The interstitium in cardiac repair: role of the immune-stromal cell interplay

Cardiac regeneration, that is, restoration of the original structure and function in a damaged heart, differs from tissue repair, in which collagen deposition and scar formation often lead to functional impairment. In both scenarios, the early-onset inflammatory response is essential to clear damaged cardiac cells and initiate organ repair, but the quality and extent of the immune response vary. Immune cells embedded in the damaged heart tissue sense and modulate inflammation through a dynamic interplay with stromal cells in the cardiac interstitium, which either leads to recapitulation of cardiac morphology by rebuilding functional scaffolds to support muscle regrowth in regenerative organisms or fails to resolve the inflammatory response and produces fibrotic scar tissue in adult mammals. Current investigation into the mechanistic basis of homeostasis and restoration of cardiac function has increasingly shifted focus away from stem cell-mediated cardiac repair towards a dynamic interplay of cells composing the less-studied interstitial compartment of the heart, offering unexpected insights into the immunoregulatory functions of cardiac interstitial components and the complex network of cell interactions that must be considered for clinical intervention in heart diseases

Resuscitation Clinical paper Prevalence and effect of fever on outcome following resuscitation from cardiac arrest

a b s t r a c t Objective: Evaluate the prevalence of fever in the first 48 h after cardiac arrest and its effect on outcomes. Methods: Review of patients treated between 1/1/2005 and 6/30/2010. Fever was defined as T ≥ 38.0 • C. We classified categories of post-cardiac arrest illness severity as (I) awake, (II) coma + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), (III) coma + moderate-severe cardiopulmonary dysfunction, and (IV) deep coma. Associations between fever and survival or good neurologic outcome were examined between hypothermia (TH) and non-TH groups. Results: In 336 patients, mean age was 60 years (SD 16), 63% experienced out-of-hospital cardiac arrest and 65% received TH. A shockable rhythm was present in 40%. Post arrest illness severity was category II in 38%, category III in 20%, and category IV in 42%. Fever was present in 42% of subjects, with a post-arrest median onset of 15 h in the non-TH cohort and 36 h in TH cohort. Fever was not associated with survival within the whole cohort (OR 0.32, CI 0.15, 0.68) or TH cohort (OR 1.21, CI 0.69, 2.14), but was associated with survival in non-TH cohort (OR 0.47, CI 0.20, 1.10). Fever was not associated with good outcomes in the whole cohort (OR 0.83, CI 0.49, 1.40), TH cohort (OR 1.09, CI 0.56, 2.12) or non-TH cohort (OR 0.34, CI 0.11, 1.06). Conclusions: The development of fever within the first 48 h after ROSC is common. Fever is associated with death in non-TH patients. TH treatment appears to mitigate this effect, perhaps by delaying fever onset

Cognitive function following treadmill exercise in thermal protective clothing.

Occupational injuries are common among firefighters who perform strenuous physical exertion in extreme heat. The thermal protective clothing (TPC) worn by firefighters inhibits normal thermoregulation, placing the firefighter at risk of hypohydration and hyperthermia that may result in cognitive decline. We tested whether cognitive function changes after treadmill exercise in TPC. In an initial study (Cog 1), ten healthy volunteers performed up to 50 min of treadmill exercise while wearing TPC in a heated room. A battery of neurocognitive tests evaluating short-term memory, sustained and divided attention, and reaction time was administered immediately before and after exercise. In a follow-up study (Cog 2), 19 healthy volunteers performed a similar exercise protocol with the battery of cognitive tests administered pre-exercise, immediately post-exercise, and serially up to 120 min after exercise. Subjects performed 46.4 ± 4.6 and 48.1 ± 3.6 min of exercise in the Cog 1 and Cog 2, respectively. In both studies heart rate approached age predicted maximum, body mass was reduced 1.0-1.5 kg, and body core temperature increased to levels similar to what is seen after fire suppression. Neurocognitive test scores did not change immediately after exercise. Recall on a memory test was reduced 60 and 120 min after exercise. The mean of the 10 slowest reaction times increased in the 120 min after exercise. Fifty minutes of treadmill exercise in TPC resulted in near maximal physiologic strain but alterations in neurocognitive performance were not noted until an hour or more following exercise in TPC

The specific relation between perception and production errors for place of articulation in developmental apraxia of speech

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