Secretion of soluble ST2 - possible explanation for systemic immunosuppression after heart surgery

BACKGROUND

Cardiopulmonary bypass is known to affect cytokine release leading to a generalized endogenous immune reaction similar to that described in sepsis, without having been explored in great detail. Therefore we evaluated the anti- and pro-inflammatory cytokine responses after heart surgery.

METHODS

16 patients who underwent coronary artery bypass graft (CABG) surgery with extracorporeal circulation were included. ST2, IL-4 and IL-10 served as markers for TH2 cytokine response; IL-6, IL-8 and IFN-gamma as TH1 markers. Furthermore, total immunoglobulin subtype analysis (IgM, IgG, IgE) was performed.

RESULTS

Serum levels of soluble ST2 started to climb at 60 minutes (from 38 +/- 14 preoperatively to 1 480 +/- 890 pg/ml) and peaked 24 hours after surgery (13 360 +/- 2 840 pg/ml, P < 0.001). IL-10 reached a maximum at 60 minutes and returned to baseline levels 24 hours later. IL-6 and IL-8 levels peaked 60 minutes after surgery. IL-4 and IFN-gamma did not change. Only IgM showed a significant peak on day eight ( P < 0.001).

CONCLUSION

Our results demonstrate that CABG surgery induces a massive long-lasting secretion of ST2, a protein related to immune suppression.

Elevated levels of interleukin-1beta-converting enzyme and caspase-cleaved cytokeratin-18 in acute myocardial infarction

BACKGROUND

Systemic inflammation and apoptosis-specific immune activation play a major role in acute coronary syndromes (ACS) including acute myocardial infarction (AMI). The role of systemic and coronary obtained inflammatory plasma protein interleukin-1beta precursor (IL-1betap), IL-1beta-converting enzyme (ICE) and the apoptosis-specific caspase-cleaved cytokeratin-18 (ccCK-18) are not known in ACS.

MATERIALS AND METHODS

Plasma samples were obtained from stable angina (SA, n = 34), unstable angina (UA, n = 37) and patients with AMI (n = 39). Coronary blood was acquired by means of thrombectomy devices (X-sizer) in AMI patients. IL-1betap, ICE and ccCK-18 were determined by enzyme-linked immunosorbent assay (ELISA). Group comparisons were evaluated by parametric Tukey test. Multivariate logistic regression analysis was performed to determine predictive values of IL-1betap, ICE and ccCK-18 as compared to creatine kinase (CK) and troponin T (TnT) in order to relate these markers with the occurrence of myocardial damage.

RESULTS

IL-1betap, ICE and ccCK-18 were identified to be significantly altered in the peripheral blood of patients suffering from AMI as compared to SA and UA. ROC curves were plotted and revealed that ccCK-18 is a novel sensitive marker for the detection of myocardial damage as compared to TnT or CK. (AUC ccCK-18 0.925, TnT AUC 0.62 and CK AUC 0.858.) Moreover, ICE and ccCK-18 were significantly increased at the site of coronary occlusion as compared to peripheral blood samples in AMI patients (both P < 0.001).

CONCLUSION

Our data suggest that ACS is related to increased concentration of systemic soluble ICE and ccCK-18. Moreover, soluble ccCK-18 was identified to be a superior marker as compared to TnT or CK, for detection of myocardial damage.

[Occupational and non-occupational risk factors in bladder cancer patients in an industrialized area located in former East-Germany]

PURPOSE

Several occupational carcinogens are metabolized by polymorphic enzymes. The distribution of the polymorphic enzymes N-acetyltransferase 2 (NAT2; substrates: aromatic amines), glutathione S-transferase M1 (GSTM1; substrates: e. g., reactive metabolites of polycyclic aromatic hydrocarbons), and glutathione S-transferase T1 (GSTT1; substrates: small molecules with 1 - 2 carbon atoms) were investigated.

MATERIAL AND METHODS

At the urological department in Lutherstadt Wittenberg, 136 patients with a histologically proven transitional cell cancer of the urinary bladder were investigated for all occupations performed for more than 6 months. Several occupational and non-occupational risk factors were asked. The genotypes of NAT2, GSTM1, and GSTT1 were determined from leucocyte DNA by PCR.

RESULTS

Compared to the general population in Middle Europe, the percentage of GSTT1 negative persons (22.1 %) was ordinary; the percentage of slow acetylators (59.6 %) was in the upper normal range, while the percentage of GSTM1 negative persons (58.8 %) was elevated in the entire group. Shifts in the distribution of the genotypes were observed in subgroups who had been exposed to asbestos (6/6 GSTM1 negative, 5/6 slow acetylators), rubber manufacturing (8/10 GSTM1 negative), and chlorinated solvents (9/15 GSTM1 negative).

CONCLUSIONS

The overrepresentation of GSTM1 negative bladder cancer patients also in this industrialized area and more pronounced in several occupationally exposed subgroups points to an impact of the GSTM1 negative genotype in bladder carcinogenesis.

Psychological impact of torture: a 3-month follow-up of mass-evacuated Kosovan adults in Sweden. Lessons learnt for prevention

OBJECTIVE

To study the impact of torture on symptomatology among mass displaced adults.

METHOD

A sample (total 131; 70 females, 61 males) of mass displaced adults from Kosovo, in Sweden, completed 3 months after a baseline study on trauma experiences and perceived symptoms, self-rated instruments measuring psychiatric symptoms, aggression and coping.

RESULTS

Torture is associated with poor coping (manageability); depression, anxiety and aggression are associated with post-traumatic stress disorder. All psychiatric symptoms and poor coping (but not aggression) are associated with being female. Limitations of the study include a relatively small sample. Ongoing trauma and stress before repatriation may also influence the responses. Several lessons learnt for prevention are discussed.

CONCLUSION

Anger and hostility are important consequences of torture. Further research is necessary to understand the associations among coping strategies, psychiatric symptoms, aggression, torture experience and gender over time after repatriation or applying for asylum.

Clearance of moxifloxacin during continuous haemofiltration (CVVHF) in vitro

BACKGROUND/AIMS

The clearance of moxifloxacin is reported to be unaltered in the presence of renal insufficiency. There is little information about the clearance of intravenous moxifloxacin in renal replacement therapies during intensive care. The aim of this study was to determine the clearance of moxifloxacin during continuous veno-venous haemofiltration (CVVHF) in vitro.

METHODS

The elimination of moxifloxacin (reservoir with 600 mL of washed human erythrocytes, 100 mL of NaHCO3 and various amounts of Ringer solution and human albumin to give a total volume of 1000 mL, pH 7.35 +/- 0.5; haematocrit 41 +/- 2) during CVVHF in vitro with two filter conditions (during priming, after priming), three protein concentrations (human albumin: 0 g/L, 20 g/L, 40 g/L) and two filtration velocities [(i) standard condition: blood flow at 100 mL/min and turnover of 2 L/h; (ii) blood flow at 50 mL/min and turnover of 1 L/h] were investigated.

RESULTS

A new filter needs 20 min of priming before moxifloxacin reaches a steady relative filtration rate. The sieving coefficient with 0 g/L albumin was 1.07, with 20 g/L 0.90 and with 40 g/L 0.80. Under standard filtration conditions (i) the renal clearance was between 26.7 and 35.7 mL/min, and under the altered conditions (ii) it was 15.2 mL/min.

CONCLUSION

During CVVHF in vitro we found filtration clearances of moxifloxacin of the same order as its renal clearance in healthy subjects. The high sieving coefficient, nearly independent of blood protein concentration, would suggest that moxifloxacin is filtered almost as freely as creatinine. These results do not indicate a need for dose adjustment under appropriate haemofiltration conditions and normal hepatic function.

A comparison of the clinopyroxene compounds CaZnSi2O6and CaZnGe2O6

Single crystals of CaZnSi2O6 (calcium zinc silicate) and CaZnGe2O6 (calcium zinc germanate) were synthesized at 1623 K and 2.5 GPa by slow cooling of the melts from 1473 K. Structure solution using Patterson methods revealed the two compounds to be isomorphous and thus isostructural. They adopt the clinopyroxene structure type with space group C2/c. The substitution of Ge4+ for Si4+ increases the distortion of the tetrahedra and octahedra. The increased size of the tetrahedral GeO4 chain is mainly compensated by (i) increasing the kinking of the tetrahedral chain and (ii) lengthening the Zn-O bonds.

Immunohistological characterization of striatal and amygdalar structures in the telencephalon of the fire-bellied toad bombina orientalis

The subpallium of the fire-bellied toad Bombina orientalis was studied by means of enzyme-histological detection of NADPH-diaphorase and immunohistological demonstration of aspartate, GABA, calretinin, choline-acetyl transferase, Leu-and Met-enkephalin, neuropeptide Y, 5-hydroxy-tryptamine (serotonin), somatostatin, substance P and tyrosine-hydroxylase. As in other vertebrates, the striato-pallidum is characterized by GABA-, substance P- and enkephalin-immunoreactivity. Neurons and fibers differing in immunoreactivity are arranged in layers. Choline-acetyl transferase-immunoreactive neurons were found in a position corresponding to the mammalian cholinergic cell-group (Ch4-group), which therefore may be homologous to the nucleus basalis of Meynert. Within the amygdaloid complex, the cortical and lateral (vomeronasal) nuclei are similar in calretinin-, GABA-, NADPH-diaphorase-, enkephalin, substance P- and neuropeptide Y-(immuno)histology. The medial and central amygdaloid nuclei reveal a dense peptidergic innervation, and the medial amygdala additionally exhibits serotonergic fibers and cell bodies staining for neuropeptides and tyrosine-hydroxylase. Differences between Bombina and other anuran species exist, such as the absence of cholinergic neurons in the striatum. Our findings corroborate the view based on recent studies on the hodology and cytoarchitecture of the anuran telencephalon that the anuran ventral telencephalon contains most of the structures found in the mammalian brain. This concerns a septal region, a dorsal and ventral striato-pallidum including a nucleus accumbens and an amygdaloid complex consisting of a central, cortical and vomeronasal amygdala. The only major difference appears to concern the lack of a basolateral amygdala.

Alpha-Gal on bioprostheses: xenograft immune response in cardiac surgery

BACKGROUND

The alpha-Gal (Galalpha1,3-Galbeta1-4GlcNAc-R) epitope is the major xenoantigen causing hyperacute rejection of pig organs transplanted into primates. Porcine bioprostheses are utilized in cardiac surgery. However, premature degeneration of bioprostheses has limited utilization in younger patients and the immune response remains elusive. We sought to investigate whether a specific alpha-Gal immune response may play a role in this clinical scenario.

MATERIALS AND METHODS

We investigated the presence of alpha-Gal-epitope on native and fixed porcine valves by means of confocal laser scanning microscope (CLSM). ELISA was utilized to evidence whether implantation of bioprostheses elicits augmentation of pre-existing cytotoxic anti alpha-Gal IgM antibodies within 10 days of surgery. Patients who underwent coronary artery bypass grafting (CABG) or mechanical valve replacement served as controls (each group, n = 12). To corroborate the clinical relevance of the alpha-Gal immune response in vivo, we studied serum obtained before and after implantation of bioprostheses and its potency to lyse porcine alpha-Gal-bearing PK15 cells.

RESULTS

We found the immunogenic alpha-Gal-epitope on fibrocytes interspersed in the connective tissue of porcine valves as determined by vimentin/IB4 lectin binding. Moreover, patients who were provided with a bioprostheses had developed a significant increase of naturally occurring cytotoxic IgM antibodies directed towards alpha-Gal after surgical intervention as compared with control patients (P < 0.0001, respectively). Sera obtained from the patients after the implantation of bioprostheses demonstrated an increased cytotoxicity against alpha-Gal-bearing PK-15 cells as compared with preoperative sera (P < 0.001). The specificity of the cytotoxic effects was proven as soluble Galalpha1-3Galbeta1-4GlcNAc markedly inhibited cell death of alpha-Gal-bearing PK15 cells (P < 0.001).

CONCLUSION

Our data suggest that implantation of bioprostheses in cardiac surgery induces a xenograft-specific immune response. Procedures diminishing the presence of alpha-Gal on bioprostheses, such as utilization of genetically manipulated alpha-Gal-deficient xenograft or pretreatment with alpha-Galactosidase, might diminuate the immune response against bioprostheses and extend durability.

Ergebnisqualität bei der Maschinellen Autotransfusion und Einflussfaktoren

Also intraoperative blood salvage (IBS) requires a system for quality management with controls of product an process quality. These can help early detection of malfunctions. For proper reaction and for improvement of quality a deep understanding of the process of blood salvage is necessary. This is supported by experimental testing of equipment, programs, and process variables, and by analysis of their effects on the process. The use of fresh whole blood and total protein as wash-out parameter in these tests is superior to outdated banked RBC and free haemoglobin. The process of aspiration turns out much less harmful than expected, when tested with fresh blood. Low wash volumes, fast washing rates, and half full bowls should be avoided. Plasma wash-out is improved by slower washing or by higher wash volumes, but the latter decrease RBC recovery. Such quality management helps to provide blood of excellent quality by IBS for optimal haemotherapy.

Topographic representation of vestibular and somatosensory signals in the anuran thalamus

In the isolated brain of the fire-bellied toad, Bombina orientalis, the spatial distribution of vestibular and somatosensory responses in thalamic nuclei was studied following electrical activation of the Vth nerve, the ramus anterior of the VIIIth nerve and of the dorsal roots of spinal nerves 3 and 8. Responses were systematically mapped in frontal planes through the diencephalon at four rostro-caudal levels. The calculated activity maps were superimposed on the outlines of diencephalic nuclei, and those nuclei that received particularly large inputs from the stimulated sensory nerve roots were indicated. Maximal response amplitudes coincided with ventral, central, and posterior thalamic areas and exhibited a topography that differed for each sensory nerve root. Maximal responses evoked from the Vth nerve were largely separated from those from spinal dorsal roots 3 and 8, whereas maximal vestibular responses partly overlapped with those from the other somatosensory nerve roots. Our findings indicate that within the amphibian thalamus sensory signals originating from different nerve roots are largely represented in separate areas as is the case in the thalamus of amniotes. However, the anterior dorsal thalamus which is the only origin of ascending pathways to the medial and dorsal pallium (assumed homologues of the mammalian hippocampus and neocortex, respectively) receives only minor vestibular and somatosensory input. This corroborates the view that amphibians lack a direct sensory thalamo-cortical, or "lemnothalamic," pathway typical of mammals and birds.

The ferriannite KFe\bf{_3^{2+}}(Al0.26Fe\bf{_{0.76}^{3+}Si3)O10(OH)2at 100 and 270 K

Unusually large and good-quality single crystals of the synthetic trioctahedral mica KFe(3)(2+)(Al(0.26)Fe(0.76)(3+)Si(3))O(10)(OH)(2) [potassium triiron(II) aluminasilaferrate(III) decaoxide dihydroxide] have been grown hydrothermally. X-ray diffraction data measured at 270 and 100 K have been used to refine the crystal structure, including the positions of the H atoms. This synthetic mica is similar to annite, KFe(3)AlSi(3)O(10)(OH)(2), and crystallizes with the same monoclinic C2/m symmetry. No phase transition has been observed down to 100 K. At low temperature, the ditrigonal distortion of the mica structure increases markedly, while the octahedral and tetrahedral bond lengths tend to decrease and increase, respectively. A detailed comparison of structural parameters in various Fe-rich micas is presented.

Increased serum concentrations of soluble CD95/Fas and caspase 1/ICE in patients with acute angina

OBJECTIVES

To investigate the expression of death inducing receptors in the sera of patients with stable and unstable angina.

DESIGN

80 consecutive patients with stable (n = 40) or unstable (n = 40) angina pectoris were studied. Serum concentrations of soluble CD95 (sCD95), soluble CD95 ligand (sCD95L; CD178), tumour necrosis factor (TNF) alpha, soluble TNFalpha receptor type 1 (sTNFR1), and interleukin 1beta converting enzyme (ICE; caspase 1) were measured by enzyme linked immunosorbent assay (ELISA).

RESULTS

Significant increases in the concentrations of sCD95 and ICE (p < 0.001 and p < 0.023, respectively) were found in the serum from patients with unstable angina relative to those with stable angina. There were no significant differences in the concentrations of sCD95L, TNF alpha, and sTNFR1 between the groups.

CONCLUSIONS

These data provide the first evidence that sCD95 and ICE are important serological markers that may help to discriminate between stable and unstable angina. This observation may warrant further clinical study to elucidate the clinical impact of sCD95 and ICE in acute coronary syndromes.

Lithium and sodium yttrium orthosilicate oxyapatite, LiY9(SiO4)6O2 and NaY9(SiO4)6O2, at both 100 K and near room temperature

Lithium yttrium orthosilicate oxyapatite [lithium nonayttrium hexakis(silicate) dioxide], LiY(9)(SiO(4))(6)O(2), crystallizes in the centrosymmetric space group P6(3)/m at both 295 and 100 K. The structure closely resembles those of fluorine apatite and sodium yttrium orthosilicate oxyapatite [sodium nonayttrium hexakis(silicate) dioxide], NaY(9)(SiO(4))(6)O(2), which was also investigated, at 270 and 100 K, in this study. There are two different crystallographic sites for the Y(3+) ion, which are coordinated by seven and nine O atoms. One-fourth of the nine-coordinated site is occupied by Li or Na atoms, thus maintaining charge balance. The Si atom occupies a tetrahedral site. The two compounds show no symmetry change between room temperature and 100 K, and the alterations in structural parameters are small.

LiInSiO4: a new monovalent-trivalent olivine

The structure of the olivine LiInSiO(4) (lithium indium silicate) is isotypic with LiScSiO(4) and MgMgSiO(4) (forsterite). The main differences between the title compound and the divalent-divalent olivines are found for the bond lengths and angles opposite common edges between the tetrahedron and the Li(+) and In(3+) ion sites. The tetrahedron shares one common edge with the Li(+) site and two common edges with the In(3+) site. The tetrahedron is distinctly distorted, as are the Li(+) and In(3+) sites.

Neuromagnetic correlates of perceived contrast in primary visual cortex

When a target grating is flashed into a larger, surrounding grating, its contrast is perceived to be lower when both gratings are oriented collinearly rather than orthogonally. This effect can be used to dissociate the perceived contrast from the physical contrast of a target grating. We recorded the transient electric potentials and magnetic fields evoked by flashed target gratings and compared them with psychophysical judgments of perceived contrast. Both early (100 ms) and late (150 ms) transients were reduced in amplitude when targets were flashed into a collinear rather than orthogonal surround, thus paralleling the reduction in perceived contrast. Although targets in orthogonal backgrounds required 40% lower physical contrast to match the perceived contrast of collinear targets, the amplitudes of electrophysiological transients of matching stimuli were almost identical. Thus the responses correlated better with perceived than with physical target contrast. This holds especially for the late transient response. Source localization indicated that the transients in question may originate in primary visual cortex. Our results therefore identify the activity of primary visual cortex as one possible neural correlate of perceived contrast.