Pentraxin 3 (PTX3) Is Associated with Severe Sepsis and Fatal Disease in Emergency Room Patients with Suspected Infection: A Prospective Cohort Study

Background

Early diagnostic and prognostic stratification of patients with suspected infection is a difficult clinical challenge. We studied plasma pentraxin 3 (PTX3) upon admission to the emergency department in patients with suspected infection.

Methods

The study comprised 537 emergency room patients with suspected infection: 59 with no systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 67 with bacterial infection without SIRS (group 2), 54 with SIRS without bacterial infection (group 3), 308 with sepsis (SIRS and bacterial infection) without organ failure (group 4) and 49 with severe sepsis (group 5). Plasma PTX3 was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay (ELISA).

Results

The median PTX3 levels in groups 1–5 were 2.6 ng/ml, 4.4 ng/ml, 5.0 ng/ml, 6.1 ng/ml and 16.7 ng/ml, respectively (p<0.001). The median PTX3 concentration was higher in severe sepsis patients compared to others (16.7 vs. 4.9 ng/ml, p<0.001) and in non-survivors (day 28 case fatality) compared to survivors (14.1 vs. 5.1 ng/ml, p<0.001). A high PTX3 level predicted the need for ICU stay (p<0.001) and hypotension (p<0.001). AUC^ROC in the prediction of severe sepsis was 0.73 (95% CI 0.66–0.81, p<0.001) and 0.69 in case fatality (95% CI 0.58–0.79, p<0.001). PTX3 at a cut-off level for 14.1 ng/ml (optimal cut-off value for severe sepsis) showed 63% sensitivity and 80% specificity. At a cut-off level 7.7 ng/ml (optimal cut-off value for case fatality) showed 70% sensitivity and 63% specificity in predicting case fatality on day 28.In multivariate models, high PTX3 remained an independent predictor of severe sepsis and case fatality after adjusting for potential confounders.

Conclusions

A high PTX3 level on hospital admission predicts severe sepsis and case fatality in patients with suspected infection.     

Life-cycle climate impacts of peat fuel: calculation methods and methodological challenges

Purpose

There has been lively debate, especially in Finland and Sweden, on the climate impacts of peat fuel. Previous studies of peat fuel's life-cycle climate impacts were controversial in their interpretation. The aim of this paper is conclusive examination of the issues of LCA methodology, derived from critical review of previous studies and recalculation based on the latest knowledge of greenhouse gas balances related to peat fuel’s utilisation and the radiative forcing impacts of greenhouse gases.

Methods

The most recent findings on emissions and the gas fluxes between soil, vegetation and atmosphere were used in calculation of the life-cycle climate impacts of the various peat fuel utilisation chains by means of LCA methodology. In the main, the calculation methods and rules were the same as in the previous studies, with the aim being to distinguish the impact of peat fuel’s utilisation from that of the natural or semi-natural situation. A dynamic method was employed for assessing changes in radiative forcing. The results of alternative peat fuel utilisation chains were compared to the corresponding result for coal.

Results

There are many steps in peat fuel LCA, where different assumptions lead to different outcomes. Determining the functional unit, reference situations and system boundaries, as well as the emission calculation methods, is important from this point of view. Determination of the initial reference situation emerged as one of the critical points in the calculations. Time scale can strongly affect the final outcomes in a study where effects of long-term land-use change are considered.

Conclusions

Each peatland area is unique. The higher the greenhouse gas emissions in the initial reference situation, the greater is the climate impact of the area and the more suitable the area is for peat extraction. The study showed that more greenhouse gas flux measurements are needed, for better assessment of the climate impacts of different potential peat extraction sites. Climate change mitigation requires quick actions, and uncertainties related to emissions are higher for longer time spans. Therefore, it can be concluded that a perspective spanning more than 100 years is inappropriate in peat fuel's life-cycle climate impact assessments.     

Load application induces changes in the expression levels of Sox-9, FGFR-3 and VEGF in condylar chondrocytes

Experimental and clinical observations have proven the modulatory effects of mechanical loading on the development and maintenance of cartilage architecture. Here we examined the involvement of Sox-9, FGFR-3 and VEGF (pivotal factors controlling cartilage development and growth) in the mechano-transduction pathway of mandibular condylar cartilage by changing the dynamics of the transmitted load via changes in food hardness. To this end, condyle cartilage tissue of rats fed with hard or soft food was analyzed immunohistochemically at various time points. Our findings demonstrate that different mechanical loading conditions in condylar chondrocytes trigger differentiation-/maturation-related processes by affecting the expression levels of these factors, ultimately influencing condylar cartilage growth.     

Abnormal behavior,striatal dopamine turnover and opioid peptide gene expression in histamine‐deficient mice

Hypothalamic histaminergic neurons regulate a variety of homeostatic, metabolic and cognitive functions. Recent data have suggested a modulatory role of histamine and histamine receptors in shaping striatal activity and connected the histaminergic system to neuropsychiatric disorders. We characterized exploratory behavior and striatal neurotransmission in mice lacking the histamine producing enzyme histidine decarboxylase (Hdc). The mutant mice showed a distinct behavioral pattern during exploration of novel environment, specifically, increased frequency of rearing seated against the wall, jumping and head/body shakes. This behavioral phenotype was associated with decreased levels of striatal dopamine and serotonin and increased level of dopamine metabolite DOPAC. Gene expression levels of dynorphin and enkephalin, opioids released by medium spiny neurons of striatal direct and indirect pathways respectively, were lower in Hdc mutant mice than in control animals. A low dose of amphetamine led to similar behavioral and biochemical outcomes in both genotypes. Increased striatal dopamine turnover was observed in Hdc KO mice after treatment with dopamine precursor l ‐Dopa. Overall, our study suggests a role for striatal dopamine and opioid peptides in formation of distinct behavioral phenotype of Hdc KO mice.     

Greenhouse gas fluxes from the eutrophic Temmesjoki River and its Estuary in the Liminganlahti Bay (the Baltic Sea)

We studied concentrations of carbon dioxide (CO₂), methane (CH₄) and nitrous oxide (N₂O) in the eutrophic Temmesjoki River and Estuary in the Liminganlahti Bay in 2003–2004 and evaluated the atmospheric fluxes of the gases based on measured concentrations, wind speeds and water current velocities. The Temmesjoki River was a source of CO₂, CH₄ and N₂O to the atmosphere, whereas the Liminganlahti Bay was a minor source of CH₄ and a minor source or a sink of CO₂ and N₂O. The results show that the fluxes of greenhouse gases in river ecosystems are highly related to the land use in its catchment areas. The most upstream river site, surrounded by forests and drained peatlands, released significant amounts of CO₂ and CH₄, with average fluxes of 5,400 mg CO₂–C m⁻² d⁻¹ and 66 mg CH₄–C m⁻² d⁻¹, and concentrations of 210 μM and 345 nM, respectively, but N₂O concentrations, at an average of 17 nM, were close to the atmospheric equilibrium concentration. The downstream river sites surrounded by agricultural soils released significant amounts of N₂O (with an average emission of 650 μg N₂O–N m⁻² d⁻¹ and concentration of 22 nM), whereas the CO₂ and CH₄ concentrations were low compared to the upstream site (55 μM and 350 nM). In boreal regions, rivers are partly ice-covered in wintertime (approximately 5 months). A large part of the gases, i.e. 58% of CO₂, 55% of CH₄ and 36% of N₂O emissions, were found to be released during wintertime from unfrozen parts of the river.     

Warming of subarctic tundra increases emissions of all three important greenhouse gases – carbon dioxide,methane, and nitrous oxide

Rapidly rising temperatures in the Arctic might cause a greater release of greenhouse gases (GHGs) to the atmosphere. To study the effect of warming on GHG dynamics, we deployed open‐top chambers in a subarctic tundra site in Northeast European Russia. We determined carbon dioxide (CO₂), methane (CH₄), and nitrous oxide (N₂O) fluxes as well as the concentration of those gases, inorganic nitrogen (N) and dissolved organic carbon (DOC) along the soil profile. Studied tundra surfaces ranged from mineral to organic soils and from vegetated to unvegetated areas. As a result of air warming, the seasonal GHG budget of the vegetated tundra surfaces shifted from a GHG sink of ?300 to ?198 g CO₂–eq m^?2 to a source of 105 to 144 g CO₂–eq m^?2. At bare peat surfaces, we observed increased release of all three GHGs. While the positive warming response was dominated by CO₂, we provide here the first in situ evidence of increasing N₂O emissions from tundra soils with warming. Warming promoted N₂O release not only from bare peat, previously identified as a strong N₂O source, but also from the abundant, vegetated peat surfaces that do not emit N₂O under present climate. At these surfaces, elevated temperatures had an adverse effect on plant growth, resulting in lower plant N uptake and, consequently, better N availability for soil microbes. Although the warming was limited to the soil surface and did not alter thaw depth, it increased concentrations of DOC, CO_2, and CH₄ in the soil down to the permafrost table. This can be attributed to downward DOC leaching, fueling microbial activity at depth. Taken together, our results emphasize the tight linkages between plant and soil processes, and different soil layers, which need to be taken into account when predicting the climate change feedback of the Arctic.     

Transmembrane carbonic anhydrase isozymes IX and XII in the female mouse reproductive organs

Background  

Carbonic anhydrase (CA) classically catalyses the reversible hydration of dissolved CO₂ to form bicarbonate ions and protons. The twelve active CA isozymes are thought to regulate a variety of cellular functions including several processes in the reproductive systems.     

Air temperature triggers the recovery of evergreen boreal forest photosynthesis in spring

The timing of the commencement of photosynthesis (P^*) in spring is an important determinant of growing‐season length and thus of the productivity of boreal forests. Although controlled experiments have shed light on environmental mechanisms triggering release from photoinhibition after winter, quantitative research for trees growing naturally in the field is scarce. In this study, we investigated the environmental cues initiating the spring recovery of boreal coniferous forest ecosystems under field conditions. We used meteorological data and above‐canopy eddy covariance measurements of the net ecosystem CO₂ exchange (NEE) from five field stations located in northern and southern Finland, northern and southern Sweden, and central Siberia. The within‐ and intersite variability for P^* was large, 30–60 days. Of the different climate variables examined, air temperature emerged as the best predictor for P^* in spring. We also found that ‘soil thaw’, defined as the time when near‐surface soil temperature rapidly increases above 0°C, is not a useful criterion for P^*. In one case, photosynthesis commenced 1.5 months before soil temperatures increased significantly above 0°C. At most sites, we were able to determine a threshold for air‐temperature‐related variables, the exceeding of which was required for P^*. A 5‐day running‐average temperature (T₅) produced the best predictions, but a developmental‐stage model (S) utilizing a modified temperature sum concept also worked well. But for both T₅ and S, the threshold values varied from site to site, perhaps reflecting genetic differences among the stands or climate‐induced differences in the physiological state of trees in late winter/early spring. Only at the warmest site, in southern Sweden, could we obtain no threshold values for T₅ or S that could predict P^* reliably. This suggests that although air temperature appears to be a good predictor for P^* at high latitudes, there may be no unifying ecophysiological relationship applicable across the entire boreal zone.