The effect of 2 mMol glutamine supplementation on HSP70 and TNF-α release by LPS stimulated blood from healthy children.

OBJECTIVE: Glutamine has been shown to promote heat shock protein 70 (HSP70) release both within experimental in vitro models of sepsis (2-10 mM) and in adults post trauma (0.5 g/kg), although the efficacy varies and is dependent on the model used. The effect of glutamine supplementation on HSP70 release in children is less clear. Therefore, the aim of this study was to investigate the effect of 2 mM glutamine added to incubation media on HSP70 and inflammatory mediator release in an in vitro model of paediatric sepsis using whole blood from healthy paediatric volunteers. METHODS: An in vitro whole blood endotoxin stimulation model using 1 µg/ml lipopolysaccharide (LPS) over a 24 h time period was used to investigate the effects of 2 mM glutamine on HSP70 and inflammatory mediator release in healthy children. RESULTS: The addition of 2 mM glutamine to the incubation media significantly increased HSP70 release over time (p < 0.05). This was associated with an early pro-inflammatory effect on TNF-α release at 4 h (p < 0.005) which was not seen at 24 h. There was a non significant trend towards higher levels of IL-6 and IL-10 following the addition of 2 mM glutamine, which appears to differ from the response reported in adult and animal models. CONCLUSION: Glutamine supplementation of incubation media promotes HSP70 and early TNF- α release in an in vitro model using blood samples from healthy children.

Médecins Sans Frontières' Clinical Guidance mobile application: analysis of a new electronic health tool.

Many health care workers lack access to clinical support tools in rural and resource-limited settings. To address this gap, the Médecins Sans Frontières (MSF) Clinical Guidelines manual was converted into a static mobile health reference application (app) entitled MSF Guidance. The app's utility and growth was examined, and within 6 months of its launch 150 countries had downloaded the app, with demonstrated retention among new and existing users. With over 3500 downloads and 36 000 sessions amounting to 250 000 screen views, MSF Guidance is a new mobile health platform with widely demonstrated utility, including potential use as an epidemiological tool, where clinical conditions investigated by app users were found to correlate with geographical outbreaks. These findings show that mobile apps can be used to disseminate health information effectively.

De nombreux travailleurs de santé n'ont pas accès à des outils de soutien clinique dans les zones rurales et celles où les ressources sont limitées. Pour répondre à ce problème, le manuel de directives cliniques de Médecins Sans Frontières (MSF) a été converti en une application mobile de référence en santé, appelée Guidance MSF. L'utilité et la croissance de cette application ont été suivies et, 6 mois après son lancement, 150 pays l'avaient téléchargée, avec une rétention démontrée parmi les usagers récents et anciens. Avec plus de 3500 téléchargements et 36 000 sessions aboutissant à 250 000 affichages d'écran, MSF Guidance est un nouvel outil de santé dont l'utilité a été largement démontrée, notamment son utilisation potentielle comme outil d'épidémiologie, car les pathologies cliniques pour lesquelles les usagers ont fait des recherches se sont avérées correspondre à des épidémies localisées. Ces résultats montrent que les applications mobiles peuvent être utilisées pour disséminer efficacement des informations sanitaires.

Muchos profesionales de salud carecen de acceso a instrumentos de ayuda clínica en los entornos rurales y de recursos limitados. Con el propósito de subsanar esta deficiencia, el manual impreso de directrices clínicas de Médicos Sin Fronteras (MSF) se convirtió en una aplicación estática de salud móvil de consulta, denominada MSF Guidance. Al examinar la utilidad de la aplicación y su difusión, se observó que 6 meses después de la introducción se había descargado la aplicación en 150 países, y se confirmó una retención efectiva por parte de los usuarios nuevos y los usuarios existentes. Esta aplicación, con más de 3500 descargas y 36 000 sesiones, equivalentes a 250 000 visualizaciones de pantalla, constituye una nueva plataforma móvil de salud con una utilidad ampliamente demostrada, que incluye la posibilidad de utilizarla como herramienta epidemiológica, pues las afecciones clínicas investigadas por los usuarios de la aplicación se correlacionaron con la localización geográfica de brotes epidémicos. Estas observaciones revelan que las aplicaciones móviles se pueden utilizar eficazmente en la difusión de la información sanitaria.

Glutamine depletion and heat shock protein 70 (HSP70) in children with meningococcal disease.

BACKGROUND & AIMS: Heat shock proteins are classified into six main families, of which HSP70 is the best studied. HSP70 is postulated to modulate the immune/inflammatory response in critical illness. Glutamine promotes HSP70 release, however, little is known about the relationship between glutamine and HSP70 in paediatric critical illness. We therefore aimed to describe plasma levels of HSP70, inflammatory mediators and glutamine in critically ill children. METHODS: A clinical audit identified 143 children with severe meningococcal disease, 78 convalescent children, in addition to 35 healthy paediatric controls. Stored plasma was used to measure plasma concentrations of HSP70, inflammatory mediators and glutamine. RESULTS: HSP70 was significantly increased on admission (n = 143, mean 26.7 ng/ml; ±SD 79.95) compared with convalescence (n = 78, mean 3.16 ng/ml; ±SD 5.67). Glutamine levels were low (n = 132, mean 0.31 mmol/l; ±SD 0.13), which continued in convalescence (n = 65, mean 0.40 mmol/l; ±SD 0.14). Enteral glutamine provided only 28% of the recommendations. Glutamine was inversely correlated with length-of-stay (n = 98, r = -0.520, p < 0.001), ventilation (n = 98, r = -0.513, p < 0.001), lactate (n = 98, r = -0.41, p < 0.001) and CRP (n = 98, r = -0.51, p < 0.001). HSP70 was correlated with length-of-stay (n = 99, r = 0.30, p < 0.001), ventilation (n = 99, r = 0.31, p < 0.001), lactate (n = 99, r = 0.26, p < 0.001) and CRP (n = 99, r = 0.29, p < 0.001) and inflammatory mediators. There was no relationship between glutamine and HSP70 or inflammatory mediators. CONCLUSIONS: During acute illness HSP70/inflammatory mediators are significantly increased, and glutamine is significantly depleted. However, glutamine and HSP70 were not correlated. Enteral feeds only provided a small proportion of the ASPEN/ESPEN recommendations for glutamine.

The youth report version of the Child and Adolescent Scale of Participation (CASP): assessment of psychometric properties and comparison with parent report.

OBJECTIVE: The Child and Adolescent Scale of Participation (CASP) parent report is a brief and valid measure for use with children and youth with chronic conditions/disabilities that has been shown to have good coverage at the chapter level of the 'Activities and Participation' component of the International Classification of Functioning, Disability and Health. The purpose of this research was to assess the psychometric properties of a CASP youth self-report version, to further validate the parent report, and to compare parent and youth reports of youths' activity and participation. METHODS: Baseline data from a longitudinal study examining predictors of changes in quality of life for youth with chronic conditions/disabilities were used. CASP data were collected on 409 youth aged 11-17 with various conditions/disabilities using youth and parent reports. Internal consistency and factor structure were examined for both versions using Cronbach's alpha and exploratory factor analyses. Inter-rater agreement and magnitude of differences between youth and parent report were evaluated using intraclass correlation coefficients and paired t-tests respectively. Gender, age and condition/disability group differences in youth report CASP scores were examined using independent t-tests or analyses of variance. RESULTS: Strong internal consistency and internal structure validity was demonstrated for the CASP youth and parent report. The youth report factor structure was similar to the parent report in this and other studies. Youth reported their activity/participation to be significantly higher than did their parents. Significant differences in CASP scores were found among condition/disability groups. CONCLUSIONS: Findings show that, from a psychometric standpoint, the youth version of the CASP is a promising new self-report measure of activity and participation. As youth perceive their activity and participation levels differently than their parents, it is important to collect data from both sources to obtain a more comprehensive understanding of this aspect of youths' lives.

Children's and parents' beliefs regarding the value of walking: rehabilitation implications for children with cerebral palsy.

BACKGROUND: Walking for children with cerebral palsy (CP) has physiological and functional benefits, but also holds symbolic significance that largely remains unexplored. The aims of this pilot study were to describe beliefs about the value of walking held by children with CP and their parents, and to examine how these beliefs inform rehabilitation choices and perceptions of 'success'. METHODS: A critical qualitative design was employed. Six parents and six children with CP (Gross Motor Function Classification System III or IV, aged 9 to 18 years) each participated in a private interview. Analyses examined the relationship between dominant social beliefs regarding walking and participants' accounts. RESULTS: Parents' accounts revealed that all adopted a stance of doing something/trying anything as part of being a 'good parent' and maintaining hope. Tapering of walking interventions contributed to feelings of guilt and doubt. Children primarily viewed walking as exercise rather than functional. Their accounts also demonstrated how they internalized negative attitudes towards disability and judged themselves accordingly. CONCLUSIONS: The results of this pilot study provide provisional evidence regarding how dominant social values regarding walking and disability are taken up by parents and children. They suggest that rehabilitation programmes need to consider how they may unintentionally reinforce potentially harmful choices, and how best to engage families in discussions of their evolving values and treatment priorities. Further research is needed with a larger sample.

The trapped human experiment.

This experiment observed the evolution of metabolite plumes from a human trapped in a simulation of a collapsed building. Ten participants took it in turns over five days to lie in a simulation of a collapsed building and eight of them completed the 6 h protocol while their breath, sweat and skin metabolites were passed through a simulation of a collapsed glass-clad reinforced-concrete building. Safety, welfare and environmental parameters were monitored continuously, and active adsorbent sampling for thermal desorption GC-MS, on-line and embedded CO, CO(2) and O(2) monitoring, aspirating ion mobility spectrometry with integrated semiconductor gas sensors, direct injection GC-ion mobility spectrometry, active sampling thermal desorption GC-differential mobility spectrometry and a prototype remote early detection system for survivor location were used to monitor the evolution of the metabolite plumes that were generated. Oxygen levels within the void simulator were allowed to fall no lower than 19.1% (v). Concurrent levels of carbon dioxide built up to an average level of 1.6% (v) in the breathing zone of the participants. Temperature, humidity, carbon dioxide levels and the physiological measurements were consistent with a reproducible methodology that enabled the metabolite plumes to be sampled and characterized from the different parts of the experiment. Welfare and safety data were satisfactory with pulse rates, blood pressures and oxygenation, all within levels consistent with healthy adults. Up to 12 in-test welfare assessments per participant and a six-week follow-up Stanford Acute Stress Response Questionnaire indicated that the researchers and participants did not experience any adverse effects from their involvement in the study. Preliminary observations confirmed that CO(2), NH(3) and acetone were effective markers for trapped humans, although interactions with water absorbed in building debris needed further study. An unexpected observation from the NH(3) channel was the suppression of NH(3) during those periods when the participants slept, and this will be the subject of further study, as will be the detailed analysis of the casualty detection data obtained from the seven instruments used.

Multiple protein extract microarray for profiling human food-specific immunoglobulins A, M, G and E.

Existing food immunoglobulin (Ig) tests require large volumes of serum, are limited to one immunoglobulin class, are not amenable to high throughput analysis and only give a limited picture of the immunological response to food antigens. Conversely a new generation of Component Resolved Diagnostic systems using pure proteins is highly specific and totally dependent on the availability of the protein in its recombinant or natural origin form. Here we demonstrate a proof-of-concept of a microarray test based on protein extracts of food components. Our approach relies on innovations on three different fronts: the novelty of using arrayed food samples sequentially extracted with detergent and chaotropic agents, the ability to measure four different Ig classes simultaneously and the ability to analyse the generated data via a suitable bioinformatics/statistical analysis interface. This approach combines high numerical power of microarrays with automation, high throughput analysis and enables detailed investigation of the Ig profiles to food antigens. The prototype shown contains extracts of approximately 350 food ingredients that cover most of the food products found in the UK. Here we showed that the use of a sequential extraction technique to solubilise and then denature food samples has its benefits in the assessment of variations in antigenicity when tested with human sera. A patient dependent degree of class specificity was observed with human sera (IgG specificity correlates well with IgA>IgM>>>>>IgE). Besides generating a simultaneous profile for IgA, IgM, IgG and IgE the array system has shown good discrimination between challenge responders in atopic and non-atopic individuals. Poly- and mono-specific IgE responders were easily identified. The mathematical modelling of specific IgE content showed good correlations when compared with established IgE antibody testing assay (UniCAP). Although in its proof-of-principle stages, the immune profiling technique described here has the potential to provide unique insights into exposure/sensitization and establish relationships between specific immunoglobulin classes and subclasses against food protein antigens. In further developments, the immune profiling technique could also be extended to other related areas such as parasite and bacterial gut infection. Full analyses of large longitudinal and retrospective clinical trials are on going to determine the positive and negative predictive values of the technique.

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease.

BACKGROUND/OBJECTIVES: The purpose of this study was to develop an activity energy expenditure (AEE) prediction equation for the Actiheart activity monitor for use in children with chronic disease. SUBJECTS/METHODS: In total, 63 children, aged 8-18 years with different types of chronic disease (juvenile arthritis, hemophilia, dermatomyositis, neuromuscular disease, cystic fibrosis or congenital heart disease) participated in an activity testing session, which consisted of a resting protocol, working on the computer, sweeping, hallway walking, steps and treadmill walking at three different speeds. During all activities, actual AEE was measured with indirect calorimetry and the participants wore an Actiheart on the chest. Resting EE and resting heart rate were measured during the resting protocol and heart rate above sleep (HRaS) was calculated. RESULTS: Mixed linear modeling produced the following prediction equation: This equation results in a nonsignificant mean difference of 2.1 J/kg/min (limits of agreement: -144.2 to 148.4 J/kg/min) for the prediction of AEE from the Actiheart compared with actual AEE. CONCLUSIONS: The Actiheart is valid for the use of AEE determination when using the new prediction equation for groups of children with chronic disease. However, the prediction error limits the use of the equation in individual subjects.

Specific detection of proteins using photonic crystal waveguides.

Specific detection of proteins is demonstrated using planar photonic crystal waveguides. Using immobilized biotin as probe, streptavidin was captured, causing the waveguide mode cut-off to red-shift. The device was shown to detect a 2.5 nm streptavidin film with a 0.86 nm cut-off red-shift. An improved photonic crystal waveguide sensor design is also described and shown to have a 40% improved bulk refractive index response.

Pilot study of fitness training and exercise testing in polyarticular childhood arthritis.

OBJECTIVE: To 1) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis (JIA), 2) test the safety and feasibility of a 3-month exercise program in JIA, 3) assess pain during exercise in JIA, 4) compare ratings of perceived effort (RPE) with heart rate (HR) achieved, and 5) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing. METHODS: Nine children with JIA were enrolled in a 12-week circuit training program involving pool, stationary bicycle, treadmill, and Fitball. They underwent formal exercise testing before and after the program, underwent a full joint assessment, were administered the Childhood Health Assessment Questionnaire and Juvenile Arthritis Functional Status Index, and were assessed for overall quality of life and health-related quality of life. A visual analog scale was used to assess pain during testing and training, and the Borg scale was used to measure RPE. RESULTS: Children with JIA were able to participate in exercise testing without any significant problems. Children with severe hip disease dropped out of the exercise program due to pain during the exercise sessions and worsened arthritis symptoms. Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions. Submaximal exercise testing showed an improvement with a small to moderate effect size. CONCLUSION: This study suggests that it is safe, feasible, and acceptable for children with arthritis, in the absence of severe hip involvement, to participate in formal exercise testing and structured fitness programs.

Circulating endothelial microparticles in acute ischemic stroke: a link to severity, lesion volume and outcome.

BACKGROUND: Endothelial membrane microparticles (EMP) in plasma are elevated in several vascular diseases. OBJECTIVES: To test the hypothesis that EMP would be increased in patients with acute ischemic stroke and would correlate with stroke severity, brain lesion volume and outcome. PATIENTS AND METHODS: Forty-one patients were studied and divided into two groups based on the National Institutes of Health Stroke Scale (NIHSS) score: 20 patients with mild stroke (NIHSS score < 5) and 21 patients with moderate-severe stroke (NIHSS score > or = 5). Lesion volume was measured using diffusion-weighted magnetic resonance imaging and discharge outcome was based on the discharge Barthel and Rankin scores. Twenty-three age-matched control subjects were also studied. Using flow cytometry, endoglin-positive EMP: CD105+ CD41a-CD45- (E(+)EMP), specific endothelial EMP expressing VE-cadherin and endoglin: CD105+CD144+ (C(+)EMP), EMP expressing phosphatidylserine: CD105+PS+ CD41a- (PS(+)EMP) and EMP expressing ICAM-1: CD105+CD54+ CD45- (I(+)EMP) were analyzed. RESULTS: Significantly higher PS(+)EMP counts were observed in the group of acute ischemic stroke patients [median 59 (25th-75th percentile: 28-86) MP microL(-1)] relative to the controls [28 (14-36) MP microL(-1)] (P = 0.002). All four EMP phenotypes studied were elevated in the subgroup of moderate-severe stroke patients relative to the controls (all P < 0.05). In the patients with acute ischemic stroke three EMP phenotypes (E(+)EMP, PS(+)EMP and I(+)EMP) correlated significantly with brain lesion volume, with I(+)EMP (P = 0.002) showing the strongest correlation. Admission counts of C(+)EMP (P = 0.0003) and E(+)EMP (P = 0.003) correlated significantly with discharge clinical outcome. CONCLUSIONS: Certain circulating EMP phenotypes may be associated with severity, lesion volume and outcome of acute ischemic stroke. EMP analysis shows promising contribution to understanding stroke pathophysiology.

An evaluation of the responsiveness of a comprehensive set of outcome measures for children and adolescents with traumatic brain injuries.

The relative responsiveness of nine outcome measure scales was evaluated with 33 children and adolescents (aged 4-18 years) who had sustained traumatic brain injuries. Scales were selected to evaluate outcomes from each of the World Health Organization (WHO) International Classification of Functioning, Disability and Health domains. The outcome measures were administered to all participants during their inpatient rehabilitation stay and again at a follow-up clinic visit. No single outcome measure captured the diversity of improvement in this sample. The measures agreed that improvement had occurred, but did not agree about which children were improving. This result suggests that the scales were measuring different skills and outcomes. Three of the measures used in combination, either the Child Health Questionnaire or the Functional Independence Measure for Children, the American Speech-Language-Hearing Association National Outcome Measures System (Birth to Kindergarten NOMS/School-aged Health Care) and the Gross Motor Function Measure, are sufficient to detect change in each of the children where change occurred. The Pediatric Evaluation of Disability Inventory and the MultiAttribute Health Status Classification were the least responsive of the nine measures used.

Immune responses following experimental human hookworm infection.

To characterize the immune response following primary human hookworm infection, an adult volunteer was infected with 50 L3 larvae of Necator americanus, reinfected 27 months later and followed for a further 6 months. Clinical signs, blood picture, ex-vivo peripheral blood cytokine production (IFN-gamma, IL-5, IL-13, IL-10 to mitogen and hookworm antigen), acute phase proteins (APP) (C-reactive protein, CRP and alpha1-antitrypsin, alpha1-AT) and antibody levels were determined. Dermatitis, oedema, mild nausea and abdominal discomfort followed the primary infection. Eosinophil counts peaked early during both infections but remained elevated ( approximately 18%) throughout. Transient production of IL-5, IL-13 and APP also followed infection but there were negligible levels of IFN-gamma or IL-10. The onset of nausea, oedema and the initial rise in CRP, alpha1-AT, eosinophilia and IL-5 coincided (days 13-27) with the late larval migration and early establishment of the preadult worms in the intestine. Apart from the eosinophilia these responses declined to baseline levels within 4 months and were less pronounced on re-infection.

Assessment of CE-MRA for the rapid detection of supra-aortic vascular disease.

BACKGROUND: Contrast-enhanced MR angiography (CE-MRA) using a combined head and neck coil permits non-invasive imaging of the vasculature from the aortic arch through to the Circle of Willis in less than 2 minutes. OBJECTIVE: To determine the accuracy of CE-MRA for the detection of vascular pathology, in particular vascular stenoses, using digital subtraction angiography (DSA) as the gold standard. METHODS: In a prospective study of 81 patients referred for DSA, CE-MRA and DSA studies were performed within 72 hours of each other. CE-MRA was performed on a 1.5 Tesla clinical MRI scanner using a five-channel neurovascular array (head and neck coil), with dynamic tracking of the IV gadolinium bolus. CE-MRAs and DSA films were read by two interventional neuroradiologists blinded to the clinical presentation of the patient. RESULTS: On DSA, there were 77 vascular stenoses > or =50% identified, 51 extracranial and 26 intracranial. The overall sensitivity of CE-MRA using the neurovascular array for the detection of vascular stenoses > or =50% was 57% (95% CI: 46 to 68%) with a specificity of 98% (97 to 99%). The sensitivity for the detection of extracranial vascular stenoses > or =50% was 82% (72 to 93%) with a specificity of 97% (96 to 98%). However, the sensitivity for the detection of intracranial vascular stenoses > or =50% was only 8% (0 to 18%), with a specificity of 99% (98 to 100%). CONCLUSIONS: At this stage Contrast-enhanced MR angiography using a neurovascular coil shows promise as a rapid, specific, and noninvasive screening method for extracranial vascular disease, but not for intracranial vascular disease.

Superoxide scavengers augment contractile but not energetic responses to hypoxia in rat diaphragm.

Acute exposure to severe hypoxia depresses contractile function and induces adaptations in skeletal muscle that are only partially understood. Previous studies have demonstrated that antioxidants (AOXs) given during hypoxia partially protect contractile function, but this has not been a universal finding. This study confirms that specific AOXs, known to act primarily as superoxide scavengers, protect contractile function in severe hypoxia. Furthermore, the hypothesis is tested that the mechanism of protection involves preservation of high-energy phosphates (ATP, creatine phosphate) and reductions of P(i). Rat diaphragm muscle strips were treated with AOXs and subjected to 30 min of hypoxia. Contractile function was examined by using twitch and tetanic stimulations and the degree of elevation in passive force occurring during hypoxia (contracture). High-energy phosphates were measured at the end of 30-min hypoxia exposure. Treatment with the superoxide scavengers 4,5-dihydroxy-1,3-benzenedisulfonic acid (Tiron, 10 mM) or Mn(III)tetrakis(1-methyl-4-pyridyl) porphyrin pentachloride (50 microM) suppressed contracture during hypoxia and protected maximum tetanic force. N-acetylcysteine (10 or 18 mM) had no influence on tetanic force production. Contracture during hypoxia without AOXs was also shown to be dependent on the extracellular Ca(2+) concentration. Although hypoxia resulted in only small reductions in ATP concentration, creatine phosphate concentration was decreased to approximately 10% of control. There were no consistent influences of the AOX treatments on high-energy phosphates during hypoxia. The results demonstrate that superoxide scavengers can protect contractile function and reduce contracture in hypoxia through a mechanism that does not involve preservation of high-energy phosphates.

Emphysematous cystitis: rapid resolution of symptoms with hyperbaric treatment: a case report.

INTRODUCTION: Emphysematous cystitis is a rare disease that occurs most often in elderly diabetic patients characterized by gas formation in the bladder wall due to infection. The infecting organism is usually an aerobic bacterium, most commonly E. coli although anaerobic species have also been reported. We report the use of hyperbaric oxygen in a patient with emphysematous cystitis and air in the femoral vein in which the treatment rapidly resolved the symptoms and radiological abnormalities. METHODS: A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness. Urinalysis was positive for white blood cells and bacteria. A CT scan of the abdomen demonstrated extensive air in the bladder wall with an air bubble in the femoral vein. Presumptive diagnosis was urinary tract infection, emphysematous cystitis, and sepsis. A question of air embolism was raised due to the intravascular gas. The patient was treated with hyperbaric oxygen (2.85 atm abs, 90 minutes) on two separate occasions in the first 12 hours. Within 24 hours, the patient's condition rapidly improved. Repeat CT scan 48 hours after admission showed near complete resolution of the emphysematous cystitis. The patient grew Klebsiella pneumonia from her urine. CONCLUSIONS: Emphysematous cystitis is a rare condition caused by either aerobic or anaerobic bacteria and may be associated with both bladder wall and intravascular gas formation. Hyperbaric oxygen therapy has not been previously reported as a treatment modality. The rapid improvement in our patient may indicate a role for hyperbaric oxygen in addition to IV hydration and antibiotics in this disease.

Elevated pro-inflammatory CD4+CD28- lymphocytes and stroke recurrence and death.

OBJECTIVE: To determine if the CD4+CD28- T-cell subset is expanded in patients with recurrent stroke or death after acute ischemic stroke. This subset of the peripheral blood T-cell lymphocyte population has a strong pro-inflammatory and tissue-damaging potential. METHODS: Consecutive patients within the first 48 hours of ischemic stroke were prospectively studied. Peripheral blood CD4+CD28- cells were quantified by flow cytometry. The study endpoint was recurrent stroke or death from any cause during 1 year of follow-up. RESULTS: One hundred six patients (mean age 75.0 +/- 13.5 years; 50 women) were studied. The median CD4+CD28- cell count was 4.5% (range 0.2 to 72.2%). Twenty-seven endpoints (10 recurrent strokes and 17 deaths) occurred during follow-up. Stroke recurrence/death rates were significantly associated with increasing CD4+CD28- counts, rising from 14.2% in patients with CD4+CD28- levels of <1.0 to 48.1% for those with CD4+CD28- counts of >8.0% (p = 0.003, Cochran linear test of trend). Higher CD4+CD28- counts were also present in patients with a history of prior stroke (p = 0.03). After adjustment for age, admission NIH Stroke Scale score, prior stroke, and atrial fibrillation, CD4+CD28- counts of >8.0% were associated with a cumulative hazard ratio of 5.81 (95% CI: 1.58 to 21.32) for stroke recurrence or death. CONCLUSIONS: Rising counts of circulating CD4+CD28- cells are associated with an increasing risk of stroke recurrence and death, in addition to an observed association with prior stroke. Expansion of this T-cell subset presumably represents a biomarker and possibly a contributory pathogenic mechanism of recurrent stroke and death after ischemic stroke.

Intra-specific host sharing in the manipulative parasite Acanthocephalus dirus: does conflict occur over host modification?

The acanthocephalan parasite Acanthocephalus dirus induces a colour change in the intermediate host, the aquatic isopod Caecidotea intermedius, which increases transmission to definitive hosts (creek chub, sunfish). We examined the potential for conflict to occur between infective (cystacanth) and non-infective (acanthor, acanthella) stages of A. dirus over the level of colour modification that should be induced when these stages share a host. Using a field survey, we showed that host sharing by infective and non-infective stages was relatively common and that infective and non-infective stages differed in their effects on colour modification. Non-infective stages induced a colour change over 40% of the body, whereas infective stages induced a colour change over 80%. Thus, conflict could occur between stages over the level of modification that should be induced. We then showed that mixed-stage infections induced a colour change in the host that was consistent with the level of modification induced by the infective stage. We discuss the potential significance of these results to patterns of host modification and their effects on stage-related survival in nature.

Segmental infarction of the omentum: a difficult diagnosis.

Segmental infarction of the greater omentum is a rare diagnosis. This report describes a case of omental torsion in an eight-year-old boy. The report assesses the predisposing factors, the classification and the place of ultrasonography.