Involvement of sympathetic reflex activity in patients with acute and chronic stroke: A comparison with functional motor capacity

OBJECTIVE: To investigate sympathetic nervous system functions in patients with acute and chronic phase of stroke by measuring sympathetic skin reflex (SSR) and the relationship between sympathetic dysfunction and motor function capacity. DESIGN: Cross-sectional, case-control study. SETTING: A physical medicine and rehabilitation department in a research hospital of a university referral center in Turkey. PARTICIPANTS: Fifty-six patients with stroke-13 in the acute phase and 43 in the chronic phase-and 42 age- and sex-matched healthy volunteers were included. INTERVENTION: SSR was recorded with electric stimulation of the bilateral median nerves. MAIN OUTCOME MEASURES: SSR was recorded to assess sympathetic reflex activity in patients in the acute and chronic phase of stroke and in controls. Motor functions was classified using the Brunnstrom stages. RESULTS: The mean SSR latency in the acute phase was significantly prolonged and the amplitudes were decreased compared with controls. In the chronic phase, the mean amplitudes were significantly attenuated compared with controls, whereas the mean latency did not change. The mean latency of SSR in patients in Brunnstrom groups 1 and 2 was longer, and the mean amplitude was smaller than in controls (P<.05). The mean amplitude was significantly reduced in patients classified as Brunnstrom groups 3 and 4 compared with controls (P<.05), but the mean latency was not affected. CONCLUSIONS: Depression of sympathetic reflex activity was more prominent in the acute phase of stroke and was associated with moderate or highly limited motor function capacity. Improvement of motor dysfunction may parallel recovery of sympathetic reflex activity.     

Topical application of aprotinin in cardiac surgery

The aim of our study was to compare a systemic and a local aprotinin application in patients during coronary artery bypass graft (CABG) surgery. The advantage of a topical aprotinin application is seen in the fact that this may not lead to systemic side effects. A prospective, randomized study comprising 97 patients was conducted. A dose of 5 x 10(6) KIU aprotinin was given systemically to 49 patients and four doses of 1.25 x 10(6) KIU aprotinin were applied topically to 48 patients by spraying the substance on the target area (A. mammaria interna region and pericardium). We determined markers for the inflammatory response, coagulation system, standard haematological markers and postoperative complications. Exclusion criteria were defined as surgical bleeding, redo operations, neurological, haematological, liver and kidney disorders. Sex, age, perfusion times, mortality, renal failure and strokes were identical in both groups. Biochemical markers and clinical outcome demonstrated no significant differences between the systemic and local applications. Interleukin 6 and elastase were tendentially higher (p = 0.1) in the local group, but with a high standard deviation in each patient. Our results suggest that there is no difference between the perioperative application of 5 x 10(6) KIU systemically given aprotinin and 1.25 x 10(6) KIU locally applied aprotinin.     

Comparison of demographic and clinical characteristics of hospitalized COVID-19 patients with severe/critical illness in the first wave versus the second wave

Due to current advances and growing experience in the management of coronavirus Disease 2019 (COVID-19), the outcome of COVID-19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID-19 patients with only severe/critical illness. Among 642 laboratory-confirmed hospitalized COVID-19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow-up were surveyed. Data on demographics, comorbidities, C-reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65–157) vs. 87 mg/L (IQR: 39–140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID-19 patients, we found similar demographics and outcomes among hospitalized COVID-19 patients with severe/critical illness in the first and second wave.     

Doppler examination of uteroplacental circulation in early pregnancy: Can it predict adverse outcome?

PURPOSE: To determine whether spectral Doppler measurements obtained from bilateral uterine, arcuate, radial, and spiral arteries in early gestation correlate with adverse pregnancy outcome. METHODS: One hundred five pregnant women underwent transvaginal Doppler sonographic examination of uteroplacental circulation at 6-12 weeks' gestation. Resistance index (RI) and pulsatility index (PI) of bilateral uterine, arcuate, radial, and spiral arteries were measured. Diameters of gestational sac (GS) and yolk sac, crown-rump length (CRL), GS-CRL difference, and GS/CRL ratio were also recorded. Correlation was made with pregnancy outcome. RESULTS: Sixteen women developed adverse pregnancy outcome. In these women, right uterine artery PI and RI were significantly higher than in women with normal obstetrical outcome. Spiral artery PI and RI values were also higher, but the difference was not statistically significant. GS-CRL difference, GS/CRL ratio, and yolk sac diameters were significantly lower in this group. CONCLUSION: Transvaginal Doppler examination can detect hemodynamic changes in uteroplacental circulation associated with subsequent adverse pregnancy outcome.     

Human Trim5α has additional activities that are uncoupled from retroviral capsid recognition

Trim5α is a host antiviral protein that recognizes incoming retroviral capsids in the cytoplasm and prevents productive infections. Although present in most mammals, the state of the Trim5 gene is dynamic in that primates have one copy with several splice variants, while rodents and cows have multiple copies. Mouse Trim30 (one of the mouse Trim5α homologs) has been shown to negatively regulate NF-kappaB activation by targeting upstream signaling intermediates TAB2 and TAB3 for degradation. We show that human Trim5α also affects levels of TAB2, resulting in abrogation of TAB2-dependent NF-kappaB activation. Surprisingly, unlike mouse Trim30, human and rhesus Trim5α are able to activate NF-kappaB-driven reporter gene expression in a dose-dependent manner. We show that Trim5α uses distinct domains for the distinct abilities of affecting TAB2 levels, regulating NF-kappaB, and recognizing retroviral capsids. Our results demonstrate functions of Trim5α that are not dependent on recognizing the retroviral capsid.     

Cell type accuracy of transthoracic fine needle aspiration in primary lung cancer

In this study, we aimed to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (TFNA) specimens in establishing the specific cell type in primary lung cancer and to study the influence of several factors on this accuracy. Forty-six patients with lung cancer diagnosed by TFNA specimens who subsequently underwent thoracotomy between April 2003 and December 2005 were included. Fourty-one patients were men and five were women with a mean age of 59.8 +/- 10 years (34-68 years). TFNA was performed by 22-Gauge Chiba needle with computed tomography guided in all patients. There was cell agreement in 38 of 46 cases (82.6%, Kappa= 0.73). The concordance was 70.8% (Kappa= 0.65) in cases with squamous cell carcinoma and 100% (Kappa= 0.74) in cases with adenocarcinoma (p= 0.01). Stage of the tumor, the diameter and location of the lesion had no effect on cell type agreement (p> 0.05). The concordance was 63.6% in poor differentiated tumors and 92.9% in well differentiated tumors (p> 0.05). Our results pointed out that tumor cell type was the only factor effecting tumor cell type agreement between TFNA and thoracotomy.     

An expanded clade of rodent Trim5 genes

Trim5α from primates (including humans), cows, and rabbits has been shown to be an active antiviral host gene that acts against a range of retroviruses. Although this suggests that Trim5α may be a common antiviral restriction factor among mammals, the status of Trim5 genes in rodents has been unclear. Using genomic and phylogenetic analyses, we describe an expanded paralogous cluster of at least eight Trim5-like genes in mice (including the previously described Trim12 and Trim30 genes), and three Trim5-like genes in rats. Our characterization of the rodent Trim5 locus, and comparison to the Trim5 locus in humans, cows, and rabbits, indicates that Trim5 has undergone independent evolutionary expansions within species. Evolutionary analysis shows that rodent Trim5 genes have evolved under positive selection, suggesting evolutionary conflicts consistent with important antiviral function. Sampling six rodent Trim5 genes failed to reveal antiviral activities against a set of eight retroviral challenges, although we predict that such activities exist.