Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection / 中华医学杂志(英文版)

Background:@#Sepsis-3 definitions have been published recently; however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection.@*Methods:@#A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates.@*Results:@#Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%, χ2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566–0.652) and 0.694 (0.654–0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795–0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001).@*Conclusion:@#In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions.@*Trial Registration:@#www.chictr.org.cn (ChiCTR-OOC-17013223).

Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection / 中华医学杂志(英文版)

BACKGROUND@#Sepsis-3 definitions have been published recently; however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection.@*METHODS@#A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates.@*RESULTS@#Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%, χ = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566-0.652) and 0.694 (0.654-0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795-0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001).@*CONCLUSION@#In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions.@*TRIAL REGISTRATION@#www.chictr.org.cn (ChiCTR-OOC-17013223).

The effects of Sestrin2 on apoptosis of heat-exposed lung epithelial cells and its mechanism / 中国应用生理学杂志

OBJECTIVE@#To investigate the protective effects of Sestrin2 protein on lung epithelial Beas-2B cells in the heat-exposure environment and its mechanism.@*METHODS@#Lung epithelial Beas-2B cells were cultured at 37℃, 39℃, 40℃ and 41℃ respectively. Cells were harvested at different times (0, 3, 6 and 12 h) after pancreatin digestion. The expressions of Sestrin2, superoxide dismutase(SOD), reactive oxygen species(ROS), cell mitochondrial membrane potential and apoptosis rate of cells were detected by Western blot, fluorescence spectrophotometer and flow cytometry, respectively. Gene expression sequence was cloned into high expression plasmid pcDNA3.1. Beas-2B cells were transfected by Lipfectamine 2000 to construct Sestrin2 and SOD high expression cells. The changes of mitochondrial membrane potential and cell apoptosis were observed in the Sestrin2 and SOD high expression cells.@*RESULTS@#With the increase of temperature, the expression level of Sestrin2 protein in heat treatment group was decreased compared with the control group. When Beas-2B cells were exposed to 41℃, the ROS level was increased, mitochondrial membrane potential was decreased significantly and apoptosis rate was increased at different time points. After high expression of Sestrin2 and SOD in the Beas-2B cells, the expression level of ROS was decreased and the change tendency of mitochondrial membrane potential was decreased, and the apoptosis rate was reduced at 41℃ exposure.@*CONCLUSION@#Sestrin2 can alleviate the apoptosis of lung epithelial cells induced by heat exposure through mitochondrial membrane potential and SOD, which has protective effect on lung epithelial Beas-2B cells.

Effect of cadmium on mitochondrial function of hematopoietic stem cells in mouse bone marrow / 军事医学

Objective To explore the effect of cadmium chloride on mitochondrial function of hematopoietic stem cells in mouse bone marrow .Methods After being quarantined for one week , male Kunming mice weighted 20 ±2 g were randomly divided into three groups: control group , low dose cadmium-exposure group and high dose cadmium-exposure group.Mice in low dose and high dose cadmium-exposure groups were exposed to cadmium chloride solution at a dose of 7.5, 15 mg/kg body mass while those in control group were given an equal volume of distilled water through gavage administration every Monday , Wednesday and Friday for six consecutive weeks before cells in mouse bone marrow were collected at the 8th week.Mitochondrial membrane potential and ROS levels of mouse hematopoietic stem cells were detected using a flow cytometry .Results Compared with control group , the gain of body weight was significantly suppressed in cadmium-exposure group (P<0.01).Compared with control group, mitochondrial ROS levels of hematopoietic stem cells significantly increased in cadmium-exposure group and was dose-related(P<0.05,P<0.01). Besides, mitochondrial membrane potential of hematopoietic stem cells decreased in cadmium -exposure group compared with control group and was dose-related(P<0.05,P<0.01).Conclusion Cadmium exposure can lead to dose-related mitochondrial dysfunction of hematopoietic stem cells via oxidative damage in Kunming mice .

Risk factors for prolonged mechanical ventilation in children with transposition of the great arteries and intact ventricular septum that underwent primary arterial switch operation / 中华实用儿科临床杂志

Objective To explore the risk factors for prolonged mechanical ventilation in children with trans-position of great arteries and intact ventricular septum who underwent arterial switch operation. Methods This study was a retrospective,single center study. One hundred and twenty patients with transposition of great arteries and intact ventricular septum who underwent primary arterial switch operation between January 2014 and December 2016 at Fuwai Hospital were eligible for this study. The data of patients from pediatric intensive care unit database and electronic medical records were collected. The data related to postoperative respiratory assist time were collected,including demo-graphic data,preoperative diagnosis,intraoperative data,and postoperative recovery data. The patients were divided into 2 groups according to ventilation time which were prolonged mechanical ventilation group(ventilation time > 72 hours) and non - prolonged mechanical ventilation group(ventilation time ≤72 hours). The data of 2 groups were analyzed by using single factor analysis,and the P≤0. 2 factors were processed into Logistic regression analysis. Results Ninety -six patients were enrolled including 22 patients in prolonged ventilation group and 74 patients in non - prolonged me-chanical ventilation group. No statistical significance was found in 2 groups in gender,age,weight,preoperative lactate, hemoglobin,use of prostaglandin E1,mechanical ventilation,cardiopulmonary time,aortic clamping time,the ratio of left ventricular pressure to right ventricular pressure,immediate postoperative plasma lactate,and vasoactive inotropic score. The weight and postoperative left atrial pressure were significantly different between 2 groups with P < 0. 2. Weight were (3. 5 ± 0. 9)kg in prolonged mechanical ventilation group and (3. 9 ± 1. 0)kg in non - prolonged mechanical ventila-tion group (P = 0. 117). Left atrial pressures were (7. 9 ± 1. 9)mmHg(1 mmHg = 0. 133 kPa)in prolonged mechani-cal ventilation group and (6. 7 ± 2. 0)mmHg in non - prolonged mechanical ventilation group(P = 0. 015). The weight and left atrial pressure were processed into Logistic regression analysis and the results revealed that high left atrial pres-sure was the risk factor for ventilation prolongation(OR = 1. 048,P = 0. 020). Respiratory assist time in prolonged and non - prolonged ventilation group was 112(80,194)h and 26(17,46)h,respectively;ICU time in prolonged and non - prolonged ventilation group was 10(1,14)d and 4(3,6)d,respectively;and all the differences were significant (all P = 0. 000). The number of death in each group was 1 with no significant difference(P = 0. 420). Conclusions High left atrial pressure is the risk factor for prolonged mechanical ventilation in children with transposition of great ar-teries and intact ventricular septum following primary arterial switch operation.

Receptor antagonist of NMDA and animal models of schizophrenia / 法医学杂志

Schizophrenia is one of the common mental diseases. Because the mechanism of the schizophrenia is significantly complicated, the cause is still unknown. N-methyl-D-aspartate receptor antagonist can simulate the positive and negative symptoms, as well as the cognitive disorder of schizophrenia. Thus it has been widely used to establish the animal models of schizophrenia. The relationship of the three blocking agents of ion channels (phencyclidine, MK-801, ketamine) and the establishment of schizophrenia animal models is reviewed in this article.

The correlation between ketamine-induced schizophrenia-like signs in mice and the expressions of NRG1, ErbB4 mRNA / 法医学杂志

OBJECTIVE@#To explore the correlation between signs similar to schizophrenia in mice after ketamine administration and the expressions of NRG1 and ErbB4 mRNA in order to explain the possible pathogenesis of schizophrenia.@*METHODS@#Fifty KM mice were randomly divided into 5 groups which were administered intraperitoneally with saline, clozapine and different dosages ketamine. The ketamine groups were administered intraperitoneally with low dosage (25 mg/kg), middle dosage (50 mg/kg) and high dosage (100 mg/kg) one time every day for 7 days. After administration of 100 mg/kg ketamine for 7 days, the clozapine group was introgastrically administered 20 mg/kg with clozapine one time every day for 7 days. The pathological changes of hippocampus neurons were observed by HE stain. The expressions of the NRG1 and ErbB4 mRNA in hippocampus were detected by reverse transcriptase polymerase chain reaction (RT-PCR).@*RESULTS@#In the group with high dosage of ketamine, the levels of NRG1 and ErbB4 mRNA were significantly lower than that of the group with saline.@*CONCLUSION@#Ketamine may induce signs similar to schizophrenia in KM mice. The mechanism may be involved in the reduction of NRG1 and ErbB4 mRNA expression.

Advances in research of ketamine addiction mechanism / 法医学杂志

Ketamine is a phencyclidine derivative acting primarily as a noncompetitive antagonist of N-methyl-D-aspartate (NMDA) excitatory glutamate receptors. As a common intravenous anaesthetic in clinic, it is also increasingly abused because of its hallucination and addiction effects. Based on the pharmacological and toxicologic characteristics of ketamine and the acknowledged addiction mechanism of other abused drugs, this article reviews the possible addiction mechanism of the ketamine in the aspects of its enhanced effects and reward systems, the anatomic structures, the related receptors and the individual differences.

Behavior study of ketamine-induced symptoms similar to schizophrenia in mice / 法医学杂志

OBJECTIVE@#To observe the symptoms similar to schizophrenia in mice after ketamine single or continuous injection and to evaluate the feasibility of schizophrenia model injected with different dose of ketamine.@*METHODS@#A total of 40 male mice were randomly divided into 4 groups, which were injected intraperitoneally with physiological saline (control group), 25 mg/kg ketamine (low dose group), 50 mg/kg ketamine (middle dose group), and 100 mg/kg ketamine (high dose group) qd for 7 days continuously. The behavior changes of mice were observed.@*RESULTS@#Hyperactivity, stereotyped behavior and ataxia (P < 0.01) were observed in high dose group after single injection. After continuous injection of ketamine for 7 days, the middle dose group showed hyperactivity, stereotyped behavior and ataxia (P < 0.05), stereotyped behavior and ataxia were more significant in high dose group (P < 0.01).@*CONCLUSION@#Ketamine can induce the symptoms similar to schizophrenia in mice after single or continuous injection. The symptoms induced by high dose ketamine will be more prominent and stable after continuous injection.

Effect of mucosal protective on the quality of gastric ulcer healing / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the mucosal protective effect on the quality of gastric ulcer healing.</p><p><b>METHODS</b>Gastric ulcers were induced in male rats by serosal application of acetic acid. Rats were gavaged for 14 days with saline, omeprazole (OME), teprenone (TEP) and TEP plus OME starting 3 days after ulcer induction. Then the tissues and blood samples were obtained and measured.</p><p><b>RESULT</b>The lower ulcer index (UI) and increased ulcer inhibition rate were observed in OME and OME+TEP groups. In TEP and OME+TEP groups, restored mucosa thickness increased, cystically dilated glands decreased, microvessels in connective tissue increased, the secretion of mucus, hexosamine, PGE(2), bFGF were enhanced, the expression of EGFR was increased.</p><p><b>CONCLUSION</b>TEP can improve the quality of gastric ulcer healing, when combined with OME,the effect is more marked.</p>

Induction of experimental acute ulcerative colitis in rats by administration of dextran sulfate sodium at low concentration followed by intracolonic administration of 30% ethanol / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Several models of experimental ulcerative colitis have been reported previously. However, none of these models showed the optimum characteristics. Although dextran sulfate sodium-induced colitis results in inflammation resembling ulcerative colitis, an obvious obstacle is that dextran sulfate sodium is very expensive. The aim of this study was to develop an inexpensive model of colitis in rats. Sprague-Dawley rats were treated with 2% dextran sulfate sodium in drinking water for 3 d followed by an intracolonic administration of 30% ethanol. The administration of 2% dextran sulfate sodium followed by 30% ethanol induced significant weight loss, diarrhea and hematochezia in rats. Severe ulceration and inflammation of the distal part of rat colon were developed rapidly. Histological examination showed increased infiltration of polymorphonuclear leukocytes, lymphocytes and existence of cryptic abscesses and dysplasia. The model induced by dextran sulfate sodium at lower concentration followed by 30% ethanol is characterized by a clinical course, localization of the lesions and histopathological features similar to human ulcerative colitis and fulfills the criteria set out at the beginning of this study.

Effect of ligustrazine on the expression of bFGF in bone marrow stromal cells of mice after BMT / 中国实验血液学杂志

This study was purposed to investigate the effect of ligustrazine on the expression of bFGF in bone marrow stromal cells (BMSC) and to explore the mechanism of hematopoietic reconstitution after bone marrow transplantation (BMT). The mice were randomly divided into 3 groups: normal group, saline group and ligustrazine group. BMT mouse models were established. The mice of normal group were not treated, the mice of saline group were given normal saline (0.2 ml/mouse, twice a day) through gastric tube, while the mice of ligustrazine group were given ligustrazine (0.2 ml/mouse, twice a day) through gastric tube. On day 7, 14, 21 and 28 after BMT, the femora were taken and the bone marrow mononuclear cell (BMMNC) suspensions were used for the cultivation of bone marrow stromal cells according to Dexter's culture method. The mRNA and protein expressions of bFGF in BMSC were assayed by RT-PCR and Western blot respectively. The results showed that the expression of bFGF in BMSC on the level of mRNA and protein were all reduced significantly after BMT, and increased slowly with the time. On day 7, 14 and 21 after BMT, the expressions of bFGF mRNA and protein in bone marrow stromal cells of ligustrazine group and saline group were lower than that in bone marrow stromal cells of normal group, but the expressions of bFGF mRNA and protein in ligustrazine group were obviously higher than that in saline group (P < 0.01 or P < 0.05). On day 28 after BMT, the expressions of bFGF mRNA and protein in ligustrazine group returned to normal level, while the expressions of bFGF mRNA and protein in saline group not returned to normal level, there was significant difference between these two groups. It is concluded that ligustrazine can enhance bFGF expression level in bone marrow stromal cells after syngeneic bone marrow transplantation in mice, which confirms that ligustrazine can enhance the repair of bone marrow microvessels, improve bone marrow microenvironment and promote hematopoietic reconstitution.