[Comparison of younger and elder patients after multiple trauma]

The purpose of this study was to clarify any influences by age on the outcome after multiple trauma. 520 patients (age > 20 years) were analysed after inclusion in a 3-year national multi-centre study for polytrauma injured subjects. The patients were recruited from 10 German neurosurgical university departments. Criteria for inclusion were head injury and coma at the time of admittance. The elderly were mostly injured by falls, and showed more often intracranial injuries and fractures of the pelvis. The majority of intracranial injuries were characterised by acute subdural haematomas in the elderly and contusions in younger patients. Hence, craniotomy within the first 24 hours was found more often in the elderly. There was a significant trend towards a craniotomy and placement of a pressure catheter in younger patients compared with the elderly. There were significantly lower values for the Glasgow Outcome Scale (GOS) in the elderly, especially in terms of lethality. The depth of coma was a strong predictor for GOS in both groups.

A new transgenic rat model overexpressing the angiotensin II type 2 receptor provides evidence for inhibition of cell proliferation in the outer adrenal cortex

This study aimed to elucidate the role of the AT(2) receptor (AT(2)R), which is expressed and upregulated in the adrenal zona glomerulosa (ZG) under conditions of increased aldosterone production. We developed a novel transgenic rat (TGR; TGRCXmAT(2)R) that overexpresses the AT(2)R in the adrenal gland, heart, kidney, brain, skeletal muscle, testes, lung, spleen, aorta, and vein. As a consequence the total angiotensin II (Ang II) binding sites increased 7.8-fold in the kidney, 25-fold in the heart, and twofold in the adrenals. The AT(2)R number amounted to 82-98% of total Ang II binding sites. In the ZG of TGRCXmAT(2)R, the AT(2)R density was elevated threefold relative to wild-type (WT) littermates, whereas AT(1)R density remained unchanged. TGRCXmAT(2)R rats were viable and exhibited normal reproduction, blood pressure, and kidney function. Notably, a slightly but significantly reduced body weight and a moderate increase in plasma urea were observed. With respect to adrenal function, 24-h urinary and plasma aldosterone concentrations were unaffected in TGRCXmAT(2)R at baseline. Three and 14 days of Ang II infusion (300 ng·min(-1)·kg(-1)) increased plasma aldosterone levels in WT and in TGR. These changes were completely abolished by the AT(1)R blocker losartan. Of note, glomerulosa cell proliferation, as indicated by the number of Ki-67-positive glomerulosa cells, was stimulated by Ang II in TGR and WT rats; however, this increase was significantly attenuated in TGR overexpressing the AT(2)R. In conclusion, AT(2)R in the adrenal ZG inhibits Ang II-induced cell proliferation but has no obvious lasting effect on the regulation of the aldosterone production at the investigated stages.

Immunogenic and tolerogenic signatures in human immunodeficiency virus (HIV)-infected controllers compared with progressors and a conversion strategy of virus control

Epidemiological studies have identified a small cohort of controllers of human immunodeficiency virus (HIV)-1 infection, who without treatment have no detectable virus, and others who progress at a variable rate. The objective of this study was to distinguish immune signatures in HIV controllers and progressors, by evaluating tolerogenic and immunogenic factors in untreated HIV-1 infected individuals. The recruited population was divided into putative elite controllers (PEC), long-term non-progressors (LTNP), normal progressors (NP) and fast progressors (FP). The proportion of regulatory T cells [T(regs) , CD4+ CD25+ forkhead box P3 (FoxP3+)], programmed death (PD)-1 and cytotoxic T lymphocyte antigen (CTLA)-inhibitory molecules and CD40L, CD69 and Ki67 activation markers were evaluated in peripheral blood mononuclear cells (PBMC) by flow cytometry. Significant differences were found between HIV controllers and HIV progressors, with up-regulation of T(regs) , PD-1 and CTLA-4 and decrease of CD40L expression in progressors compared with controllers. Expression of CD40L and concentrations of interleukin (IL)-6, CCL-3, and CCL-4 were significantly higher in PEC and LTNP than in NP and FP. In an attempt to convert immune signatures of progressors to those of controllers, seven agents were used to stimulate PBMC from the four cohorts. Treatment with CD40L and IL-4 or PD-1 antibodies in vitro were most effective in converting the immune signatures of progressors to those observed in controllers by down-regulating T(regs) and up-regulating CD40L expression in CD4+ T cells. The conversion concept merits translation to in vivo immune control of HIV infection.

Efficacy and safety of 5-mm-diameter bipolar and ultrasonic shears for cutting carotid arteries of the hybrid pig

BACKGROUND

Experimental data about the efficacy and safety of sealing devices are rare. Therefore, this study investigated these parameters for three commercially available energy-based vascular sealing and cutting systems.

METHODS

In male hybrid pigs, 487 carotid artery segments were sealed and cut using the harmonic scalpel or several bipolar sealing devices. The sealing failure rate, burst pressure, process time, and extent of lateral thermal damage were analyzed.

RESULTS

A regular sealing and cutting process in more than 90% of the carotid arteries was found using the following instruments: LS1520, ACE (level 1), ACE (level 3), CS14C (level 1), WAVE (level 1), and WAVE (level 5). The largest failure rate was found for the CS14C device (level 5: initial sealing failure, 21.5%). The maximal mean burst pressure (1727±453 mmHg) was reached using the ACE device (level 1). Significant differences were found in the size of the lateral thermal damage, which a ranged from 2.5 mm (LS1520) to 1.51 mm (CS14C, level 1). The process time ranged widely from 6.8 s (ACE, level 5) to 31.83 s (WAVE, level 1).

CONCLUSION

The current study demonstrated that all the tested devices are efficacious and safe in sealing and cutting arteries up to 5 mm in diameter. All the devices showed supraphysiologic mean burst pressures. Differences in failure rate, thermal damage, and process time lead to an advised application of the different systems.

[Cranial magnetic resonance imaging and serum marker S-100 for expert opinions in severe brain injuries]

Detailed imaging of the brain is necessary to come to an expert opinion on the consequences of severe brain injuries (BI). As lesions are not visualised on computerised tomography, magnetic resonance imaging (MRI) data and serum marker S-100 are currently favoured. Our study analyses the predictive qualities of MRI and S-100 for the outcome in severe BI in 100 patients. The location of brain stem lesions identified with the aid of MRI significantly correlated with the outcome. Special types of brain stem lesions could be distinguished. S-100 was a rough measure for the amount of destruction of CNS tissue, but the exact location of the destroyed tissue appeared to be more significantly related with the outcome than its volume. For an expert opinion on severe BI, follow up MRI after brain injury can definitely not exclude relevant lesions. Early MRI is recommended.

Psychological effects of occupational exposure to organic solvent mixtures on printers

PURPOSE

Neuropsychiatric symptoms associated with long-term exposure to organic solvents have been investigated for a long time in many occupational studies. The aim of our study was to identify preclinical effects of low-level chronic solvent exposure on the cognitive performance of silk-screen printers.

METHODS

A cross-sectional study was conducted including 38 printers which were exposed to organic solvent mixtures and 45 controls without neurotoxic exposure. The psychometric test battery included nine tests and two questionnaires.

RESULTS

The sum of scales or the total score of the PNF was also significantly (p <0.001) higher in the exposed group than in the non-exposed. The printers performed worse in some psychometric tests than did controls. Cross validation with the psychometric performances resulted in 69.6% of participants being correctly classified (55.9% printers and 80% controls). Highly significant differences (p<0.001) between both groups of exposed and non-exposed workers were found for the mean values of the multidimensional psychometric score.

CONCLUSIONS

These results of our study proved not only that chronic exposure to organic solvent mixtures could induce a psychological effect but also that the psychological/psychometrical tests performed in this study were capable of predicting neurotoxicity.

Meta-analysis of immune epitope data for all Plasmodia: overview and applications for malarial immunobiology and vaccine-related issues

We present a comprehensive meta-analysis of more than 500 references, describing nearly 5000 unique B cell and T cell epitopes derived from the Plasmodium genus, and detailing thousands of immunological assays. This is the first inventory of epitope data related to malaria-specific immunology, plasmodial pathogenesis, and vaccine performance. The survey included host and pathogen species distribution of epitopes, the number of antibody vs. CD4(+) and CD8(+) T cell epitopes, the genomic distribution of recognized epitopes, variance among epitopes from different parasite strains, and the characterization of protective epitopes and of epitopes associated with parasite evasion of the host immune response. The results identify knowledge gaps and areas for further investigation. This information has relevance to issues, such as the identification of epitopes and antigens associated with protective immunity, the design and development of candidate malaria vaccines, and characterization of immune response to strain polymorphisms.

A renin transcript lacking exon 1 encodes for a non-secretory intracellular renin that increases aldosterone production in transgenic rats

Renin transcripts lacking exon 1 and thus the signal sequence for co-translational transport to the endoplasmatic reticulum encode for a protein (exon[2-9]renin), that is confined to the cytoplasm. The function of exon(2-9)renin is currently unknown. Mitochondrial renin increases under conditions which stimulate aldosterone production. We hypothesized that exon(2-9)renin (1) is translated into a functionally active protein in vivo, (2) is not secreted but remains within the cytoplasm and (3) stimulates aldosterone production. To test these hypotheses we generated transgenic rats overexpressing exon(2-9)renin. Four transgenic lines were obtained expressing the transcript in various tissues including the heart and the adrenal gland. Renin was enriched particularly in the cytoplasm of transgenic rats. Renin was not elevated in plasma, indicating that exon(2-9)renin is produced but not secreted. The ratio of aldosterone to renin concentrations in plasma (PAC/PRC) was elevated in all transgenic lines except line 307, which also did not exhibit elevated cytoplasmatic renin levels in the adrenal gland (PAC/PRC in controls: 2.8±2.3; line 307: 1.9±0.8; n. s.; line 284: 5.8±1.9; P<0.02; line 294: 5.0±2.3; P<0.001; line 276: 10.3±5.1; P<0.001). We conclude that the exon(1A-9) renin transcript (1) is translated into a functionally active intracellular protein; (2) is targeted to the cytoplasm rather than being sorted to the secretory pathways and (3) is functionally active, regulating aldosterone production. The CX-(exon2-9)renin transgenic rat appears to be a useful model to study the role and the mechanisms of action of cytoplasmatic renin derived from exon(1A-9) transcripts.

The curation guidelines of the immune epitope database and analysis resource

The IEDB houses antibody and T cell epitope data and makes them accessible and searchable. The curation of literature references requires explicit guidelines in order to capture the data in an objective and consistent manner. Description of these guidelines ensures transparency of the database and facilitates direct submissions to the database.

Automated analysis of viral integration sites in gene therapy research using the SeqMap web resource

Research in gene therapy involving genome-integrating vectors now often includes analysis of vector integration sites across the genome using methods such as ligation-mediated PCR (LM-PCR) or linear amplification-mediated PCR (LAM-PCR). To help researchers analyze these sites and the functions of nearby genes, we have developed SeqMap (http://seqmap.compbio.iupui.edu/) a secure, web-based comprehensive vector integration site management tool that automatically analyzes and annotates large numbers of vector integration sites derived from LM-PCR experiments in human and model organisms upon a common genome database. We believe the use of this resource will enable better reproducibility and understanding of this important data.

Participation in two phase II prophylactic HIV vaccine trials in the UK

There will be a continued imperative to recruit large numbers of healthy volunteers to early phase prophylactic HIV vaccine (PHV) trials. We studied mechanisms associated with participation in two related phase II PHV trials. The most cited reasons for volunteering were altruism and a personal connection to HIV. The most successful recruiting strategies targeted organisations dealing with HIV, health or social issues, or were directed to large audiences through the mass media. However, circulated emails and word of mouth were the most resource-effective approaches. Group discussions and the collection of a pool of potential volunteers were much less effective than one-to-one discussions and immediate screening after recruitment. We utilised our findings to devise key recommendations to assist PHV trial teams who are planning future studies.

An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction

AIMS

We wanted to assess the factors that predict complications and patient satisfaction of totally implanted central venous access ports (TIAP).

METHODS

We reviewed 550 patients with breast or gynaecological malignancies who had initial port placement for chemotherapy between 1995 and 2006. We retrospectively assessed all TIAP complications, port duration and follow-up care until the TIAPs were removed (or the last known recorded documentation) or until the death of the patient. TIAP-related patient satisfaction was also assessed via a questionnaire-based survey of 356 patients.

RESULTS

561 TIAPs were placed in 550 cancer patients (11 patients received 2 TIAPs during the study period); the median time of port duration was 22.5 months. There were 104 complications in this group. Of these, 81 occurred during chemotherapy treatment that lasted a median time of 182 days. Removal secondary to complication was observed in 48 cases. TIAPs placed on the left chest side, through the subclavian vein or with the catheter tip localized in the peripheral part of superior vena cava demonstrated the highest incidence of complications. Patients with a BMI >28.75 had an increased risk for developing complications. Our follow-up questionnaire revealed a 93% patient satisfaction rate with the TIAP.

CONCLUSIONS

Patients with left-sided ports, catheter tips lying in the upper part of the superior vena cava and implantation via the subclavian vein are at a higher risk for TIAP-associated complications. Being excessively overweight was assessed as another risk factor for developing complications. TIAPs are highly accepted and further recommended by patients.