Extrapulmonary manifestations of severe respiratory syncytial virus infection – a systematic review

INTRODUCTION: Respiratory syncytial virus (RSV) bronchiolitis is the most important cause for admission to the paediatric intensive care unit in infants with lower respiratory tract infection. In recent years the importance of extrapulmonary manifestations of RSV infection has become evident. This systematic review aimed at summarizing the available evidence on manifestations of RSV infection outside the respiratory tract, their causes and the changes in clinical management required. METHODS: Databases searched were Medline (1950 to present), EMBASE (1974 to present), PubMed and reference lists of relevant articles. Summarized were the findings of articles reporting on manifestations of RSV infection outside the respiratory tract in patients of all age groups. RESULTS: Extrapulmonary manifestations reported in previous observational studies included cardiovascular failure with hypotension and inotrope requirements associated with myocardial damage as evident from elevated cardiac troponin levels (35–54% of ventilated infants), cardiac arrhythmias like supraventricular tachycardias and ventricular tachycardias, central apnoeas (16–21% of admissions), focal and generalized seizures, focal neurological abnormalities, hyponatraemia (33%) associated with increased antidiuretic hormone secretion, and hepatitis (46–49% of ventilated infants). RSV or its genetic material have been isolated from cerebrospinal fluid, myocardium, liver and peripheral blood. CONCLUSION: The data summarized indicate a systemic dissemination of RSV during severe disease. Cerebral and myocardial involvement may explain the association of RSV with some cases of sudden infant death. In infants with severe RSV infection cardiac rhythm, blood pressure and serum sodium need to be monitored and supportive treatment including fluid management adjusted accordingly

Changes in ion transport in inflammatory disease

Ion transport is essential for maintenance of transmembranous and transcellular electric potential, fluid transport and cellular volume. Disturbance of ion transport has been associated with cellular dysfunction, intra and extracellular edema and abnormalities of epithelial surface liquid volume. There is increasing evidence that conditions characterized by an intense local or systemic inflammatory response are associated with abnormal ion transport. This abnormal ion transport has been involved in the pathogenesis of conditions like hypovolemia due to fluid losses, hyponatremia and hypokalemia in diarrhoeal diseases, electrolyte abnormalites in pyelonephritis of early infancy, septicemia induced pulmonary edema, and in hypersecretion and edema induced by inflammatory reactions of the mucosa of the upper respiratory tract. Components of membranous ion transport systems, which have been shown to undergo a change in function during an inflammatory response include the sodium potassium ATPase, the epithelial sodium channel, the Cystic Fibrosis Transmembrane Conductance Regulator and calcium activated chloride channels and the sodium potassium chloride co-transporter. Inflammatory mediators, which influence ion transport are tumor necrosis factor, gamma interferon, interleukins, transforming growth factor, leukotrienes and bradykinin. They trigger the release of specific messengers like prostaglandins, nitric oxide and histamine which alter ion transport system function through specific receptors, intracellular second messengers and protein kinases. This review summarizes data on in vivo measurements of changes in ion transport in acute inflammatory conditions and in vitro studies, which have explored the underlying mechanisms. Potential interventions directed at a correction of the observed abnormalities are discussed

Local Characterization of Precipitation and Correlation with the Prior Austenitic Microstructure in Nb-Ti-Microalloyed Steel by SEM and AFM Methods

Precipitation is one of the most important influences on microstructural evolution during thermomechanical processing (TMCP) of micro-alloyed steels. Due to precipitation, pinning of prior austenite grain (PAG) boundaries can occur. To understand the mechanisms in detail and in relation to the thermomechanical treatment, a local characterization of the precipitation state depending on the microstructure is essential. Commonly used methods for the characterization, such as transmission electron microscopy (TEM) or matrix dissolution techniques, only have the advantage of local or statistically secured characterization. By using scanning electron microscopy (SEM) and atomic force microscopy (AFM) techniques, both advantages could be combined. In addition, in the present work a correlation of the precipitation conditions with the prior austenite grain structure for different austenitization states could be realized by Electron Backscatter Diffraction (EBSD) measurement and reconstruction methods using the reconstruction software Merengue 2

Phosphinosilylenes as a novel ligand system for heterobimetallic complexes

A dihydrophosphinosilylene iron complex [LSi{Fe(CO)(4)}PH2] has been prepared and utilized in the synthesis of novel heterobimetallic complexes. The phosphine moiety in this phosphinosilylene complex allows coordination towards tungsten leading to the iron-tungsten heterobimetallic complex [LSi{Fe(CO)(4)}PH2{W(CO)(5)}]. In contrast, the reaction of [LSi{Fe(CO)(4)}PH2] with ethylenebis(triphenylphosphine)platinum(0) results in the formation of the iron-platinum heterobimetallic complex [LSi{Fe(CO)(4)}PH{PtH(PPh3)(2)}] via oxidative addition