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https://www.readbyqxmd.com/read/28930639/50-years-of-research-in-ards-tidal-volume-selection-in-the-acute-respiratory-distress-syndrome
#1
Sarina K Sahetya, Jordi Mancebo, Roy G Brower
Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Since the publication of a large randomized clinical trial demonstrating the benefit of lower tidal volumes, the use of tidal volumes of 6 mL/kg predicted body weight (PBW, based on sex and height) has been recommended in clinical practice guidelines...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28929875/using-structured-incentives-to-increase-value-for-money-in-an-academic-health-sciences-centre
#2
Guy J Hébert, Connie Colasante, Renate G Ilse, Alan J Forster
As healthcare continues to consume more and more of provincial government spending, there is a continuing pressure to improve efficiency and cut overall costs. In this increasingly constrained healthcare system, value for money is a growing focus of discussions around accountability and system sustainability; healthcare leaders are required to find ways of measuring, enforcing, and reporting on that value. In 2014, our organization began implementing an innovative system of structured incentives, linking distribution of Ministry of Health and Long-Term Care academic physician funding to quality and performance goals...
July 2017: Healthcare Management Forum
https://www.readbyqxmd.com/read/28929577/salt-intake-and-blood-pressure-response-to-percutaneous-renal-denervation-in-resistant-hypertension
#3
Esther de Beus, Rosa L de Jager, Martine M Beeftink, Margreet F Sanders, Wilko Spiering, Evert-Jan Vonken, Michiel Voskuil, Michiel L Bots, Peter J Blankestijn
The effect of lowering sympathetic nerve activity by renal denervation (RDN) is highly variable. With the exception of office systolic blood pressure (BP), predictors of the BP-lowering effect have not been identified. Because dietary sodium intake influences sympathetic drive, and, conversely, sympathetic activity influences salt sensitivity in hypertension, we investigated 24-hour urinary sodium excretion in participants of the SYMPATHY trial. SYMPATHY investigated RDN in patients with resistant hypertension...
September 19, 2017: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/28929163/acoustic-tweezing-of-particles-using-decaying-opposing-travelling-surface-acoustic-waves-dotsaw
#4
Jia Wei Ng, Citsabehsan Devendran, Adrian Neild
Surface acoustic waves offer a versatile and biocompatible method of manipulating the location of suspended particles or cells within microfluidic systems. The most common approach uses the interference of identical frequency, counter propagating travelling waves to generate a standing surface acoustic wave, in which particles migrate a distance less than half the acoustic wavelength to their nearest pressure node. The result is the formation of a periodic pattern of particles. Subsequent displacement of this pattern, the prerequisite for tweezing, can be achieved by translation of the standing wave, and with it the pressure nodes; this requires changing either the frequency of the pair of waves, or their relative phase...
September 20, 2017: Lab on a Chip
https://www.readbyqxmd.com/read/28927432/deer-presence-rather-than-abundance-determines-the-population-density-of-the-sheep-tick-ixodes-ricinus-in-dutch-forests
#5
Tim R Hofmeester, Hein Sprong, Patrick A Jansen, Herbert H T Prins, Sipke E van Wieren
BACKGROUND: Understanding which factors drive population densities of disease vectors is an important step in assessing disease risk. We tested the hypothesis that the density of ticks from the Ixodes ricinus complex, which are important vectors for tick-borne diseases, is determined by the density of deer, as adults of these ticks mainly feed on deer. METHODS: We performed a cross-sectional study to investigate I. ricinus density across 20 forest plots in the Netherlands that ranged widely in deer availability to ticks, and performed a deer-exclosure experiment in four pairs of 1 ha forest plots in a separate site...
September 19, 2017: Parasites & Vectors
https://www.readbyqxmd.com/read/28924054/immunosurveillance-and-immunoediting-of-breast-cancer-via-class-i-mhc-receptors
#6
Megan M Tu, Mir Munir A Rahim, Celine Sayed, Ahmad Bakur Mahmoud, Andrew P Makrigiannis
Ly49 receptors, which recognize 'self' class I major histocompatibility complex (MHC-I) molecules, enable natural killer (NK) cells to detect loss of MHC-I expression on transformed and virally-infected cells. The impact of NK cell-mediated MHC-I surveillance on immunoediting of breast cancer is still not fully understood. This work assesses the impact of Ly49 receptors on tumor development in terms of cancer control and in driving immune-evading cancer mutations. Genetically modified Ly49-deficient mice and those lacking NK cells through antibody depletion were less able to control E0771-derived mammary tumors in an MHC-I-dependent fashion...
September 18, 2017: Cancer Immunology Research
https://www.readbyqxmd.com/read/28917733/stabilization-of-gas-phase-uranyl-complexes-enables-rapid-speciation-using-electrospray-ionization-and-ion-mobility-mass-spectrometry
#7
Austen L Davis, Brian H Clowers
Significant challenges exist when characterizing f-element complexes in solution using traditional approaches such as electrochemical and spectroscopic techniques as they do not always capture information for lower abundance species. However, provided a metal-complex with sufficient stability, soft ionization techniques such as electrospray offer a means to quantify and probe the characteristics of such systems using mass spectrometry. Unfortunately, the gas-phase species observed in ESI-MS systems do not always reflect the solution phase distributions due to the inherent electrochemical mechanism of the electrospray process, ion transfer from ambient to low pressures conditions, and other factors that are related to droplet evaporation...
January 1, 2018: Talanta
https://www.readbyqxmd.com/read/28915040/elucidating-the-interdependence-of-drug-resistance-from-combinations-of-mutations
#8
Debra A Ragland, Troy W Whitfield, Sook-Kyung Lee, Ronald Swanstrom, Konstantin B Zeldovich, Nese Kurt Yilmaz, Celia A Schiffer
HIV-1 protease is responsible for the cleavage of 12 non-homologous sites within the Gag and Gag-Pro-Pol polyproteins in the viral genome. Under the selective pressure of protease inhibition, the virus evolves mutations within (primary) and outside of (secondary) the active site allowing the protease to process substrates while simultaneously countering inhibition. The primary protease mutations impede inhibitor binding directly, while the secondary mutations are considered accessory mutations that compensate for a loss in fitness...
September 15, 2017: Journal of Chemical Theory and Computation
https://www.readbyqxmd.com/read/28913708/emergency-neurological-life-support-intracerebral-hemorrhage
#9
J Claude Hemphill, Arthur Lam
Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28910637/intrahost-selection-pressures-drive-rapid-dengue-virus-microevolution-in-acute-human-infections
#10
Poornima Parameswaran, Chunling Wang, Surbhi Bharat Trivedi, Meghana Eswarappa, Magelda Montoya, Angel Balmaseda, Eva Harris
Dengue, caused by four dengue virus serotypes (DENV-1 to DENV-4), is a highly prevalent mosquito-borne viral disease in humans. Yet, selection pressures driving DENV microevolution within human hosts (intrahost) remain unknown. We employed a whole-genome segmented amplification approach coupled with deep sequencing to profile DENV-3 intrahost diversity in peripheral blood mononuclear cell (PBMC) and plasma samples from 77 dengue patients. DENV-3 intrahost diversity appears to be driven by immune pressures as well as replicative success in PBMCs and potentially other replication sites...
September 13, 2017: Cell Host & Microbe
https://www.readbyqxmd.com/read/28910144/ask1-inhibition-halts-disease-progression-in-preclinical-models-of-pulmonary-arterial-hypertension
#11
Grant R Budas, Mario Boehm, Baktybek Kojonazarov, Gayathri Viswanathan, Xia Tian, Swathi Veeroju, Tatyana Novoyatleva, Friedrich Grimminger, Ford Hinojosa-Kirschenbaum, Hossein A Ghofrani, Norbert Weissmann, Werner Seeger, John T Liles, Ralph T Schermuly
RATIONALE Progression of pulmonary arterial hypertension (PAH) is associated with pathologic remodeling of the pulmonary vasculature and the right ventricle (RV). Oxidative stress drives the remodeling process through activation of mitogenactivated protein kinases (MAPKs) which stimulate apoptosis, inflammation and fibrosis. OBJECTIVES We investigated whether pharmacological inhibition of the redoxsensitive apical MAPK Apoptosis Signal-Regulating Kinase 1 (ASK1) can halt the progression of pulmonary vascular and RV remodeling...
September 14, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28905813/effect-of-hydrostatic-pressure-on-the-superconducting-properties-of-quasi-one-dimensional-superconductor-k-sub-2-sub-cr-sub-3-sub-as-sub-3-sub
#12
Jianping Sun, Yuanyuan Jiao, Chongli Yang, Wei Wu, Changjiang Yi, Bosen Wang, You Guo Shi, Jian Lin Luo, Yoshiya Uwatoko, Jinguang Cheng
K2Cr3As3 is a newly discovered quasi-one-dimensional superconductor with a Tc = 6.1 K and an upper critical field μ0Hc2(0) ~ 40 T three times larger than the Pauli paramagnetic limit μ0Hp that is suggestive of a spin-triplet Cooper pairing. In this paper, we have investigated the effects of hydrostatic pressure on its Tc and μ0Hc2 by measuring the ac magnetic susceptibility χ(T) under magnetic fields at various hydrostatic pressures up to 7.5 GPa. The major findings include: (1) Tc is suppressed gradually to below 2 K at 7...
September 14, 2017: Journal of Physics. Condensed Matter: An Institute of Physics Journal
https://www.readbyqxmd.com/read/28904998/parallel-evolution-of-group-b-streptococcus-hypervirulent-clonal-complex-17-unveils-new-pathoadaptive-mutations
#13
Alexandre Almeida, Isabelle Rosinski-Chupin, Céline Plainvert, Pierre-Emmanuel Douarre, Maria J Borrego, Claire Poyart, Philippe Glaser
Group B Streptococcus (GBS) is a commensal of the gastrointestinal and genitourinary tracts, while a prevailing cause of neonatal disease worldwide. Of the various clonal complexes (CCs), CC17 is overrepresented in GBS-infected newborns for reasons that are still largely unknown. Here, we report a comprehensive genomic analysis of 626 CC17 isolates collected worldwide, identifying the genetic traits behind their successful adaptation to humans and the underlying differences between carriage and clinical strains...
September 2017: MSystems
https://www.readbyqxmd.com/read/28904482/mathematics-of-ventilator-induced-lung-injury
#14
REVIEW
Ubaidur Rahaman
Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28901030/treating-osa-current-and-emerging-therapies-beyond-cpap
#15
REVIEW
Geraldo Lorenzi-Filho, Fernanda R Almeida, Patrick J Strollo
Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence...
September 12, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28900004/network-of-microbial-and-antibiotic-interactions-drive-colonization-and-infection-with-multidrug-resistant-organisms
#16
Joyce Wang, Betsy Foxman, Lona Mody, Evan S Snitkin
The emergence and spread of multidrug-resistant organisms (MDROs) across global healthcare networks poses a serious threat to hospitalized individuals. Strategies to limit the emergence and spread of MDROs include oversight to decrease selective pressure for MDROs by promoting appropriate antibiotic use via antibiotic stewardship programs. However, restricting the use of one antibiotic often requires a compensatory increase in the use of other antibiotics, which in turn selects for the emergence of different MDRO species...
September 12, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/28893783/evolution-of-antibiotic-resistance-without-antibiotic-exposure
#17
Anna Knöppel, Joakim Näsvall, Dan I Andersson
Antibiotic use is the main driver in the emergence of antibiotic resistance. Another unexplored possibility is that resistance evolves coincidentally in response to other selective pressures. We show that selection in the absence of antibiotics can co-select for decreased susceptibility to several antibiotics. Thus, genetic adaptation of bacteria to natural environments may drive resistance evolution by generating a pool of resistance mutations that selection could act on to enrich resistant mutants when antibiotic exposure occurs...
September 11, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28893023/itolizumab-in-the-management-of-psoriasis-with-metabolic-syndrome
#18
Shrichand G Parasramani
Psoriasis is a chronic, relapsing, inflammatory disease that has been associated with Metabolic Syndrome (MS), a cluster of cardiovascular risk factors mainly hypertension, obesity, diabetes mellitus and hyperlipidemia. A 49-year-old male patient presented with extensive plaque psoriasis from past 13 years. Past medications included methotrexate, PUVA therapy, topical immunosuppressants and corticosteroids. His baseline Psoriasis Area and Severity Index (PASI) score was 39.8. The patient was screened and diagnosed with MS as per Alberti's Criteria (his waist circumference was 100 cm, blood pressure was 160/100 mmHg and High Density Lipoprotein (HDL) was 30 mg/dl)...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28891509/role-of-the-medullary-lateral-tegmental-field-in-sympathetic-control
#19
Michael George Zaki Ghali
The sympathetic nervous system maintains and regulates arterial pressure and tissue perfusion, via control of cardiac output and vasomotor tone. Sympatho-vascular-mediated increases in blood pressure are effected by arterioloconstriction, which causes an increase in afterload, and/or venoconstriction, which increases venous return, left ventricular preload, and consequently, the force of cardiac contraction via Frank-Starling mechanisms; withdrawal of sympathetic drive elicits reciprocal effects. Spinalization reduces mammalian arterial pressure to 40-50 mm Hg consequent to the elimination of descending medullary pre-sympathetic bulbospinal drive to preganglionic sympathetic fibers in the intermediolateral cell column of the spinal cord...
2017: Journal of Integrative Neuroscience
https://www.readbyqxmd.com/read/28891046/the-association-of-postoperative-pulmonary-complications-in-109-360-patients-with-pressure-controlled-or-volume-controlled-ventilation
#20
A Bagchi, M I Rudolph, P Y Ng, F P Timm, D R Long, S Shaefi, K Ladha, M F Vidal Melo, M Eikermann
We thought that the rate of postoperative pulmonary complications might be higher after pressure-controlled ventilation than after volume-controlled ventilation. We analysed peri-operative data recorded for 109,360 adults, whose lungs were mechanically ventilated during surgery at three hospitals in Massachusetts, USA. We used multivariable regression and propensity score matching. Postoperative pulmonary complications were more common after pressure-controlled ventilation, odds ratio (95%CI) 1.29 (1.21-1.37), p < 0...
September 11, 2017: Anaesthesia
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