Host-pathogen interactions under pressure: A review and meta-analysis of stress-mediated effects on disease dynamics

Human activities have increased the intensity and frequency of natural stressors and created novel stressors, altering host-pathogen interactions and changing the risk of emerging infectious diseases. Despite the ubiquity of such anthropogenic impacts, predicting the directionality of outcomes has proven challenging. Here, we conduct a review and meta-analysis to determine the primary mechanisms through which stressors affect host-pathogen interactions and to evaluate the impacts stress has on host fitness (survival and fecundity) and pathogen infectivity (prevalence and intensity). We assessed 891 effect sizes from 71 host species (representing seven taxonomic groups) and 78 parasite taxa from 98 studies. We found that infected and uninfected hosts had similar sensitivity to stressors and that responses varied according to stressor type. Specifically, limited resources compromised host fecundity and decreased pathogen intensity, while abiotic environmental stressors (e.g., temperature and salinity) decreased host survivorship and increased pathogen intensity, and pollution increased mortality but decreased pathogen prevalence. We then used our meta-analysis results to develop susceptible-infected theoretical models to illustrate scenarios where infection rates are expected to increase or decrease in response to resource limitations or environmental stress gradients. Our results carry implications for conservation and disease emergence and reveal areas for future work.

Use of statins in cancer patients following acute myocardial infarction and its impact on long-term clinical outcomes

Background

Statin use and its impact on long-term clinical outcomes in cancer patients following acute myocardial infarction (MI) remains insufficiently elucidated.

Purpose

We sought to analyze the prevalence of statins use in MI patients with cancer hospitalized in a tertiary cardio-oncology center and its influence on long-term mortality.

Methods

Of the 1,011 consecutive acute MI patients hospitalized between 2012 and 2017, cancer was found in 134 (13.3%) subjects including newly diagnosed cancer in 24 of them. All patients underwent coronary angiography. Within a median follow-up of 69.2 (37.8–79.9) months, a mortality rate, and its determinants were analyzed.

Results

Compared with non-cancer population, MI patients with cancer were older (73 [66–79] versus 68 [60–78] years, P<0.001), had lower hemoglobin level (12.8 [11.2–14.0] vs 13.8 [12.8–15.0], P<0.001), lower total cholesterol (4.1 [3.4–4.8] vs 4.4 [3.6–5.3], P=0.006) and lower HDL cholesterol (1.1 [0.9–1.4] vs 1.2 [1.0–1.6], P<0.001), without significant differences in LDL cholesterol (2.5 [1.9–3.1] vs 2.6 [1.7–3.4], P=0.70). Statins were prescribed less frequently in MI patients with cancer as compared with non-cancer MI population (80.5% versus 92.1%, P<0.001). Atorvastatin was the most frequent statin in both cancer and non-cancer groups (68.4% versus 75.1%, P=0.13). In cancer group simvastatin was more frequently (16.7% versus 5.9%, P<0.001) while rosuvastatin was less frequently (8.8% versus 18.9%, P=0.007) prescribed than in non-cancer patients. The independent determinants of no use of statins were anemia (hazard ratio [HR] 2.3, 95% confidence interval [95% CI] 1.3–4.2, P=0.006), no coronary artery stenosis >50% (HR 5.0, 95% CI 2.5–10.1, P<0.001) and cancer (HR 1.9, 95% CI 1.01–3.7, P=0.049) but not LDL cholesterol. The mortality rates were significantly higher in MI patients not treated with statins, both in non-cancer population (29.5%/year versus 6.7%/year, P<0.001) as well as in cancer group (53.9%/year versus 24.9%/year, P<0.05) as compared to those treated with statins (Figure 1). No statin use (HR 2.3, 95% CI 1.8–3.0, P<0.001), an active cancer (HR 2.3, 95% CI 1.8–3.0, P<0.001), patient's age (HR 2.3, 95% CI 1.8–2.9, P<0.001, per year) and anemia (HR 1.7, 95% CI 1.4–2.1, P<0.001) independently increased long-term mortality while no coronary artery stenosis >50% (HR 0.65, 95% CI 0.44–0.96, P=0.03) and better left ventricular ejection fraction (HR 0.97, 95% CI 0.96–0.98, P<0.001, per 1%) improved long-term survival.

Conclusions

An active cancer, anemia and lack of significant coronary lesions were associated with no use of statins in patients following MI. By multivariable approach both no statins use in MI patients independently on an active malignancy were associated with unfavorable long-term outcomes.

Funding Acknowledgement

Type of funding sources: None.

Extent of the frontal sinuses in the aspect of neurosurgical craniotomy approaches

BACKGROUND

Frontal sinuses within the frontal bone can be a potential obstacle in neurosurgical approach in this region. Their unintended opening during craniotomy is not beneficial due to the risk of brain infections by bacteria inhabiting the sinus mucosa. Therefore, such opening should be avoided whenever the surgical procedure does not involve the sinus itself. The aim of the study was the morphometric analysis of the frontal sinuses based on computed tomography imaging.

MATERIALS AND METHODS

The width, height, projection surface area and location of the highest and most lateral points of the sinuses were determined.

RESULTS

The vertical diameter of the sinuses was found to be greater in men compared with women. The most lateral point of the sinuses was located higher in men, and in men was located higher on the left side. The results obtained may indicate that the frontal sinuses tend to be larger in men and that air cells in men extend further in the upper-lateral direction on the left side of the frontal bone.

CONCLUSIONS

This may cause an increased risk of unintentional opening of the left frontal sinus during frontal craniotomy or pterional craniotomy with frontal extension.

Practices towards SARS-CoV-2 transmission prevention among Polish high school students

Background

Adolescents play a significant role in SARS-CoV-2 spread. The study objective was to assess practices towards COVID-19 among final year Polish high school students.

Methods

Between December 2020-March 2021 an online cross-sectional survey was conducted. Multistage random sampling selected 24 high schools in the Lubuskie region then 51 classes. Students' practices were assessed by an anonymous questionnaire. Significance was tested by Chi-square test.

Results

Response rate was 72.3%; 638 students (360 females) participated (mean age 18.4±0.6 years); 68.7% attended schools in the cities with <100,000 inhabitants; 31.5% were in the science program. Most (81.3%) declared they always used masks in public spaces in the last month (74.3% males vs 86.1% females, p < 0.001; 77.2% of those living in smaller vs 90.5% in larger cities, p < 0.001; 89.6% in the science program vs 77.6% - in the other programs, p < 0.001); 35% always avoided crowded areas (26.9% males vs 39.4% females, p = 0.001; 29.5% living in smaller vs 47% in larger cities, p < 0.001; 43.8% in the science program vs 30.9% - in the other programs, p = 0.002); 24.3% declared always keeping social distance (19.4% males vs 27.2% females, p = 0.02), 29.9% stated they did not touch their faces (25% males vs 33.3% females, p = 0.02; 27.2% living in smaller vs 36% in larger cities, p = 0.02; 37.8% in the science program vs 26.3% - in the other programs, p = 0.003). Among those wearing masks - uncovered noses (64.6%) and masks around the neck (42.3%; 48.1% males vs 38.9% females, p = 0.02) were the most frequent incorrect practices.

Conclusions

Most high school students, in particular males, living in small cities and attending non-science program have inappropriate preventive practices towards COVID-19. Health education programs are urgently needed to better equip students with COVID-19 prevention skills.

Key messages

The study shows data of final year high-school students' practices towards COVID-19 and maybe used by public health experts to better address educational campaigns oriented to Polish adolescents. Health education aimed at high school students would be crucial to improve compliance with SARS-CoV-2 infection control procedures.

The determinants and significance of intraluminal stent protrusion in patients with acute myocardial infarction

Background

The mchanisms leading to intraluminal stent protrusion in patients following primary coronary angioplasty for ST-elevation myocardial infarction (STEMI) are not fully elucidated.

Purpose

We sought to investigate composition of stent protrusion, its systemic and local determinants as well as its consequences for epicardial blood flow restoration in STEMI patients.

Methods

We enrolled 85 STEMI patients with median age 61 (interquartile range 54–69) years. In all patients optical coherence tomography of an infarct-related artery was performed first following epicardial blood flow restoration after aspiration thrombectomy and second after final stent deployment. On admission, besides standard laboratory investigations we measured calibrated automated thrombogram parameters including time to start clotting, time to peak thrombin generation, peak thrombin generation and endogenous thrombin potential as well as ex vivo measured fibrin clot permeability reflecting fibrin pore size and fibrin clot lysis time.

Results

A median volume of stent protrusion was 13.4 (8.5–25.4) mm3 while atherothrombotic burden defined as a ratio of free intraluminal thrombus and tissue protrusion divided by stent volume was 6 (3.9–7.5)%. The main component of stent protrusion was lipid tissue in 32 (37.6%), fibrous tissue in 27 (31.8%) and thrombus in 26 (30.6%) patients. A volume of stent protrusion was correlated with total stent volume (R=0.79, P<0.001) and the length of lipid reach pool in the naïve coronary vessel intima (R=0.31, P=0.007) whereas atherothrombotic burden was correlated with residual thrombus volume before stent implantation (R=0.34, P=0.003), arcus of maximal lipid reach pool in the naïve coronary vessel intima (R=0.25, P=0.03) and stent area (R=0.26, P=0.02). The residual thrombus volume after aspiration thrombectomy was correlated with clot permeability (R=0.024, P=0.04) and inversely correlated with time to peak thrombin generation (R=−0.23, P=0.04). A temporary deterioration of epicardial blood flow of at least 1 point in Thrombolysis in Myocardial Infarction scale following stent implantation detected in 20 (23.5%) patients was associated with shorter lag time (3.0 [2.7–3.3] vs. 3.3 [3.0–4.0] min, P=0.015), shorter time to peak thrombin generation (5.7 [5.3–6.1] vs. 6.3 [5.7–7.1] min, P=0.026) and more frequent presence of lipid-rich stent protrusion (65 vs. 29%, P=0.007) as compared to the patients without slow-flow phenomenon after stent deployment.

Conclusions

The total volume of stent protrusion is correlated with local determinants including stent size and lipid content in the naïve coronary artery intima. After adjustment for stent volume, atherothrombotic burden is additionaly affected by residual thrombus volume after aspiration thrombectomy. However, patients with faster thrombin formation and lipid-rich stent protrusion are more prone to slow-flow phenomenon following stent implantation.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center of Poland

Coronary slow-flow phenomenon in takotsubo syndrome: the prevalence, clinical determinants and long-term prognostic impact

Background

Previous studies demonstrated that patients with takotsubo syndrome (TTS) may present with coronary slow-flow (CSF) at coronary angiography performed in the acute phase [1]. However, the exact clinical relevance and its long-term prognostic impact have not been established yet. In the only recently published study Montone et al. proved that TTS patients with CSF were characterized by a worse clinical presentation with higher rate of intrahospital complications and poor long-term clinical outcome [2].

Purpose

We sought to investigate the prevalence of CSF in TTS patients, its determinants and long-term prognostic impact.

Methods

Among 7771 myocardial infarction patients hospitalized in our center in 2012–2019 years, we identified 82 (1.1%) TTS patients with performed coronary angiography (Figure 1A). The coronary flow was assessed quantitatively with TIMI Frame Count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). The clinical and angiographic characterstics of 67 TTS patients complying with MINOCA definition were compared with representative 50 non-TTS MINOCA (Figure 1A).

Results

CSF (TIMI 2) was identified in 33 (40.2%) TTS patients. CSF-TTS patients were characterized with higher TFC and worse TMPG in each analyzed coronary vessel (Figure 1B). CSF was observed in LAD artery in each patient, in 78.8% in LCx and in 33.3% in RCA, respectively. In CSF-TTS lower values of LVEF on admission (33.5 (25–40) vs 40 (35–45)%, P=0.019) as well as more frequent midventricular TTS (27.3 vs 8.2%, P=0.020), nearly normal coronary arteries (<30% stenosis) (75.8 vs 49.0%, P=0.015) and coexistence of both physical and emotional triggers (9.1 vs 0%, P=0.032) were noted. Moreover, CSF was observed significantly more frequent than in non-TTS MINOCA (44.8 vs 10.0%, P<0.001) with different distribution in particular vessels (P<0.001). In median 55 months of long-term observation higher all-cause mortality was stated in CSF-TTS (30.3 vs 10.2%, P=0.024) (Figure 1C) without difference between TTS and non-TTS MINOCA (P=0.42) (Figure 1D). By Cox proportional hazards model the CSF was identified as an independent predictor of long-term mortality (P<0.001).

Conclusions

As has been shown high proportion of TTS patients were characterized with remarkably marked myocardial perfusion abnormalities, especially in the left coronary vessels, which were associated with unfavorable long-term prognosis. Our study is the first presenting the direct angiographic, clinical and prognostic comparison of TTS MINOCA and non-TTS MINOCA patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Chronic rhinosinusitis: microbiology and treatment of acute exacerbations in patients after endoscopic surgery

Objective

Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis, and treat with amoxicillin or amoxicillin-clavulanate.

Method

Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.

Results

The most common bacterial species present were Staphylococcus aureus (36 per cent), Pseudomonas aeruginosa (13 per cent) and Escherichia coli (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.

Conclusion

Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

Background

Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown.

Purpose

We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes.

Methods

142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected.

Results

SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007).

Conclusions

As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization.

The survival free of rehospitalization

Funding Acknowledgement

Type of funding source: None

Over-representation of myocardial infarction with nonobstructive coronary arteries in oncological patients. The prevalence, clinical characteristics and long-term mortality

Introduction

According to the current guidelines, myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined by general criteria of myocardial infarction (MI) with no hemodynamically significant lesions in coronary arteries (<50%). As shown in large MI registers, MINOCA is diagnosed in 1–13% of patients. The potential etiology of MINOCA is an intensively studied issue. To date, a number of potential mechanisms have been proposed. In our opinion, hypercoagulable states may be indicated as a direct trigger for such a sequence of events. Based on our previously published study, we found the presence of inherited thrombophilia in over 23.8% of MINOCA patients

Purpose

We suspect that oncological patients, the group with well-known prothrombotic state, are predisposed to MINOCA and have different clinical characteristics and long-term prognosis.

Methods

We analyzed a group of 1011 consecutive patients with MI who underwent coronary angiography in the years 2012–2017. A group of 134 patients with active cancer (13.3%) was separated. Working diagnosis of MINOCA was performed in accordance with current guidelines.

Results

MINOCA diagnosis was stated in 21 oncological patients (15.7%) and 51 others (5.8%) (P<0.001). Cancer patients were characterized by a higher incidence of anemia (47.6 vs 21.6%, P=0.027), lower hemoglobin levels (12.9 vs 14.1 g/dl, P=0.048) and higher troponin values (0.306 vs 0.076 ng/ml, P=0.003). Based on echocardiographic measurements, more frequent occurrence of takotsubo cardiomyopathy (19.1 vs 2.0%, P=0.010), higher values of right ventricular systolic pressure (44.5 vs 31.5 mmHg, P=0.016) and lower left atrial dimensions (36 vs 41.5 mm, P=0.020) were observed in the group of cancer patients. As expected, patients with active cancer had significantly higher all-cause mortality during long-term follow-up (66.7 vs 29.4%, P=0.003). In a multivariable analysis of oncological MINOCA was independently associated with a long-term mortality (P<0.001).

Conclusions

To our knowledge, our study is the first report concerning a high prevalence of MINOCA in oncological patients with MI. We observed a significant proportion of cancer-associated anemia in this group of patients. The high incidence of takotsubo cardiomyopathy and significant differences in individual echocardiographic parameters underline the important role of cardiac imaging in this group of patients with unfavorable long-term prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

Indocyanine Green Fluorescence Angiography Can Guide Intraoperative Localization During Parathyroid Surgery

BACKGROUND AND AIMS

Intraoperative localization of pathologic parathyroid glands is of major importance for the hyperparathyroidism treatment. Based on the small size and the anatomic variability, the localization can be very challenging. The current practice is to compare preoperative ultrasonography with Technetium-99m sestamibi scintigraphy (MIBI) and plan the resection accordingly. In this study, we implemented indocyanine green angiography for the intraoperative localization of parathyroid glands.

MATERIALS AND METHODS

This is a retrospective analysis of 37 patients with primary, secondary, or tertiary hyperparathyroidism who were operated using indocyanine green angiography for the intraoperative localization of pathological parathyroid glands. An indocyanine green solution of 2.5 mg was were intravenously administered for parathyroid gland visualization. Different fluorescence scores were correlated with changes in postoperative parathyroid hormone levels.

RESULTS

Patients were divided into two groups depending on the presence of uniglandular or multiglandular disease. Sixty-four lesions were resected, and the final histopathologic analysis confirmed the parathyroid origin in 62 of them (96.8%). None of the patients with uniglandular disease developed postoperative hypoparathyroidism, whereas three patients in the multiglandular group developed temporary hypoparathyroidism symptoms. Indocyanine green imaging had higher sensitivity for the intraoperative detection of parathyroid glands compared with ultrasonography and MIBI (p < 0.001).

CONCLUSION

Indocyanine green angiography indicated high sensitivity for the intraoperative identification of pathologic parathyroid glands leading to a resection rate of 95.16%. The modality was useful, especially in cases of revisional surgery or ectopic parathyroid glands. Randomized trials have already proven the value of indocyanine green imaging in predicting postoperative hypocalcemia. Our results support the regular use of this method during parathyroid surgery.

N-nitrosodimethylamine (NDMA) induced apoptosis dependent on Fas/FasL complex in human leukocytes

Objective:

To investigate the mechanism of apoptosis dependent on the Fas/FasL (Fas ligand) complex in the presence of N-nitrosodimethylamine (NDMA) in human leukocytes.

Methods:

Polymorphonuclear neutrophils (PMNs) and peripheral blood mononuclear cells (PBMCs) were isolated form whole blood by density centrifugation. The concentration of NDMA was assessed by cellular toxicity assay. Apoptotic cells were assessed with flow cytometry and the expression of pro- and antiapoptotic proteins was investigated by Western blotting in PMNs and PBMCs treated with NDMA and/or FasL.

Results:

PMNs showed a higher ratio of apoptotic cells than PBMCs after exposure to NDMA and/or FasL. Enhanced apoptosis was related to the increased expression of proapoptotic proteins in neutrophils following exposure to either NDMA or FasL. In PBMCs, the relation was observed after exposure to FasL only. PMNs and PBMCs incubated with NDMA and FasL simultaneously demonstrated the highest increase in protein expression.

Conclusions:

NDMA shows a stronger proapoptotic effect with PMNs than with PBMCs. The Fas/FasL complex, along with other proapoptotic proteins of the receptor (Fas, FADD) and mitochondrial pathway (Noxa, Puma, Bim), plays a key role in the induction of neutrophil apoptosis. Synergic effects of NDMA and FasL which lead to higher induction of apoptosis in PMNs than in PBMCs indicates a multistage and varied regulation of apoptosis in different populations of leukocytes.

Influence of leaf damage by the horse chestnut leafminer (Cameraria ohridella Deschka & Dimić) on mycorrhiza of Aesculus hippocastanum L

In many parts of Europe, the white horse chestnut (Aesculus hippocastanum L.) has been attacked by the horse chestnut leafminer (Cameraria ohridella Deschka & Dimić), which causes premature leaf dieback. A. hippocastanum L. establishes mutualistic symbiosis with arbuscular mycorrhizal (AM) fungi. This study involved a comparison of mature A. hippocastanum individuals susceptible to C. ohridella and individuals resistant to this insect after a one-time treatment with a chemical preparation injected into the tree trunks 7 years before the investigation began. Concentration of macronutrients in soil and the activity of soil nonspecific dehydrogenase did not differ between soils under canopies of the treated and untreated trees. Concentrations of C and N were significantly higher in leaves of the treated than those of the untreated trees. The infestation by C. ohridella and defoliation of leaves of the untreated trees did not significantly influence the frequency and intensity of AM colonization compared to the chemically treated trees, although a tendency towards higher average AM colonization of roots of the untreated trees, infested by the herbivores, than roots of the non-infested trees was observed. The results also indicated a tendency for higher biomass of fine roots per soil volume under the trees treated against C. ohridella than under the trees invaded by the insect.

Sex-specific differences in the regulation of inducible nitric oxide synthase by bisphenol A in neutrophils

The aim of the study was to evaluate the effect of bisphenol A (BPA) on nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) expression by neutrophils with regard to sex and nuclear factor-κB (NF-κB) pathway participation in this process. This study demonstrated that BPA intensifies the production of NO and the expression of iNOS in the cytoplasmic fraction of neutrophils of women as well as men. In addition, an enhanced expression of NF-κB in the cytoplasmic and nuclear fraction of neutrophils exposed to BPA was observed in the cells of both sexes. The lipopolysaccharide (LPS) stimulation of neutrophils of both sexes led to an intensification of NO production and expression of all tested proteins. However, simultaneous stimulation of neutrophils of both men and women with LPS and BPA decreased the production of NO and expression of iNOS and NF-κB in both fractions compared to the cells exposed only to xenoestrogen. Moreover, expression of iNOS and NF-κB was higher in female neutrophils than in male cells. This study demonstrated that BPA affects the production of NO with the participation of iNOS by human polymorphonuclear neutrophils. This process is associated with the activation of the NF-κB pathway. In addition, different activity of NF-κB in neutrophils, observed with respect to sex, indicates a different role of this pathway in female and male cells.

Predictors of overall and recurrence-free survival after neoadjuvant chemotherapy for gastroesophageal adenocarcinoma: Pooled analysis of individual patient data (IPD) from randomized controlled trials (RCTs)

BACKGROUND

Neoadjuvant chemotherapy improves prognosis of patients with locally advanced gastroesophageal adenocarcinoma. The aim of this study was to identify predictors for postoperative survival following neoadjuvant therapy. These could be useful in deciding about postoperative continuation of chemotherapy.

METHODS

This meta-analysis used IPD from RCTs comparing neoadjuvant chemotherapy with surgery alone for gastroesophageal adenocarcinoma. Trials providing IPD on age, sex, performance status, pT/N stage, resection status, overall and recurrence-free survival were included. Survival was calculated in the entire study population and subgroups stratified by supposed predictors and compared using the log-rank test. Multivariable Cox models were used to identify independent survival predictors.

RESULTS

Four RCTs providing IPD from 553 patients fulfilled the inclusion criteria. (y)pT and (y)pN stage and resection status strongly predicted postoperative survival both after neoadjuvant therapy and surgery alone. Patients with R1 resection after neoadjuvant therapy survived longer than those with R1 resection after surgery alone. Patients with stage pN0 after surgery alone had better prognosis than those with ypN0 after neoadjuvant therapy. Patients with stage ypT3/4 after neoadjuvant therapy survived longer than those with stage pT3/4 after surgery alone. Multivariable regression identified resection status and (y)pN stage as predictors of survival in both groups. (y)pT stage predicted survival only after surgery alone.

CONCLUSION

After neoadjuvant therapy for gastroesophageal adenocarcinoma, survival is determined by the same factors as after surgery alone. However, ypT stage is not an independent predictor. These results can facilitate the decision about postoperative continuation of chemotherapy in pretreated patients.

Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study

Background

Takotsubo cardiomyopathy (TTC) is characterised by transient contractility disturbances of the apex of the left ventricle.

Methods

We enrolled 101 patients from the northern-eastern part of Poland in the years 2008–2012 who were hospitalised for TCC. The control group consisted of female patients diagnosed with anterior myocardial infarction with ST-segment elevation (anterior STEMI) (n = 101).

Results

89 % of the study group were women. Patients with TTC had diabetes (12.6 % vs 29.7 %; p = 0.002) and hyperlipidaemia (36.8 % vs 64.4 %; p = 0.0001) significantly less frequently, and better kidney function assessed by estimated glomerular filtration rate versus patients with anterior STEMI (74.52 % vs 64.30 %; p = 0.004). In the TTC group there were more patients with chronic obstructive pulmonary disease (11.6 % vs 1.0 %; p = 0.002) and thyroid disturbances, especially hyperthyroidism (23.4 % vs 11.0 %; p = 0.021). In patients with TTC sudden cardiac arrest, pulmonary oedema and cardiogenic shock were observed less frequently than in the control group (14.7 % vs 30.7 %; p = 0.0078). Hospitalisations in TTC patients were less frequently complicated by pneumonia (20.0 % vs 35.6 %; p = 0.0148) and urinary infection (4.2 % vs 21.8 %; p = 0.0003). Cardiac rupture occurred in 3 patients with TTC and in 1 with anterior STEMI. In-hospital mortality was significantly lower in the group with TTC. Also, mortality at 30 days, 3 months, 1 year and 2.5 years was significantly lower in patients with TTC than in patients with MI (p = 0.035; p = 0.0226; p = 0.0075; p = 0.009).

Conclusions

Previously considered to be a benign syndrome, TTC should be reconsidered as a clinical condition at risk for serious complications such as cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death and causing substantial early hazard. The prognosis in TTC is significantly better than in patients with anterior STEMI.

Tools for opening new chapters in the book of Treponema pallidum evolutionary history

Treponema pallidum infections causing yaws disease and venereal syphilis are globally widespread in human populations, infecting hundreds of thousands and millions annually respectively; endemic syphilis is much less common, and pinta has not been observed in decades. We discuss controversy surrounding the origin, evolution and history of these pathogens in light of available molecular and anthropological evidence. These bacteria (or close relatives) seem to affect many wild African nonhuman primate (NHP) species, though to date only a single NHP Treponema pallidum genome has been published, hindering detection of spillover events and our understanding of potential wildlife reservoirs. Similarly, only ten genomes of Treponema pallidum infecting humans have been published, impeding a full understanding of their diversity and evolutionary history. Research efforts have been hampered by the difficulty of culturing and propagating Treponema pallidum. Here we highlight avenues of research recently opened by the coupling of hybridization capture and next-generation sequencing. We present data generated with such an approach suggesting that asymptomatic bones from NHP occasionally contain enough treponemal DNA to recover large fractions of their genomes. We expect that these methods, which naturally can be applied to modern biopsy samples and ancient human bones, will soon considerably improve our understanding of these enigmatic pathogens and lay rest to old yet unresolved controversies.

Renal Transplantation in HIV-positive Renal Transplant Recipients: Experience at the Mannheim University Hospital

Renal transplantation in HIV-positive patients with end-stage renal disease has in recent years become a successful treatment option. We report two patients who underwent renal transplantation using a combination of basiliximab, calcineurin inhibitors, mycophenolate mofetil (MMF), and steroids with a "non-interacting" antiretroviral combination therapy consisting of stavudine or abacavir, lamivudine, and nevirapine. We observed no acute rejection but a BK polyomavirus infection in both patients. In conclusion, a quadruple immunosuppression with an interleukin 2 receptor antagonist, a calcineurin inhibitor, MMF, and steroids appears to be advisable to prevent high rates of acute rejection, but if possible thereafter immunosuppression should be tapered rapidly (eg, MMF stop, prednisolone dose 5 mg/d). The selection of antiretroviral agents should avoid compounds that interact severely with the immunosuppression used.

[Cognitive Behavioral Therapy for Anxiety and Depression in Patients with Parkinson's Disease]

Non-motor symptoms in patients with Parkinson's disease (PD) are gaining more and more interest. Diagnosis of mental disorders in particular, such as anxiety and depression, are often not a part of the professional's diagnostic procedure in spite of the high prevalence rate. To provide these patients with comprehensive treatment, proper diagnosis and appropriate therapy are required. Cognitive Behavioral Therapy (CBT) has been one of the most efficient therapies for anxiety and depression, also in a group setting. This review compares studies that examined patients with PD diagnosed with anxiety disorders and/or depression. In eight studies, CBT in an individual setting was assessed. Three of these had a single case study design, three did not have a control group and two were randomized controlled trials. Two interventions were telephone-based and two were in a group therapy setting. Several results indicate that there is a decline in depressive symptoms as well as anxiety after CBT. There are very few randomized controlled studies on this issue. The efficacy of group treatment needs to be investigated better in order to offer patients effective treatment, keeping in kind their special circumstances.

Ischemic and injured bowel evaluation by Fluorescence imaging

AIM

Although fluorescence has been proposed for estimation of bowel perfusion decades ago it is still not widely used. In emergency situations like mesenteric ischemia, fluorescence might give objective criteria to evaluate the perfusion and guide the decisions of surgeons.

METHOD

The use of near-inrafrared angiography by PinPoint (Novadaq) in a serial of four emergency situations of acute mesenteric ischemia has been evaluated in a university hospital setting.

RESULTS

The use of the near-infrared tool is in emergency situations easy to handle and little time-consuming. The angiography showed clearly the perfusion in regions that were not estimated as recoverable by the surgeons. In one of the cases a significant amount of bowel could be spared by use of the system.

CONCLUSION

Although the assessment of the perfusion with the applied system is comprehensible, it would be desirable to evaluate a threshold level in order to further objectify it. While the surgeons who used the tool were subjectively assured by the expressiveness it would need a randomized and maybe experimental setting to evaluate objectively the amount of spared bowel length.

Interneurons containing somatostatin are affected by learning-induced cortical plasticity

The maintenance of neural circuit stability is a dynamic process that requires the plasticity of many cellular and synaptic components. By changing the excitatory/inhibitory balance, inhibitory GABAergic plasticity can regulate excitability, and contribute to neural circuit function and refinement in learning and memory. Increased inhibitory GABAergic neurotransmission has been shown in brain structures involved in the learning process. Previously, we showed that classical conditioning in which tactile stimulation of one row of vibrissae (conditioned stimulus, CS) was paired with a tail shock (unconditioned stimulus, UCS) in adult mice results in the increased density of GABAergic interneurons and increased expression of glutamic acid decarboxylase (GAD)-67 in barrels of the "trained" row cortical representation. In inhibitory neurons of the rat cortex GAD co-localizes with several proteins and peptides. We found previously that the density of the parvalbumin (GAD+/Prv+)-containing subpopulation is not changed after conditioning. In the present study, we examined GABAergic somatostatin (Som)-, calbindin (CB)- and calretinin (CR)-positive interneurons in the cortical representation of "trained" vibrissae after training. Cells showing double immunostaining for GAD/Som, GAD/CR and GAD/CB were counted in the barrels representing vibrissae activated during the training and in control, untouched rows. We found a substantial increase of GAD/Som-containing cells in the trained row representation. No changes in the density of GAD/CR or GAD/CB neurons were observed. These results suggest that Som-containing interneurons are involved in learning-induced changes in the inhibitory cortical network.

Indigenous Health: ACTION on Prevention - 50th annual Australian Society for Medical Research National Scientific Conference

The 50th annual National Scientific Conference of the Australian Society for Medical Research was held in Cairns, Queensland, 13-16 November 2011. The theme, 'Indigenous Health: ACTION on Prevention' highlighted the direct action being undertaken by health and medical researchers, as well as allied health professionals, to improve long-term health outcomes for Indigenous Australians.

[Significance of drains in surgery]

Placing drains is one the most common procedures following operations in surgical disciplines. The indication for placing a drain is, however, usually based on a traditional belief rather than being evidence-based. This paper presents an overview of the literature regarding the indications and the evidence level for placing drains following operations in visceral, vascular, thoracic and orthopeedic surgery as well as traumatology. In visceral surgery the indications for placing drains could be clarified over the past decades but in other surgical fields the level of evidence needs further investigation and clarification through future studies. The available data suggest that in most cases a prophylactic drainage can be avoided. In addition, drains may lead to increased morbidity and higher treatment costs.

Evidence for a smooth onset of deformation in the neutron-rich Kr isotopes

The neutron-rich nuclei 94,96Kr were studied via projectile Coulomb excitation at the REX-ISOLDE facility at CERN. Level energies of the first excited 2(+) states and their absolute E2 transition strengths to the ground state are determined and discussed in the context of the E(2(1)(+)) and B(E2;2(1)(+)→0(1)(+)) systematics of the krypton chain. Contrary to previously published results no sudden onset of deformation is observed. This experimental result is supported by a new proton-neutron interacting boson model calculation based on the constrained Hartree-Fock-Bogoliubov approach using the microscopic Gogny-D1M energy density functional.

Proton MR Spectroscopy in Patients with Leigh Syndrome

The aim of the present study was to evaluate MRS findings in patients with Leigh syndrome. We report our results of HMR spectroscopic studies performed in six patients (aged four months to ten years) with clinically proved Leigh syndrome. All examinations were done with 1.5 T scanner using an eight-channel phased array head coil. HMRS data were obtained using 2D-chemical shift imaging (CSI) and SVS sequences with short (30 ms) and long (135 ms) echo time. The MR spectra were acquired in multiple voxel localized in deep gray matter and periventricular white matter. The results were compared to the control group data. In most of our patients we found bilateral lesions in the basal ganglia and brain stem. HMRS data revealed elevated lactate in the affected areas, significantly diminished NAA/Cr ratio. The relatively high Cho/Cr ratio in the gray and white matter was also noted. HMRS is an important tool for non-invasive brain tissue analysis in Leigh syndrome.