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https://www.readbyqxmd.com/read/28829877/effect-of-ganciclovir-on-il-6-levels-among-cytomegalovirus-seropositive-adults-with-critical-illness-a-randomized-clinical-trial
#1
Ajit P Limaye, Renee D Stapleton, Lili Peng, Scott R Gunn, Louise E Kimball, Robert Hyzy, Matthew C Exline, D Clark Files, Peter E Morris, Stephen K Frankel, Mark E Mikkelsen, Duncan Hite, Kyle B Enfield, Jay Steingrub, James O'Brien, Polly E Parsons, Joseph Cuschieri, Richard G Wunderink, David L Hotchkin, Ying Q Chen, Gordon D Rubenfeld, Michael Boeckh
Importance: The role of cytomegalovirus (CMV) reactivation in mediating adverse clinical outcomes in nonimmunosuppressed adults with critical illness is unknown. Objective: To determine whether ganciclovir prophylaxis reduces plasma interleukin 6 (IL-6) levels in CMV-seropositive adults who are critically ill. Design, Setting, and Participants: Double-blind, placebo-controlled, randomized clinical trial (conducted March 10, 2011-April 29, 2016) with a follow-up of 180 days (November 10, 2016) that included 160 CMV-seropositive adults with either sepsis or trauma and respiratory failure at 14 university intensive care units (ICUs) across the United States...
August 22, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28829521/the-prevalence-of-nasal-obstruction-as-a-consideration-in-the-treatment-of-opioid-overdose
#2
Scott G Weiner, Andrew R Joyce, Heather N Thomson
OBJECTIVES: The intranasal route of administration for naloxone delivery is one treatment for opioid overdose, but treatment failures with this modality have been documented. This study determines the incidence of obstructive nasal pathology in patients who experienced serious opioid-induced respiratory depression (OIRD). DESIGN: Retrospective analysis of the IMS LifeLink: Health Plan Claims Database to detect patients with at least one opioid pharmacy claim from 2009 to 2013 and who experienced serious OIRD...
March 2017: Journal of Opioid Management
https://www.readbyqxmd.com/read/28829041/loss-of-the-melanocortin-4-receptor-in-mice-causes-dilated-cardiomyopathy
#3
Michael J Litt, G Donald Okoye, Daniel Lark, Isin Cakir, Christy Moore, Mary C Barber, James Atkinson, Josh Fessel, Javid Moslehi, Roger D Cone
Haploinsufficiency of the melanocortin-4 receptor, the most common monogenetic obesity syndrome in humans, is associated with a reduction in autonomic tone, bradycardia, and incidence of obesity-associated hypertension. Thus, it has been assumed that melanocortin obesity syndrome may be protective with respect to obesity-associated cardiovascular disease. We show here that absence of the melanocortin-4 receptor (MC4R) in mice causes dilated cardiomyopathy, characterized by reduced contractility and increased left ventricular diameter...
August 22, 2017: ELife
https://www.readbyqxmd.com/read/28828372/high-flow-nasal-oxygen-therapy-and-noninvasive-ventilation-in-the-management-of-acute-hypoxemic-respiratory-failure
#4
REVIEW
Jean-Pierre Frat, Rémi Coudroy, Nicolas Marjanovic, Arnaud W Thille
High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828370/right-heart-function-during-acute-respiratory-distress-syndrome
#5
REVIEW
Xavier Repessé, Antoine Vieillard-Baron
Acute respiratory distress syndrome (ARDS) is burdened with significant mortality, mainly in connection with circulatory failure. The right ventricle (RV) is the weak link of hemodynamic stability among ARDS patients and its failure, also named "severe" acute cor pulmonale (ACP), is responsible for excess mortality. Driving pressure ≥18 cmH2O, PaCO2 ≥48 mmHg and PaO2/FiO2 <150 mmHg are three preventable factors recently identified as independently associated with ACP, on which ventilator strategy designed to protect the RV has to focus...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828367/spontaneous-breathing-a-double-edged-sword-to-handle-with-care
#6
REVIEW
Tommaso Mauri, Barbara Cambiaghi, Elena Spinelli, Thomas Langer, Giacomo Grasselli
In acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) patients, spontaneous breathing is associated with multiple physiologic benefits: it prevents muscles atrophy, avoids paralysis, decreases sedation needs and is associated with improved hemodynamics. On the other hand, in the presence of uncontrolled inspiratory effort, severe lung injury and asynchronies, spontaneous ventilation might also worsen lung edema, induce diaphragm dysfunction and lead to muscles exhaustion and prolonged weaning...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828363/positive-end-expiratory-pressure-how-to-set-it-at-the-individual-level
#7
REVIEW
Luciano Gattinoni, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Federica Romitti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The positive end-expiratory pressure (PEEP), since its introduction in the treatment of acute respiratory failure, up to the 1980s was uniquely aimed to provide a viable oxygenation. Since the first application, a large debate about the criteria for selecting the PEEP levels arose within the scientific community. Lung mechanics, oxygen transport, venous admixture thresholds were all proposed, leading to PEEP recommendations from 5 up to 25 cmH2O. Throughout this period, the main concern was the hemodynamics...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28827077/high-potential-defense-mechanisms-of-neocortex-in-a-rat-model-of-transient-asphyxia-induced-cardiac-arrest
#8
Gerburg Keilhoff, Torben Esser, Maximilian Titze, Uwe Ebmeyer, Lorenz Schild
Cardiac arrest (CA) is a common cause of disability and mortality and thus an important risk for human health. Circulatory failure has dramatic consequences for the brain as one of the most oxygen-consuming organs. Hippocampus, striatum and neocortex rate among the most vulnerable brain regions. The neocortex is less sensitive to hypoxia/reperfusion in comparison with the hippocampal CA1 region. That implicates the existence of efficient defense mechanisms in the neocortex against hypoxia/reperfusion injury, which we analyzed in a well-established CA rat model...
August 18, 2017: Brain Research
https://www.readbyqxmd.com/read/28826916/surgical-treatment-of-intramedullary-ependymomas
#9
Marek Prokopienko, Przemysław Kunert, Anna Podgórska, Andrzej Marchel
OBJECT: The aims of this study were to present the results of surgery for intramedullary ependymomas (IEs), analyze complication and recurrence rates, and analyze factors that might influence outcome. METHODS: The charts of 29 consecutive patients (women - 8, men - 21; mean age - 38 years; range: 18-72) operated for IE were retrospectively analyzed. Mean follow-up was 9 years. Eighteen tumors (62%) were located in the cervical or cervicothoracic spine, and average tumor length was four spinal levels...
July 8, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28826824/acute-respiratory-failure-with-an-unexpected-etiology-in-an-elderly-patient
#10
Shun Yamashita, Naoko E Katsuki, Masaki Tago
No abstract text is available yet for this article.
August 18, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28822818/phrenic-long-term-facilitation-following-intrapleural-ctb-sap-induced-respiratory-motor-neuron-death
#11
Nicole L Nichols, Taylor A Craig, Miles A Tanner
Amyotrophic lateral sclerosis (ALS) is a devastating disease leading to progressive motor neuron degeneration and death by ventilatory failure. In a rat model of ALS (SOD1(G93A)), phrenic long-term facilitation (pLTF) following acute intermittent hypoxia (AIH) is enhanced greater than expected at disease end-stage but the mechanism is unknown. We suggest that one trigger for this enhancement is motor neuron death itself. Intrapleural injections of cholera toxin B fragment conjugated to saporin (CTB-SAP) selectively kill respiratory motor neurons and mimic motor neuron death observed in SOD1(G93A) rats...
August 16, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28822726/recurrent-out-of-hospital-cardiac-arrest
#12
Ziad Nehme, Emily Andrew, Resmi Nair, Stephen Bernard, Karen Smith
BACKGROUND: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. METHODS: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database...
August 16, 2017: Resuscitation
https://www.readbyqxmd.com/read/28822504/is-smog-innocuous-air-pollution-and-cardiovascular-disease
#13
EDITORIAL
Sundeep Mishra
Air pollution is a significant environmental and health hazard. Earlier studies had examined the adverse health effects associated with short- and long-term exposure to particulate matter on respiratory disease. However, later studies demonstrated that was actually cardiovascular disease that accounted for majority of mortality. Furthermore, it was not gaseous pollutants like oxides of nitrate, sulfur, carbon mono-oxide or ozone but the particulate matter or PM, of fine or coarse size (PM2.5 and PM10) which was linearly associated with mortality; PM2...
July 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28821988/presentation-and-management-of-symptomatic-central-bone-cement-embolization
#14
Ahmed Samir Barakat, Tamer Owais, Mohamed Alhashash, Mootaz Shousha, Hesham El Saghir, Bernward Lauer, Heinrich Boehm
BACKGROUND CONTEXT: With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial. PURPOSE: In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization...
August 18, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28821364/serologic-responses-of-42-mers-coronavirus-infected-patients-according-to-the-disease-severity
#15
Jae-Hoon Ko, Marcel A Müller, Hyeri Seok, Ga Eun Park, Ji Yeon Lee, Sun Young Cho, Young Eun Ha, Jin Yang Baek, So Hyun Kim, Ji-Man Kang, Yae-Jean Kim, Ik Joon Jo, Chi Ryang Chung, Myong-Joon Hahn, Christian Drosten, Cheol-In Kang, Doo Ryeon Chung, Jae-Hoon Song, Eun-Suk Kang, Kyong Ran Peck
We evaluated serologic response of 42 Middle East respiratory syndrome coronavirus (MERS-CoV)-infected patients according to 4 severity groups: asymptomatic infection (Group 0), symptomatic infection without pneumonia (Group 1), pneumonia without respiratory failure (Group 2), and pneumonia progressing to respiratory failure (Group 3). None of the Group 0 patients showed seroconversion, while the seroconversion rate gradually increased with increasing disease severity (0.0%, 60.0%, 93.8%, and 100% in Group 0, 1, 2, 3, respectively; P = 0...
July 14, 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/28820175/noninvasive-mechanical-ventilation-in-early-acute-respiratory-distress-syndrome
#16
Alice Grassi, Giuseppe Foti, John G Laffey, Giacomo Bellani
Non invasive ventilation (NIV) has a well established role in the treatment of acute-on-chronic respiratory failure and cardiogenic pulmonary oedema. Its role in acute hypoxaemic respiratory failure has been increasingly investigated, but its impact on the management and the outcome of the subset of patients affected by acute respiratory distress syndrome (ARDS) is still to be determined. ARDS could be a risk factor for NIV failure and in these patient delayed endotracheal intubation can lead to an increased mortality...
August 17, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28817480/revised-national-estimates-of-emergency-department-visits-for-sepsis-in-the-united-states
#17
Henry E Wang, Allison R Jones, John P Donnelly
OBJECTIVES: The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN: Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING: U.S. emergency department visits, 2009-2011. PATIENTS: Adult (age, ≥ 18 yr) emergency department sepsis patients...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28817366/trajectory-of-dyspnea-and-respiratory-distress-among-patients-in-the-last-month-of-life
#18
Margaret L Campbell, Jason M Kiernan, John Strandmark, Hossein N Yarandi
BACKGROUND: The trajectory of dyspnea has been reported among patients approaching the end of life. However, patients near death have been dropped from longitudinal studies or excluded altogether because of an inability to self-report; proxy estimates have been reported. It is not known whether dyspnea or respiratory distress remains stable, escalates, or abates as patients reach last days. OBJECTIVE: Determine trajectory of dyspnea (self-reported) and respiratory distress (observed) among patients who were approaching death...
August 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28816877/fractures-in-spinal-ankylosing-disorders-a-narrative-review-of-disease-and-injury-types-treatment-techniques-and-outcomes
#19
Tarush Rustagi, Doniel Drazin, Cumhur Oner, Jonathan York, Gregory D Schroeder, Alexander R Vaccaro, Rod J Oskouian, Jens R Chapman
INTRODUCTION: Spinal ankylosing disorders encompass ankylosing spondylitis (AS), disseminated hyperostosis of the spine, and end-stage spondylosis. All these result in a stiffened and frequently deformed spinal column. This makes the spinal column highly susceptible to severe injuries that are commonly associated with unfavorable outcomes. Improved understanding of the underlying disease processes and clinical comorbidities may alter the poor injury related morbidity and mortality outcomes...
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28816799/successful-extracorporeal-life-support-in-a-pediatric-hematopoietic-stem-cell-transplant-recipient-with-periengraftment-respiratory-failure
#20
Jenny Potratz, Martina Ahlmann, Claudia Rössig, Heymut Omran, Katja Masjosthusmann
The use of extracorporeal life support (ECLS) as ultimate salvage therapy for hematopoietic stem cell transplant recipients remains controversial among oncologists and critical care specialists. Prognosis is poor, particularly after allogeneic transplantation, and literature to guide clinical decision-making is scarce. Our report describes successful ECLS in a pediatric patient undergoing allogeneic hematopoietic stem cell transplantation, who developed acute respiratory failure during severe neutropenia, followed by immediate neutrophil engraftment...
August 14, 2017: Journal of Pediatric Hematology/oncology
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