INTRODUCTION Severe sepsis is a leading cause of non-coronary death in hospitals across the United States. Early identification and risk stratification in the emergency department (ED) is difficult because there is limited ability to predict escalation of care. In this study we evaluated if a sustained shock index (SI) elevation in the ED was a predictor of short-term cardiovascular collapse, d...

Early detection and management of shock are important in optimizing clinical outcomes. One regional marker, sublingual capnography (SLCO2), is particularly appealing as redistribution of blood flow away from the sublingual mucosa can happen very early in the compensatory phase of hypovolemic shock. Our objective was to test the hypothesis that SLCO2 would detect early hypovolemia in a human lab...

We measured various hemodynamic responses and muscle sympathetic nerve activity (MSNA) in human subjects during a graded lower-body negative pressure (LBNP) protocol to test the hypotheses that: (1) reduced stroke volume (SV) is linearly related to increased MSNA; and (2) the onset of symptoms of impending cardiovascular collapse is associated with hypoadrenergic responses to central hypovolemi...

Sleep apnea-hypopnea syndrome (SAHS) is characterized by recurrent episodes of upper airway collapse, which may be complete (apnea) or partial (hypopnea). The direct consequences of upper airway collapse are falls in oxygen saturation levels and arousals, which are, in turn, responsible for excessive daytime sleepiness and neurological and psychiatric disorders.1,2 The prevalence of SAHS has be...

Circulating angiotensin-II protects the circulation against sudden falls in blood pressure and is generated by the enzymatic action of angiotensin converting enzyme (ACE) on angiotensin-I. The ACE genes have 2 allelic forms, "I" and "D." The "D" genotype has both highest angiotensin-II generation and serum ACE levels compared to "I". 120 patients with IgE-anaphylaxis, 119 healthy controls, and ...

Our current understanding of the pathogenesis of sepsis suggests that bacteria as well as bacterial-derived products activate an uncontrolled network of host-derived mediators such as proinflammatory cytokines (ie, tumor necrosis factor [TNF] and interleukin [IL]-1beta), which can ultimately lead to cardiovascular collapse and death. Despite the potentially important role that TNF and IL-1beta ...

Despite aggressive measures for the treatment of cardiovascular collapse and cardiac arrest, the hypotension associated with these malignant processes usually leads to profound vital-organ ischemia and death. A fundamental therapeutic challenge of such life-threatening processes is the restoration of adequate blood flow to the heart and the brain. However, to maintain adequate forward blood flo...

Systemic capillary leak syndrome (SCLS) is a condition that's caused by the shift of fluid and protein from the intravascular space to the interstitial space as a result of repetitive episodes of capillary hyperpermeability. The pathogenesis of SCLS is still unclear, but there's recently been a report showing this syndrome in association with monoclonal gammopathy. This syndrome can be a fatal ...

The main aim of the present study is to optimize steel moment frames in the framework of performance-based design and to assess the seismic collapse capacity of the optimal structures. In the first phase of this study, four well-known metaheuristic algorithms are employed to achieve the optimization task. In the second phase, the seismic collapse safety of the obtained optimal designs is evalua...