Objective To investigate the value of extravascular lung water index ( EVLWI) and intrathoracic blood volume index ( ITBVI) monitoring in fluid management of severe pneumonia patients with sepsis shock.Methods A prospective controlled study was conducted in106 patients who were diagnosed as severe pneumonia with sepsis shock in intensive care unit fromJanuary 2010 to February 2013. 54 patients who received pulse indicator continuous output ( PiCCO) monitoring were enrolled into the EVLWI + ITBVI group, and EVLWI and ITBVI were used as indicator of fluid management. 52 patients who received central venous pressure ( CVP) as indicator of traditional fluid managementwere enrolled into the control group. The time and the rate to achieve early goal-directed therapy ( EGDT) target were compared between two groups. Acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) , sepsis related organ failure assessment ( SOFA) , noradrenaline dosage, serumlactic acid, serum creatinine were compared between 1 day and 3 days after treatment. The characteristics of fluid management were recorded and compared within 72 hours. Mechanical ventilation ratio, duration of mechanical ventilation, ICU stay and 28-day mortality were compared between two groups. Results The ratio of achieving EGDT target in 6 hours was significantly higher in the EVLWI + ITBVI group than that in the control group ( 75.9% vs. 55.7% , Plt;0.05) , whereas the time and the ratio to achieve EGDT target in 24 hours were not statistically different. APACHE Ⅱ, SOFA, norepinephrine dosage, serum lactate were significantly decreased 3 days after treatment in the EVLWI + ITBVI group, but did not change significantly in the control group. On3 days after treatment, serumcreatinine was increased in the control group, and did not change significantly in the EVLWI + ITBVI group. The fluid intake and fluid balance volume during 0-6 hours period were significantly higher in the EVLWI + ITBVI group than those in the control group ( Plt;0.05) , but showed no difference ( Pgt;0.05) in other periods. Mechanical ventilation ratio, duration of mechanical ventilation, ICU stay and 28-days mortality were significantly lower in the EVLWI + ITBVI group compared with the control group ( Plt;0.05) . Conclusion Compared with CVP, ITBVI and EVLWI can more accurately assess and guide fluid management in severe pneumonia patients with septic shock with less duration of mechanical ventilation, ICU stay and mortality.
【Abstract】Objective To explore the effect and indication of splenectomy in liver transplantation. Methods From January 2001 to April 2006, 260 patients underwent piggyback orthotopic liver transplantation (PBOLT), and 28 patients had undergone combined PBOLT and splenectomy (splenectomy group). These patients were compared to 56 randomly selected non-splenectomy patients from the same transplant period, meaningly two controls were selected for every non-splenectomy case. Two groups were analyzed with respect to rate of infection and survival rate, as well as biopsy-proven acute allograft rejection within 30 days after transplantation. Results Rate of infection in the splenectomy group was higher than that in the non-splenectomy patients (85.7% vs 55.4%, P＜0.05). Acute rejection and survival rates in the splenectomy group were lower than those in the non-splenectomy patients (3.6% vs 14.3%, P＜0.05; 46.4% vs 82.1%, P＜0.05). Conclusion Concomitant splenectomy with PBOLT has a significantly higher patient mortality rate; it is mainly due to its septic complications. At present, unless there is a certain indication for splenectomy, this procedure is not recommended.
ObjectiveTo detecte the expressions of phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene and protein in peripheral blood mononuclear cells (PBMC) of patients with sepsis and to explore its role in the pathogenesis of acute obstructive suppurative cholangitis (AOSC). MethodsThe PBMC and serum were separated from AOSC patients (n=25) before treatment and in 1 week after recure, and healthy volunteers (normal control group, n=15). The serum levels of lipopolysaccharide (LPS), tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10) were detected by enzyme linked immunosorbent assay (ELISA) methods. The mRNA and protein expression levels of PTEN, nuclear fator κB P65 (NF-κB), and inhibitor of NF-κB (IκB) were detected by real-time quantitative polymerase chain reaction (qRT-PCR) and Western blot, respectively. ResultsThe levels of LPS, TNF-α, and IL-10 before treatment were significantly higher than those of normal control group (P < 0.05), the indicators were significantly decreased and close to normal levels in 1 week after recure. The mRNA and protein expression levels of PTEN and IκB before treatment were lower than those of normal control group (P < 0.05), NF-κB P65 was higher than those of normal control group (P < 0.05), while the phosphorylation levels of PTEN and IκB were higher than those normal control group (P < 0.05), and in 1 week after recure, the above indicators returned to normal levels. ConclusionsSepsis shift may be associated with the occurrence of intestinal LPS, and caused the imbalance between proinflammatory and anti-inflammatory cytokines in the body. PTEN for phosphorylation activation of IκB or directly activation of NF-κB participate the originating process of sepsis, hinting a therapeutic potentialities in the early stage of sepsis.
Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for sepsis. Methods Such databases as The Cochrane Library (Issue 4, 2012), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect the diagnostic tests on sTREM-1 for sepsis published before April 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. Then, Meta-Disc software (Version 1.5) was used to conduct analyses, draw the summary receiver operating characteristic (SROC) curve, and calculate the area under curve and Q index. Results A total of 11 studies involving 1 615 patients were included. The value of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, area under of SROC curve, and Q index were 69%, 71%, 3.7, 0.34, 14.73, 0.875, and 0.805, respectively. Conclusion This meta-analysis shows that sTREM-1 as a single indicator has moderate accuracy for early diagnosing sepsis. It should be combined with other diagnostic indicators to further improve the sensitivity and accuracy in diagnosing sepsis.
Objective To investigate the effect of non-coding RNA activated by DNA damage (NORAD) on acute lung injury (ALI) in septic rats by regulating the miR-155-5p/TLR6 molecular axis. Methods The rats were randomly divided into control group, model group, low NORAD expression no-load group (LV-sh-NC), low NORAD expression group (LV-sh-NORAD), low NORAD expression +miR-155-5p low expression no-load group (LV-sh-NORAD+NC antagomir), NORAD low expression +miR-155-5p low expression group (LV-sh-NORAD+miR-155-5p antagomir). ELISA kits were applied to detect interleukin (IL)-8, IL-1β, and tumor necrosis factor-α (TNF-α) levels; quantitative real-time polymerase chain reaction was applied to detect the expression of NORAD, miR-155-5p, and Toll-like receptor 6 (TLR6) genes in lung tissue of rats in each group. The ratio of wet weight to dry weight (W/D) of lung tissue was measured. The pathological changes of lung tissue were observed by hematoxylin-eosin staining, and apoptosis in lung tissue cells was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling. Western blot was applied to detect the expressions of TLR6, Bax, Bcl-2, and cleaved cysteinyl aspartate specific proteinase 3 caspase-3) proteins in cells. Dual luciferase reporter gene experiment was applied to verify the relationship between miR-155-5p and NORAD and TLR6. Results Compared with the control group, the lung tissue of rats in the model group and LV-sh-NC group was obviously damaged, the levels of serum IL-1β, TNF-α, IL-8, expression of NORAD and TLR6 mRNA in lung tissue, W/D ratio, apoptosis rate, expression of TLR6, Bax, and Cleaved-caspase-3 proteins were obviously increased, the expression of miR-155-5p and Bcl-2 proteins in lung tissue was obviously reduced (P<0.05). Down-regulation of NORAD expression could reduce lung tissue injury, serum IL-1β, TNF-α, IL-8 levels, mRNA expression of NORAD and TLR6 in lung tissue, W/D ratio, apoptosis rate, TLR6, Bax, Cleaved caspase-3 protein expression, and cleaved caspase-3 protein expression. The expression of miR-155-5p and Bcl-2 protein in lung tissue were significantly increased (P<0.05). Down-regulating the expression of miR-155-5p could reduce the improvement effect of negatively regulated NORAD on sepsis ALI rats (P<0.05). Conclusion Interference with NORAD can alleviate lung injury in ALI rats by regulating the miR-155-5p/TLR6 molecular axis.
Objective To study the effects of total saponins of panax notoginseseng injection on the coagulation function in sepsis. Methods 50 sepsis patients with normal coagulation function were randomly divided into two groups. 25 patients in the control group received the routine treatment and the other 25 patients in the treatment group received total saponins of panax notoginseseng injection additionally. The levels of Plt, PT, TT, APTT, FIB and D-D were measured before the therapy and on 1st, 3rd and 7th day after the therapy. Results The levels of Plt, PT, TT, APTT, FIB and D-D before the therapy had no significant differences between the two groups ( P gt; 0. 05) . The levels of Plt and FIB had significant differences between the two groups on 7th day after therapy ( P lt;0. 01, P lt; 0. 05) . PT, TT, and APTT were prolonged in the controlled group gradually, butwere not prolonged or even shortened in the treatment group,which were significantly shorter in the treatment group on 7th day after therapy ( P lt; 0. 05) . D-D slightly elevated in the control group, but slightly elevated at first and dropped gradually in the treatment group, which was significantly lower in the treatment group on7th day after therapy. Conclusion Total saponins of panax notoginseseng injection has a protective effect on coagulation function in sepsis.
Objective To explore the clinical significances of serum procalcitonin ( PCT) and Creactive protein( CRP) in diagnosis and severity assessment of sepsis. Methods A total of 72 patients with different severities of sepsis admitted to Wenzhou Second People’s Hospital from June 2005 to September 2007, including 22 cases of sepsis, 26 cases of severe sepsis, and 24 cases of sepsis shock. Meanwhile, twenty non-sepsis patients were enrolled as control group. The differences of serum PCT and CRP levels, acute physiology and chronic health evaluation Ⅱ ( APACHEⅡ) scores and sepsis related organ failure assessment ( SOFA) scores were compared in controls and the septic patients with different severities and different prognosis. Results The PCT levels of patients with sepsis, severe sepsis and sepsis shock were significantly higher than that in the non-sepsis group [ ( 1. 51 ±1. 57) , ( 5. 62 ±3. 78) and ( 13. 56 ±8. 16) vs ( 0. 12 ± 0. 33) μg/L, P lt;0. 05 or P lt; 0. 01, respectively] . The CRP level, APACHEⅡ and SOFA were also increased in septic patients compared to control and progressively elavated by the severities of sepsis patients ( P lt; 0. 05 or P lt; 0. 01) , however, CRP levels were not significant different ( P gt; 0. 05) . The PCT levels, APACHEⅡ and SOFA of the patients with good prognosis were lower than those with poor prognosis( all P lt; 0. 01) , but the CRP levels was not significant different( P gt;0. 05) . Conclusion The serumlevel of PCT is superior to serumlevel of CRP in severity classification and prognosis assessment.
Objective To observe the effects of δ-opioid receptor agonists D-Ala2-D-Leu5-enkephali （DADLE） on hepatocyte apoptosis and expressions of bcl-2 and caspase-3 in septic rat, and to investigate the possible mechanism by which DADLE protects the liver in sepsis. Methods Sepsis was reproduced in rats by cecum ligation and puncture (CLP). Fifty-four SD rats (either male or female) were randomly divided into CLP group (n=18), DADLE group (n=18) and sham operation (SO) group (n=18). The rats were respectively killed at different time (2 h, 4 h and 6 h after operation). Hepatocyte apoptosis was detected by TdT-mediated dUTP Nick End Labeling (TUNEL). The expressions of bcl-2 and caspase-3 protein were detected by immunohistochemistry. And the changes of pathology in hepatic tissue were detected by light microscope. Results The hepatic pathological lesion of rats in CLP group was obviously serious compared with SO group, while it was obviously improved in DADLE group. The apoptosis index of rat hepatocytes in CLP group significantly increased compared with SO group, and further it was prominent at 4 h （P＜0.01). The apoptosis index of rat hepatocytes at each time of DADLE group was significantly decreased compared with CLP group （P＜0.01）. Expression of caspase-3 protein in liver tissues of CLP group significantly increased compared with SO group （P＜0.01）, while the expression of bcl-2 protein significantly decreased （P＜0.05）. Expression of caspase-3 protein in liver tissues of DADLE group significantly decreased compared with the CLP group （P＜0.01）, while the expression of bcl-2 protein significantly increased （P＜0.05）. There was positive correlation between expression of caspase-3 in liver tissues and apoptosis index of hepatocyte (r=0.83, P＜0.01) and negative correlation between expression of bcl-2 in liver tissues and apoptosis index of hepatocyte (r=-0.65, P＜0.01). Conclusions The findings indicate that δ-opioid receptor agonists DADLE can obviously improve hepatic pathological changes of septic rats. And its protective mechanism contains down regulation of caspase-3 expression, upregulation of bcl-2 expression and thus the apoptosis of hepatocyte is repressed.
Objective To investigate the expression of oncostatin M (OSM) in patients with sepsis and its role in early recognition of sepsis. Methods Thirty-four patients with sepsis admitted in Shanxi Bethune Hospital fromJune 3, 2021 to January 18, 2022 were selected as a sepsis group, 15 patients with community acquired pneumonia (CAP) as a case control group, and 16 adults who underwent physical examination in the same period were selected as a healthy control group. The patients in the sepsis group were followed up for 28 days and divided into a survival group and a death group. The serum OSM level and its correlation with clinical indexes (white blood cell, neutrophil, lymphocyte, sequential organ failure assessment score and acute physiology and chronic health evaluation Ⅱ) were analyzed, and the diagnostic value of OSM expression level in the early identification of sepsis was analyzed. Results Compared with the case control group and the healthy control group, the expression level of OSM in the sepsis group was significantly higher [(502.07±209.93)pg/mL vs. (368.22±65.95)pg/mL and (382.09±73.04)pg/mL, P<0.05]. However, the high expression of OSM had no significant correlation with white blood cell, neutrophil, lymphocyte or disease severity score (P>0.05), and there was no significant difference in serum OSM level between the sepsis survival group and the death group. Compared with white blood cell count, the high expression of OSM has certain diagnostic value in the early identification of sepsis. The area under the receiver operator characteristic curve of OSM in predicting sepsis was 0.794 (95% confidence interval 0.666 - 0.922, P<0.05), with the sensitivity of 79.4% and the specificity of 73.3%. Conclusion The expression of OSM in patients with sepsis is significantly increased, and the high expression of OSM has a certain diagnostic value in the early identification of sepsis.
Objective To explore the clinical significance of the platelet glycoproteins CD62p and CD63 in septic patients.Methods The expressions of CD62p and CD63 in peripheral platelet were measured in 40 septic patients within 24 hours after onset by flow cytometry.The expression levels of CD62p and CD63 in mild and severe sepsis and normal subjects were compared.Meanwhile the correlation of CD62p and CD63 with APACHE Ⅱ score was analyzed.Results Significant differences in the CD62p and CD63 levels were found in the septic patients when compared with the normal subjects [CD62p：（2.56±1.51）% vs （1.48±0.40）%；CD63：（2.15±0.50）% vs （1.29±0.35）%；all Plt;0.01].The expressions of CD62p and CD63 in the severe septic patients were significantly higher than those in the mild septic patients [CD62p：（3.31±1.94）% vs （2.05±0.87）%；CD63：（2.37±0.36）% vs （2.00±0.53）%；all Plt;0.05].The positive correlations of CD62p and CD63 with APACHE Ⅱ score were also found（CD62p：r=0.377，P=0.016；CD63：r=0.452，P=0.003）.Conclusion Platelets were significantly activated in septic patients at early stage which was correlated with the severity of sepsis.