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Jaafar N, Sharma R, Parkash N, Nolley EP. Decoding Altered Consciousness: An Artery of Percheron Stroke. Cureus 2024; 16:e55797. [PMID: 38586618 PMCID: PMC10999223 DOI: 10.7759/cureus.55797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
The artery of Percheron (AOP) is a unique variant of the thalamic and midbrain perforating arteries. It originates from the P1 branch of the posterior cerebral artery (PCA) and supplies the bilateral paramedian thalami (BPT) along with variable contributions to the rostral midbrain. Four infarction patterns have been identified as a result of an AOP stroke, each associated with varying prognostic outcomes. We present an 89-year-old female with an AOP infarction and discuss the associated symptoms, implicated anatomy, and prognosis.
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Affiliation(s)
- Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Neeraj Parkash
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Eric P Nolley
- Critical Care Medicine, Greater Baltimore Medical Center, Towson, USA
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Nolley EP, Sahetya SK, Hochberg CH, Hossen S, Hager DN, Brower RG, Stuart EA, Checkley W. Outcomes Among Mechanically Ventilated Patients With Severe Pneumonia and Acute Hypoxemic Respiratory Failure From SARS-CoV-2 and Other Etiologies. JAMA Netw Open 2023; 6:e2250401. [PMID: 36626168 PMCID: PMC9856712 DOI: 10.1001/jamanetworkopen.2022.50401] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Early observations suggested that COVID-19 pneumonia had a higher mortality rate than other causes of pneumonia. OBJECTIVE To compare outcomes between mechanically ventilated patients with pneumonia due to COVID-19 (March 2020 to June 2021) and other etiologies (July 2016 to December 2019). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted at the Johns Hopkins Healthcare System among adult patients (aged ≥18 years) with pneumonia who required mechanical ventilation in the first 2 weeks of hospitalization. Clinical, laboratory, and mechanical ventilation data were extracted from admission to hospital discharge or death. EXPOSURES Pneumonia due to COVID-19. MAIN OUTCOMES AND MEASURES The primary outcome was 90-day in-hospital mortality. Secondary outcomes were time to liberation from mechanical ventilation, hospital length of stay, static respiratory system compliance, and ventilatory ratio. Unadjusted and multivariable-adjusted logistic regression, proportional hazards regression, and doubly robust regression were used in propensity score-matched sets to compare clinical outcomes. RESULTS Overall, 719 patients (mean [SD] age, 61.8 [15.3] years; 442 [61.5%] were male; 460 [64.0%] belonged to a minoritized racial group and 253 [35.2%] were White) with severe COVID-19 pneumonia and 1127 patients (mean [SD] age, 60.9 [15.8] years; 586 [52.0%] were male; 459 [40.7%] belonged to a minoritized racial group and 655 [58.1%] were White) with severe non-COVID-19 pneumonia. In unadjusted analyses, patients with COVID-19 pneumonia had higher 90-day mortality (odds ratio, 1.21, 95% CI 1.04-1.41), longer time on mechanical ventilation (subdistribution hazard ratio 0.72, 95% CI 0.63-0.81), and lower compliance (32.0 vs 28.4 mL/kg PBW/cm H2O; P < .001) when compared with those with non-COVID-19 pneumonia. In propensity score-matched analyses, patients with COVID-19 pneumonia were equally likely to die within 90 days as those with non-COVID-19 pneumonia (odds ratio, 1.04; 95% CI, 0.81 to 1.35; P = .85), had similar respiratory system compliance (mean difference, 1.82 mL/cm H2O; 95% CI, -1.53 to 5.17 mL/cm H2O; P = .28) and ventilatory ratio (mean difference, -0.05; 95% CI, -0.22 to 0.11; P = .52), but had lower rates of liberation from mechanical ventilation (subdistribution hazard ratio, 0.81; 95% CI, 0.65 to 1.00) when compared with those with non-COVID-19 pneumonia. Patients with COVID-19 pneumonia had somewhat lower rates of being discharged from the hospital alive at 90 days (subdistribution hazard ratio, 0.83; 95% CI, 0.68 to 1.01) than those with non-COVID-19 pneumonia; however, this was not statistically significant. CONCLUSIONS AND RELEVANCE In this study, mechanically ventilated patients with severe COVID-19 pneumonia had similar mortality rates as patients with other causes of severe pneumonia but longer times to liberation from mechanical ventilation. Mechanical ventilation use in COVID-19 pneumonia should follow the same evidence-based guidelines as for any pneumonia.
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Affiliation(s)
- Eric P. Nolley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarina K. Sahetya
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Chad H. Hochberg
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David N. Hager
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Roy G. Brower
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth A. Stuart
- Bloomberg School of Public Health, Department of Mental Health, Johns Hopkins University, Baltimore, Maryland
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Burnim MS, Wang K, Checkley W, Nolley EP, Xu Y, Garibaldi BT. The authors reply. Crit Care Med 2022; 50:e592-e594. [PMID: 35275595 PMCID: PMC9112511 DOI: 10.1097/ccm.0000000000005530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Michael S Burnim
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric P Nolley
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
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Hochberg CH, Psoter KJ, Sahetya SK, Nolley EP, Hossen S, Checkley W, Kerlin MP, Eakin MN, Hager DN. Comparing Prone Positioning Use in COVID-19 Versus Historic Acute Respiratory Distress Syndrome. Crit Care Explor 2022; 4:e0695. [PMID: 35783548 PMCID: PMC9243245 DOI: 10.1097/cce.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Use of prone positioning in patients with acute respiratory distress syndrome (ARDS) from COVID-19 may be greater than in patients treated for ARDS before the pandemic. However, the magnitude of this increase, sources of practice variation, and the extent to which use adheres to guidelines is unknown.
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Murakami N, Baggett ND, Schwarze ML, Ladin K, Courtwright AM, Goldberg HJ, Nolley EP, Jain N, Landzberg M, Wentlandt K, Lai JC, Shinall MC, Ufere NN, Jones CA, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Solid Organ Transplantation. J Palliat Med 2022; 25:1136-1142. [PMID: 35275707 PMCID: PMC9467633 DOI: 10.1089/jpm.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Solid organ transplantation (SOT) is a life-saving procedure for people with end-stage organ failure. However, patients experience significant symptom burden, complex decision making, morbidity, and mortality during both pre- and post-transplant periods. Palliative care (PC) is well suited and historically underdelivered for the transplant population. This article, written by a team of transplant specialists (surgeons, cardiologists, nephrologists, hepatologists, and pulmonologists), PC clinicians, and an ethics specialist, shares 10 high-yield tips for PC clinicians to consider when caring for SOT patients.
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Affiliation(s)
- Naoka Murakami
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathan D Baggett
- Division of Emergency Medicine, Health Partners Institute/Regions Hospital, St. Paul, Minnesota, USA
| | | | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Andrew M Courtwright
- Department of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilary J Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eric P Nolley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nelia Jain
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kirsten Wentlandt
- Division of Palliative Care, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Lai
- Department of Medicine, University of California, San Francisco, California, USA
| | - Myrick C Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Section of Palliative Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Scully BB, Nolley EP, Bush EL. Palliative care in lung transplantation. Ann Palliat Med 2021; 11:927-935. [PMID: 34118859 DOI: 10.21037/apm-21-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
The role of palliative care in lung transplantation has grown exponentially in the past two decades. From assisting with evaluating and optimizing candidates for transplant, to playing a crucial role in patients requiring extracorporeal cardiopulmonary life support (ECLS) as a bridge to lung transplant, perioperatively, or even during their first year post-transplant, palliative care has been shown to be an effective if underutilized tool in the armamentarium used to care for lung transplant patients. For patients being considered for primary transplantation and for lung transplant recipients, palliative care can decrease symptom burden and help to lessen the psychological distress experienced by patients and family members. For older patients listed for transplant, palliative care can help address cognitive impairment, depression, and frailty. Patients listed for lung re-transplant also benefit from palliative care involvement to address frequent symptom exacerbations, hospitalizations, and higher morbidity and mortality. Even for organ donors and their families, palliative care can facilitate communication and provide support to the family. While palliative care use in lung transplantation may be gradually increasing, further work is necessary to optimally integrate palliative care into lung transplantation. Barriers to lung transplant patients receiving palliative care are multifactorial and include physician, patient, and institutional factors. The potential role of palliative care in every aspect of lung transplantation has made a knowledge of palliative care principles crucial for the lung transplant practitioner. In this review, we will clearly delineate the potential benefit of palliative care for the perioperative lung transplant patient and make an argument for its increased use in this patient population.
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Affiliation(s)
- Brandi Braud Scully
- Division of Thoracic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD, USA
| | - Eric P Nolley
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Errol L Bush
- Division of Thoracic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Metkus TS, Sokoll LJ, Barth AS, Czarny MJ, Hays AG, Lowenstein CJ, Michos ED, Nolley EP, Post WS, Resar JR, Thiemann DR, Trost JC, Hasan RK. Myocardial Injury in Severe COVID-19 Compared With Non-COVID-19 Acute Respiratory Distress Syndrome. Circulation 2020; 143:553-565. [PMID: 33186055 PMCID: PMC7864609 DOI: 10.1161/circulationaha.120.050543] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in coronavirus disease 2019 (COVID-19). We aimed to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared with acute respiratory distress syndrome (ARDS) unrelated to COVID-19. Methods: We included intubated patients with COVID-19 from 5 hospitals between March 15 and June 11, 2020, with troponin levels assessed. We compared them with patients from a cohort study of myocardial injury in ARDS and performed survival analysis with primary outcome of in-hospital death associated with myocardial injury. In addition, we performed linear regression to identify clinical factors associated with myocardial injury in COVID-19. Results: Of 243 intubated patients with COVID-19, 51% had troponin levels above the upper limit of normal. Chronic kidney disease, lactate, ferritin, and fibrinogen were associated with myocardial injury. Mortality was 22.7% among patients with COVID-19 with troponin under the upper limit of normal and 61.5% for those with troponin levels >10 times the upper limit of normal (P<0.001). The association of myocardial injury with mortality was not statistically significant after adjusting for age, sex, and multisystem organ dysfunction. Compared with patients with ARDS without COVID-19, patients with COVID-19 were older and had higher creatinine levels and less favorable vital signs. After adjustment, COVID-19–related ARDS was associated with lower odds of myocardial injury compared with non–COVID-19–related ARDS (odds ratio, 0.55 [95% CI, 0.36–0.84]; P=0.005). Conclusions: Myocardial injury in severe COVID-19 is a function of baseline comorbidities, advanced age, and multisystem organ dysfunction, similar to traditional ARDS. The adverse prognosis of myocardial injury in COVID-19 relates largely to multisystem organ involvement and critical illness.
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Affiliation(s)
- Thomas S Metkus
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lori J Sokoll
- Department of Medicine, and Department of Pathology (L.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andreas S Barth
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew J Czarny
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison G Hays
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles J Lowenstein
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric P Nolley
- Pulmonary and Critical Care Medicine (E.P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S Post
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jon R Resar
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Thiemann
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey C Trost
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rani K Hasan
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
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Affiliation(s)
- Eric P Nolley
- Department of MedicineUniversity of PittsburghPittsburgh, Pennsylvania
| | - Joseph M Pilewski
- Department of MedicineUniversity of PittsburghPittsburgh, Pennsylvania
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Nolley EP, DeSensi R, Nouraie M, Schenker Y, Morrell MR. Characteristics, Trends, and Predictors of Specialty Palliative Care Utilization after Lung Transplantation. J Palliat Med 2019; 22:1092-1098. [PMID: 30964390 DOI: 10.1089/jpm.2018.0560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Lung transplant recipients who experience serious illness could benefit from specialty palliative care (SPC), but evidence suggests that referral has been rare. Objective: Examine the characteristics of post-transplant SPC encounters, utilization trends, and patient characteristics associated with SPC at a center with established SPC services. Design: Retrospective cohort study of SPC utilization by 597 lung transplant recipients transplanted between 2010 and 2015. We collected data on pretransplant demographics and post-transplant SPC encounters, including timing, location, and referral reasons. Cumulative incidence of SPC and patient characteristics associated with SPC were examined by competing risks methods. Utilization in the first two post-transplant years was compared between subcohorts defined by year of transplantation. Results: SPC cumulative incidence was 27% and 43% at one and five years. More than 60% of encounters occurred in the first post-transplant year including 34% during the index transplant hospitalization. Over 90% of encounters occurred in the inpatient setting. The majority of consults were for symptom management. From 2010 to 2015 inpatient utilization in the first two post-transplant years increased from 23% to 42%, and outpatient utilization increased from 2% to 16%. Accounting for increasing utilization, pretransplant SPC and double-lung transplantation were associated with greater incidence of post-transplant SPC. Conclusions: Lung transplant recipients may have palliative care needs early after transplantation. Increasing utilization suggests greater awareness of or changing attitudes about the utility of SPC for lung transplant recipients. Understanding transplant recipients' palliative care needs and transplant physicians' views of SPC is critical to improving the provision of SPC in lung transplantation.
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Affiliation(s)
- Eric P Nolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca DeSensi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mehdi Nouraie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew R Morrell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Nolley EP, Trevino SE, Babcock HM, Kollef MH. A targeted educational intervention to reduce ventilator-associated complications. Am J Infect Control 2016; 44:1406-1407. [PMID: 27238942 DOI: 10.1016/j.ajic.2016.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
The optimal approach for the prevention of ventilator-associated complications (VACs) is currently unknown. A retrospective pre-post intervention analysis was conducted to assess a multifaceted educational intervention targeting the most common causes for VACs and VAC risk factors. Results indicated that the addition of this intervention to existing infection control and treatment protocols did not demonstrate a decrease in VAC occurrence or duration of mechanical ventilation.
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Fountain SB, Rowan JD, Kelley BM, Willey AR, Nolley EP. Adolescent exposure to nicotine impairs adult serial pattern learning in rats. Exp Brain Res 2008; 187:651-6. [PMID: 18478215 DOI: 10.1007/s00221-008-1346-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/04/2008] [Indexed: 11/28/2022]
Abstract
In the present study investigating the effects of adolescent nicotine exposure on adult serial pattern learning, adolescent rats received daily i.p. injections of either 1.0 mg/kg nicotine or saline for 5 days per week for 5 weeks beginning on postnatal day 25 (P25), then were allowed 35 days drug free. Rats then began training on P95 as adults on a 24-element serial pattern composed of eight 3-element chunks. Adolescent exposure to 1.0 mg/kg nicotine produced persistent retardation of learning for the first element of each 3-element chunk of the pattern, that is, for chunk boundary elements, and transient retardation of learning for elements 2 and 3 of each chunk of the pattern, that is, for the within-chunk elements. Deficits at chunk boundaries were interpreted as deficits of phrasing cue discrimination learning whereas deficits for learning responses for elements within-chunks (elements 2 and 3 of chunks) were interpreted as deficits of rule learning. These results indicate that the effects of adolescent nicotine exposure on adult learning and cognitive capacity deserve further scrutiny.
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Affiliation(s)
- Stephen B Fountain
- Department of Psychology, Kent State University, Kent, OH, 44242-0001 USA.
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Abstract
Traumatic CNS injury activates and mobilizes resident parenchymal microglia (MG), which rapidly accumulate near injured neurons where they transform into phagocytes. The mechanisms underlying this rapid 'homing' in situ are unknown. Using time-lapse confocal imaging in acutely excised neonatal hippocampal slices, we show that rapid accumulation of MG near somata of injured pyramidal neurons in the stratum pyramidale (SP) results from directed migration from tissue regions immediately adjacent to (<200 microm from) the SP. Time-lapse sequences also reveal a 'spreading activation wave' wherein MG situated progressively farther from the SP begin to migrate later and exhibit less directional migration toward the SP. Because purines have been implicated in MG activation and chemotaxis, we tested whether ATP/ADP released from injured pyramidal neurons might account for these patterns of MG behavior. Indeed, application of apyrase, which degrades extracellular ATP/ADP, inhibits MG motility and homing to injured neurons in the SP. Moreover, bath application of exogenous ATP/ADP disrupts MG homing by inducing directional migration toward the slice exterior and away from injured neurons. These results indicate that extracellular ATP/ADP is both necessary and sufficient to induce directional migration and rapid homing of neonatal MG to injured neurons in situ. Rapid, ATP/ADP-dependent MG homing may promote clearance of dead and dying cells and help limit secondary damage during the critical first few hours after neuronal injury.
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Affiliation(s)
- Dana Kurpius
- Department of Biological Sciences, The University of Iowa, Iowa City, Iowa 52242-1324, USA
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Nolley EP, Kelley BM. Adolescent reward system perseveration due to nicotine: studies with methylphenidate. Neurotoxicol Teratol 2006; 29:47-56. [PMID: 17129706 DOI: 10.1016/j.ntt.2006.09.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 09/22/2006] [Accepted: 09/24/2006] [Indexed: 12/13/2022]
Abstract
Previous data suggests adolescent nicotine exposure permanently disrupts reward systems. Behavioral pharmacological methods were used to assess the effects of adolescent nicotine exposure on methylphenidate (MPD) sensitivity and reward from adolescence to adulthood. For experiment one, testing was performed on adult mice exposed to nicotine (0.3 and 3.0 mg/kg, SC, M-F, b.i.d.) or saline during adolescence (PND 25-57). After a 28-day drug-free, time-off period, the locomotor effects (30 min, 30 cm traveled) of MPD (5, 10, 20, and 40 mg/kg, IP) were measured. Thereafter, mice underwent condition-place-preference testing (CPP). MPD (20 mg/kg) was paired with the subject's non-preferred side and saline with the preferred side. Conditioning sessions were conducted for 8 days with a drug-free post-test on the day following the final conditioning session. A second experiment was conducted to determine if adolescent mice respond differently to MPD compared to adult mice. The study compared adolescent mice (PND 25-46) to adult mice (PND 77-98) using identical MPD testing procedures as in experiment one. Adult subjects exposed to nicotine during adolescence behaved remarkably similar to adolescent subjects receiving only MPD. Both nicotine exposed subjects and naïve adolescents exhibited increased response to MPD's motor activating effects and a decreased response to MPD's rewarding effects. Taken together it appears that adolescent nicotine exposure retards the development of reward systems, thus, maintaining an adolescent state indefinitely, which could result in increased vulnerability to substance abuse problems throughout adulthood.
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Affiliation(s)
- Eric P Nolley
- Department of Psychology, Bridgewater College, Bridgewater, Virginia 22812, USA
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