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<p><b>Objective</b>Acute respiratory distress syndrome (ARDS) is an acute and lethal clinical syndrome that is characterized by the injury of alveolar epithelium, which impairs active fluid transport in the lung, and impedes the reabsorption of edema fluid from the alveolar space. This review aimed to discuss the role of pro-resolving mediators on the regulation of alveolar fluid clearance (AFC) in ARDS.</p><p><b>Data Sources</b>Articles published up to September 2017 were selected from the PubMed, with the keywords of "alveolar fluid clearance" or "lung edema" or "acute lung injury" or "acute respiratory distress syndrome", and "specialized pro-resolving mediators" or "lipoxin" or "resolvin" or "protectin" or "maresin" or "alveolar epithelial cells" or "aspirin-triggered lipid mediators" or "carbon monoxide and heme oxygenase" or "annexin A1".</p><p><b>Study Selection</b>We included all relevant articles published up to September 2017, with no limitation of study design.</p><p><b>Results</b>Specialized pro-resolving mediators (SPMs), as the proinflammatory mediators, not only upregulated epithelial sodium channel, Na,K-ATPase, cystic fibrosis transmembrane conductance regulator (CFTR), and aquaporins levels, but also improved Na,K-ATPase activity to promote AFC in ARDS. In addition to the direct effects on ion channels and pumps of the alveolar epithelium, the SPMs also inhibited the inflammatory cytokine expression and improved the alveolar epithelial cell repair to enhance the AFC in ARDS.</p><p><b>Conclusions</b>The present review discusses a novel mechanism for pulmonary edema fluid reabsorption. SPMs might provide new opportunities to design "reabsorption-targeted" therapies with high degrees of precision in controlling ALI/ARDS.</p>
Subject(s)
Animals , Humans , Acute Lung Injury , Metabolism , Cystic Fibrosis Transmembrane Conductance Regulator , Metabolism , Respiratory Distress Syndrome , MetabolismABSTRACT
Objective investigate the analgesic effect of dexmedetomidine combined with remifentanil in patients with mechanical ventilation after ICU surgery. Methods 120 patients with ICU underwent mechanical ventilation were divided into control group (propofol combined remifentanil) and observation group (dexmedetomidine remifentanil) according to the random number table method, 60 cases each group. Record the two groups of total sedation time, withdrawal time after the withdrawal, analgesic effect, adverse reactions. Results The scores of SAS score and CPOT were (3.98±0.52) and (2.23±1.04), respectively, which were significantly lower than those in the control group (4.36±0.96) and (3.46±2.23), respectively (P<0.05). (691.28±236.58) min and (1.22±0.05) min were significantly shorter than those in the control group (2642.33±341.58) min, (3.56±0.74) min, P<0.05, respectively. The adverse reaction rate was 3.33% (2/60) in the observation group, which was significantly lower than that in the control group (13.33%, 8/60),( χ2=3.92, P=0.04). Conclusion ICU postoperative mechanical ventilation patients with dexmedetomidine combined with remifentanil has a good analgesic effect, and is conducive to the patient wake up, less adverse reactions, with a certain safety.
ABSTRACT
Objective investigate the analgesic effect of dexmedetomidine combined with remifentanil in patients with mechanical ventilation after ICU surgery. Methods 120 patients with ICU underwent mechanical ventilation were divided into control group (propofol combined remifentanil) and observation group (dexmedetomidine remifentanil) according to the random number table method, 60 cases each group. Record the two groups of total sedation time, withdrawal time after the withdrawal, analgesic effect, adverse reactions. Results The scores of SAS score and CPOT were (3.98±0.52) and (2.23±1.04), respectively, which were significantly lower than those in the control group (4.36±0.96) and (3.46±2.23), respectively (P<0.05). (691.28±236.58) min and (1.22±0.05) min were significantly shorter than those in the control group (2642.33±341.58) min, (3.56±0.74) min, P<0.05, respectively. The adverse reaction rate was 3.33% (2/60) in the observation group, which was significantly lower than that in the control group (13.33%, 8/60),( χ2=3.92, P=0.04). Conclusion ICU postoperative mechanical ventilation patients with dexmedetomidine combined with remifentanil has a good analgesic effect, and is conducive to the patient wake up, less adverse reactions, with a certain safety.
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<p><b>OBJECTIVE</b>To observe the dynamic changes of CD3+, CD4+, and CD8+ T lymphocytes in the peripheral blood of patients with sepsis and discuss the clinical significance.</p><p><b>METHODS</b>Sixty-four patients admitted in the Emergency Center and Emergency Intensive Care Unit of the Second Hospital of Wenzhou Medical University between August, 2007 and July, 2009 were enrolled in this study. CD3+, CD4+, and CD8+ T lymphocytes in the peripheral blood were detected by flow cytometry on days 1, 7 and 14 after admission, and the results were compared between the patients with improvement of the condition and those without improvement, with 20 healthy subjects as the control group.</p><p><b>RESULTS</b>On day 1 after admission, CD3+ and CD4+ T lymphocytes and CD4+/CD8+ T cell ratio were obviously lower in the 2 groups of patients with sepsis than in the control group (P<0.05), but no significant difference was found in CD8+ T lymphocytes. The sepsis patients with clinical improvement showed significant higher CD3+ and CD4+ T lymphocyte percentages and CD4+/CD8+ T cell ratio than those without improvement on day 1. In the patients with clinical improvement, CD3+ and CD4+T lymphocytes and CD4+/CD8+ T cell ratio increased gradually with time and till day 14, they were comparable with the control levels; in the patients without improvement, CD3+ and CD4+ T lymphocytes and CD4+/CD8+ T cell ratio showed no obvious alterations in the course of observation.</p><p><b>CONCLUSION</b>Immune imbalance occurs in patients with sepsis represented by lowered CD3+ and CD4+T lymphocyte percentages and CD4+/CD8+ T cell ratio in relation to the severity of the condition. CD3+ and CD4+ T lymphocytes and CD4+/CD8+ T cell ratio can be used as the indicators for assessing the severity of sepsis.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , CD4-CD8 Ratio , Case-Control Studies , Flow Cytometry , Sepsis , Blood , Allergy and Immunology , T-Lymphocyte Subsets , Cell BiologyABSTRACT
<p><b>BACKGROUND</b>Lipoxins (LXs), endogenous anti-inflammatory and pro-resolving eicosanoids generated during various inflammatory conditions, have novel immunomodulatory properties. Because dendritic cells (DCs) play crucial roles in the initiation and maintenance of immune response, we determined whether LXs could modulate the maturation process of DCs and investigated the effects of lipoxin A(4) (LXA(4)) on lipopolysaccharide (LPS)-induced differentiation of RAW264.7 cells into dendritic-like cells.</p><p><b>METHODS</b>RAW264.7 cells were cultured in vitro with 1 microg/ml LPS in the absence or presence of LXA(4) for 24 hours, and cellular surface markers (MHC-II, CD80 (B7-1), CD86 (B7-2)) were measured by flow cytometry (FCM). Mixed lymphocyte reaction was performed to evaluate the allostimulatory activity. Cytoplastic IkappaB degradation and nuclear factor kappa B (NF-kappaB) translocation were detected by Western blotting. Luciferase reporter plasmid was transiently transfected into RAW264.7 cells, and luciferase activity was determined to measure the transcriptional activity of NF-kappaB.</p><p><b>RESULTS</b>LXA(4) reduced the ratio of LPS-treated RAW264.7 cells to DCs with morphological characteristics and inhibited the expression of MHC II. LPS-induced up-regulation of CD86 was moderately suppressed by LXA(4) but no obvious change of CD80 was observed. Moreover, LXA(4) weakened the allostimulatory activity of LPS-treated RAW264.7 cells. These alterations of LPS+LXA(4)-treated cells were associated with a marked inhibition of IkappaB degradation, NF-kappaB translocation and then the transcriptional activity of NF-kappaB.</p><p><b>CONCLUSIONS</b>LXA(4) negatively regulates LPS-induced differentiation of RAW264.7 cells into dendritic-like cells. This activity reveals an undescribed mechanism of LXA(4) to prevent excessive and sustained immune reaction by regulating maturation of DCs.</p>