Mesenchymal-epithelial Transition Factor Regulates Monocyte Function during Mycobacterial Infection via Indoleamine 2,3-dioxygenase.

OBJECTIVE: Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB), causes an estimated 1.6 million human deaths annually, but the pathogenesis of TB remains unclear. Immunity plays a critical role in the onset and outcome of TB. This study aimed to uncover the roles of innate and adaptive immunity in TB. METHODS: The gene expression profiles generated by RNA sequencing from human peripheral blood mononuclear cells (PBMCs) stimulated with or without Mtb strain H37Rv antigens were analyzed. A total of 973 differentially expressed mRNAs were identified. RESULTS: The differentially expressed genes were enriched in innate immunity signaling functions. The mesenchymal-epithelial transition factor (MET) gene was significantly upregulated in CD14+ monocytes. A MET inhibitor improved the uptake of the BCG strain by monocytes and macrophages as well as inhibited the expression of indoleamine 2,3-dioxygenase (IDO). The expression of IDO was increased in PBMCs stimulated with Mtb antigens, and the IDO inhibitor promoted the expression of CD40, CD83, and CD86. CONCLUSION: Our results might provide clues regarding the immunomodulatory mechanisms used by Mtb to evade the host defense system.

Left atrial appendage occlusion in a mirror-image dextrocardia: A case report and review of literature.

BACKGROUND: In mirror-image dextrocardia, the anterior-posterior position of the cardiac chambers and great vessels is maintained, but the left-right orientation of the abdominal organs is reversed. The abnormal anatomy of the heart poses surgical challenges and problems in dealing with surgical risk and monitoring complications. There are few reports on closure of the left atrial appendage (LAA) in dextrocardia and no reports on the application of enhanced recovery after surgery (ERAS) following LAA occlusion (LAAO) procedures. CASE SUMMARY: The objective for this case was to ensure perioperative safety and accelerate postoperative recovery from LAAO in a patient with mirror-image dextrocardia. ERAS was guided by the theory and practice of nursing care. Atrial fibrillation was diagnosed in a 77-year-old male patient, in whom LAAO was performed. The 2019 guidelines for perioperative care after cardiac surgery recommend that the clinical nursing procedures for patients with LAAO should be optimized to reduce the incidence of perioperative complications and ensure patient safety. Music therapy can be used throughout perioperative treatment and nursing to improve the anxiety symptoms of patients. CONCLUSION: The procedure was uneventful and proceeded without complications. Anxiety symptoms were improved.

[Relationship between severity of illness and mental status in ICU conscious patients: a nationwide multi-center clinical study].

OBJECTIVE: To survey the incidence of psychological adverse events in critical conscious patients during their ICU stay and analyze the relationship between the incidence and the severity of illness. METHODS: 234 conscious patients, 133 males and 101 females, aged (55.4 +/- 19.6), 80 with internal medicine diseases and 154 with surgical diseases, were treated in the ICUs of 31 grade 3 A hospitals over the country consecutively during the period of 2 months and then successfully transferred to other departments. The patients were interviewed with specific questionnaire within the 2 days after transfer to investigate the incidence of anxiety and depression and the tolerance of invasive medical and nursing procedures of the patients. RESULTS: The overall incidence of psychological adverse events (PAE) was 69.6%. Multi-variate Logistic analysis showed that acute physiology and chronic health evaluation (APACHE) II score was an independent high risk factor of PAE (OR = 1.07, 95% CI: 1.02-1.13, P < 0.05). The relative risk (RR) values of the patients with APACHE II scores 1-10, 11-20, and >20 were 1.29, 2.53, and 4. 85 respectively. The higher the APACHE II score, the more invasive interventions received (P < 0.01) , and the lower the mental stress threshold (P < 0.01) the higher the incidence of PAE (P < 0.01). The APACHE II scores of those who failed to tolerate noise and medical and nursing procedures were 15.8 +/- 5.7 and 16.5 +/- 6.1 respectively, both significantly higher than those of the patients who tolerated (12.1 +/- 4.4, P < 0.05; and 10.6 +/- 2.9, P < 0.01). CONCLUSION: APACHE II score is an independent high risk factor of PAE. The conscious ICU patients with higher APACHE II scores receive more invasive medical and nursing procedures. Low mental stress threshold greatly contributed to the incidence of PAE in ICU conscious critical patients with high APACHE II score.

[Midazolam attenuates mental stress in conscious patients during cardiopulmonary resuscitation performed next bed in intensive care unit].

OBJECTIVE: To evaluate the mental stress level and alterations in circulatory physiology in conscious patients during cardiopulmonary resuscitation (CPR) performed next bed in intensive care unit (ICU), and to investigate the possible effective interventions. METHODS: Eighty-seven conscious patients, selected consecutively from June 2003 to September 2006, were randomly allocated into control group (received normal saline), psychological nursing group (received psychological nursing intervention) or sedation group (received midazolam 0.1 mg/kg intravenous injection based on psychological nursing intervention) when CPR was performed in our ICU. Plasma concentrations of norepinephrine, epinephrine, cortisone and glucose were analyzed at the time points of beginning of CPR, 10 minutes, 4 and 24 hours after CPR in the first 40 patients. Heart rate (HR), systolic blood pressure (SBP), mean arterial pressure (MAP) and arrhythmia within 24 hours after CPR were recorded in all patients. RESULTS: Plasma levels of norepinephrine, epinephrine and cortisone were significantly increased at 10 minutes after CPR and persisted for 4 hours in 13 patients of the control group (P<0.05 or P<0.01). Though with the similar tendency, significant increase of cortisone level was observed in 13 patients who had received psychological nursing intervention (P<0.05 or P<0.01). The analyzed stress hormones showed little variation in 14 patients who were given midazolam at 10 minutes and 4 hours after CPR. Notably, 24 hours after CPR, they were decreased below the levels which were observed at the beginning of CPR (all P<0.01). Blood glucose levels were markedly higher in both control and psychological nursing groups than the level in sedation group within 24 hours. HR was accelerated 10 minutes after CPR, SBP was significantly increased, the incidence rate of arrhythmia was high (84.6%, 22/26; 54.5%, 18/33) in the non-sedation groups. Circulatory physiological alterations were least marked in sedation group (21.4%, 6/28, both P<0.01). CONCLUSION: Mental stress is significantly heightened in conscious patients during CPR performed next bed in ICU, and it induces severe circulatory physiological alterations. Psychological nursing alone is not affective in alleviating this acute mental stress. However, low dose of midazolam is found to be an effective intervention.

[Comparison of reliability of bispectral index and sedation-agitation scale in assessing the depth of sedation in patients treated with mechanical ventilation].

OBJECTIVE: To compare the reliability of bispectral index (BIS) with sedation agitation scale (SAS) in assessing the depth of sedation in ill patients on mechanical ventilation in intensive care unit (ICU). METHODS: Fifteen patients, aged 18-65 years old, who were receiving mechanical ventilation in ICU for longer than 72 hours and without brain dysfunction, were enrolled in this study. Sedatives and analgesics were suspended at 7:00 am. When patients fully woke up, propofol was infused till BIS score reaching 45-60. This was maintained for 10 minutes, then propofol dosage was decreased 10 microg . kg(-1) . min(-1) for every 10 minutes till all the drug was stopped. BIS was consecutively monitored and SAS was assessed in each interval. RESULTS: BIS score was markedly correlated with SAS (r=-0.6494, P<0.01). Although a significant correlation was still shown (r=-0.4566, P<0.01), there was wide variability in BIS scores when SAS reached 2-4. With decreasing of the propofol dosage, BIS score gradually increased. There was a satisfactory negative correlation between BIS scores and propofol dosage (r=-0.8076, P<0.01). SAS increased also following the decrease in propofol dosage, and a significant negative correlation was shown between SAS and the dosage of propofol (r=-0.6551, P<0.01). CONCLUSION: SAS is well correlated with BIS in assessing the depth of sedation in patients treated with mechanical ventilation in ICU. BIS is an objective, efficient tool for monitoring the depth of sedation in ICU critical patients who are receiving mechanical ventilation, and it is more reliable than SAS, especially when sedated levels reaching SAS 2-4.

[Study on safety of apnea test in clinical determination of brain death].

OBJECTIVE: To determine the occurrence of severe complications such as hypotension, pulmonary artery hypertension as well as hypercapnia during apnea test in the affirmation of brain death and to investigate the possible effective prophylactic interventions. METHODS: Conventional apnea test was performed in 15 clinically suspected brain death patients. Stable circulation was achieved by adjusting preload only (n=4) or combined with titrating norepinephrine (NE, n=11). Blood gas was respectively analyzed before apnea test, 10 minutes after 100% fraction of oxygen (FiO(2)) ventilation, at each 2-minute interval after disconnecting ventilator and 5 minutes after reventilation. Hemodynamic parameters and dosage of NE were recorded at the same time points. Plasma concentration of lactate was measured before and at the end of apnea test. RESULTS: Spontaneous breath occurred in 1 case among 15 suspected brain death patients. Partial pressure of carbon dioxide (PaCO(2)) reached higher than 60 mm Hg (1 mm Hg=0.133 kPa) within 8 minutes in positive apnea test patients (P<0.01). pH significantly decreased (P<0.05), but partial pressure of oxygen (PaO(2)) maintained higher than 100 mm Hg during the test. Heart rate (HR) and mean artery pressure (MAP) slightly lowered (P>0.05), but pulmonary artery pressure (PAP) markedly elevated (P<0.05) at the end of the test in comparison with their base lines. On the other hand, HR and MAP increased in the negative apnea test case after ventilator disconnection. Severe arrhythmia events did not occur in all the cases. There was no change in the dosage of NE infusion, the range of which was 0.10-0.60 microg.kg(-1).min(-1) with the mean level of (0.23+/-0.17) microg.kg(-1).min(-1). The trend of HR, MAP, PAP and pulmonary arterial wedge pressure (PAWP) alterations was the same in patients no matter whether or not NE was used. HR, MAP and PAWP lowered, while PAP enhanced. Plasma lactate level was not significantly altered at the end of the test compared with the base line (from (1.41+/-0.05) mmol/L to (1.47+/-0.07) mmol/L). CONCLUSION: Adequate oxygenation could be maintained during conventional apnea test. The risk of inducing severe hypotension is low in non brain death patients. Based on adequate preload, low dose of NE infusion could prevent patients with high risk circulation instability from severe hypotension.