The shape change index (SCI) of inferior vena cava (IVC) measuring by transabdominal ultrasound to predict the presence of septic shock in intensive care unit (ICU) patients.

OBJECTIVE: This study is designed as prospective and observational research of patients with sepsis. It was carried out in the intensive care unit (ICU). We investigated the shape change index (SCI) of inferior vena cava (IVC) measured with trans-abdominal ultrasound to detect the signs of septic shock. The aim of this research was to find the most effective tool in predicting shock in patients compared with that of other parameters such as brain natriuretic peptide (BNP), lactate, variation index of inferior vena cava IVC-VI, and extravascular lung water index (EVLWI). PATIENTS AND METHODS: We suppose that SCI can be used as the safest and most sensitive tool in the early recognition of septic dysfunction. The observational study was conducted in the Department of ICU, Shandong Provincial Hospital Affiliated to Shandong University from January 2016 to December 2017. SCI of IVC, serum lactate, BNP, IVC-VI, and EVLWI concentrations were measured in 30 sepsis patients. All studied biomarkers were analyzed and contrasted according to the score of the Sequential Organ Failure Assessment (SOFA). Pearson correlation analysis was analyzed to statistic the relationship between variables. RESULTS: We showed the correlation of BNP value, lactic acid value, IVC-VI, EVLWI, and SCI of IVC in sick patients suffering septic shock. Positive correlation was observed in the BNP value, lactic acid value, IVC-VI, EVLWI, and SCI of IVC (r=0.447, p=0.013; r=0.484, p=0.007; r=0.423, p=0.023; r=0.638, p<0.001; r=0.599, p<0.001; respectively). However, the SCI and EVLWI showed a stronger correlation with the SOFA than the others. SCI of IVC, as estimated by transabdominal ultrasound, was more accurate than the other commonly used non-invasive predictors. EVLWI, as an accurate and classical predictor, was an invasive predictor. SCI of IVC was faster, more convenient and safer than the other. CONCLUSIONS: SCI of IVC was faster, more convenient and safer than the other commonly used non-invasive predictors. Early recognition and diagnosis of sepsis may improve patient outcome.

The influence of high volume hemofiltration on extra vascular lung water and alveolar-arterial oxygen pressure difference in patients with severe sepsis.

OBJECTIVE: To explore the effects of high-volume hemofiltration (HVHF) on the plasma interleukin-6 (IL-6), pro-calcitonin (PCT), extra vascular lung water index (EVLWI) and alveolar-arterial oxygen exchange in patients with septic shock. PATIENTS AND METHODS: 97 cases intensive patients with septic shock were enrolled  from Department of Intensive Care Unit (ICU) of the Provincial Hospital affiliated to Shandong University between January 2011 and December 2014. According to the puting into practice of high-volume hemofiltration (HVHF) or not, all the patients were divided in two groups (NHVHF group, group A, n = 46 cases) and (HVHF group, group B, n = 51 cases). The plasma IL-6, PCT intrathoracic blood volume index (ITBVI), extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index(PVPI) was detected before treatment and after treatment 24h, 72h The Alveolar- arterial oxygen pressure difference P(A-a)DO2 was checked by arterial blood gas analysis (ABGA) at first and after treatment 24 hour, 72 hour, 7 day in two groups. The mortality at 28 day was compared between two groups. RESULTS: After 72h treatment, the plasma IL-6, PCT in group B has a significant decrease. After 72h treatment, the level ITBVI, EVLWI and PVPI in group B had a significant improvement. The levels of P(A-a)DO2 in HVHF group were reduced more significantly than N-HVHF group after 7 day. The EVLWI and P(A-a)DO2 had a significant positive correlation (correlation ratio = 0.712, 95% confident interval [0.617, 0.773], p = 0.001). The mortality at 28 day had a significant decrease between groups (15.22% vs. 34.15% χ2 = 4.242, p = 0.038). CONCLUSIONS: HVHF could decrease plasma inflammatory factors and EVLWI so that it could improve the levels of alveolar-arterial-oxygen exchange in patients with septic shock, so it could improve the survival rate of patients.

Synergistic effects of NGF, CNTF and GDNF on functional recovery following sciatic nerve injury in rats.

PURPOSE: To investigate the synergistic effects of nerve growth factor (NGF), ciliary neurotrophic factor (CNTF) and glia cell line-derived neurotrophic factor (GDNF) on survival and growth of sensory neurons and motoneurons, as well as on the functional recovery following sciatic nerve injury in rats. METHODS: Experimental rats and neurons were randomized into 8 groups: NGF group, CNTF group, GDNF group, NGF+CNTF group, CNTF+GDNF group, NGF+GDNF group, NGF+CNTF+GDNF group and control group. Each group received local intramuscular injection of indicated NTFs according to the treatment protocol. The sciatic nerve function index (SFI), nerve conduction velocity and wet weight recovery rate of gastrocnemius muscle were tested to evaluate the functional recovery in vivo. A 2 (presence or absence of NGF) x 2 (presence or absence of CNTF) x 2 (presence or absence of GDNF) analysis of variance (ANOVA) was used to examine the main effects and interactions among NGF, CNTF and GDNF, and one-way ANOVA was calculated for multiple comparison. RESULTS: NGF and GDNF acted significantly on the survival of sensory neuron and motoneuron, respectively. CNTF was a dominant factor promoting cell body development, and GDNF had the most powerful effect on neurite outgrowth and elongation of sensory neurons and motoneurons. Combined administration of the three factors resulted in optimal functional recovery following sciatic nerve injury in rats. CONCLUSIONS: It is demonstrated that differential and complementary biological effects of various neurotrophic factors contribute to synergistic promotion of nervous function recovery.

Phospholipases A2 from Callosellasma rhodostoma venom gland cloning and sequencing of 10 of the cDNAs, three-dimensional modelling and chemical modification of the major isozyme.

Callosellasma rhodostoma (Malayan pitviper) is a monotypic Asian pitviper of medical importance. Three acidic phospholipases A2 (PLA2s) and one basic PLA2-homolog were purified from its venom while 10 cDNAs encoding distinct PLA2s were cloned from venom glands of a Thailand specimen of this species. Complete amino-acid sequences of the purified PLA2s were successfully deduced from their cDNA sequences. Among the six un-translated PLA2 cDNAs, two apparently result from recombination of its Lys49-PLA2 gene with its Asp49-PLA2 genes. The acidic PLA2s inhibit platelet-aggregation, while the noncatalytic PLA2-homolog induces local edema. This basic PLA2-homolog contains both Asp49 and other, unusual substitutions unique for the venom Lys49-PLA2 subtype (e.g. Leu5, Trp6, Asn28 and Arg34). Three-dimensional modelling of the basic protein revealed a heparin-binding region, and an abnormal calcium-binding pocket, which may explain its low catalytic activity. Oxidation of up to six of its Met residues or coinjection with heparin reduced its edema-inducing activity but methylation of its active site His48 did not. The distinct Arg/Lys-rich and Met-rich region at positions 10-36 of the PLA2 homolog presumably are involved in its heparin-binding and the cell membrane-interference leading to edema and myotoxicity.

Effects of tetrandrine on gastric mucosa and liver in portal hypertensive rats.

AIM: To study the effects of tetrandrine on portal hypertensive gastric mucosal lesions. METHODS: Portal hypertensive models were induced in Wistar rats by 60% CCl4 3 mL/kg body weight through subcutaneous injection, once every 4 d for 56 d. The animals were randomly divided into portal hypertension, tetrandrine and propranolol groups and subsequently, treated by normal saline, tetrandrine and propranolol respectively for 15 d. Some healthy rats were used as control group. Portal venous pressure (PVP), gastric mucosal prostaglandin E2 (PGE2) content, gastric mucosal blood flow (GMBF), gastric adherent mucus (GAM), ALT, ALP and serum total bilirubin (STB), were measured and liver tissues were observed histologically. RESULTS: In tetrandrine group and propranolol group, PVP was significantly lower (1.43 ± 0.13, 1.45 ± 0.12 vs 1.89 ± 0.18 kPa; P < 0.01) and gastric mucosal PGE2 content (138.59 ± 12.68, 129.98 ± 14.31 vs 104.65 ± 12.97 pg/mg; P < 0.01), GMBF (11.80 ± 3.47, 10.54 ± 3.63 vs 6.61 ± 2.82 mL·h·kg; P < 0.05) and GAM (3.01 ± 0.15, 2.98 ± 0.21 vs 2.24 mg ± 0.26 mg; P < 0.01) was significantly higher than that in portal hypertension control group. In tetrandrine group intrahepatic proliferative fibrous tissues were reduced and serum ALT (47.67 ± 25.90 vs 189.33 ± 41.21 King U; P < 0.01), ALP (0.22 ± 0.04 vs 0.31 ± 0.06 µmol·s(-1)/L; P < 0.01) and STB (4.75 ± 0.76 vs 11.12 ± 2.93 µmol/L; P < 0.01) were lowered as compared with those in portal hypertension control group. ALT (209.34 ± 36.91 vs 189.33 ± 41.21 King U; P > 0.05) and STB (11.63 ± 3.01 vs 11.12 ± 2.93 µmol/L; P > 0.05) in propranolol group were not different from that in portal hypertension control group, but it showed more marked hepatocellular degeneration and necrosis and elevation of ALP (0.46 ± 0.05 vs 0.31 ± 0.06 µmol·s(-1)/L; P < 0.01). CONCLUSION: Tetrandrine can improve the functions of gastric mucosa and liver, and facilitate the absorption of intrahepatic proliferative fibrous tissues. Propranolol can aggravate hepatosis though it may improve portal hypertensive gastric mucosal lesions.

Button batteries as foreign bodies in the nasal cavities.

Two cases of foreign bodies (button batteries) in the nasal cavities were reported. The first patient was a 6-year-old girl who put a button battery into her left nostril and ulceration of the septum and inferior turbinate was found. The other patient was a 3-year-old boy, the alkaline battery caused neither septal perforation nor stenosis of the nasal meatus. All button batteries as foreign bodies in the nasal cavities should be removed immediately to prevent severe local tissue damage, resulting in late sequels, such as septal perforation or stenosis of the nasal meatus.