To evaluate the process from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies for elderly patients, we retrospectively studied the clinical data of SIRS and MODS in 292 elderly patients with surgical abdominal emergency. Results: On admission, the morbidity rate of SIRS was 41.1%. Afterwards the morbidity rate of MODS was 14.2%, and the mortality rate of the elderly patients with SIRS was 11.7%. After 48 hours of therapy, MODS was developed in 40.5% of the cases also with SIRS. Of all the 292 elderly patients, 19 cases (6.5%) developed MODS and 16 patients (84.2%) died. Conclusion: The outcome of the patients with surgical abdominal emergency may be improved if SIRS is early diagnosed, the cause of SIRS after 48 hours therapy is well defined and the body inflammatory response is properly regulated.
ObjectiveTo investigate the protective effect and mechanism of arbutin on LPS induced Acute lung injury in mice. Methods SPF BCLB/C mice were randomly divided into control group, model group,arbutin group, and arbutin+PI3K inhibitor group.arbutin group and arbutin+PI3K group were intervened with corresponding drugs respectively; Constructing an ALI model by intranasal instillation of LPS into mice; After modeling for 6 hours, the mice were killed. After staining the lung tissue slices, observe the pathological changes of the lung tissue and evaluate the lung injury score, and calculate the wet to dry weight ratio (W/D); ELISA method was used to determine the levels of TNF-a and IL-6 in serum and bronchoalveolar lavage fluid (BALF); Measure the ROS content, MDA level,and MPO activity in the lungs; Western blot method was used to detect the expression of PI3K/Akt/mTOR pathway related proteins and autophagy related proteins Beclin-1 and LC3II/I. ResultsCompared with the control group, the pathological changes in the lung tissue of model group mice worsened, and the W/D and lung injury scores increased, The levels of IL-6 and TNF-a in BALF and serum was increased, The ROS content, MDA expression and MPO activity in the lungs was increased,the expression of Beclin-1 and LC3II/I in the lungs was increased. The expression of PI3K/Akt/mTOR pathway related proteins in the lungs decreased (P<0.05). Compared with the model group, the pathological changes in the lung tissue of arbutin group mice were alleviated, with a decrease in W/D and lung injury score, The levels of IL-6 and TNF-a in BALF and serum decrease,ROS content, MDA expression and MPO activity in lung were decreased.The expression of PI3K/Akt/mTOR pathway related proteins in the lung was increased, The expression of Beclin-1 and LC3II/I decreased. However, the appeal performance was partially blocked in the arbutin+PI3K group after the administration of LY294002.ConclusionsArbutin regulates autophagy through PI3K/Akt/mTOR pathway to inhibit inflammatory response and oxidative stress in LPS-induced ALI mice, and plays a protective role in LPS-induced ALI.
Abstract: Objective To investigate the effect of modified ultrafiltration on attenuating the inflammatory reaction and endothelial cell activation or damage after cardiopulmonary bypass (CPB). Methods Forty patients undergoing cardiac operation with CPB were randomly divided into two groups. Ult rafiltration group ( n = 20) : patients underwent modified ultrafiltration after CPB; control group ( n = 20 ) : without ultrafiltration. Plasma concentrations of soluble intercellular adhesion molecules-1 ( s ICAM -1) and tumor necrosis factor-α (TNF-α) were determined with enzyme linked immunosorbent assay and radioimmunity pre-operat ively (baseline) , at the end of CPB, 4h and 24h post-operatively in both groups. Results The concentrations of sICAM -1 in the cont rol group at 4h and 24h po st-operatively were higher than those pre-operatively (P lt; 0. 01). The concentrations sICAM -1 in the ultrafiltrat ion group in pre-operatively and at the end of CPB were not significantly different from that of the control group, but they were lower at 4h and 24h post-operatively (269. 6±33. 8Lg/L vs. 409. 6±37. 3Lg/L , 245. 9±32. 2Lg/L vs. 379. 3±35. 7Lg/L ; P lt; 0. 01). In the ultrafiltration group, the concentration of TN F-α at the end of CPB and 4h post-operatively were higher than that pre-operatively (P lt; 0. 01). The concent rations of TNF-α in the ultrafiltration group at 24h post-operatively recoved to the pre-operative level (0. 177±0. 024Lg/L vs. 0. 172±0. 030Lg/L ; P gt;0.05). In the control group, the concentration of TN F-α was higher at the end of CPB than that pre-operatively (P lt;0.01) , and decreased slightly at 4h and 24h post-operatively, but remained higher than those pre-operat ively (0. 264±0.045Lg/L vs. 0.174±0.033Lg/L , 0.218±0.028Lg/L vs. 0.174±0. 033Lg/L ; P lt; 0. 05). Conclus ion CPB is known to induce inflammatory reaction and endothelial cell activation or damage. Modified ultrafiltration appears to attenuate these adverse reactions and is beneficial to postoperative convalescence.
Objective To investigate the clinical value of peripheral serum cell-free DNA/neutrophil extracellular traps (cf-DNA/NETs) level in diagnosis and severity assessment of sepsis patients. Methods Forty patients with sepsis and 40 patients with non-infectious systemic inflammatory response syndrome (nf-SIRS) were enrolled in this study. The cf-DNA/NETs level in serum of all subjects were measured. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of the cf-DNA/NETs, white blood cell count (WBC), procalcitonin (PCT) and interleukin-6 (IL-6). The sepsis patients were stratified into a survival group and a death group according to the prognosis. Sequential organ failure (SOFA) score were recorded in the sepsis patients, and the correlations between SOFA and cf-DNA/NETs, PCT, WBC, IL-6 were analyzed. Results Compared with the nf-SIRS group, cf-DNA/NETs and PCT levels were significantly higher in the sepsis group (both P<0.05). WBC and IL-6 showed no significant differences between the two groups (bothP>0.05). The area under the ROC curve (AUC) of cf-DNA/NETs was 0.884 for diagnosis of sepsis, and it was higher than the AUC of PCT (0.803). The cf-DNA/NETs showed better sensitivity (81.2% and 79.2%) and specificity (81.0% and 82.4%) than PCT. cf-DNA/NETs and PCT were significantly higher in the death group than those in the survival group. Bivariate collection analysis revealed positive correlations between SOFA score and the two biomarkers of cf-DNA/NETs and PCT (r1=0.573, r2=0.518; both P<0.01). Conclusions cf-DNA/NETs and PCT have certain value in early diagnosis of sepsis, and cf-DNA/NETs shows better diagnostic value in distinguishing sepsis from nf-SIRS than PCT. cf-DNA/NETs can be used as a routine monitoring index to help assess disease severity in sepsis.
Objective To explore the role and possible mechanisms of bone marrow mesenchymal stem cell (BMSC) in the lipopolysaccharide (LPS)-induced inflammatory response involving alveolar macrophages through the inflammatory pathways. Methods ptges and ptges shRNA were transfected into BMSC by lentivirus, and stable ptges overexpression BMSC (BMSC-PGE2(+)) and PTGEs silencing BMSC (BMSC-PGE2(-)) were established. Macrophages were divided into control group, LPS group, LPS+BMSC group, LPS+BMSC-PGE2(+) group and LPS+BMSC-PGE2(-) group. The expression levels of nucleotide-bound oligomerized domain-like receptor 3 (NLRP3), precursor cysteinyl aspartate specific proteinase 1 (pro-caspase-1), caspase-1 and pro-IL-1β proteins were detected by Western blot. The mRNA expression levels of NLRP3 and caspase-1 were determined by RT-PCR. The expression levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-10, IL-18 and prostaglandin E2 (PGE2) in cell supernatant were detected by ELISA. Results The intervention of LPS significantly increased the expression of NLRP3, pro-caspase-1, caspase-1 and pro-IL-1β in macrophages. After co-culture with BMSC, the expression of each protein decreased significantly. After the overexpression of PGE2, the difference of protein expression further decreased. The expression of NLRP3 and caspase-1 mRNA in LPS group increased significantly, but decreased significantly after co-culture with BMSC. Overexpression of PGE2 could increase this difference, but there was no significant change in PGE2 silent group. The results of ELISA showed that the contents of TNF-α, IL-1β and IL-18 in cell supernatant were the highest in LPS group. Adding BMSC and overexpressing PGE2 could decrease the related inflammatory factors. The levels of IL-10 and PGE2 in LPS group were higher than those in control group, and further increased in LPS+BMSC group and LPS+BMSC-PGE2(+) group with significant differences. Conclusions When inflammation is induced by LPS, BMSC can significantly mitigate the inflammatory response within macrophages. This process is likely mediated through the overexpression of PGE2, which inhibits the NLRP3-mediated pyroptosis pathway.
ObjectiveTo investigate the effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection (ATAAD).MethodsThe clinical data of 88 patients with ATAAD who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed. Patients were divided into a SIRS group (n=37) and a non-SIRS group (n=51) according to whether SIRS occurred within 24 hours after surgery. The perioperative data of the two groups were compared.ResultsThere was no significant difference between the two groups in general clinical data, preoperative left ventricular ejection fraction, white blood cell (WBC) and body temperature (P>0.05). Compared with the non-SIRS group, the cardiopulmonary bypass time in the SIRS group was significantly longer (P<0.05), and the WBC and body temperature within 1 day after surgery in the SIRS group were higher (P<0.01). A significant difference was revealed in the mechanical ventilation time, ICU stay, total hospitalization time and hospitalization costs between two groups (P<0.01). Patients in the SIRS group had higher postoperative acute physiology and chronic health evaluationⅡscores, sequential organ failure assessment score as well as a greater risk of developing postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, delirium, liver dysfunction and morbidity (P<0.05).ConclusionEarly postoperative SIRS significantly increases the incidence of major adverse complications and the mortality rate of patients with ATAAD.
ObjectiveTo investigate the relationship between the nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) inflammasome and inflammatory reaction of venous ulcer of lower extremity.MethodsTwenty-four patients with active venous ulcer of lower extremity (active ulcer group), 24 patients with non exudative venous ulcer of lower extremity as positive control (non-active ulcer group), and 24 patients with traumatic wound as negative control (traumatic-wound group) were enrolled. The clinical data of the three groups were compared, the tissue samples around the wound were harvested, and the expressions of NLRP3 protein were detected by immunohistochemistry among the three groups. Enzyme linked immunosorbent assay (ELISA) was used to detect the IL-1β and IL-18 protein levels, RT-PCR was used to detect the mRNA expressions of apoptosis associated speck like protein containing CARD (ASC), caspase-1, c-Jun N-terminal kinase (JNK), p38, nuclear factor (NF)-κB p65 and NF-κB inhibitor alpha (NF-κB IkBα), and Western blotting was performed to evaluate the level of NLRP3 inflammasome in wound tissues.ResultsThe inflammatory response in the non-active ulcer group and trauma-wound group were milder than that in the active ulcer group. The levels of IL-1β and IL-18 proteins in the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group [IL-1β: (146.621±11.597) ng/L vs. (80.967±14.213) ng/L vs. (84.962±19.484) ng/L, F=136.200, P<0.001; IL-18: (119.814±12.788) ng/L vs. (72.899±17.220) ng/L vs. (48.131±10.407) ng/L, F=167.910, P<0.001]. The results of RT-PCR showed that the mRNA expressions of ASC [(0.030±0.012) ng/L vs. (0.021±0.005) ng/L vs. (0.016±0.004) ng/L, F=18.106, P<0.001], caspase-1 [(0.054±0.012) ng/L vs. (0.013±0.009) ng/L vs. (0.018±0.006) ng/L, F=130.372, P<0.001], NF-κB p65 [(0.093±0.015) ng/L vs. (0.038±0.013) ng/L vs. (0.043±0.014) ng/L, F=110.950, P<0.001], NF-κB IkB-α [(0.085±0.015) ng/L vs. (0.078±0.015) ng/L vs. (0.041±0.016) ng/L, F=53.070, P<0.001], and JNK [(0.075±0.018) ng/L vs. (0.042±0.013) ng/L vs. (0.039±0.014) ng/L, F=41.271, P<0.001] in the wound tissues of the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group. And the mRNA expression of p38 in the wound tissues of the active ulcer group was lower than that in the non-active ulcer group [(0.050±0.008) ng/L vs. (0.064±0.014) ng/L, P<0.05]. The result of Western blotting showed that the relative expression level of NLRP3 protein in the wound tissues of the active ulcer group was higher than that in the trauma-wound group and non-active ulcer group (0.767±0.272 vs. 0.605±0.212 vs. 0.556±0.183, F=4.804, P=0.012).ConclusionNLRP3 inflammasome is closely related to the wound in venous ulcer of lower extremity and provides a new target to the therapy of venous ulcer of lower extremity.
Non-erosive gastroesophageal reflux disease (NERD) refers to a disease with symptoms such as acid reflux, heartburn and pathological reflux, but no significant esophageal mucosal damage under endoscopy. Its pathogenesis may be related to factors such as lower esophageal sphincter dysfunction, weakened esophageal clearance ability, visceral hypersensitivity, and disordered intestinal microecology, but the specific mechanism is still unclear. Small intestinal bacterial overgrowth (SIBO) is a common intestinal flora disorder syndrome. A number of studies have shown that SIBO has a certain correlation with NERD, and SIBO may be involved in the occurrence and development of NERD through mechanisms such as inflammatory response, gas production, and increased short-chain fatty acids. Therefore, this article reviews the correlation between NERD and SIBO, aiming to provide new ideas for the diagnosis and treatment of NERD.
Objective To assess the effect and safety of clinical nutritional supplementation with different patterns for treating systematic inflammatory response syndrome (SIRS). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Nov. 2004), EMBASE (1984 to Nov. 2002), Cochrane Controlled Trials Register (Issue 4, 2004), Chinese Cochrane Centre Database (Issue 4, 2004), CBMdisc (1978 to Nov. 2004). We handsearched related published and unpublished data and their references. All RCTs of nutritional interventions for SIRS were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.7 software was used for data analysis. Results Six RCTs involving 353 patients were included. All the results of meta-analysis were listed as the following: ① Mortality: compared with routine nutrition, one study showed that glutamine had a statistical difference with RR 0.67 and 95%CI 0.31 to 1.32. Compared with no treatment, one study showed selenium had a statistical difference with RR 1.19, 95%CI 0.59 to 2.41. ② Compared with routine nutrition, one study showed that glutamine had a statistical difference on reducing the ratio of nasocomial infection of SIRS with RR 0.5, 95%CI 0.27 to 0.91, but had no statistical difference on reducing the ratio of multiple organ dysfunction syndrome with RR 1.53, 95%CI 0.64 to 3.66. ③ Improvement of the critical condition of SIRS: compared with routine nutrition, one study showed that glutamine had a statistical differences with WMD 4.0, 95%CI 2.36 to 5.64; compared with high calorie intake, two studies showed low calorie intake had a statistical difference with WMD 4.9, 95%CI 1.76 to 8.04. ④ Reduction of the complication of hyperglycemia and hypertriglyceridemia: compared with high calorie intake, one study showed low calorie intake had statistical difference with WMD －0.70, 95%CI －1.20 to －0.20 and WMD －1.80, 95% CI －2.42 to －1.16 respectively and all P≤0.01. ⑤ Increasing of the plasma IgG concentration: compared with routine nutrition, two studies showed that glutamine had a statistical difference with WMD 4.20, 95% CI 2.23 to 6.16. ⑥ Increasing of the nitrogen balance, intestinal permeability, the level of plasma concentration of anlbumin, prealbumin and TRF: compared with control interventions, glutamine, low calorie intake, selenium supplementation and fructose-glucose-xylitol mixture showed no statistical difference. Conclusions Glutamine, low calorie intake, selenium supplementation, FGX mixture may decrease the complication of infection or metabolism and be better than the controlled interventions; but there is no benefit on reducing the rate of death result from SIRS compared with controlled interventions. The evidence of most RCTs with poor quality is too weak to draw a conclusion. More high quality trials are required.
ObjectiveTo investigate clinical efficacy of percutaneous nephroscope in treatment of patients with severe acute pancreatitis (SAP). MethodsEighty-six patients with SAP in this hospital from August 2012 to November 2015 were selected, which were divided into percutaneous nephroscope treatment group (43 cases) and laparotomy treat-ment group (43 cases) according to the difference of therapy modality. The conventional drug therapy was performed for all of them. The postoperative recovery, content of serum C reactive protein (CRP) on day 14 after operation, and post-operative complications were observed in these two groups. Results① The abdominal pain relief time, postoperative bowel sounds recovery time, normal body temperature recovery time, and postoperative hospitalization time in the percu-taneous nephroscope treatment group were significantly shorter than those in the laparotomy treatment group (P<0.05). ② The contents of serum CRP in the percutaneous nephroscope treatment group and in the laparotomy treatment group on day 14 after operation were significantly lower than those on day 1 before operation[(8.35±2.13) mg/L versus (31.44±3.45) mg/L, P<0.05; (16.42±2.44) mg/L versus (32.09±2.98) mg/L, P<0.05]. On day 14 after operation, the content of serum CRP in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treat-ment group[(8.35±2.13) mg/L versus (16.42±2.44) mg/L, P<0.05]. ③ The incidence rate of postoperative complications in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treatment group[14.0% (6/43) versus 32.6% (14/43), P<0.05]. ConclusionPercutaneous nephroscope in treatment of patients with SAP is effect, it has advantages of shorter hospital stay and early recovery, which could reduce incidence of postoperative complications, and it's mechanism might be related to systemic inflammatory response.