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Hydrogen peroxide levels were measured in the breath condensate of 43 patients receiving mechanical ventilation. In 16 patients the mean breath condensate peroxide level was 1.68 +/- 0.35 mumol/l on the day they met diagnostic criteria for adult respiratory distress syndrome (ARDS). The peak breath condensate peroxide level in the 27 patients in whom ARDS did not develop was significantly lower (0.34 +/- 0.08 mumol/l). Plasma lysozyme, a measure of in-vivo neutrophil turnover, was significantly higher in ARDS than in non-ARDS patients (9.2 +/- 2.2 U/ml v 3.4 +/- 1.1 U/ml). These findings support the hypothesis that neutrophil activation and oxidant production are involved in the pathogenesis of ARDS.

Introduction & Hypothesis Urinary incontinence (UI) is common and the relationship between its subtypes is complex. Our objective was to describe the natural history and predictors of incontinence subtypes, Stress, Urgency and Mixed, in mid-aged and older U.S. women. We hypothesized that past UI subtype history predicted future UI subtype status and sought to determine the extent to which this occurred. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women ≥50 in the 2004–2010 Health and Retirement Study database. Mixed, Stress, Urgency incontinence prevalence (2004,2006,2008,2010) and 2-year cumulative incidence and remissions (2004–6,2006–8 2008–10) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable model to determine predictors for incontinence subtype occurrence in 2010. Results Prevalence of each subtype in this population (median age 63–66) was 2.6%–8.9%. Subtype incidence equaled 2.1–3.5% and remissions for each varied between 22.3–48.7%. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, functional limitations. Compared to White women, Black women had decreased odds of incident Stress Incontinence, Hispanic women had increased odds of Stress Incontinence remission. Age 80–90 and severe obesity predicted incident Mixed Incontinence. Functional limitations predicted Mixed and Urgency Incontinence. The strongest predictor of incontinence subtypes was incontinence subtype history. Presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence [Odds Ratio (OR) Stress Incontinence=30.7, Urgency OR=47.4, Mixed OR=42.1]. Conclusions Although remissions were high, prior history of incontinence subtypes predicted recurrence. Incontinence status is dynamic but tends to recur over the longer term.

Background Treatment of urgency urinary incontinence has focused on pharmacologically treating detrusor overactivity. Recent recognition that altered perception of internal stimuli (interoception) plays a role in urgency urinary incontinence suggests that exploration of abnormalities of brain function in this disorder could lead to better understanding of urgency incontinence and its treatment. Objectives 1) To evaluate the relationship between bladder filling, perceived urgency and activation at brain sites within the interoceptive network in urgency urinary incontinence 2) To identify coactivation of other brain networks that could affect interoception during bladder filling in urgency incontinence 3) To demonstrate interaction between these sites prior to bladder filling by evaluating their resting state connectivity Study Design We performed an observational cohort study using functional magnetic resonance imaging to compare brain function in 53 women with urgency urinary incontinence and 20 Controls. Whole-brain voxel-wise ANCOVAs were performed to examine differences in functional brain activation between groups during a task consisting of bladder filling, hold (static volume) and withdrawal phases. The task was performed at three previously established levels of baseline bladder volume, the highest exceeding strong desire to void volume. All women continuously rated their urge on a 0–10 point Likert scale throughout the task and a mixed measures ANOVA was used to test for differences in urge ratings. Empirically derived regions of interest from analysis of activation during the task were used as seeds for examining group differences in resting state functional connectivity. Results In both urgency urinary incontinent participants and Controls changes in urge ratings were greatest during bladder filling initiated from a high baseline bladder volume and urgency incontinent participants’ rating changes were greater than Controls. During this bladder filling phase urgency incontinent participant’s activation of the interoceptive network was greater than Controls, including in the left insula and the anterior and middle cingulate cortex. Urgency Incontinent Participant’s activation was also greater than Controls at sites in the Ventral Attention Network and Posterior Default Mode Network. Urgency incontinent participant’s connectivity was greater than Controls between a middle cingulate seed point and the Dorsal Attention Network, a “top down” attentional network. Control connectivity was greater between the mid-cingulate seed point and the Ventral Attention Network, a “bottom up” attentional network, Conclusions Increasing urge was associated with greater urgency incontinent participant than Control activation of the interoceptive network and activation in networks that are determinants of self-awareness (Default Mode Network) and of response to unexpected external stimuli (Ventral Attention Network). Differences in connectivity between interoceptive networks and opposing attentional networks (Ventra...

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