Arterial gas embolism in a Special Forces combat dive student during free-swimming ascent training: A case study.

Free-swimming ascent is taught to military divers and submariners as a self-rescue technique in the event of an emergency or a planned covert surfacing technique. Although this technique is infrequently used, it is considered a high-risk training event due to the risk and subsequent high morbidity and mortality of pulmonary barotrauma from pulmonary over-inflation injury. This case study will illustrate an example of a pulmonary overinflation injury and arterial gas embolism in an Army Special Forces Combat Diver who had no violation of technique while conducting a 50 foot free-swimming ascent to training standards and under the supervision of experienced Dive Supervisors. Additionally, the issue of allowing such individuals to return to diving is discussed.

Nonpharmacological prevention of hospital-acquired pneumonia.

Hospital-acquired pneumonia (HAP) is the most common nosocomial infection occurring among mechanically ventilated patients. The benefits associated with the systematic prevention of HAP include fewer infections with high-risk antibiotic-resistant bacteria, lower rates of hospital mortality, reduced medical care costs, and shorter hospital lengths of stay. Unfortunately, many hospitals do not have an organized approach to the prevention of HAP. This review will describe the nonpharmacological approaches available for the prevention of HAP. It should help clinicians to design their own strategies for the prevention of this important hospital-acquired infection.

Murine antibody response to intranasally administered enterotoxigenic Escherichia coli colonization factor CS6.

Enterotoxigenic Escherichia coli (ETEC) is the most common cause of bacterial diarrhea worldwide and is an important cause of infant morbidity and mortality in developing nations. ETEC colonization factors (CF) are virulence determinants that appear to be protective antigens in humans and are the major target of vaccine efforts. One of the most prevalent CF, CS6, is expressed by about 30% of ETEC worldwide. This study was designed to compare the immunogenicity between encapsulated CS6 (CS6-PLG) and unencapsulated CS6. Recombinant CS6 was purified and encapsulated in biodegradable poly(DL-lactide-co-glycolide) (PLG) microspheres using current Good Manufacturing Practices (cGMP). CS6-PLG and CS6 were administered intranasally (IN) to BALB/c mice in three vaccinations 4 weeks apart. Enzyme linked immunosorbent assay (ELISA) was used to measure the anti-CS6 response in serum and mucosal secretions following each of the three inoculations. Mice vaccinated with two or three doses of CS6-PLG demonstrated a significantly greater rise in serum anti-CS6 IgG and mucosal IgA titer values than those immunized with two or three doses of CS6 alone. Three doses of CS6-PLG led to anti-CS6 serum IgG and mucosal IgA titer values 14-fold and 4.4-fold greater, respectively, than three doses of CS6 (P<0.02). IN administered CS6 to mice is safe and highly immunogenic either alone or when encapsulated in microspheres. PLG microsphere encapsulation of CS6 significantly augments the antibody response to that antigen when administered to a mucosal surface.