Relationship between plasma mid-regional pro-adrenomedullin level and resistance to antihypertensive therapy in stable kidney transplant recipients

We investigated the relationship between plasma mid-regional pro-adrenomedullin (MR-proADM)-like immunoreactive substance (IS) level and clinical characteristics associated with renal failure or resistance to antihypertensive therapy in stable kidney transplant recipients. Forty-six Japanese kidney transplant recipients who underwent transplantation more than 90 days prior to the study were included. To evaluate resistance to antihypertensive therapy, we calculated the treatment intensity score of the antihypertensive drugs in each recipient. Morning blood samples were collected and plasma MR-proADM-IS levels were measured using an enzyme immunoassay. A significant correlation was observed between plasma MR-proADM-IS level with creatinine clearance or treatment intensity score. Multiple regression analysis identified plasma MR-proADM level and body mass index as significant independent factors associated with treatment intensity score. Plasma MR-proADM level may be a useful biomarker indicating the degree of resistance to antihypertensive therapy.     

Significant increase in plasma 4β-hydroxycholesterol concentration in patients after kidney transplantation

Several previous studies have shown that renal failure decreases not only renal elimination but also metabolic clearance of drugs, particularly those metabolized by CYP3A. However, whether recovery of renal function results in recovery of hepatic CYP3A activity remains unknown. In this study, we evaluated the effect of renal function on CYP3A activity after kidney transplantation in patients with end-stage renal disease (ESRD) by measuring the change in CYP3A activity using plasma concentration of 4β-hydroxycholesterol as a biomarker. The study enrolled 13 patients with ESRD who underwent the first kidney allograft transplantation. Morning blood samples were collected before and 3, 7, 10, 14, 21, 30, 60, 90, 120, 150 and 180 days after kidney transplantation. Plasma concentration of 4β-hydroxycholesterol was measured using GC-MS. Compared with before kidney transplantation, creatinine clearance increased significantly from day 3 after kidney transplantation and stabilized thereafter. Plasma concentration of 4β-hydroxycholesterol was elevated significantly on days 90 and 180 after kidney transplantation. In conclusion, this study suggests the recovery of CYP3A activity with improvement in renal function after kidney transplantation in patients with ESRD.     

Intérêt pronostique de la scintigraphie au 99mTc-MAG3 pour le succès à un an de la transplantation rénale

Because of the increasing use of marginal grafts, it remains a significant difference in terms of transplants half-life between living donor or cadaver donor. The main objective of this study was to assess the prognostic value of various isotopic parameters available on the same day than surgery for the one-year outcome after kidney transplantation. A retrospective study of 100 patients, who received a renal allograft at the University Hospital of Montpellier between 1999 and 2006, and who performed ^99mTc-MAG3 renal scintigraphy within 72 h after transplantation, was performed. Measurement of various isotopic parameters was performed for angiographic and tubular phases, over three different regions of interest. According to judgment criteria, namely the success or not of transplantation after the first year, previously obtained results were statistically compared. The results of our study confirmed the importance of vascular parameters, especially the Kirchner index, with a good correlation with renal function one year after tranplantation. As expected by the physiological models, a well-perfused graft had the most chances of short-term survival. Kirchner index has a negative predictive value of more than 90% for the one-year success after transplantation (VPP = 75%). Parameters assessing more specifically nephronic functional reserve (such as tubular function slope or uptake on perfusion peaks report) are independent risk factors for the failure during the first three months.     

Plasma levels of transforming growth factor-beta 1 before and after removal of low- and high-grade astrocytomas

Transforming growth factor-beta 1 (TGF-β1) has been reported to be a possible marker for a number of tumors, including brain tumors. The aim of this study was to measure the plasma levels of TGF-β1 in patients with low- and high-grade astrocytomas before and after surgery. This prospective study included 14 patients with low-grade astrocytomas and 25 with high-grade astrocytomas who underwent tumor removal and 13 controls (patients who underwent cranioplasty for skull bone defects). Plasma levels of TGF-β1 were measured in all subjects using enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis showed that when the level of TGF-β1 before tumor removal was ?2.52 ng/ml, astrocytoma was predicted with a sensitivity of 94.9% and specificity of 100%. The mean plasma level of TGF-β1 in both the low-grade and high-grade astrocytoma groups significantly decreased after tumor removal (p < 0.05); there was no significant change in TGF-β1 plasma level of the controls following surgery. Patients with high-grade astrocytomas had a significantly higher mortality rate than patients with low-grade astrocytomas (p = 0.019) and significantly shorter survival (p = 0.008). A positive correlation between TGF-β1 level after tumor removal and tumor volume was only found in the high-grade astrocytoma group (γ = 0.597, p = 0.002). The findings show that plasma TGF-β1 level was increased in patients with low-grade and high-grade astrocytoma, and that the levels significantly decreased after tumor removal in both groups. The results provide additional evidence that TGF-β1 might be useful as a tumor marker for astrocytomas.     

Effect of supplementation with Se-enriched yeast and factors influencing Se concentration in plasma of transplant recipients

The aim of this study was to assess the bioavailability of selenium (Se) in Se-enriched yeast and the possible impact of age, sex and area of residence on the Se concentration in plasma in 179 transplant recipients, as Se clinical effects in the prevention of cutaneous epithelial lesions in organ transplant recipients has been reported elsewhere. Subjects were randomized to receive either 200 μg Se/day (group 1:91 patients) or placebo (group 2: 88 patients) for 3 years. Plasma Se levels were measured at the beginning of the study and after 4, 12, 24 and 36 months of Se or placebo supplementation. Initial plasma Se levels were 90.9±26.1 μg/L for placebo and 94.0±25.3 μg/L for Se-supplemented groups. At baseline, the Se level was not linked to sex and age but to area of residence, although the number of subjects in each area was insufficient to draw any conclusions. Plasma Se levels were statistically lower in cases of liver transplant compared to kidney and heart transplant (p=0.03). Over the 3-year period of supplementation, plasma Se in the supplemented subjects was significantly higher than in the placebo group (p<0.01) and there was an interaction (p<0.01) between supplementation and time for plasma Se. Supplementation with Se-enriched yeast significantly increased the Se concentration in plasma of the patients to a plateau: the mean plasma Se of the Se-supplemented patients increased to 164.7±35.8 μg/L at 4 months and then remained similar at 12 (176.1±48.3 μg/L), 24 (176.1±54.2 μg/L) and 36 (182.2±46.4 μg/L) months.     

Elevated plasma levels of soluble (pro)renin receptor in patients with obstructive sleep apnea syndrome: Association with polysomnographic parameters

(Pro)renin receptor ((P)RR) is a specific receptor for both renin and its precursor prorenin. (P)RR was shown to be involved in pathophysiology of cardiovascular and renal diseases. Soluble (pro)renin receptor (s(P)RR), which is generated by furin from full length (P)RR, is present in blood. The aim of the present study is to clarify the association of plasma s(P)RR levels and the severity of OSAS. Plasma levels of s(P)RR were measured by ELISA in 58 male patients diagnosed as OSAS based on polysomnography, and 14 age-matched male control subjects. Blood samples were obtained at 6:00 a.m. just after overnight polysomnography. Plasma s(P)RR levels were significantly higher in patients with OSAS (9.0 ± 2.0 ng/mL, mean ± SD) than in control subjects (7.4 ± 1.5 ng/mL) (P = 0.0026). Plasma s(P)RR levels showed a significant negative correlation with % stage rapid eye movement (REM) sleep (r = −0.377, p < 0.005), and significant positive correlations with % stage 1 (r = 0.374, p < 0.005), arousal index (r = 0.341, p < 0.01), apnea hypopnea index (AHI) (r = 0.352, p < 0.01) and desaturation index (r = 0.302, p < 0. 05). In 12 OSAS patients with AHI ≥20, plasma levels of s(P)RR were studied after 3-month treatment with nasal continuous positive airway pressure (nCPAP). Plasma s(P)RR levels were significantly decreased after the nCPAP treatment (p = 0.0016). The present study has shown for the first time elevated plasma s(P)RR levels in patients with OSAS. Plasma s(P)RR levels were associated with the severity of OSAS. Soluble (P)RR may serve as a plasma marker reflecting the severity of OSAS.     

Plasma gossypol dynamics in white-tailed deer: Implications for whole cottonseed as a supplemental feed

Whole cottonseed (WCS) is a potential supplemental feed for white-tailed deer (Odocoileus virginianus) in rangeland conditions because of its high digestible energy and protein content, moderate fiber content, and resistance to degradation in moist conditions. WCS also contains the polyphenolic secondary metabolite gossypol, which reduces palatability to non-target monogastric species but may be of concern for deer nutrition. Plasma gossypol stabilization when fed a constant dry matter intake, plasma gossypol depletion after WCS was removed from the diet, and the relationship between WCS consumption and plasma gossypol concentration was studied in 10 mature male (N = 5) and female (N = 5) captive white-tailed deer. Consumption of WCS by 73 free-ranging white-tailed deer (59 males, 14 females) was estimated using results of the captive study. Plasma gossypol concentrations declined exponentially and averaged 0.74 μg/mL 35 days after WCS was removed from the diet. Plasma gossypol concentration was linearly related to WCS consumption (P < 0.001), with females having 0.35 μg/mL greater (P = 0.04) plasma gossypol than males for a given rate of dry matter consumption. All female and 93% of male white-tailed deer captured in WCS supplemented pastures had detectable plasma gossypol. Female averaged 1.88 μg/mL of plasma gossypol and males averaged 4.84 μg/mL of plasma gossypol. Based on the captive deer data, these plasma values suggest an average WCS consumption of ∼2.6 g/kg BW/day for female free-ranging deer and ∼5.6 g/kg BW/day for male free-ranging deer. Inferentially, a large proportion of free-ranging white-tailed deer in rangeland conditions will consume WCS, with females consuming 125 g WCS/day and males consuming 428 g WCS/day. That plasma gossypol levels decrease rapidly after cottonseed is removed from the diet suggests that the long withdrawal periods often used prior to breeding season may not be needed. However, although 93% of gossypol was eliminated from the animals after a five-week withdrawal period, a small amount of gossypol can still be detected. While our preliminary data on these animals suggests that these levels are not detriment to animal health or reproduction, ranch managers may want to take a conservative approach to the feeding of WCS until these questions are answered.     

Change of telomerase activity in peripheral blood of patients with head and neck squamous cell carcinoma pre and post curative treatment

BackgroundThere is no clinically applicable tumor marker for head and neck cancers. Telomerase is detected in approximately 90% of all malignant tumors, it may predict poor or favorable outcomes, thus being both a highly attractive biomarker and a target for the development of molecular-based cancer diagnostics, prognostics, and therapeuticsAimPrimary aim was to detect a change of telomerase activity before and after curative treatment.Materials and MethodsPatients with biopsy proven head and neck squamous cell carcinoma, stage I-IVB treated with a curative intent, performance status 0–2 and malignancy at one primary site were included in the study. Telomerase levels were tested in tissue biopsy. Plasma telomerase levels were tested at baseline, 5 days and at 3 months after treatment using ELISA.ResultsRaised plasma telomerase activity was seen in all the patients with cancer at baseline. The mean plasma telomerase level at baseline was 861.4522 ng/ml, at 5 days after completion of curative treatment was 928.92 ng/ml and at 3 months of follow up was 898.87 ng/ml. The mean tissue biopsy telomerase level was 19768.53 ng/mg. There was a significant increase in baseline telomerase levels in cancer patients compared to normals (volunteers) (t = −3.52, p = 0.001).There was a significant increase in plasma levels of telomerase at 3 months compared to baseline values (z = −1.98, p = 0.04). The increase in telomerase level did not correlate with the response of the treatment.ConclusionIn patients with head and neck squamous cell carcinomas treated with a curative intent, the change in levels of telomerase correlates neither with the disease status nor with prognostic factors.     

Effects of maternal l-citrulline supplementation on renal function and blood pressure in offspring exposed to maternal caloric restriction: The impact of nitric oxide pathway

Maternal undernutrition can cause reduced nephron number and glomerular hypertrophy, consequently leading to adult kidney disease. We intended to elucidate whether NO deficiency evolves to kidney disease vulnerability in offspring from mothers with caloric restriction diets and whether maternal l-citrulline (l-Cit) supplementation can prevent this. Using a rat model with 50% caloric restriction, four groups of 3-month-old male offspring were sacrificed to determine their renal outcome: control, caloric restriction (CR), control treated with 0.25% l-citrulline solution during the whole period of pregnancy and lactation (Cit), and CR treated in the same way (CR + Cit group). The CR group had low nephron numbers, increased glomerular diameter, and an increased plasma creatinine level compared with the control group. Maternal l-Cit supplementation prevented these effects. The CR + Cit and Cit groups developed hypertension beginning at 4 and 8 weeks of age, respectively. Plasma asymmetric and symmetric dimethylarginine (ADMA and SDMA) levels were increased, but l-arginine/ADMA ratios (AAR) were decreased in the CR group vs the control group. This was prevented by maternal l-Cit supplementation. Renal cortical neuronal NOS-α (nNOSα) protein abundance was significantly decreased in the Cit and CR + Cit groups. Collectively, reduced nephron number, reduced renal nNOSα expression, increased ADMA, and decreased AAR contribute to the developmental programming of adult kidney disease and hypertension. Although maternal l-Cit supplementation prevents caloric restriction-induced low nephron number and renal dysfunction, it also induces hypertension.     

Prognostic significance of plasma visfatin levels in patients with ischemic stroke

Plasma visfatin concentration has been enhanced in ischemic stroke. The aim of the current investigation was to test whether determination of visfatin in plasma is associated with 6-month clinical outcomes including mortality and unfavorable outcome (modified Rankin Scale score > 2) in the patients with ischemic stroke. Between July 2009 and January 2012, plasma visfatin concentrations of 186 patients and 100 healthy individuals were quantified by enzyme-linked immunosorbent assay. Plasma visfatin concentrations were higher in patients than in healthy individuals (108.5 ± 41.1 ng/mL vs. 13.8 ± 3.9 ng/mL, P < 0.001). A logistic regression analysis selected plasma visfatin concentration as an independent predictor for 6-month clinical outcomes (both P < 0.01). Using receiver operating characteristic curve analysis, plasma visfatin concentration was found to predict 6-month clinical outcomes with the high predictive performance. The predictive value of visfatin was in the range of National Institutes of Health Stroke Scale score (both P > 0.05). Combined use of visfatin and National Institutes of Health Stroke Scale score did not improve the predictive significance (both P > 0.05). Thus, visfatin may help in the prediction of long-term clinical outcomes in patients with ischemic stroke.     

Positive correlation between plasma nitrite and performance during high-intensive exercise but not oxidative stress in healthy men

Several studies suggest that exercise is associated with elevated oxidative stress which diminishes NO bioavailability. The aim of the present study was to investigate a potential link between NO synthesis and bioavailability and oxidative stress in the circulation of subjects performing high-intensive endurance exercise. Twenty-two male healthy subjects cycled at 80% of their maximal workload. Cubital venous blood was taken before, during and after exercise, and heparinized plasma was generated. Plasma concentrations of nitrite and nitrate were quantified by GC–MS and of the oxidative stress biomarker 15(S)-8-iso-PGF_2α by GC–MS/MS. pH and pCO₂ fell and HbO₂ increased upon exercise. The duration of the 80% phase (d80) was 740 ± 210 s. Subjects cycled at 89.2 ± 3.3% of their peak oxygen uptake. Plasma concentration of nitrite (P < 0.01) and 15(S)-8-iso-PGF_2α (P < 0.05) decreased significantly during exercise. At the end of exercise, plasma nitrite concentration correlated positively with d80 and performed work (w80) (each P < 0.05). Changes in nitrate concentration also correlated positively with d80 (P < 0.05) and w80/kg (P < 0.01). These findings provide evidence of a favorable effect of nitrite on high-intensive endurance exercise. The lack of association between 15(S)-8-iso-PGF_2α and NO bioavailability (nitrite concentration) and NO biosynthesis (nitrate concentration) suggest that oxidative stress, notably lipid peroxidation, is not linked to the l-arginine/NO pathway in healthy male subjects being on endurance exercise.     

Plasma copeptin concentration and outcome after pediatric traumatic brain injury

Higher plasma copeptin level has been associated with poor outcomes of critical illness. The present study was undertaken to investigate the plasma copeptin concentrations in children with traumatic brain injury (TBI) and to analyze the correlation of copeptin with disease outcome. Plasma copeptin concentrations of 126 healthy children and 126 children with acute severe TBI were measured by enzyme-linked immunosorbent assay. Twenty-one patients (16.7%) died and 38 patients (30.2%) had an unfavorable outcome (Glasgow Outcome Scale score of 1–3) at 6 months. Plasma copeptin level was obviously higher in patients than in healthy children (46.2 ± 20.8 pmol/L vs. 9.6 ± 3.0 pmol/L, P < 0.001). Plasma copeptin level was identified as an independent predictor for 6-month mortality [odds ratio (OR) 1.261, 95% confidence interval (CI) 1.112–1.538, P = 0.005] and unfavorable outcome (OR 1.313, 95% CI 1.146–1.659, P = 0.003). The predictive value of copeptin was similar to that of Glasgow Coma Scale (GCS) score for 6-month mortality [area under curve (AUC) 0.832, 95% CI 0.755–0.892 vs. AUC 0.873, 95% CI 0.802–0.926, P = 0.412] and unfavorable outcome (AUC 0.863, 95% CI 0.790–0.918 vs. AUC 0.885, 95% CI 0.816–0.935, P = 0.596). Copeptin improved the AUC of GCS score for 6-month unfavorable outcome (AUC 0.929, 95% CI 0.869–0.967, P = 0.013), but not for 6-month mortality (AUC 0.887, 95% CI 0.818–0.936, P = 0.600). Thus, plasma copeptin level represents a novel biomarker for predicting 6-month clinical outcome in children with TBI.     

Hypothermic reconditioning by gaseous oxygen persufflation after cold storage of porcine kidneys

BackgroundDelayed graft function still represents a major complication in clinical kidney transplantation. Here we tested the possibility to improve functional outcome of cold stored kidneys a posteriori by hypothermic reconditioning using retrograde oxygen persufflation (ROP) immediately prior to reperfusion.MethodsKidneys from female German Landrace pigs were flushed with Histidine–Tryptophan–Ketoglutarate (HTK) solution and cold-stored for 18 h (control).Some grafts were subsequently subjected to 90 min of retrograde oxygen persufflation (ROP) via the renal vein during cold preservation. Early graft function of all kidneys was assessed thereafter by warm reperfusion in vitro (n = 6, resp.).ResultsRenal function upon reperfusion was significantly enhanced by ROP with an approximately twofold increase in renal clearances of creatinine and urea. ROP also led to higher renal vascular flow rates, enhanced urine output and mitigated histological alterations.ConclusionIt is concluded that initial graft function can be improved by 90 min of hypothermic gaseous oxygenation after arrival of the preserved organ in the transplantation clinic.     

Plasma trace elements levels are not altered by submaximal exercise intensities in well-trained endurance euhydrated athletes

The purpose of this study was to assess the effect of relative exercise intensity on various plasma trace elements in euhydrated endurance athletes.Twenty-seven well-trained endurance athletes performed a cycloergometer test: after a warm-up of 10 min at 2.0 W kg⁻¹, workload increased by 0.5 W kg⁻¹ every 10 min until exhaustion. Oxygen uptake, blood lactate concentration ([La⁻]_b), and plasma ions (Zn, Se, Mn and Co) were measured at rest, at the end of each stage, and 3, 5 and 7 min post-exercise. Urine specific gravity (U_SG) was measured before and after the test, and subjects drank water ad libitum. Fat oxidation (FAT_OXR), carbohydrate oxidation (CHO_OXR), energy expenditure from fat (EE_FAT), from carbohydrates (EE_CHO) and total EE (EE_T) were estimated using stoichiometric equations. A repeated measure (ANOVA) was used to compare plasma ion levels at each exercise intensity level. The significance level was set at P < 0.05.No significant differences were found in U_SG between, before, and after the test (1.014 ± 0.004 vs. 1.014 ± 0.004 g cm⁻³) or in any plasma ion level as a function of intensity. There were weak significant correlations of Zn (r = 0.332, P < 0.001) and Se (r = 0.242, P < 0.01) with [La⁻]_b, but no relationships were established between [La⁻]_b, VO₂, FAT_OXR, CHO_OXR, EE_FAT, EE_CHO, or EE_T and plasma ion levels.Acute exercise at different submaximal intensities in euhydrated well-trained endurance athletes does not provoke a change in plasma trace element levels, suggesting that plasma volume plays an important role in the homeostasis of these elements during exercise.     

Effect of fasting on body composition and responses to stress in sunshine bass

The integrated responses of the hormonal regulation of growth and stress in sunshine bass (Morone chrysops X Morone saxatilis) as regulated by feed deprivation were investigated. Groups of fish were fed 1.5% of the body weight per day or offered no feed for 4 weeks. Another group of fish was not fed for 3 weeks and feed was offered during the fourth week. Fish in each group were sampled immediately before or after a 15-min low water confinement stressor after each week of the experiment. Liver mass and liver glycogen content were decreased after one week of fasting and remained low until the end of the study. However, both recovered after a week of refeeding. Intraperitoneal fat was significantly lower after two weeks of fasting and did not recover after a week of refeeding. None of these components were affected by confinement stress. Plasma glucose in unstressed fish was generally unaffected by fasting or refeeding; however, plasma glucose increased after confinement stress in fed but not in fasted fish. The cortisol stress response was unaltered by fasting and remained robust. Plasma IGF-I generally decreased in fasted fish but was not significantly lower than fed fish until the fourth week. A week of refeeding did not restore plasma IGF-I concentrations. Plasma IGF-I concentrations were higher in confinement stressed fed fish after two and four weeks but were unchanged in the fourth week. There was no change in the plasma IGF-I concentrations in fasted or refed fish due to the stress. Liver weight and liver glycogen were essentially depleted after 2 weeks of fasting. The reduction of liver glycogen greatly reduced the glucose response to stress; however, the cortisol stress response was maintained for at least four weeks of fasting. Intraperitoneal fat was decreased very little after 4 weeks of fasting. Plasma IGF-I concentrations were reduced only after 3 weeks of fasting.     

Protection of renal function by green tea extract during Plasmodium berghei infection

Impairment of renal function from oxidative stress during malaria infection is one of the leading causes of death in endemic areas. Since blood urea nitrogen and creatinine levels in plasma can be used as markers for monitoring renal damage, this study investigated the effect of green tea extract on reduction of blood urea nitrogen and creatinine levels during malaria infection using Plasmodium berghei ANKA infected mice as in vivo model. For in vivo testing, ICR mice were infected with 1 × 10⁷ parasitized erythrocytes and green tea extract was subsequently administered orally twice a day for 10 consecutive days. Parasitemia was estimated by standard microscopy, and blood urea nitrogen and creatinine levels in plasma were also measured. It was found that parasitemia kept increasing until animal death, and is strongly correlated with high blood urea nitrogen and creatinine. The highest levels of blood urea nitrogen and creatinine in plasma were found on day 10 after infection. However, blood urea nitrogen and creatinine levels in plasma were reduced and decreased significantly (p < 0.01) in green tea extract treated mice, compared with untreated group. It can be concluded that green tea extract can protect and maintain renal function during malaria infection, and this extract can be developed for use as a supplement and combination therapy.     

Relationship between plasma copeptin levels and complications of community-acquired pneumonia in preschool children

High plasma copeptin level has been associated with clinical outcomes after acute illness. The present study was undertaken to investigate the plasma copeptin concentrations in preschool children with community-acquired pneumonia (CAP) and to analyze the correlations of copeptin with CAP-related complications and pleural effusion. Plasma copeptin concentrations of 100 healthy children and 165 preschool children with CAP were measured. 35 children (21.2%) presented with complicated CAP and 28 children (17.0%) presented with pleural effusion. The admission copeptin levels were significantly increased in all patients (49.7 ± 21.4 pmol/L), children with complicated CAP (73.0 ± 16.9 pmol/L), those with uncomplicated CAP (43.4 ± 17.8 pmol/L), those with pleural effusion (70.9 ± 17.4 pmol/L) and those without pleural effusion (45.3 ± 19.5 pmol/L) compared with healthy control individuals (9.0 ± 2.7 pmol/L, all P < 0.001). Multivariate logistic regression analysis showed that plasma copeptin levels were independently related to CAP-related complications (odds ratio 1.214, 95% confidence interval 1.104–1.872, P < 0.001) and pleural effusion (odds ratio 1.226, 95% confidence interval 1.109–1.917, P < 0.001). A receiver operating characteristic curve analysis showed plasma copeptin level better predicted CAP-related complications (area under curve 0.876, 95% confidence interval 0.815–0.922) and pleural effusion (area under curve 0.831, 95% confidence interval 0.765–0.885). Thus, plasma copeptin level may represent a novel biomarker for predicting CAP-related complications in preschool children.     

Low plasma leptin level at admission predicts delirium in critically ill patients: A prospective cohort study

The pathophysiology of delirium remains poorly understood. Low leptin level has been associated with features leading to delirium such as dysregulated immune functions and loss of neuroprotective effects. The purpose of the present study was to investigate the relationship between plasma leptin level at intensive care unit (ICU) entry and subsequent occurrence of delirium in critically ill patients. This single-center prospective cohort study in China allocated 336 critically ill patients admitted to ICU between 05/2015 and 05/2016 into a delirium group (n = 102) and non-delirium group (n = 234) based on whether delirium occurred during their stay at the ICU. Patients were examined at least twice daily and delirium was diagnosed using the Confusion Assessment Method for the ICU (CAM-ICU). Blood samples were obtained after ICU entry. Plasma leptin concentrations were measured by ELISA. Delirium occurred in 30.4% (102/336) of patients. Patients who developed delirium showed significantly lower leptin level at ICU entry than those who did not (6.1 ± 3.2 vs. 9.2 ± 5.9 ng/mL; P < 0.001). Low plasma leptin level at ICU entry was independently associated with subsequent occurrence of delirium (OR, 0.865; 95%CI, 0.802–0.934; P < 0.001). Other independent risk factors for delirium included increasing age (OR, 1.050; 95%CI, 1.020–1.080; P = 0.001) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score (OR, 1.148; 95%CI, 1.092–1.208; P < 0.001). Patients who developed delirium had a prolonged duration of ICU stay and higher mortality. Low plasma leptin level at ICU entry was associated with the occurrence of delirium in critically ill patients.     

Plasma Free Metanephrine and Normetanephrine Levels are Increased in Patients with Chronic Kidney Disease

ObjectivePatients with impaired renal function, particularly those on dialysis, frequently exhibit high blood pressure and hemodynamic instability, which often lead to pheochromocytoma assessment. Our objective was to assess plasma free metanephrine (MN) and normetanephrine (NMN) in chronic kidney disease patients (CKD) with or without dialysis.MethodsIn this prospective observational study we performed enzyme-linked immunosorbent assays (ELISAs) to evaluate plasma free MN and NMN in 48 CKD patients (15 with stage 3-5 CKD without dialysis, 26 on hemodialysis [HD], and 7 continuous ambulatory peritoneal dialysis [CAPD]), 30 patients with histologically proven pheochromocytoma, and 43 hypertensive patients. Adrenal masses were ruled out by abdominal computed tomography (CT) scans in all CKD and control hypertensive patients.ResultsAll 3 CKD groups (HD, CAPD, and CKD without dialysis) had significantly higher plasma free MN and NMN levels than the control hypertensive group (P < .0055). HD and CAPD patients had significantly lower plasma free NMN (P < .0055), but free MN levels were not significantly different than those observed in pheochromocytoma patients. In patients with HD, CAPD, and CKD without dialysis, plasma free MN and NMN were higher than manufacturer’s upper limits of normal in 57.7% and 28.5%, 13.3% and 61.5%, and 85.7% and 26.6%, respectively. Regression models showed that the number of dialysis years was significantly correlated with plasma free MN (r = 0.615, P < .001) but not free NMN.ConclusionPlasma free MN and NMN levels are frequently elevated in CKD patients, particularly in those on dialysis. Plasma free MN levels significantly overlap with the range in pheochromocytoma patients and correlate with the number of years on dialysis. (Endocr Pract. 2014;20:139-144)     

Differential pattern of cell-surface and soluble TREM-1 between sepsis and SIRS

ObjectiveTriggering receptor expressed on myeloid cells-1 (TREM-1) was reported to play a key roll in amplification of production of inflammatory cytokines. TREM-1 is suggested to be a specific biomarker for sepsis for this reason, but the clinical significance of TREM-1 has not been elucidated. We investigated TREM-1 expression on the cell-surface, and plasma levels of soluble TREM-1 (sTREM-1) in patients with non-infectious systemic inflammatory response syndrome (SIRS) and sepsis admitted to the ICU.MethodsThirty-five patients with SIRS and 21 patients with sepsis admitted to ICU were subjected to the study. TREM-1 expressions on the surfaces of monocytes and neutrophils were measured by flow cytometry. Plasma sTREM-1 level and serum interleukin (IL)-6 level were measured.ResultsSeptic patients had decreased TREM-1 expression, clearly on neutrophils or to a lesser extent on monocyte compared to SIRS patients on ICU admission (neutrophils p < 0.001, monocyte p < 0.05). TREM-1 expression on neutrophils had a significant inverse correlation with serum IL-6 level (r = ?0.64, p < 0.0001). Plasma sTREM-1 level in septic patients was significantly higher than that in SIRS patients (p < 0.05). Plasma sTREM-1 level positively correlated with severity score and non-survivors had increased plasma sTREM-1 level compared to survivors in all SIRS/sepsis patients (p < 0.05).ConclusionsPatients with sepsis had increased soluble TREM-1 and decreased TREM-1 expression on neutrophil compared to SIRS patients. sTREM-1 may be useful to evaluate disease severity and outcome of patients with SIRS or sepsis.