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Objective:To investigate the value of renal artery resistance index (RRI) and urinary angiotensinogen (UAGT) in the early diagnosis of acute kidney injury (AKI) in patients with sepsis.Methods:A prospective study was conducted. Seventy-eight patients with sepsis admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from January to September 2021 were enrolled. Patients were observed for the development of AKI within 1 week. General data [gender, age, body mass index (BMI), major infection sites and critical illness related scores], laboratory indicators [mean arterial pressure (MAP), central venous pressure (CVP), procalcitonin (PCT), arterial blood lactic acid (Lac), etc.], duration of mechanical ventilation and length of intensive care unit (ICU) stay were recorded. After hemodynamic stabilization of the patients, renal ultrasound was performed to measure the RRI within 24 hours after ICU admission. Urine samples were taken immediately after diagnosis, and the level of UAGT was detected by enzyme-linked immunosorbent assay (ELISA). The above parameters were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of AKI in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of related indicators for AKI in sepsis.Results:A total of 78 patients were finally enrolled, of which 45 developed AKI and 33 did not. Compared with the non-AKI group, the rates of vasoactive drugs use, 28-day mortality, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, PCT, Lac, RRI and UAGT were significantly higher in the AKI group [rates of vasoactive drugs use: 68.9% vs. 39.4%, 28-day mortality: 48.9% vs. 24.2%, SOFA score: 12.0 (10.5, 14.0) vs. 8.0 (7.0, 10.0), APACHEⅡ score: 22.0 (18.0, 27.5) vs. 16.0 (15.0, 18.5), PCT (μg/L): 12.5±2.6 vs. 10.9±2.8, Lac (mmol/L): 2.6 (1.9, 3.4) vs. 1.9 (1.3, 2.6), RRI: 0.74±0.03 vs. 0.72±0.02, UAGT (μg/L): 75.16±19.99 vs. 46.28±20.75, all P < 0.05], the duration of mechanical ventilation and the length of ICU stay were significantly prolonged [duration of mechanical ventilation (days): 8.0 (7.0, 12.0) vs. 5.0 (4.0, 6.0), length of ICU stay (days): 14.0 (10.0, 16.0) vs. 9.0 (8.0, 11.5), both P < 0.01], and MAP was significantly lowered [mmHg (1 mmHg ≈ 0.133 kPa): 68.5±11.2 vs. 74.2±12.8, P < 0.05]. There was no significant difference in other parameters between the two groups. Multivariate Logistic regression analysis showed that SOFA score [odds ratio ( OR) = 2.088, 95% confidence interval (95% CI) was 1.322-3.299], APACHEⅡ score ( OR = 1.447, 95% CI was 1.134-1.845), RRI ( OR = 1.432, 95% CI was 1.103-1.859), and UAGT ( OR = 1.077, 95% CI was 1.035-1.121) were independent risk factors for sepsis complicated with AKI (all P < 0.01). ROC curve analysis showed that SOFA score, APACHEⅡ score, RRI and UAGT had certain predictive value for AKI in septic patients, the area under the ROC curve (AUC) were 0.814 (95% CI was 0.716-0.912), 0.804 (95% CI was 0.708-0.901), 0.789 (95% CI was 0.690-0.888), and 0.840 (95% CI was 0.747-0.934), respectively, and the AUC of RRI combined with UAGT was 0.912 (95% CI was 0.849-0.974), which was better than the above single index (all P < 0.05). Conclusion:RRI combined with UAGT has a high early predictive value for septic AKI.
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Objective:To evaluate the predictive effect of the 24 h energy expenditure value obtained by indirect calorimetry (IC) on the prognosis of patients with multiple traumatic mechanical ventilation.Methods:A total of 140 patients with multiple traumatic mechanical ventilation who were hospitalized in the ICU of General Hospital of Ningxia Medical University from December 1st, 2016 to August 31st, 2018 were selected as research objects. The general information such as sex, age, Height, weight, and clinical diagnosis were recorded. The IC method was used to measure the patient's 24 h energy expenditure, and the ratio of 24 h energy expenditure to the actual body weight of the patients was calculated the energy expenditure of 24 h energy expenditure per kilogram of body weight. The patient’s mechanical ventilation time and length of stay in ICU were statistically analyzed. The outcome indexes were 28-day mortality and the incidence of hospital-acquired infection. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight.Results:The mechanical ventilation time was positively correlated with 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight ( r=0.470, r=0.247, both P<0.01). The length of sty in ICU was positively correlated with the 24 h energy expenditure of patients with multiple trauma( r=0.276, P<0.05). The area under the ROC curve (AUC) of the 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight for the 28 d mortality and the incidence of hospital-acquired infection were 0.647, 0.663, 0.832, 0.646, with the 24 h energy expenditure per kilogram of body weight greater than 30.4 kcal/(kg·d) as the best critical value for judging 28 d mortality. The sensitivity was 66.5%, specificity was 77.0%, and the 24 h energy expenditure consumption greater than 2 083 kcal/d was used as the optimal critical value for judging the susceptibility to acquire hospital infection, with a sensitivity of 80.0% and specificity of 80.7%. Conclusions:The mechanical ventilation time and length of stay in ICU are closely related to energy expenditure in patients with multiple trauma. The 24 h EE per kilogram of body weight and 24 h energy expenditure have a certain predictive effect on the prognosis of patients with multiple trauma.
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objective:To evaluate the difference 24h energy expenditure in patients with multiple trauma mechanical ventilation predicted by indirect calorimetry (IC) and HB formula. To explore the correlation between energy expenditure and Injury Severity Scoring (ISS) in patients with multiple trauma, and to predict the stress coefficient to improve the accuracy of HB prediction.Methods:A total of 152 patients with multiple trauma receiving mechanical ventilation were included in the ICU of the General Hospital of Ningxia Medical University during December 1st, 2016 to August 31st, 2018. As a research object, The IC method and the HB method were used to simultaneously measure the patient's 24h energy expenditure, and the difference between the two measurement methods was compared. The 24h energy consumption measured by the IC method was used as the "gold standard", and the 24h body weight energy expenditure per kilogram was calculated; Grouped according to the ISS score, compared 24h energy consumption with 24h body weight energy expenditure per kilogram. The Bland-Altman method was used to test the consistency of the two measurements. The two groups were compared using t test, the correlation was analyzed by pearson correlation, and the regression equation was linearly calculated by linear regression.Results:There was a significant bias between the IC method and the HB method in measuring the 24h energy expenditure of patients with multiple trauma, with an average bias of 394.0± 54.0Kcal/d. The 24h energy consumption and 24h body weight energy expenditure per kilogram in the severe injured group were significantly higher than those in the moderate injury group ( P<0.05). The stress coefficient was calculated, The stress coefficient of the HB method associated with the ISS using the one-way regression was Y=0.770+0.018×ISS. Conclusion:The HB method significantly underestimates the 24h energy expenditure of patients with multiple trauma . In order to improve the accuracy of the HB method to predict the 24h energy consumption of patients with multiple injuries, The HB method can be corrected using the stress coefficient associated with the ISS score, Y = (0.770 + 0.018 × ISS) × HB method.
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Objective@#To investigate the effect of TNF-α on the expressions of tight junction protein ZO-1 and Claudin-4 in rat alveolar epithelial typeⅡ cells (AEC-Ⅱ).@*Methods@#Rat AEC-Ⅱ cells were cultured in vitro and divided into the control group, and TNF-α 24 h, 48 h, 72 h groups. The control group was cultured with DME F12 medium containing fetal bovine serum, and the TNF-α groups were intervened by TNF-α with a concentration of 10 ng/mL for 24 h, 48 h, and 72 h, respectively. After co-culture, the transmission electron microscopy was used to identify and observe the ultrastructural changes of rat AEC-Ⅱ cells. The cell inhibition rate was determined by MTT assay, and the cell apoptosis rate was measured by flow cytometry. The expression and distribution of tight junction protein ZO-1 and Claudin-4 in each group were observed by immunofluorescence method. The transcriptional levels of ZO-1 and Claudin-4 were detected by real-time fluorescent quantitative PCR. The expressions of ZO-1 and Claudin-4 were detected by Western blot. One-way analysis of variance (ANOVA) was used for comparisons among groups and SNK-q test was used for pairwise comparisons between groups. The non-parametric test of rank transformation was used when homogeneity of variance were not met. The value of P<0.05 was considered significantly different.@*Results@#Transmission electron microscopy showed that the AEC-Ⅱ cells in the control group obtained characteristic lamellar bodies of different sizes. The lamellar bodies in each TNF-α group were gradually emptied and apoptotic cells were observed under the visual field. The cell inhibition rate and early apoptosis rate of each TNF-α group were significantly higher than those of the control group (all P<0.05). Confocal microscopy showed that ZO-1 was linearly distributed along the cell membrane, and Claudin-4 was scattered along the cell membrane. In the TNF-α groups, the fluorescence intensity of ZO-1 was weakened and the continuity was broken as well as the linear structure. The fluorescence intensity and density of Claudin-4 were decreased in the TNF-α groups. Besides, the transcription and expression of ZO-1 in the TNF-α 24 h group were lower than those in the control group, but there was no significant difference (P>0.05). However, the mRNA level of ZO-1 in the TNF-α 48 h group (0.28±0.06) and 72 h group (0.13±0.07) were significantly lower than those in the control group. And their protein levels of TNF-α 48 h group (0.44±0.09) and of TNF-α 72 h group (0.2±0.01) were lower than that of the control group (0.69±0.12). Compared with the control group, the transcription level (24 h: 0.16±0.03; 48 h: 0.04±0.01; 72 h: 0.01±0.00 vs 1.00±0.00) and expression (24 h: 0.49±0.08; 48 h: 0.34±0.05; 72 h: 0.04±0.01 vs 0.96±0.13) of Claudin-4 in each TNF-α group were significantly decreased, and showed a decreasing trend with time (all P<0.05).@*Conclusions@#TNF-α can damage the pulmonary epithelial barrier by damaging alveolar epithelial typeⅡ cells and down-regulating the expression and distribution of ZO-1 and Claudin-4.
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Objective To explore the effects of nutritional supports following target energy measured by respiratory indirect calorimetry and HB coefficient method respectively on the nutrition and immune indexes of patients with sepsis. Methods A prospective comparative study of 60 patients with sepsis who was suitable for nutritional support and respiratory indirect calorimetry in the intensive care unit ( ICU) of the hospital from Jan-uary 2015 to October 2015 was conducted. Resting Energy Expenditure ( REE) was measured simultaneously by respiratory indirect calorimetry (n=30) and HB coefficient (Harris-Benedict formula×stress coefficient, n=30) in patients with sepsis and the nutritional support was given according to the MREE measured by the two methods. The nutritional and immune indexes were obtained at 0 day, 3 day, 7 day, and 14 day after nutritional support. The nutritional and immune indexes at 0 day were considered as the baseline and the differences in the nutritional and immune indexes between the baseline and 3 day, 7 day and 14 day were expressed as a "Δ". Values of Δ were compared between the two goups. Results With nutritional support for 3 days, Δalbumin,Δ prealbumin, Δthe total T lymphocytes, Δassist/induction of T cells and ΔIgG were higher in the respiratory indirect calorimetry group than in the HB coefficient group ( P<0. 05) . With nutritional support for 7 days, Δalbumin, ΔT lymphocytes, ΔIgM were higher in the respiratory indirect calorimetry group than in the HB coefficient group ( P<0. 05) . With nutritional support for 14 days, Δtransferrin, Δsuppression/cyto-toxic T cells, ΔIgG, ΔIgA, ΔC3 andΔC4 were higher in the respiratory indirect calorimetry group than in the HB coefficient group ( P<0. 05) . Conclusion Nutritional support with REE measured by respiratory in-direct calorimetry in patients with sepsis is more effective on nutritional and immune related indexes improve-ment have different degrees of improvement, thus respiratory indirect calorimetry is more suitable to guide the target energy of sepsis patients.
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Objective To investigate the effect of TNF-α on the expressions of tight junction protein ZO-1 and Claudin-4 in rat alveolar epithelial typeⅡ cells (AEC-Ⅱ).Methods Rat AEC-Ⅱ cells were culturedin vitro and divided into the control group, and TNF-α 24 h, 48 h, 72 h groups. The control group was cultured with DME F12 medium containing fetal bovine serum, and the TNF-α groups were intervened by TNF-α with a concentration of 10 ng/mL for 24 h, 48 h, and 72 h, respectively. After co-culture, the transmission electron microscopy was used to identify and observe the ultrastructural changes of rat AEC-Ⅱ cells. The cell inhibition rate was determined by MTT assay, and the cell apoptosis rate was measured by flow cytometry. The expression and distribution of tight junction protein ZO-1 and Claudin-4 in each group were observed by immunofluorescence method. The transcriptional levels of ZO-1 and Claudin-4 were detected by real-time fluorescent quantitative PCR. The expressions of ZO-1 and Claudin-4 were detected by Western blot. One-way analysis of variance (ANOVA) was used for comparisons among groups and SNK-q test was used for pairwise comparisons between groups. The non-parametric test of rank transformation was used when homogeneity of variance were not met. The value ofP<0.05 was considered significantly different.Results Transmission electron microscopy showed that the AEC-Ⅱ cells in the control group obtained characteristic lamellar bodies of different sizes. The lamellar bodies in each TNF-α group were gradually emptied and apoptotic cells were observed under the visual field. The cell inhibition rate and early apoptosis rate of each TNF-α group were significantly higher than those of the control group (allP<0.05). Confocal microscopy showed that ZO-1 was linearly distributed along the cell membrane, and Claudin-4 was scattered along the cell membrane. In the TNF-α groups, the fluorescence intensity of ZO-1 was weakened and the continuity was broken as well as the linear structure. The fluorescence intensity and density of Claudin-4 were decreased in the TNF-α groups. Besides, the transcription and expression of ZO-1 in the TNF-α 24 h group were lower than those in the control group, but there was no significant difference (P>0.05). However, the mRNA level of ZO-1 in the TNF-α 48 h group (0.28±0.06) and 72 h group (0.13±0.07) were significantly lower than those in the control group. And their protein levels of TNF-α 48 h group (0.44±0.09) and of TNF-α 72 h group (0.2±0.01) were lower than that of the control group (0.69±0.12). Compared with the control group, the transcription level (24 h: 0.16±0.03; 48 h: 0.04±0.01; 72 h: 0.01±0.00vs 1.00±0.00) and expression (24 h: 0.49±0.08; 48 h: 0.34±0.05; 72 h: 0.04±0.01vs 0.96±0.13) of Claudin-4 in each TNF-α group were significantly decreased, and showed a decreasing trend with time (allP<0.05).Conclusions TNF-α can damage the pulmonary epithelial barrier by damaging alveolar epithelial typeⅡ cells and down-regulating the expression and distribution of ZO-1 and Claudin-4.
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Objective To investigate the protective effect of carbon monoxide release molecule-2 (CORM-2) on intestinal barrier injury in shock rats. Methods Thirty-two rats were equally and randomly divided into 4 groups: the sham operated group, shock group, carbon monoxide releasing molecule-2 (CORM-2) group and inactivated CORM-2 (iCORM-2) group. A modified Wiggers model was used in inducing hemorrhagic shock. In the CORM-2 group and iCORM-2 group, the animals were intraperitoneally injected CORM-2 (5 mg/kg) or iCORM-2 (5 mg/kg) 1 h before inducing shock. The ileum tissues were harvested 24 h after operation or 24 h after inducing shock, and the histopathologic changes and ultrastructure of the ileum were observed. The expressions of ZO-1, Occludin, and Claudin3 protein in ileum intestinal mucosa were determined by Western blot. TNF-α and D-lactic acid levels in the blood were measured by enzyme-linked immunosorbent assay (ELISA). Data of multi-groups were analyzed by one way variance (ANOVA) and inter-group comparisons were made by the least significant difference (LSD)-t tests. Kruskal Wallis rank sum test was used when homogeneity of variance were not met. The value of P<0.05 was considered statistically significant. Results (1) The pathological changes and ultrastructural damage of ileum mucosa in the shock group were obvious. CORM-2 can significantly improve the pathological morphology and ultrastructural integrity of intestinal mucosa in shock rats. (2) Compared with the sham operated group, the expressions of Claudin3, Occludin, and ZO-1 of ileum intestinal mucosa were significantly decreased in the shock group and iCORM-2 group(all P<0.05), but in the CORM-2 group, only the expression of Claudin3 and ZO-1 were decreased(P<0.05). The expression of these proteins in the CORM-2 group was higher than that in the shock group and iCORM-2 group. (3) Compared with the sham operated group, the levels of D-lactic acid and TNF-α in the shock group and iCORM-2 group were significantly higher[D-lactic acid(ng/mL): 139.49 ± 28.83, 135.75 ± 25.19 vs 65.09 ± 33.16; TNF-α(pg/mL):358.60(314.18, 395.73),312.25(275.75, 345.40) vs 65.85(47.82, 84.32); all P<0.05], TNF-α value and D-lactic acid level showed increased trend in CORM-2 group, but it's not statistically significant[ D-lactic acid(ng/mL): 75.65±34.14 vs 65.09±33.16; TNF-α(pg/mL): 104.00(93.10, 131.95) vs 65.85(47.82, 84.32); all P>0.05]. The levels of D-lactic acid and TNF-αin the CORM-2 group were lower than those in the shock group and iCORM-2 group (all P<0.05). Conclusions CORM-2 may reduce the intestinal barrier damage by anti-inflammatory effects and up-regulate the expression of tight junction proteins in the intestinal epithelium.
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Objective To evaluate the difference and correlation of 24-hour energy expenditure in patients with multiple trauma receiving mechanical ventilation predicted by indirect calorimetry (IC) and HB formula. Methods 140 patients with multiple trauma receiving mechanical ventilation admitted to intensive care unit (ICU) of the General Hospital of Ningxia Medical University from December 1st, 2016 to August 31st, 2017 were enrolled. The 24-hour energy expenditure of patients was repeatedly measured at 1, 3, 5, and 7 days after ICU admission by IC method, and the 24-hour energy expenditure measured by IC method was used as the "gold standard" to calculate the 24-hour kilogram body weight energy expenditure. The 24-hour energy expenditure value measured by IC method was compared with the 24-hour energy expenditure predicted value calculated by HB formula method, the consistency of the two measurement methods was detected by Bland-Altman method, and the correlation between the two measurement methods was analyzed by Pearson method and the linear equation was fitted. Results The 24-hour energy expenditure of patients at 1, 3, 5 and 7 days after ICU was repeatedly measured by IC method for 501 times, and there was no significant difference in 24-hour energy expenditure (kJ/d: 8 163.1±1 599.4, 8 221.1±1 694.7, 8 445.8±1 756.4, 8 707.0±1 820.7, respectively, F = 2.451, P = 0.063) and 24-hour kilogram body weight energy expenditure (kJ·kg-1·d-1: 120.5±18.9, 121.4±19.7, 122.7±19.3, 121.4±19.3, respectively, F = 0.252, P = 0.860) at each time point, indicating that the first week of multi-injury patients had no significant changes in energy metabolism. The consistency between the 24-hour energy expenditure measured by IC method on the first day [(8 163.1±1 599.4) kJ/d] and that predicted by HB formula method [(6 568.8±782.0) kJ/d] was analyzed. The results showed that there was significant bias between the two methods, with an average bias of -(1 591.8±121.4) kJ/d, but the correlation analysis showed that there was a linear correlation between them (r = 0.439, P = 0.000), using one-way regression, the fitted linear equation was Y = 2 270.5+0.897X (X was 24-hour energy expenditure predicted by the HB formula). Conclusions The energy metabolism of patients with multiple trauma receiving mechanical ventilation is not obvious within 1 week. The HB formula method underestimates the 24-hour energy expenditure of patients. The prediction formula can be used to correct the HB formula and further to improve the accuracy of predicting the 24-hour energy consumption of patients.
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Objective To observe the effects of keratinocyte growth factor-2 (KGF-2) on the expressions of chemokine FKN and tight junction protein claudin-5 in lung tissue of rats with acute lung injury (ALI). Methods Healthy male Sprague-Dawley (SD) rats were randomly divided into normal saline (NS) control group, ALI model group and KGF-2 pretreatment group, with 10 rats in each group. The rat ALI model was reproduced by injection of 0.01 mL/kg oleic acid into the tail vein, and the rats in NS control group were injected with the same amount of NS. The rats in KGF-2 pretreatment group were instilled with 5 mg/kg KGF-2 in the airway at 72 hours before the model reproduction, and the rats in the NS control group and the ALI model group were instilled with the same amount of NS. The abdominal aortic blood of rats was collected at 8 hours after model reproduction, and then the rats were sacrificed, bronchoalveolar in left lung was lavage, and the bronchoalveolar lavage fluid (BALF) was collected for determination of protein levels in plasma and BALF, and the lung permeability index (LPI) was calculated. The lung tissues were harvested, after hematoxylin-eosin (HE) staining, the histopathological changes were observed under light microscope, and the ALI pathology score (LIS) was calculated. The lung wet/dry weight (W/D) ratio was determined. Immunohistochemistry and Western Blot were used to qualitatively and quantitatively analyze the expressions of FKN and claudin-5 in the lung tissue. The correlation between two variables was analyzed by linear or curve fitting correlation analysis. Results In the ALI model group, the lung tissue was severely damaged, and obvious pathological changes were observed, including thickened alveolar space and inflammatory cell infiltration, and LIS score, lung W/D ratio and LPI were significantly higher than those of the NS control group (LIS: 3.56±0.28 vs. 0.62±0.36, lung W/D ratio: 6.37±0.29 vs. 4.39±0.33, LPI: 3.46±0.69 vs. 0.98±0.17, all P < 0.01). Compared with the NS control group, the positive expression of FKN in the lung tissue of the ALI model group was significantly increased, and the expression level was significantly increased (FKN/GAPDH: 0.97±0.18 vs. 0.62±0.04, P < 0.01); the positive expression of claudin-5 was significantly decreased, and the expression level was significantly decreased (claudin-5/GAPDH: 0.56±0.11 vs. 1.06±0.13, P < 0.01). There was a significant negative correlation between FKN and claudin-5 protein expression (r = -0.817, P = 0.025). After pretreatment with KGF-2, the degree of lung tissue damage was significantly reduced, and the pathological changes were significantly improved, and the LIS score, lung W/D ratio and LPI were significantly lower than those of the ALI model group (LIS: 2.41±0.17 vs. 3.56±0.28, lung W/D ratio: 5.45±0.55 vs. 6.37±0.29, LPI: 2.42±0.19 vs. 3.46±0.69, all P < 0.01). Compared with the ALI model group, the positive expression of FKN in the lung tissue of KGF-2 pretreatment group was significantly decreased, and the expression level was significantly decreased (FKN/GAPDH: 0.79±0.03 vs. 0.97±0.18, P < 0.01); the positive expression of claudin-5 was significantly increased, and the expression level was significantly increased (claudin-5/GAPDH: 0.80±0.05 vs. 0.56±0.11, P < 0.01). There was still a significant negative correlation between FKN and claudin-5 protein expression (r = -0.847, P = 0.012). Conclusion KGF-2 may restore the expression of tight junction protein claudin-5 by down-regulating the expression of chemokine FKN, thereby reducing the damage of blood barrier in ALI.
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Objective To investigate the effects of traditional Chinese medicine colquhounia root tablet on the expression of tight junction protein claudin-2 and ZO-1 in bronchial epithelium tissues of rats with acute lung injury (ALI), and to study the mechanism of protective effect of colquhounia root tablet on ALI. Methods Twenty-four healthy male Sprague-Dawley (SD) rats were randomly divided into control group, ALI group and colquhounia root tablet pretreatment group, with 8 rats in each group. The model of ALI was reproduced by intravenous injection of oleic acid 0.04 mL/kg, and the rats in cont rol group were given the same amount of normal saline (NS) instead. The rats in colquhounia root tablet pretreatment group were intragastric administrated with colquhounia root tablet of 600 mg·kg-1·d-1 (2 mL) for 10 days before model reproduction, and the rats in control group and ALI group were given the same amount of NS. At 4 hours after model reproduction, the blood was drawn from abdominal aorta, and bronchoalveolar lavage fluid (BALF) was collected for determination of protein content in plasma and BALF, and the lung permeability index (LPI) was calculated. The rats were sacrificed to collect lung tissues for determination of lung wet/dry weight ratio (W/D), the changes in pathology of lung tissue were observed after hematoxylin and eosin (HE) staining with light microscope, and lung injury score (LIS) was evaluated. The immunohistochemic al staining was used to detect the expression and localization of claudin-2 and ZO-1 in bronchial epithelium tissues. The protein expressions of claudin-2 and ZO-1 in bronchial epithelium tissues were determined by Western Blot. Results Compared with control group, the lung injury in ALI group was more obvious including cellular edema and structural disorder of intercellular connection by optical microscope, and LIS, W/D ratio, and LPI were significantly increased (LIS: 3.81±0.42 vs. 0.40±0.08, W/D: 7.68±0.64 vs. 4.44±0.39, LPI: 0.89±0.15 vs. 0.38±0.05, all P < 0.01). Claudin-2 and ZO-1 were mainly expressed in the bronchial epithelium cell, and the expression degrees were significantly weakened in ALI group as compared with control group. It was shown by Western Blot results that compared with control group, the protein expressions of claudin-2 and ZO-1 were significantly down-regulated in ALI group [claudin-2 protein (gray value): 0.43±0.31 vs. 2.16±1.33, ZO-1 protein (gray value): 1.25±0.41 vs. 2.82±0.76, both P < 0.01]. Compared with ALI group, colquhounia root pretreatment could effectively diminish the degree of ALI (LIS: 1.22±0.39 vs. 3.81±0.42, W/D: 4.62±0.84 vs. 7.68±0.64, LPI: 0.46±0.07 vs. 0.89±0.15, all P < 0.01), and the protein expressions of claudin-2 and ZO-1 were significantly up-regulated [claudin-2 protein (gray value): 2.98±0.91 vs. 0.43±0.31, ZO-1 protein (gray value): 2.35±0.51 vs. 1.25±0.41, both P < 0.01]. Conclusion Administration of colquhounia root table could attenuate lung injury induced by oleic acid with improving epithelial barrier function via up-regulate the expression claudin-2 and ZO-1, which play a protective effect on the lung of rats with ALI.
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Objective To compare the measured resting energy expenditure (MREE) in patients with sepsis calculated using respiratory indirect calorimetry and Harris-Benedict (HB) coefficient method,and to investigate the influence of different energy target on the prognosis of patients with sepsis.Methods This was a prospective comparative study.60 patients with sepsis who were suitable for nutrition support and respiratory indirect calorimetry in the Intensive Care Unit (ICU) of the General Hospital of Ningxia Medical University from January to October 2015 were selected.(1) MREE was measured simultaneously with respiratory indirect calorimetry and HB coefficient (Harris-Benedict equation × stress coefficient) in the 60 patients on the 0,3rd,7th,and 14th days of nutrition support.The MREE calculated with the two methods were compared to detect difference.(2) The septic patients were randomly divided into two groups according to the random number table:respiratory indirect calorimetry group (n =30),in which the nutrition support was given according to the MREE measured using respiratory indirect calorimetry as the energy target;HB coefficient method group (n =30),in which the nutrition support energy target was the MREE measured using HB coefficient method.The clinical data of the patients in both groups were recorded and compared,which included the baseline characteristics,nutrition-related complications,and prognostic indicators.Results (1) Within 2 weeks during nutrition support,the dynamic MREE in the respiratory indirect calorimetry group was significantly higher than that in the HB coefficient method group (P ＜0.05).There was no significant difference in MREE on the 0,3rd,7th,and 14th days of nutrition support measured by respiratory indirect calorimetry (P ＞ 0.05).(2) There were no significant differences between the two groups in incidence of liver function damage and abnormal blood glucose within 2 weeks of nutrition support (both P ＞ 0.05).Compared with the HB coefficient method group,the length of ICU stay and 28-day mortality were significantly lower in the respiratory indirect calorimetry group [193.5 (172.2,289.7) h vs.247.5 (194.7,393.2),Z=-2.061,P=0.039;3.3％ vs.23.3％,x2 =5.129,P=0.023],but there was no significant difference between the two groups in mechanical ventilation time (P ＞ 0.05).Conclusions The MREE of septic patients may be considerably high and with little fluctuation in a short period.Respiratory indirect calorimetry may be more suitable to guide the energy intake target in septic patients.
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Objective To evaluate the effect of colquhounia root tablet on the expression of tight junction proteins claudin-5 and ZO-1 in the renal tissues of rats with acute lung injury (ALI).Methods Twenty-four healthy male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),ALI group;and colquhounia root tablet group (group H).Oleic acid 0.04 ml/kg was injected into the trail vein to establish the model of ALI.In group H,colquhounia root tablet 600 mg · kg-1 · d-1 was instilled into the stomach of each rat for 10 consecutive days,and oleic acid was injected at 1 h after instillation on 10th day.Blood samples were collected from the abdominal aorta at 6 h after injection of oleic acid for determination of plasma creatine (Cr) and blood urine nitrogen (BUN) concentrations.The animals were then sacrificed.The lungs were removed for determination of wet/dry lung weight ratio (W/D ratio),and for examination of the pathological changes.The kidneys were removed for determination of the expression of claudin-5 and ZO-1 (by immunohischemistry assay and Western blot) and for examination of the pathological changes.The damage to the renal tubules was scored.Results Compared with group C,W/D ratio,plasma Cr and BUN concentrations,and renal tubular damage score were significantly increased,and the expression of claudin-5 and ZO-1 was down-regulated in group ALI (P＜0.01).Compared with group ALI,W/D ratio,plasma Cr and BUN concentrations,and renal tubular damage score were significantly decreased,and the expression of claudin-5 and ZO-1 was up-regulated in group H (P＜0.01).The pathological changes of lungs and kidneys were significantly attenuated in group H as compared with group ALI.Conclusion Colquhounia root tablet can attenuate kidney injury through up-regulating the expression of tight junction proteins claudin-5 and ZO-1 in the renal tissues of rats with ALI.
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Objective To investigate the influencing factors of successfully switching to sequential ventilation in patients with prolonged weaning due to acute respiratory failure (ARF) after thoracolaparotomy based on the initial rapid shallow breathing index (RSBI) at 60 min after spontaneous breathing trial (SBT), namely, the f/VT optimal value range of 80-120 times/ (min · L), thus providing the basis for determining the ideal timing of weaning in clinical practice.Methods A prospective observational study of sequential ventilation [RSBI during the initial SBT (60 min), 80-120 breaths/ (min · L)] was carried out in 42 patients on mechanical ventilation (≥ 48 h) due to post-thoracolaparotomy ARF in the ICUs.According to the duration of the mechanical ventilation, the patients were divided into 2 groups : successfully prolonged weaning group (≥ 7 days, n =24) and refractory weaning group (＜ 7 days, n =18).The patients with cardiac failure, aged less 18 or over 80, with hepatic dysfunction, or those needing gastrointestinal decompression after esophageal surgery or upper abdomen surgery were excluded.The demographics, APACHE Ⅱ scores and duration of mechanical ventilation of both groups were recorded, and the respiratory work and oxygen metabolism variables before the switch to sequential ventilation (within 24 hours after admission to ICU) and at the time of switching (24 hours in the ICU after admission) were recorded, respectively: clinical puhnonary infection score (CPIS), assessment of cough severity, pH, PaO2, PaCO2 and PaO2/FiO2;hemodynamic and microcirculation-related variables: HR, MAP, fluid balance, BNP and Lac;endocrine and metabolism variables : Hb, ALB and random serum cortisol (COR).The clinical features and the changes of the above-mentioned variables before and at the time of switching were compared between both groups.The independent sample t test was used for the single factor comparison and Mann-Whitney U test was applied to the non-normal distributions.The Fisher exact probability test was used for the single factor comparison of ranked data such as categorical variables.Results There were no significant differences in age, gender and severity of disease between two groups (P ＞ 0.05);the successfully prolonged weaning group had longer duration of invasive mechanical ventilation and ICU stay compared with the refractory weaning group (P ＜ 0.05).There were significant differences in cough severity, PaCO2, pH, HR and fluid balance between two groups before switching (P ＜ 0.05).Compared with those before switching, in the refractory weaning group there were marked decrease in Lac (P ＜ 0.05), obvious increase in cough severity, pH, Hb and ALB (P ＜ 0.05), but there was no significant difference in COR (P ＞ 0.05);while in the successfully delayed weaning group, there were significant decrease in CPIS, PaCO2, HR, MAP, BNP, fluid balance and Lac (P ＜ 0.05), and cough severity, pH, ALB and COR showed an upward trend (P ＜ 0.05).Conclusions The key of successful sequential ventilation is within the values of RSBI ranging from 80 to 120 times/ (min · L) during the initial SBT (60 min) selected as the switching point in patients with prolonged weaning after thoracolaparotomy.The major influencing factors for determining the ideal timing of switching include the matching status between respiratory endurance and respiratory work, the balance between myocardial strength and both cardiac preload and afterload, the severe disease associated with adrenal insufficiency, and malnutrition.
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Objective To observe the clinical findings about the endothelial cell injury related to the genesis of inflammatory cytokines and coagulation.Methods A total of 70 critically ill patients with SIRS (systemic inflammatory response syndrome) admitted to intensive care unit (ICU) between September 2009 and February 2010 were enrolled for a prospective and control study.According to diagnostic criteria of Sepsis/SIRS,the patients were divided into two groups:sepsis group (n =38) and SIRS group (n =32),and another 20 healthy volunteers served as control group.Patients in the sepsis group and SIRS group were matched by clinical signs of high blood pressure,diabetes and its complications.The demographics of patients including age,sex,body mass index (BMI),smoking and alcohol addict were comparable among the different groups.The 6 ml peripheral blood samples were collected within 24 h after admission to ICU for enzyme-linked immunosorbent assay (ELISA) to detect the plasma levels of s-CD62P,TNF-α,and hsCRP.And variables of coagulation function such as platelet (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),D-dimer and antithrombin-Ⅲ (AT-Ⅲ) were analyzed during 24 h after admission to ICU.Meanwhile sequential organ failure assessment (SOFA) score of critically ill patients was evaluated.Data were expressed in mean ± standard deviation and were statistically analyzed by using SPSS 17.0 statistical software.The differences in plasma levels of s-CD62P of patients in each group were analyzed by ANOVA and Kruskal Wallis test.The relationship between s-CD62P and inflammatory cytokines as well as with coagulation were determined by Pearson correlation analysis.Changes were considered as statistically significant if P value was less than 0.05.Results ① Compared with control group and SIRS group,the levels of s-CD62P,TNF-α and high sensitive C-reactive protein (hs-CRP) were significantly higher in sepsis group (P ＜ 0.05).② The plasma levels of D-dimer,PT,APTT in sepsis group and SIRS group were significantly higher than those in control group,while the platelet count (PLT) and the activity of AT-Ⅲ were obviously lower (P ＜ 0.05).③ In sepsis group,the plasma levels of hs-CRP and TNF-α positively correlated with PT,APTT,D-dimer,and negatively correlated with AT-Ⅲ,PLT (P ＜ 0.05).④ Plasma levels of s-CD62P were significantly correlated with plasma levels of TNF-α,hs-CRP,D-dimer,PT,APTT,whereas correlated negatively well with PLT,AT-Ⅲ (P ＜ 0.05).Conclusions The plasma s-CD62P concentration is elevated as a early biomarker in patients with sepsis,and it acted as one of pathogenic factors responsible for endothelial cell damage.Coagulation and mediators of inflammation promotes each other,aggravating the severity of the sepsis.The plasma s-CD62P may be the important factor associated with initiation of coagulation development and inflammatory reaction.
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Objective To study the leukocyte adhesion molecules in the pathogrnesis of ALI and ARDS.Methods The positive expression rates of CD11a、CD11b and CD18 in peripheral blood were quantitatively analyzed by flow cytometry using monoclonal antibodies in 26 cases of ALI,18cases of ARDS and 15 healthy controls.Results The expression rates of CD11a、CD11b and CD18 in polymorphonuclear neutrophils and monocytes from the ALI group and ARDS group were much higher than those in the control group(P
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Objective: To investigate the relationship of intercellular adhesion molecule-1(ICAM-1) and E-selectin with the pathogenesis of chronic obstructive pulmonary disease(COPD). Methods: The serum soluble ICAM-1(sICAM-1) and E-selectin(sE-selectin) and tumor necrosis factor-?(TNF-?) from 45 exacerbated COPD patients,35 stable patients and 30 healthy as controls were measured by double antibody sandwich quantitative enzyme linked immunosoebent assay(ELISA). Results: The levels of both sICAM-1 and sE-selectin in the exacerbated group were significantly higher than those in the control(P
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AIM:To study the effects of colquhounia root tablet on the expression of adhesion molecule in acute lung injury of rats. METHODS: The rats were divided into 3 groups: ALI group, colquhounia root tablet+ALI group and control group . ALI animal model was performed by treatment with oleic acid. The positive expression rates of CD11a, CD11b and CD18 in polymorphonuclear neutrophils and monocytes were analyzed by flow cytometry. ICAM-1 expression in lung tissue was determined by immunohistochemistry, histopathological examination and biological markers were measured from lung specimens.RESULTS: Colquhounia root tablet decreased the expression of CD11a, CD11b and CD18 in polymorphonuclear neutrophils and monocytes, and ICAM-1 in lung tissue (P
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Objective To study the protective effects of colquhounia root tablet against oleic acid-induced acute lung injury (ALI) .Methods Forty-eight healthy Wistar rats weighing 200-250 g were randomly divided into 3 groups: ALI group ( n = 18) ; colquhounia root tablet group ( n = 18) and control group ( n = 12) . The animals were anesthetized with intraperitoneal 2% pentobarbital. ALI was induced by intravenous injection of oleic acid 0.04 ml?kg-1. In colquhounia root group colquhounia root tablet 300 mg?kg-1 was instilled into the stomach twice a day for 10 days before Ⅳ oleic acid injection. In control group normal saline 0.04 ml?kg-1 was given Ⅳ instead of oleic acid. The animals were killed 4h after intravenous oleic acid. Blood was collected from left ventricle immediately before the animals were killed for determination of expression of CD11a, CD11b and CD18 in neutrophils, monocytes and lymphocytes by flow cytometry using monoclonal antibodies. The lungs were immediately removed and left lung was lavaged via left main bronchus. Broncho-alveolar lavage fluid (HALF) was collected, WBC count in BALF and the percentage of active neutrophils were determined. Lung permeability index (BALF protein concentration/plasma protein concentration) was calculated. Results The expression of CD11la, CD11b and CD18 in neutrophils and monocytes, the lung permeability index, the WBC count and percentage of active neutrophils in BALF were significantly higher in ALI group than in control group. Colquhounia root tablet pretreatment significantly attenuated the changes induced by Ⅳ oleic acid. Conclusion Colquhounia root tablet pretreatment can effectively protect the animals from oleic acid induced ALI by downregulation of the expression of CD11a / CD18 and CD11b / CD18 in WBC.