C-reactive protein (CRP) recognizes uric acid crystals and recruits proteases C1 and MASP1

Gout is caused by crystallization of uric acid in the form of monosodium urate (MSU) crystals, which induce a sterile inflammatory response that is hardly distinguishable from microbe-induced inflammatory responses. It is unclear, if MSU crystals (like microbes) are recognized by specific pattern recognition receptors. To identify possible soluble pattern recognition molecules for MSU crystals, we purified MSU-binding proteins from human body fluids. We identified C-reactive protein (CRP) as a major MSU-binding protein. Binding of CRP was strong enough to specifically deplete CRP from human serum. We found that CRP was required for fixation of complement components C1q, C1r, C1s and MASP1. Thus, we have identified a pattern recognition molecule for MSU crystals that links to the activation of complement. Notably, CRP does not show an even binding to the complete surface of the crystals. It rather binds to edges or distinct faces of the crystals

Perceived connections between information and communication technology use and mental symptoms among young adults - a qualitative study

<p>Abstract</p> <p>Background</p> <p>Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically.</p> <p>Methods</p> <p>We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model.</p> <p>Results</p> <p>Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health.</p> <p>Conclusions</p> <p>The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies.</p

Swimming-Induced Pulmonary Edema Diagnostic Criteria Validated by Lung Ultrasound

BACKGROUND: Despite the increasing popularity of open water swimming worldwide, swimming-induced pulmonary edema (SIPE) is a poorly recognized condition lacking established diagnostic criteria. RESEARCH QUESTION: The aim of this study was to identify diagnostic criteria of SIPE during a large open water swimming event. STUDY DESIGN AND METHOD: In this cross-sectional study, 17,904 individuals swam 1,000, 1,500, or 3,000 m in cold open water during Sweden's largest open water swimming event in 2018 and 2019. Of 166 swimmers seeking medical attention for acute respiratory symptoms, 160 were included in the study. Medical history, symptoms, and clinical findings were collected. On-site lung ultrasound (LUS) was performed to verify pulmonary edema. RESULTS: Pulmonary edema was confirmed by LUS in 102 patients (64%); findings were unilateral in 11 (7%). Peripheral oxygen saturation was identified as a strong independent diagnostic test for pulmonary edema, with &lt;= 95% as the suggested cut off based on receiver-operating characteristic curve analysis (area under the curve, 0.893; P &lt; .0001). Crackles on lung auscultation, predominantly over the anterior chest, identified 88% of patients with edema. Peripheral oxygen saturation &lt;= 95% or auscultation findings of crackles identified pulmonary edema with a sensitivity of 97% and a specificity of 86%. A specificity of 98% and a positive predictive value of 99% for LUS-verified pulmonary edema were reached if patients presented with both oxygen saturation &lt;= 95% and auscultation of crackles. INTERPRETATION:We suggest a clinical algorithm for diagnosis of SIPE for swimmers with acute respiratory symptoms during swimming in cold open water. Novel features of focally distributed edema in the anterior parts of the lungs, sometimes unilateral, add to this unique dataset of an underreported condition

Swimming-Induced Pulmonary Edema Evaluation of Prehospital Treatment With CPAP or Positive Expiratory Pressure Device

BACKGROUND: Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. Although optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment. RESEARCH QUESTION: Is NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment? STUDY DESIGN AND METHODS: A prospective observational study was conducted at Vans-brosimningen, Sweden's largest open water swimming event, from 2017 through 2019. Swimmers with a diagnosis of SIPE and with peripheral oxygen saturation (SpO(2)) of # 95%, persistent respiratory symptoms, or both were eligible for the study. NPPV was administered on site as CPAP by facial mask or as positive expiratory pressure (PEP) by a PEP device. Discharge criteria were SpO(2) of &gt; 95% and clinical recovery. Four outcome measures were evaluated: SpO(2), crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS), and patient-reported respiratory symptoms. RESULTS: Of 119 treated individuals, 94 received CPAP, 24 received treatment with a PEP device, and one required tracheal intubation. In total, 108 individuals (91%) were discharged after NPPV for a median of 10 to 20 min and 11 individuals (9%) required hospital transfer. NPPV resulted in increased SpO(2) from a median of 91% to 97% (P &lt; .0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales, 1-7 to 0-1; P &lt; .0001). No significant decrease in auscultation of crackles (93% vs 87%; P = .508) or pulmonary edema on LUS (100% vs 97%; P = .500) was seen during NPPV treatment. INTERPRETATION: NPPV administered as CPAP or via a PEP device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on site. SpO2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmo-nary auscultation or LUS findings did not. CHEST 2022; 162(2):410-42

Rebuilding research capacity in fragile states : The case of a Somali–Swedish global health initiative

This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions