Endocrine autoimmunity in families with type 1 diabetes: frequent appearance of thyroid autoimmunity during late childhood and adolescence

AIMS/HYPOTHESIS

Thyroid autoimmunity clusters with other endocrine and non-endocrine forms of autoimmunity. The aim of this study was to determine the chronological appearance of thyroid autoantibodies in relation to other forms of autoimmunity in at-risk children.

METHODS

The BABYDIAB study follows children of parents with type 1 diabetes. Children born in Germany between 1989 and 2000 were recruited at birth and followed up at 9 months and at 2, 5, 8, 11, 14 and 17 years. Antibodies to thyroid peroxidase were measured in samples taken at the last study visit in 1,489 children and in all previous samples in children who tested positive. Islet antibodies and antibodies to 21-hydroxylase and transglutaminase were also measured in all children. Median follow-up was 8 years.

RESULTS

The cumulative risk for developing antibodies to thyroid peroxidase was 20.3% (95% CI 12.3-28.3) by age 14 years. The risk was increased in girls (adjusted HR 2.0; 95% CI 1.2-3.4; p = 0.008), in children who had multiple first-degree family history of type 1 diabetes (adjusted HR 3.3; 95% CI 1.4-8.0; p = 0.006) and in children who also had antibodies to GAD (adjusted HR 3.0; 95% CI 1.5-5.9; p = 0.001). Thyroid peroxidase antibody appearance was most common from age 8 years and was often the last autoantibody to develop in children with other autoantibodies.

CONCLUSIONS/INTERPRETATION

Among children of patients with type 1 diabetes, the appearance of thyroid autoantibodies is frequent, is not synchronous to the appearance of other autoantibodies and is most common in late childhood and adolescence.

[ARMOR: an electromechanical robot for upper limb training following stroke. A prospective randomised controlled pilot study]

PURPOSE

Due to the complexity of the upper motor neuron syndrome, functional improvement in the paretic upper limb after stroke continues to be a challenge in neurorehabilitation. Robot-assisted training has been shown to be useful in relearning gait. In order to achieve similar results in the upper limb, an electromechanical arm robot (ARMOR), capable of moving all joints through complex patterns, has been developed.

MATERIAL AND METHOD

Eight patients following stroke of different etiologies were included in a clinical AB-BA cross-over study comparing ARMOR training with EMG-triggered neuromuscular electrical stimulation (EMG-NMES). Chedoke-McMaster Stroke Assessment, modified Ashworth Scale, goniometry (Neutral-0-Method), dynamometry and Functional Dexterity Test served as outcome measures.

RESULTS

ARMOR training resulted in more improvement of muscle tone (p = 0.004), range of movement (ROM) (p = 0.005) and dexterity, but less improvement of strength, than EMG-NMES. Chedoke-McMaster Stroke Assessment showed improvement of at least one point in shoulder pain and arm and hand activity during ARMOR training, while these values did not change with EMG-NMS. Better results of ARMOR training were achieved in the earlier phase (A1) than in the later phase (A2).

CONCLUSION

This study demonstrates the positive effect of automatised training with a new electromechanical arm robot (ARMOR), and documents its clinical applicability in the rehabilitation of the paretic upper extremity in stroke patients.

The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases

Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.

Influence of amphotericin B and amphotericin B colloidal dispersion on the functions of human phagocytes in defence against Aspergillus species

This study investigated the in vitro effects of amphotericin B and amphotericin B colloidal dispersion (ABCD) on phagocytosis and inhibition of germination of clinical isolates of Aspergillus spp. by monocyte-derived macrophages (MDMs). Both amphotericin B and ABCD caused significant reductions in uptake of conidia of Aspergillus spp. by MDMs (p < 0.01). The inhibition of germination was superior with conidia of Aspergillus fumigatus, Aspergillus niger and Aspergillus terreus isolates. Aspergillus flavus growth was significantly less inhibited of either antimycotic as compared to A. fumigatus and A. terreus (p < 0.01).We demonstrate that amphotericin B or ABCD acts as a potent inhibitor of Aspergillus germination. By contrast, treatment of MDMs with these antimycotics diminished phagocytosis of conidia in vitro.

T-cell reactivity against HSP60 relates to early but not advanced atherosclerosis

BACKGROUND

Anti-heat-shock protein 60 (HSP60) antibody-levels have been linked to carotid atherosclerosis and cardiovascular risk in a variety of studies. The potential role of cellular immune reactions against HSP60 has so far attracted little attention in epidemiological research.

METHODS AND RESULTS

In vitro T-cell reactivity to various HSP60s and tuberculin was assessed in blood samples from a elderly subpopulation of the Bruneck study (100 men, 50-69 years) and the young participants of the ARMY study (141 men, 17-18 years), and analyzed for a potential association with common carotoid artery intima-media thickness (IMT). In vivo skin reaction against tuberculin was recorded in subjects of the Bruneck study and correlated with the in vitro proliferative response to tuberculin (P=0.004). T-cells isolated from peripheral blood of all individuals proliferated upon stimulation with HSP60s. In multivariate linear regression analysis adjusted for standard risk factors, T-cell stimulation was significantly related to IMT in the ARMY (P=0.005 for human HSP60 and P=0.064 for mycobacterial HSP60) but not in the Bruneck study.

CONCLUSIONS

T-cell reactivity against HSP60s correlated with IMT in male youngsters but not in men aged 50 and over, indicating a more prominent role of specific cellular immunity to HSP60s in the young and very early stages of atherosclerosis.

Comparison of hematologic data in world elite junior speed skaters and in non-athletic juniors

During the world junior speed skating championship 2002 all athletes (60 males, 56 females) were subjected to hematologic blood testing one day before the competition as requested by International Skating Union--ISU. This study aimed to obtain hematological reference values for junior athletes, whilst the influence of endurance training on hematologic variables of young athletes was studied. Hematologic results of athletes were compared to results of non-athletes matched by age and gender (14 males, 17 females). The blood analysis was done on an ADVIA 120. To compare measurement of ferritin, erythropoietin, and soluble transferrin receptor in serum as well as in EDTA-plasma, serum and EDTA-blood was obtained from the control group. In hemoglobin and hematocrit we found no significant difference between the two groups, whereas the number of erythrocytes was lower in athletes. The mean corpuscular volume was higher in athletes, whilst the corpuscular hemoglobin content was only marginally higher in athletes than in non-athletes. Consequently corpuscular hemoglobin concentration mean was lower in athletes than in non-athletes. There was no difference of erythropoietin and soluble transferrin receptor, whilst in ferritin we found a difference between the groups. Endurance training does not change the values of hemoglobin and hematocrit. Increased mean corpuscular volume and decreased corpuscular hemoglobin concentration mean could be a result of changed properties of red blood cell-membrane caused by acidosis and higher osmolality during the training. In junior athletes we did not find an iron overload as described in some adult athletes.

Interaction of serotonin with Candida albicans selectively attenuates fungal virulence in vitro

In this study we investigated whether the direct interaction between Candida albicans CBS 5982 and 5-hydroxytryptamine (5-HT) alters candidial virulence. Hyphae elongation, phospholipase activity and the production of secreted aspartyl proteinases (Saps) following 5-HT treatment were investigated. 5-HT treatment of C. albicans significantly (P < 0.05) affected hyphal extension, phospholipase activity and the production of Saps at concentrations of 118-0.46 mM. In conclusion, our findings suggest that the interaction between 5-HT and C. albicans may diminish the virulence properties of this fungal pathogen.

Chronic paracoccidioidomycosis in a female patient in Austria

Presented here is a case of chronic paracoccidioidomycosis that occurred in a Cuban female living in Austria and was first misdiagnosed as tuberculosis. The clinical picture was one of progressive pulmonary insufficiency with fever, weight loss and productive cough. Since antituberculous therapy was started but did not achieve a long-term clinical response, an intensive diagnostic work-up was performed. Paracoccidioides brasiliensis was then diagnosed by histopathology, serology, microbiology and molecular identification. Antifungal therapy was commenced immediately with amphotericin B (1 mg/kg/day) for 10 days, followed by voriconazole (200 mg/day po) for at least 3 months, and the lesions disappeared almost completely. This report presents the first published case of imported paracoccidioidomycosis in a female patient in Austria.

Taking advantage of the positive side-effects of smallpox vaccination

From the introduction of smallpox vaccination approximately 200 years ago right up to its discontinuation (1980), reports by physicians and scientists about positive side-effects such as healing of chronic skin rashes, reduced susceptibility to various infectious diseases, e.g. measles, scarlet fever and whooping cough, and even the prophylactic use of the vaccination, e.g. against syphilis, were published again and again. Comparison with the period after cessation of vaccination confirms the experiences of the above vaccinators. As early as 1956, targeted research on these observations led to evidence of the 'ring-zone phenomenon', i.e. the production of soluble antiviral substances in infected chicken embryos and cell cultures. With the help of modern immunological and bioengineering methods, it was later possible to demonstrate that these effects are based on the activation of lymphoreticular cells and the regulatory effect of certain cytokines within the context of the non-specific immune system. These findings led to the development of paramunization with paraspecific vaccines from highly attenuated animal pox viruses. During attenuation, deletions in the virus DNA occur. Attenuated animal pox strains are therefore suited for the production of vector vaccines. The fact that these vector vaccines demonstrate an especially high level of paraspecific efficacy and lack harmful effects is likewise the result of the attenuated animal pox viruses. Optimum regulation of the entire immune system leads to increased paramunity already in the first few days after vaccination and to enhanced antigen recognition and thus accelerated commencement of specific immunity.

[Near drowning: epidemiology--pathophysiology--therapy]

Near-drowning is a frequent preventable accident with a significant morbidity and mortality in a previous healthy population. In most patients the primary injury is pulmonary failure due to fluid aspiration, resulting in severe arterial hypoxemia and secondary damage to other organs. Immediate interruption of hypoxia is of utmost importance in the emergency situation. Accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological or electrophysiological examinations. Prompt resuscitation and aggressive respiratory and cardiovascular treatment are crucial for optimal survival. This review provides the reader with detailed information on epidemiology, pathophysiology, emergency decision making and general treatment in near drowning accidents.

Development of a non-immunising, paraspecific vaccine from attenuated pox viruses: a new type of vaccine

The various research periods leading to the development of paraspecific vaccines are described. Paraspecific vaccines are new, pyrogen-free, non-toxic preparations that contain non-immunising antigens and can be used to generate endogenic protective, non-antigen specific mechanisms in the sense of paramunization in humans and animals. They consist of highly attenuated and inactivated (0.05% Betapropiolactone) virus strains of various poxvirus genera. They activate the T helper cells and cellular elements of the paraspecific (innate) immune system and initiate the associated production and release of cytokines (cytokine cascade) with the goal of eliminating dysfunctions of the immune systems, rapidly enhancing the individual's non-pathogen- and non-antigen-specific defences and exerting a regulatory effect on the interplay between the immune, hormone, nervous and vascular systems (signal-transduction mediators). They can be used systemically (intramuscularly) and locally (mucous membranes, skin). Immunization with paraspecific vaccines does not lead to postvaccinal complications and can be carried out as often as necessary, even for a number of years. They are compatible with conventional medicines and conventional specific vaccines. Closely linked protein complexes in the envelopes of the virus particles are responsible for their efficacy, some of those envelope protein complexes possess the properties of weak super antigens. Paraspecific vaccines have proved effective in combating viral infections, in particular herpes and hepatitis B and C infections, and chronic inflammatory diseases, and also as adjuvant therapy for tumours, for curing stress-related disturbances and dysfunctions of the immune system.

The seventh prototype of the mini-spindle-pump: does it fulfill the expectations of a short-term pump?

According to recent trends to develop implantable nonpulsatile blood pumps for different function modes and times, our intention was and still is to build a Mini-Spindle-Pump for a pumping duration of about 14 days. Initial conception for this plan was the premise that the device in a mock circuit should move 4 L of water/min at a speed of 12,000 to 15,000 rpm against a pressure difference of 90 mm Hg between pump inlet and outlet. Despite the development of 6 different prototypes, this project was not realized. Under the above-mentioned conditions, the main problem of this type of blood pump, the blood trauma, could not be reduced to an adequate level, i.e., the Mini-Spindle-Pump is not a high speed pump. Therefore, a revision of the conception was necessary. The device in a mock circuit should transport 5 L of water/min at a speed of about 9,000 rpm against a pressure difference of 90 mm Hg between its inlet and outlet. Considering the implantability of the blood pump, the following measurements for its components were arrived at. The U-shaped blockformed plexiglas housing was enlarged to 120 x 40 x 40 mm (length of blood chamber 86 mm, inner diameter 27 mm), and the rotor with 5 windings was redesigned at a length of 64 mm (outer diameter 25 mm, inner diameter 6.7 mm). In a mock circuit, this 7th prototype transported with a speed of 9,000 rpm about 10 L of water/min at an afterload of 80 mm Hg. In acute animal experiments with calves up to 15 h of pumping duration, the device showed the expected efficiency. Experiments with a longer pumping duration are necessary to confirm that this prototype will fulfill the criteria of a short-term pump according to Dr. Y. Nosé's advice.

[Raman and infrared spectral studies of tungsten organometallic carbyne complex at high external pressure]

The Raman and infrared spectra of complex: [Cl(CO)2 (DPPE) W identical to CC6H4C identical to CC6H4NC]2 Re Cl(CO)3 (DPPE = bis (diphenylphosphino) ethane, (Ph)2PCH2CH2P(Ph)2) were measured at high external pressure (up to about 50 kbar). The pressure induced phase transition was observed near 30 kbar. The pressure dependence d nu/dp of nu (W identical to C) at the low-pressure phase is a little high (0.59 cm-1.(kbar)-1) and is very low (0.04 cm-1.(kbar)-1) at the high-pressure phase. It shows that the pi-backbonding from W to pi*--orbital of CO is strengthened at the high external pressure in fragment Cl(CO)2 (DPPE) W identical to C; The bond intensity and the force constant of W identical to C and nu (W identical to C) are decreasing; This effect compete with the normal increasing nu (W identical to C) on compression.

Blunted erythropoietic response to anemia in multiply traumatized patients

OBJECTIVES

To assess the relations between anemia, serum erythropoietin (EPO), iron status, and inflammatory mediators in multiply traumatized patients.

DESIGN

Prospective observational study.

SETTING

Intensive care unit.

PATIENTS

Twenty-three patients suffering from severe trauma (injury severity score > or =30).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood samples were collected within 12 hrs after the accident (day 1) and in the morning on days 2, 4, 6, and 9 to determine blood cell status, serum EPO, tumor necrosis factor-alpha (TNF-alpha), soluble tumor necrosis factor-receptor I (sTNF-rI), interleukin-1 receptor antagonist (IL1-ra), interleukin-6 (IL-6), neopterin, and iron status, respectively. Hemoglobin concentration was low at admission (mean, 10.0 g/dL; range, 6.8-12.9 g/dL) and did not increase during the observation time. Serum EPO concentration was 49.8 U/L (mean value) on day 1 and did not show significant increases thereafter. No correlation was found between EPO and hemoglobin concentrations. TNF-alpha remained within the normal range. sTNF-rI was high at admission and increased further. IL1-ra was above the normal range. IL-6 was very high at admission and did not decrease thereafter. The initial neopterin concentration was normal, but increased until day 9. Serum iron was significantly decreased on day 2 posttrauma and remained low during the study. Serum ferritin increased steadily from day 2, reaching its maximum on day 9. In contrast, concentrations of transferrin were low from admission onward.

CONCLUSIONS

Multiply traumatized patients exhibit an inadequate EPO response to low hemoglobin concentrations. Thus, anemia in severe trauma is the result of a complex network of bleeding, blunted EPO response to low hemoglobin concentrations, inflammatory mediators, and a hypoferremic state.

[Development of of non-immunising, paraspecific vaccine from attenuated pox viruses: a new type of vaccine]

The various research periods leading to the development of paraspecific vaccines are described. Paraspecific vaccines are new, pyrogen-free, non-toxic preparations that contain non-immunising antigens and can be used to generate endogenic protective, non-antigen specific mechanisms in the sense of paramunization in humans and animals. They consist of highly attenuated and inactivated (0.05% beta-propiolactone) virus strains of various poxvirus genera. They activate the T helper cells and cellular elements of the paraspecific (innate) immune system and initiate the associated production and release of cytokines (cytokine cascade) with the goal of eliminating dysfunctions of the immune systems, rapidly enhancing the individual's non-pathogen- and non-antigen-specific defences and exerting a regulatory effect on the interplay between the immune, hormone, nervous and vascular systems (signal-transduction mediators). They can be used systemically (intramuscularly) and locally (mucous membranes, skin). Immunization with paraspecific vaccines does not lead to postvaccinal complications and can be carried out as often as necessary, even for a number of years. They are compatible with conventional medicines and conventional specific vaccines. Closely linked protein complexes in the envelopes of the virus particles are responsible for their efficacy some of those envelope protein complexes possess the properties of weak super antigens. Paraspecific vaccines have proved effective in combating viral infections, in particular herpes and hepatitis B and C infections, and chronic inflammatory diseases, and also as adjuvant therapy for tumours, for curing stress-related disturbances and dysfunctions of the immune system.

Risk factors associated with new onset tachyarrhythmias after cardiac surgery--a retrospective analysis

BACKGROUND

Tachyarrhythmias (TA) represent a frequent and serious problem after cardiac surgery. We retrospectively analyzed 987 cardiac surgery patients admitted to a surgical intensive care unit between 1996 and 1999 to assess incidence and risk factors associated with development of postoperative TA in the intensive care unit.

METHODS

TA (n=149) were defined as non-sinus rhythm with a heart rate (HR) > or =100 bpm in patients with preoperative sinus rhythm or as heart rate > or =130 bpm in patients with preoperative atrial fibrillation. A total of 787 patients served as controls (C). Demographic, premorbidity and perioperative data, admission SAPS and MODS-score, presence of clinical syndromes systemic inflammatory response syndrome (SIRS) and sepsis were univariately compared between groups. For prediction of independent risk factors for TA-development two multiple logistic regression models were finally established.

RESULTS

Concerning TA, atrial fibrillation and flutter (76%) were observed most frequently, followed by paroxysmal supraventricular tachycardia (15%) and ventricular tachycardia/fibrillation (11%). Age, a history or presence of congestive heart failure, development of SIRS and sepsis, severity of multiple organ dysfunction syndrome and in particular severity of cardiovascular failure proved to be independent risk factors for development of TA.

CONCLUSION

In cardiac surgery patients, age, a history or presence of congestive heart failure, postoperative development of a systemic inflammatory response syndrome or sepsis and the severity of multiple organ function syndrome were independent predictors for development of TA in the intensive care unit. The association of severity of cardiovascular dysfunction with TA strongly suggests a causal relationship between catecholamine therapy and TA-development.

Effects of epinephrine on intestinal oxygen supply and mucosal tissue oxygen tension in pigs

OBJECTIVE

To study the effects of increasing dosages of epinephrine given intravenously on intestinal oxygen supply and, in particular, mucosal tissue oxygen tension in an autoperfused, innervated jejunal segment.

DESIGN

Prospective, randomized experimental study.

SETTING

Animal research laboratory.

SUBJECTS

Domestic pigs.

INTERVENTIONS

Sixteen pigs were anesthetized, paralyzed, and normoventilated. A small segment of the jejunal mucosa was exposed by midline laparotomy and antimesenteric incision. Mucosal oxygen tension was measured by using Clark-type surface oxygen electrodes. Microvascular hemoglobin oxygen saturation and microvascular blood flow (perfusion units) were determined by tissue reflectance spectrophotometry and laser-Doppler velocimetry. Systemic hemodynamics, mesenteric-venous acid-base and blood gas variables, and systemic acid-base and blood gas variables were recorded. Measurements were performed after a resting period and at 20-min intervals during infusion of increasing dosages of epinephrine (n = 8; 0.01, 0.05, 0.1, 0.5, 1, and 2 microg x kg(-1) x min(-1)) or without treatment (n = 8). In addition, arterial and mesenteric-venous lactate concentrations were measured at baseline and at 60 and 120 mins.

MEASUREMENTS AND MAIN RESULTS

Epinephrine infusion led to significant tachycardia; an increase in cardiac output, systemic oxygen delivery, and oxygen consumption; and development of lactic acidosis. Epinephrine significantly increased jejunal microvascular blood flow (baseline, 267 +/- 39 perfusion units; maximum value, 443 +/- 35 perfusion units) and mucosal oxygen tension (baseline, 36 +/- 2.0 torr [4.79 +/- 0.27 kPa]; maximum value, 48 +/- 2.8 torr [6.39 +/- 0.37 kPa]) and increased hemoglobin oxygen saturation above baseline. Epinephrine increased mesenteric venous lactate concentration (baseline, 2.9 +/- 0.6 mmol x L(-1); maximum value, 5.5 +/- 0.2 mmol x L(-1)) without development of an arterial-mesenteric venous lactate concentration gradient.

CONCLUSIONS

Epinephrine increased jejunal microvascular blood flow and mucosal tissue oxygen supply at moderate to high dosages. Lactic acidosis that develops during infusion of increasing dosages of epinephrine is not related to development of gastrointestinal hypoxia.

[Infrared and Raman spectra studies on isomultinuclear organometallic carbyne compounds]

The infrared and Raman spectra of five isomultinuclear organometallic carbyne compounds were studied. The results show that the introduction of N atom from TMEDA or P atom from DPPE to W atom (both N and P are strong sigma-donor and weak pi-acceptor) will decrease the bonding intensity of W identical to C. The pressure tunning IR and Raman spectra of compound III indicate the presence of pressure-induced phase-transition near 20 kbar in it. There are two effects on the nu (W identical to C) of this compound with increasing pressure: the normal increasing the nu (W identical to C) wavenumber due to the shorting W identical to C bond and increasing the W-CO pi backbonding to decrease the nu (W identical to C) wavenumber.

Individual speed dependency of forelimb lameness in trotting horses

Using a system for motion analysis, linear correlation of speed and forelimb lameness was measured in 16 horses trotting on a treadmill at a minimum of three different trotting speeds. Forelimb lameness was determined as asymmetry of vertical head motion during left and right forelimb stance. In seven horses with a moderate forelimb lameness (head motion asymmetry >40%), lameness increased significantly with trotting speed. In a further seven horses with mild or subclinical forelimb lameness (head motion asymmetry <40%) and in two horses with a moderate forelimb lameness, no significant correlation between speed and motion asymmetry was found. The results indicate that moderate forelimb lameness measured as head motion asymmetry depends on the speed at which the measurements are taken. If head motion asymmetry is measured at two trotting speeds, it can be standardized to any speed within the trotting speed range.

Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study

OBJECTIVE

Incidence, types, and factors associated with new onset tachyarrhythmias (TA) in surgical intensive care patients.

DESIGN

Pairwise-matched case-controlled study.

SETTING

Surgical intensive care unit (ICU) with nine intensive care beds.

PATIENTS

During a 1-year period, all TA patients (n = 89) were included in the study. Control patients (n = 82) without TA were matched according to age, sex, and surgical region.

METHODS

TA workup included: 12-lead ECG, arterial blood gas, serum electrolyte (K+, Mg2+), and serum CK/CKMB isoenzyme analysis. Pre-existing cardiovascular and pulmonary disease, cardiovascular risk factors, preoperative regular medication, and admission SAPS were recorded in all patients. A multiple organ dysfunction syndrome (MODS) score, the presence or absence of SIRS or sepsis, and hemodynamics (MAP and CVP) before onset of TA were evaluated in TA patients, while in control patients highest MODS-score, the presence or absence of SIRS or sepsis, mean hemodynamic and laboratory values calculated from highest and lowest readings during ICU stay were used for statistical comparison. Logistic regression analysis was performed to identify variables multivariately associated with TA.

RESULTS

Eighty-nine (14.8%) of 596 patients developed TA. Atrial fibrillation was most frequent (60.7%). Presence of SIRS or sepsis (adj. OR = 36.45; 95% CI: 11.5-115.5), high admission SAPS (adj. OR = 1.25/point; 95% CI: 1.08-1.44), high CVP (adj. OR = 1.27/mmHg; 95% CI: 1.09-1.48), and low arterial oxygen tension (adj. OR = 0.97/mmHg); 95% CI: 0.95-0.99) were found to be significant predictors for development of TA.

CONCLUSIONS

In surgical patients hypoxia, high cardiac filling pressures, a greater degree of physiologic derangement at admission, and the presence of SIRS and sepsis are independent risk factors for the development of TA.

Further evidence that behavioral tests and neuropeptide mRNA and tissue level alterations can differentiate between typical and atypical antipsychotic drugs

This study was designed to compare some behavioral and biochemical effects of chronic treatment with a range of antipsychotic drugs. Gene expression of enkephalin, chromogranin A, chromogranin B, and secretogranin II and their respective peptide products were studied with in situ hybridization and radioimmunoassays after daily oral administration of haloperidol, clozapine, risperidone, or zotepine for 21 days. In behavioral tests, significant catalepsy was induced by haloperidol only. All four antipsychotic drugs increased hind paw retraction time but only haloperidol also increased forelimb retraction time. In the caudate putamen, haloperidol increased both enkephalin mRNA expression and enkephalin tissue levels. Neither of these parameters was altered by the other three drugs. In the prefrontal cortex, antipsychotic drugs generated a distinct pattern of gene expression in two regards. First, the dopamine D(2) receptor antagonist, haloperidol, did not significantly alter synaptic protein levels or their encoding mRNAs. Secondly, there was a differential change in tissue levels and mRNA expression since secretogranin II was not affected by any tested antipsychotic drug. This study shows that different types of antipsychotic drug induce distinct behavioural effects as well as differential changes in the biosynthesis of synaptic proteins and their encoding mRNAs. The data reinforce the notion that haloperidol can be classed as a typical antipsychotic drug whilst clozapine, zotepine, and risperidone reflect their atypical classification.

Acute respiratory failure associated with catastrophic antiphospholipid syndrome

We present a case of multiple organ dysfunction syndrome with acute respiratory failure due to alveolar haemorrhage associated with antiphospholipid antibodies in a 42-year-old woman with a medical history of antinuclear antibody-negative systemic lupus erythematosus and antiphospholipid syndrome. Severe respiratory failure, circulatory shock and acute renal failure necessitated artificial ventilation, inotropic and vasopressor therapy, and continuous venovenous haemofiltration. A tentative diagnosis of haemorrhagic lupus pneumonitis or pulmonary manifestation of antiphospholipid syndrome was made. Lupus anticoagulant, IgG anticardiolipin and anti-beta2-glycoprotein I antibodies were positive. High-dose glucocorticoid, anticoagulation with heparin, plasmapheresis and cyclophosphamide improved her clinical condition. Despite this, the patient died several days later of spontaneous intracranial haemorrhage. This case illustrates the uncommon manifestation of acute respiratory failure associated with antiphospholipid syndrome.

Adaptation of reptilian paramyxovirus to mammalian cells (Vero cells)

The reptilian paramyxovirus GOV was successfully adapted to Vero cells in 80 passages at 30 degrees C. The virus replicated with HA titres of 1:64 and 10(7.5) TCID50/ml in the heterologous host cells forming syncytia, giant cells and cytoplasmic inclusion bodies. After 80 passages GOV was identified by immunofluorescence, by immune electron microscopy and by PCR. Sequencing of RT-PCR products of GOV after 80 passages did not reveal changes in the nucleotide sequence of the partial L-gene of GOV.

Low platelet count and elevated serum thrombopoietin after severe trauma

Platelet count is regularly low in patients after multiple trauma, mainly due to blood loss and dilution. Thrombopoietin (TPO) is the main regulator of the circulating platelet mass. Under several clinical conditions an inverse correlation between TPO and the circulating platelet mass was reported. Since platelets bind and internalize TPO, a platelet-dependent regulation of TPO was suggested. Thus, acute blood loss should be accompanied by elevated TPO. We measured serum TPO, platelets, interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in 17 multiple traumatized victims. Blood was collected within 12 h after trauma as well as in the morning of days 2, 4, 6 and 9 after admission at the intensive care unit. Platelet count was low at admission and remained low until day 4. Thereafter platelets increased until day 9. TPO nearly doubled within the first 2 d, reaching its maximum on day 6. IL-6 was initially very high and steadily decreased until day 9. VEGF increased 3-fold during the 9 d. Statistically significant correlations of TPO were found with platelets and IL-6, but not with VEGF. In multiple traumatized patients low platelet count is followed by a rapid increase in serum TPO. This fits into the concept of a feedback regulation between circulating TPO and platelet mass.

Reptilian paramyxoviruses induce cytokine production in human leukocytes

The reptilian paramyxoviruses FDLV and GOV initiated the production and release of cytokines like IL-1alpha, IL-1beta, IL-2, TNF-alpha and IFN-alpha in human peripheral blood mononuclear cells (PBMC) at 37 degrees C. The target cells produced the cytokines without replication of virus.

[Historical review of smallpox, the eradication of smallpox and the attenuated smallpox MVA vaccine]

After the WHO had declared smallpox to be eradicated in 1980, smallpox vaccination ceased to be carried out in humans all over the world. The cutaneous inoculations carried out with live vaccines based on the vaccinia virus from 1798 onwards protected both the global population and, indirectly, the animals living with humans against orthopox infections in general. A large percentage of humans and animals no longer enjoy this protection. Idiopathic orthopox in animals (reservoir possibly rats and mice) are thus experiencing a renaissance, posing a threat to humans and animals. The paper provides an historical retrospective of smallpox epidemics in humankind, their course of development and methods employed to combat this disease, commencing long before the birth of Christ with primitive attempts in China and India and from the end of the 18th century with increasingly enhanced methods, most recently with worldwide smallpox vaccination programmes using live vaccinia vaccines. Smallpox vaccination was always accompanied by a variety of complications, especially postvaccinal encephalitis. The MVA strain was developed to reduce or prevent such adverse effects. MVA has meanwhile proved its worth both as a parenteral vaccine against orthopox infections in humans and animals and as a vector for insertion of foreign genes. The history of smallpox, the fight against this disease and the development of MVA are documented with the help of figures and tables.

[Intestinal ischemic reperfusion syndrome: pathophysiology, clinical significance, therapy]

Gut ischemia-reperfusion injury is a serious condition in intensive care patients. Activation of immune cells within the huge endothelial surface area of gut microcirculation may initiate a systemic inflammatory response with secondary injury to distant organs. Translocation of bacteria and toxins through a leaky gut mucosa may amplify or perpetuate systemic inflammation, leading to multiple organ dysfunction syndrome and death in critically ill patients. Gut ischemia promotes regional production of inflammatory mediators, expression of cell adhesion molecules on endothelial and immune cell surfaces and increases the procoagulatory properties of vascular endothelial cells. During reperfusion, gut injury may be amplified by increased production of oxygen radicals and exhaustion of endogenous antioxidant defence mechanisms. Although several therapeutic strategies to interrupt the pathophysiology of ischemia-reperfusion have been shown to be beneficial in animal experiments, none of these interventions has gained clinical relevance. After initial hemodynamic and respiratory stabilisation of critically ill patients, strategies to prevent secondary gut injury by increasing splanchnic oxygen delivery or augment mucosal cell regeneration may be the only therapeutic options for intensive medical specialists at the present time. Early enteral nutrition and treatment with specific vasoactive drugs may reduce morbidity and costs of treatment in certain critically ill patients. However definitive evidence of a reduction in mortality with these therapies has still not be provided.

Poor response to activated protein C as a prominent risk predictor of advanced atherosclerosis and arterial disease

BACKGROUND

The potential role of activated protein C (APC) resistance in arterial thrombosis and disease is a matter of ongoing controversy.

METHODS AND RESULTS

In the present population-based survey, a random sample of 826 men and women underwent high-resolution duplex ultrasound scanning of the carotid and femoral arteries. Response to APC was expressed in APC ratios. Subjects were tested for the factor V Leiden mutation. The risk of carotid stenosis increased gradually with decreasing response to APC (adjusted OR [95% CI] for a 1-U decrease of response to APC, 1.6 [1. 2 to 2.2]), as did the risk of femoral artery stenosis (1.7 [1.3 to 2.3]) and prevalent cardiovascular disease (1.4 [1.1 to 2.0]). The association between low APC ratio and atherosclerotic vascular disease applied equally to subjects with the factor V Leiden mutation and those without. Our study identified various nongenetic determinants of poor response to APC in the general population, including behavioral, hormonal, and environmental factors.

CONCLUSIONS

The present study revealed an independent and gradual association between low response to APC and both advanced atherosclerosis (stenosis) and arterial disease. Resistance to APC due to factor V Leiden mutation was only one facet of this relationship.

Successful treatment of severe myocardial failure after postpartum haemorrhage with the use of an intra-aortic balloon pump

We report a 29-year-old primigravid who developed cardiac failure following postpartum haemorrhage unresponsive to volume resuscitation and therapy with catecholamines and phosphodiesterase-inhibitors. Transoesophageal echocardiography (TEE) demonstrated left atrial and ventricular dilatation and global left ventricular hypokinesis. No elevation of serum MB-isoenzyme fraction was detected and other organ functions remained stable. Although emergency cardiac transplantation was considered in the presented patient, the institution of intra-aortic counterpulsation was decided on as a first treatment option. Intra-aortic balloon counter-pulsation rapidly improved cardiac function and led to weaning from pharmacological cardiac support within a few days. Mechanical circulatory assist devices can be life-saving in postpartum-haemorrhage-associated cardiac failure.