentrations in the serum of postcardiac surgical patients allow earlier prognostication of subsequent hospital course than APACHE II scores alone. This study further suggests that the combination of physiologic scores and cytokine receptor measurements could improve the predictive power of early postoperative risk stratification.     

Occurrence of phthalates and bisphenol A and F in the environment

Certain xenoestrogens, namely bisphenol A (BPA), bisphenol F (BPF), butylbenzyl phthalate (BBP), dibutyl phthalate (DBP), and di(2-ethylhexyl)phthalate (DEHP), were measured in various compartments (surface water, sediments, sewage treatment plant effluents, sewage sludge, dump water, liquid manure) in order to contribute to a better understanding of exposure to these compounds in different environments. Hundred and sixteen surface-water samples and 35 sediments from rivers, lakes and channels, 39 sewage effluents, and 38 sewage sludges were collected in Germany. Furthermore, ten liquid manure, two waste-dump and two compost-runoff water samples were also analysed. BPA measurements showed low concentrations from 0.0005 to 0.41 microg L(-1) in surface water, in sewage effluents from 0.018 to 0.702 microg L(-1), in sediments from 0.01 to 0.19 mgkg(-1) and in sewage sludge from 0.004 to 1.363mgkg(-1) dw. Measured concentrations of BPF were clearly lower than BPA in all environmental media. DEHP dominated the phthalate concentrations, which ranged from 0.33 to 97.8 microg L(-1) (surface water), 1.74 to 182 microg L(-1) (sewage effluents), 27.9 to 154 mgkg(-1) dw (sewage sludge) and 0.21 to 8.44 mgkg(-1) (sediment). DBP was found only in minor concentrations and BBP, only in a few samples in low amounts. Very high concentrations of BPA and phthalates were confirmed in waste dump water and compost water samples as well as in the liquid manure samples.     

Fabrication of relief-topographic surfaces with a one-step UV-lithographic process

This paper reports on a study of a methodology for fabrication of arbitrarily shaped silicon structures using technologies common to standard IC manufacturing processes. Particular emphasis is put on the design and use of halftone transmission masks for the lithography step required in the fabrication process of mechanical, optical or electronics components. The design and experimental investigation of gray-tone masks was supported by lithography simulation. Results are presented for both, simulated gray-tone patterns as well as experimental profiles.     

Zur Bedeutung der Störfall-Verordnung

The significance of the breakdown ordinance . The justification, requirements, and possible consequences of the breakdown ordinance are discussed against a background of current practice in the chemical industry. Comparisons are made with other countries and nuclear engineering. These considerations lead to the conclusion that the ordinance has not generated new standards in technology but, as a result of the enormous information and documentation demands, material, political, and economic disadvantages are to be feared for the chemical industry in West Germany.     

Identification of the resonant-grounded system parameters by evaluating fault measurement records

The operation of a resonant-grounded network during an earth-fault condition depends on the three basic parameters: damping, detuning, and unbalance factor. These parameters are influenced by the environmental conditions (e.g. humidity, temperature, and pollution), and the network topology. Accurate values of these parameters during an earth-fault condition are required to examine the operation of the compensation system. The fault records could be used for that purpose. The recorded neutral-to-ground voltage signals have been parameterized (using damping and detuning as parameters) according to the mathematical model of the transient process. Iteratively reweighted least squares algorithm has been used to fit the model. This algorithm is the major improvement over the classical least squares approach. It is able to filter out noise more efficiently. As a direct result, very accurate parameter identification has been achieved. This paper concludes with the practical examples.     

Analysis of the THR4 region on chromosome III of the yeast Saccharomyces cerevisiae

The gene encoding threonine synthase (THR4) from the yeast Saccharomyces cerevisiae was cloned by complementation of a thr4 mutant. This gene was also found on a lambda clone (5239) consisting of a fragment of chromosome III inserted in the vector lambdaMG3. The THR4 gene encodes a protein of 514 amino acids (M.W. 58 kDa), which has extensive homologies with E. coli threonine synthase (thrC) and B subtilis threonine synthase. The 5' flanking region of the gene contains three regulatory sequences [TGACT(C)] for the general amino acid control (GCN). About 130 bp downstream of the THR4 gene another large open reading frame (563 amino acids) is found in the opposite orientation. This may imply that this open reading frame, called CTR86, shares a terminator region with THR4. The function of the protein encoded by CTR86 is not yet clear, but the fact that the upstream region contains a GCN4 responsive site suggests that the gene product may also be involved in amino acid biosynthesis.     

Sex differences in endocrine and psychological responses to psychosocial stress in healthy elderly subjects and the impact of a 2-week dehydroepiandrosterone treatment

Evidence from animal as well as human studies has suggested that significant sex differences exist in hypothalamus-pituitary-adrenal axis (HPA) activity. As gonadal steroids could be important modulators of HPA sex differences, stress responses were investigated in subjects of advanced age after dehydroepiandrosterone (DHEA) or placebo treatment. After a 2-week treatment with 50 mg DHEA daily or placebo, 75 men and women (mean age, 67.6 yr) were exposed to the Trier Social Stress Test (TSST). The TSST is a brief psychosocial stress that consists of a free speech and mental arithmetic task in front of an audience. The results show that the TSST induced significant increases in ACTH, salivary free cortisol, total plasma cortisol, norepinephrine, and heart rates (all P < 0.0001) as well as decreased positive affect in the elderly (P = 0.0009). Men showed larger stress responses in ACTH (P = 0.004), salivary free cortisol (P = 0.044), and plasma total cortisol (P = 0.076) compared to women. No sex differences were observed in norepinephrine, epinephrine, or heart rate responses. In contrast to ACTH and cortisol response differences, women reported that they were significantly more stressed by the TSST than men (P = 0.0051). Women treated with DHEA showed ACTH stress responses similar to those of men, but significantly enhanced compared to those of women taking placebos (P < 0.009). No other stress response differences emerged between DHEA and placebo groups. Finally, DHEA treatment did not result in an improvement of subjective well-being. We conclude that elderly men show larger HPA responses than women to psychosocial stress, as studied in the TSST. Estrogen effects on hypothalamic CRF-producing neurons might be responsible for these sex differences.     

Polycyclic musk fragrances in different environmental compartments in Berlin (Germany)

The aim of this study was to obtain data about the contamination of different environmental compartments (102 surface water samples, 59 sediment samples and 165 eel samples) by polycyclic musks (HHCB, AHTN, ADBI, AHMI, and ATII) within the framework of an exposure monitoring program. Results for HHCB (Galaxolide) gave the following mean values in areas strongly polluted with sewage: surface water 1.59 micrograms l-1; sediment 0.92 mg kg-1 d.w. and eel 1513 micrograms kg-1 f.w. (in the edible portion) (6471 micrograms kg-1 lipid). The following average concentrations were found in waters hardly contaminated with sewage: surface water 0.07 microgram l-1, sediment < 0.02 mg kg-1 and eel 52 micrograms kg-1 f.w. (445 micrograms kg-1 lipid). Mean concentrations of 6.85 micrograms l-1 (maximum: 13.3 micrograms/l) could be measured at sewage treatment plants' outlets. It could be shown that these polycyclics are highly suited to use as indicators of the degree of contamination of waters with organic substances originating from sewage. A mean bioconcentration factor (BCF) on wet weight of 862 (HHCB) and 1069 (AHTN) for the transfer from water to eel under natural conditions could be calculated. The corresponding BCF-values based on the lipid content of eel were 3504 (HHCB) and 5017 (AHTN).