Continuous versus Intermittent Infusion of Human Antithrombin III Concentrate in the Immediate Postoperative Period after Liver Transplantation

Antithrombin-III (AT-III) concentrates have been used in the immediate postoperative period after liver transplantation to prevent critical thrombosis. We aimed to investigate more appropriate method for AT-III concentrate administration to maintain plasma AT-III activity level within targeted range. In this randomized controlled trial, 130 adult patients undergoing living-donor liver transplantation were randomized to either intermittent group or continuous group. In intermittent group, 500 international units (IU) of AT-III concentrate were administered after liver transplantation and repeated every 6 hours for 72 hours. In continuous group, 3000 IU of AT-III was continuously infused for 71 hours after a loading dose of 2000 IU over 1 hour. Plasma AT-III activity level was measured at 12, 24, 48, 72, and 84 hours from the first AT-III administration. The primary outcome was the target (80-120%) attainment rate at 72 hours. Target attainment rates at other time points and associated complications were collected as secondary outcomes. A total of 107 patients were included in the analysis. The target attainment rates at 72 hours post-dose were 30% and 62% in intermittent group and continuous group, respectively. (p=0.003) Compared to intermittent group, patients in continuous group reached the target level more rapidly (12 vs. 24 hours, median time, p<0.001) and was more likely to remain in the target range until 84 hours. For maintaining the target plasma AT-III activity level after living-donor liver transplantation, continuous infusion of AT-III seemed to be more appropriate compared to the conventional intermittent infusion regimen.

Predictive factors of bacteremia in patients with febrile urinary tract infection: an experience at a tertiary care center

PURPOSE

To investigate the clinical features in adult patients with febrile urinary tract infection (UTI) who visited the emergency department (ED) and to determine the predictive factors of bacteremia among the initial presenting clinical features.

METHODS

This retrospective cohort study was conducted at the ED of a tertiary hospital in Korea from 1 January 2012 to 31 December 2012. All adult patients who were diagnosed with febrile UTI and for whom data on blood and urine cultures were available were included in the study. Clinical examinations and laboratory tests were performed at the initial presentation.

RESULTS

A total of the 325 patients with febrile UTI (median age: 60 years) were included for analysis, of whom 82 % were female. Bacteremia was detected in 106 of the 325 patients (32.6 %), with Escherichia coli the most frequent pathogen detected (59.7 % of cases). Between the bacteremic and non-bacteremic groups, there was significant difference in age (67 vs. 57 years, respectively), flank pain (16 vs. 7.8 %), suprapubic discomfort (0 vs. 4.6 %), body temperature (38.8 vs. 38.3 °C), respiratory rate (21 vs. 20/min), platelet count (170 vs. 186 × 10(3)/μL), C-reactive protein (10.2 vs. 8.3 mg/dL), and procalcitonin (1.5 vs. 0.3 ng/mL) (P < 0.05 for all). In the multivariate logistic regression analysis, age [odds ratio (OR) 1.03; 95 % confidence interval (CI) 1.01-1.05], systolic blood pressure of <90 mmHg (OR 3.27; 95 % CI 1.13-9.45), body temperature of >39 °C (OR 4.26; 95 % CI 2.28-7.96), and procalcitonin level of >0.5 ng/dL (OR 2.03; 95 % CI 1.07-3.86) were significantly associated with bacteremia.

CONCLUSION

Among our adult patients with febrile UTI, age, systolic blood pressure, body temperature, and procalcitonin were significantly associated with bacteremia. We therefore suggest that these factors should be considered when deciding upon treatment options for febrile UTI patients at the ED.

Needle-type multi-electrode array fabricated by MEMS technology for the hypodermic continuous glucose monitoring system

A needle-type multi-electrode array for the hypodermic continuous glucose monitoring sensor was fabricated using MEMS technology. The developed multielectrode sensor has 4 electrodes of two working(Pt) electrodes, one counter(Pt) electrode, and one reference(Ag/AgCl) electrode. Two working electrodes are for the enzyme and nonenzyme electrodes which measure glucose concentration and the background current (I(0)), respectively. The developed integrated sensor system is adequate to accomplish our prereported new two-point calibration method using only one-point sample measurement. Results of in vitro performance test are also provided.