The normal systemic inflammatory response to surgical stimuli often makes early diagnosis of postoperative infections difficult.
We investigated whether serum procalcitonin (PCT) levels may be a useful marker of bacterial infections in patients after invasive surgery.
The subjects were 40 patients who had undergone radical surgery for esophageal carcinoma by a right thoracoabdominal approach. Nine patients were diagnosed to have a postoperative infection during the first 7 days after surgery. Changes in serum PCT levels were compared between the group diagnosed to have postoperative infection (infection group) and the group without infection (noninfection group).
The postoperative serum PCT levels were significantly higher in the infection group than in the noninfection group (ANOVA: p < 0.01). Serum PCT peaked on postoperative day (POD) 5 in the infection group (8.7 +/- 8.2 ng/ml, mean +/- SD) and on POD 1 in the noninfection group (0.5 +/- 0.5 ng/ml). No significant differences were found between the two groups in leukocyte count, serum CRP or cytokine levels. The receiver operating characteristics (ROC) curve was constructed for infection identification. The area under the ROC curve for peak postoperative PCT was 0.968, and at a cutoff value of 2.0 ng/ml, the sensitivity was 89% and the specificity was 93%.
Serum PCT levels may be useful for the early diagnosis of postoperative infectious complications.
"Both parameters showed similar trends on subsequent days, which means that, as IL-6 is measured mostly experimentally, measurements of PCT should be sufficient to provide the necessary information. Ito and colleagues actually found that PCT is better for monitoring the development of sepsis in patients who had undergone oesophageal surgery for carcinoma; however they were able to predict sepsis one day earlier than in our study . Unlike our patients though, their patients did not receive preoperative chemotherapy. "
[Show abstract][Hide abstract] ABSTRACT: Early diagnosis of sepsis and its differentiation from the noninfective SIRS is very important in order that treatment can be initiated in a timely and appropriate way. In this study we investigated standard haematological and biochemical parameters and thromboelastography (TEG) in patients who had undergone surgical resection of the oesophagus to find out if changes in any of these parameters could help in early differentiation between SIRS and sepsis development.
We enrolled 43 patients (aged 41-74 years) of whom 38 were evaluable. Blood samples were obtained on the morning of surgery and then at 24-hour intervals for the next 6 days. Samples were analysed for procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL- 6), aspartate transaminase (AST), alanine transaminase (ALT) , lactate, white blood count (WBC), D-dimers, antithrombin (AT), international normalised ratio (INR), activated partial thromboplastin time (APTT) and parameters of TEG.
Significant differences between patients who developed sepsis during this period (9 patients) and SIRS were found in ALT on Day 1, in AST on Days 1-4, in PCT on Days 2-6; in CRP on Days 3-6; in IL-6 on Days 2-5; in leucocytes on Days 2, 3 and 6; and in D-dimers on Days 2 and 4. Significance values ranged from p < 0.0001 to p < 0.05.
Sequential measurements of ALT, AST, PCT and IL-6 during the early postoperative period can be used for early differentiation of sepsis and postoperative SIRS after oesophagectomy. Among the coagulation parameters measured, only D-dimer concentrations appeared to be helpful in this process. TEG does not seem to be a useful early predictor of sepsis development; however it can be used to differentiate sepsis and SIRS from Day 5 after surgery.
[Show abstract][Hide abstract] ABSTRACT: Tracking uncertain mobile objects such as humans and vehicles is an important problem in computer vision, robotics, and geo-spatial visualization. As the name suggests, predictor-corrector tracking is performed in two steps -prediction and correction. Prediction steps have typically utilized a-priori motion model most common of which is a uniform motion model. In this work, we apply an expert learning framework for on-line prediction and learning the motion of an uncertain mobile object. We define a number of probabilistic experts, each of which predicts the future position of the object with some uncertainty and then combine the predictions of all the experts to produce an estimate of the object's location. Individual experts predictions are weighted adaptively depending on their performance. We show that this adaptive combination is powerful when there are changes in the pattern of the object's motion. Results of our algorithm are compared with linear extrapolation and the best off-line expert predictions. We have tested our algorithm with synthetic data using uniform and non-uniform patterns as well as real data acquired using GPS equipment in presence of intermittent and highly erroneous data.
[Show abstract][Hide abstract] ABSTRACT: The Rosetta waterway is one of the two main branches of the Nile river in Egypt. It is considered the life artery for fishermen who live at the Rosetta district in Egypt. The closure of the Rosetta estuary caused by sedimentation will not only affect their livelihood but also endangers the people live upstream of the mouth due to releasing a probable emergency flood. The present paper focuses on the accretion problem as a second phase of a comprehensive study performed by Delft3D numerical model for the Rosetta promontory. The first phase focused on combating the shoreline erosion problem at the southwestward of the Rosetta (A. S. M. Ahmed, 2004). The causes of the sedimentation problem were understood and the consequences in case of no countermeasure are explained. Based on the knowledge obtained by investigating the motivation of Rosetta sedimentation, three alternatives were simulated. The proper solution was recommended as it produces low environmental impacts.
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