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Objective:To investigate the value of growth differentiation factor-15 (GDF-15) and extravascular lung water index (EVLWI) in severity grading and prognosis prediction of patients with acute respiratory distress syndrome (ARDS).Methods:Patients with ARDS aged 18-75 years admitted to the department of respiratory intensive care unit (RICU) of Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to February 2020 were enrolled. All patients were treated with conventional therapies such as mechanical ventilation, anti-infection, stabilization of water, electrolytes and acid-base environment, blood purification and nutritional support according to their conditions. Besides, the pulse-indicated continuous cardiac output (PiCCO) was performed after admission to the department, and EVLWI before treatment and at 24, 48 and 72 hours of treatment were recorded. Serum GDF-15 level was measured by enzyme linked immunosorbent assay (ELISA) during the same period. Patients were classified as mild, moderate, and severe degree according to the 2012 Berlin Definition of ARDS, and EVLWI and GDF-15 levels in patients with different disease levels before and after treatment were compared. In addition, the length of intensive care unit (ICU) stay, ICU mortality, and 28-day mortality of patients with different GDF-15 or EVLWI levels were analyzed comparatively, with the GDF-15 3 458 ng/L and EVLWI 15 mL/kg as the cut point.Results:A total of 82 patients with ARDS were enrolled, including 22 patients with mild ARDS, 28 patients with moderate ARDS, and 32 patients with severe ARDS. The GDF-15 and EVLWI levels in patients with moderate and severe ARDS at each time point before and after treatment were higher than those in patients with mild ARDS. Both GDF-15 and EVLWI levels in patients with severe ARDS were higher than those in the patients with moderate ARDS. The differences were statistically significant at all the time points except for the difference of GDF-15 levels at 24 hours after treatment (ng/L: 3 900.41±546.43 vs. 3 695.66±604.73, P > 0.05). [GDF-15 (ng/L): 3 786.11±441.45 vs. 3 106.83±605.09 before treatment, 3 895.48±558.96 vs. 3 333.29±559.66 at 48 hours, 3 397.33±539.56 vs. 3 047.53±499.57 at 72 hours; EVLWI (mL/kg): 19.06±1.91 vs. 14.31±1.50 before treatment, 18.56±2.23 vs. 13.26±1.69 at 24 hours, 17.23±1.76 vs. 12.45±1.36 at 48 hours, 15.47±1.81 vs. 11.13±2.19 at 72 hours, all P < 0.05]. According to the cut-off value, there were 23 patients with GDF-15 ≥ 3 458 ng/L and GDF-15 < 3 458 ng/L respectively and there were 23 patients with EVLWI ≥ 15 mL/kg and EVLWI < 15 mL/kg respectively. The length of ICU stay and 28-day mortality in patients with high GDF-15 were significantly higher than those in patients with low GDF-15 [length of ICU stay (days): 21.22±2.69 vs. 15.37±3.14, 28-day mortality: 56.5% vs. 21.7%, both P < 0.05]. The length of ICU stay and 28-day mortality in patients with high EVLWI were also significantly higher than those in patients with low EVLWI [length of ICU stay (days): 18.45±2.61 vs. 14.98±2.75, 28-day mortality: 47.8% vs. 17.4%, both P < 0.05]. Conclusion:To some extent, GDF-15 and EVLWI levels reflect the severity of patients with ARDS, and high GDF-15 and EVLWI levels are significantly associated with poor prognosis in patients with ARDS.
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Objective To observe the effect of autophagy inhibitor on the activation of alcohol induced hepatic stel-late cells, and the mechanisms thereof. Methods HSC-T6 cells were cultured in vitro and divided into four groups, includ-ing blank control group, alcohol group, 5 mmol/L 3-MA+alcohol group (low alcohol group) and 10 mmol/L 3-MA+alcohol group (high alcohol group). RT-PCR was used to detect the expression levels ofα-smooth muscle actin (α-SMA) and typeⅠcollagen. The levels of LC3Ⅱ,α-SMA and typeⅠcollagen were detected by Western blot assay. The cell viability of HSC-T6 was detected by MTT assay. Results The mRNA expressions ofα-SMA, typeⅠcollagen and the protein of expressionsα-SMA, typeⅠcollagen and LC3Ⅱwere significantly up-regulated in alcohol group compared with those of control group (P<0.05), while the expressions of those parameters were significantly down-regulated in 10 mmol/L 3-MA+alcohol group (P<0.01). The mRNA and protein levels ofα-SMA and typeⅠcollagen were significantly decreased in two 3-MA-treated groups compared with those in alcohol group (P<0.05). Meanwhile, compared with the 5 mmol/L 3-MA+alcohol group,the protein expressions ofα-SMA, typeⅠcollagen and LC3Ⅱwere significantly decreased in10 mmol/L 3-MA+alcohol group (P < 0.05 ). Compared with the alcohol group,there was significantly lower proliferation activity in all two 3-MA-treated groups (P<0.05). Conclusion 3-MA can inhibit the protein expression of LC3Ⅱ,α-SMA and typeⅠcollagen induced by alcohol in HSC-T6 cells, and inhibit the proliferation of HSC cells.
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Objective To investigate the effect of penehyclidine hydrochloride (PHC) on iNOS expression in lung in septic mice.Methods Female KM mice were subjected to cecal ligation and puncture (CLP,a model of polymicrobial sepsis) or shame operation.Thirty-six KM mice weighing 20～25 g were randomly assigned into three groups:shame CLP group,CLP group and PHC group.Mice in PHC group were given PHC 0.45 mg/kg intraperitoneally at 1 h before CLP. Six hours after CLP,the lungs of each group were sampled for light and electronic microscopy.The expression of iNOS mRNA in lung tissue were detected by in situ hybridization.The survival rates were observed at 24 h after the operation. Results The CLP group was observed thickened alveolar septa,as well as mitochondrial cristae swelling and mitochondrial vacuolation under electronic microscope.Emptied lamellar bodies could be also found.Histology of lung in PHC group had little changed.Expression of iNOS in lung in PHC group was significantly lower than that of the CLP group.At 24 h after CLP challenge,70.0% of the PHC mice lived,remarkably increased compared with that of the CLP group (26.7%),P＜0.05.Conclusion PHC had effective effect for increasing the survival rates of septic mice,inhibiting the expression of iNOS and reducing the severity of lung injury.
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0.05)was found in the2groups.The costs of the2groups were1059.73yuan(RMB)?2304.26yuan(RMB)respectively;the cost-effectiveness ratios of the2groups were11.62?25.70respectively;the total cost in the course of treatment for the pantoprazole group was1244.53yuan(RMB)less than the omeprazole group.In the sensitivity analysis,the cost-effectiveness ratios of the2groups were10.51?23.22respectively.CONCLUSION:Pantoprazole is an economical and effective drug for the prevention of stress ulcer in ICU patients.
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Objective To determine if stimulation of cholinergic anti-inflammatory pathway mediated by vagus can protect liver against sepsis.Methods Male SD rats weighing 250-300 g were anesthetized with intraperitoneal methane 1g?kg~(-1).Left common carotid artery,was cannulated for MAP monitoring and blood sampling.Sepsis was produced by ligation of cecum which was punctured twice at an interspace of 3 mm with a 9G needle(CLP).Bilateral vagus nerves were isolated,ligated with 4-0 silk and cut(VGX).The distal end of the vagus nerve was stimulated with direct current(5V,2 ms,1 Hz)continuously for 20 min(STM).Forty animals were randomly divided into 4 groups(n=10 each):group Ⅰ sham operation;group Ⅱ CLP;group Ⅲ CLP + VGX and group Ⅳ CLP+VGX+STM.Arterial blood samples were obtained at 0,1,2 and 4 h after operation for determination of plasma TNF-? concentration and serum ALT and AST activities.The animals were then killed and the livers removed for ultrastructure examination with electron microscope.Results Electrical stimulation of the distal end of vagus nerve significantly attenuated the significant decrease in MAP and increase in plasma TNF-? concentration and serum AST and ALT activities and the damage to the organelle in the liver cell induced by sepsis.Conclusion Our results show that electrical stimulation of vagus nerve can protect liver from sepsis to some extent through cholinergic anti-inflammatory pathway.