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In the past, the genetically diabetic-obese diabetes/diabetes (db/db) and obese/obese (ob/ob) mouse strains were used to investigate mechanisms of diabetes-impaired wound healing. Here we determined patterns of skin repair in genetically normal C57Bl/6J mice that were fed using a high fat diet (HFD) to induce a diabetes-obesity syndrome. Wound closure was markedly delayed in HFD-fed mice compared to mice which had received a standard chow diet (CD). Impaired wound tissue of HFD mice showed a marked prolongation of wound inflammation. Expression of vascular endothelial growth factor (VEGF) was delayed and associated with the disturbed formation of wound margin epithelia and an impaired angiogenesis in the reduced granulation tissue. Normal wound contraction was retarded and disordered. Wound disorders in obese C57Bl/6J mice were paralleled by a prominent degradation of the inhibitor of NFκB (IκB-α) in the absence of an Akt activation. By contrast to impaired wound conditions in ob/ob mice, late wounds of HFD mice did not develop a chronic inflammatory state and were epithelialized after 11 days of repair. Thus, only genetically obese and diabetic ob/ob mice finally developed chronic wounds and therefore represent a better suited experimental model to investigate diabetes-induced wound healing disorders.
Objective: Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.
Design: This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.
Results: After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.
Conclusion: The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.
Background: This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis.
Methods: This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity.
Results: 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%. MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality) and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuously high MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)).
Conclusions: MR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment.
Die auf dem ACDM-Modell beruhenden numerischen Simulationen der gravitativen Strukturbildung sind auf Skalen M >> 10 hoch 10 M sehr erfolgreich, insbesondere konvergieren die Verfahren hinsichtlich des vorhergesagten Masseanteils der Halos an der Gesamtmasse von Galaxien. Jedoch konvergieren die Simulationen nicht bezüglich der lokalen Überdichten von CDM in den Halos, vielmehr setzt sich gravitative Strukturbildung auf immer kleinere Skalen fort. Numerisch kann keine Massen-Schwelle berechnet werden, unterhalb derer keine CDM-Strukturen mehr gravitativ gebildet werden. Die Kenntnis der lokalen Überdichten in den CDM-Wolken und die Verteilung der CDM-Wolken ist jedoch für Experimente zum direkten und indirekten Nachweis von CDM-Teilchen essentiell. Aus den lokalen Überdichten folgen für Experimente zum direkten Nachweis die einfallende Stromdichten der CDM-Teilchen und für Experimente zum indirekten Nachweis die Stromdichte der Annihilationsprodukte. Außerdem können die lokalen Überdichten als Gravitationslinsen wirken. In dieser Arbeit werden Massen Schwellen analytisch berechnet, unterhalb derer akustische Störungen in CDM nicht mehr zur gravitativen Strukturbildung beitragen können. Das Massen-Spektrum von lokalen Überdichten ist nach unten durch zwei unterschiedliche Mechanismen beschränkt: (1) Während der kinetischen Entkopplung formieren sich Nichtgleichgewichtsprozesse, die sich kollektiv als Reihungsphänomene konstituieren. Im lineare Regime sind dies die Volumenviskosität, die Scherungsviskosität und die Wärmeleitung. Die dissipativen Prozesse deponieren Energie und Impuls der akustischen Störungen in die Ebene senkrecht zur Ausbreitungsrichtung der Störungen und schmieren diese so aus. (II) Nach dem kinetischen Entkopplungsprozeß strömt CDM frei auf Geodäten. Dies ermöglicht einen Strom von Teilchen von überdichten in unterdichte Regionen, so daß die Amplituden der lokalen Überdichten weiter gedämpft werden. Die lokalen Transportkoeffizienten in (1) werden durch einen legitimen Vergleich von hydrodynamischer und kinetischer Beschreibung schwach dissipativer Prozesse gewonnen. Dissipative Prozesse induzieren eine Dämpfungsmasse Mc ungefähr gleich 10 hoch minus 9 M in SUSY-CDM und beschränken damit das Spektrum akustischer Störungen in SUSY-CDM. Freies Strömen (II) von CDM-Teilchen auf Geodäten induziert eine weitere Dämpfungsmasse M fs ungefähr gleich 10 hoch minus 6 M in SUSY-CDM, wobei das berechnete M d als Anfangswert dient. Die berechneten Schwellen liefern konsistente Schranken für numerische Simulationen, die weit unterhalb des momentanen numerischen Auflösungsvermögens liegen. Weiterhin folgt aus den Schwellen die Masse der ersten rein gravitativ gebundenen CDM-Wolken. Aus diesen bilden sich im Rahmen der hierarchischen Strukturbildung größere Substrukturen bis hin zu den heute vorhandenen CDM-Halos.
S1P and its receptors have been reported to play important roles in the development of renal fibrosis. Although S1P5 has barely been investigated so far, there are indications that it can influence inflammatory and fibrotic processes. Here, we report the role of S1P5 in renal inflammation and fibrosis. Male S1P5 knockout mice and wild-type mice on a C57BL/6J background were fed with an adenine-rich diet for 7 days or 14 days to induce tubulointerstitial fibrosis. The kidneys of untreated mice served as respective controls. Kidney damage, fibrosis, and inflammation in kidney tissues were analyzed by real-time PCR, Western blot, and histological staining. Renal function was assessed by plasma creatinine ELISA. The S1P5 knockout mice had better renal function and showed less kidney damage, less proinflammatory cytokine release, and less fibrosis after 7 days and 14 days of an adenine-rich diet compared to wild-type mice. S1P5 knockout ameliorates tubular damage and tubulointerstitial fibrosis in a model of adenine-induced nephropathy in mice. Thus, targeting S1P5 might be a promising goal for the pharmacological treatment of kidney diseases.