Maternal endotoxin-induced preterm birth in mice: fetal responses in toll-like receptors, collectins, and cytokines

Major cause of prematurity is spontaneous preterm birth (PTB) associated with intrauterine inflammation. Our aim was to establish a model of endotoxin Lipopolysaccharide-induced PTB of live-born pups and to study early immune activation in fetal and maternal compartments. Expression of several proteins that bind microbes (Toll-like receptors TLR4, TLR2; surfactant proteins SP-A, SP-D) was analyzed. At 16 or 17 d of gestation, C57BL/6 dams received a single dose of intraperitoneal LPS, leading to PTB within 17 h. Cytokine levels increased in maternal serum, followed by a modest increase in fetal serum and in amniotic fluid. In uterus, placenta, and fetal membranes, LPS mostly increased the expressions of TLR, SPs, and cytokines. The number of TLR2-positive macrophages increased in labyrinthine placenta. In fetal lung, intestine, liver, and brain there were modest changes in cytokine expressions. In fetal lung, SP and TLR mRNAs decreased and TLR2-positive macrophages redistributed around vessels. LPS-induced fetal deaths associated with early age (16 d gestation) rather than with proinflammatory activation. Here we propose that maternal LPS response leads to PTB and acute decrease of immune proteins in epithelial lining of fetal lung. Instead, acceleration of lung maturity has been previously observed in intraamniotic inflammation.     

Link between plasma ceramides, inflammation and insulin resistance: association with serum IL-6 concentration in patients with coronary heart disease

Aims/hypothesis  

Ceramides and IL-6 have a role in immune–inflammatory responses and cardiovascular diseases, and are suggested to be involved in insulin and glucose metabolism. We sought to assess the associations of circulating levels of IL-6, TNF-α and high-sensitivity C reactive protein (hsCRP), which are inflammatory markers related to insulin resistance (IR), with the plasma lipid metabolites ceramides and diacylglycerols (DAG) in patients with CHD.     

Dual-gated cardiac PET–Clinical feasibility study

Purpose  

Both respiratory and cardiac motions reduce image quality in myocardial imaging. For accurate imaging of small structures such as vulnerable coronary plaques, simultaneous cardiac and respiratory gating is warranted. This study tests the feasibility of a recently developed robust method for cardiac-respiratory gating. List-mode data with triggers from respiratory and cardiac cycles are rearranged into dual-gated segments and reconstructed with standard algorithms of a commercial PET/CT scanner. Cardiac gates were defined as three fixed phases and one variable diastolic phase. Chest motion was measured with a respiratory gating device and post-processed to determine gates. Preservation of quantification in dual-gated images was tested with an IEC whole-body phantom.     

Complications of palliative hepaticojejunostomy and gastrojejunostomy in unresectable periampullary cancer: patient- and disease-related risk factors

BACKGROUND/AIMS: Under 20% of the patients with periampullary cancer can be treated with curative resection. When the tumor is only found to be unresectable for cure during the operation, it is generally accepted to perform hepaticojejunostomy on the jaundiced patients. Gastric emptying problems develop after laparotomy in only 7-17% of the patients with unresectable periampullary cancer, which has made the justification of prophylactic gastrojejunostomy less clear. Because the quality of life is the most important aim in palliative surgery, the risks should be minimized. The aim of our study was to evaluate the possible risk factors for the development of complications, after palliative hepaticojejunostomy and gastrojejunostomy in patients whose periampullary tumors were not found to be unresectable for cure until during the operation. METHODOLOGY: Thirty-three patients underwent routine palliative hepaticojejunostomy (Roux-Y) and gastrojejunostomy (retrocolic) and 17 (52%) underwent also operative celiac plexus blockade (50% ethanol ad 20mL both sides), when their periampullary tumor was found not resectable for cure at laparotomy. Jaundice had been relieved preoperatively in 26 (79%) patients, with an endoscopic stent (ERCP-stent) in 13 (39%) patients and with a percutaneous transhepatic drainage (PTD) in 13 (39%) patients. Gastric emptying problems were found preoperatively in 12 (36%) patients: 7 (58%) had verified partial duodenal obstruction and 5 (42%) had only vomiting without anatomical findings. Antimicrobial and antithrombotic prophylaxis was used routinely. Patients were divided into two groups: 1) complication group (n=12, 36%) and 2) no complication group (n=21, 64%). RESULTS: Hospital mortality was 0%. In the complication group the tumor diameter was more often over 4cm compared to the no complication group (10/12 vs. 7/21, p=0.007) and gastric emptying problems were more common in the complication group (7/12 vs. 5/21, p=0.02). We also found a tendency to higher preoperative alkaline phosphatase level in the complication group (mean +/- SEM, [943 +/- 201 vs. 578 +/- 84 IU/L], p=0.06). In multivariate analysis we clarified the influence of gastric emptying problems, tumor size, treatment method of preoperative jaundice (ERCP-stent, PTD), preoperative alkaline phosphatase level and age of the patient on the risk for the development of complications, and found two independent risk factors: patients with symptoms possibly relating to gastric emptying problems developed more complications (OR=6.9, p=0.002), whereas ERCP-stent seemed to protect from complications (OR=0.2, p=0.047). The risk for developing complications in patients with two positive risk factors (gastric emptying problems and unsuccessful ERCP-stent) was 67%, with one positive risk factor 50%, compared to 8% when neither of the two significant risk factors were observed. CONCLUSIONS: Gastric emptying problems and missing ERCP-stent are risk factors for developing complications in patients who undergo palliative hepaticojejunostomy and gastrojejunostomy because of periampullary cancer. These data can be utilized in patient information and when stratifying patients in future trials.