Mussismilia braziliensis White Plague Disease Is Characterized by an Affected Coral Immune System and Dysbiosis.

Infectious diseases are one of the major drivers of coral reef decline worldwide. White plague-like disease (WPL) is a widespread disease with a complex etiology that infects several coral species, including the Brazilian endemic species Mussismilia braziliensis. Gene expression profiles of healthy and WPL-affected M. braziliensis were analyzed in winter and summer seasons. The de novo assembly of the M. braziliensis transcriptome from healthy and white plague samples produced a reference transcriptome containing 119,088 transcripts. WPL-diseased samples were characterized by repression of immune system and cellular defense processes. Autophagy and cellular adhesion transcripts were also repressed in WPL samples, suggesting exhaustion of the coral host defenses. Seasonal variation leads to plasticity in transcription with upregulation of intracellular signal transduction, apoptosis regulation, and oocyte development in the summer. Analysis of the active bacterial rRNA indicated that Pantoea bacteria were more abundant in WPL corals, while Tistlia, Fulvivirga, and Gammaproteobacteria Ga0077536 were more abundant in healthy samples. Cyanobacteria proliferation was also observed in WPL, mostly in the winter. These results indicate a scenario of dysbiosis in WPL-affected M. braziliensis, with the loss of potentially symbiotic bacteria and proliferation of opportunistic microbes after the start of the infection process.

Acupuncture for the relief of cancer-related breathlessness.

The palliation of cancer-related breathlessness is challenging and complex. An open pilot study was conducted, exploring the safety and efficacy of acupuncture in 20 patients who were breathless at rest and whose breathlessness was directly related to primary or secondary malignancy. Sternal and LI4 acupuncture points were used. Outcome measures included pulse, respiratory rate, oxygen saturation and patient-rated visual analogue scales of breathlessness, pain, anxiety and relaxation. At each time point the mean values of the variables were calculated and compared to their pretreatment levels (Student's t-test). Seventy per cent (14/20) of patients reported marked symptomatic benefit from treatment; there were significant changes in VAS scores of breathlessness, relaxation and anxiety at least up to 6 hours post acupuncture which were measured to be maximal at 90 minutes (p < 0.005, p < 0.001, respectively). There was a significant reduction in respiratory rate, which was sustained for 90 minutes post acupuncture (p < 0.02). The therapeutic value of acupuncture in the management of breathlessness requires further evaluation.

Measles pneumonia in the critically ill child: application of alternative ventilation strategies.

Measles pneumonia is a life-threatening complication in children infected with the measles virus. The increased number of reported cases over the last several years suggests a need for heightened awareness of the complication among pediatric critical care nurses. Application of alternative ventilation strategies in the critical care setting continues to be explored in children with ARDS refractory to more conventional ventilation support, because the mortality and morbidity associated with ARDS in children remain high. Patients who present with diffuse, bilateral lung injury, such as in measles pneumonia, may be candidates for alternative ventilation strategies. Few investigators have studied alternative ventilation strategies in the pediatric ICU setting. Therefore, nursing research related to the impact of nursing interventions during alternative ventilation strategies is needed. Specifically, evaluation of ET suctioning practices and other interventions that influence oxygen delivery and consumption are necessary to plan effective care during alternative ventilation strategies and improve patient outcome. Prevention of measles pneumonia is clearly the preferred "treatment." Preventive healthcare is paramount in providing optimal care for children. However, until we can address the environmental factors that predispose children to communicable diseases such as measles, critical care nurses must be knowledgeable about the assessment and management of measles pneumonia.

Patient advocacy in palliative care.

Advocacy is a contentious and topical issue and there is continued debate as to whether a nurse can ever truly represent patients' views and interests. This article will address this argument with particular reference to palliative care.

Passive euthanasia in palliative care.

Passive euthanasia is invariably practised in palliative care. This article aims to address the legal, moral and ethical implications of not hydrating dying patients and presents the results of a questionnaire assessing doctors' attitudes.