Measuring patient-centred long-term outcome following a bloodstream infection: a pilot study

OBJECTIVES

To evaluate the sequential organ failure assessment (SOFA) and modified SOFA (mSOFA) scoring and a novel performance score based on the Karnofsky score for measuring outcome following a bloodstream infection (BSI).

METHOD

This prospective observational cohort study assessed patients with BSI for mortality and functional outcomes with a novel performance score: the functional bloodstream infection score (FBIS). We also tested the SOFA and, given the difficulties with measuring SOFA on ward-based patients, the mSOFA over the first 7 days following a BSI for their association with outcomes.

RESULTS

One hundred participants were prospectively recruited. Mortality at 52 weeks following BSI was 21% (21/100). Only 57% of survivors (39/69) were at their baseline functional status at 52 weeks. Stable or improved SOFA/mSOFA over the first 7 days was associated with survival and return to premorbid performance score (risk ratio 3.2, 95%CI 1.3-9.4, p < 0.01).

CONCLUSIONS

The acute change in SOFA/mSOFA was associated with 52-week survival and return to premorbid functional performance. The FBIS measurement represents a simple and easy-to-apply measure of functional performance for patients with BSI and was associated with a high response rate (89%) from participants.

Effect of ceramide acyl chain length on skin permeability and thermotropic phase behavior of model stratum corneum lipid membranes

Stratum corneum ceramides play an essential role in the barrier properties of skin. However, their structure-activity relationships are poorly understood. We investigated the effects of acyl chain length in the non-hydroxy acyl sphingosine type (NS) ceramides on the skin permeability and their thermotropic phase behavior. Neither the long- to medium-chain ceramides (8-24 C) nor free sphingosine produced any changes of the skin barrier function. In contrast, the short-chain ceramides decreased skin electrical impedance and increased skin permeability for two marker drugs, theophylline and indomethacin, with maxima in the 4-6C acyl ceramides. The thermotropic phase behavior of pure ceramides and model stratum corneum lipid membranes composed of ceramide/lignoceric acid/cholesterol/cholesterol sulfate was studied by differential scanning calorimetry and infrared spectroscopy. Differences in thermotropic phase behavior of these lipids were found: those ceramides that had the greatest impact on the skin barrier properties displayed the lowest phase transitions and formed the least dense model stratum corneum lipid membranes at 32°C. In conclusion, the long hydrophobic chains in the NS-type ceramides are essential for maintaining the skin barrier function. However, this ability is not shared by their short-chain counterparts despite their having the same polar head structure and hydrogen bonding ability.

Lanreotide labeled with 99mTc: preparation, preclinical testing and comparison with (111)In-DTPA-octreotide

Somatostatin receptors are known to be present at a high density in a large number of tumors while (111)In-DTPA-octreotide has been routinely used in oncology for imaging somatostatin receptor-positive tumors and metastases. Lanreotide is another somatostatin receptor-specific peptide, shown to be effective in controlling the growth of some human tumors. The aim of this study was to label lanreotide with 99mTc by a direct labeling method and to evaluate the distribution and elimination characteristics of the labeled agent in rats. (111)In-octreotide was used as the reference radiopharmaceutical. For both radiolabeled-peptides the activity in blood and most organs decreased relatively rapidly with time. On the other hand, 99mTc-lanreotide was excreted mainly by the gastrointestinal tract to feces while (111)In-DTPA-octreotide was eliminated mostly into urine. The rat liver perfusion experiments showed that bile clearance of 99mTc-lanreotide was about three-order times higher than for (111)In-DTPA-octreotide. Analysis of the elimination mechanisms of 99mTc-lanreotide and (111)In-DTPA-octreotide in the perfused rat kidney confirmed that both peptides were eliminated mostly by glomerular filtration. Different protein binding of the agents ((111)In-DTPA-octreotide was only weakly bound, whereas 99mTc-lanreotide was strongly bound to proteins) resulted in substantially lower renal clearance of 99mTc-lanreotide when compared with (111)In-DTPA-octreotide. The results indicated that 99mTc-lanreotide could be of value for the scintigraphic imaging of specific tumors.