New progress in the study of anti influenza drugs in the study of influenza virus infection / 中国生化药物杂志

The antiviral drugs can quickly and directly inhibit influenza virus infection, at present, for influenza virus and replication proteins conserved sites of drugs is the main methods of influenza virus resistance;secondly, traditional Chinese medicine treatment of influenza virus also has an important role;in addition, new technology especially small RNAs mediated RNA interference (RNAi), because of its is efficient, specific and rapid, has become one of the candidate methods for antiviral therapy.

The early diagnostic value and prognostic significance of serum presepsin (sCD14-ST)in patients with sepsis / 中华急诊医学杂志

Objective To investigate the early diagnostic value and prognostic significance of serum presepsin in patients with sepsis.Methods A prospective observational study of 80 patients from ICU was carried out between January 2014 and June 2015.According to sepsis criteria,the cases were divided into sepsis group (n =50)and noninfectious systemic inflammation syndrome group (SIRS group,n =30), and another 25 healthy volunteers were collected as control group.Meanwhile,sepsis group was further divided into survival and death subgroups according to 28-day mortality.The dynamic changes of serum presepsin,procalcitonin (PCT),soluble myeloid cells expressing triggering receptor-1 (sTREM-1 ),C-reactive protein (CRP),interleukin 6 (IL-6)were monitored on the 1st,3rd and 7th day after admission. Results (1)The serum presepsin level of sepsis group was higher than SIRS group and control group on the 1st day,and the difference was statistically significant [912.0 (563.5,1514.8)pg/mL vs.462.0 (334.0,556.0)pg/mL vs.120.0 (70.2,320.1)pg/mL,P <0.05];(2)The area under the ROC curve (AUC)of presepsin for the sepsis diagnosis was greater than PCT,sTREM-1,CRP,IL-6.As cut-off point set at 672.5 pg/mL,presepsin measurements showed a sensitivity of 80%,specificity of 96.7%, combination of presepsin,PCT and sTREM-1 could offer better diagnostic confirmation;(3)The level of serum presepsin,PCT and sTREM-1 in death group were higher than those in survival group.The levels of serum presepsin,PCT,sTREM-1 and IL-6 in survival group gradually decreased to normal level following the therapy,but the levels of above markers in death group didn’t decrease significantly;(4)The AUC of presepsin in prognosis of sepsis prediction was greater than that of PCT,sTREM-1,and combination of the above three markers could offer better prognostic value.Conclusions Serum presepsin provided superior diagnostic and prognostic accuracy to PCT and sTREM-1,and the combination of presepsin,PCT and sTREM-1 can offer the reliable guide for sepsis diagnosis and death risk prediction.

The effect of conservative fluid management on Toll-like receptor 4 signal pathway of peripheral blood mononuclear cells and cardiac function in patients with septic shock / 中华传染病杂志

Objective To evaluate the effect of different fluid resuscitation strategies on the cardiac function in patients with septic shock.Methods Forty-eight patients met diagnostic criteria of septic shock were enrolled prospectively between January 2014 and April 2015.Patients were divided into conservative late fluid management (CLFM) group (n =20) and liberal late fluid management (LLFM) group (n=28) after achieving early goal-directed therapy within 24 h.Haemodynamic parameters,mRNA levels in Toll-like receptor 4 (TLR4) signal pathway and serum levels of myocardial damage markers were compared.Student t-test was used to compare means between two groups.Quantitative data that were not normally distributed were compared by Mann-Whitney U test.Qualitative data were compared using x2 test.Multivariable Logistic regression analysis was used to identify the independent predictors for prognosis.Results The cardiac function index (CFI) in CLFM group were (5.01± 1.41)/min and (5.39±1.48)/min on day 3 and day 7,respectively,and the cardiac index (CI) were (3.43±0.50) and (3.73±0.76) mL · min-1 · m-2 on day 3 and day 7,respectively.The CFI and CI in LLFM group were (4.28±1.22)/min,(4.22±1.63)/min and (3.31±1.24),(3.09±1.14) mL · min-1 · m-2 respectively on day 3 and day 7.The differences between two groups were statistically significant on day 7 (t=2.546,2.185,both P＜0.05).TheTLR4 mRNAlevelswere3.0±1.1 inCLFM group compared to 4.8±1.4in LLFM group on day 3 (t=4.786,P＜0.01) and 1.6±0.5 compared to 4.0±1.1 on day 7 (t=9.089,P＜0.01).Nuclear factor (NF)-κB mRNA levels were 3.5±1.1 inCLFM group compared to 6.8±1.5 in LLFM group on day 3 (t=8.354,P＜0.01) and 2.4±0.5 compared to 5.7±0.9 (t=14.820,P＜0.01) on day 7.The levels of serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β in CLFM group were lower than those in LLFM group on day 3 and day 7 (all P＜0.01).Multivariable Logistic regression analysis showed that fluid balance (OR =1.236,95 ％ CI:0.78-1.692,P =0.033),CFI (OR=3.263,95％CI:1.136-7.936,P=0.027) and acute physiology and chronic health evaluation Ⅱ (OR=2.064,95％CI:1.248-2.898,P=0.003) were the independent predictors for 28-day mortality.Conclusions CLFM may inhibit the product of myocardial depressant factors TNF-α and IL-1β through attenuating TLR4/NF-κB signal pathway activation and thus to improve myocardial function and decrease mortality.

Effect of resveratrol on myocardial energy metabolism in sepsis rats / 中华危重病急救医学

Objective To investigate the influence of resveratrol (RES) on myocardial energy metabolism in sepsis rats and its mechanism.Methods Twenty Sprague-Dawley (SD) rats were divided into four groups according to the random number table,5 rats in each group.The sepsis model was reproduced by intraperitoneal injection of lipopolysaccharide (LPS) 10 mg/kg,and the rats in sham group were injected intraperitoneally with the same amount of saline.The rats in RES treatment group (RES group) were injected RES 8 mg/kg 10 minutes before LPS injection,and those in RES combined with the silent information regulator 1 (sirt1) inhibitor group (RES + sirtinol group) were injected sirtinol 1 mg/kg followed by RES 8 mg/kg 10 minutes before LPS injection.The rats were sacrificed 6 hours later,and the heart was harvested.The myocardial ultrastructure was observed by transmission electron microscope.The expression of sirt1 protein was detected by Western Blot.The cytochrome C oxidase (CCO) activity was determined by ultraviolet spectrophotometry.The content of adenosine triphosphate (ATP),adenosine diphosphate (ADP),and adenosine monophosphate (AMP) were detected by high-performance liquid chromatography (HPLC).Results Under transmission electron microscopy,the mitochrondria in myocardium in sham group was normal,and mitochrondria was swollen and derangement in LPS group and RES + sirtinol group,but it was not significant in RES group.Compared with sham group,the sirt1 protein expression in LPS group was decreased (gray value:0.602 ± 0.038 vs.0.902 ± 0.037,P ＜ 0.05),the CCO activity was declined (U/mg:0.344 ± 0.019 vs.0.600 ± 0.023,P ＜ 0.05),the contents of ATP,ADP,and AMP were decreased [ATP (μg/g):89.958 ± 7.570 vs.157.460 ± 6.737,ADP (μg/g):164.658±6.742 vs.251.608±5.191,AMP (μg/g):179.926±7.303 vs.276.262±5.546,all P ＜ 0.05].Compared with LPS group,the sirt1 protein expression in RES group was increased (gray value:0.874±0.017 vs.0.602±0.038,P ＜ 0.05),the CCO activity was increased (U/mg:0.574±0.013 vs.0.344±0.019,P ＜ 0.05),the contents of ATP,ADP,and AMP were increased [ATP (μg/g):147.686± 8.853 vs.89.958 ± 7.570,ADP (μg/g):245.860±7.111 vs.164.658±6.742,AMP (μg/g:271.260±6.658 vs.179.926±7.303,all P ＜ 0.05].Compared with RES group,the sirt1 protein expression in RES + sirtinol group was decreased (gray value:0.636±0.030vs.0.874±0.017,P ＜ 0.05),the CCO activity was declined (U/mg:0.369 ± 0.040 vs.0.574 ±0.013,P ＜ 0.05),the contents of ATP,ADP,and AMP were decreased [ATP (μg/g):97.942± 11.257 vs.147.686 ± 8.853,ADP (μg/g):168.888±8.965 vs.245.860±7.111,AMP (μg/g):175.498±6.993 vs.271.260±6.658,all P ＜ 0.05].Conclusion RES could improve myocardial energy metabolism in sepsis rats,in which sirt1 is an important factor.

Diagnosis value of soluble triggering receptor expressed on myeloid cells-1 in critically ill patients complicated with sepsis / 中华传染病杂志

Objective To investigate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in critically ill patients complicated with sepsis. Methods Fifty-six cases of systemic inflammatory response syndrome (SIRS) who admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University between May 2009 and June 2010 were recruited. The SIRS patients were divided into two groups: sepsis group (n= 32) and non-sepsis group (n= 24). The levels of procalcitonin (PCT), C-reactive protein (CRP) were measured within 24 hours of hospitalization.Levels of sTREM-1 were measured by enzyme linked immunoabsorbant assay (ELISA). Based on the receiver operating characteristic curve (ROC), cut-off value, sensitivity and specificity of sTREM-1 in diagnosis of sepsis were calculated. Comparison between groups was done by t test and Mann-Whitney U test. Count data were compared by chi square test. ResultsThe serum level of sTREM-1 were significantly higher in sepsis group than that in non-sepsis group (250.9 ng/L vs 103.6 ng/L, Z= 12. 864,P=0. 002). Areas under the curve (AUC) of sTREM-1, PCT and CRP were 0. 935, 0. 891 and 0. 602, respectively. With a cut-off value of 135.0 ng/L, the sensitivity and specificity of sTREM-1 in diagnosing sepsis were 93. 8％ and 84. 7％, respectively. With a cut-off value of 2. 0 μg/L, the sensitivity and specificity of PCT were 84. 4％and 87. 8％, respectively.ConclusionSerum level of sTREM-1 could be used as an early indicator for diagnosing sepsis.

Treatment of septic shock from upper urinary obstruction / 中华泌尿外科杂志

Objective To investigate the treatment of septic shock(SS) from upper urinary obstruction(UUO). Methods Continuous veno-venous haemofiltration(CVVH) combined with surgical method was applied to 42 SS patients from UUO. Their general conditions, liver and kidney functions, APACHE Ⅱ, therapeutic intervention scorisystem(TISS), multiple organ dysfunction syndrome (MODS), complication rate and main outcomes were analysed comparing with traditional therapies groups(n=30). Results Compared with those traditional therapies, the APACHEⅡ , MODS and TISS score decreased (P＜0.05). Thirty-seven out of 42 patients survived and the survival rate was 88.0% during ICU. Conclusion CVVH combined with surgical methods may effectively decrease the incidence of complications and mortality of SS from UUO, and the mechanism may be related to the remove of mediators of inflammation.