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Background: Atherosclerotic plaques in the internal carotid artery are responsible for more than 15% of ischemic strokes. Carotid 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) detects plaque inflammation. Plasma ICAM-1 and LRP1 concentrations have been associated with inflammation in ipsilateral carotid plaque. The aim of the present study was to test the association between the soluble (s) form of these biomarkers and contralateral carotid plaques., Methods: Prospective study conducted in 53 patients with a recent ischemic stroke and at least one atherosclerotic plaque in both carotid arteries. All of the patients underwent an early carotid 18 F-FDG PET, and a blood sample was obtained at 7±1 days. Several plasma inflammatory markers were evaluated by Multiplex and sLRP1 levels were measured by commercial ELISA. Bivariate and multivariable linear regression was used to assess the association between inflammatory markers and the clinical variables, including contralateral maximum standardized uptake value (SUVmax) and mean SUVmax (mean of contralateral and ipsilateral SUVmax) of 18 F-FDG uptake. Hazard ratio (HR) was estimated with Cox models adjusted for potential confounding factors to evaluate recurrence., Results: Multivariable linear regression analysis showed an independent association between sICAM-1 and sVCAM-1 and mean SUVmax (CI=-0.064-0.325, p=0.004; CI=0.079-0.554, p=0.010). In addition, in bivariate regression analysis, sICAM-1 was associated with contralateral SUVmax (CI=0.049-0.382, p=0.012). Cox regression showed that mean SUVmax was associated with stroke recurrence (HR=5.604, p=0.044)., Conclusions: sICAM-1 was independently associated with mean carotid plaque inflammation and with inflammation in contralateral plaque. sICAM-1 could be an indicator of plaque inflammation even in asymptomatic plaques., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the effect of stress from surgery on hemodynamics, white cell count, and systemic markers during cholecystectomies performed under 2 intravenous anesthetic techniques., Patients and Method: Randomized clinical trial in patients classified ASA 1 or 2. The patients received 0.15 mg x kg(-1) of midazolam, 1 mg x kg(-1) x h(-1) of ketamine, and 2 microg x kg(-1) of fentanyl (MKF group) or 1 microg x kg(-1) x min of remifentanil and 0.15 mg x kg(-1) of midazolam (RM group). Hemodynamic parameters, white cell counts in circulating blood, and serum levels of cortisol, prolactin, and interleukin-6 were recorded before surgery, after intubation, and at the end of surgery., Results: Thirty-two patients were enrolled. Hemodynamic stability was good in both groups. After intubation, mean (SD) heart rate (75 [14] beats x min(-1)) and systolic (96 [14] mm Hg) and diastolic (60 [7] mm Hg) blood pressures were lower in the RM group than in the MKF group (99 [17] beats x min(-1); 121 [29] mm Hg; and 79 [14] mm Hg, respectively, P<0.01). After surgery whi- te cell (10528 [6480] microL(-1)) and neutrophil (8155 [5657] microL(-1)) counts and cortisol concentration (225 [257] ng x mL(-1)) were significantly lower in the RM patients than in the MKF patients (white cell count, 14,002 [5927] cells x micromL(-1); neutrophil count, 11530 [5657] cells x microL(-1), and 788.8 [146] ng x mL(-1); P<0.01)., Conclusions: The 2 intravenous anesthesia regimens compared differ slightly with regard to their effects on surgical stress. Anesthesia with remifentanil and midazolam contributes to reducing the inflammatory response through modulation of the neurohumoral response to stress.

Objective: Given the immunomodulatory effects of anesthesia and surgery, 2 anesthetic regimens in clinical use were compared to evaluate hemodynamic, stress, and immunologic response in patients undergoing laparoscopic cholecystectomy., Patients and Methods: Randomized controlled trial in patients classified ASA I and scheduled for laparoscopic cholecystectomy. Patients were randomly assigned to the inhaled anesthetic group (13 anesthetized with propofol-fentanyl-isoflurane) or the total intravenous anesthesia (TIVA) group (14 patients anesthetized with propofol-remifentanil). Patients in both groups received the muscle relaxant vecuronium. We assessed hemodynamic variables, cortisol levels, prolactin, interleukin 6, white cell and lymphocyte counts before, during (1 hour after induction) and after (24 hours and 7 days) surgery., Results: Hemodynamic variables were stable in both groups. Significant changes in prolactin levels and markers of immune and inflammatory responses between baseline and later measurements occurred in both groups. Patients who received TIVA had no change in cortisol levels at any time during the study. The TIVA group had lower levels of cortisol than did the inhaled anesthesia group (TIVA, 207 [SD, 100] ng/mL; inhaled 293 [97] ng/mL; P<0.05)), higher neutrophil counts (TIVA, 75 [12.5]%; inhaled: 62 [20]%; P<0.05) and higher CD4+ T lymphocyte counts (TIVA, 53 [11.6]%; inhaled: 42 [17.6]%; P<0.001)., Conclusion: Although both techniques afford hemodynamic stability, lower cortisol levels were observed with the application of TIVA with propofol-remifentanil. That would be the technique of choice for patients with compromised immune response.

Hypothesis and Objectives: the hypothesis of this study is that genes involved in the regulation of the immune system, expressed by HLA antigens and anti-neutrophil cytoplasmic antibodies (ANCA), could be determinants of disease susceptibility and behavior in inflammatory bowel disease (IBD)., Material and Method: seventy patients with a diagnosis of inflammatory bowel disease, 46 with ulcerative colitis and 24 with Crohn"s disease were included. HLA class I (A and B) and II (DR) antigens were studied by serological techniques. Detection of ANCA was carried out in all patients by an indirect immunofluorescence method. The relative frequencies of HLA antigens were compared with a control group made up of 156 blood donors. The control group for the ANCA study was made up of 100 individuals., Results: we found a significant increased frequency of HLA-DR2 in patients with ulcerative colitis. No significant differences were found between patients with Crohn"s disease and controls regarding HLA typing. We detected a significant increase of HLA-DR3 in extensive forms of ulcerative colitis. Detection of ANCA was positive in 46% of the patients with ulcerative colitis and in 12% of the patients with Crohn"s disease (p <0.05). We observed an increased frequency of ANCA in patients with UC and HLA-DR2 (p = 0.15)., Conclusions: the association found between HLA-DR3 and extensive forms of ulcerative colitis provides evidence of genetic heterogeneity. The relationship between ANCA and HLA phenotype (although not significant) supports this concept.

Objective: Given that anesthesia and surgery are known by their immunomodulatory effects, we aimed to compare the immune response after 1 or 3 anesthetic exposures to sevoflurane in a murine model without surgery., Material and Methods: Young adult male mice, non-controlled for body conformation, were exposed 1 (group S1) or 3 times (group S3) to 3% sevoflurane in oxygen (1.2 maximum alveolar concentration) for 40 minutes. Untreated animals were used as controls. Three days after in vivo exposure to sevoflurane, the cellular composition of peripheral blood and of the spleen were studied. We also studied the in vivo response to exogenous (sheep red blood cells: SRBC) and endogenous antigens (heat shock proteins: HSP 65 and HSP 70) as well as biomarkers of toxicity., Results: The number of leukocytes in peripheral blood decreased in S3 animals, and the number of lymphocytes decreased in both groups. B cells in spleen decreased only in the S1 group, but an increased in vivo response to SRBC was seen in both S1 and S3 mice in comparison with the control animals. Re-exposure to sevoflurane led to a decrease in immunoglobulin G response only to HSP 70. Plasma markers of liver and kidney function did not change after anesthetic exposure., Conclusion: Changes in leukocyte populations in peripheral blood and in antibody-producing capacity occur after either a single exposure or repeated exposures to sevoflurane. However no changes occur in biomarkers of toxicity.

Aim: The purpose of this study was to analyze the frequency of the different antigens of HLA in patients with diagnosis of very advanced dilated cardiomyopathy and ischemic heart disease by comparing them with a control group of supposedly healthy subjects., Material and Method: The group of dilated cardiomyopathy consisted of 35 patients (8 women and 27 men) aged between 14 and 60 years. The group of ischemic heart disease included 32 patients (4 women and 28 men) aged between 34 and 64 years. The control group comprised 1337 subjects of the Spanish Mediterranean area, supposedly healthy and recruited from paternity studies., Results: In dilated cardiomyopathy we found a higher incidence in comparison with the control group of the A-2 (62.86% vs 46.22%), B-12 (60.00% vs 32.38%) and DQ-3 (82.86 vs 49.96%) antigens, and a lower incidence of B-51 (0.00% vs 12.49%). In ischemic heart disease we found, when comparing to the control group, a higher incidence of A-11 (31.25% vs 13.08%) and A-29 (34.38% vs 14.58%) antigens and a lower incidence of DQ-2 (15.63% vs 49.88%)., Conclusions: In the Spanish Mediterranean area, the presence of A-2, B-12 and DQ-3 antigens, as well as the absence of B-51 would favour the appearance of advanced dilated cardiomyopathy. The presence of the A-11 and A-29 antigens would predispose to ischemic cardiomyopathy while the presence of DQ-2 would have a protective effect on the appearance of this cardiopathy.

A strong antibody was found in a mother (first pregnancy) who had a severe neutropenic baby. The father's granulocytes were typed by flow cytometry as NA1+, NA2+, NB1+, ND1+ and the mother as NA1-, NA2+, NB1+ and ND1+. The antibody was identified as anti-NA1 by us, and confirmed later by a reference laboratory. The serum reacted with 54.8% of the 31 donors tested. The same antibody was found in the child's serum 35 days after birth, and the reactivity was stronger than in the mother's serum. The HLA-DR, DQ from the mother was DR3, DR7; DR52, DR53; DQ2. The baby's granulocytes were recovered slowly over a four-month period, but the course was benign without any specific treatment. Five months after birth, with recovery, the child's serum became negative and his granulocytes were confirmed as NA1+. Due to the difficulties in fully diagnosing and working with granulocytes we suspect that there are undetected cases; only one case has been recorded in Spain before.

T cells and the theophylline resistant cells (the-r, helper cells) in peripheral blood of patients with different forms of leprosy were studied. Active lepromatous patients (LL+) showed a significant decrease in T lymphocytes and the-r cells. Nevertheless, in LL+ developing a reactional episode of erythema nodosum (LL-ENL) a restoration in the level of the-r cells was observed. It is concluded that in LL+ patients the depression of T cells and the-r cells represents an imbalance in the T-T cellular cooperation with a defective cellular immune response. On the other hand, the recovery of the-r cells in LL-ENL support the hypothesis of a cell mediated immune mechanism in the immunopathology of this reactional episode.