Neutrophil extracellular trap increase the risk of sepsis: a two-sample, one-way Mendelian randomization study / 中华危重病急救医学

OBJECTIVE@#To investigate the causal relationship between neutrophil extracellular trap (NET) and sepsis based on Mendelian randomization analysis.@*METHODS@#The genome wide association study (GWAS) dataset for the NET biomarker myeloperoxidase (MPO)-DNA complex based on Donkel et al. 's Rotterdam study (RS) and GWAS dataset for identifying sepsis from the UK biobank were selected to screen single nucleotide polymorphisms (SNPS) associated with MPO-DNA complex as instrumental variable (IV) for genetic variation, using MPO-DNA complex as exposure factor. Potential causal associations between MPO-DNA complex and the risk of occurrence of sepsis, 28-day death from sepsis, need for intensive care due to sepsis, and 28-day death from sepsis requiring intensive care were analyzed using a two-sample, one-way Mendelian randomization analysis primary analysis method of inverse analysis of variance (IVW). Potential pleiotropy was assessed using the MR Egger regression intercept test. Sensitivity analysis was performed using the "leave one out" test.@*RESULTS@#The GWAS data were obtained from a European population of both sexes, and the screening criteria was based on the three main assumptions of Mendelian randomization, resulting in 22 SNP entering the Mendelian randomization analysis. The results of the Mendelian randomization causal association effect analysis using the IVW method showed that for every standard deviation increase in the level of the MPO-DNA complex, the risk of sepsis increased by approximately 18% [odds ratio (OR) = 1.18, 95% confidence interval (95%CI) was 1.07-1.29, P < 0.001], the risk of 28-day death from sepsis increased by approximately 51% (OR = 1.51, 95%CI was 1.27-1.81, P < 0.001), an increase of approximately 38% in the risk of occurrence of needing intensive care due to sepsis (OR = 1.38, 95%CI was 1.12-1.70, P = 0.002), and an increase of approximately 125% in the risk of 28-day death from sepsis requiring intensive care (OR = 2.25, 95%CI was 1.21-4.18, P = 0.01). MR Egger regression intercept test suggested that there was no horizontal pleiotropy in the included SNP, and the MR-PRESSO test did not find outliers. Sensitivity analysis suggested that the results of Mendelian randomization were robust.@*CONCLUSIONS@#Rising NET can increase the risk of sepsis onset, progression and death as derived from Mendelian randomization analysis.

Statin in the treatment of ALI/ARDS: a systematic review and Meta-analysis basedon international databases / 中华危重病急救医学

Objective To confirm the effects of statin therapy on mortality of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods PubMed/Medline, Embase, Web of Science andCochrane Central Register of Controlled Trials were searched for articles using the terms acute lung injury, ALI,acute respiratory distress syndrome, ARDS, statin, simvastatin and rosuvastatin updated to November 17,2015. Randomized controlled trial (RCT) or observational cohort studies investigating the effects of statin therapy onmortality in patients with ALI or ARDS were all identified, without date or language restriction. The control group wasgiven conventional treatment, while the experimental group was treated with statins additionally. The primary outcomewas in-hospital mortality. Meanwhile, ventilator-free day, intensive care unit (ICU)-free day, ICU length of stay (LOS)and ICU mortality were also analyzed. RevMan 5.2 and STATA 13 software were used for systematic review and Metaanalysis, and funnel plot was used to analyze the publication bias. Results A total of five trials including threerandomized controlled trials and two observational studies were included. Among 1636 patients enrolled in the study,there were 739 patients in experimental group, and 897 in control group. It was shown by Meta analysis that there was nosignificant difference in in-hospital mortality between experimental group and control group [relative risk (RR) = 0.96,95% confidence interval (95%CI) = 0.79-1.15, P = 0.63]. The subgroup analysis based on RCT and cohort study, or thesubgroup analysis of different statins showed that there was no significant difference in in-hospital mortality betweenthe experimental group and the control group (both P > 0.05). There were no significant differences in ventilator-freedays [mean difference (MD) = 1.41, 95%CI = -0.32-3.13, P = 0.11], ICU-free days (MD = -0.23, 95%CI = -1.61-1.15,P = 0.75), ICU length of stay (MD = -1.03, 95%CI = -6.55-4.50, P = 0.72), or ICU mortality (RR = 0.88, 95%CI =0.68-1.14, P = 0.33) between the experimental group and the control group. It was shown by funnel plot that there was nopublication bias in in-hospital mortality. Conclusion The systematic review and meta-analysis suggests that statin may not be associated with a significant reduction in mortality, ventilator-free day, ICU-free day and ICU length of stayin patients with ALI/ARDS.

Study on physical training for the prevention of chicken′s tendon adhesion / 重庆医学

Objective To discover the best physical training way including frequency and intensity each day ,and to guide pa‐tients to get the best cure .Methods Totally 60 chicken ,which were randomly divided into 3 groups ,20 for each ,the deep flexor tendon of the third left toes were found ,repairing after cut them off .Flexor tendon proximal were found by making knees incision then indwelling long silk line .External fixation bandage were used .Their left toes were accepted physical training ,Training stand‐ards :6 pulling backs each time ,toe flexion 1/4 arc ,but less than 2 N .For group A ,exercised once a day ,twice a day for group B , three times a day for group C .Right ones were consider as control group weren′t processed after operation .28 days later ,tendon distance was recorded by using 2 N pulling forces at tendon proximal with aspiring balance .Gross specimen was observed and histo‐logical specimens using Tang Jinen classification method to classify adhesions ,and the dates were analyzed by statistics SPSS 19 .0 . Results Group A remaining of 18 ,rate of 5 .56% ,grade Ⅰ of 1 ,Ⅱ of 2 ,Ⅲ of 4 ;Ⅳ of 10 .Group B remaining of 17 ,rate of 5 .88% , grade Ⅰ of 12 ,Ⅱ of 2 ,Ⅲ of 1 ,Ⅳ of 1 .group C remaining of 16 ,15 toes broke again ,fracture rate was 93 .75 % ,grade Ⅰ of 1 ,con‐trol group were grade Ⅳ .Between group A and B there were no significant differences in degree of adhesion(P> 0 .05) .Group A and Cs′ differences were statistically tested (P α′) .Conclusion Physical training can reduce chicken′s tendon adhesion effectively .