Corynebacterium striatum meningitis combined with suspected brain and lung abscesses: a case report and review.

BACKGROUND: Intracranial infections with Corynebacterium striatum (C. striatum) have been described sporadically in the literature over the last two decades. However, C. striatum meningitis combined with multiple abscesses has not been published before. CASE PRESENTATION: In this report, we describe the clinical and imaging findings in a 54-year-old woman with meningitis caused by C. striatum and combined with suspected brain and lung abscesses. This patient who underwent multiple fractures and a recent cut presented with headache and paraphasia. C. striatum was isolated in cerebrospinal fluid and supposedly transmitted from the skin purulent wound through blood. The patient was treated with intravenous vancomycin and had a transient improvement, but died finally. Multiple abscesses, especially in the brain, could be a reason to explain her conditions were deteriorating rapidly. CONCLUSIONS: Note that C. striatum can cause life-threatening infections. Early identification and diagnosis, early administration of antibiotics to which the bacterium is susceptible, and treatment of complications will be beneficial in patients with C. striatum-related infection.

Inverse relationship between apolipoprotein A-I and cerebral white matter lesions: a cross-sectional study in middle-aged and elderly subjects.

BACKGROUND: Apolipoprotein A-I (apoA-I), the major protein for high density lipoprotein, is essential for reverse cholesterol transport. Decreased serum levels of apoA-I have been reported to correlate with subcortical infarction and dementia, both of which are highly related to white matter lesions (WMLs). However, the association between apoA-I and WMLs has never been investigated. In this study, we sought to investigate the association between apoA-I and the presence of WMLs in middle-aged and elderly subjects. METHODS: Consecutive patients aged 50 years and older of our department were prospectively enrolled in this study (n = 1282, 606 men and 676 women, 65.9 ± 9.4 years). All participants underwent MRI scans to assess the presence and severity of WMLs. Multivariate logistic regression analyses were performed to examine the association of apoA-I with WMLs. RESULTS: Patients with WMLs were older and showed significantly higher proportion of male sex, hypertension, diabetes mellitus, previous stroke, and coronary heart disease whereas levels of total cholesterol, high density lipoprotein cholesterol, and apoA-I were lower. After adjustment for potential confounders, the lowest apoA-I quartile was independently associated with an increased risk of WMLs (odds ratio: 1.87, 95% confidence interval: 1.29-2.72). In sex-specific analyses, this relationship was observed only in women. CONCLUSIONS: Our findings demonstrated that apoA-I was inversely associated with the presence of WMLs in middle-aged and elderly subjects. This results suggest that therapies which increase apoA-I concentration may be beneficial to reduce the risk of WMLs, dementia and stroke.

Carotid artery atherosclerosis is correlated with cognitive impairment in an elderly urban Chinese non-stroke population.

Carotid artery atherosclerosis may cause increased intima-media thickness (IMT), plaque formation, and vessel stenosis or occlusion. However, the association between carotid artery atherosclerosis and cognitive impairment remains uncertain. This study explored the effects of IMT and carotid artery stenosis on cognitive function in an elderly Chinese non-stroke population. A total of 2015 patients were recruited. The IMT of carotid arteries and the presence of plaques and stenosis in carotid arteries were assessed with B-mode ultrasound examination. Cognitive performance was evaluated with neuropsychological tests. The cross-sectional relationships between cognitive performance and carotid wall characteristics were analyzed. Carotid artery atherosclerosis (IMT>1.0) and stenosis were found in 86% and 51% of patients, respectively. Cognitive impairment was found in 356 (17.7%) patients. After adjustment for possible confounders, IMT (odds ratio [OR]=1.96; 95% confidence interval [CI] 1.23-3.16) and hyperdense plaque (OR=4.72; 95% CI 2.56-11.2) were associated with poor cognitive performance. Patients with severe (≥70%) carotid artery stenosis had a lower Mini-Mental State Examination score compared with the mild to modest (40-70%) carotid artery stenosis group. Cognitive performance differed between patients with left and right carotid artery stenosis, but no differences were observed between patients with severe left and right carotid artery stenosis. This study indicates that carotid artery atherosclerosis is correlated with cognitive impairment in the elderly Chinese population. A larger sample size across multiple centers and a longitudinal study are required to further explore the impact of carotid artery atherosclerosis on cognition in the elderly population.

[Changes and relations between heart function and organ blood flow in rats at early stage of severe burn].

OBJECTIVE: To investigate the instant changes in heart function and organ blood flow, and their relations in rats at early stage of severe burn. METHODS: Thirty-six SD rats were divided into sham injury group (S, n = 6) and burn group (B, n = 30) according to the random number table. Rats in B group were subjected to 30% TBSA full-thickness burn. Five time points for observation: 10 and 30 minutes, and 1, 3, and 6 hour (s) post injury (PIM/H) were set up, with 6 rats at each time point. Rats in S group were sham scalded with 37 degrees C warm water. Hemodynamics indexes including heart rate (HR), mean artery pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), LV + or - dp/dt max were determined. Blood flow of heart, brain, kidney, spleen, stomach, and ileum was determined respectively with fluorescent microspheres method. The correlation between LV + or - dp/dt max and myocardial blood flow was analyzed. RESULTS: (1) Compared with those of S group, HR in B group decreased gradually after injury; MAP, LVSP, LV +dp/dt max, LV -dp/dt max and myocardial blood flow in B group decreased obviously at PIM 10 (with F value respectively 12.062, 12.629, 11.066, 18.374, 9.468, and P values all below 0.01). Among them, myocardial blood flow decreased from (6.8 + or - 0.8) mL x min(-1) g(-1) to (2.6 + or - 0.5) mL x min(-1) x g(-1). Above-mentioned indexes increased gradually as the time after injury went on, with the highest values (except for LV +dp/dt max) observed at PIH 1, which decreased again later, with values at PIH 3 and 6 significantly lower than those in S group (the same F values as above, P values all below 0.01). There was no obvious difference in LVEDP between S group and B group at each time point (F = 1.205, with P values all above 0.05). (2) Compared with those of S group, blood flow of kidney, spleen, stomach, and ileum of rats in B group at PIM 10 declined obviously (with F value respectively 22.694, 20.856, 12.653, 7.293, P < 0.05 or P < 0.01), but the decline range was smaller than that in heart. The lowest values of above-mentioned indexes were observed at PIH 1 or PIH 3. Brain blood flow of rats in B group at each time point was close to that in S group (F = 1.812, with P values all above 0.05). (3) The correlation coefficient r between LV +dp/dt max, LV -dp/dt max and myocardial blood flow was respectively 0.651 and 0.617, showing significant positive correlation (with t value respectively 4.456 and 4.222, and P values all below 0.01). CONCLUSIONS: The myocardial ischemia and decrease in cardiac function may occur in a very short time after severe burn (PIM 10). The rapid decrease of heart blood flow plays an important role in the change in cardiac function. Myocardial damage and decrease of cardiac function may be one of the important factors result in the decline of blood flow in other organs.

[Influence of endothelin-1 and NO on the instant change in cardiac function of rats at early stage of severe burn].

OBJECTIVE: To explore whether endothelin-1 and NO are involved in the instant changes in cardiac function at early stage of severe burn. METHODS: (1) Thirty-one Wistar rats were divided into sham burn A group (SA, n = 7), burn A group (BA, n = 10), non-selective endothelin A/B receptor antagonist PD142893 group (n = 7), and the selective endothelin A receptor antagonist BQ-123 group (n = 7) according to the random number table. Rats in the latter three groups were inflicted with 30% TBSA full-thickness burn. Immediately after injury, rats in PD142893 group and BQ-123 group were intravenously injected with PD142893 (0.1 mg/kg) and BQ-123 (30 nmol x kg(-1) x min(-1)) respectively. Rats in SA group were treated the same as rats in BA group except for sham injury. The cardiac function indexes of rats in BA and SA groups including left ventricular systolic pressure (LVSP) heart rate (HR) and LV + or - dp/dt max were monitored before injury and 10, 30, 60, 180 minutes post injury (PIM) using physiological signal acquisition and processing system. The respective changes in cardiac function indexes of rate in each group between PIM 10 and pre-injury in the value of percentage were calculated. (2) Another 20 Wistar rats were enrolled and divided into sham burn B group (SB, n = 4) and burn B group (BB, n = 16) according to the random number table, and they were subjected to above-mentioned injury. Heart tissues of rats in BB group were obtained at PIM 10, 30, 60, and 180 respectively (4 rats at each time point), and that in SB group were obtained immediately after injury. Endothelin-1 and NO contents in heart tissues were determined with ELISA. RESULTS: (1) Compared with the pre-injury value, LVSP, HR, LV +dp/dt max, LV -dp/dt max of rats in BA group decreased significantly since PIM 10 (with F value respectively 7.14, 16.40, 14.09 14.98, P < 0.05 or P < 0.01). No significant change was observed in above 4 indexes in rats of SB group between above mentioned two time points (with F value respectively 0.59, 0.51, 1.03, 1.04, P values all above 0.05). (2) In BA group, compared with the pre-injury value, LVSP decreased 27%, HR decreased 14%, LV +dp/dt max decreased 51%, LV -dp/dt max decreased 50% at PIM 10. Compared with those in BA group at PIM 10, cardiac function indexes were improved significantly in PD142893 group, with LVSP decreased 14% (F = 8.10, P < 0.01), HR increased 4% (F = 6.50, P < 0.01), LV +dp/dt max decreased 31% (F = 23.67, P < 0.05), LV -dp/dt max decreased 14% (F = 10.39, P < 0.01). In BQ-123 group, compared with the pre-injury value, HR increased 3%, LV -dp/dt max decreased 26% at PIM 10, which were obviously improved as compared with those in BA group (with F value respectively 6.50 and 10.39, P < 0.05 or P < 0.01); the percentage changes of LVSP and LV +dp/dt max in BQ-123 group were close to that in BA group (with F value respectively 8.10 and 23.67, P values both above 0.05). (3) Compared with those in SB group, myocardial tissue endothelin-1 content of rats in BB group increased significantly at PIM 10, 60, 180 (F = 2.85, P < 00.05 or P < 0.01), and NO content increased significantly at PIM 60, 180 (F = 1.87, with P values all below 0.05). CONCLUSIONS: Endothelin-1 may participate in the instant decline of cardiac function of rats at early stage of severe burn, and plays an important role in the instant myocardial damage after injury.