IMPORTANCE Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis.OBJECTIVES To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation. INTERVENTIONS Patients were randomized to receive either sedation with dexmedetomidine (n = 100) or sedation without dexmedetomidine (control group; n = 101). Other agents used in both groups were fentanyl, propofol, and midazolam. MAIN OUTCOMES AND MEASURESThe co-primary outcomes were mortality and ventilator-free days (over a 28-day duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes. RESULTSOf the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8%]; hazard ratio, 0.69; 95% CI, 0.38-1.22; P = .20). Ventilator-free days over 28 days were not significantly different between groups (dexmedetomidine group: median, 20 [interquartile range, 5-24] days; control group: median, 18 [interquartile range, 0.5-23] days; P = .20). The dexmedetomidine group had a significantly higher rate of well-controlled sedation during mechanical ventilation (range, 17%-58% vs 20%-39%; P = .01); other outcomes were not significantly different between groups. Adverse events occurred in 8 (8%) and 3 (3%) patients in the dexmedetomidine and control groups, respectively. CONCLUSIONS AND RELEVANCE Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further.

An interpretation model for low reflectivity in ultrahigh spatial-frequency holographic relief gratings is proposed. The model is based on the concept that the grating effective index, caused by grating ultrahigh spatial frequency, is graded in the depth direction and forms an antireflective constitution similar to the multilayer coating. Numerical results show that a sinusoidal grating is antireflective over wide groove depth, wavelength and incident angle ranges, and a grating with nearly triangular section, having a circle arc index distribution, has a very low reflectivity, >10(-4)%. Reflectivity vs groove depth, obtained experimentally for a holographically recorded photoresist grating, agrees fairly well with the numerical results.

ADEs and medication errors were common in paediatric inpatients in Japan, though the proportion of ADEs that were preventable was low. The ordering and monitoring stages appeared most important for improving safety.

The quantitation of hepatitis C virus (HCV) viremia RNA is measured by molecular techniques such as comcan be helpful in the diagnosis, therapy, and monitoring petitive reverse-transcription polymerase chain reacof patients with chronic hepatitis C. A sensitive and tion and branched DNA (bDNA) signal amplification. 5,6 quantitative fluorescence enzyme immunoassay (FEIA) More recently, a sensitive and quantitative fluoreshas recently been developed for assaying HCV core pro-cence enzyme immunoassay (FEIA) has been developed tein in serum. To assess the utility of measurements of to measure serum HCV core protein, which may also serum HCV core protein during the course of treatment correlate with levels of HCV viremia. 8 We have evaluof chronic hepatitis C, we studied 27 patients who were ated the clinical usefulness of serum HCV core protein treated with a single schedule of interferon alfa (IFN-a) measurements in patients with chronic hepatitis C be- This study was conducted at Shinshu University 27 patients (93%). The initial serum concentration of Hospital and affiliated hospitals between July 1993 and Sep-HCV core protein was significantly (P õ .01) higher in tember 1994. Informed consent was obtained from all pathe nonresponders versus the responders. Two weeks tients. Twenty-seven Japanese patients with chronic hepatiafter initiating IFN-a therapy, HCV core protein was not tis type C who were treated with IFN-a therapy (19 men detectable in any of the 11 responders, but was detected and 8 women aged 32 to 65 years; mean, 50.6 years) were in 8 of 16 nonresponders (P õ .01). All responders, but evaluated. All had antibodies to HCV and HCV RNA in senone of the nonresponders, remained negative for core rum, and were negative for hepatitis B virus surface antigen protein after IFN-a therapy. The measurement of HCV and antibodies to human immunodeficiency virus. Chronic core protein by FEIA may be useful for predicting the hepatitis was diagnosed on the basis of persistence of serum response to IFN-a and for monitoring its therapeutic alanine transaminase (ALT) elevations, determined in serum efficacy. (HEPATOLOGY 1996;23:1330-1333.) tests performed monthly for at least 6 months, and by liver biopsy taken within the previous 6 months. Seven patients had mild, 6 had moderate, and 14 had severe chronic hepatiInfection by hepatitis C virus (HCV) can lead to tis. 9 chronic hepatitis and cirrhosis, and may also be inRecombinant IFN-a 2a (Roche, Tokyo, Japan, and Takeda, volved in the pathogenesis of hepatocellular carci-Osaka, Japan) was administered in a dose of 9 million units intramuscularly daily for 2 weeks, followed by three times a noma. 1,2 Treatment with interferon alfa (IFN-a) is efweek for 22 weeks. Patients were seen 2 and 4 weeks after fective in some patients with chronic hepatitis C, the initiation of therapy, and then every 4 weeks for at least resulting in a rapid decrease in aminotransferase activ-24 weeks after its completion. Serum samples were collected ities into the normal range and a clea...

BackgroundDexmedetomidine has been reported to improve organ dysfunction in critically ill patients. In a recent randomized controlled trial (Dexmedetomidine for Sepsis in Intensive Care Unit (ICU) Randomized Evolution [DESIRE]), we demonstrated that dexmedetomidine was associated with reduced mortality risk among patients with severe sepsis. We performed this exploratory sub-analysis to examine the mechanism underlying improved survival in patients sedated with dexmedetomidine.MethodsThe DESIRE trial compared a sedation strategy with and without dexmedetomidine among 201 mechanically ventilated adult patients with sepsis across eight ICUs in Japan. In the present study, we included 104 patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≥ 23 (54 in the dexmedetomidine [DEX] group and 50 in the non-dexmedetomidine [non-DEX] group). Initially, we compared the changes in the sequential organ failure assessment (SOFA) scores from the baseline within 6 days after randomization between groups. Subsequently, we evaluated the variables comprising the organ component of the SOFA score that showed relevant improvement in the initial comparison.ResultsThe mean patient age was 71.0 ± 14.1 years. There was no difference in the median APACHE II score between the two groups (29 [interquartile range (IQR), 25–31] vs. 30 [IQR, 25–33]; p = 0.35). The median SOFA score at the baseline was lower in the DEX group (9 [IQR, 7–11] vs. 11 [IQR, 9–13]; p = 0.01). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the DEX group on day 4 (p = 0.02). During the first 6 days, the urinary output was not significantly different (p = 0.09), but serum creatinine levels were significantly lower (p = 0.04) in the DEX group. The 28-day and in-hospital mortality rates were significantly lower in the DEX group (22% vs. 42%; p = 0.03, 28% vs. 52%; p = 0.01, respectively).ConclusionA sedation strategy with dexmedetomidine is associated with improved renal function and decrease mortality rates among patients with severe sepsis.Trial registrationThis trial was registered on ClinicalTrials.gov (NCT01760967) on January 1, 2013.