Arteriogenesis requires toll-like receptor 2 and 4 expression in bone-marrow derived cells

Adaptive collateral growth (arteriogenesis) is an important protective mechanism against ischemic injury in patients with cardiovascular disease. Arteriogenesis involves enlargement of pre-existent arterial anastomoses and shares many mechanistic similarities with inflammatory processes. Although infusion of the Toll-like receptor (TLR) 4 ligand lipopolysaccharide (LPS) has shown to result in a significant stimulation of arteriogenesis and both Toll-like receptor 2 and 4 are involved in structural arterial adaptations, the requirement for TLRs in arteriogenesis has not yet been established. We therefore subjected TLR 2 null and TLR 4 defective mice to unilateral femoral artery occlusion. At 7 days, both TLR 2 null and TLR 4 defective mice showed a significant reduction (~ 35%) of collateral perfusion. Histological staining showed that TLR 2 and TLR 4 expression during arteriogenesis is mostly restricted to infiltrating leukocytes. To distinguish between the functional importance of vascular and leukocytic TLRs in arteriogenesis, cross-over bone marrow transplantation was performed 6 weeks before femoral artery occlusion. Perfusion measurements showed that transplantation of wild-type bone marrow into TLR 2 null and TLR 4 defective mice rescued the impaired arteriogenesis, while injection of TLR 2 null and TLR 4 defective bone marrow into wild-type mice significantly reduced collateral vessel growth to levels of TLR null/defective mice. RT-PCR analysis demonstrated a significant upregulation of two endogenous TLR ligands EDA and Hsp60 (91.7 fold and 1.9 fold respectively) in regions of collateral vessel formation. This study illustrates the involvement of TLR 2 and TLR 4 in adaptive collateral artery growth and shows the importance of TLR 2 and 4 expression by bone-marrow derived cells for this process.     

Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?

Introduction and hypothesis  

The aim of the study was to report anatomic and functional outcome of midline fascial plication under continuous digital transrectal control and to identify predictors of anatomic failure.     

Cerebrospinal fluid leakage, an uncommon complication of fetal blood sampling: a case report and review of the literature

In a recently published randomized clinical trial on intrapartum fetal monitoring, fetal blood samples were obtained in 879 women. One serious complication of fetal blood sampling (FBS) was reported, a case in which physical examination of the neonate after delivery revealed clear fluid loss from the incision site. Four layers of the scalp appeared to be incised. The subarachnoid space was closed with 2 sutures, and antibiotics were started due to the risk of meningitis. The patient was discharged in good clinical condition. In this article, the case is presented and the literature reviewed. We found 12 articles reporting 37 cases of a complication due to FBS, none concerning leakage of cerebrospinal fluid. In conclusion, complications of FBS are rare but can be serious. Excessive fetal bleeding is most frequently reported and often associated with an underlying coagulopathy in the neonate. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the chance of possible complications due to fetal blood sampling; select fetuses at risk for complications due to fetal blood sampling; and evaluate certain technical precautions when performing this procedure.     

Fast network oscillations in vitro exhibit a slow decay of temporal auto-correlations

Ongoing neuronal oscillations in vivo exhibit non-random amplitude fluctuations as reflected in a slow decay of temporal auto-correlations that persist for tens of seconds. Interestingly, the decay of auto-correlations is altered in several brain-related disorders, including epilepsy, depression and Alzheimer's disease, suggesting that the temporal structure of oscillations depends on intact neuronal networks in the brain. Whether structured amplitude modulation occurs only in the intact brain or whether isolated neuronal networks can also give rise to amplitude modulation with a slow decay is not known. Here, we examined the temporal structure of cholinergic fast network oscillations in acute hippocampal slices. For the first time, we show that a slow decay of temporal correlations can emerge from synchronized activity in isolated hippocampal networks from mice, and is maximal at intermediate concentrations of the cholinergic agonist carbachol. Using zolpidem, a positive allosteric modulator of GABA(A) receptor function, we found that increased inhibition leads to longer oscillation bursts and more persistent temporal correlations. In addition, we asked if these findings were unique for mouse hippocampus, and we therefore analysed cholinergic fast network oscillations in rat prefrontal cortex slices. We observed significant temporal correlations, which were similar in strength to those found in mouse hippocampus and human cortex. Taken together, our data indicate that fast network oscillations with temporal correlations can be induced in isolated networks in vitro in different species and brain areas, and therefore may serve as model systems to investigate how altered temporal correlations in disease may be rescued with pharmacology.     

Ten‐yr results of the trans‐Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands

Minnee RC, Lardy N, Ajubi N, Idu MM, Kock RV, Legemate DA, van Donselaar‐van der Pant KAMI, Bemelman FJ. Ten‐yr results of the trans‐Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands.
Clin Transplant 2011: 25: 302–307. © 2010 John Wiley & Sons A/S. Abstract: The prevalence of end‐stage renal failure in Curaçao (Dutch Caribbean) is one of the highest in the world. In 1998, the St. Elisabeth Hospital started a unique trans‐Atlantic collaboration with the Academic Medical Center in Amsterdam, the Netherlands, and the Eurotransplant Foundation. The partnership aimed to achieve a structured transplantation program for patients in the Dutch Caribbean, who otherwise would need lifelong dialysis. This study is an analysis of the 10‐yr transplantation results of this trans‐Atlantic program. In 41 consecutive transplantations performed between January 1998 and April 2007, one‐yr graft survival and complication rates were retrospectively studied. Twenty‐four men and 17 women with a median age of 54 were transplanted. The median dialysis period prior to transplantation was 6.8 yr. The one‐yr graft survival rate was 69% (95% confidence interval: 52–80%). Initially 28 grafts functioned (68%); four grafts showed primary non‐function (10%) and delayed graft function developed in nine patients (22%). Ten recipients had 16 post‐operative complications. Our trans‐Atlantic program affords patients with end‐stage renal failure, who otherwise would need lifelong dialysis, a chance to be transplanted.     

Borderline femur fracture patients: early total care or damage control orthopaedics?

Background: A recent randomized controlled trial (RCT) favours damage control orthopaedics (DCO) over early total care (ETC) in the management of high‐energy femoral shaft fracture (FSF) patients with borderline physiology. The purpose of this study was to compare the borderline physiology FSF demographics, management and outcomes of a Level‐1 trauma centre, John Hunter Hospital (JHH) with those of the RCT. Methods: A 41‐month study of the prospective FSF database was performed. FSF patients were categorized according to the Pape system. Stable (JHH‐S) and borderline (JHH‐BL) patients' demographics, injury severity, methods of treatment and outcomes were compared with the corresponding groups of the RCT (RCT‐S and RCT‐BL). Results: Sixty‐six patients met the inclusion criteria of which 45 (68%) were in JHH‐S and 21 (32%) were in JHH‐BL group. In comparison, there were 121 (73%) RCT‐S and 44 (28%) RCT‐BL patients in the RCT study population. The demographics and injury severity were similar in the borderline groups, while JHH‐S patients were less severely injured. DCO was utilized more frequently in the RCT in both the stable group (JHH‐S: 2% versus RCT‐S: 41%), and the borderline group (JHH‐BL: 14% versus RCT‐BL: 48%). The outcomes between the JHH‐S and RCT‐S groups were comparable, except for intensive care unit (ICU) hours (JHH‐S: 20 ± 64 versus RCT‐S: 165 ± 187, P < 0.0001) and ventilator hours (JHH‐S: 13 ± 46 versus RCT‐S: 98 ± 120, P < 0.0001). Among borderline patients, JHH‐BL had a tendency to show a lower incidence of both acute respiratory distress syndrome (0% versus 14%) and multiple organ failure (4.8% versus 19.6%). JHH‐BL patients had sepsis less frequently (4.8% versus 24.5%, P < 0.05), fewer ICU hours (98 ± 129 versus 436 ± 347, P < 0.0001) and fewer ventilator hours (82 ± 119 versus 337 ± 305, P= 0.0005) compared with the RCT‐BL. Conclusions: The incidence of S and BL patients, demographics and injury severity (among BL patients) is comparable with the RCT. Our current practice of employing predominantly ETC among S (98%) and BL (86%) patients results in shorter ICU and ventilator days, fewer septic complications and a potentially lower incidence of organ failure than in the RCT which had 57% overall utilization of ETC.