Evaluation of circulating soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) to predict risk profile, response to antimicrobial therapy, and development of complications in patients with chemotherapy-associated febrile neutropenia : a pilot

The soluble Triggering Receptor Expressed on Myeloid cells 1 (sTREM-1) is a useful marker of infection in patients with sepsis, but has not been adequately evaluated in patients with chemotherapy-associated febrile neutropenia (FN). The value of sTREM-1 in this setting has been tested in a retrospective, pilot study using stored serum from 48 cancer patients with documented FN. On presentation, patients were categorized according to the Talcott risk-index clinical score. Circulating soluble sTREM-1 was measured using an ELISA procedure, while procalcitonin (PCT) or interleukins 6 (IL-6) and 8 (IL-8), included for comparison, were measured using an immunoluminescence-based assay and Bio-Plex suspension bead array system, respectively. Circulating concentrations of both sTREM-1 and PCT were significantly (P < 0.05) elevated in patients at high risk for complications or death, as predicted by the Talcott score and were significantly lower in patients who responded to empiric antimicrobial agents. Neither IL-6 nor IL-8 accurately predicted serious complications in patients with FN. These observations, albeit from a pilot study, demonstrate that sTREM-1 is indeed elevated in high-risk patients with FN and is potentially useful to predict their clinical course, either together with, or as an alternative to PCT.http://www.springerlink.com/content/0939-555

Soluble triggering receptor expressed on myeloid cells (s-TREM-1) from endotracheal aspirates in critically ill patients: A potential marker of the dynamic inflammatory burden of the lower respiratory tract

OBJECTIVES: The study was designed to evaluate the role of soluble triggering receptor expressed on myeloid cells (s-TERM-1) measured in samples of endotracheal aspirates from critically ill, intubated patients as a marker of inflammation of pneumonia. METHODS: The Clinical Pulmonary Infection Score (CPIS), a commonly utilised clinical predictor of ventilator-associated pneumonia (VAP), was calclated for each patient at the same time as endotracheal aspirates were obtained using sterile techniques, in order to correlate the CPIS with s-TERM-1 concentrations determined in the laboratory using a validated enzyme-linked immunosorbent assay (ELISA) procedure. RESULTS: Thirty patients with intensive care unit stays ranging from 2 to 39 days were included in the study. s-TERM-1 was detectable in endotracheal aspirates from all patients, and a wide range of concentrations from 13 to >4 000 pg/ml was observed. The mean s-TERM-1 concentrations for patients with a CPIS 0.05). CONCLUSIONS: s-TERM-1 is readily detectable and quantifiable in endotracheal aspirates form critically ill patients, but does not correlate with the CIPS. The wide range of measured s-TERM-1 concentrations suggests that this pro-inflammatory maker may reflect a progressive increase in the dynamic inflammatory burden of the lower respiratory tract as colonisation by microbial pathogens leads to ventilator-associated tracheobronchitis (VAT) and ultimately VAP. Serial determinations of s-TERM-1 in this setting may therefore be of greater value than the CIPS in differentiating VAT from VAP and provide an alternative threshold for the initiation of empiric antimicrobial therapy

Soft tissue augmentation applying a collagenated porcine dermal matrix during second stage surgery: A prospective multicenter case series

Background The achievement and preservation of an adequate amount of soft tissue around implants is a critical factor for the prognosis of the treatment. Purpose To evaluate the effectiveness of a porcine dermal matrix applied during second stage implant surgery for horizontal soft tissue augmentation and preservation of dimensional stability. Materials and Methods Twenty patients (mean age 50.2 +/- 11.9 [SD] years) candidate to implant therapy and requiring soft tissue augmentation were recruited in four centers. Augmentation was performed in 24 cases. A porcine dermal matrix was placed into a buccal split-thickness pouch during uncovering surgery. Silicone impressions were taken before surgery (T0), 2 weeks later at suture removal (T2), 6 months (T3), and 24 months (T4) post augmentation. Dimensional changes of soft tissue were evaluated using superimposition of digitalized study casts. Results Nineteen patients (23 implants) could be evaluated at 6 months and 13 patients (17 implants) at 24 months. After 6-month follow-up, there was a significant dimensional gain respect to baseline, averaging 0.83 +/- 0.64 mm (P 0.5 mm in 65.2% and 64.7% of the cases, respectively. Soft tissue shrinkage averaged 34.2% +/- 77.0% from T2 to T3 (P < .01) and did not change thereafter (P = .39). Shrinkage was more consistent in the posterior mandible than in the maxilla, but not significantly (P = .23 at 6-month and .36 at 24-month). No adverse events occurred. Conclusion Within the limitations of this prospective case series, the use of a porcine dermal matrix may provide consistent soft tissue augmentation that maintains up to 24-month follow-up, although graft shrinkage may occur in the first 6 months, depending on the location of surgery