The Update of the concept of sepsis and The Surviving Sepsis Campaign Bundle, The new challenges to current clinical practice / 医学研究生学报

In these years, renewal of the concept of sepsis, application of qSOFA and proposal of hour-1 bundle for sepsis further suggested to diagnose and treatment of sepsis earlier and faster than before. It presents new challenges to current clinical practice and asks us to be more alert to forewarning symptoms of patients, optimize hospital management procedures, strengthen training exercises and multidisciplinary collaboration in order to achieve optimal treatment of sepsis.

Interpretation of American Gastroenterological Association Clinical Practice update: management of pancreatic necrosis in acute pancreatitis patients / 中国实用外科杂志

American Gastroenterological Association(AGA)has published the latest clinical practice update in Gastroenterology in August 2019. The purpose of this AGA clinical practice update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. In recent decades,with the improvement in clinical practice,the management of pancreatic necrosis in patients with acute pancreatitis(AP)has undergone great changes. The well-defined step-up approach has been more advocated rather than the traditional open surgery. The treatment of pancreatic necrosis mainly includes two aspects,conservative methods, which consist of antimicrobial therapy as well as nutrition support,and invasive interventions.Drainage and/or debridement of pancreatic necrosis is best indicated in patients with infected necrosis or patients with sterile pancreatic necrosis and persistent clinical symptoms,which need proactive management. A step-up approach consists of percutaneous drainage or endoscopic transmural drainage, followed by direct endoscopic/percutaneous minimally invasive necrosectomy, and then surgical debridement is reasonable. As for the comparison between percutaneous surgical or endoscopic step-up approach,no studies have shown that there are differences between the two in the main clinical outcomes,for instance,mortality. Hence,the choice of specific treatment strategy in different AP centers depends mainly on their available clinical expertise and medical resources.

Imaging features, when and how to perform minimally invasive intervention in infected pancreatic necrosis patients / 中国实用外科杂志

Recently,with the further understanding of infected pancreatic necrosis(IPN),pancreatologists have reached consensuses on that the presence of gas on CT imaging could be the golden standard diagnosis for IPN,the intervention timing for IPN should be delayed to four weeks later,and the step-up approach acts as the first standard treatment strategy for IPN.Whereas in clinical practice,there are substantial new challenges awaiting our solutions,for instance,the lack of accurate and specific diagnostic criteria for IPN without typical gas sign on CT imaging,whether the intervention of wall-off necrosis(WON)which got infected prematurely should be delayed to four weeks later?What's more,whether the endoscopy centered step-up approach is superior to the surgical step-up approach?Is it time to abandon open surgery in IPN management?If not,when should we switch to open necrosectomy?All of these questions are still full of controversies.

A cross-sectional study on nutritional status of ICU patients in the mainland China / 解放军医学杂志

Objective To investigate nutritional treatment in the intensive care unit (ICU) of the mainland China. Methods A cross-sectional study was conducted in 116 ICUs of 118 mainland hospitals on April 26th, 2017. All patients of these ICUs were investigated at 0 o'clock on April 26th. Demographic and clinical parameters of those patients on April 25th (the investigation day) were recorded, including the dates of hospitalization, ICU admission and nutrition initiation and clinical outcome on 28 days after the investigation day. Results A total of 1953 patients were collected, including 631 females and 1306 males. The mean age was (64.1±19.3) years old (1950 cases). The means of Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores were (10.76±4.35)(1749 cases), (5.65±3.52)(1783 cases), (17.14±7.31)(1792 cases), respectively. The outcomes of 28 days after the investigation day were 1483 survivors (75.9%), 312 non-survivors (16.0%) and 158 cases (8.1%) being lost to follow-up. There were no significant differences between the males and the females in age, severity of disease and clinical outcomes of 28 days but in height and weight. There were 73.7%(1440 cases) of patients with normal or mildly injured gastrointestinal function, 10.8%(210 cases) with moderately or severely injured function, 1.7%(33 cases) with gastrointestinal failure and 13.2%(258 cases) without evaluation. To the investigation day, enteral nutrition (EN) had been initiated in 69.4%(1356 cases) of patients and parenteral nutrition (PN) in 36.4%(711 cases) of patients. There were 1720(88.1%) patients with EN administration on the investigation day. The proportion of patients with nausea, vomit/regurgitation, aspiration, abdominal pain, abdominal distention and diarrhea was 4.8%(93 cases), 5.4%(105 cases), 0.9%(17 cases), 8.7%(170 cases), 27.5%(538 cases) and 4.3%(84 cases) respectively, while that of patients using EN was 3.1%(40 cases), 4.25%(54 cases), 0.79%(10 cases), 4.41%(56 cases), 26.85%(341 cases) and 5.43%(69 cases) correspondingly. The proportion of cases starting EN within 24, 48 and 72 hours after ICU entry was 22.4%(437/1953), 38.6%(754/1953) and 46.6%(911/1953), respectively. The proportion of cases receiving ≥80% estimated energy target (=past body weight ×25 kcal/kg.d) within 3, 7 and 14 days after ICU entry was 12.9%(78/607), 18.7%(189/1010) and 23%(305/1325) respectively, while that of cases with EN was 9.9%(60/607), 15.0%(151/1010) and 18.6%(246/1325) correspondingly. Conclusions Nowadays, most of patients in the mainland ICUs receive nutrition therapy and the EN usage rate is much higher than the PN rate. However, the time of EN initiation and the target-reaching rate of energy are suboptimal and an individualized plan of nutrition therapy is still missing. Details of energy delivery still need to be improved.

Treatment of Simple Obesity Patients with Phlegm Dampness Stagnation Syndrome with Warming Needle Moxibustion / 针刺研究

OBJECTIVE: To observe the therapeutic effect of warming needle moxibustion stimulation of Hegu (LI 4), Tianshu (ST 25), Zhongwan (CV 12), Zusanli (ST 36), etc. for simple obesity patients with phlegm dampness stagnation syndrome (PDSS)．. METHODS: A total of 60 simple obesity patients with PDSS were equally randomized into control group (13 men and 17 women, 18－53 years in age) and treatment group (14 men and 16 women, 19－45 years in age). All the patients of both groups were treated by diet control (trying their best to reduce high fat, high glucose and high salt foods, supplementing proteins). Patients of the treatment group received additional treatment of warming needle moxibustion, i．e., the inserted acupuncture needles in bilateral Hegu (LI 4), Tianshu (ST 25), Zhongwan (CV 12), and Zusanli (ST 36), Fenglong (ST 40), etc., were manipulated for a while with reducing technique after "deqi"， followed by attachment of ignited moxa-cones at each of the needle handles for 30 min. The treatment was conducted once every other day for 8 weeks. The therapeutic effect was assessed according to the "Criteria for Diagnosis and Therapeutic Effect Evaluation of Simple Obesity" (1998). Before and after the treatment, body fat percentage (F%), body adiposity index (BAI), and body mass index (BMI) were calculated, serum triglyceride (TG), total cholesterol (CHO), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected using a biochemical analyzer. RESULTS: Following the treatment, of the two 30 cases of obesity patients in the control and treatment groups, 0 (0.0%) and 1 (3.3%) was under control, 11(36.7%) and 16 (53.3%) had a marked improvement, 8(26.7%) and 10 (33.3%) were effective, and 11 (36.7%) and 3 (10.0%) failed in the treatment, with the effective rates being 63.3% and 90.0%, respectively. The effective rate of the warming needle moxibustion plus diet control was significantly superior to that of the simple diet control (P<0.01). After the treatment, the BMI, F%, serum CHO and TG levels and BAI in the treatment group were significantly decreased in comparison with its own pre-treatment in treatment group (P<0.05, P<0.01), while serum HDL-C of the treatment group was obviously increased compared with its own pre-treatment (P<0.01). The decreased F%, CHO and TG levels were markedly lower in the treatment group than in the control group (P<0.05，P<0.01)．. CONCLUSION: Warming needle moxibustion has a positive effect for simple obesity patients with PDSS in controlling their symptoms.

Intercostal artery damage and massive hemothorax after thoracocentesis by central venous catheter: A case report / 中华创伤杂志(英文版)

Central venous catheters (CVCs) are widely used in various puncture and drainage operations in intensive care units (ICUs) in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation process. We came across a patient with severe acute pancreatitis (SAP) who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracocentesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.

Follow-up of N400 in the Rehabilitation of First-episode Schizophrenia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The N400 component of event-related potentials (ERP) has recently drawn widespread attention at home and abroad. This study was to explore the relationship between N400 changes and risperidone treatment and rehabilitation infirst-episode schizophrenia (FES).</p><p><b>METHODS</b>ERP component N400 was recorded by Guangzhou Runjie WJ-1 ERP instruments, in 58 FES before and 6 months, 15 months after risperidone treatment, and in 62 normal controls. The patients' syndromes were assessed by Positive and Negative Syndrome Scale (PANSS). And the stimuli are Chinese sentences with matching (congruent) or mismatching (incongruent) ending words.</p><p><b>RESULTS</b>N400 latencies were prolonged, and amplitudes were decreased in Cz, Pz, Fz, C3, C4, in FES compared with in NC, before treatment. The prolonged N400 latencies and decreased amplitudes were negatively correlated with the patients' positive scale and total scale of PANSS. There are significant differences of N400 amplitudes and latencies in 6 months and 15 months follow-up after treatment. Before treatment, 6 months and 15 months after treatment, N400 latencies are 446 ± 35 ms, 440 ± 37 ms, 414 ± 31 ms (F = 9.72, P < 0.01) in incongruent situation; N400 amplitudes are 5.2 ± 4.6 μV, 5.7 ± 4.8 μV, 7.3 ± 5.0 μV (F = 2.06, P > 0.05) in congruent situation, and 8.5 ± 5.9 μV, 10.1 ± 5.0 μV, 11.9 ± 7.0 μV (F = 3.697, P < 0.05) in incongruent situation.</p><p><b>CONCLUSIONS</b>N400 could be used to predict the effects of treatment of schizophrenia to some degree. The linguistic and cognitive impairment in schizophrenia can be improved by antipsychotic drugs.</p>

A bird's eye view of the air pollution-cancer link in China / 癌症

Air pollution in China comes from multiple sources, including coal consumption, construction and industrial dust, and vehicle exhaust. Coal consumption in particular directly determines the emissions of three major air pollutants: dust, sulfur dioxide (SO(2)), and nitrogen oxide (NOx). The rapidly increasing number of civilian vehicles is expected to bring NOx emission to a very high level. Contrary to expectations, however, existing data show that the concentrations of major pollutants [particulate matter-10 (PM10), SO(2), and nitrogen dioxide (NO(2))] in several large Chinese cities have declined during the past decades, though they still exceed the national standards of ambient air quality. Archived data from China does not fully support that the concentrations of pollutants directly depend on local emissions, but this is likely due to inaccurate measurement of pollutants. Analyses on the cancer registry data show that cancer burden related to air pollution is on the rise in China and will likely increase further, but there is a lack of data to accurately predict the cancer burden. Past experience from other countries has sounded alarm of the link between air pollution and cancer. The quantitative association requires dedicated research as well as establishment of needed monitoring infrastructures and cancer registries. The air pollution-cancer link is a serious public health issue that needs urgent investigation.

Active and passive smoking with breast cancer risk for Chinese females: a systematic review and meta-analysis / 癌症

Previous studies suggested that smoking and passive smoking could increase the risk of breast cancer, but the results were inconsistent, especially for Chinese females. Thus, we systematically searched cohort and case-control studies investigating the associations of active and passive smoking with breast cancer risk among Chinese females in four English databases (PubMed, Embase, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP). Fifty-one articles (3 cohort studies and 48 case-control studies) covering 17 provinces of China were finally included in this systematic review. Among Chinese females, there was significant association between passive smoking and this risk of breast cancer [odds ratio (OR): 1.62; 95% confidence interval (CI): 1.39-1.85; I2 = 75.8%, P < 0.001; n = 26] but no significant association between active smoking and the risk of breast cancer (OR: 1.04; 95% CI: 0.89-1.20; I2 = 13.9%, P = 0.248; n = 31). The OR of exposure to husband's smoking and to smoke in the workplace was 1.27 (95% CI: 1.07-1.50) and 1.66 (95% CI: 1.07-2.59), respectively. The OR of light and heavy passive smoking was 1.11 and 1.41, respectively, for women exposed to their husband's smoke (< 20 and ≥ 20 cigarettes per day), and 1.07 and 1.87, respectively, for those exposed to smoke in the workplace (< 300 and ≥ 300 min of exposure per day). These results imply that passive smoking is associated with an increased risk of breast cancer, and the risk seems to increase as the level of passive exposure to smoke increases among Chinese females. Women with passive exposure to smoke in the workplace have a higher risk of breast cancer than those exposed to their husband's smoking.

The effect of intra-abdominal hypertension on hemodynamics of acute necrotizing pancreatitis in porcine model / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the effect of intra-abdominal hypertension (IAH) on hemodynamics of severe acute pancreatitis (SAP) in porcine model.</p><p><b>METHODS</b>Following baseline registrations, SAP was induced in 12 animals. The N(2) pneumoperitoneum was used to increase the intra-abdominal pressure to 30 mmHg (1 mmHg = 0.133 kPa) in 6 of 12 SAP animals thereafter and keep constant during the experiment. The investigation period was 12 h. Heart rate, cardiac output (CO), central venous pressure (CVP), mean arterial pressure and pulmonary arterial wedge pressure (PAWP) were continuously measured with the aid of balloon tipped flow-directed catheter and electrocardiography monitor. Oxygen partial pressure of artery (PaO(2)), carbon dioxide partial pressure of artery (PaCO(2)), ScvO(2), base excess (BE), and blood lactic acid (LAC) were measured by acid-base analysis.</p><p><b>RESULTS</b>In the IAH group, CO decreased significantly at 12 h, CVP and PAWP increased significantly at 3 h, 6 h and 12 h compared with SAP group (all P < 0.05). Peak inspiration pressure increased immediately after pneumoperitoneum in the IAH group, to (50.2 ± 3.1) cmH(2)O (1 cmH(2)O = 0.098 kPa) and (49.8 ± 0.9) cmH(2)O at 6 h and 12 h respectively. The pH, PaO(2), ScvO(2) and BE showed a tendency to fall in the IAH group. PaCO(2) and LAC were increased significantly in the IAH group (all P < 0.05).</p><p><b>CONCLUSIONS</b>There were remarkable and relatively irreversible effects on global hemodynamics in response to sustained IAH of 12 h with the underlying condition of SAP. Abdominal decompression is beneficial for patients of SAP with IAH.</p>

Effect of decompression in different time on hemodynamics and oxygen metabolism of porcine model with severe acute pancreatitis combined intra-abdominal hypertension / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the effect of decompression in different time on systemic hemodynamics and oxygen metabolism in a 24 h lasting porcine model of severe acute pancreatitis (SAP) incorporating intra-abdominal hypertension (IAH).</p><p><b>METHODS</b>Following baseline registrations, SAP was induced in all 18 animals. A N(2) pneumoperitoneum was used to increase the intra-abdominal pressure (IAP) to 25 mmHg (1 mmHg = 0.133 kPa) in 12 of 18 SAP animals. After 6 hours, decompression was applied in 6 of these 12 pigs and the other 6 animals received decompression at 9 h since the induction of IAH. The investigation period was 24 h. Heart rate (HR), cardiac output (CO), central venous pressure (CVP), mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and electrocardiography monitor; Oxygen partial pressure of artery (PaO(2)), carbon dioxide partial pressure of artery (PaCO(2)) and central venous oxygen saturation (ScvO(2)) were measured by blood-gas analysis. Besides that, systemic oxygen delivery (DO(2)) and systemic oxygen consumption (VO(2)) were calculated according to blood-gas analysis in arterial and central venous blood.</p><p><b>RESULTS</b>After decompression, HR, CO, MAP, CVP, PAWP, PaO(2) and DO(2) showed no significant differences in the 6 h group when compared to SAP pigs. In the 9 h group, however, CO decreased significantly and HR, CVP, PAWP increased significantly after decompression than SAP only animals (all P < 0.05). PaO(2), ScvO(2) and DO(2) showed lower after 3 h of decompression compared with another two groups. VO(2) increased higher in IAH groups during 6 h of experiment than SAP pigs (all P < 0.05). Then VO(2) showed a trend to fall and no differences in three groups.</p><p><b>CONCLUSIONS</b>There are remarkable and relatively irreversible effects on global hemodynamics and oxygen metabolism in response to the decompression in different time after sustained IAH with the underlying condition of SAP. The results of this study are in favor of a decompression in patients of SAP with IAH in early time.</p>

The clinical effectiveness of percutaneous drainage and laparotomy for patients with infective pancreatic necrosis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical effectiveness of percutaneous US- or CT-guided drainage and laparotomy for patients with infective pancreatic necrosis.</p><p><b>METHODS</b>Data of 90 infective pancreatic necrosis patients admitted from January 2008 to December 2009 were included. They were divided into two groups by the different treatment choices. Twenty-seven patients in the percutaneous group received percutaneous US- or CT-guided drainage as first choice. After that a sump suction apparatus was applied for controlled drainage. If no improvement was achieved after 3 days, they would received operation soon. While patients in the laparotomy group received surgical drainage at the time when the diagnosis of infected pancreatic necrosis was confirmed. Continuous drainage was also applied for these ones.</p><p><b>RESULTS</b>The percutaneous group had a significant low rate of reoperation (7.1% vs. 14.3%, P < 0.05) and postoperative residual abscesses (7.1% vs. 28.6%, P < 0.05). Furthermore, 48.1% of patients in percutaneous group successfully avoid laparotomy. In the regard of complications, the percutaneous group presented lower incidence of both single organ dysfunction (7.4% vs. 28.6%, P < 0.05), intestinal fistula (7.4% vs. 27.0%, P < 0.05) and long-term complications (3.7% vs. 22.2%, P < 0.05). In addition, the percutaneous group costed less medical resources as evidenced by shorter ICU duration (21.2 ± 9.7 vs. 28.7 ± 12.1, P < 0.01), shorter hospital duration (48.2 ± 12.5 vs. 59.6 ± 17.5, P < 0.05) and less expenditure (191 762 ± 5892 vs. 341 689 ± 10 854, P < 0.05).</p><p><b>CONCLUSIONS</b>Percutaneous drainage can effectively lower the surgical rates and the rates of complications and reoperations in patients with infective pancreatic necrosis. Besides that, it could also reduce the cost of medical resources.</p>

Treatment experience of severe acute pancreatitis on 1033 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the treatment experience of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>From January 1997 to March 2009, a total of 1033 patients suffered SAP were admitted with a mean APACHE II score 12.0 +/- 4.3. There were 622 males and 411 females, aged from 13 to 98 years old. All patients were cared by the multidisciplinary team with intensivist, endoscopists, gastroenterologists, radiologist, nephrologist and surgeons.Patients treated in SICU in the early phase of the disease. In these 1033 patients, 365 cases received mechanical ventilation, 218 with tracheotomy, 159 cases received high-volume continuous venovenous hemofiltration (CVVH), 179 received nasobiliary drainage, 513 were treated with early enteral nutrition. CT-guided percutaneous catheter drainge for peripancreatic fluid collection was pefromed for 477 times and 438 patients received surgical debridement for infected pancreatic necrosis.</p><p><b>RESULTS</b>In all these 1033 cases, 975 patients (94.4%) survived, and 38 patients died (3.7%). The mortality of patients who received surgical debridement for infected pancreatic necrosis was 7.1% (31/438).</p><p><b>CONCLUSION</b>The muti-discipline management of severe acute pancreatitis can remarkably improve the prognosis of patients.</p>

Nuclear factor kappa B impairs insulin signaling pathway in skeletal muscle cells of rat with sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of nuclear factor kappa B (NF-kappaB) on insulin signaling in skeletal muscle cells of rat with sepsis.</p><p><b>METHODS</b>SD rats were randomly divided into two groups: control group and sepsis group.Sepsis model was reproduced by cecal ligation and puncture in sepsis group. At 8, 16, 24, 48 and 72 h after operation, the gastrocnemius was harvested. Conventional HE staining was used to observe the morphology of skeletal muscle cells. IRS-1 protein and tyrosine phosphorylation of IRS-1 and Ser(307) phosphorylation of IRS-1 were detected by Western Blotting and immuno-precipitation. Activities of NF-kappaB in skeletal muscle cells were detected by electrophoretic mobility shift assay.</p><p><b>RESULTS</b>Tyrosine phosphorylation of IRS-1 in sepsis group was significantly lower than in control group (P < 0.01), while Ser(307) phosphorylation of IRS-1 in sepsis group was significantly higher than in control group (P < 0.01). In sepsis group, NF-kappaB activity in skeletal muscle cells was significantly higher than in control group (P < 0.01). There was significant negative correlation between activity of NF-kappaB and tyrosine phosphorylation of IRS-1 (r = 0.972, P < 0.01). There was significant positive correlation between activities of NF-kappaB and Ser(307) phosphorylation of IRS-1 (r = 0.969, P < 0.01).</p><p><b>CONCLUSIONS</b>There is no inflammatory cell infiltrate in skeletal muscle cells with sepsis. But the activity of NF-kappaB in skeletal muscle cells is obviously enhanced, and it is closely related with disorder of insulin signaling in skeletal muscle cells of rat with sepsis.</p>

Enteral nutrition support in 21 patients after opening abdomen / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of enteral nutrition (EN) in patients underwent open-abdomen managements.</p><p><b>METHODS</b>Twenty-one patients who received at least 3 days of EN after opening the peritoneal cavity between January 2003 and November 2006 were included in this study. Energy expenditure and actual caloric and protein intake were determined in some patients. The levels of serum protein and nitrogen balance before and after the EN were analyzed. Other related complications were also evaluated.</p><p><b>RESULTS</b>Average daily total caloric intake was 93% - 95% of estimated needs. The EN support was administered (8.8 +/- 5.5) d after opening the abdominal cavity and lasted for (51.5 +/- 33.6) d. Initial serum protein levels were low and below normal but increased in all of the patients after the EN. The average nitrogen balance was (-28.6 +/- 5.4) g/d. Diarrhea, gastric reflux, vomiting and abdominal distention occurred in 67%, 23%, 9.5% and 23% of the patients, respectively. All the complications were managed well.</p><p><b>CONCLUSIONS</b>EN support could be effectively and safely given in patients requiring opening peritoneal cavity management.</p>

Mechanism of reduction of albumin expression induced by lipopolysaccharide in rat hepatocytes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The severity of hypoalbuminemia has been shown to be related to morbidity and mortality in some critical illnesses, illustrating the need for better understanding of molecular mechanism of hypoalbuminemia. Lipopolysaccharide (LPS) is a key mediator inducing hypoalbuminemia in sepsis and septic shock. The present study was designed to identify if the reduction of albumin expression is directly induced by LPS and modulated by activated extracellular signal-regulated protein kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) in rat hepatocytes.</p><p><b>METHODS</b>Primary rat hepatocytes were divided into five groups. In two of them, hepatocytes were treated with normal saline or 1 microg/ml LPS, then albumin mRNA expression was observed at 0, 2, 8, 12 and 24 hours after treatment. In another group, hepatocytes were pretreated with 100, 40 or 20 micromol/L of cycloheximide (CHX, an inhibitor of protein synthesis) for 30 minutes followed by 1 microg/ml LPS for 24 hours. Then the RNA was extracted from the cells for RT-PCR to detect the expression of albumin. The other two groups were administered 1 micromol/L, 10 micromol/L and 50 micromol/L of SB203580 (p38 MAPK inhibitor) or PD98059 (ERK inhibitor) 30 minutes prior to 1 microg/ml LPS treatment. After 24 hours of LPS treatment, the supernatant was collected and assayed for albumin concentrations. Data were analyzed by one-way analysis of variance, followed by the Newman-Keul test; a P<0.05 was considered significant.</p><p><b>RESULTS</b>There was no marked change in albumin mRNA expression in the control group during 24-hours treatment with normal saline. The reduction did not occur until 24 hours after LPS treatment, and albumin mRNA decreased by 30% approximately compared to the control group at 24 hours (0.587 vs 0.832, P=0.007). CHX could inhibit the decline of albumin mRNA induced by LPS and the effect was correlated with the dose of CHX. The ERK inhibitor PD98059 caused a significant increase in LPS-induced albumin production at the three concentrations (119.7, 111.4 and 80.0 ng/ml vs 44.4 ng/ml, P=0.0013, 0.0025 and 0.009, respectively), whereas SB203580 obviously blocked albumin reduction in LPS-treated cells at the concentrations of 10 and 50 micromol/L (87.5 and 93.6 ng/ml vs 44.4 ng/ml, P=0.0076 and 0.0049, respectively).</p><p><b>CONCLUSIONS</b>LPS can induce the reduction of albumin expression by new synthesized proteins indirectly, and the process may be related to the signal proteins of ERK and p38 kinase. The ERK and p38 kinase are critical signaling pathways in LPS-induced hypoalbuminemia which is worthwhile to understand in studying the molecular mechanism of hypoalbuminemia in sepsis and septic shock.</p>

Influence and mechanism of a tight control of blood glucose by intensive insulin therapy on human sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of a tight control of blood glucose by intensive insulin therapy on human sepsis, and to explore the potential mechanism of the intensive insulin therapy.</p><p><b>METHODS</b>Eligible patients were randomized by a blinded pharmacist to receive tight control of blood glucose by intensive insulin therapy (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L) or to receive conventional treatment (maintenance of glucose at a level between 10.0 and 11.1 mmol/L). The expression of HLA-DR on peripheral monocytes was measured in 54 patients by flow cytometry on 24 h, 3 d, 5 d, 7 d, 10 d and 14 d of intensive care in parallel with serum c-reactive protein (CRP), severity of the disease (APACHE II score, SOFA score) and clinical data collection.</p><p><b>RESULTS</b>Patients receiving intensive insulin therapy were less likely to require prolonged mechanical ventilation. Tight control of blood glucose significantly reduced the number of days during which leukopenia or leukocytosis and the days with hypo- or hyperthermia (P < 0.05). Hypoglycemia occurred in 3 patients (10.7%) in the tight control of blood glucose group. There were no instance of hemodynamic deterioration or convulsions. Compared with the conventional treatment, tight control of blood glucose also increased the HLA-DR expression of peripheral monocytes, and there were significantly difference on 3 d, 5 d and 7 d (P < 0.05). Whereas it suppressed the elevated serum CRP concentrations, there was significantly difference on 7 d (P < 0.05).</p><p><b>CONCLUSIONS</b>Tight control of blood glucose by intensive insulin therapy expedited healing of human sepsis, and increased the HLA-DR expression of peripheral and suppressed the elevated serum CRP. So, it is necessary to use insulin to strict control the glucose levels in human sepsis.</p>

Potential mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide in rat hepatocytes / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the potential molecular mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide (LPS) in rat hepatocytes.</p><p><b>METHODS</b>The albumin mRNA expression and albumin protein levels in the supernatant were observed at 0, 2, 8, 12 and 24 hours after 1 micro g/ml LPS treatment. The albumin mRNA expression was determined by RT-PCR, and albumin protein levels were assayed with EIA in the supernatant of hepatocytes pretreated with specific inhibitors of extracellular signal-regulated kinase (PD98059) and p38 kinase (SB203580).</p><p><b>RESULTS</b>The albumin mRNA expression was reduced to 70% of baseline value, meanwhile, the albumin protein concentration in the supernatant was reduced by 50% compared with the controls after 24 hours of LPS treatment. Pretreatment with PD98059 and SB203580 did significantly inhibit the reduction of albumin by LPS at the given dose.</p><p><b>CONCLUSION</b>The results indicate that LPS can induce the reduction of albumin synthesis by down-regulation of albumin mRNA expression at transcription level, and the process may be related to the signal transducation of extracellular signal-regulated kinase and p38 kinase.</p>

Albumin kinetics in patients with severe sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the mechanism of hypoalbuminemia in patients with severe sepsis.</p><p><b>METHODS</b>I(125)-labeled albumin was administered intravenously to 10 health volunteers and 10 patients with severe sepsis. Blood samples were taken at 0, 1, 2, 4, 8, 12, 24 hours and 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, 18, 22, 25 days for the measurement of the dose of gamma-radiation and the curve of concentration and time. Then the half-life time (t(1/2)), apparent volume of distribution (V(d)) and transportation rate (K(12)) from center compartment to side compartment of albumin were calculated.</p><p><b>RESULTS</b>The half-life time in septic group was obviously shorter than that in control group (8.2 +/- 1.4 vs. 12.5 +/- 1.7, P < 0.01). The transportation rate in the septic group was higher than that in the control group [(4.4 +/- 1.9) x 10(-2)/h vs. (2.4 +/- 0.6) x 10(-2)/h, P < 0.05]. There was no significant difference in apparent volume of distribution between the two groups.</p><p><b>CONCLUSIONS</b>In patients with severe sepsis, the distribution rate of albumin from vessel to tissue was obviously increased and the decomposition rate of albumin was markedly improved.</p>