How circulating inflammatory mediators change upon sepsis progression has not been studied. We studied the follow-up changes of circulating vasoactive peptides and cytokines until the improvement or the worsening of a patient and progression into specific organ dysfunctions. In a prospective study, concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFNγ), endocan and angiopoietin-2 (Ang-2) were measured in serum by an enzyme immunoassay in 175 patients at baseline; this was repeated within 24 h upon progression into new organ dysfunction (n = 141) or improvement (n = 34). Endocan and Ang-2 were the only parameters that were significantly increased among patients who worsened. Any increase of endocan was associated with worsening with odds ratio 16.65 (p < 0.0001). This increase was independently associated with progression into acute respiratory distress syndrome (ARDS) as shown after logistic regression analysis (odds ratio 2.91, p: 0.002). Changes of circulating cytokines do not mediate worsening of the critically ill patients. Instead endocan and Ang2 are increased and this may be interpreted as a key-playing role in the pathogenesis of ARDS and septic shock. Any increase of endocan is a surrogate of worsening of the clinical course.

Burnout is a work-specific syndrome with high incidence among intensive care unit personnel. Although several risk factors have been proposed, data regarding the association of anxiety and burnout among intensive care unit physicians are scarce. The aim of this study is to investigate the incidence of burnout and its association with state and trait anxiety and other sociodemographic, behavioural and occupational-related parameters, among intensivists. A population of intensive care physicians was evaluated using the self-completed Maslach Burnout Inventory and the State-Trait Anxiety Inventory Form Y, and data regarding sociodemographic and occupational-related variables were also recorded. From the 98 intensive care physicians addressed, 80 returned fully completed questionnaires; 26.9% of them presented with high emotional exhaustion, 37.5% with high depersonalisation and 41.5% with low personal accomplishment scores. Trait anxiety, fear of having committed a medical error and self-reporting difficulty when having to act accurately were independently associated with high burnout. In conclusion, burnout is common among intensivists and is associated with specific behavioural characteristics and personality traits, but not with work-related factors.

Background Clarithromycin may act as immune-regulating treatment in sepsis and acute respiratory dysfunction syndrome. However, clinical evidence remains inconclusive. We aimed to evaluate whether clarithromycin improves 28-day mortality among patients with sepsis, respiratory and multiple organ dysfunction syndrome. Methods We conducted a multicenter, randomized, clinical trial in patients with sepsis. Participants with ratio of partial oxygen pressure to fraction of inspired oxygen less than 200 and more than 3 SOFA points from systems other than the respiratory function were enrolled between December 2017 and September 2019. Patients were randomized to receive 1 gr of clarithromycin or placebo intravenously once daily for 4 consecutive days. The primary endpoint was 28-day all-cause mortality. Secondary outcomes were 90-day mortality; sepsis response (defined as at least 25% decrease in SOFA score by day 7); sepsis recurrence; and differences in peripheral blood cell populations and leukocyte transcriptomics. Results Fifty-five patients were allocated to each arm. By day 28, 27 (49.1%) patients in the clarithromycin and 25 (45.5%) in the placebo group died (risk difference 3.6% [95% confidence interval (CI) − 15.7 to 22.7]; P = 0.703, adjusted OR 1.03 [95%CI 0.35–3.06]; P = 0.959). There were no statistical differences in 90-day mortality and sepsis response. Clarithromycin was associated with lower incidence of sepsis recurrence (OR 0.21 [95%CI 0.06–0.68]; P = 0.012); significant increase in monocyte HLA-DR expression; expansion of non-classical monocytes; and upregulation of genes involved in cholesterol homeostasis. Serious and non-serious adverse events were equally distributed. Conclusions Clarithromycin did not reduce mortality among patients with sepsis with respiratory and multiple organ dysfunction. Clarithromycin was associated with lower sepsis recurrence, possibly through a mechanism of immune restoration. Clinical trial registration clinicaltrials.gov identifier NCT03345992 registered 17 November 2017; EudraCT 2017-001056-55.

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Η λειτουργικότητα της γαστροοισοφαγικής συμβολής και η ύπαρξη της ζώνης αυξημένων πιέσεων στον κατώτερο οισοφάγο δεν έχει διερευνηθεί πλήρως. Με σκοπό την περαιτέρω μελέτη της γαστροοισοφαγικής συμβολής διενεργήθηκε μακροσκοπική παρατήρηση της σε 25 νεκροτομικά παρασκευάσματα και έγινε για πρώτη φορά μορφομετρική μελέτη των διάμεσων κυττάρων του Cajal συγκριτικά στην ζώνη μετάπτωσης των επιθηλίων και της μεσότητας του οισοφάγου.Τα διάμεσα κύτταρα του Cajal είναι εξειδικευμένα κύτταρα τα οποία σχηματίζουν δίκτυο στο τοίχωμα του γαστρεντερικού σωλήνα και διαδραματίζουν σημαντικό ρόλο στην μεταβίβαση της νευρικής διέγερσης στα μυϊκά κύτταρα, λειτουργούν ως βηματοδότες της κινητικότητας του πεπτικού συστήματος και καθιστούν δυνατή την ανασταλτική νευροδιαβίβαση που εξαρτάται από το μονοξείδιο του αζώτου στον «κατώτερο οισοφαγικό σφιγκτήρα» και στον πυλωρό.Από την μακροσκοπική μελέτη δεν παρατηρήθηκε η ύπαρξη ανατομικού σφιγκτήρα ούτε και ιδιαίτερη πάχυνση του μυϊκού χιτώνα στην καρδιοοισοφαγική συμβολή. Οι πληθυσμοί των κυττάρων του Cajal στη γραμμή μετάπτωσης των επιθηλίων σε σύγκριση με τους πληθυσμούς που βρίσκονταν 1 εκ εκατέρωθεν αυτής δεν παρουσίαζαν στατιστικά σημαντική διαφορά. Ο πληθυσμός των κυττάρων αυτών στην περιοχή της γαστροοισοφαγικής συμβολής όμως ήταν στατιστικά σημαντικά μεγαλύτερος σε σχέση με τον αριθμό τους στην μεσότητα του οισοφάγου. Αυτά τα αποτελέσματα της μελέτης συνηγορούν υπέρ της εξειδικευμένης λειτουργίας που επιτελεί το κατώτερο τμήμα του οισοφάγου ως «κατώτερος οισοφαγικός σφιγκτήρας», στην λειτουργικότητα του οποίου ο αυξημένος αριθμός των διαμέσων κυττάρων του Cajal υποδηλώνει την συμμετοχή τους στην επάρκεια του.