Objective To investigate the effects of Nod-like receptor protein 3 inhibitor MCC950 on cognitive function in a mouse model of sepsis-associated encephalopathy (SAE). Methods Ninety adult male C57BL/6 mice were randomly (random number) divided into three groups: the sham + saline group (n=20, sham group), CLP + saline group (n=35, CLP group), and CLP + MCC950 group (n=35, MCC950 group). SAE mouse model was established by cecal ligation and puncture (CLP) surgery. Saline (10 mL/kg) or MCC950 (10 mg/kg) was intraperitoneally injected 30 min before surgery and on day 1, 2, 4 and 6 after surgery according the grouping. Seven days after surgery, six mice were taken from each group. Western blot was used to detect the hippocampal content of NLRP3, apoptosis-associated speck-like protein (ASC), interleukin-1β (IL-1β) and IL-18. The number of NLRP3-positive cells in CA1 region were detected by immunohistochemical analysis. The remaining mice in each group were used for open field and fear conditioning tests 14 days after surgery. One-way analysis of variance was used for inter-group comparison, and SNK-q test was used for pairwise comparison. A P value <0.05 was considered statistically significant. Results Compared the MCC950 group with the CLP group, the freezing time of context test was significantly increased [(137±21) s vs (84±15) s, P=0.013 ], the hippocampal content of NLRP3, IL-1β and IL-18 were significantly reduced (P 0.05). Conclusions MCC950 administration can improve cognitive function in a mouse model of SAE, which is probably due to the inhibition of NLRP3 inflammasome and downstream inflammatory cytokines IL-1β and IL-18. Key words: Sepsis-associated encephalopathy; Cognitive function; Neuroinflammation; NLRP3 inflammasome; Interleukin-1β; Interleukin-18
{"title":"Effects of MCC950 on cognitive function in a mouse model of sepsis-associated encephalopathy","authors":"Jingyu Zhang, Yunxia Fan, Qun Fu, Jing Wu, Zhi-qiang Zhou, Guo-min Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.010","url":null,"abstract":"Objective \u0000To investigate the effects of Nod-like receptor protein 3 inhibitor MCC950 on cognitive function in a mouse model of sepsis-associated encephalopathy (SAE). \u0000 \u0000 \u0000Methods \u0000Ninety adult male C57BL/6 mice were randomly (random number) divided into three groups: the sham + saline group (n=20, sham group), CLP + saline group (n=35, CLP group), and CLP + MCC950 group (n=35, MCC950 group). SAE mouse model was established by cecal ligation and puncture (CLP) surgery. Saline (10 mL/kg) or MCC950 (10 mg/kg) was intraperitoneally injected 30 min before surgery and on day 1, 2, 4 and 6 after surgery according the grouping. Seven days after surgery, six mice were taken from each group. Western blot was used to detect the hippocampal content of NLRP3, apoptosis-associated speck-like protein (ASC), interleukin-1β (IL-1β) and IL-18. The number of NLRP3-positive cells in CA1 region were detected by immunohistochemical analysis. The remaining mice in each group were used for open field and fear conditioning tests 14 days after surgery. One-way analysis of variance was used for inter-group comparison, and SNK-q test was used for pairwise comparison. A P value <0.05 was considered statistically significant. \u0000 \u0000 \u0000Results \u0000Compared the MCC950 group with the CLP group, the freezing time of context test was significantly increased [(137±21) s vs (84±15) s, P=0.013 ], the hippocampal content of NLRP3, IL-1β and IL-18 were significantly reduced (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000MCC950 administration can improve cognitive function in a mouse model of SAE, which is probably due to the inhibition of NLRP3 inflammasome and downstream inflammatory cytokines IL-1β and IL-18. \u0000 \u0000 \u0000Key words: \u0000Sepsis-associated encephalopathy; Cognitive function; Neuroinflammation; NLRP3 inflammasome; Interleukin-1β; Interleukin-18","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"851-854"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49182985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.007
Han Zhao, Wen-Xian Liu, Yanlong Ren, Shangqiu Ning
Objective To analyze the risk factors of adverse cardiac events in adults with acute myocarditis during hospitalization and provide reference for clinical diagnosis and treatment. Methods A restrospective study was conducted in 80 patients (54 males and 26 females) with acute myocarditis over 18 years old admitted to our hospital between January 2007 and December 2016. Major adverse cardiac events (MACE) were defined as death, cardiac arrest, cardiogenic shock and ventricular fibrillation. According to whether MACE occurred during hospitalization, patients were divided into two groups: the MACE group and the non-MACE group. The differences between the two groups were compared, and the risk factors were analyzed by logistic regression. Results There were 12 patients in the MACE group and 68 patients in the non-MACE group. The age of patients in the two groups was similar. Compared with the non-MACE group, the proportion of female patient in the MACE group was higher (66.7% vs 26.5%, P=0.015), and the systolic pressure (mmHg) was lower at admission (89.75±17.63 vs 112.49±16.35, P 120 ms) was significantly higher in the MACE group (75% vs 17.6%, P<0.01). In the MACE group, the proportion of diuretics and vasoactive drugs (dopamine, norepinephrine, and adrenaline) was higher (66.7% vs 25%, 91.7% vs 4.4%,66.7% vs 0,75% vs 0%, all P<0.01); the proportion of glucocorticoids and immunoglobulin was higher (33.3% vs 8.8%, P=0.038; 33.3% vs 4.4%, P=0.008), and the proportion of ventilator, CRRT, ECMO and IABP were also higher (50% vs 1.5%, 33.3% vs 0, 25% vs 0%, 25% vs 0%, all P<0.01). Logistic regression analysis showed that the OR value of MACE in female patients during hospitalization was 5.56 (95%CI: 1.49-20.71, P=0.011). The OR value of MACE in patients with reduced LVEF at admission was 5.92 (95%CI: 1.62-21.67, P=0.007).The OR value of MACE in patients with prolonged QRS wave was 14.00 (95%CI: 3.29-59.55, P<0.01). Conclusions Female patients, LVEF 120 ms) are independent risk factors for MACE in adult patients with acute myocarditis during hospitalization. Key words: Acute myocarditis; Adult; Major adverse cardiac events; Risk factors
目的分析成人急性心肌炎住院期间发生心脏不良事件的危险因素，为临床诊断和治疗提供参考。方法对2007年1月至2016年12月我院收治的80例18岁以上急性心肌炎患者(男54例，女26例)进行回顾性分析。主要心脏不良事件(MACE)定义为死亡、心脏骤停、心源性休克和心室颤动。根据住院期间是否发生MACE，将患者分为MACE组和非MACE组。比较两组间的差异，并对危险因素进行logistic回归分析。结果MACE组12例，非MACE组68例。两组患者年龄相近。与非MACE组相比，MACE组女性患者比例较高(66.7% vs 26.5%， P=0.015)，入院时收缩压(mmHg)较低(89.75±17.63 vs 112.49±16.35,P= 120ms)， MACE组显著高于非MACE组(75% vs 17.6%， P<0.01)。MACE组利尿剂和血管活性药物(多巴胺、去甲肾上腺素、肾上腺素)使用比例分别为66.7%比25%、91.7%比4.4%、66.7%比0%、75%比0%，P均<0.01);糖皮质激素和免疫球蛋白比例较高(33.3% vs 8.8%， P=0.038;33.3% vs 4.4%， P=0.008)，呼吸机、CRRT、ECMO和IABP的比例也较高(50% vs 1.5%， 33.3% vs 0, 25% vs 0%， 25% vs 0%， P均<0.01)。Logistic回归分析显示，女性患者住院期间MACE OR值为5.56 (95%CI: 1.49 ~ 20.71, P=0.011)。入院时LVEF降低患者的MACE OR值为5.92 (95%CI: 1.62 ~ 21.67, P=0.007)。QRS波延长患者MACE的OR值为14.00 (95%CI: 3.29 ~ 59.55, P<0.01)。结论女性患者(LVEF 120 ms)是成年急性心肌炎患者住院期间发生MACE的独立危险因素。关键词:急性心肌炎;成年人;主要心脏不良事件;风险因素
{"title":"Analysis of risk factors for adverse cardiac events in adults with acute myocarditis during hospitalization","authors":"Han Zhao, Wen-Xian Liu, Yanlong Ren, Shangqiu Ning","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.007","url":null,"abstract":"Objective \u0000To analyze the risk factors of adverse cardiac events in adults with acute myocarditis during hospitalization and provide reference for clinical diagnosis and treatment. \u0000 \u0000 \u0000Methods \u0000A restrospective study was conducted in 80 patients (54 males and 26 females) with acute myocarditis over 18 years old admitted to our hospital between January 2007 and December 2016. Major adverse cardiac events (MACE) were defined as death, cardiac arrest, cardiogenic shock and ventricular fibrillation. According to whether MACE occurred during hospitalization, patients were divided into two groups: the MACE group and the non-MACE group. The differences between the two groups were compared, and the risk factors were analyzed by logistic regression. \u0000 \u0000 \u0000Results \u0000There were 12 patients in the MACE group and 68 patients in the non-MACE group. The age of patients in the two groups was similar. Compared with the non-MACE group, the proportion of female patient in the MACE group was higher (66.7% vs 26.5%, P=0.015), and the systolic pressure (mmHg) was lower at admission (89.75±17.63 vs 112.49±16.35, P 120 ms) was significantly higher in the MACE group (75% vs 17.6%, P<0.01). In the MACE group, the proportion of diuretics and vasoactive drugs (dopamine, norepinephrine, and adrenaline) was higher (66.7% vs 25%, 91.7% vs 4.4%,66.7% vs 0,75% vs 0%, all P<0.01); the proportion of glucocorticoids and immunoglobulin was higher (33.3% vs 8.8%, P=0.038; 33.3% vs 4.4%, P=0.008), and the proportion of ventilator, CRRT, ECMO and IABP were also higher (50% vs 1.5%, 33.3% vs 0, 25% vs 0%, 25% vs 0%, all P<0.01). Logistic regression analysis showed that the OR value of MACE in female patients during hospitalization was 5.56 (95%CI: 1.49-20.71, P=0.011). The OR value of MACE in patients with reduced LVEF at admission was 5.92 (95%CI: 1.62-21.67, P=0.007).The OR value of MACE in patients with prolonged QRS wave was 14.00 (95%CI: 3.29-59.55, P<0.01). \u0000 \u0000 \u0000Conclusions \u0000Female patients, LVEF 120 ms) are independent risk factors for MACE in adult patients with acute myocarditis during hospitalization. \u0000 \u0000 \u0000Key words: \u0000Acute myocarditis; Adult; Major adverse cardiac events; Risk factors","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"841-845"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42882512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.004
W. Hao, J. Fan, Xiao Wang, Guanqi Zhao, Shenghui Zhou, Aobo Li, R. Guo, Han Shi, Zexuan Li, S. Nie, Yongxiang Wei
Objective To examine the prevalence of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS), and to evaluate the relationship of OSA with inflammatory biomarkers in ACS patients. Methods Patients with ACS treated at Beijing Anzhen Hopital from June 2015 to May 2017 were enrolled. Subjects were evaluated for OSA by sleep study, and were divided into a normal-mild OSA group (Apnea Hypopnea Index, AHI < 15 times/h) and a moderate-severe OSA group (AHI≥15 times/h). Laboratory examination and sleep study were monitored to analyze the effects of OSA on biomarkers by LSD-t test, Mann-whitney U test, or Chi-square test. Correlation analysis was performed to analyze the association of OSA with high sensitivity C-reactive protein (hs-CRP) by Spearman correlation anaylsis. Results A cohort of 836 patients with ACS were enrolled including 408 patients in the normal-mild OSA group and 428 patients in the moderate-severe OSA group. The levels of leukocyte(×109L) [7.78 (6.33, 9.86) vs 7.29 (6.01, 9.16), P=0.006], neutrophils(×109L) [5.05 (3.84, 7.23) vs 4.80 (3.74, 6.66), P=0.044], monocytes(×109L) [0.42 (0.33, 0.54) vs 0.39 (0.31, 0.51), P=0.033], hs-CRP(mg/L) [3.18 (1.10, 11.52) vs 1.78 (0.65, 6.46), P<0.01], fibrinogen(g/L) [3.17 (2.87, 3.74) vs 2.97 (2.59, 3.50), P=0.002], and uric acid(μmol/L) [360 (302, 422) vs 341(283, 407), P=0.006] in the moderate-severe OSA group were significant higher than those in the normal-mild OSA group. AHI (correlation coefficient=0.171, R2=0.020, P<0.01), ODI (correlation coefficient = 0.201, R2=0.027, P<0.01), and TSaO2 < 90% (correlation coefficient = 0.105, R2=0.005, P<0.01) were positively correlated with hs-CRP; minimal SaO2 (correlation coefficient=-0.100, R2=0.001, P=0.008) and mean SaO2 (correlation coefficient = -0.127, R2= 0.006, P<0.01) were negatively correlated with hs-CRP. Conclusions For patients with ACS, the level of inflammatory markers in the moderate-severe OSA group is significantly higher than that in the normal-mild OSA group. Hs-CRP is significantly associated with the severity of OSA. Diagnosis and monitoring of OSA should be considered in ACS management in the future. Key words: Acute coronary syndrome; Obstructive sleep apnea; Inflammatory marker; C-reactive protein
{"title":"Effects of obstructive sleep apnea on inflammatory markers in patients with acute coronary syndrome","authors":"W. Hao, J. Fan, Xiao Wang, Guanqi Zhao, Shenghui Zhou, Aobo Li, R. Guo, Han Shi, Zexuan Li, S. Nie, Yongxiang Wei","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.004","url":null,"abstract":"Objective \u0000To examine the prevalence of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS), and to evaluate the relationship of OSA with inflammatory biomarkers in ACS patients. \u0000 \u0000 \u0000Methods \u0000Patients with ACS treated at Beijing Anzhen Hopital from June 2015 to May 2017 were enrolled. Subjects were evaluated for OSA by sleep study, and were divided into a normal-mild OSA group (Apnea Hypopnea Index, AHI < 15 times/h) and a moderate-severe OSA group (AHI≥15 times/h). Laboratory examination and sleep study were monitored to analyze the effects of OSA on biomarkers by LSD-t test, Mann-whitney U test, or Chi-square test. Correlation analysis was performed to analyze the association of OSA with high sensitivity C-reactive protein (hs-CRP) by Spearman correlation anaylsis. \u0000 \u0000 \u0000Results \u0000A cohort of 836 patients with ACS were enrolled including 408 patients in the normal-mild OSA group and 428 patients in the moderate-severe OSA group. The levels of leukocyte(×109L) [7.78 (6.33, 9.86) vs 7.29 (6.01, 9.16), P=0.006], neutrophils(×109L) [5.05 (3.84, 7.23) vs 4.80 (3.74, 6.66), P=0.044], monocytes(×109L) [0.42 (0.33, 0.54) vs 0.39 (0.31, 0.51), P=0.033], hs-CRP(mg/L) [3.18 (1.10, 11.52) vs 1.78 (0.65, 6.46), P<0.01], fibrinogen(g/L) [3.17 (2.87, 3.74) vs 2.97 (2.59, 3.50), P=0.002], and uric acid(μmol/L) [360 (302, 422) vs 341(283, 407), P=0.006] in the moderate-severe OSA group were significant higher than those in the normal-mild OSA group. AHI (correlation coefficient=0.171, R2=0.020, P<0.01), ODI (correlation coefficient = 0.201, R2=0.027, P<0.01), and TSaO2 < 90% (correlation coefficient = 0.105, R2=0.005, P<0.01) were positively correlated with hs-CRP; minimal SaO2 (correlation coefficient=-0.100, R2=0.001, P=0.008) and mean SaO2 (correlation coefficient = -0.127, R2= 0.006, P<0.01) were negatively correlated with hs-CRP. \u0000 \u0000 \u0000Conclusions \u0000For patients with ACS, the level of inflammatory markers in the moderate-severe OSA group is significantly higher than that in the normal-mild OSA group. Hs-CRP is significantly associated with the severity of OSA. Diagnosis and monitoring of OSA should be considered in ACS management in the future. \u0000 \u0000 \u0000Key words: \u0000Acute coronary syndrome; Obstructive sleep apnea; Inflammatory marker; C-reactive protein","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"825-830"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69953519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the effects of dexmedetomidine postconditioning on brain injury after cardiac arrest and resuscitation in a swine model. Methods Twenty-eight healthy male domestic pigs, weighing 36±2 kg, were randomized (random number) into 4 groups (n=7 each group): sham operation group (S group), cardiopulmonary resuscitation group (CPR group), low-dose dexmedetomidine postconditioning group (LDP group), and high-dose dexmedetomidine postconditioning group (HDP group). Animals in the S group only underwent the surgical preparation. In the other three groups, the experimental model was established by 8 mins of electrically induced ventricular fibrillation and then 5 mins of cardiopulmonary resuscitation. At 5 min after resuscitation, a loading dose of dexmedetomidine of 0.25 μg/kg was intravenously infused followed by continuous infusion at a rate of 0.25 μg/(kg·h) for 6 h in the LDP group, and a loading dose of dexmedetomidine of 0.5 μg/kg was infused followed by continuous infusion at a rate of 0.5 μg/(kg·h) for 6 h in the HDP group. The same amount of normal saline was administered in the S and CPR groups. At 1 h, 3 h, 6 h and 24 h after resuscitation, the levels of serum neuron specific enolase (NSE) and S100B protein were measured. At 24 h after resuscitation, neurologic deficit score (NSD) was evaluated. After that, the animals were euthanized and cerebral cortex was obtained for the determination of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and malondialdehyde (MDA) contents, superoxide dismutase (SOD) activity, cell apoptosis and caspase-3 expression. Results Compared with the S group, post-resuscitation neurologic dysfunction and brain injury were observed in the other three groups, which were indicated by significantly higher NDS and markedly greater levels of serum NSE and S100B (all P<0.05). Compared with the CPR group, the score of NDS at 24 h post-resuscitation were significantly lower and the levels of serum NSE and S100B at 6 h and 24 h post-resuscitation were significantly less in the LDP and HDP groups [NDS: 194±26, 103±16 vs 278±23 at 24 h; NSE (ng/mL): 32.4±1.8, 28.6±3.7 vs 36.2±2.8 at 6 h, 39.9±4.2, 35.1±1.5 vs 45.1±3.0 at 24 h;S100B (pg/mL): 2 534±207, 2 382±170 vs 2 825±113 at 6 h, 3 719±164, 3 246±176 vs 4 085±161 at 24 h, all P<0.05]. Compared with the LDP group, neurologic dysfunction and brain injury at 24 h post-resuscitation were further significantly alleviated in the HDP group (all P<0.05). Pathological analysis indicated that brain inflammation, oxidative stress and cell apoptosis were observed after resuscitation in the CPR, LDP and HDP groups. However, the contents of TNF-α, IL-6 and MDA were significantly lower while the activity of SOD was significantly higher, and cell apoptosis and caspase-3 expression were significantly reduced in the brain after resuscitation in the LDP and HDP groups compared with the CPR group (all P<0.05). In addition, those pathological injuries mentio
目的探讨右美托咪定后处理对猪心脏骤停复苏后脑损伤的影响。方法选取体重36±2 kg的健康家猪28头，随机分为假手术组(S组)、心肺复苏组(CPR组)、右美托咪定低剂量后处理组(LDP组)和右美托咪定高剂量后处理组(HDP组)，每组n=7头。S组只做手术准备。其余三组均采用8 min电致心室颤动+ 5 min心肺复苏建立实验模型。复苏后5 min, LDP组静脉滴注右美托咪定负荷剂量0.25 μg/kg后以0.25 μg/(kg·h)的速率持续滴注6 h, HDP组静脉滴注右美托咪定负荷剂量0.5 μg/kg后以0.5 μg/(kg·h)的速率持续滴注6 h。S组和CPR组给予等量生理盐水。在复苏后1 h、3 h、6 h和24 h检测血清神经元特异性烯醇化酶(NSE)和S100B蛋白水平。复苏后24 h，评估神经功能缺损评分(NSD)。处死大鼠，取大脑皮层，测定肿瘤坏死因子-α (TNF-α)、白细胞介素-6 (IL-6)、丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性、细胞凋亡及caspase-3表达。结果与S组比较，其他3组复苏后均出现神经功能障碍和脑损伤，NDS显著升高，血清NSE、S100B水平显著升高(均P<0.05)。与CPR组相比，LDP组和HDP组复苏后24 h NDS评分显著降低，复苏后6 h和24 h血清NSE和S100B水平显著低于CPR组[NDS: 24 h NDS: 194±26、103±16 vs 278±23;NSE (ng/mL): 6h时为32.4±1.8,28.6±3.7 vs 36.2±2.8,24 h时为39.9±4.2,35.1±1.5 vs 45.1±3.0;S100B (pg/mL): 6h时为2 534±207,2 382±170 vs 2 825±113,24 h时为3 719±164,3 246±176 vs 4 085±161,P均<0.05]。与LDP组比较，复苏后24 h HDP组的神经功能障碍和脑损伤进一步显著减轻(均P<0.05)。病理分析显示，心肺复苏组、LDP组和HDP组复苏后均出现脑炎症、氧化应激和细胞凋亡。与CPR组相比，LDP组和HDP组复苏后脑组织中TNF-α、IL-6、MDA含量显著降低，SOD活性显著升高，细胞凋亡和caspase-3表达显著降低(均P<0.05)。与LDP组相比，HDP组复苏后脑内上述病理损伤进一步显著减轻(均P<0.05)。结论右美托咪定后处理可显著减轻复苏后脑损伤的严重程度，并呈剂量依赖性，可能是通过减少组织炎症、氧化应激和细胞凋亡来实现的。关键词:心脏骤停;心肺复苏;Dexmedetomidine;脑损伤;炎症反应;氧化应激;细胞凋亡;猪
{"title":"Effects of dexmedetomidine postconditioning on brain injury after cardiac arrest and resuscitation in a swine model","authors":"Wenlong Tang, Xiaohong Jin, Jiefeng Xu, Rongrong Shen, Moli Wang, Shengyao Mao, Zilong Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.012","url":null,"abstract":"Objective \u0000To investigate the effects of dexmedetomidine postconditioning on brain injury after cardiac arrest and resuscitation in a swine model. \u0000 \u0000 \u0000Methods \u0000Twenty-eight healthy male domestic pigs, weighing 36±2 kg, were randomized (random number) into 4 groups (n=7 each group): sham operation group (S group), cardiopulmonary resuscitation group (CPR group), low-dose dexmedetomidine postconditioning group (LDP group), and high-dose dexmedetomidine postconditioning group (HDP group). Animals in the S group only underwent the surgical preparation. In the other three groups, the experimental model was established by 8 mins of electrically induced ventricular fibrillation and then 5 mins of cardiopulmonary resuscitation. At 5 min after resuscitation, a loading dose of dexmedetomidine of 0.25 μg/kg was intravenously infused followed by continuous infusion at a rate of 0.25 μg/(kg·h) for 6 h in the LDP group, and a loading dose of dexmedetomidine of 0.5 μg/kg was infused followed by continuous infusion at a rate of 0.5 μg/(kg·h) for 6 h in the HDP group. The same amount of normal saline was administered in the S and CPR groups. At 1 h, 3 h, 6 h and 24 h after resuscitation, the levels of serum neuron specific enolase (NSE) and S100B protein were measured. At 24 h after resuscitation, neurologic deficit score (NSD) was evaluated. After that, the animals were euthanized and cerebral cortex was obtained for the determination of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and malondialdehyde (MDA) contents, superoxide dismutase (SOD) activity, cell apoptosis and caspase-3 expression. \u0000 \u0000 \u0000Results \u0000Compared with the S group, post-resuscitation neurologic dysfunction and brain injury were observed in the other three groups, which were indicated by significantly higher NDS and markedly greater levels of serum NSE and S100B (all P<0.05). Compared with the CPR group, the score of NDS at 24 h post-resuscitation were significantly lower and the levels of serum NSE and S100B at 6 h and 24 h post-resuscitation were significantly less in the LDP and HDP groups [NDS: 194±26, 103±16 vs 278±23 at 24 h; NSE (ng/mL): 32.4±1.8, 28.6±3.7 vs 36.2±2.8 at 6 h, 39.9±4.2, 35.1±1.5 vs 45.1±3.0 at 24 h;S100B (pg/mL): 2 534±207, 2 382±170 vs 2 825±113 at 6 h, 3 719±164, 3 246±176 vs 4 085±161 at 24 h, all P<0.05]. Compared with the LDP group, neurologic dysfunction and brain injury at 24 h post-resuscitation were further significantly alleviated in the HDP group (all P<0.05). Pathological analysis indicated that brain inflammation, oxidative stress and cell apoptosis were observed after resuscitation in the CPR, LDP and HDP groups. However, the contents of TNF-α, IL-6 and MDA were significantly lower while the activity of SOD was significantly higher, and cell apoptosis and caspase-3 expression were significantly reduced in the brain after resuscitation in the LDP and HDP groups compared with the CPR group (all P<0.05). In addition, those pathological injuries mentio","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"863-868"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48794724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.015
Wanpeng Wang, Yan Zhang, Haiyan Liu
Objective To investigate the relationship between the levels of Th1 and Th2 cells and their cytokines IFN-γ, TNF-α, IL-2, IL-4, IL -5 and IL-13 in peripheral blood of patients with acute pancreatitis and the clinical severity of acute pancreatitis, and to evaluate the diagnostic value and significance for the severity of acute pancreatitis. Methods This study enrolled 72 patients with acute pancreatitis and 30 healthy controls admitted to the Emergency Surgery Department of the First Affiliated Hospital of Zengzhou University from January 2015 to June 2017. The patients were divided into the mild MAP group, moderate MSAP group, and severe SAP group according to the 2012 Atlanta classification criteria. Whole blood and serum samples were taken on the day of admission for all confirmed cases, the number of Th1 and Th2 cells was detected by flow cytometry, the expression levels of IFN-γ, TNF-α, IL-2, IL-4, IL-5 and IL-13 were determined by ELISA. The total length of hospital stay and length of hospital stay in ICU of each group were recorded. The number of Th1 and Th2 cells and the expression of related cytokines in patients with mild, moderate and severe acute pancreatitis were compared by one-way analysis of variance. Pearson linear correlation was used to analyze the correlation between Th1and Th2 cytokines and the length of hospital stay and the length of hospital stay in ICU. A P<0.05 was considered statistically significant. Results Compared with the healthy controls, the number of Th1 and Th2 cells, the levels of Th1 cytokine IFN-γ, TNF-α, IL-2 and Th2 cytokine IL-4 were significantly increased in acute pancreatitis. Th1 cells in the SAP group were significantly higher than those in the MAP and MSAP groups (F=11.137, P<0.01), while Th2 cells in the SAP group were significantly lower than those in the MAP and MSAP groups (F=9.493, P<0.01), and there was no significant difference between the MAP group and MSAP group. The expression level of IFN-γ was higher in the SAP and MSAP groups than that in the MAP group (F=8.605, P=0.001). The expression level of TNF-α was higher in the SAP group than those in the MSAP and MAP groups (F=11.847, P<0.01), and the IL-4 expression level was significantly lower in the SAP group than those in the MAP and MSAP groups (F=8.042, P=0.001). The expression level of IFN-γ was positively correlated with the length of hospital stay and the length of hospital stay in ICU (r=0.569, P=0.014; r=0.538, P=0.021). The expression level of TNF-α was positively correlated with the length of hospital stay (r=0.475, P=0.046). The expression level of IL-4 was negatively correlated with the length of hospital stay and the length of hospital stay in ICU (r=-0.577, P=0.012; r=-0.657, P=0.003). Conclusions Th1 and Th2 cells and their associated inflammatory factors IFN-γ, TNF-α, IL-2 and IL-4 are elevated in patients with acute pancreatitis.The increase in the number of Th1 proinflammatory cytokines IFN-γ, TNF-α and
{"title":"The role of Th1 and Th2 cells in the severity of acute pancreatitis","authors":"Wanpeng Wang, Yan Zhang, Haiyan Liu","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.015","url":null,"abstract":"Objective \u0000To investigate the relationship between the levels of Th1 and Th2 cells and their cytokines IFN-γ, TNF-α, IL-2, IL-4, IL -5 and IL-13 in peripheral blood of patients with acute pancreatitis and the clinical severity of acute pancreatitis, and to evaluate the diagnostic value and significance for the severity of acute pancreatitis. \u0000 \u0000 \u0000Methods \u0000This study enrolled 72 patients with acute pancreatitis and 30 healthy controls admitted to the Emergency Surgery Department of the First Affiliated Hospital of Zengzhou University from January 2015 to June 2017. The patients were divided into the mild MAP group, moderate MSAP group, and severe SAP group according to the 2012 Atlanta classification criteria. Whole blood and serum samples were taken on the day of admission for all confirmed cases, the number of Th1 and Th2 cells was detected by flow cytometry, the expression levels of IFN-γ, TNF-α, IL-2, IL-4, IL-5 and IL-13 were determined by ELISA. The total length of hospital stay and length of hospital stay in ICU of each group were recorded. The number of Th1 and Th2 cells and the expression of related cytokines in patients with mild, moderate and severe acute pancreatitis were compared by one-way analysis of variance. Pearson linear correlation was used to analyze the correlation between Th1and Th2 cytokines and the length of hospital stay and the length of hospital stay in ICU. A P<0.05 was considered statistically significant. \u0000 \u0000 \u0000Results \u0000Compared with the healthy controls, the number of Th1 and Th2 cells, the levels of Th1 cytokine IFN-γ, TNF-α, IL-2 and Th2 cytokine IL-4 were significantly increased in acute pancreatitis. Th1 cells in the SAP group were significantly higher than those in the MAP and MSAP groups (F=11.137, P<0.01), while Th2 cells in the SAP group were significantly lower than those in the MAP and MSAP groups (F=9.493, P<0.01), and there was no significant difference between the MAP group and MSAP group. The expression level of IFN-γ was higher in the SAP and MSAP groups than that in the MAP group (F=8.605, P=0.001). The expression level of TNF-α was higher in the SAP group than those in the MSAP and MAP groups (F=11.847, P<0.01), and the IL-4 expression level was significantly lower in the SAP group than those in the MAP and MSAP groups (F=8.042, P=0.001). The expression level of IFN-γ was positively correlated with the length of hospital stay and the length of hospital stay in ICU (r=0.569, P=0.014; r=0.538, P=0.021). The expression level of TNF-α was positively correlated with the length of hospital stay (r=0.475, P=0.046). The expression level of IL-4 was negatively correlated with the length of hospital stay and the length of hospital stay in ICU (r=-0.577, P=0.012; r=-0.657, P=0.003). \u0000 \u0000 \u0000Conclusions \u0000Th1 and Th2 cells and their associated inflammatory factors IFN-γ, TNF-α, IL-2 and IL-4 are elevated in patients with acute pancreatitis.The increase in the number of Th1 proinflammatory cytokines IFN-γ, TNF-α and ","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"880-885"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46057623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.006
Yuting Li, Hongxiang Li
Objective To investigate the incidence and risk factors of septic cardiomyopathy, and to provide evidence for the diagnosis, treatment and prevention of septic cardiomyopathy. Methods Totally 208 patients with septic or septic shock (≥18 years old) were admitted to ICU Department of The First Hospital of Jilin University from January 2015 to August 2017. The clinical data of all patients were retrospectively analyzed, and the baseline data and clinical outcomes were compared between the septic cardiomyopathy group (39 cases) and non-septic cardiomyopathy group (169 cases). Multiple Logistic regression analysis was used to analyze the risk factors of septic cardiomyopathy. Results (1) The incidence of septic cardiomyopathy in patients with septic or septic shock was about 18.8%. (2) There was no significant difference in baseline body weight, atrial fibrillation, hypertension, diabetes, malignant tumor, maximum body temperature, blood leukocyte, C-reactive protein(CRP), procalcitonin(PCT), positive blood culture, in-hospital mortality and 30-day mortality between the two groups (all P>0.05). Age (P=0.01), sex (P=0.02), history of heart failure (P=0.03), history of coronary heart disease (P=0.01), platelet at ICU admission (P=0.01), lactic acid at ICU admission (P=0.02), vasoactive drugs (P=0.03), APACHE Ⅱ score (P=0.03), SOFA score (P=0.01), and ICU length of hospital stay (P=0.03) were significantly different between the two groups. (3) Patients with a history of heart failure (OR=1.55, 95%CI:0.73-1.66; P=0.01), a history of coronary heart disease (OR=1.18, 95%CI: 1.03-1.66; P=0.03), and lactic acid at ICU admission > 4.0 mmol/L (OR=1.10, 95%CI: 1.00-1.30; P=0.04) were independent risk factors for the incidence of septic cardiomyopathy. Conclusion Septic cardiomyopathy has a relatively high incidence in patients with septic or septic shock. Patients with a history of heart failure, a history of coronary heart disease and lactic acid at ICU admission > 4.0 mmol/L are independent risk factors for the incidence of septic cardiomyopathy. Key words: Septic cardiomyopathy; Morbidity; Risk factors; Sepsis; Septic shock
{"title":"Analysis of incidence and risk factors of septic cardiomyopathy","authors":"Yuting Li, Hongxiang Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.006","url":null,"abstract":"Objective \u0000To investigate the incidence and risk factors of septic cardiomyopathy, and to provide evidence for the diagnosis, treatment and prevention of septic cardiomyopathy. \u0000 \u0000 \u0000Methods \u0000Totally 208 patients with septic or septic shock (≥18 years old) were admitted to ICU Department of The First Hospital of Jilin University from January 2015 to August 2017. The clinical data of all patients were retrospectively analyzed, and the baseline data and clinical outcomes were compared between the septic cardiomyopathy group (39 cases) and non-septic cardiomyopathy group (169 cases). Multiple Logistic regression analysis was used to analyze the risk factors of septic cardiomyopathy. \u0000 \u0000 \u0000Results \u0000(1) The incidence of septic cardiomyopathy in patients with septic or septic shock was about 18.8%. (2) There was no significant difference in baseline body weight, atrial fibrillation, hypertension, diabetes, malignant tumor, maximum body temperature, blood leukocyte, C-reactive protein(CRP), procalcitonin(PCT), positive blood culture, in-hospital mortality and 30-day mortality between the two groups (all P>0.05). Age (P=0.01), sex (P=0.02), history of heart failure (P=0.03), history of coronary heart disease (P=0.01), platelet at ICU admission (P=0.01), lactic acid at ICU admission (P=0.02), vasoactive drugs (P=0.03), APACHE Ⅱ score (P=0.03), SOFA score (P=0.01), and ICU length of hospital stay (P=0.03) were significantly different between the two groups. (3) Patients with a history of heart failure (OR=1.55, 95%CI:0.73-1.66; P=0.01), a history of coronary heart disease (OR=1.18, 95%CI: 1.03-1.66; P=0.03), and lactic acid at ICU admission > 4.0 mmol/L (OR=1.10, 95%CI: 1.00-1.30; P=0.04) were independent risk factors for the incidence of septic cardiomyopathy. \u0000 \u0000 \u0000Conclusion \u0000Septic cardiomyopathy has a relatively high incidence in patients with septic or septic shock. Patients with a history of heart failure, a history of coronary heart disease and lactic acid at ICU admission > 4.0 mmol/L are independent risk factors for the incidence of septic cardiomyopathy. \u0000 \u0000 \u0000Key words: \u0000Septic cardiomyopathy; Morbidity; Risk factors; Sepsis; Septic shock","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"836-840"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47231113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.011
Liang Dong, Lang Li, Yizhe Chen, Jiaojie Hui
Objectives To determine the effect of Hippo signaling pathway on lung injury repair of bone-marrow derived mesenchymal stem cells (mMSCs) in murine lipopolysaccharide (LPS) induced acute respiratory distress syndrome (ARDS). Methods C57BL/6 mouse bone marrow-derived MSC (mMSCs) cell lines with low expression of large tumor suppressor 1 (LATS1) were constructed by lentiviral vector transfection. ARDS was modeled by intratracheally injection of 2 mg/mL lipopolysaccharide (LPS) 50 μL. C57BL/6 mice were randomly(random number) divided into four groups (n=36): normal control group, ARDS group, ARDS mice transplanted with mMSCs transfected with blank lentivirus vector (MSC-shcontrol group) or sh-LATS1 lentivirus vector (MSC-shLATS1 group). Mice were sacrificed at 3, 7, and 14 d after modeling, and lung tissue and bronchoalveolar lavage fluid (BALF) were collected. Near-infrared fluorescence imaging, immunofluorescence staining and Western blot were used to evaluate retention and differentiation of mMSCs in lung tissue. Lung tissue wet weight/body weight ratio (LWW/BW) and total protein (TP) and albumin (ALB) in BALF were determined to reflect pulmonary edema. The expression of Occludin protein in lung epithelium was tested by Western blot. The levels of interleukins (IL-1β, IL-6, and IL-10) in BALF were assessed by enzyme-linked immunosorbent assay (ELISA). Lung injury score and pulmonary fibrosis score in lung tissue were assessed. Results The retention of mMSCs at 3, 7 and 14 d in the MSC-shLATS1 group were significantly higher than those in the MSC-shcontrol group [(26.25±4.58) vs (12.13±3.75) cells/HP, (20.49±3.86) vs (9.97±2.76) cells/HP, and (13.77±3.55) vs (6.89±2.10) cells/HP, all P<0.05], so was the differentiation of mMSCs into typeⅡ alveolar epithelial cells at 14 d [(64.12±15.29)% vs (19.64±3.71)%, P<0.05]. LWW/BW and TP and ALB in BALF at 3 and 14 d in the MSC-shLATS1 group [(9.85±1.51), (6.11±0.83) (mg/g) and (5.12±0.87), (3.05±0.87) (mg/mL) and (0.44±0.18), (0.33±0.04) (mg/mL)] were higher than those in the MSC-shcontrol group [(14.88±1.74), (8.04±1.70)(mg/g) and (8.08±1.72), (5.94±1.20) (mg/mL) and (0.71±0.21), (1.07±0.29) (mg/mL)] (all P<0.05), so was the relative expression of Occludin protein[(0.79±0.11) vs (0.49±0.19), (P<0.05)]. The levels of IL-1β and IL-6(pg/mL) in BALF in the MSC-shLATS1 group [(60.11±8.58), (101.74±11.55)] was lower than those in the MSC-shcontrol group [(99.26±14.32), (145.54±13.29) ] (all P<0.05), but the levels of IL-10 in BALF in the MSC-shLATS1 group (316.65±37.88)pg/mL was higher than those in the MSC-shcontrol group (190.83±22.61)pg/mL (P<0.05). Lung injury scores at 3 and 14 d in the MSC-shLATS1 group [(7.18±1.12), (3.33±0.49)] was lower than those in the MSC-shcontrol group [(9.72±1.45), (5.11±0.86)] (all P<0.05), so was pulmonary fibrosis score at 14 d [(0.68±0.12) vs (1.47±0.18), P<0.05]. Conclusion Inhibition of Hippo signaling pathway through underexpression of LATS1 could improv
{"title":"Modulation of Hippo signaling pathway facilitates mesenchymal stem cells to repair lung injury in murine lipopolysaccharide induced acute respiratory distress syndrome","authors":"Liang Dong, Lang Li, Yizhe Chen, Jiaojie Hui","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.011","url":null,"abstract":"Objectives \u0000To determine the effect of Hippo signaling pathway on lung injury repair of bone-marrow derived mesenchymal stem cells (mMSCs) in murine lipopolysaccharide (LPS) induced acute respiratory distress syndrome (ARDS). \u0000 \u0000 \u0000Methods \u0000C57BL/6 mouse bone marrow-derived MSC (mMSCs) cell lines with low expression of large tumor suppressor 1 (LATS1) were constructed by lentiviral vector transfection. ARDS was modeled by intratracheally injection of 2 mg/mL lipopolysaccharide (LPS) 50 μL. C57BL/6 mice were randomly(random number) divided into four groups (n=36): normal control group, ARDS group, ARDS mice transplanted with mMSCs transfected with blank lentivirus vector (MSC-shcontrol group) or sh-LATS1 lentivirus vector (MSC-shLATS1 group). Mice were sacrificed at 3, 7, and 14 d after modeling, and lung tissue and bronchoalveolar lavage fluid (BALF) were collected. Near-infrared fluorescence imaging, immunofluorescence staining and Western blot were used to evaluate retention and differentiation of mMSCs in lung tissue. Lung tissue wet weight/body weight ratio (LWW/BW) and total protein (TP) and albumin (ALB) in BALF were determined to reflect pulmonary edema. The expression of Occludin protein in lung epithelium was tested by Western blot. The levels of interleukins (IL-1β, IL-6, and IL-10) in BALF were assessed by enzyme-linked immunosorbent assay (ELISA). Lung injury score and pulmonary fibrosis score in lung tissue were assessed. \u0000 \u0000 \u0000Results \u0000The retention of mMSCs at 3, 7 and 14 d in the MSC-shLATS1 group were significantly higher than those in the MSC-shcontrol group [(26.25±4.58) vs (12.13±3.75) cells/HP, (20.49±3.86) vs (9.97±2.76) cells/HP, and (13.77±3.55) vs (6.89±2.10) cells/HP, all P<0.05], so was the differentiation of mMSCs into typeⅡ alveolar epithelial cells at 14 d [(64.12±15.29)% vs (19.64±3.71)%, P<0.05]. LWW/BW and TP and ALB in BALF at 3 and 14 d in the MSC-shLATS1 group [(9.85±1.51), (6.11±0.83) (mg/g) and (5.12±0.87), (3.05±0.87) (mg/mL) and (0.44±0.18), (0.33±0.04) (mg/mL)] were higher than those in the MSC-shcontrol group [(14.88±1.74), (8.04±1.70)(mg/g) and (8.08±1.72), (5.94±1.20) (mg/mL) and (0.71±0.21), (1.07±0.29) (mg/mL)] (all P<0.05), so was the relative expression of Occludin protein[(0.79±0.11) vs (0.49±0.19), (P<0.05)]. The levels of IL-1β and IL-6(pg/mL) in BALF in the MSC-shLATS1 group [(60.11±8.58), (101.74±11.55)] was lower than those in the MSC-shcontrol group [(99.26±14.32), (145.54±13.29) ] (all P<0.05), but the levels of IL-10 in BALF in the MSC-shLATS1 group (316.65±37.88)pg/mL was higher than those in the MSC-shcontrol group (190.83±22.61)pg/mL (P<0.05). Lung injury scores at 3 and 14 d in the MSC-shLATS1 group [(7.18±1.12), (3.33±0.49)] was lower than those in the MSC-shcontrol group [(9.72±1.45), (5.11±0.86)] (all P<0.05), so was pulmonary fibrosis score at 14 d [(0.68±0.12) vs (1.47±0.18), P<0.05]. \u0000 \u0000 \u0000Conclusion \u0000Inhibition of Hippo signaling pathway through underexpression of LATS1 could improv","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"855-862"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44376121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.07.014
Z. Xiaodong, Gong Ping, W. Wenjuan, Kang Jian, Chun-Sheng Li
Objective To compare the value of presepsin, procalcitonin (PCT) and C-reactive protein (CRP) in differentiating different types of pathogenic bacteria in septic patients. Methods A prospective study was conducted to collect 322 septic patients who met the diagnostic criteria of "sepsis 3.0" in the Emergency ICU of the First Affiliated Hospital of Dalian Medical University from July 2016 to January 2018. According to the results of blood culture, patients were divided into the positive blood culture group (n=114) and negative blood culture group (n=208). Patients in the positive blood culture group were further divided into four subgroups: Gram-positive coccus (G+), Gram-negative bacilli (G-), mixed bacteria, and fungi groups. Healthy volunteers were selected as the control group (n=45). The differences in presepsin, PCT and CRP levels were compared among the groups, and the curves of the subjects' working characteristic curve (ROC) were drawn. Results Presepsin, PCT, and CRP were significantly increased in the positive blood culture and negative blood culture groups compared with the control group (all P 0.05), but PCT was significantly higher in the G- and mixed bacteria groups than that in the G+ and fungi groups (all P<0.05). Presepsin predicted a positive blood culture with area under ROC curve of 0.680, which was higher than PCT (AUC=0.599). Conclusions Presepsin is more valuable than PCT in early predicting positive blood culture in septic patients, but only PCT has an ability to differentiate pathogenic bacteria in septic patients with positive blood culture. It suggested that a combination of Presepsin and PCT should be more meaningful in clinical practice. Key words: Sepsis; Presepsin; Procalcitonin; C-reactive protein; Gram-positive coccus; Gram-negative bacilli; Fungi
{"title":"Comparison of the value of blood presepsin, procalcitonin and C-reactive protein in differentiating different types of pathogenic bacteria in septic patients","authors":"Z. Xiaodong, Gong Ping, W. Wenjuan, Kang Jian, Chun-Sheng Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.07.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.07.014","url":null,"abstract":"Objective \u0000To compare the value of presepsin, procalcitonin (PCT) and C-reactive protein (CRP) in differentiating different types of pathogenic bacteria in septic patients. \u0000 \u0000 \u0000Methods \u0000A prospective study was conducted to collect 322 septic patients who met the diagnostic criteria of \"sepsis 3.0\" in the Emergency ICU of the First Affiliated Hospital of Dalian Medical University from July 2016 to January 2018. According to the results of blood culture, patients were divided into the positive blood culture group (n=114) and negative blood culture group (n=208). Patients in the positive blood culture group were further divided into four subgroups: Gram-positive coccus (G+), Gram-negative bacilli (G-), mixed bacteria, and fungi groups. Healthy volunteers were selected as the control group (n=45). The differences in presepsin, PCT and CRP levels were compared among the groups, and the curves of the subjects' working characteristic curve (ROC) were drawn. \u0000 \u0000 \u0000Results \u0000Presepsin, PCT, and CRP were significantly increased in the positive blood culture and negative blood culture groups compared with the control group (all P 0.05), but PCT was significantly higher in the G- and mixed bacteria groups than that in the G+ and fungi groups (all P<0.05). Presepsin predicted a positive blood culture with area under ROC curve of 0.680, which was higher than PCT (AUC=0.599). \u0000 \u0000 \u0000Conclusions \u0000Presepsin is more valuable than PCT in early predicting positive blood culture in septic patients, but only PCT has an ability to differentiate pathogenic bacteria in septic patients with positive blood culture. It suggested that a combination of Presepsin and PCT should be more meaningful in clinical practice. \u0000 \u0000 \u0000Key words: \u0000Sepsis; Presepsin; Procalcitonin; C-reactive protein; Gram-positive coccus; Gram-negative bacilli; Fungi","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"875-879"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45808528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.06.014
Li Yanya, Ma Fei, Ye Gen, Hong Yimei, Li Xin
Objective To analyze the risk factors associated with acute type A aortic dissection, and to establish an effective predictive scoring model for early clinical intervention. Methods A retrospective review of 200 patients diagnosed as acute type A aortic dissection in the Department of Emergency, Guangdong Provincial People's Hospital between April 1, 2012 and March 31, 2017 was conducted as a modeling group. There were 160 males and 40 females with age of (53.30 ±13.19) years. According to the criteria of dissection rupture within 72 h after CTA examination, patients were divided into a rupture group (100 cases) and an unruptured group (100 cases). A prediction model of rupture risk was established based on the multivariate Logistic regression analysis of the risk factors of acute A-type aortic dissection in the early stage. After the establishment of the model, a prospective review of 80 patients diagnosed as acute type A aortic dissection in our hospital between April 1, 2017 and May 31, 2018 was conducted as a validation group. There were 57 males and 23 females with age of (54.00 ±13.68) years. In the validation group, there were 53 patients with rupture and 27 patients without rupture. Furthermore, this model was verified in the validation group. The scores were divided into low-risk rupture and high-risk rupture according to the best cut-off value of the receiver operating model curve of the modeling group. Results Logistic regression analysis showed that 10 factors were finally established the rupture risk prediction score model. The factors were as following: age >63 years (2 points), women (2 points), ventilator assisted ventilation (3 points), AST >80 U/L (2 points), no distortion of the inner membrane (2 points), diameter of the aortic sinus >41 mm (1 point), maximum diameter of the ascending aorta >48 mm (1 point), ratio of false lumen area to true lumen area >2.12 (2 points), Lac >1.9 mmol/L (3 points), and WBC >14.2×109 /L (1 point). The results of validation showed that the scoring model had a high predictive value (AUC = 0.928, 95% CI: 0.872-0.984, P < 0.001) and goodness of fit (Hosmer-Lemeshow χ2 = 8.331, P = 0.402). Moreover, the scoring model was further divided into low-risk (0-6 points) and high-risk (7-19 points), with sensitivity of 83.0% and specificity of 86.0%. Conclusions The predictive model of dissection risk in the acute type A aortic dissection constructed within 72 h after CTA is helpful for the evaluation of the disease and early intervention, and has certain clinical application value. Key words: aortic dissection; rupture; risk factors; risk score; model
{"title":"Construction of risk prediction model for acute type A aortic dissection","authors":"Li Yanya, Ma Fei, Ye Gen, Hong Yimei, Li Xin","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.06.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.06.014","url":null,"abstract":"Objective \u0000To analyze the risk factors associated with acute type A aortic dissection, and to establish an effective predictive scoring model for early clinical intervention. \u0000 \u0000 \u0000Methods \u0000A retrospective review of 200 patients diagnosed as acute type A aortic dissection in the Department of Emergency, Guangdong Provincial People's Hospital between April 1, 2012 and March 31, 2017 was conducted as a modeling group. There were 160 males and 40 females with age of (53.30 ±13.19) years. According to the criteria of dissection rupture within 72 h after CTA examination, patients were divided into a rupture group (100 cases) and an unruptured group (100 cases). A prediction model of rupture risk was established based on the multivariate Logistic regression analysis of the risk factors of acute A-type aortic dissection in the early stage. After the establishment of the model, a prospective review of 80 patients diagnosed as acute type A aortic dissection in our hospital between April 1, 2017 and May 31, 2018 was conducted as a validation group. There were 57 males and 23 females with age of (54.00 ±13.68) years. In the validation group, there were 53 patients with rupture and 27 patients without rupture. Furthermore, this model was verified in the validation group. The scores were divided into low-risk rupture and high-risk rupture according to the best cut-off value of the receiver operating model curve of the modeling group. \u0000 \u0000 \u0000Results \u0000Logistic regression analysis showed that 10 factors were finally established the rupture risk prediction score model. The factors were as following: age >63 years (2 points), women (2 points), ventilator assisted ventilation (3 points), AST >80 U/L (2 points), no distortion of the inner membrane (2 points), diameter of the aortic sinus >41 mm (1 point), maximum diameter of the ascending aorta >48 mm (1 point), ratio of false lumen area to true lumen area >2.12 (2 points), Lac >1.9 mmol/L (3 points), and WBC >14.2×109 /L (1 point). The results of validation showed that the scoring model had a high predictive value (AUC = 0.928, 95% CI: 0.872-0.984, P < 0.001) and goodness of fit (Hosmer-Lemeshow χ2 = 8.331, P = 0.402). Moreover, the scoring model was further divided into low-risk (0-6 points) and high-risk (7-19 points), with sensitivity of 83.0% and specificity of 86.0%. \u0000 \u0000 \u0000Conclusions \u0000The predictive model of dissection risk in the acute type A aortic dissection constructed within 72 h after CTA is helpful for the evaluation of the disease and early intervention, and has certain clinical application value. \u0000 \u0000 \u0000Key words: \u0000aortic dissection; rupture; risk factors; risk score; model","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"729-735"},"PeriodicalIF":0.0,"publicationDate":"2019-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48138981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.06.011
Yang Song, Hao Sun, Guoqin Yu, Xiaomin Zhang, Yuxuan Wu, Jun Wang, Jin-song Zhang
Objective To investigate the regulatory mechanism of Paraquat (PQ)-induced epithelial-mesenchymal transition (EMT) and the protective mechanism of N-acetyl-cysteine (NAC) in PQ-induced A549 cells by EMT markers (E-cadherin and α-smooth muscle actin). Methods EMT model was established by 30 μmol/L PQ-exposed A549 cells for 4 d. The application of 10 mmol/L NAC was incubated with A549 cells for 2 h in advance. Morphological changes of A549 cells were observed under light microscope. Western blot was used to detect the expression levels of TGF-β1, E-cadherin and α-smooth muscle actin. Results In PQ-induced EMT model, the PQ group showed typical morphological changes, and the cells changed from cobblestone-like epithelial appearance to spindle-shaped mesenchymal-like appearance compared to the control group. Western blotting showed that the protein levels of TGF-β1 and α-smooth muscle actin in the PQ group were significantly increased and the protein levels of E-cadherin were decreased in the PQ group (all P<0.05). NAC preincubation can effectively reverse the above changes caused by PQ exposure: the protein levels of E-cadherin and α-smooth muscle actin were significantly increased and decreased, respectively and morphological changes showed more cobblestone-like epithelial appearance. Conclusion Cell experiments showed that PQ exposure can cause EMT in epithelial cells, and NAC has a protective effect in this process. Thus, it may provide new ideas and strategies for the treatment of pulmonary fibrosis caused by PQ poisoning in clinical practice. Key words: Paraquat; N-Acetyl-cysteine; Transforming growth factor-β1; Epithelial-mesenchymal transition
{"title":"N-Acetyl-cysteine protects A549 cells in paraquat-induced epithelial-mesenchymal transition","authors":"Yang Song, Hao Sun, Guoqin Yu, Xiaomin Zhang, Yuxuan Wu, Jun Wang, Jin-song Zhang","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.06.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.06.011","url":null,"abstract":"Objective \u0000To investigate the regulatory mechanism of Paraquat (PQ)-induced epithelial-mesenchymal transition (EMT) and the protective mechanism of N-acetyl-cysteine (NAC) in PQ-induced A549 cells by EMT markers (E-cadherin and α-smooth muscle actin). \u0000 \u0000 \u0000Methods \u0000EMT model was established by 30 μmol/L PQ-exposed A549 cells for 4 d. The application of 10 mmol/L NAC was incubated with A549 cells for 2 h in advance. Morphological changes of A549 cells were observed under light microscope. Western blot was used to detect the expression levels of TGF-β1, E-cadherin and α-smooth muscle actin. \u0000 \u0000 \u0000Results \u0000In PQ-induced EMT model, the PQ group showed typical morphological changes, and the cells changed from cobblestone-like epithelial appearance to spindle-shaped mesenchymal-like appearance compared to the control group. Western blotting showed that the protein levels of TGF-β1 and α-smooth muscle actin in the PQ group were significantly increased and the protein levels of E-cadherin were decreased in the PQ group (all P<0.05). NAC preincubation can effectively reverse the above changes caused by PQ exposure: the protein levels of E-cadherin and α-smooth muscle actin were significantly increased and decreased, respectively and morphological changes showed more cobblestone-like epithelial appearance. \u0000 \u0000 \u0000Conclusion \u0000Cell experiments showed that PQ exposure can cause EMT in epithelial cells, and NAC has a protective effect in this process. Thus, it may provide new ideas and strategies for the treatment of pulmonary fibrosis caused by PQ poisoning in clinical practice. \u0000 \u0000 \u0000Key words: \u0000Paraquat; N-Acetyl-cysteine; Transforming growth factor-β1; Epithelial-mesenchymal transition","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"712-716"},"PeriodicalIF":0.0,"publicationDate":"2019-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44074379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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