Traumatic right atrial rupture bridge to definitive repair with extra-corporeal life support.

Cardiac injury secondary to non-penetrating trauma is more common than thought, albeit, the injury is usually minor and goes undiagnosed without significant sequelae in most cases. Blunt cardiac rupture is much rarer accounting for <0.05% of all trauma cases but lethal in most circumstances. We present a case report of a young trauma victim who presented with both right atrial rupture and traumatic atrial septal disruption (ASD) requiring extra-corporeal life support (ECLS) and surgical repair. Blunt cardiac trauma with chamber rupture and septal disruption is a devastating injury. Stopping the hemorrhage and using ECLS gave our patient time to stabilize before definitive management of her traumatic ASD.

Serum Irisin, Adropin, and Preptin in Obese Patients 6 Months After Bariatric Surgery.

BACKGROUND/OBJECTIVES: The reduction of body mass after bariatric surgery affects energy metabolism and may involve changes in irisin, preptin, and adropin production. SUBJECTS AND METHODS: Fifty-five morbidly obese patients with a mean body mass index (BMI) of 45.7 ± 5.8 kg/m2 were treated with either laparoscopic sleeve gastrectomy(n = 30) or laparoscopic adjustable gastric banding (n = 25). Forty-six (83.6%) were followed-up 6 months after surgery. The control group included 15 healthy non-obese participants. Anthropometric measurements, lipid profiles, HbA1c, and serum irisin, preptin, and adropin were assessed at baseline and on follow-up. RESULTS: The serum concentrations of all three peptides were higher at 6 months than at baseline but only irisin (p = 0.02) and adropin (p = 0.000001) were significantly higher. The increase in preptin was borderline significant (p = 0.051). Changes of serum concentrations of all three peptides were bidirectional. CONCLUSION: Body mass reduction resulting from bariatric procedures may change the production of energy regulating peptides, but not always in a favorable manner.

Chronic urticaria in myasthenia gravis patients - More than occasional coexistence?

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Amyloid aggregation inhibitory mechanism of arginine-rich D-peptides.

It is widely believed that Alzheimer's disease pathogenesis is driven by the production and deposition of the amyloid-ß peptide (Aß) in the brain. In this study, we employ a combination of in silico and in vitro approaches to investigate the inhibitory properties of selected arginine-rich D-enantiomeric peptides (D-peptides) against amyloid aggregation. The D-peptides include D3, a 12-residue peptide with anti-amyloid potencies demonstrated in vitro and in vivo, RD2, a scrambled sequence of D3, as well as truncated RD2 variants. Using a global optimization method together with binding free energy calculations followed by molecular dynamics simulations, we perform a detailed analysis of D-peptide binding to Aß monomer and a fibrillar Aß structure. Results obtained from both molecular simulations and surface plasmon resonance experiments reveal a strong binding of D3 and RD2 to Aß, leading to a significant reduction in the amount of ß structures in both monomer and fibril, which was also demonstrated in Thioflavin T assays. The binding of the D-peptides to Aß is driven by electrostatic interactions, mostly involving the D-arginine residues and Glu11, Glu22 and Asp23 of Aß. Furthermore, we show that the anti-amyloid activities of the D-peptides depend on the length and sequence of the Dpeptide, its ability to form multiple weak hydrophobic interactions with Aß, as well as the Aß oligomer size.

Side-effects of injective allergen immunotherapy administered to intermittent or persistent allergic rhinitis patients.

AIM: Evaluation of the side-effects of conventional subcutaneous allergen immunotherapy in inhalant allergy. MATERIAL AND METHODS: Retrospective analysis of early and late, local and systemic, short-term and long-term side-effects of 4723 injections given to 224 patients suffering from intermittent or persistent allergic rhinitis. RESULTS: There were 65 systemic reactions in 48 patients (21%) after 61 injections (1.29%). Most of them were late, and included dyspnoea, rhinorrhoea, fever, fatigue and urticaria. Incidence of systemic reactions did not correlate to age or sex, but was higher in grass pollen than in house dust mite allergy and during the up-dosing phase of treatment. Late intense local reactions were observed after 1.6% of injections. CONCLUSIONS: Allergen immunotherapy in inhalant allergy is a safe method of treatment.

Intracellular production of IL-2, IL-4 and IFN-gamma by peripheral blood CD3+ cells in intermittent allergic rhinitis.

BACKGROUND: Allergic inflammation is mainly driven by type 2 T helper cells. The aim was to assess the changes in production of type 1 and 2 cytokines by CD3+ T cells dependent on natural exposure to allergens in subjects with intermittent allergic rhinitis (IAR) and in non-atopic subjects. MATERIAL: A total of 13 patients with IAR and 13 healthy non-atopics were recruited into the study. 11 patients with IAR were examined during the grass pollen season and 11 patients outside the season, 9 of them were assessed on both occasions. METHODS: A flow cytometric assessment of intracellular expression of IL-2, IL-4 and IFN-gamma by CD3+ cells was performed. For statistical analysis non-parametric tests were used. RESULTS: A tendency to decreased production of IL-4 outside the season was observed (6.94% [3.42-13.33] in season vs. 2.06% [0.7-3.6] out of season). The production of IL-4 was higher in the rhinitic group in the season than in the control group (1.93% [1.07-4.97], p=0.0034) and production of IL-2 was higher both in and outside the season (9.1% [3.94-15.09] and 10.0% [4.79-25.35] vs. 3.64% (2.64-5.03), p=0.037 and 0.045, respectively). IL-4/IL-2 and IL-4/IFN-gamma ratios were higher in the IAR group in the season than outside the season. CONCLUSION: A tendency towards a switch from a predominant type 2 response during natural allergen exposure to its suppression outside the season was found, together with a stable type 1 response.

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process.

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) "Minimum Standards for Health Sciences Libraries in Hospitals." In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team.

[Mosquito bites hypersensitivity: clinical and therapeutic approach]. / Nadwrazliwosc na komary--problem kliniczny i terapeutyczny.

Hypersensitivity to mosquito bites is an underestimated clinical and therapeutical problem. When feeding, female mosquitoes inject saliva, containing antigens and potentially toxic substances, into the human skin. The cutaneous response to mosquito bites is expressed as pruritus and oedema. The systemic symptoms are observed rarely. Nevertheless, the symptoms caused by mosquito bites are troublesome. In this paper clinical picture of mosquito bites consequences and up-to-date conceptions pathomechanism relating to their are shown. Moreover, prophylactic and therapeutical approaches are presented.

Early social deprivation in nonhuman primates: long-term effects on survival and cell-mediated immunity.

BACKGROUND: Early differential social experience of non-human primates has resulted in long-term alterations in behavior and neurobiology. Although brief maternal separation has been associated with changes in immune status, the long-term effects on survival and immune function of prolonged early social deprivation are unknown. METHODS: Survival rates were examined in rhesus monkeys, half of which had been socially deprived during their first year of life. Repeated measures of immune status were tested in surviving monkeys (18-24 years old). Peripheral blood T, B, and natural killer lymphocytes, macrophages, and monocytes were measured by flow cytometry. Functional cellular immune activity measures included T-cell proliferative responses to mitogens (concanavalin and phytohemagglutinin), T-cell memory response to tetanus toxoid antigen, T-cell-dependent B-cell proliferative responses to mitogen (PWM) and natural killer cell cytotoxic activity. RESULTS: Despite identical environments following isolation, early social deprivation resulted in a significantly decreased survival rate, males being particularly vulnerable to early death. Early social deprivation was associated with a decrease in the ratio of helper to suppressor T cells, and a significant increase in natural killer cell number and in natural killer cell activity in the surviving monkeys. No differences in T- or B-lymphocyte proliferation following mitogen or tetanus toxoid antigen stimulation were observed. CONCLUSIONS: Prolonged early social deprivation of non-human primates profoundly affected mortality and resulted in lifelong effects on cell-mediated immune status.

Idiothetic orientation and path integration in unilateral hippocampal atrophy and sclerosis.

We determined the effects of hippocampal lesions on idiothetic spatial orientation by exposing 14 patients with unilateral hippocampal atrophy and/or sclerosis (HAS) and 10 normal controls to random rotational displacements (+/-30 degrees -180 degrees ) in darkness and examined their ability to rotate themselves back to the initial position. In comparison to controls, the patients responses were distinctly hypometric (p<0.005). Patients with right hippocampal lesions showed a trend towards higher come back errors p = 0.08). Normal controls could maintain their accuracy over five consecutive trials. Patients, beginning with less accuracy, showed significant improvement after each trial (p<0.001). The findings suggest that unilateral HAS impair the immediate recall of idiothetic spatial information, but does not affect long-term spatial learning.

[Coexistence of bronchial asthma and diabetes mellitus type 2--retrospective analysis]. / Wspólistnienie astmy oskrzelowej i cukrzycy typu 2--analiza retrospektywna.

Bronchial asthma and diabetes mellitus type 2 are often found among adult patients. However, coincidence of these two diseases is very rare. The aim of the study was the retrospective analysis of all patients with bronchial asthma and diabetes mellitus type 2 hospitalised in Department and Clinic of Internal Diseases and Allergology in Zabrze, Silesian School of Medicine in Katowice in 1988-1997. Diabetes mellitus type 2 was diagnosed according to WHO criteria of 1985 and bronchial asthma was diagnosed with the use of American Thoracic Society criteria. Bronchial asthma and diabetes mellitus type 2 occurring together were found in 18 patients (0.3% of all hospitalized patients). In most patients the symptoms of bronchial asthma preceded the diagnosis of diabetes mellitus by a few years. All these cases were heterogeneous in terms of the duration of the diseases, clinical picture, and therapeutical approaches. In patients with bronchial asthma the existence of diabetes mellitus type 2 was not related to use of glikocorticosteroids. Patients in whom the coexistence of bronchial asthma and diabetes mellitus type 2 was found should be subjects of further studies to extend our knowledge of patomechanism of these diseases.

Chemokine RANTES in atopic dermatitis.

Chemokines play a key role in inflammatory diseases. The aim of this study was to estimate chemokine RANTES in the sera of patients with atopic dermatitis (AD) and to analyze the correlation between RANTES serum level and the immunological and clinical parameters of the disease. Serum levels of RANTES (ELISA; R&D Systems), total IgE and specific IgE (FEIA; Pharmacia CAP System) were estimated in 24 patients with AD, 28 patients with pollinosis (PL) and 22 healthy nonatopic subjects (HC). The division of the AD group into a pure AD (pAD) subgroup, without a coexisting respiratory allergy, and a subgroup of patients with AD and a respiratory allergy (AD+AO) was done according to Wütrich. Levels of RANTES were higher in the AD group than in the HC group and the PL group. RANTES levels did not differ among subgroups with various clinical scores and between the pAD and AD+AO subgroups. There were no correlations between levels of RANTES and total IgE. Significant positive correlations between serum levels of RANTES and Dermatophagoides farinae and cat dander-specific IgE were found in the AD group. We conclude that the serum level of chemokine RANTES differs patients with AD from patients with PL. The increase of RANTES concentration in the serum of patients with AD depends neither on a clinical picture nor an IgE system.

Odor identification, consistency of label use, olfactory threshold and their relationships to odor memory over the human lifespan.

The purpose of this study was to investigate olfactory threshold, odor identification, consistency of label use and their relationships to odor memory in the context of semantic/episodic memory across the human lifespan. A total of 137 subjects aged 4-90 years were tested with several olfactory test procedures. We found that olfactory sensitivity was well developed in children despite the finding that their odor naming and odor memory were inferior to that of adults. In the elderly population, olfactory functions gradually declined, with odor memory and odor identification demonstrating the most significant decline. Semantic encoding was differentially related to odor memory over the human age span. Whereas consistency of label use was the main predictor for odor memory in children and young adults, olfactory identification ability was the main predictor in the elderly study group. We also calculated response bias for the separate age groups and found no differences between children, young adults and elderly. However, with age false alarm rates increased. We conclude that children possess equal olfactory sensitivity compared with adults; however, due to limitations in linguistic capabilities and familiarity to odorants, odor memory and odor identification performance was limited. Additionally, our data indicate major alterations of olfactory processing in advanced age with substantial losses in odor memory and odor identification performance.

Allergen-specific IgE in circulating immune complexes in patients with inhalant allergy undergoing specific immunotherapy.

Specific immunotherapy (SIT) has been used worldwide since it was introduced near the beginning of this century. Although this mode of therapy has been known for over 80 years, its mechanism of action is still not definitely clear. The problem of the presence of allergen-specific IgE in IgE-containing circulating immune complexes of patients with inhalant allergy has been mentioned in the literature. However, there are no data concerning specific immunotherapy. The aim of our study was to evaluate the influence of SIT in patients with inhalant allergy on allergen-specific IgE in serum and in IgE circulating immune complexes. A total of 112 subjects with allergic rhinitis (57 with grass pollen allergy and 55 sensitive to house dust mites Dermatophagoides pteronyssinus) were included in the study. SIT was administered to 29 patients suffering from pollinosis and 27 patients sensitive to house dust mites. The remaining patients were treated with an H2-receptor antagonist only. The decrease of allergen-specific IgE concentration in IgE circulating immune complexes was parallel to the analogous changes in the serum only in the patients with pollinosis. Immunotherapy of house dust mite-sensitive patients caused a much slower decrease of allergen-specific IgE in circulating immune complexes than in serum. The binding index of allergen-specific IgE in circulating immune complexes increased during the course of the treatment. No significant associations were found between the immunological indices studied and clinical score of the disease activity.

Platelet aggregation in atopic dermatitis.

Many observations suggest the active role of platelets in allergic inflammation. However, this problem is poorly researched in atopic dermatitis. The aim of study was to examine the intensity and velocity of platelet aggregation and a potential relationship with some immunological parameters (total IgE and specific-IgE serum levels) in atopic dermatitis patients. Platelet aggregation was evaluated in 12 subjects with atopic dermatitis and 12 healthy, nonatopic persons, according to the Born method, in a dual-channel aggregometer, in response to three exogenous stimulators (ADP, thrombin and collagen). The intensity and velocity of platelet aggregation and total platelet counts did not differ between the two groups irrespective of the type of extrinsic stimulator used. In contrast to other atopic diseases, in atopic dermatitis platelet aggregation is not impaired.

Factors predicting upper genital tract inflammation among women with lower genital tract infection.

We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.