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.

Eine eindeutige und evidenzbasierte Therapieempfehlung fur Patienten mit asymptomatischer Karotisstenose ist derzeit nicht moglich. Studien, die unter definierten Bedingungen einen Vorteil der Karotisthrombendarteriektomie gegenuber einer rein konservativen Behandlung belegen, entsprechen aus pharmakologischer Sicht nicht mehr dem heutigen Standard. Andererseits weisen Untersuchungen auf eine Schlaganfallrisikoreduktion unter konsequenter Pharmakotherapie gemas heutigem Standard hin. Untersuchungen zum Karotisstenting als dritte Behandlungsalternative sind vor allem im Vergleich gegenuber rein medikamentoser Therapie unzureichend. Die 2009 initiierte, randomisierte, kontrollierte, multizentrischen SPACE-2-Studie soll die Frage nach der bestmoglichen Therapie asymptomatischer Karotisstenosen beantworten. Zur Steigerung der Rekrutierungszahlen als Voraussetzung fur einen erfolgreichen Abschluss dieser wichtigen Studie erfolgte 2013 eine Modifizierung des Studiendesigns.

Therapie asymptomatischer Karotisstenosen

Current Trends in Therapy of Acute Ischaemic Stroke

A standardized postacute inpatient rehabilitation program (Anschlussheilbehandlung) after stroke is well established in Germany. Yet the needs of patients being admitted to an Anschlussheilbehandlung (AHB) are not completely known. Therefore sociodemographic data, handicap, impairment and neuropsychologic deficits in 200 stroke patients were evaluated before admission to an AHB with different scores (Barthel, modified Rankin Score, NIHSS, HAWIE-R, Wilde, etc.). About half of the patients were still working prestroke. Most patients suffered from several vascular risk factors, which were insufficiently treated, and about a third of the patients had cerebrovascular disease prior to this stroke. At admission to the rehabilitation program the group of patients with severe neurological deficits was small. In average the disability was rather moderate (Rankin = 2.6). Mainly gait and finger dexterity were handicapped. Functional impairment was outweighed by neuropsychological deficits.

Werner Hacke

Papers

Therapie asymptomatischer Karotisstenosen

Current Trends in Therapy of Acute Ischaemic Stroke

Rehabilitation treatment after stroke. An assessment of current status

Body temperature and infection in acute stroke. authors's replies

GACHE: German Trial of Acyclovir and Corticosteroids in Herpes simplex Encephalitis – aktueller Stand