Macrophage migration inhibitory factor—A potential diagnostic tool in severe burn injuries?

Serum macrophage migration inhibitory factor (MIF) and procalcitonin (PCT) concentrations as well as leucocyte numbers were evaluated in a retrospective study with 23 patients with severe burn injuries. The MIF and PCT concentrations as well as the number of leucocytes (LEU) were monitored over a period of 5 days. The total body surface area (TBSA) and sepsis-related organ failure assessment (SOFA) scores were also evaluated. The MIF, PCT concentrations and leucocyte counts were profoundly increased in all patients with severe burn wounds. At the time of admission into the intensive care unit, no significant differences were observed for the MIF and PCT levels between patients with a TBSA < 60% (Group 1) and patients with a TBSA > 60% (Group 2). After 48 h, however, the MIF and PCT levels reached very high levels in a subgroup of the patients, whereas these levels became normal again in other subgroups. The group of patients with a TBSA > 60% was, therefore, subdivided in three groups (subgroups 2a–c). The MIF and PCT data pairs in these subgroups appeared to correlate in an inhomogeneous manner. These levels in the subgroup 2a (i.e., lethal within 5 days) were strongly elevated over those observed in Group 1 (TBSA < 60%) and highly increased concentrations of both MIF and PCT correlated with lethal outcome. The combined determination of MIF and PCT might, therefore, be useful to discriminate between post-burn inflammation and systemic inflammatory response syndrome (SIRS) or sepsis with lethal outcome.     

Glasgow Coma Scale and laboratory markers are superior to COHb in predicting CO intoxication severity

Carbon monoxide (CO) intoxications can affect several organ systems and lead to coma or death in severe cases. To date, COHb is routinely used as a marker for detecting CO intoxication. In this retrospective study, we investigated 173 patients admitted with CO intoxication to our intensive care unit (ICU) over a period of 8 years. Standardised blood tests, chest X-ray and neurological status evaluation were performed on admission and throughout the inpatient treatment. The duration of inpatient treatment was considered to be an indication of the severity of CO-related illness. Interestingly, the data did not reveal a significant correlation between initial COHb level and the duration of inpatient treatment. Instead, a significant inverse correlation was found between the initial Glasgow Coma Scale and the duration of inpatient treatment. Furthermore, significant correlations were found between the duration of inpatient treatment and the occurrence of elevated leucocyte numbers, elevated C-reactive protein (CRP) serum concentrations and the presence of lung infiltrates. In conclusion, we postulate that clinical parameters, such as the Glasgow Coma Scale and the laboratory markers CRP and leucocyte count are adequate supportive tools for evaluating the severity of CO-related illness, and further, that the measurement of COHb alone is insufficient for this purpose.     

Cheyne-Stokes Respiration and Prognosis in Modern-Treated Congestive Heart Failure

In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 ± 18 months. Mean age was 62 ± 13 years and the mean ejection fraction was 25 ± 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index >5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox’s proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome.     

Structural basis for ligand and substrate recognition by torovirus hemagglutinin esterases

Hemagglutinin esterases (HEs), closely related envelope glycoproteins in influenza C and corona- and toroviruses, mediate reversible attachment to O-acetylated sialic acids (Sias). They do so by acting both as lectins and as receptor-destroying enzymes, functions exerted by separate protein domains. HE divergence was accompanied by changes in quaternary structure and in receptor and substrate specificity. The selective forces underlying HE diversity and the molecular basis for Sia specificity are poorly understood. Here we present crystal structures of porcine and bovine torovirus HEs in complex with receptor analogs. Torovirus HEs form homodimers with sialate-O-acetylesterase domains almost identical to corresponding domains in orthomyxo- and coronavirus HEs, but with unique lectin sites. Structure-guided biochemical analysis of the esterase domains revealed that a functionally, but not structurally conserved arginine–Sia carboxylate interaction is critical for the binding and positioning of glycosidically bound Sias in the catalytic pocket. Although essential for efficient de-O-acetylation of Sias, this interaction is not required for catalysis nor does it affect substrate specificity. In fact, the distinct preference of the porcine torovirus enzyme for 9-mono- over 7,9-di-O-acetylated Sias can be explained from a single-residue difference with HEs of more promiscuous specificity. Apparently, esterase and lectin pockets coevolved; also the porcine torovirus HE receptor-binding site seems to have been designed to use 9-mono- and exclude di-O-acetylated Sias, possibly as an adaptation to replication in swine. Our findings shed light on HE evolution and provide fundamental insight into mechanisms of substrate binding, substrate recognition, and receptor selection in this important class of virion proteins.     

Music-assisted relaxation to improve sleep quality: meta-analysis

Title.  Music-assisted relaxation to improve sleep quality: meta-analysis.
Aim.  This paper is a report of a meta-analysis conducted to evaluate the efficacy of music-assisted relaxation for sleep quality in adults and elders with sleep complaints with or without a co-morbid medical condition.
Background.  Clinical studies have shown that music can influence treatment outcome in a positive and beneficial way. Music holds the promise of counteracting psychological presleep arousal and thus improving the preconditions for sleep.
Data sources.  We conducted a search in the Embase (1997 – July 2008), Medline (1950 – July 2008), Cochrane (2000 – July 2008), Psychinfo (1987 – July 2008) and Cinahl (1982 – July 2008) databases for randomized controlled trials reported in English, German, French and Dutch. The outcome measure of interest was sleep quality.
Methods.  Data were extracted from the included studies using predefined data fields. The researchers independently assessed the quality of the trials using the Delphi list. Only studies with a score of 5 points or higher were included. A pooled analysis was performed based on a fixed effect model.
Results.  Five randomized controlled trials with six treatment conditions and a total of 170 participants in intervention groups and 138 controls met our inclusion criteria. Music-assisted relaxation had a moderate effect on the sleep quality of patients with sleep complaints (standardized mean difference, −0·74; 95% CI: −0·96, −0·46). Subgroup analysis revealed no statistically significant contribution of accompanying measures.
Conclusion.  Music-assisted relaxation can be used without intensive investment in training and materials and is therefore cheap, easily available and can be used by nurses to promote music-assisted relaxation to improve sleep quality.     

Methylation-mediated silencing and tumour suppressive function of <Emphasis Type="Italic">hsa-miR-124</Emphasis> in cervical cancer

Background  

A substantial number of microRNAs (miRNAs) is subject to epigenetic silencing in cancer. Although epigenetic silencing of tumour suppressor genes is an important feature of cervical cancer, little is known about epigenetic silencing of miRNAs. Since DNA methylation-based silencing of hsa-miR-124 occurs in various human cancers, we studied the frequency and functional effects of hsa-miR-124 methylation in cervical carcinogenesis.