The early safety profile of simultaneous vaccination against influenza and Respiratory Syncytial Virus (RSV) in patients with high-risk heart failure

The safety of simultaneous vaccination for Respiratory Syncytial Virus (RSV) and influenza in vulnerable high-risk heart failure (HF) patients remains unclear. In an open-label, prospective study, 105 patients received concurrent influenza (Vaxigrip Tetra, season 2023/2024, Sanofi) and RSV (Arexvy, GSK) vaccinations from September 15th to November 17th, 2023. Adverse events were collected on the fourth-day post-vaccination. Overall, the vaccination was well tolerated, with the most common reaction being injection site pain (63 %). General symptoms occurred in 33 % of patients, predominantly fatigue (23 %), myalgia (12 %), and headache (9 %). Grade 3 reactions were observed in 6 % of patients, and a few experienced temperature elevation or flu-like symptoms, managing them with antipyretics. Notably, there were no exacerbations of HF, hospitalizations, or deaths within a week post-vaccination. This study indicates the safety of simultaneous influenza and RSV vaccination in high-risk HF patients, with a low incidence of mild adverse events.

Diuretic, natriuretic, and chloride-regaining effects of oral acetazolamide as an add-on therapy for acute heart failure with volume overload: a single-center, prospective, randomized study

INTRODUCTION

Decongestion is a therapeutic target in acute heart failure (AHF). Acetazolamide is a diuretic that decreases proximal tubular sodium reabsorption, and may also reverse hypochloremia Objectives: We assessed the decongestive, natriuretic, and chloride‑regaining effects as well as the renal safety profile of oral acetazolamide (250 mg) used as an add‑on therapy in patients with AHF.

PATIENTS AND METHODS

This prospective, randomized study was conducted at the Institute of Heart Diseases in Wrocław, Poland. It involved patients with AHF who were randomly assigned to receive either 250 mg of oral acetazolamide or standard care, and who underwent clinical and laboratory follow‑up for 3 consecutive days since the beginning of the treatment and at discharge.

RESULTS

The study population comprised 61 patients (71% men), of whom 31 (51%) were included in the acetazolamide group. The mean (SD) age of the patients was 68 (13) years. In comparison with the controls, the acetazolamide group demonstrated significantly higher cumulative diuresis after 48 and 72 hours since treatment implementation, negative fluid balance, weight loss after 48 hours of treatment, weight loss throughout the hospitalization, natriuresis, and serum chloride concentration. In terms of the renal safety profile, no increase in the creatinine concentration and urinary renal biomarker levels was noted.

CONCLUSIONS

Oral acetazolamide seems to be a valuable add‑on therapy that helps achieve comprehensive decongestion in patients with AHF.

Sex-stratified patterns of emergency cardiovascular admissions prior and during the COVID-19 pandemic

The COVID-19 pandemic has had a significant impact on global public health, with long-term consequences that are still largely unknown. This study aimed to assess the data regarding acute cardiovascular hospital admissions in five European centers before and during the pandemic. A multicenter, multinational observational registry was created, comparing admissions to the emergency departments during a 3-months period in 2020 (during the pandemic) with the corresponding period in 2019 (pre-pandemic). Data on patient demographics, COVID-19 test results, primary diagnosis, comorbidities, heart failure profile, medication use, and laboratory results were collected. A total of 8778 patients were included in the analysis, with 4447 patients in 2019 and 4331 patients in 2020. The results showed significant differences in the distribution of cardiovascular diseases between the two years. The frequency of pulmonary embolism (PE) increased in 2020 compared to 2019, while acute heart failure (AHF) and other cardiovascular diseases decreased. The odds of PE incidence among hospitalized patients in 2020 were 1.316-fold greater than in 2019. The incidence of AHF was 50.83% less likely to be observed in 2020, and the odds for other cardiovascular diseases increased by 17.42% between the 2 years. Regarding acute coronary syndrome (ACS), the distribution of its types differed between 2019 and 2020, with an increase in the odds of ST-segment elevation myocardial infarction (STEMI) in 2020. Stratification based on sex revealed further insights. Among men, the incidence of AHF decreased in 2020, while other cardiovascular diseases increased. In women, only the incidence of STEMI showed a significant increase. When analyzing the influence of SARS-CoV-2 infection, COVID-positive patients had a higher incidence of PE compared to COVID-negative patients. COVID-positive patients with ACS also exhibited symptoms of heart failure more frequently than COVID-negative patients. These findings provide valuable information on the impact of the COVID-19 pandemic on acute cardiovascular hospital admissions. The increased incidence of PE and changes in the distribution of other cardiovascular diseases highlight the importance of monitoring and managing cardiovascular health during and post pandemic period. The differences observed between sexes emphasize the need for further research to understand potential sex-specific effects of COVID-19 on cardiovascular outcomes.

Role of dietary sodium restriction in chronic heart failure: systematic review and meta-analysis

BACKGROUND

Dietary sodium restriction remains a guidelines-approved lifestyle recommendation for chronic heart failure (CHF) patients. However, its efficacy in clinical outcome improvement is dubious.

OBJECTIVE

The study evaluated whether dietary sodium restriction in CHF reduces clinical events.

METHODS

We performed a systematic review of the following databases: Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition, MEDLINE, Embase, Clinicaltrials.gov and Cochrane Library (trials) to find studies analysing the impact of sodium restriction in the adult CHF population. Both observational and interventional studies were included. Exclusion criteria included i.e.: sodium consumption assessment based only on natriuresis, in-hospital interventions or mixed interventions-e.g. sodium and fluid restriction in one arm only. The review was conducted following PRISMA guidelines. Meta-analysis was performed for the endpoints reported in at least 3 papers. Analyses were conducted in Review Manager (RevMan) Version 5.4.1.

RESULTS

Initially, we screened 9175 articles. Backward snowballing revealed 1050 additional articles. Eventually, 9 papers were evaluated in the meta-analysis. All-cause mortality, HF-related hospitalizations and the composite of mortality and hospitalisation were reported in 8, 6 and 3 articles, respectively. Sodium restriction was associated with a higher risk of the composite endpoint (OR 4.12 [95% CI 1.23-13.82]) and did not significantly affect the all-cause mortality (OR 1.38 [95% CI 0.76-2.49]) or HF hospitalisation (OR 1.63 [95% CI 0.69-3.88]).

CONCLUSIONS

In a meta-analysis, sodium restriction in CHF patients worsened the prognosis in terms of a composite of mortality and hospitalizations and did not influence all-cause mortality and HF hospitalisation rate.

A Pilot Study on Standardized In-hospital Education About Heart Failure Conducted During the First Days After Decompensation

INTRODUCTION

Education addressed to heart failure (HF) patients constitutes an important element of modern comprehensive treatment programs. The present article demonstrates a novel method of standardized in-hospital education addressed to patients admitted due to decompensation in HF.

METHODS

This pilot study was conducted among 20 patients [19 men, age 63 ± 16 years, NYHA (Classification according to New York Heart Association) on admission (II/III/IV): 5/25/70%]. Five-day education was based on individual sessions conducted using colorful boards demonstrating selected, highly practical elements of the knowledge about HF management, prepared by experts in HF management (medical doctors, a psychologist, and a dietician). The level of knowledge about HF was measured before and after education, based on a questionnaire prepared by the authors of the boards.

RESULTS

All patients experienced an improvement of their clinical status (confirmed by reduced New York Heart Association class and body mass, both P < 0.05). Mini Mental State Exam (MMSE) confirmed that no one demonstrated cognitive impairment. The score reflecting the level of knowledge about HF improved significantly after 5 days of in-hospital treatment accompanied by education (P = 0.0001).

CONCLUSIONS

We showed that the proposed model of education addressed to patients with decompensated HF, conducted using colorful boards demonstrating selected, highly practical elements of the knowledge about HF management, prepared by experts in HF management lead to significant increase of HF-related knowledge.

Renal Assessment in Acute Cardiorenal Syndrome

Cardiorenal syndrome (CRS) is a complex, heterogeneous spectrum of symptoms that has kept cardiologists awake for decades. The heart failure (HF) population being burdened with multimorbidity poses diagnostic and therapeutic challenges even for experienced clinicians. Adding deteriorated renal function to the equation, which is one of the strongest predictors of adverse outcome, we measure ourselves against possibly the biggest problem in modern cardiology. With the rapid development of new renal assessment methods, we can treat CRS more effectively than ever. The presented review focuses on explaining the pathophysiology, recent advances and current practices of monitoring renal function in patients with acute CRS. Understanding the dynamic interaction between the heart and the kidney may improve patient care and support the selection of an effective and nephroprotective treatment strategy.

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

Despite the progress of its management, COVID-19 maintains an ominous condition which constitutes a threat, especially for the susceptible population. The cardiac injury occurs in approximately 30% of COVID-19 infections and is associated with a worse prognosis. The clinical presentation of cardiac involvement can be COVID-19-related myocarditis. Our review aims to summarise current evidence about that complication. The research was registered at PROSPERO (CRD42022338397). We performed a systematic analysis using five different databases, including i.a. MEDLINE. Further, the backward snowballing technique was applied to identify additional papers. Inclusion criteria were: full-text articles in English presenting cases of COVID-19-related myocarditis diagnosed by the ESC criteria and patients over 18 years old. The myocarditis had to occur after the COVID-19 infection, not vaccination. Initially, 1588 papers were screened from the database search, and 1037 papers were revealed in the backward snowballing process. Eventually, 59 articles were included. Data about patients' sex, age, ethnicity, COVID-19 confirmation technique and vaccination status, reported symptoms, physical condition, laboratory and radiological findings, applied treatment and patient outcome were investigated and summarised. COVID-19-related myocarditis is associated with the risk of sudden worsening of patients' clinical status, thus, knowledge about its clinical presentation is essential for healthcare workers.

An Artificial Intelligence Approach to Guiding the Management of Heart Failure Patients Using Predictive Models: A Systematic Review

Heart failure (HF) is one of the leading causes of mortality and hospitalization worldwide. The accurate prediction of mortality and readmission risk provides crucial information for guiding decision making. Unfortunately, traditional predictive models reached modest accuracy in HF populations. We therefore aimed to present predictive models based on machine learning (ML) techniques in HF patients that were externally validated. We searched four databases and the reference lists of the included papers to identify studies in which HF patient data were used to create a predictive model. Literature screening was conducted in Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition and MEDLINE. The protocol of the current systematic review was registered in the PROSPERO database with the registration number CRD42022344855. We considered all types of outcomes: mortality, rehospitalization, response to treatment and medication adherence. The area under the receiver operating characteristic curve (AUC) was used as the comparator parameter. The literature search yielded 1649 studies, of which 9 were included in the final analysis. The AUCs for the machine learning models ranged from 0.6494 to 0.913 in independent datasets, whereas the AUCs for statistical predictive scores ranged from 0.622 to 0.806. Our study showed an increasing number of ML predictive models concerning HF populations, although external validation remains infrequent. However, our findings revealed that ML approaches can outperform conventional risk scores and may play important role in HF management.

Tablet-Based Assessment of Cognitive Function Among Heart Failure Patients

BACKGROUND

Cognitive impairment accompanying heart failure (HF) is an additional HF comorbidity, which may potentially affect the patient's self-care and compliance. We aimed to assess cognitive function (CF) using an application with games created as a cognitive training tool for children and adults, applied using a tablet, and to compare the results obtained by HF patients with the results obtained by healthy age-matched controls.

METHODS

A total of 69 individuals (49 HF patients and 10 healthy controls) were assessed using 4 games dedicated to measuring cognitive skills as well as questionnaires regarding their socioeconomic status. Additionally, HF patients were asked about their quality of life and anxiety and depression.

RESULTS

HF patients demonstrated worse results in each game assessing their cognitive functions as compared to the healthy age-matched controls, which is consistent with the previous studies on CF in HF. We have also noticed interesting patterns of relations between CF and sleep and education.

CONCLUSIONS

We have demonstrated that information and communication technology devices can be successfully applied as feasible tools for cognitive assessment in the HF population. This is important as tablet-based CF assessment can be done on a large population without the involvement of trained personnel.

Novel Phenotyping for Acute Heart Failure—Unsupervised Machine Learning-Based Approach

Acute heart failure (AHF) is a life-threatening, heterogeneous disease requiring urgent diagnosis and treatment. The clinical severity and medical procedures differ according to a complex interplay between the deterioration cause, underlying cardiac substrate, and comorbidities. This study aimed to analyze the natural phenotypic heterogeneity of the AHF population and evaluate the possibilities offered by clustering (unsupervised machine-learning technique) in a medical data assessment. We evaluated data from 381 AHF patients. Sixty-three clinical and biochemical features were assessed at the admission of the patients and were included in the analysis after the preprocessing. The K-medoids algorithm was implemented to create the clusters, and optimization, based on the Davies-Bouldin index, was used. The clustering was performed while blinded to the outcome. The outcome associations were evaluated using the Kaplan-Meier curves and Cox proportional-hazards regressions. The algorithm distinguished six clusters that differed significantly in 58 variables concerning i.e., etiology, clinical status, comorbidities, laboratory parameters and lifestyle factors. The clusters differed in terms of the one-year mortality (p = 0.002). Using the clustering techniques, we extracted six phenotypes from AHF patients with distinct clinical characteristics and outcomes. Our results can be valuable for future trial constructions and customized treatment.

Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure

Heart failure is a major public health problem and, despite the constantly emerging, new, effective treatments, it remains a leading cause of morbidity and mortality. Reliable tools for early diagnosis and risk stratification are crucial in the management of HF. This explains a growing interest in the development of new biomarkers related to various pathophysiological mechanisms of HF. In the course of this review, we focused on the markers of congestion and renal dysfunction in terms of their interference with cardiovascular homeostasis. Congestion is a hallmark feature of heart failure, contributing to symptoms, morbidity, and hospitalizations of patients with HF and has, therefore, become a therapeutic target in AHF. On the other hand, impaired renal function by altering the volume status contributes to the development and progression of HF and serves as a marker of an adverse clinical outcome. Early detection of congestion and an adequate assessment of renal status are essential for the prompt administration of patient-tailored therapy. This review provides an insight into recent advances in the field of HF biomarkers that could be potentially implemented in diagnosis and risk stratification of patients with HF.

Fractional flow reserve-guided treatment in coronary artery disease: Clinical practice

The assessment of functional severity of moderate coronary stenoses is challenging. Coronary angiography remains the standard technique for diagnosis, although, due to its limitations, it is frequently insufficient to detect relevant myocardial ischemia. Fractional flow reserve (FFR) is defined as the ratio between the mean hyperemic coronary artery pressure distal to the lesion and mean pressure in the aorta. The FFR measurement is currently supported by guidelines to evaluate the hemodynamic significance of lesions. Proper identification of patients that have the potential to benefit from revascularization is crucial. Based on already published literature, we focus on the long-term follow-up of patients with FFR-driven treatment. We also provide a review of specific clinical cases such as borderline FFR values, comorbidities or lesions in anatomical risk locations, in which interpretation can be challenging during the physiological assessment. The aim of this paper is to provide an overview of the evidence of FFR implementation in daily clinical practice and determine issues that raise doubts.

Ultrafiltration in acute heart failure: Current knowledge and fields for further research

Heart failure is one of the leading causes of death in developed countries and remains a significant burden to the healthcare system. Fluid overload is a process responsible for the majority of the heart failure symptoms. Pharmacotherapy is a first-line treatment for this condition; however, due to the phenomenon of diuretic resistance, drug therapy can frequently be insufficient. Ultrafiltration is a promising but still understudied procedure that effectively targets the underlying pathophysiological mechanisms of congestion. The increased availability of simplified ultrafiltration devices, especially in intensive care units, prompted us to perform a current literature review on this treatment. In the present paper, we provide a concise review of the published trials on ultrafiltration, with a brief commentary on their conclusions and shortcomings. We also discuss the practical aspects of this treatment that remain unclear, such as the accurate selection of patients, choosing a suitable protocol for ultrafiltration, the proper time of initiation, monitoring of the therapy, and its desirable effects on renal function with further restoration of diuretic agent responsiveness.

Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge

AIMS

Most studies examined spot urine sodium's (sUNa⁺ ) prognostic utility during the early phase of acute heart failure (AHF) hospitalization. In AHF, sodium excretion is related to clinical status; therefore, we investigated the differences in the prognostic information of spot UNa⁺ throughout the course of hospitalization for AHF (admission vs. discharge).

METHODS AND RESULTS

The study population were AHF patients (n = 172), who survived the index hospitalization. We compared the relationship between early (on admission, at 24 and 48 h) and discharge sUNa⁺ measurements with post-discharge study endpoints: composite of 1 year all-cause mortality and AHF rehospitalization (with time to first event analysis) as well as with each event in separation. There were 49 (28.5%) deaths, 40 (23.3%) AHF rehospitalizations, while the composite endpoint occurred in 69 (40.1%) during 1 year follow-up. The sUNa⁺ had prognostic significance for the composite endpoint when assessed on admission, at 24 and at 48 h: hazard ratios (HRs) with 95% confidence intervals (CIs) (per 10 mmol/L) were 0.88 (0.82-0.94); 0.87 (0.81-0.91); 0.90 (0.84-0.96), all P < 0.005. In contrast to early, active decongestion phase, discharge sUNa⁺ had no prognostic significance HR (95% CI) (per 10 mmol/L): 0.99 (0.93-1.06) P = 0.79 for the composite endpoint, which was independent from the dose of oral furosemide prescribed at that timepoint (average causal mediation effects: -0.38; P = 0.71). Similarly, discharge sUNa⁺ was neither associated with 1 year mortality HR (95% CI) (per 10 mmol/L): 0.97 (0.89-1.05) P = 0.48 nor with AHF rehospitalizations HR (95% CI) (per 10 mmol/l): 1.03 (0.94-1.12), P = 0.56. The comparison of longitudinal profiles of sUNa⁺ during hospitalization showed significantly higher values within the early, active decongestive phase in those who did not experience composite endpoint when compared with those who did: admission: 94 ± 34 vs. 76 ± 35; Day 1: 85 ± 36 vs. 65 ± 37; Day 2: 84 ± 37 vs. 67 ± 35, all P < 0.005 (mmol/L), respectively. There was no difference between those groups in discharge sUNa⁺ : 73 ± 35 vs. 70 ± 35 P = 0.82 (mmol/L).

CONCLUSIONS

Spot UNa⁺ assessed at early phase of hospitalization and at discharge have different prognostic significance, which confirms that it should be always interpreted along with clinical context.

Helicobacter pylori and its secreted immunomodulator VacA protect against anaphylaxis in experimental models of food allergy

BACKGROUND

Food allergy is an increasingly common health problem in Western populations. Epidemiological studies have suggested both positive and negative associations between food allergy and infection with the gastric bacterium Helicobacter pylori.

OBJECTIVE

The objective of this work was to investigate whether experimental infection with H. pylori, or prophylactic treatment with H. pylori-derived immunomodulatory molecules, affects the onset and severity of food allergy, either positively or negatively.

METHODS

We infected neonatal C57BL/6 or C3H mice with H. pylori or treated animals with H. pylori components (bacterial lysate or the immunomodulator VacA) and subsequently subjected them to four different protocols for food allergy induction, using either ovalbumin or peanut extract as allergens for sensitization and challenge. Readouts included anaphylaxis scoring, quantification of allergen-specific serum IgE and IgG1 and of the mast cell protease MCPT1, as well as splenic T-helper-2 cell-derived cytokine production. Mesenteric lymph node CD4⁺ FoxP3⁺ regulatory T cells were subjected to flow cytometric quantification and sorting followed by qRT-PCR, and to DNA methylation analyses of the Treg-specific demethylated region (TSDR) within the FOXP3 locus.

RESULTS

Mice that had been infected with H. pylori or treated with H. pylori-derived immunomodulators showed reduced anaphylaxis upon allergen sensitization and challenge, irrespective of the allergen used. Most of the immunologic assays confirmed a protective effect of H. pylori. CD4⁺ FoxP3⁺ T cells were more abundant in protected mice and exhibited a stable Treg phenotype characterized by FOXP3 TSDR demethylation.

CONCLUSIONS AND CLINICAL RELEVANCE

Helicobacter pylori confers protection against the anaphylaxis associated with ovalbumin and peanut allergy and affects the epigenome of T cells, thereby promoting stable Treg differentiation and functionality. Prophylactic treatment with H. pylori-derived immunomodulators appears to be a promising strategy for food allergy prevention.

Wrist ultrasound examination - scanning technique and ultrasound anatomy. Part 2: Ventral wrist

Ultrasound imaging of the musculoskeletal system is an important element of the diagnostic and therapeutic protocol. Clinical decisions, including those regarding surgical procedures, are often based solely on ultrasound imaging. However, detailed knowledge on the anatomy and a correct scanning technique are crucial for an accurate diagnosis. Modern ultrasonographic equipment allows obtaining detailed anatomical images of muscle tendons, ligaments, nerves and vessels of the carpal area. Ventral wrist ultrasound is one of the most common diagnostic procedures in patients with suspected carpal tunnel syndrome. Ventral wrist evaluation is also often performed in patients with wrist pain of unclear etiology, rheumatic diseases, wrist injuries or symptoms of ulnar neuropathy. The aim of this paper is to present ultrasound images with corresponding anatomical schemes. The technique of ultrasound examination of the ventral wrist along with practical guidance to help obtain highly diagnostic images is also discussed. The present paper is the second part of an article devoted to ultrasound anatomy and wrist ultrasound technique – the part discussing the dorsal side of the wrist was published in the Journal of Ultrasonography, Vol. 15, No 61. The following anatomical structures should be visualized during an ultrasound examination of the ventral wrist, both in the carpal tunnel as well as proximally and distally to it: four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, flexor pollicis longus, flexor carpi radialis tendon, median nerve and flexor retinaculum; in the carpal tunnel as well as proximally and distally to it: the ulnar nerve, ulnar artery and veins; the tendon of the flexor carpi ulnaris muscle; carpal joints.

Platinum nanowires anchored on graphene-supported platinum nanoparticles as a highly active electrocatalyst towards glucose oxidation for fuel cell applications

The limited performance of platinum-based electrocatalysts for glucose electrooxidation is a major concern for glucose fuel cells, since glucose electrooxidation is characterized by slow reaction kinetics and low diffusion coefficient. Here, the presented graphene-supported platinum-based hierarchical nanostructures attain highly enhanced electrocatalytic activity towards glucose oxidation. Platinum nanoparticles electrodeposited on graphene support retain mechanical stability and act as junctions allowing a reliable, smooth and dense growth of platinum nanowires with extremely small diameters (>10 nm) on graphene. The electrode's surface roughness was increased by factors up to 4000 to the geometrical surface area enabling maximized exploitation of the electrocatalytic activity of platinum and efficient electron transfer between nanowires and the substrate. The unique three-dimensional geometry of these hierarchical nanostructures has a significant impact on their catalytic performance offering short diffusional paths for slow glucose species, thus, mass transport limitations are optimized leading to lower polarization losses. This was examined by galvanostatic measurements of the operation as anodes in glucose half-cells under conditions corresponding to implantable glucose fuel cells. The presented hierarchical nanostructures show remarkably enhanced catalytic performance for glucose electrooxidation, i.e. a negatively shifted open circuit potential of -580 mV vs. Ag/AgCl, hence, representing appropriate electrocatalysts for use as anodes in glucose fuel cells. In combination with a non-metal N-doped graphene cathode, a cell potential of 0.65 V was achieved at a galvanostatic load of 17.5 μA cm^-2 which noticeably surpasses the performance of state of the art catalysts for the aforementioned operation conditions.

Spatial organization of seismicity and fracture pattern in NE Italy and W Slovenia

The study focuses on the spatial organization of seismicity and the relation between fracture pattern and earthquakes in the Friuli (north-eastern Italy) and western Slovenia seismic regions. The structural setting is characterized by a complex structure resulting from the superposition of several tectonic phases that generated NW-SE trending Dinaric faults and about E-W trending Alpine faults. The upper crust is characterized by lithological and mechanical heterogeneities. The fractal analysis shows that, in general, the seismicity only partially fills a plane. Only in a few cases, the earthquakes distribute on planar structures. The orientation of planes that fit through the hypocentres shows a different disposition at the two depth intervals analysed. The shallower interval (0-10 km) is characterized by planes with highly variable orientations. The spatial seismicity is investigated in the context of a general damage model, represented by the crack density distribution. The results evidence that the seismicity appears mostly located along sharp transition areas from low crack density to higher crack density, i.e., from zones of low damage to zones of intermediate damage. These zones are characterized by high heterogeneity due to the superposition of different tectonic phases and by the maximum interference between Dinaric and Alpine domains. The orientation of the planes fitting the seismicity at 10-20-km depth appears less dispersed, coinciding with the trend of Dinaric sub-vertical faults in the northern and eastern parts of the study area, and with Alpine low-angle faults in the western and southern parts.

Diagnostic value of TREM-1 and TREM-2 expression in bronchoalveolar lavage fluid in sarcoidosis and other lung diseases

BACKGROUND

Triggering receptors expressed on myelocytes (TREM) belong to new molecules with a great role in innate immune system and inflammation. While TREM-1 is known for its pro-inflammatory activity, the TREM-2 has anti-inflammatory activity and has a great impact on granuloma formation, typical sign of sarcoidosis and other granulomatous diseases.

METHODS

In our study, we compared the TREM-1 and TREM-2 receptor expressions on the myeloid cell surfaces in bronchoalveolar lavage fluid in patients with pulmonary sarcoidosis (PS), other interstitial lung diseases (ILD), asthma bronchiale (AB), pneumonia, lung cancers, and Quantiferon TB positive patients.

RESULTS

We found increased number of all TREM variables (total number, percentage, and mean fluorescence intensity /MFI/) of TREM-1 and TREM-2 positive cells in PS and AB patients compared to the control group of patients with other ILD. In patients with pneumonia, only expression of TREM-1 receptor was increased. In ILD, AB and group of pneumonia patients, the increase of TREM-1 and TREM-2 expression was associated with an increased number of eosinophils.

CONCLUSION

TREM-1 and TREM-2 tests are good diagnostic tests for sarcoidosis. Their sensitivity and specificity are comparable with the currently common using test, that of CD4/CD8 ratio. The combination of both tests (CD4/CD8 ratio test together with TREM-1 and TREM-2 tests) resulted in an increased sensitivity and specificity (Tab. 7, Fig. 1, Ref. 28).

Dielectric Studies on Liquid Crystals under High Pressure: VI. Low Frequency Relaxation Process in the Nematic and Smectic A Phase of 4-n-Octyl-4'-Cyanobiphenyl (8 CB)

Dielectric relaxation studies of 4-n-octyl-4'-cyanobiphenyl (8 CB) were performed in the pressure range 0.1 -120 MPa, the frequency range 1 kHz -13 MHz and the temperature range 295-331 K. The dielectric behaviour of 8C B in the nematic phase is similar to that of 5 CB, 6 CB and 7 CB. In particular, the activation enthalpy decreases with increasing pressure and the activation volume decreases with increasing temperature in the nematic phase. In the smectic A phase of 8 CB both these parameters are markedly lower and show opposite pressure and temperature dependencies. We tentatively interpret these effects as a result of breaking of the dipole-dipole correlations which manifests itself differently in these liquid crystalline phases.

Dielectric Relaxation Studies of 4-n-Alkyloxy-4’-Cyanobiphenyls (nOCB, n= 5÷8)

The results of dielectric relaxation studies of series of four n-alkyloxy cyanobiphenyl (nOCB) compounds with n ranging from 5 to 8 are presented. The complex dielectric permittivity, ε*(ω) - ε’(ω) - i ε’’(ω), was measured in the frequency range 1 kHz - 3 GHz, with the use of an impedance analyzer and a time domain spectroscopy (TDS) set-up. The relaxation times: longitudinal τ|| in the nematic and smectic A phase (80CB), transverse τ⊥ in the nematic phase, and τis in the isotropic phase, were obtained as functions of the temperature. This allowed the calculation of activation barriers for different molecular relaxation processes occurring in particular phases. More-over, the retardation factors g|| and g⊥ and the nematic potential q according to two theoretical models were calculated. The analysis of q(T) and its relation to the order parameter S is done taking into account the results of NMR studies of the compounds under consideration. Finally, the dependencies of the obtained quantities on the number of carbon atoms in the alkyloxy chains are analyzed.

Phase behavior and dynamics of a cholesteric liquid crystal

The synthesis, equation of state, phase diagram, and dielectric relaxation properties are reported for a new liquid crystal, 4(')-butyl-4-(2-methylbutoxy)azoxybenzene (4ABO5*), which exhibits a cholesteric phase at ambient temperature. The steepness of the intermolecular potential was characterized from the thermodynamic potential parameter, Γ = 4.3 ± 0.1 and the dynamic scaling exponent, γ = 3.5 ± 0.2. The difference between them is similar to that seen previously for nematic and smectic liquid crystals, with the near equivalence of Γ and γ consistent with the near constancy of the relaxation time of 4ABO5* at the cholesteric to isotropic phase transition (i.e., the clearing line). Thus, chirality does not cause deviations from the general relationship between thermodynamics and dynamics in the ordered phase of liquid crystals. The ionic conductivity of 4ABO5* shows strong coupling to the reorientational dynamics.

Proinflammatory and prothrombotic effects on human vascular endothelial cells of immune-cell-derived LIGHT

Objective

LIGHT (TNFSF 14) belongs to the tumor necrosis factor superfamily and is expressed by activated T cells as well as various types of antigen presenting cells. LIGHT binds to its cellular receptors TR2 and LTßR and has a co-stimulatory role in T cell activation. Here, we compared the relative expression of LIGHT in different immune cells and the biological activity of immune cell-derived LIGHT on endothelial cells.

Methods and Results

Surface expression of LIGHT and mRNA production by PBMC and isolated T cells (CD4⁺ or CD8⁺) significantly increased after stimulation with PMA (Phorbolester-12-Myristat-13-Acetat) + ionomycin. No LIGHT expression on PMA stimulated monocytes or monocytic-like THP-1 cells could be detected; differentiation of monocytes and THP-1 cells into macrophages, however, resulted in up-regulation of LIGHT. Supernatants of stimulated T cells contained higher concentrations of soluble LIGHT than macrophage supernatants normalized to cell numbers; release of soluble LIGHT was found to be dependent on metalloproteinase activity. Size determination of released soluble LIGHT by size exclusion chromatography revealed a molecular mass of ~60 kDa, suggesting a trimeric form. Released soluble LIGHT induced expression of proinflammatory antigens ICAM-1, tissue factor and IL-8 in human endothelial cells and caused apoptosis of IFN-γ pretreated endothelial cells. Soluble LIGHT was detected at low levels in sera of healthy controls and was significantly enhanced in sera of patients with chronic hepatitis C and rheumatoid arthritis (24.93 ± 9.41 vs.129.53 ± 49.14 and 172.13 ± 77.64; p < 0.0005).

Conclusion

These findings suggest that among immune cells activated T lymphocytes are the main source of soluble LIGHT with released amounts of soluble LIGHT markedly higher compared to platelets. Immune cell-derived membrane-bound and soluble trimeric LIGHT is biologically active, inducing proinflammatory changes in endothelial cells. Enhanced plasma levels of soluble LIGHT in patients with chronic infections suggest a role of LIGHT in systemic inflammatory activation.

Interaction potential in nematogenic 6CHBT

Pressure-volume-temperature (PVT) measurements were carried out on the nematic liquid crystal 4(trans-4'-n-hexylcyclohexyl)isothiocyanatobenzene (6CHBT). In combination with previous dielectric relaxation measurements at elevated pressure and new measurements extending to GHz frequencies, the characteristics of the anisotropic interaction potential were determined. The thermodynamic potential parameter, gamma, which measures the variation of the interaction energy with volume, equals 5.03 +/- 0.06, with a barrier height equal to approximately 7 kJ/mol. Thus, there is a low potential barrier to reorientations of the 6CHBT molecule about its short axis; however, the retarding potential is strongly volume-dependent. The longitudinal reorientational times determined for various thermodynamic conditions superpose using a scaling exponent equal to gamma within the experimental error. It then follows, as found recently for other liquid crystals, that this relaxation time must be constant along the pressure-dependent clearing line. Thus, the control parameter (e.g., Gibbs free energy) governing the competition between the anisotropic energy and the entropy must also govern the rotational dynamics in the ordered phase of this liquid crystal.

Orientational order of difluorinated liquid crystals: a comparative 13C-NMR, Optical, and dielectric study in nematic and smectic B phases

Structural and orientational order properties of 3Cy2CyBF2 and of 5CyCy2BF2 have been investigated by means of (13)C-NMR, optical, and dielectric spectroscopy methods. In the case of NMR, order parameters have been independently obtained from the analysis of either (13)C-(19)F dipolar couplings or (13)C chemical shift anisotropies, both measured from (13)C-{(1)H} NMR static spectra. The assignment of the (13)C resonances has been carried out thanks to the comparison with solution state spectra and DFT calculations, and the relevant geometrical parameters and (13)C chemical shift tensors needed to derive orientational order parameters have been calculated by DFT methods. In the analysis of (13)C-(19)F dipolar couplings, empirical corrections for vibrations and anisotropic scalar couplings have been included. Dielectric measurements have been performed over a broad frequency range for two orientations of the nematic director with respect to the measuring field. At low frequencies (static case) a positive dielectric anisotropy has been determined, which has enabled the calculation of the order parameters according to a well-tested procedure. At high frequencies the dielectric anisotropy changes its sign, a property which can be useful in designing a dual addressing display. The nematic order parameter determined from optical, dielectric, and NMR methods have been compared: their trends with temperature are very similar, apart from some slight shifts, and were analyzed by Haller and Chirtoc models. The differences among the results obtained by the four methods have been discussed in detail, also with reference to the assumptions and approximations used in each case, and to the results recently reported for similar fluorinated nematogens. The presence of a non-negligible order biaxiality has been related to the presence of a CH2CH2 bridging group, linking one cyclohexylic unit with either the other cyclohexyl or the phenyl ring.

Peripheral blood dendritic cells are phenotypically and functionally intact in chronic hepatitis B virus (HBV) infection

Persistence of hepatitis B virus (HBV) infection is associated with reduced anti-viral T cell responses. Impaired dendritic cell (DC) function was suggested as the cause of reduced T cell stimulation in chronic HBV carriers. Thus, we compared myeloid (mDC) and plasmacytoid DC (pDC) from chronic HBV carriers and controls. Frequency and phenotype of isolated DC were analysed by fluorescence activated cell sorter staining, DC function by mixed lymphocyte reaction, cytokine bead array, intracellular cytokine staining, enzyme-linked immunosorbent assay and enzyme-linked immunospot. Expression of HBV DNA and mRNA was studied by polymerase chain reaction (PCR). Circulating total DC, mDC or pDC were not reduced in chronic HBV carriers. Isolated mDC and pDC from chronic HBV carriers exhibited similar expression of co-stimulatory molecules and alloreactive T helper cell stimulation as control DC, whether tested directly ex vivo or after in vitro maturation. Secretion of pro- and anti-inflammatory cytokines by CD40 or Toll-like receptor ligand-stimulated patient DC was intact, as was human leucocyte antigen A2-restricted HBV-specific cytotoxic lymphocyte stimulation. Although both DC populations contained viral DNA, viral mRNA was undetectable by reverse transcription-PCR, arguing against viral replication in DC. We found no quantitative, phenotypic or functional impairment of mDC or pDC in chronic hepatitis B, whether studied ex vivo or after in vitro maturation.

Thermodynamic analysis of the low frequency relaxation time in the smectic A and C phases of a liquid crystal

Pressure-temperature-volume (pVT) measurements were carried out on 2-(4-hexyloxyphenyl)-5-octyl-pyrimidine, a substance exhibiting nematic and smectic A and C polymorphism. Analysis of the longitudinal relaxation times obtained recently for elevated pressures [Czub et al., Z. Naturforsch. A: Phys. Sci. 58, 333 (2003)] was performed for isobaric, isothermal, and isochoric conditions within the two smectic phases. Several relationships linking the dynamical and thermodynamical quantities, derived recently for isotropic glass formers [Roland et al. Rep. Prog. Phys. 68, 1405 (2005)], were found to hold for the liquid crystal, revealing a striking similarity of behaviors for these two types of materials. The parameter gamma characterizing the steepness of the interaction potential was derived in different ways. It is interesting that the liquid crystal gives relaxation time versus TV(-gamma) plots that are linear, unlike results for glass formers, implying that the dynamics of the former is thermally activated.