Open AccessAvailable online http://ccforum.com/content/12/6/R147Page 1 of 9(page number not for citation purposes)Vol 12 No 6ResearchExcess circulating angiopoietin-2 is a strong predictor of mortality in critically ill medical patientsPhilipp Kümpers1, Alexander Lukasz1, Sascha David1, Rüdiger Horn2, Carsten Hafer1, Robert Faulhaber-Walter1, Danilo Fliser3, Hermann Haller1 and Jan T Kielstein11Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, D-30171, Germany2Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, D-30171, Germany3Renal and Hypertensive Diseases, Saarland University Medical Centre, Kirrberger Straße, D-66421, Homburg/Saar, GermanyCorresponding author: Philipp Kümpers, kuempers.philipp@mh-hannover.deReceived: 22 Aug 2008 Revisions requested: 19 Sep 2008 Revisions received: 27 Oct 2008 Accepted: 21 Nov 2008 Published: 21 Nov 2008Critical Care 2008, 12:R147 (doi:10.1186/cc7130)This article is online at: http://ccforum.com/content/12/6/R147© 2008 Kümpers et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction The endothelial specific angiopoietin (Ang)-Tie2ligand-receptor system has been identified as a non-redundantmediator of endothelial activation in experimental sepsis.Binding of circulating Ang-1 to the Tie2 receptor protects thevasculature from inflammation and leakage, whereas binding ofAng-2 antagonises Tie2 signalling and disrupts endothelialbarrier function. Here, we examine whether circulating Ang-1and/or Ang-2 independently predict mortality in a cohort ofcritically ill medical patients.Methods Circulating vascular endothelial growth factor (VEGF),Ang-1 and Ang-2 were prospectively measured in sera from 29healthy controls and 43 medical ICU patients byimmunoradiometric assay (IRMA) and ELISA, respectively.Survival after 30 days was the primary outcome studied.Results Median serum Ang-2 concentrations were increasinglyhigher across the following groups: healthy controls, patientswithout sepsis, patients with sepsis and patients with septicshock. In contrast, Ang-1 and VEGF concentrations weresignificantly lower in all patient groups compared with healthycontrols. Ang-2 correlated with partial pressure of oxygen inarterial blood (PaO2)/fraction of inspired oxygen (FiO2), tissuehypoxia, Sequential Organ Failure Assessment (SOFA) andPhysiology and Chronic Health Evaluation II (APACHE II) score.Multivariate Cox regression analyses confirmed a strongindependent prognostic impact of high Ang-2 as a novel markerof 30-day survival.Conclusions A marked imbalance of the Ang-Tie system infavour of Ang-2 is present in critically ill medical patients. Ourfindings highlight the independent prognostic impact ofcirculating Ang-2 in critical illness. Ang-2 may be used as areadily available powerful predictor of outcome and may opennew perspectives to individualise treatment in the ICU.IntroductionIn critically ill patients, impaired vascular barrier function is alife-threatening feature that is causally determined by the acti-vational state of the endothelial layer. In response to numerousdifferent stimuli, 'quiescent' endothelial cells (anti-coagulant,anti-adhesive) undergo dramatic phenotypic Plastic Bags for Prevention of Hypothermia in Preterm & Low Birth Weight Infants Alicia E Leadford, Jamie B Warren, Albert Manasyan, Elwyn Chomba, Ariel A Salas, Robert Schelonka, Waldemar A Carlo PEDIATRICS Volume 132, - 7, July 2013 1.Introduction: • Annually, ~ million infants die during the neonatal period worldwide, >80% of these neonatal deaths attributed to infection, birth asphyxia, complications of premature delivery (hypothermia, congenital anomalies) • Hypothermia contributes to neonatal mortality & morbidity, especially in preterm & LBW infants in developing countries • Neonatal hypothermia →increased risk of infection, coagulation defects, acidosis, delayed fetal-to-newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage, increased oxygen consumption, mortality • An immature skin barrier, insensible water loss, evaporative heat loss …→ hypothermia during the first 30 minutes after birth • The WHO recommendations: a warm delivery room (25°C), immediate drying & resuscitation under radiant warmers, skin-to-skin contact with the mother, or an incubator • In a Cochrane review (McCall et al), the Neonatal Resuscitation Program, the International Liaison Committee on Resuscitation consensus statement: recommend the use of a plastic bag to prevent hypothermia in preterm infants • • The objective: to determine if placing preterm and LBW infants inside a plastic bag at birth maintains normothermia without causing hyperthermia at hour after birth 2.METHODS: • Infants at 26 - 36 weeks days’ gestational age and/or with a birth weight of 1000 - 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation & parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag (25.4 X 20 x 61 cm & 0.03 mm thick) at birth • The primary outcome measure was axillary temperature in the WHO–defined normal range (36.5–37.5°C) at hour after birth • Secondary outcomes on patients admitted to the NICU: hypotension, hypoglycemia, seizures / first 24 hours after birth, respiratory distress syndrome, bronchopulmonary dysplasia, pneumothorax, sepsis, major brain injury (defined as intraventricular hemorrhage grade or or periventricular leukomalacia), necrotizing enterocolitis, bowel perforation, pulmonary hemorrhage, death before discharge 3.RESULTS: A total of 104 infants were randomized (August – October 2011, the range of ambient temperature in Lusaka, Zambia: 17 - 35°C) 10 • At hour after birth, infants randomized to plastic bag (n= 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n= 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16–2.81; P= 007) • The temperature at hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P, 001) • The duration of use of the plastic bag in hypothermic infants ranged from 80 to 120 minutes Hyperthermia (>38.0°C) or skin side effects did not occur in any infant 11 12 • 23 of the 104 infants (14 in the intervention group and in the control group, P= 13) were admitted to the NICU unrelated to the trial interventions Among infants admitted to the NICU, no significant differences were found in mean temperature after 24 hours of admission, length of hospital stay, or death • Hypotension, hypoglycemia, seizures in the first 24 hours after birth, bronchopulmonary dysplasia, pneumothorax, major brain injury, bowel perforation, or pulmonary hemorrhage were not documented in any of the study infants during their NICU admission 13 4.CONCLUSIONS: • Placement of preterm/ LBW infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings where there is limited availability of radiant warmers and incubators 14 1 MINISTRY OF EDUCATION AND TRAINING UNIVERSITY OF DANANG TRƯƠNG LÊ BÍCH TRANG A STUDY OF LINGUISTIC FEATURES OF INSTRUCTIONS FOR USE OF FOODSTUFFS IN ENGLISH AND VIETNAMESE Subject area: THE ENGLISH LANGUAGE Code : 60.22.15 MASTER THESIS IN THE ENGLISH LANGUAGE (SUMMARY) Danang, 2012 2 The thesis has been completed at the College of Foreign Languages, Danang University. Supervisor: Nguyễn Văn Long, Ph.D. Examiner 1: Assoc. Prof Dr. Ngô Đình Phương Examiner 2: Trần Quang Hải, Ph.D The thesis was orally defended at Examining Committee. Time: October 28 th , 2012 Venue: Danang University This thesis is available found at the libraries of : - Information Resources, University of Da Nang. - College of Foreing Langueges, University of Da Nang 3 CHAPTER 1 INTRODUCTION 1.1. RATIONALE Language instruction for use not only fulfills its informative function by manufacturers but also has its influence on the safety and the health of ultimate consumers. Especially, together with the development of the society and the world, people’s living standards are increasing. According to Maslow [64], human needs form a pyramid-shaped hierarchy from low to high. Maslow argues that the higher-level needs cannot be achieved unless the basic needs have been satisfied. Foodstuffs are a good example: in the case of persons with allergies or diabetes or restricted to a particular diet, failure to understand instructions for use may have serious health consequences. Here are some examples related to instructional terms of some English and Vietnamese instructions for use below: Fisherman’s Friend Sugar: This product isn’t recommended for children under 5 years of age. [E-28] Viên Gia Vị - Bún Bò Huế: Bỏ 1 viên vào 0,5 lít nước ñun sôi, ñun từ 2 ñến 3 phút. Dùng cho 2 tô BÚN BÒ HUẾ (150g cho mỗi tô). [V-145] Therefore, to understand any language more deeply and clearly, language learners should know not only the role of lexicon and of syntax and, but also the semantic aspect of its language to get a thorough insight in the language use. Moreover, language will not be a barrier to the free movement of products. As a balance needs to be found between the safeguarding of free movement and safety and health of consumers, I realize that language instruction for food use is a very important matter for ultimate consumers who will directly use food products as well as 4 food manufacturing of companies. Therefore, “A Study of Linguistic Features of Instructions for Use of Foodstuffs in English and Vietnamese” is the title of the master thesis I wish to perform. 1.2. AIMS AND OBJECTIVES 1.2.1. Aims The research aims to find out the lexical, syntactic, and semantic features of instructions for use of foodstuffs in English and Vietnamese. This study also considers these aspects to clarify similarities and differences of instructions for use of foodstuffs in two languages so that the paper helps language learners, translators, as well as ultimate consumers gain a better insight into the meaning of instructions for food use in a more effective way. 1.2.2. Objectives - To identify and describe lexical, syntactic, and semantic features of instructions for use of Tamoxifen for Prevention of Breast Cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study Bernard Fisher, Joseph P. Costantino, D. Lawrence Wickerham, Carol K. Redmond, Maureen Kavanah, Walter M. Cronin, Victor Vogel, Andre´ Robidoux, Nikolay Dimitrov, James Atkins, Mary Daly, Samuel Wieand, Elizabeth Tan-Chiu, Leslie Ford, Norman Wolmark, and other National Surgical Adjuvant Breast and Bowel Project Investigators Background: The finding of a decrease in contralateral breast cancer incidence following tamoxifen administration for adjuvant therapy led to the concept that the drug might play a role in breast cancer prevention. To test this hypoth- esis, the National Surgical Adjuvant Breast and Bowel Proj- ect initiated the Breast Cancer Prevention Trial (P-1) in 1992. Methods: Women (N = 13388) at increased risk for breast cancer because they 1) were 60 years of age or older, 2) were 35–59 years of age with a 5-year predicted risk for breast cancer of at least 1.66%, or 3) had a history of lobular carcinoma in situ were randomly assigned to receive placebo (n = 6707) or 20 mg/day tamoxifen (n = 6681) for 5 years. Gail’s algorithm, based on a multivariate logistic regression model using combinations of risk factors, was used to esti- mate the probability (risk) of occurrence of breast cancer over time. Results: Tamoxifen reduced the risk of invasive breast cancer by 49% (two-sided P<.00001), with cumulative incidence through 69 months of follow-up of 43.4 versus 22.0 per 1000 women in the placebo and tamoxifen groups, re- spectively. The decreased risk occurred in women aged 49 years or younger (44%), 50–59 years (51%), and 60 years or older (55%); risk was also reduced in women with a history of lobular carcinoma in situ (56%) or atypical hyperplasia (86%) and in those with any category of predicted 5-year risk. Tamoxifen reduced the risk of noninvasive breast can- cer by 50% (two-sided P<.002). Tamoxifen reduced the oc- currence of estrogen receptor-positive tumors by 69%, but no difference in the occurrence of estrogen receptor-negative tumors was seen. Tamoxifen administration did not alter the average annual rate of ischemic heart disease; however, a reduction in hip, radius (Colles’), and spine fractures was observed. The rate of endometrial cancer was increased in the tamoxifen group (risk ratio = 2.53; 95% confidence in- terval = 1.35–4.97); this increased risk occurred predomi- nantly in women aged 50 years or older. All endometrial cancers in the tamoxifen group were stage I (localized dis- ease); no endometrial cancer deaths have occurred in this group. No liver cancers or increase in colon, rectal, ovarian, or other tumors was observed in the tamoxifen group. The rates of stroke, pulmonary embolism, and deep-vein throm- bosis were elevated in the tamoxifen group; these events occurred more frequently in women aged 50 years or older. Conclusions: Tamoxifen decreases the incidence of invasive and noninvasive breast cancer. Despite side effects resulting from administration of tamoxifen, its use as a breast cancer preventive agent is appropriate in many women at increased risk for the disease. [J Natl Cancer Inst 1998;90:1371–88] On June 1, 1992, the National Surgical Adjuvant Breast and Bowel Project (NSABP) implemented a Fukunaga et al. Journal of Cardiothoracic Surgery 2010, 5:38 http://www.cardiothoracicsurgery.org/content/5/1/38 Open Access CASE REPORT BioMed Central © 2010 Fukunaga et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case report Mitral valve replacement via right thoracotomy approach for prevention of mediastinitis in a female patient with long-term uncontrolled diabetes mellitus: a case report Naoto Fukunaga*, Takashi Hashimoto, Yasuhisa Ozu, Shigeru Komori, Yu Shomura, Hiroshi Fujiwara, Michihiro Nasu and Yukikatsu Okada Abstract A 76-year-old woman with a history of percutaneous transvenous mitral commissurotomy and repeated hospital admissions due to heart failure was referred for an operation for severe mitral valve stenosis. She presented with hypertension, hyperlipidemia and cerebral infarction with stenosis of right internal carotid artery, retinopathy, neuropathy and nephropathy caused by long-term uncontrolled diabetes mellitus, hemoglobin A1c of 9.4%, and New York Heart Association (NYHA) functional classification of 3/4. Echocardiography revealed severe mitral valve stenosis with mitral valve area of 0.6 cm 2 , moderate tricuspid valve regurgitation, and dilatation of the left atrium. Taking into consideration the NYHA functional classification and severe mitral valve stenosis, an immediate surgical intervention designed to prevent mediastinitis was performed. The approach was via the right 4th thoracotomy, as conventional sternotomy would raise the risk of mediastinitis. Postoperative antibiotics were administered intravenously for 2 days, and signs of infection were not recognized. In patients with long-term uncontrolled diabetes mellitus, mid-line sternotomy can easily cause mediastinitis. The choice of operative approach plays an important role in preventing this complication. In this report, the importance of the conventional right thoracotomy for prevention for mediastinitis is reviewed. Background In patients with long-term uncontrolled diabetes melli- tus, mediastinitis is a critical complication of cardiovas- cular surgery and may easily be caused by mid-line sternotomy. Therefore, the choice of operative approach plays an important role in preventing mediastinitis. In this report, the importance of a minimally invasive con- ventional right thoracotomy approach for the prevention of mediastinitis is reviewed. Case report A 76-year-old woman with a history of percutaneous transvenous mitral commissurotomy and repeated admissions due to heart failure was referred for the pur- pose of an operation for severe mitral valve stenosis. The patient had dyspnea, retinopathy, neuropathy and neph- ropathy caused by long-term uncontrolled diabetes melli- tus, Basedow's disease, hypertension, hyperlipidemia and cerebral infarction with stenosis of the right internal carotid artery, and New York Heart Association (NYHA) functional classification of 3/4. Laboratory examination revealed plasma creatinine of 1.06 mg/dl and a hemoglo- bin A1c of 9.4%. Transthoracic echocardiography revealed severe mitral valve stenosis with a mitral valve area of 0.6 cm 2 , moderate tricuspid valve regurgitation, and dilatation of the left atrium. The patient had previ- ously delayed a mitral valve operation because of uncon- trolled diabetes mellitus. Taking into consideration the NYHA functional classification and symptoms associated with severe mitral valve stenosis, an immediate operation was performed. Postoperative infection in the context of uncontrolled diabetes mellitus was a major concern. As * Correspondence: naotowakimachi@hotmail.co.jp 1 Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 4-6 Minatojimanakamachi, Chuo-ku, ANTIBACTERIAL AND ANTIFOULING POLYMER COATINGS FOR PREVENTION OF CATHETER-ASSOCIATED INFECTIONS DING XIN NATIONAL UNIVERSITY OF SINGAPORE 2014 ANTIBACTERIAL AND ANTIFOULING POLYMER COATINGS FOR PREVENTION OF CATHETER-ASSOCIATED INFECTIONS DING XIN (B.Eng., XI’AN JIAOTONG UNIVERSITY) A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY NUS GRADUATE SCHOOL FOR INTEGRATIVE SCIENCES AND ENGINEERING NATIONAL UNIVERSITY OF SINGAPORE 2014 Acknowledgements This thesis is impossible without the support of many people over the past four years. Here, I would like to express my sincere gratitude to these lovely people. First of all, I would like to thank my supervisor Dr. Yi Yan Yang for her guidance and support throughout my Ph.D. study in the past four years. Her passions, optimism, attitudes towards academic research and invaluable suggestions inspired me all the way. I would also like to thank our collaborators, Dr. James L. Hedrick from IBM Almaden Research Centre for his helpful discussion and inputs in the manuscripts. Thanks to Associated Professor Yen Wah Tong and Assistant Professor Rachel Ee for being in my Thesis Advisory Committee and giving me a lot of valuable suggestions. I would like to thank my labmates in the Nanomedicine Group of the Institute of Bioengineering and Nanotechnology (IBN) for their constant help on experiments and discussions on my projects. I would especially thank Dr. Chuan Yang for synthesizing all the polymers used in this study and Dr. Shaoqiong Liu for her great inputs in hydrogel work. I would like to acknowledge NUS Graduated School of Integrative Sciences and Engineering (NGS) for supporting me with the scholarship and IBN for the financial support of my PhD research work. I also would like to thank all the staffs in NGS and IBN for their helps. ii Last but not the least, I would like to express my deepest gratitude to my parents and my girlfriend for their endless love and understanding during my graduate study. iii Table of Contents Declaration . i Acknowledgements . ii Table of Contents . iv Summary . vii List of Tables . x List of Figures xi List of Schemes . xv List of Abbreviations xvi Chapter 1. Introduction . 1 1.1 Catheter-associated infections (CAIs) . 1 1.2 Bacterial biofilm 3 1.2.1 Bacteria-surface interaction and biofilm formation 3 1.2.2 Strategies for prevention and eradication of bacterial biofilm . 5 1.3 Antibacterial coatings 7 1.3.1 Coatings delivering antibacterial agents 7 1.3.2 Surfaces immobilized with antibacterial agents 10 1.4 Antifouling coatings 18 1.4.1 PEG-based antifouling coatings 18 1.4.2 Zwitterionic polymer coatings and other antifouling coatings 22 1.5 Mussel-inspired adhesive coatings using dopamine/polydoamine (PDA) 25 1.6 Gaps, objectives and scope 31 1.7 References . 35 Chapter 2. Antibacterial and Antifouling Catheter Coatings Using Surfaces Grafted with PEG-b-Cationic Polycarbonate Diblock Copolymers . 47 2.1 Background . 47 2.2 Materials and methods ... recommend the use of a plastic bag to prevent hypothermia in preterm infants • • The objective: to determine if placing preterm and LBW infants inside a plastic bag at birth maintains normothermia... 0.6°C in standard care infants (P, 001) • The duration of use of the plastic bag in hypothermic infants ranged from 80 to 120 minutes Hyperthermia (>38.0°C) or skin side effects did not occur in. .. brain injury, bowel perforation, or pulmonary hemorrhage were not documented in any of the study infants during their NICU admission 13 4.CONCLUSIONS: • Placement of preterm/ LBW infants inside