How should we define a 'good' outcome from encephalitis? A systematic review of the range of outcome measures used in the long-term follow-up of patients with encephalitis.

INTRODUCTION: Encephalitis is typically caused by infection or autoimmunity. Most survivors suffer complex neurological and psychiatric sequelae. Standardised outcome measures are needed for accurate interpretation of observational studies and clinical trials. Step one in this process is understanding the strengths and weaknesses of those in use. METHODS: We performed a systematic literature review searching six databases. One reviewer screened titles and abstracts, and two reviewers determined if shortlisted full-text articles met inclusion criteria. Key data were extracted from these papers and presented as a narrative summary. RESULTS: Thirty-seven outcome measures were used for 3,133 patients across the 35 included papers, of which, only one was developed for encephalitis. The outcome measures used in most patients were the Glasgow Outcome Score used in 1,436 (46%), Barthel Index used in 1,173 (37%), Euro-QoL-5D used in 1,107 (35%) and modified Rankin Scale used in 1,034 (33%). CONCLUSION: Most of the 37 measures assessed a single category of sequelae using 5-8-point scales and were not validated for use in encephalitis. Research is needed to develop a composite outcome measure for use in clinical practice and a core-outcomes set for use in clinical trials. For now, the Liverpool Outcome Score offers a good choice for clinicians.

Transcription of canine toll-like receptor 2, ß-defensin 1 and ß-defensin 103 in infected atopic skin, non-infected atopic skin, healthy skin and the CPEK cell line.

Dogs and humans with atopic dermatitis (AD) have a high prevalence of recurrent staphylococcal pyoderma. ß-Defensins (BDs) and toll-like receptors (TLRs) are important in innate immunity against bacterial skin infections, and decreased BD and TLR2 expression has been associated with human AD. However, findings from recent studies of BD expression in human and canine AD have been variable and contradictory. The aim of this study was to further our understanding of the role of antimicrobial proteins in canine AD by quantifying mRNA for canine (c) BD1, cBD103 and TLR2 in healthy skin (n=17 dogs), matched samples of atopic skin with and without active infection by Staphylococcus pseudintermedius (n=13 dogs), and the canine keratinocyte cell line CPEK cultured with 5 ng/ml tumour necrosis factor alpha (TNFα) and 10 µg/ml lipopolysaccharide (LPS). mRNA for cBD1, CB103 and TLR2 were detected in all samples. TNFα significantly increased transcription of cBD1, cBD103 and TLR2 in the CPEK cells. mRNA for cBD103 was also significantly increased after stimulation with LPS. There were no significant differences in mRNA levels for cBD1, cBD103 or TLR2 in healthy, non-infected atopic or infected atopic skin. Canine AD did not appear to be associated with altered expression of cBD1, cBD103 and TLR2 in these dogs. Other studies have reported both increased and decreased expression of these antimicrobial peptides in canine AD and pyoderma, and therefore further investigation of the clinical significance of these mediators is required.