抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.

Der „maligne Mediainfarkt”: Syndrom oder Artefakt?

Received wisdom vs evidence in stroke prevention: carotid endarterectomy remains the gold standard for patients requiring carotid revascularization.

ACUTE STROKE CARE: HOW CAN MODERN STROKE CARE BE MADE AVAILABLE TO MORE PATIENTS? Much progress has been made in acute stroke management during the last 20 years. Today we can offer organized stroke unit care in many regions in Europe and some in the United States and Canada; we have an approved acute medical treatment for ischemic stroke, i.v. rtPA. Clot retrieval devices are approved and available and we have evidence-based treatment strategies for critically ill stroke patients. A number of promising new approaches, still await formal evidence, although they are already used quite frequently. However, this progress is not available everywhere. There are large disparities between what is known and what can be offered in many countries and regions throughout the world. The standard of care in some regions is far from routine in others, or may be available only at selected places for very few privileged people. Unfortunately, there is no uniform way in which the application and expansion of what we know in acute stroke management can be promoted throughout the world. Rather, individual routes must be defi ned with respect to availability of resources, standards of training and teaching, and priorities in health economics. The establishment of Stroke Units and Stroke Centers has been the most valuable contribution to the fi eld of acute stroke management. It is not only the single most effective intervention for the vast majority of stroke patients, but it is also a major factor towards increasing the number of patients receiving thrombolytic therapy. Together with pre-hospital system organisation and access to rehabilitation and secondary prevention, these are the most important columns on which the expansion of stroke treatment is built. Once “Stroke” has reached political awareness, implementation of care systems proceeds more smoothly. The political will to improve stroke care will allow new activities in the fi eld of stroke to be launched. Nationor statewide documentation, standards, and quality control instruments can be implemented, and more fi nancial resources will be made available for the development of stroke management and prevention. Stroke care is expensive, and stroke care has to be paid out of the shrinking budgets of general health care. Increasing the resources for one area means cutting resources in others, not an action that will be warmly welcomed by colleagues in other fi elds. Although capitalizing on existing therapies is well justifi ed, fl exibility has to be built into the system to facilitate the successful investigation and application of new diagnostic and therapeutic approaches as they are developed. By doing so, the stroke care system will remain fl exible and will be amenable to incorporate advances that will continue to improve the care of the stroke patient. We propose a stepwise approach to improvement of stroke care.

/pdf/challenges-for-cerebrovascular-disease-2gdld7ip6c.pdf

Werner Hacke

Papers

Der „maligne Mediainfarkt”: Syndrom oder Artefakt?

Received wisdom vs evidence in stroke prevention: carotid endarterectomy remains the gold standard for patients requiring carotid revascularization.

Challenges for cerebrovascular disease

76 – Decompressive Craniectomy for Infarction and Hemorrhage

Cerebrovascular occlusions. Indications for thrombolytic therapy