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Sample records for shock syndrome occurred

  1. Toxic Shock Syndrome

    MedlinePlus

    ... toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused ... a skin or wound infection. Bacteria, most commonly Staphylococcus aureus (staph), causes toxic shock syndrome. It can also ...

  2. Toxic Shock Syndrome (For Teens)

    MedlinePlus

    ... I Help Someone Who's Being Bullied? Volunteering Toxic Shock Syndrome KidsHealth > For Teens > Toxic Shock Syndrome Print ... it, then take some precautions. What Is Toxic Shock Syndrome? If you're a girl who's had ...

  3. Toxic Shock Syndrome

    MedlinePlus

    ... manufacturers pulled certain types of tampons off the market, the incidence of toxic shock syndrome in menstruating ... Nondiscrimination Advertising Mayo Clinic is a not-for-profit organization and proceeds from Web advertising help support ...

  4. [A case of anaphylactoid shock occurring immediately after the initiation of second intravenous administration of high-dose immunoglobulin (IVIg) in a patient with Crow-Fukase syndrome].

    PubMed

    Takahashi, Teruyuki; Ono, Shin-ichi; Ogawa, Katuhiko; Tamura, Masato; Mizutani, Tomohiko

    2003-06-01

    We report a case of anaphylactoid shock occurring immediately after the initiation of second intravenous administration of high-dose immunoglobulin (IVIg) in a patient with Crow-Fukase syndrome. The patient was a 57-year-old woman, who was admitted to our hospital because of numbness and muscle weakness in the four extremities, difficulty in walking, and foot edema. On admission, her skin was dry and rough, and also showing scattered pigmentation, small hemangiomas, and hypertrichosis in both legs. She had distal dominant muscle weakness, more prominent in her legs, and was not able to walk. Deep tendon reflexes in her four extremities were markedly diminished or absent. She had a glove and stocking type of paresthesia, severe impairment of vibration, and absence of joint position sensation in her four extremities. On laboratory data, serum vascular endothelial growth factor (VEGF) was markedly elevated to 5,184 pg/ml (normal: below 220 pg/ml). Cerebrospinal fluid examination revealed cell counts of 2/microliter and protein level of 114 mg/dl. Abdominal echo showed marked hepatosplenomegaly. On peripheral nerve conduction study, both motor and sensory conduction velocity were undetectable in her legs. We diagnosed her condition as Crow-Fukase syndrome, and started IVIg of polyethyleneglycol-treated gamma-globulin (PEG-glob) at 400 mg/kg/day for 5 consecutive days for polyneuropathy. Since the first IVIg mildly improved muscle weakness, we tried the second IVIg of PEG-glob. However, immediately after the initiation of second IVIg of PEG-glob, she developed hypotention, dyspnea, cold sweating, cyanosis, and became lethargic. We immediately stopped IVIg and started first-aid treatment with epinephrine and corticosteroid for these symptoms. This treatment was successful and the patient fully recovered without any sequelae. Since serum IgE level remained unchanged and lymphocyte stimulation test (LST) was positive against the same rot number of PEG-glob, we diagnosed

  5. Dengue shock syndrome

    PubMed Central

    Sudulagunta, Sreenivasa Rao; Sodalagunta, Mahesh Babu; Sepehrar, Mona; Bangalore Raja, Shiva Kumar; Nataraju, Aravinda Settikere; Kumbhat, Mounica; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Dengue fever is a mosquito-borne arthropod-borne viral (arboviral) tropical disease in humans affecting 50–528 million people worldwide. The acute abdominal complications of dengue fever are acute appendicitis, acute pancreatitis, acute acalculous cholecystitis and non-specific peritonitis. Acute pancreatitis with new onset diabetes in dengue shock syndrome (DSS) is very rarely reported. We describe a case of 30-year-old man admitted in intensive care unit and was diagnosed with DSS with RT-PCR, NS1 antigen and dengue IgM antibody being positive. Abdominal ultrasound and computerized tomography confirmed acute pancreatitis. Patient required insulin after recovery. Diabetes mellitus caused by DSS is under-reported and lack of awareness may increase mortality and morbidity. PMID:28031845

  6. Staphylococcus aureus of phage type 187 isolated from people occurred to be a genes carrier of eneterotoxin C and toxic shock syndrome toxin-1 (TSST-1).

    PubMed

    Piechowicz, Lidia; Garbacz, Katarzyna; Galiński, Janusz

    2008-07-01

    The aim of this study was to examine the genotype properties of Staphylococcus aureus of phage type 187 strains that constitute a separate group among the strains of S. aureus. Sixteen strains were collected from the hospital patients (n=12) and the healthy carriers (n=4) in 13 medical centres in Poland during 1991 and 2005. Biotyping, antibiotic susceptibility, phage typing, detection the genes of enterotoxins and toxic shock syndrome toxin, genotyping of chromosomal DNA by pulsed-field gel electrophoresis (PFGE), also amplification and restriction analysis of the coagulase (coa) and the protein A genes (spa) (PCR/restriction fragment length polymorphism (RFLP)) was tested. The results of this study showed that all staphylococcus of phage type 187 belonged to the human biotype (A) and appeared to be sensitive to all of the tested antibiotics, including methicillin (MSSA). Finding out the toxin genes showed that almost all of them (93.8%) had the enterotoxin C gene (sec) and TSST-1 gene (tst). The PFGE typing proved that the phage type 187 strains (except for one) constitute one PFGE type. These results and the identical restriction patterns in the PCR/RFLP method, also the same biotype, sensitivity to antibiotics and the presence genes of the same type of toxins confirmed that the phage type 187 strains constitute one clone within our country. Additionally, the fact that almost all of them have the enterotoxin genes and tst gene allows to consider them the strains of potentially high virulence.

  7. Toxic shock syndrome in Canada.

    PubMed Central

    Clayton, A. J.; Peacocke, J. E.; Ewan, P. E.

    1982-01-01

    Since 1976, 53 confirmed or suspected cases of toxic shock syndrome (TSS) have been reported in Canada. Twenty-two cases occurred in 1980, and by October 1981 another 21 had been reported. In Canada, like the United States, where nearly 1200 cases have been recorded, TSS appears to be associated with tampon use, although a few cases have occurred in males and in nonmenstruating women. Of the 53 patients 3 died. The enterotoxin produced by Staphylococcus aureus is probably responsible for TSS. Manufacturers of tampons have now placed warning labels on tampon boxes and information on TSS in the instruction inserts. Women should select tampons of appropriate absorbency for the various stages of menstruation. PMID:7042059

  8. Toxic shock syndrome complicating influenza A in a child: case report and review.

    PubMed

    Tolan, R W

    1993-07-01

    Despite extensive literature on toxic shock syndrome, reports of its manifestations in children remain relatively uncommon. Similarly, toxic shock syndrome in association with influenza B or influenza-like illness has been reported in 12 patients, but it has been reported to occur following influenza A in only two patients to date. We report a third case of toxic shock syndrome in a child with influenza A and review the association between epidemic influenza and toxic shock syndrome ("the Thucydides syndrome").

  9. Toxic shock syndrome.

    PubMed Central

    Todd, J K

    1988-01-01

    In the past 10 years, we have learned much about TSS and S. aureus and its toxins. A number of important biologic principles have been reemphasized in this first decade of TSS research: S. aureus is a very complex organism, one not likely to yield quick answers; in vitro observations must always be confirmed in the patient; animal models may not always be reliable replicates of human disease; and epidemiologic associations cannot be equated with causation. Toxic shock is an intricate phenomenon with many interesting scientific facets. Unraveling its mysteries will undoubtedly teach us more about the complex interaction of patients and microorganisms. PMID:3069202

  10. Streptococcus agalactiae Toxic Shock-Like Syndrome

    PubMed Central

    Al Akhrass, Fadi; Abdallah, Lina; Berger, Steven; Hanna, Rami; Reynolds, Nina; Thompson, Shellie; Hallit, Rabih; Schlievert, Patrick M.

    2013-01-01

    Abstract We present 2 patients with Streptococcus agalactiae toxic shock-like syndrome and review another 11 well-reported cases from the literature. Streptococcal toxic shock-like syndrome is a devastating illness with a high mortality rate, therefore we stress the importance of early supportive management, antimicrobial therapy, and surgical intervention. Toxic shock-like syndrome is likely to be underestimated in patients with invasive Streptococcus agalactiae infection who present with shock. Early diagnosis requires high suspicion of the illness, along with a thorough mucocutaneous examination. Streptococcus agalactiae produces uncharacterized pyrogenic toxins, which explains the ability of the organism to cause toxic shock-like syndrome. PMID:23263717

  11. Myelodysplastic Syndrome Occurring in a Patient with Gorlin Syndrome.

    PubMed

    Mull, Jamie L; Madden, Lisa M; Bayliss, Susan J

    2016-07-01

    We report a case of myelodysplastic syndrome (MDS) occurring in an African American boy with Gorlin syndrome with a novel PTCH1 mutation. Before developing MDS, the patient had been treated with chemotherapy and radiation for a medulloblastoma. He received a bone marrow transplant for the MDS and eventually died of treatment complications. Secondary hematologic malignancies are a known complication of certain chemotherapeutics, although whether a patient with Gorlin syndrome has a greater propensity for the development of such malignancies is unclear.

  12. [Staphylococcal toxic shock syndrome after breast surgery].

    PubMed

    Pelissier, A; Dumesnil, J; Levy, R; Charron, C; Rouzier, R

    2014-09-01

    The surgical site infection occurs within 30 days after surgery. It is the most common complication of surgery, with a rate of 1 to 5% without antibiotic prophylaxis and less than 1% with antibiotic prophylaxis. The toxic shock syndrome (TSS) is a dramatic complication. We report the case 39-year-old woman who presented a life-threatening TSS acquired after breast surgery. We describe the signs and symptoms of this condition as well as treatment principles. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Hypercalcitoninemia, hypocalcemia, and toxic shock syndrome.

    PubMed

    Sperber, S J; Blevins, D D; Francis, J B

    1990-01-01

    Toxic shock syndrome is a multisystem illness frequently complicated by hypocalcemia. The etiology of the hypocalcemia, which may be severe, is not well understood. We report two cases of fatal toxic shock syndrome accompanied by severe hypocalcemia; each patient also had an inappropriately elevated serum calcitonin level, which in one case was as high as 179,000 pg/mL. Hypercalcitoninemia may be a cause of the low serum calcium levels as well as of certain clinical manifestations of toxic shock syndrome.

  14. Recognition of a Kawasaki Disease Shock Syndrome

    PubMed Central

    Kanegaye, John T.; Wilder, Matthew S.; Molkara, Delaram; Frazer, Jeffrey R.; Pancheri, Joan; Tremoulet, Adriana H.; Watson, Virginia E.; Best, Brookie M.; Burns, Jane C.

    2010-01-01

    objective We sought to define the characteristics that distinguish Kawasaki disease shock syndrome from hemodynamically normal Kawasaki disease. methods We collected data prospectively for all patients with Kawasaki disease who were treated at a single institution during a 4-year period. We defined Kawasaki disease shock syndrome on the basis of systolic hypotension for age, a sustained decrease in systolic blood pressure from baseline of ≥20%, or clinical signs of poor perfusion. We compared clinical and laboratory features, coronary artery measurements, and responses to therapy and analyzed indices of ventricular systolic and diastolic function during acute and convalescent Kawasaki disease. results Of 187 consecutive patients with Kawasaki disease, 13 (7%) met the definition for Kawasaki disease shock syndrome. All received fluid resuscitation, and 7 (54%) required vasoactive infusions. Compared with patients without shock, patients with Kawasaki disease shock syndrome were more often female and had larger proportions of bands, higher C-reactive protein concentrations, and lower hemoglobin concentrations and platelet counts. Evidence of consumptive coagulopathy was common in the Kawasaki disease shock syndrome group. Patients with Kawasaki disease shock syndrome more often had impaired left ventricular systolic function (ejection fraction of <54%: 4 of 13 patients [31%] vs 2 of 86 patients [4%]), mitral regurgitation (5 of 13 patients [39%] vs 2 of 83 patients [2%]), coronary artery abnormalities (8 of 13 patients [62%] vs 20 of 86 patients [23%]), and intravenous immunoglobulin resistance (6 of 13 patients [46%] vs 32 of 174 patients [18%]). Impairment of ventricular relaxation and compliance persisted among patients with Kawasaki disease shock syndrome after the resolution of other hemodynamic disturbances. conclusions Kawasaki disease shock syndrome is associated with more-severe laboratory markers of inflammation and greater risk of coronary artery

  15. Mermaid and Potter's syndrome occurring simultaneously.

    PubMed

    Liatsikos, E N; Perimenis, P; Dandinis, K; Kaladelfou, E; Barbalias, G A

    1999-01-01

    We herein report a case of a female embryo who died in utero and at autopsy she was found to have bilateral renal agenesis with the extrarenal manifestations of Potter's syndrome together with mermaid syndrome which is a rare combination. From all the anomalies of the upper urinary tract bilateral renal agenesis seems to have a cardinal role in the survival of the embryo afflicted with the spectrum of associated anomalies.

  16. Clinical pathology of the shock syndromes

    PubMed Central

    Bonanno, Fabrizio Giuseppe

    2011-01-01

    The clinical aspects of shock syndromes are described from their inception as compensated physiology to a stage of decompensation. The clinical significance of hypotension, fluid-responsive and non fluid-responsive hypotension, is discussed. Untimely or inadequate treatment leads to persistent subclinical shock despite adjustments of the macrohemodynamic variables, which evolves in a second hit of physiological deterioration if not aggressively managed. Irreversible shock ensues as consequence of direct hit or as result of inadequate or delayed treatment and is characterized by drug-resistant hypotension. PMID:21769211

  17. Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

    PubMed Central

    Rimawi, B. H.; Graybill, W.; Pierce, J. Y.; Kohler, M.; Eriksson, E. A.; Shary, M. T.; Crookes, B.; Soper, D. E.

    2014-01-01

    Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary to Clostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention. PMID:24822140

  18. Bubble Proliferation in Shock Wave Lithotripsy Occurs during Inertial Collapse

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Pishchalnikova, Irina V.; Williams, James C.; Bailey, Michael R.; Sapozhnikov, Oleg A.

    2008-06-01

    In shock wave lithotripsy (SWL), firing shock pulses at slow pulse repetition frequency (0.5 Hz) is more effective at breaking kidney stones than firing shock waves (SWs) at fast rate (2 Hz). Since at fast rate the number of cavitation bubbles increases, it appears that bubble proliferation reduces the efficiency of SWL. The goal of this work was to determine the basis for bubble proliferation when SWs are delivered at fast rate. Bubbles were studied using a high-speed camera (Imacon 200). Experiments were conducted in a test tank filled with nondegassed tap water at room temperature. Acoustic pulses were generated with an electromagnetic lithotripter (DoLi-50). In the focus of the lithotripter the pulses consisted of a ˜60 MPa positive-pressure spike followed by up to -8 MPa negative-pressure tail, all with a total duration of about 7 μs. Nonlinear propagation steepened the shock front of the pulses to become sufficiently thin (˜0.03 μm) to impose differential pressure across even microscopic bubbles. High-speed camera movies showed that the SWs forced preexisting microbubbles to collapse, jet, and break up into daughter bubbles, which then grew rapidly under the negative-pressure phase of the pulse, but later coalesced to re-form a single bubble. Subsequent bubble growth was followed by inertial collapse and, usually, rebound. Most, if not all, cavitation bubbles emitted micro-jets during their first inertial collapse and re-growth. After jetting, these rebounding bubbles could regain a spherical shape before undergoing a second inertial collapse. However, either upon this second inertial collapse, or sometimes upon the first inertial collapse, the rebounding bubble emerged from the collapse as a cloud of smaller bubbles rather than a single bubble. These daughter bubbles could continue to rebound and collapse for a few cycles, but did not coalesce. These observations show that the positive-pressure phase of SWs fragments preexisting bubbles but this initial

  19. Toxic Shock Syndrome: A Family Physician's Perspective

    PubMed Central

    Myhre, D. L.

    1982-01-01

    Although similar cases have been reported as far back as 1927, the term toxic shock syndrome was coined in 1978 to describe an acute fever involving Staph. aureus. The reported mortality rate in Canada is 3.8%, but may be much higher. Association with tampon use was made in 1980, but is still unclear. Treatment remains supportive and is aimed at reducing risk of recurrence, until the role of the exotoxin can be explained. This article reviews reported cases to date, listing diagnostic criteria, signs and symptoms. A high index of suspicion for this new syndrome is recommended. PMID:21286566

  20. Toxic shock syndrome in two dogs.

    PubMed

    Slovak, Jennifer E; Parker, Valerie J; Deitz, Krysta L

    2012-01-01

    Two young, unrelated, spayed female Labrador retrievers were evaluated for severe, diffuse, generalized erythema and edema of the skin. Both dogs exhibited signs of disseminated intravascular coagulopathy and were euthanized. On postmortem examination, toxic shock syndrome (TSS) was diagnosed based on histopathology and supported by skin cultures. TSS is a rarely reported disease in veterinary medicine and can cause acute and profound clinical signs. Rapid recognition of this disease process and immediate treatment may improve the clinical outcome.

  1. Toxic shock syndrome. Possible confusion with Kawasaki's disease.

    PubMed

    Raimer, S S; Tschen, E H; Walker, M K

    1981-07-01

    Toxic shock syndrome (TSS) is a recently recognized condition associated with toxin-producing strains of Staphylococcus aureus. Patients affected with this syndrome are frequently young and have multisystemic complaints such as fever, headache, edema, myalgia, scarlatiniform rash, conjunctival injection, confusion, diarrhea, oliguria, hypotension and shock, This is followed by desquamation of the skin, especially the palms and soles. The majority of cases reported have been in menstruating women who used vaginal tampons regularly. Because similarities exist between toxic shock syndrome and Kawasaki's disease (mucocutaneous lymph node syndrome), as well as other conditions, proper diagnosis and management are of the utmost importance.

  2. Heat-shock-induced cellular responses to temperature elevations occurring during orthopaedic cutting.

    PubMed

    Dolan, E B; Haugh, M G; Tallon, D; Casey, C; McNamara, L M

    2012-12-07

    Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 and osteoblast-like MC3T3-E1 cells, using flow cytometry. The regeneration capacity of heat-shocked Balb/c mesenchymal stem cells (MSCs) and MC3T3-E1s has been investigated following 7 and 14 day's recovery, by quantifying proliferation, differentiation and mineralization. An immediate necrotic response to heat-shock was shown in cells exposed to elevated temperatures (45°C, 47°C and most severe at 60°C). A longer-term apoptotic response is induced in MLO-Y4s and, to a lesser extent, in MC3T3-E1s. Heat-shock-induced differentiation and mineralization by MSCs. These findings indicate that heat-shock is more likely to induce apoptosis in osteocytes than osteoblasts, which might reflect their role as sensors detecting and communicating damage within bone. Furthermore, it is shown for the first time that mild heat-shock (less than equal to 47°C) for durations occurring during surgical cutting can positively enhance osseointegration by osteoprogenitors.

  3. Heat-shock-induced cellular responses to temperature elevations occurring during orthopaedic cutting

    PubMed Central

    Dolan, E. B.; Haugh, M. G.; Tallon, D.; Casey, C.; McNamara, L. M.

    2012-01-01

    Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 and osteoblast-like MC3T3-E1 cells, using flow cytometry. The regeneration capacity of heat-shocked Balb/c mesenchymal stem cells (MSCs) and MC3T3-E1s has been investigated following 7 and 14 day's recovery, by quantifying proliferation, differentiation and mineralization. An immediate necrotic response to heat-shock was shown in cells exposed to elevated temperatures (45°C, 47°C and most severe at 60°C). A longer-term apoptotic response is induced in MLO-Y4s and, to a lesser extent, in MC3T3-E1s. Heat-shock-induced differentiation and mineralization by MSCs. These findings indicate that heat-shock is more likely to induce apoptosis in osteocytes than osteoblasts, which might reflect their role as sensors detecting and communicating damage within bone. Furthermore, it is shown for the first time that mild heat-shock (less than equal to 47°C) for durations occurring during surgical cutting can positively enhance osseointegration by osteoprogenitors. PMID:22915633

  4. Infectious Shock and Toxic Shock Syndrome Diagnoses in Hospitals, Colorado, USA

    PubMed Central

    Smit, Michael A.; Nyquist, Ann-Christine

    2013-01-01

    In Colorado, USA, diagnoses coded as toxic shock syndrome (TSS) constituted 27.3% of infectious shock cases during 1993–2006. The incidence of staphylococcal TSS did not change significantly overall or in female patients 10–49 years of age but increased for streptococcal TSS. TSS may be underrecognized among all ages and both sexes. PMID:24188357

  5. Toxic shock syndrome associated with diaphragm use.

    PubMed

    Hyde, L

    1983-03-01

    A case report is presented of toxic shock syndrome associated wtih diaphragm use. The patient, an 18-year old white woman, gravida 1, para 1, was in good health prior to the reported episode. She had a low transverse cesarean section for fetal distress 3 months prior to admission and had not yet resumed menstruation. 48 hours prior to admission, after unprotected intercourse, she developed a vaginal discharge requiring the use of a pad. 12 hours later she used a diaphragm, left it in place overnight, and failed to remove it the next morning. During the day pelvic and lumbar pain developed, followed by vomiting and a fever as high as 103 degrees Farenheit. That evening, 12 hours before admission, the diaphragm was removed with drainage of copious purulent discharge. The edges of the diaphragm and the discharge were blood streaked. She also developed a diffuse macular blanching rash, sparing only the circumoral region. At the time of admission the following morning her blood pressure was 60/0mmHg; pulse, 180 beats/minute; and temperature, 102 degrees Farenheit. Significant physical findings included the rash, conjunctivitis, a pharyngeal infection, and a lack of adenopathy. Pelvic examination showed a vaginal discharge, a very tender, slightly enlarged warm uterus, and normal adnexa. Cultures of the vaginal discharge were positive for Staphylococcus aureus, resistant to penicillin and ampicillin, and sensitive to methicillin, cephalothin, erythromycin, colistin, chloramphenicol, tetracycline, sulfisoxazole, and aminoglycoside antibiotics. The white blood count rose from 11,000/mm on admission to a high of 13,000/mm with a left shift the next day. The patient received 1.2 million units of intravenous penicillin every 4 hours, 80 mg of gentamicin every 8 hours, and 300 mg of clindamycin every 6 hours, as well as fluid replacement of 2 g of methylprednisolone followed by 1 g every 6 hours. The shock, fever, and rash resolved in the following 48 hours. 2 days after

  6. The temporal evolution of acute respiratory distress syndrome following shock.

    PubMed

    Greer, Ruari

    2010-03-01

    The objective of this review is to provide an comprehensive overview of the evolution of acute respiratory distress syndrome (ARDS) in cellular, animal and human models with specific reference to sepsis and haemorrhage. Within this work we have attempted to describe the temporal evolution of the disease process.ARDS is a complication of pulmonary and systemic disease and it can follow sepsis or haemorrhage. The definition of this condition states an acute onset and this review seeks to clarify the time course of that onset following sepsis and haemorrhage. The underlying pathophysiological mechanisms include activation of the immune response, neutrophil activation and sequestration of these into the alveolus with subsequent tissue damage and hypoxia. The biological evolution of these processes from sepsis or haemorrhage has been well described and the earliest measurable changes in the process occur within 15 min with the clinical manifestations of the syndrome occurring within 12 h. The rapid development of this condition should be considered during the treatment of haemorrhagic or septic shock.

  7. Fatal streptococcal toxic shock syndrome in a child with varicella and necrotizing fasciitis of the face.

    PubMed

    Minodier, Philippe; Chaumoitre, Kathia; Vialet, Renaud; Imbert, Guenièvre; Bidet, Philippe

    2008-08-01

    The report described here presents a fatal streptococcal toxic shock syndrome secondary to a necrotizing fasciitis of the face in a 3-year-old girl with varicella. Pathogenesis and treatment of streptococcal toxic shock syndrome are discussed below.

  8. Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease.

    PubMed

    Çakan, Mustafa; Gemici, Hakan; Aktay-Ayaz, Nuray; Keskindemirci, Gonca; Bornaun, Helen; İkizoğlu, Tarkan; Çeliker, Alpay

    2016-01-01

    Kawasaki disease is an acute systemic vasculitis that occurs most commonly in young children. It affects medium-sized muscular arteries and the coronary arteries are the predominant site of involvement. Morbidity and mortality is generally due to coronary artery aneurysms that develop during the chronic phase. Although it is well known that Kawasaki disease can cause myocarditis, tachycardia and heart failure during acute stage, Kawasaki disease shock syndrome has been recently described. It is characterized by hypotension, signs and symptoms of poor perfusion and a shock-like state. Herein we describe two cases of Kawasaki disease shock syndrome that were treated in the pediatric intensive care unit and followed a course without morbidity or mortality.

  9. Staphylococcal Toxic Shock Syndrome Caused by Tampon Use

    PubMed Central

    McDermott, Cian; Sheridan, Michael

    2015-01-01

    The authors report a case of near-fatal sepsis with multiorgan failure resulting from a Staphylococcal tampon-associated toxic shock syndrome, requiring a lengthy critical care admission. Successful treatment of this condition focuses on early identification, source control, and administration of antimicrobial agents. Intravenous immunoglobulin therapy used early may prevent widespread tissue necrosis. PMID:25692047

  10. Death in pediatric Cushing syndrome is uncommon but still occurs

    PubMed Central

    Gkourogianni, Alexandra; Lodish, Maya B.; Zilbermint, Mihail; Lyssikatos, Charalampos; Belyavskaya, Elena; Keil, Margaret F.; Stratakis, Constantine A.

    2014-01-01

    Cushing syndrome (CS) in children is rare. Delayed diagnosis and treatment of CS may be associated with increased morbidity and, unfortunately, mortality. We performed a retrospective review of all patients with CS under the age of 18 referred to the NIH from 1998 to 2013 in order to describe deceased patients among cases of pediatric CS referred to the National Institutes of Health (NIH). The deaths of 4 children (3 females and 1 male), aged 7.5–15.5 years (mean age 11.2 years) with length of disease 2–4 years were recorded among 160 (2.5%) children seen at, or referred to the NIH over the last 15 years. All died at different institutions, prior to coming to the NIH (two of them) or after leaving NIH (two of them). Presenting symptoms included increasing weight and decreasing height gain, facial plethora, dorsocervical fat pad (webbed neck), striae, headache, vision disturbances and depression and other mood or behavior changes; there were no differences between how these patients presented and the others in our cohort. The causes of CS in the deceased patients were also not different, in fact, they spanned the entire spectrum of CS: pituitary disease (on of them), ectopic corticotropin production (one of them), and primary adrenal hyperplasia (1). In one patient, the cause of CS could not be verified. Three died of sepsis and one due to residual disease and complications of the primary tumor. Conclusions Despite advances in early diagnosis and treatment of pediatric CS, a 2.5% mortality rate was identified in a large cohort of patients with this condition referred to an experienced, tertiary care referral center (although these deaths occurred elsewhere). Pediatricians need to recognize the possibility of death, primarily due to sepsis, in a patient with pediatric CS and act accordingly. PMID:25241829

  11. Streptococcal toxic shock syndrome secondary to group A Streptococcus vaginitis.

    PubMed

    Hikone, Mayu; Kobayashi, Ken-Ichiro; Washino, Takuya; Ota, Masayuki; Sakamoto, Naoya; Iwabuchi, Sentaro; Ohnishi, Kenji

    2015-12-01

    Streptococcal toxic shock syndrome (TSS) is a systemic illness usually caused in the setting of infection by group A Streptococcus (GAS). The primary infections are often invasive infections of the respiratory tract or necrotizing infections of the skin and soft tissue, but some infections occur without relevant focus. GAS vaginitis is a rare condition among adult women and is accordingly thought to be uncommon as a cause of streptococcal TSS. Here we report the cases of two postmenopausal women with streptococcal TSS secondary to GAS vaginitis, one aged 55 and one aged 60. Both came to our emergency department with complaints or symptoms of abdominal pain, fever, hypotension, and multi-organ failure. In both cases, the relevant factor associated with streptococcal infection was a recent episode of GAS vaginitis. Both underwent fluid management and 14 days of antibiotic treatment and fully recovered without complications. Vaginitis was likely to be the primary infectious trigger of TSS in these two cases. Intrauterine device insertion, endometrial biopsy, and post-partum state have all been previously reported in TSS patients, and the female genital tract has been described as a portal of entry. GAS vaginitis warrants appropriate treatment as it may progress to severe systemic infection as described. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock.

    PubMed

    Sinhabahu, Vindika Prasad; Suntharesan, Janani; Wijesekara, Dimuthu Saraji

    2016-01-01

    Kawasaki disease is diagnosed when fever lasts for more than 5 days with the presence of four out of five of the following clinical features: bilateral conjunctival congestion, changes in the lips and oral cavity, polymorphous exanthem, changes in peripheral extremities, and acute nonpurulent cervical lymphadenopathy (Nakamura et al., 2012). The average age of onset is 2 years and 90% of patients are below 5 years of age. Boys are more affected than girls (Cox and Sallis, 2009). This case report describes an adolescent female who was initially managed as having septic shock and subsequently found to have Kawasaki shock syndrome.

  13. Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock

    PubMed Central

    Suntharesan, Janani; Wijesekara, Dimuthu Saraji

    2016-01-01

    Kawasaki disease is diagnosed when fever lasts for more than 5 days with the presence of four out of five of the following clinical features: bilateral conjunctival congestion, changes in the lips and oral cavity, polymorphous exanthem, changes in peripheral extremities, and acute nonpurulent cervical lymphadenopathy (Nakamura et al., 2012). The average age of onset is 2 years and 90% of patients are below 5 years of age. Boys are more affected than girls (Cox and Sallis, 2009). This case report describes an adolescent female who was initially managed as having septic shock and subsequently found to have Kawasaki shock syndrome. PMID:28101385

  14. Progressive multifocal leukoencephalopathy occurring with the acquired immune deficiency syndrome.

    PubMed

    England, J D; Hsu, C Y; Garen, P D; Goust, J M; Biggs, P J

    1984-08-01

    A 33-year-old homosexual man with symptoms and signs of a focal brain process was subsequently found to have an acquired immune deficiency syndrome (AIDS) with biopsy-proven progressive multifocal leukoencephalopathy. This report reemphasizes the association of progressive multifocal leukoencephalopathy with AIDS and probably is best viewed as another example of an opportunistic CNS infection complicating deficient cell-mediated immunity.

  15. Recurrent SDSE bacteraemia resulting in streptococcal toxic shock syndrome in a patient with Noonan syndrome.

    PubMed

    Suzuki, Kei; Nakamura, Akiko; Ishikura, Ken; Imai, Hiroshi

    2016-08-02

    A 19-year-old man with chronic lymphoedema due to Noonan syndrome presented at our hospital with septic shock and pain in his lower leg. Blood cultures were positive for Streptococcus dysgalactiae subsp equisimilis (SDSE), resulting in a diagnosis of cellulitis with toxic involvement. He was treated with ampicillin for 3 weeks. Although he did well for 6 weeks, septic shock recurred. Blood culture again revealed SDSE, with the strain being identical to the first episode, suggesting that this infection had relapsed. He was treated with ampicillin for 6 weeks and prophylactically with trimethoprim-sulfamethoxazole for 12 months. Although SDSE bacteraemia occurs commonly in elderly patients, findings in this patient showed that it can also develop in younger persons with predisposing factors. This case also indicates that SDSE has the potential to recur, despite generally sufficient antibiotic administration, and that patients who experience recurrent episodes may require prolonged treatment with antibiotics, including prophylaxis. 2016 BMJ Publishing Group Ltd.

  16. Toxic shock syndrome: an opportunity for nursing intervention.

    PubMed

    Creehan, P A

    1995-01-01

    Toxic Shock Syndrome (TSS) is a potentially fatal illness caused by a particular strain of Staphylococcus aureus. The clinical presentation is similar to that of septic shock. The incidence of TSS peaked in the late 1970s and early 1980s, probably as a result of availability of super absorbent tampons. Although most commonly associated with menstruation, the overall incidence of menstrual and nonmenstrual TSS in men and women ranges from 1 to 3 per 100,000. There are almost equal numbers of menstrual and nonmenstrual cases of TSS identified annually. S aureus, the causative microorganism in cases of TSS, has been isolated from many body tissues. Toxic shock syndrome presents as a flu-like illness with high fever, vomiting, diarrhea, general malaise, and muscle weakness. Nursing and medical management focus on controlling or preventing potentially serious complications, such as adult respiratory distress syndrome, renal failure, electrolyte imbalances, disseminated intravascular coagulation, encephalopathy, and cardiomyopathy. Judicious use of tampons and barrier contraceptive devices may decrease the risk of developing TSS.

  17. Hospitalized dogs recovery from naturally occurring heatstroke; does serum heat shock protein 72 can provide prognostic biomarker?

    PubMed

    Bruchim, Yaron; Segev, Gilad; Kelmer, Efrat; Codner, Carolina; Marisat, Ahmad; Horowitz, Michal

    2016-01-01

    Heatstroke is a serious illness in dogs characterized by core temperatures above 41°C with central nervous system dysfunction. Experimental heatstroke models have tried to correlate biomarker levels with the severity of the syndrome. Serum heat shock protein (eHSP70) levels were recently evaluated as a biomarker of heat tolerance and acclimation, their role as a marker of heatstroke is inconclusive. Here, we monitored eHSP70 levels in correlation with systemic biomarkers in 30 naturally occurring canine heatstroke cases. Thirty dogs diagnosed with environmental (33%) or exertional (66%) heatstroke admitted to hospital (0-14 h post-injury) were tested for biomarkers of organ damage and coagulation parameters. eHSP70 levels were measured upon admission and 4, 12, and 24 h later (T1, T2, and T3, respectively). No differences were found between exertional and environmental heatstroke cases. The eHSP profile demonstrated an inverted bell shape, with the lowest levels at the 12 h time point. A positive correlation between eHSP70, lactate, and aPPT was also noted at T2 in all the dogs in the study. Twenty-four h after presentation, eHSP70 levels returned to those measured upon admission, this change was only significant in the survivors. The obtained results suggest that eHSP72 level profile may be predictive of survival.

  18. Maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma.

    PubMed

    Takahashi, Hironori; Matsubara, Shigeki; Kuwata, Tomoyuki; Ohkuchi, Akihide; Mukoda, Yukiko; Saito, Koyomi; Usui, Rie; Suzuki, Mitsuaki

    2014-04-01

    Various fetal or placental disorders cause Ballantyne's (mirror) syndrome. For the first time, we report a maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma (CMN). In a pregnant woman with a CMN fetus, lung edema, hypertension, hyperthyroidism, and high serum human chorionic gonadotrophin level occurred, all of which characterize maternal manifestation of Ballantyne's syndrome. The fetus and placenta were devoid of 'edema', lacking 'triple edema', and thus this condition was not diagnosed as Ballantyne's syndrome; however, we considered this condition as the maternal manifestation of Ballantyne's syndrome. We performed emergent cesarean section at 28 weeks. Delivery acutely ameliorated maternal symptoms. Tumor was resected and was confirmed as CMN. Maternal manifestations of Ballantyne's syndrome, such as lung edema and hypertension, can occur in a mother with fetal CMN even without fetal and/or placental edema. The clinical course of this patient may suggest an etiology of Ballantyne's syndrome.

  19. Posterior Reversible Encephalopathy Syndrome Occurring After Uterine Artery Embolization for Uterine Myoma

    SciTech Connect

    Suzuki, Satoshi Tanigawa, Noboru; Kariya, Syuji; Komemushi, Atsushi; Kojima, Hiroyuki; Tokuda, Takanori; Kishimoto, Masanobu; Tomino, Atsutoshi; Fujioka, Masayuki; Kitazawa, Yasuhide; Sawada, Satoshi

    2011-02-15

    This case report describes posterior reversible encephalopathy syndrome (PRES) occurring after uterine artery embolization (UAE) for uterine myoma. This is the first report of PRES occurring after uterine vascular radiologic intervention. The mechanism by which UAE induced PRES is unclear.

  20. Anaphylactic Shock: Kounis Hypersensitivity-Associated Syndrome Seems to be the Primary Cause

    PubMed Central

    Kounis, Nicholas G; Soufras, George D; Hahalis, George

    2013-01-01

    Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance. PMID:24404540

  1. Anaphylactic Shock: Kounis Hypersensitivity-Associated Syndrome Seems to be the Primary Cause.

    PubMed

    Kounis, Nicholas G; Soufras, George D; Hahalis, George

    2013-11-01

    Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivity-associated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.

  2. Hypovolemia and hypovolemic shock in children with nephrotic syndrome.

    PubMed

    Wang, S J; Tsau, Y K; Lu, F L; Chen, C H

    2000-01-01

    Hypovolemic shock is not an uncommon presentation in nephrotic syndrome, yet it is seldom mentioned in the literature. This study was performed to investigate the prevalence of hypovolemia and hypovolemic shock in the acute nephrotic stage, and the association of hemoconcentration and abdominal pain with hypovolemic status. Two hundred and twenty-five patients with a total of 328 admissions to the pediatric ward of our hospital during 1983 to 1996 were retrospectively reviewed for hypovolemic episodes. Clinical presentation and laboratory data including hemoglobin, serum sodium, albumin, cholesterol, and triglyceride levels were investigated. Thirteen patients with 19 episodes (5.8%) of hypovolemic shock were found, and had more severe hemoconcentration (hemoglobin 19.6 +/- 2.2 g/dL) and hyponatremia (127.3 +/- 7.2 mEq/L). Another 33 patients with 41 symptomatic hypovolemic episodes without hypotension (12.5%) were found, and their hemoglobin levels were higher compared to patients without hypovolemic symptoms. Among 61 episodes of abdominal pain and hemoconcentration, 58 were responsive to albumin infusion. This suggested the presence of hypovolemia. Twenty patients had abdominal pain without hemoconcentration, and 18 of them had primary peritonitis. Hypovolemia was found in patients at the acute nephrotic stage, and was usually associated with hemoconcentration and abdominal pain. A combined examination of hemoglobin and serum sodium is the best indicator of hypovolemic status. Both primary peritonitis and hypovolemic episodes should be taken into consideration when managing abdominal pain in children with nephrotic syndrome.

  3. Co-occurring anger in young people with Asperger's syndrome.

    PubMed

    Quek, Lake-Hui; Sofronoff, Kate; Sheffield, Jeanie; White, Angela; Kelly, Adrian

    2012-10-01

    The co-occurrence of anger in young people with Asperger's syndrome (AS) has received little attention despite aggression, agitation, and tantrums frequently being identified as issues of concern in this population. The present study investigated the occurrence of anger in young people with AS and explores its relationship with anxiety and depression. Sixty-two young people (12-23 years old) diagnosed with AS were assessed using the Beck Anger Inventory for Youth, Spence Children's Anxiety Scale, and Reynolds Adolescent Depression Scale. Among young people with AS who participated in this study, 41% of participants reported clinically significant levels of anger (17%), anxiety (25.8%) and/or depression (11.5%). Anger, anxiety, and depression were positively correlated with each other. Depression, however, was the only significant predictor of anger. Anger is commonly experienced by young people with AS and is correlated with anxiety and depression. These findings suggest that the emotional and behavioral presentation of anger could serve as a cue for further assessment, and facilitate earlier identification and intervention for anger, as well as other mental health problems. © 2012 Wiley Periodicals, Inc.

  4. The Hyperferritinemic Syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome

    PubMed Central

    2013-01-01

    Background Over the last few years, accumulating data have implicated a role for ferritin as a signaling molecule and direct mediator of the immune system. Hyperferritinemia is associated with a multitude of clinical conditions and with worse prognosis in critically ill patients. Discussion There are four uncommon medical conditions characterized by high levels of ferritin, namely the macrophage activation syndrome (MAS), adult onset Still’s disease (AOSD), catastrophic antiphospholipid syndrome (cAPS) and septic shock, that share a similar clinical and laboratory features, and also respond to similar treatments, suggesting a common pathogenic mechanism. Ferritin is known to be a pro-inflammatory mediator inducing expression of pro-inflammatory molecules, yet it has opposing actions as a pro-inflammatory and as an immunosuppressant. We propose that the exceptionally high ferritin levels observed in these uncommon clinical conditions are not just the product of the inflammation but rather may contribute to the development of a cytokine storm. Summary Here we review and compare four clinical conditions and the role of ferritin as an immunomodulator. We would like to propose including these four conditions under a common syndrome entity termed “Hyperferritinemic Syndrome”. PMID:23968282

  5. Lipopolysaccharide-Induced Toxic Shock Syndrome in Rabbits.

    PubMed

    Stach, Christopher S; Schlievert, Patrick M

    2016-01-01

    Enhancement of susceptibility to lipopolysaccharide (LPS; endotoxin) is a defining characteristic of Staphylococcus aureus superantigens. At the time of this publication, there are 24 identified staphylococcal superantigens (SAgs), some of which have yet to be fully characterized. Testing the capacity of superantigens to potentiate LPS sensitivity is essential to characterize the role of these proteins in disease development. Here we describe how to perform studies of the enhancement of LPS-induced toxic shock syndrome in rabbits. This protocol also provides information on a second important activity of superantigens: the production of fever.

  6. Rely and Toxic Shock Syndrome: A Technological Health Crisis

    PubMed Central

    Vostral, Sharra L.

    2011-01-01

    This essay examines factors leading to the identification of Toxic Shock Syndrome with the bacteria Staphylococcus aureus in 1978 and the specific role of Rely tampons in generating a technologically rooted health crisis. The concept biologically incompatible technology is offered to explain the relationship between constituent bacteria, women’s menstrual cycles, and a reactive technology that converged to create the ideal environment for the S. aureus bacteria to live and flourish in some women. The complicated and reactive relationship of the Rely tampon to emergent disease, corporate interests, public health, and injury law reveals the dangers of naturalizing technologies. PMID:22180682

  7. [Cardiogenic shock associated with inappropriate nutritional regimen: refeeding syndrome].

    PubMed

    Campos-Ferrer, C; Cervera-Montes, M; Romero, A; Borrás, S; Gómez, E; Ricart, C

    2004-01-01

    Situations of cardiac arrest have been reported in under-nourished patients with protein and calorie deficits when the provision of nutrients was initiated in an uncontrolled manner. The recognition of the association between the provision of food in these circumstances and the serious clinical consequences, generally heartbeat disorders, has led this condition to be described as "re-feeding syndrome". The case presented here is of severe acute respiratory failure and cardiogenic shock in a 44-year-old female patient with severe protein and calorie malnutrition associated with the start of hyperproteic nutritional support. Treatment with inotropic-vasoactive drugs and diuretics together with a progressive nutritional programme brought about the complete reversal of her heart failure and the concomitant endocrine-metabolic syndrome.

  8. Staphylococcal toxic shock syndrome presenting as acute respiratory distress and cor pulmonale.

    PubMed

    Zaki, S A; Shanbag, P; Chavan, V; Shenoy, P

    2010-01-01

    We describe a 7-year-old boy with staphylococcal toxic shock syndrome who presented with acute respiratory distress and cor pulmonale. We wish to highlight this unusual presentation as the diagnosis of toxic shock syndrome depends chiefly on a high degree of clinical suspicion. Early diagnosis and prompt institution of appropriate therapy will significantly reduce morbidity and mortality.

  9. Group B Streptococcal Toxic Shock Syndrome and covR/S Mutations Revisited

    PubMed Central

    Sendi, Parham; el Hay, Muad Abd; Brandt, Claudia M.

    2017-01-01

    Gene mutations in the virulence regulator CovR/S of group A Streptococcus play a substantial role in the pathogenesis of streptococcal toxic shock syndrome. We screened 25 group B Streptococcus (GBS) isolates obtained from patients with streptococcal toxic shock syndrome and found only 1 GBS clone harboring this kind of mutation. PMID:27983484

  10. Dengue haemorrhagic fever or dengue shock syndrome in children

    PubMed Central

    2015-01-01

    Introduction Dengue haemorrhagic fever and dengue shock syndrome are major causes of hospital admission and mortality in children. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of supportive treatments for dengue haemorrhagic fever or dengue shock syndrome in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding blood component transfusion to standard intravenous fluids; adding corticosteroids or intravenous immunoglobulin to standard intravenous fluids; and crystalloids versus colloids. PMID:25860404

  11. Tampon absorbency, composition and oxygen content and risk of toxic shock syndrome.

    PubMed

    Lanes, S F; Rothman, K J

    1990-01-01

    Tampon use has been identified as a major risk factor for toxic shock syndrome, although the etiologic role of tampons is not clearly understood. Two epidemiologic studies conducted to date have reported an association between tampon absorbency and risk of toxic shock syndrome. This finding is not corroborated by laboratory studies, however, which have suggested that absorbency may be a marker for other characteristics that create an environment conductive to the elaboration of toxic shock syndrome toxin 1. We used data from the previously reported Tri-state study to estimate simultaneously the effects of tampon oxygen content, absorbency and chemical composition. Although the data are sparse, oxygen content was more strongly associated with risk of toxic shock syndrome than either absorbency or chemical composition. The results suggest that it may be possible to develop a highly absorbent tampon that is not associated with a high risk of toxic shock syndrome.

  12. Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor

    PubMed Central

    Yoshida, Masataka; Takazono, Takahiro; Tashiro, Masato; Saijo, Tomomi; Morinaga, Yoshitomo; Yamamoto, Kazuko; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Sawai, Toyomitsu; Nishino, Tomoya; Izumikawa, Koichi; Yanagihara, Katsunori; Mukae, Hiroshi; Kohno, Shigeru

    2016-01-01

    Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible. PMID:27803422

  13. State-of-the-art monitoring in treatment of dengue shock syndrome: a case series.

    PubMed

    Moulton, Steven L; Mulligan, Jane; Srikiatkhachorn, Anon; Kalayanarooj, Siripen; Grudic, Greg Z; Green, Sharone; Gibbons, Robert V; Muniz, Gary W; Hinojosa-Laborde, Carmen; Rothman, Alan L; Thomas, Stephen J; Convertino, Victor A

    2016-08-24

    Early recognition and treatment of circulatory volume loss is essential in the clinical management of dengue viral infection. We hypothesized that a novel computational algorithm, originally developed for noninvasive monitoring of blood loss in combat casualties, could: (1) indicate the central volume status of children with dengue during the early stages of "shock"; and (2) track fluid resuscitation status. Continuous noninvasive photoplethysmographic waveforms were collected over a 5-month period from three children of Thai ethnicity with clinical suspicion of dengue. Waveform data were processed by the algorithm to calculate each child's Compensatory Reserve Index, where 1 represents supine normovolemia and 0 represents the circulatory volume at which hemodynamic decompensation occurs. Values between 1 and 0 indicate the proportion of reserve remaining before hemodynamic decompensation. This case report describes a 7-year-old Thai boy, another 7-year-old Thai boy, and a 9-year-old Thai boy who exhibited signs and symptoms of dengue shock syndrome; all the children had secondary dengue virus infections, documented by serology and reverse transcriptase polymerase chain reaction. The three boys experienced substantial plasma leakage demonstrated by pleural effusion index >25, ascites, and >20 % hemoconcentration. They received fluid administered intravenously; one received a blood transfusion. All three boys showed a significantly low initial Compensatory Reserve Index (≥0.20), indicating a clinical diagnosis of "near shock". Following 5 days with fluid resuscitation treatment, their Compensatory Reserve Index increased towards "normovolemia" (that is, Compensatory Reserve Index >0.75). The results from these cases demonstrate a new variation in the diagnostic capability to manage patients with dengue shock syndrome. The findings shed new light on a method that can avoid possible adverse effects of shock by noninvasive measurement of a patient's compensatory

  14. Two distinctive classic genetic syndromes, 22q11.2 deletion syndrome and Angelman syndrome, occurring within the same family.

    PubMed

    Kosaki, Rika; Migita, Ohsuke; Takahashi, Takao; Kosaki, Kenjiro

    2009-02-15

    We document a sib pair born to a mother with a reciprocal translocation, t(15;22)(q13;q11.2): the daughter had the Angelman syndrome phenotype associated with a maternally derived 15q deletion, and the son had a phenotype associated with a 22q deletion. Adjacent two-type segregation during gametogenesis in the mother can account for the unbalanced karyotypes of the siblings. From a tetravalent chromatid formed by normal chromosome 15, derivative chromosome 15, normal chromosome 22, and derivative chromosome 22, the daughter inherited chromosome 22 and derivative chromosome 22 and the son inherited chromosome 15 and derivative chromosome 15. The family is unique in that two distinctive genetic syndromes, 22q11.2 deletion syndrome and Angelman syndrome, occurred within the same family. The family is also elucidative from an educational standpoint in that major concepts of non-Mendelian inheritance (microdeletion, genomic imprinting, and reciprocal translocation) need to be considered to appreciate the inheritance pattern. Furthermore, the family illustrates the importance of cryptic rearrangements at the most proximal end of acrocentric chromosomes in the evaluation of siblings with multiple congenital anomaly-mental retardation phenotypes that are dissimilar among affected siblings. The situation is analogous to parental balanced translocation between the most "distal" segments of a chromosome, that is, the subtelomere region, a recently appreciated cause of familial recurrence of multiple congenital anomaly-mental retardation phenotype with a normal G-banding karyotype. We suggest that cryptic rearrangements at the most proximal end, analogous to those at the most distal end, should be considered as an appreciable cause of recurrent multiple congenital anomaly-mental retardation phenotype.

  15. [The pathophysiology of hemodynamic shock syndrome (part one)].

    PubMed

    Kovac, Z; Belina, D

    1998-12-01

    Hemodynamic shock syndrome represents an acute circulatory failure leading to a multiple organ failure. Such circulatory failure develops due to a decrease of arteriovenous blood pressure gradient as a consequence of three independent groups of pathogenic mechanisms (cardiogenic, vasohypotonic and hypovolemic), all of which lead to the common pathogenic pathways. A decrease of arteriovenous pressure gradient induces vasomotoric responses, reactive body fluids redistribution, endocrine, metabolic as well as tissue energy adjustments. In this review a comprehensive synopsis of pathogenic processes is outlined. The cardiogenic mechanisms include the acute systolic and/or diastolic heart failure. Vasohypotonic mechanisms (neurogenic, septic and anaphylactic) are due to vascular tonus missadjustment. Hypovolemia caused by blood, plasma, water and electrolytes losses and/or sequestration, leads to decrease of pressure gradient as soon as the extent of hypovolemia overcomes the compensatory vascular capacity. The decrease of tissue perfusion is direct consequence of the arteriovenous pressure gradient loss. Tissue hypoperfusion causes a progressive depletion of cellular ATP concentration (cellular hypoenergosis), which very often falls lower than 0,1 mmol/L. Cellular hypoenergosis plays the critical role in conversion of negative homeostatic regulation into a positive feedback mode. Positive homeostatic regulation (circuli vitiosi) amplifies deterioration of arteriovenous blood pressure gradient, which reversely intensifies the degree of energy depletion in the tissues. Such homeostatic conversion plays a critical role in the development of progressive phase (systemic failure, decompensation) of the shock.

  16. Novel Toxic Shock Syndrome Toxin-1 Amino Acids Required for Biological Activity

    PubMed Central

    Brosnahan, Amanda J.; Schaefers, Matthew M.; Amundson, William H.; Mantz, Mary J.; Squier, Christopher A.; Peterson, Marnie L.

    2009-01-01

    Superantigens interact with T lymphocytes and macrophages to cause T lymphocyte proliferation and overwhelming cytokine production, which lead to toxic shock syndrome. Staphylococcus aureus superantigen toxic shock syndrome toxin-1 is a major cause of menstrual toxic shock syndrome. In general, superantigen-secreting S. aureus remain localized at the vaginal surface, and the superantigen must therefore penetrate the vaginal mucosa to interact with underlying immune cells to cause toxic shock syndrome. A dodecapeptide region (toxic shock syndrome toxin-1 amino acids F119-D130), relatively conserved among superantigens, has been implicated in superantigen penetration of epithelium. The purpose of this study was to determine amino acids within this dodecapeptide region that are required for interaction with vaginal epithelium. Alanine mutations were constructed in S. aureus toxic shock syndrome toxin-1 amino acids D120 to D130. All mutants maintained superantigenicity, and selected mutants were lethal when given intravenously to rabbits. Toxic shock syndrome toxin-1 induces interleukin-8 from immortalized human vaginal epithelial cells; however three toxin mutants (S127A, T128A, and D130A) induced low levels of interleukin-8 compared to wild type toxin. When carboxy-terminal mutants (S127A to D130A) were administered vaginally to rabbits, D130A was nonlethal, while S127A and T128A demonstrated delayed lethality compared to wild type toxin. In a porcine ex vivo permeability model, mutant D130A penetrated vaginal mucosa more quickly than wild type toxin. Toxic shock syndrome toxin-1 residue D130 may contribute to binding an epithelial receptor, which allows it to penetrate vaginal mucosa, induce interleukin-8, and cause toxic shock syndrome. PMID:19012411

  17. Novel toxic shock syndrome toxin-1 amino acids required for biological activity.

    PubMed

    Brosnahan, Amanda J; Schaefers, Matthew M; Amundson, William H; Mantz, Mary J; Squier, Christopher A; Peterson, Marnie L; Schlievert, Patrick M

    2008-12-09

    Superantigens interact with T lymphocytes and macrophages to cause T lymphocyte proliferation and overwhelming cytokine production, which lead to toxic shock syndrome. Staphylococcus aureus superantigen toxic shock syndrome toxin-1 is a major cause of menstrual toxic shock syndrome. In general, superantigen-secreting S. aureus remains localized at the vaginal surface, and the superantigen must therefore penetrate the vaginal mucosa to interact with underlying immune cells to cause toxic shock syndrome. A dodecapeptide region (toxic shock syndrome toxin-1 amino acids F119-D130), relatively conserved among superantigens, has been implicated in superantigen penetration of the epithelium. The purpose of this study was to determine amino acids within this dodecapeptide region that are required for interaction with vaginal epithelium. Alanine mutations were constructed in S. aureus toxic shock syndrome toxin-1 amino acids D120 to D130. All mutants maintained superantigenicity, and selected mutants were lethal when given intravenously to rabbits. Toxic shock syndrome toxin-1 induces interleukin-8 from immortalized human vaginal epithelial cells; however, three toxin mutants (S127A, T128A, and D130A) induced low levels of interleukin-8 compared to wild type toxin. When carboxy-terminal mutants (S127A to D130A) were administered vaginally to rabbits, D130A was nonlethal, while S127A and T128A demonstrated delayed lethality compared to wild type toxin. In a porcine ex vivo permeability model, mutant D130A penetrated the vaginal mucosa more quickly than wild type toxin. Toxic shock syndrome toxin-1 residue D130 may contribute to binding an epithelial receptor, which allows it to penetrate the vaginal mucosa, induce interleukin-8, and cause toxic shock syndrome.

  18. A confirmed case of toxic shock syndrome associated with the use of a menstrual cup

    PubMed Central

    Mitchell, Michael A; Bisch, Steve; Arntfield, Shannon; Hosseini-Moghaddam, Seyed M

    2015-01-01

    Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk. The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described. PMID:26361491

  19. A confirmed case of toxic shock syndrome associated with the use of a menstrual cup.

    PubMed

    Mitchell, Michael A; Bisch, Steve; Arntfield, Shannon; Hosseini-Moghaddam, Seyed M

    2015-01-01

    Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk. The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described.

  20. [The hemodynamic characteristics of septic shock and relationship with syndrome types of traditional Chinese medicine].

    PubMed

    He, Jianzhuo; Wang, Lei; Yin, Xin; Guo, Liheng; Zhang, Minzhou

    2016-02-01

    .711, P = 0.007], while SVRI was increased [kPa×s×L(-1)×m(-2): 248.7 (202.1, 324.5) vs. 143.4 (102.7, 171.4), Z = -5.336, P = 0.000]. Accompanied symptoms were found to occur more commonly in septic shock patients, and the most common syndrome elements were Qi deficiency syndrome (n = 45), blood stasis syndrome (n = 40), heat-toxin syndrome (n = 37), Fushi syndrome (n = 24) and Yin deficiency syndrome (n = 10), respectively. There was no significant difference in hemodynamic parameters among patients with five types of syndrome (all P > 0.05). However, only the CI of those with Qi deficiency syndrome was significantly lower than that of heat-toxin syndrome (mL×s(-1)×m(-2): 48.3±18.3 vs. 53.3±21.7, P < 0.05). While the results after removing the effect of accompanied symptoms showed that CI of Qi deficiency syndrome was significantly lower than that of non-Qi deficiency syndrome (mL×s(-1)×m(-2): 48.3±18.3 vs. 61.7±21.7, t = -2.783, P = 0.007), CI of heat-toxin syndrome was significantly higher than that of non-heat-toxin syndrome (mL×s(-1)×m(-2): 58.3±21.7 vs. 48.3±16.7, t = 2.133, P = 0.037), EVLWI of blood stasis syndrome was significantly lower than that of non-blood stasis syndrome [mL/kg: 10.0 (7.0, 15.1) vs. 14.9 (8.5, 26.8), Z = -2.075, P = 0.038]. Compared with survival group (n = 38), APACHEII score in death group (n = 30) was increased (25.8±8.4 vs. 19.1±5.4, t = -3.940, P = 0.000), the proportion of continuous renal replacement therapy (CRRT) was increased [60.0% (18/30) vs. 31.6% (12/38), χ (2) = 5.493, P = 0.019], HR was increased (bpm: 118.5±20.5 vs. 98.1±19.9, t = -4.157, P = 0.000), and the proportion of Qi deficiency syndrome was increased [86.7% (26/30) vs. 50.0% (19/38), χ (2) = 10.070, P = 0.002]. Patients with sepsis shock may be divided into high-output and low-resistance and low-output and high-resistance groups according to hemodynamics, with respective hemodynamic characteristics. Hemodynamic performance differed among

  1. Sulphoraphane, a naturally occurring isothiocyanate induces apoptosis in breast cancer cells by targeting heat shock proteins

    SciTech Connect

    Sarkar, Ruma; Mukherjee, Sutapa; Biswas, Jaydip; Roy, Madhumita

    2012-10-12

    Highlights: Black-Right-Pointing-Pointer HSPs (27, 70 and 90) and HSF1 are overexpressed in MCF-7 and MDA-MB-231 cells. Black-Right-Pointing-Pointer Sulphoraphane, a natural isothiocyanate inhibited HSPs and HSF1 expressions. Black-Right-Pointing-Pointer Inhibition of HSPs and HSF1 lead to regulation of apoptotic proteins. Black-Right-Pointing-Pointer Alteration of apoptotic proteins activate of caspases particularly caspase 3 and 9 leading to induction of apoptosis. Black-Right-Pointing-Pointer Alteration of apoptotic proteins induce caspases leading to induction of apoptosis. -- Abstract: Heat shock proteins (HSPs) are involved in protein folding, aggregation, transport and/or stabilization by acting as a molecular chaperone, leading to inhibition of apoptosis by both caspase dependent and/or independent pathways. HSPs are overexpressed in a wide range of human cancers and are implicated in tumor cell proliferation, differentiation, invasion and metastasis. HSPs particularly 27, 70, 90 and the transcription factor heat shock factor1 (HSF1) play key roles in the etiology of breast cancer and can be considered as potential therapeutic target. The present study was designed to investigate the role of sulphoraphane, a natural isothiocyanate on HSPs (27, 70, 90) and HSF1 in two different breast cancer cell lines MCF-7 and MDA-MB-231 cells expressing wild type and mutated p53 respectively, vis-a-vis in normal breast epithelial cell line MCF-12F. It was furthermore investigated whether modulation of HSPs and HSF1 could induce apoptosis in these cells by altering the expressions of p53, p21 and some apoptotic proteins like Bcl-2, Bax, Bid, Bad, Apaf-1 and AIF. Sulphoraphane was found to down-regulate the expressions of HSP70, 90 and HSF1, though the effect on HSP27 was not pronounced. Consequences of HSP inhibition was upregulation of p21 irrespective of p53 status. Bax, Bad, Apaf-1, AIF were upregulated followed by down-regulation of Bcl-2 and this effect was prominent

  2. Are culture-bound syndromes as real as universally-occurring disorders?

    PubMed

    Cooper, Rachel

    2010-12-01

    This paper asks what it means to say that a disorder is a "real" disorder and then considers whether culture-bound syndromes are real disorders. Following J.L. Austin I note that when we ask whether some supposed culture-bound syndrome is a real disorder we should start by specifying what possible alternatives we have in mind. We might be asking whether the reported behaviours genuinely occur, that is, whether the culture-bound syndrome is a genuine phenomenon as opposed to a myth. We might be wondering whether the condition should rightly be considered a disorder, as opposed to some sort of non-disorder condition (for example, a non-disorder form of deviance, or a potentially valuable condition). We might want to know whether the culture-bound syndrome is really a distinct disorder, in the sense that scientific classification systems should include it as a separate category, or whether it is just a variant of a universally occurring disorder. I argue that some specific difficulties can arise with determining whether a culture-bound syndrome is a real disorder in each of these three senses. However, the frequent assumption that real disorders will necessarily occur universally, and that those that occur only in certain environments are suspicious is not generally justified. Copyright © 2010 Elsevier Ltd. All rights reserved.

  3. [A patient with toxic shock syndrome following correction of the nasal septum].

    PubMed

    Schweitzer, D H; Moffie, B G; van der Mey, A G; Thompson, J

    1990-11-03

    A male aged 30 suffered from toxic shock syndrome after septorhinoplasty with positioning of a tampon. Initial treatment consisted of removing the tampon and supportive care, as a result of which the patient recovered. The patient was a carrier of Staphylococcus aureus which produced toxic shock syndrome toxin-I (TSST-I). Anti-TSST-I antibodies were already found in the serum in the initial phase of the disease.

  4. Evidence of staphylococcal toxic shock syndrome caused by MRSA in a mother-newborn pair.

    PubMed

    Rostad, Christina A; Philipsborn, Rebecca Pass; Berkowitz, Frank E

    2015-04-01

    A neonate and his mother presented with fever and erythroderma. The mother met full diagnostic criteria for staphylococcal toxic shock syndrome, whereas the neonate lacked hypotension and multiorgan dysfunction. A wound culture from the neonate's circumcision site grew methicillin-resistant Staphylococcus aureus containing the tst gene. This provides evidence of the first reported case of toxic shock syndrome caused by methicillin-resistant Staphylococcus aureus in a mother-newborn pair.

  5. Comment on "Electrostatic compressive and rarefactive shocks and solitons in relativistic plasmas occurring in polar regions of pulsar"

    NASA Astrophysics Data System (ADS)

    Hafez, M. G.; Talukder, M. R.; Hossain Ali, M.

    2016-05-01

    The aim of this comment is to show the solution of the KdVB equation used by Shah et al. (Astrophys. Space Sci. 335:529-537, 2011, doi: 10.1007/s10509-011-0766-y) is not correct. So, the numerical results that are predicted in this manuscript should not be helpful for further investigations in a plasma laboratory. For this reason, we have employed the Bernoulli's equation method to obtain the correct form of analytical solution to this equation, which is appropriate for the study of electrostatic compressive and rarefactive shocks and solitons in relativistic plasmas occurring in polar regions of pulsar.

  6. Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

    PubMed Central

    Lee, Woo Seok; Kwon, Chang-Hee; Choi, Jin Hee; Jo, Uk; Kim, Yoo Ri; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2016-01-01

    Background and Objectives Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. Subjects and Methods We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. Results Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. Conclusion Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks. PMID:27014348

  7. Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome

    PubMed Central

    Berkes, Andrea; Szikszay, Edit; Kerényi, Adrienne; Szabó, Tamás; Ujhelyi, László; Bari, Krisztina; Balla, György

    2017-01-01

    Background Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. Case Presentation A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. Conclusion The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed. PMID:28791185

  8. Altered expression of glomerular heat shock protein 27 in experimental nephrotic syndrome.

    PubMed Central

    Smoyer, W E; Gupta, A; Mundel, P; Ballew, J D; Welsh, M J

    1996-01-01

    Although nephrotic syndrome is a very common kidney disease, little is known about the molecular changes occurring within glomerular capillary loops during development of disease. The characteristic histologic change is retraction (effacement) of the distal "foot" processes of glomerular epithelial cells (GEC) which surround the capillary loops. The GEC foot processes are an essential part of the kidney's filtration barrier, and their structure is regulated primarily by actin microfilaments, cytoskeletal proteins present in high concentrations in foot processes. Actin polymerization has been reported to be regulated via phosphorylation of the low molecular weight heat shock protein, hsp27. We localized hsp27 within normal rat GECs using immunofluorescence and immunoelectron microscopy. Induction of nephrotic syndrome and GEC foot process effacement using the puromycin aminonucleoside rat model resulted in significant increases in: (a) renal cortical hsp27 mRNA expression (826 +/- 233%, x +/- SEM, P < 0.01 vs. control); (b) glomerular hsp27 protein expression (87 +/- 2%, P < 0.001 vs. control); and (c) glomerular hsp27 phosphorylation (101 +/- 32%, P < 0.05 vs. control). These findings support the hypothesis that hsp27, by regulating GEC foot process actin polymerization, may be important in maintaining normal foot process structure, and regulating pathophysiologic GEC cytoskeletal changes during development of nephrotic syndrome. PMID:8675679

  9. Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia

    PubMed Central

    Liao, Chen-Yi; Su, Kuan-Jen; Lin, Cheng-Hui; Huang, Shu-Fang; Chin, Hsien-Kuo; Chang, Chin-Wen; Kuo, Wu-Hsien; Ben, Ren-Jy; Yeh, Yen-Cheng

    2016-01-01

    Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period. The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality. PMID:27366188

  10. Heat shock-induced degradation of Msn2p, a Saccharomyces cerevisiae transcription factor, occurs in the nucleus.

    PubMed

    Lallet, S; Garreau, H; Poisier, C; Boy-Marcotte, E; Jacquet, M

    2004-10-01

    In the yeast Saccharomyces cerevisiae, the zinc finger transcription factor Msn2p is a central component of the general stress response. It is activated in response to a wide variety of environmental changes, including physicochemical stresses as well as nutritional starvation, and induces the expression of a large set of genes required for cellular adaptation. The transcriptional activity of Msn2p in response to stresses is transient, and must therefore be strictly controlled. It is mainly regulated by reversible translocation from the cytoplasm to the nucleus upon the onset of stress, under the control of the cAMP-APK and the TOR pathways. In this report, we describe a new level of control: heat shock-induced degradation of Msn2p by the 26S proteasome. This degradation occurs in the nucleus and is further enhanced when Msn2p is fully active. Moreover, we show that the cyclin-dependent protein kinase Srb10p, a component of the transcription machinery, plays a role in the enhanced degradation of Msn2p upon heat shock. These findings provide new insights into the mechanisms by which Msn2p is transiently activated in response to stress.

  11. Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

    PubMed Central

    2016-01-01

    The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome. PMID:28119844

  12. Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management.

    PubMed

    Saugel, Bernd; Umgelter, Andreas; Martin, Friedrich; Phillip, Veit; Schmid, Roland M; Huber, Wolfgang

    2010-07-05

    Systemic Capillary Leak Syndrome (SCLS) is a rare disorder characterized by increased capillary hyperpermeability leading to hypovolemic shock due to a markedly increased shift of fluid and protein from the intravascular to the interstitial space. Hemoconcentration, hypoalbuminemia and a monoclonal gammopathy are characteristic laboratory findings. Here we present a patient who suffered from SCLS with hypovolemic shock and compartment syndrome of both lower legs and thighs. Volume and catecholamine management was guided using transpulmonary thermodilution. Extended hemodynamic monitoring for volume and catecholamine management as well as monitoring of muscle compartment pressure is of crucial importance in SCLS patients.

  13. Necrotizing arteritis occurring in an intralobar pulmonary sequestration of a patient without systemic vasculitis syndrome.

    PubMed

    Hashimoto, Hirotsugu; Hara, Kei; Matsumoto, Jun; Nashiro, Tamaki; Nagano, Masaaki; Kusakabe, Masashi; Kurata, Atsushi; Kuroda, Masahiko; Suzuki, Yoshio; Horiuchi, Hajime

    2016-01-01

    Necrotizing arteritis is a complex lesion of pulmonary hypertension, as are plexiform lesions, and is classically recognized as grade 6 in the Heath and Edwards grading scheme for hypertensive pulmonary vascular disease. The vascular changes observed in intralobar pulmonary sequestration have been reported to be similar to those observed in pulmonary hypertension, such as plexiform lesions. However, necrotizing arteritis occurring in an intralobar sequestration of a patient without systemic vasculitis syndrome has never been reported to our knowledge. Here, we report a case of a 38-year-old woman with pulmonary sequestration detected on a medical checkup. She was treated with surgery, and subsequent pathological analyses revealed necrotizing vasculitis in her sequestrated lung. We suspected systemic vasculitis syndromes, such as Takayasu arteritis, polyarteritis nodosa, and antineutrophil cytoplasmic antibody-associated vasculitis. However, physical and blood examination did not show any other abnormalities, and hence, she did not have systemic vasculitis syndrome. Immunohistochemical analyses of the resected specimen showed that inflammatory cells of the arteries were mainly composed of T lymphocytes. T-lymphocytic inflammation with little neutrophil and histiocyte infiltration may be a pathological feature of necrotizing arteritis observed in pulmonary sequestration. This is the first case to our knowledge of necrotizing arteritis in an intralobar pulmonary sequestration of a patient without systemic vasculitis syndrome.

  14. Immune Reconstitution Inflammatory Syndrome Occurring in a Kidney Transplant Patient with Extrapulmonary Tuberculosis

    PubMed Central

    Ledesma, Kandria Jumil; Liu, Jessie

    2017-01-01

    Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state. We describe the development of immune reconstitution inflammatory syndrome (IRIS), a unique complication occurring during the treatment of extrapulmonary tuberculosis occurring after transplant which resulted from decreasing immunosuppression in a patient who received Alemtuzumab induction therapy. Although (IRIS) has been originally described in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART), solid organ transplant recipients with diagnosed or occult TB whose immune system may undergo immune reconstitution during their posttransplant course represent a new high risk group. PMID:28367350

  15. Immune Reconstitution Inflammatory Syndrome Occurring in a Kidney Transplant Patient with Extrapulmonary Tuberculosis.

    PubMed

    Iglesias, Jose; Ledesma, Kandria Jumil; Couto, Paul J; Liu, Jessie

    2017-01-01

    Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state. We describe the development of immune reconstitution inflammatory syndrome (IRIS), a unique complication occurring during the treatment of extrapulmonary tuberculosis occurring after transplant which resulted from decreasing immunosuppression in a patient who received Alemtuzumab induction therapy. Although (IRIS) has been originally described in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART), solid organ transplant recipients with diagnosed or occult TB whose immune system may undergo immune reconstitution during their posttransplant course represent a new high risk group.

  16. Selective expansion of T cells expressing V beta 2 in toxic shock syndrome

    PubMed Central

    1990-01-01

    Infection with Staphylococcus aureus and the production of toxic shock syndrome toxin-1 (TSST-1) have been implicated in the pathogenesis of toxic shock syndrome. Previous in vitro studies have demonstrated that TSST-1 is a powerful but selective stimulator of human T cells, and that the majority of activated cells express the TCR V beta 2 gene segment. We therefore studied patients with toxic shock syndrome using a modification of the PCR to determine if expansion of V beta 2+ T cells is a marker of the in vivo disease process. Five of eight patients studied demonstrated markedly elevated levels of circulating V beta 2+ T cells, whereas none showed significantly elevated levels of T cells expressing other V beta gene segments. The results suggest that toxin-mediated T cell activation, which involves a large fraction of the human T cell repertoire, may be critical in the pathogenesis of this disease. PMID:2117641

  17. Shock

    MedlinePlus

    ... you think a person is in shock: Call 911 for immediate medical help. Check the person's airway, ... help. When to Contact a Medical Professional Call 911 any time a person has symptoms of shock. ...

  18. Superantigenic activity of toxic shock syndrome toxin-1 is resistant to heating and digestive enzymes.

    PubMed

    Li, S-J; Hu, D-L; Maina, E K; Shinagawa, K; Omoe, K; Nakane, A

    2011-03-01

    To elucidate the stability of superantigenic activity and pathogenesis of toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxin A (SEA) against heating and digestive enzymes. Purified TSST-1 and SEA were treated with heating, pepsin and trypsin that are related to food cooking, stomach and intestine conditions. The integrity, superantigenic activity and toxicity of treated TSST-1 and SEA were analysed by Western blotting, spleen cell culture, cytokine assay and toxic shock models. Both TSST-1 and SEA showed strong resistance to heating, pepsin and trypsin digestion. Furthermore, the treated TSST-1 showed significant higher induction of interferon-γ and toxic shock compared with that of SEA. Pepsin- or trypsin-digested TSST-1 fragments still showed significant superantigenic and lethal shock toxicities. The superantigenic activity of TSST-1 was stable to heating and digestive enzymes. Pepsin- and trypsin-digested TSST-1 fragments still showed superantigenic and lethal shock activities, indicating that digested TSST-1 could cross epithelial cells and induce systemic toxicity. This study found, for the first time, that pepsin- or trypsin-digested smaller TSST-1 retained significant superantigenic and lethal shock activities. The different resistance of TSST-1 and SEA participates in the different pathogenic activities during food poisoning and toxic shock syndrome. © 2011 The Authors. Journal of Applied Microbiology © 2011 The Society for Applied Microbiology.

  19. Travel-related Streptococcal toxic shock syndrome caused by emm type 78 Streptococcus pyogenes.

    PubMed

    Tappe, Dennis; Schulze, Marco H; van der Linden, Mark; Ziegler, Uwe; Müller, Andreas; Stich, August

    2011-08-01

    Streptococcal toxic shock syndrome is a serious health problem in developed and developing countries. We here report a case of severe protracted disease after a minor skin infection in a young traveler returning from West Malaysia which was caused by an unusual emm-type strain harboring speG and smeZ superantigen genes.

  20. Brain injury due to anaphylactic shock: broadening manifestations of Kounis syndrome.

    PubMed

    Soufras, G D; Kounis, G N; Kounis, N G

    2014-04-01

    Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  1. Streptococcal Toxic Shock Syndrome Caused by Group G Streptococcus, United Kingdom

    PubMed Central

    Morgan, Marina

    2017-01-01

    We describe successful management of 3 patients with streptococcal toxic shock syndrome (STSS) attributable to group G Streptococcus infection. This small series supports recognition of group G Streptococcus in the etiology of STSS. We propose intravenous immunoglobulin be used in treatment as it is for STSS caused by group A Streptococcus. PMID:27983491

  2. Shock

    MedlinePlus

    ... the heart cannot pump blood effectively. This may happen after a heart attack. Neurogenic shock is caused by damage to the nervous system. Symptoms of shock include Confusion or lack of alertness Loss of consciousness Sudden and ongoing rapid heartbeat Sweating Pale skin ...

  3. Streptococcal Toxic Shock Syndrome: Life Saving Role of Peritoneal Lavage and Drainage

    PubMed Central

    Yokoyama, Minako; Oyama, Fumie; Ito, Asami; Yokota, Megumi; Matsukura, Daisuke; Tsutsumi, Shinji; Kasai, Tomonori; Nitobe, Yohshiro; Morikawa, Akiko; Ozaki, Takashi; Yokoyama, Yoshihito

    2016-01-01

    PURPOSE We encountered a case where an infection with group A streptococcus (GAS; ie, Streptococcus pyogenes) initially caused primary peritonitis and then subsequently caused streptococcal toxic shock syndrome. The patient’s life was likely saved by an emergency laparotomy followed by extensive peritoneal lavage and drainage. CASE PRESENTATION A 40-year-old woman was admitted to the Emergency Department for lower abdominal pain and numbness in the extremities. She presented with systemic inflammatory response syndrome. An emergency laparotomy was performed, and ascites that resembled pus and general peritonitis were noted. Peritoneal lavage and drainage were performed, and GAS was isolated from peritoneal fluid. Gram staining of cervical polyp specimens revealed Gram-positive bacteria. CONCLUSIONS The patient was diagnosed with streptococcal toxic shock syndrome due to an ascending GAS infection originating from vagina. PMID:27579001

  4. Atrophic pityriasis versicolor occurring in a patient with Sjögren's syndrome.

    PubMed

    Marinello, Elena; Piaserico, Stefano; Alaibac, Mauro

    2017-01-18

    Pityriasis versicolor is one of the most frequent epidermal mycotic infections in the world, but its atrophic variant is rarely described. The aetiology of the atrophy is still unknown, and two main hypotheses have been formulated, one suggesting a correlation with long-term use of topical steroids and the other a delayed type hypersensitivity to epicutaneous antigens derived from components of the fungus. Atrophic pityriasis versicolor is a benign disease, but needs to be distinguished from other more severe skin diseases manifesting with cutaneous atrophy. The diagnosis can be easily confirmed by direct microscopic observation of the scales soaked in 15% potassium hydroxide, which reveals the typical 'spaghetti and meatball' appearance, or by a skin biopsy in doubtful cases. Here, we describe a case of extensive atrophic pityriasis versicolor occurring in a woman affected by Sjögren's syndrome which completely resolved after topical antifungal treatment. 2017 BMJ Publishing Group Ltd.

  5. Ovarian hyperstimulation syndrome may be more likely if multiple pregnancy occurs following assisted conception.

    PubMed

    Mathur, R S; Joels, L A; Jenkins, J M

    1995-01-01

    Whereas modern assisted conception with such techniques as in vitro fertilisation now helps many subfertile couples to fulfill their ambition to have a child, it has not been without a price. The increased incidence of multiple pregnancies, with their attendant maternal and perinatal sequelae following assisted conception is well known, but perinatologists may be far less familiar with the Ovarian Hyperstimulation Syndrome (OHSS) which is the other major complication when controlled ovarian hyperstimulation is used during assisted conception treatment. Mild forms of OHSS are common and require no more than symptomatic treatment. Severe forms of OHSS are uncommon occurring in 0.6% to 14% of IVF cycles, but are nonetheless very important to identify as they may lead to thrombo-embolic disease, cardiorespiratory dysfunction, renal failure and even death [6]. This review considers whether OHSS may be related to multiple pregnancy by reviewing the available literature and local experience.

  6. Toxic-shock syndrome not associated with menstruation. A review of 54 cases.

    PubMed

    Reingold, A L; Dan, B B; Shands, K N; Broome, C V

    1982-01-02

    An increasing proportion of reported cases of toxic-shock syndrome (TSS) are not associated with menstruation (13.2% of reported cases with onset in 1981). The 54 cases of TSS not associated with menstruation reported through the U.S.A. national surveillance system between January, 1980, and June, 1981, were either associated with Staphylococcus aureus infections (cutaneous or subcutaneous lesions, infected surgical wounds, bursitis, mastitis, adenitis, lung abscess, or primary bacteraemia) or followed childbirth by vaginal delivery and caesarean section. Patients with TSS not associated with menstruation differed significantly in age and racial distributions from those with menstruation-associated TSS, and 17 of them were male. The clinical features of TSS not associated with menstruation and the characteristics of the S. aureus strains isolated from these patients were similar to those observed in TSS related to menstruation. The median incubation period of the disease in the post-surgical cases was 2 days. TSS can occur in many clinical settings in patients of both sexes and of all ages and racial groups.

  7. Heat shock proteins and chronic fatigue in primary Sjögren's syndrome.

    PubMed

    Bårdsen, Kjetil; Nilsen, Mari Mæland; Kvaløy, Jan Terje; Norheim, Katrine Brække; Jonsson, Grete; Omdal, Roald

    2016-04-01

    Fatigue occurs frequently in patients with cancer, neurological diseases and chronic inflammatory diseases, but the biological mechanisms that lead to and regulate fatigue are largely unknown. When the innate immune system is activated, heat shock proteins (HSPs) are produced to protect cells. Some extracellular HSPs appear to recognize cellular targets in the brain, and we hypothesize that fatigue may be generated by specific HSPs signalling through neuronal or glial cells in the central nervous system. From a cohort of patients with primary Sjögren's syndrome, 20 patients with high and 20 patients with low fatigue were selected. Fatigue was evaluated with a fatigue visual analogue scale. Plasma concentrations of HSP32, HSP60, HSP72 and HSP90α were measured and analysed to determine if there were associations with the level of fatigue. Plasma concentrations of HSP90α were significantly higher in patients with high fatigue compared with those with low fatigue, and there was a tendency to higher concentrations of HSP72 in patients with high fatigue compared with patients with low fatigue. There were no differences in concentrations of HSP32 and HSP60 between the high- and low-fatigue groups. Thus, extracellular HSPs, particularly HSP90α, may signal fatigue in chronic inflammation. This supports the hypothesis that fatigue is generated by cellular defence mechanisms.

  8. Compartment Syndrome of the Gluteus Medius Occurred without Bleeding or Trauma: A Case Report.

    PubMed

    Kong, Gyu-Min; Kwon, Yong-Uk; Park, Jun-Ho

    2015-12-01

    Compartment syndrome is an ischemic change resulting from an increase in compartment pressure. Initially, patients present with direct tenderness and swelling, and the weak circulation secondary to compartment syndrome can eventually lead to motor and sensory impairment. If the increase in pressure results in neurological impairment, emergency intervention is required to decompress the compartment. Typically, compartment syndrome develops on forearms or lower legs. The gluteal compartment is rarely the location of compartment syndrome and only a few cases have been presented in the literature with trauma or hematoma. We have treated a patient with gluteal compartment syndrome who presented with no history of trauma or hemorrhage and present that case report here.

  9. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.

    PubMed

    Rompe, Jan D; Segal, Neil A; Cacchio, Angelo; Furia, John P; Morral, Antonio; Maffulli, Nicola

    2009-10-01

    There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome. Hypothesis The null hypothesis was that local corticosteroid injection, home training, and repetitive low-energy shock wave therapy produce equivalent outcomes 4 months from baseline. Randomized controlled clinical trial; Level of evidence, 2. Two hundred twenty-nine patients with refractory unilateral greater trochanter pain syndrome were assigned sequentially to a home training program, a single local corticosteroid injection (25 mg prednisolone), or a repetitive low-energy radial shock wave treatment. Subjects underwent outcome assessments at baseline and at 1, 4, and 15 months. Primary outcome measures were degree of recovery, measured on a 6-point Likert scale (subjects with rating completely recovered or much improved were rated as treatment success), and severity of pain over the past week (0-10 points) at 4-month follow-up. One month from baseline, results after corticosteroid injection (success rate, 75%; pain rating, 2.2 points) were significantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment success at 4 months, radial shock wave therapy led to significantly better results (68%; 3.1 points) than did home training (41%; 5.2 points) and corticosteroid injection (51%; 4.5 points). The null hypothesis was rejected. Fifteen months from baseline, radial shock wave therapy (74%; 2.4 points) and home training (80%; 2.7 points) were significantly more successful than was corticosteroid injection (48%; 5.3 points). The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered. Subjects should be properly informed about the advantages and disadvantages of the treatment options, including the economic burden. The significant short-term superiority of a single corticosteroid injection over home training and shock wave therapy

  10. Immune reconstitution syndrome in a human immunodeficiency virus infected child due to giardiasis leading to shock

    PubMed Central

    Nandy, Sneha; Shah, Ira

    2015-01-01

    Human immunodeficiency virus (HIV)-associated immune reconstitution inflammatory syndrome has been reported in association with tuberculosis, herpes zoster (shingles), Cryptococcus neoformans, Kaposi's sarcoma, Pneumocystis pneumonia, hepatitis B virus, hepatitis C virus, herpes simplex virus, Histoplasma capsulatum, human papillomavirus, and Cytomegalovirus. However, it has never been documented with giardiasis. We present a 7-year-old HIV infected girl who developed diarrhea and shock following the initiation of antiretroviral therapy, and her stool showed the presence of giardiasis. PMID:26985424

  11. Demographics and co-occurring conditions in a clinic-based cohort with Down syndrome in the United Arab Emirates.

    PubMed

    Corder, Jennifer Price; Al Ahbabi, Fatima Jaber Sehmi; Al Dhaheri, Hind Saif; Chedid, Fares

    2017-09-01

    The majority of studies describing demographics and co-occurring conditions in cohorts with Down syndrome come from regions outside of the Middle East, mainly from Europe and North America. This paper describes demographics and co-occurring conditions in a hospital-based cohort of individuals with Down syndrome living in the Middle Eastern country of the United Arab Emirates (UAE). The first dedicated Down syndrome clinic in the UAE was established in 2012 at Tawam Hospital in Al Ain. This paper describes a clinic-based cohort of 221 participants over 4 years from the Gulf Down Syndrome Registry, a new Down syndrome database and contact registry created at Tawam Hospital. Key demographic findings include mean maternal age of 37 years, among the highest described in the literature. Sixty-two percent of mothers are >35 years. Over 90% of mothers received post-natal diagnosis of Down syndrome. High sex ratio, parental consanguinity, and large family size also characterize the group. The spectrum of many co-occurring conditions mirrors that of previously described populations, with some notable differences. Cardiovascular malformations are well represented, however, atrioventricular canal is not the most common. Genitourinary conditions are common, as evidenced by 12% of males with hypospadias and 15% with undescended testes. Glucose-6-phosphate dehydrogenase deficiency, alpha thalassemia trait, hypovitaminosis D, and dental caries are common in our cohort. This study describes a large hospital-based group with Down syndrome presenting to a new dedicated Down syndrome clinic in the UAE, highlighting unique demographic and co-occurring conditions found in that population. © 2017 Wiley Periodicals, Inc.

  12. Cardiogenic shock

    MedlinePlus

    Shock - cardiogenic ... electrical system of the heart (heart block) Cardiogenic shock occurs when the heart is unable to pump ... orthostatic hypotension) Weak (thready) pulse To diagnose cardiogenic shock, a catheter (tube) may be placed in the ...

  13. Clinical Audit of Gastrointestinal Conditions Occurring among Adults with Down Syndrome Attending a Specialist Clinic

    ERIC Educational Resources Information Center

    Wallace, Robyn A.

    2007-01-01

    Background: Adults with Down syndrome (DS) are predisposed to syndromic and environmental gastrointestinal conditions. Method: In a hospital-based clinic for adults with DS, a chart audit was conducted to assess the range and frequency of gastrointestinal conditions. Results: From January 2003 to March 2005, 57 patients attended the clinic,…

  14. Clinical Audit of Gastrointestinal Conditions Occurring among Adults with Down Syndrome Attending a Specialist Clinic

    ERIC Educational Resources Information Center

    Wallace, Robyn A.

    2007-01-01

    Background: Adults with Down syndrome (DS) are predisposed to syndromic and environmental gastrointestinal conditions. Method: In a hospital-based clinic for adults with DS, a chart audit was conducted to assess the range and frequency of gastrointestinal conditions. Results: From January 2003 to March 2005, 57 patients attended the clinic,…

  15. Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study.

    PubMed

    Handa, Rajash K; Liu, Ziyue; Connors, Bret A; Alloosh, Mouhamad; Basile, David P; Tune, Johnathan D; Sturek, Michael; Evan, Andrew P; Lingeman, James E

    2015-04-01

    We performed a pilot study to assess whether renal shock wave lithotripsy influences metabolic syndrome onset and severity. Three-month-old juvenile female Ossabaw miniature pigs were treated with shock wave lithotripsy (2,000 shock waves at 24 kV with 120 shock waves per minute in 2) or sham shock wave lithotripsy (no shock waves in 2). Shock waves were targeted to the upper pole of the left kidney to model treatment that would also expose the pancreatic tail to shock waves. Pigs were then instrumented to directly measure arterial blood pressure via an implanted radiotelemetry device. They later received a hypercaloric atherogenic diet for about 7 months. Metabolic syndrome development was assessed by the intravenous glucose tolerance test. Metabolic syndrome progression and severity were similar in the sham treated and lithotripsy groups. The only exception arterial blood pressure, which remained relatively constant in sham treated pigs but began to increase at about 2 months towards hypertensive levels in lithotripsy treated pigs. Metabolic data on the 2 groups were pooled to provide a more complete assessment of metabolic syndrome development and progression in this juvenile pig model. The intravenous glucose tolerance test revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months. These preliminary results suggest that renal shock wave lithotripsy is not a risk factor for worsening glucose tolerance or diabetes mellitus onset. However, it appears to be a risk factor for early onset hypertension in metabolic syndrome. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Ataxia and secretory diarrhea: two unusual paraneoplastic syndromes occurring concurrently in the same patient with ganglioneuroblastoma.

    PubMed

    Gesundheit, Benjamin; Smith, Charles R; Gerstle, J Ted; Weitzman, Sheila S; Chan, Helen S L

    2004-09-01

    The presence of rare paraneoplastic syndromes, the opsoclonus-myoclonus-ataxia syndrome (OMA), presumably caused by antineuronal antibody production, and diarrhea, caused by vasoactive intestinal peptide (VIP) secreted by neuroblastoma, may strongly signal the presence of neuroblastoma. The authors describe a child who presented with both syndromes concurrently; this has never been described previously in the same patient. However, diagnosis of neuroblastoma was delayed by a workup focused on the prolonged diarrhea rather than the ataxia. The diarrhea resolved after tumor resection, whereas OMA required further therapy. Increased awareness of VIP-secretory diarrhea, especially in an ataxic child, might contribute to an earlier diagnosis of neuroblastoma.

  17. Severe regimen-related toxicity occurring in a patient with XYY syndrome receiving allogeneic peripheral blood stem cell transplantation.

    PubMed

    Shibata, S; Kami, M; Kishi, Y; Hamaki, T; Ueyama, J-I; Miyakoshi, S; Morinaga, S-I; Hirabayashi, N; Kanda, Y; Mutou, Y

    2002-07-01

    A 23-year-old man with chronic myelocytic leukemia (CML) in the first chronic phase underwent allogeneic peripheral blood stem cell transplantation (PBSCT) from his HLA-identical sibling. Pretransplant evaluations showed that he had a low risk of transplantation-related mortality and that the interval between the diagnosis of CML and PBSCT was only 6 months. However, he developed a variety of complications, including acute renal failure requiring hemodialysis, severe hepatic damage, hemorrhagic cystitis, and gastrointestinal hemorrhage leading to hypovolemic shock. Pathological examination of the colonic mucosa showed vascular endothelial damage and thrombotic lesions, leading to the diagnosis of thrombotic microangiopathy. Later, we found that he had the constitutional abnormality XYY. XYY syndrome is a frequent congenital abnormality, and mental disorders and congenital abnormalities of kidney and liver are common manifestations. Considering his clinical course, it was interesting that complications were severe in the organs which are frequently involved in cases of XYY syndrome. These organs may have poor function or poor reserves and may be more vulnerable to endothelial damage caused by high-dose cytotoxic chemotherapy. Patients with XYY syndrome might have a high risk of transplantation-related mortality.

  18. Shock.

    PubMed

    Wacker, David A; Winters, Michael E

    2014-11-01

    Critically ill patients with undifferentiated shock are complex and challenging cases in the ED. A systematic approach to assessment and management is essential to prevent unnecessary morbidity and mortality. The simplified, systematic approach described in this article focuses on determining the presence of problems with cardiac function (the pump), intravascular volume (the tank), or systemic vascular resistance (the pipes). With this approach, the emergency physician can detect life-threatening conditions and implement time-sensitive therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Toxic shock syndrome post open reduction and Kirschner wire fixation of a humeral lateral condyle fracture

    PubMed Central

    Chan, Yuen; Selvaratnam, Veenesh; Garg, Neeraj

    2015-01-01

    Use of Kirschner wires (K-wires) is the most common method of fracture stabilisation in lateral condyle fracture fixation in children. We report a case of toxic shock syndrome (TSS) following an open reduction and internal fixation using K-wires for a humeral lateral condyle fracture in a 5-year-old girl. TSS is a toxin-mediated multisystem illness. It typically presents with shock and it is most often attributed to toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes. It can lead to multiorgan failure and, ultimately, death. It is important to be aware of TSS, as it can present within any setting. Patients often have non-specific symptoms and their condition can worsen rapidly. TSS postorthopaedic surgery is rare; however, due to the serious nature of this disease, it is important to promptly recognise and diagnose TSS, and to ensure appropriate treatment is started without delay. PMID:26264942

  20. Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome?

    PubMed

    Alyeşil, Cansu; Doğan, Nurettin Özgür; Özturan, İbrahim Ulaş; Güney, Seda

    2017-06-01

    Distributive shock is a hyperdynamic process resulting from excessive vasodilatation. Impaired blood flow causes inadequate tissue perfusion, which can lead to end-organ damage. Although the most common etiology is septic shock, anaphylactic and other etiologies should be considered. We report the case of a 30-year-old female who presented to the emergency department with nonspecific symptoms and hypotension after a viral upper respiratory infection. Her physical examination revealed mild edema and rebound tenderness in the right upper and bilateral lower quadrants. She also presented with hypotension concomitant with hypoperfusion symptoms, which were manifested by the loss of consciousness in the hour after her presentation. Neither etiologic agent nor drug use history was provided at the presentation; these may have caused anaphylaxis; however, she later reported that she took a propolis extract 1 day earlier. The hypotensive state was refractory to large amount of crystalloid infusion and a series of examinations were performed to determine the shock etiology. Computed tomography images showed pneumonic infiltrates in the lower zone of the right lung, an enlarged liver, a thickened gallbladder wall, and an extensive amount of free fluid in the perihepatic and retroperitoneal areas. All radiologic changes were thought to be due to a secondary condition that triggers them, none were considered as septic focus. Capillary leak syndrome was considered in differential diagnosis and 3 days after her presentation, her hypotension improved and she was discharged in a healthy state. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Capillary leak syndrome is a variant of distributive shock. After assessing other etiologies for this condition, emergency physicians should focus on a triggering event that may have caused hypoalbuminemia and a fluid shift. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [Emergency operation and perioperative management for a patient with strangulated ileus and shock associated with Rubinstein-Taybi syndrome].

    PubMed

    Oku, S; Goto, H; Arakawa, K; Goto, K; Hirakawa, M

    1994-08-01

    A 21-year-old white male with Rubinstein-Taybi syndrome (RTS) underwent emergency laparotomy and volvulus reduction for a strangulated ileus. Low blood pressure, rapid heart rate and dusky skin color indicated that he was in a hypovolemic and/or septic shock state. Communication with the patient was impossible because of severe mental retardation, deafness, and blindness, and he was quite combative and agitated. Because of an urgent situation and in anticipation of a great risk of regurgitation, no sedatives or anesthetics were used for induction of anesthesia. A large dose of vecuronium with a priming principle technique was the only agent used for endotracheal intubation. Vigorous fluid replacement and appropriate catecholamine therapy were required for the perioperative management and recovery from the shock state. Any cardiac episodes which have been reported in patients with RTS, such as supra-ventricular or ventricular arrhythmia, did not occur throughout the perioperative period. Lack of communication with the patient was an obstacle in the postoperative care, such as respiratory management or the estimation for the timing of extubation. In conclusion, the preparations for a possibly difficult airway and the possible occurrence of arrhythmia were thought to be prudent for the management of the patient with RTS.

  2. Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child.

    PubMed

    Fang, Li-Ching; Shyur, Shyh-Dar; Peng, Chun-Chih; Jim, Wai-Tim; Chu, Szu-Hung; Kao, Yu-Hsuan; Chen, Chen-Kuan; Liu, Ling-Chun

    2014-04-01

    We report a 3-year-old girl with Kawasaki disease who presented with retropharyngeal edema and shock syndrome. This is the first reported case in Taiwan. The patient initially presented with fever, cough, and pyuria followed by rapidly progressive enlarged bilateral cervical lymphadenopathy. On the third day of the fever, computed tomography for airway compression sign found widening of the retropharyngeal space mimicking a retropharyngeal abscess. Later, an endotracheal tube was inserted for respiratory distress. A skin rash over her trunk was also noted. On the fifth day of the fever, the clinical course progressed to hypotension and shock syndrome. Because of more swelling of bilateral neck lymph nodes, computed tomography was arranged again and revealed partial resolution of the edematous changes in the retropharyngeal space. Edema of the hands and feet, bilateral bulbar conjunctivitis, and fissured lips were subsequently found. The diagnosis of Kawasaki disease was confirmed on the eighth day of fever. There was no evidence of bacterial infection. She was administered intravenous immunoglobulin (2 mg/kg) and high dose aspirin (100 mg/kg/day). One day later, the fever subsided, and her blood pressure gradually became stable. Heart echocardiography on the Day 13 revealed dilated left coronary artery and mitral regurgitation. Follow-up echocardiography six months later showed normal coronary arteries. To date, the patient has not experienced any complications. This case illustrates that retropharyngeal edema and shock syndrome can be present in the same clinical course of Kawasaki disease. Clinicians and those who work in intensive care units should be aware of unusual presentations of Kawasaki disease to decrease rates of cardiovascular complications. Copyright © 2012. Published by Elsevier B.V.

  3. The pathophysiology of shock.

    PubMed

    Skowronski, G A

    1988-06-06

    Shock describes a group of circulatory syndromes, all of which result in generalized cellular hypoxia. This leads to the depletion of adenosine triphosphate, the failure of the sodium-potassium pump, mitochondrial dysfunction, and ultimately, the release of a variety of toxic substances. Eventually these given rise to irreversible cardiovascular collapse because of their effects on the microcirculation. Shock may arise due to a failure of preload (hypovolaemic shock), myocardial contractility (cardiogenic shock), afterload (septic shock) or combinations of these (for example, anaphylactic shock, traumatic shock and neurogenic shock). During shock, important physiological changes occur in the nervous, respiratory, renal and gastrointestinal systems, as well as in intermediary metabolism. Hypotension is not synonymous with shock, and emphasis should be placed on the detection of more subtle, early signs. Management requires a systematic approach in which diagnostic and therapeutic processes take place in parallel. Particular attention must be paid to ventilation, oxygenation, fluid and electrolyte therapy, haemodynamic monitoring and, where appropriate, inotropic drugs. Corticosteroid and opioid antagonist agents probably do not have a role, but other agents, such as thyroid hormones, are under investigation.

  4. NSD1 Mutations Are the Major Cause of Sotos Syndrome and Occur in Some Cases of Weaver Syndrome but Are Rare in Other Overgrowth Phenotypes

    PubMed Central

    Douglas, Jenny; Hanks, Sandra; Temple, I. Karen; Davies, Sally; Murray, Alexandra; Upadhyaya, Meena; Tomkins, Susan; Hughes, Helen E.; Cole, Trevor R. P.; Rahman, Nazneen

    2003-01-01

    Sotos syndrome is a childhood overgrowth syndrome characterized by a distinctive facial appearance, height and head circumference >97th percentile, advanced bone age, and developmental delay. Weaver syndrome is characterized by the same criteria but has its own distinctive facial gestalt. Recently, a 2.2-Mb chromosome 5q35 microdeletion, encompassing NSD1, was reported as the major cause of Sotos syndrome, with intragenic NSD1 mutations identified in a minority of cases. We evaluated 75 patients with childhood overgrowth, for intragenic mutations and large deletions of NSD1. The series was phenotypically scored into four groups, prior to the molecular analyses: the phenotype in group 1 (n=37) was typical of Sotos syndrome; the phenotype in group 2 (n=13) was Sotos-like but with some atypical features; patients in group 3 (n=7) had Weaver syndrome, and patients in group 4 (n=18) had an overgrowth condition that was neither Sotos nor Weaver syndrome. We detected three deletions and 32 mutations (13 frameshift, 8 nonsense, 2 splice-site, and 9 missense) that are likely to impair NSD1 functions. The truncating mutations were spread throughout NSD1, but there was evidence of clustering of missense mutations in highly conserved functional domains between exons 13 and 23. There was a strong correlation between presence of an NSD1 alteration and clinical phenotype, in that 28 of 37 (76%) patients in group 1 had NSD1 mutations or deletions, whereas none of the patients in group 4 had abnormalities of NSD1. Three patients with Weaver syndrome had NSD1 mutations, all between amino acids 2142 and 2184. We conclude that intragenic mutations of NSD1 are the major cause of Sotos syndrome and account for some Weaver syndrome cases but rarely occur in other childhood overgrowth phenotypes. PMID:12464997

  5. Group G streptococcal toxic shock-like syndrome in three cats.

    PubMed

    Taillefer, Mylène; Dunn, Marilyn

    2004-01-01

    Three 8-week-old kittens were presented with a history of acute, generalized weakness and severe fever. One cat was dead upon presentation, and necropsy findings were supportive of a group G Streptococcus spp. septicemia. During their clinical courses, two of the three kittens developed a progressive, marked swelling of one or more limbs. One moribund and severely hypothermic cat was euthanized a few hours after presentation, and necropsy was also supportive of a group G Streptococcus spp. septicemia. One kitten recovered. Group G streptococcal toxic shock-like syndrome was suspected because of the fulminant progression of the septicemia.

  6. KCOT Occurring in Bilateral Maxillary Sinus in Non-Syndromic Patient

    PubMed Central

    Newaskar, Vilas; Rajmohan, Sushmita; Dashore, Dolly

    2016-01-01

    Odontogenic Keratocyst (OKC) also termed as Keratocystic Odontogenic Tumour (KCOT) (WHO 2005) is a pathology with unique behavior because of which it is under much scrutiny and continued study. The pathology usually presents itself commonly in mandible and less commonly in maxilla. The occurrence of KCOT in maxillary sinus is reported as rare and multiple occurrences are mostly associated along with the presence of Nevoid Basal Cell Carcinoma (NBCC) syndrome. Here, we present a rare case of bilateral Maxillary OKC involving maxillary sinuses, without the presence of NBCC syndrome. An interesting feature of this case is the presence of left upper third molar in ectopic position in maxillary sinus and a vertically impacted right third molar suggesting an origin from the dental lamina. PMID:27656578

  7. Total palliative care for a patient with multiple cerebral infarctions that occurred repeatedly in association with gastric cancer (Trousseau's syndrome).

    PubMed

    Ukai, Katsuyuki; Okajima, Akiko; Yamauchi, Aya; Sasaki, Eiji; Yamaguchi, Yohsuke; Kimura, Hiroyuki; Aleksic, Branko; Ozaki, Norio

    2013-04-01

    Malignancy-related thromboembolism, also referred to as Trousseau's syndrome, can present as acute cerebral infarction, nonbacterial thrombotic endocarditis (NBTE), and migratory thrombophlebitis. Therefore, many physical, neurological, and psychological symptoms associated with Trousseau's syndrome may occur in the clinical course. To illustrate this, we report a case of a male patient in his 50s with carcinomatous peritonitis caused by gastric cancer, with multiple cerebral infractions that developed during disease progression. The patient was admitted to our hospital for the treatment of side effects of chemotherapy, although he strongly hoped to go home as soon as possible. In addition to making social supports plans, we were required to perform intensive total palliative care, because of his physical pain, general fatigue, anorexia, abdominal and neck pain, and psychological issues (insomnia, delirium, depression, suicidal thoughts, self-mutilation, panic attacks, agoraphobia, fear of death, and feelings of hopelessness). To the best of our knowledge, based on the literature search, this is the first reported case of Trousseau's syndrome described in the context of total palliative care, especially psychological care. We propose that neurological symptoms of Trousseau's syndrome cause these extensive mental disorders. Furthermore, because of the prognosis of Trousseau's syndrome, we should utilize our expertise fulfill the patient's wishes.

  8. Refractory Toxic Shock-Like Syndrome from Streptococcus dysgalactiae ssp. equisimilis and Intravenous Immunoglobulin as Salvage Therapy: A Case Series

    PubMed Central

    Karter, Dennis; Altshuler, Jerry; Altshuler, Diana; Schwartz, David; Torregrossa, Gianluca

    2016-01-01

    Infections from Streptococcus dysgalactiae ssp. equisimilis (SDSE) can cause a wide variety of infections, ranging from mild cellulitis to invasive disease, such as endocarditis and streptococcal toxic shock-like syndrome (TSLS). Despite prompt and appropriate antibiotics, mortality rates associated with shock have remained exceedingly high, prompting the need for adjunctive therapy. IVIG has been proposed as a possible adjunct, given its ability to neutralize a wide variety of superantigens and modulate a dysregulated inflammatory response. We present the first reported cases of successful IVIG therapy for reversing shock in the treatment of SDSE TSLS. PMID:27597908

  9. Acute encephalopathy with biphasic seizures and late reduced diffusion associated with staphylococcal toxic shock syndrome caused by burns.

    PubMed

    Yokochi, Takaoki; Sakanishi, Shinpei; Ishidou, Yuuki; Kawano, Go; Matsuishi, Toyojiro; Akita, Yukihiro; Obu, Keizo

    2016-10-01

    We report a case of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) associated with toxic shock syndrome caused by burns. A one-year-old girl was admitted to our hospital for treatment of severe burns. On day 3, she exhibited a fever, generalized rash and multiple organ failure. She was diagnosed with toxic shock syndrome after burns. She had seizures with fever twice on the same day, followed by secondary seizures on day 8 and transient deterioration of the gross motor functions involved in sitting alone and rolling over. On day 9, MRI diffusion-weighted images showed bright tree appearance (BTA). We conclude that she developed AESD.

  10. Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome.

    PubMed

    Du, Jundong; Liu, Hongming; Liu, Rong; Yao, Yongming; Jiao, Huabo; Zhao, Xiaodong; Yin, Huinan; Li, Zhanliang

    2011-04-01

    The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

  11. Influence of the Vaginal Microbiota on Toxic Shock Syndrome Toxin 1 Production by Staphylococcus aureus

    PubMed Central

    MacPhee, Roderick A.; Miller, Wayne L.; Gloor, Gregory B.; McCormick, John K.; Hammond, Jo-Anne; Burton, Jeremy P.

    2013-01-01

    Menstrual toxic shock syndrome (TSS) is a serious illness that afflicts women of premenopausal age worldwide and arises from vaginal infection by Staphylococcus aureus and concurrent production of toxic shock syndrome toxin-1 (TSST-1). Studies have illustrated the capacity of lactobacilli to reduce S. aureus virulence, including the capacity to suppress TSST-1. We hypothesized that an aberrant microbiota characteristic of pathogenic bacteria would induce the increased production of TSST-1 and that this might represent a risk factor for the development of TSS. A S. aureus TSST-1 reporter strain was grown in the presence of vaginal swab contents collected from women with a clinically healthy vaginal status, women with an intermediate status, and those diagnosed with bacterial vaginosis (BV). Bacterial supernatant challenge assays were also performed to test the effects of aerobic vaginitis (AV)-associated pathogens toward TSST-1 production. While clinical samples from healthy and BV women suppressed toxin production, in vitro studies demonstrated that Streptococcus agalactiae and Enterococcus spp. significantly induced TSST-1 production, while some Lactobacillus spp. suppressed it. The findings suggest that women colonized by S. aureus and with AV, but not BV, may be more susceptible to menstrual TSS and would most benefit from prophylactic treatment. PMID:23315732

  12. Epithelial Proinflammatory Response and Curcumin-Mediated Protection from Staphylococcal Toxic Shock Syndrome Toxin-1

    PubMed Central

    Schaefers, Matthew M.; Breshears, Laura M.; Anderson, Michele J.; Lin, Ying-Chi; Grill, Alex E.; Panyam, Jayanth; Southern, Peter J.; Schlievert, Patrick M.; Peterson, Marnie L.

    2012-01-01

    Staphylococcus aureus initiates infections and produces virulence factors, including superantigens (SAgs), at mucosal surfaces. The SAg, Toxic Shock Syndrome Toxin-1 (TSST-1) induces cytokine secretion from epithelial cells, antigen presenting cells (APCs) and T lymphocytes, and causes toxic shock syndrome (TSS). This study investigated the mechanism of TSST-1-induced secretion of proinflammatory cytokines from human vaginal epithelial cells (HVECs) and determined if curcumin, an anti-inflammatory agent, could reduce TSST-1-mediated pathology in a rabbit vaginal model of TSS. TSST-1 caused a significant increase in NF-κB-dependent transcription in HVECs that was associated with increased expression of TNF- α, MIP-3α, IL-6 and IL-8. Curcumin, an antagonist of NF-κB-dependent transcription, inhibited IL-8 production from ex vivo porcine vaginal explants at nontoxic doses. In a rabbit model of TSS, co-administration of curcumin with TSST-1 intravaginally reduced lethality by 60% relative to 100% lethality in rabbits receiving TSST-1 alone. In addition, TNF-α was undetectable from serum or vaginal tissue of curcumin treated rabbits that survived. These data suggest that the inflammatory response induced at the mucosal surface by TSST-1 is NF-κB dependent. In addition, the ability of curcumin to prevent TSS in vivo by co-administration with TSST-1 intravaginally suggests that the vaginal mucosal proinflammatory response to TSST-1 is important in the progression of mTSS. PMID:22431984

  13. Mutants of staphylococcal toxic shock syndrome toxin 1: mitogenicity and recognition by a neutralizing monoclonal antibody.

    PubMed Central

    Blanco, L; Choi, E M; Connolly, K; Thompson, M R; Bonventre, P F

    1990-01-01

    Toxic shock syndrome toxin 1 (TSST-1), a 22-kilodalton protein made by strains of Staphylococcus aureus harboring the chromosomal toxin gene, may elicit toxic shock syndrome in humans. In vitro, TSST-1 induces T cells to proliferate and macrophages to secrete interleukin-1. To conduct a structure-function analysis, point mutations on the TSST-1 gene were generated by site-directed mutagenesis to identify amino acids critical for activity of the toxin. Specific tyrosine and histidine residues were replaced by alanines. Wild-type and mutant TSST-1 gene constructs were expressed in Escherichia coli, and the products were tested for their mitogenic potential and reactivity with a TSST-1 neutralizing monoclonal antibody (MAb 8-5-7). Four of the mutants were similar to the wild type; i.e., the mutant toxins stimulated murine T cells and reacted with MAb 8-5-7 equally as well as the wild type. Two mutants exhibited a decrease in mitogenic activity, but one of these retained the capacity to bind with MAb 8-5-7 while the other was no longer recognized by the same antibody. One double mutant demonstrated minimal mitogenic activity and did not react in enzyme-linked immunosorbent and immunoblot assays with MAb 8-5-7. The data show that specific residues near the carboxy terminus of TSST-1 are essential for mitogenic activity and in forming the epitope recognized by neutralizing MAb 8-5-7. Images PMID:1696937

  14. Varicella infection in a neonate with subsequent staphylococcal scalded skin syndrome and fatal shock.

    PubMed

    Singh, Shakal Narayan; Tahazzul, Mohammad; Singh, Anita; Chandra, Surabhi

    2012-08-01

    A male term neonate, at day 23 of life, presented with vesicular lesions over the trunk, which spread to allover the body on the next day. Five days later, he started developing blistering of the skin over the trunk and extremities, which subsequently ruptured, leaving erythematous, tender raw areas with peeling of the skin. The mother had vesicular eruptions, which started on the second day of delivery and progressed over the next 3 days. Subsequently, similar eruptions were noticed in two of the siblings before affecting the neonate. On the basis of the exposure history and clinical picture, a diagnosis was made of varicella infection with staphylococcal scalded skin syndrome (SSSS). The blood culture and the wound surface culture grew Staphylococcus aureus. Treatment included intravenous fluid, antibiotics, acyclovir and wound care. However, after 72 h of hospitalisation, the neonate first developed shock, refractory to fluid boluses, vasopressors and catecholamine along with other supports; and he then succumbed. In all neonates, staphylococcal infection with varicella can be fatal due to SSSS, the toxic shock syndrome or septicaemia.

  15. Update through 1985 on the incidence of toxic shock syndrome among members of a prepaid health plan.

    PubMed

    Petitti, D B; Reingold, A L

    1989-01-01

    Through hospital records of men and women aged 15-34 years who were members of the Northern California Kaiser-Permanente Medical Care Program, trends in the incidence of toxic shock syndrome (TSS) requiring hospitalization in 1984-1985 were examined, and the results were compared with those for the period 1972-1983. No definite or probable cases of TSS were found in men during either 1984 or 1985. A total of 16 cases of TSS (10 definite and six probable) were found in women in 1984-1985. Ten (71%) of 14 cases for which the menstrual status of the patient could be determined unambiguously from the medical record occurred during menstruation, and two of the four nonmenstrual cases occurred in postpartum women using barrier contraception. Of the 16 cases, 14 (88%) were diagnosed as TSS or probable TSS by the attending physician, although only nine (64%) of the 14 diagnosed cases were given the correct discharge code. While trends in the incidence of TSS requiring hospitalization in women 15-34 years of age generally paralleled changes in the absorbency of available tampons, the contribution of other factors (e.g., changes in the chemical composition of tampons, changes in patterns of tampon use) to these trends could not be assessed.

  16. Guillain-Barré syndrome: report of two rare clinical cases occurring after allergenic bone grafting in oral maxillofacial surgery

    PubMed Central

    Cicciù, Marco; Herford, Alan Scott; Bramanti, Ennio; Maiorana, Carlo

    2015-01-01

    Guillaine-Barré Syndrome (GBS), also known as post-infectious polyneuropathy or acute idiopathic polyneuritis, is an infrequent disorder of the peripheral nervous system. The cause of GBS is unknown. It has been associated in the past with microbial infections, vaccinations, surgical procedures and debilitation of the patient. The classic signs of GBS occurring in the two patients being reported here are muscle weakness, motor and sensory impairment and ascending paralysis with respiratory involvement. The documented cases involved GBS syndrome following oral and maxillofacial surgery in which allogeneic-banked freeze-dried bone have been utilized along with autogenous grafting. There were no incidents of viral infection, vaccination or the other prodromal incidents involved in these cases. It is believed that the description of these two cases would be of interest in that it may stimulate the reporting of similar anecdotal occurrences by other surgeons. Both patients fully recovered from the GBS and are presently alive and well. PMID:26261679

  17. Enterococcus faecalis Inhibits Superantigen Toxic Shock Syndrome Toxin-1-Induced Interleukin-8 from Human Vaginal Epithelial Cells through Tetramic Acids

    PubMed Central

    Brosnahan, Amanda J.; Merriman, Joseph A.; Salgado-Pabón, Wilmara; Ford, Bradley; Schlievert, Patrick M.

    2013-01-01

    The vaginal mucosa can be colonized by many bacteria including commensal organisms and potential pathogens, such as Staphylococcus aureus. Some strains of S. aureus produce the superantigen toxic shock syndrome toxin-1, which can penetrate the vaginal epithelium to cause toxic shock syndrome. We have observed that a female was mono-colonized with Enterococcus faecalis vaginally as tested in aerobic culture, even upon repeated culture for six months, suggesting this organism was negatively influencing colonization by other bacteria. In recent studies, we demonstrated an “outside-in” mechanism of cytokine signaling and consequent inflammation that facilitates the ability of potential pathogens to initiate infection from mucosal surfaces. Thus, we hypothesized that this strain of E. faecalis may make anti-inflammatory factors which block disease progression of more pathogenic organisms. E. faecalis MN1 inhibited interleukin-8 production from human vaginal epithelial cells in response to the vaginal pathogens Candida albicans, Gardnerella vaginalis, and Neisseria gonorrhoeae, as well as to toxic shock syndrome toxin-1. We further demonstrated that this organism secretes two tetramic acid compounds which appear responsible for inhibition of interleukin-8 production, as well as inhibition of T cell proliferation due to toxic shock syndrome toxin-1. Microbicides that include anti-inflammatory molecules, such as these tetramic acid compounds naturally produced by E. faecalis MN1, may be useful in prevention of diseases that develop from vaginal infections. PMID:23613823

  18. Enterococcus faecalis inhibits superantigen toxic shock syndrome toxin-1-induced interleukin-8 from human vaginal epithelial cells through tetramic acids.

    PubMed

    Brosnahan, Amanda J; Merriman, Joseph A; Salgado-Pabón, Wilmara; Ford, Bradley; Schlievert, Patrick M

    2013-01-01

    The vaginal mucosa can be colonized by many bacteria including commensal organisms and potential pathogens, such as Staphylococcus aureus. Some strains of S. aureus produce the superantigen toxic shock syndrome toxin-1, which can penetrate the vaginal epithelium to cause toxic shock syndrome. We have observed that a female was mono-colonized with Enterococcus faecalis vaginally as tested in aerobic culture, even upon repeated culture for six months, suggesting this organism was negatively influencing colonization by other bacteria. In recent studies, we demonstrated an "outside-in" mechanism of cytokine signaling and consequent inflammation that facilitates the ability of potential pathogens to initiate infection from mucosal surfaces. Thus, we hypothesized that this strain of E. faecalis may make anti-inflammatory factors which block disease progression of more pathogenic organisms. E. faecalis MN1 inhibited interleukin-8 production from human vaginal epithelial cells in response to the vaginal pathogens Candida albicans, Gardnerella vaginalis, and Neisseria gonorrhoeae, as well as to toxic shock syndrome toxin-1. We further demonstrated that this organism secretes two tetramic acid compounds which appear responsible for inhibition of interleukin-8 production, as well as inhibition of T cell proliferation due to toxic shock syndrome toxin-1. Microbicides that include anti-inflammatory molecules, such as these tetramic acid compounds naturally produced by E. faecalis MN1, may be useful in prevention of diseases that develop from vaginal infections.

  19. Ultrastructural findings in lymph nodes from pigs suffering from naturally occurring postweaning multisystemic wasting syndrome.

    PubMed

    Rodriguez-Cariño, C; Segalés, J

    2009-07-01

    The aims of this study were to evaluate ultrastructural lesions in lymph nodes from postweaning multisystemic wasting syndrome (PMWS)-affected pigs and to correlate these alterations with detection of viral-like particles (VLPs). Samples of lymph nodes were taken from 4 PMWS-affected pigs and 2 healthy animals and processed by transmission electron microscopy. Significant ultrastructural alterations were only noted in PMWS-affected pigs, mainly in histiocytes and rarely in other cell types. Histiocytes showed severe swelling and proliferation of mitochondria, and proliferation and dilation of rough endoplasmic reticulum and Golgi complex. Infected histiocytes contained large numbers of intracytoplasmic inclusion (ICI) bodies with VLPs; some histiocytes also had intranuclear inclusions (INIs). Small inclusions were surrounded by double membrane, with a granular appearance or containing paracrystalline arrays; icosahedral VLPs were 8-17 nm in diameter. Large ICIs were double-membrane bounded or not and contained VLPs usually forming paracrystalline arrays. ICIs were often found next to mitochondria with severe swelling, and also inside them. INIs were not surrounded by membranes and contained virions of 10-13 nm diameter. Lymphocyte depletion was a striking finding of lymph nodes from PMWS-affected pigs. The inclusion bodies containing VLPs referred to in the present study should be classified as viral factories, suggesting that viral replication is probably a frequent event in macrophages, in which mitochondria might play a role.

  20. Study of instabilities in geoelectric time series measured during the preparation process of a main shock occurred in Mexico by means of the multifractal analysis and Tsallis statistics

    NASA Astrophysics Data System (ADS)

    Ramírez-Rojas, Alejandro; Flores-Márquez, Elsa Leticia

    2016-04-01

    In [1] has been shown that the q-value that appears in Tsallis statistics is related to the extremes αmax and αmin of the multifractal spectrum f(α). This relationship has been used in order to study the underlying statistics describing properly the fully developed turbulence. One of the features for those systems indicates that the underlying statistics is not extensive. In this work we study the fluctuations, like a Seismo Electrical Signals, observed in geoelectric time series measured prior a main shock in México with M = 6. 6, occurred on 24 October 1993. For this time series we obtain the multifractal spectrum and then we can calculate the q-values of the Tsalliśstatistics. Our findings indicate a possible measure of the correlation between the preparation processes and the instability of the system. [1] Lyra M L and Tsallis C 1998 Phys. Rev. Lett. 80 53

  1. Guillain–Barré Syndrome (42 Cases) Occurring During a Zika Virus Outbreak in French Polynesia

    PubMed Central

    Watrin, Louise; Ghawché, Frédéric; Larre, Philippe; Neau, Jean-Philippe; Mathis, Stéphane; Fournier, Emmanuel

    2016-01-01

    Abstract Zika virus (transmitted by mosquitoes) reached French Polynesia for the first time in 2013, leading to an epidemic affecting 10% of the total population. So far, it has not been known to induce any neurological complications, but, a few weeks after the outbreak, an unexpectedly high number of 42 patients presented with Guillain–Barré syndrome. We report the clinical and electrophysiological characteristics of this series. Males predominated with a sex ratio of 2.82 (mean age: 46). All patients (except 2) were native Polynesian. At admission, 55% were able to walk unaided against 38% at nadir, 24% had swallowing troubles (nadir: 45%), 74% had motor weakness of the limbs (nadir: 86%) and deep tendon reflexes were diminished or not found in the vast majority of patients. Mean duration of the progressive phase and of the plateau phase was respectively 7 and 9 days. Thirty-eight percent of the patients were admitted in intensive care unit and 10 patients underwent tracheotomy. Nerve electrophysiological studies at admission showed marked distal motor conduction alterations, which had almost completely disappeared at the 4th month; this pattern was more suggestive of acute motor axonal neuropathy (AMAN) than of acute inflammatory demyelinating polyneuropathy (AIDP). Lumbar puncture showed elevated proteins in 90% of the cases, with cell count always inferior to 50/μL. This epidemic raises several questions, such as the potential existence of interactions between Zika virus and Polynesian HLA system and/or the consequences of several recombination events of this virus. This situation should call for increased vigilance, especially in countries where Aedes mosquitoes are present. PMID:27057874

  2. MicroRNA Expression for Early Prediction of Late Occurring Hematologic Acute Radiation Syndrome in Baboons

    PubMed Central

    Port, Matthias; Herodin, Francis; Valente, Marco; Drouet, Michel; Ullmann, Reinhard; Doucha-Senf, Sven; Lamkowski, Andreas; Majewski, Matthäus; Abend, Michael

    2016-01-01

    For effective medical management of radiation-exposed persons after a radiological/nuclear event, blood-based screening measures in the first few days that could predict hematologic acute radiation syndrome (HARS) are needed. For HARS severity prediction, we used microRNA (miRNA) expression changes measured on days one and two after irradiation in a baboon model. Eighteen baboons underwent different patterns of partial or total body irradiation, corresponding to an equivalent dose of 2.5 or 5 Gy. According to changes in blood cell counts (BCC) the surviving baboons (n = 17) exhibited mild (H1-2, n = 4) or more severe (H2-3, n = 13) HARS. In a two Stage study design we screened 667 miRNAs using a quantitative real-time polymerase chain reaction (qRT-PCR) platform. In Stage II we validated candidates where miRNAs had to show a similar regulation (up- or down-regulated) and a significant 2-fold miRNA expression difference over H0. Seventy-two candidate miRNAs (42 for H1-2 and 30 for H2-3) were forwarded for validation. Forty-two of the H1-2 miRNA candidates from the screening phase entered the validation step and 20 of them showed a statistically significant 2–4 fold up-regulation relative to the unexposed reference (H0). Fifteen of the 30 H2-3 miRNAs were validated in Stage II. All miRNAs appeared 2–3 fold down-regulated over H0 and allowed an almost complete separation of HARS categories; the strongest candidate, miR-342-3p, showed a sustained and 10-fold down-regulation on both days 1 and 2. In summary, our data support the medical decision making of the HARS even within the first two days after exposure where diagnostic tools for early medical decision are required but so far missing. The miRNA species identified and in particular miR-342-3p add to the previously identified mRNAs and complete the portfolio of identified mRNA and miRNA transcripts for HARS prediction and medical management. PMID:27846229

  3. MicroRNA Expression for Early Prediction of Late Occurring Hematologic Acute Radiation Syndrome in Baboons.

    PubMed

    Port, Matthias; Herodin, Francis; Valente, Marco; Drouet, Michel; Ullmann, Reinhard; Doucha-Senf, Sven; Lamkowski, Andreas; Majewski, Matthäus; Abend, Michael

    2016-01-01

    For effective medical management of radiation-exposed persons after a radiological/nuclear event, blood-based screening measures in the first few days that could predict hematologic acute radiation syndrome (HARS) are needed. For HARS severity prediction, we used microRNA (miRNA) expression changes measured on days one and two after irradiation in a baboon model. Eighteen baboons underwent different patterns of partial or total body irradiation, corresponding to an equivalent dose of 2.5 or 5 Gy. According to changes in blood cell counts (BCC) the surviving baboons (n = 17) exhibited mild (H1-2, n = 4) or more severe (H2-3, n = 13) HARS. In a two Stage study design we screened 667 miRNAs using a quantitative real-time polymerase chain reaction (qRT-PCR) platform. In Stage II we validated candidates where miRNAs had to show a similar regulation (up- or down-regulated) and a significant 2-fold miRNA expression difference over H0. Seventy-two candidate miRNAs (42 for H1-2 and 30 for H2-3) were forwarded for validation. Forty-two of the H1-2 miRNA candidates from the screening phase entered the validation step and 20 of them showed a statistically significant 2-4 fold up-regulation relative to the unexposed reference (H0). Fifteen of the 30 H2-3 miRNAs were validated in Stage II. All miRNAs appeared 2-3 fold down-regulated over H0 and allowed an almost complete separation of HARS categories; the strongest candidate, miR-342-3p, showed a sustained and 10-fold down-regulation on both days 1 and 2. In summary, our data support the medical decision making of the HARS even within the first two days after exposure where diagnostic tools for early medical decision are required but so far missing. The miRNA species identified and in particular miR-342-3p add to the previously identified mRNAs and complete the portfolio of identified mRNA and miRNA transcripts for HARS prediction and medical management.

  4. Successful Treatment of Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome with the Addition of Linezolid

    PubMed Central

    Bojikian, Karine D.; Lucar, Jose

    2017-01-01

    Necrotizing fasciitis is a deep-seated subcutaneous tissue infection that is commonly associated with streptococcal toxic shock syndrome (TSS). Surgical debridement plus penicillin and clindamycin are the current standard of care. We report a case of necrotizing fasciitis and streptococcal TSS where linezolid was added after a failure to improve with standard therapy. Briefly after isolation of Streptococcus pyogenes from tissue cultures, the patient underwent two surgical debridement procedures and was changed to standard of care therapy. While the patient was hemodynamically stable, the patient's wounds, leukocytosis, and thrombocytopenia all progressively worsened. After initiation of linezolid, the patient slowly improved clinically. The present report is the first to highlight the role of linezolid in streptococcal necrotizing fasciitis and TSS not improving with standard therapy. PMID:28299216

  5. [Systemic capillary leak syndrome: hypoalbuminemia, hemoconcentration and shock. Presentation of a case].

    PubMed

    Muñoz-Guillén, N M; León-López, R; de la Cal-Ramírez, M A; Dueñas-Jurado, J M

    2014-03-01

    Systemic capillary leak syndrome is a rare disorder of unknown etiology and often recurrent episodes characterized by increased capillary permeability that allows a leakage of fluid and proteins from the circulatory system to the interstitial space leading to shock and massive edema. The lack of recognition of this disease may be due to its unespecific signs and symptons of presentation, its rapid clinical progression and high mortality of the acute episodes. General physicians are usually the first to evaluate patients with this kind of disorder, either in the pre-hospital situation, hospital emergency units or even (in the milder cases) in the health centers. Its poor outcome and the improvement in the prognosis, if appropriate treatment is initiated, leads us to emphasize the importance of recognizing this pathology in order to start the appropriate intensive care and emergency treatment.

  6. Recent trends in the incidence of toxic shock syndrome in northern California.

    PubMed Central

    Petitti, D B; Reingold, A L

    1991-01-01

    The incidence of toxic shock syndrome in women members of a large prepaid medical care program in Northern California was 1.5 cases per 100,000 in a period after removal of tampons containing polyacrylate rayon and reductions in tampon absorbency. This rate was lower, but not significantly lower, than the rate of 2.2 per 100,000 in the prior interval. It was higher, but not significantly higher, than the rate of 0.4 per 100,000 in the era before "superabsorbent" materials were introduced into tampons. The incidence in men has been stable at about 0.1 cases per 100,000 for the 15-year period from 1972 though 1987. PMID:1951837

  7. Case control study of thermal environment preceding haemorrhagic shock encephalopathy syndrome

    PubMed Central

    Bacon, C; Bell, S; Gaventa, J; Greenwood, D

    1999-01-01

    The purpose of the study was to investigate whether the thermal environment in which babies slept before developing haemorrhagic shock encephalopathy syndrome (HSES) differed from that of other babies. Data were collected by standardised interview from parents of 31 babies who had had HSES before the age of 7 months and compared with equivalent data for 124 control babies, with matching for outside temperature on the relevant night and for age. Multivariate analysis showed a strong association between HSES and covering of the baby's head by bedding, the odds ratio being 30.7 (95% confidence interval, 2.5 to 384). There were weaker associations with other aspects of the thermal environment. This suggests a link between HSES and some cases of cot death, supports the suggestion that HSES may be caused by overheating, and reinforces advice that babies should be placed to sleep in such a way that they are less likely to become totally covered.

 PMID:10490526

  8. Dye labelled monoclonal antibody assay for detection of Toxic Shock Syndrome Toxin -1 from Staphylococcus aureus

    PubMed Central

    Javid, Khojasteh V; Foster, HA

    2011-01-01

    Objective The aim of study was to develop a rapid assay, dye labelled monoclonal antibody assay (DLMAA), using non-radioactive organic synthetic dyes for identification of Toxic Shock Syndrome Toxin-1 (TSST-1) producing strains of Staphylococcus aureus. Materials and Methods The assay protocol required only two simple steps; addition of TSST-1 antigen to a nitrocellulose membrane and then adding a colloidal dye labelled antibody (D/A) suspension detection reagent. Results The sensitivity and specificity of the assay was determined relative to positive and negative strains compared to an ELISA assay. Overall 100% agreement was found between both assays. The sensitivity for detection of TSST-1 was 30 ng. Conclusion The DLMAA did not require handling and disposal of radioactive materials. It is a rapid qualitative technique for detection of TSST-1 toxin at room temperature within a short time. PMID:22530084

  9. Antibody titres to heat shock protein 27 are elevated in patients with acute coronary syndrome.

    PubMed

    Ghayour-Mobarhan, Majid; Sahebkar, Amirhossein; Parizadeh, Seyyed Mohammad Reza; Moohebati, Mohsen; Tavallaie, Shima; Rezakazemi-Bajestani, Seyyed Mohammad; Esmaeili, Habib-Allah; Ferns, Gordon

    2008-06-01

    IgG antibody titres to heat shock protein 27 (anti-Hsp27) were measured to determine whether these titres were affected in patients admitted with acute coronary syndrome. Blood samples were taken from 94 patients admitted with acute coronary syndrome. Anti-Hsp27 IgG titres were determined using an in-house enzyme-linked immunosorbent assay (ELISA) in the first and second 12 h after the onset of symptoms and compared with values for 81 age- and sex-matched control subjects. Median antibody titres to Hsp27 in the first sample from patients whose diagnosis was a myocardial infarction (n = 42) was 0.41 absorbancy units (range 0.28-0.57) and for those with unstable angina (n = 52) was 0.31 (range 0.20-0.42), both being significantly higher than for controls (n = 81), which was 0.08 (range 0.05-0.15) (P < 0.05). However, titres fell in the second samples collected in the coronary syndrome patients and were then no longer significantly different from controls (P > 0.05). Myocardial infarction patients also had significantly higher anti-Hsp27 titres in the first 12 h than patients with unstable angina (P < 0.05), but again the difference in the second sample did not reach statistical significance (P > 0.05). Serum antibody titres to Hsp27 rise and fall rapidly after the onset of acute coronary syndrome, and may be an early marker of myocardial ischaemia as patients with myocardial infarction or unstable angina both had high titres.

  10. Synthetic human monoclonal antibodies toward staphylococcal enterotoxin B (SEB) protective against toxic shock syndrome.

    PubMed

    Karauzum, Hatice; Chen, Gang; Abaandou, Laura; Mahmoudieh, Mahta; Boroun, Atefeh R; Shulenin, Sergey; Devi, V Sathya; Stavale, Eric; Warfield, Kelly L; Zeitlin, Larry; Roy, Chad J; Sidhu, Sachdev S; Aman, M Javad

    2012-07-20

    Staphylococcal enterotoxin B (SEB) is a potent toxin that can cause toxic shock syndrome and act as a lethal and incapacitating agent when used as a bioweapon. There are currently no vaccines or immunotherapeutics available against this toxin. Using phage display technology, human antigen-binding fragments (Fabs) were selected against SEB, and proteins were produced in Escherichia coli cells and characterized for their binding affinity and their toxin neutralizing activity in vitro and in vivo. Highly protective Fabs were converted into full-length IgGs and produced in mammalian cells. Additionally, the production of anti-SEB antibodies was explored in the Nicotiana benthamiana plant expression system. Affinity maturation was performed to produce optimized lead anti-SEB antibody candidates with subnanomolar affinities. IgGs produced in N. benthamiana showed characteristics comparable with those of counterparts produced in mammalian cells. IgGs were tested for their therapeutic efficacy in the mouse toxic shock model using different challenge doses of SEB and a treatment with 200 μg of IgGs 1 h after SEB challenge. The lead candidates displayed full protection from lethal challenge over a wide range of SEB challenge doses. Furthermore, mice that were treated with anti-SEB IgG had significantly lower IFNγ and IL-2 levels in serum compared with mock-treated mice. In summary, these anti-SEB monoclonal antibodies represent excellent therapeutic candidates for further preclinical and clinical development.

  11. Polymyxin-B immobilized column-direct hemoperfusion for adolescent toxic shock syndrome.

    PubMed

    Nanishi, Etsuro; Hirata, Yuichirou; Lee, Sooyoung; Kaku, Noriyuki; Momii, Kenta; Kubota, Kensuke; Nishio, Hisanori; Maehara, Yoshihiko; Hara, Toshiro

    2016-10-01

    Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well. © 2016 Japan Pediatric Society.

  12. Synthetic Human Monoclonal Antibodies toward Staphylococcal Enterotoxin B (SEB) Protective against Toxic Shock Syndrome*

    PubMed Central

    Karauzum, Hatice; Chen, Gang; Abaandou, Laura; Mahmoudieh, Mahta; Boroun, Atefeh R.; Shulenin, Sergey; Devi, V. Sathya; Stavale, Eric; Warfield, Kelly L.; Zeitlin, Larry; Roy, Chad J.; Sidhu, Sachdev S.; Aman, M. Javad

    2012-01-01

    Staphylococcal enterotoxin B (SEB) is a potent toxin that can cause toxic shock syndrome and act as a lethal and incapacitating agent when used as a bioweapon. There are currently no vaccines or immunotherapeutics available against this toxin. Using phage display technology, human antigen-binding fragments (Fabs) were selected against SEB, and proteins were produced in Escherichia coli cells and characterized for their binding affinity and their toxin neutralizing activity in vitro and in vivo. Highly protective Fabs were converted into full-length IgGs and produced in mammalian cells. Additionally, the production of anti-SEB antibodies was explored in the Nicotiana benthamiana plant expression system. Affinity maturation was performed to produce optimized lead anti-SEB antibody candidates with subnanomolar affinities. IgGs produced in N. benthamiana showed characteristics comparable with those of counterparts produced in mammalian cells. IgGs were tested for their therapeutic efficacy in the mouse toxic shock model using different challenge doses of SEB and a treatment with 200 μg of IgGs 1 h after SEB challenge. The lead candidates displayed full protection from lethal challenge over a wide range of SEB challenge doses. Furthermore, mice that were treated with anti-SEB IgG had significantly lower IFNγ and IL-2 levels in serum compared with mock-treated mice. In summary, these anti-SEB monoclonal antibodies represent excellent therapeutic candidates for further preclinical and clinical development. PMID:22645125

  13. Toxic shock syndrome toxin 1 binds to major histocompatibility complex class II molecules.

    PubMed Central

    Scholl, P; Diez, A; Mourad, W; Parsonnet, J; Geha, R S; Chatila, T

    1989-01-01

    Toxic shock syndrome toxin 1 (TSST-1) is a 22-kDa exotoxin produced by strains of Staphylococcus aureus and implicated in the pathogenesis of toxic shock syndrome. In common with other staphylococcal exotoxins, TSST-1 has diverse immunological effects. These include the induction of interleukin 2 receptor expression, interleukin 2 synthesis, proliferation of human T lymphocytes, and stimulation of interleukin 1 synthesis by human monocytes. In the present study, we demonstrate that TSST-1 binds with saturation kinetics and with a dissociation constant of 17-43 nM to a single class of binding sites on human mononuclear cells. There was a strong correlation between the number of TSST-1 binding sites and the expression of major histocompatibility complex class II molecules, and interferon-gamma induced the expression of class II molecules as well as TSST-1 binding sites on human skin-derived fibroblasts. Monoclonal antibodies to HLA-DR, but not to HLA-DP or HLA-DQ, strongly inhibited TSST-1 binding. Affinity chromatography of 125I-labeled cell membranes over TSST-1-agarose resulted in the recovery of two bands of 35 kDa and 31 kDa that comigrated, respectively, with the alpha and beta chains of HLA-DR and that could be immunoprecipitated with anti-HLA-DR monoclonal antibodies. Binding of TSST-1 was demonstrated to HLA-DR and HLA-DQ L-cell transfectants. These results indicate that major histocompatibility complex class II molecules represent the major binding site for TSST-1 on human cells. Images PMID:2542966

  14. Correlation between different Chinese medicine syndromes and changes in microcirculation in septic shock patients.

    PubMed

    Liu, Jing-feng; Zhao, Meng-ya; Zhuang, Hai-zhou; Liu, Chong; Weng, Yi-bing; Li, Ang; Zhang, Shu-wen; Duan, Mei-li

    2013-10-01

    To investigate the correlation between different Chinese medicine (CM) syndromes and variations in microcirculation in septic shock patients. seventy Septic shock patients were divided into four groups: heat damaging qi-yin group (HDQY, 23 cases); yin exhaustion and yang collapse group (YEYC, 26 cases); excessive heat in Fu organ group (EHFO, 10 cases); and heat damaging nutrient-blood group (HDNB, 11 cases). Sublingual microcirculation parameters were observed by sidestream dark-field (SDF) imaging and scored by Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA), and parameters of microcirculation perfusion variations and prognoses were analyzed. Compared with those with qi-yin heat damage, perfused vessel density (PVD) in other groups decreased dramatically (P<0.05), and APACHE II scores increased significantly (P<0.05). In addition, the recovery time was prolonged substantially (P<0.05), and the mixed venous oxygen saturation (SVO2) decreased (P<0.05). Blood lactic acid increased significantly (P<0.05), and the mixed SVO decreased (P<0.05), in the YEYC group. Compared with the thermal injury camp blood group, sublingual microcirculation parameter variations showed no obvious difference in the YEYC and EHFO groups (P>0.05). There were significant positive correlations between CM syndromes and APACHE II scoring in different groups (r=0.512, P<0.05). There were negative correlations between PVD and APACHE II scoring (r=-0.378, P=0.043), the proportion of perfused vessels (PPV) and APACHE II scoring (r=-0.472, P=0.008), as well as between the microvascular flow index (MFI) and APACHE II scoring (r=-0.424, P=0.023) in different patients. Sublingual microcirculation may serve as a clinical diagnostic parameter of the patient condition, as well as being a prognostic indicator.

  15. Hemophagocytic lymphohistiocytosis: a potentially underrecognized association with systemic inflammatory response syndrome, severe sepsis, and septic shock in adults.

    PubMed

    Raschke, Robert A; Garcia-Orr, Roxanne

    2011-10-01

    Hemophagocytic lymphohistiocytosis (HLH) was originally described as a genetic disorder of immune regulation, presenting in neonates with protracted fever, hepatosplenomegaly, and cytopenia. A secondary form of HLH, triggered by serious infections, was subsequently described in adults. We report three adult patients who presented with systemic inflammatory response syndrome and features consistent with severe sepsis and septic shock, who subsequently received a diagnosis of secondary HLH. We reviewed the relationship between infection-triggered HLH and septic shock from the perspective of the adult intensivist. The hyperinflammatory pathophysiologic characteristics of HLH and septic shock are closely intertwined. Clinical and laboratory features of HLH and septic shock overlap in some patients, making the syndromes difficult to distinguish. In our experience and review, progressive pancytopenia was the feature most likely to suggest secondary HLH in the adult patient with presumed (or definite) septic shock. Use of other HLH-2004 diagnostic criteria is hindered by the poor operating characteristics of these tests in critically ill adults. Bone marrow aspiration is the most useful diagnostic test, but may yield an initial false-negative result. The HLH-2004 treatment protocol is not of proven benefit in critically ill adults, but observational data suggest that aggressive immunosuppressive therapy should not be delayed. Further study of HLH in the critical care setting might provide important insights into the pathogenesis and clinical treatment of sepsis.

  16. Protective effects of granulocyte colony-stimulating factor on endotoxin shock in mice with retrovirus-induced immunodeficiency syndrome.

    PubMed

    Toki, S; Hiromatsu, K; Aoki, Y; Makino, M; Yoshikai, Y

    1997-10-01

    Mice with retrovirus-induced murine acquired immunodeficiency syndrome (MAIDS) were hypersensitive to lipopolysaccharide (LPS)-induced lethal shock accompanied by marked elevations of systematic interleukin 1beta (IL-beta) and interferon gamma (IFN-gamma) after LPS challenge. Pretreatment with 10 microg of recombinant human granulocyte colony-stimulating factor (rhG-CSF) protected MAIDS mice from hypersensitivity to LPS-induced lethal shock and this protection was concomitant with suppression of IFN-gamma production. Copyright 1997 Academic Press Limited.

  17. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius.

    PubMed

    Ji, Hye Min; Kim, Ho Jeong; Han, Soo Jeong

    2012-10-01

    To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer. Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm(2), 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm(2). The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer. There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group. ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.

  18. Recurrent differentiation syndrome or septic shock? Unresolved dilemma in a patient with acute promyelocytic leukemia.

    PubMed

    Jeddi, Ramzi; Ghédira, Hela; Amor, Ramzi Ben; Menif, Samia; Belhadjali, Zaher; Meddeb, Balkis

    2011-03-01

    Differentiation syndrome (DS) is a life-threatening complication observed in patients with acute promyelocytic leukemia (APL) receiving induction therapy with all-trans-retinoic acid (ATRA). A bimodal incidence of DS has been observed, with a majority of cases occurring during the first week of ATRA treatment ("early" DS), but a substantial number of cases occurring during the third or even fourth week of ATRA treatment ("late" DS). However, to our knowledge occurrence of both early and late DS in the same patient has not been reported. We report an APL patient treated with the AIDA regimen, who experienced both early and late DS, a situation where differential diagnosis was difficult.

  19. Like Father, Like Daughter-inherited cutis aplasia occurring in a family with Marfan syndrome: a case report.

    PubMed

    Islam, Yasmin Florence Khodeja; Williams, Charles A; Schoch, Jennifer Jane; Andrews, Israel David

    2017-01-01

    We present the case of a newborn with co-occurrence of Marfan syndrome and aplasia cutis congenita (ACC) and a family history significant for Marfan syndrome and ACC in the father. This case details a previously unreported mutation in Marfan syndrome and describes a novel coinheritance of Marfan syndrome and ACC.

  20. Clinical manifestations of Kawasaki disease shock syndrome: a case-control study.

    PubMed

    Chen, Pei-Shin; Chi, Hsin; Huang, Fu-Yuan; Peng, Chun-Chih; Chen, Ming-Ren; Chiu, Nan-Chang

    2015-02-01

    Kawasaki disease shock syndrome (KDSS) is a severe condition related to Kawasaki disease (KD), and sometimes it is difficult to diagnose. This is a case-control study to ascertain the clinical presentations, risk factors, and clinical outcomes of children who had KDSS. Children who were hospitalized during 2001-2011 with the diagnosis of KD combined with hypotension, sepsis, or shock were retrospectively reviewed and were defined as case patients. For each case patient, three season-matched patients diagnosed as having KD with normal blood pressure were identified to serve as control patients. Demographic characteristics, clinical presentations, laboratory features, therapies, and outcomes were analyzed. Nine KDSS patients and 27 control patients were identified. The average age of patients with KDSS was 3.2 ± 3.2 years. Compared with controls, KDSS patients were less likely to have a diagnosis of KD at admission (22.2% vs. 66.7%) and had a higher risk of coronary artery dilatation (77.8% vs. 11.1%). Risk factors for KDSS included higher neutrophil counts and proportions of bands, higher C-reactive protein (CRP), and lower platelet counts. All case patients received aspirin therapy; eight patients received intravenous immunoglobulin therapy, with two receiving more than one course. Seven KDSS patients required fluid resuscitation, and eight patients required vasoactive infusions. Patients with KDSS may have uneven clinical course and may be misdiagnosed in the beginning. They may have more prominent inflammatory markers in the early phase and higher risk of coronary artery dilatation. Copyright © 2013. Published by Elsevier B.V.

  1. Hemorrhagic shock and encephalopathy syndrome – the markers for an early HSES diagnosis

    PubMed Central

    Rinka, Hiroshi; Yoshida, Takeshi; Kubota, Tetsushi; Tsuruwa, Miho; Fuke, Akihiro; Yoshimoto, Akira; Kan, Masanori; Miyazaki, Dai; Arimoto, Hideki; Miyaichi, Toshinori; Kaji, Arito; Miyamoto, Satoru; Kuki, Ichiro; Shiomi, Masashi

    2008-01-01

    Background The hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease that affects young children. The outcomes of HSES patients are often fatal or manifesting severe neurological sequelae. We reviewed the markers for an early diagnosis of HSES. Methods We examined the clinical, biological and radiological findings of 8 patients (4 months to 9 years old) who met the HSES criteria. Results Although cerebral edema, disseminated intravascular coagulopathy (DIC), and multiple organ failure were seen in all 8 cases during their clinical courses, brain computed tomography (CT) scans showed normal or only slight edema in 5 patients upon admission. All 8 patients had normal platelet counts, and none were in shock. However, they all had severe metabolic acidosis, which persisted even after 3 hours (median base excess (BE), -7.6 mmol/L). And at 6 hours after admission (BE, -5.7 mmol/L) they required mechanical ventilation. Within 12 hours after admission, fluid resuscitation and vasopressor infusion for hypotension was required. Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission. Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure. Conclusion CT scan, platelet count, hemoglobin level and renal function upon admission are not useful for an early diagnosis of HSES. However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment. PMID:18922188

  2. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome

    PubMed Central

    Vahdatpour, Babak; Kiyani, Abolghasem; Dehghan, Farnaz

    2016-01-01

    Background: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS. Materials and Methods: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student’s t-test, and Chi-square test. Results: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period. Conclusion: It is recommended to use ESWT as a conservative treatment in patients with CTS. PMID:27563630

  3. Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome

    PubMed Central

    Kounis, Nicholas G.; Soufras, George D.; Davlouros, Periklis; Tsigkas, Grigorios; Hahalis, George

    2015-01-01

    Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance. PMID:25849705

  4. Combined etiology of anaphylactic cardiogenic shock: amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome.

    PubMed

    Kounis, Nicholas G; Soufras, George D; Davlouros, Periklis; Tsigkas, Grigorios; Hahalis, George

    2015-01-01

    Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance.

  5. Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from mainland China.

    PubMed

    Qian, Yun; Wong, Chi-Chun; Lai, San-Chuan; Lin, Zheng-Hua; Zheng, Wei-Liang; Zhao, Hui; Pan, Kong-Han; Chen, Shu-Jie; Si, Jian-Min

    2016-03-07

    We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient's condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in mainland China. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.

  6. Comparison of cotton and cotton/rayon tampons for effect on production of toxic shock syndrome toxin.

    PubMed

    Schlievert, P M

    1995-10-01

    Studies were done to compare tampons made solely of cotton and made of both cotton and rayon for effect on growth of Staphylococcus aureus and production of toxic shock syndrome toxin-1 (TSST-1). Under stationary in vitro conditions in which tampons were either oversaturated or 50% saturated with culture media, the same amount of or more TSST-1 was made with cotton tampons than with cotton/rayon tampons. Similarly, when tested with the tampon sac method, cotton tampons yielded the same amount of or more toxin than did the cotton/rayon tampons. Bacterial cell numbers generally paralleled toxin production. These data indicate that cotton tampons neither prevent TSST-1 production nor significantly adsorb toxin onto the fibers to make toxin unavailable to cause toxic shock syndrome, in contrast to results of a previous study.

  7. Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from mainland China

    PubMed Central

    Qian, Yun; Wong, Chi-Chun; Lai, San-Chuan; Lin, Zheng-Hua; Zheng, Wei-Liang; Zhao, Hui; Pan, Kong-Han; Chen, Shu-Jie; Si, Jian-Min

    2016-01-01

    We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in mainland China. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease. PMID:26973425

  8. Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome.

    PubMed

    Thébaud, B; Husson, B; Navelet, Y; Huault, G; Landrieu, P; Devictor, D; Sebire, G

    1999-03-01

    The haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease. The aetiology of this syndrome is unknown, and, despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. To assess the neurological features and potential prognostic markers of the disease. Retrospective study. Division of Neuropaediatrics in a children's university hospital. Fourteen patients fulfilling the HSES criteria out of 42 children admitted with fever and shock to the Paediatric Intensive Care Unit between 1986 and 1994, were analysed for clinical, biological, neuroradiological, EEG and neuropathological findings. The patients (age range from 2 to 33 months) were found at night or in the morning either comatous (n = 3) or convulsing (n = 11). All but one were healthy before admission, although eight had had a brief prodromal infectious disease. All were febrile (mean body temperature 39.9 degrees C +/-0.9 degrees). Seasonal clustering during the winter months was observed. Coma and seizures with frequent status epilepticus were the main neurological manifestations. All children recovered from their multiple organ failure within a few days. Seven died (50%); four survivors had neurological sequelae (29%) with a developmental quotient (DQ) of 50% or less in three and a DQ of 75% in one and three infants (21%) had normal outcomes. Computed tomography (CT) displayed a diffuse area of low density mainly in the cerebral cortex and intraventricular and parenchymal haemorrhages. Magnetic resonance imaging (MRI) showed haemorrhagic cortical lesions. Postmortem examination of the brain conducted in three patients showed necrotic and haemorrhagic lesions, mainly in cortical areas. Comparison of the children with adverse outcome (death or neurological sequelae) with those with normal outcome revealed that predictors of poor outcome were status epilepticus (p = 0.003) and coma for more than 24 h (p = 0.01). Infants without disseminated

  9. Electrophysiological correlates of reinforcement learning in young people with Tourette syndrome with and without co-occurring ADHD symptoms.

    PubMed

    Shephard, Elizabeth; Jackson, Georgina M; Groom, Madeleine J

    2016-06-01

    Altered reinforcement learning is implicated in the causes of Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). TS and ADHD frequently co-occur but how this affects reinforcement learning has not been investigated. We examined the ability of young people with TS (n=18), TS+ADHD (N=17), ADHD (n=13) and typically developing controls (n=20) to learn and reverse stimulus-response (S-R) associations based on positive and negative reinforcement feedback. We used a 2 (TS-yes, TS-no)×2 (ADHD-yes, ADHD-no) factorial design to assess the effects of TS, ADHD, and their interaction on behavioural (accuracy, RT) and event-related potential (stimulus-locked P3, feedback-locked P2, feedback-related negativity, FRN) indices of learning and reversing the S-R associations. TS was associated with intact learning and reversal performance and largely typical ERP amplitudes. ADHD was associated with lower accuracy during S-R learning and impaired reversal learning (significantly reduced accuracy and a trend for smaller P3 amplitude). The results indicate that co-occurring ADHD symptoms impair reversal learning in TS+ADHD. The implications of these findings for behavioural tic therapies are discussed.

  10. [Following sensory neuropathy, anti-Hu antibody-positive paraneoplastic neurological syndrome presenting with limbic encephalitis occurs after complete remission].

    PubMed

    Fukami, Yuki; Umemura, Toshitaka; Shimono, Tetufumi; Yokoi, Takamasa; Kamijo, Mikiko; Sakakibara, Toshimasa

    2013-01-01

    Paraneoplastic limbic encephalitis is a rare neurological disorder that frequently precedes the detection of malignancy. We report the case of a 68-year-old male with small-cell lung cancer who developed paraneoplastic limbic encephalitis associated with presence of the anti-Hu antibody, after achieving complete remission of the tumor by chemotherapy. The patient visited our hospital because of progressive sensory disturbance of the distal extremities at 65 years of age. Though paraneoplastic sensory neuropathy was suspected, we could not find any tumor and he did not improve with steroids or immunoglobulin therapy. Chest computed tomography (CT) revealed large mediastinal lymphadenopathy. He was subsequently diagnosed with small cell lung cancer at one year and three months after the neurological symptoms occurred. As his serum analysis was positive for the anti-Hu antibody, we diagnosed paraneoplastic sensory neuropathy. The lung cancer disappeared with chemotherapy, but he had developed short-term memory loss six months later. Brain fluid attenuated inversion recovery (FLAIR) imaging showed an abnormal high-intensity lesion in the left medial temporal lobe including the hippocampus. We therefore made the diagnosis of paraneoplastic limbic encephalitis following subacute sensory neuropathy associated with the anti-Hu antibody. To our knowledge, this is the first report of a patient presenting with paraneoplastic neurological syndrome in which limbic encephalitis developed after tumor disappearance. So we must recognize the possibility of neurological symptoms occurring during remission. As the mechanism of pathogenesis, delayed neuronal cell damage due to immune responses against the tumor is implicated.

  11. The Effectiveness of Radial Extracorporeal Shock Waves for Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial.

    PubMed

    Raissi, Gholam Reza; Ghazaei, Fatemeh; Forogh, Bijan; Madani, Seyed Pezhman; Daghaghzadeh, Abbas; Ahadi, Tannaz

    2017-02-01

    This study examined the effectiveness of radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome (CTS). Forty patients with mild to moderate CTS were allocated to two groups: (i) shock wave + wrist splint and (ii) wrist splint. Patients used wrist splints followed by three sessions of low-energy shock wave therapy in the intervention group and wrist splints alone in the other group. The QuickDASH Questionnaire, visual analogue scale and nerve conduction studies were used to evaluate the patients before the study and at 3, 8 and 12 wk after the start of the treatment. At the end of the study, both groups saw the same clinical benefits. However, a significantly greater improvement in the median nerve distal sensory latency was noted in the shock wave group compared with the control group. We suggest that application of shock wave with alternative protocols may be effective in the treatment of CTS in future studies. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  12. Staphylococcus aureus nasal carriage in rheumatoid arthritis: antibody response to toxic shock syndrome toxin-1.

    PubMed Central

    Tabarya, D; Hoffman, W L

    1996-01-01

    OBJECTIVE: To determine the prevalence of Staphylococcus aureus nasal carriage and to compare antibody responses to two superantigens, staphylococcal toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxin A (SEA), in rheumatoid arthritis patients and normal subjects. METHODS: 88 rheumatoid arthritis patients and 110 control subjects were cultured for nasal carriage of S aureus; 62 isolates were bacteriophage typed. Twenty five patients and 11 spouses were tested for antibodies to TSST-1, SEA, and sonicate extracts of Bacteroides fragilis and Escherichia coli; 19 patients were HLA-DR typed. RESULTS: 50% of patients and 33% of normal subjects were S aureus carriers. Bacteriophage typing of isolates suggested significant differences between strains isolated from the two groups. Patients showed higher IgG (P = 0.0025) and IgA (P = 0.0372) antibody levels to TSST-1 than normal spouses and these responses were not related to rheumatoid factor titres or HLA-DR type. CONCLUSION: When compared to normals, rheumatoid arthritis patients more often carry S aureus in their nasal vestibule, carry a distinct subpopulation of S aureus strains, and have higher average antibody levels to TSST-1. PMID:8976639

  13. Vitamin D serostatus and dengue fever progression to dengue hemorrhagic fever/dengue shock syndrome.

    PubMed

    Villamor, E; Villar, L A; Lozano, A; Herrera, V M; Herrán, O F

    2017-09-14

    Vitamin D could modulate pathways leading to dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We examined the associations of serum total 25-hydroxy vitamin D [25(OH)D] and vitamin D binding protein (VDBP) concentrations in patients with uncomplicated dengue fever (DF) with risk of progression to DHF/DSS. In a case-control study nested in a cohort of DF patients who were followed during the acute episode in Bucaramanga, Colombia, we compared 25(OH)D and VDBP at onset of fever between 110 cases who progressed to DHF/DSS and 235 DF controls who did not progress. 25(OH)D concentrations were also compared between the acute sample and a sample collected >1 year post-convalescence in a subgroup. Compared with 25(OH)D ⩾75 nmol/l, adjusted odds ratios (95% CI) for progression were 0·44 (0·22-0·88) and 0·13 (0·02-1·05) for 50 to 75 nmol/l (vitamin D insufficiency) and <50 nmol/l (vitamin D deficiency), respectively (P, trend = 0·003). Mean 25(OH)D concentrations were much lower post-convalescence compared with the acute episode, regardless of case status. Compared with controls, mean VDBP was non-significantly lower in cases. We conclude that low serum 25(OH)D concentrations in DF patients predict decreased odds of progression to DHF/DSS.

  14. Production of toxic shock syndrome toxin 1 by Staphylococcus aureus restricted to endogenous air in tampons.

    PubMed Central

    Reiser, R F; Hinzman, S J; Bergdoll, M S

    1987-01-01

    All types of four brands of tampons were tested in triplicate by a tampon sac method for their effect on production of toxic shock syndrome toxin 1 (TSST-1). In this method the available air is limited to that which is in the tampon sac. Tampons were weighed and inserted into dialysis sacs inoculated with a TSST-1-producing Staphylococcus aureus strain; the sacs were submerged into brain heart infusion agar, which was allowed to harden around the sacs, and were incubated for 18 h at 37 degrees C. The tampons were removed, weighed, and extracted; the CFU of staphylococci and the amount of toxin present in the extracts were determined. Glass wool was used in place of the tampons as one control, and inoculated empty sacs were used as a second control. The total CFU were consistently greater than 2 X 10(11) for the tampons and glass wool and less than or equal to 10(11) for the empty sac control. Total toxin production for all tampons tested and the glass wool was 2 to 10 times higher than the toxin produced with the empty sac control. These results indicate that tampons provide increased surface area for the staphylococci to grow and adequate oxygen for toxin production. No significant inhibition of growth of the staphylococci or TSST-1 production by any of the tampons tested was noted. PMID:3624443

  15. Sudden infant death syndrome: no significant expression of heat-shock proteins (HSP27, HSP70).

    PubMed

    Doberentz, Elke; Führing, Sarah; Madea, Burkhard

    2016-03-01

    In industrialized countries, sudden infant death is the most common cause of death in young children. Although prone sleeping position is a well-known risk factor, hyperthermia might also be important. Pathognomonic findings of premortem hyperthermia do not exist. During stress, including thermal effects, heat-shock protein (HSP) expression increases. This study investigated hyperthermia as a contributing or pathogenic factor for sudden infant death syndrome (SIDS). Immunohistochemical staining for HSP27 and HSP70 in the kidney, heart, and lung from 120 SIDS cases was examined. HSP70 immunostaining was negative in kidney, heart, and lung tissues in all cases and in tissues from the control group. HSP27 staining was positive in the kidney from one case, and was positive in the lungs (respiratory epithelia in 27% of cases; vascular endothelia in 19% of cases) and was negative in the heart. In the control group HSP27 was positive in 8% of renal tubular tissues and in 29% of renal vascular endothelia. Staining for HSP27 in lung tissues was positive in respiratory epithelia in 8% of cases and for vascular endothelia in 29%, whereas tissues from the heart were positive in only 4%. The hypothesis of hyperthermia being a pathogenic factor for SIDS was not supported by immunohistochemical visualization of HSP70 or HSP27.

  16. Emerging patterns of tampon use in the adolescent female: the impact of toxic shock syndrome.

    PubMed Central

    Irwin, C E; Millstein, S G

    1982-01-01

    From November 1980 through January 1981, we queried 714 post menarchal adolescents (ages 12 to 19) about menstrual product use at menarche (T1), during summer 1980 (T2), at last menstrual period (T3), and about intended product for next menstrual period (T4). The percentage of adolescents reporting use of tampons at each point in time were: T1, 3.1 per cent; T2, 24.1 per cent; T3 (following the media coverage of toxic shock syndrome [TSS]), 19.3 per cent; and T4, 19.5 per cent. Prior to TSS coverage there was a shift toward tampon use in 141 of the 672 subjects who used napkins (21 per cent) and no increase in napkin use. Following media coverage, shifts toward tampon use among napkin users decreased to 2.3 per cent while 32.9 per cent of the 168 summer tampon users (T2) shifted to the use of napkins; reasons for the shift were significantly associated with TSS (p less than .001). Ethnicity (White) was highly associated with reported tampon use. Following TSS coverage, adolescents in all ethnic groups decreased their tampon use at the same rate. PMID:7065334

  17. Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip.

    PubMed

    d'Agostino, Cristina; Romeo, Pietro; Lavanga, Vito; Pisani, Salvatore; Sansone, Valerio

    2014-11-01

    There is no gold standard for treatment of bone marrow edema syndrome of the hip (BMESH). Usually, treatment is conservative, owing to the favorable and self limiting prognosis. In musculoskeletal disorders, the effectiveness of extracorporeal shock wave therapy (ESWT) has been widely recognized and recent research supports its use in the treatment of the first stages of avascular osteonecrosis of the proximal femur and in other conditions where bone marrow edema is present. On this basis, we performed a prospective study to evaluate the effectiveness of ESWT in normalizing the symptoms and imaging features of BMESH. Twenty consecutive symptomatic patients underwent two treatments of high-energy ESWT and were followed-up at 2, 3 and 6 months, with a final clinical follow-up at mean 15.52 ± 1.91 months. Patients underwent magnetic resonance imaging of the hip and were evaluated according to the Harris hip score. The mean improvement in HHS over the course of the study was of 58.5 ± 14.9 points (p < 0.0001), and the mean edema area reduced from 981.9 ± 453.2 mm(2) pre-treatment to 107.8 ± 248.1 mm(2) at 6 months. ESWT seems to be a powerful, non-pharmacological tool that produces rapid pain relief and functional improvement and aids the normalization of the vascular and metabolic impairments which characterize BMESH.

  18. Neutralization of toxic shock syndrome toxin-1 by monoclonal antibodies in vitro and in vivo.

    PubMed Central

    Bonventre, P F; Thompson, M R; Adinolfi, L E; Gillis, Z A; Parsonnet, J

    1988-01-01

    Sixteen monoclonal antibodies (MAbs) directed against toxic shock syndrome toxin-1 (TSST-1) were generated by immunization of mice with purified TSST-1 and subsequent fusion of spleen cells with myeloma cells. Antibody-producing clones, identified by an enzyme-linked immunosorbent assay, were maintained as ascites tumors, and MAbs were purified by protein A chromatography. High-titered clones were further characterized and tested for the ability to neutralize several biological activities of TSST-1. The MAbs, which are of several immunoglobulin subtypes, reacted specifically with purified TSST-1 and TSST-1 present in Staphylococcus aureus culture supernatants. Three MAbs neutralized TSST-1-induced mitogenesis in a dose-dependent manner. Three of eight MAbs tested were able to neutralize induction by TSST-1 of interleukin-1 production by human monocytes. One neutralizing MAb, 8-5-7, was tested for the ability to protect rabbits from a constant infusion of TSST-1. Rabbits given the MAb had an attenuated clinical illness and were protected from the hypocalcemia, lipemia, and hepatic and renal insufficiency seen in control rabbits. Six of seven control rabbits died, compared with only one of seven rabbits treated with MAb 8-5-7. These experiments suggest that MAb 8-5-7 is directed against an antigenic determinant critical to the toxicity of TSST-1 and that the MAbs should be useful as probes in structure-function analyses of the TSST-1 molecule. Images PMID:3257201

  19. Toxic shock syndrome toxin 1 enhances synthesis of endotoxin-induced tumor necrosis factor in mice.

    PubMed Central

    Henne, E; Campbell, W H; Carlson, E

    1991-01-01

    Toxic shock syndrome toxin 1 (TSST-1) was tested for its ability to enhance the production of endotoxin-induced tumor necrosis factor (TNF) in C3H/HeN mice. The TNF level in serum was quantified by a sandwich enzyme-linked immunosorbent assay (ELISA). It was found that when mice were injected with 20 micrograms of TSST-1 12 h before exposure to 1 micrograms of endotoxin, the serum endotoxin-induced TNF was 20 times as high as that found in mice exposed to endotoxin alone. Although 20 micrograms of TSST-1 did induce a maximum level of near 1 ng of TNF per ml of serum 1.5 h after exposure, the TNF concentration was greatly diminished after 5 to 6 h and was no longer detectable after 12 h. Pretreatment of mice with 20 micrograms of TSST-1 or 1 micrograms of endotoxin did not influence TNF induction by TSST-1 12 h later. Also, pretreatment of mice with 1 micrograms of endotoxin did not enhance TNF induction by endotoxin 12 h later. Enhancement was achieved only when mice were exposed to TSST-1 more than 4 h and less than 24 h before injection of endotoxin. Despite the relatively high serum TNF levels (30 to 50 ng/ml), no mortality was observed in the mice treated with both TSST and endotoxin. PMID:1879919

  20. Spontaneous mutations in Streptococcus pyogenes isolates from streptococcal toxic shock syndrome patients play roles in virulence

    PubMed Central

    Ikebe, Tadayoshi; Matsumura, Takayuki; Nihonmatsu, Hisako; Ohya, Hitomi; Okuno, Rumi; Mitsui, Chieko; Kawahara, Ryuji; Kameyama, Mitsuhiro; Sasaki, Mari; Shimada, Naomi; Ato, Manabu; Ohnishi, Makoto

    2016-01-01

    Streptococcus pyogenes (group A Streptococcus; GAS) is a widespread human pathogen and causes streptococcal toxic shock syndrome (STSS). STSS isolates have been previously shown to have high frequency mutations in the csrS/csrR (covS/covR) and/or rgg (ropB) genes, which are negative regulators of virulence. However, these mutations were found at somewhat low frequencies in emm1-genotyped isolates, the most prevalent STSS genotype. In this study, we sought to detect causal mutations of enhanced virulence in emm1 isolates lacking mutation(s) in the csrS/csrR and rgg genes. Three mutations associated with elevated virulence were found in the sic (a virulence gene) promoter, the csrR promoter, and the rocA gene (a csrR positive regulator). In vivo contribution of the sic promoter and rocA mutations to pathogenicity and lethality was confirmed in a GAS mouse model. Frequency of the sic promoter mutation was significantly higher in STSS emm1 isolates than in non-invasive STSS isolates; the rocA gene mutation frequency was not significantly different among STSS and non-STSS isolates. STSS emm1 isolates possessed a high frequency mutation in the sic promoter. Thus, this mutation may play a role in the dynamics of virulence and STSS pathogenesis. PMID:27349341

  1. [[Staphylococcus aureus producing toxic shock syndrome toxin 1 in the lower genital tract of the female].

    PubMed

    Puig de Centorbi, O N; Calleri de Milán, M C; Abdón de Cuadrado, A M; Ciácera de Carrizo, S C; Giménez, D F

    1987-01-01

    Staphylococcus sp was investigated in the female lower genital tract of 102 healthy women aged between 18 and 48 years in San Luis, Argentina. Three hundred and six samples were obtained from labia, introitus and vagina (posterior fornix). Samples were plated on sheep blood, mannitol salt and Baird-Parker media. Strains were identified by tube coagulase test; thermonuclease, fibrinolysin, pigment and hemolysin production; glucose and mannitol utilization and novobiocin sensitivity. Antibiotic susceptibility was assayed. Strains were examined for their ability to produce staphylococcal enterotoxins (SE) and toxic shock syndrome toxin-1 (TSST-1). Fourteen women (13.7%) had S. aureus in one or more samples: 10.7% labia, 3.9% introitus and 3.9% vaginal. All strains were sensitive to cephalotin, clindamycin, erythromycin, gentamycin and chloramphenicol; 21.0% were intermediate to methicillin; 15.7% were resistant to methicillin, 94.7% to penicillin and 21.0% to tetracycline. Three strains (15.7%) produced SEB, three (15.7%) SED, one (5.7%) SEC and three (15.7%) TSST-1. Only one strain (5.7%) produced both SEB and TSST-1. All strains produced hemolysins. Coagulase negative staphylococci were found in 40.1% of vaginal samples: S. epidermidis (32.2%) and S. saprophyticus (9.8%) were identified.

  2. Toxic shock syndrome toxin-1, not α-toxin, mediated Bundaberg fatalities.

    PubMed

    Mueller, Elizabeth A; Merriman, Joseph A; Schlievert, Patrick M

    2015-12-01

    The 1928 Bundaberg disaster is one of the greatest vaccine tragedies in history. Of 21 children immunized with a diphtheria toxin-antitoxin preparation contaminated with Staphylococcus aureus, 18 developed life-threatening disease and 12 died within 48  h. Historically, the deaths have been attributed to α-toxin, a secreted cytotoxin produced by most S. aureus strains, yet the ability of the Bundaberg contaminant microbe to produce the toxin has never been verified. For the first time, the ability of the original strain to produce α-toxin and other virulence factors is investigated. The study investigates the genetic and regulatory loci mediating α-toxin expression by PCR and assesses production of the cytotoxin in vitro using an erythrocyte haemolysis assay. This analysis is extended to other secreted virulence factors produced by the strain, and their sufficiency to cause lethality in New Zealand white rabbits is determined. Although the strain possesses a wild-type allele for α-toxin, it must have a defective regulatory system, which is responsible for the strain's minimal α-toxin production. The strain encodes and produces staphylococcal superantigens, including toxic shock syndrome toxin-1 (TSST-1), which is sufficient to cause lethality in patients. The findings cast doubt on the belief that α-toxin is the major virulence factor responsible for the Bundaberg fatalities and point to the superantigen TSST-1 as the cause of the disaster.

  3. Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.

    PubMed

    De Luca, Leonardo; Olivari, Zoran; Farina, Andrea; Gonzini, Lucio; Lucci, Donata; Di Chiara, Antonio; Casella, Gianni; Chiarella, Francesco; Boccanelli, Alessandro; Di Pasquale, Giuseppe; De Servi, Stefano; Bovenzi, Francesco Maria; Gulizia, Michele Massimo; Savonitto, Stefano

    2015-11-01

    Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS. We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS. Out of 28 217 ACS patients enrolled, 1209 (4.3%) had CS: 526 (44%) at the time of admission and 683 (56%) later on during hospitalization. Over the years, a reduction in the incidence of CS was observed, even though this was not statistically significant (P for trend = 0.17). The proportions of CS patients with a history of heart failure declined, whereas the proportion of those with hypertension, renal dysfunction, previous PCI, and AF significantly increased. The use of PCI considerably increased from 2001 to 2014 [19% to 60%; percentage change 41, 95% confidence interval (CI) 29-51]. In-hospital mortality of CS patients decreased from 68% (95% CI 59-76) in 2001 to 38% (95% CI 29-47) in 2014 (percentage change -30, 95% CI -41 to -18). Compared with 2001, the risk of death was significantly lower in all of the registries, with reductions in adjusted mortality between 45% and 66%. Over the last 14 years, substantial changes occurred in the clinical characteristics and management of patients with CS complicating ACS, with a greater use of PCI and a significant reduction in adjusted mortality rate. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  4. Propensity of Tampons and Barrier Contraceptives to Amplify Staphylococcus aureusToxic Shock Syndrome Toxin-I

    PubMed Central

    Tierno, Philip M.

    1994-01-01

    Objective: Although the incidence of reported cases of toxic shock syndrome (TSS) has declined in recent years, the disease continues to occur in menstruating women using the newer, less-absorbent tampons or barrier contraceptives. Extant tampons and other vaginal devices were tested for the ability to induce TSS toxin-1 (TSST-1) by a TSS strain of Staphylococcus aureus MN8, a known high-toxin producer. Tested for the first time were 20 varieties of tampons, including 2 all-cotton brands newly introduced in the United States, a polyurethane contraceptive sponge, a latex diaphragm, and a polymer menstrual collection cup. Methods: All products were washed in sterile distilled water prior to use to reduce the effect of leachable chemicals. Duplicate experiments with unwashed products were also performed. Entire tampons and other test products were immersed in brain heart infusion broth plus yeast extract (BHIY) and inoculated with S. aureus MN8, a known TSST-1 producer. After incubation, the culture supernatants were assayed for TSST-1 by gel immunodiffusion. Results: Except for all-cotton tampons, greater amounts of TSST-1 were detected in the supernatant fluid of washed tampons than detected in those which were not washed. While TSST-1 levels in unwashed non-cotton tampons ranged from 0.5 to 8 μg/ml, when these products were washed, TSST-1 levels increased to 2–32 μg/ml. In all-cotton tampons, whether washed or not, there was no detectable TSST-1. Conclusions: The propensity for all-cotton tampons not to amplify TSST-1 in vitro suggests they would lower the risk for tampon-associated TSS. PMID:18475381

  5. Dengue shock syndrome at the emergency room of Queen Sirikit National Institute of Child Health, Bangkok, Thailand.

    PubMed

    Bunnag, Thanyanat; Kalayanarooj, Siripen

    2011-08-01

    Dengue virus infection is an important mosquito-borne disease with the reported 40,000-100,000 cases per year in Thailand. Shock is one of the common presentations at the emergency room (ER) and dengue shock syndrome (DSS) is among the common causes of shock. Proper and timely management of DSS determines the outcomes and prognosis of DSS patients. To find the prevalence of DSS at the ER and evaluate the medical management and risk factors associated with the outcome of DSS patients. A retrospective study on patients who presented with shock, including DSS patients at the ER of Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand, from 1st January 2008 to 31st December 2009 was done. The prevalence of patients who presented with shock at the ER was retrieved from the Statistical and Information Technology Departments. Out-patient cards and In-patient charts of DSS patients were reviewed. Clinical and laboratory data were compared between recovered and death cases. Statistical analysis was done by using SPSS version 14.0. There were 109 shock patients seen at the ER during the present study period with 59 DSS (54.1%), 30 septic shock (27.5%), 13 hypovolemic shock (11.9%), 1 cardiogenic shock (0.9%) and 6 other non-specific shock (5.5%). DSS cases were found all year round with the peak prevalence from June to August which is the rainy season. Twenty-six of DSS (44.1%) were referred cases and 5 of them died, case fatality rate was 8.8%. All death cases had prolonged shock, massive bleeding and liver failure at presentation while these findings were found in 2 (4.4%), 16 (35.6%) and 10 (22.2%) cases of recovered cases. Encephalopathy, renal failure and respiratory failure were found in 80, 60 and 60% of the death cases while in recovered cases they were found in 11.1, 4.4 and 2.2%. Acidosis was found higher in the death group (60%) than in recovered group (8.9%). Other common presenting findings in death and recovered groups were bleeding (35

  6. Streptococcal toxic shock syndrome from necrotizing soft-tissue infection of the breast caused by a mucoid type strain.

    PubMed

    Kohayagawa, Yoshitaka; Ishitobi, Natsuko; Yamamori, Yuji; Wakuri, Miho; Sano, Chiaki; Tominaga, Kiyoshi; Ikebe, Tadayoshi

    2015-02-01

    Streptococcal toxic shock syndrome is a severe infectious disease. We report a Japanese case of Streptococcal toxic shock syndrome caused by a highly mucoid strain of Streptococcus pyogenes. A 31-year old female with shock vital sign presented at a tertiary medical center. Her left breast was necrotizing and S. pyogenes was detected by Immunochromatographic rapid diagnostic kits. Intensive care, including administration of antibiotics and skin debridement, was performed. After 53 days in our hospital, she was discharged. The blood cultures and skin swab cultures all grew S. pyogenes which displayed a highly mucoid morphology on culture media. In her course of the disease, the Streptococcus strain had infected two other family members. All of the strains possessed the T1 and M1 antigens, as well as the emm1.0 gene. As for fever genes, the strains were all positive for speA, speB, and speF, but negative for speC. All of the strains exhibited and the same pattern in PFGE with the SfiI restriction enzyme. The strain might have spread in the local area by the data from the Japanese Infectious Disease Surveillance Center. Immunochromatographic rapid diagnostic kits are very useful for detecting S. pyogenes. However, they can not be used to diagnose severe streptococcul disease by highly mucoid strain alone. Careful observation of patients and colony morphology are useful methods for diagnosing severe streptococcal disease by highly mucoid strain.

  7. Epstein-Barr virus-related post-transplant lymphoproliferative disorder occurring after bone marrow transplantation for aplastic anemia in Down's syndrome.

    PubMed

    Furuya, Aya; Ishida, Mitsuaki; Hodohara, Keiko; Yoshii, Miyuki; Okuno, Hiroko; Horinouchi, Akiko; Nakanishi, Ryota; Harada, Ayumi; Iwai, Muneo; Yoshida, Keiko; Kagotani, Akiko; Yoshida, Takashi; Okabe, Hidetoshi

    2014-01-01

    It is well established that Down's syndrome exhibits a predisposition to development of leukemia, however, association between aplastic anemia and Down's syndrome is exceptional. Herein, we describe a case of aplastic anemia occurring in Down's syndrome following post-transplant lymphoproliferative disorder (PTLD) after bone marrow transplantation (BMT). A 27-year-old Japanese male with Down's syndrome presented with a headache. Laboratory tests revealed severe pancytopenia, and bone marrow biopsy demonstrated hypocellular bone marrow with decrease of trilineage cells, which led to a diagnosis of aplastic anemia. One year after diagnosis, he was incidentally found to have an anterior mediastinal tumor, which was histopathologically diagnosed as seminoma. Subsequently, he received BMT from a female donor, and engraftment was observed. Three months after transplantation, he experienced cough and high fever. Biopsy specimen from the lung revealed diffuse proliferation of large-sized lymphoid cells expressing CD20 and EBER. These lymphoid cells had XY chromosomes. Thus, a diagnosis of EBV-associated PTLD was made. This is the seventh documented case of aplastic anemia occurring in Down's syndrome. Association between aplastic anemia and Down's syndrome has not been established, therefore, additional clinicopathological studies are needed. Moreover, this is the first case to undergo BMT for aplastic anemia in Down's syndrome. Although engraftment was observed, he developed EBV-positive PTLD. The neoplastic cells of the present case were considered to be of recipient origin, although the majority of PTLD cases with BMT are of donor origin.

  8. Factors Associated with Dengue Shock Syndrome: A Systematic Review and Meta-Analysis

    PubMed Central

    Thuy, Dinh Ha Duy; Kikuchi, Mihoko; Hien, Tran Tinh; Zamora, Javier; Hirayama, Kenji

    2013-01-01

    Background The pathogenesis of dengue shock syndrome (DSS, grade 3 and 4) is not yet completely understood. Several factors are reportedly associated with DSS, a more severe form of dengue infection that reportedly causes 50 times higher mortality compared to that of dengue patients without DSS. However, the results from these reports remain inconclusive. To better understand the epidemiology, clinical manifestation, and pathogenesis of DSS for development of new therapy, we systematically reviewed and performed a meta-analysis of relevant studies that reported factors in both DSS and dengue hemorrhagic fever (DHF, grade 1 and 2) patients. Methods and Findings PubMed, EMBASE, Scopus, Google Scholar, Dengue Bulletin, Cochrane Library, Virtual Health Library, and a manual search of reference lists of articles published before September 2010 were used to retrieve relevant studies. A meta-analysis using fixed- or random-effects models was used to calculate pooled odds ratios (OR) or event rate with corresponding 95% confidence intervals. Assessment of heterogeneity and publication bias, meta-regression analysis, subgroup analysis, sensitivity analysis, and analysis of factor-specific relationships were further performed. There were 198 studies constituting 203 data sets that met our eligibility criteria. Our meta-regression analysis showed a sustained reduction of DSS/dengue hemorrhagic fever (DHF) ratio over a period of 40 years in Southeast Asia, especially in Thailand. The meta-analysis revealed that age, female sex, neurological signs, nausea/vomiting, abdominal pain, gastrointestinal bleeding, hemoconcentration, ascites, pleural effusion, hypoalbuminemia, hypoproteinemia, hepatomegaly, levels of alanine transaminase and aspartate transaminase, thrombocytopenia, prothrombin time, activated partial thromboplastin time, fibrinogen level, primary/secondary infection, and dengue virus serotype-2 were significantly associated with DSS when pooling all original relevant

  9. Pro-inflammatory exoprotein characterization of toxic shock syndrome Staphylococcus aureus†

    PubMed Central

    Lin, Ying-Chi; Anderson, Michele J.; Kohler, Petra L.; Strandberg, Kristi L.; Olson, Michael E.; Horswill, Alexander R.; Schlievert, Patrick M.; Peterson, Marnie L.

    2011-01-01

    Pulsed-field gel electrophoresis (PFGE) clonal type USA200 is the most widely disseminated Staphylococcus aureus colonizer of the nose and is a major cause of toxic shock syndrome (TSS). Exoproteins derived from these organisms have been suggested to contribute to their colonization and causation of human diseases, but have not been well-characterized. Two representative S. aureus USA200 isolates, MNPE (α-toxin positive) and CDC587 (α-toxin mutant), isolated from pulmonary post-influenza TSS and menstrual vaginal TSS, respectively, were evaluated. Biochemical, immunobiological and cell-based assays, including mass spectrometry, were used to identify key exoproteins derived from the strains that are responsible for pro-inflammatory and cytotoxic activity on human vaginal epithelial cells. Exoproteins associated with virulence were produced by both strains, and cytolysins (α-toxin and γ-toxin), superantigens, and proteases were identified as the major exoproteins, which caused epithelial cell inflammation and cytotoxicity. Exoprotein fractions from MNPE were more pro-inflammatory and cytotoxic than those from CDC587 due to high concentrations of α-toxin. CDC587 produced a small amount of α-toxin, despite the presence of a stop codon (TAG) at codon 113. Additional exotoxin identification studies of USA200 strain [S. aureus MN8 (α-toxin mutant)] confirmed that MN8 also produced low levels of α-toxin despite the same stop codon. The differences observed in virulence factor profiles of two USA200 strains provide insight into environmental factors that select for specific virulence factors. Cytolysins, superantigens, and proteases were identified as potential targets, where toxin neutralization may prevent or diminish epithelial damage associated with S. aureus. PMID:21749039

  10. Improved purification and biologic activities of staphylococcal toxic shock syndrome toxin 1.

    PubMed Central

    Kum, W W; Laupland, K B; See, R H; Chow, A W

    1993-01-01

    An improved method for producing highly purified toxic shock syndrome toxin 1 (TSST-1) by preparative isoelectric focusing in a Bio-Rad Rotofor cell and then chromatofocusing is described. Purification to homogeneity was confirmed by silver staining after sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE; 50 micrograms of protein was loaded), by immunoblotting with polyclonal rabbit antiserum raised against the crude culture supernatant used for purification, and by autoradiography after iodination and SDS-PAGE. Biologic activity was demonstrated by mitogenicity and cytokine induction (tumor necrosis factor alpha [TNF-alpha], interleukin 1-beta [IL-1 beta], and IL-6) of human peripheral blood mononuclear cells (PBMCs) and by lethality in New Zealand White rabbits following subcutaneous infusion. In contrast to commercial TSST-1 preparations, our TSST-1 preparation required the presence of both monocytes and T cells for the induction of TNF-alpha and IL-1 beta from human PBMCs. A 46-kDa contaminating protein in the commercial TSST-1 preparation, identified as staphylococcal lipase, was likely responsible for the induction of TNF-alpha and IL-1 beta from human monocytes in the absence of T cells, a biologic activity falsely attributed to purified TSST-1. Our improved purification procedure for TSST-1 provides a high yield and is both more rapid and less labor intensive than previously reported methods. Furthermore, our studies clearly demonstrate the need for stringent methods of purity assessment of TSST-1 preparations before ascribing to them their potent biologic activities. Images PMID:8253961

  11. Shock wave lithotripsy targeting of the kidney and pancreas does not increase the severity of metabolic syndrome in a porcine model.

    PubMed

    Handa, Rajash K; Evan, Andrew P; Connors, Bret A; Johnson, Cynthia D; Liu, Ziyue; Alloosh, Mouhamad; Sturek, Michael; Evans-Molina, Carmella; Mandeville, Jessica A; Gnessin, Ehud; Lingeman, James E

    2014-10-01

    We determined whether shock wave lithotripsy of the kidney of pigs with metabolic syndrome would worsen glucose tolerance or increase the risk of diabetes mellitus. Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce metabolic syndrome. At age 15 months the pigs were treated with 2,000 or 4,000 shock waves (24 kV at 120 shock waves per minute) using an unmodified HM3 lithotripter (Dornier MedTech, Kennesaw, Georgia). Shock waves were targeted to the left kidney upper pole calyx to model treatment that would also expose the pancreatic tail to shock waves. The intravenous glucose tolerance test was done in conscious fasting pigs before lithotripsy, and 1 and 2 months after lithotripsy with blood samples taken for glucose and insulin measurement. Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant, consistent with metabolic syndrome. Assessments of insulin resistance, glucose tolerance and pancreatic β cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to the intravenous glucose tolerance test were similar before and after lithotripsy. The metabolic syndrome status of pigs treated with shock wave lithotripsy was unchanged 2 months after kidney treatment with 2,000 high amplitude shock waves or overtreatment with 4,000 high amplitude shock waves. These findings do not support a single shock wave lithotripsy treatment of the kidney as a risk factor for the onset of diabetes mellitus. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Functioning in individuals with chronic fatigue syndrome: increased impairment with co-occurring multiple chemical sensitivity and fibromyalgia

    PubMed Central

    Brown, Molly M; Jason, Leonard A

    2007-01-01

    Background Chronic fatigue syndrome (CFS), multiple chemical sensitivity (MCS), and fibromyalgia (FM) commonly co-occur. Some propose that CFS, MCS, and FM are manifestations of the same illness based on high rates of co-occurrence and overlapping diagnostic criteria. This study seeks to differentiate these diagnoses by comparing individuals with one or more illness on functioning, psychiatric comorbidity, coping style, and in vivo physical measures. Methods Participants included 114 men and women who met criteria for CFS. FM was diagnosed during a physical examination, and MCS was assessed using a questionnaire. Participants were divided into four groups: CFS alone, CFS-MCS, CFS-FM, and CFS-MCS-FM. Self-report measures, a psychiatric interview, and in vivo physical measures were given. Results 43.9% met criteria for CFS alone, 23.7% met criteria for CFS-MCS, 15.8% met criteria for CFS-FM, and 16.7% met criteria for CFS-MCS-FM. The CFS-MCS-FM group was more disabled than the CFS alone group on measures of physical functioning, general health, and bodily pain. In vivo measures did not differ, but the CFS-MCS-FM group rated exertion higher than the CFS alone group. Conclusion Individuals with CFS alone were the highest functioning group across several domains, such as disability, depression, and severity of symptoms. Participants with three diagnoses experienced the greatest amount of disability. While substantial co-occurrence of these illnesses was found, this study provides evidence that having more than one illness exacerbates one's disability beyond CFS alone. PMID:17540028

  13. Autoantibodies to villin occur frequently in IPEX, a severe immune dysregulation, syndrome caused by mutation of FOXP3.

    PubMed

    Kobayashi, Ichiro; Kubota, Mitsuru; Yamada, Masafumi; Tanaka, Hiroshi; Itoh, Shuichi; Sasahara, Yoji; Whitesell, Luke; Ariga, Tadashi

    2011-10-01

    Intractable diarrhea is a major symptom of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome and associated with autoantibodies against enterocytes. Although autoimmune enteropathy (AIE)-related 75 kDa antigen (AIE-75) is a prominent autoantigen involved in the enteropathy associated with IPEX syndrome, some patients with this syndrome demonstrated autoantibody recognizing a 95 kDa protein rather than AIE-75 in the small intestine. We, herewith, identified villin, an actin-binding protein, as the 95 kDa antigen. Four of five sera from patients with IPEX syndrome reacted with a fusion protein of glutathione-S-transferase and full length villin (GST-villin), whereas only three of 98 control sera weakly reacted with GST-villin. Anti-AIE-75 antibody was detected in all five IPEX sera but not in normal or control disease sera. We conclude that both AIE-75 and villin appear to be brush border autoantigens in IPEX syndrome and could be used for the diagnosis of AIE in patients with presumptive IPEX syndrome. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Toxic Shock Syndrome Toxin-1-Mediated Toxicity Inhibited by Neutralizing Antibodies Late in the Course of Continual in Vivo and in Vitro Exposure

    PubMed Central

    Stich, Norbert; Model, Nina; Samstag, Aysen; Gruener, Corina S.; Wolf, Hermann M.; Eibl, Martha M.

    2014-01-01

    Toxic shock syndrome (TSS) results from the host’s overwhelming inflammatory response and cytokine storm mainly due to superantigens (SAgs). There is no effective specific therapy. Application of immunoglobulins has been shown to improve the outcome of the disease and to neutralize SAgs both in vivo and in vitro. However, in most experiments that have been performed, antiserum was either pre-incubated with SAg, or both were applied simultaneously. To mirror more closely the clinical situation, we applied a multiple dose (over five days) lethal challenge in a rabbit model. Treatment with toxic shock syndrome toxin 1 (TSST-1) neutralizing antibody was fully protective, even when administered late in the course of the challenge. Kinetic studies on the effect of superantigen toxins are scarce. We performed in vitro kinetic studies by neutralizing the toxin with antibodies at well-defined time points. T-cell activation was determined by assessing T-cell proliferation (3H-thymidine incorporation), determination of IL-2 release in the cell supernatant (ELISA), and IL-2 gene activation (real-time PCR (RT-PCR)). Here we show that T-cell activation occurs continuously. The application of TSST-1 neutralizing antiserum reduced IL-2 and TNFα release into the cell supernatant, even if added at later time points. Interference with the prolonged stimulation of proinflammatory cytokines is likely to be in vivo relevant, as postexposure treatment protected rabbits against the multiple dose lethal SAg challenge. Our results shed new light on the treatment of TSS by specific antibodies even at late stages of exposure. PMID:24887085

  15. Toxic shock syndrome toxin-1-mediated toxicity inhibited by neutralizing antibodies late in the course of continual in vivo and in vitro exposure.

    PubMed

    Stich, Norbert; Model, Nina; Samstag, Aysen; Gruener, Corina S; Wolf, Hermann M; Eibl, Martha M

    2014-05-30

    Toxic shock syndrome (TSS) results from the host's overwhelming inflammatory response and cytokine storm mainly due to superantigens (SAgs). There is no effective specific therapy. Application of immunoglobulins has been shown to improve the outcome of the disease and to neutralize SAgs both in vivo and in vitro. However, in most experiments that have been performed, antiserum was either pre-incubated with SAg, or both were applied simultaneously. To mirror more closely the clinical situation, we applied a multiple dose (over five days) lethal challenge in a rabbit model. Treatment with toxic shock syndrome toxin 1 (TSST-1) neutralizing antibody was fully protective, even when administered late in the course of the challenge. Kinetic studies on the effect of superantigen toxins are scarce. We performed in vitro kinetic studies by neutralizing the toxin with antibodies at well-defined time points. T-cell activation was determined by assessing T-cell proliferation (3H-thymidine incorporation), determination of IL-2 release in the cell supernatant (ELISA), and IL-2 gene activation (real-time PCR (RT-PCR)). Here we show that T-cell activation occurs continuously. The application of TSST-1 neutralizing antiserum reduced IL-2 and TNFα release into the cell supernatant, even if added at later time points. Interference with the prolonged stimulation of proinflammatory cytokines is likely to be in vivo relevant, as postexposure treatment protected rabbits against the multiple dose lethal SAg challenge. Our results shed new light on the treatment of TSS by specific antibodies even at late stages of exposure.

  16. Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome

    PubMed Central

    2016-01-01

    Objective To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. Methods In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. Results VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). Conclusion rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP. PMID:27446789

  17. Local Epidermal Growth Factor Receptor Signaling Mediates the Systemic Pathogenic Effects of Staphylococcus aureus Toxic Shock Syndrome

    PubMed Central

    Gillman, Aaron N.; Stach, Christopher S.; Schlievert, Patrick M.; Peterson, Marnie L.

    2016-01-01

    Secreted factors of Staphylococcus aureus can activate host signaling from the epidermal growth factor receptor (EGFR). The superantigen toxic shock syndrome toxin-1 (TSST-1) contributes to mucosal cytokine production through a disintegrin and metalloproteinase (ADAM)-mediated shedding of EGFR ligands and subsequent EGFR activation. The secreted hemolysin, α-toxin, can also induce EGFR signaling and directly interacts with ADAM10, a sheddase of EGFR ligands. The current work explores the role of EGFR signaling in menstrual toxic shock syndrome (mTSS), a disease mediated by TSST-1. The data presented show that TSST-1 and α-toxin induce ADAM- and EGFR-dependent cytokine production from human vaginal epithelial cells. TSST-1 and α-toxin also induce cytokine production from an ex vivo porcine vaginal mucosa (PVM) model. EGFR signaling is responsible for the majority of IL-8 production from PVM in response to secreted toxins and live S. aureus. Finally, data are presented demonstrating that inhibition of EGFR signaling with the EGFR-specific tyrosine kinase inhibitor AG1478 significantly increases survival in a rabbit model of mTSS. These data indicate that EGFR signaling is critical for progression of an S. aureus exotoxin-mediated disease and may represent an attractive host target for therapeutics. PMID:27414801

  18. [A case report of toxic shock-like syndrome associated with prevalence of streptococcal pharingitis in the family].

    PubMed

    Shimizu, Y; Sakashita, H; Takada, C; Otsuka, Y; Ooe, K; Tsumita, R

    1994-09-01

    A case of streptococcal toxic shock-like syndrome in a previously healthy, 57 year old Japanese female has been reported. Initially, she had a sore throat and low grade fever for 5 days. Because of sudden severe pain on the extremities and erythema on bilateral forearms, she was hospitalized. On admission, her conciousness was clear. Although profound hypotension, anuria and prolonged blood coagulation were observed. Antibiotics, fluid therapy and dopamine were given. Four hours after admission, she died in spite of resuscitation efforts, by sudden cardiac arrest. Streptococcus pyogenes was isolated in her blood. At the same time as when she died, three of the five people of the patient's family living with her, had pharingitis or pneumonia. From the pharynxs of the three people with pharingitis, Streptococcus pyogenes was also isolated. The serotype of all organisms was T11, and they produced exotoxintype B in vitro. This case suggests that infection of Streptococcus pyogenes is not essential for the development of toxic shock-like syndrome.

  19. Mitogenic effect contributes to increased virulence of Streptococcus suis sequence type 7 to cause streptococcal toxic shock-like syndrome.

    PubMed

    Zheng, H; Ye, C; Segura, M; Gottschalk, M; Xu, J

    2008-09-01

    Streptococcus suis serotype 2 sequence type 7 strains emerged in 1996 and caused a streptococcal toxic shock-like syndrome in 1998 and 2005 in China. Evidence indicated that the virulence of S. suis sequence type 7 had increased, but the mechanism was unknown. The sequence type 7 strain SC84, isolated from a patient with streptococcal toxic shock-like syndrome during the Sichuan outbreak, and the sequence type 1 strain 31533, a typical highly pathogenic strain isolated from a diseased pig, were used in comparative studies. In this study we show the mechanisms underlying cytokine production differed between the two types of strains. The S. suis sequence type 7 strain SC84 possesses a stronger capacity to stimulate T cells, naive T cells and peripheral blood mononuclear cell proliferation than does S. suis sequence type 1 strain 31533. The T cell response to both strains was dependent upon the presence of antigen-presenting cells. Histo-incompatible antigen-presenting cells were sufficient to provide the accessory signals to naive T cell stimulated by the two strains, indicating that both sequence type 7 and 1 strains possess mitogens; however, the mitogenic effect was different. Therefore, we propose that the difference in the mitogenic effect of sequence type 7 strain SC84 compared with the sequence type 1 strain 31533 of S. suis may be associated with the clinical, epidemiological and microbiological difference, where the ST 7 strains have a larger mitogenic effect.

  20. Globodontia in the Otodental Syndrome: A Rare Defect of Tooth Morphology Occurring with Hearing Loss in an Eight-Year-Old.

    PubMed

    Enright, Sinead; Humphrys, A Karen; Rea, Gillian; James, Jacqueline A

    2015-12-01

    Otodental syndrome is a hereditary disorder comprising globodontia and sensorineural hearing loss. Globodontia is characterized by distinctively bulbous, enlarged crowns of molar and primary canine teeth. Anomalies including taurodontism and hypodontia also occur. We report on the dental treatment and multidisciplinary management of an eight-year-old girl with this rare condition. Referral to Clinical Genetics and Oral Pathology was instrumental in establishing a diagnosis of otodental syndrome for this young patient and her mother, who had similar dental defects. CPD/Clinical Relevance: To increase awareness among practitioners of this rare dental disorder and highlight the need for multidisciplinary management of such cases.

  1. Identification of molecular mechanisms related to nonthyroidal illness syndrome in skeletal muscle and adipose tissue from patients with septic shock.

    PubMed

    Rodriguez-Perez, Alfonso; Palos-Paz, Fernando; Kaptein, Ellen; Visser, Theo J; Dominguez-Gerpe, L; Alvarez-Escudero, Julian; Lado-Abeal, Joaquin

    2008-05-01

    Septic shock is one of various causes of nonthyroidal illness syndrome (NTIS). In humans, the molecular mechanisms involved in NTIS are mostly unknown. The aim of this study was to investigate, in patients with NTIS secondary to septic shock, changes in the expression of genes involved in the actions of thyroid hormones and in the activity of deiodinase enzymes, in two tissues important for protein and energy metabolism, skeletal muscle (SM) and subcutaneous adipose tissue (SAT). Hospitalized patients were divided into a control and a septic shock NTIS group. Serum collection for biochemical measurements, and SM and SAT biopsies for mRNA expression analysis of thyroid hormone receptors (THRB1, THRA1), retinoid X receptors (RXRA, RXRB, RXRG), nuclear receptor corepressor (NCOR1), silencing mediator of retinoid and thyroid hormone receptor (SMRT), steroid receptor coactivator (SRC1), type 1 and 2 deiodinases (D1, D2), monocarboxylate transporter 8 (MCT8), SECIS binding protein 2 (SBP2) and uncoupling protein 3 (UCP3) as well as D1, D2 and D3 enzyme activity measurements. The NTIS group had lower serum TSH, and free T3 and higher rT3 than controls. D1 and D3 were detected in SAT, with no differences found between the two groups; SM had very low D2 activity and again no differences were found between groups; D3 activity in SM was higher in NTIS than controls. SM expression of THRB1, RXRG and D2 was lower and RXRA higher in NTIS than controls. SAT from NTIS patients had lower MCT8, THRB1, THRA1, RXRG and SMRT, and higher UCP3 expression than controls. In patients with septic shock NTIS tissue responses are orientated to decrease production and increase degradation (muscle) or decrease uptake (adipose tissue) of T3, as well as to decrease thyroid hormone actions.

  2. First Generation Gene Expression Signature for Early Prediction of Late Occurring Hematological Acute Radiation Syndrome in Baboons.

    PubMed

    Port, M; Herodin, F; Valente, M; Drouet, M; Lamkowski, A; Majewski, M; Abend, M

    2016-07-01

    We implemented a two-stage study to predict late occurring hematologic acute radiation syndrome (HARS) in a baboon model based on gene expression changes measured in peripheral blood within the first two days after irradiation. Eighteen baboons were irradiated to simulate different patterns of partial-body and total-body exposure, which corresponded to an equivalent dose of 2.5 or 5 Gy. According to changes in blood cell counts the surviving baboons (n = 17) exhibited mild (H1-2, n = 4) or more severe (H2-3, n = 13) HARS. Blood samples taken before irradiation served as unexposed control (H0, n = 17). For stage I of this study, a whole genome screen (mRNA microarrays) was performed using a portion of the samples (H0, n = 5; H1-2, n = 4; H2-3, n = 5). For stage II, using the remaining samples and the more sensitive methodology, qRT-PCR, validation was performed on candidate genes that were differentially up- or down-regulated during the first two days after irradiation. Differential gene expression was defined as significant (P < 0.05) and greater than or equal to a twofold difference above a H0 classification. From approximately 20,000 genes, on average 46% appeared to be expressed. On day 1 postirradiation for H2-3, approximately 2-3 times more genes appeared up-regulated (1,418 vs. 550) or down-regulated (1,603 vs. 735) compared to H1-2. This pattern became more pronounced at day 2 while the number of differentially expressed genes decreased. The specific genes showed an enrichment of biological processes coding for immune system processes, natural killer cell activation and immune response (P = 1 × E-06 up to 9 × E-14). Based on the P values, magnitude and sustained differential gene expression over time, we selected 89 candidate genes for validation using qRT-PCR. Ultimately, 22 genes were confirmed for identification of H1-3 classifications and seven genes for identification of H2-3 classifications using qRT-PCR. For H1-3 classifications, most genes were

  3. [Postpartum endocrine syndrome].

    PubMed

    Ducarme, G; Châtel, P; Luton, D

    2008-05-01

    Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome.

  4. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum.

    PubMed

    Hong, Jin Oh; Park, Joon Sang; Jeon, Dae Geun; Yoon, Wang Hyeon; Park, Jung Hyun

    2017-08-01

    To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.

  5. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

    PubMed Central

    2017-01-01

    Objective To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. Methods In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. Results Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. Conclusion Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum. PMID:28971042

  6. Mild Electrical Stimulation and Heat Shock Ameliorates Progressive Proteinuria and Renal Inflammation in Mouse Model of Alport Syndrome

    PubMed Central

    Fukuda, Ryosuke; Morino-Koga, Saori; Suico, Mary Ann; Koyama, Kosuke; Sato, Takashi; Shuto, Tsuyoshi; Kai, Hirofumi

    2012-01-01

    Alport syndrome is a hereditary glomerulopathy with proteinuria and nephritis caused by defects in genes encoding type IV collagen in the glomerular basement membrane. All male and most female patients develop end-stage renal disease. Effective treatment to stop or decelerate the progression of proteinuria and nephritis is still under investigation. Here we showed that combination treatment of mild electrical stress (MES) and heat stress (HS) ameliorated progressive proteinuria and renal injury in mouse model of Alport syndrome. The expressions of kidney injury marker neutrophil gelatinase-associated lipocalin and pro-inflammatory cytokines interleukin-6, tumor necrosis factor-α and interleukin-1β were suppressed by MES+HS treatment. The anti-proteinuric effect of MES+HS treatment is mediated by podocytic activation of phosphatidylinositol 3-OH kinase (PI3K)-Akt and heat shock protein 72 (Hsp72)-dependent pathways in vitro and in vivo. The anti-inflammatory effect of MES+HS was mediated by glomerular activation of c-jun NH2-terminal kinase 1/2 (JNK1/2) and p38-dependent pathways ex vivo. Collectively, our studies show that combination treatment of MES and HS confers anti-proteinuric and anti-inflammatory effects on Alport mice likely through the activation of multiple signaling pathways including PI3K-Akt, Hsp72, JNK1/2, and p38 pathways, providing a novel candidate therapeutic strategy to decelerate the progression of patho-phenotypes in Alport syndrome. PMID:22937108

  7. The effect of site-specific monoclonal antibodies directed to toxic shock syndrome toxin-1 in experimental Staphylococcus aureus arthritis

    PubMed Central

    Verdrengh, M; Kum, W; Chow, A; Tarkowski, A

    1999-01-01

    Staphylococcus aureus produces a large number of potential virulence factors, among these the superantigen toxic shock syndrome toxin-1 (TSST-1). We have recently demonstrated that TSST-1 is involved in the pathogenesis of septic arthritis. Recent data show that the TSST-1 molecule is composed of two distinct domains, one proposed to interact with T cell receptor (TCR) and one with the MHC class II. The aim of this study was to assess if interaction between TSST-1-specific MoAbs directed to sites on the MHC and/or TCR Vβ affects the development of experimental S. aureus-induced arthritis. For that purpose we used a panel of seven MoAbs, which were injected intraperitoneally before and after inoculation with a TSST-1-producing S. aureus strain. Administration of antibodies did not affect the development of arthritis, suggesting inefficacy of such a procedure in neutralization of exotoxin-mediated disease manifestations. PMID:10540189

  8. Heat shock transcription factor 1 is a key determinant of HCC development by regulating hepatic steatosis and metabolic syndrome

    PubMed Central

    Jin, Xiongjie; Moskophidis, Demetrius; Mivechi, Nahid F.

    2011-01-01

    Hepatocellular carcinoma (HCC) occurrence and progression is linked tightly to progressive hepatic metabolic syndrome associated with insulin resistance, hepatic steatosis, and chronic inflammation. Heat shock transcription factor 1 (HSF1), a major transactivator of stress proteins, increases survival by protecting cells against environmental stressors. It has been implicated in the pathogenesis of cancer, but specific mechanisms by which HSF1 supports cancer development remain elusive. We propose a pathogenic mechanism whereby HSF1 activation promotes growth of pre-malignant cells and HCC development by stimulating lipid biosynthesis and perpetuating chronic hepatic metabolic disease induced by carcinogens. Our work shows that inactivation of HSF1 impairs cancer progression, mitigating adverse effects of carcinogens on hepatic metabolism by enhancing insulin sensitivity and sensitizing activation of AMP-activated protein kinase (AMPK), an important regulator of energy homeostasis and inhibitor of lipid synthesis. HSF1 is a potential target for the control of hepatic steatosis, hepatic insulin resistance, and HCC development. PMID:21723507

  9. Pleural empyema and streptococcal toxic shock syndrome due to Streptococcus pyogenes in a healthy Spanish traveler in Japan.

    PubMed

    Sakai, Tetsuya; Taniyama, Daisuke; Takahashi, Saeko; Nakamura, Morio; Takahashi, Takashi

    2017-01-01

    Group A Streptococcus (GAS, Streptococcus pyogenes) causes invasive infections including streptococcal toxic shock syndrome (STSS) and local infections. To our knowledge, this is the first report of a case of an invasive GAS infection with pneumonia and pleural empyema (PE) followed by STSS (disseminated intravascular coagulation [DIC] and acute renal insufficiency) in a healthy male adult. He received combined supportive therapies of PE drainage, anti-DIC agent, hemodialysis, and antimicrobials and eventually made a clinical recovery. GAS isolated from PE was found to have emm1/speA genes, suggestive of a pathogenic strain. Clinicians should be aware of the possibility of this disease entity (pneumonia, PE, and STSS) in healthy male adults as well as children and adult women.

  10. Staphylococcal enterotoxin B toxic shock syndrome induced by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).

    PubMed

    Kashiwada, Takeru; Kikuchi, Ken; Abe, Shinji; Kato, Hidehito; Hayashi, Hiroki; Morimoto, Taisuke; Kamio, Koichiro; Usuki, Jiro; Takeda, Shinhiro; Tanaka, Keiji; Imanishi, Ken'ichi; Yagi, Junji; Azuma, Arata; Gemma, Akihiko

    2012-01-01

    We herein report a case of toxic shock syndrome (TSS) associated with the 2009 pandemic H1N1 (pH1N1) influenza virus and a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in a 16-year-old Vietnamese girl. Staphylococcal enterotoxin B (SEB) was detected in the patient's serum, and the level of anti-SEB antibodies was found to be elevated. A flow cytometric analysis showed evidence of activated SEB-reactive Vβ3+ and Vβ12+ T cells. These data suggest that the CA-MRSA-induced activation of SEB-reactive T cells may cause TSS in patients with pH1N1 virus infection. Moreover, this is the first report describing immunological confirmation of SEB contributing directly to TSS in a patient fulfilling the diagnostic criteria of TSS.

  11. A Sphingosine-1 Phosphate agonist (FTY720) limits trauma/hemorrhagic shock induced multiple organ dysfunction syndrome

    PubMed Central

    Bonitz, Joyce A.; Son, Julie Y.; Chandler, Benjamin; Tomaio, Jacquelyn N.; Qin, Yong; Prescott, Lauriston M.; Feketeova, Eleonora; Deitch, Edwin A.

    2014-01-01

    BACKGROUND Trauma/hemorrhagic shock is one of the major consequences of battlefield injury as well as civilian trauma. FTY720 (sphingosine-1 phosphate agonist) has the capability to decrease the activity of the innate and adaptive immune systems and, at the same time, maintain endothelial cell barrier function and vascular homeostasis during stress. For this reason, we hypothesize that FTY720, as part of resuscitation therapy, would limit T/HS induced multiple organ dysfunction syndrome (MODS) in a rodent trauma-hemorrhagic shock (T/HS) model. METHODS Rats subjected to trauma/sham-shock (T/SS) or T/HS (30 mm Hg × 90 min), were administered FTY720 (1 mg/kg) post-T/HS during volume resuscitation. Lung injury (permeability to Evans Blue dye), PMN priming (respiratory burst activity), and RBC rigidity were measured. In addition, lymph duct cannulated rats were used to quantify the effect of FTY720 on gut injury (permeability and morphology) and the biologic activity of T/HS vs. T/SS lymph on PMN-RB and RBC deformability. RESULTS T/HS-induced increased lung permeability, PMN priming and RBC rigidity were all abrogated by FTY720. The systemic protective effect of FTY720 was only partially at the gut level, since FTY720 did not prevent T/HS-induced gut injury (morphology or permeability,) however, it did abrogate T/HS lymph-induced increased respiratory burst and RBC rigidity. CONCLUSION FTY720 limited T/HS-induced MODS (lung injury, red cell injury, and neutrophil priming) as well as T/HS lymph bioactivity, although it did not limit gut injury. PMID:25004059

  12. Synthetic Toll-like receptor 4 agonist enhances vaccine efficacy in an experimental model of toxic shock syndrome.

    PubMed

    Morefield, Garry L; Hawkins, Lynn D; Ishizaka, Sally T; Kissner, Teri L; Ulrich, Robert G

    2007-11-01

    The development of new protein subunit vaccines has stimulated the search for improved adjuvants to replace traditional aluminum-containing products. We investigated the adjuvant effects of a synthetic Toll-like receptor 4 (TLR4) agonist on vaccine efficacy in an experimental model of toxic shock syndrome. The TLR4 agonist E6020 has a simplified structure consisting of a hexa-acylated acyclic backbone. The vaccine examined is a recombinantly attenuated form of staphylococcal enterotoxin B (STEBVax). Using cells stably transfected with TLRs, E6020 transduced signals only through TLR4, suggesting monospecificity, while Escherichia coli 055:B5 lipopolysaccharide activated both the TLR2/6 heterodimer and TLR4. Coadministration of E6020 with STEBVax, by the intramuscular or intranasal route, induced significant levels of immunoglobulin G (IgG) in BALB/c mice. Further, increased IgG production resulted from the combination of E6020 with aluminum hydroxide adjuvant (AH). The antibody response to the vaccine coadministered with E6020 was a mixed Th1/Th2 response, as opposed to the Th2-biased response obtained with AH. Mice vaccinated with STEBVax coadministered with AH, TLR4 agonists, or a combination of both adjuvants were protected from toxic shock. Our data demonstrate the effectiveness of the synthetic TLR4 agonist E6020 as an alternative adjuvant for protein subunit vaccines that may also be used in combination with traditional aluminum-containing adjuvants.

  13. HLA-DR polymorphisms influence in vivo responses to staphylococcal toxic shock syndrome toxin-1 in a transgenic mouse model.

    PubMed

    Krogman, A; Tilahun, A; David, C S; Chowdhary, V R; Alexander, M P; Rajagopalan, G

    2017-01-01

    Toxic shock syndrome toxin-1 (TSST-1) is a potent superantigen produced by Staphylococcus aureus. In addition to menstrual and nonmenstrual toxic shock syndromes, TSST-1 is also implicated in the immunopathogenesis of pneumonia, infective endocarditis, neonatal exanthematous disease, and atopic dermatitis among others. Superantigens first bind to major histocompatibility complex (MHC) class II molecules and then activate a large proportion of T cells by cross-linking their T cell receptor. As binding to MHC class II molecules is a critical step in the robust activation of the immune system by TSST-1 and other superantigens, polymorphic variations between different HLA-DR alleles could potentially influence the magnitude of immune activation and immunopathology caused by TSST-1. As TSST-1 is highly toxic to humans and given that multiple variations of alleles of HLA-DR and HLA-DQ are expressed in each individual, it is difficult to determine how HLA-DR polymorphisms quantitatively and qualitatively impact immune activation caused by TSST-1 in humans. However, such investigations can be conducted on transgenic mice lacking all endogenous MHC class II molecules and expressing specific HLA class II alleles. Therefore, transgenic mice expressing different HLA-DRB1 alleles (HLA-DRB1*15:01, HLA-DRB1*15:02, HLA-DRB1*03:01, HLA-DRB1*04:01), and sharing HLA-A1*01:01 chain, were systemically challenged with purified TSST-1 and multiple immune parameters were assessed. Among the HLA-DR alleles, mice expressing HLA-DRB1*15:01 allele elicited a significantly higher serum cytokine/chemokine response; greater splenic T cell expansion and most severe organ pathology. Our study highlights the potential utility of human leukocyte antigen (HLA) transgenic mice in understanding the impact of HLA polymorphisms on the outcomes of diseases caused by TSST-1 and other superantigens. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Glycerol Monolaurate and Dodecylglycerol Effects on Staphylococcus aureus and Toxic Shock Syndrome Toxin-1 In Vitro and In Vivo

    PubMed Central

    Lin, Ying-Chi; Schlievert, Patrick M.; Anderson, Michele J.; Fair, Christina L.; Schaefers, Matthew M.; Muthyala, Ramaiah; Peterson, Marnie L.

    2009-01-01

    Background Glycerol monolaurate (GML), a 12 carbon fatty acid monoester, inhibits Staphylococcus aureus growth and exotoxin production, but is degraded by S. aureus lipase. Therefore, dodecylglycerol (DDG), a 12 carbon fatty acid monoether, was compared in vitro and in vivo to GML for its effects on S. aureus growth, exotoxin production, and stability. Methodology/Principal Findings Antimicrobial effects of GML and DDG (0 to 500 µg/ml) on 54 clinical isolates of S. aureus, including pulsed-field gel electrophoresis (PFGE) types USA200, USA300, and USA400, were determined in vitro. A rabbit Wiffle ball infection model assessed GML and DDG (1 mg/ml instilled into the Wiffle ball every other day) effects on S. aureus (MN8) growth (inoculum 3×108 CFU/ml), toxic shock syndrome toxin-1 (TSST-1) production, tumor necrosis factor-α (TNF-α) concentrations and mortality over 7 days. DDG (50 and 100 µg/ml) inhibited S. aureus growth in vitro more effectively than GML (p<0.01) and was stable to lipase degradation. Unlike GML, DDG inhibition of TSST-1 was dependent on S. aureus growth. GML-treated (4 of 5; 80%) and DDG-treated rabbits (2 of 5; 40%) survived after 7 days. Control rabbits (5 of 5; 100%) succumbed by day 4. GML suppressed TNF-α at the infection site on day 7; however, DDG did not (<10 ng/ml versus 80 ng/ml, respectively). Conclusions/Significance These data suggest that DDG was stable to S. aureus lipase and inhibited S. aureus growth at lower concentrations than GML in vitro. However, in vivo GML was more effective than DDG by reducing mortality, and suppressing TNF-α, S. aureus growth and exotoxin production, which may reduce toxic shock syndrome. GML is proposed as a more effective anti-staphylococcal topical anti-infective candidate than DDG, despite its potential degradation by S. aureus lipase. PMID:19838303

  15. Physiopathology of shock

    PubMed Central

    Bonanno, Fabrizio Giuseppe

    2011-01-01

    Shock syndromes are of three types: cardiogenic, hemorrhagic and inflammatory. Hemorrhagic shock has its initial deranged macro-hemodynamic variables in the blood volume and venous return. In cardiogenic shock there is a primary pump failure that has cardiac output/mean arterial pressure as initial deranged variables. In Inflammatory Shock it is the microcirculation that is mainly affected, while the initial deranged macrocirculation variable is the total peripheral resistance hit by systemic inflammatory response. PMID:21769210

  16. Bifurcation balloon for left main shock syndrome: facilitating the simultaneous percutaneous reperfusion of the LAD and circumflex.

    PubMed

    de Man, Karen; Patterson, Mark; Kiemeneij, Ferdinand

    2006-11-01

    Acute occlusion of the left main coronary artery frequently causes cardiogenic shock and, when this occurs with an initial TIMI 0 flow, has an extremely poor prognosis. The use of a bifurcation system has not been described previously in this situation but has advantages that may result in a simpler and quicker solution then other strategies. This case describes a distal LMCA occlusion, 2 weeks post-stenting of the proximal LAD and proximal Cx, where this strategy was successfully used as a bridge to surgery. Such a strategy may be crucially beneficial in this commonly fatal condition.

  17. Combined Measurement of Soluble ST2 and Amino-Terminal Pro-B-Type Natriuretic Peptide Provides Early Assessment of Severity in Cardiogenic Shock Complicating Acute Coronary Syndrome.

    PubMed

    Tolppanen, Heli; Rivas-Lasarte, Mercedes; Lassus, Johan; Sadoune, Malha; Gayat, Etienne; Pulkki, Kari; Arrigo, Mattia; Krastinova, Evguenia; Sionis, Alessandro; Parissis, John; Spinar, Jindrich; Januzzi, James; Harjola, Veli-Pekka; Mebazaa, Alexandre

    2017-07-01

    Mortality in cardiogenic shock complicating acute coronary syndrome is high, and objective risk stratification is needed for rational use of advanced therapies such as mechanical circulatory support. Traditionally, clinical variables have been used to judge risk in cardiogenic shock. The aim of this study was to assess the added value of serial measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide to clinical parameters for risk stratification in cardiogenic shock. CardShock (www.clinicaltrials.gov NCT01374867) is a prospective European multinational study of cardiogenic shock. The main study introduced CardShock risk score, which is calculated from seven clinical variables at baseline, and was associated with short-term mortality. Nine tertiary care university hospitals. Patients with cardiogenic shock caused by acute coronary syndrome (n=145). In this substudy, plasma samples from the study patients were analyzed at eight time points during the ICU or cardiac care unit stay. Additional prognostic value of the biomarkers was assessed with incremental discrimination improvement. The combination of soluble ST2 and amino-terminal pro-B-type natriuretic peptide showed excellent discrimination for 30-day mortality (area under the curve, 0.77 at 12 hr up to 0.93 at 5-10 d after cardiogenic shock onset). At 12 hours, patients with both biomarkers elevated (soluble ST2, ≥ 500 ng/mL and amino-terminal pro-B-type natriuretic peptide, ≥ 4,500 ng/L) had higher 30-day mortality (79%) compared to those with one or neither biomarkers elevated (31% or 10%, respectively; p < 0.001). Combined measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide at 12 hours added value to CardShock risk score, correctly reclassifying 11% of patients. The combination of results for soluble ST2 and amino-terminal pro-B-type natriuretic peptide provides early risk assessment beyond clinical variables in patients with acute coronary syndrome

  18. Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: a case report

    PubMed Central

    2014-01-01

    Introduction Drug reaction with eosinophilia and systemic symptoms syndrome is a potentially life-threatening cutaneous hypersensitivity reaction characterized by extensive mucocutaneous eruption, fever, hematologic abnormalities including eosinophilia and/or atypical lymphocytosis, and extensive organ involvement. The drugs most often responsible for causing drug reaction with eosinophilia and systemic symptoms syndrome are anticonvulsants, antimicrobial agents and antipyretic or anti-inflammatory analgesics. Although azithromycin is widely prescribed in clinical practice, serious cutaneous reactions from this agent have been rarely described. We report the first adult case of drug reaction with eosinophilia and systemic symptoms syndrome associated with azithromycin. Case presentation A 44-year-old previously healthy Caucasian man with history of tobacco use presented to his primary care physician with fever and productive cough. He was prescribed azithromycin, promethazine hydrochloride and dextromethorphan hydrobromide syrup. One week later, he developed a blistering erythematous rash over both hands, which over the next two weeks spread to involve nearly his entire body surface, sparing only his face. He was admitted to an outside hospital with signs of systemic inflammatory response syndrome and severe sepsis, presumably from a skin infection. Despite aggressive therapy he deteriorated, with worsening diffuse erythema, and was transferred to our institution. He developed multiple organ failure requiring ventilatory and hemodynamic support. Pertinent laboratory studies included a leukocytosis with a white blood cell count of 17.6×109/L and 47% eosinophils. A skin biopsy showed evidence of spongiotic lichenoid dermatitis with eosinophils and neutrophils, compatible with a systemic drug-induced hypersensitivity reaction. Our patient was started on high-dose steroids and showed dramatic improvement within 48 hours. Conclusions We report the first adult case of

  19. Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: a case report.

    PubMed

    Sriratanaviriyakul, Narin; Nguyen, Lam-Phuong; Henderson, Mark C; Albertson, Timothy E

    2014-10-08

    Drug reaction with eosinophilia and systemic symptoms syndrome is a potentially life-threatening cutaneous hypersensitivity reaction characterized by extensive mucocutaneous eruption, fever, hematologic abnormalities including eosinophilia and/or atypical lymphocytosis, and extensive organ involvement. The drugs most often responsible for causing drug reaction with eosinophilia and systemic symptoms syndrome are anticonvulsants, antimicrobial agents and antipyretic or anti-inflammatory analgesics. Although azithromycin is widely prescribed in clinical practice, serious cutaneous reactions from this agent have been rarely described. We report the first adult case of drug reaction with eosinophilia and systemic symptoms syndrome associated with azithromycin. A 44-year-old previously healthy Caucasian man with history of tobacco use presented to his primary care physician with fever and productive cough. He was prescribed azithromycin, promethazine hydrochloride and dextromethorphan hydrobromide syrup. One week later, he developed a blistering erythematous rash over both hands, which over the next two weeks spread to involve nearly his entire body surface, sparing only his face. He was admitted to an outside hospital with signs of systemic inflammatory response syndrome and severe sepsis, presumably from a skin infection. Despite aggressive therapy he deteriorated, with worsening diffuse erythema, and was transferred to our institution. He developed multiple organ failure requiring ventilatory and hemodynamic support. Pertinent laboratory studies included a leukocytosis with a white blood cell count of 17.6 × 10(9)/L and 47% eosinophils. A skin biopsy showed evidence of spongiotic lichenoid dermatitis with eosinophils and neutrophils, compatible with a systemic drug-induced hypersensitivity reaction. Our patient was started on high-dose steroids and showed dramatic improvement within 48 hours. We report the first adult case of drug reaction with eosinophilia and

  20. Vascular Endothelium and Hypovolemic Shock.

    PubMed

    Gulati, Anil

    2016-01-01

    Endothelium is a site of metabolic activity and has a major reservoir of multipotent stem cells. It plays a vital role in the vascular physiological, pathophysiological and reparative processes. Endothelial functions are significantly altered following hypovolemic shock due to ischemia of the endothelial cells and by reperfusion due to resuscitation with fluids. Activation of endothelial cells leads to release of vasoactive substances (nitric oxide, endothelin, platelet activating factor, prostacyclin, mitochondrial N-formyl peptide), mediators of inflammation (tumor necrosis factor α, interleukins, interferons) and thrombosis. Endothelial cell apoptosis is induced following hypovolemic shock due to deprivation of oxygen required by endothelial cell mitochondria; this lack of oxygen initiates an increase in mitochondrial reactive oxygen species (ROS) and release of apoptogenic proteins. The glycocalyx structure of endothelium is compromised which causes an impairment of the protective endothelial barrier resulting in increased permeability and leakage of fluids in to the tissue causing edema. Growth factors such as angiopoetins and vascular endothelial growth factors also contribute towards pathophysiology of hypovolemic shock. Endothelium is extremely active with numerous functions, understanding these functions will provide novel targets to design therapeutic agents for the acute management of hypovolemic shock. Hypovolemic shock also occurs in conditions such as dengue shock syndrome and Ebola hemorrhagic fever, defining the role of endothelium in the pathophysiology of these conditions will provide greater insight regarding the functions of endothelial cells in vascular regulation.

  1. Deletions of the elastin gene at 7q11.23 occur in {approximately}90% of patients with Williams syndrome

    SciTech Connect

    Nickerson, E.; Greenberg, F.; McCaskill, C.; Shaffer, L.G.; Keating, M.T.

    1995-05-01

    To investigate the frequency of deletions of the elastin gene in patients with Williams syndrome (WS), we screened 44 patients by both FISH and PCR amplification of a dinucleotide repeat polymorphism. FISH was performed using cosmids containing either the 5{prime} or the 3{prime} end of the elastin gene. PCR analysis was performed on the patients and their parents with a (CA){sub n} repeat polymorphism found in intron 17 of the elastin locus. Of the 44 patients screened, 91% were shown to be deleted by FISH. Using the DNA polymorphism, both maternally (39%) and paternally (61%) derived deletions were found. Four patients were not deleted for elastin but have clinical features of WS. Since deletions of elastin cannot account for several features found in WS, these patients will be valuable in further delineation of the critical region responsible for the WS phenotype. Although PCR can be useful for determining the parental origin of the deletion, our results demonstrate that FISH analysis of the elastin locus provides a more rapid and informative test to confirm a clinical diagnosis of WS. The presence of two copies of the elastin locus in a patient does not, however, rule out WS as a diagnosis. 25 refs., 3 figs., 1 tab.

  2. The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: an observational study.

    PubMed

    Fuller, Brian M; Mohr, Nicholas M; Graetz, Thomas J; Lynch, Isaac P; Dettmer, Matthew; Cullison, Kevin; Coney, Talia; Gogineni, Swetha; Gregory, Robert

    2015-02-01

    Acute respiratory distress syndrome (ARDS) is associated with significant mortality and morbidity in survivors. Treatment is only supportive, therefore elucidating modifiable factors that could prevent ARDS could have a profound impact on outcome. The impact that sepsis-associated cardiac dysfunction has on ARDS is not known. In this retrospective observational cohort study of mechanically ventilated patients with severe sepsis and septic shock, 122 patients were assessed for the impact of sepsis-associated cardiac dysfunction on incidence of ARDS (primary outcome) and mortality. Sepsis-associated cardiac dysfunction occurred in 44 patients (36.1%). There was no association of sepsis-associated cardiac dysfunction with ARDS incidence (p= 0.59) or mortality, and no association with outcomes in patients that did progress to ARDS after admission. Multivariable logistic regression demonstrated that higher BMI was associated with progression to ARDS (adjusted OR 11.84, 95% CI 1.24 to 113.0, p= 0.02). Cardiac dysfunction in mechanically ventilated patients with sepsis did not impact ARDS incidence, clinical outcome in ARDS patients, or mortality. This contrasts against previous investigations demonstrating an influence of nonpulmonary organ dysfunction on outcome in ARDS. Given the frequency of ARDS as a sequela of sepsis, the impact of cardiac dysfunction on outcome should be further studied. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: a Case Report

    PubMed Central

    Lewis, Paul A.; Cunningham, Joan E.

    2016-01-01

    Background In the context of breast cancer, axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery. This painful condition, likely lymphofibrotic in origin, restricts upper extremity range of motion (ROM). There is no established treatment, although physical therapy and other approaches have been used to variable effect. This report describes treatment of a female client with AWS, who had recently undergone a unilateral simple mastectomy with sentinel node biopsy plus axillary dissection. Methods The client presented with pain upon movement (self-reported as 5 on the 0–10 Oxford Pain Scale), visible cording and restricted use of the ipsilateral upper extremity. Clinical assessment included determining the extent of AWS cording (taut, from axilla to wrist) and measuring glenohumeral joint ROM (140° flexion by goniometer). A therapeutic massage with movement protocol, termed dynamic angular petrissage, was administered over two sessions: Swedish massage combined with dynamically taking the limb through all possible angles of movement (passive ROM), controlling stretch and tension while simultaneously and segmentally applying petrissage and non-petrissage techniques to the underlying soft tissue. Careful attention was taken to not break the cord. Home care consisted of prescribed exercises performed by the patient. Results After Session One, pain was reduced (to 0/10), ROM improved (to 170° flexion), and cording was visibly reduced. After Session Two the cord was residually apparent only on hyperextension, with no ROM restrictions in glenohumeral joint flexion. Follow-up at three months revealed absence of visual or palpable evidence of cording, unrestricted glenohumeral joint ROM, and absence of movement-associated pain. Conclusion The signs and symptoms of AWS were quickly and effectively eliminated, without causing any pain or discomfort to the client. We propose that dynamic angular petrissage may be

  4. Atypical Double Right Coronary Artery Presenting With Acute Coronary Syndrome, Cardiogenic Shock and Complete Heart Block

    PubMed Central

    Sinha, Santosh Kumar; Singh, Shravan; Chaturvedi, Vikash; Agrawal, Puneet; Razi, Mahmadula; Mahrotra, Anupam; Mishra, Vikas; Kumar, Mukesh; Abdali, Nasar; Khanra, Dibbendhu; Thakur, Ramesh; Varma, Chandra Mohan; Pandey, Umeshwar

    2017-01-01

    Double right coronary artery (RCA) is an extremely rare coronary artery anomaly. We here report an atherosclerotic double RCA which appeared after primary percutaneous intervention performed to treat a 34-year-old male presenting with acute inferior myocardial infarction, cardiogenic shock and complete heart block. This is an unusual case as double RCA had been hidden by total atherosclerotic occlusion of the proximal part of the RCA and complete restoration of patency led complete heart block back to normal sinus rhythm. PMID:28179971

  5. Investigation by improved syringe method of effect of tampons on production in vitro of toxic shock syndrome toxin 1 by Staphylococcus aureus.

    PubMed Central

    Wong, A C; Downs, S A

    1989-01-01

    Twenty-seven types of commercial tampons from five manufacturers were tested in a sealed-syringe method to determine their effect on the growth of Staphylococcus aureus and the production of toxic shock syndrome toxin 1. In this improvement of the syringe method, the available air is limited to that which is contained within the sealed syringe containing the tampon. The culture medium was buffered, and blood and CO2 were included in the incubation to better simulate the vaginal environment during menstruation. Variables of tampon weight, composition, air volume, and absorbency were examined for their effect on the production of toxic shock syndrome toxin 1. Generally, with the exception of brand E, toxin production in the presence of tampons was equal to or lower than that in a sealed control syringe containing air but no tampon. PMID:2808672

  6. [Presence of enterotoxin C and toxic shock syndrome toxin--1 (TSST-1) genes in population of Staphylococcus aureus phage type 187].

    PubMed

    Garbacz, Katarzyna; Piechowicz, Lidia; Galiński, Janusz

    2006-01-01

    The aim of this study was to examine whether Staphylococcus aureus of phage type 187 possess the genes of enterotoxins and toxic shock syndrom toxin. Sixteen phage type 187 strains were isolated from the hospital patients (12) and the carriers (4) in twelve medical centres in Poland during 1991 and 2005. Biotyping, phage typing, antibiotic susceptibility, detection of the genes of enterotoxins (sea--sed) and toxic shock syndrome toxin (tst) was tested. The results of this study showed that all staphylococci of phage type 187 belonged to the human biotype (A) and appeared to be sensitive to all of the tested antibiotics, including methicillin (MSSA). Almost all of them (93.8%) had the enterotoxin C gene and TSST-1 gene. This fact allows to consider them the strains of potentially high virulence.

  7. Toxic shock syndrome toxin 1 (TSST-1) production by staphylococci isolated from goats and presence of specific antibodies to TSST-1 in serum and milk.

    PubMed Central

    Valle, J; Vadillo, S; Piriz, S; Gomez-Lucia, E

    1991-01-01

    The ability of staphylococcal strains isolated from different anatomical sites in 133 healthy goats to produce toxic shock syndrome toxin 1 (TSST-1) and the presence of antibodies to this toxin in serum and milk were studied. The enzyme-linked immunosorbent assay method was used to detect both the toxin and the presence of antibodies. Of a total of 342 staphylococcal strains studied, 86 (25.2%) were found to produce TSST-1. Specific antibodies to TSST-1 were found in the serum of 57 (42.9%) of the animals studied and the milk of 63 (47.4%) of the animals. These results suggest that goats are frequently in contact with staphylococci that produce TSST-1, a toxin usually associated with Staphylococcus aureus strains isolated from cases of toxic shock syndrome in humans. PMID:2039240

  8. Dilated cardiomyopathy with cardiogenic shock in a child with Kearns-Sayre syndrome.

    PubMed

    Sehgal, Swati; Choudhry, Swati; Debelenko, Larisa; L'Ecuyer, Thomas

    2016-02-16

    Kearns-Sayre syndrome (KSS) is a mitochondrial myopathy resulting from mitochondrial DNA deletion. This syndrome primarily involves the central nervous system, eyes, skeletal muscles and the heart. The most well-known cardiac complications involve the conduction system; however, there have been case reports describing cardiomyopathy. We describe a case of a child with KSS who presented with decompensated cardiac failure from dilated cardiomyopathy representing cardiomyocyte involvement of KSS. Our patient had a rapidly progressing course, despite maximal medical management, requiring emergent institution of extracorporeal membrane oxygenation and transition to a ventricular assist device. To the best of our knowledge, this is the youngest patient in the literature to have dilated cardiomyopathy in KSS.

  9. Extracorporeal shock wave treatment for non-inflammatory chronic pelvic pain syndrome: a prospective, randomized and sham-controlled study.

    PubMed

    Zeng, Xiao-Yong; Liang, Chen; Ye, Zhang-Qun

    2012-01-01

    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a clinical syndrome characterized by pain in the perineum, pelvis, suprapubic area, or external genitalia and variable degrees of voiding and ejaculatory disturbance. The analgesic effect of extracorporeal shock wave treatment (ESWT) was an interesting phenomenon with an unclear mechanism discovered by chance in the applications for urolithiasis, on which ESWT has become an increasingly popular therapeutic approach as an alternative option for the treatment of a number of soft tissue complaints. In this study, we aimed to evaluate the feasibility and efficacy of ESWT in non-inflammatory (IIIB) CP/CPPS. Men diagnosed with IIIB CP/CPPS were randomized to either ESWT (group 1, n = 40) or the control (group 2, n = 40). Group 1 received 20 000 shock wave impulses in 10 sessions over a two-week period, whereas group 2 received only a sham procedure. The total scores and sub-domain scores of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) for both groups were assessed at baseline, mid-treatment, end-point, and 4-week and 12-week follow-up visits. The mean total NIH-CPSI score of group 1 was significantly decreased from baseline at all post-treatment time points (P < 0.01 for all). Decreases in pain domain and quality of life (QOL) scores were also significant. In group 2, no significant decreases of total NIH-CPSI score and pain domain score were found at all post-treatment time points. At the end-point of treatment, 71.1% of group 1 exhibited perceptible improvement in total NIH-CPSI compared with 27.0% of group 2 (P < 0.001); additionally, 28.9% of group 1 exhibited clinically significant improvement compared with 10.8% of group 2 (P < 0.01). Moreover, a greater number of patients in group 1 at 4-week and 12-week follow-up were rated as responders (perceptible and clinically significant response) compared with group 2. ESWT exhibits a potentially therapeutic role in the

  10. Role of cognitive parameters in dengue hemorrhagic fever and dengue shock syndrome

    PubMed Central

    2013-01-01

    Dengue is becoming recognized as one of the most important vector-borne human diseases. It is predominant in tropical and subtropical zones but its geographical distribution is progressively expanding, making it an escalating global health problem of today. Dengue presents with spectrum of clinical manifestations, ranging from asymptomatic, undifferentiated mild fever, dengue fever (DF), to dengue hemorrhagic fever (DHF) with or without shock (DSS), a life-threatening illness characterized by plasma leakage due to increased vascular permeability. Currently, there are no antiviral modalities or vaccines available to treat and prevent dengue. Supportive care with close monitoring is the standard clinical practice. The mechanisms leading to DHF/DSS remains poorly understood. Multiple factors have been attributed to the pathological mechanism, but only a couple of these hypotheses are popular in scientific circles. The current discussion focuses on underappreciated factors, temperature, natural IgM, and endotoxin, which may be critical components playing roles in dengue pathogenesis. PMID:24305068

  11. Distributive shock due to systemic capillary leak syndrome treated with high-dose immunosuppression

    PubMed Central

    Sheehan, James Robert; Keating, Liza; Chan, Antoni; Walden, Andrew

    2013-01-01

    A female patient in her 60s presented with a history of malaise, chills, headache and vomiting. She was in shock on presentation with a high haematocrit and a low albumin with evidence of rhabdomyolysis. Severe limb and truncal oedema developed with worsening hypotension leading to intensive care unit admission for multiple organ support. Extensive radiological, microbiological and immunological work up was negative with the exception of a monoclonal gammopathy. A review of patient investigations led to a diagnosis of Clarkson's disease. Treatment with high-dose methylprednisolone and intravenous immunoglobulins led to a rapid decline in the creatine kinase (CK) level and vasopressor requirements. The patient was discharged home on long-term terbutaline and has made a good recovery. PMID:23576661

  12. Distributive shock due to systemic capillary leak syndrome treated with high-dose immunosuppression.

    PubMed

    Sheehan, James Robert; Keating, Liza; Chan, Antoni; Walden, Andrew

    2013-04-09

    A female patient in her 60s presented with a history of malaise, chills, headache and vomiting. She was in shock on presentation with a high haematocrit and a low albumin with evidence of rhabdomyolysis. Severe limb and truncal oedema developed with worsening hypotension leading to intensive care unit admission for multiple organ support. Extensive radiological, microbiological and immunological work up was negative with the exception of a monoclonal gammopathy. A review of patient investigations led to a diagnosis of Clarkson's disease. Treatment with high-dose methylprednisolone and intravenous immunoglobulins led to a rapid decline in the creatine kinase (CK) level and vasopressor requirements. The patient was discharged home on long-term terbutaline and has made a good recovery.

  13. Septic shock non-thyroidal illness syndrome causes hypothyroidism and conditions for reduced sensitivity to thyroid hormone.

    PubMed

    Castro, Isabel; Quisenberry, Leah; Calvo, Rosa-Maria; Obregon, Maria-Jesus; Lado-Abeal, Joaquin

    2013-04-01

    Non-thyroidal illness syndrome (NTIS) is part of the neuroendocrine response to stress, but the significance of this syndrome remains uncertain. The aim of this study was to investigate the effect of lipopolysaccharide (LPS)-induced NTIS on thyroid hormone (TH) levels and TH molecular targets, as well as the relationship between septic shock nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) activation and TH receptor β (THRB) gene expression at a multi-tissue level in a pig model. Prepubertal domestic pigs were given i.v. saline or LPS for 48 h. Serum and tissue TH was measured by chemiluminescence and RIA. Expression of THRs and cofactors was measured by real-time PCR, and deiodinase (DIO) activity was measured by enzyme assays. Tissue NF-kB nuclear binding activity was evaluated by EMSA. LPS-treated pigs had decreased TH levels in serum and most tissues. DIO1 expression in liver and kidney and DIO1 activity in kidney decreased after LPS. No changes in DIO2 activity were observed between groups. LPS induced an increase in hypothalamus, thyroid, and liver DIO3 activity. Among the other studied genes, monocarboxylate transporter 8 and THRB were the most commonly repressed in endotoxemic pigs. LPS-induced NF-kB activation was associated with a decrease in THRB gene expression only in frontal lobe, adrenal gland, and kidney cortex. We conclude that LPS-induced NTIS in pigs is characterized by hypothyroidism and tissue-specific reduced TH sensitivity. The role of NF-kB in regulating THRB expression during endotoxemia, if any, is restricted to a limited number of tissues.

  14. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial.

    PubMed

    Wu, Yung-Tsan; Ke, Ming-Jen; Chou, Yu-Ching; Chang, Chih-Ya; Lin, Ching-Yueh; Li, Tsung-Ying; Shih, Feng-Mei; Chen, Liang-Cheng

    2016-06-01

    Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo-controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double-blinded study to assess the effect of rESWT for treating CTS. Thirty-four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo-controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977-984, 2016.

  15. Assessment of the pathogenesis of Streptococcus suis type 2 infection in piglets for understanding streptococcal toxic shock-like syndrome, meningitis, and sequelae.

    PubMed

    Bi, Yuhai; Li, Jing; Yang, Limin; Zhang, Shuang; Li, Yun; Jia, Xiaojuan; Sun, Lei; Yin, Yanbo; Qin, Chuan; Wang, Beinan; Gao, George Fu; Liu, Wenjun

    2014-10-10

    Streptococcus suis type 2 (SS2) is an zoonotic pathogen that had caused outbreaks in 1998 and 2005 in China. It is still not very clear how the disease progresses into the streptococcal toxic shock-like syndrome (STSLS) or meningitis, as well as the sequelae from the survivals. The present study used piglets as infection model to systematically investigate the pathogenesis of the infection caused by the SS2 strain 05ZYH33. The infected piglets showed joint swelling, lameness, and crouch at beginning, then developed into septic-like shock syndrome (SLSS) or prostration syndrome, at last the survivals showed physical activity impairment. The morbidity and mortality were 100% (71% for SLSS, 29% for prostration syndrome) and 29%, respectively. The pigs exhibiting SLSS had deep invasive infections in tissues and organs, and displayed more severe bacteremia and cytokine secretion in the bloodstream and organs than pigs with prostration syndrome. Moreover, the polymorphisms in the toll-like receptor 1 (TLR1) and TLR2 genes varied between the pigs affected with SLSS and prostration syndrome. Several lines of evidence indicated that SS2 infection progression into SLSS or relatively lighter prostration syndrome in pigs is closely related to the degrees of bacteremia and cytokine storm, which may be inherently determined by the diversity of innate immunity-associated genes. Furthermore, brain lesions, such as venous thrombosis, may directly contribute to the sequelae in human cases, were identified in the pigs. These results might help us to further understand the pathogenesis of SS2 in humans.

  16. Serological characterization of dengue virus infections observed among dengue hemorrhagic fever/dengue shock syndrome cases in upper Myanmar.

    PubMed

    Ngwe Tun, Mya Myat; Thant, Kyaw Zin; Inoue, Shingo; Kurosawa, Yae; Lwin, Yee Yee; Lin, Sanda; Aye, Kay Thi; Thet Khin, Pe; Myint, Tin; Htwe, Khin; Mapua, Cynthia A; Natividad, Filipinas F; Hirayama, Kenji; Morita, Kouichi

    2013-07-01

    In Myanmar, dengue fever (DF)/dengue hemorrhagic fever (DHF) is one of the leading causes of morbidity and mortality among children. From Pyinmana Hospital in 2004 and Mandalay Children Hospital in 2006, 160 patients diagnosed clinically to have DHF/dengue shock syndrome (DSS) were examined for immunoglobulin M (IgM) and IgG levels. A focus reduction neutralization test was also used to determine primary or secondary dengue virus (DENV) infection. By using IgM-capture ELISA, 139 cases were confirmed as DENV infections. Of these IgM-positives, 94 samples were collected 7-24 days from the onset of illness, to which 13 (14%) and 81 (86%) were determined to be primary and secondary DENV infections, respectively. The 13 primary DENV infection cases were spread among the various severity groups (DHF grade I-IV and DSS) and represented age groups ranging from <1 year of age to 9 years of age. The patients in these primary infection cases showed a remarkably high IgM with a low IgG titer response compared with the secondary infection cases. No significant differences were observed in IgG titers with clinical severity. The data obtained in this study suggest that primary DENV infection cases exist certainly among DHF/DSS cases in Myanmar, and that additional mechanism(s) aside from the antibody-dependent enhancement mechanism could have influenced the clinical severity in DHF/DSS cases.

  17. Epidemiological Factors Associated with Dengue Shock Syndrome and Mortality in Hospitalized Dengue Patients in Ho Chi Minh City, Vietnam

    PubMed Central

    Anders, Katherine L.; Nguyet, Nguyen Minh; Van Vinh Chau, Nguyen; Hung, Nguyen Thanh; Thuy, Tran Thi; Lien, Le Bich; Farrar, Jeremy; Wills, Bridget; Hien, Tran Tinh; Simmons, Cameron P.

    2011-01-01

    Understanding trends in dengue disease burden and risk factors for severe disease can inform health service allocation, clinical management, and planning for vaccines and therapeutics. Dengue admissions at three tertiary hospitals in Ho Chi Minh City, Vietnam, increased between 1996 and 2009, peaking at 22,860 in 2008. Children aged 6–10 years had highest risk of dengue shock syndrome (DSS); however, mortality was highest in younger children and decreased with increasing age (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36–0.75 in 6- to 10- year-old children and OR = 0.27, 95% CI = 0.16–0.44 in 11- to 15-year-old children compared with 1- to 5-year-old children). Males were overrepresented among dengue cases; however, girls had higher risk of DSS (OR = 1.19, 95% CI = 1.14–1.24) and death (OR = 1.57, 95% CI = 1.14–2.17). Young children with dengue had greatest risk of death and should be targeted in dengue vaccine and drug trials. The increased risk of severe outcomes in girls warrants further attention in studies of pathogenesis, health-seeking behavior, and clinical care. PMID:21212214

  18. Effects of tampon materials on the in-vitro physiology of a toxic shock syndrome strain of Staphylococcus aureus.

    PubMed

    Ingham, E; Eady, E A; Holland, K T; Gowland, G

    1985-08-01

    Seven materials used in the manufacture of tampons-four rayon, one modified rayon, one cotton and one carboxy-methyl cellulose (a modified cotton)-were compared for their effects in vitro on the physiology of a strain of Staphylococcus aureus isolated from a patient with Toxic Shock Syndrome. Experiments were performed in broth culture and, with the exception of two rayon samples, all of the materials tested reduced growth rate and cell yield compared with control values. Exocellular acid phosphatase, lipase, proteinase, hyaluronate lyase and haemolysin in culture filtrates were measured and the lethality of filtrates was determined in mice. The tampon materials had different effects on the levels of exocellular products. Cotton and carboxy-methyl cellulose cotton materials reduced the levels of all of the activities tested. The activities of the other enzymes were reduced or increased, depending on which material was present. All materials reduced both haemolytic activity and lethality of the culture filtrates. The in-vitro data suggest an extremely complex interaction between tampon materials and S. aureus.

  19. Production of staphylococcal enterotoxin F and pyrogenic exotoxin C by Staphylococcus aureus isolates from toxic shock syndrome-associated sources.

    PubMed Central

    Bonventre, P F; Weckbach, L; Staneck, J; Schlievert, P M; Thompson, M

    1983-01-01

    A total of 136 isolates of Staphylococcus aureus were tested for production of staphylococcal enterotoxin F (SEF) and pyrogenic exotoxin C (PEC), both of which have been identified as reliable indicators of toxic shock syndrome (TSS)-associated strains. SEF and PEC production by isolates from TSS-associated and other sources was tested independently in two laboratories, after which the two sets of data were compared. A 100% concordance between SEF and PEC production was obtained. The TSS toxin candidates were produced by 30 of 136 isolates, and in all instances SEF and PEC were made concurrently by the same strains; in no case was one toxin made and not the other. In the five groups of S. aureus tested, toxins were detected as follows: 23 of 25 (92%) acute TSS isolates, 2 of 48 (4.2%) genital non-TSS isolates, 2 of 16 (12.5%) recovered TSS isolates, 1 of 23 (4.3%) clinical nongenital isolates, and 2 of 24 (8.3%) enterotoxigenic food outbreak isolates. Comparison of purified SEF and purified PEC by immunological and biochemical criteria by immunodiffusion, isoelectric focusing, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and Western blot analysis show that the toxins are immunologically identical and strongly suggest that the two nominal TSS toxins are in fact a single protein. Images PMID:6189784

  20. Characterization of Staphylococcus aureus isolates from patients with toxic shock syndrome, using polyethylene infection chambers in rabbits.

    PubMed

    Scott, D F; Kling, J M; Kirkland, J J; Best, G K

    1983-01-01

    Isolates of Staphylococcus aureus from patients with toxic shock syndrome (TSS) were compared with non-TSS strains of S. aureus with respect to their virulence in rabbits. When the organisms were injected into subcutaneous chambers (perforated polyethylene golf balls) to assess virulence, a rapid mortality was observed with TSS but not with non-TSS strains. Of 16 TSS strains, 11 caused lethal infections in 33 rabbits tested, and none of the 5 control strains caused mortality in 10 rabbits. This evidence of enhanced virulence associated with TSS strains did not appear to be associated with the size of the inoculum. In addition, strains which produced lethal infections appeared to do so despite a reduction in the size of the original inoculum during the first 24 h. All of the TSS strains and none of the non-TSS strains elaborated extracellular protein(s) with a neutral pI when grown in a dialyzed beef heart medium. No other physiological difference was noted between the TSS and non-TSS strains.

  1. Guillain-Barré Syndrome Presenting with Sinus Node Dysfunction and Refractory Shock

    PubMed Central

    Ha, Le Dung; Abbas, Farrukh; Rao, Mohan

    2017-01-01

    Patient: Male, 76 Final Diagnosis: Guillain-Barré syndrome Symptoms: Bradycardia • refractory hypotension Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy that is usually associated with preceding respiratory or gastrointestinal infection and has the hallmark manifestation of ascending flaccid paralysis. We report an atypical presentation of GBS. Case Report: A 76-year-old male presented with acute onset of diaphoresis and altered mental status. He subsequently developed severe bradycardia and refractory hypotension, which initially responded to dopamine infusion. A temporary pacemaker wire was placed to stabilize the heart rate but hypotension persisted. Acute autonomic dysfunction was suspected. Head and chest imaging was unrevealing. Lumbar puncture revealed albuminocytologic dissociation that was consistent with a diagnosis of GBS. Hospital course was complicated with acute kidney injury and metabolic acidosis. Plasmapharesis was initiated. The patient eventually died of multi-organ failure. Conclusions: Autonomic dysfunction is a known but rare presentation of GBS. In patients presenting with refractory bradycardia and hypotension, GBS should be considered in the differential diagnosis. PMID:28283677

  2. Understanding the Shock in "Culture Shock."

    ERIC Educational Resources Information Center

    Schnell, Jim

    "Culture shock" is the expression generally associated with the frustrations that occur when persons have difficulty functioning in a different culture or when persons are exposed to individuals from another culture. Culture shock typically occurs in a 4-stage process that can unfold over varying lengths of time: the honeymoon, crisis,…

  3. Septic Shock

    PubMed Central

    Lansing, Allan M.

    1963-01-01

    Septic shock may be defined as hypotension caused by bacteremia and accompanied by decreased peripheral blood flow, evidenced by oliguria. Clinically, a shaking chill is the warning signal. The immediate cause of hypotension is pooling of blood in the periphery, leading to decreased venous return: later, peripheral resistance falls and cardiac failure may occur. Irreversible shock is comparable to massive reactive hyperemia. Reticuloendothelial failure, histamine release, and toxic hypersensitivity may be factors in the pathogenesis of septic shock. Adrenal failure does not usually occur, but large doses of corticosteroid are employed therapeutically to counteract the effect of histamine release or hypersensitivity to endotoxin. The keys to successful therapy are time, antibiotics, vasopressors, cortisone and correction of acidosis. PMID:14063936

  4. Pre- and perinatal complications in relation to Tourette syndrome and co-occurring obsessive-compulsive disorder and attention-deficit/hyperactivity disorder.

    PubMed

    Abdulkadir, Mohamed; Tischfield, Jay A; King, Robert A; Fernandez, Thomas V; Brown, Lawrence W; Cheon, Keun-Ah; Coffey, Barbara J; de Bruijn, Sebastian F T M; Elzerman, Lonneke; Garcia-Delgar, Blanca; Gilbert, Donald L; Grice, Dorothy E; Hagstrøm, Julie; Hedderly, Tammy; Heyman, Isobel; Hong, Hyun Ju; Huyser, Chaim; Ibanez-Gomez, Laura; Kim, Young Key; Kim, Young-Shin; Koh, Yun-Joo; Kook, Sodahm; Kuperman, Samuel; Lamerz, Andreas; Leventhal, Bennett; Ludolph, Andrea G; Madruga-Garrido, Marcos; Maras, Athanasios; Messchendorp, Marieke D; Mir, Pablo; Morer, Astrid; Münchau, Alexander; Murphy, Tara L; Openneer, Thaïra J C; Plessen, Kerstin J; Rath, Judith J G; Roessner, Veit; Fründt, Odette; Shin, Eun-Young; Sival, Deborah A; Song, Dong-Ho; Song, Jungeun; Stolte, Anne-Marie; Tübing, Jennifer; van den Ban, Els; Visscher, Frank; Wanderer, Sina; Woods, Martin; Zinner, Samuel H; State, Matthew W; Heiman, Gary A; Hoekstra, Pieter J; Dietrich, Andrea

    2016-11-01

    Pre- and perinatal complications have been implicated in the onset and clinical expression of Tourette syndrome albeit with considerable inconsistencies across studies. Also, little is known about their role in co-occurring obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) in individuals with a tic disorder. Therefore, we aimed to investigate the role of pre- and perinatal complications in relation to the presence and symptom severity of chronic tic disorder and co-occurring OCD and ADHD using data of 1113 participants from the Tourette International Collaborative Genetics study. This study included 586 participants with a chronic tic disorder and 527 unaffected family controls. We controlled for age and sex differences by creating propensity score matched subsamples for both case-control and within-case analyses. We found that premature birth (OR = 1.72) and morning sickness requiring medical attention (OR = 2.57) were associated with the presence of a chronic tic disorder. Also, the total number of pre- and perinatal complications was higher in those with a tic disorder (OR = 1.07). Furthermore, neonatal complications were related to the presence (OR = 1.46) and severity (b = 2.27) of co-occurring OCD and also to ADHD severity (b = 1.09). Delivery complications were only related to co-occurring OCD (OR = 1.49). We conclude that early exposure to adverse situations during pregnancy is related to the presence of chronic tic disorders. Exposure at a later stage, at birth or during the first weeks of life, appears to be associated with co-occurring OCD and ADHD.

  5. Septic Shock

    PubMed Central

    Seymour, Christopher W.; Rosengart, Matthew R.

    2015-01-01

    IMPORTANCE Septic shock is a clinical emergency that occurs in more than 230 000 US patients each year. OBSERVATIONS AND ADVANCES In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin. CONCLUSIONS AND RELEVANCE The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence. PMID:26284722

  6. Volume of fluids administered during resuscitation for severe sepsis and septic shock and the development of the acute respiratory distress syndrome.

    PubMed

    Chang, Dong W; Huynh, Richard; Sandoval, Eric; Han, Neung; Coil, Clinton J; Spellberg, Brad J

    2014-12-01

    The purpose of this study was to examine the association between the volume of intravenous (IV) fluids administered in the resuscitative phase of severe sepsis and septic shock and the development of the acute respiratory distress syndrome (ARDS). This was a retrospective cohort study of adult patients admitted with severe sepsis and septic shock at a large academic public hospital. The relationship between the volume of IV fluids administered and the development of ARDS was examined using multivariable logistic regression analysis. Among 296 patients hospitalized for severe sepsis and septic shock, 75 (25.3%) developed ARDS. After controlling for confounding variables, there was no significant association between the volume of IV fluids administered in the first 24 hours of hospitalization and the development of ARDS (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.95-1.18). Serum albumin (OR, 0.52; 95% CI, 0.31-0.87) and Acute Physiology and Chronic Health Evaluation II score (OR, 1.08; 95% CI, 1.04-1.13) on admission were the most informative covariates for the development of ARDS in the regression model. For patients hospitalized for severe sepsis and septic shock, fluid administration to improve end-organ perfusion should remain the top priority in early resuscitation despite the potential risk of inducing ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Emergence of Streptococcus pyogenes emm102 causing toxic shock syndrome in Southern Taiwan during 2005-2012.

    PubMed

    Lin, Jiun-Nong; Chang, Lin-Li; Lai, Chung-Hsu; Lin, Hsi-Hsun; Chen, Yen-Hsu

    2013-01-01

    Streptococcal toxic shock syndrome (STSS) is an uncommon but life-threatening disease caused by Streptococcus pyogenes. To understand the clinical and molecular characteristics of STSS, we analyzed clinical data and explored the emm types, superantigen genes, and pulsed-field gel electrophoresis of causative S. pyogenes isolates obtained between 2005 and 2012. In total, 53 patients with STSS were included in this study. The median age of the patients was 57 years (range: 9-83 years), and 81.1% were male. The most prevalent underlying disease was diabetes mellitus (45.3%). Skin and soft-tissue infection accounted for 86.8% of STSS. The overall mortality rate was 32.1%. Underlying diseases had no statistical impact on mortality. A total of 19 different emm types were identified. The most prevalent emm type was emm102 (18.9%), followed by emm11 (17%), emm1 (11.3%), emm87 (9.4%), and emm89 (7.5%). There was no statistically significant association between emm type and a fatal outcome. Among the superantigen genes, speB was the most frequently detected one (92.5%), followed by smeZ (90.6%), speG (81.1%), speC (39.6%), and speF (39.6%). The majority of emm102 strains were found to have speB, speC, speG, and smeZ. The presence of speG was negatively associated with a fatal outcome (P = 0.045). Our surveillance revealed the emergence of uncommon emm types, particularly emm102, causing STSS in southern Taiwan. Characterization of clinical, epidemiological, and molecular characteristics of STSS will improve our understanding of this life-threatening disease.

  8. Heat Shock Proteins, L-Arginine, and Asymmetric Dimethylarginine Levels in Patients With Obstructive Sleep Apnea Syndrome.

    PubMed

    İn, Erdal; Özdemir, Cengiz; Kaman, Dilara; Sökücü, Sinem Nedime

    2015-11-01

    Vascular endothelial inflammation and enhanced oxidative stress are important factors in the pathogenesis of obstructive sleep apnea syndrome (OSAS). The aim of this study was to determine the levels of heat shock protein (HSP) 27, HSP70, HSP90, L-arginine, and asymmetric dimethylarginine (ADMA) in patients with OSAS and determine their relationship with cardiovascular (CV) risk factors. Forty patients with OSAS, comprising 26 with and 14 without traditional CV risk factors (obesity, hypercholesterolemia, diabetes, hypertension, and smoking), and 20 control subjects without OSAS were included. All patients underwent a full polysomnographic evaluation, and blood samples were obtained in the morning after the night the diagnostic study was performed. No significant differences were found in serum HSP27 and HSP70 levels between the groups. HSP90 and ADMA levels increased significantly, whereas L-arginine levels decreased significantly in patients with OSAS, both with and without CV risk factors, compared with controls, but were not different among the subgroups. In all patients with OSAS, serum HSP70 levels were positively correlated with a percent time with saturation<90% (r=.349, P=.027). Serum L-arginine levels were negatively correlated with desaturation number (r=-.360, P=.022) and apnea-hypopnea index (r=-.354, P=.025) and positively correlated with mean oxygen saturation (r=.328, P=.039). Serum levels of HSP90 and ADMA increased, whereas those of L-arginine decreased in patients with OSAS regardless of CV risk factors. These findings indicate the presence of oxidative stress and endothelial dysfunction in patients with OSAS. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  9. EFFECT OF RENAL SHOCK WAVE LITHOTRIPSY ON THE DEVELOPMENT OF METABOLIC SYNDROME IN A JUVENILE SWINE MODEL: A PILOT STUDY

    PubMed Central

    Handa, Rajash K.; Liu, Ziyue; Connors, Bret A.; Evan, Andrew P.; Lingeman, James E.; Basile, David P.; Tune, Johnathan D.

    2014-01-01

    Purpose A pilot study was conducted to assess whether renal shock wave lithotripsy (SWL) influences the onset and severity of metabolic syndrome (MetS). Materials and Methods Three-month-old juvenile female Ossabaw miniature pigs were treated with SWL (2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter; n=2) or sham-SWL (no SWs; n=2). SWs were targeted to the upper pole of the left kidney so as to model treatment that would also expose the pancreatic tail to SWs. Pigs were then instrumented for direct measurement of arterial blood pressure via an implanted radiotelemetry device, and later fed a hypercaloric atherogenic diet for ~7 months. The development of MetS was assessed from intravenous glucose tolerance tests (IVGTTs). Results The progression and severity of MetS was similar in the sham-treated and SWL-treated groups. The only exception was with respect to arterial blood pressure, which remained relatively constant in the sham-treated pigs but began to rise at ~2 months towards hypertensive levels in SW-treated pigs. Metabolic data from both groups were pooled to provide a more complete assessment of the development and progression of MetS in this juvenile pig model. IVGTTs revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months. Conclusions These preliminary results suggest that renal SWL is not a risk factor for worsening of glucose tolerance or the onset of diabetes mellitus, but does appear to be a risk factor for early onset hypertension in MetS. PMID:25245490

  10. High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock

    PubMed Central

    Cornejo, Rodrigo; Romero, Carlos; Ugalde, Diego; Bustos, Patricio; Diaz, Gonzalo; Galvez, Ricardo; Llanos, Osvaldo; Tobar, Eduardo

    2014-01-01

    We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team. PMID:25028955

  11. Persistence survey of Toxic Shock Syndrome toxin-1 producing Staphylococcus aureus and serum antibodies to this superantigen in five groups of menstruating women

    PubMed Central

    2010-01-01

    Background Menstrual Toxic Shock Syndrome (mTSS) is thought to be associated with the vaginal colonization with specific strains of Staphylococcus aureus TSST-1 in women who lack sufficient antibody titers to this toxin. There are no published studies that examine the seroconversion in women with various colonization patterns of this organism. Thus, the aim of this study was to evaluate the persistence of Staphylococcus aureus colonization at three body sites (vagina, nares, and anus) and serum antibody to toxic shock syndrome toxin-producing Staphylococcus aureus among a small group of healthy, menstruating women evaluated previously in a larger study. Methods One year after the completion of that study, 311 subjects were recalled into 5 groups. Four samples were obtained from each participant at several visits over an additional 6-11 month period: 1) an anterior nares swab; 2) an anal swab; 3) a vagina swab; and 4) a blood sample. Gram stain, a catalase test, and a rapid S. aureus-specific latex agglutination test were performed to phenotypically identify S. aureus from sample swabs. A competitive ELISA was used to quantify TSST-1 production. Human TSST-1 IgG antibodies were determined from the blood samples using a sandwich ELISA method. Results We found only 41% of toxigenic S. aureus and 35.5% of non-toxigenic nasal carriage could be classified as persistent. None of the toxigenic S. aureus vaginal or anal carriage could be classified as persistent. Despite the low persistence of S. aureus colonization, subjects colonized with a toxigenic strain were found to display distributions of antibody titers skewed toward higher titers than other subjects. Seven percent (5/75) of subjects became seropositive during recall, but none experienced toxic shock syndrome-like symptoms. Conclusions Nasal carriage of S. aureus appears to be persistent and the best predicator of subsequent colonization, whereas vaginal and anal carriage appear to be more transient. From these

  12. [Heart failure and anaphylactic shock. A report of two cases].

    PubMed

    Verdier, F; Petitjeans, F; Griffet, V; Caignault, J-R; Guerard, S

    2011-04-01

    Anaphylactic shock can sometimes take the appearance of heart failure, in relation to an acute coronary syndrome, even with normal coronary arteries, that we illustrate by two observations. We firstly report the case of an anaphylactic shock caused by succinylcholine, after anesthesia induction for inguinal hernia surgery in a 50-year-old man with cardiovascular risks, who presented with ventricular fibrillation followed by a cardiac arrest. An acute and severe anterior coronary syndrome was suspected and treated with thrombolysis. Then the electrocardiogram normalized, as well as the left ventricular function. No significant coronary stenosis was retrospectively revealed by coronarography, and a severe coronary vasospasm induced by the anaphylactic reaction was confirmed. We also describe the case of an anaphylactoid shock caused by cisatracurium infusion, that occurred at the beginning of an adnexectomy in a 55-year-old woman without any particular history. She presented with a cardiogenic shock after intravenous administration of epinephrine. The echocardiograpghic evaluation pointed out an aspect of stress-induced cardiomyopathy, and the coronarography showed normal coronary arteries. The left ventricular dysfunction completely normalized, strongly suggesting the diagnosis of Takotsubo-like syndrome after the anaphylactic shock and its treatment. Both of these cases point out the major interest of cardiologic and allergic evaluation in case of heart failure during general anesthesia. Coronary vasospasm and stress-induced cardiomyopathy are two pathologies that may be observed during anaphylactic shock, and their diagnosis should be considered after elimination of coronary thrombosis. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  13. A community outbreak of haemolytic-uraemic syndrome in children occurring in a large area of northern Italy over a period of several months.

    PubMed Central

    Tozzi, A. E.; Niccolini, A.; Caprioli, A.; Luzzi, I.; Montini, G.; Zacchello, G.; Gianviti, A.; Principato, F.; Rizzoni, G.

    1994-01-01

    From March to October 1993, 15 cases of haemolytic-uraemic syndrome (HUS) in children were detected in a large area of northern Italy, where only 8 cases had occurred in the previous 5 years. Analysis of stool and serum specimens obtained from 14 cases showed evidence of Verotoxin-producing Escherichia coli (VTEC) infection in 13. Serum antibodies to the E. coli O157 lipopolysaccharide (LPS) were found in 8 patients and to the O111 LPS in 2. An O86 VTEC was isolated from another patient. Fourteen children needed dialysis, and 1 died. No obvious epidemiologic link was observed among cases, most of whom lived in small townships. A case-control study did not show an association between HUS and food or exposure to cattle, but suggested an association with contact with chicken coops (OR = 6.5, 95% C.I. 1.2-34.9). However, VTEC were not isolated from stool samples obtained from the chicken coops involved. The risk factors for VTEC infection related to living in rural settlements, including the exposure to live poultry, should be considered in outbreak investigations. PMID:7925660

  14. Acute Radiation Hypotension in the Rabbit: a Model for the Human Radiation Shock Syndrome.

    NASA Astrophysics Data System (ADS)

    Makale, Milan Theodore

    This study has shown that total body irradiation (TBI) of immature (40 to 100 day old) rabbits leads to an acute fall in mean arterial pressure (MAP) 30 to 90 minutes after exposure, which takes no more than about three minutes, and often results in pressures which are less than 50% of the lowest pre-exposure MAP. This is termed acute cardiovascular collapse (ACC). ACC is often accompanied by ECG T-wave elevation, a sharp rise in ear temperature, labored breathing, pupillary constriction, bladder emptying, and loss of abdominal muscle tone. About 73% of 40 to 100 day rabbits exhibit ACC; the others and most older rabbits display gradual pressure reductions (deliberate hypotension) which may be profound, and which may be accompanied by the same changes associated with ACC. ACC and deliberate hypotension occurred in rabbits cannulated in the dorsal aorta, and in non-operated animals. The decline in MAP for all 40 to 100 day cannulated rabbits (deliberate and ACC responders) is 55.4%. The experiments described below only involved 40 to 100 day cannulated TBI rabbits. Heart region irradiation resulted in an average MAP decline of 29.1%, with 1/15 rabbits showing ACC. Heart shielding during TBI reduced the decline in MAP to 19%, with 1/10 rabbits experiencing ACC. These results imply that the heart region, which includes the heart, part of the lungs, neural receptors, roots of the systemic vessels, and the blood, is a sensitive target. Bilateral vagotomy reduced the decline in MAP to 24.9%, and abolished ACC. Atropine (6 mg/kg) reduced the frequency of ACC to 26%, and the decline in MAP to 41.4%. In 11/13 rabbits the voltage generated by left vagal transmission rose after TBI. The vagi appear to participate in radiation hypotension. Heart shielding together with bilateral vagotomy reduced the decline in MAP to only 9.9%, with no ACC responders. The mean right ventricular pressure (MRVP) rose after TBI in 8/10 rabbits. In animals which displayed either ACC or steep

  15. Inhaled nitric oxide in acute respiratory distress syndrome with and without septic shock requiring norepinephrine administration: a dose–response study

    PubMed Central

    Mourgeon, Eric; Puybasset, Louis; Law-Koune, Jean-Dominique; Lu, Qin; Abdennour, Lamine; Gallart, Lluis; Malassine, Patrick; Rao, GS Umamaheswara; Cluzel, Philippe; Bennani, Abdelhai; Coriat, Pierre; Rouby, Jean-Jacques

    1997-01-01

    Background: The aim of this prospective study was to assess whether the presence of septic shock could influence the dose response to inhaled nitric oxide (NO) in NO-responding patients with adult respiratory distress syndrome (ARDS). Results: Eight patients with ARDS and without septic shock (PaO2 = 95 ± 16 mmHg, PEEP = 0, FiO2 = 1.0), and eight patients with ARDS and septic shock (PaO2 = 88 ± 11 mmHg, PEEP = 0, FiO2 = 1.0) receiving exclusively norepinephrine were studied. All responded to 15 ppm inhaled NO with an increase in PaO2 of at least 40 mmHg, at FiO2 1.0 and PEEP 10 cmH2O. Inspiratory intratracheal NO concentrations were recorded continuously using a fast response time chemiluminescence apparatus. Seven inspiratory NO concentrations were randomly administered: 0.15, 0.45, 1.5, 4.5, 15, 45 and 150 ppm. In both groups, NO induced a dose-dependent decrease in mean pulmonary artery pressure (MPAP), pulmonary vascular resistance index (PVRI), and venous admixture (QVA/QT), and a dose-dependent increase in PaO2/FiO2 (P ≤ 0.012). Dose-response of MPAP and PVRI were similar in both groups with a plateau effect at 4.5 ppm. Dose-response of PaO2/FiO2 was influenced by the presence of septic shock. No plateau effect was observed in patients with septic shock and PaO2/FiO2 increased by 173 ± 37% at 150 ppm. In patients without septic shock, an 82 ± 26% increase in PaO2/FiO2 was observed with a plateau effect obtained at 15 ppm. In both groups, dose-response curves demonstrated a marked interindividual variability and in five patients pulmonary vascular effect and improvement in arterial oxygenation were dissociated. Conclusion: For similar NOinduced decreases in MPAP and PVRI in both groups, the increase in arterial oxygenation was more marked in patients with septic shock. PMID:11056694

  16. Interferon Gamma-Dependent Intestinal Pathology Contributes to the Lethality in Bacterial Superantigen-Induced Toxic Shock Syndrome

    PubMed Central

    Tilahun, Ashenafi Y.; Holz, Marah; Wu, Tsung-Teh; David, Chella S.; Rajagopalan, Govindarajan

    2011-01-01

    Toxic shock syndrome (TSS) caused by the superantigen exotoxins of Staphylococcus aureus and Streptococcus pyogenes is characterized by robust T cell activation, profound elevation in systemic levels of multiple cytokines, including interferon-γ (IFN-γ), followed by multiple organ dysfunction and often death. As IFN-γ possesses pro- as well as anti-inflammatory properties, we delineated its role in the pathogenesis of TSS. Antibody-mediated in vivo neutralization of IFN-γ or targeted disruption of IFN-γ gene conferred significant protection from lethal TSS in HLA-DR3 transgenic mice. Following systemic high dose SEB challenge, whereas the HLA-DR3.IFN-γ+/+ mice became sick and succumbed to TSS, HLA-DR3.IFN-γ−/− mice appeared healthy and were significantly protected from SEB-induced lethality. SEB-induced systemic cytokine storm was significantly blunted in HLA-DR3.IFN-γ−/− transgenic mice. Serum concentrations of several cytokines (IL-4, IL-10, IL-12p40 and IL-17) and chemokines (KC, rantes, eotaxin and MCP-1) were significantly lower in HLA-DR3.IFN-γ−/− transgenic mice. However, SEB-induced T cell expansion in the spleens was unaffected and expansion of SEB-reactive TCR Vβ8+ CD4+ and CD8+ T cells was even more pronounced in HLA-DR3.IFN-γ−/− transgenic mice when compared to HLA-DR3.IFN-γ+/+ mice. A systematic histopathological examination of several vital organs revealed that both HLA-DR3.IFN-γ+/+ and HLA-DR3.IFN-γ−/− transgenic mice displayed comparable severe inflammatory changes in lungs, and liver during TSS. Remarkably, whereas the small intestines from HLA-DR3.IFN-γ+/+ transgenic mice displayed significant pathological changes during TSS, the architecture of small intestines in HLA-DR3.IFN-γ−/− transgenic mice was preserved. In concordance with these histopathological changes, the gut permeability to macromolecules was dramatically increased in HLA-DR3.IFN-γ+/+ but not HLA-DR3.IFN-γ−/− mice during TSS. Overall, IFN

  17. Temperature variability analysis using wavelets and multiscale entropy in patients with systemic inflammatory response syndrome, sepsis, and septic shock

    PubMed Central

    2012-01-01

    Background Even though temperature is a continuous quantitative variable, its measurement has been considered a snapshot of a process, indicating whether a patient is febrile or afebrile. Recently, other diagnostic techniques have been proposed for the association between different properties of the temperature curve with severity of illness in the Intensive Care Unit (ICU), based on complexity analysis of continuously monitored body temperature. In this study, we tried to assess temperature complexity in patients with systemic inflammation during a suspected ICU-acquired infection, by using wavelets transformation and multiscale entropy of temperature signals, in a cohort of mixed critically ill patients. Methods Twenty-two patients were enrolled in the study. In five, systemic inflammatory response syndrome (SIRS, group 1) developed, 10 had sepsis (group 2), and seven had septic shock (group 3). All temperature curves were studied during the first 24 hours of an inflammatory state. A wavelet transformation was applied, decomposing the signal in different frequency components (scales) that have been found to reflect neurogenic and metabolic inputs on temperature oscillations. Wavelet energy and entropy per different scales associated with complexity in specific frequency bands and multiscale entropy of the whole signal were calculated. Moreover, a clustering technique and a linear discriminant analysis (LDA) were applied for permitting pattern recognition in data sets and assessing diagnostic accuracy of different wavelet features among the three classes of patients. Results Statistically significant differences were found in wavelet entropy between patients with SIRS and groups 2 and 3, and in specific ultradian bands between SIRS and group 3, with decreased entropy in sepsis. Cluster analysis using wavelet features in specific bands revealed concrete clusters closely related with the groups in focus. LDA after wrapper-based feature selection was able to classify

  18. The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes

    PubMed Central

    Kounis, N. G.; Mazarakis, A.; Almpanis, G.; Gkouias, K.; Kounis, G. N.; Tsigkas, G.

    2014-01-01

    Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits. PMID:25097390

  19. The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes.

    PubMed

    Kounis, N G; Mazarakis, A; Almpanis, G; Gkouias, K; Kounis, G N; Tsigkas, G

    2014-07-01

    Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.

  20. Particle Acceleration in Shock-Shock Interaction

    NASA Astrophysics Data System (ADS)

    Nakanotani, Masaru; Matsukiyo, Shuichi; Hada, Tohru

    2015-04-01

    Collisionless shock waves play a crucial role in producing high energy particles. One of the most plausible acceleration mechanisms is the first order Fermi acceleration in which non-thermal particles statistically gain energy while scattered by MHD turbulence both upstream and downstream of a shock. Indeed, X-ray emission from energetic particles accelerated at supernova remnant shocks is often observed [e.g., Uchiyama et al., 2007]. Most of the previous studies on shock acceleration assume the presence of a single shock. In space, however, two shocks frequently come close to or even collide with each other. For instance, it is observed that a CME (coronal mass ejection) driven shock collides with the earth's bow shock [Hietala et al., 2011], or interplanetary shocks pass through the heliospheric termination shock [Lu et al., 1999]. Colliding shocks are observed also in high power laser experiments [Morita et al., 2013]. It is expected that shock-shock interactions efficiently produce high energy particles. A previous work using hybrid simulation [Cargill et al., 1986] reports efficient ion acceleration when supercritical two shocks collide. In the hybrid simulation, however, the electron dynamics cannot be resolved so that electron acceleration cannot be discussed in principle. Here, we perform one-dimensional full Particle-in-Cell (PIC) simulations to examine colliding two symmetric oblique shocks and the associated electron acceleration. In particular, the following three points are discussed in detail. 1. Energetic electrons are observed upstream of the two shocks before their collision. These energetic electrons are efficiently accelerated through multiple reflections at the two shocks (Fermi acceleration). 2. The reflected electrons excite large amplitude upstream waves. Electron beam cyclotron instability [Hasegawa, 1975] and electron fire hose instability [Li et al., 2000] appear to occur. 3. The large amplitude waves can scatters energetic electrons in

  1. Mycobacterium tuberculosis septic shock.

    PubMed

    Kethireddy, Shravan; Light, R Bruce; Mirzanejad, Yazdan; Maki, Dennis; Arabi, Yaseen; Lapinsky, Stephen; Simon, David; Kumar, Aseem; Parrillo, Joseph E; Kumar, Anand

    2013-08-01

    Septic shock due to Mycobacterium tuberculosis (MTB) is an uncommon but well-recognized clinical syndrome. The objective of this study was to describe the unique clinical characteristics, epidemiologic risk factors, and covariates of survival of patients with MTB septic shock in comparison with other bacterial septic shock. A retrospective nested cohort study was conducted of patients given a diagnosis of MTB septic shock derived from a trinational, 8,670-patient database of patients with septic shock between 1996 and 2007. In the database, 53 patients had been given a diagnosis of MTB shock compared with 5,419 with septic shock associated with isolation of more common bacterial pathogens. Patients with MTB and other bacterial septic shock had in-hospital mortality rates of 79.2% and 49.7%, respectively (P < .0001). Of the cases of MTB shock, all but five patients had recognized respiratory tract involvement. Fifty-five percent of patients (29 of 53) were documented (by direct culture or stain) as having disseminated extrapulmonary involvement. Inappropriate and appropriate initial empirical therapy was delivered in 28 patients (52.8%) and 25 patients (47.2%); survival was 7.1% and 36.0%, respectively (P = .0114). Ten patients (18.9%) did not receive anti-MTB therapy; all died. The median time to appropriate antimicrobial therapy for MTB septic shock was 31.0 h (interquartile range, 18.9-71.9 h). Only 11 patients received anti-MTB therapy within 24 h of documentation of hypotension; six of these (54.5%) survived. Only one of 21 patients (4.8%) who started anti-MTB therapy after 24 h survived (P = .0003 vs < 24 h). Survival differences between these time intervals are not significantly different from those seen with bacterial septic shock due to more common bacterial pathogens. MTB septic shock behaves similarly to bacterial septic shock. As with bacterial septic shock, early appropriate antimicrobial therapy appears to improve mortality.

  2. Increased Neutrophil Gelatinase-Associated Lipocalin is Associated with Mortality and Multiple Organ Dysfunction Syndrome in Severe Sepsis and Septic Shock.

    PubMed

    Wang, Biao; Chen, Gang; Zhang, Jun; Xue, Jiping; Cao, Yifei; Wu, Yunfu

    2015-09-01

    This study examines the clinical utility of increased neutrophil gelatinase-associated lipocalin (NGAL) as an indicator of mortality and multiple organ dysfunction syndrome (MODS) in severe sepsis and septic shock. We designed a prospective cohort study in an intensive care unit, and 123 patients with severe sepsis or septic shock were included. Data were used to determine a relationship between NGAL and the development of MODS and mortality. These associations were determined by the Mann-Whitney U test, log-rank test, Cox proportional hazards regression analyses, and plotting the receiver operating characteristic curve. Patients with high NGAL (75th percentile) had increased risk of mortality and MODS compared with patients with low NGAL (log-rank test, P < 0.05). There were 39 patients (32%) with mortality during follow-up at 12 months, 10 patients (8%) with MODS on day 1, and 37 patients (30%) on day 7. The area under the receiver operating characteristic curve showed that high NGAL could predict mortality (0.6385) during intensive care unit stay. After adjustment for confounding risk factors chosen by backward elimination by Cox regression analysis, high NGAL remained an independent predictor of mortality and MODS (hazard ratios, 2.128 [95% confidence interval, 1.078-4.203; P = 0.030] and 1.896 [95% confidence interval, 1.012-3.552; P = 0.046], respectively). High plasma NGAL independently predicts mortality and MODS in severe sepsis and septic shock.

  3. Successful rescue of an adult with refractory anaphylactic shock and abdominal compartment syndrome with venoarterial extracorporeal membrane oxygenation and bedside laparotomy.

    PubMed

    Weiss, Gregory Michael; Fandrick, Ashley D; Sidebotham, David

    2015-03-01

    The incidence of life-threatening anaphylactic reactions related to anesthesia is approximately 1 in 6000 anesthetics administered, and is associated with mortality as high as 5%. In such cases the use of extracorporeal membrane oxygenation (ECMO) in the setting of refractory shock following anaphylaxis may be life saving. Abdominal compartment syndrome (ACS) itself and in this case complicating ECMO support, is a potentially devastating complication of high-volume resuscitation. Decompressive laparotomy is the treatment of choice for ACS. We present a patient treated with venoarterial ECMO for refractory shock following anaphylaxis who developed ACS that was successfully treated with urgent decompressive laparotomy performed in the intensive care unit. This case report highlights the role of abdominal compartment syndrome as a rare but potentially fatal cause of low circuit flow in ECMO-supported patients and proposes a stepwise approach to decision making in this setting. Urgent decompressive laparotomy is potentially lifesaving in this circumstance, and should be urgently considered once other causes of low ECMO flow have been excluded. © The Author(s) 2014.

  4. Surfactants, Aromatic and Isoprenoid Compounds, and Fatty Acid Biosynthesis Inhibitors Suppress Staphylococcus aureus Production of Toxic Shock Syndrome Toxin 1▿

    PubMed Central

    McNamara, Peter J.; Syverson, Rae Ellen; Milligan-Myhre, Kathy; Frolova, Olga; Schroeder, Sarah; Kidder, Joshua; Hoang, Thanh; Proctor, Richard A.

    2009-01-01

    Menstrual toxic shock syndrome is a rare but potentially life-threatening illness manifest through the actions of Staphylococcus aureus toxic shock syndrome toxin 1 (TSST-1). Previous studies have shown that tampon additives can influence staphylococcal TSST-1 production. We report here on the TSST-1-suppressing activity of 34 compounds that are commonly used additives in the pharmaceutical, food, and perfume industries. Many of the tested chemicals had a minimal impact on the growth of S. aureus and yet were potent inhibitors of TSST-1 production. The TSST-1-reducing compounds included surfactants with an ether, amide, or amine linkage to their fatty acid moiety (e.g., myreth-3-myristate, Laureth-3, disodium lauroamphodiacetate, disodium lauramido monoethanolamido, sodium lauriminodipropionic acid, and triethanolamine laureth sulfate); aromatic compounds (e.g. phenylethyl and benzyl alcohols); and several isoprenoids and related compounds (e.g., terpineol and menthol). The membrane-targeting and -altering effects of the TSST-1-suppressing compounds led us to assess the activity of molecules that are known to inhibit fatty acid biosynthesis (e.g., cerulenin, triclosan, and hexachlorophene). These compounds also reduced S. aureus TSST-1 production. This study suggests that more additives than previously recognized inhibit the production of TSST-1. PMID:19223628

  5. Effects of blood and different media on the production of toxic shock syndrome toxin 1 by Staphylococcus aureus in the tampon sac method.

    PubMed

    Reiser, R F; Denzin, L K; Bergdoll, M S

    1988-12-01

    The use of three different agar concentrations in the tampon sac method resulted in slightly higher fluid uptake by the tampons when a 0.5% agar concentration was used. However, there was essentially no difference in the total amount of toxin produced. The largest amount of toxic shock syndrome toxin 1 was produced with brain heart infusion agar, followed closely by 3% NZ-amine NAK-1% yeast extract medium. The addition of plasma and serum to the inoculum resulted in increases (62 and 73%, respectively) in toxin production. The addition of whole blood to the inoculum had a variable effect on toxin production, with an increase in the amount of toxin produced with some tampons and not with others. Over fivefold differences in the amount of toxin produced were obtained when duplicate experiments were done on successive days, whereas the differences were less than twofold for experiments done on the same day. This was related to the effect of small changes in the parameters on toxic shock syndrome toxin 1 production.

  6. Characterization of SEMA3A-Encoded Semaphorin as a Naturally Occurring Kv4.3 Protein Inhibitor and its Contribution to Brugada Syndrome

    PubMed Central

    Boczek, Nicole J.; Ye, Dan; Johnson, Eric K.; Wang, Wei; Crotti, Lia; Tester, David J.; Dagradi, Federica; Mizusawa, Yuka; Torchio, Margherita; Alders, Marielle; Giudicessi, John R.; Wilde, Arthur A.; Schwartz, Peter J.; Nerbonne, Jeanne M.; Ackerman, Michael J.

    2016-01-01

    Rational SEMA3A-encoded semaphorin is a chemorepellent that disrupts neural patterning in the nervous and cardiac systems. In addition, SEMA3A has an amino acid motif that is analogous to hanatoxin, an inhibitor of voltage-gated K+ channels. SEMA3A knockout mice exhibit an abnormal ECG pattern and are prone to ventricular arrhythmias and sudden cardiac death. Objective To determine whether SEMA3A is a naturally occurring protein inhibitor of Kv4.3 (Ito) channels and its potential contribution to Brugada syndrome (BrS). Methods and Results Kv4.3, Nav1.5, Cav1.2, or Kv4.2 were co-expressed or perfused with SEMA3A in HEK293 cells and electrophysiological properties were examined via whole-cell patch clamp technique. SEMA3A selectively altered Kv4.3 by significantly reducing peak current density without perturbing Kv4.3 cell-surface protein expression. SEMA3A also reduced Ito current density in cardiomyocytes derived from human induced pluripotent stem cells. Disruption of a putative toxin binding domain on Kv4.3 was used to assess physical interactions between SEMA3A and Kv4.3. These findings in combination with co-immunoprecipitations of SEMA3A and Kv4.3 revealed a potential direct binding interaction between these proteins. Comprehensive mutational analysis of SEMA3A was performed on 198 unrelated SCN5A-genotype negative patients with BrS and two rare SEMA3A missense mutations were identified. The SEMA3A mutations disrupted SEMA3A’s ability to inhibit Kv4.3 channels, resulting in a significant gain of Kv4.3 current compared to WT-SEMA3A. Conclusions This study is the first to demonstrate semaphorin3A as a naturally occurring protein that selectively inhibits Kv4.3 and SEMA3A as a possible BrS-susceptibility gene through a Kv4.3 gain-of-function mechanism. PMID:24963029

  7. Toxic shock syndrome

    MedlinePlus

    ... Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 196. Review Date 4/12/2016 Updated by: Jatin M. Vyas, MD, PhD, Assistant ...

  8. Toxic Shock Syndrome

    MedlinePlus

    ... Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight ... Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight ...

  9. Thyroid hormone receptors are down-regulated in skeletal muscle of patients with non-thyroidal illness syndrome secondary to non-septic shock.

    PubMed

    Lado-Abeal, J; Romero, A; Castro-Piedras, I; Rodriguez-Perez, A; Alvarez-Escudero, J

    2010-11-01

    Non-thyroidal illness syndrome (NTIS) is related to changes in thyroid hormone (TH) physiology. Skeletal muscle (SM) plays a major role in metabolism, and TH regulates SM phenotype and metabolism. We aimed to characterize the SM of non-septic shock NTIS patients in terms of: i) expression of genes and proteins involved in TH metabolism and actions; and ii) NFKB's pathway activation, a responsible factor for some of the phenotypic changes in NTIS. We also investigated whether the patient's serum can induce in vitro the effects observed in vivo. Serum samples and SM biopsies from 14 patients with non-septic shock NTIS and 11 controls. Gene and protein expression and NFKB1 activation were analyzed by quantitative PCR and immunoblotting. Human SM cell (HSkMC) cultures to investigate the effects of patient's serum on TH action mediators. Patients with non-septic shock NTIS showed higher levels of pro-inflammatory cytokines than controls. Expression of TRβ (THRB), TRα1 (THRA), and retinoid X receptor γ (RXRG) was decreased in NTIS patients. RXRA gene expression was higher, but its protein was lower in NTIS than controls, suggesting the existence of a post-transcriptional mechanism that down-regulates protein levels. NFKB1 pathway activation was not different between NTIS and control patients. HSkMC incubated with patient's serum increased TH receptor and RXRG gene expression after 48  h. Patients with non-septic shock NTIS showed decreased expression of TH receptors and RXRs, which were not related to increased activation of the NFKB1 pathway. These findings could not be replicated in cultures of HSkMCs incubated in the patient's serum.

  10. Microstructures of shocked quartz

    SciTech Connect

    Gratz, A.J.; Nellis, W.J.

    1991-12-01

    Shock recovery experiments show three phases in shocked single-crystal quartz: melt-glass in a thin network connecting quartz crystallites containing transformation lamellae of diapletic glass. Both melting and solid-state amorphization occur, but in separate regions of the sample. These results are consistent with real-time measurements and suggest that the high-pressure of shocked quartz is six-coordinated glass. Stishovite probably is not synthesized in more than trace amounts along the Hugoniot.

  11. Ion acceleration and its effect in shock-shock interaction

    NASA Astrophysics Data System (ADS)

    Nakanotani, M.; Matsukiyo, S.; Hada, T.; Mazelle, C. X.

    2016-12-01

    In space it often occurs that two collisionless shocks hit each other. In the near Earth environment it was actually observed in-situ by Hietala et al. [2011] that an interplanetary shock collides with the Earth's bow shock. They also observed energetic ions which may be accelerated through multiple interactions with the two approaching shocks. On the other hand, self-consistent numerical simulation of such a colliding shock system has been seldom performed so far. Almost the only example is given by Cargill et al. [1986, 1991] who reproduced a head-on collision of two shocks by using one-dimensional hybrid simulations.In this study a one-dimensional full particle-in-cell simulation of a head-on colliding two shock system is performed. We previously confirmed that electrons are strongly accelerated through multiply reflected by the approaching two shocks but ions are not when the two shocks are quasi-perpendicular. Here, the interaction of two quasi-parallel shocks is investigated. When a shock angle, the angle between upstream magnetic field and shock normal, is 30° (and 150°), not only some upstream electrons but also some upstream ions are reflected at the two shocks. Some of the reflected ions multiply interact with the shocks and are accelerated to relativistic energy, even when the two shocks are well separated. During their interaction with each shock, they gain energy through the so-called trapped ion acceleration mechanism [Sugiyama and Terasawa, 1999]. When the distance between the two shocks is comparable to the gyro radii of the energetic ions, they are further accelerated through the similar process previously seen in the two quasi-perpendicular shock interaction. The upstream energetic ions result in strong enhancement of local pressure which is higher than the pressure downstream. Influence of such a strong modification of the approaching shocks in the shock-shock interaction will also be discussed.

  12. Physics of collisionless shocks: theory and simulation

    NASA Astrophysics Data System (ADS)

    Stockem Novo, A.; Bret, A.; Fonseca, R. A.; Silva, L. O.

    2016-01-01

    Collisionless shocks occur in various fields of physics. In the context of space and astrophysics they have been investigated for many decades. However, a thorough understanding of shock formation and particle acceleration is still missing. Collisionless shocks can be distinguished into electromagnetic and electrostatic shocks. Electromagnetic shocks are of importance mainly in astrophysical environments and they are mediated by the Weibel or filamentation instability. In such shocks, charged particles gain energy by diffusive shock acceleration. Electrostatic shocks are characterized by a strong electrostatic field, which leads to electron trapping. Ions are accelerated by reflection from the electrostatic potential. Shock formation and particle acceleration will be discussed in theory and simulations.

  13. Alpha tryptase allele of Tryptase 1 (TPSAB1) gene associated with Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) in Vietnam and Philippines.

    PubMed

    Velasquez, Clara Vasquez; Roman, Arthur Dessi; Lan, Nguyen Thi Phuong; Huy, Nguyen Tien; Mercado, Edelwisa Segubre; Espino, Fe Esperanza; Perez, Ma Lucila M; Huong, Vu Thi Que; Thuy, Tran Thi; Tham, Vo Dinh; Nga, Cao Thi Phi; Ha, Tran Thi Ngoc; Bilar, Josie M; Bajaro, Jemimah Dawn P; Baello, Benilda Q; Kikuchi, Mihoko; Yasunami, Michio; Morita, Kouichi; Watanabe, Naohiro; Karbwang, Juntra; Hirayama, Kenji

    2015-05-01

    We previously reported, significantly higher levels of Chymase and Tryptase in early stage plasma of DSS patients prior to the occurrence of shock suggesting a possible role of mast cells in dengue pathogenesis. To further investigate, we analyzed CMA1 promoter SNP (rs1800875) and TPSAB1 gene alleles, which encode the Human Chymase and α- and β- tryptase 1 enzymes respectively, for susceptibility to Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) in patients from hospitals in Vietnam (Ho Chi Minh City and Vinh Long) and the Philippines. While the CMA1 promoter SNP (rs1800875) was not associated with DHF/DSS, the homozygous form of α-tryptase allele was associated with DSS patients in Vinh Long and the Philippines (OR=3.52, p<0.0001; OR=3.37, p<0.0001, respectively) and with DHF in Ho Chi Minh City (OR=2.54, p=0.0084). Also, a statistically significant association was observed when DHF and DSS were combined in Vinh Long (OR=1.5, p=0.034) and the Philippines (OR=2.36, p=0.0004); in Ho Chi Minh City when DHF and DSS were combine an association was observed, but it was not statistically significant (OR=1.5, p=0.0505). Therefore, the α-tryptase might have a possible effect on the susceptibility to severe form of Dengue infection. Copyright © 2015 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  14. Preliminary investigation of human serum albumin-Vβ inhibition on toxic shock syndrome induced by staphylococcus enterotoxin B in vitro and in vivo.

    PubMed

    Yuan, Qifeng; Li, Lin; Pian, Yaya; Hao, Huaijie; Zheng, Yuling; Zang, Yating; Jiang, Hua; Jiang, Yongqiang

    2016-04-01

    Staphylococcus enterotoxin B (SEB) is a superantigen that can induce massive activation of T cells with specific Vβ and inflammatory cytokine cascades, which mediate shock. To date, no SEB vaccine has been developed for preventing toxic shock syndrome (TSS). Here, we evaluated the therapeutic effect of a fusion protein human serum albumin-Vβ (HSA-Vβ) on TSS induced by SEB. Compared with Vβ, the preparation of HSA-Vβ was much easier to handle owing to its solubility. Affinity testing showed that HSA-Vβ had high affinity for SEB. In vitro results showed that HSA-Vβ could effectively inhibit interferon (IFN)-γ and tumor necrosis factor (TNF)-α secretion by human peripheral blood mononuclear cells. Moreover, in vivo, HSA-Vβ reduced IFN-γ and TNF-α levels in the serum and protected mice from SEB lethal challenge when administered simultaneously with SEB or 30 min after SEB. In summary, we simplified the preparation of Vβ by fusion with HSA, creating the HSA-Vβ protein, which effectively inhibited cytokine production and protected mice from lethal challenge with SEB. These data indicated that HSA-Vβ may represent a novel therapeutic strategy for the treatment of SEB-induced TSS.

  15. Secondary infection as a risk factor for dengue hemorrhagic fever/dengue shock syndrome: an historical perspective and role of antibody-dependent enhancement of infection.

    PubMed

    Guzman, Maria G; Alvarez, Mayling; Halstead, Scott B

    2013-07-01

    Today, dengue viruses are the most prevalent arthropod-borne viruses in the world. Since the 1960s, numerous reports have identified a second heterologous dengue virus (DENV) infection as a principal risk factor for severe dengue disease (dengue hemorrhagic fever/dengue shock syndrome, DHF/DSS). Modifiers of dengue disease response include the specific sequence of two DENV infections, the interval between infections, and contributions from the human host, such as age, ethnicity, chronic illnesses and genetic background. Antibody-dependent enhancement (ADE) of dengue virus infection has been proposed as the early mechanism underlying DHF/DSS. Dengue cross-reactive antibodies raised following a first dengue infection combine with a second infecting virus to form infectious immune complexes that enter Fc-receptor-bearing cells. This results in an increased number of infected cells and increased viral output per cell. At the late illness stage, high levels of cytokines, possibly the result of T cell elimination of infected cells, result in vascular permeability, leading to shock and death. This review is focused on the etiological role of secondary infections (SI) and mechanisms of ADE.

  16. Detection and quantitation of toxic shock syndrome toxin 1 in vitro and in vivo by noncompetitive enzyme-linked immunosorbent assay.

    PubMed Central

    Rosten, P M; Bartlett, K H; Chow, A W

    1987-01-01

    Toxic shock syndrome toxin 1 (TSST-1), an exotoxin produced by many Staphylococcus aureus strains, is implicated as the prime causal agent of toxic shock syndrome (TSS). A sensitive and specific noncompetitive enzyme-linked immunosorbent assay (ELISA) capable of detecting TSST-1 at concentrations from 0.5 to 16 ng/ml was developed. This assay did not detect other staphylococcal enterotoxins including A, B, C1, C2, C3, D, and E. Possible interactions with protein A were readily eliminated by pretreatment of test samples with 10% normal rabbit serum. The assay was adapted for rapid screening of TSST-1 production by S. aureus isolates in culture supernatants in vitro and for detection of TSST-1 in vaginal washings of TSS patients and healthy controls in vivo. All 35 S. aureus isolates confirmed to be TSST positive by Ouchterlony immunodiffusion and 59 of 60 isolates confirmed to be TSST-1 negative gave concordant results by ELISA. Interestingly, toxigenic S. aureus strains isolated from TSS patients quantitatively produced significantly more TSST-1 in vitro compared with toxigenic control strains (P less than 0.05, Mann-Whitney rank sum test). TSST-1 could be detected by ELISA in three of four vaginal washings collected within 3 days of hospitalization from three women with acute menstrual TSS, compared with 0 of 17 washings from nine TSS patients hospitalized longer than 3 days (P = 0.003, Fisher's exact test) and 1 of 15 washings from 14 healthy control women (P = 0.016). This noncompetitive ELISA should be particularly useful for rapid screening of TSST-1 production by S. aureus isolates, for the purification and biochemical characterization of TSST-1, and for human and animal studies of the pathogenesis of TSS. PMID:3818927

  17. Prevalence of Toxic Shock Syndrome Toxin 1-Producing Staphylococcus aureus and the Presence of Antibodies to This Superantigen in Menstruating Women

    PubMed Central

    Parsonnet, Jeffrey; Hansmann, Melanie A.; Delaney, Mary L.; Modern, Paul A.; DuBois, Andrea M.; Wieland-Alter, Wendy; Wissemann, Kimberly W.; Wild, John E.; Jones, Michaelle B.; Seymour, Jon L.; Onderdonk, Andrew B.

    2005-01-01

    Menstrual toxic shock syndrome (mTSS) is thought to be associated with colonization with toxic shock syndrome toxin 1 (TSST-1)-producing Staphylococcus aureus in women with insufficient antibody titers. mTSS has been associated with menstruation and tampon use, and although it is rare, the effects can be life threatening. It remains of interest because of the widespread use of tampons, reported to be about 70% of women in the United States, Canada, and much of Western Europe. This comprehensive study was designed to determine S. aureus colonization and TSST-1 serum antibody titers in 3,012 menstruating women in North America between the ages of 13 and 40, particularly among age and racial groups that could not be assessed reliably in previous small studies. One out of every four subjects was found to be colonized with S. aureus in at least one of three body sites (nose, vagina, or anus), with approximately 9% colonized vaginally. Eighty-five percent of subjects had antibody titers (≥1:32) to TSST-1, and the vast majority (81%) of teenaged subjects (13 to 18 years) had already developed antibody titers. Among carriers of toxigenic S. aureus, a significantly lower percentage of black women than of white or Hispanic women were found to have antibody titers (≥1:32) to TSST-1 (89% versus 98% and 100%). These findings demonstrate that the majority of teenagers have antibody titers (≥1:32) to TSST-1 and are presumed to be protected from mTSS. These findings also suggest that black women may be more susceptible to mTSS than previously thought. PMID:16145118

  18. Anaphylactic shock depends on PI3K and eNOS-derived NO

    PubMed Central

    Cauwels, Anje; Janssen, Ben; Buys, Emmanuel; Sips, Patrick; Brouckaert, Peter

    2006-01-01

    Anaphylactic shock is a sudden, life-threatening allergic reaction associated with severe hypotension. Platelet-activating factor (PAF) is implicated in the cardiovascular dysfunctions occurring in various shock syndromes, including anaphylaxis. Excessive production of the vasodilator NO causes inflammatory hypotension and shock, and it is generally accepted that transcriptionally regulated inducible iNOS is responsible for this. Nevertheless, the contribution of NO to PAF-induced shock or anaphylactic shock is still ambiguous. We studied PAF and anaphylactic shock in conscious mice. Surprisingly, hyperacute PAF shock depended entirely on NO, produced not by inducible iNOS, but by constitutive eNOS, rapidly activated via the PI3K pathway. Soluble guanylate cyclase (sGC) is generally regarded as the principal vasorelaxing mediator of NO. Nevertheless, although methylene blue partially prevented PAF shock, neither 1H-[1,2,4]oxadiazole[4,3-a]quinoxalin-1-one (ODQ) nor sGCα1 deficiency did. Also, in 2 different models of active systemic anaphylaxis, inhibition of NOS, PI3K, or Akt or eNOS deficiency provided complete protection. In contrast to the unsubstantiated paradigm that only excessive iNOS-derived NO underlies cardiovascular collapse in shock, our data strongly support the unexpected concept that eNOS-derived NO is the principal vasodilator in anaphylactic shock and define eNOS and/or PI3K or Akt as new potential targets for treating anaphylaxis. PMID:16886062

  19. [Historical vision of shock].

    PubMed

    Dosne Pasqualini, C

    1998-01-01

    The concept of shock and its close relationship with that of stress dates back to the experiments of Hans Selye initiated in 1936 at McGill University in Montreal, with whom I collaborated between 1939 and 1942. It was demonstrated that the General Adaptation Syndrome begins with an Alarm Reaction, which consists of a Stage of Shock and one of Counter-Shock, followed by a Stage of Adaptation and finally a Stage of Exhaustion. My Ph.D. thesis concluded that shock was due to an adrenal insufficiency postulating that active metabolic processes drain the body of certain essential compounds the lack of which causes shock. My interest in the role of the glucose metabolism in shock led me to work with Bernardo Houssay in 1942 at the Institute of Physiology of the University of Buenos Aires and in 1944 with C.N.H. Long at Yale University. There I developed a method for the induction of hemorrhagic shock in the guinea pig with 94% lethality; curiously, the administration of 200 mg of ascorbic acid prevented death. Upon my return to Buenos Aires, these results were confirmed and moreover, it was demonstrated that the administration of cortisone led to 40% survival of the animals while desoxycorticosterone had no effect. At the time, no explanation was available but to-day, half a century later, this Symposium should be able to explain the mechanisms leading to death by hemorrhagic shock.

  20. [The disguised face of blast injuries: shock waves].

    PubMed

    Ozer, M Tahir; Coşkun, Kağan; Oğünç, Gökhan I; Eryılmaz, Mehmet; Yiğit, Taner; Kozak, Orhan; Apaydın, Kanbi; Uzar, A Ihsan

    2010-09-01

    The increase in terrorist attacks has brought a profound and new knowledge of blast injuries. In order to improve our knowledge regarding the mechanisms of blast injuries, we analyzed the effects of shock waves. 100 g TNT and 1000 g C4 were detonated and recorded by high-speed camera. Blast wind, shock wave and shrapnel speeds were calculated, and final condition of the target was examined. A flash ball appeared first followed by the shock wave. Finally, blast wind occurred and shrapnel was distributed. The macroscopic structure of targets was not affected by the shock wave but was affected by shrapnel and blast wind. Shock waves created a transparent ballistic gel inside the target mat by changing its microscopic structure. The speed of the shock wave was 6482-7194 m/sn and shrapnel speed was 1420-1752 m/sn. Shock waves especially affect the air-filled organs and cause lung injury, acute respiratory distress syndrome, and intestinal and eardrum perforation. Blast wind destroys targets due to its high speed and high density. The main cause of mortality is shrapnel injury. The high temperature created by the explosion causes thermal injuries. Being informed of the mechanisms of blast injuries will assist in providing better treatment. Additionally, consideration of all mechanisms of blast injuries will facilitate lower mortality and morbidity rates.

  1. Induction by toxic-shock-syndrome toxin-1 of a circulating tumor necrosis factor-like substance in rabbits and of immunoreactive tumor necrosis factor and interleukin-1 from human mononuclear cells.

    PubMed

    Ikejima, T; Okusawa, S; van der Meer, J W; Dinarello, C A

    1988-11-01

    A shock-like syndrome was induced in rabbits by administering toxic-shock-syndrome toxin-1 (TSST-1); tumor necrosis factor (TNF)-like activity was detected in sera of rabbits 3.5 h after injection, as measured by cytotoxic effects on the tumorigenic L929 murine fibroblast cell line. Appearance of this activity in sera coincided with onset of significant shock-related hemodynamic changes. TSST-1 stimulated release of TNF-like material from rabbit mononuclear cells in culture. Human mononuclear cells also secreted a cytotoxic substance shown to be TNF by radioimmunoassay. Maximal TNF secretion was higher in human mononuclear cells stimulated with TSST-1 than in those stimulated with bacterial lipopolysaccharide. Lipopolysaccharide, however, was a more potent inducer of interleukin-1 alpha and interleukin-1 beta from the same cells than was TSST-1. Because TNF and interleukin-1 act synergistically during induction of a shock-like state, these results suggest that part of the TSST-1-induced shock is due to production of interleukin-1 and TNF.

  2. Electron Acceleration in Shock-Shock Interaction: Simulations and Observations

    NASA Astrophysics Data System (ADS)

    Nakanotani, M.; Matsukiyo, S.; Mazelle, C. X.; Hada, T.

    2015-12-01

    Collisionless shock waves play a crucial role in producing high energy particles (cosmic rays) in space. While most of the past studies about particle acceleration assume the presence of a single shock, in space two shocks frequently come close to or even collide with each other. Hietala et al. [2011] observed the collision of an interplanetary shock and the earth's bow shock and the associated acceleration of energetic ions. The kinetic natures of a shock-shock collision has not been well understood. Only the work done by using hybrid simulation was reported by Cargill et al. [1986], in which they focus on a collision of two supercritical shocks and the resultant ion acceleration. We expect similarly that electron acceleration can also occur in shock-shock collision. To investigate the electron acceleration process in a shock-shock collision, we perform one-dimensional full particle-in-cell (PIC) simulations. In the simulation energetic electrons are observed between the two approaching shocks before colliding. These energetic electrons are efficiently accelerated through multiple reflections at the two shocks (Fermi acceleration). The reflected electrons create a temperature anisotropy and excite large amplitude waves upstream via the electron fire hose instability. The large amplitude waves can scatter the energetic electrons in pitch angle so that some of them gain large pitch angles and are easily reflected when they encounter the shocks subsequently. The reflected electrons can sustain, or probably even strengthen, them. We further discuss observational results of an interaction of interplanetary shocks and the earth's bow shock by examining mainly Cluster data. We focus on whether or not electrons are accelerated in the shock-shock interaction.

  3. Understanding hypovolaemic, cardiogenic and septic shock.

    PubMed

    Garretson, Sharon; Malberti, Shelly

    Shock is a complex physiological syndrome. If it is not detected and treated promptly, it can lead to death. This article reviews and summarises the latest findings, treatment and nursing and medical interventions for three of the most common forms of shock, namely, hypovolaemic, cardiogenic and septic shock.

  4. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

    PubMed Central

    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-01-01

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect. PMID:27910920

  5. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial.

    PubMed

    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-12-02

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

  6. Characterisation of the Bacterial and Fungal Communities Associated with Different Lesion Sizes of Dark Spot Syndrome Occurring in the Coral Stephanocoenia intersepta

    PubMed Central

    Sweet, Michael; Burn, Deborah; Croquer, Aldo; Leary, Peter

    2013-01-01

    The number and prevalence of coral diseases/syndromes are increasing worldwide. Dark Spot Syndrome (DSS) afflicts numerous coral species and is widespread throughout the Caribbean, yet there are no known causal agents. In this study we aimed to characterise the microbial communities (bacteria and fungi) associated with DSS lesions affecting the coral Stephanocoenia intersepta using nonculture molecular techniques. Bacterial diversity of healthy tissues (H), those in advance of the lesion interface (apparently healthy AH), and three sizes of disease lesions (small, medium, and large) varied significantly (ANOSIM R  = 0.052 p<0.001), apart from the medium and large lesions, which were similar in their community profile. Four bacteria fitted into the pattern expected from potential pathogens; namely absent from H, increasing in abundance within AH, and dominant in the lesions themselves. These included ribotypes related to Corynebacterium (KC190237), Acinetobacter (KC190251), Parvularculaceae (KC19027), and Oscillatoria (KC190271). Furthermore, two Vibrio species, a genus including many proposed coral pathogens, dominated the disease lesion and were absent from H and AH tissues, making them candidates as potential pathogens for DSS. In contrast, other members of bacteria from the same genus, such as V. harveyii were present throughout all sample types, supporting previous studies where potential coral pathogens exist in healthy tissues. Fungal diversity varied significantly as well, however the main difference between diseased and healthy tissues was the dominance of one ribotype, closely related to the plant pathogen, Rhytisma acerinum, a known causal agent of tar spot on tree leaves. As the corals’ symbiotic algae have been shown to turn to a darker pigmented state in DSS (giving rise to the syndromes name), the two most likely pathogens are R. acerinum and the bacterium Oscillatoria, which has been identified as the causal agent of the colouration in Black

  7. When shock waves collide

    SciTech Connect

    Martinez, D.; Hartigan, P.; Frank, A.; Hansen, E.; Yirak, K.; Liao, A. S.; Graham, P.; Foster, J.; Wilde, B.; Blue, B.; Rosen, P.; Farley, D.; Paguio, R.

    2016-06-01

    Supersonic outflows from objects as varied as stellar jets, massive stars, and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures, and therefore a higher-excitation spectrum than does an oblique shock. In this paper, we summarize the results of a series of numerical simulations and laboratory experiments designed to quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and subcritical angles, larger ones persist in these situations and can regrow if the intersection angle changes to become more favorable. Furthermore, the experimental and numerical results show that although Mach stems occur only over a limited range of intersection angles and size scales, within these ranges they are relatively robust, and hence are a viable explanation for variable bright knots observed in Hubble Space Telescope images at the intersections of some bow shocks in stellar jets.

  8. When Shock Waves Collide

    NASA Astrophysics Data System (ADS)

    Hartigan, P.; Foster, J.; Frank, A.; Hansen, E.; Yirak, K.; Liao, A. S.; Graham, P.; Wilde, B.; Blue, B.; Martinez, D.; Rosen, P.; Farley, D.; Paguio, R.

    2016-06-01

    Supersonic outflows from objects as varied as stellar jets, massive stars, and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures, and therefore a higher-excitation spectrum than does an oblique shock. In this paper, we summarize the results of a series of numerical simulations and laboratory experiments designed to quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and subcritical angles, larger ones persist in these situations and can regrow if the intersection angle changes to become more favorable. The experimental and numerical results show that although Mach stems occur only over a limited range of intersection angles and size scales, within these ranges they are relatively robust, and hence are a viable explanation for variable bright knots observed in Hubble Space Telescope images at the intersections of some bow shocks in stellar jets.

  9. When shock waves collide

    DOE PAGES

    Martinez, D.; Hartigan, P.; Frank, A.; ...

    2016-06-01

    Supersonic outflows from objects as varied as stellar jets, massive stars, and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures, and therefore a higher-excitation spectrum than does an oblique shock. In this paper, we summarize the results of a series of numerical simulations and laboratory experiments designed tomore » quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and subcritical angles, larger ones persist in these situations and can regrow if the intersection angle changes to become more favorable. Furthermore, the experimental and numerical results show that although Mach stems occur only over a limited range of intersection angles and size scales, within these ranges they are relatively robust, and hence are a viable explanation for variable bright knots observed in Hubble Space Telescope images at the intersections of some bow shocks in stellar jets.« less

  10. When shock waves collide

    SciTech Connect

    Martinez, D.; Hartigan, P.; Frank, A.; Hansen, E.; Yirak, K.; Liao, A. S.; Graham, P.; Foster, J.; Wilde, B.; Blue, B.; Rosen, P.; Farley, D.; Paguio, R.

    2016-06-01

    Supersonic outflows from objects as varied as stellar jets, massive stars, and novae often exhibit multiple shock waves that overlap one another. When the intersection angle between two shock waves exceeds a critical value, the system reconfigures its geometry to create a normal shock known as a Mach stem where the shocks meet. Mach stems are important for interpreting emission-line images of shocked gas because a normal shock produces higher postshock temperatures, and therefore a higher-excitation spectrum than does an oblique shock. In this paper, we summarize the results of a series of numerical simulations and laboratory experiments designed to quantify how Mach stems behave in supersonic plasmas that are the norm in astrophysical flows. The experiments test analytical predictions for critical angles where Mach stems should form, and quantify how Mach stems grow and decay as intersection angles between the incident shock and a surface change. While small Mach stems are destroyed by surface irregularities and subcritical angles, larger ones persist in these situations and can regrow if the intersection angle changes to become more favorable. Furthermore, the experimental and numerical results show that although Mach stems occur only over a limited range of intersection angles and size scales, within these ranges they are relatively robust, and hence are a viable explanation for variable bright knots observed in Hubble Space Telescope images at the intersections of some bow shocks in stellar jets.

  11. Heat shock factor 2 is a stress-responsive mediator of neuronal migration defects in models of fetal alcohol syndrome

    PubMed Central

    El Fatimy, Rachid; Miozzo, Federico; Le Mouël, Anne; Abane, Ryma; Schwendimann, Leslie; Sabéran-Djoneidi, Délara; de Thonel, Aurélie; Massaoudi, Illiasse; Paslaru, Liliana; Hashimoto-Torii, Kazue; Christians, Elisabeth; Rakic, Pasko; Gressens, Pierre; Mezger, Valérie

    2014-01-01

    Fetal alcohol spectrum disorder (FASD) is a frequent cause of mental retardation. However, the molecular mechanisms underlying brain development defects induced by maternal alcohol consumption during pregnancy are unclear. We used normal and Hsf2-deficient mice and cell systems to uncover a pivotal role for heat shock factor 2 (HSF2) in radial neuronal migration defects in the cortex, a hallmark of fetal alcohol exposure. Upon fetal alcohol exposure, HSF2 is essential for the triggering of HSF1 activation, which is accompanied by distinctive post-translational modifications, and HSF2 steers the formation of atypical alcohol-specific HSF1–HSF2 heterocomplexes. This perturbs the in vivo binding of HSF2 to heat shock elements (HSEs) in genes that control neuronal migration in normal conditions, such as p35 or the MAPs (microtubule-associated proteins, such as Dclk1 and Dcx), and alters their expression. In the absence of HSF2, migration defects as well as alterations in gene expression are reduced. Thus, HSF2, as a sensor for alcohol stress in the fetal brain, acts as a mediator of the neuronal migration defects associated with FASD. Subject Categories Development & Differentiation; Neuroscience PMID:25027850

  12. Heat shock factor 2 is a stress-responsive mediator of neuronal migration defects in models of fetal alcohol syndrome.

    PubMed

    El Fatimy, Rachid; Miozzo, Federico; Le Mouël, Anne; Abane, Ryma; Schwendimann, Leslie; Sabéran-Djoneidi, Délara; de Thonel, Aurélie; Massaoudi, Illiasse; Paslaru, Liliana; Hashimoto-Torii, Kazue; Christians, Elisabeth; Rakic, Pasko; Gressens, Pierre; Mezger, Valérie

    2014-08-01

    Fetal alcohol spectrum disorder (FASD) is a frequent cause of mental retardation. However, the molecular mechanisms underlying brain development defects induced by maternal alcohol consumption during pregnancy are unclear. We used normal and Hsf2-deficient mice and cell systems to uncover a pivotal role for heat shock factor 2 (HSF2) in radial neuronal migration defects in the cortex, a hallmark of fetal alcohol exposure. Upon fetal alcohol exposure, HSF2 is essential for the triggering of HSF1 activation, which is accompanied by distinctive post-translational modifications, and HSF2 steers the formation of atypical alcohol-specific HSF1-HSF2 heterocomplexes. This perturbs the in vivo binding of HSF2 to heat shock elements (HSEs) in genes that control neuronal migration in normal conditions, such as p35 or the MAPs (microtubule-associated proteins, such as Dclk1 and Dcx), and alters their expression. In the absence of HSF2, migration defects as well as alterations in gene expression are reduced. Thus, HSF2, as a sensor for alcohol stress in the fetal brain, acts as a mediator of the neuronal migration defects associated with FASD.

  13. Heat Shock Protein HSP27 Secretion by Ovarian Cancer Cells Is Linked to Intracellular Expression Levels, Occurs Independently of the Endoplasmic Reticulum Pathway and HSP27's Phosphorylation Status, and Is Mediated by Exosome Liberation

    PubMed Central

    Klinkmann, Gerd; Diesing, Karoline; Koensgen, Dominique; Burchardt, Martin

    2017-01-01

    The heat shock protein HSP27 has been correlated in ovarian cancer (OC) patients with aggressiveness and chemoresistance and, therefore, represents a promising potential biomarker for OC diagnosis, prognosis, and treatment response. Notably, secretion of soluble HSP27 has been described by a few cell types and may take place as well in OC cells. Therefore, we studied HSP27 secretion mechanisms under diverse cellular conditions in an OC cell model system. Secretion of HSP27 was characterized after overexpression of HSP27 by transfected plasmids and after heat shock. Intra- and extracellular HSP27 amounts were assessed by Western blotting and ELISA. Protein secretion was blocked by brefeldin A and the impact of the HSP27 phosphorylation status was analyzed overexpressing HSP27 phosphomutants. The present study demonstrated that HSP27 secretion by OVCAR-3 and SK-OV-3 cells depends on intracellular HSP27 concentrations. Moreover, HSP27 secretion is independent of the endoplasmic reticulum secretory pathway and HSP27 phosphorylation. Notably, analysis of OC cell-born exosomes not only confirmed the concentration-dependent correlation of HSP27 expression and secretion but also demonstrated a concentration-dependent incorporation of HSP27 protein into exosomes. Thus, secreted HSP27 may become more important as an extracellular factor which controls the tumor microenvironment and might be a noninvasive biomarker. PMID:28325957

  14. Shock waves data for minerals

    NASA Technical Reports Server (NTRS)

    Ahrens, Thomas J.; Johnson, Mary L.

    1994-01-01

    Shock compression of the materials of planetary interiors yields data which upon comparison with density-pressure and density-sound velocity profiles constrain internal composition and temperature. Other important applications of shock wave data and related properties are found in the impact mechanics of terrestrial planets and solid satellites. Shock wave equation of state, shock-induced dynamic yielding and phase transitions, and shock temperature are discussed. In regions where a substantial phase change in the material does not occur, the relationship between the particle velocity, U(sub p), and the shock velocity, U(sub s), is given by U(sub s) = C(sub 0) + S U(sub p), where C(sub 0) is the shock velocity at infinitesimally small particle velocity, or the ambient pressure bulk sound velocity. Numerical values for the shock wave equation of state for minerals and related materials of the solar system are provided.

  15. Functional analysis and treatment of chronic hair pulling in a child with cri du chat syndrome: effects on co-occurring thumb sucking.

    PubMed

    Vorndran, Christina M; Pace, Gary M; Luiselli, James K; Flaherty, Jennifer; Christian, Lauren; Kleinmann, Ava

    2008-01-01

    The relation between hair pulling and thumb sucking in a child with Cri du Chat syndrome was evaluated during the assessment and treatment of hair pulling. A functional analysis suggested that both behaviors were maintained by automatic reinforcement and possibly by attention. Treatment combining differential reinforcement (praise), response interruption, and access to toys decreased hair pulling. A corresponding decrease in thumb sucking was observed even though it was not directly treated. After an initial evaluation in a controlled setting, the treatment was extended to the participant's classroom setting. A 1-year follow up revealed that hair pulling, but not thumb sucking, remained at near-zero frequency. Clinical and research-to-practice implications are discussed.

  16. Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

    PubMed Central

    2016-01-01

    Objective. To investigate the effects of 72-hour early-initiated continuous venovenous hemofiltration (ECVVH) treatment in patients with septic-shock-induced acute respiratory distress syndrome (ARDS) (not acute kidney injury, AKI) with regard to serum E-selectin and measurements of lung function and hemodynamic stability. Methods. This prospective nonblinded single institutional randomized study involved 51 patients who were randomly assigned to receive or not receive ECVVH, an ECVVH group (n = 24) and a non-ECVVH group (n = 27). Besides standard therapies, patients in ECVVH group underwent CVVH for 72 h. Results. At 0 and 24 h after initiation of treatment, arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, extravascular lung water index (EVLWI), and E-selectin level were not significantly different between groups (all P > 0.05). Compared to non-ECVVH group, PaO2/FiO2 is significantly higher and EVLWI and E-selectin level are significantly lower in ECVVH group (all P < 0.05) at 48 h and 72 h after initiation of treatment. The lengths of mechanical ventilation and stay in intensive care unit (ICU) were shorter in ECVVH group (all P < 0.05), but there was no difference in 28-day mortality between two groups. Conclusions. In patients with septic-shock-induced ARDS (not AKI), treatment with ECVVH in addition to standard therapies improves endothelial function, lung function, and hemodynamic stability and reduces the lengths of mechanical ventilation and stay in ICU. PMID:28044135

  17. The SaeRS Two-Component System Is a Direct and Dominant Transcriptional Activator of Toxic Shock Syndrome Toxin 1 in Staphylococcus aureus.

    PubMed

    Baroja, Miren L; Herfst, Christine A; Kasper, Katherine J; Xu, Stacey X; Gillett, Daniel A; Li, Jingru; Reid, Gregor; McCormick, John K

    2016-10-01

    Toxic shock syndrome toxin 1 (TSST-1) is a Staphylococcus aureus superantigen that has been implicated in both menstrual and nonmenstrual toxic shock syndrome (TSS). Despite the important role of TSST-1 in severe human disease, a comprehensive understanding of staphylococcal regulatory factors that control TSST-1 expression remains incomplete. The S. aureus exotoxin expression (Sae) operon contains a well-characterized two-component system that regulates a number of important exotoxins in S. aureus, although regulation of TSST-1 by the Sae system has not been investigated. We generated a defined deletion mutant of the Sae histidine kinase sensor (saeS) in the prototypic menstrual TSS strain S. aureus MN8. Mutation of saeS resulted in a complete loss of TSST-1 expression. Using both luciferase reporter experiments and quantitative real-time PCR, we demonstrate that the Sae system is an important transcriptional activator of TSST-1 expression. Recombinant SaeR was able to bind directly to the tst promoter to a region containing two SaeR consensus binding sites. Although the stand-alone SarA transcriptional regulator has been shown to be both a positive and a negative regulator of TSST-1, deletion of sarA in S. aureus MN8 resulted in a dramatic overexpression of TSST-1. As expected, mutation of agr also reduced TSST-1 expression, but this phenotype appeared to be independent of Sae. A double mutation of saeS and sarA resulted in the loss of TSST-1 expression. This work indicates that the Sae system is a dominant and direct transcriptional activator that is required for expression of TSST-1. The TSST-1 superantigen is an exotoxin, produced by some strains of S. aureus, that has a clear role in both menstrual and nonmenstrual TSS. Although the well-characterized agr quorum sensing system is a known positive regulator of TSST-1, the molecular mechanisms that directly control TSST-1 expression are only partially understood. Our studies demonstrate that the Sae two

  18. Shock induced dissociation of polyethylene

    SciTech Connect

    Morris, C.E.; Loughran, E.D.; Mortensen, G.F.; Gray, G.T. III; Shaw, M.S.

    1989-01-01

    To identify the physical processes occurring on the Hugoniot, shock-recovery experiments were performed. Cylindrical recovery systems were used that enabled a wide range of single-shock Hugoniot states to be examined. Mass spectroscopy was used to examine the gaseous dissociation products. X-ray and TEM measurements were made to characterize the post-shock carbon structures. A dissociation product equation of state is presented to interpret the observed results. Polyethylene (PE) samples that were multiply shocked to their final states dissociated at much higher pressures than single-shocked samples. 5 refs., 2 figs., 1 tab.

  19. Coronary stenting during burn shock: diagnostic and treatment considerations.

    PubMed

    Gregg, Shea C; Fidler, Philip E; Atweh, Nabil A

    2006-01-01

    Myocardial injury is known to occur in victims of both thermal and electrical burns. A variety of mechanisms have been ascribed to the pathogenesis of cardiac damage during burn shock. However, limited evidence exists that coronary artery thrombosis plays a frequent role. Distinguishing between acute coronary syndrome (impending myocardial infarction from coronary artery occlusion) vs global cardiac injury is essential; the care diverges drastically. The following case describes a patient who was angiographically proven to have acute coronary thrombosis amidst burn shock ftera 50% TBSA electrical flash burn. Managing the patient's burn shock, myocardial injury, and multiple surgical procedures while considering antiplatelet medications for a newly placed coronary artery stent presented a number of challenges not previously reported.

  20. Acoustic shock injury (ASI).

    PubMed

    Westcott, Myriam

    2006-12-01

    The potential severity and persistence of ASI symptoms has significant clinical and medico-legal implications. With the rapid growth of call centres around the world, professionals providing tinnitus and hyperacusis therapy are increasingly likely to encounter some or all of the cluster of ASI symptoms in their clients. Acoustic shock injury (ASI), occurring as a result of exposure to a sudden unexpected loud sound, has been observed to cause a specific and consistent pattern of neurophysiological and psychological symptoms. These include aural pain, tinnitus, hyperacusis/phonophobia, vertigo and other unusual symptoms such as numbness or burning sensations around the ear. A range of emotional reactions including trauma, anxiety and depression can develop. Call centre staff using a telephone headset or handset are vulnerable to ASI because of the increased likelihood of exposure, close to their ear(s), of sudden unexpected loud sounds randomly transmitted via the telephone line. This paper presents an overview of a study of 103 people exposed to 123 acoustic incidents, and of the proposed neurophysiological mechanism of ASI, in particular tonic tensor tympani syndrome (TTTS). An understanding of TTTS has the potential to provide insight into the neurophysiological and psychological development of tinnitus and hyperacusis and the association with high levels of emotional trauma and anxiety. ASI rehabilitation is discussed.

  1. Reversible kallmann syndrome, delayed puberty, and isolated anosmia occurring in a single family with a mutation in the fibroblast growth factor receptor 1 gene.

    PubMed

    Pitteloud, Nelly; Acierno, James S; Meysing, Astrid U; Dwyer, Andrew A; Hayes, Frances J; Crowley, William F

    2005-03-01

    Kallmann syndrome (KS) is a clinically and genetically heterogeneous disorder. Recently, loss-of-function mutations in the fibroblast growth factor receptor 1 (FGFR1) gene have been shown to cause autosomal dominant KS. To date, the detailed reproductive phenotype of KS associated with mutations in the FGFR1 has yet to be described. We report a kindred comprising a male proband with KS and spontaneous reversibility, whose mother had delayed puberty and whose maternal grandfather isolated anosmia. The proband presented at age 18 yr with KS and was subsequently treated with testosterone (T) therapy. Upon discontinuation of T therapy, he recovered from his hypogonadotropic hypogonadism, as evidenced by a normal LH secretion pattern, sustained normal serum T levels, and active spermatogenesis. The three members of this single family harbor the same FGFR1 mutation (Arg(622)X) in the tyrosine kinase domain. This report demonstrates 1) the first genetic cause of the rare variant of reversible KS, 2) the reversal of hypogonadotropic hypogonadism in a proband carrying an FGFR1 mutation suggests a role of FGFR1 beyond embryonic GnRH neuron migration, and 3) a loss of function mutation in the FGFR1 gene causing delayed puberty.

  2. A fatal case of streptococcal and meningococcal meningitis in a 2-years-old child occurring as Waterhouse-Friderichsen Syndrome.

    PubMed

    Ventura, Francesco; Bonsignore, Alessandro; Portunato, Federica; Orcioni, Giulio Fraternali; Varnier, Oliviero E; De Stefano, Francesco

    2013-08-01

    We report a fatal case of streptococcal and meningococcal meningitis in a previously healthy 2-year-old child, a simultaneous co-infection of both pathogens that is poorly reported in the reviewed literature. The lack of a clinical diagnosis in addition to the medico-legal aspects arising from possible professional liability for the emergency service doctor who had failed to recognize the child's symptoms led to a forensic autopsy within 48 h after the death. After external and internal examination, Waterhouse-Friderichsen Syndrome (WFS) was suspected. Consequently, cerebrospinal fluid, whole blood, nasal and pharyngeal swab and pleural liquid samples were selected and collected for microbiological studies. All tested samples resulted Neisseria meningitidis DNA and Streptococcus pneumoniae DNA positive. The NM genotyping Real-Time PCR resulted positive for NM serotype C. Microscopic histological study confirmed these findings. We underline that when a patient presents fever and petechiae (50-60% of patients), WFS must be considered, even when the patient has a non-toxic appearance. Due to its rapid progression and often devastating consequences, therapy should be started as soon as WFS is suspected. Emphasis should also be placed on the importance of public education programs and on broadening protection against meningitis through new vaccines. In such cases, from a forensic point of view, there is a strong need for a robust, multidisciplinary approach in order to reach the correct post-mortem diagnosis.

  3. Cutaneous necrotizing venulitis: a sequential analysis of the morphological alterations occurring after mast cell degranulation in a patient with a unique syndrome.

    PubMed Central

    Soter, N A; Mihm, M C; Dvorak, H F; Austen, K F

    1978-01-01

    An unusual patient, with dermal nodules, flexion contractures of the fingers and toes, cold-induced urticaria, dermographism and serum hypocomplementaemia, had necrotizing cutaneous venulitis underlying the spontaneous lesions. Since necrotizing cutaneous venulitis could be experimentally induced by the physical stimuli of cold or trauma, the time-course of histopathological events was documented in the skin of this patient. The histopathological alterations were studied in 1 micron thick, Epon-embedded skin biopsy specimens over an interval of 6 days. The early massive degranulation of the mast cells was followed by the sequential infiltration of neutrophilic, eosinophilic and basophilic polymorphonuclear leucocytes, by the development of venular endothelial cell necrosis and by the deposition of fibrin. The persistent serum hypocomplementaemia involved the classic activating and amplification pathways. It seems possible that the unusual combination of pathobiological processes involving the mast cells and the complement system in this patient has created a unique syndrome, in which venules are damaged and the sheaths of the extensor tendons of the hands and feet become affected in time. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 PMID:668192

  4. Shock effects in meteorites

    NASA Technical Reports Server (NTRS)

    Stoeffler, D.; Bischoff, A.; Buchwald, V.; Rubin, A. E.

    1988-01-01

    The impacts that can occur between objects on intersecting solar system orbits can generate shock-induced deformations and transformations, creating new mineral phases or melting old ones. These shock-metamorphic effects affect not only the petrography but the chemical and isotopic properties and the ages of primordial meteoritic materials. A fuller understanding of shock metamorphism and breccia formation in meteorites will be essential not only in the study of early accretion, differentiation, and regolith-evolution processes, but in the characterization of the primordial composition of the accreted material itself.

  5. A case report of Sheehan's syndrome with acute onset, hyponatremia and severe anemia.

    PubMed

    Anfuso, Salvatore; Patrelli, Tito Silvio; Soncini, Emanuele; Chiodera, Paolo; Fadda, Giovanni Maria; Nardelli, Giovanni Battista

    2009-04-01

    Sheehan's syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, that generally occurs after an intra- or postpartum bleeding episode characterized by severe hypertension or hemorrhagic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with an early diagnosis of early-onset Sheehan's syndrome associated with severe hyponatremia following dystocic childbirth complicated by postpartum hemorrhage.

  6. Shock front nonstationarity of supercritical perpendicular shocks

    NASA Astrophysics Data System (ADS)

    Hada, Tohru; Oonishi, Makiko; LembèGe, Bertrand; Savoini, Philippe

    2003-06-01

    The shock front nonstationarity of perpendicular shocks in super-critical regime is analyzed by examining the coupling between "incoming" and "reflected" ion populations. For a given set of parameters including the upstream Mach number (MA) and the fraction α of reflected to incoming ions, a self-consistent, time-stationary solution of the coupling between ion streams and the electromagnetic field is sought for. If such a solution is found, the shock is stationary; otherwise, the shock is nonstationary, leading to a self-reforming shock front often observed in full particle simulations of quasi-perpendicular shocks. A parametric study of this numerical model allows us to define a critical αcrit between stationary and nonstationary regimes. The shock can be nonstationary even for relatively low MA(2-5). For a moderate MA(5-10), the critical value αcrit is about 15 to 20%. For very high MA (>10), αcrit saturates around 20%. Moreover, present full simulations show that self-reformation of the shock front occurs for relatively low βi and disappears for high βi, where βi is the ratio of upstream ion plasma to magnetic field pressures. Results issued from the present theoretical model are found to be in good agreement with full particle simulations for low βi case; this agreement holds as long as the motion of reflected ions is coherent enough (narrow ion ring) to be described by a single population in the model. The present model reveals to be "at variance" with full particle simulations results for the high βi case. Present results are also compared with previous hybrid simulations.

  7. Staphylococcus aureus toxic shock syndrome toxin-1 (TSST-1) production and Lactobacillus species growth in a defined medium simulating vaginal secretions.

    PubMed

    Stingley, Robin L; Liu, Huanli; Mullis, Lisa B; Elkins, Christopher A; Hart, Mark E

    2014-11-01

    Lactobacillus species are commensal with the healthy vaginal environment and inhibit the growth of many pathogenic bacteria in the vaginal tract by a variety of mechanisms, such as the production of hydrogen peroxide, organic acids, and antimicrobial substances. Simulation of the vaginal environment is crucial for proper investigation of the effects of Lactobacillus species on pathogenic bacteria. In this study, we modified a medium used to simulate vaginal secretions to improve the growth of toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus clinical strains and Lactobacillus species so that interactions between these bacteria may be examined. A medium consisting of basal salts, vitamins, albumin, glycogen, mucin, urea, sodium bicarbonate, polyoxyethylene sorbitan monolaurate, and amino acids supported the growth of S. aureus and the production of TSST-1 as determined by Western analysis. Improved growth of the Lactobacillus species was seen when this same medium was supplemented with manganese chloride, sodium acetate, and an increase in glucose concentration. However, growth of S. aureus in the supplemented medium resulted in reduced levels of TSST-1. Production of TSST-1 was not detected in a medium routinely used for the growth of Lactobacillus species although S. aureus growth was not inhibited. The development of an improved genital tract secretion medium provides a more authentic environment in which to study the interactions of Lactobacillus species and vaginal pathogens, such as S. aureus.

  8. Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study.

    PubMed

    Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Wang, Weiguo; Cheng, Liming; Yue, Debo; Zhang, Nianfei; Savarin, Amanda

    2015-12-05

    The aim of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in normalizing the symptoms and imaging features of primary bone marrow edema syndrome (BMES) of the knee. This study compared the outcomes of ESWT (Group A) (n = 20) and intravenously applied prostacyclin and bisphosphonate (Group B) (n = 20) in the treatment of BMES of the knee in our department between 2011 and 2013. The Visual Analog Scale for pain (VAS, 100 mm), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the SF-36 scores and MRI scans as well as plain radiographs were obtained before and after therapy between two groups. Compared with Group B, we found greater improvement in VAS, the WOMAC Osteoarthritis Index and SF-36 score at 1, 3 and 6 months post-treatment in Group A (P < 0.05). Furthermore, MRI scans showed a higher incidence of distinct reduction and complete regression of bone marrow edema at 6 months in Group A (95 vs. 65 %; P = 0.018). The MRI at 1 year follow-up showed complete regression in all patients in Group A. However, two cases in Group B continued to normalize over the subsequent follow-up period. ESWT can produce rapid pain relief and functional improvement. It may be an effective, reliable, and non-invasive technique for rapid treatment of BMES of the knee. Research Registry UIN 528, September 03, 2015.

  9. Oligonucleotide probes for detection and differentiation of Staphylococcus aureus strains containing genes for enterotoxins A, B, and C and toxic shock syndrome toxin 1.

    PubMed Central

    Neill, R J; Fanning, G R; Delahoz, F; Wolff, R; Gemski, P

    1990-01-01

    Different synthetic DNA nucleotide sequences were evaluated as gene probes for the specific detection and differentiation of Staphylococcus aureus strains encoding enterotoxins A (SEA), B (SEB), and C (SEC) and toxic shock syndrome toxin 1 (TSST-1). Identification of sequences unique to each toxin, based on knowledge of their nucleotide sequences, led to preparation of the specific 18-base oligonucleotide probes EA1 (encoding amino acids 177 to 182 of SEA), EB2 (encoding amino acids 105 to 110 of SEB), EC5 (encoding amino acids 125 to 131 of SEC1), and TS1 (encoding amino acids 160 to 166 of TSST-1). In colony blot hybridization analyses, these probes hybridized specifically with DNA from strains that produced the respective toxin serotypes. An excellent (greater than or equal to 93%) correlation between hybridization results (genotype) and toxin protein detection by an enzyme-linked immunosorbent assay (phenotype) was observed in the characterization of both reference and clinical strains of S. aureus for SEA, SEB, and TSST-1. A lower correlation (64%) for SEC reflected a lack of sensitivity in detecting toxin production. Our findings demonstrate that molecular DNA hybridization with synthetic oligonucleotide probes provides another approach for establishing the toxigenicity of S. aureus. Images PMID:2380378

  10. Expression of type 8 capsular polysaccharide and production of toxic shock syndrome toxin 1 are associated among vaginal isolates of Staphylococcus aureus.

    PubMed Central

    Lee, J C; Liu, M J; Parsonnet, J; Arbeit, R D

    1990-01-01

    A colony immunoblot method was developed for serotyping the capsular polysaccharides expressed by Staphylococcus aureus isolates. The method was rapid and specific and was performed with either polyclonal or monoclonal antibodies specific for each of the capsule types. S. aureus isolates were obtained from patients with toxic shock syndrome (TSS) or other staphylococcal infections and from asymptomatic women with vaginal colonization. Among the vaginal isolates of S. aureus, expression of the type 8 capsule was significantly (P less than 0.001) more frequent among strains that produced TSS toxin 1 (TSST-1) than it was among TSST-1-negative strains. In contrast, the frequency of type 8 capsule expression was similar among both TSST-1-positive and -negative strains of S. aureus from patients with nonvaginal TSS. When all vaginal and nonvaginal isolates were compared, TSST-1-negative S. aureus strains were equally distributed among the type 5 and 8 and nontypeable capsule groups, whereas TSST-1-positive strains were predominantly capsule type 8. Images PMID:2279990

  11. Efficacy of endotoxin adsorption therapy (polymyxin B hemoperfusion) for methicillin-resistant Staphylococcus aureus toxic shock syndrome: a case report about five patients.

    PubMed

    Taniguchi, T; Sato, K; Kurita, A; Noda, T; Okajima, M

    2013-07-01

    Toxic shock syndrome (TSS), which can be life-threatening, is clinically and pathologically characterized by the presence of high fever, skin rash, desquamation, hypotension, and multiple organ failure caused by an enterotoxin produced by Staphylococcus aureus. In this study, we evaluated the effects of endotoxin adsorption therapy (polymyxin B [PMX] hemoperfusion) in critical patients with methicillin-resistant Staphylococcus aureus TSS (MRSA-TSS) who showed no improvement with the conventional therapy. Five MRSA-TSS patients (men/women: 3/2; median age: 39 years) who showed no improvement with the conventional therapy underwent PMX hemoperfusion in addition to the conventional therapy. The primary outcomes were change in the systolic arterial pressure (SAP) and requirement of a vasopressor after PMX hemoperfusion, and the secondary outcomes were change in laboratory data and sequential organ failure assessment (SOFA) scores 24 h after the therapy. The median duration of PMX hemoperfusion was 9 h (range, 4-20 h). SAP significantly increased (from 89 to 125 mmHg, P<0.05) and the requirement of a vasopressor significantly decreased (from 10 to 2, P<0.05) after PMX hemoperfusion. Furthermore, the patients' white blood cell count decreased (from 17640 to 10090 /uL, P<0.05), and SOFA scores decreased (from 13 to 9, P<0.05) after PMX hemoperfusion. All patients recovered and were discharged from the ICU. Our results showed that PMX hemoperfusion significantly improved the hemodynamics and severity in patients with life-threatening MRSA-TSS.

  12. SHOCK WAVE LITHOTRIPSY TARGETING OF THE KIDNEY AND PANCREAS DOES NOT INCREASE THE SEVERITY OF METABOLIC SYNDROME IN A PORCINE MODEL

    PubMed Central

    Handa, Rajash K.; Evan, Andrew P.; Connors, Bret A.; Johnson, Cynthia D.; Liu, Ziyue; Alloosh, Mouhamad; Sturek, Michael; Evans-Molina, Carmella; Mandeville, Jessica A.; Gnessin, Ehud; Lingeman, James E.

    2014-01-01

    Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus. PMID:24657667

  13. The 60- and 70-kDa heat-shock proteins and their correlation with cardiovascular risk factors in postmenopausal women with metabolic syndrome.

    PubMed

    Nahas, Eliana A P; Nahas-Neto, Jorge; Orsatti, Claudio L; Tardivo, Ana Paula; Uemura, Gilberto; Peraçoli, Maria Terezinha S; Witkin, Steven S

    2014-07-01

    We investigated the association between circulating levels of 60 and 70 kDa heat-shock proteins (HSP60 and 70) and cardiovascular risk factors in postmenopausal women with or without metabolic syndrome (MetS). This cross-sectional study included 311 Brazilian women (age ≥45 years with amenorrhea ≥12 months). Women showing three or more of the following diagnostic criteria were diagnosed with MetS: waist circumference (WC) ≥88 cm, blood pressure ≥130/85 mmHg, triglycerides ≥150 mg/dl, high-density lipoprotein (HDL) <50 mg/dl, and glucose ≥100 mg/dl. Clinical, anthropometric, and biochemical parameters were collected. HSP60, HSP70, antibodies to HSP60 and HSP70, and C-reactive protein (CRP) levels were measured in serum. Student's t test, Kruskal-Wallis test, chi-square test, and Pearson correlation were used for statistical analysis. Of the 311 women, 30.9 % (96/311) were diagnosed with MetS. These women were, on average, obese with abdominal fat deposition and had lower HDL values as well as higher triglycerides and glucose levels. Homeostasis model assessment-insulin resistant (HOMA-IR) test values in these women were compatible with insulin resistance (P < 0.05). CRP and HSP60 concentrations were higher in women with MetS than in women without MetS (P < 0.05). HSP60, anti-HSP70, and CRP concentrations increased with the number of features indicative of MetS (P < 0.05). There was a significant positive correlation between anti-HSP70 and WC, blood pressure and HOMA-IR, and between CRP and WC, blood pressure, glucose, HOMA-IR, and triglycerides (P < 0.05). In postmenopausal women, serum HSP60 and anti-HSP70 concentrations increased with accumulating features of the metabolic syndrome. These results suggest a greater immune activation that is associated with cardiovascular risk in postmenopausal women with metabolic syndrome.

  14. Suppressive and Facilitative Effects of Shock Intensity and Interresponse Times Followed by Shock

    ERIC Educational Resources Information Center

    Everly, Jessica B.; Perone, Michael

    2012-01-01

    Although response-dependent shock often suppresses responding, response facilitation can occur. In two experiments, we examined the suppressive and facilitative effects of shock by manipulating shock intensity and the interresponse times that produced shock. Rats' lever presses were reinforced on a variable-interval 40-s schedule of food…

  15. Suppressive and Facilitative Effects of Shock Intensity and Interresponse Times Followed by Shock

    ERIC Educational Resources Information Center

    Everly, Jessica B.; Perone, Michael

    2012-01-01

    Although response-dependent shock often suppresses responding, response facilitation can occur. In two experiments, we examined the suppressive and facilitative effects of shock by manipulating shock intensity and the interresponse times that produced shock. Rats' lever presses were reinforced on a variable-interval 40-s schedule of food…

  16. Is this septic shock? A rare case of distributive shock.

    PubMed

    Val-Flores, Luis Silva; Fior, Alberto; Santos, Ana; Reis, Luís; Bento, Luís

    2014-01-01

    The authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration--a combination of three symptoms typical of the disease. The authors discussed the differential diagnosis and also conducted a review of the diagnosis and treatment of the disease.

  17. Is this septic shock? A rare case of distributive shock

    PubMed Central

    Val-Flores, Luis Silva; Fior, Alberto; Santos, Ana; Reis, Luís; Bento, Luís

    2014-01-01

    The authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration - a combination of three symptoms typical of the disease. The authors discussed the differential diagnosis and also conducted a review of the diagnosis and treatment of the disease. PMID:25607273

  18. Turbulence in electrostatic ion acoustic shocks

    NASA Technical Reports Server (NTRS)

    Means, R. W.; Coroniti, F. V.; Wong, A. Y.; White, R. B.

    1973-01-01

    Three types of collisionless electrostatic ion acoustic shocks are investigated using a double plasma (DP) device: (1) laminar shocks; (2) small amplitude turbulent shocks in which the turbulence is confined to be upstream of the shock potential jump; and (3) large amplitude turbulent shocks in which the wave turbulence occurs throughout the shock transition. The wave turbulence is generated by ions which are reflected from the shock potential; linear theory spatial growth increments agree with experimental values. The experimental relationship between the shock Mach number and the shock potential is shown to be inconsistent with theoretical shock models which assume that the electrons are isothermal. Theoretical calculations which assume a trapped electron equation of a state and a turbulently flattened velocity distrubution function for the reflected ions yields a Mach number vs potential relationship in agreement with experiment.

  19. The merging of quasiperpendicular collisionless shocks

    NASA Technical Reports Server (NTRS)

    Cargill, P. J.

    1990-01-01

    The overtaking of one collisionless shock by another is studied by means of hybrid numerical simulations. The two shocks merge into a stronger shock and trailing nonshock discontinuities. The strong shock continues to propagate in the same direction as the two weaker shocks. The merging is shown to occur by a self-consistent process involving the interaction of ions reflected at the overtaking shock with the plasma upstream of the leading shock. The characteristic time scale for the merging is typically 1/Omega(i), where Omega(i) is the ion gyrofrequency. For exactly perpendicular shocks, the trailing discontinuity is a tangential discontinuity. It has a width of 2-3 ion Larmor radii. For oblique shocks, a contact discontinuity is present in the downstream plasma state. These results are of relevance to shock interactions in the very distant solar wind as well as in other energetic astrophysical situations such as solar flares.

  20. Bench-to-bedside review: Mechanisms of critical illness – classifying microcirculatory flow abnormalities in distributive shock

    PubMed Central

    Elbers, Paul WG; Ince, Can

    2006-01-01

    Over 30 years ago Weil and Shubin proposed a re-classification of shock states and identified hypovolemic, cardiogenic, obstructive and distributive shock. The first three categories have in common that they are associated with a fall in cardiac output. Distributive shock, such as occurs during sepsis and septic shock, however, is associated with an abnormal distribution of microvascular blood flow and metabolic distress in the presence of normal or even supranormal levels of cardiac output. This Bench-to-bedside review looks at the recent insights that have been gained into the nature of distributive shock. Its pathophysiology can best be described as a microcirculatory and mitochondrial distress syndrome, where time and therapy form an integral part of the definition. The clinical introduction of new microcirculatory imaging techniques, such as orthogonal polarization spectral and side-stream dark-field imaging, have allowed direct observation of the microcirculation at the bedside. Images of the sublingual microcirculation during septic shock and resuscitation have revealed that the distributive defect of blood flow occurs at the capillary level. In this paper, we classify the different types of heterogeneous flow patterns of microcirculatory abnormalities found during different types of distributive shock. Analysis of these patterns gave a five class classification system to define the types of microcirculatory abnormalities found in different types of distributive shock and indicated that distributive shock occurs in many other clinical conditions than just sepsis and septic shock. It is likely that different mechanisms defined by pathology and treatment underlie these abnormalities observed in the different classes. Functionally, however, they all cause a distributive defect resulting in microcirculatory shunting and regional dysoxia. It is hoped that this classification system will help in the identification of mechanisms underlying these abnormalities and

  1. [Severe sepsis and septic shock].

    PubMed

    Tønnesen, Else; Larsen, Kim

    2014-07-07

    Sepsis, severe sepsis and septic shock are syndromes. The incidence of sepsis is as high as 35% and with mortality rates in the intensive care unit from 27% to 54% in sepsis and septic shock, respectively. Many new treatments have been tested but only few have been implemented in clinical practise. The treatment of severe sepsis and septic shock is based on the Surviving Sepsis Campaign guidelines developed by an international expert panel. Early diagnosis, optimization of haemodynamics, rapid identification of focus and adequate antibiotic treatment are the most important strategies.

  2. Functional definition and global regulation of Zur, a zinc uptake regulator in a Streptococcus suis serotype 2 strain causing streptococcal toxic shock syndrome.

    PubMed

    Feng, Youjun; Li, Ming; Zhang, Huimin; Zheng, Beiwen; Han, Huiming; Wang, Changjun; Yan, Jinghua; Tang, Jiaqi; Gao, George F

    2008-11-01

    Zinc is an essential trace element for all living organisms and plays pivotal roles in various cellular processes. However, an excess of zinc is extremely deleterious to cells. Bacteria have evolved complex machineries (such as efflux/influx systems) to control the concentration at levels appropriate for the maintenance of zinc homeostasis in cells and adaptation to the environment. The Zur (zinc uptake regulator) protein is one of these functional members involved in the precise control of zinc homeostasis. Here we identified a zur homologue designated 310 from Streptococcus suis serotype 2, strain 05ZYH33, a highly invasive isolate causing streptococcal toxic shock syndrome. Biochemical analysis revealed that the protein product of gene 310 exists as a dimer form and carries zinc ions. An isogenic gene replacement mutant of gene 310, the Delta310 mutant, was obtained by homologous recombination. Physiological tests demonstrated that the Delta310 mutant is specifically sensitive to Zn(2+), while functional complementation of the Delta310 mutant can restore its duration capability, suggesting that 310 is a functional member of the Zur family. Two-dimensional electrophoresis indicated that nine proteins in the Delta310 mutant are overexpressed in comparison with those in the wild type. DNA microarray analyses suggested that 121 genes in the Delta310 mutant are affected, of which 72 genes are upregulated and 49 are downregulated. The transcriptome of S. suis serotype 2 with high Zn(2+) concentrations also showed 117 differentially expressed genes, with 71 upregulated and 46 downregulated. Surprisingly, more than 70% of the genes differentially expressed in the Delta310 mutant were the same as those in S. suis serotype 2 that were differentially expressed in response to high Zn(2+) concentration, consistent with the notion that 310 is involved in zinc homeostasis. We thus report for the first time a novel zinc-responsive regulator, Zur, from Streptococcus suis

  3. Rapid and Rigorous IL-17A Production by a Distinct Subpopulation of Effector Memory T Lymphocytes Constitutes a Novel Mechanism of Toxic Shock Syndrome Immunopathology.

    PubMed

    Szabo, Peter A; Goswami, Ankur; Mazzuca, Delfina M; Kim, Kyoungok; O'Gorman, David B; Hess, David A; Welch, Ian D; Young, Howard A; Singh, Bhagirath; McCormick, John K; Haeryfar, S M Mansour

    2017-04-01

    Toxic shock syndrome (TSS) is caused by staphylococcal and streptococcal superantigens (SAgs) that provoke a swift hyperinflammatory response typified by a cytokine storm. The precipitous decline in the host's clinical status and the lack of targeted therapies for TSS emphasize the need to identify key players of the storm's initial wave. Using a humanized mouse model of TSS and human cells, we herein demonstrate that SAgs elicit in vitro and in vivo IL-17A responses within hours. SAg-triggered human IL-17A production was characterized by remarkably high mRNA stability for this cytokine. A distinct subpopulation of CD4(+) effector memory T (TEM) cells that secrete IL-17A, but not IFN-γ, was responsible for early IL-17A production. We found mouse "TEM-17" cells to be enriched within the intestinal epithelium and among lamina propria lymphocytes. Furthermore, interfering with IL-17A receptor signaling in human PBMCs attenuated the expression of numerous inflammatory mediators implicated in the TSS-associated cytokine storm. IL-17A receptor blockade also abrogated the secondary effect of SAg-stimulated PBMCs on human dermal fibroblasts as judged by C/EBP δ expression. Finally, the early IL-17A response to SAgs was pathogenic because in vivo neutralization of IL-17A in humanized mice ameliorated hepatic and intestinal damage and reduced mortality. Together, our findings identify CD4(+) TEM cells as a key effector of TSS and reveal a novel role for IL-17A in TSS immunopathogenesis. Our work thus elucidates a pathogenic, as opposed to protective, role for IL-17A during Gram-positive bacterial infections. Accordingly, the IL-17-IL-17R axis may provide an attractive target for the management of SAg-mediated illnesses.

  4. Role of T Cells and Gamma Interferon during Induction of Hypersensitivity to Lipopolysaccharide by Toxic Shock Syndrome Toxin 1 in Mice

    PubMed Central

    Dinges, Martin M.; Schlievert, Patrick M.

    2001-01-01

    The superantigenic function of toxic shock syndrome toxin 1 (TSST-1) is generally regarded as an important determinant of its lethal effects in humans or experimental animals. This study examined the role of superantigenicity in a BALB/c mouse model of lethal TSST-1-induced hypersensitivity to lipopolysaccharide (LPS). In this model, TSST-1 greatly potentiated both LPS-induced lethality, as well as LPS-induced serum tumor necrosis factor alpha (TNF-α) activity. Although BALB/c-SCID mice were resistant to these LPS enhancement effects of TSST-1, BALB/c-SCID mice reconstituted with T cells were completely susceptible to the enhancement effect of TSST-1 on LPS-induced serum TNF-α. Mice pretreated with cyclosporine (Cs) or neutralizing antibodies against gamma interferon (IFN-γ) did not develop lethal LPS hypersensitivity when injected with TSST-1, and these agents reduced the enhancement effect of TSST-1 on LPS-induced serum TNF-α by 99 and 85%, respectively. Cs pretreatment also completely inhibited the known capacity of TSST-1 to amplify LPS-induced levels of IFN-γ in serum. In contrast, mice given Cs after a priming injection of TSST-1, but before LPS, still exhibited lethal hypersensitivity to LPS. Cs given after TSST-1 also did not inhibit enhancement of LPS-induced serum TNF-α by TSST-1 but inhibited the enhancement effect of TSST-1 on LPS-induced serum IFN-γ by 50%. These experiments support the theory that TSST-1-induced hypersensitivity to LPS is mediated primarily by IFN-γ derived from superantigen-activated T cells. PMID:11179286

  5. The CD5 ectodomain interacts with conserved fungal cell wall components and protects from zymosan-induced septic shock-like syndrome.

    PubMed

    Vera, Jorge; Fenutría, Rafael; Cañadas, Olga; Figueras, Maite; Mota, Rubén; Sarrias, Maria-Rosa; Williams, David L; Casals, Cristina; Yelamos, José; Lozano, Francisco

    2009-02-03

    The CD5 lymphocyte surface receptor is a group B member of the ancient and highly conserved scavenger receptor cysteine-rich superfamily. CD5 is expressed on mature T and B1a cells, where it is known to modulate lymphocyte activation and/or differentiation processes. Recently, the interaction of a few group B SRCR members (CD6, Spalpha, and DMBT1) with conserved microbial structures has been reported. Protein binding assays presented herein indicate that the CD5 ectodomain binds to and aggregates fungal cells (Schizosaccharomyces pombe, Candida albicans, and Cryptococcus neoformans) but not to Gram-negative (Escherichia coli) or Gram-positive (Staphylococcus aureus) bacteria. Accordingly, the CD5 ectodomain binds to zymosan but not to purified bacterial cell wall constituents (LPS, lipotheicoic acid, or peptidoglycan), and such binding is specifically competed by beta-glucan but not by mannan. The K(d) of the rshCD5/(1-->3)-beta-d-glucan phosphate interaction is 3.7 +/- 0.2 nM as calculated from tryptophan fluorescence data analysis of free and bound rshCD5. Moreover, zymosan binds to membrane-bound CD5, and this induces both MAPK activation and cytokine release. In vivo validation of the fungal binding properties of the CD5 ectodomain is deduced from its protective effect in a mouse model of zymosan-induced septic shock-like syndrome. In conclusion, the present results indicate that the CD5 lymphocyte receptor may sense the presence of conserved fungal components [namely, (1-->3)-beta-d-glucans] and support the therapeutic potential of soluble CD5 forms in fungal sepsis.

  6. Combination of flucloxacillin and gentamicin inhibits toxic shock syndrome toxin 1 production by Staphylococcus aureus in both logarithmic and stationary phases of growth.

    PubMed Central

    van Langevelde, P; van Dissel, J T; Meurs, C J; Renz, J; Groeneveld, P H

    1997-01-01

    Production of exotoxins by staphylococci and streptococci may lead to the development of toxic shock syndrome (TSS). Because clindamycin inhibits exotoxin production, its use has been advocated for the treatment of TSS. However, the bacteriostatic action of clindamycin might be a disadvantage for the treatment of overwhelming infections. We investigated the effects of flucloxacillin and gentamicin on exotoxin production, because incubation with these antibiotics combines bactericidal action with protein synthesis inhibition. Staphylococcus aureus during the logarithmic and stationary phases of growth was incubated with either clindamycin, flucloxacillin, or a combination of flucloxacillin and gentamicin at concentrations of 2 or 10 times the MIC. In logarithmic-phase cultures clindamycin had a static effect on bacterial growth. After incubation with flucloxacillin, either alone or in combination with gentamicin, a rapid and large reduction in the number of viable bacteria was demonstrated. In stationary-phase cultures none of the antibiotics significantly changed the number of viable bacteria. TSS toxin 1 (TSST-1) production during logarithmic-phase growth was inhibited by > or =95% by all antibiotics. In stationary-phase cultures, clindamycin, flucloxacillin, and the combination of flucloxacillin and gentamicin inhibited TSST-1 production by 95, 30, and 75%, respectively, compared with the level of exotoxin production in the controls. The present results indicate that clindamycin inhibits TSST-1 production and exerts bacteriostatic activity in both bacterial growth phases. Because the combination of flucloxacillin and gentamicin combines the inhibition of exotoxin production with high bactericidal activity at least in logarithmic-phase cultures, it should be considered an alternative to clindamycin for the treatment of exotoxin-mediated diseases, especially in patients with overwhelming infections. PMID:9257741

  7. Chronic fatigue syndrome: acute infection and history of physical activity affect resting levels and response to exercise of plasma oxidant/antioxidant status and heat shock proteins.

    PubMed

    Jammes, Y; Steinberg, J G; Delliaux, S

    2012-07-01

    A history of high-level physical activity and/or acute infection might constitute stress factors affecting the plasma oxidant-antioxidant status and levels of heat shock proteins (HSPs) in patients with chronic fatigue syndrome (CFS). This case-control study compared data from 43 CFS patients to results from a matched control group of 23 healthy sedentary subjects. Five patients had no relevant previous history (group I). Eighteen had practised high-level sport (group II), and severe acute infection had been diagnosed in nine patients (group III). A combination of sport practice and infection was noted in 11 patients (group IV). After examination at rest, all subjects performed a maximal cycling exercise test. Plasma levels of two markers of oxidative stress [thiobarbituric acid reactive substances (TBARS) and reduced ascorbic acid (RAA)] and both HSP27 and HSP70 were measured. At rest, compared with the control group, the TBARS level was higher in groups II, III and IV patients, and the RAA level was lower in groups III and IV. In addition, HSP70 levels were significantly lower in all CFS groups, compared with controls, but negative correlations were found between resting HSP27 and HSP70 levels and the history of physical activity. After exercise, the peak level of TBARS significantly increased in groups II, III and IV, and the variations in HSP27 and HSP70 were attenuated or suppressed, with the greatest effects in groups III and IV. The presence of stress factors in the history of CFS patients is associated with severe oxidative stress and the suppression of protective HSP27 and HSP70 responses to exercise. © 2011 The Association for the Publication of the Journal of Internal Medicine.

  8. Prevalence of Toxic Shock Syndrome Toxin 1 (TSST-1)-Producing Strains of Staphylococcus aureus and Antibody to TSST-1 among Healthy Japanese Women▿

    PubMed Central

    Parsonnet, Jeffrey; Goering, Richard V.; Hansmann, Melanie A.; Jones, Michaelle B.; Ohtagaki, Kumiko; Davis, Catherine C.; Totsuka, Kyoichi

    2008-01-01

    Many cases of neonatal toxic shock syndrome (TSS)-like exanthematous disease but few cases of menstrual TSS (mTSS) have been reported in Japan. We determined the prevalence of mucosal colonization with Staphylococcus aureus and of positive antibodies to TSS toxin 1 (TSST-1) among 209 healthy Japanese women in Tokyo. S. aureus isolates from mucosal sites were characterized with respect to TSST-1 production and resistance genotype. Antibody titers were determined for test subjects and for 133 Japanese and 137 Caucasian control women living in the United States. S. aureus was isolated from at least one site in 108 of 209 women (52%) in Tokyo. Of the 159 S. aureus isolates recovered, 14 (9%) were TSST-1 positive (12 unique strains). Twelve of 209 women (6%) were colonized with a TSST-1-producing strain; two (<1%) had vaginal colonization. Only 2 of 12 unique toxigenic strains (14%) were methicillin resistant. Of the 12 TSST-1-positive strains isolated, 6 (50%) were pulsed-field gel electrophoresis type USA200, multilocus sequence type clonal complex 30. Fewer Japanese women in Tokyo (47%) than Caucasian and Japanese women in the United States (89% and 75%, respectively) had TSST-1 antibodies. The prevalences of colonization with TSST-1-producing S. aureus were comparable in Japan and the United States, despite low seropositivity to TSST-1 in Japan. Environmental factors appear to be important in promoting the development of anti-TSST-1 antibodies, as there was a significant difference in titers between Japanese women living in Tokyo and those living in the United States. Most colonizing TSST-1-producing S. aureus strains in Japan were genotypically similar to mTSS strains found in the United States. PMID:18550735

  9. Targeting TREM-1 Signaling in the Presence of Antibiotics is Effective Against Streptococcal Toxic-Shock-Like Syndrome (STSLS) Caused by Streptococcus suis.

    PubMed

    Yang, Chao; Zhao, Jianqing; Lin, Lan; Pan, Shan; Fu, Lei; Han, Li; Jin, Meilin; Zhou, Rui; Zhang, Anding

    2015-01-01

    Streptococcus suis (S.suis), a major swine pathogen, is also a severe threat to human health. Infection with highly virulent strains of S. suis can cause human Streptococcal toxic-shock-like syndrome (STSLS), which is associated with high serum pro-inflammatory cytokine levels and a high mortality rate. Our previous study indicated that highly virulent S. suis infection could activate the TREM-1 signaling pathway, which promotes host clearance of S. suis during early infection. However, it remained to be elicited whether TREM-1 signaling could be a target against STSLS in the presence of antibiotic. In the present study, mice were infected with a highly virulent S. suis strain and then treated with rTREM-1 (the recombinant extracellular domain of TREM-1) to block TREM-1 signaling, antibiotics, both rTREM-1 and antibiotics, or PBS. The survival rates, clinical signs, serum IL-1β and TNF-α levels, and serum bacterial loads were evaluated. Treatment with rTREM-1 could aggravate the outcome of infection as described previously. Although the conventional treatment with antibiotics contributed to effective S. suis clearance, it did not improve survival significantly. In comparison, due to the reduction of the exaggerated pro-inflammatory response, treatment combined with rTREM-1 and antibiotics not only led to efficient bacterial clearance but also alleviated inflammation. In conclusion, TREM-1 signaling contributed to severe inflammatory response and benefited S. suis clearance. Therefore, blocking TREM-1 signaling could still be a target for the treatment of STSLS in the presence of antibiotics.

  10. Targeting TREM-1 Signaling in the Presence of Antibiotics is Effective Against Streptococcal Toxic-Shock-Like Syndrome (STSLS) Caused by Streptococcus suis

    PubMed Central

    Yang, Chao; Zhao, Jianqing; Lin, Lan; Pan, Shan; Fu, Lei; Han, Li; Jin, Meilin; Zhou, Rui; Zhang, Anding

    2015-01-01

    Streptococcus suis (S.suis), a major swine pathogen, is also a severe threat to human health. Infection with highly virulent strains of S. suis can cause human Streptococcal toxic-shock-like syndrome (STSLS), which is associated with high serum pro-inflammatory cytokine levels and a high mortality rate. Our previous study indicated that highly virulent S. suis infection could activate the TREM-1 signaling pathway, which promotes host clearance of S. suis during early infection. However, it remained to be elicited whether TREM-1 signaling could be a target against STSLS in the presence of antibiotic. In the present study, mice were infected with a highly virulent S. suis strain and then treated with rTREM-1 (the recombinant extracellular domain of TREM-1) to block TREM-1 signaling, antibiotics, both rTREM-1 and antibiotics, or PBS. The survival rates, clinical signs, serum IL-1β and TNF-α levels, and serum bacterial loads were evaluated. Treatment with rTREM-1 could aggravate the outcome of infection as described previously. Although the conventional treatment with antibiotics contributed to effective S. suis clearance, it did not improve survival significantly. In comparison, due to the reduction of the exaggerated pro-inflammatory response, treatment combined with rTREM-1 and antibiotics not only led to efficient bacterial clearance but also alleviated inflammation. In conclusion, TREM-1 signaling contributed to severe inflammatory response and benefited S. suis clearance. Therefore, blocking TREM-1 signaling could still be a target for the treatment of STSLS in the presence of antibiotics. PMID:26618144

  11. Shock Surface Undulation and Particle Acceleration at Oblique Shocks

    NASA Astrophysics Data System (ADS)

    Krauss-Varban, D.; Li, Y.; Luhmann, J. G.

    2006-12-01

    Considering the average Parker spiral magnetic field configuration, CME-driven interplanetary (IP) shocks within 1 AU should have oblique portions over much of their domain. Indeed, CME-driven shocks observed close to Earth are often oblique. However, it is well known that the standard diffusive shock acceleration mechanism, which relies on self-consistent wave generation via upstream propagating ions and their scattering, becomes increasingly inefficient with greater shock normal angle. Not only is a higher threshold energy required for the ions to leave the shock upstream, but also, approximately-parallel propagating waves are more quickly convected back into the shock, and the growth rate for waves propagating normal to the shock (the ones with the largest convective growth) decreases. As a result, typical, small-scale hybrid simulations of oblique shocks only show a dilute upstream beam, similar to what is often observed at the oblique Earth's bow shock - and no scattered, highly-energized ions. On the other hand, there are many "energetic storm particle" (ESP) events associated with oblique shocks that have significant fluxes of energetic ions. Recently, we have found that when run for a long time, our hybrid simulations (kinetic ions, electron fluid) show that the initial, weak beam is sufficient to generate compressive, steepening upstream waves. These waves are capable of disturbing the shock surface, resulting in an undulation that is propagating along the surface and growing in amplitude over time. The process is akin to that of the well-known reformation occurring at sufficiently strong quasi-parallel shocks. However, here the perturbations require at least two dimensions, show a strong spatial correlation, and travel along the shock surface. This process not only leads to enhanced ion acceleration, but also means that the shock characteristics are difficult to pinpoint, observationally: both the local jumps and the shock normal angle are highly variable

  12. Quasiperpendicular High Mach Number Shocks

    NASA Astrophysics Data System (ADS)

    Sulaiman, A. H.; Masters, A.; Dougherty, M. K.; Burgess, D.; Fujimoto, M.; Hospodarsky, G. B.

    2015-09-01

    Shock waves exist throughout the Universe and are fundamental to understanding the nature of collisionless plasmas. Reformation is a process, driven by microphysics, which typically occurs at high Mach number supercritical shocks. While ongoing studies have investigated this process extensively both theoretically and via simulations, their observations remain few and far between. In this Letter we present a study of very high Mach number shocks in a parameter space that has been poorly explored and we identify reformation using in situ magnetic field observations from the Cassini spacecraft at 10 AU. This has given us an insight into quasiperpendicular shocks across 2 orders of magnitude in Alfvén Mach number (MA ) which could potentially bridge the gap between modest terrestrial shocks and more exotic astrophysical shocks. For the first time, we show evidence for cyclic reformation controlled by specular ion reflection occurring at the predicted time scale of ˜0.3 τc , where τc is the ion gyroperiod. In addition, we experimentally reveal the relationship between reformation and MA and focus on the magnetic structure of such shocks to further show that for the same MA , a reforming shock exhibits stronger magnetic field amplification than a shock that is not reforming.

  13. Quasiperpendicular High Mach Number Shocks.

    PubMed

    Sulaiman, A H; Masters, A; Dougherty, M K; Burgess, D; Fujimoto, M; Hospodarsky, G B

    2015-09-18

    Shock waves exist throughout the Universe and are fundamental to understanding the nature of collisionless plasmas. Reformation is a process, driven by microphysics, which typically occurs at high Mach number supercritical shocks. While ongoing studies have investigated this process extensively both theoretically and via simulations, their observations remain few and far between. In this Letter we present a study of very high Mach number shocks in a parameter space that has been poorly explored and we identify reformation using in situ magnetic field observations from the Cassini spacecraft at 10 AU. This has given us an insight into quasiperpendicular shocks across 2 orders of magnitude in Alfvén Mach number (M_{A}) which could potentially bridge the gap between modest terrestrial shocks and more exotic astrophysical shocks. For the first time, we show evidence for cyclic reformation controlled by specular ion reflection occurring at the predicted time scale of ~0.3τ_{c}, where τ_{c} is the ion gyroperiod. In addition, we experimentally reveal the relationship between reformation and M_{A} and focus on the magnetic structure of such shocks to further show that for the same M_{A}, a reforming shock exhibits stronger magnetic field amplification than a shock that is not reforming.

  14. Particles Acceleration in Converged Shocks

    NASA Astrophysics Data System (ADS)

    Wang, Xin

    2016-07-01

    Observations show that there is a proton spectral ``break" with E_{break} at 1-10MeV in some large CME-driven shocks. However, the understanding of this energy spectral ``break" from the diffusive shock acceleration theory still remains uncertain. Although previous numerical methods can hardly predict this ``break" from current theoretical models due to high computational expense, the present paper focuses on simulating this energy spectrum in converged two shocks by Monte Carlo numerical method. Considering the Dec 13 2006 CME-driven shock interaction with an Earth bow shock, we examine whether the energy spectral ``break" could occur on an interaction between two shocks. As result, we indeed obtain the maximum proton energy up to 10MeV, and we further find a proton spectral ``break" appears distinctly at the energy ˜5MeV.

  15. Energetic ion acceleration at collisionless shocks

    NASA Technical Reports Server (NTRS)

    Decker, R. B.; Vlahos, L.

    1985-01-01

    An example is presented from a test particle simulation designed to study ion acceleration at oblique turbulent shocks. For conditions appropriate at interplanetary shocks near 1 AU, it is found that a shock with theta sub B n = 60 deg is capable of producing an energy spectrum extending from 10 keV to approx. 1 MeV in approx 1 hour. In this case total energy gains result primarily from several separate episodes of shock drift acceleration, each of which occurs when particles are scattered back to the shock by magnetic fluctuations in the shock vicinity.

  16. ANAPHYLACTIC SHOCK BY AZODYES

    PubMed Central

    Landsteiner, K.; van der Scheer, J.

    1933-01-01

    Experiments are described which show that anaphylactic shock can be induced in animals sensitized with azoproteins by injecting them with azodyes containing the same azo components as the sensitizing antigen. The anaphylactic reactions are specific and occur with quantities of the dyes as small as fractions of milligrams. PMID:19870151

  17. Rett syndrome and gastric perforation.

    PubMed

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  18. Use of porcine vaginal tissue ex-vivo to model environmental effects on vaginal mucosa to toxic shock syndrome toxin-1

    SciTech Connect

    Davis, Catherine C.; Baccam, Mekhine; Mantz, Mary J.; Osborn, Thomas W.; Hill, Donna R.; Squier, Christopher A.

    2014-01-15

    Menstrual toxic shock syndrome (mTSS) is a rare, recognizable, and treatable disease that has been associated with tampon use epidemiologically. It involves a confluence of microbial risk factors (Staphylococcus aureus strains that produce the superantigen—TSST-1), as well as environmental characteristics of the vaginal ecosystem during menstruation and host susceptibility factors. This paper describes a series of experiments using the well-characterized model of porcine vaginal mucosa ex-vivo to assess the effect of these factors associated with tampon use on the permeability of the mucosa. The flux of radiolabeled TSST-1 and tritiated water ({sup 3}H{sub 2}O) through porcine vaginal mucosa was determined at various temperatures, after mechanical disruption of the epithelial surface by tape stripping, after treatment with surfactants or other compounds, and in the presence of microbial virulence factors. Elevated temperatures (42, 47 and 52 °C) did not significantly increase flux of {sup 3}H{sub 2}O. Stripping of the epithelial layers significantly increased the flux of labeled toxin in a dose-dependent manner. Addition of benzalkonium chloride (0.1 and 0.5%) and glycerol (4%) significantly increased the flux of {sup 3}H{sub 2}O but sodium lauryl sulfate at any concentration tested did not. The flux of the labeled toxin was significantly increased in the presence of benzalkonium chloride but not Pluronic® L92 and Tween 20 and significantly increased with addition of α-hemolysin but not endotoxin. These results show that the permeability of porcine vagina ex-vivo to labeled toxin or water can be used to evaluate changes to the vaginal environment and modifications in tampon materials, and thus aid in risk assessment. - Highlights: • Model assessed local effects of tampon use on vaginal mucosa. • Risks were evaluated using two tracers to assess permeability in an ex vivo model. • Mechanical damage to the epithelial surface increased tracer penetration.

  19. Disseminated intravascular coagulation and the Waterhouse-Friderichsen syndrome

    PubMed Central

    Fox, B.

    1971-01-01

    In a clinico-pathological study of 13 children who died with Waterhouse-Friderichsen syndrome, there were deposits of fibrin in many organs, especially the adrenal glands and the kidneys. This finding supports the hypothesis that disseminated intravascular coagulation (DIC) occurs in this syndrome. The exact role that DIC plays has not been defined; though it probably contributes to the severe shock and the widespread haemorrhages; the adrenal haemorrhages appear not to be due directly to DIC. The presence of DIC in the Waterhouse-Friderichsen syndrome suggests that heparin should be a logical form of treatment. ImagesFIG. 1FIG. 2 PMID:5118056

  20. Down Syndrome

    MedlinePlus

    ... cells is caused by abnormal cell division after fertilization. Translocation Down syndrome. Down syndrome can also occur ... one option available for couples undergoing in vitro fertilization who are at increased risk of passing along ...

  1. Basic Shock Physiology and Critical Care.

    PubMed

    Roberts, Brian K

    2016-05-01

    Veterinarians practicing emergency medicine and/or working with exotic animals must be well versed in the pathophysiology of shock because many exotic pets present with an acute crisis or an acute manifestation of a chronic process causing poor organ perfusion. This article discusses the pathophysiology of shock and the systemic inflammatory response syndrome, which may lead to organ dysfunction, organ failure, sepsis, and death. The physiology of perfusion, perfusion measurements, categories of shock, and altered function of the immune system, gastrointestinal barrier, and coagulation system are discussed. Veterinarians providing emergency care to patients with shock must also be aware of comorbidities.

  2. Toxic Shock Syndrome (For Parents)

    MedlinePlus

    ... Looking for Health Lessons? Visit KidsHealth in the Classroom What Other Parents Are Reading Your Child's Development ( ... and better habits for using them, such as changing them often. The number of TSS cases dropped ...

  3. Toxic Shock Syndrome (For Teens)

    MedlinePlus

    ... of bacteria, Staphylococcus aureus (often called staph) and Streptococcus pyogenes (often called strep), with most cases related ... 3 days after an infection with Staphylococcus or Streptococcus , although this can vary depending on the infection. ...

  4. Toxic Shock Syndrome (For Parents)

    MedlinePlus

    ... Menstrual Problems Talking to Your Child About Menstruation Cellulitis MRSA Staph Infections What Are Germs? Why Is Hand Washing So Important? Pads and Tampons Cellulitis Osteomyelitis Tampons, Pads, and Other Period Supplies Can ...

  5. Naturally occurring chemical carcinogens

    USDA-ARS?s Scientific Manuscript database

    Natural products are chemicals found in nature which have unique pharmacological effects. Humans are exposed to many of these bioactive naturally occurring chemicals via the air breathed, the water drunk and the food eaten. Exposure also occurs in clinical settings. Naturally occurring chemicals ...

  6. Dependence of the Spectrum of Shock-Accelerated Ions on the Dynamics at the Shock Crossing

    NASA Astrophysics Data System (ADS)

    Gedalin, M.; Dröge, W.; Kartavykh, Y. Y.

    2016-12-01

    Diffusive shock acceleration (DSA) of ions occurs due to pitch-angle diffusion in the upstream and downstream regions of the shock and multiple crossing of the shock by these ions. The classical DSA theory implies continuity of the distribution at the shock transition and predicts a universal spectrum of accelerated particles, depending only on the ratio of the upstream and downstream fluid speeds. However, the ion dynamics at the shock front occurs within a collision-free region and is gyrophase dependent. The ions fluxes have to be continuous at the shock front. The matching conditions for the gyrophase-averaged distribution functions at the shock transition are formulated in terms of the transition and reflection probabilities. These probabilities depend on the shock angle and the magnetic compression as does the power spectrum of accelerated ions. Their spectral index is expressed in terms of the reflectivity. The spectrum is typically harder than the spectrum predicted by the classical DSA theory.

  7. Culture shock and travelers.

    PubMed

    Stewart, L; Leggat, P A

    1998-06-01

    As travel has become easier and more affordable, the number of people traveling has risen sharply. People travel for many and varied reasons, from the business person on an overseas assignment to backpackers seeking new and exotic destinations. Others may take up residence in different regions, states or countries for family, business or political reasons. Other people are fleeing religious or political persecution. Wherever they go and for whatever reason they go, people take their culture with them. Culture, like language, is acquired innately in early childhood and is then reinforced through formal and complex informal social education into adulthood. Culture provides a framework for interpersonal and social interactions. Therefore, the contact with a new culture is often not the exciting or pleasurable experience anticipated. When immersed in a different culture, people no longer know how to act when faced with disparate value systems. Contact with the unfamiliar culture can lead to anxiety, stress, mental illness and, in extreme cases, physical illness and suicide. "Culture shock" is a term coined by the anthropologist Oberg. It is the shock of the new. It implies that the experience of the new culture is an unpleasant surprise or shock, partly because it is unexpected and partly because it can lead to a negative evaluation of one's own culture. It is also known as cross-cultural adjustment, being that period of anxiety and confusion experienced when entering a new culture. It affects people intellectually, emotionally, behaviorally and physically and is characterized by symptoms of psychological distress. Culture shock affects both adults and children. In travelers or workers who have prolonged sojourns in foreign countries, culture shock may occur not only as they enter the new culture, but also may occur on their return to their original culture. Children may also experience readjustment problems after returning from leading sheltered lives in expatriate

  8. Shock drift mechanism for Forbush decreases

    NASA Technical Reports Server (NTRS)

    Cheng, Andrew F.; Sarris, E. T.; Dodopoulos, C.

    1990-01-01

    Consideration is given to the way in which Forbush decreases can arise from variable drifts in nonuniform shocks, where the variation in shock strength along the shock front causes both the shock drift distance and the energy gain to become variable. More particles can then be transported out of a given region of space and energy interval than were transported in, so a spacecraft passing through this region can observe a Forbush decrease in this energy interval despite shock energization and compression. A simple example of how this can occur is presented.

  9. Shock drift mechanism for Forbush decreases

    SciTech Connect

    Cheng, A.F.; Sarris, E.T.; Dodopoulos, C. Thrace Democritus Univ., Xanthe )

    1990-02-01

    Consideration is given to the way in which Forbush decreases can arise from variable drifts in nonuniform shocks, where the variation in shock strength along the shock front causes both the shock drift distance and the energy gain to become variable. More particles can then be transported out of a given region of space and energy interval than were transported in, so a spacecraft passing through this region can observe a Forbush decrease in this energy interval despite shock energization and compression. A simple example of how this can occur is presented. 20 refs.

  10. [Extracorporeal shock wave lithotripsy for ureteral stone in patient with implanted cardiac pacemaker: a case report].

    PubMed

    Kato, Yuji; Hou, Kyokushin; Hori, Junichi; Taniguchi, Narumi; Yamaguchi, Satoshi; Yachiku, Sunao; Azumi, Makoto; Osanai, Hiroaki

    2003-09-01

    We report a case of extracorporeal shock wave lithotripsy (SWL) for ureteral stone in patient with implanted cardiac pacemaker. A 68-year-old woman was admitted to our hospital for left back pain due to left single ureteral stone (13 x 7 mm) in 2002. A permanent cardiac pacemaker has been implanted for sick sinus syndrome in 1997. After evaluation for cardiac function and pacemaker function by a cardiologist and a pacemaker technician, SWL (MFL 5000, Dornier) was performed without changing pacemaker mode (DDD mode). Shock waves were incorrectly exposed a few time triggered by arterial pacing amplitude, but no cardiovascular event or malfunction of the pacemaker was occurred during or after SWL. The ureteral stone was successfully fragmented with 2,400 shock waves (24 kV) and the fragments were delivered immediately.

  11. SUPPRESSIVE AND FACILITATIVE EFFECTS OF SHOCK INTENSITY AND INTERRESPONSE TIMES FOLLOWED BY SHOCK

    PubMed Central

    Everly, Jessica B.; Perone, Michael

    2012-01-01

    Although response-dependent shock often suppresses responding, response facilitation can occur. In two experiments, we examined the suppressive and facilitative effects of shock by manipulating shock intensity and the interresponse times that produced shock. Rats' lever presses were reinforced on a variable-interval 40-s schedule of food presentation. Shock followed either long or short interresponse times. Shock intensity was raised from 0.05 mA to 0.4 mA or 0.8 mA. Overall, shock contingent on long interresponse times punished long interresponse times and increased response rates. Shock contingent on short interresponse times punished short interresponse times and decreased response rates. In Experiment 1, raising the range of interresponse times that produced shock enhanced these effects. In Experiment 2, the effects of shock intensity depended on the interresponse times that produced shock. When long interresponse times produced shock, low intensities increased response rates. High intensities decreased response rates. When short interresponse times produced shock, high shock intensities punished short interresponse times and decreased response rates more than low intensities. The results may explain why punishment procedures occasionally facilitate responding and establish parameters for future studies of punishment. PMID:23144508

  12. Sarcoidosis Occurring After Lymphoma

    PubMed Central

    London, Jonathan; Grados, Aurélie; Fermé, Christophe; Charmillon, Alexandre; Maurier, François; Deau, Bénédicte; Crickx, Etienne; Brice, Pauline; Chapelon-Abric, Catherine; Haioun, Corinne; Burroni, Barbara; Alifano, Marco; Le Jeunne, Claire; Guillevin, Loïc; Costedoat-Chalumeau, Nathalie; Schleinitz, Nicolas; Mouthon, Luc; Terrier, Benjamin

    2014-01-01

    Abstract Sarcoidosis is a granulomatous disease that most frequently affects the lungs with pulmonary infiltrates and/or bilateral hilar and mediastinal lymphadenopathy. An association of sarcoidosis and lymphoproliferative disease has previously been reported as the sarcoidosis-lymphoma syndrome. Although this syndrome is characterized by sarcoidosis preceding lymphoma, very few cases of sarcoidosis following lymphoma have been reported. We describe the clinical, biological, and radiological characteristics and outcome of 39 patients presenting with sarcoidosis following lymphoproliferative disease, including 14 previously unreported cases and 25 additional patients, after performing a literature review. Hodgkin lymphoma and non-Hodgkin lymphoma were equally represented. The median delay between lymphoma and sarcoidosis was 18 months. Only 16 patients (41%) required treatment. Sarcoidosis was of mild intensity or self-healing in most cases, and overall clinical response to sarcoidosis was excellent with complete clinical response in 91% of patients. Sarcoidosis was identified after a follow-up computerized tomography scan (CT-scan) or 18fluorodeoxyglucose-positron emission tomography/computerized tomography (18FDG-PET/CT) evaluation in 18/34 patients (53%). Sarcoidosis is therefore a differential diagnosis to consider when lymphoma relapse is suspected on a CT-scan or 18FDG-PET/CT, emphasizing the necessity to rely on histological confirmation of lymphoma relapse. PMID:25380084

  13. Bow Shocks in Space

    NASA Image and Video Library

    2016-01-05

    Bow shocks thought to mark the paths of massive, speeding stars are highlighted in these images from NASA's Spitzer Space Telescope and Wide-field Infrared Survey Explorer, or WISE. Cosmic bow shocks occur when massive stars zip through space, pushing material ahead of them in the same way that water piles up in front of a race boat. The stars also produce high-speed winds that smack into this compressed material. The end result is pile-up of heated material that glows in infrared light. In these images, infrared light has been assigned the colored red. Green shows wispy dust in the region and blue shows stars. The two images at left are from Spitzer, and the one on the right is from WISE. The speeding stars thought to be creating the bow shocks can be seen at the center of each arc-shaped feature. The image at right actually consists of two bow shocks and two speeding stars. All the speeding stars are massive, ranging from about 8 to 30 times the mass of our sun. http://photojournal.jpl.nasa.gov/catalog/PIA20062

  14. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius.

    PubMed

    Taheri, Parisa; Vahdatpour, Babak; Andalib, Somayeh

    2016-01-01

    The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle. In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment. One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment). According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results.

  15. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius

    PubMed Central

    Taheri, Parisa; Vahdatpour, Babak; Andalib, Somayeh

    2016-01-01

    Background: The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle. Materials and Methods: In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment. Results: One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment). Conclusion: According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results. PMID:27656607

  16. Quasi-perpendicular shocks: Length scale of the cross-shock potential, shock reformation, and implication for shock surfing

    NASA Astrophysics Data System (ADS)

    Scholer, Manfred; Shinohara, Iku; Matsukiyo, Shuichi

    2003-01-01

    One-dimensional (1-D) full particle simulations of almost perpendicular supercritical collisionless shocks are presented. The ratio of electron plasma frequency ωpe to gyrofrequency Ωce, the ion to electron mass ratio, and the ion and electron β (β = plasma to magnetic field pressure) have been varied. Due to the accumulation of specularly reflected ions upstream of the shock, ramp shocks can reform on timescales of the gyroperiod in the ramp magnetic field. Self-reformation is not a low ωpe/Ωce process but occurs also in (ωpe/Ωce)2 ≫ 1, low β simulations. Self-reformation also occurs in low ion β runs with an ion to electron mass ratio mi/me = 1840. However, in the realistic mass ratio runs, an electromagnetic instability is excited in the foot of the shock, and the shock profile is considerably changed compared to lower mass ratio runs. Linear analysis based on three-fluid theory (incident ions, reflected ions, and electrons) indicates that the instability is a modified two-stream instability between the decelerated solar wind electrons and the solar wind ions on the whistler mode branch. In the reforming low ion β shocks, part of the potential drop occurs at times across the foot, and part of the potential (˜40%) occurs over a few (˜4) electron inertial lengths in the steepened up ramp. Self-reformation is a low ion β process and disappears for a Mach 4.5 shock at/or above βi ≈ 0.4. It is argued that the ion thermal velocity has to be an order of magnitude smaller than the shock velocity in order for reformation to occur. Since according to these simulations only part of the potential drop occurs for relatively short times over a few electron inertial lengths, it is concluded that coherent shock surfing is not an efficient acceleration mechanism for pickup ions at the low β heliospheric termination shock.

  17. Cellular Alterations in Shock and Ischemia and Their Correction.

    ERIC Educational Resources Information Center

    Chaudry, Irshad H.

    1985-01-01

    Reviews recent advances in cellular alterations in shock to help physicians and physiologists keep abreast of current research. Specifically addresses changes occurring as a result of hemorrhagic shock and possible ways such lesions could be corrected. (DH)

  18. Shock normal determination for multiple-ion shocks

    NASA Technical Reports Server (NTRS)

    Kessel, R. L.; Coates, A. J.; Motschmann, U.; Neubauer, F. M.

    1994-01-01

    We have adapted the single-ion Vinas and Scudder (1986) solution to the Rankine-Hugoniot (R-H) problem to a multiple-on solution. Using this technique, we can calculate a shock normal direction, shock speed, best estimate of the upstream and downstream magnetic field and plasma asymptotic states, and theta(sub Bn), the angle between the shock normal and the upstream magnetic field. We test the multi-ion solution with a theoretical case but are restricted to a perpendicular shock in order to close the multi-ion Rankine-Hugoniot equations. For this test case both single-ion and multi-ion solutions are equally valid. We examine parameter regimes to look for differences between single-ion and multi-ion solutions of the R-H equations, and we find that the largest differences occur for quasi-parallel shocks, small values of solar wind speed, large values of heavy ion density, and very strong and very weak shocks. For both the inbound and outbound crossing of comet Halley we have a slow solar wind speed, small values of water group ions and fairly weak shocks. We examine both the quasi-perpendicular inbound crossing and the quasi-parallel outbound crossing at comet Halley.

  19. Identification of functional antigenic segments of toxic shock syndrome toxin 1 by differential immunoreactivity and by differential mitogenic responses of human peripheral blood mononuclear cells, using active toxin fragments.

    PubMed Central

    Edwin, C; Kass, E H

    1989-01-01

    When toxic shock syndrome toxin 1 was subjected to papain hydrolysis, two serologically active fragments of 16.3 kilodaltons (16K fragment) and 12.4 kilodaltons (12K fragment) were generated, whereas a third fragment of 9.7 kilodaltons (10K fragment) was inactive. The biologic activities of the fragments were evaluated in vitro by determining their ability to promote nonspecific proliferation of human peripheral blood mononuclear cells. The 12K fragment was significantly (P less than or equal to 0.013) more stimulatory than the 16K fragment. When human peripheral blood mononuclear cells were preincubated for a period of 24 h with various concentrations of the 16K fragment, followed by incubation with a constant amount (2 x 10(-2) ng/ml) of whole toxin, the level of DNA synthesis induced by the holotoxin was reduced by approximately 60% when compared with that of controls exposed to whole toxin alone. The 12K fragment did not demonstrate a similar blocking effect. Immunoblots of the toxic shock syndrome toxin 1 digest, which were exposed to monoclonal antibodies (MAbs) developed against native toxin, depicted the presence of two different antigenic regions (epitopes). One MAb, 8-5-7, which has been shown previously to inhibit the biologic activity of the holotoxin in vitro and in vivo, reacted primarily with the 12K fragment. A second MAb, 10-6-1, that did not neutralize interleukin-1 production reacted primarily with the 16K fragment. On the basis of the differential mitogenic responses and the identification of heterologous epitopes, it was concluded that the functional region of the holotoxin can be partitioned into at least two functional segments encompassed between amino acid residues 53 and 87 and between amino acid residues 88 and 194 on the polypeptide chain. Images PMID:2731989

  20. Chondrule Destruction in Nebular Shocks

    NASA Astrophysics Data System (ADS)

    Jacquet, Emmanuel; Thompson, Christopher

    2014-12-01

    Chondrules are millimeter-sized silicate spherules ubiquitous in primitive meteorites, but whose origin remains mysterious. One of the main proposed mechanisms for producing them is melting of solids in shock waves in the gaseous protoplanetary disk. However, evidence is mounting that chondrule-forming regions were enriched in solids well above solar abundances. Given the high velocities involved in shock models, destructive collisions would be expected between differently sized grains after passage of the shock front as a result of differential drag. We investigate the probability and outcome of collisions of particles behind a one-dimensional shock using analytic methods as well as a full integration of the coupled mass, momentum, energy, and radiation equations. Destruction of protochondrules seems unavoidable for solid/gas ratios epsilon >~ 0.1, and possibly even for solar abundances because of "sandblasting" by finer dust. A flow with epsilon >~ 10 requires much smaller shock velocities (~2 versus 8 km s-1) in order to achieve chondrule-melting temperatures, and radiation trapping allows slow cooling of the shocked fragments. Initial destruction would still be extensive; although re-assembly of millimeter-sized particles would naturally occur by grain sticking afterward, the compositional heterogeneity of chondrules may be difficult to reproduce. We finally note that solids passing through small-scale bow shocks around few kilometer-sized planetesimals might experience partial melting and yet escape fragmentation.

  1. Chondrule destruction in nebular shocks

    SciTech Connect

    Jacquet, Emmanuel; Thompson, Christopher

    2014-12-10

    Chondrules are millimeter-sized silicate spherules ubiquitous in primitive meteorites, but whose origin remains mysterious. One of the main proposed mechanisms for producing them is melting of solids in shock waves in the gaseous protoplanetary disk. However, evidence is mounting that chondrule-forming regions were enriched in solids well above solar abundances. Given the high velocities involved in shock models, destructive collisions would be expected between differently sized grains after passage of the shock front as a result of differential drag. We investigate the probability and outcome of collisions of particles behind a one-dimensional shock using analytic methods as well as a full integration of the coupled mass, momentum, energy, and radiation equations. Destruction of protochondrules seems unavoidable for solid/gas ratios ε ≳ 0.1, and possibly even for solar abundances because of 'sandblasting' by finer dust. A flow with ε ≳ 10 requires much smaller shock velocities (∼2 versus 8 km s{sup –1}) in order to achieve chondrule-melting temperatures, and radiation trapping allows slow cooling of the shocked fragments. Initial destruction would still be extensive; although re-assembly of millimeter-sized particles would naturally occur by grain sticking afterward, the compositional heterogeneity of chondrules may be difficult to reproduce. We finally note that solids passing through small-scale bow shocks around few kilometer-sized planetesimals might experience partial melting and yet escape fragmentation.

  2. [Anaphylactic shock].

    PubMed

    Müller-Werdan, U; Werdan, K

    2000-02-25

    IgE-dependent and IgE-independent hypersensitivity reactions, the latter due to physical, chemical or hyperosmolar stimuli, may evolve as anaphylaxis or an anaphylactoid reaction, by an escalating release of mediators from mast cells and basophils. Without immediate treatment, anaphylaxis goes along with substantial morbidity (shock, multiple organ failure) and mortality; within minutes this explosive clinical response can be fatal. The severity of anaphylactic/anaphylactoid reactions is graded from stages 0 to IV in order to guide the management of this disease, stage III corresponding to anaphylactic shock. Severe anaphylactic reactions may take a progressive course despite adequate therapy; even in the case of an initial favourable response to treatment measures life-threatening symptoms may recur; there may be late-phase reactions 6 to 12 hours after the initial reaction. For the initial emergency management a differentiation between IgE-mediated and IgE-independent anaphylactoid reactions is not required. These are the pertinent principles of therapy in hypotensive and hypoxic patients: removal of the likely noxious agent at the site of introduction, provision of a patent airway, 100% oxygen supplementation, intravenous fluid therapy and pharmacological support with catecholamines. After primary care the monitoring and therapy of the patient with anaphylactic shock has to be continued on the intensive care unit. Guidelines for management of acute anaphylaxis referring to both the stage of disease including shock and the main clinical manifestation (cutaneous, pulmonary, cardiovascular) have been established by a German interdisciplinary consensus conference and were published in 1994; consensus guidelines for emergency medical treatment have been communicated by the ILCOR (1997) and the Project Team of the Resuscitation Council (UK) (1999).

  3. Septic shock in canine babesiosis.

    PubMed

    Matijatko, Vesna; Kis, Ivana; Torti, Marin; Brkljacić, Mirna; Kucer, Nada; Rafaj, Renata Barić; Grden, Darko; Zivicnjak, Tanja; Mrljak, Vladimir

    2009-06-10

    The records of all canine patients (86) that had been diagnosed with babesiosis and that were admitted to the Clinic for Internal Diseases, Faculty of Veterinary Medicine, Zagreb from January 2007 to December 2007 were reviewed retrospectively. All dogs that had been diagnosed with canine babesiosis and that had systemic inflammatory response syndrome (SIRS) followed by multiple organ dysfunction syndrome (MODS), and refractory hypotension, were included in this study. Of 86 patients diagnosed with canine babesiosis that were admitted during the study period, 10 had evidence of septic shock and were included in this study. Seven of the 10 dogs had a level of parasitaemia above 1%, with the highest level being 20.2%, seven of the 10 dogs were anaemic and three of the 10 dogs were leucopoenic. Thrombocytopenia was present in nine dogs. Hypoglycaemia was noted in two dogs, and bilirubinaemia in nine dogs. Four patients had involvement of two organs, five had involvement of three organs, and one had involvement of four organs. The organ that was most frequently involved was the kidney (nine cases). Central nervous system dysfunction was the rarest complication noted (one case). The mortality rate in non-septic shock canine babesiosis was 2.6%. All dogs that developed septic shock died between the first and the fourth day after admission. The 100% mortality rate that is reported here reflects the fact that in cases in which progression of the inflammatory response leads to the development of septic shock, an unfavourable outcome should be expected.

  4. Shock Isolation on Planet Mars

    NASA Astrophysics Data System (ADS)

    Kletz, Bjorn T.; Melcher, Jorg

    2014-06-01

    In 2016 the 'InSight' mission will be launched towards planet Mars. Within parts of this mission, sensitive electronics have to be isolated for occurring shocks, as these components are hammered into the Martian soil. A mechanical shock isolation interface - that is based on patented double spiral springs - is integrated into the hammering structure to protect the integrated electronics from the harmful peak accelerations.This paper starts with introducing the theoretical background for the development of such devices and continues with the description and analysis of the actually implemented interface version. Additionally, this paper describes the used mechanism to protect the system during launch. Measurements during the hammering process and the penetration of Mars-like soil prove the effectiveness of the described shock isolation device in real conditions. Finally, this paper highlights the achieved extreme shock reduction performance that reduces the critical accelerations by factor 127 with this novel device.

  5. Dehydration kinetics of shocked serpentine

    NASA Technical Reports Server (NTRS)

    Tyburczy, James A.; Ahrens, Thomas J.

    1988-01-01

    Experimental rates of dehydration of shocked and unshocked serpentine were determined using a differential scanning calorimetric technique. Dehydration rates in shocked serpentine are enhanced by orders of magnitude over corresponding rates in unshocked material, even though the impact experiments were carried out under conditions that inhibited direct impact-induced devolatilization. Extrapolation to temperatures of the Martian surface indicates that dehydration of shocked material would occur 20 to 30 orders of magnitude more rapidly than for unshocked serpentine. The results indicate that impacted planetary surfaces and associated atmospheres would reach chemical equilibrium much more quickly than calculations based on unshocked material would indicate, even during the earliest, coldest stages of accretion. Furthermore, it is suggested that chemical weathering of shocked planetary surfaces by solid-gas reactions would be sufficiently rapid that true equilibrium mineral assemblages should form.

  6. Shock compression of liquid hydrazine

    SciTech Connect

    Garcia, B.O.; Chavez, D.J.

    1996-05-01

    Liquid hydrazine (N{sub 2}H{sub 4}) is a propellant used for aerospace propulsion and power systems. Because the propellant modules can be subject to debris impacts during their use, the shock states that can occur in the hydrazine need to be characterized to safely predict its response. Several shock compression experiments have been conducted to investigate the shock detonability of liquid hydrazine; however, the experiments{close_quote} results disagree. Therefore, in this study, we reproduced each experiment numerically to evaluate in detail the shock wave profiles generated in the liquid hydrazine. This paper presents the results of each numerical simulation and compares the results to those obtained in experiment. {copyright} {ital 1996 American Institute of Physics.}

  7. Observations of shock acceleration processes in the solar wind

    NASA Technical Reports Server (NTRS)

    Scholer, M.

    1986-01-01

    Substantial evidence was accumulated over more than two decades that ion acceleration occurs at all collisionless shocks sampled directly in the solar system. The various shock waves in the heliosphere and the associated energetic particle phenomena are shown schematically. Three shocks have attracted considerable attention in recent years: corotating shocks due to the interaction of fast and slow solar wind streams during solar minimum, travelling interplanetary shocks due to coronal mass ejections, and planetary bow shocks. The signatures of these shocks and of their energetic particles are briefly reviewed. The most prominent theoretical models for shock acceleration are also reviewed. Recent observations at the earth's bow shock and at quasi-parallel interplanetary shocks are discussed in detail.

  8. [Definition of shock types].

    PubMed

    Adams, H A; Baumann, G; Gänsslen, A; Janssens, U; Knoefel, W; Koch, T; Marx, G; Müller-Werdan, U; Pape, H C; Prange, W; Roesner, D; Standl, T; Teske, W; Werner, G; Zander, R

    2001-11-01

    Definitions of shock types. Hypovolaemic shock is a state of insufficient perfusion of vital organs with consecutive imbalance of oxygen supply and demand due to an intravascular volume deficiency with critically impaired cardiac preload. Subtypes are haemorrhagic shock, hypovolaemic shock in the narrow sense, traumatic-haemorrhagic shock and traumatic-hypovolaemic shock. Cardiac shock is caused by a primary critical cardiac pump failure with consecutive inadequate oxygen supply of the organism. Anaphylactic shock is an acute failure of blood volume distribution (distributive shock) and caused by IgE-dependent, type-I-allergic, classical hypersensibility, or a physically, chemically, or osmotically induced IgE-independent anaphylactoid hypersensibility. The septic shock is a sepsis-induced distribution failure of the circulating blood volume in the sense of a distributive shock. The neurogenic shock is a distributive shock induced by generalized and extensive vasodilatation with consecutive hypovolaemia due to an imbalance of sympathetic and parasympathetic regulation of vascular smooth muscles.

  9. "Naturally occurring asbestos

    NASA Astrophysics Data System (ADS)

    Cagnard, F.; Lahondère, D.; Blein, O.; Lahfid, A.; Wille, G.

    2012-04-01

    The term asbestos refers to six silicate minerals from amphibole and serpentine groups. By definition, it consists in bundles of thin and flexible long fibers, with high-tensile strength, and chemical and heat resistance. In contrast to asbestos found within commercial products and mining, the specific term ''naturally occurring asbestos'' (NOA) refers to asbestiform minerals occurring within rocks or soils that can be released by human activities or weathering processes. The fact that the exposure to asbestos is related to lung pathologies is now widely demonstrated (e.g. asbestosis, mesothelioma and lung cancer). However, if health risks associated with exposure to NOA exist, they are not yet well documented. The crystallization of natural asbestos occurs in specific Mg-rich lithologies associated with peculiar structural and metamorphic conditions. By recognizing and combining such specific geologic criteria, the presence or the absence of asbestos in bedrock terrains can be reasonably predicted and maps of NOA hazard can be drawn. We present here new results of geological mapping and petrological study concerning the evaluation of the NOA hazard in the Alps and Corsica, in France. The three folds approach consists in (1) a determination of lithologies with potential NOA from a bibliographic compilation and extraction of target zones from a geological geodatabase (2) a geological mapping of the target zones followed by a petrological characterization of sampled asbestiform minerals in the laboratory (optical microscopy, TEM, SEM, and Raman spectroscopy technics), and (3) the drawing of the final map of NOA hazard, at regional-scale. Occurrence criteria can be retained as follows: 1. NOA are abundant in the internal zones of the Alps and Corsica, especially within ophiolitic complexes. Natural asbestos are mostly concentrated within ultramafic rocks but can also occur within basic lithologies such as Mg-metagabbros, metabasalts and meta-pillow-lavas, 2. Asbestos

  10. [Shock: concepts for a definition].

    PubMed

    Poderoso, J J; Carreras, M C; Lisdero, C; Schöpfer, F; Riobó, N; Peralta, J

    1998-01-01

    The shock syndrome has been classically considered as a consequence of both decreased tissue perfusion and O2 supply; however, in some types of shock like septic or traumatic ones, regional blood flows may be increased. A decade ago, mitochondrial alterations consistent with uncoupling of oxidative phosphorylation were reported in either endotoxemic or hemorrhagic experimental shock or in humans. Recently, the discovery of nitric oxide (NO) and its increase in the shock state, has opened new perspectives in the understanding of this problem. Nitric oxide produces vasodilatation and, at the same time, increases the mitochondrial production of O2 active species like superoxide anion. Both radicals react to form a strong oxidant that is able to nitrate the phenolic rings of proteins: peroxynitrite. This effect leads to the impairment of the activities of different mitochondrial enzymes like succinate dehydrogenase and ATPase and the mitochondrial function and finally, to decreased energy levels and to multiorgan failure. The increase in NO release is due to the effects of circulating peptides and of increased adhesion of neutrophils to the endothelium and to the positive effects of inflammatory mediators like TNF-alpha and cytokines on inducible NOS (iNOS) expression in endothelium and tissues. It is suggested that the shock state is the consequence of an imbalance between NO and O2 and their metabolites.

  11. Geomagnetic avtivity triggered by interplanetary shocks: The shock impact angle as a controlling factor

    NASA Astrophysics Data System (ADS)

    Oliveira, D. M.; Raeder, J.; Tsurutani, B.; Gjerloev, J. W.

    2015-12-01

    We study the influence of interplanetary (IP) shock impact angles in the shock geoeffectiveness focusing on simulations and observations. In our simulations, we use OpenGGCM simulations to study the magnetospheric and ionospheric responses to shock impacts. Three cases are presented here: two inclined shocks, with 3.7 and 7.4 Mach numbers, and a frontal shock, whose shock normal is along the Sun-Earth line, with Mach number of 7.4. We find that, in the two inclined cases, due to the north-south asymmetry, the magnetotail is deflected southward, leading to a mild compression. The geomagnetic activity observed in the nightside ionosphere is then weak. On the other hand, in the head-on case, the magnetotail is compressed from both sides symmetrically. This compression triggers a substorm. By comparing the strong inclined shock and the frontal shock, we find that, despite the inclined shock having a larger Mach number, the frontal shock leads to a larger geomagnetic response in the nightside ionosphere. As a result, we conclude that IP shocks with similar upstream conditions, such as Mach number, can have different geoeffectiveness, depending on their shock normal orientation. In our observational study, we present a survey of IP shocks at 1 AU using Wind and ACE satellite data from Jan 1995 to Dec 2013 to study the same shock-related effects. A shock list covering one and a half solar cycle is compiled. We use data from SuperMAG, a large chain with more than 300 geomagnetic stations, to study geoeffectiveness triggered by IP shocks. The SuperMAG SML index (enhanced AL index), is used to quantify substorm strength. The jumps of the SML index triggered by shock impacts is investigated in terms of shock orientation and speed. We find that, in general, strong and almost frontal shocks are more geoeffective than inclined shocks with low speed. The highest correlations (R = 0.78) occurs for fixed shock speed and varying the shock impact angle. We attribute this result

  12. Multiple shocks

    NASA Astrophysics Data System (ADS)

    Shenker, Stephen H.; Stanford, Douglas

    2014-12-01

    Using gauge/gravity duality, we explore a class of states of two CFTs with a large degree of entanglement, but with very weak local two-sided correlation. These states are constructed by perturbing the thermofield double state with thermal-scale operators that are local at different times. Acting on the dual black hole geometry, these perturbations create an intersecting network of shock waves, supporting a very long wormhole. Chaotic CFT dynamics and the associated fast scrambling time play an essential role in determining the qualitative features of the resulting geometries.

  13. Diffuse alveolar haemorrhage and severe hypoxemia from Strongyloides stercoralis hyperinfection syndrome.

    PubMed

    El-Sameed, Yaser Abu; Beejay, Nigel; Al Maashari, Rehab

    2015-10-01

    Strongyloides stercoralis hyperinfection syndrome is a rare, yet highly fatal disorder. It occurs most commonly in immunocompromised patients. We report a case of a 36-year-old Ethiopian female who presented with abdominal pain and hypotension. Shortly thereafter, she developed acute respiratory failure and progressed to acute respiratory distress syndrome and septic shock. She was found to have diffuse alveolar hemorrhage due to disseminated strongyloidiasis. We discuss the clinical condition of Strongyloides hyperinfection syndrome presenting with severe hypoxemia and complicated by severe diffuse alveolar hemorrhage leading to death. Similar cases in the literature are also describe. © 2014 John Wiley & Sons Ltd.

  14. Porcine Reproductive and Respiratory Syndrome Virus Replicase - Isoforms of Nonstructural Protein 2 and Interaction with Heat Shock 70kDa Protein 5

    USDA-ARS?s Scientific Manuscript database

    The nsp2 replicase protein of porcine reproductive and respiratory syndrome virus (PRRSV), when expressed independently, was recently demonstrated to be processed from its precursor by the PL2 protease at or near the G**1196|G**1197 dipeptide in transfected CHO cells. The proteolytic cleavage of nsp...

  15. Dimension limit for thermal shock failure

    NASA Astrophysics Data System (ADS)

    Shao, Y. F.; Liu, Q. N.; Tian, H. J.; Lin, Z. K.; Xu, X. H.; Song, F.

    2014-08-01

    We analytically present the characteristic dimensional limit below which the thermal shock failure of ceramics never occurs. This limit, together with the critical temperature difference, separates the state space of the ceramics under thermal shock into two parts - the cracked and the uncracked. Based on the water-quench tests of ceramics, we experimentally proved that when the states of ceramics are in the uncracked region, the ceramics do not produce any cracks during thermal shock. The results provide a guide to prevent thermal shock failure in ceramic.

  16. Naturally occurring insecticides.

    PubMed Central

    Soloway, S B

    1976-01-01

    Naturally occurring insecticides are abundant and varied in their effects, though but a few are articles of commerce. Even for these, pyrethrum, nicotine, rotenone, hellebore, ryania, and sabadilla, there is a paucity of information on mammalian toxicology and environmental effects. In general, these materials are characterized favorably by low acute toxicity and ready dissipation in nature. Unfavorable aspects of natural insecticides are the contained mixture of active and inactive components and the low active ingredient content on a crop yield basis pointing to a high unit cost. Natural insecticides can serve additionally as leads to unnatural mimics, of which the commercially successful synthetic pyrethroids are prime examples. The chemical nature, relationship of insecticidal activity to chemical structure, occurrence, production, and utilization, registered uses, metabolism, and insect and mammalian toxicity are reviewed. PMID:789058

  17. Shock Prevention

    NASA Technical Reports Server (NTRS)

    1978-01-01

    The electrician pictured is installing a General Electric Ground Fault Interrupter (GFI), a device which provides protection against electrical shock in the home or in industrial facilities. Shocks due to defective wiring in home appliances or other electrical equipment can cause severe burns, even death. As a result, the National Electrical Code now requires GFIs in all new homes constructed. This particular type of GFI employs a sensing element which derives from technology acquired in space projects by SCI Systems, Inc., Huntsville, Alabama, producer of sensors for GE and other manufacturers of GFI equipment. The sensor is based on the company's experience in developing miniaturized circuitry for space telemetry and other spacecraft electrical systems; this experience enabled SCI to package interruptor circuitry in the extremely limited space available and to produce sensory devices at practicable cost. The tiny sensor measures the strength of the electrical current and detects current differentials that indicate a fault in the functioning of an electrical system. The sensing element then triggers a signal to a disconnect mechanism in the GFI, which cuts off the current in the faulty circuit.

  18. Standing shocks in a rotating channel

    NASA Astrophysics Data System (ADS)

    Jacobson, Tivon E.; Tabak, Esteban G.

    2004-10-01

    This paper discusses the stationary shallow water shocks occurring in a reentrant rotating channel with wind stress and topography. Asymptotic predictions for the shock location, strength, and associated energy dissipation are developed by taking the topographic perturbation to be small. It is shown that under appropriate conditions, a mean flow develops under the action of the wind stress, with a transverse profile determined by the need to support stationary shocks. The scaling arguments for the asymptotics are developed by demanding integrated energy and momentum balance, with the result that the free surface perturbation is of the order of the square root of the topographic perturbation. Shock formation requires that linear waves be nondispersive, which sets a solvability condition on the mean flow and which leads to a class of generalized Kelvin waves. Two-dimensional shock-resolving numerical simulations validate the asymptotic expressions and demonstrate the presence of stationary separated flow shocks in some cases.

  19. Culture Shock as a Barrier to Intercultural Business Communication.

    ERIC Educational Resources Information Center

    Waltman, John L.

    The phenomenon of culture shock as it affects intercultural business communication is examined. The symptoms of the syndrome and its effects on the business traveler and his/her business are discussed. Flaws in current training that increase rather than reduce the impact of culture shock are explored. It is suggested that much training prepares…

  20. Hypovolemic shock resuscitation.

    PubMed

    Kobayashi, Leslie; Costantini, Todd W; Coimbra, Raul

    2012-12-01

    Several changes in the way patients with hemorrhagic shock are resuscitated have occurred over the past decades, including permissive hypotension, minimal crystalloid resuscitation, earlier blood transfusion, and higher plasma and platelet-to-red cell ratios. Hemostatic adjuncts, such as tranexamic acid and prothrombin complex, and the use of new methods of assessing coagulopathy are also being incorporated into resuscitation of the bleeding patient. These ideas have been incorporated by many trauma centers into institutional massive transfusion protocols, and adoption of these protocols has resulted in improvements in mortality and morbidity. This article discusses each of these new resuscitation strategies and the evidence supporting their use.

  1. Geometrical shock dynamics of fast magnetohydrodynamic shocks

    NASA Astrophysics Data System (ADS)

    Mostert, Wouter; Pullin, Dale I.; Samtaney, Ravi; Wheatley, Vincent

    2016-11-01

    We extend the theory of geometrical shock dynamics (GSD, Whitham 1958), to two-dimensional fast magnetohydrodynamic (MHD) shocks moving in the presence of nonuniform magnetic fields of general orientation and strength. The resulting generalized area-Mach number rule is adapted to MHD shocks moving in two spatial dimensions. A partially-spectral numerical scheme developed from that of Schwendeman (1993) is described. This is applied to the stability of plane MHD fast shocks moving into a quiescent medium containing a uniform magnetic field whose field lines are inclined to the plane-shock normal. In particular, we consider the time taken for an initially planar shock subject to an initial perturbed magnetosonic Mach number distribution, to first form shock-shocks. Supported by KAUST OCRF Award No. URF/1/2162-01.

  2. An Introduction to the Physics of Collisionless Shocks

    SciTech Connect

    Russell, C.T.

    2005-08-01

    Collisionless shocks are important in astrophysical, heliospheric and magnetospheric settings. They deflect flows around obstacles; they heat the plasma, and they alter the properties of the flow as it intersects those obstacles. The physical processes occurring at collisionless shocks depend on the Mach number (strength) and beta (magnetic to thermal pressure) of the shocks and the direction of the magnetic field relative to the shock normal. Herein we review how the shock has been modeled in numerical simulations, the basic physical processes at work, including dissipation and thermalization, the electric potential drop at the shock, and the formation of the electron and ion foreshocks.

  3. Naturally Occurring Food Toxins

    PubMed Central

    Dolan, Laurie C.; Matulka, Ray A.; Burdock, George A.

    2010-01-01

    Although many foods contain toxins as a naturally-occurring constituent or, are formed as the result of handling or processing, the incidence of adverse reactions to food is relatively low. The low incidence of adverse effects is the result of some pragmatic solutions by the US Food and Drug Administration (FDA) and other regulatory agencies through the creative use of specifications, action levels, tolerances, warning labels and prohibitions. Manufacturers have also played a role by setting limits on certain substances and developing mitigation procedures for process-induced toxins. Regardless of measures taken by regulators and food producers to protect consumers from natural food toxins, consumption of small levels of these materials is unavoidable. Although the risk for toxicity due to consumption of food toxins is fairly low, there is always the possibility of toxicity due to contamination, overconsumption, allergy or an unpredictable idiosyncratic response. The purpose of this review is to provide a toxicological and regulatory overview of some of the toxins present in some commonly consumed foods, and where possible, discuss the steps that have been taken to reduce consumer exposure, many of which are possible because of the unique process of food regulation in the United States. PMID:22069686

  4. Naturally occurring food toxins.

    PubMed

    Dolan, Laurie C; Matulka, Ray A; Burdock, George A

    2010-09-01

    Although many foods contain toxins as a naturally-occurring constituent or, are formed as the result of handling or processing, the incidence of adverse reactions to food is relatively low. The low incidence of adverse effects is the result of some pragmatic solutions by the US Food and Drug Administration (FDA) and other regulatory agencies through the creative use of specifications, action levels, tolerances, warning labels and prohibitions. Manufacturers have also played a role by setting limits on certain substances and developing mitigation procedures for process-induced toxins. Regardless of measures taken by regulators and food producers to protect consumers from natural food toxins, consumption of small levels of these materials is unavoidable. Although the risk for toxicity due to consumption of food toxins is fairly low, there is always the possibility of toxicity due to contamination, overconsumption, allergy or an unpredictable idiosyncratic response. The purpose of this review is to provide a toxicological and regulatory overview of some of the toxins present in some commonly consumed foods, and where possible, discuss the steps that have been taken to reduce consumer exposure, many of which are possible because of the unique process of food regulation in the United States.

  5. They seldom occur alone.

    PubMed

    Crous, Pedro W; Groenewald, Johannes Z

    2016-11-01

    Species of Coleophoma have been reported as plant pathogenic, saprobic or endophytic on a wide host range. The genus is characterised by having pycnidial conidiomata, phialidic conidiogenous cells intermingled among paraphyses, and cylindrical conidia. Coleophoma has had a confusing taxonomic history with numerous synonyms, and its phylogeny has remained unresolved. The aim of the present study was to use a polyphasic approach incorporating morphology, ecology, and molecular data of the partial large subunit of nrDNA (LSU), the internal transcribed spacer region with intervening 5.8S nrDNA (ITS), partial β-tubulin (tub2), and translation elongation factor 1-alpha (tef1) gene sequences to resolve its taxonomy and phylogeny. Based on these results the genus was found to be polyphyletic, with taxa tentatively identified as Coleophoma clustering in Dothideomycetes and Leotiomycetes. Species corresponding to the concept of Coleophoma s.str. (Dermateaceae, Helotiales, Leotiomycetes) were found to form a distinct clade, with five new species. Furthermore, Coleophoma was found to be linked to the newly established sexual genus, Parafabraea, which is reduced to synonymy. Isolates occurring on Ilex aquifolium in the Netherlands also clustered in Dermateaceae, representing a novel genus, Davidhawksworthia. In the Dothideomycetes, several taxa clustered in Dothiora (Dothideaceae, Dothideales), which is shown to have Dothichiza and Hormonema-like asexual morphs, with four new species. Furthermore, Pseudocamaropycnis is introduced as a new genus (Mytilinidiaceae, Mytilinidiales), along with Briansuttonomyces (Didymellaceae, Pleosporales) and Dimorphosporicola (Pleosporaceae, Pleosporales). Copyright © 2016 British Mycological Society. Published by Elsevier Ltd. All rights reserved.

  6. The Treatment of Shock Based Upon Physiological Principles and Impedence Method for Measuring Cardiac Output in Shock

    DTIC Science & Technology

    1967-01-01

    cardiogenic shock following intracoronary artery microsphere embolization. The syndrome has been previously characterized by a fall in cardiac output and a...previously been oub- jected to and survived usually lethal cardiogenic shock, 5 dogs were selected. One month after intracoronary embolization, an LD, 0 0

  7. Smoother Turbine Blades Resist Thermal Shock Better

    NASA Technical Reports Server (NTRS)

    Czerniak, Paul; Longenecker, Kent; Paulus, Don; Ullman, Zane

    1991-01-01

    Surface treatment increases resistance of turbine blades to low-cycle fatigue. Smoothing removes small flaws where cracks start. Intended for blades in turbines subject to thermal shock of rapid starting. No recrystallization occurs at rocket-turbine operating temperatures.

  8. Back-transformation of high-pressure minerals in shocked chondrites: Low-pressure mineral evidence for strong shock

    NASA Astrophysics Data System (ADS)

    Hu, Jinping; Sharp, Thomas G.

    2017-10-01

    Post-shock annealing of meteorites can destroy their shock-induced features, particularly high-pressure minerals, and complicate the estimation of impact pressure-temperature conditions. However, distinguishing post-shock annealing features from thermal metamorphism effects can be practically difficult. Here we report results from Mbale, a highly shocked L chondrite, to investigate the mechanisms, kinetics and identification criteria for post-shock annealing of high-pressure signatures. Olivine fragments within shock-melt veins in Mbale occur as chemically heterogeneous nanocrystalline aggregates that contain trace wadsleyite and ringwoodite. Their strong variation in fayalite content provides evidence of iron partitioning during transformation of olivine to wadsleyite, followed by back-transformation to olivine after decompression. Experimental studies of transformation kinetics show that wadsleyite transforms to olivine in seconds at temperatures above ∼1200 K and in hours at temperatures between 900 and 1200 K. Thermal models of shock-melt cooling show that shock veins in Mbale cooled to 1200 K in 1 s. The shock pulse must have been shorter than ∼1 s to provide the high temperature conditions for post-shock back-transformation of wadsleyite. Many highly shocked L chondrites, which have abundant high-pressure minerals, must have experienced relatively long shock durations combined with rapid cooling of shock-melt regions to preserve high-pressure phases. The most highly shocked samples, such as impact melt breccias, lack high-pressure phases because of post-shock back-transformations.

  9. Observation of traveling thermoacoustic shock waves (L).

    PubMed

    Biwa, Tetsushi; Takahashi, Takuma; Yazaki, Taichi

    2011-12-01

    Shock waves were explored in the thermoacoustic spontaneous gas oscillations occurring in a gas column with a steep temperature gradient. The results show that a periodic shock occurs in the traveling wave mode in a looped tube but not in the standing wave mode in a resonator. Measurements of the harmonic components of the acoustic intensity reveal a clear difference between them. The temperature gradient acts as an acoustic energy source for the harmonic components of the shock wave in the traveling wave mode but as an acoustic energy sink of the second harmonic in the standing wave mode. © 2011 Acoustical Society of America

  10. Relationship of Extreme Cold Weather and Implantable Cardioverter Defibrillator Shocks.

    PubMed

    Cloutier, Justin M; Liu, Shuangbo; Hiebert, Brett; Tam, James W; Seifer, Colette M

    2017-09-15

    Cold weather to 0°C has been implicated as a risk factor for ventricular arrhythmias and implantable cardioverter defibrillator (ICD) shocks. The effect of more extreme cold weather on the risk of ventricular arrhythmias and ICD shocks is unknown. We sought to describe the relationship between extreme cold weather and the risk of ICD shocks. We retrospectively identified patients seen at the Pacemaker and Defibrillator Clinic at St. Boniface Hospital in Winnipeg, Manitoba, Canada between 2010 and 2015 with an ICD shock. We excluded multiple shocks occurring on the same day in a single patient. We collected weather data, and evaluated the relationship between ICD shocks and weather on the same day as the shock using Negative Binomial regression. Three hundred and sixty patients experienced a total of 1,355 shocks. When excluding multiple shocks occurring in a single patient on the same day, there were 756 unique shocks. The daily high (DH) was the strongest predictor of receiving an ICD shock. Compared with the warmest days (DH above 10°C), shocks were 25% more common on the coldest days (DH below -10°C), and 8% more common on cold days (DH between -10°C and 10°C). This linear trend was statistically significant, with a p-value of 0.04. In conclusion, we found an association between extreme cold weather and ICD shocks. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Role of the adhesion molecule lymphocyte function associated antigen 1 in toxic shock syndrome toxin 1-induced tumor necrosis factor alpha and interleukin-1 beta secretion by human monocytes.

    PubMed Central

    See, R H; Chow, A W

    1992-01-01

    We previously demonstrated that the induction by staphylococcal toxic shock syndrome toxin 1 (TSST-1) of tumor necrosis factor alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) secretion by human monocytes requires direct T cell-monocyte contact. In the present study, a role for the adhesion molecule lymphocyte function associated antigen 1 (LFA-1) in TSST-1-induced cytokine secretion by human monocytes among 12 normal healthy donors was investigated. Monoclonal antibodies to the alpha chain (anti-CD11a) and to the beta chain (anti-CD18) of LFA-1 significantly inhibited TSST-1-induced TNF-alpha and IL-1 beta secretion (P < 0.025; Wilcoxon signed-rank test, two tailed), while a control monoclonal antibody directed against the monocyte CD14 antigen had no effect. These results suggest that LFA-1 may play an important role in the secretion of TNF-alpha and IL-1 beta by TSST-1-stimulated human monocytes, likely by promoting cell-cell adhesion between monocytes and lymphocytes. PMID:1399006

  12. Vibrational energy transfer in shocked molecular crystals.

    PubMed

    Hooper, Joe

    2010-01-07

    We consider the process of establishing thermal equilibrium behind an ideal shock front in molecular crystals and its possible role in initiating chemical reaction at high shock pressures. A new theory of equilibration via multiphonon energy transfer is developed to treat the scattering of shock-induced phonons into internal molecular vibrations. Simple analytic forms are derived for the change in this energy transfer at different Hugoniot end states following shock compression. The total time required for thermal equilibration is found to be an order of magnitude or faster than proposed in previous work; in materials representative of explosive molecular crystals, equilibration is predicted to occur within a few picoseconds following the passage of an ideal shock wave. Recent molecular dynamics calculations are consistent with these time scales. The possibility of defect-induced temperature localization due purely to nonequilibrium phonon processes is studied by means of a simple model of the strain field around an inhomogeneity. The specific case of immobile straight dislocations is studied, and a region of enhanced energy transfer on the order of 5 nm is found. Due to the rapid establishment of thermal equilibrium, these regions are unrelated to the shock sensitivity of a material but may allow temperature localization at high shock pressures. Results also suggest that if any decomposition due to molecular collisions is occurring within the shock front itself, these collisions are not enhanced by any nonequilibrium thermal state.

  13. Mutations in the heat-shock protein A9 (HSPA9) gene cause the EVEN-PLUS syndrome of congenital malformations and skeletal dysplasia

    PubMed Central

    Royer-Bertrand, Beryl; Castillo-Taucher, Silvia; Moreno-Salinas, Rodrigo; Cho, Tae-Joon; Chae, Jong-Hee; Choi, Murim; Kim, Ok-Hwa; Dikoglu, Esra; Campos-Xavier, Belinda; Girardi, Enrico; Superti-Furga, Giulio; Bonafé, Luisa; Rivolta, Carlo; Unger, Sheila; Superti-Furga, Andrea

    2015-01-01

    We and others have reported mutations in LONP1, a gene coding for a mitochondrial chaperone and protease, as the cause of the human CODAS (cerebral, ocular, dental, auricular and skeletal) syndrome (MIM 600373). Here, we delineate a similar but distinct condition that shares the epiphyseal, vertebral and ocular changes of CODAS but also included severe microtia, nasal hypoplasia, and other malformations, and for which we propose the name of EVEN-PLUS syndrome for epiphyseal, vertebral, ear, nose, plus associated findings. In three individuals from two families, no mutation in LONP1 was found; instead, we found biallelic mutations in HSPA9, the gene that codes for mHSP70/mortalin, another highly conserved mitochondrial chaperone protein essential in mitochondrial protein import, folding, and degradation. The functional relationship between LONP1 and HSPA9 in mitochondrial protein chaperoning and the overlapping phenotypes of CODAS and EVEN-PLUS delineate a family of “mitochondrial chaperonopathies” and point to an unexplored role of mitochondrial chaperones in human embryonic morphogenesis. PMID:26598328

  14. Shock compression of liquid hydrazine

    SciTech Connect

    Garcia, B.O.; Chavez, D.J.

    1995-01-01

    Liquid hydrazine (N{sub 2}H{sub 4}) is a propellant used by the Air Force and NASA for aerospace propulsion and power systems. Because the propellant modules that contain the hydrazine can be subject to debris impacts during their use, the shock states that can occur in the hydrazine need to be characterized to safely predict its response. Several shock compression experiments have been conducted in an attempt to investigate the detonability of liquid hydrazine; however, the experiments results disagree. Therefore, in this study, we reproduced each experiment numerically to evaluate in detail the shock wave profiles generated in the liquid hydrazine. This paper presents the results of each numerical simulation and compares the results to those obtained in experiment. We also present the methodology of our approach, which includes chemical kinetic experiments, chemical equilibrium calculations, and characterization of the equation of state of liquid hydrazine.

  15. Plasma Stratification by Planar Shocks

    NASA Astrophysics Data System (ADS)

    Keenan, Brett; Simakov, Andrei; Taitano, William; Chacon, Luis; Daughton, William

    2016-10-01

    A number of experimental observables in neutron yield and capsule compression in Inertial Confinement Fusion (ICF) experiments have been evading explanation by standard, single-fluid, hydrodynamic (hydro) numerical simulations. Fuel stratification - resulting from particle diffusion, multi-ion temperature separation (in the case of OMEGA experiments with gas filled capsules), and certain kinetic effects - is a likely culprit. As a preliminary step to elucidate these effects, we consider mass fraction and temperature stratification by shocks in plasmas with two ion species. We present an analytical solution valid for very weak shocks (M - 1 << 1). Employing the state-of-the-art Vlasov-Fokker-Planck code, iFP, we describe the stratification for shocks with arbitrary mach number, and we rigorously delineate the kinetic and hydrodynamic regimes in terms of Mach number, relative species concentration, and ion species mass ratio - thereby clarifying the conditions under which significant departure from single-fluid hydrodynamics may occur.

  16. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

    PubMed

    Pajovic, B; Radojevic, N; Dimitrovski, A; Vukovic, M

    2016-09-01

    The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

  17. Shock compression of formic acid

    NASA Astrophysics Data System (ADS)

    Manner, Virginia W.; Sheffield, S. A.; Dattelbaum, Dana M.; Stahl, David B.

    2012-03-01

    Simple molecules such as formic acid, HCOOH, have been suggested to play important roles in the origin of life due to their high pressure and temperature chemistry. The hydrogen bonding characteristics and polymerization of HCOOH under static high pressure have been recently investigated using both molecular dynamics calculations and experimental work. These works suggest that symmetric hydrogen bonding of HCOOH (forming a linear chain polymer where all C-O bonds are equivalent) occurs at 16 - 21 GPa at room temperature. In order to examine the shock compression behavior of this simple carboxylic acid, we present a series of gas gun-driven plate impact experiments on formic acid with shock inputs in the range of 5.5 - 23.0 GPa. Using in-situ electromagnetic gauges, shock wave profiles (particle velocities) were measured at multiple positions as a function of shock input pressure, providing valuable information about its unreacted equation of state. No easily recognizable shock-induced reactions were observed in any of the four experiments, and the four points lie close to a universal liquid Hugoniot based only on the sound speed of formic acid.

  18. Shock Compression of Formic Acid

    NASA Astrophysics Data System (ADS)

    Manner, Virginia; Sheffield, Stephen; Dattelbaum, Dana; Engelke, Ray; Stahl, David; Shock; Detonation Physics Team

    2011-06-01

    Simple molecules such as formic acid, HCOOH, have been suggested to play important roles in the origin of life due to their high pressure and temperature chemistry. The hydrogen bonding characteristics and polymerization of HCOOH under high pressure have been recently investigated using both molecular dynamics calculations and experimental work. These works suggest that symmetric hydrogen bonding of HCOOH (forming a linear chain polymer where all C-O bonds are equivalent) occurs at 16 - 21 GPa at room temperature. In order to examine the shock compression behavior of this simple carboxylic acid, we present a series of gas gun-driven plate impact experiments on formic acid with shock inputs in the range of 10 - 20 GPa, overlapping in pressure with the earlier static experimental results. Using in-situ electromagnetic gauges, shock wave profiles (particle velocities) were measured at multiple Lagrangian positions as a function of shock input pressure, providing valuable information about its unreacted equation of state and shock-induced chemical reactions. The results are discussed in the context of the Hugoniot conditions, phase diagram and static high-pressure behavior, and related chemistry of other simple hydroxyl-/carboxyl-containing molecules.

  19. Shock wave-droplet interaction

    NASA Astrophysics Data System (ADS)

    Habibi Khoshmehr, Hamed; Krechetnikov, Rouslan

    2016-11-01

    Disintegration of a liquid droplet under the action of a shock wave is experimentally investigated. The shock wave-pulse is electromagnetically generated by discharging a high voltage capacitor into a flat spiral coil, above which an isolated circular metal membrane is placed in a close proximity. The Lorentz force arising due to the eddy current induced in the membrane abruptly accelerates it away from the spiral coil thus generating a shock wave. The liquid droplet placed at the center of the membrane, where the maximum deflection occurs, is disintegrated in the process of interaction with the shock wave. The effects of droplet viscosity and surface tension on the droplet destruction are studied with high-speed photography. Water-glycerol solution at different concentrations is used for investigating the effect of viscosity and various concentrations of water-sugar and water-ethanol solution are used for studying the effect of surface tension. Here we report on how the metamorphoses, which a liquid drop undergoes in the process of interaction with a shock wave, are affected by varied viscosity and surface tension.

  20. Brugada Syndrome

    MedlinePlus

    ... you suspect it may be because of a heart condition, seek emergency medical attention. If your parent, sibling or child ... especially in children. Complications of Brugada syndrome require emergency ... loss of heart function, breathing and consciousness, which often occurs while ...

  1. Piriformis syndrome

    MedlinePlus

    ... the sciatic nerve. The syndrome, which affects more women than men, is uncommon. But when it occurs, it can cause sciatica . Causes The piriformis muscle is involved in nearly every movement you make with your lower body, from walking ...

  2. Hunter Syndrome

    MedlinePlus

    ... normal or near-normal height. Hernias (inguinal and umbilical) are common in Hunter syndrome. A hernia occurs ... in which the membranes that surround the spinal cord may become thick and scarred (hypertrophic cervical pachymeningitis). ...

  3. [Mobius syndrome].

    PubMed

    Vladuţiu, Cristina; Duma, Ionela

    2012-01-01

    Mobius syndrom, an anomaly in cranial nerve developement, presents with a remarkable clinical polymorphism. The rare occurence of this pathology and the questions raised by the diagnosis and treatment determined us to make this presentation.

  4. Effect of leading edge sweep on shock-shock interference at Mach 8

    NASA Technical Reports Server (NTRS)

    Glass, Christopher E.; Wieting, Allan R.; Holden, Michael S.

    1989-01-01

    These Mach 8 experimental results are applicable to the details of a shock-shock interference that may occur on an engine inlet of a hypersonic vehicle from a swept forebody shock interacting with a swept cowl leading edge bow shock or from a swept splitter plate shock interacting with a swept fuel injection strut bow shock. Peak surface pressure and heat transfer rate on the cylinder were about 10 and 30 times the undisturbed flow stagnation point value, respectively, for the 0 deg sweep test. A comparison of the 15 deg and 30 deg swept results with the 0 deg swept results shows that peak pressure was reduced about 13 percent and 44 percent, respectively, and peak heat transfer rate was reduced about 7 percent and 27 percent, respectively.

  5. Viscous Shear Layers Formed by Non-Bifurcating Shock Waves in Shock-Tubes

    NASA Astrophysics Data System (ADS)

    Grogan, Kevin; Ihme, Matthias

    2015-11-01

    Shock-tubes are test apparatuses that are used extensively for chemical kinetic measurements. Under ideal conditions, shock-tubes provide a quiescent region behind a reflected shock wave where combustion may take place without complications arising from gas-dynamic effects. However, due to the reflected shock wave encountering a boundary layer, significant inhomogeneity may be introduced into the test region. The bifurcation of the reflected shock-wave is well-known to occur under certain conditions; however, a viscous shear layer may form behind a non-bifurcating reflected shock wave as well and may affect chemical kinetics and ignition of certain fuels. The focus of this talk is on the development of the viscous shear layer and the coupling to the ignition in the regime corresponding to the negative temperature conditions.

  6. Gut as source of sepsis after hemorrhagic shock

    SciTech Connect

    Sori, A.J.; Rush, B.F. Jr.; Lysz, T.W.; Smith, S.; Machiedo, G.W.

    1988-02-01

    In a model of severe hemorrhagic shock in rats, blood culture findings became positive within 2 to 4 hours of shock. The organisms cultured were primarily gram-negative. To test the hypothesis that the gut was the source of the bacteria, E. coli labeled with carbon-14 oleic acid were fed to rats undergoing hemorrhagic shock. Their plasma was then assayed for carbon-14 activity. Seven of the 14 shocked animals demonstrated increased plasma carbon-14 activity during or after shock. The mortality rate was 100 percent 80 hours postshock, and all animals had E. coli on subsequent blood culture. The seven rats without increased plasma carbon-14 activity had a survival rate of 83 percent postshock. Sham-shocked animals did not exhibit plasma carbon-14 levels greater than the background levels. These data suggest that bacterial translocation occurs during hemorrhagic shock and that the gut is the source of the bacteremia seen during hemorrhagic shock.

  7. Analysis of shock-wave propagation in aqueous foams using shock tube experiments

    NASA Astrophysics Data System (ADS)

    Jourdan, G.; Mariani, C.; Houas, L.; Chinnayya, A.; Hadjadj, A.; Del Prete, E.; Haas, J.-F.; Rambert, N.; Counilh, D.; Faure, S.

    2015-05-01

    This paper reports experimental results of planar shock waves interacting with aqueous foams in a horizontal conventional shock tube. Four incident shock wave Mach numbers are considered, ranging from 1.07 to 1.8, with two different foam columns of one meter thickness and expansion ratios of 30 and 80. High-speed flow visualizations are used along with pressure measurements to analyse the main physical mechanisms that govern shock wave mitigation in foams. During the shock/foam interaction, a precursor leading pressure jump was identified as the trace of the liquid film destruction stage in the foam fragmentation process. The corresponding pressure threshold is found to be invariant for a given foam. Regarding the mitigation effect, the results show that the speed of the shock is drastically reduced and that wetter is the foam, slower are the transmitted waves. The presence of the foam barrier attenuates the induced pressure impulse behind the transmitted shock, while the driest foam appears to be more effective, as it limits the pressure induced by the reflected shock off the foam front. Finally, it was found that the pressure histories in the two-phase gas-liquid mixture are different from those previously obtained within a cloud of droplets. The observed behavior is attributed to the process of foam fragmentation and to the modification of the flow topology past the shock. These physical phenomena occurring during the shock/foam interaction should be properly accounted for when elaborating new physical models.

  8. Radiative Shock Waves In Emerging Shocks

    NASA Astrophysics Data System (ADS)

    Drake, R. Paul; Doss, F.; Visco, A.

    2011-05-01

    In laboratory experiments we produce radiative shock waves having dense, thin shells. These shocks are similar to shocks emerging from optically thick environments in astrophysics in that they are strongly radiative with optically thick shocked layers and optically thin or intermediate downstream layers through which radiation readily escapes. Examples include shocks breaking out of a Type II supernova (SN) and the radiative reverse shock during the early phases of the SN remnant produced by a red supergiant star. We produce these shocks by driving a low-Z plasma piston (Be) at > 100 km/s into Xe gas at 1.1 atm. pressure. The shocked Xe collapses to > 20 times its initial density. Measurements of structure by radiography and temperature by several methods confirm that the shock wave is strongly radiative. We observe small-scale perturbations in the post-shock layer, modulating the shock and material interfaces. We describe a variation of the Vishniac instability theory of decelerating shocks and an analysis of associated scaling relations to account for the growth of these perturbations, identify how they scale to astrophysical systems such as SN 1993J, and consider possible future experiments. Collaborators in this work have included H.F. Robey, J.P. Hughes, C.C. Kuranz, C.M. Huntington, S.H. Glenzer, T. Doeppner, D.H. Froula, M.J. Grosskopf, and D.C. Marion ________________________________ * Supported by the US DOE NNSA under the Predictive Sci. Academic Alliance Program by grant DE-FC52-08NA28616, the Stewardship Sci. Academic Alliances program by grant DE-FG52-04NA00064, and the Nat. Laser User Facility by grant DE-FG03-00SF22021.

  9. A new class of solutions for interstellar magnetohydrodynamic shock waves

    NASA Technical Reports Server (NTRS)

    Roberge, W. G.; Draine, B. T.

    1990-01-01

    An analysis is presented of the equations of motion for steady MHD shock waves proopagating in interstellar clouds, for boundary conditions that preclude C shocks. In addition to J shocks, in which the neutral fluid component becomes subsonic at an adiabatic jump front, the equations admit a new class of solutions, called C-asterisk shocks, in which the transition to subsonic flow occurs continuously at a sonic point. Numerical methods are developed for computing the structure of J and C-asterisk shocks propagating in diffuse interstellar clouds. The effects of chemical, ionization, and recombination processes are included in this treatment. An alternative numerical method, which uses artificial viscosity to facilitate integration through sonic points, is analyzed and shown to be invalid. A set of exemplary solutions, computed for realistic shock parameters, shows that C-asterisk shocks occur for a broad range of conditions relevant to diffuse interstellar clouds.

  10. Shock-induced devolatilization of calcite

    NASA Technical Reports Server (NTRS)

    Boslough, M. B.; Ahrens, T. J.; Vizgirda, J.; Becker, R. H.; Epstein, S.

    1982-01-01

    Experimental measurements of the release adiabats by Vizgirda (1981) indicate that substantial vaporization takes place upon release from shock pressures of 37 GPa for calcite and 14 GPa for aragonite. The present investigation includes the first controlled partial vaporization experiments on calcite. The experiments were conducted to test the predictions of the release adiabat experiments. The quantities of the gaseous species produced from shocked calcite and their carbon and oxygen isotopic compositions were determined, and the shock-induced effect on the Mn(2+) electron spin resonance spectrum in the shock-recovered calcite was observed. On the basis of the obtained results, it is concluded that shock stresses at the 17-18 GPa level give rise to volatilization of 0.03-0.3 (mole) percent of calcite to CO2 and CO. The devolatilization of calcite occurs at low pressure at significantly lower entropy densities than predicted on the basis of thermodynamic continuum models.

  11. Impact angle control of interplanetary shock geoeffectiveness: A statistical study

    NASA Astrophysics Data System (ADS)

    Oliveira, Denny M.; Raeder, Joachim

    2015-06-01

    We present a survey of interplanetary (IP) shocks using Wind and ACE satellite data from January 1995 to December 2013 to study how IP shock geoeffectiveness is controlled by IP shock impact angles. A shock list covering one and a half solar cycle is compiled. The yearly number of IP shocks is found to correlate well with the monthly sunspot number. We use data from SuperMAG, a large chain with more than 300 geomagnetic stations, to study geoeffectiveness triggered by IP shocks. The SuperMAG SML index, an enhanced version of the familiar AL index, is used in our statistical analysis. The jumps of the SML index triggered by IP shock impacts on the Earth's magnetosphere are investigated in terms of IP shock orientation and speed. We find that, in general, strong (high speed) and almost frontal (small impact angle) shocks are more geoeffective than inclined shocks with low speed. The strongest correlation (correlation coefficient R = 0.78) occurs for fixed IP shock speed and for varied IP shock impact angle. We attribute this result, predicted previously with simulations, to the fact that frontal shocks compress the magnetosphere symmetrically from all sides, which is a favorable condition for the release of magnetic energy stored in the magnetotail, which in turn can produce moderate to strong auroral substorms, which are then observed by ground-based magnetometers.

  12. Pharmacotherapy of circulatory shock.

    PubMed

    Higgins, T L; Chernow, B

    1987-06-01

    The rubric "shock" encompasses a wide spectrum of critical events, which if untreated, result in morbidity and mortality. Understanding of the various forms of shock has evolved rapidly in the past 20 years as new laboratory and clinical observations have been published. In this article, the authors discuss the physiology of the shock state, review the circumstances in which shock becomes likely, and review the etiologies and diagnostic characteristics of distributive (septic, spinal, anaphylactoid/anaphylactic), cardiogenic, hypovolemic, and obstructive shock. The rationale and applications of conventional and controversial therapies are discussed. The therapeutic potentials of current lines of shock research are also discussed.

  13. Antiphospholipids Syndrome Complicated by a Systemic Capillary Leak-Like Syndrome Treated With Steroids and Intravenous Immunoglobulins

    PubMed Central

    Prete, Marcella; Urso, Livio; Fatone, Maria Celeste; Pinto, Vincenzo; Perosa, Federico

    2016-01-01

    Abstract This report describes the onset of systemic capillary leak (SCL)-like syndrome in a 30-year-old woman with antiphospholipids syndrome (APS) during puerperium. Twelve hours after a cesarean section, she presented a sudden fever and abdominal pains followed by dyspnea, severe edema of the limbs and pelvis. Computer tomography shows congestion of interstitial pulmonary parenchyma, pericardial and pleural effusion, edema of intestinal wall and of perivisceral adipose tissue, and periportal lymphedema. Laboratory tests showed neutrophilic leukocytosis, hypoalbuminemia, and an increase of erythrocyte sedimentation rate and C-reactive protein. Because fever and raised inflammation parameters are not observed in idiopathic capillary leak syndrome (SCLS; Clarkson disease), a diagnosis of SCL-like syndrome was made. Albumin solution, high-dose methylprednisolone and intravenous immunoglobulins (IVIG) infusion were administered with a rapid improvement of her clinical condition. The prompt treatment with steroids and IVIG likely prevented the life-threatening shock syndrome that can occur in SCLS, with acute hypotensive attacks, and severe limbs edema requiring fasciotomy. All clinical and laboratory findings supported autoinflammation as the underlying pathogenic mechanism of the syndrome. The data indicate that SCL-like syndrome can be considered a novel clinical syndrome, which can complicate APS. PMID:26844485

  14. Role of molecular dynamics on descriptions of shock front processes

    NASA Astrophysics Data System (ADS)

    Karo, A. M.

    1981-07-01

    A computational approach, based on classical molecular dynamics, is used to form a realistic picture of shock induced processes occurring at the shock front and resulting from the detailed, violent motion associated with shock motion on an atomic scale. Prototype studies of phase transitions are discussed. The interaction of the shock front with defects, surfaces, voids, and inclusions, and across grain boundaries are summarized. The critical question of how mechanical energy imparted to a condensed material by shock loading is converted to the activation energy required to overcome some initial energy barrier in an initiation process, is addressed.

  15. PRECURSORS TO INTERSTELLAR SHOCKS OF SOLAR ORIGIN

    SciTech Connect

    Gurnett, D. A.; Kurth, W. S.; Stone, E. C.; Cummings, A. C.; Krimigis, S. M.; Decker, R. B.; Burlaga, L. F.

    2015-08-20

    On or about 2012 August 25, the Voyager 1 spacecraft crossed the heliopause into the nearby interstellar plasma. In the nearly three years that the spacecraft has been in interstellar space, three notable particle and field disturbances have been observed, each apparently associated with a shock wave propagating outward from the Sun. Here, we present a detailed analysis of the third and most impressive of these disturbances, with brief comparisons to the two previous events, both of which have been previously reported. The shock responsible for the third event was first detected on 2014 February 17 by the onset of narrowband radio emissions from the approaching shock, followed on 2014 May 13 by the abrupt appearance of intense electron plasma oscillations generated by electrons streaming outward ahead of the shock. Finally, the shock arrived on 2014 August 25, as indicated by a jump in the magnetic field strength and the plasma density. Various disturbances in the intensity and anisotropy of galactic cosmic rays were also observed ahead of the shock, some of which are believed to be caused by the reflection and acceleration of cosmic rays by the magnetic field jump at the shock, and/or by interactions with upstream plasma waves. Comparisons to the two previous weaker events show somewhat similar precursor effects, although differing in certain details. Many of these effects are very similar to those observed in the region called the “foreshock” that occurs upstream of planetary bow shocks, only on a vastly larger spatial scale.

  16. Thermal shock resistance of ceramic matrix composites

    NASA Technical Reports Server (NTRS)

    Carper, D. M.; Nied, H. F.

    1993-01-01

    The experimental and analytical investigation of the thermal shock phenomena in ceramic matrix composites is detailed. The composite systems examined were oxide-based, consisting of an aluminosilicate matrix with either polycrystalline aluminosilicate or single crystal alumina fiber reinforcement. The program was divided into three technical tasks; baseline mechanical properties, thermal shock modeling, and thermal shock testing. The analytical investigation focused on the development of simple expressions for transient thermal stresses induced during thermal shock. The effect of various material parameters, including thermal conductivity, elastic modulus, and thermal expansion, were examined analytically for their effect on thermal shock performance. Using a simple maximum stress criteria for each constituent, it was observed that fiber fracture would occur only at the most extreme thermal shock conditions and that matrix fracture, splitting parallel to the reinforcing fiber, was to be expected for most practical cases. Thermal shock resistance for the two material systems was determined experimentally by subjecting plates to sudden changes in temperature on one surface while maintaining the opposite surface at a constant temperature. This temperature change was varied in severity (magnitude) and in number of shocks applied to a given sample. The results showed that for the most severe conditions examined that only surface matrix fracture was present with no observable fiber fracture. The impact of this damage on material performance was limited to the matrix dominated properties only. Specifically, compression strength was observed to decrease by as much as 50 percent from the measured baseline.

  17. Shock experiments on maskelynite-bearing anorthosite

    NASA Technical Reports Server (NTRS)

    Lambert, P.; Grieve, R. A. F.

    1984-01-01

    A series of shock recovery experiments over 9.9-60.4 GPa have been carried out on naturally shocked anorthosite from the Mistastin impact structure in Labrador consisting primarily of diaplectic plagioclase glass or maskelynite, An(50), and pyroxene. Petrographic observations of the experimental products indicate that the component minerals and diaplectic glasses generally retained their initial character throughout, the only exception being the increase in fracturing which occurred in the 9.9 GPa shot. Reshocking at pressures higher than the initial shock tends to lower the refractive index of maskelynite. The increase in refractive index of maskelynite reshocked to pressures lower than the initial pressure is interpreted as due to shock densification of the diaplectic glass above the Hugoniot elastic limit and below the mixed phase regime. The data suggest that the low-high-low density transition of maskelynite occurs about 8 GPa below that of the crystal of corresponding composition.

  18. Fluorescence depolarization measurements under shock compression

    NASA Astrophysics Data System (ADS)

    Wang, Jue; Banishev, Alexandr; Bassett, Will P.; Dlott, Dana D.

    2017-01-01

    Measurements of the time-dependent fluorescence depolarization of emissive probe molecules enable real-time observations of molecular rotations in shocked materials. In shocked solids, molecular rotations occur as a result of shear deformations. An apparatus is described to measure time-dependent fluorescence depolarization of shocked materials using laser-driven flyer plates and either a picosecond or a nanosecond probe laser. The emission was separated into parallel and perpendicular channels and imaged onto a streak camera. Time-dependent fluorescence depolarization of rhodamine 6G (R6G) dye dissolved in poly-methyl methacrylate (PMMA) was measured with a 16 ns duration impact at 1 km s-1. A partial depolarization of the dye emission was observed to occur during a 150 ns period after the shock.

  19. Shock Initiation of Damaged Explosives

    SciTech Connect

    Chidester, S K; Vandersall, K S; Tarver, C M

    2009-10-22

    Explosive and propellant charges are subjected to various mechanical and thermal insults that can increase their sensitivity over the course of their lifetimes. To quantify this effect, shock initiation experiments were performed on mechanically and thermally damaged LX-04 (85% HMX, 15% Viton by weight) and PBX 9502 (95% TATB, 5% Kel-F by weight) to obtain in-situ manganin pressure gauge data and run distances to detonation at various shock pressures. We report the behavior of the HMX-based explosive LX-04 that was damaged mechanically by applying a compressive load of 600 psi for 20,000 cycles, thus creating many small narrow cracks, or by cutting wedge shaped parts that were then loosely reassembled, thus creating a few large cracks. The thermally damaged LX-04 charges were heated to 190 C for long enough for the beta to delta solid - solid phase transition to occur, and then cooled to ambient temperature. Mechanically damaged LX-04 exhibited only slightly increased shock sensitivity, while thermally damaged LX-04 was much more shock sensitive. Similarly, the insensitive explosive PBX 9502 was mechanically damaged using the same two techniques. Since PBX 9502 does not undergo a solid - solid phase transition but does undergo irreversible or 'rachet' growth when thermally cycled, thermal damage to PBX 9502 was induced by this procedure. As for LX-04, the thermally damaged PBX 9502 demonstrated a greater shock sensitivity than mechanically damaged PBX 9502. The Ignition and Growth reactive flow model calculated the increased sensitivities by igniting more damaged LX-04 and PBX 9502 near the shock front based on the measured densities (porosities) of the damaged charges.

  20. How Is Cardiogenic Shock Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Cardiogenic Shock Diagnosed? The first step in diagnosing cardiogenic shock ... is cardiogenic shock. Tests and Procedures To Diagnose Shock and Its Underlying Causes Blood Pressure Test Medical ...

  1. Delayed Failure in a Shock Loaded Alumina

    SciTech Connect

    Cooper, G. A.; Millett, J. C. F.; Bourne, N. K.; Dandekar, D. P.

    2006-07-28

    Manganin stress gauges have been used to measure the lateral stress in a shock-loaded alumina. In combination with known longitudinal stresses, these have been used to determine the shear strength of this material, behind the shock front. The two-step nature of the lateral stress traces shows a slow moving front behind the main shock, behind which shear strength undergoes a significant decrease. Results also show that this front decreases markedly in velocity as the HEL is crossed, suggesting that limited plasticity occurs during inelastic deformation. Finally, comparison of measured shear strengths with other aluminas shows a high degree of agreement.

  2. Shocks generate crossover behavior in lattice avalanches.

    PubMed

    Burridge, James

    2013-11-22

    A spatial avalanche model is introduced, in which avalanches increase stability in the regions where they occur. Instability is driven globally by a driving process that contains shocks. The system is typically subcritical, but the shocks occasionally lift it into a near- or supercritical state from which it rapidly retreats due to large avalanches. These shocks leave behind a signature-a distinct power-law crossover in the avalanche size distribution. The model is inspired by landslide field data, but the principles may be applied to any system that experiences stabilizing failures, possesses a critical point, and is subject to an ongoing process of destabilization that includes occasional dramatic destabilizing events.

  3. Neptune inbound bow shock

    NASA Technical Reports Server (NTRS)

    Szabo, Adam; Lepping, Ronald P.

    1995-01-01

    Voyager 2 crossed the inbound or upstream Neptunian bow shock at 1430 spacecraft event time on August 24 in 1989 (Belcher et al., 1989). The plasma and magnetic field measurements allow us to study the solar wind interaction with the outermost gas giant. To fully utilize all of the spacecraft observations, an improved nonlinear least squares, 'Rankine-Hugoniot' magnetohydrodynamic shock-fitting technique has been developed (Szabo, 1994). This technique is applied to the Neptunian data set. We find that the upstream bow shock normal points nearly exactly toward the Sun consistent with any reasonable large-scale model of the bow shock for a near subsolar crossing. The shock was moving outward with a speed of 14 +/- 12 km/s. The shock can be characterized as a low beta, high Mach number, strong quasi-perpendicular shock. Finally, the shock microstructure features are resolved and found to scale well with theoretical expectations.

  4. Shock & Anaphylactic Shock. Learning Activity Package.

    ERIC Educational Resources Information Center

    Hime, Kirsten

    This learning activity package on shock and anaphylactic shock is one of a series of 12 titles developed for use in health occupations education programs. Materials in the package include objectives, a list of materials needed, information sheets, reviews (self evaluations) of portions of the content, and answers to reviews. These topics are…

  5. A possible shock effect associated with seaquakes

    NASA Technical Reports Server (NTRS)

    Quann, J.; Eberstein, I.; Curtis, S.

    1972-01-01

    The effects of earthquakes felt on board vessels at sea are discussed along with the possibility of cohesive shock wave propagating through the ocean. The large earthquake of shallow focus which occurred on 29 April 1970, in the Guatemala Basin is analyzed. The thermal information recorded by ITOS-1 spacecraft showed an anomalous temperature enhancement of +3 K in the immediate vicinity, indicating a thermal effect attributed to shock waves.

  6. Biomass shock pretreatment

    DOEpatents

    Holtzapple, Mark T.; Madison, Maxine Jones; Ramirez, Rocio Sierra; Deimund, Mark A.; Falls, Matthew; Dunkelman, John J.

    2014-07-01

    Methods and apparatus for treating biomass that may include introducing a biomass to a chamber; exposing the biomass in the chamber to a shock event to produce a shocked biomass; and transferring the shocked biomass from the chamber. In some aspects, the method may include pretreating the biomass with a chemical before introducing the biomass to the chamber and/or after transferring shocked biomass from the chamber.

  7. Colliding Two Shocks: 1-D full Particle-in-Cell Simulation

    NASA Astrophysics Data System (ADS)

    Nakanotani, Masaru; Hada, T.; Matsukiyo, Shuichi; Mazelle, Christian

    2016-07-01

    Shock-shock interactions occur on various places in space and the interaction can produce high energy particles. A coronal mass ejection driven shock can collide with the Earth's bow shock [Hietala et al., 2011]. This study reported that ions are accelerated by the first Fermi acceleration between the two shocks before the collision. An electron acceleration through an interplanetary shock-Earth's bow shock interaction was also reported [Terasawa et al., 1997]. Shock-shock interactions can occur in astrophysical phenomena as well as in the heliosphere. For example, a young supernova shock can collide with the wind termination shock of a massive star if they are close to each other [Bykov et al., 2013]. Although hybrid simulations (ions and electrons treated as super-particles and mass-less fluid, respectively) were carried out to understand the kinetic nature of a shock-shock interaction [Cargill et al., 1986], hybrid simulations cannot resolve electron dynamics and non-thermal electrons. We, therefore, use one-dimensional full particle-in-cell (PIC) simulations to investigate a shock-shock interaction in which two shocks collide head-on. In a case of quasi-perpendicular shocks, electrons are accelerated by the mirror reflection between the two shocks before the collision (Fermi acceleration). On the other hand, because ions cannot go back upstream, the electron acceleration mechanism does not occur for ions. In a case of quasi-parallel shocks, ions can go back upstream and are accelerated at the shocks. The accelerated ions have great effect on the shock structure.

  8. Shock, Post-Shock Annealing, and Post-Annealing Shock in Ureilites

    NASA Technical Reports Server (NTRS)

    Rubin, Alan E.

    2006-01-01

    The thermal and shock histories of ureilites can be divided into four periods: 1) formation, 2) initial shock, 3) post-shock annealing, and 4) post-annealing shock. Period 1 occurred approx.4.55 Ga ago when ureilites formed by melting chondritic material. Impact events during period 2 caused silicate darkening, undulose to mosaic extinction in olivines, and the formation of diamond, lonsdaleite, and chaoite from indigenous carbonaceous material. Alkali-rich fine-grained silicates may have been introduced by impact injection into ureilites during this period. About 57% of the ureilites were unchanged after period 2. During period 3 events, impact-induced annealing caused previously mosaicized olivine grains to become aggregates of small unstrained crystals. Some ureilites experienced reduction as FeO at the edges of olivine grains reacted with C from the matrix. Annealing may also be responsible for coarsening of graphite in a few ureilites, forming euhedral-appearing, idioblastic crystals. Orthopyroxene in Meteorite Hills (MET) 78008 may have formed from pigeonite by annealing during this period. The Rb-Sr internal isochron age of approx.4.0 Ga for MET 78008 probably dates the annealing event. At this late date, impacts are the only viable heat source. About 36% of ureilites experienced period 3 events, but remained unchanged afterwards. During period 4, approx.7% of the ureilites were shocked again, as is evident in the polymict breccia, Elephant Moraine (EET) 83309. This rock contains annealed mosaicized olivine aggregates composed of small individual olivine crystals that exhibit undulose extinction. Ureilites may have formed by impact-melting chondritic material on a primitive body with heterogeneous O isotopes. Plagioclase was preferentially lost from the system due to its low impedance to shock compression. Brief melting and rapid burial minimized the escape of planetary-type noble gases from the ureilitic melts. Incomplete separation of metal from silicates

  9. Shock, Post-Shock Annealing, and Post-Annealing Shock in Ureilites

    NASA Technical Reports Server (NTRS)

    Rubin, Alan E.

    2006-01-01

    The thermal and shock histories of ureilites can be divided into four periods: 1) formation, 2) initial shock, 3) post-shock annealing, and 4) post-annealing shock. Period 1 occurred approx.4.55 Ga ago when ureilites formed by melting chondritic material. Impact events during period 2 caused silicate darkening, undulose to mosaic extinction in olivines, and the formation of diamond, lonsdaleite, and chaoite from indigenous carbonaceous material. Alkali-rich fine-grained silicates may have been introduced by impact injection into ureilites during this period. About 57% of the ureilites were unchanged after period 2. During period 3 events, impact-induced annealing caused previously mosaicized olivine grains to become aggregates of small unstrained crystals. Some ureilites experienced reduction as FeO at the edges of olivine grains reacted with C from the matrix. Annealing may also be responsible for coarsening of graphite in a few ureilites, forming euhedral-appearing, idioblastic crystals. Orthopyroxene in Meteorite Hills (MET) 78008 may have formed from pigeonite by annealing during this period. The Rb-Sr internal isochron age of approx.4.0 Ga for MET 78008 probably dates the annealing event. At this late date, impacts are the only viable heat source. About 36% of ureilites experienced period 3 events, but remained unchanged afterwards. During period 4, approx.7% of the ureilites were shocked again, as is evident in the polymict breccia, Elephant Moraine (EET) 83309. This rock contains annealed mosaicized olivine aggregates composed of small individual olivine crystals that exhibit undulose extinction. Ureilites may have formed by impact-melting chondritic material on a primitive body with heterogeneous O isotopes. Plagioclase was preferentially lost from the system due to its low impedance to shock compression. Brief melting and rapid burial minimized the escape of planetary-type noble gases from the ureilitic melts. Incomplete separation of metal from silicates

  10. Implications of heterogeneity in the shock wave propagation of dynamically shocked materials

    NASA Astrophysics Data System (ADS)

    LaJeunesse, Jeff

    The field of shock physics as a whole has only recently begun to pay particular attention to modeling heterogeneous materials under shock loading. These materials are important because of their practicality in terms of creating stronger, more shock resistant materials. To understand why they absorb shock impact energy better than homogeneous materials means that the small-scale processes that occur during the shock loading of these heterogeneous materials needs to be understood. Recent computational experiments, called mesoscale simulations, have shown that explicitly incorporating small-scale heterogeneous features into hydrocode simulations allows the bulk shock response of the heterogeneous material to be observed while not requiring the use of empirically determined constitutive equations. Including these features in simulations can offer insights into the irreversible mechanisms that dominate the propagation of shock waves in heterogeneous materials. Three cases where the mesoscale approach for modeling the dynamic shock loading of heterogeneous materials are presented. These materials fall into three categories: granular - dry sand, granular with binder - concrete, and granular contained in a metal foam with a binder - granular explosive contained in an aluminum foam. The processes in which shock waves propagate through each material are addressed and relationships between the three materials are discussed. Particle velocity profiles for dry sand and concrete was obtained from Harvard University and Eglin Air Force Base, respectively. Mesoscale simulations using CTH are conducted for each type of heterogeneous material and the results are compared to the experimental data.

  11. Multispacecraft study of shock-flux rope interaction

    NASA Astrophysics Data System (ADS)

    Blanco-Cano, Xochitl; Burgess, David; Sundberg, Torbjorn; Kajdic, Primoz

    2017-04-01

    Interplanetary (IP) shocks can be driven in the solar wind by fast coronal mass ejections. These shocks can accelerate particles near the Sun and through the heliosphere, being associated to solar energetic particle (SEP) and energetic storm particle (ESP) events. IP shocks can interact with structures in the solar wind, and with planetary magnetospheres. In this study we show how the properties of an IP shock change when it interacts with a medium scale flux rope (FR) like structure. We use data measurements from CLUSTER, WIND and ACE. These three spacecraft observed the shock-FR interaction at different stages of its evolution. We find that the shock-FR interaction locally changes the shock geometry, affecting ion injection processes, and the upstream and downstream regions. While WIND and ACE observed a quasi-perpendicular shock, CLUSTER crossed a quasi-parallel shock and a foreshock with a variety of ion distributions. The complexity of the ion foreshock can be explained by the dynamics of the shock transitioning from quasi-perpendicular to quasi-parallel, and the geometry of the magnetic field around the flux rope. Interactions such as the one we discuss can occur often along the extended IP shock fronts, and hence their importance towards a better understanding of shock acceleration.

  12. Rett Syndrome: Overview

    MedlinePlus

    ... Selected Staff Profiles Multimedia About NICHD Institute ... this: Page Content Rett syndrome is a neurological and developmental genetic disorder that occurs mostly in females. Infants with Rett syndrome seem to grow and ...

  13. DNA fragmentation in mouse organs during endotoxic shock.

    PubMed Central

    Bohlinger, I.; Leist, M.; Gantner, F.; Angermüller, S.; Tiegs, G.; Wendel, A.

    1996-01-01

    The systemic inflammatory response syndrome has still an unpredictable outcome, and patients often die of multiple organ failure despite circulatory stabilization therapy. The still incompletely understood pathophysiological mechanisms include organ damage due to direct toxic actions of cytokines elicited by overactivation of the host response. To study this process of organ failure in experimental septic shock, we injected mice with a lethal dose of endotoxin and examined apoptotic and necrotic tissue damage biochemically, histologically, and ultrastructurally. Endotoxin administration caused oligonucleosomal as well as random DNA fragmentation in liver, lung, kidney, and intestine. In the liver, DNA fragmentation was not restricted to hepatocytes but also occurred in nonparenchymal cells. The DNA fragmentation was mediated by tumor necrosis factor and attenuated by endogenous nitric oxide release. Unlike the situation in D-galactosamine-sensitized mice, in which injection or release of tumor necrosis factor causes massive hepatocyte apoptosis, liver failure due to high doses of endotoxin was characterized by single-cell necrosis, a low incidence of apoptosis, and simultaneous damage to nonparenchymal cells. We conclude that, even though endotoxin causes cytokine-mediated DNA fragmentation in several organs including the liver, hepatocyte apoptosis itself seems to be a minor phenomenon in high-dose endotoxic shock in mice. Images Figure 2 Figure 3 Figure 4 Figure 5 PMID:8863685

  14. Shock structure in shock-turbulence interactions

    NASA Astrophysics Data System (ADS)

    Donzis, Diego A.

    2012-12-01

    The structure of a shock wave interacting with isotropic turbulence is investigated. General principles of similarity scaling show that consistency with known physical limiting behavior requires incomplete similarity solutions where the governing non-dimensional parameters, namely, the Reynolds, convective, and turbulent Mach numbers (Rλ, M, and Mt, respectively), can be combined to reduce the number of similarity parameters that describes the phenomenon. An important parameter is found to be K = Mt/Rλ1/2(M - 1) which is proportional to the ratio of laminar shock thickness to the Kolmogorov length scale. The shock thickness under turbulent conditions, on the other hand, is essentially a random variable. Under a quasi-equilibrium assumption, shown to be valid when K2 ≪ 1, analytical results are obtained for the first and second moments of the turbulent shock thickness, velocity gradient, and dilatation at the shock. It is shown that these quantities exhibit universal behavior in the parameter K with corrections in Mt/(M - 1), for velocity fields with arbitrary statistics. Excellent agreement is observed with available data from direct numerical simulations. Two-point statistics of velocity gradients at the shock show that the distribution of dilatation over the shock surface is determined by transverse structure functions of the incoming turbulence. The regimes of the interaction are also investigated. It is found that the appropriate parameter to delimit the different regimes is Mt/(M - 1). Flow retardation ahead of the shock is suggested as a mechanism for so-called broken shocks.

  15. Nitric oxide in shock.

    PubMed

    Cauwels, A

    2007-09-01

    Refractory hypotension with end-organ hypoperfusion and failure is an ominous feature of shock. Distributive shock is caused by severe infections (septic shock) or severe systemic allergic reactions (anaphylactic shock). In 1986, it was concluded that nitric oxide (NO) is the endothelium-derived relaxing factor that had been discovered 6 years earlier. Since then, NO has been shown to be important for the physiological and pathological control of vascular tone. Nevertheless, although inhibition of NO synthesis restores blood pressure, NO synthase (NOS) inhibition cannot improve outcome, on the contrary. This implies that NO acts as a double-edged sword during septic shock. Consequently, the focus has shifted towards selective inducible NOS (iNOS) inhibitors. The contribution of NO to anaphylactic shock seems to be more straightforward, as NOS inhibition abrogates shock in conscious mice. Surprisingly, however, this shock-inducing NO is not produced by the inducible iNOS, but by the so-called constitutive enzyme endothelial NOS. This review summarizes the contribution of NO to septic and anaphylactic shock. Although NOS inhibition may be promising for the treatment of anaphylactic shock, the failure of a phase III trial indicates that other approaches are required for the successful treatment of septic shock. Amongst these, high hopes are set for selective iNOS inhibitors. But it might also be necessary to shift gears and focus on downstream cardiovascular targets of NO or on other vasodilating phenomena.

  16. Shocks in collisionless plasmas

    NASA Astrophysics Data System (ADS)

    Parks, G. K.; Lee, E.; Fu, S. Y.; Lin, N.; Liu, Y.; Yang, Z. W.

    2017-06-01

    The Earth's bow shock is the best-known collisionless shock in space. Although much is known about the bow shock, the mechanisms of heating and thermalization processes still remain poorly understood. Collisionless shocks are different from ordinary fluid shocks, because a fraction of the incident solar wind is reflected from the bow shock and the transmitted particles are not immediately thermalized. The reflected particles interact with the incident solar wind producing waves and instabilities that can heat and accelerate particles to high energies. Some of the waves can grow to large amplitudes such as Short Large Amplitude Magnetic Structures. Other upstream nonlinear structures include hot flow anomalies and density holes. The upstream nonlinear structures subsequently convect Earthward with the SW and could impact the structure and dynamics of the bow shock. These observations have clearly indicated that the upstream dynamics are an integral part of the bow shock system. Although much has been learned about the behavior of Earth's bow shock dynamics from the existing data, many fundamental questions remain not answered. This article will review observations of ion dynamics of Earth's bow shock system, what we have learned from recent and past observations. We provide new perspectives from multi-spacecraft Cluster observations about the spatial and temporal variations including the fundamental shock heating, acceleration, and entropy generation processes.

  17. A Transmission Electron Microscope Study of Experimentally Shocked Pregraphitic Carbon

    NASA Technical Reports Server (NTRS)

    Rietmeijer, Frans J. M.

    1995-01-01

    A transmission electron microscope study of experimental shock metamorphism in natural pre-graphitic carbon simulates the response of the most common natural carbons to increased shock pressure. The d-spacings of this carbon are insensitive to the shock pressure and have no apparent diagnostic value, but progressive comminution occurs in response to increased shock pressure up to 59.6 GPa. The function, P = 869.1 x (size(sub minimum )(exp -0.83), describes the relationship between the minimum root-mean-square subgrain size (nm) and shock pressure (GPa). While a subgrain texture of natural pregraphitic carbons carries little information when pre-shock textures are unknown, this texture may go unnoticed as a shock metamorphic feature.

  18. Dehydration of potassium alum induced by shock loading

    NASA Astrophysics Data System (ADS)

    Kishimura, H.; Imasu, Y.; Matsumoto, H.

    2014-05-01

    Potassium alum (KAl(SO4)2·12H2O) powder filled into a copper container were shock loaded up to 6.3 GPa by flyer plate impact. Recovered samples were characterized by X-ray diffraction (XRD) analysis, Raman spectroscopy, and scanning electron microscopy (SEM). XRD and Raman results of samples shocked at 4.4 GPa and below indicated that there was no sign of phase transition. In contrast, the XRD pattern of the sample shocked at 6.3 GPa was clearly different from the initial sample. Unlike previous results obtained from hydrostatic pressure experiments, an irreversible phase transition to an amorphous phase occurred under shock compression at 6.3 GPa. The morphology of the sample surface indicated the ejection of water vapor caused by shock loading. The amorphization may be attributed to the vaporization of water molecules caused by shock pressure and shock-induced heat.

  19. Nonthyroidal illnesses syndrome in full-term newborns with sepsis.

    PubMed

    Silva, Maria Helena Baptista Nunes da; Araujo, Maria Cristina Korbage de; Diniz, Edna Maria de Albuquerque; Ceccon, Maria Esther Jurfest Rivero; Carvalho, Werther Brunow de

    2015-12-01

    To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock.

  20. Shock-implanted noble gases. II - Additional experimental studies and recognition in naturally shocked terrestrial materials

    NASA Technical Reports Server (NTRS)

    Bogard, Donald; Horz, Friedrich; Johnson, Pratt

    1989-01-01

    The process by which ambient gases can be implanted into silicates by shocks was investigated by analyzing the noble-gas content of several experimentally and naturally shocked silicate samples. The retentivity of shock-implanted gas during stepwise heating in the laboratory was defined in terms of two parameters, namely, the activation energy for diffusion and the extraction temperature at which 50 percent of the gas is released, both of which correlate with the shock pressure. The experiments indicate that, with increasing shock pressure, gas implantation occurs through an increasing production of microcracks/defects in the silicate lattice. The degree of annealing of these defects control the degree of diffusive loss of implanted gas.

  1. Impaired Fracture Healing after Hemorrhagic Shock.

    PubMed

    Lichte, Philipp; Kobbe, Philipp; Pfeifer, Roman; Campbell, Graeme C; Beckmann, Rainer; Tohidnezhad, Mersedeh; Bergmann, Christian; Kadyrov, Mamed; Fischer, Horst; Glüer, Christian C; Hildebrand, Frank; Pape, Hans-Christoph; Pufe, Thomas

    2015-01-01

    Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP) of 35 mmHg for 90 minutes). Serum cytokines (IL-6, KC, MCP-1, and TNF-α) were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  2. Syndromic craniosynostosis.

    PubMed

    Derderian, Christopher; Seaward, James

    2012-05-01

    Although most cases of craniosynostosis are nonsyndromic, craniosynostosis is known to occur in conjunction with other anomalies in well-defined patterns that make up clinically recognized syndromes. Patients with syndromic craniosynostoses are much more complicated to care for, requiring a multidisciplinary approach to address all of their needs effectively. This review describes the most common craniosynostosis syndromes, their characteristic features and syndrome-specific functional issues, and new modalities utilized in their management. General principles including skull development, the risk of developing increased intracranial pressure in craniosynostosis syndromes, and techniques to measure intracranial pressure are discussed. Evolving techniques of the established operative management of craniosynostosis are discussed together with more recent techniques including spring cranioplasty and posterior cranial vault distraction osteogenesis.

  3. Finite Time Shock Acceleration at Interplanetary Shocks

    NASA Astrophysics Data System (ADS)

    Channok, C.; Ruffolo, D.; Desai, M. I.; Mason, G. M.

    2004-05-01

    Observations of energetic ion acceleration at interplanetary shocks sometimes indicate a spectral rollover at ˜ 0.1 to 1 MeV nucl-1. This rollover is not well explained by finite shock width or thickness effects. At the same time, a typical timescale of diffusive shock acceleration is several days, implying that the process of shock acceleration at an interplanetary shock near Earth usually gives only a mild increase in energy to an existing seed particle population. This is consistent with a recent analysis of ACE observations that argues for a seed population at substantially higher energies than the solar wind. Therefore an explanation of typical spectra of interplanetary shock-accelerated ions requires a theory of finite-time shock acceleration, which for long times (or an unusually fast acceleration timescale) tends to the steady-state result of a power-law spectrum. We present analytic and numerical models of finite-time shock acceleration. For a given injection momentum p0, after a very short time there is only a small boost in momentum, at intermediate times the spectrum is a power law with a hump and steep cutoff at a critical momentum, and at longer times the critical momentum increases and the spectrum approaches the steady-state power law. The composition dependence of the critical momentum is different from that obtained for other cutoff mechanisms. The results are compared with observed spectra. Work in Thailand was supported by the Commission for Higher Education, the Rachadapisek Sompoj Fund of Chulalongkorn University, and the Thailand Research Fund. Work at the University of Maryland was supported by NASA contract NAS5-30927 and NASA grant PC 251428.

  4. Interaction of two collisionless shocks

    NASA Technical Reports Server (NTRS)

    Cargill, P. J.; Goodrich, C. C.; Papadopoulos, K.

    1986-01-01

    Kinetic simulations of the interaction between two collisionless shocks are presented. During the collision of two perpendicular shocks, the shock electromagnetic field structures pass through each other, while the previously shocked ions are kept separate by the electric field arising in the collision. When two supercritical shocks collide, a fraction of ions are accelerated up to an order of magnitude in energy by first being reflected at one shock, then interacting with the electric fields of the other shock.

  5. [Suprahepatic vein catheterization in 4 cases of severe septic shock].

    PubMed

    Inzunza, C; Cornu, M; Bruhn, A; Castillo, L; Bugedo, G; Acuña, D; Medeiros, S; Hernández, G

    2001-05-01

    Splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. We report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. Suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients. These parameters improved only in the patient that survived. Gastric tonometry was more inconsistent. We conclude that suprahepatic vein catheterization could have a role in the management of septic shock.

  6. Structure in Radiating Shocks

    NASA Astrophysics Data System (ADS)

    Doss, Forrest

    2010-11-01

    The basic radiative shock experiment is a shock launched into a gas of high-atomic-number material at high velocities, which fulfills the conditions for radiative losses to collapse the post-shock material to over 20 times the initial gas density. This has been accomplished using the OMEGA Laser Facility by illuminating a Be ablator for 1 ns with a total of 4 kJ, launching the requisite shock, faster than 100 km/sec, into a polyimide shock tube filled with Xe. The experiments have lateral dimensions of 600 μm and axial dimensions of 2-3 mm, and are diagnosed by x-ray backlighting. Repeatable structure beyond the one-dimensional picture of a shock as a planar discontinuity was discovered in the experimental data. One form this took was that of radial boundary effects near the tube walls, extended approximately seventy microns into the system. The cause of this effect - low density wall material which is heated by radiation transport ahead of the shock, launching a new converging shock ahead of the main shock - is apparently unique to high-energy-density experiments. Another form of structure is the appearance of small-scale perturbations in the post-shock layer, modulating the shock and material interfaces and creating regions of enhanced and diminished aerial density within the layer. The authors have applied an instability theory, a variation of the Vishniac instability of decelerating shocks, to describe the growth of these perturbations. We have also applied Bayesian statistical methods to better understand the uncertainties associated with measuring shocked layer thickness in the presence of tilt. Collaborators: R. P. Drake, H. F. Robey, C. C. Kuranz, C. M. Huntington, M. J. Grosskopf, D. C. Marion.

  7. Collective osmotic shock in ordered materials.

    PubMed

    Zavala-Rivera, Paul; Channon, Kevin; Nguyen, Vincent; Sivaniah, Easan; Kabra, Dinesh; Friend, Richard H; Nataraj, S K; Al-Muhtaseb, Shaheen A; Hexemer, Alexander; Calvo, Mauricio E; Miguez, Hernan

    2011-11-27

    Osmotic shock in a vesicle or cell is the stress build-up and subsequent rupture of the phospholipid membrane that occurs when a relatively high concentration of salt is unable to cross the membrane and instead an inflow of water alleviates the salt concentration gradient. This is a well-known failure mechanism for cells and vesicles (for example, hypotonic shock) and metal alloys (for example, hydrogen embrittlement). We propose the concept of collective osmotic shock, whereby a coordinated explosive fracture resulting from multiplexing the singular effects of osmotic shock at discrete sites within an ordered material results in regular bicontinuous structures. The concept is demonstrated here using self-assembled block copolymer micelles, yet it is applicable to organized heterogeneous materials where a minority component can be selectively degraded and solvated whilst ensconced in a matrix capable of plastic deformation. We discuss the application of these self-supported, perforated multilayer materials in photonics, nanofiltration and optoelectronics.

  8. Condensed matter at high shock pressures

    SciTech Connect

    Nellis, W.J.; Holmes, N.C.; Mitchell, A.C.; Radousky, H.B.; Hamilton, D.

    1985-07-12

    Experimental techniques are described for shock waves in liquids: Hugoniot equation-of-state, shock temperature and emission spectroscopy, electrical conductivity, and Raman spectroscopy. Experimental data are reviewed and presented in terms of phenomena that occur at high densities and temperatures in shocked He, Ar, N/sub 2/, CO, SiO/sub 2/-aerogel, H/sub 2/O, and C/sub 6/H/sub 6/. The superconducting properties of Nb metal shocked to 100 GPa (1 Mbar) and recovered intact are discussed in terms of prospects for synthesizing novel, metastable materials. Ultrahigh pressure data for Cu is reviewed in the range 0.3 to 6TPa (3 to 60 Mbar). 56 refs., 9 figs., 1 tab.

  9. Myasis occuring in a neonate

    PubMed Central

    Obasa, Temitope O.; Sowunmi, Funmilola Olusola

    2012-01-01

    Myasis is the infestation of skin by larvae or maggots of a variety of flies. It is a condition that occurs more commonly in adults who are living and/or have visited tropical countries. It rarely occurs in neonates, and even when seen, only few larvae are extracted. This case report describes myasis occurring in an 11-day-old female who had 47 larvae in her skin. PMID:23355934

  10. [Death caused by anaphylactic shock: a forensic pathological analysis of 142 cases].

    PubMed

    Hu, Dong-yang; Huang, Cui; Liu, Shuang-gao; Huang, Lei; Zheng, Jin-xiang; Huang, Er-wen; Wu, Qiu-ping; Cheng, Jian-ding; Tang, Shuang-bo

    2014-08-01

    To explore the forensic pathological features of death caused by anaphylactic shock. One hundred and forty-two death cases of anaphylactic shock were retrospectively analyzed. The IgE level in the serum of anaphylactic shock cases were statistically compared with that of 62 non-anaphylactic shock cases. Most cases (77.46%) of anaphylactic shock death occurred in the medical institutes, with intravenous drug administration accounting for 53.53% of anaphylactic shock death. β-Lactam antibiotics, glucocorticoid and herbal medications were responsible for a significant proportion of such cases. Although characteristic histopathological changes were absent in vast majority of these anaphylactic shock cases, the differences of IgE levels in the serum between anaphylactic shock group and non-anaphylactic shock group were statistically significant (P<0.05). Combined information including clinical data, autopsy results, IgE level, and other specific test results should be evaluated together in the forensic pathological diagnosis of anaphylactic shock.

  11. SAPHO syndrome.

    PubMed

    Carneiro, Sueli; Sampaio-Barros, Percival D

    2013-05-01

    SAPHO syndrome is a disorder characterized by Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis. As the osteoarticular and skin manifestations often do not occur simultaneously and there are no validated diagnostic criteria, the diagnosis can be difficult. Clinical and imaging investigation is necessary to establish the many differential diagnoses of SAPHO syndrome. The etiopathogenesis involves infectious (probably Propionibacterium acnes), immunologic, and genetic factors. Treatment is based on information gathered from case reports and small series, and is related to specific skin or articular symptoms.

  12. Ion heating and energy redistribution across supercritical perpendicular shocks: Application to planetary and interplanetary shocks

    NASA Astrophysics Data System (ADS)

    Yang, Z.; Liu, Y. D.; Richardson, J. D.; Parks, G. K.

    2013-12-01

    We investigate how the ion dissipative process across supercritical perpendicular shocks depends on the shock front micro-structures. At a collisionless plasma shock, the dissipation and micro-structure of the shock font are dominated by wave-particle interactions. Comparison of the ion thermalization at different kinds of shocks, e.g., planetary and interplanetary shocks, can quantify how much interaction is occurring at the shock boundary. Investigation of this problem for diverse solar wind (SW) conditions will yield important information on the dependences of the ion thermalization and energy redistribution on plasma parameters. With the aid of a successful automatic separation method [Yang et al., 2009], the incident ions at the shock can be divided into two parts: reflected (R) ions and directly transmitted (DT) ions. Corresponding heating efficiency of each population of ions at the shock can be calculated respectively. Wilkinson & Schwartz [1990] have theorized that the amount of reflected ions at perpendicular shocks depends on plasma parameters. Based on the Rankine-Hugoniot (R-H) conservation laws, they found that the fraction reflected is strongly dependent on the magnitude of the ratio of specific heat capacities γ chosen in the R-H relations. The main goal of this work is to investigate how the plasma parameters, e.g. the particle velocity distribution, the plasma beta value, seed populations, etc. (from a particle dynamic point of view), control the amount of reflected ions by using one-dimensional (1-D) full-particle-cell simulations. The simulation results may help to explain the ion heating efficiency and energy redistribution at shocks observed by Cluster, Wind, Voyager, etc.

  13. Galileo flybys of Earth: The nature of the distant shock

    NASA Technical Reports Server (NTRS)

    Kivelson, M. G.; Prevost, A.; Coroniti, F. V.; Khurana, K. K.; Southwood, D. J.

    1995-01-01

    We report on observations of the Earth's bow shock at unprecedentedly large downtail distances, some as remote as 360 R(sub E). Suprisingly, we find that even at these large distances, the bow shock signature remains clear. The cases we report are among the weakest shocks ever clearly identified. These shocks reveal patterns of field changes remarkably similar to those observed for stronger shocks. Indeed, several of the shocks could serve as textbook examples because they occur in unusually quiet and steady solar wind conditions. The quasi- perpendicular shocks are, in some cases preceded by whistler wave trains. Several of the shocks which have normal vectors in the transitional region between quasiperpendicular and quasiparallel are associated with large amplitude wave disturbances in the downstream plasma. Although low Mach number, these shocks are the source of large amplitude turbulence. We show a range of fits to the locations of the shock crossings, and argue that, for steady solar wind conditions, there is no sign of tail flapping. The displacement of the shock from the tail axis appears to be governed by the interplanetary magnetic field orientation as previously reported for Venus.

  14. [DRESS syndrome].

    PubMed

    Adamcová, Monika; Šturdík, Igor; Koller, Tomáš; Payer, Juraj

    2016-04-01

    DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is severe drug-induced allergic-type reaction which occurs few days to weeks after taking a drug in a predisposed patient. Organ damage, eosinophilia and skin rash are typical at presentation. Corticotherapy is often necessary in severe cases. In this report we describe a case of 56-year old female with fever, elevated liver tests and skin rash. DRESS syndrome was diagnosed and allopurinol was indentified as a causative drug. Due to possible fatal outcome, DRESS syndrome should be considered in a differential diagnosis of all patients presenting with similar signs and symptoms.

  15. Lethal endotoxic shock using alpha-galactosylceramide sensitization as a new experimental model of septic shock.

    PubMed

    Ito, Hiroyasu; Koide, Naoki; Hassan, Ferdaus; Islam, Shamima; Tumurkhuu, Gantsetseg; Mori, Isamu; Yoshida, Tomoaki; Kakumu, Shinichi; Moriwaki, Hisataka; Yokochi, Takashi

    2006-03-01

    The effect of alpha-galactosylceramide (alpha-GalCer) on lipopolysaccharide (LPS)-mediated lethality was examined. Administration of LPS killed all mice pretreated with alpha-GalCer, but not untreated control mice. The lethal shock in alpha-GalCer-sensitized mice was accompanied by severe pulmonary lesions with marked infiltration of inflammatory cells and massive cell death. On the other hand, hepatic lesions were focal and mild. A number of cells in pulmonary and hepatic lesions underwent apoptotic cell death. alpha-GalCer sensitization was ineffective for the development of the systemic lethal shock in Valpha14-positive natural killer T cell-deficient mice. Sensitization with alpha-GalCer led to the circulation of a high level of interferon (IFN)-gamma and further augmented the production of tumor necrosis factor (TNF)-alpha in response to LPS. The lethal shock was abolished by the administration of anti-IFN-gamma or TNF-alpha antibody. Further, the lethal shock did not occur in TNF-alpha-deficient mice. Taken together, alpha-GalCer sensitization rendered mice very susceptible to LPS-mediated lethal shock, and IFN-gamma and TNF-alpha were found to play a critical role in the preparation and execution of the systemic lethal shock, respectively. The LPS-mediated lethal shock using alpha-GalCer sensitization might be useful for researchers employing experimental models of sepsis and septic shock.

  16. Three-dimensional shock-shock interactions on the scramjet inlet

    SciTech Connect

    Singh, D.J.; Tiwari, S.N.; Kumar, A.

    1990-01-01

    The effects of shock impingement on the inlet of a scramjet engine are investigated numerically. The impinging shock is caused by the vehicle forebody. The interaction of this forebody shock with the inlet leading edge shock results in a very complex fully three-dimensional flowfield containing local regions of high pressure and intense heating. In the present investigation, this complex flowfield is calculated by solving the thin-layer Navier-Stokes equations using a finite-volume flux splitting technique due to van Leer. For zero or small sweep angles a Type IV interaction occurs while for moderate sweep of about 25 deg, a Type V interaction occurs. Both Type IV and Type V interactions are investigated. 25 refs.

  17. Protective and Enhancing HLA Alleles, HLA-DRB1*0901 and HLA-A*24, for Severe Forms of Dengue Virus Infection, Dengue Hemorrhagic Fever and Dengue Shock Syndrome

    PubMed Central

    Lan, Nguyen Thi Phuong; Kikuchi, Mihoko; Huong, Vu Thi Que; Ha, Do Quang; Thuy, Tran Thi; Tham, Vo Dinh; Tuan, Ha Manh; Tuong, Vo Van; Nga, Cao Thi Phi; Van Dat, Tran; Oyama, Toshifumi; Morita, Kouichi; Yasunami, Michio; Hirayama, Kenji

    2008-01-01

    Background Dengue virus (DV) infection is one of the most important mosquito-borne diseases in the tropics. Recently, the severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), have become the leading cause of death among children in Southern Vietnam. Protective and/or pathogenic T cell immunity is supposed to be important in the pathogenesis of DHF and DSS. Methodology/Principal Findings To identify HLA alleles controlling T cell immunity against dengue virus (DV), we performed a hospital-based case control study at Children's Hospital No.2, Ho Chi Minh City (HCMC), and Vinh Long Province Hospital (VL) in Southern Vietnam from 2002 to 2005. A total of 211 and 418 patients with DHF and DSS, respectively, diagnosed according to the World Health Organization (WHO) criteria, were analyzed for their characteristic HLA-A, -B and -DRB1 alleles. Four hundred fifty healthy children (250 from HCMC and 200 from VL) of the same Kinh ethnicity were also analyzed as population background. In HLA class I, frequency of the HLA-A*24 showed increased tendency in both DHF and DSS patients, which reproduced a previous study. The frequency of A*24 with histidine at codon 70 (A*2402/03/10), based on main anchor binding site specificity analysis in DSS and DHF patients, was significantly higher than that in the population background groups (HCMC 02-03 DSS: OR = 1.89, P = 0.008, DHF: OR = 1.75, P = 0.033; VL 02-03 DSS: OR = 1.70, P = 0.03, DHF: OR = 1.46, P = 0.38; VL 04-05 DSS: OR = 2.09, P = 0.0075, DHF: OR = 2.02, P = 0.038). In HLA class II, the HLA-DRB1*0901 frequency was significantly decreased in secondary infection of DSS in VL 04-05 (OR = 0.35, P = 0.0025, Pc = 0.03). Moreover, the frequency of HLA-DRB1*0901 in particular was significantly decreased in DSS when compared with DHF in DEN-2 infection (P = 0.02). Conclusion This study improves our understanding of the risk of HLA-class I for

  18. Shock absorber control system

    SciTech Connect

    Nakano, Y.; Ohira, M.; Ushida, M.; Miyagawa, T.; Shimodaira, T.

    1987-01-13

    A shock absorber control system is described for controlling a dampening force of a shock absorber of a vehicle comprising: setting means for setting a desired dampening force changeable within a predetermined range; drive means for driving the shock absorber to change the dampening force of the shock absorber linearly; control means for controlling the drive means in accordance with the desired dampening force when the setting of the desired dampening force has been changed; detecting means for detecting an actual dampening force of the shock absorber; and correcting means for correcting the dampening force of the shock absorber by controlling the drive means in accordance with a difference between the desired dampening force and the detected actual dampening force.

  19. The clinical and hemodynamic presentation of the shock patient.

    PubMed

    Summers, G

    1990-06-01

    It is the nurse's responsibility to assess the critically ill patient and to interpret data so that therapy can be directed to optimally treat that individual. Shock is a complex progressive syndrome that includes specific types, such as cardiogenic, septic, anaphylactic, and hypovolemic. Clinical and hemodynamic parameters provide clues to the specific type of shock and its clinical progress. The progression of the shock state must be monitored by critical care nurses who are knowledgeable of and proficient in clinical assessment skills and the acquisition and interpretation of significant hemodynamic data.

  20. Advances in Vascular Hyporeactivity After Shock: The Mechanisms and Managements.

    PubMed

    Duan, Chenyang; Yang, Guangming; Li, Tao; Liu, Liangming

    2015-12-01

    Vascular reactivity to vasoconstrictors and vasodilators is greatly reduced after severe trauma, shock, and sepsis or multiple organ dysfunction syndrome. This reduced vascular reactivity severely interferes with the treatment of shock and other critical conditions. In particular, it interferes with the efficacy of vasoactive agents. Consequently, it is very important to elucidate the mechanisms and search for the effective treatment measures. In recent years, a lot of studies focused on the characteristics and the change rules of vascular hyporeactivity and mechanisms following shock. Also, the treatment approaches based on various mechanisms have been a hot pot these years.

  1. Anti-Shock Garment

    NASA Technical Reports Server (NTRS)

    1996-01-01

    Ames Research Center developed a prototype pressure suit for hemophiliac children, based on research of astronauts' physiological responses in microgravity. Zoex Corporation picked up the design and patents and developed an anti-shock garment for paramedic use. Marketed by Dyna Med, the suit reverses the effect of shock on the body's blood distribution by applying counterpressure to the legs and abdomen, returning blood to vital organs and stabilizing body pressure until the patient reaches a hospital. The DMAST (Dyna Med Anti-Shock Trousers) employ lower pressure than other shock garments, and are non-inflatable.

  2. Shock initiation of nitromethane

    SciTech Connect

    Yoo, C.S.; Holmes, N.C.

    1993-12-31

    The shock initiation processes of nitromethane have been examined by using a fast time-resolved emission spectroscopy at a two-stage gas gun. a broad, but strong emission has been observed in a spectral range between 350 and 700 nm from shocked nitromethane above 9 GPa. The temporal profile suggests that shocked nitromethane detonates through three characteristic periods, namely an induction period, a hock initiation period, and a thermal explosion period. This paper discusses temporal and chemical characteristics of these periods and present the temperature of the shock-detonating nitromethane at pressures between 9 and 15 GPa.

  3. Shock Effects in Experimentally Shocked Samples of the H6 Chondrite Kernouve

    NASA Astrophysics Data System (ADS)

    Schmitt, R. T.; Deutsch, A.; Stoffler, D.

    1993-07-01

    extinction. In the pressure range from 10 to 20 GPa, plagioclase displays undulatory extinction. In the 35-GPa sample most of the plagioclase is transformed to maskelynite (diaplectic glass). This transformation is complete in the 60-GPa sample. The first effects of localized shock-induced melting are observed in the 35- GPa sample, where a few melt pockets occur. The 60-GPa sample shows abundant melt pockets, shock veins, and troilite injections into fractures of the silicates. Troilite of the unshocked sample is monocrystalline. In the pressure range from 10 to 20 GPa, troilite shows undulatory extinction and twinning. The 35- and 60-GPa samples contain only recrystallized troilite. This troilite is polycrystalline and consists of equant grains with 120-degree angles between grain boundaries. Shock Classification and Conclusions: Using the classification scheme of [1], the experimentally shocked Kernouve samples can be classified into the following stages: Unshocked--S1; 10 GPa--S3; 15 and 20 GPa--S4; 35 GPa--S5; and 60 GPa--S6. The transition between shock stage 3 and 4 appears to be somewhat lower than proposed by [1] and occurs in the pressure range of 10 to 15 GPa, probably near to 15 GPa.The investigation of the experimentally shocked chondrite Kernouve shows the same pressure-dependent features as observed in naturally shocked ordinary chondrites [1]. For this reason shock recovery experiments provide an important basis for a better understanding of natural shock features in ordinary chondrites. References: [1] St"ffler D. et al. (1991) GCA, 55, 3845-3867. [2] Bogard D. D. et al. (1987) GCA, 51, 2035-2044. [3] Dai C.-D. et al. (1991) Chin. Sci. Bull., 36, 1984-1988. [4] Sears D. W. et al. (1984) GCA, 48, 343-360. [5] M ller W. F. and Hornemann U. (1969) EPSL, 7, 251-264.

  4. [A case of anaphylactic shock by multiple causes].

    PubMed

    Sonofuchi, Kei; Watanabe, Kazuhiro; Onuma, Toshiyasu; Kaneko, Toshikazu; Ohmizo, Hiroshi; Furuta, Setsuo; Endo, Katsuya; Morota, Tomoko

    2010-08-01

    We experienced anaphylactic shock after introduction of the general anesthesia twice in the same patient. After the first incidence of anaphylactic shock, we judged that the allergen was a latex. For the second time we planned the latex free environment, but the anaphylactic shock occurred again. As a result of the investigation, it turned out that the allergens were due to latex and sevoflurane. After the first incidence, it was necessary to retrieve the antigen from all the agents used. When we encounter the anaphylactic shock, it is necessary to examine all the medicines, and should have two or more suspectible medicines in mind.

  5. Effects of Interaction Between Normal Shock and Boundary Layer

    NASA Technical Reports Server (NTRS)

    Donaldson, Coleman duP.

    1944-01-01

    A discussion of the interaction between normal shocks and boundary layers on the basis of experimental evidence obtained in studies of supersonic flows in passages is given. The investigation was made as a result of the inability of the existing normal-shock theory to explain phenomena involving normal shocks that occurred in the presence of boundary layers. Assumptions with regard to the character of the effects of interaction between boundary layer and normal shock are proposed; these assumptions seem to give good agreement with certain experimental results.

  6. Ultrafast shock initiation of exothermic chemistry in hydrogen peroxide.

    PubMed

    Armstrong, Michael R; Zaug, Joseph M; Goldman, Nir; Kuo, I-Feng W; Crowhurst, Jonathan C; Howard, W Michael; Carter, Jeffrey A; Kashgarian, Michaele; Chesser, John M; Barbee, Troy W; Bastea, Sorin

    2013-12-12

    We report observations of shock compressed, unreacted hydrogen peroxide at pressures up to the von Neumann pressure for a steady detonation wave, using ultrafast laser-driven shock wave methods. At higher laser drive energy we find evidence of exothermic chemical reactivity occurring in less than 100 ps after the arrival of the shock wave in the sample. The results are consistent with our MD simulations and analysis and suggest that reactivity in hydrogen peroxide is initiated on a sub-100 ps time scale under conditions found just subsequent to the lead shock in a steady detonation wave.

  7. The interaction of hydrodynamic shocks with self-gravitating clouds

    NASA Astrophysics Data System (ADS)

    Falle, S. A. E. G.; Vaidya, B.; Hartquist, T. W.

    2017-02-01

    We describe the results of 3D simulations of the interaction of hydrodynamic shocks with Bonnor-Ebert spheres performed with an adaptive mesh refinement code. The calculations are isothermal and the clouds are embedded in a medium in which the sound speed is either 4 or 10 times that in the cloud. The strengths of the shocks are such that they induce gravitational collapse in some cases and not in others, and we derive a simple estimate for the shock strength required for this to occur. These results are relevant to dense cores and Bok globules in star-forming regions subjected to shocks produced by stellar feedback.

  8. Ultrafast dynamic ellipsometry and spectroscopy of laser shocked materials

    SciTech Connect

    Bolme, Cynthia A; Mc Grane, Shawn D; Dang, Nhan C; Whitley, Von H; Moore, David S.

    2011-01-20

    Ultrafast dynamic ellipsometry is used to measure the material motion and changes in the optical refractive index of laser shock compressed materials. This diagnostic has shown us that the ultrafast laser driven shocks are the same as shocks on longer timescales and larger length scales. We have added spectroscopic diagnostics of infrared absorption, ultra-violet - visible transient absorption, and femtosecond stimulated Raman scattering to begin probing the initiation chemistry that occurs in shock reactive materials. We have also used the femtosecond stimulated Raman scattering to measure the vibrational temperature of materials using the Stokes gain to anti-Stokes loss ratio.

  9. The Heat Shock Paradox and Cardiac Myocytes: Role of Heat Shock Factor

    PubMed Central

    Kobba, Samuel; Kim, Se-Chan; Chen, Le; Kim, EunJung; Tran, Alice L.; Knuefermann, Pascal; Knowlton, Anne A.

    2012-01-01

    The induction of the heat shock response is accepted to be a protective response, reducing injury and improving cell survival. However, when inflammation precedes heat shock there is an unexpected increase in injury, known as the heat shock paradox, which is hypothesized to be a mechanism underlying multi-organ dysfunction. We hypothesized that the heat shock paradox would occur in adult cardiac myocytes and that heat shock factor (HSF)1 would contribute to injury. Heat shock (HS) at 42°C and TNF (10 ng/ml) were used as the HS and the inflammatory insult, respectively. The combination of TNF followed by HS (TNF/HS) caused the greatest amount of apoptosis in adult rat cardiac myocytes. TNF/HS resulted in an increase in heat shock protein (HSP) 60, compared to untreated cells, those receiving HS/TNF, or TNF alone. There was no increase in heme oxygenase 1 in any of the groups. HSP72 increased in all the groups, with the greatest levels with TNF/HS. NFκB activation was greatest with TNF/HS. Pretreatment with a DNA binding decoy for HSF1 prevented the increase in HSPs and decreased apoptosis in all groups. However, the increase in iNOS, seen in all treatment groups, was unaffected by the HSF1 binding decoy. We conclude that the heat shock paradox occurs in adult cardiac myocytes, that HSP60 is increased as part of the heat shock paradox, and that HSF1 activation contributes to injury. PMID:21192280

  10. Extracorporeal Life Support for Refractory Cardiac Arrest or Shock: A 10-Year Study.

    PubMed

    Brunet, Jennifer; Valette, Xavier; Ivascau, Calin; Lehoux, Philippe; Sauneuf, Bertrand; Dalibert, Yves; Masson, Romain; Sabatier, Remi; Buklas, Dimitrios; Seguin, Amélie; Terzi, Nicolas; du Cheyron, Damien; Parienti, Jean-Jacques; Daubin, Cedric

    2015-01-01

    We aimed to identify factors associated with hospital mortality among patients receiving extracorporeal life support (ECLS). All consecutive patients treated with ECLS for refractory cardiac arrest or shock in the Caen University Hospital in northwestern France during the last decade were included in a retrospective cohort study. Sixty-four patients were included: 29 with refractory cardiac arrest and 35 with refractory shock. The main reasons for ECLS were acute coronary syndrome (n = 23) and severe poisoning caused by drug intoxication (n = 19). At ECLS initiation, the left ventricular ejection fraction was 16% (±11). Initial blood test results were arterial pH = 7.19 (±0.20) and plasma lactate = 8.02 (±5.88) mmol/L. Forty (63%) patients died including 33 under ECLS. In a multivariate analysis, two factors were independently associated with survival: drug intoxication as the reason for ECLS (adjusted odds ratio [AOR], 0.07; 95% confidence intervals [CI], 0.01-0.28; p < 0.001) and arterial pH (an increase of 0.1 point [AOR, 0.013; 95% CI, <0.001-0.27; p < 0.01]). This study supports early ECLS as a last resort therapeutic option in a highly selected group of patients with refractory cardiac arrest or shock, in particular before profound acidosis occurs and when the cause is reversible.

  11. [Acute respiratory distress syndrome].

    PubMed

    Estenssoro, Elisa; Dubin, Arnaldo

    Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance. ARDS always occurs within a week of exposition to a precipitating factor; most frequently pneumonia, shock, aspiration of gastric contents, sepsis, and trauma. In CT scan, the disease is frequently inhomogeneous, with gravitational infiltrates coexisting with normal-density areas and also with hyperaerated parenchyma. Mortality is high (30-60%) especially in ARDS associated with septic shock and neurocritical diseases. The cornerstone of therapy lies in the treatment of the underlying cause and in the use mechanical ventilation which, if inappropriately administered, can lead to ventilator-induced lung injury. Tidal volume = 6 ml/kg of ideal body weight to maintain an end-inspiratory (plateau) pressure = 30 cm H2O ("protective ventilation") is the only variable consistently associated with decreased mortality. Moderate-to-high PEEP levels are frequently required to treat hypoxemia, yet no specific level or titration strategy has improved outcomes. Recently, the use of early prone positioning in patients with PaO2/FIO2 = 150 was associated with increased survival. In severely hypoxemic patients, it may be necessary to use adjuvants of mechanical ventilation as recruitment maneuvers, pressure-controlled modes, neuromuscular blocking agents, and extracorporeal-membrane oxygenation. Fluid restriction appears beneficial.

  12. Normal Shock Vortex Interaction

    DTIC Science & Technology

    2003-03-01

    Figure 9: Breakdown map for normal-shock vortex-interaction. References [1] O. Thomer, W. Schroder and M. Meinke , Numerical Simulation of Normal...and Oblique-Shock Vortex Interaction, ZAMM Band 80, Sub. 1, pp. 181-184, 2000. [2] O. Thomer, E. Krause, W. Schroder and M. Meinke , Computational

  13. Blueberry shock virus

    USDA-ARS?s Scientific Manuscript database

    Blueberry shock disease first observed in Washington state in 1987 and initially confused with blueberry scorch caused by Blueberry scorch virus (BlScV). However, shock affected plants produced a second flush of leaves after flowering and the plants appeared normal by late summer except for the lac...

  14. Mechanical Properties of Shock-Damaged Rocks

    NASA Technical Reports Server (NTRS)

    He, Hongliang; Ahrens, T. J.

    1994-01-01

    Stress-strain tests were performed both on shock-damaged gabbro and limestone. The effective Young's modulus decreases with increasing initial damage parameter value, and an apparent work-softening process occurs prior to failure. To further characterize shock-induced microcracks, the longitudinal elastic wave velocity behavior of shock-damaged gabbro in the direction of compression up to failure was measured using an acoustic transmission technique under uniaxial loading. A dramatic increase in velocity was observed for the static compressive stress range of 0-50 MPa. Above that stress range, the velocity behavior of lightly damaged (D(sub 0) less than 0.1) gabbro is almost equal to unshocked gabbro. The failure strength of heavily-damaged (D(sub 0) greater than 0.1) gabbro is approx. 100-150 MPa, much lower than that of lightly damaged and unshocked gabbros (approx. 230-260 MPa). Following Nur's theory, the crack shape distribution was analyzed. The shock-induced cracks in gabbro appear to be largely thin penny-shaped cracks with c/a values below 5 x 10(exp -4). Moreover, the applicability of Ashby and Sammis's theory relating failure strength and damage parameter of shock-damaged rocks was examined and was found to yield a good estimate of the relation of shock-induced deficit in elastic modulus with the deficit in compressive strength.

  15. Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress.

    PubMed

    Yacoub, Sophie; Trung, Trieu Huynh; Lam, Phung Khanh; Thien, Vuong Huynh Ngoc; Hai, Duong Ha Thi; Phan, Tu Qui; Nguyet, Oanh Pham Kieu; Quyen, Nguyen Than Ha; Simmons, Cameron Paul; Broyd, Christopher; Screaton, Gavin Robert; Wills, Bridget

    2017-07-01

    Dengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue. We performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded. 102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3-5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01-1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001). Echo-derived intravascular volume assessment and venous lactate levels can help identify dengue patients at high risk of recurrent

  16. Shock Dynamics for particle-laden thin film

    NASA Astrophysics Data System (ADS)

    Wang, Li; Bertozzi, Andrea

    2013-11-01

    We study the shock dynamics for a recently proposed system of conservation laws (Murisic et al. [J. Fluid Mech. 2013]) describing gravity-driven thin film flow of a suspension of particles down an incline. When the particle concentration is above a critical value, singular shock solutions can occur. We analyze the Hugoniot topology associated with the Riemann problem for this system, describing in detail how the transition from a double shock to a singular shock happen. We also derive the singular shock speed based on a key observation that the particles pilling up at the maximum packing fraction near the contact line. These results are further applied to constant volume case to generate a rarefaction-singular shock solution. The particle/fluid front are shown to move linearly to the leading order with time to the one-third power as predicted by the Huppert solution for clear fluid.

  17. A second-generation constrained reaction volume shock tube.

    PubMed

    Campbell, M F; Tulgestke, A M; Davidson, D F; Hanson, R K

    2014-05-01

    We have developed a shock tube that features a sliding gate valve in order to mechanically constrain the reactive test gas mixture to an area close to the shock tube endwall, separating it from a specially formulated non-reactive buffer gas mixture. This second-generation Constrained Reaction Volume (CRV) strategy enables near-constant-pressure shock tube test conditions for reactive experiments behind reflected shocks, thereby enabling improved modeling of the reactive flow field. Here we provide details of the design and operation of the new shock tube. In addition, we detail special buffer gas tailoring procedures, analyze the buffer/test gas interactions that occur on gate valve opening, and outline the size range of fuels that can be studied using the CRV technique in this facility. Finally, we present example low-temperature ignition delay time data to illustrate the CRV shock tube's performance.

  18. Shock initiation of 1,3,3-trinitroazetidine (TNAZ)

    SciTech Connect

    Simpson, R.L.; Urtiew, P.A.; Tarver, C.M.

    1995-07-19

    The shock sensitivity of the pressed solid explosive 1,3,3-trinitroazetidine (TNAZ) was determined using the embedded manganin pressure gauge technique. At an initial pressure of 1.3 GPa, pressure buildup (exothermic reaction) was observed after ten {mu}s. At 2 GPa, TNAZ reacted rapidly and transitioned to detonation in approximately 13 mm. At 3.6 GPa, detonation occurred in less than 6 mm of shock propagation. Thus, pure TNAZ is more shock sensitive than HMX-based explosives but less shock sensitive than PETN-based explosives. The shocked TNAZ exhibited little reaction directly behind the shock front, followed by an extremely rapid reaction. This reaction caused both a detonation wave and a retonation wave in the partially decomposed TNAZ. An Ignition and Growth reactive model for TNAZ was developed to help understand this complex initiation phenomenon.

  19. Shock initiation of 1,3,3-trinitroazetidine (TNAZ)

    SciTech Connect

    Simpson, R.L.; Urtiew, P.A.; Tarver, C.M.

    1996-05-01

    The shock sensitivity of the pressed solid explosive 1,3,3-trinitroazetidine (TNAZ) was determined using the embedded manganin pressure gauge technique. At an initial pressure of 1.3 GPa, pressure buildup (exothermic reaction) was observed after ten {mu}s. At 2 GPa, TNAZ reacted rapidly and transitioned to detonation in approximately 13 mm. At 3.6 GPa, detonation occurred in less than 6 mm of shock propagation. Thus, pure TNAZ is more shock sensitive than HMX-based explosives but less shock sensitive than PETN-based explosives. The shocked TNAZ exhibited little reaction directly behind the shock front, followed by an extremely rapid reaction. This reaction caused both a detonation wave and a retonation wave in the partially decomposed TNAZ. An Ignition and Growth reactive flow model for TNAZ was developed to help explain this complex initiation phenomenon. {copyright} {ital 1996 American Institute of Physics.}

  20. Detecting shock waves in cosmological smoothed particle hydrodynamics simulations

    NASA Astrophysics Data System (ADS)

    Pfrommer, C.; Springel, V.; Enßlin, T. A.; Jubelgas, M.

    2006-03-01

    occurring in central high-density regions of haloes. When combined with radiative dissipation and star formation, our formalism can also be used to study CR injection by supernova shocks, or to construct models for shock-induced star formation in the interstellar medium.

  1. Shock propagation and attenuation in high-power excimer lasers

    NASA Astrophysics Data System (ADS)

    Holzwarth, Achim; Berger, Peter; Huegel, Helmut

    1993-05-01

    Theoretical and experimental investigations on the propagation, reflection, and attenuation of shock waves as they occur in excimer lasers have been performed. The numerical simulations have been carried out using a two-dimensional, unsteady finite difference scheme. The experimental setup is a piston driven shock tube with a rectangular cross section working in air at atmospheric pressure. The shocks were detected interferometrically as well as by means of pressure transducers. This shock tube allows us to investigate basic phenomena of shock diffraction which can be used to confirm the computational results in the range of weak shock waves. In particular, the influence of the shape of the wall contour on the reflection of shock waves has been investigated theoretically. The decay time of pressure and density perturbations differs for various wall configurations in such a way that short electrodes accelerate the attenuation as well as does a strong area increase in the vicinity of them. After each laser pulse there is a shock travelling into the laser channel. Experiments have been carried out on the reflection of this shock at a specially formed bend that is able to focus the shock into a muffling element.

  2. Reflection of curved shock waves

    NASA Astrophysics Data System (ADS)

    Mölder, S.

    2017-09-01

    Shock curvatures are related to pressure gradients, streamline curvatures and vorticity in flows with planar and axial symmetry. Explicit expressions, in an influence coefficient format, are used to relate post-shock pressure gradient, streamline curvature and vorticity to pre-shock gradients and shock curvature in steady flow. Using higher order, von Neumann-type, compatibility conditions, curved shock theory is applied to calculate the flow near singly and doubly curved shocks on curved surfaces, in regular shock reflection and in Mach reflection. Theoretical curved shock shapes are in good agreement with computational fluid dynamics calculations and experiment.

  3. Reflection of curved shock waves

    NASA Astrophysics Data System (ADS)

    Mölder, S.

    2017-03-01

    Shock curvatures are related to pressure gradients, streamline curvatures and vorticity in flows with planar and axial symmetry. Explicit expressions, in an influence coefficient format, are used to relate post-shock pressure gradient, streamline curvature and vorticity to pre-shock gradients and shock curvature in steady flow. Using higher order, von Neumann-type, compatibility conditions, curved shock theory is applied to calculate the flow near singly and doubly curved shocks on curved surfaces, in regular shock reflection and in Mach reflection. Theoretical curved shock shapes are in good agreement with computational fluid dynamics calculations and experiment.

  4. Some recent developments in the prediction of shock interaction phenomena at hypersonic speeds

    NASA Technical Reports Server (NTRS)

    Crawford, D. H.

    1979-01-01

    The shock strengths for which either Edney type I or type II shock interference patterns can occur when two oblique shocks of opposite families intersect were determined graphically at Mach 10 by using logarithmic shock polar diagrams. The theoretical region of overlap for the two types of interaction was investigated by observing in the Schlieren system of the Langley 15-inch hypersonic flow apparatus the intersection of oblique shocks generated by two sharp 10 degree wedges as the wedge angles of attack and their relative positions were altered. A range of shock strengths for which either of the two interference patterns can exist was demonstrated.

  5. The role of interplanetary shock orientation on SC/SI rise time and geoeffectiveness

    NASA Astrophysics Data System (ADS)

    Selvakumaran, R.; Veenadhari, B.; Ebihara, Y.; Kumar, Sandeep; Prasad, D. S. V. V. D.

    2017-03-01

    Interplanetary (IP) shocks interact with the Earth's magnetosphere, resulting in compression of the magnetosphere which in turn increases the Earth's magnetic field termed as Sudden commencement/Sudden impulse (SC/SI). Apart from IP shock speed and solar wind dynamic pressure, IP shock orientation angle also plays a major role in deciding the SC rise time. In the present study, the IP shock orientation angle and SC/SI rise time for 179 IP shocks are estimated which occurred during solar cycle 23. More than 50% of the Shock orientations are in the range of 140°-160°. The SC/SI rise time decreases with the increase in the orientation angle and IP shock speed. In this work, the type of IP shocks i.e., Radio loud (RL) and Radio quiet (RQ) are examined in connection with SC/SI rise time. The RL associated IP shock speeds show a better correlation than RQ shocks with SC/SI rise time irrespective of the orientation angle. Magnetic Cloud (MC) associated shocks dominate in producing less rise time when compared to Ejecta (EJ) shocks. Magneto hydrodynamic (MHD) simulations are used for three different IP shock orientation categories to see the importance of orientation angle in determining the geoeffectiveness. Simulations results reveal that shocks hitting parallel to the magnetosphere are more geoeffective as compared to oblique shocks by means of change in magnetic field, pressure and Field Aligned Current (FAC).

  6. Collisionless parallel shocks

    SciTech Connect

    Khabibrakhmanov, I.K. ); Galeev, A.A.; Galinsky, V.L. )

    1993-02-01

    A collisionless parallel shock model is presented which is based on solitary-type solutions of the modified derivative nonlinear Schrodinger equation (MDNLS) for parallel Alfven waves. We generalize the standard derivative nonlinear Schrodinger equation in order to include the possible anisotropy of the plasma distribution function and higher-order Korteweg-de Vies type dispersion. Stationary solutions of MDNLS are discussed. The new mechanism, which can be called [open quote]adiabatic[close quote] of ion reflection from the magnetic mirror of the parallel shock structure is the natural and essential feature of the parallel shock that introduces the irreversible properties into the nonlinear wave structure and may significantly contribute to the plasma heating upstream as well as downstream of the shock. The anisotropic nature of [open quotes]adiabatic[close quotes] reflections leads to the asymmetric particle distribution in the upstream as well in the downstream regions of the shock. As a result, nonzero heat flux appears near the front of the shock. It is shown that this causes the stochastic behavior of the nonlinear waves which can significantly contribute to the shock thermalization. The number of adiabaticaly reflected ions define the threshold conditions of the fire-hose and mirror type instabilities in the downstream and upstream regions and thus determine a parameter region in which the described laminar parallel shock structure can exist. The threshold conditions for the fire hose and mirror-type instabilities in the downstream and upstream regions of the shock are defined by the number of reflected particles and thus determine a parameter region in which the described laminar parallel shock structure can exist. 29 refs., 4 figs.

  7. Shock-induced CO2 loss from CaCO3: Implications for early planetary atmospheres

    NASA Technical Reports Server (NTRS)

    Lange, M. A.; Ahrens, T. J.

    1984-01-01

    Recovered samples from shock recovery experiments on single crystal calcite were subjected to thermogravimetric analysis to determine the amount of post-shock CO2, the decarbonization interval and the activation energy, for the removal of remaining CO2 in shock-loaded calcite. Comparison of post-shock CO2 with that initially present determines shock-induced CO2 loss as a function of shock pressure. Incipient to complete CO2 loss occurs over a pressure range of approximately 10 to approximately 70 GPa. Optical and scanning electron microscopy reveal structural changes, which are related to the shock-loading. The occurrence of dark, diffuse areas, which can be resolved as highly vesicular areas as observed with a scanning electron microscope are interpreted as representing quenched partial melts, into which shock-released CO2 was injected. The experimental results are used to constrain models of shock-produced, primary CO2 atmospheres on the accreting terrestrial planets.

  8. Dumping syndrome (image)

    MedlinePlus

    Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine. The ... causing nausea, cramping, diarrhea, sweating, faintness, and palpitations. Dumping usually occurs after the consumption of too much ...

  9. Development of the hybrid numerical simulation to clarify shock viscosity effects in a plastic shock wave front

    NASA Astrophysics Data System (ADS)

    Abe, A.

    Shock viscous stress can be defined as the stress differences between the stress on Rayleigh line and the equilibrium stress at the same strain. The shock viscous stress is one of the important parameters with respect to rising times of elastic and plastic shock wave fronts [1]. Swegle and Grady took the routine program of the shock viscous stress into their one-dimensional finite difference wave code, and they predicted the shock wave rise times occurred in several kind of materials with relatively small stress impacts [2]. Their numerical results seemed to represent the experimental results measured by the velocity interferometer system (VISAR). Strictly speaking, however, their method was not sufficiently accurate because their expression of the shock viscous stress was the stress differences between Rayleigh line and Hugoniot. Recently, we had proposed a new analytical method to get temperature in steady shock wave fronts and the effects were ascertained for a ceramic material and some metals [3-6]. When we derive the temperature in shock wave fronts by our method, we can also get the quasistatic (equilibrium) stresses. Therefore, it is possible to obtain the shock viscous stress analytically. The structured variations in the shock wave rising process are closely related to the dissipative processes in the material, and it is interesting to investigate these structured characteristics.

  10. The Culture Game: A Simulation of Culture Shock.

    ERIC Educational Resources Information Center

    Noesjirwan, Jennifer; Freestone, Colin

    1979-01-01

    Presents a simulation game used to verify the theory that culture shock in the form of confusion, hostility, and anxiety occurs when interpersonal communication between interactors from different cultures breaks down. (CMV)

  11. Nonthermal Electrons at High Mach Number Shocks: Electron Shock Surfing Acceleration

    NASA Astrophysics Data System (ADS)

    Hoshino, M.; Shimada, N.

    2002-06-01

    We study the suprathermal electron acceleration mechanism in a perpendicular magnetosonic shock wave in a high Mach number regime by using a particle-in-cell simulation. We find that shock surfing/surfatron acceleration producing suprathermal electrons occurs in the shock transition region, where a series of large-amplitude electrostatic solitary waves (ESWs) are excited by Buneman instability under the interaction between the reflected ions and the incoming electrons. It is shown that the electrons are likely to be trapped by ESWs, and during the trapping phase they can be effectively accelerated by the shock motional/convection electric field. We discuss that suprathermal electrons can be accelerated up to mic2(v0/c), where mic2 is the ion rest mass energy and v0 is the shock upstream flow velocity. Furthermore, some of these suprathermal electrons may be effectively trapped for an infinitely long time when the Alfvén Mach number MA exceeds several tens, and they are accelerated up to the shock potential energy determined by the global shock size.

  12. Repetition Blindness Occurs in Nonwords

    ERIC Educational Resources Information Center

    Harris, Catherine L.; Morris, Alison L.

    2004-01-01

    Theorists have predicted that repetition blindness (RB) should be absent for nonwords because they do not activate preexisting mental types. The authors hypothesized that RB would be observed for nonwords because RB can occur at a sublexical level. Four experiments showed that RB is observed for word-nonword pairs (noon noof), orthographically…

  13. Comparison of shock severity measures

    SciTech Connect

    Baca, T.J.

    1989-01-01

    In an effort to clarify the issues associated with quantifying shock severity, this paper compares the merits of two measures of shock severity. The first measure is the widely used absolute acceleration shock response spectrum (SAA). The second measure of shock severity is relatively new and is known as the shock intensity spectrum (SIS). Overall information content of SAA and SIS spectra are compared and discussed in the context of two shock excitations having known amplitude, duration, and frequency content. The first is a burst of band-limited white noise and the second is a classical haversine pulse. After describing both the SAA and SIS shock measures, numerous examples are described which emphasize the strengths and limitations of each shock characterization method. This discussion reveals how the use of different shock measures may alter an engineer's conclusions about relative shock severity between two shock environments. 8 refs., 15 figs.

  14. Shock formation in stellar perturbations and tidal shock waves in binaries

    NASA Astrophysics Data System (ADS)

    Gundlach, Carsten; Murphy, Jeremiah W.

    2011-09-01

    We investigate whether tidal forcing can result in sound waves steepening into shocks at the surface of a star. To model the sound waves and shocks, we consider adiabatic non-spherical perturbations of a Newtonian perfect fluid star. Because tidal forcing of sound waves is naturally treated with linear theory, but the formation of shocks is necessarily non-linear, we consider the perturbations in two regimes. In most of the interior, where tidal forcing dominates, we treat the perturbations as linear, while in a thin layer near the surface we treat them in full non-linearity but in the approximation of plane symmetry, fixed gravitational field and a barotropic equation of state. Using a hodograph transformation, this non-linear regime is also described by a linear equation. We show that the two regimes can be matched to give rise to a single-mode equation which is linear but models non-linearity in the outer layers. This can then be used to obtain an estimate for the critical mode amplitude at which a shock forms near the surface. As an application, we consider the tidal waves raised by the companion in an irrotational binary system in circular orbit. We find that shocks form at the same orbital separation where Roche lobe overflow occurs, and so shock formation is unlikely to occur.

  15. Biphasic shocks compared with monophasic damped sine wave shocks for direct ventricular defibrillation during open heart surgery.

    PubMed

    Schwarz, Birgit; Bowdle, T Andrew; Jett, G Kimble; Mair, Peter; Lindner, Karl H; Aldea, Gabriel S; Lazzara, Robert G; O'Grady, Sharon G; Schmitt, Paul W; Walker, Robert G; Chapman, Fred W; Tacker, Willis A

    2003-05-01

    Biphasic waveform shocks are more effective than monophasic shocks for transchest ventricular defibrillation, atrial cardioversion, and defibrillation with implantable defibrillators but have not been studied for open chest, intraoperative defibrillation. This prospective, blinded, randomized clinical study compares biphasic and monophasic shock effectiveness and establishes intraoperative energy dose-response curves. Patients undergoing cardiothoracic surgery with bypass cardioplegia were randomly assigned to the monophasic or biphasic shock group. Ventricular fibrillation occurring after aortic clamp removal was treated with escalating energies of 2, 5, 7, 10, and 20 J until defibrillation occurred. If ventricular fibrillation persisted, a 20-J crossover shock of the other waveform was used. Cumulative defibrillation success at 5 J, the primary end point of the study, was higher in the biphasic group than in the monophasic group (25 of 50 vs. 9 of 41 defibrillated; P = 0.011). In addition, the biphasic group required lower threshold energy (6.8 vs. 11.0 J; P = 0.003), less cumulative energy (12.6 vs. 23.4 J; P = 0.002), and fewer shocks (2.5 vs. 3.5; P = 0.002). Crossover-shock effectiveness did not differ between groups. Dose-response curves show biphasic shocks to have higher cumulative success rates at all energies tested. Biphasic shocks are substantially more effective than monophasic shocks for direct defibrillation. The dose-response curve guides selection of first-shock energy for traditional step-up protocols. Starting at 5 J optimizes for lowest threshold and cumulative energy, whereas 10 or 20 J optimizes for more rapid defibrillation and fewer shocks.

  16. Syndromes with supernumerary teeth.

    PubMed

    Lubinsky, Mark; Kantaputra, Piranit Nik

    2016-10-01

    While most supernumerary teeth are idiopathic, they can be associated with a number of Mendelian syndromes. However, this can also be a coincidental finding, since supernumerary teeth occur in 6% or more of the normal population. To better define this relationship, we analyzed the evidence for specific associations. We excluded conditions with a single affected patient reported, supernumerary teeth adjacent to clefts or other forms of alveolar disruption (as secondary rather than primary findings), and natal teeth, which can involve premature eruption of a normal tooth. Since, the cause of supernumerary teeth shows considerable heterogeneity, certain findings are less likely to be coincidental, such as five or more supernumerary teeth in a single patient, or locations outside of the premaxilla. We found only eight genetic syndromes with strong evidence for an association: cleidocranial dysplasia; familial adenomatous polyposis; trichorhinophalangeal syndrome, type I; Rubinstein-Taybi syndrome; Nance-Horan syndrome; Opitz BBB/G syndrome; oculofaciocardiodental syndrome; and autosomal dominant Robinow syndrome. There is also suggestive evidence of an association with two uncommon disorders, Kreiborg-Pakistani syndrome (craniosynostosis and dental anomalies), and insulin-resistant diabetes mellitus with acanthosisnigricans. An association of a Mendelian disorder with a low frequency manifestation of supernumerary teeth is difficult to exclude without large numbers, but several commonly cited syndromes lacked evidence for clear association, including Hallermann-Streiff syndrome, Fabry disease, Ehlers-Danlos syndrome, Apert and Crouzon syndromes, Zimmermann-Laband syndrome, and Ellis-van Creveld syndrome. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Shock Bench Enhancements

    NASA Astrophysics Data System (ADS)

    Charvet, B.; Dilhan, D.; Palladino, M.

    2014-06-01

    In 2008 a contract placed by CNES in partnership with ESA has led MECANO ID to develop a shock bench to qualify spacecraft equipment. A spacecraft shall withstand several shocks without degradation: launcher fairing or stages separation, spacecraft separation, the release of appendage (solar arrays, antenna reflectors, booms) and shocks generated when the pyrovalves of the propulsion system are fired.The Shock Response Spectrum (SRS) requirement, to be applied to the equipment, depends on its mass, its size and its location in the satellite. CNES has performed a survey of the pyroshock qualification requirements on CNES and ESA satellites. The outcome of the activity was the input for the bench development (Fig. 1). The design and sizing of the pyroshock bench started with non linear shock analysis with the help of the Dytran software.A lot of solutions have been compared: mono-plate, bi- plate, Hopkinson bar. The bi-plate was chosen thanks to its very rich frequency content. Also, the shock can be generated on one plate with the equipment mounted on the other, to avoid the direct transmission of the shock to the equipment basis.This study led to a 1000 mm x 650 mm steel bi-plate with a 300 mm aluminum cube fitted on one side. The equipment to test is mounted on the cube (Fig. 2 & 3).

  18. Investigations of Mach reflection of a shock wave. I - Configurations and domains of shock reflection

    NASA Astrophysics Data System (ADS)

    Ikui, T.; Matsuo, K.; Aoki, T.; Kondoh, N.

    1982-10-01

    In reflection problems arising when a plane-moving shock wave encounters an inclined wall and is reflected, shock tube experiments have indicated four different types of reflection: regular, single-Mach, complex Mach, and double-Mach. In the present study, the reflection phenomena of the shock waves have been experimentally investigated over a range of incident shock Mach numbers and wedge angles using air or Freon-12 as a working gas. In the Freon-12 experiments, a new type of reflection which cannot be classified in terms of the previously studied four was observed. A discussion is presented of the domains where these five reflection types can occur, and of the transition boundaries between reflection types.

  19. Naturally Occurring Radioactive Materials (NORM)

    SciTech Connect

    Gray, P.

    1997-02-01

    This paper discusses the broad problems presented by Naturally Occuring Radioactive Materials (NORM). Technologically Enhanced naturally occuring radioactive material includes any radionuclides whose physical, chemical, radiological properties or radionuclide concentration have been altered from their natural state. With regard to NORM in particular, radioactive contamination is radioactive material in an undesired location. This is a concern in a range of industries: petroleum; uranium mining; phosphorus and phosphates; fertilizers; fossil fuels; forestry products; water treatment; metal mining and processing; geothermal energy. The author discusses in more detail the problem in the petroleum industry, including the isotopes of concern, the hazards they present, the contamination which they cause, ways to dispose of contaminated materials, and regulatory issues. He points out there are three key programs to reduce legal exposure and problems due to these contaminants: waste minimization; NORM assesment (surveys); NORM compliance (training).

  20. Nonstandard Analysis and Jump Conditions for Converging Shock Waves

    NASA Technical Reports Server (NTRS)

    Baty, Roy S.; Farassat, Fereidoun; Tucker, Don H.

    2008-01-01

    Nonstandard analysis is an area of modern mathematics which studies abstract number systems containing both infinitesimal and infinite numbers. This article applies nonstandard analysis to derive jump conditions for one-dimensional, converging shock waves in a compressible, inviscid, perfect gas. It is assumed that the shock thickness occurs on an infinitesimal interval and the jump functions in the thermodynamic and fluid dynamic parameters occur smoothly across this interval. Predistributions of the Heaviside function and the Dirac delta measure are introduced to model the flow parameters across a shock wave. The equations of motion expressed in nonconservative form are then applied to derive unambiguous relationships between the jump functions for the flow parameters.

  1. Nonstandard analysis and jump conditions for converging shock waves

    NASA Astrophysics Data System (ADS)

    Baty, Roy S.; Farassat, F.; Tucker, Don H.

    2008-06-01

    Nonstandard analysis is an area of modern mathematics that studies abstract number systems containing both infinitesimal and infinite numbers. This article applies nonstandard analysis to derive jump conditions for one-dimensional, converging shock waves in a compressible, inviscid, perfect gas. It is assumed that the shock thickness occurs on an infinitesimal interval and the jump functions in the thermodynamic and fluid dynamic parameters occur smoothly across this interval. Predistributions of the Heaviside function and the Dirac delta measure are introduced to model the flow parameters across a shock wave. The equations of motion expressed in nonconservative form are then applied to derive unambiguous relationships between the jump functions for the flow parameters.

  2. A cylindrical converging shock tube for shock-interface studies.

    PubMed

    Luo, Xisheng; Si, Ting; Yang, Jiming; Zhai, Zhigang

    2014-01-01

    A shock tube facility for generating a cylindrical converging shock wave is developed in this work. Based on the shock dynamics theory, a specific wall profile is designed for the test section of the shock tube to transfer a planar shock into a cylindrical one. The shock front in the converging part obtained from experiment presents a perfect circular shape, which proves the feasibility and reliability of the method. The time variations of the shock strength obtained from numerical simulation, experiment, and theoretical estimation show the desired converging effect in the shock tube test section. Particular emphasis is then placed on the problem of shock-interface interaction induced by cylindrical converging shock waves. For this purpose, membrane-less gas cylinder is adopted to form the interface between two different fluids while the laser sheet technique to visualize the flow field. The result shows that it is convenient to perform such experiments in this facility.

  3. Shocks near Jamming

    NASA Astrophysics Data System (ADS)

    Gómez, Leopoldo R.; Turner, Ari M.; van Hecke, Martin; Vitelli, Vincenzo

    2012-02-01

    Nonlinear sound is an extreme phenomenon typically observed in solids after violent explosions. But granular media are different. Right when they jam, these fragile and disordered solids exhibit a vanishing rigidity and sound speed, so that even tiny mechanical perturbations form supersonic shocks. Here, we perform simulations in which two-dimensional jammed granular packings are dynamically compressed and demonstrate that the elementary excitations are strongly nonlinear shocks, rather than ordinary phonons. We capture the full dependence of the shock speed on pressure and impact intensity by a surprisingly simple analytical model.

  4. Sepsis and septic shock.

    PubMed

    Maloney, Patrick J

    2013-08-01

    Early recognition of sepsis and septic shock in children relies on obtaining an attentive clinical history, accurate vital signs, and a physical examination focused on mental status, work of breathing, and circulatory status. Laboratory tests may support the diagnosis but are not reliable in isolation. The goal of septic shock management is reversal of tissue hypoperfusion. The therapeutic end point is shock reversal. Mortality is significantly better among children when managed appropriately. Every physician who cares for children must strive to have a high level of suspicion and keen clinical acumen for recognizing the rare but potentially seriously ill child.

  5. Shock formation of HCO/+/

    NASA Astrophysics Data System (ADS)

    Elitzur, M.

    1983-04-01

    It is shown that shocks propagating in dense molecular regions will lead to a decrease in HCO(+) relative abundance, in agreement with previous results by Iglesias and Silk (1978). The shock enhancement of HCO(+) detected in the supernova remnant IC 443 by Dickinson et al. (1980) is due to enhanced ionization in the shocked material. This is the result of the material penetrating the remnant cavity where it becomes exposed to the trapped cosmic rays. A similar enhancement appears to have been detected by Wootten in W28 and is explained by the same model.

  6. [Management of endotoxic shock in abortion].

    PubMed

    Del Rio, G; Grudsky, C; Monetta, O; Herrera, M

    1976-01-01

    The article analyzes 26 cases of septic shock caused by septic abortion which occurred in 1974 and in 1975 in a large metropolitan hospital in Santiago, Chile. Patients were mostly between 26-27 and with parity 2; hospital stay was on average 10.5 days; 5 patients died. Several causes intervene in the process of septic abortion, among which are a massive intravascular coagulation, and an increase in the product of fibrin degradation. The article describes in details the protocol of treatment of septic shock, and emphasizes the need for a massive program of prevention of induced abortion.

  7. Massive Organ Inflammation in Experimental and in Clinical Meningococcal Septic Shock.

    PubMed

    Hellerud, Bernt C; Olstad, Ole K; Nielsen, Erik W; Trøseid, Anne-Marie S; Skadberg, Øyvind; Thorgersen, Ebbe B; Vege, Åshild; Mollnes, Tom E; Brandtzæg, Petter

    2015-11-01

    Fulminant meningococcal sepsis is characterized by a massive growth of bacteria in the circulation, regarded as the primary inflammatory site, with no specific solid organ focus. Here we aimed to study the local inflammatory response in organs using a porcine model of fulminant meningococcal septic shock challenged with exponentially increasing doses of heat inactivated Neisseria meningitidis. The results were compared with those obtained in organs post mortem from three patients with lethal meningococcal septic shock. Nine patients with lethal pneumococcal disease and 14 patients with sudden infant death syndrome served as controls. Frozen tissue were thawed, homogenized and prepared for quantification of bacterial DNA by real-time polymerase chain reaction, and key inflammatory mediators were measured by ELISA in the pig material and by multiplex in the human material. In addition, gene expression assayed by Affymetrix gene expression profiling was performed in the pig study. The porcine model revealed a major influx of N. meningitidis in lungs, liver, spleen, and kidneys accompanied with major production of cardinal inflammatory mediators including tumor necrosis factor, interleukin (IL)-1β, IL-6, and IL-8, far exceeding the amount detected in blood. Genes encoding for these mediators revealed a similar profile. By comparing the wild-type with a lipopolysaccharide (LPS) deficient meningococcal strain, we documented that LPS was the dominant group of molecules inducing organ inflammation and was required for IL-8 production. IL-10 production was predominantly stimulated by non-LPS molecules. The massive organ inflammation in the porcine model was present in the three patients dying of meningococcal shock and differed markedly from the patients with lethal pneumococcal infections and sudden infant death syndrome. In conclusion, in meningococcal sepsis, a massive local inflammatory response occurs in specific organs.

  8. Relative frequencies of seismic main shocks after strong shocks in Italy

    NASA Astrophysics Data System (ADS)

    Gasperini, Paolo; Lolli, Barbara; Vannucci, Gianfranco

    2016-10-01

    We analysed a catalogue of Italian earthquakes, covering 55 yr of data from 1960 to 2014 with magnitudes homogeneously converted to Mw, to compute the time-dependent relative frequencies with which strong seismic shocks (4.0 ≤ Mw < 5.0), widely felt by the population, have been followed by main shocks (Mw ≥ 5.0) that threatened the health and the properties of the persons living in the epicentral area. Assuming the stationarity of the seismic release properties, such frequencies are estimates of the probabilities of potentially destructive shocks after the occurrence of future strong shocks. We compared them with the time-independent relative frequencies of random occurrence in terms of the frequency gain that is the ratio between the time-dependent and time-independent relative frequencies. The time-dependent relative frequencies vary from less than 1 per cent to about 20 per cent, depending on the magnitudes of the shocks and the time windows considered (ranging from minutes to years). They remain almost constant for a few hours after the strong shock and then decrease with time logarithmically. Strong earthquakes (with Mw ≥ 6.0) mainly occurred within two or three months of the strong shock. The frequency gains vary from about 10 000 for very short time intervals to less than 10 for a time interval of 2 yr. Only about 1/3 of main shocks were preceded by at least a strong shock in the previous day and about 1/2 in the previous month.

  9. Ebolavirus and Haemorrhagic Syndrome

    PubMed Central

    Matua, Gerald A.; Van der Wal, Dirk M.; Locsin, Rozzano C.

    2015-01-01

    The Ebola virus is a highly virulent, single-stranded ribonucleic acid virus which affects both humans and apes and has fast become one of the world’s most feared pathogens. The virus induces acute fever and death, with haemorrhagic syndrome occurring in up to 90% of patients. The known species within the genus Ebolavirus are Bundibugyo, Sudan, Zaïre, Reston and Taï Forest. Although endemic in Africa, Ebola has caused worldwide anxiety due to media hype and concerns about its international spread, including through bioterrorism. The high fatality rate is attributed to unavailability of a standard treatment regimen or vaccine. The disease is frightening since it is characterised by rapid immune suppression and systemic inflammatory response, causing multi-organ and system failure, shock and often death. Currently, disease management is largely supportive, with containment efforts geared towards mitigating the spread of the virus. This review describes the classification, morphology, infective process, natural ecology, transmission, epidemic patterns, diagnosis, clinical features and immunology of Ebola, including management and epidemic containment strategies. PMID:26052448

  10. PIC simulations on the termination shock: Microstructure and electron acceleration

    NASA Astrophysics Data System (ADS)

    Matsukiyo, S.; Scholer, M.

    2013-05-01

    The ability of the termination shock as a particle accelerator is totally unknown. Voyager data and recent kinetic numerical simulations revealed that the compression ratio of the termination shock is rather low due to the presence of pickup ions, i.e., the termination shock appears to be a weak shock. Nevertheless, two Voyager spacecraft observed not only high energy ions called termination shock particles, which are non-thermal but less energetic compared to the so-called anomalous cosmic rays, but also high energy electrons. In this study we focus especially on microstructure of the termination shock and the associated electron acceleration process by performing one-dimensional full particle-in-cell (PIC) simulations for a variety of parameters. For typical solar wind parameters at the termination shock, a shock potential has no sharp ramp with the spatial scale of the order of electron inertial length which is suitable for the injection of anomalous cosmic ray acceleration. Solar wind ions are not so much heated, which is consistent with Voyager spacecraft data. If a shock angle is close to 90 deg., a shock is almost time stationary or weakly breathing when a relative pickup ion density is 30%, while it becomes non-stationary if the relative pickup ion density is 20%. When the shock angle becomes oblique, a self-reformation occurs due to the interaction of solar wind ions and whistler precursors. Here, the shock angle is defined as the angle between upstream magnetic field and shock normal. For the case with relatively low beta solar wind plasma (electron beta is 0.1 and solar wind ion temperature equals to electron temperature), modified two-stream instability (MTSI) gets excited in the extended foot sustained by reflected pickup ions, and both solar wind electrons and ions are heated. If the solar wind plasma temperature gets five times higher, on the other hand, the MTSI is weakened and the pre-heating of the solar wind plasma in the extended foot is

  11. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report

    PubMed Central

    Kelly, J; Ryan, DJ; O'Brien, N; Kirwan, WO

    2009-01-01

    The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation. PMID:19527504

  12. Neuroacanthocytosis syndromes.

    PubMed

    Jung, Hans H; Danek, Adrian; Walker, Ruth H

    2011-10-25

    Neuroacanthocytosis (NA) syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis and progressive degeneration of the basal ganglia. NA syndromes are exceptionally rare with an estimated prevalence of less than 1 to 5 per 1'000'000 inhabitants for each disorder. The core NA syndromes include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome which have a Huntington's disease-like phenotype consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. In addition, cardiomyopathy may occur in McLeod syndrome. Acanthocytes are also found in a proportion of patients with autosomal dominant Huntington's disease-like 2, autosomal recessive pantothenate kinase-associated neurodegeneration and several inherited disorders of lipoprotein metabolism, namely abetalipoproteinemia (Bassen-Kornzweig syndrome) and hypobetalipoproteinemia leading to vitamin E malabsorption. The latter disorders are characterized by a peripheral neuropathy and sensory ataxia due to dorsal column degeneration, but movement disorders and cognitive impairment are not present. NA syndromes are caused by disease-specific genetic mutations. The mechanism by which these mutations cause neurodegeneration is not known. The association of the acanthocytic membrane abnormality with selective degeneration of the basal ganglia, however, suggests a common pathogenetic pathway. Laboratory tests include blood smears to detect acanthocytosis and determination of serum creatine kinase. Cerebral magnetic resonance imaging may demonstrate striatal atrophy. Kell and Kx blood group antigens are reduced or absent in McLeod syndrome. Western blot for chorein demonstrates absence of this protein in red blood cells of chorea-acanthocytosis patients. Specific genetic testing is possible in all NA syndromes. Differential diagnoses

  13. Early Treatment in Shock

    DTIC Science & Technology

    2007-06-01

    1471–2210/2/7. Accessed April 15, 2005. 20. Wang CJ, Lee MJ, Chang MC, Lin JK. Inhibition of tumor promotion in benzo [ a ] pyrene -initiated CD-1 mouse...model. Deliverable: A panel of genes that are reproducibly altered in white blood cells and in liver and muscle by shock and resuscitation. 1. To...Deliverable: Coordinated with objective #1, A panel of genes that are reproducibly altered in white blood cells and in liver and muscle by shock and

  14. "Smart" Electromechanical Shock Absorber

    NASA Technical Reports Server (NTRS)

    Stokes, Lebarian; Glenn, Dean C.; Carroll, Monty B.

    1989-01-01

    Shock-absorbing apparatus includes electromechanical actuator and digital feedback control circuitry rather than springs and hydraulic damping as in conventional shock absorbers. Device not subject to leakage and requires little or no maintenance. Attenuator parameters adjusted in response to sensory feedback and predictive algorithms to obtain desired damping characteristic. Device programmed to decelerate slowly approaching vehicle or other large object according to prescribed damping characteristic.

  15. "Smart" Electromechanical Shock Absorber

    NASA Technical Reports Server (NTRS)

    Stokes, Lebarian; Glenn, Dean C.; Carroll, Monty B.

    1989-01-01

    Shock-absorbing apparatus includes electromechanical actuator and digital feedback control circuitry rather than springs and hydraulic damping as in conventional shock absorbers. Device not subject to leakage and requires little or no maintenance. Attenuator parameters adjusted in response to sensory feedback and predictive algorithms to obtain desired damping characteristic. Device programmed to decelerate slowly approaching vehicle or other large object according to prescribed damping characteristic.

  16. Fluid therapy in shock.

    PubMed

    Mandell, D C; King, L G

    1998-05-01

    The goal of treatment for all types of shock is the improvement of tissue perfusion and oxygenation. The mainstay of therapy for hypovolemic and septic shock is the expansion of the intravascular volume by fluid administration, including crystalloids, colloids, and blood products. Frequent physical examinations and monitoring enable the clinician to determine the adequacy of tissue oxygenation and thus the success of the fluid therapy.

  17. Shock Properties of Kimberlite

    NASA Astrophysics Data System (ADS)

    Willmott, G. R.; Proud, W. G.; Field, J. E.

    2004-07-01

    Plate impact experiments have been performed on the igneous diamond-bearing matrix kimberlite. Longitudinal and lateral stresses were measured in the uniaxial strain regime using manganin stress gauges. The shock Hugoniot of the kimberlite has been characterized at axial stresses between 1 and 9 GPa. The kimberlite has a low impedance response when compared with similar data for other geological materials. The data indicate that the rock behaves inelastically above shock stresses of 1 GPa.

  18. [Pathophysiology of hemorragic shock].

    PubMed

    Copotoiu, R; Cinca, E; Collange, O; Levy, F; Mertes, P-M

    2016-11-01

    This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The initial neuroendocrine response is mainly a sympathetic activation. Haemorrhagic shock is associated altered microcirculatory permeability and visceral injury. It is also responsible for a complex inflammatory response associated with hemostasis alteration. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Compaction shock dissipation in low density granular explosive

    NASA Astrophysics Data System (ADS)

    Rao, Pratap T.; Gonthier, Keith A.; Chakravarthy, Sunada

    2016-06-01

    The microstructure of granular explosives can affect dissipative heating within compaction shocks that can trigger combustion and initiate detonation. Because initiation occurs over distances that are much larger than the mean particle size, homogenized (macroscale) theories are often used to describe local thermodynamic states within and behind shocks that are regarded as the average manifestation of thermodynamic fields at the particle scale. In this paper, mesoscale modeling and simulation are used to examine how the initial packing density of granular HMX (C4H8N8O8) C4H8N8O8 having a narrow particle size distribution influences dissipation within resolved, planar compaction shocks. The model tracks the evolution of thermomechanical fields within large ensembles of particles due to pore collapse. Effective shock profiles, obtained by averaging mesoscale fields over space and time, are compared with those given by an independent macroscale compaction theory that predicts the variation in effective thermomechanical fields within shocks due to an imbalance between the solid pressure and a configurational stress. Reducing packing density is shown to reduce the dissipation rate within shocks but increase the integrated dissipated work over shock rise times, which is indicative of enhanced sensitivity. In all cases, dissipated work is related to shock pressure by a density-dependent power law, and shock rise time is related to pressure by a power law having an exponent of negative one.

  20. Ion dynamics at supercritical quasi-parallel shocks: Hybrid simulations

    NASA Astrophysics Data System (ADS)

    Su, Yanqing; Lu, Quanming; Gao, Xinliang; Huang, Can; Wang, Shui

    2012-09-01

    By separating the incident ions into directly transmitted, downstream thermalized, and diffuse ions, we perform one-dimensional (1D) hybrid simulations to investigate ion dynamics at a supercritical quasi-parallel shock. In the simulations, the angle between the upstream magnetic field and shock nominal direction is θBn=30°, and the Alfven Mach number is MA˜5.5. The shock exhibits a periodic reformation process. The ion reflection occurs at the beginning of the reformation cycle. Part of the reflected ions is trapped between the old and new shock fronts for an extended time period. These particles eventually form superthermal diffuse ions after they escape to the upstream of the new shock front at the end of the reformation cycle. The other reflected ions may return to the shock immediately or be trapped between the old and new shock fronts for a short time period. When the amplitude of the new shock front exceeds that of the old shock front and the reformation cycle is finished, these ions become thermalized ions in the downstream. No noticeable heating can be found in the directly transmitted ions. The relevance of our simulations to the satellite observations is also discussed in the paper.