A biomarker panel of C-reactive protein, procalcitonin and serum amyloid A is a predictor of sepsis in severe trauma patients.

Severe trauma could induce sepsis due to the loss of control of the infection, which may eventually lead to death. Accurate and timely diagnosis of sepsis with severe trauma remains challenging both for clinician and laboratory. Combinations of markers, as opposed to single ones, may improve diagnosis. We compared the diagnostic characteristics of routinely used biomarkers of sepsis alone and in combination, trying to define a biomarker panel to predict sepsis in severe patients. This prospective observational study included patients with severe trauma (Injury severity score, ISS = 16 or more) in the emergency intensive care unit (EICU) at a university hospital. Blood samples were collected and plasma levels of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) were measured using commercial enzyme linked immunosorbent assay (ELISA) kits. A total of 100 patients were eligible for analysis. Of these, 52 were diagnosed with sepsis. CRP yielded the highest discriminative value followed by PCT. In multiple logistic regression, SAA, CRP, and PCT were found to be independent predictors of sepsis. Bioscore which was composed of SAA, CRP, and PCT was shown to be far superior to that of each individual biomarker taken individually. Therefore, compared with single markers, the biomarker panel of PCT, CRP, and SAA was more predictive of sepsis in severe polytrauma patients.

[Effects of fluid resuscitation on myocardial injury in patients with severe sepsis and septic shock].

OBJECTIVE: To observe the influence of fluid resuscitation on patients suffered from myocardial injury with severe sepsis and septic shock, and to evaluate the markers of myocardial injury during fluid resuscitation. METHODS: Acute physiology and chronic health evaluation II (APACHE II) score of 78 patients with severe sepsis and septic shock induced by combined injuries was 18-35. Serum cardiac troponin I (cTnI), N-terminal-ventricular natriuretic peptide precursor (NT-proBNP) and the hemodynamic parameters were recorded before, 3 days, and 5 days after treatment, and correlative analysis was conducted. RESULTS: Serum cTnI was increased in 62.8% (49/78) patients with severe sepsis and septic shock, and in 73.5% of patients (36/49) the increase was greater than 2-fold of the borderline value, and in 30.6% of patients (15/49) was greater than 4-fold of the borderline value. The patients with elevated serum NT-proBNP at admission accounted for 46.2% (36/78), and after fluid resuscitation treatment, patients with continuously rising value accounted for 74.4% (58/78). The serum cTnI, NT-proBNP, pulmonary arterial wedge pressure (PAWP) and cardiac index (CI) after treatment in survival group (55 cases) were obviously improved, and changes in them in non-survival group (23 cases) was not obvious. The serum cTnI (µg/L) and NT-proBNP (ng/L) levels in the non-survival group were distinctly higher than those of the survival group (cTnI 3 days: 2.09 ± 1.00 vs. 1.57 ± 0.93, 5 days: 1.78 ± 0.67 vs. 0.72 ± 0.51; NT-proBNP 3 days: 3.52 ± 0.73 vs. 3.16 ± 0.65, 5 days: 3.21 ± 0.66 vs. 2.66 ± 0.58), and CI [ml·s(-1)·m(-2)] was obviously lower than that of the survival group (3 days: 57.6 ± 6.2 vs. 68.3 ± 5.6, 5 days: 40.5 ± 4.7 vs. 80.7 ± 6.8, all P < 0.05). The cTnI level (µg/L) of 46 patients whose fluid resuscitation achieved the target was lower than that of the 32 cases without achieving the target (1.16 ± 0.62 vs. 1.97 ± 0.76, P < 0.05), and the CI [ml·s(-1)·m(-2)] was obviously increased (61.2 ± 6.4 vs. 49.3 ± 6.1, P < 0.05). The results suggested that whether the fluid resuscitation achieved the target or not was not related to changes in serum NT-proBNP and PAWP. A positive correlation was found between serum cTnI and NT-proBNP (r = 0.865, Y = 2.069 + 0.695X, P < 0.01), also between NT-proBNP and PAWP (r = 0.762, Y = 1.125 + 4.929X, P < 0.01), and a negative correlation was found between cTnI and CI (r = -0.891, Y = 50.623 - 6.114X, P < 0.01). CONCLUSIONS: There is an obvious myocardial injury in the patient with severe sepsis and septic shock, and fluid resuscitation can improve the myocardial injury; the serum levels of cTnI and NT-proBNP are related to the prognosis of patients, but the significance of NT-proBNP guiding the fluid resuscitation can not be ascertained.

The Effects of In Ovo Injection of Synbiotics on the Early Growth Performance and Intestinal Health of Chicks.

In this study, the effects of synbiotic inclusion at the intra-amniotic stage in layer chicks were evaluated with different parameters, such as performance, immunological function, intestinal development, and cecal microflora content. A total of 1,200 eggs with fertile embryos were allocated into four treatment groups. For every treatment, five replicates were used, and 60 eggs were included in each replicate. The following four treatment groups were established: the non-injected group, 0.9% physiological saline injection (saline) group, 1 × 106 CFU/egg Lactobacillus plantarum injection (probiotic) group, and 1 × 106 CFU/egg L. plantarum + 2 mg/egg Astragalus polysaccharide injection (synbiotic) group. In ovo injection was carried out at 18.5 days of incubation. The results showed that in ovo injection of probiotics or synbiotics did not affect the hatching or growth performance of the chicks but significantly increased their feed intake (FI), body weight (BW), and the feed conversion ratio (FCR). Additionally, in ovo injection of synbiotics enhanced the levels of serum interleukin-2 (IL-2), interferon-γ (IFN-γ), and secretory immunoglobulin A (SIgA) in intestinal lavage fluid and the histomorphological development of the small intestine. Our results also indicated that intra-amniotic synbiotic injection significantly increased Lactobacillus and Bifidobacterium colonization while decreasing the relative abundance of Escherichia coli in the chicken cecum (P < 0.05). In summary, in ovo injection of synbiotics had positive impacts on the performance, immunological function, gut development, and microbiota of growing chicks.

Effects of in ovo Injection of Astragalus Polysaccharide on the Intestinal Development and Mucosal Immunity in Broiler Chickens.

The purpose of this study was to examine the effects of in ovo injection of Astragalus polysaccharide (APS) on hatchability, body weight (BW), intestinal histomorphology, the number of IgA+ cells and sIgA content in intestine, and the expression of intestinal immune-related genes in broiler chickens. On day 18 of the incubation, a total of 960 live embryo eggs were weighed and randomly divided into 4 treatment groups: a control group and three APS groups. The eggs in the control group were injected with 0.5 mL physiological saline. The eggs in the APS groups were injected with 3 different amounts of APS in 0.5 mL physiological saline: 1 mg (APSL), 2 mg (APSM) and 4 mg (APSH). The solution was injected into the amnion of each egg. The results showed that in ovo injection of APS did not affect the hatchability but increased the body weight of the 14 d and 21 d chickens, with a significant increase observed in the APSM group (P < 0.05). At most time points, the villus height (VH) was increased (P < 0.05) and the crypt depth (CD) was decreased (P < 0.05) in the small intestine of the broilers, with higher VH/CD ratios in the APSL and APSM groups compared with the control group. The number of IgA+ cells in the mucosa and the secretory immunoglobulin A (sIgA) levels in the intestinal washings were higher in the APSM and APSH groups than in the APSL and control groups. The gene expression levels of interleukin (IL)-2, interleukin (IL)-4, interferon gamma (IFN-γ), and Toll-like receptor (TLR)-4 were significantly enhanced by APS stimulation at most time points (P < 0.05). These results indicated that in ovo injection of APS has the potential of promoting intestinal development and enhancing intestinal mucosal immunity of broiler chickens in the early stage after hatching.

[The influence of intensive insulin therapy on hemodynamics in patients with septic shock].

OBJECTIVE: To elucidate effects of intensive insulin therapy and target glucose control on hemodynamics and cardiac function in patients with septic shock. METHODS: Twenty-seven patients of septic shock with myocardial depression were divided into routine group (14 cases, level of blood glucose was 4.1 to 6.1 mmol/L) and target group (13 cases, level of blood glucose was 6.2 to 8.3 mmol/L). Hemodynamics and cardiac function parameters were obtained via pulmonary artery catheter after 48 hours. RESULTS: Mean blood glucose level in target group was lower than that in routine group [(6.0+/-1.5) mmol/L vs. (8.2+/-1.9) mmol/L, P<0.05], with dosage of insulin infusion in target group increased as compared with that of routine group [(10.3+/-3.7) U/h vs. (7.5+/-3.0) U/h, P<0.05]. Furthermore, oxygenation index (PaO(2)/FiO(2)), stroke volume index (SVI), cardiac index (CI) and oxygen delivery index (DO(2)I) were increased 20.2%, 23.3%, 15.1% and 11.7%, respectively (all P<0.05). On the other hands, there was no significant difference between target and routine group in mean artery pressure, acute physiology and chronic health evaluation II (APACHEII) score, blood lactic acid (all P>0.05), although the incidence of severe hypoglycemia was higher in target group than the routine group (38.5% vs. 28.6%, P>0.05). CONCLUSION: Intensive insulin therapy and blood glucose control may improve hemodynamic status and enhance cardiac function in patients with septic shock and myocardial depression.

[Three dimensional measurement and analysis of maxillary protraction treatment in skeletal Class III malocclusion].

PURPOSE: To study the three-dimensional mechanism of maxillary protraction in skeletal Class III malocclusion by cone-beam CT (CBCT). METHODS: Fourteen patients (6 males and 8 females with a mean age of 10.9 years) of early permanent dentition with skeletal Class III malocclusion were treated with maxillary protraction. CBCT was used to obtain the Dicom data both before and after treatment, and then digitized with the software Dolphin 11.0 was used to reconstruct and establish the tridimensional coordinate system. 23 landmarks were chosen for measurement and analysis. The data was analyzed using SPSS 17.0 software package. RESULTS: After maxillary protraction, A- coronal plane distance, SNA and ANB increased significantly (P<0.01); A- horizontal plane distance, ANS-PNS increased significantly (P<0.05), suggest maxillary growth was forward and downward. Po-S-N increased significantly (P<0.01), while SNB decreased significantly (P<0.05), suggesting that the chin was rotated downward and backward, and mandibular growth was inhibited. U1j - the coronal plane distance increased significantly (P<0.01), suggesting that the upper incisor moved forward; U1-SN angle increased significantly (P<0.05), suggesting anterior teeth inclined labially. The distance between U6j- horizontal plane and U6j- the coronal plane increased significantly (P<0.05), suggesting that maxillary molar elongated and moved mesially. Frontomaxillary suture changed on the three-dimensional direction, but without significant difference (P<0.05). CONCLUSIONS: Three-dimensional measurements confirm that growth and remodeling of bone suture (such as pterygopalatine suture) play an important role in maxilla development. The maxilla and maxillary teeth move forward and downward, while the mandibular growth is inhibited after maxillary protraction.

Cardioprotective effect of erythropoietin on sepsis-induced myocardial injury in rats.

BACKGROUND: Sepsis-induced myocardial injury is one of the major predictors of morbidity and mortality of sepsis. The cytoprotective function of erythropoietin (EPO) has been discovered and extensively studied. However, the cardioprotective effects of EPO on sepsis-induced myocardial injury in the rat sepsis model has not been reported. METHODS: The rat models of sepsis were produced by cecal ligation and perforation (CLP) surgery. Rats were randomly (random number) assigned to one of three groups (n=8 for each group): sham group, CLP group and EPO group (1000 IU/kg erythropoietin). Arterial blood was withdrawn at 3, 6, 12, and 24 hours after CLP. cTnI, BNP, CK-MB, LDH, AST, TNF-α, IL-6, IL-10, and CRP were tested by the ELISA assay. Changes of hemodynamic parameters were recorded at 3, 6, 12, 24 hours after the surgery. Histological diagnosis was made by hematoxylin and eosin. Flow cytometry was performed to examine cell apoptosis, myocardium mitochondrial inner membrane potential, and NF-κB (p65). Survival rate at 7 days after CLP was recorded. RESULTS: In the CLP group, myocardial enzyme index and inflammatory index increased at 3, 6, 12 and 24 hours after CLP compared with the sham group, and EPO significantly blocked the increase. Compared with the CLP group, EPO significantly improved LVSP, LV +dp/dt max, LV -dp/dt min, and decreased LVEDP at different time. EPO blocked the reduction of mitochondrial transmembrane potential, suppressed the cardiomyocyte apoptosis, inhibited the activation of NF-κB, and reduced the production of proinflmmatory cytokines. No difference in the survival rate at 7 days was observed between the CLP group and the EPO group. CONCLUSION: Exogenous EPO has cardioprotective effects on sepsis-induced myocardial injury.