Toxic shock syndrome - the seven Rs of management and treatment.

PubMed

Wilkins, Amanda L; Steer, Andrew C; Smeesters, Pierre R; Curtis, Nigel

2017-06-01

Staphylococcal and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality. There has been considerable progress in understanding the pathophysiology and delineating optimal management and treatment. This article reviews the management of TSS, outlining the 'Seven Rs of Managing and Treating TSS': Recognition, Resuscitation, Removal of source of infection, Rational choice of antibiotics, Role of adjunctive treatment (clindamycin and intravenous immunoglobulin), Review of progress and Reduce risk of secondary cases in close contacts. © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

[Staphylococcal toxin of toxic shock syndrome].

PubMed

Fluer, F S

2007-01-01

Literature data on toxic shock syndrome staphylococcal toxin (TSST-1) are summarized; properties of Staphylococcus aureus strains producing TSST-1, nutrient media, and factors influencing on production of TSST-1 are reviewed. Physical and chemical properties of the toxin, its molecular characteristics, genetic regulation of its production, mechanism of action, and diseases which it causes are also discussed. Clinical and histologic signs of toxic shock syndrome (TSS), its diagnostic criteria, susceptibility of people to TSS, antigenic and serologic properties of the toxin, epidemiology of the infection caused by TSST-1-producing strains of staphylococci, methods of TSST-1 extraction and identification are described.

Streptococcal toxic shock syndrome occurring in the third trimester of pregnancy: A case report.

PubMed

Irani, Mohamad; McLaren, Rodney; Savel, Richard H; Bogatyryova, Oksana; Khoury-Collado, Fady

2017-10-01

Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare life-threatening illness. Most reported cases have occurred in the post-partum period. Here, we report a rare case of a primigravid who developed GAS TSS in the third trimester. We also review the potential preventive measures and treatment modalities for this syndrome. A 29-year-old primigravid presented at 36 weeks' gestation with diarrhea, abdominal pain, fever, and fetal bradycardia. She underwent an emergency cesarean section and was subsequently diagnosed with GAS TSS. She had a complicated post-partum course marked by a 3-month hospital stay and major sequelae. Her infant died on post-partum day 4. GAS TSS should be considered in the differential diagnosis of pregnant patients presenting with fever and rapid onset of septic shock. A consideration to treat GAS that is detected incidentally during routine screening for group B streptococcus is suggested. © 2017 Japan Society of Obstetrics and Gynecology.

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

PubMed

Chan, Yuen; Selvaratnam, Veenesh; Garg, Neeraj

2015-08-11

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. 2015 BMJ Publishing Group Ltd.

[Toxic shock syndrome].

PubMed

Tyll, T; Bílková, M; Revinová, A; Müller, M; Čurdová, M; Zlámal, M; Holub, M

2015-10-01

The authors present an up-to-date review of toxic shock syndrome (TSS) - a life-threatening condition where toxins of the Gram-positive bacteria Staphyloccocus aureus and Streptococcus pyogenes play a key role in the pathogenesis. The authors provide insight into the epidemiology and pathogenesis of the disease and point out the relevant patient history data and clinical signs and symptoms that may indicate progression of TSS. Last but not least, the state of the art diagnostic and therapeutic approaches to early and full blown TSS are summarized. Case reports are presented to illustrate two different etiological forms of this relatively rare nosological entity.

Use of recombinant human activated protein C in nonmenstrual staphylococcal toxic shock syndrome.

PubMed

Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

2010-07-01

Toxic shock syndrome (TSS) is a serious, potentially life-threatening condition resulting from an overwhelming immunological response to an exotoxin released by Staphylococcus aureus and group A streptococci. High index of suspicion, early diagnosis and aggressive therapeutic measures must be instituted in view of high mortality of the TSS. In recent years, new agents have been tested to reduce morbidity and mortality in patients with severe sepsis, in addition to standard supportive measures. Among them, recombinant human activated protein C (rhAPC) has been reported to significantly reduce mortality and morbidity in patients with severe sepsis and two or more acute organ failures. We describe our experience with this drug in the early reversal of septic shock from TSS.

Use of recombinant human activated protein C in nonmenstrual staphylococcal toxic shock syndrome

PubMed Central

Nasa, Prashant; Sehrawat, Deepak; kansal, Sudha; Chawla, Rajesh

2010-01-01

Toxic shock syndrome (TSS) is a serious, potentially life-threatening condition resulting from an overwhelming immunological response to an exotoxin released by Staphylococcus aureus and group A streptococci. High index of suspicion, early diagnosis and aggressive therapeutic measures must be instituted in view of high mortality of the TSS. In recent years, new agents have been tested to reduce morbidity and mortality in patients with severe sepsis, in addition to standard supportive measures. Among them, recombinant human activated protein C (rhAPC) has been reported to significantly reduce mortality and morbidity in patients with severe sepsis and two or more acute organ failures. We describe our experience with this drug in the early reversal of septic shock from TSS. PMID:21253349

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.

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.

Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression.

PubMed

Kulhankova, Katarina; King, Jessica; Salgado-Pabón, Wilmara

2014-08-01

Infectious diseases caused by Staphylococcus aureus present a significant clinical and public health problem. S. aureus causes some of the most severe hospital-associated and community-acquired illnesses. Specifically, it is the leading cause of infective endocarditis and osteomyelitis, and the second leading cause of sepsis in the USA. While pathogenesis of S. aureus infections is at the center of current research, many questions remain about the mechanisms underlying staphylococcal toxic shock syndrome (TSS) and associated adaptive immune suppression. Both conditions are mediated by staphylococcal superantigens (SAgs)-secreted staphylococcal toxins that are major S. aureus virulence factors. Toxic shock syndrome toxin-1 (TSST-1) is the SAg responsible for almost all menstrual TSS cases in the USA. TSST-1, staphylococcal enterotoxin B and C are also responsible for most cases of non-menstrual TSS. While SAgs mediate all of the hallmark features of TSS, such as fever, rash, hypotension, and multi-organ dysfunction, they are also capable of enhancing the toxic effects of endogenous endotoxin. This interaction appears to be critical in mediating the severity of TSS and related mortality. In addition, interaction between SAgs and the host immune system has been recognized to result in a unique form of adaptive immune suppression, contributing to poor outcomes of S. aureus infections. Utilizing rabbit models of S. aureus infective endocarditis, pneumonia and sepsis, and molecular genetics techniques, we aim to elucidate the mechanisms of SAg and endotoxin synergism in the pathogenesis of TSS, and examine the cellular and molecular mechanisms underlying SAg-mediated immune dysfunction.

Toxic shock syndrome caused by suture abscess with methicillin-resistant Staphylococcus aureus (MRSA) with late onset after Caesarean section.

PubMed

Komuro, Hiroyasu; Kato, Takaharu; Okada, Shinichiro; Nakatani, Kensuke; Matsumoto, Risa; Nishida, Kazuhiro; Iida, Hiroyuki; Iida, Maki; Tsujimoto, Shiro; Suganuma, Toshiyuki

2017-01-01

Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disease known to develop in the early postoperative period after various surgery. We report a rare case in which a patient who underwent Caesarean section developed TSS caused by methicillin-resistant Staphylococcus aureus (MRSA) on the 39th postoperative day. She was treated with debridement because of the possible diagnosis of necrotizing soft tissue infections. Culture test from the resected specimen was positive for MRSA. She was diagnosed with TSS caused by suture abscess and was treated with intensive care including antimicrobials. After a good postoperative course, she was discharged on the 30th postoperative day. TSS occurring 4 weeks after operation is extremely rare, but late-onset of suture abscess is known to occur. We should becognizant of development with TSS beyond early postoperative period.

[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.

Lesson of the month 2: toxic shock syndrome.

PubMed

Shalaby, Tamer; Anandappa, Samantha; Pocock, Nicholas John; Keough, Alexander; Turner, Angus

2014-06-01

Toxic shock syndrome (TSS) represents a fascinating example of immune activation caused by infection resulting in a dramatic and challenging clinical syndrome. TSS is commonly associated with tampon use and still causes significant morbidity and mortality in young healthy women. A misconception is that TSS presents with a skin rash and only occurs in women and children; however, it can occur in males and can present without skin changes. TSS presents initially as a febrile illness and within a few hours can progress to severe hypotension and multiple organ failure (MOF). Staphylococcus aureus and group A beta haemolytic streptococcus (GABHS) can secrete toxins from a small or hidden focus of infection and hence blood culture and sensitivity (C+S) tests can be negative, thereby making diagnosing this condition challenging. Clindamycin is superior to penicillin in the treatment of this condition and significantly decreases the mortality rate in TSS. However, there is also an important role for intravenous immunoglobulins (IVIG). Early intensive care unit (ICU) as well as surgical team involvement (in selected cases) is required to avoid mortality which may approach 70%. © 2014 Royal College of Physicians.

Toxic Shock Syndrome (For Teens)

MedlinePlus

... isn't strictly related to tampons. The contraceptive sponge and the diaphragm , two types of birth control ... associated with TSS (such as diaphragms and contraceptive sponges). What Do Doctors Do? TSS is a medical ...

Diagnostic value of Vbeta2-positive T-cell expansion in toxic shock syndrome.

PubMed

Wenisch, Christoph; Strunk, D; Krause, R; Smolle, K H

2007-06-01

diagnostic dilemma in toxic shock syndrome (TSS) is that the results of microbiologic investigations are often not available immediately because of the need for incubation, or no obvious entry point can be found. We describe three patients with a clinical diagnosis of TSS in whom microbiologic tests were negative. All patients had complicated courses with vasopressor-dependent shock, renal and respiratory failure, and disseminated intravascular coagulation for at least 1 week. In all three patients, diagnosis was considerably faster with the assessment of the expansion of T-cell-receptor Vbeta2-positive T cells (> 15%) than by Centers for Disease Control and Prevention (CDC) diagnosis, because of the complicated clinical picture or the delay caused by waiting for the results of microbiologic investigations. Our results indicate that diagnostic procedures incorporating Vbeta2-positive T cells could be a useful tool for the diagnosis of TSS.

Right in Front of Our Eyes: Evolution of Streptococcal Toxic Shock Syndrome with Ischemic Optic Neuropathy.

PubMed

Elhamamsy, Salaheldin M; Al-Qadi, Mazen O; Minami, Taro; Neill, Marguerite

2016-12-01

Toxic shock syndrome occurs from dysregulation of host inflammatory responses. Toxin- producing strains of Group A streptococcus cause TSS. Ischemic optic neuropathy rarely complicates septic shock. We present a rare case of streptococcal pharyngitis complicated by septic arthritis and TSS with reversible blindness due to non-arteritic ischemic optic neuropathy. A 28-year-old man drove to our ED with exudative pharyngitis. A rapid streptococcal test was positive. While awaiting oral penicillin he became hypotensive refractory to IV fluids and developed knee effusion. The patient noted progressive dimming of his vision. Arthrocentesis yielded GAS. ICU course was complicated by ARDS but after 2 weeks the patient was weaned off vasopressors and the ventilator. He regained his vision and had no neurological sequelae. The patient's GAS isolate was M protein gene (emm) type 1 and T type 1. He was followed in the IM clinic for 9 months post discharge with complete resolution of symptoms. The rapidity of the development of shock is attributed to streptococcal exotoxins acting as superantigens. GAS type M1 is commonly associated with severe shock in TSS. The severe shock was the likely cause of his ischemic optic neuropathy. Early recognition and aggressive management of TSS are crucial to clinical outcome. [Full article available at http://rimed.org/rimedicaljournal-2016-12.asp].

Lack of muco-cutaneous signs of toxic shock syndrome when T cells are absent: S.aureus shock in immunodeficient adults with multiple myeloma

PubMed Central

KAMEL, N S; BANKS, M C; DOSIK, A; URSEA, D; YARILINA, A A; POSNETT, D N

2002-01-01

Staphylococcal toxic shock syndrome (TSS) is an acute life threatening disease. The diagnosis can be made clinically based on diagnostic criteria. The clinical manifestations are caused in large part by the release of high levels of T-cell-derived cytokines as a result of potent toxins, also called superantigens (SAg), produced by Staphylococcus aureus, but it is not clear which clinical symptoms/signs are strictly T-cell dependent. Here, we report on three adults with multiple myeloma (MM) presenting with S. aureus sepsis/shock, and two patients with typical TSS. The MM patients had compromised humoral immunity because of depression of normal immunoglobulin (Ig) levels at the expense of the M protein. In addition, their T cells were absent due to high dose chemotherapy initiated for bone marrow transplantation. The MM cases lacked mucosal hyperemia, erythroderma and desquamation, but were otherwise indistinguishable from the TSS cases. All patients grew S. aureus and in each case, SAg genes were detected by PCR. In several cases, the plasma contained biological SAg activity resulting in Vβ specific proliferation of indicator T cells in vitro. The same specific activity was observed with the supernatant fluids of S. aureus broth cultures from the respective bacterial isolates. This confirms the presence of bio-active toxins in the plasma but did not lead to full blown TSS when T cells were lacking. Thus, S.aureus sepsis/shock can be clinically distinguished from typical TSS, and we suggest that muco-cutaneous manifestations of TSS are the most telling signs of massive T-cell-dependent cytokine release. PMID:12033193

Toxic shock syndrome in Australian children.

PubMed

Chen, Katherine Y H; Cheung, Michael; Burgner, David P; Curtis, Nigel

2016-08-01

There are limited data describing the epidemiology, management and outcomes of children with toxic shock syndrome (TSS), a potentially life-threatening illness. Here, we describe the incidence, clinical features, treatment and outcome of children with staphylococcal and streptococcal TSS in Victoria, Australia. Retrospective chart review of children admitted between 2003 and 2014 to two tertiary paediatric referral centres who fulfilled the Centers for Disease Control and Prevention case definition of TSS. There were 62 cases over the 11-year period; 43 staphylococcal TSS and 19 streptococcal TSS. The majority (46 (74%)) of cases were admitted to an intensive care unit and 44 (71%) required inotropic support. Compared with those with staphylococcal TSS, patients with streptococcal TSS were younger, more unwell and more likely to have residual morbidity. Adjunctive therapy with intravenous immunoglobulin or clindamycin was used in 58 (94%) of cases and fresh frozen plasma was used in 15 (24%). Seven patients received extracorporeal membrane oxygenation. All patients survived. This study highlights the importance of early recognition of TSS and supports rapid tertiary referral and intensive care management, which includes the use of adjunctive therapy with intravenous immunoglobulin and clindamycin. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

Toxic shock syndrome surveillance in UK children.

PubMed

Adalat, S; Dawson, T; Hackett, S J; Clark, J E

2014-12-01

Toxic shock syndrome (TSS) is an acute toxin-mediated illness caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes. There is no recent data regarding incidence, management and mortality of TSS in UK children. Consultants from paediatric and burns units in the UK and Ireland, reported cases of TSS seen between November 2008 and December 2009, via the British Paediatric Surveillance Unit. Respondents were sent questionnaires requesting detailed information about TSS cases. Established criteria were used to divide cases into staphylococcal or streptococcal TSS. Forty-nine cases were identified overall; 29 cases of streptococcal TSS (18 confirmed and 11 probable) and 20 cases of staphylococcal TSS (15 confirmed and 5 probable). The incidence of TSS children in the UK & the Republic of Ireland was calculated to be 0.38 per 100 000 children. Children with staphylococcal TSS were older than those with streptococcal TSS (9.5 vs 3.8 years; p<0.003). Paediatric intensive care facilities were used for 78% of cases (invasive ventilatory support 69%; inotropic support 67%; haemofiltration 12%). Agents with antitoxin effects were underused; clindamycin 67%, intravenous immunoglobulin (IVIG) 20%, fresh frozen plasma 40%. There were eight deaths, all in the streptococcal group (28% of streptococcal cases)-none were given IVIG. Streptococcal TSS was as frequent as staphylococcal TSS, contrasting with previous literature. Children with streptococcal TSS had a higher mortality than those with staphylococcal TSS (28% vs 0%; p<0.05). Recommended immunomodulatory agents (IVIG and clindamycin) were underused. This study highlights the need for a guideline to improve management of TSS in children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mesenchymal stromal (stem) cells suppress pro-inflammatory cytokine production but fail to improve survival in experimental staphylococcal toxic shock syndrome.

PubMed

Kim, Hani; Darwish, Ilyse; Monroy, Maria-Fernanda; Prockop, Darwin J; Liles, W Conrad; Kain, Kevin C

2014-01-14

Toxic shock syndrome (TSS) is caused by an overwhelming host-mediated response to bacterial superantigens produced mainly by Staphylococcus aureus and Streptococcus pyogenes. TSS is characterized by aberrant activation of T cells and excessive release of pro-inflammatory cytokines ultimately resulting in capillary leak, septic shock, multiple organ dysfunction and high mortality rates. No therapeutic or vaccine has been approved by the U.S. Food and Drug Administration for TSS, and novel therapeutic strategies to improve clinical outcome are needed. Mesenchymal stromal (stem) cells (MSCs) are stromal cells capable of self-renewal and differentiation. Moreover, MSCs have immunomodulatory properties, including profound effects on activities of T cells and macrophages in specific contexts. Based on the critical role of host-derived immune mediators in TSS, we hypothesized that MSCs could modulate the host-derived proinflammatory response triggered by Staphylococcal enterotoxin B (SEB) and improve survival in experimental TSS. Effects of MSCs on proinflammatory cytokines in peripheral blood were measured in wild-type C57BL/6 mice injected with 50 μg of SEB. Effects of MSCs on survival were monitored in fatal experimental TSS induced by consecutive doses of D-galactosamine (10 mg) and SEB (10 μg) in HLA-DR4 transgenic mice. Despite significantly decreasing serum levels of IL-2, IL-6 and TNF induced by SEB in wild-type mice, human MSCs failed to improve survival in experimental TSS in HLA-DR4 transgenic mice. Similarly, a previously described downstream mediator of human MSCs, TNF-stimulated gene 6 (TSG-6), did not significantly improve survival in experimental TSS. Furthermore, murine MSCs, whether unstimulated or pre-treated with IFNγ, failed to improve survival in experimental TSS. Our results suggest that the immunomodulatory effects of MSCs are insufficient to rescue mice from experimental TSS, and that mediators other than IL-2, IL-6 and TNF are likely to play critical mechanistic roles in the pathogenesis of experimental TSS.

Phlegmonous gastritis associated with group A streptococcal toxic shock syndrome.

PubMed

Morimoto, Masaya; Tamura, Shinobu; Hayakawa, Takahiro; Yamanishi, Hirofumi; Nakamoto, Chiaki; Nakamoto, Hiromichi; Ikebe, Tadayoshi; Nakano, Yoshio; Fujimoto, Tokuzo

2014-01-01

Phlegmonous gastritis (PG) is a rare, acute, severe infectious disease of the gastric wall that is often fatal due to Streptococcus spp. A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. The patient expired less than 9 hours after admission despite intensive treatments. Later, an analysis of the blood and gastric juice revealed group A streptococcus (GAS) and virulence factors associated with toxic shock syndrome (TSS). We herein diagnosed a patient with an extremely aggressive course of PG caused by GAS TSS.

The Great Tampon Scare of 1980: Helping the Consumer Cope.

ERIC Educational Resources Information Center

Frank, Andrea

1981-01-01

It is the health educator's responsibility to provide the consumer with information about toxic shock syndrome (TSS). An educational program should be developed which would encompass four areas: a description of TSS, an outline of theorized causes, a discussion of tampon health risks, and mechanisms for consumer action. (JN)

Human Leukocyte Antigen Class II Transgenic Mouse Model Unmasks the Significant Extrahepatic Pathology in Toxic Shock Syndrome

PubMed Central

Tilahun, Ashenafi Y.; Marietta, Eric V.; Wu, Tsung-Teh; Patel, Robin; David, Chella S.; Rajagopalan, Govindarajan

2011-01-01

Among the exotoxins produced by Staphylococcus aureus and Streptococcus pyogenes, the superantigens (SAgs) are the most potent T-cell activators known to date. SAgs are implicated in several serious diseases including toxic shock syndrome (TSS), Kawasaki disease, and sepsis. However, the immunopathogenesis of TSS and other diseases involving SAgs are still not completely understood. The commonly used conventional laboratory mouse strains do not respond robustly to SAgs in vivo. Therefore, they must be artificially rendered susceptible to TSS by using sensitizing agents such as d-galactosamine (d-galN), which skews the disease exclusively to the liver and, hence, is not representative of the disease in humans. SAg-induced TSS was characterized using transgenic mice expressing HLA class II molecules that are extremely susceptible to TSS without d-galN. HLA-DR3 transgenic mice recapitulated TSS in humans with extensive multiple-organ inflammation affecting the lung, liver, kidneys, heart, and small intestines. Heavy infiltration with T lymphocytes (both CD4+ and CD8+), neutrophils, and macrophages was noted. In particular, the pathologic changes in the small intestines were extensive and accompanied by significantly altered absorptive functions of the enterocytes. In contrast to massive liver failure alone in the d-galN sensitization model of TSS, findings of the present study suggest that gut dysfunction might be a key pathogenic event that leads to high morbidity and mortality in humans with TSS. PMID:21641398

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

Influence of the vaginal microbiota on toxic shock syndrome toxin 1 production by Staphylococcus aureus.

PubMed

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

2013-03-01

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.

[Toxic-shock syndrome. Three cases (author's transl)].

PubMed

Rapin, M; D'Enfert, J; Cabane, J

1981-06-13

Several cases of toxic shock syndrome (T.S.S) have been recently reported from the U.S.A. Clinical features of this new syndrome include fever, desquamative scarlatiniform rash, hypotension and involvement of central nervous system, liver, kidney and muscles. More than 90% of cases are women with staphylococcic vaginitis using tampons during menstruations. A toxin produced by staphylococcus aureus is thought to be the causative agent, because the germ has been isolated in local (vaginal, pharyngeal, subcutaneous or other sites) but not systemic (blood, cerebrospinal fluid) cultures. The mortality rate is 3-10%, and relapse can occur. We report the first three french cases of T.S.S.: a 17 year old girl with typical tampon-associated vaginitis, a 36 year old woman with a postoperative peritonitis and a 20 year old man with a popliteal abscess. Staphylococcus aureus of type I or IV was identified at the site of infection in all cases, but never in blood cultures. These three patients recovered with antistaphylococcic antibiotics and supportive therapy, but local treatment of infections seems to have been of utmost importance. These cases suggest that T.S.S. can occur with several staphylococcus serotypes and confirm that this syndrome is not always associated with tampons and vaginitis.

Invariant Natural Killer T Cells Are Pathogenic in the HLA-DR4-Transgenic Humanized Mouse Model of Toxic Shock Syndrome and Can Be Targeted to Reduce Morbidity.

PubMed

Szabo, Peter A; Rudak, Patrick T; Choi, Joshua; Xu, Stacey X; Schaub, Robert; Singh, Bhagirath; McCormick, John K; Haeryfar, S M Mansour

2017-03-01

During toxic shock syndrome (TSS), bacterial superantigens trigger a polyclonal T -cell response leading to a potentially catastrophic "cytokine storm". Whether innate-like invariant natural killer T (iNKT) cells, with remarkable immunomodulatory properties, participate in TSS is unclear. Using genetic and cell depletion approaches, we generated iNKT cell-deficient, superantigen-sensitive HLA-DR4-transgenic (DR4tg) mice, which were compared with their iNKT-sufficient counterparts for responsiveness to staphylococcal enterotoxin B (SEB). Both approaches indicate that iNKT cells are pathogenic in TSS. Importantly, treating DR4tg mice with a TH2-polarizing glycolipid agonist of iNKT cells reduced SEB-inflicted morbidity/mortality. Therefore, iNKT cells may constitute an attractive therapeutic target in superantigen-mediated illnesses. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Structural and functional properties of antibodies to the superantigen TSST-1 and their relationship to menstrual toxic shock syndrome.

PubMed

Kansal, Rita; Davis, Catherine; Hansmann, Melanie; Seymour, Jon; Parsonnet, Jeffrey; Modern, Paul; Gilbert, Steve; Kotb, Malak

2007-05-01

Menstrual toxic shock syndrome (mTSS) is an acute febrile disease accompanied by hypotension and multiple organ involvement. Infection with Staphylococcus aureus producing the superantigen toxic shock syndrome toxin-1 (TSST-1) vaginally is necessary; however, only a small fraction of those infected with TSST-1 producing bacteria actually develop mTSS, suggesting that host factors modulate disease susceptibility. Serum antibodies to the toxin protect against development of the syndrome, but not all antibodies can neutralize the toxin. We set out to determine whether risk of developing the syndrome is related to the absence of neutralizing antibody and if antibody isotypes influence the neutralization capacity. In healthy subjects, TSST-1-binding serum antibodies were exclusively of the IgG and IgM classes; however, toxin-neutralizing capacity was correlated to the TSST-1-specific IgG1 and IgG4 antibodies (r (2)=0.88, p<0.0001 and 0.33, p<0.0086, respectively) but not with IgM antibodies. Specific IgA was not detectable. Compared to healthy matched controls who were colonized vaginally with S. aureus, IgG1 anti-TSST-1 antibodies and toxin neutralizing activity was lacking in all of the acute phases and in the majority of convalescent sera, suggesting that these patients may be incapable of generating TSST-1 neutralizing antibodies. These new findings support the hypothesis that host factors are important in the development of mTSS and that the anti-toxin isotype impacts antibody functionality.

A 33-year-old white female with abdominal pain, nausea, vomiting and hypotension.

PubMed

Westfall, M D; Lumpkin, J

1993-01-01

A thirty-three year old female presented to our emergency department complaining of severe abdominal pain, nausea, and vomiting. On physical examination she was hypotensive with a firm, tender abdomen, cervical motion tenderness and a diffuse erythematous rash. A surgical diagnosis of Acute Pelvic Inflammatory Disease was made during laparoscopy. Coagulant studies, liver function tests, culture results, and the desquamation of the patient's palms led to the additional diagnosis of Toxic Shock Syndrome. A literature search failed to reveal any similar cases of Pelvic Inflammatory Disease (PID) and Toxic Shock Syndrome (TSS) occurring concomitantly. Patients may present severely ill with either of these disease entities but potential for serious illness is greater when both of these syndromes occur in the same patient. We conclude that in patients with a similar presentation, the symptoms should not be attributed completely to PID without further investigation and consideration of a concomitant disease process including TSS.

Prevalence of toxic shock syndrome toxin 1-producing Staphylococcus aureus and the presence of antibodies to this superantigen in menstruating women.

PubMed

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

2005-09-01

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 (> or =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 (> or =1:32) to TSST-1 (89% versus 98% and 100%). These findings demonstrate that the majority of teenagers have antibody titers (> or =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.

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

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

The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature.

PubMed

Gottlieb, Michael; Long, Brit; Koyfman, Alex

2018-01-20

Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid. TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients. Published by Elsevier Inc.

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.

[Toxic shock syndrome after open ankle fracture].

PubMed

Klüter, T; Fitschen-Oestern, S; Weuster, M; Fickenscher, H; Seekamp, A; Lippross, S

2015-07-01

The treatment of open fractures is a challenge for the attending surgeon. Depending on the severity, the risk of infection rises up to 50%. Local infection up to the point of sepsis can develop in spite of surgical and antimicrobial therapy. The present case demonstrates the case of an 18-year-old man who developed toxic shock syndrome (TSS) after an open ankle fracture. This potentially life-threating syndrome usually presents with the main symptoms of fever, hypotension and exanthema and is caused by toxins, such as toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins A-D. In some cases it is associated with cardiopulmonary decompensation and can rapidly progress to multiorgan failure.

Toxic shock syndrome in paediatric thermal injuries: A case series and systematic literature review.

PubMed

Gutzler, Linda; Schiestl, Clemens; Meuli, Martin; Oliveira, Carol

2018-02-01

Toxic shock syndrome (TSS) is a rare, but potentially life-threatening complication of thermal injuries in children. The study objective was to systematically review the literature on paediatric TSS after burns or scalds, and describe our experience with this condition in Switzerland. All tertiary paediatric healthcare centres managing burns and scalds in Switzerland were inquired. A systematic literature review was performed using EMBASE (1947-2016), MEDLINE (1946-2016), Web of Science (1900-2016) and Google Scholar in October 2016. Data on patient characteristics, symptoms, laboratory parameters, management and outcome were extracted from paper and electronic patient charts. Descriptive statistics were performed. The literature review revealed 25 articles describing 59 cases observed in 10 countries (UK, USA, Hungary, Austria, Sweden, Denmark, Israel, Japan, Spain, Switzerland) from 1985 to 2016. The patient age ranged from 8 months to 8 years at the time point of TSS-diagnosis. The injured total body surface area ranged from <1% to 41%. Forty-one patients suffered from scalds, 6 from burns and in 12 cases the type of injury was not specified. The TSS-diagnosis was made 1-7days after thermal injury. Nineteen children underwent admission to the Intensive Care Unit. Six children died from TSS. In Switzerland, we identified 11 consecutive cases between 07/2001 and 06/2011 (median age 15 months, range 9 months-14 years; 9 male, 2 female; 3 burns, 8 scalds; 7% median total body surface area (TBSA), range 2-30%). Diagnosis of TSS was made on day 5 after injury in median (range 3-34 days). Eight of eleven patients received intensive care. Survivors (10/11) suffered no long-term sequelae besides scars. One 13-month old boy died 3days after a 7%-TBSA scald. Toxic shock syndrome is an important complication of paediatric burns in Switzerland and several other countries world-wide. Diagnosis and management remain challenging. Awareness among treating clinicians is crucial for a favourable outcome. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Toxic Shock Syndrome (For Parents)

MedlinePlus

... TSS isn't strictly related to tampons. The contraceptive sponge and the diaphragm, two types of birth ... causing the symptoms. Medical staff will remove tampons, contraceptive devices, or wound packing; clean any wounds; and, ...

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Group A streptococcus-induced toxic shock syndrome in pregnancy: a case report of cesarean section].

PubMed

Yamada, Kumiko; Fukuda, Taeko; Kimura, Maiko; Hagiya, Keiichi; Danmura, Masato; Nakayama, Shin; Ogura, Tsuyoshi; Tanaka, Makoto

2012-12-01

Group A streptococcus (GAS)-induced toxic shock syndrome (TSS) in pregnancy is rare, but its clinical course is fulminant. The mortality rates of mother and fetus are reported to be 58 and 66%, respectively. We report a case of GAS-TSS after cesarean section. A 38-year-old pregnant woman of 38 weeks gestation was admitted to our hospital because of vomiting, fever of 39 degrees C, and continuous abdominal pain with scanty genital bleeding. She had complained of sore throat several days before. One hour after admission, external fetal monitoring revealed periodic pulse deceleration to 90 x beats min(-1). The emergent cesarean section was performed under general anesthesia. Approximately 8 hours after the cesarean section, she developed coma, shock and respiratory insufficiency requiring intubation. Streptococcus pyogens were isolated from her blood sample and the patient met criteria for GAS-TSS. She was treated with antibiotics (penicillin and clindamycin), antithrombin III, recomodulin, catecholamins, and continuous hemodialysis with filtration of toxins. Although the patient recovered and was discharged on 63rd day, the infant died on postpartum day 4. Early recognition and intensive treatment for GAS is recommended in a late stage pregnancy with an episode of sore throat, vomiting, high fever, strong labor pain, and DIC signs.

Systemic Inflammatory Response Elicited by Superantigen Destabilizes T Regulatory Cells Rendering them Ineffective during Toxic Shock Syndrome 1

PubMed Central

Tilahun, Ashenafi Y.; Chowdhary, Vaidehi R.; David, Chella S.; Rajagopalan, Govindarajan

2014-01-01

Life-threatening infections caused by Staphylococcus aureus, particularly the community-acquired methicillin-resistant strains of S. aureus (CA-MRSA), continue to pose serious problems. Greater virulence and increased pathogenicity of certain S. aureus strains are attributed to higher prevalence of exotoxins. Of these exotoxins, the superantigens (SAg) are likely most pathogenic because of their ability to rapidly and robustly activate the T cells even in extremely small quantities. Therefore, countering SAg-mediated T cell activation using T regulatory cells (Tregs) might be beneficial in diseases such as toxic shock syndrome (TSS). As the normal numbers of endogenous Tregs in a typical host are insufficient, we hypothesized that increasing the Treg numbers by administration of IL2-anti-IL2 antibody complexes (IL2C) or by adoptive transfer of ex vivo expanded Tregs might be more effective in countering SAg-mediated immune activation. HLA-DR3 transgenic mice that closely recapitulate human TSS, were treated with IL2C to increase endogenous Tregs or received ex vivo expanded Tregs. Subsequently, they were challenged with SAg to induce TSS. Analyses of various parameters reflective of TSS (serum cytokine/chemokine levels, multiple organ pathology and SAg-induced peripheral T cell expansion) indicated that increasing the Tregs failed to mitigate TSS. On the contrary, serum IFN-γ levels were increased in IL2C treated mice. Exploration into the reasons behind the lack of protective effect of Tregs revealed IL-17 and IFN-γ-dependent loss of Tregs during TSS. In addition, significant upregulation of GITR on conventional T cells during TSS could render them resistant to Treg mediated suppression, contributing to failure of Treg-mediated immune regulation. PMID:25092888

Prevalence, comorbidities and mortality of toxic shock syndrome in children and adults in the USA.

PubMed

Strom, Mark A; Hsu, Derek Y; Silverberg, Jonathan I

2017-11-01

Toxic Shock Syndrome (TSS), a superantigen-mediated illness, is characterized by rash, hypotension and multi-organ dysfunction. Predictors of TSS and related morbidity and mortality are poorly defined. In this study, data on 61,959,084 hospitalizations from the 2003-2012 Nationwide Inpatient Sample, a 20% stratified sample of US hospitalizations, were analyzed and ICD-9-CM coding used to identify 4491 hospitalizations with a diagnosis of TSS. Incidence, in-hospital mortality rate, comorbidities, length of stay and costs of care attributable to TSS were determined. In multivariate survey logistic regression models, TSS was associated with female sex (adjusted odds ratio [95% confidence interval], 1.54 [1.48-1.60]), younger age (0-17 years, 2.17 [2.06-2.29]; 40-59: 0.53 [0.50-0.56]; 60-79: 0.28 [0.26-0.30]; 80+: 0.13 [0.11-0.14] compared with 18-39) and race/ethnicity (black, 0.63 [0.59-0.67]; Hispanic: 0.60 [0.56-0.64]; Asian, 1.11 [1.00-1.11]; and other, 0.83 [0.75-0.92] compared with white). Patients with TSS had a three-fold greater cost of care (mean: $36,656 ± 942) and length of stay (LOS) (mean: 10.65 ± 0.23 days) than patients without TSS. Shared predictors of increased LOS and costs in patients with TSS were male sex; age 40-79 years; Black, Hispanic, Asian and other race/ethnicity; and more than one chronic condition. Predictors of in-hospital mortality included respiratory failure (13.66 [11.37-16.43]), liver disease/failure (3.36 [2.59-4.34]), chickenpox (91.26 [27.74-300.25]), coagulopathy (2.14 [1.85-2.48]), and higher age. In conclusion, there are significant racial/ethnic, socioeconomic, and comorbid disparities in the incidence and mortality of TSS in adults and children in the USA. © 2017 The Societies and John Wiley & Sons Australia, Ltd.

Characterization and biological properties of a new staphylococcal exotoxin

PubMed Central

1994-01-01

Staphylococcus aureus strain D4508 is a toxic shock syndrome toxin 1- negative clinical isolate from a nonmenstrual case of toxic shock syndrome (TSS). In the present study, we have purified and characterized a new exotoxin from the extracellular products of this strain. This toxin was found to have a molecular mass of 25.14 kD by mass spectrometry and an isoelectric point of 5.65 by isoelectric focusing. We have also cloned and sequenced its corresponding genomic determinant. The DNA sequence encoding the mature protein was found to be 654 base pairs and is predicted to encode a polypeptide of 218 amino acids. The deduced protein contains an NH2-terminal sequence identical to that of the native protein. The calculated molecular weight (25.21 kD) of the recombinant mature protein is also consistent with that of the native molecules. When injected intravenously into rabbits, both the native and recombinant toxins induce an acute TSS-like illness characterized by high fever, hypotension, diarrhea, shock, and in some cases death, with classical histological findings of TSS. Furthermore, the activity of the toxin is specifically enhanced by low quantities of endotoxins. The toxicity can be blocked by rabbit immunoglobulin G antibody specific for the toxin. Western blotting and DNA sequencing data confirm that the protein is a unique staphylococcal exotoxin, yet shares significant sequence homology with known staphylococcal enterotoxins, especially the SEA, SED, and SEE toxins. We conclude therefore that this 25-kD protein belongs to the staphylococcal enterotoxin gene family that is capable of inducing a TSS-like illness in rabbits. PMID:7964453

Intravenous immunoglobulin in children with streptococcal toxic shock syndrome.

PubMed

Shah, Samir S; Hall, Matthew; Srivastava, Raj; Subramony, Anupama; Levin, James E

2009-11-01

Streptococcal toxic shock syndrome (TSS) is a rare and severe manifestation of group A streptococcal infection. The role of intravenous immunoglobulin (IVIG) for streptococcal TSS in children is controversial. This study aims to describe the epidemiology of streptococcal TSS in children and to determine whether adjunctive therapy with IVIG is associated with improved outcomes. A multicenter, retrospective cohort study of children with streptococcal TSS from 1 January 2003 through 31 December 2007 was conducted. Propensity scores were used to determine each child's likelihood of receiving IVIG. Differences in the primary outcomes of death, hospital length of stay, and total hospital costs were compared after matching IVIG recipients and nonrecipients on propensity score. The median patient age was 8.2 years. IVIG was administered to 84 (44%) of 192 patients. The overall mortality rate was 4.2% (95% confidence interval, 1.8%-8.0%). Differences in mortality between IVIG recipients (n = 3; 4.5%) and nonrecipients (n = 3; 4.5%) were not statistically significant (p > .99). Although patients receiving IVIG had higher total hospital and drug costs than nonrecipients, differences in hospital costs were not significant once drug costs were removed (median difference between matched patients, $6139; interquartile range, -$8316 to $25,993; P = .06). No differences were found in length of hospital stay between matched IVIG recipients and nonrecipients. This multicenter study is, to our knowledge, the largest to describe the epidemiology and outcomes of children with streptococcal TSS and the first to explore the association between IVIG use and clinical outcomes. IVIG use was associated with increased costs of caring for children with streptococcal TSS but was not associated with improved outcomes.

Intravenous Immune Globulin in Children with Streptococcal Toxic Shock Syndrome

PubMed Central

Shah, Samir S.; Hall, Matthew; Srivastava, Raj; Subramony, Anupama; Levin, James E.

2009-01-01

Background Streptococcal toxic shock syndrome (TSS) is a rare and severe manifestation of group A streptococcal infection. The role of intravenous immune globulin (IVIG) for streptococcal TSS in children is controversial. Objective To describe the epidemiology of streptococcal TSS in children and to determine whether adjunctive therapy with IVIG is associated with improved outcomes. Methods A multicenter retrospective cohort study of children with streptococcal TSS from 2003-2007 was conducted. Propensity scores were used to determine each child's likelihood of receiving IVIG. Differences in the primary outcomes of death, hospital length of stay, and total hospital costs were compared after matching IVIG-recipients and non-recipients on propensity score. Results The median age was 8.2 years. IVIG was administered to 84 (44%) of 192. Overall mortality was 4.2% (95% confidence interval: 1.8% to 8.0%). Differences in mortality between IVIG recipients (n=3, 4.5%) and non-recipients (n=3, 4.5%) were not statistically significant (P=1.00). While patients receiving IVIG had higher total hospital and drug costs than non-recipients, differences in hospital costs were not significant once drug costs were removed (median difference between matched patients, $6,139; interquartile range: -$8,316 to $25,993; P=0.06). There were no differences in length of stay between matched IVIG recipients and non-recipients. Conclusion This multicenter study is the largest to describe the epidemiology and outcomes of children with streptococcal TSS and the first to explore the association between IVIG use and clinical outcomes. IVIG use was associated with increased costs of caring for children with streptococcal TSS but was not associated with improved outcomes. PMID:19788359

Innate immune responses following Kawasaki disease and toxic shock syndrome

PubMed Central

Messina, Nicole; Germano, Susie; Bonnici, Rhian; Freyne, Bridget; Cheung, Michael; Goldsmith, Greta; Kollmann, Tobias R.; Levin, Michael; Burgner, David; Curtis, Nigel

2018-01-01

The pathogenesis of Kawasaki disease (KD) remains unknown and there is accumulating evidence for the importance of the innate immune system in initiating and mediating the host inflammatory response. We compared innate immune responses in KD and toxic shock syndrome (TSS) participants more than two years after their acute illness with control participants to investigate differences in their immune phenotype. Toxic shock syndrome shares many clinical features with KD; by including both disease groups we endeavoured to explore changes in innate immune responses following acute inflammatory illnesses more broadly. We measured the in vitro production of interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-1 receptor antagonist (IL-1ra), and IL-10 following whole blood stimulation with toll-like receptor and inflammasome ligands in 52 KD, 20 TSS, and 53 control participants in a case-control study. Analyses were adjusted for age, sex, and unstimulated cytokine concentrations. Compared to controls, KD participants have reduced IL-1ra production in response to stimulation with double stranded RNA (geometric mean ratio (GMR) 0.37, 95% CI 0.15, 0.89, p = 0.03) and increased IL-6 production in response to incubation with Lyovec™ (GMR 5.48, 95% CI 1.77, 16.98, p = 0.004). Compared to controls, TSS participants have increased IFN-γ production in response to peptidoglycan (GMR 4.07, 95% CI 1.82, 9.11, p = 0.001), increased IL-1β production to lipopolysaccharide (GMR 1.64, 95% CI 1.13, 2.38, p = 0.01) and peptidoglycan (GMR 1.61, 95% CI 1.11, 2.33, p = 0.01), and increased IL-6 production to peptidoglycan (GMR 1.45, 95% CI 1.10, 1.92, p = 0.01). Years following the acute illness, individuals with previous KD or TSS exhibit a pro-inflammatory innate immune phenotype suggesting a possible underlying immunological susceptibility or innate immune memory. PMID:29447181

Innate immune responses following Kawasaki disease and toxic shock syndrome.

PubMed

Chen, Katherine Y H; Messina, Nicole; Germano, Susie; Bonnici, Rhian; Freyne, Bridget; Cheung, Michael; Goldsmith, Greta; Kollmann, Tobias R; Levin, Michael; Burgner, David; Curtis, Nigel

2018-01-01

The pathogenesis of Kawasaki disease (KD) remains unknown and there is accumulating evidence for the importance of the innate immune system in initiating and mediating the host inflammatory response. We compared innate immune responses in KD and toxic shock syndrome (TSS) participants more than two years after their acute illness with control participants to investigate differences in their immune phenotype. Toxic shock syndrome shares many clinical features with KD; by including both disease groups we endeavoured to explore changes in innate immune responses following acute inflammatory illnesses more broadly. We measured the in vitro production of interferon (IFN)-γ, tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-1 receptor antagonist (IL-1ra), and IL-10 following whole blood stimulation with toll-like receptor and inflammasome ligands in 52 KD, 20 TSS, and 53 control participants in a case-control study. Analyses were adjusted for age, sex, and unstimulated cytokine concentrations. Compared to controls, KD participants have reduced IL-1ra production in response to stimulation with double stranded RNA (geometric mean ratio (GMR) 0.37, 95% CI 0.15, 0.89, p = 0.03) and increased IL-6 production in response to incubation with Lyovec™ (GMR 5.48, 95% CI 1.77, 16.98, p = 0.004). Compared to controls, TSS participants have increased IFN-γ production in response to peptidoglycan (GMR 4.07, 95% CI 1.82, 9.11, p = 0.001), increased IL-1β production to lipopolysaccharide (GMR 1.64, 95% CI 1.13, 2.38, p = 0.01) and peptidoglycan (GMR 1.61, 95% CI 1.11, 2.33, p = 0.01), and increased IL-6 production to peptidoglycan (GMR 1.45, 95% CI 1.10, 1.92, p = 0.01). Years following the acute illness, individuals with previous KD or TSS exhibit a pro-inflammatory innate immune phenotype suggesting a possible underlying immunological susceptibility or innate immune memory.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report.

PubMed

Kosami, Koki; Kenzaka, Tsuneaki; Sagara, Yuka; Minami, Kensuke; Matsumura, Masami

2016-04-18

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a mild encephalopathy caused by various pathological processes, but encephalopathy due to bacteria is rare. We report the case of a 45-year-old Japanese woman who on receiving chemotherapy for advanced breast cancer developed an altered mental status and dysarthria soon after fever from infection of a subcutaneous implantable port. Staphylococcus aureus was detected in her blood cultures. Magnetic resonance imaging (MRI) revealed an ovoid lesion in the central portion of the splenium of the corpus callosum (SCC). Although hypotension was not observed, we diagnosed probable toxic shock syndrome (TSS) based on fever (temperature: >38.9 °C), altered mental status, erythema, desquamation, thrombocytopenia, liver dysfunction, and creatine phosphokinase elevation. We administered antimicrobial therapy and her neurological symptoms improved gradually. The lesion in the SCC completely disappeared on MRI 7 days after disease onset. We diagnosed this case as MERS caused by S. aureus bacteremia with TSS. This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics.

PubMed

DeVries, Aaron S; Lesher, Lindsey; Schlievert, Patrick M; Rogers, Tyson; Villaume, Lourdes G; Danila, Richard; Lynfield, Ruth

2011-01-01

Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986. Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000-2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases. Of 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32-0.77), 0.69 (0.39-1.16), and 0.32 (0.12-0.67), respectively. Women 13-24 years had the highest incidence at 1.41 (0.63-2.61). No increase in incidence was observed from 2000-2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p<0.01), and 25% vs 13% (p = 0.5), respectively]. TSS incidence remained stable across our surveillance period of 2000-2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. tst-1 continues to be the superantigen associated with the majority of menstrual cases. The CDC case definition identifies the most severe cases and has been consistently used but likely results in a substantial underestimation of the total TSS disease burden.

Interferon gamma-dependent intestinal pathology contributes to the lethality in bacterial superantigen-induced toxic shock syndrome.

PubMed

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

2011-02-03

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-γ seemed to play a lethal role in the immunopathogenesis of TSS by inflicting fatal small bowel pathology. Our study thus identifies the important role for IFN-γ in TSS.

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

PubMed

Breshears, Laura M; 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.

Neutralization of Staphylococcal Enterotoxin B by an Aptamer Antagonist

PubMed Central

Wang, Kaiyu; Gan, Longjie; Jiang, Li; Zhang, Xianhui; Yang, Xiangyue; Chen, Min

2015-01-01

Staphylococcal enterotoxin B (SEB) is a major virulence factor for staphylococcal toxic shock syndrome (TSS). SEB activates a large subset of the T lymphocytic population, releasing proinflammatory cytokines. Blocking SEB-initiated toxicity may be an effective strategy for treating TSS. Using a process known as systematic evolution of ligands by exponential enrichment (SELEX), we identified an aptamer that can antagonize SEB with nanomolar binding affinity (Kd = 64 nM). The aptamer antagonist effectively inhibits SEB-mediated proliferation and cytokine secretion in human peripheral blood mononuclear cells. Moreover, a PEGylated aptamer antagonist significantly reduced mortality in a “double-hit” mouse model of SEB-induced TSS, established via sensitization with d-galactosamine followed by SEB challenge. Therefore, our novel aptamer antagonist may offer potential therapeutic efficacy against SEB-mediated TSS. PMID:25624325

Prevalence of antibody to toxic shock syndrome toxin-1 in burn patients.

PubMed

Park, Ji-Young; Kim, Jae-Seok; Woo, Heungjeong

2015-01-01

Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS. A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene. One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged ≥61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%. Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS.

RS3PE syndrome developing during the course of probable toxic shock syndrome: a case report.

PubMed

Kyotani, Moe; Kenzaka, Tsuneaki; Nishio, Ryo; Akita, Hozuka

2018-04-13

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome characterized by "remitting," "seronegative" (namely rheumatoid factor-negative), and "symmetrical" synovitis with pitting edema on the dorsum of the hands and feet. Recently, there have been reports that serum vascular endothelial growth factor (VEGF) is elevated in this condition. An 85-year-old man visited our department with a rash that had appeared 2 days earlier and a fever that had developed on the day of his visit. Based on clinical findings of fever, erythema exudativum multiforme, transitory hypotension, conjunctiva hyperemia, elevated creatine kinase, and desquamation, we suspected toxic shock syndrome (TSS). Therefore, we started treatment with vancomycin (1 g/day) and clindamycin (600 mg/day), after which his fever rapidly remitted. However, pitting edema on the dorsum of his hands and feet appeared on day 7, and the patient also had painful wrist and ankle joints. Additional tests were negative for rheumatoid factor, and anti-cyclic citrullinated protein antibodies were < 0.2 U/mL. Further, serum matrix metalloproteinase-3 (199.6 ng/mL; reference value ≤123.8 ng/mL) and serum VEGF (191 pg/mL; reference value ≤38.3 pg/mL) levels were elevated, and human leukocyte antigen-A2 was detected. The patient was thus diagnosed with RS3PE syndrome, for which he satisfied all four diagnostic criteria: 1) pitting edema in the limbs, 2) acute onset, 3) age ≥ 50 years, and 4) rheumatoid factor negativity. He was treated with oral prednisolone, resulting in the normalization of his serum VEGF level to 34.5 pg/mL 1 month after starting treatment. It is currently 1 year since disease onset, and although the patient has stopped taking prednisolone, there has been no recurrence of RS3PE syndrome. To the best of our knowledge, this is the first reported case of a patient developing RS3PE syndrome during the clinical course of TSS. We propose that the onset mechanism involved an increase in blood VEGF due to TSS, which induced RS3PE syndrome. As serum VEGF becomes elevated with both severe infections associated with shock and RS3PE syndrome, awareness that these conditions can occur concurrently is essential.

Prevalence of toxic shock syndrome toxin 1 (TSST-1)-producing strains of Staphylococcus aureus and antibody to TSST-1 among healthy Japanese women.

PubMed

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

2008-08-01

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.

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 (T EM ) cells that secrete IL-17A, but not IFN-γ, was responsible for early IL-17A production. We found mouse "T EM -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 + T EM 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. Copyright © 2017 by The American Association of Immunologists, Inc.

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-γ seemed to play a lethal role in the immunopathogenesis of TSS by inflicting fatal small bowel pathology. Our study thus identifies the important role for IFN-γ in TSS. PMID:21304813

Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics

PubMed Central

DeVries, Aaron S.; Lesher, Lindsey; Schlievert, Patrick M.; Rogers, Tyson; Villaume, Lourdes G.; Danila, Richard; Lynfield, Ruth

2011-01-01

Introduction Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000–2003. The last population-based assessment of TSS was 1986. Methods Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000–2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases. Results Of 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32–0.77), 0.69 (0.39–1.16), and 0.32 (0.12–0.67), respectively. Women 13–24 years had the highest incidence at 1.41 (0.63–2.61). No increase in incidence was observed from 2000–2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p<0.01), and 25% vs 13% (p = 0.5), respectively]. Discussion TSS incidence remained stable across our surveillance period of 2000–2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. tst-1 continues to be the superantigen associated with the majority of menstrual cases. The CDC case definition identifies the most severe cases and has been consistently used but likely results in a substantial underestimation of the total TSS disease burden. PMID:21860665

Propensity of tampons and barrier contraceptives to amplify Staphylococcus aureusToxic shock syndrome toxin-I.

PubMed

Tierno, P M; Hanna, B A

1994-01-01

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. 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. 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 microg/ml, when these products were washed, TSST-1 levels increased to 2-32 microg/ml. In all-cotton tampons, whether washed or not, there was no detectable TSST-1. The propensity for all-cotton tampons not to amplify TSST-1 in vitro suggests they would lower the risk for tampon-associated TSS.

[Toxic shock syndrome caused by pyogenic bacteria].

PubMed

Gábor, Zsuzsa; Szekeres, Sándor; Gacs, Mária

2003-01-12

Case reports and review of the literature. Severe toxic shock syndrome caused by invasive infection with pyogenic bacteria Staphylococcus aureus or group A Streptococcus pyogenes, with high mortality rates in cases of the latter, remained one of the most problematic chapters of critical care medicine to date. To give an overview on the epidemiology, clinical manifestations, the complex therapeutical approaches of the syndrome and, on the role and mechanisms of action of bacterial superantigens in the pathophysiological processes as well. Literary data, and some illustrative selected cases demonstrate that, the incidence of TSS shows increasing tendency worldwide and, that otherwise healthy, younger people are the most frequently affected. As for prognosis: early diagnosis and treatment with sufficient radicality are of decisive importance.

Clinical features of neonatal toxic shock syndrome-like exanthematous disease emerging in Japan.

PubMed

Takahashi, Naoto; Uehara, Ritei; Nishida, Hiroshi; Sakuma, Izumi; Yamasaki, Chika; Takahashi, Kayo; Honma, Yoko; Momoi, Mariko Y; Uchiyama, Takehiko

2009-09-01

An epidemic of neonatal toxic shock syndrome (TSS)-like exanthematous disease (NTED) has emerged in Japan. NTED is caused by TSS toxin-1 produced predominantly by methicillin-resistant Staphylococcus aureus (MRSA). Using a large-scale investigation, the present study aimed to elucidate the overall clinical picture of NTED in Japan. We performed nationwide surveys regarding NTED in Japanese neonatal intensive care units (NICUs) in 2000, 2002 and 2005, and summarized the clinical findings of 540 patients. We also performed a case-control study to identify the relationship between patients' clinical findings and NTED. The frequency of NTED in Japanese NICUs in 2000 was 52.2% and declined to 28.3% in 2005. The number of NTED patients in 2000 was 240 and decreased to 139 in 2005. In 2005, the isolation of methicillin-sensitive S. aureus (MSSA) increased to 20.0% in term patients. Although no term infants suffered shock or death, preterm patients sometimes developed severe symptoms. The number of NTED patients decreased over the 5-year period from 2000 to 2005, even though more than 100 patients contracted NTED in Japanese NICUs in 2005. MSSA as well as MRSA can cause NTED, and NTED is more severe in preterm infants than in term infants.

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

Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score–Matched Analysis From 130 US Hospitals

PubMed Central

Swihart, Bruce J.; Bonne, Stephanie L.; Hohmann, Samuel F.; Hennessy, Laura V.; Louras, Peter; Evans, Heather L.; Rhee, Chanu; Suffredini, Anthony F.; Hooper, David C.; Follmann, Dean A.; Bulger, Eileen M.; Danner, Robert L.

2017-01-01

Abstract Background. Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear. Methods. Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS). Results. Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55–1.83]; P = .99). Early IVIG (≤2 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13–49] vs 26 [11–43]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals. Conclusions. Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics. PMID:28034881

One in five mortality in non-menstrual toxic shock syndrome versus no mortality in menstrual cases in a balanced French series of 55 cases.

PubMed

Descloux, E; Perpoint, T; Ferry, T; Lina, G; Bes, M; Vandenesch, F; Mohammedi, I; Etienne, J

2008-01-01

Staphylococcus aureus superantigenic toxins are responsible for menstrual and non-menstrual toxic shock syndrome (TSS). We compared the clinical and biological characteristics of 21 cases of menstrual TSS (MTSS) with 34 cases of non-menstrual TSS (NMTSS) diagnosed in France from December 2003 to June 2006. All 55 S. aureus isolates had been spontaneously referred to the French National Staphylococcal Reference Center, where they were screened for superantigenic toxin gene sequences. Most of the patients had previously been in good health. The most striking differences between MTSS and NMTSS were the higher frequency in NMTSS of neurological disorders (p=0.028), of S. aureus isolation by blood culture (50% versus 0% in MTSS), and the higher mortality rate in NMTSS (22% versus 0% in MTSS). The tst and sea genes were less frequent in isolates causing NMTSS than in those causing MTSS (p<0.001 and 0.051, respectively). Higher mortality was significantly associated with the presence of the sed gene (p=0.041), but when considering NMTSS survivors and non-survivors, no clinical or bacteriological factors predictive of vital outcome were identified. Specific antitoxinic therapy was rarely prescribed, and never in fatal cases. Higher mortality was observed in NMTSS than in MTSS, and no definite factors could explain the higher severity of NMTSS. NMTSS would require more aggressive therapy, comprising systematic rapid wound debridement, antistaphylococcal agents, including an antitoxin antibiotics, and intravenous immunoglobulin.

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

Lactobacillus reuteri-produced cyclic dipeptides quench agr-mediated expression of toxic shock syndrome toxin-1 in staphylococci

PubMed Central

Li, Jingru; Wang, Wenliang; Xu, Stacey X.; Magarvey, Nathan A.; McCormick, John K.

2011-01-01

The production of the staphylococcal exotoxin toxic shock syndrome toxin-1 (TSST-1) by Staphylococcus aureus has been associated with essentially all cases of menstruation-associated toxic shock syndrome (TSS). In this work, we show that the human vaginal isolate Lactobacillus reuteri RC-14 produces small signaling molecules that are able to interfere with the staphylococcal quorum-sensing system agr, a key regulator of virulence genes, and repress the expression of TSST-1 in S. aureus MN8, a prototype of menstrual TSS S. aureus strains. Quantitative real-time PCR data showed that transcription from the Ptst promoter, as well as the P2 and P3 promoters of the agr system from all four agr subgroups of S. aureus, was strongly inhibited in response to growth with L. reuteri RC-14 cultural supernatant. Alterations in the transcriptional levels of two other virulence-associated regulators sarA and saeRS were also observed, indicating a potential overall influence of L. reuteri RC-14 signals on the production of virulence factors in S. aureus. S. aureus promoter-lux reporter strains were used to screen biochemically fractionated L. reuteri RC-14 supernatant, and the cyclic dipeptides cyclo(l-Phe-l-Pro) and cyclo(l-Tyr-l-Pro) were identified as the signaling molecules. The results from this work contribute to a better understanding of interspecies cell-to-cell communication between Lactobacillus and Staphylococcus, and provide a unique mechanism by which endogenous or probiotic strains may attenuate virulence factor production by bacterial pathogens. PMID:21282650

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.

Lactobacillus reuteri-produced cyclic dipeptides quench agr-mediated expression of toxic shock syndrome toxin-1 in staphylococci.

PubMed

Li, Jingru; Wang, Wenliang; Xu, Stacey X; Magarvey, Nathan A; McCormick, John K

2011-02-22

The production of the staphylococcal exotoxin toxic shock syndrome toxin-1 (TSST-1) by Staphylococcus aureus has been associated with essentially all cases of menstruation-associated toxic shock syndrome (TSS). In this work, we show that the human vaginal isolate Lactobacillus reuteri RC-14 produces small signaling molecules that are able to interfere with the staphylococcal quorum-sensing system agr, a key regulator of virulence genes, and repress the expression of TSST-1 in S. aureus MN8, a prototype of menstrual TSS S. aureus strains. Quantitative real-time PCR data showed that transcription from the Ptst promoter, as well as the P2 and P3 promoters of the agr system from all four agr subgroups of S. aureus, was strongly inhibited in response to growth with L. reuteri RC-14 cultural supernatant. Alterations in the transcriptional levels of two other virulence-associated regulators sarA and saeRS were also observed, indicating a potential overall influence of L. reuteri RC-14 signals on the production of virulence factors in S. aureus. S. aureus promoter-lux reporter strains were used to screen biochemically fractionated L. reuteri RC-14 supernatant, and the cyclic dipeptides cyclo(L-Phe-L-Pro) and cyclo(L-Tyr-L-Pro) were identified as the signaling molecules. The results from this work contribute to a better understanding of interspecies cell-to-cell communication between Lactobacillus and Staphylococcus, and provide a unique mechanism by which endogenous or probiotic strains may attenuate virulence factor production by bacterial pathogens.

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

Non-lethal Clostridium sordellii bacteraemia in an immunocompromised patient with pleomorphic sarcoma.

PubMed

Bonnecaze, Alex K; Stephens, Sarah Ellen Elza; Miller, Peter John

2016-08-03

Clostridium sordellii is a spore-forming anaerobic Gram-positive rod that has rarely been reported to cause disease in humans. Resultant mortality from infection is estimated at nearly 70% and is most often correlated with gynaecological procedures, intravenous drug abuse or trauma. C. sordellii infection often presents similarly to toxic shock syndrome (TSS); notable features of infection include refractory hypotension, haemoconcentration and marked leucocytosis. Although clinically similar to TSS, a notable difference is C. sordellii infections rarely involve fever. The organism's major toxins include haemorrhagic (TcsH) and lethal factor (TcsL), which function to disrupt cytoskeletal integrity. Current literature suggests treating C. sordelli infection with a broad-spectrum penicillin, metronidazole and clindamycin. We present a case of C. sordellii bacteraemia and septic shock in an immunocompromised patient who was recently diagnosed with pleomorphic gluteal sarcoma. Despite presenting in critical condition, the patient improved after aggressive hemodynamic resuscitation, source control and intravenous antibiotic therapy. 2016 BMJ Publishing Group Ltd.

Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score-Matched Analysis From 130 US Hospitals.

PubMed

Kadri, Sameer S; Swihart, Bruce J; Bonne, Stephanie L; Hohmann, Samuel F; Hennessy, Laura V; Louras, Peter; Evans, Heather L; Rhee, Chanu; Suffredini, Anthony F; Hooper, David C; Follmann, Dean A; Bulger, Eileen M; Danner, Robert L

2017-04-01

Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear. Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS). Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55-1.83]; P = .99). Early IVIG (≤2 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13-49] vs 26 [11-43]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals. Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Investigators unable to substantiate suspected link between sponge, TSS.

PubMed

1983-12-01

Federal investigators have failed to substantiate a suspected link between the contraceptive sponge and toxic shock syndrome (TSS). In September the US Food and Drug Administration (FDA) reported the case of a woman who inserted the contraceptive sponge last July 17 and removed itthe following day. About 6 hours later she noted the sudden onset of a fever of 104 degrees Farenheit, nausea, redness, shaking chills, and an inflamed vagina. Cultures from the sponge revealed S. aureus and S. epidemis. There was initial concern that the case may have represented early TSS. A toxin produced by certain strains of S. aureus is thought to cause TSS. The syndrome includes a fever greater than 102 degrees, rash, blood pressure less than 90mmHG, peelin g skin on the palms and soles 1-2 weeks after onset, and involvement of 3 or more of the following organ systems: gastrointestinal, muscular, mucous membrane, renal, hepatic, hematologic,or central nervous system. FDA medical Officers Dr. William J. McCann told "Contraceptive Technology Update" (CTU) that the reported case failed to fill the Centers for Disease Control criteriaof the diagnosis of TSS. Because the woman has been treated with antibiotics early in the course of her disease, McCann said he could not entirely exclude the possibility that she might have developed TSS if she had gone untreated. He added that the possibility was "remote". Dr. Gail Bolan, CDC epidemiologist, told CTU that "antibiotics do not seem to affect the outcome of the original episode" of TSS cases. She commented that milder forms of TSS might exist that may not meet CDC's strict case definition. Without a specific test, there is no way to separate milder TSS cases from viral or other diseases that may appear similar. According to Deborah Gaynor, the sponge's package insert states that clinical trials were not large enough to assess the risk of TSS. The sponge is not recommended for use during menstration. Gaynor cites a variety of reasons why the contraceptive sponge does not cause TSS: Remarketing trials of the sponge included more than 1000 women years of experience without a reported case of TSS; nonoxynol 9 spermicide and citric, ascorbic, and benzoic acids in the sponge are hostile to S. aureus; unlike tampons, the sponge is not highly absorbant and does not cause microabrasions of the vagina; and during testing, contraceptive sponges were innoculated with the Harrisburg strain of S. aureus known to cause TSS fatality, and after incubation in growth medium for 28 days the S. aureus failed to grow in the innoculated sponges.

Toxic shock syndrome: characterization of human immune responses to TSST-1 and evidence for sensitivity thresholds.

PubMed

Kimber, Ian; Nookala, Suba; Davis, Catherine C; Gerberick, G Frank; Tucker, Heidi; Foertsch, Leslie M; Dearman, Rebecca J; Parsonnet, Jeffrey; Goering, Richard V; Modern, Paul; Donnellen, Meghan; Morel, Jorge; Kotb, Malak

2013-07-01

Noninvasive vaginal infections by Staphylococcus aureus strains producing the superantigen TSST-1 can cause menstrual toxic shock syndrome (mTSS). With the objective of exploring the basis for differential susceptibility to mTSS, the relative responsiveness to TSST-1 of healthy women has been investigated. Peripheral blood mononuclear cells from healthy donors were incubated with purified TSST-1 or with the T-cell mitogen phytohemmaglutinin (PHA), and proliferation was measured. The concentrations of TSST-1 and PHA required to elicit a response equivalent to 15% of the maximal achievable response (EC15) were determined. Although with PHA, EC15 values were comparable between donors, subjects could be classified as being of high, medium, or low sensitivity based on responsiveness to TSST-1. Sensitivity to TSST-1-induced proliferation was associated with increased production of the cytokines interleukin-2 and interferon-γ. When the entire T lymphocyte population was considered, there were no differences between sensitivity groups with respect to the frequency of cells known to be responsive to TSST-1 (those bearing CD3(+) Vβ2(+)). However, there was an association between sensitivity to TSST-1 and certain HLA-class II haplotypes. Thus, the frequencies of DR7DQ2, DR14DQ5, DR4DQ8, and DR8DQ4 haplotypes were greater among those with high sensitivity, a finding confirmed by analysis of responses to immortalized homozygous B cell lines. Collectively, the results reveal that factors other than neutralizing antibody and the frequency of Vβ2(+) T lymphocytes determine immunological responsiveness to TSST-1. Differential responsiveness of lymphocytes to TSST-1 may form the basis of interindividual variations in susceptibility to mTSS.

Staphylococcal superantigens in colonization and disease

PubMed Central

Xu, Stacey X.; McCormick, John K.

2012-01-01

Superantigens (SAgs) are a family of potent immunostimulatory exotoxins known to be produced by only a few bacterial pathogens, including Staphylococcus aureus. More than 20 distinct SAgs have been characterized from different S. aureus strains and at least 80% of clinical strains harbor at least one SAg gene, although most strains encode many. SAgs have been classically associated with food poisoning and toxic shock syndrome (TSS), for which these toxins are the causative agent. TSS is a potentially fatal disease whereby SAg-mediated activation of T cells results in overproduction of cytokines and results in systemic inflammation and shock. Numerous studies have also shown a possible role for SAgs in other diseases such as Kawasaki disease (KD), atopic dermatitis (AD), and chronic rhinosinusitis (CRS). There is also now a rich understanding of the mechanisms of action of SAgs, as well as their structures and function. However, we have yet to discover what purpose SAgs play in the life cycle of S. aureus, and why such a wide array of these toxins exists. This review will focus on recent developments within the SAg field in terms of the molecular biology of these toxins and their role in both colonization and disease. PMID:22919643

Alpha-Toxin Promotes Staphylococcus aureus Mucosal Biofilm Formation

PubMed Central

Anderson, Michele J.; Lin, Ying-Chi; Gillman, Aaron N.; Parks, Patrick J.; Schlievert, Patrick M.; Peterson, Marnie L.

2012-01-01

Staphylococcus aureus causes many diseases in humans, ranging from mild skin infections to serious, life-threatening, superantigen-mediated Toxic Shock Syndrome (TSS). S. aureus may be asymptomatically carried in the anterior nares or vagina or on the skin, serving as a reservoir for infection. Pulsed-field gel electrophoresis clonal type USA200 is the most widely disseminated colonizer and the leading cause of TSS. The cytolysin α-toxin (also known as α-hemolysin or Hla) is the major epithelial proinflammatory exotoxin produced by TSS S. aureus USA200 isolates. The current study aims to characterize the differences between TSS USA200 strains [high (hla+) and low (hla−) α-toxin producers] in their ability to disrupt vaginal mucosal tissue and to characterize the subsequent infection. Tissue viability post-infection and biofilm formation of TSS USA200 isolates CDC587 and MN8, which contain the α-toxin pseudogene (hla−), MNPE (hla+), and MNPE isogenic hla knockout (hlaKO), were observed via LIVE/DEAD® staining and confocal microscopy. All TSS strains grew to similar bacterial densities (1–5 × 108 CFU) on the mucosa and were proinflammatory over 3 days. However, MNPE formed biofilms with significant reductions in the mucosal viability whereas neither CDC587 (hla−), MN8 (hla−), nor MNPE hlaKO formed biofilms. The latter strains were also less cytotoxic than wild-type MNPE. The addition of exogenous, purified α-toxin to MNPE hlaKO restored the biofilm phenotype. We speculate that α-toxin affects S. aureus phenotypic growth on vaginal mucosa by promoting tissue disruption and biofilm formation. Further, α-toxin mutants (hla−) are not benign colonizers, but rather form a different type of infection, which we have termed high density pathogenic variants (HDPV). PMID:22919655

Impact of currently marketed tampons and menstrual cups on Staphylococcus aureus growth and TSST-1 production in vitro.

PubMed

Nonfoux, Louis; Chiaruzzi, Myriam; Badiou, Cédric; Baude, Jessica; Tristan, Anne; Thioulouse, Jean; Muller, Daniel; Prigent Combaret, Claire; Lina, Gérard

2018-04-20

Fifteen currently marketed intravaginal protection products (11 types of tampon and four menstrual cups) were tested by the modified tampon sac method to determine their effect on Staphylococcus aureus growth and toxic shock toxin 1 (TSST-1) production. Most tampons reduced S. aureus growth and TSST-1 production, with differences based on brand and composition, and S. aureus growth was higher in de-structured than in unaltered tampons. We observed higher S. aureus growth and toxin production in menstrual cups than in tampons, potentially due to the additional air introduced to the bag by cups, with differences based on cup composition and size. Importance Menstrual toxic shock syndrome is a rare but severe disease. It occurs in healthy women vaginally colonized by Staphylococcus aureus producing toxic shock syndrome toxin 1 using intravaginal protection such as tampons or menstrual cups. Intravaginal protection induces TSS production by collecting catamenial products which act as a growth medium for S. aureus Previous studies have evaluated the impact of tampon composition on S. aureus producing toxic shock syndrome toxin 1, but they are not recent and did not include menstrual cups. This study demonstrates that highly reproducible results for S. aureus growth and TSST-1 production can be obtained using a simple protocol that reproduces the physiological conditions of tampon and cup usage as closely as possible, providing recommendations for tampon or cup use to both manufacturers and consumers. Notably, our results do not show that menstrual cups are safer than tampons and suggest that they require similar precautions. Copyright © 2018 American Society for Microbiology.

Recombinant Factor XIII Mitigates Hemorrhagic Shock-Induced Organ Dysfunction

PubMed Central

Zaets, Sergey B.; Xu, Da-Zhong; Lu, Qi; Feketova, Eleonora; Berezina, Tamara L.; Malinina, Inga V.; Deitch, Edwin A.; Olsen, Eva H.

2012-01-01

Background Plasma factor XIII (FXIII) is responsible for stabilization of fibrin clot at the final stage of blood coagulation. Since FXIII has also been shown to modulate inflammation, endothelial permeability, as well as diminish multiple organ dysfunction (MOD) after gut ischemia-reperfusion injury, we hypothesized that FXIII would reduce MOD caused by trauma-hemorrhagic shock (THS). Materials and methods Rats were subjected to a 90 min THS or trauma sham shock (TSS) and treated with either recombinant human FXIII A2 subunit (rFXIII) or placebo immediately after resuscitation with shed blood or at the end of the TSS period. Lung permeability, lung and gut myeloperoxidase (MPO) activity, gut histology, neutrophil respiratory burst, microvascular blood flow in the liver and muscles, and cytokine levels were measured 3 h after the THS or TSS. FXIII levels were measured before THS or TSS and after the 3-h post-shock period. Results THS-induced lung permeability as well as lung and gut MPO activity was significantly lower in rFXIII-treated than in placebo-treated animals. Similarly, rFXIII-treated rats had lower neutrophil respiratory burst activity and less ileal mucosal injury. rFXIII-treated rats also had a higher liver microvascular blood flow compared with the placebo group. Cytokine response was more favorable in rFXIII-treated animals. Trauma-hemorrhagic shock did not cause a drop in FXIII activity during the study period. Conclusions Administration of rFXIII diminishes THS-induced MOD in rats, presumably by preservation of the gut barrier function, limitation of polymorphonuclear leukocyte (PMN) activation, and modulation of the cytokine response. PMID:21276979

The role of lymph factors in lung injury, bone marrow suppression, and endothelial cell dysfunction in a primate model of trauma-hemorrhagic shock.

PubMed

Deitch, Edwin A; Forsythe, Raquel; Anjaria, Dev; Livingston, David H; Lu, Qi; Xu, Da-Zhong; Redl, Heinz

2004-09-01

Studies in rodent models of trauma-hemorrhagic shock (T/HS) have shown that factors contained in the intestinal lymph are responsible for acute lung injury and bone marrow suppression, and that they contribute to a systemic inflammatory state. Because results observed in rodent T/HS models may not fully reflect the response of injured patients, it is necessary to determine if these results can be replicated in primates before the institution of invasive studies in humans. Thus, the three goals of this study were to determine if diversion of thoracic duct lymph reduced T/HS-induced lung injury; to compare the biologic activity of thoracic duct lymph from baboons subjected to T/HS or trauma sham-shock (T/SS); and to compare the biologic activity and composition of plasma from baboons subjected to T/SS, T/HS, and T/HS with thoracic duct lymph drainage. Three groups of baboons were studied: T/SS plus lymph diversion via a thoracic duct catheter, T/HS, and T/HS plus lymph diversion (T/HS-LD). The trauma component consisted of a neck dissection with resection of the proximal clavicle plus a laparotomy. HS was to a mean arterial pressure of 40 mmHg and was maintained at 40 mmHg until the base excess reached -5 mEq or the total shock period reached 3 h. Volume resuscitation was carried out by reinfusing the shed blood plus crystalloids. Before, during, and after the T/HS or T/SS period, blood and lymph samples were obtained for analysis, and lung samples were harvested for measurement of lung wet-to-dry ratio at 5 h after the end of the shock period. Diversion of thoracic duct lymph prevented T/HS-induced lung injury as reflected in lung wet-to-dry weight ratios (T/SS = 4.6 +/- 0.5; T/HS+LD = 4.8 +/- 0.7; T/HS = 5.4 +/- 0.6; P < 0.05). Lymph from the T/HS group collected during the early postshock period was cytotoxic for human endothelial cells (HUVECs; 16% vs. 100% survival in T/SS lymph) and increased HUVEC monolayer permeability almost 2-fold (P < 0.01). T/HS lymph and plasma also suppressed red blood cell (erythroid burst-forming unit) and white blood cell (granulocyte-monocyte colony-forming unit) progenitor cell growth of human bone marrow to approximately 50% of control, whereas T/SS lymph and plasma were not suppressive (P < 0.05). Plasma cytokine levels were increased to a similar degree in the two T/HS groups. Thus, in a primate model of T/HS, gut-derived factors carried in the lymph potentiates lung injury and endothelial dysfunction, and suppresses bone marrow progenitor cell growth.

Effect of transient sodium chloride shock loads on the performance of submerged membrane bioreactor.

PubMed

Yogalakshmi, K N; Joseph, Kurian

2010-09-01

Membrane bioreactor (MBR) is a promising technological option to meet water reuse demands. Though MBR provides effluent quality of reusable standard, its versatility to shock loads remains unexplored. The present study investigates the robustness of MBR under sodium chloride shock load (5-60 g/L) conditions. A bench scale aerobic submerged MBR (6L working volume) with polyethylene hollow fiber membrane module (pore size 0.4 microm) was operated with synthetic wastewater at steady state OLR of 3.6g COD/L/d and HRT of 8h. This resulted in 99% TSS removal and 95% COD and TKN removal. The COD removal during the salt shock load was in the range of 84-64%. The TSS removal showed maximum disturbance (88%) with a corresponding decrease in biomass MLVSS by 8% at 60 g/L shock. TKN removal was reduced due to inhibition of nitrification with increasing shock loads. It took about 4-9 days for the MBR to regain its steady state performance. Copyright 2010 Elsevier Ltd. All rights reserved.

Group A Streptococcus Toxic Shock Syndrome: An outbreak report and review of the literature.

PubMed

Al-ajmi, Jameela Alkhowaiter; Hill, Peter; O' Boyle, Carol; Garcia, Ma Leni Basco; Malkawi, Manal; George, Ancy; Saleh, Fatma; Lukose, Bency; Ali, Badriya Al; Elsheikh, Mamoun

2012-12-01

Group A Streptococcal (GAS) Toxic Shock Syndrome (TSS) is an acute, rapidly progressive, and often fatal illness. Outbreaks can occur in hospitals. However, early infection control measures may interrupt transmissions and prevent morbidity and mortality. Two cases of invasive GAS TSS were diagnosed within 48h after two uncomplicated laparoscopic surgeries that were performed in the same operating room of a women's hospital. Investigations conducted by the infection prevention and control department of the hospital identified 46 obstetrical staff members who were involved in the surgeries and/or had contact with either of the patients. All of the staff members were interviewed regarding any recent history of upper respiratory tract infections, the presence of skin lesions and vaginal or rectal symptoms. Throat, rectal, and vaginal cultures were obtained two times from all of the involved staff members. Throat colonization with GAS was detected in the cultures from one obstetrical intern who attended the 1st surgery and from one nurse who had formerly worked in the postnatal ward. These two strains were epidemiologically different from each other and from the outbreak strain. Both carriers were suspended from direct patient care and were treated with a ten-day course of oral clindamycin. The success of their decolonization status was assessed at the end of therapy and at three, six, nine and twelve months thereafter before reassigning them to routine work. Unfortunately, in spite of the extensive investigation of all involved personnel and of the environment, the mode of transmission to the second patient could not be established. However, droplet or airborne transmission could not be ruled out. Early and meticulous implementation of infection control measures was crucial and instrumental in the successful management and control of this outbreak. Furthermore, there were no subsequent GAS cases detected during the 24 months following the outbreak. Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Persistence survey of toxic shock syndrome toxin-1 producing Staphylococcus aureus and serum antibodies to this superantigen in five groups of menstruating women.

PubMed

Parsonnet, Jeffrey; Hansmann, Melanie A; Seymour, Jon L; Delaney, Mary L; Dubois, Andrea M; Modern, Paul A; Jones, Michaelle B; Wild, John E; Onderdonk, Andrew B

2010-08-23

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. 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. 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. 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 findings, it appears that antibody titers in women found to be colonized with toxigenic S. aureus remained skewed toward higher titers whether or not the colonies were found to be persistent or transient in nature. This suggests that colonization at some point in time is sufficient to elevate antibody titer levels and those levels appear to be persistent. Results also indicate that women can become seropositive without experiencing signs or symptoms of toxic shock syndrome.

Toxic shock syndrome

MedlinePlus

Staphylococcal toxic shock syndrome; Toxic shock-like syndrome; TSLS ... Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock- ...

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome.

PubMed

Koulouri, Olympia; Steuwe, Andrea; Gillett, Daniel; Hoole, Andrew C; Powlson, Andrew S; Donnelly, Neil A; Burnet, Neil G; Antoun, Nagui M; Cheow, Heok; Mannion, Richard J; Pickard, John D; Gurnell, Mark

2015-10-01

We report our experience of functional imaging with (11)C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome. Twenty patients with i) de novo Cushing's disease (CD, n=10), ii) residual or recurrent hypercortisolism following first pituitary surgery (±radiotherapy; n=8) or iii) ectopic Cushing's syndrome (n=2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI. All patients underwent (11)C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of (11)C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging. In seven of ten patients with de novo CD, asymmetric (11)C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal (11)C-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region. (11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy. © 2015 European Society of Endocrinology.

[Streptococcal toxic shock syndrome].

PubMed

Gvozdenović, Ljiljana; Pasternak, Janko; Milovanović, Stanislav; Ivanov, Dejan; Milić, Sasa

2010-01-01

Streptococcal toxic shock syndrome is now recognized as a toxin-mediated, multisystem illness. It is characterized by an early onset of shock with multiorgan failure and continues to be associated with high morbidity and mortality, caused by group A Streptococcus pyogenes. The symptoms for staphylococcal and streptococcal toxic shock syndrome are similar. Streptococcal toxic shock syndrome was not well described until 1993, when children who had suffered from varicella presented roughly 2-4 weeks later with a clinical syndrome highly suggestive of toxic shock syndrome. It is characterized by a sudden onset of fever, chills, vomiting, diarrhea, muscle aches and rash. It can rapidly progress to severe and intractable hypotension and multisystem dysfunction. Almost every organ system can he involved. Complications of streptococcal toxic shock syndrome may include kidney failure, liver failure (and even death. Crystalloids and inotropic agents are used to treat the hypovolemic shock aggressively, with close monitoring of the patient's mean arterial pressure and central venous pressure. An immediate and aggressive management of hypovolemic shock is essential in streptococcal toxic shock syndrome. Targeted antibiotics are indicated: penicillin or a beta-lactam antibiotic is used for treating group A streptococci, and clindamycin has emerged as a key portion of the standard treatment.

Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study

PubMed Central

Juma, Jane; Nyothach, Elizabeth; Laserson, Kayla F; Oduor, Clifford; Arita, Lilian; Ouma, Caroline; Oruko, Kelvin; Omoto, Jackton; Mason, Linda; Alexander, Kelly T; Fields, Barry; Onyango, Clayton; Phillips-Howard, Penelope A

2017-01-01

Objective Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. Design Observational studies nested in a cluster randomised controlled feasibility study. Setting 30 primary schools in a health and demographic surveillance system in rural western Kenya. Participants Menstruating primary schoolgirls aged 14–16 years participating in a menstrual feasibility study. Interventions Insertable menstrual cup, monthly sanitary pads or ‘usual practice’ (controls). Outcome measures Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes. Results Among 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureusprevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65 S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12). Conclusions Among this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety. PMID:28473520

Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study.

PubMed

Juma, Jane; Nyothach, Elizabeth; Laserson, Kayla F; Oduor, Clifford; Arita, Lilian; Ouma, Caroline; Oruko, Kelvin; Omoto, Jackton; Mason, Linda; Alexander, Kelly T; Fields, Barry; Onyango, Clayton; Phillips-Howard, Penelope A

2017-05-04

Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. Observational studies nested in a cluster randomised controlled feasibility study. 30 primary schools in a health and demographic surveillance system in rural western Kenya. Menstruating primary schoolgirls aged 14-16 years participating in a menstrual feasibility study. Insertable menstrual cup, monthly sanitary pads or 'usual practice' (controls). Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes. Among 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureus prevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65  S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12). Among this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Use of porcine vaginal tissue ex-vivo to model environmental effects on vaginal mucosa to toxic shock syndrome toxin-1.

PubMed

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 ((3)H2O) 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 (3)H2O. 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 (3)H2O 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. Copyright © 2013 Elsevier Inc. All rights reserved.

Toxic Shock Syndrome

MedlinePlus

... toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be ... a skin or wound infection. Causes Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome ...

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

Heparin use in a rat hemorrhagic shock model induces biologic activity in mesenteric lymph separate from shock

PubMed Central

Qin, Yong; Prescott, Lauriston M.; Deitch, Edwin A.; Kaiser, Vicki L.

2011-01-01

Experimental data has shown that mesenteric lymph from rats subjected to trauma-hemorrhagic shock (THS) but not trauma-sham shock (TSS) induces neutrophil activation, cytotoxicity, decreased red blood cell deformability and bone marrow colony growth suppression. These data have lead to the hypothesis that gut factors produced from THS enter the systemic circulation via the mesenteric lymphatics and contribute to the progression of Multiple Organ Failure (MOF) following THS. Ongoing studies designed to identify bioactive lymph agents implicated factors associated with the heparin use in the THS procedure. We investigated if heparin itself was responsible for reported toxicity to human umbilical vein endothelial cells (HUVECs). HUVEC toxicity was not induced by lymph when alternate anti-coagulants (citrate and EDTA) were used in THS. HUVEC toxicity was induced by lymph after heparin but not saline or citrate injection into TSS and naïve animals and was dose dependent. Activities of both heparin-releasable lipases (lipoprotein (LPL) and hepatic (HL)) were detected in the plasma and lymph from THS and naïve animals receiving heparin but not citrate or saline. Lymph-induced HUVEC toxicity correlated with lymph lipase activities. Finally, incubation of HUVECs with purified LPL added to naïve lymph induced toxicity in vitro. These data show that heparin, not THS, is responsible for the reported lymph-mediated HUVEC toxicity through its release of lipases into the lymph. These findings can provide alternative explanations for several of the THS effects reported in the literature using heparin models thus necessitating a review of previous work in this field. PMID:21063238

Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels.

PubMed

Cunha, Burke A; Pherez, Francisco M; Alexiadis, Varvara; Gagos, Marios; Strollo, Stephanie

2010-01-01

Kawasaki's disease is a disease of unknown cause. The characteristic clinical features of Kawasaki's disease are fever> or =102 degrees F for> or =5 days accompanied by a bilateral bulbar conjunctivitis/conjunctival suffusion, erythematous rash, cervical adenopathy, pharyngeal erythema, and swelling of the dorsum of the hands/feet. Kawasaki's disease primarily affects children and is rare in adults. In children, Kawasaki's disease is more likely to be associated with aseptic meningitis, coronary artery aneurysms, and thrombocytosis. In adult Kawasaki's disease, unilateral cervical adenopathy, arthritis, conjunctival suffusion/conjunctivitis, and elevated serum transaminases (serum glutamic oxaloacetic transaminase [SGOT]/serum glutamate pyruvate transaminase [SGPT]) are more likely. Kawasaki's disease in adults may be mimicked by other acute infections with fever and rash, that is, group A streptococcal scarlet fever, toxic shock syndrome (TSS), and Rocky Mountain Spotted Fever (RMSF). Because there are no specific tests for Kawasaki's disease, diagnosis is based on clinical criteria and the syndromic approach. In addition to rash and fever, scarlet fever is characterized by circumoral pallor, oropharyngeal edema, Pastia's lines, and peripheral eosinophilia, but not conjunctival suffusion, splenomegaly, swelling of the dorsum of the hands/feet, thrombocytosis, or an elevated SGOT/SGPT. In TSS, in addition to rash and fever, there is conjunctival suffusion, oropharyngeal erythema, and edema of the dorsum of the hands/feet, an elevated SGOT/SGPT, and thrombocytopenia. Patients with TSS do not have cervical adenopathy or splenomegaly. RMSF presents with fever and a maculopapular rash that becomes petechial, first appearing on the wrists/ankles after 3 to 5 days. RMSF is accompanied by a prominent headache, periorbital edema, conjunctival suffusion, splenomegaly, thrombocytopenia, an elevated SGOT/SGPT, swelling of the dorsum of the hands/feet, but not oropharyngeal erythema. We present a case of adult Kawasaki's disease with myocarditis and splenomegaly. The patient's myocarditis rapidly resolved, and he did not develop coronary artery aneurysms. In addition to splenomegaly, this case of adult Kawasaki's disease is remarkable because the patient had highly elevated serum ferritin levels of 944-1303 ng/mL; (normal<189 ng/mL). To the best of our knowledge, this is the first report of adult Kawasaki's disease with highly elevated serum ferritin levels. This is also the first report of splenomegaly in adult Kawasaki's disease. We conclude that Kawasaki's disease should be considered in the differential diagnosis in adult patients with rash/fever for> or =5 days with conjunctival suffusion, cervical adenopathy, swelling of the dorsum of the hands/feet, thrombocytosis and otherwise unexplained highly elevated ferritin levels. Copyright 2010 Elsevier Inc. All rights reserved.

Novel Tissue Level Effects of the Staphylococcus aureus Enterotoxin Gene Cluster Are Essential for Infective Endocarditis.

PubMed

Stach, Christopher S; Vu, Bao G; Merriman, Joseph A; Herrera, Alfa; Cahill, Michael P; Schlievert, Patrick M; Salgado-Pabón, Wilmara

2016-01-01

Superantigens are indispensable virulence factors for Staphylococcus aureus in disease causation. Superantigens stimulate massive immune cell activation, leading to toxic shock syndrome (TSS) and contributing to other illnesses. However, superantigens differ in their capacities to induce body-wide effects. For many, their production, at least as tested in vitro, is not high enough to reach the circulation, or the proteins are not efficient in crossing epithelial and endothelial barriers, thus remaining within tissues or localized on mucosal surfaces where they exert only local effects. In this study, we address the role of TSS toxin-1 (TSST-1) and most importantly the enterotoxin gene cluster (egc) in infective endocarditis and sepsis, gaining insights into the body-wide versus local effects of superantigens. We examined S. aureus TSST-1 gene (tstH) and egc deletion strains in the rabbit model of infective endocarditis and sepsis. Importantly, we also assessed the ability of commercial human intravenous immunoglobulin (IVIG) plus vancomycin to alter the course of infective endocarditis and sepsis. TSST-1 contributed to infective endocarditis vegetations and lethal sepsis, while superantigens of the egc, a cluster with uncharacterized functions in S. aureus infections, promoted vegetation formation in infective endocarditis. IVIG plus vancomycin prevented lethality and stroke development in infective endocarditis and sepsis. Our studies support the local tissue effects of egc superantigens for establishment and progression of infective endocarditis providing evidence for their role in life-threatening illnesses. In contrast, TSST-1 contributes to both infective endocarditis and lethal sepsis. IVIG may be a useful adjunct therapy for infective endocarditis and sepsis.

Coronary artery dilatation in toxic shock-like syndrome: the Kawasaki disease shock syndrome.

PubMed

Yim, Deane; Ramsay, James; Kothari, Darshan; Burgner, David

2010-11-01

Kawasaki disease is a common systemic vasculitis of childhood that may result in life-threatening coronary artery abnormalities. Despite an overlap of clinical features with toxic shock syndrome, children with Kawasaki disease generally do not develop shock. We report two cases of older children who presented with a toxic shock-like illness, and were diagnosed with Kawasaki disease when coronary artery abnormalities were found on echocardiography, in keeping with the recently described 'Kawasaki disease shock syndrome'. Clinicians should consider Kawasaki disease in all children presenting with toxic shock and assess for coronary artery damage.

Streptococcus agalactiae toxic shock-like syndrome: two case reports and review of the literature.

PubMed

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

2013-01-01

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.

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

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

PubMed

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

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.

Fatal toxic shock syndrome from an intrauterine device.

PubMed

Klug, Cameron D; Keay, C Ryan; Ginde, Adit A

2009-11-01

Toxic shock syndrome is a rare toxin-mediated condition that can rapidly produce multiorgan failure and severe shock. Toxic shock syndrome has been previously recognized in various clinical situations relating to surgery, nasal packing, abscesses, burns, and most notably menstrual-related cases. This case report describes a previously healthy 33-year-old woman presenting to the emergency department with complaints of nausea, vomiting, and diarrhea; vital signs at triage were normal. Within hours, she developed shock and cardiopulmonary arrest. The patient met all 6 of the Centers for Disease Control and Prevention diagnostic criteria for toxic shock syndrome, and her intrauterine device grew out Staphylococcus aureus. To our knowledge, this is the first reported case in the medical literature of fatal toxic shock syndrome related to an intrauterine device.

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.

Streptococcal toxic shock syndrome following total thyroidectomy.

PubMed

Hung, J A Z; Rajeev, P

2013-10-01

Group A streptococcal toxic shock syndrome following clean surgery is a rare occurrence. Its incidence following thyroid surgery has not been described in the literature. We report on the presentation and management of severe streptococcal toxic shock syndrome following a total thyroidectomy for a multinodular goitre in a patient with Cowden syndrome. This report presents an overview of streptococcal toxic shock syndrome with a focus on the management issues to consider so as to improve patient outcome. All surgeons must maintain a high index of suspicion for this rare but dangerous entity.

Streptococcal toxic shock syndrome following total thyroidectomy

PubMed Central

Hung, J AZ

2013-01-01

Group A streptococcal toxic shock syndrome following clean surgery is a rare occurrence. Its incidence following thyroid surgery has not been described in the literature. We report on the presentation and management of severe streptococcal toxic shock syndrome following a total thyroidectomy for a multinodular goitre in a patient with Cowden syndrome. This report presents an overview of streptococcal toxic shock syndrome with a focus on the management issues to consider so as to improve patient outcome. All surgeons must maintain a high index of suspicion for this rare but dangerous entity. PMID:24112488

Streptococcal Toxic Shock syndrome.

PubMed

Krishna, Vidya; Sankaranarayan, Shuba; Sivaraman, Rajakumar Padur; Prabaharan, Krithika

2014-09-01

Streptococcal Toxic Shock syndrome (STSS) is a serious complication caused by exotoxins of Group A Streptococcus (GAS). It presents with fulminant shock and rash, is rapidly progressive with Multi-Organ Dysfunction Syndrome (MODS) and requires aggressive therapy with fluids, antibiotics and source control.

Disseminated viridians streptococcus (Streptococcus mitis) infection presenting with toxic shock-like syndrome.

PubMed

Intalapaporn, Poj; Wongcharoen, Sunee; Chinapha, Anongnart; Jariyasethpong, Tavatchai

2013-03-01

The authors report a case of a 35-year-old man with no known underlying disease who presented with fever, cellulitis with hemorrhagic blebs on the left leg, monoarthricular left knee arthritis, multiple organ failure and septic shock. His clinical syndrome was compatible with toxic shock syndrome and his blood grew alpha hemolytic (viridians) Streptococcus mitis. To our knowledge, there are few reported cases of toxic shock syndrome cause by Streptococcus mitis in immune-competent adults.

[Superantigens and toxic shock syndrome. A report of three cases treated with intravenous gammaglobulin].

PubMed

Vázquez García, Rubén Eduardo; Hernández Bautista, Víctor; Espinosa Padilla, Sara

2006-01-01

The superantigens cause a massive polyclonal activation of T-cells, producing an immense liberation of proinflamatory cytokines, which induces the clinical data of toxic shock syndrome. In international studies the administration of polyclonal intravenous gammaglobulin has been observed to diminish the mortality 50 to 20%. But at the present it has not been reported in Mexico the clinical effectiveness of this therapeutic modality in toxic shock syndrome. We report three cases of toxic shock syndrome treated with gammaglobulin intravenous, and we describe their favorable clinical evolution.

Toxic Shock Syndrome Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) After Expander-Based Breast Reconstruction.

PubMed

Suga, Hirotaka; Shiraishi, Tomohiro; Takushima, Akihiko; Harii, Kiyonori

2016-01-01

Toxic shock syndrome is a rare but life-threatening complication after plastic surgery procedures. We experienced 2 cases of toxic shock syndrome after expander-based breast reconstruction caused by methicillin-resistant Staphylococcus aureus. The first patient took a severe clinical course due to the delayed diagnosis and treatment, and the second patient recovered rapidly after the early diagnosis and treatment based on our experience of the first case. Fever, rash, and gastrointestinal symptoms (diarrhea and/or vomiting) were characteristic and important for the early diagnosis of toxic shock syndrome. Considering the increased prevalence of methicillin-resistant Staphylococcus aureus, we should suspect methicillin-resistant Staphylococcus aureus in cases of toxic shock syndrome that occur postoperatively, and the empiric administration of vancomycin should be initiated in such cases.

Toxic shock syndrome in a patient with systemic lupus erythematosus.

PubMed Central

Chan, R. M.; Graham, H. R.; Birmingham, C. L.

1983-01-01

A case is presented of toxic shock syndrome in a patient with systemic lupus erythematosus. Toxic shock syndrome is rarely reported in patients who are immunosuppressed, perhaps because such patients are often treated vigorously with antibiotics at the earliest sign of infection. The association in this case may have been coincidental. PMID:6640456

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

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

PubMed

Sendi, Parham; El Hay, Muad Abd; Brandt, Claudia M; Spellerberg, Barbara

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.

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

PubMed

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

2017-01-01

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. 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. 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.

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

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

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.

Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas.

PubMed

Saldarriaga, Carolina; Lyssikatos, Charlampos; Belyavskaya, Elena; Keil, Margaret; Chittiboina, Prashant; Sinaii, Ninet; Stratakis, Constantine A; Lodish, Maya

2018-04-01

To define the incidence and risk factors of postoperative sodium alterations in pediatric patients undergoing transsphenoidal surgery (TSS) for adrenocorticotropic hormone and growth hormone secreting pituitary adenomas. We retrospectively reviewed 160 patients ≤18 years of age who had TSS for pituitary adenomas at our institution from 1999 to 2017. Variables included daily serum sodium through postoperative day 10, urine specific gravity, and medications administered. We examined associations between sex, repeat surgery, manipulation of the posterior pituitary (PP), tumor invasion into the PP, tumor type and size, cerebrospinal fluid (CSF) leak, lumbar drain insertion, body mass index, puberty, and development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). Mean age was 12.9 ± 3.4 years (female = 81). Patients had adrenocorticotropic hormone (150/160) and growth hormone (10/160) producing adenomas. Forty-two (26%) patients developed DI. Among the 37 of 160 who required desmopressin acutely, 13 of 37 required it long term. Risk of long-term need for desmopressin was significantly higher in patients who had CSF leak 9 of 48 (P = .003), lumbar drain 6 of 30 (P = .019), manipulation 11 of 50 (P < .001), or invasion 4 of 15 (P = .022) of the PP. Sixty patients developed hyponatremia, 19 because of SIADH, 39 to hypotonic fluids and 2 to cerebral salt wasting syndrome. Patients with SIADH were placed on fluid restriction; 1 received salt tablets. Among 160 children who underwent TSS for pituitary adenomas, the incidence of DI and SIADH after TSS was 26% and 14%, respectively. Combined risk factors for DI and/or SIADH include female sex, manipulation of and/or tumor invasion into the PP, and CSF leak or lumbar drain. ClinicalTrials.gov: NCT00001595 and NCT00060541. Published by Elsevier Inc.

Knowledge of Toxic Shock Syndrome among Adolescent Females: A Need for Education.

ERIC Educational Resources Information Center

Witzig, Diane K.; Ostwald, Sharon K.

1985-01-01

Female high school students were surveyed to determine the relationship between choice of menstrual product and knowledge about toxic shock syndrome. Recommendations are offered for the development of toxic shock education programs. (Author/DF)

Recurrent menstrual toxic shock syndrome despite discontinuation of tampon use: is menstrual toxic shock syndrome really caused by tampons?

PubMed

Dixit, Shreya; Fischer, Gayle; Wittekind, Carola

2013-11-01

Menstrual toxic shock syndrome (MTSS) is a rare and potentially life-threatening illness. We present a case of recurrent MTSS initially associated with tampon use that continued to recur when tampons were discontinued, which was successfully treated with rifampicin and clindamycin. © 2012 The Authors Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.

Modulating the Biologic Activity of Mesenteric Lymph after Traumatic Shock Decreases Systemic Inflammation and End Organ Injury.

PubMed

Langness, Simone; Costantini, Todd W; Morishita, Koji; Eliceiri, Brian P; Coimbra, Raul

2016-01-01

Trauma/hemorrhagic shock (T/HS) causes the release of pro-inflammatory mediators into the mesenteric lymph (ML), triggering a systemic inflammatory response and acute lung injury (ALI). Direct and pharmacologic vagal nerve stimulation prevents gut barrier failure and alters the biologic activity of ML after injury. We hypothesize that treatment with a pharmacologic vagal agonist after T/HS would attenuate the biologic activity of ML and prevent ALI. ML was collected from male Sprague-Dawley rats after T/HS, trauma-sham shock (T/SS) or T/HS with administration of the pharmacologic vagal agonist CPSI-121. ML samples from each experimental group were injected into naïve mice to assess biologic activity. Blood samples were analyzed for changes in STAT3 phosphorylation (pSTAT3). Lung injury was characterized by histology, permeability and immune cell recruitment. T/HS lymph injected in naïve mice caused a systemic inflammatory response characterized by hypotension and increased circulating monocyte pSTAT3 activity. Injection of T/HS lymph also resulted in ALI, confirmed by histology, lung permeability and increased recruitment of pulmonary macrophages and neutrophils to lung parenchyma. CPSI-121 attenuated T/HS lymph-induced systemic inflammatory response and ALI with stable hemodynamics and similar monocyte pSTAT3 levels, lung histology, lung permeability and lung immune cell recruitment compared to animals injected with lymph from T/SS. Treatment with CPSI-121 after T/HS attenuated the biologic activity of the ML and decreased ALI. Given the superior clinical feasibility of utilizing a pharmacologic approach to vagal nerve stimulation, CPSI-121 is a potential treatment strategy to limit end organ dysfunction after injury.

Anaerobic treatment of wastewater with high suspended solids from a bulk drug industry using fixed film reactor (AFFR).

PubMed

Rao, A Gangagni; Naidu, G Venkata; Prasad, K Krishna; Rao, N Chandrasekhar; Mohan, S Venkata; Jetty, Annapurna; Sarma, P N

2004-07-01

Studies are carried out on the treatment of wastewater from a bulk drug industry using an anaerobic fixed film reactor (AFFR) designed and fabricated in the laboratory. The chemical oxygen demand (COD) and total dissolved solids (TDS) of the wastewater are found to be very high with low Biochemical oxygen demand (BOD) to COD ratio and high total suspended solid (TSS) concentration. Acclimatization of seed consortia and start up of the reactor is carried out by directly using the wastewater, which resulted in reducing the period of startup to 30 days. The reactor is studied at different organic loading rates (OLR) and it is found that the optimum OLR is 10 kg COD/m3/day. The wastewater under investigation, which is having considerable quantity of SS, is treated anaerobically without any pretreatment. The COD and BOD of the reactor outlet wastewater are monitored and reduction at steady state and optimum OLR is observed to be 60-70% of COD and 80-90% of BOD. The reactor is subjected to organic shock loads at two different OLR and it is observed that the reactor could withstand shocks and performance could be restored to normalcy at that OLR. The results obtained indicated that AFFR could be used efficiently for the treatment of wastewater from a bulk drug industry having high COD, TDS and TSS. Copyright 2003 Elsevier Ltd.

Anaerobic treatment of wastewater with high suspended solids from a bulk drug industry using fixed film reactor (AFFR).

PubMed

Gangagni Rao, A; Venkata Naidu, G; Krishna Prasad, K; Chandrasekhar Rao, N; Venkata Mohan, S; Jetty, Annapurna; Sarma, P N

2005-01-01

Studies were carried out on the treatment of wastewater from a bulk drug industry using an anaerobic fixed film reactor (AFFR) designed and fabricated in the laboratory. The chemical oxygen demand (COD) and total dissolved solids (TDS) of the wastewater were found to be very high with low biochemical oxygen demand (BOD) to COD ratio and high total suspended solid (TSS) concentration. Acclimatization of seed consortia and startup of the reactor was carried out by directly using the wastewater, which resulted in reducing the period of startup to 30 days. The reactor was studied at different organic loading rates (OLR) and it was found that the optimum OLR was 10 kg COD/m(3)/day. The wastewater under investigation, which had a considerable quantity of SS, was treated anaerobically without any pretreatment. COD and BOD of the reactor outlet wastewater were monitored and at steady state and optimum OLR 60-70% of COD and 80-90% of BOD were removed. The reactor was subjected to organic shock loads at two different OLR and the reaction could withstand the shocks and performance could be restored to normalcy at that OLR. The results obtained indicated that AFFR could be used efficiently for the treatment of wastewater from a bulk drug industry having high COD, TDS and TSS.

[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.

An Australian case of Streptococcus suis toxic shock syndrome associated with occupational exposure to animal carcasses.

PubMed

Tramontana, Adrian R; Graham, Maryza; Sinickas, Vincent; Bak, Narin

2008-05-05

Streptococcus suis is known to cause sporadic infections in people who have occupational exposure to pigs and pig meat. A large outbreak occurred in China in 2005, where there was 62% mortality among those who developed toxic shock syndrome. Despite S. suis being common in pigs, this is the first published report of a human case of S. suis toxic shock syndrome in Australia.

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.

[Staphylococcal toxic shock syndrome at a chronic hemodialysis].

PubMed

Alaoui, Hassan; Belhadj, Ayoub; Aissaoui, Younes; Seddiki, Rachid; Zoubir, Mohamed; Bougalem, Mohamed

2017-01-01

Staphylococcal toxic shock syndrome is an acute and systemic infectious syndrome associated with the super-antigenic activity of staphylococcal toxins. It is a pathology that is rather rare but remains burdened with a considerable mortality despite the therapeutic management. The gateway is usually cutaneous with secondary bacteremic spread could be subject to preventive measures. We report the case of a rapidly fatal staphylococcal toxic shock, developed in a chronic hemodialysis whose entry from the arteriovenous fistula was suspected.

Early and Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion of T-Cell-Receptor Vβ2-Positive T Cells

PubMed Central

Kato, Hidehito; Yamada, Ritsuko; Okano, Hiroya; Ohta, Hiroaki; Imanishi, Ken’ichi; Kikuchi, Ken; Totsuka, Kyouichi; Uchiyama, Takehiko

2003-01-01

We describe two cases of early toxic shock syndrome, caused by the superantigen produced from methicillin-resistant Staphylococcus aureus and diagnosed on the basis of an expansion of T-cell-receptor Vβ2-positive T cells. One case-patient showed atypical symptoms. Our results indicate that diagnostic systems incorporating laboratory techniques are essential for rapid, definitive diagnosis of toxic shock syndrome. PMID:12643839

Hypothermia in the sepsis syndrome and clinical outcome. The Methylprednisolone Severe Sepsis Study Group.

PubMed

Clemmer, T P; Fisher, C J; Bone, R C; Slotman, G J; Metz, C A; Thomas, F O

1992-10-01

To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock. Analysis of data from a multi-institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death. Multi-institutional medical and surgical ICUs. Patients meeting predetermined criteria for severe sepsis syndrome. Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo. The occurrence rate of hypothermia (< 35.5 degrees C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission. This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.

A Term Infant of Neonatal Toxic Shock Syndrome-Like Exanthematous Disease Complicated with Hemophagocytic Syndrome.

PubMed

Kaga, Akimune; Watanabe, Hiroshi; Miyabayashi, Hiroki; Metoki, Takaya; Kitaoka, Setsuko; Kumaki, Satoru

2016-10-01

Neonatal toxic shock syndrome-like exanthematous disease (NTED) is a newly recognized neonatal infectious disease, caused by the superantigen toxic shock syndrome toxin-1 (TSST-1). TSST-1 is mainly produced by methicillin-resistant Staphylococcus aureus, and the immune responses to TSST-1 are known to cause toxic shock syndrome, a life-threatening infectious disease. The clinical symptoms of NTED are skin rash, fever, and thrombocytopenia, but severe thrombocytopenia is rare in term infants with NTED. Although the cause of NTED is the same as that of toxic shock syndrome, the clinical symptoms of NTED are milder than toxic shock syndrome. The mild phenotype of NTED has been explained by selectively elevated serum levels of anti-inflammatory cytokine interleukin (IL)-10, which suppress immune responses to TSST-1. In the present study, we report a term female infant of NTED complicated with hemophagocytic syndrome (HPS). HPS is characterized by systemic inflammation and hemophagocytosis, caused by uncontrolled activation of T cells and macrophages. The serum IL-10 level of the patient at 4 days of age was relatively low (67 pg/mL) for NTED but still higher than normal controls (< 2.0 pg/mL). The patient also showed severe thrombocytopenia. We speculate that the serum IL-10 level of the patient was enough to supress immune responses to TSST-1, thereby resulting in NTED, but not enough to suppress the onset of HPS. This is the first reported case of NTED complicated with HPS. If a physician encounters an NTED patient with severe cytopenia, microscopic examination of peripheral blood smear should be carried out to exclude HPS.

Fatal streptococcal toxic shock syndrome from an intrauterine device.

PubMed

Cho, Elizabeth E; Fernando, Dinali

2013-04-01

The occurrence of toxic shock syndrome from an intrauterine device (IUD) is very rare. To raise awareness of the risk of toxic shock syndrome caused by an IUD, to educate others about when to suspect this complication, and to provide treatment recommendations. A 49-year-old woman presented to the Emergency Department in septic shock after complaining of 5 days of nausea, vomiting, and diarrhea. Physical examination findings included a diffusely tender and rigid abdomen with free fluid on bedside sonogram. She was found, on computed tomography of her abdomen and pelvis, to have an IUD with moderate ascites. The IUD was removed, and both her IUD and her blood cultures grew out group A Streptococcus. Despite aggressive medical management, which included multiple vasopressors and broad-spectrum antibiotics, she died from group A streptococcal sepsis, with the IUD as her most likely source. Her clinical presentation and laboratory findings meet the Centers for Disease Control and Prevention diagnostic criteria for streptococcal toxic shock syndrome. Her diagnosis was confirmed by autopsy. IUDs should be considered as a possible source of infection in patients with an IUD who present with symptoms consistent with toxic shock syndrome. These patients need to be aggressively managed with early surgical intervention. Copyright © 2013. Published by Elsevier Inc.

Similar Metabolic, Innate Immunity, and Adipokine Profiles in Adult and Pediatric Sepsis Versus Systemic Inflammatory Response Syndrome-A Pilot Study.

PubMed

Tavladaki, Theonymfi; Spanaki, Anna Maria; Dimitriou, Helen; Kondili, Efmorfia; Choulaki, Christianna; Georgopoulos, Dimitris; Briassoulis, George

2017-11-01

To examine whether the septic profiles of heat shock protein 72, heat shock protein 90α, resistin, adiponectin, oxygen consumption, CO2 production, energy expenditure, and metabolic pattern, along with illness severity, nutritional, and inflammatory indices, differ between adult and pediatric patients compared with systemic inflammatory response syndrome and healthy controls. To evaluate whether these biomolecules may discriminate sepsis from systemic inflammatory response syndrome in adult and pediatric patients. Prospective cohort study. University ICU and PICU. Seventy-eight adults (sepsis/23; systemic inflammatory response syndrome/23; healthy controls/33), 67 children (sepsis/18; systemic inflammatory response syndrome/23; controls/27), mechanically ventilated. None. Flow cytometry determined mean fluorescence intensity for monocyte or neutrophil heat shock protein expression. Resistin, adiponectin, and extracellular heat shock proteins were measured using enzyme-linked immunosorbent assay; energy expenditure by E-COVX (GE Healthcare). Genomic DNA was extracted with PureLink Genomic DNA kit (Invitrogen, Carlsbad, CA) to detect heat shock protein 72 single nucleotide polymorphisms. Similarly, in adult and pediatric patients, Acute Physiology and Chronic Evaluation-II/Acute Physiology and Pediatric Risk of Mortality-III, Simplified Acute Physiology Score-III, C-reactive protein, lactate, and resistin were higher and myocardial contractility, monocyte heat shock protein 72, oxygen consumption, CO2 production, energy expenditure, metabolic pattern, glucose, and albumin lower in sepsis compared with systemic inflammatory response syndrome or controls (p < 0.05). For discriminating sepsis from systemic inflammatory response syndrome, resistin, extracellular heat shock protein 90α, and lactate achieved a receiver operating characteristic curve greater than 0.80 in children and greater than 0.75 in adults (p < 0.05). In both, adults and children, genotype heat shock protein 72 analysis did not disclose any diagnosis or mortality group differences regarding either rs6457452 or rs1061581 haplotypes. Sepsis presents with similar profiles in adult and pediatric patients, characterized by enhanced inflammatory hormonal response and by repressed innate immunity, metabolism, and myocardial contractility. These features early distinguish sepsis from systemic inflammatory response syndrome across all age groups.

Use of porcine vaginal tissue ex-vivo to model environmental effects on vaginal mucosa to toxic shock syndrome toxin-1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Davis, Catherine C.; Baccam, Mekhine; Mantz, Mary J.

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 determinedmore » 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. • Surfactants increased penetration of tracers across vaginal mucosa. • Alpha-hemolysin increased the penetration of bacterial toxin across vaginal mucosa.« less

In-Hospital Quality-of-Care Measures for Pediatric Sepsis Syndrome.

PubMed

Odetola, Folafoluwa O; Freed, Gary; Shevrin, Caroline; Madden, Brian; McCormick, Julie; Dombkowski, Kevin

2017-07-24

Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome. Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts. The measures were tested for reliability and validity among children 0 to 18 years of age hospitalized with sepsis syndrome from January 1, 2012, to June 30, 2013. Of 27 hospitals, 59% had no protocol for the identification and treatment of pediatric sepsis syndrome. Blood culture was performed in only 70% of patients with pediatric sepsis syndrome. Antibiotics were administered within 1 hour of diagnosis in 70% of patients with pediatric severe sepsis or septic shock, and timely fluid resuscitation was performed in 50% of patients with severe sepsis or septic shock. Documentation of heart rate during fluid resuscitation of children with severe sepsis or septic shock was observed in 18% of cases. Two measures could not be rigorously tested for validity and reliability given the rarity of septic shock and were deemed infeasible. This multisite study to develop and validate measures of the quality of hospital care of children with sepsis syndrome highlights the existence of important gaps in delivery of care. Copyright © 2017 by the American Academy of Pediatrics.

Gynecology: select topics.

PubMed

Sidani, Mohamad; Campbell, James

2002-06-01

Menopause, premenstrual syndrome, dysmenorrhea, female fertility, and mastalgia are common problems not easily treated by conventional medicine. Women often seek alternative therapies to help address these conditions. Some evidence points to the efficacy of black cohosh, exercise, and possibly Kava and St. John's wort, in the treatment of menopausal symptoms. Clinical trials indicate that symptoms of premenstrual syndrome may be alleviated with calcium, magnesium, vitamin E. Thiamine, omega-3 fatty acids, the Japanese herbal concoction, TSS, and calcium have proved useful in treating women with dysmenorrhea. Symptoms of mastalgia may be attenuated by evening primrose oil, chaste tree and flaxseed oil may be helpful.

Toxic shock syndrome due to community-acquired methicillin-resistant Staphylococcus aureus infection: Two case reports and a literature review in Japan.

PubMed

Sada, Ryuichi; Fukuda, Saori; Ishimaru, Hiroyasu

2017-01-01

Community-acquired methicillin-resistant Staphylococcus aureus has been spreading worldwide, including in Japan. However, few cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus have been reported in Japan. We report 2 cases, in middle-aged women, of toxic shock syndrome due to Community-acquired methicillin-resistant Staphylococcus aureus via a vaginal portal of entry. The first patient had used a tampon and the second patient had vaginitis due to a cleft narrowing associated with vulvar lichen sclerosus. Both patients were admitted to our hospital with septic shock and severe acute kidney injury and subsequently recovered with appropriate antibiotic treatment. In our review of the literature, 8 cases of toxic shock syndrome caused by Community-acquired methicillin-resistant Staphylococcus aureus were reported in Japan. In these 8 cases, the main portals of entry were the skin and respiratory tract; however, the portal of entry of Community-acquired methicillin-resistant Staphylococcus aureus from a vaginal lesion has not been reported in Japan previously.

[An rare complication of scarlet fever : invasive group A streptococcal infection with streptococcal toxic shock syndrome].

PubMed

Warnier, H; Depuis, Z; Nyamugabo, K; Desprechins, B; Seghaye, M-C

2017-03-01

Invasive Group A Streptococcus infections and streptococcal toxic shock syndrome are rare complications of common diseases in children such as scarlet fever or impetigo. These invasive diseases are particulary challenging because of their rapid progression and the lack of predisposing factors in most cases. Prompt diagnosis and treatment are mandatory to reduce the mortality associated with these severe diseases. We report the case of an 8- year-old girl who developped an invasive group A streptococcal disease with osteomyelitis and streptococcal toxic shock syndrome in the course of a classical scarlet fever.

Intractable bone marrow edema syndrome of the hip.

PubMed

Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji

2015-04-01

There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches. Copyright 2015, SLACK Incorporated.

Update: Toxic Shock Syndrome.

ERIC Educational Resources Information Center

Price, James H.

1981-01-01

School health professionals can help reduce the incidence of Toxic Shock Syndrome by suggesting that women not use tampons continuously during menses and that tampons should not be left in place for long periods of time. Tampons should be changed every few hours and used intermittently with pads. (JN)

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

PubMed

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

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. 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. The patient was diagnosed with streptococcal toxic shock syndrome due to an ascending GAS infection originating from vagina.

ICA Occlusion by an ACTH-secreting pituitary adenoma post-TSS and irradiation

PubMed Central

El-Zammar, Diala; Akagami, Ryojo

2011-01-01

Occlusion of intracranial arteries by a pituitary adenoma with ensuing infarction is a rare occurrence. In this case study, we show the instance of a pituitary macroadenoma and apoplexy causing mechanical obstruction of the internal carotid artery with consequent infarction following transphenoidal surgery (TSS) and radiation therapy in a patient with Cushing's disease. We report a 44-year-old woman presented with amenorrhea and headaches. Necessary investigations, resection by TSS, and microscopic examination revealed an adenocorticotropin (ACTH)-secreting pituitary macroadenoma. The pituitary tumour recurred in subsequent years, resulting in the development of Cushing's disease and syndrome. Despite two more transphenoidal surgeries, radiotherapy, and medical suppressive therapy, the pituitary adenoma continued to enlarge, and the hypercortisolemia and Cushingoid symptoms persisted. A craniotomy was arranged as the next step in the treatment strategy. Only hours prior to the scheduled surgery, the patient developed left-sided hemiplegia, was diagnosed with acute occlusion of the right ICA and underwent an emergency bifrontal craniotomy with evacuation of the tumour and decompression. Pathological examination revealed evidence of apoplexy in the ACTH-secreting pituitary adenoma. This case demonstrates the vast scope of complications that can arise from pituitary adenomas despite combination therapy and forewarns clinicians to be prepared to manage these infrequent but conceivable occurrences. PMID:22399870

Sequence of the toxic shock syndrome toxin gene (tstH) borne by strains of Staphylococcus aureus isolated from patients with Kawasaki syndrome.

PubMed Central

Deresiewicz, R L; Flaxenburg, J; Leng, K; Kasper, D L

1996-01-01

To explore whether a novel staphylococcal clone or structural variant of toxic shock syndrome toxin 1 is associated with Kawasaki syndrome, six toxigenic strains of Staphylococcus aureus from Kawasaki syndrome patients were studied. The strains were divisible into two groups based on phenotypic and genotypic characteristics and are therefore unequivocally not clonal. Portions of the tstH genes of each strain were sequenced. Three were sequenced in their entirety, while the remainder were sequenced from codon 66 to codon 137 of the mature protein only. Two of the former group differed slightly in the sequences of their signal peptides relative to the sequence published for the tstH signal peptide. Those differences did not affect toxin processing or secretion. The sequenced portions of the regions encoding mature toxic shock syndrome toxin 1 were identical in all six strains and corresponded exactly to the published sequence of tstH. No evidence was found for the existence of a structural variant of tstH uniquely associated with Kawasaki syndrome. PMID:8757881

International Conference on Computing Methods in Applied Sciences and Engineering (9th) Held in Paris, France on 29 January-2 February 1990

DTIC Science & Technology

1990-02-02

National Aero-Space Plane NTC no time counter TSS-2 Tethered Satellite System - 2 VHS variable hard sphere VSL viscous shock-layer Introduction With...required at each time step to evaluate the mass fractions Yi+’ it is shown in [21] that the matrix of this linear system is an M-matrix (see e.g. [42]), and...first rewrite system (4.7)- (4.8) under the following form, separating the time -dependent, convective, diffusive and reactive terms: VW’ + F(W)r + G(,W

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.

Severe group A streptococcal infection and streptococcal toxic shock syndrome.

PubMed

Baxter, F; McChesney, J

2000-11-01

To review the literature on group A streptococcal toxic shock syndrome, (STSS). Medline and EMBASE searches were conducted using the key words group A streptococcal toxic shock syndrome, alone and in combination with anesthesia; and septic shock, combined with anesthesia. Medline was also searched using key words intravenous immunoglobulin, (IVIG) and group A streptococcus, (GAS); and group A streptococcus and antibiotic therapy. Other references were included in this review if they addressed the history, microbiology, pathophysiology, incidence, mortality, presentation and management of invasive GAS infections. Relevant references from the papers reviewed were also considered. Articles on the foregoing topics were included regardless of study design. Non-English language studies were excluded. Literature on the efficacy of IVIG and optimal antibiotic therapy was specifically searched. Reports of invasive GAS infections have recently increased. Invasive GAS infection is associated with a toxic shock syndrome, (STSS), in 8-14% of cases. The STSS characteristically results in shock and multi-organ failure soon after the onset of symptoms, and is associated with a mortality of 33-81%. Many of these patients will require extensive soft tissue debridement or amputation in the operating room, on an emergency basis. The extent of tissue debridement required is often underestimated before skin incision. Management of STSS requires volume resuscitation, vasopressor/inotrope infusion, antibiotic therapy and supportive care in an intensive care unit, usually including mechanical ventilation. Intravenous immunoglobulin infusion has been recommended. Further studies are needed to define the role of IVIG in STSS management and to determine optimal anesthetic management of patients with septic shock.

Triggering Receptor Expressed on Myeloid Cells-1 Signaling: Protective and Pathogenic Roles on Streptococcal Toxic-Shock-Like Syndrome Caused by Streptococcus suis.

PubMed

Han, Li; Fu, Lei; Peng, Yongbo; Zhang, Anding

2018-01-01

Streptococcus suis infections can cause septic shock, which is referred to as streptococcal toxic-shock-like syndrome (STSLS). The disease is characterized by a severe inflammatory response, multiple organ failure, and high mortality. However, no superantigen that is responsible for toxic shock syndrome was detected in S. suis , indicating that the mechanism underlying STSLS is different and remains to be elucidated. Triggering receptor expressed on myeloid cells-1 (TREM-1), belonging to the Ig superfamily, is an activating receptor expressed on myeloid cells, and has been recognized as a critical immunomodulator in several inflammatory diseases of both infectious and non-infectious etiologies. In this review, we discuss the current understanding of the immunoregulatory functions of TREM-1 on acute infectious diseases and then highlight the crucial roles of TREM-1 on the development of STSLS.

Refined structures of three crystal forms of toxic shock syndrome toxin-1 and of a tetramutant with reduced activity.

PubMed Central

Prasad, G. S.; Radhakrishnan, R.; Mitchell, D. T.; Earhart, C. A.; Dinges, M. M.; Cook, W. J.; Schlievert, P. M.; Ohlendorf, D. H.

1997-01-01

The structure of toxic shock syndrome toxin-1 (TSST-1), the causative agent in toxic shock syndrome, has been determined in three crystal forms. The three structural models have been refined to R-factors of 0.154, 0.150, and 0.198 at resolutions of 2.05 A, 2.90 A, and 2.75 A, respectively. One crystal form of TSST-1 contains a zinc ion bound between two symmetry-related molecules. Although not required for biological activity, zinc dramatically potentiates the mitogenicity of TSST-1 at very low concentrations. In addition, the structure of the tetramutant TSST-1H [T69I, Y80W, E132K, I140T], which is nonmitogenic and does not amplify endotoxin shock, has been determined and refined in a fourth crystal form (R-factor = 0.173 to 1.9 A resolution). PMID:9194182

Awareness, Knowledge and Perceived Risk for Toxic Shock Syndrome in Relation to Health Behavior.

ERIC Educational Resources Information Center

Riggs, Richard S.; Noland, Melody Powers

1983-01-01

A study of how female college students' behavior was affected by their awareness, knowledge, and perception of the risk of toxic shock syndrome shows that about 21 percent of those interviewed bought different products after learning of the disease. Implications for health education are drawn. (Authors/PP)

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

PubMed

Baxter, Melissa; 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.

Incidence of adrenal insufficiency and impact of corticosteroid supplementation in critically ill children with systemic inflammatory syndrome and vasopressor-dependent shock.

PubMed

Hebbar, Kiran B; Stockwell, Jana A; Leong, Traci; Fortenberry, James D

2011-05-01

Adrenal insufficiency may be common in adults and children with vasopressor-resistant shock. We developed a protocolized approach to low-dose adrenocorticotropin testing and empirical low-dose glucocorticoid/mineralocorticoid supplementation in children with systemic inflammatory response syndrome and persistent hypotension following fluid resuscitation and vasopressor infusion. We hypothesized that absolute and relative adrenal insufficiency was common in children with systemic inflammatory response syndrome requiring vasopressor support and that steroid administration would be associated with decreased vasopressor need. Retrospective review of pediatric patients with systemic inflammatory response syndrome and vasopressor-dependent shock receiving protocol-based adrenocorticotropin testing and low-dose steroid supplementation. The incidence of absolute and relative adrenal insufficiency was determined using several definitions. Vasopressor dose requirements were evaluated before, and following, initiation of corticosteroids. Seventy-eight patients met inclusion criteria for systemic inflammatory response syndrome and shock; 40 had septic shock. Median age was 84 months (range, 0.5-295). By adrenocorticotropin testing, 44 (56%) had absolute adrenal insufficiency, 39 (50%) had relative adrenal insufficiency, and 69 (88%) had either form of adrenal insufficiency. Adrenal insufficiency incidence was significantly higher in children >2 yrs (p = .0209). Therapeutic interventions included median 80-mL/kg fluid resuscitation; 65% of patients required dopamine, 58% norepinephrine, and 49% dopamine plus norepinephrine. With steroid supplementation, median dopamine dose decreased from 10 to 4 μg/kg/min at 4 hrs (p = .0001), and median dose of norepinephrine decreased from 0.175 μg/kg/min to 0.05 μg/kg/min at 4 hrs (p = .039). Absolute and relative adrenal insufficiency was prevalent in this cohort of children with systemic inflammatory response syndrome and vasopressor-dependent shock and increased with age. Introduction of steroids produced a significant reduction in vasopressor duration and dosage. Use of low-dose adrenocorticotropin testing may help further delineate populations who require steroid supplementation.

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-related cardiogenic shock and may help therapeutic decision making in these patients.

Fulminant streptococcal toxic shock syndrome.

PubMed

Zavala, S; Arias, M; Legua, P

2018-03-01

We present a case of a previously healthy 37-year-old male who developed fever, nausea, vomiting, diarrhoea, and hypovolaemia. Within 5.5 h he presented with tachycardia, tachypnoea, became hypotensive and displayed a diffuse erythematous rash. In the following hours he developed persistent hypotension, acute respiratory distress syndrome, liver failure, kidney failure and disseminated intravascular coagulation. A diagnosis of toxic shock syndrome was made, but despite antibiotic therapy, immunoglobulin administration, and supportive measures, the patient died 50 h after presentation. Streptococcus pyogenes was isolated from blood cultures.

Toxic Shock Syndrome within 24 H of an Office Hysteroscopy.

PubMed

Bhagat, Nanak; Karthikeyan, Akilandeshwari; Kalkur, Sanjaya

2017-01-01

Office hysteroscopy is now a common procedure performed to look at the endometrial cavity and is relatively free of serious complications. A 68-year-old lady, previously fit and well, presented with abdominal pain, rigors, sweats, and vomiting within 24 h of an outpatient hysteroscopy for postmenopausal bleeding. She was diagnosed with streptococcal toxic shock syndrome (STSS) due to Group A beta-hemolytic streptococci. She was managed in the Intensive Care Unit, with inotropic and antibiotic support. She recovered eventually and was discharged home with oral antibiotics. Toxic shock syndrome due to Streptococci is an unusual occurrence, whose incidence has been slowly increasing over the years. However, this appears to be the first case of STSS manifesting within 24 h following an outpatient hysteroscopy.

Transcription Start Site Evolution in Drosophila

PubMed Central

Main, Bradley J.; Smith, Andrew D.; Jang, Hyosik; Nuzhdin, Sergey V.

2013-01-01

Transcription start site (TSS) evolution remains largely undescribed in Drosophila, likely due to limited annotations in non-melanogaster species. In this study, we introduce a concise new method that selectively sequences from the 5′-end of mRNA and used it to identify TSS in four Drosophila species, including Drosophila melanogaster, D. simulans, D. sechellia, and D. pseudoobscura. For verification, we compared our results in D. melanogaster with known annotations, published 5′-rapid amplification of cDNA ends data, and with RNAseq from the same mRNA pool. Then, we paired 2,849 D. melanogaster TSS with its closest equivalent TSS in each species (likely to be its true ortholog) using the available multiple sequence alignments. Most of the D. melanogaster TSSs were successfully paired with an ortholog in each species (83%, 86%, and 55% for D. simulans, D. sechellia, and D. pseudoobscura, respectively). On the basis of the number and distribution of reads mapped at each TSS, we also estimated promoter-specific expression (PSE) and TSS peak shape, respectively. Among paired TSS orthologs, the location and promoter activity were largely conserved. TSS location appears important as PSE, and TSS peak shape was more frequently divergent among TSS that had moved. Unpaired TSS were surprisingly common in D. pseudoobscura. An increased mutation rate upstream of TSS might explain this pattern. We found an enrichment of ribosomal protein genes among diverged TSS, suggesting that TSS evolution is not uniform across the genome. PMID:23649539

Evaluation of streptococcal toxic shock-like syndrome caused by group B streptococcus in adults in Japan between 2009 and 2013.

PubMed

Ikebe, Tadayoshi; Chiba, Kazuki; Shima, Tomoko; Masuda, Chieko; Okuno, Rumi; Ohya, Hitomi; Ogata, Kikuyo; Katsukawa, Chihiro; Kawahara, Ryuji; Tominaga, Kiyoshi; Yabata, Junko; Tada, Yuki; Okabe, Nobuhiko; Watanabe, Haruo; Chang, Bin; Ogawa, Michinaga; Ohnishi, Makoto

2015-03-01

Infection with Streptococcus agalactiae has long been recognized in infants. In recent years, S. agalactiae is an important cause of morbidity and mortality among adults and among those with underlying medical condition. Several cases of GBS infection and more fulminant disease similar to streptococcal toxic shock syndrome have recently been reported. We report here that 19 S. agalactiae strains were isolated from streptococcal toxic shock-like syndrome cases involving adult patients in Japan between 2009 and 2013. The average age of the patients was 66.3 years. At least one underlying disease was present in 47.4% (9/19) of the patients. The most prevalent serotype among these strains was Ib. All serotype Ib strains belonged to clonal complex 10 and were ciprofloxacin resistant. In contrast, all strains were susceptible to penicillin G, ampicillin, cefazolin, cefotaxime, imipenem, panipenem, and linezolid. The characteristic type distributions of streptococcal toxic shock-like syndrome isolates differed between isolates obtained from vaginal swabs of women and infants with invasive infections. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Influence of total soluble salt concentration on growth and elemental concentration of winged bean seedlings, Psophocarpus tetragonolobus (L. ) DC

DOE Office of Scientific and Technical Information (OSTI.GOV)

Csizinszky, A.A.

Winged bean (Psophocarpus tetragonolobus) (L.) DC) seedlings of the accession TPT-1, were grown in a greenhouse with graded, balanced total soluble salt (TSS) concentrations. After 45 days, plant height increased quadratically, with a maximum (149 cm) at 3000 ppm TSS. Seedlings were shortest at 1000 and 10,000 ppm TSS, 44.0 and 79.0 cm, respectively. Fresh weight of shoots increased quadratically with greatest weight, 29.03 g, at 5000 ppm TSS. Percent dry matter increased linearly with increasing TSS. Concentration of N, K and P increased quadratically with an increase in the TSS concentration in the growth medium. Concentration of Ca decreasedmore » quadratically with increasing TSS. Among the micronutrients, Fe and Mo concentration was quadratic, both elements were highest in the seedlings at 1000 and 10,000 ppm TSS rates. Concentrations of Mn and Zn increased linearly with increasing TSS. Winged bean seedlings at the 1000 to 3000 ppm TSS rates had spindly stems and a sparse, yellow foliage, typical for winged bean seedlings observed in the field during the first 4 to 5 weeks of growth. Seedlings at the 4000 and 5000 ppm TSS rates had sturdy stems and an abundant green foliage. At higher TSS concentrations, 5000 to 10,000 ppm TSS, seedlings had short intermodes and dark green foliage.« less

Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol--United States and Canada, 2001-2005.

PubMed

2005-07-29

On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol. Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada. All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome.

Drug rash, eosinophilia, and systemic symptoms syndrome: Two pediatric cases demonstrating the range of severity in presentation--A case of vancomycin-induced drug hypersensitivity mimicking toxic shock syndrome and a milder case induced by minocycline.

PubMed

Vinson, Amy E; Dufort, Elizabeth M; Willis, Matthew D; Eberson, Craig P; Harwell, Joseph I

2010-07-01

Drug rash, eosinophilia, and systemic symptoms syndrome is a type of drug hypersensitivity reaction characterized by the clinical triad of skin eruption, fever, and internal organ involvement. Drug rash, eosinophilia, and systemic symptoms syndrome has rarely been reported in association with vancomycin or in the pediatric population. There have only been four pediatric case reports of drug rash, eosinophilia, and systemic symptoms syndrome and three cases of drug rash, eosinophilia, and systemic symptoms syndrome involving vancomycin published in the English literature to date. We describe two pediatric cases of drug rash, eosinophilia, and systemic symptoms syndrome to illustrate the range in severity of presentation. The first case illustrates drug rash, eosinophilia, and systemic symptoms syndrome associated with vancomycin exposure in a 14-yr-old boy with Duchenne muscular dystrophy after posterior spinal fusion, whose clinical presentation was indistinguishable from toxic shock syndrome. The second case illustrates a milder and more typical presentation of drug rash, eosinophilia, and systemic symptoms syndrome in a 14-yr-old boy being treated with minocycline for acne. We also present a review of the literature relevant to this syndrome. : Drug rash, eosinophilia, and systemic symptoms syndrome is relatively unknown among general pediatricians and pediatric intensivists and may potentially become more common with the increasing use of long-term medications in the pediatric population. Our cases demonstrate the importance of an awareness of drug rash, eosinophilia, and systemic symptoms syndrome among general pediatricians and pediatric intensivists because drug rash, eosinophilia, and systemic symptoms syndrome may present in any range of severity, from indolent illness to frank and refractory shock.

Skin test performed with highly purified Mycobacterium tuberculosis recombinant protein triggers tuberculin shock in infected guinea pigs.

PubMed

Reece, Stephen T; Stride, Nicole; Ovendale, Pamela; Reed, Steven G; Campos-Neto, Antonio

2005-06-01

Tuberculin shock due to inoculation of Mycobacterium tuberculosis antigens in patients with tuberculosis is a serious syndrome originally described over 100 years ago by Robert Koch. Here, we present experimental evidence that a single M. tuberculosis recombinant protein, CFP-10, triggers this syndrome. Intradermal inoculation of CFP-10 elicits in M. tuberculosis-infected mice high levels of serum tumor necrosis factor alpha and causes tuberculin shock in infected guinea pigs characterized by hypothermia and death within 6 to 48 h after the antigen inoculation. Autopsies of these animals revealed intense polycythemia and hemorrhagic patches in the lung parenchyma, a pathological observation consistent with tuberculin shock. These results point to the possible occurrence of tuberculin shock in sensitive individuals inoculated with highly purified M. tuberculosis recombinant proteins as vaccine candidates or skin test reagents.

Morbidity in pediatric burns, toxic shock syndrome, and antibiotic prophylaxis: a retrospective comparative study.

PubMed

Mulgrew, Stephen; Khoo, Anna; Cartwright, Rufus; Reynolds, Nick

2014-01-01

The prophylactic use of antibiotic for pediatric burns has been suggested as a possible means of reduction of toxic shock syndrome. In our study, we review 1250 burn cases during a 16-year period (1983-1999). There was a change in protocol during this period (after 1991, all pediatric burn received prophylactic antibiotics irrespective of presentation), thus creating 2 groups: our control who received antibiotics when clinically necessary and our cases who received antibiotics as routine prophylaxis. Our results show no statistical difference between the 2 groups both in signs of morbidity and signs of potential toxic shock syndrome. We conclude that prophylactic antibiotic use is unnecessary and the use of antibiotics should be guided on a case by case basis according to symptoms.

Mild forms of toxic shock syndrome toxin-1-mediated exanthematous disease related to Staphylococcus aureus infection.

PubMed

Moriguchi, Naohiko; Kano, Tomowa; Yoshimatsu, Yutaka; Yanagida, Hidehiko

2016-08-01

The present report describes three patients with toxic shock syndrome toxin (TSST)-1-associated exanthematous disease. In all patients, fever and systemic erythema without hemodynamic disturbance occurred following cellulitis of the lower limbs. At the site of infection, TSST-1 producing Methicillin-susceptible Staphylococcus aureus was detected. They defervesced and erythema resolved in response to administration of an antimicrobial drug, thereby avoiding severe illness. These patients did not meet the criteria for a clinical diagnosis of toxic shock syndrome. Measurement of T-cell receptor Vβ2-positive T cells in the peripheral blood early after onset of symptoms was useful for diagnosis. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Survey of Genes Encoding Staphylococcal Enterotoxins, Toxic Shock Syndrome Toxin 1, and Exfoliative Toxins in Members of the Staphylococcus sciuri Group

PubMed Central

Dakić, Ivana; Vuković, Dragana; Stepanović, Srdjan; Hauschild, Tomasz; Ježek, Petr; Petráš, Petr; Morrison, Donald

2005-01-01

Genes encoding staphylococcal enterotoxins (sea to see, seg, and seh), toxic shock syndrome toxin 1 (tst), and exfoliative toxins (eta and etb) were not detected in a large panel of 48 Staphylococcus sciuri group isolates tested. This strongly suggests that production of the staphylococcal exotoxins by these bacteria is highly unlikely. PMID:16145164

Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma*#

PubMed Central

Dai, Jin; Chen, Shen-jie; Yang, Bing-sheng; Lü, Shu-min; Zhu, Min; Xu, Yi-fei; Chen, Jie; Cai, Hong-wen; Mao, Wei

2017-01-01

Pheochromocytoma is a rare neuroendocrine tumor which derives from chromaffin cells of the adrenal gland or relevant to sympathetic nerves and ganglia. The clinical features of pheochromocytoma are various. Paroxysmal episodes of serious hypertension, headache, palpitation, and diaphoresis are the typical manifestations (Bravo, 2004). Hypotension shock, pulmonary edema, and acute coronary syndrome induced by pheochromocytoma are uncommon (Malindretos et al., 2008; Batisse-Lignier et al., 2015). In this study, we present a rare case of cystic pheochromocytoma causing recurrent hypotension shock, non-cardiogenic pulmonary edema, and acute coronary syndrome, and the possible mechanisms are discussed. PMID:28471119

Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma.

PubMed

Dai, Jin; Chen, Shen-Jie; Yang, Bing-Sheng; Lü, Shu-Min; Zhu, Min; Xu, Yi-Fei; Chen, Jie; Cai, Hong-Wen; Mao, Wei

2017-05-01

Pheochromocytoma is a rare neuroendocrine tumor which derives from chromaffin cells of the adrenal gland or relevant to sympathetic nerves and ganglia. The clinical features of pheochromocytoma are various. Paroxysmal episodes of serious hypertension, headache, palpitation, and diaphoresis are the typical manifestations (Bravo, 2004). Hypotension shock, pulmonary edema, and acute coronary syndrome induced by pheochromocytoma are uncommon (Malindretos et al., 2008; Batisse-Lignier et al., 2015). In this study, we present a rare case of cystic pheochromocytoma causing recurrent hypotension shock, non-cardiogenic pulmonary edema, and acute coronary syndrome, and the possible mechanisms are discussed.

Differential Effects of Inescapable Stress on Locus Coeruleus GRK3, Alpha2-Adrenoceptor and CRF1 Receptor Levels in Learned Helpless and Non-Helpless Rats: A potential link to stress resilience

PubMed Central

Taneja, Manish; Salim, Samina; Saha, Kaustuv; Happe, H. Kevin; Qutna, Nidal; Petty, Frederick; Bylund, David B.; Eikenburg, Douglas C.

2011-01-01

Exposure of rats to unpredictable, inescapable stress results in two distinct behaviors during subsequent escape testing. One behavior, suggestive of lack of stress resilience, is prolonged escape latency compared to non-stressed rats and is labeled learned helplessness (LH). The other behavior suggestive of stress resilience is normal escape latency and is labeled non-helpless (NH). This study examines the effects of unpredictable, inescapable tail-shock stress (TSS) on alpha2-adrenoceptor (α2-AR) and corticotropin-releasing factor 1 receptor (CRF1) regulation as well as protein levels of G protein-coupled receptor kinase 3 (GRK3), GRK2, tyrosine hydroxylase (TH) plus carbonylated protein levels in locus coeruleus (LC), amygdala (AMG), cortex (COR) and striatum (STR). In NH rats, α2-AR and CRF1 receptors were significantly down-regulated in LC after TSS. No changes in these receptor levels were observed in the LC of LH rats. GRK3, which phosphorylates receptors and thereby contributes to α2-AR and CRF1 receptor down-regulation, was reduced in the LC of LH but not NH rats. GRK2 levels were unchanged. In AMG, GRK3 but not GRK2 levels were reduced in LH but not NH rats, and receptor regulation was impaired in LH rats. In STR, no changes in GRK3 or GRK2 levels were observed. Finally, protein carbonylation, an index of oxidative stress, was increased in the LC and AMG of LH but not NH rats. We suggest that reduced stress resilience after TSS may be related to oxidative stress, depletion of GRK3 and impaired regulation of α2-AR and CRF1 receptor in LC. PMID:21333691

Structural Characterization and Oligomerization of the TssL Protein, a Component Shared by Bacterial Type VI and Type IVb Secretion Systems*

PubMed Central

Durand, Eric; Zoued, Abdelrahim; Spinelli, Silvia; Watson, Paul J. H.; Aschtgen, Marie-Stéphanie; Journet, Laure; Cambillau, Christian; Cascales, Eric

2012-01-01

The Type VI secretion system (T6SS) is a macromolecular system distributed in Gram-negative bacteria, responsible for the secretion of effector proteins into target cells. The T6SS has a broad versatility as it can target both eukaryotic and prokaryotic cells. It is therefore involved in host pathogenesis or killing neighboring bacterial cells to colonize a new niche. At the architecture level, the T6SS core apparatus is composed of 13 proteins, which assemble in two subcomplexes. One of these subcomplexes, composed of subunits that share structural similarities with bacteriophage tail and baseplate components, is anchored to the cell envelope by the membrane subcomplex. This latter is constituted of at least three proteins, TssL, TssM, and TssJ. The crystal structure of the TssJ outer membrane lipoprotein and its interaction with the inner membrane TssM protein have been recently reported. TssL and TssM share sequence homology and characteristics with two components of the Type IVb secretion system (T4bSS), IcmH/DotU and IcmF, respectively. In this study, we report the crystal structure of the cytoplasmic domain of the TssL inner membrane protein from the enteroaggregative Escherichia coli Sci-1 T6SS. It folds as a hook-like structure composed of two three-helix bundles. Two TssL molecules associate to form a functional complex. Although the TssL trans-membrane segment is the main determinant of self-interaction, contacts between the cytoplasmic domains are required for TssL function. Based on sequence homology and secondary structure prediction, we propose that the TssL structure is the prototype for the members of the TssL and IcmH/DotU families. PMID:22371492

Tension pneumocephalus mimicking septic shock: a case report.

PubMed

Miranda, Caroline; Mahta, Ali; Wheeler, Lee Adam; Tsiouris, A John; Kamel, Hooman

2018-02-01

Tension pneumocephalus can lead to rapid neurologic deterioration. We report for the first time its association with aseptic systemic inflammatory response syndrome mimicking septic shock and the efficacy of prompt neurosurgical intervention and critical care support in treating this condition. A 64-year-old man underwent 2-stage olfactory groove meningioma resection. The patient developed altered mental status and gait instability on postoperative day 6. Imaging showed significant pneumocephalus. The patient subsequently developed worsening mental status, respiratory failure, and profound shock requiring multiple vasopressors. Bedside needle decompression, identification and repair of the cranial fossa defect, and critical care support led to improved mental status and reversal of shock and multiorgan dysfunction. Thorough evaluation revealed no evidence of an underlying infection. In this case, tension pneumocephalus incited an aseptic systemic inflammatory response syndrome mimicking septic shock. Prompt neurosurgical correction of pneumocephalus and critical care support not only improved neurologic status, but also reversed shock. Such a complication indicates the importance of close monitoring of patients with progressive pneumocephalus.

Toxic Shock Syndrome: An Unusual Organism.

PubMed

Young, Katie; Luni, Faraz Khan; Yoon, Youngsook

2016-07-01

Streptococcal toxic shock syndrome is a rapidly fatal disease causing hypotension with multi organ dysfunction (MODS) early in the course of infection, which by definition is caused by Group A streptococcus (GAS). We describe a case of Toxic Shock like Syndrome (TSLS) in which the causative organism was not a GAS. A 71-year-old woman with hepatitis C and primary biliary cirrhosis had sudden onset of slurred speech and left arm and facial numbness. She had bilateral erythematous macular rash present on the flanks and legs. She was started on empiric antibiotics but her condition rapidly deteriorated 6 hours after admission. During this time, the development of multiple large reddish-pink areas of ecchymosis with bullae on her lower extremities, flanks, and groin were noted. She also developed multiorgan dysfunction (MODS) with renal dysfunction, coagulopathy and liver involvement. Patient expired before surgery could be performed and the time from presentation to the time of death was 16 hours. The blood and bullae fluid cultures grew Streptococcus dysgalactiae equisimilis. Streptococcus dysgalactiae equisimilis is a rare cause of TSLS which typically affects elderly or immunocompromised patients and only a few cases have been described in the literature. Our patient met criteria for TSLS which caused rapid shock and MODS. We review the literature of the cases describing the clinical characteristics of TSLS cause by non-GAS. Group G Streptococci is a rare but lethal cause of streptococcal toxic shock syndrome. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Streptococcal toxic shock syndrome after breast reconstruction.

PubMed

Agerson, Ashley N; Wilkins, Edwin G

2005-05-01

Streptococcal toxic shock syndrome (STSS) is an increasingly common disease entity but has rarely been described in the plastic surgery literature. We present the first known case of STSS associated with a reconstructive procedure. Two weeks postoperatively from a transverse rectus abdominis musculocutaneous flap for breast reconstruction, our patient presented with flulike symptoms and progressed rapidly to multiorgan failure. Though initially no nidus for infection was evident, the abdominal donor site was surgically debrided and found to contain group A Streptococcus. Following aggressive rehydration and antibiotic therapy, the patient gradually made a full recovery. In this case report, we review the presentation and epidemiology of STSS and compare it to the more common staphylococcal toxic shock syndrome. In addition, we discuss the management and outcomes of STSS, with an emphasis on raising clinical suspicion for this rare but dangerous entity.

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. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Toxic shock syndrome: clinical and laboratory features in 15 patients.

PubMed

Tofte, R W; Williams, D N

1981-02-01

Toxic shock syndrome is a recently recognized illness with serious morbidity and mortality that occurs primarily in healthy menstruating women who use tampons. Thirteen women and two men were evaluated; two of the women died in spite of seemingly appropriate therapy. All patients had a temperature of 38.9 degrees C or greater, hypotension of syncope, a skin rash with subsequent desquamation, mucous membrane inflammation, and laboratory evidence of multiple organ dysfunction. Staphylococcus aureus was isolated from the cervix or vagina in eight women and from soft-tissue infections in both men. Two patients were bacteremic. The significant heterogeneity in the clinical manifestations, laboratory abnormalities, and therapeutic requirements among patients may result in diagnostic confusion and inappropriate therapy. Although toxic shock syndrome appears to be associated with tampon usage and S. aureus, the pathogenesis remains unknown.

Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience.

PubMed

Conte, Giulio; Sieira, Juan; Ciconte, Giuseppe; de Asmundis, Carlo; Chierchia, Gian-Battista; Baltogiannis, Giannis; Di Giovanni, Giacomo; La Meir, Mark; Wellens, Francis; Czapla, Jens; Wauters, Kristel; Levinstein, Moises; Saitoh, Yukio; Irfan, Ghazala; Julià, Justo; Pappaert, Gudrun; Brugada, Pedro

2015-03-10

Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Toxic shock syndrome complicated by laryngeal oedema.

PubMed Central

Gatling, W.; Mufti, G. J.; McDonald, S. J.

1983-01-01

A 50-year-old woman was admitted as an acute medical emergency and was diagnosed as having toxic shock syndrome. Thirty-six hours after admission she went into hepato-renal failure and had disseminated intravascular coagulation. She developed severe laryngeal oedema, a complication which has not been reported previously, and was intubated with great difficulty. She recovered from this, but died 5 weeks after the presentation of a pulmonary embolus. PMID:6866887

Retention of duplicated ITAM-containing transmembrane signaling subunits in the tetraploid amphibian species Xenopus laevis

PubMed Central

Guselnikov, S.V.; Grayfer, L.; De Jesús Andino, F.; Rogozin, I.B.; Robert, J.; Taranin, A.V.

2015-01-01

The ITAM-bearing transmembrane signaling subunits (TSS) are indispensable components of activating leukocyte receptor complexes. The TSS-encoding genes map to paralogous chromosomal regions, which are thought to arise from ancient genome tetraploidization(s). To assess a possible role of tetraploidization in the TSS evolution, we studied TSS and other functionally linked genes in the amphibian species Xenopus laevis whose genome was duplicated about 40 MYR ago. We found that X. laevis has retained a duplicated set of sixteen TSS genes, all except one being transcribed. Furthermore, duplicated TCRα loci and genes encoding TSS-coupling protein kinases have also been retained. No clear evidence for functional divergence of the TSS paralogs was obtained from gene expression and sequence analyses. We suggest that the main factor of maintenance of duplicated TSS genes in X. laevis was a protein dosage effect and that this effect might have facilitated the TSS set expansion in early vertebrates. PMID:26170006

Early water intake restriction to prevent inappropriate antidiuretic hormone secretion following transsphenoidal surgery: low BMI predicts postoperative SIADH.

PubMed

Matsuyama, Junko; Ikeda, Hidetoshi; Sato, Shunsuke; Yamamoto, Koh; Ohashi, Genichiro; Watanabe, Kazuo

2014-12-01

The goals of this study were to assess the incidence of and risk factors for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients following transsphenoidal surgery (TSS), and to validate the effectiveness of early prophylactic restriction of water intake. Retrospective analysis was performed for 207 patients who had undergone TSS, including 156 patients not placed on early prophylactic water restriction. Sixty-four patients received treatment for SIADH. We compared the incidence of SIADH between patients with and without early water intake restriction, and analyzed various risk factors for SIADH using statistical analyses. BMI was significantly lower for patients with SIADH than for those patients without SIADH. Statistical analysis revealed that the threshold BMI predicting SIADH was 26. Serum sodium levels on postoperative days 5-10 and daily urine volumes on postoperative days 5-10 were significantly lower in patients with SIADH than in those without SIADH. Postoperative body weight loss on days 6, 8, 10, and 11 was significantly higher in patients with SIADH. The incidence of SIADH after starting prophylactic water intake restriction (14%) was significantly lower than the rate before early water restriction (38%; P<0.05). SIADH is relatively common after TSS, and serum sodium concentrations and daily urine volumes should be carefully monitored. Patients with low preoperative BMI should be closely observed, as this represented a significant preoperative risk factor for SIADH. Early prophylactic water intake restriction appears effective at preventing postoperative SIADH. © 2014 European Society of Endocrinology.

Identification of Two Loci in Tomato Reveals Distinct Mechanisms for Salt Tolerance

PubMed Central

Borsani, Omar; Cuartero, Jesus; Fernández, José A.; Valpuesta, Victoriano; Botella, Miguel A.

2001-01-01

Salt stress is one of the most serious environmental factors limiting the productivity of crop plants. To understand the molecular basis for salt responses, we used mutagenesis to identify plant genes required for salt tolerance in tomato. As a result, three tomato salt-hypersensitive (tss) mutants were isolated. These mutants defined two loci and were caused by single recessive nuclear mutations. The tss1 mutant is specifically hypersensitive to growth inhibition by Na+ or Li+ and is not hypersensitive to general osmotic stress. The tss2 mutant is hypersensitive to growth inhibition by Na+ or Li+ but, in contrast to tss1, is also hypersensitive to general osmotic stress. The TSS1 locus is necessary for K+ nutrition because tss1 mutants are unable to grow on a culture medium containing low concentrations of K+. Increased Ca2+ in the culture medium suppresses the growth defect of tss1 on low K+. Measurements of membrane potential in apical root cells were made with an intracellular microelectrode to assess the permeability of the membrane to K+ and Na+. K+-dependent membrane potential measurements indicate impaired K+ uptake in tss1 but not tss2, whereas no differences in Na+ uptake were found. The TSS2 locus may be a negative regulator of abscisic acid signaling, because tss2 is hypersensitive to growth inhibition by abscisic acid. Our results demonstrate that the TSS1 locus is essential for K+ nutrition and NaCl tolerance in tomato. Significantly, the isolation of the tss2 mutant demonstrates that abscisic acid signaling is also important for salt and osmotic tolerance in glycophytic plants. PMID:11283342

Long-term outcomes of children treated for Cushing's disease: a single center experience.

PubMed

Yordanova, Galina; Martin, Lee; Afshar, Farhad; Sabin, Ian; Alusi, Ghassan; Plowman, Nicholas P; Riddoch, Fiona; Evanson, Jane; Matson, Matthew; Grossman, Ashley B; Akker, Scott A; Monson, John P; Drake, William M; Savage, Martin O; Storr, Helen L

2016-12-01

Pediatric Cushing's disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients. Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7-17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9-27.2). Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT). One patient underwent bilateral adrenalectomy (BA). CD recurrence occurred in 3 (14.3 %) patients: 2 at 2 and 6 years after TSS and 1 7.6 years post-RT. The BA patient developed Nelson's syndrome requiring pituitary RT 0.6 years post-surgery. Short-term growth hormone deficiency (GHD) was present in 14 patients (81 % patients tested) (11 following TSS and 3 after RT) and 4 (44 % of tested) had long-term GHD. Gonadotropin deficiency caused impaired pubertal development in 9 patients (43 %), 4 requiring sex steroid replacement post-puberty. Four patients (19 %) had more than one pituitary hormone deficiency, 3 after TSS and 1 post-RT. Five patients (24 %) had long-term psychiatric co-morbidities (cognitive dysfunction or mood disturbance). There were significant long-term improvements in growth, weight and bone density but not complete reversal to normal in all patients. The long-term consequences of the diagnosis and treatment of CD in children is broadly similar to that seen in adults, with recurrence of CD after successful treatment uncommon but still seen. Pituitary hormone deficiencies occurred in the majority of patients after remission, and assessment and appropriate treatment of GHD is essential. However, while many parameters improve, some children may still have mild but persistent defects.

TssA forms a gp6-like ring attached to the type VI secretion sheath.

PubMed

Planamente, Sara; Salih, Osman; Manoli, Eleni; Albesa-Jové, David; Freemont, Paul S; Filloux, Alain

2016-08-01

The type VI secretion system (T6SS) is a supra-molecular bacterial complex that resembles phage tails. It is a killing machine which fires toxins into target cells upon contraction of its TssBC sheath. Here, we show that TssA1 is a T6SS component forming dodecameric ring structures whose dimensions match those of the TssBC sheath and which can accommodate the inner Hcp tube. The TssA1 ring complex binds the T6SS sheath and impacts its behaviour in vivo In the phage, the first disc of the gp18 sheath sits on a baseplate wherein gp6 is a dodecameric ring. We found remarkable sequence and structural similarities between TssA1 and gp6 C-termini, and propose that TssA1 could be a baseplate component of the T6SS Furthermore, we identified similarities between TssK1 and gp8, the former interacting with TssA1 while the latter is found in the outer radius of the gp6 ring. These observations, combined with similarities between TssF and gp6N-terminus or TssG and gp53, lead us to propose a comparative model between the phage baseplate and the T6SS. © 2016 The Authors. Published under the terms of the CC BY 4.0 license.

Stochastic modeling of total suspended solids (TSS) in urban areas during rain events.

PubMed

Rossi, Luca; Krejci, Vladimir; Rauch, Wolfgang; Kreikenbaum, Simon; Fankhauser, Rolf; Gujer, Willi

2005-10-01

The load of total suspended solids (TSS) is one of the most important parameters for evaluating wet-weather pollution in urban sanitation systems. In fact, pollutants such as heavy metals, polycyclic aromatic hydrocarbons (PAHs), phosphorous and organic compounds are adsorbed onto these particles so that a high TSS load indicates the potential impact on the receiving waters. In this paper, a stochastic model is proposed to estimate the TSS load and its dynamics during rain events. Information on the various simulated processes was extracted from different studies of TSS in urban areas. The model thus predicts the probability of TSS loads arising from combined sewer overflows (CSOs) in combined sewer systems as well as from stormwater in separate sewer systems in addition to the amount of TSS retained in treatment devices in both sewer systems. The results of this TSS model illustrate the potential of the stochastic modeling approach for assessing environmental problems.

The use of recombinant factor VIIa in a patient with Noonan syndrome and life-threatening bleeding.

PubMed

Tofil, Nancy M; Winkler, Margaret K; Watts, Raymond G; Noonan, Jacqueline

2005-05-01

To present a case report of a patient with Noonan syndrome who developed life-threatening gastrointestinal bleeding shortly after cardiac surgery that was successfully treated with recombinant factor VIIa. Case report. Pediatric intensive care unit of a children's hospital. Ten-month-old with Noonan syndrome and massive gastrointestinal bleeding resulting in severe hypovolemic shock. Recombinant factor VIIa was used in this patient's severe bleeding associated with Noonan syndrome after no other supportive measures were successful. Recombinant Factor VIIa significantly decreased the patient's bleeding and allowed his hypovolemic shock to improve. Ultimately, the patient made a complete recovery. Noonan syndrome has a constellation of both cardiac and noncardiac malformations including an increased risk of bleeding, and recombinant factor VIIa is an important agent in the treatment of significant bleeding.

What Is Restless Legs Syndrome?

MedlinePlus

... creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the ... creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Severe RLS may cause painful feelings. However, ...

Surgical Outcome of Endoscopic Endonasal Surgery for Non-Functional Pituitary Adenoma by a Team of Neurosurgeons and Otolaryngologists Adenoma by a Team of Neurosurgeons and Otolaryngologists.

PubMed

Kikuchi, Ryogo; Toda, Masahiro; Tomita, Toshiki; Ogawa, Kaoru; Yoshida, Kazunari

2017-01-01

This study aimed to assess the efficacy of endoscopic endonasal surgery, conducted by a team of neurosurgeons and otolaryngologists. We studied 40 patients who were undergoing surgery for primary non-functional pituitary adenomas with Knosp grades 1 to 3, at Keio University Hospital between 2005 and 2012. We compared the endoscopic endonasal transsphenoidal approach (team-eTSS; T-eTSS), with a microscopic transsphenoidal approach (mTSS). Analyses were conducted for differences between the two groups in tumor resection rates, operating durations, and complications from the non-functional pituitary adenomas. We also compared the heminostril and binostril approaches for T-eTSS. Tumor resection rates were higher when the surgeries were conducted by T-eTSS than mTSS. In particular, when the maximum tumor diameter was more than 25 mm, resection rates were significantly higher for T-eTSS than for mTSS. There were no unexpected complications in either group. There was no significant difference in resection rates between the heminostril and binostril approaches when T-eTSS was performed. T-eTSS is an efficacious surgical option for non-functional pituitary adenomas, particularly when the adenoma is of large size. Benefits of the heminostril approach are evident.

In vitro studies of toxic shock toxin-1-secreting Staphylococcus aureus and implications for burn care in children.

PubMed

Laabei, Maisem; Young, Amber; Jenkins, Toby A

2012-05-01

The main etiologic agent of toxic shock syndrome is the toxic shock syndrome toxin-1 (TSST-1) protein secreted by Staphylococcus aureus. Diagnosis of toxic shock syndrome is difficult and is significantly underdiagnosed in young children with burns due to the nonspecific presentation coupled with a rapid deterioration in patient condition. The lytic and cytolytic activity of a number of clinical and laboratory TSST-1-positive strains of methicillin-susceptible S. aureus (101, 253, 279 and RN4282, respectively) and Pseudomonas aeruginosa PAO1 strain were tested in vitro using an assay designed to assess the relative exotoxin activity of bacteria using phospholipid vesicles and a T cell toxicity assay. In addition, the activity of lytic exotoxins such as δ -toxin and the secretion of nonlytic TSST-1 toxin from S. aureus was measured using the vesicle assay and Western blotting over the 20-hour growth of TSST-1-positive S. aureus culture. Both the vesicle and T cell assays suggest a lytic exotoxin-mediated mechanism of vesicle rupture and T cell death, with high levels of vesicle lysis and T cell toxicity. It is important to note that the clinical TSST-1-positive methicillin-susceptible S. aureus strains exhibited lytic exotoxin production as well as TSST-1 expression as confirmed by Western blot. We suggest that there is no correlation between the expression of TSST-1 and lack of exotoxin production. We also suggest that apurulence in an S. aureus-infected burn wound in a child should not be used to rule out toxic shock syndrome.

Development of an indicator for characterizing particle size distribution and quality of stormwater runoff.

PubMed

Wang, Qian; Zhang, Qionghua; Dzakpasu, Mawuli; Lian, Bin; Wu, Yaketon; Wang, Xiaochang C

2018-03-01

Stormwater particles washed from road-deposited sediments (RDS) are traditionally characterized as either turbidity or total suspended solids (TSS). Although these parameters are influenced by particle sizes, neither of them characterizes the particle size distribution (PSD), which is of great importance in pollutant entrainment and treatment performance. Therefore, the ratio of turbidity to TSS (Tur/TSS) is proposed and validated as a potential surrogate for the bulk PSD and quality of stormwater runoff. The results show an increasing trend of Tur/TSS with finer sizes of both RDS and stormwater runoff. Taking heavy metals (HMs, including Cu, Pb, Zn, Cr, and Ni) as typical pollutants in stormwater runoff, the concentrations (mg/kg) were found to vary significantly during rainfall events and tended to increase significantly with Tur/TSS. Therefore, Tur/TSS is a valid parameter to characterize the PSD and quality of stormwater. The high negative correlations between Tur/TSS and rainfall intensity demonstrate that stormwater with higher Tur/TSS generates under low intensity and, thus, characterizes small volume, finer sizes, weak settleability, greater mobility, and bioavailability. Conversely, stormwater with lower Tur/TSS generates under high intensity and, thus, characterizes large volume, coarser sizes, good settleability, low mobility, and bioavailability. These results highlight the need to control stormwater with high Tur/TSS. Moreover, Tur/TSS can aid the selection of stormwater control measures with appropriate detention storage, pollution loading, and removal effectiveness of particles.

National Imperative to Establish a Domestic Medical Intelligence Center

DTIC Science & Technology

2007-09-01

in children ɝ years • Syphilis • Syphilis , congenital • Tetanus • Toxic-shock syndrome (other than Streptococcal) • Trichinellosis...Rabies • Rocky Mountain spotted fever • Rubella • Rubella, congenital syndrome • Salmonellosis • Severe Acute Respiratory Syndrome

Group A streptococcal toxic shock syndrome secondary to necrotizing pelvic inflammatory disease in a postmenopausal woman.

PubMed

Paulson, Qiwei; Douglass, Elizabeth; Moreno, Alejandro; Aydelotte, Jayson

2016-01-01

Group A β-hemolytic streptococcus (GAS) is well known to cause upper respiratory tract or cutaneous infections, but some more virulent species of GAS can lead to a rapidly progressive life threatening soft tissue necrotizing infection and streptococcal toxic shock syndrome (STSS). In the modern era, GAS infections within the female reproductive tract leading to STSS are unusual and are often the result of retained products of conception or intrauterine devices. This report describes a case of GAS necrotizing pelvic infection in a previously healthy menopausal woman with no obvious portal of entry. Her clinical course rapidly progressed to septic shock and multiorgan failure. She required multiple surgeries in addition to targeted antimicrobials and aggressive management of shock and organ failures. After a prolonged hospital stay, she had a full recovery.

Cardiogenic shock caused by a left midventricular obstruction during refeeding in a patient with anorexia nervosa.

PubMed

Sakamoto, Yoko; Kioka, Hidetaka; Hashimoto, Ryota; Takeda, Saori; Momose, Kota; Ohtani, Tomohito; Yamaguchi, Osamu; Wasa, Masafumi; Nakatani, Satoshi; Sakata, Yasushi

2017-03-01

Refeeding syndrome occurs when reinstating nutrition to severely malnourished patients. It can sometimes be fatal, particularly as a result of cardiac involvement such as congestive heart failure and arrhythmias. The aim of this study was to report a case of cardiogenic shock that occurred during refeeding in a patient with anorexia nervosa (AN). The cardiogenic shock was due to a previously unrecognized mechanism, namely a transient left midventricular obstruction that completely disappeared after treatment. A 46-y-old woman with AN who had followed a carbohydrate- and a fat-deficient diet for >10 y was hospitalized for dyspnea on exertion. She had severely impaired cardiac systolic function on admission and was considered high risk for refeeding syndrome. During a stepwise increase of calories, she showed no electrolyte or mineral abnormalities characteristic of refeeding syndrome. After intravenous administration of a fat emulsion, the patient suffered from cardiogenic shock due to an unexpected mechanism, namely a left midventricular obstruction caused by cardiac hypercontraction, a thickened left ventricular wall, and intravascular volume depletion. With cessation of the fat emulsion and initiation of volume repletion she recovered from shock immediately and her echocardiogram returned to normal by discharge. This case illustrated a novel cause of cardiogenic shock during refeeding and the need for caution during the intravenous administration of a fat emulsion in patients with initial left ventricular systolic dysfunction. Copyright © 2016 Elsevier Inc. All rights reserved.

Solar Flare Termination Shock and Synthetic Emission Line Profiles of the Fe xxi 1354.08 Å Line

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guo, Lijia; Li, Gang; Reeves, Kathy

Solar flares are among the most energetic phenomena that occur in the solar system. In the standard solar flare model, a fast mode shock, often referred to as the flare termination shock (TS), can exist above the loop-top source of hard X-ray emissions. The existence of the TS has been recently related to spectral hardening of a flare’s hard X-ray spectra at energies >300 keV. Observations of the Fe xxi 1354.08 Å line during solar flares by the Interface Region Imaging Spectrograph ( IRIS ) spacecraft have found significant redshifts with >100 km s{sup −1}, which is consistent with amore » reconnection downflow. The ability to detect such a redshift with IRIS suggests that one may be able to use IRIS observations to identify flare TSs. Using a magnetohydrodynamic simulation to model magnetic reconnection of a solar flare and assuming the existence of a TS in the downflow of the reconnection plasma, we model the synthetic emission of the Fe xxi 1354.08 line in this work. We show that the existence of the TS in the solar flare may manifest itself in the Fe xxi 1354.08 Å line.« less

Sepsis

MedlinePlus

Septicemia; Sepsis syndrome; Systemic inflammatory response syndrome; SIRS; Septic shock ... The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response. A bacterial infection anywhere ...

Changing prevalent T serotypes and emm genotypes of Streptococcus pyogenes isolates from streptococcal toxic shock-like syndrome (TSLS) patients in Japan.

PubMed

Ikebe, T; Murai, N; Endo, M; Okuno, R; Murayama, S; Saitoh, K; Yamai, S; Suzuki, R; Isobe, J; Tanaka, D; Katsukawa, C; Tamaru, A; Katayama, A; Fujinaga, Y; Hoashi, K; Ishikawa, J; Watanabe, H

2003-06-01

We surveyed T serotypes and emm genotypes of Streptococcus pyogenes isolates from streptococcal toxic shock-like syndrome (TSLS) patients. T1 (emm1) remained dominant through 1992 to 2000, but the dominant T3 (emm3.1) strains from 1992 to 1995 disappeared during 1996-2000. Strains of several emm genotypes emerged during 1996-2000, indicating alterations in the prevalent strains causing TSLS.

Toxic shock syndrome mimicking pelvic inflammatory disease presumably resulting from tattoo.

PubMed

Cowan, R K; Martens, M G

1993-12-01

The female patient with a variety of genital tract symptoms offers a distinct challenge to the gynecologist. We report a case that on initial examination was thought to be pelvic inflammatory disease (PID). After further evaluation, our patient was found to be suffering from toxic shock syndrome, which in many ways may resemble PID. This case demonstrates the importance of a careful and thorough evaluation of the gynecologic patient who has several nonspecific signs and symptoms.

A fatal case of bone marrow embolism of unknown cause masquerading clinically as dengue shock syndrome.

PubMed

Selvi, Subramanian Kalaivani; Kar, Rakhee; Vadivelan, Mehalingam; Subrahmanyam, Dharanipragada Krishna Suri

2012-01-01

Bone marrow fat embolism usually occurs following multiple bone fractures, intraosseous surgical procedures, following vigorous cardiac resuscitation, ecclampsia, sickle cell anemia, malignancies, etc. We present a case of 70-year-old male who presented with fever, cough with expectoration, respiratory distress, altered sensorium, hypotension and thrombocytopenia, and diagnosed to have dengue shock syndrome and expired within 1 day of admission. Postmortem lung biopsy revealed bone marrow fat embolism.

The Aplication of Landsat 8 OLI for Total Suspended Solid (TSS) Mapping in Gajahmungkur Reservoir Wonogiri Regency 2016

NASA Astrophysics Data System (ADS)

Yanti, Apriwida; Susilo, Bowo; Wicaksono, Pramaditya

2016-11-01

Gajahmungkur reservoir is administratively located in Wonogiri Regency, Central Java, with the main function as a flood control in the upstream of Bengawan Solo River. Other functions of the reservoir are as hydroelectric power plant (PLTA), water supply, irrigation, fisheries and tourism. Economic utilization of the reservoir is estimated until 100 years, but it is begun to be threatened by the silting of the reservoir. Eroded materials entering water body will be suspended and accumulated. Suspended Material or TSS (Total Suspended Solid) will increase the turbidity of water, which can affect the quality of water and silting the reservoir. Remote sensing technology can be used to determine the spatial distribution of TSS. The purposes of this study were to 1) utilize and compare the accuracy of single band Landsat 8 OLI for mapping the spatial distribution of TSS and 2) estimate the TSS on Gajahmungkur reservoir surface waters up to the depth of 30 cm. The method used for modelling the TSS spatial distribution is the empirical modelling that integrates image pixel values and field data using correlation analysis and regression analysis. The data used in the empirical modelling are single band of visible, NIR, and SWIR of Landsat 8 OLI, which was acquired on 8 May 2016, and field-measured TSS values based on the field data collection conducted on 12 April 2016. The results revealed that mapping the distribution and the estimated value of TSS in Reservoir Gajahmungkur can be performed more accurately using band 4 (red band). The determinant coefficient between TSS field and TSS value of image using band 4 is 0.5431. The Standard Error (SE) of the predicted TSS value is 16.16 mg/L. The results also showed that the estimated total TSS of May 2016 according to band 4 is 1.087,56 tons. The average estimation of TSS value in up to the depth of 30 cm is 61.61 mg/L. The highest TSS distribution is in the northern parts, which was dominated by eroded materials from Keduang River.

Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis.

PubMed

Almutairi, Reem D; Muskens, Ivo S; Cote, David J; Dijkman, Mark D; Kavouridis, Vasileios K; Crocker, Erin; Ghazawi, Kholoud; Broekman, Marike L D; Smith, Timothy R; Mekary, Rania A; Zaidi, Hasan A

2018-05-01

Microscopic transsphenoidal surgery (mTSS) is a well-established method to address adenomas of the pituitary gland. Endoscopic transsphenoidal surgery (eTSS) has become a viable alternative, however. Advocates suggest that the greater illumination, panoramic visualization, and angled endoscopic views afforded by eTSS may allow for higher rates of gross total tumor resection (GTR). The aim of this meta-analysis was to determine the rate of GTR using mTSS and eTSS. A meta-analysis of the literature was conducted using PubMed, EMBASE, and Cochrane databases through July 2017 in accordance with PRISMA guidelines. Seventy case series that reported GTR rate in 8257 pituitary adenoma patients were identified. For all pituitary adenomas, eTSS (GTR=74.0%; I 2  = 92.1%) was associated with higher GTR as compared to mTSS (GTR=66.4%; I 2  = 84.0%) in a fixed-effect model (P-interaction < 0.01). For functioning pituitary adenomas (FPAs) (n = 1170 patients), there was no significant difference in GTR rate between eTSS (GTR=75.8%; I 2  = 63.9%) and mTSS (GTR=75.5%; I 2  = 79.0%); (P-interaction = 0.92). For nonfunctioning pituitary adenomas (NFPAs) (n = 2655 patients), eTSS (GTR=71.0%; I 2  = 86.4%) was associated with higher GTR as compared to mTSS (GTR=60.7%; I 2  = 87.5%) in a fixed-effect model (P-interaction < 0.01). None of the associations were significant in a random-effect model (all P-interaction > 0.05). No significant publication bias was identified for any of the outcomes. Among patients who were not randomly allocated to either approach, eTSS resulted in a higher rate of GTR as compared to mTSS for all patients and for NFPA patients alone, but only in a fixed-effect model. For FPA, however, eTSS did not seem to offer a significantly higher rate of GTR. These conclusions should be interpreted with caution because of the nature of the included non-comparative studies.

HUBBLE SPACE TELESCOPE CONSTRAINTS ON THE WINDS AND ASTROSPHERES OF RED GIANT STARS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wood, Brian E.; Müller, Hans-Reinhard; Harper, Graham M., E-mail: brian.wood@nrl.navy.mil

We report on an ultraviolet spectroscopic survey of red giants observed by the Hubble Space Telescope , focusing on spectra of the Mg ii h and k lines near 2800 Å in order to study stellar chromospheric emission, winds, and astrospheric absorption. We focus on spectral types between K2 III and M5 III, a spectral type range with stars that are noncoronal, but possessing strong, chromospheric winds. We find a very tight relation between Mg ii surface flux and photospheric temperature, supporting the notion that all K2-M5 III stars are emitting at a basal flux level. Wind velocities ( Vmore » {sub w} ) are generally found to decrease with spectral type, with V {sub w} decreasing from ∼40 km s{sup −1} at K2 III to ∼20 km s{sup −1} at M5 III. We find two new detections of astrospheric absorption, for σ Pup (K5 III) and γ Eri (M1 III). This absorption signature had previously only been detected for α Tau (K5 III). For the three astrospheric detections, the temperature of the wind after the termination shock (TS) correlates with V {sub w} , but is lower than predicted by the Rankine–Hugoniot shock jump conditions, consistent with the idea that red giant TSs are radiative shocks rather than simple hydrodynamic shocks. A full hydrodynamic simulation of the γ Eri astrosphere is provided to explore this further.« less

Relative adrenal insufficiency in severe congestive heart failure with preserved systolic function: a case report.

PubMed

Lovelock, Joshua D; Coslet, Sandra; Johnson, Marie; Rich, Stuart; Gomberg-Maitland, Mardi

2007-09-01

Relative adrenal insufficiency in critically ill patients is an important syndrome in septic shock. The insufficient stress response of the hypothalamic-pituitary-adrenal axis in acute illness contributes to hemodynamic instability. Treatment of this state in septic shock improves patient outcomes. In this report, we describe the case of a patient with severe diastolic dysfunction who presented in cardiogenic shock associated with relative adrenal insufficiency and had a complete recovery with corticosteroid replacement. Alteration of the hypothalamic-pituitary-adrenal axis may be more prevalent than suspected in end-stage heart failure, and the diagnosis and treatment of this syndrome may ultimately improve outcomes in a subgroup of heart failure patients.

Regulation of gene expression by the BLM helicase correlates with the presence of G-quadruplex DNA motifs

PubMed Central

Nguyen, Giang Huong; Tang, Weiliang; Robles, Ana I.; Beyer, Richard P.; Gray, Lucas T.; Welsh, Judith A.; Schetter, Aaron J.; Kumamoto, Kensuke; Wang, Xin Wei; Hickson, Ian D.; Maizels, Nancy; Monnat, Raymond J.; Harris, Curtis C.

2014-01-01

Bloom syndrome is a rare autosomal recessive disorder characterized by genetic instability and cancer predisposition, and caused by mutations in the gene encoding the Bloom syndrome, RecQ helicase-like (BLM) protein. To determine whether altered gene expression might be responsible for pathological features of Bloom syndrome, we analyzed mRNA and microRNA (miRNA) expression in fibroblasts from individuals with Bloom syndrome and in BLM-depleted control fibroblasts. We identified mRNA and miRNA expression differences in Bloom syndrome patient and BLM-depleted cells. Differentially expressed mRNAs are connected with cell proliferation, survival, and molecular mechanisms of cancer, and differentially expressed miRNAs target genes involved in cancer and in immune function. These and additional altered functions or pathways may contribute to the proportional dwarfism, elevated cancer risk, immune dysfunction, and other features observed in Bloom syndrome individuals. BLM binds to G-quadruplex (G4) DNA, and G4 motifs were enriched at transcription start sites (TSS) and especially within first introns (false discovery rate ≤ 0.001) of differentially expressed mRNAs in Bloom syndrome compared with normal cells, suggesting that G-quadruplex structures formed at these motifs are physiologic targets for BLM. These results identify a network of mRNAs and miRNAs that may drive the pathogenesis of Bloom syndrome. PMID:24958861

Regulation of gene expression by the BLM helicase correlates with the presence of G-quadruplex DNA motifs.

PubMed

Nguyen, Giang Huong; Tang, Weiliang; Robles, Ana I; Beyer, Richard P; Gray, Lucas T; Welsh, Judith A; Schetter, Aaron J; Kumamoto, Kensuke; Wang, Xin Wei; Hickson, Ian D; Maizels, Nancy; Monnat, Raymond J; Harris, Curtis C

2014-07-08

Bloom syndrome is a rare autosomal recessive disorder characterized by genetic instability and cancer predisposition, and caused by mutations in the gene encoding the Bloom syndrome, RecQ helicase-like (BLM) protein. To determine whether altered gene expression might be responsible for pathological features of Bloom syndrome, we analyzed mRNA and microRNA (miRNA) expression in fibroblasts from individuals with Bloom syndrome and in BLM-depleted control fibroblasts. We identified mRNA and miRNA expression differences in Bloom syndrome patient and BLM-depleted cells. Differentially expressed mRNAs are connected with cell proliferation, survival, and molecular mechanisms of cancer, and differentially expressed miRNAs target genes involved in cancer and in immune function. These and additional altered functions or pathways may contribute to the proportional dwarfism, elevated cancer risk, immune dysfunction, and other features observed in Bloom syndrome individuals. BLM binds to G-quadruplex (G4) DNA, and G4 motifs were enriched at transcription start sites (TSS) and especially within first introns (false discovery rate ≤ 0.001) of differentially expressed mRNAs in Bloom syndrome compared with normal cells, suggesting that G-quadruplex structures formed at these motifs are physiologic targets for BLM. These results identify a network of mRNAs and miRNAs that may drive the pathogenesis of Bloom syndrome.

A Landsat-based model for retrieving total suspended solids concentration of estuaries and coasts in China

NASA Astrophysics Data System (ADS)

Wang, Chongyang; Chen, Shuisen; Li, Dan; Wang, Danni; Liu, Wei; Yang, Ji

2017-11-01

Retrieving total suspended solids (TSS) concentration accurately is essential for sustainable management of estuaries and coasts, which plays a key role in the interaction between hydrosphere, pedosphere and atmosphere. Although many TSS retrieval models have been published, the general inversion method that is applicable to different field conditions is still under research. In order to obtain a TSS remote sensing model that is suitable for estimating TSS concentrations with wide range in estuaries and coasts by Landsat imagery, after reviewing a number of Landsat-based TSS retrieval models and improving a comparatively better one among them, this study developed a quadratic model using the ratio of logarithmic transformation of red band and near-infrared band and logarithmic transformation of TSS concentration (QRLTSS) based on 119 in situ samples collected in 2006-2013 from five regions of China. It was found that the QRLTSS model works well and shows a satisfactory performance. The QRLTSS model based on Landsat TM (Thematic Mapper), ETM+ (Enhanced Thematic Mapper Plus) and OLI (Operational Land Imager) sensors explained about 72 % of the TSS concentration variation (TSS: 4.3-577.2 mg L-1, N = 84, P value < 0.001) and had an acceptable validation accuracy (TSS: 4.5-474 mg L-1, root mean squared error (RMSE) ≤ 25 mg L-1, N = 35). In addition, a threshold method of red-band reflectance (OLI: 0.032, ETM+ and TM: 0.031) was proposed to solve the two-valued issue of the QRLTSS model and to retrieve TSS concentration from Landsat imagery. After a 6S model-based atmospheric correction of Landsat OLI and ETM+ imagery, the TSS concentrations of three regions (Moyangjiang River estuary, Pearl River estuary and Hanjiang River estuary) in Guangdong Province in China were mapped by the QRLTSS model. The results indicated that TSS concentrations in the three estuaries showed large variation ranging from 0.295 to 370.4 mg L-1. Meanwhile we found that TSS concentrations retrieved from Landsat imagery showed good validation accuracies with the synchronous water samples (TSS: 7-160 mg L-1, RMSE: 11.06 mg L-1, N = 22). The further validation from EO-1 Hyperion imagery also showed good performance (in situ synchronous measurement of TSS: 106-220.7 mg L-1, RMSE: 26.66 mg L-1, N = 13) of the QRLTSS model for the area of high TSS concentrations in the Lingding Bay of the Pearl River estuary. Evidently, the QRLTSS model is potentially applied to simulate high-dynamic TSS concentrations of other estuaries and coasts by Landsat imagery, improving the understanding of the spatial and temporal variation of TSS concentrations on regional and global scales. Furthermore, the QRLTSS model can be optimized to establish a regional or unified TSS retrieval model of estuaries and coasts in the world for different satellite sensors with medium- and high-resolution similar to Landsat TM, ETM+ and OLI sensors or with similar red bands and near-infrared bands, such as ALI, HJ-1 A and B, LISS, CBERS, ASTER, ALOS, RapidEye, Kanopus-V, and GF.

[Septic shock Fusobacterium necrophorum from origin gynecological at complicated an acute respiratory distress syndrome: a variant of Lemierre's syndrome].

PubMed

Huynh-Moynot, Sophie; Commandeur, Diane; Danguy des Déserts, Marc; Drouillard, Isabelle; Leguen, Patrick; Ould-Ahmed, Mehdi

2011-01-01

We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical.

RSK2 represses HSF1 activation during heat shock

PubMed Central

Wang, Xiaozhe; Asea, Alexzander; Xie, Yue; Kabingu, Edith; Stevenson, Mary Ann; Calderwood, Stuart K.

2000-01-01

Heat shock transcription factor 1(HSF1) activation is a multistep process. The conversion of a latent cytoplasmic form to a nuclear, DNA binding state appears to be activated by nonsteroidal anti-inflammatory drugs. In previous studies, we showed that HSF 1 is phosphorylated by the protein kinase RSK2 in vitro and that this effect is inhibited by nonsteroidal anti-inflammatory drugs at the concentration that leads to the activation of HSF1 in vivo (Stevenson et al 1999). In the present study, using cells from a patient with Coffin-Lowry syndrome (deficient in RSK2), we demonstrate that RSK2 slightly represses activation of HSF1 in vivo at 37°C. In Coffin-Lowry syndrome cells, HSF1-HSE DNA binding activity after treatment with sodium salicylate was slightly higher than that in untreated cells, indicating that although RSK2 is involved in HSF1 regulation, it is not the unique protein kinase that suppresses HSF1-HSE binding activity at 37°C. However, heat shock treatment resulted in significantly higher HSF1-HSE binding activity in Coffin-Lowry syndrome cells as compared with normal controls, suggesting that RSK2 represses HSF1-HSE binding activity during heat shock. PMID:11189448

RSK2 represses HSF1 activation during heat shock.

PubMed

Wang, X; Asea, A; Xie, Y; Kabingu, E; Stevenson, M A; Calderwood, S K

2000-11-01

Heat shock transcription factor 1(HSF1) activation is a multistep process. The conversion of a latent cytoplasmic form to a nuclear, DNA binding state appears to be activated by nonsteroidal anti-inflammatory drugs. In previous studies, we showed that HSF 1 is phosphorylated by the protein kinase RSK2 in vitro and that this effect is inhibited by nonsteroidal anti-inflammatory drugs at the concentration that leads to the activation of HSF1 in vivo (Stevenson et al 1999). In the present study, using cells from a patient with Coffin-Lowry syndrome (deficient in RSK2), we demonstrate that RSK2 slightly represses activation of HSF1 in vivo at 37 degrees C. In Coffin-Lowry syndrome cells, HSF1-HSE DNA binding activity after treatment with sodium salicylate was slightly higher than that in untreated cells, indicating that although RSK2 is involved in HSF1 regulation, it is not the unique protein kinase that suppresses HSF1-HSE binding activity at 37 degrees C. However, heat shock treatment resulted in significantly higher HSF1-HSE binding activity in Coffin-Lowry syndrome cells as compared with normal controls, suggesting that RSK2 represses HSF1-HSE binding activity during heat shock.

Burkholderia mallei tssM encodes a putative deubiquitinase that is secreted and expressed inside infected RAW 264.7 murine macrophages.

PubMed

Shanks, John; Burtnick, Mary N; Brett, Paul J; Waag, David M; Spurgers, Kevin B; Ribot, Wilson J; Schell, Mark A; Panchal, Rekha G; Gherardini, Frank C; Wilkinson, Keith D; Deshazer, David

2009-04-01

Burkholderia mallei, a category B biothreat agent, is a facultative intracellular pathogen that causes the zoonotic disease glanders. The B. mallei VirAG two-component regulatory system activates the transcription of approximately 60 genes, including a large virulence gene cluster encoding a type VI secretion system (T6SS). The B. mallei tssM gene encodes a putative ubiquitin-specific protease that is physically linked to, and transcriptionally coregulated with, the T6SS gene cluster. Mass spectrometry and immunoblot analysis demonstrated that TssM was secreted in a virAG-dependent manner in vitro. Surprisingly, the T6SS was found to be dispensable for the secretion of TssM. The C-terminal half of TssM, which contains Cys and His box motifs conserved in eukaryotic deubiquitinases, was purified and biochemically characterized. Recombinant TssM hydrolyzed multiple ubiquitinated substrates and the cysteine at position 102 was critical for enzymatic activity. The tssM gene was expressed within 1 h after uptake of B. mallei into RAW 264.7 murine macrophages, suggesting that the TssM deubiquitinase is produced in this intracellular niche. Although the physiological substrate(s) is currently unknown, the TssM deubiquitinase may provide B. mallei a selective advantage in the intracellular environment during infection.

The Impact of Retardance Pattern Variability on Nerve Fiber Layer Measurements over Time Using GDx with Variable and Enhanced Corneal Compensation

PubMed Central

Grewal, Dilraj S.; Sehi, Mitra; Cook, Richard J.

2011-01-01

Purpose. To examine the impact of retardance pattern variability on retinal nerve fiber layer (RNFL) measurements over time using scanning laser polarimetry with variable (GDxVCC) and enhanced corneal compensation (GDxECC; both by Carl Zeiss Meditec, Inc., Dublin, CA). Methods. Glaucoma suspect and glaucomatous eyes with 4 years of follow-up participating in the Advanced Imaging in Glaucoma Study were prospectively enrolled. All eyes underwent standard automated perimetry (SAP), GDxVCC, and GDxECC imaging every 6 months. SAP progression was determined with point-wise linear regression analysis of SAP sensitivity values. Typical scan score (TSS) values were extracted as a measure of retardance image quality; an atypical retardation pattern (ARP) was defined as TSS < 80. TSS fluctuation over time was measured using three parameters: change in TSS from baseline, absolute difference (maximum minus minimum TSS value), and TSS variance. Linear mixed-effects models that accommodated the association between the two eyes were constructed to evaluate the relationship between change in TSS and RNFL thickness over time. Results. Eighty-six eyes (51 suspected glaucoma, 35 glaucomatous) of 45 patients were enrolled. Twenty (23.3%) eyes demonstrated SAP progression. There was significantly greater fluctuation in TSS over time with GDxVCC compared with GDxECC as measured by absolute difference (18.40 ± 15.35 units vs. 2.50 ± 4.69 units; P < 0.001), TSS variance (59.63 ± 87.27 units vs. 3.82 ± 9.63 units, P < 0.001), and change in TSS from baseline (−0.83 ± 11.2 vs. 0.25 ± 2.9, P = 0.01). The change in TSS over time significantly (P = 0.006) influenced the TSNIT average RNFL thickness when measured by GDxVCC but not by GDxECC. Conclusions. Longitudinal images obtained with GDxECC have significantly less variability in TSS and retardance patterns and have reduced bias produced by ARP on RNFL progression assessment. PMID:21296821

Electrical injury and amyotrophic lateral sclerosis: a systematic review of the literature

PubMed Central

Abhinav, Kumar; Al‐Chalabi, Ammar; Hortobagyi, Tibor; Leigh, P Nigel

2007-01-01

Electrical injury may act as a potential precipitating or risk factor for amyotrophic lateral sclerosis (ALS). A systematic review of the literature was undertaken to assess the relationship between electrical injury and the development of ALS. Information for the review was obtained using five medical databases, and from manual searching of individual papers. Patients presenting with a neurological syndrome after electrical injury, including lightning, were included and classified into four categories: ALS; progressive upper motor neurone (UMN) syndrome; progressive lower motor neurone (LMN) syndrome; and non‐progressive syndrome. Linear regression and χ2testing were used for analysis of the data. 96 individuals, comprising 44 with ALS, 1 with a progressive UMN syndrome, 7 with a progressive LMN syndrome and 44 with a non‐progressive syndrome, were identified from 31 papers with publication dates between 1906 and 2002. The median interval between electrical injury and disease onset was 2.25 years for all progressive syndromes and just over 1 week for the non‐progressive syndrome. The more severe the shock (excluding lightning), the more likely individuals were to have a non‐progressive motor syndrome. A non‐progressive spinal cord syndrome is associated with more severe electrical injury. Overall, the evidence reviewed does not support a causal relationship between ALS and electric shock. PMID:17098839

The spatial and temporal variation of total suspended solid concentration in Pearl River Estuary during 1987-2015 based on remote sensing.

PubMed

Wang, Chongyang; Li, Weijiao; Chen, Shuisen; Li, Dan; Wang, Danni; Liu, Jia

2018-03-15

The movement and migration of total suspended solid (TSS) are the essential component of global material cycling and change. Based on the TSS concentrations retrieved from 112 scenes of Landsat remote sensing imageries during 1987-2015, the spatial and temporal variations of TSS concentration in high flow season and low flow seasons of six sub-regions (west shoal, west channel, middle shoal, east channel, east shoal and Pearl River Estuary Chinese White Dolphin National Nature Reserve and its adjacent waters (NNR)) of Pearl River Estuary (PRE) were analyzed and compared by statistical simulation. It was found that TSS concentrations in east and west shoals were about 23mg/L and 64mg/L higher than that of the middle shoal, respectively. There was a significant decreasing trend of TSS concentration from the northwest (223.7mg/L) to southeast (51.4mg/L) of study area, with an average reduction of 5.86mg/Lperkm, which mainly attributes to unique interaction of runoff and tide in PRE. In high flow season, there existed a significant and definite annual cycle period (5-8years) of TSS concentration change primarily responding to the periodic variation of precipitation. There were five full-fledged period changes of TSS detected in west shoal and west channel (the years of changes in 1988, 1994, 1998, 2003, 2010, 2015), while there were the last four cycle periods found in middle shoal, east channel, east shoal and NNR only. TSS concentrations in shoals and channels of PRE showed a significant decreased trend mainly due to the dam construction at the same time, with an average annual TSS concentration decrease of 5.7-10.1mg/L in high flow season from 1988 to 2015. There was no significant change trend of TSS concentration in NNR before 2003, but the TSS concentration decreased significantly after the establishment of the NNR since June 2003, with an average annual decrease of 9.7mg/L from 2004 to 2015. It was deduced that man-made protection measures had a great influence on the variation trend and intensity of TSS concentration in PRE, but had little effect on the cycle of TSS changes, indicating that the cyclical change is a very strong natural law. In low flow season, there was no significant change trend of TSS concentrations in PRE except that TSS concentrations in west channel and middle shoal showed a weak increasing trend (2.1mg/L and 2.9mg/L, respectively), which is probably because of controlled discharge for avoiding the intrusion of saltwater in PRE. Evidently, the change trend and cycle periods of TSS concentration in high- and low-flow seasons in six sub-regions of PRE had significant difference. The decreasing trend and cycle periods of TSS concentration mainly occurred in high flow season. The change trend and cycle periods of TSS concentration in low flow season was relatively small in PRE. The study shows that long series mapping of Landsat remote sensing images is an effective way to help understanding the spatial and temporal variation of TSS concentrations of estuaries and coasts, and to increase awareness of environmental change and human activity effects. Copyright © 2017 Elsevier B.V. All rights reserved.

[Invasive infection caused Streptococcus group A and streptococcal toxic shock syndrome].

PubMed

Danilova, T A

2001-01-01

Modern data on the etiology and pathogenesis of invasive streptococcal infection and the syndrome of streptococcal toxic shock are presented. In the course of the last 10-15 years essential changes in the system of interaction of group A streptococci and the macroorganism have been noted. The growth of morbidity in severe invasive forms of streptococcal infection with different clinical manifestations, including the syndrome of toxic shock, is observed. Most often this disease develops in elderly people, making up a group of risk, but sometimes affects healthy young people. Different pathogenicity factors of streptococci, capable of inducing the development of infection, are analyzed. Special attention is given to superantigens: pyrogenic toxins and M-protein. The suggestion that the development of the disease is seemingly linked with the state of specific protective immunity is substantiated. In spite of achievements in the field of the microbiology and immunology of group A streptococci, the causes of the appearance and development of invasive streptococcal infection have not yet been determined.

[Cases of menstrual toxic shock syndrome in the Czech Republic in 1997-2011].

PubMed

Petrás, P; Machová, I; Rysková, L; Prásil, P

2011-11-01

To determine toxigenicity and other basic characteristics of 47 strains of Staphylococcus aureus referred to the National Reference Laboratory for Staphylococci (NRL) as suspected causative agents of menstrual toxic shock syndrome (MTSS). S. aureus strains were collected from 11 administrative regions of the Czech Republic in 1997-2011. The diagnosis was based on phenotypic (reverse latex agglutination test) and genotypic (polymerase chain reaction) methods. Forty-four S. aureus strains were producers of toxic shock syndrome toxin 1 (TSST-1), either alone or in combination with staphylococcal enterotoxin. Three strains only produced enterotoxin (B, C, and H). MTSS is a serious multisystem disease. In this study, MTSS often had a severe course requiring intensive care. All MTSS patients used vaginal tampons that had been identified in the literature as a risk factor for MTSS. The case of MTSS in a 36-year-old woman caused by an enterotoxin H positive strain of S. aureus is probably the first to be reported in the world.

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.

Atmospheric verification mission for the TSS/STARFAC tethered satellite

NASA Technical Reports Server (NTRS)

Wood, George M., Jr.; Stuart, Thomas D.; Crouch, Donald S.; Deloach, Richard; Brown, Kenneth G.

1991-01-01

Two types of a tethered satellite system (TSS) - a basic 1.8-m-diameter spherical spacecraft and the Shuttle Tethered Aerothermodynamic Research Facility (STARFAC) are considered. Issues related to the deployment and retrieval of a large satellite with exceedingly long tethers are discussed, and the objectives of an Atmospheric Verification Mission (ATM) are outlined. Focus is concentrated on the ATM satellite which will fly after TSS-1 and before the fully instrumented and costlier TSS-2. The differences between the AVM and TSS-2, including the configuration of the aerodynamic stabilizers, instrumentation, and the materials of construction are outlined. The basic Kevlar tether defined for the TSS-2 is being considered for use with the AVM, however, a complex tether is under consideration as well.

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. Copyright © 2014 Elsevier B.V. All rights reserved.

Staphylococcal Infections

MedlinePlus

... number of skin infections (eg, impetigo, pimples, boils). Staphylococcus aureus also causes toxin-related illnesses, including toxic shock syndrome, scalded skin syndrome, and staphylococcal-related food poisoning. In fact, ... Staphylococcus that you should be familiar with include the ...

Gram Positive Bacterial Superantigen Outside-In Signaling Causes Toxic Shock Syndrome

PubMed Central

Brosnahan, Amanda J.; Schlievert, Patrick M.

2011-01-01

Staphylococcus aureus and Streptococcus pyogenes (group A streptococci) are gram-positive pathogens capable of producing a variety of bacterial exotoxins known as superantigens. Superantigens interact with antigen-presenting cells (APCs) and T cells to induce T cell proliferation and massive cytokine production, which leads to fever, rash, capillary leak, and subsequent hypotension, the major symptoms of toxic shock syndrome. Both S. aureus and group A streptococci colonize mucosal surfaces, including the anterior nares and vagina for S. aureus, and the oropharynx and less commonly the vagina for group A streptococci. However, due to their abilities to secrete a variety of virulence factors, the organisms can also cause illnesses from the mucosa. This review provides an updated discussion of the biochemical and structural features of one group of secreted virulence factors, the staphylococcal and group A streptococcal superantigens, and their abilities to cause toxic shock syndrome from a mucosal surface. The main focus of this review, however, is the abilities of superantigens to induce cytokines and chemokines from epithelial cells, which has been linked to a dodecapeptide region that is relatively conserved among all superantigens and is distinct from the binding sites required for interactions with APCs and T cells. This phenomenon, termed outside-in signaling, acts to recruit adaptive immune cells to the submucosa, where the superantigens can then interact with those cells to initiate the final cytokine cascades that lead to toxic shock syndrome. PMID:21535475

Gram-positive bacterial superantigen outside-in signaling causes toxic shock syndrome.

PubMed

Brosnahan, Amanda J; Schlievert, Patrick M

2011-12-01

Staphylococcus aureus and Streptococcus pyogenes (group A streptococci) are Gram-positive pathogens capable of producing a variety of bacterial exotoxins known as superantigens. Superantigens interact with antigen-presenting cells (APCs) and T cells to induce T cell proliferation and massive cytokine production, which leads to fever, rash, capillary leak and subsequent hypotension, the major symptoms of toxic shock syndrome. Both S. aureus and group A streptococci colonize mucosal surfaces, including the anterior nares and vagina for S. aureus, and the oropharynx and less commonly the vagina for group A streptococci. However, due to their abilities to secrete a variety of virulence factors, the organisms can also cause illnesses from the mucosa. This review provides an updated discussion of the biochemical and structural features of one group of secreted virulence factors, the staphylococcal and group A streptococcal superantigens, and their abilities to cause toxic shock syndrome from a mucosal surface. The main focus of this review, however, is the abilities of superantigens to induce cytokines and chemokines from epithelial cells, which has been linked to a dodecapeptide region that is relatively conserved among all superantigens and is distinct from the binding sites required for interactions with APCs and T cells. This phenomenon, termed outside-in signaling, acts to recruit adaptive immune cells to the submucosa, where the superantigens can then interact with those cells to initiate the final cytokine cascades that lead to toxic shock syndrome. © 2011 The Authors Journal compilation © 2011 FEBS.

Atypical retardation patterns in scanning laser polarimetry are associated with low peripapillary choroidal thickness.

PubMed

Tornow, Ralf P; Schrems, Wolfgang A; Bendschneider, Delia; Horn, Folkert K; Mayer, Markus; Mardin, Christian Y; Lämmer, Robert

2011-09-29

Scanning laser polarimetry (SLP) results can be affected by an atypical retardation pattern (ARP). One reason for an ARP is the birefringence of the sclera. The purpose of this study was to investigate the influence of the peripapillary choroidal thickness (pChTh) on the occurrence of ARP. One hundred ten healthy subjects were investigated with SLP and spectral domain OCT. pChTh was measured in B-scan images at 768 positions using semiautomatic software. Values were averaged to 32 sectors and the total peripapillary mean. Subjects were divided into four groups according to the typical scan score (TSS) provided by the GDxVCC: group 1 TSS, 100; group 2 TSS, 90-99; group 3 TSS, 80-89; group 4 TSS, <80. Mean pChTh (± SD) in 110 healthy subjects was 141 μm (±49 μm). There was a significant correlation between pChTh and TSS (r = 0.608; P < 0.001). In TSS groups 1 to 4, mean pChTh was 168 μm (±38 μm), 148 μm (± 48 μm), 119 μm (±35 μm), and 92 (±42 μm). Mean pChTh of TSS groups 3 and 4 was significantly lower than that of TSS group 1 (P < 0.001). Low values of TSS resulting from the appearance of ARP in SLP are associated with low peripapillary choroidal thickness. Reduced choroidal thickness may result in an increased amount of confounding light getting to the SLP light detectors.

Burkholderia mallei tssM Encodes a Putative Deubiquitinase That Is Secreted and Expressed inside Infected RAW 264.7 Murine Macrophages▿ †

PubMed Central

Shanks, John; Burtnick, Mary N.; Brett, Paul J.; Waag, David M.; Spurgers, Kevin B.; Ribot, Wilson J.; Schell, Mark A.; Panchal, Rekha G.; Gherardini, Frank C.; Wilkinson, Keith D.; DeShazer, David

2009-01-01

Burkholderia mallei, a category B biothreat agent, is a facultative intracellular pathogen that causes the zoonotic disease glanders. The B. mallei VirAG two-component regulatory system activates the transcription of ∼60 genes, including a large virulence gene cluster encoding a type VI secretion system (T6SS). The B. mallei tssM gene encodes a putative ubiquitin-specific protease that is physically linked to, and transcriptionally coregulated with, the T6SS gene cluster. Mass spectrometry and immunoblot analysis demonstrated that TssM was secreted in a virAG-dependent manner in vitro. Surprisingly, the T6SS was found to be dispensable for the secretion of TssM. The C-terminal half of TssM, which contains Cys and His box motifs conserved in eukaryotic deubiquitinases, was purified and biochemically characterized. Recombinant TssM hydrolyzed multiple ubiquitinated substrates and the cysteine at position 102 was critical for enzymatic activity. The tssM gene was expressed within 1 h after uptake of B. mallei into RAW 264.7 murine macrophages, suggesting that the TssM deubiquitinase is produced in this intracellular niche. Although the physiological substrate(s) is currently unknown, the TssM deubiquitinase may provide B. mallei a selective advantage in the intracellular environment during infection. PMID:19168747

Space Shuttle Projects

NASA Image and Video Library

1996-02-23

An STS-75 onboard photo of the Tethered Satellite System-1 Reflight (TSS-1R) atop its extended boom. The TSS-1R was a reflight of TSS-1, which was flown on the Space Shuttle in July/August, 1992. Building on the knowledge gained on the TSS-1 about tether dynamics, the TSS will circle the Earth at an altitude of 296 kilometers (184 miles), placing the tether system well within the rarefield, electrically charged layer of the atmosphere known as the ionosphere. The satellite was plarned to be deployed 20.7 kilometers (12.9 miles) above the Shuttle. The conducting tether, generating high voltage and electrical currents as it moves through the ionosphere cutting magnetic field lines, would allow scientists to examine the electrodynamics of a conducting tether system. In addition, the TSS would increase our understanding of physical processes in the near-Earth space environment, such as plasma waves and currents. The tether on the TSS broke as the Satellite was nearing the full extent of its 12.5 mile deployment from the Shuttle. The TSS was a cooperative development effort by the Italian Space Agency (ASI) and NASA, and was managed by scientists at the Marshall Space Flight Center.

MAIT cells launch a rapid, robust and distinct hyperinflammatory response to bacterial superantigens and quickly acquire an anergic phenotype that impedes their cognate antimicrobial function: Defining a novel mechanism of superantigen-induced immunopathology and immunosuppression

PubMed Central

Shaler, Christopher R.; Choi, Joshua; Rudak, Patrick T.; Memarnejadian, Arash; Szabo, Peter A.; Tun-Abraham, Mauro E.; Rossjohn, Jamie; Corbett, Alexandra J.; McCluskey, James; McCormick, John K.; Lantz, Olivier; Hernandez-Alejandro, Roberto; Haeryfar, S.M. Mansour

2017-01-01

Superantigens (SAgs) are potent exotoxins secreted by Staphylococcus aureus and Streptococcus pyogenes. They target a large fraction of T cell pools to set in motion a “cytokine storm” with severe and sometimes life-threatening consequences typically encountered in toxic shock syndrome (TSS). Given the rapidity with which TSS develops, designing timely and truly targeted therapies for this syndrome requires identification of key mediators of the cytokine storm’s initial wave. Equally important, early host responses to SAgs can be accompanied or followed by a state of immunosuppression, which in turn jeopardizes the host’s ability to combat and clear infections. Unlike in mouse models, the mechanisms underlying SAg-associated immunosuppression in humans are ill-defined. In this work, we have identified a population of innate-like T cells, called mucosa-associated invariant T (MAIT) cells, as the most powerful source of pro-inflammatory cytokines after exposure to SAgs. We have utilized primary human peripheral blood and hepatic mononuclear cells, mouse MAIT hybridoma lines, HLA-DR4-transgenic mice, MAIThighHLA-DR4+ bone marrow chimeras, and humanized NOD-scid IL-2Rγnull mice to demonstrate for the first time that: i) mouse and human MAIT cells are hyperresponsive to SAgs, typified by staphylococcal enterotoxin B (SEB); ii) the human MAIT cell response to SEB is rapid and far greater in magnitude than that launched by unfractionated conventional T, invariant natural killer T (iNKT) or γδ T cells, and is characterized by production of interferon (IFN)-γ, tumor necrosis factor (TNF)-α and interleukin (IL)-2, but not IL-17A; iii) high-affinity MHC class II interaction with SAgs, but not MHC-related protein 1 (MR1) participation, is required for MAIT cell activation; iv) MAIT cell responses to SEB can occur in a T cell receptor (TCR) Vβ–specific manner but are largely contributed by IL-12 and IL-18; v) as MAIT cells are primed by SAgs, they also begin to develop a molecular signature consistent with exhaustion and failure to participate in antimicrobial defense. Accordingly, they upregulate lymphocyte-activation gene 3 (LAG-3), T cell immunoglobulin and mucin-3 (TIM-3), and/or programmed cell death-1 (PD-1), and acquire an anergic phenotype that interferes with their cognate function against Klebsiella pneumoniae and Escherichia coli; vi) MAIT cell hyperactivation and anergy co-utilize a signaling pathway that is governed by p38 and MEK1/2. Collectively, our findings demonstrate a pathogenic, rather than protective, role for MAIT cells during infection. Furthermore, we propose a novel mechanism of SAg-associated immunosuppression in humans. MAIT cells may therefore provide an attractive therapeutic target for the management of both early and late phases of severe SAg-mediated illnesses. PMID:28632753

Traits of surface water pollution under climate and land use changes: A remote sensing and hydrological modeling approach

NASA Astrophysics Data System (ADS)

Jordan, Yuyan C.; Ghulam, Abduwasit; Hartling, Sean

2014-01-01

In this paper, spatial and temporal trajectories of land cover/land use change (LCLUC) derived from Landsat data record are combined with hydrological modeling to explore the implication of vegetation dynamics on soil erosion and total suspended sediment (TSS) loading to surface rivers. The inter-annual coefficient of variation (CoV) of normalized difference vegetation index (NDVI) is used to screen the LCLUC and climate change. The Soil and Water Assessment Tool (SWAT) is employed to identify the monthly TSS for two times interval (1991 to 2001 and 2001 to 2011) at subbasin levels. SWAT model is calibrated from 1991 to 2001 and validated from 2002 to 2011 at three USGS gauging sites located in the study area. The Spearman's rank correlation of annual mean TSS is used to assess the temporal trends of TSS dynamics in the subbasins in the two study periods. The spatial correlation among NDVI, LCLUC, climate change and TSS loading rate changes is quantified by using linear regression model and negative/positive trend analysis. Our results showed that higher rainfall yields contribute to higher TSS loading into surface waters. A higher inter-annual accumulated vegetation index and lower inter-annual CoV distributed over the uplands resulted in a lower TSS loading rate, while a relatively low vegetation index with larger CoV observed over lowlands resulted in a higher TSS loading rate. The TSS loading rate at the basin outlet increased with the decrease of annual NDVI due to expanding urban areas in the watershed. The results also suggested nonlinearity between the trends of TSS loading with any of a specific land cover change because of the fact that the contribution of a factor can be influenced by the effects of other factors. However, dominant factors that shape the relationship between the trend of TSS loading and specific land cover changes were detected. The change of forest showed a negative relationship while agriculture and pasture demonstrated positive relationships with TSS loading change. Our results do not show any significant causal relationship between urbanization and the TSS loading change suggesting that further investigation needs to be carried out to understand the mechanism of the impact of urban sprawl on surface water quality.

Hyperspectral sensing for turbid water quality monitoring in freshwater rivers: Empirical relationship between reflectance and turbidity and total solids.

PubMed

Wu, Jiunn-Lin; Ho, Chung-Ru; Huang, Chia-Ching; Srivastav, Arun Lal; Tzeng, Jing-Hua; Lin, Yao-Tung

2014-11-28

Total suspended solid (TSS) is an important water quality parameter. This study was conducted to test the feasibility of the band combination of hyperspectral sensing for inland turbid water monitoring in Taiwan. The field spectral reflectance in the Wu river basin of Taiwan was measured with a spectroradiometer; the water samples were collected from the different sites of the Wu river basin and some water quality parameters were analyzed on the sites (in situ) as well as brought to the laboratory for further analysis. To obtain the data set for this study, 160 in situ sample observations were carried out during campaigns from August to December, 2005. The water quality results were correlated with the reflectivity to determine the spectral characteristics and their relationship with turbidity and TSS. Furthermore, multiple-regression (MR) and artificial neural network (ANN) were used to model the transformation function between TSS concentration and turbidity levels of stream water, and the radiance measured by the spectroradiometer. The value of the turbidity and TSS correlation coefficient was 0.766, which implies that turbidity is significantly related to TSS in the Wu river basin. The results indicated that TSS and turbidity are positively correlated in a significant way across the entire spectrum, when TSS concentration and turbidity levels were under 800 mg·L(-1) and 600 NTU, respectively. Optimal wavelengths for the measurements of TSS and turbidity are found in the 700 and 900 nm range, respectively. Based on the results, better accuracy was obtained only when the ranges of turbidity and TSS concentration were less than 800 mg·L(-1) and less than 600 NTU, respectively and used rather than using whole dataset (R(2) = 0.93 versus 0.88 for turbidity and R(2) = 0.83 versus 0.58 for TSS). On the other hand, the ANN approach can improve the TSS retrieval using MR. The accuracy of TSS estimation applying ANN (R(2) = 0.66) was better than with the MR approach (R(2) = 0.58), as expected due to the nonlinear nature of the transformation model.

Hyperspectral Sensing for Turbid Water Quality Monitoring in Freshwater Rivers: Empirical Relationship between Reflectance and Turbidity and Total Solids

PubMed Central

Wu, Jiunn-Lin; Ho, Chung-Ru; Huang, Chia-Ching; Srivastav, Arun Lal; Tzeng, Jing-Hua; Lin, Yao-Tung

2014-01-01

Total suspended solid (TSS) is an important water quality parameter. This study was conducted to test the feasibility of the band combination of hyperspectral sensing for inland turbid water monitoring in Taiwan. The field spectral reflectance in the Wu river basin of Taiwan was measured with a spectroradiometer; the water samples were collected from the different sites of the Wu river basin and some water quality parameters were analyzed on the sites (in situ) as well as brought to the laboratory for further analysis. To obtain the data set for this study, 160 in situ sample observations were carried out during campaigns from August to December, 2005. The water quality results were correlated with the reflectivity to determine the spectral characteristics and their relationship with turbidity and TSS. Furthermore, multiple-regression (MR) and artificial neural network (ANN) were used to model the transformation function between TSS concentration and turbidity levels of stream water, and the radiance measured by the spectroradiometer. The value of the turbidity and TSS correlation coefficient was 0.766, which implies that turbidity is significantly related to TSS in the Wu river basin. The results indicated that TSS and turbidity are positively correlated in a significant way across the entire spectrum, when TSS concentration and turbidity levels were under 800 mg·L−1 and 600 NTU, respectively. Optimal wavelengths for the measurements of TSS and turbidity are found in the 700 and 900 nm range, respectively. Based on the results, better accuracy was obtained only when the ranges of turbidity and TSS concentration were less than 800 mg·L−1 and less than 600 NTU, respectively and used rather than using whole dataset (R2 = 0.93 versus 0.88 for turbidity and R2 = 0.83 versus 0.58 for TSS). On the other hand, the ANN approach can improve the TSS retrieval using MR. The accuracy of TSS estimation applying ANN (R2 = 0.66) was better than with the MR approach (R2 = 0.58), as expected due to the nonlinear nature of the transformation model. PMID:25460816

Impact of the spatial resolution of satellite remote sensing sensors in the quantification of total suspended sediment concentration: A case study in turbid waters of Northern Western Australia.

PubMed

Dorji, Passang; Fearns, Peter

2017-01-01

The impact of anthropogenic activities on coastal waters is a cause of concern because such activities add to the total suspended sediment (TSS) budget of the coastal waters, which have negative impacts on the coastal ecosystem. Satellite remote sensing provides a powerful tool in monitoring TSS concentration at high spatiotemporal resolution, but coastal managers should be mindful that the satellite-derived TSS concentrations are dependent on the satellite sensor's radiometric properties, atmospheric correction approaches, the spatial resolution and the limitations of specific TSS algorithms. In this study, we investigated the impact of different spatial resolutions of satellite sensor on the quantification of TSS concentration in coastal waters of northern Western Australia. We quantified the TSS product derived from MODerate resolution Imaging Spectroradiometer (MODIS)-Aqua, Landsat-8 Operational Land Image (OLI), and WorldView-2 (WV2) at native spatial resolutions of 250 m, 30 m and 2 m respectively and coarser spatial resolution (resampled up to 5 km) to quantify the impact of spatial resolution on the derived TSS product in different turbidity conditions. The results from the study show that in the waters of high turbidity and high spatial variability, the high spatial resolution WV2 sensor reported TSS concentration as high as 160 mg L-1 while the low spatial resolution MODIS-Aqua reported a maximum TSS concentration of 23.6 mg L-1. Degrading the spatial resolution of each satellite sensor for highly spatially variable turbid waters led to variability in the TSS concentrations of 114.46%, 304.68% and 38.2% for WV2, Landsat-8 OLI and MODIS-Aqua respectively. The implications of this work are particularly relevant in the situation of compliance monitoring where operations may be required to restrict TSS concentrations to a pre-defined limit.

Impact of the spatial resolution of satellite remote sensing sensors in the quantification of total suspended sediment concentration: A case study in turbid waters of Northern Western Australia

PubMed Central

Fearns, Peter

2017-01-01

The impact of anthropogenic activities on coastal waters is a cause of concern because such activities add to the total suspended sediment (TSS) budget of the coastal waters, which have negative impacts on the coastal ecosystem. Satellite remote sensing provides a powerful tool in monitoring TSS concentration at high spatiotemporal resolution, but coastal managers should be mindful that the satellite-derived TSS concentrations are dependent on the satellite sensor’s radiometric properties, atmospheric correction approaches, the spatial resolution and the limitations of specific TSS algorithms. In this study, we investigated the impact of different spatial resolutions of satellite sensor on the quantification of TSS concentration in coastal waters of northern Western Australia. We quantified the TSS product derived from MODerate resolution Imaging Spectroradiometer (MODIS)-Aqua, Landsat-8 Operational Land Image (OLI), and WorldView-2 (WV2) at native spatial resolutions of 250 m, 30 m and 2 m respectively and coarser spatial resolution (resampled up to 5 km) to quantify the impact of spatial resolution on the derived TSS product in different turbidity conditions. The results from the study show that in the waters of high turbidity and high spatial variability, the high spatial resolution WV2 sensor reported TSS concentration as high as 160 mg L-1 while the low spatial resolution MODIS-Aqua reported a maximum TSS concentration of 23.6 mg L-1. Degrading the spatial resolution of each satellite sensor for highly spatially variable turbid waters led to variability in the TSS concentrations of 114.46%, 304.68% and 38.2% for WV2, Landsat-8 OLI and MODIS-Aqua respectively. The implications of this work are particularly relevant in the situation of compliance monitoring where operations may be required to restrict TSS concentrations to a pre-defined limit. PMID:28380059

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.

National Department of Defense Surveillance for Clinical Group A Streptococcal Isolates, Antibiotic Resistance, and emm Gene Types from 8 Basic Training Military Sites

DTIC Science & Technology

2003-01-08

streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 1989;321:1-7. 7. Gunzenhauser JD... fever (ARF), necrotizing fasciitis, sepsis, and streptococcal toxic shock syndrome [1]. In the 1980s both U.S. civilian and military personnel...Orsmond G, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med 1987;316:421-7. 3. Wallace MR

Intrauterine device infection causing concomitant streptococcal toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus bacteraemia

PubMed Central

Wu, Carolyn M Yu; Noska, Amanda

2016-01-01

Intrauterine devices (IUDs) are rarely associated with serious infections. We report an unusual concomitant infection of group A Streptococcus (GAS) causing toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus associated with an IUD in a healthy 50-year-old patient. The IUD was subsequently removed and the patient recovered on the appropriate antibiotics. This case highlights the importance of clinicians’ high index of suspicion of an IUD infection and prompt removal of the infected foreign body to obtain source control. PMID:26965406

Intrauterine device infection causing concomitant streptococcal toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus bacteraemia.

PubMed

Wu, Carolyn M Yu; Noska, Amanda

2016-03-10

Intrauterine devices (IUDs) are rarely associated with serious infections. We report an unusual concomitant infection of group A Streptococcus (GAS) causing toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus associated with an IUD in a healthy 50-year-old patient. The IUD was subsequently removed and the patient recovered on the appropriate antibiotics. This case highlights the importance of clinicians' high index of suspicion of an IUD infection and prompt removal of the infected foreign body to obtain source control. 2016 BMJ Publishing Group Ltd.

Atypical birefringence pattern and the diagnostic ability of scanning laser polarimetry with enhanced corneal compensation in glaucoma.

PubMed

Rao, Harsha L; Yadav, Ravi K; Begum, Viquar U; Addepalli, Uday K; Senthil, Sirisha; Choudhari, Nikhil S; Garudadri, Chandra S

2015-03-01

To evaluate the effect of typical scan score (TSS), when within the acceptable limits, on the diagnostic performance of retinal nerve fibre layer (RNFL) parameters with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in glaucoma. In a cross-sectional study, 203 eyes of 160 glaucoma patients and 140 eyes of 104 control subjects underwent RNFL imaging with the ECC protocol of SLP. TSS was used to quantify atypical birefringence pattern (ABP) images. Influence of TSS on the diagnostic ability of SLP parameters was evaluated by receiver operating characteristic (ROC) regression models after adjusting for the effect of disease severity [based on mean deviation (MD)] on standard automated perimetry). Diagnostic abilities of all RNFL parameters of SLP increased when the TSS values were higher. This effect was statistically significant for TSNIT (coefficient: 0.08, p<0.001) and inferior average parameters (coefficient: 0.06, p=0.002) but not for nerve fibre indicator (NFI, coefficient: 0.03, p=0.21). In early glaucoma (MD of -5 dB), predicted area under ROC curve (AUC) for TSNIT average parameter improved from 0.642 at a TSS of 90 to 0.845 at a TSS of 100. In advanced glaucoma (MD of -15 dB), AUC for TSNIT average improved from 0.832 at a TSS of 90 to 0.947 at 100. Diagnostic performances of TSNIT and inferior average RNFL parameters with ECC protocol of SLP were significantly influenced by TSS even when the TSS values were within the acceptable limits. Diagnostic ability of NFI was unaffected by TSS values. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Regulation of K+ Transport in Tomato Roots by the TSS1 Locus. Implications in Salt Tolerance1

PubMed Central

Rubio, Lourdes; Rosado, Abel; Linares-Rueda, Adolfo; Borsani, Omar; García-Sánchez, María J.; Valpuesta, Victoriano; Fernández, José A.; Botella, Miguel A.

2004-01-01

The tss1 tomato (Lycopersicon esculentum) mutant exhibited reduced growth in low K+ and hypersensitivity to Na+ and Li+. Increased Ca2+ in the culture medium suppressed the Na+ hypersensitivity and the growth defect on low K+ medium of tss1 seedlings. Interestingly, removing NH4+ from the growth medium suppressed all growth defects of tss1, suggesting a defective NH4+-insensitive component of K+ transport. We performed electrophysiological studies to understand the contribution of the NH4+-sensitive and -insensitive components of K+ transport in wild-type and tss1 roots. Although at 1 mm Ca2+ we found no differences in affinity for K+ uptake between wild type and tss1 in the absence of NH4+, the maximum depolarization value was about one-half in tss1, suggesting that a set of K+ transporters is inactive in the mutant. However, these transporters became active by raising the external Ca2+ concentration. In the presence of NH4+, a reduced affinity for K+ was observed in both types of seedlings, but tss1 at 1 mm Ca2+ exhibited a 2-fold higher Km than wild type did. This defect was again corrected by raising the external concentration of Ca2+. Therefore, membrane potential measurements in root cells indicated that tss1 is affected in both NH4+-sensitive and -insensitive components of K+ transport at low Ca2+ concentrations and that this defective transport is rescued by increasing the concentration of Ca2+. Our results suggest that the TSS1 gene product is part of a crucial pathway mediating the beneficial effects of Ca2+ involved in K+ nutrition and salt tolerance. PMID:14684839

Theory and Modeling in Support of Tether

NASA Technical Reports Server (NTRS)

Chang, C. L.; Bergeron, G.; Drobot, A. D.; Papadopoulos, K.; Riyopoulos, S.; Szuszczewicz, E.

1999-01-01

This final report summarizes the work performed by SAIC's Applied Physics Operation on the modeling and support of Tethered Satellite System missions (TSS-1 and TSS-1R). The SAIC team, known to be Theory and Modeling in Support of Tether (TMST) investigation, was one of the original twelve teams selected in July, 1985 for the first TSS mission. The accomplishments described in this report cover the period December 19, 1985 to September 31, 1999 and are the result of a continuous effort aimed at supporting the TSS missions in the following major areas. During the contract period, the SAIC's TMST investigation acted to: Participate in the planning and the execution on both of the TSS missions; Provide scientific understanding on the issues involved in the electrodynamic tether system operation prior to the TSS missions; Predict ionospheric conditions encountered during the re-flight mission (TSS-lR) based on realtime global ionosounde data; Perform post mission analyses to enhance our understanding on the TSS results. Specifically, we have 1) constructed and improved current collection models and enhanced our understanding on the current-voltage data; 2) investigated the effects of neutral gas in the current collection processes; 3) conducted laboratory experiments to study the discharge phenomena during and after tether-break; and 4) perform numerical simulations to understand data collected by plasma instruments SPES onboard the TSS satellite; Design and produce multi-media CD that highlights TSS mission achievements and convey the knowledge of the tether technology to the general public. Along with discussions of this work, a list of publications and presentations derived from the TMST investigation spanning the reporting period is compiled.

Epidermal Growth Factor Receptor Signaling Enhances the Proinflammatory Effects of Staphylococcus aureus Gamma-Toxin on the Mucosa.

PubMed

Gillman, Aaron N; Breshears, Laura M; Kistler, Charles K; Finnegan, Patrick M; Torres, Victor J; Schlievert, Patrick M; Peterson, Marnie L

2017-06-28

Staphylococcus aureus ( S. aureus ) produces many different exotoxins including the gamma-toxins, HlgAB and HlgCB. Gamma-toxins form pores in both leukocyte and erythrocyte membranes, resulting in cell lysis. The genes encoding gamma-toxins are present in most strains of S. aureus, and are commonly expressed in clinical isolates recovered from menstrual Toxic Shock Syndrome (mTSS) patients. This study set out to investigate the cytotoxic and proinflammatory effects of gamma-toxins on vaginal epithelial surfaces. We found that both HlgAB and HlgCB were cytotoxic to cultured human vaginal epithelial cells (HVECs) and induced cytokine production at sub-cytotoxic doses. Cytokine production induced by gamma-toxin treatment of HVECs was found to involve epidermal growth factor receptor (EGFR) signaling and mediated by shedding of EGFR ligands from the cell surface. The gamma-toxin subunits displayed differential binding to HVECs (HlgA 93%, HlgB 97% and HlgC 28%) with both components (HlgAB or HlgCB) required for maximum detectable binding and significant stimulation of cytokine production. In studies using full thickness ex vivo porcine vaginal mucosa, HlgAB or HlgCB stimulated a dose-dependent cytokine response, which was reduced significantly by inhibition of EGFR signaling. The effects of gamma-toxins on porcine vaginal tissue and cultured HVECs were validated using ex vivo human ectocervical tissue. Collectively, these studies have identified the EGFR-signaling pathway as a key component in gamma-toxin-induced proinflammatory changes at epithelial surfaces and highlight a potential therapeutic target to diminish toxigenic effects of S. aureus infections.

[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.

Biomarkers for pediatric sepsis and septic shock

PubMed Central

Standage, Stephen W; Wong, Hector R

2011-01-01

Sepsis is a clinical syndrome defined by physiologic changes indicative of systemic inflammation, which are likely attributable to documented or suspected infection. Septic shock is the progression of those physiologic changes to the extent that delivery of oxygen and metabolic substrate to tissues is compromised. Biomarkers have the potential to diagnose, monitor, stratify and predict outcome in these syndromes. C-reactive protein is elevated in inflammatory and infectious conditions and has long been used as a biomarker indicating infection. Procalcitonin has more recently been shown to better distinguish infection from inflammation. Newer candidate biomarkers for infection include IL-18 and CD64. Lactate facilitates the diagnosis of septic shock and the monitoring of its progression. Multiple stratification biomarkers based on genome-wide expression profiling are under active investigation and present exciting future possibilities. PMID:21171879

Clostridium sordellii Toxic Shock Syndrome: A Case Report and Review of the Literature

PubMed Central

Savage, Beverley A.; Vaccarello, Luis

1996-01-01

Background: Since the 1980s, there have been isolated reports of a toxic shock syndrome associated with Clostridium sordellii necrotizing subcutaneous infections during the puerperium. Relatively localized fascial and muscle necrosis is noted at the surgical incision sites. However, circulating toxins produce marked edema, resulting in shock and cardiovascular collapse. Despite aggressive surgical and supportive therapy, all postpartum cases thus far have been fatal. Case: A 24-year-old primipara developed an episiotomy infection which progressed to involve the underlying fascia and muscle. Despite early and adequate debridement of the devitalized tissue, she developed anasarca, marked leukocytosis, refractory hypotension, hypothermia, and a persistent coagulopathy, and expired on postpartum day 5. The cultures from the excised tissue grew C. sordellii All blood cultures were negative. Conclusion: Treatment modalities aimed solely at the eradication of the microbe and removal of necrotic tissue, although essential components of therapy, have proved inadequate. Future efforts should be directed toward neutralization or elimination of the circulating exotoxins responsible for the systemic shock. PMID:18476062

Clinical and clinical laboratory correlates in sea otters dying unexpectedly in rehabilitation centers following the Exxon Valdez oil spill

USGS Publications Warehouse

Rebar, A.H.; Lipscomb, T.P.; Harris, R.K.; Ballachey, Brenda E.

1995-01-01

Following the Exxon Valdez oil spill, 347 oiled sea otters (Enhydra lutris) were treated in rehabilitation centers. Of these, 116 died, 94 within 10 days of presentation. Clinical records of 21 otters dying during the first 10 days of rehabilitation were reviewed to define the laboratory abnormalities and clinical syndromes associated with these unexpected deaths. The most common terminal syndrome was shock characterized by hypothermia, lethargy, and often hemorrhagic diarrhea. In heavily and moderately oiled otters, shock developed within 48 hours of initial presentation, whereas in lightly oiled otters shock generally occurred during the second week of captivity. Accompanying laboratory abnormalities included leukopenia with increased numbers of immature neutrophils (degenerative left shift), lymphopenia, anemia, azotemia (primarily prerenal), hyperkalemia, hypoproteinemia/hypoalbuminemia, elevations of serum transaminases, and hypoglycemia. Shock associated with hemorrhagic diarrhea probably occurred either as a direct primary effect of oiling or as an indirect effect secondary to confinement and handling in the rehabilitation centers. Lightly oiled otters were less likely to die from shock than were heavily oiled otters (22% vs. 72%, respectively). Heavily oiled otters developed shock more rapidly and had greater numbers of laboratory abnormalities, suggesting that exposure to oil was an important contributing factor.

Resiliency of the western Chesapeake Bay to total suspended solid concentrations following storms and accounting for land-cover

NASA Astrophysics Data System (ADS)

Hasan, Mejs; Benninger, Larry

2017-05-01

The effect of storms on water quality in the Chesapeake Bay has been studied in a patchwork fashion at various sites for short periods of time. In this paper, we use a relationship between MODIS-Terra red light reflectance and total suspended solid (TSS) concentrations in order to develop a fourteen-year time period of TSS estimates during which effects of storms and land cover can be studied over a large portion of the Bay. Exponential fits were most appropriate, resulting in viable reflectance-TSS relationships for the five major Western Shore rivers and the Mainstem of the Bay. Other tributaries were less well-disposed for such relationships due to lack of a large range of TSS concentrations, shallow river beds, or low number of data points. Treating the entire Chesapeake as a single entity and modeling a single reflectance-TSS relationship for the entire estuary produced poorer models with less significance compared to treating each channel separately. Over 2800 rain events were studied in the Lower Western Shore between 2000 and 2014. We found some evidence that higher rainfall amounts correspond to a lower distribution of TSS concentrations 1 day following the event in forested watersheds. At rainfall events of <50 mm, maximum TSS within one day of the storm was highly variable, suggesting that rainfall amounts alone cannot explain variation in TSS levels. Finally, we found value in the use of prediction intervals around TSS estimates, a statistical procedure uncommonly used heretofore with satellite-based estimates but which can help to determine if results are significant or not.

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.

Operating microscope light-induced phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens implantation.

PubMed

Kweon, Eui Yong; Ahn, Min; Lee, Dong Wook; You, In Cheon; Kim, Min Jung; Cho, Nam Chun

2009-01-01

The purpose of this study is to report the features of operating microscope light-induced retinal phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens (TSS PC-IOL) implantation. The charts of 118 patients who underwent TSS PC-IOL implantation surgery at Chonbuk National University Hospital (Jeonju, Korea) between March 1999 and February 2008 were retrospectively reviewed. Fourteen patients underwent combined 3-port pars plana vitrectomy and TSS PC-IOL implantation (vitrectomy group), and 104 patients underwent TSS PC-IOL implantation only (nonvitrectomy group). All surgeries were performed under the same coaxial illuminated microscope. All diagnoses were confirmed through careful fundus examination and fluorescein angiography (FA). Diagnoses of retinal phototoxic maculopathy were established in 10 (8.47%) of 118 TSS PC-IOL implantation cases. Phototoxic maculopathy occurred more frequently in the vitrectomy group than in the nonvitrectomy group (6/14 versus 4/104, respectively; P < 0.001, chi-square = 24.21). Affected patients reported decreased vision and were found to have coarse alterations of the retinal pigment epithelium (RPE). In 5 of the phototoxic maculopathy cases (50%), the visual acuity was 20/200 or worse. Operating microscope light-induced retinal phototoxic maculopathy can occur more frequently after TSS PC-IOL implantation than after casual cataract surgery, especially when TSS PC-IOL is combined with vitrectomy surgery. Surgeons should take precautions to prevent retinal phototoxicity after TSS PC-IOL implantation and vitrectomy.

Vaccination with plasmid DNA encoding a mutant toxic shock syndrome toxin-1 ameliorates toxin-induced lethal shock in mice.

PubMed

Feng, Mao-Hui; Cui, Jing-Chun; Nakane, Akio; Hu, Dong-Liang

2013-09-01

Staphylococcal toxic shock syndrome toxin-1 (TSST-1), a superantigenic toxin produced by Staphylococcus (S.) aureus, is a major cause of septic shock and toxic shock syndrome. To investigate whether vaccination with a plasmid DNA encoding a non-toxic mutant TSST-1 (mTSST-1) can protect mice against wild-type TSST-1-induced lethal shock, the mice were intranasally immunized with the plasmid DNA (named pcDNA-mTSST-1) plus a mucosal adjuvant, a non-toxic mutant labile toxin (mLT). After the immunization, the mice were challenged with TSST-1 and lipopolysaccharide (LPS). The survival rate of mice immunized with pcDNA-mTSST-1 plus mLT was higher than that of the control mice immunized with PBS alone, mLT alone, pcDNA-mTSST-1 alone, or a parent plasmid plus mLT. The titers of interferon-γ (IFN-γ) in the sera of mice immunized with pcDNA-mTSST-1 plus mLT were significantly lower than those of the mLT control mice. Immunization with pcDNA-mTSST-1 plus mLT increased the serum levels of TSST-1-specific antibodies, especially immunoglobulin G1 (IgG1) and IgG2a subclasses. Furthermore, the sera obtained from mice immunized with pcDNA-mTSST-1 plus mLT significantly inhibited the TSST-1-induced secretion of IFN-γ and tumor necrosis factor-α (TNF-α) in murine spleen cells in vitro. These results indicate that immunization with pcDNA-mTSST-1 plus mLT provides protection against the lethal toxic shock of mice induced by wild-type TSST-1. The protective effect could be due to TSST-1-specific neutralizing antibodies as well as the inhibition of IFN-γ and TNF-α secretions. Since TSST-1 is commonly released by invasive S. aureus, the pcDNA-mTSST-1 should be useful in preventing toxin-induced shock resulting from S. aureus infection.

A fatal case of streptococcal toxic shock syndrome caused by Streptococcus suis carrying tet (40) and tet (O/W/32/O), Italy.

PubMed

Mancini, Fabiola; Adamo, Francesco; Creti, Roberta; Monaco, Monica; Alfarone, Giovanna; Pantosti, Annalisa; Ciervo, Alessandra

2016-11-01

We report the first human fatal case of streptococcal toxic shock syndrome (STSS) caused by Streptococcus suis serotype 2 carrying the tetracycline efflux tet (40) gene and the tetracycline ribosomal protection tet (O/W/32/O) gene. The patient was splenectomized. The case was characterized by multi-organ dysfunction and disseminated intravascular coagulopathy, in accordance with the clinical parameters of STSS. More investigations are needed to improve the epidemiology and the pathogenesis of S. suis in human infection. Published by Elsevier Ltd.

Surveillance of group B streptococcal toxic shock-like syndrome in nonpregnant adults and characterization of the strains in Japan.

PubMed

Chang, Bin; Ikebe, Tadayoshi; Wada, Akihito; Ogata, Kikuyo; Tomita, Masaaki; Katsukawa, Chihiro; Kawahara, Ryuji; Suzuki, Rieko; Endo, Miyoko; Isobe, Junko; Tanaka, Daisuke; Hirasawa, Kyoko; Watanabe, Haruo

2006-06-01

Nine group B streptococci (GBS) strains were isolated from five toxic shock-like syndrome cases of nonpregnant adults in Japan from 2001 to 2005. All of them were identified as Streptococcus agalactiae. The serotypes of these strains were Ib, III, V, and VII. Pulsed-field gel electrophoresis revealed that the patterns of the strains isolated from the different patients were variable. Antimicrobial susceptibility tests showed that all of the strains were susceptible to penicillin G, ampicillin, cefotaxime, clindamycin, and telithromycin. One strain showed intermediate resistance to erythromycin.

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

Viridans streptococcal shock syndrome during bone marrow transplantation.

PubMed

Martino, R; Manteiga, R; Sánchez, I; Brunet, S; Sureda, A; Badell, I; Argilés, B; Subirá, M; Bordes, R; Domingo-Albós, A

1995-01-01

Of 320 patients receiving a marrow transplant at the Hospital de Sant Pau between 1986 and 1992, 12% developed viridans streptococcal bacteremia during severe neutropenia. Five of these patients (13%) developed a rapidly progressive fatal shock syndrome characterized by bilateral pulmonary infiltrates, acute respiratory failure (ARDS) and septic shock early in the transplantation course (6 or 7 days posttransplantation). All patients were transplanted for acute leukemia in remission, and 2 received an allogeneic and 3 an autologous transplant. Four of these subjects were younger than 15 years of age and all had received cyclophosphamide and total body irradiation as conditioning regimen for marrow transplantation. All 5 patients died, and postmortem examinations revealed diffuse pulmonary lesions characteristic of the ARDS. These observations contribute to defining the clinical and pathologic characteristics of this serious complication of intensive anticancer treatment.

Adjustment of total suspended solids data for use in sediment studies

USGS Publications Warehouse

Glysson, G. Douglas; Gray, John R.; Conge, L.M.; Hotchkiss, Rollin H.; Glade, Michael

2000-01-01

The U.S. Environmental Protection Agency identifies fluvial sediment as the single most widespread pollutant in the Nation's rivers and streams, affecting aquatic habitat, drinking water treatment processes, and recreational uses of rivers, lakes, and estuaries. A significant amount of suspended-sediment data has been produced using the total suspended solids (TSS) laboratory analysis method. An evaluation of data collected and analyzed by the U.S. Geological Survey and others has shown that the variation in TSS analytical results is considerably larger than that for traditional suspended-sediment concentration analyses (SSC) and that the TSS data show a negative bias when compared to SSC data. This paper presents the initial results of a continuing investigation into the differences between TSS and SSC results. It explores possible relations between these differences and other hydrologic data collected at the same stations. A general equation was developed to relate TSS data to SSC data. However, this general equation is not applicable for data from individual stations. Based on these analyses, there appears to be no simple, straightforward way to relate TSS and SSC data unless pairs of TSS and SSC results are available for a station.

Cardiac complications in a metamizole-induced type I Kounis syndrome.

PubMed

Juste, Jose F Martínez; Garces, Tomas Ruiz; Enguita, Rafael Gonzalez; Blasco, Pedro Cia; Trallero, Jara Altemir

2016-01-01

Kounis syndrome is defined as the coincidental occurrence of allergic reaction and acute coronary syndrome secondary to vasospasm. Anti-inflammatory drugs are included as one of the multiple causes. Current data available about this syndrome come from case reports. We present the case of a patient who suffered Kounis syndrome with cardiogenic shock and asystole after intravenous infusion of Metamizole, and in which no lesions were observed in coronariography. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Streptococcal toxic-shock syndrome due to Streptococcus dysgalactiae subspecies equisimilis in breast cancer-related lymphedema: a case report.

PubMed

Sumazaki, Makoto; Saito, Fumi; Ogata, Hideaki; Yoshida, Miho; Kubota, Yorichika; Magoshi, Syunsuke; Kaneko, Hironori

2017-07-14

Breast cancer-related lymphedema often causes cellulitis and is one of the most common complications after breast cancer surgery. Streptococci are the major pathogens underlying such cellulitis. Among the streptococci, the importance of the Lancefield groups C and G is underappreciated; most cases involve Streptococcus dysgalactiae subspecies equisimilis. Despite having a relatively weak toxicity compared with group A streptococci, Streptococcus dysgalactiae subspecies equisimilis is associated with a mortality rate that is as high as that of group A streptococci in cases of invasive infection because Streptococcus dysgalactiae subspecies equisimilis mainly affects elderly individuals who already have various comorbidities. An 83-year-old Japanese woman with breast cancer-related lymphedema in her left upper limb was referred to our hospital with high fever and acute pain with erythema in her left arm. She showed septic shock with disseminated intravascular coagulation. Blood culture showed positive results for Streptococcus dysgalactiae subspecies equisimilis, confirming a diagnosis of streptococcal toxic-shock syndrome. She survived after successful intensive care. To the best of our knowledge, this case represents the first report of Streptococcus dysgalactiae subspecies equisimilis-induced streptococcal toxic-shock syndrome in a patient with breast cancer-related lymphedema. Breast cancer-related lymphedema is a common problem, and we must pay attention to invasive streptococcal soft tissue infections, particularly in elderly patients with chronic disease.

Efficient MRI labeling of endothelial progenitor cells: design of thiolated surface stabilized superparamagnetic iron oxide nanoparticles.

PubMed

Shahnaz, Gul; Kremser, Christian; Reinisch, Andreas; Vetter, Anja; Laffleur, Flavia; Rahmat, Deni; Iqbal, Javed; Dünnhaupt, Sarah; Salvenmoser, Willi; Tessadri, Richard; Griesser, Ulrich; Bernkop-Schnürch, Andreas

2013-11-01

The aim of this study was to design thiolated surface stabilized superparamagnetic iron oxide nanoparticles (TSS-SPIONs) for efficient internalization with high MRI sensitivity. TSS-SPIONs were developed by chelation between thiolated chitosan-thioglycolic acid (chitosan-TGA) hydrogel and iron ions (Fe(2+)/Fe(3+)). Likely, unmodified chitosan hydrogel SPIONs (UC-SPIONs) and uncoated SPIONs were used as control. Moreover, TSS-SPIONs were investigated regarding to their iron core size, hydrodynamic diameter, zeta potential, iron contents, molar relaxivities (r1 and r2), and cellular internalization. TSS-SPIONs demonstrated an iron oxide core diameter (crystallite size by XRD) of 3.1 ± 0.02 nm, a hydrodynamic diameter of 94 ± 20 nm, a zeta potential of +21 ± 5 mV, and an iron content of 3.6 ± 0.9 mg/mL. In addition, internalization of TSS-SPIONs into human endothelial progenitor cells (EPC) from umbilical cord blood was more than threefold and 17-fold higher in contrast to UC-SPIONs and SPIONs, respectively. With twofold lower incubation iron concentration of TSS-SPIONs, more than threefold higher internalization was achieved as compared to Resovist®. Also, cell viability of more than 90% was observed in the presence of TSS-SPIONs after 24h. The molar MR relaxivities (r2) value at 1.5 T was threefold higher than that of Resovist® and demonstrated that TSS-SPIONs have the potential as very effective T2 contrast-enhancement agent. According to these findings, TSS-SPIONs with efficient internalization, lower cytotoxicity, and high MRI sensitivity seem to be promising for cell tracking. Copyright © 2013 Elsevier B.V. All rights reserved.

Developing the remote sensing-based early warning system for monitoring TSS concentrations in Lake Mead.

PubMed

Imen, Sanaz; Chang, Ni-Bin; Yang, Y Jeffrey

2015-09-01

Adjustment of the water treatment process to changes in water quality is a focus area for engineers and managers of water treatment plants. The desired and preferred capability depends on timely and quantitative knowledge of water quality monitoring in terms of total suspended solids (TSS) concentrations. This paper presents the development of a suite of nowcasting and forecasting methods by using high-resolution remote-sensing-based monitoring techniques on a daily basis. First, the integrated data fusion and mining (IDFM) technique was applied to develop a near real-time monitoring system for daily nowcasting of the TSS concentrations. Then a nonlinear autoregressive neural network with external input (NARXNET) model was selected and applied for forecasting analysis of the changes in TSS concentrations over time on a rolling basis onward using the IDFM technique. The implementation of such an integrated forecasting and nowcasting approach was assessed by a case study at Lake Mead hosting the water intake for Las Vegas, Nevada, in the water-stressed western U.S. Long-term monthly averaged results showed no simultaneous impact from forest fire events on accelerating the rise of TSS concentration. However, the results showed a probable impact of a decade of drought on increasing TSS concentration in the Colorado River Arm and Overton Arm. Results of the forecasting model highlight the reservoir water level as a significant parameter in predicting TSS in Lake Mead. In addition, the R-squared value of 0.98 and the root mean square error of 0.5 between the observed and predicted TSS values demonstrates the reliability and application potential of this remote sensing-based early warning system in terms of TSS projections at a drinking water intake. Copyright © 2015 Elsevier Ltd. All rights reserved.

Plasma levels of F-actin and F:G-actin ratio as potential new biomarkers in patients with septic shock.

PubMed

Belsky, Justin B; Morris, Daniel C; Bouchebl, Ralph; Filbin, Michael R; Bobbitt, Kevin R; Jaehne, Anja K; Rivers, Emanuel P

2016-01-01

To compare plasma levels of F-actin, G-actin and thymosin beta 4 (TB4) in humans with septic shock, noninfectious systemic inflammatory response syndrome (SIRS) and healthy controls. F-actin was significantly elevated in septic shock as compared with noninfectious SIRS and healthy controls. G-actin levels were greatest in the noninfectious SIRS group but significantly elevated in septic shock as compared with healthy controls. TB4 was not detectable in the septic shock or noninfectious SIRS group above the assay's lowest detection range (78 ng/ml). F-actin is significantly elevated in patients with septic shock as compared with noninfectious SIRS. F-actin and the F:G-actin ratio are potential biomarkers for the diagnosis of septic shock.

Streamflow and water-quality properties in the West Fork San Jacinto River Basin and regression models to estimate real-time suspended-sediment and total suspended-solids concentrations and loads in the West Fork San Jacinto River in the vicinity of Conroe, Texas, July 2008-August 2009

USGS Publications Warehouse

Bodkin, Lee J.; Oden, Jeannette H.

2010-01-01

To better understand the hydrology (streamflow and water quality) of the West Fork San Jacinto River Basin downstream from Lake Conroe near Conroe, Texas, including spatial and temporal variation in suspended-sediment (SS) and total suspended-solids (TSS) concentrations and loads, the U.S. Geological Survey, in cooperation with the Houston-Galveston Area Council and the Texas Commission on Environmental Quality, measured streamflow and collected continuous and discrete water-quality data during July 2008-August 2009 in the West Fork San Jacinto River Basin downstream from Lake Conroe. During July 2008-August 2009, discrete samples were collected and streamflow measurements were made over the range of flow conditions at two streamflow-gaging stations on the West Fork San Jacinto River: West Fork San Jacinto River below Lake Conroe near Conroe, Texas (station 08067650) and West Fork San Jacinto River near Conroe, Texas (station 08068000). In addition to samples collected at these two main monitoring sites, discrete sediment samples were also collected at five additional monitoring sites to help characterize water quality in the West Fork San Jacinto River Basin. Discrete samples were collected semimonthly, regardless of flow conditions, and during periods of high flow resulting from storms or releases from Lake Conroe. Because the period of data collection was relatively short (14 months) and low flow was prevalent during much of the study, relatively few samples collected were representative of the middle and upper ranges of historical daily mean streamflows. The largest streamflows tended to occur in response to large rainfall events and generally were associated with the largest SS and TSS concentrations. The maximum SS and TSS concentrations at station 08067650 (180 and 133 milligrams per liter [mg/L], respectively) were on April 19, 2009, when the instantaneous streamflow was the third largest associated with a discrete sample at the station. SS concentrations were 25 mg/L or less in 26 of 29 environmental samples and TSS concentrations were 25 mg/L or less in 25 of 28 environmental samples. Median SS and TSS concentrations were 7.0 and 7.6 mg/L, respectively. At station 08068000, the maximum SS concentration (1,270 mg/L) was on April 19, 2009, and the maximum TSS concentration (268 mg/L) was on September 18, 2008. SS concentrations were 25 mg/L or less in 16 of 27 of environmental samples and TSS concentrations were 25 mg/L or less in 18 of 26 environmental samples at the station. Median SS and TSS concentrations were 18.0 and 14.0 mg/L, respectively. The maximum SS and TSS concentrations for all five additional monitoring sites were 3,110 and 390 mg/L, respectively, and the minimum SS and TSS concentrations were 5.0 and 1.0 mg/L, respectively. Median concentrations ranged from 14.0 to 54.0 mg/L for SS and from 11.0 to 14.0 mg/L for TSS. Continuous measurements of streamflow and selected water-quality properties at stations 08067650 and 08068000 were evaluated as possible variables in regression equations developed to estimate SS and TSS concentrations and loads. Surrogate regression equations were developed to estimate SS and TSS loads by using real-time turbidity and streamflow data; turbidity and streamflow resulted in the best regression models for estimating near real-time SS and TSS concentrations for stations 08097650 and 08068000. Relatively large errors are associated with the regression-computed SS and TSS concentrations; the 90-percent prediction intervals for SS and TSS concentrations were (+/-)48.9 and (+/-)43.2 percent, respectively, for station 08067650 and (+/-)47.7 and (+/-)43.2 percent, respectively, for station 08068000. Regression-computed SS and TSS concentrations were corrected for bias before being used to compute SS and TSS loads. The total estimated SS and TSS loads during July 2008-August 2009 were about 3,540 and 1,900 tons, respectively, at station 08067650 and about 156,000 an

Coincident patterns of waste water suspended solids reduction, water transparency increase and chlorophyll decline in Narragansett Bay.

PubMed

Borkman, David G; Smayda, Theodore J

2016-06-15

Dramatic changes occurred in Narragansett Bay during the 1980s: water clarity increased, while phytoplankton abundance and chlorophyll concentration decreased. We examine how changes in total suspended solids (TSS) loading from wastewater treatment plants may have influenced this decline in phytoplankton chlorophyll. TSS loading, light and phytoplankton observations were compiled and a light- and temperature-dependent Skeletonema-based phytoplankton growth model was applied to evaluate chlorophyll supported by TSS nitrogen during 1983-1995. TSS loading declined 75% from ~0.60×10(6)kgmonth(-1) to ~0.15×10(6)kgmonth(-1) during 1983-1995. Model results indicate that nitrogen reduction related to TSS reduction was minor and explained a small fraction (~15%) of the long-term chlorophyll decline. The decline in NBay TSS loading appears to have increased water clarity and in situ irradiance and contributed to the long-term chlorophyll decline by inducing a physiological response of a ~20% reduction in chlorophyll per cell. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of Toki-Shakuyaku-San on Regional Cerebral Blood Flow in Patients with Mild Cognitive Impairment and Alzheimer's Disease

PubMed Central

Matsuoka, Teruyuki; Narumoto, Jin; Shibata, Keisuke; Okamura, Aiko; Taniguchi, Shogo; Kitabayashi, Yurinosuke; Fukui, Kenji

2012-01-01

The aim of this study was to examine the effect of toki-shakuyaku-san (TSS) on mild cognitive impairment (MCI) and Alzheimer's disease (AD) using single-photon emission computed tomography (SPECT). All subjects were administered TSS (7.5 g/day) for eight weeks. SPECT and evaluations using the Mini Mental State Examination (MMSE), Neuropsychiatric Inventory, and Physical Self-Maintenance Scale were performed before and after treatment with TSS. Three patients with MCI and five patients with AD completed the study. No adverse events occurred during the study period. After treatment with TSS, regional cerebral blood flow (rCBF) in the posterior cingulate was significantly higher than that before treatment. No brain region showed a significant decrease in rCBF. TSS treatment also tended to improve the score for orientation to place on the MMSE. These results suggest that TSS could be useful for treatment of MCI and AD. PMID:22454658

Optimization and validation of indirect ELISA using truncated TssB protein for the serodiagnosis of glanders amongst equines.

PubMed

Singha, Harisankar; Malik, Praveen; Goyal, Sachin K; Khurana, Sandip K; Mukhopadhyay, Chiranjay; Eshwara, Vandana K; Singh, Raj K

2014-01-01

To express truncated TssB protein of Burkholderia mallei and to evaluate its diagnostic efficacy for serological detection of glanders among equines. In an attempt to develop recombinant protein based enzyme-linked immunosorbent assay (ELISA), N-terminal 200 amino acid sequences of B. mallei TssB protein-a type 6 secretory effector protein--were expressed in prokaryotic expression system. Diagnostic potential of recombinant TssB protein was evaluated in indirect ELISA using a panel of glanders positive (n = 49), negative (n = 30), and field serum samples (n = 1811). Cross-reactivity of the assay was assessed with equine disease control serum and human melioidosis positive serum. In comparison to CFT, diagnostic sensitivity and specificity of ELISA were 99.7% and 100%, respectively. The indirect ELISA method using the truncated TssB offered safer and more rapid and efficient means of serodiagnosis of glanders in equines. These data highlight the use of TssB as potential diagnostic antigen for serological diagnosis of glanders.

Awareness of the Tuskegee syphilis study: impact on offenders' decisions to decline research participation.

PubMed

Poythress, Norman; Epstein, Monica; Stiles, Paul; Edens, John F

2011-01-01

Ethnic and racial minorities are often under-represented in research. There is considerable speculation that Blacks, in particular, are discouraged from research participation because of researcher improprieties in the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee (aka the Tuskegee Syphilis Study [TSS]), a 40-year (1932-1972) study in which investigators withheld medical treatment from African-American men infected with syphilis. We debriefed 281 offenders who declined participation in a research study to assess the extent to which knowledge of the TSS impacted their decisions not to enroll. Relatively few (44/281; 15.6%) reported awareness of the TSS. Half (n = 22) of these "aware" individuals could cite factually accurate information about the TSS, and only four individuals indicated that awareness of TSS had "somewhat" influenced their decision to not participate. Findings suggest that the legacy of the TSS played a relatively minor role in these offenders' decisions to decline research participation. 2011 John Wiley & Sons, Ltd.

Influence of atypical retardation pattern on the peripapillary retinal nerve fibre distribution assessed by scanning laser polarimetry and optical coherence tomography.

PubMed

Schrems, W A; Laemmer, R; Hoesl, L M; Horn, F K; Mardin, C Y; Kruse, F E; Tornow, R P

2011-10-01

To investigate the influence of atypical retardation pattern (ARP) on the distribution of peripapillary retinal nerve fibre layer (RNFL) thickness measured with scanning laser polarimetry in healthy individuals and to compare these results with RNFL thickness from spectral domain optical coherence tomography (OCT) in the same subjects. 120 healthy subjects were investigated in this study. All volunteers received detailed ophthalmological examination, GDx variable corneal compensation (VCC) and Spectralis-OCT. The subjects were divided into four subgroups according to their typical scan score (TSS): very typical with TSS=100, typical with 99 ≥ TSS ≥ 91, less typical with 90 ≥ TSS ≥ 81 and atypical with TSS ≤ 80. Deviations from very typical normal values were calculated for 32 sectors for each group. There was a systematic variation of the RNFL thickness deviation around the optic nerve head in the atypical group for the GDxVCC results. The highest percentage deviation of about 96% appeared temporal with decreasing deviation towards the superior and inferior sectors, and nasal sectors exhibited a deviation of 30%. Percentage deviations from very typical RNFL values decreased with increasing TSS. No systematic variation could be found if the RNFL thickness deviation between different TSS-groups was compared with the OCT results. The ARP has a major impact on the peripapillary RNFL distribution assessed by GDx VCC; thus, the TSS should be included in the standard printout.

Clinical profile and outcomes of acute cardiorenal syndrome type-5 in sepsis: An eight-year cohort study.

PubMed

Vallabhajosyula, Saraschandra; Sakhuja, Ankit; Geske, Jeffrey B; Kumar, Mukesh; Kashyap, Rahul; Kashani, Kianoush; Jentzer, Jacob C

2018-01-01

To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5. Acute Kidney Injury (AKI) was defined by both serum creatinine and urine output criteria of the AKI Network and the cardiac injury was determined by troponin-T levels. Outcomes included in-hospital mortality, ICU and hospital length of stay, and one-year survival. Of 602 patients meeting the study inclusion criteria, 430 (71.4%) met criteria for acute cardiorenal syndrome type-5. Patients with cardiorenal syndrome type-5 had higher severity of illness, greater vasopressor and mechanical ventilation use. Cardiorenal syndrome type-5 was associated higher unadjusted in-hospital mortality, ICU and hospital lengths of stay, and lower one-year survival. When adjusted for age, gender, severity of illness and mechanical ventilation, cardiorenal syndrome type-5 was independently associated with 1.7-times greater odds of in-hospital mortality (p = .03), but did not predict one-year survival (p = .06) compared to patients without cardiorenal syndrome. In sepsis, acute cardiorenal syndrome type-5 is associated with worse in-hospital mortality compared to patients without cardiorenal syndrome.

Present and Reference Concentrations and Yields of Suspended Sediment in Streams in the Great Lakes Region and Adjacent Areas

USGS Publications Warehouse

Robertson, Dale M.; Saad, David A.; Heisey, Dennis M.

2006-01-01

In-stream suspended sediment and siltation and downstream sedimentation are common problems in surface waters throughout the United States. The most effective way to improve surface waters impaired by sediments is to reduce the contributions from human activities rather than try to reduce loadings from natural sources. Total suspended sediment/solids (TSS) concentration data were obtained from 964 streams in the Great Lakes, Ohio, Upper Mississippi, and Souris-Red-Rainy River Basins from 1951 to 2002. These data were used to estimate median concentrations, loads, yields, and volumetrically (flow) weighted (VW) concentrations where streamflow data were available. SPAtial Regression-Tree Analysis (SPARTA) was applied to land-use-adjusted (residualized) TSS data and environmental-characteristic data to determine the natural factors that best described the distribution of median and VW TSS concentrations and yields and to delineate zones with similar natural factors affecting TSS, enabling reference or natural concentrations and yields to be estimated. Soil properties (clay and organic-matter content, erodibility, and permeability), basin slope, and land use (percentage of agriculture) were the factors most strongly related to the distribution of median and VW TSS concentrations. TSS yields were most strongly related to amount of precipitation and the resulting runoff, and secondarily to the factors related to high TSS concentrations. Reference median TSS concentrations ranged from 5 to 26 milligrams per liter (mg/L), reference median annual VW TSS concentrations ranged from 10 to 168 mg/L, and reference TSS yields ranged from about 980 to 90,000 kilograms per square kilometer per year. Independent streams (streams with no overlapping drainage areas) with TSS data were ranked by how much their water quality exceeded reference concentrations and yields. Most streams exceeding reference conditions were in the central part of the study area, where agricultural activities are the most intensive; however, other sites exceeding reference conditions were identified outside of this area. Whether concentrations or yields should be considered in guiding rehabilitation efforts depends on whether in-stream or downstream effects are more important. Although this study attempted to obtain all available water-quality data for the study area, any actual prioritization of sites for remediation would need to rely on more extensive data collection or numerical models that can accurately simulate the effects of various human activities in a range of environmental settings.

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis.

PubMed

Chua, Wei Chuan; Mazlan, Mohd Zulfakar; Ali, Saedah; Che Omar, Sanihah; Wan Hassan, Wan Mohd Nazaruddin; Seevaunnantum, S Praveena; Mohd Zaini, Rhendra Hardy; Hassan, Mohd Hasyizan; Muhd Besari, Alwi; Abd Rahman, Zaidah; Salmuna Ayub, Zeti Norfidiyati; Abd Ghani, Sabrina; Yaacob, Normalinda; Wan Rosli, Wan Rosilawati

2017-01-01

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.

Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study

PubMed Central

Zhu, De-Sheng; Fu, Jue; Zhang, Yi; Xie, Chong; Wang, Xiao-Qing; Zhang, Yue; Yang, Jie; Li, Shi-Xu; Liu, Xiao-Bei; Wan, Zhi-Wen; Dong, Qiang; Guan, Yang-Tai

2015-01-01

Background Transverse sinus stenosis (TSS) is common among patients with cerebral venous sinus thrombosis. No previous studies have reported on double-track sign detected on axial Gd-enhanced T1WI in TSS. This study aimed to determine the sensitivity and specificity of the double-track sign in the detection of TSS. Methods We retrospectively reviewed medical records of 383 patients with transverse sinus thrombosis (TST) and 30 patients with normal transverse sinus from 5 participating hospitals in china from January 2008 to June 2014. 167 feasible transverse sinuses included in this study were categorized into TSS (n = 76), transverse sinus occlusion (TSO) (n = 52) and transverse sinus normal (TSN) groups (n = 39) according to imaging diagnosis on digital subtraction angiography (DSA) or magnetic resonance venography (MRV). Double-track sign on axial Gd-enhanced T1WI was compared among the three groups. Sensitivity and specificity of double-track sign in detection of TSS were calculated, with final imaging diagnosis of TSS on DSA or MRV as the reference standard. Results Of 383 patients with TST recruited over a 6.5-year period, 128 patients were enrolled in the study, 255 patients were excluded because of insufficient clinical data, imaging finding and delay time, and 30 matched patients with normal transverse sinus were enrolled in the control group. Therefore, double-track sign assessment was conducted in 167 available transverse sinuses of 158 patients. Of the 76 sinuses in TSS group, 51 had double-track sign. Of the other 91 sinuses in TSO and TSN groups, 3 had a false-positive double-track sign. Thus, double-track sign on axial Gd-enhanced T1WI was 67.1% (95% CI 55.3–77.2) sensitive and 96.7% (95% CI 89.9–99.1) specific for detection of TSS. Conclusions The double-track sign on axial Gd-enhanced T1WI is highly specific and moderate sensitive for detection of TSS. Nevertheless, it could be a direct sign and might provide an early clue for TSS. PMID:26291452

Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study.

PubMed

Zhu, De-Sheng; Fu, Jue; Zhang, Yi; Xie, Chong; Wang, Xiao-Qing; Zhang, Yue; Yang, Jie; Li, Shi-Xu; Liu, Xiao-Bei; Wan, Zhi-Wen; Dong, Qiang; Guan, Yang-Tai

2015-01-01

Transverse sinus stenosis (TSS) is common among patients with cerebral venous sinus thrombosis. No previous studies have reported on double-track sign detected on axial Gd-enhanced T1WI in TSS. This study aimed to determine the sensitivity and specificity of the double-track sign in the detection of TSS. We retrospectively reviewed medical records of 383 patients with transverse sinus thrombosis (TST) and 30 patients with normal transverse sinus from 5 participating hospitals in china from January 2008 to June 2014. 167 feasible transverse sinuses included in this study were categorized into TSS (n = 76), transverse sinus occlusion (TSO) (n = 52) and transverse sinus normal (TSN) groups (n = 39) according to imaging diagnosis on digital subtraction angiography (DSA) or magnetic resonance venography (MRV). Double-track sign on axial Gd-enhanced T1WI was compared among the three groups. Sensitivity and specificity of double-track sign in detection of TSS were calculated, with final imaging diagnosis of TSS on DSA or MRV as the reference standard. Of 383 patients with TST recruited over a 6.5-year period, 128 patients were enrolled in the study, 255 patients were excluded because of insufficient clinical data, imaging finding and delay time, and 30 matched patients with normal transverse sinus were enrolled in the control group. Therefore, double-track sign assessment was conducted in 167 available transverse sinuses of 158 patients. Of the 76 sinuses in TSS group, 51 had double-track sign. Of the other 91 sinuses in TSO and TSN groups, 3 had a false-positive double-track sign. Thus, double-track sign on axial Gd-enhanced T1WI was 67.1% (95% CI 55.3-77.2) sensitive and 96.7% (95% CI 89.9-99.1) specific for detection of TSS. The double-track sign on axial Gd-enhanced T1WI is highly specific and moderate sensitive for detection of TSS. Nevertheless, it could be a direct sign and might provide an early clue for TSS.

A fatal case of streptococcal toxic shock syndrome due to Streptococcus dysgalactiae subsp. equisimilis possibly caused by an intramuscular injection.

PubMed

Hagiya, Hideharu; Okita, Shunji; Kuroe, Yasutoshi; Nojima, Hiroyoshi; Otani, Shinkichi; Sugiyama, Junichi; Naito, Hiromichi; Kawanishi, Susumu; Hagioka, Shingo; Morimoto, Naoki

2013-01-01

An 88-year-old man died of streptococcal toxic shock syndrome due to a group G streptococcus infection that was possibly caused by an intramuscular injection given 30 hours earlier in his right deltoid muscle. The causative pathogen was later identified to be Streptococcus dysgalactiae subsp. equisimilis (stG485). Although providing intramuscular injections is an essential skill of health care workers that is performed daily worldwide, it may constitute a port of entry for pathogens via skin breaches that can cause life-threatening infections. All invasive procedures should be carefully performed, especially when immunologically compromised patients are involved.

The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die.

PubMed

Weiss, Scott L; Balamuth, Fran; Hensley, Josey; Fitzgerald, Julie C; Bush, Jenny; Nadkarni, Vinay M; Thomas, Neal J; Hall, Mark; Muszynski, Jennifer

2017-09-01

The epidemiology of in-hospital death after pediatric sepsis has not been well characterized. We investigated the timing, cause, mode, and attribution of death in children with severe sepsis, hypothesizing that refractory shock leading to early death is rare in the current era. Retrospective observational study. Emergency departments and ICUs at two academic children's hospitals. Seventy-nine patients less than 18 years old treated for severe sepsis/septic shock in 2012-2013 who died prior to hospital discharge. None. Time to death from sepsis recognition, cause and mode of death, and attribution of death to sepsis were determined from medical records. Organ dysfunction was assessed via daily Pediatric Logistic Organ Dysfunction-2 scores for 7 days preceding death with an increase greater than or equal to 5 defined as worsening organ dysfunction. The median time to death was 8 days (interquartile range, 1-12 d) with 25%, 35%, and 49% of cumulative deaths within 1, 3, and 7 days of sepsis recognition, respectively. The most common cause of death was refractory shock (34%), then multiple organ dysfunction syndrome after shock recovery (27%), neurologic injury (19%), single-organ respiratory failure (9%), and nonseptic comorbidity (6%). Early deaths (≤ 3 d) were mostly due to refractory shock in young, previously healthy patients while multiple organ dysfunction syndrome predominated after 3 days. Mode of death was withdrawal in 72%, unsuccessful cardiopulmonary resuscitation in 22%, and irreversible loss of neurologic function in 6%. Ninety percent of deaths were attributable to acute or chronic manifestations of sepsis. Only 23% had a rise in Pediatric Logistic Organ Dysfunction-2 that indicated worsening organ dysfunction. Refractory shock remains a common cause of death in pediatric sepsis, especially for early deaths. Later deaths were mostly attributable to multiple organ dysfunction syndrome, neurologic, and respiratory failure after life-sustaining therapies were limited. A pattern of persistent, rather than worsening, organ dysfunction preceded most deaths.

Sampling Methodologies for Epidemiologic Surveillance of Men Who Have Sex with Men and Transgender Women in Latin America: An Empiric Comparison of Convenience Sampling, Time Space Sampling, and Respondent Driven Sampling

PubMed Central

Clark, J. L.; Konda, K. A.; Silva-Santisteban, A.; Peinado, J.; Lama, J. R.; Kusunoki, L.; Perez-Brumer, A.; Pun, M.; Cabello, R.; Sebastian, J. L.; Suarez-Ognio, L.; Sanchez, J.

2014-01-01

Alternatives to convenience sampling (CS) are needed for HIV/STI surveillance of most-at-risk populations in Latin America. We compared CS, time space sampling (TSS), and respondent driven sampling (RDS) for recruitment of men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. During concurrent 60-day periods from June–August, 2011, we recruited MSM/TW for epidemiologic surveillance using CS, TSS, and RDS. A total of 748 participants were recruited through CS, 233 through TSS, and 127 through RDS. The TSS sample included the largest proportion of TW (30.7 %) and the lowest percentage of subjects who had previously participated in HIV/STI research (14.9 %). The prevalence of newly diagnosed HIV infection, according to participants’ self-reported previous HIV diagnosis, was highest among TSS recruits (17.9 %) compared with RDS (12.6 %) and CS (10.2 %). TSS identified diverse populations of MSM/TW with higher prevalences of HIV/STIs not accessed by other methods. PMID:24362754

Sampling methodologies for epidemiologic surveillance of men who have sex with men and transgender women in Latin America: an empiric comparison of convenience sampling, time space sampling, and respondent driven sampling.

PubMed

Clark, J L; Konda, K A; Silva-Santisteban, A; Peinado, J; Lama, J R; Kusunoki, L; Perez-Brumer, A; Pun, M; Cabello, R; Sebastian, J L; Suarez-Ognio, L; Sanchez, J

2014-12-01

Alternatives to convenience sampling (CS) are needed for HIV/STI surveillance of most-at-risk populations in Latin America. We compared CS, time space sampling (TSS), and respondent driven sampling (RDS) for recruitment of men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. During concurrent 60-day periods from June-August, 2011, we recruited MSM/TW for epidemiologic surveillance using CS, TSS, and RDS. A total of 748 participants were recruited through CS, 233 through TSS, and 127 through RDS. The TSS sample included the largest proportion of TW (30.7 %) and the lowest percentage of subjects who had previously participated in HIV/STI research (14.9 %). The prevalence of newly diagnosed HIV infection, according to participants' self-reported previous HIV diagnosis, was highest among TSS recruits (17.9 %) compared with RDS (12.6 %) and CS (10.2 %). TSS identified diverse populations of MSM/TW with higher prevalences of HIV/STIs not accessed by other methods.

A Case Report of Churg–Strauss Syndrome Presenting With Cardiogenic Shock Treated With Extracorporeal Membrane Oxygenation

PubMed Central

Cui, Na; Su, Longxiang; Wang, Hao; Long, Yun; Pang, Cheng; Yang, Fei; Liu, Dawei

2015-01-01

Abstract Churg–Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease. A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm). Laboratory tests revealed that eosinophil was significantly increased (WBC: 34.46 × 109/L, neutrophil: 7.56 × 109/L[21.9%], eosinophil: 23.84 × 109/L[69.2%]), and serum myocardial enzymes was abnormal (CK 1049U/L, CKMB-mass 145.1 μg/L, cTnI 16.24 μg/L). Myocardial injury (tachycardia with ST elevation) and poor heart function (LVEF 31%) were found by electrocardiogram and transthoracic echocardiography. On the next day, cardiogenic shock had been developed as demonstrated by deteriorating the perfusion index. Churg–Strauss Syndrome with cardiogenic shock. A series of conservative therapy with drugs such as corticosteroids, anticoagulant, antiplatelet, nitrates, calcium antagonists, inotrope, and vasopressors were initiated on the day of admission. The treatment was ineffective and a cardiogenic shock developed on the next day. Thus, ECMO was initiated immediately to stabilize circulation and perfusion. At the same time, high-dose corticosteroids combined with immunosuppressive therapy were continuously used. Symptoms of cardiogenic shock were gradually improved after ECMO treatment. Elevated values of cardiac enzymes were decreased and the dose of vasoactive drugs was reduced. Extracorporeal membrane oxygenation was discontinued after 8 days, and the patient was eventually weaned off the ventilator. The patient was discharged after 40 days treatment. Once a CSS develops into a cardiogenic shock, the ECMO should be considered as an alternative therapeutics in that it stabilizes hemodynamic status, maintains effective tissue perfusion, and provides an opportunity for the recovery of cardiac function. PMID:26512570

A Case Report of Churg-Strauss Syndrome Presenting With Cardiogenic Shock Treated With Extracorporeal Membrane Oxygenation.

PubMed

Cui, Na; Su, Longxiang; Wang, Hao; Long, Yun; Pang, Cheng; Yang, Fei; Liu, Dawei

2015-10-01

Churg-Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease.A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm). Laboratory tests revealed that eosinophil was significantly increased (WBC: 34.46 × 10/L, neutrophil: 7.56 × 10/L[21.9%], eosinophil: 23.84 × 10/L[69.2%]), and serum myocardial enzymes was abnormal (CK 1049U/L, CKMB-mass 145.1 μg/L, cTnI 16.24 μg/L). Myocardial injury (tachycardia with ST elevation) and poor heart function (LVEF 31%) were found by electrocardiogram and transthoracic echocardiography. On the next day, cardiogenic shock had been developed as demonstrated by deteriorating the perfusion index.Churg-Strauss Syndrome with cardiogenic shock.A series of conservative therapy with drugs such as corticosteroids, anticoagulant, antiplatelet, nitrates, calcium antagonists, inotrope, and vasopressors were initiated on the day of admission. The treatment was ineffective and a cardiogenic shock developed on the next day. Thus, ECMO was initiated immediately to stabilize circulation and perfusion. At the same time, high-dose corticosteroids combined with immunosuppressive therapy were continuously used.Symptoms of cardiogenic shock were gradually improved after ECMO treatment. Elevated values of cardiac enzymes were decreased and the dose of vasoactive drugs was reduced. Extracorporeal membrane oxygenation was discontinued after 8 days, and the patient was eventually weaned off the ventilator. The patient was discharged after 40 days treatment.Once a CSS develops into a cardiogenic shock, the ECMO should be considered as an alternative therapeutics in that it stabilizes hemodynamic status, maintains effective tissue perfusion, and provides an opportunity for the recovery of cardiac function.

Glaucoma diagnostic performance of GDxVCC and spectralis OCT on eyes with atypical retardation pattern.

PubMed

Hoesl, Laura Maria; Tornow, Ralf P; Schrems, Wolfgang A; Horn, Folkert K; Mardin, Christian Y; Kruse, Friedrich E; Juenemann, Anselm G M; Laemmer, Robert

2013-01-01

To investigate the impact of typical scan score (TSS) on discriminating glaucomatous and healthy eyes by scanning laser polarimetry and spectral domain optical coherence tomography (SD-OCT) in 32 peripapillary sectors. One hundred two glaucoma patients and 32 healthy controls underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, GDxVCC, and SD-OCT measurements. For controls, only very typical scans (TSS=100) were accepted. Glaucoma patients were divided into 3 subgroups (very typical: TSS=100; typical: 99≥TSS≥80, atypical: TSS<80). Receiver operating characteristic curves were constructed for mean retinal nerve fiber layer values, sector data, and nerve fiber indicator (NFI). Sensitivity was estimated at ≥90% specificity to compare the discriminating ability of each imaging modality. For discrimination between healthy and glaucomatous eyes with very typical scans, the NFI and inferior sector analyses 26 to 27 demonstrated the highest sensitivity at ≥90% specificity in GDxVCC and SD-OCT, respectively. For the typical and atypical groups, sensitivity at ≥90% specificity decreased for all 32 peripapillary sectors on an average by 10.9% and 17.9% for GDxVCC and by 4.9% and 0.8% for SD-OCT. For GDxVCC, diagnostic performance of peripapillary sectors decreased with lower TSS, especially in temporosuperior and inferotemporal sectors (sensitivity at ≥90% specificity decreased by 55.3% and by 37.8% in the atypical group). Diagnostic accuracy is comparable for SD-OCT and GDxVCC if typical scans (TSS=100) are investigated. Decreasing TSS is associated with a decrease in diagnostic accuracy for discriminating healthy and glaucomatous eyes by scanning laser polarimetry. NFI is less influenced than the global or sector retinal nerve fiber layer thickness. The TSS score should be included in the standard printout. Diagnostic accuracy of SD-OCT is barely influenced by low TSS.

Coevolution of the ATPase ClpV, the Sheath Proteins TssB and TssC, and the Accessory Protein TagJ/HsiE1 Distinguishes Type VI Secretion Classes*

PubMed Central

Förster, Andreas; Planamente, Sara; Manoli, Eleni; Lossi, Nadine S.; Freemont, Paul S.; Filloux, Alain

2014-01-01

The type VI secretion system (T6SS) is a bacterial nanomachine for the transport of effector molecules into prokaryotic and eukaryotic cells. It involves the assembly of a tubular structure composed of TssB and TssC that is similar to the tail sheath of bacteriophages. The sheath contracts to provide the energy needed for effector delivery. The AAA+ ATPase ClpV disassembles the contracted sheath, which resets the systems for reassembly of an extended sheath that is ready to fire again. This mechanism is crucial for T6SS function. In Vibrio cholerae, ClpV binds the N terminus of TssC within a hydrophobic groove. In this study, we resolved the crystal structure of the N-terminal domain of Pseudomonas aeruginosa ClpV1 and observed structural alterations in the hydrophobic groove. The modification in the ClpV1 groove is matched by a change in the N terminus of TssC, suggesting the existence of distinct T6SS classes. An accessory T6SS component, TagJ/HsiE, exists predominantly in one of the classes. Using bacterial two-hybrid approaches, we showed that the P. aeruginosa homolog HsiE1 interacts strongly with ClpV1. We then resolved the crystal structure of HsiE1 in complex with the N terminus of HsiB1, a TssB homolog and component of the contractile sheath. Phylogenetic analysis confirmed that these differences distinguish T6SS classes that resulted from a functional co-evolution between TssB, TssC, TagJ/HsiE, and ClpV. The interaction of TagJ/HsiE with the sheath as well as with ClpV suggests an alternative mode of disassembly in which HsiE recruits the ATPase to the sheath. PMID:25305017

Llama heavy-chain antibody fragments efficiently remove toxic shock syndrome toxin 1 from plasma in vitro but not in experimental porcine septic shock.

PubMed

Brummelhuis, Walter J; Joles, Jaap A; Stam, Jord C; Adams, Hendrik; Goldschmeding, Roel; Detmers, Frank J; El Khattabi, Mohamed; Maassen, Bram T; Verrips, C Theo; Braam, Branko

2010-08-01

Staphylococcus aureus produces the superantigen toxic shock syndrome toxin 1 (TSST-1). When the bacterium invades the human circulation, this toxin can induce life-threatening gram-positive sepsis. Current sepsis treatment does not remove bacterial toxins. Variable domains of llama heavy-chain antibodies (VHH) against toxic shock syndrome toxin 1 ([alpha]-TSST-1 VHH) were previously found to be effective in vitro. We hypothesized that removing TSST-1 with [alpha]-TSST-1 VHH hemofiltration filters would ameliorate experimental sepsis in pigs. After assessing in vitro whether timely removing TSST-1 interrupted TSST-1-induced mononuclear cell TNF-[alpha] production, VHH-coated filters were applied in a porcine sepsis model. Clinical course, survival, plasma interferon [gamma], and TSST-1 levels were similar with and without VHH-coated filters as were TSST-1 concentrations before and after the VHH filter. Plasma TSST-1 levels were much lower than anticipated from the distribution of the amount of infused TSST-1, suggesting compartmentalization to space or adhesion to surface not accessible to hemofiltration or pheresis techniques. Removing TSST-1 from plasma was feasible in vitro. However, the [alpha]-TSST-1 VHH adsorption filter-based technique was ineffective in vivo, indicating that improvement of VHH-based hemofiltration is required. Sequestration likely prevented the adequate removal of TSST-1. The latter warrants further investigation of TSST-1 distribution and clearance in vivo.

21 CFR 801.430 - User labeling for menstrual tampons.

Code of Federal Regulations, 2010 CFR

2010-04-01

... risk of TSS to all women using tampons during their menstrual period, especially the reported higher risks to women under 30 years of age and teenage girls, the estimated incidence of TSS of 1 to 17 per 100,000 menstruating women and girls per year, and the risk of death from contracting TSS; (3) The...

Characterization of the Truncated Androgen Receptor Generated by Calpain-Dependent Proteolysis in Prostate Cancer

DTIC Science & Technology

2009-08-31

hierarchical network of transcription factors governs androgen receptor-dependent prostate cancer growth. Mol Cell, 2007. 27(3): p. 380 -92. 26. Takayama, K...TSS_upstream * 69570641 69571326 0.02 UGT2B15 -5 TSS_upstream 71417985 71418195 0.05 UNQ689 -796 TSS_upstream 29 83631386 83632082 0.02 MASA 60948

Structure of the ent -Copalyl Diphosphate Synthase PtmT2 from Streptomyces platensis CB00739, a Bacterial Type II Diterpene Synthase

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rudolf, Jeffrey D.; Dong, Liao-Bin; Cao, Hongnan

Terpenoids are the largest and most structurally diverse family of natural products found in nature, yet their presence in bacteria is underappreciated. The carbon skeletons of terpenoids are generated through carbocation-dependent cyclization cascades catalyzed by terpene synthases (TSs). Type I and type II TSs initiate cyclization via diphosphate ionization and protonation, respectively, and protein structures of both types are known. Most plant diterpene synthases (DTSs) possess three alpha-helical domains (alpha beta gamma), which are thought to have arisen from the fusion of discrete, ancestral bacterial type I TSs (alpha) and type II TSs (beta gamma). Type II DTSs of bacterialmore » origin, of which there are no structurally characterized members, are a missing piece in the structural evolution of TSs. Here, we report the first crystal structure of a type II DTS from bacteria. PtnaT2 from Streptomyces platensis CB00739 was verified as an ent-copalyl diphosphate synthase involved in the biosynthesis of platensimycin and platencin. The crystal structure of PtmT2 was solved at a resolution of 1.80 angstrom, and docking studies suggest the catalytically active conformation of geranylgeranyl diphosphate (GGPP). Site-directed mutagenesis confirmed residues involved in binding the diphosphate moiety of GGPP and identified DxxxxE as a potential Mg2+-binding motif for type II DTSs of bacterial origin. Finally, both the shape and physicochemical properties of the active sites are responsible for determining specific catalytic outcomes of TSs. The structure of PtmT2 fundamentally advances the knowledge of bacterial TSs, their mechanisms, and their role in the evolution of TSs.« less

Tanshinone IIA Sodium Sulfonate Attenuates LPS-Induced Intestinal Injury in Mice

PubMed Central

Yang, Xin-Jing; Qian, Jin-Xian; Wei, Yao; Guo, Qiang; Jin, Jun; Sun, Xue; Liu, Sheng-Lan

2018-01-01

Background Tanshinone IIA sodium sulfonate (TSS) is known to possess anti-inflammatory effects and has exhibited protective effects in various inflammatory conditions; however, its role in lipopolysaccharide- (LPS-) induced intestinal injury is still unknown. Objective The present study is designed to explore the role and possible mechanism of TSS in LPS-induced intestinal injury. Methods Male C57BL/6J mice, challenged with intraperitoneal LPS injection, were treated with or without TSS 0.5 h prior to LPS exposure. At 1, 6, and 12 h after LPS injection, mice were sacrificed, and the small intestine was excised. The intestinal tissue injury was analyzed by HE staining. Inflammatory factors (TNF-α, IL-1β, and IL-6) in the intestinal tissue were examined by ELISA and RT-PCR. In addition, expressions of autophagy markers (microtubule-associated light chain 3 (LC3) and Beclin-1) were detected by western blot and RT-PCR. A number of autophagosomes were also observed under electron microscopy. Results TSS treatment significantly attenuated small intestinal epithelium injury induced by LPS. LPS-induced release of inflammatory mediators, including TNF-α, IL-1β, and IL-6, were markedly inhibited by TSS. Furthermore, TSS treatment could effectively upregulate LPS-induced decrease of autophagy levels, as evidenced by the increased expression of LC3 and Beclin-1, and more autophagosomes. Conclusion The protective effect of TSS on LPS-induced small intestinal injury may be attributed to the inhibition of inflammatory factors and promotion of autophagy levels. The present study may provide novel insight into the molecular mechanisms of TSS on the treatment of intestinal injury. PMID:29706995

Structure of the ent-Copalyl Diphosphate Synthase PtmT2 from Streptomyces platensis CB00739, a Bacterial Type II Diterpene Synthase

PubMed Central

2016-01-01

Terpenoids are the largest and most structurally diverse family of natural products found in nature, yet their presence in bacteria is underappreciated. The carbon skeletons of terpenoids are generated through carbocation-dependent cyclization cascades catalyzed by terpene synthases (TSs). Type I and type II TSs initiate cyclization via diphosphate ionization and protonation, respectively, and protein structures of both types are known. Most plant diterpene synthases (DTSs) possess three α-helical domains (αβγ), which are thought to have arisen from the fusion of discrete, ancestral bacterial type I TSs (α) and type II TSs (βγ). Type II DTSs of bacterial origin, of which there are no structurally characterized members, are a missing piece in the structural evolution of TSs. Here, we report the first crystal structure of a type II DTS from bacteria. PtmT2 from Streptomyces platensis CB00739 was verified as an ent-copalyl diphosphate synthase involved in the biosynthesis of platensimycin and platencin. The crystal structure of PtmT2 was solved at a resolution of 1.80 Å, and docking studies suggest the catalytically active conformation of geranylgeranyl diphosphate (GGPP). Site-directed mutagenesis confirmed residues involved in binding the diphosphate moiety of GGPP and identified DxxxxE as a potential Mg2+-binding motif for type II DTSs of bacterial origin. Finally, both the shape and physicochemical properties of the active sites are responsible for determining specific catalytic outcomes of TSs. The structure of PtmT2 fundamentally advances the knowledge of bacterial TSs, their mechanisms, and their role in the evolution of TSs. PMID:27490479

Structure of the ent-Copalyl Diphosphate Synthase PtmT2 from Streptomyces platensis CB00739, a Bacterial Type II Diterpene Synthase.

PubMed

Rudolf, Jeffrey D; Dong, Liao-Bin; Cao, Hongnan; Hatzos-Skintges, Catherine; Osipiuk, Jerzy; Endres, Michael; Chang, Chin-Yuan; Ma, Ming; Babnigg, Gyorgy; Joachimiak, Andrzej; Phillips, George N; Shen, Ben

2016-08-31

Terpenoids are the largest and most structurally diverse family of natural products found in nature, yet their presence in bacteria is underappreciated. The carbon skeletons of terpenoids are generated through carbocation-dependent cyclization cascades catalyzed by terpene synthases (TSs). Type I and type II TSs initiate cyclization via diphosphate ionization and protonation, respectively, and protein structures of both types are known. Most plant diterpene synthases (DTSs) possess three α-helical domains (αβγ), which are thought to have arisen from the fusion of discrete, ancestral bacterial type I TSs (α) and type II TSs (βγ). Type II DTSs of bacterial origin, of which there are no structurally characterized members, are a missing piece in the structural evolution of TSs. Here, we report the first crystal structure of a type II DTS from bacteria. PtmT2 from Streptomyces platensis CB00739 was verified as an ent-copalyl diphosphate synthase involved in the biosynthesis of platensimycin and platencin. The crystal structure of PtmT2 was solved at a resolution of 1.80 Å, and docking studies suggest the catalytically active conformation of geranylgeranyl diphosphate (GGPP). Site-directed mutagenesis confirmed residues involved in binding the diphosphate moiety of GGPP and identified DxxxxE as a potential Mg(2+)-binding motif for type II DTSs of bacterial origin. Finally, both the shape and physicochemical properties of the active sites are responsible for determining specific catalytic outcomes of TSs. The structure of PtmT2 fundamentally advances the knowledge of bacterial TSs, their mechanisms, and their role in the evolution of TSs.

Transsphenoidal surgery and diabetes mellitus: An analysis of inpatient data and complications.

PubMed

Pines, Morgan J; Raikundalia, Milap D; Svider, Peter F; Baredes, Soly; Liu, James K; Eloy, Jean Anderson

2015-10-01

Transsphenoidal surgery (TSS) has emerged as the standard approach for pituitary resection due to its minimally invasive nature. There has been little analysis examining the impact of diabetes mellitus (DM) on patients undergoing TSS. In this study, we characterize DM's association with postoperative TSS complications. In addition to analysis of associated charges and patient demographics, we performed comparison of complication rates between DM and non-DM patients who have undergone TSS in recent years. The Nationwide Inpatient Sample, a database encompassing nearly 8 million inpatient hospitalizations, was evaluated for patients undergoing TSS from 2002 to 2010. Of 12,938 TSS patients, 2,173 (16.8%) had a DM diagnosis. The non-DM cohort was younger (50.1 y ± 16.6SD vs. 56.8 y ± 14.1; P < 0.001) and had shorter hospitalizations and lesser charges. DM patients had a greater incidence of pulmonary, cardiac, urinary/renal, and fluid/electrolyte complications, and had a lesser incidence of diabetes insipidus (P < 0.05). Upon controlling for age, the greater incidence of pulmonary and fluid/electrolyte complications was present only among patients < 60 years of age. Higher occurrence of cerebrospinal fluid rhinorrhea was noted among black diabetics when compared to non-DM blacks. DM is associated with greater length of stay and hospital charges among TSS patients. DM patients undergoing TSS have a significantly greater incidence of pulmonary and fluid/electrolyte complications among patients under the age of 60, and greater risk for urinary/renal complications across all ages. Despite a theoretical concern due to an impaired wound-healing in DM patients, association with cerebrospinal fluid rhinorrhea was only noted among black diabetics. 2C. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Characterization of transsphenoidal complications in patients with acromegaly: an analysis of inpatient data in the United States from 2002 to 2010.

PubMed

Raikundalia, Milap D; Pines, Morgan J; Svider, Peter F; Baredes, Soly; Folbe, Adam J; Liu, James K; Eloy, Jean Anderson

2015-05-01

Transsphenoidal surgery (TSS) is a common procedure for a variety of pituitary lesions. This procedure can be associated with complications related to the surgery or specific pathology. In this study, we evaluate inpatient postoperative complications among patients who underwent TSS for growth hormone adenomas using a nationally representative database, and compare patient characteristics and complications to patients who underwent TSS for other benign pituitary neoplasms. Analysis of the Nationwide Inpatient Sample revealed 13,070 TSS patients (including 892 with acromegaly) between 2002 and 2010. Complication rates, outcomes, patient demographics, hospital stay, and total charges were evaluated among TSS patients with and without acromegaly. There was an increase in TSS performed in both cohorts from 2002 to 2010. Acromegaly patients were younger, had shorter hospital stays, and incurred fewer charges. Acromegaly patients had a lower occurrence of postoperative urinary/renal complications (0.2% vs 1.1%), thromboembolic events (0% vs 0.4%), fluid/electrolyte abnormalities (5.7% vs 9.1%), and iatrogenic hypopituitarism (0.3% vs 1.1%) compared to other TSS patients (all p < 0.05). After adjusting for age, acromegalic patients maintained a statistically lower occurrence of fluid/electrolyte abnormalities (p = 0.007). Cerebrospinal fluid leak occurrence in acromegaly patients was 2.6% vs 1.7% in non-acromegaly patients, a result that did not reach significance (p = 0.054). Upon comparison of inpatient hospitalizations for patients undergoing TSS for growth hormone adenomas and other benign pituitary neoplasms, acromegaly patients had a significantly lower occurrence of postoperative fluid/electrolyte abnormalities. Acromegaly patients had shorter hospitalizations and subsequently fewer total charges. © 2015 ARS-AAOA, LLC.

The contribution of group A streptococcal virulence determinants to the pathogenesis of sepsis

PubMed Central

Reglinski, Mark; Sriskandan, Shiranee

2014-01-01

Streptococcus pyogenes (group A streptococcus, GAS) is responsible for a wide range of pathologies ranging from mild pharyngitis and impetigo to severe invasive soft tissue infections. Despite the continuing susceptibility of the bacterium to β-lactam antibiotics there has been an unexplained resurgence in the prevalence of invasive GAS infection over the past 30 years. Of particular importance was the emergence of a GAS-associated sepsis syndrome that is analogous to the systemic toxicosis associated with TSST-1 producing strains of Staphylococcus aureus. Despite being recognized for over 20 years, the etiology of GAS associated sepsis and the streptococcal toxic shock syndrome remains poorly understood. Here we review the virulence factors that contribute to the etiology of GAS associated sepsis with a particular focus on coagulation system interactions and the role of the superantigens in the development of streptococcal toxic shock syndrome. PMID:24157731

Norlestrin-induced pseudopregnancy in the baboon. Effects on blood coagulation and endocrine glands during attempted production of Sheehan's syndrome.

PubMed

Klaus, H; Rao, P S; Gaston, L W; Russfield, A B

1975-02-15

Production of Sheehan's syndrome was attempted. As it was not possible to obtain pregnant baboons initially, pseudopregnancy was induced with norlestrin, 2.k mg., for 3 and 4 months, respectively. Sheehan's syndrome was not produced with massive hypovolemic shock but failure to obtain true pregnancy has given serendipitous information on the long-term action of norlestrin on the pituitary and its target organs. Unusual abundance of prolactin acidophils and decrease of growth hormone acidophils was found. Further studies will be necessary to show the possible significance of these findings. As fibrin degradation products did not appear in the serum, we can make no inference about the necessity of intravascular coagulation for the production of Sheehan's phenomenon. Finally one animal became pregnant. Sheehan's phenomenon was not produced in her despite induction of intrapartum hypovolemic shock. Histologic findings in her pituitary resemble those of the pseudopregnant animals.

Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research.

PubMed

Davis, Jenna L; Green, B Lee; Katz, Ralph V

2012-01-01

To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research. Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association. No association between scary beliefs and willingness or fear to participate in research was found (P > 0.05). These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks' willingness to participate in research.

Modelling the influence of total suspended solids on E. coli removal in river water.

PubMed

Qian, Jueying; Walters, Evelyn; Rutschmann, Peter; Wagner, Michael; Horn, Harald

2016-01-01

Following sewer overflows, fecal indicator bacteria enter surface waters and may experience different lysis or growth processes. A 1D mathematical model was developed to predict total suspended solids (TSS) and Escherichia coli concentrations based on field measurements in a large-scale flume system simulating a combined sewer overflow. The removal mechanisms of natural inactivation, UV inactivation, and sedimentation were modelled. For the sedimentation process, one, two or three particle size classes were incorporated separately into the model. Moreover, the UV sensitivity coefficient α and natural inactivation coefficient kd were both formulated as functions of TSS concentration. It was observed that the E. coli removal was predicted more accurately by incorporating two particle size classes. However, addition of a third particle size class only improved the model slightly. When α and kd were allowed to vary with the TSS concentration, the model was able to predict E. coli fate and transport at different TSS concentrations accurately and flexibly. A sensitivity analysis revealed that the mechanisms of UV and natural inactivation were more influential at low TSS concentrations, whereas the sedimentation process became more important at elevated TSS concentrations.

Ratios of total suspended solids to suspended sediment concentrations by particle size

USGS Publications Warehouse

Selbig, W.R.; Bannerman, R.T.

2011-01-01

Wet-sieving sand-sized particles from a whole storm-water sample before splitting the sample into laboratory-prepared containers can reduce bias and improve the precision of suspended-sediment concentrations (SSC). Wet-sieving, however, may alter concentrations of total suspended solids (TSS) because the analytical method used to determine TSS may not have included the sediment retained on the sieves. Measuring TSS is still commonly used by environmental managers as a regulatory metric for solids in storm water. For this reason, a new method of correlating concentrations of TSS and SSC by particle size was used to develop a series of correction factors for SSC as a means to estimate TSS. In general, differences between TSS and SSC increased with greater particle size and higher sand content. Median correction factors to SSC ranged from 0.29 for particles larger than 500m to 0.85 for particles measuring from 32 to 63m. Great variability was observed in each fraction-a result of varying amounts of organic matter in the samples. Wide variability in organic content could reduce the transferability of the correction factors. ?? 2011 American Society of Civil Engineers.

Evolutionary analysis of a novel zinc ribbon in the N-terminal region of threonine synthase.

PubMed

Kaur, Gurmeet; Subramanian, Srikrishna

2017-10-18

Threonine synthase (TS) catalyzes the terminal reaction in the biosynthetic pathway of threonine and requires pyridoxal phosphate as a cofactor. TSs share a common catalytic domain with other fold type II PALP dependent enzymes. TSs are broadly grouped into two classes based on their sequence, quaternary structure, and enzyme regulation. We report the presence of a novel zinc ribbon domain in the N-terminal region preceding the catalytic core in TS. The zinc ribbon domain is present in TSs belonging to both classes. Our sequence analysis reveals that archaeal TSs possess all zinc chelating residues to bind a metal ion that are lacking in the structurally characterized homologs. Phylogenetic analysis suggests that TSs with an N-terminal zinc ribbon likely represents the ancestral state of the enzyme while TSs without a zinc ribbon must have diverged later in specific lineages. The zinc ribbon and its N- and C-terminal extensions are important for enzyme stability, activity and regulation. It is likely that the zinc ribbon domain is involved in higher order oligomerization or mediating interactions with other biomolecules leading to formation of larger metabolic complexes.

Evaluation of Total Suspended Sediment (TSS) Distribution Using ASTER, ALOS, SPOT-4 Satellite Imagery in 2005-2012

NASA Astrophysics Data System (ADS)

Hariyanto, T.; Krisna, T. C.; Pribadi, C. B.; Kurniawan, A.; Sukojo, B. M.; Taufik, M.

2017-12-01

Lapindo mud thrown to Porong River from September 27, 2006 brought an enormous impact to the environment and surrounding communities. This will exacerbate the damage Porong ecosystems, and pollute the Madura Strait and surrounding areas (Wibisono, 2006). Disposal of sludge in large quantities and continuously to Porong also indicated sedimentation resulted in Porong River, Porong River estuary and along coastal of Surabaya-Pasuruan. This is because the material sediment transport along water flow, and the influence of geographical conditions, and the waves of the sea water. Satellite image data used in this study is the ASTER in 2005-2008, ALOS/AVNIR-2 in 2010, and SPOT-4 years 2009.2011 and 2012. In the satellite image processing, for obtain the value of is used TSS algorithm of Jing Li (2008) for ASTER satellite imagery, algorithms of Hendrawan and Asai (2008) for the ALOS satellite imagery, and algorithm of Budiman (2004) for the SPOT-4 satellite imagery. TSS value of the image processing results then performed validation / test precision using reference data TSS In-Situ to obtain linear correlation (R2). R2 value was obtained is 0.854 in 2009, 0.761 in 2011, and 0712 in 2013. That indicates that the value of TSS in the field is proportional with the TSS value in image and has a very good correlation. The results show the value of TSS in the study area ranged from 25 until more than 150 mg/L and according to the results of the analysis showed an upward trend of TSS values over time. There are several locations that indicated experiencing severe sedimentation impacts such as in Porong River, Porong River Estuary, Alo River Estuary, and the surrounding area of the estuary. According to Government Regulation Number 82 in 2001, the maximum value of TSS in the river or water is must less than 50 mg/L and so the value of TSS in the study area is very improper that if allowed to continue may damage the ecosystem in the area. Results from this study is expected to be referenced in the rehabilitation, development, and utilization of the area in the research area and coastal zone management in the future.

The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache – Where do we stand? A qualitative systematic review of the literature

PubMed Central

Stapelmann, Henrike; Türp, Jens C

2008-01-01

Background The NTI-tss device is an anterior bite stop, which, according to the manufacturer, is indicated for the prevention and treatment of bruxism, temporomandibular disorders (TMDs), tension-type headaches, and migraine. The aim of this systematic review was to appraise the currently available evidence regarding the efficacy and safety of the NTI-tss splint. Methods We performed a systematic search in nine electronic databases and in NTI-tss-associated websites (last update: December 31, 2007). The reference lists of all relevant articles were perused. Five levels of scientific quality were distinguished. Reporting quality of articles about randomized controlled trials (RCTs) was evaluated using the Jadad score. To identify adverse events, we searched in the identified publications and in the MAUDE database. Results Nine of 68 relevant publications reported about the results of five different RCTs. Two RCTs concentrated on electromyographic (EMG) investigations in patients with TMDs and concomitant bruxism (Baad-Hansen et al 2007, Jadad score: 4) or with bruxism alone (Kavaklı 2006, Jadad score: 2); in both studies, compared to an occlusal stabilization splint the NTI-tss device showed significant reduction of EMG activity. Two RCTs focused exclusively on TMD patients; in one trial (Magnusson et al 2004, Jadad score: 3), a stabilization appliance led to greater improvement than an NTI-tss device, while in the other study (Jokstad et al 2005, Jadad score: 5) no difference was found. In one RCT (Shankland 2002, Jadad score: 1), patients with tension-type headache or migraine responded more favorably to the NTI-tss splint than to a bleaching tray. NTI-tss-induced complications related predominantly to single teeth or to the occlusion. Conclusion Evidence from RCTs suggests that the NTI-tss device may be successfully used for the management of bruxism and TMDs. However, to avoid potential unwanted effects, it should be chosen only if certain a patient will be compliant with follow-up appointments. The NTI-tss bite splint may be justified when a reduction of jaw closer muscle activity (e.g., jaw clenching or tooth grinding) is desired, or as an emergency device in patients with acute temporomandibular pain and, possibly, restricted jaw opening. PMID:18662411

Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study.

PubMed

Mearelli, Filippo; Fiotti, Nicola; Giansante, Carlo; Casarsa, Chiara; Orso, Daniele; De Helmersen, Marco; Altamura, Nicola; Ruscio, Maurizio; Castello, Luigi Mario; Colonetti, Efrem; Marino, Rossella; Barbati, Giulia; Bregnocchi, Andrea; Ronco, Claudio; Lupia, Enrico; Montrucchio, Giuseppe; Muiesan, Maria Lorenza; Di Somma, Salvatore; Avanzi, Gian Carlo; Biolo, Gianni

2018-05-07

To derive and validate a predictive algorithm integrating a nomogram-based prediction of the pretest probability of infection with a panel of serum biomarkers, which could robustly differentiate sepsis/septic shock from noninfectious systemic inflammatory response syndrome. Multicenter prospective study. At emergency department admission in five University hospitals. Nine-hundred forty-seven adults in inception cohort and 185 adults in validation cohort. None. A nomogram, including age, Sequential Organ Failure Assessment score, recent antimicrobial therapy, hyperthermia, leukocytosis, and high C-reactive protein values, was built in order to take data from 716 infected patients and 120 patients with noninfectious systemic inflammatory response syndrome to predict pretest probability of infection. Then, the best combination of procalcitonin, soluble phospholypase A2 group IIA, presepsin, soluble interleukin-2 receptor α, and soluble triggering receptor expressed on myeloid cell-1 was applied in order to categorize patients as "likely" or "unlikely" to be infected. The predictive algorithm required only procalcitonin backed up with soluble phospholypase A2 group IIA determined in 29% of the patients to rule out sepsis/septic shock with a negative predictive value of 93%. In a validation cohort of 158 patients, predictive algorithm reached 100% of negative predictive value requiring biomarker measurements in 18% of the population. We have developed and validated a high-performing, reproducible, and parsimonious algorithm to assist emergency department physicians in distinguishing sepsis/septic shock from noninfectious systemic inflammatory response syndrome.

Suspected toxic shock-like syndrome in a dog with closed-cervix pyometra.

PubMed

Declercq, Jan

2007-02-01

Several cases of toxic shock-like syndrome (TSLS) have been reported in dogs but no inciting cause has been identified. TSLS associated with a closed-cervix pyometra was suspected in the reported bitch. The dog was evaluated for the complaint of generalized dermatopathy (erythema and oedema) and systemic signs with multiorganic involvement (depression, fever, immature neutrophilia, hypoalbuminaemia, renal disease, vomiting and diarrhoea). Histological features consistent with TSLS included superficial dermatitis with epidermal neutrophilic exocytosis and necrotic keratinocytes. The tentative diagnosis of TSLS was based on case history, clinical presentation, laboratory and histopathological findings, and the resolution of all clinical signs following surgical removal of the localized bacterial infection.

Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome.

PubMed

Syed, Faisal F; Ackerman, Michael J; McLeod, Christopher J; Kapa, Suraj; Mulpuru, Siva K; Sriram, Chenni S; Cannon, Bryan C; Asirvatham, Samuel J; Noseworthy, Peter A

2016-05-01

Although the vast majority of mitral valve prolapse (MVP) is benign, a small subset of patients, predominantly women, with bileaflet prolapse, complex ventricular ectopy (VE), and abnormal T waves comprise the recently described bileaflet MVP syndrome. We compared findings on electrophysiological study in bileaflet MVP syndrome patients with and without cardiac arrest to identify factors that may predispose to malignant ventricular arrhythmia. Fourteen consecutive bileaflet MVP syndrome patients (n=13 women; median [limits], age at index ablation, 33.8 [21.0-58.7] years; ejection fraction, 60% [45%-67%]; all ≤ moderate mitral regurgitation; n=6 with previous cardiac arrest and implantable cardioverter defibrillator shocks for ventricular fibrillation; and n=8 without implantable cardioverter defibrillator although with symptomatic complex VE) were included. The 2 groups had similar baseline echocardiographic and electrocardiographic characteristics. All patients had at least 1 left ventricular papillary or fascicular VE focus. Purkinje origin VE was identified as the ventricular fibrillation trigger in 6 of 6 cardiac arrest patients (4 from papillary muscle) and Purkinje origin of dominant VE was seen in 5 of 8 (3 from papillary muscle) nonarrest patients. Acute success was seen in 17 of 19 procedures, and a ventricular fibrillation storm occurred within 24 hours of ablation in a single patient. Repeat ablation for recurrent symptomatic arrhythmia was performed in 6 patients. At 478 (39-2099) days of follow-up, 2 cardiac arrest patients received appropriate shocks. Symptoms from VE were reduced in 12 of 14. Bileaflet MVP syndrome is characterized by fascicular and papillary muscle VE that triggers ventricular fibrillation. Ablation of clinically dominant VE foci improves symptoms and reduces appropriate implantable cardioverter defibrillator shocks. © 2016 American Heart Association, Inc.

Unique Results and Lessons Learned From the TSS Missions

NASA Technical Reports Server (NTRS)

Stone, Nobie H.

2016-01-01

The Tethered Satellite System (TSS) Space Shuttle missions, TSS-1 in 1993 and TSS-1R in 1996, were the height of space tether technology development in the U.S. Altogether, the investment made by NASA and the Italian Space Agency (ASI) over the thirteen-year period of the TSS Program totaled approximately $400M-exclusive of the two Space Shuttle flights provided by NASA. Since those two pioneering missions, there have been several smaller tether flight experiments, but interest in this promising technology has waned within NASA as well as the DOD agencies. This is curious in view of the unique capabilities of space tether systems and the fact that they have been flight validated in earth orbit and shown to perform better than the preflight dynamic or electrodynamic theoretical predictions. While it is true that the TSS-1 and TSS-1R missions experienced technical difficulties, the causes of these early developmental problems are now known to have been engineering design flaws, material selection, and procedural issues that (1) are unrelated to the basic viability of space tether technology, and (2) can be readily corrected. The purpose of this paper is to review the dynamic and electrodynamic fundamentals of space tethers and the unique capabilities they afford (that are enabling to certain types of space missions); to elucidate the nature, cause, and solution of the early developmental problems; and to provide an update on progress made in development of the technology.

Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient.

PubMed

David, Sascha; Thamm, Kristina; Schmidt, Bernhard M W; Falk, Christine S; Kielstein, Jan T

2017-01-01

Sepsis and septic shock are major healthcare problems, affecting millions of individuals around the world each year. Pathophysiologically, septic multiple organ dysfunction (MOD) is a life-threatening condition caused by an overwhelming systemic inflammatory response of the host's organism to an infection. We experimentally tested if high circulating cytokine levels might increase vascular permeability-a critical hallmark of the disease-and if this phenomenon can be reversed by therapeutic cytokine removal (CytoSorb®) in an exemplary patient. A 32-year-old Caucasian female presented with septic shock and accompanying acute kidney injury (Sequential Organ Failure Assessment (SOFA) = 18) to our ICU. In spite of a broad anti-infective regimen, adequate fluid resuscitation, and high doses of inotropics and catecholamines, she remained refractory hypotensive. The extraordinary severity of septic shock suggested an immense overwhelming host response assumingly accompanied by a notable cytokine storm such as known from patients with toxic shock syndrome. Thus, a CytoSorb® filter was added to the dialysis circuit to remove excess shock-perpetuating cytokines. To analyze the endothelial phenotype in vitro before and after extracorporeal cytokine removal, we tested the septic shock patient's serum on human umbilical vein endothelial cells (HUVECs). The effect on endothelial integrity was assessed both on the morphological (fluorescent immunocytochemistry for VE-cadherin and F-actin) and functional (transendothelial electrical resistance (TER)) level that was recorded in real time with an "electric cell-substrate impedance sensing" (ECIS) system (ibidi). We found (1) severe alterations of cell-cell contacts and the cytoskeletal architecture and (2) profound functional permeability changes, the putative cellular correlate of the clinical vascular leakage syndrome. However, the endothelial barrier was protected from these profound adverse effects when HUVECs were challenged with septic shock serum that was collected after extracorporeal cytokine removal. Beneficial observations of extracorporeal cytokine removal in septic shock patients might-at least in part-be promoted via protection of vascular barrier function.

Mechanisms Explaining Muscle Fatigue and Muscle Pain in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a Review of Recent Findings.

PubMed

Gerwyn, Morris; Maes, Michael

2017-01-01

Here, we review potential causes of muscle dysfunction seen in many patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) such as the effects of oxidative and nitrosative stress (O&NS) and mitochondrial impairments together with reduced heat shock protein production and a range of metabolic abnormalities. Several studies published in the last few years have highlighted the existence of chronic O&NS, inflammation, impaired mitochondrial function and reduced heat shock protein production in many patients with ME/CFS. These studies have also highlighted the detrimental effects of chronically elevated O&NS on muscle functions such as reducing the time to muscle fatigue during exercise and impairing muscle contractility. Mechanisms have also been revealed by which chronic O&NS and or impaired heat shock production may impair muscle repair following exercise and indeed the adaptive responses in the striated muscle to acute and chronic increases in physical activity. The presence of chronic O&NS, low-grade inflammation and impaired heat shock protein production may well explain the objective findings of increased muscle fatigue, impaired contractility and multiple dimensions of exercise intolerance in many patients with ME/CFS.

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

Ectopic ACTH and CRH co-secreting tumor localized by 68Ga-DOTA-TATE PET/CT

PubMed Central

Papadakis, Georgios Z.; Bagci, Ulas; Sadowski, Samira M.; Patronas, Nicholas J.; Stratakis, Constantine A.

2015-01-01

Diagnosis of ectopic adrenocorticotropic hormone (ACTH) and corticotropin releasing hormone (CRH) co-secreting tumors causing Cushing syndrome (CS) is challenging, since these tumors are rare and their diagnosis is frequently confused with Cushing disease (CD), due to the effect of CRH on the pituitary. We report a case of a 21-year-old male who was referred to our institution with persistent hypercortisolemia and CS after undergoing unnecessary transsphenoidal surgery (TSS). 68Ga-DOTA-TATE PET/CT revealed increased tracer uptake in the thymus which was histologically proved to be neuroendocrine tumor (NET) staining positive for ACTH and CRH. Imaging with 18F-FDG PET/CT was not diagnostic. PMID:26018709

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

Skin dendritic cell and T cell activation associated with dengue shock syndrome.

PubMed

Duyen, Huynh Thi Le; Cerny, Daniela; Trung, Dinh The; Pang, Jassia; Velumani, Sumathy; Toh, Ying Xiu; Qui, Phan Tu; Hao, Nguyen Van; Simmons, Cameron; Haniffa, Muzlifah; Wills, Bridget; Fink, Katja

2017-10-27

The pathogenesis of severe dengue remains unclear, particularly the mechanisms underlying the plasma leakage that results in hypovolaemic shock in a small proportion of individuals. Maximal leakage occurs several days after peak viraemia implicating immunological pathways. Skin is a highly vascular organ and also an important site of immune reactions with a high density of dendritic cells (DCs), macrophages and T cells. We obtained skin biopsies and contemporaneous blood samples from patients within 24 hours of onset of dengue shock syndrome (DSS), and from healthy controls. We analyzed cell subsets by flow cytometry, and soluble mediators and antibodies by ELISA; the percentage of migratory CD1a + dermal DCs was significantly decreased in the DSS patients, and skin CD8 + T cells were activated, but there was no accumulation of dengue-specific antibodies. Inflammatory monocytic cells were not observed infiltrating the skin of DSS cases on whole-mount histology, although CD14 dim cells disappeared from blood.

[An outbreak of human Streptococcus suis serotype 2 infections presenting with toxic shock syndrome in Sichuan, China].

PubMed

Yang, Wei-zhong; Yu, Hong-jie; Jing, Huai-qi; Xu, Jian-guo; Chen, Zhi-hai; Zhu, Xiao-ping; Wang, Hua; Liu, Xue-cCheng; Wang, Shi-wen; Liu, Lun-guang; Zu, Rong-qiang; Luo, Long-ze; Xiang, Ni-juan; Liu, Hong-lu; Zhong, Wen-jun; Liu, Li; Meng, Ling; Yuan, Heng; Gao, Yong-jun; DU, Hua-mao; Ou, Yang-bin; Ye, Chang-yun; Jin, Dong; Lv, Qiang; Cui, Zhi-gang; Huang, Yan; Zhang, Shou-yin; An, Xiang-dong; Huang, Ting; Zhou, Xing-yu; Feng, Liao; Pang, Qi-di; Shu, Yue-long; Wang, Yu

2006-03-01

In mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted. An enhanced surveillance program were established in Sichuan, the following activities were introduced: active case finding in Sichuan of (a) laboratory diagnosed Streptococcus suis infection and (b) clinically diagnosed probable cases with exposure history; supplemented by (c) monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors. From June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six (38%) presented with toxic shock syndrome of which 15 (58%) died. Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef and sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations. An outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.

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. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research

PubMed Central

Davis, Jenna L.; Green, B. Lee; Katz, Ralph V.

2013-01-01

Objectives To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research. Methods Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association. Results No association between scary beliefs and willingness or fear to participate in research was found (P>0.05). Conclusions These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks’ willingness to participate in research. PMID:22924230

Relationship between turbidity and total suspended solids concentration within a combined sewer system.

PubMed

Hannouche, A; Chebbo, G; Ruban, G; Tassin, B; Lemaire, B J; Joannis, C

2011-01-01

This article confirms the existence of a strong linear relationship between turbidity and total suspended solids (TSS) concentration. However, the slope of this relation varies between dry and wet weather conditions, as well as between sites. The effect of this variability on estimating the instantaneous wet weather TSS concentration is assessed on the basis of the size of the calibration dataset used to establish the turbidity - TSS relationship. Results obtained indicate limited variability both between sites and during dry weather, along with a significant inter-event variability. Moreover, turbidity allows an evaluation of TSS concentrations with an acceptable level of accuracy for a reasonable rainfall event sampling campaign effort.

Enhancing dewaterability of waste activated sludge by combined oxidative conditioning process with zero-valent iron and peroxymonosulfate.

PubMed

Zhou, Xu; Jin, Wenbiao; Chen, Hongyi; Chen, Chuan; Han, Songfang; Tu, Renjie; Wei, Wei; Gao, Shu-Hong; Xie, Guo-Jun; Wang, Qilin

2017-11-01

The enhancement of sludge dewaterability is of great importance for facilitating the sludge disposal during the operation of wastewater treatment plants. In this study, a novel oxidative conditioning approach was applied to enhance the dewaterability of waste activated sludge by the combination of zero-valent iron (ZVI) and peroxymonosulfate (PMS). It was found that the dewaterability of sludge was significantly improved after the addition of ZVI (0-4 g/g TSS) (TSS: total suspended solids) and PMS (0-1 g/g TSS). The optimal addition amount of ZVI and PMS was 0.25 g/g TSS and 0.1 g/g TSS, respectively, under which the capillary suction time of the sludge was reduced by approximately 50%. The decomposition of sludge flocs could contribute to the improved sludge dewaterability. Economic analysis demonstrated that the proposed conditioning process with ZVI and PMS was more economical than the ZVI + peroxydisulfate and the traditional Fenton conditioning processes.

40 CFR 437.43 - Effluent limitations attainable by the application of the best conventional pollutant control...

Code of Federal Regulations, 2010 CFR

2010-07-01

...&G, pH, and TSS are the same as the corresponding limitation specified in § 437.42(b). (c) Combined waste receipts from subparts A and B of this part: Limitations for O&G, pH, and TSS are the same as the... part: Limitations for BOD5, O&G, pH, and TSS are the same as the corresponding limitation specified in...

40 CFR 437.43 - Effluent limitations attainable by the application of the best conventional pollutant control...

Code of Federal Regulations, 2011 CFR

2011-07-01

...&G, pH, and TSS are the same as the corresponding limitation specified in § 437.42(b). (c) Combined waste receipts from subparts A and B of this part: Limitations for O&G, pH, and TSS are the same as the... part: Limitations for BOD5, O&G, pH, and TSS are the same as the corresponding limitation specified in...

Loads of nitrate, phosphorus, and total suspended solids from Indiana watersheds

USGS Publications Warehouse

Bunch, Aubrey R.

2016-01-01

Transport of excess nutrients and total suspended solids (TSS) such as sediment by freshwater systems has led to degradation of aquatic ecosystems around the world. Nutrient and TSS loads from Midwestern states to the Mississippi River are a major contributor to the Gulf of Mexico Hypoxic Zone, an area of very low dissolved oxygen concentration in the Gulf of Mexico. To better understand Indiana’s contribution of nutrients and TSS to the Mississippi River, annual loads of nitrate plus nitrite as nitrogen, total phosphorus, and TSS were calculated for nine selected watersheds in Indiana using the load estimation model, S-LOADEST. Discrete water-quality samples collected monthly by the Indiana Department of Environmental Management’s Fixed Stations Monitoring Program from 2000–2010 and concurrent discharge data from the U. S. Geological Survey streamflow gages were used to create load models. Annual nutrient and TSS loads varied across Indiana by watershed and hydrologic condition. Understanding the loads from large river sites in Indiana is important for assessing contributions of nutrients and TSS to the Mississippi River Basin and in determining the effectiveness of best management practices in the state. Additionally, evaluation of loads from smaller upstream watersheds is important to characterize improvements at the local level and to identify priorities for reduction.

Ozonation strategies to reduce sludge production of a seafood industry WWTP.

PubMed

Campos, J L; Otero, L; Franco, A; Mosquera-Corral, A; Roca, E

2009-02-01

In this work, several alternatives related to the application of ozone in different streams of a seafood industry WWTP were evaluated to minimize the production of waste sludge. The WWTP was composed of two coagulation-flocculation units and a biological unit and generated around of 6550 kg/d of sludge. Ozone was applied to sludge coming from flotation units (110 g TSS/L) at doses up to 0.03 g O(3)/g TSS during batch tests, no solids solubilization being observed. Ozone doses ranging from 0.007 to 0.02 g O(3)/g TSS were also applied to the raw wastewater in a bubble column reaching a 6.8% of TSS removal for the highest ozone dose. Finally, the effect of the pre-ozonation (0.05 g O(3)/g TSS) of wastewater coming from the first flotation unit was tested in two activated sludge systems during 70 days. Ozonation caused a reduction of the observed yield coefficient of biomass from 0.14 to 0.07g TSS/g COD(Tremoved) and a slight improvement of COD removal efficiencies. On the basis of the capacity for ozone production available in the industry, a maximum reduction of sludge generated by the WWTP of 7.5% could be expected.

TSS concentration in sewers estimated from turbidity measurements by means of linear regression accounting for uncertainties in both variables.

PubMed

Bertrand-Krajewski, J L

2004-01-01

In order to replace traditional sampling and analysis techniques, turbidimeters can be used to estimate TSS concentration in sewers, by means of sensor and site specific empirical equations established by linear regression of on-site turbidity Tvalues with TSS concentrations C measured in corresponding samples. As the ordinary least-squares method is not able to account for measurement uncertainties in both T and C variables, an appropriate regression method is used to solve this difficulty and to evaluate correctly the uncertainty in TSS concentrations estimated from measured turbidity. The regression method is described, including detailed calculations of variances and covariance in the regression parameters. An example of application is given for a calibrated turbidimeter used in a combined sewer system, with data collected during three dry weather days. In order to show how the established regression could be used, an independent 24 hours long dry weather turbidity data series recorded at 2 min time interval is used, transformed into estimated TSS concentrations, and compared to TSS concentrations measured in samples. The comparison appears as satisfactory and suggests that turbidity measurements could replace traditional samples. Further developments, including wet weather periods and other types of sensors, are suggested.

Analysing a cycling grand tour: Can we monitor fatigue with intensity or load ratios?

PubMed

Sanders, Dajo; Heijboer, Mathieu; Hesselink, Matthijs K C; Myers, Tony; Akubat, Ibrahim

2018-06-01

This study evaluated the changes in ratios of different intensity (rating of perceived exertion; RPE, heart rate; HR, power output; PO) and load measures (session-RPE; sRPE, individualized TRIMP; iTRIMP, Training Stress Score™; TSS) in professional cyclists. RPE, PO and HR data was collected from twelve professional cyclists (VO 2max 75 ± 6 ml∙min∙kg -1 ) during a two-week baseline training period and during two cycling Grand Tours. Subjective:objective intensity (RPE:HR, RPE:PO) and load (sRPE:iTRIMP, sRPE:TSS) ratios and external:internal intensity (PO:HR) and load (TSS:iTRIMP) ratios were calculated for every session. Moderate to large increases in the RPE:HR, RPE:PO and sRPE:TSS ratios (d = 0.79-1.79) and small increases in the PO:HR and sRPE:iTRIMP ratio (d = 0.21-0.41) were observed during Grand Tours compared to baseline training data. Differences in the TSS:iTRIMP ratio were trivial to small (d = 0.03-0.27). Small to moderate week-to-week changes (d = 0.21-0.63) in the PO:HR, RPE:PO, RPE:HR, TSS:iTRIMP, sRPE:iTRIMP and sRPE:TSS were observed during the Grand Tour. Concluding, this study shows the value of using ratios of intensity and load measures in monitoring cyclists. Increases in ratios could reflect progressive fatigue that is not readily detected by changes in solitary intensity/load measures.

Quantifying suspended solids in small rivers using satellite data.

PubMed

Isidro, Celso M; McIntyre, Neil; Lechner, Alex M; Callow, Ian

2018-09-01

The management of suspended solids and associated contaminants in rivers requires knowledge of sediment sources. In-situ sampling can only describe the integrated impact of the upstream sources. Empirical models that use surface reflectance from satellite images to estimate total suspended solid (TSS) concentrations can be used to supplement measurements and provide spatially continuous maps. However, there are few examples, especially in narrow, shallow and hydrologically dynamic rivers found in mountainous areas. A case study of the Didipio catchment in Philippines was used to address these issues. Four 5-m resolution RapidEye images, from between the years 2014 and 2016, and near-simultaneous ground measurements of TSS concentrations were used to develop a power law model that approximates the relationship between TSS and reflectance for each of four spectral bands. A second dataset using two 2-m resolution Pleiades-1A and a third using a 6-m resolution SPOT-6 image along with ground-based measurements, were consistent with the model when using the red band data. Using that model, encompassing data from all three datasets, gave an R 2 value of 65% and a root mean square error of 519mgL -1 . A linear relationship between reflectance and TSS exists from 1mgL -1 to approximately 500mgL -1 . In contrast, for TSS measurements between 500mgL -1 and 3580mgL -1 reflectance increases at a generally lower and more variable rate. The results were not sensitive to changing the pixel location within the vicinity of the ground sampling location. The model was used to generate a continuous map of TSS concentration within the catchment. Further ground-based measurements including TSS concentrations that are higher than 3580mgL -1 would allow the model to be developed and applied more confidently over the full relevant range of TSS. Copyright © 2018 Elsevier B.V. All rights reserved.

Impact of pH and Total Soluble Solids on Enzyme Inactivation Kinetics during High Pressure Processing of Mango (Mangifera indica) Pulp.

PubMed

Kaushik, Neelima; Nadella, Tejaswi; Rao, P Srinivasa

2015-11-01

This study was undertaken with an aim to enhance the enzyme inactivation during high pressure processing (HPP) with pH and total soluble solids (TSS) as additional hurdles. Impact of mango pulp pH (3.5, 4.0, 4.5) and TSS (15, 20, 25 °Brix) variations on the inactivation of pectin methylesterase (PME), polyphenol oxidase (PPO), and peroxidase (POD) enzymes were studied during HPP at 400 to 600 MPa pressure (P), 40 to 70 °C temperature (T), and 6- to 20-min pressure-hold time (t). The enzyme inactivation (%) was modeled using second order polynomial equations with a good fit that revealed that all the enzymes were significantly affected by HPP. Response surface and contour models predicted the kinetic behavior of mango pulp enzymes adequately as indicated by the small error between predicted and experimental data. The predicted kinetics indicated that for a fixed P and T, higher pulse pressure effect and increased isobaric inactivation rates were possible at lower levels of pH and TSS. In contrast, at a fixed pH or TSS level, an increase in P or T led to enhanced inactivation rates, irrespective of the type of enzyme. PPO and POD were found to have similar barosensitivity, whereas PME was found to be most resistant to HPP. Furthermore, simultaneous variation in pH and TSS levels of mango pulp resulted in higher enzyme inactivation at lower pH and TSS during HPP, where the effect of pH was found to be predominant than TSS within the experimental domain. Exploration of additional hurdles such as pH, TSS, and temperature for enzyme inactivation during high pressure processing of fruits is useful from industrial point of view, as these parameters play key role in preservation process design. © 2015 Institute of Food Technologists®

4G/5G polymorphism of PAI-1 gene is associated with multiple organ dysfunction and septic shock in pneumonia induced severe sepsis: prospective, observational, genetic study.

PubMed

Madách, Krisztina; Aladzsity, István; Szilágyi, Agnes; Fust, George; Gál, János; Pénzes, István; Prohászka, Zoltán

2010-01-01

Activation of inflammation and coagulation are closely related and mutually interdependent in sepsis. The acute-phase protein, plasminogen activator inhibitor-1 (PAI-1) is a key element in the inhibition of fibrinolysis. Elevated levels of PAI-1 have been related to worse outcome in pneumonia. We aimed to evaluate the effect of functionally relevant 4G/5G polymorphism of PAI-1 gene in pneumonia induced sepsis. We enrolled 208 Caucasian patients with severe sepsis due to pneumonia admitted to an intensive care unit (ICU). Patients were followed up until ICU discharge or death. Clinical data were collected prospectively and the PAI-1 4G/5G polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism technique. Patients were stratified according to the occurrence of multiple organ dysfunction syndrome, septic shock or death. We found that carriers of the PAI-1 4G/4G and 4G/5G genotypes have a 2.74-fold higher risk for multiple organ dysfunction syndrome (odds ratio [OR] 95% confidence interval [CI] = 1.335 - 5.604; p = 0.006) and a 2.57-fold higher risk for septic shock (OR 95%CI = 1.180 - 5.615; p = 0.018) than 5G/5G carriers. The multivariate logistic regression analysis adjusted for independent predictors, such as age, nosocomial pneumonia and positive microbiological culture also supported that carriers of the 4G allele have a higher prevalence of multiple organ dysfunction syndrome (adjusted odds ratio [aOR] = 2.957; 95%CI = 1.306 -6.698; p = 0.009) and septic shock (aOR = 2.603; 95%CI = 1.137 - 5.959; p = 0.024). However, genotype and allele analyses have not shown any significant difference regarding mortality in models non-adjusted or adjusted for acute physiology and chronic health evaluation (APACHE) II. Patients bearing the 4G allele had higher disseminated intravascular coagulation (DIC) score at admission (p = 0.007) than 5G/5G carriers. Moreover, in 4G allele carriers the length of ICU stay of non-survivors was longer (p = 0.091), fewer ventilation-free days (p = 0.008) and days without septic shock (p = 0.095) were observed during the first 28 days. In Caucasian patients with severe sepsis due to pneumonia carriers of the 4G allele of PAI-1 polymorphism have higher risk for multiple organ dysfunction syndrome and septic shock and in agreement they showed more fulminant disease progression based on continuous clinical variables.

Efficacy and safety of iota-carrageenan nasal spray versus placebo in early treatment of the common cold in adults: the ICICC trial.

PubMed

Eccles, R; Winther, B; Johnston, S L; Robinson, P; Trampisch, M; Koelsch, S

2015-10-05

Iota-carrageenan (I-C) is active against respiratory viruses in vitro and was effective as nasal spray in three previous clinical trials. The current trial served to further investigate I-C in patients with early common cold symptoms. This randomized, placebo-controlled, double-blind phase IV trial was conducted in 200 adult patients with self-diagnosed colds of <48 h' duration that were confirmed by baseline cold symptom scores. Patients were to self-administer 0.12 % I-C or placebo spray (NaCl 0.5 %) four times daily for four to ten days and record symptom information for ten days. Common respiratory viruses were quantified by RT-PCR during pretreatment and on Day 3 or 4. The primary endpoint was the mean total symptom score (TSS) of eight cold symptoms on Days 2-4 (TSS2-4). Patients in both treatment groups had similar baseline TSSs (mean TSS: 6.75 for I-C and 6.79 for placebo). Viruses were detected in baseline samples from 53 of 98 I-C patients (54.1 %) and 54 of 97 placebo patients (55.7 %). Mean ± SE for TSS2-4 was 5.78 ± 0.25 for I-C patients and 6.39 ± 0.25 for placebo (p = 0.0895). Exploratory analyses after unblinding (TSS2-4 excluding a patient with aberrantly high symptom scores [TSS2-4, ex 1pt]; mean of TSS over Days 1-4 [TSS1-4]; change in TSS1-4 relative to baseline [TSS1-4, rel]) demonstrated treatment differences in favor of I-C (p = 0.0364, p = 0.0495 and p = 0.0421, respectively). For patients with quantifiable rhinovirus/enterovirus at baseline, there was a trend towards greater reduction of virus load at Day 3 or 4 (p = 0.0958; I-C: 90.2 % reduction in viral load; placebo: 72.0 %). Treatments were well tolerated with no differences in adverse event rates. The primary endpoint did not demonstrate a statistically significant difference between I-C and placebo but showed a trend towards I-C benefit. Exploratory analyses indicated significant reduction of cold symptoms in the I-C group relative to placebo during the first four days when symptoms were most severe, and also substantiated I-C's activity against rhinovirus/enterovirus. NCT01944631 (clinicaltrials.gov).

Organochlorine pesticides in the Johnson Creek Basin, Oregon, 1988-2002

USGS Publications Warehouse

Tanner, Dwight Q.; Lee, Karl K.

2004-01-01

Organochlorine pesticides were detected in unfiltered samples from Johnson Creek that were collected during a storm in March, 2002. Total DDT (the sum of DDT and its metabolites), as well as dieldrin, potentially exceeded Oregon chronic, freshwater criteria at all four Johnson Creek stream-sampling sites. The total DDT criterion was also potentially exceeded at a storm drain at SE 45th Avenue and Umatilla Street. The concentration of total DDT in water samples has decreased by an order of magnitude since previous sampling was done on Johnson Creek in 1989?1990. This decrease was probably due to the movement of these compounds out of the basin and to degradation processes. Concentrations and loads of the organochlorine pesticides were largest at the most upstream sampling site, Johnson Creek at Palmblad Road, which has historically been primarily affected by agricultural land cover. Concentrations and loads were smaller at downstream locations, and there were only a few detections from storm drains. For the purposes of assessing trends in total DDT concentration in Johnson Creek, data for total suspended solids (TSS) were examined, because TSS is often correlated with DDT concentrations, and TSS data are collected routinely by regulatory agencies. As an intermediate step, linear regression was used to relate TSS (measured in the recent study) and turbidity (measured both in the earlier and in the recent studies). For 77 samples, TSS (in mg/L [milligrams per liter]) = 0.88 x Turbidity (in nephleometric turbidity units). The r2 value was 0.82. The TSS concentration (measured, or estimated by the regression) was compared to the concentration of total DDT using linear regression. The TSS concentration associated with meeting the Oregon water-quality criterion for total DDT was 15 to 18 mg/L in the lower and middle part of the basin and 8 mg/L in the upper reaches of the basin. This TSS/DDT relationship is based on only one storm and may not be valid for other conditions of streamflow and runoff. Dieldrin concentration was not well correlated with TSS. Organochlorine compounds also were detected in significant concentrations in Kelley Creek, an important tributary to Johnson Creek, but quality-control considerations made it difficult to interpret some of the data. It does appear, however, that some of the metabolites of DDT were positively associated with TSS. The high concentrations of the DDT metabolites and dieldrin were correlated with agricultural areas.

Dissolved organic C and N pools in soils amended with composted and thermally-dried sludge as affected by soil tillage systems and sampling depth

NASA Astrophysics Data System (ADS)

García-Gil, Juan Carlos; Soler-Rovira, Pedro Angel; García López de Sa, Esther; Polo, Alfredo

2013-04-01

Soil tillage practices exert a significant influence on the dynamic of soluble organic C and N pools, affecting nutrient cycling in agricultural systems by enhancing its mineralization through microbial activities or stabilization in soil microaggregates, which contribute to mitigate greenhouse gases emissions. The objective of the present research was to determine the influence of three different soil management systems (moldboard plowing, chisel and no-tillage) and the application of composted sludge (CS) and thermally-dried sewage sludge (TSS) obtained from wastewater treatment processes on dissolved organic C (water-soluble organic C -WSOC-, carbohydrates, phenolic compounds) and soluble N (total-N, NH4+, NO3-) pools in a long-term field experiment (27 years) conducted on a sandy-loam soil at the experimental station "La Higueruela" (40° 03'N, 4° 24'W) under semi-arid conditions. Both organic amendments were applied at a rate of 30 tonnes per hectare prior to tillage practices. Unamended soils were used as control for each tillage system. Soil sampling was performed two months after tillage practices at the following depths for each treatment: 0-10 cm, 10-20 cm and 20-30 cm. Results obtained for unamended soils showed that no-tillage management increased total-N, NH4+ and NO3- contents at the 0-10 cm depth samples, meanwhile WSC and carbohydrates contents were larger at 20-30 cm depth samples in both moldboard and no-tillage plots. CS and TSS-amended soils presented a general increase in soluble C and N compounds, being significantly higher in TSS-amended soils, as TSS contains a great amount of labile organic C and N substrates due to the lack of stabilization treatment. TSS-amended soils under no-tillage and chisel plowing showed larger N, NH4+ and NO3- content at the 0-10 cm samples, meanwhile moldboard management exhibited larger NH4+ and NO3- content at 10-20 and 20-30 cm samples, possibly due to the incorporation of TSS at deeper depths (20-40 cm). CS and TSS-amended soils in no-tillage system showed the largest content of organic C pools at 0-10 cm depth samples due to less soil disturbance and the input of organic substrates with CS and TSS on soil surface. CS and TSS-amended soils under chisel plowing exhibited similar contents of soluble organic C pools at 10-20 and 20-30 cm depth samples and only TSS-amended soils increased significantly WSOC content at 0-10 cm samples. Similarly, contents of WSOC and carbohydrates in moldboard plowing were distributed more uniformly throughout the soil profile due to the turnover of soil and CS and TSS amendments into the plow layer. Acknowledgements: this research was supported by the Spanish CICYT, Project no. CTM2011-25557.

Most of the tight positional conservation of transcription factor binding sites near the transcription start site reflects their co-localization within regulatory modules.

PubMed

Acevedo-Luna, Natalia; Mariño-Ramírez, Leonardo; Halbert, Armand; Hansen, Ulla; Landsman, David; Spouge, John L

2016-11-21

Transcription factors (TFs) form complexes that bind regulatory modules (RMs) within DNA, to control specific sets of genes. Some transcription factor binding sites (TFBSs) near the transcription start site (TSS) display tight positional preferences relative to the TSS. Furthermore, near the TSS, RMs can co-localize TFBSs with each other and the TSS. The proportion of TFBS positional preferences due to TFBS co-localization within RMs is unknown, however. ChIP experiments confirm co-localization of some TFBSs genome-wide, including near the TSS, but they typically examine only a few TFs at a time, using non-physiological conditions that can vary from lab to lab. In contrast, sequence analysis can examine many TFs uniformly and methodically, broadly surveying the co-localization of TFBSs with tight positional preferences relative to the TSS. Our statistics found 43 significant sets of human motifs in the JASPAR TF Database with positional preferences relative to the TSS, with 38 preferences tight (±5 bp). Each set of motifs corresponded to a gene group of 135 to 3304 genes, with 42/43 (98%) gene groups independently validated by DAVID, a gene ontology database, with FDR < 0.05. Motifs corresponding to two TFBSs in a RM should co-occur more than by chance alone, enriching the intersection of the gene groups corresponding to the two TFs. Thus, a gene-group intersection systematically enriched beyond chance alone provides evidence that the two TFs participate in an RM. Of the 903 = 43*42/2 intersections of the 43 significant gene groups, we found 768/903 (85%) pairs of gene groups with significantly enriched intersections, with 564/768 (73%) intersections independently validated by DAVID with FDR < 0.05. A user-friendly web site at http://go.usa.gov/3kjsH permits biologists to explore the interaction network of our TFBSs to identify candidate subunit RMs. Gene duplication and convergent evolution within a genome provide obvious biological mechanisms for replicating an RM near the TSS that binds a particular TF subunit. Of all intersections of our 43 significant gene groups, 85% were significantly enriched, with 73% of the significant enrichments independently validated by gene ontology. The co-localization of TFBSs within RMs therefore likely explains much of the tight TFBS positional preferences near the TSS.

Sepsis and Septic Shock Strategies.

PubMed

Armstrong, Bracken A; Betzold, Richard D; May, Addison K

2017-12-01

Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Vaginal Toxic Shock Reaction Triggering Desquamative Inflammatory Vaginitis

PubMed Central

Pereira, Nigel; Edlind, Thomas D.; Schlievert, Patrick M.; Nyirjesy, Paul

2012-01-01

Objective To report two cases of desquamative inflammatory vaginitis (DIV) associated with toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus strains. Materials and Methods Case report of two patients, one with an acute and one with a chronic presentation, diagnosed with DIV on the basis of clinical findings and wet mount microscopy. Pre- and posttreatment vaginal bacterial and yeast cultures were obtained. Results Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial cultures following oral antibiotic therapy were negative. Conclusions DIV may be triggered through TSST-1-mediated vaginal toxic shock reaction. PMID:23222054

Vaginal toxic shock reaction triggering desquamative inflammatory vaginitis.

PubMed

Pereira, Nigel; Edlind, Thomas D; Schlievert, Patrick M; Nyirjesy, Paul

2013-01-01

The study aimed to report 2 cases of desquamative inflammatory vaginitis associated with toxic shock syndrome toxin 1 (TSST-1)-producing Staphylococcus aureus strains. Case report of 2 patients, 1 with an acute and 1 with a chronic presentation, diagnosed with desquamative inflammatory vaginitis on the basis of clinical findings and wet mount microscopy. Pretreatment and posttreatment vaginal bacterial and yeast cultures were obtained. Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial culture results after oral antibiotic therapy were negative. Desquamative inflammatory vaginitis may be triggered through TSST-1-mediated vaginal toxic shock reaction.

Interesting presentation of Kounis syndrome secondary to amoxicillin/ clavulanate use: Coronary vasospasm and simultaneous appropriate implantable defibrillator shock.

PubMed

Canpolat, Uğur; Koçyiğit, Duygu; Aytemir, Kudret

2017-07-01

Kounis syndrome (KS) is defined as concurrent acute coronary syndrome and allergic or hypersensitivity reactions. Despite being increasingly reported, it is still an underdiagnosed entity. Several medications are already known to result in KS. Amoxicillin/clavulanic acid is a frequently used antibiotic, and its use has been linked with KS. The aim of the present report was to draw attention to rare clinical manifestation of KS following peroral amoxicillin/clavulanate use.

Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives.

PubMed

Borghesi, M; Brunocilla, E; Schiavina, R; Gentile, G; Dababneh, H; Della Mora, L; del Prete, C; Franceschelli, A; Colombo, F; Martorana, G

2015-01-01

Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated. No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety. Copyright © 2013 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Long-term remission and recurrence rates after first and second transsphenoidal surgery for Cushing's disease: care reality in the Munich Metropolitan Region.

PubMed

Dimopoulou, C; Schopohl, J; Rachinger, W; Buchfelder, M; Honegger, J; Reincke, M; Stalla, G K

2014-02-01

Transsphenoidal surgery (TSS) presents the treatment of choice for Cushing's disease (CD). Remission and recurrence rates vary dependent on tumor size, extension, adenoma visibility on magnetic resonance imaging, and neurosurgical expertise. Other than published from single-surgeon neurosurgical series so far, we have aimed to describe long-term remission and recurrence rates of CD in a series incorporating different neurosurgeons, trying to reflect care reality in the Munich Metropolitan Region, which is accommodated by three tertiary university and multiple, smaller neurosurgical centers. We conducted a retrospective analysis of 120 patients who underwent first and 36 patients who underwent second TSS as treatment for CD between 1990 and 2012. Patients were divided into three groups according to remission status. Potential risk factors for recurrence, pituitary function, and strategy in persistent disease were assessed. THREE OUTCOME GROUPS WERE IDENTIFIED ACCORDING TO REMISSION STATUS AFTER FIRST TSS (MEAN FOLLOW-UP 79 MONTHS): remission, 71% (85/120), disease persistence, 29% (35/120), and disease recurrence, 34% (29/85) (mean time to recurrence 54 months). After second TSS (n=36, mean follow-up 62 months), we documented remission in 42% (15/36), disease persistence in 58% (21/36), and disease recurrence in 40% (6/15) (mean time to recurrence 42 months). Postoperative hypocortisolism after first, though not after second, TSS was associated with a lower risk of suffering disease recurrence (risk=0.72; 95% CI 0.60-0.88; exact significance (two-sided) P=0.035). Our study shows higher recurrence rates of CD after first TSS than previously reported. Second TSS leads an additional 8% of the patients to long-term CD remission.

Comparability of river suspended-sediment sampling and laboratory analysis methods

USGS Publications Warehouse

Groten, Joel T.; Johnson, Gregory D.

2018-03-06

Accurate measurements of suspended sediment, a leading water-quality impairment in many Minnesota rivers, are important for managing and protecting water resources; however, water-quality standards for suspended sediment in Minnesota are based on grab field sampling and total suspended solids (TSS) laboratory analysis methods that have underrepresented concentrations of suspended sediment in rivers compared to U.S. Geological Survey equal-width-increment or equal-discharge-increment (EWDI) field sampling and suspended sediment concentration (SSC) laboratory analysis methods. Because of this underrepresentation, the U.S. Geological Survey, in collaboration with the Minnesota Pollution Control Agency, collected concurrent grab and EWDI samples at eight sites to compare results obtained using different combinations of field sampling and laboratory analysis methods.Study results determined that grab field sampling and TSS laboratory analysis results were biased substantially low compared to EWDI sampling and SSC laboratory analysis results, respectively. Differences in both field sampling and laboratory analysis methods caused grab and TSS methods to be biased substantially low. The difference in laboratory analysis methods was slightly greater than field sampling methods.Sand-sized particles had a strong effect on the comparability of the field sampling and laboratory analysis methods. These results indicated that grab field sampling and TSS laboratory analysis methods fail to capture most of the sand being transported by the stream. The results indicate there is less of a difference among samples collected with grab field sampling and analyzed for TSS and concentration of fines in SSC. Even though differences are present, the presence of strong correlations between SSC and TSS concentrations provides the opportunity to develop site specific relations to address transport processes not captured by grab field sampling and TSS laboratory analysis methods.

Feeding strategies during dry summer for lactating desert goats in a rainfed area under tropical conditions.

PubMed

Ahmed, M M.M.; El Hag, F M.; Wahab, F S.; Salih, S F.

2001-02-01

Feeding strategies aimed at improving the nutritive value of crop residues through chemical treatment or utilizing other available feed resources as small ruminant feeds were carried out during the hot dry summer season when rangeland pasture deteriorates drastically. The study utilized small-scale farmer animals and crop residues chemically treated as animal feeds. Other feeds were groundnut haulms (GNH) and tree pods (TP) of Faidherbia albida. A total of 30 adult lactating goats with their kids (30) were allocated in completely randomized design to the following treatments: untreated sorghum straw (USS, control), sorghum straw treated with 4.7% urea solution (TSS), TSS+treepods (TSS+TP), USS+groundnuthaulms (USS+GNH) and TSS+GNH. Parameters investigated were: changes in body weight (BW) of the does and their kids as well as milk composition of the does. The results showed that dry matter intake (DMI) was reduced (P<0.05) by urea treatment, but it was increased (P<0.05) by supplementation. In vitro organic matter digestibility (IVOMD) was improved (P<0.05) by urea treatment and supplementation with either GNH or TP. BW of does decreased (P<0.05) in the TSS group, while a significant increase was obtained in the TSS+GNH group. BW of the kids belonging to the does given USS+GNH or TSS+TP was higher (P<0.05) than BW of the kids that belonged to the does fed other rations. However, no losses in BW were detected. It could be concluded that the combination of urea treatment and supplementation with either GNH or TP improved DMI, BW, digestibility and milk yield.

Odors from Sewage Sludge and Livestock: Associations with Self-Reported Health

PubMed Central

Lowman, Amy; Keil, Alex; Marshall, Stephen W.

2014-01-01

Objectives Class B treated sewage sludge (TSS) contains microbes and toxicants and is applied to land in areas where livestock wastes may be present. We evaluated relationships of reports of TSS and livestock odors with acute symptoms and excessive flies. Methods A total of 158 adults living near liquid TSS application sites, 85 living near cake TSS application sites, and 188 living in comparison areas responded to a household survey regarding odors, health, and demographics. We identified symptom groups using factor analysis. We used generalized estimating equations to fit linear models for associations between factor scores and odors, and Poisson models for associations with specific symptoms. Results Most factor scores were similar between exposure groups. Covariate-adjusted z-scores for lower respiratory symptoms were 0.28 (95% confidence interval [CI] –0.10, 0.65) higher among residents who reported moderate to very strong liquid TSS odor than among residents in comparison areas, and 0.28 (95% CI 0.05, 0.50) higher among residents who reported moderate to very strong livestock odor compared with residents reporting no or faint livestock odor. The factor score for dermatologic conditions was higher among residents who reported higher liquid sludge odor (0.27, 95% CI –0.13, 0.68), primarily due to skin rash (prevalence ratio = 2.21, 95% CI 1.13, 4.32). Excessive flies were reported twice as commonly among respondents who reported moderate to very strong TSS odor than among other residents. Conclusions Reported odors from TSS and livestock were associated with some acute symptoms. Health departments should monitor land applications of human and animal wastes and conduct surveillance of health problems reported by neighbors. PMID:25364052

Event-based total suspended sediment particle size distribution model

NASA Astrophysics Data System (ADS)

Thompson, Jennifer; Sattar, Ahmed M. A.; Gharabaghi, Bahram; Warner, Richard C.

2016-05-01

One of the most challenging modelling tasks in hydrology is prediction of the total suspended sediment particle size distribution (TSS-PSD) in stormwater runoff generated from exposed soil surfaces at active construction sites and surface mining operations. The main objective of this study is to employ gene expression programming (GEP) and artificial neural networks (ANN) to develop a new model with the ability to more accurately predict the TSS-PSD by taking advantage of both event-specific and site-specific factors in the model. To compile the data for this study, laboratory scale experiments using rainfall simulators were conducted on fourteen different soils to obtain TSS-PSD. This data is supplemented with field data from three construction sites in Ontario over a period of two years to capture the effect of transport and deposition within the site. The combined data sets provide a wide range of key overlooked site-specific and storm event-specific factors. Both parent soil and TSS-PSD in runoff are quantified by fitting each to a lognormal distribution. Compared to existing regression models, the developed model more accurately predicted the TSS-PSD using a more comprehensive list of key model input parameters. Employment of the new model will increase the efficiency of deployment of required best management practices, designed based on TSS-PSD, to minimize potential adverse effects of construction site runoff on aquatic life in the receiving watercourses.

Ozonation of return activated sludge for disintegration and solubilisation with synthesized titanium oxide as catalyst

NASA Astrophysics Data System (ADS)

Sarif, S. F. Z. Mohd; Alias, S. S.; Ridwan, F. Muhammad; Salim, K. S. Ku; Abidin, C. Z. A.; Ali, U. F. Md.

2018-03-01

Ozonation of activated sludge in the present of titanium dioxide (TiO2) as catalyst to enhance the production of hydroxyl radical was evaluated in comparison to the sole ozonation process. In this process, the catalytic ozontion showed improvement in increasing ozone consumption and improving activated sludge disintegration and solubilisation. The reduction of total suspended solid (TSS), volatile suspended solid (VSS) and soluble chemical oxygen demand (SCOD) solubilisation was better in the catalytic ozonation system. Initial pH 7 of activated sludge was found best to disintegrate and solubilise the sludge flocs. However upon additional of sodium hydroxide (NaOH) in pH adjustment enhanced the solubilisation of organic matter from the flocs and cells, making the initial pH 9 is the best condition for activated sludge solubilisation. Yet the initial pH 7 of activated sludge supernatant was the best condition to achieve SCOD solubilisation due to sludge floc disintegration, when it had stronger correlation between TSS reduction and SCOD solubilisation (R2=0.961). Lower amount of catalyst of 100 mgTiO2/gTSS was found to disintegrate and solubilise the activated sludge better with 30.4% TSS reduction and 25.2% SCOD solubilisation efficiency, compared to 200 mgTiO2/gTSS with 21.9% and 17.1% TSS reduction and SCOD solubilisation, respectively.

Rotating belt sieves for primary treatment, chemically enhanced primary treatment and secondary solids separation.

PubMed

Rusten, B; Rathnaweera, S S; Rismyhr, E; Sahu, A K; Ntiako, J

2017-06-01

Fine mesh rotating belt sieves (RBS) offer a very compact solution for removal of particles from wastewater. This paper shows examples from pilot-scale testing of primary treatment, chemically enhanced primary treatment (CEPT) and secondary solids separation of biofilm solids from moving bed biofilm reactors (MBBRs). Primary treatment using a 350 microns belt showed more than 40% removal of total suspended solids (TSS) and 30% removal of chemical oxygen demand (COD) at sieve rates as high as 160 m³/m²-h. Maximum sieve rate tested was 288 m³/m²-h and maximum particle load was 80 kg TSS/m²-h. When the filter mat on the belt increased from 10 to 55 g TSS/m², the removal efficiency for TSS increased from about 35 to 60%. CEPT is a simple and effective way of increasing the removal efficiency of RBS. Adding about 1 mg/L of cationic polymer and about 2 min of flocculation time, the removal of TSS typically increased from 40-50% without polymer to 60-70% with polymer. Using coagulation and flocculation ahead of the RBS, separation of biofilm solids was successful. Removal efficiencies of 90% TSS, 83% total P and 84% total COD were achieved with a 90 microns belt at a sieve rate of 41 m³/m²-h.

Osmolality urine - series (image)

MedlinePlus

Greater-than-normal measurements may indicate: Addison's disease (rare) Congestive heart failure Shock Syndrome of inappropriate ADH secretion Lower-than-normal measurements may indicate: Aldosteronism (very rare) Diabetes insipidus (rare) ...

Toxic Shock Syndrome

MedlinePlus

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

Cellular Basis for Learning Impairment in Fragile X Syndrome

DTIC Science & Technology

2014-08-01

oxygen is restored. Induction of the heat shock proteins (HSPs) is one of the first lines of defense against physiological stress , shifting cellular...Haddad, 2001), and aid resistance to glutamate and hypoxic stress in mammals (Zhang et al., 2000). AMPA receptor currents, meanwhile, are also...level in anoxic turtle brain. These include increases in heat shock proteins, anti-apoptotic factors, the MAP kinases, antioxidants and modulation of

Prevention of Blast-Related Injuries

DTIC Science & Technology

2016-07-01

mTBI) as the signature wound in returning service members [1,2]. Shell shock and post concussive syndrome had a similar prominence during World Wars I...head only exposed blast overpressure of 241 kPa [43]. Turner et al, using a tabletop shock tube, reported graded astrocytic reactivity in the corpus...in astrocytes with increasing pressure [63]. This is different from Turner et al who reported an increase in the number of corpus callosum

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial.

PubMed

Zhang, Zhongheng; Xu, Xiao; Yao, Min; Chen, Huilan; Ni, Hongying; Fan, Haozhe

2013-02-01

Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS). The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown. The study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days. We investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO. http://www.clinicaltrials.gov NCT01526382.

Rectal ulcer in a patient with VZV sacral meningoradiculitis (Elsberg syndrome).

PubMed

Matsumoto, Hideyuki; Shimizu, Takahiro; Tokushige, Shin-ichi; Mizuno, Hideo; Igeta, Yukifusa; Hashida, Hideji

2012-01-01

This report describes the case of a 55-year-old woman with varicella-zoster virus (VZV) sacral meningoradiculitis (Elsberg syndrome) who presented with herpes zoster in the left S2 dermatome area, urinary retention, and constipation. Lumbar magnetic resonance imaging showed the left sacral nerve root swelling with enhancement. Thereafter, she suddenly showed massive hematochezia and hemorrhagic shock because of a rectal ulcer. To elucidate the relation between Elsberg syndrome and rectal ulcer, accumulation of similar cases is necessary. To avoid severe complications, attention must be devoted to the possibility of rectal bleeding in the early stage of Elsberg syndrome.

Acute abdomen due to group A streptococcus bacteremia caused by an isolate with a mutation in the csrS gene.

PubMed

Kaneko, Masahiko; Maruta, Masaki; Shikata, Hisaharu; Hanayama, Masakazu; Ikebe, Tadayoshi

2015-11-01

Streptococcus pyogenes (group A streptococcus) is an aerobic gram-positive coccus that causes infections ranging from non-invasive pharyngitis to severely invasive necrotizing fasciitis. Mutations in csrS/csrR and rgg, negative regulator genes of group A streptococcus, are crucial factors in the pathogenesis of streptococcal toxic shock syndrome, which is a severe, invasive infection characterized by sudden onset of shock and multiorgan failure, resulting in a high mortality rate. Here we present a case of group A streptococcal bacteremia in a 28-year-old Japanese woman with no relevant previous medical history. The patient developed progressive abdominal symptoms that may have been due to spontaneous bacterial peritonitis, followed by a state of shock, which did not fulfill the proposed criteria for streptococcal toxic shock. The isolate was found to harbor a mutation in the negative regulator csrS gene, whereas the csrR and rgg genes were intact. It was noteworthy that this strain carrying a csrS mutation had caused group A streptococcal bacteremia characterized by acute abdomen as the presenting symptom in a young individual who had been previously healthy. This case indicates that group A streptococcus with csrS mutations has potential virulence factors that are associated with the onset of group A streptococcal bacteremia that does not meet the diagnostic criteria for streptococcal toxic shock syndrome. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Solar cycle dependence of the heliospheric shape deduced from a global MHD simulation of the interaction process between a nonuniform time-dependent solar wind and the local interstellar medium

NASA Astrophysics Data System (ADS)

Tanaka, T.; Washimi, H.

1999-06-01

The global structure of the solar wind/very local interstellar medium interaction is studied from a fully three-dimensional time-dependent magnetohydrodynamic model, in which the solar wind speed increases from 400 to 800 km/s in going from the ecliptic to pole and the heliolatitude of the low-high-speed boundary changes from 30° to 80° in going from the solar minimum to solar maximum. In addition, the interplanetary magnetic field (IMF) changes its polarity at the solar maximum. As a whole, the shapes of the terminal shock (TS) and heliopause (HP) are elongated along the solar polar axis owing to a high solar wind ram pressure over the poles. In the ecliptic plane, the heliospheric structure changes little throughout a solar cycle. The TS in this plane shows a characteristic bullet-shaped structure. In the polar plane, on the other hand, the shape of the TS exhibits many specific structures according to the stage of the solar cycle. These structures include the polygonal configuration of the polar TS seen around the solar minimum, the mesa- and terrace-shaped TSs in the high- and low-speed solar wind regions seen around the ascending phase, and the chimney-shaped TS in the high-speed solar wind region seen around the solar maximum. These structures are formed from different combinations of right-angle shock, oblique shock, and steep oblique shock so as to transport the heliosheath plasma most efficiently toward the heliotail (HT). In the HT, the hot and weakly-magnetized plasma from the high-heliolatitude TS invades as far as the ecliptic plane. A weakly time-dependent recirculation flow in the HT is a manifestation of invading flow. Distributions of magnetic field in the HT, which are a pile-up of the compressed MF over several solar cycles, are modified by the flow from high-heliolatitude.

Hubble Space Telescope Constraints on the Winds and Astrospheres of Red Giant Stars

NASA Astrophysics Data System (ADS)

Wood, Brian E.; Müller, Hans-Reinhard; Harper, Graham M.

2016-10-01

We report on an ultraviolet spectroscopic survey of red giants observed by the Hubble Space Telescope, focusing on spectra of the Mg II h and k lines near 2800 Å in order to study stellar chromospheric emission, winds, and astrospheric absorption. We focus on spectral types between K2 III and M5 III, a spectral type range with stars that are noncoronal, but possessing strong, chromospheric winds. We find a very tight relation between Mg II surface flux and photospheric temperature, supporting the notion that all K2-M5 III stars are emitting at a basal flux level. Wind velocities (V w ) are generally found to decrease with spectral type, with V w decreasing from ˜40 km s-1 at K2 III to ˜20 km s-1 at M5 III. We find two new detections of astrospheric absorption, for σ Pup (K5 III) and γ Eri (M1 III). This absorption signature had previously only been detected for α Tau (K5 III). For the three astrospheric detections, the temperature of the wind after the termination shock (TS) correlates with V w , but is lower than predicted by the Rankine-Hugoniot shock jump conditions, consistent with the idea that red giant TSs are radiative shocks rather than simple hydrodynamic shocks. A full hydrodynamic simulation of the γ Eri astrosphere is provided to explore this further. Based on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with program GO-13462. This paper also presents observations obtained with the Harlan J. Smith Telescope at McDonald Observatory of the University of Texas at Austin.

Fort Dix Remedial Investigation/Feasibility Study for 13 Sites, Final Technical Plan, Data Item A004

DTIC Science & Technology

1995-09-01

39 oxygen demand (COD), TSS, total dissolved solids ( TDS ), nitrate/nitrite, sulfate, W0109314.M80 7133-04 5-4 SECTION 5 phosphateand alkalinity...TSS, TDS , BOD-5, COD, alkalinity, hardness, 38 and gross alpha, beta, and gamma radiation (Table 2). 39 W0109314.M80 12-2 7133-°4 SECTION 12 l...wells. Groundwater samples 28 will be analyzed for TCL VOCs, TCL SVOCs, TAL metals (nonfiltered and filtered) 29 TSS, TDS , BOD-5, COD, alkalinity

High voltage characteristics of the electrodynamic tether and the generation of power and propulsion

NASA Technical Reports Server (NTRS)

Williamson, P. R.

1986-01-01

The Tethered Satellite System (TSS) will deploy and retrieve a satellite from the Space Shuttle orbiter with a tether of up to 100 km in length attached between the satellite and the orbiter. The characteristics of the TSS which are related to high voltages, electrical currents, energy storage, power, and the generation of plasma waves are described. A number of specific features of the tether system of importance in assessing the operational characteristics of the electrodynamic TSS are identified.

40 CFR 436.42 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2011 CFR

2011-07-01

...— TSS 45 mg/l 25 mg/l. pH (1) (1) 1 Within the range 6.0 to 9.0. (2) Except as provided in paragraphs (a... daily values for 30 consecutive days shall not exceed— TSS 0.046 0.023 Total fluoride .006 .003 pH (1... consecutive days shall not exceed— TSS 45 mg/l 25 mg/l. pH (1) (1) 1 Within the range 6.0 to 9.0. (b) Any...

40 CFR 471.53 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 4.29 TSS 6.44 5.15 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Drawing spent... Nickel 0.655 0.441 Fluoride 70.8 31.4 Molybdenum 5.99 2.66 Oil and grease 11.9 11.9 TSS 17.9 14.3 pH (1... and grease 2.81 2.81 TSS 4.22 3.37 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (j...

40 CFR 471.53 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 4.29 TSS 6.44 5.15 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Drawing spent... Nickel 0.655 0.441 Fluoride 70.8 31.4 Molybdenum 5.99 2.66 Oil and grease 11.9 11.9 TSS 17.9 14.3 pH (1... and grease 2.81 2.81 TSS 4.22 3.37 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (j...

40 CFR 417.163 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... per 1,000 kg of anhydrous product) BOD5 0.10 0.05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .05 Oil....05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .005 Oil and grease 0.01 .005 pH (1) (1) 1 Within the... (kilograms per 1,000 kg of anhydrous product) BOD5 0.02. COD 0.07. TSS 0.002. Surfactants 0.02. Oil and...

40 CFR 417.163 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... per 1,000 kg of anhydrous product) BOD5 0.10 0.05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .05 Oil....05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .005 Oil and grease 0.01 .005 pH (1) (1) 1 Within the... (kilograms per 1,000 kg of anhydrous product) BOD5 0.02. COD 0.07. TSS 0.002. Surfactants 0.02. Oil and...

40 CFR 417.163 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... per 1,000 kg of anhydrous product) BOD5 0.10 0.05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .05 Oil....05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .005 Oil and grease 0.01 .005 pH (1) (1) 1 Within the... (kilograms per 1,000 kg of anhydrous product) BOD5 0.02. COD 0.07. TSS 0.002. Surfactants 0.02. Oil and...

40 CFR 417.163 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... per 1,000 kg of anhydrous product) BOD5 0.10 0.05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .05 Oil....05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .005 Oil and grease 0.01 .005 pH (1) (1) 1 Within the... (kilograms per 1,000 kg of anhydrous product) BOD5 0.02. COD 0.07. TSS 0.002. Surfactants 0.02. Oil and...

40 CFR 417.163 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... per 1,000 kg of anhydrous product) BOD5 0.10 0.05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .05 Oil....05 COD 0.44 .22 TSS 0.01 .005 Surfactants 0.10 .005 Oil and grease 0.01 .005 pH (1) (1) 1 Within the... (kilograms per 1,000 kg of anhydrous product) BOD5 0.02. COD 0.07. TSS 0.002. Surfactants 0.02. Oil and...

Effect of dobutamine on extravascular lung water index, ventilator function, and perfusion parameters in acute respiratory distress syndrome associated with septic shock.

PubMed

Zhou, Min; Dai, Ji; Du, Min; Wang, Wei; Guo, Changxing; Wang, Yi; Tang, Rui; Xu, Fengling; Rao, Zhuqing; Sun, Gengyun

2016-08-01

The role of dobutamine in the relief of pulmonary edema during septic shock-induced acute respiratory distress syndrome (ARDS) remains undetermined, due to a lack of controllable and quantitative clinical studies. Our objective was to assess the potential effects of dobutamine on extravascular lung water index (ELWI) in septic shock-induced ARDS, reflecting its importance in pulmonary edema. At the same time, ventilator function and perfusion parameters were evaluated. We designed a prospective, non-randomized, non-blinded, controlled study to compare the differences in PiCCO parameters after 6 h of constant dobutamine infusion (15 μg/kg/min), in the baseline parameters in 26 septic shock-related ARDS patients with cardiac index ≥ 2.5I/min/m(2) and hyperlactatemia. These patients (12 survivors/14 non-survivors) were monitored using the PiCCO catheter system within 48 h of onset of septic shock. The dynamic changes in ELWI, which is typically used for quantifying the extent of pulmonary edema, were evaluated, and the corresponding ventilator function and tissue perfusion parameters were also measured. Decreasing ELWI (p = 0.0376) was accompanied by significantly decreased SVRI (p < 0.0001). Despite a significant increase in cardiac output (p < 0.0001), no differences were found in ITBI or GEDI. Moreover, the required dose of norepinephrine was decreased (p = 0.0389), and urine output was increased (p = 0.0358), accompanied by stabilized lactacidemia and MAP. Additionally, airway pressure was moderately improved. During the early stage of septic shock-induced ARDS, dobutamine treatment demonstrated a beneficial effect by relieving pulmonary edema in patients, without a negative elevation in preload or hemodynamics, which might account for the improvements in ventilator function and tissue hypoperfusion.

Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature.

PubMed

Geri, Guillaume; Rabbat, Antoine; Mayaux, Julien; Zafrani, Lara; Chalumeau-Lemoine, Ludivine; Guidet, Bertrand; Azoulay, Elie; Pène, Frédéric

2015-12-01

Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted in intensive care unit (ICU) with SHS and report a literature review of such cases. Retrospective multicenter study of 11 patients admitted to the ICU of tertiary hospitals with SHS between 2000 and 2013. Literature review with Pubmed retrieved 122 cases. Logistic regression analysis was performed to identify predictive factors of ICU mortality and shock occurrence. 133 patients [median age 53 (39, 64), 72.2 % males] were included. Underlying immunosuppression was present in 127 patients, mostly long-term corticosteroid treatment in 111 (83.5 %) patients. Fever (80.8 %), respiratory (88.6 %), and gastrointestinal (71.2 %) symptoms were common clinical manifestations. Shock occurred in 75 (57.3 %) patients and mechanical ventilation was required in 89 (67.9 %) patients. Hypereosinophilia and a concomitant bacterial infection were observed in 34 (34.3 %) and 51 (38.4 %) patients, respectively. The in-ICU mortality rate was 60.3 %. Predictive factors of ICU mortality were shock occurrence [Odds ratio (OR) 18.1, 95 % confidence interval (95 % CI) 3.03-107.6, p < 0.01] and mechanical ventilation (OR 28.1, 95 % CI 3.6-217, p < 0.01). Hypereosinophilia (OR 0.21, 95 % CI 0.06-0.7, p = 0.01) and a concomitant bacterial infection (OR 4.68, 95 % CI 1.3-16.8, p = 0.02) were independent predictors of shock occurrence. SHS remains associated with a poor outcome, especially when associated with shock and mechanical ventilation. Deterioration to shock is often related to concomitant bacterial infection. The poor outcome of established SHS pleads for a large application of antiparasitic primary prophylaxis in at-risk patients.

Changes in peroxisome proliferator-activated receptor-gamma activity in children with septic shock.

PubMed

Kaplan, Jennifer M; Denenberg, Alvin; Monaco, Marie; Nowell, Marchele; Wong, Hector; Zingarelli, Basilia

2010-01-01

To assess changes in peroxisome proliferator-activated receptor-gamma (PPARgamma) in peripheral blood mononuclear cells (PBMC) from critically ill children with sepsis. Additionally, to investigate the effects of sepsis on the endogenous activator of PPARgamma, 15-deoxy-(12,14)-PGJ(2) (15d-PGJ(2)), and the downstream targets of PPARgamma activity, adiponectin and resistin. Single-center, prospective case-control study in critically ill children with systemic inflammatory response syndrome, sepsis or septic shock. PPARgamma nuclear protein expression was decreased but PPARgamma activity was increased in PBMC from children with septic shock compared with controls. PPARgamma activity on day 1 was significantly higher in patients with higher pediatric risk of mortality (PRISM) score compared with controls [mean 0.22 optical density (OD) +/- standard error of the mean (SEM) 0.03 versus 0.12 OD +/- 0.02; p < 0.001]. Patients with resolved sepsis had increased levels of the endogenous PPARgamma ligand, 15d-PGJ(2), compared with patients with systemic inflammatory response syndrome (SIRS) and septic shock (77.7 +/- 21.7 versus 58 +/- 16.5 pg/ml; p = 0.03). Plasma high-molecular-weight adiponectin (HMWA) and resistin levels were increased in patients with septic shock on day 1 and were significantly higher in patients with higher PRISM scores. Nonsurvivors from sepsis had higher resistin levels on the first day of hospitalization compared with survivors from septic shock [660 ng/ml, interquartile range (IQR) 585-833 ng/ml versus 143 ng/ml, IQR 66-342 ng/ml; p < 0.05]. Sepsis is associated with altered PPARgamma expression and activity in PBMC. Plasma adipokines correlate with risk of mortality scores in sepsis and may be useful biomarkers. Further studies are needed to understand the mechanisms underlying changes in PPARgamma in sepsis.

[Analysis of drug resistance and drug resistance genes of imipenem-resistant Pseudomonas aeruginosa strains isolated from burn wards].

PubMed

Liu, Shuhua; Liu, Pinghong; Xue, Xiaodong; Chen, Zhaojun; Pei, Decui

2014-02-01

To analyze the drug resistance and drug resistance genes of imipenem-resistant Pseudomonas aeruginosa (IRPA) strains isolated from burn wards. From June 2011 to June 2012, 30 strains of IRPA were isolated from wound excretion, sputum, and venous catheter attachment from burn patients hospitalized in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine. Drug resistance of the IRPA to 12 antibiotics commonly used in clinic, including ceftazidime, amikacin, ciprofloxacin, etc., was tested with K-B paper agar disk diffusion method. Metallo-β-lactamase (MBL)-producing IRPA was detected by synergism test with imipenem-2-mercaptoethanol. Plasmid of IRPA was extracted, and it was inserted into competent cells, producing transformation strains (TSs). Drug resistance of TSs to imipenem and the MBL-producing TSs were detected. The genes blaIMP, blaVIM, blaOXA-1, blaOXA-2 and blaOXA-10 of IRPA and the TSs were detected by polymerase chain reaction. The drug resistance of IRPA producing MBL or OXA enzyme was summed up. The sensitive rates of the 30 strains of IRPA to the 12 antibiotics were equal to or above 60.0%. Six strains of MBL-producing IRPA were screened. Twenty-four TSs were resistant to imipenem, and 6 strains among them were MBL-producing positive. Among the 30 strains of IRPA, 6 strains and their corresponding TSs carried blaVIM; 20 strains and their corresponding TSs carried blaOXA-10; no strain was detected to carry blaIMP, blaOXA-1 or blaOXA-2. Two strains and their corresponding TSs were detected carrying both blaVIM and blaOXA-10. No significant difference of drug resistance was observed between strains producing only MBL or OXA enzyme, with the same high resistance to β-lactam antibiotics and some degree of sensitivity to aminoglycoside antibiotics. Strains producing enzymes MBL and OXA were all resistant to the 12 antibiotics. IRPA strains isolated from burn wards of Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine are multidrug-resistant, and they mainly produce type B and D carbapenemases.

Soy Allergy

MedlinePlus

... most allergic responses, including a runny nose, itchy eyes, dry throat, rashes and hives, nausea, diarrhea, difficulty breathing, and anaphylactic shock. Food protein-induced enterocolitis syndrome (FPIES) A food allergen can also cause what's ...

Complete Genome Sequence and Comparative Genomics of a Streptococcus pyogenes emm3 Strain M3-b isolated from a Japanese Patient with Streptococcal Toxic Shock Syndrome.

PubMed

Ogura, Kohei; Watanabe, Shinya; Kirikae, Teruo; Miyoshi-Akiyama, Tohru

2017-01-01

Epidemiologic typing of Streptococcus pyogenes (GAS) is frequently based on the genotype of the emm gene, which encodes M/Emm protein. In this study, the complete genome sequence of GAS emm3 strain M3-b, isolated from a patient with streptococcal toxic shock syndrome (STSS), was determined. This strain exhibited 99% identity with other complete genome sequences of emm3 strains MGAS315, SSI-1, and STAB902. The complete genomes of five additional strains isolated from Japanese patients with and without STSS were also sequences. Maximum-likelihood phylogenetic analysis showed that strains M3-b, M3-e, and SSI-1, all which were isolated from STSS patients, were relatively close.

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.

Streptococcal toxic shock syndrome complicating a peritonsillar abscess.

PubMed

Aalling, Mathilde; Klug, Tejs Ehlers

2015-02-01

A 68-year-old man was admitted to hospital in an acute confusional state with a 2-week history of fever, influenza-like illness and sore throat. He quickly developed coagulation disturbances, hypotension and renal function impairment. Despite broad-spectrum antibiotic therapy, he deteriorated. Group A streptococcus (GAS) was recovered from blood cultures, which gave the diagnosis streptococcal toxic shock syndrome (STSS). A computed tomography scan showed a right-sided peritonsillar abscess (PTA). Acute tonsillectomy was carried out and the patient recovered. STSS complicating PTA has not previously been described in the literature, but GAS is a common pathogen in PTA. Clinicians should be aware that STSS can develop secondary to tonsillar infections and that abscess development should be suspected in STSS patients who do not respond to antibiotic treatment.

A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death.

PubMed

Cho, Jong Tae; Han, Jin Hyung

2016-07-01

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.

[A teenager with Prader-Willi syndrome with loss of appetite].

PubMed

Smorenberg, Annemieke; Buter, Nynke H; Mollema, Robert; Toornvliet, Arnoud C; Hack, W W M Wilfried

2014-01-01

Prader-Willi syndrome is characterised by hyperphagia and binge eating, without regurgitation. We present a 16-year-old girl with Prader-Willi syndrome exhibiting loss of appetite, stomach ache and regurgitation. Gastro-enteritis was suspected. However, she rapidly developed severe septic shock. During emergency surgery, a fully necrotic and ruptured stomach was seen. Despite respiratory, haemodynamic and surgical efforts, the patient died of necrotic intestinal bleeding. Binge eating or deviant gastric homeostasis could account for the relatively high incidence of gastric necrosis in patients with Prader-Willi syndrome. Loss of appetite and regurgitation in patients with this syndrome should be considered as warning signs of a possible life-threatening disorder.

Case of streptococcal toxic shock syndrome caused by rapidly progressive group A hemolytic streptococcal infection during postoperative chemotherapy for cervical cancer.

PubMed

Nogami, Yuya; Tsuji, Kousuke; Banno, Kouji; Umene, Kiyoko; Katakura, Satomi; Kisu, Iori; Tominaga, Eiichiro; Aoki, Daisuke

2014-01-01

Streptococcal toxic shock syndrome (STSS) is a severe infectious disease caused by group A hemolytic streptococcus (Streptococcus pyogenes). This condition is a serious disease that involves rapidly progressive septic shock. We experienced a case of STSS caused by primary peritonitis during treatment with paclitaxel and cisplatin (TP therapy) as postoperative chemotherapy for cervical cancer. STSS mostly develops after extremity pain, but initial influenza-like symptoms of fever, chill, myalgia and gastrointestinal symptoms may also occur. TP therapy is used to treat many cancers, including gynecological cancer, but may cause adverse reactions of neuropathy and nephrotoxicity and sometimes fever, arthralgia, myalgia, abdominal pain and general malaise. The case reported here indicates that development of STSS can be delayed after chemotherapy and that primary STSS symptoms may be overlooked because they may be viewed as adverse reactions to chemotherapy. To our knowledge, this is the first report of a case of STSS during chemotherapy. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Inhibition of Neutrophil Collagenase/MMP-8 and Gelatinase B/MMP-9 and Protection against Endotoxin Shock

PubMed Central

Qiu, Zheng; Chen, Jianghai; Xu, Hanmei; Van den Steen, Philippe E.; Opdenakker, Ghislain; Wang, Min

2014-01-01

Endotoxin shock is a life-threatening disorder, associated with the rapid release of neutrophil enzymes, including neutrophil collagenase/matrix metalloproteinase-8 (MMP-8) and gelatinase B/matrix metalloproteinase-9 (MMP-9). After activation, these enzymes cleave extracellular matrix components and cytokines and thus may contribute to shock syndrome development. MMP inhibitors have been suggested as immunotherapy of endotoxin shock. However, little is known about the therapeutic time window of MMP inhibition. Here, a sublethal endotoxin shock mouse model was used to evaluate the effect of an MMP inhibiting peptide (P2) after intravenous or intraperitoneal injection and to study the time window between LPS and inhibitor injections. With the use of a specific ELISA the plasma P2 concentrations were monitored. Whereas we corroborated the treatment strategy of MMP targeting in endotoxin shock with a new inhibitor, we also demonstrated that the time window, within which effective MMP inhibition increased the survival rates, is rather limited. PMID:25762310

Physical activity, muscle, and the HSP70 response.

PubMed

Kilgore, J L; Musch, T I; Ross, C R

1998-06-01

Selye (1936) described how organisms react to various external stimuli (i.e., stressors). These reactions generally follow a programmed series of events and help the organism adapt to the imposed stress. The heat shock response is a common cellular reaction to external stressors, including physical activity. A characteristic set of proteins is synthesised shortly after the organism is exposed to stress. Researchers have not determined how heat shock proteins affect the exercise response. However, their role in adaptation to exercise and training might be inferred, since the synthetic patterns correlate well with the stress adaptation syndrome that Selye described. This review addresses the 70 kilodalton heat shock protein family (HSP70), the most strongly induced heat shock proteins. This paper provides an overview of the general heat shock response and a brief review of literature on HSP70 function, structure, regulation, and potential applications. Potential applications in health, exercise, and medicine are provided.

Mesenchymal Stem Cells for the Prevention of Acute Respiratory Distress Syndrome after Pulmonary Contusion and Hemorrhagic Shock

DTIC Science & Technology

2017-10-01

Contusion and Hemorrhagic Shock PRINCIPAL INVESTIGATOR: Martin Schreiber, MD CONTRACTING ORGANIZATION: Oregon Health & Science University Portland, OR...PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Oregon Health & Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239 Blood Systems...extubated the animals was not logistically or physically feasible. To improve the welfare of the animal and consistency in the model, we revised our model

Results of repeated transsphenoidal surgery in Cushing's disease. Long-term follow-up.

PubMed

Valderrábano, Pablo; Aller, Javier; García-Valdecasas, Leopoldo; García-Uría, José; Martín, Laura; Palacios, Nuria; Estrada, Javier

2014-04-01

Transsphenoidal surgery (TSS) is the treatment of choice for Cushing's disease (CD). However, the best treatment option when hypercortisolism persists or recurs remains unknown. The aim of this study was to analyze the short and long-term outcome of repeat TSS in this situation and to search for response predictors. Data from 26 patients with persistent (n=11) or recurrent (n=15) hypercortisolism who underwent repeat surgery by a single neurosurgeon between 1982 and 2009 were retrospectively analyzed. Remission was defined as normalization of urinary free cortisol (UFC) levels, and recurrence as presence of elevated UFC levels after having achieved remission. The following potential outcome predictors were analyzed: adrenal status (persistence or recurrence) after initial TSS, tumor identification in imaging tests, degree of hypercortisolism before repeat TSS, same/different surgeon in both TSS, and time to repeat surgery. Immediate postoperative remission was achieved in 12 patients (46.2%). Five of the 10 patients with available follow-up data relapsed after surgery (median time to recurrence, 13 months). New hormone deficiencies were seen in seven patients (37%), and two patients had cerebrospinal fluid leakage. No other major complications occurred. None of the preoperative factors analyzed was predictive of surgical outcome. When compared to initial surgery, repeat TSS for CD is associated to a lower remission rate and a higher risk of recurrence and complications. Further studies are needed to define outcome predictors. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Predicting runoff of suspended solids and particulate phosphorus for selected Louisiana soils using simple soil tests.

PubMed

Udeigwe, Theophilus K; Wang, Jim J; Zhang, Hailin

2007-01-01

This study was conducted to evaluate the relationships among total suspended solids (TSS) and particulate phosphorus (PP) in runoff and selected soil properties. Nine Louisiana soils were subjected to simulated rainfall events, and runoff collected and analyzed for various parameters. A highly significant relationship existed between runoff TSS and runoff turbidity. Both runoff TSS and turbidity were also significantly related to runoff PP, which on average accounted for more than 98% of total P (TP) in the runoff. Runoff TSS was closely and positively related to soil clay content in an exponential fashion (y=0.10e0.01x, R2=0.91, P<0.001) while it was inversely related to soil electrical conductivity (EC) (y=0.02 x(-3.95), R2=0.70, P<0.01). A newly-devised laboratory test, termed "soil suspension turbidity" (SST) which measures turbidity in a 1:200 soil/water suspension, exhibited highly significant linear relationships with runoff TSS (y=0.06x-4.38, R2=0.82, P<0.001) and PP (y=0.04x+2.68, R2=0.85, P<0.001). In addition, SST alone yielded similar R2 value to that of combining soil clay content and EC in a multiple regression, suggesting that SST was able to account for the integrated effect of clay content and electrolytic background on runoff TSS. The SST test could be used for assessment and management of sediment and particulate nutrient losses in surface runoff.

Particle size distribution variance in untreated urban runoff and its implication on treatment selection.

PubMed

Charters, Frances J; Cochrane, Thomas A; O'Sullivan, Aisling D

2015-11-15

Understanding the particle size distribution (PSD) of sediment in urban runoff assists in the selection of appropriate treatment systems for sediment removal as systems vary in their ability to remove sediment across different particle size fractions. Variation in PSD in runoff from individual urban surfaces both during and across multiple rain events is not well understood and it may lead to performance uncertainty in treatment systems. Runoff PSDs in international literature were compiled to provide a comparative summary of PSDs from different urban surfaces. To further assess both intra-event and inter-event PSD variation, untreated runoff was collected from road, concrete roof, copper roof, and galvanized roof surfaces within an urban catchment exposed to the same rainfall conditions and analysed for PSD and total suspended solids (TSS). Road runoff had the highest TSS concentrations, while copper roofs had high initial TSS that reduced to very low levels under steady state conditions. Despite variation in TSS concentrations, the median particle diameter of the TSS was comparable across the surfaces. Intra-event variation was generally not significant, but substantial inter-event variation was observed, particularly for coarser road and concrete roof surfaces. PSD variation for each surface contributed to a wide range in predicted treatment performance and suggests that short-retention treatment devices carry a high performance risk of not being able to achieve adequate TSS removal across all rain events. Copyright © 2015 Elsevier Ltd. All rights reserved.

The impact of transsphenoidal surgery on neurocognitive function: A systematic review.

PubMed

Alsumali, Adnan; Cote, David J; Regestein, Quentin R; Crocker, Erin; Alzarea, Abdulaziz; Zaidi, Hasan A; Bi, Wenya Linda; Dawood, Hassan Y; Broekman, Marike L; van Zandvoort, Martine J E; Mekary, Rania A; Smith, Timothy R

2017-08-01

Cognitive impairment following transsphenoidal surgery (TSS) among patients with pituitary tumors has been intermittently reported and is not well established. We performed a systematic review to summarize the impact of TSS on cognitive function. We conducted a systematic search of the literature using the PubMed, Cochrane, and Embase databases through October 2014. Studies were selected if they reported cognitive status after surgery and included at least 10 adult patients with pituitary tumors undergoing either endoscopic or microscopic TSS. After removing 69 duplicates, 758 articles were identified, of which 24 were selected for full text review after screening titles and abstracts. After reviewing full texts, nine studies with a combined total of 682 patients were included in the final analysis. Eight studies were cross-sectional and one was longitudinal. These studies used a wide variety of neurocognitive tests to assess memory, attention and executive function post-operatively. Of the eight studies, six reported impairments in verbal and non-verbal memory post-operatively, while others found no association related to memory, and some reported an improvement in episodic, verbal, or logical memory. While four studies found an impaired association between TSS and attention or executive function, another four studies did not. The current literature on cognitive impairments after TSS is limited and inconsistent. This review demonstrates that patients undergoing TSS may experience a variety of effects on executive function and memory post-operatively, but changes in verbal memory are most common. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical Management of Heat-Related Illnesses

DTIC Science & Technology

2012-01-01

rhabdomyolysis and multiorgan dysfunction syndrome, and it may result in death from overwhelming cell necrosis caused by a lethal heat-shock exposure...complications such as rhabdomyolysis and multiorgan dysfunction syndrome, and it may result in death from overwhelming cell necrosis caused by a...acetaminophen lower Tco by normalizing the elevated hypothalamic set point that is caused by pyrogens; in heatstroke, the set point is normal, with

[Two cases of "scombroid syndrome" with severe cardiovascular compromise].

PubMed

Ascione, A; Barresi, L S; Sarullo, F M; De Silvestre, G

1997-12-01

Two cases of severe intoxication after ingestion of cooked tuna fish were observed. Symptoms and clinical signs were consistent with the scombroid syndrome. Cardiovascular shock was observed in both patients and was associated with subendocardial myocardial infarction in 1 case and acute pulmonary edema with myocardial ischemia in the other. The importance of ECG monitoring in the Intensive Coronary Care Unit is stressed.

A gene-specific non-enhancer sequence is critical for expression from the promoter of the small heat shock protein gene αB-crystallin

PubMed Central

2014-01-01

Background Deciphering of the information content of eukaryotic promoters has remained confined to universal landmarks and conserved sequence elements such as enhancers and transcription factor binding motifs, which are considered sufficient for gene activation and regulation. Gene-specific sequences, interspersed between the canonical transacting factor binding sites or adjoining them within a promoter, are generally taken to be devoid of any regulatory information and have therefore been largely ignored. An unanswered question therefore is, do gene-specific sequences within a eukaryotic promoter have a role in gene activation? Here, we present an exhaustive experimental analysis of a gene-specific sequence adjoining the heat shock element (HSE) in the proximal promoter of the small heat shock protein gene, αB-crystallin (cryab). These sequences are highly conserved between the rodents and the humans. Results Using human retinal pigment epithelial cells in culture as the host, we have identified a 10-bp gene-specific promoter sequence (GPS), which, unlike an enhancer, controls expression from the promoter of this gene, only when in appropriate position and orientation. Notably, the data suggests that GPS in comparison with the HSE works in a context-independent fashion. Additionally, when moved upstream, about a nucleosome length of DNA (−154 bp) from the transcription start site (TSS), the activity of the promoter is markedly inhibited, suggesting its involvement in local promoter access. Importantly, we demonstrate that deletion of the GPS results in complete loss of cryab promoter activity in transgenic mice. Conclusions These data suggest that gene-specific sequences such as the GPS, identified here, may have critical roles in regulating gene-specific activity from eukaryotic promoters. PMID:24589182

Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes.

PubMed

Workman, Jennifer K; Ames, Stefanie G; Reeder, Ron W; Korgenski, E Kent; Masotti, Susan M; Bratton, Susan L; Larsen, Gitte Y

2016-10-01

The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly. Single center retrospective cohort study. Emergency department and PICU at an academic children's hospital. Three hundred twenty-one patients treated for septic shock in the emergency department and admitted directly to the PICU. None. The exposure was receipt of emergency department care compliant with the Surviving Sepsis Campaign recommendations (delivery of IV fluids, IV antibiotics, and vasoactive infusions within 1 hr of shock recognition). The primary outcome was development of new or progressive multiple organ dysfunction syndrome. Secondary outcomes included mortality, need for mechanical ventilation or vasoactive medications, and hospital and PICU length of stay. Of the 321 children studied, 117 received Surviving Sepsis Campaign compliant care in the emergency department and 204 did not. New or progressive multiple organ dysfunction syndrome developed in nine of the patients (7.7%) who received Surviving Sepsis Campaign compliant care and 25 (12.3%) who did not (p = 0.26). There were 17 deaths; overall mortality rate was 5%. There were no significant differences between groups in any of the secondary outcomes. Although only 36% of patients met the Surviving Sepsis Campaign guideline recommendation of bundled care within 1 hour of shock recognition, 75% of patients received the recommended interventions in less than 3 hours. Treatment for pediatric septic shock in compliance with the Surviving Sepsis Campaign recommendations was not associated with better outcomes compared with children whose initial therapies in the emergency department were administered more slowly. However, all patients were treated rapidly and we report low morbidity and mortality. This underscores the importance of rapid recognition and treatment of septic shock.

4G/5G polymorphism of PAI-1 gene is associated with multiple organ dysfunction and septic shock in pneumonia induced severe sepsis: prospective, observational, genetic study

PubMed Central

2010-01-01

Introduction Activation of inflammation and coagulation are closely related and mutually interdependent in sepsis. The acute-phase protein, plasminogen activator inhibitor-1 (PAI-1) is a key element in the inhibition of fibrinolysis. Elevated levels of PAI-1 have been related to worse outcome in pneumonia. We aimed to evaluate the effect of functionally relevant 4G/5G polymorphism of PAI-1 gene in pneumonia induced sepsis. Methods We enrolled 208 Caucasian patients with severe sepsis due to pneumonia admitted to an intensive care unit (ICU). Patients were followed up until ICU discharge or death. Clinical data were collected prospectively and the PAI-1 4G/5G polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism technique. Patients were stratified according to the occurrence of multiple organ dysfunction syndrome, septic shock or death. Results We found that carriers of the PAI-1 4G/4G and 4G/5G genotypes have a 2.74-fold higher risk for multiple organ dysfunction syndrome (odds ratio [OR] 95% confidence interval [CI] = 1.335 - 5.604; p = 0.006) and a 2.57-fold higher risk for septic shock (OR 95%CI = 1.180 - 5.615; p = 0.018) than 5G/5G carriers. The multivariate logistic regression analysis adjusted for independent predictors, such as age, nosocomial pneumonia and positive microbiological culture also supported that carriers of the 4G allele have a higher prevalence of multiple organ dysfunction syndrome (adjusted odds ratio [aOR] = 2.957; 95%CI = 1.306 -6.698; p = 0.009) and septic shock (aOR = 2.603; 95%CI = 1.137 - 5.959; p = 0.024). However, genotype and allele analyses have not shown any significant difference regarding mortality in models non-adjusted or adjusted for acute physiology and chronic health evaluation (APACHE) II. Patients bearing the 4G allele had higher disseminated intravascular coagulation (DIC) score at admission (p = 0.007) than 5G/5G carriers. Moreover, in 4G allele carriers the length of ICU stay of non-survivors was longer (p = 0.091), fewer ventilation-free days (p = 0.008) and days without septic shock (p = 0.095) were observed during the first 28 days. Conclusions In Caucasian patients with severe sepsis due to pneumonia carriers of the 4G allele of PAI-1 polymorphism have higher risk for multiple organ dysfunction syndrome and septic shock and in agreement they showed more fulminant disease progression based on continuous clinical variables. PMID:20429897

Breast infection

MedlinePlus

Breast infections are usually caused by common bacteria ( Staphylococcus aureus ) found on normal skin. The bacteria enter through ... 2017:chap 8. Que Y-A, Moreillon P. Staphylococcus aureus (including staphylococcal toxic shock syndrome). In: Bennett JE, ...

Spray-on transdermal drug delivery systems.

PubMed

Ibrahim, Sarah A

2015-02-01

Transdermal drug delivery possesses superior advantages over other routes of administration, particularly minimizing first-pass metabolism. Transdermal drug delivery is challenged by the barrier nature of skin. Numerous technologies have been developed to overcome the relatively low skin permeability, including spray-on transdermal systems. A transdermal spray-on system (TSS) usually consists of a solution containing the drug, a volatile solvent and in many cases a chemical penetration enhancer. TSS promotes drug delivery via the complex interplay between solvent evaporation and drug-solvent drag into skin. The volatile solvent carries the drug into the upper layers of the stratum corneum, and as the volatile solvent evaporates, an increase in the thermodynamic activity of the drug occurs resulting in an increased drug loading in skin. TSS is easily applied, delivering flexible drug dosage and associated with lower incidence of skin irritation. TSS provides a fast-drying product where the volatile solvent enables uniform drug distribution with minimal vehicle deposition on skin. TSS ensures precise dose administration that is aesthetically appealing and eliminates concerns of residual drug associated with transdermal patches. Furthermore, it provides a better alternative to traditional transdermal products due to ease of product development and manufacturing.

Distribution of suspended sediment in a partially mixed estuary, Charleston Harbor, South Carolina, U.S.A.

NASA Astrophysics Data System (ADS)

Althausen, J. D.; Kjerfve, Björn

1992-11-01

A well-defined turbidity maximum zone (TMZ) exists 15-45 km upstream of the entrance to Charleston Harbor, South Carolina, on the Cooper River, where the salinity varies between 5-15 ppt. The TMZ is characterized by less than 60% light transmission over a 5 cm path-length near the bottom, as compared to 70-90% light transmission elsewhere. The TMZ oscillates along the Cooper River 3-13 km during a tidal cycle. The range of total suspended sediment (TSS) concentration is 40-100 mg l -1 in the TMZ, while 10-30 mg l -1 is the most common TSS concentration elsewhere in the estuarine portion of Charleston Harbor and the Cooper River. Transmissivity is well-correlated with TSS ( r2 = 0·77) throughout the estuary. TSS concentration depends largely on tidal stage and varies significantly from spring to neap tide. Spring tide TSS concentrations are 2-3 times greater than concentrations during neap tides. The net downstream transport of suspended sediment is primarily a function of fresh water discharge, but is particularly large when flood events coincide with spring tides as was evident during the sampling of the TMZ following Hurricane Hugo (22 September 1989).

Kuiper Airborne Observatory's Telescope Stabilization System: Disturbance Sensitivity Reduction Via Velocity Loop Feedback

NASA Technical Reports Server (NTRS)

Lawrence, David P.; Tsui, K. C.; Tucker, John; Mancini, Ronald E. (Technical Monitor)

1995-01-01

In July of 1994 the Kuiper Airborne Observatory's (KAO) Telescope Stabilization System (TSS) was upgraded to meet performance goals necessary to view the Shoemaker-Levy 9 comet collision with Jupiter. The KAO is a modified C-141 Aircraft supporting a 36 inch Infrared telescope used to gather and analyze astronomical data. Before the upgrade, the TSS exhibited approximately a 10 arc-second resolution pointing accuracy. The majority of the inaccuracy was attributable to aircraft vibration and wind buffeting entering through the aircraft's telescope door opening; in other words, the TSS was overly sensitive to external disturbances. Because of power limitations and noise requirements, improving the pointing accuracy of the telescope required more sophistication than simply raising the bandwidth as some classical control strategies might suggest. Instead, relationships were developed between the disturbance sensitivity and closed loop transfer functions. These relationships suggested that employing velocity feedback along with an increase in current loop gain would dramatically improve the pointing resolution of the TSS by decreasing the control system's sensitivity to external disturbances. With the implementation of some classical control techniques and the above philosophy, the KAO's TSS's resolution was improved to approximately 2-3 arc-seconds.

Proteomic analysis of broccoli (Brassica oleracea) under high temperature and waterlogging stresses.

PubMed

Lin, Hsin-Hung; Lin, Kuan-Hung; Chen, Su-Ching; Shen, Yu-Hsing; Lo, Hsiao-Feng

2015-12-01

The production of broccoli (Brassica oleracea) is largely reduced by waterlogging and high temperature stresses. Heat-tolerant and heat-susceptible broccoli cultivars TSS-AVRDC-2 and B-75, respectively, were used for physiological and proteomic analyses. The objective of this study was to identify TSS-AVRDC-2 and B-75 proteins differentially regulated at different time periods in response to waterlogging at 40 °C for three days. TSS-AVRDC-2 exhibited significantly higher chlorophyll content, lower stomatal conductance, and better H 2 O 2 scavenging under stress in comparison to B-75. Two-dimensional liquid phase fractionation analyses revealed that Rubisco proteins in both varieties were regulated under stressing treatments, and that TSS-AVRDC-2 had higher levels of both Rubisco large and small subunit transcripts than B-75 when subjected to high temperature and/or waterlogging. This report utilizes physiological and proteomic approaches to discover changes in the protein expression profiles of broccoli in response to heat and waterlogging stresses. Higher levels of Rubisco proteins in TSS-AVRDC-2 could lead to increased carbon fixation efficiency to provide sufficient energy to enable stress tolerance under waterlogging at 40 °C.

Repeated transsphenoidal surgery for resection of pituitary adenoma.

PubMed

Wang, Shousen; Xiao, Deyong; Wang, Rumi; Wei, Liangfeng; Hong, Jingfang

2015-03-01

To investigate the surgical strategy of repeated microscopic transsphenoidal surgery (TSS) for treatment of pituitary adenoma, surgical techniques and treatment outcomes for 29 patients with pituitary adenoma were reviewed and analyzed. There were 17 patients who underwent TSS 18 times and 12 patients who underwent TSS 13 times. The interval between each TSS ranged from 3 months to 18 years, with a median time of 4 years. The tumor height was 15 to 45 mm on the last surgery. Among the 29 patients, 16 patients underwent total tumor resection, 11 patients underwent subtotal resection, and 2 patients underwent partial resection. Cerebrospinal fluid leak occurred in 10 patients. Among 24 patients who were followed up effectively, 1 patient developed abducens paralysis after surgery, 1 patient had chronic diabetes insipidus, and 1 patient received steroid-dependent alternative treatment. The repeated TSS may present satisfied outcomes in experienced hands. The upper edge of the posterior choanae should be identified to ensure the right orientation. The openings of the anterior wall of the sphenoid sinus and the sellar floor should be appropriately expanded to improve tumor exposure. The artificial materials should be identified and removed carefully. Intraoperative cerebrospinal fluid leakage should be managed well.

TSS-1R satellite integration in O&C Building

NASA Technical Reports Server (NTRS)

1995-01-01

John Powell (left) and Jim Nail (second from right) of McDonnell Douglas Space and Defense Systems prepare the satellite element of the Tethered Satellite System-1R (TSS-1R) for integration with its support unit in the Operations and Checkout (O&C) Building. The TSS-1R is one of two primary payloads scheduled to fly aboard the Orbiter Columbia during the STS-75 mission in early 1996. The TSS program is a joint venture between NASA and the Agenzia Spaziale Italiana, or Italian Space Agency. The 'R' designation indicates a reflight. The TSS-1 flew aboard Atlantis during the STS-46 mission in July 1992 and achieved only a partial success when its tether reel mechanism became jammed after only approximately 840 feet of the 12-mile-long tether had been unwound as the satellite rose from its cradle in the orbiter's payload bay. Once deployed to the 12-mile height on the STS-75 mission, the satellite will be used to validate theories that such a system could possibly be used in the future to generate electrical power to power orbital systems, raise and lower spacecraft, study atmospheric conditions at several different heights and for many other applications.

Diagnosis of hantavirus infection in humans.

PubMed

Mattar, Salim; Guzmán, Camilo; Figueiredo, Luis Tadeu

2015-08-01

Rodent-borne hantaviruses (family Bunyaviridae, genus Hantavirus) cause hantavirus pulmonary syndrome in the Americas and hemorrhagic fever with renal syndrome in Europe and Asia. The viruses are transmitted to humans mainly by inhalation of virus-contaminated aerosols of rodent excreta and secreta. Classic clinical hemorrhagic fever with renal syndrome occurs in five phases: fever, hypotension, oliguria, polyuria, and convalescence. Hantavirus pulmonary syndrome is a severe acute disease that is associated with respiratory failure, pulmonary edema and cardiogenic shock. The diagnosis of hantavirus infections in humans is based on clinical and epidemiological information as well as laboratory tests. We review diagnosis for hantavirus infections based on serology, PCR, immunochemistry and virus culture.

Evaluation of decentralized treatment of sewage employing Upflow Septic Tank/Baffled Reactor (USBR) in developing countries.

PubMed

Sabry, Tarek

2010-02-15

A new concept for a low-cost modified septic tank, named Upflow Septic Tank/Baffled Reactor (USBR), was constructed and tested in a small village in Egypt. During almost one year of continuous operation and monitoring, this system was found to have very satisfactory removal results, where the average results of COD, BOD, and TSS removal efficiencies were 84%, 81%, and 89%, respectively, and the results of the experiment proved that the second compartment (Anaerobic Baffled Reactor) was the main treatment unit in removing the pollutants during the start-up period and at the very early steady-state stage. However, after this period and during the steady-state operation conditions, the second compartment served as a polishing step. Also, it was observed that the USBR system was not affected by the imposed shock loads at the peak flow and organic periods. The results showed that the system is slightly influenced by the drop in the temperature. Decreasing in BOD and COD removal by factor of 9% was observed, when temperature decreases from the average of 35 degrees C in summer time (for the first 127 days) to the average of 22 degrees C in winter time (between day 252 and day 280). Whereas, the TSS removals were not affected by the drop in temperature. The results of the sewage flow variations during one year of operation were compared with Goodrich Formula to see the applicability of this equation in rural developing countries. MAIN FINDING OF THE WORK: The Upflow Septic Tank/Baffled Reactor system could become a promising alternative to the conventional treatment plants in rural developing countries.

Clinical and molecular analyses of Beckwith-Wiedemann syndrome: Comparison between spontaneous conception and assisted reproduction techniques.

PubMed

Tenorio, Jair; Romanelli, Valeria; Martin-Trujillo, Alex; Fernández, García-Moya; Segovia, Mabel; Perandones, Claudia; Pérez Jurado, Luis A; Esteller, Manel; Fraga, Mario; Arias, Pedro; Gordo, Gema; Dapía, Irene; Mena, Rocío; Palomares, María; Pérez de Nanclares, Guiomar; Nevado, Julián; García-Miñaur, Sixto; Santos-Simarro, Fernando; Martinez-Glez, Víctor; Vallespín, Elena; Monk, David; Lapunzina, Pablo

2016-10-01

Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome characterized by an excessive prenatal and postnatal growth, macrosomia, macroglossia, and hemihyperplasia. The molecular basis of this syndrome is complex and heterogeneous, involving genes located at 11p15.5. BWS is correlated with assisted reproductive techniques. BWS in individuals born following assisted reproductive techniques has been found to occur four to nine times higher compared to children with to BWS born after spontaneous conception. Here, we report a series of 187 patients with to BWS born either after assisted reproductive techniques or conceived naturally. Eighty-eight percent of BWS patients born via assisted reproductive techniques had hypomethylation of KCNQ1OT1:TSS-DMR in comparison with 49% for patients with BWS conceived naturally. None of the patients with BWS born via assisted reproductive techniques had hypermethylation of H19/IGF2:IG-DMR, neither CDKN1 C mutations nor patUPD11. We did not find differences in the frequency of multi-locus imprinting disturbances between groups. Patients with BWS born via assisted reproductive techniques had an increased frequency of advanced bone age, congenital heart disease, and decreased frequency of earlobe anomalies but these differences may be explained by the different molecular background compared to those with BWS and spontaneous fertilization. We conclude there is a correlation of the molecular etiology of BWS with the type of conception. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Key issues of ultraviolet radiation of OH at high altitudes

NASA Astrophysics Data System (ADS)

Zhang, Yuhuai; Wan, Tian; Jiang, Jianzheng; Fan, Jing

2014-12-01

Ultraviolet (UV) emissions radiated by hydroxyl (OH) is one of the fundamental elements in the prediction of radiation signature of high-altitude and high-speed vehicle. In this work, the OH A2Σ+→ X2Π ultraviolet emission band behind the bow shock is computed under the experimental condition of the second bow-shock ultraviolet flight (BSUV-2). Four related key issues are discussed, namely, the source of hydrogen element in the high-altitude atmosphere, the formation mechanism of OH species, efficient computational algorithm of trace species in rarefied flows, and accurate calculation of OH emission spectra. Firstly, by analyzing the typical atmospheric model, the vertical distributions of the number densities of different species containing hydrogen element are given. According to the different dominating species containing hydrogen element, the atmosphere is divided into three zones, and the formation mechanism of OH species is analyzed in the different zones. The direct simulation Monte Carlo (DSMC) method and the Navier-Stokes equations are employed to compute the number densities of the different OH electronically and vibrationally excited states. Different to the previous work, the trace species separation (TSS) algorithm is applied twice in order to accurately calculate the densities of OH species and its excited states. Using a non-equilibrium radiation model, the OH ultraviolet emission spectra and intensity at different altitudes are computed, and good agreement is obtained with the flight measured data.

40 CFR 471.31 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2011 CFR

2011-07-01

... TSS 6.97 3.32 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Rolling contact cooling... Nickel 7.24 4.79 Fluoride 225 99.6 Oil and grease 75.4 45.3 TSS 155 73.5 pH (1) (1) 1 Within the range of... 0.295 Fluoride 13.8 6.13 Oil and grease 4.64 2.79 TSS 9.51 4.53 pH (1) (1) 1 Within the range of 7.5...

40 CFR 471.31 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2010 CFR

2010-07-01

... TSS 6.97 3.32 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Rolling contact cooling... Nickel 7.24 4.79 Fluoride 225 99.6 Oil and grease 75.4 45.3 TSS 155 73.5 pH (1) (1) 1 Within the range of... 0.295 Fluoride 13.8 6.13 Oil and grease 4.64 2.79 TSS 9.51 4.53 pH (1) (1) 1 Within the range of 7.5...

40 CFR 471.21 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Zinc 4.22 1.77 Ammonia 385 170 Fluoride 172 76.3 Oil and grease 57.8 34.7 TSS 119 56.4 pH (1) 1 Within... and grease 79.0 47.4 TSS 162 77.1 pH (1) 1 Within the range of 7.5 to 10.0 at all times. (f) Surface....895 TSS 3.06 1.46 pH (1) 1 Within the range of 7.5 to 10.0 at all times. (b) Forging spent lubricants...

40 CFR 471.83 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

... Zinc 0.365 0.151 Oil and grease 3.58 3.58 TSS 5.37 4.30 pH (1) (1) 1 Within the range of 7.5 to 10.0 at....17 1.03 Cyanide 0.338 0.135 Zinc 1.73 0.710 Oil and grease 16.9 16.9 TSS 25.4 20.3 pH (1) (1) 1... Cyanide 0.0003 0.0001 Zinc 0.002 0.0006 Oil and grease 0.014 0.014 TSS 0.021 0.017 pH (1) (1) 1 Within the...

40 CFR 471.61 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2011 CFR

2011-07-01

... grease 1.44 0.863 TSS 2.95 1.4 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (f) Extrusion... 0.202 Zinc 1.48 0.616 Ammonia 135 59.2 Fluoride 60.1 26.7 Oil and grease 20.2 12.1 TSS 41.4 19.7 pH....50 TSS 8.53 4.06 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (n) Surface treatment...

40 CFR 471.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... Nickel 0.094 0.063 Fluoride 10.1 4.49 Oil and grease 1.70 1.70 TSS 2.55 2.04 pH (1) (1) 1 Within the....103 0.069 Fluoride 11.2 4.94 Oil and grease 1.87 1.87 TSS 2.81 2.25 pH (1) (1) 1 Within the range of 7....122 Nickel 0.450 0.300 Fluoride 48.2 21.4 Oil and grease 8.1 8.1 TSS 12.2 9.72 pH (1) (1) 1 Within the...

40 CFR 471.63 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

....86 TSS 20.0 9.52 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Drawing spent neat... Zinc 0.260 0.109 Ammonia 23.7 10.5 Fluoride 10.6 4.70 Oil and grease 3.56 2.14 TSS 7.30 3.47 pH (1) (1... Zinc 0.146 0.061 Ammonia 13.3 5.86 Fluoride 5.95 2.64 Oil and grease 2.00 1.20 TSS 4.10 1.95 pH (1) (1...

40 CFR 471.63 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

....86 TSS 20.0 9.52 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (c) Drawing spent neat... Zinc 0.260 0.109 Ammonia 23.7 10.5 Fluoride 10.6 4.70 Oil and grease 3.56 2.14 TSS 7.30 3.47 pH (1) (1... Zinc 0.146 0.061 Ammonia 13.3 5.86 Fluoride 5.95 2.64 Oil and grease 2.00 1.20 TSS 4.10 1.95 pH (1) (1...

40 CFR 471.61 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2010 CFR

2010-07-01

... grease 1.44 0.863 TSS 2.95 1.4 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (f) Extrusion... 0.202 Zinc 1.48 0.616 Ammonia 135 59.2 Fluoride 60.1 26.7 Oil and grease 20.2 12.1 TSS 41.4 19.7 pH....50 TSS 8.53 4.06 pH (1) (1) 1 Within the range of 7.5 to 10.0 at all times. (n) Surface treatment...

40 CFR 471.41 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Copper 7.93 4.17 Cyanide 1.21 0.501 Silver 1.71 0.709 Oil and grease 83.4 50.1 TSS 171 81.3 pH (1) (1) 1... 1.68 Copper 21.3 11.2 Cyanide 3.25 1.35 Silver 4.59 1.91 Oil and grease 224 135 TSS 459 219 pH (1....74 Copper 22.1 11.6 Cyanide 3.37 1.39 Silver 4.76 1.97 Oil and grease 232 139 TSS 476 226 pH (1) (1...

40 CFR 471.83 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... Zinc 0.365 0.151 Oil and grease 3.58 3.58 TSS 5.37 4.30 pH (1) (1) 1 Within the range of 7.5 to 10.0 at....17 1.03 Cyanide 0.338 0.135 Zinc 1.73 0.710 Oil and grease 16.9 16.9 TSS 25.4 20.3 pH (1) (1) 1... Cyanide 0.0003 0.0001 Zinc 0.002 0.0006 Oil and grease 0.014 0.014 TSS 0.021 0.017 pH (1) (1) 1 Within the...

40 CFR 471.33 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

... Nickel 0.094 0.063 Fluoride 10.1 4.49 Oil and grease 1.70 1.70 TSS 2.55 2.04 pH (1) (1) 1 Within the....103 0.069 Fluoride 11.2 4.94 Oil and grease 1.87 1.87 TSS 2.81 2.25 pH (1) (1) 1 Within the range of 7....122 Nickel 0.450 0.300 Fluoride 48.2 21.4 Oil and grease 8.1 8.1 TSS 12.2 9.72 pH (1) (1) 1 Within the...

40 CFR 464.12 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... TSS 3.80 1.50 pH (1) (1) 1 Within the range of 7.0 to 10.00 at all times. Maximum for any 1 day... 0.022 Zinc (T) 1.14 0.43 0.027 Oil & grease 30 10 0.501 TSS 38 15 1.0 pH (3) (3) (3) 1 kg/1,000 kkg...) 0.0096 0.0047 Zinc (T) 0.0138 0.0052 Oil & grease 0.363 0.121 TSS 0.46 0.182 pH (1) (1) 1 Within the...

40 CFR 464.12 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... TSS 3.80 1.50 pH (1) (1) 1 Within the range of 7.0 to 10.00 at all times. Maximum for any 1 day... 0.022 Zinc (T) 1.14 0.43 0.027 Oil & grease 30 10 0.501 TSS 38 15 1.0 pH (3) (3) (3) 1 kg/1,000 kkg...) 0.0096 0.0047 Zinc (T) 0.0138 0.0052 Oil & grease 0.363 0.121 TSS 0.46 0.182 pH (1) (1) 1 Within the...

40 CFR 464.12 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... TSS 3.80 1.50 pH (1) (1) 1 Within the range of 7.0 to 10.00 at all times. Maximum for any 1 day... 0.022 Zinc (T) 1.14 0.43 0.027 Oil & grease 30 10 0.501 TSS 38 15 1.0 pH (3) (3) (3) 1 kg/1,000 kkg...) 0.0096 0.0047 Zinc (T) 0.0138 0.0052 Oil & grease 0.363 0.121 TSS 0.46 0.182 pH (1) (1) 1 Within the...

Polio

MedlinePlus

... severe they are. Treatment may include: Antibiotics for urinary tract infections Moist heat (heating pads, warm towels) to reduce ... abnormal buildup of fluid in the lungs) Shock Urinary tract infections Post-polio syndrome is a complication that develops ...

Systematic analysis of transcription start sites in avian development.

PubMed

Lizio, Marina; Deviatiiarov, Ruslan; Nagai, Hiroki; Galan, Laura; Arner, Erik; Itoh, Masayoshi; Lassmann, Timo; Kasukawa, Takeya; Hasegawa, Akira; Ros, Marian A; Hayashizaki, Yoshihide; Carninci, Piero; Forrest, Alistair R R; Kawaji, Hideya; Gusev, Oleg; Sheng, Guojun

2017-09-01

Cap Analysis of Gene Expression (CAGE) in combination with single-molecule sequencing technology allows precision mapping of transcription start sites (TSSs) and genome-wide capture of promoter activities in differentiated and steady state cell populations. Much less is known about whether TSS profiling can characterize diverse and non-steady state cell populations, such as the approximately 400 transitory and heterogeneous cell types that arise during ontogeny of vertebrate animals. To gain such insight, we used the chick model and performed CAGE-based TSS analysis on embryonic samples covering the full 3-week developmental period. In total, 31,863 robust TSS peaks (>1 tag per million [TPM]) were mapped to the latest chicken genome assembly, of which 34% to 46% were active in any given developmental stage. ZENBU, a web-based, open-source platform, was used for interactive data exploration. TSSs of genes critical for lineage differentiation could be precisely mapped and their activities tracked throughout development, suggesting that non-steady state and heterogeneous cell populations are amenable to CAGE-based transcriptional analysis. Our study also uncovered a large set of extremely stable housekeeping TSSs and many novel stage-specific ones. We furthermore demonstrated that TSS mapping could expedite motif-based promoter analysis for regulatory modules associated with stage-specific and housekeeping genes. Finally, using Brachyury as an example, we provide evidence that precise TSS mapping in combination with Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)-on technology enables us, for the first time, to efficiently target endogenous avian genes for transcriptional activation. Taken together, our results represent the first report of genome-wide TSS mapping in birds and the first systematic developmental TSS analysis in any amniote species (birds and mammals). By facilitating promoter-based molecular analysis and genetic manipulation, our work also underscores the value of avian models in unravelling the complex regulatory mechanism of cell lineage specification during amniote development.

Untreated runoff quality from roof and road surfaces in a low intensity rainfall climate.

PubMed

Charters, Frances J; Cochrane, Thomas A; O'Sullivan, Aisling D

2016-04-15

Sediment and heavy metals in stormwater runoff are key pollutants of urban waterways, and their presence in stormwater is driven by climatic factors such as rainfall intensity. This study describes the total suspended solids (TSS) and heavy metal concentrations found in runoff from four different urban surfaces within a residential/institutional catchment, in a climate where rainfall is typically of low intensity (<5.1mm·h(-1)). The results were compared to untreated runoff quality from a compilation of international studies. The road runoff had the highest TSS concentrations, while copper and galvanized roof runoff had the highest copper and zinc concentrations, respectively. Pollutant concentrations were found to be significantly different between surfaces; quantification and prediction of pollutant contributions from urban surfaces should thus take account of the different surface materials, instead of being aggregated into more generalized categories such as land use. The TSS and heavy metal concentrations were found to be at the low to medium end of ranges observed internationally, except for total copper and zinc concentrations generated by dissolution of copper and galvanized roofing material respectively; these concentrations were at least as high as those reported internationally. TSS wash-off from the roofs was seen to be a source-limited process, where all available TSS is washed off during the rain event despite the low intensity rainfall, whereas both road TSS and heavy metals wash-off from roof and road surfaces appeared to all be transport-limited and therefore some carryover of pollutants occurs between rain events. A first flush effect was seen from most surfaces for TSS, but not for heavy metals. This study demonstrates that in low intensity rainfall climates, quantification of untreated runoff quality from key individual surface types in a catchment are needed to enable development of targeted and appropriately sized stormwater treatment systems. Copyright © 2016 Elsevier B.V. All rights reserved.

Monitoring of event-based mobilization of hydrophobic pollutants in rivers: calibration of turbidity as a proxy for particle facilitated transport in field and laboratory.

PubMed

Rügner, Hermann; Schwientek, Marc; Egner, Marius; Grathwohl, Peter

2014-08-15

Transport of many pollutants in rivers is coupled to mobilization of suspended particles which typically occurs during floods. Since the amount of total suspended solids (TSS) in rivers can be monitored by turbidity measurements this may be used as a proxy for the total concentration of particle associated pollutants such as PAHs, PCBs, etc. and several heavy metals. Online turbidity measurements (e.g. by optical backscattering sensors) would then also allow for an assessment of particle and pollutant flux dynamics if once calibrated against TSS and total pollutant concentrations for a given catchment. In this study, distinct flood and thus turbidity events were sampled at high temporal resolution in three contrasting sub-catchments of the River Neckar in Southwest Germany (Ammer, Goldersbach, Steinlach) as well as in the River Neckar itself and investigated for the total amount of PAHs and TSS in water; turbidity (NTU) and grain size distributions of suspended solids were determined as well. Laboratory experiments were performed with natural river bed sediments from different locations (Ammer) to investigate PAH concentrations, TSS and turbidity during sedimentation of suspended particles under controlled conditions (yielding smaller and smaller suspended particles and TSS with time). Laboratory and field results agreed very well and showed that turbidity and TSS were linearly correlated over an extended turbidity range up to 2000 NTU for the field samples and up to 8000 NTU in lab experiments. This also holds for total PAH concentrations which can be reasonably well predicted based on turbidity measurements and TSS vs. PAHs relationships - even for high turbidity values observed during flood events (>2000 NTU). Total PAH concentrations on suspended solids were independent of grain size of suspended particles. This implies that for the rivers investigated the sorption capacity of particles did not change significantly during the observed events. Copyright © 2014. Published by Elsevier B.V.

Cavβ2 transcription start site variants modulate calcium handling in newborn rat cardiomyocytes.

PubMed

Moreno, Cristian; Hermosilla, Tamara; Morales, Danna; Encina, Matías; Torres-Díaz, Leandro; Díaz, Pablo; Sarmiento, Daniela; Simon, Felipe; Varela, Diego

2015-12-01

In the heart, the main pathway for calcium influx is mediated by L-type calcium channels, a multi-subunit complex composed of the pore-forming subunit CaV1.2 and the auxiliary subunits CaVα2δ1 and CaVβ2. To date, five distinct CaVβ2 transcriptional start site (TSS) variants (CaVβ2a-e) varying only in the composition and length of the N-terminal domain have been described, each of them granting distinct biophysical properties to the L-type current. However, the physiological role of these variants in Ca(2+) handling in the native tissue has not been explored. Our results show that four of these variants are present in neonatal rat cardiomyocytes. The contribution of those CaVβ2 TSS variants on endogenous L-type current and Ca(2+) handling was explored by adenoviral-mediated overexpression of each CaVβ2 variant in cultured newborn rat cardiomyocytes. As expected, all CaVβ2 TSS variants increased L-type current density and produced distinctive changes on L-type calcium channel (LTCC) current activation and inactivation kinetics. The characteristics of the induced calcium transients were dependent on the TSS variant overexpressed. Moreover, the amplitude of the calcium transients varied depending on the subunit involved, being higher in cardiomyocytes transduced with CaVβ2a and smaller in CaVβ2d. Interestingly, the contribution of Ca(2+) influx and Ca(2+) release on total calcium transients, as well as the sarcoplasmic calcium content, was found to be TSS-variant-dependent. Remarkably, determination of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) messenger RNA (mRNA) abundance and cell size change indicates that CaVβ2 TSS variants modulate the cardiomyocyte hypertrophic state. In summary, we demonstrate that expression of individual CaVβ2 TSS variants regulates calcium handling in cardiomyocytes and, consequently, has significant repercussion in the development of hypertrophy.

Phenotypic Characterization of a Novel Virulence-Factor Deletion Strain of Burkholderia mallei That Provides Partial Protection against Inhalational Glanders in Mice.

PubMed

Bozue, Joel A; Chaudhury, Sidhartha; Amemiya, Kei; Chua, Jennifer; Cote, Christopher K; Toothman, Ronald G; Dankmeyer, Jennifer L; Klimko, Christopher P; Wilhelmsen, Catherine L; Raymond, Jolynn W; Zavaljevski, Nela; Reifman, Jaques; Wallqvist, Anders

2016-01-01

Burkholderia mallei (Bm) is a highly infectious intracellular pathogen classified as a category B biological agent by the Centers for Disease Control and Prevention. After respiratory exposure, Bm establishes itself within host macrophages before spreading into major organ systems, which can lead to chronic infection, sepsis, and death. Previously, we combined computational prediction of host-pathogen interactions with yeast two-hybrid experiments and identified novel virulence factor genes in Bm, including BMAA0553, BMAA0728 (tssN), and BMAA1865. In the present study, we used recombinant allelic exchange to construct deletion mutants of BMAA0553 and tssN (ΔBMAA0553 and ΔTssN, respectively) and showed that both deletions completely abrogated virulence at doses of >100 times the LD50 of the wild-type Bm strain. Analysis of ΔBMAA0553- and ΔTssN-infected mice showed starkly reduced bacterial dissemination relative to wild-type Bm, and subsequent in vitro experiments characterized pathogenic phenotypes with respect to intracellular growth, macrophage uptake and phagosomal escape, actin-based motility, and multinucleated giant cell formation. Based on observed in vitro and in vivo phenotypes, we explored the use of ΔTssN as a candidate live-attenuated vaccine. Mice immunized with aerosolized ΔTssN showed a 21-day survival rate of 67% after a high-dose aerosol challenge with the wild-type Bm ATCC 23344 strain, compared to a 0% survival rate for unvaccinated mice. However, analysis of histopathology and bacterial burden showed that while the surviving vaccinated mice were protected from acute infection, Bm was still able to establish a chronic infection. Vaccinated mice showed a modest IgG response, suggesting a limited potential of ΔTssN as a vaccine candidate, but also showed prolonged elevation of pro-inflammatory cytokines, underscoring the role of cellular and innate immunity in mitigating acute infection in inhalational glanders.

Phenotypic Characterization of a Novel Virulence-Factor Deletion Strain of Burkholderia mallei That Provides Partial Protection against Inhalational Glanders in Mice

PubMed Central

Bozue, Joel A.; Chaudhury, Sidhartha; Amemiya, Kei; Chua, Jennifer; Cote, Christopher K.; Toothman, Ronald G.; Dankmeyer, Jennifer L.; Klimko, Christopher P.; Wilhelmsen, Catherine L.; Raymond, Jolynn W.; Zavaljevski, Nela; Reifman, Jaques; Wallqvist, Anders

2016-01-01

Burkholderia mallei (Bm) is a highly infectious intracellular pathogen classified as a category B biological agent by the Centers for Disease Control and Prevention. After respiratory exposure, Bm establishes itself within host macrophages before spreading into major organ systems, which can lead to chronic infection, sepsis, and death. Previously, we combined computational prediction of host-pathogen interactions with yeast two-hybrid experiments and identified novel virulence factor genes in Bm, including BMAA0553, BMAA0728 (tssN), and BMAA1865. In the present study, we used recombinant allelic exchange to construct deletion mutants of BMAA0553 and tssN (ΔBMAA0553 and ΔTssN, respectively) and showed that both deletions completely abrogated virulence at doses of >100 times the LD50 of the wild-type Bm strain. Analysis of ΔBMAA0553- and ΔTssN-infected mice showed starkly reduced bacterial dissemination relative to wild-type Bm, and subsequent in vitro experiments characterized pathogenic phenotypes with respect to intracellular growth, macrophage uptake and phagosomal escape, actin-based motility, and multinucleated giant cell formation. Based on observed in vitro and in vivo phenotypes, we explored the use of ΔTssN as a candidate live-attenuated vaccine. Mice immunized with aerosolized ΔTssN showed a 21-day survival rate of 67% after a high-dose aerosol challenge with the wild-type Bm ATCC 23344 strain, compared to a 0% survival rate for unvaccinated mice. However, analysis of histopathology and bacterial burden showed that while the surviving vaccinated mice were protected from acute infection, Bm was still able to establish a chronic infection. Vaccinated mice showed a modest IgG response, suggesting a limited potential of ΔTssN as a vaccine candidate, but also showed prolonged elevation of pro-inflammatory cytokines, underscoring the role of cellular and innate immunity in mitigating acute infection in inhalational glanders. PMID:26955620

Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units.

PubMed

Rodríguez-Nuñez, Antonio; Dosil-Gallardo, Silvia; Jordan, Iolanda

2011-05-01

Streptococcal toxic shock syndrome (STSS) is a very rare and severe form of group A streptococcal infection whose clinical characteristics, therapy, morbidity, and mortality in children are not well known. Our objective was to describe the clinical characteristics of STSS in a series of children admitted to pediatric intensive care units (PICU). A multicenter, retrospective study of children with STSS admitted to 14 PICUs between January 1998 and December 2009 was conducted. Clinical information was obtained retrospectively by chart review. Data from 41 children were collected, 90% corresponding to the second half of the study period. Initial symptoms and signs were nonspecific. All patients developed shock and organ dysfunction, 78.0% developed coagulopathy, 70.7% neurologic dysfunction, and 68.3% respiratory failure. Rapid pharyngeal test for Streptococcus was positive in 78.0%. Initial leukocyte count was quite variable, with leukopenia present in 51.2% of patients and leukocytosis in 31.7%. Children were treated with antibiotics against group A Streptococcus (GAS), usually G penicillin or cephalosporin plus clindamycin. After a median PICU stay of 7 days (range 0-41), 65.8% of patients survived, 26.8% with sequelae. The cause of death of the 11 non-survivors was refractory shock and multi-organ failure. STSS is a very severe condition secondary to invasive GAS infection. It can occur at any age, but especially in young children. Due to the lack of specific symptoms and signs and its very rapid progression to shock and organ dysfunction, pediatricians and emergency physicians must be aware of this possibility and immediately initiate aggressive treatment when suspected.

40 CFR 415.645 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

...): The limitations for pH, TSS, cadmium (T), selenium (T), and zinc (T), are the same as specified in... following new source performance standards (NSPS): The limitations for pH, TSS, cadmium (T), selenium (T...

Overview of Research Transition Products

NASA Technical Reports Server (NTRS)

Robinson, John

2014-01-01

Demonstrate increased, more consistent use of Performance- Based Navigation (PBN). Accelerate transfer of NASA scheduling and spacing technologies for inclusion in late mid-term NAS. During high-fidelity human-in-the-loop simulations of Terminal Sequencing and Spacing, air traffic controllers have significantly improved their use of PBN procedures during busy traffic periods without increased workload. Executed an aggressive, short timeframe development schedule. Developed TSS prototype based upon FAA operational systems. Conducted multiple joint FAA/NASA human-in-the-loop simulations. Performed repeated incremental deliveries of tech transfer material to non-traditional RTT stakeholders. Will continue to participate in later phases of FAA acquisition process. ATD-1 transferred Terminal Sequencing and Spacing (TSS) technologies to the FAA. TSS enables routine use of underutilized advanced avionics and PBN procedures. Potential benefits to airlines operating at initial TSS sites estimated to be $300-400M/year. FAA is planning for an initial capability in the NAS in 2018.

Development and psychometric validation of the Task-Specific Self-Efficacy Scale for Chinese people with mental illness.

PubMed

Chou, Chih Chin; Cardoso, Elizabeth Da Silva; Chan, Fong; Tsang, Hector W H; Wu, Mingyi

2007-12-01

The aim of this study was to validate a Task-Specific Self-Efficacy Scale for Chinese people with mental illness. The study included 79 men and 77 women with chronic mental illness. The Task-Specific Self-Efficacy Scale for People with Mental Illness (TSSES-PMI) and Change Assessment Questionnaire for People with Severe and Persistent Mental Illness were used as measures for the study. Factor analysis of the TSSES-PMI resulted in four subscales: Symptom Management Skills, Work-Related Skills, Help-Seeking Skills, and Self-Emotional-Regulation Skills. These community living skills were found to be related to the level of readiness for psychiatric rehabilitation among Chinese people with mental illness. In conclusion the results support the construct validity of the TSSES-PMI for the Chinese population and the TSSES-PMI can be a useful instrument for working with Chinese people with mental illnesses.

Group A Streptococcal Peritonitis and Toxic Shock Syndrome in a Postmenopausal Woman.

PubMed

Iwata, Yuri; Iwase, Shigeru

2017-09-15

We herein report the case of a 66-year-old woman presenting with symptoms of gastroenteritis. Computed tomography showed small-bowel dilation without ischemic signs. After admission, she went into shock and was treated for sepsis of unknown origin. She was later diagnosed with group A streptococcal peritonitis due to an ascending vaginal infection. This case highlights the importance of considering Group A Streptococcus (GAS) infection as a cause of peritonitis in postmenopausal women.

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

Case report: Guillain-Barre syndrome with pneumococcus - A new association in pediatrics.

PubMed

Khatib, Hassan El; Naous, Amal; Ghanem, Soha; Dbaibo, Ghassan; Rajab, Mariam

2018-01-01

Guillain-Barre Syndrome, an acute flaccid paralysis known to be caused by recent Gastro-intestinal infections mainly campylobacter, and Respiratory infections mainly mycoplasma pneumoniae and influenza. One reported case of severe invasive pneumococcal disease in a 68 year old female, that presented with Austrian's triad of meningitis, pneumonia and endocarditis, and progressed to develop Guillain Barre syndrome, an association never been documented before. We present a case of 13 year old male, presented with hypoactivity and inability to bare his own weight, developed septic shock due to pneumococcus with Acute Respiratory Distress Syndrome, and was found to have neurological findings of Guillain-Barre Syndrome. A new association in pediatric age group, never been reported before.

Effect of environmental conditions on production of toxic shock syndrome toxin 1 by Staphylococcus aureus.

PubMed Central

Wong, A C; Bergdoll, M S

1990-01-01

The kinetics of toxic shock syndrome toxin 1 (TSST-1) production by Staphylococcus aureus was studied in a fermentor in which aeration rate, atmospheric composition, pH, and temperature were controlled. The toxin was synthesized at a maximal rate during the exponential phase. High bacterial populations were not necessarily accompanied by high TSST-1 yields. Aerobiosis increased TSST-1 production, but excessive aeration had an adverse effect. Addition of CO2 enhanced TSST-1 yield by increasing toxin production rate and efficiency. Cultures with no pH control made more TSST-1 than those maintained at pH 5.5 to 7.5. Maximum TSST-1 yields were obtained when cultures were supplied with air (20 cm3/min) and CO2 (5 cm3/min) via a sintered glass sparger. PMID:2108084

Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit.

PubMed

Layer, Franziska; Sanchini, Andrea; Strommenger, Birgit; Cuny, Christiane; Breier, Ann-Christin; Proquitté, Hans; Bührer, Christoph; Schenkel, Karl; Bätzing-Feigenbaum, Jörg; Greutelaers, Benedikt; Nübel, Ulrich; Gastmeier, Petra; Eckmanns, Tim; Werner, Guido

2015-10-01

Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected. Copyright © 2015 Elsevier GmbH. All rights reserved.

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.

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

PubMed Central

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

2008-01-01

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. PMID:18803762

Suspended sediment projections in Apalachicola Bay in response to altered river flow and sediment loads under climate change and sea level rise

NASA Astrophysics Data System (ADS)

Huang, Wenrui; Hagen, Scott C.; Wang, Dingbao; Hovenga, Paige A.; Teng, Fei; Weishampel, John F.

2016-10-01

Suspended sediments, or total suspended solids (TSS), are an important factor for oyster habitat. While high concentrations of suspended sediments can cause a reduction of oyster density, some level of suspended sediment is required to supply oysters with necessary nutrients. In this study, characteristics of TSS variations in response to sea level rise (SLR) at two oyster reefs in Apalachicola Bay are investigated by coupled estuarine hydrodynamic and sediment transport modeling. A storm event in 1993 and a year-long period in 2010 under recent sea level conditions are selected as the baseline conditions. Scenarios of river flow and sediment loads under SLR and climate change are obtained by downscaled global climate modeling. Compared to the baseline conditions, simulations of TSS indicate that predicted SLR yields a substantial decrease in TSS near the two oyster reefs. However, TSS levels differed at the two study locations. TSS changes by SLR revealed minimal impact on oyster habitat at the Dry Bar site (to the west of the mouth of the Apalachicola River) but are projected to have a significant impact at the Cat Point site (to the east of the Apalachicola River). At Cat Point, because SLR causes the increase of salt water intrusion from the Gulf through a large tidal inlet (East Pass), maximum sediment concentration is near zero for 0.2-m SLR and equal to zero for 0.5- and 1.2-m SLR. Therefore, SLR may result in a substantial loss of nutrients from suspended sediment in the oyster reef at Cat Point.

Therapy of endocrine disease: outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence.

PubMed

Petersenn, Stephan; Beckers, Albert; Ferone, Diego; van der Lely, Aart; Bollerslev, Jens; Boscaro, Marco; Brue, Thierry; Bruzzi, Paolo; Casanueva, Felipe F; Chanson, Philippe; Colao, Annamaria; Reincke, Martin; Stalla, Günter; Tsagarakis, Stelios

2015-06-01

A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience. The variety of methodologies used in clinical evaluation of TSS for Cushing's disease strongly support the call for standardization and optimization of studies to inform clinical practice and maximize patient outcomes. Clinically significant rates of failure of initial TSS highlight the need for effective second-line treatments. © 2015 European Society of Endocrinology.

Water quality effects of herded stream crossings by domestic sheep bands.

PubMed

Clark, Patrick E; Moffet, Corey A; Lewis, Gregory S; Seyfried, Mark S; Hardegree, Stuart P; Pierson, Fredrick B

2012-01-01

Livestock impacts on total suspended solids (TSS) and pathogen (e.g., ) levels in rangeland streams are a serious concern worldwide. Herded stream crossings by domestic sheep () are periodic, necessary managerial events on high-elevation rangelands, but their impacts on stream water quality are largely unknown. We evaluated the effects of herded, one-way crossings by sheep bands (about 2000 individuals) on TSS and concentration and load responses in downstream waters. Crossing trials were conducted during the summers of 2005 and 2006 on two reaches within each of three perennial streams in the Centennial Mountains of eastern Idaho and southwestern Montana. Water samples were collected at 2-min intervals at an upstream background station and at stations 25, 100, 500, and 1500 m downstream just before and during each crossing trial. Crossings produced substantial increases in TSS and concentrations and loads downstream, but these concentration increases were localized and short lived. Maximum TSS concentration was highest 25 m downstream, declined as a function of downstream distance, and at 500 m downstream was similar to background. Post-peak TSS concentrations at all downstream stations decreased to <25 mg L within 24 to 48 min after reaching their maxima. Findings for concentration and load responses were similar to that of TSS but less clear cut. Stream-crossing sheep do affect water quality; therefore, producers and resource managers should continue to evaluate the efficacy of herdsmanship techniques for reducing water quality impact. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Sediment and nutrient budgets are inherently dynamic: evidence from a long-term study of two subtropical reservoirs

NASA Astrophysics Data System (ADS)

O'Brien, Katherine R.; Weber, Tony R.; Leigh, Catherine; Burford, Michele A.

2016-12-01

Accurate reservoir budgets are important for understanding regional fluxes of sediment and nutrients. Here we present a comprehensive budget of sediment (based on total suspended solids, TSS), total nitrogen (TN) and total phosphorus (TP) for two subtropical reservoirs on rivers with highly intermittent flow regimes. The budget is completed from July 1997 to June 2011 on the Somerset and Wivenhoe reservoirs in southeast Queensland, Australia, using a combination of monitoring data and catchment model predictions. A major flood in January 2011 accounted for more than half of the water entering and leaving both reservoirs in that year, and approximately 30 % of water delivered to and released from Wivenhoe over the 14-year study period. The flood accounted for an even larger proportion of total TSS and nutrient loads: in Wivenhoe more than one-third of TSS inputs and two-thirds of TSS outputs between 1997 and 2011 occurred during January 2011. During non-flood years, mean historical concentrations provided reasonable estimates of TSS and nutrient loads leaving the reservoirs. Calculating loads from historical mean TSS and TP concentrations during January 2011, however, would have substantially underestimated outputs over the entire study period, by up to a factor of 10. The results have important implications for sediment and nutrient budgets in catchments with highly episodic flow. First, quantifying inputs and outputs during major floods is essential for producing reliable long-term budgets. Second, sediment and nutrient budgets are dynamic, not static. Characterizing uncertainty and variability is therefore just as important for meaningful reservoir budgets as accurate quantification of loads.

Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation

PubMed Central

Kumm, Kayla; Kueht, Michael; Ha, Cindy P.; Yoeli, Dor; Cotton, Ronald T.; Rana, Abbas; O'Mahony, Christine A.; Halff, Glenn; Goss, John A.

2018-01-01

Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo's Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure. PMID:29670765

40 CFR 417.166 - Pretreatment standards for new sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... pollutant property Pretreatment standard BOD5 No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease... No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease Do. pH Do. [40 FR 27455, June 30, 1975...

40 CFR 417.166 - Pretreatment standards for new sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pollutant property Pretreatment standard BOD5 No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease... No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease Do. pH Do. [40 FR 27455, June 30, 1975...

40 CFR 417.166 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pollutant property Pretreatment standard BOD5 No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease... No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease Do. pH Do. [40 FR 27455, June 30, 1975...

40 CFR 417.166 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pollutant property Pretreatment standard BOD5 No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease... No limitation. COD Do. TSS Do. Surfactants Do. Oil and grease Do. pH Do. [40 FR 27455, June 30, 1975...

40 CFR 424.35 - Standards of performance for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

...— Metric units (kg/kkg processed) TSS 0.271 0.136 Chromium total .0054 .0027 Manganese total 0.054 .027 pH (1) (1) English units (lb/ton processed) TSS .542 .271 Chromium total .011 .0054 Manganese total .108...

40 CFR 424.35 - Standards of performance for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

...— Metric units (kg/kkg processed) TSS 0.271 0.136 Chromium total .0054 .0027 Manganese total 0.054 .027 pH (1) (1) English units (lb/ton processed) TSS .542 .271 Chromium total .011 .0054 Manganese total .108...

40 CFR 424.35 - Standards of performance for new sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

...— Metric units (kg/kkg processed) TSS 0.271 0.136 Chromium total .0054 .0027 Manganese total 0.054 .027 pH (1) (1) English units (lb/ton processed) TSS .542 .271 Chromium total .011 .0054 Manganese total .108...

40 CFR 432.25 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fecal coliform, O&G, and TSS are the same as the limitations specified in § 432.22(a)(1), and the... on-site, the standards for BOD5, fecal coliform, O&G, and TSS are the same as the corresponding...

40 CFR 432.85 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, O&G, and TSS specified in § 432.82(a). (b) Facilities that generate more than 50 million pounds per year of finished products must achieve the limitations for BOD5, fecal coliform, O&G, and TSS...

40 CFR 432.35 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, TSS, and O&G are the same as the limitations specified in § 432.32(a)(1) and the... on-site, the standards for BOD5, fecal coliform, TSS, and O&G are the same as the corresponding...

40 CFR 432.65 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, O&G, and TSS specified in § 432.62(a). (b) Facilities that generate more than 50 million pounds per year of finished products must achieve the limitations for BOD5, fecal coliform, O&G, and TSS...

40 CFR 432.35 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fecal coliform, TSS, and O&G are the same as the limitations specified in § 432.32(a)(1) and the... on-site, the standards for BOD5, fecal coliform, TSS, and O&G are the same as the corresponding...

40 CFR 432.45 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fecal coliform, TSS, and O&G are the same as the limitations specified in § 432.42(a)(1); and standards... on-site, the standards for BOD5, fecal coliform, TSS, and O&G are the same as the limitations...

40 CFR 432.15 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, O&G, and TSS are the same as the corresponding limitations specified in § 432.12(a)(1... on-site, the standards for BOD5, fecal coliform, O&G, and TSS are the same as the limitations...

40 CFR 432.25 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, O&G, and TSS are the same as the limitations specified in § 432.22(a)(1), and the... on-site, the standards for BOD5, fecal coliform, O&G, and TSS are the same as the corresponding...

40 CFR 432.85 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fecal coliform, O&G, and TSS specified in § 432.82(a). (b) Facilities that generate more than 50 million pounds per year of finished products must achieve the limitations for BOD5, fecal coliform, O&G, and TSS...

40 CFR 432.15 - New source performance standards (NSPS).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fecal coliform, O&G, and TSS are the same as the corresponding limitations specified in § 432.12(a)(1... on-site, the standards for BOD5, fecal coliform, O&G, and TSS are the same as the limitations...

40 CFR 432.45 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

..., fecal coliform, TSS, and O&G are the same as the limitations specified in § 432.42(a)(1); and standards... on-site, the standards for BOD5, fecal coliform, TSS, and O&G are the same as the limitations...

40 CFR 424.35 - Standards of performance for new sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

...— Metric units (kg/kkg processed) TSS 0.271 0.136 Chromium total .0054 .0027 Manganese total 0.054 .027 pH (1) (1) English units (lb/ton processed) TSS .542 .271 Chromium total .011 .0054 Manganese total .108...

40 CFR 424.35 - Standards of performance for new sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

...— Metric units (kg/kkg processed) TSS 0.271 0.136 Chromium total .0054 .0027 Manganese total 0.054 .027 pH (1) (1) English units (lb/ton processed) TSS .542 .271 Chromium total .011 .0054 Manganese total .108...

40 CFR 471.51 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Molybdenum 7.87 4.07 Oil and grease 23.8 14.3 TSS 48.8 23.2 pH (1) (1) 1 Within the range of 7.5 to 10.0 at... Fluoride 7,200 3,200 Molybdenum 800 414 Oil and grease 2,420 1,450 TSS 4,960 2,360 pH (1) (1) 1 Within the... Molybdenum 2.21 1.14 Oil and grease 6.68 4.01 TSS 13.7 6.51 pH (1) (1) 1 Within the range of 7.5 to 10.0 at...

40 CFR 471.51 - Effluent limitations representing the degree of effluent reduction attainable by the application...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Molybdenum 7.87 4.07 Oil and grease 23.8 14.3 TSS 48.8 23.2 pH (1) (1) 1 Within the range of 7.5 to 10.0 at... Fluoride 7,200 3,200 Molybdenum 800 414 Oil and grease 2,420 1,450 TSS 4,960 2,360 pH (1) (1) 1 Within the... Molybdenum 2.21 1.14 Oil and grease 6.68 4.01 TSS 13.7 6.51 pH (1) (1) 1 Within the range of 7.5 to 10.0 at...

40 CFR 464.22 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

Code of Federal Regulations, 2013 CFR

2013-07-01

....399 TSS 1.52 0.598 pH (1) (1) 1 Within the range of 7.0 to 10.0 at all times. Maximum for any 1 day....39 0.0088 Zinc (T) 1.14 0.43 0.0108 Oil and grease 30 10 0.199 TSS 38 15 0.399 pH (3) (3) (3) 1 kg....506 Lead (T) 0.952 0.47 Zinc (T) 1.37 0.518 Oil and grease 36.2 12.1 TSS 45.8 18.1 pH (1) (1) 1 Within...

Determination of the effect of wind velocity and direction changes on turbidity removal in rectangular sedimentation tanks.

PubMed

Khezri, Seyed Mostafa; Biati, Aida; Erfani, Zeynab

2012-01-01

In the present study, a pilot-scale sedimentation tank was used to determine the effect of wind velocity and direction on the removal efficiency of particles. For this purpose, a 1:20 scale pilot simulated according to Frude law. First, the actual efficiency of total suspended solids (TSS) removal was calculated in no wind condition. Then, the wind was blown in the same and the opposite directions of water flow. At each direction TSS removal was calculated at three different velocities from 2.5 to 7 m/s. Results showed that when the wind was in the opposite direction of water flow, TSS removal efficiency initially increased with the increase of wind velocity from 0 to 2.5 m/s, then it decreased with the increase of velocity to 5 m/s. This mainly might happen because the opposite direction of wind can increase particles' retention time in the sedimentation tank. However, higher wind velocities (i.e. 3.5 and 5.5 m/s) could not increase TSS removal efficiency. Thus, if sedimentation tanks are appropriately exposed to the wind, TSS removal efficiency increases by approximately 6%. Therefore, energy consumption will be reduced by a proper site selection for sedimentation tank unit in water and waste water treatment plants.

Evaluation of stream water quality data generated from MODIS images in modeling total suspended solid emission to a freshwater lake.

PubMed

Ayana, Essayas K; Worqlul, Abeyou W; Steenhuis, Tammo S

2015-08-01

Modeling of suspended sediment emission into freshwater lakes is challenging due to data gaps in developing countries. Existing models simulate sediment concentration at a gauging station upstream and none of these studies had modeled total suspended solids (TSS) emissions by inflowing rivers to freshwater lakes as there are no TSS measurements at the river mouth in the upper Blue Nile basin. In this study a 10year TSS time series data generated from remotely sensed MODIS/Terra images using established empirical relationship is applied to calibrate and validate a hydrology model for Lake Tana in Upper Blue Nile Basin. The result showed that at a monthly time scale TSS at the river mouth can be replicated with Nash-Sutcliffe efficiency (NS) of 0.34 for calibration and 0.21 for validation periods. Percent bias (PBIAS) and ratio of the root-mean-square error to the standard deviation of measured data (RSR) are all within range. Given the inaccessibility and costliness to measure TSS at river mouths to a lake the results found here are considered useful for suspended sediment budget studies in water bodies of the basin. Copyright © 2015 Elsevier B.V. All rights reserved.

Characterizing response of total suspended solids and total phosphorus loading to weather and watershed characteristics for rainfall and snowmelt events in agricultural watersheds

USGS Publications Warehouse

Danz, Mari E.; Corsi, Steven; Brooks, Wesley R.; Bannerman, Roger T.

2013-01-01

Understanding the response of total suspended solids (TSS) and total phosphorus (TP) to influential weather and watershed variables is critical in the development of sediment and nutrient reduction plans. In this study, rainfall and snowmelt event loadings of TSS and TP were analyzed for eight agricultural watersheds in Wisconsin, with areas ranging from 14 to 110 km2 and having four to twelve years of data available. The data showed that a small number of rainfall and snowmelt runoff events accounted for the majority of total event loading. The largest 10% of the loading events for each watershed accounted for 73–97% of the total TSS load and 64–88% of the total TP load. More than half of the total annual TSS load was transported during a single event for each watershed at least one of the monitored years. Rainfall and snowmelt events were both influential contributors of TSS and TP loading. TSS loading contributions were greater from rainfall events at five watersheds, from snowmelt events at two watersheds, and nearly equal at one watershed. The TP loading contributions were greater from rainfall events at three watersheds, from snowmelt events at two watersheds and nearly equal at three watersheds. Stepwise multivariate regression models for TSS and TP event loadings were developed separately for rainfall and snowmelt runoff events for each individual watershed and for all watersheds combined by using a suite of precipitation, melt, temperature, seasonality, and watershed characteristics as predictors. All individual models and the combined model for rainfall events resulted in two common predictors as most influential for TSS and TP. These included rainfall depth and the antecedent baseflow. Using these two predictors alone resulted in an R2 greater than 0.7 in all but three individual models and 0.61 or greater for all individual models. The combined model yielded an R2 of 0.66 for TSS and 0.59 for TP. Neither the individual nor the combined models were substantially improved by using additional predictors. Snowmelt event models were statistically significant for individual and combined watershed models, but the model fits were not all as good as those for rainfall events (R2 between 0.19 and 0.87). Predictor selection varied from watershed to watershed, and the common variables that were selected were not always selected in the same order. Influential variables were commonly direct measures of moisture in the watershed such as snowmelt, rainfall + snowmelt, and antecedent baseflow, or measures of potential snowmelt volume in the watershed such as air temperature.

[Statement of the Polish Gynecological Society Expert Group on the use of ellen probiotic tampon].

PubMed

2012-08-01

The group of experts representing the Polish Gynecologic Society has issued this Statement based on the review of available literature on the potential benefits of the use of ellen probiotic tampon. It has been firmly proven that during menstrual bleeding the vaginal flora undergoes profound changes prodisposing to both bacterial and fungal infections. Safety of menstrual tampons has been studied for over 60 years. According to the current state of knowledge, the use of tampons does not lead to any clinically significant change in the vaginal flora. The link between tampon use and Toxic Shock Syndrome (TTS) was revealed in 1978 after introduction of superabsorbent tampons to the United States market. Following the replacement of carboxymethylcellulose and polyester based tampons by the new generation of cotton based tampons, cases of tampon connected TSS are extremely rare in the US. The proper use of modern tampons is considered to be safe. Ellen tampon features dioxin and chlorine free natural fibres treated with the acidic acid producing probiotic Lacto Naturel (LN), which contains a combination of patented benevolent bacteria that can strengthen women's defense against vaginal infections. Both in vivo and in vitro studied have shown that ellen probiotic tampons are able to succesfully colonize vagina with the LN probiotic bacteria which then coexist with endogenous Lactobacilli present in the patients vaginal ecosystem. The ellen probiotic tampon constitutes an innovative solution of the vaginal probiotic application during menses. The use of this product is aimed to maintain natural vaginal flora as well as its pH during menstrual bleeding. According to the available clinical data, the potential benefits of the probiotic tampon use include: prevention of the vaginal/vulval discomfort as a result of frequent swimming poll use, maintaning of the therapeutic effect of antibacterial/antifungal vaginal treatment and prevention of the recurrent infections, prevention of iatrogenic vaginal flora imbalance after an antibiotic treatment.

Urgent care in gynaecology: resuscitation and management of sepsis and acute blood loss.

PubMed

Fischerova, Daniela

2009-10-01

Sepsis and/or acute blood loss can be encoutered as an emergency condition in gynaecology, especially in women with ectopic pregnancy/miscarriage, acute pelvic inflammatory disease (PID)/tuboovarian abscesses, post-puerperal sepsis/haemorrhage and even in postoperative scenarios. If underestimated or suboptimally treated, both can lead to an inadequate tissue perfusion (defined as shock) and the development of multi-organ failure. Morbidity and mortality after development of one of the shock syndromes (septic or haemorrhagic) correlates directly with the duration and severity of the malperfusion. The patient's prognosis depends on a prompt diagnosis of the presence of shock and immediate resuscitation to predefined physiological end-points, often before the cause of the shock has been identified. In septic shock, hypotension is primarily treated with fluid administration and eventually vasopressors, if required, in order to improve the circulation. Timely administration of antibiotics, control of infectious foci, appropriate use of corticoids and recombinant human activated protein C, tight glucose control, prophylaxis of deep vein thrombosis and stress ulcer prevention complete the therapy of septic shock. In haemorrhagic shock, the treatment primarily involves controlling haemorrhage, reversal of possible coagulopathy and administration of sufficient volumes of fluids and blood products to restore normal tissue perfusion.

40 CFR 432.75 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... achieve the standards for BOD5, fecal coliform, O&G, and TSS specified in § 432.72(a). (b) Facilities that..., fecal coliform, O&G, and TSS specified in § 432.72(b) and the limitations for ammonia (as N) and total...

40 CFR 432.95 - New source performance standards (NSPS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... standards for BOD 5, fecal coliform, O&G, and TSS specified in § 432.92(a). (b) Facilities that generate... coliform, O&G, and TSS specified in § 432.92(b) and the limitations for ammonia (as N) and total nitrogen...

Use of infrared thermography in children with shock: A case series

PubMed Central

Ortiz-Dosal, Alejandra; Rivera-Vega, Rosalina; Simón, Jorge; González, Francisco J

2014-01-01

Shock is a complex clinical syndrome caused by an acute failure of circulatory function resulting in inadequate tissue and organ perfusion. Digital infrared thermal imaging is a non-invasive technique that can detect changes in blood perfusion by detecting small changes in the temperature of the skin. In this preliminary study, eight pediatric patients (five boys, three girls), ages ranging from 6 to 14 years (average: 9.8 years), were admitted to the Intensive Care Unit at “Dr. Ignacio Morones Prieto” Central Hospital; here, the patients were examined using digital infrared thermal imaging. Patients in shock showed a significant decrease in distal temperature (at least 7°), compared to critically ill patients without shock. The latter group presented a skin temperature pattern very similar to the one previously reported for healthy children. The results show that infrared thermography can be used as a non-invasive method for monitoring the temperature in pediatric patients in intensive care units in order to detect shock in its early stages. PMID:27489669

Use of infrared thermography in children with shock: A case series.

PubMed

Ortiz-Dosal, Alejandra; Kolosovas-Machuca, Eleazar S; Rivera-Vega, Rosalina; Simón, Jorge; González, Francisco J

2014-01-01

Shock is a complex clinical syndrome caused by an acute failure of circulatory function resulting in inadequate tissue and organ perfusion. Digital infrared thermal imaging is a non-invasive technique that can detect changes in blood perfusion by detecting small changes in the temperature of the skin. In this preliminary study, eight pediatric patients (five boys, three girls), ages ranging from 6 to 14 years (average: 9.8 years), were admitted to the Intensive Care Unit at "Dr. Ignacio Morones Prieto" Central Hospital; here, the patients were examined using digital infrared thermal imaging. Patients in shock showed a significant decrease in distal temperature (at least 7°), compared to critically ill patients without shock. The latter group presented a skin temperature pattern very similar to the one previously reported for healthy children. The results show that infrared thermography can be used as a non-invasive method for monitoring the temperature in pediatric patients in intensive care units in order to detect shock in its early stages.

Origins of enhanced thermoelectric power factor in topologically insulating Bi{sub 0.64}Sb{sub 1.36}Te{sub 3} thin films

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Wei; State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070; Chi, Hang

2016-01-25

In this research, we report the enhanced thermoelectric power factor in topologically insulating thin films of Bi{sub 0.64}Sb{sub 1.36}Te{sub 3} with a thickness of 6–200 nm. Measurements of scanning tunneling spectroscopy and electronic transport show that the Fermi level lies close to the valence band edge, and that the topological surface state (TSS) is electron dominated. We find that the Seebeck coefficient of the 6 nm and 15 nm thick films is dominated by the valence band, while the TSS chiefly contributes to the electrical conductivity. In contrast, the electronic transport of the reference 200 nm thick film behaves similar to bulk thermoelectric materialsmore » with low carrier concentration, implying the effect of the TSS on the electronic transport is merely prominent in the thin region. The conductivity of the 6 nm and 15 nm thick film is obviously higher than that in the 200 nm thick film owing to the highly mobile TSS conduction channel. As a consequence of the enhanced electrical conductivity and the suppressed bipolar effect in transport properties for the 6 nm thick film, an impressive power factor of about 2.0 mW m{sup −1} K{sup −2} is achieved at room temperature for this film. Further investigations of the electronic transport properties of TSS and interactions between TSS and the bulk band might result in a further improved thermoelectric power factor in topologically insulating Bi{sub 0.64}Sb{sub 1.36}Te{sub 3} thin films.« less

Phosphorus losses from an irrigated watershed in the northwestern United States: case study of the upper snake rock watershed.

PubMed

Bjorneberg, David L; Leytem, April B; Ippolito, James A; Koehn, Anita C

2015-03-01

Watersheds using surface water for irrigation often return a portion of the water to a water body. This irrigation return flow often includes sediment and nutrients that reduce the quality of the receiving water body. Research in the 82,000-ha Upper Snake Rock (USR) watershed from 2005 to 2008 showed that, on average, water diverted from the Snake River annually supplied 547 kg ha of total suspended solids (TSS), 1.1 kg ha of total P (TP), and 0.50 kg ha of dissolved P (DP) to the irrigation tract. Irrigation return flow from the USR watershed contributed 414 kg ha of TSS, 0.71 kg ha of TP, and 0.32 kg ha of DP back to the Snake River. Significantly more TP flowed into the watershed than returned to the Snake River, whereas there was no significant difference between inflow and return flow loads for TSS and DP. Average TSS and TP concentrations in return flow were 71 and 0.12 mg L, respectively, which exceeded the TMDL limits of 52 mg L TSS and 0.075 mg L TP set for this section of the Snake River. Monitoring inflow and outflow for five water quality ponds constructed to reduce sediment and P losses from the watershed showed that TSS concentrations were reduced 36 to 75%, but DP concentrations were reduced only 7 to 16%. This research showed that continued implementation of conservation practices should result in irrigation return flow from the USR watershed meeting the total maximum daily load limits for the Snake River. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Treatment outcomes of intracranial dural arteriovenous fistulas of the transverse and sigmoid sinuses from a single institute in Asia.

PubMed

Cho, Won-Sang; Han, Jung Ho; Kang, Hyun-Seung; Kim, Jeong Eun; Kwon, O-Ki; Oh, Chang Wan; Han, Moon Hee; Chung, Young Seob

2013-07-01

Intracranial dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses (TSS) are rare in Asian populations. This study sought to evaluate the treatment outcomes of intracranial TSS DAVFs at a single Asian institute. Between 1989 and 2007, 122 patients presented to the Seoul National University Hospital with intracranial DAVFs; we performed a retrospective analysis of the 38 patients (31.1%) with TSS DAVFs. The common clinical presentations were headache (44.7%), tinnitus (39.5%), and intracranial hemorrhage (26.3%), and 71.1% had Borden type II or III lesions. Two patients were conservatively managed, two underwent surgery, and 34 were treated endovascularly with transarterial embolization (TAE), transvenous embolization (TVE), or both. The complete occlusion rate immediately after treatment was 50%. Of the 31 patients (81.6%) who underwent follow-up angiography, initial complete occlusion was achieved in 51.6%, and, at the last follow-up, the complete occlusion rate was 64.5%, with the surgery and TVE groups achieving 100% occlusion. The clinical cure rate was 34.2%, and 86.8% of patients had a favorable clinical outcome. However, all patients in both the surgery and TVE groups achieved a favorable clinical outcome. Four (26.7%) of 15 lesions with initially partial embolization showed delayed occlusion. Five patients (13.2%) exhibited clinical or angiographic signs of recurrence, and five patients had permanent complications. TSS DAVFs were less common than cavernous sinus DAVFs, unlike in Western countries, but the angiographic and clinical characteristics of TSS DAVFs were similar to those in Western countries. TSS DAVFs were successfully managed with different modalities, but both surgery and TVE were superior to conservative management or TAE. Copyright © 2012 Elsevier Ltd. All rights reserved.

PREDICTORS OF BIOCHEMICAL REMISSION AND RECURRENCE AFTER SURGICAL AND RADIATION TREATMENTS OF CUSHING DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PubMed

Abu Dabrh, Abd Moain Abu; Singh Ospina, Naykky M; Al Nofal, Alaa; Farah, Wigdan H; Barrionuevo, Patricia; Sarigianni, Maria; Mohabbat, Arya B; Benkhadra, Khalid; Carranza Leon, Barbara G; Gionfriddo, Michael R; Wang, Zhen; Mohammed, Khaled; Ahmed, Ahmed T; Elraiyah, Tarig A; Haydour, Qusay; Alahdab, Fares; Prokop, Larry J; Murad, Mohammad Hassan

2016-04-01

We conducted a systematic review and meta-analysis to synthesize the evidence about predictors that may affect biochemical remission and recurrence after transsphenoidal surgery (TSS), radiosurgery (RS), and radiotherapy (RT) in Cushing disease. We searched multiple databases through December 2014 including original controlled and uncontrolled studies that enrolled patients with Cushing disease who received TSS (first-line), RS, or RT. We extracted data independently, in duplicates. Outcomes of interest were biochemical remission and recurrence. A meta-analysis was conducted using the random-effects model to estimate event rates with 95% confidence intervals (CIs). First-line TSS was associated with high remission (76% [95% CI, 72 to 79%]) and low recurrence rates (10% [95% CI, 6 to 16%]). Remission after TSS was higher in patients with microadenomas or positive-adrenocorticotropic hormone tumor histology. RT was associated with a high remission rate (RS, 68% [95% CI, 61 to 77%]; RT, 66% [95% CI, 58 to 75%]) but also with a high recurrence rate (RS, 32% [95% CI, 16 to 60%]; RT, 26% [95% CI, 14 to 48%]). Remission after RS was higher at short-term follow-up (≤2 years) and with high-dose radiation, while recurrence was higher in women and with lower-dose radiation. Remission was after RT in adults who received TSS prior to RT, and with lower radiation doses. There was heterogeneity (nonstandardization) in the criteria and cutoff points used to define biochemical remission and recurrence. First-line TSS is associated with high remission and low recurrence, while RS and RT are associated with reasonable remission rates but important recurrence rates. The current evidence warrants low confidence due to the noncomparative nature of the studies, high heterogeneity, and imprecision.

Treatment of leydig cell tumours of the testis: Can testis-sparing surgery replace radical orchidectomy? Results of a systematic review.

PubMed

Bozzini, G; Ratti, D; Carmignani, L

2017-04-01

The gold standard for Leydig cell tumours (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. Studies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. The present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months). In the TSS group, the follow-up varied from 6 to 192 months. Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%. None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrence In selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. The results confirm the favourable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Multi-slice computed tomography-assisted endoscopic transsphenoidal surgery for pituitary macroadenoma: a comparison with conventional microscopic transsphenoidal surgery.

PubMed

Tosaka, Masahiko; Nagaki, Tomohito; Honda, Fumiaki; Takahashi, Katsumasa; Yoshimoto, Yuhei

2015-11-01

Intraoperative computed tomography (iCT) is a reliable method for the detection of residual tumour, but previous single-slice low-resolution computed tomography (CT) without coronal or sagittal reconstructions was not of adequate quality for clinical use. The present study evaluated the results of multi-slice iCT-assisted endoscopic transsphenoidal surgery for pituitary macroadenoma. This retrospective study included 30 consecutive patients with newly diagnosed or recurrent pituitary macroadenoma with supradiaphragmatic extension who underwent endoscopic transsphenoidal surgery using iCT (eTSS+iCT group), and control 30 consecutive patients who underwent conventional endoscope-assisted transsphenoidal surgery (cTSS group). The tumour volume was calculated by multiplying the tumour area by the slice thickness. Visual acuity and visual field were estimated by the visual impairment score (VIS). The resection extent, (preoperative tumour volume - postoperative residual tumour volume)/preoperative tumour volume, was 98.9% (median) in the eTSS+iCT group and 91.7% in the cTSS group, and had significant difference between the groups (P = 0.04). Greater than 95 and >90% removal rates were significantly higher in the eTSS+iCT group than in the cTSS group (P = 0.02 and P = 0.001, respectively). However, improvement in VIS showed no significant difference between the groups. The rate of complications also showed no significant difference. Multi-slice iCT-assisted endoscopic transsphenoidal surgery may improve the resection extent of pituitary macroadenoma. Multi-slice iCT may have advantages over intraoperative magnetic resonance imaging in less expensive, short acquisition time, and that special protection against magnetic fields is not needed.

Co-culture of 3D tumor spheroids with fibroblasts as a model for epithelial–mesenchymal transition in vitro

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Sun-Ah, E-mail: j.sarah.k@gmail.com; Lee, Eun Kyung, E-mail: leeek@catholic.ac.kr; Cancer Evolution Research Center, College of Medicine, The Catholic University of Korea, Seoul 137-701

Epithelial–mesenchymal transition (EMT) acts as a facilitator of metastatic dissemination in the invasive margin of malignant tumors where active tumor–stromal crosstalks take place. Co-cultures of cancer cells with cancer-associated fibroblasts (CAFs) are often used as in vitro models of EMT. We established a tumor–fibroblast proximity co-culture using HT-29 tumor spheroids (TSs) with CCD-18co fibroblasts. When co-cultured with TSs, CCD-18co appeared activated, and proliferative activity as well as cell migration increased. Expression of fibronectin increased whereas laminin and type I collagen decreased in TSs co-cultured with fibroblasts compared to TSs alone, closely resembling the margin of in vivo xenograft tissue. Activemore » TGFβ1 in culture media significantly increased in TS co-cultures but not in 2D co-cultures of cancer cells–fibroblasts, indicating that 3D context-associated factors from TSs may be crucial to crosstalks between cancer cells and fibroblasts. We also observed in TSs co-cultured with fibroblasts increased expression of α-SMA, EGFR and CTGF; reduced expression of membranous β-catenin and E-cadherin, together suggesting an EMT-like changes similar to a marginal region of xenograft tissue in vivo. Overall, our in vitro TS–fibroblast proximity co-culture mimics the EMT-state of the invasive margin of in vivo tumors in early metastasis. - Highlights: • An adjacent co-culture of tumor spheroids and fibroblasts is presented as EMT model. • Activation of fibroblasts and increased cell migration were shown in co-culture. • Expression of EMT-related factors in co-culture was similar to that in tumor tissue. • Crosstalk between spheroids and fibroblasts was demonstrated by secretome analysis.« less

Hitch-hiker taken for a ride: an unusual cause of myocarditis, septic shock and adult respiratory distress syndrome

PubMed Central

Kushawaha, Anurag; Brown, Mark; Martin, Ismael; Evenhuis, Walther

2013-01-01

Rocky Mountain spotted fever (RMSF) is a serious tick-borne illness caused by Rickettsia rickettsii that is endemic in southeastern USA. Although RMSF has been described as causing the classic clinical triad of fever, headache and a characteristic rash, serious and potentially life-threatening manifestations can occur. Cardiopulmonary involvement, although infrequent, may occur with severe cases of RMSF. Rickettsial myocarditis is an uncommon occurrence. We present a case of a previously healthy 26-year-old man, who was hitch-hiking across the southeastern USA, with serologically proven RMSF causing adult respiratory distress syndrome, septic shock and myocarditis manifested by elevated cardiac enzymes and decrease in myocardial function. After treatment with antibiotics, the myocarditis resolved. Therefore, although unusual, clinicians should be aware of possible myocardial involvement in patients with appropriate tick-exposure histories or other clinical signs of RMSF. PMID:23314875

Promising novel therapy with hydrogen gas for emergency and critical care medicine.

PubMed

Sano, Motoaki; Suzuki, Masaru; Homma, Koichiro; Hayashida, Kei; Tamura, Tomoyoshi; Matsuoka, Tadashi; Katsumata, Yoshinori; Onuki, Shuko; Sasaki, Junichi

2018-04-01

It has been reported that hydrogen gas exerts a therapeutic effect in a wide range of disease conditions, from acute illness such as ischemia-reperfusion injury, shock, and damage healing to chronic illness such as metabolic syndrome, rheumatoid arthritis, and neurodegenerative diseases. Antioxidant and anti-inflammatory properties of hydrogen gas have been proposed, but the molecular target of hydrogen gas has not been identified. We established the Center for Molecular Hydrogen Medicine to promote non-clinical and clinical research on the medical use of hydrogen gas through industry-university collaboration and to obtain regulatory approval of hydrogen gas and hydrogen medical devices (http://www.karc.keio.ac.jp/center/center-55.html). Studies undertaken by the Center have suggested possible therapeutic effects of hydrogen gas in relation to various aspects of emergency and critical care medicine, including acute myocardial infarction, cardiopulmonary arrest syndrome, contrast-induced acute kidney injury, and hemorrhagic shock.

Two variants of fat embolism syndrome evolving in a young patient with multiple fractures

PubMed Central

Bajuri, Mohd Yazid; Johan, Rudy Reza; Shukur, Hassan

2013-01-01

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24–36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting. PMID:23576653

Two variants of fat embolism syndrome evolving in a young patient with multiple fractures.

PubMed

Bajuri, Mohd Yazid; Johan, Rudy Reza; Shukur, Hassan

2013-04-09

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24-36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting.

Bacterial Phenotype Variants in Group B Streptococcal Toxic Shock Syndrome1

PubMed Central

Johansson, Linda; Dahesh, Samira; Van Sorge, Nina M.; Darenberg, Jessica; Norgren, Mari; Sjölin, Jan; Nizet, Victor; Norrby-Teglund, Anna

2009-01-01

We conducted genetic and functional analyses of isolates from a patient with group B streptococcal (GBS) necrotizing fasciitis and toxic shock syndrome. Tissue cultures simultaneously showed colonies with high hemolysis (HH) and low hemolysis (LH). Conversely, the HH and LH variants exhibited low capsule (LC) and high capsule (HC) expression, respectively. Molecular analysis demonstrated that the 2 GBS variants were of the same clonal origin. Genetic analysis found a 3-bp deletion in the covR gene of the HH/LC variant. Functionally, this isolate was associated with an increased growth rate in vitro and with higher interleukin-8 induction. However, in whole blood, opsonophagocytic and intracellular killing assays, the LH/HC phenotype demonstrated higher resistance to host phagocytic killing. In a murine model, LH/HC resulted in higher levels of bacteremia and increased host mortality rate. These findings demonstrate differences in GBS isolates of the same clonal origin but varying phenotypes. PMID:19193266

Streptococcal toxic shock syndrome caused by the dissemination of an invasive emm3/ST15 strain of Streptococcus pyogenes.

PubMed

Sekizuka, Tsuyoshi; Nai, Emina; Yoshida, Tomohiro; Endo, Shota; Hamajima, Emi; Akiyama, Satoka; Ikuta, Yoji; Obana, Natsuko; Kawaguchi, Takahiro; Hayashi, Kenta; Noda, Masahiro; Sumita, Tomoko; Kokaji, Masayuki; Katori, Tatsuo; Hashino, Masanori; Oba, Kunihiro; Kuroda, Makoto

2017-12-18

Streptococcus pyogenes (group A Streptococcus [GAS]) is a major human pathogen that causes a wide spectrum of clinical manifestations. Although invasive GAS (iGAS) infections are relatively uncommon, emm3/ST15 GAS is a highly virulent, invasive, and pathogenic strain. Global molecular epidemiology analysis has suggested that the frequency of emm3 GAS has been recently increasing. A 14-year-old patient was diagnosed with streptococcal toxic shock syndrome and severe pneumonia, impaired renal function, and rhabdomyolysis. GAS was isolated from a culture of endotracheal aspirates and designated as KS030. Comparative genome analysis suggested that KS030 is classified as emm3 (emm-type) and ST15 (multilocus sequencing typing [MLST]), which is similar to iGAS isolates identified in the UK (2013) and Switzerland (2015). We conclude that the global dissemination of emm3/ST15 GAS strain has the potential to cause invasive disease.

Bacterial phenotype variants in group B streptococcal toxic shock syndrome.

PubMed

Sendi, Parham; Johansson, Linda; Dahesh, Samira; Van-Sorge, Nina M; Darenberg, Jessica; Norgren, Mari; Sjölin, Jan; Nizet, Victor; Norrby-Teglund, Anna

2009-02-01

We conducted genetic and functional analyses of isolates from a patient with group B streptococcal (GBS) necrotizing fasciitis and toxic shock syndrome. Tissue cultures simultaneously showed colonies with high hemolysis (HH) and low hemolysis (LH). Conversely, the HH and LH variants exhibited low capsule (LC) and high capsule (HC) expression, respectively. Molecular analysis demonstrated that the 2 GBS variants were of the same clonal origin. Genetic analysis found a 3-bp deletion in the covR gene of the HH/LC variant. Functionally, this isolate was associated with an increased growth rate in vitro and with higher interleukin-8 induction. However, in whole blood, opsonophagocytic and intracellular killing assays, the LH/HC phenotype demonstrated higher resistance to host phagocytic killing. In a murine model, LH/HC resulted in higher levels of bacteremia and increased host mortality rate. These findings demonstrate differences in GBS isolates of the same clonal origin but varying phenotypes.

Development of a field test method for total suspended solids analysis.

DOT National Transportation Integrated Search

2013-11-01

Total suspended solids (TSS) are all particles in water that will not pass through a glass fiber filter with a pore size less : than 2 m, including sediments, algae, nutrients, and metals. TSS is an important water quality parameter because of its ...

Comparative impacts of stormwater runoff on water quality of an urban, a suburban, and a rural stream.

PubMed

Mallin, Michael A; Johnson, Virginia L; Ensign, Scott H

2009-12-01

Water quality data at 12 sites within an urban, a suburban, and a rural stream were collected contemporaneously during four wet and eight dry periods. The urban stream yielded the highest biochemical oxygen demand (BOD), orthophosphate, total suspended sediment (TSS), and surfactant concentrations, while the most rural stream yielded the highest total organic carbon concentrations. Percent watershed development and percent impervious surface coverage were strongly correlated with BOD (biochemical oxygen demand), orthophosphate, and surfactant concentrations but negatively with total organic carbon. Excessive fecal coliform abundance most frequently occurred in the most urbanized catchments. Fecal coliform bacteria, TSS, turbidity, orthophosphate, total phosphorus, and BOD were significantly higher during rain events compared to nonrain periods. Total rainfall preceding sampling was positively correlated with turbidity, TSS, BOD, total phosphorus, and fecal coliform bacteria concentrations. Turbidity and TSS were positively correlated with phosphorus, fecal coliform bacteria, BOD, and chlorophyll a, which argues for better sedimentation controls under all landscape types.

Tethered Satellite System Project Overview

NASA Technical Reports Server (NTRS)

Laue, J. H.

1985-01-01

The Skyhook concept is reviewed and the use of a tethered satellite system (TSS) to enable scientific investigations from the shuttle using a closed loop control system is examined. The tethered satellite system has capabilities for deployment toward or away from Earth, for multiple round trip missions, and for deployment at distances up to 100 KN from the orbiter. The deployer, which consists of an entendable boom, a reel for the tether, and the tether itself, permits deployment and retrieval at a safe distance, allows alignment of the force vector of the tether through the center of gravity of the shuttle, and gives some initial gravity gradient separation to aid in deployment and ultimate retrieval of the tethered satellite. Charts show TSS activities in terms of systems studies, key guidelines, Italian and U.S. responsibilities, user activities, and major science and applications accommodation features. Scientific objectives for TSS-1 and TSS-2 verification missions and the current status of the project are also given.

Identification of cranial nerves around trigeminal schwannomas using diffusion tensor tractography: a technical note and report of 3 cases.

PubMed

Wei, Peng-Hu; Qi, Zhi-Gang; Chen, Ge; Li, Ming-Chu; Liang, Jian-Tao; Guo, Hong-Chuan; Bao, Yu-Hai; Hao, Qiang

2016-03-01

There are no large series studies identifying the locations of cranial nerves (CNs) around trigeminal schwannomas (TSs); however, surgically induced cranial neuropathies are commonly observed after surgeries to remove TSs. In this study, we preoperatively identified the location of CNs near TSs using diffusion tensor tractography (DTT). An observational study of the DTT results and intraoperative findings was performed. We preoperatively completed tractography from images of patients with TSs who received surgical therapy. The result was later validated during tumorectomy. A total of three consecutive patients were involved in this study. The locations of CNs V-VIII in relation to the tumor was clearly revealed in all cases, except for CN VI in case 3.The predicted fiber tracts were in agreement with intraoperative observations. In this study, preoperative DTT accurately predicted the location of the majority of the nerves of interest. This technique can be applied by surgeons to preoperatively visualize nerve arrangements.

Conventional and two step sintering of PZT-PCN ceramics

NASA Astrophysics Data System (ADS)

Keshavarzi, Mostafa; Rahmani, Hooman; Nemati, Ali; Hashemi, Mahdieh

2018-02-01

In this study, PZT-PCN ceramic was made via sol-gel seeding method and effects of conventional sintering (CS) as well as two-step sintering (TSS) were investigated on microstructure, phase formation, density, dielectric and piezoelectric properties. First, high quality powder was achieved by seeding method in which the mixture of Co3O4 and Nb2O5 powder was added to the prepared PZT sol to form PZT-PCN gel. After drying and calcination, pyrochlore free PZT-PCN powder was synthesized. Second, CS and TSS were applied to achieve dense ceramic. The optimum temperature used for 2 h of conventional sintering was obtained at 1150 °C; finally, undesired ZrO2 phase formed in CS procedure was removed successfully with TSS procedure and dielectric and piezoelectric properties were improved compared to the CS procedure. The best electrical properties obtained for the sample sintered by TSS in the initial temperature of T 1 = 1200 °C and secondary temperature of T 2 = 1000 °C for 12 h.

Exploring the "legacy" of the Tuskegee Syphilis Study: a follow-up study from the Tuskegee Legacy Project.

PubMed

Katz, Ralph V; Green, B Lee; Kressin, Nancy R; James, Sherman A; Wang, Min Qi; Claudio, Cristina; Russell, Stephanie Luise

2009-02-01

The purpose of this follow-up 2003 3-City Tuskegee Legacy Project (TLP) Study was to validate or refute our prior findings from the 1999-2000 4 City TLP Study, which found no evidence to support the widely acknowledged "legacy" of the Tuskegee Syphilis Study (TSS), ie, that blacks are reluctant to participate in biomedical studies due to their knowledge of the TSS. The TLP Questionnaire was administered in this random-digit-dial telephone survey to a stratified random sample of 1162 black, white, and Puerto Rican Hispanic adults in 3 different US cities. The findings from this current 3-City TLP Study fail to support the widely acknowledged "legacy" of the TSS, as awareness of the TSS was not statistically associated with the willingness to participate in biomedical studies. These findings, being in complete agreement with our previous findings from our 1999-2000 4-City TLP, validate those prior findings.

Exploring the “Legacy” of the Tuskegee Syphilis Study: A Follow-up Study From the Tuskegee Legacy Project

PubMed Central

Katz, Ralph V.; Green, B. Lee; Kressin, Nancy R.; James, Sherman A.; Wang, Min Qi; Claudio, Cristina; Russell, Stephanie Luise

2009-01-01

The purpose of this follow-up 2003 3-City Tuskegee Legacy Project (TLP) Study was to validate or refute our prior findings from the 1999–2000 4 City TLP Study, which found no evidence to support the widely acknowledged “legacy” of the Tuskegee Syphilis Study (TSS), ie, that blacks are reluctant to participate in biomedical studies due to their knowledge of the TSS. The TLP Questionnaire was administered in this random-digit-dial telephone survey to a stratified random sample of 1162 black, white, and Puerto Rican Hispanic adults in 3 different US cities. The findings from this current 3-City TLP Study fail to support the widely acknowledged “legacy” of the TSS, as awareness of the TSS was not statistically associated with the willingness to participate in biomedical studies. These findings, being in complete agreement with our previous findings from our 1999–2000 4-City TLP, validate those prior findings. PMID:19378637

Nontrivial Nature and Penetration Depth of Topological Surface States in SmB6 Thin Films

NASA Astrophysics Data System (ADS)

Liu, Tao; Li, Yufan; Gu, Lei; Ding, Junjia; Chang, Houchen; Janantha, P. A. Praveen; Kalinikos, Boris; Novosad, Valentyn; Hoffmann, Axel; Wu, Ruqian; Chien, C. L.; Wu, Mingzhong

2018-05-01

The nontrivial feature and penetration depth of the topological surface states (TSS) in SmB6 were studied via spin pumping. The experiments used SmB6 thin films grown on the bulk magnetic insulator Y3Fe5O12 (YIG). Upon the excitation of magnetization precession in the YIG, a spin current is generated in the SmB6 that produces, via spin-orbit coupling, a lateral electrical voltage in the film. This spin-pumping voltage signal becomes considerably stronger as the temperature decreases from 150 to 10 K, and such an enhancement most likely originates from the spin-momentum locking of the TSS and may thereby serve as evidence for the nontrivial nature of the TSS. The voltage data also show a unique film thickness dependence that suggests a TSS depth of ˜32 nm . The spin-pumping results are supported by transport measurements and analyses using a tight binding model.

Modeling And Economics Of Extreme Subduction Earthquakes: Two Case Studies

NASA Astrophysics Data System (ADS)

Chavez, M.; Cabrera, E.; Emerson, D.; Perea, N.; Moulinec, C.

2008-05-01

The destructive effects of large magnitude, thrust subduction superficial (TSS) earthquakes on Mexico City (MC) and Guadalajara (G) has been shown in the recent centuries. For example, the 7/04/1845 and the 19/09/1985, two TSS earthquakes occurred on the coast of the state of Guerrero and Michoacan, with Ms 7+ and 8.1. The economical losses for the later were of about 7 billion US dollars. Also, the largest Ms 8.2, instrumentally observed TSS earthquake in Mexico, occurred in the Colima-Jalisco region the 3/06/1932, and the 9/10/1995 another similar, Ms 7.4 event occurred in the same region, the later produced economical losses of hundreds of thousands US dollars.The frequency of occurrence of large TSS earthquakes in Mexico is poorly known, but it might vary from decades to centuries [1]. Therefore there is a lack of strong ground motions records for extreme TSS earthquakes in Mexico, which as mentioned above, recently had an important economical impact on MC and potentially could have it in G. In this work we obtained samples of broadband synthetics [2,3] expected in MC and G, associated to extreme (plausible) magnitude Mw 8.5, TSS scenario earthquakes, with epicenters in the so-called Guerrero gap and in the Colima-Jalisco zone, respectively. The economical impacts of the proposed extreme TSS earthquake scenarios for MC and G were considered as follows: For MC by using a risk acceptability criteria, the probabilities of exceedance of the maximum seismic responses of their construction stock under the assumed scenarios, and the estimated economical losses observed for the 19/09/1985 earthquake; and for G, by estimating the expected economical losses, based on the seismic vulnerability assessment of their construction stock under the extreme seismic scenario considered. ----------------------- [1] Nishenko S.P. and Singh SK, BSSA 77, 6, 1987 [2] Cabrera E., Chavez M., Madariaga R., Mai M, Frisenda M., Perea N., AGU, Fall Meeting, 2005 [3] Chavez M., Olsen K.B., Cabrera E., 13th World Conf. Earthq. Eng., 2004

Oxidative stress may be involved in distant organ failure in tourniquet shock model mice.

PubMed

Nishikata, Rie; Kato, Naho; Hiraiwa, Kouichi

2014-03-01

Crush syndrome is characterized by prolonged shock resulting from extensive muscle damage and multiple organ failure. However, the pathogenesis of multiple organ failure has not yet been completely elucidated. Therefore, we investigated the molecular biological and histopathological aspects of distant organ injury in crush syndrome by using tourniquet shock model mice. DNA microarray analysis of the soleus muscle showed an increase in the mRNA levels of Cox-2, Hsp70, c-fos, and IL-6, at 3h after ischemia/reperfusion injury at the lower extremity. In vivo staining with hematoxylin and eosin (HE) showed edema and degeneration in the soleus muscle, but no change in the distant organs. Immunohistological staining of the HSP70 protein revealed nuclear translocation in the soleus muscle, kidney, liver, and lung. The c-fos mRNA levels were elevated in the soleus muscle, kidney, and liver, displaying nuclear translocation of c-FOS protein. Terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) analysis suggested the involvement of apoptosis in ischemia/reperfusion injury in the soleus muscle. Apoptotic cells were not found in greater quantities in the kidney. Oxidative stress, as determined using a free radical elective evaluator (d-ROM test), markedly increased after ischemia/reperfusion injury. Therefore, examination of immunohistological changes and determination of oxidative stress are proposed to be useful in evaluating the extent of tourniquet shock, even before changes are observed by HE staining. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Automatic control of a primary electric thrust subsystem

NASA Technical Reports Server (NTRS)

Macie, T. W.; Macmedan, M. L.

1975-01-01

A concept for automatic control of the thrust subsystem has been developed by JPL and participating NASA Centers. This paper reports on progress in implementing the concept at JPL. Control of the Thrust Subsystem (TSS) is performed by the spacecraft computer command subsystem, and telemetry data is extracted by the spacecraft flight data subsystem. The Data and Control Interface Unit, an element of the TSS, provides the interface with the individual elements of the TSS. The control philosophy and implementation guidelines are presented. Control requirements are listed, and the control mechanism, including the serial digital data intercommunication system, is outlined. The paper summarizes progress to Fall 1974.

Fast Distributed Dynamics of Semantic Networks via Social Media.

PubMed

Carrillo, Facundo; Cecchi, Guillermo A; Sigman, Mariano; Slezak, Diego Fernández

2015-01-01

We investigate the dynamics of semantic organization using social media, a collective expression of human thought. We propose a novel, time-dependent semantic similarity measure (TSS), based on the social network Twitter. We show that TSS is consistent with static measures of similarity but provides high temporal resolution for the identification of real-world events and induced changes in the distributed structure of semantic relationships across the entire lexicon. Using TSS, we measured the evolution of a concept and its movement along the semantic neighborhood, driven by specific news/events. Finally, we showed that particular events may trigger a temporary reorganization of elements in the semantic network.

Fast Distributed Dynamics of Semantic Networks via Social Media

PubMed Central

Carrillo, Facundo; Cecchi, Guillermo A.; Sigman, Mariano; Fernández Slezak, Diego

2015-01-01

We investigate the dynamics of semantic organization using social media, a collective expression of human thought. We propose a novel, time-dependent semantic similarity measure (TSS), based on the social network Twitter. We show that TSS is consistent with static measures of similarity but provides high temporal resolution for the identification of real-world events and induced changes in the distributed structure of semantic relationships across the entire lexicon. Using TSS, we measured the evolution of a concept and its movement along the semantic neighborhood, driven by specific news/events. Finally, we showed that particular events may trigger a temporary reorganization of elements in the semantic network. PMID:26074953

Tethered Satellite System (TSS)-1R survey photography

NASA Image and Video Library

1996-03-18

STS075-325-014 (25 Feb. 1996) --- The frayed end of the tether portion of the Tethered Satellite System (TSS) is seen at the end of the supportive boom. On February 25, 1996, the crew deployed the TSS, which later broke free. The seven member crew was launched aboard the Space Shuttle Columbia on February 22, 1996, and landed on March 9, 1996. Crewmembers were Andrew M. Allen, mission commander; Scott J. Horowitz, pilot; Franklin R. Chang-Diaz, payload commander; and Maurizio Cheli, European Space Agency (ESA); Jeffrey A. Hoffman and Claude Nicollier (ESA), all mission specialists; along with payload specialist Umberto Guidoni of the Italian Space Agency (ASI).

[Bacterial toxic shock as a complication of calculous pyelonephritis].

PubMed

Lopatkin, N A; Rumiantsev, V B; Ianenko, E K

1994-01-01

The causes of bacteriotoxic shock were examined in 33 patients (11 lethal outcomes). It has arisen as a complication of treatment given to 7830 patients for urolithiasis. Aggravation of chronic pyelonephritis, occlusion of the urinary tracts, urogenital mucosal and parenchymal injuries, low resistance to infection contribute to microbacteria and their toxins entering blood with resultant bacteriotoxic shock. Transcutaneous operative interventions, therapeutic and diagnostic procedures also produce high risk of blood infection with gram-negative microflora, especially in violation of asepsis and antisepsis rules. As shown by microflora tests, the dominating bacteria consisted of opportunistic agents which had acquired the resistance to antibacterial drugs. In view of rapid progression of bacteriotoxic shock therapeutic efforts should be concentrated on fast normalization of hemodynamics, recovery of urine passage, introduction of sorption detoxication, prevention of DIC syndrome. The schemes of combined antibiotic treatment adjusted to the kind of infectious agent are suggested.

Evolutionary genomics of Staphylococcus aureus: insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic.

PubMed

Fitzgerald, J R; Sturdevant, D E; Mackie, S M; Gill, S R; Musser, J M

2001-07-17

An emerging theme in medical microbiology is that extensive variation exists in gene content among strains of many pathogenic bacterial species. However, this topic has not been investigated on a genome scale with strains recovered from patients with well-defined clinical conditions. Staphylococcus aureus is a major human pathogen and also causes economically important infections in cows and sheep. A DNA microarray representing >90% of the S. aureus genome was used to characterize genomic diversity, evolutionary relationships, and virulence gene distribution among 36 strains of divergent clonal lineages, including methicillin-resistant strains and organisms causing toxic shock syndrome. Genetic variation in S. aureus is very extensive, with approximately 22% of the genome comprised of dispensable genetic material. Eighteen large regions of difference were identified, and 10 of these regions have genes that encode putative virulence factors or proteins mediating antibiotic resistance. We find that lateral gene transfer has played a fundamental role in the evolution of S. aureus. The mec gene has been horizontally transferred into distinct S. aureus chromosomal backgrounds at least five times, demonstrating that methicillin-resistant strains have evolved multiple independent times, rather than from a single ancestral strain. This finding resolves a long-standing controversy in S. aureus research. The epidemic of toxic shock syndrome that occurred in the 1970s was caused by a change in the host environment, rather than rapid geographic dissemination of a new hypervirulent strain. DNA microarray analysis of large samples of clinically characterized strains provides broad insights into evolution, pathogenesis, and disease emergence.

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

Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients.

PubMed

Oda, Jun; Ueyama, Masashi; Yamashita, Katsuyuki; Inoue, Takuya; Noborio, Mitsuhiro; Ode, Yasumasa; Aoki, Yoshiki; Sugimoto, Hisashi

2006-01-01

Secondary abdominal compartment syndrome is a lethal complication after resuscitation from burn shock. Hypertonic lactated saline (HLS) infusion reduces early fluid requirements in burn shock, but the effects of HLS on intraabdominal pressure have not been clarified. Patients admitted to our burn unit between 2002 and 2004 with burns > or =40% of the total body surface area without severe inhalation injury were entered into a fluid resuscitation protocol using HLS (n = 14) or lactated Ringer's solution (n = 22). Urine output was monitored hourly with a goal of 0.5 to 1.0 mL/kg per hour. Hemodynamic parameters, blood gas analysis, intrabladder pressure as an indicator of intraabdominal pressure (IAP), and the peak inspiratory pressure were recorded. Pulmonary compliance and the abdominal perfusion pressure were also calculated. In the HLS group, the amount of intravenous fluid volume needed to maintain adequate urine output was less at 3.1 +/- 0.9 versus 5.2 +/- 1.2 mL/24 h per kg per percentage of total body surface area, and the peak IAP and peak inspiratory pressure at 24 hours after injury were significantly lower than those in the lactated Ringer's group. Two of 14 patients (14%) in the HLS group and 11 of 22 patients (50%) developed IAH within 20.8 +/- 7.2 hours after injury. In patients with severe burn injury, a large intravenous fluid volume decreases abdominal perfusion during the resuscitative period because of increased IAP. Our data suggest that HLS resuscitation could reduce the risk of secondary abdominal compartment syndrome with lower fluid load in burn shock patients.

Tethered Satellite System (TSS) core equipment

NASA Technical Reports Server (NTRS)

Bonifazi, C.

1986-01-01

To date, three Tethered Satellite System (TSS) missions of the Italian provided scientific satellite orbiting in the ionosphere connected to U.S. Space Shuttle is foreseen. The first mission will use an electrically conductive tether of 20 km deployed upward from the orbiter flying at 300 km altitude. This mission will allow investigation of the TSS electrodynamic interaction with the ionosphere due to the high voltage induced across the two terminators of the system during its motion throughout the geomagnetic field. The second mission will use a dielectric tether of 100 km deployed downward from the Orbiter flying at 230 km altitude. Tethered-vehicle access to altitude as low as 120 to 150 km from the Orbiter would permit direct long term observation of phenomena in the lower thermosphere and determination of other dynamical physical processes. The third mission would use the same configuration of the first electrodynamic mission with the complete Core Equipment. Study of power generation by tethered systems would be possible by operating the Core Equipment in the inverted current mode. This mode of operation would allow ion current collection upon the TSS satellite by controlling its potential with respect to the ambient ionospheric plasma. The main requirements of the Core Equipment configuration to date foreseen for the first TSS electrodynamic mission is described. Besides the Core Equipment purposes, its hardware and operational sub-modes of operation are described.

Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors?

PubMed

Bojanic, Nebojsa; Bumbasirevic, Uros; Bojanic, Gordana; Vukovic, Ivan; Milojevic, Bogomir; Pekmezovic, Tatjana

2017-03-01

To evaluate the results of testis-sparing surgery (TSS) in patients, with small testicular lesions and a normal contralateral testicle. In all, 28 patients were treated with TSS for small testicular lesions and a normal contralateral testicle. TSS was considered in patients with testicular lesions smaller than 2 cm and no evidence of metastatic disease. The mean age of patients was 35.3 ± 7.3 years, while the mean diameter of the testicular lesions was 11.4 ± 3.7 mm. After pathological examination, 18 patients (64.3%) were diagnosed with stromal tumors and miscellaneous lesions, while 10 (35.7%) had a germ cell tumor. The median follow-up time for the former group was 33 months and no recurrences were observed. In one patient with germ cell tumor, immediate orchiectomy was performed, while the remaining nine were followed-up (median time, 45 months). One patient developed local recurrence after 39 months. Excellent outcomes for benign lesions could be achieved using TSS. TSS could be offered safely in highly selected patients with germ cell tumors, specifically within a clinical trial but there is more data needed regarding the potential risks and benefits. J. Surg. Oncol. 2017;115:287-290. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Symbolic interactionism: a perspective for understanding parent-nurse interactions following the birth of a child with Down syndrome.

PubMed

van Riper, M; Pridham, K; Ryff, C

1992-01-01

The birth of a child with Down syndrome is a challenge to parental and societal expectations. Feelings of shock, sadness, confusion, denial, fear, anger, guilt, and helplessness may be evoked. In this paper, the impact of stigma on individuals with Down syndrome and their families will be reviewed to clarify why interactions between parents and others need to be explored. Next, the central concepts important to the symbolic interactionist perspective will be reviewed. Then, qualitative data from an ongoing study of 90 parents of children with Down syndrome (ages 3 months to 18 years) will be presented to illustrate how symbolic interactionism can be applied to the to care of children with Down syndrome and their families. Finally, implications for nurses working with families that include a child with Down syndrome will be addressed.

Acute fatal posthypoxic leukoencephalopathy following benzodiazepine overdose: a case report and review of the literature.

PubMed

Aljarallah, Salman; Al-Hussain, Fawaz

2015-04-30

Among the rare neurological complications of substances of abuse is the selective cerebral white matter injury (leukoencephalopathy). Of which, the syndrome of delayed post hypoxic encephalopathy (DPHL) that follows an acute drug overdose, in addition to "chasing the dragon" toxicity which results from chronic heroin vapor inhalation remain the most commonly described syndromes of toxic leukoencephalopathy. These syndromes are reported in association with opioid use. There are very few cases in the literature that described leukoencephalopathy following benzodiazepines, especially with an acute and progressive course. In this paper, we present a patient who developed an acute severe fatal leukoencephalopathy following hypoxic coma and systemic shock induced by benzodiazepine overdose. A 19-year-old male was found comatose at home and brought to hospital in a deep coma, shock, hypoxia, and acidosis. Brain magnetic resonant imaging (MRI) revealed a strikingly selective white matter injury early in the course of the disease. The patient remained in a comatose state with no signs of neurologic recovery until he died few weeks later following an increase in the brain edema and herniation. Toxic leukoencephalopathy can occur acutely following an overdose of benzodiazepine and respiratory failure. This is unlike the usual cases of toxic leukoencephalopathy where there is a period of lucidity between the overdose and the development of white matter disease. Unfortunately, this syndrome remains of an unclear pathophysiology and with no successful treatment.

The utility of alpha-fetoprotein screening in Beckwith-Wiedemann syndrome.

PubMed

Duffy, Kelly A; Deardorff, Matthew A; Kalish, Jennifer M

2017-03-01

Beckwith-Wiedemann syndrome (BWS) is one of the most common cancer predisposition disorders. As a result, BWS patients receive tumor screening as part of their clinical management. Until recently, this screening has been employed uniformly across all genetic and epigenetic causes of BWS, including the utilization of ultrasonography to detect abdominal tumors and alpha-fetoprotein (AFP) to detect hepatoblastoma. The advancements in our understanding of the genetics and epigenetics leading to BWS has evolved over time, and has led to the development of genotype/phenotype correlations. As tumor risk appears to correlate with genetic and epigenetic causes of BWS, several groups have proposed alterations to tumor screening protocols based on the etiology of BWS, with the elimination of AFP as a screening measure and the elimination of all screening measures in BWS patients with loss of methylation at the KCNQ1OT1:TSS-DMR 2 (IC2). There are many challenges to this suggestion, as IC2 patients may have additional factors that contribute to risk of hepatoblastoma including fetal growth patterns, relationship with assisted reproductive technologies, and the regulation of the IC2 locus. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Key issues of ultraviolet radiation of OH at high altitudes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yuhuai; Wan, Tian; Jiang, Jianzheng

2014-12-09

Ultraviolet (UV) emissions radiated by hydroxyl (OH) is one of the fundamental elements in the prediction of radiation signature of high-altitude and high-speed vehicle. In this work, the OH A{sup 2}Σ{sup +}→X{sup 2}Π ultraviolet emission band behind the bow shock is computed under the experimental condition of the second bow-shock ultraviolet flight (BSUV-2). Four related key issues are discussed, namely, the source of hydrogen element in the high-altitude atmosphere, the formation mechanism of OH species, efficient computational algorithm of trace species in rarefied flows, and accurate calculation of OH emission spectra. Firstly, by analyzing the typical atmospheric model, the verticalmore » distributions of the number densities of different species containing hydrogen element are given. According to the different dominating species containing hydrogen element, the atmosphere is divided into three zones, and the formation mechanism of OH species is analyzed in the different zones. The direct simulation Monte Carlo (DSMC) method and the Navier-Stokes equations are employed to compute the number densities of the different OH electronically and vibrationally excited states. Different to the previous work, the trace species separation (TSS) algorithm is applied twice in order to accurately calculate the densities of OH species and its excited states. Using a non-equilibrium radiation model, the OH ultraviolet emission spectra and intensity at different altitudes are computed, and good agreement is obtained with the flight measured data.« less