Mycoplasma pneumoniae
(
M. pneumoniae
) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation ...period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children,
M. pneumoniae
is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant
M. pneumoniae
-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe
M. pneumoniae
-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe
M. pneumoniae
- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood–brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in
M. pneumoniae
disease, which is commonly self-limited.
The co-ordinated polarity of cells within the plane of a single tissue layer (planar polarity) is intensively studied in animal epithelia but has only recently been systematically analysed in plants. ...The polar positioning of hairs in the root epidermis of Arabidopsis thaliana provides an easily accessible system for the functional dissection of a plant-specific planar polarity. Recently, mutants originally isolated in genetic screens for defects in root hair morphogenesis and changes in the sensitivity to or the production of the plant hormones auxin and ethylene have identified players that contribute to polar root hair placement. Here, we summarize and discuss recent progress in research on polar root hair positioning from studies in Arabidopsis.
Objectives
Sleep-disordered breathing represents a risk factor for cardiovascular morbidity and mortality and negatively affects short-term and long-term outcome after an ischemic stroke or transient ...ischemic attack. The effect of continuous positive airways pressure in patients with sleep-disordered breathing and acute cerebrovascular event is poorly known. The SAS CARE 1 study assesses the effects of sleep-disordered breathing on clinical evolution, vascular functions, and markers within the first three-months after an acute cerebrovascular event. The SAS CARE 2 assesses the effect of continuous positive airways pressure on clinical evolution, cardiovascular events, and mortality as well as vascular functions and markers at 12 and 24 months after acute cerebrovascular event.
Methods
SAS CARE 1 is an open, observational multicenter study in patients with acute cerebrovascular event acutely admitted in a stroke unit: a sample of 200 acute cerebrovascular event patients will be included. Vascular functions and markers (blood pressure, heart rate variability, endothelial function by peripheral arterial tonometry and specific humoral factors) will be assessed in the acute phase and at three-months follow-up. SAS CARE 2 will include a sample of patients with acute cerebrovascular event in the previous 60–90 days. After baseline assessments, the patients will be classified according to their apnea hypopnea index in four arms: non-sleep-disordered breathing patients (apnea hypopnea index <10), patients with central sleep-disordered breathing, sleepy patients with obstructive apnea hypopnea index ≥20, which will receive continuous positive airways pressure treatment, nonsleepy patients with obstructive sleep-disordered breathing (apnea hypopnea index ≥20), which will be randomized to receive continuous positive airways pressure treatment or not.
Conclusions
The SAS CARE study will improve our understanding of the clinical sleep-disordered breathing in patients with acute cerebrovascular event and the feasibility/efficacy of continuous positive airways pressure treatment in selected patients with acute cerebrovascular event and sleep-disordered breathing.
Background and purpose
Little data exists about longterm outcome, quality of life (QOL) and its predictors after spontaneous cervical artery dissections (sCAD).
Methods
Clinical and radiological data ...of 114 patients with sCAD were collected prospectively. Six patients died within 3 months, the remaining 108 were contacted after a mean of 1498 days (range: 379–3455), 99 survivors (92 %) replied. QOL, assessed with the stroke-specific QOL scale (SSQOL), and functional abilities, measured with modified Rankin Scale (mRS) were compared, and predictors of QOL were analyzed. Subgroup analyses were performed for patients with ischemic stroke, those with isolated local symptoms or transient ischemic symptoms and those without significant disabilities (mRS 0–1) at follow-up.
Results
Seventy-one of 99 patients (72 %) had no significant disability, but only 53 (54 %) reported a good QOL (SS-QOL ≥ 4). Compared to the self-rated premorbid QOL of all patients, SS-QOL was impaired after sCAD (p < 0.001); impairment of QOL was observed in patients with ischemic stroke (p < 0.001), in patients with isolated local or transient ischemic symptoms (p < 0.038) and those without significant disabilities at follow-up (p = 0.013). Nevertheless, low mRS was associated with better overall QOL (Kendall’s tau > 0.5). High National Institute of Health Stroke Scale score on admission and higher age were independent predictors of impaired QOL (p < 0.05).
Conclusion
QOL is impaired in almost half of long-term survivors after sCAD, even in patients with local or transient symptoms or without functional disability. Impairment of QOL is a surprisingly frequent long-term sequela after sCAD and deserves attention as an outcome measure in these patients.
The interaction of basal processes with the subglacial drainage system is a critical issue in understanding glacier dynamics. Since the recognition that many glaciers and ice masses overlie soft ...sediments rather than hard bedrock, much research has been undertaken to investigate how mechanical and hydrological conditions of a deformable substrate control the coupling at the ice–bed interface and thus affect fast ice flow and glacier surging.
In research undertaken on Trapridge Glacier, a small surge-type glacier in the St. Elias Mountains, Yukon Territory, Canada, we have combined extensive field investigations using novel measurement techniques and theoretical modelling to study hydro-mechanical coupling processes. Measurements of subglacial water pressure indicate that the basal water system can be dramatically inhomogeneous, both spatially and temporally. Since ice–bed coupling is strongly influenced by subglacial water pressure, the stresses at the bed are also markedly heterogeneous and are expected to form a patchwork distribution which mimics the pressure distribution of the basal water system. This heterogeneity in the stress field at the ice–bed interface introduces a pronounced variability to the basal motion mechanics. As such, basal sliding and subglacial sediment deformation are not steady and continuous processes. Instead, the variability of the subglacial water system leads to a spatial and temporal interplay of increased ice–bed coupling at low water pressures at one site or time with ice–bed decoupling during rising water pressures at other sites or times. Thus, on the one hand there is downglacier shear deformation of the bed and accumulation of elastic strain in ice and sediment, while on the other hand there is enhanced slip-sliding of the glacier and upglacier shear motion of the bed due to an elastic relaxation of the sediment.
The mechanical interaction between a glacier and subglacial sediment can be observed using an instrumented rod that we refer to as the UBC ploughmeter. For clast-rich sediments, the rate of collision ...between clasts and a rod dragged through these sediments should be related to the glacier sliding rate. By assuming that proglacial measurements of sediment granulometry represent the subglacial granulometry of Trapridge Glacier, Yukon Territory, Canada, we have used ploughmeter results to obtain an estimated sliding rate of ∼45 mm d−1, in good agreement with known rates. In addition, for a subglacial material treated as a solid-liquid dispersion having a linear viscous rheology, the force of collision experienced by the rod should be proportional to the effective sediment viscosity. Our estimate of ∼2.0 × 1010 Pa s agrees well with previously, derived values.
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