Factors Associated With Rebound Hyperthermia After Targeted Temperature Management in Out-of- Hospital Cardiac Arrest Patients: An Explorative Substudy of the Time- Differentiated Therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest Survivors Trial

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Factors Associated With Rebound Hyperthermia After Targeted Temperature Management in Out-of-Hospital Cardiac Arrest Patients: An Explorative Substudy of the Time-Differentiated Therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest Survivors Trial

OBJECTIVES:To investigate rebound hyperthermia following targeted temperature management after cardiac arrest and its impact on functional outcome.DESIGN:Post hoc analysis.SETTING:Ten European ICUs.PATIENTS:Patients included in the time-differentiated therapeutic hypothermia in out-of-hospital cardiac arrest survivors trial treated with targeted temperature management at 33°C for 48 or 24 hours. Favorable functional outcome was defined as a Cerebral Performance Category of 1 or 2 at 6 months.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Of 338 included patients, 103 (30%) experienced rebound hyperthermia defined as a maximum temperature after targeted temperature management and rewarming exceeding 38.5°C. Using multivariate logistic regression analysis, increasing age (odds ratio, 0.97; 95% CI, 0.95–0.99; p = 0.02) and severe acute kidney injury within 72 hours of ICU admission (odds ratio, 0.35; 95% CI, 0.13–0.91; p = 0.03) were associated with less rebound hyperthermia, whereas male gender (odds ratio, 3.94; 95% CI, 1.34–11.57; p = 0.01), highest C-reactive protein value (odds ratio, 1.04; 95% CI, 1.01–1.07; p = 0.02), and use of mechanical chest compression during cardiopulmonary resuscitation (odds ratio, 2.00; 95% CI, 1.10–3.67; p = 0.02) were associated with more rebound hyperthermia. Patients with favorable functional outcome spent less time after rewarming over 38.5°C (2.5% vs 6.3%; p = 0.03), 39°C (0.14% vs 2.7%; p CONCLUSIONS:One-third of targeted temperature management patients experience rebound hyperthermia, and it is more common in younger male patients with an aggravated inflammatory response and those treated with a mechanical chest compression device. Later onset of rebound hyperthermia and temperatures exceeding 38.5°C associate with unfavorable outcome.</p

Antibodies against a Surface Protein of Streptococcus pyogenes Promote a Pathological Inflammatory Response

Streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes is a clinical condition with a high mortality rate despite modern intensive care. A key feature of STSS is excessive plasma leakage leading to hypovolemic hypotension, disturbed microcirculation and multiorgan failure. Previous work has identified a virulence mechanism in STSS where M1 protein of S. pyogenes forms complexes with fibrinogen that activate neutrophils to release heparin-binding protein (HBP), an inducer of vascular leakage. Here, we report a marked inter-individual difference in the response to M1 protein–induced HBP release, a difference found to be related to IgG antibodies directed against the central region of the M1 protein. To elicit massive HBP release, such antibodies need to be part of the M1 protein–fibrinogen complexes. The data add a novel aspect to bacterial pathogenesis where antibodies contribute to the severity of disease by promoting a pathologic inflammatory response

The Sign of the V: Papers in Honour of Sten Vikner

‘The Sign of the V’ is a festschrift in honour of Sten Vikner, written by friends, colleagues, and collaborators, present and past, to celebrate both his 60th birthday and his contribution to the field of linguistics. The papers cover a wide range of topics in theoretical and empirical linguistic research, from phonetics and phonology, through morphology, semantics, and syntax, to pragmatics, as well as language acquisition, second-language learning, language processing, language teaching, language contact, historical linguistics, and language variation and change. Many different languages are featured, including the Scandinavian languages (i.e. Danish, Faroese, Icelandic, Norwegian and Swedish), Catalan, Dutch, English, Finnish, West Flemish, French, German, Greek, Italian, Scots, and Yiddish. The scope and depth of the chapters in this anthology is a clear indication of the scope and depth of Sten Vikner’s own comparative research well as his impact on the field of linguistics.‘The Sign of the V’ is a festschrift in honour of Sten Vikner, written by friends, colleagues, and collaborators, present and past, to celebrate both his 60th birthday and his contribution to the field of linguistics. The papers cover a wide range of topics in theoretical and empirical linguistic research, from phonetics and phonology, through morphology, semantics, and syntax, to pragmatics, as well as language acquisition, second-language learning, language processing, language teaching, language contact, historical linguistics, and language variation and change. Many different languages are featured, including the Scandinavian languages (i.e. Danish, Faroese, Icelandic, Norwegian and Swedish), Catalan, Dutch, English, Finnish, West Flemish, French, German, Greek, Italian, Scots, and Yiddish. The scope and depth of the chapters in this anthology is a clear indication of the scope and depth of Sten Vikner’s own comparative research well as his impact on the field of linguistics

The Sign of the V: Papers in Honour of Sten Vikner

‘The Sign of the V’ is a festschrift in honour of Sten Vikner, written by friends, colleagues, and collaborators, present and past, to celebrate both his 60th birthday and his contribution to the field of linguistics. The papers cover a wide range of topics in theoretical and empirical linguistic research, from phonetics and phonology, through morphology, semantics, and syntax, to pragmatics, as well as language acquisition, second-language learning, language processing, language teaching, language contact, historical linguistics, and language variation and change. Many different languages are featured, including the Scandinavian languages (i.e. Danish, Faroese, Icelandic, Norwegian and Swedish), Catalan, Dutch, English, Finnish, West Flemish, French, German, Greek, Italian, Scots, and Yiddish. The scope and depth of the chapters in this anthology is a clear indication of the scope and depth of Sten Vikner’s own comparative research well as his impact on the field of linguistics.‘The Sign of the V’ is a festschrift in honour of Sten Vikner, written by friends, colleagues, and collaborators, present and past, to celebrate both his 60th birthday and his contribution to the field of linguistics. The papers cover a wide range of topics in theoretical and empirical linguistic research, from phonetics and phonology, through morphology, semantics, and syntax, to pragmatics, as well as language acquisition, second-language learning, language processing, language teaching, language contact, historical linguistics, and language variation and change. Many different languages are featured, including the Scandinavian languages (i.e. Danish, Faroese, Icelandic, Norwegian and Swedish), Catalan, Dutch, English, Finnish, West Flemish, French, German, Greek, Italian, Scots, and Yiddish. The scope and depth of the chapters in this anthology is a clear indication of the scope and depth of Sten Vikner’s own comparative research well as his impact on the field of linguistics

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms