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Compensated Shock

Louise Dunphy, Elizabeth Keating, T Parke
A man aged 33 years, born in Nepal, but resident in the UK for 7 years presented to the emergency department with a 4-day history of general malaise, fever (temperature 38.6°C) and a non-productive cough. His medical history was unremarkable and no high-risk behaviour was identified. Clinical examination confirmed decreased air entry bilaterally with bibasal crackles. He was tachycardic, with a heart rate of 120 bpm. Further investigation with a 12-lead ECG confirmed supraventricular tachycardia (SVT) which was terminated with vagal manoeuvres...
November 2, 2016: BMJ Case Reports
Benjamin Derman, Milli Jain, Elizabeth McAninch, Casey Gashti
A 59-year-old man presented with polyuria and polydipsia immediately following his sixth cycle of rituximab and bendamustine for chronic lymphocytic leukemia. He initially compensated by increasing his oral fluid intake at home, but later developed septic shock and was admitted with orders to be kept nil per os (NPO). This prompted an episode of acute hypernatremia during which he exhibited continued polyuria with inappropriately dilute urine. Desmopressin challenge yielded no response in the urine osmolality, indicating a nephrogenic source of his diabetes insipidus (DI)...
October 10, 2016: Clinical Nephrology
Ying Wang, Linli Wang, Weili Yu, Dawei Gao, Guoxing You, Penglong Li, Shan Zhang, Jun Zhang, Tao Hu, Lian Zhao, Hong Zhou
Hemoglobin (Hb)-based oxygen carriers (HBOCs) have been used as blood substitutes in surgery medicine and oxygen therapeutics for ischemic stroke. As a potent HBOC, the PEGylated Hb has received much attention for its oxygen delivery and plasma expanding ability. Two PEGylated Hbs, Euro-Hb and MP4 have been developed for clinical trials, using human adult hemoglobin (HbA) as the original substrate. However, HbA was obtained from outdated human blood and its quantity available from this source may not be sufficient for mass production of PEGylated HbA...
October 3, 2016: Biotechnology Progress
Marc Blondel, Flavie Soubigou, Justine Evrard, Phu Hai Nguyen, Naushaba Hasin, Stéphane Chédin, Reynald Gillet, Marie-Astrid Contesse, Gaëlle Friocourt, Guillaume Stahl, Gary W Jones, Cécile Voisset
6AP and GA are potent inhibitors of yeast and mammalian prions and also specific inhibitors of PFAR, the protein-folding activity borne by domain V of the large rRNA of the large subunit of the ribosome. We therefore explored the link between PFAR and yeast prion [PSI(+)] using both PFAR-enriched mutants and site-directed methylation. We demonstrate that PFAR is involved in propagation and de novo formation of [PSI(+)]. PFAR and the yeast heat-shock protein Hsp104 partially compensate each other for [PSI(+)] propagation...
2016: Scientific Reports
Bratislav Stanković, Goran Stojanović
INTRODUCTION: Massive transfusion is defined as blood transfusion in quantities equal to or greater than the estimated patients' blood volume over a relatively short period of time (3-4 hours). The study was aimed at analyzing the application of chemotherapy in treatment of patients with acute massive bleeding and evaluating the results of hemostasis and platelet counts screening tests in the patients receiving massive transfusions. MATERIAL AND METHODS: Attempts were made to fully compensate hemostatic factors in 24 patients (14 male and 10 female, aged 23 to 76 years) with acute massive and uncontrolled surgical bleeding (polytrauma, abdominal aortic aneurysm, digestive tract bleeding as a result of a farina overdose, mortus fetus) over the five-year period, wherein a circulating patients' blood volume was compensated over a relatively short period of time...
January 2016: Medicinski Pregled
Mariana Lagadari, Nadia R Zgajnar, Luciana I Gallo, Mario D Galigniana
FK506-binding proteins are members of the immunophilin family of proteins. Those immunophilins associated to the 90-kDa-heat-shock protein, Hsp90, have been proposed as potential modulators of signalling cascade factors chaperoned by Hsp90. FKBP51 and FKBP52 are the best characterized Hsp90-bound immunophilins first described associated to steroid-receptors. The reverse transcriptase subunit of telomerase, hTERT, is also an Hsp90 client-protein and is highly expressed in cancer cells, where it is required to compensate the loss of telomeric DNA after each successive cell division...
August 2016: Molecular Oncology
Camille L Stewart, Jane Mulligan, Greg Z Grudic, Mark E Talley, Gregory J Jurkovich, Steven L Moulton
INTRODUCTION: Humans are able to compensate for significant blood loss with little change in traditional vital signs. We hypothesized that an algorithm, which recognizes compensatory changes in photoplethysmogram (PPG) waveforms, could detect active bleeding and ongoing volume loss in injured patients. METHODS: Injured adults were prospectively enrolled at a level I trauma center. PPG data collection was conducted using a custom-made pulse oximeter. Waveform data were post-processed by an algorithm to calculate the compensatory reserve index (CRI), measured on a scale of 1 to 0, with 1 indicating fully compensated and 0 indicating no reserve, or decompensation...
September 2016: Shock
Barney Thomas Jesudason Isaac, Thomas McLellan, Johnson Samuel, Bernard Yung
A 66-year-old man, an asthmatic, presented with symptoms suggestive of an acute exacerbation of asthma. His arterial blood gas revealed type 1 respiratory failure (PaO2 <8 kPa or 60 mm Hg with normal or low PaCO2) with a compensated lactic acidosis. He was treated for an asthma exacerbation and sepsis. Despite treatment, his respiratory rate remained elevated although his hypoxaemia improved. There was progressive worsening of the lactic acidosis. Treatment for sepsis was augmented. Peak flow measurements were not used to assess the severity of his exacerbation nor his response to treatment...
May 10, 2016: BMJ Case Reports
Obed Dolo, Alice Clack, Hannah Gibson, Naomi Lewis, David P Southall
PROBLEM: The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. APPROACH: In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. LOCAL SETTING: The training took place in CB Dunbar Maternity Hospital...
May 1, 2016: Bulletin of the World Health Organization
Dig B Mahat, H Hans Salamanca, Fabiana M Duarte, Charles G Danko, John T Lis
The heat shock response (HSR) is critical for survival of all organisms. However, its scope, extent, and the molecular mechanism of regulation are poorly understood. Here we show that the genome-wide transcriptional response to heat shock in mammals is rapid and dynamic and results in induction of several hundred and repression of several thousand genes. Heat shock factor 1 (HSF1), the "master regulator" of the HSR, controls only a fraction of heat shock-induced genes and does so by increasing RNA polymerase II release from promoter-proximal pause...
April 7, 2016: Molecular Cell
Junjian Yi, James J Heckman, Junsen Zhang, Gabriella Conti
An open question in the literature is whether families compensate or reinforce the impact of child health shocks. Discussions usually focus on one dimension of child investment. This paper examines multiple dimensions using household survey data on Chinese child twins whose average age is 11. We find that, compared with a twin sibling who did not suffer from negative early health shocks at ages 0-3, the other twin sibling who did suffer negative health shocks received RMB 305 more in terms of health investments, but received RMB 182 less in terms of educational investments in the 12 months prior to the survey...
November 2015: Economic Journal
Loretta Ho, Lawrence Lau, Leonid Churilov, Bernhard Riedel, Larry McNicol, Robert G Hahn, Laurence Weinberg
INTRODUCTION: The most effective rate of fluid resuscitation in haemorrhagic shock is unknown. METHODS: We performed a randomized crossover pilot study in a healthy volunteer model of compensated haemorrhagic shock. Following venesection of 15 mL/kg of blood, participants were randomized to 20 mL/kg of crystalloid over 10 min (FAST treatment) or 30 min (SLOW treatment). The primary end point was oxygen delivery (DO2). Secondary end points included pressure and flow-based haemodynamic variables, blood volume expansion, and clinical biochemistry...
August 2016: Shock
Michael Tytell, Raymond J Lasek, Harold Gainer
Of all cellular specializations, the axon is especially distinctive because it is a narrow cylinder of specialized cytoplasm called axoplasm with a length that may be orders of magnitude greater than the diameter of the cell body from which it originates. Thus, the volume of axoplasm can be much greater than the cytoplasm in the cell body. This fact raises a logistical problem with regard to axonal maintenance. Many of the components of axoplasm, such as soluble proteins and cytoskeleton, are slowly transported, taking weeks to months to travel the length of axons longer than a few millimeters after being synthesized in the cell body...
2016: F1000Research
Victor A Convertino, Michael D Wirt, John F Glenn, Brian C Lein
Shock is deadly and unpredictable if it is not recognized and treated in early stages of hemorrhage. Unfortunately, measurements of standard vital signs that are displayed on current medical monitors fail to provide accurate or early indicators of shock because of physiological mechanisms that effectively compensate for blood loss. As a result of new insights provided by the latest research on the physiology of shock using human experimental models of controlled hemorrhage, it is now recognized that measurement of the body's reserve to compensate for reduced circulating blood volume is the single most important indicator for early and accurate assessment of shock...
June 2016: Shock
Ichiro Tatsuno, Ryo Okada, Masakado Matsumoto, Nanako Hata, Hideyuki Matsui, Yan Zhang, Masanori Isaka, Tadao Hasegawa
Streptococcus pyogenes is a causative agent of streptococcal toxic shock syndrome (STSS). Mutations in covR/S or rgg, negative regulators, can reportedly modulate the severity of infection in this pathogen. Recently, we showed that the regions encoding the SalR-SalK, a two-component regulatory system, were deleted in some emm 1-type isolates (named as 'novel-type'). In this study, the two novel 'STSS' isolates 10-85stss and 11-171stss were more virulent than the two novel 'non-STSS' isolates 11O-2non and 11T-3non when examined using a mouse model of invasive infection...
May 2016: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Andrew S Burrows, John H Burrows
The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense.
2016: Medical Law Review
K Mertens, L Jacobs, J Maes, C Kabaseke, M Maertens, J Poesen, M Kervyn, L Vranken
Landslides affect millions of people worldwide, but theoretical and empirical studies on the impact of landslides remain scarce, especially in Sub-Saharan Africa. This study proposes and applies a method to estimate the direct impact of landslides on household income and to investigate the presence of specific risk sharing and mitigation strategies towards landslides in a tropical and rural environment. An original cross-sectional household survey is used in combination with geographical data to acquire detailed information on livelihoods and on hazards in the Rwenzori mountains, Uganda...
April 15, 2016: Science of the Total Environment
K Brooks Low, Sean R Murray, John Pawelek, David Bermudes
Tumor-targeted Salmonella offers a promising approach to the delivery of therapeutics for the treatment of cancer. The Salmonella strains used, however, must be stably attenuated in order to provide sufficient safety for administration. Approaches to the generation of attenuated Salmonella strains have included deletion of the msbB gene that is responsible for addition of the terminal myristol group to lipid A. In the absence of myristoylation, lipid A is no longer capable of inducing septic shock, resulting in a significant enhancement in safety...
2016: Methods in Molecular Biology
K Lamvik, E Guiu Hernandez, R Jones, M-L Huckabee
BACKGROUND: A substantial pressure drift in high-resolution manometry (HRM) has been reported; however, fundamental questions remain regarding the origin and management of this drift. The aim of this study was to provide critical in-depth analyses of ManoScan(™) HRM drift in vitro and in vivo. METHODS: A total of sixteen 15-min studies and twelve 5-h studies were performed in a water bath at 37 °C at 4.0 cm depth (2.9 mmHg) with ESO and ESO Z catheters. Six 5-h in vitro studies were performed similarly at a depth of 9...
May 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Shi Qiang Liu, Rong Zhu
Errors compensation of micromachined-inertial-measurement-units (MIMU) is essential in practical applications. This paper presents a new compensation method using a neural-network-based identification for MIMU, which capably solves the universal problems of cross-coupling, misalignment, eccentricity, and other deterministic errors existing in a three-dimensional integrated system. Using a neural network to model a complex multivariate and nonlinear coupling system, the errors could be readily compensated through a comprehensive calibration...
2016: Sensors
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