Biomarkers in the prognostic evaluation of ischemic stroke: Is there benefit in the measurements of TREM-1 and TREM-2 in the acute phase?

Background and purposeTriggering receptors expressed on myeloid cells 1 and 2 (TREM-1 and TREM-2) are cell surface receptors important for modulation of microglia immune response. In this study, we evaluate serum levels of TREM-1 and TREM-2 as potential biomarkers in acute ischemic stroke (AIS).Material and methodsProspective cohort study of 50 patients with AIS admitted at our hospital. Serum TREM-1 and TREM-2 was evaluated within 24 h of the acute event and on the third and fifth days after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times and at the time of hospital discharge.ResultsTREM-1 and TREM-2 levels were elevated in stroke. TREM-1, but not TREM-2, exhibited correlations with NIHSS and mRS within 24 h (NIHSS and TREM-1: r_S = 0.31, p = 0.029; mRS and TREM-1: r_S = 0.32, p = 0.023). The serum level of TREM-1 within 24 h correlated with the neurological outcomes at hospital discharge (NIHSS and TREM-1: p = 0.021; mRS and TREM-1: p = 0.049). The serum concentrations of TREM-1 protein within 24 h after stroke was significantly higher in patients with poor outcome (mRS > 2) at hospital discharge (p = 0.021). After Exact Logistic Regression, large segmental stroke (O.R. = 4.14; 95CI = 1.07–16.09; p = 0.040) and initial sTREM levels (O.R. = 1.02; 95CI 1.00–1.04; p = 0.045) remained independent prognostic factors for AIS poor outcome (mRS > 2).ConclusionIn our study, TREM-1 and TREM-2 were significantly increased in AIS. Early elevation of TREM-1 correlated with stroke severity and it was an independent prognostic factor for stroke outcome.     

糖尿病患者围手术期血糖管理的证据总结

目的 收集国内外糖尿病患者围手术期血糖管理的证据,并对最佳证据进行总结。 方法 2019年11月,系统检索美国国立指南库、苏格兰校际指南网、加拿大安大略注册护理协会网站、英国国家卫生与临床优化研究所网站、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）网站、Cochrane Library、PubMed、Web of Science、国际糖尿病联盟网站、美国糖尿病协会网站、加拿大糖尿病协会网站、澳大利亚糖尿病协会网站、维普、中国知网、万方数据库和中国生物医学文献数据库等数据库和网站,纳入关于糖尿病患者围手术期血糖管理的证据,包括指南、系统评价、最佳实践信息册、证据总结、专家共识等。检索时限为建库至2019年11月29日。由6名研究者对文献质量进行独立评价,结合专业人士的判断,对符合标准的文献进行资料提取。 结果 共纳入9篇文献,其中指南6篇、专家共识2篇、系统评价1篇。最佳证据包括血糖管理原则、血糖监测频次、血糖控制目标、控糖用药管理4个类别,共33条证据。 结论 证据应用人员需结合医院特点和临床实践,有针对性地选择最佳证据,以减少糖尿病患者血糖异常事件、降低术后切口感染、加速术后切口愈合时间。     

Unidentified Bacterial Microorganisms Entrapped Within Blood Capillary Spaces of Tissue From Different Epidemiological Types of Kaposi's Sarcoma

Tissue specimens of different epidemiological types of Kaposís sarcoma (KS) from various geographical regions were investigated by transmission electron microscopy. Freshly fixed KS biopsies originated from 9 German patients: 3 classic KS cases, 5 AIDS-associated KS cases, and 1 atypical classic KS case. Additionally, KS autopsy material from the brain of a German AIDS patient was examined. Further biopsies came from 29 Ugandan patients: 16 endemic KS cases and 13 AIDS-associated KS cases. While investigating the ultrastructure, we discovered relatively small-sized bacterial microorganisms within blood capillary spaces of tumor tissue from 5 KS cases of different epidemiological type. The microorganisms often occurred in clusters. They were of coccoid-bacillary form and limited by a wrinkled multilayered cell wall. Many of them were encapsulated. They were not observed outside of the capillary lumen. The bacterial structures were often seen attached to capillary endothelial cells, which sometimes showed blistering into the capillary lumen. The observed bacterial microorganisms obviously represented agents of a bloodstream infection and must have been entrapped and accumulated within capillary spaces of KS tissue. The bacteria, which had an almost identical morphology in all 5 KS cases, could not be identified. If they are of pathogenic significance, it remains unknown.     

Phagocytosis of Hemozoin (Native and Synthetic Malaria Pigment), and Plasmodium falciparum Intraerythrocyte-Stage Parasites by Human and Mouse Phagocytes

Hemozoin, the detoxification product of hemoglobin heme, piles up as electron-dense material in the food vacuole (FV) of intraerythrocytic malaria parasites (malaria pigment). In infected individuals, pigment is internalized by both circulating and resident phagocytes, thus modulating their functions. Synthetic beta-hematin, prepared in vitro from hematin (ferriprotoporphyrin IX hydroxide) in acidic condition, is spectroscopically identical to hemozoin. In this electron microscopy study, native and synthetic hemozoin also prove to be morphologically indistinguishable (large polygonal crystals with apparent transverse banding) and to undergo the same process when internalized by phagocytes (primarily a direct uptake of crystals, similar to what is described for asbestos fibers). On the contrary,whole parasites appear to follow a classical endocytic pathway. This suggests that there may be differences between the ingestion of free particles and whole parasites in terms of modulation of phagocytes' functions.     

Elevated IGF2 prevents leptin induction and terminal adipocyte differentiation in hemangioma stem cells

Infantile hemangioma is a benign vascular tumor that exhibits a unique yet predictable lifecycle of rapid proliferation followed by spontaneous regression. Recent studies have identified that insulin-like growth factor-2 (IGF2), a fetal mitogen, is highly expressed during the proliferative phase of hemangioma growth. Since hemangiomas arise from CD133 + stem cells, high levels of IGF2 may regulate the activity of the stem cells and therefore, hemangioma growth. The aim of this study was to understand the functional significance of elevated IGF2 in hemangiomas. We show that IGF2 localizes to the CD133 + cells in hemangioma specimens. We, therefore, hypothesized that IGF2 may be regulating the plasticity of hemangioma stem cells. To test our hypothesis, we used CD133-selected cells from hemangiomas to knockdown the expression of IGF2. We found that IGF2 is a mitogen for hemangioma stem cells and prevents leptin induction and full terminal differentiation of hemangioma stem cells into adipocytes. We also show that IGF2 does not alter the initial commitment phase. These findings implicate an important role of IGF2 in expanding hemangioma stem cells and preventing terminal adipocyte differentiation.     

Association of Type D personality with the autonomic and hemodynamic response to the cold pressor test

Mechanisms relating Type D personality to poor health are largely unknown, with autonomic nervous system function being a candidate. This study examined the physiologic response to cold stress. Undergraduates (N = 101, 84% female) underwent a cold pressor test. An electrocardiogram, impedance cardiogram, and blood pressure were recorded. Type D personality was assessed by self‐report questionnaire. Type D was associated with increased systolic and diastolic blood pressure reactivity. Exploratory analyses showed Type D men to respond with increased respiratory sinus arrhythmia (i.e., higher parasympathetic activity), and decreased pre‐ejection period (i.e., larger sympathetic activity), while Type D women showed a reciprocal response pattern. In conclusion, Type D personality was associated with an exaggerated hemodynamic response to cold stress, which may contribute to an increased risk of hypertension in Type D individuals.     

Low forced expiratory volume is associated with blunted cardiac reactions to acute psychological stress in a community sample of middle-aged men and women

It has been argued recently that blunted cardiovascular reactions to acute psychological stress have adverse behavioural and health corollaries that reflect dysregulation of the neural systems that support motivation. We examined the association between cardiovascular reactions to a standard stress task, the paced auditory serial arithmetic rest, and forced expiratory volume in one second, an effort, hence motivation, dependent assessment of lung function measured by spirometry. Low forced expiratory volume, expressed as a ratio to height squared was associated with blunted heart rate, but not blood pressure, stress reactivity, r = .17, p < .001. The association survived adjustment for smoking, a range of anthropometric and sociodemographic covariates, resting heart rate and stress task performance, β = .11, p = .005. As such, our results provide support for the hypothesis that blunted stress reactivity may be a peripheral marker of a dysfunction in the brain systems that support motivated behaviour.     

Carbon dioxide inhalation as a human experimental model of panic: The relationship between emotions and cardiovascular physiology

Inhaling carbon dioxide (CO₂)-enriched air induces fear and panic symptoms resembling real-life panic attacks, the hallmark of panic disorder. The present study aimed to describe the emotional and cardiovascular effects evoked by inhaling CO₂, taking shortcomings of previous studies into account. Healthy volunteers underwent a double inhalation of 0, 9, 17.5, and 35% CO₂, according to a randomized, cross-over design. In addition to fear, discomfort, and panic symptom ratings, blood pressure and heart rate were continuously monitored. Results showed a dose-dependent increase in all self-reports. Systolic and diastolic blood pressure rose with increasing CO₂ concentration, whereas heart rate results were less consistent. Diastolic blood pressure and heart rate variation correlated with fear and discomfort. Based on this relationship and the observation that the diastolic blood pressure most accurately mimicked the degree of self-reported emotions, it might serve as a putative biomarker to assess the CO₂-reactivity in the future.     

Differential Susceptibility to Experimental Allergic Encephalomyelitis (EAE) in Genetically Defined A+ and A− Rabbits

Only one out of 57 A-/ A- rabbits immunized with rat or guinea-pig myelin developed clinical signs suggestive of EAE. On the contrary, clinical signs of acute or chronic EAE were found in two thirds of the 102 A + /A+ and A + /A - rabbits immunized in the same way. About one third of the diseased animals had reversible acute EAE, another third died paralysed and the last third developed chronic progressive or relapsing EAE. Incidence and severity of EAE symptoms were positively correlated with age and no significant difference was observed between males and females.

Cellular and humoral anti-myelin responses were stronger in A⁺ than in A^? rabbits. Anti-A antibodies, on the contrary, were only detected in A ^? rabbits. The A ⁺ rabbits did not make Anti-A at any time. Anti-A antibodies increased early, in A^? rabbits, after immunization with myelin (11–30 days) and were later replaced by a low, but specific, anti-myelin response (60–90 days).

The gene responsible for the susceptibility to EAE is autosomal and dominant over resistance. This gene must be closely linked to the A locus or might be the A gene itself. The low susceptibility of A^? rabbits to the disease could be, in this last case, a consequence of the competition between the early anti-A and the normal anti-myelin immune responses, both induced by the injection of myelin.