Toward an operative diagnosis in sepsis: a latent class approach

<p>Abstract</p> <p>Background</p> <p>Recent data have suggested that 18 million of new sepsis cases occur each year worldwide, with a mortality rate of almost 30%. There is not consensus on the clinical definition of sepsis and, because of lack of training or simply unawareness, clinicians often miss or delay this diagnosis. This is especially worrying; since there is strong evidence supporting that early treatment is associated with greater clinical success. There are some difficulties for sepsis diagnosis such as the lack of an appropriate gold standard to identify this clinical condition. This situation has hampered the assessment of the accuracy of clinical signs and biomarkers to diagnose sepsis.</p> <p>Methods/design</p> <p>Cross-sectional study to determine the operative characteristics of three biological markers of inflammation and coagulation (D-dimer, C-reactive protein and Procalcitonin) as diagnostic tests for sepsis, in patients admitted to hospital care with a presumptive infection as main diagnosis.</p> <p>Discussion</p> <p>There are alternative techniques that have been used to assess the accuracy of tests without gold standards, and they have been widely used in clinical disciplines such as psychiatry, even though they have not been tested in sepsis diagnosis. Considering the main importance of diagnosis as early as possible, we propose a latent class analysis to evaluate the accuracy of three biomarkers to diagnose sepsis.</p

Combining regenerative medicine strategies to provide durable reconstructive options: auricular cartilage tissue engineering

Recent advances in regenerative medicine place us in a unique position to improve the quality of engineered tissue. We use auricular cartilage as an exemplar to illustrate how the use of tissue-specific adult stem cells, assembly through additive manufacturing and improved understanding of postnatal tissue maturation will allow us to more accurately replicate native tissue anisotropy. This review highlights the limitations of autologous auricular reconstruction, including donor site morbidity, technical considerations and long-term complications. Current tissue-engineered auricular constructs implanted into immune-competent animal models have been observed to undergo inflammation, fibrosis, foreign body reaction, calcification and degradation. Combining biomimetic regenerative medicine strategies will allow us to improve tissue-engineered auricular cartilage with respect to biochemical composition and functionality, as well as microstructural organization and overall shape. Creating functional and durable tissue has the potential to shift the paradigm in reconstructive surgery by obviating the need for donor sites

Intrinsic factors and the embryonic environment influence the formation of extragonadal teratomas during gestation

Background: Pluripotent cells are present in early embryos until the levels of the pluripotency regulator Oct4 drop at the beginning of somitogenesis. Elevating Oct4 levels in explanted post-pluripotent cells in vitro restores their pluripotency. Cultured pluripotent cells can participate in normal development when introduced into host embryos up to the end of gastrulation. In contrast, pluripotent cells efficiently seed malignant teratocarcinomas in adult animals. In humans, extragonadal teratomas and teratocarcinomas are most frequently found in the sacrococcygeal region of neonates, suggesting that these tumours originate from cells in the posterior of the embryo that either reactivate or fail to switch off their pluripotent status. However, experimental models for the persistence or reactivation of pluripotency during embryonic development are lacking. Methods: We manually injected embryonic stem cells into conceptuses at E9.5 to test whether the presence of pluripotent cells at this stage correlates with teratocarcinoma formation. We then examined the effects of reactivating embryonic Oct4 expression ubiquitously or in combination with Nanog within the primitive streak (PS)/tail bud (TB) using a transgenic mouse line and embryo chimeras carrying a PS/TB-specific heterologous gene expression cassette respectively. Results: Here, we show that pluripotent cells seed teratomas in post-gastrulation embryos. However, at these stages, induced ubiquitous expression of Oct4 does not lead to restoration of pluripotency (indicated by Nanog expression) and tumour formation in utero, but instead causes a severe phenotype in the extending anteroposterior axis. Use of a more restricted T(Bra) promoter transgenic system enabling inducible ectopic expression of Oct4 and Nanog specifically in the posteriorly-located primitive streak (PS) and tail bud (TB) led to similar axial malformations to those induced by Oct4 alone. These cells underwent induction of pluripotency marker expression in Epiblast Stem Cell (EpiSC) explants derived from somitogenesis-stage embryos, but no teratocarcinoma formation was observed in vivo. Conclusions: Our findings show that although pluripotent cells with teratocarcinogenic potential can be produced in vitro by the overexpression of pluripotency regulators in explanted somitogenesis-stage somatic cells, the in vivo induction of these genes does not yield tumours. This suggests a restrictive regulatory role of the embryonic microenvironment in the induction of pluripotency

The relationship of telomere length to baseline corticosterone levels in nestlings of an altricial passerine bird in natural populations

Artículo de publicación ISIBackground: Environmental stressors increase the secretion of glucocorticoids that in turn can shorten telomeres via oxidative damage. Modification of telomere length, as a result of adversity faced early in life, can modify an individual's phenotype. Studies in captivity have suggested a relationship between glucocorticoids and telomere length in developing individuals, however less is known about that relationship in natural populations. Methods: In order to evaluate the effect of early environmental stressors on telomere length in natural populations, we compared baseline corticosterone (CORT) levels and telomere length in nestlings of the same age. We collected blood samples for hormone assay and telomere determination from two geographically distinct populations of the Thorn-tailed Rayadito (Aphrastura spinicauda) that differed in brood size; nestlings body mass and primary productivity. Within each population we used path analysis to evaluate the relationship between brood size, body mass, baseline CORT and telomere length. Results: Within each distinct population, path coefficients showed a positive relationship between brood size and baseline CORT and a strong and negative correlation between baseline CORT and telomere length. In general, nestlings that presented higher baseline CORT levels tended to present shorter telomeres. When comparing populations it was the low latitude population that presented higher levels of baseline CORT and shorter telomere length. Conclusions: Taken together our results reveal the importance of the condition experienced early in life in affecting telomere length, and the relevance of integrative studies carried out in natural conditions.FONDECYT Grant 11130245 FONDECYT 1140548 USA National Science Foundation Grant IOS-0750540 ICM-005-002 PFB-23-CONICY

Are hermit crabs looking for light and large shells? evidence from natural and field induced shell exchanges

Terrestrial hermit crabs (Coenobita compressus (H. Milne Edwards)) on Isabel island, Mexico, prefer Nerita (Ritena) scabricosta (Lanark 1822) over other species of shells. Nerita scabricosta, the lightest species of shell, has the highest internal volume/weight ratio (IV/W ratio) of all species available at the island. Heavier shells (low IV/W ratio) are more costly to carry and may restrain growth. We hypothesized that crabs will search for shells with high IV/W ratios to save energy, and predicted that in every individual shell-exchange crabs will prefer a shell with a higher IV/W ratio. Observations of spontaneous aggressive shell-exchange interactions in nature between crabs carrying preferred shells (with high IV/W ratio) and crabs using less preferred species of shells (low IV/W ratio) support this idea. By inducing individual shell exchanges in the field, we experimentally confirmed the preference for shells with high IV/W ratio, and we also showed that crabs prefer larger shells over those they were bearing. Moving to a larger but not heavier shell may facilitate growth though saving energy that would otherwise be spent in locomotion. High growth rates seem to be advantageous because size is a correlate of fertility, since large males apparently have more access to females, and large females produce larger clutches, thus indicating the possible reproductive benefits for preferred light and large shells. (C) 1998 Elsevier Science B.V

Bioerosion rates of the sponge Cliona orientalis Thiele, 1900: Spatial variation over short distances

We studied bioerosion rates and tissue growth of the sponge Cliona orientalis Thiele, 1900. Experimental blocks grafted with sponge tissue were deployed at three sites in Moreton Bay, QLD, Australia, which have different environmental conditions. Bioerosion rates varied between 4, 5, and 10 kg m year when related to final tissue area and between 4, 7, and 16 kg m year when related to initial tissue area of the graft, which supports findings of earlier studies. Comparing results between the sites, eutrophication appeared to have the most stimulating effect and is most likely to have caused the measured differences. However, slight differences between shading and current speeds may also have played a role. Variation may have masked spatial differences of sponge growth, which were insignificant between study sites. Growth and bioerosion nevertheless followed the same trend and were weakly correlated. Habitat quality itself had no influence. Overall, the twofold difference in sponge bioerosion over a distance as short as 10 km suggests that when estimating bioerosion rates, subsamples should be tested at different locations