***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / Aims : We investigated whether urinary podocytes are present in septic patients with methicillin-resistant Staphylococcus aureus (MRSA)-associated glomerulonephritis and whether polymyxin B-immobilized fiber ( PMX-F ) treatment affects proteinuria and urinary podocyte excretion in these patients . Methods : Twenty septic patients with MRSA-associated glomerulonephritis ( mean age : 63.7 years ) and 80 septic patients whose MRSA infection was not followed by glomerulonephritis ( mean age : 60.5 years ) were included in this study . All septic patients were treated with fosfomycin sodium , β-lactams , arbekacin sulfate , and teicoplanin , or a combination of these . Twenty septic patients with MRSA-associated glomerulonephritis were r and omly assigned to one of two treatments : PMX-F treatment ( group A , n = 10 ) and conventional treatment ( group B , n = 10 ) . PMX-F treatment was repeated twice . Results : Urinary podocytes and urinary protein excretion were not detected in MRSA septic patients without glomerulonephritis . However , urinary podocytes ( 1.7 ± 0.6 cells/ml ) and proteinuria ( 2.6 ± 0.6 g/d ) were detected in the 20 septic patients with MRSA-associated glomerulonephritis . Plasma endotoxin levels were decreased from 13.6 ± 4.6 pg/ml to 6.6 ± 2.2 pg/ml ( p < 0.05 ) in group A. Levels in group B , however , showed little difference after treatment . Urinary podocytes were reduced in group A ( from 1.8 ± 0.6 cells/ml to 0.4 ± 0.2 cells/ml , p < 0.01 ) as was urinary protein excretion ( from 3.0 ± 0.5 g/d to 0.8 ± 0.4 g/d , p < 0.01 ) but urinary podocytes and protein excretion levels showed little difference after treatment in group B. Conclusion : PMX-F treatment may be effective in reducing urinary protein and urinary podocyte excretion in septic patients with MRSA-associated glomerulonephritis Introduction The objective of this study was to clarify the efficacy and mechanism of action of direct hemoperfusion with an immobilized polymyxin B fiber column ( DHP-PMX ) in patients with acute lung injury or acute respiratory distress syndrome caused by sepsis . Method Thirty-six patients with sepsis were included . In each patient a thermodilution catheter was inserted , and the oxygen delivery index and oxygen consumption index were measured . DHP-PMX was performed in patients with a normal oxygen delivery index and oxygen consumption index ( > 500 ml/minute per m2 and > 120 ml/minute per m2 , respectively ) . The Acute Physiology and Chronic Health Evaluation II score was used as an index of the severity of sepsis , and survival was assessed after 1 month . The humoral mediators measured were the chemokine IL-8 , plasminogen activator inhibitor-1 , and neutrophil elastase ( NE ) . These mediators were measured before DHP-PMX treatment , and at 24 , 48 , and 78 hours after the start of treatment . The arterial oxygen tension (PaO2)/fractional inspired oxygen ( FiO2 ) ratio was measured before DHP-PMX treatment and at 24 , 48 , 72 , 92 , and 120 hours after the start of treatment . Results All patients remained alive after 1 month . Before DHP-PMX treatment , the Acute Physiology and Chronic Health Evaluation II score was 24 ± 2.0 , the IL-8 level was 54 ± 15.8 pg/ml , plasminogen activator inhibitor-1 was 133 ± 28.1 ng/ml , and NE was 418 ± 72.1 μg/l . These three humoral mediators began to decrease from 24 hours after DHP-PMX treatment , and the decline became significant from 48 hours onward . The PaO2/FiO2 ratio was 244 ± 26.3 before DHP-PMX treatment but improved significantly from 96 hours onward . There were significant negative correlations between the PaO2/FiO2 ratio and blood levels of NE and IL-8 . Conclusion The mechanism of action of DHP-PMX is still not fully understood , but we report the following findings . The mean blood levels of plasminogen activator inhibitor-1 , NE , and IL-8 were significantly decreased from 48 hours after DHP-PMX treatment . The mean PaO2/FiO2 ratio was significantly improved from 96 hours after DHP-PMX treatment . Improvement in the PaO2/FiO2 ratio appeared to be related to the decreases in blood NE and IL-8 levels OBJECTIVE the aim of the present study was to determine whether serum neopterin and soluble interleukin (IL)-2 receptor levels were related to the development of septic shock and whether polymyxin B-immobilized fibre ( PMX-F ) treatment affects these levels . METHODS we examined 24 patients admitted to our intensive care unit with Gram-negative septic shock .  Serum neopterin and soluble IL-2 receptor levels were measured using commercially available test kits . Patients were treated with direct hemoperfusion using PMX-F columns . RESULTS fifteen out of 24 patients ( 63 % ) survived and were discharged from our hospitals within 30 days after PMX-F treatment .  Blood endotoxin levels decreased significantly from 49.2+/-8.6 pg/ml to 13.2+/-4.4 pg/ml after PMX-F treatment . The pretreatment serum concentrations of neopterin and IL-2 receptor were significantly higher in the nine non-surviving patients with septic shock than in the 15 surviving patients ( P<0.01 ) and 20 control subjects ( P<0.001 ) . Serum concentrations of neopterin and IL-2 receptor in patients with septic shock decreased significantly after PMX-F treatment ( P<0.01 ) . CONCLUSIONS these data suggest that serum neopterin and IL-2 receptor concentrations may be prognostic indicators in patients with septic shock . PMX-F treatment may be effective for reducing serum neopterin and IL-2 receptor concentrations Endotoxin plays an important role in the pathogenesis of septic shock . Exposure of endothelial cells to endotoxin activates endothelial cells and increases the surface expression of adhesion molecules , markers of endothelial damage in organ dysfunction . Endotoxin adsorption therapy by polymyxin B-immobilized fiber column ( PMX ) hemoperfusion has been used for the treatment of septic shock patients . In this study , we measured plasma concentrations of endotoxin and soluble adhesion molecules in septic shock patients before and after the PMX treatment then observed on the relationships between actual duration of use and various outcomes . Sixteen patients with septic shock were studied . The 28-day mortality rate was 50 % . The elevated plasma concentrations of endotoxin decreased after the PMX treatment in the survivors but not in the nonsurvivors . The norepinephrine dose and plasma concentrations of soluble endothelial leukocyte adhesion molecule 1 and soluble intercellular adhesion molecule 1 significantly ( P < 0.05 ) decreased in the PMX greater-than-2-h ( prolonged ) group than in the PMX 2-h ( conventional ) group ( −17.8 ± 14.6 vs. −1.8 ± 2.7 & mgr;g/min , −143.0 ± 111.0 vs. 0 ± 2.8 ng/mL , and −126.2 ± 144.9 vs. 16.5 ± 108.1 ng/mL , respectively ) . Changes in the PaO2-FiO2 ratio and the Sequential Organ Failure Assessment score were significantly ( P < 0.05 ) more improved in the PMX greater-than-2-h group than in the PMX 2-h group ( 75.4 ± 80.7 vs. 1.2 ± 49.2 and −0.8 ± 1.8 vs. 2.2 ± 1.9 torr , respectively ) . We thus suggest that a longer duration of PMX treatment may improve the pulmonary oxygenation associated with decreased adhesion molecules in septic shock Background : CD16 + CD14 + monocytes dramatically increase in number in patients with severe infection .  Hemoperfusion with PMX-F ( direct hemoperfusion with polymyxin B immobilized fibers ) has been reported to be a safe and effective treatment for patients with septic shock , although the molecular mechanism that accounts for its effectiveness is still unclear . The purpose of this study was to quantify the number of CD16+CD14 + monocytes in patients with an intra-abdominal infection and to evaluate the effects of PMX-F treatment on clinical parameters and leukocyte surface antigen expression in these patients . Material s and Methods : Seventeen septic patients who had an intra-abdominal infection were enrolled in this study ; 7 of these patients received PMX-F treatment . Peripheral blood sample s were obtained immediately after admission , and were also collected from the above 7 patients before , during , and immediately after their PMX-F treatment . The expression of CD14 , CD16 , and Toll-like receptor (TLR)-4 on these patients ' monocytes was evaluated using flow cytometry . In addition , lipopolysaccharide (LPS)-induced production of TNF-α and IL-1β by these cells was measured by ELISA . Results : Monocytic expression of CD16 and TLR-4 was significantly greater in septic patients than in healthy controls , and their proportion of CD16+CD14 + monocytes was similarly elevated . LPSinduced production of TNF-α and IL-1β by peripheral blood mononuclear cells ( P BMC s ) of septic patients was significantly reduced compared to controls . Furthermore , there was a reduction in the proportion of CD 16+CD 14 + monocytes  during PMX-F treatment , and in the expression of TLR-4 on monocytes after PMX-F treatment . Conclusions : These results showed that the number of peripheral blood CD16+CD14 + monocytes and monocytic TLR-4 expression were markedly increased , and the production of pro-inflammatory cytokines in response to LPS significantly reduced in patients with sepsis . PMX-F treatment was found to be effective in reducing the number of CD 16+CD 14 + monocytes and in decreasing the monocytic expression of TLR-4 in patients with septic shock Objective : To determine the impact of a thyroid hormone infusion ( T4 ) on the vasopressor requirements in children with cessation of neurologic function ( i.e. , brain death ) during evaluation for organ recovery Design : Retrospective cohort study . Setting : The 1998–2002 data base of a regional organ recovery program . Patients : Children ≤18 yrs with cessation of neurologic function during evaluation for organ recovery ( n = 171 ) were included . The treated group ( n = 91 ) received a weight-based bolus and continuous infusion of T4 according to the organ procurement agency protocol . All other children ( n = 80 ) were considered untreated . Interventions : T4 was administered at the clinician ’s discretion . All children ( treated and untreated ) had identical goals for fluids , blood pressure , and organ function criteria . Vasopressor score ( [ dopamine × 1 ] + [ dobutamine × 1 ] + [ epinephrine × 100 ] + [ norepinephrine × 100 ] + [ phenylephrine × 100 ] ) at the time of the program ’s involvement ( T0 ) and at organ recovery ( TOR ) were recorded . The Wilcoxon rank sum and Student ’s two- sample t-test were used to compare the average vasopressor score at T0 vs. TOR . The Wilcoxon signed rank test was used to analyze the difference in median vasopressor score at T0 vs. TOR . Multivariable linear regression was used to assess the impact of T4 on the ability to wean vasopressor support while accounting for the effects of several potential confounders . Measurements and Main Results : One hundred seventy-one subjects were included in the final analysis .  T4 administration was associated with an unadjusted decrease in the vasopressor score of 32 ( 95 % confidence interval , 12–53 ; p = .002 ) . After adjusting for steroid administration , fluid balance , and baseline vasopressor  score , T4 administration was associated with a decrease in vasopressor score of 24 ( 95 % confidence interval , 6–43 ; p = .011 ) . Conclusions : T4 reduced vasopressor needs in children with cessation of neurologic function and hemodynamic instability . A prospect i ve study of T4 in critically ill and hemodynamically unstable children appears warranted Objective To analyze the effects of polymyxin B-immobilized fiber ( PMX-F ) on bone resorption in septic patients . Design and setting Observational prospect i ve study in intensive care units of a general hospital . Patients and participants 25 patients with severe sepsis and 20 healthy controls . Measurements and results Septic patients were r and omly assigned to two groups : PMX-F treatment group ( n=15 ) and conventional treatment group ( n=10 ) . Total pyridinium crosslink pyridinoline ( PYD ) and deoxypyridinoline ( DPD ) in urine were determined by 
    Output:
    
This systematic review found positive effects of PMX-DHP on mean arterial pressure and dopamine/ dobutamine use , PaO2/FiO2 ratio , endotoxin removal , and mortality .
The EUPHAS study , a multicenter RCT performed in ten Italian intensive care units in 2009 , found that PMX-DHP improved 28-day survival , blood pressure , vasopressor requirement , and degree of organ failure .