ObjectiveTo investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery.MethodsFrom September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared.ResultsThere was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05).ConclusionThe non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.
Although great progress has been achieved in the techniques and materials of cardiopulmonary bypass (CPB), cardiac surgery under CPB is still one of the surgeries with the highest complication rate. The systemic inflammatory response is an important cause of complications, mainly characterized by activation of innate immune cells and platelets, and up-regulation of inflammatory cytokines. After activation, a variety of molecules on the membrane surface are up-regulated or down-regulated, which can amplify tissue inflammatory damage by releasing cytoplasmic protease and reactive oxygen species, and activate multiple inflammatory signaling pathways in the cell, ultimately leading to organ dysfunction. Therefore, the expression of these cell membrane activation markers is not only a marker of cell activation, but also plays an important role in the process of vital organ injury after surgery. Identification of these specific activation markers is of great significance to elucidate the mechanisms related to organ injury and to find new prevention and treatment methods. This article will review the relationship between these activated biomarkers in the innate immune cells and vital organ injuries under CPB.
ObjectiveTo evaluate the effectiveness of Ilizarov technique-based transverse tibial bone transport on the treatment of severe diabetic foot ulcer (Wagner grades 3 to 5) complicated with systemic inflammatory response syndrome (SIRS).MethodsBetween August 2014 and December 2017, 33 patients with severe diabetic foot and SIRS were treated with Ilizarov technique-based transverse tibial bone transport. There were 27 males and 6 females, with a mean age of 60.6 years (range, 34-79 years). All of them suffered from type 2 diabetes mellitus. The duration of diabetes was 1-28 years (mean, 10 years) and the duration of diabetic foot was 1-12 months (mean, 2.7 months). According to Wagner classification, there were 8 cases in grade 3, 23 cases in grade 4, and 2 cases in grade 5. The wound healing condition was observed after operation, and the limb salvage rate was calculated. The changes in body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein concentration were assessed. The skin temperature of the dorsum of the foot was measured, and the visual analogue scale (VAS) score was used to evaluate the improvement of foot pain.ResultsAll 33 patients were followed up 3-30 months (mean, 14.1 months). All ulcers healed and the healing time was 3-12 months (mean, 5.3 months); the limb salvage rate was 100%. Postoperative body temperature, heart rate, respiratory rate, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein concentration were significantly lower than those before operation (P<0.05). The skin temperature of the dorsum of the foot was (32.64±2.17)℃ at 1 month after operation, which was significantly improved when compared with preoperative value [(31.28±1.99)℃] (t=0.05, P=0.00); but there was no significant difference in skin temperature compared with healthy side [(32.46±2.10)℃] (t=2.04, P=0.41). The VAS score was 2.4±0.7 at 1 month after operation, which was significantly improved when compared with preoperative score (4.3±0.8) (t=3.10, P=0.00).ConclusionIlizarov technique-based transverse tibial bone transport is an effective way to treat severe diabetic foot complicated with SIRS. It can promote foot ulcer healing and avoid amputations.
【Abstract】ObjectiveThere are two main functions of gastrointestinal tract, digestion and absorption, and barrier function. The latter has an important defensive effect, which keeps the body away from the invading and damaging of bacteria and endotoxin. It maintains the systemic homeostasis. Intestinal dysfunction would happen when body suffers from diseases or harmful stimulations. The more serious intestinal disorders would harm the intestinal protective mechanism, or intestinal barrier function, and bacterial/endotoxin translocation, of intestinal failure (IF) would ensue. This article provides a critical review of the evidence indicating that an increase in bacterial translocation is associated with sepsis, and even the multiple organ failure syndrome in critically ill patients. The intransit microorganisms play an essential role in the homeostasis of local and systemic immunity. MethodsAll studies published from 2000 to June 2005 about intestinal permeability, bacterial translocation, and systemic inflammatory response syndrome were located by search of PubMed. ResultsClinical and experimental studies investigating the correlation between bacterial translocation and systemic inflammatory response syndrome, associated with the damage of the gut barrier function . To keep the mucosal barrier function intact is one of the main issues in the prevention of bacterial translocation. This could be achieved by the adequate delivery of oxygen and nutrient supplementation to the gut. Enteral nutrition, probiotic can be a good choice. ConclusionWith a better understanding of the bacteriahost interactions in health and the alterations induced by critical illness, new therapies that improve the environment of both may lead to better recovery rates in intensive care unit patients.
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 relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level and in-hospital prognosis in patients with acute type A aortic dissection within 24 hours of admission.MethodsFortysix patients diagnosed with type A aortic dissection were included in our hospital and their Lp-PLA2 levels within 24 hours of admission were measured between January 2017 and June 2019. According to their Lp-PLA2 levels within 24 hours of admission, 23 patients were classified into a high Lp-PLA2 group (Lp-PLA2 > 200 μg/L, 16 males and 7 females at age of 52.0±14.0 years) and 23 patients were into a low Lp-PLA2 group (Lp-PLA2 ≤200 μg/L, 15 males and 8 females at age of 53.0±11.0 years). The relationship between Lp-PLA2 level and clinical outcome was analyzed.ResultsThe incidences of bleeding, hospital infection, multiple organ dysfunction and mortality in the high Lp-PLA2 group were higher than those in the low Lp-PLA2 group (P<0.05). Seven (15.2%) patients died during 3 months of follow-up. The 3-month survival rate of patients with an increase of Lp-PLA2 was significantly lower than that of the patients with normal Lp-PLA2 (P<0.01), which was an independent predictor of adverse outcomes at 3 months of onset (P<0.01).ConclusionLp-PLA2 may be a predictor of disease progression in the patients with acute type A aortic dissection, and the patients with significantly elevated Lp-PLA2 have a higher 3-month mortality than the patients with normal Lp-PLA2.
Objective To construct and compare logistic regression and decision tree models for predicting systemic inflammatory response syndrome (SIRS) in patients with type B aortic dissection (TBAD) after interventional surgery. Methods A retrospective analysis was conducted on clinical data of TBAD patients at Peking University Shenzhen Hospital from 2020 to 2024. The patients were divided into a SIRS group and a non SIRS group based on whether SIRS occurred within 24 hours after surgery. Multivariate logistic regression was used to analyze the influencing factors of SIRS occurrence in TBAD intervention patients, and a decision tree model was constructed using SPSS Modeler to compare the predictive performance of the two models. Results A total of 742 patients with TBAD were included, including 579 males and 163 females, aged between 27 and 97 (58.85±10.79) years. Within 24 hours after intervention, a total of 506 patients developed SIRS, with an incidence rate of 68.19%. Logistic regression analysis showed that the extensive involvement of the dissection, the surgical time≥ 2 hours, PET coated stents implanted, serum creatinine, white blood cell count, C-reactive protein, monocyte count (MONO), neutrophil count levels elevated, estimated glomerular filtration rate and decreased albumin levels were independent risk factors for SIRS (P<0.05). The decision tree model selected a total of 10 explanatory variables and 6 layers with 37 nodes, among which MONO was the most important predictor. The area under the decision tree model curve was 0.829 [95% CI (0.800, 0.856)], which was better than the logistic regression model's 0.690 [95% CI (0.655, 0.723)], and the difference was statistically significant (P<0.001). Conclusion The incidence of SIRS after TBAD intervention is high, and the decision tree model has better predictive performance than logistic regression. It can identify high-risk patients with higher accuracy and provide a practical tool for early clinical intervention.
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.
Objective To explore whether microRNA-203 (miR-203) targets and regulates the Toll-like receptor 4 (TLR4)/nuclear transcription factor kappa B (NF-κB)/nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) to protect alveolar epithelial cells from lipopolysaccharide (LPS)-induced apoptosis and inflammation injury. Methods The alveolar epithelial A549 cells were used as the research objects and divided into: Control group (normal culture), LPS group (LPS treatment), LPS+miR-NC mimics group (LPS treatment after transfection of miR-NC mimics), LPS+ miR-203 mimics group (LPS treatment after transfection of miR-203 mimics), LPS+miR-203 mimics+pcDNA group (LPS treatment after transfection of miR-203 mimics and pcDNA), LPS+miR-203 mimics+pcDNA-TLR4 group (LPS treatment after transfection of miR-203 mimics and pcDNA-TLR4). Dual luciferase reporter gene was used to detect the targeting relationship between miR-203 and TLR4; Real-time quantitative reverse transcription-polymerase chain reaction was used to detect the relative expression levels of miR-203 and TLR4 mRNA; enzyme-linked immunosorbent assay was used to measure the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6; flow cytometry was used to detect the apoptosis rate of A549 cells; Western blot was used to detect the expression of B-cell lymphoma/leukemia-2 gene (Bcl-2) and Bcl-2 associated X protein (Bax), TLR4, NF-κB and NLRP3 proteins in A549 cells. Results There was a targeted regulation relationship between miR-203 and TLR4. Compared with the Control group, the expression of miR-203, TLR4 mRNA and protein, Bax, NF-κB, and NLRP3 proteins in A549 cells in the LPS group increased, the levels of TNF-α, IL-1β and IL-6 in the cell supernatant increased, the apoptosis rate increased, the level of Bcl-2 protein in cells decreased (P<0.05). Compared with the LPS+miR-NC mimics group, the expression of TLR4 mRNA and protein, Bax, NF-κB, and NLRP3 proteins in A549 cells in the LPS+miR-203 mimics group decreased, the levels of TNF-α, IL-1β and IL-6 in the cell supernatant decreased, the apoptosis rate decreased, the expression level of miR-203 and the level of Bcl-2 protein in cells increased (P<0.05). Compared with the LPS+miR-203 mimics+pcDNA group, the expression of miR-203, TLR4 mRNA and protein, Bax, NF-κB, and NLRP3 proteins in A549 cells in the LPS+miR-203 mimics+pcDNA-TLR4 group increased, the levels of TNF-α, IL-1β and IL-6 in the cell supernatant increased, the apoptosis rate increased, the expression level of miR-203 and the level of Bcl-2 protein in cells decreased (P<0.05). Conclusion MiR-203 can target TLR4/NF-κB/NLRP3 to protect alveolar epithelial cells from apoptosis and inflammation induced by LPS.
Radiofrequency ablation for hepatic hemangioma is safe and effective, and can obtain the same curative effect as traditional surgical resection. For hepatic hemangiomas with large volume, abundant arterial blood supply and long ablation time, systemic inflammatory response syndrome (SIRS) often occurs after radiofrequency ablation, which can lead to injury or dysfunction of important organs. This paper systematically summarizes the mechanism, prevention and treatment of SIRS after radiofrequency ablation of hepatic hemangioma, so as to provide reference for improving the safety of radiofrequency ablation of hepatic hemangioma.