A hyperacute immune map of ischaemic stroke patients reveals alterations to circulating innate and adaptive cells

Systemic immune changes following ischaemic stroke are associated with increased susceptibility to infection and poor patient outcome due to their role in exacerbating the ischaemic injury and long-term disability. Alterations to the abundance or function of almost all components of the immune system post-stroke have been identified, including lymphocytes, monocytes and granulocytes. However, subsequent infections have often confounded the identification of stroke-specific effects. Global understanding of very early changes to systemic immunity is critical to identify immune targets to improve clinical outcome. To this end, we performed a small, prospective, observational study in stroke patients with immunophenotyping at a hyperacute time point (< 3 h) to explore early changes to circulating immune cells. We report, for the first time, decreased frequencies of type 1 conventional dendritic cells (cDC1), haematopoietic stem and progenitor cells (HSPCs), unswitched memory B cells and terminally differentiated effector memory T cells re-expressing CD45RA (TEMRA). We also observed concomitant alterations to human leucocyte antigen D-related (HLA-DR), CD64 and CD14 expression in distinct myeloid subsets and a rapid activation of CD4+ T cells based on CD69 expression. The CD69+ CD4+ T cell phenotype inversely correlated with stroke severity and was associated with naive and central memory T (TCM) cells. Our findings highlight early changes in both the innate and adaptive immune compartments for further investigation as they could have implications the development of post-stroke infection and poorer patient outcomes.

Burns from ECG leads in an MRI scanner: Case series and discussion of mechanisms

Iatrogenic burns are rare and preventable. The authors present two cases of burns from ECG leads, sustained during magnetic resonance imaging (MRI). Common features included a long duration spinal MR scan (120 and 60 minutes) and high patient body mass index (BMI >30). Both patients were discharged within 24 hours of admission, but required a period of outpatient burn care. The causation of these injuries remains unclear but there are several possible mechanisms including: electromagnetic induction heating, antenna effects and closed-loop current induction. The authors provide a description of the injuries, discuss possible mechanisms that may lead to burn injury in the MRI environment and suggest ways to reduce the risks of such injuries.