Significance of thrombocytopenia in assessment of the severity and prognosis of sepsis / 中华实用儿科临床杂志

Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response due to infection, and it can further develop into septic shock.Currently, sepsis is still a leading cause of death in children all over the world.Therefore, early assessment of the severity and prognosis of sepsis is of great significance.However, there are no indexes with high sensitivity and specificity for evaluating the severity and prognosis of sepsis at present.In recent years, a large number of studies have revealed the essential role of platelets in sepsis.It has been reported that the platelet count is an independent factor affecting the severity and prognosis of sepsis patients.Up to now, the specific mechanism of sepsis-induced thrombocytopenia has not been fully clarified.In this review, the value of thrombocytopenia in predicting the severity and prognosis of sepsis patients was elaborated.

Effects of interIeukin-6 on mitochondriaI biogenesis in activated astrocytes and its mechanism / 中华实用儿科临床杂志

Objective To invkstigatk thk kffkcts of intkrlkucin-6(IF-6)on mitochondrial biogknksis in ac-tivatkd astrocetks(LS)and thk rolk of adknosink monophosphatk protkin cinask( LMPK)in this prockss. Methods Thk LS isolatkd from nkonatal rat ckrkbral codkx wkrk purifikd and culturkd. Thk LS was randomle dividkd into 5 groups:control group,lipopolesaccharidk(FPS)+intkrfkron-γ(IPN-γ)group( IPN-γ group),FPS+IPN-γ+IF-6 group(IF-6 group),FPS+IPN-γ+IF-6A siANL+IF-6 group(siANL group),and FPS+IPN-γ+nkga-tivk control(NC)+IF-6 group(NC group),thkn,LS in kach group was trkatkd for 6 h. Tumor nkcrosis factor-α (TNP-α)mANL and intkrlkucin-1β(IF-1β)mANL kxprkssion wkrk dktkctkd be adopting rkvkrsk transcription-polemkrask chain rkaction(AT-PCA). Thk lkvkls of rkactivk oxegkn spkciks(AOS)wkrk dktkctkd be fluorksknt probk mkthod and thk lkvkls of adknosink triphosphatk(LTP)wkrk dktkctkd be lucifkrask mkthod. Ckll viabilite was kvaluatkd be using ckll count Kit-8. Pkroxisomk prolifkrator-activatkd rkckptor gamma coactivator-1α(PGC-1α),nuclkar rk-spiratore factor-1(NAP-1),mitochondrial transcription factor L( TPLM)and phospho-adknosink monophosphatk activatkd protkin cinask(p-LMPK)protkin kxprkssion wkrk dktkctkd be using Zkstkrn blotting. ResuIts (1)Com-parkd with thk control group,thk mANL kxprkssions of TNP-α and IF-1β(2. 548 ± 0. 154 vs. 1. 000 ± 0. 001,P﹦ 0. 000;2. 912 ± 0. 102 vs. 1. 000 ± 0. 001,P﹦0. 000),thk lkvkls of AOS[(245. 307 ± 13. 379)APR vs.(69. 460 ± 7. 257)APR,P﹦0. 000]and LTP[(1. 558 ± 0. 008)nmol╱mg protkin vs.(1. 016 ± 0. 025)nmol╱mg protkin,P﹦0. 000]significantle klkvatkd,and thk ckll viabilite(0. 840 ± 0. 013 vs. 1. 000 ± 0. 001,P﹦0. 000)dkcrkaskd,whilk thk protkin kxprkssion of NAP-1(0. 406 ± 0. 045 vs. 0. 157 ± 0. 016,P﹦0. 017),TPLM(0. 605 ± 0. 025 vs. 0. 416 ± 0. 013,P﹦0. 005)klkvatkd in FPS+IPN-γ group,and thk diffkrkncks wkrk significant(all P＜0. 05).(2)Comparkd with FPS+IPN-γ group,thk lkvkls of LTP[(1. 763 ± 0. 028)nmol╱mg protkin vs.(1. 558 ± 0. 008)nmol╱mg pro-tkin,P﹦0. 000],thk ckll viabilite(0. 910 ± 0. 024 vs. 0. 840 ± 0. 013,P﹦0. 008)wkrk klkvatkd,whilk thk protkin kx-prkssion of PGC-1α(0. 724 ± 0. 027 vs. 0. 586 ± 0. 039,P﹦0. 000),NAP-1(1. 036 ± 0. 211 vs. 0. 406 ± 0. 045,P﹦0. 000),TPLM(0. 786 ± 0. 058 vs. 0. 605 ± 0. 025,P﹦0. 002)and p-LMPK(1. 094 ± 0. 223 vs. 0. 755 ± 0. 084,P﹦0. 014)wkrk klkvatkd in IF-6 group,and thk diffkrkncks wkrk significant( all P＜0. 05).(3)Comparkd with IF-6 group,LTP[(1. 187 ± 0. 005)nmol╱mg protkin vs.(1. 763 ± 0. 028)nmol╱mg protkin,P﹦0. 000]and thk ckll viabili-te(0. 680 ± 0. 040 vs. 0. 910 ± 0. 024,P ﹦0. 000)all dkcrkaskd in siANL group,whilk thk protkin kxprkssion of PGC-1α(0. 631 ± 0. 022 vs. 0. 724 ± 0. 027,P﹦0. 020),NAP-1(0. 386 ± 0. 066 vs. 1. 036 ± 0. 211,P﹦0. 000), TPLM(0. 593 ± 0. 022 vs. 0. 786 ± 0. 058,P﹦0. 009)and p-LMPK(0. 365 ± 0. 063 vs. 1. 094 ± 0. 223,P﹦0. 002) significantle dkcrkaskd in siANL group,and thk diffkrkncks wkrk significant(all P＜0. 05). ConcIusions IF-6 can incrkask mitochondrial biogknksis in activatkd LS,which is probable mkdiatkd through up-rkgulating thk kxprkssion of LMPK.

Improvement of Vitamin C on septic brain injury in rats / 中华实用儿科临床杂志

Objective To preliminarily investigate the role of Vitamin C in cecal ligation and puncture-induced septic brain injury.Methods Male specific pathogen free (SPF) Sprague-Dawley male rats were randomly assigned into control group,sham operation group,sepsis group and sepsis therapy group.The rats in sepsis group were prepared by cecal ligation and puncture.The rats in sepsis therapy group were injected sodium ascorbate through the tail vein 3 h after the cecal ligation and punature procedure.The animals in other groups were subjected only to subcutaneous bolus injection of 9 g/L saline only.Animals were evaluated by neurologic reflex scores before sacrifice and brain tissues were quickly removed at the indicated time points.Reactive oxygen species (ROS),superoxide dismutase (SOD),malondialdehyde (MDA),nitric oxide (NO),inducible nitric oxide synthase (iNOS) and catalase (CAT) were determined by using enzyme assay kits.Hematoxylin-eosin (HE) staining was used to observe morphological changes in brain tissues.Results The survival rate of the sepsis group (30％ at 7th day) was significantly lower than that of the control group (100％ at 7th day)and sham operation group(100％ at 7th day).The survival rate of the sepsis therapy group (45％ at 7th day)was significantly higher than that of the sepsis group(P ＜ O.05).The neurological reflex assessment began to decrease at 6 h in sepsis group and reached the lowest at 24 h (6.00 ± 0.53).The sepsis therapy group (7.62 ± 0.52) was significantly higher (P ＜ 0.05) than the sepsis group and began to recover at 72 h (8.63 ±0.52).ROS,SOD,MDA,NO and iNOS in the sepsis group and the sepsis therapy group reached a peak at 24 h,which decreased at 72 h.The value in sepsis therapy group was significantly decreased than that in the sepsis group,and the difference was statistically significant(P ＜0.05).CAT changed in the opposition.The SOD/CAT in sepsis group was the highest 24 h after the operation,while the ratio in sepsis therapy group was significantly improved.SOD/CAT and MDA were positively correlated(r =0.968,P ＜ 0.05).HE staining showed significant damage to the brain tissue structure in the sepsis group,however some improvement was observed in the sepsis therapy group.Conclusion Vitamin C can significantly improve the survival rate and encephalopathy prognosis in the cecal ligation and puncture SD rat models.The mechanism may be related to the reduction of oxidative stress.

Association between endothelial injury and organ dysfunction in sepsis / 中华实用儿科临床杂志

The definition of sepsis has been updated as life-threatening organ dysfunction caused by a dysregulated host response to infection according to the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3).Sepsis affects functions of endothelial cell (EC) which include vasoregulation,barrier function,inflammation,hemostasis,and is thought to be the key factor in the progression from sepsis to organ failure.Recent studies also demonstrated the mechanism of endothelial dysfunction in sepsis is mediated by glycocalyx shedding.This review covers the current insight in sepsis-associated endothelial dysfunction in different organ systems,as well as the clinical assessmeut and clinical trial aiming at the system of endothelium.

Xingnaojing injection improves brain mitochondrial oxidative stress in rats with lipopolysaccharide-induced sepsis / 医学研究生学报

Objective Mitochondrial dysfunction, cell energy metabolism, and oxidative stress play important roles in sepsis-induced acute brain injury.This study was to investigate the effects of Xingnaojing Injection (XNJ) on brain mitochondrial oxidative stress in rats with lipopolysaccharide (LPS)-induced sepsis.Methods Totally, 252 male SD rats were randomly divided into a normal control group, 3 LPS-induced sepsis model groups (LPS 6, 24, and 48 h), and 3 XNJ treatment groups (XNJ 6, 24, and 48 h), with 36 in each group.After treatment, the mitochondrial membrane potential (MMP) was monitored by flow cytometry and the levels of manganese superoxide dismutase (Mn-SOD), malondialdehyde (MDA), nitric oxide (NO), and nitric oxide synthase (NOS) were determined by chromatometry.Results The MMP was significantly increased in the XNJ 6 h group as compared with the LPS 6 h group (0.80±0.11 vs 0.54±0.19, P<0.05).In the LPS and XNJ groups, the levels of MDA and NOS reached the peak at 6 hours and then dropped gradually, while those of NO and Mn-SOD rose to the peak at 24 hours followed by a gradual fall.Statistically significant differences were observed in the levels of MDA, NOS and NO between the LPS 6h and XNJ 6 h groups (P<0.05), as well as in those of NOS, NO and Mn-SOD between the LPS 24 h and XNJ 24 h groups (P<0.05).Conclusion Xingnaojing Injection can elevate the level of the brain mitochondrial membrane potential, improve anti-oxidation indexes in the mitochondria, and protect brain mitochondria in sepsis rats.

Association between endothelial injury and organ dysfunction in sepsis / 中华实用儿科临床杂志

The definition of sepsis has been updated as life-threatening organ dysfunction caused by a dysregulated host response to infection according to the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3).Sepsis affects functions of endothelial cell (EC) which include vasoregulation,barrier function,inflammation,hemostasis,and is thought to be the key factor in the progression from sepsis to organ failure.Recent studies also demonstrated the mechanism of endothelial dysfunction in sepsis is mediated by glycocalyx shedding.This review covers the current insight in sepsis-associated endothelial dysfunction in different organ systems,as well as the clinical assessmeut and clinical trial aiming at the system of endothelium.

Protective effects and mechanism of insulin on brain in septic rats / 中华实用儿科临床杂志

Objective To investigate the protective effects and mechanism of insulin(INS) on brain in septic rats,and explore the possible role of uncoupling protein 2 (UCP2) in these effects.Methods Fifty male specific pathogen free(SPF) Sprague-Dawley rats were randomly divided into normal control (CN) group(n=10),lipopolysaccharide(LPS) group(n=20) and INS group (n=20) according to random number table.The septic rat model was established through an intraperitoneal injection of 15 mg/kg LPS of gram-negative bacteria.The rats in the INS group received a 1 U/kg INS injection subcutaneously 30 minutes before the injection of LPS,and the rats in the CN group were given equivalent 9 g/L saline in the same way.Eight rats in each group were killed,and their cerebral cortex were collected after the injection of LPS for 24 h.Pathological change of cerebral cortex was detected by Hematoxylin-Eosin(HE) staining.The cerebral cortex mitochondia were extracted for detecting the levels of reactive oxygen species(ROS),malondialdehyde (MDA) and the activity of superoxide dismutase(SOD).Neuronal apoptosis was detected by terminal dexynucleotidyl transferase(TdT)-mediated dUTP nick end labeling staining.UCP2 mRNA expression was detected by quantitative real-time(RT)-PCR.Apoptosis-associated protein B lymphocyte tumor-2(Bcl-2),Bcl-2 associated X protein(Bax),cleaved cysteinyl aspartate specific protease(cleaved Caspase-9) and UCP2 protein expression were determined by Western blot.Results (1)Compared with the CN group,obvious abnormal pathological change was revealed by HE staining in cerebral cortex of rats in the LPS group and the INS group,but the pathological change was attenuated in the INS group compared with the LPS group.(2)Compared with the CN group,the levels of mitochondrial ROS[(210.01±14.09) RFU vs.(49.06±7.28) RFU] and MDA[(2.19±0.18) nmol/mg pro vs.(1.25±0.11)nmol/mg pro]in the LPS group significantly increased,whereas SOD activity significantly decreased [(238.49±35.60) U/g pro vs.(446.66±24.90)U/g pro],and the differences were significant(all P<0.05).Compared with the LPS group,the levels of ROS [(152.69±15.83) RFU vs.(210.01±14.09) RFU] and MDA[(1.55±0.14) nmol/mg pro vs.(2.19±0.18) nmol/mg pro] in the INS group decreased,while SOD activity increased[(327.8±23.26) U/g pro vs.(238.49± 35.60) U/g pro],and the differences were significant(all P<0.05).(3)Compared with the CN group,the neuronal apoptosis index of cortex in the LPS group was elevated[(54.16±6.84)% vs.(5.45±1.43)%],while the expression of Bcl-2 decreased (627±0.018 vs.0.739±0.020),but the expressions of Bax(0.768±0.019 vs.0.520±0.010) and cleaved Caspase-9(0.739±0.016 vs.0.467±0.030) increased,and the differences were significant(all P<0.05).Compared with the LPS group,the neuronal apoptosis index of cortex in the INS group decreased [(33.30±3.07)% vs.(54.16±6.84)%],but the Bcl-2 expression increased (0.743±0.022 vs.0.627±0.018),and Bax (0.687±0.034 vs.0.768±0.019) and cleaved Caspase-9(0.551±0.013 vs.0.739±0.016) were reduced,and the differences were significant (all P<0.05).(4)Compared with the CN group,the mRNA (2.248±0.155 vs.1.000±0.100) and protein expression of UCP2 (0.659±0.016 vs.0.599±0.018) were elevated in the LPS group.Compared with the LPS group,the UCP2 mRNA (2.944±0.117 vs.2.248±0.155) and UCP2 protein (0.719±0.018 vs.0.659±0.016) increased,and the differences were significant(all P<0.05).Conclusions INS can protect the brain of septic rats through alleviating mitochondrial oxidative stress and inhibiting the mitochondrial-initiated apoptotic pathway to reduce neuronal apoptosis.INS upregulates UCP2 expression in the brain of septic rats,which may play a role in the protective effects mentioned above.

Effects of epinephrine on early inflammatory cytokines and acute lung injury in endotoxemic rats / 中国小儿急救医学

Objective To investigate the effects of epinephrine in sepsis-associated lung injury in rats. Methods Thirty SD rats were randomly divided into three groups(n =10 per group):control group received intravenous 0. 9% saline 2. 4 ml/( kg·h ); LPS group received intravenous LPS ( 6 mg/kg ); epi-nephrine treatment group received an infusion of epinephrine 0. 6μg/( kg·min) after LPS intravenous injec-tion . Blood samples were taken at 2 h and 6 h after LPS injection and the levels of serum tumor necrosis factor ( TNF)-α,interleukin( IL)-6 and IL-10 were detected. The rats were sacrificed at 6 h. The lung tissues and bronchoalveolar lavage fluid( BALF) were collected. Pathological changes of the lung tissues were observed under light microscope. Water content of lung,expression of TNF-α,IL-6 and IL-10 in BALF and in serum were detected. Results (1) The water content of lung in LPS group significantly increased compared with that in control group(85. 24% ± 5. 87% vs. 70. 19% ± 5. 87%) and epinephrine group(78. 00% ± 6. 41%) (P<0. 05). (2)Pathological examination showed that LPS could cause pulmonary capillary hyperemia,ede-ma,inflammatory cells infiltration. Atelectasis and alveolar edema were found in small number of lung tissue. Compared with LPS group, epinephrine ameliorated the lung pathological injury. ( 3 ) Compared with LPS group,serum levels of TNF-α and IL-6 significantly decreased ( P <0. 05 ) , whereas IL-10 increased ( P <0. 05) in epinephrine group. (4)Compared with LPS group,BALF levels of TNF-α[(78 ± 9)ng/L vs. (102 ±16)ng/L]andIL-6[(268±42)ng/Lvs.(347±50)ng/L]significantlydepressed(P<0.05),whereas BALFlevelsofIL-10[(210±23)ng/Lvs.(146±34) ng/L]elevated(P <0.05) inepinephrinegroup. Conclusion Epinephrine could reduce the acute lung injury caused by LPS. Its protective effect may be re-lated to decreasing the levels of TNF-α and IL-6,elevating IL-10 level.

Uncoupling protein 2 in regulatory mechanisms and basical experiments / 国际儿科学杂志

Uncoupling protein 2(UCP2)is a proton transporter which presents in the mitochondrial inner membrane. Recent studies have found that UCP2 plays important roles in protecting mitochondria functions,re-ducing mitochondrial ROS generation by inducing proton leak across the inner mitochondrial membrane and pro-moting mild uncoupling which leading to a decrease in the mitochondrial inner membrane′s potential. Because of its antioxidant function,UCP2 has been studied in several domains. This review provides novel insights into the molecular mechanisms,by which the activity of UCP2 is regulated and describe novel findings concerning basical experiments of UCP2.

Expression of microRNA -30e in sepsis - induced acute lung injury rats and its correlation with the levels of inflammatory cytokines / 中华实用儿科临床杂志

Objective To investigate the differential expression of microRNA - 30e in sepsis - induced acute lung injury(ALI)and its correlation with interleukin(IL)- 1β and tumor necrosis factor(TNF)- α from two aspects of in vivo and in vitro. Methods Thirty SD male rats were randomly divided into 5 groups:normal control group,3 - hour sepsis group,6 - hour sepsis group,12 - hour sepsis group and 24 - hour sepsis group in equal number. Sepsis - in-duced ALI model was induced by intraperitoneal injection of lipopolysaccharide(LPS,10 mg/ kg). The rat alveolar mac-rophages NR8383 were divided into blank control group and LPS(1 mg/ L)stimulated 3,6,12,24 hour groups. Inverse transcription - polymerase chain reaction was used to assay the production changes of IL - 1β,TNF - α and miRNA - 30e in lungs and cells. The injury of lung tissue was evaluated through histopathology. Results The levels of IL - 1β and TNF - α in lung tissues of rats in sepsis groups were obviously up - regulated when compared with those in normal control groups(all P ﹤ 0. 01). The lung tissue hematoxylin - eosin staining indicated ALI in the sepsis group. The relative expression of miR - 30e in rat lung tissue in sepsis 3,6,12,24 hour groups were respectively 0. 26 ± 0. 02, 0. 41 ± 0. 08,0. 29 ± 0. 05 and 0. 18 ± 0. 05,which were significantly lower than those in normal control group(1. 23 ± 0. 24,all P ﹤ 0. 01). The levels of IL - 1β and TNF - α in LPS stimulated NR8383 cells at different time points were obviously up - regulated when compared with those in blank control groups(all P ﹤ 0. 01). The relative expression of miR - 30e in LPS stimulated 3,6,12,24 hour groups were respectively 0. 27 ± 0. 04,0. 55 ± 0. 05,0. 65 ± 0. 02 and 0. 41 ± 0. 10,which were significantly lower than those in blank control group(1. 17 ± 0. 21,all P ﹤ 0. 01). The expres-sion of miR - 30e in lung tissues of groups showed significantly negative correlations with those of IL - 1β and TNF - α(IL - 1β:r = - 0. 417,P = 0. 022;TNF - α:r = - 0. 437,P = 0. 016). The expression of miR - 30e in LPS stimulated NR8383 cells of groups also showed significantly negative correlations with those of IL - 1β and TNF - α(IL - 1β :r =- 0. 713,P = 0. 003;TNF - α:r = - 0. 712,P = 0. 002). Conclusions The expression level of miR - 30e was signifi-cantly down - regulated in sepsis - induced ALI,and had a significantly negative correlation with IL - 1β and TNF - α, which may be used as a new biomarker of diagnostic,prognosis evaluation and therapy of sepsis - induced ALI.