Identification of a mannose-binding pilus on Vibrio cholerae El Tor

The mannose-sensitive hemagglutinin (MSHA) that is associated with Vibrio cholerae strains of El Tor biotype is identified as a pilus composed of subunits with a molecular mass of approximately 17 kDa. In immunoelectron microscopy, a monoclonal antibody against MSHA that inhibited El Tor vibrio-mediated mannose-sensitive agglutination of chicken erythrocytes or El Tor bacterial binding to mannose-coated agarose beads, bound specifically to repetitive subunits along typical fimbriae extending from the surface of El Tor vibrios. No such pili were seen on the surface of MSHA negative classical vibrios, although non-surface exposed fimbrial subunits could be demonstrated in these bacteria by immunoblotting techniques.     

The effects of nitric oxide inhalation on respiratory mechanics and gas exchange during endotoxaemia in the pig

Background : In the adult respiratory distress syndrome, nitric oxide (NO) inhalation improves oxygenation through reducing ventilation-perfusion mismatching, but detailed information on the pulmonary effects of NO inhalation in septic shock is scarce. The present study investigated the effects of inhaled NO on alveolar dead space (Vdalv) and venous admixture as well as on respiratory system compliance (Crs) and respiratory system resistance (Rrs) in a porcine model of septic shock. Protective effects of NO are discussed.
Methods : Thirteen anaesthetised and ventilated pigs were given an infusion of endotoxin for an observation time of 220 min to induce acute lung injury (ALI). In the NO-early group (n=6), an inhalation of 60 ppm NO was started simultaneously with the endotoxin infusion and continued for 190 min. In 7 control/NO-late animals, 60 ppm NO was administered for 30 min following 190 min of endotoxin infusion. Haemodynamics, single-breath CO₂-, pressure-, and flow signals were recorded.
Results : Endotoxin induced haemoconcentration, pulmonary vasoconstriction, and a decrease in Crs, while venous admixture, Vdalv, and Rrs increased. In the NO-early group, the pulmonary vasoconstriction was attenuated, no increase in pulmonary venous admixture or in Vdalv was seen before cessation of NO, and the improvements in oxygenation outlasted the NO inhalation. In the control/NO-late group, the NO inhalation reversed the changes in dead space and venous admixture. NO had no effect on the changes in respiratory mechanics.
Conclusion : In porcine ALI, 60 ppm NO diminishes pulmonary vasoconstriction and improves gas exchange by reducing pulmonary venous admixture and alveolar dead space, but does not prevent a fall in Crs. NO inhalation may help prevent longlasting pulmonary failure.     

Sex- and age-related normal limits for the QRS complex in vectorcardiography

In order to provide reference values for vectorcardiography (VCG), which are relevant with regard to sex, age and available computer technology. VCG from a normal material were studied. VCG according to Frank were recorded in 159 men and 193 women, healthy and randomly selected from a defined caucasian urban population. The technique used includes noise reduction by averaging and a spatial algorithm for QRS delineation. The results are given separately for men and women and for young and old subjects. Significant differences between these groups were found to be common and of potential importance for interpretation of VCG. Discrepancies between our results and other reports on normal ranges can be explained by both different techniques used and different composition of the material studied. On the basis of our data normal limits for a number of measurements, commonly used in diagnostic criteria for myocardial infarction and ventricular hypertrophy are reported.     

Vasoactive drugs and elastic properties of human arteries in vivo, with special reference to the action of nitroglycerine

Pulsatile changes in the volume of an arm segment were recordedwith an air-filled plethysmograph and related to intra-arterialblood pressure. Alterations in transmural arterial pressurewere obtained by changing the pressure in a large chamber surroundingthe entire arm. Arterial compliance values were calculated inlate diastole when pressure and volume changes were slow. Compliancevaried with transmural arterial pressure in a hyperbolic manner,rising steeply at low pressure. Noradrenaline and hypertensin did not change the arterial compliancevalues, while dihydroergotamine reduced them. Nitroglycerinecaused a pronounced increase in compliance values in doses thatdid not change cardiac output and arterial pressure.     

Genomic profiling and directed ex vivo drug analysis of an unclassifiable myelodysplastic/myeloproliferative neoplasm progressing into acute myeloid leukemia

Myelodysplastic/myeloproliferative neoplasms, unclassifiable (MDS/MPN‐U) are rare genetically heterogeneous hematologic diseases associated with older age and a poor prognosis. If the disease progresses into acute myeloid leukemia (AML), it is often refractory to treatment. To gain insight into genetic alterations associated with disease progression, whole exome sequencing and single nucleotide polymorphism arrays were used to characterize the bone marrow and blood samples from a 39‐year‐old woman at MDS/MPN‐U diagnosis and at AML progression, in which routine genetic diagnostics had not identified any genetic alterations. The data revealed the presence of a partial tandem duplication of the MLL gene as the only detectable copy number change and 11 non‐silent somatic mutations, including DNMT3A R882H and NRAS G13D. All somatic lesions were present both at initial MDS/MPN‐U diagnosis and at AML presentation at similar mutant allele frequencies. The patient has since had two extramedullary relapses and is at high risk of a future bone marrow relapse. A directed ex vivo drug sensitivity analysis showed that the patient's AML cells are sensitive to, for example, the MEK inhibitor trametinib and the proteasome inhibitor bortezomib, indicating that she may benefit from treatment with these drugs. © 2016 Wiley Periodicals, Inc.     

Setting and monitoring of high-frequency jet ventilation in severe respiratory distress syndrome

High-frequency jet ventilation (HFJV) is used in respiratory distress syndrome (RDS) to avoid high airway pressures and barotrauma. This study was designed to find rational strategies to regulate oxygenation and alveolar ventilation at HFJV and to determine appropriate monitoring methods. Seven dogs were subjected to total lung lavage with saline to induce RDS. PEEP was increased at conventional intermittent positive-pressure ventilation until re-expansion was indicated by a PaO2 of 300 torr at an FIO2 of 1.0 HFJV at 4 and 15 Hz was each tried at 0 and 10 cm H2O PEEP. Intermittent low-frequency inflations were also added to HFJV at 0 PEEP. Lung expansion was maintained without circulatory depression by adjustment of minute ventilation (VE) delivered by the HFJ ventilator; external PEEP was a useful complement. PaCO2 was controlled by frequency adjustment. HFJV at 4 Hz resulted in hypocapnia; intermittent low-frequency inflations had no effect. VE monitoring, CO2 elimination monitoring, and PEEP adjustment was done with a standard ventilator during HFJV. This study illustrates that HFJV is efficient in RDS; VE and external PEEP strongly influence oxygenation and may be used to regulate this factor, and frequency affects CO2 elimination, thus suggesting a method of PaCO2 control.     

Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms,spirometric lung function and emphysema,as assessed with HRCT

Purpose  

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV₁). FEV₁ does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV₁, symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD.