Differentiating sepsis from similar groups of symptoms at triage level in emergency care.

OBJECTIVES: Conditions that have similar initial presentations as sepsis may make early recognition of sepsis in an emergency room (ER) difficult. We investigated whether selected physiologic and metabolic parameters can be reliably used in the emergency department to differentiate sepsis from other disease states that mimic it, such as dehydration and stroke. METHODS: Loess regression on retrospective follow-up chart data of patients with sepsis-like symptoms (N = 664) aged 18+ in a large ER in Hungary was used to visualize/identify cutoff points for sepsis risk. A multivariate logistic regression model based on standard triage data was constructed with its corresponding receiver operating characteristic (ROC) curve and compared with another model constructed based on current sepsis guidelines. RESULTS: Age, bicarbonate, HR, lactate, pH, and body temperature had U, V, W, or reverse U-shaped associations with identifiable inflexion points, but the cutoff values we identified were slightly different from guideline cutoff values. In contrast to the guidelines, no inflexion points could be observed for the association of sepsis with SBP, DPB, MAP, and RR and therefore were treated as continuous variables. Compared to the guidelines-based model, the triage data-driven final model contained additional variables (age, pH, bicarbonate) and did not include lactate. The data-driven model identified about 85% of sepsis cases correctly, while the guidelines-based model identified only about 70% of sepsis cases correctly. CONCLUSION: Our findings contribute to the growing body of evidence for the necessity of finding improved tools to identify sepsis at early time points, such as in the ER.

Disparate effects of adalimumab and fumaric acid esters on cardiovascular risk factors in psoriasis patients: results from a prospective, randomized, observer-blinded head-to-head trial.

BACKGROUND: The effect of adalimumab and fumaric acid esters (FAE) on the cardiovascular risk associated with psoriasis has only been investigated scarcely in randomized controlled studies. OBJECTIVE: The aim of this prospective, randomized controlled head-to-head trial was to compare the influence of adalimumab and FAE on cardiovascular disease markers in psoriasis patients. METHODS: Sixty-five patients with moderate to severe plaque psoriasis were randomly assigned to adalimumab or FAE treatment for 6 months. Cardiovascular haemodynamic parameters [flow-mediated dilation (FMD), nitro-glycerine mediated dilation (NMD) and carotid intima-media thickness (CIMT), blood pressure] were assessed at baseline (v0) and after 6 months (v6). Cutaneous disease severity, inflammatory and lipid cardiovascular risk markers were analysed at baseline(v0), after 3 (v3) and 6 months (v6). RESULTS: After 6 months of treatment FMD in the adalimumab group increased significantly [v0 5.9% (6.4% SD), v6 8.0% (4.8% SD), P = 0.048) but not in the FAE group. (v0 7.0% (4.1% SD), v6 8.4% (6.1% SD), P = 0.753]. This was paralleled by a significant decrease of high sensitive C-reactive protein (hsCRP) in the adalimumab group in comparison to the FAE group (v0: 0.39 mg/dL (0.38 SD), v6: 0.39 mg/dL (0.48 SD), P = 0.043). No significant changes were observed in any other haemodynamic parameters. FAE, however, additionally decreased total cholesterol (P = 0.046) and apolipoprotein B (P = 0.041) levels compared to adalimumab. Mean Psoriasis Area and Severity Index (psoriasis area severity score) reduction was greater but not significant (P = 0.116) under adalimumab treatment compared to FAE treatment [-71.1% (29.9 SD) vs. -54.6% (45.7%)]. CONCLUSION: In our study, both treatments were documented to exert effects on the cardiovascular system. While adalimumab showed anti-inflammatory effects and improved FMD, FAE interacted favourably with the cholesterol metabolism.

F-actin clustering and cell dysmotility induced by the pathological W148R missense mutation of filamin B at the actin-binding domain.

Filamin B (FLNB) is a dimeric actin-binding protein that orchestrates the reorganization of the actin cytoskeleton. Congenital mutations of FLNB at the actin-binding domain (ABD) are known to cause abnormalities of skeletal development, such as atelosteogenesis types I and III and Larsen's syndrome, although the underlying mechanisms are poorly understood. Here, using fluorescence microscopy, we characterized the reorganization of the actin cytoskeleton in cells expressing each of six pathological FLNB mutants that have been linked to skeletal abnormalities. The subfractionation assay showed a greater accumulation of the FLNB ABD mutants W148R and E227K than the wild-type protein to the cytoskeleton. Ectopic expression of FLNB-W148R and, to a lesser extent, FLNB-E227K induced prominent F-actin accumulations and the consequent rearrangement of focal adhesions, myosin II, and septin filaments and results in a delayed directional migration of the cells. The W148R protein-induced cytoskeletal rearrangement was partially attenuated by the inhibition of myosin II, p21-activated protein kinase, or Rho-associated protein kinase. The expression of a single-head ABD fragment with the mutations partially mimicked the rearrangement induced by the dimer. The F-actin clustering through the interaction with the mutant FLNB ABD may limit the cytoskeletal reorganization, preventing normal skeletal development.

Filamin B plays a key role in vascular endothelial growth factor-induced endothelial cell motility through its interaction with Rac-1 and Vav-2.

Actin-binding proteins filamin A (FLNA) and B (FLNB) are expressed in endothelial cells and play an essential role during vascular development. In order to investigate their role in adult endothelial cell function, we initially confirmed their expression pattern in different adult mouse tissues and cultured cell lines and found that FLNB expression is concentrated mainly in endothelial cells, whereas FLNA is more ubiquitously expressed. Functionally, small interfering RNA knockdown of endogenous FLNB in human umbilical vein endothelial cells inhibited vascular endothelial growth factor (VEGF)-induced in vitro angiogenesis by decreasing endothelial cell migration capacity, whereas FLNA ablation did not alter these parameters. Moreover, FLNB-depleted cells increased their substrate adhesion with more focal adhesions. The molecular mechanism underlying this effect implicates modulation of small GTP-binding protein Rac-1 localization and activity, with altered activation of its downstream effectors p21 protein Cdc42/Rac-activated kinase (PAK)-4/5/6 and its activating guanine nucleotide exchange factor Vav-2. Moreover, our results suggest the existence of a signaling complex, including FLNB, Rac-1, and Vav-2, under basal conditions that would further interact with VEGFR2 and integrin alphavbeta5 after VEGF stimulation. In conclusion, our results reveal a crucial role for FLNB in endothelial cell migration and in the angiogenic process in adult endothelial cells.

Mutations in the gene encoding filamin B disrupt vertebral segmentation, joint formation and skeletogenesis.

The filamins are cytoplasmic proteins that regulate the structure and activity of the cytoskeleton by cross-linking actin into three-dimensional networks, linking the cell membrane to the cytoskeleton and serving as scaffolds on which intracellular signaling and protein trafficking pathways are organized (reviewed in refs. 1,2). We identified mutations in the gene encoding filamin B in four human skeletal disorders. We found homozygosity or compound heterozygosity with respect to stop-codon mutations in autosomal recessive spondylocarpotarsal syndrome (SCT, OMIM 272460) and missense mutations in individuals with autosomal dominant Larsen syndrome (OMIM 150250) and the perinatal lethal atelosteogenesis I and III phenotypes (AOI, OMIM 108720; AOIII, OMIM 108721). We found that filamin B is expressed in human growth plate chondrocytes and in the developing vertebral bodies in the mouse. These data indicate an unexpected role in vertebral segmentation, joint formation and endochondral ossification for this ubiquitously expressed cytoskeletal protein.

Promoter analysis of the avirulence gene Avr9 of the fungal tomato pathogen Cladosporium fulvum in the model filamentous fungus Aspergillus nidulans.

The promoter of avirulence gene Avr9 of the fungal tomato pathogen Cladosporium fulvum contains 12 sequences within a region of 0.6 kb that are reminiscent of the binding sequences of the GATA-type regulator involved in nitrogen utilisation of the filamentous fungi Aspergillus nidulans and Neurospora crassa. Mutational analysis of this 0.6-kb promoter region, fused to the beta-glucuronidase reporter gene, revealed that two regions, each containing two TAGATA boxes in inverted orientation and overlapping by two base pairs, are important for induction of Avr9 promoter activity in A. nidulans. Each overlapping TAGATA box differentially affected Avr9 promoter activity when shifted apart by nucleotide insertions. The other regions, which do not contain two overlapping TAGATA boxes have no, or only a limited, contribution to the inducibility of promoter activity.

A new member of the LIM protein family binds to filamin B and localizes at stress fibers.

Human filamins are 280-kDa proteins containing an N-terminal actin-binding domain followed by 24 characteristic repeats. They also interact with a number of other cellular proteins. All of those identified to date, with the exception of actin, bind to the C-terminal third of a filamin. In a yeast two-hybrid search of a human placental library, using as bait repeats 10-18 of filamin B, we isolated a cDNA coding for a novel 374 amino acid protein containing a proline-rich domain near its N terminus and two LIM domains at its C terminus. We term this protein filamin-binding LIM protein-1, FBLP-1. Yeast two-hybrid studies with deletion mutants localized the areas of interaction in FBLP-1 to its N-terminal domain and in filamin B to repeats 10-13. FBLP-1 mRNA was detected in a variety of tissues and cells including platelets and endothelial cells. We also have identified two FBLP-1 variants. Both contain three C-terminal LIM domains, but one lacks the N-terminal proline-rich domain. Transfection of FBLP-1 into 293A cells promoted stress fiber formation, and both FBLP-1 and filamin B localized to stress fibers in the transfected cells. The association between filamin B and FBLP-1 may play a hitherto unknown role in cytoskeletal function, cell adhesion, and cell motility.

Filamin A and Filamin B are co-expressed within neurons during periods of neuronal migration and can physically interact.

Mutations in the X-linked gene Filamin A (FLNA) lead to the human neurological disorder, periventricular heterotopia (PH). Although PH is characterized by a failure in neuronal migration into the cerebral cortex with consequent formation of nodules in the ventricular and subventricular zones, many neurons appear to migrate normally, even in males, suggesting compensatory mechanisms. Here we characterize expression patterns for FlnA and a highly homologous protein Filamin B (FlnB) within the nervous system, in order to better understand their potential roles in cortical development. FlnA mRNA was widely expressed in all cortical layers while FlnB mRNA was most highly expressed in the ventricular and subventricular zones during development. In adulthood, widespread but reduced expression of FlnA and FlnB persisted throughout the cerebral cortex. FlnA and FlnB proteins were highly expressed in both the leading processes and somata of migratory neurons during corticogenesis. Postnatally, FlnA immunoreactivity was largely localized to the cell body with FlnB in the soma and neuropil during neuronal differentiation. In adulthood, diminished expression of both proteins localized to the cell soma and nucleus. Moreover, the putative FLNB homodimerization domain strongly interacted with itself or the corresponding homologous region of FLNA by yeast two-hybrid interaction, the two proteins co-localized within neuronal precursors by immunocytochemistry and the existence of FLNA-FLNB heterodimers could be detected by co-immunoprecipitation. These results suggest that FLNA and FLNB may form both homodimers and heterodimers and that their interaction could potentially compensate for the loss of FLNA function during cortical development within PH individuals.

Different splice variants of filamin-B affect myogenesis, subcellular distribution, and determine binding to integrin [beta] subunits.

Integrins connect the extracellular matrix with the cell interior, and transduce signals through interactions of their cytoplasmic tails with cytoskeletal and signaling proteins. Using the yeast two-hybrid system, we isolated a novel splice variant (filamin-Bvar-1) of the filamentous actin cross-linking protein, filamin-B, that interacts with the cytoplasmic domain of the integrin beta1A and beta1D subunits. RT-PCR analysis showed weak, but wide, expression of filamin-Bvar-1 and a similar splice variant of filamin-A (filamin-Avar-1) in human tissues. Furthermore, alternative splice variants of filamin-B and filamin-C, from which the flexible hinge-1 region is deleted (DeltaH1), were induced during in vitro differentiation of C2C12 mouse myoblasts. We show that both filamin-Avar-1 and filamin-Bvar-1 bind more strongly than their wild-type isoforms to different integrin beta subunits. The mere presence of the high-affinity binding site for beta1A is not sufficient for targeting the filamin-Bvar-1 construct to focal contacts. Interestingly, the simultaneous deletion of the H1 region is required for the localization of filamin-B at the tips of actin stress fibers. When expressed in C2C12 cells, filamin-Bvar-1(DeltaH1) accelerates their differentiation into myotubes. Furthermore, filamin-B variants lacking the H1 region induce the formation of thinner myotubes than those in cells containing variants with this region. These findings suggest that specific combinations of filamin mRNA splicing events modulate the organization of the actin cytoskeleton and the binding affinity for integrins.

The role of reparative processes in teratogenesis.

Introducing the review article the multiple relations between reparative processes and prenatal development are briefly discussed. In continuation the theoretical framework of possible and plausible repair in teratogenesis is outlined and documented by some, so far existing direct and indirect examples from experimental and human anatomo-clinical observations. The theoretical and practical importance of the problem and the still open questions to be answered by further investigations are mentioned.

Surface-based labeling of cortical anatomy using a deformable atlas.

We describe a computerized method to automatically find and label the cortical surface in three-dimensional (3-D) magnetic resonance (MR) brain images. The approach we take is to model a prelabeled brain atlas as a physical object and give it elastic properties, allowing it to warp itself onto regions in a preprocessed image. Preprocessing consists of boundary-finding and a morphological procedure which automatically extracts the brain and sulci from an MR image and provides a smoothed representation of the brain surface to which the deformable model can rapidly converge. Our deformable models are energy-minimizing elastic surfaces that can accurately locate image features. The models are parameterized with 3-D bicubic B-spline surfaces. We design the energy function such that cortical fissure (sulci) points on the model are attracted to fissure points on the image and the remaining model points are attracted to the brain surface. A conjugate gradient method minimizes the energy function, allowing the model to automatically converge to the smoothed brain surface. Finally, labels are propagated from the deformed atlas onto the high-resolution brain surface.

The influence of beer, cognac and ethanol upon the follicular state of mouse ovaries on day 4 of pregnancy.

There exist few experimental and anatomo-clinical data with respect to the effect of preconceptional and intragestional ethanol (alcoholic beverages) intake upon ovarian morpho-physiology. In order to obtain an insight into this aspect of alcohol embryo- and fetopathy, the influence of acute intoxication with beer and cognac on the background of chronic intake (in mice) and of chronic ethanol intake (in rats) upon ovarian morphology was studied, on day 4 (mice) and 5 (rats), respectively. The following characteristics were registered: the percentage of various follicular developmental stages (I-V), of atreting follicles, of preantral and antral follicles, of follicles with precocious antrogenesis. Significant changes were round in mice with respect to antral and mature follicles (lower percentage induced by beer) and concerning atreting follicles (lower percentage induced by cognac). On the other hand, precocious antrogenesis (during follicular stage II) occurred by far more frequently than expected.

Cell death in normo- and teratogenesis. II. Cell death in teratogenesis.

The second part of the review presents the main facts and problems with respect to the role of cell death in teratogenesis (pathogenetic cell death). After mentioning the first approaches to the domain, reference is made (in order to avoid repetition) to the synthetic article published by Menkes et al. (1970), as to a series of investigations and results up to that date. Subsequently, more recent contributions are presented, first of all a series of results obtained in the Laboratory of Embryology and Teratology, Timiscara. The genetic background and the morphology of pathogenetic cell death are briefly discussed. As a conclusion, the scheme (published in 1970) of cell death linked teratogenesis is reproduced in a somewhat modified and extended way.

Cell death in normo- and teratogenesis. I. Cell death in normogenesis.

This first part of the review deals with the main facts and problems related to the role of cell death in normal prenatal development. After an overview of the pioneering work in this field, the essential contributions brought during the last few decades are presented, with special stress upon the contribution brought by the team of the Laboratory of Embryology and Teratology, Timisoara. The morphology of cell death is analysed based upon the classification of Schweichel and Merker (1973). Finally, a detailed account is given on the recent, impressive advance with respect to molecular and molecular-genetic mechanisms underlying and determining the cell death process.

Dyes as teratogens.

The main fats and problems of the role of dyes in prenatal pathology are reviewed. The first section deals with the practical aspects related to teratological screening of industrial dyes (including also the results obtained in this laboratory). In the second section, various aspects of azo-dye teratogenesis are largely discussed, including also the experimental contributions of this laboratory. Concluding remarks are made with respect to the importance and to the perspectives of this field of research.

On the prenatal noxious effects of trypan blue and of a related azo dye.

Since 1948 trypan blue has been a well-known and extensively used experimental teratogen, belonging to the group of azo dyes. Chemically, trypan blue consists of a biphenyl molecule (0-tolidine or benzidine) combined by means of azo linkages with two molecules of a substituted naphthalene. Between 1987-89 the effect of the replacement of the biphenyl molecule by a molecule of p,p'-diaminobenzanilide upon the prenatal noxious action of trypan blue has been controlled. Investigations were carried out on three species: chick embryos, albino rats and albino mice. In the species used, the replacement annihilates the teratogenic properties of the dye, with the persistence of some embryotoxic effects. On the other hand, the control of o-tolidine and of p,p'-diaminobenzanilide revealed that no one had teratogenic properties (only some embryotoxic effect, more marked in the case of o-tolidine). It results that the teratogenic action of trypan blue cannot be attributed to the o-tolidine molecule proper but to an effect which results (in a for the moment unknown manner) from its combination with the other parts of the dye molecule.

In vitro studies on normal and pathological preimplantation development. I. Events of normal mouse preimplantation development as revealed by microcinematography.

After briefly presenting the main historical data of in vitro culture of preimplantation mouse embryos and their filming, the first own observations on normal preimplantation development made by using microcinematography are presented: development from two-cell to eight-cell embryos; compaction and cavitation. The timing and the duration of various developmental events were recorded. Own observations were compared with previous cinematographic data reported by other authors. Some processes needing further investigations are evidenced: rotation within the zona pellucida, penetration of cytoplasmic emissions through the zona, contraction and reexpansion.

Homeostasis changes induced by the action of ethanol on the materno-fetal complex in rats. V. Late fetal effects of acute intoxication during the preimplantation period.

The late fetal effect of ethanol administered during the preimplantation period (in acute experiment) was investigated. Ethanol was injected i.v. (33.16% v/v in a.d., 4.80 ml/kg b.w.) to pregnant female rats on day 2 and 4 of pregnancy. Some effects concerning biochemical and morphological homeostasis on at-term fetuses (day 20 of pregnancy) were studied. Data obtained were compared with those of the control group. Biochemical investigation performed on hepatic DNA and on some serum metabolites revealed the following statistically non-significant changes: the increase of fetal hepatic DNA; the increase of total protein determined from pooled fetal serum of the whole litters; hypoalbuminemy and hyperglobulinemy; hypo-alpha 1-globulinemy and hyper-alpha 2-, beta-, gamma-globulinemy; the increase of total lipids, decrease of cholesterol; increase of uric acid and urea. In the amniotic fluid the following statistically non-significant values were found: increase of proteins, lipids, uric acid and urea content and decrease of cholesterol. Ponderal somatometry evidenced a statistically significant decrease of fetal and placental wet weight. The changes found show that--in our experimental conditions--the i.v. administration of ethanol during the preimplantation period does not significantly influence the late, fetal biochemical values and induces a significant lowering of fetal and placental wet weight and a significant increase of late fetal mortality.