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OBJECTIVE@#To explore the effect of carvacrol on the biological behavior of leukemia cells and its regulation to circ-0008717/miR-217 molecular axis.@*METHODS@#Human acute lymphoblastic leukemia cells Molt-4 were cultured in vitro, and different concentrations of carvacrol were added to the cells. si-NC and si-circ-0008717 were transfected into Molt-4 cells (si-NC group, si-circ-0008717 group). pcDNA, pcDNA-circ-0008717, anti-miR-NC, anti-miR-217 were transfected into Molt-4 cells and then added to carvacrol-treated cells (carvacrol+pcDNA group, carvacrol+pcDNA-circ-0008717 group, carvacrol+anti-miR-NC group, carvacrol+anti-miR-217 group). MTT, plate clone formation experiment, and flow cytometry were used to detect the viability of the cell, colony formation number, and apoptosis rate of cells, respectively. The RT-qPCR method was used to detect the expression levels of circ-0008717 and miR-217. The dual luciferase reporter gene experiment was used to detect the targeting relationship between circ-0008717 and miR-217.@*RESULTS@#After carvacrol treatment, the cell viability decreased significantly (r=-0.9405), expression level of circ-0008717 decreased (r=-0.9117), colonies formed number decreased (r=-0.9256), while the cell apoptosis rate increased (r= 0.8464), and the expression level of miR-217 increased (r=0.9468). Compared with the si-NC group, the expression level of miR-217 in si-circ-0008717 group increased (P＜0.001), the cell apoptosis rate increased (P＜0.001), while cell viability decreased (P＜0001), the number of colonies formed decreased (P＜0.001). Compared with the carvacrol+pcDNA group, the cell viability of the carvacrol+pcDNA-circ-0008717 group increased (P＜0.001), the number of colonies formed increased (P＜0.001), while the cell apoptosis rate decreased (P＜0.001). circ-0008717 could target miR-217. The cell viability of the carvacrol+anti-miR-217 group increased (P＜0.001), and the number of colonies formed increased (P＜0.001), while the cell apoptosis rate decreased (P＜0001) as compared with the carvacrol+anti-miR-NC group.@*CONCLUSION@#Carvacrol can promote the expression of miR-217 by down-regulating the expression of circ-0008717, thereby reducing the proliferation and cloning ability of leukemia cells and promoting cell apoptosis.
Subject(s)
Humans , Antagomirs , Apoptosis , Cell Line, Tumor , Cell Proliferation , Cymenes , Leukemia , MicroRNAs/geneticsABSTRACT
Objective To investigate the pathogenesis of early biotrauma in ventilator-induced lung injury (VILI).Methods Twenty-four 8-week-old male specific-pathogen-free Sprague-Dawley (SD) rats weighing 250-300 g were randomly divided into sham group (S group), conventional mechanical ventilation group (L group) and high tidal volume (VT) mechanical ventilation group (H group) with 8 rats in each group. All rats received tracheostomy after anesthesia. Rats in S group received no mechanical ventilation but breathe room air spontaneously. All other parameters of the ventilator were the same in both mechanical ventilation groups, and the fraction of oxygen was set to 0.21, the rats in L group received 7 mL/kg VT, and those in H group received 28 mL/kg VT. Four hours after ventilation all rats were sacrificed and the lung tissues were harvested for wet/dry (W/D) ratio. Pathological injury score was evaluated by hematoxylin and eosin (HE) staining. Transferase-mediated deoxyuridine triphosphate-biotin nick end labeling stain (TUNEL) was performed to count the apoptosis cell in lung epithelial. Western Blot was performed to evaluate hemi-channel protein Pannexin-1 expression in lung homogenate. Bronchoalveolar lavage fluid (BALF) was collected, and the concentration of lactate dehydrogenase (LDH), isoprostane, adenosine triphosphate (ATP) and white cell count in BALF were measured. Yo-pro-1/propidium iodide (PI) double stain was performed to evaluate early apoptosis cell in BALF.Results There was no significant difference in lung injury between S group and L group. Compared with S group and L group, rats in H group showed significant lung injury, represented as alveolar rupture, inflammatory cell infiltration, interstitial edema and airway epithelial exfoliation, and the lung W/D ratio was increased significantly (5.1±0.2 vs. 4.4±0.2, 4.3±0.4, bothP< 0.01), pathological score was significantly increased [4.00 (4.00, 8.00) vs. 1.00 (0, 4.00), 2.00 (0, 4.75), bothP< 0.01], the white cell in BALF was significantly increased (×106/L: 2.97±0.46 vs.1.03±0.26, 0.79±0.19, bothP< 0.01), the level of LDH was significantly increased (U/L: 148.6±38.2 vs. 34.4±13.5, 78.6±13.9, bothP< 0.01), and the expression of Pannexin-1 in lung homogenate was significantly increased (Pannexin-1/GAPDH: 0.89±0.21 vs. 0.48±0.25, 0.61±0.17, bothP< 0.01), the ATP concentration in BALF was also significantly increased (nmol/L: 456.84±148.72 vs. 19.23±13.34, 113.26±57.90, bothP< 0.01). There was no significant difference in the apoptosis cell in lung tissue or the apoptosis cell rate, isoprostane level in BALF among the three groups [apoptosis cell in lung (cells/HP): 4.00 (3.00, 5.00) vs. 5.00 (4.00, 6.00), 4.00 (3.25, 6.00); apoptosis cell rate in BALF: (0.57±0.20)％ vs. (0.42±0.16)％, (0.58±0.19)％; isoprostane in BALF (μg/L): 3.85±0.46 vs. 3.83±0.60, 3.59±0.69, allP > 0.05].Conclusion The early pathogenesis of biotrauma in VILI is related to the release of inflammation mediator via membrane channel after activating by pressure stress, but not apoptosis and lipid peroxidation.
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Objective To investigate the regulative effect of hemichannels protein Pannexin-1 on P2X7 receptor activation and caspase-1 mediated inflammatory response in the lungs of mice with lung injury. Methods Sixty male C57BL/6 mice were randomly divided into five groups with 12 mice in each group: sham operation group (Sham group), mechanical ventilation (MV) group, MV + low dose lipopolysaccharide (LPS) group (MLL group), MV + medium and high dose LPS group (MML group) and MV + high dose LPS group (MHL group). A "two-hit" lung injury model was reproduced by MV with high tidal volume combined with LPS injection in airway. All the mice underwent tracheotomy and intubation. After operation, the mice in Sham group were maintained spontaneous breathing, and those in other four groups were put on small animal ventilators to give MV with a large tidal volume of 28 mL/kg. After stable respiration in mice, those in the Sham group and MV group were injected 8 mL/kg of normal saline (NS) into the airway, and those in MLL, MML and MHL groups were given 2, 5 and 8 mg/kg of LPS respectively (diluted with NS into 8 mL/kg). After 4 hours on MV, the mice were sacrificed, and bronchoalveolar lavage fluid (BALF) was extracted to determine intracellular and extracellular ATP concentration. Lung tissue was harvested and water containing ratio of lungs was measured. The degree of lung pathological damage was observed after hematoxylin-eosin (HE) staining, and lung injury score was calculated. The expression of Pannexin-1 protein in lung tissue was calculated with immunohistochemistry. Western Blot and fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR) were used to detect the protein and mRNA expressions of Pannexin-1, P2X7 receptor, caspase-1 and interleukin-1β (IL-1β). Results There was no obvious pathological change in lung tissue in Sham group, intracellular ATP concentration was higher than extracellular ATP concentration, water content in lung tissue was lower, Pannexin-1 expression was low in lung tissue by immunohistochemical staining, and Pannexin-1, P2X7 receptor, caspase-1 and IL-1β were only expressed in micro-protein and mRNA in lung tissue. Compared with the Sham group, the alveolar lesions and hemorrhages in the MV group were not obvious, and lung injury score was slightly increased. There was no significant fluctuation between intracellular ATP concentration and extracellular ATP concentration. The water content in lung tissue was increased significantly, while the expressions of Pannexin-1, P2X7 receptor, caspase-1 and IL-1β in lung tissue were increased slightly. After LPS intervention, progressively increased lung exudation, ruptured alveoli, dilated capillaries, and inflammatory cells were found, and lung injury score was increased without significant difference among the three LPS doses groups. With the increase in LPS dosage, the concentration of extracellular ATP in BALF was increased, the concentration of intracellular ATP was decreased, the water containing ratio of lung tissue was increased gradually, and the protein and mRNA expressions of Pannexin-1, P2X7 receptor, caspase-1 and IL-1β in lung tissue were increased gradually in a dose-dependent manner. The parameters in MHL group showed significant differences as compared with those in MV group [lung injury score: 8.25±0.45 vs. 3.50±0.52; intracellular ATP concentration (μmol/L): 198.76±150.77 vs. 896.69±281.11, extracellular ATP concentration (μmol/L): 336.57±90.28 vs. 141.52±42.22; lung water containing rate: (6.37±0.11)% vs. (5.05±0.14)%; Pannexin-1 protein (gray value): 3.20±0.70 vs. 1.54±0.76, Pannexin-1 mRNA (2-ΔΔCT): 7.86±0.86 vs. 2.47±0.92; P2X7 receptor protein (gray value): 3.18±0.88 vs. 1.80±0.72, P2X7 receptor mRNA (2-ΔΔCT): 7.17±0.96 vs. 2.31±0.45; caspase-1 protein (gray value): 3.00±0.45 vs. 0.93±0.51, caspase-1 mRNA (2-ΔΔCT): 4.39±0.91 vs. 2.74±0.41; IL-1β protein (gray value): 2.54±1.08 vs. 1.16±0.53, IL-1β mRNA (2-ΔΔCT): 132.34±41.48 vs. 19.67±8.67; all P < 0.05]. Conclusion Pannexin-1 may be involved in LPS and MV induced lung injury, which may be regulated by intracellular release of ATP to the extracellular site and binding to P2X7 receptor on the cell surface, thereby regulating active caspase-1 production and release, involving in the production of IL-1β and other inflammatory factors eventually which leads to the occurrence and development of lung injury.
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Objective To observe the relationship between vitamin D3 and the severity as well as prognosis in patients with sepsis, and to explore whether exogenous vitamin D3 can improve the prognosis in patients with sepsis.Methods A prospective randomized double-blind placebo study was conducted. Fifty-seven patients with sepsis admitted to intensive care unit (ICU) of Shengjing Hospital Affiliated to China Medical University from March to November in 2015 were enrolled. Twenty patients with systemic inflammatory response syndrome (SIRS) and 20 healthy volunteers with normal physical examination as control were enrolled during the same time. Patients with sepsis were divided into general sepsis group and severe sepsis group (including septic shock) according to the criteria for the diagnosis of severe sepsis and septic shock in 2012. According to the diagnostic criteria established by the American Endocrine Society, and on the basis of 25-hydroxy vitamin D3 [25(OH)D3], the sepsis patients with deficiency [25(OH)D320-30μg/L] or insufficiency [25(OH)D3 0.05). It was shown by Kaplan-Meier survival curve analysis that there was no significance in 28-day accumulated survived rate between the two groups [log-rank test: χ2 = 0.222,P = 0.638]. It was shown by multivariate Cox regression analysis that APACHE Ⅱ score [relative risk (RR) = 8.487, 95% confidence interval (95%CI) = 1.506-47.835, P = 0.015] and 25(OH)D3 < 20μg/L (RR = 0.088, 95%CI = 0.013-0.592,P = 0.012) were the risk factors of prognosis in patients with sepsis.Conclusions The serum 25(OH)D3 level in ICU patients with sepsis was lower than that in healthy people, but there was no significant difference between patients with sepsis and SIRS. The serum 25(OH)D3 level in sepsis patients was related with gender, and the level of the female was lower than that of the male, but was not related with age. Exogenous vitamin D3 supplementation cannot improve the prognosis of ICU patients with sepsis. APACHE Ⅱ score and 25(OH)D3 < 20μg/L were risk factors for the prognosis in ICU patients with sepsis.
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Objective To develop a kind of rapid decompression equipment replacing the toughened glass simulating the state of aircraft cabin glass bursting on the fly.Methods The metallic membrane was used to isolate both chambers with different air pressures.The areas of decompression membrane and path were determined by calculating on the basis of aircraft decompression altitude,cabin pressure differential and decompression time.The structural strength was determined according to enduring force of the metallic membrane.The membrane was ejected by high pressure air using the ejection launch technology of aircraft missile.The result of simulating aircraft cabin glass bursting on the fly was achieved.Results The rapid decompression equipment ejected by air pressure in low-pressure chamber could achieve the state of simulating aircraft cabin glass bursting on the fly,and the best decompression time was 0.16 s.Conclusion The rapid decompression equipment ejected by air pressure accomplishes the decompression preparative in short time with easy operation,and can satisfy the desired requirements for the performance and precision.
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Objective To analysis the characteristics of thromboelastography and coagulation test in patients with advanced pregnancy combined with severe preeclampsia. Methods A retrospective single?center study was conducted. 35 patients with advanced pregnancy combined with se?vere preeclampsia who were admitted to hospital from January 2012 to December 2014 were analyzed compared to 43 third trimester patients with?out any complication. All the patients were treated based on the routine strategy. Blood sample were taken from the middle elbow vein to test blood cell count,serum biochemistry test,routine coagulation test and thromboelastography. All the results,including R,K,CI,α?angle and MA value, were compared between two groups. Analysis was performed to evaluate the correlation between all parameters of TEG and coagulation test. Re?sults There was no statistical significance between two groups in age ,prothrombin time and activated partial prothrombin time. In the severe pre?eclampsia group,the R value of TEG was increased(5.21±1.20 min vs 6.19±1.55 min,t=-3.144,P=0.002),α?angel was decreased(64.43°± 7.90° vs 60.37°±7.09°,t=2.367,P=0.02),and CI was decreased(0.81±2.27 vs-0.37±1.82,t=2.495,P=0.015). In blood cell count test,the platelets count was decreased in severe preeclampsia group[(217.48±65.68)×109/L vs(166.65±61.39)×109/L,t=3.500,P=0.001]. In routine coagulation test,only thrombin clotting time was increased in severe preeclampsia group(14.59±0.51 s vs 15.28±0.97 s,F=-3.800,P<0.001). In serum biochemistry test,the albumin was decreased in severe preeclampsia group(34.75±3.90 g/L vs 28.77±4.05 g/L,t=6.632,P<0.001),while serum urea nitrogen was increased(2.78±0.87 mmol/L vs 5.98±8.07 mmol/L,F=-2.333,P=0.026). In correlation analysis,thrombin clot?ting time had relationship between R(r=0.290,P=0.010),CI(r=-0.257,P=0.023)andα?angle(r=-0.243,P=0.032). Platelets count cor?related with CI(r=0.383,P=0.001),K(r=-0.409,P<0.001),α?angle(r=0.375,P=0.001)and MA(r=0.512,P<0.001). Conclusion For those who suffered from severe preeclampsia patients with advanced pregnancy,low coagulation function occurs in most of the patients com?pared to those patients without any complications. Thromboelastography may be helpful for those who have high risk factors ,especially with low platelets count and increased thrombin clotting time ,so as to reduce the incidence of bleeding or thromboembolic diseases.
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Objective To analyze blood stream infections(BSI)in ICU patients,to explore the bacterial spectrum characteristics and time distribu?tion,so as to provide a reference for the clinical use of antibiotics. Methods A retrospective analysis was carried out. A total of 1 330 patients admit?ted in our hospital intensive care unit(ICU)from January 2012 to March 2013(15 months)were selected for the study,the occurrence rate of blood stream infections,the bacteria spectrum of it and the bacteria spectrum distribution in different period of time(admitted in ICU for the first week,sec?ond week and later)were analyzed. The subjects were divided into 2 groups(CVC cases and non?CVC cases)depended on CVC indwelling or not. Results There were 971 cases with central venous catheter(CVC),the occurrence of bloodstream infection were 96 cases,the infection rate was 9.89%,including 359 non?CVC cases and 12 blood stream infection cases. The infection rate was 3.34%,and the total blood infection rate was 8.12%. A total of 157 strains of pathogen were isolated,among which 16 strains were isolated from non?CVC cases. Infection of gram?negative bacilli, gram?positive cocci and fungi were 56.7%,32.5%and 10.8%,respectively. Staphylococcus(16.6%),Bauman acinetobacter(15.9%),Enterococ?cus(14.6%),Pseudomonasaeruginosa(10.2%)and Klebsiella(10.2%)were the most common bacteria. For the distribution of time,in non?CVC cases gram?negative bacilli were more than other bacilli in the first and second week(3 vs 1,4 vs 1)in ICU,more gram?positive cocci( 5 vs 2) were isolated after two weeks,no fungi were detected;in CVC cases,gram negative bacilli were in a dominant position all the time(the number of gram negative bacilli,gram positive bacteria and fungi were 31 cases,24 cases and 3 cases in the first week respectively,23 cases,12 cases,11 cas?es in the second week,26 cases,8 cases and 3 cases after the second week),the proportion of each species in the first week were 53.4%,41.4%and 5.2%,respectively,50%,26.1%and 23.9%in the second week,70.3%,21.6%and 8.1%after the second week . The highest fungemia was found in the second week. Conclusion For the 1st 2 weeks in ICU,the most common bacilli was gram negative bacilli with BSI. After 2 weeks admitted in the ICU,it was mainly gram negative bacilli in CVC cases,and mainly gram positive cocci in non?CVC cases. In the 2nd week,fungemia had the? highest probability in CVC cases,and it appeared low possibility in non?CVC cases. Non?CVC cases have a lower risk of blood stream infection.
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Objective To analyze pathogen spectrum of intra-abdominal infection in patients in an intensive care unit (ICU).Methods Intra-abdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results 283 patients developed intra-abdominal infection,incidence of infection was 21.28%;133 (47.00%)patients were detected 186 isolates of pathogens,the proportion of gram-negative bacilli, gram-positive cocci,and fungi were 68.82%(n=128),28.49%(n= 53),and 2.69%(n=5)respectively.The major gram-negative bacilli were Escherichia coli ,Acinetobacter baumannii ,and Klebsiella pneumoniae ,the major gram-positive cocci were Enterococcus faecium,Staphylococcus aureus ,and Enterococcus faecalis .The detection rates of pathogens after patients stayed in ICU for ≤2,3-7,8-14,and>14 days were 70.43%(n=131),12.90%(n=24),10.22%(n=19), and 6.45%(n =12)respectively;Escherichia coli (n =51 )and Enterococcus faecium (n =21 )were the main pathogens when patients stayed in ICU for ≤48 hours,Acinetobacter baumannii was the main pathogen when patients stayed in ICU for >48 hours.Most intra-abdominal infection occurred after intestinal tract(53.23%)and hepatobiliary system operation (24.19%).39 (29.32%)patients isolated at least two kinds of pathogens,29 of whom isolated 2 kinds of pathogens. Conclusion Most pathogens of intra-abdominal infection in ICU patients are detected following intestinal tract and hepato-biliary operation,and mixed pathogens are common,predominantly gram-negative bacilli.Escherichia coli and Enterococcus faecium are the main pathogens when patients stayed in ICU for ≤48 hours,opportunistic pathogens are the main patho-gens when patients stay in ICU for >48 hours.
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Objective To investigate bacterial spectrum characteristics and distribution of urinary tract infections with different time phase in intensive care unit(ICU).Methods From January 2012 to March 2013,the clinical data of 1330 cases in ICU,treated with urinary catheter indwelling,was retrospectively reviewed.Among them,705 cases were male and 625 cases were female.Their age ranged from 11 to 94 years old,mean (55.4 ± 19.2)years old.Acute physiology and chronic health scores (APACHE Ⅱ) were 1 to 69,mean 17.1 ±9.3.Duration of catheter indwelling ranged from 1 to 28 days,mean 23 days.The urine was collect through catheter via sterile syringe for bacterial culture.The incidence of urinary tract infection,bacterial infection spectrum,composition ratio and bacteria distribution in 1,2 and 4 weeks after admission were recorded.Results Total urinary tract infection cases were 36(2.7％).There were 15 urinary tract infection cases in 625 famale cases(2.4％),There were 21 cases in 705 male cases (3.0％).49 pathogens were obtained,including 32 gram-negative bacilli (65.3％),17 gram-positive cocci (32.7％) and 1 fungus 2.0％.Enterococcus faecium (30.6％),E.coli (22.4％),Acinetobacter baumannii(10.2％),and Klebsiella pneumoniae (10.2％) were the predominant species.According to hospitalized time,the bacteria spectrum distribution showed Gram negative bacilli were 50.0％ (8 pathogens),57.1％ (4 pathogens),76.9％ (20 pathogens) and Gram positive bacteria were 43.8％ (7 pathogens),42.9％ (3 pathogens),23.1％ (6 pathogens) in the differet observed time point,respectively.A fungus was only observed in the first week after admission 6.3％.Concluusions Gram-negative bacilli were predominant bacterial of urinary tract infections in ICU patients.The incidence of fungus infection was low.E.coli,Acinetobacter baumannii and Klebsiella pneumoniae were the predominant species in Gramnegative bacilli.And Enterococcus faecium was the predominant specie in gram-positive cocci.It was similar for gram-negative bacilli and gram-positive cocci in the first two weeks.After two weeks Gram-negative bacilli turned to the main species.
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Objective To investigate the effect of cholecystokinin (CCK) on rat intestinal interstitial cells of Cajal (ICC) and the small intestinal motor function during experimentally induced acute pancreatitis (AP).Methods 20 male SD rats were divided with a random number table into model group (n =15) and control group (n =5):the 15 rats in the model group were further divided into 3 subgroups,i.e.0,20,40 μg/kg CCK sub-groups.L-omithine was intraperitoneally injected to induce pancreatitis,while normal saline was injected in the control group.24 hours after establishing AP model,CCK was administered intraperitoneally every day for 5 consecutive days.The rats were sacrificed by cervical dislocation 30 minutes after gavage with 2 ml ink.Length of the small intestine which have become black and that of the whole small intestine were measured.Intestinal sections were studied by confocal microscopy after immunofluorescence with specific antibodies.The number of positive cells was compared among the groups.Results In the control group,the number of ICC in the myenteric plexus and deep muscular plexus was (21.16 ± 3.19) /field and (17.20 ± 1.75) /field,respectively;in the AP group was (5.00 ± 1.05) /field and (4.52 ± 1.05) /field,respectively;in the AP + CCK20 group was (10.76 ± 2.09) /field and (9.84 ± 1.68) /field,respectively;in the AP + CCK40 group was (13.72 ±2.97) /field and (12.40 ± 1.81) /field,respectively;the number of ICC in the AP group were significantly lower than those in the control group (P =0.001).The ratio of transmission distance in small intestine in the control,AP,AP + CCK20,and AP + CCK40 groups was 0.71 ± 0.05,0.54 ± 0.07,0.68 ± 0.10,and 0.74 ± 0.07,respectively.The intestinal motor function was reduced in the AP group,demonstrated by shortened transmission distance,which was improved after the administration of CCK (P =0.003).Conclusions Pancreatitis can cause ICC damage,reduce ICC number,destroy ICC network and the small intestinal motor function.CCK can mitigate the damage to ICC and protect the integrity of ICC network,thereby improving intestinal motor function.
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Objective To investigate the impact ofα?lipoic acid(ALA)treatment on sepsis?induced acute kidney injury in rats and explore the mechanisms. Methods A total of 32 male SD rats were randomized into 4 groups:normal control group(group A),ALA?treated control group (group B),sepsis group(group C)and sepsis with ALA treated group(group D). Group A and B underwent sham operation,while CLP operations were conducted in group C and D. Rats in both group B and group D were then administered with 200 mg/kg ALA by oral gavage immediately after the surgical procedure. Twenty?four hours after the surgical procedure blood samples were obtained for the evaluation of creatinine,BUN,TNF?α,IL?6 and IL?1β. Rat kidneys were rapidly removed for PAS stain. Western blot was employed to determine the expression of NF?κB. Results Pathologi?cal changes of kidney were induced by sepsis and the level of creatinine,BUN,TNF?α,IL?6 and IL?1βwere significantly increased by 178%,66%, 55%,114%and 110%(P<0.01). respectively;simultaneously the phosphorylation and nuclear expression of NF?κB p65 in kidney tissues were significantly increased by 144%and 102%(P<0.01). Sepsis?induced acute kidney injury also significantly reduced the expression of IκBαby 61%(P<0.01). These changes were significantly suppressed by early ALA treatment. Compared with C group,the level of creatinine,BUN,TNF?α,IL?6 and IL?1βwere significantly decreased by 48%,26%,25%,37%and 40%(P<0.05),respectively,and the relative expression of IκBαwas increased by 103%(P<0.05). Conclusion The present study demonstrated that ALA can suppress the activation of NF?κB,thus ameliorat?ing sepsis?related acute kidney injury.
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Objective To retrospectively analyze bacterial time distribution of ICU?acquired infections in Shengjing Hospital of China Medical Uni?versity,so as to provide reference for the early antibiotic use for ICU?acquired infections. Methods A total of 1 330 cases in ICU from Jan. 2012 to Mar. 2013 were collected,the bacterial culture was positive in 254 cases. A total of 1 110 strains were collected from all the patients. Excluding 288 strains which were detected within 48 hours of patients′admission in ICU and 222 strains which were repeatedly detected in the same patients,600 strains were finally enrolled in the statistical analysis. Results The rate of ICU?acquired infections was 19.1%. Postoperative infections accounted for 74.3%,most of which occurred after neurosurgeries,and abdominal,orthopedic operations. Pulmonary infection ranked the first in ICU?acquired infections,accounting for 40.3%,followed by blood stream infection(25.3%),postoperative drainage infection(14.2%)and urinary tract infection (7.3%). The rate of pathogenic bacteria detection was the highest in the first week of patients′admission in ICU,and was getting lower as time went by. Strains detected in ICU mainly were Bauman Acinetobacter,Pseudomonas aeruginosa,Klebsiella pneumonia and Enterococcus faecium,most of strains resulting in infections were gram negative bacilli throughout the time. In addition,the infection rate of fungi was increased at 2 weeks of pa?tients′admission in ICU. Conclusion The treatment of ICU?acquired infections should be targeted at gram negative bacilli. The detection rate of op?portunistic pathogens gradually increased with prolonged stay in ICU,most of which are non?fermentative bacteria. Fungi infections are most likely to occur at 2 weeks of patients′admission in ICU.
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ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.
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Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P＜0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P＜0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P＜0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU admission (R 2=0.000,P=0.827),and it fit the logistic curve in a relatively low level after 3 days of ICU admission (R 2=0.036,P＜0.001).Conclusions Early fluid resuscitation could help maintain hemodynamics stability in SAP patients.Those SAP patients who showed a negative equilibrium in early stage showed a better prognosis,and the fluid equilibrium and oxygen index in improved patients fit the logistic curve after 3 days of ICU admission.
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Objective To investigate the effects of preconditioning and postconditioning with isoflurane on pro-inflammatory cytokines and lipid peroxidation in focal cerebral ischemic/reperfusion (I/R) injury in rats.Methods Thirty-two Sprague-Dawley (SD) rats were randomly divided into four groups:control group,model group,isoflurane preconditioning group and isoflurane postconditioning group,with 8 rats in each group.Rats in control group did not receive any challenge.In rats of model group right middle cerebral artery occlusion (MCAO) was conducted for 90 minutes.Rats in isoflurane preconditioning group received 2％ isoflurane exposure for 30 minutes 24 hours before MCAO for 90 minutes.Rats in isoflurane postconditioning group were given 60-minute 2％ isoflurane exposure after reperfusion of right MCAO.Twenty-four hours after the procedure,all rats were anesthetized with isoflurane,and blood sample taken from the heart was centrifuged,and the pro-inflammatory cytokines,including interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α),and lipid peroxidation products such as malonaldehyde (MDA) and superoxide dismutase (SOD) were determined.The mRNA and protein expression levels of matrix metalloproteinase (MMP-2,MMP-9),tight junction protein Calaudin-5 and Occludin were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot.Results Compared with control group,serum levels of IL-1 β (ng/L),TNF-α (ng/L) and MDA (μmol/L) were elevated and activity of SOD (U/L) decreased in rats of model group (IL-1β:76.81 ± 11.14 vs.52.43 ± 8.86,TNF-α:64.93 ± 10.81 vs.33.64 ± 7.94,MDA:8.63 ± 1.42 vs.4.14 ± 0.98,SOD:0.95 ± 0.21 vs.2.36 ± 0.80,all P＜0.05).After isoflurane preconditioning and postconditioning,compared with model group,the levels of IL-1 β,TNF-α and MDA were lowered,while activity of SOD was increased (IL-1 β:54.37 ± 9.06,56.82 ± 8.67 vs.76.81 ± 1 1.14,TNF-α:43.72 ± 6.16,39.49 ± 9.34 vs.64.93 ± 10.81,MDA:5.65 ± 0.83,5.82 ± 0.78 vs.8.63 ± 1.42,SOD:1.64 ± 0.47,1.71 ± 0.52 vs.0.95 ± 0.21,all P＜0.05).Focal cerebral I/R injury could lead to an increased expression of MMP accompanied with a decreased expression of tight junction protein.Compared with model group,after isoflurane preconditioning and postconditioning,it was found that there were decreased mRNA and protein expression of MMP-2 and MMP-9 (MMP-2 mRNA:1.25 ± 0.08,1.32 ± 0.12 vs.2.48 ± 0.26,MMP-2 protein:1.56 ± 0.09,1.50 ± 0.08 vs.2.12 ± 0.11 ; MMP-9 mRNA:1.26 ± 0.13,1.20 ± 0.12 vs.2.74 ± 0.28,MMP-9 protein:1.53 ± 0.04,1.51 ± 0.05 vs.2.23 ± 0.09,all P＜0.05) and increased levels of Calaudin-5 and Occludin (Claudin-5 mRNA:0.40 ± 0.08,0.38 ± 0.06 vs.0.28 ± 0.03,Claudin-5 protein:0.80 ± 0.06,0.81 ± 0.07 vs.0.39 ± 0.02; Occludin mRNA:0.54 ± 0.07,0.50 ± 0.08 vs.0.26 ± 0.06,Occludin protein:0.64 ± 0.06,0.69 ± 0.05 vs.0.49 ± 0.02,all P＜0.05).Conclusion Preconditioning and postconditioning with isoflurane can lower the levels of pro-inflammatory cytokines and the degree of lipid peroxidation,and lower the hydrolytic activity of MMP to the tight junction protein in cerebral tissue,thereby decrease the loss of tight junction protein and alleviate I/R injury.
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Objective To analyze the occurrence and clinical features of chronic kidney disease (CKD) in the ICU patients and identify the possible risk factors.Methods A retrospective study was performed in 2281 ICU patients enrolled from Shengjing hospital between January 2007 and December 2010,in which 1860 cases had complete data and were followed-up,the other 421 cases were excluded for the reasons of dying,suffering from CKD originally,lacking complete data and missing.The cases were divided into CKD and non-CKD groups according to SCODRED and CKD diagnosis standards.Assessment was performed to screen risk factors of CKD.Results There were obvious differences between CKD and non-CKD groups at age,pregnancy,AKI and liver function (P ＜0.05).The CKD's annual morbidity rate of ICU patients was 20％-30％,and the incidence showed an increasing trend with time.Age,pregnancy,AKI,APACHE-Ⅱ score,invasive diagnosis and treatment,mechanical ventilation,organ failure and kidney-hurt drugs were risk factors for CKD in the ICU patients.Conclusions The morbidity rate of CKD in the ICU patients is high,and the number of CKD patients show an increasing trend with time.Age,APACHE-Ⅱ score ＞ 15,the number of failed organs ≥2,the variety of kidney-hurt drug≥2,pregnancy,AKI,the number of invasive diagnosis and treatment≥3,mechanical ventilation are independent risk factors of CKD in the ICU patients.
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<p><b>OBJECTIVE</b>While the technology of the molecular sieve oxygen generation system(MSOGS) onboard was used, pilots could not breathe pure oxygen to eliminate nitrogen during a high altitude flight. There is no report whether it is a threat to altitude decompression sickness(ADS) or not in that condition. This experiment was intended to observe the effects of breathing different oxygen-rich gases of MSOGS on denitrogenation, so that we could make the medical physiological requirements for MSOGS on-board and provide experimental basis for aeromedical supply.</p><p><b>METHOD</b>Eight healthy males were breathed oxygen-rich gases (60%,70%,80%,90%and 99.6%) in turn for 60 min, and the concentration of nitrogen, oxygen, carbon dioxide and argon at the end of expiration interval in the oxygen mask were continuously measured by a flight mass spectrometer through the oxygen mask. According to the variety of the denitrogenation rate by breathing different oxygen-rich gases, its change law was analyzed.</p><p><b>RESULTS</b>There were significant differences (P < 0.05) about denitrogenation rate in different oxygen-rich gases due to different oxygen concentration and breathing time. The denitrogenation rate of pure oxygen was higher than that of the others. It was indicated that the concentration of nitrogen in lung would decrease along with the increase in oxygen concentration of oxygen-rich gases, and the nitrogen concentration in the lung almost decreased by 50% or even more if people were breathed 60%-90% oxygen-rich gas longer than 60 s.</p><p><b>CONCLUSION</b>The man-made respiration environment of low nitrogen can be provided by breathing oxygen-rich gases, although the denitrogenation velocity of breathing oxygen-rich gases is lower than that of breathing pure oxygen. So it can be used as a measure to eliminate and lower the nitrogen in the body to prevent from ADS.</p>
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Humans , Male , Altitude , Altitude Sickness , Carbon Dioxide , Decompression Sickness , Nitrogen , Oxygen , Therapeutic Uses , RespirationABSTRACT
Objective To evaluate the efficacy of serum PCT level in deciding the development and progno-sis of sepsis and its conrrelation with APACHE Ⅱ scoring.Methods 56 patients of sepsis accepted intensive care treatment and were all given APACHE Ⅱ scoring within the first 24 h after admission to ICU.The PCT level at dif-ferent time(1 d,3 d,5 d-7 d,10 d after admission)was detected.All these patients were divided into survival group and death group based on the 28-day fatality.Results The PCT level declined gradually with the treatment and it decreased obviously from the third day in comparison with the original level before admission [survival group/death group:(2.98±0.48)μg/L/(4.98±0.66)μg/L vs(4.04±0.50)μg/L/(6.02±0.50)μg/L](P<O.05).The PCT level in survival group declined quickly with the patients'condition improved and almost decreased to the normal level in the 10 day[0.48 ±0.18)μg/L],while the PCT in the death group was still in a higher level than normal even though it showed a tendency to decrease[(4.04±0.45)μg/L].The APACHE Ⅱ scores in death group was obviously higher than the survival group(death group/survival group:25.86±8.73/12.07±6.20,P<0·05).The coefficient of correlation between PCT and APACHE Ⅱ scoring was 0.656(P<0.05).Conclusion PCT,a single serology index,is characterized with conveniently and quick-which is strongly correlated with APACHE Ⅱscoring.
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<p><b>OBJECTIVE</b>To observe the curative effects of bone marrow stem cell (BMSC) and peripheral blood stem cell (PBSC) transplantations on the avascular necrosis of femoral head (ANFH).</p><p><b>METHODS</b>Totally 122 ANFH patients (211 coxae) treated by BMSC or PBSC transplantations were enrolled from July 2004 to December 2006. All of them were classed to different stages according to the ARCO. Control group were desired as themselves before and after treatment. The puncture of femoral artery was conducted with digital subtraction angiography (DSA), and the tubes were inserted into medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery with the cell suspensions were gradually poured into the arteries.</p><p><b>RESULTS</b>The joint pain, joint functions and walking distance of 122 patients were detected for the follow-up. Compared with before treatment, the calibers thickened; vessels increased and blood velocity quickened of femoral head blood-supply artery were observed in 15 patients after 6 months checked by DSA. The reduced areas of femoral head necrosis in 8 patients indicated the new bone formation between 12 and 24 months.</p><p><b>CONCLUSIONS</b>Autologous BMSC and PBSC transplantation results in the new bone formation and improvement of ischemia in areas of femoral head necrosis at 6 months. The change of angiography was observed about 12 to 24 months after cell transplantation. The stem cell transplantation is convenient, safe and effective in the treatment of the ANFH with no adverse reaction, and can be considered as a new therapy of ANFH.</p>
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Humans , Bone Marrow Transplantation , Femur Head , Pathology , General Surgery , Femur Head Necrosis , General Surgery , Follow-Up Studies , Ischemia , General Surgery , Peripheral Blood Stem Cell Transplantation , Stem Cell Transplantation , Methods , Transplantation, Autologous , Treatment OutcomeABSTRACT
Objective To analyze the relationship between serum leptin level and RAAS,insulin sensitivity.Methods We collected 38 patients with obesity-related hypertension,32 patients with hypertension,33 patients with obesity and 33 normal controls.Their serum levels of Leptin,FINS,PRA,AngⅡ,ALD and FPG were measured,and then the insulin sensitivity index(ISI) was calculated.Their body height and weight were measured,and body mass index(BMI) was calculated.Results ISI levels in patients with obesity-related hypertension,with hypertension or with obesity were significantly lower than that in the control(P