Inflammatory and Injury Responses to Ischemic Stroke in Obese Mice

Background and Purpose— Although epidemiological studies reveal an increased incidence of obesity and an association between obesity and the prevalence/severity of ischemic stroke, little is known about the mechanisms that link obesity to ischemic stroke. This study tested the hypothesis that obesity exacerbates the cerebrovascular dysfunction and tissue injury induced by brain ischemia and reperfusion.

Methods— The adhesion of leukocytes and platelets in cerebral venules, blood–brain barrier permeability, brain water content, and infarct volume were measured in wild-type, obese ( ob/ob ), and leptin-reconstituted ob/ob mice subjected to 30 minutes middle cerebral artery occlusion and reperfusion. Tissue and plasma cytokine levels were determined by cytometric bead array, and a role for monocyte chemoattractant protein-1 and interleukin-6 was assessed using blocking antibodies.

Results— Compared with wild-type mice, ob/ob exhibited larger increases in leukocyte and platelet adhesion, blood–brain barrier permeability, water content, and infarct volume after middle cerebral artery occlusion–reperfusion. Reconstitution of leptin in ob/ob mice tended to further enhance all reperfusion-induced responses. Ob/ob mice also exhibited higher plasma levels of monocyte chemoattractant protein-1 and interleukin-6 than wild-type mice. Immunoneutralization of monocyte chemoattractant protein-1, but not interleukin-6, reduced infarct volume in ob/ob mice.

Conclusions— Obesity worsens the inflammatory and injury responses to middle cerebral artery occlusion and reperfusion by a mechanism independent of leptin deficiency. monocyte chemoattractant protein-1 appears to contribute to the exaggerated responses to ischemic stroke in obese mice.

Association between nitric oxide and oxidative stress in continuous ambulatory peritoneal dialysis patients with peritonitis

BACKGROUND

Peritonitis is a major complication in continuous ambulatory peritoneal dialysis (CAPD) patients, and the mechanisms involved in the pathology are important if the success rate of treatment strategies is to increase.

MATERIAL AND METHODS

A total of 50 CAPD patients (25 with 25 episodes of peritonitis and 25 with no clinical or laboratory signs of infection) were included in the study. Malondialdehyde (MDA) and nitric oxide (NO) metabolites in serum and dialysate effluents were determined.

RESULTS

The dialysate/serum (D/S) ratio of the NO metabolites and serum NO metabolite concentrations were significantly higher in the peritonitis group. Serum and dialysate MDA concentrations were also significantly higher in the peritonitis group. The D/S ratio of MDA was significantly higher in the control group.

CONCLUSIONS

Local peritoneal NO production and oxidative stress seem to increase in CAPD patients during the peritonitis attack.

The evolving paradigm for blood cell-endothelial cell interactions in the cerebral microcirculation

Inflammation and microvascular dysfunction have been implicated in a variety of pathologic conditions affecting the brain. Features of the inflammatory response that are common to many of these pathological conditions and that are manifested in the neurovasculature include oxidative stress, diminished endothelial barrier function (increased vascular permeability), increased expression of endothelial cell adhesion molecules, and the recruitment of rolling and adherent leukocytes and platelets. The evidence implicating leukocyte-endothelial cell adhesion in cerebral microvessels as a rate-determining component of the pathophysiology associated with conditions such as ischemia-reperfusion, sickle cell disease, and gamma -irradiation is summarized. Mechanisms that have been proposed to explain the recruitment of adherent leukocytes and platelets in the diseased/injured cerebral microvasculature are also addressed, and a common paradigm for blood cell recruitment induced by seemingly unrelated pathological conditions is outlined. Although there are many structural and functional characteristics of the cerebral microvasculature that distinguish it from other regional vascular beds, the processes that underlie the recruitment of injury-causing inflammatory cells in the brain appear to closely resemble those described for other tissues.

Sexual function in women with coronary artery disease: a preliminary study

We investigated sexual function in female patients with coronary artery disease (CAD). A total of 20 consecutive female patients (38.2+/-3.8 years) with CAD diagnosed by coronary angiography and 15 healthy subjects (37.9+/-5.4 years) were enrolled in this study. The Female Sexual Function Index (FSFI) was used to assess sexual function in all the participants. Women with psychiatric disorders, gynecologic and systemic diseases that may affect sexual function were excluded from the study. The other exclusion criteria were usage of antidepressants and drugs affecting sexual function. Patients with CAD and healthy women were comparable in age, body mass index and education level. Female sexual dysfunction (FSD) was diagnosed in 12 of 20 women with CAD (60%), whereas five of 15 healthy women (33.3%) were found to have FSD (P<0.05). Patients with CAD had a significantly lower number of sexual intercourse episodes per month than healthy women volunteers (2.24 versus 5.2, respectively; P<0.05). The FSFI total score was clearly significantly decreased in the CAD group compared with that in healthy controls (17.8+/-2.9 and 26.0+/-4.8, P=0.001). When the subscores of each domain of FSFI were evaluated, all the subscores of FSFI, except the satisfaction domain, in patients with CAD were significantly lower than those of healthy subjects (P<0.05). This preliminary study demonstrates that female patients with CAD have distinct sexual dysfunction compared with healthy controls. Women with CAD should be evaluated also in terms of sexual function to provide better quality of life.

Seroprevalence of herpes simplex virus type 1 and type 2 in Turkey

BACKGROUND

Herpes simplex virus (HSV) infections are among the most common infectious diseases in humans. The prevalence of herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) varies widely across the world. HSV-2 infection is the primary cause of genital herpes. It is highly prevalent in human populations in many parts of the world, and is the most common cause of genital ulcer disease worldwide. In spite of the large prevalence and growing incidence of herpes simplex infection (HSV-1 and HSV-2), relatively few data have been published regarding the seroprevalence of herpes simplex infection, while no data exist regarding the Turkish population.

METHODS

We aimed to investigate the prevalence of HSV-1 and HSV-2 in selected populations in Turkey. A cross-sectional study was conducted involving 2082 serum samples of 725 adults, 300 pregnant women, 200 blood donors, 483 sex workers and 110 patients with genital warts and 264 hotel staff in Istanbul, Turkey. All serum samples were assessed for HSV1 and HSV-2 IgG antibodies using an HSV-type specific, enzyme-linked immunosorbent assay (ELISA).

RESULTS

The prevalence of HSV-2 and HSV-1 antibodies was 4.8 and 85.3% in sexually active adults; 5.5 and 96% in blood donors; 5 and 98% in pregnant women, 17.3 and 93.6% in patients with genital warts; 8.3 and 97.3% in hotel staff; and 60% and 99% in sex workers.

CONCLUSION

These results confirm a higher prevalence of HSV infection than estimated, especially in high risk groups in Turkey. The high prevalence of HSV infection underlines the need for education among these populations.

Opportunistic Posterior Uveal Infections in Renal Transplant Patients

AIMS

To describe the cases of opportunistic posterior uveal infection diagnosed in renal transplant recipients at a single center over a 10-year period.

METHODS

The study involved 1156 patients who underwent renal transplantation. Five of the recipients were diagnosed with posterior uveal infection. The specific diagnoses were acute retinal necrosis (two cases), cytomegalovirus retinitis (one case), nocardial chorioretinitis (one case), or tuberculoid granuloma (one case).

RESULTS

The five patients were aged 27 to 55 years, and the interval from renal transplantation to uveal infection ranged from 7 months to 16 years. All patients were receiving immunosuppressive treatment at the time of the posterior uveal infection. Acute retinal necrosis was diagnosed in cases I and II at 2 and 3 years after transplantation, respectively. In both cases, fundus examination revealed moderate vitritis and yellow-white lesions representing confluent retinitis. In case III (cytomegalovirus retinitis), 7 months after transplantation the patient developed extensive hemorrhage and confluent white exudates, periphlebitis, and perivascular sheathing in the right eye. In case IV, culture of a fine-needle aspirate from a well-demarcated, white-yellow, elevated choroidal lesion in the superotemporal region of the macula revealed nocardial infection. Fundus examination of the right eye of case V revealed a small, hypopigmented choroidal lesion superior to the optic disc. The lesion was identified as a choroidal tuberculoid granuloma.

CONCLUSIONS

Opportunistic chorioretinal infections can occur at any time after renal transplantation. So it is important that every kidney recipient undergo regular ophthalmic examinations throughout his or her lifetime.

Gamma secretase-mediated Notch signaling worsens brain damage and functional outcome in ischemic stroke

Mice transgenic for antisense Notch and normal mice treated with inhibitors of the Notch-activating enzyme gamma-secretase showed reduced damage to brain cells and improved functional outcome in a model of focal ischemic stroke. Notch endangers neurons by modulating pathways that increase their vulnerability to apoptosis, and by activating microglial cells and stimulating the infiltration of proinflammatory leukocytes. These findings suggest that Notch signaling may be a therapeutic target for treatment of stroke and related neurodegenerative conditions.

Role of T lymphocytes and interferon-gamma in ischemic stroke

BACKGROUND

Although lymphocyte recruitment and activation are associated with cerebral ischemia-reperfusion (I/R) injury, the contributions of specific lymphocyte subpopulations and lymphocyte-derived interferon-gamma (IFN-gamma) to stroke remain unknown. The objectives of this study were to define the contribution of specific populations of lymphocytes to the inflammatory and prothrombogenic responses elicited in the cerebral microvasculature by I/R and to investigate the role of T-cell-associated IFN-gamma in the pathogenesis of ischemic stroke.

METHODS AND RESULTS

Middle cerebral artery occlusion was induced for 1 hour (followed by 4 or 24 hours of reperfusion) in wild-type mice and mice deficient in lymphocytes (Rag1(-/-)), CD4+ T cells, CD8+ T cells, B cells, or IFN-gamma. Platelet and leukocyte adhesion was assessed in cortical venules with intravital video microscopy. Neurological deficit and infarct volume were determined 24 hours after reperfusion. Rag1(-/-), CD4+ T-cell(-/-), CD8+ T-cell(-/-), and IFN-gamma(-/-) mice exhibited comparable significant reductions in I/R-induced leukocyte and platelet adhesion compared with wild-type mice exposed to I/R. Infarct volume was reduced and I/R-induced neurological deficit was improved in immunodeficient Rag1(-/-) mice. These protective responses were reversed in Rag1(-/-) mice reconstituted with either wild-type or, to a lesser extent, IFN-gamma(-/-) splenocytes. B-cell-deficient mice failed to show improvement against ischemic stroke injury.

CONCLUSIONS

These findings indicate that CD4+ and CD8+ T lymphocytes, but not B lymphocytes, contribute to the inflammatory and thrombogenic responses, brain injury, and neurological deficit associated with experimental stroke. Although IFN-gamma plays a pivotal role in stroke-induced inflammatory responses, T lymphocytes appear to be a minor source of this cytokine.

Brief intervention on maternal smoking: a randomized controlled trial

OBJECTIVES

To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than mothers who received routine smoking cessation advice, which focused on their own health, or a control group of mothers.

SETTING

Tertiary referral centre.

METHODS

Randomized control trial. A total of 363 mothers were randomly assigned to a smoking cessation intervention either aimed at their children's health (n = 111) or their own health (n = 131), or to a control group receiving no smoking cessation advice (n = 121).

RESULTS

Provision to mothers of both groups of health risks of tobacco smoke resulted in significantly higher rate of cessation of smoking and smoking location change than those of the control group, with child intervention group having significantly higher rate of cessation of smoking and smoking location change than those of the maternal intervention group (P < 0.05). Post-intervention knowledge scores differed significantly for all groups; however, child intervention group was the only significantly better group than the others (P < 0.05). According to the multivariate analysis results, intervention grouping and presence of smoking friends were independent factors determining smoking cessation (P < 0.05). Intervention grouping, post-intervention knowledge, presence of other household members who smoked and family income were independent factors determining smoking location change (P < 0.05). Family income, intervention grouping and presence of smoking friends were significant independent factors influencing post-intervention knowledge (P < 0.05).

CONCLUSION

Discussion during short paediatric visits on effects of smoking on child's or maternal health may result in a significant smoking cessation, smoking location change rate or knowledge change. Those who cannot give up smoking usually change their location of smoking. Provision of information on effects of smoking on child's health, rather than maternal, may result in more significant changes in behaviour or knowledge. Maternal education on smoking should include information on effects of smoking on both child's and maternal health, but should be especially focused on child's health.

CD40/CD40 Ligand Signaling in Mouse Cerebral Microvasculature After Focal Ischemia/Reperfusion

BACKGROUND

CD40/CD40 ligand (CD40L) signaling contributes to proinflammatory and prothrombogenic responses in the vasculature. CD40/CD40L expression is elevated in patients after a transient ischemic attack or stroke. The purpose of this study was to investigate the role of CD40/CD40L signaling in cerebral microvascular dysfunction and tissue injury response to middle cerebral artery occlusion (MCAO) and reperfusion.

METHODS AND RESULTS

Intravital fluorescence microscopy was used to visualize the cerebral microcirculation of wild-type (WT), CD40-deficient, and CD40L-deficient mice subjected to 1-hour MCAO and 4-hour reperfusion. The adhesion of platelets and of leukocytes and vascular permeability were measured in postcapillary venules after 4-hour and 1-hour reperfusions, respectively. Cerebral infarct volume was analyzed 24 hours after reperfusion. Platelet and leukocyte adhesion was elevated and blood/brain barrier function was compromised by MCAO in WT mice. Blood cell recruitment and increased permeability were blunted in both CD40-deficient and CD40L-deficient mice. Infarct volume was also reduced in CD40- and CD40L-deficient mice compared with WT mice.

CONCLUSIONS

Our findings indicate that CD40/CD40L signaling contributes to inflammatory and prothrombogenic responses and brain infarction induced by MCAO and reperfusion. The CD40/CD40L dyad may play a significant pathogenic role in the acute phase of ischemic stroke.

Massive ovarian oedema in adolescents

Massive ovarian oedema is an unusual clinical entity occurring in teenage girls. It is a rare tumour-like condition of the ovary characterized by marked enlargement of one or both ovaries due to marked accumulation of oedema fluid in the ovarian stroma. Massive ovarian oedema may result from partial or intermittent torsion of the mesovary, interfering with venous and lymphatic drainage, but not with arterial blood flow. The patients most commonly present with lower abdominal pain and enlargement. This entity can clinically mimic a neoplasia. We report three cases with massive ovarian oedema.

[Nosocomial Stenotrophomonas maltophilia infections in a university hospital]

Stenotrophomonas maltophilia is a nosocomial pathogen of increasing importance. In our study, 190 S. maltophilia strains isolated from 153 hospitalized patients between January 2000-April 2004, at Farabi Hospital at Medical School of Karadeniz Technical University, were prospectively evaluated. Of these patients 67.9% were clinically compatible with nosocomial infection, and 32% were considered as colonization. It was observed that rate of infection had a tendency to increase one year of age and above 50 years of age. Nosocomial infection and/ or colonization with S. maltophilia was detected in 19.7 +/- 15.2 (1-89) days after hospitalization. The clinical manifestations were bacteremia (36.5%), pneumoniae (28.8%), urinary system infection (12.5%), surgical site infection (11.5%) and peritonitis (6.7%). The bacteremia episodes were associated with central venous catheter in 37.3% (19/51), ventilator associated pneumonia in 11.7% (6/51), urinary system infection in 7.8% (4/51), peritonitis in 3.9% (2/51), and surgical site infection in 1.9% (1/51) of cases. Nineteen patients (37.3%) had no apparent primary source of infection. Higher APACHE II score, longer duration of hospitalization and prior extended-spectrum antibiotic therapy were observed in most of the patients. Antibiotic susceptibility testing revealed that, the most effective antibiotics against the isolates were trimethoprim-sulfamethoxazole (94%), ticarcillin/clavulanate (79%) and ciprofloxacin (53.5%). Crude mortality rate in the patients with S. maltophilia infections was found to be 25%. In addition, it was observed that proper antibiotic treatment had protective role against mortality (14.6% vs 63.6%; OR = 0.1, Cl95 0.12-0.42, P = 0.000). It can be concluded that to prevent infections due to S. maltophilia , effective infection control programmes and rational antibiotic use policies should be established promptly.