Diagnostic Value of Presepsin for Sepsis: A Systematic Review and Meta-Analysis

Several individual studies have reported the diagnostic accuracy of presepsin (sCD14-ST) for sepsis, but the results are inconsistent.The present systematic review and meta-analysis pooled data to better ascertain the value of circulatory presepsin as a biomarker for sepsis.Studies published in English before November 7, 2014 and assessing the diagnostic accuracy of presepsin for sepsis were retrieved from medical databases.The quality of eligible studies was assessed using a revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The overall diagnostic accuracy of presepsin for sepsis was pooled according to a bivariate model. Publication bias was assessed using Deek funnel plot asymmetry test.Eleven studies satisfied the inclusion criteria. The overall diagnostic sensitivity of presepsin for sepsis was 0.83 (95% CI: 0.77–0.88), and specificity was 0.78 (95% CI: 0.72–0.83). The area under the summary receiver operating characteristic curve was 0.88 (95% CI: 0.84–0.90). The pretest probability of sepsis was 0.56 among all subjects. When presepsin was introduced as the diagnostic test for sepsis, the posttest probabilities were 0.81 for a positive result and 0.19 for a negative. The major design deficits of the included studies were lack of prespecified thresholds and patient selection bias. The publication bias was negative.Presepsin is an effective adjunct biomarker for the diagnosis of sepsis, but is insufficient to detect or rule out sepsis when used alone.     

热灭活白念珠菌刺激PBMC对颗粒溶素和TNF-α表达的影响

目的:研究热灭活白念珠菌刺激健康个体外周血单个核细胞对颗粒溶素和TNF-α表达的影响。方法:在热灭活白念珠菌刺激的情况下,采用ELISA和RT-PCR检测颗粒溶素的表达;采用SrCl2以及siRNA下调PBMC内颗粒溶素的表达,或者加入外源性颗粒溶素,观察TNF-α在mRNA和蛋白水平表达的变化。结果:热灭活白念珠菌刺激可以诱导PBMC合成颗粒溶素和TNF-α,采用SrCl2或siRNA下调颗粒溶素的表达均会引起TNF-α在mRNA和蛋白水平表达的下调,而加入外源性的颗粒溶素可以促进TNF-α的表达。结论:热灭活白念珠菌刺激PBMC可以引起颗粒溶素和TNF-α的表达,且颗粒溶素可能是促进TNF-α表达的因素。     

腹腔镜手术治疗胆囊结石合并胆总管结石的临床疗效

目的:比较腹腔镜手术与传统开腹手术治疗胆囊结石合并胆总管结石的临床效果.方法:按照收治随机数字表法将河北联合大学附属医院收治80例胆囊结石合并胆总管结石患者均分为观察组与对照组,分别给予腹腔镜手术和传统开腹手术治疗,比较两组患者手术一般情况、术后并发症发生情况以及随访期间残石率、胆漏率、复发率.结果:观察组患者手术时间、术中出血量、肛门排气时间、下床活动时间及出院时间均显著少于对照组(60.28 min±11.64 min vs 105.61 min±21.16 min、38.36 m L±8.31m L vs 148.36 m L±16.20 m L、1.76 d±0.82d vs 3.10 d±1.12 d、1.53 d±0.78 d vs 2.52d±1.05 d、6.62 d±2.13 d vs 14.27 d±4.58d),差异具有统计学意义(P0.05);观察组并发症总发生率显著低于对照组(7.50%vs27.50%),差异具有统计学意义(P0.05);观察组患者残石率、胆漏率及复发率均显著低于对照组(5.00%vs 20.00%、2.50%vs15.00%、0.00%vs 10.00%),差异具有统计学意义(P0.05).结论:采用腹腔镜手术治疗胆囊结石合并胆总管结石,创伤小,术后恢复快,能有效降低并发症发生率、残石和胆漏率,并减少术后复发,安全可靠,值得推广.     

Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial

European Archives of Psychiatry and Clinical Neuroscience - Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention investigated for the treatment of...     

Anti-vascular permeability of the cleaved reactive center loop within the carboxyl-terminal domain of C1 inhibitor

C1 inhibitor (C1INH), a member of the serine proteinase inhibitor (serpin) family, functions as an inhibitor of the complement and contact systems. Cleavage of the reactive center loop (RCL) within the carboxyl-terminal domain of C1INH (iC1INH), lacking of serpin function, induces a conformational change in the molecule. Our previous data demonstrated that active, intact C1INH prevents vascular permeability induced by gram-negative bacterial lipopolysaccharide (LPS). In this study, we investigate the role of RCL-cleaved, inactive C1INH (iC1INH) in vascular endothelial activation. In the cultured primary human umbilical vein endothelial cell (HUVEC) monolayer, iC1INH blocked LPS-induced cell injury by evaluated as transendothelial flux, cell detachment, and cytoskeletal disorganization. LPS-induced upregulation of vascular cell adhesion molecule-1 (VCAM-1) could be suppressed by treatment with iC1INH. Studies exploring the underlying mechanism of iC1INH-mediated suppression in VCAM-1 expression were related to reduction of NF-kappaB activation and nuclear translocation in an I kappa B alpha-dependent manner. The inhibitory effect was associated with stabilization of the NF-kappaB inhibitor I kappa B and reduction of inhibitor I kappa B kinase activity. In the model of endotoxin-induced mice, increased plasma leakage in local abdominal skin in response to LPS was reversed by treatment with iC1INH. Furthermore, systemic administration of LPS to mice resulted in increased microvascular permeability in multiple organs, which was reduced by iC1INH. These data provide evidence that iC1INH has an anti-vascular permeability independent on the serpin function.     

Adenovirus-mediated FasL gene transfer into human gastric carcinoma

AIM: To evaluate the possible value of FasL in gastric cancer gene therapy by investigating the effects of FasL expression on human gastric cancer cell line. METHODS: An adenoviral vector encoding the full-length human FasL cDNA was constructed and used to infect a human gastric cancer (SGC-7901) cell line. FasL expression was confirmed by X-gal staining, flow cytometric analysis and RT-PCR. The effect of FasL on cell proliferation was determined by clonogenic assay, cytotoxicity was detected by MTT assay, and cell viability was measured by trypan blue exclusion. The therapeutic efficiency of Ad-FasL in vivo was investigated with a xenograft tumor model in nude mice. RESULTS: SGC-7901 cells infected with Ad-FasL showed increased expression of FasL, resulting in significantly decreased cell growth and colony-forming activity when compared with control adenovirus-infected cells. The cytotoxicity of anti-Fas antibody (CH-11) in gastric cancer cells was stronger than that of ActD (91±8 vs60±5,P<0.01), and the cytotoxicity of Ad-FasL was stronger than that of CH-11 (60±5 vs50±2, P<0.05). In addition, G1-phase arrest (67.75±0.39 vs 58.03±2.16, P<0.05) and apoptosis were observed in Ad-FasL-infected SGC-7901 cells, and the growth of SGC-7901 xenografts in nude mice was retarded after intra-tumoral injection with Ad-FasL (54% vs 0%,P<0.0001). CONCLUSION: Infection of human gastric carcinoma cells with Ad-FasL induces apoptosis, indicating that this target gene might be of potential value in gene therapy for gastric cancer.     

Regional electric field induced by electroconvulsive therapy in a realistic finite element head model: influence of white matter anisotropic conductivity

We present the first computational study investigating the electric field (E-field) strength generated by various electroconvulsive therapy (ECT) electrode configurations in specific brain regions of interest (ROIs) that have putative roles in the therapeutic action and/or adverse side effects of ECT. This study also characterizes the impact of the white matter (WM) conductivity anisotropy on the E-field distribution. A finite element head model incorporating tissue heterogeneity and WM anisotropic conductivity was constructed based on structural magnetic resonance imaging (MRI) and diffusion tensor MRI data. We computed the spatial E-field distributions generated by three standard ECT electrode placements including bilateral (BL), bifrontal (BF), and right unilateral (RUL) and an investigational electrode configuration for focal electrically administered seizure therapy (FEAST). The key results are that (1) the median E-field strength over the whole brain is 3.9, 1.5, 2.3, and 2.6 V/cm for the BL, BF, RUL, and FEAST electrode configurations, respectively, which coupled with the broad spread of the BL E-field suggests a biophysical basis for observations of superior efficacy of BL ECT compared to BF and RUL ECT; (2) in the hippocampi, BL ECT produces a median E-field of 4.8 V/cm that is 1.5-2.8 times stronger than that for the other electrode configurations, consistent with the more pronounced amnestic effects of BL ECT; and (3) neglecting the WM conductivity anisotropy results in E-field strength error up to 18% overall and up to 39% in specific ROIs, motivating the inclusion of the WM conductivity anisotropy in accurate head models. This computational study demonstrates how the realistic finite element head model incorporating tissue conductivity anisotropy provides quantitative insight into the biophysics of ECT, which may shed light on the differential clinical outcomes seen with various forms of ECT, and may guide the development of novel stimulation paradigms with improved risk/benefit ratio.     

尿RBP NAG检测在早期诊断过敏性紫癜肾小管损伤的临床意义

目的　观察过敏性紫癜、紫癜性肾炎患儿尿视黄醇结合蛋白 (RBP)、尿-N -乙酰-β-D -氨基 -葡萄糖苷酶 (NAG)与肾小管受损之间的关系。方法　采用ELISA法测定 2 3例过敏性紫癜 (第 1组 ) ,31例紫癜性肾炎 (第 2组 )和 38例正常对照组儿童的尿RBP和尿NAG的含量。结果　第 1组尿RBP排量 (2 0 .9± 17.2 ) μg/mmolCr,第 2组尿RBP排量 (2 5 .7± 2 2 .8) μg/mmolCr,与对照组 (10 .4± 4.8) μg/mmolCr比较 ,差异有显著性意义 ,P <0 .0 5 ,P <0 .0 1。第 1组与第 2组之间比较差异无显著意义 ,P >0 .0 5。第 2组尿NAG排量 (3.6± 4.4)U/mmolCr ,明显高于第 1组 (1.5± 0 .8)U/mmolCr和对照组 (1.5± 0 .9)U/mmol,差异有显著性意义 (P <0 .0 5 ,P <0 .0 1)。结论　过敏性紫癜患儿尽管尿检正常 ,其近端肾小管已有不同程度损害 ,而紫癜性肾小管损害更明显。     

Electric field depth–focality tradeoff in transcranial magnetic stimulation: Simulation comparison of 50 coil designs

BackgroundVarious transcranial magnetic stimulation (TMS) coil designs are available or have been proposed. However, key coil characteristics such as electric field focality and attenuation in depth have not been adequately compared. Knowledge of the coil focality and depth characteristics can help TMS researchers and clinicians with coil selection and interpretation of TMS studies.ObjectiveTo quantify the electric field focality and depth of penetration of various TMS coils.MethodsThe electric field distributions induced by 50 TMS coils were simulated in a spherical human head model using the finite element method. For each coil design, we quantified the electric field penetration by the half-value depth, d_1/2, and focality by the tangential spread, S_1/2, defined as the half-value volume (V_1/2) divided by the half-value depth, S_1/2 = V_1/2/d_1/2.ResultsThe 50 TMS coils exhibit a wide range of electric field focality and depth, but all followed a depth–focality tradeoff: coils with larger half-value depth cannot be as focal as more superficial coils. The ranges of achievable d_1/2 are similar between coils producing circular and figure-8 electric field patterns, ranging 1.0–3.5 cm and 0.9–3.4 cm, respectively. However, figure-8 field coils are more focal, having S_1/2 as low as 5 cm² compared to 34 cm² for circular field coils.ConclusionsFor any coil design, the ability to directly stimulate deeper brain structures is obtained at the expense of inducing wider electrical field spread. Novel coil designs should be benchmarked against comparison coils with consistent metrics such as d_1/2 and S_1/2.     

Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop

Background

Neuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity transcranial electrical stimulation (tES) with direct currents (transcranial direct current stimulation, tDCS) or alternating currents (transcranial alternating current stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities.