Increased nitric oxide concentrations in the small airway of older normal subjects.

Background: There is a paucity of normal-age stratified data for fraction of exhaled nitric oxide (Feno). Our goal was to obtain normal data for large-airway nitric oxide flux (J'awno) and small-airway and/or alveolar nitric oxide concentration (Cano) in nonsmoking, healthy, adult subjects of various ages.

Methods: In 106 normal volunteer subjects (60 women) aged 55 ± 20 years (mean ± SD), Feno (parts per billion [ppb]) was measured at 50, 100, 150, and 200 mL/s and J'awno (nL/s) and Cano (ppb) were calculated using a two-compartment model with correction for axial nitric oxide (NO) back diffusion.

Central and peripheral airway/alveolar sites of exhaled nitric oxide in acute asthma.

Introduction: Central airway nitric oxide flux (J'(awNO)) and peripheral airway/alveolar nitric oxide concentration (C(ANO)) during asthma exacerbation has not been investigated after correction for axial NO back-diffusion.

Methods: After measuring exhaled NO (fraction of exhaled nitric oxide (F(E)NO); ppb) at 50, 100, 150 and 200 ml/s, J'(awNO) (nl/s) and C(ANO) (ppb) were calculated using the two-compartment model and corrected for axial NO back-diffusion. Fifteen (8 males), non-smoking, patients with moderate-to-severe treated (inhaled corticosteroid (ICS) and inhaled long-acting beta(2)-agonist (LABA)) asthma, age 57+/-13 years (mean+/-SD), were studied at baseline, during exacerbation prior to oral corticosteroid, and during recovery after an 8 day tapering prednisone course.

Th1-Th17 cells mediate protective adaptive immunity against Staphylococcus aureus and Candida albicans infection in mice.

We sought to define protective mechanisms of immunity to Staphylococcus aureus and Candida albicans bloodstream infections in mice immunized with the recombinant N-terminus of Als3p (rAls3p-N) vaccine plus aluminum hydroxide (Al(OH(3)) adjuvant, or adjuvant controls. Deficiency of IFN-gamma but not IL-17A enhanced susceptibility of control mice to both infections. However, vaccine-induced protective immunity against both infections required CD4+ T-cell-derived IFN-gamma and IL-17A, and functional phagocytic effectors.

Multiple sclerosis with initial stroke-like clinicoradiologic features: case report and literature review.

A 17-year-old male presented with sudden onset of persistent focal neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a nonenhancing white matter lesion that appeared hyperintense on fluid-attenuated inversion recovery sequence and diffusion-weighted imaging, while hypointense on apparent diffusion coefficient mapping corresponding to the patient's clinical features. A smaller subclinical lesion was also present.

Antimicrobial agents for complicated skin and skin-structure infections: justification of noninferiority margins in the absence of placebo-controlled trials.

Background: The United States Food and Drug Administration requires clinical trial noninferiority margins to preserve a fraction (eg, 50%) of the established comparator drug's efficacy versus placebo. Lack of placebo-controlled trials for many infections complicates noninferiority margin justification for and, hence, regulatory review of new antimicrobial agents. Noninferiority margin clarification is critical to enable new antimicrobial development.

Severity of hypoalbuminemia predicts response to intradialytic parenteral nutrition in hemodialysis patients.

Background: Intradialytic parenteral nutrition (IDPN) is used infrequently to correct hypoalbuminemia in maintenance hemodialysis (MHD) patients. We hypothesized that the severity of baseline hypoalbuminemia correlates with the success rate of IDPN therapy in MHD patients.

Methods: In a prospective and contemporary cohort of 196 hypoalbuminemic MHD patients who received IDPN through Pentec Health (Boothwyn, PA), predictors of IDPN response were examined using multivariate logistic regression.

Recent advances in the management of mucormycosis: from bench to bedside.

Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data.

Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience.

Objective: The first combined endovascular and surgical approach for thoracoabdominal aortic aneurysm was performed at our institution in 1998. We report a 10-year experience with a hybrid approach to thoracoabdominal aortic pathology.

Methods: Records of all patients undergoing a combined endovascular and surgical approach to thoracoabdominal aortic pathology were reviewed.

Analysis of cell membrane characteristics of in vitro-selected daptomycin-resistant strains of methicillin-resistant Staphylococcus aureus.

Our previous studies of clinical daptomycin-resistant (Dap(r)) Staphylococcus aureus strains suggested that resistance is linked to the perturbations of several key cell membrane (CM) characteristics, including the CM order (fluidity), phospholipid content and asymmetry, and relative surface charge. In the present study, we examined the CM profiles of a well-known methicillin-resistant Staphylococcus aureus (MRSA) strain (MW2) after in vitro selection for DAP resistance by a 20-day serial passage in sublethal concentrations of DAP. Compared to levels for the parental strain, Dap(r) strains exhibited (i) decreased CM fluidity, (ii) the increased synthesis of total lysyl-phosphatidylglycerol (LPG), (iii) the increased flipping of LPG to the CM outer bilayer, and (iv) the increased expression of mprF, the gene responsible for the latter two phenotypes.

Balloon-assisted transarterial embolization of intracranial dural arteriovenous fistulas.

Object: The authors report their preliminary experience using a balloon-assisted technique (BAT) in the transarterial embolization of intracranial dural arteriovenous fistulas (DAVFs).

Methods: The authors reviewed the prospectively collected data obtained in 7 consecutive patients with DAVFs in whom embolization was achieved using transarterially injected Onyx with either the venous or arterial BAT. Procedures were performed at the Division of Interventional Neuroradiology at the University of California at Los Angeles Medical Center between September 2005 and January 2008.

Burnt-out diabetes: impact of chronic kidney disease progression on the natural course of diabetes mellitus.

Many individuals with diabetic nephropathy, the leading cause of chronic kidney disease (CKD) in the United States, progress to stage 5 of CKD and undergo maintenance dialysis treatment. Recent data indicate that in up to one third of diabetic dialysis patients with a presumptive diagnosis of diabetic nephropathy, glycemic control improves spontaneously with the progression of CKD, loss of residual renal function, and the initiation of dialysis therapy, leading to normal-to-low hemoglobin A1c (<6%) and glucose levels, requiring cessation of insulin or other anti-diabetic medications. Potential contributors to this so-called "burnt-out diabetes" include decreased renal and hepatic insulin clearance, a decline in renal gluconeogenesis, deficient catecholamine release, diminished food intake (because of anorexia or diabetic gastroparesis), protein-energy wasting (with resultant loss of weight and body fat), and the hypoglycemic effects of dialysis treatment.

Economic burden of mucormycosis in the United States: can a vaccine be cost-effective?

Mucormycosis is a life-threatening infection which causes unacceptably high morbidity and mortality despite treatment. Therefore, a vaccine to prevent mucormycosis is desirable. A major barrier to developing an anti-mucormycosis vaccine is the perception that such a vaccine would not be cost-effective to deploy because the disease is rare.

A brief history of pulmonary rehabilitation.

Pulmonary rehabilitation is widely accepted as effective therapy for patients with chronic obstructive pulmonary disease (COPD). This paper presents a brief (and somewhat subjective) history of pulmonary rehabilitation, and stresses the development of the exercise component. Until the middle of the 20th century, patients with COPD were advised to avoid the dyspnea that activity brings.

The antifungal vaccine derived from the recombinant N terminus of Als3p protects mice against the bacterium Staphylococcus aureus.

Vaccination with the recombinant N terminus of the candidal adhesin Als3p (rAls3p-N) protects mice from lethal candidemia. Candidal Als3p also is structurally similar to the microbial surface components recognizing adhesive matrix molecule adhesin, clumping factor, from Staphylococcus aureus. To determine the potential for cross-kingdom vaccination, we immunized mice with rAls3p-N or negative control proteins and challenged them via the tail vein with S.

Factors associated with the steep increase in late-midlife stroke occurrence among US men.

Background: Data on recent stroke prevalence rates among middle-aged men in the United States indicate that men aged 55 to 64 years are 3 times more likely than men aged 45 to 54 years to have experienced a stroke. We aimed to determine potential risk factors that may contribute to this steep increase in late midlife stroke occurrence.

Methods: We analyzed the National Health and Nutrition Examination Survey 1999 to 2004 data sets, assessing stroke prevalence, predictors of stroke occurrence, and vascular risk factors in men across their midlife years.

Serum calcium as prognosticator in ischemic stroke.

Background And Purpose: Calcium (Ca(2+)) plays a role in the cellular and molecular pathways of ischemic neuronal death. We evaluated the impact of both early and delayed Ca(2+) levels on clinical outcomes from acute ischemic stroke.

Methods: The relations between blood calcium level obtained early (<4.

Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis.

Background: It has been axiomatic that echinocandins (e.g., caspofungin) are ineffective against mucormycosis.

Association of serum bilirubin with ischemic stroke outcomes.

Background: Higher levels of serum bilirubin may offer a therapeutic advantage in oxidative stress-mediated diseases, but may also simply reflect intensity of oxidative stress. Little is known about the role of bilirubin in stroke. We assessed the relation of serum bilirubin levels with clinical presentation and outcomes among patients hospitalized with ischemic stroke.

Transarterial embolization of clival dural arteriovenous fistulae using liquid embolic agents.

Objective: Dural arteriovenous fistulae (DAVFs) rarely involve the clivus. This report examines the clinical presentation, angiographic findings, endovascular management, and outcome of clival DAVFs. Particular attention was given to safety and efficacy of transarterial embolization using liquid embolic agents.

Dynamic surface activity of a fully synthetic phospholipase-resistant lipid/peptide lung surfactant.

Background: This study examines the surface activity and resistance to phospholipase degradation of a fully-synthetic lung surfactant containing a novel diether phosphonolipid (DEPN-8) plus a 34 amino acid peptide (Mini-B) related to native surfactant protein (SP)-B. Activity studies used adsorption, pulsating bubble, and captive bubble methods to assess a range of surface behaviors, supplemented by molecular studies using Fourier transform infrared (FTIR) spectroscopy, circular dichroism (CD), and plasmon resonance. Calf lung surfactant extract (CLSE) was used as a positive control.

Long-term results of bone marrow transplantation in complete DiGeorge syndrome.

Background: Therapeutic options for DiGeorge syndrome (DGS) with profound T-cell deficiency are very limited. Thymic transplantation has shown promising results but is not easily available. Hematopoietic cell transplantation (HCT) has been successful in restoring immune competence in the short term.

Are racial differences in antihypertensive responsiveness reflected in usage after stroke?

Objective: We sought to evaluate whether differential antihypertensive responsiveness in blacks is reflected in discharge antihypertensive prescription patterns among patients hospitalized with an ischemic cerebrovascular event.

Methods: We analyzed use of discharge antihypertensive medications among patients hospitalized with an ischemic cerebrovascular event in the California Acute Stroke Prototype Registry, examining rates in black patients compared with all other races combined. Generalized estimating equations were used to identify factors independently associated with receipt of any antihypertensive medication overall and with use of specific types of antihypertensives.