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At day ten and forward all patients were within target for treatment. No patients were at risk for toxic S-Se concentration. CONCLUSIONS S-Se concentration was substantially lower compared to normal values at intensive care unit admission in this cohort of unselected Swedish critical care patients. Selenium supplementation restituted S-Se to levels corresponding to enzymatic saturation and the Swedish reference interval for all subjects remaining in the ICU on day 5. This article is protected by copyright. All rights reserved.Leptospires are highly invasive spirochetes equipped with efficient strategies for dissemination in the host. The Leptospira genus currently comprises 64 species divided into two major clades the saprophytes composed of nonpathogenic, free-living organisms, and the pathogens encompassing all the species that cause mild or severe infections in humans and animals. While saprophytes are highly susceptible to the lytic action of the complement system, pathogenic (virulent) strains have evolved virulence strategies that allow efficient colonization of a variety of hosts and target organs, including mechanisms to circumvent hosts' innate and acquired immune responses. selleck compound Pathogenic Leptospira avoid complement-mediated killing by recruiting host complement regulatory proteins and by targeting complement proteins using own and host-expressed proteases. This review outlines the role of complement in eradicating saprophytic Leptospira and the stratagems adopted by pathogenic Leptospira to maneuver the host complement system for their benefit. © 2020 Federation of European Biochemical Societies.Tumor necrosis factor (TNF) inhibitors are increasingly applied during pregnancy without clear knowledge of the impact on placenta and fetus. We assessed placental transfer and exposure to infliximab (n=3) and etanercept (n=3) in women with autoimmune diseases. Furthermore, we perfused healthy term placentas for 6h with 100 µg/mL infliximab (n=4) or etanercept (n=5). In pregnant women, infliximab transferred into cord blood but also entered the placenta (cord-to-maternal ratio of 1.6±0.4, placenta-to-maternal ratio of 0.3±0.1, n=3). For etanercept, a cord-to-maternal ratio of 0.04 and placenta-to-maternal ratio of 0.03 was observed in one patient only. In ex vivo placenta perfusions, the extent of placental transfer did not differ between the drugs. Final concentrations in the fetal compartment for infliximab and etanercept were 0.3±0.3 µg/mL and 0.2±0.2 µg/mL, respectively. However, in placental tissue, infliximab levels exceeded those of etanercept (19±6 µg/g versus 1±3 µg/g, p less then 0.001). In conclusion, tissue exposure to infliximab is higher than that of etanercept both in vivo as well as in ex vivo perfused placentas. However, initial placental transfer, as observed ex vivo, does not differ between infliximab and etanercept when administered in equal amounts. The difference in placental tissue exposure to infliximab and etanercept may be of clinical relevance and warrants further investigation. More specifically, we suggest that future studies should look into the occurrence of placental TNF inhibition and possible consequences thereof. This article is protected by copyright. All rights reserved.BACKGROUND Different metrics exist to evaluate the impact of a paper. Traditionally, scientific citations are leading, but nowadays new, internet-based, metrics like downloads or Altmetric Attention Score receive increasing attention. We hypothesised a gap between these metrics, reflected by a divergence between scientific and clinical appreciation of anaesthesia literature. METHODS We collected the top 100 most cited and the top 100 most downloaded articles in Acta Anaesthesiologica Scandinavica (AAS) and Anesthesia & Analgesia (A&A) published between 2014 and 2018. We analysed the relationship between the average number of citations per year, downloads per year and Altmetric Attention Score. RESULTS For both AAS and A&A, a significant correlation between the 100 most cited articles and their downloads (r = .573 and .603, respectively, P less then .001) was found. However, only a poor correlation with Altmetric Attention Score was determined. For the 100 most downloaded articles, download frequency did not correlate with their number of citations (r = .035 and .139 respectively), but did correlate significantly with the Altmetric Attention Score (r = .458 and .354, P less then .001). CONCLUSION Highly cited articles are downloaded more frequently. The most downloaded articles, however, did not receive more citations. In contrast to the most cited articles, more frequently downloaded papers had a higher Altmetric Attention Score. Thus, a 'trending' anaesthesia paper is not a prerequisite for scientific appreciation, reflecting a gap between clinical and scientific appreciation of literature. © 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.BACKGROUND Volatile anesthetics potentially trigger malignant hyperthermia crises in susceptible patients. We therefore aimed to identify preparation procedures for the Draeger Primus that minimize residual concentrations of desflurane and sevoflurane with and without activated charcoal filtration. METHODS A Draeger Primus test workstation was primed with 7% desflurane or 2.5% sevoflurane for 2 hours. Residual anesthetic concentrations were evaluated with five preparation procedures, three fresh gas flow rates, and three distinct applications of activated charcoal filters. Finally, non-exchangeable and autoclaved parts of the workstation were tested for residual emission of volatile anesthetics. Concentrations were measured by multicapillary column-ion mobility spectrometry with limits of detection/quantification being less then 1 part per billion (ppb) for desflurane and less then 2.5 ppb for sevoflurane. RESULTS The best preparation procedure included a flushing period of 10 minutes between removal and replacement of all parts of the ventilator circuit which immediately produced residual concentrations less then 5 ppm. A fresh gas flow of 10 L/minute reduced residual concentration as effectively as 18 L/minute, whereas flows of 1 or 5 L/minute slowed washout. Use of activated charcoal filters immediately reduced and maintained residual concentrations less then 5 ppm for up to 24 hours irrespective of previous workstation preparation. The fresh gas hose, circle system, and ventilator diaphragm emitted traces of volatile anesthetics. CONCLUSION In elective cases, presumably safe concentrations can be obtained by a 10-minute flush at ≥10 L/minute between removal and replacement all components of the airway circuit. For emergencies, we recommend using an activated charcoal filter. © 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
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