Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves.

INTRODUCTION: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) has emerged as an important treatment method for patients with severe chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are a frequent complication following BLVR with EBV. However, there is no consensus on the prevention of AECOPD. OBJECTIVES: Our study aims to compare the outcomes of different prophylactic measures on the occurrence of AECOPD after BLVR with EBV. METHODS: We conducted a multicenter, retrospective study of patients who underwent BLVR with EBV at six different institutions. Emphasis was directed towards the specific practices aimed at preventing AECOPD: antibiotics, steroids, antibiotics plus steroids, or no prophylaxis. Subgroups were compared, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. RESULTS: A total of 170 patients were reviewed. The rate of AECOPD was 21.2% for the full cohort. Patients who received prophylaxis had a significantly lower rate of AECOPD compared with those who did not (16.7% vs. 46.2%; p = 0.001). The rate was lowest in patients who received antibiotics alone (9.2%). There was no significant difference in the rate of AECOPD between patients who received steroids alone or antibiotics plus steroids, compared with the other subgroups. The OR for AECOPD was 4.3 (95% CI: 1.8-10.4; p = 0.001) for patients not receiving prophylaxis and 3.9 (95% CI: 1.5-10.1; p = 0.004) for prophylaxis other than antibiotics alone. CONCLUSIONS: Administration of antibiotics after BLVR with EBV was associated with a lower rate of AECOPD. This was not observed with the use of steroids or in combination with antibiotics.

A Case of Invasive Pneumococcal Infection with Septic Shock and Rare Complications.

Invasive pneumococcus is a serious illness with potentially devastating outcomes. A 64-year-old female with a medical history of psoriatic arthritis and diabetes was transferred from an outside hospital for ventilator dependent respiratory failure and altered mental status. She initially presented with worsening back pain and was found to have leukocytosis with bandemia and acute renal failure but she was in septic shock upon arrival to our tertiary care center. Her blood cultures grew Streptococcus pneumoniae and MRI of the brain revealed pus within the posterior lateral ventricles and multiple infarcts. MRI of the spine revealed a psoas abscess. Transesophageal echocardiogram revealed mitral valve vegetation and her right eye developed endogenous endophthalmitis. She was treated with intravenous and intravitreal antibiotics and underwent drainage of the abscess with no improvement in mental status. Repeat imaging revealed multiple new thalamic, basal ganglia, and parietal lobe infarcts likely from septic emboli. After a protracted ICU stay, the patient's family opted for comfort care. The incidence of invasive pneumococcal infections has declined rapidly since the advent of antibiotics and vaccines. With the growing incidence of antibiotic resistance as well as the emergence of new immunomodulating drugs for various pathologies, there is a concern that invasive infections will reemerge. Ventriculitis and endogenous endophthalmitis are very rare complications of pneumococcal bacteremia.

Thermal acclimation in rainbow smelt, Osmerus mordax, leads to faster myotomal muscle contractile properties and improved swimming performance.

Rainbow smelt (Osmerus mordax) display an impressive ability to acclimate to very cold water temperatures. These fish express both anti-freeze proteins and glycerol in their plasma, liver, muscle and other tissues to avoid freezing at sub-zero temperatures. Maintenance of glycerol levels requires active feeding in very cold water. To understand how these fish can maintain activity at cold temperatures, we explored thermal acclimation by the myotomal muscle of smelt exposed to cold water. We hypothesized that cold-acclimated fish would show enhanced swimming ability due to shifts in muscle contractile properties. We also predicted that shifts in swimming performance would be associated with changes in the expression patterns of muscle proteins such as parvalbumin (PV) and myosin heavy chain (MyHC). Swimming studies show significantly faster swimming by smelt acclimated to 5°C compared to fish acclimated to 20°C when tested at a common test temperature of 10°C. The cold-acclimated fish also had faster muscle contractile properties, such as a maximum shortening velocity (Vmax) almost double that of warm-acclimated fish at the same test temperature. Cold-acclimation is associated with a modest increase in PV levels in the swimming muscle. Fluorescence microscopy using anti-MyHC antibodies suggests that MyHC expression in the myotomal muscle may shift in response to exposure to cold water. The complex set of physiological responses that comprise cold-acclimation in smelt includes modifications in muscle function to permit active locomotion in cold water.