***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: We investigated whether serum cardiac troponin T levels are altered in septic patients undergoing hemodialysis and whether polymyxin B-immobilized fiber ( PMX-F ) treatment affects these levels . Fourteen hemodialysis patients with sepsis , 14 hemodialysis patients without sepsis , and 12 age matched healthy controls were included in this study . Cardiac troponin T levels in hemodialysis patients with sepsis ( 0.56 ± 0.28 & mgr;g/L ) were higher than levels in hemodialysis patients without sepsis ( 0.16 ± 0.06 & mgr;g/L , p < 0.01 ) and healthy control subjects ( 0.03 ± 0.01 & mgr;g/L , p < 0.001 ) . The 14 hemodialysis patients with sepsis were r and omly assigned to one of two treatment approaches : PMX-F treatment ( n = 7 ) or conventional treatment ( n = 7 ) . Plasma endotoxin levels were significantly reduced from 46.6 ± 17.8 pg/ml to 8.2 ± 2.4 pg/ml , p < 0.01 , in patients treated with PMX-F , and serum cardiac troponin T levels were also reduced from 0.62 ± 0.30 & mgr;g/L to 0.26 ± 0.12 & mgr;g/L , p < 0.05 . Cardiac troponin T levels were unchanged in patients under conventional treatment . These data suggest that cardiac troponin T is indeed elevated in septic patients undergoing hemodialysis and may reflect sub clinical myocardial cell damage . PMX-F is effective in reducing myocardial damage , in part , due to reducing plasma endotoxin levels 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 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 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 modified high-performance liquid chromatography . Nitric oxide production was assessed by measuring the ratio of the nitric oxide breakdown products to urinary creatinine ( NOx/Cr ) . Plasma endotoxin levels were determined by endospecy test . The blood albumin , ionized calcium , and parathyroid hormone were also measured . PMX-F treatment was performed twice separated by 24 h. Urinary NOx/Cr , PYD/Cr , and DPD/Cr were significantly increased in septic patients compared with those in healthy controls . Blood ionized calcium in septic patients was lower than in healthy controls , while parathyroid hormone levels in septic patients were higher than in healthy controls ( P<0.01 ) . PMX-F treatment reduced plasma endotoxin , urinary NOx/Cr , PYD/Cr , DPD/Cr , and serum parathyroid hormone levels and increased blood ionized calcium significantly ; however , conventional treatment did not affect these levels . Conclusions Septic patients increased nitric oxide production and bone resorption , and PMX-F treatment is effective in reducing nitric oxide levels and bone resorption markers Endotoxin is an important pathogenic trigger for sepsis . The polymyxin B-immobilized endotoxin removal hemoperfusion cartridge , Toraymyxin ( hereafter PMX ) , has been shown to remove endotoxin in pre clinical and open-label clinical studies . In a multicenter , open-label , pilot , r and omized , controlled study conducted in the intensive care unit in six academic medical centers in Europe , 36 postsurgical patients with severe sepsis or septic shock secondary to intra-abdominal infection were r and omized to PMX treatment of 2 h ( n = 17 ) or st and ard therapy ( n = 19 ) . PMX was well tolerated and showed no significant side effects . There were no statistically significant differences in the change in endotoxin levels from baseline to 6 to 8 h after treatment or to 24 h after treatment between the two groups . There was also no significant difference in the change in interleukin (IL)-6 levels from baseline to 6 to 8 h after treatment or to 24 h after treatment between the two groups . Patients treated with PMX demonstrated significant increases in cardiac index ( CI ; P = 0.012 and 0.032 at days 1 and 2 , respectively ) , left ventricular stroke work index ( LVSWI , P = 0.015 at day 2 ) , and oxygen delivery index ( DO2I , P = 0.007 at day 2 ) compared with the controls . The need for continuous renal replacement therapy ( CRRT ) after study entry was reduced in the PMX group ( P = 0.043 ) . There was no significant difference between the groups in organ dysfunction as assessed by the Sequential Organ Failure Assessment ( SOFA ) scores from day 0 ( baseline ) to day 6 . Treatment using the PMX cartridge is safe and may improve cardiac and renal dysfunction due to sepsis or septic shock . Further studies are needed to prove this effectiveness Objective To test the hypothesis that extracorporeal therapy with polymyxin B ( PMX-B ) may prevent Gram-negative sepsis-induced acute renal failure ( ARF ) by reducing the activity of proapoptotic circulating factors . Setting Medical-Surgical Intensive Care Units . Patients and interventions Sixteen patients with Gram-negative sepsis were r and omized to receive st and ard care ( Surviving Sepsis Campaign guidelines ) or st and ard care plus extracorporeal therapy with PMX-B.  Measurements and results Cell viability , apoptosis , polarity , morphogenesis , and epithelial integrity were evaluated in cultured tubular cells and glomerular podocytes incubated with plasma from patients of both groups . Renal function was evaluated as SOFA and RIFLE scores , proteinuria , and tubular enzymes . A significant decrease of plasma-induced proapoptotic activity was observed after PMX-B treatment on cultured renal cells . SOFA and RIFLE scores , proteinuria , and urine tubular enzymes were all significantly reduced after PMX-B treatment . Loss of plasma-induced polarity and permeability of cell cultures was abrogated with the plasma of patients treated with PMX-B. These results were associated to a preserved expression of molecules crucial for tubular and glomerular functional integrity . Conclusions Extracorporeal therapy with PMX-B reduces the proapoptotic activity of the plasma of septic patients on cultured renal cells . These data confirm the role of apoptosis in the development of sepsis-related ARF Objective : To find out whether polymyxin B-immobilized fiber ( PMX-F ) treatment affects the clinical parameters and plasma concentrations of erythropoietin ( EPO ) and interleukin (IL)-6 . Design : A prospect i ve case series study . Setting : Intensive care unit of the Department of Internal Medicine , Misato Junshin Hospital , Saitama , and Koto Hospital , Tokyo , Japan . Patients : 17 consecutive patients ( 10 men , 7 women ; mean age 54.6 years ) with clinical ly defined septic shock and 20 healthy volunteers ( 12 men , 8 women ; mean age 52.2 years ) . Main results : Of the 17 patients with septic shock , 9 ( 53 % ) survived . The systolic blood pressure increased significantly from 78 ± 6 to 106 ± 8 mm Hg 2 h after PMX-F treatment in patients with septic shock . Plasma endotoxin levels decreased significantly after treatment , from 40 ± 6 to 12 ± 4 pg/ml . The pretreatment plasma concentrations of EPO and IL-6 were significantly higher in the 8 nonsurviving patients with septic shock ( EPO : 400 ± 36 mlU/ml ; IL-6 : 6260 ± 1180 pg/ml ) than in the 9 surviving patients ( EPO : 120 ± 22 mlU/ml ; IL-6 : 680 ± 138 pg/ml ) and the 20 control subjects ( EPO , 12 ± 6 mlU/ml ; IL-6 , 8 ± 2 pg/ml ) . Plasma concentrations of EPO and IL-6 in patients with septic shock decreased significantly after PMX-F treatment ( EPO , nonsurviving : 320 ± 28 mlU/ml , p < 0.05 ; survivors : 26 ± 8 mlU/ml , p < 0.001 ; IL-6 , nonsurviving : 3860 ± 840 
    Output:
    
Polymyxin B-immobilized fiber column hemoperfusion adsorbed monocytes , activated neutrophils , and an and amide , as well as endotoxin through direct covalent bond , hydrophobic and ionic interactions , and hydrodynamics , and reduced the blood concentrations of inflammatory cytokines , plasminogen activator inhibitor 1 and adhesion molecules .
Polymyxin B-immobilized fiber column hemoperfusion increased blood pressure and reduced the dosage requirements for vasopressive/inotropic agents .
The meta- analysis showed that PMX treatment had beneficial effects on the hemodynamics , pulmonary oxygenation , and mortality .
These beneficial effects may be attributable to the direct adsorption of endotoxin , monocytes , activated neutrophils , and an and amide , as well as indirect decrease in inflammatory cytokines and other mediators .
Polymyxin B-immobilized fiber column hemoperfusion treatment has additional effects on reducing endothelial damage , proapoptotic activity , and immunosuppression .